Assessment of musculoskeletal ultrasound guided injection of the new regenerative medicine techniques (neural prolotherapy and platelet rich plasma) impact versus well established techniques (steroid injection) in cases of carpal tunnel syndrome secondary to rheumatoid arthritis

Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive and deforming poly-arthritis with extra-articular manifestations in 10­20% of patients, especially those with high titers of rheumatoid factor. Extra articular pathology includes bursitis, tendonitis and neuritis, which results from entrapment, nerve ischemia due to vasculitis or drugs used to treat this condition. Carpal tunnel syndrome is the most common compression neuropathy associated with rheumatoid arthritis. Aim of the Work: To evaluate the efficacy of Neural Prolotherapy and Platelet Rich Plasma in treatment of carpal tunnel syndrome secondary to rheumatoid arthritis. Patients and Methods: Ninety patients with Rheumatoid Arthritis (RA) that were all fulfilling the 2016 ACR/EULAR classification criteria for RA. All were over the age of sixteen years at time of diagnosis, complaining of burning pain or paresthesia in the median nerve distribution of the hand. They were recruited from Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from December 2018 to July 2019. Results: Neural Prolotherapy and Platelet Rich Plasma (PRP) have improved all measured parameters like visual analogue scale (VAS), nerve conduction studies and neuromuscular ultrasonography parameters in carpal tunnel syndrome secondary to rheumatoid arthritis. Conclusion: Neural Prolotherapy and Platelet Rich Plasma proved to be effective treatments of carpal tunnel syndrome secondary to rheumatoid arthritis

Correlation between dyslipidiemia and the severity of coronary artery disease using SYNTAX scoring system

Background: the relationship between hyperlipidiemia and an increased risk of coronary heart disease has been well documented and has served as a motivating factor for research into lipoproteins structure, function and metabolism. Many epidemiological studies have revealed that chronically elevated lipid and cholesterol levels are associated with an increased incidence of atherosclerosis. Dyslipidemia together with hypertension and diabetes is major modifiable risk factors for atherosclerotic disease and the subsequent development of cardiovascular events. Dyslipidemia is known to be an independent predictor for cardiovascular events, other risk factors including family history, hypertension, tobacco use, age, sex and diabetes also have been found to be associated with an increased risk of coronary artery disease (CAD). This cross-sectional study was aimed to investigate the association of Dyslipidemia as an atherosclerosis predictor and its relationship to the severity of CAD using SYNTAX score. Patients and Methods: the current study included 535 patients who presented during 2015 with chest pain to Dar Al Fouad Hospital, experiencing symptoms of CAD or evidence of CAD by noninvasive testing were enrolled, a fasting blood sample was extracted and assessed for lipids profile. Patients underwent coronary angiography either using femoral or radial approach, and the resulting angiographic study was used to calculate the SYNTAX score of each patient. Patients were divided in to two group i.e. CAD and Non-CAD group. The CAD group was further divided into three sub-groups according to the SYNTAX score into low risk, intermediate risk and high risk group. Results: in this study, triglycerides, total cholesterol and LDL-C levels were positively associated with sever CAD and higher number of diseased vessels. Higher HCL-C levels were also found in subjects with normal coronaries. Conclusion: there was no significant proportionate, linear relation between the SYNTAX score and the levels of triglycerides, total cholesterol or LDL-C