Neurophysiological assessment of skeletal muscles in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease [COPD] is a chronic debilitating disease with disabling symptoms. It has recently become apparent that skeletal muscle dysfunction is common in patients with COPD, and may play a role in reducing exercise tolerance. The peripheral muscles seem to be more affected than the respiratory muscles, especially those of the lower limb in comparison to those of the upper limb. In this thesis the relation between skeletal muscles dysfunction and the severity of COPD was studied. The form of dysfunction emphasized in this study was the muscle strength; being measured as amplitude and envelope or as torque. Thirty COPD patients and ten control subjects were included in this study. All were submitted to the following a- thorough history taking. b-Clinical examination. c- Chest X-ray. d- Arterial blood gases, e- Resting spirometry, f- Isokinetic dynamometry, g- Quantitative Interference pattern electromyography. Results were tabulated and statistically analyzed. There was statistically significant difference between the COPD patients and the control group regarding the strength of the muscle represented in this study by: quadriceps muscle in isokinetic dynamometry and Vastus medialis, in particular, in EMG. There was also a significant correlation between smoking index represented by pack years and the weakness of the muscle. Ex. smokers were found to be more affected. The COPD patients, whether they showed manifestations of hyperinflation or chronic bronchitis, had significant correlation with muscle weakness by surface EMG. However, the correlation was not significant regarding the isokinetic dynamometry, measuring the torque of the muscle, although it was evident that the isokinetic dynamometry was much lowered in COPD in relation to the control group. So, COPD patients diagnosed by clinical assessment, radiology and resting spirometry, showed significant impairment of the strength of their quadriceps muscle; especially, the vastus medialis muscle. The weakness of peripheral muscles was attributed to severity of COPD, and smoking habits

Visual function evaluation of Egyptian beta-thalassemia major patients on long-term desferal therapy

The success of the iron chelator desferal [DFO] in the treatment of beta - thalassemia is limited by its lack of bioavailability. Also, high dosage has been associated with toxicity of the eyes, ears and others. To investigate a possible subclinical visual neurotoxicity, 30 Egyptian p-thalassemia major [BTM] patients on long-term, recommended DFO dosage were studied using visual evoked potentials [VEPs] and electroretinogram [ERG]. We also aimed to clarify the relation of the possible abnormalities to various clinical, hematologic and biochemical parameters. Ten healthy age - matched individuals were enrolled as controls. Sixteen/30 [53.3%] patients showed subclinical abnormalities using VEP and/or ERG. Nine/30 [30%] had VEPs abnormalities, 10 [33.3%] had ERG abnormalities and 3 [10%] revealed abnormalities by both methods. An interesting observation was the significant association of abnormal VEP and MALE sex [P=0.0002]. No significant correlation was found between neurophysiologic abnormalities and all data studied as: age, frequency of blood transfusion, DFO dosage/ duration, splenectomy, CBC values; S. ferritin, Serum Copper, S. Zinc and S. vitamin E. A single patient could have subclinical DFO-induced visual toxicity using VEP as his "toxicity" index [TI] was high [0.078]. the abnormalities can not be mostly attributed to long-term DFO therapy. Serial visual monitoring [including VEP and ERG] of all BTM patients is warranted. It is worthwhile to compare the long-term toxicity of the oral chelating agents [e.g. L 1 and ICL670] with that of DFO before definite conclusions are drawn on any visual neurotoxicity and its relation with the disease state or drug therapy

Clinical spectrum associated with some structural cerebellar abnormalities

To review the clinical, neuroimaging, cytogenetic, and biochemical studies obtained in 20 patients with different cerebellar structural abnormalities presenting at variable ages of onset with variable signs and symptoms. These patients visited the Clinical Genetics Department, National Research Center, Cairo, Egypt during the period from September 2002 to September 2003. All patients were subjected to complete personal and family history taking 3 generation family pedigree construction and full clinical examination, including complete eye evaluation. Metabolic screening, chromosomal examination and brain CT or MRI, or both, were also carried out. Patients with cerebellar structural abnormalities were broadly divided into those with cerebellar hypoplasia [15 patients; 75%], cerebellar atrophy [3 patients; 15%] and cerebellar white matter abnormalities [2 patients; 10%]. Further, cerebellar hypoplasia was subdivided into cerebello-vermal hypoplasia [4 patients; 20%], vermal-cerebellar hypoplasia [3 patients; 15%] and associated with involvement of other features such as brain stem [4 patients; 20%], posterior fossa [1 patient; 5%]; and intracranial calcification [3 patients; 15%]. This study showed that the type of cerebellar structural abnormality is not the main determining factor of the clinical outcome, but rather the underlying etiology. A high incidence of mostly autosomal-recessive inheritance was diagnosed in 65% of the patients with cerebellar structural abnormalities. Nevertheless, the high rate of consanguinity [18 cases; 90%] with mean inbreeding coefficient of 0.05312 and the similarly affected sibs highlights the role of the autosomal recessive gene in our country

Predictors of medically intractable childhood epilepsy: clinical, electroencephalographic and neuroimaging factors

Predicting which children are destined to develop medically intractable seizures would be very helpful in developing treatment strategies that would be more aggressive than in children with easily controlled epilepsy. Little is known about the natural history, particularly the time course of development, of refractory epilepsy. To identify clinical, electroencephalographic [EEC] and neuroradiological factors associated with both seizure control and medical intractability in children with epilepsy and to be acquainted with predictors of uncontrolled seizures. A case-control study to identify predictors of medically intractable epilepsy in children. Cases were children who had an average of one seizure or more a month over a 2-year period and who, during that time, had failed trials of at least three different anti-epileptic drugs [AEDs]. Controls were children who had epilepsy, who had been seizure-free for >/= 2 years, and who had never, before becoming seizure-free, met the definition for intractable epilepsy. Features of clinical findings, EEG and Magnetic Resonance Imaging [MR1] were compared in 20 children with well controlled seizures and 40 with intractable epilepsy using contingency 2x2 tables for inference of associations, odds ratios, predictive values, sensitivity and specificity. Logistic regression -was performed for multivariate analysis. Strong associates of clinical factors with intractability included: age at onset; duration of epilepsy; multiple types of seizures; complex partial, simple partial, tonic, atonic and myoclonic seizures; initial seizure frequency; history of status epilepticus; history of febrile seizures; duration of fit at onset; lapse of time before treatment; receiving more than one A ED; a symptomatic etiology of the seizures, and abnormal magnetic resonance imaging [MRl] of the brain. Strong associates were noted between intractability and several EEG factors: abnormal EEG background including diffuse slowing, asymmetry and high frequency spikes. These factors were predictors of refractory epilepsy. With multiple logistic regression, independent predictors of intractability included: early risk factors, complex partial seizures and multi-focal or focal epileptic discharges with secondary generalization. There are a number of clinical, EEG and neuroradiological features that can be identified early in the course of childhood epilepsy that are predictive of outcome. These findings will need to be verified in a prospective study

Neurological prognosis of perinatal asphyxia: a clinical and electroencephalographic study

Perinatal asphyxia complicated by hypoxic ischemic brain injury still remains the source of serious and definitive neurological lesions. To establish a relation between clinical signs, EEC and outcome of perinatal asphyxia. A cohort of 64 neonates from the Neonatal Intensive Care Unit [NICU] Faculty of Medicine, Cairo University was enrolled in a prospective study. All the newborns had at least one criteria of perinatal asphyxia. Full clinical assessment and staging was done immediately after birth and one month later. An early electroencephalogram [EEG] was carried out on seventh day of life. Multivariate analysis based on the intake variables identified hypotonia, spasticity, weak or absent crying and EEG epileptogenic activity as independent predictors of poor outcome. All patients with mild encephalopathy had normal EEG background activity. Severe stages of asphyxia were significantly associated with low amplitude background, burst suppression pattern and other forms of background abnormalities as well as non-reactivity. Epileptogenic activity in EEG of these neonates increased the likelihood of uncontrolled seizures. Our study confirms the interest of the association of clinical settings and EEG tracings in the diagnosis and the prognostic of the hypoxic-ischemic encephalopathy in neonates

Infrared laser per se or with ultrasound in management of carpal tunnel syndrome

The aim of this study was to find out the role of laser therapy in the treatment of carpal tunnel syndrome [CTS]. Thirty female patients suffered from CTS participated in this study, their age ranged between 20 and 40 years with a mean of 30.83 +/- 7.15 years. They were classified into two groups of an equal number: Group 1 received infrared [IR] laser only, while group 2 received both IR laser and pulsed 1:4 ultrasound [US]. IR laser in each group was applied for ten minutes on the skin of the palmar surface of the affected hand, started 3 cm proximal to flexor retinaculum, then passed distally across the retinaculum to pass laterally 2 cm over thenar eminence. Pulsed US was applied for 15 minutes on the area which extends from wrist crease to palmar region to cover an area of 3-5 cm length and 2-2.5 cm width. Both groups received three sessions per week for four weeks. The patients were assessed clinically [visual analogue scale and pinch dynamometer] and electrophysiologically [motor and sensory distal latencies and sensory conduction velocity] before and after treatment program