EPI-EGYPT 238940 fy aati eRe tet ta Code: FQP-EPI-008/01 le 98 Lb Hil ge yaslly E54 Lill G0 18h ans) ge sl AT + Ala pul yal ea ase yal ue Aaa bY aaolna gl EU cpa RAGyl Gigs | Ge lagen Anat! ‘gilt aD ial Taal hej 20 Wa LN) ys 3 Jay) Fal gp Heals Ay yaad) : : a P ce Oe. Ball oe EAN! be Dad (ARS) hall pal Fy no ‘al el Real yal 11 Mat atise G\PUYI aa rt aus 7 oe so Sl LD; Alacal ebase Had! oliaey} sbti wale!) Chill pap aie 5 yall a 9d EUW I ages Ape ll eye! DS LA SLs! Wad Lacy ulaal aay Aptally Aig gael) ] —— Ryyptally aaa ll yiane | Bly sea ll tae i! Sal i ‘eal 2014 J 9/9 : ell wi 2010 101/30 : pueyl 0101: dust / jiaatPoa meu, EPI-EGYPT Daa a 33 oe gy fla Ded Salo! jared AFP Case Clinical Examination Form y GL Spam a all 3 Ib DS om gl alll ali a ill tue si a FOS Sl SA pats Gl ose ; ‘Other (specify): Right |Arm Le ry Site of paralysis eh u { Jbeg Let: LJAnm LJ Leg Ye ‘Asymmetry No 7 Paralyzed part is flaccid No | Yes | Intact sensation in Yes paralyzed parts No | Musele pain No | Yes Any of the following symptoms present before or at onset of paralysis Any other clinical signs (spec Fever Yes [No] ifyes,date:/__/__ Diarrhea Yes [No] ifyes date: /_ ‘Vomiting Yes [No] ifyesdate; —/_/ Coryza (cold-runny nose) Yes [No| —ifyessdate: / _/___ Sphineter control No | Yes Neck stiffness No_| Yes Convulsions No | Yes Babinski Sign No | Yes Hyper-reflexia Hyperonia Reflexes a Muscle Tone Rane ify): the ea) coset ry eel Toma yaad Se coanill SGD Cae pat citnall Ssh fy 5 y PP) abd DAS cla est] 7 fh Juss as Ff Qh dyiay gas “ SY Sie apg ll Ue a AS Sale ay DLT as | HS) gad Sal Ge IS A tT A pl Gly Gaal os EG oy nA culpa ws a” GV) as vale Aye yall Provision: ical diagnosis: 2(OLD Guadl Gaal pul) DE GOW pak Tosa a fl Jyiene Tyee sel Tptee cally a) Ga 1 2017 / 10/3: Spall a 2010 101/30 : tae aut OW/01 : hast / jl)yaw Code: FQP-EPI-008/03 EPI-EGYPT cence ast alia | | | | dhe gh) Sli AlLad city gt! 51 a 918 an) cell Mal pul ea sage yal J Saas | aaa 37! Aad faa gl EL US day OF) cs ! iD Mal os ‘Abia sya¥l yavallian ih eu ‘Lyle AY) Gl ye | | scsi by ost] Gol] tbe oye Lay | : : | “Ala AS ey! i 4 € oe ae AD (GES) de) a ge 1 pail! pc tl aah | ieee 2H) pay ga 35 | cells [ OLA +4) ded a 30 HL is as S51 wt gl ao GLUT pal oly Seer) eee Eye ee CeCe Ee EEE | TOES A ELT FD 6 Ui pas 60 da 9h Gd Ha ST i Jf a 5 Dall | chaste Ais Lat py JE 99 30 UG Ga paball GLA GH Sally GI) gl 9S | ail ah Oey ab gil Gi DR, Slay gh pul ni i i essay SESE SES 7 i FO by os A BL PLR oy GE ay 60 Sa KJ a fy: LS pay GJS ‘olga rel a 7 20147 979 : datas 2010 70130 eae 01/01 dsi/ jaa)EPI-EGYPT aga gu ‘ Code: FQP-EPI-008/03 CUAL Giga ay Ant! Yale Cita 5 gill Ayal Cpa! Que 553i Hetlae a eee yal cells gat a ys Yoo | Ys Yow ct hash Go oly Ml ube cag a haat egal hs GAA Ga) LA cig Geally |S) Bal] SGD Sela anal galt gl) yd Jlibyi itis sll ales | _— sass | Oat 3! AMI ull gf Edt) 29) dll gl clquatly u (us las ctl 9) Dt ph cea | Aatlall ote yall axe 2 20147 979 :dadi@F ~~ 2010 70130 : ayes 1104 : des] jalSt Zysawy . iS ated Estas : ¥ Sei ent Code: FQP-EPI-008/03 Abell as op LAY op sae Ge eee Sel ppl Slam Ge GLB Eagan ye ia hy DN eayan ya Gil fe all eeeeee ESET S| ae = ze T, xe | feet | cyatead fans) “AY | es | gam | A | cs | gang! | oa aa ikea gi { ary lls Ral St es (al) aly Ate eee Aha gua | abba Ayyptaly giligtl yaall Ay gptally ue sll dL pian By) ee ill ghana 1H ae “| ret oo eal | em 3 2014 7 979 :ded es 2010/01/80 aes 101 Des je]yore, EPI-EGYPT Code: FQP-EPI-008/04 gglanal) Gaal St) SUA Cla Ga Jy CLUS pilus Slay! Cag Sy (Hal ans Lat) 4 ys seal AID put esi saat al dual go ce eeeeitvestne kM Ald I ole ae een eee Sat sil ea L hl ey YU atl 5 js Wall Se | thes] ee Reno] | celyyt | Chesles Jt tao] etal : CUM y Suen dige tia Jlay! Ye Uplaall aul YU stl po 8 tals are Ct bpiay B4 alias YL] st] iil Gan Ca gh pd ogpy we YO] es] Sigal cass Galil! Chal Sh lad! Sater YO) std ili! gen Gals! Gil! laste YO) st) tpl ashy pls YO) tl aha Clip gh gu gk bowi Ff pail git HD dain pal] pau dels sd 5 7 Aazedally (gig jytatl Ay ydally sea sal gies BMY dee jl dpe [esi al I E ‘gual 1 2014 7 97 9 : dual 2010 TOI BO: ayes 0101 : das / jayEPI-EGYPT sha 985 dle ba! ogy 60 sy Ania Code: FQP-EPI-008/05 4 i) 2 Alla pal 7 aan i Atal ge eiity eal tasgeilyaatt | fda fy Atle} jail aha Qt Tf Bil so ot Gast sea | aes SYR Mad By [] ese ef] ae] det 17 tag ue Ut cape Sp.58 60 aay in 93.) Jub sary a Ya ae 7 “es CiSe tae pad i Sebanlly sya sage da oF ly pel Aa uall Y Hand pLAEY 3 yp.50 Galea) Ja a) JU Gat [| ef] od Slug) Glial (plana! Gand) gi Alem od |] ote ant] Test results: 1- CT/MRI : 2- Electro-myelograph (EMG) : | 3- Cerebro-Spinal Fluid Other clinical signs: (CSF) results : Normal _[ |Septic _[ |Aseptic Final diagnosis (causing para Aladl ce ENN Ale LR yee lll lap pal SY Anal! digs publ gaat | gua | Geedily Aig oo UL aT Ge 1 2014 (9/9 : deed a 2010 01/30): imey! ais ~ 0101 : pans J janetCode: FQP-EPI-008/06 1B yi 2 Ui past obi Aa 980 JL AA pl 2017 / 1¥f 13 sds as 2010 /01 130 Sane Go OVI01 : pai / jlaal Apel me pies BMY maui JoieEPI-EGYPT Code: FQP-EPI-008/07 2014 / 979 :dubae 2010 101/30 : Nua¥l ue Shall gM) Glan Ye aaa Gad ‘las Bist a ie Aa aaa Dy sv DENT] = Soy zi Ga cag Se GIG TT GSN Gn EAN ss Je LDS a Ih raya Aspe ly se Ay yaadly a sl sia BIS se il dye 01/01 = die J isa)Code: FQP-EPI-008/08 Fin Adal Slay! 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Be etl iar i Soot pe esl oul os dball Rydal SEs pelt yyy dol gene By Vy dee lt Sgt em os wi 1 7 7 Fel ga 2016 111: eee OOO F Gas jaca Sunsets Code: FQP-EPI-008/10 EPI-EGYPT seeemcieEOM pal dete Ga Bed SSI! araill Clinical Examination tl shtml Sgro fyi I madly pila! 2 4 ‘ rning Signs © 1 Four or more new ear infections wi 2 ‘Two or more serious sinus infections within 1 year 3 Two or more months on antibiotics with little effect 4 5 6 7 Failure of an infant to gain weight or grow normally Recurrent, deep skin or organ abscesses Persistent thrush in month or fungal infection on skin 8 Need for intravenous antibiotics to clear infections 9 Two or more deep-seated infections including septicemia 10 | _A family history of PID Poe So Gea ae Pe T 2016 7 T/T dates 2010 101/80 : av ae 02/01 = dat / ia)yo ea, EPI-EGYPT sided feet gi! pal gph Dhl aut = i Oe eee : a Ralien ei | ealear got | Mga Seal L a eH Eo 2 7 sae genes eS pl gar 1S ae dy ei Eh dh ol Ll op salt | Maller Qt | tell gr ly eae I SA Sa ge al pa Bs sage nye 84 yl dys — Sl gar oll ed apy pe Cl gars PO OUI pica — Sieg ga La aM planes = Bip tay pase — ) | DIU Stal Jp get ge sal pest ae | er | eh pea al Sayyed dee | tale ge dp il Uyldy sei dye 1 2016 7 117 1 ee 2010 10180: Sea es 02/01: di/ ea}oe ew, EPI-EGYPT $2080 Bais Zdys Teer, : heal aught ead say NuID: Summary Case Investigation Report Form \ bia Ee Personal Data ; ce Name Age Y/M | | Sex | T Residence | Gov. | Dist. | aaa, Complaint (in patient own words ) Clinical Examination Hi 1- General (Fever, Vomiting, Headache, Diarrhoea sn) | 2- Neurological i |__- Sensations intact I Tost oe EH Motor tone l reflexes, ] = Autonamic sphineterie control Investigation Laboratory - Blood (CBC , ESR, K+, CPK) T > GBF (eell, proteins ...) 1 Radiological - MRI - EMG - NCV Provisional Diagnosis Final Diagnosis Signture : Neurologist Pediatrician heren ihe specialist Date 1 2017 7 ANT 3 shal ae 2010 701 20: jucyl ee OWT: dec) JaaPe EPI-EGYPT ( shel ) gigolo gu! 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