The prevalence and correlation of depression and anxiety with disease activity in rheumatoid arthritis.

Introduction: Depression and anxiety share similar symptoms with rheumatoid arthritis (RA) and these conditions are often not diagnosed or overlooked in RA. This study aimed to determine the prevalence of depression/anxiety in RA and their correlation with RA activity. Material and methods: Rheumatoid arthritis patients who presented at a rheumatology clinic were selected consecutively. The diagnosis of RA was confirmed by the ACR/EULAR criteria, disease activity was assessed by Disease Activity Score based on the 28-joint count (DAS28) and patients with DAS28 > 2.6 were considered to have active RA. The diagnosis of depression and anxiety was made by the Hospital Anxiety and Depression Scale (HADS). The Pearson test was used to determine the correlation between DAS28 and HADS scores. Results: Two-hundred patients (female, 82%) with a mean age of 53.5 ±10.1 years and mean disease duration of 6.6 ±6.8 years were studied. Depression was diagnosed in 27 (13.5%) patients and anxiety in 38 (19%) patients. The DAS28 score correlated positively with depression (r = 0.173, p = 0.014) and anxiety score (r = 0.229, p = 0.001). In multiple logistic regression analysis after adjustment for all covariates, age < 40 years and female sex were independently associated with RA activity in patients with depression, with OR = 4.21 (p = 0.002) and OR = 3.56 (p = 0.028) respectively. Conclusions: These findings indicate that depression and anxiety are prevalent in RA and correlate positively with active disease in particular in depressive female patients aged < 40 years.

A Survey of Psychological Distress Among the Community in the COVID-19 Epidemic: A Cross-Sectional Study.

Aim The ongoing COVID-19 outbreak has not only had an impact on physical health but also on psychological health. The aim of this study was to measure the prevalence and severity of psychological distress in the community due to the COVID-19 pandemic. Methods This cross-sectional survey was conducted in February and March 2020 in Tehran, Iran. We analyzed demographic characteristics and assessed depression, anxiety, and stress levels in 241 people using convenience sampling and the DASS-21 questionnaire. All statistical analyses were performed using R. Results The study population included 241 community-dwelling participants, of whom 145 were women and 96 were males. The mean age was 49.16 ± 8.01 years. Approximately two-thirds of participants (n = 158) reported no history of comorbid illness. The mean scores of depression and stress were at a "severe" level, while anxiety levels were at an "extremely severe" level. The prevalence of severe and extremely severe depression readings was 51.45 and 38.17%, respectively. In the anxiety subscale, the prevalence of severe and extremely severe depression was 95.90 and 4.1%, and in the stress subscale the prevalence was 48.97 and 4.98%, respectively. Conclusion In this study, people reported experiencing severe and extremely severe psychological distress. Therefore, there is an urgent need to implement mental health intervention policies to cope with this ongoing challenge. We suggest that the incorporation of molecular biomarker tests into the algorithm could aid in assessment of patients and guide the most appropriate therapeutic response.

Efficacy and predictive factors of response to intra-articular corticosteroids in knee osteoarthritis.

In knee osteoarthritis (KOA), synovial inflammation is linked with pain, swelling and structural abnormalities. Intra-articular corticosteroids (IACS) have been considered for pain relief in subjects who are non-responders to standard therapy. However, the results vary across different studies. This review aims to determine efficacy of IACS in KOA by review of the existing data. In several randomized controlled trials (RCTs), meta-analyses and uncontrolled studies a single IACS resulted in pain relief from 1 to a few weeks. In a few studies repeated IACS every three months provided a longer duration of pain relief and functional improvement in a proportion of patients. Baseline synovitis was predictor of treatment response in some but not all studies. Based upon the existing data, IACS provides a short-term pain relief in a proportion of patients. Given, anti-inflammatory properties of IACS, it is likely to be more effective in subgroups of KOA who display inflammatory phenotype.

Factors Associated with Mortality in Patients with Coronavirus Disease (COVID-19) in Babol, North of Iran.

BACKGROUND: The spectrum of the clinical features of coronavirus disease 2019 (COVID-19) spans from asymptomatic or mild disease to severe respiratory failure, while different factors are related to its mortality rate. This research aimed to determine the clinical and laboratory characteristics and the associated factors of mortality in patients with COVID-19. MATERIALS AND METHODS: Data were collected from hospitalized patients (May to June 2020), and COVID-19 was confirmed in patients by real-time polymerase chain reaction (PCR). The patient group was classified into survivor and deceased groups. The chi-square and the independent t-test with Statistical Package for the Social Sciences (SPSS) software program, version 18, were used for analysis. RESULTS: Mean age, hemoglobin, serum C-reactive protein (CRP), alkaline phosphatase (ALP), white blood cells, and level of procalcitonin in non-survivors were significantly higher than in survivors. Serum tumour necrosis factor-alpha (TNF-a) had a significant relationship with D-dimer (p = 0.0006). The risk of mortality in patients with serum CRP > 100 mg/dl was significantly higher than those with CRP < 100 mg/dl (odds ratio (OR) = 4.8 (95 % CI, 1.33-12.44, p = 0.01). CONCLUSION: COVID-19 has different clinical features and can be an asymptomatic, mild, or severe disease. Thus, findings about the disease and the consequent outcomes differ in patients. Further studies are needed to evaluate the clinical features and consequences of COVID-19 infection.

Reliability and validity of the Persian version of psoriatic arthritis screening questionnaire.

Background: The Early Arthritis for Psoriatic Patients (EARP) questionnaire is a fast and simple way to screen psoriatic arthritis. This study was carried out to investigate the diagnostic accuracy of the Persian version of the Early Arthritis for Psoriatic Patients (P-EARP) questionnaire. Methods: A total of 100 psoriasis patients responded to the questionnaire after the translation procedure (translation, back translation). After determining the validity of the questionnaire, the diagnostic accuracy of the P-EARP questionnaire was assessed using the ROC curve (receiver operating characteristic curve). Internal and external reliability of the questionnaire were also evaluated by statistical tests. Results: In assessing the reliability of the questionnaire using test-retest, correlation coefficient (r=0.994, p <0.001) and Cronbach's alpha (α = 0.85) were obtained. The P-EARP questionnaire had a sensitivity and specificity of 90.48% and 96.55% in ROC analysis, respectively, and cutoff point 3 was regarded as the cutoff point of the P-EARP questionnaire like the original version of the questionnaire (EARP). Conclusion: The results of this study showed that the P-EARP questionnaire had high sensitivity and specificity for the identification of psoriatic arthritis. The P-EARP questionnaire is an appropriate screening tool for the identification of psoriatic arthritis in the dermatology clinics.

The effects of functional foods mixture on inflammatory cytokines and biochemical findings in hospitalized patients with COVID-19: a randomized double-blind controlled trial.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has been shown to affect nutritional recommendations. Some functional foods have been demonstrated to be useful in the treatment of people with COVID-19. However, little is known about the impact of combining functional foods on disease control. This study aimed to investigate the effects of functional foods mixture on serum levels of inflammatory cytokines and biochemical findings in patients with COVID-19. METHODS: A randomized double-blind controlled trial was conducted in Baqiyatallah Al-Azam hospital in Tehran, Iran. Sixty patients were randomly assigned to receive either a soup containing functional foods (n = 30) or a usual soup (control group) (n = 30). Participants' sociodemographic information was gathered using a general questionnaire. Blood levels of inflammatory markers and biochemical findings were assessed using standard protocols. RESULTS: The results showed that soup containing functional foods was more effective in controlling serum levels of D-dimer, blood urea nitrogen, and creatinine than the control group (P < 0.05). Also, more significant improvement was found in the intervention group vs control group in terms of interleukin (IL)-1ß, IL-6, IL-17, IL-10, and tumor necrose factor-α (P < 0.05). In contrast, the control intervention more efficiently controlled potassium levels and reduced quantitative C-reactive protein than the intervention group (P < 0.05). CONCLUSIONS: This study indicates a soup containing functional foods could alleviate biomarkers of inflammation in patients with COVID-19. However, its effectiveness on biochemical findings remained inconclusive which warranted further research. TRIAL REGISTRATION: IRCT, IRCT20180201038585N11. Registered 23 August 2021, https://www.irct.ir/trial/57338.

The Association of Clinical Symptoms and Coexistent Clinical Conditions with Ophthalmic Manifesting in COVID-19 Patients.

Background: The ocular symptoms are common manifestations in coronavirus infectious disease 2019 (COVID-19), which faces secondary complications and therapeutic challenges. Underlying diseases actuate the body to infectious diseases and their related manifestations through the aberration of metabolism and suppressing the immune system. This study aimed to investigate the correlation of underlying diseases and ocular manifestations in COVID-19 patients. Methods: This cross-sectional study was held on 108 hospitalized COVID-19 patients (confirmed by molecular detection) admitted to Rouhani hospital, Babol, Iran. Upon hospitalization, all clinical symptoms and underlying diseases were registered. Detailed clinical examinations regarding ophthalmological protocols were used to investigate the ocular symptoms. All analyses were performed by SPSS, version 25. Results: Our results showed that 26.67% of patients with at least one ocular symptom had hyperlipidemia, while 10.42% of patients without any ocular symptoms had hyperlipidemia (P=0.049). In this study, 97.81% of COVID-19 patients without epiphora had no thyroid disorders (hyper-/hypo-thyroidism), while 82.35% of COVID-19 patients with epiphora had not any thyroid disorders (P=0.012). Also, 75.00% of patients with blurred vision had diabetes mellitus, while 35.00% of patients without blurred vision suffered from diabetes mellitus. This difference was borderline significant (P=0.051). Other results showed that 13.04% of COVID-19 patients with eye redness suffer from myalgia, while 35.29% of patients without eye redness had myalgia (P=0.044). Also, 35.11% of COVID-19 patients without photophobia had myalgia, while none of the patients with photophobia had myalgia (P=0.005). Finally, 70.00% of patients with respiratory distress had at least one ocular symptom, while 43.10% of patients without respiratory distress had at least one ocular symptom (P=0.007). Conclusion: Some underlying diseases, e.g., hyperlipidemia, diabetes mellitus, and thyroid disorders, and some clinical symptoms in hospitalized patients, e.g., myalgia and respiratory distress, are correlated with ocular manifestations in COVID-19 patients.

Association of nutrition risk screening 2002 and Malnutrition Universal Screening Tool with COVID-19 severity in hospitalized patients in Iran.

BACKGROUND: Malnutrition affects normal body function and is associated with disease severity and mortality. Due to the high prevalence of malnutrition reported in patients with coronavirus disease 2019 (COVID-19), the current study examined the association between malnutrition and disease severity in hospitalized adult patients with COVID-19 in Iran. METHODS: In this prospective observational study, 203 adult patients with COVID-19 verified by real-time polymerase chain reaction test and chest computed tomography were recruited from those admitted to a university hospital in Iran. To determine COVID-19 intensity, patients were categorized into four groups. Malnutrition assessment was based on the Malnutrition Universal Screening Tool (MUST) and nutrition risk screening score (NRS-2002). An ordinal regression model was run to assess the association between malnutrition and disease severity. RESULTS: In the studies sample of Iranian patients with COVID-19, 38.3% of patients had severe COVID-19. According to NRS-2002, 12.9% of patients were malnourished. Based on MUST, 2% of patients were at medium, and 13.4% of patients were at high risk of malnutrition. Malnutrition was associated with a higher odds of extremely severe COVID-19 according to NRS-2002 (odds ratio, 1.38; 95% confidence interval, 0.21-2.56; P=0.021). CONCLUSIONS: Malnutrition was not prevalent in the studies sample of Iranian patients with COVID-19; however, it was associated with a higher odds of extremely severe COVID-19.

One-year prevalence and the association between SARS-CoV-2 cycle threshold, comorbidity and outcomes in population of Babol, North of Iran (2020-2021).

Background: The present study aimed to investigate the one-year prevalence of SARS-CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran. Methods: This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran. Results: Out of the 19232 suspected to COVID-19 patients, 7251 (37.7%) had a positive rRT-PCR result; 652 (9%), 4599 (63.4%) and 2000 (27.6%) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8% cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6%) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5%) (p<0.001). Conclusion: In summary, 37.7% of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9% were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate.

Prevention of Osteoarthritis Progression by Statins, Targeting Metabolic and Inflammatory Aspects: A Review.

BACKGROUND AND PURPOSE: Several traditional risk factors of atherosclerosis such as age, obesity, and altered lipid metabolism are shared with osteoarthritis (OA). Metabolic abnormalities and atheromatous vascular disease are linked with systemic inflammation and progression of OA. Hence, treatment of OA with statins is expected to improve metabolic abnormalities and prevent OA progression. Many studies which have addressed this issue found inconsistent results. This review aims to elucidate the effect of statins in OA by summarizing the existing data. METHODS: Potential studies in English language published in Medline/PubMed, Scopus and Google Scholar since 2000 were searched by using keywords such as osteoarthritis, statins, progression, treatment, prevalence, synovitis, pain. Fourteen papers were found to be relevant and were summarised. RESULTS: Data regarding symptomatic effect of statins in OA are scarce and the results varied from no effect to a small improvement or even increased risk of pain in knee OA. However, most studies on the incidence and progression of OA found a significant decreased risk of incident OA, as well as reduced risk of radiographic progression in statin users vs. non-users. Factors such as patient adherence, duration of treatment, and higher cumulative statin doses were associated with greater efficacy. CONCLUSION: Existing data indicate a preventing effect of statin therapy on OA progression. However, unless a formal meta-analysis with weight analysis is made, a conclusion cannot be drawn.

Comparing 2 Appointment Scheduling Policies Using Discrete-Event Simulation.

BACKGROUND AND OBJECTIVES: Two of the most important policies for dealing with the negative effects of high rates of no-show patients and appointment cancellations include double-booking and walk-in admission policies. This study aimed to compare these policies to identify their differences and their effects as well as the best circumstances for using each one. METHODS: The main approach used in this study was discrete-event simulation using the Arena software application. Moreover, the average waiting time (considering patients' lateness) and the number of missed patients (considering no-show and cancelled patients) were accounted for in the performance evaluation criteria for both of the selected policies. RESULTS: When the patients' arrival rate was high, the double-booking system resulted in higher productivity, while when it was low, the walk-in admission policy was the best policy for patient admission. The successful appointment rates of the current system, the walk-in admission system, and the double-booking system were 61.18%, 89.45%, and 93.24%, respectively. CONCLUSIONS: Although both double-booking and walk-in policies reduced the negative effects of cancelled and no-show patients, they had significantly different results in different situations. In general, there is no best system for appointment scheduling, and the choice of the superior system depends on the demand rate and its fluctuations.

Analgesic effect of duloxetine compared to nortryptiline in patients with painful neuropathy: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Diabetic neuropathic pain (DNP) is a common complication of diabetes and has a profound effect on patients' quality of life. Therefore. The purpose of the present study was to compare the analgesic effects of duloxetine and nortryptiline in the management of patients with diabetic neuropathy. METHODS: This was a randomized, double-blind, parallel-group, placebo-controlled trial in subjects with a proven diagnosis of DM and suffered from neuropathic pain. Patients were recruited in this study from 20 February 2016 (first patient, first visit) to 22 June 2017 (last patient, last visit), including 5 weeks follow-up. A diagnosis of DNP was based on history, clinical examination, Nerve conduction velocity and Diabetic neuropathy symptom score (more than one point). RESULTS: Both drugs reduced pain when compared with placebo. A significant VAS reduction from 6.4 at baseline to 3.75 at endpoint was observed in the duloxetine group. However, there was no significant difference in the efficacy between nortriptyline and duloxetine based on patient's visual analogue scale (VAS) (p>0.05). No clinically significant changes or serious adverse events were found among treatment groups including changes in vital signs, laboratory assessments, physical examination or electrocardiograms. The decrease in the mean pain intensity was significantly greater in the duloxetine and nortriptyline group compared to the placebo group both in the primary analysis and in the by-visit analysis (p<0.003). CONCLUSION: The present study demonstrates the safety and effectiveness of both duloxetine and nortriptyline in the management of DNP.

Risk of COVID-19 infection in patients with rheumatic disease taking disease-modifying anti-rheumatic drugs.

BACKGROUND AND OBJECTIVE: Patients with rheumatic disease taking long-term disease-modifying anti-rheumatic drugs (DMARDs) are expected to have a higher risk of infection due to the alterations in cellular immunity associated with these medications. However, the potential risks associated with these drugs remain unclear. This study aimed to estimate the risk of COVID-19 infection in patients with rheumatic disease taking disease-modifying anti-rheumatic drugs. METHODS: Patients with autoimmune rheumatic disease taking DMARDs with or without long-term (> 6 months) HCQ treatment prior to the COVID-19 outbreak were selected consecutively. The diagnosis of COVID-19 was made based on the history of symptoms suggestive of the disease and/or serum IgG positivity. During statistical analysis, the risk of COVID-19 infection was calculated in rheumatic patients taking DMARDs versus controls, as well as in patients taking HCQ versus those who are not. The ORs and 95% CIs were also calculated. The participants in the control group were selected from individuals without RD. RESULTS: A total of 800 patients with RD and 449 controls were analyzed. COVID-19 infection was detected in 16.8% of rheumatic patients versus 17.6% of controls (OR 0.95; 95% CI 0.7-1.28). The proportions of COVID-19 infection in HCQ users versus non-users were 15.3% and 18.1%, respectively (OR 0.87; 95% CI 0.61-1.26). These results remained unchanged after adjusting for all covariates using logistic regression analysis. CONCLUSION: These findings indicate that rheumatic patients taking DMARDs are not at a higher risk of COVID-19 infection, and that HCQ therapy has no influence on the risk of COVID-19 infection. Key points • The risk of COVID-19 infection is not higher in patients with RD on DMARD therapy. • The prevalence of COVID-19 infection in HCQ users has not significant difference relative to non-users. • Significant percent of RD patients taking DMARDs had asymptomatic infection. • There was a positive association between leflunamide therapy and the risk of COVID-19 infection.

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.

Effectiveness and safety of routine calcium supplementation in postmenopausal women. A narrative review.

BACKGROUND: To determine whether routine administration of calcium supplementation is useful in postmenopausal women, while it is associated with an increased risk of cardiovascular complications. METHODS: A literature search was performed using Medline/PubMed, Scopus and Google Scholar by using relevant keywords. RESULTS: Calcium supplement exerts a small protective effect against bone loss which disappears after cessation. Antifracture effect of supplemental calcium is limited to older frail women or community-dwelling residents who are vitamin D deficient and have inadequate dietary calcium intake. The results of studies on the association between calcium supplementation and cardiovascular complications are contradictory and do not lead to a decisive conclusion CONCLUSION: Current data do not support routine calcium supplementation to all postmenopausal women for prevention of bone loss or bone fracture.

Therapeutic and Preventive Potential of Vitamin D Supplementation in Knee Osteoarthritis.

OBJECTIVE: Vitamin D deficiency is linked with pain, function, and radiographic progression of knee osteoarthritis (KOA), but the results of studies addressing the association and effect of vitamin D supplementation for pain, function, quality of life, radiographic disease, and progression are inconsistent. The aim of this review is to determine the therapeutic and preventive potential of vitamin D supplementation in KOA. METHOD: Eligible pertinent English language studies published in 2000 and thereafter in Medline/PubMed, Scopus, and Google Scholar were selected by using keywords that include "knee osteoarthritis," "vitamin D supplementation," "pain," "structural abnormalities," "treatment," and "progression." RESULTS: The results of a few studies showed a preventive potential for vitamin D in KOA, but most of the randomized clinical trials that assessed the therapeutic efficacy of vitamin D supplementation in KOA found no clear therapeutic effect, with the exception of one study that found a small but significant effect of vitamin D on pain and knee function. Nonetheless, the results of a few longitudinal studies as well as systematic reviews are promising and thus encourage further studies. Inconsistent results on the effect of vitamin D on KOA may be attributed to factors such as severity of KOA, baseline level of serum vitamin D, duration of treatment, and vitamin D dosages. CONCLUSION: Given the multiple skeletal and extraskeletal benefits of vitamin D supplementation in elderly people, the issue of vitamin D supplementation in KOA requires further study to elucidate the dosage and duration of treatment that provides the most effective therapeutic effect.

Vitamin D Deficiency and Rheumatoid Arthritis: Epidemiological, Immunological, Clinical and Therapeutic Aspects.

BACKGROUND/AIM: Vitamin D displays an immunologic effect which can modulate function of Th17-related cytokines and thereby prevent perpetuation of inflammation in chronic disorders like rheumatoid arthritis (RA). This review aims to conduct a literature review to provide a summary of recent studies addressing the relationship between vitamin D deficiency and RA based on epidemiological, immunological and therapeutic aspects. METHODS: PubMed, Scopus and Google scholar were searched for relevant papers published between 2000-2018. RESULTS: Low intake of vitamin D increases the risk of incident RA, and vitamin D deficiency has been shown to be inversely associated with RA activity in most of these studies. However, characteristics of RA and serum vitamin D status differ across the studies. The results of studies on the effect of supplemental vitamin D in RA vary, from no efficacy to significant improvement in disease activity, as well as quality of life. This should be attributed to variations in dosage of vitamin D, duration of treatment, baseline serum vitamin D in RA patients and characteristics of RA across diverse studies. CONCLUSION: Current data indicate a therapeutic potential for vitamin D in RA. However, further studies are needed to identify an optimal and effective dosage, duration of treatment and patients who will get the best benefit from the treatment.

Serum Uric Acid Status and Its Association with Bone Mineral Density in the Elderly People Aged 60 Years and More.

BACKGROUND: Osteoporosis is associated with decreased antioxidant defenses and serum uric acid (UA) as an antioxidant may exert a protective effect on bone mass. OBJECTIVES: This study aimed to determine the association between serum UA and bone mineral density (BMD) in the elderly population. METHODS: All participants of the Amirkola Health and Ageing Project aged ≥ 60 years entered the study. BMD in the femoral neck (FN-BMD) and lumbar spine (LS-BMD) was determined by dual energy X-ray absorptiometry and osteoporosis was defined as BMD T-score < - 2.5 at either FN or LS. The patients were classified according to serum UA levels as < 4; 4 - 4.99; 5 - 5.99; 6 - 6.99 and > 7 mg/dL. In statistical analysis, the value of BMD as well as frequency of osteoporosis in each subgroup were compared with the control group (UA < 4 mg/dL). RESULTS: A total of 1080 patients were studied. By increasing serum UA from < 4 mg/dL to > 7 mg/dL the BMD at both measurement sites increased as well. The serum UA was associated with decreased risk of osteoporosis. In multivariate analysis, the odds of osteoporosis in the subgroup with serum UA levels between 4 - 4.99 mg/dL was significantly lower than the control group (OR = 0.66, 95% CI, 0.44 - 0.99). Age and female sex were associated with increased odds of osteoporosis (OR = 1.08, 95% CI, 1.05 - 1.10 and OR = 10.62, 95% CI, 7.53 - 14.97 respectively). CONCLUSIONS: These findings indicate a negative association between serum UA and osteoporosis in the elderly population aged ≥ 60 years.

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.

Relationship between big five personality factors, problem solving and medical errors.

BACKGROUND: Human behavior is recognized as the main factor in the occurrence of accidents (70-90 percent), with human personality and problem solving ability as two related factors in the occurrence of medical errors (annually 42.7 million in the world). The objectives of this study were to investigate the relationship between personality factors, problem solving ability and medical errors. MATERIAL AND METHODS: This study was a questionnaire case control study. Information on 49 members of medical and nursing staff with medical errors (case group) and 46 without medical errors (control group) were analyzed. To collect the data, two Heppner problem solving questionnaires and the NEO-Five Factor Inventory were used, which were completed by the study population. RESULTS: The results illustrate that individuals without medical errors showed higher scores in contentiousness, extraversion and agreeableness and lower scores in neuroticism than those with medical errors. Individuals without medical errors also showed higher scores in problem solving ability scales than those with medical errors. CONCLUSION: Results of this study, suggest that personality factors and problem solving ability are related to medical errors and it may be possible for hospital authorities to use this knowledge when selecting capable medical staff.