مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هشتاد و دوم شماره 4 (پیاپی 279، تیر 1403)

Tendon ruptures may occur as a result of acute injuries or degenerative changes in the tendons caused by aging, excessive and long-term use of the shoulders, and sudden wear and tear. This tear may be partial or completely separate the tendon from its attachment to the bone. Rotator cuff tendinopathy of the shoulder is one of the common causes in patients that affect the daily performance and quality of life. Tendinopathy problems are one of the most common problems of people who refer to medical centers, and in some people, improvement is very important because of their job position. Platelet-rich plasma has received attention due to having growth factors involved in tissue repair in tendinopathy patients. This review study examined the clinical effect of platelet-rich plasma injection in rotator cuff tendinopathy, as well as other studies comparing it with corticosteroids. A literature search was conducted in various scientific databases to obtain articles up to 2022 examining the clinical effects of PRP injection on tendinopathy. Platelet-rich plasma (PRP) is one of the products derived from blood that contains a greater number of physiological platelets. PRP contains a large amount of growth factors such as TGF-β, platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF), which play an important role in cell proliferation, cell differentiation, chemotaxis and angiogenesis. These growth factors are significantly upregulated following tendon injury and are active at different stages of the healing process. Platelet-rich plasma is an autologous source of growth factors and has been shown to be beneficial in the treatment of tendinopathy and osteoarthritis. PRP injection can be recommended as a suitable and desirable method in tendinopathy and rotator cuff tear patients, especially in adults, and can be substituted for corticosteroids. PRP is a minimally invasive treatment method that is used to treat muscle diseases and tendon injuries. In this method, blood is taken from the person, and after that, the components of the blood are separated during a process, and the platelet-enriched plasma is re-injected into the muscles and tendons of the shoulder.

Today, addiction is a major problem in modern society, which affects the management of patients during anesthesia. In patients with long-term use of opioids, higher doses of opioids are needed to create analgesia and control pain during and after surgery. Also, addicted patients have more resistance to local anesthetic drugs when they are used to perform peripheral and central nerve blocks. Therefore, many drugs are added to local anesthetics to enhance their analgesic properties, one of the most common of which is narcotic compounds. Itching caused by opium may be generalized and often occurs shortly after injection. Therefore, this study aims to investigate the amount of itching caused by intrathecal injection of fentanyl in opium addicts who undergo elective orthopedic surgeries of the lower limbs with spinal anesthesia. have been taken, designed and established.

This study was a double-blind clinical trial conducted on 68 patients who were candidates for elective lower limb orthopedic surgeries under spinal anesthesia and referred to 5 Azar Hospital in Gorgan in 2023. Patients were divided into two groups using random numbers table, Intervention (a group of addicted patients who received intrathecal marcaine together with fentanyl for spinal anesthesia) and control (a group of addicted patients who received only intrathecal marcaine for spinal anesthesia). Pruritus, nausea and vomiting were measured in both groups. Data analysis was done using descriptive statistics and inferential statistical tests.

In terms of age, gender, and BMI, there was no statistically significant difference between the intervention and control groups. There was no statistically significant difference in the incidence of nausea and vomiting between the two groups. The incidence of itching was zero in the bupivacaine group and 17.6% in the fentanyl and bupivacaine group, of which 3% required anti-itch medication for treatment.

The results of this study showed that due to the low incidence of pruritus in the group using fentanyl along with bupivacaine, its use is beneficial in people with drug addiction.

The prevalence of cesarean section (CS) has recently increased dramatically. Cesarean scar defect (CSD) is one of the most common complications of CS. This study aims to investigate and compare the depth and volume of the CSD in symptomatic patients with and without uterine adenomyosis.

This retrospective case-control study was done from November 2020 to November 2022 at our referral women's hospital. The patients who underwent sonohysterography with a previous history of one or two CS for at least one year ago and chief complaints of abnormal uterine bleeding were included in our study. The patients with myometrial or endometrial pathology were excluded from the study. The symptomatic patients who met the inclusion criteria were divided into two groups: with adenomyosis (case) and without adenomyosis (control). The demographic data, medical history, and sonohysterography findings were obtained from the patient’s documents and archived images. In sonohysterography, CSD features, including the length, depth, width, volume, RMT (Remained Myometrial Thickness), AMT (Adjacent Myometrial Thickness), and RMT/AMT were measured. To analyze the variables, t-tests, and chi-square were used.

Among 310 symptomatic women with a history of previous cesarean section underwent sonohysterography, 160 patients met the inclusion criteria (case group with adenomyosis: 82 patients and control group without adenomyosis: 78 patients). The chief complaints were post-menstrual bleeding (43.8%), prolonged bleeding (34.3%), and intermenstrual bleeding (21.9%). In the case group, 25.6% had CSD with RMT<2mm, but in the control group (without adenomyosis), only 6.4% had RMT<2mm. CSD depth and volume were significantly larger in patients with underlying adenomyosis (P-value of 0.002 and 0.038, respectively). Also, the mean RMT and RMT/AMT ratio were significantly lower in the case group (P-values of 0.004 and 0.00, respectively).

Our study demonstrated a strong association between the presence of adenomyosis and larger CSDs. To establish a causative relationship, we suggest a prospective cohort study to follow up the patients and compare the evolution of CSD in patients with and without adenomyosis.

Liver fibrosis is a major concern associated with long-term side effects among patients with rheumatoid arthritis (RA) treated with methotrexate. The aim of the present study was to compare the fibrosis-4 (FIB-4) index and the results of liver fibrosis severity derived from FibroScan device in rheumatoid arthritis patients who were treated with methotrexate.

The present cross-sectional study was conducted in 70 RA patients referred to rheumatology clinic of Hazrat Rasool Akram Hospital, Tehran, from July 2022 to July 2023. First, FIB-4 was calculated and the data from transient elastography, which was performed using a FibroScan device to diagnose liver fibrosis for each patient, will be compared with the results of the FIB-4 of each patient. Furthermore, the correlation between FIB-4 index and FibroScan grade with demographic characteristic, methotrexate dose and disease duration was also evaluated.

The average age of patients was 59.59±11.75 and most of them (74.3%) were women. Most patients (75.71%) with a normal to mild FIB-4 index stage had a normal to mild elastography stage. of patients had normal to mild liver fibrosis. FibroScan grade were not related to the age, gender, body mass index, methotrexate dose and duration of the disease (P>0.05). The average FIB-4 was 1.25±0.6, which was not significantly related to gender, body mass index, disease duration and methotrexate dose but directly related to the age of patients (P<0.001, (CL95%, 0.51-0.53)).The correlation between FIB-4 and FibroScan grade of the patients showed a positive association, which was not statistically significant (P=0.594, r=0.06, CL95%, -0.24-0.4). The FIB-4 in normal to mild grade was 85% rejecting the moderate to severe grade in FibroScan but none of them were statistically significant (P=0.146).

Overall, the FIB-4 was incapable of predicting the FibroScan result. On the contrary, this case was also inconclusive and the results of FibroScan did not justify FIB-4 results of the patients. The FIB-4 cannot replace in RA patients. It is recommended to conduct future studies with a larger sample size in RA patients.

Recently, epinephrine is used to increase the depth and duration of local anesthetic pain, and it is widely used topically to reduce local anesthetic release and reduce bleeding caused by surgery.

This study was a randomized, double-blind clinical trial on 30 patients aged 18 to 85 years undergoing lower limb orthopedic surgery referred to Peymaniyeh Hospital in Jahrom from September to December 2022. Patients were randomly assigned to two groups, A (epinephrine+fentanyl+bupivacaine) and B (bupivacaine+fentanyl). Systolic blood pressure, diastolic pressure, mean arterial pressure, arterial blood oxygen saturation percentage, and pulse rate were measured and recorded before drug administration, before spinal anesthesia, after anesthesia, and then every half hour until the end of surgery (15, 45, 30, 60, 75, 90, 120) and during recovery. Data analysis was performed using SPSS version 21 software and descriptive (mean, standard deviation) and inferential statistics (t-test, chi-square, Mann-Whitney, Friedman) at a significance level of P<0.05.

Thirty patients aged 18 to 85 years (in two groups of 15) with anesthesia class I and II undergoing lower limb orthopedic surgery were evaluated. The study groups are matched in terms of age and gender variables. There was no significant difference in mean systolic, diastolic, mean arterial blood pressure, and heart rate before and after anesthesia, 15, 45, 30, 60, 75, 90, and 120 minutes after drug injection, and at entry and exit from recovery between the Epinephrine+Fentanyl+Bupivacaine and Fentanyl+Bupivacaine groups. There was a significant difference in mean O2SAT before anesthesia, 15, 30, and 75 minutes after drug injection between the epinephrine+fentanyl+bupivacaine and fentanyl+ bupivacaine groups (P<0.05).

The use of the combination of epinephrine+fentanyl+intrathecal bupivacaine compared to the combination of fentanyl+bupivacaine did not have a significant difference in the studied variables of patients' vital signs.

Nephrolithiasis is one of the oldest known systemic diseases of kidney and urinary tract in children. This study aimed to compare the serum level of vitamin D in children with nephrolithiasis and healthy children.

The present descriptive-cross-sectional study was conducted from October 2017 to September 2019. 74 children with kidney stones and 63 healthy children referring to Afzalipour Hospital in Kerman were selected by simple sampling method. Healthy children who were considered as the control group were matched with the case group in terms of age and gender. All patients underwent kidney and urinary tract ultrasound. The diagnosis of kidney stones was based on the radiologist's opinion. Demographic characteristics of patients (age and sex) were recorded. Patients' blood tests were checked for vitamin D and calcium. Descriptive and analytical methods and SPSS software version 21 were used to analyze the data.

The average age of children with kidney stones and healthy children was 5.41±1.8 and 10.06±0.41 years old, respectively (P=0.971). The most number of patients were boys (58.1%). 29.7% of patients and 15.9% of healthy children had a family history of kidney stones (P=0.056). 71.6% of patients had unilateral kidney stones and 28% had bilateral kidney stones. The mean serum level of vitamin D was higher in healthy children (P=0.021). The average calcium was higher in children with kidney stones (P=0.001). The average calcium was higher in children with kidney stones who had a family history of kidney stones (P=0.018). Average calcium was higher in children with bilateral kidney stones (11.4±1.1) (P=0.033). The mean calcium was higher in children with kidney stones with vitamin D deficiency (P=0.001) and sufficient vitamin D levels (P=0.037).

The average level of vitamin D serum in healthy children was significantly higher than that of children with kidney stones, and the average level of calcium in children with kidney stones was significantly higher than that of healthy children. Larger studies with more patients are needed to investigate these relationships.

Rhinoplasty is a challenging and complex surgery because it is designed to meet the unique needs of the patient. In rhinoplasty surgery, many factors contribute to achieving the desired result. These factors include the surgeon's care and observation, analysis of the existing anatomy, choice of surgical technique, degree of soft tissue and cartilage trauma, amount of bleeding, quality of surgical instruments and anesthesia, and anything that helps reduce bleeding.

This double-blind study was conducted on 50 patients aged 18 to 45 years undergoing septorhinoplasty surgery referred to Motahari Hospital in Jahrom city in 2022. Patients were randomly divided into dexmedetomidine and control groups. The degree of sedation, bleeding and surgeon satisfaction were evaluated and recorded. Data analysis was performed using SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and descriptive statistics (mean, standard deviation, percentage, number, frequency) and inferential statistical tests (Mann-Whitney U test, Kruskal-Wallis, t-test, chi-square test). The significance level in all tests was considered P<0.05.

The majority of patients in the study groups were female and the mean age of patients in the dexmedetomidine group was 34.36±7.33 years and in the control group was 36.60±9.59 years. The study groups were similar in terms of age and body mass index (P<0.05). The frequency of patient sedation in the dexmedetomidine group was lower than the control group, but it was not statistically significant (P<0.05). The results showed that at the beginning of the operation and 90 minutes later, the satisfaction level of the patient surgeon in the dexmedetomidine group was significantly better than the control group (P<0.001). In the dexmedetomidine group, the field of view of the surgeon was relatively clear and completely clear. The amount of bleeding in the dexmedetomidine group was lower than the control group, but it was not statistically significant (P<0.05).

Dexmedetomidine increased the surgeon's satisfaction by reducing bleeding and improving the surgeon's visual field. Therefore, this drug can be used as an anesthetic aid in surgery.

Although the respiratory system is the main element involved in the disease of COVID-19, nevertheless, there are reports of the involvement of other organs and their lesser symptoms. This study was conducted with the aim of investigating the frequency of gastrointestinal symptoms in patients with COVID-19.

This cross-sectional descriptive study was conducted on all patients diagnosed with COVID-19 hospitalized in Imam Khomeini Hospital from April to September 2021 by census method. The data was collected using a checklist that included demographic information. After the data was collected, it was entered into SPSS software, version 18 (IBM SPSS, Armonk, NY, USA) and analyzed with the help of descriptive statistics.

In this study, the results showed that out of 2580 hospitalized patients, 54% were women and 46% were men. And the average age of the patients was 58.67±17.68. The highest frequency of people was in the age range of 40-59 years (925 people). 64% of patients had at least one gastrointestinal symptom, Each of the symptoms had a different prevalence, Anorexia 40% with a preference for men (57%) and the highest frequency in the age range of 40-59 years (430 people), gastrointestinal bleeding 10% with a preference for men (80%), And the highest frequency in the age range of 60-79 years (112 people), abdominal pain 8% with preference for women (65%) with preference for frequency in the age range of 40-59 years (65 people), vomiting 3% with preference for women (51%) with abundance in the age range of 80-99 years (58 people), diarrhea 1.5% with preference in men (51%) with abundance in the age range of 60-79 years (18 people) and constipation in 0.2% with preference Women (67%), all of whom were over 60 years old.

The findings of this study showed that the COVID-19 disease can not only involve the respiratory system but also the digestive system in the course or beginning of the disease.

Spinal Muscular Atrophy (SMA) is a neurodegenerative disorder caused by a mutation in the survival motor neuron 1 (SMN1) gene. It is classified into five types (from type 0 to 4) based on the age of onset of symptoms and maximum motor function. This autosomal recessive mutation results in progressive weakness and atrophy of the proximal muscles. Due to the high cost of treatment, the critical timing of intervention, and the varied responses of patients, many individuals do not sufficiently benefit from current therapeutic methods. This study evaluates the impact of resistance training on the quality of life and fatigue in patients with SMA type III, considering the potential benefits of such training.

The present study was developmental and semi-experimental. Fourteen ambulatory patients with SMA type III were randomly assigned to exercise and control groups. The exercise group engaged in lower limb resistance training at an intensity of 6 to 8 on an adult resistance exercise scale for 10 weeks (25 sessions). During this period, the control group maintained their usual daily activities. Patients in the exercise group did not engage in any exercise activity other than the protocol of the present study. Patients' quality of life was measured with the Short Form 36 (SF-36) questionnaire, and fatigue severity was measured with the Fatigue Severity Scale (FSS), both evaluated pre- and post-intervention. The assessments and exercises were conducted in the occupational therapy department of Shariati Hospital, Tehran, from July 2023 to September 2023.

Analysis of the results showed significant improvements (P<0.05) in the exercise group compared to the control group in the subscales of physical functioning and fatigue within the quality of life assessment. Additionally, notable differences were found between the groups on the fatigue intensity scale. However, No significant difference was observed in the patients' Body Mass Index (BMI) measurements.

Progressive resistance training of the lower limbs enhances the quality of life and reduces fatigue in patients with SMA type III.

Death is one of the serious consequences of burns, which usually occurs as a result of hospital infections. This study was conducted with the aim of investigating the existing disagreement regarding the admission of more than 90% patients in the burn intensive care unit with the isolation room of the burn unit.

This retrospective descriptive-analytical study was conducted based on case review. The statistical population included the files of patients hospitalized in the burn wards and burn intensive care unit of Zare'e Sari Burn and Psychiatric Center from 2011 to 2023 who died. All these patients were included in the study as a census. The data was extracted through a checklist prepared by the researcher. Descriptive and inferential analysis of the data was performed using SPSS version 21 software. The variables studied included gender, age, burn percentage, burn factor, and duration of hospitalization, and determining the relationship between burn percentage and survival time in the two burn intensive care units and the isolation room of the burn unit was the main variable. The mean and standard deviation were used to describe quantitative data, and the frequency and percentage were used to describe qualitative data.

Among 882 cases, 226 patients had burns above 90%. 143 cases were related to men (63.3%). Most patients were in the age group of 19 to 40 years (61.9%). The cause of the burn (54.9%) was flame. Among the patients (83.2%) were hospitalized in the isolation room of the burn ward. Although the average days of hospitalization of patients above 90% in the burn intensive care unit was 13.71±11.82 days and the burn isolation room was 8.66±9.11 days, the Mann-Whitney test showed that the average survival time of these patients in the burn isolation room of the burn ward was significantly different from the intensive care unit. (sig.=0.001).

Although the average survival time in the two groups showed a significant difference, ultimately all patients in the two groups died within a few days of each other.