Local injection of autologous platelet rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: randomized clinical trial

This randomized controlled study was designed to compare the effectiveness of local injection of autologous platelet rich plasma [PRP] and local steroid in reducing pain and improving function in a cohort of patients with tennis elbow [TE] and plantar fasciitis [PF]. The study population comprised two groups; Group 1 patients with TE [n = 30] and Group 2 patients with PF [n = 30]. In each group patients were allocated randomly to receive either a steroid or PRP injections. All patients filled in visual analog scale [VAS], disability of arm, shoulder and hand [DASH] score for TE and foot health status questionnaire [FHSQ] for PF at base line and after 6 weeks. Relative to TE group of patients significant differences were observed between VAS and DASH scores at base line and 6 weeks after treatment in both groups [p < 0.001]. While no significant differences were observed relative to VAS and DASH score changes between both groups [p > 0.05]. In PF patients comparison of VAS and FHSQ at base line and 6 weeks after treatment between control group and PRP group showed significant differences for VAS [p = 0.005 and p < 0.001, respectively], and for FHSQ [p = 0.03 and p < 0.001, respectively]. While highly significant difference were observed between both groups regarding VAS and FHSQ changes [p = 0.001]. Local injection of autologous PRP proved to be a promising form of therapy for TE and PF. It is both safe and effective in relieving pain and improving function and superior to local steroids in PF

Association of high serum ferritin concentration with metabolic syndrome

The metabolic syndrome affects 25% of western adults. It is closely linked to insulin resistance and implies an increased cardiovascular risk. Studies have shown an association between serum ferritin and one or more metabolic syndrome feature. The association between elevated iron stores and the metabolic syndrome, however, has been less well explored. We investigated the occurrence of iron overload in subjects selected for having metabolic syndrome, and investigated whether the association between elevated iron stores and the metabolic syndrome, if present will be related lo the sex or to the presence or absence of menstruation in females or not. The present study was done on 60 adult patients who have metabolic syndrome and divided into 3 groups; 20 premenopausal females, 20 postmenopausal females and 20 male patients. Age and sex matched 20 normal volunteers [7 premenopausal females, 7 postmenopausal females and 6 males] were taken as controls. Laboratory measurements included total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Serum ferritin, C-reactive protein, fasting serum insulin and plasma glucose. Homeostasis model assessment of insulin resistance [HOMA-IR] was calculated as fasting insulin [micro U/ml] x fasting glucose [mg/dl]/ 405. Mean levels of serum ferritin were significantly higher in metabolic syndrome patients as one group compared to control subjects [168.3 +/- 23 Vs 85.6 +/- 17 micro g/l, p<0.001], the elevation was significant in premenopausal women [112.4 +/- 11 Vs 85.6 +/- 17 micro g/l, p<0.05] and was highly significant in postmenopausal women and in men [145.1 +/- 16 and 199.6 +/- 21 micro g/l respectively Vs 85.6 +/- 17 micro g/l, p<0.001]. Mean levels of serum ferritin were significantly higher in postmenopausal women compared with premenopausal women [145.1 +/- 16 Vs 112.4 +/- 11 micro g/l, p<0.05] and higher in men compared with postmenopausal women but were statistically not significant [199.6 +/- 21 Vs 145.1 +/- 16 micro g/l, p>0.05]. The occurrence of body iron excess in metabolic syndrome patients was 15% in premenopausal women, 30% in postmenopausal women, and 40% in men. Mean values of fasting serum insulin were significantly higher in metabolic syndrome patients as one group compared to control subjects [14.78 +/- 4.3 Vs 12.34 +/- 4.2 micro U/ml, p<0.001]. Mean values of estimated insulin resistance using the homeostasis model assessment [HOMA-IR] were significantly higher in metabolic syndrome patients as one group compared to control subjects [4.13 +/- 1.2 Vs 2.87 +/- 0.09, p<0.001]. Ferritin was positively correlated with W/H ratio, BMI, elevated triglycerides, elevated glucose levels, Insulin and HOMA-IR in metabolic syndrome patients. Elevated iron stores were found in metabolic syndrome patients and it was positively associated with BMI, elevated triglycerides, glucose and insulin resistance

Decreasing soluble intercellular adhesion molecule-1 serum level, has a predictive value for the response to interferon therapy in patients with chronic hepatitis C virus

Intercellular adhesion molecule-1 [ICAM-1] plays a fundamental role during liver inflammation. In fact, weak ICAM-1 expression is physiologically restricted to the endothelium of portal vessels and to sinusoidal lining cells, but it becomes markedly evident on sinusoidal lining cells and at the surface of hepatocytes during inflammatory liver diseases. The aim of this study was to evaluate the level of soluble ICAM-1 [sICAM-1] in chronic hepatitis C [CHC] patients and its changes during interferon [IFN] therapy. Sixty subjects were divided into 2 groups: group A included 40 patients with CHC [subdivided according to their response to treatment into responders and non-responders] and group B included 20 healthy subjects representing the control group. Levels of sICAM-1 were measured in 40 patients with CHC treated with IFN and ribavarin, at baseline and after 3 months of therapy, and in 20 normal control subjects. All the patients were negative for HBV surface antigen. All the controls were negative for HBV surface antigen, and HCV antibody. The levels of sICAM-1 were significantly higher in the patient than in the control subject group [3.40 +/- 1.44 micro g/Lvs. 1.91 +/- 0.34/ micro g/L; p<.001]. Baseline sICAM-1 levels were similar in responders and non-responders [3.58 +/- 1.8 micro g/L vs. 3.24 +/- 1.04 micro g/L; P. NS]. By contrast, the concentration of sICAM-1 decreased significantly only in responders after 3 months of therapy [3.58 +/- 1.87 micro g/L vs.2.50 +/- 0.59 micro g/L; P<.001] and not in non-responders [3.24 +/- 1.04 micro g/L vs. 3.12 +/- 1.02 Pg/L; P. NS]. The probability of response to treatment, analyzed by Kaplan-Meier analysis, was much higher in the group showing a decrease of sICAM-1 than in the patients who did not show such a decrease. In conclusion, a longitudinal evaluation of serum levels of sICAM-1 in the first period of treatment is particularly useful in the identification of patients with high significant probability of response to treatment

Elevated high-sensitive C-reactive protein associates with early-stage carotid atherosclerosis in patients with type II diabetes

To evaluate whether low-grade inflammation contributes to early-stage advanced carotid atherosclerosis in patients with type II diabetes. The mean and maximum [max] intima-media thicknesses [IMT] of the carotid artery were assessed using ultrasound B-mode imaging in 75 patients with type II diabetes [32 men and 43 women, aged 52.1 +/- 3.6 years [ +/- SD], duration of diabetes 9.2 +/- 3.7 years] and 75 age-matched healthy nondiabetic subjects [28 men and 47 women]. High-sensitive C-reactive protein [hs-CRP] levels were measured with a latex-enhanced immunonephelometer. Patients with type II diabetes had significantly higher hs-CRP levels [median 0.35, range 0.05-1.47mg/l vs. median 0.14, range 0.05-1.44mg/l; p=0.001] as well as significantly higher mean IMT and max IMT than the nondiabetic subjects [mean IMT 0.76 +/- 0.09 vs 0.72 +/- 0.04mm p = 0.003; max IMT 0.84 +/- 0.11 vs. 0.77 +/- 0.06mm, p<0.0001]. Hs-CRP levels were significantly correlated with the mean and max IMT of patients with type II diabetes and with the max IMT of nondiabetic subjects. Multivariate regression analyses for both diabetic and nondiabetic subjects as a single group showed that hs-CRP levels are independently correlated with the mean IMT and max IMT levels [p=0.002 and p=0.023, respectively] as well as with diastolic blood pressure, sex and duration of diabetes. Our data indicate that hs-CRP levels are elevated in patients with type II diabetes possibly corresponding with early-stage advanced carotid atherosclerosis

Ultrastructure and types of fimbriae in uropathogenic E-coli among bilharzial patients

The aim of this work was to study the association of different types of fimbriae of urinary E coli isolates with different disease entities. We collected a total of 57 urinary E. coli isolates from 3 groups of bilharzial patients: group 1: with cystitis [21 isolates]: group 2: with pyelonephritis [18 isolates] and group 3: with urinary bladder carcinoma [18 isolates]. Each isolate was studied for: I-fimbrial expression and type determination by haemagglutination [HA] of human and guinea pig erythrocytes, II- Electron microscopic [E/M] structure using negative staining, standard transmission and scanning electron microscopy. It was found that infection with mannose-resistant type I fimbriated Ecoli dominated in group 1 and 3 [80.95% and 77.78% respectively]. In group 2. 55.56% were caused by man- nose resistant P fimbriated Ecoli. Although there was a perfect correlation between HA and the presence of fimbriae by E/M [p< 0.01], yet E/M detected other byres of fimbriae which could have, been missed by HA alone. Negative staining was the best technique in electron microscopy. We concluded that detection of P fimbriae in urinay Ecoli strains may justify a vigorous antibiotic treatment to prevent development of pyelonephritis. Although type I fimbriae was associated with simple cystitis, yet follow up and complete investigations are recommended to detect an .associated carcinoma

Evaluation and monitoring of infection control practices

Nosocomial infections on neonatal intensive care units [NICUs] have been a recognized cause for concern for many years. Blood stream infections are the most frequent nosocomial infections in NICUs. This work was done to evaluate the impact of infection control practices implementation on intra venous fluid [IVF], medication contamination and neonatal sepsis at NICUs. The study was designed to conduct an infection control practice training course at six private neonatal intensive care units at three governorates with evaluation of the results before and after the study. Samples of all available in-use intravenous fluid bottles and previously used bottles, opened medication ampoules and blood samples from the clinically suspected infants were collected and cultured to detect the organisms and their sensitivity to antimicrobial agents before and one month later after the training course. Also infection control practice observation tool was designed and used for evaluation of the infection control practice at each NICU before the study and one month later. The results showed that K. Pneumonia, K. Terregina and Enterobacter were the commonest types of organisms at the pre-training visit; while at the post-training visit, K. Pneumonia and coagulase negative Staph. were the commonest types of organisms. At the pre-training visit, the IVF contamination rate was 62%, the medication contamination rate was 16.1% and the blood infection rate was 64.8%. At the post training visit, IVF contamination rate dropped to 32%, medication contamination dropped to 0% and the blood infection rate to 50%. There is significant reduction in both IVF and medication contamination frequency [P value = 0.000]. The mean score of infection control practices concerning the training aspects are significantly increased at the post-training visit at the six NICUs. A significant positive correlation was found between infection control practice score in the six NICUs and the negative IV fluid [free samples] [r = 0.5 and P = 0.003]

Conclusions: Surveillance of nosocomial infections in NICUs and successful strategies to decrease infections, such as infection control practice and optimal antibiotic use, are warranted. The significant decrease in contamination rate of IV fluids and medications and positive blood culture results after the training practice point to the importance of microbiological culture of in-use IV fluids which could be a helpful adjunct to epidemiologic studies to directly assess the effectiveness of infection control practices related to IV fluid preparation and use, also point to the significance of proper health hygiene in nosocomial infection control

Performance of helicobacter pylori, [HP] stool test in comparison to urea breath test and invasive tests in patients undergoing endoscopy

One hundred dyspeptic patients [52 females and 48 males with mean age 52 years, range 15-69] undergoing gasteroscopy and tested for Helicobacter pylori using non invasive method which detect Helicobacter antigen in stool samples by an immunoenzymatic assay and urea breath test were included in this study. The results of HPSA were compared to urea breath test and invasive tests to detect sensitivity, specificity, positive and negative predictive values of HP stool test. During endoscopic examination, biopsies from antrum and body of stomach were taken for culture, histology and rapid urease; patients were subjected to urea breath test and stool samples were also collected from patients for helicobacter stool antigen enzyme linked immunoassay [Premier platinum HPSA, Meridian Diagnostic]. The results revealed that 56 patients were considered as Helicobacter pylori positive and 44 as Helicobacter pylori negative according to invasive tests and urea breath test. Moreover, 52/56 patients were positive in stool tests whereas 4 were false negative and 36/44 were true negative in stool test whereas 8 were false positive. H. pylori patients as regard 13C-urea breath test and invasive test were treated with omeprazole 20 mg twice daily, clarithromycin 250mg twice daily and metronidazole 400mg twice daily for seven days; at least 4 weeks after the end of treatment, patients were retested with invasive test, breath test and antigen detection. Based on these results, HP stool test has a sensitivity of 93.5%, a specificity of 93.7%, positive predictive value of 98% and negative predictive value of 96.5%

Flowcytometric study of activated lymphocytes in chronic hepatitis C: study of the impact of treatment by interferon

The aim of this work was to study T-cell function in patients with chronic HCV infection. It included 50 subjects [38 males and 12 females] aged between 23 and 42 years old [mean age 30.97 +/- 4.48 years] divided into two main categories. The first category included 40 subjects with chronic HCV infection and further subdivided into four groups [ten patients each] according to the type of treatment received: Group 1 had a long-term remission after interferon treatment, group 2 was on a nonspecific treatment, group 3 did not receive any treatment and group 4 was resistant to interferon treatment. The second category was composed of only one group of ten normal control subjects. All studied subjects were free from all other hepatitis viruses [A, B and D viruses], were not diabetic and did not receive any immunosuppressive drugs either before, during or after the study. All subjects in the different groups were subjected to an immunological profile study which was based on the assays of peripheral blood mononuclear cell [pBMC] including total B-and T- cells, CD4, CD8, NK-cells and CD69 by flow cytometry using monoclonal antibodies. The result of this work revealed no significant statistical difference between the five studied groups. This may be attributed to different CD4 T-cell subsets, termed Th1 that may be activated in individual patient and an efficient virus control or elimination may depend upon an appropriate lymphokine profile of HCV specific CD4 T-lymphocyte

Gamma interferon as a diagnostic marker for tuberculous pleural effusion

This study was performed on 74 patients [45 males and 29 females] suffering from pleural effusion due to different etiologies to evaluate the use of gamma interferon [IFN-gamma] as a diagnostic marker for tuberculous pleural effusion. The patients were classified into five groups according to one or more of the following criteria: Clinical examination, tuberculin intradermal test, histopathological and microbiological examination of both sputum and pleural fluid by ZN stains and culture on Bactec-460 [Becton Dickinson]. The five groups were tuberculous effusion group [30 patients], malignant effusion group [11 patients], empyemic effusion group [10 patients] and nonspecific effusion group [14 patients]. For each pleural effusion, glucose, total protein and albumin were estimated calorimetrically and IFN-gamma was evaluated by radio-immunoassay technique

Blood lead level in children with behavioral and or psychiatric disorders

A case-control study was carried out compromising 60 children enrolled into two groups: Group I included 40 cases suffering from different behavioral and/or psychiatric disorders and group II included 20 clinically healthy children serving as controls. Full medical history taking, assessment of exposure to risk factors of lead poisoning as well as its symptomatology using a standardized questionnaire, thorough clinical examination, delineation of behavior problems using Arabic translated child behavior checklist, diagnosis of psychiatric disorders in the studied cases using DSM IV criteria, scaling of depression and anxiety using children depression inventory [CDI] and child manifest anxiety scale, respectively, for children above the age of eight years, cognitive function assessment, language age and language age delay estimation, complete blood count, blood smear examination, assessment of blood indices and estimation of blood lead level using the technique of flameless atomic absorption spectrophotometry were done for all children enrolled in the current study. The current study showed a significant direct link between blood lead level and inattentiveness, conduct disorder and socialized aggression in the studied sample of cases with behavior and/or psychiatric disorders as well as a significant negative correlation with the patients' cognitive abilities and some hematological variables; namely, hemoglobin and mean corpuscular hemoglobin