Early predictors of increased bone resorption in juvenile idiopathic arthritis: OPG/RANKL ratio, as a key regulator of bone metabolism

To explore early changes in the predictors of bone turnover in children with juvenile idiopathic arthritis [JIA]. To identify osteoprotegerin/receptor activator of nuclear factor-kappaB ligand [OPG/RANKL] ratio in the serum of the same patients and its relation to the parameters of joint inflammation and joint destruction. Seventy children with JIA and 30 healthy children individually matched for age, sex, race, and county of residence were included in this study. Serum levels of calcium [Ca], phosphorus [Ph], alkaline phosphatase [ALP], osteocalcin [OC], RANKL and [OPG] were measured. Urinary concentration of deoxypyridinoline [DPD] was also done. All involved joints were assessed by plain radiography. Significant low serum concentrations of ALP and OPG was observed in JIA group, while there was a significant increase in serum level of RANKL and urine level of DPD compared to controls. OPG/RANKL ratio was significantly lower in JIA patients than in controls. OPG/RANKL ratio is correlated with most clinical characteristics, disease activity variables, JIA outcome measures and radiographic findings. DPD, RANKL and OPG/RANKL ratio, respectively, are considered as independent predictors of juxta-articular osteoporosis. OPG/RANKL ratio was the only predictor of bone erosion. The OPG/RANKL ratio could be an early predictor of increased bone resorption and a valuable biomarker for joint inflammation and bone injury in JIA patients

Teaching program for mothers of children with bronchial asthma in Al Zarqa governorate hospital

Bronchial asthma is one of the most common chronic diseases of the childhood. Knowledge and beliefs of caregivers' specially mothers related managing their child's asthma, have a major influence on health status. Meanwhile, poor knowledge, skills and lack of self-efficacy may lead to improper decisions about disease management which resulted in delayed care. Aim of this study was to design, implement, and evaluate the effectiveness of teaching program on mother's knowledge and practices for their children with bronchial asthma in Al Zarqa Governorate Hospital. Quasi-experimental study was conducted. Pediatric Department at Al Zarqa Governorate Hospital, Zarqa City, Jordan during Ocloher, 2008 to January, 2009. a representative sample of eighty mothers of children with bronchial asthma was involved. Tools of data collection consisted of pre/post assessment questionnaire. pre/post mothers' Practice Checklist and the educational program. Results revealed an improvement in mothers' post-program total means scores of knowledge and practices as compared to pre-program mean scores with a statistical significance difference at p-value of<0.00]. A statistically significant positive correlation was detected between total mothers knowledge scores and their practice at pro/post-program implementation [p<0.01]. There was an improvement regarding child's attacks occurrence after the teaching program implementation. The results of this study indicated the positive effectiveness of a teaching program on mother's knowledge and practices for their children with bronchial asthma. Application of the same teaching program in similar settings and other countries worldwide to confirm its effectiveness, with emphasis on nursing role strongly recommends

Subclinical involvement of cardiovascular system in juvenile collagen diseases

Cardiovascular lesions are commonly found in children and adolescence with different collagen diseases with relevant implication in mortality and morbidity. The purpose of the study was to verify whether there is any sign of cardiovascular involvement in juvenile collagen diseases using electrocardiography [ECG] and echocardiography [ECHO]. The study was carried out on 77 patients, 52 juvenile idiopathic arthritis [JIA], 20 systemic lupus erythematosus [SLE], 3 spondylarthropathy [SPA] and 2 juvenile dermatomyositis [JDM]. They were free of any clinically evident of cardiac manifestations. Thirty six healthy children were enrolled as control group All subjects underwent complete history and physical examinations, x ray chest, ECG and two dimensional, M mode, continuous wave [CW], pulse wave [PW] and color flow Doppler examinations. The following investigations were done erythrocyte sedimentation. rate[ESR], antistreptolysin O titre [ASOT], C reactive protein[CRP], rheumatoid factor[RF], antinuclear antibodies[ANA] and anti double stranded DNA[anti ds DNA]. Minor ECG changes were detected in 3 SLE and 2 JDM. ECHO showed pericardial effusion in 2 [3.3%] JIA and 3[15%] SLE. Aortic insufficiency was detected in 5[9.6%] JIA, 4 [20%] SLE. Mitral regurge was found in 7[13.4%] JIA, 5 [25%] SLE. Mild tricuspid regurge was detected in 3[15%] SLE. Mild pulmonary hypertension was found in 4[20%] SLE. Significant systolic dysfunction was elicited in JIA in form of increased left ventricular end diastolic diameter [LVEDD], left ventricular end systolic diameter[LVESD], left ventricular end diastolic volume[LVEDV] and left ventricular end systolic volume[LVESV] and reduction of ejection fraction [EF] and fractional shortening [FS]. In SLE .there was significant reduction, of EF and FS. Significant diastolic dysfunction was manifested in JIA by decreased peak early [E], E acceleration time [Eat], E duration [Edur], Total duration [Tdur], [E/A] ratio and A acceleration time [Aat] and increased peak atrial filling velocity [A], E deceleration time [Edt], isovolumic relaxation time [IVRT] and A deceleration time [Adt] and in SLE by decreased [E] and [E/A] ratio and increased [Edt] and in JDM by decreased [E] and [E/A] ratio and increased [IVRT]. In JIA, there was a positive correlation between age and [LVEDD] and disease duration with both [LVEDD] and [LVESD] and negative correlation between disease duration and EF. Cardiovascular involvement in juvenile collagen diseases is common. Regular cardiac evaluation using [ECG] and [ECHO] is recommended for early diagnosis of cardiac involvement. Key words: Cardiovascular-juvenile-collagen diseases

Effect of concommitant Helicobacter pylori infection in patients with Giardiasis lamblia in Egypt

Giardiasis is one of the most common enteroprotozoal diseases; its association with Helicobacter pylori is a common clinical finding. This work studied the impact of such association. Fifty giardiasis patients were classified into two groups according to the concomitant presence of H. pylori and ten normal healthy controls were also included. All patients were subjected to complete history taking, thorough clinical and stool examination, endoscopy, and biopsy of gastric and duodenal mucosa as well as histopatological examination. Results revealed significant upper gastrointestinal symptoms [epigastric pain and anorexia] in giardiasis patients with H. pylori. Also, endoscopic and histopathologic examination showed significant gastric lesions in this group of patients as compared to those suffering only G. lamblia

Post-streptococcal reactive arthritis [PSRA]: is it a distinct disease entity?

Reactive arthritis is defined as a sterile inflammatory arthritis occurring in association with primary infection at a distant site. Arthritis following primary throat infection with Group A beta, haemolytic Streptococci [GA beta S] may apply to this definition, Because of the similarity between the diagnostic criteria for acute rheumatic fever [ARF] and post-streptococcal reactive arthritis [PSRA], the diagnosis and treatment of PSRA are not well defined. To clarify whether PSRA is a separate disease entity? and to evaluate the extent of joint affection by using various clinical, laboratory and radiological tools. Twenty-five patients with arthritis secondary to infection with GA beta S who attended the Outpatient Rheumatology Clinics in Assuit University Hospitals were included in this study. Other forms of reactive arthritis [ReA] were excluded. All patients were submitted to complete medical history and clinical examination. Erythrocytic sedimentation rate [ESR], C-reactive protein [CRP], complete blood count, rheumatoid factor [RF], antinuclear antibodies [ANA], throat swab and Antistreptolysin O Titre [ASOT], have been done to all patients. Electrocardiogram [ECG] and Echocardiogram [ECHO] were performed. Plain radiography, ultrasonography [US] and Magnetic Resonance Imaging [MRI] to both knees and ankles were done to all patients. Twenty-five patients with a mean age +/- standard deviation of 22.40 +/- 7.42 years were selected. The arthritis persisted for up to six months with a latent period from 10 days to 2 weeks. ASOT was positive with a range from 200-800 IU. Culture of throat swab was positive for GA beta S in 72% of cases, in addition to other organisms [staphylococci in 24% and pneumococci in 16% of the patients]. All of the patients had non migratory arthritis of lower limbs, Knees and ankles synovitis with minimal effusion was detected in 36% of the patients by using ultrasound and 32% and 40% by using MRI respectively. Synovitis with marked effusion of the knees and ankles was detected in 36% and 44% of patients respectively by ultrasound and 40% by MRI. Post-streptococcal arthritis is a separate disease entity. The extent of joint affection might be evaluated by the use of US and MRI as the findings were concordant in knee joint affection. MRI was preferable in evaluating ankle joint synovitis

Trichomonas vaginalis antigens in vaginal and urine specimens by immunochromatography, compared to culture and microscopy

This study evaluated the immunochromatographic [1C] capillary flow technology for detection of T. vaginalis antigens in vaginal and urine specimens. The 1C antigen-detection test and microscopy wet smears were assessed against the InPouch TV culture. Vaginal-swabs and first-voided urine specimens were obtained from 348 sexually active symptomatic or asymptomatic, >/= 16 years old women. Nineteen samples [5%] were positive by culture [95%, CI 0.3-0.8]. The 1C test [vaginal-specimens] was more sensitive than the wet smears. 1C sensitivity was 84% [95%CI, 0.68-1.01], specificity 98% [95%CI, 0.96-0.99], positive predictive value [PPV] 70% [95%CI, 0.51-0.88], negative predictive value [NPV] 99% [95%CI, 0.98-1], [positive likelihood ratio [+LR]: 39.6, and negative likelihood ratio [-LR] 0.2. The 1C test using urine as a substrate had less performance than both microscopy and 1C .test of vaginal specimens. Urine-IC sensitivity was 53% [95%CI, 0.30-0.75], specificity 99% [95% CI, 0.98-1.00], PPV 77% [95%CI, 0.54-1], NPV 97% [95%CI, 0.96-0.99], +LR: 57.7, and -LR: 0.5. Sensitivity of vaginal smear was 68% [95%CI, 0.48-0.89], specificity 100%, PPV 100% [95% CI, 1], NPV 98% [95% CI, 0.97-1], +LR>225, and -LR: 0.3. T. vaginalis was diagnosed in two wet urine samples, but not in smears. The 1C antigen improved T. vaginalis diagnosis, especially in screening, rapid, or point-of-care test, but in urine was less reliable than with vaginal smear

Laboratory screening for rhabdomyolysis among beginners practicing vigorous exercises

The objectives of this study were: screening for cases of exertional rhabdomyolysis among beginners in practicing vigorous exercises, and finding out reference laboratory values for the students who will exercise for the first time. The study was conducted in Assuit university hospital on 222 male students of first year of faculty of sports, who practiced vigorous exercises for one hour with maximal load, for the first time, and 20 apparently healthy subjects as a control group [GI]. Twenty four hours after vigorous exercise [24hs AVE], blood samples were collected and the students were classified according to [CK] levels into two groups, group II [GII] :125 students, with total CK<183U/L[cut off value] and group III [GIII]: 97 students, with total CK>183U/L. One month after vigorous exercises [I m AVE], blood samples were collected from [GIII] which represent the follow up group [GIV, baseline]. All participants were subjected to medical history, clinical examination including body mass index [BMI], and quadriceps circumferences. Laboratory investigations included peripheral haemogram, kidney and liver function tests, blood minerals, and specific tests including: total CK, CK-MB and CK-MM isoenzymes, LDH, and serum myoglobin. This study revealed statistically highly significant elevation of total CK, CK-MM, CK-MB, AST and serum myoglobin when comparing [GIII] with each of [GI] and [GII] while a high significant reduction was found when comparing [GIV] with [GIII]. No significant difference could be detected when [GIV] compared with [GI] and [GII] compared with [GI]. There was a significant reduction in serum Na+ and serum Ca+ + level and highly significant elevation in serum K+ and phosphorus in GIII when compared with GI. No statistical significance in [BMI] was detected. Twenty four hours after vigorous exercises, 16 students [7.2%] showed total CK level more than 5 times the cut off value [183 U/L]. These students showed no signs and symptoms of rhabdomyolysis except muscle pain. The participant students who showed total CK values five times or more than the cut off value [183 U/L], are considered by some authors to be suspicious of having rhabdomyolysis. Laboratory values of the students who did not show rhabdomyolysis, could be taken as reference values for students and untrained persons who will practice exercise vigorously for the first time

Significance of calcium pyrophosphate dihydrate and monosodium urate crystal identification in synovial fluid of arthritic patients

Diagnosis of joint arthritis usually depends upon certain clinico-investigatory criteria settled by international organizations. These criteria do not reveal a solid diagnosis in many occasions, also sometimes coexistence of more than one type of arthritis results in poor management and worsen the prognosis of the case. This descriptive study aimed to evaluate the role of synovial fluid crystal identification in reaching a final diagnosis of undiagnosed effusion - associated arthritis, also, to assess the value of crystal identification in diagnosis of coexistence of two or more types of arthropathies. Sixty-one patients with established joint effusion due to arthritis [acute or chronic] were included in the study. The patients were grouped into six groups according to the type of rheumatological disease after careful clinical, laboratory and radiological evaluation. Twelve cases were diagnosed as rheumatoid arthritis [RA], sixteen as osteoarthritis [OA], nine as gout, one as pseudogout, four as systemic lupus erythematosus [SLE], and four as spondyloarthropathies [SPA]. The seventh group was the undiagnosed group. All patients had subjected to synovial fluid [SF] aspiration by arthrocentesis. The aspirated samples were examined macroscopically, and microscopically for leucocytic count and crystals using polarized light microscopy [PLM]. Two types of crystals were specifically looked for: monosodium uratre [MSU] crystals that cause gout and calcium pyrophosphate dihydrate [CPPD] crystals that cause calcium pyrophosphate deposition disease. Other laboratory investigations included C- reactive protein, serum uric acid, and rheumatoid factor. After using [PLM] we found that, out of 61 cases examined, twenty samples [32.8%] showed crystals[six[9.8%] were MSU, nine[14.8%] CPPD, and five[8.2%] showed both MSU and CPPD crystals], Examination of SF for MSU and CPPD crystals showed significant changes in the diagnosis of arthritis. Out of 61 examined cases, combined arthritis was diagnosed in ten cases [16.4%] [combined OA and CPPD in five cases, combined RA and CPPD in two cases, and combined RA, MSU and CPPD in one case, combined SLE and CPPD was diagnosed in one case and combined SPA and MSU in another one]. Consequently, PLM examination allowed us to reduce the undiagnosed cases from 24.6% to 16.4%. In conclusion: Examination of SF for MSU and CPPD crystals is worth looking and can change the management strategy. It allowed us to reach a definite diagnosis in undiagnosed arthritis,and to identify the coexistence of two or more types of arthropathies. Polarized light microscopy remains the only practical way for identifying SF crystals

Human muscle sarcocystosis in relation to non specific rheumatic diseases and rheumatoid arthritis

Human muscle sarcocystosis is a parasitic infestation acquired by ingestion of the sporocysts of the sarcocystis species. Sarcocystis antibodies were said to be encountered in patients with connective or mixed connective tissue disorders. Parasitological etiology of musculoskeletal disorders may help to modify the line of treatment of these patients. This study was performed on 22 non specific rheumatic patients, 21 rheumatoid arthritic [RA] patients and 10 apparently healthy persons as controls. Using the sarcocystis fusiformis antigen [Ag.], serum samples of the patients were tested for the presence of sarcocystis species antibodies using the Westren Blot technique. Of the 22 patients of the first group, 14 were positive [63.7%], of the 21 patients of the second group 5 were positive [23.8%]. They deducted several band ranges from 15-116 KD. Most of these samples had eosinophilia ranging from 7-20%. None of the control group serum reacted against sarcocystis Ag. Statistically the difference between the two groups was significant [P <0.04]. Sarcocystis infection may be an important cause of the non specific rheumatic diseases associated with myositis. Diagnosis and treatment of such a frequent infestation in carefully chosen cases would relieve them from prolonged intake of antirheumatics and their side effects

Impact of helicobacter pylori infection on the activities of urease and lipase enzymes in patients with giardiasis

The study of the effect of Giardia lamblia and Helicobacter pylori organisms coexistence on the activities of urease and lipase enzymes was the aim of this work which was done through choosing 50 cases of giardiasis in addition to 10 normal individuals chosen as a control group [free from giardiasis]. It is well known that H. pylori is considered one of the most important causes of gastric and duodenal inflammations which could predispose to ulcers and hypochlorhydria leading to increased susceptibility to giardiasis as it is known that HCl acts as a chemical barrier to microbes. The biochemical tests were done to investigate the activity of both urease and lipase enzymes extracted from the gastric juice of patients and controls. A significant increase in urease activity in the group having combined infection [giardiasis and H.pylori] than the group infected with G.lamblia alone and the control group was found. The same findings were obtained regarding the lipase activity. In the present work, both infections H. pylori and G. lamblia coexisted in 75% of epigastric pain cases which could be explained on the basis that both organisms predispose to each other

Dorsal disc prolapse with myelopathy: physical therapy influence

The purpose of this study was to identify the effect of postero-anterior spinal manipulation on dorsal disc prolapse with mild myelopathy; regarding back pain, ROM of lower dorsal trunk flexion and cadence. Ten volunteer's patients participated in the study. Their age ranged from 34 to 48 years, with duration of illness from one to six months. Patients were diagnosed clinically and by MRI as a dorsal disc prolapse. All patients complained of myelopathy with paraparesis with grade 1+ or 2 spasticity according to a modified Ashworth scale. VAS was used to measure local pain intensity. Functional plain X-ray was used to measure ROM of lower dorsal trunk flexion. Cadence was used as a kinematic parameter of gait for those patients. All these evaluation procedures were performed before and at the end of physiotherapy program. Physiotherapy consisted of ultrasound, hot packs and postero-anterior central spinal manipulation. This program was applied three times per week; for six weeks. Results of this study revealed a significant decrease of local back pain intensity at the end of the treatment program. Results also showed a significant increase of both ROM of lower dorsal trunk flexion and cadence at the end of treatment program. Results presented a strong correlation between clinical and kinematic parameters. In conclusion, postero-anterior central spinal manipulation was an efficient and non risky maneuver in the treatment of dorsal disc prolapse with mild myelopathy. Both local and cord manifestations can be improved in these patients

calcified intraarticular mass in a man with severe shoulder osteoarthritis: what are the implications?

Rapidly progressive osteoarthritis in the shoulder in the elderly is often associated with chronic rotator cuff calcifications and damage and with apatite crystals identifiable in the joint fluid. The key roles of the crystals and rotator cuff lesions although suspected have been disputed. We describe a 57-year-old man with severe degenerative changes at the right shoulder and other joints. A calcified mass 2-cm in length was found on radiographs medially in relation to the proximal humeral diaphysis. At arthroscopy, the mass was confirmed to be in the joint and due to calcified synovium. Biopsy revealed synovium with apatite like crystal clumps in this mass. Calcium pyrophosphate crystals were also found but in the cartilage only. This case with the apatite crystals only in synovium and with destructive arthritis without a complete rotator cuff tear raise the possibility that synovium as a primary site for apatite deposition might be important in the destructive arthritis. Management of this patient like many with rotator cuff tear arthropathy has been difficult. Rapidly destructive osteoarthritis at the shoulder, much like that in the patient reported here, has been described under a variety of terms that suggest implications for pathogenesis. Neer et al used the term cuff tear arthropathy to describe glenohumeral degenerative arthritis and a rotator cuff tear in twenty-six patients who had required a total shoulder replacement.[1] McCarty et al described 4 elderly women with destructive arthropathy of the shoulder, large effusions, apatite crystals present in the joint effusions and massive tears of the rotator cuffs and coined the term Milwaukee shoulder syndrome.[2],[3],[4]. Dieppe et al suggested the terms apatite-associated destructive arthritis and idiopathic destructive arthritis.[5] Calcifications have been noted in the rotator cuff structures but have not been reported in the joint or synovium.[3] We describe a patient with a similar destructive arthropathy, who had a calcified mass about 2-cm in length in the right shoulder, well visible by X-ray and arthroscopy, that was localized to synovium at arthroscopy. Since this patient did not have prominent rotator cuff disease, our case suggests that intraarticular crystals can be associated with difficult to manage progressive shoulder osteoarthritis without a prominent primary rotator cuff cause

Polarized light microscopy [PLM]: a role in filling the gaps of undiagnosed arthritis

Joint arthritis is a major clinical problem for any rheumatologic clinic. Diagnosis of these types of arthritis usually depends upon certain clinico-investigatory criteria usually settled by international organizations. Even the use of these criteria does not always revealed a solid diagnosis in many occasions. Moreover, there are reported literatures about presence of coexistence between different types of arthritis. Lack of diagnosis may result in poor outcome of management and sometimes worsen the prognosis of the case. This study aimed t. To evaluate synovial fluid analysis in diagnosis of effusion-associated arthritis to reach a final diagnosis in undiagnosed cases and to role out the importance of Polarized Light Microscopy [PLM] in diagnosis of the coexistence of two or more types of arthropathies. The present study is a cross-sectional descriptive hospital-based study, conducted in the department of Rheumatology and Rehabilitation in Assiut University Hospital. Sixty-one patients with established joint effusion [acute or chronic] were included in the study. The patients were grouped according to the type of rheumatological disease into 6 groups each of them represented one of the rheumatological diseases. Twelve cases were diagnosed as RA, 16 as OA, 9 as gout, 1 as pseudogout, 4 as SLE, and 4 as SPA. The final diagnosis could not be reached in 15 of them. The seventh group was the undiagnosed group. All the allocated participants were subjected to synovial fluid [SF] examination, macroscopically using [PLM] and microscopically, for leukocytic count and crystals. Monosodium urate [MSU] and Calcium pyrophosphate dihydrate [CPPD] crystals were identified. Of [SF] analysis were correlated with the preliminary clinical diagnosis which revealed that out of 61 examined cases combined arthritis was diagnosed in 10 cases [16.4%]. These 10 cases were combined OA and CPPD in 5 cases, combined RA and CPPD in 2 cases, and combined RA, MSU and CPPD in one case. Additionally, combined SLE and CPPD was diagnosed in one case and combined SPA and MSU in another one. Consequently, [PLM] examination allowed us to reduce the undiagnosed cases from 24.6% to 16.4%. Examination of SF for MSU and CPPD crystals was worth looking and can change the management strategy. PLM remained the only practical way of identifying these particles in the clinical setting

Alterations of P53, and BCL-2 protein expression in the recurrent laryngeal and pharyngeal squamous cell carcinoma

Identification of molecular events of the recurrent squamous cell carcinoma [SCC] of the larynx and pharynx may aid in refining treatment strategies and improving outcome. The underlying molecular events of these recurrent tumours involves alterations in the tumor suppressor genes [p53] and protooncogenes [Bc1-2]. We hypothesize that the development of these recurrent tumours involves alterations of the p53 and Bcl-2 proteins. To test this hypothesis, 15 laryngeal and pharyngeal biopsy specimens obtained from 15 patients with recurrent laryngeal or pharyngeal squamous cell carcinoma with different grades [II-IV] were immunostained for p53 and Bcl-2 protein expression. Examination of the percentage of positive cells in the normal mucosa and SCC, respectively, showed significant upregulation of p53 [0.0 +/- 0.0 Vs. 51.8 +/- 5.9; p= 0.00] and Bcl-2 protein expression [36.5 +/- 3.5 vs. 74.6 +/- 1.9; p= 0.00]. Alterations of the p53 and Bcl-2 proteins occur during the development of recurrent SCC. Additional studies are needed to confirm and extend our results

Study of anatomical and functional results of myringoplasty in children

Opinions about the timing and surgical techniques of myringoplasty in children with chronic supportive otitis media have been conflicting for many years. The aim of this study was to evaluate surgical and functional results of myringoplasty in selected children with tympanic membrane perforation and assess factors potentially influencing their outcome. The study included 82 patients aged from 7 to 14 years. Forty two were females and forty were males. All of the children underwent myringoplasty using underlay technique. Higher rate of anatomical failure was observed in cases with wet middle ear mucosa and with longer duration of discharge. The relation was statistically significant. One year postoperatively, the hearing level changes in patients with take11 grafts [66 patients] were as follows, in eleven cases the air bone gaps were closed to within 10 dB or less [mean preoperative gap was 21.5 dB and mean post-operative gap was 6.2dB]. In 51 cases the gaps were improved [the mean preoperative gap was 30.3 dB and mean postoperative gap was 18.15dB]. In three cases there were no changes and in one patient the hearing deteriorated. In cases with broken graft [12 cases] one year postoperatively there was seven cases of deterioration of hearing [mean preoperative ABG was 28 dB and mean postoperative gap was 47dB]. In five cases, there were no changes between pre and post-operative ABG. The overall clinical success rate after one year was 80.5% [66/82]. The overall audiological success rate after one year was 79.5% [62/78]. These cases included 11 cases with closed gap and 55 cases with azndioZogica1 improvement. Based on our study findings, we recommend pediatric myringoplasty to preserve and restore hearing, prevent recurrent attach of chronic otitis media and leave the child to bath and participate in water activities without restriction. The operation gives the child a safe, dry and functioning ear. We also recommend proper management of the ear to get a dry ear at the time of surgery; this will increase the success rate of the operation

Assessment of ground reaction force components in parkinsonian patients

The purpose of this study was to evaluate the ground reaction force components in Parkinsonian patients and to compare them with that of age matched normal subjects. Twenty Parkinsonian patients and ten normal subjects participated in this study. This study calculated kinetic quantities of human gait, by using all components of the ground reaction force [vertical load, horizontal shear forces in the fore-aft and mediolateral directions], both in normal subjects and Parkinsonian patients by using force plate form. The results of this study showed a highly significant reduction of ground reaction force in all parameters of ground reaction force of Parkinsonian patients when compared with control group, except the reduction of the mediolateral component of the first peak which was non significant. So assessment of ground reaction force should be considered as a valuable tool in diagnosis, rehabilitation and prognosis of Parkinsonian patients

Early detection of neurological involvement in Behcet's disease: electrophysiological, study

Several studies have been done to characterize the pattern of neurological involvement in Behcet's disease with neurological involvement. Multi modal neurophysiological studies to characterize cases with non-neurological involvement have not been yet done. The work was to study the electroencephalography pattern [EEG] and evoked potentials abnormalities that may help to diagnose sub-clinical neurological involvement inpatient with Behcet's disease. The study included 29 patients with Behcet's disease [18 male and 11 female] with a male to female ratio 3:2, their mean age was 32.4 years [ranged from /4-48 year] and the duration of the illness ranged from one year to sixteen years [mean 3.76 year]. The patient group was compared with 25 age and sex matched healthy normal control group. Electroencephalography [EEG] was done for the studied patients it was abnormal in 69%., Visual evoked potential [VEP] was done for 22 patients; it was abnormal in 9 [41%] of the cases., Brain stem auditory evoked potential [BAEP] was done for 22 patients, it was abnormal in 5 patients [22.7%]. Somato-sensory evoked potential [SSEP] was done for 18 patients; it was abnormal in 3 patients [16.6%]

Human leukocytes antigens in insulin dependent diabetes mellitus [IDDM] type I

This study consists of 72 diabetic patients of type I and 52 diabetic patients of type II besides 35 normal control of matched age and sex. There are some alleles more frequent in IDDM group than in control. In patients, they are DQA1 *0301/2,*0102, *0101- DQBl*0201,*0302,*0602-3,*0301- DRB1*0101,*0301,*04,1101,. While in normal control,they are DQAI*0101,*0102,*103,*0201,*0501 DQBI*0301,*0602-3,*0201,*0601 ORB1*1101,*1501/2/3. Three times high positive percent were observed regarding rubella IgM of IDDM as compared to NIDDM while it was zero percent with respect to control

Paravertebral nerve block vs general anaesthesia in cancer breast surgery

The aim of this study to evaluate the effect of thoracic paravertebral nerves block[PVB] as an alternative for general anaesthesia [GA] in cancer breast surgery on haemodynamic, stress responses, pulmonary function tests[PFT] and postoperative pain relief. Fifty patients undergoing for elective simple mastectomy and clearance of axilla allocated for 2 groups. Group 1 [GAG] and group II [PVB]. All patient premedicated by fentanyl 1micro g/kg and 40 micro g midazolam. Group 1 [GAG] received general anaesthesia by propofol 2 mg/kg and 80 mirco g / kg vecuronium and anaesthesia was maintained by gas, oxygen and isoflurane. In PVB group single injection of 0.3 mg/kg bupivacain 0.5% at T4 spine and the patients were sedated by propofol infusion. PVB decreased HR, MABP, blood glucose and plasma cortisol significantly when compared with GAG and significantly improved pulmonary functions tests [FVC and FEVI]. PVB produced significant increase in duration of analgesia and decreased visual analogue scale scores [VAS] when compared with GA. PVB with bupivacain 0.5% at T4 in conjunction with intraoperative sedation was safe and effective for surgical anaesthesia in patient undergoing major breast surgery and attenuated the stress response to surgery and provided complete pain relief postoperative

Our experience in management of severe closed head injury [targeted therapy in neurotraumatology mangement of diffuse brain injury]

36 comatosed patients diagnosed as diffuse brain injury DBI [diffuse axonal injury DAI or/and diffuse brain swelling DBS] after severe head injury [unconscious from the moment of severe impact with or without evidence of space-occupying intracranial lesions on CT or MRI] were successfully managed in Kasr-El Aini trauma hospital via a novel classification and treatment protocol; in this paper we explain in detail our successful experience