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ORIGINAL ARTICLES
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
DOI:10.4103/1110-161X.132458  
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.
  10,119 469 1
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
DOI:10.4103/1110-161X.140525  
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.
  3,279 557 1
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
DOI:10.4103/1110-161X.177424  
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.
  2,271 756 -
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
DOI:10.4103/1110-161X.147360  
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.
  2,125 145 -
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
DOI:10.4103/1110-161X.140524  
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.
  2,093 100 -
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
DOI:10.4103/1110-161X.168151  
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.
  634 1,542 -
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
DOI:10.4103/1110-161X.128128  
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.
  1,684 230 -
Suprascapular nerve block in the treatment of hemiplegic shoulder pain
Mohja A El-Badawy
January-March 2014, 41(1):20-27
DOI:10.4103/1110-161X.128131  
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.
  1,701 177 -
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
DOI:10.4103/1110-161X.147352  
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%).
  734 977 -
Relationship between serum 25-hydroxy vitamin D levels, knee pain, radiological osteoarthritis, and the Western Ontario and McMaster Universities Osteoarthritis Index in patients with primary osteoarthritis
Ahmed A Lotfi, Rasha A. Abdel-Magied, Rawhya R. El-Shereef, Ahmed A. Saedii, Ehab A. AbdelGawad
April 2014, 41(2):66-70
DOI:10.4103/1110-161X.132459  
Objective This study aims to detect the relationship between serum 25-hydroxy vitamin D (25-OHD) levels in patients with primary osteoarthritis (OA) of the knees and with other disease parameters of OA, mainly radiological findings, functional assessment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and pain [numerical rating scale (NRS)]. Patients and methods We studied 140 consecutive patients with primary knee OA, 110 female patients and 30 male patients. They were clinically, radiologically, and also functionally evaluated regarding OA; pain was also assessed using NRS, and serum 25-OHD, serum parathormone, serum calcium, phosphorus, and alkaline phosphatase were measured. Results In our patient sample, we found that 90 (64.3%) patients had lower 25-OHD levels. The mean serum 25-OHD was 35.77 ± 14.6 (range 10.62-71.82) ng/ml; 25-OHD was negatively significantly correlated with patients' age (P = 0.013, r = −0.236), radiological degree of OA (P = 0.036, r = −0.20), WOMAC (P < 0.0001, r = −0.337), and NRS for pain (P < 0.0001, r = −0.580). When comparing between patients with hypovitaminosis, 25-OHD less than 40 ng/ml, and patients with desirable 25-OHD levels, we found that radiographic grading of OA was significantly higher in the hypovitaminosis group (t = 2.024, P = 0.045); WOMAC was also significantly higher in the hypovitaminosis group (t = 3.226, P = 0.002) and NRS was also higher in the hypovitaminosis group (t = 4.468, P < 0.0001). Conclusion 25-OHD deficiency is prevalent in our patients suffering from OA; in addition, 25-OHD may play a role in patients suffering from OA.
  1,469 196 1
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
DOI:10.4103/1110-161X.147356  
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.
  1,344 297 -
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
DOI:10.4103/1110-161X.123789  
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.
  887 715 -
Risk factors of persistent synovitis development in early undifferentiated arthritis patients
Ghada S. Nageeb, Enass A. Elewa, Taghreed M. Azmy, Hazem Tantawy
April 2014, 41(2):79-84
DOI:10.4103/1110-161X.132461  
Background Persistent synovitis (PS) may lead to erosive joint damage and result in functional disability. Objectives The aim of the study was to identify the risk factors for development of PS in early undifferentiated arthritis patients (EUA) attending Al Sharqia Governorate Hospitals, Egypt. Patients and methods A total of 80 EUA patients comprised the patients group. Assessment was performed twice (baseline and after 1 year) using clinical, laboratory, functional, and radiological [high resolution ultrasonography (HRUS) and power Doppler (PD)] assessments. Results Among 80 patients assessed, 20 (25%) showed evidence of self-limiting arthritis and 60 (75%) had PS (PS):16 (27%) developed rheumatoid arthritis, 14 (23%) progressed to spondyloarthropathy, and 30 (50%) remained undifferentiated (UA). Baseline tender and swollen Joint Counts (TJC and SJC) and anti-CCP2 titer were significantly evident in PS patients. Baseline HRUS total score of synovitis and PD total score were significantly higher in PS patients. Family history of any specific rheumatic disease, SJC, anti-CCP2 titer, HRUS total synovitis score, and PD total score were the significant risk factors of PS development. The most significant risk factor of PS (logistic regression analysis) was the baseline PD total score. Conclusion Baseline PD total score is the most significant risk factor for development of PS in EUA patients. Recommendation PD examination of all patients presenting with EUA should be performed.
  1,372 90 -
Assessment of serum vitamin D level in patients with systemic lupus erythematosus
Fahmi E. Emam, Taghreed M Abd El-Wahab, Maha S. Mohammed, Amal S. Elsalhy, Sabah I Abdel Rahem
April 2014, 41(2):71-78
DOI:10.4103/1110-161X.132460  
Objective To evaluate the serum level of vitamin D in patients with systemic lupus erythematosus (SLE) and its relationship with disease activity. Patients and methods Forty patients suffering from SLE were enrolled in this study (group I). They were further divided into two subgroups according to the SLE disease activity index (SLEDAI) score: group Ia with respect to disease activity and group Ib with respect to disease remission. Another 20 age-matched and sex-matched healthy individuals were chosen as control group II. All patients underwent complete medical history taking and thorough clinical examination; the disease activity was assessed by the use of SLEDAI score. Serum vitamin D level in all patients and controls was measured. Results Vitamin D level was significantly higher in controls than in patients. The vitamin D deficiency was highly prevalent among patients with disease activity than in the remission group. There was highly significant inverse correlation between vitamin D level and SLEDAI score in the patient group. Vitamin D level correlated inversely with C reactive protein (CRP) and anti-dsDNA in the disease activity group, whereas it correlated positively with C3. Conclusion Vitamin D deficiency is prevalent in SLE patients more than in healthy controls; vitamin D deficiency is highly prevalent among patients with disease activity than in the remission group, and vitamin D level correlated inversely with disease activity, which suggest that inadequate vitamin D level, among other factors, probably contributed to the development of active disease in patients with SLE.
  1,226 153 -
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
DOI:10.4103/1110-161X.155649  
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.
  1,202 169 -
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
DOI:10.4103/1110-161X.192256  
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.
  471 855 -
Role of vascular endothelial growth factor expression in pathogenesis of postmenopausal osteoporosis
Mahmoud E Nasser, Henaz F Khaled, Eman A Kaddah, Ahmed M Elbadrawy, Sahar M Mahdi, Mary A Sharobeem
October-December 2013, 40(4):211-223
DOI:10.4103/1110-161X.123809  
Background Vascular endothelial growth factor (VEGF), an angiogenic growth factor, has been proved to play a significant role in bone remodeling. It may be involved in the molecular pathogenesis of postmenopausal osteoporosis. Aim The aim of this study was to investigate the expression of VEGF in bone biopsies of postmenopausal osteoporotic patients, assess the relation between the expression of VEGF and bone mineral density (BMD), and to evaluate the association between VEGF, serum estradiol, and bone estrogen receptor-α. Patients and methods This study was carried out on 30 female patients who were further subdivided into three groups: premenopausal, perimenopausal, and postmenopausal. All of them were subjected to full assessment of history, thorough clinical examination, and routine laboratory investigations. Serum estradiol levels were measured using ELISA. BMD was detected using DEXA. Bone biopsies were taken and three sections were obtained from each specimen. One was stained with hematoxylin and eosin stain for bone histomorphometrical assessment. The other two sections were stained immunohistochemically for the detection of VEGF and estrogen receptor-α (ER-α) expression. Results A highly statistically significant difference was found in VEGF expression between the premenopausal, perimenopausal, and postmenopausal women and also between osteoporotic and nonosteoporotic women. A highly statistically positive correlation was found between VEGF and each of the following: BMD, bone anabolic histomorphometrical parameters E2, and ER-α. However, a highly statistically negative correlation was observed between VEGF and bone histomorphometrical resorption parameters. Conclusion VEGF expression is decreased in bone of postmenopausal osteoporotic patients and is correlated to BMD. Its release is dependent on E2 and mediated through ER-α. These suggest that bone alterations induced by reduced estrogen in postmenopausal osteoporosis may be partly through decreased VEGF release. This makes it one of the possible targets in the treatment of postmenopausal osteoporosis.
  1,208 104 1
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
DOI:10.4103/1110-161X.147362  
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.
  1,182 99 -
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
DOI:10.4103/1110-161X.155622  
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.
  1,008 220 -
Use of the SS Scale, FIQR, and FIQ VASs for assessment of symptom severity in Egyptian fibromyalgia patients
Gihan M Omar, Shereen R Kamel, Rasha A Abdel-Magied, Nashwa M Abd-Allah
January-March 2014, 41(1):28-33
DOI:10.4103/1110-161X.128133  
Background Fibromyalgia (FM) is a complex syndrome associated with significant impairment in the quality of life and function. The ability to evaluate and measure the severity of FM is likely to provide several benefits. Objective This study aimed to assess symptom severity in Egyptian FM patients using the Symptom Severity Scale (SS Scale), Revised Fibromyalgia Impact Questionnaire (FIQR), and Fibromyalgia Impact Questionnaire Visual Analog Scales (FIQ VASs). Patients and methods Twenty-four female patients who fulfilled the ACR-2010 criteria of FM were included in the present study. The SS Scale, FIQR, and FIQ VASs were used to assess symptom severity of FM. Results The respective mean of the SS Scale, FIQR, and FIQ VASs were 7.3 ± 2.4, 52.9 ± 22.1, and 39.3 ± 14.2, and they were positively correlated with measure of pain distribution [widespread pain index (WPI)] in our patients. The SS Scale, WPI, FIQR, and FIQ VASs scores were positively correlated with many regional pain distribution sites (upper arm pain and jaw pain at most) and somatic pain symptoms (central nervous system symptoms, musculoskeletal symptoms, otological and hypersensitivity symptoms). The high scores of the SS Scale, FIQR, and FIQ VASs and their positive correlations with most of the regional pain sites and distribution and somatic symptoms indicate the severity of symptoms in the studied population. The FIQ VAS was the only significant independent determinant of FM severity (P < 0.001) in backward/stepwise multiple linear regression models. Conclusion The SS Scale of the ACR-2010 criteria, FIQR, and FIQ VASs were excellent methods for assessment of symptom severity in our Egyptian FM patients.
  1,094 102 -
Anti-Saccharomyces cerevisiae antibodies and its relationship with radiological damage in ankylosing spondylitis
Eman El-Dessoky El-Shahawy, Dalia S. Fahmy, Ghada S. Nageeb, Hanan Samir, Alaa A Al Moaty Omran, Inas M. El-Fiki
April 2014, 41(2):45-50
DOI:10.4103/1110-161X.132456  
Aim The presence of anti-Saccharomyces cerevisiae antibodies (ASCA) is controversial in ankylosing spondylitis (AS). In this study, we aimed to investigate the prevalence of ASCA in AS and its relationship with disease activity and radiological damage in patients attending Sharkia governorate hospitals. Patients and methods Thirty AS patients and 30 apparently healthy volunteers were included in the present study. All patients were questioned for Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis metrology Index and Bath Ankylosing Functional Index (BASFI). Total Bath Ankylosing Spondylitis Radiology Index (BASRI-T) and ASCA levels were measured. Results ASCA IgA level was significantly higher in AS patients than in healthy controls (P < 0.001). The ASCA-positive group, although not significant, tended to have higher BASFI scores. ASCA IgA-positive patients had higher BASRI-T levels (P = 0.037). In AS patients, significant positive correlation was found between ASCA IgA level and BASRI-T and BASFI (r = 0.19 and 0.31, respectively, P < 0.05). Bath Ankylosing Spondylitis Disease Activity Index scores, BASFI and ASCA IgA positivity were significantly associated with increased BASRI-T (P= 0.01, 0.03 and 0.04, respectively). The most significant risk factor for increased BASRI-T is ASCA IgA positivity (P < 0.001). Conclusion ASCA IgA was detected more frequently in AS patients than in healthy controls. ASCA IgA could be considered a marker of severe radiological damage. Further studies are recommended to investigate ASCA level versus radiological damage and intestinal involvement in AS patients.
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Value of musculoskeletal ultrasonography in the diagnosis of peripheral enthesopathy in early spondyloarthropathy
Amal A. Hassan, Ayman F. Darwish, Fatma A. Mohamed, Mohamed A. Ibrahim, Ahmed H Abd El-Karima
April 2014, 41(2):51-57
DOI:10.4103/1110-161X.132457  
Objective The aim of the study was to evaluate peripheral enthesopathy ultrasonography in early spondyloarthritis. Patients and methods A total of 50 patients were divided into two groups: group I included 30 patients who were diagnosed as spondyloarthropathy (SpA) and were divided into two subgroups - axial subgroup (19 patients) and peripheral subgroup (11 patients) - and group II included 20 patients diagnosed as rheumatoid arthritis. All patients were subjected to history taking, clinical examination and laboratory and radiological investigations: plain radiography and musculoskeletal ultrasonography. Results A significant difference was found between subgroups regarding clinical examination of plantar fascia, distal patellar ligament and proximal patellar ligament. We found a high significant difference between mean of Bath Ankylosing Spondylitis Metrology Index (BASMI) in axial (0.8 ± 0.6) and peripheral (0.09 ± 0.3) patients. A high significant difference was found between group I and group II regarding Madrid Sonographic Enthesitis Index (MASEI). In addition, a significant difference was found regarding the number of abnormal enthesis examined by ultrasonography. We found a highly significant difference between groups regarding structure, bursa, erosion, calcification and power Doppler scores (higher in group I); a significant difference was found between groups regarding distal patellar ligament thickness, calcification and power Doppler signal; proximal patellar ligament thickness, calcification and power Doppler and quadriceps tendon structure, thickness and power Doppler. We found significant difference between subgroups regarding structure score. Conclusion Enthesis are affected early in spondyloarthritis. MASEI score is a valuable tool for early diagnosis of SpA and can improve diagnostic accuracy of early SpA patients
  1,076 115 -
Central neuroplasticity and functional outcome of swinging upper limbs following repetitive locomotor training of lower limbs in stroke patients
Enas M Shahine, Tarek S Shafshak
January-March 2014, 41(1):14-19
DOI:10.4103/1110-161X.128130  
Aims The aim of the study was to investigate the effect of long-term repetitive locomotor training on a treadmill with partial body weight support (TTPBWS) on motor performance of the swinging and supported paretic upper limb and to explore the neurophysiological mechanism underlying this improvement. Materials and Methods Thirty ambulatory chronic hemiparetic stroke patients were assigned randomly to either one of two experimental conditions while being trained for 20 min on a treadmill with PBWS 6 days a week for 8 weeks. Patients under condition 1 received verbal cueing to perform bilateral upper limb swinging. In condition 2, patients were instructed to support both upper limbs by holding the treadmill handrails. Fugel-Meyer upper extremity motor performance test (FMUE) and motor evoked potentials (MEPs) of the paretic middle deltoid (D), biceps brachii (BB), and abductor pollicis brevis muscles were assessed before rehabilitation (A-begin), immediately at its end (A-end), and 3 months later (A-3m). Changes in the FMUE scores and MEP variables were used for comparisons among groups. Results Both rehabilitation conditions resulted in a greater than 10% increase in the mean FMUE score. Group I showed a significant improvement in MEP variables (lower resting threshold, shorter central motor conduction time, and higher amplitude) in the three tested muscles. Group II showed a significant improvement in all the MEP variables of abductor pollicis brevis muscle and an increase in the MEP amplitude of only the BB muscle. Changes in the MEP threshold and amplitude of D and BB muscles were significantly higher in the patients in group I than those in group II. Conclusion Active bilateral upper limb swinging during treadmill training is more effective in improving paretic upper limb motor performance than training with supported upper limbs on treadmill handrails. Central neural plasticity may be underlying this recovery. Task-dependent neuronal coupling between lower and upper limb muscles during walking could be beneficial in stroke rehabilitation.
  1,090 97 1
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
DOI:10.4103/1110-161X.177425  
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.
  938 176 -
Low-dose intra-articular autologous conditioned serum in treatment of primary knee osteoarthritis
Fatma K Abd-EL Motaal, Amal M Elganzoury, Mahmoud M Fathalla, Ola Abdulkareem
July-September 2014, 41(3):98-102
DOI:10.4103/1110-161X.140523  
Background Interleukin-1 (IL-1) plays an important role in the pathogenesis of osteoarthritis. Hence, agents that inhibit such cytokine have a high therapeutic potential. A method of therapy depends on competitive inhibition of IL-1 at the receptor level - that is, IL-1 receptor antagonist; such antagonist is called Orthokin, which is a normal product of monocytes and is prepared within autologous conditioned serum (ACS) from the patient's own blood cells. It is capable of blocking the effects of IL-1, including the induction of matrix metalloproteinases, prostaglandin E 2 synthesis, and expression of other cytokines. Objective The aim of the study was to clinically evaluate the effect of intra-articular injection of low-dose ACS enriched with Orthokin on primary knee osteoarthritis to assess its validity in treatment. Patients and methods This study included 30 knees with primary osteoarthritis. Baseline clinical evaluation using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score was performed. Then ACS enriched with Orthokin (IL-1 receptor antagonist) was prepared. The knee joint was injected with 1 ml ACS weekly for 3 successive weeks. Patients were assessed using WOMAC questionnaire (1 week after each injection for 3 weeks and monthly after the last injection for 3 months). Results On comparing WOMAC score with baseline data, there was a highly significant improvement in all scores, where P was less than 0.01 during all assessment periods and improvement persisted until the end of follow-up after 3 months in comparison with baseline data. Conclusion The synthesis and introduction of interleukin-1 receptor antagonists derived from own blood cells established a promising strategy in the treatment of osteoarthritis.
  976 130 1
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