synergetic effect of alternative medicine with acyclovir in the treatment and control of herpes labialis; HSV1

Background: herpes simplex is a common viral infection of the skin or mucous membranes. The lesions caused by this infection are often painful, burning, or pruritic, and tend to recur in most patients. Short term treatment with acyclovir can accelerate the healing of an acute outbreak, and continuous acyclovir therapy is often prescribed for people with frequent recurrences. While this drug can reduce the recurrence rate by 60-90 percent, it can also cause a wide array of side effects, including renal failure, hepatitis, and anaphylaxis. Safe and effective alternatives are therefore needed

Aim of the Study: is to examine and provide evidence on the potent effect of alternative medicine in Herpes treatment and recurrence prevention

Patients and methods: 60 Patients were divided into 3 major groups according to the severity of the infection with 7 subgroups split according to the treatment protocol

Results: among 60 patients with varies severity, recurrence of outbreaks was significantly reduced when a combined therapy was used while 0-10 percent outbreak recurrence rate was observed for a year when alternative therapy was used alone for mild cases

Conclusion: there is evidence that certain dietary modifications and the use of alternative medicine can be significantly useful for treating active Herpes simplex lesions and preventing recurrences

Prevalence of dysmenorrhea in young women [16-25 years]: a cross-sectional study

Objective: To determine the frequency of dysmenorrhea among women in the 16-25 age groups in Ajman

Materials and Methods: A cross-sectional survey was done in 300 female students from two universities in Ajman United Arab Emirates. The data was collected using a pilot tested, self administered questionnaire. Data was analyzed using the SPSS-19 and is presented mainly as tables and graphs. To verify associations the Chi square test was done

Result: The study found that the prevalence of dysmenorrhea among women within the age group of 16-25 years was 75%. Females with heavy menstrual flow with clots have higher prevalence of dysmenorrhea [91.7%] than women with slight and moderate menstrual flow [69.7%]. The most common symptoms reported by females suffering from dysmenorrhea are mild fatigue, moderate cramps, moderate back pain and mild premenstrual tension. Most common remedies taken for dysmenorrhea were taking rest [13%] and taking over the counter painkillers [41%]

Conclusion: The frequency of dysmenorrhea among women of age group 16-25 was high with three fourth of the study subjects reporting dysmenorrhea. Most common symptoms suffered were cramps followed by back pain and fatigue. Mostly dysmenorrhea was managed with over the counter pain killers

Prevalence of dysmenorrhea in young women [16-25 years]: a cross-sectional study

To determine the frequency of dysmenorrhea among women in the 16-25 age groups in Ajman. A cross-sectional survey was done in 300 female students from two universities in Ajman United Arab Emirates. The data was collected using a pilot tested, self administered questionnaire. Data was analyzed using the SPSS-19 and is presented mainly as tables and graphs. To verify associations the Chi square test was done. The study found that the prevalence of dysmenorrhea among women within the age group of 16-25 years was 75%. Females with heavy menstrual flow with clots have higher prevalence of dysmenorrhea [91.7%] than women with slight and moderate menstrual flow [69.7%]. The most common symptoms reported by females suffering from dysmenorrhea are mild fatigue, moderate cramps, moderate back pain and mild premenstrual tension. Most common remedies taken for dysmenorrhea were taking rest [13%] and taking over the counter painkillers [41%]. The frequency of dysmenorrhea among women of age group 16-25 was high with three fourth of the study subjects reporting dysmenorrhea. Most common symptoms suffered were cramps followed by back pain and fatigue. Mostly dysmenorrhea was managed with over the counter pain killers

audit of the quality of care indicators for the management of diabetes in family practice clinics in Karachi, Pakistan

Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month. For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient's medical records were selected and analyzed who attended the studied clinics for at least one year and had minimum of four out-patient visits. Majority [68%] of the audited medical records were of females. Of the total medical records analyzed, only one-quarter of the cases qualified the criteria of 'excellent' or 'good' diabetes care. Monitoring of body weight of the patient was only one indicator which was according the recommendations in 100% case at every visit. The other nearest quality of care indicator documented was blood glucose advice at every visit in 79.5% [95% CI: 71.1-87.9] of cases. Physical activity advised/reinforced at every visit was least observed [27.3%; 95% CI: 18.0-36.6]. In addition, blood sugar control was reported in less than a quarter [23.9%] with 95% CI of 15.0-32.8. This work has identified a big gap in the management of type 2 diabetes provided by family practitioners. In addition, majority of the patients found to have poor glycemic control. Interventions are suggested to improve the quality of diabetes care. More such audits and research are recommended at the larger scale

Scintigraphic evaluation of disease activity in rheumatiod arthritis

This study was undertaken in a trial to assess the activity of RA in the Joints through using[99] Tc[m] HMPAO scintigraphy. Also, to investigate the repeatability of this technique and the correlation between the labeled white cell uptake, pain, inflammation and joint destruction. Twenty-nine RA patients were subjected to scanning on the first visit and 18 of them have been for a second visit. The score of pain and inflammation of the knee joint was rated using the visual analogue scale [VAS] of pain and inflammation by the patients. 99Tcm HMPAO labeled white cell uptake was estimated in each knee on both visits. The joint was measured on both imaging occasions. Joint destruction of the knee was measured by scoring the joint x-Ray using Larson's score. The data obtained were analyzed using the Pearson correlation analysis to estimate the correlation of the mean white cell uptake in the joints with other disease activity parameters are presented followed by the scatter plot of the mean white cell uptake in the joints against the significantly correlated variables. Pain correlated with objective measures of inflammation [labeled white cell uptake] and with the degree of joint destruction. There was no correlation with either x-ray scores or white cell uptake in the depressed patients

Bone turnover markers in relation to menopause in rhematoid arthritis patients

Biochemical markers of bone turnover are extremely useful for the management of generalized osteoporosis associated with rheumatoid arthritis [RA]. They provide information that is different and complementary to bone mass measurements. We assessed the effect of menopause and disease activity on bone turnover markers in RA patients by measuring two bone formation markers ;Bone Alkaline Phosphatase [BAP] and Osteocalcin [OC] as well as two bone resorption markers by measuring urinary pyridinoline [PYD] and deoxypyridinoline [D-PYD]. The present work was done on 80 females aged between 35-65 years. They were divided into two groups: Group I normal controls [NC] constituted 20 females; 10 premenopausal [Pre NC] and 10 postmenopausal [Post NC]. Group II RA patients: 30 premenopausal RA [Pre RA] and 30 postmenopausal RA [Post RA]. Among bone formation markers, both BAP and OC were significantly lowered in RA than in NC [p<0. 05 each] particularly in postmenopausal period. On the other hand bone resorption markers urinary PYD and D -PYD were increased in RA in comparison to NC during both premenopause and postmenopause [p<0. 05 each] and menopause exaggerated this condition. Meanwhile, RA activity altered bone formation markers with increased OC in premenopausal [p<0. 05] and decreased BAP in postmenopausal period [p<0. 05]. On the other hand, RA activity exaggerated the increased bone resorption markers PYD and D-PYD especially in the postmenopausal period [p<0. 05 each]. Both RA and menopause accelerated osteporosis by inducing a disequilibrium between bone formation markers [BAP and OC] and bone resorption markers [PYD and D-PYD]. While bone formation markers were reduced, bone resorption markers were exaggerated. RA activity further altered bone formation markers and exaggerated bone resorption markers which should be considered during management of osteoporosis. Furthermore, biochemical markers of bone turnover are simple, cost effective, non-invasive methods that offer an alternative to bone imaging techniques

Serum levels of soluble Fas and Bcl-2 in rheumatoid arthritis and osteoarthritis patients and relationships to oxidative stress

To determine the circulating levels of soluble Fas [sFas] and Bcl-2 as apoptotic indices in patients with rheumatoid arthritis [RA] and osteoarthritis [OA] and their relationships to oxidative stress indices. Levels of sFas, Bcl-2, lipid peroxides, nitric oxide [NO], glutathione [GSH] and zinc were measured in the sera of 32 RA patients and 18 OA patients. Fourteen age and sex matched healthy persons represented a control group. The serum levels of sFas, and Bcl-2 were determined using specific ELISA assays. Serum levels of NO, lipid peroxides and GSH were measured with colorimetric methods. Serum levels of zinc were measured with an atomic absorption flame emission spectrophotometer. The study revealed significantly increased levels of sFas, lipid peroxides and NO, but significantly decreased levels of Bcl-2, GSH and zinc in RA and OA patients as compared to controls. Moreover, the levels of sFas, lipid peroxides and NO were significantly higher, but the levels of GSH were significantly lower in RA than OA patients. Non-significant differences in Bcl-2 and zinc levels were shown between RA and OA patients. Moreover, significant positive correlations were observed between sFas and both NO and lipid peroxides in OA patients. Bcl-2 significantly correlated with GSH and zinc levels in RA and OA patients. Lipid peroxide level significantly correlated with NO and both erythrocyte sedimentation rate and C-reactive protein in RA and OA patients. In addition, a significant correlation was found between the articular index and lipid peroxides in RA patients. Higher levels of sFas protein and oxidative stress indices were associated with lower levels of Bcl-2 protein and antioxidants in RA and OA patients. This dysregulation of apoptosis and the oxidant/antioxidant imbalance may have a role in the pathology of RA as well as OA

possible prognostic role of VCAM-1 in stroke patients

The vascular endothelium promotes inflammation through the up-regulation of inflammatory leukocyte-endothelial cell adhesion molecules such as intercellular adhesion molecule-1 [ICAM-1], vascular cell adhesion molecule-1 [VCAM-1] and E-selectin. These molecules bind to circulating leucocytes and facilitate their migration into the Central Nervous system CNS. In the CNS, these cells produce a number of cytotoxic molecules that may facilitate cell death and increase the infarct volume. To define the extent of expression of VCAM-1 in correlation to the clinical disability and outcome in stroke patients. Complete lipid profile, fibrinogen assay, lipoprotein [a] and FIM were determined in 25 recent stroke patients at the time of admission and compared with 15 matched apparently healthy control subjects. The difference between the mean total cholesterol [TC] level of patients and controls was not significant. However, high density lipoprotein [HDL] was significantly lower in patients as compared to controls but low density lipoprotein LDL was significantly higher. The concentration of Lp [a] and fibrinogen level, were significantly higher in the patients' group than controls. The concentration of VCAM-1 was significantly higher in stroke patients as compared to controls. Multiple regression analysis was performed to assign the predictors for functional independence measures [FIM] as a clinical outcome for the functional disability. The independent parameters were the duration of stroke as well as the laboratory tests [lipid profile, Lp [a], fibrinogen and VCAM-1]. The duration of stroke and VCAM-1 level negatively correlated with FIM, meaning that patients with high VCAM-1 level demonstrated more functional disability as manifested by low FIM score. The most sensitive parameters that can predict FIM were the duration of stroke and VCAM-1 level. Further research on the role of inflammatory CAMs in the pathogenesis of ischemic cerebrovascular disorders should lead to new diagnostic and therapeutic strategies in an attempt to reduce leukocyte-induced damage in stroke

Early detection of cervical myelopathy in some rheumatic diseases using somatosensory and motor evoked potentials

Neurological affection in rheumatoid arthritis [RA], systemic lupus erythematosus [SLE] and systemic sclerosis [SSc] may be subclinical but once they occur, they are irreversible and add an extra burden and suffering to the patient's lives. Early detection of such disease subclinical neurological affection helps a lot in the early intervention to prevent and avoid the irreversible damage to the nervous system. To characterize the neurological manifestations in RA, SLE and SSc and to obtain the electro-physiological documentation of possible cervical myelopathy. Twenty four RA patients, 11 SLE patients, and 9 SSC patients were included in this study. Thirty control age and sex matched persons were also enrolled. All subjects were submitted to the following: clinical and systemic examination, rheumatological and neurological examinations for signs of myelopathy or neuropathy. Laboratory studies included complete blood count, liver function tests, kidney function tests, erythrocyte sedimentation rate [ESR], C- reactive protein [CRP], and quantitative Rheumatoid factor tests. Specific tests were anti-nuclear antibody [ANA], anti-double stranded DNA [ds-DNA], anti SCL70, and Anti cardiolipin antibodies. Somatosensory and motor evoked potentials [SSEP, MEP] of upper limbs were recorded. Overt neurological signs were found in 50% of SLE patients, which are much more than that found in RA [29%] and SSC [22.2%]. Clinical cervical myelopathy was recorded in 40% in SLE, 22.2% in SSC and 16.7% in RA. Cervical myelopathy was detected with SSEP and MEP in 50% of SLE, 66.6% in SSC, and 20.8 in RA. There was a significant correlation between central conduction time with rheumatoid factor [p=0.017], anticardiolipin antibody [p = 0.001], and anti ds DNA antibody [p= 0.00!] in RA. The results support that SSEP and MEP are the most reliable data evaluating the risk of cervical myelopathy in some rheumatic diseases

Evaluation of some angiogenic stimulators in rheumatoid and osteoarthritis patients

Angiogenesis, the development of new blood vessels, is important in rheumatological disorders. Vascular endothelial growth factors [VEGF], itnerleukin-8 [IL-8] and nitric oxide [NO] are important angiogenic stimulators that play a crucial role in angiogenesis. Serum levels of VEGP, IL-8 and NO were determined in 20 rheumatoid arthritis [RA] patients; 32 osteoarthritis [OA] patients and 10 completely healthy individuals comparable to patients in age and serving as a control group. The serum levels of these bioindices were correlated to criteria of activity of RA and OA. The study revealed significantly increased levels of angiogenic factors in RA and OA as compared to controls. However, the levels of VEGP and IL-8 were insignificantly higher in RA as compared to OA. But NO levels were significantly higher in RA as compared to OA. The levels of these indices were related to activity criteria of RA, being higher in patients with greater number of joints affected, advanced function loss or x-ray grade, and correlated significantly with ESR and articular index as well. In OA, VEGP, IL-8 and NO reflected the activity of the disease, being higher in advanced grades of disease and correlated with ESR. The sources of these agiogenic stimulators are multiple. They can be derived from a variety of activated cells [including chondrocytes, synovial cells and macrophages]. The effect of some currently used antirheumatic agents could be attributed to their effects on those angiogenic stimulators. New pharmacologic interventions using new antiangiogenic drugs could be helpful in rheumatology

Cardiac involvement in primary sjogren's syndrome patients detected with echocardiography

To determine a pattern of cardiac involvement in primary Sjogren's syndrome patients and to evaluate these cardiac abnormalities in asymptomatic patients. The study was carried out on 20 primary Sjogren's syndrome patients [PSS] as well as 10 healthy controls matched in age and sex. None of the patients had evidence of cardiac symptoms. All subjects had complete history, clinical examination, laboratory tests [Rh F, ANA and anti Ro and anti La], chest X-ray, ECG and echocardiography. Cardiac abnormalities were detected in 7 [35%] primary Sjogren's syndrome patients out of 20 [PSS] patients examined with echocardiography. Seven [35%] presented with left ventricle diastolic dysfunction and 6 [30%] presented with pulmonary hypertension but only [15%] showed left ventricle hypertrophy, there were 2 patients with mitral regurge and only 1 patient with mitral stenosis and prolapse and also, 1 [5%] presented with aortic regurge and 1 [5%] patient by tricuspid regurge. There was significant difference between PSS patients and control subjects as regards to diastolic functions [E peak, A peak, E/A and DFT] and there was no correlation between the occurrence of these silent cardiac abnormalities and the clinical and laboratory findings. Cardiac involvement is common in PSS but clinically with silent manifestations. Thus, echocardiography should be done for all patients with PSS to detect any cardiac abnormalities