Orthostatic hypotension in stroke patients

To assess the incidence of orthostatic hypotension [OH] in stroke patients undergoing rehabilitation and to determine clinical variables associated with it. Thirty patients with a first clinical stroke who underwent rehabilitation within one month of stroke onset were included in this study. They were 17 males and 13 females. Their age ranged from 49 to 68 years [mean +/- SD= 58.1 +/- 6.3]. Patients were subjected to full history taking, thorough clinical examination and investigations. Patients' blood pressure was measured in the supine position and on tilting at 90[0]. OH was defined as a drop in systolic blood pressure [SBP] of 20 mmHg or more. OH was present in 14 [46.7%] patients. Age was highly significantly associated [p<0.001] with OH and admission modified Barthel Index [MBI] score was significantly associated [p<0.05] with OH. There was a non-significant correlation with the site of stroke or the use of anti-hypertensives. OH was common in stroke patients undergoing inpatient rehabilitation especially in older patients who have a lower functional status

Effects of methotrexate and leflunomide therapy on knee synovium of adjuvant induced arthritis as a model for rheumatoid arthritis

Leflunomide and methotrexate have proven to be efficacious in reducing joint inflammation and joint destruction in clinical models of arthritis and in rheumatoid arthritis. The objective of this study was to evaluate the effects of both drugs as well as their combination therapy on the synovium and cartilage of adjuvant arthritis as a model of rheumatoid arthritis [RA] in humans. This study was carried out on forty animals stratified into 5 groups: normal, adjuvant arthritis [AA] control, AA who received leflunomide in a dose of 20 mg/kg orally, AA who received intraperitoneal methotrexate in a dose of 0.3 mg/kg twice weekly and AA who received both leflunomide and methotrexate of the same dose given in groups 3 and 4. All animals were sacrificed after 3 weeks; the right knee was dissected and examined with light microscopy. Oxidants markers [nitric oxide [NO] and malondialdhyde [MAD]] and antioxidants markers [glutathione [GSH], erythrocyte superoxide dismutase [SOD] and ceruloplasmin [CP]] were all measured. All the treatment modalities showed variable degrees of improvement of synovial and cartilage scoring in comparison to AA [the non-treated group]. The leflunomide treated group [group 3] showed the best improvement of synovial pathology, while the combined therapy group [group 5] showed the best improvement of cartilage pathology. The oxidative stress markers showed some changes with different modalities of treatment where, nitric oxide did not change significantly between all groups. Malondialdhyde [MAD] was significantly lower in the methotrexate [MTX] treated group as compared to AA controls. Also, superoxide dismutase [SOD] was significantly lower in the leflunomide treated group, MTX treated group as well as in the group who received combined therapy as compared to AA the controls. Glutathione [GSH] level was significantly decreased with combination therapy as compared to the leflunomide treated group. Serum ceruloplasmin [CP] showed a significant decrease in its level in the MTX treated group as compared to the AA controls. MTX treatment [group 4] was the best in controlling oxidative stress markers. Further study is needed to evaluate the duration and dose effect of each drug on synovium, cartilage and oxidative markers

Soluble selectin adhesion molecules in systemic sclerosis and Behcet's disease

To detect the serum level of soluble E, P and L-selectins in systemic sclerosis [SSc] and Behcet's disease [BD] patients and compare them to normal healthy controls. Also, to determine their relation to clinical parameters of disease activity Serum samples from 15 SSc patients, 10 BD patients and 10 apparently healthy age and sex matched controls were examined with a sensitive linked immunosorbent assay. All patients were evaluated for the presence of gastrointestinal, pulmonary, renal, cardiac, Raynaud's phenomenon as well as joint or muscle involvement. Serum levels of E and P-selectins were highly significantly increased in SSc patients as compared to healthy controls. L-selectin was significantly higher in Raynaud's related scleroderma. Serum level of P-selectin was found to be higher in the diffuse form of SSc. There was no correlation of any selectin and pulmonary fibrosis. As regards BD, there was a highly significant increase in E-selectin and a significant increase in P-selectin in comparison with normal controls. Comparing SSc and BD as regards selectin; there was a significant increase of E and P-selectins in SSc. The values of E and P-selectins were found to be elevated in SSc and BD patients that might reflect their role in the pathogenesis of both diseases. The correlation of E, P and L-selectins with clinical parameters of SSc may help in evaluation of progression or remission of the disease. Further large long term study and serial measurements at different intervals of therapy are needed to correlate it with clinical deterioration or improvement and response to therapy