Serum Vitamin D Status in Iranian Fibromyalgia Patients: according to the Symptom Severity and Illness Invalidation

BACKGROUND: This study was designed to assess serum vitamin D status (25-OHD) in the fibromyalgia (FM) patients and to compare it with a healthy control group. It also aimed to investigate the correlation of serum vitamin D level with FM symptom severity and invalidation experiences. METHODS: A total of 74 consecutive patients with FM and 68 healthy control participants were enrolled. The eligible FM patients completed the Illness Invalidation Inventory (3*I), the Revised Fibromyalgia Impact Questionnaire (FIQR) and a short-form health survey (SF-12). Venous blood samples were drawn from all participants to evaluate serum 25-OHD levels. Mann-Whitney tests and multiple logistic regression analyses were performed and Spearman's correlations were calculated. RESULTS: 88.4% of FM patients had low levels of serum 25-OHD. FM patients had significantly higher level of serum 25-OHD than the control group (17.24 ± 13.50 and 9.91 ± 6.47 respectively, P = 0.0001). There were no significant correlations between serum 25-OHD levels and the clinical measures of disease impact, invalidation dimensions, and health status. Multiple logistic regression analyses revealed that an increased discounting of the disease by the patient's spouse was associated with a 4-fold increased risk for vitamin D deficiency (OR = 4.36; 95% CI, 0.95-19.87, P = 0.05). CONCLUSIONS: This study showed that although high rates of vitamin D insufficiency or deficiency were seen among FM patients and healthy non-FM participants, but it seems there was no intrinsic association between FM and vitamin D deficiency. Addressing of invalidation experience especially by the patient's spouse is important in management of FM.

The Iceberg Nature of Fibromyalgia Burden: The Clinical and Economic Aspects

This review has focused on important but less visible aspects of fibromyalgia (FM) with respect to the high impact of this disorder on patients and societies. FM is a common but challengeable illness. It is characterized by chronic widespread pain, which can be accompanied by other symptoms including fatigue, sleep disturbances, cognitive dysfunction, anxiety and depressive episodes. While our understanding of this debilitating disorder is limited, diagnosis and treatment of this condition is very difficult, even in the hands of experts. Due to the nature of disease, where patients experience invalidation by medical services, their families and societies regarding the recognition and management of disease, direct, indirect and immeasurable costs are considerable. These clinical and economic costs are comparable with other common diseases, such as diabetes, hypertension and osteoarthritis, but the latter usually receives much more attention from healthcare and non-healthcare resources. Present alarming data shows the grave and "iceberg-like" burden of FM despite the benign appearance of this disorder and highlights the urgent need both for greater awareness of the disease among medical services and societies, as well as for more research focused on easily used diagnostic methods and target specific treatment.

Sleep patterns and sleep problems among preschool and school-aged group children in a primary care setting

To describe sleep patterns and sleep problems among preschool and school aged group children in a primary care setting in Iran. This cross sectional study was conducted in two primary care pediatric clinics in Tehran from March 2006 to September 2006. Sleep patterns of 215 children studied [101 were in preschool age group; 2-6 years old, and 114 were in primary school age group; 7-12 years old]. Sleep problems were common in study group, as follows: bedtime problems 21.05%-56.44%, excessive daytime sleepiness 26.73%-42.98%, awakening during the night 13.86%-32.46%, regularity and duration of sleep 17, 54%-27.72%, sleep-disordered breathing 10.53%-17.82%. [These high frequencies of sleep problems in children explains the importance and burden of sleep disorders in children which unfortunately are not noticed by primary care providers in Iran and inadequate attention to them may have negative consequences on a host of functional domains, including mood, behavior, school performance, and health outcomes

[ etiology of persistent diarrhea in hospitalized patients at Children's Medical Center in Tehran]

The objective of this study was to determine the causes of persistent diarrhea in hospitalized patients at Children's Medical Center in Tehran. Primarily we determined the 41 different etiologies of persistent diarrhea which were recognizable in Iran at the time of study. then we studied all hospitalized patients with these diagnoses between the years 1992 till 1998. During the period of study there were 1300 patients who had been hospitalized in children's hospital. Among these patients 215 had persistent diarrhea. 10 most common etiologies of persistent diarrhea were celiac disease, cystic fibrosis, ulcerative colitis, malnutrition, immune deficiencies, urinary tract infections, giardiasis, gastroenteritis, cow milk allergy, and intestinal lymphangiectasia. Based on the results of this study, in approaching patients with persistent diarrhea, it is better to consider more common and probable etiologies primarily to avoid unnecessary costs and then perform suitable diagnostic studies