Nicotine dependence and visceral adiposity as risk factors for the development and severity of carotid artery stenosis.

Nicotine dependence (ND) and visceral adiposity are emerging as independent risk factors for cardiovascular diseases, including carotid artery stenosis (CAS). This study aimed to determine the relationship between ND and the contribution of abdominal fat to the onset of CAS, which is indicated by a luminal narrowing of at least 60% as determined by duplex and/or Doppler ultrasound. We prospectively collected data from 60 patients with CAS and 60 age- and gender-matched healthy subjects. The Fagerström Test for Nicotine Dependence (FTND), a common research tool, was used in the study. The original questionnaire was designed to gather social and demographic data. Anthropometric measurements, visceral adiposity index (VAI), and lipid accumulation products (LAP) were used to assess obesity. Most patients showed a high or mild-moderate degree of ND: 46.67% and 35%, respectively. The median visceral adiposity index (VAI) and lipid accumulation product (LAP) in patients was 3.92 and 32.83, respectively. Prolonged smoking duration, increased intensity, and high ND are hallmarks of CAS patients.

Plasma tau and neurofilament light chain as biomarkers of Alzheimer's disease and their relation to cognitive functions.

Alzheimer's disease (AD) dementia is the most frequent cause of neurodegenerative dementia. The cognitive and behavioral symptoms associated with this disorder often have overlapping characteristics, potentially resulting in delayed diagnosis or misdiagnosis. This study aimed to assess the level of peripheral blood neurofilament light chain (NfL) and total tau (t-tau) protein in AD patients and investigate their relationship with cognitive impairment. The study included 80 participants of both sexes between the ages of 60 to 85 years. The participants were divided into two groups, consisting of 40 individuals in the control group (mean age 75±6.6 years) who had no cognitive or functional impairments and 40 AD patients (mean age 74.98±5.03 years). This study utilized the DSM-5 diagnostic criteria for major or mild neurocognitive disorder attributed to Alzheimer's disease (AD). The clinical and biochemical features of all participants were documented, and the Alzheimer's disease Assessment Scale cognitive subscale (ADAS-cog) scores were evaluated. Sandwich ELISA was employed to determine serum NfL and t-tau protein levels. The median serum NfL and t-tau protein levels in AD patients were significantly higher than those of the controls (47.84 pg/ml versus 17.66 pg/ml and 12.05 pg/ml versus 11.13 pg/ml, respectively). Age was positively correlated with NfL, t-tau levels, and ADAS-cog. Although elevated NfL and t-tau protein levels may play a role in disease progression, their diagnostic value for AD was limited.

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.

Electrophysiological findings in patients with restless legs syndrome.

BACKGROUND: Restless legs syndrome (RLS) manifests as an urge to move the body to relieve the discomfortable sensations, primarily when resting, sitting, laying down, or sleeping. Diagnosis of RLS relies on clinical criteria, and the immobilization test was the only instrumental tool with equivocal results. OBJECTIVES: To assess different electrophysiological findings in patients with RLS, and compare the diagnostic values of these parameters in the diagnosis of RLS. METHODS: 30 patients with primary RLS and 30 controls who were matched for age and gender were studied. Participant's demographics, laboratory findings, and electrophysiological test, namely nerve conduction studies (NCS), cutaneous silent period (CSP), H reflex and sympathetic skin response (SSR), F-wave latency, amplitude, F-wave duration (FWD), and the ratio between FWD and duration of the corresponding compound muscle action potential (FWD/CMAPD) were analyzed. RESULTS: None of the patients showed altered NCS data. FWD of upper (12.37 ± 2.77 ms) and lower limb (21.71 ± 5.24 ms) were significantly longer in patients. Also, FWD/CMAP duration of the upper (1.03 ± 0.2) and lower limb (2.02 ± 0.55) was longer in patients. Likewise, they exhibited delayed CSP latency from TA (110.62 ± 13.73 ms) and APB (77.35 ± 12.16 ms) whereas the CSP duration from TA and APB was decreased (37.36 ± 11.59 ms; 42.55 ± 7.97 ms, respectively). The SSR latency was not different, and right-sided H reflex amplitude (5.07 ± 3.98 mV) and H/M ratio (0.65 ± 1.81) were significantly increased in the patient group. CONCLUSION: The data suggest that there may be a dysfunction of the inhibitory/excitatory circuits at a spinal level; and no pathology in the peripheral nerves. The unilateral difference of H reflex amplitude and H/M ratio may suggest asymmetrical central inhibitory dysfunction. Further prospective studies with larger cohorts are now needed to evaluate the pathophysiology of RLS with different neurophysiological assessment tools.

Correlation of staging and risk factors with cardiovascular autonomic neuropathy in patients with type II diabetes mellitus.

The impairment of cardiovascular autonomic control among the underdiagnosed complication of diabetes mellitus (DM) with a high prevalence rate of up to 60% in type 2 DM (T2DM). Cardiac autonomic neuropathy (CAN) is an independent risk factor for cardiovascular mortality, arrhythmia, silent ischemia, any major cardiovascular event, and heart failure. We aimed to evaluate cardiovascular autonomic activity by different physiological maneuvers, study risk factors for diabetic CAN including age, gender, duration of diabetes, body mass index (BMI), and glycemic control, and correlate CAN stage with risk factors. One hundred and forty-two T2DM patients consisted of 62 males and 80 females and 100 volunteers as a control sample. Cardiac autonomic functions were assessed by Ewing's tests. Glycated hemoglobin (HbA1c), body weight, height, body mass index (BMI), and waist-hip ratio (WHR) were also measured. Cardiovascular autonomic functions and Ewing scores were significantly different in people with diabetes when compared with control healthy subjects. Ewings test values and Ewing scores were significantly different between diabetics with and without CAN and within patients with different CAN staging. People with diabetes with CAN have a significantly longer duration of disease when compared to those without CAN. A strong association has been found between CAN severity and patient age, duration of disease, HbA1c severity, and the WHR (P < 0.001) but not with BMI. The duration of disease and HbA1c level appear to be associated with the development of CAN (P = 0.001 and P = 0.008, respectively). The poorer glycemic control and the longer the duration of the disease, the higher the prevalence of CAN in T2DM. Age, duration of disease, WHR, and HbA1c are well correlated with the severity of CAN. Parasympathetic impairment is more sensitive to the detection of autonomic dysfunctions than do sympathetic impairment.

Association of ABCB1 gene polymorphism (C1236T and C3435T) with refractory epilepsy in Iraqi patients.

The mechanisms of refractory epilepsy (RE) are most likely multifactorial, involving environmental, genetic, as well as disease- and drug-related factors. We aimed to study is to investigate the possible association of two ABCB1 gene polymorphism (C3435T and C1236T) with the development of RE in Iraqi patients. One hundred patients with either generalized tonic-clonic seizures, myoclonic epilepsy, or absence epilepsy comprised of 60 patients responsive to AEDs and 40 patients who were refractory to treatment who used multi AEDs for at least one month were studied. Fifty family-unrelated age- and sex-matched healthy subjects represent the control group. ABCB1 gene fragments corresponding to two targeted polymorphisms were amplified with conventional polymerase chain reaction using specific sets of primers. Genotyping was performed by restriction fragment length polymorphism (RFLP) technique. Epileptic patients refractory to AEDs showed a significantly higher frequency of CC genotypes of C3435T polymorphism than controls. Allele C was significantly higher in patients than controls and far more frequent among patients with RE. C1235T polymorphism had no significant role neither in the incidence of epilepsy nor in the AEDs resistance. The CT haplotype was more frequent among patients refractory to AEDs. In contrast, the haplotype block TT was more frequent among responsive (41.3%) than refractory patients (28.7%) (p = 0.068). The CC genotype and C allele of the C3435T polymorphism can increase the risk of RE. The haplotype block CT of C3435T and C1236T can predispose for epilepsy as well as the drug resistance.

Maternal plasma kisspeptin-10 level in preeclamptic pregnant women and its relation in changing their reproductive hormones.

AIMS: To evaluate plasma kisspeptin-10 (KP-10) as a marker for preeclampsia and assess its relation to altered reproductive hormones in preeclamptic pregnant women. METHODS: First time pregnant women (n = 100) at 20 weeks of gestation participated in this study and divided into preeclamptics (n = 60) and normotensives (n = 40). KP-10, luteinizing hormone (LH), follicle stimulating hormone (FSH), beta-human chorionic gonadotropin (ß-hCG), estradiol (E2) and progesterone were evaluated during 2nd and 3rd trimesters of pregnancy for all women. RESULTS: Kisspeptin-10 levels were reduced in preeclampsia (PE) women compared with normotensive pregnancies. In the 2nd trimester, area under receiver-operator characteristic (ROC) curve was 0.662, positive and negative predictive values were 32.8 and 94.6, and test sensitivity and specificity were 55% and 87.5%, respectively. In the 3rd trimester, area under ROC curve was 0.747 positive and negative predictive values were 22.2 and 97.3, and test sensitivity and specificity were 83.3% and 67.5%, respectively. In PE patients, plasma KP-10 demonstrated an inverse correlation with E2 (during the 2nd trimester), LH and FSH (during the 3rd trimester), and positively correlated with ß-hCG (during the 3rd trimester). CONCLUSION: This study showed significantly reduced plasma KP-10 levels in PE women. This suggests that KP-10 may play an important role in the pathophysiology of PE. Therefore, combined with previous studies, to diagnose the PE, testing for maternal KP-10 plasma levels may be useful as an effective screening, but because of low positive predictive value and inadequate test sensitivity, screening cannot be recommended. Furthermore, KP-10 in PE patients demonstrated significant positive correlation with ß-hCG.

Association of BCR/ABL transcript variants with different blood parameters and demographic features in Iraqi chronic myeloid leukemia patients.

BACKGROUND: Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the presence of BCR-ABL fusion gene (GenBank accession NC_000022.11). In the vast majority of CML patients, the typical subtype of BCR-ABL transcript are b3a2, b2a2 or both. The aim of this study was to determine the different subtypes of BCR-ABL transcript and their impact on the demographic and hematological parameters in Iraqi patients with CML. METHODS: One hundred patients with chronic phase CML (11 newly diagnosed and 89 imatinib-resistant) were enrolled in this study. Ribonucleic acid (RNA) was extracted from leukocytes, and complementary DNA was created using reverse transcriptase polymerase chain reaction technique. A multiplex polymerase chain reaction with four specific primers was used to determine the BCR-ABL fusion subtypes in each patient. RESULTS: Male to female ratio was 1.38:1. Fifty-nine patients expressed b3a2 transcript, whereas 39 of the remaining cases were positive for b2a2 variant. One case expressed b2a3 transcript, while the last case coexpressed the two subtypes of mRNA b3a2/b2a2. Male and female were significantly associated with b3a2 and b2a2 subtypes, respectively. The b3a2 subtype showed higher total leukocyte count than b2a2 subgroup, while b2a2 variant demonstrated significantly elevated platelet counts compared to those with b3a2 transcript. A significantly higher plateletcrit percentage (PCT%) was found in patients with b2a2 transcript whereas. CONCLUSIONS: The testified Iraqi group expressed M-BCR-ABL type with preponderance of b3a2 over b2a2 subtype. There was a gender-skewed distribution in BCR-ABL transcript types with b3a2 transcript more prevalent in males. The type of BCR-ABL transcript is reflected by different leukocyte and platelet counts at diagnosis, which might represent a distinct phenotype and disease biology.

Paternal exposure to low-dose lead acetate: effect on implantation rate,pregnancy outcome, and sex ratio in mice.

BACKGROUND/AIM: It has been reported from in vivo exposed experimental animals that paternal lead exposure reduces birth rate; however, there is limited evidence to suggest a decrease in the proportion of male births. This study investigated the role of paternal exposure to lower lead acetate doses on early embryonic development (implantation) and the sex ratio of their offspring. MATERIALS AND METHODS: In total 180 Swiss Webster mice were used (60 male and 120 female). The males were divided into 3 groups: G1 (untreated group), G2 (treated daily with 50 µg/kg BW lead acetate), and G3 (treated daily with 100 µg/kg BW lead acetate). The implantation success rate, pregnancy outcome, and sex ratio were measured. RESULTS: The results showed a highly significant reduction in both the percentage of implantation rate and the number of offspring in the G3 mice, but there was no signification difference for the G2 mice. There was a slight insignificant reduction in the number of newborn males compared with females for both G2 and G3 mice. CONCLUSION: The findings of this study suggest lead exposure in experimental animals reduces implantation rate with paternal BLL of 28 µg/dL and the sex ratio for offspring showed a slight insignificant reduction with both paternal BLLs of 23.5 µg/dL and 28 µg/dL.

Correlation of Kisspeptin-10 level and fetal well-being in preeclamptic patients.

OBJECTIVE: This study aims to evaluate the role of kisspeptin-10 in preeclampsia and check for possible relationship between its severity and fetal growth well-being. Kisspeptin-10 may participate in implantation of the embryo, placenta formation, and maintenance of pregnancy. MATERIALS AND METHODS: One hundred women who completed 20 weeks of gestation with singleton pregnancies were divided into 60 peeclamptic and 40 normotensive control women. Kisspeptin-10 level estimation, and ultrasound and Doppler ultrasound studies for umbilical artery were performed during their second and third trimesters of pregnancy. RESULTS: Plasma kisspeptin-10 level was lower in preeclamptic groups and inversely correlated with the severity of the disease. Its level directly correlated with estimated fetal weight in utero during both trimesters in patients with severe preeclampsia and with fetal birth weight in patients with mild preeclampsia, whereas an inverse correlation was observed in those with severe preeclampsia during their second trimester. Kisspeptin-10 level was directly related to the resistance index in the second trimester in patients with severe preeclampsia, while it inversely correlated with the systolic/diastolic ratio and resistance index in the third trimester in patients with mild preeclampsia. CONCLUSION: Kisspeptin-10 level is useful in assessing the severity of preeclampsia and can be a novel marker downregulated in pregnant women with preeclampsia, especially in those who also developed impaired uteroplacental perfusion or intrauterine growth restriction.

Electrophysiologic and clinico-pathologic characteristics of statin-induced muscle injury.

OBJECTIVES: In this study, we aimed at evaluation of electrophysiological and histopathalogical characteristics of statin-induced muscle injury as well as clinical features of patients who develop this condition in terms of frequency and pattern of evolution. MATERIALS AND METHODS: Forty patients (age 39-74 years) including 25 subjects with type 2 diabetes mellitus, 9 with cardiovascular diseases and 6 with hyperlipidemia, who were receiving atrovastatin 40 mg/day for variable period, were studied. Thirty three healthy subjects (age 31-74 years) served as control group. Creatine phosphokinease level, thyroid function, motor unit potential parameters and muscle fiber conduction velocity of biceps brachii and tibialis anterior muscles were measured. RESULTS: Creatine phosphokinase level was elevated in statin users, particularly in those with diabetes mellitus. Less than 50% of statin users experienced symptoms related to muscle injury. Muscle fiber conduction velocity of the biceps brachii muscle was significantly reduced. Statin users with diabetes mellitus showed significant changes in electrophysiological parameters as compared to those with cardiovascular diseases and hyperlipidemia. Muscle biopsies showed muscle fiber variation in size, fibrosis and mild inflammatory cell infiltration. Immunohistochemical evaluation of muscle biopsies showed positive expression of Bcl-2 and one patient showed positive P53 immunohistochemical expression with elevated level of creatine phosphokinase. CONCLUSION: Atorvastatin increased average creatine kinase, statins produce mild muscle injury even in asymptomatic subjects. Diabetic statin users were more prone to develop muscle injury than others. Muscle fiber conduction velocity evaluation is recommended as a simple and reliable test to diagnose statin-induced myopathy instead of invasive muscle biopsy.

Autonomic dysfunction in women with polycystic ovary syndrome.

BACKGROUND: Central obesity and hyperinsulinaemia of polycystic ovary syndrome (PCOS) are associated with chronic sympathetic over activity. OBJECTIVE: To evaluate the autonomic functions and to indicate the superiority, if any, for those functions in the diagnosis of sympathetic over activity in PCOS women. MATERIALS AND METHODS: Sixty-four PCOS patients and 40 women served as the control group were studied. The two groups were subdivided according to the body mass index (BMI) into two obese and non-obese groups. Waist:hip ratio (WHR), plasma epinephrine level was estimated, sympathetic skin response (SSR); postural orthostatic tachycardia syndrome, heart rate variability (HRV), and valsalva ratio were measured in both groups. RESULTS: Compared to the control group, obese PCOS patients demonstrated higher BMI and WHR, reduced palmar SSR latency and higher amplitude, altered HRV, higher plasma epinephrine level, and rapid pulse rate. Moreover, non-obese patients show reduced palmar SSR latency and higher amplitude, higher plasma epinephrine level, and higher pulse rate. BMI and WHR of the patients were positively correlated with plasma epinephrine level; while the HRV was negatively correlated WHR. CONCLUSION: Women with PCOS exhibits altered autonomic function and sympathoexcitation is more pronounced in obese than non-obese patients; therefor the SSR could be useful auxiliary electrophysiological test to predict autonomic dysfunction in those patients. Receiver operating characteristics curve demonstrate the pulse rate in standing position as the autonomic function test that is superior to others in predicting sympathetic over activity in those patients.

INSR gene variation is associated with decreased insulin sensitivity in Iraqi women with PCOs.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is a complex, heterogeneous disorder of uncertain etiology with strong genetic background. Insulin resistance is present in the majority of PCOS cases with linkage and association between single nucleotide polymorphisms of insulin receptor (INSR) gene and PCOS. OBJECTIVE: To examine whether the exon 17 of INSR gene contributes to genetic susceptibility to PCOS in Iraqi women and its effects on glucose tolerance test and lipid profile. MATERIALS AND METHODS: Sixty-five healthy Iraqi women and eighty-four infertile women with PCOS, divided into two subgroups depending on the BMI were studied. Restriction fragment length polymorphism (RFLP-PCR) analysis was performed to determine the genotypes for the His 1058 C/T polymorphism at the tyrosine kinase domain in the INSR gene. Clinical, anthropometric and biochemical parameters were also estimated. RESULTS: The C/T polymorphism at His 1058 in exon 17 of INSR was associated with PCOS (obese and non-obese). CC genotype frequency was higher in PCOS patients whereas TT genotype was higher in control women. Those with CC genotype had higher BMI, GTT and lipid profile than those with TT genotype. CONCLUSION: An association of C/T polymorphism at His1058 of INSR with PCOS in Iraqi women was observed. Its association with indices of insulin resistance and dyslipidemia were also noticed.

Diabetic hand syndromes as a clinical and diagnostic tool for diabetes mellitus patients.

Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia with various complications including diabetic hand syndrome (DHS); a condition characterized by association of distinct entities; limited joint mobility (LJM), Dupuytren's disease (DD), flexor tenosynovitis (FTS) and carpal tunnel syndrome (CTS) resulting in significant morbidity and mortality. The aim of this study was to evaluate the prevalence of these changes and their association to diabetes duration. We studied 142 type 2 and 45 type 1 DM patients and investigated the presence of these hand changes and peripheral neuropathy (PNP). The prevalence of LJM was 29.4%, DD was 17.6%, FTS was 10.7% and CTS 41.7% in all diabetics. The prevalence of CTS was more in type 2 DM (83.3%) as compared to type 1 DM (24.4%). Age and duration of diabetes were clearly related to these changes. A clear association between these changes and PNP was observed. The prevalence of CTS and hand changes was higher in type 2 diabetics. The association of DD and PNP suggests that common factors could contribute to their pathogenesis. Consequently, clinical examination for diabetic hand should not ignore it.

Smoking practices in Jordanian people and their impact on semen quality and hormonal levels among adult men.

Despite worldwide anti-smoking campaigns, cigarette smoking prevalence is increasing in the third-world countries. It is now regarded as the most important public health issue. Here, we study the current smoking situation and investigate the impact of cigarette smoking on semen quality and hormonal levels among adult people. Furthermore, we suggest various strategies to reduce smoking consumption among young individuals. Across-sectional data from 804 adult smoker subjects (male n = 530 and female n = 274) aged between 15 and 45 years were analyzed. One hundred and eleven males were agreed for further evaluation of their semen quality and hormones compared with 93 age-matched non-smoking males. This study showed that the majorfactors initiating smoking among women were friends' influence (49%), life pressures (16%) and parental imitation (14%). The major reasons in men was friends' influence (65%). Furthermore, 61% ofwomen and 89% of men smoke in public implying social acceptance oreven encouragement of this habit. This study also found that low-income Jordanians consume more tobacco materials than those in the middle- and higher income. Furthermore, smokers had significantly lower (p < 0.001) sperm concentration and motility values and higher (p < 0.001) serum testosterone and luteinizing hormone (LH) levels than non-smokers.

Somatosensory evoked potentials as a predictor for functional recovery of the upper limb in patients with stroke.

BACKGROUND: Predicting motor recovery in the arm of patients with stroke is generally based on clinical examination. However, neurophysiologic measures may also have a predictive value. OBJECTIVE: We sought to assess the value of somatosensory evoked potentials (SSEPs) in predicting motor recovery of the upper limb and to determine whether any of the SSEPs components can predict the severity of the deficit so that it can document the size of the stroke (lacunar or large-vessel stroke). METHOD: In all, 22 patients who had had a first-ever stroke and presented with obvious motor deficit of the arm were examined in terms of 3 clinical variables (motor performance, muscle tone, and overall disability) and for SSEPs. Clinical (Medical Research Council [MRC] scale and Barthel index scores) and neurophysiologic examinations were done at entry to the study (first week poststroke) and 3 months after stroke. RESULTS: Significantly low mean MRC scale score was found at first week versus after 3 months of stroke and in patients with large-vessel as compared with lacunar stroke both at first week and after 3 months. The mean Barthel index score was significantly higher after 3 months than at first week, whereas it was significantly lower in large-vessel as compared with lacunar stroke both at first week and after 3 months of stroke. Significantly prolonged N(20) latency, low peak-to-peak amplitude (PPA), and low amplitude ratio were found in patients with stroke as compared with control subjects. None of the neurophysiologic parameters were different in the patients with stroke between first week and third month. The MRC score and PPA were correlated well with the outcome MRC and Barthel index scores after 3 months. N(20) latency correlates with the outcome MRC score but not with the outcome Barthel index score. Interestingly, the N(20) latency was significantly different in lacunar from large-vessel stroke. CONCLUSION: The muscle power (MRC score) is the main outcome predictor in patients with stroke. PPA is the main SSEPs component with high prognostic value in stroke. The SSEPs N(20) latency can predict (even roughly) the size of cerebral infarction (whether lacunar or large-vessel stroke).

Assessment of erectile dysfunction in diabetic patients.

Erectile dysfunction (ED) aetiology is multifactorial, including endocrine, neurological, vascular, systemic disease, local penile disorders, nutrition, psychogenic factors, and drug-related. This study was performed to compare the relevant comprehensive biochemical parameters as well as the clinical characteristics in diabetic ED and healthy control subjects and to assess the occurrence of penile neuropathy in diabetic patients and thus the relationship between ED and diabetes. A total of 56 patients accepted to undergo assessment for penile vasculature using intracavernosal injection and colour Doppler ultrasonography. Of the 56 diabetic patients, 38 patients were found with normal blood flow and thus they were considered as the diabetic-ED group, whereas, ED diabetic patients with an arteriogenic component were excluded. These patients with an age range between 17 and 58 years, complaining of ED, with duration of diabetic illness ranging from 2 to 15 years. The Control group comprised of 30 healthy subject aged between 19 and 55 years. Peripheral venous levels of testosterone, prolactin, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), malondialdehyde and glycosylated haemoglobin (HbA(1)c) were obtained in all subjects. Valsalva manoeuvre and neurophysiological tests were also determined. Testosterone, prolactine, FSH, LH, and TSH hormones of the diabetic patients were not significantly different from those of the control group. Diabetic patients with ED have higher HbA(1)c and oxidative stress levels while the R-R ratio was significantly decreased. Bulbocavernosus reflex latency was significantly prolonged, whereas its amplitude, the conduction velocity and amplitude of dorsal nerve of penis were significantly reduced in the diabetic patients. We concluded that although ED is a multifactorial disorder, yet, the present study revealed that in ED patients without arteriogenic ED a neurogenic component is present. Furthermore, the complex effect of the Valsalva manoeuvre on cardiovascular function is the basis of its usefulness as a measure of autonomic function. Thus, it can be of value in the diagnosis of ED although these hypotheses require follow-up in a large study cohort.

The role of different neurophysiological tests in the differential diagnosis of diabetic axonal neuropathy and lumbosacral radiculopathy.

OBJECTIVE: To evaluate the role of different neurophysiological tests in the differential diagnosis of diabetic axonal neuropathy (DAN) and lumbosacral radiculopathy (LSR). METHODS: This study was conducted at Al-Kadhimiya Teaching Hospital, Baghdad, Iraq, from July 2006 to February 2007. Twenty-seven healthy subjects, 44 type 2 diabetics, and 36 LSR patients were studied. The HbA1c level, plain x-ray, and MRI of the lumbosacral region and different electrophysiological tests were assessed. RESULTS: The sural sensory nerve action potential (SNAP) amplitude values were reduced in 56.3%, and the sural/radial amplitude ratio (SRAR) values were reduced in 71.8% in the diabetic patients, but not in the LSR group. The peroneal compound muscle action potential (CMAP) amplitude was low in 70.45% DAN patients versus 35.5% LSR patients. Peroneal F-minimum (Fmin) values were prolonged in 56.8% DAN versus 32.25% LSR patients. The Fpersistence (Fp) values were low in 72.7% of DAN, versus 45.2% of LSR patients. However, the Fchronodispersion (Fc) was abnormal in 71% of LSR versus 11.4% of DAN patients. CONCLUSION: The SRAR was found to be more significant than the sural SNAP amplitude alone in the differential diagnosis of the 2 groups. Abnormal peroneal Fc and Fp seems to be valuable tests in the detection of LSR and DAN patients.

The propensity of common peroneal nerve in thigh-level injuries.

BACKGROUND: Sciatic nerve lesions comprise the largest subset of lower extremity nerve injuries. Military gunshot injury reports in civilians are not as predominant as wartime experience. Most sciatic nerve injuries result in deficits to the peroneal component. This study aims to report experience with civilian sciatic nerve injuries and to suggest the mechanism behind the peculiarity of the common peroneal component in thigh-level injuries. METHODS: A retrospective study was conducted on 1,463 civilian patients with military gunshot sciatic nerve injury diagnosed and evaluated by neurophysiologic studies during a period of 3 years. RESULTS: Most of the patients (95.4%) presented with thigh-level injury in which 95% suffered complete but isolated common peroneal territory palsy. The rest of the patients had either solitary complete tibial division palsy or complete tibial and common peroneal deficits. CONCLUSIONS: The propensity of the common peroneal nerve in thigh-level injuries inflicted by military-type weapons in civilians is consistent with wartime injury reports. Because of its special anatomic situation, entrapment of the common peroneal nerve whether distally or proximally may render its axons more prone to mechanical damage. Moreover, the smaller contribution of the common peroneal component to the main nerve may result in its damage more readily than the tibial component whose larger contribution may spare some of its fibers. Finally, the components of the sciatic nerve diverge at a variable distance from the knee. Thus, distal thigh injuries may involve the diverging common peroneal nerve where it has a superficial position and is more prone to injury.

Neurophysiologic evaluation of the temporomandibular joint and related masticatory muscles in rheumatoid arthritis patients.

OBJECTIVES: To study the effect of rheumatoid arthritis (RA) on the temporomandibular joints (TMJ) and related muscles using CT scan and neurophysiologic tests. METHODS: Forty-two RA patients referred from the Maxillofacial Clinic at the Special Surgeries Hospital, Medical City, Baghdad, Iraq from February 2006 to September 2006 were included in this study. Thirty-seven of them underwent CT scan of the TMJ and 25 of these patients were neurophysiologically examined. The data were compared to 30 age-matched control subjects. RESULTS: Fifteen patients showed normal TMJ, whereas, abnormal TMJ on CT scan was present in 22 patients. Of these 22 patients, 6 showed decrease in the intra-articular space, 6 exhibited erosion of the condylar head, and 3 had flattening of the condylar head. The remaining 7 patients had all the abnormalities present. Electromyography (EMG) examination showed reduced interference pattern, poor recruitment of motor unit potentials, shift of the power spectra to the lower frequencies, low mean power frequency, and root mean square values, and prolonged blink reflex component latencies. CONCLUSION: Rheumatoid arthritis patients with positive CT scan findings have poorer neurophysiologic data than those without CT scan detectable lesions. Trigeminal motor neuropathy is suggested to be the cause of the masticatory muscle weakness. Root mean square voltage as a parameter of the EMG power spectra is of great value in diagnosing such weakness.