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Background & Aim: Volunteers’ perceptions may affect their future decisions to participate in crisis intervention. Few studies in Iran have been conducted to examine the experiences of medical personnel who volunteered during the COVID-19 pandemic. This qualitative study describes the experiences of medical volunteers during COVID-19 in Iran. Methods & Materials: A total 17 healthcare volunteers who worked in COVID-19 hospital wards were recruited using purposive sampling. All participants were recruited in the current study from the hospitals affiliated with the Tehran University of Medical Sciences if they expressed their willingness to participate and had at least two months experience of working as healthcare volunteers in COVID-19 wads. In-depth video-call semi-structured interviews were conducted from August to November 2020. The data were analyzed using the qualitative thematic analysis method. Results: One main theme “from nuisance to helpful assistants” and four sub-themes including the “feeling of inefficiency”, “negligent managing”, “situation orientation”, and “transformation for integrity” emerged from the data. Conclusion: Despite experiencing challenges, the volunteers and hospital staff tried to change their approaches to joint collaboration by improving their capabilities for situation awareness and creating integrity. These findings provide policymakers with a better understanding of health volunteers' challenges in hospitals during crises.

Backgrounds N-acetylcysteine (NAC) has broadly been used as an anti-oxidant agent in various types of diseases. This study aimed to assess the effect of NAC on the systemic lupus erythematosus (SLE) disease activity and outcome. Methods In this randomized, double-blind clinical trial study, 80 SLE patients were recruited that were classified into two groups: 40 patients received NAC (1800 mg/day; 3 times per day with 8-h intervals) for 3 months and 40 patients as the control group received normal therapies. Laboratory measurements and disease activity based on the British Isles Lupus Assessment Group (BILAG) and SLE Disease Activity Index (SLEDAI) were determined before the initiation of treatment and after the study time period. Results A statistically significant decrease in BILAG (P= 0.023) and SLEDAI (P= 0.034) scores after receiving NAC for a 3-month period was observed. BILAG (P= 0.021) and SLEDAI (P= 0.030) scores were significantly lower in NAC-receiving patients compared to the control group after 3 months. The disease activity in each organ based on BILAG score after treatment indicated a significant decrease in the NAC group compared to the baseline level in general (P=0.018), mucocutaneous (P=0.003), neurological (P=0.015), musculoskeletal (P=0.048), cardiorespiratory (P=0.047), renal (P=0.025), and vascular (P=0.048) complications. Analysis indicated a significant increase in CH50 level in the NAC group after treatment compared to the baseline level (P=0.049). No adverse event was reported by the study subjects. Conclusions It appears that the administration of 1800 mg/day NAC to SLE patients can decrease the SLE disease activity and its complications.

Background: Among suggested medications for the treatment of COVID-19, chloroquine derivates and angiotensin-converting– enzyme inhibitors (ACEIs)/angiotensin II type 1 receptor blockers (ARBs) are the two medications with conflicting effects on the development of the disease. Objectives: The present study aimed to evaluate COVID-19 in patients with rheumatic diseases receiving chloroquine derivate. Methods: Every patient with proven rheumatologic diseases registered in two referral centers in Tehran and Alborz, Iran was enrolled in the present descriptive cross-sectional study between May and June 2020. At first, the symptoms of COVID-19 were assessed, and if a case had suspicious symptoms, reverse transcription-polymerase chain reaction (RT-PCR) COVID-19 tests were done. Demographic and clinical data are documented for every patient. Then, the patients were grouped once according to their COVID-19 infection status and another time according to their hydroxychloroquine use. Results: 1159 patients enrolled in the study with a mean age of 49.39 years. Frequency of hypertension was 22.17 %, diabetics (9.49%) and 20 (1.7%) patients were positive for COVID-19 testing. The most common symptoms of the COVID-19 positive cases were cough (5.2%) and fever (4%). There was no significant difference in receiving ACEIs/ARBs or other medications between COVID-19 positive or negative patients. Among the patients receiving hydroxychloroquine, 15 patients (1.7%) had proved COVID-19 versus 5 patients (1.7%) who were not receiving these medications (P>0.999). Conclusion: The present study demonstrated that receiving ARBs or ACEIs was not different among patients with or without COVID-19. Moreover, receiving chloroquine derivate was not related to the development of COVID-19 in patients with rheumatologic disorders.

Systemic sclerosis is an autoimmune chronic sclerotic disease that can damage organs and cause serious complications for the patient such as musculoskeletal manifestations, Gastrointestinal involvement, pulmonary involvement, and renal disease. Acro-osteolysis is one of the musculoskeletal manifestations that causes corrosion of the bones in the fingertips of the hand and feet. In this paper, we have reported the rarely current evidence of severe Acro-osteolysis of the distal phalanges of the hands by radiological x-ray.

We aimed to study the outcomes of coronavirus disease 2019 (COVID-19) in patients with a history of rheumatoid arthritis (RA) in Iran, where most patients receive corticosteroids and are at high risk for COVID-19 infection.We collected the demographic, diagnostic, and treatment data of all COVID-19 patients by the clinical COVID-19 registry system. We recruited 38 RA patients and 2216 non-RA patients from the COVID-19 registry. The primary outcome was mortality due to COVID-19. We also studied the risk of intensive care unit admission and intubation in RA patients compared to non-RA patients. We used multiple logistic regression analysis to study the association between RA and the risk of COVID-19 outcomes.We recruited 38 RA patients and 2216 non-RA patients from the COVID-19 registry. The RA patients had a higher mean age (59.9 years) than the non-RA patients (57.7 years). The group of RA patients had a larger proportion of women (76.3%) than the non-RA patients (40.8%). The death rate due to COVID-19 was significantly higher in RA patients than non-RA patients (odds ratio [OR] = 2.69, 95% confidence interval [CI] = 1.24-5.81). The OR was higher among those who received prednisolone than among those who did not (OR = 3.59, 95% CI = 1.54-7.81). The odds of intubation were statistically significant among patients who received corticosteroid therapy (OR = 2.58, 95% CI = 1.07-6.18).The risk of COVID-19 outcomes was higher in RA patients than non-RA patients, especially for RA patients who received a low dose of prednisolone. The results of this study can be used to triage RA patients who get infected by COVID-19. Further studies with larger sample sizes are required to more precisely define the high-risk groups.

Background and Objectives: Rheumatoid arthritis is one of the most common diseases of the immune system which is increasing rapidly. The results of the recent literature review confirm the roles of stress and psychosocial stressors on physiological mechanisms, such as psychoneuroimmunology, as causal factors leading to the development of rheumatoid arthritis. Considering the effectiveness of psychological problems in the development of this disease, the present study was conducted to compare the effectiveness of coping therapy and cognitive-behavioral therapy in cognitive immunity and psychological well-being indicators of patients with rheumatoid arthritis referring to Imam Khomeini Hospital, Tehran, Iran. Methods: This was a quasi-experimental study with a pretest-posttest control group design. In the present study, the effectiveness of two independent variables (i.e., coping therapy and cognition-behavioral therapy) on dependent variables (i.e., immune-cognitive and psychological well-being indicators) was examined. The statistical population consisted of patients with rheumatoid arthritis referring to Imam Khomeini Hospital from March-August in 2019. The final sample (n=60) was selected by the purposive sampling method and the subjects were randomized into two groups of experimental and control (n=20 each). Subsequently, the experimental group was subjected to coping therapy and cognitive-behavioral therapy interventions. The instruments used in the present study included Psychological Welfare Scale, C-reactive protein (CRP) immunological indicators test, and erythrocyte sedimentation rate (ESR) test. The collected data were analyzed using the analysis of covariance model. Results: The results of the analysis of covariance model were indicative of a p-value of < 0.05 as significant. Moreover, it was found out that the effectiveness of coping therapy and cognitive-behavioral therapy on CRP, ESR, psychological well-being was significant (P

Background: Researchers have already reported a high level of interleukin (IL)-6 in patients affected by Coronavirus Disease 2019 (COVID-19). In this study, we investigated the surge of IL-6 level and its association with the clinical and paraclinical markers in these patients. Materials and Methods: The study sample comprised 205 confirmed hospitalized patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and 70 healthy volunteer individuals. Routine laboratory examinations, including hematology, biochemistry, and hormone analysis, as well as IL-6 level measurement, were conducted. The patients grouped into 5 based on their IL-6 levels. Then, they were compared with regard to their need for mechanical ventilator and clinical laboratory routine tests. Results: IL-6 levels were significantly higher in hospitalized patients compared with healthy individuals (P

Since mid-December of 2019, an outbreak of pneumonia has been spread from Wuhan City, Hubei province, China, as a viralpneumonia. After virus identification and isolation, the pathogen for this pneumonia was originally called 2019 novelcoronavirus (2019-nCoV). 2019-nCoV has been associated with progressive cytokine storm leading to a hyper-inflammatorystate that this state associated with respiratory failure. We hereby reported a known case of Rheumatoid arthritis, Hypertensionand Coronary artery bypass graft that confirmed 2019-nCoV and he was associated with progressive cytokine storm leading torespiratory failure. After corticosteroid administration, respiratory failure and extremely high levels of IL6 respondeddramatically to pulse-doses of Methylprednisolone. We concluded that pulse-doses of Corticosteroids can be effective incontrolling and relieving cytokine storms and related respiratory failure.

Kidney involvement is a major cause of death and disability in patients with systemic lupus erythematosus (SLE). Early andaccurate determination of the type of involvement is essential in choosing the appropriate treatment for these patients. Thecurrent study aimed to determine whether laboratory findings are consistent with kidney biopsy for biopsy classification.This descriptive analytic cross-sectional study was performed on 17 patients with SLE admitted to rheumatology and nephrologydepartments. All patients underwent renal biopsy and received appropriate treatment according to the reported pathology. Dataanalysis was performed using SPSS software version 25. The participants comprised 14 females and 3 males with a mean ageof 32.23±11.12 years. The findings of this study showed that mean serum C3 and 24-hour urine protein concentrations weresignificantly different between the four studied groups according to the type of kidney pathology (p =0.042, p =0.041;respectively). No significant relationship was found between pathological findings and clinical signs, demographic information,and other laboratory findings (p >0.05). Based on the findings of the present study, it can be concluded that renal biopsy is themost accurate method available for the diagnosis and classification of lupus nephritis. Nonetheless, renal biopsy has limitationsincluding side effects, the need for an experienced pathologist, and suboptimality in some cases; renal biopsy was suboptimalin three cases of the current study. Therefore, noninvasive faster methods with high efficacy should be sought.

Background and objective: Vasculitis is a rare disease and its prevalence varies according to age, race, time and geographical location. Due to the fact that no study has been conducted in Iran to investigate the frequency, clinical and laboratory symptoms of vasculitis in a considerable population of vasculitis patients, so the need for this study is felt. The aim of this study was to evaluate the frequency and clinical signs of granulomatosis with polyangitis (GP) patients who admited in rheumatology ward of Valiasr hospital in the last 10 years.Methods and material: In this study, all patients with a possible diagnosis of vasculitis in the rheumatology ward of Valiasr Hospital during the past 10 years were evaluated. Then the GP patients were evaluated for clinical, laboratory, radiological, pathological findins, outcome, mortality, and major complications. Results: During the last 10 years, 223 vasculitis patients have been admitted to Valiasr hospital. Of these, 87 % were primary vasculitis and 13% were secondary vasculitis. The highest frequncy was related to GP (21.52 %) followed by Behcet's disease. Women and men were included 52.08 % and 47.91 % of GP patients, respectively. Upper and lower airway involvement and totally ear, nose and throat (ENT) involvement were the most common clinical symptoms in GP patients.Conclusion: According to the finding of this study, GP vasculitis was the most common type of vasculitis that ENT involvements were the most common clinical symptoms in this patients. However, more studies are required to confirm these data in Iran.

Background and objectiveRheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease characterized by inflammatory arthritis, rheumatoid factor (RF) and anti-cyclic citrullinated peptide (Anti-CCP) autoantibodies. In the present study, the aim was to register RA patients in Tehran Imam Khomeini Hospital.Methods and materialThe study population was RA patients referred to the rheumatology clinic of Imam Khomeini Hospital in Tehran, who were visited at this clinic in 1398 and were diagnosed during the 5 years ago. Demographic, clinical, and laboratory information of patients at the beginning of referral, 3 months, 1, 2, 3, and 4 years after referral were carefully recorded in each patients’ questionnaire.ResultsIn the first visit, 79 RA patients were examined and in the other 5 visits, 73, 52, 33, 20, 13 patients and all of 270 visits were examined, respectively. RF and Anti-CCP were positive in 58.22% and 62.02% of patients, respectively.The mean age of patients was 52.5±11.25 years. The results of the present study showed that the mean morning stiffness, DAS, arthritis, arthralgia, ESR and CRP decreased from the second visit to the five visits, which indicates disease control.ConclusionClinical and laboratory data showed considarable disease control, however, relapse of disease was seen due to drug discontinuation. Disease registry make it possible to recording the necessary information of each patient, including demographic, clinical, paraclinical findings and consultations, also gives the physician accurate access to patient information and unnecessary duplication of paraclinical examinations.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with an unknown aetiology. Although there is no definite treatment for this disease using proper prescribed medications, mortality and morbidity ratios could be decreased. The present study attempted to investigate adherence to medical treatment in patients suffering from SLE and to evaluate the related factors which influence adherence in order to improve patients’ prognoses. In this cross-sectional study, 132 patients with SLE who referred to the rheumatology clinic of Imam Khomeini Hospital (Tehran, Iran) over the period of 2012-2013 wereexamined using a questionnaire. The applied questionnaire included two parts; the first part pertained to adherence to medication treatments (CQR: compliance questionnaire rheumatology), and the second part was related to the factors involved in adherence to medication treatments. The obtained data were analyzed using the Chi-Square test and processed by SPSS16.0 software.In this research, the mean adherence to drug treatment was calculated to be 72.48%. Among the variables of age, marital status, salary, education, distance from the clinic (accessibility), disease duration, level of patient activity, main medications consumed, and side effects, the only significant association was found between adherence level and lack of side effects due to SLE (p

Background: There are controversies regarding the diagnosis of lupus nephritis. Also, its clinical manifestations and severity are different from one patient to another. Objectives: The current study aimed to interpret clinical and laboratory features of lupus nephritis according to the results of the biopsy. Methods: Following a retrospective design, 30 patients with lupus, who were candidates for renal biopsy and undergoing kidney biopsy, were studied. Clinical findings (blood pressure and limb edema) and laboratory findings (Cr, ESR, CRP, BUN, C3, C4, CH50, Anti-ds DNA, and hematuria) were gathered. Finally, the diagnostic value of clinical and laboratory findings was interpreted according to the biopsies and the staging of samples in the pathology. Data were analyzed using SPSS. Quantitative variables are displayed using mean and quartiles. Fisher’s exact test was used to compare study groups. Also, independent samples t-test and Levene’s test were used to evaluate variances of quantitative variables. Results: Of 30 cases, 5 had a biopsy of 3 and FSGN. Also, 8 cases were on stages 3 and 4, 9 had a stage of 4 biopsy, and 8 cases were on stage 4 - 5, 5, and 5 - 6. The association between age, Limp edema, ESR, and biopsy was statistically significant (P < 0.05). Conclusions: This study demonstrated the usefulness of clinical and laboratory findings to determine the severity of the disease in the shortest time, mainly due to its easy, non-invasive access and early preparation of the results, which will facilitate the initiation of treatment.

Dermatomyositis (DM) and polymyositis (PM) are known as two major types of idiopathic inflammatory myopathies (IMMs). During the past years, growing data strongly suggest the clinical significance of myositis-associated autoantibodies (MAAs) and myositis-specific autoantibodies (MSAs). The present study aimed to determine the profile of MSAs and MAAs, subsequently to address the clinical significance of these autoantibodies in Iranian myositis patients.In this cross-sectional study, 28 DM and 24 PM patients were entered. Demographic and clinical characteristics were collected by direct examination and patients' medical record. The existence of MSAs and MAAs was assessed by indirect immunofluorescence then using immunoblotting (FA 1510-1005-1, DL 1530-1601-4 G; Euroimmun, Germany). Data were analyzed using the SPSS software (v22; SPSS Inc. Chicago, IL, USA).The mean age of the patients was 46.18 ± 12.95 years and male/female ratio was 28.8/71.2. Autoantibodies were positive in 63.46% of myositis patients. Interestingly, anti-TIF1γ and anti-PL7 were significantly associated with malignancy (P 0.001, P = 0.008; respectively). The existence of autoantibody and anti-Jo1 had significant relation with interstitial lung disease (ILD) (P = 0.034, P = 0.006; respectively). Joint involvements including arthritis and arthralgia were significantly associated with anti-Ro52 and anti-Jo1 (P = 0.04, P = 0.02; respectively).Taken together, it can be concluded that certain myositis autoantibodies present clinical significance which is in line with the literature. The use of these autoantibodies as biomarkers by line blotting along with indirect immunofluorescence facilitates diagnosis of inflammatory myopathies and makes it more accurate as well as better management of myositis patients if used based on a science-based manner. Key Points • Identification of MSAs and MAAs facilitates the diagnosis of inflammatory myopathies and provides better myositis patient's management if used according to a science-based manner. • Anti-rod and ring antibody was detected in a patient with ovarian cancer-induced dermatomyositis. • Malignancy and ILD are integrated parts of myositis which can be associated with MSAs and MAAs.

Rheumatoid arthritis (RA) is an autoimmune disease that is characterized by inflammation of the articular tissue. This study aims to evaluate the expression of microRNA (miR)-146a-5p, miR-24-3p, and miR-125a-5p in the plasma of RA patients and compare them with those of healthy controls to obtain a specific expression profile for earlier diagnosis and assistance in treating patients. This study was performed on 50 RA patients and 50 healthy controls. Five microliters of blood were taken from each patient/control. Plasma RNA was extracted using the Trisol solution. cDNAs were synthesized; using moloney murine leukemia virus (MMLV) and deoxynucleoside triphosphate (dNTP). Real-time PCR was performed using SYBR green kit. The mean expression of miR-146a-5p, miR-24-3p, and miR-125a-5p in the RA group were 8.1±1.9, 6.5±1.2, and 6.8±2.2 and in the healthy group were 4.8±1.6, 3.6±2.2, and 3.4±1.7, respectively. Significant differences were also observed in the mean expression of these three miRNAs in four subgroups of RA patients with different disease activity based on disease activity score 28 (DAS28) (p

The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) spread rapidly all over the world in late 2019 and caused critical illness and death in some infected patients. This study aimed at examining several laboratory factors, especially inflammatory and immunological mediators, to identify severity and mortality associated biomarkers. Ninety-three hospitalized patients with confirmed coronavirus disease 2019 (COVID-19) were classified based on disease severity. The levels of biochemical, hematological, immunological, and inflammatory mediators were assessed, and their association with severity and mortality were evaluated. Hospitalized patients were mostly men (77.4%) with an average (standard deviation) age of 59.14 (14.81) years. The mortality rate was significantly higher in critical patients (85.7%). Increased serum levels of blood sugar, urea, creatinine, uric acid, phosphorus, total bilirubin, serum glutamic-oxaloacetic transaminase, serum glutamic-oxaloacetic transaminase, lactic dehydrogenase, C-reactive protein, ferritin, and procalcitonin were significantly prevalent (p=0.002, p

Introduction There are no determined treatment agents for severe COVID-19. It is suggested that methylprednisolone, as an immunosuppressive treatment, can reduce the inflammation of the respiratory system in COVID-19 patients. Methods We conducted a single-blind, randomised controlled clinical trial involving severe hospitalised patients with confirmed COVID-19 at the early pulmonary phase of the illness in Iran. The patients were randomly allocated in a 1:1 ratio by the block randomisation method to receive standard care with methylprednisolone pulse (intravenous injection, 250 mg·day−1 for 3 days) or standard care alone. The study end-point was the time of clinical improvement or death, whichever came first. Primary and safety analysis was done in the intention-to-treat (ITT) population. Results 68 eligible patients underwent randomisation (34 patients in each group) from April 20, 2020 to June 20, 2020. In the standard care group, six patients received corticosteroids by the attending physician before the treatment and were excluded from the overall analysis. The percentage of improved patients was higher in the methylprednisolone group than in the standard care group (94.1% versus 57.1%) and the mortality rate was significantly lower in the methylprednisolone group (5.9% versus 42.9%; p, This study showed that methylprednisolone pulse administration at the beginning of the early pulmonary phase of illness decreased the mortality rate and improved pulmonary involvement, oxygen saturation and inflammatory markers in COVID-19 patients https://bit.ly/3hik4JB

Background: Researchers have already reported a high level of interleukin (IL)-6 in patients affected by coronavirus disease 2019 (COVID-19). In this study, we investigated the surge of IL-6 level and its association with the critical health factors in these patients. Methods: The study sample comprised 111 confirmed hospitalized patients with SARS-CoV-2 and 70 healthy volunteer individuals. Routine laboratory examinations, including hematology, biochemistry, and hormone analysis, as well as IL-6 level measurement, were conducted. Findings: IL-6 levels were significantly high in hospitalized patients compared with healthy individuals (P < 0.001). The IL-6 level was approximately ten-fold of the normal range in 23.7% of the patients and more than 50% of them signify IL-6 over three-fold of normal range. The levels of BS, LDL, VLDL, ALP, TSH, CRP, platelets, neutrophils, and monocytes were significantly different between patients with diverse levels of IL-6. The values of triglyceride, LDL, VLDL, red blood cells and platelets showed an indirect linear trend and the levels of lactate dehydrogenase, serum glutamic oxaloacetic transaminase, creatine phosphokinase, dehydroepiandrosterone sulfate, and CRP demonstrated a direct linear trend with elevating rate of IL-6. Furthermore, IL-6 levels had a significant and direct correlation with troponin I, CRP, ferritin and pro-calcitonin while it had a significant and indirect correlation with VLDL.Interpretation: A hazardous level of IL-6 probably threatening the critical health factors and has a crucial role in immune-mediated acute lung injury in CIOVID-19 patients. Funding Statement: Immunoregulation Research Center of Shahed University Ministry of Health, Treatment and Medical Training of Iran. Declaration of Interests: The authors declare no conflicting of interests. Ethics Approval Statement: The study was approved by the National Ethics Committee on Research in Medical Sciences affiliated to the Iranian Ministry of Health (Ethical Code: IR.NIMAD.REC.1398.411).

Background: Occasionally rheumatologic syndromes are the presenting symptom of an underlying malignancy. Objectives: The main goal of this cross-sectional study was to determine the presence of rheumatic manifestations by age, gender, type of solid tumors, and the stage of disease. Methods: The patients who suffered from solid tumors and referred for first time chemotherapy, were studied. All the extracted data from the questionnaire was collected and analyzed using SPSS (2016) software. Results: Four hundred and one patients were studied. Sixty-four patients had rheumatologic manifestations. The most representative age group was 61 - 70 years, the most common rheumatologic manifestation observed was fibromyalgia (30 female and 4 male). Most rheumatic syndromes were observed in breast cancer (31 patients) and stage 4 of breast cancer was the most common stage (38 patients). The presence of associated rheumatologic manifestations was as follows: fibromyalgia (53.1%), arthropathy (15.6%), polymyalgia rheumatica (10.9%), Raynaud’s phenomenon (9.4%), frozen shoulder (9.4%) and hypertrophic osteoarthropathy (1.6%). In this study, with the exception of hypertrophic osteoarthropathy, rheumatic manifestation is more common in female patients. Conclusions: From the findings, most rheumatologic manifestations (RMs) are gender dependent. These results can be used as a tool for more effective treatment and monitoring clinical studies of RM in patients with solid tumors especially fibromyalgia and breast cancer. If there is early recognition of the disease, it will lead to timely diagnosis and it is essential to improve outcomes in patients with paraneoplastic syndromes. Therefore, rheumatologists must work closely with oncologists to identify those paraneoplastic syndromes.

Our clinical trial supports the beneficial use of a high dose of methylprednisolone for the treatment of severe COVID-19 patients.https://bit.ly/3qvc4Kz

The primary hypertrophic osteoarthropathy (PHOA or pachydermoperiostosis) is a rare (5% of total HOA) hereditary disease. One study described that the prevalence of PHOA is 0.16%. PHOA characterized by skin thickening (pachydermia), finger clubbing, and proliferation of periosteum (periostitis) with subperiosteal new bone formation and enlarged extremities secondary to periarticular and bone proliferation. Clinical manifestations are variable; the term complete syndrome is used for the patient with pachydermia, coarsening of the face skin and scalp, periostitis, and cutis verticis gyrata; the incomplete form is used when there is no sparing of the scalp; and the frusted form is used for pachydermia with minimal or absent periostitis. We describe a 29-year-old white man with PHOA, and clinical and radiological characteristics of this syndrome, as well as therapeutic approach of PHOA.

Background: Rheumatoid arthritis (RA) is the most prevalent chronic infl ammatory disease of the joints. It is correlated with periodontal disease due to similar factors that exist in both diseases. The present study assessed the relationship of periodontal disease with RA and juvenile idiopathic arthritis (JIA). Materials and Methods: In this case-control study, 30 RA and 30 JIA patients along with similar number of matched controls were selected among patients referred to Imam Khomeini Hospital, Tehran, Iran. Periodontal parameters including pocket depth (PD), clinical attachment level (CAL), O’Leary and Bay plaque index (PI) and bleeding on probing (BOP) were determined in cases and controls. Erythrocyte sedimentation rate, number of painful and infl amed joints and severity of disease were evaluated in RA and JIA patients. Mann-Whitney U-test nonparametric, Spearman and Pearson’s correlation coeffi cients, and Chi-square tests were used as statistical analysis (α = 0.05). Results: PD (4.17 vs. 3.6 mm; P 4 mm (58.83% vs. 44.33%; P 3 mm (74.13% vs. 64.4%; P < 0.001), percentage of sites with BOP (9.67% vs. 6.87%; P < 0.0001) and PI index (85.73% vs. 80.63%; P < 0.0001) were signifi cantly higher in RA patients than controls. In this group, direct and signifi cant correlations were found between serologic fi ndings, disease severity and number of painful and infl amed joints with periodontal factors. In JIA patients, no signifi cant relationships were found between JIA fi ndings and periodontal parameters. Conclusion: Considering the limitations of this study, there was a relationship between RA and periodontal disease. Severity of periodontal disease increases in patients with RA, while no increased risk of periodontal disease or its severity was observed among JIA patients. Key Words: Juvenile, rheumatoid arthritis, periodontitis, case-control studies

The development of alternative approaches to prevent and/or treat osteoporosis, as a chronic progressive bone disease, is being considered currently. Among dietary supplements, probiotics may have favorable effects on bone metabolism. Therefore, the aim of this study was to evaluate the effects of a multispecies probiotic supplementation on bone biomarkers and bone density in osteopenic postmenopausal women.This randomized double-blind placebo-controlled clinical trial was performed on 50 patients with osteopenia aged 50-72 years. Participants were randomly assigned to take either a multispecies probiotic supplement (GeriLact; n = 25) or placebo (n = 25) for 6 months. GeriLact contains 7 probiotic bacteria species. Participants received 500 mg Ca plus 200 IU vitamin D daily. Bone mineral density (BMD) of lumbar spine and total hip and blood biomarkers including bone-specific alkaline phosphatase (BALP), osteocalcin (OC), collagen type 1 cross-linked C-telopeptide (CTX), deoxypyridinoline (DPD), parathyroid hormone (PTH), 25-OH vitamin D, and serum pro-inflammatory cytokines (tumor necrosis factor [TNF]-α and interleukin [IL]-1β) were assessed at baseline and at the end of the study.The multispecies probiotic significantly decreased BALP (p = 0.03) and CTX (p = 0.04) levels in comparison with the control group but had no effect on BMD of the spine and total hip. Moreover, there was a statistically significant decrease in serum PTH (p = 0.01) and TNF-α (p = 0.02) in the intervention group compared to the placebo group.These results may suggest the favorable effects of the multispecies probiotic supplementation for 6 months on bone health in postmenopausal women due to slowing down the rate of bone turnover.

The present study was conducted to determine the prevalence of T-score discordance and its risk factors in a group of patients with spinal cord injury in a university teaching hospital in the Iranian capital of Tehran.This cross-sectional study was conducted on paraplegic men undergoing bone density testing in an outpatient clinic at a hospital in the Iranian capital, Tehran, between March 2011 and 2012. A questionnaire on demographic and anthropometric characteristics, including age, height, weight, engagement in physical activity and personal smoking habits, was filled out for each subject. All the subjects underwent bone mineral density measurement and blood samples were sent for laboratory testing.Major T-score discordance between two sites was noted in 54 (41.22%) patients. Multivariate logistic regression revealed that every unit increase in serum calcium levels, as the only factor influencing T-score discordance, was associated with a 2.49-fold increased risk in T-score discordance in the area. As for the spine and radius, BMI was the only influencing factor as every unit increase in BMI was associated with a 14% lower risk for T-score discordance in these regions. Body mass index was the only factor, based on the multivariate model, affecting the risk of developing T-score discordance between two sites.Our study revealed the high prevalence of T-score discordance in patients with spinal cord injury. Physicians should therefore be encouraged to perform BMD at three sites when visiting patients with such injuries.

Objective: The aims of this study are scoring the educational wards of Imam Hospital complex, comparison of different wards according to educational, research and treatment scores and finally improvement of hospital's curriculum.Methods: For assessing the educational performance a questionnaire was filled by the wards' directors. Another questionnaire was filled by faculty members in order to evaluating the research situation of the ward. Customers' satisfaction was assessed through questionnaires which were filled by residents, interns, students and patients. Data were analyzed using SPSS-13.Results: In educational sector, pediatric ward has the first rank, infection ward the second rank. In the research sector infection ward the first and the pediatric ward have the second rank. Training customers have the most satisfaction of general ward and Patient had more satisfaction of surgery ward (3 and 4 surgery ward).With 47% score to training sector, 28% to research sector and 25%to satisfaction, the infection ward has the first rank, pediatric ward second rank and orthopedic ward the third rank of Imam Khomeini complex.Conclusion: In Imam Khomeini complex survey of wards ranking, the infection ward has the first rank pediatric ward second rank and orthopedic ward the third rank in overall survey.

"nBackground: Mitral valve prolapse is a relatively common valvular abnormality in most communities and joint hypermobility (JHM) is also seen in many healthy people as well as in certain clinical disorders, such as Marfan syndrome. The present study was designed to investigate the association between joint hypermobility and mitral valve prolapse (MVP) in an Iranian population sample. "nMethods: Fifty-seven patients with nonrheumatic and isolated mitral anterior leaflet prolapse (24 men and 33 women, mean age 23.5 +/-2.3) and 51 healthy subjects (20 men and 31 women, mean age 22.9+/-2.3) were studied. The presence of JHM was evaluated according to the Carter-Wilkinson & Beighton criteria. Echocardiographic examination was performed in all subjects and the correlation between the echocardiographic features of the mitral valve and the hypermobility score were investigated. "nResults: The frequency of JHM in patients with MVP was found to be significantly higher than that of controls (26.3% vs. 7.8%), with mean JHM scores of 3.1+/-2.2 and 1.9+/-1.7, respectively. The patients in the MVP group had significantly increased the anterior mitral leaflet thickness (AMLT, 3.4+/-0.4 mm vs. 3.0+/-0.3 mm; p

Background: Rheumatoid factor (RF) is an IgM antibody against the Fc portion of IgG, which together form an immune complex. RF is an important criterion in the diagnosis of early-stage rheumatoid arthritis (RA) and prognosis of RA pathogenesis, as higher levels of RF indicate a higher possibility of more damage. Although 2/3 to 3/4 of patients that undergo ordinary standard tests and have final clinical diagnosis are also positive for RF, a 70-90% prevalence of RF among RA patients can be achieved, depending on the method of detection and the target antibody, IgG or IgM. In this study, we measured the frequency of IgG and IgM RF isotypes using the ELISA and latex agglutination methods and compare these results with those of a hospital control group, tested using standard methods, in order to determine the best method for the measurement of RF.Methods: Of the patients referred to the Rheumatology Clinic of Imam Khomeini Hospital during 2005-2006, one hundred randomly selected rheumatoid arthritis patients, 75 females and 25 males, with classical or definite rheumatoid arthritis (defined by the criteria of the American College of Rheumatology), with a short disease duration of 12-24 months, underwent testing for RF using the latex method for IgM and ELISA for IgM-IgG. The healthy control group (75 females and 25 males) were tested for RF using the ELISA method for IgM-IgG. The variables were compared using the Pearson's chi-square test.Results: We found that the measurement of RF among RA patients using did not differ significantly between the two methods. The immune complex in RA is mainly IgM. The positive IgM results in RF patients using two similar methods showed a significant relationship by Pearson's correlation co-efficient (r=0.60, p

Background: Heterotopic ossification (HO) is a complication after spinal cord injury. There are limited studies evaluating hip ossification in Iranian patients with spinal cord injury. Objectives: We designed this study to evaluate prevalence of HO in cases with spinal cord injury and clinical factors related to this finding. Patients and Methods: In this study, 135 patients with traumatic spinal cord injury who were referred to a spinal cord injury clinic were enrolled. A structured questionnaire was used to collect data. Hip radiography was performed for all patients to evaluate hip ossifications. An expert radiologist assessed the obtained radiographs. Results: Thirty one (23%) participants were women and 104 (77%) were men. The most common cause of injury was accident (66.7%) followed by falling (28.1%). HO was present in 51 (37.8%) cases, and hip X-ray was normal in 84 (62.2%) Duration of injury and bed sore were significantly higher in patients with HO. Logistic regression analysis considering HO as a dependent variable showed that only bedsore was an independent predictor of HO. Conclusions: Evaluation for hip ossification should be considered in patients with spinal cord injury.

Dear Editor, The stomach is the most dilated portion of the GI tract (1). In Iranian traditional medicine (ITM) stomach is very important organ and its disorders can affect other organs (2-5). Avicenna (Ibn Sina), a Muslim scientist of the tenth and eleventh centuries has an important role in the history of medicine in Iran and the world (6). Canon, his famous book that was the greatest work by Avicenna, was translated into Latin in the 12th century and used as a major reference in medical education from the 12th until the 17th centuries (7). In addition, this book is one the most important textbooks in ITM. The foundation of ITM system was based on the balancing humors in the human body (8). In ITM, Mizaj (temperament) plays a key role in preventive, therapeutic, and lifestyle recommendations (9). Normally there are four humors in the human body: Phlegm or Balgham, Blood or Dam, Yellow bile or Safra, and Black bile or Sauda (10). Their imbalances in the body causes some disorders such as stomach swelling (2, 8). Persistent or repeated stomach pain that does not resolve with suitable treatments is the main symptom of stomach swelling (8). According to Avicenna, swelling is a complex disease (8). Swelling is thickness and bulging occurring in organ by material accumulation that expand it and fills the cavity. This material is usually infused by another organ or the organ of swelling itself (2, 8). Stomach swelling is divided into different types according to the materials: “warm” (Haar Safravi or Damavi), “cold Phlegm” (Barede Balghami), and “Solbe Ghaliz” (Hard and thick swelling) (8). The warm swelling is made by not only blood or yellow bile, but also any substance that is warm in essence or is heated by infection (2, 8). Prolonged and progressive pain, severe inflammation, strong burned, thirst and associated fever, and radiating pain are the symptoms of warm swelling. It may even lead to a mixing of mind, melancholy, and meningitis (8). “Cold phlegm” swelling is made by phlegm and predisposing factors such as moisture, indigestion, exercise reduction, and other moisture-generating causes. The symptoms and signs of “cold Phlegm” swelling are persistent or repeated pain even during sleep, diluted and increased mouth water, leaden face color, little thirst, poor digestion, poor appetite, hate and suffer moist food, tendency to dry food, without fever, inflammation, and obsession (8). Sometimes, hard and thick swelling in the stomach is formed primarily by “Sauda” or from transmission and conversion of warm swellings. Phlegm swelling seldom becomes the hard stomach swelling. There are strength to the touch, a lot of dryness, loss of body weight, and other symptoms associated with swelling in the stomach (2, 8). Treatment in warm swelling includes reducing the swelling matter by venesection or prescribed laxatives, reducing the swelling by rubbing astringent and cold medications over swollen stomach, and avoiding vomiting and potent laxatives. Topical use of Radea (deterrent) drugs, Quince oil, and grated cucurbit, avoiding food, and use of easily digestible food at first and then laxative food and drugs such as beer, cucurbit, and Khiarshanbar (Cassia fistula) is recommended. Safravi swelling remedy is consisted of topical cold drugs such as Sandal (Santalum album), Kafoor (Cinnamomum camphora), alcohol-free beer, and Enabolsalab (Solanum nigrum L.). Treatment in “cold Phlegm” swelling include oral use of astringent solvent drugs such as extract of Celery and Fennel, almond oil, topical use of Baboone (Matricaria chamomilla) and shebet (Anethum graveolens), and avoiding vomiting. Finally, potent solvent drugs is recommended in hard swelling astringent and use of camel bone marrow and cow calf brain in topical drugs is obligatory (2, 8). Based on this study, diagnosis and treatments of stomach swelling can be helpful in patients with persistent or repeated episodes stomachache.

Coexisting ankylosing spondylitis and hereditary multiple exostoses have rarely been reported (three patients) previously. A 27-year-old man with hereditary multiple exostoses is presented as a fourth report. At the age of 15 years, the patient had multiple exostoses around the knee, ankle and shoulder joints. He was diagnosed with ankylosing spondylitis 3 years ago. The patient’s sister and his 3 brothers also have multiple exostoses without any family history of spondyloarthropathy or inflammatory arthritis. The aim of this report is to discuss an interesting coexistence of these two diseases. The increasing number of reported patients who have a coexistence of these two diseases might suggest that the association of these two diseases is stronger than a coincidence.

Background: Treatment of gastrointestinal symptoms in patients with systemic sclerosis has been a challenge for years. Drugs, immunosuppressive or anti-fibrotic have always been associated with complications. The effectiveness of probiotics as live microorganisms of nonpathogenic always was to treat the symptoms.Methods:In this clinical trial, 37 patients with systemic sclerosis with mild to severe symptoms in the intervention and control groups were studied. Inventory (UCLA SCTC GIT 2.0) was used for rating the severity of the gastrointestinal tract. Collected data was analysed by statistical methods using SPSS.19.Results: Improvement was seen in total score after the use of probiotics in gastrointestinal reflux condition ((P=0.001), gastric distention (P =0.001), emotional function ((P=0.001), social.Conclusions:This study showed that probiotics were significantly effective in treatment of gastrointestinal symptoms in patients with systemic sclerosis.

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Systemic scleroderma (SSc) is a generalized connective tissue disorder of unknown origin which most notably is characterized by skin thickening and organ damage. Endothelin-1 (ET-1) antibody plays a role in skin fibrosis. The aim of this study was to determine the prevalence and correlation of different manifestations of SSc with ET-1 plasma levels."n"nMethods: This cross-sectional analytical study was conducted on 95 patients (91 women and four men) with scleroderma in 2006. The patients had been referred to the Rheumatology Clinic of Shariati Hospital in Tehran, Iran. The demographic data and signs and symptoms were entered in a questionnaire and endothelin-1 concentrations were measured. "n"nResults: The mean age of the patients was 38±12.29 years. Diffuse cutaneous SSc (dcSSc) was diagnosed in 52 and limited cutaneous SSc (lcSSc) in 43 patients. Raynaud's phenomenon (91%) was the most common manifestation in the patients. The relationship between the resorption of terminal phalanges due to fibrosis with the plasma concentration of Endothelin-1 was statistically significant (p=0.001). Pitting ulcers had significant relationships with endothelin-1 concentrations too (p

Background: To evaluate the possibility that prolactin is involved in the pathogenesis and flare-up of systemic lupus erythematosus (SLE).Methods: In this cross-sectional study we determined serum prolactin levels in sixty (60) serum samples from sixty patients diagnosed with SLE by the criteria of the American College of Rheumatology (ACR). All patients were females between 13-64 years of age. Disease activity was defined according to lupus activity criteria count and scored by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Serum prolactin concentrations were determined by immunoradiometric assay (IRMA) [125I]. Patient blood samples were taken between 10 a.m. and 12 p.m. Serum was separated and kept frozen at -20 °C.Results: Hyperprolactinemia (>21 ng/mL) was found in 7 (11.7%) patients. SLEDAI scores of 15 active disease and 4-15 moderate activity. Accordingly, 6.7% of our patients had active disease.Normal serum prolactin levels range from 2 to 21ng/mL. Among those with active disease, prolactin levels were higher, with mean prolactin levels of 18.15, 15.11 and 11.5 ng/mL for active, moderate and nonactive groups, respectively. Increased prolactin levels correlated with activity of SLE disease (p=0.019, r=0.305). No correlation was found between tissue involvement and prolactin level (p=0.24) and no significant correlation was found between prolactin level and age (p=0.19).Conclusion: Hyperprolactinemia, detected in patients with SLE by IRMA, was associated with disease activity. Our findings suggest that prolactin may play a role in the pathogenesis of SLE.

Background The Arthritis Impact Measurement Scales 2 (AIMS2) has not been translated and validated for Persian-speaking patients with osteoarthritis of the knee. This was to provide a validated instrument to measure functional disability and health-related quality of life in patients with osteoarthritis of the knee in Iran. The aim of this study was to culturally adapt and validate the AIMS2 for Persian-speaking patients with osteoarthritis of the knee in Iran. Methods A consecutive sample of patients with knee osteoarthritis were asked to complete the AIMS2, the Short Form Health Survey (SF-36) and four visual analog scales for pain, joint stiffness, patient's and physician's global assessment. Internal consistency and convergent validity were applied to examine psychometric properties of the AIMS2. In addition, 30 randomly selected patients were asked to complete the questionnaire two days later for the second time for test-retest reliability. Finally factor structure of the Persian AIMS2 was performed using the principal component factor analysis. Results In all 230 patients were entered into the study. The mean (SD) age of the participants was 56.9 (8.7) years and the mean (SD) duration of disease was 7.2 (3.5) years. Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) for the Persian AIMS2 scales ranged from 0.74 to 0.92 and 0.85 to 0.96, respectively. The correlation between most of the Persian AIMS2 scales and the physical and mental summary scores of the SF-36 and the visual analogue scales for pain, joint stiffness, patient's and physician's global assessment were statistically significant indicating a good convergent validity (p < 0.05). The results obtained from factor analysis indicated three latent factors that jointly accounted for 67.5% of the total variance. Conclusion The results showed that the Persian AIMS2 had reasonably good internal consistency, test-retest reliability, and convergent validity in patients with osteoarthritis of the knee. It is simple and easy to use and now can be applied in the future studies in Iran. However, its sensitivity to change needs still to be studied.