Randomized controlled trial of local progesterone vs corticosteroid injection for carpal tunnel syndrome.

OBJECTIVES: A number of studies have demonstrated the neuroprotective effects of progesterone and its influence on the recovery after neural injury. Few studies investigated the efficacy of local progesterone in carpal tunnel syndrome. The objective of this study was to compare the long-term effects of progesterone vs corticosteroid local injections in patients with mild and moderate carpal tunnel syndrome. METHODS: In this randomized clinical trial, 78 patients with carpal tunnel syndrome were assigned to two groups. Patients were treated with a single local injection of triamcinolone acetonide in one group and single local injection of hydroxy progesterone in the other group. Variables including pain (based on visual analogue scale), symptom severity, and functional status (based on Bostone/Levine symptom severity and functional status scale) and nerve conduction study were evaluated before and 6 months after the treatments. RESULTS: All outcome measures including pain and electrophysiologic findings, improved in both groups and there were no meaningful differences between two groups regarding mentioned variables except for functional outcome, which was significantly better in progesterone compared with corticosteroid group at 6-month follow-up (P=.04). CONCLUSIONS: The efficacy of progesterone local injection in mild and moderate CTS is equal and somehow superior to corticosteroid injection for relieving symptoms and improving functional and electrophysiologic findings at long-term follow-up.

Effect of neurofeedback and electromyographic-biofeedback therapy on improving hand function in stroke patients.

PURPOSE: The aim of the present study was to evaluate the effect of applying electroencephalogram (EEG) biofeedback (neurobiofeedback) or electromyographic (EMG) biofeedback to conventional occupational therapy (OT) on improving hand function in stroke patients. METHODS: This study was designed as a preliminary clinical trial. Thirty patients with stroke were entered the study. Hand function was evaluated by Jebsen Hand Function Test pre and post intervention. Patients were allocated to 3 intervention cohorts: (1) OT, (2) OT plus EMG-biofeedback therapy, and (3) OT plus neurofeedback therapy. All patients received 10 sessions of conventional OT. Patients in cohorts 2 and 3 also received EMG-biofeedback and neurofeedback therapy, respectively. EMG-biofeedback therapy was performed to strengthen the abductor pollicis brevis (APB) muscle. Neurofeedback training was aimed at enhancing sensorimotor rhythm after mental motor imagery. RESULTS: Hand function was improved significantly in the 3 groups. The spectral power density of the sensorimotor rhythm band in the neurofeedback group increased after mental motor imagery. Maximum and mean contraction values of electrical activities of the APB muscle during voluntary contraction increased significantly after EMG-biofeedback training. CONCLUSION: Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT. Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy.

Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial.

BACKGROUND: Myofascial pain syndrome (MPS) is one of the most prevalent musculoskeletal diseases. MPS impaired quality of life in the patients. There is a lot of controversy about different treatment options which include medical treatments, physical therapy, injections, ultrasound and laser. The effects of laser in MPS are challenging. AIM: To assess the effects of laser and ultrasound in treatment of MPS. DESIGN: Randomized single blinded clinical trial SETTING: Outpatient physical therapy clinic at university hospital POPULATION: Sixty three subjects (females: 46, males: 17), (age range: 17-55 year old) who had a diagnosis of definite MPS were entered in the study. METHODS: We measured the pain intensity at rest, during activity and at night using Visual Analogue Scale (VAS) questionnaire. The patients also filled the Neck Disability Index (NDI) form and the pain threshold provoked by pressure was determined using algometric assessment. Then, the patients were categorized randomly in groups A, B and C (receiving laser therapy, ultrasound and sham laser therapy, respectively). Six weeks after the initial visit, they were visited again and filled the forms again. RESULTS: Ultrasound was effective in VAS improvement during activity (46%), at rest (39%) and at night (35%). It also improved NDI scores (34%) and algometric assessment (37%). Laser was effective in VAS improving during activity (54%), at night (51%) and at rest (51%) and also improved NDI scores (73%). It was also found effective in algometric assessment improvement (105%). Laser resulted in more NDI score and algometric assessment improvements comparing to ultrasound (p<0.05). CONCLUSION: This study introduces laser as one of the preferred treatments of myofascial pain syndrome in shoulder.

Alterations in humoral immunity in relatives of patients with common variable immunodeficiency.

BACKGROUND AND OBJECTIVES: It has been reported that there is a high prevalence of immunodeficiency and autoimmunity in relatives of patients with common variable immunodeficiency (CVID). The aim of this study was to determine the prevalence of immunoglobulin deficiency in relatives of patients with CVID in Iran, where there is a high rate of consanguineous marriage. METHODS: A descriptive study was undertaken in 64 family members of 23 unrelated CVID patients. The group contained 17 fathers, 18 mothers, 18 sisters, 9 brothers, and 2 children. Serum immunoglobulin levels were measured by nephelometry. Immunoglobulin (Ig) G subclass levels were measured in a subgroup of 36 individuals. Serum IgA levels were confirmed by enzyme-linked immunosorbent assay for subjects with suspected IgA deficiency. RESULTS: The rate of consanguineous marriage in families containing relatives with antibody deficiencies was significantly higher than in those families in whom relatives did not have immune deficiencies. IgA deficiency was observed in 2 relatives of patients with CVID. Also CVID was observed in 2 family members. In 3 fathers and 1 brother, IgM levels were lower than normal. Three relatives had IgG4 deficiency and 1 person had combined IgG4 and IgG2 deficiency. Twenty percent of the relatives had hypogammaglobulinemia (including IgA deficiency, CVID, decreased levels of IgM, and IgG subclass deficiencies). CONCLUSION: In our study, alteration in humoral immunity in relatives of CVID patients was higher than previously reported, and this could be attributed to the high rate of consanguineous marriage in Iran. Since the family members of CVID patients are at high risk of hypogammaglobulinemia, it is advisable that they be evaluated for immunodeficiency disorders and monitored throughout their lifetimes.