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

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

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%]