Silent osteonecrosis of the femoral head following high-dose corticosteroids in patients with systemic rheumatic diseases

Background: Osteonecrosis (ON) is known to be one of the most disabling complications following corticosteroid (CS) medications. However, evidence regarding risk of asymptomatic prevalence of ON among different diseases and the impact of variable steroid regimens are conflicting. We aimed to determine the prevalence of ON of femoral head in asymptomatic patients with systemic rheumatic diseases who received high-dose CS and also clarify its relationship with different dosages and regimens. Methods: In this cross-sectional study, 50 consecutive patients receiving high-dose CS for rheumatic diseases who have no pelvic pain were recruited. MRI of both hips was performed on all patients using a 1.5 Tesla to diagnose ON. Results: Of 50 subjects, 18 (36) developed ON of the femoral head. Groups with and without ON were comparable in terms of sex, age and mean starting CS dose. There was no statistical difference in the type of CS regimen including daily dose, peak dose and cumulative dose between the two groups. However, silent ON was associated with both the cumulative CS dose and the duration of CS therapy. Conclusion: According to high prevalence of ON in our selected patients with no other identifiable risk factor for ON, monitoring of high risk patients with periodic hip MRI would help diagnose necrosis in early stage

Diagnostic value of anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis.

Background Anti-cyclic citrullinated peptide (anti-CCP) antibodies have been of diagnostic value in Northern European Caucasian patients with rheumatoid arthritis (RA). In these populations, anti-CCP antibodies are associated with the HLA-DRB1 shared epitope. We assessed the diagnostic value of anti-CCP antibodies in Greek patients with RA where the HLA shared epitope was reported in a minority of patients. Methods Using an enzyme-linked immunosorbent assay (ELISA) (CCP2) kit, we tested anti-CCP antibodies in serum samples from 155 Greek patients with RA, 178 patients with other rheumatic diseases, and 100 blood donors. We also determined rheumatoid factor (RF) and compared it to anti-CCP antibodies for area under the curve (AUC), sensitivity, specificity and likelihood ratios. Results Sensitivity of anti-CCP2 antibodies and RF for RA was 63.2% and 59.1%, and specificity was 95.0% and 91.2%, respectively. When considered simultaneously, the AUC for anti-CCP antibodies was 0.90 with 95% CI of 0.87 to 0.93 and the AUC for RF was 0.71 with 95% CI of 0.64 to 0.77. The presence of both antibodies increased specificity to 98.2%. Anti-CCP antibodies were positive in 34.9% of RF-negative RA patients. Anti-CCP antibodies showed a correlation with the radiographic joint damage. Anti-CCP-positive RA patients had increased the swollen joint count and serum CRP concentration compared to anti-CCP-negative RA patients (Mann-Whitney U test, p = 0.01, and p < 0.001, respectively). However, no correlation was found between anti-CCP antibodies and DAS28 score (r = 0.13, p = 0.12). Conclusion In Greek patients with RA, anti-CCP2 antibodies exhibit a better diagnostic value than RF and a correlation with radiological joint damage and therefore are useful in everyday rheumatology practice

The first report of Distoleon nuristanus (Neuroptera: Myrmeleontidae) from Iran

An investigation on the fauna of Myrmeleontidae (Neuroptera) was carried out in Markazi Province in August 2009. Identification and taxonomy was studied via examining morphological characteristics and their internal male genitalia. As a result, Distoleon nuristanus Hölzel, 1972 is presently reporting as new for Iran faun

Rubber friction on (apparently) smooth lubricated surfaces

We study rubber sliding friction on hard lubricated surfaces. We show that even if the hard surface appears smooth to the naked eye, it may exhibit short wavelength roughness, which may give the dominant contribution to rubber friction. That is, the observed sliding friction is mainly due to the viscoelastic deformations of the rubber by the substrate surface asperities. The presented results are of great importance for rubber sealing and other rubber applications involving (apparently) smooth surfaces.Comment: 7 pages, 15 figure

Prevalence of hepatitis D virus infection in HBsAg positive subjects in Iran

Abstract This study was carried out to determine the seroprevalence of hepatitis D virus among HBsAg positive individuals in the northeast part of Iran. One hundred thirty nine HBsAg positive subjects detected from a population based single stage cluster sampling in Golestan province of Iran were enrolled. All cases were evaluated for the presence of anti-HDV antibodies using commercially available ELISA kits. Logistic regression was used to determine the relationship between independent variables and HDV seropositivity. Of 139 cases, 68(48.9%) were males and 71(51.1%) were females. The mean age was 41.89±11.30 years (25-64 years). Anti-HDV antibody was positive in 8 (5.8%) subjects with female predominance (9.9% versus 1.5%, p = 0.06; odds ratio = 7.32, 95%CI: 0.87-61.23). No significant relationship was seen between anti-HDV seropositivity and demographic factors such as age, place of residence and marital status. These findings showed that HDV infection was endemic in Golestan province (northeast) of Iran. Seroprevalence of Anti-HDV in the present study was higher than some previous studies from other parts of Iran. Our results suggest that the prevalence of HBV/HDV co-infection in Iran has increased during the last decade. Therefore, practitioners and all health care managers should be made aware of the risk of dual infection with HBV and HDV. © 2007 Asian Network for Scientific Information

Can intravenous acetaminophen reduce the needs to more opioids to control pain in intubated patients?

Aims: To evaluate the effect of intravenous (IV) acetaminophen on reducing the need for morphine sulfate in intubated patients admitted to the Intensive Care Unit (ICU). Settings and Design: Current study was done as a clinical trial on the patients supported by mechanical ventilator. Subjects and Methods: Behavioral pain scale (BPS) scoring system was used to measure pain in the patients. All of the patients received 1 g, IV acetaminophen, every 6 h during the 1 st and 3 rd days of admission and placebo during the 2 nd and 4 th days. Total dose of morphine sulfate needed, its complications, and the BPS scores at the end of every 6 h interval were compared. Results: Totally forty patients were enrolled. The mean pain scores were significantly lower in the 2 nd and 4 th days (4.33 and 3.66, respectively; mean: 4.0) in which the patients had received just morphine sulfate compared to the 1 st and 3 rd days (7.36 and 3.93, respectively; mean: 5.65) in which the patients had received acetaminophen in addition to morphine sulfate too (P &lt; 0.001). Cumulative dose of morphine sulfate used, was significantly higher in the 1 st and 3 rd days (8.92 and 3.15 mg, respectively; 12.07 mg in total) compared to the 2 nd and 4 th days (6.47 mg and 3.22 mg, respectively; 9.7 mg in total) (P = 0.035). Conclusion: In our study, IV acetaminophen had no effect on decreasing the BPSs and need of morphine sulfate in intubated patients admitted to ICU. © 2016 Indian Journal of Critical Care Medicine