نشریه پژوهش در پزشکی
سال سی و چهارم شماره 3 (پیاپی 135، پاییز 1389)

EMG needling is not a painless procedure. In recent studies it has been shown that a form of lidocaine has the efficacy which is similar to EMLA, for prevention of pain associated with EMG needling. The aim of this study was to evaluate the efficacy of Lidocaine H ointment in alleviating the pain caused by EMG needling. This study was performed on patients referred to Shohadaye Tajrish Hospital for EDx study in APR 2009- APR 2010. A double blinded, placebo controlled study was performed in 47 adult patients (94 lower limbs) to compare the pain of EMG needling into the tibialis anterior muscle after application of lidocaine-H ointment or placebo. Pain scores were obtained by using visual analog scale (VAS). Experimental and placebo groups were compared with Mann-U-Whitney and Chi-square tests. The study was performed on 47 patients, 38.3% male & 61.7% female, mean age being 45.5 ± 16.4years. Median VAS score was 4.66 ± 2.14 vs. 6.11 ± 2.07, (P<0.05). 51.1% of patients in experimental group as compared to 21.3% in controls reported mild pain (VAS < 4), (P<0/01). It seems that lidocaine-H ointment has beneficial effects in prevention of the pain associated with EMG needling.

Myofascial pain syndrome of upper trapezius muscle is common; reports about successful treatment with dry needling and physical therapy have been published. This study was performed with the objective of comparing the efficacy of these two treatment modalities in relieving the symptoms in patients with myofascial pain in the trapezius referred to the Physical Medicine and Rehabilitation Center at the Shohadaye Tajrish Hospital from Apr 2009 to March 2010.

It was a randomized controlled trial performed on 28 patients. After matching age, sex, duration of symptoms, pain severity, pain pressure threshold of trigger point and quality of life measures, subjects were randomly put in to subgroups of case (dry needling) or control (physical therapy). One week and one month after receiving treatment, outcomes and intra and inter group changes in pain severity, pain pressure threshold of trigger point and quality of life measures were evaluated and compared.

28 subjects in two 14 patients groups took part in this study. After one month of both physical therapy and dry needling, there was a decrease in resting, night and activity pain levels, (p<0.05). Pain pressure threshold of trigger point, scores of physical functioning, role limitation due to physical problems, social functioning and bodily pain were improved (p<0.05). Results were similar in the two groups, (p<0.4).

It seems that both physical therapy modalities and dry needling have equal effect in decreasing myofascial pain of upper trapezius muscle.

Stress gradually suppresses the immune system making the body susceptible to various diseases. The aim of this study was to show the effects of cold and immobilization stress on growth of malignant cells in Balb/c mice.

In an experimental study which was carried out in the Molecular & Cellular Research Center of Shahrekord University of Medical Sciences in 2008, 3 groups of 10 Balb/c mice were selected to investigate the effects of cold stress and immobilization stress on growth of WEHI – 164 fibrosarcoma cells in groups of 10, Balb/c mice. Each mouse was injected with tumor cells subcutaneously in the chest; for 2 hours/day mice in group 1were subjected to cold stress and mice in group 2 were immobilized; the control group received tumor cells with no stresses. Tumor sizes were measured every two days and case groups were compared with the control group.

Results showed that the tumor sizes in stressed mice were significantly different from controls. After 14 days of tumor inoculation, mean tumor size in mice subjected to cold stress and immobilization was 31.99±2.61 and 37.13±3.51cumm respectively, but in the control group the mean tumor size was 18.15±3.09 cumm, (p<0.05).

Results in this study showed that cold and immobilization stresses increase the growth of WEHI-164 tumor cells.

In the absence of specific symptomology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. This study was performed to evaluate the diagnostic utility of serum procalcitonin levels in children with acute pyelonephritis.

Serum procalcitonin was measured with a rapid, semi-quantitative immune-chromatographic test in 56 children who presented with symptoms of UTI; a level >0.5 ng/mL was considered abnormally elevated. A DMSA scan was done on all cases and the procalcitonin levels were compared with the DMSA study; positive and negative predictive values, (ppv & npv), were determined.

The procalcitonin test was positive in 43 of the 49 patients with a positive DMSA scan; p.p.v. of the procalcitonin test was 95.3%; n.p.v was 38.5%.

Procalcitonin test may be utilized as a sensitive marker for early diagnosis of acute pyelonephritis.

Various studies have shown the age changes of menopause in Iran, in a relatively wide area, approximately from 46 to 51 years. This broad range of the changes can attribute not only to the essential difference between women of different regions, but could also be related to methodological problems. Because the model of menopause age could be estimated by cohort or a cross-sectional survey; that each has advantages and disadvantages. On a special type of cross-sectional studies, the target is only the status of menopause for each woman, such that the prevalence of menopause can be calculated in each age group. Therefore, how one can estimate the pattern of the age at menopause using the prevalence data?

For estimating the patterns of the age at natural menopause and its characteristics, parametric and non-parametric methods are introduced and the data from the survey:" Estimating the pattern of the age at natural menopause and its effective factors in Semnan" are used to illustration of the methods. In that survey, during the year 2007, Total number of 3545 urban and rural women were randomly selected and their status in terms of menopause or not asked, then by excluding abnormal menopause, 3404 of whom have participated in the study. Finally, it was determined which procedure provides better natural menopause age model.

The pattern of menopause age obtained with the help of generalized linear models (GLM) with parametric base and non-parametric method in which the probability distribution is estimated empirically. Although there were not many differences between the estimated values in the different models, but the log - log model had greater estimation than two-parametric, logistic and probit, models and its results were more like non-parametric model. Among parametric models, logistic model had the best fitting.

It seems, logistic model is more appropriate than other models to estimate the pattern of the age at natural menopause, although further research is needed.

Although current medicine has some advantages compared with traditional medicine, one of its important problems is overuse of chemical drugs that leads to drug resistance and side effects. According to antibacterial effects of Glycyrrhiza glabra extracts, this study was conducted to Compare effects of Glycyrrhiza glabra and nalidixic acid and nitrofurantoin on isolated bacteria from urinary tract infections and stones

This is an experimental study was done on 100 patients with urinary tract infections and stones. Glycyrrhiza glabra extract was taken from risome of 3- or 4- year herb by method of perculation with methanol 85% solvent. Solvent was vaporized by rotary and lyophilized. Antibacterial effects of extract, nitrofurantoin and nalidixic acid were evaluated by two methods of disc diffusion and MIC. Statistical analysis was performed by ANOVA and paired t- test.

In disc diffusion, 100% of Streptococcus and MRSA and 33% of E.coli were susceptible to Glycyrrhiza glabra extract. In MIC, Streptococcus, MRSA, Enterococcus fecalis in 1:128 dilution, and E.coli in 1:64 dilution of Glycyrrhiza glabra extract were susceptible. Klebsiella, Serattia, and Entrococcus facium were resistant. Diameter of no growth of bacteria among gram positive and negative bacteria were significantly different in Glycyrrhiza glabra extract and nitrofurantoin groups (p<0.05), and was non significantly different in nalidixic acid group (p=0.9).

It seems that Glycyrrhiza glabra extract with antibiotics can be useful in the treatment of urinary tract infections.

Backgraound: Regarding the prevalence and high mortality rate of ovarian cancers, importance of markers to determine ovarian malignancies earlier, considerable experimental evidence about serum Gonadotropins to cyst fluid ratio with pathology of ovarian tumors and finally not enough experiments in our country, the present study was performed in Imam Hossein hospital between 2008 and 2010. This study was cross-sectional and performed in patients operated because of ovarian mass. Their serum samples and cyst fluid obtained at the time of laparatomy and histopathologic diagnosis was established after removal of the tumor. FSH and LH concentration were measured in serum and tumor fluid based on Microparticle Enzyme Immunoassay technology in Imam Hossein laboratory. Ratios of them were determined in four pathologic groups (simple cyst, benign, borderline and malignant) and statistical comparison was done with the Kruskal-Wallis and Mann-Whitney U-test. We studied 100 patients with ovarian mass but pathology of 79 patients was epithelial tumors and simple cysts. The most common mass were simple cysts (48.1%) and then benign tumors (27.8%), malignant tumors (16.5%) and borderline tumors (7.6%). Serum FSH / tumor fluid ratios were in simple cysts (21.1±53.8), benign tumors (50.7±174.9), borderline tumors (1.5±0.7) and malignant tumors (1.9±1.9) (P<0.001) and serum LH/tumor fluid ratios were in simple cysts (12.1±26.5), benign tumors (20.0±29.1), borderline tumors (2.6±2.3) and malignant tumors (2.8±3.7) (P<0.002). Our findings suggest that serum gonadotropins / tumor fluid ratio can be used as a tumor marker for identification of ovarian tumors. Also serum gonadotropins / tumor fluid ratio could be of value in differential diagnosis of ovarian tumors after determination normal and abnormal cut off point and ratios of them.

Hodgkin's lymphoma (HL) is a curable lymphoid malignancy. Different Immunohistochemical markers specially CD15 & CD30 are used to diagnose HL and differentiate it from other lymphomas including anaplastic large cell lymphoma (ALCL); regarding different reports on the frequency of immunoreactivity for these markers in the literature and lack of information in this regard in Iran, this study is carried out in Iranian Hodgkin’s lymphoma patients to determine the frequency of these markers in Iranian HL patients.

A cross sectional study is carried out on all patients with definite diagnosis of classic Hodgkin’s lymphoma in studied hospitals. Patients were classified according to WHO classification into: mixed cellularity, nodular sclerosis, lymphocyte rich and lymphocyte depletion subtypes. CD15 & CD30 immunophenotype were detected by monoclonal immunostaining method. The frequency was determined in each group and C.I. (confidence interval) was calculated for Iranian population.

The studies carried out on 65 patients. Mean age was 31.9±18.1 years. 28 (43.1%) patients were female and 37 (56.9%) were male. CD15 and CD30 was positive in 50 (76.9%) and 58 (89.2%) respectively. Both markers were positive in 46 (70.8%) and were negative in 3 (4.6%). There was no significant relationship between CD15 and CD30 immunostaining and age and gender (p<0.6).

It seems that there is a high frequency of immunostaining for CD15 or CD30 in Iranian Hodgkin’s lymphoma patients. These markers are useful in diagnosis of Hodgkin’s lymphoma. However, in CD15 negative, CD30 positive cases, it is better to use additional markers for avoiding misdiagnosis as anaplastic large cell lymphoma.

Breast cancer is more common in women with high serum testosterone level. Few studies showed that high level of serum testosterone is associated with poor prognosis. The association of testosterone level with histopathological findings has not been studied yet. In this study we investigated this association. Patients referred to a medical oncology clinic with no history of previous chemotherapy, hormone therapy, oophorectomy, or other cancers enrolled in the study. Morning serum testosterone was checked. Histopathologic findings were extracted from pathologic reports. Relationship between testosterone level and histopathologic types was analysed. 106 patients were studied whose mean age was 47±10 years. 63.2% of our patients were premenopausal. Histopathologic factors were unfavourable in 50%. The rate of vascular invasion was 56.4% and 73% were receptor positive. Mean level of serum testosterone was 0.56±0.52 ng/ml in patients with favourable histopathology and 0.70 ±0.77 ng/ml with unfavourable histopathology (p<0.4). No testosterone level was above normal range. There was no relation between serum testosterone level and histopathologic findings; viz. serum testosterone level was not higher in breast cancers with unfavourable histopathologic factors. So we need to conduct more studies to figure out the reasons for the poor prognosis observed in patients with higher levels of serum testosterone.

Gorham’s disease is rare and is associated with progressive bone destruction. The first case was reported in 1838 and until now 175 cases with Gorham's disease have been reported in the literature. In this article a patient with concurrent involvement of lumbar spine and trochanteric region is reported. Case report: A 32 years old woman with intensive back pain and paraplegia was admitted to our center. Radiological and laboratory studies were done. Spinal x-rays revealed L3 collapse and a potential metastatic lesion in L3 and trochanteric region. Patient underwent cord decompression and stabilization of the spine and biopsy was done. Histological studies demonstrated that the lesion is due to Gorham's disease. Gorham’s disease can involve spine and cause paraplegia and in this conditions, decompression can be helpful. Also, our case portrayed that this disease can involve distant bones concurrently.

Successful clinical decisions are the outcome of a complex process. In making them, we draw on information from scientific evidences, our personal experience and external rules and constraints. Considering that the explosive increase in the amount and quality of the scientific evidence that has come from both the laboratory bench and the bedside, we may lack the time, motivation, and basic skills needed to find, critically appraise, and synthesize information. Fortunately, systematic reviews help us and answer sharply defined clinical questions. This article deals with two questions; a: what is a systematic review and, b: how should we organize it?

We searched MEDLINE database with search terms of systematic review and narrative review, restricted to English language, without time limitation. Then we selected those articles written by renowned experts.

There are two types of review articles: narrative review and systematic review. Narrative review has been the conventional method for writing review articles; since it is subjective, it may be subject to error and bias; in areas where there is lack or paucity of evidence, the narrative review may still be the best writing method. Systematic review is the precise, systematic and classified method of reviewing the existing data and evidences. It is objective, constructive and comprehensive and has much less error and bias than the narrative review.

Systematic reviews are thus a vital link in the great chain of evidence that stretches from the laboratory bench to the bedside. It is absolutely essential for targeting these goals, for writing a systematic review, a fully trained team with an expert leader and a precise protocol is essential.