مجله دانشکده پزشکی اصفهان
پیاپی 413 (هفته اول اسفند 1395)

Gastroenterologists may be susceptible to various musculoskeletal disorders in the absence of proper position, because of working in various positions in offices and hospitals. This study aimed to assess the relationship between the posture and musculoskeletal disorders among gastroenterologists in Isfahan city, Iran.
Three methods of posture evaluating are self-report, observational method and direct measurement. Based on studies, the validity and reliability of the observational method is more than others. In this study, gastroenterologist's postures during endoscopy and colonoscopy were analyzed using two observational methods of Rapid Upper Limb Assessment (RULA) and Ovako Working Posture Assessment System (OWAS). They also completed Nordic questionnaire for assessment of musculoskeletal disorders.
Findings: Based on OWAS, the posture risk was 1 in 22.2% and 2 in 77.8% of gastroenterologists; while based on RULA, this risk was 4 in 38.9%, 5 in 38.9% and 6 in 22.2% of them. Musculoskeletal disorders had a direct relationship with the level of risk based on RULA, but had no significant association with the level of risk based on OWAS. The level of risk based on RULA had a direct relationship with the number of procedures per day. In addition, the rate of musculoskeletal disorders had a direct relationship with the number of procedures per day and body mass index (BMI). The level of risk based on RULA had a direct relationship with incidence of musculoskeletal disorders in the neck, upper back and knees.
Musculoskeletal disorders are highly prevalent among gastroenterologists in Isfahan city. Postural analysis results showed that the risk of incidence of these disorders is to a large extent, too. High body mass index was one of the factors contributing to the occurrence of musculoskeletal disorders. Since about half of the target group were overweight, losing weight can help to reduce the incidence of musculoskeletal disorders. In addition, the high number of procedures per day increases the risk of posture and musculoskeletal problems simultaneously. So, reducing the number of procedures or increasing the rest time between appointments, discontinuous endoscopy and colonoscopy, increasing precision and accurate positioning and using Tele-Robotic techniques instead of manually ones, would be effective for gastroenterologists that have more workload.

Cutaneous leishmaniasis is a parasitic skin disease that is endemic in many parts of the world, particularly in Iran. Although the microscopic technique is a common method of diagnosis of leishmaniasis, species of leishmania cannot be differentiated by this method. So, molecular methods have special importance.
In this study, kinetoplast-DNA polymerase chain reaction (kDNA-PCR) method was used to diagnose the leishmania species in Dargaz city, Iran. Direct slide smears were obtained from skin lesions of 94 patients suspected to the leishmaniasis referred to health centers of this city. Smears were stained using Gimsa method. PCR method was performed using specific kDNA primers. Data were analyzed using SPSS software.
Findings: Among 94 subjects with skin ulcers suspected to cutaneous leishmaniasis, 82 (87.2%) were positive by direct microscopic smear and 85 (90.4%) by PCR in which 22 patients (26%) had Leishmania tropica and 63 (74%) had Leishmania major. Sensitivity and specificity of direct microscopic examination were calculated as 96% and 100%, respectively. There were statistically significant differences between disease occurrence and seasons (P = 0.045), habitat (P = 0.004), new or old building (new or old) (P = 0.003), and distance to rodent's living sites (P = 0.025).
Dargaz city is a known site of zoonotic leishmaniasis in Iran; but this study shows that there are some new sites of anthroponotic leishmaniasis in this city, too. Leishmania major is the dominant species in Dargaz city but there is Leishmania tropica foci in this area, too.

After the surgery, radiation therapy is the most important part of treating brain tumors. Thyroid cancer is the second most prevalent malignancy, as a result of radiation therapy of head and neck. Therefore, in whole-brain radiation therapy, determining the absorption dose of thyroid and the risk of secondary thyroid cancer is important. The aim of this study was to calculate the absorption dose of thyroid and the risk of secondary thyroid cancer in whole-brain radiation therapy.
The study included 50 patients undergoing whole-brain radiation therapy, with a mean age of less than 30 years old, in Isfahan Milad Hospital, Iran, using the ONCOR accelerator and 6-MV photon. Thermoluminescence dosimeter (TLD) was used to determine the dose received by the thyroid. Then, to calculate the risk of secondary thyroid cancer, the method of calculating risk in Biological Effected of Ionizing Radiation Committee (BEIR VII) report and the suggested quantity of International Commission on Radiological Protection (ICRP), which means excessive relative risk (ERR), were used.
Findings: The calculated mean absorbed dose was 1.976 ± 0.611 and 2.213 ± 1.041 cGy in women and men, respectively. The mean risk of secondary cancer of the thyroid 3, 5, 10, 15 and 20 years after whole-brain radiation therapy was 4.601 ± 1.614, 1.559 ± 0.595, 0.176 ± 0.063, 0.050 ± 0.018, and 0.022 ± 0.009, in women and 3.253 ± 1.721, 1.150 ± 0.516, 0.125 ± 0.066, 0.035 ± 0.019, 0.016 ± 0.008 in men, respectively. The absorption dose of thyroid was not related to age (P = 0.743).
The risk of secondary cancer of the thyroid is associated with sex and is 1.4 times more in women. In addition, by increasing the age after radiation the mean risk of induced cancer had a reducing behavior.

Nowadays, fear-avoidance model is the best model for the assessment and treatment of chronic musculoskeletal pain in which, the role of the pain vulnerability (neuroticism, experiential avoidance and negative affect) is not well defined. The purpose of present study was to evaluate the structural pattern of the relationships between the pain vulnerability, catastrophizing, fear of pain and pain adjustment (pain intensity and inability) in the framework fear-avoidance model.
Patients with chronic musculoskeletal pain were selected from hospitals and private clinics in Isfahan city, Iran, during 2015 using convenience sampling method. They participated in the research by filling out six questionnaires: NEO Five-Factor Inventory (NEO-FFI), Positive and Negative Affect Schedule (PANAS), Acceptance and Action Questionnaire (AAQ), Pain Catastrophizing Scale (PCS), Tampa Scale Kinesiophobia (TSK) and Graded Chronic Pain Scale (GCP). Data were analyzed using structural equation modeling method.
Findings: Pain vulnerability had significant direct effects on catastrophizing and catastrophizing on fear of pain and fear of pain on pain adjustment (P The results of this research showed that pain vulnerability could predict pain adjustment in the framework fear-avoidance model. Therefore, reducing pain vulnerability can reduce pain intensity and inability in patients with chronic musculoskeletal pain.