Diagnostic and prognostic value of some biochemical markers in early knee osteoarthritis

Osteoarthritis [OA]; the most common joint disease, is not only characterized by cartilage destruction; but also by alteration of bone and synovial tissue metabolism, though their relative importance in the initiation and progression of OA is still debated. To identify patients with a high risk for destructive OA, more sensitive techniques than plain X-rays are needed. To study the diagnostic and prognostic value of some biochemical markers serum hyaluronic acid [HA] and serum cartilage oligomeric matrix protein [COMP], high sensitive C-reactive protein [hs-CRP] in the included patients had early OA knees and their relation to disease progression. Sixty patients had early knee OA and 20 control subjects were included. WOMAC index, laboratory investigations [COMP, HA, hs-CRP] and radiological evaluation [Kellgren and Lawrence grading scale and Thomas compartmental score] were performed for each patient at baseline and after one year. HA was significantly higher in patients than controls [p > 0.001] with the highest specificity and positive predictive value. It was significantly correlated with COMP at baseline and after one year [p = 0.01]. The levels of HA at baseline correlated with its levels after one year [p > 0.001]. It also correlated with K-L grading score [p = 0.02]. COMP was significantly higher in patients than controls [p > 0.001]. It was significantly correlated with Thomas score after one year [p = 0.007]. Baseline levels of COMP correlated significantly with its levels after one year [p = 0.005]. The differences of the serum levels of hs-CRP at the baseline evaluation and after one year between patients and controls were not statistically significant [p = 0.4, 0.5, respectively]. The measurements of HA and COMP may be of diagnostic and prognostic value in differentiating patients with early joint destruction and in determining disease progression. A single biochemical marker has definitive diagnostic value and the combination with other biochemical markers as well as with clinical and radiographic data would most likely help to improve the clinical assessment of patients. Serum hs-CRP is not a good predictor of individual patient progression and has a poor sensitivity and specificity

Platelet count/bipolar spleen diameter ratio for the prediciton of esophageal varices: the special egyptian situation

Esophageal variceal hemorrhage is a devastating complication of portal hypertension that occurs in approximately one-third of cirrhotic patients. We assessed the value of the platelet count/ bipolar spleen diameter ratio as a noninvasive parameter for the prediction of esophageal varices [EVs] in Egyptian cirrhotic patients. Laboratory and ultrasonographic and imaging variables were prospectively evaluated in 175 patients with liver cirrhosis. All patients underwent upper gastrointestinal endoscopy. Patients with active gastrointestinal bleeding at the time of admission were excluded. The platelet count/ bipolar spleen diameter ratio in patients with Evs was significantly lower than in patients without EVs. In an analysis of the receiver operating characteristic curves [ROCs], we calculated an optimal cutoff value of 939.7 for this ratio, which gave 100% sensitivity and negative predictive values, 86.3% specificity, a 95.6% positive predictive value, and an area under the ROC curve of 0.94 +/- 0.02, reflecting its overall diagnostic accuracy. These findings were extended to a subset analysis of compensated cirrhotic patients. The platelet count/ bipolar spleen diameter ratio has excellent accuracy in the noninvasive assessment of Evs in patients with compensated or decompensated liver cirrhosis. It is easy to calculate and can lower the financial and sanitary burdens of endoscopy units, especially in developing countries

CT guided biopsy from spinal lesions

To evaluate feasibility of CT guided per-cutaneous spinal biopsy in obtaining specimens for histopathological and bacteriological examination. twenty two patients with spinal lesions observed at CT or MRI examinations underwent spinal biopsy under CT guidance, spinal needles, tru-cut needles and ostycut needles were used. The posterolateral approach was preferred for accessible lesions and transpedicualr approach for vertebral body lesions. The Obtained samples sent for histopathological and bacteriological examination. CT guided biopsy was successful in obtaining sufficient materials for histopathological examination in 90.9% of cases. No complications were encountered. Percutaneous spinal biopsy is highly effective for help in the diagnosis of spinal abnormalities to guide management decisions

Ultrasonographic and color doppler evaluation of adnexal masses

This is a prospective study conducted on 30 patients with adnexal masses, presented at El-Minia University Hospital at Gynecology department. The aim of this study was how to differentiate between benign and malignant adnexal swellings depending on morphological criteria of the lesion by abdominal and transvaginal gray scale ultrasonography and color Doppler and Pulsed Doppler parameters. The examined females ages ranged between 14 to 70 years with a mean age 42.5 year. Dermoid cyst and infected simple cysts were the most common benign lesions evaluated in our study. Mucinous cystadenocarcinoma was the most common malignant lesion detected. We followed an objective scheme for sonographic assessment of adnexal masses depending on morphological criteria including wall thickness, echogenicity, septations and inner wall structure. Our results revealed that this score is sensitive [100 percent] but less specific [56.3 percent]. As this score is numerical so changing the threshold to 10 instead of 9, the score will be less sensitive but more specific. Color Doppler assessment depends upon vessel location whereas central vessels usually indicate malignant lesions while peripheral detection of vascularity with benign lesions. Diastolic notch was present with benign lesions while absent at malignant lesions as neovascularity have no smooth muscle support. Resistive index [RI] at 0.6 was sensitive in differentiation between benign and malignant lesions [100 percent] but less specific [42.9 percent], changing the parameter to 0.4, the sensitivity become 78.6 percent and specificity 85.6 percent. As regards pulsatility index [PI] a cut off 1 gave sensitivity 100 percent and specificity 92.9 percent and accuracy of 96.4 percent. The combination of ultrasonographic scoring system with Doppler indices was able to discriminate between benign and malignant adnexal masses as this combination correctly identified 13 out of 14 ovarian cancer and rolled out the disease in 14 out of 16 benign cases

Clinical and neuroimaging assessement of neonatal asphyxia

This is a prospective study conducted on fifty neonates presented with manifestations of neonatal asphyxia at El-Minia University Hospital. They were 34 male and 16 female. All studied groups were subjected to clinical and neuroimaging assessment [cranial sonar and CT]. Cranial ultrasound was done at 2[nd] day of life, 7[th] day, 1month and 6 months follow up. CT was done at 7[th] day once. Clinical assessment was done according to Apgar score at birth. Hypoxic- ischemic encephalopathy was assessed according to both Sarnat and HIE scoring. Both clinical data and neuroimaging findings were correlated with the outcome of examined newborns. Normal cranial ultrasound at initial examination correlated well with good outcome. Cranial ultrasonography was sensitive in detection of brain edema with no statistically significant difference between it and CT at 7[th] day examination, while CT was more sensitive in detection of extra-axial blood collection. As regards late squeal, ultrasound was sensitive in detection of periventricular leukomalacia [PVL], atrophic changes and ventricular dilatation. So cranial ultrasound is ideal as a screening modality in neonatal HIE and in follow up ICH correlated with poor outcome and also early brain edema had poor outcome. 14 babies died at 6 months follow up. 20 babies developed neurological morbidity in the form of: CP [with or without convulsions] in 9 cases, delayed motor development 4 cases, delayed mental development 3 cases and 4 cases with epilepsy