Evaluating the rate of post-surgical complications between three surgical methods in management of pulmonary hydatid disease.

INTRODUCTION: Hydatid disease is a zoonotic disease caused by Echinococcus. Surgery remains the gold standard approach of treatment. AIM: This study reports on 10 years of experience on surgical management of 78 cases of pulmonary hydatid disease and compares the rates of post-surgical complications between three approaches. MATERIAL AND METHODS: Three different surgical approaches - the Ugon method, cystectomy and lobectomy - were performed for pulmonary hydatid disease treatment during a 1-year follow-up program. The relationships between patient's age, sex, cyst location and surgical approach and occurrence of post-surgical complications were first assessed. Then post-surgical complications between these three methods were compared. RESULTS: From 78 patients, 51.5% were female and 48.5% were male (whose average age was 36.1). Hydatid cysts were found in the right (43.58%) and left (37.17%) lung while 19.23% of patients had bilateral cysts. Patient's age, sex and cyst location did not have any significant effect on the occurrence of complications. Post-surgical complications were only dependent on the surgical approach. 23% of the patients had post-surgical complications (including air leak, fistula, empyema, seroma and wound infection) and air leak was the most frequent one. CONCLUSIONS: Since complications were only dependent on the surgical method, the rate of post-surgical complications were compared between the three approaches. Cystectomy and lobectomy had similar rates of complications, which were lower than that of the Ugon method. It can be concluded that cystectomy is the method of choice for management of pulmonary hydatid disease, with the lowest rate of complications.

Effect of interbody fusion cage on clinical and radiological outcome of surgery in L4-L5 lumbar degenerative spondylolisthesis.

BACKGROUND: Lumbar degenerative spondylolisthesis (LDS) is a degenerative slippage of a lumbar vertebra relative to the adjacent vertebra below that can be clinically symptomatic. We aim to compare radiological and clinical outcome of surgery in L4-L5 LDS with or without applying the interbody fusion cage. METHODS: We studied 60 patients (mean age, 51.3±13.2 years; follow-up, 53.3±14.6 months) with L4-L5 LDS who had been treated by decompression, pedicle screw and rod instrumentation associated with posterolateral fusion (PLF) without and with transforaminal lumbar interbody fusion (TLIF) in equally divided groups A and B, respectively. Intraoperative parameters were recorded and outcome assessment carried out by visual analog scale (VAS), Oswestry Disability Index questionnaire (ODI), subjective satisfaction, radiologic union, and loss of reduction. We judged the differences by t-test and cross-tab. RESULTS: Using an interbody fusion cage was associated with a significant increase in intraoperative blood loss, operative time, and instrument cost. Improvement in VAS and ODI were significant but comparable. Satisfaction rate was higher in group A (P=0.52). Fusion rate and loss of correction were more favorable in group B but these differences were not significant. CONCLUSIONS: In the surgical treatment of the patients with L4-L5 LDS, interbody fusion cage probably does not significantly improve the radiologic and clinical outcomes and may also be associated with more complication and morbidity.

The Zarit Caregiver Burden Interview Short Form (ZBI-12) in spouses of Veterans with Chronic Spinal Cord Injury, Validity and Reliability of the Persian Version.

BACKGROUND: To test the psychometric properties of the Persian version of Zarit Burden Interview (ZBI-12) in the Iranian population. METHODS: After translating and cultural adaptation of the questionnaire into Persian, 100 caregiver spouses of Iran- Iraq war (1980-88) veterans with chronic spinal cord injury who live in the city of Mashhad, Iran, invited to participate in the study. The Persian version of ZBI-12 accompanied with the Persian SF-36 was completed by the caregivers to test validity of the Persian ZBI-12.A Pearson`s correlation coefficient was calculated for validity testing. In order to assess reliability of the Persian ZBI-12, we administered the ZBI-12 randomly in 48 caregiver spouses again 3 days later. RESULTS: Generally, the internal consistency of the questionnaire was found to be strong (Cronbach's alpha 0.77). Intercorrelation matrix between the different domains of ZBI-12 at test-retest was 0.78. The results revealed that majority of questions the Persian ZBI_12 have a significant correlation to each other. In terms of validity, our results showed that there is significant correlations between some domains of the Persian version the Short Form Health Survey -36 with the Persian Zarit Burden Interview such as Q1 with Role Physical (P=0.03),General Health (P=0.034),Social Functional (0.037), Mental Health (0.023) and Q3 with Physical Function (P=0.001),Viltality (0.002), Socil Function (0.001). CONCLUSIONS: Our findings suggest that the Zarit Burden Interview Persian version is both a valid and reliable instrument for measuring the burden of caregivers of individuals with chronic spinal cord injury.

Is human T-lymphotropic virus type 1 infection associated with hearing loss?

OBJECTIVES/HYPOTHESIS: Human T-lymphotropic virus type 1 (HTLV-1) infection is endemic in the northeast area of Iran. Although various neurological disturbances have been reported in HTLV-1 infection, possible audiovestibular involvement during this infection has not yet been studied. STUDY DESIGN: Case control study. METHODS: Sixty-eight cases in three groups including 24 HTLV-1-infected patients with HTLV-1- associated myelopathy/tropical spastic paraparesis (HAM/TSP) (group 1), 23 HTLV-1-infected cases without clinical presentation (group 2), and 21 normal individuals (group 3) entered our study. A complete history of hearing-related disorders and a profile of audiologic tests, including pure-tone audiometry (PTA) with high frequencies, speech reception threshold (SRT), and auditory brainstem response (ABR) were taken. RESULTS: Subjective audiovestibular complaints of participants showed a significant difference among HAM/TSP patients and the two other groups regarding hearing loss and tinnitus, but not vertigo or aural fullness. Hearing evaluation by SRT and PTA in all frequencies showed a significant difference between HAM/TSP patients (group 1) and the controls (group 3). The difference was also significant between asymptomatic cases (group 2) and the controls only in PTA frequencies above 4 kHz. Auditory brainstem-evoked potential did not show any significant differences among the groups regarding latency of I, III, and V waves and interwave differences. CONCLUSIONS: HTLV-1 infection, particularly in those with a clinical presentation, appears to accompany hearing loss. Based on the results of PTA and ABR tests, this study may suggest a cochlear source of hearing impairment rather than neural problems.

The International Knee Documentation Committee (IKDC) Subjective Short Form: a validity and reliability study.

PURPOSE: The purpose of the present research was to translate the original English version of International Knee Documentation Committee (IKDC) Subjective Short Form to Persian and to assess validity and reliability of it in Iranian patients with ACL injury. METHOD: The Persian version of the IKDC Subjective Short Form was administered to 145 patients including 111 men (76 %) and 34 women (24 %) with the clinical diagnosis of knee ACL tear that were referred to our Knee and Shoulder Center at Mashhad University of Medical Sciences, Mashhad, Iran. The Persian IKDC Subjective Short Form and Persian SF-36 questionnaire were completed by patients in the clinic before beginning any treatment intervention. Patients filled out the Persian IKDC 72 h again before receiving a major treatment; we were then able to use the test-retest method to calculate reliability. RESULTS: The average age of the subjects was 30.9 ± 10.4 years. The calculated ICC with 95 % confidence interval was 0.845. In this study, Cronbach's alpha was 0.845. There were significant correlations between mean total score of the Persian IKDC and all items of the SF36 (P < 0.05) except for MCS (P = 0.055). CONCLUSION: Cronbach's alpha and correlation of IKDC Subjective Short Form and SF-36 demonstrated that the Persian version of IKDC has both strong reliability and validity. The Iranian version of IKDC has favourable validity and reliability and therefore can be used to assess Persian-speaking patients with cruciate ligament injuries. LEVEL OF EVIDENCE: Level II.

A Comparative Serological Study of Toxoplasmosis in Pregnant Women by CLIA and ELISA Methods in Chalus City Iran.

BACKGROUND: Toxoplasmosis is the most common disease in humans and animals (zoonosis) caused by the protozoan parasite Toxoplasma gondii. The disease is usually appeared as asymptomatic in immunocompromised individuals but its most common symptom is lymphadenopathy. Shortly before or during the first trimester of pregnancy, this disease can be transferred to the fetus and cause serious infection in the fetus. In late pregnancy (third trimester), the complications of this infection is very low or unsigned. Due to the absence of non-specific clinical symptoms or slight infection in pregnant women, prenatal diagnosis is often impossible. OBJECTIVES: Since no research compared these two methods, we decided to compare these methods and determine which method works better for diagnosis of toxoplasmosis. PATIENTS AND METHODS: In this study, 50 pregnant women who referred to the Chalus Health Center laboratory were included and the blood samples were tested for presence of IgG and IgM antibodies of Toxoplasma gondii by both ELISA and Chemiluminescence methods. RESULTS: Of the 50 samples tested by the ELISA method, 26 samples (52%) were positive for IgG . No samples were positive for IgM. Of the 50 samples tested by the Chemiluminescence method, 28 samples (56%) were positive for IgG. No samples were positive for IgM. CONCLUSIONS: A significant relationship between the age of the youngest child and the infection rate was seen. No significant correlation between age, number of individuals in the household, number of children, location, type of construction, consumption of greens, the way of greens and meat consumption, drug use, history of stillbirth and infection levels was seen.

Depression, anxiety and quality of life in caregiver spouses of veterans with chronic spinal cord injury.

OBJECTIVE: We were curious about the degree of anxiety and depression and their effect on the quality of life of the caregivers of veterans with spinal cord injury (SCI). METHODS: A convenience sample of 72 out of 120 caregiver spouses of veterans with spinal cord injury participated in our study. The Hospital Anxiety and Depression Scale (HADS) were considered as a measure of depression and anxiety. The World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF) was considered to evaluate the quality of life. To compare the caregivers, we enrolled 74 matched caregiver spouses of patients without spinal cord injury. RESULTS: The average age of the spouses was 44.7±6.5. The average time elapsed from the injury was 26.4±3.1 years. There was a significant difference in all domains of quality of life and depression between the caregivers and the control group, but there was not a significant difference in terms of anxiety. There was a negative correlation between depression and age, level of education and quality of life. CONCLUSION: Mental care support should be implemented for veterans and their spouses in addition to the provided facilities.

Correlation between health-related quality of life in veterans with chronic spinal cord injury and their caregiving spouses.

BACKGROUND: Recently, investigations have indicated that caring of a chronically ill family member strongly influences the health status and the quality of life (QOL) of the caregiving family members. OBJECTIVES: The purpose of this study was to examine the relationship between health-related QOL of veterans with chronic spinal cord injury and their caregiving spouses. PATIENTS AND METHODS: We designed a cross-sectional study including two groups; veterans with chronic spinal cord injury and their caregiving wives who were living in the city of Mashhad, Iran. The patients with spinal cord injury were veterans from the Iran-Iraq war (1980-1988). All the participants filled out the short form 36 (SF-36) health survey questionnaire. A Pearson correlation coefficient was calculated for the scales of the two groups. RESULTS: The mean age and standard deviation of veterans and their spouses were 48.5 ± 5.9 and 44.8 ± 7.2, respectively and their number of children ranged between 0-6. Our data analysis showed that there was a significant difference between the two groups in some domains of the SF-36, including PF, MH, PCS, MCS, BP and GH (P < 0.05), but there was no significant difference in RP, VT, SF and RE between the two groups. CONCLUSIONS: The results indicate that a decrease in health status level of veterans, physically and mentally, can affect the health-related QOL of their caregiving spouses.

Percutaneous vertebroplasty in symptomatic hemangioma versus osteoporotic compression fracture.

BACKGROUND: Percutaneous vertebroplasty (PVP) is more commonly used for osteoporotic compression fractures (OCFs) and osteolytic vertebral body tumors. This study aimed to study the differences between OCFs and vertebral hemangiomas (VHs) treated with PVP. MATERIALS AND METHODS: Between September 2007 and January 2010, we prospectively treated 28 consecutive patients of OCFs (43 recently symptomatic OCFs) and 24 cases of VHs (26 VHs). We used visual analogue scale (VAS) pain and Oswestry Disability Index (ODI) to evaluate the patients. The followup period in group 1 and 2 were 25.1 months (range 12 - 31 months) and 21.3 months (range 14 - 28 months), respectively. Comparison of means was carried out with the Chi Square Tests, t-test, and N Par-Test for multiple comparisons, whenever appropriate. The level of statistical significance was set at P < 0.05. RESULTS: Following PVP the VAS score decreased to 4.57 and 4.17 in group 1 and 2, respectively. The ODI scores were 32.5% and 30%, respectively. This decrease in ODI scores lasted throughout the followup period. CONCLUSIONS: Although the preoperative scores were significantly different between group 1 and 2, there was no significant difference between two groups following the PVP.

Validation and cross-cultural adaptation of the Persian version of Craig Handicap Assessment and Reporting Technique (CHART) short form.

OBJECTIVE: To test the psychometric specifications of the Persian version of the Craig Handicap Assessment and Reporting Technique (CHART) short form in an Iranian population. DESIGN: Cross-sectional study. SUBJECTS: Fifty-two individuals with a mean age of 49.3 years (SD 7.9, minimum 38 years and maximum 80 years), who had chronic spinal cord lesions, were included in this study. Most of them were paraplegic (88.5%) and unemployed (76.9%). METHODS: Reliability (internal consistency) of the measure was examined by applying Cronbach's alpha. In addition, validity (construct) was tested by Pearson's correlation. RESULTS: Overall, the internal consistency of the questionnaire was found to be satisfactory (Cronbach's alpha 0.613). Regarding construct validity, the minimum and maximum significant correlations were among Physical Component Summery and Cognitive Independence (r = 0.267, p < 0.05), Vitality and Social Integration (r = -0.429, p < 0.01) respectively. CONCLUSION: By analyzing data regarding the psychometric specifications of the Persian version of CHART, we can conclude that this version is a valid, reliable and unique measure that can be used for spinal cord-injured individuals. As demonstrated in our preliminary study, it is easy to be filled out and is not confusing. Implications for Rehabilitation The Persian version of the CHART has been successfully validated. It can be used by those working specifically in the field of spinal cord injury and also more generally. It will enable both initial assessment and follow-up for people in Persian-speaking areas of the world.

Quality of life and the related factors in spouses of veterans with chronic spinal cord injury.

BACKGROUND: The quality of life (QOL) of caregivers of individuals with chronic spinal cord injuries may be affected by several factors. Moreover, this issue is yet to be documented fully in the literature. The purpose of this study was to evaluate the health related quality of life of spouses who act as primary caregivers of veterans with chronic spinal cord injuries in Iran. METHODS: The study consisted of 72 wives of 72 veterans who were categorized as spinal cord injured patients based on the American Spinal Injury Association (ASIA) classification. Health related quality of life was assessed by the Short Form (SF-36) Health Survey. Pearson's correlation was carried out to find any correlation between demographic variables with SF-36 dimensions. To find the effect of the factors like age, employment status, duration of care giving, education, presence or absence of knee osteoarthritis, and mechanical back pain on different domains of the SF-36 health survey, Multivariate analysis of variance (MANOVA) was used. RESULTS: The mean age of the participants was 44.7 years. According to the ASIA classification 88.9% and 11.1% of the veterans were paraplegic and tetraplegic respectively. Fifty percent of them had a complete injury (ASIA A) and 85% of the spouses were exclusive care givers. All of the SF-36 scores of the spouses were significantly lower than the normal population. Pearson's correlation demonstrated a negative significant correlation between both age and duration of caring with the PF domain. The number of children had a negative correlation with RE and VT. CONCLUSION: The burden of caregiving can impact the QOL of caregivers and cause health problems. These problems can cause limitations for caregiver spouses and it can lead to a decrease in the quality of given care.

Morphine-induced place preference: involvement of the central amygdala NMDA receptors.

In the present study, the effects of bilateral injections of N-methyl-d-aspartate (NMDA) receptor agonist and/or antagonist into the central amygdala (CeA) on the acquisition and expression of morphine-induced conditioned place preference (CPP) were investigated in male Wistar rats. Animals that received 3 daily subcutaneous (s.c.) injections of morphine (1-9 mg/kg) or saline (1.0 ml/kg) indicated a significant preference for compartment paired with morphine in a dose dependent manner. Intra-CeA administration of the NMDA (0.01, 0.1 or 1 microg/rat) with an ineffective dose of morphine (1 mg/kg, s.c.) elicited a significant CPP. Administration of the non-competitive NMDA receptor antagonist, MK-801 (0.1, 0.3 or 0.5 microg/rat), into the central amygdala dose-dependently inhibited the morphine (6 mg/kg, s.c.)-induced place preference. Furthermore, intra-CeA administration of MK-801 (0.25, 0.5 or 1 microg/rat) reduced the response induced by NMDA (1 microg/rat, intra-CeA) plus morphine (1 mg/kg, s.c.). Neither NMDA nor MK-801 alone produce a significant place preference or place aversion. Moreover, intra-CeA injection of NMDA but not MK-801 before testing significantly increased the expression of morphine (6 mg/kg, s.c.)-induced place preference. NMDA or MK-801 injections into the CeA had no effects on locomotor activity on the testing sessions. These results suggest that the NMDA receptor mechanisms in the central amygdala may be involved in the acquisition and expression of morphine-induced place preference.