Role of ultrasound in assessment of joint pain among hemodialysis patients

Background: Few studies including limited number of patients assessed the rheumatologic effects of hemodialysis [HD] on joints using ultrasonography. Joint ultrasound has been emerged as a cheap noninvasive tool for assessment of joint pain among HD patients. This was the aim of our study to make use of such tool in such life quality threatening complaint

Objective: to determine the role of ultrasound in evaluation of joint pain and its causes among patients on regular HD

Patients and Methods: One hundred and four patients with end stage renal disease [ESRD] who were regular on HD three sessions per week four hours per session were subjected to history taking, complete physical examination stressing on musculoskeletal examination and ultrasonography of painful joints by a an ultrasonography expert

Results: Dialysis related arthropathy [DRA] was not the only cause of joint pain among HD patients but there were diverse causes in different joints. As regard affected joints, knee was the most affected one then came wrist, shoulder, ankle and elbow respectively. As regard causes of joint pain, DRA was the commonest one then came osteoarthritis, nonspecific ultrasonographic findings and few cases showed normal ultrasonographic studies

Conclusion: This study confirmed that joint pain in HD patients has diverse causes not DRA by necessity but other causes must be considered as well as multifactorial etiologies

Prevalence of macrovascular disease in systemic sclerosis

To detect the prevalence of macrovascular disease in systemic sclerosis. Thirty patients with systemic sclerosis and ten normal controls matched in age and sex were included in the study. All subjects were screened for atherosclerosis risk factors and non-invasive vascular assessment as carotid duplex scanning and measurement of ankle brachial blood pressure index. There was no significant difference in risk factors as cigarette smoking, systolic, diastolic blood pressure, cholesterol, triglycerides and glucose levels between patients and controls groups. Twenty three out of 30 patients [76.7%] had carotid artery disease compared to [30%] of normal controls with a highly significant difference. Macrovascular disease is a common finding in systemic sclerosis. Early identification allows early intervention and treatment with better control of high rate of cardiovascular mortality

Sex hormones in relation to bone mineral density and bone turnover markers in rheumatoid patients

To study the changes in serum and salivary testosterone in rheumatoid arthritis [RA] patients and their implication on bone mineral density [BMD] and bone turnover markers. The above mentioned hormonal levels were measured in fifty post-menopausal RA women [thirty patients with glucocorticoid therapy and twenty treated with other drugs]. Bone turnover markers were also assessed namely Carboxy terminal cross linked telopeptide of type I collagen [ICTP] and carboxy terminal propeptide of type I procollagen [PICP] as well as their relation to BMD was assessed. Although serum and salivary testosterone were higher than controls, there was no significant difference between patients and controls. We observed significantly lower salivary testosterone level in RA on steroids as compared to those not taking steroids. Also salivary testosterone correlated with lumbar BMD and inversely with ICTP

Orthostatic hypotension in stroke patients

To assess the incidence of orthostatic hypotension [OH] in stroke patients undergoing rehabilitation and to determine clinical variables associated with it. Thirty patients with a first clinical stroke who underwent rehabilitation within one month of stroke onset were included in this study. They were 17 males and 13 females. Their age ranged from 49 to 68 years [mean +/- SD= 58.1 +/- 6.3]. Patients were subjected to full history taking, thorough clinical examination and investigations. Patients' blood pressure was measured in the supine position and on tilting at 90[0]. OH was defined as a drop in systolic blood pressure [SBP] of 20 mmHg or more. OH was present in 14 [46.7%] patients. Age was highly significantly associated [p<0.001] with OH and admission modified Barthel Index [MBI] score was significantly associated [p<0.05] with OH. There was a non-significant correlation with the site of stroke or the use of anti-hypertensives. OH was common in stroke patients undergoing inpatient rehabilitation especially in older patients who have a lower functional status

Nutrient intake among Egyptian elderly living in geriatric homes

This study was done as a part of national survey to assess the nutritional status of elderly population aged 65 years and above. The sample was selected from geriatric homes in different governorates; namely, Cairo, Alexandria, Port-Said, Gharbia, Fayoum and Aswan. The total number of the sample was 876 [328 males and 548 female]. The results showed that underweight was more prevalent among males than females, while the opposite was observed regarding obesity with highly significant difference between both sexes. Data on food consumption were collected using the 24 hours recall method. The results showed that protein and micronutrient consumption were less than their RDA. The shortage from the RDA was observed mostly in antioxidant consumption of both males and females as median values of vitamin E representing 28% and 21.30%, vitamin C [66.7% and 66.71%] and zinc [42.86% and 51.02%] of their standard requirements. The results emphasize the importance of applying better nutritional programs in geriatric homes to improve the quality of life for those sector of the population

Prevalence of staphylococci in rheumatoid arthritis patients

Recent studies suggested that staphylococcal exotoxin may be involved in the pathogenesis of rheumatoid arthritis. The objective of this study was to determine the prevalence of oral staphylococcal carriage in patients with RA compared with healthy controls. This study was performed on 27 patients with RA and 25 healthy volunteers. Clinical and laboratory data of RA activity were studied. Tongue and anterior nasal swabs were obtained for culture on blood agar. Isolates of staphylococci were identified and collected from oral cavity of 96.3% of RA patients, 53.8% of whom carried staphy. aureus. On the other hand 88% of the healthy volunteers showed staphylococci, 36.4% of whom carried staph aureus. The carriage rate of staph aureus was significantly higher in RA patients than in healthy controls [P<0.05]. So we conclude that the oral carriage of staph. aureus was common in patients with RA. This may be the source of septic arthritis in such patients

role of laryngeal electromyography in vocal fold immobility

Vocal fold paralysis could be caused by a wide variety of etiological factors that interfere with the nerve supply of the larynx. To assess the utility of laryngeal-EMG as a diagnostic method for patients with immobile vocal folds and to evaluate its possible role as a prognostic indicator in the management of those cases. The study included 35 patients with unilateral vocal fold immobility [VFI] in addition to 10 normal individuals who served as controls. All patients were subjected to full history taking and thorough clinical examination and radiological investigations. Laryngeal EMG was performed for all the patients and controls. None of the control group showed abnormal EMG data while abnormal EMG findings were detected in 23 out of 35 of the patients' group i.e. the specificity of EMG was [100%] while the sensitivity was [65.7%] in detecting VFI. On clinical follow up with indirect laryngoscopy, 6 months later revealed recovery in 10 of the 25 cases [40%]. None of the recovered patients showed abnormal EMG data at presentation while 13 out of 15 cases of non-recovered patients showed abnormal EMG data i.e. the specificity of EMG was 100% while the sensitivity was 86.6% in predicting recovery in patients with VFI. The quantitative analysis of the interference pattern was more sensitive [65.7% and 86.6%] than the conventional methods of analysis [60% and 80%] in detecting and predicting recovery in patients with immobile vocal folds respectively. The clinical use of L-EMG was shown to be an efficient and objective test in the study of patients with immobile vocal folds and in predicting recovery of those cases

Human parvovirus B19 infection: its role in acute arthropathies

Viral infections have a number of important effects on the immune system. Infection with human parvovirus B19 [B19] has a diverse range of clinical manifestations including erythema infectiosum, polyarthropathy, transient aplastic crisis, hydrops fetalis and fetal death as well as chronic infection and anemia in immunocompromised hosts. Since its discovery in 1975, it has been noted that HPV B19 frequently causes a self-limiting polyarthritis in adults. It has also been debated whether, in some patients, B19 may act as a trigger for RA. The aim was to determine the incidence and significance of antibodies to the parvovirus B19, we detected the presence of B19 IgM and IgG antibodies in 40 rheumatoid arthritis [RA] patients, 10 SLE patients, 10 osteoarthritis patients and 30 normal adults. B19 IgM was positive in 60% of RA patients. This rate was significantly higher than the control group. They were mostly females [70%], duration of illness was 3 months to one year [68.7%] with polyarthritis, large and small joints were more affected [72.7%] with manifestations of acute inflammation. Rheumatoid factor [RF] was negative in 70% of them. Regarding osteoarthritis patients, B19 IgM antibodies were detected in 40% of them. They were females [60%] with polyarthritis, large and small joints were more affected [75%]. On the other hand B19 IgM antibodies were not detected in SLE patients or in the control group. Parvovirus B19 is important viral agent causing joint manifestations and should be considered in the differential diagnosis of acute arthropathy in adults, as early treatment of these cases results in fewer complications

Neurological features and anti-myeloperoxidase antibodies in rheumatoid arthritis patients

To determine if there is a relation between the level of anti-myeloperoxidase antibodies [AMP] and the occurrence of peripheral neuropathy [PN] in rheumatoid arthritis [RA] patients. Serum levels of C3, C4 and circulating immune complex [CIC] were also assayed to determine whether their levels are related to RA activity or not. The levels of AMP antibodies as well as that of C3, C4 and circulating immune complex [CIC] were measured in 48 RA patients. All patients underwent electrophysiological studies for both median and radial nerves in the upper limbs and the sural nerve in the lower limbs to detect peripheral neuropathy. Peripheral neuropathy was found in thirteen out of 48 patients. There was a significantly higher level of serum AMP antibodies in patients with PN, the mean being 11.4 +15.1 microg/ml as compared to patients without PN [4.5 + 2.1 microg/ml]. Serum level of C4 was significantly lower in patients with PN [30.9 +10.4 IU/ml] than those without PN [37.2+ 17.1 IU/ml]. No significant difference was found as regards either C3 or CIC between the two groups. Also, a significant correlation was found between AMP and clinical vasculitis. Peripheral neuropathy seems to be a common complication of RA. The high level of AMP anti-bodies in RA complicated with PN suggests that PN is associated with vasculitis that may be fatal if it involves other main organs