Sympathetic skin response in carpal tunnel syndrome

Sympathetic skin response [SSR] is most frequently used in diagnosing functional impairment of non-myelinated postganglionic sympathetic fibers. Early diagnosis of autonomic dysfunction is important in patients with carpal tunnel syndrome [CTS] as the earlier the diagnosis the more effective the treatment. Aim of this work was to measure the SSR in patients with CTS to detect its relation with possible autonomic dysfunction. This study included 18 patients [23 hands] with CTS, graded according to Bland [2000]. SSR measurement was done, and the latency and amplitude were measured. Clinical manifestations of autonomic dysfunction were present in 6 hands [26%]. There was statistically high significant longer disease duration among patients with autonomic dysfunction in comparison to those without. Among our patients, 3 hands [13%] had no elicited SSR. This was associated with very severe carpal tunnel syndrome, female sex, and long disease duration. There was a statistically high significant difference between patients and controls as regards the latency of SSR with no significant difference as regards the amplitude. There was a statistically high significant positive correlation between the SSR latency and the grading of CTS, and statistically high significant negative correlation between the amplitude of SSR and the grading of CTS. SSR can be used in the electrodiagnostic workup for patients with carpal tunnel syndrome where it can be used as a method for detection of autonomic dysfunction in these patients

Preliminary study of CD34 stem cells in rheumatoid arthritis patients

To study CD34+ stem cells count in the peripheral blood [PB] of patients with rheumatoid arthritis [RA] and to correlate it with the activity and severity of the disease as a preliminary study for their role in the disease pathogenesis. This study was conducted on 20 RA patients in addition to 10 healthy subjects as a control group. All patients were subjected to full history taking and thorough clinical examination. Assessment was done using modified DAS far disease activity, Speed severity index [SSI] for disease severity, and Larsen score for radiological assessment of the plain x-ray findings of both hands. Assessment of CD34+ stem cells count in the PB was done by using fluorescence-activated cell sorting [FACS]. In this study there was a significantly higher count of CD34+ stem cells in the PB of RA patients compared to the controls. Stem cells absolute count and percentage were significantly negatively correlated with modified DAS, SSI and Larsen score. Bone marrow stem cells [CD34 cells] could play a crucial role in RA. Their level is elevated in the PB of RA patients in comparison with controls. It is suggested that the reduced number of CD34[+] cells in the PB of patients with more severely destructed joints is due to their recruitment to sites of inflammation. Studies are required to further investigate the role of the bone marrow and stem cells in the disease pathogenesis of RA. It could be a future target of treatment in these patients

periodontitis an occult source of recurrent infection in patients with systemic lupus erythematosus?

To determine if periodontitis can be considered as an occult source and septic focus for recurrent infections in patients with Systemic lupus erythematosus [SLE]. The present study was conducted on 60 subjects divided into 4 groups. Group 1: included 30 SLE patients with periodontitis [SLE/P]. They were further subdivided according to the CRP titer into: Group 1A: 20 patients with CRP titer > 6 and Group 1B: 10 patients with CRP titer < 6. Group 2: included 10 SLE patients without periodontitis [SLE/X], Group 3: 10 non SLE subjects with periodontitis [X/P] and lastly Group 4: 10 healthy subjects. SLE disease activity was assessed by SLAM score. Periodontal examination was assessed by periodontal disease index [PDI]. Laboratory investigations: serum [s] and salivary [sal] CRP titre, CBC, ESR and urine analysis. Microbiological examination of plaque specimens was done. Comparative study between Group 1A and Group 3 revealed a highly significant difference as regards PDI and a significant difference as regards WBC count, ESR, s/CRP, sal/CRP titre indicating more severe periodontal disease in patients with SLE. There was a highly significant greater severity of periodontal disease in patients additionally receiving immunosuppressive therapy. The plaque culture showed Streptococci, Klebsiella, Staphylococci, E. coli and Pneumococci. In selected patients from Group 1, there was a highly significant decrease of s/CRP and sal/CRP after periodontal treatment. Periodontitis is an occult infection that can be considered as a septic focus in SLE patients. CRP is a sensitive indicator for the presence of infection in SLE patients. Periodontal examination must be done routinely for all SLE patients