Reliability,validity and responsiveness of the Arabic version of the Disability of Arm,Shoulder and Hand (DASH-Arabic)

Purpose: To investigate the psychometric properties (reliability, validity and responsiveness) of the DASH-Arabic in a cohort of Arabic patients presenting with various upper extremity conditions.

Methods: Participants were 139 patients with various upper extremity conditions, who completed the DASH-Arabic at the baseline, 2–5 days later and 30–36 days later. Participants completed demographic data forms, the SF-36 and VAS at baseline, and a Global Rating of Change scale at first and second follow-ups.

Results: Cronbach’s alpha of the DASH-Arabic was 0.94. Test–retest reliability was excellent with an ICC of 0.97. The SEM was 3.50 and the MDC₉₅ was 9.28. Construct validity of the DASH-Arabic with the SF-36 subscales and VAS scores ranged from r??0.32 to??0.57, all statistically significant (p?CI?=?0.72–0.92, p?Conclusions: The DASH-Arabic is a reliable, valid and responsive upper extremity outcome measure for patients whose primary language is Arabic; it can be used to document patient status and outcomes and support evidence-based practice.

• Implications for Rehabilitation

• The DASH-Arabic demonstrated sound psychometric properties of reliability, validity and responsiveness.

• It is an effective patient status and outcome tool that will support evidence-based practice.

• This tool is recommended for evaluating upper extremity work-related injuries and tracking therapeutic outcomes.

     

Retrospective analysis of the causes of rejection of potential donors for living related liver transplantation

Background  A major prerequisite for living related liver transplantation is to ensure both donor safety and optimal graft quality. Therefore, excluding unsuitable donor candidates should be an important priority of the transplant team. Purpose  To analyze the criteria for exclusion of potential living related liver donors. Patients and methods  From November 2000 to March 2005, 327 potential living related donors for 136 potential recipients for liver transplantation were screened and worked up at the Liver Transplant Center, King Abdul Aziz Medical City. They were evaluated in a stepwise manner, including medical, physical, laboratory, psychosocial, and imaging assessment. Data regarding potential donors were retrospectively reviewed. Reasons for rejection of disqualified donors were analyzed. Results  Out of the 327 potential donors, 223 (68.2%) were rejected at an early stage. A total of 104 cases (31.8%) had computed tomographic (CT) volumetry and/or magnetic resonance cholangiography (MRCP). While 44 (42.3% of those who had CT volumetry and/or MRCP) had their workup completed and proved to be suitable candidates, 24 (23%) went for surgery. Causes for donor rejection were classified as donor-related factors (inadequate volume, unsafe anatomy, abnormal liver function tests, medical/psychiatric, fatty liver, etc.; n = 191) and recipient-related factors (too ill, died, received cadaveric transplant, etc.; n = 112). Conclusion  In our experience, as well as in those from other centers, a small proportion of potential donors prove to be satisfactory candidates. Therefore, strict adherence to a stepwise evaluation process is of utmost importance, so unsuitable potential donors can be disqualified, as early as possible during workup.     

Characterization of three types of Schistosoma mansoni soluble egg antigen and determination of their immunodiagnostic potential by western blot immunoassay

On the search of highly sensitive and specific antigenic components for use in serological tests, the serologic activities of the various protein fractions of three types of Schistosoma mansoni soluble egg antigen (SEA) were compared in an immunoblot analysis for their ability to detect schistosomiasis mansoni infections . Three types of soluble egg antigen (SEA) were prepared from three suspensions of Schistosoma mansoni eggs; namely living SEA (L-SEA), dead SEA (D-SEA) and mixed SEA (M-SEA). The three antigens were resolved by sodium dodecyl sulphate polyacrylamide gel electrophoresis. A total of 80 Egyptian individuals were enrolled in the present study. After being screened by clinical examination, urine and stool analysis, sigmoidoscopy rectal snip examination, abdominal ultrasonography and indirect haemagglutination test (IHAT), the study population were grouped into an active intestinal schistosomiasis group (group I, n=20), a schistosomiasis seropositive group by IHA test (group II, n=20), a parasite control group including 10 patients with hydatidosis & 10 patients with fascioliasis (group III, n = 20) and a normal control group (group IV, n=20). Sera of all subjects were studied by immunoblotting for the presence of IgG antibodies against the various protein fractions of the three prepared types of SEA. Several protein bands from the 3 types of SEA reacted with the schistosomiasis patients' sera in a heterogenous manner. However, a 31-32 kilo daltons (kDa) protein fraction of L-SEA reacted with 80% (16/20) of group I sera, 40% (8/20) of group II sera, one hydatidosis serum, but no reaction occurred with normal sera. Also, in the active intestinal schistosomiasis group, the 31-32 kDa fraction of L-SEA was more recognized by patients with early active intestinal schistosomiasis without organomegaly (100%, 12/12) than in those with organomegaly (50%, 4/8) (P < 0.05). On the other hand, a 80-82 kDa band of M-SEA was recognized by 70% (14/20) of group 1, 30% (6/20) of group II & sera from 3 hydatidosis and 2 fascioliasis cases, but not by normal human sera. So, it can be concluded that the 31-32 kDa protein fraction of L-SEA is highly immunogenic, with the least cross reaction with other parasitic infections, and may be a useful serologic marker for diagnosing and differentiating between early and chronic schistosomiasis mansoni infection.     

Prevalence of early repolarization pattern and its association with sudden cardiac death and arrhythmia over one-year follow-up in an Egyptian cohort

Background and objectives

Early repolarization pattern (ERP) is not uncommon electrocardiography (ECG) finding and could be associated with arrhythmia and sudden cardiac death (SCD). We aimed to prospectively determine the prevalence of ERP and its association with arrhythmia and SCD during one-year follow-up in an outpatient Egyptian cohort.

Ovariectomy disregulates osteoblast and osteoclast formation through the T-cell receptor CD40 ligand

The bone loss induced by ovariectomy (ovx) has been linked to increased production of osteoclastogenic cytokines by bone marrow cells, including T cells and stromal cells (SCs). It is presently unknown whether regulatory interactions between these lineages contribute to the effects of ovx in bone, however. Here, we show that the T-cell costimulatory molecule CD40 ligand (CD40L) is required for ovx to expand SCs; promote osteoblast proliferation and differentiation; regulate the SC production of the osteoclastogenic factors macrophage colony-stimulating factor, receptor activator of nuclear factor-κB ligand, and osteoprotegerin; and up-regulate osteoclast formation. CD40L is also required for ovx to activate T cells and stimulate their production of TNF. Accordingly, ovx fails to promote bone loss and increase bone resorption in mice depleted of T cells or lacking CD40L. Therefore, cross-talk between T cells and SCs mediated by CD40L plays a pivotal role in the disregulation of osteoblastogenesis and osteoclastogenesis induced by ovx.     

Contribution of immunoglobulin lambda light chain gene rearrangement analysis in the diagnosis of B-cell neoplasms

Identification of clonal IGH, IGK and IGL gene rearrangements offers diagnostic adjunct in suspected B-cell neoplasms. However, many centres omit IGL analysis as its value is uncertain. A review of 567 cases with IGH, IGK and IGL rearrangement assessed using BIOMED-2 assays showed clonal immunoglobulin gene rearrangement in 54% of cases, of which 24% had a clonal IGL rearrangement. In two cases, the clonal rearrangement was detected exclusively by IGL analysis. This finding demonstrates the added value of IGL analysis for clonality assessment, especially in suspected B-cell neoplasms in which a clonal IGH and/or IGK rearrangement is not detected or is equivocal.     

Dasatinib in imatinib‐resistant or ‐intolerant chronic‐phase,chronic myeloid leukemia patients: 7‐year follow‐up of study CA180‐034

Dasatinib was approved at 100 mg once daily for imatinib‐resistant or ‐intolerant patients with chronic myeloid leukemia (CML) in chronic phase, based on results of the phase 3 CA180‐034 (NCT00123474) study. Here we present the final 7‐year analysis of this pivotal study, the longest follow‐up to date of any second‐generation BCR–ABL1 tyrosine kinase inhibitor (TKI). Patients (n = 670) with imatinib‐resistant or ‐intolerant CML in chronic phase received dasatinib. Nineteen percent of patients continued on study treatment, with a greater proportion in the 100 mg once daily arm remaining on therapy. Seven‐year rates for major molecular response (MMR), progression‐free survival (PFS), and overall survival (OS) were similar across doses; MMR, PFS, and OS results were 46, 42, and 65% at 100 mg once daily, respectively. Improved PFS and OS rates were reported in patients who achieved BCR–ABL1 ≤10% at 3 and 6 months. No new safety signals were identified. The incidence of drug‐related pleural effusion was 28% at 100 mg once daily and 35% at the other three dose groups. Incidence of drug‐related pulmonary hypertension and pulmonary arterial hypertension remained low (≤3% across all doses). Arterial ischemic events occurred in ≤4% of patients across all doses. These data support the long‐term efficacy and well‐established safety profile of dasatinib for patients with imatinib‐resistant or ‐intolerant CML in chronic phase. Am. J. Hematol. 91:869–874, 2016. © 2016 Wiley Periodicals, Inc.     

Diabetes Mellitus Is Associated with Impaired Response to Antiviral Therapy in Chronic Hepatitis C Infection

Insulin resistance may promote hepatic fibrosis in chronic hepatitis C (HCV) and has emerged as a cofactor in failure to achieve sustained viral response (SVR). Aims (1) To assess the association of diabetes mellitus (DM) in HCV patients to the severity of hepatic fibrosis and to the response to antiviral treatment. (2) To assess the safety of pegylated interferon and ribavirin combination therapy (Peg IFN/RBV) in diabetic HCV patients. Methods HCV diabetics (n = 61) were identified. A 2:1 matching control group was used to identify independent factors of advanced fibrosis and treatment failure. Results Compared to HCV non-diabetics, HCV diabetics were more likely to have steatosis (P < 0.0001) and advanced fibrosis (P = 0.003). Patients’ age, Caucasian ethnicity, obesity, and histologic activity index were independently associated with advanced fibrosis (P < 0.05). Only 23% of HCV diabetics achieved SVR compared to 46% of HCV non-diabetics (P = 0.003). DM, genotype 1, high baseline viral load, and African-American ethnicity were independently associated with less SVR (P < 0.05). Significant adverse events were more common in HCV diabetics compared to HCV non-diabetics (P = 0.001). Side effects did not increase in patients receiving PEG IFN/RBV and insulin sensitizers. Conclusion DM was associated with impaired virologic response to PEG IFN/RBV in HCV patients. Adverse events during therapy were more frequent in diabetic compared to non-diabetic HCV patients.