RESUMO
Stroke is the third leading cause of death and is an important cause of long term disability. Inflammatory processes have fundamental roles in stroke in both the etiology of ischemic cerebrovascular disease [CVD] and the pathophysiology of cerebral ischemia. Chronic infection with Chlamydia pneumoniae [C. pneumoniae], a common respiratory pathogen capable of infecting endothelium, arterial smooth muscle, and monocytes, is a recently proposed risk factor for atherosclerosis and first ischemic stroke. In the present study we tried to provide evidence for the presence of C. pneumoniae in peripheral blood mononuclear cells [PBMCs] by tissue culture confirmed immunofluroscence [IF], polymerase chain reaction [PCR] on PBMCs and enzyme linked immunosorbent assay [ELISA] for detection of immunoglobulin A [IgA] to C. pneumoniae in patients with first ischemic stroke. The study included 157 cases with first ischemic stroke and 50 aged and gender matched healthy controls. The mean of age +/- SD of all patients was 61.68 +/- 11 years old. The patients were divided into two groups according to the age of onset: early onset group with age < 65 years old and late onset group with age >/= 65 years old. Using the multiple logistic regression analysis between patients and control, there was significant association between smoking [odds ratio= 7.8 and 95% confidence interval [C.I.] = 2.5 - 23.9, P=0.0001] and diabetes mellitus [odds ratio= 3.29 and 95% C.I. = 1.2 - 8.3, P= 0.013] as risk factors for ischemic stroke. There was statistical significant difference between patients and control groups for the presence of C. pneumoniae by tissue culture, IF, PCR on PBMCs and ELISA for IgA to C. pneumoniae. A statistical significant differences was found between both patients groups and control group for C. pneumoniae by all used laboratory measures. But there was no significant statistical difference between both patients groups in the frequency of C. pneumoniae by all used laboratory measures. On the other hand, there was no significant statistical relation between risk factors and C. pneumoniae presence in patients with first ischemic stroke. Measuring the sensitivity and specificity of each laboratory technique for C. pneumonia, we found that tissue culture is more sensitive [97%] but less specific than IF, and PCR is the most specific [100%], but also less sensitive than IF, and ELISA is more sensitive [93%], less specific than IF. There was statistical significant positive correlation between ELISA IgA for C. pneumoniae and both IF and PCR. Conclusions it is concluded that C. pneumoniae could be one of the important sharing factors in fist ischemic stroke occurrence, it should be searched fore in those patients admitted with first ischemic stroke. Tissue culture confirmed by IF could be used as routine measure for diagnosis of C. pneumoniae, and if needed it could be confirmed by PCR on PBMCs. ELISA IgA for C. pneumoniae could be used for screening of these patients for C. pneumoniae because of the time consumed to carryover tissue culture or PCR. Treatment of patients with ischemic stroke with C. pneumoniae antimicrobial therapy is needed to eliminate the infectious risk factor that may contribute in this disease especially in young patients which may not have other risk factors
RESUMO
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