Afraa Musa - Academia.edu (original) (raw)
Papers by Afraa Musa
Journal of the Neurological Sciences, Nov 30, 2023
IBRO Neuroscience Reports
Khartoum Medical Journal
We report a nine-year-old girl who presented with complete drooping of the left eyelid and restri... more We report a nine-year-old girl who presented with complete drooping of the left eyelid and restriction ofmedial gaze following an attack of febrile illness. The child was admitted into a rural hospital where shewas misdiagnosed and managed as a case of meningitis. She was referred to a tertiary children hospitalwhen her condition was not improving and where she developed the eye signs. She was diagnosed as a caseof severe malaria which responded well to quinine therapy. In our neurophysiology clinic, examinationrevealed partial unilateral left eye ptosis, weak frontalis, neck flexors, fingers extensors & knee flexors.Her investigations revealed positive neostigmine test, decremental response to repetitive nerve stimulation(-15.6%,nasalis), increased jitter in single-fibre electromyography (left frontalis & extensor-digitorumcommunis) and negative serology for myasthenia gravis antibodies. She showed remarkable improvementafter pyridostigmine therapy which continued for three months....
Khartoum Medical Journal
Background: Distractor analysis is an important component of item analysis. It helps in the desig... more Background: Distractor analysis is an important component of item analysis. It helps in the design and construction of items with functional effective distractors which are valid for future use and developmentof proper question banks.Objectives: This study aimed at investigating distractors’ functionality of physiology multiple choicequestion (MCQ) items at the Faculty of Medicine, Khartoum University using post- examination item analysis data. Methods: Analyzing test statistics reports produced by Remark-Software, the frequency distribution of non-functioning (NFD) or non-effective distractors (NED) on ten summative physiology MCQ exams administered to undergraduate medical students in the period from September 2015 to September 2016 was assessed. Item analysis reports provided detailed options analyses in the form of response frequency and discrimination power of each option. Each exam paper consisted of 60-80 (five-option) items and the number of the examinees ranged from 332 to ...
Clinical Neurophysiology, 2018
Introduction Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affec... more Introduction Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM. There are four main types of diabetic neuropathy; Peripheral neuropathy, autonomic neuropathy, radiculo-plexus neuropathy (diabetic-amyotrophy) and mononeuropathy. The aim of the study was to describe the clinical presentation, electrophysiological investigations and in the future the immunological profile of such patients. Methods Seven type II diabetic patients were selected for the study. Ethical approval and patients’ informed consent have been obtained. They are all presented with acute and subacute onset of predominantly lower limb distal muscle weakness, on occasion proximal. The onset of this weakness was not preceded by upper respiratory tract infection, diarrhea or febrile illness. Results On examination there was symmetrical weakness of the distal foot flexors and extensors (power ranges 0–3), lower limb reflexes varie...
Khartoum Medical Journal, 2019
Background: One of the major challenges that face exam constructors is generating highly reliable... more Background: One of the major challenges that face exam constructors is generating highly reliable exams. An assessment cannot be viewed as valid unless it is reliable. Test reliability, which is the best single measure of test accuracy, is the extent to which test results are consistent, stable, reproducible and free of error variance. Reliability is influenced by internal factors related to exam construction, as well as external factors which depend on the situation of test administration. Objective: To estimate the reliability of multiple choice questions (MCQs) of physiology exams as part of an overall quality assessment at the Faculty of Medicine, University of Khartoum. Methods: Reliability influential factors related to exam construction and administration were controlled and catered for by departmental and administrative staff according to the exam regulations of the faculty. Remark software was used for post-examination analysis of scores of ten consecutive summative physio...
Clinical Neurophysiology, 2018
Scheffer et al., 2017). Methods: We applied multiple overlapping methods of case ascertainment to... more Scheffer et al., 2017). Methods: We applied multiple overlapping methods of case ascertainment to our study population from January 1st 2017 to identify all patients presenting with suspected first seizure or new diagnosis of epilepsy. Neonatal seizures and febrile seizures are excluded. Case ascertainment methods include daily review of emergency department (ED) triage, radiology, EEG databases, neurology outpatient/ inpatient departments, neurosurgical ward, geriatrics wards, oncology wards, paediatric services and community surveillance through survey of general practice and residential care facilities. Results: Two hundred and sixty-three cases met our inclusion criteria for the first three months of data collection (Jan-Mar 2017). EEG database review yielded the greatest number of novel cases (n = 60). 26% (n = 69) of cases met criteria for definite new diagnosis of epilepsy. Only 25 % (n = 16) of these had epileptiform abnormalities on routine EEG. The majority of cases were c...
Scientific Reports, 2020
Single fibre electromyography is the most sensitive neurophysiological test for the diagnosis of ... more Single fibre electromyography is the most sensitive neurophysiological test for the diagnosis of neuromuscular junction disorders, particularly myasthenia gravis. The study aimed at establishing concentric needle (CN) normal jitter values for voluntarily activated orbicularis-oculi (V-OOc) & Frontalis (V-FRO) muscles in Sudanese population. 57 healthy volunteers (20 males & 37 females) were included in the study (mean Age 43.6 ± 14.2 years, range 18–70 years). V-OOc and V-FRO were tested in the same individual using CN. Jitter values were expressed as the mean consecutive difference (MCD) of 30 potential pairs in microseconds. The mean jitter, mean individual fibre pairs jitter & mean outliers jitter values with (upper 95% Confidence Limit-CL) for [OOc] were [26.9 ± 3.3 (31.97), 26.1 ± 8.9 (41.8) & 38.5 ± 5.7 (49.0) µs] & for [FRO] were [27.1 ± 3.0 (31.32), 26.4 ± 9.4 (42.9) & 39.9 ± 5 (49.2) µs] respectively. The suggested practical upper limits for mean jitter & for outliers were ...
Objective: This study aimed at finding out the normal physiological parameters of blink reflex in... more Objective: This study aimed at finding out the normal physiological parameters of blink reflex in Sudanese population. The study was meant to compare between the parameters of both the right and left sides and to look for the effect of age and gender on these parameters Background: The blink reflex (BR) is a neural-reflex that requires two neurons, a sensory (Trigeminal) and a motor (Facial) neuron connected by interneurons. It can be stimulated electrically through supraorbital nerve stimulation and recorded through recordings from the orbicularis-oculi muscles. The reflex shows two responses, a first, unilateral response(R1) and a late, bilateral responses [ipsilateral R2 (R2i) and contralateral (R2c)]. The R2 response is clinically observed as the actual blink. It is useful for the diagnosis of different central and peripheral trigeminal and facial nerve disorders. Design/Methods: Fifty normal healthy individuals were included in the study [mean age (24.58± 9.07) years, ranges ( ...
Background. Nerve conduction studies (NCS) are electrodiagnostic tests used to evaluate periphera... more Background. Nerve conduction studies (NCS) are electrodiagnostic tests used to evaluate peripheral nerves functions and aid in the assessment of patients with neuromuscular complaints. There is contrasting evidence concerning the use of NCS in the assessment of patients with lumbosacral radiculopathy. Objectives. This study was conducted to evaluate nerve conduction studies abnormalities in patients with lumbosacral radiculopathy and to find out their relation to abnormal physical examination findings. Materials and Methods. Twenty-seven patients with lumbosacral radiculopathy caused by L4/5 or L5/S1 intervertebral disc prolapse confirmed by magnetic resonance imaging (MRI) were recruited in the study. Twenty-five healthy subjects matched in age and sex served as control. Motor nerve conduction study bilaterally for both common peroneal and tibial nerves, F-wave for both nerves, and H-reflex had been conducted. Results. No significant difference was found in the motor nerve conducti...
Background: Item analysis is an essential tool used in the evaluation of the quality of MCQ exami... more Background: Item analysis is an essential tool used in the evaluation of the quality of MCQ examinations. Objectives: This study aimed at assessing the quality of items of physiology MCQ examinations at the Faculty of Medicine, Khartoum University, using post-examination item analysis. Methods: A descriptive, cross-sectional study was carried-out on test statistics reports using Remarksoftware which provides analysis of students’ responses in the form of Excel file formats. Ten physiology MCQ exams held from September 2015 - September 2016 were included in the study. Each exam paper consisted of 60-80 (five-option) items. Item Difficulty index [DIF I] and Discrimination Index (DI) (using point biserial correlation coefficient/rpbis) were measured as quality indicators. Results: The mean DIF I of 645 items was (56.01±19.97) & the mean rpbis was (0.37±0.13). The majority of items (63.3%) were of acceptable difficulty; (25.5%) were easy & (11.1%) were difficult. The highest proportion ...
Journal of the Neurological Sciences
Journal of Diabetes Research
Diabetic peripheral neuropathy (DPN) involves sensory and motor nerves, resulting in demyelinatio... more Diabetic peripheral neuropathy (DPN) involves sensory and motor nerves, resulting in demyelination as well as axonal degeneration. This study was conducted to describe the pattern of lower limb nerve involvement in children with type 1 diabetes mellitus (DM) based on the parameters of nerve conduction study (NCS). This cross-sectional study recruited 50 children with type 1 DM having mean disease duration of 4.92±3.84 years who attended the referred clinic in Sudan Childhood Diabetes Center. Their mean age was 15.00±2.19 years, 42% were males, and 58% were females. Twenty six matched healthy control subjects were involved; their mean age was 13.88±2.46 years, 38.46% were males, and 61.54% were females. Bilateral NCS of the sensory and motor lower limb nerves was performed using Medelec Synergy machine. Interpretation of the patients’ results was based on our own control reference values. Data was analysed using IBM SPSS statistics. Out of the 50 diabetic patients, 44 (88%) had elect...
Advances in Orthopedics, Jan 29, 2020
Purpose The aim of this study was to find out the correlation between magnetic resonance imaging ... more Purpose The aim of this study was to find out the correlation between magnetic resonance imaging (MRI) and nerve conduction studies' (NCS) findings in patients with lumbosacral radiculopathy caused by lumbar intervertebral disc herniation. In addition, the study aimed at finding the correlation between the clinical manifestations of lumbosacral radiculopathy and both MRI and NCS. Patients and Methods. The study was a cross-sectional analytic study which included thirty patients with a history suggestive of lumbosacral radiculopathy. Inclusion criteria were as follows: patients who had an MRI confirmed L4/5 and/or L5/S1 intervertebral disc prolapse in addition to one or more of the following (dermatomal distribution of symptoms appropriate with MRI level, presence of motor weakness, sensory impairment, absent ankle jerk, or positive straight leg raising test). All patients underwent clinical assessment and NCS, and their MRI examination was reviewed. The Chi-Squared/Fisher's exact test was used to test the correlation. Results There was a statistically significant correlation between abnormal physical findings and nerve root compression in MRI. Statistically significant correlation was neither found between abnormal physical examination findings and abnormal NCS nor between nerve root compression in MRI and abnormal NCS findings. Conclusion Abnormal neurological examination findings can be used to predict nerve root compression in MRI examination. On the contrary, positive findings of physical examination do not predict abnormal NCS, as well as negative findings do not exclude abnormal NCS; therefore, it is useful to add NCS when MRI findings do not match clinical examination findings or when no neuroimaging abnormalities can be identified.
Journal of the Neurological Sciences, Nov 30, 2023
IBRO Neuroscience Reports
Khartoum Medical Journal
We report a nine-year-old girl who presented with complete drooping of the left eyelid and restri... more We report a nine-year-old girl who presented with complete drooping of the left eyelid and restriction ofmedial gaze following an attack of febrile illness. The child was admitted into a rural hospital where shewas misdiagnosed and managed as a case of meningitis. She was referred to a tertiary children hospitalwhen her condition was not improving and where she developed the eye signs. She was diagnosed as a caseof severe malaria which responded well to quinine therapy. In our neurophysiology clinic, examinationrevealed partial unilateral left eye ptosis, weak frontalis, neck flexors, fingers extensors & knee flexors.Her investigations revealed positive neostigmine test, decremental response to repetitive nerve stimulation(-15.6%,nasalis), increased jitter in single-fibre electromyography (left frontalis & extensor-digitorumcommunis) and negative serology for myasthenia gravis antibodies. She showed remarkable improvementafter pyridostigmine therapy which continued for three months....
Khartoum Medical Journal
Background: Distractor analysis is an important component of item analysis. It helps in the desig... more Background: Distractor analysis is an important component of item analysis. It helps in the design and construction of items with functional effective distractors which are valid for future use and developmentof proper question banks.Objectives: This study aimed at investigating distractors’ functionality of physiology multiple choicequestion (MCQ) items at the Faculty of Medicine, Khartoum University using post- examination item analysis data. Methods: Analyzing test statistics reports produced by Remark-Software, the frequency distribution of non-functioning (NFD) or non-effective distractors (NED) on ten summative physiology MCQ exams administered to undergraduate medical students in the period from September 2015 to September 2016 was assessed. Item analysis reports provided detailed options analyses in the form of response frequency and discrimination power of each option. Each exam paper consisted of 60-80 (five-option) items and the number of the examinees ranged from 332 to ...
Clinical Neurophysiology, 2018
Introduction Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affec... more Introduction Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM. There are four main types of diabetic neuropathy; Peripheral neuropathy, autonomic neuropathy, radiculo-plexus neuropathy (diabetic-amyotrophy) and mononeuropathy. The aim of the study was to describe the clinical presentation, electrophysiological investigations and in the future the immunological profile of such patients. Methods Seven type II diabetic patients were selected for the study. Ethical approval and patients’ informed consent have been obtained. They are all presented with acute and subacute onset of predominantly lower limb distal muscle weakness, on occasion proximal. The onset of this weakness was not preceded by upper respiratory tract infection, diarrhea or febrile illness. Results On examination there was symmetrical weakness of the distal foot flexors and extensors (power ranges 0–3), lower limb reflexes varie...
Khartoum Medical Journal, 2019
Background: One of the major challenges that face exam constructors is generating highly reliable... more Background: One of the major challenges that face exam constructors is generating highly reliable exams. An assessment cannot be viewed as valid unless it is reliable. Test reliability, which is the best single measure of test accuracy, is the extent to which test results are consistent, stable, reproducible and free of error variance. Reliability is influenced by internal factors related to exam construction, as well as external factors which depend on the situation of test administration. Objective: To estimate the reliability of multiple choice questions (MCQs) of physiology exams as part of an overall quality assessment at the Faculty of Medicine, University of Khartoum. Methods: Reliability influential factors related to exam construction and administration were controlled and catered for by departmental and administrative staff according to the exam regulations of the faculty. Remark software was used for post-examination analysis of scores of ten consecutive summative physio...
Clinical Neurophysiology, 2018
Scheffer et al., 2017). Methods: We applied multiple overlapping methods of case ascertainment to... more Scheffer et al., 2017). Methods: We applied multiple overlapping methods of case ascertainment to our study population from January 1st 2017 to identify all patients presenting with suspected first seizure or new diagnosis of epilepsy. Neonatal seizures and febrile seizures are excluded. Case ascertainment methods include daily review of emergency department (ED) triage, radiology, EEG databases, neurology outpatient/ inpatient departments, neurosurgical ward, geriatrics wards, oncology wards, paediatric services and community surveillance through survey of general practice and residential care facilities. Results: Two hundred and sixty-three cases met our inclusion criteria for the first three months of data collection (Jan-Mar 2017). EEG database review yielded the greatest number of novel cases (n = 60). 26% (n = 69) of cases met criteria for definite new diagnosis of epilepsy. Only 25 % (n = 16) of these had epileptiform abnormalities on routine EEG. The majority of cases were c...
Scientific Reports, 2020
Single fibre electromyography is the most sensitive neurophysiological test for the diagnosis of ... more Single fibre electromyography is the most sensitive neurophysiological test for the diagnosis of neuromuscular junction disorders, particularly myasthenia gravis. The study aimed at establishing concentric needle (CN) normal jitter values for voluntarily activated orbicularis-oculi (V-OOc) & Frontalis (V-FRO) muscles in Sudanese population. 57 healthy volunteers (20 males & 37 females) were included in the study (mean Age 43.6 ± 14.2 years, range 18–70 years). V-OOc and V-FRO were tested in the same individual using CN. Jitter values were expressed as the mean consecutive difference (MCD) of 30 potential pairs in microseconds. The mean jitter, mean individual fibre pairs jitter & mean outliers jitter values with (upper 95% Confidence Limit-CL) for [OOc] were [26.9 ± 3.3 (31.97), 26.1 ± 8.9 (41.8) & 38.5 ± 5.7 (49.0) µs] & for [FRO] were [27.1 ± 3.0 (31.32), 26.4 ± 9.4 (42.9) & 39.9 ± 5 (49.2) µs] respectively. The suggested practical upper limits for mean jitter & for outliers were ...
Objective: This study aimed at finding out the normal physiological parameters of blink reflex in... more Objective: This study aimed at finding out the normal physiological parameters of blink reflex in Sudanese population. The study was meant to compare between the parameters of both the right and left sides and to look for the effect of age and gender on these parameters Background: The blink reflex (BR) is a neural-reflex that requires two neurons, a sensory (Trigeminal) and a motor (Facial) neuron connected by interneurons. It can be stimulated electrically through supraorbital nerve stimulation and recorded through recordings from the orbicularis-oculi muscles. The reflex shows two responses, a first, unilateral response(R1) and a late, bilateral responses [ipsilateral R2 (R2i) and contralateral (R2c)]. The R2 response is clinically observed as the actual blink. It is useful for the diagnosis of different central and peripheral trigeminal and facial nerve disorders. Design/Methods: Fifty normal healthy individuals were included in the study [mean age (24.58± 9.07) years, ranges ( ...
Background. Nerve conduction studies (NCS) are electrodiagnostic tests used to evaluate periphera... more Background. Nerve conduction studies (NCS) are electrodiagnostic tests used to evaluate peripheral nerves functions and aid in the assessment of patients with neuromuscular complaints. There is contrasting evidence concerning the use of NCS in the assessment of patients with lumbosacral radiculopathy. Objectives. This study was conducted to evaluate nerve conduction studies abnormalities in patients with lumbosacral radiculopathy and to find out their relation to abnormal physical examination findings. Materials and Methods. Twenty-seven patients with lumbosacral radiculopathy caused by L4/5 or L5/S1 intervertebral disc prolapse confirmed by magnetic resonance imaging (MRI) were recruited in the study. Twenty-five healthy subjects matched in age and sex served as control. Motor nerve conduction study bilaterally for both common peroneal and tibial nerves, F-wave for both nerves, and H-reflex had been conducted. Results. No significant difference was found in the motor nerve conducti...
Background: Item analysis is an essential tool used in the evaluation of the quality of MCQ exami... more Background: Item analysis is an essential tool used in the evaluation of the quality of MCQ examinations. Objectives: This study aimed at assessing the quality of items of physiology MCQ examinations at the Faculty of Medicine, Khartoum University, using post-examination item analysis. Methods: A descriptive, cross-sectional study was carried-out on test statistics reports using Remarksoftware which provides analysis of students’ responses in the form of Excel file formats. Ten physiology MCQ exams held from September 2015 - September 2016 were included in the study. Each exam paper consisted of 60-80 (five-option) items. Item Difficulty index [DIF I] and Discrimination Index (DI) (using point biserial correlation coefficient/rpbis) were measured as quality indicators. Results: The mean DIF I of 645 items was (56.01±19.97) & the mean rpbis was (0.37±0.13). The majority of items (63.3%) were of acceptable difficulty; (25.5%) were easy & (11.1%) were difficult. The highest proportion ...
Journal of the Neurological Sciences
Journal of Diabetes Research
Diabetic peripheral neuropathy (DPN) involves sensory and motor nerves, resulting in demyelinatio... more Diabetic peripheral neuropathy (DPN) involves sensory and motor nerves, resulting in demyelination as well as axonal degeneration. This study was conducted to describe the pattern of lower limb nerve involvement in children with type 1 diabetes mellitus (DM) based on the parameters of nerve conduction study (NCS). This cross-sectional study recruited 50 children with type 1 DM having mean disease duration of 4.92±3.84 years who attended the referred clinic in Sudan Childhood Diabetes Center. Their mean age was 15.00±2.19 years, 42% were males, and 58% were females. Twenty six matched healthy control subjects were involved; their mean age was 13.88±2.46 years, 38.46% were males, and 61.54% were females. Bilateral NCS of the sensory and motor lower limb nerves was performed using Medelec Synergy machine. Interpretation of the patients’ results was based on our own control reference values. Data was analysed using IBM SPSS statistics. Out of the 50 diabetic patients, 44 (88%) had elect...
Advances in Orthopedics, Jan 29, 2020
Purpose The aim of this study was to find out the correlation between magnetic resonance imaging ... more Purpose The aim of this study was to find out the correlation between magnetic resonance imaging (MRI) and nerve conduction studies' (NCS) findings in patients with lumbosacral radiculopathy caused by lumbar intervertebral disc herniation. In addition, the study aimed at finding the correlation between the clinical manifestations of lumbosacral radiculopathy and both MRI and NCS. Patients and Methods. The study was a cross-sectional analytic study which included thirty patients with a history suggestive of lumbosacral radiculopathy. Inclusion criteria were as follows: patients who had an MRI confirmed L4/5 and/or L5/S1 intervertebral disc prolapse in addition to one or more of the following (dermatomal distribution of symptoms appropriate with MRI level, presence of motor weakness, sensory impairment, absent ankle jerk, or positive straight leg raising test). All patients underwent clinical assessment and NCS, and their MRI examination was reviewed. The Chi-Squared/Fisher's exact test was used to test the correlation. Results There was a statistically significant correlation between abnormal physical findings and nerve root compression in MRI. Statistically significant correlation was neither found between abnormal physical examination findings and abnormal NCS nor between nerve root compression in MRI and abnormal NCS findings. Conclusion Abnormal neurological examination findings can be used to predict nerve root compression in MRI examination. On the contrary, positive findings of physical examination do not predict abnormal NCS, as well as negative findings do not exclude abnormal NCS; therefore, it is useful to add NCS when MRI findings do not match clinical examination findings or when no neuroimaging abnormalities can be identified.