Rehabilitation outcomes in patients with spinal cord injury: one year follow up

There are many scales and methods for evaluation of spinal cord disability. Only few data are reported about the effect of either early or delayed rehabilitation programs. This study used a simple and reproducible index [Modified Barthel Index] to evaluate patients of spinal cord injury in different stages of their rehabilitation within one year. Forty patients with spinal cord injury were evaluated in this study to find the functional outcomes from rehabilitation program using the 100 point modified Barthel Index [MBI]. Also a comparative study was done between the functional outcome and the level of sensory and motor recovery using Sensory Index Score [SIS] and Motor Index Score [MIS]. Twenty patients had spinal cord injury at the level of cervical spine [tetraplegic] and the other twenty patients were paraplegic [lumbar cord injury]. Serial clinical assessment was done at admission, one month, three months, six months and one year for muscle power, sensation, self care and mobility activities. For the tetraplegic patients, our results showed significant improvement in the self care subscore assessed after six months [P<0.005] and one year [P<0.05] of rehabilitation while the mobility subscore was insignificant in the first 6 months [P> 0.05] and became significant after one year [P<0.02] of training program . The mean MIS showed insignificant improvement during the same period [P>0.05] while the Mean SIS was significantly increased [P<0.05]. A good positive correlation was found between MIS and SIS as well as between them and self care and mobility subscores. The paraplegic patients showed a significant improvement in the self care subscore in the first six months and while the mobility subscore showed a significant increase during the total rehabilitation course [P<0.05], the mean MIS and SIS was insignificantly increased. Correlation studies found a good positive association between MIS and SIS as well as between them and the self care subscore but no correlation was found between the MIS and the mobility subscore. In tetraplegic patients, improvement in self care started after 6 months, while mobility did not improve until 1 year of rehabilitation. Sensory scores improved significantly, but not mobility scores in those patients. Paraplegic patients had early mobility improvement, but the motor and sensory scores did not. Positive correlations were detected between MIS, SIS, self care and mobility in tetraplegics and the same was found in paraplegic patients with the exception of mobility subscores

Bone mineral density in ankylosing spondylitis

We investigated the frequency and distribution of osteopenia osteoporosis according to the clinical severity In ankylosing spondylitis [AS]. Through clinical examination, laboratory investigations and plain radiography were done to all patients. Twenty three patients with AS were recruited to this study and divided according to the disease severity into 2 groups; mild and advanced. Twelve men with a mean age of 36.6 +/- 7.5 years with mild disease of mean duration 8.7 years represented the first group. The second subgroup of patients consisted of 11 men with a mean age of 42.5 +/- 10.1 years with severe disease and a mean duration of 11.7 years. Bone mineral density [BMD] was measured in patients with mild and advanced AS with dual energy X-ray absorptiometry [DEXA]- Definition of clinical severity was based on the Schober's test. Twenty two age-matched male subjects had BMD measurements as a control group. Osteopenia was commonly detected [48% in mild AS and 39% severe AS] and, in mild disease, more frequently observed at the lumbar spine than the femoral neck. In severe AS, however, the frequency of osteopenia at the femoral neck was as high as at the lumbar spine. Both bone mineral density and t-scores in severe disease were lower than In mild disease at the femoral neck, but not in the lumbar spine. The progression of osteopenia/osteoporosis may be reflected more reliably at the proximal femur than at the lumbar spine

Triglyceride and high-density lipoprotein levels as markers of systemic lupus erythematosus activity and their association with TNF-alpha and TNF receptor

There are some clues that measurement of triglyceride [TG] and high-density lipoprotein [HDL] and their correlation with tumor necrosis factor alpha [TNF-alpha]. soluble TNF-alpha receptor type I and type 2 [sTNFR1, sTNFR2] in serum could be valuable in the assessment of disease activity of systemic lupus erythematosus [SLE] patients. In this cross-sectional study, fasting blood samples were obtained from 43 SLE patients fulfilling four or more of the American College of Rheumatology [ACR] 1997 revised classification criteria for SLE. Disease activity was determined by using the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI]. TG and HDL obtained after overnight fasting were analyzed by routine chemistry. Levels of circulating TNF-alpha. sTNFR1, and sTNFR2 were determined by enzyme-linked immunosorbent assay. Triglyceride levels were associated with SLEDAI [r = 0.59. P<0.001]. TNF-alpha [r = 0.27. P<0.01], and with sTNFR1 [r = 0.54. P < 0.001]: on the contrary. HDL levels were negatively associated with SLEDAI [r = -0.29. P<0.007]. TNF-alpha [r = -0.27. P<0.01] and sTNFR1 [r = -0.35. P<0.001]. The correlation of TG and HDL with sTNFR2 were [r = 0.13. P> 0.23] and [r = -0.17. P> 0.1]. respectively. In multiple logistic regression models, the levels of TNF-alpha and HDL were omitted. Dyslipoproteinemia with high TG/low HDL levels correlates with disease activity in SLE. and enhanced activity In the TNF-alpha .sTNFR system. With results of this study and similar studies, serum levels of TG, HDL, TNF-alpha. sTNFR1, sTNFR2 are valuable markers for estimation of disease activity in SLE