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Biomedical subjects

L Neumann

Publications and source records attributed to L Neumann.

At least 55 records · Page 3Linked to original sources
PubMed1999

Evaluation of a Hebrew version of the revised and expanded Arthritis Impact Measurement Scales (AIMS2) in patients with fibromyalgia.

OBJECTIVE: To validate a translated version of the revised and expanded Arthritis Impact Measurement Scales (AIMS2) to be used by Hebrew speaking populations. METHODS: The AIMS2 was translated into Hebrew and administered to 66 women with fibromyalgia (FM) along with the Hebrew versions of the Fibromyalgia Impact Questionnaire (FIQ) and the Quality of Life (QOL) Scale. All subjects were asked about the presence and severity (assessed by visual analog scale) of FM symptoms (pain, fatigue, anxiety, etc.); a count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were measured by dolorimetry. Test-retest reliability was assessed by Pearson correlation coefficients, and internal consistency was evaluated with Cronbach's alpha coefficient of reliability. Construct validity was tested by correlating the AIMS2 items with measures of symptom severity, count of tender points, tenderness thresholds, physical functioning measured by FIQ, and with a score of QOL. RESULTS: Test-retest reliability coefficients ranged from 0.84 to 0.99, and Cronbach's alpha coefficients from 0.74 to 0.93. Significant moderate to high correlations were obtained between the AIMS2 subscales (except self-care) and measures of physical functioning, quality of life, severity of FM symptoms, and number of tender points. CONCLUSION: The AIMS2 is a reliable and valid instrument for measuring health status and physical functioning in Israeli women with FM.

Evaluation Studies as Topic↗
PubMed1999

Recessively inherited multiple epiphyseal dysplasia with normal stature, club foot, and double layered patella caused by a DTDST mutation.

We have observed over 25 different mutations in the diastrophic dysplasia sulphate transporter gene (DTDST) in association with the recessive disorders achondrogenesis 1B, atelosteogenesis 2, and diastrophic dysplasia. The c862t (R279W) transition is the most common mutation in non-Finnish patients, but in these disorders it is usually combined with other DTDST mutations. We had not seen a case of homozygosity for c862t (R279W) until we analysed DNA from a 36 year old male with tall-normal stature (180 cm) who asked for genetic counselling for suspected multiple epiphyseal dysplasia. He was treated for club foot and hip dysplasia at birth. Skeletal changes consistent with multiple epiphyseal dysplasia, with the peculiar finding of a double layered patella, were recognised during childhood. Cleft palate, swelling of the ear pinna, and hitch hiker thumb were absent. He was found to be homozygous, and both healthy parents heterozygous, for the R279W mutation in DTDST, and his fibroblasts showed a sulphate incorporation defect typical of DTDST disorders. Counselling was given for a recessive disorder, thereby considerably reducing the probability of affected offspring. Multiple epiphyseal dysplasia is more frequently caused by dominant mutations in the COMP (EDM1, McKusick 132400) and COL9A2 genes (EDM2, McKusick 600204). A few other patients and families with features similar to our proband have been described previously and considered to have autosomal recessive MED (EDM4, McKusick 226900). This observation confirms the existence of this entity and assigns it to the phenotypic spectrum associated with mutations at the DTDST locus.

Adult↗
PubMed1999

Quality of life in systemic lupus erythematosus: a controlled study.

OBJECTIVE: To assess the quality of life (QOL) of patients with systemic lupus erythematosus (SLE) and to compare it with that of healthy women and patients with primary fibromyalgia (FM). METHODS: QOL was evaluated using the QOL scale, which includes 16 items, each scored on a 7 point scale. Healthy controls were chosen from hospital personnel. RESULTS: The study population comprised 75 female patients with SLE, 50 healthy women, and 30 women with primary FM. Compared to controls, patients with SLE had significantly lower scores for the health, work, active recreation, and independence items. The QOL scores were not associated with disease activity. Patients with SLE and FM had significantly lower scores for the health related items compared with patients with SLE without FM. CONCLUSION: The QOL of patients with SLE was found to be impaired compared with controls. FM adversely affects the QOL of patients with SLE.

Adult↗
PubMed1998

Unilateral terminal aphalangia in father and daughter--exogenous or genetic cause?

Published cases of familial unilateral terminal transverse defects are scarce. We report on a morphologically similar defect of the hand in a father and his daughter. The hand anomaly is similar in both, but on the opposite side. Thalidomide was taken in the sensitive period of the pregnancy by the father's mother. To our knowledge this is the second description of unilateral terminal aphalangia in successive generations. In order to evaluate the possible genetic basis we analyze epidemiological studies in respect to the recurrence risk of cases with isolated limb reduction defects. We compare reports of familial occurrence concerning the degree of relationship as well as the pattern of malformation. The latter seems to be an important aspect from an evolutionary and a developmental viewpoint. For our observation an autosomal dominant transmission is the most likely although multifactorial determination cannot be excluded.

Adult↗
PubMed1998

[Training on a wobble board following lateral ankle joint sprains].

The aim of this study was to investigate whether the number of patients with residual symptoms following ankle sprains could be reduced by training on a wobble board during a 12-week training recovery period. The effect of a 12-week training program was compared to no training. Forty-eight patients completed the study. In the follow-up period (mean 230 days) we found significantly fewer recurrent distorsions and fewer patients had functional instability in the study group compared to controls. There were no differences between the two groups concerning subjective complaints during the recovery period. Volumetric measurements revealed no difference in the speed of reduction of haematoma and oedema in the two groups. We conclude that training on a wobble board is effective in reducing residual symptoms following ankle sprains.

Adolescent↗
PubMed1998

[Penicillin prophylaxis in complicated wounds of hands and feet. A randomized, double-blind study].

Five hundred and ninety-nine patients with traumatic wounds of hands or feet with underlying lesions of the bone, tendon or joint, were randomized to double blind treatment with either A) one injection of penicillin, B) penicillin tablets for six days or C) no antibiotic treatment. In group A the infection rate was 4.9%, in group B it was 6.6% and in group C 10.2%. The difference between the infection rates in group A and C was 5.3% with a 95% confidence interval (CI) from 0.1 to 10.4%, (p = 0.046). Correction for an interim analysis and subgroup analysis increases this p-value to 0.096. The difference between the infection rates in group B and C was 3.6% (95%, CI from -1.9 to 8.9%, p = 0.20). Patients in group B had gastrointestinal complaints five times as often as patients in group A and C. Based on the results we advise that a single prophylactic injection of penicillin is given to patients with these injuries.

Adolescent↗
PubMed1998

Musculoskeletal manifestations and autoantibody profile in 90 hepatitis C virus infected Israeli patients.

OBJECTIVES: Recent interest has been expressed in rheumatic manifestations in hepatitis C virus (HCV)-infected populations. The aim of this study was to determine the prevalence and characteristics of the musculoskeletal manifestations and serological markers of autoimmunity in HCV-infected patients in Israel. METHODS: Ninety anti-HCV-positive patients were consecutively interviewed and examined. The prevalence of autoantibodies and their association with rheumatologic symptoms were also determined. RESULTS: Rheumatic manifestations were found in 28 subjects (31%), and included arthralgias (9%), arthritis (4%), cryoglobulinemia (11%), sicca symptoms (8%), cutaneous vasculitis (2%), polymyositis (1%), and antiphospholipid syndrome (1%). Rheumatic complications were not associated with liver disease severity, or subjects' gender. In addition, myalgia was reported by 22 patients (24%), and fibromyalgia was diagnosed in 14 (16%). Sixty-nine percent of the patients had at least one autoantibody detected in their serum, the most prevalent being rheumatoid factor (RF), 44%; antinuclear antibody (ANA), 38%; and IgM and IgG anticardiolipin antibodies (ac1), 28% and 22%, respectively. The frequency of autoantibodies was not associated with liver disease severity or rheumatic disorders. CONCLUSIONS: Musculoskeletal manifestations and autoimmune markers are common in HCV infection. An investigation of risk factors for HCV infection is pertinent in a patient presenting new rheumatic manifestations and should be included in the history of present illness. Future studies of these disorders may uncover the full spectrum of these associations and provide new insights into their operating mechanisms.

Adolescent↗
PubMed1998

Normal melatonin levels in patients with fibromyalgia syndrome.

OBJECTIVE: To assess urine levels of melatonin measured by 6-sulphatoxymelatonin (aMT6s) in patients with fibromyalgia (FM). METHODS: Nocturnal aMT6s urine levels were measured by ELISA, in a sample of urine collected from 10 PM to 7 AM from 39 female patients with FM and 39 age matched healthy female controls. All subjects were interviewed and assessed for nonarticular tenderness, FM symptoms, quality of life, and physical functioning. RESULTS: Nocturnal aMT6s levels of patients with FM were not statistically different from those of controls: 16.7+/-9.2 vs 16.0+/-11.3 microg, respectively. No association was observed between aMT6s levels of patients with FM and disease duration, reproductive status, sleep and mood disturbances. CONCLUSION: Nocturnal urine aMT6s levels were similar in patients with FM and controls. Studies are needed to elucidate the possible role of melatonin in FM and should include larger samples of newly diagnosed untreated patients with FM.

Adult↗
PubMed1998

Ethnocultural and educational differences in Israeli women correlate with pain perception in fibromyalgia.

OBJECTIVE: To compare the clinical features of patients with fibromyalgia (FM) in 2 ethnic groups in Israel. METHODS: One hundred women with FM participated in the study; 70 were of Sephardic (Mediterranean) origin and 30 of Ashkenazic (European-American) origin. Assessment of FM related symptoms, tenderness, quality of life, and physical functioning was conducted in all subjects. Analysis of covariance and multivariate regression were performed to study the association between these measures and ethnicity, controlling for age and education. RESULTS: Sephardic patients with FM reported more frequent and more severe symptoms than Ashkenazic patients. They had higher point counts and decreased quality of life. When the patients were divided into 2 age groups (age 45 being the cutoff point), the differences were observed only among the older subjects, most of whom were immigrants. Sephardic older patients had significantly higher point counts than Ashkenazic patients, and lower tenderness thresholds. They reported significantly higher levels of pain, fatigue, and stiffness, and were less satisfied with their life. However, these differences observed between the 2 ethnic groups in the univariate data analysis disappeared when age and education were jointly controlled in multivariate regression analysis. Age had significantly contributed to the variation in the point count, the reported pain, and physical functioning. Education made a significant contribution in explaining the point count, quality of life, pain, and fatigue. CONCLUSION: Education, rather than ethnic identity, has been found to be an important factor in clinical features of FM. Future studies should include ethnocultural and educational assessment, especially in countries with high immigration rates and diverse ethnic groups, such as the USA and Canada.

Adult↗
PubMed1997

Fibromyalgia in hepatitis C virus infection. Another infectious disease relationship.

BACKGROUND: Fibromyalgia syndrome (FS) is a common disorder of diffuse pain in the muscles or joints accompanied by tenderness at specific tender points and a constellation of related symptoms. The potential role of infections in the pathogenesis of FS has only recently been investigated. OBJECTIVES: To evaluate the prevalence of FS and to assess tenderness thresholds in patients infected with hepatitis C virus (HCV). METHODS: The study included 90 patients with HCV, 128 healthy, anti-HCV-negative controls, and 32 patients with non-HCV-related cirrhosis. Tenderness was measured by manual palpation (18 tender points) and with a dolorimeter. Fibromyalgia syndrome was diagnosed according to the 1990 American College of Rheumatology criteria. RESULTS: The diagnosis of FS was established in 14 patients (16%) with HCV, in 1 patient (3%) with non-HCV-related cirrhosis, and in none of the healthy controls (P < .001). Thirteen of the HCV-positive patients with FS were women. The patients with HCV had significantly (P < .01) more tender points (mean [+/- SD] 3.6 +/- 5.3) than the healthy controls (0.1 +/- 0.5) and the patients with non-HCV-related cirrhosis (1.2 +/- 2.7). Specifically, the patients with cirrhosis were most tender on both tenderness measures owing to the high proportion of women in this group. Patients with FS were significantly more tender than those without FS: their dolorimetry thresholds were 2.9 kg vs 6.0 kg (P < .001). CONCLUSIONS: A high prevalence of FS was observed in patients infected with HCV, especially women. Recognizing FS in patients with HCV will prevent misinterpretation of FS symptoms as part of the liver disease and will enable the physician to reassure the patient about these symptoms and to alleviate them.

Adult↗
PubMed1997

The active domain of the herpes simplex virus protein ICP47: a potent inhibitor of the transporter associated with antigen processing.

The herpes simplex virus type 1 (HSV-1) protein ICP47 binds specifically to the transporter associated with antigen processing (TAP), thereby blocking peptide-binding and translocation by TAP and subsequent loading of peptides onto MHC class I molecules in the endoplasmic reticulum. In consequence, HSV-infected cells are masked for immune recognition by cytotoxic T-lymphocytes. To investigate the molecular details of this, so far, unique transporter-inhibitor interaction, the active domain and critical amino acid residues were identified by using short overlapping fragments and systematic deletions of the viral inhibitor. A fragment of 32 amino acid residues, ICP47(3-34), was found to be the minimal region harboring an activity to inhibit peptide-binding to TAP comparable to the action of the full-length protein and therefore representing the active domain. Further N or C-terminal truncations cause an abrupt loss in activity. Within the identified active domain, various mutants and chimeras of ICP47 derived from HSV-1 and HSV-2 helped to identify amino acid residues critical for TAP inhibition. On the basis of these results, therapeutic drugs could be designed that are applicable in treatment of allograft rejection or in novel vaccination strategies against HSV, restoring the ability of the immune system to recognize HSV-infected cells.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1997

Structure of the viral TAP-inhibitor ICP47 induced by membrane association.

Herpes simplex virus type I protein ICP47 (IE12) turns off antigen presentation by specifically binding to and blocking the major histocompatibility complex- (MHC-) encoded transporter associated with antigen processing (TAP). Due to the lack of translocated peptides inside the endoplasmic reticulum, MHC class I molecules fail to assemble and therefore MHC-peptide complexes do not reach the cell surface for immune recognition by cytotoxic T-lymphocytes. Here we investigated the structure of ICP47 representing the first natural inhibitor of an ATP-binding-cassette (ABC) transporter identified so far. First, we demonstrate that the N-terminal half of ICP47 is as active in inhibition of human TAP as the full-length protein and therefore serves as an ideal model to investigate structural and functional aspects of the inhibitor. Second, from circular dichroism analysis, the viral inhibitor of TAP appears to be mainly unstructured in aqueous solution. However, in the presence of membrane mimetics or lipid membranes an alpha-helical structure is induced. Third, circular dichroism and fluorescence spectroscopy reveal that membrane adsorption and conformational change of ICP47 are directly dependent on the surface charge density of the lipid membrane. Therefore we conclude that docking to membranes induces a conformational change in ICP47 that may be prerequisite to blocking TAP function.

ATP-Binding Cassette Transporters↗
PubMed1997

Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury.

OBJECTIVE: To study the relationship between cervical spine injury and the development of fibromyalgia syndrome (FMS). METHODS: One hundred two patients with neck injury and 59 patients with leg fractures (control group) were assessed for nonarticular tenderness and the presence of FMS. A count of 18 tender points was conducted by thumb palpation; and tenderness thresholds were assessed by dolorimetry at 9 tender sites. All patients were interviewed about the presence and severity of neck and FMS-related symptoms. FMS was diagnosed using the American College of Rheumatology 1990 criteria. Additional questions assessed measures of physical functioning and quality of life (QOL). RESULTS: Although no patient had a chronic pain syndrome prior to the trauma, FMS was diagnosed following injury in 21.6% of those with neck injury versus 1.7% of the control patients with lower extremity fractures (P = 0.001). Almost all symptoms were more common and severe in the group with neck injury. FMS was noted at a mean of 3.2 months (SD 1.1) after the trauma. Neck injury patients with FMS (n = 22) had more tenderness, had more severe and prevalent FMS-related symptoms, and reported lower QOL and more impaired physical functioning than did those without FMS (n = 80). In spite of the injury or the presence of FMS, all patients were employed at the time of examination. Twenty percent of patients with neck injury and 24% of patients with leg fractures filed an insurance claim. Claims were not associated with the presence of FMS, increased FMS symptoms, pain, or impaired functioning. CONCLUSION: FMS was 13 times more frequent following neck injury than following lower extremity injury. All patients continued to be employed, and insurance claims were not increased in patients with FMS.

Adult↗
PubMed1997

Posttraumatic stress disorder, tenderness and fibromyalgia.

The aims of the present study were to inquire into the prevalence of fibromyalgia syndrome, to assess nonarticular tenderness, to measure fibromyalgia syndrome-related symptoms, quality of life, and functional impairment among posttraumatic stress disorder (PTSD) patients as compared with control subjects. Furthermore, the differences between the PTSD patients with and without fibromyalgia syndrome were studied. Twenty-nine PTSD patients and 37 control subjects were assessed as to the diagnosis of fibromyalgia syndrome according to the American College of Rheumatology. Tenderness was assessed manually and with a dolorimeter. Fibromyalgia syndrome-related symptoms, quality of life, physical functioning, PTSD symptomatology, and psychiatric features were assessed by valid and reliable self-report inventories. Results showed that the prevalence of fibromyalgia syndrome in the PTSD group was 21% vs. 0% in the control group. Furthermore, the PTSD group was more tender than the control group. PTSD subjects suffering from fibromyalgia syndrome were more tender, reported more pain, lower quality of life, higher functional impairment and suffered more psychological distress than the PTSD patients not having fibromyalgia syndrome. It is suggested that previous reports on diffuse pain in PTSD in fact described undiagnosed fibromyalgia syndrome. The link between psychological stress and pain syndromes is emphasized.

Activities of Daily Living↗
PubMed1997

Quality of life and physical functioning of relatives of fibromyalgia patients.

OBJECTIVES: The quality of life (QOL) and health status of fibromyalgia syndrome (FS) patients is impaired, and may adversely affect their close relatives. The aim of this study was to assess the QOL and physical functioning of relatives of FS patients. METHODS: A total of 118 relatives (parents, husbands, siblings, and offspring) of 30 FS female patients were evaluated using a QOL scale and the Fibromyalgia Impact Questionnaire (FIQ) and were compared with 124 healthy controls. These measures of functioning and QOL were further studied in relatives with and without FS. RESULTS: Although the QOL of the relatives was better than that of the FS index women, they were significantly less satisfied than the controls with functioning-related aspects, namely work (job or home), independence, and health (P < .05). Relatives with FS (n = 29) and female relatives (n = 40) reported lower QOL than relatives without FS (n = 89) and male relatives (n = 78), respectively. Similarly, physical functioning of relatives, though better than in FS index cases, was significantly worse than in healthy controls. Furthermore, the health status of female relatives and relatives with FS was significantly worse than that of male relatives and relatives without FS, respectively. CONCLUSIONS: The quality of life and physical functioning of relatives of FS patients were found to be impaired, especially in female relatives and those with undiagnosed FS. This finding may be attributed to the psychological distress in families of FS patients and to the high prevalence (25%) of undiagnosed FS among the relatives.

Adolescent↗
PubMed1997

Awareness of diagnostic and clinical features of fibromyalgia among family physicians.

OBJECTIVES: The aim was to assess the awareness and knowledge of family physicians about diagnostic and clinical features of fibromyalgia syndrome (FS), and to evaluate the contribution of rheumatology education to the improvement of this knowledge. METHODS: A detailed questionnaire on FS was completed by 172 family physicians. A composite score, based on five items, was constructed to quantitatively assess knowledge of FS (maximum score of 5). A comparison was made between physicians exposed to extensive education on FS (in Beer Sheva medical centre) and physicians without such exposure (in other centres). RESULTS: Ninety-six per cent of the physicians claimed to be familiar with FS. They recognized most of the FS-related symptoms, but had limited knowledge of the diagnostic criteria, treatment modalities and prognosis. Only 55% knew that FS is associated with widespread pain and 25% were familiar with the point count criterion. Physicians trained in Beer Sheva scored significantly higher than those trained elsewhere: 3.0 +/- 1.2 versus 2.4 +/- 1.2, respectively (P = 0.006), and their knowledge of FS treatment was significantly better. CONCLUSION: Family physicians in Israel are quite unfamiliar with the diagnostic criteria of FS, though educational exposure improves their awareness and knowledge.

Adult↗