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  Citation statistics : Table of Contents
   2016| April-June  | Volume 43 | Issue 2  
    Online since May 6, 2016

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Healing effects of prolotherapy in treatment of knee osteoarthritis healing effects of prolotherapy in treatment of knee osteoarthritis
D. M. I. Soliman, NM Sherif, OH Omar, AK El Zohiery
April-June 2016, 43(2):47-52
Purpose Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a two-arm controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis (OA). Materials and methods A total of 104 adults with at least 6 months of painful primary knee OA were treated with dextrose prolotherapy (group I). They were divided into two subgroups: Ia and Ib. Subgroup Ia was treated with both techniques of prolotherapy (Hackett technique - classic, traditional prolotherapy - and Lyftgot technique - neural prolotherapy), whereas subgroup Ib was treated with the Hackett technique only. Extra-articular and intra-articular injections were administered at 1, 2, and 3 months, with as needed additional treatments at months 4 and 5. A total of 24 adults with at least 6 months of painful primary knee OA were treated with physiotherapy (group II). Outcome measures included the following: clinical assessment; visual analogue scale (VAS), 10; Western Ontario McMaster University Osteoarthritis Index (WOMAC), 96 points; plain radiographs; and musculoskeletal ultrasound. Postprocedure hot packs were applied, and at-home massage and exercises were taught. Results 128 Patients enrolled in the study were matched with each other for sex, age, disease durations, and BMI. Subgroups Ia and Ib reported a significant improvement as regards the clinical assessment, VAS, WOMAC, and radiological assessment at 12 months, compared with their baseline at month 0 and compared with group II (P ≤ 0.001). At 12 months, the mean ± SD of VAS was 0.32 ± 0.27 for subgroup Ia, 0.44 ± 0.5 for subgroup Ib, and 9.9 ± 1.65 for group II, and the mean ± SD of WOMAC was 11.32 ± 10.3 for subgroup Ia, 18.5 ± 10.25 for subgroup Ib, and 79.5 ± 22.63 for group II. Postprocedure application of hot packs, massage, and paracetamol resulted in diminution of injection-related pain. There were no adverse events. Conclusion Prolotherapy resulted in clinically sustained improvement of pain, function, and radiological assessment, which means that the healing effects of prolotherapy is better than that of physiotherapy. The combination of the two prolotherapy techniques results in quicker and better improvement for patients in terms of the clinical assessment, VAS, and WOMAC.
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Urinary C-terminal telopeptide of type II collagen, radiological severity, and functional assessment in knee osteoarthritis: are these related?
Hayam M Abdel Ghany, Sarah S El Tawab, Ahmed M Moghazy
April-June 2016, 43(2):73-77
Introduction Osteoarthritis (OA) is a chronic, debilitating joint disease characterized by the degeneration of articular cartilage, sclerosis of the subchondral bone, and osteophyte formation. This work aimed at estimating the level of urinary C-terminal telopeptide of type II collagen (CTX-II) as a biomarker of cartilage turnover and to determine its relation with radiological and functional assessment of knee OA. Patients and methods The current study included 40 postmenopausal women with symptomatic knee OA fulfilling the American Rheumatism Association clinical diagnostic criteria for knee OA. A total of 20 healthy volunteers were enrolled as a control group. Patients were assessed radiologically using the Kellgren-Lawrence grading system and functionally using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Urinary CTX-II was measured for the patient and control groups. Results There was no statistically significant difference as regards age and BMI between patients and controls. Disease duration affects both function assessed using the WOMAC and cartilage degradation assessed using urinary CTX-II. There was a statistically significant correlation between the WOMAC and urinary CTX-II, whereas there was no statistically significant correlation between the Kellgren-Lawrence scale and both urinary CTX-II and the WOMAC. Conclusion This study further confirms that urinary CTX-II is an index of early cartilage degradation in knee OA even before radiological changes occurs. The functional assessment using the WOMAC is an easy inexpensive method in reflecting cartilage degradation. Moreover, this work supports the lack of association between the functional status of knee OA patients assessed using the WOMAC and their radiological severity measured using the Kellgren-Lawrence grading scale.
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Erratum: Assessment of serum antimutated citrullinated vimentin antibodies in rheumatoid arthritis

April-June 2016, 43(2):84-84
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Subclinical heart failure in juvenile idiopathic arthritis: a consequence of chronic inflammation and subclinical atherosclerosis
Hamada S Ahmad, Gamal Othman, Sherief E Farrag, Afaf A El-Hafez, Amir A Monir
April-June 2016, 43(2):78-83
Background and aim of work Chronic inflammation is the basis of juvenile idiopathic arthritis (JIA). Hence, it is expected that JIA may produce harmful effects on the cardiovascular system. The aim of this study was to explore the presence of subclinical atherosclerosis and subclinical heart failure in JIA patients without manifest cardiovascular disease and to examine the risk factors that may be associated with the subclinical heart failure. Patients and methods Fifty JIA patients and 50 healthy matched controls were enrolled in this study. Inflammatory markers in the serum, together with intima-media thickness (IMT) and flow-mediated dilation (FMD) of brachial arteries as surrogate markers of subclinical atherosclerosis, were assessed and compared between patients and controls. Echocardiographic parameters of heart failure, including the Tei index and ejection fraction%, were also evaluated. Results JIA patients had significantly increased IMT and impaired endothelial dysfunction as measured by FMD% of the brachial artery in comparison with controls. JIA patients had significantly higher Tei index and significantly lower ejection fraction% in comparison with controls. In regression analysis only systemic JIA, FMD%, and IMT were significantly associated with the presence of subclinical heart failure among patients with JIA. Conclusion Our findings indicate the presence of subclinical heart failure in these patients. JIA patients with subclinical atherosclerosis, with systemic disease, and with active disease are at greatest risk of developing subclinical heart failure.
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Assessment of the implication of epidural steroid injection versus other conservative measures in the management of lumbar disc herniation
Amal F Soliman, Gamal A Hammad, Ranina I El-gamal, Mohamed A Al-Rabiei
April-June 2016, 43(2):53-58
Introduction The aim of this work was to compare the potential efficacy of epidural steroid injection versus other conservative measures for relieving pain and improving function in patients with lumbar disc herniation (LDH). Methods This study included 45 patients who presented with low back pain and sciatica due to LDH (at levels of L4-L5 or L5-S1) diagnosed clinically and confirmed by means of MRI. Patients were classified into two groups: group I (15 patients) was treated with drugs and physiotherapy, and group II (30 patients) was subclassified into two subgroups of 15 patients each (group IIL received lumbar epidural injection, whereas group IIC received caudal epidural injection). All patients were assessed at presentation and after starting the treatment at the first week and first, second, and third month using the visual analogue scale (VAS) for pain and the Oswestry Disability Index (ODI) for function status. Results Groups I, IIL, and IIC showed improvement in pain and function, confirmed by a decrease in the mean VAS and ODI scores. Both groups of injection showed a significant difference (P < 0.05) when compared with group I with regard to VAS and ODI. There was an insignificant difference (P > 0.05) between the lumbar and caudal groups in the VAS, except at the second month (P < 0.05), and in the ODI, except at first week and first month (P < 0.05). Conclusion Epidural injection could be a preferable choice in managing low back and radicular pain due to LDH. It was a clinically useful mode of treatment that is cost-effective and could offset the need for surgery.
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Measurement of serum trace elements levels in patients with juvenile idiopathic arthritis
Soliman A Yasser, Nashwa I Hashaad, Ali M Shouzan, Hala A El Nouty
April-June 2016, 43(2):59-66
Aim This study was designed to assess the serum levels boron (B), copper (Cu), and zinc (Zn) in patients with juvenile idiopathic arthritis (JIA), and to evaluate their relationships with the disease activity parameters. Patients and methods This study was conducted on 30 children with JIA and 20 apparently healthy children. Patients were subjected to a thorough history-taking, clinical examination, plain radiography of both hands, and laboratory investigations including erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and antinuclear antibodies. Disease activity was measured using the Juvenile arthritis disease activity score 27 (JADAS-27 score). Serum B, Cu, and Zn levels were also measured. Results The mean serum B level was highly statistically significantly lower in the JIA patients' group than that in the control group. The mean serum Cu level was highly statistically significantly higher in the JIA patients' group than that in the control group. Finally, the mean serum Zn level was statistically insignificantly lower in the JIA patients group than that in the control group. There were significant negative correlations between serum B concentrations and tender joint count (TJC). There were significant positive correlations between serum Cu concentrations and TJC, erythrocyte sedimentation rate, and JADAS-27. There were significant negative correlations between serum Zn concentrations and TJC and JADAS-27. Conclusion B serum level may play a role in the pathophysiology of JIA and its severity. Serum levels of B, Cu, and Zn seem to be of fundamental importance in the assessment of a JIA patient.
  - 2,105 321
Somatosensory evoked potentials and dynamic postural assessment in adolescent idiopathic scoliosis
Dalia Mohamed Ezz El Mikkawy, Eman Ahmed Tawfek, Mohja Ahmed El Badawy, Fathy Naeem
April-June 2016, 43(2):67-72
Background Dysfunction of the somatosensory pathways may cause an impaired postural balance when the somatosensory system is challenged, and this impaired balance may play a role in the etiology or development of scoliosis. Angle of scoliosis may affect the somatosensory evoked potentials (SSEPs) and dynamic balance control. Purpose The aim of this study was to investigate possible abnormalities and correlations in SSEPs and dynamic posturography in adolescent idiopathic scoliosis (AIS) patients. Patients and methods This study was conducted on 14 adolescents ranging in age from 10 to 16 years with AIS. Both sexes were included. Measurement of Cobb's angle, SSEPs of both posterior tibial nerves with cortical recording, dynamic postural assessment including sensory organization test, and motor control test were performed. Results There was a highly significant positive correlation between the angle of scoliosis and right and left SSEP. There was a highly significant negative correlation between the angle of scoliosis and equilibrium score-composite and ratio for sensory analysis-vestibular, and significant negative correlation with motor control-composite. There was a highly significant negative correlation between right SSEP and balance parameters. There was significant negative correlation between left SSEP and equilibrium score-composite and ratio for sensory analysis-vestibular. Conclusion The study demonstrates abnormal somatosensory and postural function in patients with AIS, and a significant inter-relationship between the scoliotic angle, the somatosensory system, and posture. Thus, optimum assessment and treatment of neurological pathway and balance are important in these patients.
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