Anticyclic citrullinated peptide antibodies in systemic sclerosis

To measure the serum levels of anti CCP antibodies in patients with systemic sclerosis and to correlate these levels with joint involvement extent of skin sclerosis and pulmonary involvement. 22 SSc patients were grouped into [group II] included 10 patients had limited cutaneous SSc and [group III] included 12 patients had diffuse SSc in addition to 10 healthy subjects as a control group [group I]. All patients and controls were subjected to full history taking, thorough clinical examination, routine blood investigations, chest and hand-x-ray, pulmonary function tests, capillary microscope. Measurement of anti-CCP antibodies using ELISA technique. Anti-CCP antibodies serum level was significantly higher in SSc patients than the control [p<0.05]. Also anti-CCP antibodies serum level was significantly higher in patients with arthritis and pulmonary affection than those without arthritis or pulmonary affection. There was a significant association between anti-CCP antibodies positivity and capillaroscopic abnormalities. Our results suggest that anti-CCP antibodies might be linked to disease severity

Metacarpal index phalanx versus dual-energy X-Ray absorptiometry in osteoporosis

Osteoporosis is one of the most common metabolic diseases. It is responsible for considerable morbidity, mortality and costs. Our aim was to evaluate metacarpal index as a diagnostic tool for bone mass measurement as compared with DEXA. The study included 50 males above 60 years of age with a history of osteoporotic fractures as well as 20 apparently healthy males. Their ages ranged from 20-25 years. Metacarpals index had sensitivity of 46%, specificity of 95% positive predictive value 96%, negative predictive value 41% in comparison to DEXA. Metacarpals index can be used as a routine test for exclusion of osteoporosis

Plasma osteopontin concentration in lupus nephritis

To measure plasma concentration of osteopontin and to correlate these levels with clinical, laboratory, disease activity and histopathological parameters in SLE patients. This study was performed on 20 SLE patients and 10 normal control subjects. Plasma osteopontin concentrations were measured by ELISA technique for both patients and control groups. All patients underwent renal biopsies within 3 months of onset of proteinuria or hematuria. There was a highly significant difference between patients and control groups as regards plasma osteopontin concentration [p<0.001]. There was a significant positive correlation between osteopontin and SLEDAI [p<0.001] and activity index of renal biopsies [p<0.05]. Also there was a highly significant differences as regard osteopontin plasma concentration between patients with and without renal affection [p<0.001]. Osteopontin has been shown at least partly to account for SLE nephritis probably through predominance of Th[1]-type response in both peripheral and renal tissue. Further investigation of this mechanism in lupus nephritis may allow the design of new therapeutic strategies of lupus nephritis such as manipulation of Th[1]/Th[2] and down-regulation of Th[1]-response

Pulmonary manifestations in ankylosing spondylitis: value of high resolution computed tomography

Hypothesis: Pulmonary involvement in ankylosing spondylitis [AS] is often asymptomatic and chest radiographs may be insensitive to early changes

Objective: To study the distribution of pulmonary lesions in AS patients with high resolution computed tomography [HRCT] and to correlate findings with disease duration and pulmonary function tests [PFTs]

Methodology: The study was conducted on 18 AS patients. PFTs and HRCT of thorax were performed on same day chest x-ray was taken

Results: 9 patients had interstitial lung abnormalities on HRCT. Only 3 out of 18 patients had abnormal findings on plain chest x-ray. PFTs showed a restrictive process in 4 patients and obstructive pattern in 2 patients

Conclusion: No correlation was found between HRCT abnormalities and either PFTs or disease duration. As HRCT findings did not correlate with PFTs impairments, so this impairment could be a sequel of stiffness of thoracic cage in AS patients

impact of type 2 diabetes mellitus on bone mass and bone turnover in postmenopausal females

Objectives: Osteoporosis is a prevalent bone disease characterized by a decrease in bone mass and altered bone architecture leading to increased fracture risk. The present study aimed at evaluation of the impact of type 2 diabetes mellitus [T[2]DM] on bone mass and the status of bone turnover in postmenopausal females

Methodology: In this cross sectional study we evaluated bone turnover and bone mineral density [BMD] in 39 postmenopausal T[2]DM and 25 non-diabetic postmenopausal females. We measured serum levels of calcium, phosphate, osteocalcin, bone specific alkaline phosphatase [BS-ALP] and urinary excretion of c-terminal telopeptide cross links/creatinine ratio while BMD was evaluated by dual energy x-ray absorptiometry [DEXA]

Results: We found significantly higher BMD values for lumbar spine in the patients' group, [0.828 g/cm[2] for the study group and 0.720 g/cm[2] for controls]. Levels of, BS-ALP, osteocalcin and c-terminal telopeptide cross links/creatinine ratio were significantly lower in the diabetic subjects [68.667U/L, 3.856 ng/ml and 4.157 mg/mg creatinine respectively in the patient group versus 94.640 UL, 7.472 ng/ml and 5.851 mg/mg creatinine in the control group]

Conclusion: Our results suggested protective effect of T2DM on bone mass of lumbar spine together with decreased bone turnover in postmenopausal females

Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty

Background: Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty. The primary focus of early rehabilitation is ambulation of patients and regaining range of motion in the knee. Although many studies suggested that continuous passive motion should be implemented in the first rehabilitation phase following surgery, others concluded that the use of continuous passive motion was of no added benefit

Objective: The aim of our study was to compare the effectiveness of rehabilitation programs with and without continuous passive motion for range of motion in knee flexion and knee extension, functional ability and length of stay after primary total knee arthroplasty

Methodology: Forty patients suffered from osteoarthritis who underwent unilateral total knee arthroplasty were selected. Immediately after total knee arthroplasty, they were subdivided into two groups. Group 1 of 20 patients who received conventional physical therapy only and group 2 of another 20 patients who received conventional physical therapy with two hours of continuous passive motion applications daily. All subjects were evaluated once before total knee arthroplasty and at discharge. The primary outcome measures was active range of motion in knee flexion at discharge. Active range of motion at knee extension, timed "Up and Go" test results, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire scores, and length of stay were the secondary outcome measures

Results: The characteristics of and outcome measurement for the subjects in the two groups were similar at baseline. No significant difference between the two groups was demonstrated in primary or secondary outcomes at discharge

Conclusion: The results of this study do not support the addition of continuous passive motion application to conventional physical therapy in rehabilitation program after primary unilateral total knee arthroplasty. It did not further reduce knee motion impairments or disability or reduce the length of the hospital stay

Is acquired total protein s deficiency associated with antiphospholipid antibodies in systemic lupus erythematosus?

Hypothesis: protein S [PS] is a vitamin K dependent plasma protein, and it's free from is required for protein C to be functional. Antiphospholipid antibodies [apl] may cause functional PS deficiency by binding free PS. In patients with SLE have increased incidence of apl, which have been associated with thrombotic events

Objective: to determine the level of total protein S and its relation to [apl]

Methodology: 22 SLE patients diagnosed according to ACR revised criteria [Tan et al., 1982] and ten healthy subjects were included in this study. Assays for protein S, IgG, up1 were performed in patients and control groups

Results: the protein S was lower in the patients than the control and the difference was highly significant. There was a highly significant differences between the level of PS in patients with apl+ve compared with apl-ve patients [p<0.01]

Conclusion: this study confirms an association between apl and PS deficiency

Serum growth-regulated oncogene-alpha chemokine and its correlation with pulmonary fibrosis in systemic sclerosis

To determine serum levels of Growth-Regulated Onchogene-alpha [GRO-alpha] in systemic sclerosis [SSc] patients and correlate these levels with the presence and extent of pulmonary fibrosis detected by pulmonary function tests [% DLCO] and high resolution CT scan of lungs [HRCT]. The study included 23 SSc patients [8 limited and 15 diffuse] and 15 age and sex-matched healthy controls. All patients and controls were subjected to full history taking, thorough clinical examination, routine blood investigations, manometry, chest X-ray, spirometry to calculate the diffusing capacity of the lung for carbon monoxide [DLCO] and high resolution CT lung scan. Serum levels of GRO-alpha, anticentromere [ACA] and antitopoisomerase I [anti-top.I] antibodies were detected by enzyme linked immunosorbent assay [ELISA technique]. Serum levels of GRO-alpha were significantly higher in SSc patients [21.6 +/- 10.98 pg/ml] than in healthy controls [8 +/- 1.13 pg/ml] [p<0.001]. While there was no statistically significant difference between diffuse and limited SSc as regards GRO-alpha level [p>0.05], SSc patients with high serum GRO-alpha level had significantly increased frequency of decreased% DLCO [p<0.01] and the presence of anti-top I [p<0.01] compared to those with normal GRO-alpha level. In contrast, SSc patients with normal GRO-alpha level had increased frequency of ACA [p<0.001]. There was statistically significant association between elevated level of GRO-alpha and severity of lung function detected by decreased% DLCO [p<0.01] and high resolution lung CTscan [p<0.001]. Also, a highly significant negative correlation existed between serum GRO-alpha and decreased% DLCO [r= -0. 768, p<0.001]. Our results suggest that elevated serum level of GRO-alpha in SSc patients is correlated with pulmonary affection and may reflect the severity of lung fibrosis. Repeated and sequential analysis of GRO-alpha may clarify their usefulness as a serological marker for the severity of lung injury and enable us to better understand the pathogenesis of pulmonary fibrosis in SSc