Association between dietary inflammatory index and musculoskeletal disorders in adults.

This research investigated how the Dietary Inflammatory Index (DII) related to musculoskeletal issues in adults. It used a cross-sectional design with a sample of 3477 female and 3572 male participants aged 35 to 65 from the Ravansar Non-Communicable Diseases cohort study in western Iran. The DII is calculated from a Food Frequency Questionnaire (FFQ) to measure dietary intake. Musculoskeletal disorders including back pain, back pain/stiffness, joint pain, and joint pain/stiffness were evaluated by the RaNCD cohort study physician using a standard questionnaire. Logistic regression analysis examined the association between DII and musculoskeletal disorders. The findings demonstrated a positive association between higher DII scores and back pain/stiffness (OR 1.32, 95% CI 1.04-1.73, P = 0.047). Furthermore, DII displayed a significant association with a heightened odd to joint pain (OR 1.26, CI 1.10-1.46) when compared to those with lower DII scores (Q3 vs. Q1). After adjusting for cofounding factors, the Q3 DII quintile participants showed a 44% higher odd of experiencing joint pain/stiffness (OR 1.44, CI 1.01-2.05, P = 0.047). However, the study found no significant association between back pain and DII (P > 0.05). In conclusion, the research suggests that consuming a pro-inflammatory diet might be linked to developing musculoskeletal issues in adults.

Opinion: "High-Dose Immunosuppression to Prevent Death after Paraquat Self-Poisoning"- Under Estimation of a Significant Effect with Small Mortality Rate Reduction.

A randomised double blinded clinical trial about high dose immunosuppression in Paraquat self-poisoning was published by Professor I. Gawaramanna et al. Before their research, it seems that a little overestimation might be present in the small previous non-randomised clinical trials. This new valuable work clarified the previous exaggerated favourable response to immunosuppression in paraquat self-poisoning; however, their analysis underestimated the favourable response to high dose immunosuppression. According to their results, high dose immunosuppression could decrease mortality considering serum paraquat level and effect time of immunosuppressive drugs but the opposite is concluded. They did not mention the impact of incomplete sample size on their results. Severe paraquat self-poisoning seems to be unresponsive to any treatment and these patients should be analyzed separately according to serum paraquat level. So after reanalysis of their results, the findings seem to be in favour of immunosuppression benefit in paraquat-self poisoning.

Methotrexate Hepatotoxicity in Rheumatoid Arthritis: An Analysis of the Physicians' Policy.

BACKGROUND: Methotrexate hepatotoxicity could be a reason for the discontinuation or dose reduction in patients with Rheumatoid Arthritis (RA); however, the consequence of different policies in this situation is unclear and the physicians need to know what would happen after their decision. OBJECTIVE: To demonstrate the consequence of multiple approaches towards transaminitis management in patients with RA receiving Methotrexate (MTX). METHODS: Data were obtained from the previous work (2006) on 295 patients with RA undergoing MTX treatment. Those who developed transaminitis at least one time were selected for this study. Then, the physicians' decisions regarding discontinuing, decreasing, or prescribing a fixed dose of MTX along with the effect of each decision on the next liver enzyme were evaluated. RESULTS: Strategies of decreasing dose or discontinuing MTX were adopted in 31.4% of patients and prescribing fixed dose was done in 53.9% of patients, leading to 93% and 65% next enzyme normalization, respectively. Thirty-four patients had definite MTX induced transaminitis and 55.9% of the physicians decided to decrease MTX dose for them, causing normalization of the next enzyme in 83% of these patients. In contrast, continuing MTX, even with the same dose, in definite MTX induced transaminitis cases led to consecutive enzyme elevations in 88.9% of these patients (p=0.001). CONCLUSION: Normalization of liver enzymes was observed after decreasing dose or discontinuing MTX, suggesting this policy as the best practice for the management of MTX induced transaminitis. However, the trend to improvement, despite the type of physicians' decision, was observed. This trend was not found in definite MTX induced transaminitis, revealing the prominence of the physician's policy in this situation.

Validity of Self-reported Hypertension and Factors Related to Discordance Between Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study in Iran.

OBJECTIVES: Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort. METHODS: The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard. RESULTS: Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency. CONCLUSIONS: The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.