BACKGROUND AND OBJECTIVES:Lifestyle modifications and coping with migraine triggers have a crucial role in migraine management. This study aimed to assess the knowledge of patients with migraine about triggers, managing strategies for these triggers, and the counselling provided by physicians regarding these topics. METHODS:A cross-sectional study was conducted on individuals with a confirmed diagnosis of migraine through an online survey to assess their knowledge of common migraine triggers, whether the healthcare provider had discussed migraine triggers or recommended lifestyle modifications, and strategies followed to manage migraine triggers. RESULTS:Five hundred fifteen patients with migraines responded to the survey, with a median age of thirty-one years. Only 43% thought they had sufficient knowledge about migraine triggers. Stress got the highest awareness level (93.4%), followed by sleep-related issues. About 40% of participants were aware of certain food triggers. While 63.1% of participants said their physicians had addressed lifestyle changes to help reduce migraines, only 28.3% reported actively managing their migraine triggers. The most frequently discussed aspect was sleep hygiene improvements (78.1%), followed by stress management techniques (68.7%), and dietary modifications (59.8%). Regarding the approaches applied for migraine management, following a consistent sleep schedule, stress management techniques, and a specific diet were reported by 54.0%, 49. 5%, and 34.0%, respectively. Moreover, only 18% keep a detailed migraine diary to track their triggers. CONCLUSION:Addressing migraine triggers and coping strategies should be integrated into migraine management to reduce reliance on medications and activate personalized plans to optimize outcomes.

Introduction The mild cognitive impairment (MCI) refers to a condition that falls in between dementia and the normal cognitive ageing process. Aim of the study: to explore how a physical therapy rehabilitation program affected patients with type 2 diabetes mellitus (T2DM) and MCI. Methods The study included 37 elderly patients with T2DM and MCI from Al-Azhar University Hospital aged from 60 to 75 years old. After a physician’s referral, they were randomly allocated into two groups. Group A: 27 patients, underwent a three-session per week, 60-minute physical therapy rehabilitation program in addition to medical treatment. The twelve-week program also included resistive exercise, stretching exercises, and aerobic treadmill walking. The 10 patients in Group B only received medical treatment for a total of twelve weeks. Researchers assessed Glycosylated haemoglobin (HbA1c), the p300 neurophysiological test, Mini-Mental State Examination (MMSE) scale, and Montreal Cognitive Assessment (MOCA). Results There were significantly decreased HbA1c and P300 post-treatment compared to pre-treatment within the study group ( p = 0.0001 and p = 0.0001, respectively) and control group ( p = 0.005 and p = 0.0001, respectively). The MOCA significantly increased post-treatment compared to pre-treatment within the study group, but there was no significant difference in the MOCA between pre- and post-treatment in the control group. The study group had decreased HbA1c, and increased MMS, MOCA, and P300 (13.72, 19.34, 18.7, and 7.2%, respectively) compared to the control group (11.06, 11.06, 9.3, 5.98%, respectively). Conclusions Physical therapy rehabilitation programs are important in helping patients with T2DM for improving their memory and cognitive function as well as decreasing the MCI progression.

AbstractObjectiveIn epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day‐to‐day practice in Egypt as well as several other resource‐limited countries. Premature mortality, poor quality of life, socio‐economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus.MethodsThe consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements.ResultsOf 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements.SignificanceWith the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt.Plain Language SummaryThis work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource‐limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.

Progressive multifocal leukoencephalopathy (PML) is a rare, life-threatening, infectious, lytic, demyelinating disease that results from reactivation of the virulent JC polyomavirus (JCV) "major opportunistic infection" in immunosuppressed individuals. We reported a case of a young girl who presented with new onset focal neurological defect, evaluated, and laboratory and radiological findings in the context of a clinical setting confirmed HIV-related-PML infection. However, remyelination does not occur, the patients may develop complications in the long term including cognitive impairment, sensory deficits, motor deficits, and disturbances in balance. We must increase our knowledge about HIV- related PML in any patient with reduced immunity and who presented with new onset neurological defect.

Background: Piriformis syndrome (PS) is a painful musculoskeletal condition characterized by a deep gluteal pain that may radiate to the posterior thigh and leg. This study was designed to compare the effectiveness of ozone and BTX to lidocaine injection in treating piriformis syndrome that was resistant to medication and/or physical therapy. Study design: Between November 2018 and August 2019, we involved eighty-four subjects diagnosed with piriformis syndrome in a double-blinded, prospective, randomized comparative study to receive an ultrasound-guided injection of lidocaine (control group), botulinum toxin A, or local ozone (28 patients each group) in the belly of the piriformis muscle. Pain condition evaluated by the visual analog score (VAS) was used as a primary outcome, and the Oswestry Disability Index (ODI) as a secondary outcome, before, at one month, two months, three months, and six months following the injection. Results: The majority (58.3%) of patients were male, while (41.7%) were female. At one month, a highly significant decrease occurred in VAS and ODI in the lidocaine and ozone groups compared to the botulinum toxin group (p < 0.001). At six months, there was a highly significant decrease in VAS and ODI in the botulinum toxin group compared to the lidocaine and ozone groups (p < 0.001). Conclusion: Botulinum toxin may assist in the medium- and long-term management of piriformis syndrome, while lidocaine injection and ozone therapy may help short-term treatment in patients not responding to conservative treatment and physiotherapy.

Purpose: Diabetes is a documented risk factor for peripheral neuropathy. It was reported that associated hypertension could increase this risk. The present study aimed to assess the effect of hypertension and diabetes on median nerve using high-resolution ultrasound. Methods: The study includes 50 hypertensive patients (HTN group), 50 diabetic patients (DM group), 50 patients with coexisting diabetes and hypertension (HTN + DM group) and 50 healthy controls. Median nerve affection in the studied groups was studied by vibration perception thresholds (VPT). The median nerve cross-sectional area was determined at the nerve cross-sectional area of the median nerve at the carpal tunnel by high-resolution ultrasound. Clinical symptoms were assessed using Toronto Clinical Severity Score (TCSS). Results: There was significantly higher median nerve CSA in all patient groups in compar-ison to controls. HTN + DM group had significantly higher median nerve CSA when compared with DM group. Patients with peripheral neuropathy in HTN + DM and DM groups had significantly higher median nerve CSA than patients without. Using ROC curve analysis, it was shown that median CSA could successfully distinguish patients with periph-eral neuropathy from patients without in HTN + DM group [AUC (95% CI): 0.71 (0.54- 0.89)] and in DM group [AUC (95% CI): 0.86 (0.72-0.99)]. Conclusion: Hypertensive patients with and without diabetes have significantly higher median nerve CSA when compared with controls.

Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic is a challenge for all participants in the healthcare system. At the beginning of the pandemic, many doctors asked themselves how to manage patients with multiple sclerosis(MS).we had followed 87 patient with MS(Al- azhar university MS clinic, cairo,Egypt). With regard to the different disease types and different disease modifying therapies (DMTs),many patients were fear from coming to hospitals and clinics to avoid catching infection. We did follow up through mobile calls, including video calls,to help our patient and encourage telemedicine phenomenon. When looking at the severe and fatal cases, we managed them by cell phones calls and described treatment, it is reasonable to assume that this maneuver could be protective and helpful to MS patients.Material(s) and Method(s): At the beginning of the pandemic, many doctors asked themselves how to manage patients with multiple sclerosis(MS).we had followed 87 patient with MS(Al- azhar university MS clinic, cairo,Egypt). With regard to the different disease types and different disease modifying therapies (DMTs),many patients were fear from coming to hospitals and clinics to avoid catching infectionResult(s): we managed MS patients by cell phones calls and described treatment, it is reasonable to assume that this maneuver could be protective and helpful to MS patients.Conclusion(s): MS patients could be easily managed during the era of COVID-19 Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic is a challenge for all participants in the healthcare system. At the beginning of the pandemic, many doctors asked themselves how to manage patients with multiple sclerosis(MS).we had followed 87 patient with MS(Al- azhar university MS clinic, cairo,Egypt). With regard to the different disease types and different disease modifying therapies (DMTs),many patients were fear from coming to hospitals and clinics to avoid catching infection. We did follow up through mobile calls, including video calls,to help our patient and encourage telemedicine phenomenon. When looking at the severe and fatal cases, we managed them by cell phones calls and described treatment, it is reasonable to assume that this maneuver could be protective and helpful to MS patients. Material(s) and Method(s): At the beginning of the pandemic, many doctors asked themselves how to manage patients with multiple sclerosis(MS).we had followed 87 patient with MS(Al- azhar university MS clinic, cairo,Egypt). With regard to the different disease types and different disease modifying therapies (DMTs),many patients were fear from coming to hospitals and clinics to avoid catching infection Result(s): we managed MS patients by cell phones calls and described treatment, it is reasonable to assume that this maneuver could be protective and helpful to MS patients. Conclusion(s): MS patients could be easily managed during the era of COVID-19

BACKGROUND AND AIM:This randomized study aimed to evaluate the effect of green tea extract (GTE) intake on clinical and neurophysiological parameters in patients with mild-to-moderate diabetic peripheral neuropathy (DPN).PATIENTS AND METHODS:The present study included 194 patients with DPN. Patients were randomized into two treatment arms: GTE (n = 96) and placebo (n = 98) arms who received allocated treatment for 16 weeks. Symptoms of DPN were assessed using Toronto Clinical Scoring System (TCSS). Sensorineural pain was assessed using visual analog scale (VAS). Neural dysfunction was evaluated using the vibration perception thresholds (VPT). Assessments were made at baseline and after 4, 8, and 16 weeks of starting treatment.RESULTS:At baseline and after 4 weeks of treatment, VAS, TCSS and VPT were comparable in the studied groups. However, after 8 weeks of treatment, patients in GTE group expressed lower VAS scores, significantly lower TCSS scores and significantly lower VPT. As treatment continued, the differences between groups regarding the outcome parameters became more evident at 16 weeks.CONCLUSIONS:GTE intake may have a beneficial value in treatment of DPN.

Background and Aim Diabetic peripheral neuropathy (DPN) is one of the most common and disabling complications of DM. Many studies documented the prevalence of clinical and subclinical hypothyroidism (SCH) in diabetic patients but not in the particular group of patients with DPN. The present study aimed to determine the prevalence of SCH in DPN patients and to evaluate its association with severity of DPN. Patients and Methods The present cross-sectional study was conducted on 300 consecutive patients with DPN. The clinical manifestations of DPN were documented according to the validated Arabic version of the Michigan Neuropathy Screening Instrument. Severity of DPN was categorized into mild (6–8 points), moderate (9–11 points) or severe (12+ points) according to the Toronto Clinical Scoring System. All patients were submitted to careful history-taking and full clinical and neurological examination. Patients were diagnosed with SCH if they had TSH level above the upper limit of the normal reference range in association with normal free thyroxine (FT4) level. Results SCH was prevalent in 53 patients (17.7%, 95% CI: 13.5%–22.5%). Patients with SCH had significantly higher frequency of severe DPN (52.8% versus 28.3%, p=0.003). It was also shown that patients with SCH had significantly higher HbA1c (8.4 ± 1.0 versus 7.3 ± 1.2%, p<0.001) and HOMA-IR (3.7 ± 0.8 versus 2.7 ± 0.9, p<0.001) when compared with patients without SCH. Logistic regression analysis identified patients’ age [OR (95% CI): 1.06 (1.03–1.08), p<0.001], HbA1c [OR (95% CI): 2.2 (1.7–2.9), p<0.001] and SCH [OR (95% CI): 7.7 (3.6–15.5), p<0.001] as independent predictors of DPN severity. Conclusion The present study showed that SCH is highly prevalent in DPN patients and is independently related to its severity.

Background: The second prevalent cause of death globally is cerebrovascular stroke. It’s responsible for a great extent of disabilities than any other condition. A large share of this disability is related to poststroke neurocognitive impairment. Objective: to assess neuroimaging indices related to cognitive dysfunction in a sample of Egyptian stroke patients. Patients & methods: This study included 70 patients diagnosed with ischemic or hemorrhagic stroke after 3 months from the onset. Cognitive functions were assessed using the Montreal Cognitive Assessment test (MoCA). Results: This study included 70 stroke patients. They comprised 29 men and 41 women with an age of 52.9 ± 10.4 years. According to MoCA score, cognitive impairment was detected in 22 patients (31.4 %) while the remainder 48 patients had normal cognitive function. Patients with cognitive impairment are significantly older (59.6 ± 6.2 versus 4 9.9 ± 10.6 years; p < 0.001) and have significantly higher frequency of atherosclerotic disease (64 % versus 36 %, p < 0.001). It was found that patients with cognitive impairment show significantly higher frequency of left hemisphere strokes (68 % versus 42 %; p=0.039), both cortical and deep strokes (59 % versus 18 % and 23 %; p=0.042). It was also demonstrated that patients with cognitive impairment had significantly larger stroke lesions when compared with patients with normal cognition (12.8 ± 1.9 versus 3.9 ± 0.9 cm; p < 0.001). Conclusions: Cognitive impairment is prevalent in stroke patients. Risk factors included older age, left hemispheres strokes, cortical strokes and larger stroke lesions.

Background: It's though that mitochondrial dysfunction is participated in multiple sclerosis (MS) pathogenesis.Serum lactate and uric acid levels are biochemical markers related to mitochondrial dysfunction.Aim of work: to assess mitochondrial dysfunction in sufferers with MS through investigating lactate and uric acid serum levels.Subjects and Methods: This case carried out on 32 patients with MS and 20 safe controls matched by age and sex.Patients have been diagnosed with MS in keeping with McDonald Criteria 2017.Both participants underwent a careful history taking, thorough general and neurological exam and evaluation of serum lactate and uric acid.Using the expanded disability status scale (EDSS), the degree of impairment in sufferers with MS became assessed and fatigue became evaluated the usage of the fatigue severity scale (FSS).Results: Patients had significantly higher serum lactate levels when relative to controls (40.7 ± 18.1 versus 20. 1 ± 5.8 mg/dl, p=0.001).There were no statistically relevant variations among patients and controls regarding serum uric acid levels (4.9± 1.1 versus 5.3 ± 1.2 mg/dl, p=0.337).Correlation analysis showed significantly inverse correlation among levels of serum lactate andEDSS (r=-0.124,p=0.016) and FSS (r=-0.504,p=0.003).Conclusion: Serum lactate but not serum uric acid is elevated in MSpatients.It was associated with EDSS and FSS.

Objective Stroke is one of the leading causes of disability and death worldwide. Intravenous thrombolytic therapy has been widely recommended as a standard treatment for acute ischemic stroke in most clinical practice guidelines. The authors aimed to report on the efficacy and safety of rt-plasminogen activator (PA) in the management of acute ischemic stroke in a sample of Egyptian patients. Patients and methods There were 58 patients treated with IV rt-PA within 4.5 h of stroke onset during the study period between 2014 and 2018 at the Stroke Units of Al-Azhar University Hospitals and Al-Maadi Military Hospital. Results The studied patients had an age of 62.55±9.94 years and comprised 36 men and 22 women. Treatment window was within the first 3 h of stroke onset in 24 (41.3%) patients, while it was within 3–4.5 h in 34 (58.7%) patients. Forty-six (79.3%) patients had an early improvement and the remaining 12 (20.7%) patients experienced early deterioration. Treatment complications included symptomatic intracranial hemorrhage (10.3%), asymptomatic intracranial hemorrhage (3.4%), and hematuria (3.4%). The in-hospital mortality rate was 10.3%. Comparison between patients with early improvement and those with early deterioration shows significant association between treatment within the first 3 h of stroke onset and early improvement. Conclusions The authors have been able to show that IV thrombolysis is feasible and safe in our hospitals. However, the number of stroke patients receiving rt-PA in the developing world is relatively low.

People with multiple sclerosis (MS) have an increased incidence of headaches, although the comorbidity of headaches and MS is poorly understood. Lifetime prevalence are variable with incidence ranging from 4% to 58%. Evidence suggests that headaches may vary based on MS form and lesion location. MS patients with migraines have a more symptomatic clinical course of the disease. This study conducted on 100 Egyptian patients coming to MS clinic at Al-azhar university hospitals (75 female and 25 male) diagnosed as clinically definite multiple sclerosis according to Mc Donald criteria for Multiple Sclerosis 2017.The survey was conducted from May 2017 till May 2019. Patients with MS underwent baseline and 2-year follow-up scans. All patients underwent an examination by MS specialist neurologist. Patients completed a 28-item questionnaire about headache. Only MS patients with a self-identified history of headaches were asked to participate. For patients with more than 3-months history of headache,patients were invited to complete this survey in the waiting room. To ensure anonymity, no names or other patient identifiers were recorded. From the responses, we examined in detail each patient's demographics, medications use, headache characteristics, frequency, location, duration, pain description, modifying factors, triggers, and impact on patient functioning. We also assessed headache features in relation to MS diagnosis, disease exacerbations, and physiological conditions such as pregnancy and menses. Patients who reported the presence of headaches before the start of their MS symptoms were 70% (P < .013). Out of them, 40% reported that they had headaches at least once a week (P < .001), with the majority stating that their headaches were severe at least some of the time. 60% of the patients reported that their headaches lasted for more than 4 hours without medication (P < .001). If they took medication immediately after headache onset, many patients reported a reduction in headache duration (P < .001), although for 17% headaches continued to last for more than 4 hours. Among patients who waited until headaches became severe to take medication, far fewer received considerable benefits in headache reduction. 25 % of patients who had headaches before MS onset had migraine with aura. However, 60 % of the patients who did not experience headaches before MS reported the presence of aura. Headache severity was increased during MS exacerbation: only 8 % of patients who never or rarely experienced severe headaches had worsening upon MS exacerbation. The most common lesions locations were cortex (33.3%) and cortex plus brainstem (43.%). Among headache-positive MS patients, there were 31 (45.6%) patients with cortical and brainstem lesions, 20 (29.4%) patients with cortical lesions, 16 (23.5%) patients with cortical plus brainstem and spinal cord lesions and 1 (1.5%) patient with spinal cord and cortical lesions. The majority of headaches reported in our study were migraine, although tension-type headache (TTH) is also commonly observed. Although the mechanisms of this correlation were unknown, several theories were suggested. The first was that migraine could initiate an inflammatory response in the brain that would be associated with greater numbers of T1- and T2-enhancing MS lesions. Headache may be the only symptom of a flare-up in MS patients. The relationship between stabbing g headache and MS relapses merits further investigation. Therefore, we suggest that headache should be investigated during examination of MS patients and a concurrent MS attack should be suspected at the time of headache in MS patients.

Conventional brain imaging is increasingly used to support clinicians in diagnosing and monitoring the progression of multiple sclerosis (MS). Nevertheless, the correlation between a patient's clinical manifestation and conventional magnetic resonance imaging (MRI) measures is often weak, especially in patients with progressive MS (PMS). Imaging markers for monitoring disease progression in progressive multiple sclerosis (PMS) are scarce, thereby limiting the possibility to monitor disease evolution and to test effective treatments in clinical trials. Advanced imaging techniques that have the advantage of metrics with increased sensitivity to short-term tissue changes and increased specificity to the structural abnormalities characteristic of PMS have recently been applied in clinical trials of PMS. This study conducted on 200 Egyptian patients coming to MS clinic at Al-azhar university hospitals (120 female and 80 male) diagnosed as clinically definite multiple sclerosis according to 2017McDonald criteria for Multiple Sclerosis.The survey was conducted from May 2017 till May 2019. MS patients underwent baseline and 2-year follow-up scans. All patients underwent an examination by MS specialist neurologist including evaluation of the Expanded Disability Status Scale (EDSS) score and timed 25-foot walk (T25FW). All patients received disease-modifying immunotherapy during the observation period, as was selected and prescribed by their treating physician according to routine clinical care. The data came from the combination of computational tools of image processing and neuroimaging acquired in a 1.5 Tesla scanner using different techniques: Diffusion, T2,T1, FLAIR and Structural Morphometry. Data from more than 25 brain regions of 25 healthy individuals and 200 MS patients were collected. This study assessed MRI lesions from 200 clinically well-documented MS with a mean disease duration of 5 years, of whom 10 patients were diagnosed with primary progressive MS (PPMS), 15 with secondary progressive MS (SPMS), and175 with relapsing–remitting MS (RRMS). Twelve of them had an undetermined clinical course. We analysed the heterogeneity of lesion activity and its relationship to the disease course and severity. Compared with patients who had RRMS, those with progressive MS had a higher lesion load and a higher proportion of mixed active–inactive lesions, which helped to explain their greater disease severity (a shorter time to reach an EDSS score of 6). The study demonstrated that extensive cortical damage at disease onset and during the first 2 years of disease monitoring, as assessed by the number and volume of cortical lesions and cortical atrophy, was associated with a higher relapse rate during the study and more rapid onset of a progressive phase. Most importantly, a high cortical lesion count at disease onset predicted conversion to SPMS, and the number of lesions correlated with the speed of conversion (on average 4 years earlier in patients with ≥7 cortical lesions than in those with 1–3 lesions). None of the patients without cortical lesions at baseline evolved to SPMS. Combined with data from patients with clinically isolated syndrome, which suggest that cortical lesions are specific to MS and are associated with the accrual of more severe disability, these findings support the development of standardized MRI sequences for the assessment of cortical lesions in clinical practice. The importance of grey matter involvement for long-term prognosis was also confirmed by follow-up study of 49 patients with RRMS. An MRI model that included diffusion tensor measures of grey matter damage at baseline and measures of neurodegeneration — namely, formation of new T1-hypointense lesions and changes in brain volume — during the first 15 months of follow-up allowed the prediction of long-term disability in 77.6% of the patients. In contrast to previous studies of PPMS with a shorter follow-up (2 years), spinal cord atrophy was not associated with clinical deterioration, suggesting that the processes leading to accrual of disability evolve over time. Conventional and modern magnetic-resonance-based techniques to the study of MS has improved our ability to diagnose and monitor MS, as well as our understanding of disease pathophysiology. New techniques need to be refined and validated before they can be properly integrated into clinical research and practice. New schemes and analysis procedures require standardisation and optimisation so that they can be used in multi-site settings, both in natural history studies and treatment trials. From the data available, it is evident that the combining of different magnetic resonance methods, which are sensitive to different aspects of MS pathology, is a promising way to increase further our understanding of the mechanisms underlying the accumulation of irreversible disability.

Background: Acute ischemic stroke (AIS) is a common condition with significant consequences. Advances in treatment modified outcome and prognosis. Aim: The present study aimed to discuss the predictors of functional outcome of AIS after the first three months. Patients and Methods: All the studied 131 patients had careful history taking, thorough clinical examination, and non-contrast brain CT scans. The initial severity of the stroke and evolution after thrombolysis was evaluated using the National Instituted of Health Stroke Scale (NIHSS). Patients were treated with low molecular weight heparin (LMWH) or rt-PA. Functional status at three months was evaluated using the modified Rankin Scale. Results: The present study included 131 patients with AIS. Favorable functional outcome was achieved in 52 patients (39.7 %) while the remainder 79 patients had a poor outcome. Using logistic regression analysis, significant predictors of poor outcome on univariate analysis included age ≥ 60 years (OR:3.2, CI: 1.3-7.9,p=0.014), presence of atheromatous plaques (OR: 16.8, CI: 4.8-58.3, p < 0.001), late initiation of treatment (OR: 10.6, CI: 3.4-32.1,p < 0.001) and persistent occlusion (OR: 7.8, CI: 3.2-18.8, p < 0.001). However, on multivariate analysis, variable predictive of poor outcome included age ≥ 60 years (OR: 32.5, CI: 5.4-196.5, p < 0.001), presence of atheromatous plaques (OR: 9.4, CI: 1.7-51.2, p= 0.01), late initiation of treatment (OR: 10.0, CI: 1.5-67.1,p= 0.018) and persistent occlusion (OR:25.7, CI: 6.9-95.8,p < 0.001). Conclusions: Independent predictors of poor outcome in AIS patients include age ≥ 60 years, presence of atheromatous plaques, late initiation of treatment, and persistent occlusion.

Background: Peripheral diabetic neuropathy (PDN) may be associated with nerve compression neuropathies including tarsal tunnel syndrome (TTS).Low levels of laser therapy (LLLT) is a suggested treatment.The present prospective study investigated the effect of LLLT on the clinical and neurophysiological parameters in diabetic patients with TTS.Method and Materials: Thirty diabetic patients with TTS aged 40-60 years received LLLT.LLLT was achieved using a double diode laser device (LUMIX® 2 device, Fisioline, Italy) emitting at 904 nm.Patients received 3 sessions weekly for 12 weeks.Neurophysiological parameters and visual analog scale were measured before and after 12 weeks of LLLT.Results: Comparison between pre and post-treatment outcome parameters revealed significant improvement of VAS (8.5 ± 1.2 versus 4.6 ± 1.7, p<0.001), motor distal latency (6.7 ± 0.9 versus 5.1 ± 0.9 ms, p<0.001), sensory peak distal latency (4.6 ± 0.5 versus 3.2 ± 0.3 ms, p<0.001), motor amplitude (2.6 ± 0.6 versus 4.1 ± 0.5 mV, p<0.001), medial planter amplitude (6.1 ± 3.2 versus 15.1 ± 3.5 mV, p<0.001) and medial planter amplitude (4.3 ± 2.0 versus 12.5 ± 1.6 mV, p<0.001).Conclusion: LLLT has a positive impact on clinical and neurophysiological parameters in diabetic patients with TTS.

Background: peripheral neuropathy is damage to or disease affecting nerves which may impair sensation, movement, gland or organs function or other aspects of health depending on the type of nerve affected. Peripheral neuropathy is a common complication of liver cirrhosis either due to viral (mostly HCV), NASH, Alcoholic or mixed. Objectives: the aim of this study was to define the prevalence of peripheral neuropathy in a sample of Egyptian patients with liver cirrhosis and to determine any etiologic correlation. Patients and Methods: this descriptive study was conducted on 47 Egyptian liver cirrhotic patients. Patients were subjected to history taking, detailed neurological examination and clinical and neurophysiological assessment. Results: viral hepatitis was the commonest cause of liver cirrhosis 59.6% while non viral causes 25.5% e.g. NASH, the main duration of liver cirrhosis was 10 + 3.98 yrs ranging from 3-23 yrs. The majority of patients were asymptomatic, 48.9%, while the most presenting symptoms were sensory symptoms 25.5%, the prevalence of PN among a sample of Egyptian patients with liver cirrhosis according to neurophysiological assessment was 72.3% mostly of mixed sensory and motor polyneuropathic pattern, not related to the cause of liver cirrhosis but affected by the duration and severity of liver cirrhosis determined by Child Pugh classification. Conclusion: peripheral neuropathy is a common complication of liver cirrhosis related mainly to the duration and severity of liver cirrhosis, but not affected by the causes of liver cirrhosis.