Ultrasound-Guided Versus Landmark-Guided Local Corticosteroid Injection for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective

To review the literature and assess the comparative effectiveness of ultrasound-guided versus landmark-guided local corticosteroid injections in patients with carpal tunnel syndrome (CTS).

Fetal cerebral hemodynamic in gestational diabetic versus normal pregnancies: a Doppler velocimetry of middle cerebral and umbilical arteries

Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancies. Evaluating other conditions, including intra uterine growth restriction and pre-eclampsia, some studies have shown significant changes in blood flow velocity of fetal middle cerebral artery (MCA). Our study is one of the few that has aimed to assess the effects of GDM on Doppler parameters of the fetal MCA and umbilical artery (UA) and to compare with normal pregnancies. This cross-sectional study was performed on 66 pregnant women, including 33 women with GDM and the others without it, in Akbar-Abadi University Hospital in Tehran, Iran during 2010–2011. Peak systolic and diastolic velocities, pulsatility index (PI), resistance index (RI) and systolic diastolic ratio (SD) were recorded in UA as well as both right and left fetal MCAs for every recruited pregnant women by means of Doppler ultrasonography. The mean gestational age at the time of examination was 34.45 (SD = 2.62) weeks in GDM group. Although all of the measured Doppler parameters had higher values in GDM pregnancies, the differences were not significant between two groups of study; except for the left fetal MCA-PI, which was significantly higher in GDM group [2.07 (SD = 0.07) vs. 1.85 (SD = 0.74), P = 0.03]. Our results show that gestational diabetes may contribute to an elevated PI in the fetal MCA. Although there is not yet strong proof for the effect of GDM on the fetal brain hemodynamics, the significant higher MCA-PI warrants more attention towards better controlling of the hyperglycemia during pregnancy.     

Carotid duplex ultrasound and transcranial Doppler findings in commercial divers and pilots

The risky working environments of divers and pilots, and the possible role of extreme ambient pressure in carotid stenosis, make ischemic stroke an important occupational concern among these professionals. In this study, we aimed to evaluate the association of being exposed to hyperbaric or hypobaric conditions with carotid artery stenosis by comparing common carotid intima-media thickness (CCIMT) and blood flow velocities of cerebral arteries in divers and pilots using carotid duplex ultrasound (CDUS) and transcranial Doppler (TCD). CDUS and transtemporal TCD were performed in 29 divers, 36 pilots and 30 control participants. Medical history, blood pressure, lipid profile and blood sugar were recorded to control the previously well-known risk factors of atherosclerosis. Findings of the CDUS and TCD [including: CCIMT and blood flow velocities of internal carotid artery (ICA), common carotid artery (CCA), and middle cerebral artery (MCA)] of divers and pilots were compared with those of the control group using regression analysis models. Both right and left side CCIMT were significantly higher in divers (P < 0.05) and pilots (P < 0.05) in comparison with the control group. Carotid index [peak systolic velocity (PSV) of ICA/PSV of CCA) of divers and pilots were also higher than the control group. TCD findings were not significantly different between divers, pilots, and the control group. Increased CCIMT and carotid index in diver and pilot groups appear to be suggestive of accelerated atherosclerosis of carotid artery in these occupational groups.     

Urine macrophage migration inhibitory factor (MIF) in children with urinary tract infection: a possible predictor of acute pyelonephritis

Macrophage migration inhibitory factor (MIF) is an important pro-inflammatory cytokine expressed at sites of inflammation. We have assessed this factor (MIF) in urinary tract infections with the aim of determining a non-invasive and sensitive method to differentiate upper and lower renal involvement. Thirty-three pediatric patients with urinary track infection (25 with acute pyelonephritis, eight with acute cystitis) and 40 healthy subjects were recruited for this prospective case-control study. Pyelonephritis was differentiated from cystitis by dimercaptosuccinic acid (DMSA) scan. Urinary MIF concentration was determined using an enzyme-linked immunosorbent assay method. The urine MIF/creatinine (Cr) ratio was significantly higher in pyelonephritis patients than in those with acute cystitis and the control group (P < 0.001). The optimal cut-point of 4.90 pg/micromol Cr for the urine MIF/Cr ratio has the potential to be a biomarker for distinguishing patients with acute pyelonephritis from those with acute cystitis. Determination of the urinary MIF was also useful in selecting the patients at risk of permanent renal damage. Of those patients with pyelonephritis, based on the DMSA scan at the time of infection, scarring on follow-up DMSA scan 9-12 months later occurred in patients with the highest urinary MIF/Cr ratios. We conclude that the urine MIF/Cr ratio is a sensitive test for differentiating acute pyelonephritis from acute cystitis and also for detecting children with acute pyelonephritis who are at a higher risk for permanent renal scars in the future.     

The Callender modification of the Macintosh laryngoscope blade reduces the risk of tooth-blade contact in children

Background: Dental injury is well recognized as a potential complication of laryngoscopy and tracheal intubation. The flange of the Macintosh blade may contact teeth during laryngoscopy causing damage. The Callander modification of the Macintosh blade (Callander blade) with a shortened heel at the proximal end has been shown to increase the blade–tooth distance and reduce contact rates in adults. Aim: This study was designed to evaluate the effectiveness of the Callander blade on reducing dental contact in children. Methods: One hundred children, aged 4–14 years, scheduled for general anesthesia requiring endotracheal intubation were studied prospectively. The children were preoperatively evaluated for Mallampati score and dental defects, looseness, and avulsions. Following induction of anesthesia, laryngoscopy was performed twice on each child in succession, once with a standard Macintosh blade and once with a Callander blade of the same size in a random order. The blade–tooth distance and contact rate were compared between the two blades. Results: With the Callander blade, the blade–tooth distance was greater than with the Macintosh (1.78 ± 1.77 vs 0.28 ± 0.76 mm, P = 0.001). The frequency of direct contact was less with the Callander blade than it was with the Macintosh blade (33% vs 86%, respectively, P = 0.008). However, difficult laryngoscopy rate did not differ between the blades. Tracheal intubation was successful in all children and there was no dental injury. Conclusion: Our findings suggest that the Callander blade decreases the risk for dental injury and provides tracheal intubating conditions in children with normal airways similar to those obtained with a traditional Macintosh blade.     

Trauma care system in Iran

Objective

The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function.

Methods

The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.

Results

Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources), it is not yet established in our system of trauma care.

Conclusions

It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.     

C-reactive protein as an available biomarker determining mental component of health-related quality of life among individuals with spinal cord injury

Objectives: C-reactive protein (CRP) has been shown to correlate with health-related quality of life (HRQL) in some chronic medical conditions. However, these associations have not yet described in spinal cord injury (SCI). In this study, we tried to identify biomarkers associated with HRQL in SCI.

Design: Cross-sectional.

Setting: Tertiary rehabilitation center.

Participants: Referred patients to Brain and Spinal Cord Injury Research Center between November 2010 and April 2013.

Outcome Measure: Blood samples were taken to measure circulatory CRP, leptin, adiponectin, ferritin, parathyroid hormone, calcitonin, thyroid hormones, fasting plasma glucose and lipid profile. All the analyses were performed with adjustment for injury-related confounders (level of injury, injury completeness and time since injury) and demographic characteristics. HRQL was measured with Short Form health survey (SF-36).

Results: The initial inverse association between CRP and total score of SF-36 (P: 0.006, r?=??0.28) was lost after adjustment for confounders. However, the negative correlation between CRP and Mental Component Summary (MCS) remained significant (P: 0.0005, r?=??0.38). Leptin level was inversely correlated with Physical Component Summary (PCS) (P: 0.02, r?=??0.30).

Conclusion: Although CRP and leptin levels were not related with total scores of SF-36 questionnaire, CRP can be more useful in determining mental component of HRQL whereas leptin can be a determinant of physical component. The combined consideration of these two biomarkers may help to predict HRQL in individuals with SCI.     

Live birth/parity number and the risk of incident hypertension among parous women during over 13 years of follow‐up

The effect of live birth/parity number on incident hypertension was investigated among Iranian parous women aged 30–70 years. The study population included 2188 normotensive women who were enrolled in 1999–2001. They were followed for incident hypertension (based on JNC 7 report) by 3‐year intervals up to April 2018. Multivariable Cox proportional hazard models, adjusted for a wide set of potential hypertension risk factors, reproductive factors, and pregnancy complications, were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the number of parity/live birth(s) for incident hypertension. Additionally, as a sensitivity analysis, age‐scale Cox regression was also done. During a median follow‐up of 13.5 years, 935 incident hypertension have occurred. Compared to those with two live births, the participants who had 3 and ≥4 live births were at higher risk of hypertension development by the HRs of 1.25 [95% CI: 1.02–1.55] and 1.39 [1.12–1.72], respectively, in the full‐adjusted model. Moreover, each additional live birth increased the risk of hypertension by a HR of 1.06 [95%CI: 1.02–1.11]. Results of parity number were also similar. Considering age as time scale also did not change the results generally. The authors found a significant interaction between live birth/parity number and age groups; the adverse effect of higher live birth/parity numbers on hypertension development was mainly found among those aged < 50 years. To sum up, compared to the live birth/parity number of two, Iranian women with ≥3 live birth/parity had a higher risk of incident hypertension; the issue was more prominent among younger mothers.     

Ethnobotanical survey of herbal remedies traditionally used in Kohghiluyeh va Boyer Ahmad province of Iran

Ethnopharmacological relevance

Medicinal plants are an important element of medical system. These resources are usually regarded as part of cultural traditional knowledge. We present for the first time the results of an ethnobotanical survey in Kohghiluyeh va Boyer Ahmad province of Iran, conducted between 2008 and 2010. This information could be the basis of an evidence based investigation to discover new drugs.

Materials and methods

Ethnobotanical data were analyzed by use-reports in addition important indices like relative frequency of citation (RFC) and cultural importance index (CI) were calculated. Totally 23 informants were interviewed.

Results

Our study reports 138 traditionally used plant species, belonging to 52 plant families from this province. Asteraceae and Lamiaceae are the dominant locally used families. The highest number of species and application were reported for digestive system disorder, metabolic disorder and respiratory system, respectively. The part of the plant most frequently used was the aerial part (31.9%), leaves (14.8%) and fruits (11.7%). The plants are used both for medicinal and non-medicinal purposes. Daphne mucronata Royle. and Teucrium polium L. have the largest value of relative frequency of citation and cultural importance index, respectively.

Conclusion

Kohghiluyeh va Boyer Ahmad has good ethnobotanical potential for medicinal plants. This study is the first contribution to the ethnobotany of this region. We have gathered from this province some considerable knowledge about local medicinal plants for treating common health problem that is ready to be further investigated in the laboratory.