فهرست مطالب

  • Volume:6 Issue:3, 2019
  • تاریخ انتشار: 1398/05/01
  • تعداد عناوین: 12
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  • Arezoo Chouhdari, Omidvar Rezaei, Parinaz Rezapour, Mohammad Samadian, di ShahrabiFarahani, Mohammadreza Hajiesmaeili, Kaveh Ebrahimzadeh * Page 1
    Background
    Lumbar disc degeneration is one of the mostcommoncauses of low back pain which can gradually reduce the healthrelated quality of life (HRQoL).
    Objectives
    The aim of this study was determining factors related with improvement of QOL in lumbar spine decompression surgery.
    Methods
    This quasi-experimental research was conducted on 145 patients with lumbar disc degeneration who underwent lumbar spine decompression surgery during 2017 - 2018. We analyzed the quality of life based on EQ5D/VAS score by self-assessment examination according to age, gender, BMI, educational level, life model, smoking habit, leg and back pain scale, regular activity and walking distance (meters). For the reporting of results, descriptive analysis and repeated measure ANOVA for comparison quality of life (QOL) in three times before, 6 and 12 months after surgery were used. P value less than 0.05 was considered statistically significant. All analyses were conducted using SPSS version 19.
    Results
    Overall, 90 (62.1%) of patients were female. Most patients (30.3%) were in the 41 - 50 years age groups. The EQ-5D/VAS scores improved in all age groups in the three times measured (P = 0.001). QOL in normal BMI improved more than overweight and obese (P = 0.001). High level of education was associated with more improvement of QOL after surgery (P < 0.001). Patients who lived with the family had significantly higher QOL score before, 6 and 12 months after surgery (P < 0.001). No association was observed cigarette smoking (P = 0.03) so the lower duration of pain preparation was associated with higher QOL statistically. Overall, EQ5D score in the leg, back pain, regular activity and walking distance (meters) improved in the duration of one year in all subgroups (P < 0.001).
    Conclusions
    According to the results, various factors were effective in improving postoperative quality of life in patients who underwentlumbarspine decompression. So,morestudy isrecommendedonthe socioeconomic, lifestyle to furtherimprovequality of life after surgery.
    Keywords: Basic Characteristics, Health-Related Quality of Life (HRQoL), Lumbar Spine Decompression Surgery, EQ5DQuestionnaire
  • Ali Reza Shafiee, Kandjani, Shahrokh Amiri *, Zahra Mousavi, Mazyar Hashemilar, SalmanSafikhanlou, Salman Abdi, Majid Khalili Page 2
    Background
    Multiple sclerosis (MS) is a chronic inflammatory disease characterized by central nervous system lesions that can lead to severe cognitive and physical disability, as well as neurological deficits such as attention and memory decline. The complications may bring about many difficulties for patients in educational and occupational functioning and low quality of life.
    Objectives
    Considering the remarkable prevalence of cognitive deficits and its important effects on the occupational and social functioning of MSpatients, this study was conducted to investigate cognitive deficits in these patients compared to a control group.
    Methods
    This case-control study was carried out on 34 MS patients selected from among patients admitted to Imam Reza Hospital and Razi Psychiatric Hospital in Tabriz, Iran. Moreover, a control group of 34 age and gender-matched patients admitted to internal wards was formed. The Persian version of the paper and pencil cognitive assessment package (PCAP) was used to assess cognitive functions. Data analysis was performed using SPSS version 22 software through descriptive statistics (mean and standard deviation) and inferential statistics (Student t-test and Pearson’s correlation test). A P value of < 0.05 was considered statistically significant.
    Results
    The results of t-test showed that MS patients had lower PCAP mean scores than the control group in cognitive functions (executive function, attention, focus and work memory) (P < 0.05).
    Conclusions
    The findings of this preliminary study confirmed that MS patients suffered from cognitive impairments. The assessment of cognitive functions must be done in MS patients. Cognitive enhancement therapy would be helpful for afflicted patients.
    Keywords: Attention, Cognitive Functions, Executive Function, Multiple Sclerosis, Working Memory
  • Naser Sedghi Goyaghaj, Amir Hosein Pishgooie *, Shahla Aliyari, Armin Zareiyan Page 3
    Background
    Advances in surgicalandmedicalmanagementhave significantly reduced the length of time that patients with spinal cord injury have to stay in hospital; however, less attention has been paid to their psychological issues.
    Objectives
    This study aimed to determine the effect of self-care program training on self-efficacy in veteran with spinal cord injury.
    Methods
    This study is a randomized control trial study that in that pre-test/post-test plan with the control group was used. All of the veterans with paraplegia spinal cord injury,whoreferred to a private hospital in 2017 - 2018, were our statistical study population. Sixty veterans were selected based on the inclusion criteria and purposive sampling method and randomly divided into two groups of experimental and control by using a table of random numbers. For the intervention group, six sessions of a 60 - 45-minute selfcare education were performed. Patients filled Moorong self-efficacy scale before, one week and one month after the intervention. SPSS statistical software version 19 was used to analyze the data using chi-square, Fisher’s exact test, independent t-test, and repeated measures.
    Results
    The results showed that no significant difference was between the two groups of the intervention and control in terms of demographic characteristics. Themeanself-efficacy score was 39.264.03 in the intervention group, and 38.563.99 in the control group before the intervention, which reached to 43.865.15 and 38.363.89 one week and 51.165.36 and 39.264.16 one month after the implementation of the intervention, respectively and this difference was significant in the intervention group (P0.001).
    Conclusions
    According to the results, self-care program training is effective in self-efficacy of veterans with spinal cord injury. Therefore, this method is simple, non-invasive, low-cost, and effective in increasing self-efficacy and the treatment of these veterans, which may be applied to nurses.
    Keywords: Self-Care, Education, Self-Efficacy, Veteran, Spinal Cord Injury
  • Aminollah Vasigh, Asma Tarjoman *, Behrouz Soltani, Milad Borji Page 4
    Background
    Migraine is one of the common diseases, which has been considered as one of the reasons of disability and since this disease is widespread, attention to this subject is necessity.
    Objectives
    The aim of study was to determine the relationship between mindfulness and self-compassion with perceived pain in migraine patients.
    Methods
    This was a descriptive analytic cross-sectional study, which was carried outonthe 168 patients with migraine in the west of Iran, in Ilam, during year 2018. The tools used included several sections of mind-consciousness questionnaires, self-compassionate questionnaire, and numerical scale pain. Patients with migraine referring to Ilam health centers (hospitals, clinics, and offices) were studied in the research with the sampling method. The researcher collected data by referring to the required centers in order to sample. After data collection, data entry to SPSS statistical software version 16 was performed.
    Results
    MeanSD of the total score of mind-consciousness variables was 53.334.69, self-compassion was 71.484.85, and pain was 3.331.75. Findings showed that there is a correlation between mindfulness and pain (F = 81.78, P = 0.000, r = 0.57), and there is no relationship between self-compassion and pain (F = 0.004, P = 0.95, r = 0.005).
    Conclusions
    Considering the effect of mindfulness in controlling pain, it is necessary to perform interventions based on mindconsciousness. Also, due to there being no relationship between self-compassionate behavior and pain, more research is needed in this area to provide researchers with complete information.
    Keywords: Mindfulness, Self-Compassion, Pain, Migraine
  • Mohsen Davoudkhan, Fateme Rajabi, Abbas Norouzi Javidan, Farnaz Younesi, MaryamNoroozian * Page 5
    Background
    Thememory impairment screen (MIS) test is a brief, four-item, delay-free, andcued-recall test of memory impairment. It is highly correlated with Alzheimer’s pathology and can be easily used by trained non-specialists. However, the application of this test might be restricted due to minimum literacy levels requirement. The picture based MIS (PMIS) is a modified version that can be used by even illiterate or low-education people. The pictures can be adapted based on cultural differences.
    Objectives
    The aim of this study was to provide and validate the Persian version of illustrated memory impairment screen (PIMIS) test in elderly patients with Alzheimer’s disease in Iran.
    Methods
    This validation was a cross-sectional study on people 60 years of age and older with different levels of education (illiterate to > 13 years of education). The participants consisted of subjects with normal cognition, subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and different types of Dementia. Cognitive impairment was diagnosed by a neurologist with expertise in dementia (gold standard). The validity was assessed by comparing MISIP with the gold standard. Area under ROC curve, optimal cut-point, sensitivity, specificity, and Cronbach’s alpha were estimated.
    Results
    Data were collected from 119 participants, 38 of which were diagnosed with Dementia, 17 with MCI, 21 with SCI and also 43 had normal cognition. The PIMIS score was significantly lower in patients diagnosed with dementia compared to the other groups (7.1 versus 4.3 for PIMIS score with a P value of less than 0.001). The PIMIS had a sensitivity of 60% and specificity of 91% for detecting dementia at a cut-point of five. Level of education had no significant effect on the test.
    Conclusions
    IMIS is a simple reliable screening test in elderly population with variable literacy rates.
    Keywords: Alzheimer’s Disease, Validation, Assessment, Screening, Persian Version Illustrated Form of MIS
  • Shole Vatanparasti, Anoshirvan Kazemnejad, Shahram Oveisgharan, Payman HassaniAbharian, Ali Yoonessi * Page 6
    Background
    Writing is a human communication tool. No disability behavioral assessment of dysgraphia due to stroke-induced neglect has been conducted in Iran.
    Objectives
    We investigated rehabilitation of dysgraphia in patients with stroke-related neglect in Persian language- specific constructive errors of writing.
    Methods
    All patients were suffering from stroke-induced visual neglect. Five patients were evaluated for dysgraphia in a spontaneous writing task before and after rehabilitation without writing practice for 10 sessions with prism adaption (PA). Dysgraphia was classified into visuospatial omission error, visuospatial destruction error, visuospatial size error, visuospatial tilting error, poor handwriting style, visuospatial distance error, and visuospatial perseveration (addition) error. Neglect was evaluated using the star cancellation test (SCT), and line bisection test (LBT) and activities of daily living (ADL) was assessed by the Barthel index (BI) and the Catherine Bergego scale (CBS).
    Results
    All patients showed significant improvement in dysgraphia (measured using spontaneous writing test), ADL (measured using CBS and BI), and neglect (measured using LBT and SCT) (P < 0.05). Visuospatial destruction errors were the most frequent and visuospatial omission errors were the least frequent errors.
    Conclusions
    PA is a potential effective strategy in stroke rehabilitation of dysgraphia, visuospatial neglect and ADL. Unilateral spatial neglect and rehabilitation improves dysgraphia in Persian language speaking patients with right brain stroke.
    Keywords: Rehabilitation, Neglect, Dysgraphia, Writing, Language, Prism Adaption
  • Alireza Nikbakht Nasrabadi, Nooredin Mohammadi, Keyvan Davatgaran, MirsaeedYekaninejad, Abbas Noroozi Javidan, Maryam Shabany * Page 7
    Background
    Spinal cord injury (SCI) causes financial, social, and psycho-emotional problems for both the person afflicted with SCI
    andthe family. Family asanimportant source of care playsanimportant role in patients’ rehabilitationandcomplication reduction.
    Objectives
    The present study aimed at designing a client and family empowerment model for SCI patients.
    Methods
    This was a qualitative study with the grounded theory approach conducted in 2017. Unstructured interviews were used as
    the main method of data collection. Saturation was achieved with 43 participants, including people with SCI, family caregivers, and
    people involved in providing health care and rehabilitation services for people with SCI. Data analysis was performed on the basis of
    continuous comparative analysis of Strauss and Corbin (1998). In the second stage, the findings of the grounded theory study were
    used for designing the prescriptive model based onWalker and Avant (2005) three-step method.
    Results
    The main concern of people with SCI and their families was the loss of physical ability, financial and physical independence,
    and lack of constructive life. Ultimately, a “client and family empowerment model to promote constructive life recovery for
    individuals with SCI” was developed based on the findings of the grounded theory study. This model includes four main concepts:correction of environment, educational empowerment of the clients and families, modification of the method of providing rehabilitation
    services, and recovery of a constructive life.
    Conclusions
    There were several barriers to the client and family empowerment of people with SCI. In this study, a client and family
    empowerment model was developed to promote constructive life recovery and strategies were identified to remove the barriers.
    Hence, this model can help people with SCI to return their effective lives.
    Keywords: Spinal Cord Injuries, Empowerment, Family, Qualitative
  • Jyotsna Punj *, Pallavi Misra, Ravindra Pandey, Vanlal Darlong Page 8
    Background
    The entropy electrode is centrally placed on the forehead over the muscles of frontalis, orbicularis oculi, and corrugator supercilii. It determines response entropy (RE), which is the electromyogram component, and state entropy (SE), which is the electroencephalogram component. We hypothesized that due to the central location of entropy, the decreasing value of RE-SE  2 with SE  45 could denote an adequate combination of hypnosis, muscle paralysis, and analgesia required for endotracheal intubation. This could result in earlier intubation compared to when guided by train-of-four (TOF) = 0.
    Objectives
    The primary objective of the study was to evaluate if entropy values of RE-SE2 with SE45 can be used as a measure of adequate condition for endotracheal intubation. We also sought to determine the TOF at this point.
    Methods
    Endotracheal intubation was performed in group E (Entropy; n = 30) at RE-SE  2 with SE  45 and in group T (TOF; n = 30) at TOF = 0. A propofol bolus (20 mg) was administered if the patient had a hypertensive response or moved in response to endotracheal intubation. The TOF was noted at the time of intubation in group E. We also measured the time to intubation, jaw and vocal cord relaxation, patient movement or coughing, SE, TOF, and vital parameters. Statistical analysis was performed with two-tailed students’ t test, paired t test, chi-square test, and ANOVA. The difference between groups was considered significant if the p value was < 0.05.
    Results
    The time to intubation was significantly shorter in group E than in group T (92.563.5 seconds vs. 209.259.6 seconds; P < 0.001) with a mean TOF of 87.3%  8.4% in group E. Intubating conditions in terms of jaw relaxation, patient movement, and coughing were not significantly different between the two groups. Vocal cord relaxation was significantly inadequate in six patients in group E (P < 0.01); however, there was no difficulty in introducing the endotracheal tube with no postoperative adverse effects such as sore throat.
    Conclusions
    Adequate conditions for endotracheal intubation were achieved 90 seconds after the administration of fentanyl, propofol, and vecuronium for anesthesia induction when it is guided by RE-SE2 with SE45, which is earlier than when guided by TOF = 0.
    Keywords: State Entropy, Muscle Relaxants, Neuromuscular Blocking Agents
  • Bahareh Rezaei, Fariba Yadegari *, Anahita Khorrami Banaraki, Mohsen Shati, MehrdokhtMazdeh Page 9
    Background
    Post-stroke persons with aphasia (PWA) may suffer from deficits in executive function (EF). Cognitive flexibility, as an important element of EF, may be affected by PWA. As a task of cognitive flexibility, set-shifting can be measured by the Wisconsin Card Sorting Test (WCST). Assessing these EF basics may have important implications for cognitive-communicative rehabilitation of PWA.
    Objectives
    The aim of the current study was to examine set-shifting skills and their correlation with language components of Persian-speaking PWA.
    Methods
    Nineteen Persian-speaking, non-fluent PWA (13 males and six females; mean age was 54.26  8.88 years, and age range was 32 to 69 years old) participated in this study. The bedside version of the PersianWestern Aphasia Battery (P-WAB-1) and the WCST were performed to assess language and set-shifting abilities, respectively. The Spearman’s rank correlation coefficient test was used to examine the correlation between the variables. Statistical analyses were performed using the SPSS 18.0 software.
    Results
    The results showed that the P-WAB-1 score was inversely correlated with perseverative errors index of WCST (r = -0.48, P < 0.05). Also, there was a significant correlation between the “fluency of spontaneous speech” subtest of P-WAB-1 and WCST indices, including number of categories completed (r = 0.54, P < 0.05), total number of correct responses (r = 0.61, P < 0.05), total number of errors (r = -0.60, P < 0.05), and non-perseverative errors (r = - 0.44, P < 0.05).
    Conclusions
    Based on these results, it appears that decreased cognitive flexibility of PWA may coincide with decreased language ability. This study broadens current understanding of the complex relationship between language and EF by measuring set-shifting in a sample of non-fluent PWA. These results may be beneficial to cognitive-communicative rehabilitation programs for PWA.
    Keywords: Executive Function, Aphasia, Stroke, Acquired Language Disorders
  • Tayyeb Ghasemi, Hamid Sohanaki, Mansoor Keshavarz, Ensieh Ghasemi, Mohsen Parviz * Page 10
    Alzheimer’s disease (AD) is a multifactorial and debilitating condition without precise etiology and definite cure burdened with highmonetaryandhumanresources to the societyaroundthe globe. Given that Iranian traditional medicine has a valuable treasure of medicinal plants with multi-dimensional effects, we designed this study to examine one week daily low single-dose treatment protocol of 3 mg/kg Teucrium polium (TP) hydro-alcoholic extract effects on rat’s spatial memory performance and CA1 hippocampal neuronal count in rat A 25-35 as an AD model. Animals were bilaterally microinjected with single 10 g/2 g intrahippocampal A 25-35 fragment for the AD induction. After a two-week recovery period, daily intraperitoneal injection of TP for a week was initiated in A -received TP-treated (treated) and TP-received animals (control). Spatial memory performance and CA1 neuronal count were evaluated. TP significantly reduced time latency and distance swum during the first three days of the training protocol compared with A -received rats (sham). Probe reference test findings, however, were not statistically different in treated, sham, and control groups. Intact CA1 hippocampal neuronal count showed a significant increase in A -received TP-treated (case) rats in comparison with A -received (sham) animals. It seems that the least reported low dose TP has the active chemical components capable of memory enhancing effects in Morris water maze (MWM) setting and potential neuronal survival property in hippocampal tissue. In spite of myriad claims against TP use, we should reconsider the matter and domore research to find the exact active ingredients of various species of the plant plus possible underlying mechanisms for ensuring potential use for human clinical trials in AD and other central nervous system-related diseases.
    Keywords: Teucrium Polium, Alzheimer’s Disease, A 25-35, MorrisWater Maze, Hippocampus, CA1 Neuronal Count
  • Mohsen Davoudkhani, Reza Kormi, Nouri, Abbas Norouzi Javidan, Farshad Sharifi, FarnazYounesi, Azadeh Sadat Zendehbad, Maryam Noroozian * Page 11
    Background
    The brief version of community screening instrument for dementia (CSI-D) is a neuropsychological tool, which can be used even by non-specialists in primary care settings following a short training. The CSI-D evaluates the cognitive and functional domainsof the subjectsandincludesaninformant interview. However, it should beadapted basedonliteracy levelandsociocultural profile of population in each country.
    Objectives
    The current study examined the validity and reliability of the Persian version of the brief CSI-D in elderly patients of Iran.
    Methods
    The current descriptive, cross sectional study was conducted on people 60 and over from 16 provinces of Iran with seven different ethnicities and various levels of education (0 - 13 to 13 years). The participants consisted of subjects with normal cognition, subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and different types of dementia. Cognitive impairment was diagnosed by a neurologist with expertise in dementia. The psychometric properties were assessed by comparing Persian version of brief CSI-D with the gold standard. Area under ROC curve, optimal cutoff point, and sensitivity and specificity were also calculated.
    Results
    Data were collected from 262 participants. Of all the participants, 112 were diagnosed with dementia, 64 with MCI, 32 with SCI, and 53 with normal cognition. The best cutoff point for the test- regardless of gender and level of education- was 8.5 compared with 8 - 9 in the original version of CSI-D and also the cutoff point for patient with dementia was 5.5, while it was 4 in the original version.
    Conclusions
    The Persian version of CSI-D seems to be an accurate and sensitive tool to screen dementia and MCI in primary care setting, especially among low-educated and illiterate people.
    Keywords: Dementia, Mild Cognitive Impairment, Validation, Persian, Brief CSI-D, Screening
  • Majid Reza Farrokhi *, Hamid Rezaei, Nima Derakhshan, Saber Zafar Shamspour Page 12
    Introduction
    Metastatic involvement of the spine may present with pathologic fractures, deformity, neurologic deficit due to vertebral canal compromise, and pain. Pain is usually managed with non-steroidal anti-inflammatory agents, corticosteroid injections, calcitonin, etc. Since the introduction of percutaneous vertebroplasty in 1984, it has proven as an effective armamentarium in the management of painful metastatic spine lesions. Herein, we present a case of breast cancer with osteolytic C2 metastasis, forwhom trans-oral vertebroplasty without posterior fusion resulted in long-standing pain control and maintenance of normal motions and stability.
    Case Presentation
    A41-year-oldwoman, aknowncase of breast cancer with severe neck pain for three months, was admitted due to an osteolytic lesion in C2. The pain was incapacitating and resistant to conservative measures. Standalone transoral vertebroplasty resulted in pain control and a three-year follow-up showed durable control of pain. After positioning the patient and insertion of Dingman mouth gag, the oropharynx was prepped and injected with epinephrine/lidocaine solution. Under biplanar fluoroscopic guidance, a needle was introduced into the C2 body through the oropharynx. The lytic lesion was filled with about 2 cc of PMMA cement. The VAS score decreased from 10 prior to operation to 5 immediately after recovery from general anesthesia and improved to 2 after six months. At a 36-month follow-up visit, the VAS score was 0, normal cervical motions were preserved, and lateral neutral and dynamic cervical X-rays disclosed stability.
    Conclusions
    Standalone transoral vertebroplasty can be safely practiced as an effective treatment for painful osteolytic metastases of C2 with normal dynamics.
    Keywords: Transoral Vertebroplasty, Breast Cancer, Osteolytic C2 Metastasis, Pain