Background: The management of spasticity remains a major challenge in rehabilitation medicine. Many studies have demonstrated the efficacy of local injections of botulinum toxin A (BTX-A) into the upper limb for reducing spasticity. Lidocaine has been used as a nerve block for the treatment of spasticity of the upper limb. Objectives: to evaluate the outcome and to compare the efficacy of rehabilitation program after botulinum toxin type-A injection versus serial lidocaine injections. Patients and methods: 50 patients suffering from spasticity of the upper limb after stroke attending the Rehabilitation Clinic were enrolled in the study. Assessment of spasticity, upper limb function, self care ability and pain were done by using the Modified Ashworth Scale (MAS), Medical research council scale (MRCS), the Barthel-Index and Visual Analogue Scale (VAS) respectively. Electrophysiological assessment was done by conventional nerve conduction studies; H-Reflex and Hmax/Mmax ratio and F-wave and F/M ratio. The patients were divided into two equal groups. The first group submitted to botulinum toxin type-A intramuscular injection and the second group submitted to 10 serial lidocaine intramuscular motor point block. Both groups were subjected to the same rehabilitation program after injection and had been worn the suitable orthotic. Evaluation of all patients had been done before treatment and at one and four month after treatment. Results: the spasticity in both studied groups was alleviated and the patients experienced relief of pain, increase muscle power and decrease disability. These acquired benefits continued through the fellow up period. No much difference found between efficacies of the two treatment modalities used in this study. Conclusion: Lidocaine might be considered as an effective and costless in the symptomatic treatment of the post stroke upper limb spasticity. The study suggests that this effect can be maintained with repeated serial and booster dose injections and intensive regular rehabilitation program.

Patients with systemic lupus erythematosus (SLE) have increased risk of atherosclerosis and cardiovascular disease (CVD) that cannot be explained by traditional risk factors. Several studies indicate that mannose-binding lectin (MBL) may modify the development of atherosclerosis. The study was designed to investigate association of MBL gene polymorphism with occurrence of preclinical atherosclerosis in systemic lupus erythematosus patients. The study was carried out on 46 patients with SLE and 17 age and sex matched healthy volunteers as control group. MBL2 genotypes were assessed in patients and controls by polymerase chain reaction restriction fragment length polymorphism methods and intima-media thickness of the common carotid artery (ccIMT) was determined by means of ultrasonography. In addition, lipogram profile, ESR, CRP, anti-ds DNA antibodies and C3, C4 were measured and disease activity index (SLEDAI) was estimated. Frequency of A/B + B/B genotypes of MBL was significantly higher in SLE patients (47.8%) compared to controls (29.4%). ccIMT was significantly increased in patients having A/B, B/B, A/B+B/B genotypes when compared with wild genotype (A/A). Patients with A/B+B/B genotypes showed significant increase in serum LDL, TG, ESRI, CRP and SLEDAI score, and significant decrease in HDL, C3, and C4 compared to wild genotype. ccIMT of mutant SLE subgroup was significantly correlated with SLE related risk factors for atherosclerosis. In conclusion: The mutant genotypes of MBL may be atherogenic and their SLE patients had a higher IMT which correlated significantly with SLE related risk factors for atherosclerosis. Further studies should focus on the mechanisms by which MBL and MBL genotypes affect atherosclerosis development.

Patients with systemic lupus erythematosus (SLE) have increased risk of atherosclerosis and cardiovascular disease (CVD) that cannot be explained by traditional risk factors. Several studies indicate that mannose-binding lectin (MBL) may modify the development of atherosclerosis. The study was designed to investigate association of MBL gene polymorphism with occurrence of preclinical atherosclerosis in systemic lupus erythematosus patients. The study was carried out on 46 patients with SLE and 17 age and sex matched healthy volunteers as control group. MBL2 genotypes were assessed in patients and controls by polymerase chain reaction restriction fragment length polymorphism methods and intima-media thickness of the common carotid artery (ccIMT) was determined by means of ultrasonography. In addition, lipogram profile, ESR, CRP, anti-ds DNA antibodies and C3, C4 were measured and disease activity index (SLEDAI) was estimated. Frequency of A/B + B/B genotypes of MBL was significantly higher in SLE patients (47.8%) compared to controls (29.4%). ccIMT was significantly increased in patients having A/B, B/B, A/B+B/B genotypes when compared with wild genotype (A/A). Patients with A/B+B/B genotypes showed significant increase in serum LDL, TG, ESRI, CRP and SLEDAI score, and significant decrease in HDL, C3, and C4 compared to wild genotype. ccIMT of mutant SLE subgroup was significantly correlated with SLE related risk factors for atherosclerosis. In conclusion: The mutant genotypes of MBL may be atherogenic and their SLE patients had a higher IMT which correlated significantly with SLE related risk factors for atherosclerosis. Further studies should focus on the mechanisms by which MBL and MBL genotypes affect atherosclerosis development.

Patients with systemic lupus erythematosus (SLE) have increased risk of atherosclerosis and cardiovascular disease (CVD) that cannot be explained by traditional risk factors. Several studies indicate that mannose-binding lectin (MBL) may modify the development of atherosclerosis. The study was designed to investigate association of MBL gene polymorphism with occurrence of preclinical atherosclerosis in systemic lupus erythematosus patients. The study was carried out on 46 patients with SLE and 17 age and sex matched healthy volunteers as control group. MBL2 genotypes were assessed in patients and controls by polymerase chain reaction restriction fragment length polymorphism methods and intima-media thickness of the common carotid artery (ccIMT) was determined by means of ultrasonography. In addition, lipogram profile, ESR, CRP, anti-ds DNA antibodies and C3, C4 were measured and disease activity index (SLEDAI) was estimated. Frequency of A/B + B/B genotypes of MBL was significantly higher in SLE patients (47.8%) compared to controls (29.4%). ccIMT was significantly increased in patients having A/B, B/B, A/B+B/B genotypes when compared with wild genotype (A/A). Patients with A/B+B/B genotypes showed significant increase in serum LDL, TG, ESRI, CRP and SLEDAI score, and significant decrease in HDL, C3, and C4 compared to wild genotype. ccIMT of mutant SLE subgroup was significantly correlated with SLE related risk factors for atherosclerosis. In conclusion: The mutant genotypes of MBL may be atherogenic and their SLE patients had a higher IMT which correlated significantly with SLE related risk factors for atherosclerosis. Further studies should focus on the mechanisms by which MBL and MBL genotypes affect atherosclerosis development.

Patients with systemic lupus erythematosus (SLE) have increased risk of atherosclerosis and cardiovascular disease (CVD) that cannot be explained by traditional risk factors. Several studies indicate that mannose-binding lectin (MBL) may modify the development of atherosclerosis. The study was designed to investigate association of MBL gene polymorphism with occurrence of preclinical atherosclerosis in systemic lupus erythematosus patients. The study was carried out on 46 patients with SLE and 17 age and sex matched healthy volunteers as control group. MBL2 genotypes were assessed in patients and controls by polymerase chain reaction restriction fragment length polymorphism methods and intima-media thickness of the common carotid artery (ccIMT) was determined by means of ultrasonography. In addition, lipogram profile, ESR, CRP, anti-ds DNA antibodies and C3, C4 were measured and disease activity index (SLEDAI) was estimated. Frequency of A/B + B/B genotypes of MBL was significantly higher in SLE patients (47.8%) compared to controls (29.4%). ccIMT was significantly increased in patients having A/B, B/B, A/B+B/B genotypes when compared with wild genotype (A/A). Patients with A/B+B/B genotypes showed significant increase in serum LDL, TG, ESRI, CRP and SLEDAI score, and significant decrease in HDL, C3, and C4 compared to wild genotype. ccIMT of mutant SLE subgroup was significantly correlated with SLE related risk factors for atherosclerosis. In conclusion: The mutant genotypes of MBL may be atherogenic and their SLE patients had a higher IMT which correlated significantly with SLE related risk factors for atherosclerosis. Further studies should focus on the mechanisms by which MBL and MBL genotypes affect atherosclerosis development.

OBJECTIVE: To evaluate the therapeutic effects of peripheral repetitive magnetic stimulation (rMS) on recovery of traumatic brachial plexopathy. MATERIAL AND METHODS: Thirty four patients who presented with traumatic brachial plexopathy were studied. Strength of different muscles of upper limbs was evaluated neurologically. Assessment of nerve conduction study (NCS) and F wave of upper limbs visual analogue scale (VAS) for each pain. They were assigned randomly into two groups with a ratio of 2:1; each patient received conventional physiotherapy modalities and active exercises as well as real rMS or sham rMS applied over the superior trapezius muscle of the affected limb daily for 10 sessions. They were reassessed after the 5th, 10th session and then 1 month after rMS treatment using the same parameters. RESULTS: No significant differences between groups were recorded at base line assessment. Significant improvement was observed (time X groups) after real rMS in comparison to the sham group (p = 0.0001 for muscle strength and 0.01 for VAS). These improvements were still present at 1 month after the end of treatment. In accordance with the clinical improvement, a significant improvement was recorded in the neurophysiological parameters in the real versus the sham group. CONCLUSIONS: The results show that peripheral rMS for 10 sessions may have positive therapeutic effects on motor recovery and pain relief in patients with traumatic brachial plexopathy, and is a useful adjuvant in the therapy of these patients.

OBJECTIVE: To evaluate the therapeutic effects of peripheral repetitive magnetic stimulation (rMS) on recovery of traumatic brachial plexopathy. MATERIAL AND METHODS: Thirty four patients who presented with traumatic brachial plexopathy were studied. Strength of different muscles of upper limbs was evaluated neurologically. Assessment of nerve conduction study (NCS) and F wave of upper limbs visual analogue scale (VAS) for each pain. They were assigned randomly into two groups with a ratio of 2:1; each patient received conventional physiotherapy modalities and active exercises as well as real rMS or sham rMS applied over the superior trapezius muscle of the affected limb daily for 10 sessions. They were reassessed after the 5th, 10th session and then 1 month after rMS treatment using the same parameters. RESULTS: No significant differences between groups were recorded at base line assessment. Significant improvement was observed (time X groups) after real rMS in comparison to the sham group (p = 0.0001 for muscle strength and 0.01 for VAS). These improvements were still present at 1 month after the end of treatment. In accordance with the clinical improvement, a significant improvement was recorded in the neurophysiological parameters in the real versus the sham group. CONCLUSIONS: The results show that peripheral rMS for 10 sessions may have positive therapeutic effects on motor recovery and pain relief in patients with traumatic brachial plexopathy, and is a useful adjuvant in the therapy of these patients.

OBJECTIVE: To evaluate the therapeutic effects of peripheral repetitive magnetic stimulation (rMS) on recovery of traumatic brachial plexopathy. MATERIAL AND METHODS: Thirty four patients who presented with traumatic brachial plexopathy were studied. Strength of different muscles of upper limbs was evaluated neurologically. Assessment of nerve conduction study (NCS) and F wave of upper limbs visual analogue scale (VAS) for each pain. They were assigned randomly into two groups with a ratio of 2:1; each patient received conventional physiotherapy modalities and active exercises as well as real rMS or sham rMS applied over the superior trapezius muscle of the affected limb daily for 10 sessions. They were reassessed after the 5th, 10th session and then 1 month after rMS treatment using the same parameters. RESULTS: No significant differences between groups were recorded at base line assessment. Significant improvement was observed (time X groups) after real rMS in comparison to the sham group (p = 0.0001 for muscle strength and 0.01 for VAS). These improvements were still present at 1 month after the end of treatment. In accordance with the clinical improvement, a significant improvement was recorded in the neurophysiological parameters in the real versus the sham group. CONCLUSIONS: The results show that peripheral rMS for 10 sessions may have positive therapeutic effects on motor recovery and pain relief in patients with traumatic brachial plexopathy, and is a useful adjuvant in the therapy of these patients.

OBJECTIVE: To evaluate the therapeutic effects of peripheral repetitive magnetic stimulation (rMS) on recovery of traumatic brachial plexopathy. MATERIAL AND METHODS: Thirty four patients who presented with traumatic brachial plexopathy were studied. Strength of different muscles of upper limbs was evaluated neurologically. Assessment of nerve conduction study (NCS) and F wave of upper limbs visual analogue scale (VAS) for each pain. They were assigned randomly into two groups with a ratio of 2:1; each patient received conventional physiotherapy modalities and active exercises as well as real rMS or sham rMS applied over the superior trapezius muscle of the affected limb daily for 10 sessions. They were reassessed after the 5th, 10th session and then 1 month after rMS treatment using the same parameters. RESULTS: No significant differences between groups were recorded at base line assessment. Significant improvement was observed (time X groups) after real rMS in comparison to the sham group (p = 0.0001 for muscle strength and 0.01 for VAS). These improvements were still present at 1 month after the end of treatment. In accordance with the clinical improvement, a significant improvement was recorded in the neurophysiological parameters in the real versus the sham group. CONCLUSIONS: The results show that peripheral rMS for 10 sessions may have positive therapeutic effects on motor recovery and pain relief in patients with traumatic brachial plexopathy, and is a useful adjuvant in the therapy of these patients.

Because of the similarity between the diagnostic criteria for acute rheumatic fever (ARF) and post-streptococcal reactive arthritis (PSRA), therefore 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. Fifty patients with arthritis secondary to infection with Group A ß-haemolytic streptococcus (GAβS) attended Outpatient Rheumatology Clinics of Rheumatology and Rehabilitation and Internal Medicine Departments; Assuit University Hospitals, in addition to 20 healthy volunteers as controls were included in this study. All patients were submitted to complete medical history and clinical examination. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Rheumatoid factor (RF), Antinuclear antibody (ANA), throat swab, Anti-streptolycin-O titre (ASOT), Electrocardiography (ECG) and Echocardiography have been done to all patients. Plain radiography, ultrasonography (US) and Magnetic Resonance Imaging (MRI) to both knees and ankles were done to all patients. ASOT was positive with a range (200-800) IU. Culture of throat swab was positive for GAßS in 72%, staphylococci in 24% and pneumococci in 16% of the patients. All patients had non migratory arthritis of lower limbs. Knees and ankles synovitis with minimal effusion was detected in 36% of the patients by US, and 32% and 40% by MRI respectively. Synovitis with marked effusion of knees and ankles was detected in 36% and 44% of patients respectively by US and 40% by MRI. In conclusion, PSRA 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.