Genetic variants of ALR (-106C → T /-12C → G) and serum PKC-δ are associated with peripheral neuropathy in Egyptian diabetic patients with impaired handwriting.

Purpose: Diabetic peripheral neuropathy can injure the hand median nerve and cause extensive nerve damage. PKC and ALR are associated with progression of diabetic complications. We hypothesized a genetic association between the ALR polymorphisms (-106C → T/-12C → G) and elevated serum PKC-δ levels in diabetic neuropathy and its adverse effects on handwriting in Egyptian population. Methods: One hundred DPN were compared with 100 DP and 100 healthy volunteers. ALR -106C → T/-12C → G variants were studied using the PCR-RFLP method. A routine set of standard laboratory markers was determined. Serum PKC-δ concentration was determined by ELISA. Logistic regression analysis and areas under the receiver characteristic curves (AUCs) were evaluated to investigate the predictors of diabetic neuropathy. Arabic handwriting was analyzed based on the recognition of functional features, word shape, and ascending/descending parts of letters. Results: Individuals carrying ALR-106C → C and -12G → G had a significantly higher risk of developing diabetic neuropathy than individuals with -106C → T and -12C → G genotypes (P = 0.01, P = 0.02). Carriers of the (-106C → T) CC and (-12C → G) GG genotypes had significantly increased serum levels of PKC-δ, FBG, TC, and LDL-c. PKC- δ serum levels were significantly correlated with glycemic and lipid indicators (P < 0.001). PKC-δ is a significant predictor of diabetes with or without neuropathy at a cutoff value of 16.6, sensitivity was 89%, and specificity 100%. All DPN showed complete deterioration of handwriting after the onset of diabetic neuropathy. Conclusion: The genetic variants ALR-106C → C / -12G → G and PKC-δ in serum may help in the detection and treatment of diabetic neuropathy in Egyptian population before writing performance is affected.

Impacts of deficiency in vitamin D derivatives on disease severity in adult bronchial asthma patients.

Vitamin D affects innate and adaptive immunity processes that impact treatment, severity, and morbidity of acute asthma episodes. Several vitamin D forms may help modulate immunity, including vitamin D2 (D2), vitamin D3 (D3), 25-hydroxyvitamin D3 (25(OH)D3), and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3). This study assessed serum levels of vitamin D derivatives in bronchial asthma patients and their correlation with disease markers. One hundred thirteen subjects, divided into two groups, were enrolled. The first group included 73 asthmatic patients (57 males and 16 females), and the second included 40 healthy adults (31 males and 9 females) as a control group. All subjects were evaluated with a careful history and clinical examination, a chest X-ray with a posteroanterior view, routine laboratory examination, spirometry, and asthma control tests (ACT). Vitamin D serum levels were assessed using ultra-performance liquid chromatography (UPLC) with tandem mass spectrometry. Disease markers were assessed and correlated with serum levels of vitamin D forms. Markers included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC%, peak expiratory flow (PEF), forced expiratory flow25-75% (FEF25-75%), eosinophilic blood count, and total immunoglobulin E (IgE). Asthmatic patients had significantly lower serum levels of vitamin D than healthy controls (p ≤ 0.001). Further, serum vitamin D levels decreased significantly in uncontrolled asthmatic patients than partially controlled and controlled patients. Correlations for 25(OH)D3 and 1,25-(OH) 2D3 were stronger than for D2 and D3. There were negative correlations for eosinophilic blood count, total IgE, and ACT. Serum levels of all vitamin D forms were reduced in asthmatic patients with moderate to strong correlations with disease severity. Vitamin D deficiency or even insufficiency may thus play a role in disease severity.

Total assessment-reassessment & evaluation using bioKinesiologic (TAREK) approach: case presentation for theoretical formulation.

[Purpose] To introduce a new systematic physical therapy evaluation aiming to facilitate the process of examining complicated musculoskeletal cases. [Subject and Methods] The patient was a 20 years old male college student who had major motor vehicle accident one year ago. The patient was poorly responding to physical therapy and he felt that his case was worsening. The complexity of the case dictated a new evaluation with a different approach to resolve the barriers hindering the patient from showing functional improvements. [Results] The new evaluation approach explained many undetermined and stubborn symptoms experienced by the patient. The expert confirmed that the traditional evaluations methods utilized were insufficient to address patient's complaints. [Conclusion] Total Assessment-Reassessment & Evaluation using bioKinesiologic (TAREK) approach is comprehensive evaluation strategy using systematic pathway that guides clinicians to pinpoint the contribution of pathoanatomical structures in producing pathomechanical mobility and poor functional outcomes.

Telemedicine in General Neurology: Interrater Reliability of Clinical Neurological Examination Via Audio-Visual Telemedicine.

INTRODUCTION: While there are several studies on reliability of telemedicine in assessing stroke scales, little is known about the validity of a general neurological examination performed via telemedicine. Therefore, we sought to test the agreement between bedside and remote examination in acute patients of the emergency room. METHODS: Acute patients at the emergency room of a 450-bed academic teaching hospital were included in this study. A clinical neurological examination consisting of 22 items was performed at bedside and also remotely via an audio-visual link by a different neurologist; both were experienced clinicians at the consultant level. Kappa statistics were calculated for each item of the examination. RESULTS: Forty three patients completed both examinations (mean age 58.3 years, 56% female). Patients were seen between 8 and 72 min after admission (mean 36.3 min). Total time for remote examination was 12.6 min (8-21 min) and 8.9 min (5-18 min) for bedside examination. K-coefficients ranged from 0.32 (muscle tone) - 0.82 (language) indicating a fair to excellent agreement in most items. CONCLUSIONS: Remote examination via an audio-visual link produces comparable results to bedside performance even in acute patients of the emergency room. Compared to the scarce data available, inter-observer agreement is about the same as that between 2 examiners at bedside. However, more studies on reliability and validity of clinical neurological examination are required.

Serum SP-D levels as a biomarker of lung injury in children suffering of bronchopneumonia.

The efficacy of SP-D concentration as a useful biomarker of the severity of lung injury in children with bronchopneumonia with or without chronic airway disease was studied. A total of 48 patients (2 to 4 years old) diagnosed bronchopneumonia were admitted to Department of Pediatrics, Al-Dar hospital, Al-Madinah, Saudi Arabia over the year 2009. They were divided into two groups: G1 included patients without any underlying disease and G2 included asthmatic patients. They were assigned to one of three categories. Stage A patients without oxygen dosage, Stage B patients required oxygen dosage, and Stage C patients required ICU admission. We evaluated baseline characteristics, clinical features, and serum SP-D concentration in G1, G2, and G3a (healthy control cross-matched infants). The mean serum SP-D concentrations in G1 and G2 were higher than those in G3 (118.7 +/- 46.2 & 39.7 +/- 18.7 ng/ml, respectively), but also higher in G2 than in G1 (149.9 +/- 52.8 & 109.8 + 36.7 ng/ml, respectively). The mean serum SP-D concentrations were higher in Stage C than in Stages A or B patients, and mean serum SP-D concentrations were higher in Stage B than in Stage A.