Neurofascial Dextrose Prolotherapy for Managing Chronic Ankle Ligament Injury

Objectives

Due to the anti-inflammatory effects of dextrose prolotherapy, we evaluated the effectiveness of extra-articular, neurofascial dextrose prolotherapy in chronic ankle ligament injury.

Methods

Patients with chronic ankle ligament injury entered this uncontrolled before-after study based on eligibility criteria. Patients who consented to participate in the study filled out the prepared questionnaire containing demographic data, the Cumberland ankle instability tool (CAIT), and the Visual Analogue Scale (VAS). The initial CAIT score of less than 25 indicated functional instability following an ankle sprain. Patients underwent neurofascial prolotherapy with dextrose 12.5%. Two injections within one month were done. The CAIT was completed one, three, and six months after the intervention.

Results

Twenty-five patients with chronic ankle ligament injury were investigated. The mean CAIT score was 1.88 (± 2.35) before the intervention, which increased significantly over the study (P < 0.001). The CAIT score reached 21.84 (± 6.04) in the sixth month after the intervention. Moreover, the VAS score decreased significantly over the study from 6.12 (± 2.35) before the intervention to 1.24 (± 0.43) in the sixth month after the intervention (P < 0.001).

Conclusions

Our findings revealed the therapeutic effectiveness of dextrose neurofascial prolotherapy in decreasing pain and functional instability in patients suffering chronic ankle pain due to ligamentous injury accompanied by chronic ankle instability.

Therapeutic Effects of Intra-articular Botulinum Neurotoxin Versus Physical Therapy in Knee Osteoarthritis

Background

Knee osteoarthritis (KOA) is the most common cause of chronic knee pain, and disability and different modalities have been used to improve pain and function. Botulinum toxin intra-articular injection is proposed to manage resistant joint pains.

Objectives

This study was carried out to compare therapeutic effects of intra-articular botulinum neurotoxin (BTX) versus physical therapy (PT) in KOA.

Methods

In this single-blind randomized clinical trial, patients with KOA attending to Imam-Reza Hospital, Tehran, Iran, from June 2018 to March 2019 were enrolled. Patients who met the inclusion criteria were randomly divided into BTX receiving a single intra-articular dose of 100 units (250 units from disport brand) and PT groups. The study was described for patients, and informed consent forms were received. For assessment of the pain and related severity, the VAS score and KOOS scales were used. Post-intervention assessment was done 1, 3, and 6 months after the intervention. The level of significance was set at α = 0.05. All data analyses were performed with SPSS version 26 for windows.

Results

In this study, 50 patients were randomly divided into BTX and PT groups. All patients completed the study, and there was no loss to follow-up. There was no significant difference between demographic data of the two groups, including age and BMI. The VAS score was similar in the two groups at the beginning. KOOS subscales were not significantly different, but the quality of life was better in the BTX than the PT group (86.2 ± 15 vs. 72.1 ± 11.5, P < 0.001). One month after the intervention, all KOOS subscales were improved in the BTX group in comparison to the PT group (P < 0.001). This difference was statistically significant in the 3rd (P < 0.001 in all comparisons except Sport/Rec subscale in which P = 0.02) and 6th months (P < 0.001) after the intervention, and the improvement in all KOOS subscales and VAS score were higher in the BTX group than the PT group. The trend of KOOS subscales and VAS score was improved over time in the BTX (P < 0.001 in all tests), but the PT group showed no improvement (P > 0.05) except for Sport/Rec and VAS score (P < 0.001).

Conclusions

Totally, it is concluded that the use of BTX can reduce pain and improve the function and quality of life in patients with KOA.

Transcranial direct current stimulation for knee osteoarthritis: a single-blind randomized sham-controlled trial

OBJECTIVE

To evaluate the effects of transcranial direct current stimulation on pain and other symptoms of knee osteoarthritis.

METHODS

We performed a single-blind randomized sham-controlled trial with two parallel arms in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. We randomized 54 patients, 30-70 years of age, with knee osteoarthritis into two groups. They had morning stiffness ≤ 30 min, knee pain ≥ 3 months, joint crepitus, and Kellgren-Lawrence grade 1 or 2 on radiographs. For the active stimulation we administered 2 mA current, 20 min for each session and for the sham group 30 s stimulation and 20 min no current. Using the 10/20 International EEG system, the anode was fixed over the contralateral primary motor cortex (C3 or C4), and the cathode was placed on the ipsilateral supraorbital region (Fp1 or Fp2), with respect to the included knee. The program was repeated once daily over 5 consecutive days. Both groups received acetaminophen. We assessed the patients before and after the interventions, and three months post-intervention. The primary outcome was knee pain on the visual analog scale, and the secondary outcome was the Knee injury and Osteoarthritis Outcome Score.

RESULTS

There was a statistically significant reduction in the intensity of pain within sham and active groups (both p < 0.001), but no significant difference between the groups (p = 0.226). Analyses of the Knee injury and Osteoarthritis Outcome Scores showed no clinically important changes.

CONCLUSIONS

Transcranial direct current stimulation does not reduce knee pain, does not abate other symptoms, and does not restore knee function in patients with knee osteoarthritis. The pain reduction in our study could be attributed to either placebo or the acetaminophen effect.

Investigating the association between chronological age and thyroid cartilage ossification using CT imaging

Background: Thyroid cartilage ossifies through time. In addition to different methods for age estimation, ossified volume can be a valuable index for age estimation. In this study, anthropometric characteristics and ossified volume were measured using CT scan imaging to find potential correlations between measures and age. Methods: In this study, 100 thyroid cartilage of Iranian corpses (60 men and 40 women) were studied. Corpses from Kahrizak hall of Tehran Legal Medicine Organization were included in this study. After obtaining required consent from their family, their thyroid cartilage was separated by an expert, and anthropometric properties of the cartilage were recorded. A 64-slice Siemens CT scan machine was used to measure specimen ossified volume and Hounsfield score by 3D reconstruction of images. Pearson's correlation test was used to measure the correlation between thyroid calcified volume and chronological age. Repeated measurement ANOVA test was also used to measure the correlation of the ossified volume and Hounsfield score with different age groups. SPSS version 22 was used for statistical analysis, and significance level was set at than 0.05. Results: All thyroid cartilage measures were higher in men than in women, except for thyroid angle, and the differences were statistically significant. Height of the laminae (R=0.23, p=0.023) and depth of the thyroid notch (R=0.198, p=0.049) were correlated with age. Mean ossified volume (6.1±1.7 cc) and Hounsfield score (308.8±53.5 HU) were directly correlated with age (R=0.205; p=0.040 and R=0.219; p=0.029, respectively), but none of these two radiologic parameters were correlated with age groups (p=0.331 and 0.063, respectively). No specific ossification pattern was obtained from CT images in different age groups. Conclusion: A combination of anthropometric measures such as the height of the laminae and depth of the thyroid notch with CT scan imaging measures such as ossified volume and the Hounsfield score are useful to estimate age with low precision. In addition, thyroid cartilage measures are useful for sex determination.

Spectroscopic properties of various blood antigens/antibodies

Since the traditional method generates biological waste, there is a significant demand for an easy, quick technique of blood type identification without contamination. In fact, individuals can be divided into four main blood groups whose antigens are available in red blood cell (RBC) membranes and the antibodies in the plasma. Here, UV-vis and photoluminescence (PL) spectroscopic methods are systematically used to find the spectra of blood typing antigens (A, B and AB) and antibodies i.e. A-Anti, B-Anti, AB-Anti and D reagent. The PL spectra of RBCs in different blood groups as well as the corresponding antibodies are successfully resolved for the purpose of blood typing. The unique photophysical characteristics of these biomolecules including signal intensity and peak emission wavelength in PL spectra are lucidly anticipated to accurately discriminate ABO groups. PL spectra of RBC in positive blood typing indicate larger signal and shorter emission peak wavelength corresponding to negative ones. Furthermore, the monoclonal antibody PL emissions emphasize that Anti-A benefits higher intensity and shorter peak wavelength (blue shift) than B-Anti. In the following, lucid blue shifts are obtained in terms of antibody concentrations accompanying the elevation of fluorescence signal, most likely due to the aggregation induced emission (AIE) phenomenon, quite the opposite of the aggregation-caused quenching (ACQ) that is widely observed from conventional chromophore. Those are envisaged as unique properties of each antibody to utilize in the spectral blood typing.

Incidence and Residual Risk of HIV, HBV and HCV Infections Among Blood Donors in Tehran

Estimation of residual risk is essential to monitor and improve blood safety. Our epidemiologic knowledge in the Iranian donor population regarding transfusion transmitted viral infections (TTIs), is confined to a few studies based on prevalence rate. There are no reports on residual risk of TTIs in Iran. In present survey, a software database of donor records of Tehran Blood Transfusion Center (TBTC) was used to estimate the incidence and residual risk of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections, by applying the incidence rate/window period (IR-WP) model. A total of 1,207,155 repeat donations was included in the analysis and represented a mean of 8.4 donations per donor over 6 years. The incidence amongst repeat donors was estimated by dividing the number of confirmed seroconverting donors by the total number of person-years at risk. The residual risk was calculated using the incidence/window period model. Incidence rate and residual risk for HBV, HCV and HIV infections were calculated for total (2005-2010) and two consecutive periods (2005-2007 and 2008-2010) of the study. According to the IR-WP model, overall residual risk for HIV and HCV in the total study period was 0.4 and 12.5 per million units, respectively and for HBV 4.57/100,000 donations. The incidence and residual risk of TTIs, calculated on TBTC's blood supply was low and comparable with developed countries for HIV infection but high for HCV and HBV infections. Blood safety may therefore be better managed by applying other techniques like nucleic acid amplification tests.

Bile cast nephropathy due to cholestatic jaundice after using stanozolol in 2 amateur bodybuilders

Elevated level of bile can cause bile cast nephropathy, which can be seen in patients with severe cholestatic liver disease. Stanozolol is a C17α-alkylation steroid derived from dihydrotestosterone and its major adverse effect is cholestatic jaundice. We report 2 bodybuilders who received stanozolol for 6 weeks and developed icterus. Serum total bilirubin was around 50 mg/dL. Liver biopsy showed intrahepatic cholestasis. In spite of fluid and albumin therapy, serum creatinine increased and the patients experienced oliguria. Urine sediment showed granular cast and normal erythrocyte count. Protein excretion in 24-hour urine was less than 1000 mg in both patients. Hemodialysis was started on and renal biopsy revealed acute tubular epithelial cell damage along with bile pigment (cast) deposition, compatible with bile cast-related nephropathy. Serum bilirubin decreased gradually and urine output increased. Serum creatinine was around 1.5 mg/dL in both of the patients 2 months after discharge.

Comparison of the accuracy and reproducibility of focused abdominal sonography for trauma performed by emergency medicine and radiology residents

We compared the diagnostic accuracy of emergency medicine residents (EMRs) and radiology residents (RRs) in performing focused abdominal sonography for trauma (FAST). The cohort in this prospective study comprised 200 unstable patients (163 males and 37 females; mean ± standard deviation of age, 34.3 ± 16.4 y) who presented with trauma. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. Patients with positive FAST results underwent further diagnostic procedures such as computed tomography, diagnostic peritoneal lavage and laparotomy. Those with negative FAST results underwent clinical follow-up for 72 h until their condition deteriorated or they were discharged. Sensitivity, specificity, positive and negative predictive values and accuracy in evaluating free intraperitoneal fluid were 80%, 95%, 57%, 98% and 94% when FAST was performed by EMRs and 86%, 95%, 59%, 98% and 94% when FAST was performed by RRs. The level of agreement between EMRs and RRs was moderate (κ = 0.525). FAST is a useful screening tool for initial assessment of free abdominal fluid in patients with trauma. Our results indicate that EMRs can perform sonography on trauma patients as successfully as RRs.

Reliability and validity of Persian version of World Health Organization health and work performance questionnaire in Iranian health care workers

BACKGROUND

The effect of health status on productivity has widely been studied and discussed in literature. Valid and reliable tools are needed to evaluate the levels of health and productivity and provide detailed information, before any intervention is implemented. World Health Organization Health and Work Performance Questionnaire (HPQ) is a widely used instrument in estimating the workplace costs of health problems in terms of reduced job performance, sickness absence, and work-related accidents and injuries.

OBJECTIVE

To assess the reliability and validity of Persian version of HPQ in Iranian health care workers.

METHODS

The questionnaire was translated to Persian and back translated. 102 health care workers completed the questionnaire. Absence and sick-leave data was extracted from administrative records.

RESULTS

Factor analysis revealed acceptable validity for the questionnaire in part A (health). Cronbach's alpha was >0.73 for all scales of Parts B (work) and C (demographic). Questions targeting days of absence and sick-leave had acceptable correlation with administrative records (Pearson's r >0.75), while questions on total hours worked showed lower correlation.

CONCLUSION

Persian version of HPQ can be considered a reliable and valid tool in Iranian health workers.

Contact lens disinfecting solutions antibacterial efficacy: comparison between clinical isolates and the standard ISO ATCC strains of Pseudomonas aeruginosa and Staphylococcus aureus

PURPOSE

To evaluate the disinfectant properties of the three multipurpose contact lens disinfecting solutions available in Iran, against clinical isolates and the standard ISO ATCC strains of Pseudomonas aeruginosa and Staphylococcus aureus, based on the international organization for standardization (ISO) 14729 guidelines.

METHODS

Three multipurpose solutions that were tested were ReNu Multiplus, Solo Care Aqua and All-Clean Soft. The test solutions were challenged with clinical isolates and the standard strains of P. aeruginosa(ATCC 9027) and S. aureus(ATCC 6538), based on the ISO Stand-alone procedure for disinfecting products. Solutions were sampled for surviving microorganisms at manufacturer's minimum recommended disinfection time. The number of viable organisms was determined and log reductions calculated.

RESULTS

All of the three test solutions in this study provided a reduction greater than the required mean 3.0 logarithmic reduction against the recommended standard ATCC strains of P. aeruginosa and S. aureus. Antibacterial effectiveness of Solo Care Aqua and All-Clean Soft against clinical isolates of P. aeruginosa and S. aureus were acceptable based on ISO 14729 Stand-alone test. ReNu MultiPlus showed a minimum acceptable efficacy against the clinical isolate of S. aureus, but did not reduce the clinical isolate by the same amount.

CONCLUSIONS

Although the contact lens disinfecting solutions meet/exceed the ISO 14729 Stand-alone primary acceptance criteria for standard strains of P. aeruginosa and S. aureus, their efficacy may be insufficient against clinical isolates of these organisms.