Effect of modifiable and non-modifiable risk factors as predictors of functional outcome of stroke rehabilitation

The old myth that the survival of patients with complete stroke is not sufficiently long enough to justify the great expenses and efforts of rehabilitation has been disproved by recent studies which show that at least 50 percent of the survivors lived for 7.5 years or longer. The risk factors may act as stroke outcome predictors and hence determine the intensity and type of rehabilitation program. To investigate the stroke outcome predictors that will define groups of patients with maximal or minimal benefit from rehabilitation of stroke. This prospective study included 115 Ischemic stroke patients attending the Department of Rheumatology and Rehabilitation, Zagazig University Hospitals, Zagazig Health Insurance Hospital and Zagazig Rehabilitation Centre, Ministry of Social Affairs, Egypt during 2005-2006. All the patients were subjected to full history and clinical examination and routine investigations. We analyzed the influence of modifiable risk factors: diabetes mellitus [DM], hypertension [HTN], ischemic heart disease [IHD] and the duration before rehabilitation and non modifiable factors; age, sex and side of lesion on stroke outcome. All patients received regular rehabilitation and an evaluation at enrolling and discharge, using the modified Barthel Index. The study lasted for 9 months duration. Our results after statistical analysis showed that patients with ischemic heart disease [IHD] showed the greatest improvement after 4 months of rehabilitation. The group of patients without risk co-morbid factor followed and then patients with hypertension [HTN], patients with diabetes mellitus, patients with combined DM and HTN and patients with combined HTN and ischemic heart disease IHD. The group of patients known to have HTN, DM and IHD combined did not show significant improvement. The non modifiable risk factors age, sex and site of cerebrovascular lesion did not show any significant difference although younger patients showed better improvement without significant difference. Modifiable risk factors have a strong effect as predictors of functional outcome at rehabilitation. Patients with more than 2 risk factors as well as late entry for rehabilitation may have bad prognosis

Serum YKL-40 as marker of articular manifestations in inflammatory bowel disease

Articular disease is a well-recognized manifestation of inflammatory bowel disease [IBD].A variety of joint disease patterns were described from oligo to polyarthritis or spondyloarthropathy. The aim of this study was to evaluate serum YKL-40 as a possible marker for articular disease in patients with IBD and to compare it with levels of CRP in these patients. This study included 38 patients suffering from IBD, including UC and CD. Patients with IBD were classified into two groups: Group A included 20 patients without articular manifestations. While Group B included 18 patients with articular manifestations and were subdivided into 3 subgroups according to their articular pattern. Fifteen age and sex matched healthy controls were enrolled as Group C. All patients and controls were subjected to complete history taking with stress on presence of articular disease, full clinical examination, laboratory investigations including: ESR, CRP [Avitex- Latex test] and Serum YKL-40 [MetraT YKL-40 EIA Kit]and radiological assessment. The distribution of articular disease in group B, type III [axial disease] was the commonest [61.1%], followed by type I [oligoarthritis] [22.2%] and lastly type II [polyarthritis] [16.7%]. Serum YKL-40 was the highest in group B, with significant difference when compared with group A and highly significant difference between both groups when compared with controls. While ESR and CRP showed non significant difference between groups A and B but significant difference was recognized when comparing both groups with control group. Also serum YKL-40 was the highest in type II subgroup of group B without any significant difference between the 3 subgroups. The latter observation was also found as regards results of CRP values in these subgroups, but type I was the highest. The mean number of affected joints [NAJs] in the 3 subgroups was the highest in type II without any significant difference between them. While a positive correlation was observed between [NAJs] and serum YKL-40 but no correlation was found between [NAJs] and CRP. SerumYKL-40 may be a useful laboratory marker in IBD which is able to predict the presence and perhaps the degree of joint disease regardless the influence of bowel inflammation. While CRP, although is a sensitive inflammatory marker lacks specificity to joint disease among these patients