Researcher Bulletin of Medical Sciences
Year:2008 | Volume:12 | Issue:5 (59)|Papers Count:16

Background: Cervical interbody cages have been developed to provide anterior structural support. Limited numbers of investigations have focused on results of anterior cervical fusion, using cage implants considering the material used for filling the cage. The objective of this study is to report the surgical results of anterior cervical fusion using interbody cages filled with Novabone and autologous bone graft and, moreover, to compare these results with other series applied autologous graft, solely, as the filler material.Materials and Methods: Demographic and clinical characteristics of 33 cases with cervical degenerative disc disease, who underwent fusion using interbody cages filled with Novabone and autologous bone graft in Mehrad Hospital from 2003 to 2006 were evaluated and the outcome was determined by assessing the improvement of postoperative axial and radicular pain and fusion success by radiographic assessment including sagittal alignment and kyphosis and the results were compared with other series applied autologous graft as the cage filling material. In follow up visits, complications related to cage implants were reported, as well.Results: Thirty three patients with cervical degenerative disc disease underwent fusion procedure with interbody cages filled with Novabone mixed with autologous bone graft in Mehrad Hospital between 2003 and 2006. Nineteen cases were male (57.6%) and fourteen ones (42.4%) were female. The mean age at the time of diagnosis was 47.1 y. One-level fusion was performed in 23 cases, 10 patients underwent two-level fusion, and in one patient three-level fusion was performed. The mean follow-upperiod was 13 months. After one year, successful fusion occurred in 91.3% of cases with one level fusion and 80% in cases with multiple level fusions.Conclusion: According to this study, the early-phase fusion success rate of Novabone-filled cervical cages mixed with autologous bone graft, are inferior to the results obtained from cages filled with pure autologous bone. Nevertheless, after one year, the results in both groups are same. Therefore, it is advocated to use the bone fragments obtained from resection of osteophytes, as the filler material mixed with synthetic bone grafts not only to achieve more appropriate fusion, but also to obviate harvesting bone from iliac crest.

Background: Hypercholesterolemia is an important risk factor in development of atherosclerosis and cardiovascular disease. Several studies have shown that frequent nut consumption in healthy people has some beneficial effects on their lipid profiles. Therefore, we performed this study in affiliated hospitals of Shaheed Beheshti Medical University in 2004 to show the effects of peanut consumption on lipid profiles of hypercholesterolemic people without changing their habitual diet.Materials and Methods: Thirty - seven hypercholesterolemic patients with blood cholesterol levels of 200-300 mg/dl who had the inclusion criteria, enrolled this clinical trial (before - after). Peanut used up to 15% of the daily calorie intake of subjects (about 50gr) daily with no other changes in their habitual diet for 4 weeks. Paired t - test was used for statistical analysis.Results: Thirty - seven subjects aging 43±8.6 years were participated in our study. Serum cholesterol level had significant reduction from 233±29 to 215±34 mg/dl (P<0.001), as well as LDL cholesterol levels (from 103±18 to 94±12 mg\dl (P=0.001)) and triacylglycerol (from 218±116 to 189±92 mg\dl (P=0.03)). In addition, the ratios of LDL-C/HDL-C and total Cholesterol/HDL-C decreased from 2.07±0.18 to 1.94±0.09 (P<0.001) and from 4.8±1.03 to 4.43±0.25 (P= 0.04), respectively. Systolic blood pressure decreased from 115±15 to 109±16 mmhg (P= 0.002). Body weight and BMI did not change significantly during the study.Conclusion: It seems that peanut consumption with no further changes in the habitual diet of hypercholesterolemic subjects sets favorable lipid profiles without weight gaining. Experimental surveys with control groups are recommended to evaluate the long-term effects of peanut consumption in hypercholesterolemic subjects.

Background: The etiological role of vitamin D deficiency in glucose tolerance and type 2 diabetes is well defined. It can reduce insulin secretion and, therefore, impair glucose tolerance. The present study was designed to determine the effects of vitamin D supplementation on insulin resistance in type 2 diabetic patients.Materials and Methods: This study was a double - bind clinical trial. Fifty - seven diabetic patients (34 males and 23 females) being treated with oral hypoglycemic agents who had normal serum calcium level, were enrolled in the study. The study was conducted in winter (when the vitamin D is in its lowest level in Iran). The patients were randomly divided into 2 groups and received 1500 IU/d oral vitamin D3 or placebo for 1month. Fasting glucose, insulin, C- peptide, serum 25-hydroxy-vitamin D and Quantitative Insulin Sensitivity Check Index (QUICKI) were evaluated before and after the treatment. Measurement of energy, macronutrients, fiber, vitamin E, vitamin C, Magnesium, Zinc, Calcium and vitamin D status intake was performed in the onset, during and at the end of the study.Results: The mean of primary serum level of 25-hydroxy-vitaminD was 10.42±10.67ng/ml. 47 subjects (82.5%) out of 57 ones were vitamin D deficient. After the treatment, only 60% of patients in vitamin D-received group achieved normal level of 25-hydroxy - vitamin D. Fasting glucose and insulin decreased in vitamin D-received group, although it was not significant. Serum C - peptide level increased significantly in vitamin D-received group from 2.47±0.88ng/ml (in pre-treatment stage) to 2.78±1.14nglml (in Post - treatment stage) (P<0.02). Serum Calcium level increased significantly in vitamin D - received group (P<0.04), however, it remained at a normal range. The mean of changes of QUICKI was significantly higher in vitamin D - received group than that of placebo group in post-treatment stage (P<0.03). It indicates that insulin resistance was reduced in this group.Conclusion: Results of this study suggest that vitamin D supplementation can reduce insulin resistance in type 2 diabetic patients and it should be, therefore, recomended to improve the control of diabetes, especially in winter.

Background: Psoriasis is a chronic, genetically determined disorder affecting approximately 1-3% of population. Various modalities have been used for treatment of psoriasis, including ultra violet radiation (UV), narrowband UVB (311 nm) and 308 nm excimer laser. The excimer laser delivers high energy monochromatic ultraviolet (UV) at 308nm. Advantages of excimer laser over conventional UV sources include targeting of lesion, reducing cumulative dose and inducing faster clearance. This study evaluated the efficacy and adverse effects of a single high dose 308-nm excimer laser in treatment of stable plaque psoriasis.Materials and Methods: Fifteen volunteers (8 males and 7 females) with plaque psoriasis were enrolled in the study whom had a mean age of 32.7±13. At the baseline, the mean Psoriasis Area and Severity Index (PASI) score was 10.9±1.9.The minimal erythematic dose (MED) was tested on unaffected skin of back or abdomen. Two plaques were selected, one plaque was treated with a single dose of either 8 or 12multiples of MED, and the other on the opposite side was held as control.Results: The patients and the PASI score of each lesion were evaluated 2 weeks, 1, 2, and 4 months after treatment. Ten patients showed significant (75% or more) improvement of PASI score within treated area compared with no change in the control areas. Three patients did not show any improvement. Generalized lesions of psoriasis developed in 2 patients, 2 and 4 months after treatment. There was no correlation between MED values and responsiveness. The response was not age and sex - related.Conclusion: In this prospective trial of treatment, 12 plaques of 10 patients showed significant improvement. This mode of treatment was well-tolerated. Only 2 patients complained of burning sensation and developed small vesicles which healed without scarring. These results suggest that single high - dose excimer laser can be considered as a valuable therapeutic option for treatment of selected forms of plaque psoriasis.

Background: Organizational commitment is an important factor in understanding employees' behavior and influences the employee's performance in increasing productivity, improving delivery and quality of services provided by them. Despite the importance, there has been no study that addressed organizational commitment of nurses in Iran.Materials and Methods: A descriptive design was adapted to describing and evaluating relationships between variables. 220 questionnaire set (including individual informational form, organizational commitment and job satisfaction questionnaire) distributed among nurses. Nurses responded to 202-questionaireset. 198 – Questionnaire set identified appropriate for analysis.Results: Data showed that there was no significant correlation between individuals' variables and dimensions of organizational commitment among nurses. There was a significant positive correlation between job satisfaction and affective and normative dimension of commitment. In contrast, there was a significant negative correlation between job satisfaction and organizational commitment.Conclusion: Personal factor should not be considered as a recruitment factor in recruiting nurses. Nurse managers, therefore, should try to increase nurses' organizational commitment after requirement phase. In other words, nurse Managers can enhance nurse's performance by increasing affective and normative dimensions of commitment. To achieve this purpose, they should decrease their job dissatisfaction by enhancing satisfaction by means of their salary and benefit, work conditions and job security, supporting and appreciating.

Background: Nodulocystic Acne is a well-known dermatological disorder, and application of isotretinoin for its treatment may result in skeletal and muscular pains and can develop some variations in serum levels of some metabolites. This study was conducted to determine the serum levels of vitamin D metabolites, Calcium, Phosphorus and Parathyroid hormone (PTH), before and after the oral administration of isotretinoin and also investigate the radiographic bone changes of patients with severe acne.Materials and Methods: 1,25-dihydroxy-vitamin D and 25-hydroxy-vitamin D, Calcium, Phosphorus, Parathyroid hormone and axial spines radiographies were measured in 30 patients with nodulocystic acne, before and after the initiation of treatment.Results: 25-hydroxy-vitamin D was low in three patients before the treatment, whereas in one patient it was found to be low after the treatment (P=0.7). 1.25-dihydroxy-vitaminD was low in one patient before and in two ones after the treatment (P=0.9). Calcium decreased in four patients after treatment, (P=0.2). Phosphorus and PTH levels were normal before and after treatment. There were no significant changes in bone radiographic examinations before and after treatment.Conclusion: Oral isotretinoin did not lead to any significant changes in serum vitamin D metabolites, Calcium, Phosphorus, PTH and bone radiography among acne patients.

Background: Pregnancy is a normal physiologic evidence wherein some dramatic variations in body weight, ligamental stability and muscular strenght would result in alteration of mothers' gait. The aim of this study was to determine the relationship between lumbar properioception in each trimester of pregnancy and after - delivery period (up to 4.5 months) with kinetics of gait.Materials and Methods: This research was a prospective study which began from the first trimester and followed during the second and third trimester and also after delivery. 35 healthy pregnant women were evaluated. In each session the lumbar properioception was measured in 45 degrees of flexion repositioning and kinetics of stance phase were also evaluated.Results: It was found that the lumbar properioception accuracy was significantly decreased while the progression of pregnancy (P=0.01). From the lumbar properioception accuracy point of view, subjects were divided into 3 groups. The trend of variations during the pregnancy period was statistically significant between all these groups. This decreasing trend in lumbar properioception has significant correlation with reducing the speed of walking, and increasing the vertical ground reaction force.Conclusion: There was a significant relation between lumbar properioception accuracy and kinetics of gait. We suggest further researches to reveal more precisely the effect of walking on lumbar properioception and its role subsiding and preventing the pregnancy-related low back pain.

Background: First-trimester spontaneousabortion is one of the most common causes for referring to clinics of obstetrics. Despite the beneficials of transvaginal sonography, the standard diagnostic method is still the utrine curettage; an invasive procedure which must be performed by an expert master. The aim of this study was to assess the use of transvaginal sonography to detect retained product of conception after the first-trimester spontaneous abortion.Materials and Methods: ALL women who arrived at our hospital with abnormal vaginal bleeding due to first - trimester spontaneous abortion were included in this study and underwent a preliminarily transvaginal sonography and then curettage. The final diagnosis of complete or incomplete abortion was made based on the histopathologic findings at dilatation and curettage. The sensitivity, specificity, positive and negative predictive values of transvaginal sonography for detecting the products of conception was measured.Results: A total of 100women were studied. The averages of gestational age and women's age were 9.6:±1.4 weeks and 25.8±4.9 years old, respectively. The false positive value for sonographic diagnosis was 29.5%. Also, the sensitivity, specificity, positive and negative predictive values were 96%, 27.7%, 74% and 83%, respectively.Conclusion: Transvaginal sonography is a useful supplemental tool in clinical assessment of women who experience a first-trimester spontaneous abortion. For its relatively high scores of negative predictive value, applying this diagnostic method would reduce the numbers of unnecessary general anesthesias and utrine curettages.

Background: Patients with primary cleft lip deformities are almost always being operated within the first year of their life. Different factors may ultimately distort the preliminary surgical result. Some of these factors are inaccurate surgical design, primary tissue anomalies and effect of rapid growth. Consequently, the correction of these secondary deformities is an integral part in survey of such patients. The aim of this study is to investigate the relationship between common surgical techniques for primary repair and the incidence of secondary deformities.Materials and Methods: This descriptive-analytical cross - sectional study was performed on 30 patients with secondary deformities of unilateral cleft lip repair. Secondary deformities and technique of primary repair were checked in each patient and data were analyzed by Chi-square test.Results: The common techniques of primary lip repair were rotation advancement (43%) and straight line repair (43%). Deformities of vermilion (malalignment & deficiency) were the most common secondary deformities (53%). In this regards, short lip deformity was more frequent in straight line repair than rotation advancement repair (P<0.05).Conclusion: The obtained results clarify that the prevalence and the type of secondary deformities depend on primary surgical procedures. The ideal time to address secondary deformities is at the time of initial operation, when every effort should be made to prevent them.

Background: Health systems are constantly trying to improve their services to satisfy better the clients' needs. This can reduce health problems and increase patient satisfaction. The importance of measuring the client's satisfaction has been increased during recent years. The purpose of this study was to develop a questionnaire for measuring client satisfaction.Materials and Methods: Item construction was undertaken following a thorough search through the literature. To test the content validity of the questionnaire, the researcher selected 11 lecturer, health worker and clients. The experts were asked to rate item based on 'relevance', 'clarity and 'simplicity' on a four-point scale. Following these process, the questionnaire was tested for face validity by a panel 11 lectures, health worker and clients. Constructed validity was measured with 300 clients in different centers. To determine the reliability, internal consistency and test-retest were measured.Results: We analyzed the results of content validity of the scale. The items which had over 90% of this value remained. The items were modified and increased based on the experts' opinions. By increasing items of the scale, the number of the items increased. The Alpha Coronach was 0.9 for internal consistency and Pearson's correlation (r) for test-retest was 0.85.Conclusion: The results of this study showed that the "Clients Satisfaction Questionnaire" (CSQ) in Community including 26 Likert-types items is valid and reliable. Respecting the importance of questionnaire for measuring client satisfaction and its close connection to quality of services, measuring other kinds of validity such as discriminate and concurrent validity is suggested.

Background: While planning for orthodontic/orthopedic treatment, using maturation indices to measure the skeletal maturity level is inevitable in evalating the patient's growth. A new method is based on morphologic changes of cervical vertebrae which can be readily seen on lateral cephalogram. In this diagnostic study we aimed to compare this new method determining skeletal maturity level with conventional method (Hand-Wrist).Materials and Methods:  80 subjects (19 males and 61 females) contributed in the study. Each subject had a lateral Cephalogram and Hand - wristr adiogram taken simultaneously Maturation level was diagnosed based on atlas vertebras, represented by both methods and in following, data were analyzed. Correlation coefficient between two methods was calculated by Spearman's analysis and reliability of this new method of diagnosis the skeletal maturity was measured by McNemar's statistical test.Results: The sensivity and specificity of lateral cephalogram were 98.2% and 88%, respectively. Also, the positive and negative predictive values were 94.7% and 95.6% for this modality. Correlation coefficient between both methods was 93%. The reliability and reproducibility of the new method in determining the skeletal maturity was 95%.Conclusion: High correlation and reliability obtained between both methods suggesting the applicability of the new methods to determine skeletal maturity.

Background: Background: Varicocele is defined as an abnormal venous dilatation of the pampinformis plexus, a common finding that have been reported in approximately 10-15% of adult men. Since now, a few studies on testicular artery parameters have been performed. The aim of this study was to determine the changes in peak systolic velocity of testicular arteries in patients with varicocele.Materials and Methods: twenty eight patients with clinical diagnosis of left, right or bilateral varicocele with scrotal vein diameter of more that 2.5 mm on their color Doppler ultrasonography were included in this study.Results: Peak systolic velocity of intratesticular and testicular arteries of men with varicocele was not significantly different from those of controls who had no varicoceles.Conclusion: Varicocele does not significantly alter the testicular peak systolic velocity.