Tehran University Medical Journal

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Introduction: The bone mass density (BMD) may vary in different countries due to different genetic and environmental factors. This study was performed to determine the BMD of the normal population in Iran.

Methods and Materials: Subjects were selected randomly from different works and social classes in Tehran (from the lowest to the highest). For each decade and sexes, 20 normal subjects were selected (140 men and 140 women). BMD was measured with a Hologic 1000 plus machine by dual energy x-ray absorptiometry (DEXA) method for the lumber spine (L1, L2, L3, L4, L1-L4) and the femoral neck (neck, trochanter, intertrochanter, ward, total). Data were treated by polynomial approximation (3 rd degree). The obtained curves were compared with the standard Hologic curves for Caucasians.

Results: In female the peak bone mass (PBM) was 1.019 g/cm² for the lumbar spine and 0.832 for the femoral neck. In male the peak bone mass (PBM) was 0.987 g/cm² for the lumbar spine and 0.907 for the femoral neck. The BMD of both lumbar spine and femoral neck were lower than the Hologic standards. For the lumbar spine the mean difference was 6.5 percent (2 to 21 percent, CI=1) for women and 13.8 percent (2 to 36 percent, CI=1.45) for men. In femoral neck the mean difference was 5.4 percent (2 to 16 percent, CI=0.96) for women and 4.6 percent (1 to 14 percent, CI=0.96) for men.

Conclusion: The BMD of the lumbar spine and the femoral neck was lower in Iranian compared to the Hologic standards for Caucasians. This was seen in all age groups and in both sexes. It was less pronounced for the PBM in spine was lower in men than woman. The lower BMD of the spine in men was also seen in a cohort of patients with different diseases (inflammatory and non-inflammatory).

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Background: Pulmonary involvement is a common and serious complication of rheumatoid arthritis. This cross sectional study sought to determine the prevalence of pulmonary disease in patients with rheumatoid arthritis on the basis of history, physical examination, chest X-ray and PFT.

Materials and Methods: 103 patients (81 Women, 22 Men) fulfilling the ACR (American College of Rheumatology) criteria for RA (Rheumatoid arthritis) were consecutively included in a cross sectional study. Detailed medical (including respiratory symptoms and the disease activity symptoms) and drug and occupational histories and smoking were obtained. All patients underwent a complete pulmonary and rheumatologic examination and conventional chest radiography. All patients underwent PFT that comprised spirometry and body plethysmography.Results for PFTs were expressed as percentage of predicted values for each individual adjusted for age, sex, and height.

Results: On the basis of history: Their mean age was 43.3 ± 2.6 years (range: 17-74) and the mean duration of the disease was 69.3 ± 15.6 months. Rheumatoid factor was positive in% 61.2. No patients were 0.5Pack/Year smoker in whole life. Prevalence of pulmonary involvement based on radiographic and pulmonary function test detected in 41 patients (39/7%). The most frequent respiratory clinical finding was dyspnea (33%), (NYHA grade I in 17.5% and NYHA grade II in 15.5%), Cough (with or without sputum) in 13.6 %, Crackle was the most sign in pulmonary examination (5.8%). Chest X-ray was abnormal in 13.3 % that the most common finding in this study was reticulonodular pattern in 20 patients (19.4 %), and pleural effusion detected in 7 patients (6.7%). PFT was abnormal in 30 patients (29.1 %). A significant decrease of FEF 25%-75% below 1.64 SD. Small airway involvements was the most abnormal finding of PFT. No relation between rheumatoid arthritis disease activity (ESR>30, Morning stiffness>30', Anemia, thrombocytosis) with pulmonary disease was seen.

Conclusion: This study suggests a high prevalence of lung involvement in patients with rheumatoid arthritis.Therefore we recommend a complete investigation in patients with RA with any respiratory symptom.

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Background: Scleroderma is an important chronic disease with unknown ethiology and two subtypes: limited type: Skin involvement limited to distal of extremity and face. Diffuse type: Skin involvement is both distal and proximal of extremity, face and thrunk. Thyroid dysfunction is a main problem in these patients but there is no published data of Iranian scleroderma patients
Methods: This is a cross-sectional study to determine the prevalence of hypothyroidism (clinical, subclinical and autoimmune) in patients with scleroderma 125 patients with scleroderma selected and T3, T4, TSH Anti Tpo Ab and Anti TG Ab measured in them.
Results: 33 patients with scleroderma had hypothyroidism. (%26/4). Two patients with scleroderma had hyperthyroidism. (%1/6). %12/8 had clinical hypothyroidism. And %13/6 had subclinical hypothyroidism, %33/3 of patients with subclinical hypothyroidism and positive autoantibody had limited type. Where as %66/6 of patients with subclinical hypothyroidism and autoantibody had diffuse type, %28/5 of patients with clinical hypothyroidism and positive auto anti body had limited type. Where as %71/4 of patients with clinical hypothyroidism and auto anti body had diffuse type. All of patients with hyper thyroidism had diffuse type and autoantibody positive.
Conclusion: It seems hypothyroidism has an increased prevalence in patients with scleroderma and we suggest that thyroid function test must be done in primary evaluation of these patients

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Background: The cause of osteoporosis is multifactorial and many dietary factors are important in the prevention of this disease. Antioxidants as free radical scavengers may influence osteoporosis by reducing the effects of oxidative stress that may be associated with bone loss. Vitamin E is an important antioxidant that protects polyunsaturated fatty acids (PUFA) in cell membranes from oxidation. There are only two studies regarding vitamin E plasma levels in subjects suffering from osteoporosis. The purpose of this study was to investigate the association between plasma vitamin E levels and bone mineral density (BMD) in Iranian patients.
Methods: Subjects were consecutively recruited between May and September 2005 from among a total of approximately 1000 people referred for instrumental screening for osteoporosis to the Jami Clinic in Tehran. Inclusion criteria for the study group were: a femoral neck T-score of -1 or less, osteopenia, severe osteopenia and osteoporosis. A total of 137 subjects were enrolled. According to their femoral and spinal BMD scores, 54 persons were selected as a control group. The control group consisted of subjects with a femoral neck T-score and spine T-score of -1 or more. In selecting the case group, only the femoral BMD score was used. Plasma vitamin E was measured, after extraction with methanol, by HPLC with UV detection at 280 nm. Methanol, deionized water and butanol (90:4:6) was used as a mobile phase with a C8 column. The flow rate was 1.0 ml. min-1 and the acetate ester of vitamin E was used as an internal standard.
Results: The results show no significant difference in plasma vitamin E between the control and case groups, however linear regression analysis does reveal a significant difference between the T-score and plasma vitamin E.
Conclusion: Deceleration Femoral bone Density during osteoporosis will be Accelerated with Decrease of Vitamin E Antioxidant level.

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Background: Both isokinetic testing and functional tests are commonly used to evaluate anterior cruciate ligament reconstructed (ACLR) patients. The object of this study was to evaluate motor performance of the knee and determine the relationship of isokinetic test scores to scores on a variety of lower extremity functional tests.
Methods: Ten healthy subjects and eleven ACLR patients at least six months after surgery performed the following: knee isokinetic tests at 60 and 180 deg/sec three functional tests including leg vertical jump, single hop, and triple cross-over hop for distance. The International Knee Document Committee Subjective Knee Evaluation Form (IKDCSKEF) was used to score the self-assessment of each study participant. Paired T-test was used to compare the involved and uninvolved knee. Pearson correlation coefficients were used to determine the relationship between the scores on the isokinetic test and functional tests. Significance was determined by P<0.05.
Results: IKDCSKEF score was significantly lower in patients than control subjects. Quadriceps peak torque and functional test scores were significantly lower in the involved knee of the ACLR subjects compared to the uninvolved knee. Correlation coefficients of isokinetic peak torque to body weight and functional testing were not significant in patients or control subjects, whi1e the limb symmetry index (LSI) of the quadriceps isokinetics peak torque to body weight and the LSI of the functional tests were significant (r = 0.54 to 0.97).
Conclusion: These results indicate a significant relationship between the LSI of various functional tests and the LSI of isokinetic testing among ACLR patients. Thus, in situations where an isokinetic dynamometer is not available, the LSI of functional tests can be used to estimate quadriceps deficiency for ACLR patients.

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Background: Heat-shock proteins are part of a strictly controlled biological system that allows organisms to respond to environmental stresses. Different proinflammatory cytokines are present in the synovial tissue of rheumatoid arthritis patients. Such tissues respond to stress and induce heat-shock proteins. In addition, synovial cells are exposed to mechanical stress caused by joint motion. The effects of mechanical stress on the metabolism of the synovial cells may be substantial, even pathogenic. Heat-shock proteins are often implicated in the pathogenesis of rheumatoid arthritis. Here, we compare the levels of heat-shock protein 70 from the synovial fluid of rheumatoid arthritis and osteoarthritis patients.

Methods: Synovial fluid samples from 34 rheumatoid arthritis patients and 34 osteoar-thritis patients were analyzed for heat-shock protein 70 by an ELISA method. Statistical analysis was performed using independent T-test and one-way ANOVA. Differences were considered statistically significant at p< 0.05.

Results: The mean value of synovial fluid heat-shock protein 70 levels in rheumatoid arthritis patients was 156.30 ±128.51 and that of osteoarthritis patients was 14.98 ±11.58. The differences were statistically significant at p<0.0001. For seven rheumatoid arthritis patients suffering from mechanical knee pain, synovial fluid analysis revealed non-inflammatory effusion. The mean value of synovial fluid heat-shock protein 70 level in inflammatory synovial fluid of rheumatoid arthritis patients was significantly higher at 191±121.73 and that of non-inflammatory synovial fluid from rheumatoid arthritis patients was 21.93 ±10.06 (p< 0.05).

Conclusion: The level of heat shock protein 70 is higher in inflammatory arthritis than in non-inflammatory arthritis. Considering that patients with rheumatoid arthritis are known to have a hypertrophic synovial-lining layer, and that heat-shock protein 70 is known to protect cells against a variety of toxic conditions as well as apoptotic death, further research is needed to determine if heat-shock protein 70 induction is a sign of significant changes in the cellular and tissue metabolism or is actively participating in the pathogenesis of rheumatoid arthritis.

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Background: Osteoporosis threatens the aged population especially the menopausal women and can lead to life long disability and death. Appropriate knowledge and behavior have an important role in prevention of osteoporosis. In this study the knowledge, attitude and behavior of women regarding osteoporosis is assessed and compared in different age groups.
Methods: This cross sectional study includes 390 women in reproductive, premenopausal and menopausal age groups who had come to Shariati hospital clinics and each had answered the designed questionnaire. The questionnaires were scored and analyzed. Women’s knowledge, attitude and behavior were assessed and compared by X2 test in the three age groups and P<0.05 was considered significant.
Results: 15–30% of women didn’t know what osteoporosis is and in 380 of them attitude or behavior was not good. Education had a significant effect on knowledge of women in reproductive and premenopausal ages (P=0.002, 0.04 respectively), but had no effect on their attitude or behavior. Age had a significant effect on knowledge and attitude (P=0.001) but had no effect on behavior. Age had significant effect on the knowledge that exercise can prevent osteoporosis (P=0.014) but not on attitude or behavior. Age had no effect on knowledge, attitude or behavior of daily calcium intake to prevent osteoporosis. (P=0.123, 0.12, 0.153 respectively) 93% to 95% of women thought the risks of osteoporosis are less than cardiovascular disease or breast cancer.
Conclusions: 15–30% of women didn’t know what osteoporosis is. The total knowledge about osteoporosis was low. Although 22-75% of women younger than 54 years old had knowledge about the predisposing factors but their attitude or behavior was not good.