Hamna Wajid-Muscular Dystrophy-(Pakistan)

Name: Hamna Wajid
Sex: Female
Nationality: Pakistani
Age: 17
Diagnosis: 1. Muscular Dystrophy (MD) 2. Urinary infection
Date of Admission: May 11, 2016
Treatment hospital/period: Wu Medical Center/20 days

Before treatment:
In 2005, Hamna’s running position became abnormal and she also developed hypertrophy of the gastrocnemius muscle. She was taken to the local hospital and it was found that her CK level and aminopherase level were higher than normal, so the doctor diagnosed her with muscular dystrophy. At the same time, her younger brother also had a higher level of minopherase. So in 2007, all of her family members had genetic testing done and were diagnosed with muscular dystrophy. After that, Hamna’s condition became worse, she had muscular atrophy, her knees and ankle joints were contracted. She was not able to walk or stand two years ago, and she needed to use a wheelchair. She was able to turn her body over and sit up, but she was not able to wash her hands, eat unassisted or take of herself. The shoulder girdle muscle, pelvic girdle muscle and  the muscles in all four limbs were atrophied to different degrees.
Hamna was in good spirits. Her appetite was normal. Her sleeping habits were normal. Her urinary routine and bowel movements were normal.

Admission PE:
Bp: 137/82mmHg, Hr: 95/min. Temperature: 36.7 degrees. The skin and mucous membranes were complete, with no yellow stains or petechia on the skin or mucous. The respiration was clear. There were no dry or moist rales. The rhythm of the heartbeat was normal with no obvious murmur in the valves. The abdomen was soft and flat with no pressing pain or rebound tenderness. The liver and spleen were normal. She had shoulder girdle, pelvic girdle and muscular atrophy in all four limbs. She had slight left lateral bending. Her ankle joints and knee joints were slightly contracted. There was no edema in the lower limbs. CK2588 IU/L, AST 73IU/L, WBC 3+.

Nervous System Examination:
Hamna Wajid was alert and in good spirits. Her memory, calculation ability, comprehension and orientation were normal. Both pupils were equal in size and round, their diameter was 3 mms, both eyes had sensitive response to light stimuli. Both eyeballs could move freely. The nasolabial fold and forehead wrinkle pattern were symmetrical. She was able to close her eyes strongly. The tongue was centered in the oral cavity. There was no teeth deflection. When she expanded her cheeks, there was no leakage or air. She was able to raise her soft palate powerfully. She had difficulty turning her head and shrugging her shoulders. The abductor muscle power of the left upper arm was at level 2-, the adductor muscle power was at level 3-, the flexor muscle power of the left forearm was at level 3, the extensor muscle power was at level 2, the muscle power of the extending and flexing of the wrist was at level 4. The abductor muscle power of the right upper arm was at level 2, the adductor muscle power was at level 3-, the flexor muscle power of the right forearm was at level 3-, the extensor muscle power was at level 2, the muscle power of the extending and flexing of the wrist was at level 4. The gripping strength of both hands was at level 4. The muscle power of the bending and abduction of the hips was at level 1+, the muscle power of the extending and adduction was at level 2. The flexor muscle power of the knees was at level 3-, the extensor muscle power was at level 2+. The dorsiflexion muscle power of the ankles was at level 1, and the planter flexion muscle power of the ankles was at level 2. The muscle tension of all four limbs was lower than normal. She was able to turn her body over, sit up and maintain a sitting position by herself, but she was not able to stand up or walk by herself. The tendon reflex and abdominal reflexes were abnormal. The bilateral pathological sign was negative. The deep sensation, superficial sensation and epicritic sensation were basically normal. She was not able to do the finger-to-nose test. She was able to complete the finger-to-finger test and rapid rotation test slowly. She was not able to do the heel-knee-tibia test. The meningeal irritation sign was negative.

Treatment:
After the admission, Hamna was diagnosed with 1. muscular dystrophy (MD) 2. urinary infection, she received four neural stem cell injections and four mesenchymal stem cell injections to activate the stem cells in her body, repair the damaged cells, protect the functioning of the organs, regulate the immune system function, improve blood circulation, nourish the neurons and muscle cells,  and repair the damaged muscle cells. We also gave her daily physical rehabilitation.

Post-treatment:
After 20 days of treatment, her exercise tolerance was better; she was not so tired when she did the exercises. The muscle power of both upper limbs was higher, she was able to raise her arms higher over her head, her fingers and limbs were flexible, and both of her hands were able to grasp objects better. The muscle power of her back and waist was higher, her sitting posture was better. The muscle power of the hips and lower limbs was higher and she was able to move more flexibly. The abductor muscle power of the left upper arm was at level 2, the adductor muscle power was at level 3, the flexor muscle power of the left forearm was at level 3, the extensor muscle power was at level 2, the muscle power of the extension and flexing of her wrist was at level 4. The abductor muscle power of the right upper arm was at level 2, the adductor muscle power was at level 3, the flexor muscle power of the right forearm was at level 3-, the extensor muscle power was at level 2+, the muscle power of the extension and flexing of her wrist was at level 4. The flexor muscle power of the knees was at level 3, the extensor muscle power was at level 3. The gripping power of both hands was at level 4+. CK level was lower than before. CK460 IU/L, AST 53 IU/L. Urine routine was normal. 

Follow up

Date: 2016-05-07

Question 1:their general condition including Height, Weight, Appetite, Sleep and Bowel movements.
Question2:How about their Blood Pressure and Heart Rate? Is there any change in your condition?
Answer:
Height：Normal
Weight： Little Increase in weight
Appetite：Normal
Sleep： Normal
Bowl Movement：Pass Daily
Blood Pressure：Normal
Heart Rate：Normal

Question3: Did they take all medications regularly according to our doctor’s prescription?
Answer:
Yes
Question 4: Did they adhere to rehabilitation training in accordance with the rehabilitation guidance plan?  
Answer:
Yes
Question 5: Please provide their report of blood tests according to the requirement of our Discharge Summary
Answer:
Children Lab Test Reports are attached by name