Effects of Atorvastatin in Patients with Acute Spinal Cord Injury

STUDY DESIGN: Clinical trial study. PURPOSE: The aim of this study was to evaluate the effect of atorvastatin on sensory and motor function in patients with acute spinal cord injury. OVERVIEW OF LITERATURE: The prevalence and incidence of traumatic spinal cord injury are increasing. Statins are well established for use in hypercholesterolemia as well as during anti-inflammatory events. METHODS: This clinical trial study included 60 patients with acute spinal cord injury. These were randomly divided into two groups: the case group which received atorvastatin and also underwent surgical therapy and the control group which only underwent surgical therapy. RESULTS: The severity of spinal cord lesions was evaluated based on the Frankel grade at three periods; this showed no significant difference between the two groups. Comparisons of the levels of pain between the groups based on a Visual Analog Scale system showed no significant difference at the three periods. CONCLUSIONS: We observed no improvement at the 3- and 6-month follow-up in patients who were administered atorvastatin. However, a comparison of the two groups based on pain severity demonstrated a significant difference, suggesting that atorvastatin had a positive effect on patients with spinal cord injury.

Effect of intravenous injection of erythropoietin on hospitalization period in patients with acute spinal cord trauma

Background and Aim: spinal cord injury [SCI] has a very long history, and its cases form a large proportion of patients admitted to trauma centers in Iran. Studies show that repair after spinal cord injury can be done. In fact, many pharmaceutical agents, such as erythropoietin [EPO], are applied to reduce secondary injury following the initial disorder and to maintain the nerve tissue

Methods and Materials/Patients: in this clinical trial, 60 patients with acute spinal cord injury classified as A to C according to Frankel classification grading system were selected and matched with regard to the Frankel classes, the cervical and dorsal levels and then divided into two groups A and B [each containing 30 patients]. Group A, in addition to receive conventional treatment, took EPO and was evaluated in terms of hospitalization period outcomes [mean length of stay, lower extremity thrombosis, intubation, bedsores] and was compared with group B [receiving conventional medicines, such as methylprednisolone]

Results: of the 60 patients, 15 patients were female and 45 were male, with the age range of 19-72 years. The mean length of stay in the case and control group was 10.6+/-6.52 and 13.8+/-10.37 days, respectively. Six patients died during hospitalization, including three patients in the case group and three patients in the control group. 12 patients were intubated during this period, including five patients in the case group and seven patients in the control group. Of the 29 patients with bedsores, 14 patients were in the case group and 15 patients were in the control group. None of the patients had lower extremity venous thrombosis during hospitalization

Conclusion: no significant difference was found between the case and control group in the hospital stay length, intubation, bedsores and lower extremities venous thrombosis

Evaluation of the national health care reform program from the perspective of experts

Background: Health is a national priority and it is always a duty of the government to establish a good and fair health system. The National heath care system reform program and evaluation of health system reform plan funding these programs were enforced by the Honorable Minister of Health and Medical Education on May 5th, 2014. Given the importance of this issue, the present study was conducted to evaluate the implementation of 6 programs of national health system reform plan based on the main indexes of each program

Methods: This is a cross-sectional, applied study conducted from May 8th, 2014 to September 2nd, 2014. The sample of study which were selected through random sampling method included 197 hospitals affiliated to 57 universities of Medical Sciences. A standard checklist designed by experts of Commission of Ministry of Health and Medical Education, including the main indexes which after confirmation of its validity and reliability, was reviewed and monitored by the experts at the Department of Health Monitoring and Accreditation of Ministry of Health and Medical Education through observation and interview

Results: Findings of this study showed that the indicators of current health care reform have been improved related to indexes of the cost paid by hospitalized patients, promotion of natural birth, promotion of inpatient services, residency of doctors, encouraging doctors to remain in deprived areas and improvement of the quality of hoteling. The following objectives were achieved too: 'not providing medication and medical supplies and equipment from outside the hospitals' [88.5%], 'free franchise of natural birth' [90.8%], 'active participation of resident doctors according to the program and suitability of the facilities and conditions of doctors' residence at the hospitals' [60.3%], 'timely payment of doctors' salary according to the regulations and based on monitoring their performance' [81.8%], 'employing approved specialists in accordance with the type of visits and patients' [65.2%] 'operational program, Gantt chart of the program in terms of evaluation and executive measures regarding the building and facilities' [73.3%] had the most desirable condition in comparison with other indexes

Conclusion: The findings of this study showed that health care system reform program has been successful in Iran. Among the objectives of the program, promotion of natural birth has been more successful than other indexes of health care system reform program

Assessment of the role of health system reform plan in franchise reduction for patients referred to university hospitals in Iran

Background: Today health care system is considered as a important organization to achieve equity and improve the performance so it is necessary for policy makers and decision makers improve performance of health care system. This study was performed to evaluate the health care reform program with emphasis to decrease catastrophic payment of patients hospitalized in public hospitals

Methods: This study is a descriptive cross-sectional design which was done from 8 May 2014 to 2 Sept. 2014. A sample of hospitals included 197 hospitals out of 550 hospitals affiliated to 57 universities of medical sciences which were selected randomly and were visited by experts. The main tool of this study was a standard checklist prepared by experts of headquarters of Minstry of Healh and Medical Education [MoHMD]

Results: Out of the entire hospitals studied, 79% were public and 21% were private. The highest mean and standard deviation was related to referral chain [2.71 +/- 0.53] as the most favorable dimension and the least mean and standard deviation was related to two dimensions of education and information of staff personnel [2.37 +/- 0.67] as the most unfavorable dimension. The results of study also indicated that there is statistical, significant correlation between dimension of informing personnel and type of hospitals. The difference in mean of sections scores was significant except for the dimension of investigating health documents at universities

Conclusion: As a result, current health care reform plan will increase responsiveness and accessibility and will finally decrease unnecessary expenses in health market

[Comparison of pharmacologic prophylaxis and mechanical prophylaxis on prevention of deep vein thrombosis in spinal cord injury patients]

Background and Objectives: deep vein thrombosis is one of the most important complications in patients with spinal cord injury. The aim of this study was to compare the effects of mechanical prophylaxis with or without pharmacological prophylaxis on prevention of deep vein thrombosis in patients with spinal cord injury

Materials and Methods: we conduct a double blind clinical trial study with 75 cases. These patients were divided in to three groups which matched by age and sex. In first group, compressive stocking with prophylactic dose of Enoxaparin [40mg daily] was implemented. For second group compressive stocking with prophylactic dose Heparin [5000 u bid SC] was the therapeutic strategy and for the third group only compressive stocking was applied. Collected data was analyzed by statistical methods

Results: the incidence rate of deep vein thrombosis in hospitalization period for the first group:%12, second group:% 4 and third group was%4. No statistical significant differences was detected between the results of these groups. [p=0.424]

Conclusion: based on the results of our study, rate of deep vein thrombosis incidence is lower than the other studies. We didn't see any preferences between pharmacologic prophylaxis and mechanical methods on deep vein thrombosis preventive effects

Effect of low-dose intravenous dexamethasone on post-lumbar discectomy pain: randomized and double blind study

The Pain is the most common complaint in various diseases. Postoperative pain is common complication and spatially in elderly patient because of exacerbation of heard and vessel was impotents. The aim of this study was evaluation of the effect of low-dose IV dexamethasone on postoperative pain in patients with lumbar discectomy. In a clinical trial that studied in neurosurgery wards of Shohada and Imam Reza hospitals affiliated to the Tabriz University of Medical Sciences on patients underwent lumbar discectomy, the effect of low-dose IV dexamethasone on postoperative pain was evaluated. 80 patients divided in 2 equal groups, we used IV morphine [present routine treatment] in group A and IV morphine in addition to 8mg IV dexamethasone in group B, for reducing post lumbar discectomy pain. 21 patients in group A, and 22 in group B were male and 19 patients in group A and and 18 in group B were female [P=0.823]. Mean age of patients in groups A and B was 39.32 and 39.22 years, respectively [P=0.945]. Mean of pain score [VAS] at 6 hours post-operation in group A and B was 6.97 and 6.75, respectively [P=0.065]. VAS at 12, 18 or 24 hours post-operation in both groups didn't differ significantly, too [P>0.05]. We didn't observe any significant reduction in post lumbar discectomy pain after adding 8 mg dexamethasone into morphine. Regarding other studies, it seems that higher doses of dexamethasone should be used to achieve a significant pain reduction

Interaoperative use of epidural methylprednisolone or bupivacaine for postsurgical lumbar discectomy pain relief: a randomized, placebo-controlled trial

Many patients with lumbar disc surgery experience postoperative back and radicular pain, delaying hospital discharge and resumption of normal activity. Some surgeons have used intraoperative epidural corticosteroids and local anesthetics to decrease pain following surgery for a herniated lumbar disc. Controversies still exist regarding the benefits of these drugs. The present study was meant to compare the effects of the intraoperative administration of epidural methylprednisolone and bupivacaine with that of normal saline [placebo] in lumbar disc surgery for postoperative pain control. One hundred fifty patients with single level herniated nucleus pulposus [L4-L5 or L5-S1], which was refractory to 6 weeks of conservative management, were divided randomly in three groups. A standard hemipartial lamimectomy and discectomy was performed on all patients. At the end of the surgery, before the closure of fascia, 40 mg methylprednisolone with 3 mL normal saline for group 1, 2 mL bupivacaine 5% with 2 mL normal saline for group 2 and 4 mL normal saline for group 3 were instilled onto the epidural and exposed nerve root. Postoperative back and radicular pain intensity was assessed by a visual analogue scale [VAS] before and at 24, 48, 72, and 96 hours after surgery. There was no significant difference in back and radicular pain intensity between the three groups. Intraoperative administration of epidural methylprednisolone or bupivacaine does not relieve postoperative back and radicular pain

Solitary plasmacytoma of the cranial vault

Solitary skull vault plasmacytoma is a relatively rare disorder where the ample involvement of bone usually makes the diagnosis easy, but we report a case of a solitary skull vault plasmacytoma presenting acutely masquerading as an extradural hematoma

Giant cell tumor of the frontal bone and the frontal sinus

We describe a 7-year-old girl with Giant Cell Tumor involving the frontal bone and the frontal sinus. She presented with headache and a large swelling at the forehead. On skull x-ray a large nonspecific lytic lesion was seen. Total resection of the tumor and cranioplasty of the skull defect was performed and there was no relapse after 4 - year follow-up