Tanzeel Ur Rehman-Muscular Dystrophy-(Pakistan)

Name: Tanzeel Ur Rehman
Sex: Male
Nationality: Pakistani
Age: 13Y
Diagnosis: Muscular Dystrophy
Discharge Date: 2019/04/19

Before treatment:
The baby was born normal. In 2007 the family found that his feet could not land normally when he walked and the muscle strength of both lower extremities gradually decreased. When he walked his foot landed on the outside. He was diagnosed with "muscular dystrophy" by a doctor in the local hospital. With the extension of time, muscle weakness gradually aggravated, in 2012  he had serious foot varus deformity and he couldn’t walk. In 2014 the bilateral arms were involved, muscle strength decreased and his condition gradually aggravated. At present he cannot sit up, stand or walk alone. He also had scoliosis and bipedal varus deformity. In the recent 3 months, after exposure to cold air he coughed a lot and he had severe wheezing but no obvious dyspnea.
His spirit, diet and sleep are normal. He can’t urinate or defecate by himself and he has gained a lot of weight in 4 years. 

Admission PE:
Bp: 106/85mmHg, Hr: 110/min, body temperature: 36.7 degrees. Weight 50-60Kg. There is no injury or bleeding spots of his skin and mucosa, no blausucht and no throat congestion. There is Scoliosis, the respiratory sounds in both lungs were clear and there were no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was flat and soft with no masses or tenderness. The liver and spleen were normal, strephenopodia is present.

Nervous System Examination:
Patient was alert with clear speech. His mental status was fine, his memory,  comprehension and calculation abilities were normal. Both pupils were equal in size and round, diameter of 3 mm, the reaction to light was sensitive, the eyeballs can move freely and there is no obvious nystagmus. The bilateral forehead wrinkle and nasolabial fold are symmetrical, he could make his tongue extend out normally, could close his eyes normally and show his teeth in a normal manner. The soft palate could lift powerfully, the uvula was in middle, pharyngeal reflex was normal, the head turning ability was weak and he could not shrug. The arms proximal side muscle power was 1 degree, distal side muscle power was 2 degrees, right hand grip force was 3 degrees and the left hand grip force was 2+ degrees. The proximal side muscle power of the legs was 0 degrees, only his ankle joints had slight movement. The 4 limbs muscle tone were low, tendon reflex of the 4 limbs could not be induced. Abdomen reflex was normal, bilateral palm-jaw reflex was negative, the Hoffmann sign, Rossilimo sign and Babinski sign were all negative and his deep and superficial sensory were normal by gross measure. He could not perform the finger to nose test because of weakness, he could perform the finger opposite movement and fast alternate movement in a clumsy manner and he could not do the heel-knee-tibia test because of weakness. The meningeal irritation sign was negative.

Treatment:
After the admission he received 3 nerve regeneration treatments   (mesenchymal stem cells and neural stem cells) to repair his damaged muscle cells, replace dead cells, nourish muscle tissue, improve body environment, regulate his immune system and improve blood circulation. This was combined  with rehabilitation training.   

Post-treatment:
After 14 days treatment the power of his four limbs and body was increased,the back and waist muscles were stronger, his sitting posture was much better,strength in his arms was increased, he could grasp better and move his arms faster. His ankle joint contracture alleviated, the muscle strength of both legs was increased 20-30% and he can now inclose and outsprea for short a distance on the bed.


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