Effect of platelet-rich plasma intra articular injection on patients with primary knee osteoarthritis

Background: Osteoarthritis [OA] is the most common type of arthritis. It is a degenerative joint disease. OA is usually defined according to radiographic changes. Conventional radiographs [CR] were considered the most relevant outcome measure to assess the progression of OA in clinical trials and epidemiological studies. Many modalities are used in treatment of knee OA. There is a distinct need for new procedures that are cost effective by reducing the need for pharmaceutical and surgical management, while targeting the biochemical process of OA. Platelet-rich plasma [PRP] is one of these new procedures. PRP was found to increase hyaluronic acid [HA] concentration, stabilizing angiogenesis in patients with osteoarthritic knees

Aim of the study: Was to assess the value of intra articular injection of autologous platelet rich plasma in management of knee osteoarthritis

Patients and methods: This study was conducted on 40 patients with primary knee osteoarthritis, divided into 2 groups; study group treated with 3 injections of PRP, and control group treated with single dosed high-molecular weight HA. Clinical assessment and visual analogue scale [VAS] scoring were done pretreatment and 3 months post treatment

Results: Clinical improvement and reduction of VAS in both groups which is significant at the study group

Conclusion: PRP injection could be considered as a simple, safe, effective and non-palliative treatment that may promote cartilage healing in knee osteoarthritis as it improve the clinical condition and the function of the joint. Hence, it may represent a useful addition to the available therapeutic options for knee osteoarthritis

Capillaria philippinensis: a cause of chronic diarrhea in Upper Egypt

Capillaria philippinensis is a rare zoonotic intestinal parasite that is endemic in Philippines and Thailand. A few cases have been reported in Japan, Iran, Egypt, and Taiwan. The outcome of C. philippinensis may be fatal if untreated in due time. C. philippinensis is an emerging infection in Egypt as a cause of chronic diarrhea; thus, we carried out this study to determine the presence and frequency of C. philippinensis in patients with chronic diarrhea in Upper Egypt. The study included 113 patients with chronic diarrhea attending the Department of Tropical Medicine and Gastroenterology, Assiut University Hospital. All patients were subjected to full history taking, clinical examination, and laboratory investigations including stool examination, complete blood count, and assessment of blood urea and serum creatinine, serum albumin, and electrolytes [sodium, potassium, and calcium]. Also, gastroduodenoscopy, duodenal biopsy for histopathological examination, and colonoscopy were performed for every patient. C. philippinensis was reported in seven patients. All of them were young female patients with severe chronic diarrhea, associated with vomiting, abdominal pain, anorexia, borborygmi, weight loss, and ankle edema; three patients had mild ascites. The seven patients had hyponatremia, hypocalcemia, marked hyokalemia, and hypoalbuminemia. The diagnosis of C. philippinensis was established on finding the characteristic egg of C. philippinensis in the stool of all cases; histopathological examination of the duodenal biopsies indicated heavy cellular infiltration around the adult worm in one of them and larvae in another one. Six patients recovered completely with albendazole treatment 200 mg twice daily for 21 days, whereas one patient died of heart failure because of severe hypoalbuminemia and hypokalemia. Capillariasis is one of the parasitic causes of chronic nonbloody diarrhea in patients in Upper Egypt

Plasma levels of tumor necrosis factor-alpha and ammonia in patients with liver cirrhosis: correlation with severity of hepatic encephalopathy

The pathogenesis of hepatic encephalopathy [HE] is still incompletely understood, and the precise mechanisms causing brain dysfunction in liver failure are still not fully established. Several theories concerning the pathogenesis of HE have been previously suggested, including the ammonia theory, which received the most attention. Ammonia is still the most incriminated substance in the pathogenesis of HE. However, several problems exist with the ammonia theory. It is traditionally considered that circulating ammonia levels do not correlate well with severity of HE, and some patients with HE have normal circulating levels of ammonia. Another theory is that TNF-alpha is implicated in apoptosis of hepatocytes. This study aimed to determine the plasma levels of TNF-alpha and ammonia in patients with liver cirrhosis and their relation to hepatic encephalopathy [HE]. Circulating levels of TNF-alpha and ammonia were measured in 84 patients with liver cirrhosis [due to hepatitis C in 50 patients and due to hepatitis B in 34 patients], 21 of them had no HE and 63 had various clinical grades of HE [grades 1-4]. TNF-alpha concentrations were measured using commercially available solid-phase high sensitivity enzyme-linked immunosorbent assay. Ammonia levels were determined in venous plasma by the Berthelot reaction. Twenty four healthy controls with matched age and sex were included in the study. There were a statistically significant difference between plasma levels of TNF-alpha and ammonia in patients with liver cirrhosis compared to healthy controls. A significant positive correlation was found between circulating levels of TNF-alpha and those of ammonia [r=0.974, P< 0.0001], and also between circulating levels of both substances and severity of HE in all studied patients [r=0.950, P<0.0001, and r=0.900, P<0.0001 respectively]. TNF-alpha and ammonia were both significant independent predictors of severity of HE [P<0.0001 for both variables]. The results of this study demonstrate a significant positive relationship between TNF-alpha and ammonia in patients with chronic liver disease with HE and strengthen the suggestion that TNF-alpha could be strongly involved in the pathogenesis of HE which would stimulate the development of new treatment modalities to decrease this cytokine. This possibility needs further investigation and elucidation

Irritable bowel syndrome in Upper Egypt: the role of intestinal parasites and evidence of Th2 response

The pathophysiology of irritable bowel syndrome [IBS] remains elusive. In countries where enteric parasitic infection is common, its role in the development of IBS is controversial. Parasites induce the Th2 immune response that elaborates cytokines such as interleukin [IL]-5, which causes eosinophilia. Eosinophilic cationic protein [ECP] is one of the mediators released during the activation of eosinophils. This study aims to determine the relationship between symptoms suggestive of IBS and parasitic infection in IBS patients and to evaluate the serum levels of IL-5, ECP and eosinophilic count as potentially useful serological tests in those patients. Thirty-five IBS patients fulfilling Rome II criteria with absence of intestinal helminthic infection by direct smear method and no history of associated allergic conditions were studied. Ten healthy controls were included. Microscopic examination of stools for intestinal parasites, eosinophilic count and erythrocyte sedimentation rate were done. Colonoscopy was performed to rule out inflammatory bowel changes. Serum levels of IL-5 and ECP were measured. Intestinal parasitic infection was present in 37% [13/35] of IBS patients vs. 20% [2/10] in controls. Of the 35 IBS patients, 13 [37%] had protozoal infection. Mean eosinophilic count, IL-5 level and ECP were significantly higher in IBS patients than in controls. Eosinophilic count and ECP serum level were significantly high in IBS patients with parasitic infection. A significant number of patients with symptoms suggestive of IBS demonstrated evidence of parasitic infection in their stool samples. The IL-5 serum level, eosinophilic count and ECP serum level might be useful tests for detecting parasitic infection aetiology in IBS patients after exclusion of conditions inducing the Th2 response. Larger case-controlled studies are required to clearly define the parasitic pathophysiology in IBS