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Abstract Aim of the work. Studies describing the epidemiology of vasculitis in the Middle East and Africa are limited. The aim of this multi-centre study is to describe the distribution and outcome of vasculitic syndromes among Egyptian vasculitis patients seen by rheumatologists. Patients and Methods The files of patients diagnosed with vasculitis between January 2002 and December 2016 were reviewed and were classified according to The Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis CHCC 2012 and disease- specific criteria. The vasculitis damage index (VDI) was calculated for all patients at the last visit. Results Six hundred and thirty patients with ages ranging from of 9 months-74 years, including 264 (41.9%) males and 366 (58.1%) females were studied. Vasculitis associated with hepatitis C virus (HCV) infection was detected in 151 (24%), Behçet's disease in 148 (23.5%), Immunoglobulin A vasculitis in 101 (16%), vasculitis associated with systemic lupus erythematosus in 93 (14.8%), Takayasu's arteritis in 33 (5.2%), Kawasaki's disease in 22 (3.5%) patients, respectively. Other vasculitic syndromes were uncommon and each accounted for less than 2% of the studied cases. The VDI ranged from 0 to 13. Only 109/630 (17.3%) patients had no vasculitis-related damage (VDI = 0). Mortality was recorded in 36 (5.7%) patients; out of these, 27 deaths were vasculitis-related. Conclusion HCV-associated vasculitis and Behçet's disease were the most frequently diagnosed vasculitic syndromes. [ABSTRACT FROM AUTHOR]

Aim of the work To assess the diagnostic value of salivary gland ultrasonography (SGUS) for Sjӧgren's syndrome (SS) and to compare it with minor salivary gland biopsy (MSGB) in patients with sicca symptoms. Patients and methods Thirty patients with suspected SS (sicca symptoms only) were included in the study. The diagnosis of SS was confirmed according to the 2012 American College of Rheumatology criteria. SGUS was performed for all patients and the bilateral echostructure of the parotid and submandibular glands were graded from 0 to 3. SGUS score ≥2 was considered abnormal. A complete work up for SS was performed in all patients including a standardized clinical examination performed by the same rheumatologist, serological and laboratory tests, ocular tests and MSGB. Schirmer’s test and the Ocular Staining Score (OSS) using rose Bengal were performed. Results Of the 30 patients, 10 had primary sicca symptoms (mean age 42.3 ± 13.1 years) and 20 secondary (49.5 ± 8.6 years) and most were females. The frequency of SS syndrome by ACR criteria was 6.7%. By adding ultrasound item to ACR criteria (SGUS score ≥2) the frequency of SS syndrome increased to 10%. The SGUS (cutoff score ≥2) showed a sensitivity of 66.6% and a specificity of 85.2% for SS diagnosis. Histopathology of MSGB showed no significant correlation with SGUS scores and remained the most diagnostic method for SS that had sensitivity and specificity of 100%. Conclusion SGUS is a noninvasive method with high diagnostic value for diagnosis of primary and secondary SS. [ABSTRACT FROM AUTHOR]

Background: Current laboratory criteria for antiphospholipid syndrome (APS) classification recommend testing positive for antiphospholipid (aPL) antibodies. However, there appears to be a subset of patients with classical APS manifestations who test negative. Aim of the work: To analyze the potential clinical usefulness of testing for anti-annexin A5 antibodies in patients with APS and to study the effectiveness of testing for non-criteria aPLs in an attempt to increase the diagnostic yield, particularly in seronegative APS. Patients and methods: 60 APS patients were divided into two groups; 30 seropositive (SP-APS) (group I) and 30 age and sex matched seronegative (sN-APS) testing negative for aPL antibodies. Serum assay for detection of isotypes of anti-annexin A5 antibodies (IgG and IgM) were conducted. Results: The mean age of the patients was 32.9 ± 5.8 years, female:male 57:3 and disease duration in SP-APS versus sN-APS (10.17 ± 4.9 years versus 9.6 ± 5.5 years) respectively. Secondary APS was present in 16(53.3%) patients in group I compared to 3(10%) in group II (p < 0.0001). The mean anti-AnxA5 IgG level was 10.7 ± 5.6 U/ml and IgM was 11.2 ± 7.1 U/ml and were comparable between the 2 groups. The obstetric and thrombotic morbidity had no significant differences between SP and sN-APS. The IgG and IgM levels significantly correlated with the pregnancy morbidity, venous and arterial thrombosis events and showed reasonable sensitivities in their prediction (IgG:71.2%,72.8% and 75.8%; IgM: 68%,67.8% and 71.4% respectively) and specificities (IgG:75.9%,77.8% and 81.5%; IgM: 70.9%,73.1% and 73.7% respectively). Conclusion: anti-annexinA5 antibodies are promising for detecting obstetric and thrombotic morbidity in both SP- and sN-APS patients. [ABSTRACT FROM AUTHOR]

Background Carpal tunnel syndrome (CTS) is the most common upper limb neuropathy with increasing incidence especially among females, having a high economic and social impact on patients. CTS can be treated either with conservative measures or surgically. Steroid injection, as a conservative treatment, could be carried out using anatomical landmarks or via ultra-sonographic guidance. Aim of the work To compare the clinical outcomes of the ultrasound guided injection versus blinded one for management of CTS. Patients and methods Thirty patients with CTS were included in this study. Diagnosis was based on clinical, electro-physiological and ultrasound imaging. 28 patients had moderate CTS and 2 patients mild. Patients were equally grouped; 15 patients with ultrasound-guided injection technique and another 15 were injected blindly. Injection was performed once at baseline with 0.5 ml lidocaine 1% and 40 mg of triamcinolone. Evaluation at baseline and after 4 weeks of injection included Boston carpal tunnel questionnaire; symptom severity scale and functional status scale, nerve conduction study, ultrasound parameters (cross-sectional area, flattening ratio). Results Patients were 28 females and 2 males; their mean age was 35.3 ± 7.5 years with unilateral CTS and disease duration of 8.8 ± 1.9 years. Patients with ultrasound-guided injection had significant improvement of clinical, neurophysiological, ultrasound parameters outcomes than blind injected patients . Reported complications at baseline included tingling sensation in 6 (40%) patients injected blindly while non in US-guided injected. No complications were reported in all patients after 4 weeks. Conclusion Ultrasound-guided injection of the carpal tunnel provides precision, maximizes the effectiveness and reduces complications. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: A great number of nickel-titanium (NiTi) rotary systems with noncutting tips, different cross-sections, superior resistance to torsional fracture, varying tapers, and manufacturing method have been introduced to the market. The purpose of this study was to evaluate and compare the effect of 4 rotary NiTi preparation systems, Revo-S (RS; Micro-Mega, Besancon Cedex, France), Twisted file (TF; SybronEndo, Amersfoort, The Netherlands), ProFile GT Series X (GTX; Dentsply, Tulsa Dental Specialties, Tulsa, OK), and ProTaper (PT; Dentsply Maillefer, Ballaigues, Switzerland), on volumetric changes and transportation of curved root canals. Methods: Forty mesiobuccal canals of mandibular molars with an angle of curvature ranging from 25° to 40° were divided according to the instrument used in canal preparation into 4 groups of 10 samples each: group RS, group TF, group GTX, and group PT. Canals were scanned using an i-CAT CBCT scanner (Imaging Science International, Hatfield, PA) before and after preparation to evaluate the volumetric changes. Root canal transportation and centering ratio were evaluated at 1.3, 2.6, 5.2, and 7.8 mm from the apex. The significance level was set at P ≤ .05. Results: The PT system removed a significantly higher amount of dentin than the other systems (P = .025). At the 1.3-mm level, there was no significant difference in canal transportation and centering ratio among the groups. However, at the other levels, TF maintained the original canal curvature recording significantly the least degree of canal transportation as well as the highest mean centering ratio. Conclusions: The TF system showed superior shaping ability in curved canals. Revo-S and GTX were better than ProTaper regarding both canal transportation and centering ability. [Copyright &y& Elsevier]

Abstract: Introduction: Avascular necrosis (AVN) is a major cause of morbidity in SLE. Several factors have been associated with the development of osteonecrosis in SLE but corticosteroid therapy has been the most consistent. Many factors such as thromboembolism, fat embolism, thrombophilia, hypofibrinolysis, intramedullary haemorrhage, vasculitis and increased bone marrow pressure are related to corticosteroid-induced osteonecrosis. Aim of the work: To determine the prevalence of avascular necrosis (AVN) of bone in patients with systemic lupus erythematosus (SLE) and to study the predictive factors for AVN in patients with SLE and its association with other SLE disease manifestations. Patients and methods: One hundred consecutive SLE patients, diagnosed according to the updated American College of Rheumatology criteria (ACR), were studied. A full medical history and rheumatologic examination were administered to all patients. Laboratory and serologic tests were also carried out. Systemic disease activity was scored using the systemic lupus erythematosus disease activity index (SLEDAI). Cases of symptomatic AVN were identified by plain X-ray and magnetic resonance imaging (MRI). Comparisons between groups of patients with and without AVN, and associations between groups were analyzed by the t-test, Pearson correlation as well as multiple regression models to study the predictive factors for AVN in patients with SLE. Results: AVN was detected in 15% (n =15) of SLE patients. Osteonecrosis of one hip joint was highly predictor for the other (p =0.000). Cumulative corticosteroid dose, Gait disturbance, myalgia and hypertension are the clinical predictors of AVN (p =0.000, 0,000, 0.001, 0.000), respectively, in the regression analysis model. Haemoglobin and proteinuria were the laboratory predictive (p =0.000, 0.000), respectively. Conclusions: Lupus patients are at high risk for avascular necrosis (AVN), this risk extended to those on high dose corticosteroid of which patient’s screening should be considered and closely monitored by sensitive techniques such as MRI. [Copyright &y& Elsevier]

Cone-beam computed tomography (CBCT) has become popular, and its many inherent advantages are indisputable. Nevertheless, CBCT is prescribed cautiously because the radiation dosage is higher than that of conventional radiography. When and to what extent should CBCT be prescribed for orthodontic patients? The purpose of this article is to present 4 curious cases in which a considerable discrepancy was found between the conventional panoramic radiograph and the CBCT view. Is it time to spare patients an unnecessary conventional panoramic radiograph and shift to CBCT for all patients? [Copyright &y& Elsevier]