SPECT imaging of the brain: regional cerebral blood flow before and after treatment of patients with primary fibromyalgia

Whether regional cerebral blood flow [rCBF] is affected by Duloxitine Hcl in Egyptian women with primary fibromyalgia [FM] and if it correlates with clinical findings. Thirty untreated women with FM [group I] and ten apparently healthy controls [group II] were studied with single photon emission computed tomography of the brain [brain SPECT] after IVI of Tc-99[m] HMPAO as a cerebral perfusion agent. The resting state [rCBF] was measured for the deep structures [thalamus and caudate] and cerebral cortices [anterior, lateral, posterior] of both sides. Fifteen patients[group Ia] received the conventional therapy of fibromyalgia and the other fifteen [group Ib] received a Duloxitine Hcl 60 mg daily for 3 months followed by measuring rCBF. There was a statistically highly significant lower [rCBF] in the thalamus and caudate nucleus in patients as compared to controls [p<0.01] but no such difference in the anterior, lateral and posterior cerebral cortices [p>0.05]. No significant difference clinically or radiologically was found comparing group Ia results before and after 12 weeks. There was a highly significant difference with fatigue and a significant difference as regard neck pain, headache, generalized body ache and morning stiffness when comparing group lb results before and after 12 weeks. The rCBF to thalamus and caudate nucleus showed a highly significant increase in group lb after 3 months. There was a significant difference in number of tender points, the duration of morning stiffness as well as thalamic and caudate blood flow comparing the change in Ia and lb. The decrease of regional cerebral blood flow to the thalamus and caudate nucleus in patients with primary FM may be the cause of their symptoms. Improvement of the symptoms by administration of duloxitine Hcl may be due to improvement of the cerebral blood flow

Botulinium toxin type-A and spasticity due to traumatic spinal cord injury

Spasticity is a prevalent disabling clinical symptom for spinal cord injuries patients. Treatment of spasticity with botulinium toxin is helpful in focal, controlled muscle weakness with reduction in spasticity. To evaluate the effect of botulinium toxin type A on spasticity in spinal cord injured patients and its effect on functional outcome. Forty patients with spasticity due to traumatic spinal cord injury were included in the study. Initial assessment includes general and neurological examination to detect the level, ASIA classification, motor power. Spasticity grading using clonus score, global pain scale, spasm frequency scale, adductor tone scale and modified ashowrth scale.Functional assessment using activity of daily living [ADL] measures, lower extremity muscle strength [LEMS] and functional impairment measure [FIM] rating levels of disability, these assessment were done at the start, at 3 months and 6 months.All patients received regular conventional physiotherapy rehabilitation programs on daily bases for 3 months then three times per week for another 3 months. Thirty patients of them [group I] received botulinium toxin type A in the spastic muscles and the dose was calculated according to the body weights, 10 patients [group II] didn't receive botulinium toxin type A. There was no significant difference between group I and group II as regard ADL, at start and at 3 and 6 months. The FIM results showed no significant difference between group I and II at start but there was a statistical significant lower mean FIM in group 2 at 3 and 6 months. In group I there was a significant increase in FIM mean at 3 months and significant decrease at 6 months, on the other hand group II showed a significant decrease FIM mean at 3 and 6 months.Clonus score showed no significant difference between group I and group Il at start and at 3 months but significant higher score of grade 3 and 4 was observed at 6 months in group II. There was a significant lower clonus score at 3 months in group I with no change at 6 months on the other hand there was a significant higher score at 3 months with no change at 6 months in group II. Spasm frequency scale showed no significant difference between group I and group II at start but there was a significant higher rate of scale 3 and 4 in group II at 3 and 6 months. In group I, there was a significant change of spasm frequency scale at 3 and 6 months with tendency towards lower scale, although group II showed no significant change at 3 and 6 months. Global pain scale showed no significant difference between group I and II at start, 3 and 6 months. In group I there was a significant decrease in pain scale after 3 months with no change at 6 months while in group II there was no significant difference at 3 months with significant increase at 6 months compared to 3 months. Adductor tone scale results showed no significant difference between group I and II at start but significant higher rate of scale 3 and 4 was observed in group II at 3 and 6 months. Group I showed a significant decrease of adductor tone scale at 3 and 6 months while group II showed no significant change at Smonths with significant increase at 6 months. Modified ashowrth scale showed no significant difference between group I and II at start with significant higher rate of scale 3 and 4 in group II at 3 and 6 months. Group I showed a significant decrease in modified ashowrth scale at 3 and 6 months, while group II showed significant increase in scale at 3 months with no change at 6 months compared to 3 months but there was an increase in scale at 6 months compared to the start. The botulinium toxin has a reducing effect of spasticity in spinal cord injured patients -.consequently, it improves their functional outcome. It is recommended to use it on more frequent bases as it helps to improve spasticity safely and decreases the dose of central muscle relaxant with reduction of its adverse effect

correlation of patellar alignment with knee pain and function in knee osteoarthritis

Osteoarthritis is a complex disease, affected by many factors, including genetic, environmental, traumatic and biomechanical factors. Patellofemoral arthritis found in approximately 5% of patients with osteoarthritis of the knee having symptomatic patellofemoral arthritis in the absence of tibiofemoral arthritis. The etiology of arthritis is equally divided among patellar dislocation, fracture, and primary osteoarthritis. The aim of this study was to evaluate the correlation of patellar alignment with knee pain and function in knee osteoarthritis. Sixty patients with osteoarthritis [OA] were included in our study. All patients were subjected to clinical assessment; body mass index, psychometric assessment using Center of Epidemiologic Studies Depression Scale [CES-D].Knee pain and function assessment using the Western Ontario and McMaster Universities [WOMAC] index; which includes visual analogue pain subscale and function scale. Laboratory investigations as; CBCs, ESR, uric acid and urine analysis. Radiological investigations; plain x-ray in weight bearing postero-anterior view for radiological grading of osteoarthritis using K- L score. Magnetic resonance image [MRI] is done in a sagittal plane to measure patellar length [PL], trochlear length [TL] then patellar length ratio [PLR] was calculated by dividing PL by TL.MRI is done in a transverse plane to measure trochlear indices [trochlear depth SA, inclination LTI and trochlear angle TA] and patellar indices [LPTA and BO]. There was a statistical significant increase of patellar length ratio [PLR] and lateral trochlear inclination [LTI] with WOMAC pain; there were no statistical significant difference of trochlear angle [TA] and sulcus angle [SA] with WOMAC pain. There was an increase of lateral patellar tilt angle [LPTA] and a decrease of bisect offset [BO] with WOMAC pain but; it didn't reach a statistical significant level. There was a tendency of lateral trocniear inclination [LTI] to increase with WOMAC function also; there was an increase of patellar length ratio with WOMAC function but it didn't reach a statistical significant level. The other parameters of patellar alignments measures [TA, SA, LPTA, BO] showed no significant change with WOMAC function. PF arthritis should be considered as an entity separate from arthritis of medial and lateral compartments. There is an association between patellar alignment with knee pain and function. So, procedures to improve patellar biomechanics to correct articular damage may be beneficial to alleviate pain

relationship between placental growth factor, psoriasis and rheumatoid arthritis

Psoriasis is a chronic dermatosis characterized by the presence of heavy neutrophilic infiltrate in both the dermis and epidermis, together with elongated tortuous blood vessels in dermal papillae. Rheumatoid arthritis [RA] is a chronic inflammatory disease characterized by neovascularization and inflammatory cell infiltration within the synovium with associated synoviocyte hyperplasia. Several factors are found to be behind such a type of inflammation, including PIGF. Recognition of how this factor involved in the pathogenesis of psoriasis and RA may be of great help in the development of a new specific therapeutic modality of these disease. Is to study the role of PIGF [serum and synovial] as one of the factors underlying the pathogenesis of psoriasis and rheumatoid arthritis and its correlation with disease severity, duration and activity. Twenty eight RA patients were included in this study, diagnosed according to ACR classification. Forty psoriatic patients were also included in this study, examination and determination of the disease severity using PASI score were done. Measurement of the serum and synovial fluid [SF]PIGF level using ELISA technique was performed and correlation of disease duration and severity with its level was also done. We found that s.PIGF was high in serum of 64% of RA pts and in all synovial fluid samples. There is apositive correlation between the disease severity and its level ,however the correlation between the disease duration and the serum level of P1GF was insignificant.There is a positive correlation between serum and synovial PIGF in rheumatic patients. Serum PIGF [s.PIGF] was high in 92.5% of psoriatic patients and was significantly high in those with severe and moderate disease activity in comparison to those of mild activity and control group. s.PIGF was highly significant correlated with lesion severity. The prevalence of PsA is 35% of psoriatic pts,[male to female 5/2]. 8 patients have oligoarthritis, 6 patient have polyarthritis and DIP involvement .2 of them have spondyloarthropathy. PIGF has a role in the pathogenesis in rheumatoid arthritis and skin lesion of psoriasis and psoriatic arthritis

Orthostatic hypotension in stroke patients

To assess the incidence of orthostatic hypotension [OH] in stroke patients undergoing rehabilitation and to determine clinical variables associated with it. Thirty patients with a first clinical stroke who underwent rehabilitation within one month of stroke onset were included in this study. They were 17 males and 13 females. Their age ranged from 49 to 68 years [mean +/- SD= 58.1 +/- 6.3]. Patients were subjected to full history taking, thorough clinical examination and investigations. Patients' blood pressure was measured in the supine position and on tilting at 90[0]. OH was defined as a drop in systolic blood pressure [SBP] of 20 mmHg or more. OH was present in 14 [46.7%] patients. Age was highly significantly associated [p<0.001] with OH and admission modified Barthel Index [MBI] score was significantly associated [p<0.05] with OH. There was a non-significant correlation with the site of stroke or the use of anti-hypertensives. OH was common in stroke patients undergoing inpatient rehabilitation especially in older patients who have a lower functional status

Effects of methotrexate and leflunomide therapy on knee synovium of adjuvant induced arthritis as a model for rheumatoid arthritis

Leflunomide and methotrexate have proven to be efficacious in reducing joint inflammation and joint destruction in clinical models of arthritis and in rheumatoid arthritis. The objective of this study was to evaluate the effects of both drugs as well as their combination therapy on the synovium and cartilage of adjuvant arthritis as a model of rheumatoid arthritis [RA] in humans. This study was carried out on forty animals stratified into 5 groups: normal, adjuvant arthritis [AA] control, AA who received leflunomide in a dose of 20 mg/kg orally, AA who received intraperitoneal methotrexate in a dose of 0.3 mg/kg twice weekly and AA who received both leflunomide and methotrexate of the same dose given in groups 3 and 4. All animals were sacrificed after 3 weeks; the right knee was dissected and examined with light microscopy. Oxidants markers [nitric oxide [NO] and malondialdhyde [MAD]] and antioxidants markers [glutathione [GSH], erythrocyte superoxide dismutase [SOD] and ceruloplasmin [CP]] were all measured. All the treatment modalities showed variable degrees of improvement of synovial and cartilage scoring in comparison to AA [the non-treated group]. The leflunomide treated group [group 3] showed the best improvement of synovial pathology, while the combined therapy group [group 5] showed the best improvement of cartilage pathology. The oxidative stress markers showed some changes with different modalities of treatment where, nitric oxide did not change significantly between all groups. Malondialdhyde [MAD] was significantly lower in the methotrexate [MTX] treated group as compared to AA controls. Also, superoxide dismutase [SOD] was significantly lower in the leflunomide treated group, MTX treated group as well as in the group who received combined therapy as compared to AA the controls. Glutathione [GSH] level was significantly decreased with combination therapy as compared to the leflunomide treated group. Serum ceruloplasmin [CP] showed a significant decrease in its level in the MTX treated group as compared to the AA controls. MTX treatment [group 4] was the best in controlling oxidative stress markers. Further study is needed to evaluate the duration and dose effect of each drug on synovium, cartilage and oxidative markers

Soluble selectin adhesion molecules in systemic sclerosis and Behcet's disease

To detect the serum level of soluble E, P and L-selectins in systemic sclerosis [SSc] and Behcet's disease [BD] patients and compare them to normal healthy controls. Also, to determine their relation to clinical parameters of disease activity Serum samples from 15 SSc patients, 10 BD patients and 10 apparently healthy age and sex matched controls were examined with a sensitive linked immunosorbent assay. All patients were evaluated for the presence of gastrointestinal, pulmonary, renal, cardiac, Raynaud's phenomenon as well as joint or muscle involvement. Serum levels of E and P-selectins were highly significantly increased in SSc patients as compared to healthy controls. L-selectin was significantly higher in Raynaud's related scleroderma. Serum level of P-selectin was found to be higher in the diffuse form of SSc. There was no correlation of any selectin and pulmonary fibrosis. As regards BD, there was a highly significant increase in E-selectin and a significant increase in P-selectin in comparison with normal controls. Comparing SSc and BD as regards selectin; there was a significant increase of E and P-selectins in SSc. The values of E and P-selectins were found to be elevated in SSc and BD patients that might reflect their role in the pathogenesis of both diseases. The correlation of E, P and L-selectins with clinical parameters of SSc may help in evaluation of progression or remission of the disease. Further large long term study and serial measurements at different intervals of therapy are needed to correlate it with clinical deterioration or improvement and response to therapy