H. Omar

Quality of life in elderly diabetic patients with peripheral arterial disease.

Aim:  To study the impact of peripheral arterial disease (PAD) on quality of life and functional status in Egyptian elderly diabetic patients.

Healing effects of prolotherapy in treatment of knee osteoarthritis healing effects of prolotherapy in treatment of knee osteoarthritis

Purpose Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a two-arm controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis (OA). Materials and methods A total of 104 adults with at least 6 months of painful primary knee OA were treated with dextrose prolotherapy (group I). They were divided into two subgroups: Ia and Ib. Subgroup Ia was treated with both techniques of prolotherapy (Hackett technique - classic, traditional prolotherapy - and Lyftgot technique - neural prolotherapy), whereas subgroup Ib was treated with the Hackett technique only. Extra-articular and intra-articular injections were administered at 1, 2, and 3 months, with as needed additional treatments at months 4 and 5. A total of 24 adults with at least 6 months of painful primary knee OA were treated with physiotherapy (group II). Outcome measures included the following: clinical assessment; visual analogue scale (VAS), 10; Western Ontario McMaster University Osteoarthritis Index (WOMAC), 96 points; plain radiographs; and musculoskeletal ultrasound. Postprocedure hot packs were applied, and at-home massage and exercises were taught. Results 128 Patients enrolled in the study were matched with each other for sex, age, disease durations, and BMI. Subgroups Ia and Ib reported a significant improvement as regards the clinical assessment, VAS, WOMAC, and radiological assessment at 12 months, compared with their baseline at month 0 and compared with group II (P ≤ 0.001). At 12 months, the mean ± SD of VAS was 0.32 ± 0.27 for subgroup Ia, 0.44 ± 0.5 for subgroup Ib, and 9.9 ± 1.65 for group II, and the mean ± SD of WOMAC was 11.32 ± 10.3 for subgroup Ia, 18.5 ± 10.25 for subgroup Ib, and 79.5 ± 22.63 for group II. Postprocedure application of hot packs, massage, and paracetamol resulted in diminution of injection-related pain. There were no adverse events. Conclusion Prolotherapy resulted in clinically sustained improvement of pain, function, and radiological assessment, which means that the healing effects of prolotherapy is better than that of physiotherapy. The combination of the two prolotherapy techniques results in quicker and better improvement for patients in terms of the clinical assessment, VAS, and WOMAC.

Subendometrial Blood Flow Changes by 3-Dimensional Power Doppler Ultrasound After Hysteroscopic Lysis of Severe Intrauterine Adhesions: Preliminary Study

OBJECTIVE To evaluate the changes in subendometrial blood flow and endometrial volume after hysteroscopic lysis of severe intrauterine adhesions (IUAs). DESIGN A pilot observational study. Forty infertile women with severe IUAs served as their own controls and were included in this study only once, to avoid selection bias. INTERVENTION Three-dimensional power Doppler ultrasound was performed in all patients 1 day before hysteroscopic lysis of severe IUA, and repeated 1 month later, to assess subendometrial blood flow [as measured by vascularization index (VI), flow index (FI), and vascularization flow index (VFI)] and endometrial volume. Main outcome measures were subendometrial blood flow (VI, FI, VFI) and endometrial volume. RESULTS There were statistically significant postoperative increases in endometrial volume, VI, FI, and VFI. Subendometrial blood flow improved in 14 women (35%), and menstrual improvement occurred in 15 women (37.5%). CONCLUSION Hysteroscopic lysis of severe IUAs improves subendometrial blood flow, with subsequent increases in endometrial volume.

Abdominal Aortic Diameter in Elderly with Asymptomatic Uncomplicated Hypertension and its Relation to Peripheral Arterial Disease

Background: Abdominal Aortic Diameter (AAD) is a crucial measurement in diagnosing Abdominal Aortic Aneurysm, a life threatening condition that is closely linked to Peripheral Arterial Disease (PAD). Aim: To recognize the relationship between AAD and PAD in asymptomatic uncomplicated hypertensive elderly.

Abdominal Aortic Diameter and the Risk for Asymptomatic Peripheral Arterial Disease in Patients with Type 2 Diabetes

Peripheral arterial disease (PAD) is common among older people because it often results from atherosclerosis, which becomes more common with age. The disease is particularly common among people who have diabetes. Little information is available on the relation between abdominal aortic diameter and PAD in elderly patients with diabetes. This article studies the relationships between abdominal aortic diameter, PAD, and the cardiovascular risk factors in asymptomatic elderly patients suffering from type 2 diabetes mellitus. A case-control study was conducted on 90 participants aged 60 years and older divided into 60 cases (30 males and 30 females) and 30 age-matched healthy controls (15 males and 15 females). The relationships between the size of the abdominal aorta and ankle-brachial index (ABI), plasma cholesterol, triglycerides (TG), and high-sensitivity C-reactive protein were examined. Approximately, 15% of patients with diabetes had asymptomatic PAD. The patients with diabetes with PAD were of older age (70.4 ± 3.6 vs. 63.4 ± 3.9 years; p = 0.000), had larger abdominal aortic diameter (22.4 ± 3.08 vs. 18.7 ± 2 mm; p = 0.000), and higher CRP levels (8.3 ± 1.1 vs. 5.8 ± 2.2 mg/L; p = 0.002), while other variables revealed no significant difference. Abdominal aortic diameter correlated well with ABI measured by Doppler method in diabetic patients (r =  - 0.471, p = 0.000). Older age and larger abdominal aorta are independent risk factors for asymptomatic PAD in the elderly with type 2 diabetes mellitus.

Prevalence of silent nontraumatic vertebral fracture in rheumatoid arthritis: relation with disease duration, disease activity, corticosteroid, and hip buckling ratio

Objectives To detect the prevalence of silent nontraumatic vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) and its relation with disease duration, disease activity, corticosteroid (CS), and hip buckling ratio (BR). Patients and methods This cross-sectional study included a total of 150 RA patients. Disease activity was assessed using Disease Activity Score-28 (DAS-28). Dual-energy x-ray absorptiometry (DXA) was used to detect bone mineral density (BMD), VFs by vertebral fracture assessment (VFA), and hip BR by hip structural analysis program. Results A total of 17 (11.33%) RA patients had 27 silent VFs. Of the 17 VFs patients, 11 and six patients had single and multiple VFs, respectively. Of the 27 VFs, nine and 18 VFs had mild and moderate degree of VF. VF cases were significantly older in age ( P = 0.001), had longer disease duration ( P P P = 0.02), and increased BR ( P = 0.001). There were statistically significant relation between VFs and disease duration, DAS-28 and BR ( P P < 0.001). Conclusion VFA-DXA should be performed on all RA patients. VF cases were significantly older in age, had long-standing disease duration, increased disease activity, reduced spinal BMD, increased cumulative CS dose, and increased BR. VFs were significantly related to increased disease duration, increased disease activity score, and increased BR of more than 10.