C - reactive protein levels in cerebral infaarctioninpatients on hemodialysis

Serum C-reactive protein [CRP] concentration issensitive marker of underlying systemic inflammation. Patientsunder continuous hemodialysis have an activated inflammatoryresponse, evidenced by increased serum CRP levels especiallyin patients with cerebral stroke. The study was performed toevaluate serum levels of CRP as inflammatory markers inpatients with stroke under continuous hemodialysis. The study was included 33 patients with chronicrenal failure under continuous hemodialysis divided into twogroups. Group I included 23 patients with acute stroke. Group II [control group] included 10 patients without stroke. All patientswere subjected to complete history and clinical examinationwith special emphasis to history of co-morbid conditions,hypertension, diabetes mellitus and cardiovascular disease.Serum creatinine, urea, CBC, albumin, lipid profile, calcium,fasting and post prandial blood sugar, sodium, potassium, serumuric acid, phosphorus, C-reactive protein and other investigationwere evaluated. In addition axial CT or MRI was performed atadmission and after 72 hours. The following parameterswere significantly higher in groupe I when compared to group II;ages [t=3.5. p< 0.01], CRP [t=7.1, p<0.001], serum creatinine [tett, p<0.0] and blood urea [t=4.3, p<0.01], while serumlevels of Hb% and serum calcium were significantly lower ingroup I when compared to group II [t=3.1, p<0.01 and t=2.2,p<0.05 respectively]. On the hand no significant differences inthe other studied parameters between two groups. Serum levelsof CRP were positively correlated with INR [r=520, p<0.05] and negatively correlated with serum calcium [r=0.580, p<0.05] and serum albumin [r=-540, p<0.05]. On the other hand nosignificant correlations were found between CRP and otherstudied parameters. According to ROC curve between group Iand II in CRP the cutoff were greater than 12 with sensitivity,specificity, Positive Perdictive Value and Negative PredictiveValue were 100% by accuracy 100%. Elevatedserum CRP could be a predictor of cerebrovascular stroke indialysis patients. Therefore, regular determination of serumCRP may be helpful to detect early signs of tissue damage andasymptomatic inflammation in these patients

Study of neuropathic pain among patients with chronic low back pain

Chronic low back pain refers to pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal fold [with or without leg pain] of 3 months or more in duration. Identify the neuropathic pain among patients with chronic low back pain through application of LANSS scale, identify the different aetiogenesis, study the associated medical conditions and socio-demographic features of neuropathic pain among patients with chronic low back pain. The study was carried out at Neurology department of AL Azhar University Hospitals, between Nov., 2006 and Dec., 2008. Sixty consecutive patients were included in the study. All of them suffered from chronic low back pain of 3 months or more in duration. They were subjected to the following: Complete history taking, full general and neurological examination with application of LANSS scale for detection of the neuropathic group. Routine laboratory investigation. Lumbosacral Plain x-ray anteroposterior, lateral and oblique views. Neurophysiological examination [NCS, EMG, SSEP] for the neuropathic group. Lumbosacral MRI for the neuropathic group. Ten normal controls were selected to match patient of neuropathic group in age, height and sex, they were subjected only for neurophysiologic examination [NCS and EMG]. The most prominent clinical features of neuropathic pain among patients presented mainly with neuropathic LBP where paroxysmal pain, dysesthesia, allodynia and altered pin prick threshold. The MRI has highly sensitivity for identification of disc prolapse. The needle electrode examination [NEE] has highly specificity for identification of radicuolopathy. The neuropathic pain is a contributing factor among patients presented with chronic low back pain and was attributed to many factors in our study like compressive radiculopathy, radiculopathy, nonspecific and discogenic cause. LANSS Scale is good bedside diagnostic tool that evaluate the presence of a neuropathic component of the low back pain

Choroidal metastases: clinical and echographic patterns

The purpose of this study is to report the clinical and echographic data from a retrospective series of patients diagnosed of having choroidal metastases. This study included twenty two patients [26 eyes] with choroidal metastases. They were fifteen females and seven males. Their ages ranged from 35-65 years. All the patients were subjected to careful history taking, thorough ophthalmic examination and ultrasonography. At the time of ocular diagnosis of choroidal metastases, 14 patients [63.6%] reported a history of malignancy, while 8 patients [36.4%] had no knowledge about their malignancy. After systemic work up, in the fifteen female patients the primary malignancy site was breast cancer in 12 patients [80%], lung cancer in one patient [6.7%] and unknown in two patients [13.3%], while in the 7 male patients the primary malignancy site was lung cancer in four patients. [57.1%], colon cancer in one patient [14.3%] and unknown in two patients [28.6%]. On ophthalmoscopy visible tumors appeared as yellow or creamy yellow subretinal mass lesions. Exudative retinal detachment was noted in 84.6% of the eyes. On ultrasonography, in 5 eyes [19.2%] the tumors were dome-shaped, and in 21 eyes [80.8%] the tumors were flat and diffuse. In 25 eyes [96.2%] these metastatic tumors had medium to high intemal reflectivity with irregular internal structure, and in only one eye [3.8%] the tumor had medium to low internal reflectivity with irregular internal structure. Bullous non rhegmatogenous retinal detachment and/or choroidal metastases can be the first manifestation of cancer. Ultrasonography, using A- and B-mode criteria, offers an opportunity for high accuracy in the diagnosis of choroidal metastases. The best set of echographic parameters for differentiation of choroidal metastases is moderate to high internal reflectivity, irregular internal structure and a flat shape with irregular surface contour. Routine ophthahlic examination should be included as a part of evaluation of patients with cancers. Prompt detection can provide the patients access to therapeutic modalities reducing their ocular morbidity as well as, overall morbidity and mortality