Motor evoked potentials as a predictor for upper limb function following acute stroke

To record the MEPs in the affected upper limb of hemiplegic patients in order to study its role in the prediction of functional and motor recovery of the upper limb in cases of acute stroke. This study included 30 patients suffering from acute stroke, all of them were subjected to history taking, clinical and neurological examination and clinical assessment scales [initially and after three months of conventional physiotherapy] including Medical Research Council [MRC] scale, Nine Hole Peg test [NHPT] and action research arm test [ARAT]. Also, all patients and controls were subjected to MEPs recording in order to evaluate resting motor threshold, MEP amplitude and central motor conduction Time [CMCT]. The mean of initial MRC scale, NHPT and ARAT was 1.73 +/- 1.17, 4.23 +/- 2.34 and 21.53 +/- 14.42 respectively. As regards MEPs, the mean of resting motor threshold [mamp], MEP amplitude [microv] and CMCT [msec] were 109.57, 0.56 and 11.28 respectively showing a highly significant difference from the control group whose mean values were 73.4, 2.98 and 7 respectively. Patients were divided according to initial CMCT into three groups: group I and II [patients with normal and delayed CMCT respectively] and Group III [patients with absent MEP]. On comparing the initial and follow up motor and functional recovery according to the clinical scales [MRC, NHPT and ARAT] in the three patient groups, group I and II exhibited highly significant [P<0.01] higher scores than group III. Correlation study showed a significant negative correlation between CMCT and MRC scale and ARAT, also there was a significant positive correlation between CMCT and NHPT while no significant correlation was found between resting motor threshold or amplitude of MEPs and the follow up clinical scales. Predictive value of CMCT for improvement of different scores [MRC, NHPT and ARAT] was 22, 38 and 36.6% respectively. CMCT of MEPs was the parameter with the highest predictive value to functional improvement of affected upper limb in stroke patients. These data can be helpful for clinicians to plan the program of rehabilitation according to the expected recovery of motor function

Oncostatin-M and matrix metalloproteinase-3 production in rheumatoid arthritis and osteoarthritis

To evaluate the significance of measuring serum levels of Oncostatin-M [OS-M] and matrix metalloproteinase-3 [MMP-3] in the assessment of rheumatoid arthritis [RA] and osteoarthritis [OA]. The study was performed on 15 RA, 15 OA patients and 10 controls age and sex matched. Laboratory and clinical data for all the patients were assessed and serum MMP-3 and OS-M were measured in all subjects. Statistical analysis and correlations were done for all the data. Serum levels of MMP-3 and OS-M were higher in RA than OA patients and controls. The difference was of a high statistical significance [p<0.001, p<0.001]. In RA patients OS-M level correlated positively with MMP-3 level [r=0.826] but OS-M and MMP-3 did not correlate with any parameters of disease activity. There was a significant difference in serum levels of OS-M and MMP-3 in patients taking steroid therapy and those who were not on steroid therapy. In OA patients, serum MMP-3 and OS-M were also higher than those of controls and the difference was highly significant. MMP-3 in OA patients correlated positively with ESR [r=0.77] and this was higher in patients with severe erosive changes. Measuring serum MMP-3 and OS-M is necessary for evaluating synovial inflammation and cartilage destruction in RA and OA patients. Using MMP inhibitor may be useful to stop the progression of synovitis and erosions

Role of ultrasonography in the diagnosis and management of plantar fasciitis

To evaluate the sonographic features of plantar fasciitis and to investigate the efficacy of ultrasound-guided local steroid injection in its management. Forty patients, aged 25-55 years who had a clinical diagnosis of plantar fasciitis, 1-3 years previously and twenty age-matched healthy volunteers [control group], were evaluated with conventional x-rays then with ultrasound using a 7.0 MHZ linear-array transducer. All patients had calcaneal spurs in their X-rays. Heel pain was unilateral in 24 patients and bilateral in 16. Sagittal sonograms were obtained, and the thickness of plantar fascia was measured at its proximal end near its insertion into the calcaneus. Other findings including hypoechoic fascia, fiber rupture, perifascial fluid collections and calcifications were searched for. Evaluations were performed before, at 2 weeks and 3 months after a single dose of ultrasound-guided local steroid [7 mg Betamethasone and 0.5ml of 1% lidocaine] injection into the inflamed plantar fascia. Pain intensity was quantified with a tenderness threshold [TT] and visual analog scale [VAS]. Plantar fascia thickness was significantly increased in heels of patients with plantar fasciitis [mean 3.91 +/- 0.53] as compared to control [mean 2.13 +/- 0.18] [p<0.0005]. The mean thickness of the plantar fascia had decreased significantly on evaluation after 2 weeks [mean 3.73 +/- 0.53] [p<0.05]. While after 3 months there was a highly significant decrease [mean 2.39 +/- 0.43] [p<0.0005]. The mean VAS score and TT showed a highly significant improvement on evaluation after 2 weeks and 3 months [mean 4.57 +/- 0.98, 1.55 +/- 0.84 and 7.12 +/- 0.75, 9.47 +/- 1.66 respectively, p<0.0005]. The comparison between the second and third evaluations of all our parameters showed a highly significant improvement [p<0.0005]. The proximal plantar fascia was diffusely hypoechoic as compared to controls. No fascial rupture, perifascial fluid collection or calcifications were identified. Increased thickness of the fascia and hypoechoic fascia are sonographic findings of plantar fasciitis. Sonography provides sufficient information for the physician to confirm an initial diagnosis of plantar fasciitis and assess individual treatment regimens

Treatment of chronic rotator-cuff impingement with arthroscopic subacromial decompression

We made a prospective study on 29 patients who had arthroscopic subacromial decompression for chronic rotator-cuff impingement. All patients were diagnosed as having chronic rotator-cuff impingement on the basis of clinical and sonographic examination. All patients were assessed pre-operatively and at 3, 6 and 12 months post-operatively using the shoulder-rating scale of the University of California at Los Angeles [UCLA]. The dominant arm was affected in 24 patients. There were 26 males and only three females. Before operation, the UCLA shoulder score was poor or fair in all patients. After three months of the operation 48% of patients had satisfactory relief of symptoms but at one year 93% of patients examined had a good or excellent result We concluded that arthroscopic subacromial decompression is an effective form of treatment, but full recovery of function and relief of symptoms could take long time

Problems underlying impaired hand function in rheumatoid arthritis

In this study we used the grip strength to evaluate the hand function in rheumatoid patients and determined the relation between grip strength and different parameters measured in those patients. We divided our patients into two groups according to their grip strength. Patients with higher grip strength showed a higher visual analogue scale of pain which was of a high statistical significance [p<0.001]. Also we found that grip strength correlated negatively with age, disease duration and visual analogue scale of pain. As regards drug intake, low grip strength was associated with disease modifying drugs while high grip strength was associated with NSAIDs. This shows that several cofactors contribute to the rheumatoid hand function not a single factor

Insight on the relationship between osteoporosis and osteoarthritis

In this study, we tried to investigate some of the factors that may have a role in the pathogenesis of osteoarthritis OA and osteoporosis OP, such as BMI, levels of estrogen, IGF-1 and bone mass density. We correlated all these parameters to find the relation between those two pathologic conditions. Forty postmenopausal females were studied, 20 with OP and 20 with OA. Our results showed a significant elevation of estrogen and IGF levels and BMD in OA group in relation to OP group. The mean BMI showed a significant increase in OA than OP. This inverse relation could be explained by the difference in growth factors and estrogen that stimulate bone formation. There is an inverse relationship between OA and OP. Thus OA might have a protective or retarding effect on the development of OP and could be a negative risk factor for OP. This could be an important element in determining patients who at risk developing OP and should take preventive therapy for OP at the time of menopause