Role of dexamethasone iontophoresis in treatment of epicondylitis as evaluated with quantitative high resolution ultrasonography

To evaluate the effect of dexamethasone iontophoresis in treatment of epicondylitis based on high resolution ultrasonography. This study included 25 patients with epicondylitis and 14 healthy controls. Pain intensity was assessed by visual analogue score [VAS] and by patient global assessment [PGA]. Measuring the maximum grip force of the sound side, maximum grip force [MGF] and pain-free grip force [PFGF] of the affected side, using the hand grip dynamometer, were also assessed. Ultrasonographic assessment was performed for the site of complaint either the common extensor origin [CEO] or the common flexor origin [CFO]. Patients received 6 sessions of 4 mg/ml dexamethasone [DXM] iontophoresis on alternating days over a period of two weeks. After the treatment program, the patients were re-assessed both clinically and by ultrasonography. After treatment with dexamethasone iontophoresis, the decrease in the VAS, PGA as well as the changes in MGF and PFGF of the affected side was statistically significant. Regarding diagnostic US, abnormal findings were detected in 11 patients [44%] at the beginning of the study with no abnormal findings in the control group. High resolution ultrasonography proved to be of 48.5% sensitivity. and 65.7% specificity in diagnosing epicondylitis. The improvement of epicondylitis after iontophoresis treatment, though well evident and proved on clinical reassessment, couldn't be detected except in 3 patients out of the 6 patients reassessed by ultrasonography. Dexamethasone iontophoresis could be considered a simple, easy, safe, effective and non-invasive therapeutic option for epicondylitis. High resolution ultrasonography has a role in diagnosing epicondylitis but has no role in follow up

expression of osteopontin in synovial fluid of patients with rheumatoid arthritis: relation to high resolution ultrasound and disease activity

To demonstrate the expression of OPN in the synovial fluid of patients with RA and to correlate it with high resolution ultrasonographic [HRUS] findings and disease activity. This study was conducted on 30 RA patients and 20 patients with osteoarthritis [OA]. For RA patients, disease activity was assessed using the modified disease activity score [DAS]. For all patients, plasma and synovial fluid OPN concentrations were quantified using ELISA system. HRUS with B-mode ultrasound supplemented with power Doppler [PDUS] using standardized technique, was done for joints from which synovial fluid was obtained, then the cartilage thickness was measured, synovial thickening and bone erosions were recorded, and the resistive index was calculated. OPN levels were elevated in plasma and synovial fluid of RA patients. Comparison of OPN synovial fluid between RA and OA patients showed a highly significant statistical difference [p<0.001], being higher in the RA patients. OPN synovial fluid level in RA correlated significantly with disease activity score as well as with HR US findings. OPN levels were elevated in plasma and synovial fluid of RA patients. OPN level correlated significantly with disease activity, also with increased synovial thickness and bone erosions, as detected by HRUS. OPN could serve as a useful biochemical marker of RA

Assessment of serum levels of resistin and homa index in obese subjects: effect of weight loss programs on these levels and on body fat mass

To assess the serum levels of resistin and HOMA in obese subjects and to evaluate the association of resistin with insulin resistance [HOMA index]. Also to study the effect of weight loss programs on their levels and on body fat mass. Forty-five obese premenopausal females and fifteen healthy ones [serving as a control group] were included. Obese subjects were equally divided into 3 groups [A, B, C] according to the weight loss program. Group A were subjected to diet regimen, Group B to diet regimen and exercise program, and Group C to exercise program only. All studied groups were subjected to full clinical examination, assessment of BML WC, HC, WHR and laboratory investigations including serum resistin and HOMA index. Body fat content was measured by DEXA. Programs of weight loss were carried out for three months, followed by reassessment. There was a significant difference between obese subjects and controls regarding BMI, WC, HC, WHR, Triglycerides, Cholesterol, HDL, LDL, Resistin, TB-FM, Trumk - FM, Leg-FM, Body fat percentage and HOMA index. A highly significant difference was found, in the three groups before and after weight loss regarding all parameters except for WHR which showed significant difference with group B only. Following weight loss, the comparison between the 3 groups together, revealed a significant difference between them with the greatest change being noticed in group B. Also a significant positive correlation was found between BMI and HOMA index. Resistin is believed to be a key factor for obesity, cardiovascular and type II diabetes. The combined program of diet regimen and exercise seems to be the optimal approach for prevention and management of obesity, metabolic and cardiovascular disorders

Anticyclic citrullinated peptide antibodies in systemic sclerosis

To measure the serum levels of anti CCP antibodies in patients with systemic sclerosis and to correlate these levels with joint involvement extent of skin sclerosis and pulmonary involvement. 22 SSc patients were grouped into [group II] included 10 patients had limited cutaneous SSc and [group III] included 12 patients had diffuse SSc in addition to 10 healthy subjects as a control group [group I]. All patients and controls were subjected to full history taking, thorough clinical examination, routine blood investigations, chest and hand-x-ray, pulmonary function tests, capillary microscope. Measurement of anti-CCP antibodies using ELISA technique. Anti-CCP antibodies serum level was significantly higher in SSc patients than the control [p<0.05]. Also anti-CCP antibodies serum level was significantly higher in patients with arthritis and pulmonary affection than those without arthritis or pulmonary affection. There was a significant association between anti-CCP antibodies positivity and capillaroscopic abnormalities. Our results suggest that anti-CCP antibodies might be linked to disease severity

Value of anti-cyclic citrullinated peptide antibodies and magnetic resonance imaging in early rheumatoid arthritis

To assess the value of the presence of anti-cyclic citrullinated peptide antibody [anti-CCPAb] as well as magnetic resonance imaging [MRI] in early rheumatoid arthritis [RA]. The study was performed on twenty early RA patients [with disease duration <1 year] diagnosed according to the 1987 ACR classification criteria. They underwent full history taking and thorough clinical examination. Anti-CCPAb was assessed with ELISA technique. MRI study was done for both wrist joints and hands of all patients and evaluated according to the OMERACT 2002 RAMRIS scoring system. Disease activity was assessed with CRP and 28 joint disease activity score [DAS28]. Rheumatoid factor [RF] IgM was analyzed with latex agglutination. We divided the patients according to the presence or absence of anti-CCP antibodies into two groups: Eleven [55%] patients were positive for anti-CCP and 9 [45%] patients were anti-CCP negative. Comparison between the two groups revealed that there was a highly statistical significant difference as regards the CRP level and DAS28 score [p<0.001]. There was a statistically significant difference in the initial presentation between the two groups; in anti-CCP positive patients symptoms started more often in the upper limbs while the anti-CCP negative group they often presented in both upper and lower limbs. Bone marrow edema was more frequent in patients with positive than those with negative anti-CCP-Ab with a highly statistical significant difference [p<0.001]. The highest global scores for bone edema were seen in triquetral and lunate bones. The prevalence and severity of synovitis as well as the MRI scoring of bone erosions did not differ significantly between the two groups [p>0.05]. The highest global score of erosions was located in the same sites in the wrist and MCP joints. Tenosynovitis was observed nearly equally in both groups of patients. Global scores of tenosynovitis in both groups were high in the extensor tendons of the wrist and in the flexor tendons of the MCP joints. The study showed the importance of the presence of positive anti-CCPAb at baseline and its high association with greater disease activity [DAS28], higher levels of CRP, and bone marrow edema as an indicator of future bone erosion in early RA. MRI can be added as a useful tool for evaluation of early RA. This aspect is important because an early diagnosis of RA may modify the therapeutic strategy substantially, suggesting the use of more aggressive pharmacological agents that can delay progression of joint damage and thus substantially change the natural history of the disease

Clinical validity of a novel doppler time interval, in assessment of left ventricular filling pressure in patients with severe mitral stenosis

Non invasive assessment of diastolic filling pressure by Doppler echocardiography is important for the interpretation of symptoms and optimization of unloading therapy in patients with severe mitral stenosis. Recently a novel Doppler time interval between the onset of early diastolic velocity mitral inflow velocity [E] and annular early diatolic velocity [Ea] by tissue Doppler imaging [T[E-Ea]], have been proposed as one of the useful indices for this assessment. Therefore, this research was intended to assess the clinical utility of this time interval [T[E-Ea], have been proposed as one of the useful indices for this assessment. Therefore, this research was intended to assess the clinical utility of this time interval [T[E-Ea] for evaluation and prediction of pulmonary capillary wedge pressure [PCWP] in patients with severe mitral stenosis. Fifty patients with severe mitral stenosis were subjected to conventional and Tissue Doppler Imaging echocardiography to estimate the time interval [T[E-Ea], and all the routine 2D, M-mode, and Doppler echocardiographic measurement were taken, simultaneously right side heart catheterization for assessment of pulmonary capillary wedge pressure was done [as can as possible] before and after balloon mitral valvuloplasty. The mean age was [26.7 +/- 5.1 years], mitral valve area range was [0.8 to 1.2Cm[2]], and before mitral valvuloplasty the estimated PCWP [by Doppler equations] was [30.8 +/- 15.3] and assessed one [by catheterization] was [30.2 +/- 14.1 for], where both values were nearly comparable. While among several Doppler measurements the strongest correlation with PCWP had been observed with Isovolumetric Relaxation Time/time constant of LV relaxation [IVRT/Tau] where [r=-0.96, p<0.001] followed by IVRT/TE-Ea [r=-0.40, p<0.001]. Also, the same previous Doppler ratios tracked well the changes in PCWP after mitral valve dilatation, and both of them were able to predict PCWP. While other Doppler parameters failed to predict it. Importantly the cutoff value to predict PCWP> 15mmHg in mitral stenosis patients, was an IVRT/T[E-Ea] <4.7 with sensitivity and specificity of 100%. Time interval [T[E-Ea] is a useful novel Doppler index for evaluation of filling pressure, since the ratios of IVRT/T[E-Ea] or IVRT to Tau were more accurate than IVRT alone when correlated to PCWP or predict it in patients with severe mitral stenosis, as well it can track changes in PCWP after mitral valvuloplasty. Clinical Implication: Such simple equation could be used for daily application and one can use the simple ratio of IVRT/T[E-Ea] to predict PCWP> 15mmHg in patients with severe mitral stenosis and that well help to decide therapeutic strategies for such patients

QRS duration in isolated left bundle branch block: a marker of ventricular remodling and septal hypoperfusion

Isolated left bundle branch block [LBBB] per se may compromise cardiac mechanics and perfusion; this may contribute to the unfavorable outcome of such patients. The relation of QRS duration in isolated LBBB with cardiac function and perfusion is unknown. So, we sought to evaluate the left ventricular [LV] function and myocardial perfusion in isolated LBBB in relation to QRS duration. The study included 30 patients with isolated LBBB and 10 age and gender matched subjects without conduction delay. All study population had normal coronary angiogram. LBBB patients were divided into group I [17 patients] with 120/=140 msec. LV end diastolic dimension [LVED], LV end systolic dimension [LVES], septal wall thickness [SWT], posterior wall thickness [PWT] and LV ejection fraction [LVEF] were detected by echocardiography and myocardial perfusion was assessed by Thallium-201 [[201]Th] scintigraphy. LV remodeling [as detected from increased LVSD and PWT and decreased LVEF] and septal hypoperfusion [as detected by 201Th scintigraphy] were more frequent in group II [patients with QRS>140 msec]. QRS as it correlated positively with LVES [r 0.79, p<0.001] and negatively with LVEF [r-0.56, p<0.002], it also showed good agreement with myocardial perfusion imaging, the prolonged QRS the more frequent septal hypoperfusion. Moreover, there was a relation between cardiac function and myocardial perfusion in LBBB patients as these patients with perfusion defects showed increased LVES and SWT and decreased LVEF versus those without perfusion defects suggesting that there is link between cardiac function and myocardial perfusion in LBBB. Electrocardiography is commonly used as the first assessment tool for possible cardiac disease. QRS duration in patients with isolated LBBB is closely related to LV remodeling and septal hypoperfusion