Background: Parkinson's disease (PD) is one of the most common degenerative diseases of the central nervous system (CNS). Alpha-synuclein (A-syn) plays a critical role in the pathogenesis of PD. The close relation between the salivary glands and the CNS could render the A-syn secretions in the saliva useful biomarkers for PD. Aim of the work: To study the salivary A-syn levels in a cohort of PD Egyptian patients and to correlate these Asyn levels with the patients' clinical data and disease severity. Patients and methods: Twenty-five PD patients and 15 age-and sex-matched healthy subjects, as a control group, were enrolled. Evaluation of PD patients was performed using the Unified Parkinson's Disease Rating Scale (UPDRS) and modified Hoehn and Yahr scale (HYS). Samples of the saliva were analyzed using the enzyme-linked immunosorbent assay (ELISA) technique for the specific anti A-syn total and anti A-syn oligomer (A-synolig). Results: There was a statistically significant increase in A-synolig level and A-synolig/A-syn total ratio and a decrease in A-syn total level among PD patients. A statistically significant increase in A-synolig level was detected among patients having bradykinesia and rigidity as predominant symptoms. Also, there was a statistically significant positive correlation between A-synolig level and the disease duration. No statistically significant correlation was found between A-syn concentrations and disease severity. Conclusion: Salivary A-syn total and A-synolig can be used as potential biomarkers for PD diagnosis.

BackgroundCerebrovascular ischemic stroke is highly prevalent in the general population and is considered one of the frequent causes of mortality and disability. Insulin-like growth factor-1 (IGF-1) is recognized as an important neuro-protective factor against cerebral vascular ischemic insult.Aim of the workTo study the relationship between serum IGF-1 levels and acute ischemic stroke (AIS) in the Egyptian population.Patients and methodsTwo hundred patients with AIS (within the first 24 h) were subjected to full neurological examination, assessment of stroke severity using National Institute of Health Stroke Scale (NIHSS) and measurement of serum IGF-1 levels. The control group included 100 subjects matched for age, gender, and conventional vascular risk factors.ResultsSerum IGF-1 levels were significantly reduced in cases of first AIS compared to control group. A reduced serum IGF-1 level was an independent risk factor for ischemic stroke with cut off value less than 148.3 ng/ml associated with increased AIS risk.ConclusionLower IGF-1 levels are significantly related to risk of ischemic stroke occurrence, independent from other conventional risk factors in the Egyptian population.

BackgroundCarnitine deficiency is relatively common in epileptic patients. The risk factors reported include the combination of valproic acid with other antiepileptic drugs (AEDs), young age, multiple neurologic disabilities, non-ambulatory status, and being underweight.ObjectivesTo study the level of carnitine deficiency and its associated risk factors among a group of children with idiopathic epilepsy treated with different AEDs.Patients and methodsFifty children with idiopathic epilepsy and 40 age-matched controls were enrolled. For all, serum carnitine level was measured by enzyme-linked immune sorbent assay (ELISA).ResultsThe mean carnitine level was lower in cases compared to controls (p = 0.04). Patients receiving monotherapy treatment had a high percentage of carnitine deficiency compared to controls (p = 0.04). Patients receiving valproate with other AEDs had a lower level of carnitine compared to controls (p = 0.03). The age of the patients, the duration of treatment, and the doses of different AEDs were not risk factors for carnitine deficiency.ConclusionsCarnitine deficiency is common in our population, and the use of valproate with other AEDs is considered the most important risk factor for it in epileptic children.

Background: Approximately half of stroke patients show impaired upper limb and hand function. Task-oriented training focuses on functional tasks, while joint mobilization technique aims to restore the accessory movements of the joints. Objective: To investigate the effect of adding joint mobilization to task-oriented training to help the patients in reaching a satisfactory level of recovery for their hand function. Patients and methods: Thirty chronic stroke patients with paretic hand participated in the study; they were divided equally into study and control groups. The study group received joint mobilization followed by taskoriented training for the affected hand. Meanwhile, the control group received task-oriented training only. Both groups received their treatment in the form of 3 sessions per week for 6 successive weeks. The primary outcome measures were hand function that was assessed by Jebsen-Taylor hand function test (JTT) and active and passive wrist extension range of motion (ROM) that was measured by a standard goniometer. The secondary outcome measure was the grip strength of the hand that was assessed by a JAMAR adjustable hand dynamometer. Results: There was a significant improvement in all the outcome measurements in both groups that were more evident in the study group. Conclusion: Combining joint mobilization with task-oriented training had a highly significant effect in improving the hand function in chronic stroke patients compared to task-oriented training alone.

Background The administration of recombinant tissue plasminogen activator (rt-PA) has increased the focus on acute ischemic stroke (AIS) as an emergency condition. The emergency physicians have to rapidly recognize the patients who are candidates for rt-PA and refer them to the specialized stroke team within the proper time window. The knowledge of the emergency physicians about the benefit and the drawbacks of this therapy is crucial and it affects their attitudes towards its use. Objective To apply a survey on the Egyptian emergency physicians aiming to investigate their knowledge about the use rt-PA therapy in AIS. Methodology A self-administered questionnaire was sent to the emergency physicians who are working in three Egyptian governorates. Results Out of 120 emergency physicians, the total knowledge of the study group was good with a score of 7 ± 1.8/11. Most of the participants mentioned the correct answers (over 50%) for all items except for one question regarding the blood glucose control before the use of rt-PA. Significant positive correlation was noted between the knowledge score and the age. Conclusions The surveyed emergency physicians had a good knowledge about the use of rt-PA in AIS, yet, this knowledge is mainly theoretical. Therefore, tutorials, clinical training, and active engagement in the stroke care team are warranted to improve their clinical practice.