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  • ISSN: 2373-9290
    Volume 3, Issue 1
    Letter to Editor
    Iraj Salehi-Abari*
    Rheumatoid arthritis (RA) is the most common inflammatory arthritis which presents itself as a chronic progressive systemic autoimmune disease with the hallmark of chronic erosive polyarthritis [1]. We introduced a new set of criteria for early diagnosis of RA, called Iran criteria [2]. The main purpose of developing such criteria is to begin RA treatment before irreversible changes in the joints are established. But here, we would like to explain and do define individuals who are not affected by RA currently, but are vulnerable to progress to RA in the future; this condition is called pre-RA state. Hence, based on documented risk factors for RA we designed a scoring system to characterize subjects with the pre-RA state (Table 1). We believe that using this scoring system would result in less aggressive treatments and better outcomes, as well as avoidance of unnecessary administration of potentially toxic medications for those at lower risk of pre-RA state.
    Research Article
    Kevin L Ju*, Rachel M Deering, Dafang Zhang, Mitchel B Harris, Christopher M Bono
    Background: Developing a randomized controlled trial requires a power analysis to calculate the number of patients needed to determine if a difference exists between two groups. While it is generally assumed that simple randomization will result in homogeneous groups, post hoc analysis is performed to compare demographical variables, comorbidities, and other covariables. In many cases, the experimental and control groups have significant differences in key covariables (despite adequate sample size) that can influence outcomes. The purpose of our study was to assess covariate frequency differences between mock randomized study groups comprised of patients seen in one spine clinic over a 12-month period.
    Methods: A retrospective review was performed on all new patients seen in a spine clinic over the course of one calendar year. For each patient, demographical data and variables were recorded. Patients were categorized into 3 groups: 1) all new patients presenting to clinic, 2) new patients who underwent spinal surgery (a subgroup of Group 1), and 3) new patients who underwent lumbar surgery (a subgroup of Group 2). Each group was mock randomized into a control and experimental subgroup. Frequency differences between baseline variables in each subgroup were statistically compared.
    Results: Group 1 showed an insignificant trend towards differences in the prevalence of diabetes (p=0.11), osteoporosis (p=0.12), and years smoked (p=0.09); Group 2 had statistically significant differences in education level (p=0.026) and marital status (p=0.022); Group 3 showed an insignificant trend towards differences in age (p=0.12) and prevalence of osteoarthritis (p=0.07).
    Conclusion: The risk of producing demographically inequitable groups via randomization is low. In the event that a particular covariable is considered critically influential (e.g. diabetes in a study of lumbar fusion), block randomization based on known confounders may be useful to minimize covariate imbalance in addition to enrolling enough patients based on the power analysis.
    Sheikh Irfan Bashir* Shuja Rashid
    Abstract: One of the commonest ailments making patients to consult the Physical Medicine and Rehabilitation Specialist is severe nuchal pain. There are various modalities for the treatment of Nuchal pain worldwide but very few randomised controlled trials have been done to assess the efficacy of particular regimen. One of the most accepted regimens is the Nsaid Thiocolchicoside combination. This randomised study was undertaken to compare the efficacy oforal Aceclofenac Thiocolchiside fixed dose combination against injectable Piroxicamin the treatment of severe acute nuchal pain. A total of 100 patients divided randomly in two groups were included in the study out of which only 94 completed the study.Group A patients received oral Aceclofenac Thiocolchicoside (100mg+4mg) fixed dose combination while group B patients received intramuscular Piroxicam(40mg) daily for seven days.Patients were assessed by Visual Analogue Scale, Shafat’s Range of Motion Index and Shafat’s Nuchal Tenderness Index both before the start of treatment and on seventh day of treatment. There was significant improvement in all scores in both groups but group B showed much better response than group A and the difference was significant. Moreover group A required further continuation of pharmacological therapy while in group B; pharmacological therapy was discontinued after 7th day. Physiotherapy was continued in both groups afterwards. The study favours the use of injectable piroxicam in the treatment of severe acute nuchal pain.
    Iraj Salehi-Abari1*, Shabnam Khazaeli2, Mohammad Khak3, Mohammad-Taghi Khorsandi-Ashtiani5, Mehrdad Hasibi6, Abbas Nourazar7 and Seid-Mahmoud Eshagh-hosseini8
    Background: The most commonly used American-European classification group (AECG) classification criteria for Sjogren’s syndrome and the newly developed American College of Rheumatology (ACR)-Sjogren’s International Collaborative Clinical Alliance (SICCA) classification criteria for Sjogren’s syndrome both lack a good sensitivity for diagnosis. The corresponding author (ISA) present a new set of criteria according to the experience of more than 15 years of clinical practice in rheumatology: Iran Criteria for Sjogren’s syndrome.
    Methods: Iran criteria consist of two domains considering clinical manifestations of the disease and paraclinical findings. A total of 4 out of 10 points with at least one point from the domain of clinical manifestations make the diagnosis. Medical records of 42 patients at the outpatient Rheumatology Clinic of the author were reviewed for the data on new Criteria for Sjogren’s syndrome, AECG and ACR-SICCA classification criteria for Sjogren’s syndrome. Sensitivity of the three classifications was calculated considering the clinical diagnosis by a single rheumatologist as the gold standard.
    Results: 6 male and 36 female patients with a mean follow-up duration of 22.86 ± 35.23 months were included. Mean age at diagnosis and mean disease duration were 47.36 ± 13.33 years and 24.43 ± 29.28 months, respectively. The sensitivity for new Criteria for Sjogren’s syndrome, AECG classification criteria for SS and ACR-SICCA classification criteria for Sjogren’s syndrome were calculated as 100%, 54.8% and 47.6%, respectively.
    Conclusions: Iran-criteria for SS are a highly sensitive instrument for detecting Sjogren’s syndrome compared with AECG criteria and ACR-SICCA criteria.
    Case Report
    Akash A. Shah1*, Francis J. Hornicek1, William T. Curry2 and Joseph H. Schwab1
    A rare neoplasm derived from notochordal remnants, chordoma has a well-characterized tendency to recur following an intralesional resection. Margin-free total en bloc spondylectomy (TES) is the only surgical approach associated with no tumor recurrence at follow-up longer than 5 years. Incidental durotomy is a common complication of TES. We report a novel technique to repair incidental durotomies in two patients who underwent TES for thoracic/thoracolumbar chordoma – a 76-year-old male who presents with an L1 chordoma and a 65-year-old female who presents with acute spinal cord compression from recurrence of a T9-T11 chordoma.
    Both patients underwent high dose pre-operative radiation therapy and TES for resection of their respective tumors. Both patients developed incidental durotomies that were initially repaired by primary suture. As we were concerned with the irradiated dura’s ability to heal and hold sutures, we supplemented primary repair with collagen matrix grafts. For each patient, the graft was passed in front of the thecal sac and wrapped circumferentially around the thecal sac, forming a seal. After repair, the patients recovered without complications.
    Here we describe two patients who presented with chordoma of the thoracic/thoracolumbar spine and have undergone TES for tumor resection. Due to preoperative radiation therapy, this population may have friable dura that are not amenable to repair by primary suture alone in the event of incidental durotomy. We thus augmented our primary repair by passing a collagen matrix graft circumferentially around the thecal sac. These procedures were greatly aided by the maximum accessibility provided by the initial TES procedures.
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