Khaled Aly Matrawy

Angiopoietin-2, endothelial dysfunction and renal involvement in patients with systemic lupus erythematosus.

BACKGROUND Angiopoietin-2 (ang-2) that activates endothelial cells and increases vascular inflammation might have significant roles in the pathogenesis of glomerular diseases. This study aimed at assessing the level of ang-2 as a marker of renal involvement in SLE patients to elucidate its correlation with disease activity and endothelial dysfunction. METHODS This study included 81 subjects. The control group included 21 healthy subjects. The patients group included 60 SLE patients, 24 patients without lupus nephritis (LN) and 36 patients with LN. Clinical examination and laboratory investigations including 24 hours urinary protein, estimation of serum ang-2 and creatinine and calculation of estimated glomerular filtration rate (eGFR). Measurement of SLE disease activity index (SLEDAI), flow mediated dilatation (FMD) and carotid intima media thickness (CIMT) were done. Renal biopsy was done for patients with LN. RESULTS Ang2 level was significantly higher in subjects with FMD <=10%, than in subjects with FMD >10%. Ang2 level was significantly increased in SLE patients than controls, and it was significantly higher in patients with LN than in patients without nephritis. Ang2 was significantly positively correlated with SLEDAI, 24 hours urinary protein and histological activity index, and was negatively correlated with C3, eGFR and FMD. There were no significant differences between patients with proliferative and non proliferative LN regarding Ang2 level. CONCLUSIONS Ang2 can reflect the extent of endothelial activation and may be used as a biomarker of both disease activity and renal involvement in SLE patients. Ang2 level cannot distinguish between proliferative and non proliferative lesions in LN.

MRI features of some uncommon causes of painful knee

Abstract Aim of the work The purpose of this study is to describe the MRI features of some uncommon causes of knee pain. Materials and methods This is a retrospective study. We reviewed our database including the last 1000 knee MRI examinations done within the period from January 2012 till June 2013. This revision revealed 12 cases with reported variable uncommon diagnoses explaining knee pain. Unenhanced MRI of the knee was performed and included sagittal T1, T2, T2∗ and proton density fat suppression (PDFS), axial T2 and coronal PDFS. Some cases had complementary CT assessment. Results The selected 12 cases included the following; three cases of supero-lateral Hoffa’s pad of fat edema expressing edema signal at the superolateral aspect of the Hoffa’s pad of fat. Three cases with fabella syndrome with chondral and subchondral edema signal at the posterior aspect of the lateral femoral condyle. Two cases with symptomatic bipartite patella showing marrow edema around the patellar synostosis. One case with proximal tibio-fibular synostosis evident on MRI as bony fusion. Two cases with quadriceps (suprapatellar) fat-pad impingement syndrome manifested as edema signal within the supra-patellar fat-pad and lastly one case with lipoma arborescence seen as frond like projections with fat signal protruding into the supra-patellar bursa. Conclusion MRI is a useful tool in evaluation of some uncommon causes of painful knee.

Local infliximab injection of sacroiliac joints in non-radiographic axial spondyloarthritis: Impact on clinical and magnetic resonance imaging parameters of disease activity

Abstract Objectives. To evaluate the effectiveness of infliximab (IFX) injection into sacroiliac joints (SIJs) of non-radiographic axial spondyloarthritis (nr-axial SpA) and its impact on clinical and MRI parameters of disease activity. Methods. Thirty-seven patients fulfilling the Association of Spondyloarthritis International Society (ASAS) criteria for axial SpA were initially studied, with disease duration not exceeding 1 year and failed to respond to non-steroidal anti-inflammatory drugs (NSAIDs). Only SpA having active sacroiliitis on MRI without spondylitis (number = 7) were selected to receive bilateral SIJ injection of 20 mg IFX. Follow-up MRI was done at 24 weeks post-injection. Patients were clinically evaluated before, and 12 and 24 weeks after SIJ injection. Evaluation included back pain and stiffness scores, and Bath Ankylosing Spondylitis (BAS) Disease indices and C-reactive protein (CRP) levels. ASAS response criteria were also assessed. Results. Twelve and twenty-four weeks after injection, there was significant decrease in back pain, stiffness, and BAS Disease Activity and Global indices. BAS Functional index, CRP, and mean bone marrow edema score of SIJs were decreased without reaching statistical significance. All patients achieved ASAS20 and five (71.4%) achieved ASAS40. Conclusion. SIJ injection of IFX could be a therapeutic option in early nr-axial SpA who failed to respond to NSAIDs.

Intestinal obstruction: Role of multi-slice CT in emergency department.

Abstract Objective This article presents the characteristic CT imaging findings for different causes of intestinal obstruction, in correlation with their clinical background in emergency department. Materials and methods Reviewing the cases (50 patients) that were presented to the emergency department (over a duration of 3 months) with acute abdomen and suspected of having intestinal obstruction, underwent multi-slice CT. Image interpretations performed by independent radiologists were compared with the final diagnosis that was based on all available clinical and lab information as well as surgical findings at operated cases. Results Of our 50 patients, intestinal obstruction with different causes was found in 20 patients and other causes of acute abdomen (pancreatitis, bowel ischemia, etc.) in 30 patients. Cancer colon in 5 cases, Crohn’s disease in 6 cases, closed loop obstruction in one case, internal hernia in 2 cases, intussusception in one case, post-traumatic ileus in two cases, fecal impaction in one case, sigmoid volvulus in one case and cecal volvulus in one case. Conclusion Multi-slice CT shows high diagnostic efficacy in discriminating intestinal obstruction from other causes of acute abdomen and in evaluation of different causes of intestinal obstruction in emergency department.

Ultrasound screening for developmental dysplasia of the hip and its socioeconomic impact: Experience of tertiary care health level

Abstract Objective The purpose of this study was to investigate the usefulness of screening ultrasound to detect developmental dysplasia of the hip in infants with risk factors and to assess its socioeconomic impact. Patients and methods This is a retrospective study. In the duration of 30 months, all infants born at Hospitals in our region were examined clinically for hip dislocation. All those with clinically dislocated hips were excluded and referred for follow up to a pediatric orthopedic surgeon. After referral to our tertiary care center, a 6 week hip ultrasound scan was performed for those infants with stable hips on examination, having risk factors for dysplastic hips including positive family history, breech presentation and inconclusive clinical findings. We used an ultrasound technique that combines the two known methods (Graf’s technique and Harcke’s method). Results 3540 Hip ultrasound scans were performed, of those scanned 12 (0.33%) were found to have dislocated hips and 98 (2.8%) to have different grades of dysplastic hips. Among these twelve patients; six of them had a first degree relative with congenital dislocation of hips, three had breech presentation at birth and three had inconclusive clinical findings. Those with dysplastic hips were followed up by serial ultrasound examinations but did not require active intervention. Conclusion Screening ultrasound is a useful tool for detection of hip dislocation and dysplasia especially among the population of infants at increased risk of developmental dysplasia of the hip. Limitation of screening ultrasound programs for those at risk only reduces the financial burden with better outcome in choosing candidates for further workup especially surgical intervention.