Botulinum neurotoxin-A in a patient with post-stroke spasticity: a neurophysiological study.

INTRODUCTION: Post-stroke spasticity (PSS) is a disorder of the sensory-motor control, leading to upper motor neuron lesions manifesting either as intermittent or sustained involuntary activation of muscles. Botulinum neurotoxin-A (BoNT-A) is mostly utilized in a variety of therapeutic indications, and it is effective and safe in the management of focal PSS in the rehabilitation scenario. The study aimed to evaluate the effect of BoNT-A administration on H-reflex of upper and lower limbs following PSS. In addition, the investigation of the association among the degree of spasticity (assessed by the Modified Ashworth Scale [MAS]) and motor neuron pool excitability (assessed by analysing H-reflex excitability) was done. MATERIAL AND METHODS: Fifty patients with a stroke of either sex aged 30 to 60 years presented with either upper or lower limb focal spasticity were studied. BoNT-A was given on two occasions to the gastrocnemius, soleus, biceps brachii muscles and flexor carpi radialis (FCR). H-reflex was documented from the FCR and soleus muscles at baseline and 3-4 weeks post BoNT-A injection. Medical Research Council scale and MAS were used to assess the PSS and muscle strength. RESULTS: H-reflex latency and amplitude, H/M ratio recorded from FCR and soleus muscles were significantly different between pre- and post-management. The MRC scale was significantly increased whereas the MAS was significantly reduced post BoNT-A injection. CONCLUSIONS: BoNT-A causes obvious improvement in PSS clinically as assessed by MAS and MRC scale as well as neurophysiologically by H-reflex. A negative correlation between H-reflex latency but not the amplitude or H max /M max ratio and MAS was observed.

ASSESSMENT OF INTERNS' TRAINING IN THE TEACHING HOSPITALS OF BAGHDAD MEDICAL CITY COMPLEX.

OBJECTIVE: The aim: The aim of this study is to assess the training of medical interns in Baghdad Medical City Complex. PATIENTS AND METHODS: Materials and methods: A cross-sectional observational study was conducted in the Medical City Complex, Baghdad. The study targeted all the medical interns who finished year one of internship. A questionnaire form was designed for data collection. A questionnaire form was done according to the Medical Interns' Guideline adopted by the Minister of Health in 2015. RESULTS: Results: A total of 60 interns filled the questionnaire, their mean age is 27.07 years (SD = 2.04), male respondents constituted 48.3%. Twenty-seven respondents (45%) were from Baghdad Medical College. More than half (58%) of them were singles. The mean pre-internship score was 69.32 (SD = 6.6). About half of the interns (29, 48.3%) have a future interest in surgery. Average preparedness for the internship was reported in 45% of interns. Half of the interns had prior ideas about the internship through variable means. A larger percentage of interns reported average/poor quality of training in different aspects of medical internships. Accepted quality of training (above average and excellent) and average one were reported respectively by 19 (31.7%) and 31(51.7%) of interns in general surgery, followed by the internal medicine branch. Thirty-one (51.7%) interns were moderately prepared for their future medical careers. Surgeons and general physicians gained better opinions (above average and excellent) from the interns (17, 28.3%, and 13, 21.6%) respectively. CONCLUSION: Conclusion: There was a deficiency in the preparedness of newly graduated doctors for the internship. But they reported an average skill performance in major medical branches, and some related laboratory and medical procedures, there was a defect in dealing with emergency cases. The Supervision of interns was below average in gynecology and obstetrics units and was good in other branches. The medical school training was poor to help interns in dealing with deaths and legal medicine cases. More than 50% of trainees were prepared for the future medical branches of interest.