Factors contributing to disability in rheumatoid arthritis patients: An Egyptian multicenter study

OBJECTIVE

Minimizing disability and enhancing physical function to its optimal levels is still a challenge in management of rheumatoid arthritis (RA). The aim is to identify factors leading to disability in RA.

METHODS

This is a cross-sectional Egyptian multicenter study carried out on 215 RA patients attending to our inpatient and outpatient rheumatology clinics during 4 months starting from April to July 2017 who agreed to participate in the study; 170 patients were from Cairo University hospitals and 45 from Zagazig University hospitals. We recorded a number of possible risk factors including demographic, clinical, serological and therapeutic factors. The assessment of patients' disability was done using Modified HAQ (MHAQ).

RESULTS

A significant positive correlation was found between MHAQ and different markers of activity in addition to age and depression score (P<0.001). Illiteracy accounted for higher MHAQ scores (P=0.001). A higher MHAQ was found in patients with ischemic heart disease (P<0.05). Patients with erosions on X-rays had significantly higher MHAQ scores. Subluxations also accounted for higher MHAQ scores (P=0.000).

CONCLUSION

Aging, illiteracy, disease activity, erosions, subluxations, depression and ischemic heart disease were all related to higher disability. Good control of disease activity which in turn reduces erosions and subluxations is mandatory. Screening for depression and proper use of anti-depressants is of great value. Proper screening and prophylaxis is recommended against ischemic heart disease by controlling modifiable risk factors like obesity, dyslipidaemia, hypertension, smoking and sedentary lifestyle.

Role of school teachers in identifying attention deficit hyperactivity disorder among primary school children in Mansoura, Egypt

There is a knowledge gap in primary school teachers that affects their ability to detect attention deficit hyperactivity disorder (ADHD). This study measured primary school teachers' knowledge about ADHD, and implemented a training programme to improve early detection of ADHD. The prevalence and risk factors of ADHD were also studied. The training programme was implemented through a 2-day workshop for 39 primary school teachers who completed a validated Arabic version of the ADHD Rating Scale for 873 primary school children. The children's parents completed the questionnaire to explore ADHD risk factors. The teachers' pre-training knowledge scores of ADHD ranged from 17.9 to 46.2%. Post-training, their scores improved significantly to 69.2-94.9%. Prevalence rate of ADHD was 12.60%. On logistic regression, independent predictors of ADHD were female gender, unemployed fathers and rural residence. In conclusion, ADHD is a significant health problem among primary school children in Mansoura, Egypt. Efforts should be made to improve teachers' knowledge about ADHD and control modifiable risk factors.

Possible risk factors associated with greater damage in systemic lupus erythematosus patients: an Egyptian multicenter study

OBJECTIVES

Systemic lupus erythematosus (SLE) is a prototypic multisystem autoimmune disorder. The total damage in a patient with SLE may result from SLE itself or from any other pathologic process. The aim of this study was to assess risk factors of greater damage in a sample of Egyptian SLE patients.

METHODS

This Egyptian multicenter retrospective study included 100 SLE patients: 64 patients from Cairo University Hospitals and 36 patients from Zagazig University Hospitals. The Systemic Lupus International Collaborative Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (ACR-DI) was used to document the damage in each patient.

RESULTS

The total SLICC/ACR-DI score ranged from 0 to 8. A higher DI score was found in hypertensive patients, compared to normotensive patients; and among those with positive anti-phospholipid antibodies, compared to those with negative anti-phospholipid antibodies. This difference was statistically significant (p < 0.01). Also, a higher DI score was found in cyclophosphamide users, compared to non-users; and in those with proteinuria and seizures, compared to those without; and the difference was statistically significant (p < 0.05). There was a significant positive correlation between the DI and patient age (p < 0.05).

CONCLUSIONS

Damage in SLE cannot be prevented completely, as SLE disease is considered an aggressive disease treated by aggressive medications, but rheumatologists should try to minimize damage as much as possible to maintain the patients' health, functioning and general wellbeing.

Use of holmium laser for urethral strictures in pediatrics: A prospective study

INTRODUCTION

The management of urethral strictures is very challenging and requires the wide expertise of different treatment modalities ranging from endoscopic procedures to open surgical interventions.

OBJECTIVE

To assess the effectiveness and complications of retrograde endoscopic holmium: yttrium-aluminum-garnet laser (Ho: YAG) urethrotomy (HLU) for the treatment of pediatric urethral strictures.

PATIENTS AND METHODS

From January 2010 to January 2013, 29 male pediatric patients with a mean age of 5.9 years and primary urethral strictures 0.5-2 cm long were treated using HLU. The stricture length was <1 cm in 16 (55%) patients and >1 cm in 13 (45%). Fifteen (51.7%) patients had an anterior urethral stricture, while 14 (48.3%) had a posterior urethral stricture. No positive history was found in 14 (48.3%) patients for the stricture disease, while six (20.7%) had straddle trauma and nine (31%) had an iatrogenic stricture. All of the patients were pre-operatively investigated and at 3 and 6 months postoperation by uroflowmetry and voiding cystourethrography (VCUG). If there were suspicious voiding symptoms, selective uroflowmetry and VCUG were performed at 12 months postoperation.

RESULTS

The mean operation time was 31.7 min (20-45 min). Twenty-three (79.3%) and 18 (62.1%) patients showed normal urethra on VCUG with improvement of symptoms at 3 and 6 months, respectively. Thus, recurrence was 37.9% after 6 months of follow-up. The mean pre-operative peak urinary flow rate (Qmax) was 6.47 ml/s. The mean postoperative Qmax at 3 and 6 months was 17.17 ml/s and 15.35 ml/s, respectively. The success rate and flowmetry results did not show any statistical significance in relation to site, length and cause of the strictures. The other 11 patients who failed to improve underwent repeated HLU sessions: 4/11 (36.3%) achieved successful outcomes. Among the seven patients with failed HLU for the second time, a third session was conducted. However, only one patient (14.2%) was cured, while open repair was needed for the remaining six.

DISCUSSION

One study has previously been published on the management of pediatric urethral strictures using HLU. The present results are similar to short-term studies after a single session of visual internal urethrotomy using cold knife (VIU). In the present study, the length, location and cause of strictures did not significantly affect the results. However, the outcomes with strictures <1 cm were better than strictures >1 cm, although patients with strictures >2 cm were excluded. In the present study, the success rates among patients with second and third sessions of HLU were 36.3% and 14.2%, respectively. This was similar to other studies, which reported low success rate with the second session of VIU. The present study was limited by the relatively short period of follow-up and the small number of patients. However, it was the first prospective study evaluating HLU for pediatric strictures. The use of flowmetry and VCUG for evaluation of all patients added to the strength of the study.

CONCLUSION

HLU can be safely used with good success rates for the treatment of primary urethral strictures (<2 cm) in children. Repeat HLU (more than twice) adds little to success.

Serum Sclerostin Level Among Egyptian Rheumatoid Arthritis Patients: Relation to Disease Activity, Bone Mineral Density and Radiological Grading

<p>

INTRODUCTION

Bone loss in rheumatoid arthritis is caused by increased bone resorption without increasing bone formation. The Wnt pathway is important in the control of bone formation through the regulation of osteoblast activity. Sclerostin is an important regulator of the Wnt pathway by blocking Wnt binding to its receptor and thereby inhibiting bone formation.

AIM

This study aimed to assess the serum sclerostin level in a group of Egyptian rheumatoid arthritis patients and to correlate its level with bone mineral density, disease activity and radiological grading.

METHODS

Forty rheumatoid arthritis patients (mean age 48.9 ± 11.6 years, disease duration 8 ± 6.4 years) and 40 age and sex matched apparently healthy subjects were included. Serum sclerostin level was measured using Enzyme linked Immunosorbent Assay. Plain radiographs of hands and feet and dual-energy x-ray absorptiometry test were done for all patients.

RESULTS

No significant difference was found between rheumatoid arthritis patients and healthy controls as regard mean value of sclerostin level. Postmenopausal healthy women had higher levels of sclerostin than premenopausal healthy women only. Serum sclerostin had significantly positive correlations with the age of onset and weight of rheumatoid arthritis patients and negative correlation with Erythrocyte Sedimentation Rate. No correlation was encountered between sclerostin level and bone mineral density, disease activity or radiographic grading.

CONCLUSION

For better clarification of the role of sclerostin on bone mass in rheumatoid arthritis, larger sample size is needed. More studies on serum sclerostin levels among different grades of RA activity are encouraged.</p>.

Successful total replantation of a forearm after 11 hours of warm ischaemia

We present a case of a young female patient who underwent total replantation of an amputated forearm after 11 h of warm ischaemia. The immediate and long-term outcome of the procedure was totally satisfactory in terms of limb survival and satisfactory enough in terms of functionality. This outcome was due in part to the use of post-operative hyperbaric oxygen therapy, to minimize the effects of ischaemia-reperfusion injury. Considering that replantation of amputated limbs usually results in poor outcomes after 6 h of ischaemia, the present success represents a rare case.

Individual inorganic nanoparticles: preparation, functionalization and in vitro biomedical diagnostic applications

Inorganic nanoparticles have become the focus of modern materials science due to their potential technological importance, particularly in bionanotechnology, which stems from their unique physical properties including size-dependent optical, magnetic, electronic, and catalytic properties. The present article provides an overview on the currently used individual inorganic nanoparticles for in vitro biomedical domains. These inorganic nanoparticles include iron oxides, gold, silver, silica, quantum dots (QDs) and second harmonic generation (SHG) particles. For each of these interesting nanoparticles, the main issues starting from preparation up to bio-related applications are presented.

Gall bladder sludge and stones in multitransfused Egyptian thalassaemic patients

One hundred Egyptian beta-thalassaemic patients on a long-term transfusion/chelation programme were evaluated for the prevalence of gall bladder sludge and stones and the associated risk factors. Fifty healthy individuals served as controls. Abdominal ultrasonography revealed that 14% of the thalassaemic patients had gall bladder sludge or stones (6% stones and 8% sludge). The thalassaemic patients with this complication were older, had a higher prevalence of gall bladder symptoms, higher levels of pretransfusion haemoglobin, larger amounts of transfused red cells, and more were regularly transfused. Multiple logistic regression analysis revealed that the presence that gall bladder symptoms and the amount of transfused red cells were the only significant predictors of the occurrence of gall bladder sludge or stones.

The effect of topically applied vasoactive agents and testosterone versus testosterone in the treatment of erectile dysfunction in aged men with low sexual interest

The objective was to evaluate the efficacy and safety of topically applied cream containing testosterone, isosorbide dinitrate and co-dergocrine mesylate compared to testosterone cream in the treatment of erectile dysfunction in aged men with low sexual interest. A randomised double-blind crossover trial was performed over two months. The subjects were 42 men with erectile dysfunction and low normal or slightly depressed testosterone level randomly allocated to two equal groups. Polypharmacy cream containing testosterone 0.8%, isosorbide dinitrate 0.5% and co-dergocrine mesylate 0.06% was applied for one month, and testosterone 0.8% cream for another month. The serum level of total testosterone was measured before and after each phase of treatment. Response to each therapy was assessed by a sexual questionnaire, measurement of tumescence and repeat penile duplex ultrasonography. Twenty-eight patients reported full erection and satisfactory intercourse with the polypharmacy cream. Thirteen men reported full erection and satisfactory intercourse with either cream. Polypharmacy cream increased penile arterial flow (P<0.001) and induced tumescence in 34 patients in lab. No patient in either phase of the study has tumescence or a significant increase in cavernous arterial peak systolic velocities after the application of testosterone cream. Serum level of total testosterone increased in all patients (P<0.05). Sexual desire was improved in 85% and 62% of patients during the treatment with polypharmacy cream and testosterone cream, respectively. No marked side effects were reported after either of them. Topical treatment with cream containing testosterone and vasoactive agents may represent a new effective treatment for erectile dysfunction associating with aging.

Percutaneous management of renal calculi: experience with percutaneous nephrolithotomy in 60 children

PURPOSE

We report our experience with percutaneous nephrolithotomy in a pediatric population in which primary as well as recurrent stone episodes are frequent and the need for less invasive procedures is imperative.

MATERIALS AND METHODS

Percutaneous nephrolithotomy was performed in 60 children 3 to 13 years old (average age 6), including 44 boys (73.3%) and 16 girls (26.7%). There was a single obstructing renal calculus in 43 patients, while 17 had multiple calculi. The procedure was performed in 1 stage in 49 patients, and it was staged with preliminary nephrostomy in 11 who presented with calculous anuria and elevated serum creatinine. Normal saline was used as an irrigant and perioperatively serum electrolytes were measured to monitor fluid absorption in 18 patients. Stones were extracted intact from 40 patients (66.6%) and ultrasonic lithotripsy was performed in 20 (33.3%).

RESULTS

Of the 60 patients 50 (83.3%) were rendered stone-free at 1 session. Incomplete stone clearance at 1 session was due to intraoperative bleeding requiring blood transfusion, extravasation, multiple stones that were inaccessible via 1 tract, displacement of stone fragments into an inaccessible calix and insignificant residual fragments less than 3 mm. in 2 cases each. During followup of 3 months to 6 years (average 1 year) no late complications were noted.

CONCLUSIONS

Percutaneous nephrolithotomy is a safe and relatively efficacious mode of managing pediatric renal calculi. Although higher success rates are achieved in adults, caution should be exercised in children, in whom diligent attempts at stone clearance in 1 session may be made at the expense of safety.

Topical treatment of erectile dysfunction: randomised double blind placebo controlled trial of cream containing aminophylline, isosorbide dinitrate, and co-dergocrine mesylate

OBJECTIVE

To examine the effectiveness in treating impotence to topically applied cream containing three vasodilators--aminophylline, isosorbide dinitrate, and co-dergocrine mesylate--which act by different mechanisms.

DESIGN

Randomised double blinded placebo controlled crossover trial over two weeks.

SUBJECTS

36 men with erectile dysfunction randomly allocated to two equal groups.

INTERVENTIONS

Active cream containing aminophylline 3%, isosorbide dinitrate 0.25%, and co-dergocrine mesylate 0.05% for one week and placebo for another.

MAIN OUTCOME MEASURES

Patients' reported experience of penile responses and side effects of treatment in questionnaires. Penile tumescence and arterial flow in the laboratory.

RESULTS

21 patients reported full erection and satisfactory intercourse with the active cream. Three men reported full erection and satisfactory intercourse with either cream. The active cream was more effective in psychogenic than organic impotence (eight out of nine men with psychogenic impotence achieved a full erection upsilon four out of eight with neurogenic impotence and two out of seven with arterial insufficiency). No major side effects were reported. In the laboratory the active cream increased penile arterial flow (0.19 (SD 0.08) m/s upsilon 0.02 (0.15) m/s with placebo) and induced tumescence in 24 patients.

CONCLUSIONS

Topical treatment with a cream containing three different vasodilators might be considered before intracavernous injection of vasoactive agents, particularly in psychogenic impotence.

Neonatal screening for congenital hypothyroidism: Incidence, imaging, feasability, and difficulties of a nationwide program

A pilot project was carried out in Riyadh to study the incidence and pattern of congenital hypothyroidism (CH) among newborn delivered at the Ministry of Health (MOH) hospitals. Cord blood was assayed for thyroid stimulating hormone (TSH). For affected infants, Tc-99m pertechnetate thyroid scintigraphy and perchlorate discharge test (PDT) using I(123) were performed to determine the caused of congenital hypothyroidism. Fifteen affected newborns were diagnosed among 40,000 newborns screened giving an incidence of 1:2666. Tc-99m thyroid scan revealed athyreosis in five infants; the thyroid gland was ectopic in eight and thyroid in two infants. In eight infants thyroid tissue was visualized, PDT was performed and the test was positive in seven cases (two eutopic and five ectopic). We concluded that the incidence of CH was higher compared with other parts of the world. Thyroid scintigraphy has a primary role in the evaluation of infants with congenital hypothyroidism and should be part of the protocol for the screening program. As early initiation of thyroxine therapy will prevent neurological and physical handicaps of the disease, the decision was made to have a nationwide screening program established in Saudi Arabia. The organization and difficulties of the screening program are being discussed.

Iodide concentrations in Saudi waters: A cause for concern

Samples of tap water and drinking mineral water from different regions of Saudi Arabia were analyzed for iodide content. Low iodide concentrations were found in all samples. This finding may reflect an overall low iodide content in the soil and consequently also in locally grown food, which could predispose to endemic goiter. In the absence of data on the prevalence of endemic goiter, we recommend the routine use of iodized salt in Saudi Arabia.

Blood pressure and obesity in childhood and adolescence. Epidemiologic aspects

Blood pressure and body mass index (BMI) are first considered independently, and then jointly, on the basis of both cross-sectional and longitudinal epidemiologic studies. The relations between these two attributes are investigated further by analysis of the "velocity curves" of age increments, from ages 6 to 24, in both blood pressure (systolic and fifth-phase diastolic) and BMI, from data from the US Health and Nutrition Examination Survey, 1971-1974. The results of both reported studies and the present exploratory analysis indicate sometimes strong but quite variable relations between blood pressure and BMI, which differ by age, gender, and the particular blood pressure measure under consideration.

Detection of a ruptured aneurysmal sac by MRI in a case of negative angiogram. Successful clipping of an anterior communicating artery aneurysm. Case report

A case of a ruptured aneurysm is presented in which the angiograms did not disclose the sac. Rupture of an aneurysm of the anterior communicating artery was suspected from the distribution of subarachnoid blood on computerized tomography (CT), and the presence of a sac was highly suggestive on magnetic resonance imaging (MRI), which led us to open surgery. A non-thrombosed aneurysm was discovered at the suspected site, and successfully clipped. The necessity is discussed of MRI investigation in patients with subarachnoid haemorrhage (SAH) of unknown aetiology.

Renal disease in hepatosplenic schistosomiasis: a clinicopathological study

Thirty-nine cases of hepatosplenic schistosomiasis associated with renal disease are included. They were investigated for renal function, serum and urinary immunoglobulins, some serological tests, and bacteriological studies for evidence of associated salmonellosis. Renal biopsy was obtained from 23 subjects and studied by light microscopy. It was possible to distinguish two groups of cases "salmonella-negative" and "salmonella-positive". The former group was characterized by marked glomerular lesions, mainly membrano-proliferative, in different phases of evolution. Salmonella-positive cases were categorized into those with clinical, laboratory and histological evidence of interstitial nephropathy (six cases), that seems to result from salmonella pyelonephritis; and those with overt glomerular lesions (17 cases). The latter group differed from salmonella-negative cases in having mainly proliferative glomerular lesions with minimal or no basement membrane thickening; the lesions were diffuse and appeared in the same stage of evolution. The possible relation of schistosomiasis and associated salmonellosis to the pathogenesis of these lesions is discussed, suggesting an immunological basis for the glomerular injury and outlining the possible significance of hepatic fibrosis.