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  Citation statistics : Table of Contents
   2015| January-June  | Volume 2 | Issue 1  
    Online since June 15, 2015

 
 
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ORIGINAL ARTICLES
A comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in prolonged dysphagic stroke patients
Gamal Y Selim Youssef, Adeeba Alnajjar, Mona Elsherbiny
January-June 2015, 2(1):14-18
DOI:10.4103/2314-8667.158727  
Objective To evaluate the effectiveness and the safety of percutaneous endoscopic gastrostomy (PEG) as compared with a nasogastric (NG) tube for adults with prolonged neurological dysphagia after stroke. Design A prospective case-controlled study. Patients and methods This study included 90 patients with severe neurogenic dysphagia categorized into two groups: those on PEG feeding and those on NG feeding because they refused PEG. A comparison of both groups was assessed by several methods. The primary outcome measures were death and aspiration pneumonia during 3 months' observation and the 2ry outcome measures were changes in the nutritional state during this period and patient and family satisfaction. Results Weight gain was significantly higher among patients in the NG group. The incidence of aspiration pneumonia was significantly higher among patients in the NG group (14) compared with seven patients in PEG. There were four (8.3%) deaths in the PEG group compared with eight (18.2%) in the NG group. Conclusion This study has demonstrated that PEG feeding in long-term dysphagic patients with stroke is associated with a significant reduction in the incidence of aspiration pneumonia with reduced mortality at 3 months. PEG is more acceptable and less irritating to patients and is superior in the delivery of feed and maintaining the nutritional status and improves the long-term quality of life.
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The effects of the Lee Silverman Voice Treatment program and traditional dysarthria therapy in flaccid dysarthria
Gamal Y Selim Youssef, Amr Anter, Hatem E Hassen
January-June 2015, 2(1):5-13
DOI:10.4103/2314-8667.158726  
Objective The aim of this study was to investigate the short-term and long-term speech effects of the Lee Silverman Voice Treatment (LSVT) program in a group of individuals with flaccid dysarthria and compare its effectiveness with traditional dysarthria therapy (TDT) methods. Design This study was designed as a randomized controlled trial. Patients and methods The study included 22 patients with flaccid dysarthria who were randomized into two groups and received either the LSVT or the TDT. Both interventions were administered at the same frequency, for 1 h a day, 4 days a week, for 4 weeks. Participants underwent a three-phase assessment: (a) before treatment, (b) immediately after treatment, and (c) 6 months after treatment or follow-up. Outcome measures included auditory perceptual analysis, acoustic and spectral analysis, aerodynamic analysis, nasometry, and Communication Partner questionnaire. Results There was significant improvement in most auditory perceptual analysis and instrumental variables in both treatment groups but most of these improvements were not maintained during follow-up in either group. Comparative statistical analysis revealed no significant differences between the two groups in the three assessment phases in most studied variables. Conclusion The apparent equity between LSVT and TDT in flaccid dysarthria highlights the clinical value of teaching the LSVT method and the potential for this treatment to yield improvements comparable to traditional articulation therapy methods through a technique that is cognitively less demanding. Thus the advantage of LSVT is not the amount of improvement but the less-demanding nature, cognitive-wise, of the technique.
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High-resolution computerized tomography and Magnetic Resonance Imaging (MRI) in preoperative evaluation of cochlear implant patients
Vyas D Pooja, Garge S Shaileshkumar, Vyas D Deepak, Rasool B Bushra, Thakker R Nirav, Jaggi T Sunila, Talwar A Inder
January-June 2015, 2(1):1-4
DOI:10.4103/2314-8667.158148  
Context Preoperative cross-sectional imaging evaluation of cochlear implant patients is critically important in deciding whether the patient is suitable for implantation and in choosing the side of implantation. Aims The aim of this prospective study was to determine the incidence of structural cochlear anomalies in patients with congenital profound bilateral sensorineural hearing loss, who were being evaluated for the feasibility of cochlear implantation. Settings and design This was a prospective observational nonrandomized study. Patients and methods A total of 26 patients with congenital profound bilateral sensorineural hearing loss, who were being evaluated for feasibility of cochlear implantation were included in this study. These patients were evaluated with high-resolution computerized tomography of the temporal bone and MRI for incidence of structural cochlear anomalies. Results The incidence of structural cochlear anomalies, excluding cochlear nerve aplasia, in patients with congenital profound bilateral sensorineural hearing loss, who were being evaluated for the feasibility of cochlear implantation was 50%. Conclusion This study highlights the importance of preoperative radiological scanning in the assessment of patients undergoing cochlear implantation. It provides vital information on cochlear status and in ruling out noncochlear causes where cochlear implantation is not feasible or contraindicated.
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Ocular motor tests in relapsing remitting multiple sclerosis
Hesham Mohamed Negm, Mohamed Ibrahim Shabana, Hatem Samir Mohamed Shehata
January-June 2015, 2(1):19-27
DOI:10.4103/2314-8667.158728  
Background Multiple sclerosis (MS) is the quintessential neurologic disorder from which one can gain insights into the principles of afferent and efferent neuro-ophthalmology. The popularity of eye movements as an experimental tool can be partly attributed to the fact that they can be conveniently and accurately measured and analyzed, and also because much is known about their neural substrate. It is therefore no surprise that eye movements have been commonly applied to better understand the visual and motor disorders in patients with MS. Objectives The aim of this study was to demonstrate the vast ocular motor abnormalities that occur in this disease using videonystagmography as our tool of description and determine the relationship with Expanded Disability Status Scale (EDSS) and MRI findings. Materials and methods The current study included 76 patients who were divided into two groups. Group I comprised 54 patients with relapsing-remitting multiple sclerosis who fulfilled the Revised Mcdonald's criteria for diagnosis of MS. The age of the patients in group I ranged from 20 to 68 years, with a mean of 35.13 ± 9.42 SD (23 men and 31 women). Group II comprised 22 healthy age-matched and sex-matched individuals who were recruited from the general population and were not relatives of the patients. Their ages ranged from 19 to 54 years, with a mean of 33.81 years ± 10.07 SD (11 men and 11 women). Video-nystagmography, saccadic tracking, random horizontal saccades, optokinetic tracking (at 20, 40, and 60΀/s), smooth pursuit (0.2, 0.3, 0.4, 0.5, 0.6, and 0.7 Hz), and gaze-evoked nystagmus were examined in both groups. Group I, in addition, was subjected to a thorough neurological history and neurological examination, EDSS assessment, ophthalmologic examination (visual acuity and ocular motility), and radiological assessment by MRI with and without contrast. Results The eye movement disorders most commonly noted are saccadic dysmetria, followed by gaze-evoked nystagmus and pendular nystagmus. They are caused by disease affecting the brain stem and cerebellar circuits. Reduced pursuit gain and saccadic pursuit were also noted. A strong correlation between brainstem and cerebellar MRI lesions and the affection of the ocular motor system was well noted. A high EDSS score was well correlated with abnormal ocular motor test findings. Conclusion Ocular motor system tests are more sensitive than conventional clinical examinations in identifying abnormalities in MS.
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Evaluation of dizzy adult patients using the Arabic dizziness questionnaire and its correlation with different vestibular test results
Mohamed T Ghannoum, Mona H Selim, Mohamed S Elminawi, Mariam M Medhat
January-June 2015, 2(1):28-38
DOI:10.4103/2314-8667.158730  
Objectives The aim of this study was to develop an Arabic dizziness questionnaire for adults and compare the questionnaire conclusion with the results of vestibular evaluation. Participants and methods Twenty dizzy adults, age 21-60 years, were subjected to an interview with patients using the Arabic dizziness questionnaire, otological examination, bedside examination for dizzy patients, basic audiological evaluation, and vestibular assessment, which included the following: videonystagmography, cervical vestibular-evoked myogenic potentials, and sensory organization testing through dynamic posturography. Parameters under study were questionnaire scores and conclusion, videonystagmography results including canal paresis, and cervical vestibular-evoked myogenic potentials latency, amplitude, and threshold. Sensory organization testing result analysis in the form of equilibrium scores and sensory analysis. Results Comparisons and correlations between the vestibular score of the questionnaire and results of the vestibular assessment were nonstatistically significant. The most common diagnoses for dizziness in the adult group were vestibular neuritis (four cases), Mιniθre's disease (four cases), benign paroxysmal positional vertigo (three cases), and migraine-associated dizziness (three cases). Conclusion Adult patients sharing the same diagnosis consistently answered certain questions positively in the questionnaire. We recommend the use of the dizziness questionnaire as a first step of the test battery for the evaluation of dizzy patients.
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