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

Efficacy of punica granatum extract on in-vitro and in-vivo control of trichomonas vaginalis

Trichomoniasis vaginalis is now an important worldwide health problem. Metronidazole has so far been used in treatment, but the metronidazole-resistant strains and unpleasant adverse effects have been developed. Treatment of patients with metronidazole refractory vaginal trichomoniasis constitutes a major therapeutic challenge and treatment options are extremely limited. The last 7 years have seen over seven times as many publication indexed by Midline dealing with pomegranate [Punica granatum] than in all the years preceding them, because of this, and the virtual explosion of interest in pomegranate as a medicinal and nutritional product that has followed, this work is accordingly launched. Natural plant extract purified from Pomegranate [Roman] was in-vitro investigated for its efficacy against T. vaginalis on Diamond media. Besides, infection women [18/20] who accepted to be treated with P. granatum juice were completely cured and followed-up for two months. The anti-trichomoniasis vaginalis activity of P. granatum extract [in-vitro and in-vivo] gave very promising results

Efficacy of two plant extracts against vaginal trichomoniasis

Trichomoniasis vaginalis is now an important worldwide health problem. Metronidazole has so far been used in treatment, but the metronidazole-resistant strains and unpleasant adverse effects have been developed. Treatment of patients with metronidazole refractory vaginal trichomoniasis constitutes a major therapeutic challenge and treatment options are extremely limited. In the present study, 33 metronidazole-resistant T. vaginalis females were treated with a combined course of metronidazole and tinidazole. Those still resistant to the combined treatment were given Commiphora molmol [Myrrh] as two capsules for six to eight successive days on an empty stomach two hours before breakfast. Also, natural plant extract purified from [Roman] was in-vitro investigated for its efficacy against T. vaginalis on fresh Diamond media. The anti-trichomoniasis vaginalis activity of both P. granatum [in-vitro] and C. molmol [in-vivo] extracts gave promising results

comparison of cervical and lumbar epidural anesthesia on Heart rate variability and spontaneous baroreflex sensitivity

We designed this study to test the hypothesis that cervical epidural anesthesia would increase the high-frequency [HF] component of heart rate variability [HRV] as a result of cardiac sympathectomy, whereas lumbar epidural anesthesia would cause sympathetic predominance. HRV and spontaneous baroreflex [SBR] sensitivity were assessed before and after cervical and lumbar epidural anesthesia by using plain 1.5% lidocaine in healthy patients. Electrocrdiogram and noninvasive beat-to-beat arterial blood pressure were monitored. HRV was analyzed. Our results indicate that cervical, but not lumbar, epidural anesthesia depresses phasic and tonic dynamic modulation of the cardiac cycle by vagal nerve in conscious humans, we hypothesized that cervical epidural anesthesia would produce an imbalance of cardiac autonomic status i.e an increase vagaly mediated HR component of HRV as result of cardiac sympathectomy, whereas lumbar epidural anesthesia would cause sympathetic predominance

new technique for total thyroidectomy with preservation of parathyroid glands and function

Thyroid lobectomy is the basic thyroid operation. The most dangerous complications of this operation are permanent hypoparathyroidism and recurrent laryngeal nerve paralysis. Many attempts have been made to preserve parathyroid gland function including the use of complex microsurgical techniques, and reimplantation techniques that are not always successful. In this article we describe a new technique that preserves the parathyroid glands and their blood supply thereby avoiding permanent hypoparathyroidism. Forty seven patients were operated upon using this technique between January 1998 and March 2000. Twenty nine cases underwent total thyroidectomy [seven of them with unilateral or bilateral functional neck dissection] while eleven patients underwent lobectomy on one side and subtotal thyroidectomy on the other side. Lobectomy on one side only was performed in seven patients. Parathyroid integrity and function was demonstrated by serum calcium estimation and thalium technitium subtraction scans while recurrent laryngeal nerve integrity was demonstrated by indirect and direct laryngoscopy. There were no cases with either permanent hypoparathyroidism or recurrent laryngeal nerve injury as proved by thalium technitium scans, serum calcium and laryngoscopy. Operative time was within the normal range for comparable operations using the classic technique. No postoperative complications were noted. Total thyroid lobectomy using this technique was found to be safe, reproducible and avoids two potentially catastrophic complications. We advocate a minimum of unilateral thyroid lobectomy in all cases regardless the pathology to minimize the possibility and inherent risks involved in reexploration of both sides of the neck

Isolation of Yersinia enterocolitica from cases of acute appendicitis and ice-cream

Seventy [70] appendiceal specimens and 80 ice-cream samples were analysed to detect Yersinia enterocolitica using three different media. Both Y. enterocolitica and Citrobacter freundii were recovered in appendiceal specimens [17.1% and 8.6%] and ice-cream [26.25% and 18.75%] respectively. Thioglycollate medium was more selective and productive in isolating Yersinia. Y. enterocolitica was the major causative agent of acute appendicitis [11/25, 44%]. It was sensitive to chloramphenicol, gentamicin, tetracycline and trimethoprim- sulfamethoxazole

Beta - 2 microglobulin concentration as a marker of renal affection in asphyxiated newborns

This study was undertaken to evaluate the clinical usefulness of serum and urinary Beta 2 microglobulin [Beta 2 m] determination as a marker of renal damage following perinatal asphyxia. 24 newborns with severe birth asphyxia were included in the study along with 12 normal newborns who comprised the control group. The results revealed that the mean serum urea [mg/dl] was 72.9 +/- 43.2 in cases and 58.3 +/- 52.9 in controls with no significant difference while the mean serum creatinine [mg/dl] in cases was 1.7 +/- 0.88. This value was significantly higher than the mean value [0.7 +/- 33] in controls. The urinary Beta 2 microglobulin [ng/ml] in the cases was 218.3 +/- 100.9 which was significantly higher than controls [40.8 +/- 35.49]; while the serum Beta 2 microglobulin [ng/ml] in cases [46.16 +/- 22.2] was significantly lower than controls [68.83 +/- 34.3]. There was a negative significant correlation between B2 microglobulin in urine and values of Apgar score. We concluded that inspite of low sensitivity of urinary Beta 2 microglobulin, it can be considered as highly specific simple rapid noninvasive test for early detection of renal damage [mainly tubular affection] in neonates with birth asphyxia

Diagnostic and prognostic value of adenosine deaminase in typhoid fever

For assessment of adenosine deaminase activity in febrile patients and to determine its usefulness in the early diagnosis of typhoid fever, 174 children were included in this study, their ages ranged from 1 to 14 years of age [124 febrile children and 50 healthy controls]. The results showed that mean serum Adenosine Deaminase [ADA] in typhoid cases on admission was 56.52 +/- 2.93 U/L, and on discharge [after 10-14 days] it was 28.92 +/- 12.72 U/L which was significantly higher than controls [12.32 +/- 2.6 U/L]. The mean serum ADA in uncomplicated typhoid cases [77.6 +/- 12.5 U/L] on admission was significantly higher than in complicated ones [40.5 +/- 8.5 U/L]. The mean serum ADA levels were 21.25 +/- 3.59 U/L in hepatitis [A], 20.25 +/- 4.95 U/L in T.B. 19.68 +/- 4.82 U/L in meningitis and 19.81 +/- 4.5 U/L in measles. It was noted that the mean serum ADA in typhoid cases on admission was significantly higher than any reported values in non-typhoid cases. The sensitivity of ADA in typhoid cases was 95%, the specificity was 100%, the positive predictive value was 100%, the negative predictive value was 98.5% and accuracy was 96%. We concluded that serum ADA activity in typhoid fever could be used as an early diagnostic test, in addition its level had a prognostic value in typhoid fever

Mid-trimester missed abortion in a rudimentary horn-diagnosis and management

A 27 year old 5th gravida had been referred to our hospital from a private hospital as a case of failed termination of a missed abortion at 17 weeks gestation. The case was diagnosed by Ultrasonography as a rudimentary horn pregnancy and a laparotomy for complete horn excision was performed. This case indicates the importance of confirmation of intrauterine pregnancy before deciding the proper management

Prevalence of enterotoxigenic bacillus cereus in raw and pasteurized milk

A total of 150 milk samples collected from different dairy farms and supermarkets were analyzed for the presence of Bacillus cereus and detection of Bacillus diarrheal enterotoxin using two immunological tests BCET-RPLA and TECRA-VIA kits. Of the 150 milk samples, 40% and 30% of raw and pasteurized milk, respectively, were yielded. B. cereus colonies on Bacillus cereus selective medium were identified biochemically using API 50 CHB and API 20 kits. Twenty-six Bacillus cereus strains showed visible growth at 7C within 10 days. Two different immunological kits for the detection of the diarrheal toxin were compared. TECRA-VIA kit seems to be a reliable and productive than RPLA fit for detection the toxin

Detection of local antibody response in urine as a tool for diagnosis of urinary tract infection

Identifying urinary tract infection [UTI] is based mainly on culture of uropathogens which may take at least 3 days before a final report is issued. We tried to study the possibility of identifying UTI by the detection of local antibodies [IgG and IgA] in urine. A total number of 69 patients complaining of dysuria, frequency, loin pain and or suprapubic pain were examined urologically and midstream urine sample was collected from each patient. The urine samples were examined microscopically for pus cells, RBCs and crystals. They were also cultured quantitatively and assayed for local IgG and IgA antibodies in urine to common urinary pathogens. The 69 patients had significant pyuria, 50 patients showed positive urine culture E. coli [27], Klebsiella [13], Staphylococcus saprophiticus [8] and Proteus 2 patients. From the 50 patients 48 had positive local specific urinary antibodies and 2 were negative for the local urinary antibodies. The 19 patients with negative urine culture 15 had positive local urinary antibodies. The control group 13 subjects had no pus in urine, negative culture and negative local antibodies. Two subjects had. no pus, positive culture [E. coli] and positive local antibodies. In conclusion the local specific IgG and IgA to common uropathogens could help in the primary identification of UTI and thus the clinical doctor can initiate a blind antibiotic treatment, till culture and sensitivity results are obtained. Since it is possible to identify UTI with the positive results of the local antibodies in urine of symptomatizing patients with significant pyuria. Also it could help in screening asymptomatic bacteruria

Tumour necrosis factor production in patients with carcinoma of the bladder associated with bilharziasis

Tumour necrosis factor [TNF] is produced by activated macrophages in response to the presence of a malignant tumour. In this study we evaluated the level of TNF in patients bearing carcinoma of the bladder with bilharziasis in comparison either to similar patients who underwent surgical procedures or even normal individuals. Twenty three patients eight of whome were bearing cancer bladder associated with bilharziasis. The remaining fifteen patients had a surgical intervention for removal of their cancer bladder. They underwent either total cystectomy with urine diversion [11 cases] or transurethral resection with or without intravesical therapy [4 cases]. The TNF level in the urine and serum of the 23 patients was assayed. The TNF level in urine and serum of 11 normal individuals [control] was also measured. The mean value of TNF level in the urine and serum of patients who underwent different surgical procedures [10.78 pg/ml. and 16. 2pg/ml] was higher when compared to the normal control [4.68 pg/ml and 12.77 pg/ml]. Also the mean value of the TNF level in the urine of the same group of patients was higher than the group of patients who had cancer bladder associated with bilharziasis before treatment [6.814 pg/ml]. Yet, there was a slight decrease in the mean value of the TNF level in the serum of the postoperative group when compared to the preoperative [17.375 pg/ml] although it was statistically insignificant. At the same time it was found that patients with carcinoma of the bladder associated with bilharziasis had a significantly higher TNF level in serum and urine [P<0.01 and P<0.05] when compared to normal individuals. Our conclusion was that TNF level assay in the urine and serum of patients bearing cancer bladder associated with bilhariziasis after being surgically treated is of an insignificant value since there are many factors to interplay [metabolic, metastasize, recurrence intravesical therapy. Also it is possible to take the TNF level whether in urine or serum of patients having cancer bladder associated with bilharziasis before treatment as an indication to the existance of the malignant tumour

Tumour necrosis factor alpha in stools as a marker in colonic diseases

This study was conducted on 40 patients with different inflammatory bowel diseases depending on the clinical examination, colonoscopic findings and histopthological reports. We aimed at measuring local stool TNF alpha and serum CRP in an attempt to explore their usefulness in assessing inflammatory bowel diseases. The patients were 10 colonic schistosomal patients [CS], 10 active ulcerative colitis [AUC], 10 cancer colon [CC], 5 irritable bowel syndrome [IBS], 3 inactive ulcerative colitis [lUC] and 2 with colonic diverticulosis [DV]. It was found that serum CRP in the different groups of patients were insignificantly different either from the control group or the IBS group. The TNF alpha level in the stool of patients with schistosomal polyposis, AUC and CC were significantly higher than the control group [P< 0.001]. From this data we concluded that serum CRP is of little value in the evaluation of inflammatory bowel diseases, while local TNF alpha may monitor disease activity and even low values exclude active inflammatory bowel diseases, cancer colon and polyposis of any aetiology

level of Interleukin 6 in septic and aseptic meningitis

In this study the level of interleukin-6 [IL[6]] was evaluated in cerebrospinal fluid [CSF] and serum of septic [n=14] and aseptic meningitis [n=16] patients, in addition to its evaluation in 10 controls. CSF IL6 was elevated in 85.7% of patients with septic meningitis [SM] [mean 1471. 4 pg/ml] and in 43.7% of aseptic meningitis [AM] patients [mean 192.8 pg/ml], the difference in between was significant [P< 0. 0001]. Elevation of serum IL[6] was found in 28. 6% of the SM group [means 192.8 pg/ml] and none of the AM group [mean 122.5]. CRP was elevated in CSF and serum of SM and Am groups. Positive correlation was found between IL[6] and CRP in CSF and serum but not with other inflammatory parameters. It is concluded that marked elevation of IL[6] in patients with meningitis suggest a septic aetiology. It is also claimed that IL[6] plays a role in aseptic meningitis which is believed to be dependant on the causative agent

Immune response to Helicobacter pylori infection in endemic hepatosplenomegaly patients

Patients with endemic hepatosplenomegaly and evidence of portal hypertension have gastritis as a common finding. while H. pylori is accused to be an aetiological agent of gastritis and peptic ulcer. Three groups of patients. The first 23 had endemic hepatosplenomegaly and evidence of portal hypertension, the second 22 patients had endemic hepatosplenomegaly only, while the last 21 patients were suffering from gastrointestinal disturbances. The percentage of isolation of H. pylori in the three groups ranged between 47. 8% and 59% while the percentage of identification ranged between 82. 6% and 90.0.The protein concentration of the H. pylori antigen in a whole cell sonicate of 10 strains was determined, and the protein profile of the antigen preparation was examined using SDS-page. The values of absorbances of the Ig[G] and Ig[A] in the sera of the patients were determined using an in house prepared and a commercially purchased ELIZA test. When comparing between the mean values of absorbances [Ig[G] and Ig[A]] of the three groups of patients it was found that the first group of patients had their mean value of absorbance significantly higher than patients of group two and three. The Ig[M] mean values of absorbances did not show any statisticaly significant difference between the three groups of patients. Seven patients received a course of triple therapy for two weeks, five patients showed a decline in their antibody levels [Ig[G] and Ig[A]] six weeks post treatment, while two patients had their antibody levels unchanged. It was concluded that hepatosplenomegalic patients with portal hypertension suffer a heavier bacterial innoculum, and long term treatment in an attempt to erradicate H. pylori would improve the accompanied gastritis and avoid the expected sequalae

value of laparoscopy in obscured acute lower abdominal pain in females

Obscured acute lower abdominal pain, especially in females in reproductive age, is one of the most difficult challenges facing surgeons in the emergency room. This study included 33 females having this problem in an attempt to evaluate the role of laparoscopy in this field. In 18 cases the problem could be solved by a laparoscopic surgical intervention while in the rest of patients laparotomy was avoided with exception of 2 cases. Through this limited number of patients, laparoscopy proved both effective and safe in this field

correlation of antibody coated bacteria test with various methods of bacterial culture in children with bilharziasis

Urine samples from 35 children with urinary schistosomiasis and symptoms of urinary tract infection[UTI] were studied by urine culture on various aerobic media and reduced anaerobic media and reduced anaerobic media, the antibody coated bacteria [ACB] test was done simultaneously.All 35 children with positive ACB test showed anaerobic growth.The use of ACB for rapid diagnosis of UTI especially when urine culture on conventional media showed no growth was advocated

Quantitative evaluation of bacterial colonic flora in bilharzial patients

From quantitative evaluation of the aerobic colonic flora of 45 patients suffering from advanced and moderate hepatosplenomegaly with or without polyposis were compared with 20 normal subjects. The count revealed a significant difference between the total aerobic bacteria and the total coliforms [p=/<0.001] in the number of faecal specimens examined