Evaluation of postural instability in IDDM patients: relationship with staging of diabetic peripheral neuropathy

The objective of this study was to use posturography to assess control of balance under static and dynamic conditions in patients with insulin dependent diabetes mellitus [IDDM], and to investigate relationship between the severity of IDDM peripheral neuropathy [PN] and postural stability. Computerized dynamic posturography [CDP] was used to assess postural stability and to investigate its relationship with staging of PN using sensory Organization Test [SOT]. Sixty IDDM patients were included in the study. According to the clinical and electrophysiological evaluation, patients were divided into four groups: severe, moderate, mild and absent neuropathy. Patients with absent neuropathy were taken as controls for other groups. SOT showed significant dysfunction of somatosensory function of type two diabetic patients with peripheral neuropathy. Posturographic parameters [Dynamic test conditions SOT4, SOT5, SOT6 and Composite Equilibrium score [ES] were all significantly impaired in IDDM patients with PN. ES also showed a direct relationship to the severity of neuropathy. Posturographic study allows a disclosure of the failure of postural control in IDDM patients with PN even in the absence of clinical evidence of postural instability

Hand disability related variables in an Egyptian female RA patients sample

The aim of the present work is to study hand affection in Rheumatoid Arthritis [RA] in an Egyptian female sample to establish a map of lesions underlying the rheumatoid hand dysfunction using clinical, laboratory and imaging techniques. This study comprised 100 adult female RA patients. They were clinically assessed for pain using visual analogue scale [VAS], joint tenderness using Ritchie Articular Index, assessment of grip strength, assessment of functional ability using Health Assessment Questionnaire [HAQ], and assessment of hand function using Sequential Occupational Dexterity Assessment score [SODA] patients were subjected to the following laboratory investigations: full blood picture, ESR, C-reactive protein concentration and rheumatoid factor. Radiological investigations included plain X-ray examination and Magnetic resonance imaging. SODA score for hand dexterity had highly significant correlations with disease duration, morning stiffness, ESR, Ritchie index, VAS, HAQ, Duke index disease activity, and hand grip [p<0.001 for all]. It was significantly higher in patients with muscle wasting, deformity and tenosynovitis of the hand, moreover, it showed highly significant correlations with X-ray score and MRI scores. SODA score for hand dexterity had highly significant correlations with clinical findings. SODA score is valuable for evaluation of hand disability and disclosure of the underlying clinical, laboratory and imaging variables in RA female patients

Endothelial and platelet activation markers in early and convalescent phases of ischemic stroke: correlation with clinical and functional disability

The soluble form of selectins in the blood may play an important role in the pathophysiology of atherosclerotic ischemic stroke. To determine whether blood concentrations of the soluble form of selectins are elevated among patients with atherosclerotic ischemic stroke, whether their concentrations in blood correlate with clinical and functional disability and to estimate differences in their levels between lacunar and territorial strokes. We measured the serum levels of soluble E-selectin [sE-selectin] and soluble P-selectin [sP-selectin] during the early and convalescent phases of 37 patients with ischemic stroke compared to controls. We, also did correlation analysis between their levels at baseline and after 3 months with clinical and functional disability scores [National Institutes of Health Stroke Scale-NIHSS-and Barthel Index-BI-respectively]. Levels of sE-selectin and sP-selectin in stroke patients were significantly elevated compared with controls during the early phase, with significant fall in their levels below baseline measurements and below those in controls after three months. sE-selectin levels after 3 months correlated with a better functional status as measured by BI, while sP-selectin levels didn't show any correlation with clinical or functional scores. No significant differences were found in the course of sE-selectin, sP-selectin levels between lacunar and territorial strokes. The evaluation of endothelial and platelet markers would represent the pathophysiological status of stroke. This may offer the possibility of researching the application of antagonists and/ or activity modulators of some of them in ischemic brain disease therapy

Clinico - epidemiological pattern and survival in colorectal cancer: an inter institutional comparative study

Seventy-four patients with colorectal cancer were treated at King Abdul-Aziz Hospital and Oncology Center [KAAH], Jeddah, as well as 105 patients were treated at National Cancer Institute [NCI], Cairo. Surgery in the form of hemicolectomy or anterior resection was performed for patients with colon cancer and abdominoperineal resection [AP] or low anterior resection [LAR] for rectal cancer. Adjuvant 5-FU based chemotherapy was used for one year in addition to postoperative radiotherapy to patients at high risk of recurrence. The patients were followed up for a median of 27 and 29 months for KAAH and NCI patients, respectively. It was apparent that colorectal cancer occurred at a younger age among Egyptian population. There was a survival advantage for NCI patients, particularly females with early stage cancer rectum and particularly who have undergone low anterior resection. This subset of patients at KAAH had an exceptionally older age compared with their correspondings at NCI, a factor, which might compromise the choice of surgery for those patients. It was recommended that surgery should be optimized irrespective of age, gender or stage of the disease with a better utilization of the different diagnostic modalities as well as adjuvant therapies to achieve the highest control and survival for this disease

Survival and prognostic factors in differentiated thyroid carcinoma-ongoing controversial Issue

Eighty-one patients with thyroid carcinoma have been treated at King Abdul Aziz Hospital and Oncology Center, Jeddah, KSA between 1992 and January 2000. They were referred postoperatively to Oncology Center for radioiodine ablation, hormone suppression +/- external irradiation. Their mean age was 39 years, with a peak in the 4th decade and follicular carcinoma patients were older than those with papillary carcinoma [median 42 Vs 35]. Females represented 76.6%, with female to male ratio 3.2:1. Diagnostic work up revealed that only 22.2% performed fine needle aspiration [FNA], 37% performed preoperative thyroid scan and 92.5% performed thyroid ultrasonography. Papillary carcinoma represented 84% Vs 12% for follicular carcinoma and the rest were medullary and anaplastic carcinoma. Survival analysis was performed for differentiated thyroid carcinoma patients only [78 patients]. Over a mean follow up of 42.6 months, the mean values for locoregional free survival was 35.4 months, distant metastases free survival was 38.1 months and overall survival was 38.5 months. Correlation of survival parameters with the different prognostic factors showed statistically insignificant difference for age variable [above and below 40 years], gender, tumour size [less or more than 4 cm diameter], presence or absence of cervical adenopathy, type of pathology and extent of surgical resection [lobectomy Vs. thyroidectomy in papillary carcinoma patients]. But there was a borderline statistical significance difference [p=0.07] for locoregional disease free survival for patients with or without capsular invasion. Also, there was a statistical significant difference [p=0.02] for distant metastases free survival and overall survival [p=0.02] for patients with or without vascular invasion. The estimated overall 5-year survival was 96.8% and it was 80% for patients with vascular invasion and 97.6% for paints without vascular invasion. The rate of local recurrence and distant metastases in correlation with the different risk factors showed only significance for capsular and vascular invasion. The prognostic impact of age, gender, cervical adenopathy, size of the nodule, pathological subtypes and extent of surgical resection needs a longer follow-up to clarify the exact significance of those factors; However, capsular and vascular invasion carried a worse prognosis on loco-regional, distant metastases and overall survival on short term follow-up, hence those patients should be treated aggressively. FNA should be one of the main diagnostic methods of malignancy, by which unnecessary surgery for benign conditions could be avoided. We have to expand our efforts to identify high-risk patients more accurately, thereby facilitating a more rational approach to treatment and till this time lobectomy for papillary carcinoma should be extremely restricted even for low risk patients to those in whom surgical morbidity is highly expected