Ayman El-Garf

MEFV mutations in Egyptian patients suffering from familial Mediterranean fever: analysis of 12 gene mutations

The objective of the study is to screen 12 MEFV gene mutations in Egyptian patients with familial Mediterranean fever (FMF) and to study the initial hypothesis that the phenotypic expression of the disease may be attributable to the existence of a particular mutation. We enrolled 136 Egyptian patients (74 males, and 62 females) with a clinical diagnosis of FMF. DNA was amplified by PCR and subjected to reverse hybridization for the detection of 12 MEFV gene mutations. The phenotypic expression of the disease was compared in two subgroups according to the presence of homozygote E148Q and M694V gene mutations. The most frequent gene mutations in the studied group were V726A, M694V, M680I, E148Q and M694I in 41.2, 32.4, 29.4, 25 and 20.6%, respectively. At least one of these main five founder mutations was present in 132 patients (97.1%). Thirty-two patients (23.5%) were homozygote for one of the main five founder mutations. The most common homozygote gene mutations were E148Q and M694V, each in 12 patients (8.8%). Significant increase in abdominal pain and arthritis was found in patients with homozygote M694V mutation compared to those with E148Q mutation. All patients with amyloidosis had M694V gene mutation. The increased frequency of V726A gene mutation and the rarity of amyloidosis in this study suggest that Egyptian patients may have a milder form of FMF compared to other populations. The five main founder mutations account for the vast majority of cases of FMF. M694V gene mutation may be associated with increased frequency of abdominal pain, arthritis and the presence of amyloidosis.

Double-blind Study Comparing the Use of Voltaren Emulgel® versus Regular Gel during Ultrasonic Sessions in the Treatment of Localized Traumatic and Rheumatic Painful Conditions

A total of 120 patients with moderate to severe pain due to localized rheumatic or traumatic conditions participated in a double-blind, randomized trial. Patients were randomly allocated to receive ultrasonic sessions three times weekly for 4 weeks, using either diclofenac in a gel base (Voltaren Emulgel®) or regular gel as a coupling medium. A statistically significant (P < 0.01) improvement was achieved in both treatment groups in most of the evaluation criteria by the end of the first week. Treatment was prematurely discontinued due to complete cure in 60% of patients using Voltaren Emulgel® compared with only 15% of those using regular gel (P < 0.01). Physicians assessment of complete relief of pain was also statistically significant (P < 0.01) in favour of Voltaren Emulgel® throughout the trial period and the physicians overall assessment of therapeutic efficacy revealed that a satisfactory result was achieved in 86% of Voltaren Emulgel®-treated patients compared with 76% of patients receiving regular gel (P < 0.05). Tolerability was good or excellent in over 95% of patients in both treatment groups. The results of the study strongly suggest that the use of Voltaren Emulgel® as a coupling medium during ultrasonic therapy is a preferable, effective alternative to the currently used regular gel.

The validity and reliability of the graphic rating scale and verbal rating scale for measuring pain across cultures : A study in egyptian and dutch women with rheumatoid arthritis

ObjectiveTo compare the validity and reliability of a graphic rating scale (GRS) and a verbal rating scale (VRS) for measuring pain intensity in young female Egyptian and Dutch patients with rheumatoid arthritis (RA). MethodsData were obtained in a cross-cultural study of 42 Egyptian and 30 Dutch female outpatients with stable RA. Construct validity was assessed by correlating the scales with other core measures of disease activity in RA. Test-retest reliability was assessed over a 1-week interval. ResultsThe GRS and the VRS were strongly intercorrelated in the total study cohort and in the Egyptian and Dutch subgroups. In the individual subgroups, only the GRS demonstrated the expected pattern of correlations with other disease activity measures. Test-retest reliability of the GRS was adequate in both Egyptian and Dutch patients (intraclass correlation coefficient 0.78 vs. 0.83, respectively), whereas reliability of the VRS was unsatisfactory in the Egyptian subgroup (weighted κ 0.60 vs. 0.82 in the Netherlands). DiscussionThe study confirmed that the GRS and VRS were reliable and valid in the total study cohort. Within the individual countries, the GRS seemed to perform better than the VRS.