Fuzzy Approach for Determination the Optimum Therapeutic Parameters in Neuromuscular Stimulation Systems

This paper presents a fuzzy system for determination the optimum therapeutic parameters (frequency, amplitude and session duration) in neuromuscular stimulation systems. The developed approach has many clinical benefits and features. These include: capability to determine and adjust the therapeutic parameters online during any treatment session, reduction of time and number of sessions needed to overcome the neuromuscular disorders, preventing patient from fatigue or pain that may occur during or after treatment, considering differences between various patients and improving the efficiency of the available neuromuscular stimulation systems.     

Pomegranate protective effect on experimental ischemia/reperfusion retinal injury in rats (histological and biochemical study)

Oxidative stress is one mechanism involved in the pathogenesis of ischemia/reperfusion (/R) retinal injury. The histological, biochemical, and functional changes associated with pomegranate (PMG) treatment prior to retinal I/R were analyzed using 40 adult male albino rats. Rats were divided into four groups: Groups I and II (sham operated and received saline or PMG, respectively); Groups III and IV (I/R rat models with prior administration of saline or 250 mg/kg/day PMG, respectively). Electroretinogram (ERG) results were recorded and eye specimens were taken and processed for light and electron microscopic examinations and for assessment of oxidative status in retinal homogenate. I/R lead to degenerative changes in retinal layers with a significant reduction in nuclear factor erythroid 2-related factor 2 (Nrf2) immunoreactivity in concomitant with significant oxidant–antioxidant disturbance and decreased a- and b-wave amplitude in the ERG. These alterations were ameliorated with prior PMG treatment. In conclusion, PMG treatment, as an antioxidant, attenuated retinal structural and functional I/R injury through activation of Nrf2 which could be a base for future therapy designs.     

Affectively Salient Meaning in Random Noise: A Task Sensitive to Psychosis Liability

Stable differences in the tendency to attribute meaning and emotional value to experience may represent an indicator of liability to psychosis. A brief task was developed assessing variation in detecting affectively meaningful speech (speech illusion) in neutral random signals (white noise) and the degree to which this was associated with psychometric and familial vulnerability for psychosis. Thirty patients, 28 of their siblings, and 307 controls participated. The rate of speech illusion was compared between cases and controls. In controls, the association between speech illusion and interview-based positive schizotypy was assessed. The hypothesis of a dose-response increase in rate of speech illusion across increasing levels of familial vulnerability for psychosis (controls, siblings of patients, and patients) was examined. Patients were more likely to display speech illusions than controls (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.4–11.7), also after controlling for neurocognitive variables (OR = 3.8, 95% CI = 1.04–14.1). The case-control difference was more accentuated for speech illusion perceived as affectively salient (positively or negatively appraised) than for neutrally appraised speech illusions. Speech illusion in the controls was strongly associated with positive schizotypy but not with negative schizotypy. In addition, the rate of speech illusion increased with increasing level of familial risk for psychotic disorder. The data suggest that the white noise task may be sensitive to psychometric and familial vulnerability for psychosis associated with alterations in top-down processing and/or salience attribution.     

Bilateral macular sub‐retinal fluid and retinal pigment epithelial detachment associated with type 2 membrano‐proliferative glomerulonephritis

Choroidal neovascularisation (CNV) and idiopathic central serous chorioretinopathy (ICSC) are recognised ocular complications related to type 2 membrano‐proliferative glomerulonephritis. We report a 38‐year‐old white male who presented with a 10‐day history of blurring of vision, micropsia and metamorphopsia. He had been diagnosed recently to have type 2 membrano‐proliferative glomerulonephritis. On examination, there was bilateral retinal pigment epithelial (RPE) detachment with overlying sub‐retinal fluid without any drusen. Fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) confirmed the diagnosis of atypical ICSC. Three months later, sub‐retinal fluid and RPE detachment resolved and VA had recovered to 6/6. The case highlights the importance of ophthalmological assessment in these patients to recognise sight‐threatening complications.     

Topical platelet-derived growth factor enhances wound closure in the absence of wound contraction: an experimental and clinical study

The effects of platelet-derived growth factor (PDGF) on wound healing in animal and human models were investigated. Four 1-cm2 wounds were made on the dorsum of 3 rats. A 0.5-cm punch wound was made behind each ear of 4 patients. Half the wounds were treated daily with vehicle, controls, and the rest were treated with PDGF. Treated wounds closed faster than the controls (animals: 16 +/- 3.2 days vs. 17.8 +/- 2.17 days; p < 0.05) and (patients: 16 +/- 0.67 days vs. 19.5 +/- 0.33 days; p < 0.05). Biopsies were taken at day 20 for polarized light-Sirius red histological analysis. The granulation tissue of PDGF-treated wounds showed fine collagen fibers with weak birefringence, characteristic of immature granulation tissue, deposited throughout the healed wound site. Such a pattern indicates wound closure by reepithelialization and filling in with scar. Control wound biopsies showed a small area of immature granulation tissue surrounded by intact dermal thick collagen fibers with strong birefringence. Such a pattern indicates wound closure by wound contraction. This shows that PDGF enhances wound closure by reepithelialization and the prevention of wound contraction.     

Rare variants of Cutaneous Leishmaniasis: whitlow, paronychia, and sporotrichoid

Cutaneous Leishmaniasis is endemic in certain areas of Pakistan, with the wet form of the disease being the most prevalent. It has a number of morphological variants, which are dependent on the immune status of the host, the subspecies of the Leishmania, and also, to some extent, on the site of involvement. We describe here a case of Leishmaniasis showing two very rare variants, whitlow and paronychial lesions, occurring concurrently with sporotrichoid spread. The patient responded to intramuscular sodium stibogluconate with resolution of the skin lesions.     

Spinal accessory neuropathy,droopy shoulder,and thoracic outlet syndrome

Droopy shoulder has been proposed as a cause of thoracic outlet syndrome. Two patients developed manifestations of neurovascular compression upon arm abduction, associated with unilateral droopy shoulder and trapezius muscle weakness caused by iatrogenic spinal accessory neuropathies following cervical lymph node biopsies. The first patient developed a cold, numb hand with complete axillary artery occlusion when his arm was abducted to 90 degrees. The second patient complained of paresthesias in digits 4 and 5 of the right hand, worsened by elevation of the arm, with nerve conduction findings of right lower trunk plexopathy (low ulnar and medial antebrachial cutaneous sensory nerve action potentials). Spinal accessory nerve grafting (in the first patient) coupled with shoulder strengthening physical exercises in both patients resulted in gradual improvement of symptoms in 2 years. These two cases demonstrate that unilateral droopy shoulder secondary to trapezius muscle weakness may cause compression of the thoracic outlet structures.