حسنين عباس فرهود الخالدي

Vitamin D deficiency is defined when serum 25(OH)D concentration is less than 25 ng/ml; it is associated with many painful syndromes, such as carpal tunnel syndrome (CTS). CTS is a common entrapment neuropathy that is caused by compression of the median nerve at the wrist joint. We sought to describe the relationship between CTS and vitamin D deficiency, as well as the effect of vitamin D therapy on decreasing the severity of CTS-associated pain. We selected 32 out of 44 patients who presented with CTS at our hospital in Najaf province, Iraq. We then clinically assessed the severity of pain using the visual analog score (VAS) and an electromyography/nerve conduction study (EMG/NCS). We tested all patients for serum vitamin D levels before and after 3 months of vitamin D therapy. CTS was most common in females aged 40 to 49 years who were right-hand dominant. There was a significant relationship between vitamin D deficiency and pain score before and after treatment with vitamin D. The increased level of vitamin D, the lower the pain score. Thus, there is a clear link between vitamin D therapy and improvement of clinical symptoms in patients with CTS.

Background: As idiopathic facial nerve paralysis (Bell’s palsy) is thought to be related to cold weather. This is a prospective study done in Al-Najaf city, Iraq to evaluate the relationship between the season’s changes and Bell’s palsy. Methods: A total of 101 patients who presented with facial paralysis at the outpatients clinic of the Middle Euphrates Neurosciences Center between January 2019 and December 2019. The age, gender, side of palsy, month and season in which the facial paralysis was seen were evaluated. Results: The patients with Bell’s palsy comprised 51(50.5%) females and 50(49.5%) males with a mean age of 35.6±20.1 years. Right side palsy seen in 56(55.4%) of patients. There was an increase in cases during winter but the probability of occurrence was equal for four seasons. Conclusion: Based on this study in Najaf, Iraq, the relationship of Bell’s palsy with season remains uncertain.

COVID-19 infection is a major cause for acute respiratory distress syndrome, multi-organ dysfunction, coagulopathy, and intravascular thrombosis; therefore, it is the main causative factor for acute limb ischemia. Aim. To compare the treatment outcome of two limb ischemic groups post COVID-19 infection in a single center and detect at least which is better for the patients in the period of COVID-19 pandemic. Material and methods. Here, in this study, we collect 26 patients and divided them into two groups, G1 (14) patients treated conservatively and G2 (12) patients treated with surgical thrombectomy. Data were analyzed to look for the outcome of groups after 24 hours and 30 days. Results. The successful rate of conservative treatment was 85,72% in G1, while it was 75% in G2. There were two amputations below the knee joint in each group. Three patients died in both groups. Conclusion. In conclusion, both conservative treatment and surgical thrombectomy have a comparable successful rate in the selected group of COVID-19 patients.

Carpal tunnel syndrome (CTS) is regarded as most frequent entrapment neuropathy in upper extremities with high prevalence in females. It is a multi-factorial disease that had signs and symptoms due to compression of median nerve at the carpal tunnel in wrist, although may be asymptomatic. Immune system has been recognized as the main factor of neuropathic pain. Regulated on Activation, Normal T cell Expressed and Secreted (RANTES) is among the cytokines that revealed a dysregulated pattern of neuropathy specific cytokine profile in CTS and, in human, it is encoded by CCL5 gene. Sixty-four patients suffering from CTS were enrolled in this controlled cross sectional study. For all, nerve conduction study was performed to prove the diagnosis of CTS and to classify its severity. The mean age of all patients was 44.9±7.8 years, 89.1 % were female, 40.7% had mild type CTS and 40.7 % had right side CTS. 5 ml blood was obtained from each participant to measure the level of serum RANTES using specific ELISA kit. There was significant high RANTES levels in CTS patients when compared with its reference value. We conclude that RANTES level increases in patients with carpal tunnel syndrome and can be used as a predictor for its diagnosis despite its proposed neuroprotective role.

Venous thromboembolism (VTE) it refer to all forms of pathologic thrombosis , occurring on the venous side of the circulation and when it effect the deep veins it is referred to as deep venous thrombosis (DVT).Many of acute stroke patient develop pulmonary embolism in the absence of symptomatic DVT (silent DVT), the clinical significance of silent DVT in relation to acute stroke is unclear at present. It remains to be seen whether silent DVT is a common complication among patient with acute stroke. Objective: The aim of this study was to help clarify occurrence of DVT based on a screening DUS in patient with acute stroke (ischemic & hemorrhagic) and risk factors for its development. Methods: This cross-sectional study carried out in the period between January and September 2015 in Middle Euphrates neuroscience center at Annajaf city. Ninety tow patients with acute stroke show no clinical evidence of DVT enrolled in the study .36 were female and 56 were male, their ages ranged from 42 to 70 years old. We classified study group into subgroups for purposes of statistical analysis. Results: silent DVT was found in six patients with acute stroke (6.52%, n=92). Patients with silent DVT tended to be older as they had mean age of 66.33.While patients without silent DVT had mean age of 58 (P value =0.002),Silent DVT effect age group older than 70 years(p value (0.002).Patient with silent DVT tended to have higher NIHSS score than those without silent DVT (mean 14 vs 7.39, p value=0.003).Silent DVT significantly affect Patients with severe stroke (P value=0.002) and those with sever lower limbs disability (P value =0.006). Conclusion: Our study shows significant presence of silent DVT in patient with acute stroke; hemorrhagic stroke subtype, old age, sever stroke, and sever lower limbs disability were the independent risk factors of its development.

Coronavirus disease is a global infection presenting with a variety of clinical features, both pulmonary and extrapulmonary symptoms. Its diagnosis depend on clinical symptoms, laboratory tests, and the typical CT chest scan findings. In this report, a 72-year-old patient (known to have lung cancer) present with pleural effusion as possible sequel of COVID-19 pneumonia. Pleural effusion may present as a complication in a patient with coronavirus disease, but there is poor evidence to this claim in the medical literature.