Is Level of injury a determinant of quality of life among individuals with spinal cord injury? a tertiary rehabilitation center report

Objectives: The role of injury-related variables in determining health-related quality of life [HRQOL] among Iranian persons with spinal cord injury [SCI] has not yet been fully described. In this study, we compared HRQOL between individuals with injury at cervical level and those with injury at thoracolumbar sections and evaluated the discriminating value of injury level as a determinant of HRQOL among Iranian people with SCI

Methods: Individuals with SCI, who were referred to Brain and Spinal Cord Injury Research Center, were invited to participate in this investigation. HRQOL was assessed using the Short Form [SF-36] questionnaire to determine the quality of life [QOL] in eight domains: physical functioning [PF], role limitation due to physical problems [RP], bodily pain [BP], general health [GH], vitality [VT], social functioning [SF], role limitation due to emotional problems [RE], and mental health [MH]

Results: Ninety patients with paraplegia and 94 quadriplegic patients participated in this investigation. The mean score of PF domain was significantly lower in patients with injury at cervical level [p < 0.0001]. There was no significant difference in other domains of SF-36 between subjects with paraplegia and quadriplegia [p = 0.670, 0.700, 0.910, 0.710, 0.730, 0.290 and 0.850 for RP, RE, VT, MH, SF, BP and GH, respectively]. Similarly, the mean physical component summary [PCS] score was significantly higher among individuals with injury at thoracolumbar sections [p < 0.0001]. The mean mental component summary [MCS] score did not differ between the two groups [p = 0.720]

Conclusions: Patients with SCI at the cervical level have similar mental health compared to those with injury at thoracolumbar sections, which shows proper mental adaptability in quadriplegic individuals. Injury level can be used as a major determinant of the physical component of QOL among people with SCI

Pregnancy complications and neonatal outcomes in multiple pregnancies: a comparison between assisted reproductive techniques and spontaneous conception

This study compared neonatal outcome and maternal complications in multiple pregnancies after assisted reproductive technologies [ART] to spontaneous pregnancies. In this cross-sectional study, we reviewed medical records of 190 multiple pregnancies and births conceived by ART or spontaneous conceptions between 2004 and 2009 in Women Hospital. Obstetric history and outcomes were recorded and compared between these two groups. SPSS version 13 was used for data analysis. The results were analyzed using student's t test, chi square and logistic regression [p<0.05]. There were 106 deliveries from spontaneous conceptions and 84 that resulted from ART. Parity history and mode of delivery significantly differed between the two groups [p<0.001]. The ART group had significantly higher preterm labor and premature rupture of membranes [PROM] whereas pregnanc-induced hypertension [PIH] was higher in the spontaneous group [p=0.01]. Newborn intensive care unit [NICU] admission, duration of hospitalization, still birth and low gestational age were significantly higher in the ART group while neonatal jaundice was higher in the spontaneous group. Logistic regression analysis by considering neonatal complications as the dependent variable showed that respiratory distress syndrome [RDS], NICU admission and Apgar score were independent predictors for neonatal complications. Obstetric and neonatal outcomes must be considered in multiple pregnancies conceived by ART

Sexual function in women with multiple sclerosis

Multiple sclerosis [MS] is an inflammatory disease of central nervous system [CNS] and sexual dysfunction [SD] is one of the most common disabilities of MS women. The aim of this study was to determine sexual function of women with MS [multiple sclerosis]. One hundred definite MS patients MS patients and fifty age-matched healthy controls were enrolled. Demographic data [sex, age], duration of the disease and disease pattern extracted from patient's files and Kurtzke Expanded Disability Status Scale [EDSS] recorded for each patient by an expert neurologist. Participants were asked to answer the valid and reliable Persian version of Beck depression inventory [BDI] and Female Sexual Function Index [FSFI] questionnaires. The total FSFI score and subscale scores differed significantly between the MS patients and the controls. There was a significant negative correlation between EDSS and FSFI scores [rho=-0.44, P<0.001] and significant positive correlation between EDSS and BDI [rho=0.36,P<0.001] in patients. Mean BDI and all subscales of FSFI differed significantly between patients with total FSFI score higher and lower than 26.55. Sexual dysfunction should be considered in women with multiple sclerosis

Emotional intelligence [EI] of patients with multiple sclerosis [MS]

Multiple sclerosis [MS] is an autoimmune disease that affects physical and emotional aspects of patient's lives. The aim of this study was to evaluate Emotional Intelligence [EI] in cases with MS. One hundred sixty six clinically definite MS and 110 healthy subjects were enrolled in this study. All participants filled valid and reliable Persian version Emotional Quotient inventory [EQ-i] questionnaire, which had been developed due to Bar-On model. Mean EI total score and 12 out of 15 subscales were significantly different between patients and controls. Total EI score and most of its subscales were significantly higher in patients with RR [Relapsing Remitting] than Secondary Progressive [SP] ones. There was significant negative correlation between EDSS and total EI score [rho=-0.4, P<0.001]. Multiple linear regression analysis between the EI as a dependent variable and sex, type of disease, level of education, age and marital status as independent variables in patients showed that type of disease and level of education were independent predictors of EI. Emotional intelligence as the ability to behave better and communicate with others should be considered in MS cases as their physical and psychological health are affected by their illness

Sono-elastography for differentiating benign and malignant cervical lymph nodes: a systematic review and meta-analysis

We did this systematic review to determine diagnostic accuracy of sono-elastography in evaluating cervical lymph nodes [LNs]. A highly sensitive search for sono-elastography and LNs was performed in MEDLINE, Cochrane Library, ACP Journal Club, EMBASE, Health Technology assessment, and ISI web of knowledge for studies published prior to December 2012. SPSS version 18 [SPSS Inc., Chicago, IL, USA] used for descriptive analysis and meta-disk version 1.4 applied for meta-analysis. Forest plots for pooled estimates and summery of receiver operating characteristic plots for different cut-offs were produced. The literature and manual search yielded 69 articles, of which 10 were eligible to include. A total of 578 individuals with a total number of 936 cervical LNs was evaluated [502 malignant and 434 benign]. The summary sensitivity of the scoring and strain ratio [SR] measurements for the differentiation of benign and malignant LNs were 0.76 [95% CI: 0.71-0.8] and 0.83 [95% CI: 0.78-0.87]. The summary specificities were 0.8 [95% confidence interval [CI]: 0.75-0.84] and 0.84 [95% CI: 0.79-0.88], respectively. Area under the curve for scoring system was 0.86 [standard error [SE] = 0.03] and 0.95 [SE = 0.02] for SR measurement. Sono-elastograohy has high accuracy in differentiating benign and malignant cervical LNs

Relationship between sleep quality and quality of life in patients with multiple sclerosis

Impaired quality of life [QOL] is an issue considered in patients with multiple sclerosis [MS]. There are limited studies evaluated poor sleep and impaired QOL in these cases. The aim of this study was to evaluate quality of sleep and poor sleep in Iranian patients with MS and the relationship between Pittsburgh Sleep Quality Index [PSQI] score and QOL subscales. One-hundred and fourteen cases with definite MS due to MC Donald criteria enrolled who referred to MS clinic of Sina and Imam Hospitals were enrolled. Patients asked to fill valid and reliable Persian versions of PSQI and MSQOL-54 questionnaires. Demographic data [sex, age], duration of the disease, education level and marital status were extracted from patients medical files. After neurological examination, Kurtzke Expanded Disability Status Scale [EDSS] was assessed. Ninety-one [79.8%] patients were female and 23 [20.2%] were male. Mean age and EDSS was 34.7 +/- 9.6 years and 2.3 [median: 1.5]. Mean PSQI score and overall QOL score were 4.5 and 57. Sixty-seven cases were good sleepers [PSQI 5]. Except five subscales, all others were significantly different between good and poor sleepers. There was significant positive correlation between PSQI score and EDSS [r = 0.24, P < 0.001] and negative correlation between EDSS and physical and mental health [r = -0.48, P < 0.001, r = -0.43, P < 0.001]. EDSS and total PSQI score were independent predictors of physical and mental health composites. Sleep quality as a factor which affecting QOL should be considered and evaluated properly in MS patients

Bipolar disorder in women with polycystic ovarian syndrome [PCO]

This study was designed to determine the prevalence of bipolar disorder in women with polycystic ovarian syndrome [PCO]. One hundred and ten women with definite diagnosis of PCO and one hundred and ten age-matched infertile women due to other reasons except for PCO were enrolled in this case control study. Ten ml fasting venous blood sample obtained to measure fasting glucose, LH and FSH. Height, weight and waist-to-hip ratio [WHR] were also recorded by an expert technician. A psychiatrist examined all 220 cases in order to determine the prevalence of depression and bipolarity. Mean age of each group participants were not significantly different while FBS, LH and LH/FSH levels were significantly higher in PCO patients. Eighty eight case were depressed in PCO group while 96 were depressed in control group [P=0.03]. Bipolar disorder were higher in PCO group in comparison with controls [8 vs. 0, P=0.004]. Psychiatric disorders should be considered in PCO women

Depression, poor sleep, and sexual dysfunction in migraineurs women

Migraine is a chronic disorder affecting women more than men. Sexual dysfunction is one the complaints of women with migraine, which is not regarded as it should be. The goal of this study was to determine sexual dysfunction in women with migraine, and possible effects of depression and sleep quality on their sexual function. One hundred married migraineurs women were enrolled. All participants were asked to fill out valid and reliable Persian versions of Pittsburgh Sleep Questionnaire [PSQI], female sexual function index [FSFI] and beck depression inventory [BDI]. Mean BDI, PSQI, and FSFI scores were 15.1 +/- 9.1, 7.6 +/- 4, and 21.6 +/- 8.8 in all patients, respectively. Sexual dysfunction found in 68% and 79% were poor sleepers. Mean BDI and PSQI scores were significantly higher in women with sexual dysfunction [FSFI < 26.55]. There was significant negative correlation between BDI score and FSFI [r = -0.1, P = 0.001] as well as significant positive correlation between BDI and PSQI [r = 0.42, P < 0.001] Multiple linear regression analysis showed that BDI and age were independent predictors of FSFI score. Physicians should consider sexual dysfunction in women with migraine along with depression and poor sleep in such cases

effects of healthy diet in pregnancy

To evaluate the importance of observing healthy habits by pregnant women that influences different aspects of mother and fetus health, we assessed the change in dietary behavior, and cigarette smoking after distributing the guidelines among 485 prenatal care patients. The subjects were pregnant women who enrolled in health care centers of Tehran University from September, 18, 2010 to July 21, 2012. At first the standard questionnaires including questions about socio demographic factors and also their dietary behavior, and cigarette smoking were filled out. Then we gave them the guideline. After 2 months the participants received the similar questionnaires. The change in their behavior was evaluated comparing the 2 series of questionnaires by SPSS-16 analysis methods. Totally 1.9% of participants met fruit and vegetable guidelines before education and 5.6% after that [3.7% rise] [p < 0.0001]. In studied group 99% met cigarette smoking guidelines before and 100% after education. There was a meaningful association between the amount of fruit and vegetables consumption before and after pregnancy [p < 0.0001]. According to the significant effect of education, we can apply it as an effective way of improving the healthy behaviors in our society. Furthermore, discovering related factors to healthy behavior can lead to addressing the most appropriate [needy, necessitous, deserving] group of population for education

Diagnosis of spontaneous bacterial peritonitis in children by reagent strips

This study was aimed to evaluate the efficacy of dipstick tests [leukocyte esterase and nitrite] in diagnosis of spontaneous bacterial peritonitis [SBP] in cirrhotic patients. Forty six children with ascites hospitalized between 2009 and 2010 in Children Medical Center were enrolled in this study. Reagent strip assays for leukocyte esterase and nitrite were performed on ascetic fluid and the results were compared to manual cell counting and ascitic fluid culture. SBP was defined as having a polymorphonuclear ascites count of >/= 250/mm[3]. Twenty children were female and twenty six were male with mean age of 3 +/- 3.9 years. The sensitivity specificity, positive and negative predictive values of the leukocyte esterase reagent strips were all 100%. The sensitivity, specificity, positive and negative predictive value of the nitrite reagent strip test were 100%, 97%, 90% and 100% respectively. Leukocyte esterase reagent strips may provide a rapid, bedside diagnostic test for the diagnosis of SBP

Emotional intelligence of medical residents of Tehran university of medical sciences

Nowadays, educators pay attention to emotional intelligence which is defined as the ability to monitor and explain one's own and other's emotional experience and feelings to differentiate between them as well as applying necessary information for determining thoughts and actions. The goal of this study was to determine emotional intelligence of medical residents of Tehran University of Medical Sciences. By means of two stage cluster sampling, 98 medical residents of Tehran University of Medical Sciences were selected. Participants were asked to fill valid and reliable Persian version of Emotional Quotient inventory [EQ-i] questionnaire which had been developed due to Bar-On model. Seventy two filled-up questionnaires were returned [RR=73%]. Mean EI score of all participants was 319.94. 32.4. Mean EI score was not significantly different between male and female also, single and married participants. EI did not differ significantly in residents in respect to their discipline. Mean responsibility subscale differ significantly between male and female participants [P=0.008]. Multiple regression analysis showed that happiness subscale is a predictive factor for total EI score [B=-0.32, P=0.009]. Responsibility subscale differed significantly between men and women participants and happiness subscale was a good predictor for emotional intelligence score. These factors should be considered in education of medical residents

Attitude toward plagiarism among Iranian medical faculty members

The goal of this study was to assess attitude towards plagiarism in faculty members of Medical School at Tehran University of Medical Sciences. One hundred and twenty medical faculty members of Tehran University of Medical Sciences were enrolled in this cross-sectional study. They were asked to answer to valid and reliable Persian version of attitude towards plagiarism questionnaire. Attitude toward plagiarism, positive attitude toward self-plagiarism and plagiarism acceptance were assessed. Eighty seven filled-up questionnaires were collected. Mean total number of correct answers was 11.6 +/- 3.1. Mean number of correct answers to questions evaluating self-plagiarism was 1.7 +/- 0.4 and mean number of correct answers to questions evaluating plagiarism acceptance was 1.4 +/- 0.2. There was no significant correlation between plagiarism acceptance and self-plagiarism [r=0.17, P=0.1]. It is essential to provide materials [such as workshops, leaflets and mandatory courses] to make Iranian medical faculty members familiar with medical research ethics issues such as plagiarism

Prevalence of vitamin d deficiency and rickets in children with cholestasis in Iran

This study was aimed to determine prevalence of Vitamin D deficiency and rickets in children with cholestatic liver diseases. Forty eight children with established cholestatic liver disease who referred to gastrointestinal clinic of Children Medical Center [Tehran, Iran] between April 2010 and March 2011 were enrolled in a cross-sectional study. Laboratory analysis including calcium, phosphate, albumin, total and direct bilirubin, aminotransferases, alkalinephosphatase [ALP], prothrombin time [PT], parathyroid hormone [PTH], total protein determined by routine laboratory techniques. Mean age of participants was 299.1 +/- 676.8 days [range 2-3600 days] whereas twenty one were female [43.8%] and 27 [56.3%] were male. Twenty two [45.8%] had evidences of rickets in X-ray evaluation. Three children with rickets and two with normal X-ray had Vitamin D deficiency while ten in rickets group and 16 in normal group had Vitamin D insufficiency. The main underlying diseases were anatomical biliary atresia in cases with rickets and idiopathic in other group. Rickets and Vitamin D deficiency should be considered in chronic cholestatic children.

Associations between skin diseases and quality of life: a comparison of psoriasis, vitiligo, and alopecia areata

The goal of this study was to compare depression and quality of life in three auto immune diseases: psoriasis, vitiligo, and alopecia areata. From January 2009 until January 2010, 300 patients [100 with alopecia areata, 100 with psoriasis and 100 with vitiligo] who were randomly selected [by simple random selection] from outpatient clinic of Razi Hospital [Center of Skin Diseases of Tehran University of Medical Sciences] were asked to answer to Beck Depression Inventory [BDI], SF-36 and Dermatology Life Quality Index [DLQI] questionnaires. DLQI scores were significantly higher in psoriasis cases than others [12.8 +/- 6.1, P<0.0001] and SF-36 score were significantly lower [59.8 +/- 19.5, P=0.007], both indicating poor quality of life. Significant correlation was found between DLQI and BDI in all disease groups [r=0.44, P<0.001]. BDI scores were the highest in psoriasis group but this difference was not significant [P=0.2]. Based on these results, dermatologists should consider psychological aspects of autoimmune skin diseases.

[Learning styles of medical residents of different disciplines in Tehran University of Medical Sciences]

Learning is a complex process that many factors such as learning style has key roles on it. The goal of this study was to determine learning style of different field of medical residents. By random selection, seven medical fields [radiology, internal medicine, surgery, pediatrics, psychology, ophthalmology and emergency medicine] selected. Sixteen residents from each field were chosen. They asked to fill Kolb learning style Inventory. The most common learning style among medical residents was assimilator followed by converger. Considering assimilator and converger learning styles among medical residents is recommended that faculty members should use diagrams, lectures and self-learning methods.

effect of paternal age on preterm births; a survey of 281 cases

To determine the effect of paternal age on preterm births in Iranian neonates. From January 2005 to January 2006, two hundred eighty one preterm neonates born in Mirza Kuchakkhan Hospital enrolled in this cross-sectional study. A structured questionnaire was applied for recording following data: birth weight, sex, gestational age, maternal age and paternal age. The study was limited to neonates whose maternal age was between 20 and 30 years to eliminate its confounding effect. Near 50% of fathers were between 30-39 years old and more than half of neonates had gestational age between 35-37 weeks. There were no relation between either paternal age [p= 0.1] or birth weight [p=0.5] and neonatal gestational age. In women with parity one, there was not significant difference between gestational age among different paternal age levels [p= 0.6] as well as women with parity two and three [p=0.2, p=0.3]. Paternal age has no effect on gestational age and birth

Fatigue, depression and sleep disturbances in Iranian patients with multiple sclerosis

Fatigue is one of the most frequent symptoms in patients with multiple sclerosis [MS] and it is difficult to clarify the nature of this symptom and manage it. This study was aimed to evaluate the frequency of fatigue, depression and sleep disturbances in Iranian patients with MS. 100 patients from the outpatient MS clinic of Sina hospital were asked to complete Beck Depression Inventory [BDI], Pittsburg Sleep Quality Index [PSQI], Sleep Disorder Questionnaire [SDQ], Modified Fatigue Impact Scale [MFIS] and Epworth Sleepiness Scale [ESS] questionnaires. Student's t-test, ANOVA, Spearman correlation and Stepwise multiple linear regressions by SPSS version 15.0 were used for data analysis. From participants, 64 had fatigue complaint during day time and 36 did not feel fatigued. BDI, PSQI, MFIS and SDQ scores were significantly higher in fatigued patients than non-fatigued group but there were no statistically significant differences in ESS, EDSS and duration of disease between fatigued and non-fatigued cases. There were significant correlations between MFIS and BDI scores [r=0.49, P=0.01], MFIS and PSQI scores [r=0.399, P=0.01] and MFIS and ESS [r=0.25, P=0.01]. This study demonstrates that depression is not the only cause of fatigue in patients with MS and it is also associated with sleep disorders, so this complaint should be carefully evaluated and managed in these patients

Quality of life and depression in patients with vitiligo

Vitiligo is a chronic skin disease which is characterized by depigmented patches due to loss of melanocytes. On contrary of low physical impairment, vitiligo causes a lot of cosmetic problems which can lead to psychological problems. The aim of this study was to evaluate the quality of life and depression in Iranian patients with vitiligo, who were referred to Razi Hospital in 2009 and 2010. From January 2009 until January 2010 one hundred vitiligo patients were randomly selected from outpatient clinic of Razi Hospital and asked to answer to the following valid and reliable instruments Beck Depression Inventory [BDI], SF-36 and Dermatology Life Quality Index [DLQI]. The mean age +/- standard deviation of the participants was 28.9 +/- 11.5 years and mean scores of BDI, SF-36 and DLQI of all patients were 15.9 +/- 11.8, 63.8 +/- 19.4 and 8.4 +/- 6.9 respectively. There was a significant relationship between DLQI scores and the duration of the disease [r=0.3, P<0.001] while there was no significant relationship between DLQI scores and age [r-0.1, P-0.2]. Evaluation of quality of life and depression in patients with vitiligo and consequences of the disease on patients' lives should be considered

Hydatid cyst of the knee: a case report

Hydatid disease is a parasitic infection which occurs in specific geographical areas such as the Mediterranean region. We report a case of hydatid cyst of the knee in a 34-year-old man who was admitted with inability to walk and a painful knee. He had a past history of liver infection nine years ago. Laboratory findings were negative. According to the high prevalence of hydatid disease in Iran, it should be considered as a differential diagnosis of Baker's cyst, synovial cyst and lipoma