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Hypothyroidism in patients with rheumatoid arthritis and its relation to disease activity
Enas A. Elattar, Takwa B. Younes, Sameh A. Mobasher
April 2014, 41(2):58-65
Background and objective The relationship between thyroid disease and rheumatic disorders has been the subject of considerable debate. Thyroid abnormal function and/or autoimmune thyroid disease were observed in patients with rheumatoid arthritis (RA), which could be attributed to the natural feature of autoimmune diseases and their tendency to overlap. Consideration of the fact that autoimmunity plays a role in the pathogenesis of both RA and hypothyroidism has raised the need to study the frequency of hypothyroidism and thyroid antibodies in RA patients and their relation to disease activity. Patients and methods One hundred and fifty RA patients and 50 control participants were included in this study. RA patients were subjected to a full assessment of medical and rheumatological history, and examination as well as routine lab tests. Patients and controls underwent thyroid function testing including thyroid antibodies. Patients' disease activity was determined using the Modified Disease Activity Score and their functional status was assessed using the Modified Health Assessment Questionnaire. Results The most common thyroid dysfunction was hypothyroidism, which was found in 36 (24%) RA patients, followed by subclinical hypothyroidism in six (4%) patients, whereas subclinical hyperthyroidism was present in two (1.3%) patients. Autoimmune thyroid disease was present in 10 (6.6%) patients and absent in the controls. There was a significant positive correlation between thyroid stimulating hormone levels and RA disease activity parameters. Conclusion Hypothyroidism was the most common thyroid disorder associated with RA, present in 24%, with a significant association with RA disease activity parameters.
  20,767 907 3
Manual therapy intervention in the treatment of patients with carpal tunnel syndrome: median nerve mobilization versus medical treatment
Faten I Mohamed, Amal A Hassan, Rasha A Abdel-Magied, Reem N Wageh
January-March 2016, 43(1):27-34
Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Median nerve mobilization is a manual therapy intervention used for treating CTS. Aim The aim of the present study was to investigate the effectiveness of median nerve mobilization in relieving manifestations of CTS when compared with conventional medical treatment. Patients and methods A total of 28 CTS patients were divided into two groups: patients in group I (n = 18) underwent median nerve mobilization, and those in group II (n = 10) underwent conventional medical treatment. Median nerve mobilization consisted of 18 treatments (three/week for 6 weeks). Patients were assessed for hand sensitivity, paresthesia, strength, pain, night awakening, thenar eminence atrophy, and were subjected to Phalen's test, Tinel's sign, Boston Carpal Tunnel Questionnaire's Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), and sensory and motor conduction studies for median nerve at baseline and at 6 weeks after treatment. Results At baseline versus at 6 weeks, pain, sensation, paresthesia, tingling, Tinel's signs, and Phalen's test outcomes were significantly improved in both groups; wrist flexion and extension improved only in group I. The difference between group I and group II after 6 weeks was significant as regards tingling, pain, wrist flexion, and extension. BCTQ-SSS and BCTQ-FSS scores improved after 6 weeks compared with baseline in patients in group I, whereas in group II the improvement was observed in BCTQ-FSS; the difference between the groups was significant. Sensory nerve conduction velocity, sensory distal latency, sensory amplitude, distal motor latency, and motor amplitude were significantly improved after 6 weeks in group I. In addition, there was a change in the grade of CTS, whereas in group II there was improvement only in sensory nerve conduction velocity; the difference between the groups was not significant. Conclusion CTS improves after median nerve mobilization, which is better than conventional medical treatment. It provides support for the use of manual therapy in conservative management of CTS with satisfactory results.
  9,655 1,604 2
Prevalence of low back pain in working nurses in Zagazig University Hospitals: an epidemiological study
Amany M Abou El-Soud, Amany R El-Najjar, Nada A El-Fattah, Aida A Hassan
July-September 2014, 41(3):109-115
Background Nursing is one of the occupations with a high risk for back injuries. The etiology of low back pain (LBP) among nurses is usually multifactorial, probably because job demands in nursing is a mixture of physically demanding and mentally demanding tasks. Objective The aim of this study was to identify the prevalence of and risk factors for chronic LBP in nursing personnel working in Zagazig University Hospitals. Materials and methods This study is a quantitative, retrospective, analytical, cross-sectional one. It included 150 female nurses who are currently working in Zagazig University Hospitals. All participants completed a self-administered Oswestry Low Back Disability Questionnaire. Data for risk factors of LBP (age, height, weight, BMI, marital state, parity) and working conditions (duration of employment in the current work, average working hours per week, work demands, duration of absence from work in the last year) were collected. Results LBP prevailed in 79.3% of the studied group of working nurses. The highest percentage was found among nurses working in the ICU (95.0%) and the least among those working in the outpatient clinics (64.0%). There was a highly significant association between LBP and body mass index (BMI) (P < 0.001). A higher incidence of LBP was associated with lifting heavy loads, followed by twisting, prolonged standing, prolonged sitting, walking for long distances, and bending forward. Conclusion Prevalence of LBP is high among nurses, resulting in significant medical and socioprofessional consequences. Risk factors necessitate multidisciplinary involvement to reduce the incidence of LBP and related costs.
  6,983 1,005 3
Prevalence and risk factors of liver biochemical abnormalities in patients with systemic lupus erythematosus
Reem Ismail El Shazly, Wafaa Hob Sharkawy Mohammed, Sahar Fakhreldin Mohamed, Mohamed Ibrahim Saif Elnasr
October-December 2014, 41(4):139-147
Aim of the work The aim of this work was to study the prevalence and risk factors of liver biochemical abnormalities in patients with systemic lupus erythematosus (SLE) and to investigate the cause of these abnormalities. Patients and methods A total of 200 SLE patients attending the Rheumatology and Rehabilitation Department, Cairo University, were subjected to full medical history, assessment of disease activity using SLE disease activity index, calculation of BMI, laboratory investigations including complete blood count (CBC), erythrocyte sedimentation rate, C3, C4, liver and kidney functions, lipid profile, antinuclear antibodies, and anti-dsDNA. Patients with alteration of liver functions had further laboratory tests including viral hepatitis markers, hepatitis C virus (HCV) antibodies, hepatitis B virus surface antigen and hepatitis A virus antibodies, PCR for patients who had HCV-positive tests, autoimmune hepatitis (AIH) profile (antimitochondrial antibodies, antismooth muscle antibodies, and anti-liver-kidney microsomal antibodies), antiphospholipid profile (anticardiolipin, lupus anticoagulant, and B 2 glycoproteins), creatine phoshokinase (CPK), and abdominal ultrasound. Results The prevalence of liver biochemical abnormalities was 6.5% two patients (15.4%) had HCV-positive antibodies, two patients (15.4%) had probable AIH, five patients (38.5%) had fatty liver, four patients (30.8%) had drug-induced hepatotoxicity, and two patients (15.4%) had no cause other than SLE itself. Hypertension, diabetes mellitus, and hyperlipidemia were more frequent in patients with elevated liver enzymes. Conclusion The prevalence of elevated liver enzymes among SLE patients attending the Rheumatology and Rehabilitation Department during the time of the study was 6.5%. The most common liver abnormality was found to be fatty liver, affecting 38.5% of the patients, followed by drug-induced hepatotoxicity (30.8%), and then HCV infection, AIH, and SLE (each 15.4%).
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The regenerative effect of human umbilical cord blood mesenchymal stem cells in a rabbit model of osteoarthritis
Ola Gharbia, Abd Elmoaty Afify, Hassan Abd El Ghaffar, Sherif El Bassiony, Amira K El Hawary, Ahmed Lotfy, Aziza Elsayed, Amel A Mahmoud, Amir Youssef
October-December 2015, 42(4):163-169
Background Osteoarthritis (OA) is a degenerative disorder characterized by changes in subchondral and periarticular bone. The limited number of therapeutic choices for articular injury and disease has increased the need for stem cells as a biological replacement for damaged cartilage. Umbilical cord (UC) blood cells are easily available and less immunogenic than other sources of stem cells, and there are no ethical concerns surrounding their use. These cells are isolated from young donors. Human umbilical cord blood mesenchymal stem cells (HUCB-MSCs) appear to be an ideal candidate for cartilage regeneration. Objective The aim of the study was to investigate the regenerative effect of HUCB stem cells on degenerated articular cartilage in New Zealand white rabbits experimentally induced with OA. Materials and methods This study was performed on 42 New Zealand white rabbits. They were surgically induced with OA in the left knees by cutting the anterior cruciate ligament. After confirmation of the development of OA histopathologically, we delivered a single dose of HUCB-MSCs directly intra-articularly in the cell-treated groups. Controls were injected with only suspension media. Histopathological tests were performed 8 and 24 weeks after injection. Results Histopathologically, 8 weeks after the injection, cell-treated rabbits showed better cartilage quality and lower degree of degeneration, whereas 24 weeks after the injection all parameters in the cell-treated groups were significantly better. Conclusion HUCB-MSCs are a promising stem cell source for cartilage tissue formation and can decrease the development of OA in rabbits.
  2,341 4,552 1
New role for insulin injection in the treatment of idiopathic carpal tunnel syndrome
Soha Eldessouki Ibrahim, Azza Hussein
October-December 2016, 43(4):157-162
Objective Local insulin injection for the median nerve was administered in patients with mild to moderate idiopathic carpal tunnel syndrome (CTS) to evaluate its effectiveness on the median nerve regeneration as it has been suggested that insulin has an effect on nerve regeneration, similar to that of nerve growth factor. Patients and methods This study included 82 patients (130 hands) with clinical and electrophysiologic evidence of mild to moderate idiopathic CTS (grade 3 or less according to Bland’s classification). The 130 hands were randomly assigned to two groups: group I received insulin injection of 10 IU Neutral Protamine Hagedorn known as humulin N (NPH) insulin locally into the affected carpal tunnel at the first visit and a similar dose of insulin after 2 weeks; and group II received a single injection of 40 mg triamcinolone acetonide injection into the carpal tunnel. Clinical and electrophysiologic evaluations were carried out at the start of the study and at 1 month after treatment. Patients were evaluated on the basis of the mean score on the Symptom Severity Scale and Functional Status Scale of the Boston Carpal Tunnel Questionnaire. Results All patients showed a symptomatic and functional improvement. Distal motor latency and distal sensory latency were decreased for both groups (4.84±0.74 vs. 4.61±0.72 and 2.88±0.27 vs. 2.55±0.19, respectively), with a significant decrease in the mean of Functional Status Scale score and Symptom Severity Scale score for patients treated with the insulin injection (2.5±0.6 vs. 2.07±0.55 and 3.13±0.47 vs. 2.23±0.5, respectively). Conclusion Local insulin injection effectively reduced the symptoms of CTS and improved electrophysiological findings in the present study. Our findings suggest that local insulin injection may be of great benefit in improving nerve functions in patients with mild to moderate idiopathic CTS. Further controlled studies are needed to confirm our preliminary findings and to compare local insulin injection with conventional approaches for the treatment of CTS.
  2,513 4,075 1
Clinical diagnosis of distal diabetic polyneuropathy using neurological examination scores: correlation with nerve conduction studies
Shereen R Kamel, Mona Hamdy, Hanaa A.S. Abo Omar, Amal Kamal, Lamia H Ali, Ahmed H Abd Elkarim
July-September 2015, 42(3):128-136
Aim The aim of this study was to diagnose diabetic sensorimotor polyneuropathy using neurological examination scores and to correlate the findings with nerve conduction studies (NCS). Patients and methods Thirty patients with type 2 diabetes were included in the study. Detection and grading of neuropathy were carried out based on the Diabetic Neuropathy Symptom (DNS) Score, modified Neuropathy Symptom Score (NSS), Diabetic Neuropathy Examination (DNE), and modified Neuropathy Disability Score (NDS). For the NCS, amplitudes, velocities, and latencies of seven nerves - that is, four motor (median, ulnar, tibial, and common peroneal) and three sensory (median, ulnar, and sural) nerves - were recorded. If the patient had two or more abnormal findings in any of these nerves, the patient was diagnosed as having peripheral sensorimotor neuropathy. Thereafter, the sensitivity, specificity, and diagnostic efficacy of each neurological score were recorded taking NCS as the gold standard. Results Diabetic sensorimotor polyneuropathy was diagnosed clinically and electrophysiologically in 17 patients (56.7%). However, there were nine cases (30%) of subclinical neuropathy. Neurological examination scores were significantly correlated with each other and with individual variables of NCS and the nerve conduction sum score. Taking the NCS as gold standard, DNS, modified NSS, DNE, and modified NDS had 65.4, 61.5, 30.8, and 61.5% sensitivity and 100, 75, 100, and 100% specificity, respectively. Their diagnostic efficacies were 70, 63.3, 40, and 66.7%, respectively. Conclusion Neurological examination scores can detect and grade neuropathy in the majority of cases. However, NCS was accurate for detection of diabetic sensorimotor polyneuropathy, especially for the subclinical neuropathies.
  5,486 675 -
Musculoskeletal disorders in hemodialysis patients and its impact on physical function (Zagazig University Nephrology Unit, Egypt)
Amany R El-Najjar, Hanan A Amar, Heba A El wahab Selim, Enas M El sherbiny, Medhat Ibrahem, Mohamed Fouad
October-December 2014, 41(4):152-159
Background A number of musculoskeletal disorders have been reported in hemodialysis (HD) patients and they exert an impact on their functional status. Objectives This study was designed to determine the most common musculoskeletal system involvement in chronic HD patients and to show its effect on physical function (disability). Patients and methods This study was carried out on HD patients at the Nephrology Unit in Zagazig University Hospitals, Egypt. Pain intensity was measured using a 100-mm pain visual analogue scale. Physical disability was measured using the Health Assessment Questionnaire. A blood sample was obtained to measure calcium, phosphorus, alkaline phosphatase, parathyroid hormone, serum uric acid, serum albumin, serum iron, serum ferritin, and transferrin. Radiography of the symptomatic joints was performed. Dual-energy x-ray absorptiometry was performed at the femoral neck and the lumbar spine. Results Of the 144 HD patients, 87 patients (60.4%) had musculoskeletal manifestations. The most common musculoskeletal disorder was joint pain (arthralgia) (25.3%), followed by osteoarthritis (17.2%), carpal tunnel syndrome (14.9%), and osteoporosis (13.7%). The results of dual-energy x-ray absorptiometry showed that the median T-score was −1.43 of the hip and −2.76 at the lumbar spine. There were highly significant positive correlations between the duration of HD and parathyroid hormone (P < 0.02). Higher Health Assessment Questionnaire scores were significantly associated with shoulder pain (P < 0.02), wrist pain (P < 0.03), small joint pain (P < 0.01), knee pain (P < 0.04), hip pain (P < 0.04), osteoarthritis (P < 0.02), and osteoporosis (P < 0.00). Conclusion Musculoskeletal system involvement remains a common problem that limits the physical function of patients with renal failure, in particular, those treated with long-term maintenance dialysis.
  5,487 673 1
Suprascapular nerve block followed by Codman's manipulation and exercise in the rehabilitation of idiopathic frozen shoulder
Mohja A El-Badawy, Mahmoud Mohamed Fathalla
October-December 2014, 41(4):172-178
Background Frozen shoulder is characterized by inflammation of the synovial lining and capsule, with subsequent generalized contracture of the glenohumeral joint causing shoulder pain and a gradual loss of both passive and active range of motion. Pain relief through suprascapular nerve block (SSNB) followed by manipulation and home exercises may be a suitable treatment option in such patients. Objective The aim of this study was to evaluate the role of SSNB followed by Codman's shoulder manipulation and home exercises in the management of idiopathic frozen shoulder. Patients and methods Twenty patients with idiopathic unilateral frozen shoulder underwent SSNB followed by Codman's manipulation of the glenohumeral joint and a home exercise program. Differences in range of motion, visual analog scale for pain, and Shoulder Disability Questionnaire were assessed before manipulation and at 1, 6, and 12 weeks after manipulation. Results The mean age of the patients was 52.1 years. Active range of motion increased significantly for flexion, abduction, internal rotation, and external rotation. Significant decrease in visual analog scale and Shoulder Disability Questionnaire scores between baseline and follow-up assessments was observed. Conclusion Manipulation under SSNB is a safe, effective, and minimally invasive procedure for relieving pain, improving range of motion, and decreasing disability in patients with idiopathic frozen shoulder.
  5,651 403 1
Pulmonary hypertension in scleroderma and its relation to disease activity
Rawhya R Elshereef, Amal A Hassan, Aymen F Darwish, Hany T Asklany, Lamiaa Hamdy
October-December 2013, 40(4):173-180
Aim The aim of this study was to screen for pulmonary hypertension (PH) in scleroderma patients using Doppler echocardiography, and correlate it with inflammatory parameters of the disease. Patients and methods Doppler echocardiography was performed in 39 patients with scleroderma (three men and 36 women) and was compared with 20 age-matched and sex-matched healthy controls. Fifteen (38.5%) patients had limited scleroderma and 24 (61.5%) patients had diffuse scleroderma. PH was diagnosed if the peak systolic pressure gradient at the tricuspid valve was more than 25 mmHg. All patients were subjected to full assessment of history, rheumatological examination, laboratory studies, chest radiography, and pulmonary function tests. Results In 39 scleroderma patients, PH was detected in five patients (12.8%); four of them had limited scleroderma and one had diffuse scleroderma. The range of pulmonary artery systolic pressure was 37-63 mmHg (mean ± SD = 49.2 ± 10.1). There was a highly statistically significant difference between patients and controls (P < 0.0001). There were no significant differences between patients with and without PH in clinical features, except for arthritis and Raynaud's phenomena (P < 0.04, 0.01). Significant differences in the level of erythrocyte sedimentation rate, complement, and anticentromere antibodies were found in patients with PH versus those without PH (P < 0.04, <0.03, <0.002, respectively). There was a statistically significant correlation between pulmonary artery pressure with disease duration (P < 0.001) and Valentini Disease Activity Index (P < 0.001). Conclusion Patients with scleroderma have an increased risk of pulmonary arterial hypertension. Echocardiography should be used as a screening tool in patients who are at a higher risk of developing PH.
  2,656 3,366 -
Foot neuropathy in rheumatoid arthritis patients: clinical, electrophysiological, and ultrasound studies
Abd El-Samad I El-Hewala, Samar G Soliman, Alaa A Labeeb, Ashraf A Zytoon, Amira T El-Shanawany
July-September 2016, 43(3):85-94
Aim This study aimed to evaluate neuropathic foot pain in patients with rheumatoid arthritis (RA) using electrophysiological studies and musculoskeletal ultrasound (MSUS) to address the association between these findings and disease activity. Evaluation of the usefulness of this combination was undertaken. Design The present study was designed as a cross-sectional study. Patients and methods A total of 50 RA patients underwent a complete history-taking and rheumatologic examination. According to the cut-off point of Disease Activity Score in 28 joints, patients were divided into two equal groups (25 patients each): active and inactive. In total, 25 healthy individuals were included as controls. Routine tibial and peroneal nerve conduction studies, as well as electromyography of tibialis anterior and abductor hallucis muscles, were carried out. MSUS assessment of the ankle joint and extra-articular portion of the foot complex was also performed. Results Electrophysiological findings of foot neuropathy were observed in 78% of the patients, irrespective of the disease activity level. In total, 48% of the patients had mononeuropathies of a demyelinating pattern (entrapment neuropathies), whereas the other 30% had symmetrical polyneuropathy with axonal degeneration. Combined distal tibial and peroneal nerve entrapments were reported in 16% of the patients. A positive power Doppler signal and joint erosions showed a highly statistical significant prevalence among the active group in comparison with patients in remission (P ≤ 0.001). Conclusion Peripheral nerve affection is common in the rheumatoid foot, irrespective of the disease activity status. The most common neuropathies were posterior tarsal tunnel syndrome, peroneal nerve entrapment at the fibular neck, and pure sensory axonal neuropathy. A positive power Doppler signal and bone erosions of the ankle joint, detected by MSUS, were associated with RA disease activity. Electrophysiology was superior to MSUS for the diagnosis of posterior tarsal tunnel syndrome.
  5,281 355 -
Treatment of premature ejaculation: a new combined approach
Adel Kurkar, Sherif M Abulsorour, Rania M Gamal, Ahmed M Eltaher, Ahmed S Safwat, Mohammed M Gadelmoula, Ahmed A Elderwy, Mahmoud M Shalaby, Abeer M Ghandour
January-March 2015, 42(1):39-44
Background Selective serotonin reuptake inhibitors (SSRIs) are utilized to treat premature ejaculation (PE). However, their effect is moderate, with no universally adopted schedule. A possible role for pelvic floor dysfunction in the pathogenesis of PE was reported previously. Objective The aim of this study was to compare the efficacy of combined sertraline and pelvic floor rehabilitation with either line in patients with an unsatisfactory response to SSRIs. Design, setting, and participants From June 2009 to December 2012, 74 PE patients with an unsatisfactory response to sertraline 50 mg were enrolled and subjected to pelvic floor rehabilitation as an alternative therapy, and then a combination of both was tested on the same group. Outcome measurements and statistical analysis Relationships with outcome were analyzed using the Student t-test, Pearson's correlation, and linear regression. Results and limitations The baseline intravaginal ejaculatory latency time (IELT) was 20-110 s (mean ± SD = 56.35 ± 21.67). With sertraline 50 mg therapy alone, IELT reached 90-180 s (mean ± SD = 121.69 ± 21.76, P = 0.0001). Of them, 44 (59.46%) patients failed to exceed an IELT of 120 s. With pelvic floor rehabilitation alone, IELT reached 90-270 s (mean ± SD = 174.73 ± 45.79, P = 0.0001). Of them, 13 (17.56%) patients failed to exceed an IELT of 120 s. Using a combination therapy of both, IELT reached 180-420 s (mean ± SD = 297.57 ± 59.19, P = 0.0001). This response was significantly higher than the baseline IELT and that of either lines alone (P = 0.0001, for all tests). Conclusion Pelvic floor rehabilitation is an important addition when treating PE, particularly in patients with pelvic floor dysfunction. We recommend this combination in patients with an unsatisfactory response to SSRIs. Patient summary Causes of PE differ considerably. In this paper, we compared the outcomes of two single treatment lines together with a combination of both. The combination therapy was more effective than either line alone.
  4,901 470 1
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
Shereen R Kamel
April-June 2018, 45(2):43-48
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.
  4,957 350 2
The role of biofeedback in the rehabilitation of veno-occlusive erectile dysfunction
Mohamed R Al-Helow, Hala Abdul-Hady, Mahmoud M Fathalla, Mohammad A Zakaria, Omar Hussein, Tarek El Gahndour
October-December 2014, 41(4):179-186
Background Pelviperineal muscles play a role in erection through the enhancement of blood flow to the penis. Hence, the reinforcement of the power of such muscles through noninvasive visual pressure biofeedback rehabilitation may be helpful in erectile function improvement. Aim The aim of this study was to assess the value of pelviperineal muscles' visual pressure biofeedback rehabilitation in the treatment of organic veno-occlusive erectile dysfunction (ED). Materials and methods This study included 30 patients with veno-occlusive ED. Exclusion criteria were neurological, psychological, endocrinal, and arterial insufficiency ED. Also, patients with malignancies, chronic renal failure, liver cell failure, urological congenital abnormalities, pelvic surgery, pelvic radiation, or trauma and patients on medications known to cause ED were excluded. All patients performed visual pressure biofeedback strengthening of the pelviperineal muscles three times weekly for 3 months. In addition to clinical and laboratory evaluations, patients were assessed by a self-administered questionnaire, a neurophysiological examination, a pharmacopenile duplex ultrasound, and the anal hold pressure. Results According to the self-administered questionnaire, 16/30 patients (53.3%) showed either partial or complete improvement (11 and five patients, respectively). On comparing prerehabilitation and postrehabilitation results of the pharmacopenile duplex ultrasound, 18/30 patients (60%) showed either partial or complete improvement (13 and five patients, respectively). The anal hold pressure improved from 120.7 to 189.9 after biofeedback rehabilitation. Conclusion Pelviperineal muscles' visual pressure biofeedback rehabilitation is effective, inexpensive, noninvasive, safe, and easily applicable in the treatment of venogenic ED and does not have as much side effects as medication.
  4,951 300 -
The effect of repetitive bilateral arm training with rhythmic auditory cueing on motor performance and central motor changes in patients with chronic stroke
Enas M Shahine, Tarek S Shafshak
January-March 2014, 41(1):8-13
Objective The aim of this study was to compare the effects of bilateral arm training with auditory cueing (BATRAC) versus control intervention on motor performance of the upper extremity (UE) and to explore the central neurophysiological mechanism underlying this effect in moderately impaired chronic stroke patients. Design This was a randomized-controlled clinical trial. Materials and Methods Overall, 76 chronic stroke patients (mean age = 50.2 ± 6.2 years), 6-67 months after the onset of the first stroke were enrolled. They received either BATRAC (with both UE trained simultaneously in symmetric and asymmetric patterns) or control intervention (unilateral therapeutic exercises for the paretic UE). Each session lasted for 1 h, scheduled as three sessions/week (on an alternate day) for 8 successive weeks. Outcome measures included the Fugl-Meyer motor performance test for the UE (FMUE) and percutaneous transcranial magnetic stimulation to elicit motor-evoked potential (MEP) in paretic abductor pollicis brevis muscle. Results Group comparisons indicated a significantly better improvement in the MEP parameters (transcranial magnetic stimulation threshold, central motor conduction time, and MEP amplitude) in the BATRAC group. The FMUE scores increased in both groups, but there was no significant difference between groups in the FMUE scores. Conclusion These findings recommend the use of BATRAC in chronic stroke patients not only to improve motor performance but also to induce central neurophysiological effects.
  4,646 558 5
The effectiveness of intensive versus standard physical therapy for motor progress in children with spastic cerebral palsy
Mohammad H Elgawish, Mohammad A Zakaria
January-March 2015, 42(1):1-6
Background Cerebral palsy (CP) remains the most common cause of physical disability in children that results from a static brain lesion during pregnancy or early life. Although the brain lesion is static, the physical manifestations and medical issues may progress, leading to altered motor patterns. Objective The aim of the study was to assess gross motor progress in children with spastic (quadriplegic and diplegic) CP treated with intensive physical therapy (PT) as compared with a matched group treated with a standard PT regimen. Patients and methods Out of 45 patients with spastic CP aged 2-6 years, 25 patients were assigned to an intensive therapy group (group A), whereas 20 patients were assigned to standard therapy (control group B). Patients were classified according to the gross motor function classification system. The intervention program was administered for 16 weeks, with sitting and walking as the treatment goal. The gross motor function measures 88 and 66 (GMFM-88 and GMFM-66) and gross motor performance measure (GMPM) were used for assessment at baseline, at 8 weeks, and at 16 weeks after intervention. Results At baseline, there were no statistically significant differences between the two groups. After 8 weeks, there were significant differences between the two groups as regards the total scores of GMFM-88 and GMPM (P < 0.05). However, highly significant differences for GMFM-88 (P < 0.001) and only significant differences (P < 0.05) for GMPM were observed after 16 weeks. No statistically significant differences were found between the two groups as regards GMFM-66 scores after 8 weeks, and significant differences were found only after 16 weeks (P < 0.05). After 16 weeks, all dimensions of GMFM-88 were significantly increased in both groups (P < 0.001). Only sitting showed no statistically significant difference in group B (P > 0.05). Conclusion Intensive PT regimens were more beneficial than standard therapy in spastic CP, especially in children with a low functional level.
  4,535 666 -
Clinical and immunological profile of systemic lupus erythematosus in a pediatric population in North India
Yadav Vijay, Bhardwaj Parveen
October-December 2014, 41(4):148-151
Context Systemic lupus erythematosus is usually missed in the pediatric population because of lower awareness among pediatricians. Aims The aim of this work was to study the clinical and immunological profile of lupus in children. Settings and design This study was carried out at a tertiary teaching institute of North India; this was a retrospective hospital-based study. Participants and methods Case records of 16 children of systemic lupus erythematosus in the age group 5-15 years were reviewed from hospital records. Statistical analysis used Means, proportions, and percentages were calculated using Epi Info 7. Results The mean age of children at the time of diagnosis was 12.1 years, with a female to male ratio of 5: 1. Fever (81.2%), rash (68.7%), arthritis (56.2%), and photosensitivity (56.2%) were the common clinical manifestations. Anemia was observed in 56.2%, whereas thrombocytopenia was noted in 31.2%. The kidney was the second most common system to be involved, with involvement in 43.7% of cases. Central nervous system involvement was observed in 31.2% of cases. Cardiac involvement was noted in 18% of cases. Antinuclear antibody was positive in all children. Three children died; two died of severe sepsis and one because of cardiogenic shock. Conclusion Systemic lupus should be considered a possible cause in adolescents presenting with multisystem involvement.
  2,965 2,151 1
Intra-articular injection of hyaluronic acid for treatment of osteoarthritis knee: comparative study to intra-articular corticosteroids
Soad A Elsawy, Mona Hamdy, Manal S Ahmed
October-December 2017, 44(4):143-146
Objective Osteoarthritis (OA) is a chronic degenerative joint disease characterized by pain and progressive functional limitation. Although both corticosteroid and hyaluronic acid (HA) injections are widely used to palliate the symptoms of knee OA, few researches involving a comparison of two interventions have been conducted. The objective of the study was to compare the efficacy and safety of HA to corticosteroid injections for the treatment of knee OA. Patients and methods We enrolled 60 patients with knee OA who were randomized to receive intra-articular injection of either HA or the corticosteroid. The therapy was followed for 6 months. The patients treated with HA received one course of injections per week for 3 weeks and the other group received single injection of corticosteroid. The two groups were compared as regards pain and functional improvement using the Western Ontario and McMaster University Osteoarthritis Index and visual analog scale. Results The study included 60 patients, with age ranging from 36 to 65 years with a mean of 51.8 years. All of them were diagnosed with knee OA using ACR clinical classification criteria. Patients were recruited between May and December 2015. After 6 months of the treatment, both groups showed functional improvement. HA group showed significant improvement compared with the corticosteroid group as regards the Western Ontario and McMaster University Osteoarthritis Index and visual analog scale (P=0.01). Conclusion Both HA and corticosteroid groups showed improvement in pain and knee function, but the intra-articular HA was superior to corticosteroid on long-term follow-up. This supports the potential rate of intra-articular HA as an effective long-term therapeutic option for patients with OA of the knee.
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Hemophilic arthropathy: clinical, radiologic, and functional evaluation: a single-center experience in a limited resource country
Hayam M Abdel Ghany, Hoda M.A. Hassab, Khaled I El-Noueam
January-March 2016, 43(1):35-40
Introduction Hemophilia A and B are clinically indistinguishable and are heterogeneous disorders. The severity of bleeding symptoms correlates with the coagulant activity of the deficient factor. Joint bleeding initially leads to independent adverse changes in both the synovial tissue and the articular cartilage. Aim The aim of the present work was to evaluate hemophilic joints clinically, radiologically, and functionally in patients with hemophilic arthropathy. Materials and methods The study was carried out on 30 boys suffering from hemophilic arthropathy; the mean age was 10.6 ± 2.95 years. All patients were subjected to thorough history taking and local physical examination of the 'target joint'. Functional Independence Score in Hemophilia (FISH) and the Pettersson scoring system were assessed for all patients. Results The age at first hemarthrosis decreased with the severity of hemophilia, whereas the number of bleeds/year and the number of joints affected increased with the severity, and the results were statistically significant. A statistically significant positive correlation was found between the Pettersson score and both the age of the patients and the number of bleeds/year. However, a negative correlation was found with factor activity level. In contrast, the FISH score had a significant positive correlation with factor activity level. Conclusion A significant decrease in the functional ability was demonstrated on the basis of the severity of hemophilia. Both the FISH and Pettersson scoring systems are of great importance in assessing patients with hemophilic arthropathy.
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Healing effects of prolotherapy in treatment of knee osteoarthritis healing effects of prolotherapy in treatment of knee osteoarthritis
D. M. I. Soliman, NM Sherif, OH Omar, AK El Zohiery
April-June 2016, 43(2):47-52
Purpose Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a two-arm controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis (OA). Materials and methods A total of 104 adults with at least 6 months of painful primary knee OA were treated with dextrose prolotherapy (group I). They were divided into two subgroups: Ia and Ib. Subgroup Ia was treated with both techniques of prolotherapy (Hackett technique - classic, traditional prolotherapy - and Lyftgot technique - neural prolotherapy), whereas subgroup Ib was treated with the Hackett technique only. Extra-articular and intra-articular injections were administered at 1, 2, and 3 months, with as needed additional treatments at months 4 and 5. A total of 24 adults with at least 6 months of painful primary knee OA were treated with physiotherapy (group II). Outcome measures included the following: clinical assessment; visual analogue scale (VAS), 10; Western Ontario McMaster University Osteoarthritis Index (WOMAC), 96 points; plain radiographs; and musculoskeletal ultrasound. Postprocedure hot packs were applied, and at-home massage and exercises were taught. Results 128 Patients enrolled in the study were matched with each other for sex, age, disease durations, and BMI. Subgroups Ia and Ib reported a significant improvement as regards the clinical assessment, VAS, WOMAC, and radiological assessment at 12 months, compared with their baseline at month 0 and compared with group II (P ≤ 0.001). At 12 months, the mean ± SD of VAS was 0.32 ± 0.27 for subgroup Ia, 0.44 ± 0.5 for subgroup Ib, and 9.9 ± 1.65 for group II, and the mean ± SD of WOMAC was 11.32 ± 10.3 for subgroup Ia, 18.5 ± 10.25 for subgroup Ib, and 79.5 ± 22.63 for group II. Postprocedure application of hot packs, massage, and paracetamol resulted in diminution of injection-related pain. There were no adverse events. Conclusion Prolotherapy resulted in clinically sustained improvement of pain, function, and radiological assessment, which means that the healing effects of prolotherapy is better than that of physiotherapy. The combination of the two prolotherapy techniques results in quicker and better improvement for patients in terms of the clinical assessment, VAS, and WOMAC.
  4,154 503 3
Suprascapular nerve block in the treatment of hemiplegic shoulder pain
Mohja A El-Badawy
January-March 2014, 41(1):20-27
Objective The aim of the study was to study the effectiveness of suprascapular nerve block (SSNB) in reducing pain and increasing range of motion (ROM) in hemiplegic shoulder pain and to compare them with therapeutic ultrasound (U/S). Design The study was designed as a randomized controlled trial. Setting The study was conducted in the Department of Physical Medicine, Rheumatology and Rehabilitation. Patients and methods Stroke patients with hemiplegic shoulder pain who met the inclusion criteria were included in the present study and allocated to the SSNB or U/S groups. Both groups were given the same standard program of ROM exercise, and visual analog scale score of pain, passive maximum ROM, and Croft Disability Questionnaire at second and fourth weeks were evaluated. Results Twenty stroke patients were equally allocated to the SSNB and U/S groups. There was a significant improvement in visual analog scale scores and Croft Disability Questionnaire at the second and fourth weeks in the SSNB group. For ROM outcome of the SSNB group, the increase in flexion at the second and fourth weeks was 18.96 ± 11.73 and 34.93 ± 17.58 and in abduction was 22.26 ± 15.48 and 41.12 ± 22.02, respectively. SSNB produced faster relief of pain and more effective restoration of ROM compared with U/S. Conclusion The present study suggested that SSNB is a safe and effective treatment for hemiplegic shoulder pain. It was more effective than therapeutic U/S in reducing pain score and improving ROM and upper limb function.
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Primary Sjögren’s syndrome with polymyositis, a rare amalgamation
Harpreet Singh, Deepak Jain, B Kiran, Neeraj Kumar
January-March 2018, 45(1):39-41
Sjögren’s syndrome is characterized by diminished lacrimal and salivary gland secretory function. This disorder is not strictly confined to the exocrine glands and its manifestations may extend to extraglandular sites, such as the lungs, kidneys, reticuloendothelial system, and the musculoskeletal system. Although muscular manifestations are very common with Sjögren’s syndrome, true myopathy is very rare. Here, we report a case of a 45-year-old woman who presented with complaints of bilateral progressive weakness of upper and lower limbs associated with difficulty in neck holding with a history of dryness of the mouth and the eyes. The diagnosis of polymyositis associated with Sjögren’s syndrome was established on the basis of clinical picture and diagnostic tests. True polymyositis is very rare in primary Sjögren syndrome and there are scarcely any cases of primary Sjögren’s syndrome with polymyositis reported in the literature.
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Medial calcaneal neuropathy: a missed etiology of chronic plantar heel pain
Emmanuel Kamal Aziz Saba, Sarah Sayed El-Tawab, Hussein Al-Moghazy Sultan
October-December 2017, 44(4):147-152
Introduction Medial calcaneal neuropathy had been implicated as a source of chronic plantar heel pain. Aim The aim was to determine the presence of medial calcaneal neuropathy as a cause of chronic plantar heel pain. Patients and methods The present study included 43 heels obtained from 38 patients with chronic plantar heel pain and 30 apparently healthy volunteers as a control group. Clinical examination was done. Sensory nerve conduction study of the medial calcaneal nerve was performed. This was a single-center, public hospital-based study. It was designed as a cross-sectional examination of consecutive patients with chronic plantar heel pain. Results There were 27 (62.79%) heels, from 23 (60.52%) patients, who had medial calcaneal neuropathy. From them, unobtainable medial calcaneal nerve response was present in 10 (37.03%) heels of nine (39.13%) patients. Medial calcaneal neuropathy was the solitary cause of chronic plantar heel pain in 10 (37.03%) heels from 10 (43.48%) patients. However, it was associated with other local heel pathologies in the remaining patients. The majority of them were having plantar fasciitis in nine (33.34%) heels from five (21.73%) patients. Conclusion Medial calcaneal neuropathy is present in a considerable number of patients with chronic plantar heel pain. It should be taken into consideration during the assessment of any patient with chronic plantar heel pain.
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Electrophysiological Phalen’s provocation test in carpal tunnel syndrome
Dina A Farrag, Abeer K El-Zohiery
January-March 2018, 45(1):13-17
Objective Routine nerve conduction studies (NCS) are considered the golden standard for the objective diagnosis of clinically detectable carpal tunnel syndrome (CTS); however, fallacies can still befall. Clinically, phalen’s provocation test has proven reliability for screening CTS, yet, its use during NCS is still to be assessed. Thus, we aim to evaluate the role of our newly proposed electrophysiological Phalen’s provocation test (EPPT) in the diagnostic work-up of CTS. Patients and Methods One-hundred clinically suspected CTS hands and forty healthy hands were included in this study. Routine median motor and sensory NCSs were performed twice; once before and secondly, after provocation with wrist in 90 degrees flexion for 60 seconds (EPPT). Results All patients showed significantly delayed median distal motor and sensory latencies than controls (P<0.001). After EPPT, the percentage of change in median nerve distal sensory latency (MDSL) only was significantly higher in patients compared to controls (P<0.05). Moreover, the increased MDSL after provocation was more significant among clinically phalen’s positive hands (P=0.001). In addition, a cut off value of 3.2 msec could detect median sensory neuropathy at the thumb after provocation and it showed better performance than distal sensory recording before provocation. Conclusion EPPT might be promising for early detection of sensory neuropathic changes in CTS.
  4,038 207 1
Evaluation of exercise training on work capacity, functional mobility, and quality of life in hemodialysis patients
Amany M Abou El-Saoud, Omyma Z Shehata, Ahmad A Emerah, Elsayed F Sayed
July-September 2014, 41(3):103-108
Introduction Patients with chronic renal failure are restricted in their physical and social aspects of life because of their treatment and comorbid medical conditions. Aim of the work The aim of this study was to evaluate the effect of an exercise training program on functional work capacity, functional mobility, and quality of life (QOL) in patients with renal failure on hemodialysis. Patients and methods Thirty patients with chronic renal failure on maintenance hemodialysis participated in a regular exercise training program three times/week for 12 weeks. Each exercise session consisted of a warm up, cycle or trade mill exercises, stretching exercise, and cool down. All patients were subjected to a cardiovascular graded exercise tolerance test, the sit-to-stand-to sit test, and the 6-min walk test. A questionnaire was used to assess the QOL of the study group 1 week before and after the exercise training program. Fifteen normal individuals, age and sex matched with our patients, were used as controls to compare the respiratory function. Results There was a significant improvement in work capacity before and after the training exercise program, respectively (7.24 ± 0.90 to 9.62 ± 1.1; P < 0.001); also, there was a highly significant improvement in functional mobility. The QOL had improved after the exercise training program on four of five scales of the 36 questionnaire. Conclusion A suitable exercise training program is essential for improvement of work capacity and mobility, and improvement of psychological status and QOL.
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