role of rheumatoid factor and anti-cyclic citrullinated peptide antibody in diagnosis of rheumatoid arthritis

Rheumatoid Factor [RF] occurs in 70- 90% of patients with established rheumatoid arthritis [RA]. Anti-cyclic Citrullinated peptide antibody [Anti-CCP] detection may be used to confirm the diagnosis of RA in patients with uncharacterized chronic inflammatory arthritis. This study is an attempt to evaluate the role of RF and anti-CCP in the diagnosis and prognosis of rheumatoid arthritis. Blood samples were obtained from 55 patients with established RA and 55 healthy controls. Anti-CCP and RF were measured by ELISA and nephelometry. The patient's demographics, disease duration, DMARDs usage, ESR and radiographic abnormalities were recorded. Fifty five RA patients and 55 healthy age and sex matched controls were enrolled. Odd ratio [OR] was 87.42 [C 1=11.2-680.1] for RF and 27.48 [6/08-124/09] for Anti- CCP. Five patients had used more than 3 DMARDs; all of them were RF positive and 4 were also anti-CCP positive. Eleven patients had erosions in their radiographs; 10 of them were seropositive for RF and 9 positive for anti-CCP. Our study suggests that despite lack of specificity, RF continues to be a central part of the definition of RA due to favorable sensitivity profile and the combined use of RF. Also, anti-CCP is a more powerful diag-nostic and prognostic tool

Endometrial stromal sarcoma presented with galactorrhea

Sarcomas are rare forms of endometrial [uterine] cancer. We report here a 52 years old woman who was hospitalized due to abnormal uterine bleeding [menorrhagia]. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and para-iliac lymphadenectomy. The pathological result was endometrial stromal sarcoma/low grade. Meanwhile, she had an ESR of 80 mm/h. After 4 years, the patient referred with dyspnea and galactorrhea. Her serum prolactin level was more than 100 ng/ml. The lung CT-scan revealed metastatic lesions. Brain MRI with hypophysis view was normal. Thus chemotherapy with CYADIC regimen was begun for her and her ESR reached 13. Also, a decline in prolactin level occurred. After 2 years, she was hospitalized for abdominal pain and the assessments revealed progressive metastasis of the abdomen and whole body scan demonstrated the metastatic bone disease. Also, prolactin level highly increased [11102 mIu/Lit]. The MRI of the brain was normal again. Serum macroprolactin was measured, revealing a negative result. The ESR reached 80 mm/h

Assessment of the relationship between hypocalcaemia with hypotension, during hemoadialysis at Imam Khomeini and Fatemeh Zahra Hospitals in Sari 2007

Hypotension during Hemoadialysis is one of the risk factors of mortality and morbidity in patients. This study was preformed at Imam Khomeini and Fatemeh Zahra Hospitals, in Sari during 2007. 100 Hemoadialysis patients were evaluated. Serum calcium and serum albumin levels were measured prior to Hemoadialysis. Patient's blood pressure was measured before, during and after Hemoadialysis and data was analyzed using descriptive statistics, X[2] test. Hypotension, during Hemoadialysis was seen in 28% of patients. Of the total patients, 25% had hypocalcaemia. Of 25 patients with hypocalcaemia, 39.3% had hypotension, while 19.4% had normal blood pressure, thus, showing a significant difference between the two groups. It is suggested to revise the calcium concentration of dialysate

[Comparison of the adequacy of specimens provided by fine needle aspiration, fine needle non - aspiration sampling and combined technique in thyroid nodules]

Thyroid dysfunctions are one of the most important diseases in endocrinology. Fine needle aspiration [FNA] is currently the first line diagnostic tool for the evaluation of thyroid nodules. The adequacy of specimens provided by this method is also very important. FNA puncture in thyroid causes intra- parenchyma hemorrhage, which may distribute the quality of tissue specimens. Fine needle non-aspiration [FNNA], may provide better specimens without this problem. The aim of this study was to evaluate the adequacy of thyroid nodules specimens provided by fine needle aspiration and fine needle non - aspiration sampling in Imam Hospital. This descriptive study was performed on 200 patients with thyroid nodules in Imam Hospital, Sari, Iran. After a detailed clinical history, systemic examination and thyroid sonography, FNA and FNNA sampling were performed in all patients. The adequacy of specimens was evaluated by Mair scoring system in both techniques. All data, including demographic data and sonographic results and background blood, amount of cellular material, degree of cellular degeneration, degree of cellular trauma and retention of appropriate architecture were recorded. Results were analyzed by means of SPSS [11] software and Wilcoxon Signed Rank Test. The P.value less than 0.05 were considered to be significant statistically. 200 patients, 189 [94.5%] females and 11 [5.5%] males, with mean age of 43.36 +/- 12.3 years were studied. Cytological findings showed that in FNA technique, 26[13%] of specimens were unsuitable for diagnosis, 97[48.5%] were diagnostic/adequate, while 77[38.5%] were diagnostic/superior for diagnosis. In FNNA technique, 32[16%] of specimens were unsuitable, 96 [48%] were diagnostic/ adequate, while 72 [36%] were diagnostic/superior for diagnosis. In the combined application of FNA and FNNA, 9 [4.5%] of specimens were not diagnostible and 191 [95.5%] were diagnostic. Mean of total score in FNA was 5.82 +/- 2.3, while in FNNA was 5.70 +/- 2.4, with the difference was not statistically significant. Furthermore, there was no statistically significant difference between other parameters. Our study demonstrates that there is no difference between FNA and FNNA sampling, however, applying the combination of these two techniques, may improve the diagnostic quality

[Prevalence of lipodystrophy associated with human recombinant insulin]

Lipodystrophy is potentially a clinical adverse effect, associated with insulin therapy and is believed that usage of human recombinant insulin's is associated with decreasing prevalence of Lipodystrophy. The objective of this study was to determine the prevalence of insulin induced Lipodystrophy, among diabetic out-patients referred to Imam Khomeini Hospital, in Sari during 2007. In this cross sectional descriptive study, 220 diabetic patients referred to the Diabetes Center at Imam Khomeini Hospital, in Sari, who under treatment by insulin at least three months prior to referral was evaluated. First, the demographic and clinical characteristics of the patients were recorded in a questionnaire; then all patients were examined clinically to evaluate lipodystrophy. In all subjects, glycated hemoglobin [HbA1C] was measured to assess the range of blood glucose level control. Recorded data were analyzed by statistical methods, such as descriptive T-test and X[2].Of 220 diabetic patients studied, thirty-five [15.9%] showed clinical evidences of insulin induced Lipodystrophy; 32 out of 35 cases of Lipodystrophic patients [14.5%] had Lipohypertrophy, while 3 cases [1.4%] had Lipoatrophy. The factors included Age, Sex, Education, BMI [Body mass index], type of Diabetes, The duration of insulin consumption and injection site had statistically significant effects on development of insulin induced Lipodystrophy [P<0.05]. The results of this study demonstrated that despite using human recombinant insulin's, the prevalence of insulin induced lipodystrophy, especially Lipohypertrophy, has remained high up to present. Therefore, regular examination of patients for this side effect is necessary, especially in subjects without good control of blood glucose level

[Efficacy of oral versus intravenous vitamin c on serum oxalate level in hemodialysis patients]

Long term of high doses of vitamin C treatment might be a potential risk for the development of secondary oxalosis in end stage renal disease patients. Hyperoxalatemia may increase the risk of cardiac, vascular and bone diseases. Hemodialysis patients [HD] are at high risk for Scurvy disease due to dietary limitation and ascorbic acid losses through dialysis. Vitamin C also decreases HTN and accelerated arthrosclerosis. Thus, vitamin C supplementation is necessary for these patients. The aim of this study was to evaluate efficacy of oral versus intravenous vitamin C on serum oxalate level in hemodialysis patients. This clinical-trial study was done on hemodialysis patients referred to the three treatment centers of Mazandaran Province. 41 HD patients, who had not consumed vitamin C for two months, were randomly divided into two groups, oral and intravenous. In intravenous [IV AA] group, vitamin C 500 mg/day was administered three times a week; and oral group received vitamin C 125 mg/day for two months. Oxalate serum level was measured before and after treatment. Individual, laboratory, and treatment complication data were gathered in a questionnaire. Intra group comparison was done with t-student test and inter group comparison was done with independent- sample t-test. Data were expressed as SE +/- Mean and p-value<0.05 was considered significant. Serum oxalate level in each group increased, there was no significant differences intra group and between two groups [p= 0.3] [in oral, from 1.8 +/- 0.4mgl/L to 1.85 +/- 0.8mgl/L, P=0.4 and in IVAA from 1.8 +/- 0.7mg/L to 2.1 +/- 0.9mg/L, P=0.3]. Oral and IV AA in the used dosage did not increase serum oxalate level and were safe to use as supplementation in HD patients

Efficacy and safety of oral versus intravenous vitamin C in hemodialysis patients with functional iron deficiency

Hemodialysis patients [HD] with functional iron deficiency[FID] often develop resistance to recombinant human erythropoietin [rHuEpo]. Recent studies suggest that intravenous ascorbic acid [IVAA] may circumvent rHuEpo resistance, while oral [AA] is readily attainable. The aim of this study was to evaluate efficacy and safety of oral versus intravenous vitamin C on FID and whether this can improve anemia in hemodialysis patients. In this study, 31 hemodialysis patients with serum ferritin >100 micro g/L, transferin saturation [TS] < 30% and Hb <11g/dL were selected and randomly divided into the oral and IV groups. The IVAA group received vitamin C 1.5 g, administered weekly and the oral group, 125 mg vitamin C daily for two months. Hb, ferritin, serum iron, Tsat and serum oxalate were measured at the beginning of the study and 2 months later. Independent - sample T-Test were used for intergroup comparison. P value < 0/05 was considered significant. Mean Hb difference was 1.1 +/- 0.7g/dL in the oral and 0.1 +/- 1g/dL in the IVAA group, being significantly higher in the oral group [p=0.02]. There were no significant differences between the two groups in the delta means of ferritin and Tsat [p=0.5, p=0.3]. Delta means of serum oxalate in the 2 groups were 0.05 +/- 0.4mg/L, and 0.1 +/- 0.3mg/L respectively, difference not significant [p=0.3]. Oral AA significantly increased Hb in HD patients suffering from FID. Considering the feasibility and cost-effectiveness, clinicians could consider oral instead IVAA in rHuEpo hyporesponsive patients undergoing HD