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Background: Worsening of acute stroke early in its course (within 48–72 h of its onset) is a common occurrence and haspotentially serious short term and long term consequences. The incidence of early neurological deterioration (END) amonghospitalized patients varies widely in different studies between 13% and 38%. Aim of the Work: To define incidence and timing of END in relation to acute ischemic stroke (AIS) onset. To identify possible causes and predictors associated with END. To assess the relation between END and the patient functional level at three months post stroke. Patients and Methods: Three hundred patients were recruited into this hospital prospective comparative study. Clinical history,laboratory indices, structural brain imaging, Magnetic Resonance Angiography (MRA) and Carotid Duplex ultrasonography were done. Patients were examined on NIHSS and Glasgow Coma Scale (GCS) in day 1, 2, 3 and patients with END did a follow up (MRI diffusion film or CT brain) at day4 or 5 and all patients were followed up by Modified Rankin scale (MRs) at three-month post stroke. Results: Of the Three hundred patients included in the study, the incidence of END was 16.7%. The median NIHSS on admission was 9.25. END was associated with long duration of DM (P 0.012), IHD (p 0.015), AF (p 0.048), severe stroke (p 0.0044), low blood pressure on admission (p 0.0079), high uric acid (p 0.033) and MCA occlusion(p 0.0007). END was associated with significant increase in MRS at 3 month (p

Few studies examine health-related quality of life (HRQoL) in Arabic-speaking multiple sclerosis (MS) patients. However, HRQoL tools such as the Short Form-36 QoL instrument (SF-36) and the Multiple Sclerosis International QoL (MusiQoL) questionnaire have been validated in other languages. The primary objective of this study was to prospectively assess HRQoL using the MusiQoL questionnaire among Arabic-speaking MS patients treated with subcutaneous interferon (sc IFN β-1a) over 12 months, as part of a prospective, multinational, multicenter cohort study. Patients’ clinical parameters and HRQoL were assessed at baseline, 6 months, and 12 months. Changes in MusiQoL total and subdomain scores were compared using a Friedman test. Correlation between MusiQoL total score and Expanded Disability Status Score (EDSS) was also evaluated. In total, 439 patients from four Arabic-speaking countries were included. The mean age was 32.44 (±0.34) years, 71.5% were female, and 63.1% had an education level of university or above. The mean MS duration was 4.13 (±0.12) years, mean age at first attack was 27.35 (±0.26) years, and mean baseline EDSS score was 2.05 (±0.04). MusiQoL total score significantly improved at 6 months; however, this diminished at 12 months ( 65.67 ± 0.8 at baseline vs. 67.21 ± 0.79 at 6 months and 65.75 ± 0.8 at 12 months; p = 0.0015 ). Several aspects of patients’ HRQoL including activity of daily living, physical well-being, symptoms, and coping improved. Overall HRQoL measured using SF-36 remained generally unchanged over time ( p = 0.215 ). There was a statistically significant inverse relationship between change in EDSS score over time and change in overall MusiQoL score over time. In summary, findings confirm the utility of using MusiQoL for assessing changes in HRQoL during treatment with sc IFN β-1a in Arabic-speaking patients with MS.

Pesticide exposure is associated with increased risk of Parkinson’s disease (PD). We investigated in Egypt whether common variants in genes involved in pesticide detoxification or transport might modify the risk of PD evoked by pesticide exposure. We recruited 416 PD patients and 445 controls. Information on environmental factors was collected by questionnaire-based structured interviews. Candidate single-nucleotide polymorphisms (SNPs) in 15 pesticide-related genes were genotyped. We analyzed the influence of environmental factors and SNPs as well as the interaction of pesticide exposure and SNPs on the risk of PD. The risk of PD was reduced by coffee consumption [OR = 0.63, 95% CI: 0.43–0.90, P = 0.013] and increased by pesticide exposure [OR = 7.09, 95% CI: 1.12–44.01, P = 0.036]. The SNP rs1126680 in the butyrylcholinesterase gene BCHE reduced the risk of PD irrespective of pesticide exposure [OR = 0.38, 95% CI: 0.20–0.70, P = 0.002]. The SNP rs1803274, defining K-variant BCHE, interacted significantly with pesticide exposure (P = 0.007) and increased the risk of PD only in pesticide-exposed individuals [OR = 2.49, 95% CI: 1.50–4.19, P = 0.0005]. The K-variant BCHE reduces serum activity of butyrylcholinesterase, a known bioscavenger for pesticides. Individuals with K-variant BCHE appear to have an increased risk for PD when exposed to pesticides.

Background: epileptic patients suffer from many autonomic symptoms either during the seizure or in between seizures. Interictal autonomic cardiac changes may cause arrhythmia which may be life threatening. Aim of the work: to recognize the presence of cardiac autonomic changes in patients with temporal lobe epilepsy and to find the relation between autonomic cardiac changes and different variables. Patients and methods: Twenty patients with well controlled TLE and twenty patients with uncontrolled TLE were subjected to standard 12-lead ECG and 24 hour holter ECG. Results: QTc was significantly shorter in patients with uncontrolled TLE than in patients with well controlled TLE. Patients with uncontrolled TLE had a faster heart rate than patients with well controlled TLE. Patients with uncontrolled TLE showed significant less SDNN, rMSSD and PNN50 than those with well controlled seizures.On the other hand, LF and LF/HF ratio was significantly more in uncontrolled group than the controlled group. Conclusion: There is an interictal alteration in autonomic control of the heart in TLE. This alteration is corrected with proper control of seizures

BACKGROUND Despite the high prevalence of viral hepatic cirrhosis all over the world, the characteristic motor features of related Parkinsonism (extrapyramidal manifestations) are not well described. The current study aimed to characterize such disorder in a sample of Egyptian patients with chronic viral liver disease (CLD), and their clinical correlates. METHODS Ninety-six (96) patients with CLD were examined for the presence of extrapyramidal signs. Parkinsonism was assessed using the UPDRS-III scale and its sub scores. Ataxia and dystonia were also assessed by related scales. Patients with Parkinsonism were compared to other patients and correlations with clinical features of CLD were done. RESULTS The clinical diagnosis of extrapyramidal manifestations was justified in 57 patients (59.4%) with predominant akinetic rigid syndrome (ARS) (87.7%). Bradykinesia and axial features were the most frequent signs (89.5% and 70.2%, respectively). 38.6% of patients had postural tremors, whereas only 3.5% had rest tremors. Gait and postural abnormalities were detected in 38.6% and 36.8% respectively. Parkinsonism was associated with advanced hepatic cirrhosis (p=0.02) and increased episodes of hepatic encephalopathy (HE) (p=0.006). Severity of parkinsonian features was correlated to patients' age, age of onset of CLD and rapid progression, while impaired speech and gait were rather correlated to a number of episodes of HE. CONCLUSION Advanced viral cirrhosis is associated with high prevalence of parkinsonism that is characterized by symmetrical ARS with frequent axial features, postural tremor, gait and postural impairment. Severity of these signs is correlated to age, age of onset, rapid progression and frequency of HE.