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.

Clinical Manifestations of Behçet's Disease: A Retrospective Cross-Sectional Study.

Introduction: Behçet's Disease (BD) is a systemic vasculitis, highly prevalent in Eastern Asia to Mediterranean countries. Iran is among the countries with the highest prevalence of BD, and previous studies in different countries have shown a broad range of clinical manifestations of the disease. The present study is conducted to evaluate the prevalence of the clinical manifestations of BD in patients referring to rheumatology clinics of two distinct referral hospitals in Tehran and Zanjan, Iran. Methods: In this retrospective, cross-sectional study, the medical records of patients with BD were reviewed, and age at onset, sex, the delay between the onset of symptoms and diagnosis, clinical manifestations, HLA B27, HLA B51, HLA B5, haematuria, proteinuria, leukocyturia, Erythrocyte Sedimentation Rate (ESR), and pathergy phenomenon were included in the study. The collected data were analysed by χ2 test using SPSS 23. Results: A total of 188 patients (Male/female ratio = 1.47) were included in the study with mean ± SD age at onset of 27.98 ± 10.47 years and a mean ± SD of delay between the onset of symptom and diagnosis of 5.70 ± 7.16 years. The most common clinical manifestation was mucosal involvement (85.1%), followed by the ocular lesion (55.3%) and skin manifestations (44.7%). The Pathergy phenomenon was observed in 98 patients (52.1%). Moreover, 45.2% had positive HLA B5, followed by HLA B51 (35.1%) and HLA B27 (12.2%). Conclusion: This study demonstrated that male/female ratio and mean age at onset were comparable to the results of previous studies in Iran. Significant associations between HLAB5 and clinical manifestations underline the pivotal role of genetic factors in BD.

Caregiving burden, depression, and anxiety among family caregivers of patients with cancer: An investigation of patient and caregiver factors.

Background: Caring for patients with cancer can result in significant burden, anxiety, and depression among family caregivers, leading to alterations in their mental and physical wellbeing. Evidence on the level of cancer caregivers' burden, depression, anxiety, their role in assisting their patients, and other patient and caregiver factors that play in improving/worsening the outcomes, is limited. This study explored the prevalence of caregiving burden, depression, and anxiety with a focus on the patient and caregiver-related factors among cancer family caregivers. Methods: A cross-sectional study was conducted on the population of caregivers of adult patients with cancer in Zanjan, Iran between 2019 and 2020. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Zarit Burden Inventory (ZBI) were used to measure outcome variables. Clinical and basic characteristics of the caregivers and patients were also collected. An independent samples t-test, analysis of variance, Pearson's correlation coefficient, and stepwise linear regression were performed using SPSS software version 26. Results: Mean ± standard deviation age of the caregivers (167 men and 133 women) was 40.77 ± 12.56. Of the caregivers, 46.3, 53, and 30.7% showed severe depression, anxiety, and burden, respectively. There was a significant positive correlation between ZBI with both BDI [r (298) = 0.19, p < 0.01] and BAI [r (298) = 0.20, p < 0.01]. Caregiving ≥24 months (B = 14.36, p < 0.001), outpatient care setting (B = -12.90, p < 0.001), being retired (B = -12.90, p < 0.001), depression (B = 0.28, p < 0.001), supplemental health insurance (B = -7.79, p < 0.001), being illiterate (B = 7.77, p < 0.01), surgery (B = 8.55, p < 0.01), ECOG1 (B = 4.88, p < 0.01), and patient's age (B = 0.11, p < 0.05) were found to be significant predictors of caregiving burden. Conclusion: High levels of depression, anxiety, and burden were observed among the caregivers of patients with cancer. These findings underline the importance of paying close attention to the needs and psychological challenges of this population.

Effectiveness of isometric exercises on disability and pain of cervical spondylosis: a randomized controlled trial.

BACKGROUND: Neck pain and disability is a significant public health problem with only very few evidence-based treatment option. The aim of this study was to evaluate the effect of isometric exercise on pain and disability of cervical spondylosis. METHODS: Twenty four patients with cervical osteoarthritis and neck pain (22 females and 2 males; mean age, 46.70 ± 13.71 years) were recruited and randomly allocated into 2 arms: neck isometric exercises (n = 12) and conservative management without exercise (n = 12). The Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPAD) were used to assess participants at baseline and after 4 weeks. RESULTS: Basic characteristics, NDI score and NPAD score were not significantly different between groups at baseline. The exercise arm demonstrated significantly lower scores regarding NDI (mean, 17.41 vs. 25.58; P-value = 0.035) and NPAD (mean, 25.33 vs. 66.67; P < 0.001), compared to the control arm after 4 weeks. The exercise arm also showed significant within group reduction considering NDI and NPAD scores after 4 weeks (Both, P < 0.001). CONCLUSION: Our findings suggested that isometric exercises might be a beneficial treatment for improving pain and disability caused by cervical spondylosis. Trial registration This study was registered at irct.ir (Iranian Registry of Clinical Trials) with the code IRCT20220206053950N1, 07.05.2022, retrospectively registered.

Concurrent Chemo- Radiobrachytherapy with Cisplatin and Medium Dose Rate Intra- Cavitary Brachytherapy for Locally Advanced Uterine Cervical Cancer

Objective: Cervical carcinoma is the third most common gynecologic cancer, after ovarian and uterine cancers in Iran. The aim of this study was to evaluate the efficacy (response rate) and toxicity of adding Medium Dose Rate (MDR) brachytherapy with concurrent chemotherapy to External Beam Radiotherapy (EBRT) for the treatment of locally advanced uterine cervical carcinoma. Methods: This phase I-II study was conducted in 2007-2008 at the cancer institute, Tehran University of Medical Sciences. Patients were treated with pelvic EBRT (50 Gy in 25 Fraction) with concomitant chemotherapy to obtain tumor shrinkage and permit optimal intra-cavitary placement. One week after the completion of EBRT, patients were treated by 12 Gy MDR Intra-cavitary brachytherapy for two periods of one day with a one week interval and concomitant platinum based chemotherapy. Response rate was evaluated by gynecologic physical examination and pelvic MRI +- GD within three months of treatment. Acute and late toxicity were assessed using Radiation Therapy Oncology Group criteria. Results: A total of 33 patients with locally advanced cervical cancer were treated according to the above described treatment protocol. The patients mean age was 53.2 (range 31­78) years. Three months after the completion of treatment, the complete clinical, pathologic and radiologic response rate according to WHO-criteria was 81.8% (27 patients). Six cases had a partial response or stable disease. After 48 months, average disease free survival periods were 45.1, 23.0, 33.4 and 8 months for stage IIB, IIIA, IIIB and: IVA lesions (according to The International Federation of Gynecology and Obstetrics staging system). The most frequently observed side effects were leukopenia, anemia, proctitis, cystitis, nausea and vomiting (mostly grade 1 and 2). Conclusion: Concomitant brachytherapy and chemotherapy with platinum compounds can be well tolerated and is effective in the treatment of locally advanced cervical cancer.

Thermoluminescence dosimetry of the dose received by scrotum and testes in radiotherapy of rectal cancer, compared to the point doses calculated by 3D-planning software.

PURPOSE: Radiation received by the testes in the course of radiotherapy for rectal cancer may cause oligospermia and azospermia. We sought to determine the dose to the scrotum and testes with thermoluminescence dosimetry (TLD), and compare it to the dose calculated by 3D planning software. METHODS: The TLDs were fixed to the scrotum in six points anteriorly and posteriorly in two fractions of radiotherapy. All patients received a 50-50.4 Gy total dose in prone position with 3D-planning. The average dose of TLD measurements was compared to the average of 6 relevant point doses calculated by the planning software. RESULTS: The mean scrotal dose of radiation in 33 patients as measured by TLD was 3.77 Gy (7.5% of the total prescribed dose), and the mean of point doses calculated by the planning software was 4.11 Gy (8.1% of the total dose), with no significant difference. A significant relationship was seen between the position of the inferior edge of the fields and the mean scrotal dose (P = .04). Also body mass index (BMI) was inversely related with the scrotal dose (P = .049). CONCLUSION: We found a dose of about 4 Gy received by the scrotum and testes from a total prescribed dose of 50 Gy in the radiotherapy of rectal carcinoma patients, with TLD measurements confirming testicular dose estimations by the planning software. This dose could be significantly harmful for spermatogenesis. Thus careful attention to the testicular dose in radiotherapy of rectal cancer for men desiring continued fertility is a necessity.