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  Citation statistics : Table of Contents
   2014| October-December  | Volume 41 | Issue 4  
    Online since December 19, 2014

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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.
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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.
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Serum interleukin-18 and interleukin-10 levels in systemic lupus erythematosus: correlation with SLEDAI score and disease activity parameters
Sahar Abou El-Fetouh, Reem Hamdy A Mohammed, Hanan S Mohmad Abozaid
October-December 2014, 41(4):160-166
Aim The aim of the study was to assess serum levels of interleukin (IL)-18 and IL-10 in systemic lupus erythematosus (SLE) patients and their relationship with disease activity. Patients and methods Thirty patients with SLE and 20 healthy controls were investigated in this study. The serum IL-18 and IL-10 levels were determined using enzyme-linked immunosorbent assay and their correlations with the disease activity were measured using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and laboratory parameters, including erythrocyte sedimentation rate, anti-ds DNA antibody, complement 3, and complement 4 levels were analyzed. Results The serum IL-18 and serum IL-10 levels were significantly higher (mean values 1770.2 ± 360.4 and 842.65 ± 315.37 pg/ml for IL-18 and IL-10, respectively) in SLE patients compared with the controls (110.65 ± 30.37 vs. 76 ± 14.2 pg/ml, respectively, P < 0.001). The increase in serum levels of IL-18 and IL-10 directly and significantly correlated with each other (r = 0.404, P = 0.037). Furthermore, such an increase in the levels of these two cytokines showed a highly significant positive correlation with the SLEDAI scores and anti-ds DNA in the studied patients (P < 0.001). Conclusion The circulating IL-18 and IL-10 concentrations were significantly elevated in SLE patients and correlated with the SLEDAI score. The study emphasized that there exists an upregulated proinflammatory as well as anti-inflammatory responses in patients with active SLE; however, the anti-inflammatory response is not enough to suppress the active disease. Identifying the exact contribution of the currently studied cytokines might provide future insights for targeted therapeutic strategies in SLE.
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Serum vitamin D and peripheral T-regulatory cells in systemic lupus erythematosus and their relation with disease activity
Reem A Habeeb, Rania H Elkabarity
October-December 2014, 41(4):167-171
Background Systemic lupus erythematosus (SLE) patients have a decreased number of T-regulatory cells (Tregs) in peripheral blood. Vitamin D deficiency is prevalent in SLE. Immunomodulatory effects of vitamin D include the expansion of Tregs. Objectives The aim of this study was to assess the percentage of Tregs and vitamin D level in SLE and their relation with disease activity. Patients and Methods A total of 40 SLE patients underwent evaluation for disease activity using the SLE disease activity index and were tested for the percentage of peripheral Tregs using anti-CD4, anti-CD25, and anti-FOXP3 monoclonal antibodies. Vitamin D was assessed using a commercially available 25-OH VitD-EIA kit. The study also included 40 healthy individuals who served as controls. Results SLE patients had lower levels of vitamin D (22.3 ± 7.53) and Treg% (1.95 ± 0.18) in comparison with controls. Patients with active disease had significantly lower levels of vitamin D. However, there was no significant difference between patients with and those without disease activity as regards Tregs. Correlation between vitamin D and various disease parameters showed negative correlation between vitamin D and each of disease activity, creatinine, and urinary protein (P < 0.05) and a positive correlation with C 4 (P < 0.05). Correlation between Tregs% and various disease parameters showed a significant negative correlation as regards anti-dsDNA (P < 0.05). No correlation was detected between Tregs% and vitamin D. Conclusion There are decreased levels of vitamin D and Treg% in SLE. Lower levels of vitamin D correlate with disease activity; yet, no correlation between serum vitamin D and Treg% was detected.
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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.
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Eosinophilic granulomatosis with polyangitis (Churg-Strauss syndrome): a diagnostic rarity with an atypical presentation
Sujeet Raina, Rashmi Kaul, Navjot Kaur, Narvir S Chauhan
October-December 2014, 41(4):187-189
We report a case of a 33-year-old woman who presented to us with symptoms of bronchial asthma and peripheral neuropathy. After investigations, the diagnosis of eosinophilic granulomatosis and polyangitis (Churg-Strauss syndrome) was made.
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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 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.
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