[Frequency of musculoskeletal complications among the diabetic patients referred to Kashan diabetes center during 2009-10]

Diabetes Mellitus is one of the most common metabolic disorders causing pathophysiologic changes in multiple organs. Considering the burden of diabetes and its complications, this study aimed to evaluate the frequency of musculoskeletal complications in diabetic patients. This cross-sectional study was performed on 327 diabetic patients referred to Kashan diabetes center during 2009-10. Age, the type of diabetes and clinical manifestations such as arthralgia, paresthesia, and limited joint movements were obtained from the hospital medical records of patients and then musculoskeletal complaints [e.g., adhesive capsulitis, carpal tunnel syndrome, dupuytren's contracture, trigger finger, and limited joint movements] were diagnosed and recorded by a rheumatologist. The mean ages of type II and I diabetic patients were 54.6 +/- 12.61 and 29.7 +/- 10.36 years, respectively. Carpal tunnel syndrome [49.8%], knee osteoarthritis [45%], sclerodactyly [27.2%], dupuytren's contracture [14.1%], trigger finger [11.9%], adhesive capsulitis [11.9%], limited joint movements' syndrome [8%] and Charcot joint [0.6%] were seen in patients. There was a significant relationship between the type of diabetes and knee osteoarthritis [P<0.003; OR=1.86; CI=1.05-3.30] and also carpal tunnel syndrome [P<0.045]. A significant relationship was also seen between duration of disease and trigger finger, dupuytren's contracture [OR=3.76; CI=1.9-7.41] and limited joint movements. The findings of this study indicated that type of diabetes and also its duration [over 15 years] may increase the risk of musculoskeletal complications. Hence, careful periodic examinations of all diabetic patients are recommended

[Evaluating the efficacy of anti-cyclic citrullinated peptide antibody in the diagnosis of rheumatoid arthritis disease]

Background: Rheumatoid arthritis is one of the most common autoimmune diseases. Early diagnosis can prevent side effects and disability. Anti-cyclic citrullinated peptide antibody is a specific marker to diagnose rheumatoid arthritis. This study was carried out to evaluate the efficacy of anti-cyclic citrullinated peptide in comparison with rheumatoid factor in rheumatoid arthritis patients referred to Behshti Hospital of Kashan city during 2006-7

Materials and Methods: This diagnostic value study was done on 98 randomly selected rheumatoid arthritis patients and 75 patients with other rheumatic diseases. In this study rheumatoid factor titer>35 IU/ml and anti-cyclic citrullinated peptide>6.25 IU/ml were considered positive

Results: Anti-cyclic citrullinated peptide compared to rheumatoid factor had a higher sensitivity [73.5% vs. 69.4%], specificity [88% vs. 84%], positive predictive value [88.9% vs. 85%], and negative predictive value [71.7% vs. 67.7%] for rheumatoid arthritis. The use of rheumatoid factor and anti-cyclic citrullinated peptide test together increased the specificity and positive predictive value for diagnosis of rheumatoid arthritis to 93.3% and 92.4%, respectively. The mean anti-cyclic citrullinated peptide showed a significant difference in Rheumatoid arthritis [46.8 IU/ml] in comparison to non rheumatoid arthritis patients [5.3 IU/ml]

Conclusion: Anti-cyclic citrullinated peptide had a better diagnostic value when compared to rheumatoid factor for detection of rheumatoid arthritis. Also combined use of rheumatoid factor and anti-cyclic citrullinated peptide had a higher specificity and positive predictive value than each alone for the diagnosis of rheumatoid arthritis

[ frequency of osteoporosis in hip fracture following minor trauma and the resulting mortality rate and direct treatment costs in patients over 45 years old in Kashan Naghavi Hospital During 2005-2007]

Osteoporosis is the most common metabolic bone disease .In the recent decades due to the increase of population age, the prevalence of osteoporosis has been increased. The most important complication of osteoporosis is bone fracture, especially in the hip. The aim of this study was to evaluate the prevalence of osteoporosis, its mortality rate and direct treatment costs in patients over 45 years old referred to Kashan Naghavi hospital following hip fracture during 2005-2007. This cross-sectional study was done on 119 patients with hip fracture following minor trauma admitted during one year to Naghavi hospital in Kashan Iran. Demographic findings, types of fracture, costs of hospitalization, treatment and prosthesis were recorded in a questionnaire. BMD of lumbar spine and neck of femur was done with Osteocore II instrument by DXA method. Data analysis was done by SPSS 14. Mean age of patients was 71/6 +/- 9/35 years. From all, 72/3% were female and 27/7% was male and 67/8% had fracture of neck of femur and 23/2% had intertrocanter fracture. In whole, 65% had osteoporosis. In 51.3%, it was in lumbar and in 23.5% it was in femur. Mean hospitalization period was 7.92 +/- 3.66 days. Mortality rate was 17/2%. Mean cost of hospitalization and treatment was 277 $ and mean cost of prosthesis for each person was 1670$. Osteoporosis is a predisposing factor for hip fracture in old patients after minor trauma. Since Hip fracture places a high cost burden on the healthcare system, wise programming for prevention of hip fracture seems to be highly necessary

[Carotid wall thickness in patients with acute unilateral nonarteritic anterior ischemic optic neuropathy]

To compare ipsilateral and contralateral carotid wall thickness in patients with acute unilateral non-arteritic anterior ischemic optic neuropathy [NAION]. This prospective case series included 17 [10 male and 7 female] patients with unilateral NAION of less than 8 weeks' duration who underwent B-mode ultrasonography to measure intima-media thickness [IMT] in the common carotid and internal carotid arteries. IMT values of the affected side were compared with those on the contralateral side. Mean patient age was 59.6 +/- 10.8 [range 45-74] years. Mean interval between onset of NAION and measurements was 27.6 +/- 13.2 [range 10-45] days. Mean IMT of both common and internal carotid arteries on the affected side [1.19 +/- 0.14 and 1.41 +/- 0.29 mm, respectively] was significantly [P<0.001] higher than the noninvolved side [0.92 +/- 0.11 and 0.83 +/- 0.2, respectively]. NAION may be accompanied by increased carotid wall thickness. Carotid wall thickness measurement using ultrasound in patients with NAION may be useful to identify concomitant carotid artery disease