Comparison between the effects of insulin versus corticosteroid local injections in diabetic patients with carpal tunnel syndrome

Background: Carpal tunnel syndrome [CTS] is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. Carpal tunnel syndrome is the most commonly diagnosed and treated entrapment neuropathy and is a significant cause of morbidity. It is estimated to affect one out of ten people during their lifetime. Diabetic patients have a higher incidence with carpal tunnel syndrome. It has been reported that insulin improves the nerve regeneration and myelination through its role as neurotrophic factor

Aim of the Work: was to compare the short-term effects of insulin and corticosteroid local injections in the treatment of diabetic patients with carpal tunnel syndrome

Patients and Methods: Fifty diabetic patients with clinical and electrophysiological evidence of mild to moderate carpal tunnel syndrome were included in this study. All Patients had been sub-classified into two equal groups:- Group [1]: Twenty five patients have received local insulin injection of 10 IU Neutral Protamine Hagedorn [NPH] \{Insulinagypt N\} into the affected carpal tunnel at the first visit and the same dose of insulin after 2 weeks. Group [2]: twenty five patients have received a single dose of 40 mg triamcinolone acetonide \{Epirelefan\} local injection into the affected carpal tunnel. Nerve conduction study [NCS], Boston Carpal Tunnel Questionnaire [BCTQ] and clinical evaluation were carried out for both groups at baseline and four weeks after second dose of insulin injection and one month after steroid injection

Results: In steroid group, significant improvement in nerve conduction study as regard distal sensory latency and sensory conduction velocity without significant improvement in distal motor latency and motor conduction velocity and significant improvement in [BCTQ]. In insulin group, a more significant improvement in all parameters of nerve conduction study and also in [BCTQ] was observed with insulin injection than steroid done. Also, there were significant differences between results of both groups for insulin injection group

Conclusion: Local insulin injection is an effective treatment for restoring median nerve function in diabetic patients with mild to moderate carpal tunnel syndrome and produce significant improvement in NCS and BCTQ

Assessment of different diagnostic tests of helicobacter pylori in children

H.pylori was first identified and .recognized by marshal and warren in 1983 [1],recently, H.pylori antigen detection test in stool [HPS A] was reported to be a sensitive and reliable screening test for H.pylori infection as compared to urea breath test. This study was carried out on 3 groups of children aged 6 months-14 years selected from pediatric patients of Damnhour hospital. In group I [hematemesis] upper upper gastrointestinal endoscopy revealed mucosal erythema in 60% associated with antral nodularity in 4 patients. All patients who had a positive urease test [40%], had a histopathological diagnosis of chronic active full thickness gastritris. The results of endoscopic, histopathologic examination and rapid urease test in group II [RAP] showed mucosal erythema in 90% [18 patients], antral nodularity in 60% urease test was positive in 12 children [60%]. The results of HPS A showed that 30% of patients in group II had positive test. When these results were compared to the histopathologic and urease test and results of HpSA was 70%, specificity 100% +ve and -ve predictive values of 100, 75.2% respectively

Screening of renal and urinary tract problems in pre-school children and their relationship with parasitic infection

This cross sectional study was done for pre-school children households of an Egyptian village with evaluation of possible relationship between urinary tract problems detected and parasitic agents especially those causing diarrhea. A systematic random sample of houses was selected. Urine was examined using microscopic examination and dipstick techniques Stool was examined by direct smear and standard Kato-Katz techniques. The history taking included family history of congenital anomalies and relative parents; clinical and ultrasonographic examinations were performed in presence of mothers. Results showed that, a high percentage of children had positive urinary findings [pyuria and haematuria were found in 40% of children while 80% had crystaluria]; females had more problems than males. Microscopic examination was more superior to dipstick testing in detecting urinary problems except protein in urine. Pin worm infection showed positive relationship with urinary findings especially with males [O.R. 1.7 for pynria and 2.1 for haematuria]. Children having parasites causing diarrhea had higher percentage of pyuria than free children. Ultrasonographic examination showed four positive cases including congenital anomalies. Screening programs for preschool children should be adopted for early detection of urinary tract problems as urinary tract infection [UTI] and congenital anomalies especially in villages. Microscopic examination is the technique of choice for screening programs. Selected dipstick testing for proteinuria could be used. Screening for UTI in diarrheic children and those having pin worms or other parasites should be considered by health care personnel