[ contribution of the new scale for assessing disability]

The assessment of disability and its management is complex and problematic. With a view to ensuring equality of opportunity between disabled people and others, a new law adopted in August 2005 proposed a new method for assessing disability is applicable on a wider scale by GPs. Assessing the contribution of the new scale for assessing disability in patients suffering from debilitating diseases, to verify compliance in Tunisia. Cross- sectional study on 60 hemiplegic, paraplegic and post traumatic head injuries. The patients underwent clinical evaluation and a functional assessment. The assessment tools used were: the classification of the American Spinal Injury Association, the Barthel index, Glasgow Outcome Scale, Functional independence Measure, the Health Assessment Questionnaire and the Social Function-36. Patients were also evaluated with the new scale of disability. Concerning paraplegic patients, limitations of activity concerned mobility, maintenance staff, domestic life, social relationships, community life and major areas of life. On the hemiplegic, areas related to communication, mobility, maintenance staff, domestic life, social relationships, community life and major areas of life have been affected. We have noted a correlation between the new scale and the Barthel Index. Regarding traumatic brain injury, the areas most affected were those related to mobility, maintenance staff, domestic life and the major areas of life. A correlation was found between the new scale and the Functional Independence Measure in three populations, as well as the quality of life that has been correlated with disability. Disability was observed in 90% of paraplegics, 80% and 50% of hemiplegic patients with severe brain injury. The handicap was the heaviest seen in traumatic brain injury patients with a frequency of 20%. The new scale for assessing disability has reproduced disability and special needs of paraplegic patients, stroke patients and traumatic brain injury

[Functional impairment in patients with rheumatoid pelvispondilyte]

To assess functional impairment in patients with rheumatoid pelvispondylite. cross-sectional study conducted on patients with rheumatoid pelvispondylite. Data are collected in a form specifying the epidemiological and demographic data, disease activity by Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]. metrological static and dynamic examination. Evaluation of functional impairment by Bath Ankylosing Spondylitis Functional Index [BASFI], and likert scale assessing social, economic arid physical disability. 30 patients [22 men], the mean age is 37.2 years old; twenty one patients are without work. The mean duration of disease is 13.36 years, 50%are annoyed by morning stiffness than one hour, spinal pain and fatigue. The average value of BASDAI is 43.72/100: the average value of EVA fatigue is 56.16/100. The average value of BASFI is 56.36/100. An important or very important social economic and physical disability was felt among 67%of the patients, which is correlated with duration of the disease, the BASDAI index, work, and the BASFI index. The functional impairment caused is statistically correlated with the intensity of the pain, the fatigue, the morning stiffness and BASDAI index. This impact on the quality of life is increased by the low level of education and poor professional integration

[Neurogenic bladder in diabetes mellitus]

Diabetic bladder dysfunction is among the most common complications of diabetes mellitus. It is principally caused by autonomic neuropathy defining diabetic cystopathy. Characterize the bladder dysfunction in patients with diabetes mellitus. The clinical and urodynamic records of patients with diabetes mellitus were reviewed. 40 patients with diabetes mellitus were included in the study mean aged 55 years. 32 patients had voiding dysfunction. Urinary frequency and difficulty emptying were the predominant symptoms that led to patient referral. 15 patients [31.25%] had decreased flow rates. 12 patients [37.5%] had diminished bladder sensation and/or impaired detrusor contractility. 10 patients [25%] had detrusor hyperreflexia. And 6 patients had impaired detrusor contractility with increased bladder sensation. Vescico-uretral dyssynergia was found in 2 patients [5%]. This study suggests that classical diabetic cystopathy is not the most common urodynamic findings in patients with diabetes mellitus and demonstrates the importance of urodynamic studies in diagnosing bladder dysfunction in diabetics before initiation of therapy