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   Table of Contents - Current issue
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April-June 2018
Volume 45 | Issue 2
Page Nos. 43-85

Online since Monday, April 2, 2018

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ORIGINAL ARTICLES  

Using Rheumatoid Arthritis Disease Activity Index-5 questionnaire in the assessment of disease activity in patients with rheumatoid arthritis: correlation with quality of life, pain, and functional status p. 43
Shereen R Kamel
DOI:10.4103/err.err_31_17  
Objective The aim of our study was to assess the disease activity in patients with rheumatoid arthritis (RA) using Rheumatoid Arthritis Disease Activity Index-5 (RADAI‑5) questionnaire and to find its correlation with Disease Activity Score-28 (DAS28), quality of life, pain, and functional status. Patients and methods A total of 40 patients with RA were included. Quality of life was evaluated by Quality of Life–Rheumatoid Arthritis scale. The severity of pain was measured by 100-mm visual analog scale-pain. Health Assessment Questionnaire Disability Index was used to evaluate functional status. Disease activity was measured by using the DAS28 and RADAI-5. Results Mean RADAI-5 score was 4.2±1.7 (moderate disease activity). A total of seven (17.5%) patients were in remission, four (10%) patients had mild disease activity, 19 (47.5%) patients had moderate disease activity, and 10 (25%) patients had high disease activity. RADAI-5 was significantly correlated with DAS28, quality of life scale, pain scale, and functional status (r=0.9, P<0.001; r=0.9, P<0.001; r=0.4, P=0.02; and r=0.6, P<0.001, respectively). Moreover, RADAI-5 was found to be significantly correlated with morning stiffness duration, Ritchie articular index, tender 28-joint count, swollen 28-joint count, erythrocyte sedimentation rate, anticyclic citrullinated peptide, and rheumatoid factor positivity (r=0.3, P=0.03; r=0.8, P<0.001; r=0.9, P<0.001; r=0.7, P<0.001; r=0.6, P<0.001; r=0.6, P<0.001; and r=0.4, P=0.008, respectively). Conclusion RADAI-5 is a simple and low-cost self-report questionnaire that reflects patients’ perception of signs and symptoms. The correlations of RADAI-5 with DAS28, quality of life, pain, and functional status reflect its value in the assessment of disease activity in patients with RA.
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Subclinical neuropsychiatric dysfunctions in female patients with systemic lupus erythematosus p. 49
Caroline S Morad, Howaida E Mansour, Soha E Ibrahim, Khaled A Ahmad, Shaimaa G Arafa
DOI:10.4103/err.err_46_17  
Objective To examine for presence of subclinical neuropsychiatric lupus and cerebral atherosclerosis and their correlation with MRI/magnetic resonance angiography (MRA) findings and disease activity and to find if these radiological changes compared with laboratory parameters could be predictive of the early NP affection aiming for early management of these dysfunctions. Patients and methods Thirty adult female patients with systemic lupus erythematosus (SLE) were enrolled, with assessment of SLE disease activity using Systemic Lupus Erythematosus Disease Activity Index; psychometric evaluations using the Modified Mini-Mental State Examination to assess for cognitive dysfunction; Hamilton Depression Rating Scale and Hamilton Anxiety Scale to assess for depression and anxiety, respectively; and brain MRI/MRA to detect any changes in subclinical cases. Results The mean age was 31.7 years. Twelve (40%) patients had positive antiphospholipid (aPL) antibodies with or without clinically evident antiphospholipid syndrome, 22 (73.33%) had different NP manifestations, 13 (43.3%) depression, 15 (50%) anxiety, and 16 (53.3%) cognitive dysfunction. All patients with depression and anxiety and 87.5% of patients with dementia showed abnormalities on MRI. All patients with positive aPL showed abnormalities on MRI, whereas abnormalities on MRI were found in only eight patients with SLE with negative aPL (100 vs. 44.4%). There was a significant correlation between SLE disease activity and both NP manifestations and abnormalities on MRI/MRA, and also between aPL antibodies and NP manifestations. Abnormalities on MRI included discrete white matter lesions, cortical atrophy, and gross infarctions. Conclusion Significant number of patients with SLE without overt NP manifestations had subclinical cerebrovascular and cognitive dysfunctions, depression, and anxiety by simple bedside questionnaires. SLE disease activity positively correlates with NP manifestations. The presence of aPL antibodies is a strong risk factor for developing NP SLE. Several distinct brain MRI patterns were observed in patients with active NP SLE, suggestive of different pathogenic mechanisms.
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Toward sensitive and specific electrodiagnostic techniques in early carpal tunnel syndrome p. 57
Sara E Hegab, Mohamed K Senna, Eman A Hafez, Seif E A Farag
DOI:10.4103/err.err_41_17  
Context There remains no gold standard or even true agreement among clinicians as to which electrophysiological tests are most important and most relevant particularly in the mild and early carpal tunnel syndrome (CTS). Aim The aim of this study was to determine the sensitivity and specificity of electrodiagnostic (EDX) techniques to confirm the clinically diagnosed patients with mild CTS. Patients and methods This is a descriptive study. A total of 109 hands (68 right hands and 41 left hands) with symptoms consistent with mild idiopathic CTS, as well as 100 hands from controls, were clinically examined and underwent EDX evaluation. Results The ring-difference and thumb-difference had the highest sensitivity, with the distal sensory latency (DSL) of the median nerve coming next. Combined sensory index (CSI) test at a cutoff point more than 1.1 had 100% specificity and positive predictive value. Abnormal DSL of the median nerve had the best negative predictive value. In patients with early and mild CTS and with normal distal motor latency and DSL, the CSI at cutoff point more than 1.1 is the best EDX test that is able to detect most of these patients. Conclusion CSI and its individual components appear as the best EDX tests that help in the diagnosis of patients with early and mild idiopathic CTS.
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Usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome p. 65
Faten I Mohamed, Shereen R Kamel, Ahmed E Hafez
DOI:10.4103/err.err_22_17  
Objective The aim of the study was to assess the usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome (CTS) and to determine the relationships of ultrasonographic measurements with the clinical severity and the electrophysiological grading scale. Patients and methods One hundred CTS diseased hands and 100 nondiseased hands were assessed clinically and by nerve conduction studies. We measured ultrasonographic cross-sectional area (CSA) of the median nerve at various levels of the carpal canal (inlet and outlet), flattening ratio (FR), palmar bowing of the flexor retinaculum, wrist/forearm ratio, as well as median nerve mobility and power doppler signals. Data from patients and controls were compared to determine the diagnostic relations and the grade of severity. Results Measures of CSA of the median nerve at the inlet and at the outlet, palmer bowing and inlet/forearm ratio in the CTS group were significantly higher than the control group (P<0.05); 50% of diseased hands showed restriction of mobility of the median nerve, while 31% had doppler signals. Positive correlations of ultrasonographic measurements with patient-oriented measures, clinical severity scale and electrophysiological grade were observed. Conclusion Ultrasonographic measurements of CSA at the inlet and flexor retinaculum have a relatively higher diagnostic accuracy than FR for CTS. The correlation between clinical scores, historical-objective-distribution scale, electrophysiological grade and ultrasonographic measurements reflects the usefulness of neuromuscular ultrasound in the diagnosis of idiopathic CTS.
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The utility of maximal oxygen uptake testing as cardiovascular disease risk marker in female patients with rheumatoid arthritis without associated lung disease p. 74
Samah H El-Medany, Gehan H Abo El-Magd
DOI:10.4103/err.err_23_17  
Aim The aim of this study was to evaluate maximal oxygen uptake (VO2 max) as a marker of cardiovascular disease (CVD) in rheumatoid arthritis (RA) and its relation to the CVD risk factors in a cohort of female patients with RA without associated lung disease. Patients and methods A total of 132 female patients with RA were assessed for cardiopulmonary fitness with a VO2 max testing. Moreover, 100 healthy female individuals were recruited as control group. Exclusion of patients with pulmonary fibrosis/nodules by using high-resolution computed tomography was done. Traditional CVD risk factors and disease characteristics and their correlation with VO2 max level were assessed in all patients. Results Based on VO2 max mean, patients were classified into three groups: unfit (<16.72 ml/kg/min), fairly fit (16.73–25.6 ml/kg/min), and with average fitness (>25.6 ml/kg/min). Patients had significantly worse VO2 max mean (21.28±6.96 ml/kg/min) compared with control (30.88±7.36 ml/kg/min). Patients with poor VO2 max level were more likely to be older, hypertensive, with family history of CVD, with high BMI, and with high mean of Framingham risk score. Significant differences were detected between the fitness subgroups in mean of carotid intima–media thickness and presence of carotid plaques. Long duration of RA, uncontrolled disease activity, high health assessment questionnaire, high C-reactive protein, and positive anticyclic citrullinated protein antibodies were correlated significantly with reduced VO2 max level. Conclusion VO2 max test can be used as a surrogate CVD marker in patients with RA. VO2 max can be used as a noninvasive test to detect and quantify fitness defects in patients with RA at increased risk of CVD.
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Effect of a 6-week agility training program on lower limb isometric strength and fatigue index of indian taekwondo players p. 81
Amrinder Singh, Abhinav Sathe, Jaspal S Sandhu
DOI:10.4103/err.err_28_17  
Background Taekwondo is a martial art sport requiring high level of agility and lower limb strength as it helps improve performance in activities. The purpose of the study was to determine the effect of a 6-week agility training program on lower limb isometric strength and fatigue index of Indian taekwondo players. Materials and methods A total of 30 elite national-level taekwondo players (mean age: 19.86±1.81 years, mean height: 1.70±7 m, and mean mass: 60.36±13.74 kg) volunteered and were randomly assigned into two groups: group 1 (n=15) agility training group and group 2 (n=15) control group. Both agility training group and control group were assessed for lower limb isometric strength and fatigue index assessed by HUR 5340 leg extension/curl computer controlled isotonic/isometric dynamometer. Control group had followed their routine training schedule, and agility training group had performed agility training for 6 weeks. After 6 weeks of training, post-training measures were taken. Results Significant changes (P<0.05) in group 1 (agility training group) were observed in all the variables tested. No significant changes/decline in performance was found in group 2 group (control group). Conclusion This program significantly improved the performance and may be implemented as a regular part of the training schedule.
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