Avascular necrosis of bone in systemic lupus erythematosus

Avascular necrosis [AVN] is a major cause of morbidity in SLE. Several factors have been associated with the development of osteonecrosis in SLE but corticosteroid therapy has been the most consistent. Many factors such as thromboembolism, fat embolism, thrombophilia, hypofibrinolysis, intramedullary haemorrhage, vasculitis and increased bone marrow pressure are related to corticosteroid-induced osteonecrosis. To determine the prevalence of avascular necrosis [AVN] of bone in patients with systemic lupus erythematosus [SLE] and to study the predictive factors for AVN in patients with SLE and its association with other SLE disease manifestations. One hundred consecutive SLE patients, diagnosed according to the updated American College of Rheumatology criteria [ACR], were studied. A full medical history and rheumatologic examination were administered to all patients. Laboratory and serologic tests were also carried out. Systemic disease activity was scored using the systemic lupus erythematosus disease activity index [SLEDAI]. Cases of symptomatic AVN were identified by plain X-ray and magnetic resonance imaging [MRI]. Comparisons between groups of patients with and without AVN, and associations between groups were analyzed by the t-test, Pearson correlation as well as multiple regression models to study the predictive factors for AVN in patients with SLE. AVN was detected in 15% [n = 15] of SLE patients. Osteonecrosis of one hip joint was highly predictor for the other [p = 0.000]. Cumulative corticosteroid dose, Gait disturbance, myalgia and hypertension are the clinical predictors of AVN [p = 0.000, 0,000, 0.001, 0.000], respectively, in the regression analysis model. Haemoglobin and proteinuria were the laboratory predictive [p = 0.000, 0.000], respectively. Lupus patients are at high risk for avascular necrosis [AVN], this risk extended to those on high dose corticosteroid of which patient's screening should be considered and closely monitored by sensitive techniques such as MRI

Topical emulsions stabilized by silica nanoparticles: in vitro release and anti-inflammatory studies of flurbiprofen and diclofenac sodium

Simple and multiple emulsions have a wide range of pharmaceutical applications. Therefore, the stabilization of such emulsions is a challenge to ensure a stable formulation along the period of storage, usage and at the same time to conserve the efficacy of the incorporated medicament. Simple o/w and multiple w/o/w emulsions were prepared using castor and paraffin oils as oil phases and stabilized solely by silica nanoparticles of well-controlled surface properties. Two non-steroidal ant-inflammatory drugs, namely flurbiprofen and diclofenac sodium were incorporated in the stabilized simple and multiple emulsions, respectively. The stability of emulsions and the in vitro release of the drugs from the prepared emulsions were studied. In addition, the anti-inflammatory activity of the drugs from these liquid formulations was assessed using carageenan-induced hindpaw edema in rats. The results indicated that the prepared liquid emulsions, which stabilized with silica nanoparticles, were highly stable. The in vitro release of flurbiprofen and diclofenac sodium from these simple and multiple emulsions showed higher rates compared with those preapred from paraffin oil due to their lower viscosities. The results revealed also that the percentage of oil has a pronounced effect on the in vitro release rates of the drugs from the emulsions. Furthermore, topical flurbiprofen and diclofenac sodium emulsions exhibited a potent local anti-inflammatory activity compared with the orally adminstered drugs in the suspension form and this activity reached its peak [57-84%] 3 hrs after carrageenan injection and persisted for 5 hrs, the period of study

Controllbd-release prednisolone poly [DL-lactide] microspheres: impact of formulation parameters, characterization and release mechanism

The steroidal drug prednisolone was encapsulated into microspheres using the biodegradable polymer poly [DL-lactide] using emulsion-solvent evaporation method. The produced microspheres were characterized using scanning electron microscopy, X-ray diffractometery, FT-IR spectroscopy, DSC, and laser light diffraction. The morphology, particle size distribution, encapsulation efficiency [EE%], and drug release showed marked dependence upon formulation parameters viz. initial polymer concentration, surfactant concentration, drug-to-polymer ratio, and volume of the external aqueous phase. The effect of the addition of hydrophilic additives such as PVP or PEG 8000 was also investigated. The encapsulation efficiency percent and the mean particle size were increased by increasing the initial polymer concentration and drug polymer ratio. On the other hand, increasing the surfactant concentration resulted in decreasing the mean particle size and increasing the drug release from the microspheres. The probable mechanism of drug release was estimated and found to be via diffusion through channels and/or pores present within the polymeric matrix. Release data of almost all formulae fitted Higuchi's planar model better than spherical model. This finding could be due to the small extent of drug release [- 40%], or the presence of a large fraction of the encapsulated drug nearby the surface of the microspheres

Effect of inspiratory muscle training on dyspnea in chronic obstructive pulmonary disease

To evaluate the effect of inspiratory muscle training among COPD patients on the inspiratory muscle strength and severity of dyspnea. Twenty COPD patients were included in this study. They were subjected to thorough clinical examination, Radiological chest assessment, FEV [1]/FVC%, FEV [I] of predicted measurement, maximal inspiratory muscle strength [PI [max]] and dyspnea evaluation, before and after inspiratory muscle training protocol [IMT] for 6 weeks. Dyspnea was evaluated by Mahler's base linedyspnea index [BDI] before IMT and by Mahler's transitional dyspnea index [TDI] after 6 weeks of IMT.All subjects tolerated the training load with a high significant important of FEV[1] /FVC%, FEV[1]% of predicted and PI max which reflects an important of inspiratory muscle strength. There were an improvement in TDI categories when compared to the initial one in BDI as the effort needed to produce certain task was decreased after IMT with a total perception of reduced dyspnea. IMT is of beneficial effects for improving inspiratory muscle strength and reduce dyspnea in COPD. Application of home training programme is recommended for COPD patients

Methylprednisolone as a prophylactic drug aginst multiple organ failure [MOF] in severely injured patients

The objective of this retrospective and prospective study was to assess the prophylactic use of mega doses of Methyl prednisolone to prevent Multiple Organ Failure [MOF] after sever trauma. Review of all severely injured patients who were admitted from Accident and Emergency Department to SICU in Hamad G. Hospital and to surgical dept. in Al Zahraa University Hospital in the period between Jan 1997 to May 1998. Eighty five patients were included based on an injury severity score [I.S.S.] of at least 36. The diagnosis of MOF was based on Multiple Organ Failure scoring system [adapted from Goris et al. 1985]. All patients had received I.V. bolus dose of M.P. [30 mg/kg, body weight within first 6 hours after trauma]. Most of the patients were in the 3 rd decade of life with mean age of [33 years]. Male sex was predominant [90.6%] and the Qatari people followed by the Egyptians occupied the highest number involved in this study [30.6%], [14.1%]. Road Traffic Accident was the most common mechanism of injury [68.2%] followed by Fall from height [21.2%]. The head was the most commonly injured organ [72.9%], followed by the limbs [40.0%], the chest [36.5%], then the abdomen and pelvis. All patients were thoroughly investigated both biochemically and radiologically. CT and MRI as well when indicated. Some patients were submitted to Diagnostic Peritoneal lavage [15.1%] and Ultra sound for [9.6%], one patient exposed to angiographic embolisation. 37 patients [43.5%], had different surgical procedures, craniotomy, chest procedure, laparotomy and orthopedic operations. 7 patients developed MOF [8.2%], within the first week. 85 severely injured patients given Methylprednisolone were studied retrospectively and prospectively. 7 patients [8.2%] developed MOF. This reflect an encouraging result for the use of Methyl prednisolone as a prophylactic drug against MOF in severe trauma patients taking in consideration a high incidence at different centers who are not using Methylprednisolone

Role of arthroscopy in chronic knee effusion

Thirty one patients who had chronic knee effusion [C.K.E.] underwent 31 knee arthroscopic examination. Trauma was the most common cause of C.K.E. [22 patients, 71%]. Subsequent arthrotomy was done for 17 patients [54.8%] and operative arthroscopy was needed for 14 patients [45.2%]. The clinical findings and arthroscopic data were evaluated to estimate the value of arthroscopy and the degree of its diagnostic accuracy [93.5%]. Arthroscopy proved to be useful in 27 cases [87.1%]. The diagnostic arthroscopy was found to be superior to clinical diagnosis [93.5%], espically when the clinical diagnosis was not definite. Probing was very essential for accurate interpretation and diagnosis of synovial, meniscal, ligamentous and chondral lesions. The study recommends arthroscopy as an important routine step in C.K.E. to reach the final diagnosis. Arthroscopy was useful in localizing the underlying pathology and for removal of this causative pathology, or outlying the therapeutic approach for the knee pathology

Monitoring heparin effect in patients at risk of DV thrombosis

This work was designed to find out the optimal investigation [s] for monitoring heparin therapy. 50 patients, 25 males and 25 females, suffering from various cardiopulmonary diseases having or at risk of deep venous thrombosis admitted to ICU of Ain Shams University hospitals were treated with intermittent [4 hourly] I.V. heparin therapy. Blood samples were withdrawn before, 1, 2, 3 and 4 hours after heparin injections and the samples were analysed for ACT, APTT, IT and factor X[a] assay as well as protamine sulphate titration for heparin level and in vitro estimation of heparin level in plasma by APTT and IT. We found that ACT is the most practical and reliable test for monitoring heparin effect as it correlated significantly with heparin level using protamine titration test. It is especially useful when APTT and TT were paralyzed. On the other hand, factor X[a] assay is very unreliable as it measures mainly the anti-X[a] activity of heparin without the antithrombin effect. It was also found that therapeutic levels 3 hours after heparin injection were not significantly different from pre - injection levels denoting increase risk of thrombosis. Thus intermittent schedule for heparin injection is unreliable method of anticoagulation in patients at risk of D.V.T, pulmonary, or coronary embolism

Genital chlamydia trachomatis infection amongst intrauterine device users

The effect of intrauterine contraceptive device on chlamydia trachomatis infection was examined in 160 women attending the family planning clinic at Ain Shams Maternity Hospital. They were asymptomatic. Two endocervical swabs were taken and innoculated into Hela cells, and the sera of these women were examined for chlamydial antibodies by indirect immunofluor scent technique. In group I consisting of 120 women using copper T380 A applied for variable periods with mean age 27.9 years; 6 IUD users had positive chlamydial culture [5%] and 21 of IUD users had positive test of chlamydial antibodies [17.5%]. Group I is divided into 3 subgroups on the basis of duration of application of the IUD; it is found that the duration of IUD use has no effect on the prevalence of chlamydial endocervical infection as regard the detection by the culture method. By serological methods, the prevalence of chlamydial infection in the subgroups of group I [study group], was found to be of no statistical significance. In group II [control group] which included 40 women of mean age 27.5 years, the prevalence of chlamydial infection by the culture method was 2.5%, and the serological method was 12.5%. There was no relationship between the prevalence of chlamydial infection and IUD application regardless the duration of use. Further studies are needed to confirm this finding especially researches concerning with the use of different methods of contraception and using different types of IUDs

Heat stroke and heat exhaustion in pilgrims performing the Haj [annual pilgimage] in Saudi Arabia

Heat stroke and heat exhaustion are not common problems among Saudi Arabians. They are, however, of significance in pilgrims from other parts of the world during Haj season, which varies according to the lunar calendar year. In recent years, Haj has coincided with the summer months of July and August. The temperatures during Haj reach an average high of 54 C [130 F]. Lack of protection and precautionary measures is the primary reason for the high number of heat-stroke and heat-exhaustion cases among the pilgrims, reported cases of which increased from 258 in 1981 to 1, 119 in 1982, due partly to the mandatory reporting system introduced by the Ministry of Health in 1982. The government of Saudi Arabia provides the best possible health services free of charge to all pilgrims. By 1985, there were a total of 4, 635 hospital beds and 64 Makkah Al Mukarramah Body Cooling Units commissioned in the cities of Arafat, Mina and Makkah. In addition, adequate preventive and educational measures are being promulgated to provide better and safer Haj seasons future

Different methods of tension band wiring for transverse fracture patella

A series of patients were suffered from transverse fracture patella. Three methods of treatment were applied. Group I. : Includes 11 cases and treated by tension band wiring. Group II. : Comprises 10 cases and treated by modified tension band technique. Group III. : 10 cases were managed by longitudinal anterior band. The average age was 39 years old. The male to female ratio was 3 : 1. Closed fractures were in 28 cases and open fractures in 3 patients. All cases were followed with an average 12 months. The details of the results and complications in the text. The longitudinal anterior band method obtained better results than the original tension band wiring and the modified tension band technique. The patella is a sesamoid bone, which acts as an intermediate link of cartilage cells making friction of cartilage to cartilage instead of cartilage to tendon[1,2]. From full extension to 90 the patellar facets of the femur articulate with the medial and lateral facets of the patella. Beyound 90 the patella rotates around a vertical axis and shift laterally, in this position the medial femoral condyle articulate with the odd facet[3]. The patella acts as a pulley which displaces the quadriceps tendon anteriorly in extension and this improves the function of the extensor apparatus[4, 5, 6]. It also of cosmetic value especially in females. The aim of this work is the treatment of transverse fracture patella by: 1. The tension band wiring. 2. The internal fixation with two Kirschner wires in addition to tension band wiring. 3. Longitudinal anterior band with or without circulage. A clinico-radiologic studies of the results of these three methods, hoping at finding the proper indication of every method and the advantages of each one