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Outcomes of the Fluoroscopically-Guided vs. Computed-Tomography-Guided Transforaminal Epidural Steroid Injection in Low Back Pain: A Propensity-matched Prospective Cohort
No full textBACKGROUND: Low back pain (LBP), the most common musculoskeletal condition, imposes a significant burden on healthcare and triggers mental and physical disorders. Before surgery, patients are eligible for minimally-invasive treatments, including transforaminal epidural steroid injection (TFESI). We aimed to compare fluoroscopically- and CT-guided TFESI in patients with subacute (4-12 weeks) and chronic (>/=12 weeks) LBP. METHODS: In this prospective cohort study, 121 adults with subacute or chronic LBP were recruited. Using propensity score matching (PSM), we created two age, sex, and body mass index (BMI) matched groups of fluoroscopically- and CT-guided TFESI, each including 38 patients. The outcomes of interest were the Oswestry disability index (ODI) and numerical rating scale (NRS), which were measured in all patients before the procedure and at the three-month follow-up. Then, the ODI and NRS mean changes were compared between Fluoroscopy and CT groups using repeated measures ANOVA. All analyses were performed with IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, NY, USA). RESULTS: Of the total 76 matched patients with a mean (SD) age of 66.22 (13.49), 81 (66.9) were female. ODI and NRS scores significantly decreased from baseline to the three-month follow-up in both treatment groups. The ODI score mean change from baseline to follow-up compared between the two groups was insignificant (fluoroscopy vs. CT mean difference (95 CI): 1.092 (-0.333-2.518), P = 0.131). Similarly, the NRS score mean change from baseline to follow-up compared between the two groups was insignificant (fluoroscopy vs. CT mean difference (95 CI): -0.132 (-0.529-0.265), P = 0.511). CONCLUSION: Fluoroscopically- and CT-guided TFESI show similar therapeutic effectiveness in patients with subacute and chronic LBP
Prevalence of Orthopedic Pains in Children and Adolescents: A Systematic Review and Meta-analysis
No full textContext: Musculoskeletal disorders are among the main causes of death and disability and can impose high costs on individuals and countries. Considering the importance of pain, the present meta-analysis study aimed to investigate the prevalence of orthopedic pains in Iranian children and adolescents. Methods: The present study was reported in line with PRISMA. The searching process was carried out using keywords, including ado-lescents, pain, youth, school-age children, shoulder pain, neck pain, shoulder, and neck, AND/OR operators for the articles published during 2000 and 2022 in Scopus, Embase, PubMed, Scientific Information Database, Magiran, International Statistical Institute, and Islamic World Science Citation Center databases. This study reviewed the articles that reported the prevalence of orthopedic pains (i.e., wrists/hands, shoulders, elbows, and knees) among the 5-18-year age group in Iran and extracted their results. Two researchers conducted the search quite independently and extracted the necessary data using a researcher-made checklist. The collected data were analyzed using Comprehensive Meta-Analysis software (CMA3). Results: Initially, 418 articles were identified, and 14 articles were entered into the systematic review stage. The prevalence rates of pains related to wrists/hands, shoulders, elbows, and knees were 6.6 (95 confidence interval CI: 3.2-13.0), 26.9 (95% CI: 17.0-39.7), 2.9 (95% CI: 1.3-6.3), and 6.6 (95% CI: 3.0-14.2), respectively. Conclusions: The prevalence of shoulder and knee pains in individuals under 18 years in Iran was high. Therefore, it is necessary to make necessary interventions and take preventive measures. © 2023, Author(s)
Relationship between Personality Disorders in Parents and Psychiatric Disorders in Children and Adolescents in Ilam and its Suburbs, Iran 2018-2019
No full textBackground and purpose: Behavioral and personality traits of family members, especially the parents can affect a child's behavior. According to high prevalence of mental disorders in Iran, this study was conducted to determine the relationship between personality disorders in parents and psychiatric disorders in children and adolescents. Materials and methods: A cross-sectional-analytical survey was performed in children and adolescents aged 6-18 years in Ilam and its suburbs, west of Iran, 2018-2019. A total of 1022 children and adolescents were selected using multi-stage cluster sampling. Semi-structured interviews were carried out and data were collected using Kiddie-SADS-Present and Lifetime Version (K-SADS-PL) and Millon Clinical Multiaxial Inventory. Data analysis was done applying descriptive statistics and calculation of odds ratio with 95 confidence interval. Results: The prevalence of psychiatric disorders was 10.80 in boys and 8.15 in girls. The most prevalent disorders in boys were depression (0.81), enuresis (3.67 ), hyperactivity (1.84 ), and specific fear (1.22 ) and in girls separation anxiety (4.17) was more common. Findings showed significant direct relationships between depressive personality disorder in mothers and depression in children (OR= 1.07, 95 CI: 1-1.14, P=0.02) and between depressive personality disorder in fathers and nocturnal enuresis in children (OR= 1.07, 95 CI: 1.01-1.14, P=0.02), and also between avoidant personality disorder in fathers and specific fear disorder in children (OR=1.09, 95 CI: 1-1.20, P=0.04). Conclusion: In this study, we observed high prevalence of psychiatric disorders in children and adolescents that are significantly linked to the personality traits of parents and should be taken into account in making diagnosis and designing interventions. © 2023, Mazandaran University of Medical Sciences. All rights reserved
Prevalence of depression in rheumatoid arthritis patients and its relationship with disease activity: A cross-sectional study
No full textBackground. Depression is a common disorder in rheumatoid arthritis (RA) patients and can affect clinical outcomes. This study was conducted to determine the prevalence of depression and its relationship with disease activity in RA patients. Methods. In this cross-sectional study, 144 patients with RA were recruited from the Rheumatology Outpatients Clinic, Mostafa Khomeini Hospital Ilam, and were examined for disease activity and depression symptoms. Disease activity was assessed by DAS28 using laboratory tests and physical examination. The Beck self-report questionnaire was used for measuring depression disorder. Data were analyzed using the linear regression models in STATA 14 software. Results. The prevalence of depression in the sample was 61. Multivariate analyses showed that patients with severe disease activity faced a significantly greater risk of depression compared to those with mild disease activity. Average levels increased by about 12.43 points in depression for patients with severe disease activity compared to those with mild disease activity. This association was statistically significant after adjusting for the model's other predictors (P<0.001). Furthermore, predicted models showed that the probability of depression increased with age and disease duration in patients with severe activity. Conclusion. Considering the relationship between depression and severe RA disease activity, the need to screen RA patients in terms of depression disorder and pay attention to comprehensive mental and physical care and cure for better clinical outcomes seems necessary. Practical Implications. Severe disease activity in RA may have been influenced by a psychological phenomenon such as depression; therefore, it was suggested that depression, as one of the diseases worsening the RA symptoms, should be screened and evaluated. It was also recommended that a comprehensive and multidisciplinary approach should be adopted by seeking assistance from psychiatric and psychological specialists in RA disease management. © 2023 The Author
The effect of metformin administration on cancerspecific survival, overall survival, progression-free survival, and disease progression in renal cell carcinoma patients; a systematic review and meta-analysis
No full textIntroduction: The increase in the incidence of renal cell carcinoma (RCC) has been reported worldwide. The anti-cancer impacts of metformin on the various types of cancer have been observed in clinical studies. Therefore, this study aims to survey the effect of metformin use on RCC patients using systematic review and meta-analysis methods. Materials and Methods: In this research, Cochrane, Web of Science, PubMed, Scopus databases, and Google Scholar web browser were searched using standard keywords. Data were analyzed with STATA 14 software. The significance level of tests P < 0.05 was considered. Results: The improvement in the progression-free survival (PFS) (HR: 0.72 95% CI: 0.54, 0.94, P = 0.169, I2 = 37.8%) and cancer-specific survival (CSS) (HR: 0.36 95% CI: 0.18, 0.75, P = 0.339, I2 = 7.5%) was observed in eight studies with 10404 patients affected by RCC. However, no significant statistical effect was observed on the improvement in the disease progression (OR: 1.10 95% CI: 0.85, 1.42, P = 0.326, I2 = 0%) and cancer overall survival (OS) (HR: 0.72 (95% CI: 0.51, 1.01), P = 0.153, I2 = 43.1%). Conclusion: This study showed metformin administration improved CSS and PFS in RCC patients. More studies are warranted on the effect of metformin on the improvement in disease progression and OS of cancer. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID= CRD42022369108; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022369108). © 2023 The Author(s); Published by Nickan Research Institute. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Relationship between Moral Intelligence and Clinical Competency of Nurses in Ilam Educational Hospitals
No full textIn this descriptive-analytical study, 110 nurses working in educational hospitals of the Ilam University of Medical Sciences were included. Participants were selected using a random sampling method. The data collection tools were the demographic information form, the moral intelligence questionnaire of Lenik and Kiel (2005), and the standard clinical competency assessment questionnaire (CIRN). Data were analyzed using SPSS software, version 21. Descriptive and inferential statistical tests were used to analyze the data. The mean +/- SD score of nurses' moral intelligence and clinical competency was estimated at 157.59 +/- 26.60 and 136.65 +/- 46.08, respectively. Fifty-one percent of participants had low clinical competency, and 46 had high clinical competency. There was a significant association between moral intelligence and clinical competency (p<0.001, r=0.517). The moral intelligence and clinical competency of nurses were significantly associated with age, education status, work experience, employment status, and rank/position (P<0.05). A negative association was found between working unit/ ward and clinical competency (P<0.05)
Antimicrobial resistance and biofilm formation capacity among Acinetobacter baumannii strains isolated from patients with burns and ventilator-associated pneumonia
No full textBackgroundAcinetobacter baumannii is a pathogen responsible for nosocomial infections, especially in patients with burns and ventilator-associated pneumonia (VAP). The aims of this study was to compare the biofilm formation capacity, antimicrobial resistance patterns and molecular typing based on PFGE (Pulsed-Field Gel Electrophoresis) in A. baumannii isolated from burn and VAP patients. Materials and MethodsA total of 50 A. baumannii isolates were obtained from burn and VAP patients. In this study, we assessed antimicrobial susceptibility, biofilm formation capacity, PFGE fingerprinting, and the distribution of biofilm-related genes (csuD, csuE, ptk, ataA, and ompA). ResultsOverall, 74 of the strains were multidrug resistant (MDR), and 26 were extensively drug-resistant (XDR). Regarding biofilm formation capacity, 52, 36, and 12 of the isolates were strong, moderate, and weak biofilm producers. Strong biofilm formation capacity significantly correlated with XDR phenotype (12/13, 92.3). All the isolates harbored at least one biofilm-related gene. The most prevalent gene was csuD (98), followed by ptk (90), ataA (88), ompA (86), and csuE (86). Harboring all the biofilm-related genes was significantly associated with XDR phenotype. Finally, PFGE clustering revealed 6 clusters, among which cluster No. 2 showed a significant correlation with strong biofilm formation and XDR phenotype. ConclusionOur findings revealed the variable distribution of biofilm-related genes among MDR and XDR A. baumannii isolates from burn and VAP patients. A significant correlation was found between strong biofilm formation capacity and XDR phenotype. Finally, our results suggested that XDR phenotype was predominant among strong-biofilm producer A. baumannii in our region
Molecular characterizations of antibiotic resistance, biofilm formation, and virulence determinants of Pseudomonas aeruginosa isolated from burn wound infection
No full textBackgroundBurn injuries result in disruption of the skin barrier against opportunistic infections. Pseudomonas aeruginosa is one of the main infectious agents colonizing burn wounds and making severe infections. Biofilm production and other virulence factors along with antibiotic resistance limit appropriate treatment options and time. Materials and MethodsWound samples were collected from hospitalized burn patients. P. aeruginosa isolates and related virulence factors identified by the standard biochemical and molecular methods. Antibiotic resistance patterns were determined by the disc diffusion method and beta-lactamase genes were detected by polymerase chain reaction (PCR) assay. To determine the genetic relatedness amongst the isolates, enterobacterial repetitive intergenic consensus (ERIC)-PCR was also performed. ResultsForty P. aeruginosa isolates were identified. All of these isolates were biofilm producers. Carbapenem resistance was detected in 40 of the isolates, and bla(TEM) (37/5), bla(VIM) (30), and bla(CTX-M) (20) were the most common beta-lactamase genes. The highest resistance was detected to cefotaxime, ceftazidime, meropenem, imipenem and piperacillin, and 16 (40) isolates were resistant to these antibiotics. The minimum inhibitory concentrations (MIC) of colistin was lower than 2 mu g/mL and no resistance was observed. Isolates were categorized to 17 MDR, 13 mono-drug resistance, and 10 susceptible isolates. High genetic diversity was also observed among the isolates (28 ERIC types) and most carbapenem-resistant isolates were classified into four main types. ConclusionAntibiotic resistance, particularly carbapenem resistance was considerable among the P. aeruginosa isolates colonizing burn wounds. Combining carbapenem resistance with biofilm production and virulence factors would result in severe and difficult-to-treat infections
Amoxicillin-docosahexaenoic acid encapsulated chitosan-alginate nanoparticles as a delivery system with enhanced biocidal activities against Helicobacter pylori and improved ulcer healing
No full textEncapsulation of amoxicillin (AMX) for drug delivery against Helicobacter pylori infection and aspirin-induced ulcers in rat's stomachs was performed using docosahexaenoic acid (DHA)-loaded chitosan/alginate (CA) nanoparticles (NPs) developed by ionotropic gelation method. The physicochemical analyses of the composite NPs were performed by scanning electron microscopy, Fourier transform infrared spectroscopy, zeta potential, X-ray diffraction, and atomic force microscopy. The encapsulation efficiency of AMX was increased to 76 by incorporating DHA, which resulted in a reduction in the particle size. The formed CA-DHA-AMX NPs effectively adhered to the bacteria and rat gastric mucosa. Their antibacterial properties were more potent than those of the single AMX and CA-DHA NPs as demonstrated by the in vivo assay. The composite NPs attained higher mucoadhesive potential during food intake than during fasting (p = 0.029). At 10 and 20 mg/kg AMX, the CA-AMX-DHA showed more potent activities against H. pylori than the CA-AMX, CA-DHA, and single AMX. The in vivo study showed that the effective dose of AMX was lower when DHA was included, indicating better drug delivery and stability of the encapsulated AMX. Both mucosal thickening and ulcer index were significantly higher in the groups receiving CA-DHA-AMX than in the groups receiving CA-AMX and single AMX. The presence of DHA declines the pro-inflammatory cytokines including IL-1 beta, IL-6, and IL-17A. The synergistic effects of AMX and the CA-DHA formulation increased the biocidal activities against H. pylori infection and improved ulcer healing properties
Toxoplasma and Risk of Spontaneous Abortion: A Meta-Analysis in A Population of Iranian Women
No full textToxoplasma gondii is found as an intracellular protozoan parasite in the Apicomplexa phylum that can be transmitted to the fetus and causes miscarriage, infection, and asymptomatic neonatal disease. In the present study, we characterized the seroprevalence rate of anti-Toxoplasma gondii antibodies in a population of Iranian women with a recent a spontaneous abortion. We examined our national and international databases including Irandoc, Magiran, SID, Medlib, Scopus, PubMed, and the Science Direct. The search strategy was carried out by using keywords and MeSH terms. The statistical analysis was performed by STATA 14.2. By using the random effects model and the fixed effects model the statistical analysis was performed while the heterogeneity was >= 75 and <= 50, respectively. We used the chi-squared test and I2 index to calculate heterogeneity among studies, and for evaluating publication bias, Funnel plots and Egger tests were used. The seroprevalence positive rate of IgG among women who had experienced abortion was observed 32 95% confidence interval (CI): 20-45% based on the random-effects model. The seroprevalence positive rate of IgM based on the fixed-effect model and positive IgG rate based on the random-effect model was evaluated 4% (95% CI: 3-6%) and 32% (9% CI: 3-42%) among women immediately after an abortion, respectively. According to the finding of our study, toxoplasmosis can be one of the most significant causes of abortion