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  Citation statistics : Table of Contents
   2015| January-March  | Volume 42 | Issue 1  
    Online since April 22, 2015

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Interleukin-17 in Behçet's disease: relation with clinical picture and disease activity
Dina S Al-Zifzaf, Abir N Mokbel, Doaa M Abdelaziz
January-March 2015, 42(1):34-38
Aim The aim of this study was to assess serum levels of interleukin-17 (IL-17) in patients with Behçet's disease (BD) and to evaluate its relation to the clinical picture and disease activity. Patients and methods This case-control study was carried out on 38 patients with BD. A total of 20 age-matched and sex-matched healthy volunteers serving as the control group were also enrolled in this study. All patients were subjected to full history taking, thorough clinical examination, and clinical activity assessment using Behçet's Disease Current Activity Form. Serum IL-17 levels were measured with enzyme-linked immunosorbent assay. Results Serum IL-17 levels were significantly elevated among BD patients. Patients with ocular involvement had higher IL-17 levels compared with those without; however, the difference did not reach statistical significance. Patients with neurological involvement had significantly higher IL-17 levels in their serum compared with those without neurological involvement and controls. Twenty-seven patients had active disease, whereas 11 patients had inactive disease. Serum IL-17 levels were significantly elevated in active BD patients. Patients with and without activity showed highly significant rise in IL-17 levels compared with healthy controls. There was no significant correlation between the amount of corticosteroids or colchicine being used and serum IL-17 levels. Conclusion IL-17 is elevated among BD patients and further increased with activity, ocular affection, and neuroinvolvement. Our findings suggest that IL-17 exerts an important role in the pathogenesis of BD, thus providing a promising target for novel therapy.
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Clinical and subclinical neuropsychiatric abnormalities in rheumatoid arthritis patients
Eman M Khedr, Noha Abo El Fetoh, Omar Herdan, Dina H El-Hammady, Hosam Khalifa, Rania M Gamal, Anwar M Ali
January-March 2015, 42(1):11-18
Background Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease with probable autoimmune aetiology. RA has many secondary complications and a variety of neuropsychological consequences. Aim The aim of this study was to estimate the frequencies of neuropsychiatric disorders in RA patients and their relationship with the duration and activity of disease. Patients and methods Seventy-four consecutive female RA patients were recruited and compared with 25 age-matched and education status-matched female healthy volunteers. All eligible participants underwent clinical, laboratory and electrophysiological examinations (motor and sensory nerve conduction study, F-wave of four limbs, P300 event-related potential and electroencephalography). The Structured Clinical Interview for Diagnostic and statistical manual of mental disorders, 3rd ed., Revised (DSM-III-R) Axis I Disorders (SCID-I) for diagnosis of psychiatric illness and the Wechsler Adult Intelligence Scale, 3rd ed. (WAIS-III) with assessment of total scale, verbal and performance intelligence quotients (IQ) were administered to all participants. Results Fourteen (18.9%) patients had evidence of symptomatic peripheral neuropathy and radiculopathy, whereas 60.8% had psychiatric disorders. Depression was the most prevalent psychiatric disorder (45%), followed by anxiety (27%) and comorbid anxiety with depression (21.6%). Low IQ scores were recorded in 54% of patients. P300 latency was significantly prolonged (P = 0.0001), and seven (9.5%) RA patients recorded abnormal P300 latency (>mean ± 2 SD) compared with control values. Abnormal electroencephalography findings were observed in 48.6%. Visual analogue scale pain score was significantly higher among patients with psychiatric disorders versus patients without psychiatric disorders (P = 0.0001). Significant negative correlation was recorded between Disease Activity Score and total IQ score (P = 0.01), whereas no significant association was seen between Disease Activity Score and the presence of neuropathy or psychiatric disorders. Conclusion Cognitive impairment, depression, anxiety and peripheral neuropathy are common in RA patients. Early diagnosis and management of neuropsychiatric disorders in RA patients may greatly improve the patients' health-related quality of life.
  2 1,936 265
Treatment of premature ejaculation: a new combined approach
Adel Kurkar, Sherif M Abulsorour, Rania M Gamal, Ahmed M Eltaher, Ahmed S Safwat, Mohammed M Gadelmoula, Ahmed A Elderwy, Mahmoud M Shalaby, Abeer M Ghandour
January-March 2015, 42(1):39-44
Background Selective serotonin reuptake inhibitors (SSRIs) are utilized to treat premature ejaculation (PE). However, their effect is moderate, with no universally adopted schedule. A possible role for pelvic floor dysfunction in the pathogenesis of PE was reported previously. Objective The aim of this study was to compare the efficacy of combined sertraline and pelvic floor rehabilitation with either line in patients with an unsatisfactory response to SSRIs. Design, setting, and participants From June 2009 to December 2012, 74 PE patients with an unsatisfactory response to sertraline 50 mg were enrolled and subjected to pelvic floor rehabilitation as an alternative therapy, and then a combination of both was tested on the same group. Outcome measurements and statistical analysis Relationships with outcome were analyzed using the Student t-test, Pearson's correlation, and linear regression. Results and limitations The baseline intravaginal ejaculatory latency time (IELT) was 20-110 s (mean ± SD = 56.35 ± 21.67). With sertraline 50 mg therapy alone, IELT reached 90-180 s (mean ± SD = 121.69 ± 21.76, P = 0.0001). Of them, 44 (59.46%) patients failed to exceed an IELT of 120 s. With pelvic floor rehabilitation alone, IELT reached 90-270 s (mean ± SD = 174.73 ± 45.79, P = 0.0001). Of them, 13 (17.56%) patients failed to exceed an IELT of 120 s. Using a combination therapy of both, IELT reached 180-420 s (mean ± SD = 297.57 ± 59.19, P = 0.0001). This response was significantly higher than the baseline IELT and that of either lines alone (P = 0.0001, for all tests). Conclusion Pelvic floor rehabilitation is an important addition when treating PE, particularly in patients with pelvic floor dysfunction. We recommend this combination in patients with an unsatisfactory response to SSRIs. Patient summary Causes of PE differ considerably. In this paper, we compared the outcomes of two single treatment lines together with a combination of both. The combination therapy was more effective than either line alone.
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Lipoma arborescens: is it the cause or effect?
Saifullah Khalid, Naiyer Asif, Ruquiya Afrose, Mohd Faizan, Mohd Khalid, Rana K Sherwani
January-March 2015, 42(1):45-48
Lipoma arborescens is benign villous lipomatous proliferation of the synovium. The fronds-like masses are non-neoplastic fatty deposits on the synovium. The word arborescens is a Latin term meaning 'tree-forming' or 'tree-like'. This article presents two cases of young adults who presented with pain and swelling around knee joint and were diagnosed on the basis of characteristic MRI findings, and hence signifies the role of MRI in diagnosing the cause of inflammatory synovitis in young patients. In addition, MRI helped in deciding the management of these patients. There was significant symptomatic improvement seen on follow-up, which further helps to strengthen the hypothesis that underlying lipoma arborescens could be a rare underlying cause for undiagnosed inflammatory synovitis in young adults.
  - 2,367 185
Added advantage of ayurvedic management in a series of 100 cases of osteoarthritis of the knee joint: a shared experience between Orthopaedic and Ayurvedic Faculty
Akash Saoji, Sonal Mahajan, Sanjay Deshpande
January-March 2015, 42(1):7-10
Osteoarthritis of the knee joint is a disease due to the uncoupling of balance between cartilage degeneration and regeneration in the elderly, causing knee joint pain, deformity and limp. About half of the population after the fifth decade of life have symptoms of osteoarthritis of the knee. The treatment of osteoarthritis varies from conservative to operative procedures. As yet, no long-term definitive conservative management has been described. We compared the results of osteoarthritis among 100 patients in the Orthopaedic outpatient department who either underwent (42 patients) or did not undergo (58 patients) added ayurvedic panchakarma (snehan and swedan) therapy. Patients' visual anologue scores and satisfaction scores were assessed before the treatment and after 2 and 4 weeks. Patients with early to moderate grade of osteoarthritis treated with added ayurvedic therapy showed better improvment in terms of pain and mobilization compared with the patients treated with analgesics only.
  - 2,085 216
Verification of an ultrasonographic scoring system in discriminating rheumatoid arthritis from osteoarthritic and normal joints in an Egyptian cohorts
Naglaa GadAllah, Mona Elhossieny, Nouran Abaza, Shahdan Yousry, Samah A El-Bakry
January-March 2015, 42(1):19-26
Background The use of musculoskeletal ultrasound in rheumatoid arthritis (RA) has been growing over the last decades mainly to monitor response to treatment and for early detection of erosions. Suggestions to include this technique in the diagnosis of RA have been made, but not yet been implemented (because of the lack of specific sonographic criteria for RA). Objectives To verify the performance of a proposed combined structural and synovial scoring system in differentiating RA from osteoarthritis (OA) and healthy sonographic findings in the small joints of the hand. Patients and methods Twenty RA patients, 20 patients with hand OA, and 10 healthy controls were subjected to musculoskeletal ultrasound of the metacarpophalyngeal and proximal interphalyngeal joints. The novel proposed scoring system was applied characterizing each joint as either RA supported or RA unsupported. Grading of synovitis as mild, moderate, or severe was also performed. In the RA group, disease activity was assessed by Disease Activity Score 28 (DAS28) and anticyclic citrullinated peptide serum levels were measured. Results When one or more RA-supported joints were detected using this scoring system, it had a sensitivity of 100.0% and a specificity of 83.0%, with a diagnostic accuracy of 90.0%, for the diagnosis of RA. If two or more joints were detected, it had a sensitivity of 95.0% and a specificity of 96.7%, with a diagnostic accuracy of 96.0% for the diagnosis of RA. Conclusion The novel suggested combined structural and synovial scoring system showed high performance in differentiating RA from OA and controls.
  - 1,313 162
Efficiency of therapeutic ultrasound, low-level laser and compression therapy for healing of venous leg ulcers
Nillie Ezzeldin, Dina Said, Sahar Said, Mahmoud Mustafa Ashour, Medhat EL-leboudy
January-March 2015, 42(1):27-33
Aim To evaluate the efficiency of therapeutic Ultrasound, low level laser and compression therapy for healing of venous Leg ulcers and Compare the effect of modalities on the ulcers. Subjects and methods Three groups were included in the study. Group I: 20 patients with leg ulcers treated with low level laser therapy. Group II: 20 patients with leg ulcers treated with ultrasound therapy. Group III: 20 patients with leg ulcers treated by compression therapy (four layer bandage) were used in this study. All patients were subjected to detailed history, clinical evaluation in addition to X-ray of legs and feet, and Doppler ultrasound of both legs. The main variables for follow up were the measurement of the area of the lesions under aseptic conditions at 0, 1, 2, 3 months and qualitative clinical evaluation of the ulcers by physician and by the patient. The results from group I, group II and group III were obtained and then compared with each others. Results According to the size of the ulcer, some ulcers heal within 1 month which is (15.6%) in group I, (10%) in group II, and (28.5%) in group III. Some ulcers heal within 2 months which is (28%) in group I, (23.3%) in group II and (37%) in group III. The remaining ulcers heal within 3 months or more which are (56%) in group I, (66.6%) in group II and (34.2%) in group III. Thus the percentage of healing denoting that compression bandage technique used in group III is the most efficient in healing of chronic venous leg ulcer followed by laser therapy and lastly US therapy (P = 0.04 at the end of the first month and P = 0.03 at the end of the third month). Conclusion Compression therapy is the most efficient treatment of venous leg ulcers. Low level laser therapy and Ultrasound therapy are useful methods as a conservative treatment of venous leg ulcers and can be used in ulcers of small size.
  - 1,956 248
The effectiveness of intensive versus standard physical therapy for motor progress in children with spastic cerebral palsy
Mohammad H Elgawish, Mohammad A Zakaria
January-March 2015, 42(1):1-6
Background Cerebral palsy (CP) remains the most common cause of physical disability in children that results from a static brain lesion during pregnancy or early life. Although the brain lesion is static, the physical manifestations and medical issues may progress, leading to altered motor patterns. Objective The aim of the study was to assess gross motor progress in children with spastic (quadriplegic and diplegic) CP treated with intensive physical therapy (PT) as compared with a matched group treated with a standard PT regimen. Patients and methods Out of 45 patients with spastic CP aged 2-6 years, 25 patients were assigned to an intensive therapy group (group A), whereas 20 patients were assigned to standard therapy (control group B). Patients were classified according to the gross motor function classification system. The intervention program was administered for 16 weeks, with sitting and walking as the treatment goal. The gross motor function measures 88 and 66 (GMFM-88 and GMFM-66) and gross motor performance measure (GMPM) were used for assessment at baseline, at 8 weeks, and at 16 weeks after intervention. Results At baseline, there were no statistically significant differences between the two groups. After 8 weeks, there were significant differences between the two groups as regards the total scores of GMFM-88 and GMPM (P < 0.05). However, highly significant differences for GMFM-88 (P < 0.001) and only significant differences (P < 0.05) for GMPM were observed after 16 weeks. No statistically significant differences were found between the two groups as regards GMFM-66 scores after 8 weeks, and significant differences were found only after 16 weeks (P < 0.05). After 16 weeks, all dimensions of GMFM-88 were significantly increased in both groups (P < 0.001). Only sitting showed no statistically significant difference in group B (P > 0.05). Conclusion Intensive PT regimens were more beneficial than standard therapy in spastic CP, especially in children with a low functional level.
  - 3,744 574