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Table of Contents
October-December 2013
Volume 40 | Issue 4
Page Nos. -
Online since Monday, December 30, 2013
Accessed 25,261 times.
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ORIGINAL ARTICLES
Pulmonary hypertension in scleroderma and its relation to disease activity
p. 173
Rawhya R Elshereef, Amal A Hassan, Aymen F Darwish, Hany T Asklany, Lamiaa Hamdy
DOI
:10.4103/1110-161X.123789
Aim
The aim of this study was to screen for pulmonary hypertension (PH) in scleroderma patients using Doppler echocardiography, and correlate it with inflammatory parameters of the disease.
Patients and methods
Doppler echocardiography was performed in 39 patients with scleroderma (three men and 36 women) and was compared with 20 age-matched and sex-matched healthy controls. Fifteen (38.5%) patients had limited scleroderma and 24 (61.5%) patients had diffuse scleroderma. PH was diagnosed if the peak systolic pressure gradient at the tricuspid valve was more than 25 mmHg. All patients were subjected to full assessment of history, rheumatological examination, laboratory studies, chest radiography, and pulmonary function tests.
Results
In 39 scleroderma patients, PH was detected in five patients (12.8%); four of them had limited scleroderma and one had diffuse scleroderma. The range of pulmonary artery systolic pressure was 37-63 mmHg (mean ± SD = 49.2 ± 10.1). There was a highly statistically significant difference between patients and controls (
P
< 0.0001). There were no significant differences between patients with and without PH in clinical features, except for arthritis and Raynaud's phenomena (
P
< 0.04, 0.01). Significant differences in the level of erythrocyte sedimentation rate, complement, and anticentromere antibodies were found in patients with PH versus those without PH (
P
< 0.04, <0.03, <0.002, respectively). There was a statistically significant correlation between pulmonary artery pressure with disease duration (
P
< 0.001) and Valentini Disease Activity Index (
P
< 0.001).
Conclusion
Patients with scleroderma have an increased risk of pulmonary arterial hypertension. Echocardiography should be used as a screening tool in patients who are at a higher risk of developing PH.
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Evaluation of the effect of exercise training program on work capacity, functional mobility, and quality of life in hemodialysis patients
p. 181
Amany M Abo El-Saoud, Omayma Z Shehata, Ahmad A Emerah, Elsayed F Sayed
DOI
:10.4103/1110-161X.123794
Introduction
Patients with chronic renal failure are restricted in physical and social dimensions of life because of their treatment and their comorbid medical conditions.
Aim of the work
The aim of this study was to evaluate the effect of exercise training programs on functional work capacity, functional mobility, and quality of life in patients with renal failure on hemodialysis.
Patients and methods
Thirty patients with chronic renal failure on maintenance hemodialysis participated in a regular exercise training program three times per week for 12 weeks. Each exercise session consisted of warm up, cycle or treadmill exercises, stretching exercises, and cool down. All patients underwent the cardiovascular graded exercise tolerance test, the sit-to-stand-to-sit test, and the 6-min walk test. Questionnaires were used to assess the quality of life of the study group 1 week before and after the exercise training program. A total of 15 normal individuals who were age-matched and sex-matched with our patients were used as controls to compare the respiratory function.
Results
There was significant improvement in work capacity after the training exercise program compared with that before the program (from 7.24 ± 0.90 to 9.62 ± 1.1;
P
< 0.001); in addition, there was also a highly significant improvement in functional mobility. The quality of life was improved after the exercise training program according to four of five scales of 36 questionnaires.
Conclusion
A suitable exercise training program is an important method for improvement of work capacity, mobility, psychological status, and quality of life.
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Clinical significance of phospholipid-cofactor antibodies in patients with systemic lupus erythematosus-associated antiphospholipid syndrome
p. 188
Shereen A Machalya, Hesham A Sharaf El-Din
DOI
:10.4103/1110-161X.123795
Objectives
To establish whether antibodies directed against phospholipid-binding plasma proteins such as β2-glycoprotein I (β2GPI), prothrombin (PT), and Annexin V (AnxV) constitute a risk factor for thrombosis in patients with systemic lupus erythematosus (SLE)-associated antiphospholipid syndrome (SLE/APS).
Patients and methods
A group of SLE patients (with and without APS) and patients with primary APS (PAPS) were included in this study. Fifteen patients with deep vein thrombosis but without antiphospholipid (aPL) antibodies, and another 15 age-matched and sex-matched apparently healthy individuals served as a control group. All patients were investigated for lupus anticoagulants and detection of anticardiolipin (aCL) immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies. Antibodies against β2GPI (IgG and IgM), PT (IgG and IgM), and AnxV (IgG) were also measured using the respective enzyme-linked immunosorbent assays.
Results
The study included 58 SLE patients (18 SLE/APS patients and 40 patients without APS) as well as 40 patients with PAPS, mean age 43 years (range: 18-74 years). IgG and/or IgM aCL antibodies were detected in all patients with PAPS (100%), whereas the prevalence rates of aPL-cofactor antibodies were as follows: 75% anti-β2GPI, 70% anti-PT, and 25% anti-AnxV antibodies. In SLE patients without APS, aCL antibodies were detected in 17.5%, anti-β2GPI antibodies in 20%, anti-AnxV antibodies in 20%, and anti-PT antibodies in 10% of patients. None of the antibodies measured were detected in deep vein thrombosis cases or healthy controls.
Conclusion
Measurement of antiphospholipid-cofactor antibodies in addition to the more widely used aCL and anti-β2GPI antibodies could be a useful prognostic marker for the risk of thrombosis in SLE/APS patients.
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Baseline angiopoietin-2/angiopoietin-1 (Ang2/Ang1) ratio is correlated with the synovial vascularity measured 1 month later in rheumatoid arthritis
p. 193
Mohammed Kamal Senna, Shereen Aly Machaly, Manal Foda, Nermeen Eid
DOI
:10.4103/1110-161X.123797
Background
Synovial angiogenesis is a component of rheumatoid pannus and considered to be an important early step in the pathogenesis of rheumatoid arthritis (RA).
Objectives
The aim of this study was to evaluate the serum levels of angiopoietin-1 (Ang1), angiopoietin-2 (Ang2), as well as the significance of the Ang2/Ang1 ratio in RA in relation to the joints' blood flow signals and RA activity parameters. In addition, we studied their relevance in predicting the state of angiogenesis.
Patients and methods
This study was carried out on 65 consecutive very early RA patients. Power Doppler ultrasonography was performed in a total of 10 joints. The blood flow signals of each joint were scored on a three-grade scaling system. The total of the scores of the 10 joints was defined as the total signal score (TSS). On the same day, serum variables including vascular endothelial growth factor (VEGF), Ang1 and Ang2 levels, and clinical disease activity were evaluated. All the parameters measured were reassessed after 1 month.
Results
Serum VEGF, Ang2 levels, and Ang2/Ang1 ratio were significantly correlated with C-reactive protein, DAS28-CRP, and TSS at baseline and after 1 month. Moreover, significant correlations were observed between serum VEGF and Ang2 levels and Ang2/Ang1 ratio both at baseline and 1 month later. Interestingly, baseline serum VEGF level and Ang2/Ang1 ratio were significantly correlated with TSS after 1 month.
Conclusion
Serum concentrations of VEGF and Ang2 as well as Ang2/Ang1 ratio were correlated with parameters of inflammation in early RA. Elevated serum VEGF and Ang2/Ang1 ratio (in favor of Ang2) could reflect a phase of vigorous angiogenesis.
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Therapeutic pulsed ultrasound with or without intra-articular methotrexate in the management of rheumatoid arthritis
p. 198
Alaa A Labeeb, Roberto Casale, Samar G Soliman, Waleed A Mosa
DOI
:10.4103/1110-161X.123807
Objectives
The aim of the study was to evaluate the role of combined therapeutic pulsed ultrasound with intra-articular methotrexate as against pulsed ultrasound treatment program alone in the management of chronic synovitis in rheumatoid arthritis patients.
Patients and methods
A total of 38 patients were enrolled in the study. All patients were above 18 years of age with inadequate clinical response in the form of persistent monoarthritis. Of them, 24 completed the study. Patients were divided into two equal treatment groups: The first group (12 patients) received three consecutive intra-articular methotrexate injections and daily therapeutic pulsed ultrasound sessions, whereas the second group (12 patients) received daily therapeutic low-intensity pulsed ultrasound sessions. All patients were subjected to clinical, laboratory, and ultrasound evaluation before and after treatment.
Results
Patients were subjected to an ultrasound evaluation before and after treatment to detect synovial thickness, hot spots, erosions and effusion, with highly statistically significant difference observed in the number of swollen joints, tender joint count, visual analogue scale scores and synovial thickness at the wrist (
P
<0.01) in the group of patients who received ultrasound and methotrexate. In addition, there was a statistically significant difference with respect to hot spots, number of erosions and joint space narrowing (
P
<0.05).
Conclusion
The combination of pulsed ultrasound therapy with repeated intra-articular methotrexate can give us better results in the form of decreased effusion, tenderness, inflammation and synovial membrane thickness, all of which translate into significant recovery of function and reduction in pain in rheumatoid patients with resistant monoarthritis or oligoarthritis, with the least number of side effects and without the need of adding another disease-modifying agent and/or resorting to surgical synovectomy.
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Electrophysiological assessment of hand elevation test in the diagnosis of carpal tunnel syndrome
p. 203
Takwa B Younes, Enas A Elattar
DOI
:10.4103/1110-161X.123808
Background
Provided that the hand elevation test can reproduce the symptoms of carpal tunnel syndrome (CTS), this phenomenon prompted the idea of developing a simple test to diagnose CTS.
Aim
The aim of this study was assess the electrophysiological values of the hand elevation test in the diagnosis of CTS syndrome.
Patients and methods
Thirty patients with initial symptoms and clinical signs of CTS in 49 hands were included. Special provocative tests for CTS were carried out before the hand elevation tests and the electrophysiological studies at least 5 min to avoid their effect on the intended test. The hand elevation test was performed and the test result was considered positive if symptoms occurred within 2 min. Nerve conduction study, including motor and sensory nerve conduction studies with F-wave study for both median nerves, was performed twice immediately before and after the hand elevation provocative test.
Results
This study was carried out on 60 hands; however, the initial complaint was in 49 hands, where the results showed a highly significant difference in parasthesia and hand pain, values of nerve conduction study (distal motor and sensory latencies) both before and after the hand elevation test, and a nonsignificant difference in the F-wave latencies. The posthand elevation distal motor and sensory latencies showed a sensitivity of 100 versus 78.6%, a specificity of 75 versus 81.2%, a positive predictive value of 77.8 versus 78.6%, and a negative predictive value of 100 versus 81.2%, respectively.
Conclusion
Hand elevation is a simple provocative test that could be the physical examination of choice and can be used as a first-order provocative test instead of other tests for the diagnosis of CTS. Its significant provocative value was documented electrophysiologically.
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Role of vascular endothelial growth factor expression in pathogenesis of postmenopausal osteoporosis
p. 211
Mahmoud E Nasser, Henaz F Khaled, Eman A Kaddah, Ahmed M Elbadrawy, Sahar M Mahdi, Mary A Sharobeem
DOI
:10.4103/1110-161X.123809
Background
Vascular endothelial growth factor (VEGF), an angiogenic growth factor, has been proved to play a significant role in bone remodeling. It may be involved in the molecular pathogenesis of postmenopausal osteoporosis.
Aim
The aim of this study was to investigate the expression of VEGF in bone biopsies of postmenopausal osteoporotic patients, assess the relation between the expression of VEGF and bone mineral density (BMD), and to evaluate the association between VEGF, serum estradiol, and bone estrogen receptor-α.
Patients and methods
This study was carried out on 30 female patients who were further subdivided into three groups: premenopausal, perimenopausal, and postmenopausal. All of them were subjected to full assessment of history, thorough clinical examination, and routine laboratory investigations. Serum estradiol levels were measured using ELISA. BMD was detected using DEXA. Bone biopsies were taken and three sections were obtained from each specimen. One was stained with hematoxylin and eosin stain for bone histomorphometrical assessment. The other two sections were stained immunohistochemically for the detection of VEGF and estrogen receptor-α (ER-α) expression.
Results
A highly statistically significant difference was found in VEGF expression between the premenopausal, perimenopausal, and postmenopausal women and also between osteoporotic and nonosteoporotic women. A highly statistically positive correlation was found between VEGF and each of the following: BMD, bone anabolic histomorphometrical parameters E2, and ER-α. However, a highly statistically negative correlation was observed between VEGF and bone histomorphometrical resorption parameters.
Conclusion
VEGF expression is decreased in bone of postmenopausal osteoporotic patients and is correlated to BMD. Its release is dependent on E2 and mediated through ER-α. These suggest that bone alterations induced by reduced estrogen in postmenopausal osteoporosis may be partly through decreased VEGF release. This makes it one of the possible targets in the treatment of postmenopausal osteoporosis.
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Auditory-evoked potentials as a tool for follow-up of fibromyalgia
p. 224
Ahmed A Abdel-Kader, Nadia S Kamel, Amal M El-Ganzouri, Dina S Al-Zifzaf, Nadia M Kamal, Abdel N Omar
DOI
:10.4103/1110-161X.123810
Aim of the study
In this study, we assessed the value of auditory-evoked potentials (AEPs) as objective measurable reproducible tests for the follow-up of patients with fibromyalgia (FM) in response to pharmacologic and rehabilitative therapy.
Patients and methods
This study included 30 female FM patients and 10 age-matched female controls. All participants underwent a clinical examination, a psychiatric and functional assessment (sleep score, Fibromyalgia Impact Questionnaire, and Hospital Anxiety and Depression Scale) and measurement of AEPs elicited by tones of increasing intensity (60, 70, 80, and 90 dB) known as late cortical responses and cognitive auditory potentials (P300). Patients were subdivided into three equal groups. Group 1 received pregabalin, group 2 received fluoxetine, and group 3 included patients who performed a graded aerobic exercise program. Assessment was repeated at the end of the 8-week treatment period.
Results
Patients had significantly shorter N1 latencies at 60 and 70 dB, significantly shorter P2 latencies at all the studied intensities, and significantly higher N1P2 amplitudes at 90 dB.There was a statistically significant decrease in amplitude and a significant increase in P300 latency when compared with controls. Changes in AEP values before and after treatment were closely associated with the changes in psychiatric and functional assessment parameters.
Conclusion
Improvement in the clinical assessment of the different symptoms of FM goes hand in hand with the improvement in the late cortical and cognitive components of AEPs, which provides evidence of the value of AEP as a simple, noninvasive, objective, and reproducible follow-up tool for assessment of hypervigilance and cognitive function in FM patients.
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© Egyptian Rheumatology and Rehabilitation | Published by Wolters Kluwer -
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Online since 31st Dec, 2013