The effects of balance board on the balance parameters in five children with spastic cerebral palsy.

PURPOSE: This study evaluated the effects of an instrumented balance board on the balance parameters in children with spastic cerebral palsy by carrying out a pilot single-group pre-post clinical trial. METHODS: Five children aged 5 to 15 years with spastic diplegia and a Gross Motor Function Classification System level of I or II were included. All participants attended 20 sessions with an instrumented balance board, 45 minutes per session, 3 times a week for 7 weeks. The main outcome measures included the center of pressure excursion, velocity, and overshoot during quiet standing with open and closed eyes. The assessments were performed in the mediolateral and anteroposterior directions at pre- and one week post-intervention. RESULTS: Non-parametric tests showed that the excursion did not change significantly except in the mediolateral direction with eyes closed (p < 0.05). The velocity of the center of pressure improved in both directions and eye conditions (p < 0.05). Also, the maximum velocity decreased with eyes open (mediolateral, anteroposterior, and total) (p < 0.05), while the change was not significant with the eyes closed. The overshoot measurements did not change significantly. CONCLUSION: It is recommended to consider balance board training for improving balance parameters in children with cerebral palsy.

The diagnostic accuracy of median nerve ultrasonography in elderly patients with carpal tunnel syndrome: sensitivity and specificity assessment.

BACKGROUND: Accurate diagnosis of carpal tunnel syndrome (CTS), the most common entrapment neuropathy, and its differentiation from other diseases are essential, especially in older individuals with advanced symptoms and modified electrophysiological abnormalities. The current study was conducted to evaluate the diagnostic accuracy of ultrasonography (US), regarding sensitivity and specificity in the diagnosis of CTS in elderly patients. METHODS: Individuals with upper limb complaints and reference subjects were recruited from the Rofaydeh Hospital, Tehran, Iran, from June 2013 to October 2014 - (15 months). We evaluate case and control subjects for health status, demographics, clinical characteristics of CTS, median nerve physiology by electrodiagnostic tests, and anatomy by US. Median nerve cross-sectional area (CSA) at precanal, tunnel inlet, midcanal, tunnel outlet, and antecubital levels was measured applying US examination. RESULTS: Of the 723 complaining patients, we assessed 380 patients with CTS symptoms. Electrodiagnostic studies (EDX) confirmed the CTS diagnosis in 203 of these clinically diseased patients. A total of 103 patients (of the 113 reference subjects) had normal EDX in the reference group. Comparisons of wrists between the afflicted and reference subjects demonstrated the CSA at precanal, tunnel inlet, midcanal, and tunnel outlet levels being significantly more abundant in the diseased hands than in the nondiseased hands. CSA at the tunnel inlet and the inlet-to-antecubital CSA ratio with a threshold of 8.5 mm2 and 0.65 gave the best diagnostic accuracy with a sensitivity and specificity of 96.9 and 93.6% for the inlet CSA and 99 and 28% for the CSA ratio, respectively. CONCLUSION: The US as a noninvasive diagnostic method may serve for the investigation of CTS in elderly patients with excellent sensitivity and specificity.

Sensitivity of high-resolution ultrasonography in clinically diagnosed carpal tunnel syndrome patients with hand pain and normal nerve conduction studies.

BACKGROUND: Suspecting carpal tunnel syndrome (CTS) in patients with hand pain is usual. Considering the variable rate of false-negative results in nerve conduction study (NCS), as a frequent reference confirmatory standard test, we aimed to evaluate the diagnostic accuracy of neuromuscular ultrasound in patients with clinical evidence of CTS and normal NCS. METHODS: It was a diagnostic accuracy study conducted in the outpatient clinic of Rofaydeh Hospital, Tehran, Iran, between July 2012 and December 2016; it recruited clinically diagnosed CTS patients and a control group. All participants underwent comprehensive clinical examination, NCS, and high-resolution ultrasonography of the median nerve. RESULTS: Two hundred and fifty patients with clinical evidence of CTS met the inclusion criteria, of whom 103 (27.1%) had normal NCS and underwent an ultrasound examination. A cutoff point of 9.4 mm2 (mean + 2 standard deviation) for median nerve cross-sectional area at the carpal tunnel inlet from the control group was set to detect 73% abnormality in the case group. CONCLUSION: Ultrasonography had a sensitivity rate of 73% in patients with clinical CTS and negative NCS, increasing the overall diagnostic sensitivity for clinically suspected CTS in the electrodiagnostic lab setting to 92%. The study highlights the complementary role of ultraso-nography in diagnosing CTS in conjunction with NCS.

Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial.

BACKGROUND: Carpal tunnel syndrome (CTS) is commonly seen in elderly populations, in part due to increased presence of predisposing comorbidities as well as physiological changes. We aimed at comparing the effectiveness of different doses of steroid using the ultrasound-guided hydrodissection method in elderly patients with CTS. METHODS: We conducted a prospective, triple-blind, randomized, controlled trial in elderly patients with CTS. Patients were allocated to one of three groups by simplified randomization. Groups I-III received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; and 1 mL of 2% lidocaine and 2 mL normal saline, respectively to make up to 3 mL volume. A wrist splint was then applied for support. Outcome measures included the visual analog scale (VAS) and the Boston Carpal Tunnel Questionnaire, and median motor and sensory nerve conduction and its sonographic inlet cross-sectional area were used as objective measures. All data were recorded at baseline and 2, 12, and 24 weeks after injection. The investigators, patients, and statistician were blinded to the treatment assignment. RESULTS: In total, 161 patients were recruited without statistically significant demographic differences between the three groups. There were no statistically significant differences between groups in any outcome, with the exception of the median distal motor latency, which was greater in Group II at all three follow-up visits, and significant baseline VAS difference between Groups I and III. CONCLUSION: Hydrodissection with lidocaine and normal saline is as effective as hydrodissection with low- and high-dose steroid medication in elderly patients with CTS in this study, but further studies with matched baseline measures and also a sham group are suggested for definitive recommendation.

The effects of low-volume high-intensity interval versus moderate intensity continuous training on heart rate variability, and hemodynamic and echocardiography indices in men after coronary artery bypass grafting: A randomized clinical trial study.

BACKGROUND: Heart rate variability (HRV) declines after coronary artery bypass grafting (CABG). The purpose of this study was to evaluate the effect of low-volume high-intensity interval training (LV-HIIT) and moderate-intensity continuous training (MICT) on HRV as well as, hemodynamic and echocardiography indices. METHODS: Forty-two men after CABG (55.12 ± 3.97 years) were randomly assigned into LV-HIIT, MICT, and control (CTL) groups. The exercise training in LV-HIIT consisted of 2-minute interval at 85-95 percent of maximal heart rate (HRmax), 2-minute interval at 50% of HRmax and 40-minute interval at 70% of HRmax in MICT for three sessions in a week, for 6-weeks. HRV parameters were evaluated by 24-hour Holter electrocardiography (ECG) recording, and echocardiography parameters at baseline and end of intervention were measured in all 3 groups. RESULTS: At the end of the intervention, left ventricular ejection fraction (LVEF) significantly increased in LV-HIIT group (58.53 ± 7.26 percent) compared with MICT (52.26 ± 7.91 percent) and CTL (49.68 ± 7.27 percent) groups (P < 0.001). Furthermore, mean R-R interval, root mean square successive difference (RMSSD) of R-R interval, and standard deviation of R-R interval (SDRR) in LV-HIIT group considerably increased compared with MICT group (P < 0.001). High-frequency power (HF) significantly increased in LV-HIIT and MICT groups compared with CTL group (P < 0.001). On the other hand, low frequency (LF) and LF/HF ratio significantly decreased in LV-HIIT group in comparison with MICT group (P < 0.010). CONCLUSION: These results suggest that LV-HIIT has a greater effect on improvement of cardiac autonomic activities by increasing R-R interval, SDRR, RMSSD, and HF, and decreasing LF and LF/HF ratio in patients after CABG.

Paresthesia and forearm pain after phlebotomy due to medial antebrachial cutaneous nerve injury.

BACKGROUND: Although phlebotomy is a common procedure, there is limited information concerning to documented complications of venipuncture. CASE PRESENTATION: A 45 year old left- handed woman was refered for elecrodiagnostic study with dysesthesia and pain in left medial forearm. She noted these symptoms three weeks after phelebotomy. Electrodiagnostic study showed severe involvement of left side Medial Antebrachial Cutaneous nerve (MAC nerve). CONCLUSION: Phelebotomy is a cause of MAC nerve injury. Electrodiagnostic testing can be helpful in evaluating cases of sensory disturbance after phlebotomy.

Serum gamma-glutamyltransferase, alanine aminotransferase, and aspartate aminotransferase activity in Iranian healthy blood donor men.

AIM: To determine serum gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) activity, and to assess their correlation with demographic and clinical findings in healthy blood donors. METHODS: This cross-sectional study was performed in 934 male blood donors, aged 18 to 68 years, who consecutively attended Tehran blood transfusion service in 2006. All participants were seronegative for HBV or HCV infections, non alcohol users, and all underwent a standard interview and anthropometric tests. Clinical and biochemical parameters including AST, ALT, and GGT activities were determined. Patients taking drugs known to cause hepatic fat deposition were excluded. For AST, ALT, and GGT variables, we used 33.33 and 66.66 percentiles, so that each of them was divided into three tertiles. RESULTS: Mean AST, ALT, and GGT activities were 25.26 +/- 12.58 U/L (normal range 5-35 U/L), 33.13 +/- 22.98 (normal range 5-35 U/L), and 25.11 +/- 18.32 (normal range 6-37 U/L), respectively. By univariate analyses, there were significant associations between increasing AST, ALT, or GGT tertiles and age, body weight, body mass index, and waist and hip circumferences (P<0.05). By multiple linear regression analyses, ALT was found to be positively correlated with dyslipidemia (B=6.988, P=0.038), whereas ALT and AST were negatively correlated with age. AST, ALT, and GGT levels had positive correlation with family history of liver disease (B=15.763, P<0.001), (B=32.345, P<0.001), (B=24.415, P<0.001), respectively. CONCLUSION: Although we did not determine the cutoffs of the upper normal limits for AST, ALT, and GGT levels, we would suggest screening asymptomatic patients with dyslipidemia and also subjects with a family history of liver disease.

Screening for peripheral neuropathy in chemical warfare victims.

We aimed to assess the prevalence of peripheral neuropathy in chemical warfare victims. We speculated that peripheral neuropathy is a late complication of exposure to chemical warfare agents. Late complications of exposure to chemical warfare agents are not well known and are poorly discussed in the existing literature. Scientific data regarding delayed complications are sparse, but this warrants recognition, especially when the clinician has to treat chemical warfare victims. The hazards of organophosphate pesticides and several toxins, although recognized to some extent, are, however, different from the hazards of chemical warfare agents which are far more serious. In this study, 100 chemical warfare patients, with varying degrees of exposure and an average age of 37.2+/-9.0 years, were examined clinically and studied electrodiagnostically from January 2002 to January 2003. Five of these patients proved to be suffering from axonal neuropathy. This rate was significantly higher than that found in the normal population. Our data indicate that chemical warfare agents may cause peripheral neuropathy in chemical warfare victims. In conclusion, organophosphorous agents used against Iranian troops during the war on Iran correlate with delayed neuropathy in these victims.