Hypothetical protein predicted to be tumor suppressor: a protein functional analysis

Litorilituus sediminis is a Gram-negative, aerobic, novel bacterium under the family of Colwelliaceae, has a stunning hypothetical protein containing domain called von Hippel-Lindau that has significant tumor suppressor activity. Therefore, this study was designed to elucidate the structure and function of the biologically important hypothetical protein EMK97_00595 (QBG34344.1) using several bioinformatics tools. The functional annotation exposed that the hypothetical protein is an extracellular secretory soluble signal peptide and contains the von Hippel-Lindau (VHL; VHL beta) domain that has a significant role in tumor suppression. This domain is conserved throughout evolution, as its homologs are available in various types of the organism like mammals, insects, and nematode. The gene product of VHL has a critical regulatory activity in the ubiquitous oxygen-sensing pathway. This domain has a significant role in inhibiting cell proliferation, angiogenesis progression, kidney cancer, breast cancer, and colon cancer. At last, the current study depicts that the annotated hypothetical protein is linked with tumor suppressor activity which might be of great interest to future research in the higher organism.

Strengthening acute coronary syndrome referral network: Insights from initiatives of Penang General Hospital cardiology centre

@#The importance of networking for the management of acute coronary syndrome (ACS) has been emphasised in the 2012 guidelines by the European Society of Cardiology (ESC) on ST-segment elevation myocardial infarction (STEMI). In Penang, the ACS referral network has the Penang General Hospital (PGH), a percutaneous coronary intervention (PCI)- capable hospital, with 14 other hospitals referring their patients for PCI to PGH on a daily basis. In one of its review regarding the referral methodology in the network, PGH’s Cardiology centre observed gaps in the referral systems, which was leading to poor quality of referrals. To address these issues, the PGH Cardiology centre developed a standardised protocol and conducted a one-day workshop to educate medical officers about the standardised protocol. This commentary piece is a proof of this concept, and aims to share the experience and provide an overview on the initiatives by the PGH, which has resulted in improved quality of PCI referrals.

Pattern of MRI brain abnormalities in rheumatic patients with neurological involvement: a tertiary care teaching hospital experience

To explore the pattern of abnormalities seen on MRI in rheumatic patients with neurological manifestations and to interpret the findings in relation to clinical picture. Descriptive study. Rheumatology unit, King Khalid University Hospital, Riyadh, Saudi Arabia from January 2013 to February 2014. We prospectively included rheumatic patients with neurological symptoms and signs. The clinical data were correlated with MRI findings by a team comprising of a rheumatologist, neurologist and neuro-radiologist. Data was analyzed using simple statistical analysis. Fifty patients were recruited with a mean age of 36.4 +/- 10.76 years [range 17-62]. Among SLE patients with seizures, focal deficit and headache white matter hyperintensities were found in 9 [64.28%], 4 [50%], 4 [80%] patients respectively. Out of seven SLE patients with global dysfunction, 3 [42.85%] had brain atrophy and 2 [28.57%] normal MRI. In Behcet's disease with focal deficit, 3 [75%] patients had white matter hyperintensities and 1 [25%] had brainstem involvement. In Behcet's disease with headache, 2 [50%] had normal MRI, 1 [25%] brainstem hyper-intensities and 1 [25%] had subacute infarct. Two [66%] of three Primary APS patients had white matter hyperintensities while third [33%] had old infarct. Both patients of polyarteritisnodosa, had white matter hyperintensities. Out of two Wegener's granulomatosis one had white matter hyperintensities and other had ischemic changes in optic nerves. The only one scleroderma patient had white matter hyperintensities. We found that white matter hyperintensities was the most common MRI abnormality in our study group which in most of the cases had poor clinical correlation. No distinct pattern of CNS involvement on MRI was observed in various rheumatic disorders

Association of GRACE Risk Score with Angiographic Severity of Coronary Artery Disease in patients with ST Elevation Myocardial Infarction.

Background: Clinical guidelines recommend that optimal management of acute coronary syndrome should include patient risk stratification. Predicting the anatomical extension of coronary artery disease is also potentially useful for clinical decision. The objective of our study is to determine whether the GRACE risk score correlates with the angiographic extent and severity of coronary artery disease in patients with ST elevation myocardial infarction. Methodology: 50 patients diagnosed with Acute Myocardial Infarction were included as sample by purposive sampling method. GRACE risk score for each patient was calculated and the patients were divided into groups according to the GRACE risk score: low risk (<108); intermediate risk (109-140). The severity of the coronary artery disease was assessed by vessel score and Gensini score. Relation between Grace score and Gensini score was evaluated. Results: Mean GRACE score of study population was 128.3±22.7. Mean Gensini score was 23.88±17. Mean Gensini score were 15.47±10.4, 27.75±9.26 and 31.52±16.91 in low GRACE risk group, intermediate group and high risk group respectively and the difference of mean Gensini score was statistically significant (p=0.006). In our study correlation co-efficient between GRACE risk score and Gensini score was r=0.17 (p=0.04). Multiple regression analysis showed that age more than 50 years (p=0.02), ST segment deviation (p=0.01), smoking (p=0.02), hypertension (p=0.01) were able to independently predict patients with severe CAD. Conclusion: Our study demonstrates that the GRACE risk score carries a significant positive correlation with the coronary artery disease severity in patients with STEMI.

Mutation spectrum and birth prevalence of inborn errors of metabolism among Emiratis. A study from Tawam hospital metabolic center, United Arab Emirates

This study aimed to determine the mutation spectrum and prevalence of inborn errors of metabolism [IEM] among Emiratis. The reported mutation spectrum included all patients who were diagnosed with IEM [excluding those with lysosomal storage diseases [LSD]] at Tawam Hospital Metabolic Center in Abu Dhabi, United Arab Emirates, between January 1995 and May 2013. Disease prevalence [per 100,000 live births] was estimated from data available for 1995-2011. In 189 patients, 57 distinct IEM were diagnosed, of which 20 [35%] entities were previously reported LSD [65 patients with 39 mutations], with a birth prevalence of 26.87/100,000. This study investigated the remaining 37 [65%] patients with other IEM [124 patients with 62 mutations]. Mutation analysis was performed on 108 [87%] of the 124 patients. Five patients with biotinidase deficiency had compound heterozygous mutations, and two siblings with lysinuric protein intolerance had two homozygous mutations. The remaining 103 [95%] patients had homozygous mutations. As of this study, 29 [47%] of the mutations have been reported only in Emiratis. Two mutations were found in three tribes [biotinidase deficiency [BTD, c.1330G>C] and phenylketonuria [PAH, c.168+5G>C]]. Two mutations were found in two tribes [isovaleric aciduria [IVD, c.1184G>A] and propionic aciduria [PCCB, c.990dupT]]. The remaining 58 [94%] mutations were each found in individual tribes. The prevalence was 48.37/100,000. The most prevalent diseases [2.2-4.9/100,000] were biotinidase deficiency; tyrosinemia type 1; phenylketonuria; propionic aciduria; glutaric aciduria type 1; glycogen storage disease type Ia, and mitochondrial deoxyribonucleic acid depletion. The IEM birth prevalence [LSD and non-LSD] was 75.24/100,000. These results justify implementing prevention programmes that incorporate genetic counselling and screening

cytotoxicity of aflatoxin B[1] in human lymphocytes

Aflatoxin B[1] [AFB[1]] is a naturally occurring carcinogenic and immunosuppressive compound. This study was designed to measure its toxic effects on human peripheral blood mononuclear cells [PBMC]. The study recruited 7 healthy volunteers. PBMC were isolated and cellular respiration was monitored using a phosphorescence oxygen analyser. The intracellular caspase activity was measured by the caspase-3 substrate N-acetyl-asp-glu-val-asp-7-amino-4-methylcoumarin. Phosphatidylserine exposure and membrane permeability to propidium iodide [PI] were measured by flow cytometry. Cellular oxygen consumption was inhibited by 2.5 micro M and 25 micro M of AFB[1]. Intracellular caspase activity was noted after two hours of incubation with 100 micro M of AFB[1]. The number of Annexin V-positive cells increased as a function of AFB[1] concentration and incubation time. At 50 micro M, a significant number of cells became necrotic after 24 hours [Annexin V-positive and PI-positive]. The results show AFB[1] is toxic to human lymphocytes and that its cytotoxicity is mediated by apoptosis and necrosis

Salutary value of haruan, the striped snakehead Channa striatus - a review

Murrel namely Channa striatus or haruan contains all essential elements to maintain good health and to recover the lost energy after prolonged illness. The fatty acid composition (% of total fatty acid) indicated the abundant presence of C16:0 fatty acid as 30% and the other major fatty acids were C22:6 (15%), C20:4 (19%), C18:1 (12%) and C18:0 (15%). Haruan contains arachidonic acid (C20:4) as 19.0%, a precursor for prostaglandin and thromboxane biosyntheses. Both fatty and amino acids are important components for wound healing processes. Both the fillet and mucus extracts of haruan were found to exhibit a concentration dependent antinociceptive activity. In vitro antioxidant activity was higher in Channa roe protein hydrolysate than in Labeo roe protein hydrolysate in both DPPH radical scavenging and ferric reducing power. Protein content of roe concentrates (RPC) was found to be 90.2% (Channa) and 82.5% (Lates). Water absorption, oil absorption, foam capacity, stability and emulsifying capacity were found to be higher in Channa RPC than in Lates RPC. Characterization of protein hydrolysates from muscle and myofibrillar samples of haruan showed different kinetic and proteolytic activities. The skin extract of haruan influences the serotonergic receptor system thus they can function as an anti-depressant. Thus, haruan is the best example for food as medicine.

Impact of chewing Khat on the mode of delivery of Yemeni pregnant women

Khat chewing is common among Yemeni women, even during pregnancy where it may affect the wellbeing during pregnancy and during delivery of these pregnant women. This study was conducted to determine the impact of Khat chewing on the mode of delivery of pregnant Yemeni women. This is a prospective study for 60 regular Khat chewing pregnant women and 120 non-Khat chewing pregnant women, selected from those attended with singleton pregnancy in their first or second trimester from the ANC unit of AL-Gamhouri Teaching Hospital in Taiz [Republic of Yemen]. Khat chewer pregnant women, when compared with the control, showed statistically significant risk of 6.06 times to deliver at gestational age earlier than 37 weeks and insignificant risk of 2.27 times to deliver after 42 weeks. They showed a statistically significant risk of 2.65 times to deliver by cesarean section [CS] and insignificant risk of 4.86 times for instrumental delivery. This study concluded that Khat chewing is associated with higher rate of cesarean and instrumental deliveries that may affect maternal and fetal wellbeing

Mitochondrial oxygen consumption by the foreskin and its fibroblast-rich culture

This study investigated the feasibility of using a phosphorescence oxygen analyser to measure cellular respiration [mitochondrial O[2] consumption] in foreskin samples and their fibroblast-rich cultures. Foreskin specimens from normal infants were collected immediately after circumcision and processed for measuring cellular respiration and for culture. Cellular mitochondrial O[2] consumption was determined as a function of time from the phosphorescence decay of the Pd [II] meso-tetra-[4-sulfonatophenyl]-tetrabenzoporphyrin. In sealed vials containing a foreskin specimen and glucose, O[2] concentration decreased linearly with time, confirming the zero-order kinetics of O[2] consumption by cytochrome oxidase. Cyanide inhibited O[2] consumption, confirming that the oxidation occurred mainly in the mitochondrial respiratory chain. The rate of foreskin respiration [mean +/- SD] was 0.074 +/- 0.02 microM O[2] min[-1] mg[-1] [n = 23]. The corresponding rate for fibroblast-rich cultures was 9.84 +/- 2.43 microM O[2] min[-1] per 10[7] cells [n = 15]. Fibroblast respiration was significantly lower in a male infant with dihydrolipoamide dehydrogenase gene mutations, but normalised with the addition of thiamine or carnitine. The foreskin and its fibroblast-rich culture are suitable for assessment of cellular respiration. However, the clinical utility of foreskin specimens to detect disorders of impaired cellular bioenergetics requires further investigation

Relief of chronic shoulder pain: a comparative study of three approaches

Shoulder pain is one of the most common complaints in pain clinics and rheumatology departments, usually originates from trauma, degeneration, inflammation, vascular disease and also be referred from the hand and neck pain or headache. The aim of this study was to compare the effectiveness of continuous suprascapular nerve block under ultrasound guidance versus intra-articular corticosteroid injection of the shoulder and/or physiotherapy in management of chronic shoulder pain and to assess the effectiveness of these methods for relieving pain, improve range of movement of the shoulder and to demonstrate the most suitable method for treatment of such patients. 50 patients with a total of 63 shoulders were randomly divided into Group 1 [23 shoulders] received continuous suprascapular nerve block under ultrasound guidance in addition to rehabilitation program. Group II [20 shoulders] received intra-articular injection of steroid in addition to rehabilitation program. Group III [20 shoulders] received rehabilitation program only. The patients were followed up for 12 weeks and reviewed for Pain, disability, and range of movement data at weeks 1, 4, and 12 after each treatment. The result of our study demonstrates that, from the first week to 12 weeks, there was marked improvement in pain score in all times of follow up, and the best improvement in group I versus group II or III. The disability score showed improvement of non significant difference over the three time periods. Highly significant mean changes were found in group I versus group II and III [p=0.001] as regard SPADI pain, disability, total SPADI score and active movements. After 12 weeks of follow up, RA patients reported significant differences between 3 approaches of treatment [SSNB was the most effective one] as regard SPADI pain and total SPADI scores but frozen shoulder patients showed significant difference between three groups as regard SPADI pain only. Combination of physical treatment with Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in frozen and arthritis. It improves pain, disability, and range of movement of the shoulders compared with intra-articular corticosteroid injection of the shoulder and/or physiotherapy alone. SSNB is a useful adjunct treatment for management of chronic shoulder pain. Direct ultrasound visualization significantly improve outcome

Dexmedetomidine versus propofol for sedation in patients undergoing vitreoretinal surgery under sub-Tenon's anesthesia

The purpose of this study was to evaluate the hemodynamic, respiratory effects, the recovery profile, surgeons, and patients satisfaction with dexmedetomidine sedation compared with those of propofol sedation in patients undergoing vitreoretinal surgery under sub-Tenon's anesthesia. Sixty patients were enrolled in this prospective, single-blind, randomized study. The patients were divided into two groups to receive either dexmedetomidine [group D] or propofol [group P]. Sedation level was titrated to a Ramsay sedation scale [RSS] of 3. Hemodynamic and respiratory effects, postoperative recovery time, analgesic effects, surgeons and patients satisfaction were assessed. Both groups provided a similar significant reduction in heart rate and mean arterial pressure compared with baseline values. The respiratory rate values of the dexmedetomidine group were significantly higher than those in the propofol group. The oxygen saturation values of the dexmedetomidine group were significantly higher than those of the propofol group. The expired CO[2] was similar in both groups. Postoperatively, the time to achieve an Aldrete score of 10 was similar in both groups. Dexmedetomidine patients have significantly lower visual analog scale for pain than propofol patients. The surgeon satisfaction with patients' sedation was similar for both groups. The patients' satisfaction was higher in the dexmedetomidine group. Dexmedetomidine at similar sedation levels with propofol was associated with equivalent hemodynamic effects, maintaining an adequate respiratory function, similar time of discharge from PACU, better analgesic properties, similar surgeon's satisfaction, and higher patient's satisfaction. Thus, dexmedetomidine may prove to be a valuable adjuvant for sedation in patients undergoing vitreoretinal surgery under sub-Tenon's anesthesia

Preanesthetic medication in children: a comparison of intranasal dexmedetomidine versus oral midazolam

Relieving preoperative anxiety is an important concern for the pediatric anesthesiologist. Midazolam has become the most frequently used premedication in children. However, new drugs such as the alpha2 -agonists have emerged as alternatives for premedication in pediatric anesthesia. One hundred and twenty children scheduled for adenotonsillectomy were enrolled in this prospective, double-blind, randomized study. The children were divided into two equal groups to receive either intranasal dexmedetomidine 1 microg/kg [group D], or oral midazolam 0.5 mg/kg [group M] at approximately 60 and 30 mins, respectively, before induction of anesthesia. Preoperative sedative effects, anxiety level changes, and the ease of child-parent separation were assessed. Also, the recovery profile and postoperative analgesic properties were assessed. Children premedicated with intranasal dexmedetomidine achieved significantly lower sedation levels [P=0.042], lower anxiety levels [P=0.036], and easier child-parent separation [P=0.029] than children who received oral midazolam at the time of transferring the patients to the operating room. Postoperatively, the time to achieve an Aldrete score of 10 was similar in both the groups [P=0.067]. Also, the number of children who required fentanyl as rescue analgesia medication was significantly less [P=0.027] in the dexmedetomidine group. Intranasal dexmedetomidine appears to be a better choice for preanesthetic medication than oral midazolam in our study. Dexmedetomidine was associated with lower sedation levels, lower anxiety levels, and easier child-parent separation at the time of transferring patients to the operating room than children who received oral midazolam. Moreover, intranasal dexmedetomidine has better analgesic property than oral midazolam with discharge time from postanesthetic care unit similar to oral midazolam

Single-injection percutaneous peribulbar anesthesia with a short needle versus sub-Tenon's anesthesia for cataract extraction

This study compared the efficacy of single-injection percutaneous peribulbar anesthesia [PBA] with a short needle with sub-Tenon's anesthesia [STA] to produce optimal operating conditions for cataract extraction in patients with complicated cataract. Two hundred patients with complicated cataract were enrolled in this prospective, double-blinded, randomized study. Adequate akinesia was a surgical requisite for all cases included in the study because of the expected difficult surgery. The patients were divided into two equal groups to receive either peribulbar anesthesia [PBA] with a 16-mm needle or sub-Tenon's anesthesia. Surgical akinesia [as a primary end point], analgesia, incidence of complications, as well as patient and surgeon satisfaction [as secondary end points] were assessed. Both techniques provided similar analgesia during the operation and similar rates of incidence of chemosis with no serious complications; while the PBA group provided higher degree of akinesia 10 minutes after injection of the local anesthetic, a lower incidence of subconjunctival hemorrhage [SCH] and higher patient and surgeon satisfaction compared to the STA group. We concluded that when globe akinesia is necessary during surgery, the single-injection technique for percutaneous peribulbar anesthesia with a short needle proved to be more suitable than the STA in providing akinesia for cataract surgery. Also, this PBA technique demonstrated a lower incidence of SCH and was preferred to STA by the patients and surgeon

Difficult intubation management in a child with I-cell disease

I-cell disease [mucolipidosis II] is a rare metabolic disorder resulting from the deficiency of a specific lysosomal enzyme, N-acetylglucosamine-1-phosphotransferease. Developmental delay and growth failure are common presentations of I-cell disease. Psychomotor deterioration is rapid and progressive. Some physical signs such as hip dislocations, inguinal hernia, hepatomegaly, joint limitation, and skin changes may be present at birth. Coarse facial features and skeletal abnormalities become more conspicuous with time. The life expectancy of children with this condition is poor, with death usually occurring around the fifth year. A case report of the anesthetic management of gingivectomy with multiple dental extractions in a 5-year-old Omani female with I-cell disease is presented. The problems faced and their management during anesthesia are described

Combined use of remifentanil and propofol to limit patient movement during retinal detachment surgery under local anesthesia

One of the drawbacks of performing ophthalmic surgery under local anesthesia is patient movement, which might affect optimal surgical outcome. The study aims to evaluate the efficacy of the combined use of propofol and remifentanil as a sedative technique in comparison with the use of propofol alone to limit patient discomfort and movement during local anesthesia for vitreo-retinal surgery lasting for more than two hours. A total of 140 patients scheduled for vitreo-retinal surgery under local anesthesia, with an expected surgical time of more than two hours, were included in the study. Patients were divided randomly into two equal groups: group I where patients were given propofol and remifentanil by continuous infusion and group II where patients were given propofol alone by continuous infusion. The two groups were comparable with regard to age, weight, gender, ASA physical status and duration of surgery. There was a significant decrease in heart rate and mean arterial blood pressure [MABP] in each group 10 minutes after the start of sedation compared with pre-sedation data and continued all through the procedure. There was an insignificant difference between the two groups with regard to changes in heart rate and MABP all through surgical procedure. There was no significant difference between the two groups with regard to the incidence of complications except for an increased incidence of breakthrough pain and discomfort which necessitated the use of fentanyl as a rescue treatment in the propofol group P<0.001. There were no instances of movements with a major effect on the surgical field, which could have affected surgical outcome, in the two groups. The number of patients who did not move was significantly higher, 56 [80%], in group I compared with 38 [54.29%] in group II with P<0.001. The ophthalmologist satisfaction scale was significantly higher in group I [4.5 +/- 0.63] compared with group II [3.7 +/- 1.04] with P=0.0016. The combined use of propofol and remifentanil as a continuous infusion before performance of the block and during lengthy vitreo-retinal surgery was associated with a lower incidence of patient discomfort, breakthrough pain, and patient movement along with high degree of surgeons' satisfaction and hemodynamic stability

Anaesthetic management of congenital laryngeal web presenting with acute upper airway obstruction

This is a case of failed intubation in a child of 15 months due to presence of laryngeal web. The airway was maintained by Cole Neonatal tube size 2 mm held at the available orifice of the glottis with maintenance of spontaneous respiration under general anesthesia till emergency tracheostomy was performed

Role of short term out patient video electroencephalography in diagnosis of paroxysmal disorders

To distinguish epileptic seizures from non epileptic paroxysmal events, we often use video electroencephalography [EEG] recording. Long term video electroencephalography recording for inpatients is of good value, but, it necessitates much resources [financial and manpower]. There is some evidence suggesting that short term video EEG [STVEEG] is useful, but its role in practice has yet to be evaluated. To assess the usefulness of STVEEG in the diagnosis of different paroxysmal disorders and classifying epilepsy if present. Thirty sex patients had STVEEG recordings [for 2 hours] during a 15 months period. A diagnostic event was recorded in 21 of 36 [58.3%] within the first 2 hours of monitoring: PNES [n =11], epilepsy [n=5], and other paroxysmal disorders e.g. syncope, hemifacial spasm, movement disorder [n=5]. STVEEG is a useful diagnostic technique in diagnosis of different paroxysmal disorders and it can be used as a successful screening test for saving other resources like prolonged inpatient video EEG recording

Caffeine impairs HL-60 cellular respiration

We investigated the effect of caffeine on mitochondrial O[2] consumption in human promyelocytic leukemia [HL-60] cells. A phosphorescence analyzer that measures O[2] concentrations in cell suspensions as function of time was used for this purpose. O[2] concentrations were determined from the phosphorescence of Pd phosphor, calculated by fitting the phosphorescence decays to exponentials. In sealed vials, O[2] concentrations in the cell suspensions containing glucose declined linearly with time, showing zero-order kinetics for O[2] consumption. NaCN inhibited O[2] consumption, confirming the oxidation occurred in the mitochondrial respiratory chain. A rapid decline in the rate of respiration was observed when 50 [micro]M to 4.0 mM caffeine was added to HL-60 cells in cell growth media [containing 1.41 mM Ca[2+]] or phosphate-buffered-salts [containing 0.91 mM Ca[2+]]. This reversible inhibition was blocked by verapamil and was concentration-dependent, reaching a plateau [43 +/- 7% inhibition] at 50 [micro]M caffeine. The inhibition was not observed when cellular Can+ stores were depleted. T-cell lymphoma [Jurkat] cells and isolated mitochondria were less sensitive to caffeine. Thus, caffeine is a potent inhibitor of HL-60 respiration. This effect is possibly mediated by Ca[2+]-flooding into the cytosol and neighboring mitochondria

Serum amyloid A protein concentration in ankylosing spondylitis and its role in monitoring disease activity

Serum amyloid A [SAA] has been reported to be more sensitive than C-reactive protein [CRP] as a marker of disease activity. It may function in immune regulation and is linked to the development of secondary amyloidosis. We investigated SAA in ankylosing spondylitis patients and compared it with CRP, erythrocyte sedimentation rate [ESR] and interleukin [IL]-6 in relation to disease activity. Using a sensitive and specific ELISA, SAA and IL-6 were measured in the serum of 25 patients with ankylosing spondylitis and in 20 subjects control group. CRP, ESR and clinical disease activity using Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] were also recorded. Patients with AS had a significantly higher mean SAA level than controls [96.34 ug/ml, versus 3.84 ug/ml. p<0.001]. Serum IL-6 had significantly higher level in AS patients than in controls. Although statistical significance was not found, the mean BASDAI score of patients with elevated SAA levels was higher than that of patients with normal SAA levels. It was found that SAA showed significant correlation with ESR, CRP, IL-6 and BASDAI score. Additionally, the correlation between IL-6 and both ESR and CRP appeared to be significant but no significant correlation was found between IL-6 and BASDAI score. In patients with normal ESR and CRP levels, SAA levels showed positive significant correlation with BASDAI score. SAA seems to be an additional very useful disease activity marker used in monitoring of ankylosing spondylitis patients

Electrophysiological study and glutamic acid decarboxylase 65 in detection of subclinical neuropathy in type 1 diabetes mellitus

To evaluate the role of electrophysiological studies and serum glutamic acid decarboxylase [GAD65Ab] in the detection of subclinical neuropathy, in Type 1 diabetes mellitus [TIDM]. This study was conducted on 30 patients of Type 1 diabetes mellitus within the first year of diagnosis and 20 controls. All subjects were evaluated for subjective neuropathy symptoms, neurological examination, electrophysiological findings, GAD65Ab, glycosylated hemoglobin [HbA1], cholesterol and triglyceride in serum. At least two abnormal independent neurophysiological nerve parameters were accepted as the criteria of peripheral nervous system involvement. Electrophysiological study showed peripheral nervous system involvement in 93.3% of patients. The percentages of affection were 90% in sural nerve, 82.4% in peroneal motor nerve, 68.5% in posterior tibial motor nerve, 62.2% in median motor nerve, 59.9% in ulnar motor nerve, 65.2% in median sensory nerve, and 60.5% in ulnar sensory nerve. Antibodies to GAD65 were detected in 18 of 30 patients [60%]. Patients with positive GAD65Ab had slower motor nerve conduction velocities in the median, ulnar, and peroneal nerves and prolonged sural nerve latency. There is a positive correlation between HbA1 levels and peripheral nerve dysfunction in the lower extremity. Highly significant correlation between HhA1 and GAD65 in patients group was noticed. Subclinical diabetic peripheral neuropathy can be detected by electrophysiological tests, especially for nerves of lower extremity. The poor glycemic control and GAD65Ab have an impact on peripheral nerve function