Journal of Isfahan Medical School
Year:2016 | Volume:34 | Issue:370|Papers Count:8

Background: Median neuropathy due to nerve compression in the wrist, or carpal tunnel syndrome (CTS), is the most common entrapment neuropathy. Incidence of CTS is high at an estimated value of 280.6 per 100, 000 patients per year. Accurate diagnosis of CTS is essential for treatment and preventing disability and morbidity.Methods: 64 patients with clinical diagnosis of CTS from the out-patient clinic of Alzahra Hospital, Isfahan, Iran were evaluated between January and March 2013. All the patients (54 women and 10 men) underwent nerve conduction study (NCS) and ultrasonography. The cross sectional area of the median nerve at the level of pisiform bone and 12cm proximal to that in elbow was estimated via ultrasonography which were used to calculate wrist/forearm ratio (WFR). The cut-off point value for WFR of median nerve was assessed and sensitivity and specificity of ultrasonography for CTS diagnosis was also determined.Findings: The optimal diagnostic cut-off values of CTS that we obtained by ROC curve was 2.07 and the areas under the ROC curve, was 0.8. This cut-off value had a sensitivity of 76%, specificity of 83%, positive predictive value (PPV) of 95% and negative predictive value (NPV) of 45%.Conclusion: The WFR is a new option in the ultra-sonographic diagnosis of CTS. This technique does not add significant time to routine ultra-sonographic examination.The use of a ratio also helps to omit the variability between populations and anatomic variation. Our initial findings suggest a high sensitivity for this method, but study of a larger population is needed for confirmation.

Background: Some studies suggest that besides the known effects of vitamin D on calcium hemostasis and bone safety, it might also play a non-classic role in our body such as in chronic hepatic disorders. So, considering the high prevalence of vitamin D deficiency and HCV in our society, the aim of this study was to evaluate serum levels of vitamin D in HCV patients compared to a control group.Methods: In this case-control study, 60 HCV patients and 60 healthy pupils were selected and serum level of vitamin D was measured and compared between the two groups.Findings: The mean serum level of Vitamin D in the case and control group was 26.23±18.53 and 29.6±13.61, respectively and no statistical difference was reported between the two groups (P=0.260).Vitamin D insufficiency was found in 3 patients (5.0%) in the case group and none of the control group. Vitamin D deficiency was found in 43 (71.7%) of the case group but only 6 (10.0%) of the control group and this difference between the two group was statistically significant (P=0.033).Conclusion: According to the results of this study, vitamin D deficiency in HCV patients was higher than the normal population and high prevalence of vitamin D deficiency can affect other organs and decrease the quality of HCV treatment. Thus, measuring the serum levels of vitamin D in HCV patients and prescribing vitamin D supplements are recommended.

Background: Prevalence of post-surgery headache is different based on the type of operation, but there are no reports on prevalence of headache after cataract surgery. Therefore, in this study we have investigated the factors that influence this kind of headache.Methods: This study was performed on 770 patients undergoing cataract surgery. After collecting demographic information, patients underwent phacoemulsification and extracapsular cataract surgery. The data about headache after recovery period and 24 hours after surgery, surgery type, anesthesia method and drugs consumption was also recorded. The variables were analyzed using t-test, chi-square and Mann-Whitney tests.Findings: The incidence of headache in recovery period was higher among men (44.8%) (P<0.001), extracapsular technique (57.1%) (P<0.004), in general anesthesia (43.8%) (P<0.004), the use of fentanyl (46.2%) (P<0.05), in patients with a history of headache (69.5%) (P<0.001), in patients without a history of caffeine consumption (50.5%) (P<0.001), with no history of using analgesic drugs (41.4%) (P<0.001), eyepain (41.6 %) (P<0.001) and surgery in the afternoon (39.3%) (P<0.001). Similarly, 24 hours after surgery, this number was higher in extracapsular technique (39.1%) (P<0.001), the use of fentanyl (25.8%) (P<0.027), surgery lasting more than 30 minutes (40.0%) (P<0.001), in patients with a history of headache (32.0%)(P<0.001), in patients with a history of sinusitis (19.4%) (P<0.001), in patients without a history of smoking and drug abuse (18.3%) (P<0.001) and surgery in the afternoon (17.2%) (P<0.027).Conclusion: The prevalence of headache in patients undergoing cataract surgery is high and the risk factors are male, general anesthesia, use of fentanyl, extracapsular surgery, history of previous headaches, sinusitis, pain of eye after surgery and patients without a history of caffeine, cigarettes and analgesic drug use.

Background: Cognitive performance appears to diminish with age and passing of time, probably due to the basal forebrain cholinergic dysfunction. Given the physiological significance of the acute effect of estrogen, this study was conducted aiming to investigate the effect of 17b-estradiol treatment on cognitive performance in nucleus basalis magnocellularis (NBM) induced lesions.Methods: In this experimental study, 40 adult male Wistar rats were divided into five different groups (8 rat in each group): Control (intact), NBM lesion group, which received electrically-induced lesion (0.5 mA, 3s) in NBM, Sham group (the electrode was impaled into the NBM with no lesion), Estrogen group (lesion+45mg/kg 17b-estradiol) and Vehicle group (NBM lesion+200ml sesame oil). Acquisition and retention testing was done using an eight-radialarm maze, in which, the patterns of arm entries in each group was recorded for calculating correct choices, working memory errors, reference memory errors and latency.Findings: Bilateral NBM lesion showed the reduction of spatial memory acquisition in the form of increased working and reference memory errors (P<0.001). It further reduced these functions in retention testing (P<0.001) compared to the control group. Post-lesion treatment with 45 mg/kg estrogen improved the parameters of spatial memory errors in the acquisition and retention tasks comparing to the Sham group (P>0.05).Conclusion: Electrical NBM lesion can reduce spatial memory function. Estrogen therapy after brain injury improved cognitive disorder.

Background: Vitiligo is the most common chronic depigmentation disorder caused by melanocyte loss in the basal epidermis. Drug therapy and surgical procedures are two main modalities for its treatment and one of the most effective surgical procedures is non-cultured epidermal cell transplantation suspension containing melanocytes and keratinocytes cells. This pilot study evaluates the effectiveness of an innovative method of melanocyte-keratinocyte cell suspension for treatment of patients with stable vitiligo.Methods: Twenty patients with stable vitiligo which where resistant to standard treatment participated in this study. Melanocyte- keratinocyte cell suspension (with Patent No.81687 method) was transferred to the affected lesions. Repigmentation of the lesions was scored as excellent, good, fair or weak by comparing lesion photos before and 6 months after the treatment.Findings: Mean repigmentation score was excellent in 1 (5%), good in 4 (20%), fair in 11 (55%) and weak in 4 (20%) of the patients 6 months after the intervention.Conclusion: The results of this study demonstrated that melanocyte-keratinocyte cell suspension can provide good results and repigmentation in more than 50% of cases.