Stroke is considered one of the main causes of adult disability and the second most serious cause of death worldwide. The combination of botulinum toxin type A (BTX) with rehabilitation techniques such as modified constraint-induced movement therapy (mCIMT) has emerged as a highly efficient intervention for stroke patients to start synchronized motor function along with spasticity reduction. The current systematic review and meta-analysis were conducted in order to evaluate the available literature about the safety and efficacy of constraint-induced movement therapy (CIMT) combined with BTX in stroke patients with upper limb spasticity. Searches were conducted on WoS (Web of Science), Ovid, EBSCO-ASC&BSC, and PubMed for identifying relevant literature published from 2000-2020. Randomized Controlled Trials (RCTs) and Quasi-experimental studies were considered for inclusion. Rayyan (systematic review tool) QCRI (Qatar Computing Research Institute) was used for independent screening of the studies by two reviewers. For risk of bias and study quality assessment, Cochrane risk of bias tool (RoB 2) and Physiotherapy Evidence Database (PEDro) scales were used. Cochrane review manager was used to carry out the meta-analyses of the included studies. The search resulted in a total of 13065 references, of which 4967 were duplicates. After the title, abstract and full-text screening, two RCTs were deemed eligible for inclusion. Both the RCTs scored 8 on PEDro and were level evidence. The studies were heterogeneous. The findings of this meta-analysis in all the three joints post-stroke spasticity assessed on modified Ashworth scale (MAS) at four weeks post-injection aren’t statistically significant (elbow P-value 0.74, wrist P-value 0.57, fingers P-value 0.42), however, according to one of the included studies the therapeutic efficacy of the combination of BTX-mCIMT injection assessed at four weeks post-injection in wrist and finger flexors was promising. The effectiveness of BTX-CIMT combination over conventional therapy (CT) for improving post-stroke spasticity still needs to be explored with long-term, multicenter rigorously designed RCTs having a good sample size. However, the BTX-CIMT combination is promising for enhancing motor function recovery and improving activities of daily living (ADLs).

Background and Aim: The data about the role of regulatory B cells (Breg) in Behcet Disease (BD) are scarce. We aimed to evaluate the frequency of total B lymphocytes and Breg cells in different BD phenotypes and therapies attempting to unravel their function. Methods: This cross-sectional study included 35 BD patients and 39 healthy controls (HCs). The demographic data of the study subjects were collected including age and gender. Current medications including disease-modifying anti-rheumatic drugs (DMARDs) were recorded. All patients underwent testing for baseline laboratory investigations including full blood count, liver and kidney function tests, erythrocyte sedimentation rate (ESR) by Westergren blot and C-reactive protein (CRP). Measurement of the total B lymphocytes and their subtypes B regulatory lymphocytes by flow cytometric assay. Assessment of BD activity was done using the revised Behçet’s Disease Current Activity Form (BDCAF) 2006 and Behçet’s Syndrome Activity Score (BSAS) ^1111111111. All participants were assessed for the presence of erectile dysfunction using the International Index of Erectile Function (IIEF-5 score), and for depression using the Beck Depression Inventory. Results: A dramatic drop in the number of B cells, total and regulatory, was observed in the patients compared to the HCs. Regulatory cells (Bregs) tend to be upregulated with genital ulcers or vascular disease. Bregs but not B lymphocytes were associated with BSAS and ESR. Neither the total B lymphocytes nor the Bregs correlated with CRP or the sexual function or depression scores. Of all the used medications, low-dose aspirin was seen with markedly high Bregs proportions. Conclusion: This study supports the role of B cells in BD pathogenesis and strongly suggests a possible role for Bregs in the resolution of different BD manifestations.

Background and aim: Pulmonary artery aneurysms (PAAs) are the most well-defined type of pulmonary vascular complication in Behcet's disease (BD). The aim of this study is to analyze which CT pulmonary angiography (CTPA) signs are associated with serious morbidity and mortality. Methods: The study included 42 BD patients with pulmonary vascular complications. All patients' medical records were reviewed retrospectively in terms of demographics, disease characteristics, laboratory investigations, pulmonary manifestations, arterial and/or venous thrombosis and CTPA vascular and parenchymal findings. Results: Deep venous thrombosis was observed in 31 (73.8%) patients, arterial thrombosis in 13 (31%), peripheral arterial aneurysms in 12 (28.5%), haemoptysis in 38 (90.5%), and fatal haemoptysis in 8 (19 %) patients. CTPA revealed: in situ thrombosis in 14(33.3%) patients, true stable PAAs in 13 (31), true unstable PAAs in 11 (26.2%), stable pulmonary artery pseudoaneurysms (PAPs) in 7 (16.7%), unstable PAPs in 17 (40.5%), perianeurysmal leaking in 26 (61.9%) and bronchial indentation in 19(45.2%). In regression analysis, fatal outcomes were associated with age in years (p=0.035), arterial thrombosis (p=0.025), peripheral arterial aneurysms (p=0.010), intracardiac thrombosis (p=0.026) and positively associated with haemoptysis severity (p<0.001). The severity of hemoptysis affects the likelihood of death over time (p=0.0057), whereas combined immunomodulator therapy reduces the risk of death over time (P= 0.0680). Conclusion: Peripheral arterial thrombosis and/or aneurysms, intracardiac thrombosis and haemoptysis severity are predictors of fatal outcomes in BD pulmonary vasculitis. PAPs with perianeurysmal alveolar haemorrhage and/or bronchial indentation are serious CTPA signs that require prompt identification and aggressive treatment. PAPs are a more serious aneurysmal pattern than true PAAs because they are a contained rupture of a PA branch in the context of pulmonary vasculitis.

To describe various demographic, clinical, laboratory, and capillaroscopic features of Egyptian patients with systemic sclerosis (SSc) and to explore the relation between various capillaroscopic features and internal organ involvement as well as other disease parameters. In this cross-sectional multi-centric prospective analysis, two hundred twenty-two adult patients with SSc were recruited. Data regarding general and rheumatological examination including the modified Rodnan skin score (MRSS), internal organ involvement and related imaging and laboratory investigations were collected. Both activity and severity indices were measured. Nail fold capillary microscopy (NFC) was performed for 144 patients. Out of 222 patients; 139 (62.6%) had limited type while 83 (37.4%) had diffuse type, middle aged females were predominant (91%). Peripheral vascular, pulmonary, gastrointestinal and general manifestations were the most frequently documented affection with high activity, severity profiles and bad prognostic features in more than half of the patients. MRSS was above 20 in 122 patients (55%), and 126 patients (56.8%) had pulmonary hypertension (SPAP) while 78.4% had ILD which showed a weak correlation to age and disease duration (r = 0.135, r = − 0.152 respectively). Significant weak correlations were found between disease duration and SPAP (r = 0.134), Medseger’s severity score (r = 0.189), peripheral vascular, skin, and GIT affection severity (r = 0.210, 0.135, and 0.196 respectively). Significant difference was observed between different NFC patterns and antibodies, severity scale, some disease manifestations i.e.: general, gastrointestinal, myopathy, and digital ulceration while no significance was found between NFC patterns and the type of SSc. This study provided a comprehensive clinical and laboratory characterization of a large cohort of Egyptian patients with SSc which reflects a more severe disease with unfavorable prognostic aspects compared to the available world-wide reports. Nail fold capillaroscopy showed many associations to different aspects of the disease especially in late and active capillaroscopic features, if introduced early, it may improve the disease outcome.

Background: Systemic sclerosis (SSC) affects the urinary bladder and many other body organs. Systemic sclerosis commonly manifests as lower urinary tract symptoms (LUTS), which are usually reported using validated questionnaires. This study aimed to correlate questionnaire-reported LUTS with urodynamic findings in patients with SSC. Materials and methods: This cross-sectional study was performed at our center between August 2018 and July 2021. Lower urinary tract symptoms were assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Female Lower Urinary Tract Symptoms Modules and ICIQ Male Lower Urinary Tract Symptoms Module and urodynamic studies. Univariate analyses were then performed on variables affecting detrusor activity. Results: This study included 22 patients (5 men, 17 women). The mean ± standard deviation age, body mass index, and disease duration were 37.2 ± 11.1 years, 25.5 ± 4.2 kg/m ² , and 6.2 ± 5.3 years, respectively. Lower urinary tract symptoms occurred in 19 (86.4%) patients, of whom 18 (94.7%) had mild to moderate symptoms. The ICIQ scores for voiding and filling symptoms were higher than those for incontinence. The most frequent organ involvements included Raynaud’s phenomenon in 22 (100%), skin conditions in 20 (90.9%), gastrointestinal tract maladies in 17 (77.3%), joint disorders in 16 (72.7%), and lung diseases in 14 (63.6%) patients. Abnormal detrusor contractions occurred in only 5 patients (22.7%). Univariate analyses showed that disease duration <5 years ( p = 0.010), nonobstructive uroflowmetry findings ( p = 0.024), absence of incontinence ( p = 0.024) and telangiectasia ( p = 0.010), and negative rheumatoid factors ( p = 0.043) were significantly associated with normal detrusor contractions. Conclusions: Mild to moderate severity of ICIQ-measured LUTS affected most patients with SSC but was not correlated with urodynamic findings. Normal detrusor contractions were significantly associated with shorter disease duration, nonobstructive uroflowmetry findings, absence of incontinence and telangiectasia, and negative rheumatoid factors.

Background: The objective was to determine which of midazolam or hyalase could improve the pain score and functional disability in median nerve hydrodissection. Methods: In a double-blind study with two groups, both received bupivacaine 15 mg with either 300 IU hyalase in 2 ml of saline (group HA) or 2 mg of midazolam in 2 ml of sterile saline (group MZ). Results: Statistically significantly lower post-injection Visual Analog Scale scores in group MZ compared with group HA at all follow-ups. Group MZ had significantly lower functional disability scores than group HA. Conclusion: Both drugs yielded favorable results. Midazolam was more impactful in alleviating pain and reducing functional disability up to 6 months.