Rasool Akram Hospital

Considering the effectiveness of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis and the existence of different methods of preparing PRP, it is necessary to investigate various techniques as well as the number of leukocytes and platelets in the solutions prepared with these techniques and their effectiveness. This study aimed to compare the effectiveness of PRP obtained through single centrifuged or double centrifuged methods, as well as a placebo injection, in addressing pain, range of motion, and physical performance in patients with knee osteoarthritis. This study was a double-blind, randomized Controlled clinical trial. A randomized controlled trial enrolled 45 participants aged 50 to 75 years diagnosed with knee osteoarthritis, in the years 2021–2022, at the Sports and exercise Medicine Clinic. The participants were randomly assigned to one of three groups: platelet-rich plasma injection, single centrifuged PRP, double centrifuged PRP, or normal saline as a placebo. Pain intensity, knee range of motion, functional tests, and WOMAC Questionnaire scores were evaluated before and after one, three, and six months of the intervention. Statistical analyses were employed to assess the data and identify any superior group post-intervention and during the follow-up period. The findings of this investigation demonstrated notable variations among the groups in the ROM 122.14 ± 6.71 (p = 0.001) and Stair-up 25.21 ± 9.45 (p = 0.014) variables one month after the intervention in double-centrifuged group and ROM 118.92 ± 11.95 (p = 0.001) in single-centrifuged group compared to the control group. Furthermore, there was significant improvement (p < 0.05) in the majority of variables within the single and double centrifuged groups compared to the control group at three and six-months post-intervention. Nevertheless, no significant differences were observed in any of the variables between the single and double centrifuged groups except the Stair-Up test after six-month post-intervention. Platelet-rich plasma (PRP) exhibits the capacity to enhance pain relief, increase range of motion, and ameliorate function and WOMAC scores in knee osteoarthritis. Both single and double centrifuged PRP methodologies yield comparable effects, but double centrifugation yields more prompt positive outcomes. Consequently, both techniques are viable options in the PRP injection protocol for treating knee osteoarthritis. Clinical trial registration: IRCT20140907019073N5.

Background and Aims Androgenetic alopecia (AGA) is a common and distressing medical condition that negatively affects the patient’s quality of life. The conditioned medium (CM) contains secreted proteins and has been investigated for several therapeutic applications. This study sought to assess the efficacy of human foreskin fibroblast (HFF)–CM in AGA treatment. Methods A pilot trial was conducted on eligible AGA patients. Initially, HFFs were isolated, expanded under sterile GMP‐compliant conditions, and characterized by mesenchymal surface marker expression prior to HFF–CM preparation. The resulting HFF–CM was collected after serum‐reduced culture, cleared of cellular debris, sterilized by filtration, and analyzed by ELISA to quantify key growth factors. Subjects received four injections of HFF–CM at 4‐week intervals. The cases were followed up for 6 months, and structural changes were evaluated by sonography, VisioFace software, and trichoscopy. Moreover, subjective satisfaction was assessed. Results During HFF–CM preparation, HFF exhibited MSC‐like morphology and mesenchymal marker expression, and the resulting CM contained a diverse growth factor profile, with IGF‐1 and KGF/FGF‐7 present at the highest levels. Fourteen eligible cases were included in this study (mean age: 34.8 ± 8.1 years, female: 78.6%). The pre‐ and post‐treatment results indicated significant changes in Ludwig’s score ( p = 0.38). Sonography showed notable changes from baseline in complete and dermal density ( p &lt; 0.001), as well as significant improvements in trichosan at both × 60 and × 150 magnification ( p &lt; 0.001). Physician and patient satisfaction assessments revealed excellent and good results in most cases. Conclusion AGA treatment with HFF–CM led to improvement in both objective and subjective parameters. However, large‐scale clinical studies with long‐term follow‐ups are recommended. Trial Registration: Iranian Registry of Clinical Trials: IRCT20221026056309N1

IntroductionAdult intussusception is rare, accounting for approximately 5 % of all intussusceptions and 1–5 % of bowel obstructions in adults. Gastric heterotopia of the small intestine is an uncommon lead point. This case underscores the need to consider gastric heterotopia in recurrent presentations. Recognizing this entity can facilitate prompt diagnosis, guide selection between selective reduction and en bloc resection, and expedite definitive management.Presentation of caseA 31-year-old woman with prior ileocecectomy for intussusception presented with worsening colicky right lower-quadrant pain. CT and colonoscopy showed ileo-ileal intussusception. Controlled pneumatic reduction revealed a polypoid ileal mass; biopsies indicated gastric heterotopia. She underwent laparoscopic segmental ileal resection (10 cm) with side-to-side extracorporeal anastomosis. Histology confirmed polypoid gastric heterotopia with clear margins. Recovery was uneventful with complete symptom resolution.DiscussionAdult intussusception is uncommon and typically arises from a pathologic lead point. Ileal gastric heterotopia is a rare benign cause with potential for recurrence. Cross-sectional imaging, often complemented by endoscopy, helps characterize the lesion and assess for ischemia. When findings indicate a benign intraluminal process without ischemia or suspected malignancy, selective reduction can aid localization and facilitate a limited, minimally invasive resection; when malignancy is suspected, en bloc resection without reduction is preferred. Definitive management is segmental resection with histopathologic confirmation.ConclusionIleal gastric heterotopia is an exceptionally rare cause of recurrent adult intussusception, including after prior bowel resection. Surgical resection remains definitive and yields favorable outcomes.

Background: Lower limbs have been reported as the most common site of acute injury in mountain sports, however, the long-term effect of participating in sports that are practiced in steep terrain is not clear. This study aimed to investigate specifically the frequency of lower limb injuries and functional disorders of athletes in different disciplines of mountain sports including mountaineering, skiing, and sky running. Methods: In this cross-sectional study, 114 athletes registered in the Mountaineering and Skiing Federations of Iran, completed an online survey. The link sent to volunteers included a checklist for demographic profile, history of acute injury, and the Persian version of the Lower Extremity Functional Scale (LEFS). Results: The overall prevalence of lower limb injury was 27.4%, and the median score of LEFS was 78, which was in the normal range. However, 44.2% of the athletes had an LEFS score that indicated a lower-than-normal lower extremity function. No correlation was found between a history of acute injury and reduced LEFS score. Conclusion: The high prevalence of lower limb dysfunction in mountain athletes and the lack of correlation between the history of acute injury and lower limb dysfunction in this study indicates the possible role of other risk factors in the development of overuse injuries.

Background: Pancreaticoduodenectomy (PD), or the Whipple procedure, is commonly associated with high morbidity. Traditional reconstruction using a single jejunal limb carries risks due to the interaction between pancreatic and biliary secretion. The double roux reconstruction procedure (DRRP) may mitigate these risks. Objectives: We hypothesized that DRRP would reduce postoperative pancreatic fistula and related complications compared to the classic Whipple procedure. Methods: This prospective study included 50 patients (31 classic, 19 DRRP). In DRRP, one Roux limb was used for pancreatic anastomosis, and another for gastrojejunostomy and hepaticojejunostomy. Two drains were placed near each anastomosis and removed once biliary and pancreatic secretions decreased to &lt; 10 mL/day for two consecutive days. Results: The DRRP group had a lower, though not statistically significant, rate of postoperative pancreatic fistula (POPF, 5.3% vs. 16.1%). Reoperation rates were higher in the DRRP group (26.3% vs. 9.7%). Conclusions: The DRRP may reduce certain risks but is associated with specific challenges such as anastomotic leaks and port thrombosis, emphasizing the need for careful patient selection, and further investigations for establishing its benefits definitively.

To compare the effects of intravitreal Stivant® (a biosimilar to bevacizumab) alone and in combination with triamcinolone acetonide in center-involved diabetic macular edema (DME). In this randomized controlled study, patients with center-involved DME (central macular thickness [CMT] > 300 µm) were assigned to receive either intravitreal Stivant® 1.25 mg alone (IVS group) or in combination with triamcinolone acetonide 1 mg (IVST group). The regimen consisted of injections every 4 weeks, administered three times. Changes in best-corrected visual acuity (BCVA) and CMT from baseline to follow-up visits were compared between the groups. Of the 140 enrolled participants, 70 eyes of 70 patients were assigned to each group. By week 12, both groups showed improvements in BCVA and CMT compared to baseline values ( P s < 0.001). BCVA (in logarithm of the minimum angle of resolution [logMAR] scale) improved more in the IVST group (0.75 ± 0.62 logMAR) compared to the IVS group (0.92 ± 0.93 logMAR, P < 0.001) at week 4. However, by week 12, BCVA did not differ between the two groups ( P = 0.089). Similarly, although the IVST group demonstrated a higher reduction in mean CMT (-143.40 ± 58.28 µm) compared to the IVS group (-92.19 ± 52.31 µm, P < 0.001) at week 4, this effect did not persist at the next follow-up visits. In eyes with center-involved DME, IVST is more effective in reducing CMT and improving BCVA than IVS up to 1 month, but this superiority does not persist over time.