Parastomal hernia repair: a five-year experience from a single centre in the UK.

Parastomal hernias can affect significantly quality of life in patients who often had underwent major operations. The incidence and recurrence is still high although many techniques have been introduced to improve outcomes. Hence, there is still no agreement on what procedure has better results when it comes to repairing a parostomal hernia. Our aim is to compare outcomes of laparoscopic and open parastomal hernia repair in terms of recurrence, reoperations, post-operative complications and length of stay. Sixty-three parastomal hernia repairs were performed in a single Colorectal Centre over a period of 4 years. Eighteen procedures were performed laparoscopically and 45 open. All the 7 emergency procedures were approached open. Both the techniques showed to be safe with post-operative major complication rate (Clavien-Dindo III or above) of 9.52%. The laparoscopic group was found to have a shorter length of stay (p = 0.04) and earlier start of stoma function (p = 0.01), more uneventful recoveries (0.02) and less minor post-operative complications (Clavien-Dindo I or II-p = 0.01,) but similar recurrence rate (p = 0.41). In the open group, the placement of a mesh showed to reduce the rate of recurrence (p = 0.0001). However, this was not found in the laparoscopic approach. In conclusion, the laparoscopic approach showed do give less post-operative complications and a shorter length of stay, with no benefit in the recurrence rate. Considering the open technique, the use of a mesh seemed to reduce the rate of recurrence.

Outcome of Intra-articular Injection of Total Stromal Cells and Platelet-Rich Plasma in Primary Knee Osteoarthritis: A Randomized Clinical Trial.

INTRODUCTION:  Mesenchymal stem cell (MSC) therapy appeared promising in knee osteoarthritis (OA). We examined if a single intra-articular (IA) autologous total stromal cells (TSC) and platelet-rich plasma (PRP) injection improved knee pain, physical function, and articular cartilage thickness in knee OA. METHODS:  The study was performed in the physical medicine and rehabilitation department of Bangabandhu Shaikh Mujib Medical University, Dhaka, Bangladesh. Knee OA was diagnosed according to the American College of Rheumatology criteria and randomly assigned to treatment (received TSC and PRP) and control groups. Kallgreen-Lawrance (KL) scoring system was used to grade primary knee OA. The Visual Analogue Scale (VAS, 0-10 cm) for pain, WOMAC (Western Ontario and McMaster Universities Arthritis Index) for physical function, and medial femoral condylar cartilage (MFC) thickness (millimeters) under ultrasonogram (US) were documented and compared between groups before and after treatment. Statistical Package analyzed data for Social Scientists (SPSS 22.0; IBM Corp, Armonk, NY) was used for data analysis. Pre- and post-intervention outcomes were measured using the Wilcoxon-sign test, whereas Mann-Whitney U-test calculated the difference between groups; a p-value <0.05 was considered statistically significant.  Result: In the treatment group, 15 received IA-TSC and PRP preparation, and in the control group, 15 patients received no injection, but quadricep muscle-strengthening exercise. There was no significant difference between groups regarding VAS for pain, WOMAC physical function, and cartilage thickness before starting the treatment and two weeks after intervention. VAS for pain and WOMAC physical function scores improved profoundly in the treatment group after 12 and 24 weeks of intervention; the pain and physical function scores difference between groups was also significant. However, significant mean femoral cartilage thickness was not changed until the end of 24 weeks (U=175.00, p=0.009 two-tailed and U= 130.00, p=0.016 two-tailed, respectively, for right and left knee). CONCLUSION:  Single TSC and PRP injection reduces knee pain and improves physical function and cartilage thickness in knee OA. While pain and physical function improvement happen earlier, cartilage thickness change takes more time.

Stem Cell Therapy for Cirrhosis of Liver in Bangladesh: Specific Design Compatible for Developing Country.

AIMS AND OBJECTIVES: To assess the safety and efficacy of stem cell therapy in patients with cirrhosis of the liver (LC) in the context of developing country with limited facilities for cell-based therapy and advanced technologies. MATERIALS AND METHODS: A total of 34 patients received granulocyte colony-stimulating factor at a dose of 30 IU, daily for 2 to 11 days to upregulate the numbers of white blood cells and stem cells. Subsequently, stem cells were isolated from the peripheral blood of LC patients in a closed chamber using a harvesting machine. Variable amounts of autologous stem cells were injected to LC patients for once. The patients were followed for 3 months and various factors related to safety and parameters of efficacy were analyzed in this interim report. RESULTS: Out of 34 patients available for final analysis, 3 months after the start of stem therapy, 4 patients died within this period. There was no significant alteration in biochemical parameters due to stem cell therapy, and patients also did not develop any features of acute liver failure indicating that short-term safety parameters of stem cell therapy may be acceptable. Stem cell therapy had a dominant effect on ascites of in this cohort. Although 24 of 34 patients had ascites at the start of therapy,ascites were found in 11 patients after one month and only 4 patients had ascites after 3 months. The positive role of stem cell therapy on ascites in LC patients may be attributed, even in part, to increased serum levels of albumin after therapy compared to basal levels (p <0.001). CONCLUSION: This first study about stem cell therapy in Bangladesh indicates that cell therapy may be accomplished in general hospitals of developing countries if the proper design and mild to moderate types of invasive approach is utilized. The apparent safety of administered stem cells in LC patients and the observed effect on ascites of LC patients inspire optimism about the installation of new and innovative therapy in Bangladesh. Future studies with phase I/II may with stem cell and others cell may be planned at Bangladesh in patients with LC and other intractable diseases with suitable control arms.How to cite this article: Mahtab MA, Akbar SMF, Begum M, Islam MA, Rahim MA, Noor-E-Alam SM, Alam MA, Khondaker FA, Moben AL, Mohsena M, Khan SI, Huq MZ, Munshi S, Hoque A, Haque SA. Stem Cell Therapy for Cirrhosis of Liver in Bangladesh: Specific Design Compatible for Developing Country. Euroasian J Hepatogastroenterol, 2018;8(2):121-125.

Correlation between helicobacter pylori and gastric diseases: a study in King Fahad Hospital at Al-Baha of Saudi Arabia.

Helicobacter pylori (H. pylori) infection is a common and significant public health problem. About 70-90% of the population in developing countries and 25-50% in developed countries were infected with H. pylori. Many studies have been undertaken concerning the role of H. pylori in the etiopathogenesis of chronic gastritis and peptic ulcer, as well as its role in the development of stomach malignancies. The objective of the present study was to find out the correlation between helicobacter pylori and gastric diseases among the Saudi population. This retrospective study was conducted at King Fahad Hospital at Al-Baha of Saudi Arabia between 1st January and 31st December 2004. Patients presented with gastrointestinal symptoms attending at hospital were included in the study. Gastric biopsy specimens were obtained from 187 patients with different type of gastroduodenal diseases. Histopathological study of gastric biopsy was carried out in the laboratory of the same hospital. Grades of H. pylori density in specimens in the present study was classified according to Sydney classification. Total 187 patients were included in the present study. There age range was 06-98 years and 108 were male and 79 were female. Maximum 30.5% patients were belonged to above 60 years age group. Out of all respondents maximum 86.6% patients had gastritis followed by 6.4% had normal histopathological finding, 3.7% had non specific findings and 3.2% had malignancy. Positive correlation was observed between severity of gastritis and grading of H. pylori load. (r=+0.382; p value <0.001). The findings of the present study reveal that H. Pylori is responsible for many gastric diseases. It was also concluded from the study that severity of gastritis associated with H. Pylori increases with the heavy load of infection. To confirm the association prospective study with large sample size is recommended.

Leptin: a mysterious hormone; its physiology and pathophysiology.

Leptin (meaning thin) is attracting the attention of many scientists of the world recently. It is an adipocyte-derived protein hormone discovered in 1994. Human leptin gene is located on chromosome 7. It is mainly expressed in adipose tissue but also in skeletal muscle, stomach, placenta and mammary gland. Leptin play key role in food intake, energy balance, and adiposity as well as in immune and endocrine system. It acts as feedback loop to maintain the constant store of body fat. Leptin acts as an antiobesity hormone raising the potential of its use as antiobesity drugs. In future, leptin or its analogue may offer noble therapeutic approach for obesity or other leptin related disorders. This review focuses on current knowledge of leptin biology and the role of leptin in various physiological and pathophysiological states.