This document summarizes a study of 8 cases of Subacute sclerosing panencephalitis (SSPE) in Iraq. The patients ranged from 7-10 years old. Diagnosis was based on clinical features and detection of measles virus antibodies in cerebrospinal fluid and serum using ELISA and PCR techniques. ELISA showed all 8 patients were positive for measles virus IgG in serum and CSF. PCR also confirmed presence of measles virus genomic DNA in all patients. 5 patients showed evidence of oligoclonal bands in CSF. The study highlights the importance of childhood measles immunization programs in preventing SSPE.
AUTOIMMUNE DISORDERS OF NERVOUS SYSTEMANILKUMAR BR
Autoimmune disorders of the nervous system can attack the central nervous system (CNS), Autoimmune disorders affecting both the central and peripheral nervous system.) which includes the brain and spinal cord, or the peripheral nervous system, consisting of nerves that connect the CNS with the limbs and organs.
The most common disorders are multiple sclerosis and myasthenia gravis.
Autoimmune nervous system disorders include:
Multiple sclerosis
Myasthenia gravis
Guillain-Barré syndrome. (GB Syndrome)
Guillain barre syndrome - its clinical picture, presentation, investigations and treatment - management. Also images to further improve your understanding
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
AUTOIMMUNE DISORDERS OF NERVOUS SYSTEMANILKUMAR BR
Autoimmune disorders of the nervous system can attack the central nervous system (CNS), Autoimmune disorders affecting both the central and peripheral nervous system.) which includes the brain and spinal cord, or the peripheral nervous system, consisting of nerves that connect the CNS with the limbs and organs.
The most common disorders are multiple sclerosis and myasthenia gravis.
Autoimmune nervous system disorders include:
Multiple sclerosis
Myasthenia gravis
Guillain-Barré syndrome. (GB Syndrome)
Guillain barre syndrome - its clinical picture, presentation, investigations and treatment - management. Also images to further improve your understanding
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
Intraepithelial lymphocyte distribution differs between the bulb and the seco...Enrique Moreno Gonzalez
Evaluation of intraepithelial duodenal lymphocytosis (IDL) is important in celiac disease (CD). There is no established cut-off value for increased number of IELs in the bulb. We therefore investigated the relation between IEL counts in the bulb and duodenal specimens in non-celiac subjects.
The study to measure the level of serum annexin V in patients with renal hype...inventionjournals
ABSTRACT : Renovascular hypertension reflects the causal relation between anatomically evident arterial occlusive disease and elevated blood pressure. The coexistence of renal arterial vascular disease and hypertension roughly defines this type of nonessential hypertension. The aim of this study was to measure the level of serum Anti-Annexin V antibodies in patients with renal hypertension. Methods. This study was conducted on 115 patients, diagnosed with renal hypertension and hypertension. Informed consents were obtained from the patients and the study was approved by the Kharkiv National Medical University ethics committee. Ten healthy age and sex matched volunteers were included as a control group. All patients and controls were subjected to the following full history taking and thorough clinical examination. Routine laboratory testing included a complete blood count, and erythrocyte sedimentation rate (ESR) and kidney function tests (blood urea nitrogen and serum creatinine). Immunological tests for antinuclear antibody (ANA) and anticentromere antibodies (ACA) was performed by the indirect immunofluorescence technique. AntiScl-70 (anti-topoisomerase antibodies) and anticardiolipin antibodies (ACA: IgG and IgM) were tested using the ELISA technique. The anti-annexin V antibodies titre used the ZYMUTEST anti-Annexin IgG ELISA kit. [Hyphen-BioMed, France.]: to measure the IgG isotype of auto-antibodies to annexin V in human serum. Results. Anti-annexin V antibodies were present in 75% of patients (mean 83.46 ± 22.44 AU/mL) vs. 0% in the controls (mean 3.94 ± 4.5 AU/mL). Comparison between patients and controls as regards levels of anti-annexin V showed a highly significant difference (P < 0.001). Furthermore, correlation of anti-annexin V titres with the disease activity score in the patient group showed a statistically significant positive correlation (r = 0.51, P < 0.05).In addition, the anti-annexin V antibody titres in this study showed a highly significant positive correlation with ACL antibodies (r = 0.74, P < 0.001). Patients with antiphospholipid syndrome (APS) have been known to have a higher frequency of anti-annexin V antibodies, and thrombotic events have been reported more frequently in patients with positive anti-annexin V antibodies. Furthermore, inhibition of annexin V binding to negatively charged phospholipids may be an additional pathogenic mechanism of APS.
ABSTRACT- Coronary artery disease (CAD) is suspected as a leading cause of mortality in developed countries. Due
to cholesterol and fat deposit plaque is forming into the inner walls of the arteries of the heart, which leads to narrowing
of blood vessels of heart and reduce the blood flow rate into heart. Proprotein convertase subtilisin-like kexin type 9
(PCSK9) is one of the candidate gene that regulate lipoprotein retention pathway of CAD development. It is a newly
discovered serine protease that plays a key role in LDL-C homeostasis by mediating LDL receptor (LDLR). The LDL
receptor is breakdown through a post transcriptional mechanism and induces the production of very low-density
lipoprotein in the fasting state. The aim of this study was to investigate the frequency of single nucleotide
polymorphism (SNP) of PCSK9 gene of 155 CAD patients and 102 ages matched healthy controls. Serum lipids
including total cholesterol (TC), triglycerides (TG), HDL, LDL, and VLDL were analyzed. PCR-RFLP analysis was
carried out to genotype regions carrying Eam 1104I restriction site in the PCSK9. Gene considering significant
difference in serum TC, TG, HDL-C, LDL-C and VLDL-C levels (P<0.001, <0.0001) of patients and control samples.
In CAD patients, G allele frequency is less than A allele frequency. G allele is responsible for decreasing the
LDL: HDL ratio which shows evidence in having its protecting effect on the occurrence of CAD in West Bengal Population.
Key-words- CAD, PCSK9, SNP, Eam1104I, Polymorphism, West Bengal population
Experimental Analysis of Tear Fluid and their Processing for the Diagnosis of...semualkaira
A pilot analysis of the tear fluid of patients with multiple sclerosis (MS) collected by glass microcapillary was performed using various experimental methods: liquid chromatography-mass spectrometry, Raman spectroscopy, infrared spectroscopy, and atomic force microscopy. Infrared spectroscopy found no significant difference in both MS patients and control spectra of tear fluid; all three significant peaks were located at around the same position
Experimental Analysis of Tear Fluid and their Processing for the Diagnosis of...semualkaira
A pilot analysis of the tear fluid of patients with multiple sclerosis (MS) collected by glass microcapillary was performed using
various experimental methods: liquid chromatography-mass spectrometry, Raman spectroscopy
Experimental Analysis of Tear Fluid and their Processing for the Diagnosis of...semualkaira
A pilot analysis of the tear fluid of patients with multiple sclerosis (MS) collected by glass microcapillary was performed using
various experimental methods: liquid chromatography-mass spectrometry, Raman spectroscopy, infrared spectroscopy, and atomic
force microscopy. Infrared spectroscopy found no significant difference in both MS patients and control spectra of tear fluid; all
three significant peaks were located at around the same position
Experimental Analysis of Tear Fluid and their Processing for the Diagnosis of...semualkaira
A pilot analysis of the tear fluid of patients with multiple sclerosis (MS) collected by glass microcapillary was performed using
various experimental methods: liquid chromatography-mass spectrometry, Raman spectroscopy, infrared spectroscopy, and atomic
force microscopy. Infrared spectroscopy found no significant difference in both MS patients and control spectra of tear fluid; all
three significant peaks were located at around the same position.
Raman analysis showed the differences between the spectrum of
tear fluid of the MS patients and the spectrum of healthy subjects,
which indicate a decrease in tryptophan and phenylalanine content
and changes in the relative contributions of secondary structures
of polypeptide chains of tear proteins
Experimental Analysis of Tear Fluid and their Processing for the Diagnosis of...semualkaira
A pilot analysis of the tear fluid of patients with multiple sclerosis (MS) collected by glass microcapillary was performed using
various experimental methods: liquid chromatography-mass spectrometry, Raman spectroscopy, infrared spectroscopy, and atomic
force microscopy.
Experimental Analysis of Tear Fluid and their Processing for the Diagnosis of...semualkaira
A pilot analysis of the tear fluid of patients with multiple sclerosis (MS) collected by glass microcapillary was performed using
various experimental methods: liquid chromatography-mass spectrometry, Raman spectroscopy, infrared spectroscopy, and atomic
force microscopy. Infrared spectroscopy found no significant difference in both MS patients and control spectra of tear fluid
Experimental Analysis of Tear Fluid and their Processing for the Diagnosis of...semualkaira
A pilot analysis of the tear fluid of patients with multiple sclerosis (MS) collected by glass microcapillary was performed using
various experimental methods: liquid chromatography-mass spectrometry, Raman spectroscopy, infrared spectroscopy, and atomic
force microscopy. Infrared spectroscopy found no significant difference in both MS patients and control spectra of tear fluid
BACKGROUND: Sequential Epstein-Barr virus (EBV)–positive B cell lymphoma to the initial diagnosis of angioimmunoblastic T cell lymphoma (AITL) is very rare, the exact mechanism and standard therapy of which is still being explored. CASE: A 50-year-old man was admitted to our hospital in January 2014 with a three-week history of enlargement of multiple lymph nodes. His initial pathological evaluation indicated AILT. The reactivation of EBV was observed during the immunosuppression therapy for AITL, accompanied by onset of subcutaneous nodules proven to be EBV-positive diffuse large B cell lymphoma (DLBCL) based on the pathological findings of rebiopsy. The patient was successfully treated with chidamide, a histone deacetylase (HDAC) inhibitor, and rituximab.
Conclusion: The sufficient surveillance for serum EBV and repeat biopsy is necessary for patients with AITL, and this treatment modality may become an active option.
Keywords: angioimmunoblastic T cell lymphoma, Epstein-Barr virus, HDAC inhibitor, non-Hodgkin lymphoma, peripheral T cell lymphoma
An Examination of Effectuation Dimension as Financing Practice of Small and M...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Does Goods and Services Tax (GST) Leads to Indian Economic Development?iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Childhood Factors that influence success in later lifeiosrjce
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Customer’s Acceptance of Internet Banking in Dubaiiosrjce
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Student`S Approach towards Social Network Sitesiosrjce
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Broadcast Management in Nigeria: The systems approach as an imperativeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study on Retailer’s Perception on Soya Products with Special Reference to T...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study Factors Influence on Organisation Citizenship Behaviour in Corporate ...iosrjce
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Consumers’ Behaviour on Sony Xperia: A Case Study on Bangladeshiosrjce
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Design of a Balanced Scorecard on Nonprofit Organizations (Study on Yayasan P...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Public Sector Reforms and Outsourcing Services in Nigeria: An Empirical Evalu...iosrjce
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Media Innovations and its Impact on Brand awareness & Considerationiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer experience in supermarkets and hypermarkets – A comparative studyiosrjce
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Social Media and Small Businesses: A Combinational Strategic Approach under t...iosrjce
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Secretarial Performance and the Gender Question (A Study of Selected Tertiary...iosrjce
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Implementation of Quality Management principles at Zimbabwe Open University (...iosrjce
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Organizational Conflicts Management In Selected Organizaions In Lagos State, ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Sachpazis:Terzaghi Bearing Capacity Estimation in simple terms with Calculati...Dr.Costas Sachpazis
Terzaghi's soil bearing capacity theory, developed by Karl Terzaghi, is a fundamental principle in geotechnical engineering used to determine the bearing capacity of shallow foundations. This theory provides a method to calculate the ultimate bearing capacity of soil, which is the maximum load per unit area that the soil can support without undergoing shear failure. The Calculation HTML Code included.
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Water scarcity is the lack of fresh water resources to meet the standard water demand. There are two type of water scarcity. One is physical. The other is economic water scarcity.
Saudi Arabia stands as a titan in the global energy landscape, renowned for its abundant oil and gas resources. It's the largest exporter of petroleum and holds some of the world's most significant reserves. Let's delve into the top 10 oil and gas projects shaping Saudi Arabia's energy future in 2024.
Hybrid optimization of pumped hydro system and solar- Engr. Abdul-Azeez.pdffxintegritypublishin
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Immunizing Image Classifiers Against Localized Adversary Attacksgerogepatton
This paper addresses the vulnerability of deep learning models, particularly convolutional neural networks
(CNN)s, to adversarial attacks and presents a proactive training technique designed to counter them. We
introduce a novel volumization algorithm, which transforms 2D images into 3D volumetric representations.
When combined with 3D convolution and deep curriculum learning optimization (CLO), itsignificantly improves
the immunity of models against localized universal attacks by up to 40%. We evaluate our proposed approach
using contemporary CNN architectures and the modified Canadian Institute for Advanced Research (CIFAR-10
and CIFAR-100) and ImageNet Large Scale Visual Recognition Challenge (ILSVRC12) datasets, showcasing
accuracy improvements over previous techniques. The results indicate that the combination of the volumetric
input and curriculum learning holds significant promise for mitigating adversarial attacks without necessitating
adversary training.
Final project report on grocery store management system..pdfKamal Acharya
In today’s fast-changing business environment, it’s extremely important to be able to respond to client needs in the most effective and timely manner. If your customers wish to see your business online and have instant access to your products or services.
Online Grocery Store is an e-commerce website, which retails various grocery products. This project allows viewing various products available enables registered users to purchase desired products instantly using Paytm, UPI payment processor (Instant Pay) and also can place order by using Cash on Delivery (Pay Later) option. This project provides an easy access to Administrators and Managers to view orders placed using Pay Later and Instant Pay options.
In order to develop an e-commerce website, a number of Technologies must be studied and understood. These include multi-tiered architecture, server and client-side scripting techniques, implementation technologies, programming language (such as PHP, HTML, CSS, JavaScript) and MySQL relational databases. This is a project with the objective to develop a basic website where a consumer is provided with a shopping cart website and also to know about the technologies used to develop such a website.
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Student information management system project report ii.pdfKamal Acharya
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Subacute sclerosing panencephalitis (SSPE) In Iraq
1. IOSR Journal of Computer Engineering (IOSR-JCE)
e-ISSN: 2278-0661,p-ISSN: 2278-8727, Volume 17, Issue 6, Ver. VI (Nov – Dec. 2015), PP 20-24
www.iosrjournals.org
DOI: 10.9790/0661-17662024 www.iosrjournals.org 20 | Page
Subacute sclerosing panencephalitis (SSPE) In Iraq
1
Dr. Akram M. Al-Mahdawi, 2
Dr. Anmar O. Hatem, 3
Dr. Eman Sh. Mahmood
1
CABM*MRCP(London ), FRCP ( london;Edinburgh),FACP . Department of Medicine-Baghdad Teaching
2
FIBMS .Department of Medicine-Baghdad Teaching Hospital / Medical City (Acquisition of data analysis,
critical revision)
3
Hospital / Medical City (study conception, study design) Diploma, M.Sc, Ph.D Immunology. Baghdad
Teaching Hospital / Medical City (Interpretation of data)
Abstract
Objective: Subacute sclerosing panencephalitis (SSPE) is a progressive inflammatory disease of the central
nervous system with poor prognosis and high mortality, caused by the persistent infection with measles virus
(MV). Despite much research into SSPE, its pathology remains obscure. Only 5% of individuals with SSPE
undergo spontaneous remission, with the remaining 95% dying within 5 years of diagnosis. The prevalence of
the disease varies depending on the measles vaccine immunization status. The clinical manifestations occur, on
an average 6 years after measles virus infection and may initially present with a varied clinical picture ranging
from psychiatric to ophthalmological to neurological symptoms and signs. The diagnosis is based upon
characteristic clinical manifestations of myoclonus, the presence of characteristic periodic EEG discharges,
and demonstration of raised antibody titer. We are reporting 8 cases of Iraqi patients with SSPE and we
describe the test methodology used for detection of MV in those patients
Methods: Cerebral spinal fluid (CSF) and 5 ml of blood sample obtained from eight patients from those
attended the neurology unite- Baghdad Teaching Hospital in the Medical City during the period from October
2010 to November 2013, were enrolled in this study, their ages were ranged between 7-10 years, with an
average age of 8.2 years.
Enzyme linked immunosorbent assay (ELISA) were used for the detection of anti-measles virus IgG by the use
of Bio ELISA Kits (Biokit S.A.Spain) , the positive results were confirmed by (RT-PCR) technique((DYNAL
kits,USA) .
Protein electrophoresis were done for all CSF samples and oligoclonal bands (OCB) were detected by
isoelectric focusing (IEF).
Results: ELISA technique showed that, 8(100 %) of SSPE patients were positive for serum and CSF anti- MV
IgG . Those patients were subjected to PCR techniques as a confirmatory test. The results showed that all
patients with positive result for IgG was positive for MV genomic DNA. Five patients (62.5%) showed evidence
of oligoclonal bands (OCB).
Conclusion: This study showed that,The increased risk of developing SSPE after measles virus infection in
young children underscores the importance of childhood immunization programs that decrease measles virus
transmission and, therefore, reduce the risk of exposure to measles among infants. The success of global
programs to eliminate measles will not only prevent the severe complications and death associated with acute
cases of measles but will also prevent the devastating disease SSPE . in addition, the overall relative sensitivity
of PCR for detection SSPE were found to be 100%.
Keywords: Measles virus; Polymerase chain reaction (PCR); Subacute sclerosing panencephalitis ( SSPE),
oligoclonal bands (OCB).
I. Introduction
Subacute sclerosing panencephalitis (SSPE) is a progressive fatal disease of the central nervous system
that is caused by a persistent measles virus infection. Early clinical characteristics of SSPE may be variable, but
they often include behavioral changes, cognitive deterioration, sporadic episodes of falling, and optic
disturbances such as optic atrophy, chorioretinitis (1,2). As the disease advances, neurologic symptoms, such as
myoclonic jerks or spasms, become more pronounced, and the patient develops severe physical and mental
impairment. SSPE has an average period of latency of 7–10 years (range, 1 month to 27 years) after measles
virus infection, and death generally occurs ∼1–3 years after the onset of symptoms. There are known risk
factors for SSPE, such as the development of measles virus infection at an early age (i.e., before 2 years of age),
and most studies have noted that a greater proportion of cases of SSPE occur among males. The reason why
measles virus persists in some individuals and results in deadly consequences is unknown, but it is likely to be
host related (3,4).
2. Subacute sclerosing panencephalitis (SSPE) In Iraq
DOI: 10.9790/0661-17662024 www.iosrjournals.org 21 | Page
MV belongs to the family of single stranded paramyxovi-ruses. It is the causative agent for several
diseases including subacute sclerosing panencephalitis (SSPE) and measles inclusion body encephalitis (5,6).
Measles ranked as one of the leading causes of childhood mortality in the late 20th
century (7). In developing
countries, 1 million deaths each year are related to MV infections.
The diagnosis of SSPE requires the fulfilment of at least three of the five criteria (8), which include i) a
typical clinical picture of progressive subacute mental deterioration with typical signs like myoclonus; ii)
characteristic EEG changes; iii) elevated CSF globulin levels greater than 20% of total CSF protein; iv) raised
titers of measles antibodies in blood and CSF and v) typical histopathological finding in brain biopsy or autopsy
We are reporting eight cases of SSPE in the Iraq and we describe the test methodology used for
detection of MV in those patients
II. Patients, Materials And Methods
This study was conducted at the Teaching Laboratories- Medical City- Baghdad National and involved
eight SSPE patients evaluated during the period from October 2010 to November 2013.
Eight patients aged7-10 years at first symptom onset were considered to have adult onset SSPE and
their data regarding measles vaccination, any history of measles, age at onset of symptoms and diagnosis,
presenting symptoms, initial diagnosis, clinical staging, course of the disease, electroencephalographic changes,
and measles anti- body status were recorded. Ethical approval letter to all patients was done.
Diagnosis was based on the characteristic clinical features of progressive cognitive and/or behavioral
changes, myoclonus, electroencephalographic evidence of periodic complexes, and raised IgG (40-80 Iu/ml)
anti-measles antibody in cerebrospinal fluid (CSF) and (60-160 IU/ml) in serum, detected by ELISA in all
patients.
Classical protein electrophoresis was done as described by Teitez. The formula used was lgG/albumin
index18 given below: IgG (CSF) x Albumin (serum)fLgG (serum) x Albumin (CSF)
The principle of electrophoresis is electrophoretic separation on agrose medium with a subsequent blotting with
nitrocellulose membrane and visualization of separated protein bands with gold stain.
As a routine 5 micro liters unconcentrated CSF was used. Reagents used were Agrose gel (usually serum protein
gel is used), Nitrocellulose membrane, Filter papers, Gold Chloride (Chloro-auie acid), Stannous Chloride, HCI
Tween20 and Anhydrous Citric acid. Instruments in use were Beckman electrophoretic chambers, Electric
shakers and heavy weights to press the gel.
Procedure
One positive and one negative control with each strip containing 8 patient samples were prepared.
Electrophoresis procedure was performed for 30 minutes at constant voltage using the setting of 100mV.
For blotting, nitrocellulose membrane was used. After electrophoresis completion, the gel was removed from the
chamber and placed in a clean dry surface. The gel was over layered by sheet of Nitrocellulose membrane and
then pressed with few absorbent papers by keeping heavy weights on them for 30 minutes.
Incubation Gold Stain was prepared by adding to 75ml of deionized water the following reagents drop wise with
vigorous mixing: 1 ml of 1% aqueous gold chloride, 0.4 ml of 1% stannous (prepared by dissolving 0.1gm
stannous chloride in 0.5ml of 1M HCI and mixing to 10ml water to give a cloudy solution), 10 ml of 2%
aqueous Tween2O and finally 25 ml of 9.6g/l of anhydrous citric acid.
After removing the filter papers, the lower sheet was immersed in the Gold Stain at room temperature.
Staining was completed within 1 hour; after which the membrane was washed thoroughly with water and
interpreted and then stored after labelling. The results were visually interpreted by finding a characteristic OCB
in the gamma globulin region.
Detection and analysis of measles virus genome from CSF
RNA was extracted from CS samples according to the procedure of the kits. RNA was extracted by
use of the guanidinium-acid phenol method . The supernatant was then acidified and extracted using phenol-
chloroform [//27]. The RNA pellet was resuspended in 30 μL of RNase-free water, and the RNA concentration
was determined by ultraviolet spectroscopy
RT-PCR and sequence analysis
To prepare templates for sequencing, RT-PCR was performed using the Superscript One Step RT-PCR
kit (Gibco BRL). Primers were designed to amplify the 450 nucleotides coding for the COOH-terminal 150
amino acids of the nucleoprotein. PCR products were purified using the PCR Preps DNA Purification System
(Promega) and were analyzed by agarose gel electrophoresis followed by ethidium bromide staining. Templates
were sequenced using a cycle sequencing reaction with fluorescent dye terminators (Applied Biosystems
Division, Perkin-Elmer), and the reaction products were analyzed using an ABI 3100 automatic sequencer
3. Subacute sclerosing panencephalitis (SSPE) In Iraq
DOI: 10.9790/0661-17662024 www.iosrjournals.org 22 | Page
(Applied Biosystems Division, Perkin-Elmer). Sequence data from multiple reactions were analyzed using the
Genetics Computer Group Package (version 10.1; Accelrys) [//29]
The PCR primers used in the RT-PCR are known to amplify all genotypes of measles virus.
SPSS v10 software was used for statistical analysis.
Student’s t test and Pearson x2 test were applied to compare various parameters. Data were considered
significant for p values less than 0.05 (p(0.05).
III. Results
Imaging
Two patients had normal CT while others, the CT changes were as follows: white matter hypodensities
involving frontal/parietal/occipital/temporal regions (two), cerebral atrophy (one), thalamic hypodensities (one),
and diffuse oedema (two). MRI was carried out in all patients. One patients had normal MRI. In the remaining
seven patients, the MRI abnormalities included focal or diffuse white matter signal changes in three patients and
cerebral atrophy of varying degrees in the other two, gray matter in one patient, u fibers generally spared.
EEG finding:
Digital acquired EEG showed paroxysmal activity in the form of generalized giant slow wave
complexes which were time locked to the myoclonic jerks, and occurred at 4-6 seconds interval and slow back
ground activity giving the typical periodic pattern which is seen in SSPE, ( figure -1).
Demographic profile
The demographic profile of those 8 patients (6 males, 2 females) were presented in table-1
No. of patients 8
Male/ female 6/2
Age range (mean)years 7-10 years (8.2)
Duration from onset to diagnosis 3 months
Interval between measles symptoms 6-8 years
Myoclonus
Behavioral changes
8 patients
8 patients
Visual disturbance 3 patients
Seizures (myoclonic, generalized tonic-clonic, atonic )
Lateralizing deficits
5 patients
4 patients
Clinical profile
Those presented with history of behavioral changes fallowed by myoclonic body jerks involving the
upper imbs and facial muscles for 8 months-1 year. These myoclonic jerks were involuntary, more frequent
during wakefulness and less frequent during sleep. Initially, these myoclonic jerks were infrequent but became
worse after one year.
Currently, it is repeated more than hundred times per day; there is no clear loss of consciousness or eye
deviation. Other seizure types described by parents include generalized tonic-clonic seizures and atonic seizures.
The drop attacks and generalized tonic-clonic seizures were reasonably controlled but the myoclonic
jerks continued to occur frequently. During the course of the illness, the patient showed clear decline in her
educational performance with poor attention span and emotional instability. No clear visual and hearing
impairment was noted and ambulation was maintained. Past medical history was unremarkable, except that five
of them had measles at around one year of age; the patient was fully vaccinated including MMR vaccine.
Family history was negative for epilepsy orother chronic neurological disorders. The patients' mini
mental examination was on the lower side with non fluent slurred speech; there was no ophthalmoplegia and the
rest of cranial nerves were normal. Fundoscopic examination show that one patient has optic atrophy, one with
chorionetenitis , other normal.
Motor examination showed pyramidal signs in the lower limbs with brisk deep tendon reflexes and
upgoing plantares; the gait was maintained; ataxia, no organomegaly or neurocutaneous stigmata. Systemic
examination was unremarkable.
Laboratory studies
All patients underwent CSF analysis. The results presented in table-2:
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Table-2: The laboratory finding of SSPE patients
Lab Findings
Protein (mg/100ml) 20-96 (mean=30.6)
Glucose (mg/100ml) 48-78 (mean=50.2)
Total WBCs/C.mm 0-30
% of Lymphocytes 55-90
Conc. Of anti-Mesales (IgG-serum) 60-160 IU/ml *
Conc. Of anti-Mesales (IgG-CSF) 40-80 IU/ml *
*Significant Conc. For anti-measles (IgG)=10.0 IU/ml
CSF oligoclonal band was positive in 5 patients (62.5%) indicating intrathecal immunoglobulin
synthesis with high level of IgG index.
Comparison of PCR results was made with other investigative techniques like MRI, CT scan, EEG,
OCB, ELIZA which could be supportive to the diagnosis of SSPE. Most of these were concordant with the final
clinical diagnosis (Table-3).
Table-3: comparison of PCR with other investigative techniques
No. of patients %
MRI 7 87.5
CT scan 6 75
EEG 8 100
PCR 8 100
ELIZA (IgG) 8 100
OCB 5 62.5
IV. Discussion
SSPE is a progressive neurological disorder caused by persistent measles infection and failure to clear
up primary infection due to defective measles virus replication cycle.
The mutated measles genome produces abnormal matrix protein (M-protein) which is important for viral
budding and establishingextracellular infection. The preserved hemagglutinin and fusion protein allow
spreading of measles virus from cell to cell (9).
SSPE patients develop a hyperimmune response to measles virus, which fails to control persistent
infection(10).
The patients go into several stages. In stage I, behavioral and intellectual changes are noted; rarely
SSPE is diagnosed at this stage ( 11,12).
In stage II, continued intellectual deterioration and onset of typical pattern jerk, both are hallmarks of
SSPE. Visual impairment and dressing apraxia may be apparent indicating parieto-occipital involvement (13).
In stage III, prominent hyperkinetic movements, chorioathetosis are noted indicating basal ganglia
involvement. Ambulation is usually clearly affected at this stage. Autonomic dysfunction is a prominent feature
(14).
In stage IV, the patients become completely bedridden, the myoclonic jerks and seizures may
disappear with the appearance of pathological laughter, persistence of autonomic dysfunction and startle reflex.
Ten percent of patients, develop slower progressive course, some may survive up to 10 years; but in
another 10%, the disease has a more fulminant course (15).
EEG findings are quite characteristic of SSPE. The slow wave complexes occur in a periodic pattern
with interburst interval of 4-12 seconds, the jerks are time locked to the
complexes. With the progression of the disease, the interburst interval gets shorter with further
background activity slowing. Neuroimaging study correlates with the stage of the disease (16,17).
The white matter changes progress from occipital lobe to the frontal lobe, with subsequent loss of
white matter volume. Basal ganglia show abnormalities. In neuroimaging, we can see areas of wedge
likeappearance of cortical and subcortical white matter involvement mimicking stroke(18).
Many studies have been performed in Western countries, to determine the role of PCR in the diagnosis
of SSPE and all these studies found that MV was detectable in 100% of the patients (19).
Positive measles antibodies in serum and CSF are common, positive oligoclonal band in the CSF
indicates intrathecal immunoglobulin synthesis.
The viral burden between patients differed up to four fold by quantitative PCR and corresponded with
detection of measles virus protein. The level of both viral RNA and antigen in the brain may correlate with
disease progression (20).
The introduction of measles vaccination program reduced the SSPE incidence. There is no proof that
SSPE caused by measles vaccine as it was thought by some. The possible mechanism of SSPE in vaccinated
5. Subacute sclerosing panencephalitis (SSPE) In Iraq
DOI: 10.9790/0661-17662024 www.iosrjournals.org 24 | Page
children is either due to the preceding primary measles infection or aborted vaccine. Currently, the patient has
follow up with neurology service and infectious team was involved.
V. Conclusion
We are reporting 8 cases of SSPE diagnosed and confirmed through serology and neuroimaging.
Subacute sclerosing panencephalitis is a rare complication of measles infection. We need to keep it in mind
during evaluation of any child presenting with progressive myoclonic epilepsy and behavioral and intellectual
changed seek a history of previous measles infection as it may cause a latent infection. Although the treatment
options are not promising but the introduction of measles vaccination program reduced the prevalence of the
disease. PCR technique have high sensitivity for detection of MV in SSPE. This study is probably the first
reported study in Iraq.
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