Acupuncture for chronic nonpulsatile tinnitus: A randomized clinical trial.

BACKGROUND: There is challenge to find an effective treatment for tinnitus. Few studies were done on the effects of acupuncture on tinnitus. This study evaluated the effect of acupuncture on chronic non-pulsatile tinnitus. METHODS: This randomized double-blind clinical trial was conducted from December 2014 to September 2015. Patients suffering from chronic non-pulsatile tinnitus were randomly allocated into two groups: acupuncture vs. placebo. They were treated in 15 sessions and at the end of the fifteenth sessions and 3 weeks after completion of the treatment, visual analog scale (VAS) for tinnitus loudness and tinnitus severity index (TSI) questionnaires were completed. RESULTS: The case group included 26 males and 18 females, and in the control group there were 27 males and 17 females: with mean age of 49.11±1.07 and 55.20±8.33 years, respectively (p=0.005). TSI and VAS before treatment were 43.84±2.81 and 9.56±0.43 in cases and 43.52±2.94 and 9.54±0.45 in controls, respectively. Both measures improved after 15 sessions in cases to 24.82±1.04 and 2.88±0.33, and to 33.16±1.24 and 7.86±0.23 in controls. The changes of TSI and VAS were significant in all groups (p<0.001). TSI and VAS in acupuncture group were lower than placebo group in each session (p<0.001), except TSI in the tenth session (p=0.392). CONCLUSIONS: Acupuncture is effective in reducing the loudness and severity of tinnitus and can be a useful treatment for nonpulsatile chronic tinnitus.

Genetic Dimension of Intervertebral Disc Degeneration: Polymorphism of Matrix Metalloproteinase 1 and 3 in the North Iranian Population.

AIM: The etiology of intervertebral disc degeneration is still vague and both genetic and environmental factors are assumed as the main causes. One of the proposed genetic factors is the polymorphism of matrix metalloproteinases (MMPs) genes. The aim of this study was to explore the relationship between two polymorphisms (MMP-1-755 T/G [rs498186] and MMP-3 A/C [rs632478]) and disc degeneration. MATERIAL AND METHODS: We performed a case-control study on 130 cases with intervertebral disc degeneration confirmed by magnetic resonance imaging (MRI) and 210 healthy individuals. The Schneiderman criterion was used to determine the severity of the disc degeneration. Blood samples were collected from the participants. The genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Odds ratios and 95% CIs were determined as measures of the strength of association between genotypes and disc degeneration. RESULTS: The most frequent intervertebral disc degeneration was observed in age range of 31-40 years (43.2%). A significant association was found between the MMP-3 polymorphism and disc degeneration (p < 0.001). The homozygote CC was associated with an increased risk of disc degeneration compared with the AA genotype (OR=5.25; 95%CI=2.82-9.77, p < 0.001). We did not find any significant association of the MMP-1 polymorphism with disc degeneration (p=0.95). CONCLUSION: The MMP-3 [rs632478] polymorphism may contribute to susceptibility to disc degeneration. To confirm our findings, additional well-designed studies in diverse ethnic populations are required.

Acupuncture and botulinum toxin A injection in the treatment of chronic migraine: A randomized controlled study.

BACKGROUND: Migraine is a common type of headache. Sometimes adequate pain relief is not achieved by conventional treatments. Acupuncture and botulinum toxin-A injection are known as non-pharmacological interventions for this purpose. The aim of this research was to compare the effect of acupuncture with botulinum toxin-A injection and pharmacological treatment in controlling chronic migraine. METHODS: This clinical trial was conducted on patients with chronic migraine in the North of Iran during 2014-2015. Eligible patients were randomly allocated to groups receiving acupuncture (A) or botulinum toxin A (B) and controls (C) by designed quadripartite blocks. All patients were evaluated at baseline, one, two and three months after treatment using visual analogue scale (VAS) score and other parameters. The analysis of data was performed in SPSS software Version 19. RESULTS: One hundred fifty patients (48 males and 102 females) completed this study. During the 3- month study, the pain severity significantly diminished in three groups (P=0.0001), with greater reduction in group A (P=0.0001). The number of days per month with migraine, absence from work and the need for medication significantly decreased in three groups at 3 times of evaluation (p<0.05) with fewer side effects in group A (P=0.021). CONCLUSION: Acupuncture, botulinum toxin-A injection and pharmacological treatment have beneficial effects on chronic migraine; however, acupuncture showed more effectiveness and fewer complications.

Comparing the effect of topical anesthesia and retrobulbar block with intravenous sedation on hemodynamic changes and satisfaction in patients undergoing cataract surgery (phaco method).

BACKGROUND: Cataract is one of the most common surgical procedures in the elderly. In most cases, the elderly have cardiac ischemia or chronic coronary diseases, which would lead to more ischemic events during general anesthesia. Therefore, surgeons and anesthetists prefer regional aesthesia to the general one owing to its more advantages and less complications. OBJECTIVES: Therefore, this study aimed to compare topical method and retrobulbar block for pain intensity, patient's satisfaction, hemodynamic changes and intra and postoperative complications. PATIENTS AND METHODS: In a single-blinded clinical trial, 114 patients scheduled for cataract surgery, aged 50 to 90 years with ASA physical status of I-III, were randomly assigned to two groups under monitored anesthesia care as topical anesthesia and retrobulbar block. After the injection of intravenous sedation, which was the combination of midazolam 0.5-1 mg with fentanyl 0.5-1 µ/kg, patients received retro bulbar block or topical anesthesia. During the operation, heart rate, systolic and diastolic blood pressure, mean arterial blood pressure and arterial saturation of O2were measured every five minutes. In addition, pain (VAS) and satisfaction (ISAS) scores were recorded every 15 minutes, then at recovery and one hour after the ending of operation in the ward. Findings were statistically analyzed using SPSS 16. RESULTS: In this study, no significant association was found between age, gender, education and physical condition of patients in both topical and retro bulbar block groups. Comparison of pain based on VAS, satisfaction based on ISAS score and MAP in the studied periods had no significant differences between the two groups of patients undergoing cataract surgery. However, significant differences were found between the two groups (P = 0.045, 0.02, 0.042 and P < 0.05) regarding heart rate, systolic and diastolic blood pressure and arterial oxygen saturation percentage after 20-30 minutes of the operation. CONCLUSIONS: Both methods, topical and retro bulbar block had similar impression in cataract surgery regarding analgesia and patient satisfaction. However, in non-complicated cataract surgeries with short duration, topical anesthesia may be the preferable method, because of non-invasiveness, appropriate analgesia, patient satisfaction and hemodynamic stability.