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Tareq Ali Al-Salmi - Limb-girdle muscular dystrophy (Palestine) Posted on November 3, 2014

Author Tracy Views Posted at 2014/10/17

Name: Tareq Ali Al-Salmi 
Sex: Male
Country: Palestine
Age: 24years
Diagnoses: 1. Limb-girdle muscular dystrophy 2. Hyperlipidemia 3.  Fatty liver (moderate) 4. Hyperuricemia
Date: September 22, 2014
Days Admitted to Hospital: 29 days

Before treatment:
The patient suffered from weakness of limbs when he was 14 years old. There was gait abnormality when he walked. He always walked tiptoes. The disease aggravated gradually. He had aggravated walking difficulty. He received rehabilitation training 4 years later after the onset of disease. But his condition had no improvement. He went to a hospital and received related examination and was diagnosed with duchenne muscular dystrophy. The rehabilitation was still considered. The disease aggravated and he was unable to walk 3 years ago. The muscle strength of both upper limbs was weakened. About 1 year ago, the patient went to foreign country and was diagnosed with limb-girdle muscular dystrophy.

From the onset of disease, the patient's spirit was good. His sleep and diet were good. His weight had increased in recent 6 months. The patient's defecation and urine were normal. There was no genetic disease his family.

Admission PE:
Bp: 132/96mmHg; Hr: 83/min, temperature: 36.5 degrees. The skin and mucosa were normal, with no yellow stains or petechia. Through auscultation, the respiratory sounds in both lungs were clear, with no dry or moist rales. The heart sounds were strong, the cardiac rate was normal, with no obvious murmur in each valves. The abdomen was enlarged and soft. There was no pressing pain or rebound tenderness. The liver and spleen under the ribs were not enlarged. There was muscle atrophy in shoulders, both upper limbs and both lower limbs. There was tendon contracture in bilateral elbow joints and wrist joints. Both elbow joints were bent and the angles were about 135 degrees. There was obvious tendon contracture in bilateral achilles tendon. The right side was more severe. There was moderate edema. The temperature and the color of skin was normal. The pulse was strong in dorsum pedis.

Nervous System Examination:
Tareq Ali Al-Salmi was alert and his spirit was good. His speech was clear. His memory, calculation ability, comprehension and orientation were all normal. Both pupils were equal in size and round, the diameter was 3.0mms. Both pupils were sensitive to light stimulus. Both eyeballs had flexible movement. The forehead wrinkle pattern was symmetrical. The bilateral nasolabial sulcus was equal in depth. The ability to close his eyes was strong and symmetrical. The tongue was centered in the oral cavity, with no teeth deflection. He could raise the soft palate strongly. There was no air leakage when he drummed cheeks. The muscle strength of neck was normal. The muscle strength to shrug shoulders was weak. The muscle strength of left upper's near-end was at level 3, and that of far-end was at level 4. The muscle strength of right upper limbs' near-end was at level 3-, and that of far-end was at level 3+. The hold power of both hands was at level 5-. Both hands only could reached his lips. The muscle strength of both lower limbs was between level 0-1. The muscle tone of his four limbs was low. Left patellar tendon reflex could be elicited. Other tendon reflexes were not elicited. Bilateral abdominal reflex was not elicited. Bilateral palm jaw reflex was negative. Bilateral Hoffmman sign and Rossilimo sign were negative. Bilateral Babinski sign was negative. Bilateral deep, shallow and fine sensation were normal through loose measure. He was able to finish the finger - nose test, fingers coordinate examination and the rapid rotation test in a slow manner. He had difficulty with the heel- knee - shin test. There were no signs of meningeal irritation.

Treatment:
We initially gave Tareq Ali Al-Salmi a complete examination. He received treatment for muscle fiber repair and regeneration. He received treatment to enhance his liver function, reduce creatase, reduced blood lipid, nourish the nerves, activate muscle stem cells in the body, stabilize organ function and promote nerve regeneration. He also received treatment to improve the blood circulation in order to increase the blood supply to the damaged neurons. This was accompanied with physical rehabilitation treatment.

Post-treatment:
The patient's condition has improved. The diet, defecation and urine are normal. He can stretch elbow joints better, the angle of elbow joints has increased to 150 degrees. The muscle strength to shrug shoulders has increased. The muscle strength of left upper limb's near-end is at level 3+, and that of far-end is at level 4+. The muscle strength of right upper limb's near-end is at level 3, and that of far-end is at level 4-. Both upper limbs can raise higher than before and the height has increased to about 20cm. The hold power of both hands is at level 5. The muscle strength of right lower limb's outside group muscles is at level 3-, and that of the inside group muscles is at level 2-. The muscle strength of left lower limb's outside group muscles is at level 3, and that of the inside group muscles is at level 2. There is new muscle tissue growth in four limbs, neck, shoulders and back.

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