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   2013| July-September  | Volume 40 | Issue 3  
    Online since May 23, 2014

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Comparison between early active and passive mobilization programs after hand flexor tendon repair in zone II
Dalia M.E. El Mikkawy, Adel H. Amr, Ahmed Gad, Reham Lasheen, Sheren Fawaz, Hala A. El Sabour
July-September 2013, 40(3):134-140
Objective The objective of this study was to study the efficacy of an early active mobilization program in comparison with passive mobilization on the range of motion (ROM) and grip strength after flexor tendon repair in zone II. Patients and methods The Modified Kessler technique, followed by a continuous epitenon suture was used to repair 21 digits in 18 patients with hand flexor tendon injury in zone II (which extends from the distal palmar crease to the middle of the intermediate phalanx of the digit). Early active mobilization of the repaired digit was started 1 day postoperatively in nine digits (group I), whereas early passive mobilization with the use of elastic bands was started in the other 12 digits (group II). ROM was monitored and compared in the two groups at 4, 8, and 12 weeks using the Total Active Motion (TAM) Score of the American Society for Surgery of the Hand, whereas hand grip strength was assessed at 8 weeks. Results There were better improvements in the TAM score in the early active mobilization group than in the passive mobilization group (11.1% excellent grade compared with 0%, 33.3% good grade compared with 8.3%, 55.6% fair grade compared with 58.3%, 0% poor grade compared with 33.3%, respectively). Comparison between progression of the TAM score at 4, 8, and 12 weeks postoperatively showed a highly significant improvement in the early active mobilization group (P =0.002, 0.0001, and 0.002, respectively), whereas improvement in the passive mobilization group was found to be significant (P= 0.012) only between 4 and 12 weeks. There were highly significant differences in grip strength between the normal and the affected side in both groups but the mean average grip strength was higher among the patients in the early active mobilization group. Conclusion An early active mobilization program after flexor tendon repair in zone II leads to better results in terms of the total active ROM. Progressive improvement occurred earlier than that in the passive mobilization program. The mean average grip strength was higher among the patients in the early active mobilization group.
[ABSTRACT]   Full text not available  [PDF]
  1,437 163 -
Transcutaneous electrical nerve stimulation of the hypoglossal nerve as adjuvant treatment of obstructive sleep apnea
Hany M. Mohamed, Mohamed A. Hefny, Tarek F. Youssef, Nagy M. Iskander
July-September 2013, 40(3):147-152
Background Hypoglossal nerve stimulation has been demonstrated to relieve upper airway obstruction acutely; implantable devices for hypoglossal nerve stimulation have shown potential functional improvement. Objective The aim of this study was to determine the effect of transcutaneous electrical nerve stimulation (TENS) of the hypoglossal nerve as a noninvasive adjuvant therapy for obstructive sleep apnea (OSA). Patients and methods A total of 25 patients with OSA were examined. Snoring, the apnea-hypopnea index, daytime sleepiness, Mallampati grading, and Friedman tongue position were examined at baseline and after TENS application. Nerve conduction studies including amplitude and distal motor latency were performed before and after TENS application. TENS was applied for stimulation of the hypoglossal nerve for three sets per week for 1 month. Results Hypoglossal nerve stimulation using TENS showed a significant improvement in daily snoring, severe apnea-hypopnea index, moderately excessive daytime sleepiness, and Friedman tongue position grade III in the studied patients after the physiotherapy program compared with before (P <0.01). The frequency of patients with delayed distal latency of the hypoglossal nerve decreased after TENS therapy (50% of patients had delayed latency in the left and 37.5% of patients had the same in the right hypoglossal nerve). The mean left distal latency of the patients decreased significantly after TENS therapy when compared with before therapy (2.23± 0.52 vs. 3.17± 0.98 ms, respectively, P = 0.0026). The mean right distal latency of the patients also decreased significantly after TENS therapy when compared with before therapy (2.31 ±0.29 vs. 3.32± 1.12 ms, respectively, P = 0.023). Conclusion The findings demonstrate the feasibility and therapeutic potential of hypoglossal nerve stimulation using TENS in OSA.
[ABSTRACT]   Full text not available  [PDF]
  1,222 143 -
The relation between serum bone morphogenetic protein-7 and severity of enthesitis in psoriatic arthritis
Nermen H. Abd-Elsalam, Nadia S. Kamel, Mona A. Zamzam, Rana El-Hilaly, Mohamed Sobhib, Moshiro H. Sabryc
July-September 2013, 40(3):129-133
Background Enthesitis is an inflammation at the insertions of ligaments, tendons, or joint capsules to bone and is one of the crucial clinical characteristics of psoriatic arthritis (PsA). Bone morphogenetic protein-7 (BMP-7) belongs to the transforming growth factor-b superfamily of cytokines that play a direct role in the pathogenesis of psoriatic enthesitis. High-resolution musculoskeletal ultrasound is a useful tool to evaluate superficial structures such as tendons, ligaments, bursae, and joints in PsA. Objective The aim of this study was to evaluate serum BMP-7 levels in PsA patients as an indicator of the severity of psoriatic enthesitis in correlation with ultrasonographic findings. Materials and methods This study involved 30 PsA patients and 10 healthy controls. The serum BMP-7 level (pg/ml) was measured through a blood sample. The clinical severity of skin affection in psoriatic patients was estimated using the Psoriasis Area and Severity Index (PASI). Lower limb enthuses were assessed using the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Results PsA patients showed significantly higher serum BMP-7 levels compared with controls. The serum BMP-7 level showed a positive correlation with the erythrocyte sedimentation rate, the disease activity score using DAS 28, the PASI% score, and GUESS but no correlation with disease duration. Conclusion The serum BMP-7 level can be used as a marker of disease activity in PsA and as a marker of the severity of psoriatic enthesitis. Musculoskeletal ultrasound can be used for early detection of subclinical enthesitis.
[ABSTRACT]   Full text not available  [PDF]
  1,010 101 -
Overuse versus carpal tunnel syndrome among childcaring mothers
Mahmoud S. Youssef, Tarek M. Saber, Nesreen Ismail, Amany El Baz
July-September 2013, 40(3):153-158
Objectives The aim of this study was to detect the pattern of upper-extremity overuse disorders among nursing mothers and mothers caring for young children and to determine the occurrence of carpal tunnel syndrome (CTS) in these women. Materials and methods Detailed history taking, physical examination, and motor and sensory nerve conduction velocity studies were performed for 50 hands (35 nursing mothers and mothers caring for young children) of mothers who presented with upper limb pain after exclusion of medical and cervical problems that may cause median nerve neuropathy or CTS. Results The mean values of the distal motor latencies and motor and sensory nerve conduction velocities were in the normal range. There was a significant increase in the severity of pain in mothers who have more young children or infants. No significant relationship was found between the offspring's sex and the overuse syndrome. Conclusion The overuse syndrome is more prevalent among mothers who nurse and care for young children. There is no electrophysiological evidence of an increased occurrence of CTS among nursing women.
[ABSTRACT]   Full text not available  [PDF]
  953 109 -
Anti-C1q antibodies in systemic lupus erythematosus patients and their significance in lupus nephritis
Ali M El-Sayed Yousef, Sherry K Abd El-Rahman, Hatem Mezayen, Fathy EL Taweel, Walaa Elsayed
July-September 2013, 40(3):141-146
Background Systemic lupus erythematosus (SLE) is a prototype of systemic autoimmune diseases characterized by overproduction of various autoantibodies. It was reported that over 150 autoantibodies had been identified in sera from patients with SLE. Earlier investigations suggested that anti-C1q antibodies (anti-C1q Abs) are found in SLE patients, particularly in patients with renal involvement. Objective The aim of this study was to evaluate the prevalence of anti-C1q Abs in the serum of patients with SLE and to investigate their association with systemic lupus erythematosus disease activity index (SLEDAI), lupus nephritis (LN) as well as other clinical and laboratory parameters. Patients and methods We studied 70 SLE patients (68 women and two men) defined by the Systemic Lupus International Collaborating Clinics (SLICC) criteria. Patients' mean age was 30.5 ΁ 9.8 years. They were classified into two groups: group I included 40 SLE patients with LN diagnosed according to the renal parameters of the American Collage of Rheumatology for the classification of SLE. LN activity was determined by the renal SLEDAI (rSLEDAI). Group II included 30 SLE patients without LN. Thirty age-matched and sex-matched healthy individuals were included in the study as a control group. Results Anti-C1q Abs occurred in about 73% of SLE patients and 100% of patients with LN. The mean anti-C1q Abs titers were significantly elevated (Po0.0001) in SLE patients compared with the controls (41.5 vs. 3U/ml), as well as in patients with LN (Po0.0001) than in those without LN (67.4 vs. 15.5U/ml); also, they were elevated in active SLE patients (without LN) compared with inactive SLE patients (without LN) (24 vs. 6.6U/ml) and also in active LN patients compared with LN patients, in whom they were inactive (89.8. vs. 29.4U/ml). Significant positive correlations were found between anti-C1q Abs titers with erythrocyte sedimentation rate (r=0.575, P<0.0001), creatinine (r=0.809, P<0.0001), antinuclear antibodies titers (r=0.747, P<0.0001), anti-dsDNA titers (r=0.585, P<0.0001), proteinuria (r=0.860, P<0.0001), SLEDAI-2000 (r=0.736, P<0.0001), and rSLEDAI (r=0.843, P<0.0001), whereas they had significant negative correlations with hemoglobin percentage (r= - 0.640, P<0.0001), C3 (r= - 0.666, P<0.0001), and C4 (r= - 0.655, P<0.0001) levels. Conclusion In SLE, the prevalence of anti-C1q Abs is about 73%. Higher titers of these autoantibodies can be considered as surrogate markers for an active disease, an active LN, and an increased inflammatory burden. In LN, the positive predictive value of anti-C1q Abs titers was 65%, whereas their negative predictive value was 100%.
[ABSTRACT]   Full text not available   
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Vitamin D in systemic lupus erythematosus patients with and without nephropathy
Tarek E. Korah, Samar G. Soliman, Dina R., Ghada E. Hammoda
July-September 2013, 40(3):165-175
Background Limited data are available on vitamin D deficiency in systemic lupus erythematosus (SLE) patients with and without nephropathy. Aim The aim of this study was to determine serum 25-hydroxyvitamin D [25(OH) D] levels in patients with SLE versus controls and also to correlate these levels with clinical and laboratory parameters. Patients and methods This study included 80 premenopausal female participants, divided into three groups, matched for age. Group I included 24 SLE patients with lupus nephropathy (eight of them on regular hemodialysis); group II included 36 SLE patients without lupus nephropathy; and group III included 20 healthy controls. Results Serum 25(OH) D levels were significantly lower in group I versus groups II and III (P=0.007 and P=0.001, respectively). Also, they were significantly lower in group II versus group III, (P=0.001). Serum 25(OH) D levels were significantly associated with fatigue (P=0.001) and significantly negatively correlated with SLE Disease Activity Index (r= - 0.275, P=0.033). Serum creatinine and calcium levels were significant predictors of serum 25(OH) D levels for all SLE patients (t=3.23, P=0.002; and t=8.81, P<0.001). Conclusion Premenopausal female SLE patients have significantly low serum 25(OH) D levels, particularly in those with lupus nephropathy. Serum 25(OH) D levels are correlated negatively with disease activity, and associated with fatigue, in SLE patients. Total leukocytic count, serum creatinine, and serum calcium levels are of particular importance for the prediction of 25(OH) D deficiency in these patients. Therefore, we suggest measurement of serum 25(OH) D levels in SLE patients experiencing increasing tiredness. Also, we recommend calcium and vitamin D supplementation, particularly for those patients with leukopenia and lupus nephropathy.
[ABSTRACT]   Full text not available  [PDF]
  787 122 -
Subclinical brainstem involvement in peripheral polyneuropathies
Enas M. Shahine
July-September 2013, 40(3):159-164
Objectives The objective of this study was to investigate the subclinical brainstem involvement in patients presenting with peripheral polyneuropathy (PN). Patients and methods Patients with various disorders presenting with clinical manifestations of PN were evaluated by routine sensory and motor nerve conduction studies and only patients with electrophysiologically documented PN were included in this study. Patients with a previous history of cranial nerve lesions and stroke were excluded. Seventy-eight patients and 30 age-matched and sex-matched healthy individuals were included for the evaluation of blink reflex (BR). BRs were obtained after bilateral electrical stimulation of the supraorbital nerve for quantitative analysis of three responses, early ipsilateral component (R1), late ipsilateral (R2i), and late contralateral (R2c). Results R1, R2i, and R2c latencies were prolonged and of low amplitude in diabetic patients with PN. Fifty percent of cancer patients with PN had abnormally delayed BR responses. R1 was delayed in 58.3% of patients with chronic renal failure and it was associated with prolonged R2i and R2c latencies in 41.6% of those patients. In 53.8% of patients with hypothyroidism, R2i and R2c latencies were prolonged whereas R1 latency was normal. Sixty percent of patients with hereditary motor sensory neuropathy had prolonged latency of at least one component of the BR responses. Three patients with scleroderma had markedly low amplitude but normal latency BR responses. Conclusion Subclinical involvement of the facial, trigeminal nerves, and brainstem may occur in patients with various disorders presenting with PN, which could be identified by easy and noninvasive BR testing.
[ABSTRACT]   Full text not available  [PDF]
  677 71 -