Mediatory role of the serum mineral level and discharge disability of stroke survivors.

Background: Possible association between minerals contributing and mortality related to stroke were seen, but prospective data on the relation of vitamin D, magnesium and calcium serum levels with stroke were inconsistent. Consideration about the potential health effects of minerals and nutrients, the current study was conducted. Methods: This analytical cross-sectional study was conducted on 216 stroke survivors who were referred to the Ayatollah Rouhani Hospital of Babol, Iran. Demographic characteristics, clinical variables, and serum mineral levels were completed in the checklist. Admit score and discharge scale of these patients were determined according to the National Institute of Health Stroke Scale. A path model was constructed to explore the interrelationship between variables and to verify the relationship between variables and disability discharges. Results: Of 216 stroke patients, 185 (85.6%) cases were ischemic. The discharge status of 29 (12.9%) cases were severe or expired. The patients with moderate and severe admit scores, hemorrhagic stroke type, diabetes mellitus, hypertension and live in the village significantly had a poor discharge disability scale (all of p<0.05). Of all direct paths, Mg (ß=-2.85), and among indirect paths, calcium(ß=-3.59) had the highest effect on the discharge scale. Only mg had affected the discharge scale through direct and indirect (ß=-2.45) paths and had the greatest reverse effect on the discharge scale (ß=-5.30; totally). Conclusion: Hypomagnesemia and hypocalcemia play a mediatory role in poor outcomes. Especially, hypomagnesemia was the direct parameter for poor outcomes. The independent role of each mineral in this issue is difficult to define and suggested for future study.

TIM-3 as a potential exhaustion marker in CD4+ T cells of COVID-19 patients.

BACKGROUND: COVID-19 causes a range of clinical symptoms from mild to critical and can be life-threatening. Up to now, it has led to many deaths. We aimed to evaluate exhausted markers on CD4+ T cells of COVID-19 patients. METHODS: In this study, we evaluated 44 patients with confirmed COVID-19 disease and 16 healthy individuals. Patients were divided into moderate/severe and critical groups. Peripheral blood mononuclear cells (PBMCs) were isolated and stained by anti-human CD39, PD-1, TIM-3, and anti-human CD4. The percentage of each CD4+  subpopulation was calculated by flow cytometry. Furthermore, we collected clinical information and laboratory data of both control and patient groups. RESULTS: We detected overexpression of TIM-3 on CD4+  T cells in both critical and moderate/severe patients than in healthy individuals (HIs; p < .01 and p < .0001, respectively). CD4+  TIM-3+ CD39+  lymphocytes were significantly higher in the critical patients than in HI (p < .05). Both Patient groups showed lymphopenia in comparison with HI, but CD4+  lymphocytes did not show any significant difference between study subjects. The increased amount of C-reactive protein, erythrocyte sedimentation rate, creatinine, blood urea nitrogen, and neutrophil count was observed in patients compared to HI. CONCLUSION: T cell exhaustion occurs during COVID-19 disease and TIM-3 is the most important exhausted marker on CD4+ T cells.

Evaluation of Serum Pentraxin-3 Level in Patients with Acute Myocardial Infarction Compared with Control Group.

BACKGROUND & OBJECTIVE: The aim of this study was to measure serum pentraxin 3 (PTX3) in patients with acute myocardial infarction (MI) and compare it with the control group. METHODS: In this case-control study, 60 patients with MI (±ST-segment elevation) were included in the case group , and those with symptoms suspicious for coronary artery disease (CAD) and with no abnormal findings in angiography and troponin I level less than 99th percentile of normal population were included as a control group (N=30). Serum PTX3 and troponin I were measured. RESULTS: In this study, 60 patients including 34 men and 26 women were included in the case group (mean age: 61.4±8.86 years in non-ST-segment elevation myocardial infarction [NSTEMI] subgroup and mean age: 57.9±9.49 years in ST-segment elevation myocardial infarction [STEMI] subgroup), as well as 13 men and 17 women as the control group (mean age: 55.47±10.09 years). PTX3 level was higher in MI cases (1128.4±1205 pg/mL) compared to controls (394.5±170.40 pg/mL) (P=0.001). There was no relationship between ejection fraction (EF) and PTX3 level in the MI group. The area under the ROC curve (AUC) of PTX3 in MI was presented by 0.828 (AUC=0.828) (P>0.001). We defined three different cutoffs for PTX in this study, in which the cutoff ≥400 pg/mL had the highest sensitivity (92%), and the cutoff ≥700 pg/mL had the highest specificity (97%). CONCLUSION: According to the results of this study, PTX3 as an inflammatory marker showed higher level in patients with MI, especially in STEMI cases. Therefore, combined evaluation of troponin I and PTX3 levels would be associated with more accuracy in diagnosis of MI.

Conjunctival polymerase chain reactions in COVID-19 patients and its correlation with clinical and paraclinical indexes.

BACKGROUND AND OBJECTIVES: This study aimed to detect SARS-CoV-2 in conjunctival samples of COVID-19 patients to investigate the transmission route of COVID-19 and its correlation with laboratory indexes. MATERIALS AND METHODS: In this cross-sectional study, 44 COVID-19 patients were tested for conjunctival PCR in Ayatollah Rouhani hospital of Babol, Iran, in January and February 2021. The conjunctival samples were collected using a conjunctival swab and suspended in a viral transport medium. After RNA extraction and cDNA synthesis, real-time PCR was performed to investigate the SARS-CoV-2 genome in samples. The ocular manifestations and laboratory indexes were evaluated for all patients. RESULTS: Among 44 COVID-19 patients, 6 samples (13.63%) were positive in terms of conjunctival PCR. The mean ± SD age of conjunctival PCR-positive patients was 76.17 ± 16.61-year-old, while conjunctival PCR-negative COVID-19 patients were aged 57.54 ± 13.61-year-old (p <0.05). D-dimer serum level is significantly higher in conjunctival PCR-positive COVID-19 patients (4001.00 ± 3043.36 µg/ml) compared to normal individuals (496.80 ± 805.92 µg/ml, p <0.01). CONCLUSION: Our study showed that the conjunctiva and tear contain the SARS-CoV-2 in COVID-19 patients as a possible transmission route.

Association of serum magnesium levels with risk factors, severity and prognosis in ischemic and hemorrhagic stroke patients.

BACKGROUND: Stroke is the third leading cause of mortality worldwide. One of the factors that affect the occurrence of stroke can be attributed to changes in the levels of trace elements. Accumulating evidence has been shown that magnesium, as an important element, is a new predictor of stroke. We aimed to determine the levels of Mg in ischemic stroke patients in comparison with those having the hemorrhagic type. METHODS: This study was conducted on 447 stroke patients. Demographic characteristics of patients, stroke severity, and risk factors such as hypertension, ischemic heart disease, diabetes mellitus, and hyperlipidemia were recorded. Stroke was diagnosed based on the neurological examination and neuroimaging findings e.g. computed tomography (CT) or magnetic resonance imaging (MRI). The colorimetric technique was used to determine the concentration of Mg at 450 nm according to the commercial kit. RESULTS: The mean of magnesium levels in ischemic patients was significantly higher than that in the hemorrhagic patients (P=0.001). Difference in magnesium status was associated with gender in thrombotic patients (P<0.05), while hyperlipidemia was associated with the status of magnesium in embolic patients (P=0.012). Furthermore, magnesium levels were correlated with ischemic heart disease in embolic (P=0.011) and sub-arachnoid hemorrhagic (SAH) patients (P=0.012), and with diabetes mellitus in thrombotic patients (P=0.012). Magnesium status was associated with the severity of ischemic stroke at the time of discharge in ischemic patients (P<0.001). Mg levels had the best area under curve (AUC) for the discrimination of ischemic patients from hemorrhagic ones. CONCLUSION: Magnesium levels were higher in ischemic patients compared to hemorrhagic ones, and these levels were associated with many risk factors contributing to a stroke. Magnesium may be used as a new predictor of stroke in ischemic patients as opposed to hemorrhagic ones.

Correlation between systemic markers of inflammation and local synovitis in knee osteoarthritis.

BACKGROUND: In the elderly population joint swelling, effusion and pain indicate local synovitis and the presence of inflammation. At present, no serum marker has been shown linking to knee synovitis in KOA. With regard to serum high sensitive C-reactive protein (hsCRP) as a measure of inflammation, this study aimed to determine the association of systemic inflammation with local synovitis, as well as with pain and muscle strength in KOA. METHODS: The study population was selected consecutively among patients with KOA presented to Ayatollah Rouhani Hospital Rheumatology Clinic with knee joint synovitis. The diagnosis of KOA was confirmed according to the American College of Rheumatology diagnostic criteria. Data regarding radiographic, demographic and biochemical characteristics were provided and IL-17, IL-10, TGF-ß and hsCRP in serum and synovial fluid (SF) were measured in all patients. Stepwse linear regression models were used to determine the correlation between SF- hsCRP as a measure of local inflammation with other systemic or local markers of inflammation. RESULTS: A total of 40 patients (women 65%) with mean age 65.6+8.9 (49-86) years, mean BMI 27.7+3.7 (22-38) kg/m2, were analyzed. SF-hsCRP was positively correlated with serum hsCRP as well as serum and SF cytokines. Knee pain was positively associated with BMI and radiographic severity and negatively with quadriceps muscle strength (QMS) (r=-0.350, p=0.029). In stepwise linear regression analysis the SF-hsCRP was positively correlated with serum hs-CRP (r=0.769, p=0.001), SF-IL-17 (r=0.428, p=0.001) and negatvely with serum IL-10 (r=-0.316, p=0.002). CONCLUSION: These findings indicate that systemic markers of inflammation such as serum hsCRP, and IL-17 are associated with local inflamation in KOA.

Does the low-density lipoprotein cholesterol play a key role in predicting metabolic syndrome in the Iranian adult population?

BACKGROUND: The low density lipoprotein cholestrol (LDL-C) has an important role in the pathogenesis of cardiovascular disease but its association and predictive accuracy with metabolic syndrome (MetS) remains controversial. The objective of this study was to investigate the association and predictive ability of LDL-C with MetS. METHODS: We analyzed the data from a population-based cross-sectional study conducted on representative samples of an Iranian adult population. The demographic data, anthropometric measures and the lipid profiles were measured with standard methods, and MetS was diagnosed by ATP III criteria. Logistic regression model and ROC analysis were used to estimate the predictive accuracy of LDL-C and its association with MetS. RESULTS: The mean age (±SD) of participants with and without MetS was 47.6±12.5 years and 39.1±12.9 years, respectively (p=0.001). All anthropometric measures (body mass index, waist circumference, waist to hip ratio, waist to height ratio), systolic blood pressure, total cholesterol, triglycerides and fasting blood glucose were significantly higher in MetS, but a significantly higher difference in LDL-C was observed only in women. Accuracy of LDL-C in predicting MetS for men and women was 0.48 (95% CI: 0.43-0.54) and 0.55 (95% CI: 0.51-0.60), respectively. The unadjusted and adjusted odds ratios of different quartiles of LDL-C compared with 1st quartile did not reach to a significant level. CONCLUSION: Serum LDL-C level is not significantly associated with MetS but exhibits a weak ability in predicting MetS in women.

Quadriceps Muscle Strength Correlates With Serum Vitamin D and Knee Pain in Knee Osteoarthritis.

BACKGROUND: Quadriceps muscle weakness and vitamin D deficiency are associated with knee osteoarthritis (KOA). This study aimed to investigate the relationship between quadriceps muscle strength (QMS) and vitamin D in KOA. METHODS: Patients with KOA aged 40 years and above were studied. QMS was assessed by the dynanometry method and serum 25-hydroxyvitamin D (25-OHD) by the ELISA method. Serum 25-OHD<20 ng/mL was considered as a deficiency. The intensity of knee pain was determined by the Western Ontario and McMaster Universities Osteoarthritis Index Pain Scale. The Pearson test was used for correlation analysis between QMS and serum 25-OHD as well as knee pain. RESULTS: A total of 92 patients (female, 80%) with a mean age of 49.6±11.7 years were studied. QMS was correlated positively with serum 25-OHD (r=0.304, r=9.24%, P=0.005) and negatively with knee pain (r=-0.232, r=5.3%, P=0.034). After adjustment for age, sex, and body mass index, the positive correlation increased to a higher level (r=0.496, r=24.9%, P=0.01). For each 1 ng/mL increase in serum 25-OHD, the value of QMS increased by 14.2%±3.5% (P=0.014). There was no significant correlation between serum 25-OHD and knee pain (P=0.13). CONCLUSIONS: These findings demonstrated a significant correlation between QMS with both serum vitamin D and knee pain, indicating a confounding role for quadriceps muscle in the association between serum vitamin D and osteoarthritis knee pain. On the basis of the findings of this study, vitamin D supplementation may affect pain by strengthening quadriceps muscle in KOA.

Huge epithelial nonparasitic splenic cyst: A case report and a review of treatment methods.

BACKGROUND: Splenic cysts are rare in all age groups and there are a few reports in the world literature. Primary cysts occur most frequently in children and young adults, comprising around 25% of all nonparasitic splenic cysts. Various techniques are suggested for the treatment of splenic cysts. In this case report, a huge epithelial splenic cyst in a 17-year-old female is presented and different treatment methods of splenic cysts are evaluated. CASE PRESENTATION: A 17-year-old female presented with progressive abdominal mass in left upper quadrant associated with abdominal pain and food intolerance of duration of several months. There was no history of trauma. On physical examination, there was a huge mass located in the upper left side of abdomen. Computerized tomography scan revealed that a large cystic lesion had occupied the spleen with dimensions of 32x21xI5.6 cm. After patient preparation laparotomy was performed and complete cyst excision was done with splenectomy, patient was discharged after 2 days. This is a report of a case of epithelial splenic cyst of the spleen in a 17-year old female. CONCLUSION: The management of splenic cysts continues to evolve and the optimum treatment of patients with nonparasitic splenic cysts is controversial, as a principle preservation technique of the spleen with minimally invasive methods such as laparoscopy is preferred to splenectomy with the exception of very large cysts and when splenic hilum is involved in cyst wall. However, significant cyst recurrences were encountered with these techniques. Recently open partial splenectomy has been proposed as a safe and effective method in the management of NPSCs it ensures complete cyst removal, lack of cyst recurrence, and preservation of the spleen functions.

Serum C-reactive protein in asthma and its ability in predicting asthma control, a case-control study.

BACKGROUND: Increased serum high sensitive C-reactive protein (hs-CRP) in asthma and its association with disease severity has been investigated in many studies. This study aimed to determine serum hs-CRP status in asthma versus healthy controls and to examine its ability in predicting asthma control. METHODS: Serum CRP was measured by ELISA method using a high sensitive CRP kit. Severity of asthma was determined using Asthma Control Test. Spearman and chi square tests were used for association and correlation respectively. The predictive ability was determined by receiver operating characteristics (ROC) analysis. Accuracy was determined by determination of area under the ROC curve (AUC). RESULTS: A total of 120 patients and 115 controls were studied. Median serum hs-CRP in asthma was higher than control (P=0.001. In well controlled asthma the hs-CRP decreased significantly compared with poorly controlled (P=0.024) but still was higher than control (P=0.017). Serum hs-CRP at cutoff level of 1.45 mg/L differentiated the patients and controls with accuracy of 63.5 % (AUC= 0.635±0.037, P=0.001). Serum hs-CRP ≤ 2.15 mg/L predicted well controlled asthma with accuracy of 62.5% (AUC= 0.625±0.056, p=0.025). After adjusting for age, sex, weight and smoking, there was an independent association between serum hs-CRP >1.45 mg/L and asthma by adjusted OR=2.49, p=0.018). CONCLUSION: These findings indicate that serum hs-CRP in asthma is higher than healthy control and increases with severity of asthma and decreases with. Thus, serum hs-CRP measurement can be helpful in predicting asthma control and treatment response.

Cord Blood Alkaline Phosphatase as an Indicator of Neonatal Jaundice.

BACKGROUND: Management of hyperbilirubinemia remains a challenge for neonatal medicine because of the risk of neurological complications related to the toxicity of severe hyperbilirubinemia. OBJECTIVES: The purpose of this study was to examine the validity of cord blood alkaline phosphatase level for predicting neonatal hyperbilirubinemia. PATIENTS AND METHODS: Between October and December 2013 a total of 102 healthy term infants born to healthy mothers were studied. Cord blood samples were collected for measurement of alkaline Phosphatase levels immediately after birth. Neonates were followed-up for the emergence of jaundice. Newborns with clinical jaundice were recalled and serum bilirubin levels measured. Appropriate treatment based on serum bilirubin level was performed. Alkaline phosphatase levels between the non-jaundiced and jaundiced treated neonates were compared. RESULTS: The incidence of severe jaundice that required treatment among followed-up neonates was 9.8%. The mean alkaline phosphatase level was 309.09 ± 82.51 IU/L in the non-jaundiced group and 367.80 ± 73.82 IU/L in the severely jaundiced group (P = 0.040). The cutoff value of 314 IU/L was associated with sensitivity 80% and specificity 63% for predicting neonatal hyperbilirubinemia requiring treatment. CONCLUSIONS: The cord blood alkaline phosphatase level can be used as a predictor of severe neonatal jaundice.

Vitamin D status and distribution in patients with chronic obstructive pulmonary disease versus healthy controls.

BACKGROUND: Vitamin D has a potential to modulate inflammatory response against noxious particles in patients with chronic obstructive pulmonary disease (COPD). The present study was conducted to determine the status of serum vitamin D in COPD versus healthy group. METHODS: The patients presented to the outpatient pulmonary clinic of Ayatollah Rouhani Hospital, Babol Iran. Diagnosis of COPD was confirmed based on airflow limitation defined as FEV1/FVC ratio <70% and FEV1< 80% of predicted. All eligible patients aged ≥ 40 years old entered the study. Pulmonary infection, tuberculosis, pleural effusion, congestive heart failure, pulmonary hypertension and embolism, restrictive airway disease, conditions leading changes in vitamin D metabolism and absorption were excluded. Serum 25-hydroxyvitamin D (25-OHD) was determined by electrocheminluminescence method and levels <20, 20-29, and ≥30ng/ml were considered as deficiency, insufficiency, and sufficiency. In statistical analysis, the frequency of serum 25-OHD deficiency and insufficiency in patients were compared regarding age of ≤ 50 or >50 years old. All patients were males and age and sex-matched controls were selected among healthy subjects accompanied COPD patients. RESULTS: Ninety patients and 100 controls with respective mean (±SD) age of 64.8±11.7 and 62.6±11.7 years old (P=0.19) were studied. Compared with control, proportions of serum 25-OHD deficiency and insufficiency in patients >50 years were higher and deficiency was lower (61.5% vs 87.5%, P=0.11). CONCLUSION: These findings indicate that a significant proportion of young COPD patients have insufficient serum 25-OHD. Regarding a positive relationship between 25-OHD and FEV1 in COPD, these findings highlight serum 25-OHD assessment in COPD for recognizing high risk patients.

The discriminatory performance of body mass index, waist circumference, waist-to-hip ratio and waist-to-height ratio for detection of metabolic syndrome and their optimal cutoffs among Iranian adults.

BACKGROUND: The superiority of either of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) for prediction of metabolic syndrome (MetS) is remained controversial in Asian population. The objective of this study was to compare the discriminative capacity of either of these measures in prediction of non-adipose components of MetS. METHODS: In this population-based cross sectional study, 1000 representative samples of adults were recruited in Babol, northern Iran. The demographic, anthropometric measures and blood pressure were determined by standard method. Fasting plasma glucose (FPG), triglycerides (TG), total cholesterol (CHL), high density lipoprotein (HDL) cholesterol levels were measured with enzymatic methods by an auto analyzer. The presence of two or more any of four non-obese components were considered as MetS. RESULTS: The diagnostic accuracies (AUCs) of four different measures were rather similar. While AUC for BMI (AUC=0.684; 95% CI: 0.633, 0.736) slightly tended to be higher than that of WC (AUC=0.640; 95% CI: 0.587, 0.693) and WHtR (AUC=0.649; 95% CI: 0.596, 0.701) in men but the accuracy of WC (equivalently WHtR (AUC=0.708; 95% CI: 0.664, 0.751) is tended to be greater than that of BMI in women. The optimal cut-off value for WC was higher in men compared with women. CONCLUSIONS: Overall, BMI, WC and WHtR were significant predictors of MetS equally but WC (equivalently WHtR) was a better predictor than BMI and WHR in women. The optimal cut-offs of WC are lower compared with western population for men but not for women.

Serum C-reactive protein level and distribution in chronic obstructive pulmonary disease versus healthy controls: a case-control study from Iran.

Inflammation has a contributive role in the development and progression of chronic obstructive pulmonary disease (COPD).The present study was designed to determine the level and the distribution of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in COPD compared with controls. Ninety patients with COPD presented to an outpatient hospital clinic and 50 controls who were selected among personals of the same hospital entered the study. Serum high sensitive CRP (hs-CRP) was measured by immunoturbidimetric method and the ESR by Westergren method. Receiver operating characteristic curve was applied to determine a cutoff point for differentiation of the COPD and control group. In statistical analysis, the patients and controls were compared regarding levels and distribution of hs-CRP and ESR. Mean age of patients and controls was 67 ± 11.6 and 51.3 ± 6.7 years, respectively (p = 0.001). Mean hs-CRP was significantly higher (4.76 ± 5.6 vs 1.72 ± 1.68 mg/L, p = 0.001) but mean ESR was nonsignificantly higher (9.1 ± 11.2 vs 7.2 ± 7.4 m/h, p = 0.95) in patients than control. Serum hs-CRP at 1.55 mg/L, differentiated patients and controls at sensitivity of 77.3 % and specificity of 60 %. Serum hs-CRP >3 mg/L was observed in 39 (44.3 %) patients and 9 (18 %) controls (p = 0.001) and >6 mg/L in 22 (25 %) patients and 2 (4 %) controls (p = 0.001).Serum hs-CRP was significantly correlated with ESR in patient but not in control group (Spearman correlation coefficient = 0.516, p = 0.001). Serum hs-CRP and ESR was not correlated with age, weigh, smoking, and the severity of COPD. The results of this study indicated a systemic inflammatory process in COPD. Since inflammation has an important contribution in development of future pulmonary and extrapulmonary complications, serum CRP assessment will provide additional information beyond that achieved by conventional method of pulmonary function test.

Relationship between serum vitamin D and forced expiratory volume in patients with chronic obstructive pulmonary disease (COPD).

BACKGROUND: Vitamin D deficiency seems to be associated with pulmonary function deterioration. The present study was designed to investigate the relationship between serum vitamin D and forced expiratory volume in patients with chronic obstructive pulmonary disease (COPD). METHODS: From September 2011 to April 2012 eighty consecutive patients with COPD presented to an outpatient clinic of Babol University- Teaching Hospital entered to the study. Diagnosis of COPD was confirmed according to clinical findings and pulmonary function test. Serum 25-hydroxyvitamin D (25-OHD) was assessed by chemiluminuscence method and postbronchodilator forced expiratory volume in 1s (FEV1) was measured in all patients. The objective of this study was to determine the relationship between serum 25-OHD concentrations and FEV1 value. The patients were classified according to serum 25- OHD concentrations as less 10ng/ml, 10-19.9; 20-29.9; 30-39.9; and 40ng/ml or higher. The mean values of FEV1 for each class of serum 25-OHD were determined and compared. RESULTS: The mean age of patients was 67.4±11.5 years. The mean FEV1 volume in serum 25-OHD deficient COPD was lower than sufficient COPD (1.550±0.55 vs 1.650±-0.58, p=0.45). Mean FEV1 values increased from 1.55±0.55 L in patients with mean serum 25-OHD <20 ng/ml to 1.94±0.74 L in COPD patients with mean serum 25-OHD ±>40 ng/ml. There was a dose-response pattern of relationship between FEV1 and serum 25-OHD. However, the relationship did not reach to a statistically significant level. CONCLUSION: These findings indicated a relationship between serum 25-OHD concentration and FEV1 volume in patients with COPD and suggest optimization of serum vitamin D levels in COPD.

Diagnostic value of synovial fluid anti-cyclic citrullinated peptide antibody for rheumatoid arthritis.

Early and accurate diagnosis and treatment of rheumatoid arthritis (RA) improves disease outcome. Anti-cyclic citrullinated peptide antibody (anti-CCP) which is highly specific for RA is produced locally from inflamed synovium. The present study was designed to assess the diagnostic performance of synovial fluid anti-CCP (sf-CCP) for RA. A total of 128 patients consisted of 37 RA confirmed by the American College of Rheumatology revised criteria, 91 non-RA (50 non-RA inflammatory arthritis and 41 osteoarthritis) entered the study. Serum anti-CCP (sm-CCP) and Sf-CCP were measured by the ELISA method. Receiver operating characteristics curves were constructed to determine the optimal cutoff point levels for sf-CCP and sm-CCP to discriminate RA from non-RA. Diagnostic characteristics of both variables were determined by comparison of RA patients with non-RA controls. Mean levels of sf-CCP and sm-CCP were significantly higher in RA than in non-RA (P < 0.001). Sf-CCP discriminated RA from non-RA at the optimal cutoff value of 10 U/mL with high accuracy at AUC value of 0.897 +/- 0.039, P < 0.001) sensitivity of 83.7% and specificity of 95.6%. Sm-CCP diagnosed RA at optimal cutoff level of 14.6 U/mL with respective sensitivity, specificity and AUC values of 84.8, 94.3% and 0.895 +/- 0.049, P < 0.001). Sm-CCP was strongly correlated with sf-CCP (r = 0.75, r (2) = 0.57, P < 0.0001). Two of 5 sm-CCP negative RA and 25.7% of serum rheumatoid factors negative RA were sf-CCP positive. These findings indicate that sf-CCP yields diagnostic ability as comparable as sm-CCP for RA. Respecting to local production of sf-CCP prior to disease onset, therefore sf-CCP determination may offer earlier as well as additional diagnostic information which may be more helpful in recognizing RA particularly among recent onset arthritis.

Association between nonspecific skeletal pain and vitamin D deficiency.

BACKGROUND: Deficiency of vitamin D has been reported in patients with many types of musculoskeletal pain. The present study was designed to determine the association between serum 25-hydroxyvitamin D [25-(OH)D] deficiency and nonspecific skeletal pain. METHODS: A total of 276 patients with nonspecific skeletal pain at different regions of the skeletal system diagnosed as leg pain, widespread pain, arthralgia, rib pain, back pain and fibromyalgia were compared with 202 matched controls with regard to mean serum 25-(OH)D level and 25-(OH)D deficiency. Serum 25-(OH)D was measured by enzyme-linked immunosorbent assay method and levels < 20 ng/mL were considered as deficient. Nonparametric one-way analysis of variance, Kruskal Wallis and Wilcoxon tests were used for group comparisons. Multiple logistic regression analysis with calculation of adjusted odds ratio (OR) and 95% confidence interval (95% CI) were performed to determine associations. RESULTS: In patients with nonspecific skeletal pain the mean 25-(OH)D was significantly lower (P = 0.0001) and the proportion of 25-(OH)D deficiency was significantly higher (63.4%vs. 36.1%, P = 0.0001) compared with controls. There was a significantly positive association between 25-(OH)D deficiency and skeletal pain (OR = 2.94, 95% CI = 1.01-4.3, P = 0.0001). The strength of association varied across the groups with strongest association observed with leg pain (OR = 7.4; 95% CI = 3.9-13.9, P = 0.0001) followed by arthralgia (OR = 3.9, 95% CI = 2.1-7.1, P = 0.0001) and widespread pain (OR = 2.8, 95% CI = 1.1-6.6, P = 0.020) but no association with back pain and fibromyalgia. There was a greater positive associations in women compared with men (OR = 2.1, 95% CI = 1.1-4.3, P = 0.001). CONCLUSION: The results of this study indicate a positive association of vitamin D deficiency with a variety of nonspecific bone pain, particularly in women. More studies with larger samples are required to confirm these findings. Increasing serum vitamin D to sufficient levels and longitudinal follow-up of patients may provide further evidence in relation to vitamin D deficiency and skeletal pain.

The prevalence and diagnostic performance of anti-cyclic citrullinated peptide antibody in rheumatoid arthritis: the predictive and discriminative ability of serum antibody level in recognizing rheumatoid arthritis.

BACKGROUND AND OBJECTIVES: The utility of anticyclic citrullinated peptide (anti-CCP) antibody in the diagnosis of rheumatoid arthritis (RA) varies across different studies. We determined the diagnostic performance and predictive ability of anti-CCP for RA. METHODS: We studied 201 patients with RA and compared them with 208 non-RA patients as controls. RA patients included in the study fulfilled the American College of Rheumatology revised criteria and patients with other diseases as well as those with undifferentiated arthritis (UIA) were used as controls. Anti-CCP was measured by enzyme-linked immunosorbent assay (ELISA) and rheumatoid factor (RF) by the agglutination method. The optimal cutoff value and diagnostic accuracy were determined using receiver operating characteristics (ROC) curve and area under the curve (AUC).The sensitivity and specificity were determined by comparison of RA patients with non-RA controls. RESULTS: The anti-CCP test was positive in 164 patients with RA for a sensitivity of 81.6%, specificity of 87.5%, and overall accuracy of 84.6%. The respective values for RF were 75.6%, 86.5% and 84.4%. The anti-CCP test discriminated RA from non-RA patients with high accuracy (AUC=0.889 [0.017] 95% CI, 0.856-0.952, P=.001), and predicted progression of UIA to RA with moderate accuracy (AUC=0.733 [0.069], 95% CI 0.60-0.87, P<.006) at a sensitivity of 75% and a specificity of 68.1%. Among 60 UIA patients, in 16 (26.7%) who differentiated to RA, the mean (standard deviation) for anti-CPP was significantly higher than in 24 (40%) patients who progressed to non-RA (134.8 [172] vs 46 [86] U/mL, P<.01). CONCLUSION: These findings indicate that anti-CCP yields higher sensitivity and overall accuracy, but slightly greater specificity than RF for diagnosis of RA. Anti-CCP positivity, particularly a higher level of serum antibody in patients with UIA, may be a predictor of subsequent RA.