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   2014| July-September  | Volume 41 | Issue 3  
    Online since September 11, 2014

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Prevalence of low back pain in working nurses in Zagazig University Hospitals: an epidemiological study
Amany M Abou El-Soud, Amany R El-Najjar, Nada A El-Fattah, Aida A Hassan
July-September 2014, 41(3):109-115
Background Nursing is one of the occupations with a high risk for back injuries. The etiology of low back pain (LBP) among nurses is usually multifactorial, probably because job demands in nursing is a mixture of physically demanding and mentally demanding tasks. Objective The aim of this study was to identify the prevalence of and risk factors for chronic LBP in nursing personnel working in Zagazig University Hospitals. Materials and methods This study is a quantitative, retrospective, analytical, cross-sectional one. It included 150 female nurses who are currently working in Zagazig University Hospitals. All participants completed a self-administered Oswestry Low Back Disability Questionnaire. Data for risk factors of LBP (age, height, weight, BMI, marital state, parity) and working conditions (duration of employment in the current work, average working hours per week, work demands, duration of absence from work in the last year) were collected. Results LBP prevailed in 79.3% of the studied group of working nurses. The highest percentage was found among nurses working in the ICU (95.0%) and the least among those working in the outpatient clinics (64.0%). There was a highly significant association between LBP and body mass index (BMI) (P < 0.001). A higher incidence of LBP was associated with lifting heavy loads, followed by twisting, prolonged standing, prolonged sitting, walking for long distances, and bending forward. Conclusion Prevalence of LBP is high among nurses, resulting in significant medical and socioprofessional consequences. Risk factors necessitate multidisciplinary involvement to reduce the incidence of LBP and related costs.
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Evaluation of exercise training on work capacity, functional mobility, and quality of life in hemodialysis patients
Amany M Abou El-Saoud, Omyma Z Shehata, Ahmad A Emerah, Elsayed F Sayed
July-September 2014, 41(3):103-108
Introduction Patients with chronic renal failure are restricted in their physical and social aspects of life because of their treatment and comorbid medical conditions. Aim of the work The aim of this study was to evaluate the effect of an exercise training program on functional work capacity, functional mobility, and quality of life (QOL) 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/week for 12 weeks. Each exercise session consisted of a warm up, cycle or trade mill exercises, stretching exercise, and cool down. All patients were subjected to a cardiovascular graded exercise tolerance test, the sit-to-stand-to sit test, and the 6-min walk test. A questionnaire was used to assess the QOL of the study group 1 week before and after the exercise training program. Fifteen normal individuals, age and sex matched with our patients, were used as controls to compare the respiratory function. Results There was a significant improvement in work capacity before and after the training exercise program, respectively (7.24 ± 0.90 to 9.62 ± 1.1; P < 0.001); also, there was a highly significant improvement in functional mobility. The QOL had improved after the exercise training program on four of five scales of the 36 questionnaire. Conclusion A suitable exercise training program is essential for improvement of work capacity and mobility, and improvement of psychological status and QOL.
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Low-dose intra-articular autologous conditioned serum in treatment of primary knee osteoarthritis
Fatma K Abd-EL Motaal, Amal M Elganzoury, Mahmoud M Fathalla, Ola Abdulkareem
July-September 2014, 41(3):98-102
Background Interleukin-1 (IL-1) plays an important role in the pathogenesis of osteoarthritis. Hence, agents that inhibit such cytokine have a high therapeutic potential. A method of therapy depends on competitive inhibition of IL-1 at the receptor level - that is, IL-1 receptor antagonist; such antagonist is called Orthokin, which is a normal product of monocytes and is prepared within autologous conditioned serum (ACS) from the patient's own blood cells. It is capable of blocking the effects of IL-1, including the induction of matrix metalloproteinases, prostaglandin E 2 synthesis, and expression of other cytokines. Objective The aim of the study was to clinically evaluate the effect of intra-articular injection of low-dose ACS enriched with Orthokin on primary knee osteoarthritis to assess its validity in treatment. Patients and methods This study included 30 knees with primary osteoarthritis. Baseline clinical evaluation using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score was performed. Then ACS enriched with Orthokin (IL-1 receptor antagonist) was prepared. The knee joint was injected with 1 ml ACS weekly for 3 successive weeks. Patients were assessed using WOMAC questionnaire (1 week after each injection for 3 weeks and monthly after the last injection for 3 months). Results On comparing WOMAC score with baseline data, there was a highly significant improvement in all scores, where P was less than 0.01 during all assessment periods and improvement persisted until the end of follow-up after 3 months in comparison with baseline data. Conclusion The synthesis and introduction of interleukin-1 receptor antagonists derived from own blood cells established a promising strategy in the treatment of osteoarthritis.
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Prevalence of vitamin D deficiency in Egyptian rheumatoid arthritis patients: correlation with disease activity, functional disability, and bone mineral density
Nashwa T Allam, Mohamed M El-Wakd, Dina M El-Abd, Dalia A Dorgham
July-September 2014, 41(3):92-97
Aim of Work To detect the prevalence of 25-hydroxyvitamin D 3 [25(OH)D 3 ] deficiency in rheumatoid arthritis (RA) patients and its correlation with disease activity, functional disability and bone mineral density (BMD). Patients and Methods Cross-sectional case control study included 104 RA patients and 60 matched controls. All patients were subjected to full history taking, clinical examination and routine laboratory investigations in addition to measurements of serum 25(OH)D 3 . Disease activity was assessed by 28-Disease Activity Score (DAS-28) with three variables; tender and swollen 28-joints (T-28 and S-28) and erythrocyte sedimentation rate (ESR). Functional disability was assessed by Modified Health Assessment Questionnaire (M-HAQ). BMD was measured by dual energy x-ray absorptiometry. Results 25(OH)D 3 deficiency was similar in both RA patients and controls (99.1% versus 100%). Although, the mean serum 25(OH)D 3 level was less among RA patients than among controls but there was no statistical significant difference (5.98 ± 6.8 nmol/l versus 8.4 ± 9.6 nmol/l, p = 0.06). There were statistically significant correlations between 25(OH)D 3 and body weight (r = −0.256, p < 0.009), T-28 (r = −0.559, p < 0.001 ), S-28 (r = −0.631, p < 0.001), DAS-28 (p < 0.001), M-HAQ (p < 0.001) scores, ESR (r = −0.39, p < 0.001) and hemoglobin (r = 0.28, p = 0.004). No significant correlation was found between 25(OH)D 3 level and BMD or drug intake. Conclusion Although the prevalence of 25(OH)D 3 deficiency is similar in both RA patients and controls but its deficiency is significantly correlated with increased disease activity and disability but not with BMD.
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Central neuroplasticity and lower limbs functional outcome following repetitive locomotor training in stroke patients
Enas M Shahine, Tarek S Shafshak
July-September 2014, 41(3):85-91
Objective To evaluate the efficacy of electromechanical gait training (EGT) versus treadmill training with partial body weight support (TTPBWS) on lower limb motor performance (MP) and on motor evoked potential (MEP) in patients with chronic stroke. Patients and Methods Fifty patients (age 43-75 years) with hemiparetic stroke (7-72 months' duration) were allocated randomly to two groups. Patients of group I (n = 25) received EGT and those of group II (n = 25) received TTPBWS (20 min/day, 6 days/week for 8 weeks). Main outcome measurements: Fugel-Meyer lower extremity (FMLE) MP test and MEP were assessed in all patients before rehabilitation (A-begin), at the end of rehabilitation (A-end), and 3 months later (A-3m). By transcranial magnetic stimulation, MEP threshold, MEP amplitude (MEPamp), and cortical latencies to the rectus femoris, tibialis anterior, and gastrocnemius (GC) muscles were assessed. Results Better improvement in FMLE was observed in group I compared with group II. In group I, FMLE scores improved significantly at A-3m compared with A-end. A significant reduction in GC cortical latencies and increase in GC MEPamp on the second and third follow-up were observed in group I compared with group II. Although all MEP parameters of the three lower limb muscles tested improved throughout the follow-up periods on intragroup compression, they did not reach statistically significant levels. More patients in group I (unlike group II) with unobtainable MEP at A-begin had obtainable MEP at A-end and A-3m from rectus femoris and GC muscles. The change in MEPamp was the most frequent MEP variable that correlated with the change in FMLE scores (in either group). Conclusion Better improvement in MP was observed following EGT at A-3m. Therefore, one EGT rather than TTPBWS may be recommended to improve lower extremity MP in chronic ambulatory stroke patients.
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The prevalence of fibromyalgia among school children in Kalubia
Ali Fuda, Yasser A Soliman, Nashwa E Hashaad, Eman Said, Mahmoud Fawzi
July-September 2014, 41(3):135-138
Aim of the work This study aimed to determine the prevalence of juvenile fibromyalgia syndrome (JFMS) among school children in Kalubia. Patients and methods This is a cross-sectional study conducted on school children in Kalubia governorate in January 2012 to determine the prevalence of fibromyalgia syndrome among school children. A total of 2000 children attending on the days of our visits were recruited from (a) primary and (b) preparatory schools. JFMS was diagnosed according to American College of Rheumatology (ACR) revised criteria 2010. Results We found that the prevalence of fibromyalgia among students in Kalubia governorate was 1.25%. Widespread pain and fatigue were found in all JFMS cases (100%), muscle stiffness was found in 14 cases (56%), and decreased physical activity in 12 cases (48%). Migraine was detected in 13 cases (52%), whereas sleep disturbance was present in 10 cases (40%). Also, depression was found in 10 cases (40%) and anxiety in two cases (8%). Irritable bowel symptom was detected in five cases (20%), but both weight fluctuation and atypical chest pain were recorded in one case (4%). Conclusion Pediatricians and other health providers should suspect JFMS in children suffering from pain, fatigue, and heat and exercise intolerance.
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Serum prohepcidin concentrations in rheumatoid arthritis and its relation to disease activity
Ahmad Emerah, Samah F Abbas, Heba F Pasha
July-September 2014, 41(3):130-134
Objectives The aim of this study was to assess the possible relations between serum level of prohepcidin in patients with rheumatoid arthritis (RA) and their rheumatoid anemia profiles and disease activity. Patients and methods A total of 80 patients with RA (34 male and 46 female) were enrolled. Their mean age was 43.3 ± 11.5 years, and the mean duration of the disease was 7.7 ± 7.0 years. RA disease activities were measured using Disease Activity Score 28 (DAS28). Anemia profiles were measured. Serum concentration of prohepcidin, the prohormone of hepcidin, was measured using enzyme-linked immunosorbent assay. Results The patients' mean concentration of serum prohepcidin was 211.4 ± 5.88 ng/ml, which was significantly higher than in the control group (167 ± 5.2 ng/ml). Serum level of interleukin-6 and tumor necrosis factor-α were significantly higher in RA patients than in the healthy control group (21.11 ± 5.88 vs. 3.36 ± 1.3 pg/ml and 17.8 ± 3.7 vs. 3.7 ± 1.1 pg/ml, respectively). The prohepcidin concentration was correlated with rheumatoid factor, C-reactive protein, erythrocyte sedimentation rate, and DAS28. There was a significant correlation between prohepcidin with tumor necrosis factor-α and interleukin-6. The prohepcidin concentration was significantly higher in the patients with active RA (DAS28 > 5.1) than those with inactive-to-moderate RA (DAS28≤5.1). Serum prohepcidin concentration in patients negatively correlated with serum iron (r = −0.23, P = 0.04). However, the prohepcidin concentration did not correlate with other anemia profiles. There was no difference of prohepcidin concentration between the patients with anemia of chronic disease and those without. Conclusion Serum concentration of prohepcidin reflects the disease activity, regardless of the anemia states in RA patients, and thus prohepcidin could be used as another useful marker for RA disease activity.
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Validity of high-resolution ultrasonographic measurement versus electrophysiological study in the detection of frequency of carpal tunnel syndrome in patients with rheumatoid arthritis
Rawhya R El-Shereef, Ahmad Lotfi, Fatma Ali, Sammer F El-Shayb
July-September 2014, 41(3):122-129
Objectives This study aimed to determine the frequency of occurrence of carpal tunnel syndrome (CTS) in rheumatoid arthritis (RA) patients, determine its relation to disease activity, describe the ultrasonographic (US) finding of CTS, and compare the diagnostic value of US with the electrodiagnosis in the detection of CTS. Patients and methods This study was carried out on 54 adult RA patients (group II) compared with 20 healthy volunteers as controls (group I). The disease activity in all patients was assessed using DAS28. All patients and controls underwent complete rheumatological and neurological examinations. Nerve conduction study (NCS) and high-resolution sonography were assessed in a blinded manner to clinical data. The patients were subdivided into two groups according to the measurement of NCS (group IIA: RA patients with CTS and group IIB: RA patients without CTS). Results The frequency of CTS in RA patients was 40.7%. A strong positive correlation was found between group IIA and the disease activity scale (P < 0.0001). There was a significantly higher level of cross-sectional area at the carpal tunnel inlet in group IIA than in group IIB and the control group (P < 0.0001). There was a significant correlation between the mean cross-sectional area with the grades of CTS detected by the electrophysiological study. The area under the curve was large for all receiver operating characteristic curves for each measurement (0.800). Conclusion The frequency of CTS in RA patents is high. High-frequency US examination of the median nerve should be strongly considered as a new alternative diagnostic modality for the evaluation of CTS. Sonography is probably preferable because it is painless, fast, easily accessible, and preferred by the patients.
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Prevalence of silent nontraumatic vertebral fracture in rheumatoid arthritis: relation with disease duration, disease activity, corticosteroid, and hip buckling ratio
Mohamed M El-Wakd, Omar H Omar, Hala Abou Senna
July-September 2014, 41(3):116-121
Objectives To detect the prevalence of silent nontraumatic vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) and its relation with disease duration, disease activity, corticosteroid (CS), and hip buckling ratio (BR). Patients and methods This cross-sectional study included a total of 150 RA patients. Disease activity was assessed using Disease Activity Score-28 (DAS-28). Dual-energy x-ray absorptiometry (DXA) was used to detect bone mineral density (BMD), VFs by vertebral fracture assessment (VFA), and hip BR by hip structural analysis program. Results A total of 17 (11.33%) RA patients had 27 silent VFs. Of the 17 VFs patients, 11 and six patients had single and multiple VFs, respectively. Of the 27 VFs, nine and 18 VFs had mild and moderate degree of VF. VF cases were significantly older in age (P = 0.001), had longer disease duration (P < 0.001), more active DAS-28 (P < 0.001), more cumulative CS dose, decreased spinal BMD (P = 0.02), and increased BR (P = 0.001). There were statistically significant relation between VFs and disease duration, DAS-28 and BR (P < 0.001 for all). VFs were independently associated with increased cumulative CS dose, high disease duration, and increased DAS-28 score (P < 0.001). Conclusion VFA-DXA should be performed on all RA patients. VF cases were significantly older in age, had long-standing disease duration, increased disease activity, reduced spinal BMD, increased cumulative CS dose, and increased BR. VFs were significantly related to increased disease duration, increased disease activity score, and increased BR of more than 10.
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