Effect Of Fasting And Vegetarian Diet On The Improvement Of Rheumatoid Arthritis

Background: The high incidence of Rheumatoid Arthritis (RA), the conventional treatments and the experimental observations have shown that by taking particular foods or omitting some foods form ordinary diet, the disease symptoms of the patients reduce. The interesting point is that fasting lowers the objective and subjective indexes of disease activities in most patients who suffer from rheumatoid arthritis. The effects of a short-time fast and subsequent vegetarian diets for one year, on the rheumatoid arthritis patients were studied in this research. Materials and Methods: 52 patients (40 females and 12 males) with definite rheumatoid arthritis, based on the American College of Rheumatology (ACR) criteria were selected and duly studied with single blind method. 28 patients were selected after one month fasting at Ramadan. From the tenth day, a vegetarian diet was prescribed for them. This diet was continued for three moths. After three moths, the diet was changed to a combination of milk, vegetables and fruits. Two of the patients left the study at the end of Ramadan. A group of 24 non-fasting patients with ordinary food diet were selected as control group. Results: In the patients subject of study (with the average age of 39+14.5) and average 36 months disease, after four weeks of fasting under vegetarian diet, significant improvement was found in many of their disease indexes based on ACR criteria, such as joint pain and joint swelling, length of morning stiffness and responds to a health evaluation questionnaires. These suitable effects have still remained the same after one year. With respect to the findings, it is concluded that fasting and a changed diet had left significant effects on all calculated indexes. Although short time fasting had suitable effects in most patients suffering from rheumatoid arthritis, almost in all cases, the disease recurred when the patient returned to his/her ordinary food diet. Conclusion: The results of the study show that the patient’s improvement can continue through selecting a type of food diet and based on a regulated diet, the rheumatoid arthritis activities decrease. It is suggested to set a tolerable food diet for the rheumatoid arthritis patients and those foods, which involve in the disease, should be omitted or at least, balanced

A PROSPECTIVE CROSS-SECTIONAL STUDY OF JOINT MOTION IN HEALTHY ADULT SUBJECTS

Normal range of joint motion is an important factor in joint examination in clinical practice which is related to factors such as age, sex and geographic region. There is no data in the literature on the range of joint motions in healthy Iranian adults. We studied joint motions in 100 healthy volunteer subjects, 49 men and 51 women, from 19 and 58 years of age. The joint mobility was examined in saggital, frontal, transversal and rotating levels (SFTR). The normal range of motion of all peripheral and axial joint was examined using the standard goniometric technique. There were no significant difference in elbow flexion, shoulder adduction, inward rotation of shoulder and inward and outward rotation of hip, in relation to the age and gender of the studied subjects. There was inverse relationship between joint motion indices and age

The accuracy of clinical diagnosis of discal sciatic neuralgia at construction labors: a comparison study

Background: Mechanical low back pain (L.B.P) is most common in middle-aged people especially in developing countries and the symptom compromises routine life activities of the patients. Disk herniation is the most frequent cause of LBP. The less costly way for diagnosing the cause of LBP is performing a careful physical examinations. This study aimed to evaluate the sensitivity and specificity of clinical diagnosis of the cause of Discal Sciatic Neuralgia at Construction Labors in comparison to MRI as the gold standard. Methods: In a descriptive- analytic study 60 middle-aged professional construction workers were evaluated. Their age range was 25-45 years old and all of them had the complaint of mechanical LBP. Medical history was taken and all cases under went a cautious physical examination. The presence of disk herniation between L4-L5 orL5-S1 was recorded according to clinical signs and symptoms. Lumbosacral MRI was performed for all cases and the results were compared to clinical data. Results: The clinical diagnosis of presence and severity of pathology was confirmed by MRI in all stages of discopathy in L5-S1 and L4-L5 vertebrae (sensitivity= 100%). Conclusion: This study showed that careful physical examinations will be sufficient for the sciatic neuralgia diagnosis and even the staging of disk herniation can be performed clinically. Requesting MRI as an expensive procedure is not recommended for diagnosis of Discal sciatic neuralgia because of feasibility of the cost effective way of precise physical examination

Demographic and pathologic findings of squamous cell carcinoma of skin and lip in pathology department of Razi Hospital1

Squamous cell carcinoma, a cancer of keratinocytes origin, mostly involves sun-exposed areas of the skin. To study the pathologic and demographic features of this disease, records of 395 patients of squamous cell carcinoma of skin and lip were reviewed. Most of the patients (83%) aged 40 years or more at the time of diagnosis. Respectively, 74.4% and 75.8% of cases with skin and lower lip carcinoma were men, but in upper lip cases frequencies of both sexes were equal. The number of patients referred from western and north-western provinces were much more than those of other provinces of the country. The most frequent histologic stage was grade I (53% and 58.8% in skin and lip carcinoma, respectively), showing that most patients visit physicians early enough, and are diagnosed in early stages of the disease

Evaluation of clinical symptoms of patients with scleroderma according to the onset time

Systemic sclerosis is a generalized disorder of connective tissue, in which the pattern of disease extent, progression and outcome is heterogenous. To determine clinical features, disease extent and progression, we studied our patients in two phases of disease; early (the first 3 years) and late phases (after 6 years of disease). 19 patients had diffuse cutaneous and 34 patients had limited cutaneous scleroderma. In patients with diffuse cutaneous scleroderma, disease progression has occurred mostly in the early phase of disease, but in patients with limited cutaneous scleroderma, disease progression was slow and incidious, so disease progression has occurred mostly in the late phase of the disease, thus raynaud's phenomenon, telangiectasia, hyperpigmentation and esophagitis were observed more in the late phase of the disease (statistically significant). In comparison of two groups, early and extensive organ involvement was observed in patients with diffuse cutaneous sclerodema

Evaluation of clinical symptoms of patients with scleroderma according to the onset time1

Systemic sclerosis is a generalized disorder of connective tissue, in which the pattern of disease extent, progression and outcome is heterogenous. To determine clinical features, disease extent and progression, we studied our patients in two phases of disease; early (the first 3 years) and late phases (after 6 years of disease). 19 patients had diffuse cutaneous and 34 patients had limited cutaneous scleroderma. In patients with diffuse cutaneous scleroderma, disease progression has occurred mostly in the early phase of disease, but in patients with limited cutaneous scleroderma, disease progression was slow and incidious, so disease progression has occurred mostly in the late phase of the disease, thus raynaud's phenomenon, telangiectasia, hyperpigmentation and esophagitis were observed more in the late phase of the disease (statistically significant). In comparison of two groups, early and extensive organ involvement was observed in patients with diffuse cutaneous sclerodema

The comparison between monotherapy and combination therapy in rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory condition. The condition can affected many tissues throught out the body, but the joints are usually most severely affected. The high incidence of RA, the conventional treatments and the experimental observation have shown by combination therapy, the disease symptoms of the patients reduce. To compare the efficacy and tolerability of single-agent Hydroxychloroquin (HCQ) with combination therapies composed of (HCQ) and Methotrexate (MTX) and (HCQ), (MTX) and Sulfasalazin (SSZ) in active rheumatoid arthritis patients with additive arthritis. Methods: One hundred and twenty RA patients with active arthritis (male/female: 30/90) who were treated in rheumatology clinic between 2003 and 2005 were enrolled in this trial. Patients treated with (HCQ) alone(200 mg/day)were include in group (I), patients treated with combination of (HCQ) (200 mg/day)and (MTX) (7.5mg/week)in group (II),and patents treated with combination of (HCQ) (200mg/day),(MTX) (7.5mg/week)and (SSZ)(1 gr/day)in group (III), Forty patients (male/female:10/30) in group (I),(II) and (III)were eligible for statistical analysis at the end of study. Changes in variable were compared by the T-test. Results: The combination of (MTX), (HCQ)and (SSZ) and the combination of (MTX) and (HCQ) were more effective regarding the clinical and laboratory parameters than (HCQ) alone (P<0.05). Moreover the combination of (MTX), (HCQ) and (SSZ) was more effective than the combination of (MTX) and (HCQ) (P<0.05). Combination therapies seem to be more effective and no more toxic than monotherapy in RA patients with additive arthritis. Conclusion: Combination therapy with methotrexate, hydroxychloroquin and sulfasalazin is more effective than hydroxychloroquin alone or a combination of methotrexate and hydroxychloroquin in RA. We suggest starting combination therapy for the patients with early RA, when the diagnosis has been established

Evaluation of Rheumatoid Factor using ELISA versus Latex method: a cross sectional study

Background: Rheumatoid factor (RF) is an IgM antibody against the Fc portion of IgG, which together form an immune complex. RF is an important criterion in the diagnosis of early-stage rheumatoid arthritis (RA) and prognosis of RA pathogenesis, as higher levels of RF indicate a higher possibility of more damage. Although 2/3 to 3/4 of patients that undergo ordinary standard tests and have final clinical diagnosis are also positive for RF, a 70-90% prevalence of RF among RA patients can be achieved, depending on the method of detection and the target antibody, IgG or IgM. In this study, we measured the frequency of IgG and IgM RF isotypes using the ELISA and latex agglutination methods and compare these results with those of a hospital control group, tested using standard methods, in order to determine the best method for the measurement of RF.Methods: Of the patients referred to the Rheumatology Clinic of Imam Khomeini Hospital during 2005-2006, one hundred randomly selected rheumatoid arthritis patients, 75 females and 25 males, with classical or definite rheumatoid arthritis (defined by the criteria of the American College of Rheumatology), with a short disease duration of 12-24 months, underwent testing for RF using the latex method for IgM and ELISA for IgM-IgG. The healthy control group (75 females and 25 males) were tested for RF using the ELISA method for IgM-IgG. The variables were compared using the Pearson's chi-square test.Results: We found that the measurement of RF among RA patients using did not differ significantly between the two methods. The immune complex in RA is mainly IgM. The positive IgM results in RF patients using two similar methods showed a significant relationship by Pearson's correlation co-efficient (r=0.60, p<0.001). In addition, comparison of the IgM and IgG RF by ELISA showed a weak correlation with low significance (r=0.10, p<0.001). In sum, this study showed a significant difference (r=0.24, p<0.001) between the IgM in RA patients and that in healthy people, who had no IgM or IgG RF.Conclusion: Approximately 75% of confirmed RA cases had the IgM RF; however, we found little advantage in using the one method over the other, nor was the measurement of IgG more useful than IgM as a diagnostic criteria

Medical student training and patient satisfaction in the internal medicine clinics of Imam Khomeini Hospital

Introduction: The aim of this study was to investigate the effect of Medical Student Training on patients satisfaction referred to the internal medicine clinics. Methods: This is a cross sectional descriptive study. 200 outpatients referred to the internal medicine clinic Imam Khomeini Hospital were selected by convenient sampling. The participants were divided into two groups. The group which firstly visited by a specialist and the group which firstly visited by intern and then a specialist. In this study, researcher made questionnaire was used for measuring the patient satisfaction. Data were analyzed by using one-sample t-test, independent t-test and pair-t test. Results: The finding showed that patients are satisfied of the presence and performance of medical interns in clinics and they preferred to be visited by intern and a specialist rather than only by a specialist (p<0.001, t=13.55). The satisfaction scores of the patients in the areas of description of personal issues, a doctor knowledge, involvement in treatment decisions, feeling of visitor comfort and understand the patient's feeling visited by an intern were higher than those who were visited by only a doctor. Also, the mean scores of the patient satisfaction in the dimensions of asking questions, understandable given information, complete treatment, compliance of respectable and understand competence of given information in patients who were visited by only a doctor were more than the patients who were visited by an intern (p<0.05, t= 1.99). Conclusion: It can be concluded that the training medical students in internal medicine clinic of hospitals can be an effective strategy for the rate of satisfaction level of patients from their treatment

EVALUATION OF IL1-α AND TNF-α SERUM LEVELS IN RHEUMATOID ARTHRITIS PATIONTS WITH ACTIVE AND INACTIVE, WITH OR WITHOUT BONE EROSION

Rheumatoid arthritis is the most common inflammatory joint disease with 1 percent prevalence in community which presents with symmetrical polyarthritis of hands with inflammatory behavior. Several studies in recent years were conducted for evaluation of inflammatory cytokines such as IL1-&amp;alpha; (Interlukin 1&amp;alpha;) and TNF- &amp;alpha; (Tumor necrosis factor) in rheumatologic disorders including rheumatoid arthritis to find new treatment methods base to pathogenesis. In this study different serum levels of IL1-&amp;alpha; and TNF- &amp;alpha; in 160 rheumatoid arthritis patients with active and inactive disease and also disease with or without bone erosion are assessed. 4% of our patients had rheumatoid nodule and 70% of all patients had positive RF, IL1-&amp;alpha;, and TNF- &amp;alpha; levels. Active with bone erosion patients had IL1-&amp;alpha; and TNF- &amp;alpha; serum levels higher than active without bone erosion patients; it was not significant in T-test but it was significant in Mann-Whitney Test. The results was the same as expected; IL1-&amp;alpha;, and TNF- &amp;alpha; serum levels were higher in active with bone erosion in comparison with inactive without bone erosion patients