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   2016| October-December  | Volume 43 | Issue 4  
    Online since October 14, 2016

 
 
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ORIGINAL ARTICLES
New role for insulin injection in the treatment of idiopathic carpal tunnel syndrome
Soha Eldessouki Ibrahim, Azza Hussein
October-December 2016, 43(4):157-162
DOI:10.4103/1110-161X.192256  
Objective Local insulin injection for the median nerve was administered in patients with mild to moderate idiopathic carpal tunnel syndrome (CTS) to evaluate its effectiveness on the median nerve regeneration as it has been suggested that insulin has an effect on nerve regeneration, similar to that of nerve growth factor. Patients and methods This study included 82 patients (130 hands) with clinical and electrophysiologic evidence of mild to moderate idiopathic CTS (grade 3 or less according to Bland’s classification). The 130 hands were randomly assigned to two groups: group I received insulin injection of 10 IU Neutral Protamine Hagedorn known as humulin N (NPH) insulin locally into the affected carpal tunnel at the first visit and a similar dose of insulin after 2 weeks; and group II received a single injection of 40 mg triamcinolone acetonide injection into the carpal tunnel. Clinical and electrophysiologic evaluations were carried out at the start of the study and at 1 month after treatment. Patients were evaluated on the basis of the mean score on the Symptom Severity Scale and Functional Status Scale of the Boston Carpal Tunnel Questionnaire. Results All patients showed a symptomatic and functional improvement. Distal motor latency and distal sensory latency were decreased for both groups (4.84±0.74 vs. 4.61±0.72 and 2.88±0.27 vs. 2.55±0.19, respectively), with a significant decrease in the mean of Functional Status Scale score and Symptom Severity Scale score for patients treated with the insulin injection (2.5±0.6 vs. 2.07±0.55 and 3.13±0.47 vs. 2.23±0.5, respectively). Conclusion Local insulin injection effectively reduced the symptoms of CTS and improved electrophysiological findings in the present study. Our findings suggest that local insulin injection may be of great benefit in improving nerve functions in patients with mild to moderate idiopathic CTS. Further controlled studies are needed to confirm our preliminary findings and to compare local insulin injection with conventional approaches for the treatment of CTS.
  1,458 3,340 1
The relationship between auditory brainstem response, nerve conduction studies, and metabolic risk factors in type II diabetes mellitus
Noha M Abo-Elfetoh, Enass S Mohamed, Lubna M Tag, Rania M Gamal, Abeer M Gandour, Mohamed R Abd EL Razek, Mona A El-Baz, Manal E Ez Eldeen
October-December 2016, 43(4):163-171
DOI:10.4103/1110-161X.192253  
Background Few studies have reported a correlation between auditory brainstem response (ABR) findings and nerve conduction studies (NCSs). The correlation between ABR findings and the metabolic profile of these patients is not well documented in previous studies. The present study was designed to investigate the impact of the disturbed metabolic profile (hyperglyceridemia and hyperlipidemia) in diabetic patients on the peripheral nervous system as well as the auditory brainstem response. Aim The present study aimed to detect the effect of diabetic control on the presence of abnormal ABR and/or peripheral nerve affection in Egyptian diabetic patients. Patients and methods The study was conducted on two groups: the diabetic group (n=68) and the control group, which was matched for age, sex, blood pressure, and BMI (n=60). All participants were subjected to clinical assessment, basic audiologic assessment, brainstem auditory evoked potential, NCS, and metabolic profile [serum level of glycated hemoglobin (HbA1c%) and lipid profile]. Results There was a significant increase in absolute wave latencies of ABR and interpeak latencies (IPLs) in the diabetic group compared with the control group. Twenty-six (38.2%) patients had abnormal ABR values. IPLs (I–III and III–V) were significantly negatively correlated with sensory conduction velocity of the sural, median, and ulnar nerves as well as F-wave latency of the posterior tibial, median, and ulnar nerves (P=0.01 and 0.001, respectively). Moreover, IPL III–V and sural sensory conduction velocity were significantly correlated with HbA1c% and total cholesterol, as well as triglyceride serum levels. Conclusion Brainstem dysfunction and ABR changes are common in patients with type II diabetes mellitus. These changes are significantly correlated to NCS parameters on one hand and serum HbA1c% and lipid profile (total cholesterol and triglycerides) on the other hand.
  1,450 1,347 -
The effectiveness of combined prescription of ankle–foot orthosis and stretching program for the treatment of recalcitrant plantar fasciitis
Rehab A.E. Sallam, Atif I El Ghaweet
October-December 2016, 43(4):172-177
DOI:10.4103/1110-161X.192255  
Introduction Plantar fasciitis frequently responds to a wide range of conservative treatments with various degrees of success. Therefore, a continued search for an effective conservative treatment for plantar fasciitis exists. Aim The aim of this study was to evaluate the effects of individually prescribed night ankle–foot orthosis, stretching exercises, and a combined prescription of them on chronic plantar fasciitis. Settings and design This study is a prospective randomized case–control study. Patients and methods Seventy-five patients with unilateral recalcitrant plantar fasciitis were randomized to one of three treatment groups. Group I was treated with stretching exercises to the plantar flexors and plantar fascia. Group II was treated using a night-stretch ankle–foot orthosis. Group III received the same stretching exercises as in group I in combination with night-stretch ankle–foot orthosis as in group II. Results Patients receiving the combination of stretching exercises and night ankle–foot orthosis showed a statistically significant reduction in morning and activity pain, improvement in assessment scores, and improvement of ankle dorsiflexion range of motion as compared with those receiving night ankle–foot orthosis only. Patients receiving stretching exercises provide no statistically significant improvement of pain, assessment scores, and ankle dorsiflexion range of motion. No significant differences were observed in the ankle plantar flexion after treatment in the three groups. Conclusion Combined prescription of night-stretch ankle–foot orthosis and stretching exercises for plantar flexors and fascia had greater therapeutic effects compared with each treatment alone. Stretching exercises alone are not beneficial in the treatment of recalcitrant plantar fasciitis.
  1,628 384 -
Study of the association between nailfold capillaroscopic changes and serum level of interleukin-17 in rheumatoid: a clue for emerging vaculitis
HK Koryem, MY Tayel, SS Eltawab, RF Moftah, Omneya E Elazzay
October-December 2016, 43(4):190-195
DOI:10.4103/1110-161X.192254  
Objectives The aim of this work was to study nailfold capillaroscopic (NC) abnormalities and serum interleukin-17 (IL-17) level among rheumatoid arthritis (RA) patients and to find whether IL-17 is causally involved in the changes in the capillary vascular bed, such as autoimmune prevasculitic changes. Patients and methods The study was conducted on a group of RA Egyptian patients (n=40) who were diagnosed as having RA based on ACR criteria. Those 40 patients were further divided into two groups. Group 1 included RA patients with clinical signs of skin vasculitis and NC changes (n=6). Group 2 included RA patients with no clinical signs of skin vasculitis and no NC changes (n=34). All patients were subjected to demographic data collection, clinical examination, disease activity score 28 calculation, laboratory measurement (including erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibody, anti-cyclic citrullinated peptide, and IL-17) and NC examination. In addition, group 1 (n=6) was further subjected to electrophysiological evaluation using peripheral nerve conduction studies to determine the effect of vasculitis on the peripheral nerves. Results IL-17 level and NC changes showed a significant association in RA vasculitis patients. Conclusion Elevated levels of serum IL-17 and characteristic NC changes raise their importance in the detection of preclinical rheumatoid vasculitis.
  1,310 94 -
Electrophysiological study of the ulnar palmar cutaneous nerve in normal individuals
Emmanuel Kamal Aziz Saba
October-December 2016, 43(4):184-189
DOI:10.4103/1110-161X.192258  
Introduction The electrophysiological assessment of the ulnar palmar cutaneous nerve (UPCN) is clinically essential to assess the integrity of this nerve in some clinical situations that involve compression or injury of this nerve. Aim This study proposed to assess the electrophysiological antidromic technique of the UPCN and to obtain normal reference values for the electrophysiological parameters of this nerve. Settings and design It is a single-center public hospital-based electromyography laboratory. It is a cross-sectional study of consecutive apparently healthy volunteers. Patients and methods The study included 70 apparently healthy volunteers. Antidromic sensory nerve conduction study of the UPCN was carried out. Statistical analysis Quantitative data were analyzed using Student’s t-test and paired t-test. Correlation was tested using the Pearson correlation test. Results The present study included 119 hands of 70 healthy individuals [36 (51.43%) women]. Their mean age was 41.91±13.21 years. The UPCN was elicited in 116 (97.48%) hands. The estimated reference values (mean±2 standard deviations) for the UPCN sensory nerve action potential were determined for onset latency (≤2.1 ms), peak latency (≤2.8 ms), conduction velocity (≥46.4 m/s), amplitude (≥6.9 µV), and interside sensory nerve action potential amplitude ratio (≥0.50). Conclusion This study provided a feasible electrophysiological antidromic technique and normal reference values for sensory conduction study of the UPCN.
  1,043 113 -
Serum and synovial matrix metalloproteinase-3 as markers of disease activity in early rheumatoid arthritis
Rasha M Fawzy, Yasser A Abdel Hamid, Mona M Albehesy, Rasha F Aboelmaged
October-December 2016, 43(4):178-183
DOI:10.4103/1110-161X.192257  
Background Matrix metalloprotein ase-3 (MMP-3) is one of the MMPs produced in rheumatoid arthritis (RA) joints. Aim The aim of this study was to evaluate serum and synovial fluid (SF) MMP-3 as markers of disease activity in early RA. Patients and methods Thirty early RA patients together with age-matched and sex-matched 12 primary knee osteoarthritis patients and 12 apparently healthy individuals as control groups were enrolled in this study. MMP-3 was measured in serum and SF samples using enzyme-linked immunosorbent assay. Assessment of disease activity in RA patients was carried out using disease activity score-28 (DAS-28), and radiographs of the hands, wrists, and forefeet were obtained and evaluated according to Larsen score. Results As regards mean serum levels of MMP-3, there was a statistically significant elevation in RA patients compared with the control groups (P<0.001). Moreover, the mean SF levels of MMP-3 in RA patients were statistically significantly higher than that in osteoarthritis patients (P<0.001). In RA patients, there was a statistically significant difference (P<0.001) between mean serum and SF levels, being higher in the SF. There was a statistically significant positive correlation (P<0.05) between serum MMP-3 with disease duration, DAS-28, and Larsen score. As regards mean SF MMP-3 levels, there was a high statistically significant positive correlation (P<0.001) with DAS-28 and a statistically significant positive correlation (P<0.05) with Larsen score. Conclusion Elevated serum and synovial MMP-3 levels reflect disease activity in RA patients; thus, it could be used as a useful marker for disease activity. The cross-sectional design of our study did not allow us to produce conclusions with respect to disease course and prognosis. Thus, we recommend further studies on large numbers of patients and serial measurements of MMP-3 to determine the rate of disease progression.
  958 127 -
CASE REPORT
Primary synovial chondromatosis of the first tarsometatarsal joint: a rare case report
Mohd. Faizan, Sohail Ahmed, Latif Z Jilani, Kafil Akhtar, Ravindra Mohan, Mazhar Abbas
October-December 2016, 43(4):196-198
DOI:10.4103/1110-161X.192259  
Primary synovial chondromatosis is a rare condition and commonly involves a single large joint, although it may involve any synovial joint. It occurs as a result of metaplasia and focal formation of cartilage in the intimal layer of the synovial membrane. Diagnosis could be made after thorough clinical and radiological assessment. Diagnosis must be confirmed by histopathological examination, because malignant transformation has been reported. Here, we report a case of primary synovial chondromatosis on an extremely rare location involving the first tarsometatarsal joint.
  836 86 -
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