Name: Dimitar Nestorovski             
Sex: Male
Country: Macedonia
Age: 11 years
Diagnosis: Duchenne muscular dystrophy
Date:May 17, 2014
Days Admitted to Hospital: 28 days

Before treatment:
The patient felt down when he was 4 years old. He needed some assistance when he was going up stairs. The genetic testing revealed Duchenne muscular dystrophy. Then he received rehabilitation training. The disease progressed gradually and the weakness of both lower limbs aggravated. About 6 months ago, the patient's upper limbs had weakness too. Before the treatment, the patient could do the daily exercises and the muscle strength of upper limbs was at level 3. He couldn't stand, or walk or turn over.

From the onset of disease, the patient had good spirit. The diet and defecation were normal. There was no genetic disorders.

Admission PE:
Bp: 111/74mmHg; Hr: 109/min. 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. We didn't touch the liver or spleen under the ribs. There was tendon contracture in bilateral knee joints and ankle joints. Bilateral knee joints couldn't be straightened completely. The dorsal flexure of bilateral ankle joints was limited. Both feet dropped. The ankle joints presented with 120 degrees. The lumbar vertebra had significant lordosis.

Nervous System Examination:
Dimitar Nestorovski was alert, and his speech was fluent. His spirit was good. 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 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. There was no air leakage when he drummed his cheeks. He could raise the soft palates strongly. The muscle strength of neck was at level 4. He could turn his neck flexibly. The muscle strength to shrug his shoulders was at level 3-. The muscle strength of both upper limbs was at level 3-. The abduction strength of both lower limbs was at level 2-. The adduction strength of both lower limbs was at level 1. The muscle tone of his four limbs was low. He couldn't turn over, stand or walk by himself. The tendon reflex of his four limbs was not elicited. The abdominal reflexes were not elicited. Bilateral pathological sign was negative. The deep, shallow sensation and epicritic sensation were normal through loose measure. He was able to finish the finger-to-nose test, digital opposition test and the rapid rotation test.  He had difficulty with the heel-knee-shin test. There were no signs of meningeal irritation.

Treatment:
We initially gave Dimitar Nestorovski a complete medical examination. He received treatment for muscle fiber repair and muscle fiber regeneration. He received treatment to enhance his liver function, reduce creatase, to nourish the nerves, to promote nerve regeneration and also to stabilize organ function. 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 muscle strength and spirit has improved. The patient's heart rate is stable; between 80 to 100 each minute. The knee joint is more extended and presents 140 degrees. The muscle strength of his neck is at level 5. He can turn his neck flexibly. The muscle strength to shrug his shoulders is at level 4. The muscle strength of both upper limbs is at level 3+. The grasp power of both hands is at level 4. The abduction of both lower limbs is at level 4. The adduction of left lower limb is at level 2, the adduction of right lower limb is at level 2+.

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Date: 2015-4-21

Today we had the heart controlled. The results were excellent and thedoctor is satisfied with the heart condition. Here are the results:stable kinetics and dimensions of heart cavities Ef 0,74%; Fs 0.40; IASand IVC in continuity; Mv and Tv good. Conclusion: stableEco-cardiogram. Our doctor would like to know until when is Dimitarsupposed to receive the heart therapy, i.e. the medicine Metoprolol andcan a  pause be made. As far as Dimitar's  weight and height isconcerned we still did not manage to measure hi, but we will do that inthe shortest period possible. Still we notice that he is slowly reducingweight. I am sending his blood results.

Greetings from the Nestorovski family