Effect of educational intervention on preventing osteoporosis in postmenopausal women

In the experimental group, the average scores of knowledge, constructs of theory of planned behavior, nutrition, and walking had a significant enhancement compared to the control group after the educational intervention. After the intervention, the value of the lumbar spine bone mineral density T-score in the experimental group increased, while in the control group, it decreased.

INTRODUCTION

Osteoporosis is a global public health problem currently affecting millions of people worldwide and in Iran. This study was conducted to assess the effect of an educational intervention based on the theory of planned behavior on the prevention of osteoporosis in postmenopausal women.

METHODS

This quasi-experimental study was performed on 160 women aging over 50 who were referred to health centers in Fasa City, Iran, in 2019. A simple random sampling method was applied to assign the participants into control and intervention groups (80 participants for each group). Data were gathered by questionnaires arranged based on the constructs of the theory of planned behavior, nutrition performance, and walking performance. The educational intervention included seven 50-minute educational sessions. The obtained data were analyzed using SPSS 22 software and Chi-square test, independent T-test, and paired T-test, and the significance level was considered 0.05.

RESULTS

The mean ages of the studied participants in the experimental and control groups were 59.18 ± 6.56 and 57.92 ± 5.70, respectively. In the experimental group, the average scores of knowledge, constructs of the theory of planned behavior, nutrition performance, and walking performance had a significant enhancement compared to the control group one year after the intervention (p < 0.001). At 12 months after the intervention, the value of the lumbar spine bone mineral density T-score in the experimental group increased, while in the control group, it reduced (p < 0.001).

CONCLUSIONS

The theory of planned behavior affected nutrition and walking performance in osteoporosis prevention of subjects. This theory can be used as a framework for designing and performing educational interventions for preventing osteoporosis and promoting women's health.

The potential role of Bifidobacterium spp. as a preventive and therapeutic agent in controlling inflammation via affecting inflammatory signalling pathways

Inflammatory bowel disease (IBD) is a chronic inflammatory disease with relapses and periods of remission. Forasmuch as, dysregulation of the immune system is one of the triggers of IBD, taking probiotics as one of the immunomodulators in the gut, could help to control inflammation and IBD via influencing signalling pathways. Here, we aimed to investigate the efficacy of five selected Bifidobacterium strains in modulating JAK/STAT and NF-kB inflammatory signalling pathways via using the in vitro assay. A quantitative real-time polymerase chain reaction assay was used to analyse the expression of JAK/STAT and inflammatory genes followed by potential probiotic treatments before, after and simultaneously with the inflammation induction (sonicated pathogen). The production of IL-6 and IL-1β after probiotic treatment was evaluated. Probiotic treatment resulted in the downregulation of TIRAP, IRAK4, NEMO and RIP genes in the NF-kB pathway, as well as JAK genes compared to sonicate-treated cells. The expression of STAT genes was different after our selected Bifidobacterium strains treatment. The production of IL-6 and IL-1β decreased after probiotic treatment. These strains of Bifidobacterium spp. showed anti-inflammatory effects on HT-29 cells via modulation of JAK/STAT and NF-kB signalling pathways. The use of Bifidobacterium spp. could be considered as a suitable preventive and complementary treatment for patients with inflammatory bowel disease.

Effectiveness of Mindfulness-based Stress Reduction (MBSR) on Patients With Chronic Pain: A Randomized Clinical Trial

Objectives: This research aims to investigate the effectiveness of mindfulness-based stress reduction (MBSR) on pain intensity, anxiety, depression, and quality of life (QoL) of patients with chronic pain via randomized clinical trials. Methods: The study population consisted of all patients with chronic pain referred to Imam Reza Hospital. Of these patients, 50 cases who met the inclusion criteria and were willing to participate in the study were selected through convenience sampling and randomly assigned to the experimental (n=25) or control groups (n=25). After selecting the patients and randomly assigning them to the two groups, the research questionnaires were completed by the patients before and after the treatment. After obtaining a written consent letter from the research participants, the experimental group received MBSR therapy (8 weekly sessions) while the control group did not receive any intervention. The questionnaires included the numeric pain rating scale (NPRS), the World Health Organization quality of life (WHOQOL) (WHOQOL-BREF), the Beck anxiety inventory (BAI), and the Beck depression inventory-2nd edition (BDI-II). To comply with the ethical principles, after the end of the study, MBSR therapy was administered to the control group as well. The data were analyzed via analysis of variance and multivariate analysis of covariance in the SPSS software, v. 19. Results: The results of the analysis showed that MBSR therapy reduces pain severity, anxiety, and depression in patients with chronic pain (P<0.05). The findings also showed that MBSR therapy improves the QoL of patients with chronic pain (P<0.05). Conclusion: Along with the common medications for chronic pain, MBSR therapy can be used to improve the QoL and reduce the severity of pain, anxiety, and depression in patients with chronic pain.

Lithium and preventing chemotherapy-induced peripheral neuropathy in breast cancer patients: a placebo-controlled randomized clinical trial

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of some chemotherapy regimens. Lithium has been suggested for CIPN in some animal studies. We aimed to study lithium's preventive effect on CIPN in breast cancer patients treated with taxanes and platinum-based medications.

METHOD

A double-blind placebo-controlled randomized clinical trial (RCT) was implemented on 36 breast cancer patients in two equal-size groups by block randomization. Participants in both groups consumed daily tablets, either placebo or lithium (300 mg), for 5 days in each course of chemotherapy. The tablets were prescribed 1 day before the start of chemotherapy. The electromyography (EMG) and nerve-conduction-velocity (NCV) tests were achieved before the first chemotherapy, 3 and 9 months after the treatment. The changes and signs or symptoms of CIPN, such as numbness, tingling, freezing, sensitivity to touch, muscle weakness, fibrillation, and knee and elbow reflex disorders, were recorded by examination. The trend of outcome changes was compared between two groups during the 9 months of study.

RESULTS

In both groups, neurologic signs and symptoms were exacerbated during the first 3 months and improved up to the ninth month of study. Results showed significant changes of all EMG-NCV variables during the 9 months of research in each group (P < 0.001), but the interaction of time and group effect was not significant in none of those indices. All symptoms changed significantly over the study time (P < 0.001) without significant statistical difference between the two groups (P=0.352). No side effect was found during the study.

CONCLUSION

The study showed that 300 mg lithium prescription once daily for 5 days might not effectively prevent CIPN in breast cancer patients. Evaluation of lithium effect on CIPN on different cancers in future studies is suggested.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20160813029327N10 .  Registration date: May 16, 2018.

Clinical and imaging outcomes after intrathecal injection of umbilical cord tissue mesenchymal stem cells in cerebral palsy: a randomized double-blind sham-controlled clinical trial

BACKGROUND

This study assessed the safety and efficacy of intrathecal injection of umbilical cord tissue mesenchymal stem cells (UCT-MSC) in individuals with cerebral palsy (CP). The diffusion tensor imaging (DTI) was performed to evaluate the alterations in white-matter integrity.

METHODS

Participants (4-14 years old) with spastic CP were assigned in 1:1 ratio to receive either UCT-MSC or sham procedure. Single-dose (2 × 107) cells were administered in the experimental group. Small needle pricks to the lower back were performed in the sham-control arm. All individuals were sedated to prevent awareness. The primary endpoints were the mean changes in gross motor function measure (GMFM)-66 from baseline to 12 months after procedures. The mean changes in the modified Ashworth scale (MAS), pediatric evaluation of disability inventory (PEDI), and CP quality of life (CP-QoL) were also assessed. Secondary endpoints were the mean changes in fractional anisotropy (FA) and mean diffusivity (MD) of corticospinal tract (CST) and posterior thalamic radiation (PTR).

RESULTS

There were 36 participants in each group. The mean GMFM-66 scores after 12 months of intervention were significantly higher in the UCT-MSC group compared to baseline (10.65; 95%CI 5.39, 15.91) and control (β 8.07; 95%CI 1.62, 14.52; Cohen's d 0.92). The increase was also seen in total PEDI scores (vs baseline 8.53; 95%CI 4.98, 12.08; vs control: β 6.87; 95%CI 1.52, 12.21; Cohen's d 0.70). The mean change in MAS scores after 12 months of cell injection reduced compared to baseline (-1.0; 95%CI -1.31, -0.69) and control (β -0.72; 95%CI -1.18, -0.26; Cohen's d 0.76). Regarding CP-QoL, mean changes in domains including friends and family, participation in activities, and communication were higher than the control group with a large effect size. The DTI analysis in the experimental group showed that mean FA increased (CST 0.032; 95%CI 0.02, 0.03. PTR 0.024; 95%CI 0.020, 0.028) and MD decreased (CST -0.035 × 10-3; 95%CI -0.04 × 10-3, -0.02 × 10-3. PTR -0.045 × 10-3; 95%CI -0.05 × 10-3, -0.03 × 10-3); compared to baseline. The mean changes were significantly higher than the control group.

CONCLUSIONS

The UCT-MSC transplantation was safe and may improve the clinical and imaging outcomes.

TRIAL REGISTRATION

The study was registered with ClinicalTrials.gov ( NCT03795974 ).

Granisetron vs. lidocaine injection to trigger points in the management of myofascial pain syndrome: a double-blind randomized clinical trial

OBJECTIVES

Granisetron and lidocaine injections have been used for the management of myofascial pain syndrome. This study was aimed to compare the efficacy of granisetron and lidocaine injections to trigger points of upper trapezius in the management of myofascial pain syndrome.

METHODS

We performed a double-blind randomized clinical trial in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. A total of 40 patients aged ≥18 with neck pain due to myofascial pain syndrome were included. They had pain for at least one month with the intensity of at least 30 mm on a 100 mm visual analog scale. Each participant received a single dose of 1 mL lidocaine 2% or 1 mg (in 1 mL) granisetron. The solutions were injected into a maximum of three trigger points of the upper trapezius. We instructed all patients to remain active while avoiding strenuous activity for three or four days, and to perform stretch exercise and massage of their upper trapezius muscles. We assessed the patients before the interventions, and one month and three months post-injection. The primary outcome was the Neck Disability Index and the secondary outcome was the Neck Pain and Disability Scale.

RESULTS

Both interventions were successful in reducing neck pain and disability (all p-values <0.001). However, the neck pain and disability responded more favorably to lidocaine than granisetron (p=0.001 for Neck Disability Index, and p=0.006 for Neck Pain and Disability Scale). No significant side-effect was recognized for both groups.

CONCLUSIONS

Both lidocaine and granisetron injections to trigger points are effective and safe for the management of the syndrome and the benefits remain at least for three months. However, lidocaine is more effective in reducing pain and disability. The injections are well-tolerated, although a transient pain at the site of injections is a common complaint. One mL of lidocaine 2% is more effective than 1 mg (in 1 mL) granisetron for injecting into the trigger points of the upper trapezius in myofascial pain syndrome.

Nutritional value of whole date waste and evaluating its application in ostrich diets

Although date waste products have been used as an alternative feed source in the diets of poultry for a long time, there is no quantitative information available regarding date waste used in ostrich diets. Therefore, two experiments were performed to evaluate the feeding value of whole date waste (WDW) as a feed ingredient in ostrich diets. In the first experiment, apparent metabolizable energy corrected to zero nitrogen balance (AMEn) of WDW was determined using 12 young ostriches (6 months old). The treatments included a reference diet and a test diet consisting of 60% of the reference diet and 40% of WDW. The AMEn of the WDW determined by total collection was 3216 kcal/kg. In the second study, four groups of eight growing ostriches (seven month old), with almost similar BW (60.4 ± 1.6 kg), were individually housed in outdoor paddocks of ≈24 m² and were tested from 7 to 9 months of age. The groups were fed four isocaloric (2420 kcal of AMEn/kg) and isonitrogenous (16.4% CP) diets containing 0, 10, 20, and 30% WDW. The results demonstrated that there were no significant differences among treatments in average daily feed intake, average daily gain, feed conversion ratio, and apparent total tract digestibility coefficients of DM, organic matter, energy, ether extract, ash, nitrogen-free extract, calcium, and phosphorus. In contrast, birds fed 0, 10, and 20% WDW diets had similar CP digestibility and this was significantly (P < 0.001) higher than that of birds on 30% WDW diet. The least crude fibre digestibility (P = 0.003) was also observed in birds fed 30% WDW diet. Blood RBC count, lymphocyte percentage, glucose concentration, and glutathione peroxidase activity increased linearly (P < 0.01), whereas heterophil percentage and heterophil-to-lymphocyte ratio decreased linearly (P = 0.002), in response to dietary inclusion of WDW. It can be concluded that WDW can be incorporated into the diets of ostrich chicks at levels of up to 30% without compromising growth performance. These results also suggest that WDW could be used as a feed ingredient for growing ostriches to improve stress-related variables and antioxidant status.

Spinal Manipulation for Subacute and Chronic Lumbar Radiculopathy: A Randomized Controlled Trial

OBJECTIVE

We evaluated the efficacy of spinal manipulation for the management of nonacute lumbar radiculopathy.

METHODS

In a university hospital we performed a randomized controlled trial with 2 parallel arms. Patients (n = 44) with unilateral radicular low back pain lasting more than 4 weeks were randomly allocated to manipulation and control groups. The primary outcome was the intensity of the low back pain on a visual analog scale. The secondary outcome was the Oswestry Disability Questionnaire score. We also measured spinal ranges of motion. The assessments were carried out at the baseline, immediately after intervention, and at 3 months' follow-up. All patients underwent physiotherapy. The manipulation group received three sessions of manipulation therapy 1 week apart. For manipulation, we used Robert Maigne's technique.

RESULTS

Both groups experienced a decrease in back and leg pain significantly (all P ≤ 0.003). However, only the manipulation group showed significantly favorable results in the Oswestry scores (P < 0.001), and the straight leg raise test (P = 0.001). All ranges of motion increased significantly with manipulation (all P < 0.001), but the control group showed favorable results only in right and left rotations and in extension (all P < 0.001). Between-group analyses showed significantly better outcomes for manipulation in all measurements (all P ≤ 0.009) with large effect sizes.

CONCLUSION

Spinal manipulation improves the results of physiotherapy over a period of 3 months for patients with subacute or chronic lumbar radiculopathy.

Molecular detection of Propionibacterium acnes in biopsy samples of intervertebral disc with modic changes in patients undergoing herniated disc surgery

Background and Objectives:

Recent studies have hypothesized that sterile disc infection with the anaerobic Propionibacterium acnes, recently renamed Cutibacterium acnes, occurs in people with intervertebral disc (IVD) herniation. This study aimed to examine the presence of P. acnes in patients who have Low back pain (LBP) with Modic changes observed in their Magnetic Resonance Imaging (MRI).

Materials and Methods:

Thirty-seven patients who were candidates for surgery due to disc herniation and demonstrated Modic changes in MRI were included in the study. Before the surgery, the level of pain in patients was assessed using the visual analog score (VAS). All patients were asked to fill in the Oswestry Low Back Pain Disability Questionnaire. Intervertebral disc changes observed in MRI were recorded for all patients. Then, during surgery, sterile intervertebral disc samples were taken. P. acnes detection was performed using PCR in the laboratory. Data analysis with Chi-squared test, independent samples t-test, and Mann-Whitney U test in SPSS 18.0.

Results:

The mean age of 37 patients equaled 43.64 years and the mean duration of symptoms was 11.05 months. In molecular examination, of the 37 individuals, the genome of P. acnes was positive in 23 cases (62.2%) and negative in 14 (37.8%). The relationship between VAS, disability score, changes in MRI, and patients’ age with the positivity of the intervertebral disc sample was also assessed. Of these variables, only age was significantly correlated with the positive molecular finding, such that with an increase in age, the probability of positive findings was increased (p = 0.022).

Conclusion:

Based on the results, lumbar disc infection with P. acnes may play a significant role in causing Modic changes and the progression of the disease in patients with LBP.

Remote Versus in-Person Exercise Instruction for Chronic Nonspecific Low Back Pain Lasting 12 Weeks or Longer: A Randomized Clinical Trial

BACKGROUND

Low back pain is a common health problem. We compared the effects of a remote exercise instruction with in-person exercise instruction on the pain and disability of people with nonspecific low back pain for more than 12 weeks.

MATERIAL AND METHODS

We carried out a randomized clinical trial with two study arms in an outpatient clinic at a University Hospital. A total of 56 patients were included and randomly allocated to each study arm. The primary outcome was the intensity of the low back pain. The secondary outcome was the Oswestry Disability Questionnaire score. We measured the outcomes before the intervention and in one and three months after completion of the program. The program consisted of core stability exercises and included flexibility and strengthening for all patients. Participants in the remote exercise group carried out the exercises at home two times a day for four weeks. They were followed by telephone calls. Patients in the in-person exercise group received the same exercises at the clinic, three times a week for four weeks.

RESULTS

Between-group comparisons indicated that there were no significant differences between the two approaches in changing pain (p = 0.93) and disability scores (p = 0.74) from the baseline to three months postintervention values.

CONCLUSIONS

There was no measurable difference between an exercise program delivered remotely compared to in-person.

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.

Randomized controlled trial of aquatic exercise for treatment of knee osteoarthritis in elderly people

Aim

The aim of this study is to assess the efficacy of aquatic exercise on pain, gait, and balance among elderly patients with knee osteoarthritis.

Methods

We performed a randomized controlled trial at a university hospital. Overall, 32 men with knee osteoarthritis, aged ≥ 60 years, were included. Pain, balance, and gait were evaluated before and 2 months after interventions. The group control used acetaminophen and followed lifestyle recommendations. The intervention group performed the aquatic exercise three sessions per week for 8 weeks.

Results

At the end of the study, mean pain scores were significantly different between the groups (p = 0.010). Within-group analyses showed that group intervention experienced significant pain relief (p = 0.019), whereas group control did not show the significant change (p = 0.493). There was significant improvement in favor of aquatic exercise with regard to static (p = 0.001) and dynamic (p = 0.001) balance, step length (p = 0.038), stride length (p < 0.001), and cadence (p < 0.001). However, we did not find a significant difference in step time and width between the two groups.

Conclusions

Aquatic exercise would be beneficial in decreasing subjective pain of osteoarthritis. There are some recognizable improvements in patients’ gait and balance as well.

The Effectiveness of Intra-Articular Injection of Hypertonic Saline in Pain Control and Function of Patients with Knee Osteoarthritis

Background: The aim of this study was to report the effectiveness of intra-articular injection of hypertonic saline in pain reduction and functional improvement in patients with knee osteoarthritis (OA). Methods: Patients with knee pain and dysfunction who fulfilled the American College of Rheumatology criteria and whose illness was sub-acute or chronic were enrolled. We performed a single intra-articular injection of 5 cc of hypertonic (5%) saline solution. Measured outcomes were Visual Analogue Scale (VAS) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) evaluated before and 1 month after intervention. Results: A total of 28 patients with mean age of 66.3 years were surveyed. Overall, study participants reported clinically and statistically significant reduction in VAS and KOOS subscales for symptoms, pain, function, daily living, sports, recreational activities, and quality of life in one month of follow-up with respect to the patients’ mean baseline scores (by 24.47%, 42.74%, 54.96%, 43.78%, and 63.63%, respectively). Although obese patients [body mass index (BMI) ≥ 30 kg/m2] showed less improvement in terms of pain, sports, and quality of life subscales of KOOS, compared with non-obese patients (BMI < 30 kg/m2); VAS score difference was not significant. Conclusion: Intra-articular injection of hypertonic saline yields a statistically and clinically significant short-term pain reduction and functional improvement of patients with knee OA.

Transcranial direct current stimulation for nonspecific low back pain: double-blind randomized sham-controlled trial

Introduction: Low back pain is recognized as a major cause of morbidity worldwide. Between 70 and 80% of adults experience at least one occasion of low back pain with duration of 3 months or longer in their lifetime. Aside from the classic treatment methods, there are other new techniques yet to be clinically investigated. Transcranial direct current stimulation (tDCS) has been reported to alleviate pain by affecting the central nervous system. To date only a small number of studies have been published on the effects of tDCS on chronic low back pain. Some of these were pilot studies and others were low-powered in terms of their inference. Therefore the clinical application of tDCS requires further careful evaluation. Objective: To assess the efficacy of transcranial direct current stimulation for treatment of chronic nonspecific low back pain. Materials and methods: We carried out a double-blind randomized sham-controlled trial in a University Hospital. In total 70 people (15 women) with low back pain were randomized to either active or sham stimulation. The primary outcome was intensity of low back pain on the Visual Analog Scale. We also used the Oswestry Disability Questionnaire to evaluate the effects of back pain on daily activities. For the active stimulation group we administered 2 mA tDCS, 20 minutes for each session, once daily, 5 days per week for 2 weeks, totaling 10 sessions. For the sham stimulation group a similar program was followed with no stimulation. Both groups used analgesic medication. Results: Within-group analysis showed that an initial decrease in pain intensity was significant in both groups (both p < 0.001). However, pain reduction became stable only in the active treatment group. There was a significant difference in the pattern of change in mean pain scores in favor of tDCS (p < 0.001). Active treatment also significantly reduced disability scores (all p values < 0.001), whereas participants in the sham treatment group did not experience functional recovery. Mixed ANOVA indicated that the pattern of change in mean scores of disability differed between the two groups throughout the study course, in favor of active stimulation (p < 0.001). Conclusion: Transcranial direct current stimulation is an effective and safe initial treatment for chronic nonspecific low back pain, and the benefits remain for at least several months.

Intra-articular botulinum toxin type A for treatment of knee osteoarthritis: Clinical trial

In recent years, there is a growing interest in new medical applications of botulinum toxin, including pain control, osteoarthritis treatment, and wound healing. While clinical applications of botulinum toxin seem promising, existing evidence regarding the therapeutic effects is still inadequate. The aim was to assess the efficacy of a single injection of abobotulinumtoxin A into the knee joint cavity to reduce pain in elderly people. We carried out a single group clinical trial in a University Hospital. Thirty participants (24 women) more than 50 years of age with knee osteoarthritis were included. Diagnosis of osteoarthritis was based on clinical and radiologic findings. We gave a single injection containing 250 units of Dysport (= 100 units of botulinum neurotoxin type A) diluted with 5 ml of normal saline. The primary outcome measure was knee pain. The secondary outcome was the patients' opinion about their knee and associated problems measured with the Knee injury and Osteoarthritis Outcome Score. The outcomes were measured at the baseline and at 4 weeks after the intervention. Within-group comparisons based on the Knee injury and Osteoarthritis Outcome Scores showed favorable results for joint pain and stiffness, sports, severity of symptoms, quality of life, and daily activities (all p-values < 0.001). Also, pain intensity, joint effusion, knee clicking and locking, and flexion-extension scores showed significant beneficial results (all p-values ≤ 0.005). We concluded that botulinum neurotoxin type A is an effective and safe initial treatment of knee osteoarthritis with clear clinical advantages. Patients' satisfaction, minimum adverse effects in addition to single-dose prescription make the toxin as a choice for the first-line therapy of osteoarthritis at least at the short-term in elderly people. The symptom relief increases the patient's compliance and willing to participate in other therapeutic programs. REGISTRATION: Iranian Registry of Clinical Trials (IRCT) website http://www.irct.ir/, a WHO Primary Register setup, with registration code: Irct ID: IRCT20180416039323N1.

Obstacles facing evidence based medicine in physical medicine and rehabilitation: from opinion and knowledge to practice

Background

Evidence-based medicine (EBM) is a new approach to medicine which can guide clinical services toward effective and beneficial results with the least side effects or errors. Up to now, there have been few available articles about specialists’ EBM status, specifically the status of physiatrists in the area of EBM.

Objective

To determine the present status of physiatrists’ attitudes, knowledge and skill in the area of EBM and the existing obstacles.

Methods

The cross-sectional study was performed in 2014 among physiatrists in Iran. The valid and reliable questionnaire contained 25 questions in 8 fields including demographic and professional information, point of view regarding EBM, familiarity with databases, educational history and information about EBM, use of scientific resources, scientific evidence usage, and the amount of access to resources. Final analysis of the questionnaires was done using SPSS version 16.

Results

One hundred twenty-eight questionnaires were completed (response percentage 52.2%). In total, 48.4% specialists had attended EBM workshops and 89.6% of people were familiar with medical search engines. The amount of familiarity with databases was mostly with MEDLINE/PubMed (52.3%). Respondents mainly had a positive point of view towards EBM. Those who had access to databases at work or somewhere out of home had a more positive attitude (p=0.002). Those who had attended EBM workshops and members of faculty also had more positive attitudes (p=0.003 and p=0.01, respectively). Around 70% of responders had adequate knowledge regarding EBM. Physicians, members of faculty and participants who had spent more time on research, reviewed articles and attended workshops had more knowledge (p=0.001). There were three major obstacles recognized: An insufficient amount of knowledge regarding the principles, advantages and applications of EBM, difficulty with gaining access to associated databases and an insufficient amount of activity in judging and analyzing the related articles.

Conclusion

Results from our study revealed that although there is a significant number of physiatrists who are familiar with the practicality of EBM, they are still not familiar enough with its concepts and applications.

Association study of interleukin-1 family and interleukin-6 gene single nucleotide polymorphisms in recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is a common painful, ulcerative oral inflammatory disorder with unknown aetiology. Immune system and aberrant cytokine cascade deemed to be critical in outbreaks of RAS ulcers. Interleukin-1 (IL-1) and IL-6 are the most potent pro-inflammatory cytokines. Single nucleotide polymorphisms (SNPs) of IL-1 and IL-6 genes can affect the secretion of these cytokines. The aim of this study was to investigate the association between RAS and IL-6 and IL-1 in Iranian subjects with minor RAS. Genomic DNA was obtained from 64 Iranian patients with RAS. IL-1α C -889 T, IL-1β C -511 T, IL-1β C +3962 T, IL-1R C pst-I 1970 T, IL-1Ra C Mspa-I11100 T, IL-6 C -174 G and IL-6 A nt +565 G polymorphisms were determined using polymerase chain reaction with sequence-specific primers (PCR-SSP). The frequency of C -174 C genotype in the patients group was significantly different from the healthy control. No other significant differences were found in genotype and alleles frequencies between the two groups. These results indicate that certain SNPs of IL-6 gene at position -174 which located in promoter have association with predisposition of individuals to RAS.

Hypertonic dextrose versus corticosteroid local injection for the treatment of osteoarthritis in the first carpometacarpal joint: a double-blind randomized clinical trial

PURPOSE

To compare the advantages of prolotherapy in the treatment of first carpometacarpal osteoarthritis (OA) with those of corticosteroid local injection in the short and long term.

METHODS

We performed a randomized controlled trial from March 2010 to March 2011 in an outpatient clinic at a university hospital. Sixty participants (60 hands) with OA of the first carpometacarpal joint were assigned equally to two groups. For the corticosteroid group, after 2 monthly saline placebo injections, a single dose of 40 mg methylprednisolone acetate (0.5 ml) mixed with 0.5 ml of 2% lidocaine was injected. For the dextrose (DX) group, 0.5 ml of 20% DX was mixed with 0.5 ml of 2% lidocaine and the injection was repeated monthly for 3 months. Pain intensity, hand function and the strength of lateral pinch grip were measured at the baseline and at 1, 2, and 6 months after the treatment.

RESULTS

Mean age (STD) was 63.6 (9.7) years, and mean (STD) visual analog scale (VAS) was 6 (2). The two groups were comparable at 2 months, but significantly different at 1 month, with better results for corticosteroid, and at 6 months with apparently more favorable outcome for DX [mean difference (95% CI) in VAS = 1.1 (0.2, 2.0), p = 0.02]. After 6 months of treatment, both DX and corticosteroid injection increased functional level, but DX seemed to be more effective [mean difference (95% CI) in total function score = 1.0 (0.2, 1.8), p = 0.01].

DISCUSSION

For the long term, DX seems to be more advantageous, while the two treatments were comparable in the short term. Because of the satisfactory pain relief and restoring of function, we would prefer DX prolotherapy for the treatment of patients with OA.

LEVEL OF EVIDENCE

Therapeutic studies--investigating the results of treatment; level I.

Epidermal growth factor receptor gene expression evaluation in colorectal cancer patients

Background: Colorectal cancer is one of the most common causes of death in the world and third and fourth most common cancer among men and women in Iran respectively. Epidermal growth factor receptor (EGFR) is a tyrosine kinase receptor that shows over expression in epithelial tumors and regulates important processes in tumorigenesis. Incidence and characteristics of colorectal cancer are based on the geographic region and race. Aim: In this research work, the over expression of EGFR in formalin fixed paraffin-embedded (FFPE) colorectal cancer tumor tissue of patients was studied. Materials and Methods: Fifteen FFPE colorectal cancer tumor tissues (10 women and 5 men; 25-65 years old and stage IV) and 15 non-patients (nine women and six men; 25-65 years old) that were collected during 2006-2012. EGFR gene expression level was analyzed by real-time quantitative reverse transcriptase polymerase chain reaction (PCR). All PCR reactions were performed in triplicate for both target gene and internal control (18s ribosomal ribonucleic acid) with the 2-ΔΔCT method. Gene expression differences in patients and controls were evaluated with t-test. Results: The results were showed EGFR gene over expression in 12 (80%) of 15 patients. There was a statistically significant difference in the prevalence of EGFR expression between patients and control (P < 0.05). Conclusion: Our results demonstrated EGFR gene over expression in colorectal cancer tumor tissue compared with controls.

A randomized and controlled comparison of the wash-resistances and insecticidal efficacies of four types of deltamethrin-treated nets, over a 6-month period of domestic use with washing every 2 weeks, in a rural area of Iran

In a randomized, prospective, 6-month-long field study in a rural area of Iran, the wash resistances of 200 nets (40 PermaNet, 40 Yorkool and 40 A-Z nets), that their manufacturers claimed be long-lasting insecticidal nets (LLIN), were compared with those of 40 nets conventionally treated with deltamethrin (using K-O Tab tablets). All the nets were kept in routine domestic use and subjected to standardized hand-washing at 2-week intervals. Wild-caught or laboratory-reared Anopheles stephensi were used for the bio-assays of insecticidal activity. The regular washing and domestic use led to reductions in the insecticidal activities of all the treated nets after 6 months. Although the PermaNet nets showed the smallest reduction, they were not significantly better than the conventionally treated nets, which still showed acceptable insecticidal activity after 6 months. The PermaNet and A-Z nets both performed significantly better than the Yorkool nets, which were slightly but not significantly worse than the conventionally treated nets. In questionnaire-based interviews, the local householders were found to wash their own (non-study) nets at median and mean frequencies of every 2 and 2.1 weeks, respectively. In conclusion, the PermaNet nets showed better wash resistance than any of the other commercial nets, and were the only commercial nets tested that truly appeared to be LLIN. There still appears to be scope, however, for the impregnation, and thus the wash-resistance, of even the PermaNet nets to be improved.

Effects of a novel hydrophilic phytostanol analog on plasma lipid concentrations in gerbils

This study was designed to determine the effects of a novel hydrophilic phytostanol analog, FM-VP4, on total plasma cholesterol, total plasma triglyceride, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol concentrations after acute oral administration to gerbils. Gerbils were administered a standard gerbil diet for 4 continuous weeks, and daily water and food intake was monitored and replaced. The diet contained either no FM-VP4 (control) or FM-VP4 at the following concentrations: 0.25, 0.50, 1.0, or 2.0% w/w; six gerbils were fed each diet formulation. After 4 weeks of receiving a single diet formulation, blood was obtained from each gerbil by cardiac puncture and the animals were sacrificed humanely. Plasma obtained from this blood was analyzed for total cholesterol, total triglyceride, and HDL cholesterol levels by standard enzymatic and precipitation techniques. LDL cholesterol levels were calculated using the Friedewald equation. Administration of dietary FM-VP4 resulted in significant decreases in total plasma cholesterol and LDL cholesterol concentrations compared with controls. Dietary FM-VP4 at concentrations of 1% and 2% (w/w) decreased total plasma cholesterol by 3.4 mmol/L compared with controls. This decrease was entirely due to the loss of cholesterol from the LDL pool because LDL cholesterol was decreased by 3.3 and 3.2 mmol/L after 1% and 2% (w/w) FM-VP4, respectively. There were no significant changes in plasma triglyceride or HDL cholesterol concentrations after the administration of FM-VP4. Animals administered 1% or 2% (w/w) FM-VP4 also had significantly lower body weight after 4 weeks of treatment compared with the other groups. However, no unusual behavior was observed in these animals. No major differences in daily water or food intake were observed throughout the study. These findings indicate that FM-VP4 decreases total and LDL cholesterol concentrations.

Assessing plasma lipid levels, body weight, and hepatic and renal toxicity following chronic oral administration of a water soluble phytostanol compound, FM-VP4, to gerbils

The purpose of this project was to determine the effect of a FM-VP4 when incorporated into the diet or drinking water on plasma lipids, body weight, and hepatic and renal function following chronic oral administration to gerbils. Gerbils were administered water and food daily containing either no FM-VP4 (controls; n=6), 2% or 4% FM-VP4 incorporated into the gerbil diet (n=6 each treatment group) or 2% or 4% FM-VP4 dissolved in the drinking water (n=6 each treatment group). Body weight and food and water intake were monitored weekly. Following 8 weeks of this regiment blood was obtained via a cardiac puncture and all animals were sacrificed humanely. Plasma obtained from this blood was analyzed for total cholesterol, total triglyceride and high-density lipoprotein (HDL)-cholesterol levels by standard enzymatic and precipitation techniques. Low-density lipoprotein (LDL)-cholesterol levels were determined by the Friedewald equation. The plasma was also analyzed for changes in hepatic enzyme (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) and plasma creatinine (renal function) concentrations. 2% and 4% FM-VP4 administration incorporated both into the diet and in the drinking water resulted in a significant decrease in total plasma cholesterol and LDL cholesterol concentration compared to controls. Animals administered 4% FM-VP4 in either their diet or drinking water had significantly lower body weight following the 8 weeks of treatment compared to the other groups. Significant differences in daily water intake was observed in all treatment groups with the exception of the 2% FM-VP4 in diet group compared to controls. Significant differences in daily food intake were observed in gerbils administered 2% FM-VP4 in the drinking water and 4% FM-VP4 in the diet and drinking water groups compared to controls. A significant decrease in total plasma triglyceride concentration was observed in gerbils administered 4% FM-VP4 in their drinking water compared to controls. A significant increase in HDL cholesterol concentrations was observed in gerbils administered 2% FM-VP4 in their diet and 4% FM-VP4 in their drinking water compared to controls. No significant elevations in AST, ALT and creatinine concentrations were reported for all treatment groups compared to controls. These findings suggest that FM-VP4 significantly decrease plasma lipids and body weight with no apparent hepatic or renal toxicity.

Assessing the plasma pharmacokinetics, tissue distribution, excretion and effects on cholesterol pharmacokinetics of a novel hydrophilic compound, FM-VP4, following administration to rats

PURPOSE

The purpose of this project was to 1) assess the disposition kinetics of [3H]-cholesterol following co-administration with a novel hydrophilic compound, FM-VP4, and 2) determine the pharmacokinetics, tissue distribution and excretion of [3H]FM-VP4 following single oral (150 mg/kg which includes 100 mCi of radiolabel) and intravenous (15 mg/kg which includes 10 mCi of radiolabel) doses.

METHODS

Following an overnight fast (12-16 h) and 48 h post-surgery, adult male Sprague Dawley rats were divided into six treatment groups (n=4/group). Groups received single oral doses of 25 mCi/ml [3H]cholesterol alone or with 5, 10, 20, 50 and 100 mg/kg FM-VP4 at 0700 h. Ten percent Intralipid was used to solubilize and co-administer [3H]-cholesterol and FM-VP4. LC-MS analysis confirmed minimal cholesterol and vegetable stanol content within 10% Intralipid. Thin layer chromatography was used to confirm that the majority of radioactivity measured in plasma was associated with either esterified or unesterified cholesterol. In a second study pharmacokinetics of [3H]FM-VP4 were studied following intravenous or orally gavaged doses (n=8). Tissues, urine and feces were also collected in FM-VP4 kinetics study to measure tissue distribution of radioactivity. Plasma [3H]-cholesterol and [3H]FM-VP4 were tested for radioactivity.

RESULTS

FM-VP4 co-administration significantly decreased [3H]-cholesterol AUC0-48h and Cmax, and increased CL/F and Vd/F of [3H]-cholesterol as compared to controls in a dose-dependent manner. Following oral administration of [3H]FM-VP4, the majority of radioactivity following was recovered in the feces and gastrointestinal (GI) tract. The compound exhibited an oral bioavailability of 6.5%. Following IV administration, a two-compartment pharmacokinetic model was observed and the majority of the radioactivity was recovered in the GI tract.

CONCLUSIONS

FM-VP4 reduces plasma concentration of [3H]-cholesterol in fasting rats. [3H]FM-VP4 has a very low oral bioavailability.