Platelet-Rich Plasma in Reconstruction of Posterior Meatal Wall after Canal Wall Down Mastoidectomy

Abstract Introduction Canal wall down (CWD) mastoidectomy has many drawbacks, including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). Objectives To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using titanium mesh and platelet-rich plasma (PRP) mixed with bone pate. Methods This study was conducted with 20 patients that have atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by titanium mesh and the mixture of PRP with bone pate. All patients were exposed to a full preoperative evaluation and full postoperative assessment of the complications, the appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results The PMW reconstructed by titanium mesh and the mixture of PRP with bone pate showed a smooth contour. During the follow-up of 12 to 36 months, the postoperative appearance of the external auditory canal contour was found to be smooth without hidden pouches, irregularities or stenosis in all cases. No granulation, foreign body reaction, or extrusion and/or displacement of the titanium mesh were registered. No facial palsy or recurrent cholesteatoma was reported. Conclusion The surgical reconstruction of the PMW using PRP, bone pate and titanium mesh after CWD mastoidectomy appears to be reliable without considerable complications, giving a smooth appearance to the PMW.

FibroScan, APRI, FIB4, and GUCI: Role in prediction of fibrosis and response to therapy in Egyptian patients with HCV infection

Background and study aims: Multiple noninvasive methods have been used successfully in the prediction of fibrosis. However, their role in the prediction of response to hepatitis C virus [HCV] antiviral therapy is debatable. The aim of this study was to validate and compare the diagnostic performance of FibroScan, APRl [aspartate aminotransferase [AST]-to-platelet ratio index], FIB4, and GUCI [Goteborg University Cirrhosis Index] for the prediction of hepatic fibrosis and treatment outcome in HCV-infected patients receiving pegylated interferon and ribavirin [PEG-IFN/ribavirin]

Patients and methods: this study included 182 Egyptian patients with chronic HCV infection. They were classified into two groups based on the stages of fibrosis: mild to significant fibrosis [F1-F2] and advanved fibrosis [F3-F4]. The APRI, FIB4, and GUCI scores were calculated before the antiviral treatment. The FibroScan was performed for all patients before treatment

Results: stiffness and FIB4 have greater sensitivity and specificity in detecting advanced fibrosis of 80%, 77% and 88%, 84%, respectively. Based on multivariate regression analysis, FIB4, body mass index [BMI], and alpha-fetoprotein [AFP] level were found to be statistically significant predicators of advanced fibrosis [p-value: 0.000, 0.011, and 0.001, respectively] with odds ratio [OR: 3.184, 1.170, and 1.241, respectively]. With respect to virological response, the stiffness, APRI, FIB4, and GUCI were significantly lower in sustained virological responders. However, these are not good predictors of response to PEG-IFN/ribavirin therapy. AFP was the only statistically significant predictor of response [p = 0.002] with OR of 1.141 in multivariate regression analysis

Conclution: FibroScan and noninvasive scores such as APRI, FIB4, and GUCI can be used as good predictors of liver fibrosis in chronic hepatitis C. However, they are not good predictors of response to PEG-IFN/ribavirin therapy

Impact of dietary oils and fats on lipid peroxidation in liver and blood of albino rats

<p><b>OBJECTIVE</b>To investigate the effects of different dietary fat and oils (differing in their degree of saturation and unsaturation) on lipid peroxidation in liver and blood of rats.</p><p><b>METHODS</b>The study was conducted on 50 albino rats that were randomly divided into 5 groups of 10 animals. The groups were fed on dietary butter (Group I), margarine (Group II), olive oil (Group III), sunflower oil (Group IV) and corn oil (Group V) for 7 weeks. After 12 h of diet removal, livers were excised and blood was collected to measure malondialdehyde (MDA) levels in the supernatant of liver homogenate and in blood. Blood superoxide dismutase activity (SOD), glutathione peroxidase activity (GPx), serum vitamin E and total antioxidant capacity (TAC) levels were also measured to determine the effects of fats and oils on lipid peroxidation.</p><p><b>RESULTS</b>The results indicated that no significant differences were observed in SOD activity, vitamin E and TAC levels between the five groups. However, there was significant decrease of GPx activity in groups IV and V when compared with other groups. The results indicated that feeding corn oil caused significant increases in liver and blood MDA levels as compared with other oils and fats. There were positive correlations between SOD and GPx, vitamin E and TAC as well as between GPx and TAC (r: 0.743; P<0.001) and between blood MDA and liver MDA (r: 0.897; P<0.001). The results showed also negative correlations between blood MDA on one hand and SOD, GPx, vitamin E and TAC on the other hand.</p><p><b>CONCLUSIONS</b>The results demonstrated that feeding oils rich in polyunsaturated fatty acids (PUFA) increases lipid peroxidation significantly and may raise the susceptibility of tissues to free radical oxidative damage.</p>

Ultrasonographic evaluation of lower limb enthesis in patients with early spondyloarthropathies

The enthesopathy of seronegative spondyloarthropathies [SpA] is the hallmark of these diseases, the ultrasound examination of these entheses confirms the frequency of their involvement. To detect entheseal abnormalities with ultrasound [US] in the lower limb of patients with early Spondyloarthropathy [SpA] and to evaluate US as a valuable tool in detecting early enthesis. A total of 45 patients with early disease duration of 11.7 +/- 8.5 months, including 10 patients with psoriatic arthritis [PsA], 10 patients with ankylosing spondylitis [AS], 10 patients with reactive arthritis [ReA], eight patients with ulcerative colitis [UC] and seven patients with Crohn's disease and 20 healthy controls of matched age and sex underwent ultraso-nographic evaluation of Achilles, quadriceps, patellar entheses and plantar aponeurosis. Ultrasonographic findings were scored according to the Glasgow Ultrasound Enthesitis Scoring System [GUESS]. On US examination a total of 290/450 [64.4%] of the entheseal sites were abnormal. Mean GUESS score was significantly higher in patients with SpA as compared with controls[p < 0.001], with a higher mean value in patients with PsA, ReA and AS. The mean thickness of all tendons examined was significantly higher in SpA patients than in controls [p < 0.0001] as well as the mean number of enthesophytes and bursitis in all sites examined [p = 0.002, p = 0.003], with a higher prevalence amongst patients with PsA and ReA. The GUESS score was correlated to duration of the disease and the anti-tumour necrosis factor alpha medications. Enthesis involvement occurs early in spondyloarthritis, the enthesis US score appears to be reliable and useful for improving the diagnostic accuracy of early SpA, further studies are needed as US is an evolving technique

Virtual colonoscopy-comparison with optical colonoscopy for the detection of colonic space- occupying lesions

This prospective study was performed on 20 consecutive patients with suspected or known colonic neoplasia to evaluate the sensitivity and accuracy of a new virtual colonoscopy technique for the detection of colorectal lesions in comparison with optical [conventional] colonoscopy as the standard of reference. They were 12 males and 8 females with age ranging between 48-72 years and mean age of 56.3 years. All patients were subjected to a thorough history and clinical examination, routine laboratory tests and abdominal ultrasonography. After standard bowel preparation, all patients underwent a non-contrast helical CT scan of the abdomen and pelvis followed by conventional colonoscopy in the same day. The images of CT colonography were reconstructed into a virtual colonoscopy [VC] presentation and compared with subsequent conventional colonoscopy in a blinded manner. Conventional colonoscopy identified 22 polyps 5 mm or greater in 12 patients, and no polyps were detected in 8 patients. Virtual colonoscopy correctly identified 5 polyps of 9 polyps 5-9 mm in size, and 11 of 13 lesions greater than or equal to 10 mm in diameter. Per-patient findings of VC for lesions 5-9 mm were; sensitivity 55.6%, specificity 81.8%, positive predictive value 71.4%, negative predictive value 69.2%, over all accuracy 70% and for lesions greater than or equal to 10 mm were; sensitivity 91.7%, specificity 87.5%, positive predictive value 91.7%, negative predictive value 87.5%, over all accuracy 90%. It could he concluded that VC is feasible and has excellent sensitivity and specificity for detection of colorectal lesions 10 mm and larger and provide another effective complement for the diagnosis and screening