مجله پزشکی بالینی ابن سینا
سال بیست و ششم شماره 4 (پیاپی 94، زمستان 1398)

Carpal Tunnel Syndrome is the most prevalent type of peripheral neuropathy due to neural entrapment. This syndrome is primarily diagnosed based on clinical symptoms, and it is subsequently confirmed by electro-diagnostic studies. Ultrasonography as a safe, available, and inexpensive method is also valuable in the follow-up of patients. This study aimed to evaluate the ultrasound findings before and after local corticosteroid injection.

This interventional study was conducted on 45 patients referring to the orthopedic clinic of Besat Hospital, Hamadan, Iran, during 2017. The patients who were selected by convenient sampling method had the symptoms of carpal tunnel syndrome and were diagnosed positive based on electrodiagnostic studies indicating a moderate grade of the disease. Wrist ultrasound was performed before and after the injection of corticosteroid (two months later). Moreover, the ultrasound indices were compared before and after the injection. Data were analyzed in SPSS software (version 16). A p-value less than 0.05 was considered statistically significant.

According to the results, 80% of the patients were female. Moreover, the mean age of the patients was 47.9±11.6 years (age range: 22-72 years). About 20% of the cases were left-handed. The right hand was mostly affected by carpal tunnel syndrome (70%). After injection, there were reductions in the median nerve thickness (P=0.95), retinaculum thickness (P=0.001), and nerve cross-sectional area (P=0.001). The Disabilities of the Arm, Shoulder, and Hand (DASH) scale showed that the clinical symptoms of the patients were significantly reduced at the end of the study (P=0.001).

Corticosteroid injection in patients with moderate severity of carpal tunnel syndrome improved the clinical symptoms and caused reductions in median nerve thickness, cross-sectional area, and flexor retinaculum thickness.

Extraction of impacted lower third molars is one of the most frequent surgeries of the oral cavity. This operation might be accompanied by inevitable complications, such as pain, swelling, and trismus after surgery. Therefore, the aim of this study was to evaluate the impact of low-intensity/power laser therapy on swelling and trismus after impacted mandibular third molar surgery.

This randomized double-blind clinical trial was performed on 40 patients who required similar unilateral impacted third molars. These patients were randomly divided into two groups of 20, including the control group with no laser application and the test group receiving laser irradiation. In the intervention group, 1 cm2 of the tissue was irradiated immediately post-operation by 12 j/cm2 energy using a 980-nm laser setting with continuous wave mode at the output power of 200 MW for 60 s. Radiations were carried out at three regions, including two intraoral sites on the buccal and lingual sides of the operated area and an extraoral area on the joining point of the masseter muscle to the mandible. Inflammation and trismus were assessed by measuring the size of the face and maximum mouth opening on the second and seventh days after surgery.  

Our findings demonstrated that in the laser group, on the second day post-operation the maximum mouth opening (trismus) was 28±6 and facial swelling was 217.8±12.8. The two groups were not significantly different on this day regarding the two evaluated variables (P>0.05). On the seventh day, trismus and facial swelling were reported as 39.85±6.97 and 209.2±13.45, respectively. Moreover, improvements were observed in the irradiated group at this time point. However, no statistically significant difference was found between the test and control group concerning these factors (P>0.05).

According to the results of this study, laser application with the parameters set in this study had no significant positive effects on reducing the post-operation complications.

Stroke is the third most common cause of death in developed countries and the most common disabling neurological disease. There are several risk factors for stroke. Regarding this, the present study was conducted to investigate the effect of Helicobacter pylori antibody on the incidence of stroke.

This case-control study was conducted on 50 patients (i.e., case group) with stroke admitted to Sina Teaching Hospital of Hamadan, Iran, using convenience sampling method. This group was compared with 50 healthy controls in terms of the serum level of Helicobacter pylori antibody. The data were analyzed using SPSS software (version 21) using proper statistical tests at 95% confidence interval.

The mean serum levels of Helicobacter pylori antibody in the case and control groups were 25.93±44.03 and 35.36±41.25 Uarb/ml, respectively (P=0.108). In addition, the serum levels of this antibody were obtained as 20.78 and 35.84 (P=0.055) in the females and 31.51 and 34.31 (P=0.501) in the males of the control and case groups, respectively. The Spearman correlation coefficient revealed a positive but insignificant relationship between age and serum antibody level of Helicobacter pylori in both groups (r=0.150; P=0.13).

As the findings indicated, the stroke patients had a lower serum level of Helicobacter pylori antibody, compared to the healthy non-stroke patients; however, this difference was not statistically significant.

Multifidus muscle which is one of the para-spinal muscles plays a key role in strengthening the spine and acts as inhibitory feedback in pain control.  The present study aimed to evaluate the rate of multifidus muscle atrophy in Magnetic Resonance Imaging(MRI) images of patients with spinal pain.

In this cross-sectional study, 600 MRI images of patients with spinal pain (patients complaining of pain during clinical examination) referring to Besat Hospital of Hamadan within 2017- 2018 were selected by census method and evaluated for multifidus muscle atrophy based on its related variables.  The obtained data were analyzed in SPSS software (version 16) at 95% confidence level.

The mean age of patients was reported as 46.16 years.  In terms of gender, 46.5% of cases were male and 53.5% were female.  The frequency of multifidus muscle atrophy was measured at 63.5% out of which 38.6%, 43.6%, and 17.8% were reported as grades one, two, and third, respectively.  As evidenced by the obtained results,  multifidus muscle atrophy and its degree showed a significant correlation with such variables as age, sex, body mass index(MBI), intense physical activity, duration of daily activities, duration and symmetry of pain (P<0.05).

The frequency of atrophy of multifidus muscle was reported to be high in the patients under study. Female gender, old age, high BMI, intense physical activity, duration of daily activities, duration of spinal pain and two-sided pain were recognized as independent variables associated with multifidus muscle atrophy.

One of the most important advancements regarding the care of patients with acute myocardial infarction is the administration of anti-coagulation medicines (e.g., streptokinase). However, it must be noticed that this medicine requires rapid and timely administration. Moreover, Percutaneous Coronary Intervention (PCI) is increasingly used as a method of revascularization. Considering the importance of time for the effective use of these methods, the present study aimed to investigate the duration of the process, treatment outcome, and its associated factors in patients with ST-segment elevation myocardial infarction (STEMI) who were candidates for streptokinase or PCI.

The present descriptive-analytical study made use of total population sampling so that all patients with STEMI who did not meet the exclusion criteria were included in the study in 2017. The study population consisted of 183 patients who had referred to the emergency ward of Tohid Hospital in Sanandaj, Iran. The patients were investigated regarding their age, gender, day of admission, pain-to-admission time, the average travel time to the hospital, type of referral, underlying illness, time of myocardial infarction diagnosis, starting time of reperfusion therapy, and final outcome. The collected data were recorded in the designed forms and then entered into SPSS software (version 22). Descriptive statistics formulas (i.e., mean, standard deviation, and percentage) were used regarding research questions. Moreover, regarding the research hypotheses, the chi-square test and correlation coefficients were used in the case of qualitative and quantitative variables, respectively.

According to the results, the majority of patients were male patients over 50 years old with no history of myocardial infarction. A total of 146 (79.8%) and 37 (20.2%) of participants were male and female, respectively. Moreover, the mean age of the participants was 58.52 and 28 of them (15.3%) had a history of myocardial infarction. The mean duration time of ECG and myocardial infarction diagnosis was 4.2 and 18.85 min, respectively. Furthermore, the mean duration time from patient admission to receiving intervention was estimated at 107.68 min. It should also be mentioned that their average length of hospital stay was 4.9 days.

Based on the results, it can be said that the mortality rate was higher in older patients than in others. Moreover, the duration of ECG in female patients was longer in comparison to the male patients. In addition, starting the reperfusion therapy took longer in the night shifts.

Type 1 diabetes is the most common metabolic and chronic disease in children and adolescents. This study aimed to evaluate the factors influencing diabetic control among adolescents with Type 1 diabetes.

This cross-sectional descriptive study was conducted on 205 patients aged 11-19 years with type 1 diabetes who referred to Endocrine Clinic of Besat Hospital, Hamadan, Iran, in 2019. The participants were selected based on a census sampling method and investigated in terms of factors affecting diabetic control. The data were analyzed in SPSS software (version 16). A p-value less than 0.05 was considered statistically significant.

The mean age of the patients was 13.96±3.17 years, and 58% of the participants were female. Moreover, the mean values of diabetes duration and Hemoglobin A1c (HbA1c) were estimated at 5.71±3.16 years and 8.89±1.84%, respectively. Regarding treatment adherence, 35.2% of the patients had poor adherence. The prevalence rate of depression, anxiety, and stress were 51.2%, 72.2%, and 13.2% in patients, respectively. Poorly controlled diabetes based on HbA1c correlated significantly with father's unemployment status and poor family support. Furthermore, the status of diabetes control based on HbA1c level had a significant correlation with the scores of stress, anxiety, and depression. However, there was a negative and significant relationship between the status of diabetes control and the number of annual referrals to the clinic.

This study showed that anxiety, depression, and stress led to poor control in patients with type 1 diabetes. On the other hand, increased income and family support, as well as frequent visits to the clinic improved diabetic control.

Infection with hydatid cysts or hydatidosis, which is a zoonotic disease, is caused by the larval stage of Echinococcus granulosus in humans and animals. Hydatidosis infection is endemic in most parts of the country. In Khoda Afarin County in East Azarbaijan, Iran, as a center of animal husbandry, there is a possibility of high exposure to the Echinococcus granulosus egg. This study was carried out to determine the seroprevalence of hydatidosis in this county population.

In this descriptive cross-sectional study, 295 blood samples were collected from the population of Khoda Afarin County in a test tube without anticoagulant within 2018 to 2019. The samples were evaluated using enzyme-linked immunosorbent assay to measure immunoglobulin G against Echinococcus granulosus. The demographic data of the participants were gathered by a questionnaire, and the results were analyzed using SPSS software (version 18).

Out of 295 samples, 12 (4.07%) people were positive. The highest percentage of seropositivity was reported in the age group of 30-39 years with 3 (3.53%) cases. The frequency rates of seropositivity in urban and rural subjects were 16.7% and 83.3%, respectively.

The obtained results showed a significant prevalence of infection in the study population (similar to those reported in some other studies carried out in different parts of Iran). Therefore, it is essential to focus on the control and prevention of the disease as a priority disease in Khoda Afarin County among different occupations and age groups.

Intubation is the most common method for the management of the upper airway in general anesthesia. In this regard, the prediction of the ease or difficulty of intubation is of paramount importance for the anesthesia team. The main cause of anesthesia-related mortality is failed airway management. The present study aimed to compare the accuracy of the upper lip bite (ULBT) test and mallampati test in the fast prediction of difficult intubation.

This descriptive-analytical study was conducted on 418 patients. Prior to anesthesia, the degree of difficulty of intubation was predicted using two predictive tests, namely Mallampati test and upper lip bite test. In addition, after anesthesia, the degree of predicted difficulty was compared with the Cormack-Lehane classification of laryngoscopic view.

As evidenced by the obtained results, the frequency of difficult intubation was reported as 5.3%. Sensitivity, specificity, and negative predictive value of ULBT test were measured at 21.4%, 95.3%, and 97.2%, respectively. Moreover, the accuracy was obtained at 92.8% which was the highest value. On the other hand, sensitivity, specificity, and negative predictive value of Mallampati test were estimated at 34.7%, 87.5%, and 91%, respectively. In addition, the accuracy of this was reported as 81.3%.

The results of the current study indicated that ULBT test as an easy method with high specificity, high predictive value, and high accuracy in the evaluation and prediction of difficult laryngoscopy is more suitable than Mallamati.

Hidrocystoma are benign adnexal cystic lesion originating from sweat glands (eccrine or apocrine) which are often observed in the head and neck. Periocular hidrocystomas are relatively uncommon which can occur as single or multiple lesions. There is no gender or race predisposition for the prevalence of hydrocystoma. Spontaneous resolution is rare, especially in large cysts, and definite treatment usually requires surgery and complete removal of the cyst wall.

Here we present the case of a 44-year-old male admitted to our clinic with mobile mass in lower eyelid and conjunctival cystic lesion which had increased in size over the previous 6 months. All other ophthalmologic findings were within normal range in both eyes. The mass was exposed by blunt dissection through the lower palpebral conjunctiva. Excision was continued by careful blunt dissection in order to avoid capsule rupture and the cystic mass was removed from the surrounding tissues. The dimensions of the cyst was 8x12x10 mm macroscopically. Histological incision revealed a benign cystic mass lined with a single layer of columnar epithelium which demonstrated eccrine hidrocystoma.

Although eccrine hidrocystoma lesions rarely involve the orbit, they should be considered in differential diagnosis of cystic swelling in periorbital region. If the lesion is completely removed without rupturing capsule (such as the patient in this case study), the recurrence will be extremely rare.