Hamid Ayyaz-Progressive Muscular Dystrophy-(Pakistan)

Name:Hamid Ayyaz                    
Sex: Male
Country: Pakistan
Age: 34 years
Diagnosis: Progressive muscular dystrophy
Date:April 28, 2014

Before treatment:
The disease started with muscle pain and weakness of the left lower limb's near-end sideward, left back and waist. He took pain killer for 2 years. His disease aggravated gradually. He was diagnosed with progressive muscular dystrophy in a local hospital. He received rehabilitation training in local hospital, but the muscle strength of his limbs was weakening gradually. This accompanied with muscle atrophy. About 4 years ago, the patient suffered from muscle atrophy and muscle weakness of the right lower limb and the whole body. The activity tolerance was poor. He was unable to work or walk. He had difficulty to get up from supine position or sitting position. With assistance to both hands, he could get up. For further treatment, the patient came to our hospital and was diagnosed with muscular dystrophy.

From the onset of the disease, the patient has normal spirit, the sleep was normal. He had normal defecation. There was no family genetic disease.

Admission PE:
Bp: 121/72mmHg; Hr: 72/min, temperature: 36.0 degrees. Br: 21/min. Height: 182cm, weight: 74Kg. 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 flat and soft. There was no pressing pain or rebound tenderness. We didn’t touch the liver or spleen under the ribs. There was no edema in both lower limbs.

Nervous System Examination:
Hamid Ayyaz was alert, and his spirit was good. His speech was clear. His memory, calculation ability 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. Bilateral conjunctival congestion. Both eyeballs had flexible movement. The forehead wrinkle pattern was symmetrical. The ability to close his eyes was strong. The bilateral nasolabial sulcus was equal in depth. The tongue was centered in the oral cavity, with no teeth deflection. He could raise the soft palate strongly. The ability to swallow was normal. The neck was soft, with no resistance. There was obvious muscle atrophy in shoulder girdle,  latissimus dorsi, biceps brachii muscle, triceps brachii muscle, forearm metacarpophalangeal muscle groups, biceps femoris muscle, quadriceps femoris and gastrocnemius muscle. Bilateral deltoid suffered from pseudohypertrophy.  The muscle strength of his head and neck was strong. The muscle strength of left upper limb was at level 3. The muscle strength of the right upper limb was at level 3-. The grasp power of both hands was at level 4. The muscle strength of the left lower limb was at level 3. The muscle strength of the right lower limb was at level 2+. Both lower limbs couldn't be straightened and raised. The Gowers sign was positive. He couldn't walked by himself. The muscle tone of his four limbs was almost normal. The tendon reflex of both upper limbs was not elicited. Bilateral patellar tendon reflex, Achilles tendon reflex and abdominal reflex were normal. Bilateral pathological character was negative. The deep and shallow sensation was normal through loose measure.  He was able to finish the finger-nose test, digital opposition test and the rapid rotation test. He had difficulty with the heel-knee-shin test. The balancing control was poor. There were no signs of meningeal irritation.

Treatment:
We initially gave Hamid Ayyaz a complete examination. He received treatment for activate muscle fiber repair, inanaphysis and activate stem cells in the body. At the same time, the patient received treatment to enhance his liver function, reduce creatase, nourish the nerves and promote nerve regeneration. He also received treatment to improve the blood circulation in order to increase the blood supply to the damaged neurons and also to promote muscle fiber repair. This was accompanied with physical rehabilitation treatment.

Post-treatment:
The patient's condition has improved. The muscle strength of his four limbs has improved. The muscle strength of the left upper limb has increased to level 4. The muscle strength of right upper limb has reached level 4+. The grasp power of both hands is at level 5-. The muscle strength of left lower limb is at level 3+. The muscle strength of the right lower limb is at level 4-. Both lower limbs can be straightened and raised easily. He can fluctuate body in horizontal position.  At the same time, the patient has better control when he sits or walks and does the actions more easily. The muscle volume of bilateral shoulders, back, biceps brachii and triceps brachii have increased obviously.