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Summary Background Fibromyalgia syndrome (FMS) is characterized by altered pain perception with chronic, widespread musculoskeletal pain. The relationship between nitric oxide, oxidative stress and the severity of FMS has not been studied. This study evaluated NO levels in plasma, LPO products and antioxidants in Red Cell lysate in patients of FMS and correlated it with disease severity. Methods 105 FMS patients who fulfilled 1990 ACR Criteria and 105 age- and sex-matched healthy controls were recruited over two years from 2013 to 2015. Antioxidative enzyme activity was assessed by the estimation of catalase, glutathione peroxidase (GPx) and glutathione reductase (GR) and superoxide dismutase (SOD). Nitric oxide in plasma, MDA marker of lipid peroxidation (LPO) in the lysate was donen for estimating oxidative stress. FIQR was used to assess the severity of fibromyalgia. Results The catalase, superoxide dismutase, glutathione reductase and glutathione peroxidase levels were significantly low in patients than controls (p<0.001). Plasma NO levels and LPO were also significantly high (p<0.05). NO and LPO levels showed a significant positive correlation with FIQR (r: 0.57, 0.8 and p: <0.001) whereas a negative correlation was observed between antioxidants (Cat, GR and GPx, but not SOD) and FIQR. Conclusions Low antioxidants and raised LPO in RBC lysate in patients with FM together with high plasma NO correlated with the severity of FMS.

BACKGROUND: Fibromyalgia syndrome (FMS) is an extra-articular rheumatological disease characterised by widespread chronic musculoskeletal pain. Metal-induced oxidative stress contributes to the severity of FMS. AIMS: First, this study evaluated the association between plasma levels of toxic heavy metals and essential metals with oxidative stress (OS) markers. Second, the OS markers and metal contents were correlated with the disease severity by assessing the Fibromyalgia Impact Questioner Revised (FIQR) and tender points (TP). METHOD: A total of 105 FMS patients and 105 healthy controls of similar age and sex were recruited. OS parameter such as lipid peroxidation (LPO), protein carbonyl group (PCG), nitric oxide (NO) and essential metals such as zinc (Zn), magnesium (Mg), manganese (Mn), copper (Cu) and toxic heavy metals such as aluminium (Al), arsenic (As), lead (Pb) were estimated. RESULTS: Levels of LPO, PCG, NO (p< 0.001) and Cu, Mn, and Al (p< 0.001), were significantly higher, and Mg (p< 0.001) and Zn (p< 0.001) were significantly lower in patients compared to controls. A positive association was observed between OS parameters, FIQR and TP with Cu, Al and Mn. A significant negative association was observed between Zn and Mg with FIQR, TP and OS parameters. CONCLUSION: Heavy metals such as Al induce OS parameters and decrease the levels of essential trace elements such as Mg and Zn, which may be responsible for the severity of FMS.

The aim of this study was to evaluate the psychologic burden in terms of depression, anxiety, and stress among the parents of children with congenital craniofacial deformity, nonsyndromic cleft lip and/or palate (CL/P) with early and late diagnosis and/or treatment. In this study, total 240 patients were enrolled, out of which 72 were parents (either mother/father) of CL/P children, below 10 years (group A: before adolescence), 70 were parents of CL/P children, above 10 years of age (group B: after adolescence), and 98 were parents of children with no CL/P or any other genetic disorder (group C). Depression, anxiety, and stress scale-21 was administered in all groups after obtaining the informed consent. Mean ranks of group B revealed a higher score for all the 3 psychologic domains. The CL/P was further divided into only cleft lip, only cleft palate, and both cleft lip and palate groups. A statistically significant difference was observed in group B for all the psychologic domains. Analysis of variance was applied between the groups and a P-value <0.05 was considered as statistically significant. Analysis revealed severe to extremely severe depressed state of mind and moderate to severe levels of stress in maximum parents (above 20%) of group B. However, approximately 50% parents of group B showed extremely severe anxiety. Therefore, psychologic assessment helps in providing a psychiatric or psychologic counseling and treatment to the parents of CL/P children.

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