Thermal tactile Vs. Neuromuscular electric stimulation in the rehabilitation of stroke-induced dysphagia

To study the effect of neuromuscular electric stimulation on the swallow functional score in stroke patients having dysphagia and compare the effect of neuromuscular and thermal tactile stimulation on its rehabilitation. Fifty patients with dysphagia due to stroke were included. They were divided into two equal groups according to the rehabilitation programs they received. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. Group II received tactile thermal stimulation on the anterior faucial arch one hour daily for 12 weeks. Swallow functional score for dysphagia assessment using the modified barium swallow [MBS] was done for both groups, at the start and at 4 weeks, 8 weeks and 12 weeks. No statistically significant difference was detected between Groups I and II as regards the swallowing score at the start, 4 weeks and 8 weeks [p>0.05]. But there was a statistically significant higher score at 12 weeks [p<0.05]. There was a statistically significant higher change in the score from the start till 12 weeks in Group I as compared to Group II [p<0.05]. Also, there was a higher dysphagia score with hemispherical lesions over the 12 weeks of rehabilitation program in Group I [p<0.05] which was seen only in patients having chest problems in Group II [p<0.05]. The electrical stimulation has the advantage of being Non-invasive and actively assisting swallowing. Thus it can be used as an alternative treatment for dysphagia. It also helps in the restoration of the normal swallowing mechanism and decreases the incidence of the subsequent complications of dysphagia. To use neuromuscular electric stimulation of the neck muscles instead of thermal tactile stimulation in rehabilitation of dysphagia secondary to stroke. Further studies are needed to detect its long term effect on dysphagia rehabilitation

Possible role of serum thrombomodulin as a mediator of endothelial cell damage in systemic sclerosis

The aim of this study was to find out the role of thrombomodulin as a mediator of damage to endothelial cells in systemic sclerosis patients. This study was carried out on 20 systemic sclerosis patients who used to attend the Outpatient Clinic of the Rheumatology and Rehabilitation Department of Ain Shams University Hospitals. All patients fulfilled the American College of Rheumatology criteria for diagnosis of systemic sclerosis. Ten age and sex matched healthy controls were also included. Determination of serum thrombomodulin [TM] level was done for both patients and controls using sCD141 thrombomodulin kit, which is a solid phase sandwich enzyme linked immunosorbant assay [ELISA]. Serum TM was higher in the patients group than in the control group with a highly significant difference [t=6.75, p<0.001]. There was also, a significant difference between the level of serum TM in patients with Raynaud's phenomenon, digital ulcers and interstitial pulmonary fibrosis as compared to those without these clinical manifestations [t=0.034, 0.013, 0.25 respectively, p<0.05]. There was a significant positive correlation between serum TM level and the duration of illness, Raynaud's phenomenon, digital ulcers and interstitial pulmonary fibrosis [r=0.69, 0.48, 0.58, 0.49 respectively, p<0.05]. Also, there was a significant positive correlation between serum TM level and ESR and serum urea [r=0.72, 0.61 respectively, p<0.05]. We can conclude that the serum level of TM was higher in our patients and this may reflect its pathogenetic role [through endothelial cell damage] in systemic sclerosis

Soluble urokinase plasminogen activator receptor in plasma and synovial fluid of rheumatoid arthritis and knee osteoarthritis

To determine the level of soluble urokinase plasminogen activator receptor [suPAR] in the plasma and synovial fluid of rheumatoid arthritis [RA] patients and osteoarthritis [OA] patients in comparison to normal healthy subjects, in order to find out its possible role in the pathogenesis of these diseases and to detect whether it can be used as a marker of disease activity and severity. Our study was conducted on 53 subjects. 23 rheumatoid arthritis [RA] patients, 20 patients having knee osteoarthritis [OA] and 10 healthy subjects served as the control group. suPAR level in plasma and synovial fluid of all subjects was measured by ELISA technique. The mean value of soluble urokinase plasminogen activator receptor [suPAR] in plasma and synovial fluid of RA patients was highly significantly increased in comparison to OA patients and healthy subject [p<0.001]. The mean value of plasma suPAR level was also higher in OA patients than healthy subjects but no significant difference was found between them [p>0.05]. While its value in the synovial fluid was significantly increased in OA patients than healthy subjects. Also, no significant difference was found between plasma and synovial fluid suPAR level in RA, and the control group [p>0.05]. While a highly significant difference in its level was found between them in OA patients. There was a significant positive correlation between plasma and synovial fluid level of suPAR and age, duration of disease and disease severity in RA patients. While no significant correlation was found in RA patients between both plasma and synovial fluid level of suPAR and sex, rheumatoid factor sero reactivity, tenderness, swelling [or any of the clinical data], ESR, disease activity index and type of drug received. Also no significant correlation was found between synovial fluid level of suPAR in OA patients and age, and disease severity. A significant positive correlation was found between plasma and synovial fluid level of suPAR in RA patients. The highly significant in crease in the level of suPAR in both plasma and synovial fluid of RA patients compared to other studied groups and the significant correlation between both plasma and synovial fluid suPAR level and disease severity may clarify its possible role in the pathogenesis of RA and may reflect the destructive and erosive nature of this disease. So suPAR appears to be a useful marker that reflects disease severity in RA patients. Also the significant increase in the synovial fluid suPAR level in OA patients in comparison to the control group suggest that alterations in the PA/PAR system also occur in OA and thus might contribute to the pathogenesis of this disease. Since there was no significant difference in the level of suPAR between plasma and synovial fluid, therefore we suggest measuring plasma suPAR only. Also no correlation was found between plasma and synovial fluid suPAR level and disease activity. This needs further extended studies to confirm this result, as it will determine the value of suPAR as a marker of disease activity