FRAX calculation with and without bone mineral density for assessment of osteoporotic fracture risk in patients of rheumatic disease: a cross-sectional study.

To compare fracture risk assessment (FRAX) calculation with and without bone mineral density (BMD) in predicting 10-year probability of hip and major osteoporotic fracture in patients of rheumatic diseases. Methodology: A cross-sectional was conducted at outpatient Department of Rheumatology. Eighty-one Patients of more than 40 years of age having either sex. Diagnosed case of Rheumatic diseases were according to American College of Rheumatology (ACR) /European Alliance of Associations for Rheumatology (EULAR) criteria were included in our study. FRAX score without BMD was calculated and information was recorded in proforma. These patients were advised dual energy X-ray absorptiometry Scan and after that FRAX with BMD was calculated, after which comparison between result of two scores was made. The data were analyzed by SPSS software version 24. Effect modifiers were controlled by stratification. Post-stratification χ2 test were applied. P value less than 0.05 was considered as significant. Results: This study consisted of 63 participants, who were assessed for osteoporotic risk fracture, with and without BMD. Data analysis revealed a significant association between the type of fracture and age (p value=0.009), previous fracture (p value=0.25), parent fractured hip (p values) and treatment with bone mineral dismissal. There was no statistically significant association seen of fractures with bone deterioration with sex, weight, height, or current smoking. Conclusion: FRAX may be crucial in rural areas where dual energy X-ray absorptiometry scanning is not available since it is a readily available instrument. FRAX is a useful substitute for estimating osteoporosis risk when funds are scarce. Given the possible effect it will have on healthcare costs, this is extremely pertinent.

The prevalence of fibromyalgia among doctors in the tertiary care hospital: A cross-sectional study.

Background: Fibromyalgia syndrome (FMS) is an umbrella term for chronic pain syndrome, associated with tenderness, fatigue, reduced pain thresholds, and paresthesia in the limbs. The field of medicine places doctors in constant work-related stress, sleep deprivation, and depression, thus increasing their vulnerability to developing FMS. This study aims to evaluate the prevalence and severity of FM (fibromyalgia) among physicians in a tertiary care hospital setting. Methods: The cross-sectional study was performed at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from December 2019 to December 2020.243 physicians of either gender, and from all the departments being house officers, medical officers, and post-graduate trainees were included & divided into 3 age groups from 20 to more than 45 years. Widespread Pain Index (WPI) equal to or more than 7 and Symptom Severity Score (SSS) equal to or more than 5 OR WPI = 3 to 6 and SSS equal to or more than 9 were required, according to the modified American College of Rheumatology preliminary diagnostic criteria 2016 for fibromyalgia diagnosis. Data was analyzed using SPSS 25. Results: Among a total of 243 participants, FMS was diagnosed in 69 (28.40%) individuals. The predominant FMS population was the youngest age group 20-35 (56 = 81.16%). Increased BMI, increasing pain score category, gender, and comorbidities are significantly associated with FMS (p ≤ 0.05). Whereas, advancing age is insignificantly linked with FMS (p > 0.05). Conclusions: The prevalence of fibromyalgia was found to be high among doctors working in stressful hospital settings, particularly among the youngest ones.

The Role of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Markers of Disease Activity in Ankylosing Spondylitis.

Background Ankylosing spondylitis (AS) is a chronic rheumatological condition affecting sacroiliac joint and spine and occurs more often in younger patients than in the elderly population. Objective The purpose of the study was to determine the association of the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) with the disease activity of AS. Methodology This case-control study was conducted in the rheumatology department at the Pakistan Institute of Medical Sciences (PIMS) hospital in Islamabad from September 2018 to July 2019. The study consisted of two groups of 59 patients per group. We assessed a full blood count with erythrocyte sedimentation rate (ESR) for each participant using the PIMS hospital laboratory. NLR and PLR were calculated. Results The mean age of the participants in the control group and the cases group was the same (32 ± 4 years). The control group NLR was 1.30 ± 0.16, the PLR was 94.98 ± 17.96, and the ESR was 16.88 ± 3.76 mm/hour. For the cases group, the NLR was 3.08 ± 0.91, the PLR was 171.50 ± 38.06, and the ESR was 29.30 ± 9.20 mm/hour. There was a significant increase in cases for NLR, PLR, and ESR as compared to control samples (p<0.05). The mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score of participants with active diseases was 5.91±1.28. In the same group, the mean ESR was 27.65 ± 9.07 mm/hour, the NLR was 3.46 ± 0.80, and the PLR was 184.39 ± 36.13. For those in the inactive disease group, the mean BASDAI score was 2.84 ± 0.46, the ESR was 33.42 ± 8.48 mm/hour, the NLR was 2.17 ± 0.37, and the PLR was 139.71 ± 26.05. NLR and PLR were significantly higher in the active disease group (p<0.05). Conclusion NLR and PLR are good markers of inflammation in AS patients, and higher values indicate more active disease activity.

TNF-α Genetic Predisposition and Higher Expression of Inflammatory Pathway Components in Keratoconus.

Purpose: To date keratoconus (KC) pathogenesis is undefined; however, the involvement of inflammatory pathways in disease development is becoming apparent. In the present study, we investigated the role of a promoter region polymorphism rs1800629 (-308G>A) in the inflammatory pathway component TNF-α and its effects on the expression of TNF-α and downstream molecules tumor necrosis factor receptor 1 and 2 (TNFR1 and TNFR2), v-rel avian reticuloendotheliosis viral oncogene homolog A (RELA), and interleukin 6 (IL-6) in KC development. Methods: TNF-α promoter polymorphism rs1800629 (-308G>A), was genotyped in 257 sporadic KC patients and 253 healthy controls. Enzyme-linked immunosorbent assay (ELISA) was performed to assess for the -308G>A genotypes. Quantitative polymerase chain reaction (qPCR) was carried out to compare the mRNA expression of TNF-α, TNFR1, TNFR2, RELA, and IL6 in the corneal tissues of 20 KC patients and 20 donor controls. Results: The -308G>A genotype GA was found to be significantly associated with KC development (dominant model [odds ratio (OR) = 6.67 (95% confidence interval [CI] = 4.28-10.42), P < 0.001]) and allele-A (OR = 4.30, 95%CI = 2.93-6.34, P < 0.001). TNF-α serum levels were significantly raised in patients with GA genotype (196.5 ± 69.5 pg/mL) compared to reference genotype GG (21.7 ± 8.2 pg/mL) (P < 0.0001). There was a significant overexpression of TNF-α (P = 0.002), TNFR2 (P = 0.0001), RELA (P = 0.0117), and IL6 (P = 0.0007) in the KC corneal tissues as compared to the control. Conclusions: The GA genotype of the TNF-α -308G>A polymorphism is a significant genetic risk factor for the pathogenesis of KC. Moreover, this single nucleotide polymorphism (SNP) was observed to be associated with deregulated expression of downstream molecules, thus further reinforcing the role of the inflammatory pathway components in the development of KC.