Proteinuria as a risk factor for stroke in type 2 diabetes mellitus

The study was designed to assess the relation between proteinuria and stroke in patients with type 2 diabetes mellitus. The study was conducted on two groups; Group I included 60 patients with type 2 DM with ischemic stroke, group II included 60 patients with type 2 DM without stroke. Both groups were matched by age, sex, body mass index and duration of diabetes. The study was performed at Al-Azhar University Hospitals from May 2005 to January 2006. The patients were evaluated clinically using Glasgow Coma Scale [GCS] for comatose patients and Canadian Neurological Scale [CNS] for conscious patients. Routine laboratory investigations as well as 24 hours urine protein were measured for both groups. CT scans were performed to all patients of group I within two days and after one week from the onset of stroke to determined site, depth and size of infarction. Systolic and diastolic blood pressures, prevalence of smoking and 24 hours proteinuria were significantly higher in group I than group II. On the other hand no significant changes were found on duration of DM, fasting and postprandial blood sugar, total cholesterol, LDL cholesterol, triglycerides, HbAlc, age and gender between two groups. In group I 38 patients were found to have proteinuria 38/60 [63%] versus 16 patients 16/60 [26.7%] had proteinuria in-group II, which was statistically significant. HDL-cholesterol only was significantly lower in-patients with proteinuria than those without proteinuria in-group I [p<0.01]. On the other hand no significant correlations were found between proteinuria and severity of strokes and CT findings. In multivariate logistic regression analysis, the ORs and 95% CLs for the variables identified as risk factors for stroke were as follow; SBP [OR 14.5, 95% CL 2.5-13.9], DBP [OR 13.1, 95% CL 2.4-15.9], proteinuria [OR 7.6, 95% CL 2.5-22.9], HDL cholesterol [OR 5.5,95% CL 2.1-23.5] and smoking [OR 4.89, 95% CL 1. 7-22.3]. Our results give evidence that proteinuria is an independent risk factor for ischemic stroke in patients with type 2 DM. Further support from additional prospective studies is recommended to confirm these findings

Pulmonary function tests in Parkinson's disease

The study was a cross-sectional and patient-control study. The study was performed at Al-Azhar university Hospitals from May 2005 to January 2006. The study was performed to document changes in respiratory pump and ventilatory function in idiopathic Parkinson's disease [PD] patients and its relationship with the main clinical presentation and the specific daily living activities [DLA] inthose patients. The study was conducted on 30 patients with PD and 10 healthy control volunteers. Patients were subjected to clinical evaluation by Unified Parkinson Disease Rating Scale [UPDRS] and respiratory pump function evaluation was done for patients and controls. Among patients group, 3 patients had normal pulmonary function [PF], 15 had obstructive PF pattern, 2 had restrictive PF pattern and 17 had upper airway obstruction. A significant disturbance in respiratory neuromuscular drive represent by the tracheal occlusion pressure after 100 m / sec from the start of quit inspiration [PO.l], decrease in respiratory muscle strength evaluated by maximum inspiratory pressure [PImax], marked respiratory muscle fatigue evaluated by [PO.l / PO.lmax]. A significant decrease in partial arterial oxygen pressure [PaO[2]] and increase in PaCO2 was found in patients group when compared to control group. Rigid / hypokinetic group patients 16/30 [53.3%] had significant [p<0.05] respiratory dysfunction rather than tremulous 14/30 [46.7%] group of patients. A significant negative correlation between the duration of disease, severity of illness, total daily living activity [DLA] and the severity of pulmonary dysfunction was found. Among the specific DLA, salivation and severe axial involvement was negatively correlated with maximum voluntary ventilation [MVV], PImax and PaO[2] Patients with Parkinsonis disease have impaired pulmonary function showing both obstructive and restrictive pattern, also abnormalities in mouth occlusion pressure and maximum inspiratory pressure were evident

Effect of daily hemodialysis of uremic peripheral neuropathy

Objective and aim of the work: uremic syndrome is characterized by overall deterioration of biochemical and physiological functions in parallel with progression of renal failure. Uremic polyneuropathy represent a well- known complication of end-stage renal failure [ESRF] caused by major neurotoxins accumulating in uremia, such as urea, creatinine, uric acid, middle molecules and others. The study was performed to study the effect of daily hemodialysis on uremic polyneuropathy and improving the patients clinically and biochemically. The cases of this study were patients under regular hemodialysis in the Nephrology Unit, Medical Department, Al-Azhar University and Naser City Hospitals from October 2004 to Mayo 2005. Material and methods: the cases of this study were patients under regular hemodialysis in the Nephrology Unit, Medical Department, Al-Azhar University and Nasr City Hospitals. The patients classified into 2 groups: group 1 comprised 10 patients with ESRF under thrice-weekly hemodialysis for less than 3 years; group ii comprised 10 patiepts with ESRF under thrice-weekly hemodialysis for less than 3 years who shift to daily hemodialysis except Fridays for 6 months; and 10 healthy normal volunteers of matching age and sex were the control group. Complete clinical and laboratory instigation were performed with nerve conduction velocity [sensory] and distal latency [motor] for median, ulnar and common peroneal nerves. K [t/v] to assess the adequacy of hemodialysis. paraethesia showed significant differences after 6 months of daily dialysis [p < 0.001], while other neurological symptoms and signs showed no significant differences in both groups after 6 months of dialysis. Sensory and motor nerve conduction study was significantly impaired in the median, ulnar and common peroneal in both groups when compared to controls [p < 0.001]. Nerve conduction velocities [sensory] were significantly improved in three nerves after 6 months of daily dialysis [p < 0.01], on the other hand no significant improvement was noticed after 6 months of thrice-weekly dialysis. Distal motor latency [motor] showed no significant improvement in three nerves in both groups after 6 months of dialysis. K [t/v] value was not significantly improved after 6 months of daily dialysis [3.2 vs. 3.1, p = 0.521]. from our study we speculated that the protocol of daily hemodialysis is feasible in routine hospital practice being well tolerated by patients and having a low incidence of complications compared to the standard protocol. Further works are required to study the effect of daily home dialysis on the different clinical, biochemical and psychological aspects of dialysis patients as well as the economic aspects of the daily regimen hemodialysis

Peripheral neuropathy in patients with polyarteritis nodosa clinical and electrophysiological study

The aim of this study was to investigate the clinical and electrophysiological characteristics of peripheral neuropathy in patients with systemic polyarteritis nodosa. Thirteen patients with peripheral neuropathy and evidence of systemic vasculitis of polyarteritis nodosa type were included in this study. Eight patients presented with mononeuropathy multiplex. Three patients were presented with asymmetrical sensorimotor neuropathy. The remaining two patients presented with distal symmetrical polyneuropathy. Ulnar peroneal and sural nerves are the most common nerves affected in polyarteritis nodosa. The findings showed acute or subacute neuropathy. EMG and nerve conduction studies showed an evidence of axonal neuropathy with a significant reduction of the motor nerve action potential amplitudes