Hepatitis C virus (HCV) infection can affect the neurological system, and neuropathy is one of these manifestations. Hepatitis C virus infection is associated with diabetes mellitus (DM) type II, and diabetic patients are at higher risk of acquiring HCV infection. Sweat function has been proposed to assess early autonomic neuropathy. This study aimed to evaluate small fiber neuropathy in asymptomatic HCV-related cirrhotic patients with or without DM through sweat function assessment by Sudoscan test. Three groups were involved: 47 healthy controls, 48 HCV-related cirrhotic patients without DM (group 1), and 49 HCV-related cirrhotic patients with DM type II (group 2). All participants were subjected to liver panel tests, renal function tests, cell blood counts, HbA1c, and abdominal ultrasound. Sweat function was assessed in all patients and controls by measuring hand and feet electrochemical skin conductance (ESC, microSiemens [µS]) using Sudoscan. Peripheral neuropathy was detected in none of the controls, 39% of group 1 patients, and 62% of group 2 patients (P < 0.0001). The mean feet ESC (FESC) was 88.3 ± 6.8 µS in controls, 67.2 ± 19.2 µS in group 1, and 57.9 ± 19.4 µS in group 2 (P < 0.0001). A significant correlation was observed between FESC and bilirubin, albumin, creatinine, international normalized ratio, transaminases, and splenic size. Electrochemical skin conductance measurement is a valuable, noninvasive method for early detection of small fiber neuropathy in asymptomatic HCV-related cirrhosis, with or without DM.

An increased rate of seizures due to tramadol poisoning has been observed. However, the actual incidence and related factors are not well-studied. The purpose of this work was to investigate the relationship between the incidence of seizures and plasma tramadol level in patients with tramadol-inducing seizures. In addition, we reported the pattern of tramadol overdoses in selected patients. The study was conducted from 1 st January 2017 to 28 th February 2018. It involved 102 cases who recruited from toxicological units of Al-Azhar University Hospital (New Damietta). After free informed consent to contribute in this study and within one hour after arrival to a toxicological unit, 10 mL of blood were separated and the serum was used for extraction of tramadol residues by using a highperformance liquid chromatography (HPLC) and other blood samples were stored at _ 8 o C for the following assays to all patients; fasting blood sugar, hemoglobin levels, serum urea, serum creatinine and liver enzymes. Then clinical examination to all patients included vital signs with a special attention to central nervous system (CNS) manifestations, gastrointestinal (GIT) manifestation. The frequency of seizures (27.4%) with acute tramadol poisoning in humans is not dose dependent and seizures occurred with therapeutic doses and there were no relation between blood tramadol level and seizures. We concluded that risk of seizures increase in cases took other drugs with tramadol as alcohol and heroin. The frequency of seizures is not dose dependent; seizures occurred with therapeutic doses.

No abstract

Background: Epilepsy is a common pediatric health problem that urges the parents to seek medical advice. However, it could be associated with prodromal manifestation [e.g., headache] that usually pass unnoticed by the parents. Previous literature is defective regarding prevalence of headache among children with epilepsy. Aim of the work: Estimation of the prevalence and characteristics of headache associated with epilepsy in pediatric populations. Patients and methods: We included 130 children with epilepsy [study group], and 130 healthy children as a control group. All were selected from Al-Azhar University Hospitals [new Damietta] An inquiry about headache and its characteristics especially in relation to seizures attacks had been performed. Results: Children with epilepsy had a higher rate of headache when compared to healthy children [48.5% versus 22.3%]; migraine is the commonest type in epileptic group and tension type headache in the control group. In children with epilepsy, headache was associated with higher rate of generalized epileptiform activity, increased frequency of seizures and use of monotherapy. Conclusion: Headache is highly prevalent among children with epilepsy and necessitates proper screening, further investigations and proper treatment. Future studies to investigate the problem on a wide scale are warranted.