Musculoskeletal Disorders in Patients on Statin Therapy: Prospective and Observational Study at a Tertiary Care Hospital

Introduction: One of the major public health problems is end-stage renal disease (ESRD). ESRD is commonly associated with musculoskeletal disorders (MSDs). Objectives: Due to the importance of MSDs in hemodialysis patients and the absence of sufficient studies in Iran, this study aims to investigate MSDs in hemodialysis patients. Patients and Methods: This cross-sectional study was conducted on 75 patients with ESRD, who were under hemodialysis at the special diseases center of Birjand university of medical sciences, south Khorasan, Iran. Inclusion criteria were history of at least 2 years of hemodialysis, and age more than 18 years. All patients with previous neurological disorders, previous rheumatic diseases, previous arthroplasty of the limbs, and severe psychological disorders were excluded from the study. Baseline characteristics and laboratory data collected. MSDs examined based on the Nordic Musculoskeletal Screening Questionnaire (NMQ). Data were described using central tendency, CHI-SQUARE test, and Fisher’s exact test were used. The significance level in this study was P<0.05. Results: Seventy-five patients participated (Mean and standard deviation (SD) of age: 62.13±1.73 years, male to female ratio: 1.14). Sixty-three patients (84.0%) had MSDs. There was no significant difference based on age, dialysis vintage, gender, laboratory tests, and comorbidities (P>0.05). Dialysis etiology, knee osteoarthritis, shins pain, knee pain and knee range of motion had significantly difference between groups (respectively, P=0.047, P=0.003, P=0.012, P=0.001, P=0.002). Conclusion: The frequency of MSDs in these patients was 84.0%. There was a significant association between MSDs with the cause of hemodialysis, lower limb pain, and knee osteoarthritis.

Exploring patients’ expectations of seeking integrative medical treatment for musculoskeletal disorder: a qualitative study

Musculoskeletal disorders in patients with chronic obstructive pulmonary disease (COPD) were reviewed in the article. Main risk factors of osteoporosis and peripheral musculoskeletal dysfunction in those patients are smoking, low physical activity, chronic systemic inflammation, and treatment with glucocorticoids. Low levels of vitamin D could contribute to development and progression of musculoskeletal disorders in COPD patients. The authors described main diagnostic and differentiation criteria of sarcopenia and cachexia-frailty overlap syndrome. Recently, a new term "osteosarcopenia" is used and can also be applied to COPD patients.

Diabetes mellitus (DM) is associated with musculoskeletal disorders (MSDs) and is often not clinically diagnosed and managed. There are also no systematic reviews of literature relating to the prevalence of MSDs among people with diabetes. To determine the prevalence and areas of the body affected by MSDs in diabetic patients. A literature search of the electronic databases of CINAH, PubMed, Web of Science and Google Scholar using the keywords of "MSDs and DM" as the search term was conducted. Pooled estimates were calculated using a meta-analysis of proportion. Five thousand and eighty-eight studies were identified from the databases; 21 studies fulfilled the inclusion criteria and were included in the review. Five studies were of high quality, 13 were of moderate quality and three were of low quality. The prevalence of all types of MSDs among patients with diabetes was 58.15% (95% CI 41.4%-73.9%). The hand was the most common area of the body affected being 33.05% (95% CI 21.1-46.13) followed by the shoulder. A high prevalence of MSDs was found among diabetic patients with the hand and shoulder being the most frequently reported areas affected. However, future studies with a larger sample and the relevant type of diabetes are required.

Background. Work-related musculoskeletal disorders (MSDs) are a group of painful disorders of muscles, tendons, and nerves, such as neck and shoulder MSD. This study was designed to use miniscalpel-needle (MSN) technique as an intervention for work-related MSDs. Methods. Thirty-one patients with work-related MSDs and 28 healthy subjects were enrolled as controls in this study. The MSD symptoms of each patient were assessed by visual analog scale (VAS) and neck disability index (NDI). Blood samples were collected from control subjects and MSD patients before and after treatment. Serum levels of C-reactive protein (CRP) and tumor necrosis factor (TNF) were measured using ELISA. Results. Prior to MSN treatment, serum levels of CRP and TNF were significantly higher in the MSD patients than the healthy controls. Serum CRP levels correlated with VAS and NDI scores, and serum TNF levels correlated with NDI scores. Compared to pretreatment, VAS and NDI scores were significantly lower in MSD patients after MSN treatment, while serum CRP and TNF levels were significantly lower compared with the healthy control levels. Conclusions. Our results indicate that MSN may be an effective intervention for work-related MSDs and be associated with lower serum levels of inflammatory biomarkers.

BackgroundThere is a paucity of information describing patients with musculoskeletal disorders (MSDs) using complementary and alternative medicines (CAMs) and almost none distinguishing homeopathy from other CAMs. The objective of this study was to describe and compare patients with MSDs who consulted primary care physicians, either certified homeopaths (Ho) or regular prescribers of CAMs in a mixed practice (Mx), to those consulting physicians who strictly practice conventional medicine (CM), with regard to the severity of their MSD expressed as chronicity, co-morbidity and quality of life (QOL).MethodsThe EPI3-LASER study was a nationwide observational survey of a representative sample of general practitioners and their patients in France. The sampling strategy ensured a sufficient number of GPs in each of the three groups to allow comparison of their patients. Patients completed a questionnaire on socio-demographics, lifestyle and QOL using the Short Form 12 (SF-12) questionnaire. Chronicity of MSDs was defined as more than twelve weeks duration of the current episode. Diagnoses and co-morbidities were recorded by the physician.ResultsA total of 825 GPs included 1,692 MSD patients (predominantly back pain and osteoarthritis) were included, 21.6% in the CM group, 32.4% Ho and 45.9% Mx. Patients in the Ho group had more often a chronic MSD (62.1%) than the CM (48.6%) or Mx (50.3%) groups, a result that was statistically significant after controlling for patients' characteristics (Odds ratio = 1.43; 95% confidence interval (CI): 1.07 - 1.89). Patients seen by homeopaths or mixed practice physicians who were not the regular treating physician, had more often a chronic MSD than those seen in conventional medicine (Odds ratios were1.75; 95% CI: 1.22 - 2.50 and 1.48; 95% CI: 1.06 - 2.12, respectively). Otherwise patients in the three groups did not differ for co-morbidities and QOL.ConclusionMSD patients consulting primary care physicians who prescribed homeopathy and CAMs differed from those seen in conventional medicine. Chronic MSD patients represented a greater proportion of the clientele in physicians offering alternatives to conventional medicine. In addition, these physicians treated chronic patients as consulting rather than regular treating physicians, with potentially important impacts upon professional health care practices and organisation.

Concerns have been raised regarding sub-optimal utilization of analgesics and psychotropic drugs in the treatment of patients with chronic musculoskeletal disorders (MSDs) and their associated co-morbidities. The objective of this study was to describe drug prescriptions for the management of spinal and non-spinal MSDs contrasted against a standardized measure of quality of life. A representative population sample of 1,756 MSDs patients [38.5% with spinal disorder (SD) and 61.5% with non-spinal MSDs (NS-MSD)] was drawn from the EPI3-LASER survey of 825 general practitioners (GPs) in France. Physicians recorded their diagnoses and prescriptions on that day. Patients provided information on socio-demographics, lifestyle and quality of life using the Short Form 12 (SF-12) questionnaire. Chronicity of MSDs was defined as more than 12 weeks duration of the current episode. Chronic SD and NS-MSD patients were prescribed less analgesics and non-steroidal anti-inflammatory drugs than their non-chronic counterpart [odds ratios (OR) and 95% confidence intervals (CI), respectively: 0.4, 0.2–0.7 and 0.5, 0.3–0.6]. They also had more anxio-depressive co-morbidities reported by their physicians (SD: 16.1 vs.7.4%; NS-MSD: 21.6 vs. 9.5%) who prescribed more antidepressants and anxiolytics with a difference that was statistically significant only for spinal disorder patients (OR, 95% CI: 2.0, 1.1–3.6). Psychotropic drugs were more often prescribed in patients in the lower quartile of SF-12 mental score and prescriptions of analgesics in the lower quartile of SF-12 physical score (P < 0.001). In conclusion, anxiety and depressive disorders were commonly reported by GPs among chronic MSD patients. Their prescriptions of psychotropic and analgesic drugs were consistent with patients’ self-rated mental and physical health.

IntroductionKinesiophobia has a major health impact on patients with Musculoskeletal disorders (MSDs) in their functional and physical activities, which leads to poor outcomes, loss of motivation, loss of mobility, and decreased quality of life. Despite the burden of kinesiophobia among MSDs, there is limited evidence about the burden of kinesiophobia in Ethiopia. Thus, this study aimed to assess the prevalence and its associated factors of kinesiophobia among MSD patients attending physiotherapy outpatient clinics.MethodAn institutional multi-center cross-sectional study was conducted from February to April 2023 with a sample size of 424. A systematic random sampling technique and face-to-face interviews using a structured questionnaire and chart review were used. The collected data was entered into Epi-data version 4.6.0.6 and analyzed using SPSS version 25. Binary logistic regression analysis was employed to identify the potential candidates for multivariable logistic regression with a p-value less than 0.25. Finally, multivariate logistic regression analysis was employed and variables at p < 0.05 with 95% CI were considered statistically significant contributors to kinesiophobia.ResultThe overall prevalence of kinesiophobia among MSD patients was 48.3% (95% CI, 43.3–53.3). Being overweight and obese BMI value (AOR = 3.98; 95% CI, 2.17–7.29), having moderate pain level (AOR = 3.31; 95% CI, 1.51–7.26), having severe pain level (AOR = 9.29; 95% CI, 3.79–22.77), physical inactivity (AOR = 3.00; 95% CI = 1.84–4.89), anxiety (AOR = 2.57; 95% CI = 1.57–4.19), and depression (AOR = 8.21; 95% CI = 3.47–19.46) were significantly associated with kinesiophobia among musculoskeletal disorder patients.Conclusionkinesiophobia is a public health burden among patients with MSDs. Nearly half of the people with MSDs had reported kinesiophobia. Being overweight and obese BMI value, pain severity level, physical inactivity, anxiety, and depressive symptoms were significantly associated with kinesiophobia. Thus, we suggest screening for kinesiophobia, be physically active, avoiding being overweight and obese, and managing depression, anxiety and pain will help to reduce the occurrence of kinesiophobia.

PurposeWe aimed to determine the sensitivity of computer-aided detection (CAD) applied to digital mammography in asymptomatic and symptomatic breast cancer patients.MethodsWe retrospectively analyzed digital mammography and CAD images from 210 patients diagnosed with breast cancer. The patients were divided into symptomatic and asymptomatic groups. The sensitivity of CAD in both groups was assessed in relation to breast tissue density, histopathological type of breast cancer, and tumor size.ResultsThe detection rate of the CAD system was 87.8% in the asymptomatic group. The sensitivity in different tissue densities was 100% in fatty breasts (P1), 88.9% with scattered fibroglandular densities (P2), 94.4% in heterogeneously dense breasts (P3), and 66.7% in extremely dense breasts (P4). The detection rate of the CAD system in the symptomatic group was 87.2%, and the sensitivity was 90.5%, 90%, 86.6%, and 75% in P1-P4 breasts, respectively. In the asymptomatic group, the CAD system detected 90.3% of invasive ductal carcinomas, not otherwise specified (IDC-NOS) and 88.9% of ductal carcinomas in situ (DCIS), but did not detect other types of malignancy. In the symptomatic group, the CAD system detected 88.2% of IDC-NOS, 88.9% of DCIS and 75% of other types of malignancy. When analyzed according to tumor size, the sensitivity of CAD in the asymptomatic and symptomatic groups was 82.6% and 83.3% for tumors <1 cm, 76.5% and 82.4% for tumors between 1 and 2 cm, and 91.7% and 89% in tumors >2 cm.ConclusionThe sensitivity of CAD was low in P4 breasts and high for tumors larger than 2 cm, with no statistically significant differences between the asymptomatic and symptomatic groups for IDC-NOS and DCIS. CAD showed greater sensitivity for other neoplasms in symptomatic patients.

Cholesterol Regulation and Statin Therapy in Patients with Waldenstrom's Macroglobulinemia.

Study design: Retrospective. Background: Symptomatic bone cement displacement (BCD) is a rare complication following percutaneous kyphoplasty (PKP) interventions for osteoporotic vertebral compression fracture (OVCF). This study aimed to investigate the incidence and the outcomes of symptomatic BCD comprehensively and identify its risk factors. Methods: The clinical data of patients treated with PKP for OVCF between January 2012 and December 2020 were extracted. Patients who developed BCD following PKP during follow-up were divided into the symptomatic and asymptomatic groups. Patients who did not develop BCD were assigned to the control group. Univariate and multiple logistic regression analyses were used to compare the three clinical groups’ features to assess the independent risk factors for the symptomatic and asymptomatic groups. Results: A total of 896 patients were enrolled. Twenty-one patients (2.3%) were identified as having symptomatic BCD following PKP for OVCF, and 35 (3.9%) developed asymptomatic BCD. Compared with the control group, the symptomatic and asymptomatic groups had a higher incidence of anterior leakage, intravertebral vacuum cleft (IVC) signs, and a lower cement distribution score. The symptomatic group had a lower relative cross-sectional area (rCSA) of the paraspinal muscle (PSM), higher PSM fatty degeneration, and higher kyphotic angle (at the last follow-up) than the asymptomatic and control groups. For outcomes, the symptomatic group had a higher VAS/ODI score and a higher incidence of new vertebral fractures compared with the asymptomatic and control groups. Anterior leakage (OR: 1.737, 95% CI: 1.215–3.300), the IVC sign (OR: 3.361, 95% CI: 1.605–13.036), the cement distribution score (OR: 0.476, 95% CI: 0.225–0.904), PSM rCSA (OR: 0.953, 95% CI: 0.917–0.992), and PSM fatty degeneration (OR: 1.061, 95% CI: 1.005–1.119) were identified as independent risk factors for the symptomatic group. Anterior leakage (OR: 1.839, 95% CI: 1.206–2.803), the IVC sign (OR: 2.936, 95% CI: 1.174–9.018), and cement distribution score (OR: 0.632, 95% CI: 0.295–0.858) were independent risk factors for the asymptomatic group. Conclusion: The incidence of symptomatic BCD is 2.3% in patients treated with PKP. Anterior leakage, the IVC sign, and the distribution score were independent risk factors for BCD, and paraspinal muscle degeneration was a specific risk factor for symptomatic BCD. Symptomatic BCD can lead to poor outcomes.

Musculoskeletal (MSK) pain is frequently reported among adolescents and children and is a common reason for consultation in primary care. Our aim is to examine its prevalence in 6-year-old children in a general population and to assess associations with physical and psychosocial factors. Data from the Generation R Study, a population-based cohort, was used. Prevalence and characteristics of MSK pain were assessed with parent-reported questionnaires at 6 years of age (N = 6200). Demographics and data on physical activity, sedentary behaviors, previous reported MSK pain, and behavioral problems were extracted from questionnaires. The body mass index SD score was calculated from objectively measured weight and height. A 3-month prevalence of 10.0% was found for MSK pain in children, of which one-third was chronic, and 44.6% experienced together with pain at other sites. Univariate analyses showed that boys and children with lower socioeconomic status reported MSK pain more frequently compared to other pain and no pain. Although no associations were found between MSK pain and children's body mass index and physical activity level, children with MSK pain were more likely to watch television ≥2 hours/day. Multivariable analysis showed significant associations for MSK pain at 3 years of age (odds ratio 5.10, 95% confidence interval 3.25-7.98) and behavioral problems (odds ratio 2.10, 95% confidence interval 1.19-3.72) with the presence of MSK pain. So, MSK pain is already common in young children and is often chronic or recurrent. Previous reported MSK pain and behavioral problems are independently associated with MSK pain in the studied population.

Relationship between higher intra-amniotic pressures in polyhydramnios and maternal symptoms

To assess the frequency of deep vein thrombosis (DVT) and alternative diagnoses in patients with suspected DVT when evaluated by a rheumatologist. Secondly, to describe the distribution of different diagnoses across three Wells score categories (low, moderate, and high). This is an observational study of patients evaluated at a DVT clinic for suspected DVT, with a rheumatologist-supervised evaluation, performing ultrasound scans on the affected limbs and assessing their results. The obtained diagnoses were noted along with the initial Wells scores performed by the rheumatologist. 649 patients were included. DVT was confirmed in 119/649 (18.3%) cases, with musculoskeletal (MSK) disorders, particularly arthritis and knee-related conditions, being the most common alternative diagnoses (166/649, 25.6%). 288/649 (44.4%) patients did not receive a definitive diagnosis. Higher Wells scores were more common in confirmed DVT cases, while patients with MSK disorders generally had lower Wells scores, likely due to clinical assessments that identified alternative diagnoses early. MSK disorders frequently present with symptoms mimicking DVT, underscoring the value of rheumatologist-led evaluations in suspected DVT cases. Further research is needed to refine diagnostic approaches for patients with DVT-like symptoms, particularly regarding the role of MSK expertise in both physical and ultrasound assessments.

Musculoskeletal Disorders in Referrals for Suspected Cervical Radiculopathy