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   2015| July-September  | Volume 42 | Issue 3  
    Online since August 31, 2015

 
 
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ORIGINAL ARTICLES
Clinical diagnosis of distal diabetic polyneuropathy using neurological examination scores: correlation with nerve conduction studies
Shereen R Kamel, Mona Hamdy, Hanaa A.S. Abo Omar, Amal Kamal, Lamia H Ali, Ahmed H Abd Elkarim
July-September 2015, 42(3):128-136
DOI:10.4103/1110-161X.163945  
Aim The aim of this study was to diagnose diabetic sensorimotor polyneuropathy using neurological examination scores and to correlate the findings with nerve conduction studies (NCS). Patients and methods Thirty patients with type 2 diabetes were included in the study. Detection and grading of neuropathy were carried out based on the Diabetic Neuropathy Symptom (DNS) Score, modified Neuropathy Symptom Score (NSS), Diabetic Neuropathy Examination (DNE), and modified Neuropathy Disability Score (NDS). For the NCS, amplitudes, velocities, and latencies of seven nerves - that is, four motor (median, ulnar, tibial, and common peroneal) and three sensory (median, ulnar, and sural) nerves - were recorded. If the patient had two or more abnormal findings in any of these nerves, the patient was diagnosed as having peripheral sensorimotor neuropathy. Thereafter, the sensitivity, specificity, and diagnostic efficacy of each neurological score were recorded taking NCS as the gold standard. Results Diabetic sensorimotor polyneuropathy was diagnosed clinically and electrophysiologically in 17 patients (56.7%). However, there were nine cases (30%) of subclinical neuropathy. Neurological examination scores were significantly correlated with each other and with individual variables of NCS and the nerve conduction sum score. Taking the NCS as gold standard, DNS, modified NSS, DNE, and modified NDS had 65.4, 61.5, 30.8, and 61.5% sensitivity and 100, 75, 100, and 100% specificity, respectively. Their diagnostic efficacies were 70, 63.3, 40, and 66.7%, respectively. Conclusion Neurological examination scores can detect and grade neuropathy in the majority of cases. However, NCS was accurate for detection of diabetic sensorimotor polyneuropathy, especially for the subclinical neuropathies.
  3,292 442 -
Treatment of phantom pain with contralateral injection into tender points: a new method of treatment
Alaa A El Aziz Labeeb, Roberto Casale
July-September 2015, 42(3):103-110
DOI:10.4103/1110-161X.163929  
Objective The aim of this study was to ascertain the existence of contralateral painful muscle areas mirroring phantom pain and to evaluate the short-term effects of anaesthetics versus saline, injected contralaterally to control phantom and phantom limb pain. Design This was a double-blinded cross-over study. Participants This study included eight lower-limb amputees with phantom limb pain in the past 6 months. Interventions Either 1 ml of 0.25% bupivacaine or 0.9% saline was injected alternately in each point with a 28-G needle, with 72 h between injections. The main outcomes measured were phantom sensation modification and the intensity of phantom limb pain (visual analogue scale) before and after injections. Results Painful muscle areas in the healthy limb do not mirror the topographical distribution of phantom limb pain. At 60 min after the injection, a statistically significantly greater relief of phantom limb pain was observed after using a local anaesthetic compared with that when using saline injection (P = 0.003). Bupivacaine consistently reduced/abolished the phantom sensation in six out of eight patients. These effects on phantom sensation were not observed after saline injections. Conclusion Contralateral injections of 1 ml of 0.25% bupivacaine in the myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. Our study gives a basis of a new method of management of that kind of severe pain to improve the method of rehabilitation of amputee. However, further longitudinal studies with larger number of patients are needed to confirm our study.
  1,803 152 -
Predictive factors for progression of adolescent idiopathic scoliosis: a 1-year study
Enas A Elattar, Nayera Z Saber, Dina A Farrag
July-September 2015, 42(3):111-119
DOI:10.4103/1110-161X.163943  
Background and objective The cause of scoliosis remains unknown in 80-85% of adolescent patients. Treatment of adolescent idiopathic scoliosis (AIS) remains a complex challenge. Aim The goal of this study was to evaluate the predictive value of different factors [age, initial Risser's score and initial Cobb's angle, surface electromyography (SEMG), activity of both paraspinal muscles at the apex of the curve] in the progression of AIS. Patients and methods This study included 30 patients with AIS. Full history taking and spinal and neurological examinations were carried out. Initial Cobb's angle and Risser's staging were determined, together with SEMG of paraspinal muscles at the curve's apex. Reassessment of Cobb's angle and Risser's score was done 1 year later. Statistical analysis Analysis of data was carried out with an IBM computer using statistical program for social science (version 18) software and services. Quantitative data were presented as mean, SD, minimum and maximum values, and range. Qualitative data were presented as number and percentage, analyzed with the χ2 -test. Analytic statistics were calculated using Student's t-test to compare two independent means. A receiver-operating character curve was constructed using Medcalc program 3.5. Results Twenty-six girls and four boys with dorsal and dorsolumbar scoliosis were included in this study. There was significant increase in Cobb's angle and Risser's score. Age, Risser's score, and SEMG results on the convex side were significantly correlated with progression of the curve. Cobb's angle was the most sensitive predictor, followed by SEMG, whereas age, initial Risser's score, and SEMG had the highest specificity as predictors. Conclusion Cobb's angle, Risser's score, and SEMG are specific, sensitive, and positive predictors for progression of AIS.
  1,648 182 -
Vitamin D receptor gene polymorphism in rheumatoid arthritis and its association with atherosclerosis
Amal M El-Barbary, Manal S Hussein, Elsayed M Rageh, Salwa A Essa, Hossam A Zaytoun
July-September 2015, 42(3):145-152
DOI:10.4103/1110-161X.163947  
Aim of the work Determine vitamin D receptor gene BsmI, FokI polymorphism and 25-hydroxyvitamin D in early Egyptian rheumatoid patients and its association to subclinical atherosclerosis. Patients and methods This study included forty early rheumatoid arthritis patients and forty healthy controls. Disease activity score 28 (DAS-28), Modified Health Assessment Questionnaire (MHAQ), Carotid intima-media thickness (cIMT) were assessed using B-mode ultrasound, Erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Lipid profile, anti cyclic citrullinated PolyPeptid (anti-CCP), serum interleukin-6, Total serum vitamin D and genotype determination of BsmI, FokI polymorphism and allel frequency were measured. Results Vitamin D deficiency was observed in 25% of patients. There was no significant difference between RA patients and controls regarding the distribution of BsmI genotype frequencies and allele. However, a significant difference between rheumatoid arthritis patients and controls regarding the distribution of FokI genotype and allele frequencies was found. In addition, FokI polymorphism and the F allele was significantly associated with RA. anti-CCP, interleukin-6 levels, (cIMT) and vitamin D deficiency were significantly higher in the presence of bb homozygote of BsmI genotypes and FF homozygote of FokI genotypes. A significant negative correlation between 25 hydroxy vitamin D levels with (DAS-28), ESR, (CRP), and IL-6 (P < 0.001). However, there was positive correlation between 25 hydroxyvitamin D levels and HDL-C (P < 0.001).
  1,391 211 2
Electrophysiological and clinical comparison of local steroid injection by means of proximal versus distal approach in patients with mild and moderate carpal tunnel syndrome
Mohja Ahmed Abdel-Fattah EL-Badawy
July-September 2015, 42(3):120-127
DOI:10.4103/1110-161X.163944  
Background Local corticosteroid injection is one of the treatment modalities for carpal tunnel syndrome. Symptomatic and electrophysiological improvement following local corticosteroid injection has been documented. Objectives The aim of the present study was to compare the effects of proximal and distal approaches of local steroid injection in patients with mild and moderate carpal tunnel syndrome on clinical scores and electrophysiological parameters at the end of 1 month following injection. Patients and methods A total of 30 patients were included and randomly assigned into one of the two groups based on the local steroid injection approach either by means of distal (group I) or by mean of proximal approach (group II). Clinical and electrophysiological examinations were carried out before and 1 month following the injection. Results There was a significant reduction in the pain and disability scores of the Boston Carpal Tunnel Questionnaire between the baseline and follow-up in both groups. Median motor nerve distal latency was statistically significantly reduced in both groups 1 month after the injection. Median motor conduction velocity and amplitude (amp) showed a statistically nonsignificant difference 1 month following the injection. Median sensory distal latency, amp, and conduction velocity showed statistically significant difference between the two groups. The average duration of the procedure in group I was 9.29 ± 0.76 s compared with 47.91 ± 9.66 s in group II. The average grade of pain expressed by the patients in group I was 1.97 ± 0.82 compared with 5.11 ± 0.67 in group II. Conclusion Local corticosteroid injection at the carpal tunnel using the distal approach is associated with favorable clinical and electrophysiological results similar to those reported using the proximal approach. The distal approach is much less time consuming and more comfortable compared with the proximal approach.
  1,396 160 3
Effect of chondroitin sulfate on cartilage volume loss and subchondral bone marrow lesions in osteoarthritis knee
Mohammad H Elgawish, Mohammad A Zakaria, Hadeer S Fahmy, Anwar A Shalaby
July-September 2015, 42(3):153-158
DOI:10.4103/1110-161X.163948  
Background Chondroitin sulfate (CS) is a major component of the extracellular matrix of many connective tissues, including cartilage, bone, skin, ligaments, and tendons. Objective The aim of this work was to study the effect of CS treatment for short time (6 months) clinically and using MRI on cartilage volume loss, subchondral bone marrow lesions (BMLs), and synovitis in patients with primary knee osteoarthritis (OA). Patients and methods A total of 50 patients with primary knee OA and clinical signs of synovitis were included in this study. They were divided into two treatment groups. Group 1 included 30 patients who received two capsules of CS (structum capsule 500 mg) once daily for 6 months. Group 2 included 20 patients who received placebo once daily for 6 months. Clinical, radiological, and laboratory assessments were performed for all patients. Cartilage volume loss, subchondral BMLs, and synovial membrane thickness were assessed with MRI at baseline and after 6 months for both groups. Results The CS group showed significantly less cartilage volume loss compared with the placebo group after 6 months for the global knee, lateral compartment and tibial plateaus. However, there were no significant differences in the medial compartment and trochlea between the two groups. Significantly lower BML scores were found for the CS group compared with the placebo group after 6 months, and there were no significant differences in synovial membrane thickness between the two groups. Disease symptoms were similar in both groups. Conclusion CS treatment significantly reduces the cartilage volume loss and subchondral BMLs in primary knee OA after 6 months of treatment. These findings suggested a joint structure-protective effect of CS.
  1,128 158 -
Validity of magnetic resonance image and HLA-B27 in early detection of sacroiliitis in Egyptian spondyloarthropathic patients
Rawhya R El-Shereef, Amal Ali, Ayman Darwish, Fatma Ali, Mohammed Ibrahim, Lamia Hamdy
July-September 2015, 42(3):137-144
DOI:10.4103/1110-161X.163946  
Objective The aim of this study was to compare the validity of MRI in the early detection of sacroiliitis with laboratory findings of human leukocyte antigen-B27 (HLA-B27), conventional radiography, and clinical assessment. Participants and methods Sixty patients with spondyloarthropathy (group II) with duration of illness less than 2 years and 20 healthy controls (group I) were included in this study. Both groups were subjected to assessment of history, clinical examination, and laboratory investigations (erythrocyte sedimentation rate, C-reactive protein titer, rheumatoid factor, HLA-B27). Conventional radiography and MRI of the sacroiliac joints were performed. Spondyloarthropathic patients were divided according to MRI as follows: group IIA, which included patients with sacroiliitis, and group IIB, which included patients without sacroiliitis. Results In our study, ankylosing spondylitis was diagnosed in 22 (36.6%) patients, followed by undifferentiated spondyloarthropathy in 12 (20%) patients, reactive arthritis in 10 (16.7%) patients, psoriatic arthropathy in 10 (16.7%) patients, and enteropathic arthropathy in six (10%) patients. Evidence of sacroiliitis was found in 66.6% (40/60) of patients by MRI, which was higher than the result obtained by plain radiography 20% (12/60). HLA-B27 positivity found in 53.3% (32/60) of patients. There was a significant difference between the two groups in HLA-B27 and radiological sacroiliitis; there was no sacroiliitis in the control group. MRI showed sacroiliitis even in patients with no inflammatory back pain. There was a highly statistically significant difference between patient subgroups in disease duration (P = 0.001) and primary complaints and clinical sacroiliitis (P = 0.001). Conclusion MRI is the preferred modality in the detection of early sacroiliitis in spondyloarthropathy and HLA-B27 positivity is a highly useful predictor of early sacroiliitis
  1,157 121 -
CASE REPORT
Radiosynovectomy of ankle joint synovitis in juvenile rheumatoid arthritis treated with rhenium-188 tin colloid and imaging with SPECT/CT
Koramadai K Kamaleshwaran, Thirumalaisamy S Gounder, Boopathy Krishnan, Madhav Mallia, Radhakrishnan Kalarikal, Ajit S Shinto
July-September 2015, 42(3):159-161
DOI:10.4103/1110-161X.163949  
Rheumatoid arthritis is a chronic disease that is mainly characterized by asymmetric erosive synovitis, particularly affecting peripheral joints. Radiation synovectomy, or radiosynovectomy, was first described in 1950s as an adjuvant treatment for rheumatoid arthritis. Radiosynovectomy is based on the irradiation of the synovial joint by means of intra-articular administration of various b-emitting radiopharmaceuticals. As a generator-produced beta-emitting radionuclide, the importance of rhenium-188 (Re-188) in radionuclide therapy is increasing rapidly. There are previous studies that used Re-188 tin colloid in knee joint synovitis, but its use in ankle joint has not yet been reported. We describe the use of Re-188 tin colloid in a 19-year-old male patient who presented with ankle joint synovitis.
  1,076 122 -
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