The estimated prevalence of osteoporosis in Bahrain: a multi-centered-based study.

OBJECTIVES: the primary aim of this study was to examine the prevalence and risk factors of low bone mineral density in Bahrain. METHODS: this was a retrospective study, which targeted a cohort of 4822 Bahraini subjects (mean age 59.36 years: 93% females). Demographic data and results of lumbar and femur DEXA scan for the targeted sample, over the period 2016-2018, were retrieved from four hospitals. RESULTS: The prevalence of low BMD was 62.3% (46.4% had osteopenia and 15.9% had osteoporosis). The highest rate of osteopenia was detected at the age group younger than 44 years. However, with increasing age, the rate of osteopenia declined, whereas osteoporosis increased (P < 0.001). Females were found to be at higher risk of developing both osteopenia (45.8%) and osteoporosis (18.1%) compared to males (39% and 12.4%, respectively) (P < 0.001). Postmenopausal women exhibited higher rates of low BMD (42.4% osteopenia, 22.3% osteoporosis) compared to elderly men (30.9% osteopenia, 9% osteoporosis). CONCLUSIONS: We reported high prevalence of osteopenia and osteoporosis in Bahrain. Low BMD was more common in females, especially in postmenopausal women. Highest prevalence of osteopenia happened at young age. Therefore, we advocate screening at younger age than previously recommended.

Effects of Teriparatide on Bone Mineral Density and Prevention of Fragility Fractures in Saudi Arabian Subjects with Osteoporosis: A Two-Year Clinical Study from a Single Center.

Design: A prospective study was conducted. Setting. This study took place at King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, Dammam, Saudi Arabia. Primary and Secondary Outcomes. The study aimed to evaluate changes in BMD and prevention of fragility fractures. Materials and Methods: We followed up 439 patients who were prescribed teriparatide at the King Fahd Hospital of the University, AlKhobar, and 415 (94.5%) patients completed a 24-month teriparatide course. The data gathered before starting medication were age, sex, previous therapy, history of fractures, and other diseases like diabetes mellitus, hypertension, and cardiac disease. At the time of the final assessment after 24 months, a history of fractures if any during the treatment was collected and a DXA scan was done. Results: A total of 415 patients were followed up for 2 years. Three hundred and sixty-five patients (87.9%) were females, and the rest were males. The average age was 68.21 ± 17.6 years. Two hundred and forty-eight patients (59.8%) were treatment naïve, and 167 (40.2%) were on treatment for osteoporosis. Twenty patients (4.8%) sustained fracture on treatment. The pretreatment DXA showed that the mean hip T-score was -3.1 ± 0.79, and after completion of the treatment, it was -1.5 ± 0.62 (P < 0.001), while the T-score of the lumbar spine was 4.4 ± 0.86 versus -3.2 ± 0.87 (P < 0.001). Seventeen (4.09%) had fractures while on teriparatide treatment. The mean significant gain (MSG) for BMD for the hip was 0.095 g/cm2, and for the lumbar spine, it was was 0.109 g/cm2 with P < 0.001 at 95% CI. Conclusions: Our study shows that 94.5% completed the treatment duration, and there was an increase in the BMD. The decrease in T-scores of the lumbar spine and hip was significant so was the reduction in the number of fractures.

Genetic Influence in Developmental Dysplasia of the Hip in Saudi Arabian Children Due to GDF5 Polymorphism.

Developmental dysplasia of the hip (DDH) is quite common among Saudi Arabian babies. With an objective to assess the presence of SNP rs143383 and the alleles in the GDF5 gene among patients with DDH, parents, and unaffected siblings, we undertook this case-controlled study. We collected and analyzed for a functional single nucleotide polymorphism (SNP) in the 5'-untranslated region of the GDF5 gene (rs143383), 473 blood samples, (100 patients, 200 parents, 73 siblings and 100 healthy controls. We determined the association between the patients' genotype and their fathers', mothers' and siblings' genotype through Chi-square analysis. The majority of those screened possessed the TC genotype, and 61.8% of patients and their fathers had the TT genotype. There was no association between patients' and fathers' genotype, P value < 0.332, 95% CI (0.328-0.346), and between patients' and mothers', P < 0.006, 95% CI (0.004-0.007). When considering DDH patients' and the control group's genotypes, the odds ratios of TT versus other combined (0.641 > 1) and CC versus other combined (0.474 < 1) revealed that the TT genotype has higher risk of developing DDH compared with the CC genotype. The 95 percent confidence interval of TT versus other combined and CC versus other combined is 0.932-2.891 and 0.208-1.078, respectively. For patients' and fathers' genotypes, the odds ratios of TT versus other combined (1.275 > 1) and CC versus other combined (0.815 < 1) indicate that the TT genotype has higher risk of exhibiting DDH compared to the CC genotype. For patients' and siblings' genotypes, the odds ratios of TT versus other combined (1.669) and CC versus other combined (1.048) specify that the TT genotype possesses higher risk of developing DDH compared with the CC genotype. Our study shows that there exists a relationship between GDF5 (SNP rs143383) and DDH in our population. Second, we found for the first time that the genotype TT and the T allele were overly expressed in the patients and the fathers. More studies on the confirmation of this genetic marker for DDH are called for.

Quality of Life in Sickle Cell Patients After Cementless Total Hip Arthroplasty.

BACKGROUND: Osteonecrosis of femoral head is a serious relentlessly progressive and disabling complication in 20%-50% of sickle cell patients, majority of whom are in their second to third decades. High perioperative medical complications and short survivorship have historically discouraged arthroplasty surgeons in offering total hip arthroplasty to sickle cell patients in their 30s for the fear of inevitable technically demanding revision. In this retrospective study, the primary objective was to assess the impact of early intervention on quality of life (QOL) at midterm follow-up of mean 7.5 years using uncemented porous-coated total hip arthroplasty. The secondary objective of this study was the survival of the prostheses within the same follow-up period and discussion of surgical challenges faced in this cohort of patients. METHODS: A total of 67 (84 hip arthroplasties) sickle cell patients with advance osteonecrosis of femoral head who underwent cementless porous-coated proximal fixation are included in this study. Modified Harris Hip Score, visual analog scale, and QOL assessment criteria are used to assess the outcome. RESULT: Revision surgery was required in 7 patients for aseptic loosening and in 1 patient due to late infection. Visual analog scale improved from average 7 (6-9) to 3 (2-5). Mean Harris Hip Score improved from 46 (32-58) to 81 (74-86). QOL score rose from a mean of 3 (range 1-4) to 7 (range 6-9). In terms of gender, survival in males was 94.30%, whereas in females, it was 88.767%. Revision surgery was required in 7 patients due to aseptic loosening and in 1 patient due to late infection at 7 years. CONCLUSION: We recommend early hip arthroplasty in sickle cell patients, if the hip has reached a stage of irreversible damage and patient's lifestyle is severely compromised to minimize chronic suffering and disability.

The role of growth factor Sadat-Habdan mesenchymal stimulating peptide in healing of burn wounds.

BACKGROUND: Burns occur in everyday life and cause morbidity and mortality due to delayed healing. Many agents were tried to accelerate healing of burns. The aim of this study was to assess for the first time Sadat-Habdan mesenchymal stimulating peptide (SHMSP) known angiogenesis factor in healing of experimentally created burns in rats. METHODS: Forty male rats weighing (200-250 g) were randomly divided into 2 groups of 20 each. Under general anesthesia, reproducible, deep, partial-thickness, thermal burn injury was created by 1-cm aluminum template on the dorsal aspect of the body of each animal by heating the template at 80 °C for 10 seconds. Alternate rats were assigned to 1 of the 2 groups to minimize the difference of timing of the burn. Sadat-Habdan mesenchymal stimulating peptide 10 mg was applied on daily burn area, covered with a nonabsorbent dressing. All animals were kept in similar standard laboratory conditions. Its application continued 14 days as described by the inventors, and burned areas were photographed. On day 15, blood was collected from the animals for serum albumin levels, and the animals were killed, then the entire burn areas were excised for biopsy for general morphology and histopathology. RESULTS: There were no deaths among groups. The majority of the animals showed good to excellent healing compared with the control group. Clinical pictures revealed better healing in the SHMSP-treated group. Quantitative and qualitative analyses of images revealed significant contraction of burned areas. Image analysis showed that improved healing in the form of exaggerated fibroplasia in 19 of 20 in the study group and 11 of 20 in the control group. Regeneration of the panniculous muscle layer was observed in 19 of 20 of the study group and 5 of 20 of the control group. The mean vessel index in the study group was 53.18 ± 4.74 mm(2) and in the control group 23.7 ± 6.37 mm(2) (P < 0.001; confidence interval, 25.88-33.04), whereas the mean of vessel area density was 24.76 ± 7.35 versus 8.68 ± 4.04 mm(2) (P < 0.001; confidence interval, 12.28-19.88) in the control group. Histopathologic analysis by hematoxylin-eosin stain, CD31, and factor VIII stains showed significant angiogenesis in the quantity and quality of the new blood vessels in the study group compared with the control group. CONCLUSIONS: Sadat-Habdan mesenchymal stimulating peptide has potential of early healing of experimentally produced burns in rats. Healing was effective and better in the study group compared with the control group, in qualitative and quantitative measures.

Vancomycin flushing syndrome in orthopaedic practice: A case report.

BACKGROUND: Vancomycin flushing syndrome (VFS), also known as red man syndrome, is an allergic reaction to vancomycin. It typically presents as a rash on the face, neck, and upper torso after intravenous administration of vancomycin. VFS is blamed on rapid intravenous infusion of vancomycin during management and rarely happens after local use. A review of the literature showed that in the last 23 years, 4 such cases have been reported. Here, we add another case of VFS developed after slow local absorption of vancomycin in cement beads. CASE SUMMARY: A 44-year-old male with a known case of hypertension, no history of allergies to medications, and a history of chronic osteomyelitis of the right tibia with discharging sinus over the anterolateral aspect of the leg. The pus culture grew Staphylococcus aureus, which was sensitive to clindamycin and vancomycin. The patient underwent irrigation and debridement with the placement of vancomycin cement beads made from 4 g of vancomycin powder and 40 g of polymethyl methacrylate. Three hours postoperatively, the patient developed a pruritic, erythematous, macular rash predominantly on his face, neck, chest, and lower extremities and to a lesser extent his upper extremities. A diagnosis of VFS was made and was successfully treated with cetirizine (10 mg, oral) and methylprednisolone sodium succinate (125 mg, intravenous). The patient continued to have itching with a facial rash for 12 h with gradual improvement. A decision was made to not remove the beads as the patient continued to improve. Gradually, the rash disappeared after 96 h with no further sequela. CONCLUSION: VFS can occur not only after rapid intravenous injection of vancomycin but also with local release, as in our case. As orthopaedic surgeons routinely use vancomycin with polymethyl methacrylate in chronic osteomyelitis and revision arthroplasty, they should be aware of such a complication occurring.

Genetic Influence of Fracture Nonunion (FNU): A Systematic Review.

Purpose: Nonunion of fractures occurs in about 15% of all fractures causing repeated surgical interference and prolonged morbidity. We performed this systematic review to assess genes and polymorphisms influencing fractures' nonunion (FNU). Methods: We searched between 2000 and July 2022 in PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Genome Wide Association Studies (GWAS) Catalog, and the Science Citation Index, with the keywords nonunion of fractures, genetic influence, and GWAS. The exclusion criteria were review articles and correspondence. The data were retrieved to determine the number of studies, genes, and polymorphisms and the total number of subjects screened. Results: A total of 79 studies were reported on nonunion of fractures and genetic influence. After the inclusion and exclusion criteria, ten studies with 4402 patients' data were analyzed. Nine studies were case-controlled, and 1 GWAS. It was identified that patients with polymorphisms in the genes ANXA3, BMP2, CALY, CYR61, FGFR1, IL1ß, NOG, NOS2, PDGF gene, and TACR1 are prone to develop a nonunion of fractures. Conclusion: We believe that for patients who develop an early nonunion of fractures, a genetic study should be conducted for single nucleotide polymorphism (SNP) and genes so that alternative and more aggressive treatment can be performed to heal fractures without prolonged morbidity.

Can we suppress excessive post-surgical scar formation: A case report.

BACKGROUND: Hypertrophic scars (HSs) formation is a complication that occurs after wounds heal with secondary intention and sometimes after clean surgical incisions. Many treatments are in vogue now with varying successes. Although the mechanism or mechanisms that cause a HS to form are not clearly understood, one thing that is clear is that once scar tissue matures, any intervention will not be successful. In this paper, we report on a case where a patient who was known to develop HS was treated with a new combination of ingredients (Phyto-chemicals + Silicone JUMI) to suppress HS formation. CASE SUMMARY: A 68-year-old female of African descent presented a severe HS post total knee replacement (TKR), which the patient describes as itchy and painful. Due to complications caused by the scar, she was apprehensive about undergoing TKR on her other knee. However, after the TKR of the contralateral side post-removal of skin clips, JUMI anti-scar cream (JASC) was used to suppress excessive scar formation. CONCLUSION: JASC appears potent and efficacious at suppressing excessive scar formation. We believe that this warrants further studies on larger patient groups and on different surgical sites.

Identification of adverse events in orthopaedic practice: a step towards quality care.

Adverse Events (AE's) are unintended injuries or complications resulting in death, disability or prolonged hospital stay, that arise from deficiency in the health care management. The objective of this retrospective study is to assess the incidence of AE's, its impact on patients in terms of morbidity and mortality. All orthopaedic patients admitted to the male orthopaedic ward between 1st August 2010 to 31st July 2011, were included. Any such event that occurred in the index admission or within 30 days of discharge was included in the present study. Identification of AE's was based on the written records in case-sheet and analysis of the computer data. When clarification was required, the issue was discussed with involved physicians and nursing staff and the patient was contacted by telephone. Presence of one or more of the 12 predefined screening criteria constituted the screening process. Fifty three (10.83%) of 489 patients studied during the study period experienced a total of 101 AE's (20.65%). Majority of AE's occurred in trauma patients admitted from the emergency room--35 (66%)--and from the outpatient department (OPD)--30 (56.6%)--. Of the 101 AE's, 74 (73.1%) were estimated to have a high degree of preventability. On assessing the impact on patients, residual morbidity was noted in 1 (1.88%) patient. There was no mortality as a result of AE. AE's occurred due to non-adherence to existing protocols in totality. AE's resulted in increased morbidity of the patients, longer hospital stay, multiple surgeries and economic burden to the hospital. Identifying AE's provides the foundation and driving force for initiative to reduce morbidity. It also helps to evolve specific risk reduction strategies and self auditing and thereby improve quality care of patients.

The efficacy of new neuronal growth factor in the healing of the sciatic nerves in rabbits.

Background and Objective: Regeneration of nervous tissue is unpredictable and an ideal growth factor to influence the healing of the injured nerves is not available. A recent study in rats had shown that a new neuronal growth factor (NNGF) was effective in the early healing of the sciatic nerves. The aim of this experimental study is to test the efficacy of NNGF in the healing of iatrogenic division of the sciatic nerves in a larger animal (rabbits). Methods: White New Zealand 20 male rabbits of 6 months of age were divided into two groups. Intramuscular ketamine and xylazine were used to anesthetize the animals. The sciatic nerves were divided using scalpel blade 15 and 10/0 Vicryl was used to repair the divided neural tissue. In the study group, 10 mg/kg body weight of NNGF was instilled on the top of the divided nerves and the wound was closed. At 4 weeks, the operated limbs were observed for any trophic skin changes. Nerve conduction studies were carried out using train-of-four-Watch SX, Organon (Ireland) Ltd., and Ireland. The rabbits were put to death humanely and the sciatic nerves were removed and delivered to the pathologist in 2% formalin. The pathologists were blinded about the two groups. Results: Electromyographic study done at 4 weeks showed in the untreated group; the mean twitches 1-T4 was 0.45 ± 0.31% and in the treated group, the average was 77.912 ± 5% (P > 0.001). Microscopic anatomy in the treated group revealed prominent healing by regeneration was evidenced by showing growth of its proximal segments into an empty endoneurial tube which was not seen in the control group. In the control group, the nerves showed no histological element of healing by regeneration. Conclusions: NNGF proves that in a larger animal at 4 weeks profoundly influenced early regeneration of experimentally created divisions of myelinated nerve tissue.

Résumé Contexte et objectif: La régénération des tissus nerveux est imprévisible et un facteur de croissance idéal pour influencer la guérison des nerfs blessés n'est pas disponible. Une étude récente chez le rat a montré qu'un nouveau facteur de croissance neuronal (NNGF) était efficace dans la guérison précoce des nerfs sciatiques. L'objectif de cette étude expérimentale est de tester l'efficacité du NNGF dans la guérison de la division iatrogène des nerfs sciatiques chez un animal plus grand (lapin). Méthodes: White New Zealand 20 lapins mâles de 6 mois ont été divisés en deux groupes. La kétamine intramusculaire et la xylazine ont été utilisées pour anesthésier les animaux. Les nerfs sciatiques ont été divisés en utilisant la lame scalpel 15 et 10/0 vicryl ont été utilisés pour réparer le tissu neural divisé. Dans le groupe d'étude, 10 mg / kg de poids corporel du NNGF ont été inculqués sur le dessus des nerfs divisés et la plaie a été fermée. À 4 semaines, les membres opérés ont été observés pour tout changement de peau trophique. Des études de conduction nerveuse ont été menées à l'aide de SX Train-of-Nat-Watch, Organon (Ireland) Ltd. et Ireland. Les lapins ont été mis à mort avec humanité et les nerfs sciatiques ont été retirés et livrés au pathologiste dans 2% de formol. Les pathologistes ont été aveuglés sur les deux groupes. Résultats: électromyographique L'étude réalisée à 4 semaines a montré dans le groupe non traité; Les contractions moyennes 1 à T4 étaient de 0,45 ± 0,31% et dans le groupe traité, la moyenne était de 77,912 ± 5% (p> 0,001). L'anatomie microscopique dans le groupe traité a révélé une guérison importante par régénération a été mise en évidence en montrant la croissance de ses segments proximaux dans un tube endoneurial vide qui n'a pas été observé dans le groupe témoin. Dans le groupe témoin, les nerfs n'ont montré aucun élément histologique de guérison par régénération. Conclusions: NNGF prouve que chez un animal plus grand à 4 semaines, a profondément influencé la régénération précoce des divisions créées expérimentalement du tissu nerveux myélinisé. Mots-clés: Facteurs de croissance, régénération nerveuse, nerfs sciatiques.

Treatment of bisphosphonate induced osteonecrosis of jaw in rats using an angiogenesis factor (A-Heal) and ABMDO (Autologous Bone Marrow Derived Osteoblasts).

BACKGROUND AND OBJECTIVE: The aims of this study were to create Bisphonates Related Osteonecrosis of the Jaw (BRONJ) in rats and treat them with an angiogenesis factor (A-Heal) and ABMDO (Autologous Bone Marrow Derived Osteoblasts). MATERIALS AND METHODS: Thirty female Wistar rats were procured. Rats were labeled as Group I to III. Group I = Osteoblast group, Group II = A-Heal and Group III Control group. In Groups I-III, BRONJ was created and treated in Group I with ABMDO, Group II with A-Heal and Group III was the control group. At the end of the four weeks post treatment, all the animals were humanely killed. The intact maxillae were removed in total. Histopathological and radiological examinations were carried out with physicians blinded to the groups. RESULTS: Computerized tomography revealed that Groups I and II demonstrated the presence of dense osteosclerosis, intralesional calcifications, and adequate healing of the overlying soft tissues compared to Group III, which showed the presence of bone erosions at the alveolar ridge with a lack of intralesional calcifications and ulceration of the overlying soft tissues. Histologically, H&E staining Group 1 and Group 2 both showed marked reactive bone formation. Group 2 additionally revealed the most prominent vascular proliferation (also highlighted by Factor VIII, an endothelial cell marker) among all groups. Group 3 showed cartilaginous proliferation with less reactive bone formation, implicating decreased endochondral ossification compared to Groups 1 and 2. CONCLUSION: This study shows that angiogenesis factor (A-Heal) and ABMDO were successful in the treatment of experimentally created BRONJ in an animal model.

The clinical and radiological effectiveness of autologous bone marrow derived osteoblasts (ABMDO) in the management of avascular necrosis of femoral head (ANFH) in sickle cell disease (SCD).

PURPOSE: Avascular necrosis of the femoral head is a common issue faced by orthopaedic surgeons that ranges between 10 and 18%, but in patients with SCD, the incidence reaches 30%. There is no definite treatment except joint arthroplasty. Regenerative medicine is an option to cure or delay joint arthroplasty. We report here our experience with the injection of ABMDO to manage ANFH and report our medium-term results, the progression of the ANFH if any and the delay in total hip arthroplasty. (THA). METHODS: Sixty-Three (63) patients with SCD and ANFH were examined and thoroughly investigated, and those who had ANFH < grade II were consented to receive ABMDO. Patients were clinically assessed preoperatively using the Visual analogue scale (VAS), Modified Harris Hips Score (MHHS) and Azam-Sadat Score (ASS) for Quality of Life Score for Chronic Hip Disease. Ten millilitres of bone marrow were aspirated under local anaesthesia and placed in 20 CC of culture media. Osteoblasts were cultured from the aspirated bone marrow. Under anaesthesia, the osteonecrosed lesion was drilled using a 3-mm cannulated drill, and 5 million osteoblasts were injected at the lesion site. Patients were evaluated in the outpatient clinic after 2 weeks. At 4 months, a repeat MRI was done, and patients were followed for a minimum of 2 years. RESULTS: The average age of patients was 25.93 ± 5.48 years. There were 41 (65%) females and 22 (35%) males. The mean hemoglobin S was 83.2 ± 5.1%. The average follow-up was 49.05 ± 12.9 (range: 24-60) months. TheVAS significantly improved from 7.79 ± 1.06 initially to 4.07 ± 1.08 (p < 0.0001) at 2 weeks and continued to improve for the next 24 months, when it was 2.38 ± 0.55 (p < 0.0001). The MHHS improved from 41.77 ± 5.37 initially to 73.19 ± 6.48 at 4 months (p < 0.001), and at 24 months, it was 88.93 ± 3.6 (p < 0.001). The ASS also significantly improved from 2.76 ± 0.49 preoperatively to 7.92 ± 0.09 (p < 0.0001) at 24 months. A comparison of the MRI's from before and after the osteoblast implantation revealed new bone formation and amelioration of the avascular lesions. Three patients were unsatisfied with their outcomes. and one patient suffered a repeat attack of the vaso-occlusive crisis within 6 months of the osteoblast injection. CONCLUSIONS: The results give credence to our earlier short follow-up results showing that osteoblast transplantation has great potential in the healing of avascular lesions. Our study fits the criteria of a Phase II clinical trial, and we believe a larger study equivalent to Phase III numbers should be conducted and include patients with not only SCD but also steroid-induced and idiopathic avascular necrosis. LEVEL OF EVIDENCE: II.

Osteoporosis: Is the prevalence increasing in Saudi Arabia.

Background and Objective: The objective of this analysis is to report from a teaching hospital in eastern Saudi Arabia hospital based prevalence of osteopenia and osteoporosis. Methods: This is a retrospective study of all patients who underwent dual-energy X-ray absorptiometry (DXA) scan between January 1, and December 31, 2018, at King Fahd Hospital of the University at Alkhobar, Saudi Arabia. Demographic data of patients, which included age, sex, diabetes mellitus status based on fasting blood sugar, hemoglobin A1C, Vitamin D level, parathormone level, and T score of the neck of femur and lumbar spine was extracted from the Quadrumed patient care system. The data was entered into database and analyzed. Results: Three hundred and one patients had a DXA scan for the year 2018, a jump of 27.2% of requests to diagnose osteoporosis. There were 55 (18.27%) were male and rest females (246). The average age for males was 65.2 ± 10.5 and females 62.9 ± 9.4 years. Using T score of the lumbar spine, 63.6% were osteoporotic in males and 52.8% in females. Conclusions: The hospital-based study shows that the prevalence of osteoporosis has significantly increased in men to 63.6%, while in postmenopausal women to 58.4%, this is high compared to the earlier reports.

Résumé Contexte et objectif: L'objectif de cette analyse est de faire rapport d'un hôpital d'enseignement dans l'hôpital de l'Arabie Saoudite est basé Prévalence de l'ostéopénie et de l'ostéoporose. Méthodes: Il s'agit d'une étude rétrospective de tous les patients atteints de rayons X à double énergie Absorptiométrie (DXA) Numérisation entre le 1er janvier et le 31 décembre 2018, à l'hôpital roi Fahd de l'Université d'Alkhobar, en Arabie saoudite. Données démographiques des patients, qui comprenaient l'âge, le sexe, le diabète suit des Mellitus basé sur la glycémie à jeun, l'hémoglobine A1C, la vitamine D Le niveau de niveau, de la parathormone et du score T du col du fémur et de la colonne lombaire a été extrait du système de soins quadrumé des patients. le Les données ont été entrées dans la base de données et analysées. Résultats: Trois cent et un patients avaient une analyse DXA pour l'année 2018, un saut de 27,2% des demandes de diagnostiquer l'ostéoporose. Il y avait 55 (18,27%) étaient des femmes et des femmes de repos (246). L'âge moyen des hommes était de 65,2 ± 10,5 et les femelles 62,9 ± 9,4 ans. En utilisant la score T de la colonne lombaire, 63,6% étaient ostéoporotes chez les hommes et 52,8% chez les femmes. Conclusions: le L'étude à l'hôpital montre que la prévalence de l'ostéoporose a considérablement augmenté chez les hommes à 63,6%, tandis que dans les femmes ménopausées À 58,4%, cela est élevé par rapport aux rapports précédents. Mots-clés: ostéopénie, ostéoporose, prévalence, Arabie Saoudite, Vitamine D.

Does high serum iron level induce low bone mass in sickle cell anemia ?

Iron overload is quite common in patients suffering from hemoglobinopathies causing arthropathies, endocrinal affection and neuropathies. Recently low bone mass was added to the list of complications. This study is conducted to find any correlation between serum iron level and low bone mass in sickle cell anemia (SCA). Patients ≥18 years of age with sickle cell anemia, who attended outpatient clinics or admitted to King Fahd University Hospital, Al Khobar, Saudi Arabia,between 1st September 2006 and August 2007 were the subjects of this study. Patients age and sex were documented and body mass index was calculated. Apart from routine hematological tests, serum ferritin, serum Iron level, total estradiol, testosterone level was done. Bone mineral density measurement was done using dual energy X-ray absorptiometry (DEXA) at upper femur and lumbar spine. The data of 100 patients was analyzed, 48 males and 52 females. The mean age was 27.5 ± 6.1 years. In 64 patients (32 males and 32 females) serum iron level was 319.35 µg/dl and the mean serum ferritin level in males and females was within the normal range. Sixty-eight percent of females and 71.8% of males patients in whom serum iron was high had lower bone mass P = < 0.001. Our study shows that SCA patients in whom serum iron level was higher than normal effected bone mass. Further studies are needed to confirm this as a cause of osteoporosis in SCA patients.

Genetic markers for idiopathic scoliosis on chromosome 19p 13.3 among Saudi Arabian girls: A pilot study.

BACKGROUND AND OBJECTIVE: Genetic locus linked to chromosome 19p for Adolescent idiopathic scoliosis (AIS) has been described. This study was carried out with the aim to find any significant linkage or association between three microsatellite markers (D19S216, D19S894, and DS1034) of chromosome 19p13.3 in Saudi Arabian girls with AIS. MATERIALS AND METHODS: In eleven unrelated Saudi Arabian girls who were treated for AIS with Cobb angle of ≥30 degrees and in 10 unrelated healthy individuals, linkage analysis was performed using parametric and nonparametric methods by use of GENEHUNTER version 2.1. Multipoint linkage analysis was used in specifying an autosomal dominant trait with a gene frequency of 0.01 and an estimated penetrance of 80% at the genotype and the allele level. Fisher's exact test was used in the analysis of contingency tables for the D19S216, D19S894, and DS1034 markers. RESULTS: The analysis between the patient group and healthy girls showed that at genotypic level there was no significant association of the markers and scoliosis D19S216 (P = 0.21), D19S894 (P = 0.37), and DS1034 (P = 0.25). Whereas, at the allele level, there was statistically significant association between the marker DS1034 (P = 0.008) and no significant association with the other two markers D19S216 (P = 0.25) and D19S894 (P = 0.17). CONCLUSIONS: Our study shows that at genotypic level none of the markers reported earlier were associated with scoliosis but at allele level, marker DS1034 was significantly associated with patients with AIS. This allele marker on chromosome 19p appears important in the etiology of AIS.

Efficacy of autologous bone marrow derived Mesenchymal stem cells (MSCs), osteoblasts and osteoblasts derived exosome in the reversal of ovariectomy (OVX) induced osteoporosis in rabbit model.

Background: A recent study showed that OVX-induced osteoporosis was reversed after injection of osteoblasts cultured from the bone marrow in rats. The present study evaluated the effect of injecting MSCs, osteoblasts, and exosomes isolated from osteoblasts for the treatment of osteoporosis in the rabbit model. Methods: Osteoporosis was created in 40 rabbits by performing ovareictomy at 6 months of age, and 1 mg/kg body weight of methyl prednisolone sodium succinate was injected daily for 8 weeks. Animals were fed twice daily and were given water ad libitum. MSCs and osteoblasts were grown from the bone marrow as per the methodology described earlier. From osteoblasts, exosomes were extracted. After the 15th day, MSCs (Group 2), osteoblasts (Group 3), and exosomes (Group 4) were injected into 5 animals each, and 0.5 ml of normal saline were injected into the control group (Group 1). After 12 weeks (11 months of age), all the animals were euthanized. The whole femur and the lumbar vertebrae 3-5 were dissected out and were subjected to radiological assessment using high-resolution peripheral quantitative computerized tomography (HRpQCT). All parameters of the bone volume, trabecular number, thickness, and spacing were assessed using SPSS (Statistical Package for the Social Sciences), version 21.0, Chicago, Illinois. A p value of <0.05 was considered Statistically significant with a confidence interval (CI) of 95%. Results: Structural indices of the osteoblasts-injected animals were significantly better than the control group for the distal femur. The most significant improvement was seen in the osteoblasts, MSCs, and exosomes group in that order. The p value of all parameters was <0.0001 in the osteoblasts group, whereas the total and bone volume had a lower p value in the MSCs group. In the osteoblasts group, the positive changes were similar in the distal femur and lumbar vertebrae, but with MSCs and exosomes, the changes were more pronounced in the vertebral spine than the distal femur. Conclusions: This study shows that autologous bone marrow-derived osteoblasts have the robust influence of reversing OVX-induced osteoporosis in rabbits.

Time out: should vitamin D dosing be based on patient's body mass index (BMI): a prospective controlled study.

The recommended daily dose of vitamin D is 2000 IU was found to be insufficient in many patients. The objective of the present study is to find whether the daily dose of vitamin D should be based on BMI. Two hundred and thirty patients with an established vitamin D deficiency (serum level of 25 Hydroxy vitamin D3 (25OHD3) of ≤20 ng/ml) and patients with BMI ≥30 kg/m2 were included in the study. Demographic data, comorbidities and BMI were recorded. Pre-treatment and post-treatment serum 25OHD3, calcium, phosphorus and parathyroid hormone (PTH) were tested at 0-, 3- and 6-month periods. Patients were treated with a standard dose of 50 000 IU of vitamin D weekly and 600/1200 mg of calcium a day. Once their level of 25OHD3 reached ≥30 ng/ml, patients were randomised into two groups. Group A received a standard recommended maintenance dose of 2000 IU daily and Group B patients received 125 IU/kg/m2 of vitamin D3. The data were entered in the database and analysed. The mean age of Group A was 50⋅74 ± 7⋅64 years compared to 52⋅32 ± 7⋅21 years in Group B. In both groups, pre-treatment vitamin D level was ≤15 ng/ml and increased to 34⋅6 ± 2⋅6 and 33⋅7 ± 2⋅4 ng/ml at the end of 3 months treatment with a dose 50 000 IU of vitamin D3 and calcium 600/1200 mg once a day for group A and group B, respectively. At 6 months, patients in Group A 25OHD3 level was 22⋅8 ± 3⋅80 and in Group B was 34⋅0 ± 1⋅85 ng/ml (P < 0⋅001). This preliminary study suggests that obese patients need higher dosage of vitamin D than the recommended dose. It is prudent that the dosage should be based on the BMI to maintain normal levels for a healthy musculoskeletal system.

Autologous Bone Marrow-Derived Chondrocytes for Patients with Knee Osteoarthritis: A Randomized Controlled Trial.

RESULTS: There were a total of 60 patients who were followed up. Three patients in Group II were removed from the analysis as they underwent total knee arthroplasty (TKA). A notably significant improvement was noticed in the ABMDC group on all scores of VAS and MKSSSF with P < 0.0001. The control group continued to be dissatisfied with the treatment they were taking. CONCLUSIONS: This study reveals that a single injection of 5 million of ABMDC was efficient in reducing the symptoms, improving the functional score and betterment of QOL.

Case report: Fibroxanthoma: a complication of a biodegradable screw.

BACKGROUND: Biodegradable interference screws in anterior cruciate ligament (ACL) reconstruction have gained popularity because of their similar or superior fixation strength in comparison to metallic interference screws and because they do not cause imaging artifacts and do not need to be removed. CASE DESCRIPTION: We report the case of a 23-year-old man who presented with slowly progressive firm swelling of 2 months' duration at the site of the tibial tunnel 3 years after ACL reconstruction using a biodegradable interference screw. After curettage and débridement, the material was sent for histopathologic examination, which was reported as a fibroxanthoma. LITERATURE REVIEW: Reported complications are osteolysis around the screw, allergic reaction, sterile abscess formation, ganglion cyst formation, and intraarticular migration. A fibroxanthoma consists of fibroblasts and mononuclear or multinucleated cells with large lipid-filled histiocytes (foam cells). The cells are negative for S-100 and keratin and positive for anti-human macrophage marker HAM-56. PURPOSES AND CLINICAL RELEVANCE: Use of biodegradable screws is associated with high healing rates and low complication rates; however, awareness of their potential complications may help in early recognition and prevention of associated morbidity.