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   Table of Contents - Current issue
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October-December 2019
Volume 46 | Issue 4
Page Nos. 211-326

Online since Tuesday, October 1, 2019

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ORIGINAL ARTICLES  

Serum matrix metalloproteinase-9 level in systemic lupus erythematosus with peripheral neuropathy p. 211
Mohamed Hassan Imam, HamdyKhamis Koriem, Marwa Mohamed Hassan, Abeer Shawky El-Hadidi, Niveen Abdallah Ibrahim
DOI:10.4103/err.err_45_19  
Objective To evaluate whether serum matrix metalloproteinase-9 (MMP-9) is associated with peripheral neuropathy (PN) in patients with systemic lupus erythematosus (SLE) and to determine the relationship between MMP-9 serum level and SLE disease activity, lupus manifestations, and laboratory markers. Patients and methods A total of 30 patients with SLE with PN, 30 patients with SLE without PN, and 20 healthy controls were included in this study. SLE clinical manifestations, Systemic Lupus Activity Measure (SLAM) index, and laboratory markers were evaluated. All the data were compared and correlated with serum MMP-9 level. Results MMP-9 showed a significant increase in frequency in SLE with PN group compared with SLE without PN group (P1=0.037), SLE with PN group compared with control group (P2<0.001), and SLE without PN group compared with control group (P3<0.001). In comparison between SLE with normal MMP-9 group versus SLE with high MMP-9 group, it showed no statistically significant difference between the two groups regarding demographic data, SLAM index, Erythrocytes sedimentation rate (ESR), C-reactive protein (CRP), Antinuclear antibodies (ANA), Antiphospholipid antibodies (APL), C3, C4, anti-double-stranded DNA, and lupus clinical features, except malar rash and lupus nephritis, which showed significant increase in SLE with high MMP-9 group compared with SLE with normal MMP-9 group (P=0.042 for each). A significant positive correlation was detected between MMP-9 serum level and SLAM index (P=0.037), whereas anti-double-stranded DNA did not show significant correlation. There was a significant relation between increasing the risk of PN and MMP-9 (odds ratio=4.031). Conclusion Significant elevation of serum MMP-9 may increase the risk of PN in patients with SLE, and it may correlate with disease activity, lupus nephritis, and skin involvement.
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Serum and synovial survivin in rheumatoid arthritis: Relation to disease activity and severity p. 221
Eman Baraka, Mounir Serag El Din, Ahmed El Shambky, Nehad A Fouad, Mona Abdullah Abdelkader
DOI:10.4103/err.err_40_19  
Background Rheumatoid arthritis (RA) is a progressive debilitating autoimmune disease, affecting 1% of the world population, leading to cartilage and bone destruction caused by insufficient apoptosis in the inflamed RA synovium. Survivin is a proto-oncogene biomarker known for its anti-apoptotic and cell cycle-regulating properties. Overexpression of survivin in non-cancerous processes has been linked to inflammation, presumably contributing to the decreased apoptosis in the T cells of the cerebrospinal fluid in multiple sclerosis, in skin lesions of patients with psoriasis and in synovial tissue of patients with RA. Aim of the work The aim of this study is to measure the serum and synovial levels of survivin and clarify their relations to disease activity, functional capacity, and radiographic damage in patients with RA. Patients and methods This study was carried out on 50 patients with RA who had a mean age of 46.4±10.94 years. They were 39 females and 11 males. The control group was of matched age and sex, with a mean age of 46.03±10.53 years and female : male ratio of 23 : 7. All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity by disease activity score 28 activity score, and assessment of functional capacity and disability using Health Assessment Questionnaire. Plain radiographs of both hands of feet were done, scored and graded by Larsen score. Serum survivin from all the studied participants and survivin levels in the synovial fluid aspirated from 18 patients with RA who presented with knee effusion at the time of examination were measured by enzyme-linked immunosorbent assay, using a pair of matched anti bodies (R&D systems, Abingdon, Uk). Results The mean serum survivin level was highly statistically significantly elevated (P<0.001) in the sera of patients with RA than in the controls, being 239.1±115.15 and 77.03±30.20 pg/ml, respectively. Synovial survivin levels ranged between 420 and 575 pg/ml, with a mean of 479.61±52.68 pg/ml, which was statistically significantly higher than the mean serum survivin level in patients with RA (P<0.001). Patients were divided into survivin −ve group, which included 21 (42%) of 50 patients with serum survivin less than 167.63 pg/ml, and survivin +ve group, which included 29 (58%) of 50 patients with RA with serum survivin more than or equal to 167.63 pg/ml. Survivin +ve RA patients group had significantly longer mean disease duration (P<0.001), Higher Health Assessment Questionnaire SCORE, and higher mean Larsen score (P<0.001) than survivin −ve RA patients group. Overall, nine (69.2%) of 13 RA patients with Sjogren’s syndrome, eight (80%) of 10 of the patients with pleural effusion, three (50%) of six patients with Raynaud’s phenomenon, and all patients with SC nodules (five, 100%), episcleritis (two, 100%), and vasculitis (one, 100%) were survivin +ve. Larsen score in the patients with RA ranged from 0 to 65, with a mean of 23.6±18.98. Patients with RA who had Larsen score grading more than or equal to 2 (27/50, 52%) were considered to have an erosive RA disease. There were no statistically significant differences between patients with RA according to the presence of erosion regarding age, sex, visual analog scale values, disease activity score values, the presence of rheumatoid factor antibodies or anti-cyclic citrullinated peptides antibodies, the mean of hemoglobin %, white blood cells count, platelets count, erythrocyte sedimentation rate first hour value, or the C-reactive protein level. All patients with RA with erosive disease were survivin +ve and had statistically significantly elevated mean serum and synovial survivin levels than those patients with non erosive disease (337.37±55.19 vs. 126.78±24.33 pg/ml and 422.5±3.53 vs. 486.75±51.52 pg/ml, respectively). Conclusions High levels of survivin are detected in the sera and synovial fluid of patients with RA and are associated with erosive joint damage and poor functional outcomes. Our findings support the role of survivin in the pathogenesis of RA. Further studies are needed on a larger group of RA patients follow-up to ascertain the erosive effect of survivin. Conduction of studies on survivin antagonist to evaluate their effect on ameliorating RA disease progression is recommended.
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Evaluation of surgical outcomes of obstetric brachial plexus birth injury: clinical and electrophysiological study p. 229
Diaa F Mohasseb, Marwa M Hassan, Ahmed E Semaya, Hayam M Abdelghany, Sarah N Hassan
DOI:10.4103/err.err_4_19  
Background Obstetric brachial plexus birth injury (OBPBI) is a relatively common form of birth injury that might lead to a weighty physical disability. Early microsurgical intervention for properly selected patients will result in maximal functional benefit that couldn’t be otherwise obtained. However, the outcomes of different microsurgical techniques need to be further evaluated and compared. Aim To evaluate the outcomes of different microsurgical techniques performed in patients with OBPBI. Patients & Methods Twenty-eight patients with OBPBI meeting the criteria for surgical intervention were included in the study. Preoperative and one year postoperative clinical and electrophysiological assessments were done. Results Thirteen (46.4%) of the studied patients were males and 15 (53.6%) were females. The mean age of patients in the study was 8.64 months ± 4.40; ranging between (3.0 – 16.0 months),7 patients had Horner syndrome.C5 and C6+/-C7 roots affection was the most frequent lesion ,patients who underwent neurotization recovered earlier than patients who underwent nerve grafting ,on the other hand nerve grafting resulted in more significant postoperative improvement after a 12 months follow up period. Conclusions The current study provided additional evidence that the earlier the surgical intervention in OBPBI, the better the outcomes.Neurotization results in earlier functional recovery in patients with OBPBI than nerve grafting reconstructive techniques. On the other hand, nerve grafting was superior to neurotization regarding the degree of improvement. Postoperative electrophysiological follow-up can be done using the CMAP amplitude and AUC percentages reflecting the percentage of viable axons.
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Effect of joint range of motion on health-related quality of life in children with hemophilia p. 237
Manal Anwar El Hawary, Hanaa Hassan EL Dash, Nermeen Ahmed Foaud, Mona Hussien Mohamed
DOI:10.4103/err.err_18_19  
Background Assessment of quality of life (QOL) in patients with hemophilia is important for the disease outcome. In patients with hemophilia, repeated occurrences of hemarthrosis lead to limitations in range of motion (ROM) of major joints. Objective The aim of this work is to assess joint ROM and detect the presence of limitation of joint ROM in patients with hemophilia and their effect on the QOL in these patients. Patients and methods The study included 25 children with hemophilia recruited from Pediatric Hematology Unit, Fayoum University Hospital, during the period from June 2016 to December 2016. Their ages ranged between 4 and 16 years. Large joint examination and measurement of joint ROM were done at rheumatology clinic using goniometry by rheumatologist. QOL was assessed by using the hemophilia QOL questionnaire. Results The most impaired dimensions of QOL were family, treatment, and physical domains. Total health-related quality of life (HRQOL) score, physical health, view of self, and sport and school scores were found worse with increasing age. Patients who had target joints had poor QOL score. Limitation of movement (LOM) of the knee and ankle joints mainly impaired the physical and social aspects and the overall HRQOL, and LOM of shoulder joint impaired the treatment domain. Conclusion Age of the patient was found a factor affecting the total HRQOL score, in addition to physical, view of self, and sport and school dimensions. LOM of the knee and ankle joints mainly impaired physical and social aspects and the overall HRQOL.
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Study the relationship between vitamin A deficiency, T helper 17, regulatory T cells, and disease activity in patients with systemic lupus erythematosus p. 244
Dina S Fettouh, Dalia S Saif, Saga F El Gazzar, Ahmed A Sonbol
DOI:10.4103/err.err_5_19  
Background Systemic lupus erythematosus (SLE) is a complex autoimmune disease with activation of the innate and adaptive immune systems. Vitamin A deficiency causes imbalance of T helper 17 (Th17) and regulatory T cell (Treg), deteriorating the progression of SLE. Aim To determine the relationship between vitamin A levels and Th17 and Treg level in patients with SLE and its relation to disease activity. Patients and methods A total of 45 female patients with SLE diagnosed according to the American College of Rheumatology criteria and 45 healthy age-matched and sex-matched patients as control group were included. Full assessment was done including medications, clinical examination (pain evaluation by visual analogue scale and assessment of disease activity by SLE disease activity index), laboratory investigations, and albumin–creatinine ratio. Serum levels of vitamin A were measured by a human KAMIYA kits, and flow cytometry was used for measuring Th17 and Treg percentages. Results There was a significant deficiency of vitamin A level in patients with SLE compared with controls (P=0.001). There was a significant negative correlation between vitamin A and Th17 (P=0.001) and positive correlation between vitamin A and Treg percentages (P=0.001). There was a negative correlation between vitamin A levels and albumin–creatinine ratio in patients with SLE (R=−0.255). A positive correlation between serum levels of vitamin A and C3 and C4 was found (P=0.001). Conclusion Vitamin A deficiency is a bad prognostic factor in patients with SLE, affecting Th17/Treg balance. Routine use of retinoic acid may be a promising supplementary agent in patients with SLE, improving its prognosis.
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Electrophysiological study of accessory deep peroneal nerve in a sample of Egyptian subjects p. 251
Emmanuel K.A Saba
DOI:10.4103/err.err_19_19  
Introduction Accessory deep peroneal nerve (ADPN) is the most common anomalous innervation present in the lower limb. Aim The aim of this study was to determine the prevalence of ADPN electrophysiologically in a sample of healthy Egyptian individuals. Subjects and methods This cross-sectional study included 200 lower limbs from 100 [56 (56%) women and 44 (44%) men] Egyptian apparently healthy volunteers. Motor nerve conduction studies for the peroneal nerve and ADPN were done. Results ADPN was found in 20 (10%) lower limbs of 17 (17%) subjects. There was no statistically significant difference between the occurrence of ADPN in women versus men (P=0.797). ADPN was found in 11 (55%) right lower limbs and in nine (45%) left lower limbs. There was no statistically significant difference between the occurrence of ADPN in right lower limbs versus left lower limbs among subjects with ADPN (P=0.637). It was present bilaterally in three (17.65%) subjects. There was no statistically significant difference between the occurrence of bilateral ADPN in women versus men (P=0.761). Among the 14 (82.35%) subjects with unilateral ADPN, it was present in the right side in eight (57.14%) subjects. There was no statistically significant difference between the occurrence of unilateral ADPN in the right side versus left side (P=0.579). Conclusion This study demonstrated that ADPN prevalence in the referred Egyptian sample through electrodiagnostic studies of lower limbs was 17%, with no sex nor side difference. Recognition of ADPN is essential for proper interpretation of lower limbs electrophysiological data.
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What is the impact of traditional risk factors for vascular affection on Behcet’s disease vascular involvement: a retrospective cohort study p. 257
Marwa Abdo, Alkhateeb Alkemary, Reem El Mallah
DOI:10.4103/err.err_27_19  
Background To study the frequency, types, and outcome of vascular involvement in a cohort of Egyptian patients with Behcet’s disease (BD) and its relation to traditional risk factors for vascular affection. Patients and methods A retrospective cohort study was done involving 164 patients with BD diagnosed according to the criteria of the International Study Group for BD admitted to Cairo and Ain Shams Universities Hospitals from 2000 to 2017. They were reviewed to analyze the types, risk factors, and outcome of vascular involvement. Results A total of 148 men and 16 women were included in the study, with a mean age of 31.5±7.5 years. Their disease duration ranged from 1 to 36 years, with a mean of 7.3±5.5 years. Vascular involvement was present in 64 (39%), involving both venous and arterial sides of the circulation. Venous affection was more common than arterial (39 and 17%, respectively). No significant association was found between traditional risk factors for vascular affection (smoking, hypertension, diabetes, hyperlipidemia, and obesity) and vascular involvement in patients with BD. Although uncommon, arterial aneurysm (9.8%) is the most serious complication, as it may lead to mortality owing to aneurysm rupture and bleeding (representing 100% of deaths in this study). Conclusion Vascular involvement in patients with BD is mainly owing to the disease process itself and not owing to the effect of the traditional risk factors for vascular affection, reflecting the importance of focusing on treatment of the disease process. However, adjustment of these risk factors would lead to better health outcome for the vulnerable patients.
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TCR-CD3ζ gene expression profile in patients with rheumatoid arthritis and correlation with disease activity p. 262
Abeer Abdelati, Rehab Elnemr, Ahmed Ismail, Marwa Gamal-Eldeen
DOI:10.4103/err.err_14_19  
Objective To measure the T-cell receptor-CD3 zeta chain (TCR-CD3ζ) gene expression profile in a cohort of patients with rheumatoid arthritis (RA). Patients and methods A case–control study on 150 consecutive RA patients diagnosed according to 2010 ACR/EULAR criteria and 150 matched healthy controls without a family history of RA or other autoimmune diseases. RA patients with other autoimmune diseases, viral hepatitis B or C, malignancy or hematological disorders were excluded from the study. All participants were subjected to history taking, clinical examination, assessment of disease activity (in RA patients) using Disease Activity Score-28 and Health Assessment Questionnaire, routine laboratory investigations, inflammatory marker levels, serological tests, as well as molecular analysis for TCR-CD3ζ mRNA expression by quantitative real-time PCR. Results TCR-CD3ζ gene expression was significantly lower in RA cases than in controls (P<0.05). Expression of TCR-CD3ζ has shown a significant negative correlation with RA disease duration, rheumatoid factor, and erythrocyte sedimentation rate (P<0.05) in RA cases. The level of TCR-CD3ζ also showed a significantly less expression in patients with positive rheumatoid factor. Conclusion Our results demonstrated a lower expression of TCR-CD3ζ in RA patients than in healthy controls. We suggested that CD247 gene downregulation might contribute in the susceptibility to RA and help understanding the pathways responsible for deficient T-cell responses in RA patients.
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Rheumatoid Arthritis Disease Activity Index-5: an easy and effective way of monitoring patients with rheumatoid arthritis Highly accessed article p. 269
Vikram S Tanwar, Harpreet Singh, Anjali Saini, Gagandeep Sukhija, Sameer Arora, Ankit Kalra
DOI:10.4103/err.err_16_19  
Objective To study the utility of the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5) as a valid tool for daily rheumatoid arthritis (RA) monitoring and to compare its predictability to assess RA activity with respect to Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI). Patients and methods A total of 100 patients with RA (diagnosed as per American College of Rheumatology 1987 criteria) were enrolled in the study group. Each patient was assessed two times with 3-month interval for disease activity (DA) using DAS28, CDAI, and RADAI-5. Spearman’s correlation coefficient (ρ) for correlation and kappa for agreement between different activity measures were assessed. Results In our study group, 19% patients were men and 81% patients were women, with male to female ratio of 1 : 4.3. Their mean age was 44.4±11.8 years, and their mean disease duration was 67.5±59.8 months. On initial visit, that is, baseline, mean DA as per RADAI-5, DAS28, and CDAI were 5.14±2.17, 5.58±1.55, and 27.96±15.46, respectively, and on follow-up visit, the readings were 3.76±1.92, 4.54±1.41, and 17.67±12.46, respectively. The mean changes in DA at follow-up visit were −1.37±2.15 by RADAI-5, −1.04±1.58 by DAS28, and −10.29±15.75 by CDAI. Changes in DA indices correlated significantly with each other with ρ ranging from 0.8 to 0.9 (P<0.001). An average agreement was found among all three measures at different DA level. Conclusion RADAI-5 seems to be an effective tool with high tendency to assess the changes in RA DA in routine patient care in hospital settings as well as in home-based settings.
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MRI diagnosis in multiligamentous injuries of knee with associated dislocations and neurovasacular sequelae: a retrospective analysis of injury patterns p. 278
Reddy Ravikanth, Manu J Abraham, Anoop Pilar, Ashok Alapati
DOI:10.4103/err.err_22_19  
Background Simultaneous injury of two or more knee ligaments with concurrent tears involving the anterior cruciate and medial collateral ligaments is considered to be associated with femorotibial knee dislocations (KD). The purpose of this study is to characterize multiligamentous knee injury patterns associated with dislocations on MRI and to describe the incidence of their sequelae such as tibial plateau fractures, peroneal nerve injuries, and posterolateral corner (PLC) injuries. Participants and methods After obtaining institutional ethical committee approval, we retrospectively identified 108 multiligamentous knee injuries in 100 patients who met with trauma and were treated at our tertiary care center between April 2014 and December 2018. Descriptive statistics were reported using numbers and percentages for categorical variables in cases of multiligamentous injuries, ipsilateral tibial plateau fractures, ipsilateral femoral fractures, peroneal nerve injury, arterial injury, compartment syndrome, and PLC injuries. Results The most common (39.8%) injury pattern was a combined disruption of the anterior cruciate ligament, posterior cruciate ligament, and PLC. Schenck KD III-M was the most common injury type in KD, constituting 16.7%. Medial-sided injuries were the most common injury patterns seen with KD. There was a significant risk of peroneal nerve injury with lateral-sided injuries. Conclusion KD, though rare, may have devastating clinical sequelae such as compartment syndrome if not recognized and treated. Therefore, it is necessary to recognize imaging findings of femorotibial joint dislocations and associated injuries to the adjacent neurovascular bundles.
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Pattern of peripheral neuropathy in systemic lupus erythematosus: clinical, electrophysiological, and laboratory properties and their association with disease activity p. 285
Mohamed Hassan Imam, HamdyKhamis Koriem, Marwa Mohamed Hassan, Abeer Shawky El-Hadidi, Niveen Abdallah Ibrahim
DOI:10.4103/err.err_28_19  
Aim To study clinical, electrophysiological, and laboratory properties of peripheral neuropathy (PN) in systemic lupus erythematosus (SLE) and their association with disease activity. Patients and methods A total of 30 patients who met the American College of Rheumatology case definition criteria for SLE-PN and 30 age-matched and sex-matched patients with SLE without PN were selected from the Main Alexandria University Hospital Physical Medicine, Rheumatology and Rehabilitation clinic. Demographic data, SLE-related clinical, laboratory data, Systemic Lupus Activity Measure (SLAM) index, and nerve conduction studies were done. This case–control study compared clinical and SLE-related features, laboratory, and SLAM index in patients with SLE with PN versus those without neuropathy. Results The results showed that the most common PN subtype was sensorimotor polyneuropathy which occurred in 18 (60%) patients; the most common PN pathology was axonal degeneration, which occurred 19 (63.3%) patients; and the most common associated nerve entrapment was carpal tunnel syndrome in 10 (33.3%) patients. In comparison between group I (SLE with PN) and group II (SLE without PN), there was no statistically significant difference between the two groups regarding demographic data, disease duration, and lupus clinical features, except malar rash and lupus nephritis, which showed significant increase in patients with SLE with PN compared with patients with SLE without PN (P=0.003 and P<0.001, respectively). There was no statistically significant difference among PN subtype groups regarding sex, age, and immunological markers. Regarding diseases activity, SLAM index showed a significant increase in patients with SLE with PN compared with patients with SLE without PN (P=0.006). Conclusion The pattern of neuropathy in SLE is mainly axonal. Moreover, the most common PN subtype is sensorimotor polyneuropathy. The study suggests significant association of PN in patients with SLE with nephritis, malar rash, and SLAM index.
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The effect of botulinum toxin type A injection in decreasing intratunnel tendon tension in carpal tunnel syndrome: a randomized controlled trial for efficacy and safety p. 299
Shymaa A Hablas, Doaa W Nada, Doaa S Alashkar, Ahmed A Elsharkawy
DOI:10.4103/err.err_35_19  
Aim To evaluate the efficacy of botulinum toxin A on relieving the clinical symptoms caused by median nerve compression in patients with carpal tunnel syndrome. Patients and methods An imbalanced randomization (3 : 1) placebo-controlled parallel group study for efficacy and safety was conducted in Tanta University, Egypt. Group I received Botox injection. Group II received the same amount of normal saline as Botox injection and at the same injection points as group I. All patients were subjected to clinical assessment and electrophysiological assessment of the median nerve before and after 12 weeks. Results Highly significant improvements were noted in group I regarding clinical symptoms and electrophysiological study of the median nerve, whereas group II showed significant improvement in clinical symptoms but no improvement in the electrophysiological study, with significant difference between the two groups. Conclusion Botox injection can be used safely as a treatment option in moderate carpal tunnel syndrome.
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Impact of rheumatoid arthritis on the quality of life and its relation to disease activity p. 304
Samar H Goma, Mohamed Raouf Abdel Razek, Nesreen M Abdelbary
DOI:10.4103/err.err_39_19  
Background Quality of life (QOL) is a multidimensional concept that is used to describe the individuals’ perceptions, satisfaction, and evaluation of different areas of their own lives, such as physical health and functioning, psychological and emotional well-being, social roles, and relationships. Few studies have addressed the effect of rheumatoid disease on the QOL in the Egyptian community. Results Functional disability based on health assessment questionnaire disability index was significantly increased with the increase in disease activity based on disease activity score-28, where all patients on remission and 56% of those with low disease activity had mild functional disability. Approximately 89% of patients with low disease activity had mild anxiety based on Hamilton anxiety scale, and the majority (75%) of those patients with moderate disease activity and 83.3% of patients on remission had mild anxiety. The majority (85.7%) of those with high disease activity were depressed based on Zung self-rating depression score. Disease activity score-28 score had a positive significant correlation with health assessment questionnaire disability index (P=0.01, r=0.40), Hamilton anxiety scale-A (P=0.01, r=0.46), Zung score (P=0.01, r=0.46), and rheumatoid arthritis QOL (r=0.70, P=0.00), and negative correlation with female sexual index (r=−0.80, P=0.00), all domains of SF-36, and all five domains of WHOQOL. Conclusion This study confirms that rheumatoid arthritis causes impairment of all aspects of QOL (limitation of physical function, physical disability, and pain), mental health disorders (anxiety and depression), and social, environmental, and also sexual dysfunction.
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Relation of interleukin-15 with the severity of primary knee osteoarthritis p. 313
Ibrahim K Ibrahim, Emmanuel K Aziz Saba, Neveen L Mikhael Saad, Doaa Y.A Mohammed
DOI:10.4103/err.err_42_19  
Background Interleukin-15 (IL-15) is a proinflammatory cytokine. IL-15 could be considered a potential biomarker for primary knee osteoarthritis (OA). Aim This study aimed to assess the serum level of IL-15 in primary knee OA patients and assess its relation to clinical severity, functional disabilities, and radiological grading of knee OA. Patients and methods This study included 40 patients with primary knee OA and 40 apparently healthy individuals. Assessment of knee OA was performed using clinical examination, the Western Ontario and McMaster Universities Osteoarthritis Index score, and Health Assessment Questionnaire-Disability Index. Radiological assessment was performed using the Kellgren–Laurence grading scale. Serum level of IL-15 was measured in both patients and control participants. Results There were no statistically significant differences between patients and the control group in sex (P=1.000) and age (P=0.247). The patient group had a statistically significantly higher serum IL-15 level than its level in the control group (P≤0.0001). Serum IL-15 level was significantly higher among patients with knee joint line tenderness and effusion (P≤0.0001). There were statistically significant positive correlations between serum IL-15 level with the Western Ontario and McMaster Universities Osteoarthritis Index total score (P≤0.0001), the Health Assessment Questionnaire-Disability Index score (P≤0.0001), and the Kellgren–Laurence grading scale (P≤0.0001). Conclusion Serum IL-15 is elevated and correlated positively with pain, stiffness, functional disabilities, as well as radiological damage in primary knee OA. This suggests that IL-15 plays an important critical role in the pathogenesis of primary knee OA-related pain, stiffness, and joint damage. IL-15 might be a potential biomarker for assessing the severity of primary knee OA.
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Fas-mediated apoptosis and peripheral polyneuropathy in type 2 diabetes mellitus p. 321
Mowaffak M Abd Elhameed, Noha A Elsawy, Magdy H Zekry Mgalaa, Sarah S El-Tawab, Reham A Abo Elwafa, Marwa R Abd Elfadeel
DOI:10.4103/err.err_37_19  
Objective To evaluate the role of soluble Fas (sFas) and soluble Fas ligand (sFasL) in the pathogenesis of distal symmetrical polyneuropathy (DSPN) in patients with type 2 diabetes mellitus, and to analyze the relationship between these apoptotic markers with clinical parameters and electrophysiologic profile of DSPN, as well as with different diabetic factors among those patients. Patients and methods The study included 60 Egyptians with type 2 diabetes mellitus. All patients were evaluated clinically for DSPN by using Michigan Neuropathy Screening Instrument. Electrophysiological diagnosis of DSPN was based on the criteria suggested by the European Standardized Telematic tool to Evaluate Electrodiagnostic Methods group. Diabetic patients were divided into two groups according to the electrophysiological findings: group A included patients with DSPN (N=42), and group B included patients without DSPN (N=18). The severity of DSPN among group A patients was assessed clinically using Toronto Clinical Neuropathy Score and electrophysiologically by the severity score proposed by Hidasi and colleagues. The study also included 30 healthy volunteers as a control group. Serum levels of sFas and sFasL were assessed in all the studied groups. Results Serum level of sFas was significantly elevated in diabetic patients with DSPN compared with diabetics without DSPN and nondiabetic control (P=0.029 and 0.000). Receiver operating characteristic (ROC) curve analysis detected that sFas was statistically significant in discriminating between diabetic patients with DSPN from those patients without DSPN with an accuracy of 66%. The cutoff point that has the highest sensitivity (61%) and specificity (62%) was 33.3 ng/ml. Serum level of sFas showed a positive significant correlation with the electrophysiological severity of DSPN (P=0.020). Serum level of sFasL did not show statistically significant difference between all the studied groups. Conclusion Fas-mediated apoptosis has an important role in the development of diabetic DSPN and is correlated with its electrophysiological severity.
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