مجله دانشکده پزشکی اصفهان
پیاپی 338 (هفته دوم امرداد 1394)

During craniotomy surgery, because of the prolonged action and maintaining a fixed position, neurosurgeons, in both the sitting and standing positions, face various musculoskeletal problems in the absence of proper position. Since, no study using scientific methods was done on the neurosurgeons during craniotomy surgery, this study aimed to compare the ergonomic risk factors threating neurosurgeons during this surgery in both standing and sitting positions. In a cross sectional study, 20 standing and 20 sitting positions of neurosurgeons during craniotomy surgery were captured and the risks of exposure to musculoskeletal disorders was calculated and determined using quick exposure check (QEC) and rapid entire body assessment (REBA) scores in the three levels of mild, moderate and sever. The collected data were analyzed using SPSS software. The total percent of the mean risk of musculoskeletal disorders in the standing and sitting positions was 36.39 ± 10.06 and 31.60 ± 6.70 percent, respectively, and there was no statistically difference between the two positions (P = 0.090). In addition, the exposure level in REBA score in the two positions of standing and sitting was 6.00 ± 1.52 and 3.63 ± 0.90, respectively, and the difference between the two groups was statistically significant (P < 0.001). During craniotomy surgery, neurosurgeons either in standing or in sitting position have moderate exposure levels in different areas of the body such as the shoulders/arm, wrist/hand and neck and the risk is higher in standing position. Thus, we recommend more studies be conducted with larger sample sizes. In addition, the required equipment to reduce the risk of the underlying disorders must be provided. Knowledge of the practitioners must be improved via retraining courses, gatherings and meetings, too.

Cutaneous leishmaniasis (CL) is endemic in many parts of Iran and is discussed as a health issue. Although it has spontaneously remitting course, but the treatment is often recommended to shorten the duration of illness and limit the size of the scar. First-line therapy is topical or systemic glucantime; but because of its serious complications, it is attempted to find better drugs with fewer side effects. This study aimed to assess the skin reactions in patients with cutaneous leishmaniasis treated with topical glucantime. This prospective cohort study was performed on all patients with cutaneous leishmaniasis treated with topical glucantime and referred to the Skin and Leishmaniasis Research Center, Isfahan, in 2010-2011. Skin side effects caused by this type of the treatment were analyzed. 130 patients with cutaneous leishmaniasis treated with topical glucantime were studied. The mean age of the patients was 16.38 ± 23.97 years. In 38.5 percent of patients, skin side effects were observed that were mainly maculopapuler rashs with pruritic (12.3 percent). The mean duration of treatment initiation until the appearance of skin side effects was 12.66 ± 20.98 days. There was no significant relationship between the clinical type and the site of the lesions and the appearance of skin side effects (P > 0.05). Skin side effects were mainly maculopapuler rashes with pruritic in patients with cutaneous leishmaniasis treated with topical glucantime. According to skin side effects induced by topical glucantime, importance and necessity of the injection method and the use of adjuvant therapy is emphasized according to indications of topical treatment of patients with cutaneous leishmaniasis.

Hand injuries are the common cause of admissions in emergency departments that may lead to permanent disability and limitation of motion of the hand and loss of time work in patients. Multiplications of industries lead to increases of accidental injuries including hand injuries. As any study was not done on this issue in Iran, this research was designed for evaluation of causes, severity, distribution and functional outcomes of hand injuries.

In this prospective simple convenience study, 328 patients came to Kashani hospital, Shahrekord, Iran, with hand injuries were evaluated in 2007; evaluation was done by both, patient and physician. After 1-year follow-up of patients, collected data were analyzed via SPSS software using chi-square,ANOVA, t and Tukey statistical tests.

Hand injuries occurred in more men. 57.2% of the patients had hand injury in dominant hand. 127 adult patients were injured during work. Open hand injuries were more common in patients. Most of the hand injuries occurred between 12 midday and 6 pm. After 12 months of follow-up, 56 patients had complaints of pain, swelling and joint stiffness. 35 patients had only complaint of pain. Evaluating fingers function, pinching, finger opposition, sensibility and grasping were decreased.

Education, using safety equipment, and avoiding precise works in critical hours can lead to decrease hand injuries.

Epidemiological studies have reported a high prevalence of vitamin D deficiency in different regions of the world, including Iran. This study aimed to determine the prevalence of vitamin D deficiency in patients with degenerative diseases of spine, which underwent spine surgery, and to assess the relationship between vitamin D deficiency and age, sex, obesity, smoking, and taking supplements. In this cross-sectional and non-interventional study, the serum level of 25(OH)D was determined via electrochemiluminescence immunoassay method. Other variables were firmed through relevant questionnaires. To analyze the data, univariate and multiple regression analysis were used. 110 patients enrolled the study. The mean serum level of 25(OH) D was 27.45 ± 18.75 ng/ml. 44.5% of patients showed vitamin D deficiency [25(OH)D < 20 ng/ml], and in 17.3% of the patients, the serum level of 25(OH)D was insufficient [20 ng/ml ≤ 25(OH)D < 30 ng/ml]. In group with the history of taking supplements, the prevalence of hypovitaminosis D was 47.6%. The prevalence of vitamin D deficiency was significantly higher in younger age group (20-39 years old) (P = 0.003) and the ones without the history of taking supplements (P < 0.001). Compared to men, women showed significantly higher levels of vitamin D (P = 0.030), as well as higher levels of consumption of vitamin D supplements. There was no significant correlation between other variables. A high prevalence of vitamin D deficiency was seen in patients with degenerative diseases of spine, even in patients treated with vitamin supplements. On the other hand, considering the risk factors alone seems not to be sufficient in determining the likelihood of deficiency. So, it is recommended to screen vitamin D deficiency via measuring the serum level of 25(OH)D and consequently to treat properly and sufficiently patients with degenerative diseases of spine, especially patients with surgical interventions.

Proper method of blood collection (BC) has significant consequences in many biological productions and research activities. Due to the challenges of blood collection from laboratory rabbits, cardiac puncture is routinely performed as the routine method of blood collection in many biological material production and research centres. Besides being ethically unacceptable, this method causes high morbidity and mortality. Furthermore, cardiac puncture is very distressful for anaesthetised animals and greatly disturbs the measured data. The aim of the current study was to provide detailed technical instructions for a superior method of large volume blood collection from laboratory rabbits.

This study was performed during the course of the complement production from 91 white New Zealand rabbits aging 6-36 months and weighing 1.2-3.5 kg. Acetylpromazine was injected intramuscularly. To avoid vasoconstriction caused by needle puncture, nerves of the central ear artery were blocked via local infiltration of lidocaine. Arterial access was established using modified Butterfly catheters. At the end of the blood collection, arterial haemostasis performed appropriately.

During 3 months and 155 episodes of blood sampling, 2384 ml blood was collected via this method (15.4 ± 3.5 ml/rabbit). The mortality rate related to the blood sampling method was nil until 3 months following completion of the study which showed significant statistical difference (P < 0.001) in comparison to the data retrieved from the archives of the centre regarding previous method of cardiac puncture (mortality = 19 rabbits).

Due to the significantly lower morbidity/mortality of the presented technique, we recommend it as the proper method of large volume blood sampling in laboratory rabbits.