Comparison of Two Different Ozone Injection Sites for Knee Osteoarthritis, Tibio-femoral Joint versus Supra-patellar Recess: An Open Randomized Clinical Trial

Background:The aim of this study was to compare the efficacy of ozone injection at Tibio-femoral joint with Supra-patellar recess on knee osteoarthritis (OA).Methods: In this randomized, controlled clinical trial, 99 patients with symptomatic knee OA were randomized into two groups. 47 patients selected to receive 7-8 ml ozone (20 μg/ml) through Tibio-femoral joint injection, and 49 patients received 10 ml ozone (20μg/ml) through supra-patellar recess injection by using in-plane ultrasound-guided. The primary outcome was the change from baseline in the visual analogue scale (VAS)(0-100 mm) pain score during 3 months after injection. Secondary outcome measures included the Western Ontario and McMaster universities OA Index (WOMAC), Lequesne index, time “Up and Go” (TUG) test, single-limb stance (SLS) tests, patient satisfaction, and adverse effects. All of these measurements were evaluated at the base time, 48 hours, 2 weeks, 1 month, 2 months, and 3 months after injection.Results:Both groups had significantly improvement in the primary and secondary outcome measures. VAS pain score except at the 3–month follow-up (16.8±13.3 versus 18.1±16.6, 95% CI, -7.33 to 4.73, p =0.6), WOMAC pain score, WOMAC stiffness score at all evaluated times, and WOMAC total score at 48 hours after injection (95% CI, -19.4 to -4.9) were significantly better among Tibio-femoral ozone injection compare to Supra-patellar recess injection (95% CI, -20.68 to -6.51,p<0.001)). In both groups satisfaction, TUG and SLS times were improved, but no significant difference was seen between groups (p>0.05). At the 3-month follow-up, WOMAC pain and total scores for only Tibio-femoral joint injection group as well as WOMAC function, TUG and SLS times for both groups were gradually coming back to the baseline.Conclusion:Ozone injection in both groups was associated withpain relief, functional improvement, and quality of life in patient with knee OA. Pain and stiffness of joint were improved better in Supra-patellar recess ozone injection

Prognostic factors in gastric cancer using log-normal censored regression model.

Background & objectives: Gastric cancer is one of the most common cancers in the world. It is rarely detected early, and the prognosis remains poor. Cox proportional hazard model is used to examine the relationship between survival and covariates. Parametric survival models such as log normal regression model can also be used for this analysis. We used log normal regression model in this study to evaluate prognostic factors in gastric cancer and compared with Cox model. Methods: We retrospectively studied the 746 patients diagnosed with gastric cancer admitted in a referral hospital in Tehran, Iran, from February 2003 through January 2007. Age at diagnosis, sex, extent of wall penetration, histology type, tumour grade, tumour size, pathologic stage, lymph node metastasis and presence of metastasis were entered into a log normal model. Hazard rate (HR) was employed to interpret the risk of death and the results were compared with Cox regression. The AIC (Akaike Information Criterion) was employed to compare the efficiency of models. Results: Univariate analysis indicated that with increasing age the risk of death increased significantly in both log normal and Cox models. Patients with grater tumour size were also in higher risk of death followed by those with poorly differentiated and moderately differentiated in tumour grade and advanced pathologic stage. The presence of metastasis was significant prognostic factor only in log normal analysis. In final multivariate model, age was still a significant prognostic factor in Cox regression but it was not significant in log normal model. Presence of metastasis followed by histology type were other prognostic features found significant in log normal results. Based on AIC, log normal model performed better than Cox. Interpretation & conclusion: Our results suggest that early detection of patients in younger age and in primary stages and grade of tumour could be important to decrease the risk of death in patients with gastric cancer. Comparison between Cox and log normal models indicated that log normal regression model can be a useful statistical model to find prognostic factors instead of Cox.

Gastro-esophageal reflux symptoms and body mass index: no relation among the Iranian population.

An association between obesity and symptoms of gastro-esophageal reflux disease (GERD) has been frequently reported in western societies. A recent study indicated a consistent association between abdominal diameter and reflux-type symptoms in the white population, but no consistent association in the black population or Asians. It is unclear whether an association persists after adjusting for known risk factors of GERD among Asian populations. We did a population-based, cross-sectional interview study to estimate the strength of association between body mass and symptoms of reflux. During interviews, participants completed a valid gastro-esophageal reflux questionnaire. Odds ratio (OR) with 95% confidence interval (CI), calculated by logistic regression with multivariate adjustments for covariates, were the measures of association. Symptoms of reflux at least once a week over the past 3 months were reported by 522 (9.1%) of the 5733 interviewees. Among those who were overweight or obese (BMI> 25 kg/m2), the OR of having symptoms of reflux was 0.88 (95% CI: 0.66-1.16) compared with those who were not overweight or obese. Thus, among Asians, symptoms of GERD occur independently of body mass index.