Comparative Study Between Periostin And Osteocalcin As Biomarkers For Osteoporosis And Fracture Risk In Egyptian Postmenopausal Women

Objective: This study aimed to compare between periostin and osteocalcin as biomarkers in Egyptian postmenopausal women with osteoporosis and to explore their possible relationship with fracture risk. Methods: This study included 90 postmenopausal females recruited from Al-Hussein University Hospital, Cairo, Egypt; divided into three groups; 35 postmenopausal osteoporotic females with low fracture risk (group I), 35 postmenopausal osteoporotic females with high fracture risk (group II), and 20 apparently healthy controls. Serum periostin, osteocalcin, and estrogen were measured by Enzyme Linked Immunosorbent Assay (ELISA). Fracture risk assessment was calculated. Alkaline phosphatase (ALP), total and ionized calcium, Aspartate transaminase (AST), and Alanine transaminase (ALT) were measured spectrophotometrically. Results: The diagnostic performance of periostin for discriminating high fracture risk from low fracture risk groups showed the specificity of (68.6 %) and sensitivity of (100 %), while for osteocalcin the specificity was (51.4 %) and the sensitivity was (68.6 %) respectively. Moreover, the multi Receiver Operating Characteristics (multi-ROC) curve for periostin and osteocalcin together revealed improved specificity and sensitivity of (100 %) each. Conclusion: Periostin was superior to osteocalcin in discriminating high fracture risk from low fracture risk postmenopausal osteoporotic groups. Moreover, dual use of both markers gave the highest discriminative power between low and high fracture risk groups with 100 % specificity and sensitivity.

Khat-induced liver injuries: a report of two cases

Khat is consumed for recreational purposes in many countries, including Yemen, where >50% of adults chew khat leaves regularly. A wide spectrum of khat-induced liver injuries has been reported in the literature. Herein, we report two patients with khat-induced liver injury. Both patients clinically presented with acute hepatitis, one of whom showed radiological evidence of hepatic outflow obstruction. Based on the histological tests, both patients had acute hepatitis, which indicated drug-induced liver injury [DILI] on a background of chronic hepatitis and portal fibrosis; of the two, one presented with symptoms of immune-mediated liver injury

Malignant Phylliodes Tumours: Results of Breast Conserving Surgery and Immediate Reconstruction

Background: Malignant phylliodes tumour (MPT) is a rare breast tumor. Surgery is the mainstay in treatment but varies from local resection to modified radical mastectomy. In this study; we present our experience using wide local excision or subcutaneous mastectomy and immediate breast reconstruction in the management of MPT. Methods and Results: Twenty-three recurrent MPT and ten patients with histological evidence of MPT were included. All patients with recurrent MPT (n=23) had subcutaneous mastectomy; tow centimeter wide excision of the scar and immediate breast reconstruction with either Latissimus Dorsi (LD) myocutaneous flap (n= 10) or Latissimus Dorsi muscle flap (n=13). Seven of the newly diagnosed patients had wide local excision of the tumor; reconstruction with LD muscle flap; tow had wide local excision and reduction of contra lateral breast; and one had subcutaneous mastectomy and silicon implant. The margin resection varied between five and fifteen centimeter in wide local resection group and subcutaneous mastectomy group respectively and the size of tumors varied between five and fifteen centimeters in diameter. Discussion: During the follow up period; which ranged between twenty-four and eighty-four months one local recurrence; was recorded (3.03) and none of the patients had distant metastasis or regional lymph nodes involvement. This approach has secured wider excision of MPT; offered breast reconstruction; and has reduced the chances of recurrence in our patients

Laparoscopic treatment of common bile duct stones: [single stage] laparoscopic approach to cholelithiasis and choledocholithiasis

Treatment options of CBD stones include selective pre or postoperative ERCP, open choledochotomy and one-stage laparoscopic clearance. There are several disadvantages to ERCP including the additional invasiveness of endoscopic procedures, moreover large and/or multiple stones, or impacted stones in CBD may be difficult or impossible to retrieve at ERCP even with ES [endoscopic sphincterotomy]. Peroperative real time cholangiography has the advantage of addressing choledocholithiasis with a single procedure LCBDE [Laparoscopic Common Bile Duct Exploration] while leaving the sphincter of Oddi anatomically intact without added morbidity. The choice of treatment between immediate laparoscopic common bile duct exploration, open exploration of CBD and transsphincteric endoscopic retrieval depends on many factors. A prospective study was designed to visualize and examine the biliary ductal system by laparoscopic intra-operative cholangiography [IOC] during laparoscopic cholecystectomy [LC]. The aim was to visualize the ductal anatomy and any anomalies on filling with contrast [to avoid biliary injury], detect any CBD stones and assess the ductal emptying and patency of ampulla of Vater by immediate contrast flow through the papilla into the duodenum. Intraoperative cholangiography was performed for 302 patients underwent LC for chronic calcular cholecystitis [CCC] in Benha University Hospital from Dec. 1999 to Jan 2004. Among 302 patients underwent LC and intraoperative real-time cholangiography, 31 patients [11.3%] were harbouring silent CBD stones managed immediately for CBD clearance. LCBDE was feasible in 23/31 cases who had choledecholithiasis [74.2%], while 8 patients needed conversion to open choledochotomy. 28 patients [9.3%] had preoperative ERCP, endoscopic sphincterotomy [ES], stone retrieval Operative cholangiography during LC proved residual stones in CBD in 2 of them [7.1%] and were treated by open choledochotomy. LCBDE approach is safe, feasible and effective in management of CBD stones and carries low morbidity and mortality. It has the advantage of intraoperative diagnosis and treatment of choledocholithiasis as a [one step] procedure

Anterior endoscopic spine surgery. A new technique and early results

Endoscopic procedures have been widely used in general surgery for appendicectomy, cholecystectomy and hernia repairs. Video-assisted thoracic surgery is widely applied for pleural biopsy, lung resections and sympathectomy. From the beginning of the last decade endoscopic techniques started to be applied to spine surgery. Indications are increasing, instrumentations and techniques are rapidly refined. This study includes our early experience using these techniques. The study includes 6 cases of anterior spinal release for scoliosis, 2 cases of drainage of tuberculous thoracic cold abscesses, 2 cases of laparoscopic L[5]-S[1] fusion by bone grafts for non-specific discitis and 6 cases of complementary anterior fusion [4 cases for spondylolisthesis and 2 cases for post-laminectomy instability] by threaded cages. The techniques are briefly described; difficulties and complications and early results are discussed

Kaposi's sarcoma: a frequent cause of refractory blood diarrhea in Ugandan patients with AIDS

Between 1990-1992 we performed colonoscopy and biopsy on 123 sequential patients with CDC Group IVC AIDS seen at Mulago Hospital, Kampala, who had persistent bloody diarrhea in excess on one month despite antibiotic treatment. Kaposi's sarcoma-like lesions were noted in 69 [56%]. The lesions were predominantly macular in morphology, localized to the rectosigmoid and ascending colon, and bled easily. Kaposi's sarcoma [KS] was confirmed histologically in 56 [81%] of these patients. Inability to confirm the histology in the remaining 13 patients was attributed to the submucosal location of KS, inaccessible to the biopsy forcepsd. All patients with colonic Kaposi's sarcoma also had KS in the lesions in the skin and/or mouth. Inflammatory and granulomatous abnormalities were noted in 103 patients, accompanied by non-specific histological changes. Stool pathogenes were identified as follows: Cryptosporidium 65 patients; Strongy-Ioides stercoralis 37 patients; Giardia lamblia 8 patients; Entameba histolytica 6 patients; and Ancylostoma 5 patients. Multiple pathogens were seen in some patients. There were no correlations between the individual pathogens, gross or microscopic abnormalities, and the Kaposi's sarcoma-like lesions. Colonic Kaposi's sarcoma was strongly associated with bloody diarrhea in AIDS patients in Uganda

Adult cerebral malaria and HIV infection

In Mulago Hospital, Kampala, Uganda, 73 adult patients with cerebral malaria were screened for HIV antibodies. Thirteen patients were HIV seropositive and 60 patients were HIV negative. There were no significant differences between HIV positive and negative cases concerning depth and duration of coma, response to treatment and neurological outcome. However, HIV positive patients with cerebral malaria run a different clinical course. They showed significantly more recurrent short febrile illnesses before admission in coma and longer duration of fever before presentation. HIV positive patients had significantly more convulsive episodes during coma than HIV negative patients [OR = 4.4 [10.09 - 13.6], P < 0.0051]. Oral candidiasis was only reported in 6 [46%] patients. All were HIV positive. At time of recovery from coma, HIV patients had significantly lower total white cell count [p < 0.005]. We believe that these differences reflect the impact of each infection on the other. We think that frequent malaria attacks in an adult living in endemic area should rise the suspicion of underlying HIV infection

Endoscopy versus radiology in African AIDS patients with oesophageal disorders

Upper gastrointestinal endoscopy and double contrast barium radiology were compared prospectively in 45 Ugandan patients with AIDS and upper gastrointestinal oesophageal symptoms. Both investigating techniques were normal as was the histopathology in 5 patients. In 40 cases a definite pathological diagnosis (candidiasis; non-specific inflammation; malignancy) was made. Endoscopic examination provided a correct disgnosis in 38 cases; while only 15 cases were diagnosised from barium studies. Radiology was normal in 2 cases later proved to have definite pathology on endoscopy and histopathologic examination (oesophageal candidiasis). Endoscopy in this series was found to have 95sensitivity in diagnosing oesophageal disorders in AIDS patients; compared to a sensitivty of 37.5for radiology. The difference between the two procedures regarding sensitivity was statistically significant (p0.005). A combination of oral thrush and dysphagia was strongly associated with oesophageal candidiasis (positive predictive value 95; p0.0025). Endoscopy would be the ideal diagnostic procedure for oesophageal candidiasis. The above finding; however; provide a basis for empirical antifungal theraphy especially in places where diagnostic facilities are limited