Journal of Kerman University of Medical Sciences
Year:2013 | Volume:20 | Issue:1|Papers Count:14

Background & Aims: Treatment of osteoporotic distal radius fracture with metaphyseal defect is often complicated by secondary displacement, because of posterior cortex comminution. The aim of this study was to investigate functional outcomes and advantages of injection of bone cement in stabilizing and maintaining this fracture reduction.Methods: This prospective study was performed on 20 patients aged fifty years and older. After primary reduction and bone cement injection into metaphyseal void through minimal dorsal distal forearm incision, a short arm cast was applied for 3 weeks. Then the cast was removed and free use of the wrist was begun.Patients were assessed after 6 weeks, 3 months and 6 months in regard to active wrist range of motion, pain score, grip strength, DASH score, modified Mayo wrist score and standard radiographic parameters.Results: The patients included 3 men and 17 women withthe mean age of 67 years old. According to the AO classification, there were seventeen type-A3 and three type-C2 distal radius fractures. At final follow up, the active range of motion of the injured side relative to uninjured side averaged 91% of flexion, 93% of extension, 91% of radial deviation, 93% of ulnar deviation, 98% of pronation and 99% of supination. Mean DASH score was 4.4. Grip strength was 90% of the uninjured side. According to the modified Mayo wrist score, there were fourteen excellent and six good results. Mean final radiographic parameters were 10° of volar angle, 24o of radial inclination, 10 mm of radial length, 1 mm of ulnar variance, and 0.3 mm of intraarticular gap. Each of median nerve hyposthesia due to compression before reduction, loss of reduction, soft tissue cement deposit and reflex sympathetic dystrophy, occurred in one patient. None of the patients had further complications.Conclusion: According to the results, injection of bone cement in osteoporotic unstable distal radius fracture can be considered a safe and effective treatment method; it causes clinical functional improvement and rapid rehabilitation with little complications.

Background & Aims: The Plantaris muscle is located in the superficial posterior compartment of the leg and is absent in some individuals. The present study was undertaken to evaluate the absence variation of Plantaris muscle and its possible relation with Palmaris longus and fifth superficial flexor digitorum of the hand.Methods: 83 fresh cadavers, referred to legal medicine center, Kerman, Iran from April 2010 to November 2011 were enrolled in the study. Dissection was performed using mini incisions and the results were recorded in a questionnaire including presence or absence, length and width of the Plantaris and Palmaris longus tendons, and the presence or absence of the fifth superficial flexor. The suitability of the Palmaris and Plantaris tendons was assessed using the previously described criteria and according to the criteria that are proposed by us.Results: 8 of the 83 cadavers showed variations. Plantaris tendon was present in 80 (96.3%) and absent in 3 (3.7%), of which was absent bilaterally in two (2.3%) and unilaterally in one (1.2%).6 cadavers (7.2%) were deficient in Palmaris longus tendon, 4 bilateral (4.8%) and 2 (2.3%) unilateral. Bilateral absence of fifth flexor digitorum superficialis was observed in 2 cadavers (2.3%) and one showed unilateral absence (1.2%).There was no statistically significant relationship (p<0.05) among the presence of Palmaris longus, plantaris and fifth superficial flexor. The plantaris tendon by far showed better characteristics for graft than the Palmaris tendon.Conclusion: According to the results of the present study, considering the Plantaris tendon for graft harvest seems logic, noting its high percentage of presence and better characteristics.

Background & Aims: Since apoptotic cell death plays a crucial role in many neurodegenerative diseases, control of apoptosis can be taken into account as a putative neuroprotective strategy. Due to the reported neuroprotective effect of the herbal medicine Nepeta Menthoides (Ostokhodus) on the axotomy-induced apoptosis in the spinal motoneurons, in the present study we have investigated its prophylactic capacity.Methods: In 20 two-day neonate rats (one control and three experimental groups) the right sciatic nerve was transected and in all samples the left ventral horn was considered as internal control. The experimental groups received different doses of alcoholic extract of Ostokhodus intraperitoneally for 3 days starting 24 hours before axotomy, and the control group was treated with equal volume of normal saline similarly. At the end, in the ventral horn of the related spinal cord segments the mean number of survived motoneurons, and by means of TUNEL assay the apoptotic motoneurons were counted.Results: In all groups transection of sciatic nerve resulted in a significant reduction of motoneurons through apoptosis, which could be prevented significantly by administration of 500 and 1000mg/kg of Ostokhodus.The drug administration from 24 hours before axotomy did not result in any more prominent neuroprotection.Conclusion: The neuroprotective effect of Ostokhodus on axotomized motoneurons, which acts through inhibition of apoptosis, has no prophylactic effect and its administration before neural injury causes no more neuroprotective effect.

Background & Aims: There are several reports about anti-oxidant effects of garlic in the literature. In this study the effect of garlic alcoholic-water extract on the treatment of lead-induced toxicity in kidney of neonatal rat and the protective effect of garlic alcoholic water extract on body and kidney weight and also kidney tissue were investigated.Method: Neonatal rats were divided into 7 groups, (n=8). The first group (control) received no material, the second group (sham) received 0.1 ml normal salin, the third group received 0.6 g/l lead, the forth group received 0.4 g/kg garlic alcoholic – water extract in water and alcohol solution (each 50%) and the fifth, sixth and seventh groups first received 0.6 g/l lead and then respectively 0.1, 0.2, 0.4, g/kg garlic. All substances were administered through gavage and in 10 consecutive days. Twenty four hours after the last day of injection, body and kidney weights were measured and after mild anesthesia, kidney was removed and fixed in formalin for preparing tissue sections. Tissue alterations were investigated by light microscope.Results: Based on the obtained results, body and kidney weights in the 3rd, 5th, 6th and 7th groups showed significant Increase as compared with the control group. Body and kidney weight in the 4th group showed significant decrease as compared with lead group. Histological examination of kidney tissue showed that garlic administration decreased the rate of kidney tissue damage.Conclusion: Garlic, due to its antioxidant effect, can prevent lead-induced toxicity and tissue damage in the kidney.

Background & Aims: Full-time Practice is one of the main objectives of Iranian Ministry of Health and Medical Education (MOHME) and a priority in Iran 5th development program. The aim of this study was to explore the perception of the chancellors at Iran universities of medical sciences, regarding the challenges, possible negative consequence and their suggestions for improving the implementation of this program.Methods: In the 68th meeting of Iran medical university chancellors held in 2011 by Iranian Ministry of Health and Medical Education, a semi-structured questionnaire was completed by chancellors. The gathered data were analyzed.Results: In Medical University Chancellors’ poin of view, the need for increasing the share of healthcare budget from the gross domestic product (GDP), inefficient tariff and payment system, and difficulty in obtaining collaboration with other stakeholders are the main challenges of full-time practice program in Iran.It is suggested that this program should be implemented gradually in a specific set of Iran hospitals that have already gained more autonomy. In addition, inappropriate implementation of this program might read to unexpected and unread transfer of the experienced and high skilled physicians for public and private hospitals.Conclusion: Full-time practice has several important challenges that should be considered during its implementation. This program should be implemented gradually with other joint program especially with improvement of payment methods.

Background & Aims: Prevalence of community and hospital acquired methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing. The primary reservoir is the anterior nares; and nasal carriage is a risk factor for infection in a variety of populations. Infection due to hospital-acquired colonization is different from community acquired in clinical manifestations and antibiotics susceptibility. In this study, we investigated nasal colonization rate and antimicrobial susceptibility of community and hospital acquired staphylococcus aureus nasal colonization at childhood.Methods: This cross-sectional study was conducted in children admitted at Kerman Afzalipour hospital, Iran, during June to November 2011. Sample was taken from nostrils of 180 patients in the beginning and after 48 hours of admission for staphylococcus aureus nasal colonization and antibiotics susceptibility test.Results: Of 180 samples at the beginning of hospitalization, 22 (12.2%) had staphylococcus aureus nasal colonization; from these, 18.1% were methicillin-resistant (2.2% of total population). Methicillih-resistant staphylococcus aurous colonized children had significantly greater mean age than non-colonized (P<0.001).After 48 hours, 22 (12.2%) were colonized with staphylococcus aurous; from these, 11 (50%) were hospital acquired methicillih-resistant. All methicillih-resistant staphylococcus aurous isolates were sensitive to vancomycin. The rate of resistance to the other current in-use antibiotics was more common in hospital acquired staphylococcus aureus.Conclusion: Community acquired methicillih-resistant staphylococcus aurous is sensitive to many antistaphylococcus agents in our region. Methicillin-resistant Staphylococcus aureus (MRSA) colonization in admitted patients can occur. Empirical antibiotics recommendation in nosocomial infection should be on the base of periodic culture and antibiotics susceptibility test.

Background and Aims: The accurate mechanisms of ankle instability cannot be assessed in the absence of reliable knowledge about ground reaction force (GRF) variables. The purpose of this study was to evaluate the test-retest reliability of GRF variables during forward and lateral jump-landing in volleyball players with functional ankle instability (FAI).Methods: Eighteen professional volleyball players with unilateral FAI participated in this study. They performed four jump-landing trials in forward and lateral directions. After a one-week interval, the repeatability of GRF variables including peak and time to peak of the three components of GRF (Fx, Fy, Fz) were assessed using intraclass correlation coefficients (ICC), standard errors of measurement (SEM), and coefficient of variation (CV).Results: All variables in both forward and lateral jump-landing showed high to very high repeatability.However, time to peak of Fx in lateral jump-landing demonstrated moderate repeatability (ICC=0.67). The CVs of all GRF measures were less than 10% except for the peak and time to peak of Fx component in lateral jump-landing (14.55% and 13.15%, respectively). In general, the repeatability of GRF variables in forward jump-landing was greater than that in lateral jump-landing.Conclusion: GRF variables in forward and lateral jump-landing had high consistency. These parameters were found to be useful in the assessment of GRF patterns in subjects with FAI.

Background and Aims: Identifying risk factors for incidence of migraine headaches through an integrated model of psychosocial factors is important. This research aimed to investigate the predictive role of psychological, socioeconomic and lifestyle-related factorsin migraine headaches.Methods: In a cross-sectional descriptive study, 71 patients with migraine headaches who referred to Imam Hossein Hospital (Tehran, Iran) and 162 healthy staff members of the same hospital were selected by convenience sampling. Data was collected by a questionnaire including demographics and disease characteristics and the short form of the Depression, Anxiety, and Stress Scale (DASS-21). The collected data was analyzed using chi-square test, t-test and binary logistic regression analysis.Results: There were significant differences between patients with migraine and healthy individuals in anxiety [odds ratio (OR) =4.775; 95% confidence interval (CI): 1.371-12.895], depression (OR=5.668; 95% CI: 1.449-14.811), stress (OR=5.896; 95% CI: 1.339-12.924), low socioeconomic status (OR=6.230; 95% CI: 2.466-13.487), body mass index greater than 30 kg/m2 (OR=5.051; 95% CI: 2.454-14.660), physical activity of less than two hours a week (OR=5.290; 95% CI: 1.432-11.572), smoking (OR=4.253; 95% CI: 2.493-15.171), and history of negative life events (OR=6.899; 95% CI: 1.626-13.755).Conclusion: Psychological risk factors, inappropriate socioeconomic status, and unhealthy lifestyle could predict the incidence of migraine. This finding is fundamental for further investigations and administration of preventive and therapeutic interventions for patients with migraine.

Background & Aims: Anopheles stephensi is one of the most important malaria vectors in Hormozgan province, southern Iran. This species with high density has an effective role in malaria transmission, especially in plain and coastal areas. At present, the country malaria vector control program in areas with local transmission is using deltamethrin 5% and Bacillus thuringiensis as insecticide and larvicide, respectively. The aim of this study was to determine the current susceptibility status of Anopheles stephensi to the mentioned pesticides.Methods: Susceptibility tests to deltamethrin in diagnostic dose (0.05%) and Bacillus thuringiensis granules were conducted against the field strain of Anopheles stephensi collected from Siahoo area in the Bandar Abbas county, and Bashagard district, Iran, as well, using standard methods of World Health Organization.Results: The mortality of Anopheles stephensi mosquitoes against deltamethrin was recorded as 97 and 98 percents, for Siahoo and Bashagard strains, respectively. Therefore, both strains were susceptible, although Siahoo strain needs more study. Larviciding test by recommended dose of Bacillus thuringiensis granules after 24 hours showed 63.5 and 39 percent mortality for Siahoo and Bashagard strains, respectively. These values increased to 77 and 56 percent after 48 hours.Conclusion: Targeted insecticide application is recommended to prevent the resistance in malaria vectors, while regular susceptibility tests are advised for monitoring of resistance status.

Acute myopia following use of some drugs is a relatively rare condition. Topiramate prescribed for seizure prophylaxis is one of these drugs. In this paper a case of acute transient myopia after taking topiramate is reported.The reported patient is a 28-year old woman who had no history of any eye disease. Following consumption of topiramate pill for one week, she had found blurred vision since one day prior to the admission. A complete ocular examination revealed acute bilateral myopia. This disease was resolved about 48 hours after discontinuation of topiromate. Due to the wide spectrum of indications for the administration of Topiramate, neurologists and psychiatrists should be aware of its ocular side effects. In conclusion, ocular complications following this drug should be taken seriously and be subjected to ophthalmic counsaltation.

Background & Aims: Teleradiology as an efficient way for avoiding unnecessary transfer of patients to special medical centers requires the images with digital format. However, in some developing countries, including Iran, imaging is being done using non digital devices. In such cases, changing analog images into digital ones can solve the problem. The method which is nowadays used for digitalizing analog images is using digitizers. Since in some regions digitizers are not available, using digital cameras as more accessible and cost-effective devices is a good choice, provided that the reliability of digital cameras for providing digital formats of radiographs would be confirmed.Method: In this study, at first, 91 radiographs were randomly selected. These images were then shown to a radiologist and he was asked to interpret them. Next, a digital image was produced from each radiograph using a digital camera. After 40 days, these digital images were shown to the same radiologist and he was asked to interpret them. The interpretations were then analyzed and compared using Kappa agreement coefficient.Results: The calculated Kappa agreement coefficient indicated a “Good” diagnostic agreement (kappa=0.708, P<0.000) between diagnoses made by using radiographs and their digitalized images.Conclusion: This study recommends that in cases of need for consultation with a specialist, capturing a digital image of radiograph by a digital camera and sending it to the spesialist via an internet line can be a reliable solution. This method can be used as a useful and cost-effective way of consultation with a radiologist who is working in another medical center.