Neurological, neurophysiological and neuropsychological effects of exposure to pesticides

The present study is a cross sectional field study aimed to investigate long-term effects of pesticides on the nervous system. It was conducted in citrus farm in Sahel Sleim, Assuit Govemerate. It was composed of 3 groups: I .Directly exposed group which consisted of 30 men using organophosphorus compounds [OP]. They were involved directly in application of pesticides for variable durations of time. 2. Indirectly exposed group consisted of 30 men living at the same environment and exposed indirectly to the same compounds through water, air, vegetables and milk. 3. Control group, consisted of 30 men who were never exposed occupationally or environmentally to pesticides, they lived in urban areas. All groups were subjected to clinical assessment, neuropsychological examination with: Mini mental state examination [MMSE], Wechsler memory scale [WMS], and Beck's depression scale. Neurophysiological assessment [Event related pattern [P300], Visual evoked potential [VEP] and Brain stem auditory evoked potential [AEP] to detect minor and early affection of nervous system due to exposure to pesticides. The neurological symptoms [Asthenia, headache, and vertigo, dizziness, blurring of vision, numbness and tingling] were more frequent in the directly exposed group than other groups and the most frequent symptoms were dizziness and blurring of vision, which were present in 23.33%. Neurological signs [superficial sensory loss, deep sensory loss, decrease or lost ankle or deep reflexes, muscle weakness and trophic changes] were more frequent in directly exposed group than the other groups, and this increase is positively correlated to the duration of exposure to pesticides. The most frequent findings were abdominal complaint and respiratory signs, which were present in 30%. General signs and symptoms [abdominal, respiratory, topical and sexual] were not showing statistically significant differences between the three groups. There was prolonged latency of P300 in directly and indirectly exposed group than in control group, but the difference was not statistically significant, except in reaction time [P<0.02]. Auditory evoked potential demonstrated that there was statistically significant difference between directly exposed group and control group in the absolute latency of wave 111, 1 V, and V in both right and left sides. There was statistically significant difference between direct and indirect exposed groups in absolute latency of wave IV, V of both right and left sides. Visual evoked potential had showed a statistically significant difference [in latency of binocular YEP] between directly and indirectly exposed groups "in one hand "and non-exposed group" in the other hand". Mini mental state examination and Wechsler memory scale showed that there was affection in different components of them in relation to direct or indirect exposure to pesticides. This means that memory is affected by long term exposure to pesticides and this effect is more extensive when exposure is direct. Results of Beck's depression scale were showed a higher incidence of depression. in conclusion, the prolonged low level exposure to the organophosphorus compound can affect the nervous system, and this appeared in directly exposed people via formulation or handling of these compounds and the appeared in the form of increasing the frequencies of neurological as well as general symptoms and signs. Effects of pesticides exposure were also include brainstem dysfunction, memory, cognitive impairment and increased risk of depression as seen in different neurophysiological and neuropsychological testing

Study of arrhythmia is some Egyptian children using different non-invasive techniques

This study was conducted on 10 patients who presented with different types of arrhythmias detected on routine 12 lead ECG and long strip lead II. Their ages ranged from 8d. to 12 y. They were 6 females and 4 males. All of them had been subjected to good history taking and full clinical examination, standard 12 lead ECG with long strip leadll, Echocardiography and Holter monitoring. It was found that 80 percent of the cases had acute onset of symptoms, Dysponea and syncope were the presenting symptoms in 30 percent and 20 percent respectively, while 10 percent [one case] was symptomless. There was [negative] family history in all the cases [negative] consanguinity in 70 percent and normal perinatal history in 60 percent. Clinical examination revealed tachycardia in 40 percent and bradycardia in 20 percent normal blood pressure in all the cases, cardiomegally in 30 percent and congestive heart failure in 20 percent. Echo showed normal heart anatomy and diminsions in 60 percent cardiomyopathy in 2 cases, one case with Fallot's tetraology and RV enlargement in 4 cases. ECG showed that 3 cases had S.V.T., 2 had premature ventricular contractions, 1 with sick sinus syndrome, 1 with ventricular tachydysrhytmia, 1 with 3rd degree heart block, 1 with wolf-Parkinson white syndrome and one with dropped beat. Holter 24 hours monitoring revealed the same findings as long strip ECG except for the case with dropped beat that proved to have No Abnormalities

Classification of ventricular septal defects using non invasive technique

The present work was conducted on 225 patients, their ages ranged from 4 months to 12 years. All were attending the cardiology clinic, Cairo University, Pediatric Hospital [C.U.P.H.]. All were diagnosed clinically as having V.S.D., either as isolated defect or associated with other cardiovascular lesions. They were subjected to thorough clinical examination, E.C.G., X -ray chest and heart and echocardiography [M-mode, 2-D, pulsed and continuous wave coloured doppler]. Isolated V.S.D. was present in 47.5 percent of the sample. There was a significant correlation between consanguinity and the group of V.S.D. associated with other cardiac defects. According to the clinical data, the cases were divided into mild [17.5 percent], moderate [60 percent] and severe [22.5 percent]. There was a positive correlation between the small age and the degree of severity. The characteristic V.S.D. murmur was present in 90 percent of cases, while 10 percent showed short systolic soft murmur. Mild cases 39[17.5 percent], were asymptomatic, non of them was below one year of age. No clinical, radiological or electrocardiographic signs of ventricular hypertrophy, were observed, By Echo, these cases had small V.S.D. [0.3-0.6 cm], 43 percent [17/39] were muscular and 57 percent were perimeembranous [17 outlet and 5 inlet]. The pressure gradient across the V.S.D was above 75 mmHg in all cases. Mild left ventricular dilatation [L.V.D] was detected in [5/39] of the cases and trial of closure by a membrane was observed in 5/39[12.8 percent] cases. In moderate and severe cases the symptoms were diminished effort tolerance in 107/135 of moderate and 45/51 of severe cases, recurrent chest infection in 88/135 of moderate and 45/51 of severe cases, cyanosis in 11/135 of moderate and 22/51 of severe cases, and dyspnea at rest was absent in moderate cases and observed in 17/51 of seven cases. Underweight was present in 22/35 moderate and 45/51 of seven cases, precordial bulge 5/135 of moderate and 51/51 of severe cases, L.V. in 101/135 moderate and 51/51 of severe, R.V. in 28/135 of moderate and 45/51 of seven cases, P.H. and CH were present only in severe cases 11/51, 17/51 respectively. The radiological data were increased C/T ratio in 152/225 [67.5 percent], and lung plethora in 169/225 [75 percent]. The E.C.G. showed normal sinus rhythm in all the cases, right axis in 17/225 [75 percent], L.V.D in 101/225 [45 percent], R.V.D. in 90/225 [40 percent], and R.B.B.B. 33/225 [15 percent]. Echocardiography showed L.V.D. in 163 /225 [72.4 percent], R.V.D. in 128/225[57 percent], and P.H. in 25/225 [11 percent]. Perimembranous V.S.D was present in 196/225 [87.1 percent] [Outlet 86/196, inlet 60/196 and trabicular 50/196]. Muscular V.S.D. 24/225 [10.6 percent] [Outlet 12/24, inlet 7/24, and trabicular 5/24]. Doubly committed sub arterial defects was present in 5/225 [2.2 percent]. The size of the V.S.D. ranged between 0.3 -1.2 cm. Pressure gradient ranged between 10 and 100 mm Hg. Trial of closure was present in 28/225 [12.5 percent]. The most common associated lesion were A.S.D., P.S., M.V.P., P.R., M.R., M.R., and T.R. respectively. Clinical evaluation is a valuable non-invasive method for the assessment of the defect size, the status of pulmonary vascular resistance and the presence of complications. Radiological and electrocardiographic findings are also helpful but less accurate and specific than echocardiography in the assessment of chamber enlargement. SO we can depend upon non-invasion methods all together to evaluate the size and site of V.S.D. pre operatively. Cardiac catheterization is recommended only when V.S.D. is associated with other intra-cardiac defects or when the P.A. pressure is markedly elevated with a bidirectional shunt