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Volume 56, Issue 1 (3-1998)
Between 270 patients complaining of symptoms of vaginitis, bacterial vaginosis was diagnosed in 68 women (%25) based on at least three of four criteria: 1. Homogenous vaginal discharge 2. Positive amine test 3. pH more than 4.5 4. Clue cell in wet smear. The results were compared to 55 normal controls.
Clue cell with more than %20 of epithelial cells was seen in %87 of cases and %5.5 of controls. A pH more than 4.5 showed the greatest sensitivity (%100) and the smallest specificity (%47). The most frequent complaints included increased discharge, bad odor, and sensing bad odor after coitus.
Volume 60, Issue 1 (4-2002)
Low back pain is among the most frequent medical complaints and a major public health problem. 1.7 percent of cases are caused by herniated disc, 20 percent of which require interventional treatment. Percutaneous laser disc decompression (P.L.DD) can be considered as an effective therapeutic alternative in certain cases.
Materials and Methods: To determine the efficacy of this method in Iran in patient's with low back pain due to disc herniation, 40 patients according to medical history, physical examination and MRI findings were selected for this study. Patients who had canal stenosis, marginal, osteophyte, advanced disc dehydration, ruptured posterior ligament and other contraindication were excluded. CT scan was used only for needle navigation. After proper positioning of needle, nucleous pulposus was evapourated with Nd-YAG laser. Total energy was 1200-1600j. The procedure was done out patient and follow up has been done at 1 day, 1 week, 1,3, 6 and 12 months.
Results: There was no serious complication. 80 percent of patients in one-year follow up showed significant clinical improvement.
Conclusion: Our findings suggests that percutaneous laser disc decompression can be considered as an effective alternative method of treatment for disc herniation and patient selection is the critical factor which determines success rate.
Volume 60, Issue 3 (6-2002)
Introduction: As spinal cholinergic receptors exhibit an action against somatic pain, this effect could be potentiated by intrathecal injection of cholinesterase inhibitor-neostigmine. This study was designed to evaluate the role of interathecal neostigmine on local back pain relief after single level lumbar disc surgery.
Methods and Materials: In an interventional-expremental study (Imam Khomeini Hospital, Jun. 2000 to sep. 2001), sixty-six patient with unilateral herniated lumbr disc at one lumber space were randomely allocated into two groups including, control (C) group and Neostigmine (N) group. Both groups underwent fenestration employing same anesthetic techniques. At the end of surgery 2 ml normal saline in groups C and 100 micrograms neostigmine methylsulfate (0.2 ml combined with 1.8 ml normal saline) in group N were injected intrathecally postoperative local back pain was measured with 10 cm chart method using Visual Analogue Scale (VAS) at 1, 4, 8 and 12 hours. Total dosage of morphine, as an analgesic rescue, used during the first 24 hours following surgery and observed complications were recorded.
Results: Mean VAS score postoperatively at 1st and 4th hours were 2.24 (Standard Error Mean, SEM=0.36) and 1.82 (SEM=0.28) in group N and 5.36 (SEM=0.39) and 5.61 (SEM=0.37) in group C respectively. Mean morphine used in the first 24 hours was 0.9 (SEM=0.4) in group N and 4.7 (SEM=0.65) mg in group C. All result were found to be statistically different in the two group (P<0.05). There was no neurologic deficit or CSF leakage in both groups postoperatively. Regarding nausea and vomiting, the difference between two groups C (15 percent) and N (24.2 percent) were not significant statistically.
Conclusion: In this study, we have found that injection of 100 micrograms hyperbaric neostigmine intrathecally is a safe and effective method with minimal complications or side effect for pain relief and curtails postoperative opiate demand.
Volume 64, Issue 9 (9-2006)
Background: Mechanical low back pain (L.B.P) is most common in middle-aged people especially in developing countries and the symptom compromises routine life activities of the patients. Disk herniation is the most frequent cause of LBP. The less costly way for diagnosing the cause of LBP is performing a careful physical examinations. This study aimed to evaluate the sensitivity and specificity of clinical diagnosis of the cause of Discal Sciatic Neuralgia at Construction Labors in comparison to MRI as the gold standard.
Methods: In a descriptive- analytic study 60 middle-aged professional construction workers were evaluated. Their age range was 25-45 years old and all of them had the complaint of mechanical LBP. Medical history was taken and all cases under went a cautious physical examination. The presence of disk herniation between L4-L5 orL5-S1 was recorded according to clinical signs and symptoms. Lumbosacral MRI was performed for all cases and the results were compared to clinical data.
Results: The clinical diagnosis of presence and severity of pathology was confirmed by MRI in all stages of discopathy in L5-S1 and L4-L5 vertebrae (sensitivity= 100%).
Conclusion: This study showed that careful physical examinations will be sufficient for the sciatic neuralgia diagnosis and even the staging of disk herniation can be performed clinically. Requesting MRI as an expensive procedure is not recommended for diagnosis of Discal sciatic neuralgia because of feasibility of the cost effective way of precise physical examination.
Volume 65, Issue 4 (7-2007)
Background: The aim of this survey was to evaluate the prevalence of some perinatal complications in birth weight discordance (BWD) among twin pregnancies.
Methods: In a descriptive analytical cross-sectional study, 490 twin neonates (245 twin pregnancies) born at Mirzakoochakkhan Hospital from 1999 to 2003 were evaluated. Maternal and neonatal data of each delivery were collected for BWD, gestational age, maternal age, parity, infant gender, neonatal death, neonatal septicemia, mode of delivery, hyperbilirubinemia, blood transfusion and duration of hospitalization.
Results: The average age of the mothers was 26±4.78 years, of which 51.8% were nullipara. The average gestational age was 35.02±2.73 weeks, with 15.9% before 32 weeks of gestation. The neonatal death rate was 7.8%, the majority of which involved male neonates and multiparas. The average duration of hospitalization was 6.07±4.45 days, 8.5 days for those twins with BWD≥20%, and longer (9.14 days) for neonates with mothers younger than 20 years old. Septicemia was most frequent (31.3%) in twins with BWD of 30-34%, as was hyperbilirubinemia requiring blood transfusion (25%). Hyperbilirubinemia was more common in neonates with mothers aged less than 20 years and more than 35 years..
Conclusions: BWD in twins is a predictive factor for septicemia and hyperbilirubinemia requiring transfusion. Therefore, healthcare workers and hospital wards dealing with twins with BWD should be especially ready and equipped to provide the additional care needed for these patients.
Volume 73, Issue 10 (1-2016)
Background: Recent studies have indicated the relation of vertebral endplate lesions (Modic changes) to low back pain (LBP). The aim of this study was to investigate the Modic changes in magnetic resonance imaging (MRI) of patients with low back pain, and its correlation with age, sex, type of changes, number of involved segments and location of changes. Additionally, association of degenerative disc changes and disc herniation was assessed.
Methods: In this retrospective study, MRI records of 229 patients with LBP referring to Medical Center of Hazrat-e-Rasoul Hospital, Tehran, Iran, from August to February 2014, were assessed and Modic changes and degenerative and herniated disc changes were recorded.
Results: Based on our observations, a significant association between Modic type and age (P= 0.003) existed in patients with LBP. The highest prevalence in Modic location were observed in anterior part of vertebral endplate (48.8%, P= 0.001). Although, observation of the Modic changes in superior vertebral endplate was higher than inferior parts, but this differences was not statistically significant. The highest prevalence in degenerative disc disease was disc dehydration which was observed in 18.1% of patients (P= 0.04). The relationship between the degenerative changes and Modic type was significant (P= 0.04), while the most prevalent change of disc contour was disc bulging which occurred in 23.7% of patients (P= 0.01). The highest frequency of abnormal disc contour were observed in Modic type 2 which was statistically significant (P= 0.01). Modic surface involvement above 25% was significantly associated with disc herniation (P= 0.04). There was no significant association between Modic height involvement above 25% and disc herniation.
Conclusion: Considering significant association between Modic changes and degenerative and herniated disc changes, reporting of Modic changes is necessary.
Volume 74, Issue 11 (2-2017)
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Intervertebral disks (IVD) acts as shock absorber between each of the vertebrae in the spinal column by keeping the vertebrae separated when the shock caused by the action. They also serve to protect the nerves that run down the middle of the spine and intervertebral disks. The disks are made of fibrocartilaginous material. The outside of the disk is made of a strong material called the annulus fibrosus. Inside this protective covering is a jelly-like substance known as mucoprotein gel. This interior is known as the nucleus pulposus. The nucleus pulposus consists of large vacuolated notochord cells, small chondrocyte-like cells, collagen fibrils, and aggrecan, a proteoglycan that aggregates by binding to hyaluronan. Attached to each aggrecan molecule are glycosaminoglycan (GAG) chains of chondroitin sulfate and keratan sulfate. Intervertebral disks degeneration is frequently associated with low back and neck pain, which accounts as a disability. Despite the known outcomes of the Intervertebral disks degeneration cascade, the treatment of IVD degeneration is limited in that available conservative and surgical treatments do not reverse the pathology or restore the IVD tissue. Regenerative medicine for IVD degeneration, by injection of Intervertebral disks cells, chondrocytes or stem cells, has been extensively studied in the past decade in various animal models of induced IVD degeneration, and has progressed to clinical trials in the treatment of various spinal disease. Despite preliminary results showing positive effects of cell-injection strategies for IVD regeneration, detailed basic research on Intervertebral disks cells and their niche demonstrates that transplanted cells are unable to survive and adapt in the avascular niche of the IVD. For this therapeutic strategy to succeed, the indications for its use and the patients who would benefit need to be better defined. To surmount these obstacles, the solution will be identified only by focused research, both in the laboratory and in the clinic. In present paper, the potential utilization of different adult stem cells for intervertebral disc regeneration has been reported. Bone marrow mesenchymal stem cells, adipose tissue derived stem cells, synovial stem cells and committed IVD cells have been studied for this purpose either in vitro or in vivo. |
Volume 75, Issue 2 (5-2017)
Background: Low back pain is one of the most important causes of disability among people around the world. Although only 2-5% of low back pain disorders resulting from herniation of lumbar intervertebral discs but surgery for lumbar disc herniation is a common procedure. The aim of this study was to determine the relation between some bio-psycho-social variables and treatment outcomes in patients who undergo first time single-level lumbar discectomy.
Methods: This is a prospective observational analytic study comprised 100 patients (age range 18-73 years) underwent single-level lumbar disc surgery. The patients who met our inclusion criteria and were willing to participate in the study were recruited from the neurosurgery ward of Logman and Imam Khomaini hospitals in Tehran, Iran, between October 2015 and March 2016. The patient completed SF-36 quality of life Questionnaires before, one and two months after surgery.
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Results: In comparison to standard values, before the surgery patients had significantly lower baseline SF-36 (36-Item Short Form Survey) Questionnaire value in all 8 domains. The role limitations due to physical health had greatest impact on quality of life. At the eight weeks’ follow-up SF-36 scores showed significant improvement in both physical and mental scales. Age had no significant impact on mental scales of weeks’ Questionnaire but in age less than 30 years there was a positive relation between the patient’s age at surgery and physical aspects of quality of life. Although there was no significant difference in physical aspects of SF-36 Questionnaire between males and females but males had a significantly higher mean mental health score than females after surgery. Smokers had lower value of mental scales of SF-36 Questionnaire than in nonsmokers. Conclusion: The result of this study showed that surgery for lumbar disc herniation had a great impact on both physical and mental scales of SF-36 Questionnaire two months after surgery. Factors such as age, sex, smoking and psychological factors can play the role of predictor for patient’s outcomes after lumbar disc surgery. |
Volume 75, Issue 3 (6-2017)
Background: Cancer is a major life-threatening disease that can evoke deep-rooted fear of death and sense of loss of hope. Even the word, cancer, has powerful connotations of anxiety, pain and suffering. Cancer has a great impact on patients’ lives, so the extent to which physicians should inform them of the diagnosis poses a difficult decision in clinical settings. Therefore, truth telling is one of the most important issues in patients- physicians’ relationship. Besides the ethical aspect, telling or not telling the truth has some legal aspects, therefore, it is important to know the effective factors and understand how to deal with this issue especially for incurable diseases such as cancer. Therefore, the aim of this research was to analyses the effective factors in physician’s truth telling to cancer-patients.
Methods: The samples of this descriptive and analytical study, (survey study) consist of 161 cancer-specialists from Tehran University of Medical Sciences who have been selected by simple random sampling method in 2015 and 2016. The data was obtained by survey approach and the data collected using a questionnaire. In order to evaluate the validity and reliability of the research, expert’s opinion and Cronbach alpha coefficient have been used. The questionnaire included scales designed to measure attitude, intention, subjective norms; perceived behavior control. Statistical package for social science software (SPSS) were used to analyses the data. T-test and ANOVA were used to compare groups.
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Results: Fifty-nine hudred percent male and 41% female physicians took part in this study. The average age of the participants was 43.4±11.27 years. The best person for truth-telling was physician and psychologist. Results showed that there was no significant difference between attitudes of male and female specialist but there was significant difference between oncologist and non-oncologist tendency to tell the truth. Results also showed that there was difference between physician’s behaviors (average 8.87). There was difference between behavior of private and public-private sectors physicians (62.8). Conclusion: Although the results show that there are differences in specialists’ attitude toward truth telling, it is not a good reason for not telling the truth. Although the physicians should consider several factors when telling the truth. |
Volume 76, Issue 7 (10-2018)
Methods: This study was performed by a prospective longitudinal design that lasted from March 2016 to February 2017. Research population were 420 internal patients that were admitted in intensive care units of Imam Reza Hospital in Mashhad, Iran. Data were collected and documented for each patient by demographic questionnaire and APACHE II scoring system daily until discharging time from intensive care units. The patient’s status after discharge from the intensive care unit was used as a criterion for statistical tests.
Results: APACHE II mean score in first day of admission was 18.9±16.20. Risk ratio of patients’ discharging from intensive care unit was 1.034. The patients were placed in four levels of inverse triage according to mortality rate and risk ratio. The scores of four levels were including: 0-10 (first level and green color), 11-16 (second level and yellow color), 27-71 (third level and black color) and 17-26 (fourth level and red color).
Conclusion: The Apache II system can be used as a tool for reverse triage in intensive care units during at the time of crisis, emergencies and disasters. When using this system for reverse triage, patients at the first to third levels can be discharged from intensive care unit. However, patients on the fourth level should not be discharged from intensive care units under any circumstances.
Volume 78, Issue 1 (4-2020)
Methods: The present cross-sectional study examines at hospitalized patients of Amiralmomenin Hospital in Zabol, Iran, to examine the reasons discharge with personal satisfaction in relation to the patient, hospital staff and the housing status of the hospital during the period from April 2017 to March 2018. All clearance patients with personal satisfaction entered the study. Demographic data, insurance status, type of insurance (social security, health services, resettlement, relief, armed forces, maternity, maternity, other supplementary insurance), number of admission days, hospital admission (morning, evening, night), type of illness or cause of referral (multiple trauma, surgery, orthopedics, neurology, neurology), the reason for possible re-admittance within the next two weeks and the main reasons for clearance with personal consent was collected and recorded using a pre-designed checklist.
Results: The most of the cases of which were due to neurological complaints (51%). 803 (80%) of patients referred back to the hospital due to self-correlated problems, 163 (16%) patients were hospital left with satisfaction due to the hospital-made staffing problem (P=0.001). The results of the study showed that the highest frequency was related to male (67%) and most of them were married (84%), while most of them had insurance (74%), especially army and municipality insurance (34%).
Conclusion: Based on the results of the present study, most cases of discharge were patient related. Adequate recovery feeling and the desire to continue treatment in private centers were the main causes.
Volume 79, Issue 4 (7-2021)
Methods: This study aims to determine the genetic variant of alpha1 type11 collagen is associated with the progress of intervertebral disc degeneration. All patients were selected from the AL-Zahra Hospital of medical university of Isfahan, Iran, between April 2016 and September 2017. SNP rs1676486 of alpha1 type11 collagen was genotyped in 100 patients and 100 healthy controls. The inclusion criteria for patients were: individuals who had typical clinical and imaging symptoms and signs of intervertebral disc degeneration. Exclusion criteria were: patients with trauma, metabolic and neuromuscular diseases, and congenital disorder of the spine. The Genomic DNA was extracted from peripheral blood samples by a Whole Blood Genomic DNA Extraction Kit. The chi-square test and fisher’s exact test were evaluated to determine differences of genotype and allele distributions between intervertebral disc degeneration patients and healthy controls. To compare the relationship between genotypes and clinical features the Mann-Whitney U test was used.
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Results: The mean age was 39.54±9.52 years for the patients and 28.14±5.32 years for the controls, respectively. The mean BMI were 26.3±3.18 kg/m2 and 27.3±3.52 kg/m2 for the patients and the controls, respectively. In addition, the results showed that the prevalence of surgical disc in patients with L4-L5 levels was 52.1% and L5-S1, with 31.1%. This study showed, rs1676486 in alpha1 type11 collagen gene was associated with modified intervertebral disc degeneration at age ≤50 years and this gene increases intervertebral disc degeneration risk at age >50 years. SNP rs1676486 had the significant association with the intervertebral disc degeneration (P=0.019), and patients were found to have higher frequency of AA than the controls.
Conclusion: This observation shows that type XI collagen is related to age and genetic factor in intervertebral disc degeneration disease. |
Volume 79, Issue 5 (8-2021)
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Methods: This study was a double-blind clinical trial that was performed on patients with moderate to severe lumbar disc pain (VAS score or Visual analog scale more than 4) in August 2019 at Shohada Tajrish hospital. Patients in the Ibuprofen-Apotel group (group A) recieved intravenous Ibuprofen (800 mg) in 100 cc Normal saline in the first 30 minutes of Recovery, then 400 mg in 100 cc Normal saline every 6 hours (48 hours after surgery), plus 30 mg Apotel for each kilogram in100 cc Normal saline in 15 minutes every 8 hours. In group B, Morphine has injected with 70 µg/kg bolus and then 20µg/kg/h infused with a PCA pump with a Maximum Rate of 1mg/hr. Then 60 minutes after surgery, patients' pain was measured using an analog scale.
The primary outcome was defined as a reduction in pain intensity of 3 or more VAS units (which was considered as therapeutic success) and the incidence of side effects was considered as secondary outcomes.
Results: Based on the results of this study, the mean age of the subjects was 33.28±12.48 years. Also, the mean age in the group of Ibuprofen-Apotel and Morphine alone were 35.4±13.6 and 31.16±11.75 years. So, there is not a significant difference between the groups. 77.14% of the subjects (54 people) were male and 22.86% (16 people) were women. In comparing the frequency distribution of individuals in terms of gender and the method of creating analgesia, no significant difference was observed between the groups studied.
According to the results, after the intervention, the highest pain intensity in both groups was significantly decreased. However, no significant difference was observed between the two groups.
Conclusion: The study indicated that Ibuprofen can be effective in controlling postoperative pain.
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