efficacy of intradermal injection of botulinum toxin in patients with post-herpetic Neuralgia

Several treatments have been suggested in shingles viral infection caused by Varicella zoster virus that may lead to complications such as PHN [Post-herpetic neuralgia]. Intradermal injection of botulinum toxin was shown with few side effects. This study evaluates the efficacy of intradermal injection of botulinum toxin in patients suffering from PHN. Fifteen patients suffering from PHN for more thanl month were enrolled. Data collected were patients' age, sex, and lesion site, the dermatome involved and the duration and severity of pain by visual analog scale [VAS]. Botulinum [15 units /every 10 cm[2] of body involved] was injected intradermally. The patients were followed 2, 14 and 30 days after injection. Of participants, 6 were males and 9 females. The mean age was 60 years and the mean duration of neuralgia was 6.5 months. The mean VAS on day 2 was 6.4, on day 14 was 7.2 and after 30 days was 7.6. The overall pain after injection decreased but was not significant. It seems that intradermal injection of botulinum toxin decreases pain in PHN patients and this de-crease is less prominent by passing time

[False positive results of carpal tunnel syndrome in electro diagnosis tests]

Carpal tunnel syndrome is identified due to compression of median nerve at wrist and develops symptoms such as wrist pain, paresthesia, numbness and the dysfunction of the hands. The gold standard to diagnose, determining prognosis and planning treatment process based on the severity of nerve involvement are electro-diagnosis tests. The purpose of this study was to specify the least and the most false positive results in common electro-diagnosis tests. This descriptive study was conducted at Shiraz University of Medical Sciences in 2009. Twelve different electro-diagnosis tests on fifty-five normal cases [110 available hands], which never had experienced the symptoms of this syndrome, were carried out. The data was statistically analyzed by SPSS software, using T test and Cochran's Q. There were false positive results in many of the performed tests. The most false-positive result was in- difference between median and ulnar motor distal latencies- test with the rate of 15.5% and the lowest false positive result was in- difference between median and ulnar sensory distal latencies of digit 4- test with the rate of 0%. This study revealed that tests which evaluate the differences between median and ulnar or radial nerves sensory distal latency [in the finger 4 and or 1, respectively], had less false positive results, and are more reliable in suspected cases of this syndrome. Also by using several different electro-diagnostic tests, rapid and efficient diagnosis can be achieved

[Central loop versus conventional H-reflex in diabetic neuropathic patients]

Diabetes mellitus is the most prevalent endocrine disease and one of the most common causes of peripheral neuropathy. Neither conventional electrodiagnostic nor imaging studies [even MRI of lumbosacral vertebrae] can precisely differentiate concomitant radiculopathy [e.g. S[1]-root irritation] and diabetic peripheral polyneuropathy. This usually leads to unnecessary surgical interventions and its complications. In this study, S[1]-roots of diabetic neuropathic patients with impaired conventional H-reflexes were evaluated by the central loop of gastrocnemius-soleus H-reflexes. This descriptive study was performed in the clinics of Shiraz medical school in 1387[2008]. Forty two diabetic patients [14 males and 28 females with a mean age of 48.2 years] with unobtainable or abnormal conventional gastrocnemius-soleus H-reflexes and peripheral neuropathy were enrolled. The central loop of H-reflex was performed bilaterally by stimulating S[1]-root with a monopolar needle and recorded in the half way of the line from popliteal crease to the medial malleolus. Collected data were analyzed by McNemar test, using SPSS software. Of 84 limbs with impaired conventional H-reflexes, 82 limbs [97.6%] had the central loop of H-reflexes with latencies less than 8 ms. All the limbs with abnormally prolonged conventional H-reflexes' latencies had the central loop of H-reflexes' latencies in the range of 5.5-7.85 ms. The latency of central loop of H-reflex in this study was 6.34 +/- 0.96 ms with the range of 4.3-7.85 ms. In case the conventional H-reflex is impaired, the central loop of H-reflex in diabetic neuropathic patients offers a valuable approach for investigating S[1]-root. It seems that this approach leads to a better diagnosis of the absence of radiculopathy and a decrease in the rate of unnecessary surgical interventions and its complications in diabetics

Prevalence of staphylococcus aureus and it's toxins in street marketing milk and some milk products

In this study, the bacteriological examination of 130 street marketing milk samples and 251 milk product samples revealed that 47 isolates of Staphylococcus aureus were recovered from 130 milk samples with a percentage of 36% and 31 isolates of S.aureus were recovered from 251 milk product samples with a percentage of 12.4%. The pathogenic activity of the isolated S.aureus from milk and milk products were studied including Heamolytic activity, DNase activity and coagulase activity. The results proved that 70 isolates out of 78 tested isolates were Heamolytic and 72 isolates have DNase activity and 60 isolates have coagulase activity. By using latex slide agglutination Test was used for detection of Protein A in isolated S.aureus from milk samples. The results proved that 46 out of 47 isolates contained protein A. Concerning the ice cream samples 11 out of 13 tested isolates contained protein A. and 16 out of 18 tested isolates from Kariesh cheese contained protein A. The results showed that, out of 78 tested isolates 20 isolates were proved to be enterotoxin A producer, 2 isolates were enterotoxin B producer and 5 isolates were enterotoxin C producer by using ELISA

Changes in ulnar nerve conduction velocity across different angles of elbow flexion

Evaluation of the ulnar nerve at the elbow is one of the most challenging areas in electrodiagnosis. The goal of this study is to determine the changes in motor and sensory nerve conduction velocity [NCV] of the ulnar nerve at the elbow area in different angles of the elbow flexion and also to define the optimum angle at which there is an ideal correlation between the elbow across and below NCVs of the ulnar nerve. Motor and sensory NCVs of the ulnar nerve were studied in 50 able-bodied subjects [100 limbs below and across the elbow segments to determine the effect of 5 different angles of the elbow [0°, 45°, 90°, 110° and 135° of the elbow flexion] on NCV changes of the ulnar nerve. At each angle, the elbow NCVs were compared with below and across segments. At 0° of the elbow flexion, the across elbow NCVs were slower than the below elbow segments and at 45? there was no statistical difference between below and across elbow NCVs. At each subsequent angles of the elbow flexion, there was an increment in motor and sensory NCVs for the across compared to below elbow segment [P<0.05]. This increment rose as the degree of flexion increased. So the most erroneous increment was found at 135° of the elbow flexion. Since elbow flexion at 45° was found to be the position of the least variation in motor and sensory NCVs between the across and below elbow segments, this position of the elbow flexion seems to be the ideal angle during the nerve conduction study of the ulnar nerve at the elbow area. In this position, the upper limit of normal difference between the across and below elbow motor NCVs [mean+2SD] was calculated 8 m/sec

analysis of two months effects of muscle stretching. Immediately following injection of methyl prednisolon in the treatment of trigger points patients

Trigger points have been described as causing pain in clinical practice and are a common source of musculoskeletal pain. Trigger point injection can effectively inactivate the trigger points and provide symptomatic relief. Efficacy of injection in the treatment of trigger points depends strongly on the technique of trigger point injection. This study compares muscle stretching immediately after injection of methyl prednisolon vs. injection without stretching in the treatment of trigger points. Patients with trigger point pain in the gluteal muscles were recruited using strict inclusion and exclusion criteria from Shiraz Medical School Clinic. Subjects under went two office visits and two phone follow-ups. All patients received injection of lidocaine and methyl prednisolon. In group A, injection was without stretching. In group B, stretching of muscle was done immediately after injection. Evaluation measure tools were 0-10 NRS, VAS and BPI. In respect to VAS, there was a significant statistical difference between both groups one month following injection. In respect to NRS, there was a significant statistical difference between both groups 1 month and 2 months after injection. However, there was no significant statistical difference between both groups in all measurement aspect of BPI, except mood. Muscle stretching immediately after injection was more effective up to two months, than without muscle stretching in the symptomatic treatment of gluteal trigger points

[Treatment of knee osteoarthritis with te comell undulate extract: a prospective controlled, double-blind randomized trial]

Lapacho is a herb that use for the treatment in herbal medicine of brezil, America and Europe. The FDA gave Lapacho a clean bill of health in 1981. The medicinal part of the tree is the bark. The active ingredient of lapacho is called lapachol. [3-7%] Te comella undulate is a species of bignoriaceae distributed in south of Iran that contains of 2-7% lapachol. This study compares topical extract of tecomella undulata bark with topical diclofenac in the knee asteorthritis. The clinical trial study was double blind patients with primary knee osteoarthritis were recruited using strict inclusion and exclusion criteria from Shiraz medical school clinics. All patients received topical agent. In group A received alcholic extract of tecomella undulota bark [20%] and in group B received topical diclofenac. [4 times a day for 4 weeks]. Subjects under went 2 office visitis 4 weeks after start of treatment and 2 weeks after finish of treatment. Evaluations measure tools were NRS and WOMAC. We have shown that 4 weeks of treatment with this extract of tecomella undulata bark relieved the symptoms of primary knee osteoarthritis significantly better than the topical diclofenac solution. The percentage improvement in NRS and WOMAC subscale score that we observed with topical extract of tecomella undulata brak therapy [41-48%] were similar to those reported for oral NSAID treatment. te comell undulate extract is a safe and effective approach for knee osteoarthritis with high success rate

[Comparison of ibuprofen with acupuncture in reducing knee osteoarthritis pain]

Osteoarthritis is the most common joint disease of humans. Acupuncture is one of the treatments for Osteoarthritis. This study aimed to compare Ibuprofen with acupuncture in the pain reduction in knee Osteoarthritis. This is a clinical trial which was performed in Shiraz Medical School Clinics in 2007. Forty six patients with chronic pain due to the knee Osteoarthritis were recruited using strict inclusion and exclusion criteria. All the patients were randomly divided into two groups [A and B] who received Ibuprofen [1200 mg/day] or acupuncture [2 sessions per week] for 2 weeks, respectively. Evaluating measuring tools were pain intensity [based on VAS], ROM [based on degree] and morning stiffness of the knee joint. Collected data were analyzed by Chi-Square test, using SPSS software. Pain intensity at baseline, after the course of treatment and 3 weeks after the treatment in group A was 7.29 +/- 0.61, 4.20 +/- 0.93 and 5.20 +/- 1.32 cm, respectively; while these figures for group B were 7.35 +/- 0.82, 3.43 +/- 0.96 and 4.93 +/- 1.32 cm, respectively [p<0.005]. Also knee ROM degree in group A was 21.54 +/- 7.46, 13.08 +/- 5.60 and 15.38 +/- 3.2; and for group B was 20.36 +/- 7.19, 12.40 +/- 5.78 and 10.36 +/- 5.30, respectively [p=0.003]. Knee morning stiffness improved more in group B. Result of this study showed that both modalities significantly reduced the pain in patients with knee osteoarthritis and improved ROM while morning stiffness improved more in group B

[ effect of provocative tests on electrodiagnosls of clinical carpal tunnel syndrome]

Nerve conduction study is the most sensitive test for diagnosis of carpal tunnel syndrome [CTS]. This test is normal in some patients with mild CTS. Median nerve conduction study evaluation after a provocative test [e.g. wrist flexion] maybe helpful for diagnosis of mild CTS. This study aimed to determine the effect of wrist flexion on median nerve conduction in patients suspected to CTS and in healthy subjects. In this case-controlled study, 20 patients [20 hands] with clinical signs of CTS and normal routine electro diagnosis test results and 20 healthy subjects were investigated. Measured parameters included median nerve distal sensory latency [DSL], nerve conduction velocity [NCV], compound nerve action potential [CNAP], distal motor latency [DML] and compound muscle action potential amplitude [CMAP AMP]. The above noted parameters were measured before and after 5 minutes of full wrist flexion. Data were collected by filling out a questionnaire and were analyzed using Paired T-test. Distal Sensory Latency increment and NCV decrement after 5 minutes wrist flexion in the patients group were statistically significant [p<0.05]. The same parameters did not show a significant incremental or decremental change in the control group. Median nerve DSL and NCV measurement after 5 minutes wrist flexion may be helpful in determining more sensitive parameters in the electro diagnosis of CTS

Sympathetic skin response in patients with carpal tunnel syndrome

Median nerve entrapment in the wrist is the most common entrapment neuropathy and is called carpal tunnel syndrome [CTS]. Conventional electrophysiologic studies evaluate only the myelinated fibers. Sympathetic skin response [SSR] is a wellestablished test for evaluation of the unmyelinated sympathetic fibers. This study was designed to evaluate the sympathetic fibers in CTS. Fifty four patients with carpal tunnel syndrome and 78 healthy subjects were enrolled in this study. Conventional electrodiangostic studies and SSR were performed in all the subjects with standard method. Latency of the SSR in healty subjects was 1520.21 +/- 87.25 ms and 1637.11 +/- 281.13ms in patients. Unmyelinated sympathetic fibers are involved in CTS and SSR which may, along with other conventional electrophysiologic tests, help in diagnosis of CTS