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   2013| April-June  | Volume 40 | Issue 2  
    Online since May 26, 2014

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Mirror movements in amyotrophic lateral sclerosis
Mohamed Imam, Marwa Hassan, Mohamed Hamdy, Reinhard Dengler
April-June 2013, 40(2):101-106
Background Mirror movements (MMs) are involuntary movements that suggest a upper motor neuron involvement. Objectives The aim of this study was to assess the MMs phenomena as an early sign of upper motor neuron involvement in amyotrophic lateral sclerosis (ALS). Patients and methods Fifty patients with ALS were subjected to full clinical neurological examination and identification of the MMs phenomena in both upper limbs (ULs) and lower limbs (LLs), if present. Detection of MM was performed using a surface electromyography (EMG) study from the abductor digitiminimi and tibialis anterior muscles and transcranial magnetic stimulation and simultaneous recording of the EMG activity and motor evoked potentials (MEPs) from the ipsilateral and contralateral sides. Results MMs were detected by analyzing ipsilateral MEP and the EMG of the patients examined. MMs detected by EMG of the examined muscles correlated well with the increased muscle tone, exaggerated reflexes, and central motor conduction time in LLs. The specificity of the MM and the positive predictive value were higher compared with the sensitivity and the negative predictive value. Subclinically, MMs were detected by analysis of ipsilateral MEP of LLs (27%), ULs (45%), and by the EMG of the ULs (45%) and the LLs (45%). Conclusion and recommendations MMs are rarely detected clinically in ALS, but they can be detected using electrophysiological procedures such as the MEP and the EMG. Detection of MM is a good specific test with high positive predictive value in diagnosing the ALS.
[ABSTRACT]   Full text not available  [PDF]
  662 81 -
Bone mineral density and serum sclerostin levels in early ankylosing spondylitis: their possible correlation with a panel of disease activity and structural change parameters
Manal A Abdel Khalek, Wael A. Nassar, Alyaa A El Sherbeny, Raafat T. Escandar
April-June 2013, 40(2):81-87
Objective The aim of this study was to investigate decreased bone mineral density (BMD) and serum sclerostin levels in early ankylosing spondylitis (AS) and to determine their possible correlation with a panel of disease activity parameters, functional impairment, bone turnover markers and syndesmophyte formation. Methods A total of 37 male patients having early AS with a disease duration of less than 10 years were included into the study and divided into two groups (group I, <5 years and group II, 5-10 years). The study also included 30 apparently healthy controls. The assessment included demographic data, clinical examination and measurement of the C-reactive protein (CRP)-based Ankylosing Spondylitis Disease Activity Score (ASDAS), the Bath Ankylosing Spondylitis Functional Index (BASFI), the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS), BMD measurement of lumbar spine and hip using dual-energy X-ray absorptiometry and determination of erythrocyte sedimentation rate (ESR), CRP levels, creatinine levels, bone alkaline phosphatase (BALP) levels, serum levels of C-telopeptides of type I collagen (sCTX) and sclerostin levels. Results Osteopaenia and osteoporosis of the lumbar spine were observed in 47 and 23.53% and in 35 and 15% of patients in group I and II, respectively. In the proximal femur, osteopaenia and osteoporosis were detected in 35.3 and 17.65% and in 45 and 25% of individuals in group I and II, respectively. ESR, CRP and sCTX levels were significantly higher in patients than in controls, with an insignificant difference between the patient groups. BALP levels showed an insignificant difference between the three groups. Serum sclerostin levels were significantly lower in AS patients compared with controls and in group II patients compared with those of group I. A low BMD correlated negatively with parameters of disease activity (ESR, CRP and ASDAS), BASFI scores and sCTX levels. No correlation was demonstrated between low BMDs and mSASSS and between BALP and sclerostin levels. Sclerostin showed a negative correlation with disease activity parameters (ESR, CRP and ASDAS), BASFI scores, sCTX levels, and mSASSS. Conclusion A low BMD is common in early AS patients; the role of inflammation seems to be pivotal in its pathogenesis. The monitoring of bone turnover markers and disease activity indices may help to predict patients at risk. Sclerostin expression is impaired in early disease and was linked to disease activity, bone turnover markers and increased structural damage, emphasizing the role of sclerostin in the pathogenesis of AS.
[ABSTRACT]   Full text not available  [PDF]
  610 106 -
Intranerve ratio and ultrasonography reliability in increasing the diagnostic sensitivity of minimal ulnar nerve entrapment at the elbow
Abd El Samad I. El Hewala, Ghada S. Nageeb, Sara M. Fouad, Khaled M. Shawky
April-June 2013, 40(2):107-113
Objective The aim of this study was to detect the role of intranerve ratio (IN-ratio) and high-resolution ultrasonography (HRUS) in increasing the diagnostic sensitivity of minimal ulnar nerve entrapment (UNE) at the elbow. Methods This study included 39 patients having clinical and electrophysiological evidence of UNE, 27 patients having only clinical evidence of UNE, and 28 apparently healthy volunteers. IN-ratios were calculated and HRUS of the ulnar nerve were performed for all individuals. Results The IN-ratio was significantly decreased in group II when compared with other groups. The cutoff value was 0.98 or less for IN-ratio and 10mm 2 or more for maximum crosssectional area (CSA-max). In group II, the CSA-max values were significantly increased in patients with positive IN-ratios ( 0.98) compared with those with negative IN-ratios (40.98). There was a significant negative correlation between IN-ratios and CSA-max values. Positive decreased IN-ratios (0.98) were detected in 26 patients. IN-ratios of 0.98 or less were more frequently observed in patients of group II compared with other groups. Moreover, a higher incidence of positive IN-ratios (0.98) along with positive CSA-max (≥10mm 2 ) values was observed among patients of group II compared with other groups. Sensitivity and specificity of IN-ratios in diagnosing UNE electrophysiological (UNE EF)- patients were 66 and 82%, respectively. Using both IN-ratios (0.98) and CSA-max (≥10mm 2 ) increased the diagnostic sensitivity and specificity of UNE to 85 and 94%, respectively. Conclusion When IN-ratio and HRUS (CSA-max) findings are positive, the patient could be classified as having 'minimal UNE'. Recommendation Using this new electrophysiological test along with CSA-max as a routine screening test for minimal cases of UNE is beneficial.
[ABSTRACT]   Full text not available  [PDF]
  581 76 -
Musculoskeletal ultrasonographic assessment of asymptomatic hyperuricemic Egyptian individuals
Takwa B. Younes, Enas A. ELattar, Hazem F Aboul Hamayed, Remon Z. Elia
April-June 2013, 40(2):88-95
Background Asymptomatic hyperuricemic individuals are discovered accidently on the basis of elevated levels of serum urate. The established use of urate-lowering treatment in patients with gouty arthritis is well documented; however, it is still an issue of research and controversy in individuals with asymptomatic hyperuricemia. Therefore, many attempts have been made to study the influence of asymptomatic hyperuricemia on different musculoskeletal organs. Objectives The aim of this study was to view the ultrasonographic musculoskeletal changes in asymptomatic hyperuricemic individuals and to compare them with the findings in normal controls. Methods Bilateral ultrasonographic examinations of the first metatarsal-phalangeal joints, ankles and knees, as well as of the related tendons and enthesis of the lower limbs, for 40 asymptomatic hyperuricemic individuals and 40 normal controls, were performed. Results A double contour sign was found at the first metatarsal-phalangeal joint in 45% of joints of hyperuricemic individuals but was absent in controls (P<0.001). It was also found in the femoral cartilage in 15% of knees of hyperuricemic individuals but was absent in controls (P<0.0001). Patellar tendenopathy was recorded in 6.25% of tendons. Intratendinous tophi were significantly reported in the patellar and Achilles tendons of patients. Achilles enthesopathy was reported in 18.75% of tendons of patients compared with 2.5% of tendons of controls (P<0.001). Intra-articular tophi were reported in 16 ankle joints (20%) of hyperuricemic individuals but were absent in controls (P<0.001). Conclusion Musculoskeletal ultrasonography of asymptomatic hyperuricemic individuals helps identify morphostructural changes suggestive of gouty arthritis induced by chronic hyperuricemia occurring in both intra-articular and extra-articular structures.
[ABSTRACT]   Full text not available  [PDF]
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Role of B-lymphocyte activating factor (BAFF) in the pathogenesis of systemic lupus erythematosus
Sherihan Salama, Nadia Kamel, Mona Zamzam, Nayera Saber, Mohammed El Tayeb, Sherif Maroof, Hanaa Amer, Ahmed Kamel
April-June 2013, 40(2):96-100
Background B-lymphocyte activating factor (BAFF) is a new member of the tumor necrosis factor family that promotes B-cell survival, acting as an antiapoptotic factor and thus contributing to the development of autoimmune disease. Objectives The aim of the study was to investigate the role of BAFF in the pathogenesis of systemic lupus erythematosus (SLE) by correlating its serum levels to different clinicopathological indices of disease activity. Methods This is a prospective study that was conducted on 20 female patients with SLE. Ten healthy controls of matching age and sex were also included in this study. All patients were subjected to full history taking and clinical examination upon presentation, and the following laboratory parameters were evaluated: complete blood picture, erythrocyte sedimentation rate, serum (creatinine, blood urea nitrogen), and complete urine analysis (anti nuclear antibody, anti-dsDNA, C3, C4 in serum). Serum BAFF levels were measured by enzyme-linked immunosorbent assay in all patients. Renal biopsy was performed whenever necessary. Results Serum BAFF levels were significantly higher in patients with active SLE than in controls (P<0.05). These levels also correlated positively with systemic lupus erythematosus disease activity index (SLEDAI) in a highly significant manner (P<0.001). Correlating serum BAFF among patients with photosensitivity and symptoms of central nervous system affection proved to be highly significant (P<0.001). In addition, within this study, serum BAFF levels correlated positively with ESR levels among patients and negatively with both C3 and C4 in a significant manner (P<0.05 and 0.001, respectively). Conclusion Serum BAFF levels were significantly higher among patients with active SLE than among controls. It correlated in a negative manner with both C3 and C4 - significantly with C3 and highly significantly with C4. BAFF levels also correlated with SLEDAI in a highly significant manner, implicating B-cell immunoglobulin production and immune complex formation in the disease activity of lupus patients.
[ABSTRACT]   Full text not available  [PDF]
  567 70 -
Ventricular diastolic dysfunction in ankylosing spondylitis patients without clinical evidence of cardiovascular disease
Ghada S. Nageeb, Amal B Abdul Sattar, Alaa A. Omran, Maha Atfy, Ghada Ebrahim
April-June 2013, 40(2):114-120
Objective The aim of this study was to evaluate the prevalence and risk factors of ventricular diastolic dysfunction (LVDD) in ankylosing spondylitis (AS) patients without clinically evident cardiovascular disease in Sharkia governorate. Methods Forty-five AS patients without clinically evident cardiovascular disease were included in the present study. The control group included 20 apparently healthy volunteers. Bath ankylosing spondylitis metrology index (BASMI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis disease activity index (BASDAI) were assessed in all patients. ECG and pulsed wave tissue Doppler imaging was performed for all patients. Results LVDD was detected in 19 (42%) patients compared with two (10%) controls. The Em/Am ratio was significantly decreased in patients. LVDD grade 1 was detected in 12 patients compared with two controls. Grade 2 LVDD was detected in five patients and grade 3 LVDD was detected in two patients compared with no controls. Univariate analysis revealed a significant risk for juvenile disease onset, increased disease duration, increased tumor necrosis factor (TNF)-α, or an increased total score for any of the following indices: BASMI, BASFI, or BASDAI. The odds ratio and 95% confidence interval were 2 (1.9-3.2), 2.7 (1.6-3.3), 2.4 (1.4-3.3), 2.1 (1.9-3.2), 3.2 (2.4-6.3), and 2.3 (1.2-3.2), respectively. According to multiple logistic regression analysis, the most significant risk factors were increased TNF-α, increased BASMI, and juvenile disease onset. P-values were less than 0.001, less than 0.01, and less than 0.05, respectively. Conclusion Risk for LVDD in AS patients is four-fold that in healthy controls. The most significant risk factor was increased TNF-α. Recommendation Pulsed wave tissue Doppler imaging should be performed routinely in AS patients for earlier detection and therapy of LVDD.
[ABSTRACT]   Full text not available  [PDF]
  561 72 -
CD4+ CD25+ T regulatory cells and proinflammatory cytokines in Egyptians with rheumatoid arthritis
Wesam S. Ibrahim, Hanan M El Saadany, Manal A Abd El khalek, Mahamoud F. Seliem
April-June 2013, 40(2):121-127
Objectives The aim of this study was to measure the levels of CD4+ CD25+ regulatory T (Treg) cells, tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-7 in both peripheral blood (PB) and synovial fluids (SFs) from rheumatoid arthritis (RA) patients and to assess their correlation with clinical, laboratory, and activity parameters in an attempt to assess their potential role in the pathophysiology of RA. Methods The study included 68 RA patients divided into two groups: group I included 42 patients with active RA and group II included 26 patients with inactive RA. Disease activity was assessed on the basis of disease activity score 28 (DAS 28), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti cyclic citrullinated peptide antibodies-3 (Anti-CCP3), and total leukocytic counts. In addition, tumor necrosis factor (TNF-α), interleukin(IL), IL-6 and IL-7 were evaluated. The presence of CD4+ and CD25+ Treg cells was determined by flow cytometry. Results The percentage of CD4+ CD25+ Treg cell in the PB peripheral blood was significantly decreased in patients with active RA compared with those with inactive RA and controls. Whereas their percentage was significantly higher in inactive RA compared with active RA and controls. Levels (%) of CD4+ and CD25 + Treg cell, IL-6, TNF-α, and IL-7 in the SF were significantly higher in patients with active RA compared with controls. There was a significant decrease in the percentage expression of CD4 + and CD25 + Treg cells in PB compared with SF in group I. The percentage of CD4 + CD25 + Treg cell in PB was inversely correlated with number of swollen and tender joints, disease activity score 28, erythrocyte sedimentation rate, and levels of C-reactive protein, RF, anti-CCP3, TNF-α, IL-6, and IL-7, whereas no significant correlations were found with age and disease duration in both the active and inactive groups. Conclusion Active RA patients exhibit a significant reduction in the levels of CD4+ CD25+ Treg cells in PB, which can be considered as a defective immune response that may contribute to the pathogenesis of RA. Hereby, the concept of an increase in the function and/or numbers of Treg cells in the PB and/or joints of RA patients could be an attractive therapeutic goal or novel paradigm in RA treatment.
[ABSTRACT]   Full text not available  [PDF]
  557 72 -
Electrophysiological study of peripheral nerves in children with acute lymphoblastic leukemia
Ibrahim K. Ibrahim, Hoda Hassab, Mohamed H. Imam, Hayam M Abd El Ghany, Kareem A. Omar
April-June 2013, 40(2):63-69
Background Estimates of the prevalence of neuropsychiatric manifestations in systemic lupus erythematosis (SLE) range from 14 to over 80% in adults. The clinical manifestations of nervous system involvement in SLE are highly diverse, and their etiology is incompletely understood. Aim of the study The aim of this study was to evaluate the prevalence of neuropsychiatric manifestations in SLE and to correlate the neuropsychiatric damage with the various disease parameters. Patients and methods A total of 100 SLE patients (48 with neuropsychiatric manifestations and 52 without) were subjected to routine laboratory testing and immunological profiling. Systemic Lupus Activity Measure scores were estimated for assessment of disease activity. Assessment of organ damage was carried out according to the Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index. The neuropsychiatric damage was measured with the corresponding domain of the SDI. The cognitive function was assessed, and MRI and electroencephalography were performed when clinically indicated. Results A total of 48% of patients had neuropsychiatric manifestations, of which headache was the most frequent (52%), followed by cognitive deficit (50%), seizures (25%), and cerebrovascular events (25%). On comparing between SLE patients with and without neuropsychiatric manifestations, it was revealed that there was a statistically significant difference between both groups as regards the presence of antiphospholipid (aPL) antibodies (P<0.001), fever, arthritis, and anti-Ro/SSA (P<0.05). The neuropsychiatric damage had a significant positive correlation with the presence of aPL antibodies (r =0.69, Po0.001), presence of anti-Ro/SSA (r = 0.42, Po0.05), disease duration (r =0.38, Po0.05), and disease activity (r = 0.41, P<0.05). Conclusion Neuropsychiatric manifestations in SLE are common; the most prevalent are headache, cognitive deficit, seizures, and cerebrovascular events. Neuropsychiatric damage in SLE patients correlates significantly with the presence of aPL and anti-Ro/SSA antibodies, disease duration, and disease activity.
[ABSTRACT]   Full text not available  [PDF]
  538 70 -
Chemokine receptor CXCR3 in peripheral blood in rheumatoid arthritis patients: its relation to disease activity and joint destruction
Amal M. El-Barbary, Salwa A. Essa, Hossam A. Zaytoun
April-June 2013, 40(2):75-80
Aim of the work The aim of this study was to investigate the role of CXCR3 in rheumatoid arthritis (RA) and its relation to disease activity, synovitis, and joint destruction. Patients and methods This study included 30 RA patients and 20 healthy controls. Morning stiffness, disease activity for 28 joint indices score (DAS-28), and Modified Health Assessment Questionnaire scores were estimated. Levels of erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, hemoglobin, and CXCR3 in peripheral blood were also determined. Radiological assessment included determination of the Van der Heijde modification scores for hands and feet and MRI scores for wrists and metacarpophalangeal joints for detection of synovitis and bone defects. Results CXCR3 levels in peripheral blood were found to be increased in RA patients compared with controls (P<0.001) and in patients with moderate and high RA activity scores. CXCR3 levels in peripheral blood were positively correlated with DAS-28 levels, Van der Heijde modification scores, and MRI scores for wrists and metacarpophalangeal joints for detection of synovitis and bone erosion. Conclusion This study demonstrates an important role of CXCR3 in the pathogenesis of chronic inflammation in RA and that CXCR3 blockade may offer a new strategy for reducing the severity and inflammatory reaction in RA patients.
[ABSTRACT]   Full text not available  [PDF]
  501 82 -
Neuropsychiatric manifestations in systemic lupus erythematosus: correlation with neuropsychiatric damage and disease activity
Reem A. Habeeb, Marwa A El Missiry
April-June 2013, 40(2):70-74
Full text not available  [PDF]
  380 63 -