Multiple Sclerosis (MS) is a chronic, inflammatory disorder of the central nervous system (CNS) with presumed autoimmune etiology. Lifestyle changes such as quitting smoking or reducing smoking doses, alcoholabstinence and maintaininghealthy weight are important for treatment success. Smoking has negative effect on MS patients, by worsening symptoms, creating more relapses and making it harder to treat the disease. Smoking MS patients that quit, may improve their condition. Method and materials: this study is performed in the hospital of Vlore during 2019 and we interviewed three MS hospitalized patients. We used 15 questions interview to get the patients opinion and information. They voluntarily participated in this study. Results: We interviewed three patients, from whom two smoked and one never did. The condition of the patients who smoked clearly became worse from the smoking, while the patient who did not smoke had a better prognosis by keeping the condition stable. One of the patients who smoked had quit two years ago. The three patients were aware of the negative effects that smoking had on their condition. Conclusions: Life quality of two of our patients changed when one of them started smoking and when one quit, the third keeps on deteriorating. In Albania there is an undisputable need to conduct such studies in order to follow up patients with MS, their smoking and the effect that it has on the progress of the disease.
{"title":"The Role of Smoking on Patient with Multiple Sclerosis, Three Cases from Vlora City","authors":"Evis Allushi, Gentian Vyshka, Vasilika Prifti","doi":"10.12691/IJCEN-8-1-3","DOIUrl":"https://doi.org/10.12691/IJCEN-8-1-3","url":null,"abstract":"Multiple Sclerosis (MS) is a chronic, inflammatory disorder of the central nervous system (CNS) with presumed autoimmune etiology. Lifestyle changes such as quitting smoking or reducing smoking doses, alcoholabstinence and maintaininghealthy weight are important for treatment success. Smoking has negative effect on MS patients, by worsening symptoms, creating more relapses and making it harder to treat the disease. Smoking MS patients that quit, may improve their condition. Method and materials: this study is performed in the hospital of Vlore during 2019 and we interviewed three MS hospitalized patients. We used 15 questions interview to get the patients opinion and information. They voluntarily participated in this study. Results: We interviewed three patients, from whom two smoked and one never did. The condition of the patients who smoked clearly became worse from the smoking, while the patient who did not smoke had a better prognosis by keeping the condition stable. One of the patients who smoked had quit two years ago. The three patients were aware of the negative effects that smoking had on their condition. Conclusions: Life quality of two of our patients changed when one of them started smoking and when one quit, the third keeps on deteriorating. In Albania there is an undisputable need to conduct such studies in order to follow up patients with MS, their smoking and the effect that it has on the progress of the disease.","PeriodicalId":75709,"journal":{"name":"Clinical and experimental neurology","volume":"8 1","pages":"9-13"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46583189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Sayed, Elsayed Abdelkreem, M. Aboonq, S. A. Thagfan, Y. Alahmadi, Osama Alhadramy, H. Baghdadi, Mohammed Hassan, F. Omran, Hytham M. Abdel-latif, Wafaa Abdel-ziz, A. Abouelella, Amr El-Dardear, Mohamed Abdel-haleem, E. Elhussainy, Hassan El-Alaf, M. Nabo
Beta-ketothiolase deficiency (BKTD) is an inborn error of ketone bodies and isoleucine metabolism. Patients with BKTD manifest during late infancy and early childhood with recurrent episodes of ketoacidosis (accumulated acetoacetate and β-hydroxybutyrate) that may be refractory to treatment and life-threatening. BKTD is exaggerated by fasting, starvation and catabolic conditions. Dichloroacetate (DCA) is a safe effective treatment for both lactic acidosis and non-Hodgkin’s lymphoma. DCA is non-toxic and non-carcinogenic at therapeutic doses. DCA toxic doses are hundred times (12- gram/l) more than the therapeutic doses. In experimental models of ketosis, DCA reduces ketonemia and ketonuria while significantly lowering blood glucose. Importantly, DCA was reported to divert pyruvate (amino group acceptor to form alanine in transamination reactions to regenerate α-ketoglutarate from glutamate) to oxidative pathways to form acetyl CoA that is oxidized in Krebs cycle. That inhibits first step of isoleucine catabolism (transamination step) and consequently blocks formation of acetoacetate and β-hydroxybutyrate. That alleviates ketone bodies-induced refractory metabolic acidosis. On biochemical and pharmacological bases, we suggest DCA as a novel evidence-based adjuvant and life-saving treatment for BKTD. Moreover, DCA-induced inhibition of ketone bodies uptake will be alleviated by insulin effects. Causes of refractory metabolic acidosis in BKTD are increased levels of ketone bodies (due to increased isoleucine catabolism, increased ketone bodies formation and decreased ketone bodies utilization). DCA relieves most of these. Biochemically, DCA and ketone bodies (acetoacetate and β-hydroxybutyrate) are structural analogs derived from acetic acid. In neonatology, DCA improved neonatal septicaemia-induced refractory metabolic acidosis that did not respond to conventional sodium bicarbonate. In conclusion, DCA is strongly suggested to treat BKTD.
{"title":"Dichloroacetate is a Novel Safe Treatment for Beta-ketothiolase Deficiency: Towards Better Therapeutic Outcomes (An Original Article)","authors":"S. Sayed, Elsayed Abdelkreem, M. Aboonq, S. A. Thagfan, Y. Alahmadi, Osama Alhadramy, H. Baghdadi, Mohammed Hassan, F. Omran, Hytham M. Abdel-latif, Wafaa Abdel-ziz, A. Abouelella, Amr El-Dardear, Mohamed Abdel-haleem, E. Elhussainy, Hassan El-Alaf, M. Nabo","doi":"10.12691/IJCEN-8-1-2","DOIUrl":"https://doi.org/10.12691/IJCEN-8-1-2","url":null,"abstract":"Beta-ketothiolase deficiency (BKTD) is an inborn error of ketone bodies and isoleucine metabolism. Patients with BKTD manifest during late infancy and early childhood with recurrent episodes of ketoacidosis (accumulated acetoacetate and β-hydroxybutyrate) that may be refractory to treatment and life-threatening. BKTD is exaggerated by fasting, starvation and catabolic conditions. Dichloroacetate (DCA) is a safe effective treatment for both lactic acidosis and non-Hodgkin’s lymphoma. DCA is non-toxic and non-carcinogenic at therapeutic doses. DCA toxic doses are hundred times (12- gram/l) more than the therapeutic doses. In experimental models of ketosis, DCA reduces ketonemia and ketonuria while significantly lowering blood glucose. Importantly, DCA was reported to divert pyruvate (amino group acceptor to form alanine in transamination reactions to regenerate α-ketoglutarate from glutamate) to oxidative pathways to form acetyl CoA that is oxidized in Krebs cycle. That inhibits first step of isoleucine catabolism (transamination step) and consequently blocks formation of acetoacetate and β-hydroxybutyrate. That alleviates ketone bodies-induced refractory metabolic acidosis. On biochemical and pharmacological bases, we suggest DCA as a novel evidence-based adjuvant and life-saving treatment for BKTD. Moreover, DCA-induced inhibition of ketone bodies uptake will be alleviated by insulin effects. Causes of refractory metabolic acidosis in BKTD are increased levels of ketone bodies (due to increased isoleucine catabolism, increased ketone bodies formation and decreased ketone bodies utilization). DCA relieves most of these. Biochemically, DCA and ketone bodies (acetoacetate and β-hydroxybutyrate) are structural analogs derived from acetic acid. In neonatology, DCA improved neonatal septicaemia-induced refractory metabolic acidosis that did not respond to conventional sodium bicarbonate. In conclusion, DCA is strongly suggested to treat BKTD.","PeriodicalId":75709,"journal":{"name":"Clinical and experimental neurology","volume":"8 1","pages":"4-8"},"PeriodicalIF":0.0,"publicationDate":"2020-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43623215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Ouvrier, D. Lewis, P. Procopis, F. Billson, M. Silink, M. de Silva
In the past 10 years, 15 children with bilateral optic nerve hypoplasia have been studied at the Royal Alexandra Hospital for Children. There were 5 boys and 10 girls. Nine were first-born and they presented at a mean age of 5 months (range: 4 days to 25 months). Five presented with suspected blindness and 7 with abnormal eye movements (nystagmus or less commonly squint). The other 3 presented because of fits or developmental delay. Eight showed evidence of neural damage--microcephaly, seizures and/or abnormalities of tone. Four appeared to be of normal or near normal intelligence, 6 were mildly retarded and 5 severely so. Two patients had already died, one suddenly. Six of the 7 cases investigated in detail had evidence of hypothalamic pituitary dysfunction. Another one had a minimal hypothalamic abnormality. Four were severely growth retarded and 2 were receiving growth hormone replacement. Two males had micropenis and a girl had precocious puberty with partial diabetes insipidus. Neuroradiological investigations showed an absent septum pellucidum in only 5 cases. Five patients had other major CNS malformations. Five patients had normal CT scans; 3 of these 5 appeared of normal intelligence and all 5 had normal neurological examinations. Bilateral optic nerve hypoplasia is frequently associated with serious brain and endocrine abnormalities.
{"title":"Bilateral optic nerve hypoplasia.","authors":"R. Ouvrier, D. Lewis, P. Procopis, F. Billson, M. Silink, M. de Silva","doi":"10.32388/atup1x","DOIUrl":"https://doi.org/10.32388/atup1x","url":null,"abstract":"In the past 10 years, 15 children with bilateral optic nerve hypoplasia have been studied at the Royal Alexandra Hospital for Children. There were 5 boys and 10 girls. Nine were first-born and they presented at a mean age of 5 months (range: 4 days to 25 months). Five presented with suspected blindness and 7 with abnormal eye movements (nystagmus or less commonly squint). The other 3 presented because of fits or developmental delay. Eight showed evidence of neural damage--microcephaly, seizures and/or abnormalities of tone. Four appeared to be of normal or near normal intelligence, 6 were mildly retarded and 5 severely so. Two patients had already died, one suddenly. Six of the 7 cases investigated in detail had evidence of hypothalamic pituitary dysfunction. Another one had a minimal hypothalamic abnormality. Four were severely growth retarded and 2 were receiving growth hormone replacement. Two males had micropenis and a girl had precocious puberty with partial diabetes insipidus. Neuroradiological investigations showed an absent septum pellucidum in only 5 cases. Five patients had other major CNS malformations. Five patients had normal CT scans; 3 of these 5 appeared of normal intelligence and all 5 had normal neurological examinations. Bilateral optic nerve hypoplasia is frequently associated with serious brain and endocrine abnormalities.","PeriodicalId":75709,"journal":{"name":"Clinical and experimental neurology","volume":"18 1","pages":"52-60"},"PeriodicalIF":0.0,"publicationDate":"2020-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45990694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Resting heart rate (RHR) is a simple but powerful predictor of autonomic health which can be used on a visit-by-visit basis for an individual patient to conveniently assess his or her neurological progress. This case report provides an example of this approach. The method incorporates outlier analysis for a total of five measurements over a 6 week period that included chiropractic care and exercise. Methods: An adult female patient with elevated RHR received chiropractic care from the author. She also began an exercise program during this time. Approximately six weeks later she experienced a substantial reduction (improvement) in RHR on a follow-up visit. Inter-quartile outlier analysis was applied to determine if the improvement was statistically unusual. The advantage of doing this analysis is that it would give an indication of whether the change occurred by chance alone. This in turn provides a level of clinical certainty regarding progress of the patient. Results: The first two RHR measurements, four days apart were 81.6 beats per minute (BPM) and 81.9 BPM respectively. Follow-up RHR measurements (in BPM) were 79.5, 77.8, and 66.3. This last reading, 66.3 BPM was detected as an extreme outlier. Conclusion: This case study shows how RHR and outlier analysis can be used to determine neurological progress on a given visit for an individual patient. In this case there was such progress following chiropractic care and exercise. Further study with other patients and longer follow-up periods will be a good next step.
{"title":"Reduction in Resting Heart Rate Following Chiropractic Adjustment and Exercise: A Case Study","authors":"J. Hart","doi":"10.12691/IJCEN-8-1-1","DOIUrl":"https://doi.org/10.12691/IJCEN-8-1-1","url":null,"abstract":"Introduction: Resting heart rate (RHR) is a simple but powerful predictor of autonomic health which can be used on a visit-by-visit basis for an individual patient to conveniently assess his or her neurological progress. This case report provides an example of this approach. The method incorporates outlier analysis for a total of five measurements over a 6 week period that included chiropractic care and exercise. Methods: An adult female patient with elevated RHR received chiropractic care from the author. She also began an exercise program during this time. Approximately six weeks later she experienced a substantial reduction (improvement) in RHR on a follow-up visit. Inter-quartile outlier analysis was applied to determine if the improvement was statistically unusual. The advantage of doing this analysis is that it would give an indication of whether the change occurred by chance alone. This in turn provides a level of clinical certainty regarding progress of the patient. Results: The first two RHR measurements, four days apart were 81.6 beats per minute (BPM) and 81.9 BPM respectively. Follow-up RHR measurements (in BPM) were 79.5, 77.8, and 66.3. This last reading, 66.3 BPM was detected as an extreme outlier. Conclusion: This case study shows how RHR and outlier analysis can be used to determine neurological progress on a given visit for an individual patient. In this case there was such progress following chiropractic care and exercise. Further study with other patients and longer follow-up periods will be a good next step.","PeriodicalId":75709,"journal":{"name":"Clinical and experimental neurology","volume":"8 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42447023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdallh Al-Mà moun Sarhan, Khaled A. M. EL-Sharkawy, T. Elkhatib, Asmaa A Hassan
Background: High red cell distribution width (RDW) has been demonstrated as a powerful predictor of mortality in patients with heart failure, myocardial infarction, and peripheral artery disease, as well as in the general population. The aim of this study was to evaluate the role of RDW as a predictor of stroke severity and functional outcome of acute ischemic stroke patients. Patients and methods: From August 2016 to October 2017, 150 consecutive acute ischemic stroke patients and 150 non stroke patients were enrolled to this analytical case- control study. The prognostic value of RDW was assessed using logistic regression model and receiver operating characteristic (ROC) curve analysis. Results: Mean RDW level in the patients group was 15.4±1.8 and in the control group was 13.66±1.41 and this difference was of high statistical significance (p <0.001). RDW values higher than 14.6 increased the risk of stroke several folds (odds ratio 4.38; p value < 0.001). Multivariate analysis revealed that, higher RDW was associated with a significant poor functional outcome in patients with acute cerebral infarction. Conclusion: RDW values can predict the occurrence, severity and functional outcome of acute ischemic stroke.
{"title":"Red Blood Cell Distribution Width as a Predictor of Clinical Outcome in Acute Ischemic Stroke Patients","authors":"Abdallh Al-Mà moun Sarhan, Khaled A. M. EL-Sharkawy, T. Elkhatib, Asmaa A Hassan","doi":"10.12691/IJCEN-7-1-3","DOIUrl":"https://doi.org/10.12691/IJCEN-7-1-3","url":null,"abstract":"Background: High red cell distribution width (RDW) has been demonstrated as a powerful predictor of mortality in patients with heart failure, myocardial infarction, and peripheral artery disease, as well as in the general population. The aim of this study was to evaluate the role of RDW as a predictor of stroke severity and functional outcome of acute ischemic stroke patients. Patients and methods: From August 2016 to October 2017, 150 consecutive acute ischemic stroke patients and 150 non stroke patients were enrolled to this analytical case- control study. The prognostic value of RDW was assessed using logistic regression model and receiver operating characteristic (ROC) curve analysis. Results: Mean RDW level in the patients group was 15.4±1.8 and in the control group was 13.66±1.41 and this difference was of high statistical significance (p <0.001). RDW values higher than 14.6 increased the risk of stroke several folds (odds ratio 4.38; p value < 0.001). Multivariate analysis revealed that, higher RDW was associated with a significant poor functional outcome in patients with acute cerebral infarction. Conclusion: RDW values can predict the occurrence, severity and functional outcome of acute ischemic stroke.","PeriodicalId":75709,"journal":{"name":"Clinical and experimental neurology","volume":"7 1","pages":"12-16"},"PeriodicalIF":0.0,"publicationDate":"2019-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47260587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
El Hady A Abd El Gawaad, Hanan Mohammad, T. Elkhatib, G. A. Khalil
Background: Acute ischemic stroke (AIS) is one of the major causes of death worldwide. An estimated 80% of strokes are thromboembolic in origin, often with carotid plaque as an embolic source. Carotid Doppler study is valuable to assess the cause, localization, extent and severity of extra cranial arterial stenosis. The aim of our work is to investigate the relation between Doppler findings in carotid artery disease and vascular risk factors in acute ischemic stroke patients. Methods: We prospectively analyze 64 consecutive patients with first-ever ischemic stroke admitted within 24 hs of the onset of stroke symptoms. Carotid doppler ultrasonography was performed to all subjects. Carotid intima-media thickness (CIMT) measurement of both right and left sides of the common carotid arteries and internal carotid arteries were taken and degree of stenosis was calculated. Results: 53.1% of our patients were males and 46.9% were females with the mean Patient's age were 66.5(±10.0) years. The mean CIMT of our patients were 1.4±0.86 while stenosis was present in 50% of our patients. The vascular risk factors showed positive association with stenosis of carotid arteries, with the hypertention showed the strongest association. Also, the CIMT was significantly high in hypertensive (p Conclusion: carotid artery stenosis and CIMT was significantly correlated with the vascular risk factors of ischemic stroke.
{"title":"Assessment of Extracranial Carotid Arteries in Acute Ischemic Stroke: Correlation with Risk Factors","authors":"El Hady A Abd El Gawaad, Hanan Mohammad, T. Elkhatib, G. A. Khalil","doi":"10.12691/IJCEN-7-1-1","DOIUrl":"https://doi.org/10.12691/IJCEN-7-1-1","url":null,"abstract":"Background: Acute ischemic stroke (AIS) is one of the major causes of death worldwide. An estimated 80% of strokes are thromboembolic in origin, often with carotid plaque as an embolic source. Carotid Doppler study is valuable to assess the cause, localization, extent and severity of extra cranial arterial stenosis. The aim of our work is to investigate the relation between Doppler findings in carotid artery disease and vascular risk factors in acute ischemic stroke patients. Methods: We prospectively analyze 64 consecutive patients with first-ever ischemic stroke admitted within 24 hs of the onset of stroke symptoms. Carotid doppler ultrasonography was performed to all subjects. Carotid intima-media thickness (CIMT) measurement of both right and left sides of the common carotid arteries and internal carotid arteries were taken and degree of stenosis was calculated. Results: 53.1% of our patients were males and 46.9% were females with the mean Patient's age were 66.5(±10.0) years. The mean CIMT of our patients were 1.4±0.86 while stenosis was present in 50% of our patients. The vascular risk factors showed positive association with stenosis of carotid arteries, with the hypertention showed the strongest association. Also, the CIMT was significantly high in hypertensive (p Conclusion: carotid artery stenosis and CIMT was significantly correlated with the vascular risk factors of ischemic stroke.","PeriodicalId":75709,"journal":{"name":"Clinical and experimental neurology","volume":"7 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43030045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Heart disease and stroke rank the second most common cause of mortality worldwide and the third most common in more developed countries. Elevated levels of serum troponin are found in 10-34% of patients with acute stroke. In addition, elevated cardiac troponin (cTnT) or cardiac troponin I (cTn-I) levels have been regarded as prognostic biomarkers of poor outcome and higher in-hospital mortality rates in acute ischemic stroke. Aim of the work: The aim of this study was to evaluate the role of cardiac troponin-I (cTn-I) as a predictive biomarker of both poor short-term outcome and in-hospital mortality in acute ischemic stroke patients. Methods: This prospective cohort study included 74 patients (30 males and 44 females) presented with acute ischemic stroke from March 2016 to December 2016. Data included clinical assessment involving detailed history taking, general examination, thorough neurological examination, laboratory data including measurement of serum level of (cTn-I) on admission, assessment of stroke severity using National Institute of Health Stroke Scale(NIHSS) within the first 48 hours of stroke onset. Stroke severity and functional outcome were assessed 2 months from stroke onset using (NIHSS) and modified Rankin scale (mRS). Results: Patients with elevated cTn-Ι level were older(mean age was 67.92(±12.77) Vs. 63.2(±13.24) years than in those with normal cTn-Ι level with no significant statistical difference, were suffering more from diabetes and TIA, having higher mean scores of NIHSS on admission (18.7±8.14 Vs 13.85±7.66 respectively, p 12 [19.52 (9.59-39.73), p=0.0001] and elevated cTn-I level > 0.01ug/l [19.42(1.293-293.276), p=0.035] were significant predictors of poor outcome and in-hospital mortality. Conclusion: This study reached to a conclusion that the short-term outcome is less favorable and the stroke is more severe in ischemic stroke patients with elevated serum level of cTn-I than in those with normal level, making it a reliable prognostic predictor of both poor stroke outcome and high in-hospital mortality rates.
{"title":"The Prognostic Value of Elevated Cardiac Troponin-I in Short-term Outcome of Acute Ischemic Stroke","authors":"H. Fathy, Walid Ashour, T. Elserafy, Mona M. Amer","doi":"10.12691/IJCEN-6-1-1","DOIUrl":"https://doi.org/10.12691/IJCEN-6-1-1","url":null,"abstract":"Background: Heart disease and stroke rank the second most common cause of mortality worldwide and the third most common in more developed countries. Elevated levels of serum troponin are found in 10-34% of patients with acute stroke. In addition, elevated cardiac troponin (cTnT) or cardiac troponin I (cTn-I) levels have been regarded as prognostic biomarkers of poor outcome and higher in-hospital mortality rates in acute ischemic stroke. Aim of the work: The aim of this study was to evaluate the role of cardiac troponin-I (cTn-I) as a predictive biomarker of both poor short-term outcome and in-hospital mortality in acute ischemic stroke patients. Methods: This prospective cohort study included 74 patients (30 males and 44 females) presented with acute ischemic stroke from March 2016 to December 2016. Data included clinical assessment involving detailed history taking, general examination, thorough neurological examination, laboratory data including measurement of serum level of (cTn-I) on admission, assessment of stroke severity using National Institute of Health Stroke Scale(NIHSS) within the first 48 hours of stroke onset. Stroke severity and functional outcome were assessed 2 months from stroke onset using (NIHSS) and modified Rankin scale (mRS). Results: Patients with elevated cTn-Ι level were older(mean age was 67.92(±12.77) Vs. 63.2(±13.24) years than in those with normal cTn-Ι level with no significant statistical difference, were suffering more from diabetes and TIA, having higher mean scores of NIHSS on admission (18.7±8.14 Vs 13.85±7.66 respectively, p 12 [19.52 (9.59-39.73), p=0.0001] and elevated cTn-I level > 0.01ug/l [19.42(1.293-293.276), p=0.035] were significant predictors of poor outcome and in-hospital mortality. Conclusion: This study reached to a conclusion that the short-term outcome is less favorable and the stroke is more severe in ischemic stroke patients with elevated serum level of cTn-I than in those with normal level, making it a reliable prognostic predictor of both poor stroke outcome and high in-hospital mortality rates.","PeriodicalId":75709,"journal":{"name":"Clinical and experimental neurology","volume":"6 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2018-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46317011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Platelet activation in cerebrovascular diseases is associated with recurrent stroke and death. Aspirin is an effective antiplatelet agent, exhibiting its action by irreversibly inhibiting platelet cyclooxygenase-1 enzyme, thus preventing the production of thromboxane A2 (TXA2). Objectives: The study is designed to find the frequency of aspirin resistance (AR) among acute ischemic non-cardioembolic stroke patients, and to assess the clinical picture of those patients. Mehtods: This study included 80 patients39 males and 41 females (mean age: 63 years 11.8 SD), they were diagnosed clinically and via brain imaging within 24 hours following stroke onset. They were given non coated, same preparation of aspirin 150 mg/day regularly and under observation, Low molecular weight heparin 40 mg per day. The patients were followed up clinically and via GCS, NIHSS and APACHEII scales. Assessment of aspirin resistance was done one week after regular aspirin intake through: bleeding time, coagulation time and assessment of thromboxaneA2 level in serum using ELIZA. The patients were classified into two groups aspirin resistant (AR) and aspirin sensitive (AS) and the data were compared in both. Results: AR patients represented 33.75% of our sample. History of TIAs and stroke was more prevalent among them. In AR patients: the followings were also more frequent: more affection of consciousness, power, sensation, language, coordination, vertigo, vomiting, large size of cerebral infarcts, temporal and parietal infarcts. There were high significant negative correlation between GCS and TXA2level and between the later and changes in bleeding time in the first day and 7 days following stroke onset. On the other hand there were high positive correlation between TXA2 level and NIHSS score and infarct size. Coclusion: AR was frequent among ischemic non-cardioembolic stroke and they were associated with history of TIAs and previous strokes, and presented with more severe clinical presentation and larger size of cerebral infarcts, So early identification of AR prevents its fruitless use.
{"title":"Aspirin Resistance in Acute Ischemic Non-cardioembolic Stroke: Frequency and Clinical Study","authors":"Y. Altaweel, A. Kamel, S. Lotfy, N. Mohammad","doi":"10.12691/ijcen-5-1-7","DOIUrl":"https://doi.org/10.12691/ijcen-5-1-7","url":null,"abstract":"Platelet activation in cerebrovascular diseases is associated with recurrent stroke and death. Aspirin is an effective antiplatelet agent, exhibiting its action by irreversibly inhibiting platelet cyclooxygenase-1 enzyme, thus preventing the production of thromboxane A2 (TXA2). Objectives: The study is designed to find the frequency of aspirin resistance (AR) among acute ischemic non-cardioembolic stroke patients, and to assess the clinical picture of those patients. Mehtods: This study included 80 patients39 males and 41 females (mean age: 63 years 11.8 SD), they were diagnosed clinically and via brain imaging within 24 hours following stroke onset. They were given non coated, same preparation of aspirin 150 mg/day regularly and under observation, Low molecular weight heparin 40 mg per day. The patients were followed up clinically and via GCS, NIHSS and APACHEII scales. Assessment of aspirin resistance was done one week after regular aspirin intake through: bleeding time, coagulation time and assessment of thromboxaneA2 level in serum using ELIZA. The patients were classified into two groups aspirin resistant (AR) and aspirin sensitive (AS) and the data were compared in both. Results: AR patients represented 33.75% of our sample. History of TIAs and stroke was more prevalent among them. In AR patients: the followings were also more frequent: more affection of consciousness, power, sensation, language, coordination, vertigo, vomiting, large size of cerebral infarcts, temporal and parietal infarcts. There were high significant negative correlation between GCS and TXA2level and between the later and changes in bleeding time in the first day and 7 days following stroke onset. On the other hand there were high positive correlation between TXA2 level and NIHSS score and infarct size. Coclusion: AR was frequent among ischemic non-cardioembolic stroke and they were associated with history of TIAs and previous strokes, and presented with more severe clinical presentation and larger size of cerebral infarcts, So early identification of AR prevents its fruitless use.","PeriodicalId":75709,"journal":{"name":"Clinical and experimental neurology","volume":"5 1","pages":"33-37"},"PeriodicalIF":0.0,"publicationDate":"2017-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49260809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Altaweel, Mahmoud E.Elebeary, Wafaa S. Mohamed, Mohamed A. Alsadek
The first-line management for idiopathic trigeminal neuralgia (ITN) is medical therapy. The effectiveness of medications typically wanes over time, so we need to evaluate other modality of therapy. Objective: To compare pharmacotherapy versus Gamma knife radiotherapy (GKRS) in relief of pain in patients with idiopathic trigeminal neuralgia (ITN). Methods: the study included sixty eight patients with idiopathic trigeminal neuralgia. They were assessed by Barrow Neurological Institute (BNI) pain intensity scale. They were classified into two groups: Group I: 34 patients, were treated by GKRS and were chosen from Gamma knife center in Nasser institute hospital. They were 19 (55.9%) male and 15 (44.1%) female with ages ranged from 40-59 years (Mean±SD was 49.5±6.1). They were assessed by BNI scale before and immediately after GKRS, One month and three months after GKRS treatment. Group II: 34 patients, were chosen from neurology department Zagazig University Hospitals. They were 19 (55.9%) male and 15 (44.1%) female with ages ranged from 40-60 years (Mean±SD was 49.0±6.95). They were assessed by BNI scale before and one week after pharmacotherapy, One month and three months after pharmacotherapy. Results: There was no statistically significant difference between the two groups regarding pain intensity before GKRS or pharmacotherapy (p=0.33) while one week after pharmacotherapy ten (29.4%) patients showed statistically significant improvement of pain.After one month, group I showed statistical significant better outcome (41.2%) than group II (8.8%). BNI score three months after managements was highly statisticallly significant better (32.4%) among group I than group II (p=0.001). Most of group I (82.4%) had good overall outcome while 50% of group II had fair outcome and26.5% had good outcome.Conclusion: medical management of ITN had an initial good results in improving pain intensity which begins to wane over one month and the effect of GKRS begins to appear. The effect of GKRS on ITN pain is still evolving through three months follow up.
{"title":"Evaluation of Some Modalities of Therapy in Idiopathic Trigeminal Neuralgia","authors":"Y. Altaweel, Mahmoud E.Elebeary, Wafaa S. Mohamed, Mohamed A. Alsadek","doi":"10.12691/IJCEN-5-1-6","DOIUrl":"https://doi.org/10.12691/IJCEN-5-1-6","url":null,"abstract":"The first-line management for idiopathic trigeminal neuralgia (ITN) is medical therapy. The effectiveness of medications typically wanes over time, so we need to evaluate other modality of therapy. Objective: To compare pharmacotherapy versus Gamma knife radiotherapy (GKRS) in relief of pain in patients with idiopathic trigeminal neuralgia (ITN). Methods: the study included sixty eight patients with idiopathic trigeminal neuralgia. They were assessed by Barrow Neurological Institute (BNI) pain intensity scale. They were classified into two groups: Group I: 34 patients, were treated by GKRS and were chosen from Gamma knife center in Nasser institute hospital. They were 19 (55.9%) male and 15 (44.1%) female with ages ranged from 40-59 years (Mean±SD was 49.5±6.1). They were assessed by BNI scale before and immediately after GKRS, One month and three months after GKRS treatment. Group II: 34 patients, were chosen from neurology department Zagazig University Hospitals. They were 19 (55.9%) male and 15 (44.1%) female with ages ranged from 40-60 years (Mean±SD was 49.0±6.95). They were assessed by BNI scale before and one week after pharmacotherapy, One month and three months after pharmacotherapy. Results: There was no statistically significant difference between the two groups regarding pain intensity before GKRS or pharmacotherapy (p=0.33) while one week after pharmacotherapy ten (29.4%) patients showed statistically significant improvement of pain.After one month, group I showed statistical significant better outcome (41.2%) than group II (8.8%). BNI score three months after managements was highly statisticallly significant better (32.4%) among group I than group II (p=0.001). Most of group I (82.4%) had good overall outcome while 50% of group II had fair outcome and26.5% had good outcome.Conclusion: medical management of ITN had an initial good results in improving pain intensity which begins to wane over one month and the effect of GKRS begins to appear. The effect of GKRS on ITN pain is still evolving through three months follow up.","PeriodicalId":75709,"journal":{"name":"Clinical and experimental neurology","volume":"5 1","pages":"28-32"},"PeriodicalIF":0.0,"publicationDate":"2017-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46671166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Altaweel, A. El-Motayam, Khaled A. M. EL-Sharkawy, Mohammed Hanafy Aly Ghonemy
Comorbid conditions are common in people with epilepsy, and their presence has important implications for diagnosis, treatment, medical costs and quality of life. Migraines are most common in patients with epilepsy, with a reported prevalence of 20-40%, while epidemiologic studies on the association between allergic disease and epilepsy in adults and children have found conflicting results. Objectives: The study was designed to assess the prevalence of migraine and atopic diseases: bronchial asthma(BA) and atopic eczema in patients with idiopathic epilepsy. Methods: This study included 118 patients with idiopathic generalized epilepsy(IGE), 68 male and 50 female with ages ranged from 2-20 years (mean age 9.8±5.4 years). The patient will be considered :to have migraine according to criteria of ICHD 3 (2013), to have BA according to diagnostic criteria of National Asthma Education and Prevention Program (2007) and to have atopic eczema according to Williams criteria (1994). The patients were classified into two groups, group Ι epileptic patients without comorbidity and groupΙΙ epileptic patients with comorbidity which was further classified into 2 subgroups, groupΙΙ-A epileptic patients with one comorbidity, group ΙΙ-B epileptic patients with multiple comorbidity. All patients were subjected to: clinical assessment via thorough history taking, complete general and neurological examination, EEG, MRI brain and routine laboratary investigations. The data were compared in both groups. Results: IGE was more common in male than female (55.9 % vs 44.1 %). Atopic eczema was the most frequent comorbid illness (32.2%) followed by migraine (24.6%) and BA (24.6%) while The prevalence of atopic eczema, migraine and BA and in the general population was 20%, 15% and 4%-20%, respectively. Epileptic patients with multiple comorbidities had a statistically significant older age of onset than epileptic patients one comorbidity and without comorbidities (P= 0.001). Also female sex was statistically significant higher in epileptics with comorbidities. Epileptics with migraine had female preponderence (69%). MA was more common (79.3%). Migraine onset followed epilepsy onset in 48.2%.Migraine attacks occurred mostly interictally. The bronchial asthma comorbidity in our patients was with a more prominent onset before epilepsy (76%). Mild asthma was more common in epileptics in our study and it was common postictally. Atopic eczema comorbidity in our patients was with an onset more commonly prior to that of epilepsy & it occurred in a mild form and usually interictally. Conclusion: Patients with IGE had comorbidity with atopic eczema (32.2%) migraine (24.6%) and BA (24.6%).Family history for epilepsy was more in patients with comorbidity and they need polytherapy of AEDs more than those without comorbidity.
{"title":"Prevalence of Comorbidity of Migraine and Atopic Diseases among Patients with Idiopathic Epilepsy in Zagazig University Hospitals","authors":"Y. Altaweel, A. El-Motayam, Khaled A. M. EL-Sharkawy, Mohammed Hanafy Aly Ghonemy","doi":"10.12691/IJCEN-5-1-5","DOIUrl":"https://doi.org/10.12691/IJCEN-5-1-5","url":null,"abstract":"Comorbid conditions are common in people with epilepsy, and their presence has important implications for diagnosis, treatment, medical costs and quality of life. Migraines are most common in patients with epilepsy, with a reported prevalence of 20-40%, while epidemiologic studies on the association between allergic disease and epilepsy in adults and children have found conflicting results. Objectives: The study was designed to assess the prevalence of migraine and atopic diseases: bronchial asthma(BA) and atopic eczema in patients with idiopathic epilepsy. Methods: This study included 118 patients with idiopathic generalized epilepsy(IGE), 68 male and 50 female with ages ranged from 2-20 years (mean age 9.8±5.4 years). The patient will be considered :to have migraine according to criteria of ICHD 3 (2013), to have BA according to diagnostic criteria of National Asthma Education and Prevention Program (2007) and to have atopic eczema according to Williams criteria (1994). The patients were classified into two groups, group Ι epileptic patients without comorbidity and groupΙΙ epileptic patients with comorbidity which was further classified into 2 subgroups, groupΙΙ-A epileptic patients with one comorbidity, group ΙΙ-B epileptic patients with multiple comorbidity. All patients were subjected to: clinical assessment via thorough history taking, complete general and neurological examination, EEG, MRI brain and routine laboratary investigations. The data were compared in both groups. Results: IGE was more common in male than female (55.9 % vs 44.1 %). Atopic eczema was the most frequent comorbid illness (32.2%) followed by migraine (24.6%) and BA (24.6%) while The prevalence of atopic eczema, migraine and BA and in the general population was 20%, 15% and 4%-20%, respectively. Epileptic patients with multiple comorbidities had a statistically significant older age of onset than epileptic patients one comorbidity and without comorbidities (P= 0.001). Also female sex was statistically significant higher in epileptics with comorbidities. Epileptics with migraine had female preponderence (69%). MA was more common (79.3%). Migraine onset followed epilepsy onset in 48.2%.Migraine attacks occurred mostly interictally. The bronchial asthma comorbidity in our patients was with a more prominent onset before epilepsy (76%). Mild asthma was more common in epileptics in our study and it was common postictally. Atopic eczema comorbidity in our patients was with an onset more commonly prior to that of epilepsy & it occurred in a mild form and usually interictally. Conclusion: Patients with IGE had comorbidity with atopic eczema (32.2%) migraine (24.6%) and BA (24.6%).Family history for epilepsy was more in patients with comorbidity and they need polytherapy of AEDs more than those without comorbidity.","PeriodicalId":75709,"journal":{"name":"Clinical and experimental neurology","volume":"5 1","pages":"18-27"},"PeriodicalIF":0.0,"publicationDate":"2017-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42225187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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