Effectiveness of muscle strengthening exercises on the clinical outcomes of patients with knee osteoarthritis: A randomized four-arm controlled trial.

Background: Knee osteoarthritis (OA) is one of the major causes of dysfunction that reduces patients' quality of life. The aim of current study was to investigate the effectiveness of muscle strengthening exercises on the clinical outcomes of patients with knee OA. Methods: We conducted a single-blind clinical trial on 96 patients with mild to moderate knee osteoarthritis. Patients were randomly assigned to 4 groups with 24 patients and followed-up for 8 weeks. Quadriceps, hamstring and both hamstring and quadriceps strengthening exercises were received by the first (G1), second (G2) and third (G3) groups, respectively. The fourth group (G4) was the control group and did not receive any intervention. The main outcome variables were pain, physical function and morning stiffness. This study was retrospectively registered at irct.ir (Iranian Registry of Clinical Trials) with the code IRCT20220206053950N2, 2022-09-07. Results: Our findings demonstrated a significant impact of interventions on VAS score, pain, and stiffness (All, p < 0.001). Nonetheless, the effect of interventions was not significant for physical function (P = 0.78). After adjusting for the potential confounders, similar results were observed. Besides, the results of Dunnett post hoc test showed that either G1 or G3 had the most decrease in VAS and WOMAC-morning stiffness scores compared to G2 and G4. Conclusion: Based on the evidence from the present study, we can recommend a combination of quadriceps and hamstring strengthening exercises as the most effective intervention to reduce pain and morning stiffness in patients with OA.

Red cell distribution width, a predictive factor in immunocompromised patients with COVID-19: A comparison retrospective study between cancer and kidney transplant patients.

We aimed to review the records of cancer and kidney transplant patients of out of 1135 COVID-19 patients, who were referred to our hospital (Valiasr) in Zanjan, from March 16th, 2020, to June 11th, 2020. This was single-center, historical cohort study. Patients were divided into different subgroups and compared of disease outcomes. The only predictor of death was lactate dehydrogenase (LDH). The rate of red cell distribution width (RDW) in patients with active cancer was higher than kidney transplant patients and was statistically significant. There was no statistically significant difference in mortality between active and non-active cancer groups. Female sex and low SpO2 has increased the chances of ICU admission. Patients with active cancer generally have severe and more complicated disease and RDW can be a predictable option.

Effects of a Mediterranean Diet Compared with the Low-Fat Diet on Patients with Knee Osteoarthritis: A Randomized Feeding Trial.

Objectives: Knee osteoarthritis is a common global problem, especially in overweight and obese people. It is not clear that weight loss is a factor for pain reduction in these patients or dietary components are important. Herein, we compared the effects of Mediterranean (MD) and low-fat diet on pain, stiffness, and physical function in patients with knee osteoarthritis. Subjects: /. Methods: In this randomized feeding trial, 129 patients with knee osteoarthritis were enrolled. Participants were randomly allocated to the MD (n = 43), low-fat diet (n = 43), and control group (regular diet) (n = 43) for 12 weeks by the blocked randomization method. Total Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and its subscales and anthropometric indices were compared among the groups at the baseline and end of the study. Results: Weight and waist circumference reduction was significantly higher in the MD and low-fat diet groups compared with the regular group (p < 0.001 and p < 0.001, respectively), but there was no significant difference between the MD and low-fat diet groups (p = 0.2). Pain was significantly decreased in the Mediterranean-style compared with the low-fat (p = 0.04) and regular (p = 0.002) diet groups. Physical function was significantly improved in the MD compared with the regular diet group (p = 0.01), but had no significant difference with the low-fat one. Stiffness had no significant difference among the dietary groups. Conclusions: Pain severity was reduced in the MD group, but no significant change was reported in patients on low-fat and regular diets. It seems that dietary components in the MD, regardless of weight loss effect, are effective on pain reduction in patients with KOA. The present study was registered in the IRCT under the code of IRCT20200929048876N1.

Dietary Pattern or Weight Loss: Which One Is More Important to Reduce Disease Activity Score in Patients with Rheumatoid Arthritis? A Randomized Feeding Trial.

Objectives: Herein, disease activity score 28 (DAS 28) was compared between patients with rheumatoid arthritis (RA) receiving the Mediterranean dietary pattern (MD) and low-fat diet. Subjects/Methods. Overweight and obese RA patients aged 15-75 y participated in this randomized feeding trial. Participants were randomized to MD (n = 51) and low-fat high-carbohydrate diet (n = 53) for 12 weeks. The control group followed their regular diet (n = 50). Participants completed the form of tender and swollen joint counts before the study enrollment and after 12 weeks to compute DAS 28. Results: Weight loss was not statistically significant between the MD and LF-HC groups. DAS 28 significantly decreased in MD compared to the LF-HC group (p=0.02) and controls (p=0.001). Adjusting for the baseline variables, MD reduced DAS 28 by 76% (95% CI = -0.45, -0.2; p=0.03) after 12 weeks of intervention. The baseline serum ESR level showed 99.8% effect on DAS 28 score at the end (95% CI = 0.014, 0.035; p < 0.001). Conclusions: The MD showed beneficial effects on DAS 28 compared to the LF-HC diet in patients with RA, regardless of weight loss. It is a better dietary choice for pain reduction in patients with RA. The trial is registered at Iranian Registry of Clinical Trials (IRCT20200929048876N2).

Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial.

INTRODUCTION: There are no determined treatment agents for severe COVID-19. It is suggested that methylprednisolone, as an immunosuppressive treatment, can reduce the inflammation of the respiratory system in COVID-19 patients. METHODS: We conducted a single-blind, randomised controlled clinical trial involving severe hospitalised patients with confirmed COVID-19 at the early pulmonary phase of the illness in Iran. The patients were randomly allocated in a 1:1 ratio by the block randomisation method to receive standard care with methylprednisolone pulse (intravenous injection, 250 mg·day-1 for 3 days) or standard care alone. The study end-point was the time of clinical improvement or death, whichever came first. Primary and safety analysis was done in the intention-to-treat (ITT) population. RESULTS: 68 eligible patients underwent randomisation (34 patients in each group) from April 20, 2020 to June 20, 2020. In the standard care group, six patients received corticosteroids by the attending physician before the treatment and were excluded from the overall analysis. The percentage of improved patients was higher in the methylprednisolone group than in the standard care group (94.1% versus 57.1%) and the mortality rate was significantly lower in the methylprednisolone group (5.9% versus 42.9%; p<0.001). We demonstrated that patients in the methylprednisolone group had a significantly increased survival time compared with patients in the standard care group (log-rank test: p<0.001; hazard ratio 0.293, 95% CI 0.154-0.556). Two patients (5.8%) in the methylprednisolone group and two patients (7.1%) in the standard care group showed severe adverse events between initiation of treatment and the end of the study. CONCLUSIONS: Our results suggest that methylprednisolone pulse could be an efficient therapeutic agent for hospitalised severe COVID-19 patients at the pulmonary phase.