Rheumatological picture of a patient having multifocal osteonecrosis associated with sickle cell anemia: a case study.

Avascular necrosis (AVN) is a critical health condition associated with local death of the bone tissue resulting in multifocal osteonecrosis (MFON). After a prior patient's consent, we present a case of sickle cell anemia associated with severe MFON that affected both long bones and short bones. She had a positive history of DVT. Initially, she presented with generalized severe bone pain with fever for seven days that got worse on the day of admission, a picture suggestive of sickle cell anemia-induced vaso-occlusive crisis. She was treated with adequate hydration, morphine, enoxaparin (a low molecular weight heparin), paracetamol and ceftriaxone. She got improved on treatment. On 5th day after admission, she developed sudden severe local tenderness at the distal tibia above the medial malleoli in both legs and she was unable to put a weight on her feet and could not stand up or walk. Plain X-ray films were not diagnostic. Complete liver function tests and kidney function tests were normal. The patient had leukocytosis, high serum urate and high serum LDH (may reflect cellular damage in bone cells). MRI scans revealed an evidence of bilateral multiple avascular necrosis in both femoral heads, left shoulder, left knee, and pelvic bones were evident. The patient's condition was evaluated and the diagnosis of MFON associated with sickle cell crisis was established. This patient responded well to same treatments and her condition got improved. In conclusion, MFON should be considered after vaso-occlusive crisis of sickle cell anemia. Plain X-ray is non-conclusive in diagnosing bony lesions induced by AVN while MRI is diagnostic.

TaibUVID nutritional supplements help rapid cure of COVID-19 infection and rapid reversion to negative nasopharyngeal swab PCR: for better public prophylaxis and treatment of COVID-19 pandemic.

Public prophylaxis to decrease the emergence of new daily COVID-19 cases is vital. Adjuvant TaibUVID nutritional supplements are promising home-made or hospital-made supplements suggested for rapidly preventing and treating COVID-19 pandemic. We report here a 44 years old male physician who caught COVID-19 infection at hospital in Egypt with confirmed positive nasopharyngeal swab PCR. Ethical committee approval and informed patient's consent were gained before performing this study. Chest X-ray revealed increased bronchovascular markings. Close follow-up was done with no treatment given and he was sent for home isolation. Few days later, he developed progressive non-productive cough and a sense of difficult breathing with no associated fever or chest pain. An antitussive drug was given to him. The patient read about TaibUVID supplements from social media and started to feel improvement after TaibUVID inhalation therapy (using the heated solution of nigella sativa and chamomile five times a day). He also received a home-made TaibUVID nutritional supplement (nigella sativa, chamomile and natural honey) five times daily for four consecutive days. The next day, he was quite better with mild symptoms. Two days later, nasopharyngeal swab PCR was negative while other patients still had positive nasopharyngeal swabs. As few attacks of mild cough and breathing difficulty existed, he was admitted to hospital. A nasopharyngeal swab PCR was done for him again and the result was negative also. Blood gases were normal. He had lymphocytosis (possibly due to TaibUVID effects) that counteract lymphopenia seen in COVID-19 patients. Biochemical and hematological evaluation were quite normal apart from increased serum chloride and lactate dehydrogenase. There was a mild decrease in serum CO2 and alkaline phosphatase. Chest CT report revealed symmetrically inflated both lungs with non-specific focal nodular infiltrates (scattered in basal and medial lung segments) in left lower lobes with faint ground glass opacities. He was discharged home. Few days later, he was quite improved with no symptoms and returned to his work comfortably. In conclusion, TaibUVID nutritional supplements may be effective in rapidly changing the nasopharyngeal swab PCR from positive to negative. TaibUVID nutritional supplements are advisable as a natural, safe and effective prophylaxis to stop COVID-19 infectiousness, transmission and emergence of new cases. Clinical studies to investigate TaibUVID nutritional benefits are strongly recommended. TaibUVID may be promising and recommended for public prophylaxis to decrease emergence of new COVID-19 cases.

Resistin is not an appropriate biochemical marker to predict severity of acute pancreatitis: a case-controlled study.

AIM: To assess levels of serum resistin upon hospital admission as a predictor of acute pancreatitis (AP) severity. METHODS: AP is both a common and serious disease, with severe cases resulting in a high mortality rate. Several predictive inflammatory markers have been used clinically to assess severity. This prospective study collected data from 102 patients who were diagnosed with an initial acute biliary pancreatitis between March 2010 and February 2013. Measurements of body mass index (BMI) and waist circumference (WC) were obtained and serum resistin levels were analyzed at the time of hospital admission using enzyme-linked immunosorbent assay. Additionally, resistin levels were measured from a control group after matching gender, BMI and age. RESULTS: A total of 102 patients (60 females and 42 males) were diagnosed with acute gallstone-induced pancreatitis. The mean age was 45 years, and mean BMI value was 30.5 kg/m(2) (Obese, class I). Twenty-two patients (21.6%) had severe AP, while eighty-eight patients had mild pancreatitis (78.4%). Our results showed that BMI significantly correlated with pancreatitis severity (P = 0.007). Serum resistin did not correlate with BMI, weight or WC. Furthermore, serum resistin was significantly higher in patients with AP compared to control subjects (P < 0.0001). The mean resistin values upon admission were 17.5 ng/mL in the severe acute biliary pancreatitis group and 16.82 ng/mL in the mild AP group (P = 0.188), indicating that resistin is not an appropriate predictive marker of clinical severity. CONCLUSION: We demonstrate that obesity is a risk factor for developing severe AP. Further, although there is a correlation between serum resistin levels and AP at the time of hospital admission, resistin does not adequately serve as a predictive marker of clinical severity.

Does the presence of obesity and/or metabolic syndrome affect the course of acute pancreatitis?: A prospective study.

OBJECTIVE: The incidence of acute pancreatitis (AP) is rising with increased prevalence of obesity, which exacerbates pancreatic injury. Metabolic syndrome (MS) is defined as a cluster condition of cardiovascular risk factors, including hyperglycemia, dyslipidemia, hypertension, and central obesity. We analyze if the presence of obesity and/or MS affects the course of pancreatitis. METHODS: Data were collected from 140 patients with AP between January 2010 and February 2013. Anthropometric data, including body mass index and waist circumference, were measured. Biochemical tests were used including fasting glucose, triglyceride, low- and high-density lipoprotein cholesterol levels, and total cholesterol level. Atlanta criteria, Acute Physiology and Chronic Health Evaluation II, and Ranson scoring system were used to define severe AP. Patients were classified as having MS based on the International Diabetic Federation criteria. RESULTS: The mean body mass index was 30.15 kg/m(2). Sixteen (11.4%) patients had severe AP, whereas 124 (88.6%) patients had mild AP. We found that 62.8% of patients with AP fulfilled the criteria of MS (P = 0.000). Body weight can be used to predict clinical severity of AP with significant P value (P = 0.009). CONCLUSIONS: The presence of MS in patients with pancreatitis is noticeable, but it does not affect the course of disease severity, whereas obesity correlates with pancreatitis severity.

Behavior of advanced gastrointestinal stromal tumor in a patient with von-Recklinghausen disease: Case report.

Gastrointestinal stromal tumors (GISTs) represent a malignant gastrointestinal tumor of neurofibromatosis type 1 (NF1) Von Recklinghausen disease. In the current case, we report a 27-year-old woman with NF1, who presented with a lower abdominal mass, symptomatic anaemia, and significant weight loss. We employed multiple approaches to assess the tumor behavior, including computed tomography (CT) scan, surgical tumor resection, histological and immunohistochemical analysis and gene sequencing. Additionally, the patient was given Imatinib mesylate (Gleevec) as adjuvant therapy. CT scan delineated a large thick wall cavity lesion connecting to the small bowel segment. Resection of the tumor yielded a mass of 17 cm × 13 cm with achievement of safety margins. The diagnosis was GIST, confirmed by immunohistochemical expression of CD117, CD34, and Bcl-2. Sequencing revealed no mutations in either KIT or platelet-derived growth factor receptor-alpha, genes which are mutated in over 85% of sporadic GIST cases. Further, there was no evidence of recurrence, metastasis or metachronous GIST for over three years in our patient. From our analyses, we believe selective genotyping is advisable for high risk patients to predict potential tumor behavior.

A rare presentation of Bochdalek's hernia containing duodenum and pancreas.

Symptomatic cases of Bochdalek's hernia are uncommon in adults; symptoms arise only due to complications. Most of symptomatic cases are related to a left-sided hernia. We describe the case of a 50-year-old woman with Bochdalek's hernia containing duodenum and pancreas. The patient was successfully treated by a surgical approach.