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

Clinical significance of anti-cyclic citrullinated peptide [anti-CCp] antibodies in juvenile idiopathic arthritis

Antibodies against cyclic citrullinated peptide [Anti-CCP] are considered to be specific for rheumatoid arthritis [RA]. To assess the clinical significance of anti-CCP antibodies in JIA, i.e. to determine if it can be detected in JIA patients and if they can be used to identify patients with a more destructive course of the disease. Fifty five JIA patients were included in this study. They represented the majority of subtypes of JIA patients. They were 14 boys and 41 girls with mean age 12.5 +/- 2.1 [Range 8-15.5 years] and mean disease duration 4.5 years [range 1-7.5 years]. One or more sera was taken from the patients at different time points of the disease course, 75 sera samples were analyzed using a commercial Kit using an Enzyme Linked Immunosorbent [ELISA] Assay. Our results showed that anti-CCP was positive in 7 patients [12.7%], 5 with polyarticular IgM-RF positive i.e. 5/12 [41.6%] and another 2 with oligoarthritis. This means that there was a significant difference between the prevalence of anti-CCP positivity in polyarticular IgM-RF positive subtypes and the other subtypes [p<0.05]. Disease duration, medications, and antinuclear antibody positivity effect did not show any significant difference between anti-CCP positive and negative patients. Follow up samples at different times also showed no significant difference of the anti-CCP results. Radiological joints damage was seen in 23 patients out of all the patients evaluated [41.8%]. All the patients with positive IgM-RF had radiological changes denoting joint damage, while 5/7 of anti-CCP positive JIA patients [71.4%] had those radiological changes with significant difference between anti-CCP positive and anti-CCP negative patients. Our study showed that anti-CCP autoantibodies can be detected in the sera of juvenile idiopathic arthritis patients, most exclusively in polyarticular IgM-RF positive patients. Longer prospective study with more patients sample will be necessary to verify whether these JIA patients with positive IgM-RF and anti-CCP constitute a differential subgroup with progressive destructive course similar to those of adult RA patients