Journal of Isfahan Medical School
Year:2011 | Volume:29 | Issue:143|Papers Count:7

Background: The aim of this study was to assess the accuracy of shoulder abduction test (SAT), spurling test (ST) and upper limb tension test (ULTT) in diagnosis of acute or chronic cervical radiculopathy (CR) based on an electrodiagnostic reference criterion.Methods: Our tests and electromyography were done on 97 patients suffering from arm and neck pain. They were classified according to electrodiagnostic findings. Then diagnostic values of provocative tests were assessed in diagnosis of acute or chronic CR on the basis of reference criterion.Findings: SAT and ST were more specific compared to ULTT while ULTT was more sensitive than those two. SAT and ST had a significant accuracy for comparison between acute and chronic CR (P<0.05).Conclusion: The ULTT is suitable for screening of CR, but SAT and ST can support diagnosis. The SAT and the ST are good diagnostic tests for comparison between acute and chronic CR.

Background: Truth telling is found as one of the most important issues in physician-patient communication and all of the physicians are concerned with it in some way. As disclosure (or truth reticence) would cause ethical or legal problems, this study aimed to assess the attitude of patients and physicians about truth telling.Methods: In this descriptive study, 50 physicians and 150 patients with cancer were envolved in Isfahan, Iran. Two standardized attitude questionnaires were used for physicians and patients. Data were analyzed by SPSS software.Findings: About 88% of patients and 90% of physicians agreed truth telling for patients in early stage of cancer.78% of patients and 72% of physicians were agreed truth telling for patients with terminal stage cancer. Both physicians and patients were agreed frankness in telling the diagnosis; they separated no effect for patient socioeconomic condition on truth telling. In both groups, doctor was the best person for telling the cancer diagnosis. Doctor office and quiet and undisturbed room were the best places for truth telling in patients and physicians viewpoints, respectively.Conclusion: Noticing the obtained results in our society culture, the majority of patients and physicians had positive attitude about truth telling to patients in different stages of cancer.

Background: Although nasal continuous positive airway pressure (NCPAP) in the treatment of respiratory distress syndrome (RDS) is an effective and a non-invasive method, some complications such as septal trauma and intolerance of NCPAP apparatus are occurred. Our objectives are to assess safety and effectiveness of humidified high flow nasal canola (HFNC) as compared to NCPAP in premature neonates with RDS.Methods: Seventy uncomplicated preterm infant (30-35 weeks gestation) with RDS at the neonatal ward of Shahid-Beheshti hospital, Isfahan, Iran, randomized into two groups; Group1 (CPAP) received NCPAP from birth and continued till respiratory distress (RD) and oxygen (O2) need improved and Group 2 (HFNC) received NCPAP for the first 24 hours after birth, then standard HFNC till RD and O2 need improved. Outcomes measures of interest included: death, morbidity such as necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), (Intraventricular hemorrhage (IVH), chronic lung disease (CLD), pnumothorax, pulmonary hemorrhage, apnea, sepsis, duration of hospitalization, duration of full entral feeding and duration of O2 need. Data entered to computer and outcomes were compared between 2 groups with SPSS software (vesion 11). P values less than 0.05 were considered statistically significant.Findings: There were no differences in death, duration of hospitalization, failure to treatment, duration of improvement of RD, NEC, PDA, IVH, CLD, pnumothorax, pulmonary hemorrhage, apnea, sepsis, duration of hospitalization, duration to reach to full entral feeding between two groups (NCPAP, HFNC). During the study, those on HFNC had more normal examination of nasal mucosa (P<0.0001). According to neonatal nurses opinions, application of HFNC was easier than NCPAP for neonates (P<0.0001).Conclusion: HFNC (after received NCPAP for the first 24 hours of birth) is as effective as NCPAP in the management of RDS in premature neonates more than 30 gestational weeks. In addition, HFNC performed easier than NCPAP with maintaining a normal nasal mucosa.

Background: Lead is a metal that has been used by humans since ancient times and it’s over dosage causes an important environmental and professional toxicity. The aim of this study was to evaluate the effectiveness of single therapy with Ethylene diamine tetra acetic acid (EDTA) in lead poisoning.Methods: The study population was all patients with suspected lead poisoning were admitted to Baharloo hospital in Iran from January 20, 2005 to March 21, 2006. Diagnosis of lead poisoning was confirmed after history taking, clinical examinations and blood lead level. After obtaining informed consent, the patients were enrolled in our study. Allowed lead level was considered<50 mg/dl. These patients were hospitalized for 5 days and treated with EDTA (1 g every 12 hours via slow intravenous infusion). CBC, urea, creatinine, liver function tests, coagulation tests and biochemical tests including glucose, lipids, electrolytes and uric acid, urinalysis, and urine volume was measured daily. The patients would be excluded if there were any contraindication for EDTA treatment, hepatic encephalopathy and blood lead level over than 150 mg/dl were considered as the exclusion criteria. All patients’ blood lead level was measured again 10 and 30 days after treatment. To analyze data, Wilcoxon test and SPSS software (version 16) were used.Findings: Forty one patients were studied. All were male. The patients’ mean age was 32±6 years. The patients’ average blood lead level was 110.3±5 37 mg/dl before the treatment. The patients’ average blood lead level was 63.4±27.1 mg/dl ten days after treatment and 79.3±28 μg/dl one month after treatment. The patients’ average blood lead level decreased significantly 10 days and one month after the treatment compared to begining (P<0.001 and P<0.012 respectively).Conclusion: EDTA is an effective drug for the treatment of patients with lead poisoning as single therapy.

Background: Approximately 30% of patients with epilepsy are medically refractory to conventional antiepileptic pharmacotherapy. In these patients, recurrent seizure and side effects of drugs interfere with the patient’s quality of life and can cause cognitive and behavioral deficits. Neuropsychological assessment plays a vital role in any comprehensive epilepsy program.Methods: We tried to find the most applicable neuropsychological assessments with high validity, reliability by reviewing valid references.Findings: The Wechsler adult intelligence scale, the Wechsler memory scale– III, Verbal learning test, Rey-Osterrieth complex figure test, Verbal fluency and naming tests, Design fluency test, Continuous performance test, Trail making A and B, Finger tapping, and Grooved pegboard test are of the most applicable tests.Conclusion: Neuropsychological assessment of patients with refractory epilepsy is a complementary section of any Comprehensive Epilepsy Program. Findings of these assessments may have great role for treatment plan and prediction of cognitive conse.