Tehran University Medical Journal

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Failed back surgery syndrome (FBSS) is many a times an intractable problem confronted in patients with surgical disease of lumbar spine and at the same time is a pressing problem for the physicians as well. This clinical entity is defined as continuation of pain in the lumbar region and lower extremities following surgery of the lumbar spine. Knowledge of the etiological factors and their prevention is the best line of treatment to overcome the evolution of this syndrome. During this study, which was conducted in Imam Khomeini hospital Tehran from the year 1989 till 1990, 43 out of 114 patients developed "FBSS". 23 cases responded to conservative treatment and psychotherapy whereas medical treatment failed to achieve fruitful results in the rest. The latter underwent extensive radiological investigations and repeat surgery. According to this study, we recommend that in the initial management of these patients. The surgeon should observe the dictum of "5-mis" to overcome and minimize the "FBSS" entity

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Ilio-sacral screw is a technique for posterior pelvic fixation. In spite of its benefits, it had not performed commonly in Iran because of its difficulties. We changed this technique to insert the screw under CT-Scan guide with lical anesthesia to increase image quality and decrease neurological complications and performed it in two patients. In both cases the screws were inserted in correct position without any complication.

 

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Background: Though many therapeutic modalities have been suggested but still no definite treatment for Cutaneous Leishmaniasis is available. Many compounds including Alkaloid, Quinones, Iridoids, Terpenes, Indole analogue have been documented to have antileishmania activity invitro. On the other hand, the aforementioned compounds can be found in the herbs including Thyme, Yarrow. Propolis is a brown color substance that is collected by honey bee from plants. Regarding the lack of data about the possible efficacy of these herbs against leishmaniasis, we have decided to evaluate and compare the efficacy of herbal extract of Thyme, Yarrow, Propolis and systemic glucantime against cutaneous leishmaniasis in Balb/c, and to formulate drugs without harmful chemical material and without side effect.

Methods: During three weeks of inoculation of parasite in base tail of mice, lesions will appear in the inoculation site. The animals divided into seven groups. We used mix alchoholic extract solution two times a day, checked lesions weekly for six week and measured size of lesion in the base of tail with kulis- vernieh.

Results: We observed significant difference between mean of lesion diameter before and after treatment in control, Yarrow and Thyme groups (p<0.05). Paired t test showed no significant difference between mean of lesion diameter after treatment between treatment and glucantime groups (p>0.05).

Conclusion: Alchoholic extract to Thyme and Yarrow have good effect on lesions treatment, we suggest repeat of this study with Thyme and Yarrow extract in gel or cream base in first stage of lesions appearance.

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Background: Psoriasis is a T-cell mediated chronic inflammatory disorder with multiple skin, nails and joints involvement. The reported prevalence of psoriatic arthritis varies from 5 to 42 cases per 100 psoriasis patients. Insulin resistance is believed to be central to the pathogenesis of metabolic syndrome, a constellation of major risk factors for cardiovascular diseases, including atherogenic dyslipidemia, truncal adiposity, hypertension and hyperglycemia. The association of psoriasis and psoriatic arthritis with metabolic syndrome is increasingly being reported. Although the literature relating psoriatic arthritis to metabolic syndrome is accumulating, there is still a paucity of evidence, especially from Asia. Here, we examined the prevalence of metabolic syndrome and its components in patients with psoriatic arthritis.

Methods: The study was performed among outpatients attending the specialty clinic and rheumatology ward of Rasoul-e-Akram general hospital between January 2014 and April 2015. A consecutive sample of 80 patients diagnosed as having psoriatic arthritis was studied. Age, gender, body mass index, blood pressure and waist circumference, and history of smoking of patients were measured and asked at the enrolment visit. Venous samples were taken after 8 h of overnight fasting for the estimation of serum lipid profile, glucose and uric acid levels. Also an ultrasonographic examination was done for detection of non-alcoholic fatty liver disease. Results: 46 patients (57.5%) were male and 34 patients (42.5%) were female. Mean age of the participants was 43 years (SD: 11.3). The prevalence of abnormal components of metabolic syndrome was 53.8% for BMI, 48.8% for TG level, 50% for HDL, 46.3 for LDL, 45% for Cholesterol, 23.8% for FBS, 46% for waist circumflex in men and 47.7% in women and 42.5 for uric acid. 40% of the patients had abnormal SBP and 41.2% had abnormal DBP. Thirty percent of the participants were current smokers and 43.8 had NAFLD on ultrasonographic examination. Conclusion: 51.3% of patients had metabolic syndrome according to the adult treatment panel III criteria for adult Asian patients.

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Background: Rheumatoid Arthritis (RA) is a chronic inflammatory disease presenting with inflammation, tenderness and destruction of the synovial joints, resulting in severe disability and early death due to complication of disease. Previous diagnostic criteria are not useful for identifying patients who need early treatment. Thus, new diagnostic criteria for faster diagnosis of disease are introduced in 2010. The aim of this study was to compared 1987 ACR (American College of Rheumatology) criteria and 2010 ACR/EULAR (European League Against Rheumatism) classification criteria for diagnosis of rheumatoid arthritis.

Methods: In this Cohort prospective study, patients with early arthritis were evaluated   according to the old and new diagnostic criteria and followed-up every two monthly for one year (2012-2013) in Hazrat-e Rasool University Hospital, Tehran. Inclusion criteria of this study were age more than 18 year and indefinite diagnosis of arthritis. For all of patients physical examination by expert rheumatologist was done and lab data include erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-cyclic citrullinated peptide (Anti-CCP) and rheumatoid factor was requested. The sensitivity, specificity, positive and negative predictive values were then determined for each diagnostic criteria. Results: In this study 104 patients including 28 males (26.9%) and 76 females (73.1%) with the mean age of 44.2±13.7 years were included. At the end of one year follow-up, 82 were diagnosed to have RA while other 22 patients were not categorized as RA. Sensitivity for ESR, CRP, Anti-CCP and rheumatoid factor in 2010 ACR/EULAR criteria was 52%, 19%, 48%, 28% and specificity for them was 45%, 71%, 27%, 79% respectively. Number of small and large joint arthritis were more in patients with Rheumatoid Arthritis (RA) rather than other arthritis (P=0.0001). Sensitivity and specificity for small joints involvement was 87% and 54% and for large joints involvement was 81% and 59%. The sensitivity, specificity, positive and negative predictive values for 2010 ACR/EULAR criteria were 65%, 40%, 81%, and 23%, respectively. The sensitivity, specificity, positive and negative predictive values for 1987 ACR criteria were 51%, 62%, 83%, and 25% respectively. Conclusion: In comparison to the old diagnostic criteria, the new one has higher sensitivity and lower specificity.

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