Bone Mineral Density and Bone Metabolism in Patients with Duchenne Muscular Dystrophy.

OBJECTIVE: Poor bone health with related morbidity is a major problem with Duchene Muscular Dystrophy (DMD). Decreased mobility and long-term corticosteroid therapy are involved in poor bone health in DMD. We investigated bone mineral density and bone metabolism in 30 steroid treated DMD patients and also compared mentioned factors between ambulated and non-ambulated patients. MATERIALS & METHODS: In this cross-sectional study, 30 boys (21 patients ambulate and 9 non-ambulate) with documented DMD, according to genetic analysis, were enrolled in 2015. Demographic characteristics, neurologic exam findings, muscle function score, corticosteroid dose and duration and food frequency questionnaire were recorded. Bone mineral density was measured with dual- energy X-ray absorptiometry (DEXA) on lumbar spine and left proximal femur. Serum 25-hydroxyvitamin D, calcium, phosphorus and parathyroid hormone (PTH) levels were measured. RESULTS: Osteoporosis was found in 86.7% patients. Mean bone density in the lumbar spine was -1.5±0.24 and -1.4±0.27 in ambulates and non-ambulates respectively (P=0.7). Mean bone density at proximal femur was -3.4±0.2 in ambulates and -3.4±0.3 in non-ambulates (P =0.48). Intra-groups statistical analysis showed significant difference between bone mineral density at lumbar spine and proximal femur in both mentioned groups (P<0.05). Vitamin D deficiency was detected in 13 patients (43.3%) and its serum level was significantly lower in non-ambulates compared with ambulates. CONCLUSION: Considering high prevalence of vitamin D deficiency and osteoporosis in DMD patients, it seems vitamin D supplementation can improve vitamin D status and osteoporosis in these patients, especially in non-ambulates.

The five factor model of personality in mixed anxiety-depressive disorder and effect on therapeutic response.

INTRODUCTION: Patients with mixed anxiety and depressive disorder suffer the sub-threshold depressive and anxiety symptoms and their negative impact upon quality of life. This study evaluates their personality dimensions and the possible effect on treatment outcome. METHODS: The diagnosis of mixed anxiety and depressive disorder was based on a structured clinical interview in 80 patients. NEO inventory measured five personality dimensions. The depression, anxiety and stress scale (DASS) was used to measure the severity of illness before and after the treatment. RESULTS: Neuroticism, disagreeableness and introversion traits were significantly more expressed among these patients compared to normal population. A significant decrease in the score of depression, anxiety and stress was observed in all patients receiving the treatment. The normalized T-score of the five personality dimensions could not predict the degree of the response to treatment. CONCLUSIONS: This study describes the personality characteristics of patients with mixed anxiety and depressive disorder and beneficial effects of treatment of such patients to be independent from personality dimensions.