فاطمه پاک نظر

Migraine is one of the common causes of headache, and refractory migraine imposes a significant eco-nomic burden; therefore, it is important to find a proper treatment method for this condition. In this study, we evaluated the response to treatment with botulinum toxin A in patients with refractory chronic mi-graine.

Fifty-two patients with refractory chronic migraine were enrolled and all data about age, gender, type of migraine, the frequency, severity, and duration of migraine episodes and frequency of need for analgesics before, one week and two weeks after Botox injection were recorded in a checklist, and the degree of re-covery and the frequency of complications after Botox injection were assessed.

After the Botox injections, the frequency, severity, and duration of migraine episodes and the frequency of analgesic use decreased (P<0.001), which were unrelated to age. Migraine episodes in men and also temporal, posterior, and frontal migraines showed greater reduction. Alterations in the severity and dura-tion of episodes and need for analgesics were not gender-related, but in patients with temporal, posterior, and frontal migraines, they showed a greater decrease. More than 70% of the patients had good or excel-lent recovery.

Botox injection reduced the frequency, severity and duration of the migraine episodes, and need for anal-gesics two weeks after the injection, and a large number of patients reported feelings of recovery, with minor and transient post-injection complications. The variables which showed the greatest reduction in-cluded the frequency, duration and severity of migraine episodes and need for analgesics in temporal, posterior and frontal migraines and the frequency of episodes in the male patients.

Surgery is one of the factors that may accelerate and intensify the progression of COVID-19. The present study was conducted with the aim of investigating the survival rate and related factors in patients with COVID19 undergoing a major surgery.

In this cross-sectional-analytical study, 43 patients with COVID-19 who underwent a major surgery in Kowsar Semnan Hospital were examined in 2021. The data collection tool was a checklist including demographic and clinical variables, which was extracted from the patients' files by referring to the medical records section. Survival of patients after surgery was also checked through telephone calls. The data was entered into Stata 14 software and Chi-squared test was used to check the relationship between variables with 6-month survival.

The mean age (± S.D) of the patients age was 50/86 (± 23/14). . The mean (± standard deviation) age of male and female patients was 47.73 (± 20.89) and 55.65 (± 26.15), respectively.The survival rate 6 months after surgery was significantly lower in patients over 50 years old, who were admitted to the intensive care unit, and were suffering from an underlying disease, high body mass index, the presence of trauma and neurosurgery (P<0/05).

Almost only half of the patients with COVID19 survived 6 months after major surgery, and age over 50, hospitalization in the intensive care unit, underlying disease, high body mass index, and presence of trauma and neurosurgery were the most important factors determining this decrease in survival.

An ankle sprain is a traumatic injury to the ankle. Repeated ankle injuries are a potential mechanism for the activation of trigger points. New theories in dry needling trigger points suggest improving ankle proprioception pain and function. Therefore, this study was designed to investigate the effect of dry needling of peroneal muscle trigger points on proprioception, movement perception, and functional disability in patients with chronic ankle instability.

In this clinical trial study, 36 patients with chronic ankle sprain and instability were identified and divided into two groups. The intervention group received dry needling in the trigger points of the involved leg muscle twice a week for 3 weeks and the control group received a sham-dry needle. Ankle proprioception (joint repositioning error angle) and movement perception threshold were assessed using the Isokinetic Biodex 4 pro system, and functional disability was evaluated using the ankle joint functional assessment tool (AJFAT), Foot and Ankle Disability Index (FADI) and Latin8- and side to side hop tests. The variables were compared between the two groups after 3 weeks of treatment and one month after the end of the treatment period.

In the present study, there were significant improvements in active and passive ankle joint repositioning error of °15 inversion, maximal inversion minus °5, FADI scores, Latin8- and side-to-side hop tests' scores, and movement perception threshold at a speed of less than °0.5 per second, after the intervention. Foot and ankle assessment questionnaire, ankle joint repositioning error of °15 inversion, and maximal inversion minus °5 showed significant differences between the two groups in the follow-up (P < 0.05). The functional tests did not show the persistency of the treatment effect (P > 0.05).

Regarding the improvement of disability and ankle joint repositioning error, dry needling of foot muscles can be an effective treatment for patients with chronic ankle instability and in the case of heavier functional activities, a longer treatment period may be needed.

Myofascial pain syndrome is one of the most common causes of pain today, the important feature of which is the presence of trigger points. The purpose of this study was to compare the effects of dry needling (DN) and electroacupuncture (EA) of the upper trapezius muscle on ultrasonic changes, pain intensity, and upper limb functional disability in patients with myofascial pain syndrome.

30 people with active trigger points in the upper trapezius muscle were included in the study and divided into two experimental groups 1 (treatment with dry needling) and experimental group 2 (treatment with electroacupuncture). The experimental groups were treated for 4 sessions (2 sessions per week) for 2 weeks, and the three variables of pain intensity, functional disability index, and upper trapezius muscle thickness before treatment (pre-test), after treatment (post-test 1), and one month after It was evaluated from the treatment (post-test 2).

The results showed that statistically significant difference between pain intensity, functional disability index, and upper trapezius muscle thickness in the post-test stages 1 and 2 compared to the pre-test stage (P<0.05. (There was no statistically significant difference between the short-term effect (post-test 1 of the pre-test ratio) and long-term (post-test 2 of the pre-test ratio) in the index of functional disability and thickness of the upper trapezius muscle (P>0.05), while the pain intensity in the long-term effect (post-test 2 ratio) pre-test) there was a statistically significant difference between the two groups (P<0.05) and pain reduction in the EA group was greater than the DN group (0.86±0.26 versus 0.73±0.38).

DN and EA treatment methods in people with trigger points in the upper trapezius muscle cause short-term improvement in pain intensity, functional disability, and muscle thickness. Of course, EA performed better in long-term effects.

Internal Shoulder impingement is one of the most common problems in athletes with postural asymmetry. The present study aimed to investigate the effect of postural restoration exercises on patients' disabilities and the torque of the shoulder rotator muscles.

In this clinical trial study, 23 patients with internal shoulder entrapment were randomly divided into control and intervention groups. A positive Ober's test on the left hip indicated pelvic asymmetry and was considered a criterion for admission. Patients in the intervention group were treated with postural restoration exercises for six weeks. The control group did not receive any intervention. Internal and external rotator muscle torque and shoulder functional disability were measured using the Biodex isokinetic and DASH (Disability of Arm, Shoulder, and Hand) questionnaires, respectively. The variables were measured before the intervention, six weeks after the intervention, and four weeks after the completion of the intervention at angular velocities of 60 and 120 o/s at 45o, 70o, and 90o of shoulder abduction. Data analysis was performed using ANOVA with repeated measurements for intergroup comparison.

Findings of the present study showed a significant increase (P=0.000) in the isokinetic torque of the shoulder rotator muscles and also a significant decrease in functional disability (P=0.000) in the intervention group compared to the control group

The results of this study showed that postural restoration exercises in athletes with pelvic asymmetry can improve functional disability and increase shoulder rotational muscle torque

Lateral epicondylitis (LE) is one of the most common causes of pain in the elbow. The aim of this study was to evaluate the effect of dry needling (DN) of wrist extensor muscles along with Mulligan mobilization (MM) technique on extensor muscle tendon thickness, pain and upper limb function in patients with LE.

39 patients with LE participated in this double-blinded clinical trial study and were randomly divided into one of three groups: first intervention (DN), second intervention (DN with MM) and control. In first intervention group, DN was inserted in the trigger point(s) of the target muscles during 3 sessions of treatment, every other day. In second intervention group, in addition to DN, MM technique was performed. Control group didn’t receive any intervention. Pain intensity, function level, grip strength, and tendon thickness of extensor muscles were assessed in three stages before treatment, 24 hours after last session, and ten days after the end of sessions.

The results showed that all variables in the DN group and DN with MM had a significant improvement compared to the control group. Function and VAS scores in the DN with MM group showed a more significant difference than in the DN alone, but the differences in tendon thickness between the two groups were not significant.

Dry needling with Mulligan mobilization can produce further improvement in grip strength, function and pain level in patients with LE. DN is sufficient to improve the thickness of the extensor muscle tendon.

Mental health in students is related to several factors. The study was conducted to investigate the mental health problems of talented students in special schools and students from ordinary ones in Semnan province in Iran (2019).

In a cross-sectional study using cluster sampling, a group of junior high school students were evaluated using the strengthens and difficulties questionnaire (SDQ) for evaluation of mental health in five domains: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behavior.

From 24 selected public schools, 624 students (304 boys and 320 girls) participated in the study. The relative frequency of problems in special schools (291 people) was 18.6% (95% CI: 14.1 to 23.0) and in ordinary schools (331 people) was 30% (95% CI: 25.1 to 34.9) (P<0.001). The overall prevalence of problems after population weighting was estimated at 28.8%. Talented students showed better status in the areas of emotional and conduct (P<0.001). Adjusting for other variables education in ordinary schools was associated with a significant increase in the chance of having mental health problem (Adjusted OR=1.90, 95% CI: 1.06, 3.42; P=0.032)

Differences in the prevalence of mental health problems may be partly related to individual and the school environment differences. However, the role of socio-economic differences should not be ignored. Given the relatively high prevalence of mental health problems, it is recommended that more attention be paid to effective and periodic screening and monitoring of students, especially in ordinary schools.

 Early maladaptive schemas are self-destructive emotional and cognitive patterns that have been formed at the beginning of development and are repeated in life. Since early maladaptive schemas can be the most predictive of addiction and social networking addiction is also considered as an injury or complication. This study aimed to determine the relationship between early maladaptive schemas and social network addiction among students.

 This cross-sectional study was performed on 350 students of Semnan University of Medical Sciences. In this study, Yang’s Short Form Questionnaire and the questionnaire of social network s addiction based on mobile were used. Data were analyzed by the Chi-square test and logistic regression.

 There were 186 (53.2%) students who had social network addiction. Of them, 215 (61.4%) had at least one early maladaptive schema. The gender of the woman (OR=0.35, P=0.021), age over 21 years (OR=0.56, P<0.001), the formation of the schema of recognition (OR=0.54, P=0.01) and the formation of the schema entitlement (OR=0.47, P=0.002) with the reduction and the formation of the schema of social isolation / emotional inhibition (OR=2.94, P=0.006) was accompanied with increasing of the chance of being addicted to social networks.

 The results showed that some of the individual characteristics and the formation of some of the schemas are associated with decreasing and increasing the chance of addiction to social networks.

After the onset of the COVID-19 outbreak in Wuhan, China, and its spread to other countries, confrontation with it as an international emergency in all countries was seriously on the agenda of governments. Our country was not immune to this outbreak. Effective measures to combat this new virus would be certainly based on a proper understanding of the epidemiological pattern and its evaluation in the community. Under these circumstances, proper understanding and use of epidemiology-based indicators or approaches are more than ever needed by authorities and decision-makers. One of the most important and commonly used indices that have been used in most epidemics, including the COVID-19 outbreak, is the Basic Reproduction Number (R_0). Given the increasing need for the medical community and health care staff to deepen their understanding of the epidemiological concepts in dealing with epidemics, this article aimed to define R_0 and its application in the evaluation and monitoring of the COVID-19 epidemiological pattern in society

Narcotics Anonymous (NA) program includes some meetings to extend the continuity of giving up addiction in patients after detoxification. The purpose of this study was to evaluate the attitudes of patients undergoing methadone maintenance therapy in comparison with narcotics anonymous towards drug abuse.

In this comparative-analytical cross-sectional study which was accomplished in Semnan, Iran, 90 single males 20 to 40 years old participated in the study as three balanced groups including Methadone Maintenance Therapy (MMT), NA and a group without past-history of drug use as controls were studied. To measure attitude, the questionnaire "Drug Attitude Questionnaire" was used.

Findings showed that the difference between the three groups was significant in terms of attitude score in general and subscales of effects, risks and consumption, so that in the MMT group it was more and in the NA group it was less unfavorable than the other two groups (P<0.001).

Comparing to MMT, participation in the NA meetings may promote or improve the attitude of the patents towards drug abuse more.

Adenocarcinoma is the most common form of gastric cancer with relatively high mortality and morbidity in Iran. In this way, the aim of this study was to estimating postoperative net survival for patients with gastric Adenocarcinoma in Iran in the context of relative survival regarding its value and accuracy as a useful indicator.

Data analysis was performed on gastric adenocarcinoma patients undergoing curative surgical treatment followed by subsequent supplementary therapies in Imam Hospital in Tehran during the years 1995 to 1999 (follow up to 2004). While describing the data with frequency and life table, the net survival of 1- to 5-year was estimated via the multiple models based on the underlying factors using stata software.

Data of 281 patients with a mean age of 66.0 ± 10.8 (200 males and 81 females) with gastric Adenocarcinoma followed up for a maximum of 10 years was used. Among all 214 patients (76.2%) were diagnosed at stages 3 and 4 of the disease.Noticeably, the survival of 1- and 5- year for patients was 68.27 (95% CI: 62.17 -73.69) and 22.17 (95% CI: 16.39-28.63), respectively. The minimum amount for the specific survival rate was 77.76% for the time interval of 1 to 1.5 years.

The risk of death from this illness is more likely to occur within 1 to 2 years after surgery. While statistical healing can be considered to be from the seventh year onwards. Patients diagnosed at higher stages and who use less complementary therapies have less survival

The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of modified sequential organ failure assessment (MSOFA) scale to predict mortality and length of stay in intensive care unit patients respectively.
This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit. All patients’ records who admitted to the intensive care unit of Kowsar Hospital, Semnan city (the capital of the province), Iran, in 2015 considered as the sample. Collecting data were done during 4 weeks in April and May 2016. The data collection tool was a demographic questionnaire and modified sequential organ failure assessment scale. Exclusion criteria included discharge in the first 24 hours after admission, the patient died a few hours after admission and incomplete information to complete the modified sequential organ failure assessment form.
The study of 105 patient's records of the intensive care unit showed that 45.7% of patients were died, 15.2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and receiver operating characteristic (ROC) curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0.635, CI= 0.527-0.743) and each unit increase in modified sequential organ failure assessment score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P= 0.001(. Also each unit increase in modified sequential organ failure assessment (MSOFA) score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P= 0.015(.
The results of this study showed that the modified sequential organ failure assessment scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.

The study aimed to identify important interactions between Interleukin-6 and two single nucleotide polymorphisms of its gene expression (IL-6-174، IL-6-572) with some other factors including gender، age group، BMI، as while as blood concentration of sugar، lipids، and C-reactive protein، in association with hypertension.

In this cross-sectional study، the data of first phase of the «Evaluation of Novel Risk Factors of NCD» project conducted in 2001by the Research Institute for Endocrine Sciences was used. To identify the interactions we used logic Features Selection approach. Analyses were done by logistic regression models using adjusted odds ratio (OR) to demonstrate the associations of interest.

Based on final selected model on data of 126 men and 208 women with age of 18 or more، significant regression coefficients were reported for individual variables including fasting blood sugar≥126mg/dl (P=0. 001)، body mass index>25 (P=0. 03)، and age>40 years of old (P<0. 001) as well as a combinational variable combined from total cholesterol>200 mg/dl+ age>40+ interloukin-6 >29+ fasting blood sugar<126mg/dl (P=0. 003).

Findings suggested that in addition to age، body mass index and fasting blood sugar، having high level of interleukin-6 besides high plasma concentration of total cholesterol in older adults with non diabetic fasting blood sugar can significantly increase hypertension prevalence، applying logic Features Selection approach.

In the present research, the association between C-reactive protein (CRP) and high-density lipoprotein of cholesterol (HDL-C) is studied among healthy adults in Tehran city.

It is performed as a cross-sectional study using data of adults with age 18 and more enrolled in the first phase of the "Evaluation of novel risk factors of NCD" project in the Research Institute for Endocrine Sciences (Tehran,Iran) in 2001. Analyses were done by logistic regression models using crude and adjusted odds ratio (OR) to demonstrate the associations between CRP and HDL-C regarding their age, gender, body mass index and smoking status as underlying variables. To get final reduced logistic model we used backward elimination strategy with likelihood ratio test.

Based on the findings of analysis on data of 126 men and 208 women, it was reported a significant association between blood concentration of CRP and HDL-C (P<0.001). Logistic regression analysis revealed that increasing the concentration of CRP to 0.2 mg/l and more in serum, increased the likelihood of decreasing the serum concentration of HDL-C to 40 and 50 mg/dl and less about two folds in men and women respectively (adjusted OR: 2.25, 95% CI: 1.49-3.41).

In apparently healthy adults from Tehran city, independent of age, sex, body mass index, blood pressure, fasting blood sugar, and smoking, serum concentrations of CRP and HDL-C are reversely associated while both of them are considered as independent factors related with cardiovascular disorders and complications.