Heart rate and blood pressure variability among hypertensive and normotensive patients with acute thrombotic stroke: clinical relevance and implications

This study was aimed to assess the circadian changes in the blood pressure, heart rate variability and the circadian changes of cortisol level in normotensive as well as hypertensive patients with acute thrombotic stroke to determine whether there is abnormality or not in their diurnal changes and their relation to stroke severity. The heart rate variability [time domain and frequency domain] from 24-hour ECG recordings were analyzed in 30 patients with first acute ischemic stroke [within 24 hours of onset]. Eighteen were known hypertensives and 12 were normotensives. Brain C-T scan and NIHSS were done after admission. Patients were monitored with a bedside monitor for 24 hours to assess blood pressure every 15 minutes and blood cortisol level was measured every 6 hours. The parasympathetic oscillation, the diastolic and mean blood pressure variability indices were reduced in hypertensive patients than normotensives. However, in the late night the parasympathetic oscillation increased in hypertensives but tend to be reduced in normotensives. Increasing in sympathetic daily variation and reduced systolic blood pressure variation were associated with increasing in the stroke severity in normotensives, but decreasing in parasympathetic daily changes were associated with increasing the stroke severity in both groups. Hypertension seemed to cause significant changes of the cardiovascular autonomic regulatory system manifested as abnormalities of heart rate and diastolic pressure variability [especially late night]. The stroke severity was increased with reduced diurnal changes of parasympathetic fluxes in both normotensives and hypertensives and excess sympathetic daily fluctuations in normotensives

Neuropsychological assessment of global and specific cognitive functions in children with epilepsy

Impairment of cognitive functions is an important problem in epileptic children that can burden their learning abilities and academic achievement. The present study aims at assessment of cognitive functions in epileptic children and to explore the relation of various neuropsychological functions to other variables such as seizure type, frequency, duration of epilepsy, EEG changes and antiepileptic drugs. The study included 58 epileptic children, 6-12 years old [39 males and 19 females]. All children were subjected to detailed history, full neurological and psychiatric examination, EEG and a battery of psychometric tests. Results confirmed that epileptic children have significant impairment in cognitive functions and this impairment is most evident in females, generalized seizures, higher frequency of seizures, right sided focus in EEG, poor seizure control and poly therapy

Carpal tunnel decompression: a randomised controlled trail of endoscopic versus open release

Carpal tunnel Syndrome is the most common compression neuropathy of the upper extremity. Open carpal tunnel release [OCTR] with longitudinal incision reaching or crossing the wrist crease has been the golden standard of surgical treatment of carpal tunnel syndrome. Many reports indicated that the endoscopic carpal tunnel release [ECTR] techniques are associated with reducing postoperative morbidity with minimal incision, minimal pain and scarring, a shortened recovery period and high level of patient satisfaction. We conducted a randomised controlled trail to evaluate endoscopic 2-portal carpal tunnel release [ECTR] technique against the traditional open carpal tunnel release [OCTR]. One hundred and twenty two patients who were diagnosed to have carpal tunnel syndrome were randonised into 2 groups. In the trail ECTR group, there were 18 males [29%] and 44 females [71%]; their mean age was 44.6 years while the control OCTR group there were 18 males [30%] and 42 females [70%]; their mean age was 45.9 years. Patients were evaluated at baseline, 1,2,6 and 12 weeks and at 1 year after surgery for symptomatic relief by the Symptom Severity Scale[9] and incidence of serious complications [vascular or nerve injury] as well as McGill pain questionnaire[10], interval between the operation and return to their daily activities and work, scar tenderness and pillar pain, and grip strength which was assessed by a Jamar dynamometer as well as overall patient satisfaction. There was no significant difference in the Symptom Severity Score between both groups. However, there was one significant complication [laceration of a digital nerve] in the ECTR group while there was none in the OCTR group. McG ill pain score and grip strength were found to be significantly better in the ECTR group at 1, 2 and 6 weeks but almost identical at 12 weeks however scar tenderness and pillar pain was better in ECTR group at 12 weeks. The interval between surgery and return to usual daily activities and work was significantly less [P value < 0.01] in the endoscopic group than OCTR group. ECTR is associated with less pain and better function in the early postoperative period reflected by earlier return to usual daily activities and work as well as less scar tenderness and pillar pain. However these benefits may be outweighed not only with the higher expense of additional operative equipment and longer operating time but with a higher re-operation rate as well as a higher complication rate

Expression of cyclooxygenase-2 and 12-lipoxygenase in human breast cancer and their relationship with HER-2/neu and hormonal receptors: impact on prognosis and therapy.

BACKGROUND: A number of studies have shown over-expression of cox-2 in breast cancer. Also it has been recorded that human breast cancer expresses high level of cox-2 and 12-lipoxygenase which may be beneficial in future therapy plan for those patients. AIMS: The present study aims to examine the level of transcripts of cox-2 and 12-lipoxygenase in Egyptian breast cancer patients and to compare between the expressions of both enzymes and TNM staging, hormone receptors status (including estrogen and progesterone) and HER2/neu expression. MATERIALS AND METHODS: Total cellular RNA was extracted from 64 frozen tissue samples of breast carcinoma and their corresponding normal adjacent tissues. Cox-2 and 12-lipooxygenase expressions were detected using RT-PCR. Hormonal receptors as well as HER2/neu were detected immuno-histochemically for each patient. RESULTS: About 47 and 62.5% of carcinoma samples showed over-expression of cox-2 and 12-lipooxygenase respectively as compared to their corresponding normal tissues. The results revealed that cox-2 significantly associated with TNM staging (P = 0.0047) and hormonal receptors status (P = 0.0201). The relationship between cox-2 and HER2/neu expression was close to a significant value (P = 0.0747). 12-lipooxygenase showed only significant association with TNM staging (P = 0.0076). Neither hormonal receptors nor HER2/neu showed significant association with this enzyme. CONCLUSION: Elevated levels of cox-2 and 12-lipoxygenase expression were detected in human breast cancer. Also, the results revealed that cox-2 and 12-lipooxygenase mRNA expressions are associated with TNM staging in human breast cancer. Furthermore, there is an inverse association between cox-2 expression and hormonal receptor status. This observation may drive us to the possible role of those two enzymes in determining the plan of therapy of breast cancer patients.

Clinico epidemiological and biochemical aspects of Egyptian children with Familial Mediterranean Fever

This prospective study was conducted over a period of three years on 46 children with familial Mediterranean fever [FMF] diagnosed mainly on a clinical basis aiming to detect some epidemiological and clinical parameters as well as to assess some biochemical markers of prognostic value. Their ages ranged between 3 and 14 years with a mean of 7 + 2.98 years and they were 29 males and 17 females. Twenty-five healthy children with ages ranging between 3 and 12 years served as a control group. Patients and controls were subjected to detailed history taking, thorough clinical examination and investigations including CBC, acute phase reactants, dopamine beta hydroxylase [DbH] plasma activity, serum and urinary etiocholanolone and urine analysis for evidence of proteinuria. The results of this study revealed that the severity and prognosis of the disease are inversely related to age at onset. Maleness may carry the risk of severity or poor prognosis. Moreover, the biochemical markers, especially SA-A, glucoproteins and DbH activity are important prognostic markers as well as they are imperative in the follow up of FMF patients on therapy