Relationship between unexplained arthralgia and vitamin D deficiency: a case control study

Arthralgia is a common presenting symptom of many rheumatic diseases. Vitamin D deficiency may lead to progression of skeletal symptoms to definite disease in susceptible subjects. This study was conducted to determine the relationship between vitamin D deficiency and unexplained arthralgia. Patients with arthralgia not related to a definite clinical condition were selected prospectively among subjects presented to a rheumatology clinic. Serum 25-hydroxyvitamin D [25-OHD] was measured by ELISA method and levels less than 20 ng/ml were considered as deficient levels. Serum 25-OHD levels and proportion of 25-OHD deficiency was compared in patients versus control. The association of serum 25-OHD and arthralgia was assessed by calculation of odds ratio [OR] using regression analysis. 167 patients with mean age of 38 +/- 13.3 and 283 controls with mean age of 42.6 +/- 14.37 years [P=0.001] were studied. In patients mean serum 25-OHD was lower and proportion of deficiency was higher [P=0.001 for both].Serum 25-OHD deficiency was associated with 3.01 times increased risk of arthralgia [OR=3.01, 95% CI, 2.0- 4.25, P=0.001]. After adjusment for age and sex, the risk of arthralgia remained significan at OR= 2.71[95%CI, 1.79-4.11,P=0.001]. The odds of arthralgia decreased with increasing serum 25-OHD from OR=3.48 [95% CI,197-6,P=0.001] at serum <10 ng/ml to 3.39 [95% CI, 1.93-5.98, P=0.001] at 10-19.9; and 1.31 [95%CI, 0.69-2.5, P=0.42] at 20-29.9 ng/ml. These findings indicate significant association of vitamin D deficiency and arthralgia. Regarding vitamin D deficiency as an environmental factor for development or progression of rheumatic diseases, this study justifies identification and correction of vitamin D deficiency in patients with arthralgia

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

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. 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. 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. 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

comparison between international obesity task force and center for disease control references in assessment of overweight and obesity among adolescents in Babol, Northern Iran

This study compares the Center for Disease Control [CDC] and International Obesity Task Force [IOTF] references in assessment of overweight and obesity among Iranian adolescents. The data of this study was drawn from a cross sectional study of a representative sample of 1200 adolescents aged 12-17 years in Babol, northern Iran. A standard procedure was used to measure height and weight and the body mass index was calculated. Each subject was classified as overweight and obese based on IOTF cut off values of BMI and CDC references BMI percentile sets by age and sex. The kappa coefficients were estimated for the degree of agreement. In assessment of obesity/overweight prevalence, the CDC and IOTF references produced a similar estimate by age group and sex. The maximum differences was about 1% and the kappa coefficients was 0.96 to 1 [P = 0.001]. While for assessment of obesity, the CDC reference produced slightly a higher rate of obesity and the difference in prevalence between the two sets of references was ranged from 1.4% to 3.2% with kappa coefficients: 0.90 to 0.70 [P = 0.001] depending on the age group and sex and a greater difference was observed among younger age group. The findings suggest an excellent agreement between the TOTF and CDC references in assessment of overall overweight/ obesity prevalence among adolescent boys and girls. While in assessment of obesity prevalence alone the degree of agreement between the two sets of references slightly diminished. Overall, the two references are comparable and the agreement varies a little with respect to age and sex

Detection of human papillomavirus in squamous cell carcinoma of conjunctiva by nested PCR: a case control study in Iran

Squamous-cell carcinoma [SCC] of the eye conjunctiva is a rare tumor. Its link with immune impairment suggests that infectious agents such as human papillomavirus [HPV] may be involved in the etiology of SCC. We conducted a case-control study on 50 SCC cases [mean age: 65.2] and 50 age frequency-matched control patients with lesion-free, normal conjunctival biopsies [mean age: 63.8] obtained from the cancer registry archive at Pathology Department of Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, where SCC has become the most common conjunctival malignancy. MY/GP nested PCR was performed for HPV detection and E6/E7 consensus primers in combination of type specific primers were used in another nested PCR series for HPV typing. HPV DNA was detected in 46 of 50 samples of squamous cell carcinoma and none of the normal biopsies by nested PCR using primer sets of the HPV consensus L1 region [MY/GP]. Subsequently, specimens from the 46 positive cases were subjected to specific PCR. Although 630bp amplicon was produced in 44 of 46 samples [E6/E7 primers], none of the specific HPV PCR reactions for HPV DNA type 16, 18, 31 or 33 resulted in the detection of HPV DNA in the 44 SCC specimens of the conjunctiva. Current results confirm the role of HPV in the etiology of conjunctival SCC. The absence of HPV 16, 18, 31 and 33 in conjunctival SCC in this study raise doubts about the role of genital types of HPV in conjunctival carcinomas

Para-aortic lymphadenopathy associated with Kawasaki disease

Kawasaki disease is an acute vasculitis that occurs mainly in children. Cervical lymphadenopathy is one of the major presenting manifestations of Kawasaki disease. We report a case of Kawasaki disease with para aortic lymphadenopathy, as an unusual feature in this disease. This 2.5 year old girl presented with persistent high grade fever, erythematous rash, bilateral non prurulent conjunctivitis, red lips, and edema of extremities. Laboratory results included an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and positive C-reactive protein. On second day after admission she developed abdominal pain. Ultrasonography of abdomen revealed multiple lymph nodes around para aortic area, the largest measuring 12mmx6mm. Treatment consisted of aspirin and high dose intravenous gamma- globulin. Ultrasonography and CT scan of abdomen performed one week later showed disappearance of the lymph nodes. There are few previous reports of lymphadenopathy in unusual sites such as mediastinum in Kawasaki disease. Para aortic lymph nodes enlargement might be an associated finding with acute phase of Kawasaki disease. In these patients a close observation and ultrasonographic follow up will prevent unnecessary further investigation

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

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. 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. 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-CCP was significantly higher than in 24 [40%] patients who progressed to non-RA [134.8 [172] vs 46 [86] U/mL, P<.01]. 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