The efficacy, safety and carry-over effect of diacerein in the treatment of painful knee osteoarthritis: a randomised, double-blind, NSAID-controlled study.

OBJECTIVE: To evaluate the efficacy, safety and carry-over effect of diacerein, in comparison to piroxicam, in the treatment of Thai patients with symptomatic knee osteoarthritis (OA). DESIGN: This was a double-blind, randomised, piroxicam-controlled, parallel-group study. A 7-day non-steroidal anti-inflammatory drug washout period was followed by a 16-week treatment period with either diacerein 100mg/day or piroxicam 20mg/day, and an 8-week treatment-free observation period. The primary efficacy criterion was pain on Western Ontario and McMaster University Osteoarthritis (WOMAC) A. The secondary criteria included WOMAC B, C and total WOMAC, paracetamol intake, Short Form-36 questionnaire and global judgements on efficacy and tolerability by patients and investigators. RESULTS: Of 171 randomised patients, 150 completed the study and 161 were analysed in the intent-to-treat population (diacerein: 82, piroxicam: 79). Pain (WOMAC A) decreased to a similar extent in both groups at Week 16 (diacerein: -69.7%+/-31.5%; piroxicam: -74.1+/-26.2%; P=n.s.). On treatment discontinuation, pain increased in the piroxicam group at Weeks 20 (-47%+/-47.8%) and 24 (-26.8%+/-60.6%) while improvements persisted in the diacerein group at Weeks 20 (-66.9%+/-35.9%) and 24 (-69.5%+/-33.7%), with a significant difference in favour of diacerein at Weeks 20 and 24, demonstrating the carry-over effects of the drug. The incidence of adverse events was similar in both groups but more patients from the piroxicam group dropped out of the study due to these events. CONCLUSIONS: Diacerein was as effective as piroxicam in reducing pain and improving function but, unlike piroxicam, displayed a carry-over effect and a better safety profile.

Results of stroke rehabilitation in Thailand.

OBJECTIVE: The purpose of this study is to identify predictors of functional outcome after acute to sub-acute stroke rehabilitation using raw FIM score and results of stroke rehabilitation in Thailand. DESIGN: Descriptive and multivariate analysis was performed on data collected prospectively from 50 patients who were on stroke rehabilitation at Thai Red Cross Rehabilitation Center from October 1, 2000 to September 30, 2001. Six independent variables were obtained from patients' medical records. RESULTS: The total FIM scores at the time of discharge and total FIM scores gain are strongly correlated with the total FIM scores at the time of admission to the hospital and correlated negatively with age using multiple linear regression analysis, significant at p < 0.05. The equation for all cases were: (discharge total FIM scores) = 82.856 + 0.708 x (admission total FIM scores) - 0.408 x (age) and (total FIM scores gain) = 82.85 - 0.292 x (admission total FIM scores) - 0.408 x (age). The models explained 76.48% of variation for total FIM scores at the time of discharge and 45.66% of variation for total FIM scores gain. The total FIM scores at the time of admission and age were the best predictors of the total FIM score at the time of discharge and the total FIM scores gain. However, the nature of stroke, gender, onset to admission interval (OAI), and length of rehabilitation stay (LOS) were not statistically significantly correlated with the total FIM scores at the time of discharge and the total FIM scores gain. CONCLUSIONS: Because the total FIM score at the time of discharge and the total FIM scores gain are highly correlated with the total FIM scores at the time of admission and age, we can inform the patient and their family about the possibility of recovery, and assess the amount and quality of care needed at home or placement after discharge.

Somatosensory evoked potentials in X-linked recessive bulbospinal neuronopathy: a case demonstration.

Clinicopathological findings in X-linked recessive bulbospinal neuronopathy were characterized by loss of myelinated fibers in the fasciculus gracilis and depletion of neurons in the ventral horn throughout the same segments. Clinical profile of this rare motor neuron disease include sign and symptom of lower motor neuron involving bulbar and spinal level with minimal or no sensory deficit. Previous electrodiagnostic findings consist of electrophysiological evidence of anterior horn cell disease and decreased or absent sensory action potentials in the peripheral nerve. The role of somatosensory evoked potential which can uncover the involvement of posterior column has never been probed. We report a 22-year-old man who had a clinical syndrome of X-linked bulbospinal neuronopathy. The peripheral electrodiagnostic studies supported the evidence of prolonged anterior horn cell disease and decreased sensory response. The median SEPs revealed delayed N11-N13 and N13-N20 interpeak latencies representing demyelination in fasciculus gracilis of upper cervical cord. Therefore, the median SEPs, an uninvasive procedure, can be used as a supportive method to identify sensory neuronopathy with posterior column lesion in this syndrome, especially when the patient has no obvious sensory and endocrine symptom.

A controlled clinical trial of multidisciplinary team approach in the general medical wards of Chulalongkorn Hospital.

The benefits and acceptability of a strengthened physician-nurse collaboration and a multidisciplinary team approach are demonstrated in the medical wards of a Thai acute-care hospital (Chulalongkorn University Hospital). The strengthened physician-nurse collaboration should be introduced or strengthened in all medical wards. Because of the lack of appropriately trained personnel, concentrating resources into a small unit or ward may be the appropriate measure at present if a multidisciplinary team approach is to be integrated into the medical ward of acute-care hospitals in South East Asia.