Efficacy of different modalities on spasticity management of spinal cord injury: clinical and electrophysiological study

To evaluate the effectiveness of TENS [versus oral anti- spasticity drugs and physical therapy alone] on management of spinal cord injury [SCI] spasticity. Also, to study the role of the clinical and electrophysiological methods of assessment of spasticity. This study was performed on 40 patients with traumatic spinal cord injury suffering from spasticity. They were 24 males [60%] and 16 females [40%], their ages ranged from 35 to 45 years with a mean + SD of 38.9 +2.9 years. The patients were randomized into 3 treatment groups: Group[I]: included 15 patients who were taking oral anti-spasticity drugs in the form of baclofen and tizanidine and performed physical therapy program [1 session daily] for 6 weeks. Group [II]: included 15 patients who were subjected to TENS therapy applied to spastic lower limbs, lasting for 15 minutes daily and performed the same previous physical therapy program for 6 weeks. Group [III]: included 10 patients who were subjected to the same previous physical therapy program only daily for 6 weeks. Spasticity of these patients was evaluated clinically by: Lower Limb Ashworth score [LLAS], ankle clonus scale, Modified Barthel Index [MBI], and Walking Index for Spinal Cord Injury [WISCI] and electrophysiologically by: H reflex including H amplitude, H[max]/M [max] ratio and H latency. These evaluations were performed at the initial presentation and after 6 weeks of the treatment program. There was a highly significant difference [p<0.001] between the pre and post treatment assessments in group [II] in all clinical parameters and H amplitude and H [max] / M [max] ratio, the same results were obtained in group [I] except for ankle clonus scale which showed significant difference [p<0.05], while in group [III] this significant difference was shown as regards MBI, H amplitude and H [max] / M [max] ratio. There was significant difference in all clinical and electrophysiological parameters when comparing groups [II] and [III], but when comparing groups [I] and [III], this result was seen as the previous except in ankle clonus scale and MBI. But when comparing groups [I] and [II], there was non significant difference in all parameters. Also, group [I] showed significant correlation between H amplitude and all clinical parameters except WISCI [showed non significant correlation], while H max / M max ratio showed highly significant correlation between it and LLAS and significant correlation between it and ankle clonus scale and WISCI. In group [II] there were non significant correlation between both H amplitude and H max/ M max ratio and LL AS and ankle clonus scale and significant correlation between them and MBI and WISCI. But, group [III] showed significant correlation between the electrophysiological [H amplitude and H [max] / M [max] ratio] and the clinical parameters except between H max/ M max ratio and MBI, there was no significant correlation detected. TENS is an effective, economic, non- invasive and readily applicable method that has few side effects. It can be used as a supplement to other treatment methods [oral medication, TENS and physical therapy] in its management

Urinary glycosaminoglycans in systemic lupus erythematosus: marker of renal affection and relation to disease activity

To evaluate glycosaminoglycans [GAG], heparan sulphate [HS] and chondroitin sulphate [CS] levels in the urine of systemic lupus erythematosus [SLE] patients. Also, to determine its possible use as a marker for lupus nephritis and its correlation with disease activity. This study was conducted on 30 patients suffering from SLE. They were subdivided according to disease activity and renal affection. Ten apparently healthy subjects were taken as a control group. GAGs were isolated from urine with ion exchange chromatography on DEAE sephacel. Determination of HS and CS levels were done with ELISA. There was a significant increase of GAGs and HS levels in SLE patients than in controls [p<0.05]. There was a highly significant difference [p<0.01] between active and inactive SLE patients as regards CS/HS ratio. GAGs and CS/HS ratio were significantly higher in active patients with lupus nephritis [p< 0.001]. Urinary GAGs may represent an additional, non-invasive diagnostic approach for lupus nephritis. It could be used as a parameter for disease activity and lupus nephritis

Diagnostic value of rheumatoid factor, antikeratin antibodies and anticyclic citrullinated peptide antibodies in rheumatoid arthritis: association with erosive articular damage

Various autoantibodies have been described in the serum of rheumatoid arthritis [RA] patients such as rheumatoid factor [RF], antikeratin antibodies [AKA] and anti-cyclic citrullinated peptide antibodies [anti-CCP]. This work was preformed to assess and compare the diagnostic value of RF, AKA and anti-CCP in RA, and to identify their predictive value for erosive articular damage in patients with RA. The study was carried out on 50 patients, 30 RA patients and 20 patients with other different rheumatic disorders who served as a control group. RA patients were 15 with early RA [<2 years disease duration] and 15 with late RA [>2 years]. Serum samples from all 50 patients were subjected to detection of IgM RF and anti-CCP by enzyme linked immunosorbent assay [ELISA] and AKA by indirect immunofluorescence. Erosive articular damage was quantified using the Larsen score. Positive anti-CCP was found in 23 out of 30 RA patients and in 2 out of 20 controls with the highest sensitivity and specificity for RA 76.7% and 90%, respectively. IgM RF was positive in 21 out of 30 RA patients and in 3 out of 20 controls with sensitivity and specificity of 70% and 85%, respectively. Lastly AKA was positive in 16 out of 30 RA patients and 4 out of 20 controls with the lowest sensitivity and specificity for diagnosis of RA 53.3% and 80%, respectively. Significant lower percentage of positivity for both AKA and IgM RF in early RA compared to late RA [p<0.01] but not for anti-CCP [p>0.05]. Patients with positive antibodies had significantly higher erosion score than those with negative ones, p<0.01 for both IgM RF and AKA and p<0.001 for anti-CCP. Anti-CCP show the highest sensitivity and specificity for RA followed by IgM RF and lastly AKA. All the studied antibodies particularly anti-CCP may help in the early diagnosis and can be considered as predictive markers for erosive articular damage in RA patients

Clinical significance of enhanced production of interleukin-6 and oncostatin M by cultured systemic sclerosis patients peripheral blood mononuclear cells from patients with systemic sclerosis

To determine whether the spontaneous production of interleukin-6 [IL-6] and oncostatin M [OSM] from peripheral blood mononuclear cells [PBMCs] in patients with systemic sclerosis [SSc] is increased and whether they are correlated with the clinical or serological features of the disease. The culture supernatants of PBMCs from patients with SSc [n = 22] and healthy controls [n = 10] were examined by enzyme- linked immunosorbent assay [ELISA] for detection of IL- 6 and OSM, also pulmonary function tests were done for all patients and controls. The production levels of IL-6 and OSM were significantly higher in patients with SSc than controls [p < 0.05 and p < 0.01 respectively]. High IL-6 levels correlated negatively with% the diffusion capacity for carbon monoxide DLco [r = -0.5; p < 0.05], and high OSM levels correlated negatively with% vital capacity [Vc] and DLco [r = -0.53; p < 0.05 and r = -0.87; p < 0.01 respectively]. The enhanced production of IL-6 and OSM may cooperatively contribute to the disease process in SSc. Enhanced IL-6 and OSM production from PBMCs may be related to the development of pulmonary fibrosis

role of bacterial antigens in reactive arthritis

The study was performed on 40 reactive arthritis patients and 20 healthy controls. Clinical and laboratory evaluation was used to elaborate the bacterial antigens role in the pathogenesis of reactive, arthritis. Serum samples were collected for rheumatoid factor, tissue typing and Widal test. Stool samples were collected for culture. Urogenital swabs were taken for culture and polymerase chain reaction [PCR] for chlamydia-DNA. There was preceding infection of the urogenital tract through positive urogenital swab cultures of mycoplasma in 8 patients [20%], positive PCR for chlamydia-DNA in 19 patients [47.5%] and previous gastro-intestinal infection through positive compylobacter culture in 10 patients [25%], shigella in 5 patients [12.5%] and salmonella in 10 patients [25%]. There was some patients had combined infection with different types of organism. There was a role of bacterial antigens in the pathogenesis of reactive arthritis, which affect gastero-intestinal tract such as salmonella and urogenital tract such as chlamydia trachomatis

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

Prevalence of digital clubbing using a new digital index in lung cancer patients

Digital clubbing occurs in association with various lung diseases including cancer. Clubbing can be a paraneoplastic manifestation of bronchogenic carcinoma. Clubbing was assessed with measurement of the thickness of both base of nail bed [distal-phalangeal depth DPD], and the distal interphalangeal depth [IPD] of the index finger in both lung cancer patients and controls. Of the 97 normal subjects, only one patient had DPD/IPD ratio more than 1.1 on right and left indexes fingers. For lung cancer patients 48.3% had bilateral clubbing with highly significant difference between them and controls [p< 0.001]. Such patients were at high risk to develop lung cancer [OR = 89.8] [p < 0.001]. There was no difference between the prevalence of clubbing and different types of lung cancer. Patients with bilateral clubbing were at risk 8 times more to develop lung cancer. Also, the prevalence of clubbing was independent on the types of lung cancer