BackgroundEpidural injections are one of the most common nonsurgical interventions for managing chronic low back pain. They have been used to treat radicular pain from herniated discs, spinal stenosis, and axial spinal pain1. Pulsed electromagnetic field stimulation therapy (PEMFs) provides a noninvasive and safe method to treat the site of injury, the source of pain, inflammation by modulating factors involved in pain signalling and the inflammatory response2.Objectives· To assess the improvement in patients with chronic low back pain treated with epidural steroid injection or Pulsed electromagnetic field stimulation. · To compare the efficacy of epidural steroid injection and pulsed electromagnetic field stimulation in treatment of patients with chronic low back pain.MethodsIn this study; sixty patients with chronic discogenic low back pain (diagnosed clinically and by magnetic resonant imaging of lumbosacral region) with or without radicular pain of at least 6 months duration were selected. We excluded patients with other causes of back pain as spondylolithesis, inflammatory, infective, neoplastic, traumatic causes. Patients were randomly divided into two equal groups (30 patients each); after informed consent; group I treated by ultrasound guided caudal epidural injection of 40 mg methylprednisolone and 2 ml 2% lidocaine and 20 ml of 9% NaCl twice one week in between and group II received PEMFs daily for 4 weeks. And all patients will be instructed to follow an exercise program. All patients were assessed clinically, functionally by Oswestry Disability Index (ODI) and by measuring serum level of beta-endorphin by ELIZA before, at the end treatment and six months after the end of treatment.ResultsIn both groups; there was highly significant improvement in pain after treatment (P1 <0.0001) the mean value of the (VAS) was 8.13+0.63, 7.70+1.34 respectively before treatment and 3.33+2.63, 2.30+2.32 respectively after treatment. Still further significant improvement at the end follow up (P1 <0.0001) in group I. There was highly significant improvement (p<0.0001) of functional status in both groups after treatment and at follow up period as compared to before treatment but there was significant decrease of functional status at follow up period as compared to after treatment in group II. There was significant improvement of serum level of beta endorphin (p>0.05) In both groups after treatment and follow up period as compared to before treatment but there was insignificant difference at follow up period as compared to after treatment.. Our result showed insignificant difference between two groups in clinical, functional or laboratory parameters.Figure 1Comparison regarding low back pain as measured by VAS before, after treatment and at 6 months follow upFigure 2Comparison regarding serum beta endorphin before, after treatment and at 6 months follow upConclusionsEpidural corticosteroid injection and Pulsed electromagnetic field stimulation are effective tools in management of chronic low back painReferences[1] Abdi S, D...

Objective: To evaluate the efficacy of anti-CCP3 as a diagnostic marker in Egyptian early rheumatoid arthritis patients. Subjects and Methods: A total  of 60 rheumatoid arthritis patients and 30 aged and sex matched volunteers participated in the study. Basic demographic, functional and clinical data were collected alongside laboratory assessment of Anti-cyclic citrullinated peptide 3 (Anti-CCP3) by ELISA. Results: Anti-CCP3 level was significantly higher in RA patients compared to controls (p 0.001)  .At cut off value 20.65 (U/mL) and AUC 0.950, Anti-CCP 3 could significantly distinguish between  RA patients and controls (p 0.001) .The sensitivity and specificity were 83.33%, and 93.33% respectively. Also, Anti-CCP 3 levels significantly correlated with the number of swollen and tender joints (P 0.05), VAS (P 0.05), DAS-28 (P 0.05), m HAQ (P 0.001), bone erosions (P 0.001), and narrow joint space (P 0.001). Conclusion: Anti-CCP3 is a potent diagnostic as well as prognostic laboratory marker and its positivity resulted in more specific identification of RA patients. Moreover, anti-CCP3 is considered the most acceptable choice for diagnosing early rheumatoid arthritis especially sero-negative type, with 83.33% sensitivity and 93.33% specificity.

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BackgroundPlatelet rich plasma (PRP) therapy is a simple, low-cost and minimally invasive method that provides a natural concentrate of autologous blood growth factors (GFs) that can be used to enhance tissue regeneration (1). Recent evidences have shown that PRP can be helpful as an osteoarthritis (OA) therapeutic tool by intra-articular injection (2). Hyaluronic acid (HA)is widely used therapy for relief of OA pain and stiffness by intraarticular injection. In addition, there is a sufficient evidence for being significant disease-modifying effects (3,4).Objectivesour aim was to compare the clinical efficacy of platelet-rich plasma with that of hyaluronic acid viscosupplementation.MethodsThis study included forty patients with knee osteoarthritis. These patients were selected from the outpatient clinic of Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University. Patients were randomly divided into two groups. The first group consisted of 20 patients treated by using intraarticular injection of 2 ml autologous PRP (PRP group).The second group consisted of 20 patients they were treated by using intraarticular injections of low molecular weight (hyaluronic acid [HA]) (32mg/2mL) of HA (HA group). All patients received 3 injections with one week interval (3) For Follow up: The subjective clinical outcome were measured at baseline, 1, 3, 6 and 12 months after the last treatment dose using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the 11-point pain intensity Numeric Rating Scale (NRS) (5).ResultsAt 1,3 months' follow-up, the PRP and LW HA groups showed an improvement, with non-significant difference between the two groups. However after 6 months follow up there was significant improvement in PRP group than HA group (P<0.005). The follow up after 12 months reveled subsided improvement than that was at 6 months. Nevertheless, this subsidence was less in PRP group.ConclusionsAutologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function. Further studies are needed to confirm these results and to investigate the persistence of the beneficial effects observed.ReferencesWasterlain A, Braun HJ and Dragoo JL (2012): Contents and Formulations of Platelet-Rich Plasma. Oper Tech Orthop. 22(1): 33–42.Arnoczky S, Delos D and Rodeo S (2011): What Is Platelet-Rich Plasma? Oper Tech Sports Med. 19(3): 142–8.Cerza F, Carnì S, Carcangiu A, et al (2012): Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis. Am J Sports Med. 40(12): 2822–7.Filardo G, Kon E, Di Martino A, et al (2012): Platelet-rich plasma versus hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord 2012; 13(1): 229.Altman R, and Bloch (1986): Criteria for the classification and reporting of osteoarthritis of the knee joint. Diagnostic and Therapeutic Cri...

Aims: To quantify the contribution of ultrasonography (US) as a complementary tool to electrodiagnostic evaluation of traumatic lesions of median and ulnar nerves after surgical repair"  Patients and Methods: The study included a total of 50 nerves from 40 patients with traumatic injury of wrist median and/ or ulnar nerves. Patients were evaluated at one and three months after primary nerve repair clinically, electrophysiological, and US examinations. Results: No significant difference (p = 0.125) was found between classification of injury by electrodiagnosis and by US. Good agreement between clinical assessment of the motor power and the severity of injury based on electrodiagnosis was found. Moderate agreement between clinical assessment of motor power and continuity of the repaired nerve based on US was noted. Good agreement between the severity of the injury by electrodiagnosis and the continuity of the repaired nerve by the US (p <0.001*) was detected. The sensitivity of US in detecting nerve continuity was 87.9% one month after repair and 80% after three months. Conclusion: As a supplement to electrodiagnostic testing, the US can offer a noninvasive and complementary tool for assessing post-operative repair of traumatic nerve lesions with respect to their exact location, course, continuity, extent, and neuroma formation and can be of value in the visualization of the morphological abnormalities associated with nerve injuries, including swelling and perilesional scar tissue formation.