Rotator cuff repair with or without proximal end detachment for long head of the biceps tendon tenodesis

Background@#Rotator cuff tears cause pathologies of the long head of the biceps tendon (LHBT). One of the surgical treatments for such a tear is LHBT tenodesis to the humerus. This study aims to compare simultaneous rotator cuff repair and LHBT tenodesis with or without detachment of the proximal end of the LHBT (PELHBT) from its site of adhesion to the glenoid. @*Methods@#This retrospective study involved patients affected by LHBT pathology with rotator cuff tear. The patients were divided into two groups, with or without PELHBT detachment from the glenoid. Therapeutic outcomes were investigated by evaluation of patient satisfaction, pain based on visual analog scale, shoulder function based on Constant score and simple shoulder test, and biceps muscle strength based on the manual muscle testing grading system before surgery, at 6 months, and at the final visit after surgery. @*Results@#Groups 1 and 2 comprised 23 and 26 patients, respectively, who showed no significant differences in demographic characteristics (p>0.05). Shoulder function, biceps muscle strength, pain, and satisfaction rate improved over time (p0.05). No post-surgical complication was found in either group. @*Conclusions@#There was no difference in final outcomes of tenodesis with or without detachment of the PELHBT from the supraglenoid tubercle. Such tendon detachment is not necessary.

Role of suprascapular nerve block in idiopathic frozen shoulder treatment: a clinical trial survey

Background@#Several therapeutic methods have been proposed for frozen shoulder syndrome. These include suprascapular nerve block, a simple and cost-effective technique that eliminates the need for nonsteroidal anti-inflammatory drug therapy. @*Methods@#This was a clinical trial that included patients with unilateral shoulder joint stiffness. Patients were divided into three groups: those treated with isolated physiotherapy for 12 weeks (PT group), those treated with a single dose intra-articular injection of corticosteroid together with physiotherapy (IACI group), and those treated with a suprascapular nerve block performed with a single indirect injection of 8-mL lidocaine HCL 1% and 2 mL (80 mg) methylprednisolone acetate together with physiotherapy (SSNB group). The variables assessed were age, sex, side of involvement, dominant limb, presence of diabetes, physical examination findings including erythema, swelling, and muscle wasting; palpation and movement findings; shoulder pain and disability index (SPADI) score; and the visual analog scale (VAS) score pre-intervention and at 2-, 4-, 6-, and 12-week post-intervention. @*Results@#Ninety-seven patients were included in this survey (34 cases in the PT group, 32 cases in the IACI group, and 31 cases in the SSNB group). Mean age was 48.55±11.06 years. Fifty-seven cases were female (58.8%) and 40 were male (41.2%). Sixty-eight patients had a history of diabetes (70.1%). VAS and SPADI scores and range of mototion degrees dramatically improved in all cases (p<0.001). Results were best in the SSNB group (p<0.001), and the IACI group showed better results than the PT group (p<0.001). @*Conclusions@#Suprascapular nerve block is an effective therapy with long-term pain relief and increased mobility of the shoulder joint in patients with adhesive capsulitis.

Assessment of pre-hospital emergency care and its associated factors in traumatic patients in north of iran

Objective: To determine the status of pre-hospital emergency care and its associated factors in traumatic patients

Methods: In across-sectional study, 577 traumatic patients who were transferred to Poursina hospital by EMS [Emergency Medical Services] personnel were selected by simple random sampling method. Pre-hospital emergency services were observed. Then the mean of taken measures scores for each domain was determined in percent and evaluated in terms of associated factors [age, working experience of staff and number of missions per day] and compared using Spearman’s test

Results: Out of 577 patients, 454 were men [78.7%] and 123 women [21.3%]. Their mean age was 35.1 years old. Accident [82.7%] was the most common mechanism of injury. Most vehicles involved in the accident were light-weight cars [48.5%] and motorcycles [32.2%]. A significant relationship was found between age, general domain [p=0.039] and hemodynamic [p=0.019] as well as between work experience and general domain [p=0.018]

Conclusion: Given that pre-hospital emergency services provided in most of the domains are relatively far from world standard, results of this research can provide information for managers to improve strategic planning on care and medical services, appropriation of budget, knowledge of personnel and necessary equipment

Anthropometric, clinical and biochemical comparison of the four polycystic ovarian syndrome phenotypes

Objectives: Polycystic ovarian syndrome [PCOS] phenotypes in different races and ethnicities present with various features. This study aimed to investigate the anthropometric, clinical and biochemical differences according to the four Rotterdam phenotypes of PCOS

Design: A cross-sectional study was conducted

Setting: Two private infertility clinics and a public endocrinology clinic in Rasht, Iran

Subjects: One hundred and sixty one women with PCOS aged between 15 and 41 years from March 2010 to July 2012 were included. Polycystic ovarian syndrome was diagnosed by irregular menstruation [IM], polycystic ovary [PCO] and hyperandrogenism [HA]

Intervention: Demographic data, and fertility features were collected and anthropometric, clinical and biochemical characteristics were measured

Main outcome measures: There were significant differences in mean levels of 17-hydroxyprogesterone [P = 0.010], luteinizing hormone [P = 0.047], and ratio of luteinizing hormone / follicle stimulation hormone [P = 0.017] among the four phenotypes

Results: Most of the subjects were categorized into the IM + PCO + HA phenotype [54%], followed by IM + HA [28%], IM + PCO [13%], and PCO + HA [5%]. Among the four phenotypes, there were no significant differences in terms of demographic characters, fertility features and anthropometric measurements [P > 0.05], but there were significant differences in the prevalence of hirsutism, alopecia and morphology of PCO [P < 0.05]

Conclusion: Phenotypes of PCOS in women from Rasht are similar in most anthropometric, clinical and biochemical features

Metabolic syndrome in patients with Polycystic Ovary Syndrome in Iran

Background: The prevalence of metabolic syndrome [MetS] in polycystic ovary syn-drome [PCOS] has been studied in different populations, but their results were so con-troversial regarding Iranian women. These controversial data indicated the need for more investigation of MetS characteristics in PCOS patients in our population. So this study aimed to evaluate the clinical and laboratory characteristics and metabolic features of patients with PCOS in Rasht

Materials and Methods: This prospective cross sectional study was conducted on 215 PCOS women who lived in Rasht, north of Iran, from March 2010 to July 2012. The participants were then divided into two groups of women with MetS [n=62] and women without MetS [n=153]. The diagnosis of PCOS and MetS were based on the Rotterdam 2003 criteria and the Adult Treatment Panel III [ATP III] criteria, respectively. Demographic characteristics, fertility characteristics, family history and laboratory findings were assessed

Results: The prevalence of MetS in women with PCOS was 28.8%. In PCOS women of both groups, the waist circumference [WC] exceeded 88cm in 72.6%, hypertension [systolic blood pressure [SBP] and/or diastolic blood pressure [DBP] >/= 130/85mm Hg] was prevalent in 9.3%, fasting blood sugar [FBS] level was >/= 110 mg/dl in 6%, triglycerides [Tg] level were >/= 150 mg/dl in 47%, and high-density lipoprotein [HDL] level was <50 mg/dl in 86%. The values of WC, SBP, DBP, body mass index [BMI], ovarian size, Tg, cholesterol, FBS, 2-hour blood sugar, aspartate aminotransferase [AST], and alanine aminotransferase [ALT] were significantly greater in PCOS women with MetS than women without MetS. Also HDL and luteinizing hormone [LH] levels in women with MetS were significantly lower than women without MetS

Conclusion: Prevalence of MetS in PCOS women was 28.8%, indicating that this value is higher than other studies conducted on PCOS women in Iran and other studies conducted on general population in Iran. PCOS women are considered as a high-risk population for MetS. The special strategies are required to prevent MetS and its associated complications in PCOS women

Curb the pain of spondylolisthesis; comparing posterolateral fusion with posterior lumbar interbody fusion

Background and Aim: the purpose of this study was to evaluate and compare the pain of patients with spondylolisthesis who had undergone either of the surgery techniques: posterolateral fusion [PLF] or posterior lumbar interbody fusion [PLIF]

Methods and Materials/Patients: in a prospective observational study, 102 surgical candidates with low grade degenerative and isthmic spondylolisthesis were enrolled from 2012 to 2014. The observed patients were into two groups: PLF and PLIF. Assessing of pain has been done by a questionnaire using Visual Analogue Scale [VAS] scores. The questionnaire was completed by all patients before surgery, the day after surgery, after six months and after one year

Results: there were no statistically significant differences in terms of age and sex distribution, type of spondylolisthesis and pre-operation pain between groups [p>0.05]. Comparison of the mean VAS scores of two groups over the whole study period showed a significant statistical difference [p-value<0.05], although comparison of VAS at three points in time showed a mixed result. VAS scores showed no significant differences between two groups before surgery, the day after surgery and one year after surgery [p>0.05], but the difference of mean VAS scores between groups 6 months after surgery was statistically significant [p<0.05]. Analyzing the course of VAS scores over the study period showed a descending pattern for either of the groups [p<0.0001]

Conclusion: both surgical fusion techniques [PLF and PLIF] showed to be effective in treating low grade degenerative and isthmic spondylolisthesis, but PLIF was related to better outcome with respect to pain control

Investigation of surgery characteristics in patents with spondylolisthesis, Rasht, Iran from 2006 to 2011

Background and Aim: spondylolisthesis is a visible deformity in lumbosacral region with vertebral slip and fracture or other deformities of pars interarticularis. This study aims at investigating the characteristics of spondylolisthesis surgery in operated patients

Methods and Materials/Patients: this is a retrospective study which included all the patients who had undergone spondylolisthesis surgery by one same surgeon from 2006 to 2011. Demographic characteristics such as age, gender, and surgery information including type of spondylolisthesis, incision site, laminectomy site, foraminotomy site, fixation site of vertebra and site of vertebral disc evacuation were collected. The data were analyzed using SPSS [Version16]

Results: 52 of 63 enrolled patients were women [82.5%] and 11 men [17.5%] with mean age of 49.6 years. Based on frequency, spondylolisthesis types were 60 degenerative [95.2%], 2 post-surgical [3.2%] and 1 post-traumatic [1.6%], respectively. 58 patients had spondylolisthesis only in one vertebra and 5 patients in two vertebrae. The total number of slipped vertebrae was 68, in which slip was seen in L3, L4 or L5 vertebrae. In 42 patients, laminectomy was performed only in one vertebra, in 19 patients in two vertebrae, in 1 patient in three vertebrae and in 1 patient in five vertebrae. The total number of vertebrae with foraminotomy was 106. The highest frequency of foraminotomy was seen in L5, L4, and S1 vertebrae, respectively. Except in one case, the rest 62 patients underwent fixation surgery in two or three vertebrae

Conclusion: based on the results, the frequency of spondylolisthesis was approximately five times in women compared to men. The most common type was degenerative spondylolisthesis. Type of surgery was fixation with pedicle screw and fusion

role of surgical treatment in traumatic subdural hygroma: a pilot study

Background and Aim: traumatic subdural hygroma is the accumulation of CSF [cerebrospinal fluid] in subdural space following head trauma. The mass effect of hygroma on brain can impinge on consciousness. There are still many ambiguities on indications of hygroma surgery. This is an 11-year follow-up study which involves the patients suffering traumatic subdural hygroma who underwent surgery

Methods and Materials/Patients: in this retrospective study, clinical records of 16 patients who were operated due to traumatic subdural hygroma were studied. The data from existing records in the hospital were collected and analyzed. They were then analyzed by Repeated Measures ANOVA using SPSS [Version 18]. The differences were considered statistically significant at P

Results: in this study, there were 13 men [81.3%] and 3 women [18.7%] [Mean age=62 years old]. In 87.75% of patients, hygroma was diagnosed 6 days after head injury. It wasunilateral in majority of patients [56.3%] and located in fronto-parietal area [81.3%]. The most frequent concomitant injuries were contusions [25%] and subarachnoid hemorrhage [18.8%], respectively. GCS trend on admission and at discharge was significantly different fromthat of hygroma formation [P<0.05]. One-fourth of patients had recurrence of hygroma after surgery. All patients [except one] had good outcome

Conclusion: subdural hygroma is a delayed lesion and surgical treatment improves the level of consciousness [LOC] in afflicted patients

Evaluation of relation between anthropometric indices and vitamin D concentrations in women with polycystic ovarian syndrome

To determine the association between serum 25 - hydroxy vitamin D concentration and anthropometric indices in patients with polycystic ovarian syndrome [PCOS]. This is a descriptive cross - sectional study which was carried out on women with PCOS aged 19-39 years old referred to an infertility clinic of Alzahra Hospital, Rasht, Iran during September2011- March2012. The study was conducted based on the Rotterdam criteria. Exclusion criteria were hyperandrogeniema and thyroid dysfunction. The data were gathered through an interview with focus on demographic characteristics and history of infertility. The height, weight and waist and hip circumferences were measured and BMI had been calculated. Also, blood sample had been checked to indicate the level of hydroxy vitamin D. While all statistical analyses were carried out using software package used for statistical analysis [SPSS] version 16 [SPCC Inc., Chicago, IL, USA]. Over 68% of patients had vitamin D deficiency [Vit D<15]. Level of vitamin D had a significant correlation with waist circumference [p<0.02], height [p<0.001] and waist-to-hip ratio [WHR] [p<0.007]. Based on the anthropometric indices, it seems that we can predict the level of 25-hydroxyvitamin D in women with PCOS

Identifying risk factors for incidence of mental disorders after traumatic brain injury

Organic brain pathology usually may be followed by mental disorders. This research was aimed at constructing a predictive model and investigating the risk factors in the incidence of mental disorders after traumatic brain injury [TBI]. Two hundred and thirty eight patients [195 males and 43 females] were entered the study in a descriptive-longitudinal design by non-probable and consecutive sampling method. They were undergone neurosurgical examinations and psychological evaluations. After a 4-month follow-up, 65.1% of the patients [N=155] referred to a psychiatrist in order to determine the nature of mental disorder following TBI, using a structured clinical interview based on DSM-IV diagnostic criteria. 75.48% [117 cases] of patients had a form of mental disorder secondary to TBI. The Results of binary logistic regression analyses for calculating odds ratio [OR] model with 95% confidence interval [CI] indicating the severity of TBI [OR=3.497, 95% CI=1.259-9.712], presence of subcranial injury [OR=2.834, 95% CI=1.022-7.857] and falling level of general compatibility, as measured by modified version of GHQ-28 [OR=1.072, 95% CI=1.035-1.111] indicated an increasing risk in the incidence of mental disorder. Findings revealed that in the development of post-TBI mental disorders, first there was a close relationship with organic brain pathology [TBI severity and subcranial injury], although the role of effective psychological factors such as level of general compatibility after trauma should not be neglected. Also in order to predict the people at risk of mental disorders after TBI, the proposed predictive model in this study can be used

Pre-hospital emergency medical services: the analysis of EMS ambulances equipment in Rasht city

Prehospital emergency is an important part of the health care system. The prerequisite for providing appropriate services in this sector is existence of the necessary equipment, particularly equipped ambulances that plays an important role in saving the patients' life who need emergency measures. Given the high incidence of traffic accidents and other emergencies, this study was concluded to investigate current status of medical equipment of prehospital EMS ambulances in Rasht and compare with Iranian standards. In this descriptive-analytical and functional study, 13 active ambulances of emergency medical services were studied in Rasht in 2013. Data were collected and studied due to the checklist of standard medical examination card of ambulances type B MOH [Ministry of Health] and the checklist of 4374 of relief vehicles and equipment of Iranian National Standards Organization. Researchers completed the checklists with reference to emergency medical centers in Rasht and observation of medical equipment and ambulances. Data were analyzed by using descriptive and inferential statistics appropriate. Overall, average medical equipment of EMS ambulances in Rasht was 66.5% and 64.8% respectively that had a significant difference with standards [p<0.05] according to standards of MOH and Iran Standard National organization. In addition, the average equipment regarding both standards was as follows: In the medical and diagnosis groups:80% and 82.4%; equipment of respiration/ventilation: 97%; injection/drugs: 73% and 58.4%; equipment of treatment-critical management: 65.3% and 55.7%; nursing care/ bandage 58.3% and 53.8% that have significant differences with Iran defined standards in all cases [p<0.05]. According to the results and both standards, about 84% of ambulances had all equipment related to the airway/ventilation management. According to the results, the best condition of medical equipment of EMS ambulances was related to equipment of airway/ventilation management. There was a significant deficiency in other equipment groups. The deficiencies of medical equipment of ambulances will reduce the efficiency of all the pre-hospital emergency medical services; therefore, it seems essential to reduce deficiencies and to achieve the national standards

[Predictive factors of job satisfaction among nurses in therapeutic-educational centers of Guilan University of Medical Science]

Introduction and Aims: continuous controlling is a useful instrument to facilitate organization progress and development, so that neglect to this crucial matter leads to job burnout and lower quality services. This study was done to explore predictors of job satisfaction among nurses employed in hospitals affiliated to Guilan University of Medical Sciences

Materials and Methods: in this cross-sectional descriptive study, 309 nurses of eight educational centers in Guilan University of Medical Sciences in 2010 were selected by stratified sampling and were investigated by a two part questionnaire including demographic information and Index of Work Satisfaction [IWS]. Data were analyzed using descriptive and inferential statistics tests [Pearson, Chi-square and Multivariate Linear Regression Model] at P<0/05 with SPSS v16

Results: the overall nurses' job satisfaction was found to be at moderate level 163/69. The highest satisfaction score was specified to the element of task requirement followed by autonomy and low level of satisfaction was due to two components including interaction and payment. We considered variables in a multivariate linear regression analysis, the main determinants of total job satisfaction were employment status [P<0/05], family income [P<0/03] and the number of children [P<0/007]

Conclusion: as satisfied employees play a crucial role in organization's success, improving and reinforcing job factors related to nurses' satisfaction in job environment, using a comprehensive program by organization managers and planners seems necessary

[ study of self-efficacy in patients with coronary artery disease and its predictors]

Enhancement of empowerment in patients with coronary artery disease has a major role in the promotion of their health behaviors. Promotion of self-efficacy is a one of the ways for improving this skill, which has a significant impact on improving patients' condition and on preventing complications and readmission. The objective of this study was to determine the predictors of general, exercise, and diet behavior self-efficacies in coronary artery disease patients. In this cross-sectional study, 195 patients with coronary artery disease referred to the Heart Clinic of Educational Treatment Center of Dr Heshmat Hospital in Rasht, were selected through convenient sampling and were surveyed through questionnaires about illness perception, general self-efficacy, exercise self-efficacy and diet behavior self-efficacy. The Chi 2 test was used to examine the relations between variables, and the multiple logistic regression test was used to determine the predictors. In this study, 74.9% of samples had desirable general self-efficacy, 86.2% had desirable diet self-efficacy, and 28.2% had desirable exercise self-efficacy. In addition, variables such as age, sex, diagnosis of heart disease, and illness perception were predictors of general self-efficacy. Occupational status and illness perception variables were the predictors of exercise self-efficacy; and the predictor of diet self-efficacy was illness perception. Considering the results of this research, it seems that more precise plannings are needed for the promotion of exercise self-efficacy in coronary artery disease patients

[Evaluation of carbamazepine and oxcarbazepine on tinnitus]

Due to multiplicity of tinnitus etiologies and the lack of accurate knowledge about its exact mechanism, it is still a challenge to find an effective treatment. The objective of this study was an evaluation of carbamazepine and oxcarbazepine effect on tinnitus in patients' reffered to Amiralmomenin Hospital Rasht-Iran. In a randomized double-blind clinical trial, a total of 57 patients [23 to 71 years old] with chronic nonpulsatile tinnitus were treated in three separate groups with carbamazepine [300-600mg], oxcarbazepine [450-900 mg] and placebo for 12 weeks. In the early stages of the study, physical examination and nessecary laboratory tests, audiometry tests, complementation of Visual Analogue Scale [VAS] and Tinnitus Severity Index [TSI] were performed. At the end of 8[th] and 12[th] weeks, VAS and TSI questionnaire were completed again. Among 51 patients [28 male, 23 female] who completed the trial course, according to VAS, carbamazepine, oxcarbazepine and placebo decreased severity of tinnitus in 56.6%, 46.2% and 38.5% of cases respectively. Decrement in tinnitus severity on the basis of TSI in the three mentioned groups were 61.1%, 58.8% and 50% respectively. Carbamazepine and oxcarbazepine were not more effective than placebo in subsiding tinnitus on the basis of VAS and TSI. Carbamazepine and its analouge, oxcarbazepine are effective in decreasing tinnitus severity, but they are not significantly more effective than placebo

[Comparison of sexual function between nulliparous with multiparous pregnant women]

Pregnancy can conflict with sexual function that can be affected by physical and psychological changes during pregnancy. The aim of this study was to compare sexual functions between nulliparous and multiparous pregnant women referred to health centers in Eastern district of Guilan. This cross-sectional study was carried out in Guilan during 2009-2010. We used convenient sampling method to select 554 pregnant women. Data were gathered using a questionnaire including demographic characteristics, sexual function and fear of harm to fetus. The SPSS-16 was used to analyze the data by the Mann-Whitney U and Generalized linear models. The level of significance was set at 5%. There was no significant difference between nulliparous and multiparous pregnant women regarding sexual function in the first and second trimesters of pregnancy [P=0.353, P=0.251]. There were significant differences between nulliparous and multiparous pregnant women regarding sexual desire [P=0.002], arousal [P=0.01], orgasm [P=0.01], pain [P=0.02] and sexual function total score [P=0.016]. There was significant difference between nulliparous and multiparous pregnant women regarding sexual function [P=0.008]. Sexual counseling and rehabilitation programs should be compiled as part of the comprehensive care of prenatal care especially for multiparous pregnant women

Otoacoustic emissions in sudden sensorineural hearing loss: changes of measures with treatment

To identify changes in OAEs parameters in treatment course of idiopathic sudden sensorineural hearing loss [iSSNHL]. In aprospective study from August 2005 to January 2009, 26 patients with iSSNHL underwent conventional audiometry/tympanometry and two types of OAEs [TEOAEs and DPOAEs] before and after the completion of standard drug therapy. The changes in pre- and posttreatment parameters were compared with each other and with normal-contralateral ears. In TEOAEs, the mean overall correlation [reproducibility] and the mean overall strength in involved ears were 10.96 +/- 23.36 and 0.99 +/- 3.45 dB, respectively, before the treatment, which reached 22.88 +/- 36.55 and 1.85 +/- 5.3, respectively, after the treatment [P>0.05]. Significant difference between "correlation score" [average of correlations at 3-4 involved frequencies] before and after treatment was found: 6.52 +/- 18.19 vs. 21.67 +/- 37.8 [P<0.034]. The difference between pre- and post-treatment overall correlation and correlation score in the "response group" were significant [P<0.031]. In DPOAEs of the involved ears, the mean DP1 level and the DP1 signal-to-noiseratio changes were not significant with the treatment [P>0.05]. Evoked OAEs, especially TEOAEs, are objective, rapid, and sensitive tools in the treatment course of iSSNHL

[ comparison of demographics, psychological and hospital care characteristics in patients with and without mental disorders following traumatic brain injury]

The main question of this study is that why some patients with traumatic brain injury [TBI], suffer mental disorders even after recovery from physical problems, while others with some similar characteristics do not receive the diagnosis of any mental disorders. In this study which was performed from March to February 2010 in the Poursina Medical and Educational Center of Rasht city overall, 238 patients [43 females and 195 males] with TBI in the form of a descriptive-longitudinal study, were chosen by non-random, consecutive sampling. Each patient was evaluated by Glasgow coma scale, Glasgow outcome scale,Wechsler adult intelligence scale-revised [WAIS-R]vocabulary and picture completion subtests, Mini-Mental State Examination and General health questionnaire. After 4 months of follow-up, 65.1% [155 cases] of patients were referred to a psychiatrist to determine the nature of mental disorder due to TBI, using check list for structured clinical interview based on diagnostic and statistical manual for mental disorders-IV [DSM-IV] diagnostic criteria. The results showed that two group of patients [with and without mental disorders] were significantly different in variables such as level of consciousness [P<0.001], duration of loss of consciousness [P<0.003], duration of confined inintensive care unit [P<0.005], length of hospitalization [P<0.013] and levels of General compatibility after the trauma [P<0.0001] 4 months after TBI. Planning effective interventions, inclusion in the neurobehavioral rehabilitation processes following TBI and also monitoring and evaluation of these patients at least four months after trauma can reduce the risk of mental disorders