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   2015| October-December  | Volume 42 | Issue 4  
    Online since October 26, 2015

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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
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.
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Serum level of brain-derived neurotrophic factor in fibromyalgia
Rasha M Fawzy, Mounir S Eldin, Alshimaa M Mouhammed, Hussein E El-shiekh
October-December 2015, 42(4):170-177
Introduction Fibromyalgia syndrome (FMS) is a complex clinical syndrome that primarily affects middle-aged women. Fibromyalgia (FM) is characterized by pain associated with sleep disturbances (nonrefreshing sleep, hypersomnolence), the presence of specific painful sites (tender points), and is often accompanied by fatigue and depression. It is believed to arise from the abnormal central sensory processing of pain signals, involving the interaction between neurotransmitters, external stressors, behavioral constructs, hormones, and the sympathetic nervous system. Brain-derived neurotrophic factor (BDNF), a member of neurotrophines, is the most prevalent growth factor in the central nervous system. It is essential for the development of the central nervous system and for neuronal plasticity. Because BDNF plays a crucial role in the development and plasticity of the brain, it is widely implicated in psychiatric diseases. Aim of the work This study aimed to evaluate serum level of BDNF in FM patients and its relation with depression. Patients and methods Thirty patients with primary fibromyalgia syndrome were enrolled into this study. These patients were subjected to clinical examination and assessment of depression using the Hamilton Rating Scale for depression. Serum BDNF levels were determined using an enzyme-linked-immunosorbent assay. Twenty age-matched and sex-matched healthy volunteers were included as controls. Results The mean serum BDNF level was age-dependent in healthy controls. FMS patients had higher level of serum BDNF compared with healthy controls. In addition, serum level of BDNF showed correlation with depression, but not with other disease manifestations. The mean serum level of BDNF increased with higher values of depression score in FM patients. Conclusion BDNF is involved in the pathophysiology of FMS. Moreover, it seems to be correlated with the intensity of depression symptoms in FMS patients.
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The health-related quality of life in stroke survivors: clinical, functional, and psychosocial correlate
Safaa A Mahran, Mohamad A Abdulrahman, Fadwa S Janbi, Rawabi A Jamalellail
October-December 2015, 42(4):188-195
Aim The aims of this study were to examine the health-related quality of life (HRQOL) in stroke survivors attending an outpatient rehabilitation clinic and to examine the relation between some clinical variables and HRQOL. Participants and methods Sixty-four stroke survivors were enrolled. Demographic data were obtained using a structured questionnaire. The functional level of the patients was assessed using the Barthel Index (BI). HRQOL was measured by the short-form 36 (SF-36) and the stroke-specific quality-of-life (SSQOL) scale. Results Our patients' ages ranged from 42 to 95 years (mean 60.81 years), and men represented 81.2% of the participants. Low mean scores of all the eight domains of SF-36 were found. The 12 domains of SSQOL showed different degrees of deterioration in their means. Statistically significant differences between the means of the mobility level, and upper-limb and lower-limb voluntary control with the means of both SF-36 and SSQOL were found in favor of functional independency and full control of the limbs (P < 0.05). Voluntary control of the limbs and BI showed a significant positive correlation with both SSQOL and the physical component of SF-36. Multiple regression analysis showed that the BI score, the nature of stroke, and the comorbidities are the most significant predictors of SSQOL, with P values of 0.004, 0.013, and 0.047, respectively. Conclusion It was concluded that HRQOL is impaired in stroke survivors, and that the functional independency level is its most significant predictor. We recommend considering the assessment of HRQOL in stroke survivors undergoing rehabilitation management as it is more relevant to the patients.
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Antiphospholipid antibody syndrome presenting as transverse myelitis
Javvid M Dandroo, Naveed Mohsin, Firdousa Nabi
October-December 2015, 42(4):204-206
The antiphospholipid syndrome (APS) is characterized by arterial and/or venous thrombosis and pregnancy morbidity in the presence of anticardiolipin antibodies and/or lupus anticoagulant. APS can occur either as a primary disorder or secondary to a connective tissue disease, most frequently systemic lupus erythematosus. Central nervous system involvement is one of the most prominent clinical manifestations of APS, and includes arterial and venous thrombotic events, psychiatric features, and a variety of other nonthrombotic neurological syndromes. Although the mechanism of neurological involvement in patients with APS is thought to be thrombotic in origin and endothelial dysfunction associated with antiphospholipid antibodies. APS presenting as acute transverse myelitis is very rarely seen with a prevalence rate of 1%. We are describing a foreigner female presenting as acute transverse myelitis which on evaluation proved to be APS induced. So far, very few cases have been reported in literature with APS as etiology.
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Assessment of fatigue in rheumatoid arthritis and its relation to pain and disease activity measures
Rasha A Abdel-Magied, Ahmed Lotfi, Fatma Ali, Mona Hamdy
October-December 2015, 42(4):178-182
Background Fatigue is a serious outcome of rheumatoid arthritis (RA). Inflammatory synovitis is potentially an important causal factor for RA fatigue. Other factors include psychosocial factors, health beliefs, illness perceptions, and poor social support. Fatigue also has strong relationships to pain and depression. Objective The aim of the study was to define the amount of fatigue experienced by RA patients, and determine the relative contribution of RA disease activity to fatigue in comparison with factors such as pain and treatment in established RA cases using different instruments to assess fatigue [visual analog scale (VAS) fatigue and the vitality subscale of the Medical Outcomes Study Short Form 36 (SF-36) questionnaire]. Patients and methods A total of 50 adult patients diagnosed with RA according to the 1987 Revised American College of Rheumatology - 42 of them being female and the remaining eight being male, with a mean age of 45.36 ± 9.6 years and a mean disease duration of 7.78 ± 4.1 years - were included in the study. Fatigue was measured using a 100 mm VAS and the SF-36 vitality scores. We measured pain using 100 mm VAS, Disease Activity Score for 28 joint counts (DAS28), early morning stiffness, the modified Health Assessment Questionnaire score, and the physician global assessment score. Results Fatigue was common in RA patients. Out of 50 patients, 42 patients had fatigue (VAS ≥ 20 mm), and at the same time 26 had high fatigue scores (VAS΃50 mm). The mean SF-36 energy and vitality score was 60.5 ± 23.1. The VAS fatigue scores and the SF-36 vitality scores were significantly correlated with disease activity measures, including duration of morning stiffness (P = 0.001), articular index (P < 0.0001), VAS pain (P < 0.0001), DAS28 (P < 0.0001), C reactive protein (CRP) (P = 0.04 and 0.001, respectively), erythrocyte sedimentation rate (ESR) (P = 0.04), and rheumatoid factor positivity (P = 0.04 and 0.01, respectively). Pain had the strongest association with fatigue, followed by articular index, duration of morning stiffness, ESR, DAS28, and finally CRP in that order. Conclusion High fatigue levels are common in RA and are mainly linked to pain. VAS fatigue scores are simple measurements that can be used for assessment of fatigue in patients with RA.
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Interleukin-17 level in rheumatoid arthritis patients and its relation to disease activity: a clinical and ultrasound study
Abd Elsamad I Elhewala, Samar G Soliman, Alaa A Labib, Waleed A Mousa, Dalia Salah
October-December 2015, 42(4):183-187
Objective The aim of this study was to measure the level of interleukin-17A (IL-17A) in the serum and synovial fluid of patients with rheumatoid arthritis (RA) and its relation to disease activity. Patients and methods A total of 100 patients suffering from RA were chosen from the outpatient clinic, Department of Physical Medicine and Rehabilitation, Menoufia University Hospital. The patient group was divided into three subgroups - mild, moderate, and severe - according to the disease activity score. All patients were subjected to clinical, laboratory, and ultrasound evaluation and to measurement of IL-17A in the serum and synovial fluid by means of the enzyme-linked immunosorbent assay technique. Fifty healthy individuals were evaluated for IL-17A level in the blood, and served as the control group. Results The present study revealed an increase in serum (P = 3.1) and synovial fluid (P = 5.2) IL-17A levels in RA patients with increased disease activity. The ultrasound study showed an increase in serum IL-17A levels with increased erosion of the knee (P = 5.99) and wrist (P = 5.03). There was an increase in serum IL-17A with increased effusion of the knee (P = 22.6) and wrist (P = 33.3). There was an increase in serum IL-17A with increased synovial hypertrophy of the knee (P = 6.39), wrist (P = 12.23), and second metacarpophalangeal (MCP) (P = 53.34). Finally, there was an increase in the blood IL-17A level, dryness of the eye (P = 3.8), dryness of the mouth (P = 3.2), and number of subcutaneous nodules (P = 2.5). Conclusion In our study; the mean serum and synovial IL-17A levels were found in high titers in patients with disease activity, and with extra-articular manifestations like dry eyes, dry mouth, and subcutaneous nodules. Also erosions, synovial hypertrophy, and effusions were found with significantly high titers of IL-17A, denoting its usefulness as a measurement tool for high disease activity and destruction. Also targeting IL-17A may be useful as a treatment option for aggressive disease and for rheumatoid patients with poor prognosis.
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Detection of serum 25(OH)-vitamin D level in the serum of women with fibromyalgia syndrome and its relation to pain severity
Alaa A Elaziz Labeeb, Dina R Al-Sharaki
October-December 2015, 42(4):196-200
Objective The aim of our study is to determine serum 25(OH)-vitamin D level in patients with fibromyalgia syndrome and its relation to pain. Patients and methods Fifty-three women with fibromyalgia syndrome diagnosed according to the American College of Rheumatology 1990 fibromyalgia diagnostic criteria and 50 age-matched healthy women as a control group were included in this study. Serum 25(OH)-vitamin D levels were determined in both the patient and the control groups. Fibromyalgia Impact Questionnaire scores and pain intensity measured by the visual analogue scale were evaluated. Results We found a statistically significant decrease in serum vitamin D level in the patient group in comparison with the control group. There was a significant negative correlation (P = 0.000) between vitamin D level and Fibromyalgia Impact Questionnaire. The same results are found between vitamin D level and visual analogue scale. There was no significant correlation between vitamin D level and erythrocyte sedimentation rate or C-reactive protein. Conclusion We found a significant association between fibromyalgia and low 25(OH)-vitamin D levels as suggested previously in other studies. Also, there was a correlation between the level of vitamin D in serum and severity of pain. We recommend vitamin D screening in every patient with chronic nonspecific musculoskeletal pain, especially fibromyalgia, and extended research in this area with large numbers of patients.
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Ocular manifestation of granulomatosis with polyangitis
Mary Grace, KJ Jacob, VK Shameer, Anitha Sebastian
October-December 2015, 42(4):201-203
Ocular manifestation of granulomatosis with polyangitis. Proptosis is the most common ocular manifestation of granulomatosis with polyangitis. It is due to inflammation of the extraocular muscles or vasculitis of the vas nervosum. It is a poor prognostic sign.
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