Body mass index and vitamin D level in carpal tunnel syndrome patients

Abstract Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. The aim of this study is to evaluate the body mass index (BMI) and vitamin D levels in CTS patients. Methods The current study was conducted at Zagazig University Hospitals. It included 50 CTS patients and 50 controls. Clinical assessment was carried out to exclude symptoms and signs of neuropathy. Laboratory investigations including vitamin D levels, glycosylated hemoglobin, liver, and kidney function were carried out for every participant. All patients underwent electrodiagnostic study and completed Boston questionnaire to assess their pain sum score, symptom severity (SSS), and functional status (FSS). Results Patients had significantly higher BMI and lower vitamin D levels compared to controls (p = 0.003 and p = 0.001, respectively). Those with severe CTS had a significantly higher BMI and lower vitamin D levels than the others (p = 0.03 and p = 0.01 respectively). No significant difference was found between CTS subgroups regarding the SSS, while a higher significant FSS and pain sum score were reported in the severe CTS patients compared to the other two groups (p = 0.01 and p = 0.04 respectively). A significant negative correlation was detected between vitamin D levels and both of BMI, and Boston pain sum scores (p = 0.01 and p = 0.03 respectively). Also, an inverse correlation was detected between vitamin D levels and both of SSS and FSS (p = 0.14, p = 0.06). Furthermore, a significant positive and negative correlation between vitamin D levels and both of conduction velocity and distal motor latency respectively was observed (p = 0.02 and p = 0.01 respectively). Conclusions Carpal tunnel syndrome was significantly associated with hypovitaminosis D especially in patients with higher BMI. This highlights the importance of vitamin D supplements and weight loss regimes to minimize the severity of their pain

Role of superficial peroneal sensory potential and high-resolution ultrasonography in confirmation of common peroneal mononeuropathy at the fibular neck

Abstract Background Common peroneal mononeuropathy at the fibular neck (CPN) is one of the most frequent neuropathies of the lower extremities. Nerve conduction studies (NCS) have been used to confirm the diagnosis of CPN and localize common peroneal nerve abnormalities. High-resolution ultrasonography (HRUS) can aid in assessing the size of the common peroneal nerve. Aim Was to evaluate the superficial peroneal sensory potential (SPSP) and HRUS role in the confirmation of CPN. Methods This study was conducted on 70 patients presented with clinical and motor electrophysiological evidence of common peroneal neuropathy at the fibular neck and 70 controls. Clinical assessment, electrophysiological evaluations, and HRUS at the fibular neck were done. Results All the patients were electrophysiologically proven to have common peroneal motor neuropathy at the fibular neck, and seven of them showed abnormalities in nerve conduction studies only. The patients showed smaller common peroneal nerve motor and sensory responses and much larger cross-sectional area (CSA) of the common peroneal nerve at the fibular neck when compared with the controls. NCS and EMG positive findings are the most significant factor related to the increased HRUS CSA. Affected SPSP is significantly detected in patients with axonal affection. CSA of common peroneal nerve at the fibular neck showed a significant positive correlation with body mass index, motor, and sensory latencies. Also, it showed a significant negative correlation with motor and sensory amplitudes. HRUS CSA localized the lesion at the fibular neck with sensitivity and specificity 83% and 53% respectively. CSA plus SPSP affection sensitivity and specificity in confirming CPN were 91.9% and 89%. Conclusion HRUS CSA plus affected SPSP improve the diagnosis of CPN compared to standard electrophysiological criteria. Recommendation Further studies on a wider scale for detection of their role in the prediction of prognosis in CPN. Trial registration ClinicalTrials.gov NCT03753178 (26-11-2018

Mean platelet volume to platelet count ratio as a laboratory indicator of mortality in pneumonia following ischemic stroke

Abstract Background Platelets have a vital role in antimicrobial host defenses. The objective of this study was to evaluate if increased mean platelet volume to platelet count (MPV/PC) ratio in acute ischemic stroke patients complicated with pneumonia was associated with increased mortality risk. Methods The current study was conducted at Zagazig University Hospitals. It included 500 acute ischemic stroke patients classified as group 1 that included 51 patients complicated with pneumonia after admission and group 2 that included the remaining 449 patients. Clinical assessment was carried out to exclude comorbid medical illnesses likely to interfere with platelet function or morphology. Laboratory investigations including MPV/PC ratio and brain imaging were carried out for all patients. Results There was a significant difference between both groups regarding age, National Institutes of Health Stroke Scale (NIHSS) score, and mortality within 30 days (p = 0.02, 0.03, 0.01). There was a significant difference between survivors and non-survivors of group 1 regarding to pneumonia severity index (PSI) classes IV and V (p = 0.01 and 0.02, respectively). Also, there was a significant difference regarding confusion, urea ≥ 7 mmol/L, respiratory rater ≥ 30 breaths/min, systolic blood pressure ≤ 90 mmHg or diastolic blood pressure ≤ 60 mmHg, and age ≥ 65 years at pneumonia occurrence (CURB-65) scores 3, 4, and 5 (p = 0.03, 0.02, and 0.01, respectively). Moreover, there was a significant difference regarding decreased GCS score at pneumonia occurrence, higher NIHSS scores, PSI, and higher MPV/PC ratio (p = 0.01, 0.01, 0.028, and 0.01, respectively). Age > 65 years, need for mechanical ventilation, GCS score of > 9, PSI class ≥ IV, CURB-65 scores ≥ 3, and increased MPV/PC ratio were all significantly associated with 30-day mortality in group 1 (p = 0.03, 0.01, 0.001, 0.04, 0.01, and 0.03, respectively). The predictors of 30-day mortality risk factors were GCS less than 9, increased MPV/PC ratio, and CURB-65 scores ≥ 3 (p = 0.001, 0.05, and 0.01, respectively). Conclusions Once pneumonia develops, MPV/PC ratio could be considered a significant laboratory indicator of 30-day mortality

Risk factors of persistent synovitis development in early undifferentiated arthritis patients

Background Persistent synovitis (PS) may lead to erosive joint damage and result in functional disability. Objectives The aim of the study was to identify the risk factors for development of PS in early undifferentiated arthritis patients (EUA) attending Al Sharqia Governorate Hospitals, Egypt. Patients and methods A total of 80 EUA patients comprised the patients group. Assessment was performed twice (baseline and after 1 year) using clinical, laboratory, functional, and radiological [high resolution ultrasonography (HRUS) and power Doppler (PD)] assessments. Results Among 80 patients assessed, 20 (25%) showed evidence of self-limiting arthritis and 60 (75%) had PS (PS):16 (27%) developed rheumatoid arthritis, 14 (23%) progressed to spondyloarthropathy, and 30 (50%) remained undifferentiated (UA). Baseline tender and swollen Joint Counts (TJC and SJC) and anti-CCP2 titer were significantly evident in PS patients. Baseline HRUS total score of synovitis and PD total score were significantly higher in PS patients. Family history of any specific rheumatic disease, SJC, anti-CCP2 titer, HRUS total synovitis score, and PD total score were the significant risk factors of PS development. The most significant risk factor of PS (logistic regression analysis) was the baseline PD total score. Conclusion Baseline PD total score is the most significant risk factor for development of PS in EUA patients. Recommendation PD examination of all patients presenting with EUA should be performed

STAT4 gene polymorphism in two major autoimmune diseases (multiple sclerosis and juvenile onset systemic lupus erythematosus) and its relation to disease severity

Abstract Background Multiple sclerosis (MS) and systemic lupus erythematosus (SLE) are chronic autoimmune mediated diseases with strong genetic and environmental components. The aim of this study is to evaluate the association of STAT4 gene polymorphism with multiple sclerosis (MS) and juvenile onset systemic lupus erythematosus (JO-SLE) and its relation to disease severity. Methods Group 1 consisted of 40 MS patients while group 2 included 40 JO-SLE patients. Forty healthy volunteers (controls) were included in this study. STAT4 genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results The STAT4 CC genotype and GC genotype frequencies were significantly more detected in MS and JO-SLE patients than in controls. The frequency of the STAT4 C allele was significantly higher in patients with MS and those with JSLE compared to controls. Malar rash, photosensitivity, and hair falling were significantly more detected in CC subtype. Malar rash, photosensitivity, and hair falling were significantly more detected in CC subtype. Increased 24-h protein in urine (mg/24 h) and ANA positivity, anti-ds-DNA, anti Sm antibodies’ detection and decreased C3 and C4 levels showed a significantly difference in CC patients. Meanwhile, only increased 24-h protein in urine (mg/24 h) and ANA positivity were significantly more detected in GC patients. STAT4 CC genotype showed a significant increase in the SLE activity index (SLEAI) score and damage index as compared to the STAT4 GG genotype patients. No significant difference was detected in MS Kurtzke’s Expanded Disability Status Scale (EDSS) comparing different STATE 4 genotypes. Conclusions STAT4 polymorphism was significantly associated with MS and JO-SLE. Though homozygous JO-SLE patients are more risky for severe disease manifestations, homozygous MS patients are not risky for severe disease disability

Anti-Saccharomyces cerevisiae antibodies and its relationship with radiological damage in ankylosing spondylitis

Aim The presence of anti-Saccharomyces cerevisiae antibodies (ASCA) is controversial in ankylosing spondylitis (AS). In this study, we aimed to investigate the prevalence of ASCA in AS and its relationship with disease activity and radiological damage in patients attending Sharkia governorate hospitals. Patients and methods Thirty AS patients and 30 apparently healthy volunteers were included in the present study. All patients were questioned for Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis metrology Index and Bath Ankylosing Functional Index (BASFI). Total Bath Ankylosing Spondylitis Radiology Index (BASRI-T) and ASCA levels were measured. Results ASCA IgA level was significantly higher in AS patients than in healthy controls (P < 0.001). The ASCA-positive group, although not significant, tended to have higher BASFI scores. ASCA IgA-positive patients had higher BASRI-T levels (P = 0.037). In AS patients, significant positive correlation was found between ASCA IgA level and BASRI-T and BASFI (r = 0.19 and 0.31, respectively, P < 0.05). Bath Ankylosing Spondylitis Disease Activity Index scores, BASFI and ASCA IgA positivity were significantly associated with increased BASRI-T (P= 0.01, 0.03 and 0.04, respectively). The most significant risk factor for increased BASRI-T is ASCA IgA positivity (P < 0.001). Conclusion ASCA IgA was detected more frequently in AS patients than in healthy controls. ASCA IgA could be considered a marker of severe radiological damage. Further studies are recommended to investigate ASCA level versus radiological damage and intestinal involvement in AS patients

Anti-C1q and anti-dsDNA antibodies in systemic lupus erythematosus: Relationship with disease activity and renal involvement in Sharkia governorate, Egypt

AbstractIntroductionRenal involvement is one of the main determinants of poor prognosis of systemic lupus erythematosus (SLE). Kidney biopsy is an invasive procedure and accompanied by potential risks. Thus defining a reliable biomarker of kidney involvement in SLE is highly desirable.Aim of the workTo assess the role of anti-C1q Ab in combination with anti-dsDNA Ab in detection of SLE disease activity and renal involvement (lupus nephritis).Patients and methodsAnti-C1q Ab and anti-dsDNA antibodies were determined in 60 randomly selected adult SLE patients one of them refused the biopsy and those who completed the study were 59. The control group included 25 age and sex matched volunteers. According to lupus nephritis (LN) and SLEDAI score, patients were divided into four groups: group 1, 11 patients had active disease with LN; group 2, 20 patients had inactive disease with LN; Group3, six patients had active disease without LN; group 4, 22 patients had inactive disease without LN.ResultsA significant association of active lupus nephritis detection and the presence of either one or both of the studied antibodies (anti-C1q Ab or anti-dsDNA). None of the patients of group 1 had anti-C1q Ab only, and none was negative for anti-C1q Ab and anti-dsDNA Ab together. Levels of anti-C1q Ab and anti-dsDNA Ab were significantly higher in more active LN than less active LN. Anti-dsDNA and anti-C1q antibodies sensitivity and specificity for detection of more active LN was 85.0% and 64.0% and 70.0% and 55.0%, respectively, and 75.0% and 91.0% for both. Both antibodies had a positive correlation with SLEDAI score and proteinuria and a negative correlation with C3 reduction. A high significant positive correlation was detected between anti-C1q Ab and anti-dsDNA Ab.ConclusionAnti-C1q Ab, in combination with anti-dsDNA Ab may serve as potential reliable and none invasive markers of SLE disease activity and renal involvement to avoid unnecessary renal biopsies