Study of clinical outcome of single intra-articular injection of artificial hyaluronic acid preparation in patients with grade III and grade IV knee osteoarthritis

Background: Knee osteoarthritis (OA) is problematic in elderlies. Intra-articular injection of hyaluronic acid (HA) has been used with good results in patients with early OA, but evidence to recommend their use in late stages is insufficient. The aim of the study was to analyse whether intra-articular injections of hyaluronic acid preparation can provide relief in patients with grade III and grade IV knee OA.Methods: This observational study was conducted over 2 years amongst patients with late knee arthritis. On standing radiographs, patients were categorized- group 1 with stage III and group 2 with stage IV knee OA. Standardized technique was employed in all participants for single shot intra-articular hylan-GF-20 injection. Clinical outcomes were evaluated at 3, 6 and 12 months.Results: Group 1 patients showed significant improvement in Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores at 3, 6 and 12 months (p<0.05). In group 2, improvement was noted in WOMAC score for pain and function at 3 months (p<0.05). There was no significant improvement in functional and total WOMAC score at 6 and 12 months (p>0.05). Results for the new OA research society international (OARSI) responder criteria measures for proposition D reflected that, 94.87% and 25% patients were responder and 5.13% and 75% of patients were non-responder in group 1 (grade III) and group 2 (grade IV) respectively at the end of 6 months.Conclusions: In patients with grade III and grade IV knee OA, a single intra-articular injection of HA preparation (Hylan GF-20) showed pain relief for medium and short duration respectively. TKA remains the mainstay of management.

Estimation of prevalence of multidrug resistance in spinal tuberculosis, antibiotic susceptibility patterns and clinical outcomes

Background: There are no adequate data in literature referring to the early diagnosis and treatment (especially surgical) of MDR tuberculosis of spine and evaluation of its clinical outcome. We aimed to address this lacunae, by using gene expert test (CBNAAT) and drug sensitivity/susceptibility tests (DST) and by studying subsequent actual clinical outcomes.Methods: Forty patients with clinico-radiological scenario of spinal tuberculosis were evaluated using biochemical, radiological and histo-pathological studies. Anti-tuberculosis treatment was empirically started based on initial clinico-radiological suspicion of spinal tuberculosis. All tissue specimen and intra-operative samples were subjected to CBNAAT, MGIT culture and histopathological examination. Culture of those samples which showed rifampicin resistance on CBNAAT were followed up for DST (Drug Susceptibility Test) and the treatment modified accordingly, if required. All cases were followed up at 3, 6, 9 and 12 months interval.Results: Out of 40 patients, mycobacterium tuberculosis was detected in 23 patients by CBNAAT. Out of these 23 cases, 20 showed mycobacterium tuberculosis sensitivity to rifampicin and 3 were resistant. Out of these 3 cases, one had culture positive. Sensitivity and negative predictive value of gene expert test in comparison with the culture were 100%. Specificity and positive predictive value were calculated at 58.6% and 47.8% respectively. Accuracy of gene expert in our study was found to be 70%.Conclusions: Early detection of MDR spinal tuberculosis using highly sensitive CBNAAT test would be helpful to avoid consequences of inappropriate chemotherapy and would result in favourable outcomes

Response of iron overload to deferasirox in rare transfusion-dependent anaemias: equivalent effects on serum ferritin and labile plasma iron for haemolytic or production anaemias

Objectives: It is widely assumed that, at matched transfusional iron-loading rates, responses to chelation therapy are similar, irrespective of the underlying condition. However, data are limited for rare transfusion-dependent anaemias, and it remains to be elucidated if response differs, depending on whether the anaemia has a primary haemolytic or production mechanism. Methods: The efficacy and safety of deferasirox (Exjade (R)) in rare transfusion-dependent anaemias were evaluated over 1 yr, with change in serum ferritin as the primary efficacy endpoint. Initial deferasirox doses were 10-30 mg/kg/d, depending on transfusion requirements; 34 patients had production anaemias, and 23 had haemolytic anaemias. Results: Patients with production anaemias or haemolytic anaemias had comparable transfusional iron-loading rates (0.31 vs. 0.30 mL red blood cells/kg/d), mean deferasirox dosing (19.3 vs. 19.0 mg/kg/d) and baseline median serum ferritin (2926 vs. 2682 ng/mL). Baseline labile plasma iron (LPI) levels correlated significantly with the transfusional iron-loading rates and with serum ferritin levels in both cohorts. Reductions in median serum ferritin levels were initially faster in the production than the haemolytic anaemias, but at 1 yr, similar significant reductions of 940 and 617 ng/mL were attained, respectively (-26.0% overall). Mean LPI decreased significantly in patients with production (P < 0.0001) and haemolytic (P = 0.037) anaemias after the first dose and was maintained at normal mean levels (< 0.4 mu m) subsequently. The most common drug-related, investigator-assessed adverse events were diarrhoea (n = 16) and nausea (n = 12). Conclusions: At matched transfusional iron-loading rates, the responses of rare transfusion-dependent anaemias to deferasirox are similar at 1 yr, irrespective of the underlying pathogenic mechanism

A prospective observational study of iron isomaltoside in haemodialysis patients with chronic kidney disease treated for iron deficiency (DINO).

Iron deficiency is frequent in haemodialysis (HD) patients with chronic kidney disease (CKD), and intravenous iron is an established therapy for these patients. This study assessed treatment routine, effectiveness, and safety of iron isomaltoside (IIM) 5% (Diafer®) in a HD cohort.This article is freely available via Open Access. Click on the link to the publisher's site to access the full-text

Clinical outcome and humoral immune responses of β-thalassemia major patients with severe iron overload to SARS-CoV-2 infection and vaccination: a prospective cohort studyResearch in context

Summary: Background: COVID-19 has raised special concern for patients with β-thalassemia major (β-TM) due to frequent comorbidities, regular blood transfusions, and iron overload. However, the exact implications of COVID-19 for patients with β-TM remain uncertain. We aimed to explore the COVID-19 incidence and severity, and the serological response to SARS-CoV-2 infection and vaccination in patients with β-TM. Methods: Patients with β-TM (n = 105) and age-matched healthy controls, all individuals of all control groups were health care workers of the hospital, were prospectively enrolled at the haematology department of Al-Shifa hospital in the Gaza Strip from January 1st, 2021 to December 31st, 2021. Data on COVID-19 incidence and severity were analysed, with Alpha, Beta, and Delta SARS-CoV-2 variants dominating at that time. Anti-SARS-CoV-2 IgG antibody levels were measured and compared between study groups. Findings: Patients with β-TM showed a higher incidence of SARS-CoV-2 infection than the general population (61.9% vs. 7.1%, p < 0.0001). Most patients with β-TM had asymptomatic (70.8%) or mild disease (26.1%), with no fatalities recorded. COVID-19 illness was more severe among female than male patients with β-TM. Anti-SARS-CoV-2 IgG antibodies were significantly higher in symptomatic patients with β-TM than controls post-infection (geometric mean ÷ geometric standard deviation 1299.0 ÷ 3.3 vs. 555.7 ÷ 2.4 AU/mL, p = 0.009) and post-vaccination (8404.0 ÷ 3.9 vs. 2785.6 ÷ 5.0 AU/mL, p = 0.015). Similar responses were observed when comparing splenectomised to non-splenectomised (both asymptomatic and symptomatic) patients with β-TM post-infection (595.4 ÷ 3.9 vs. 280.7 ÷ 3.5 AU/mL, p = 0.005) and post-vaccination (13,778.2 ÷ 3.2 vs. 4961.8 ÷ 4.1 AU/mL, p = 0.045). Interpretation: This distinctive β-TM cohort exhibited a high susceptibility to SARS-CoV-2 infection but mild disease course. Our findings support favourable serological responses to SARS-CoV-2 infection and to vaccination in patients with β-TM, indicating a potential interplay between iron availability and COVID-19-related immunity. Funding: This study was funded by Mr. Hosam and Wasim s. El Helou