Bilateral Avascular Necrosis of the Femoral Heads After Covid-19 Infection without Steroid Treatment.

BACKGROUND: Avascular necrosis (AVN) is a potentially serious multifactorial disease. In COVID-19 patients, AVN of many bones has been reported. Usually, the condition is linked to steroid therapy. In this case report, we describe our experience with bilateral AVN of femoral heads in an elderly patient months after being cured of COVID-19 infection without the use of steroids. CASE PRESENTATION: A 68-year-old male was referred to the outpatient clinic of the rheumatology and rehabilitation department for progressive bilateral hip pain starting on the left side 5 months ago. An extensive review of the patient's medical history identified documented COVID-19 infection that required hospitalization 9 months before presentation. Multiplanar MRI with fat suppression of both hips showed ill-defined areas of abnormal signal intensity affecting the left femoral head, neck and intertrochanteric regions with associated subchondral fissuring and mild joint effusion. A similar smaller area was also seen affecting the postero-superior aspect of the right femoral head. CONCLUSION: AVN in COVID-19 patients can be encountered even in the absence of steroid therapy.

Serum Levels of Pentraxin3 and Interlukin36 in Patients with Systemic Lupus and their Relation to Disease Activity.

Pentraxin3 (PTX3) plays an important role in inflammation, immunity, and atherosclerosis. Serum PTX3 has drawn attention as a marker that respond to local inflammation. Interleukin 36 (IL-36) is a novel inflammatory member of the IL-1 cytokine family comprising three different isoforms IL36α, IL-36ß and IL-36γ. The objective of this work was to evaluate the levels of PTX3 and IL36α and to determine their relationships to disease activity in patients with systemic lupus erythematosus (SLE). Forty patients with SLE diagnosed according to SLECCA/ACR2012 criteria were allocated to the study, along with 20, age and sex matched normal control subjects. SLE patients included 20 patients with active disease, each having SLEADI score over 6 points and the other 20 patients, each of them had SLEADI score less than 6 points. Levels of serum PTX3 and IL36α was measured by quantitative sandwich enzyme immunoassay technique. There was a significant increase in the serum pentraxin3 and IL36α in SLE patients (P < 0.01) compared to normal control subjects. The significance increased in serum levels of PTX3 and IL-36α, was noted in active (P=0.000 for both) and inactive SLE patients (P=0.003 and P=0.001, respectively), compared to normal control subjects. Moreover, the active SLE patients had significant increase in the serum levels of PTX3 and IL36α (P < 0.01 for both) compared to the inactive group of patients. A significant positive correlation between each of PTX3 and IL36α, and SLEADI score (P=0.008 and P=0.024, respectively) in SLE patients was observed. In conclusion, PTX3and IL36α serum levels are increased in SLE patients when compared to normal control subjects, correlated positively with SLEDAI score and thus could be used as markers of disease activity.

Protective effects of garlic and silymarin on NDEA-induced rats hepatotoxicity.

BACKGROUND: The present study was conducted to investigate the chemopreventive effects of garlic extract and silymarin on N-nitrosodiethylamine (NDEA) and carbon tetrachloride (CCl(4))-induced hepatotoxicity in male albino rats. METHODS AND RESULTS: Animals were pretreated with garlic, silymarin or both for one week prior to the injection of NDEA. Then animals received a single injection of NDEA followed by weekly subcutaneous injections of CCl(4) for 6 weeks. Oral administration was then continued along with the injection of CCl(4) for the duration of the experiment. Serum aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), hepatic lipid peroxidation (LPO), superoxide dismutase (SOD), reduced glutathione (GSH), glutathione-S-transferase (GST) and glutathione reductase (GSR) were measured. Injection of NDEA induced a significant elevation in serum AST, ALT and ALP. In the liver, NDEA increased oxidative stress through the increase in LPO and decrease in SOD, and GSH-dependent enzymes. Although administration of garlic or silymarin significantly reduced the liver toxicity, combined administration was more effective in preventing the development of hepatotoxicity. CONCLUSION: These novel findings suggest that silymarin and garlic have a synergistic effect, and could be used as hepatoprotective agents against hepatotoxicity.