فهرست مطالب نویسنده:
khodayar golabchi
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PurposeThe aim of the present study was to investigate the effect of subthreshold diode laser micropulse (SDM) in comparison with conventional laser photocoagulation in the treatment of the diabetic macular edema (DME).MethodsSixty-eight eyes from 68 patients with clinically significant DME were divided randomly into two equal groups. In the first group, SDM photocoagulation was employed, while conventional laser photocoagulation was performed on the eyes of the second group. Central macular thickness (CMT), central macular volume (CMV), and best corrected visual acuity (BCVA) were measured before, 2, and 4 months after intervention, and the results were compared.ResultsThe mean CMT was 357.3 and 354.8 microns before the treatment in Groups 1 and 2, respectively (P = 0.85), and decreased significantly to 344.3 and 349.8 after 4 months, respectively (P = 0.012 and P = 0.049). The changes in the central macular thickness was statistically higher in the first group (P = 0.001). The mean CMV significantly decreased in Group 1 (P = 0.003), but it was similar to pretreatment in Group 2 after 4 months (P = 0.31). The BCVA improved significantly in Group 1 (PConclusionsIn this study, SDM was more effective than conventional laser photocoagulation in reducing CMT and CMV and improving visual acuity in patients with DME.Keywords: Diabetic macular edema, Subthreshold diode laser micropulse, Conventional laser photocoagulation
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مقدمهدرمان استاندارد رتینوپاتی دیابتی پرولیفراتیو، لیزر فتوکواگولاسیون رتین می باشد این درمان به صورت تک نقطه ای و Pattern scan انجام می شود. هدف از این مطالعه، ارزیابی تغییرات ایسکمی رتین و پسرفت نئوواسکولاریزاسیون رتین با استفاده از روش Pattern scan در مقایسه با تک نقطه ای در بیماران مبتلا به رتینوپاتی دیابتی پرولیفراتیو بود.روش هااین مطالعه، یک کارآزمایی بالینی آینده نگر بود که در 146 چشم از 73 بیمار مبتلا به رتینوپاتی دیابتی پرولیفراتیو انجام شد. یک چشم بیماران به صورت تصادفی با لیزر Pattern scan و چشم دیگر، با لیزر تک نقطه ای تحت درمان قرار گرفت. بعد از مدت 6 ماه، میزان پسرفت نئوواسکولاریزاسیون رتین در ناحیه ی دیسک عصب اپتیک و رتین و نیز تغییرات ایسکمی رتین بر اساس میزان ناحیه ی خون رسانی نشده که در فلورسئین آنژیوگرافی مشخص گردید، مورد مقایسه قرار گرفت.یافته هاتفاوت معنی داری در میزان پسرفت نئوواسکولاریزاسیون رتین در ناحیه ی دیسک و رتین خارج از Pole خلفی بر اساس میزان لیک در آنژیوگرافی در دو روش لیزر شامل تک نقطه ای (31/0 = P) و Pattern scan (26/0 = P) وجود نداشت. پیشرفت ایسکمی در 9 چشم درمان شده با روش Pattern scan مشاهده شد، در حالی که این میزان پیشرفت در گروه دیگر تنها 2 مورد بود (02/0 = P).نتیجه گیرینواحی پیشرفت ایسکمی رتین در گروه درمان شده با لیزر Pattern scan در مقایسه با لیزر تک نقطه ای بالاتر بود. این یافته نشان داد که مطالعات بیشتری لازم است تا روشی بهتر از Pattern scan پیدا شود که اثرات مشابه پسرفت ایسکمی رتین در روش تک نقطه ای داشته باشد.
کلید واژگان: لیزر فتوکواگولاسیون تک نقطه ای, لیزر Pattern scan, لیزر فتوکواگولاسیون PanretinalBackgroundThe retinal laser photocoagulation is the gold standard treatment of the proliferative diabetic retinopathy. Nowadays, we can perform panretinal photocoagulation with single spot or pattern scan laser methods. This study aimed to compare the retinal ischemic changes and the retinal neovascularization regression between these two techniques.MethodsIn a prospective clinical trial study, 146 eyes of 73 patients with proliferative diabetic retinopathy was enrolled. One eye of patients was treated with single spot laser photocoagulation randomly and other eye was preserved for pattern scan laser photocoagulation. The changes of retinal ischemia on the basis of noncapillary perfusion and the regression of neovascularization on the basis of amount of leakage on fluorescein angiography were compared between the two groups after 6 months.FindingsThere was no significant difference in the retinal neovascularization regression of disc and elsewhere in eyes treated with pattern scan (P = 0.26) or single spot laser (P = 0.31). While the areas of the retinal ischemia progression was significantly higher (9 cases) in group treated with pattern scan in comparison to other group (2 cases) (P = 0.02).ConclusionThe areas of retinal ischemia progression were higher after treatment with pattern scan laser compared to single spot laser. Future researches are recommended to find a better modality than the pattern scan to induce regression of the retinal ischemia similar to the single spot laser technique.Keywords: Diabetic retinopathy, Pattern scan laser photocoagulation, Single spot laser photocoagulation, Panretinal photocoagulation -
BackgroundSteroids are commonly used in the treatment of cervical radiculopathy (CR), but there is limited information in this regard. We evaluated the efficacy of oral prednisone in the treatment of CR.Materials And MethodsThis randomized, double-blinded, placebo-controlled trial was conducted on adult patients with neck/shoulder pain for at least 1 month with no alarm symptoms/sings of malignancy, infection, or severe myelopathy, and no contraindication for corticosteroid use. Patients were allocated to receive prednisolone 50 mg/day for 5 days that was tapered within the following 5 days, or placebo. All patients also received acetaminophen 325 mg three times a day and ranitidine 150 mg two times a day. Neck disability index (NDI) and the verbal rating scale (VRS) were used to evaluate the outcomes.ResultsA total of 59 patients (31 female, mean ± SD age = 46.2±9.0 years) completed the study. A significant decrease was observed regarding the NDI and VAS scores from baseline to the end of study in both groups (P < 0.001). However, for both the NDI (35.7±21.4 vs. 12.9±10.2) and VRS (4.4±2.7 vs. 1.6±1.2), the amount of decrease was greater in the prednisone compared with the placebo group (P < 0.001). Based on the clinically important change in NDI, pain was improved in 75.8% (22/29) of the prednisolone and 30% (9/30) of the placebo group (P < 0.001).ConclusionA short course of oral steroid therapy with prednisolone is highly effective in reducing pain in patients referring with uncomplicated CR. Further studies are warranted on dosing, duration, and long-term efficacy and safety of oral steroid therapy, compared with injection approach.Keywords: Cervical radiculopathy, prednisone, steroids
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BackgroundThis study was aimed at assessing the accuracy of Provocative Tests in diagnosis of acute or chronic Cervical Radiculopathy (CR) based on an electrodiagnostic reference criterion.Materials And MethodsShoulder Abduction Test (SAT), Spurling Test (ST), Upper Limb Tension Test (ULTT), and electromyography were done on 97 patients who referred to Electrodiagnostic center in the university hospital from January 2010 to March 2011. All of the participants had neck and radicular pain for at least 3 weeks. They were classified according to electrodiagnostic findings. Then diagnostic values of provocative tests were assessed in diagnosis of acute or chronic CR on the basis of reference criterion.ResultsSAT and ST were more specific (85%) compared to ULTT, while ULTT was more sensitive (60.46% in acute and 35.29% in chronic) than the other two. SAT and ST had a significant accuracy for comparison between acute and chronic CR (P<0.05).ConclusionULTT is suitable for screening of CR, while SAT and ST can support diagnosis. SAT and ST are good diagnostic tests for comparison between acute and chronic CR.Keywords: Cervical radiculopathy, Electrodiagnostic study, Shoulder abduction test, Spurling test, Upper limb tension test
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مقدمهبیماری مولتیپل اسکلروز (Multiple sclerosis یا MS) یک بیماری مزمن دستگاه عصبی مرکزی با تظاهرات و انواع گوناگون است. شایع ترین نوع این بیماری نوع عودکننده-بهبود یابنده است. پالس تراپی متیل پردنیزولون درمان انتخابی حملات عود آن است که مانند هر داروی دیگر عوارض جانبی خاص خود را دارد.روش هامطالعه ی ما یک مطالعه ی توصیفی و از نوع گذشته نگر و آینده نگر بود. 64 بیمار مبتلا به MS بر اساس کرایتریای Mc Donald انتخاب شدند. این بیماران در بیمارستان کاشانی تحت درمان پالس تراپی قرار گرفتند. سپس به مدت سه ماه پیگیری شدند. اطلاعات به وسیله ی گرفتن شرح حال، معاینه ی فیزیکی و پرسشنامه جمع آوری و ثبت شد.یافته هانوع و درصد عوارض جانبی مینور و ماژور مشخص شدند. عوارض ماژور شامل هشت مورد آریتمی، سه مورد فشار خون و یک مورد نکروز آسپتیک بود. عوارض مینور نیز شامل تپش قلب در 47 درصد از بیماران، دیس پپسی در 34 درصد از آنان و بی خوابی در 33 درصد بود.نتیجه گیرینتایج مطالعه ی ما نشان داد که یک رابطه ی مستقیم بین میزان و نوع عوارض جانبی با تعداد دفعات پالس تراپی و دوز کورتون وجود دارد. در عین حال نتایج مطالعه ی ما حاکی از آن بود که رابطه ایی میان میزان و نوع عوارض جانبی با سن، جنس و شاخص توده ی بدنی بیماران وجود ندارد.
کلید واژگان: عوارض جانبی, پالس تراپی, متیل پردنیزولون, حملات تشدید, مولتیپل اسکلروزBackgroundMultiple sclerosis (MS) is a chronic central nervous system disease with different types and symptoms. The most common type of MS is the relapsing-remitting MS whose relapses are treated using methylprednisolone pulse therapy.MethodsOur study was a descriptive study on 64 patients with MS who were selected based on McDonald criteria. The patients received methylprednisolone pulse therapy at Kashani Hospital (Isfahan, Iran). After treatment, we monitored the patients for 3 months. The required information was collected by history taking, physical examination, and filling a questionnaire.FindingsThe type and percentage of minor and major side effects were specified. The major side effects were arrhythmia in 8 patients, hypertension in 3 patients, and aseptic necrosis in 1 patient. The minor side effects were palpitation in 47% of the patients, dyspepsia in 34%, and insomnia in 33%.ConclusionThe results of our study showed a direct relation between the type and severity of the side effects and the frequency of pulse therapy and the dosage of methylprednisolone. On the other hand, our study failed to establish relations between the type and severity of side effects and age, sex, and body mass index of the patients.Keywords: Side effects, Pulse therapy, Methylprednisolone, Multiple sclerosis, Acute relapsing -
BackgroundMultiple sclerosis (MS) is a disease of young and middle aged individuals with a demyelinative axonal damage nature in central nervous system that causes various signs and symptoms. As color vision needs normal function of optic nerve and macula, it is proposed that MS can alter it via influencing optic nerve. In this survey, we evaluated color vision abnormalities and its relationship with history of optic neuritis and abnormal visual evoked potentials (VEPs) among MS patients.MethodsThe case group was included of clinically definitive MS patients and the same number of normal population was enrolled as the control group. Color vision of all the participants was evaluated by Ishihara test and then visual evoked potential (VEPs) and history of optic neuritis (ON) was assessed among them. Then, frequency of color blindness was compared between the case and the control group. Finally, color blinded patients were compared to those with the history of ON and abnormal VEPs.Results63 MS patients and the same number of normal populations were enrolled in this study. 12 patients had color blindness based on the Ishihara test; only 3 of them were among the control group, which showed a significant different between the two groups (P = 0.013). There was a significant relationship between the color blindness and abnormal VEP (R = 0.53, P = 0.023) but not for the color blindness and ON (P = 0.67).ConclusionsThis study demonstrates a significant correlation between color blindness and multiple sclerosis including ones with abnormal prolonged VEP latencies. Therefore, in individuals with acquired color vision impairment, an evaluation for potentially serious underlying diseases like MS is essential.
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مقدمههدف از انجام این مطالعه، بررسی دقت تشخیصی آزمون های بالینی Shoulder abduction test (SAT)، Spurling test (ST) و Upper limb tension test (ULTT) در تشخیص رادیکولوپاتی گردنی حاد و مزمن بر اساس معیار های الکترودیاگنوستیک بود.روش هادر این مطالعه آزمون های بالینی و الکترومیوگرافی روی 97 بیمار که از درد شانه و اندام فوقانی رنج می بردند، انجام شد. آن ها بر اساس مطالعات الکترودیاگنوستیک تقسیم بندی شدند و سپس ارزش تشخیصی هر یک از تست ها برای تشخیص رادیکولوپاتی حاد و مزمن بر اساس معیارهای مرجع در نظر گرفته شده ارزیابی گردیدند.یافته هاSAT، ST بیشترین ویژگی را در میان آزمون های ما داشتند، در حالی که ULTT از دو آزمون دیگر حساس تر بود. SAT و ST دارای ارتباط معنی داری جهت افتراق در تشخیص رادیکولوپاتی گردنی حاد و مزمن بودند (05/0 > P).نتیجه گیریآزمون ULTT جهت غربالگری در تشخیص رادیکولوپاتی گردنی مناسب است، در حالی که آزمون های SAT و ST را می توان جهت تایید تشخیص به کار برد. همچنین آزمون های SAT و ST آزمون های تشخیصی مناسبی جهت افتراق رادیکولوپاتی گردنی حاد و مزمن هستند.
کلید واژگان: رادیکولوپاتی گردنی, مطالعات الکترو دیاگنوستیکBackgroundThe aim of this study was to assess the accuracy of shoulder abduction test (SAT), spurling test (ST) and upper limb tension test (ULTT) in diagnosis of acute or chronic cervical radiculopathy (CR) based on an electrodiagnostic reference criterion.MethodsOur tests and electromyography were done on 97 patients suffering from arm and neck pain. They were classified according to electrodiagnostic findings. Then diagnostic values of provocative tests were assessed in diagnosis of acute or chronic CR on the basis of reference criterion.FindingsSAT and ST were more specific compared to ULTT while ULTT was more sensitive than those two. SAT and ST had a significant accuracy for comparison between acute and chronic CR (P < 0.05).ConclusionThe ULTT is suitable for screening of CR, but SAT and ST can support diagnosis. The SAT and the ST are good diagnostic tests for comparison between acute and chronic CR. -
A middle aged woman, having a history of diastolic hypertension and sinus bradycardia since one year ago, was referred to our center with a sudden occipital headache after shouting. To evaluate the cause of headache the brain MRI was performed reporting a slight cerebellar tonsillar herniation of about one centimeter below the foramen magnum. After the patient was diagnosed to have type I Chiari malformation, a surgery procedure was done and the symptoms were recovered after that.Type I Chiari malformation is a disease mostly caused by congenital displacement of cerebellar tonsils through the foramen magnum. The most common symptom is headache, rarely reported with hypertension or sinus bradycardia.
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ObjectivesThere is no study about correlation between vitamin D serum level and multiple sclerosis (MS) in Iran. So in this survey, we investigated the serum level of 25-hydroxy vitamin D in MS patients and compared it with controls in central region of Iran, an area with medium to high risk for MS disease, in spite of high sun exposure.MethodsA case-control study was conducted from July 1, 2008 to July 31, 2009. We enrolled 50 definitive MS patients, according to McDonald's criteria as case group and 50 matched controls. Our age limits were 15 to 55 years and those patients with estimated expanded disability status scale less than 5 were introduced to the study. We measured serum level of 25-hydroxy vitamin D and compared them in both groups.ResultsWe gathered 42 females and 8 males as case group and the same numbers as control group without significant age difference. The mean serum level of 25-hydroxy vitamin D in case and control groups were 48 and 62 nmol/L, respectively, and the difference was significant (P=0.036). Also, our study showed significant discrepancy between the two groups according to the rate of deficiency, insufficiency and normal range of vitamin D categories (P=0.021).ConclusionsWe found the same results as those studies carried out in Europe and North America; i.e., lower serum vitamin D level in MS patients than that in normal population, in spite of sufficient sun exposure in Isfahan region.
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