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Ali A, Almalki D, Kotb MA, Alenazi RS. Outcomes and characteristics of myasthenia gravis: A 10-year retrospective cross-sectional study at King Fahad Medical City. Neurosciences (Riyadh) 2022; 27:237-243. [PMID: 36252965 PMCID: PMC9749576 DOI: 10.17712/nsj.2022.4.20220038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/06/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate the distribution of muscle weakness in Myasthenia gravis (MG) and the therapeutic response in each category. METHODS This is a retrospective cross-sectional study included all MG patients presented to our clinic between 2010 and 2020. The demographic, clinical, serological, electrophysiological, radiological, and histopathological data of the patients were recorded. The details of the treatment administered were also documented. Muscle weakness was divided into: ocular, bulbar, and generalized. RESULTS The mean age of the 147 patients included in this study was 34.2±16.6 years. The most common presentation was ocular MG (57.1%). There was no significant association between the gender of the patients and the MG subgroups. Antibodies against AChR were reported in 95.2%, 75%, and 87% of the patients with ocular, bulbar, and generalized myasthenia, respectively. Anti-MuSK antibodies were detected in 20% of the patients with bulbar weakness. Most of the patients with ocular (91.7%) and bulbar (90%) presentation developed generalized weakness. At the end of the follow-up, 82.6%, 70.2%, and 57.5% of the patients with generalized, ocular, and bulbar presentations, respectively demonstrated well-controlled weakness. CONCLUSION The most common initial presentation was ocular weakness. Most patients with ocular and bulbar presentation developed generalized weakness during the follow up period. The most frequently reported autoantibody was against AChR. Most patients with generalized, ocular, and bulbar presentation demonstrated well-controlled weakness at the end of the follow up period.
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Affiliation(s)
- Abdulrahman Ali
- From the Department of Neurology (Ali, Alenazi), King Fahad Medical City, Riyadh, from the Department of Medicine (Almalki, Kotb), College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, and from the Department of Neurology (Kotb), Faculty of Medicine, Minia University, Minia, Egypt
| | - Daifallah Almalki
- From the Department of Neurology (Ali, Alenazi), King Fahad Medical City, Riyadh, from the Department of Medicine (Almalki, Kotb), College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, and from the Department of Neurology (Kotb), Faculty of Medicine, Minia University, Minia, Egypt,Address correspondence and reprint request to: Dr. Daifallah M. Almalki, Department of Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-9498-6303
| | - Mamdouh A. Kotb
- From the Department of Neurology (Ali, Alenazi), King Fahad Medical City, Riyadh, from the Department of Medicine (Almalki, Kotb), College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, and from the Department of Neurology (Kotb), Faculty of Medicine, Minia University, Minia, Egypt
| | - Reem S. Alenazi
- From the Department of Neurology (Ali, Alenazi), King Fahad Medical City, Riyadh, from the Department of Medicine (Almalki, Kotb), College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, and from the Department of Neurology (Kotb), Faculty of Medicine, Minia University, Minia, Egypt
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Bedewi MA, Alhariqi BA, Aldossary NM, Gaballah AH, Sandougah KJ, Kotb MA. Shear wave elastography of the common fibular nerve at the fibular head. Medicine (Baltimore) 2022; 101:e29052. [PMID: 35356920 PMCID: PMC10684218 DOI: 10.1097/md.0000000000029052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/23/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The aim of this work is to study the sonoelastographic features of the common fibular nerve in healthy adult subjects.This is an observational cross-sectional study. Shear wave elastography was used to evaluate the common fibular nerve. Crosssectional area and stiffness were measured in kilopascal (kPa) and meters/second (m/s).The study included 82 common fibular nerves in 41 healthy adult subjects. The mean cross-sectional area of the common fibular nerve at the fibular head was 8.7 mm2. Positive correlation was noted between stiffness measurements between short and long axes by both methods. The mean stiffness of the common fibular nerve in the short axis was 22.5 kPa, and in the long axis (LA) was 35.4 kPa. Positive correlation was noted between height and stiffness measured by both methods in both axes by kPa. In m/s, the mean stiffness of the common fibular in the short axis was 2.6 m/s, and while in the LA was 3.4 m/s. Height showed positive correlation with both axes for stiff measurements in m\s. Weight showed positive correlation with stiffness measurements by m/s in the LA.The results obtained in our study could be a reference point for evaluating stiffness of the common fibular nerve in research involving different pathologies.
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Affiliation(s)
- Mohamed A. Bedewi
- Correspondence: Mohamed A. Bedewi, College of Medicine, Prince Sattam bin Abdulaziz University, P.O. Box 173, Al-kharj 11942, Kingdom of Saudi Arabia (e-mail: ).
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Bedewi MA, Kotb MA, Aldossary NM, Abodonya AM, Saleh AK, Swify SM. Shear wave elastography of the radial nerve in healthy subjects. J Int Med Res 2021; 49:300060520987938. [PMID: 33459089 PMCID: PMC7816536 DOI: 10.1177/0300060520987938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study was performed to examine the sonoelastographic features of the radial nerve in healthy subjects. Methods In this observational cross-sectional study, shear wave elastography was used to evaluate the radial nerve. The cross-sectional area and stiffness were measured. Results The study included 37 nerves in 20 healthy adult subjects. The mean cross-sectional area of the radial nerve at the arm was 6.1 mm2. The mean stiffness of the radial nerve in the short axis was 30.3 kPa, and that in the long axis was 34.9 kPa. The elasticity measurements were significantly different between the long axis and short axis. Conclusion The elastic modulus of the radial nerve was studied in healthy subjects and can serve as a reference for future assessment of different radial nerve pathologies.
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Affiliation(s)
- Mohamed A Bedewi
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Mamdouh A Kotb
- Neurology Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia.,Neurology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Nasser M Aldossary
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Ahmed M Abodonya
- Anesthesia and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Surgery Department, College of Medicine, Prince Sattam bin Abdulaziz University, Kingdom of Saudi Arabia
| | - Ayman K Saleh
- Surgery Department, College of Medicine, Prince Sattam bin Abdulaziz University, Kingdom of Saudi Arabia.,Orthopedic Department, Faculty of Medicine for Girls, Alazhar University, Cairo
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Bedewi MA, Elsifey AA, Alfaifi T, Kotb MA, Abdelgawad MS, Bediwy AM, Swify SM, Awad EM. Shear wave elastography of the tibial nerve in healthy subjects. Medicine (Baltimore) 2021; 100:e23999. [PMID: 33545992 PMCID: PMC7837829 DOI: 10.1097/md.0000000000023999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study is to investigate sonoelastographic features of the tibial nerve.The study included 72 tibial nerves in 36 healthy subjects. High resolution ultrasound and Shear wave elastography were used to evaluate the tibial nerve. Cross sectional area and stiffness were measured.The mean cross sectional area of the tibial nerve was 13.4 mm2. The mean shear elastic modulus of the tibial nerve in the short axis was 23.3 kPa. The mean shear elastic modulus of the tibial nerve in long axis was 26.1 kPa. The tibial nerve elastic modulus also showed no correlation with cross sectional area neither in the long axis nor short axis. Age, height, weight, and body mass index showed no correlation with tibial nerve elastic modulus in short or long axes.The elastic modulus of the tibial nerve has been determined in healthy subjects and can serve as a reference for future assessment of polyneuropathy.
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Affiliation(s)
| | | | | | - Mamdouh A. Kotb
- Neurology Department, College of Medicine, Prince Sattam Bin Abdulaziz university, Al-Kharj, Kingdom of Saudi Arabia
- Neurology Department, Faculty of Medicine, Minia University, Minia
| | | | | | | | - Ezzat M. Awad
- Department of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Institute for Specific Prophylaxis and Tropical Medicine [ISPTM], Center for Pathophysiology, Infectiology
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Bedewi MA, Kotb MA, Aldossary NM, Abodonya AM, Alhariqi BA, Swify SM. Shear wave elastography of the ulnar nerve at the forearm. Medicine (Baltimore) 2021; 100:e24071. [PMID: 33466166 PMCID: PMC7808468 DOI: 10.1097/md.0000000000024071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
The study included 38 ulnar nerves in 20 healthy subjects. High-resolution ultrasound and Shear wave elastography were used to evaluate the ulnar nerve at the mid forearm. The mean cross-sectional area of the ulnar nerve was 7.1 mm2. The mean shear elastic modulus of the nerve in the short axis was 27.4 kPa. The mean shear elastic modulus of the nerve in long axis was 24.7 kPa. No statistical relation could be noted between elasticity measurements in long and short axes. The ulnar nerve elastic modulus also showed no correlation with CSA neither in the long axis nor short axis. Age, height, weight, and body mass index showed no correlation with the ulnar elastic modulus in short or long axes. The elastic modulus of the ulnar nerve has been determined in healthy subjects and can serve as a reference for future assessment of compressive neuropathies of the ulnar nerve.
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Affiliation(s)
- Mohamed Abdelmohsen Bedewi
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Mamdouh A. Kotb
- Neurology Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
- Neurology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Nasser M. Aldossary
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Ahmed M. Abodonya
- Anesthesia and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Surgery Department, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Bader A. Alhariqi
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
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Abstract
The purpose of this study is to study sonoelastographic features of the saphenous nerve.The study included 72 saphenous nerves in 36 healthy subjects. High resolution ultrasound and Shearwave elastography were used to evaluate the saphenous nerve. Cross sectional area (CSA) and stiffness were measured.The mean CSA of the saphenous nerve was 5.7 mm. The mean shear elastic modulus of the saphenous nerve in the short axis was 29.5 kPa. The mean shear elastic modulus of the saphenous nerve in long axis was 29.9 kPa. The saphenous nerve elastic modulus also showed no correlation with CSA in neither the long axis nor short axis. Positive correlation between elasticity measurements in the long and short axes. Age, height, weight, and BMI showed no correlation with saphenous nerve elastic modulus in short or long axes.The elastic modulus of the saphenous nerve has been determined in healthy subjects and can serve as a reference for future assessment of the saphenous nerve before different procedures.
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Affiliation(s)
| | - Ayman A. Elsifey
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz university, College of Medicine
| | - Mamdouh A. Kotb
- Neurology Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
- Neurology Department, Faculty of Medicine, Minia University, Minia
| | | | | | | | - Ahmed M. Abodonya
- Anesthesia and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Surgery Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
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Kotb MA. Ursodeoxycholic acid in neonatal hepatitis and infantile paucity of intrahepatic bile ducts: review of a historical cohort. Dig Dis Sci 2009; 54:2231-41. [PMID: 19082720 DOI: 10.1007/s10620-008-0600-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Accepted: 10/17/2008] [Indexed: 12/26/2022]
Abstract
We retrospectively reviewed the role of ursodeoxycholic acid in infants having nonsurgical cholestasis attending the Hepatology Clinic, New Children Hospital, Cairo University, Egypt, from 1985 until 2005. Files of 496 infants with neonatal hepatitis and 97 with intrahepatic bile duct paucity were included; of them 241 (48.6%) and 52 (46.4%) received 20-40 mg/kg/day ursodeoxycholic acid for 319.2 +/- 506.9 days and 480.3 +/- 583.3 days, respectively. The outcome of infants with neonatal hepatitis with intake of ursodeoxycholic acid and those without was: 108 (44.8%) and 179 (70.2%) successful (P = 0.000), 11 (4.6%) and 13 (5.1%) improved (P = 0. 474), 112 (46.5%) and 61 (23.9%) suffered failed outcome (P = 0.000), and 10 (4.1%) and 2 (0.78%) died (P = 0.014), respectively. Likelihood of successful outcome with ursodeoxycholic acid intake was 0.345 (P = 0.000), and that of deterioration was 2.76 (P = 0.000). For those having intrahepatic bile duct paucity likelihood of successful outcome with ursodeoxycholic acid intake was 0.418 (P = 0.040) and that of deterioration was 2.64 (P = 0.028). Ursodeoxycholic acid failed in management of this cohort of infants with nonsurgical cholestasis.
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Affiliation(s)
- M A Kotb
- Department of Pediatrics, Cairo University, El Mokatam, 11571 Cairo, Egypt.
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Kotb MA, Sheba M, El Koofy N, Mansour S, El Karaksy HM, Dessouki NM, Mostafa W, El Barbary M, El-Tantawy HE, Kaddah S. Post-portoenterostomy triangular cord sign prognostic value in biliary atresia: a prospective study. Br J Radiol 2005; 78:884-7. [PMID: 16177009 DOI: 10.1259/bjr/34728497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The triangular cord sign (TC sign) is a sensitive and specific tool in prompt diagnosis of extrahepatic biliary atresia. The objective of this study is to evaluate post-operative TC sign presence in outcome prediction of infants with biliary atresia after Kasai hepato-portoenterostomy 27 infants and children with biliary atresia underwent 122 ultrasound examinations using both 5 MHz and 7 MHz convex linear transducers in 33 months follow up. For all infants TC sign identification was included pre-operatively, ultrasound was done 2 weeks post-operatively then bimonthly for 3 months, monthly for 2 months and every 3 months thereafter. 14 (53.8%) had post-operative TC sign. Once post-operatively positive, it remained positive throughout the study. It did not reappear in an initially post-operatively TC sign negative infant. Those having post-operative TC sign had statistically worse outcomes (0 became anicteric, 2 improved, 7 had progressive disease and 6 died) than those with a negative TC sign (p = 0.04) (3 became anicteric, 5 improved, 2 progressed and 1 died). Presence of TC sign post-operatively correlated with measure of removal of all fibrous cone at porta-hepatis during portoenterostomy (p = 0.026). Post-portoenterostomy TC sign is associated with more morbidity and mortality; and reflects inadequate surgical technique.
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Affiliation(s)
- M A Kotb
- Department of Paediatrics, Cairo University, Egypt
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Hafez AF, Bishara AA, Kotb MA, Hussein AS. Regular radon activity concentration and effective dose measurements inside the great pyramid with passive nuclear track detectors. Health Phys 2003; 85:210-215. [PMID: 12938968 DOI: 10.1097/00004032-200308000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Radon activity concentrations and equilibrium factors inside the great pyramid of "Cheops" were measured with passive nuclear track detectors. The variation of these concentrations in location was investigated. Seasonal variation of radon activity concentrations with winter maximum and summer minimum were observed inside the pyramid. The 1-y average radon activity concentration ranged from a minimum of 20 to a maximum of 170 Bq m(-3). Results show that the yearly average equilibrium factor between radon and its progeny was assessed as 0.16 and 0.36 inside the pyramid and near entrance, respectively. Moreover, the estimated annual effective dose was 0.05 mSv to tour guides and varied from 0.19 to 0.36 mSv for the pyramid guards; for visitors the average effective dose was 0.15 microSv per visit. These are lower than the 3-10 mSv y(-1) dose limit recommend by ICRP 65.
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Affiliation(s)
- A F Hafez
- Faculty of Science, Department of Physics, University of Alexandria, 21511, Alexandria, Egypt
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Kotb MA, Kotb A, Sheba MF, El Koofy NM, El-Karaksy HM, Abdel-Kahlik MK, Abdalla A, El-Regal ME, Warda R, Mostafa H, Karjoo M, A-Kader HH. Evaluation of the triangular cord sign in the diagnosis of biliary atresia. Pediatrics 2001; 108:416-20. [PMID: 11483808 DOI: 10.1542/peds.108.2.416] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Infantile cholestasis continues to represent a diagnostic challenge. It is very important to diagnose surgically correctable disorders, such as biliary atresia, in a timely manner to prevent progressive damage to the liver. It has been recently suggested that the triangular cord (TC) sign is a simple and useful tool in the diagnosis of biliary atresia. METHODS We prospectively studied 65 infants presenting with conjugated hyperbilirubinemia (age range: 32-161 days). All patients underwent ultrasonographic examination with a 7.0-MHz transducer (Acuson, Mountain View, CA). The TC was defined as a triangular, or tubular, echogenic density seen immediately cranial to the portal vein bifurcation. RESULTS The TC sign was identified in 25 infants, and all of them had histologic features suggestive of biliary atresia; the diagnosis was confirmed at surgery by gross morphology of hepatobiliary system, and liver biopsy, with or without intraoperative cholangiogram. Among the 40 patients who did not have the TC sign, 6 had paucity of the intrahepatic bile ducts. Three had alph-1-antitrypsin deficiency, and 31 had neonatal hepatitis. None of the 40 patients who did not have the TC sign developed acholic stools. Seven patients with biliary atresia were followed by ultrasonographic examination for 6 months after the Kasai procedure. The TC sign disappeared in all patients after the surgery; however, the TC sign reappeared in 3 patients who developed progressive cholestasis after the procedure. CONCLUSION The TC sign is a simple, timesaving, and reliable diagnostic tool in the evaluation of infants with infantile cholestasis. The TC sign may also prove to be helpful in following patients after hepatoportoenterostomy. We suggest a new diagnostic strategy for patients suspected to have biliary atresia. When the TC sign is visualized, the patient should undergo intraoperative cholangiogram to confirm the diagnosis of biliary atresia, reserving percutaneous liver biopsy for those patients in whom the TC sign could not be detected.
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Affiliation(s)
- M A Kotb
- Departments of Pediatrics and Radiology, Cairo University Children's Hospital, Cairo, Egypt
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