Omega-3 fatty acids' effect on leptin and adiponectin concentrations in patients with spinal cord injury: A double-blinded randomized clinical trial.

CONTEXT: Omega-3 fatty acids have been recently proposed to induce neural improvement in patients with spinal cord injury (SCI) while affecting some hormones including leptin and adiponectin. OBJECTIVES: We tried to evaluate the effect of omega-3 fatty acids on circulatory concentrations of leptin and adiponectin among these patients. DESIGN: This study is a double-blinded randomized clinical trial with intervention duration of 14 months. SETTING: A tertiary rehabilitation center. PARTICIPANTS: Total of 104 patients with SCI who did not meet our exclusion criteria entered the study. Those with history of diabetes, cancer, endocrinology disease, acute infection, and use of special medications were excluded. Patients were divided randomly into the treatment and control group by using permuted balanced block randomization. INTERVENTION: The treatment group received two MorDHA® capsules per day (each capsule contain 465 mg of docosahexaenoic acid (DHA) and 63 mg of eicosapentaenoic acid (EPA)) for 14 months while the control group received placebo capsules with similar color, shape, and taste. MAIN OUTCOMES MEASURES: Leptin and adiponectin concentrations in plasma were measured at the beginning of trial and then after 6 and 14 months. RESULTS: Fourteen months of treatment with DHA and EPA did not influence concentrations of leptin but adiponectin level was significantly decreased (P: 0.03). Weight was positively correlated with leptin level at stage 0 of trial (P: 0.008, r=0.41) while this association was attenuated through stages of trial after intervention. CONCLUSION: Our data show that omega-3 fatty acids may not affect plasma concentrations of leptin but adiponectin level is decreased in patients with SCI. Moreover, this intervention influences the linear relationship between weight and leptin after 14 months administration of DHA and EPA.

Health technology assessment in Iran: challenges and views.

BACKGROUND: Various decisions have been made on technology application at all levels of the health system in different countries around the world. Health technology assessment is considered as one of the best scientific tools at the service of policy- makers. This study attempts to investigate the current challenges of Iran's health technology assessment and provide appropriate strategies to establish and institutionalize this program. METHODS: This study was carried out in two independent phases. In the first, electronic databases such as Medline (via Pub Med) and Scientific Information Database (SID) were searched to provide a list of challenges of Iran's health technology assessment. The views and opinions of the experts and practitioners on HTA challenges were studied through a questionnaire in the second phase which was then analyzed by SPSS Software version 16. This has been an observational and analytical study with a thematic analysis. RESULTS: In the first phase, seven papers were retrieved; from which, twenty- two HTA challenges in Iran were extracted by the researchers; and they were used as the base for designing a structured questionnaire of the second phase. The views of the experts on the challenges of health technology assessment were categorized as follows: organizational culture, stewardship, stakeholders, health system management, infrastructures and external pressures which were mentioned in more than 60% of the cases and were also common in the views. CONCLUSION: The identification and prioritization of HTA challenges which were approved by those experts involved in the strategic planning of the Department of Health Technology Assessment will be a step forward in the promotion of an evidence- based policy- making and in the production of comprehensive scientific evidence.

The implementation of tissue banking experiences for setting up a cGMP cell manufacturing facility.

Cell manufacturing for clinical applications is a unique form of biologics manufacturing that relies on maintenance of stringent work practices designed to ensure product consistency and prevent contamination by microorganisms or by another patient's cells. More extensive, prolonged laboratory processes involve greater risk of complications and possibly adverse events for the recipient, and so the need for control is correspondingly greater. To minimize the associate risks of cell manufacturing adhering to international quality standards is critical. Current good tissue practice (cGTP) and current good manufacturing practice (cGMP) are examples of general standards that draw a baseline for cell manufacturing facilities. In recent years, stem cell researches have found great public interest in Iran and different cell therapy projects have been started in country. In this review we described the role of our tissue banking experiences in establishing a new cGMP cell manufacturing facility. The authors concluded that, tissue banks and tissue banking experts can broaden their roles from preparing tissue grafts to manufacturing cell and tissue engineered products for translational researches and phase I clinical trials. Also they can collaborate with cell processing laboratories to develop SOPs, implement quality management system, and design cGMP facilities.

The impact of the COVID-19 pandemic on surgical education: A survey and narrative review.

Background: Since the emergence of the COVID-19 pandemic, medical education has been a concerning issue, especially in surgical fields. Due to the postponement of many elective surgeries and even alternations in the pattern of emergent surgeries, concerns have been raised about whether residents of surgical disciplines are experienced enough after graduation or not. We aimed to describe the impact of the COVID-19 pandemic on surgical residency training in different fields. Materials and methods: We conducted a cross-sectional study with a 20-item questionnaire on residents of surgical disciplines from three different educational hospitals of Tehran University of Medical Sciences, Iran in 2020. In addition, we reviewed the current literature regarding the impact of COVID-19 pandemic on surgical education worldwide. Results: Our survey, with a response rate of 56.8% demonstrated significant reduction in the time spent in elective surgeries, surgical clinics and even in emergent surgeries for residents. Besides, it has reported that significant time has been spent in COVID 19 wards which resulted in decreased satisfaction of educational activities. Conclusions: The impacts of COVID 19 pandemic on surgical education are significant and inevitable. Thus, we must integrate novel educational methods in surgical curriculum to optimize training and minimize the adverse effects of the pandemic on surgical education.

Cost-effectiveness of homograft heart valve replacement surgery: an introductory study.

The clinical effectiveness of heart valve replacement surgery has been well documented. Mechanical and homograft valves are used routinely for replacement of damaged heart valves. Homograft valves are produced in our country but we import the mechanical valves. To our knowledge the cost-effectiveness of homograft valve has not been assessed. The objective of the present study was to compare the cost-effectiveness of homograft valve replacement with mechanical valve replacement surgery. Our samples were selected from 200 patients that underwent homograft and mechanical heart valve replacement surgery in Imam-Khomeini hospital (2000-2005). In each group we enrolled 30 patients. Quality of life was measured using the SF-36 questionnaire and utility was measured in quality-adjusted life years (QALYs). For each group we calculated the price of heart valve and hospitalization charges. Finally the cost-effectiveness of each treatment modalities were summarized as costs per QALYs gained. Forty male and twenty female participated in the study. The mean score of quality of life was 66.06 (SD = 9.22) in homograft group and 57.85 (SD = 11.30) in mechanical group (P < 0.05). The mean QALYs gained in homograft group was 0.67 more than mechanical group. The incremental cost-effectiveness ratio (ICER) revealed a cost savings of 1,067 US$ for each QALY gained in homograft group. Despite limitation of this introductory study, we concluded that homograft valve replacement was more effective and less expensive than mechanical valve. These findings can encourage healthcare managers and policy makers to support the production of homograft valves and allocate more recourse for developing such activities.

Coding and traceability in Iran.

Transplantation has a long history in Iran. Cornea was the first tissue transplantation in 1935. The Central Eye Bank of Iran was established in 1991 and the Iranian Tissue Bank (ITB) in 1994. Now, there are also some private cell and tissue banks in the country, that produce different tissue grafts such as homograft heart valves, musculoskeletal tissues, soft tissues, cartilages, pericardium, amniotic membrane and some cell based products. There is not a separate legislation for tissue transplantation but the legal framework for tissue donation is based on the "Deceased or Brain dead patient organ transplantation" act (passed on April 6, 2000). For tissue banking there is no regulatory oversight by the national health authority. To increase the level of safety and considering the importance of effective traceability, each tissue bank has its own policy and terminology for coding and documentation without any correlation to others. In some cases tissue banks have implemented ISO based standards (i.e., ISO 9001) as a basic quality management system.

The data set development for the National Spinal Cord Injury Registry of Iran (NSCIR-IR): progress toward improving the quality of care.

STUDY DESIGN: Descriptive study. OBJECTIVES: The aim of this manuscript is to describe the development process of the data set for the National Spinal Cord Injury Registry of Iran (NSCIR-IR). SETTING: SCI community in Iran. METHODS: The NSCIR-IR data set was developed in 8 months, from March 2015 to October 2015. An expert panel of 14 members was formed. After a review of data sets of similar registries in developed countries, the selection and modification of the basic framework were performed over 16 meetings, based on the objectives and feasibility of the registry. RESULTS: The final version of the data set was composed of 376 data elements including sociodemographic, hospital admission, injury incidence, prehospital procedures, emergency department visit, medical history, vertebral injury, spinal cord injury details, interventions, complications, and discharge data. It also includes 163 components of the International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) and 65 data elements related to quality of life, pressure ulcers, pain, and spasticity. CONCLUSION: The NSCIR-IR data set was developed in order to meet the quality improvement objectives of the registry. The process was centered around choosing the data elements assessing care provided to individuals in the acute and chronic phases of SCI in hospital settings. The International Spinal Cord Injury Data Set was selected as a basic framework, helped by comparison with data from other countries. Expert panel modifications facilitated the implementation of the registry process with the current clinical workflow in hospitals.

Organ donation workshop - a survey on nurses' knowledge and attitudes toward organ and tissue donation in Iran.

PURPOSE: Despite increasing transplantation in Iran, organ shortage and long waiting lists remain major problems in the country. Many publications have demonstrated that the willingness of healthcare professionals to participate in the donation process can improve the donation rate. Since nurses are usually the first people among the healthcare staff to recognize a patient as a potential donor, they have an important role in the procurement of organ and tissue from cadaveric donors. Our objectives were to survey nurses' knowledge and attitudes toward organ and tissue donation and to examine the effect of having them attend a workshop on organ donation. METHODS: A 39-item questionnaire was completed by 66 nurses, before and after participation in a 1-day organ donation workshop that was held at the Iranian Tissue Bank (in Tehran, Iran). The questionnaire contained demographic data, 29 questions regarding knowledge, and 8 questions on attitudes toward organ and tissue donation. RESULTS: 69.7% women and 30.3% men participated in this study. The mean score for knowledge was 16.89 (SD= 3.33) before and 23.76 (SD=1.66) after the workshop (p=0.000). The mean attitudes score was 4.76 (SD=1.71) before and 5.08 (SD=1.34) after the workshop (p=0.235). Although 63.63% claimed they were willing to have a donation card only 15.15% actually carried one. CONCLUSIONS: This study demonstrated that educational programs can enhance nurses' knowledge and commitment to the organ donation process and, ultimately, increase the donation rate. Consequently, it is of great importance for organ procurement units to focus on regular training programs for all their healthcare staff.

Treatment of chronic thoracic spinal cord injury patients with autologous Schwann cell transplantation: an interim report on safety considerations and possible outcomes.

Several experimental studies have introduced Schwann cell transplantation as a means of recovery in animal models of spinal cord injury (SCI). The reported promising results together with the availability of autologous sources for Schwann cells indicate Schwann cell transplantation as a possible treatment for SCI. To address the safety and feasibility concerns we report 1-year follow-up of four patients aged between 22 and 43 years who had stable chronic (28-80 months) spinal cord injury at mid-thoracic level and treated with autologous Schwann cell transplantation. Purified Schwann cells used for transplantation were acquired from autologous sural nerve and cultured without the use of any specific mitogenic or growth factors. The patients were evaluated by means of American Spinal Injury Association (ASIA) criteria, sphincter, sexual function and Magnetic Resonance Imaging assessments for 1 year after transplantation. None of the patients were found to have any adverse effects indicating transfer of infection, neurological deterioration or other related clinical problems. Of the four patients, only one patient with incomplete SCI showed motor and sensory improvement 1 year after transplantation with extensive and continuous rehabilitation. All the four patients experienced transient paresthesia or increased muscle spasm after transplantation. Magnetic Resonance (MR) images of the patients did not show any visible changes or pathological findings after 1 year. This preliminary report shows that autologous Schwann cell transplantation is generally safe for the selected number of SCI patients but it does not prove beneficial effects. Further safety and outcome studies are recommended.

Do patients know that physicians should be confidential? study on patients' awareness of privacy and confidentiality.

Privacy and confidentiality are among the inalienable rights of every human being that contribute to preservation of a sense of reverence and dignity. The present study was conducted to examine patients' awareness of their entitlement to these important rights. This cross-sectional study was conducted on 200 patients in Tehran, Iran during the year 2010. Collected data included patients' demographics (age, gender, marital status, place of residence, and educational level), type of hospital ward, frequency of hospitalization, duration of hospital stay, and patients' awareness of privacy and confidentiality. Two trained interviewers gathered the data using a self-made questionnaire, which was specifically designed to assess patients' awareness of privacy and confidentiality. Validity and reliability of the questionnaire were determined using content validity and Cronbach's Coefficient Alpha (a = 0.7), respectively. To analyze data, patients were assigned to three categories of poor (0 ≤ scores ≤ 3), moderate (4 ≤ scores ≤ 7) and good (8 ≤ scores ≤ 10) levels of awareness. Statistical analysis was performed by SPSS software version 21. The results showed that 21% of the patients had poor, 72% moderate, and 7% good awareness of privacy and confidentiality, with a mean of 4.61 ± 1.63. In this study, 153 patients (76.5%) provided a correct definition of privacy, and 161 patients (80.5%) were aware of instances of privacy violation. In addition, a good level of awareness was found in 77 patients (38.5%) in terms of physician confidentiality, and in 158 patients (81.4%) regarding confidentiality of examination results and medical consultations. Our study results highlight the necessity to inform patients about the ethical and legal issues related to privacy and confidentiality, before or during admission.

Assessment of Clinical Teachers' Professionalism in Iran: From Residents and Fellowships' Perspective.

In the present study, professional conduct of clinical teachers in Tehran University of Medical Sciences in Iran was assessed by their residents (n=292) and fellowships (n=48) using a standard questioner called self-reported measurement equipment. This evaluation was a descriptive cross-sectional study. Professionalism was questioned in four domains including clinical teacher-patient, clinical teacher-student, inter-professional and clinical teacher-self relationships. Accordingly, mean scores of the teachers in cases of clinical teacher-patient; clinical teacher-student, inter-professional (teamwork) and clinical teacher-self relations were 61%, 62.2%, 60.6% and 57.6%, respectively. Generally, the teachers achieved 60.35% of the positive scores, and as a result, they were assessed intermediate in the professional behaviors. The residents and fellowships stated that they were not completely satisfied with their teacher's professional conduct and had hidden concerns. It shows that the clinical teachers in our project may not be ideal role models. As a result, developing a comprehensive professionalism and implementing regulations to ensure a successful professionalism are necessary. The precise evaluation of professional conduct in clinical faculty could encourage the maintenance of professional behaviors and potentially decrease negative role modeling and positively influence the hidden curriculums. Operational approaches to formulating regulations and appropriate measures for establishing professional ethics are of great importance.

Relationship Between Sleep Quality, Obstructive Sleep Apnea and Sleepiness During Day With Related Factors in Professional Drivers.

One of the important reasons for accidents is sleepiness.With this description, the sleep disorders are associated with health and mortality, and not only affect the person but also the family and the whole society. Aim of this study was assessing of relationship between Sleep Quality, Obstructive sleep Apnea and Sleepiness during day with related factors in professional drivers. This was a cross-sectional study measuring correlation between sleep quality questionnaire (Pittsburgh Sleep Quality Index or PSQI), Epworth Sleepiness Scale (ESS) and Stop Bang questionnaire (STOP BANG).the appropriate sample size to achieve a 95% confidence level was 943 people. The study population was chosen among qualified drivers using a convenience sampling method that took place over 12 months duration. Exclusion criterion consisted of the presence of a physical or mental disability. Data analyzed by software SPSS, version 15. In this study, all drivers were men with mean of age 36±9/5 year (minimum 22 year and maximum 72 year), 799 (84.7%) were married, 535 (56.7%) had high school education. Also, 96.4 % of drivers had undesirable sleep quality, 25.8% obstructive sleep apnea and 6.8% abnormal sleepiness during day. Multiple linear regression test showed, Score of STOP-Bang was correlated with smoking (OR (ß)=0/2, P=0.006) and history of hurt disease (OR (ß)=0.95, P=0.003), shift work (OR (ß)=0.19, P=0.006) more probability. Moreover, PSQI was statistically significant with shift work (OR (ß)=0.44, P=0.02), smoking (OR (ß)=0.98, P=0.001), history of pulmonary disease (OR (ß)=3.58, P=0.009) more probability , and ESS was statistically significant with smoking (OR (ß)=0.64, P=0.007) and history of pulmonary disease(OR (ß)=2.82, P=0.006), shift work (OR (ß)=0.59, P=0.008) more probability. In our study, according to the results, it should be planning to reduce the driving time in day and night and also it are recommended short breaks during driving. It is suggested the more widespread and prospective studies, as well as informing the drivers about the benefits of proper sleep and annual checkup drivers of health.

Psychological defense mechanisms among individuals with SCI with adjustment disorder.

OBJECTIVES: The used psychological defense styles among individuals with spinal cord injury (SCI) with adjustment disorders (AJD) have not yet been described. In the present investigation, the prevalence of AJD among people with SCI has been estimated and the pattern of used defense styles has been identified. DESIGN: Cross-sectional investigation. SETTING: A tertiary rehabilitation center in Iran. PARTICIPANTS: Individuals referred to Brain and Spinal Cord Injury Research Center were invited to participate in a screening interview. AJD was diagnosed based on DSM-V criteria. Those with AJD diagnosis were scheduled for another interview to assess defense mechanisms. OUTCOME MEASURES: Demographic and injury-related variables were recorded. Defense mechanisms were assessed by the 40-item version of the Defense-Style Questionnaire (DSQ-40). RESULTS: Among 114 participants, 32 (28%) were diagnosed with AJD among whom 23 subjects attended the second interview. Mean age and time since injury were 29.57 ± 9.29 years and 11.70 ± 6.34 months, respectively. The majority of patients were using idealization defense mechanism (91.3%). In the second and third place, passive aggression (87.0%) and somatization (82.6%) defense mechanisms were observed, respectively. Neurotic style was dominantly used (11.52 ± 2.26). Sex, marital status, educational level, cause of the injury and injury level were not related to defense style (P: 0.38, 0.69, 0.88, 0.73, and P: 0.32, respectively). CONCLUSION: Prevalence of AJD is estimated to be 28% among individuals with SCI. The most prevalent defense style was neurotic and the dominant used defense mechanism was "idealization." The role of demographic and injury-related variables in determining the used defense mechanisms was insignificant.

C-reactive protein as an available biomarker determining mental component of health-related quality of life among individuals with spinal cord injury.

OBJECTIVES: C-reactive protein (CRP) has been shown to correlate with health-related quality of life (HRQL) in some chronic medical conditions. However, these associations have not yet described in spinal cord injury (SCI). In this study, we tried to identify biomarkers associated with HRQL in SCI. DESIGN: Cross-sectional. SETTING: Tertiary rehabilitation center. PARTICIPANTS: Referred patients to Brain and Spinal Cord Injury Research Center between November 2010 and April 2013. OUTCOME MEASURE: Blood samples were taken to measure circulatory CRP, leptin, adiponectin, ferritin, parathyroid hormone, calcitonin, thyroid hormones, fasting plasma glucose and lipid profile. All the analyses were performed with adjustment for injury-related confounders (level of injury, injury completeness and time since injury) and demographic characteristics. HRQL was measured with Short Form health survey (SF-36). RESULTS: The initial inverse association between CRP and total score of SF-36 (P: 0.006, r = -0.28) was lost after adjustment for confounders. However, the negative correlation between CRP and Mental Component Summary (MCS) remained significant (P: 0.0005, r = -0.38). Leptin level was inversely correlated with Physical Component Summary (PCS) (P: 0.02, r = -0.30). CONCLUSION: Although CRP and leptin levels were not related with total scores of SF-36 questionnaire, CRP can be more useful in determining mental component of HRQL whereas leptin can be a determinant of physical component. The combined consideration of these two biomarkers may help to predict HRQL in individuals with SCI.

Subfascial endoscopic perforator vein surgery: the first report from Iran.

BACKGROUND: Chronic venous stasis ulcers of the leg are still a challenge in vascular surgery. Innovation of new surgical techniques using endoscopic instruments have ushered in a new era with less complications and better results. This study was designed to evaluate the safety and long-term outcomes of this technique for the first time in Iran. METHODS: Subfascial endoscopic perforator vein surgery was performed on 10 legs in 8 patients who had signs of chronic venous insufficiency (between September 2001 and September 2003). Patients were followed up for a mean of period 12.5 months. RESULTS: The operations were performed successfully in all patients. No serious complications occurred intraoperatively. There was no mortality or significant morbidity. Complete healing of skin ulcers was observed in 5 active and 2 healed ulcers in less than 12 weeks. There were 2 recurrences after 4 and 27 months, respectively. CONCLUSION: Subfascial endoscopic perforator surgery is a safe procedure for the treatment of venous stasis ulcers. Rapid ulcer healing can be expected in selected patients.

Incidence of Post-Operative Sepsis and Role of Charlson Co-Morbidity Score for Predicting Postoperative Sepsis.

Sepsis and septic shock are among mortality causes following major surgeries. The Charlson co-morbidity index consists of 19 weighted categories related to chronic health which measures the burden of co-morbidity. The goal of this study was to determine the incidence of postoperative sepsis in patients underwent gynecological and gastrointestinal cancer surgeries and predictive role of Charlson index for this situation. Two hundred and twenty-two patients who underwent gynecological and gastrointestinal cancer surgeries were evaluated. Sixty-four (28.6%) patients developed SIRS postoperatively. Forty-four (19.7%) patients developed sepsis postoperatively. Mean age, duration of hospitalization and surgery, the Charlson score were significantly higher in patients who developed sepsis than other cases. Blood transfusion and Charlson score were independent predictors of sepsis occurrence. Charlson co-morbidity index is a predictive factor for developing postoperative sepsis.

Effect of General Health Status on Chronicity of Low Back Pain in Industrial Workers.

Recognizing patients at a higher risk of developing chronic low back pain (LBP) is important in industrial medicine. This study aimed to assess the power and quality of General Health Questionnaire (GHQ) for prediction of the odds of chronicity of acute LBP. This study was conducted on industrial workers. All subjects with acute LBP who met the inclusion criteria were enrolled. Demographic characteristics, occupational, physical, and mental parameters and the general health status of subjects were evaluated;  they were followed up for developing chronic LBP for one year. Cigarette smoking, high body mass index, job stress, physical load and high GHQ scores were found to be the risk factors for the progression of acute LBP to chronic LBP (P<0.05). Standing position while working, age, work experience, exercise, level of education, weekly work hours and shift work were not the risk factors for chronic LBP (P>0.05). High GHQ score can be a risk factor for progression of acute LBP to chronic LBP. The GHQ in combination with the Job Content Questionnaire can be used as a quick and simple screening tool for detection of subjects at high risk of chronic LBP when evaluating acute LBP in an occupational setting.

The correlation between dietary fat intake and blood pressure among people with spinal cord injury.

BACKGROUND: Studies have demonstrated the effect of different dietary fats on blood pressure (BP) in general population. However, these associations have not yet been described in people with spinal cord injury (SCI). METHODS: Referred patients to Brain and SCI Research Center between 2011 and 2014 have been invited to participate. Only paraplegic individuals were recruited and patients with injury at cervical or higher thoracic sections were excluded to omit the bias effect of autonomic dysreflexia. Dietary intakes were assessed by recording consumed foods by 24-hour dietary recall interviews using Nutritionist IV 3.5.3 modified for Iranian foods. Systolic BP (SBP) and diastolic BP (DBP) were measured 3 times and the mean values entered analysis. RESULTS: Higher intakes of cholesterol were related to higher BP (P = 0.010 and 0.011 for SBP and DBP, respectively). Similarly, intake of saturated fat was positively correlated to both SBP (P = 0.016, r = 0.21) and DBP (P = 0.011, r = 0.22). The effect of eicosapentaenoic acid (EPA) on BP was insignificant (P = 0.760 and 0.720 for SBP and DBP, respectively). However, intake of docosahexaenoic acid (DHA) was related to lower BP among people with SCI. CONCLUSION: This study has demonstrated that higher intakes of cholesterol and saturated fat are associated with increased BP, whereas DHA is an antihypertensive agent. Dietary modifications with reduction of cholesterol and saturated fat along with intake of additional DHA supplements may help to reduce BP in spinal cord injured-individuals with hypertension.

Injury-related characteristics and quality-of-life among Iranian individuals with spinal cord injury.

BACKGROUND: Health-related quality-of-life (HR-QOL) may be affected by various factors including injury-related characteristics among individuals with spinal cord injury (SCI). However, the impact of the influence of these variables has not yet been fully described in Iranian population. Here, we assessed the relationships between injury-related characteristics and HR-QOL among Iranian people with SCI. METHODS: HR-QOL was assessed using short-form health survey (SF-36). Referred patients to Brain and Spinal Injury Research Center between 2010 and 2012 were invited to participate in this investigation. Injury-related characteristics including injury level and completeness, time since injury, plegia type, and American Spinal Injury Association (ASIA) Impairment Scale were evaluated. RESULTS: Total of 104 patients (85 men and 19 women) entered the study. The majority of patients had a complete injury (77.9%). The most frequent ASIA score was A (75%), and the most common level of injury was at thoracic sections (61.5%). Lower injury levels were associated with higher scores in physical component summary (P = 0.040), mental component summary (P = 0.010) and subsequently total score (P = 0.006). Mean age and time since injury were 52.58 ± 12.69 and 10.88 ± 16.68 years, respectively, and were not related with HR-QOL (P = 0.70 and 0.220, respectively). There was no difference in terms of HR-QOL between patients with complete and incomplete injury. Paraplegic individuals had significantly higher scores in the domain of physical functioning compared to patients with tetraplegia (P = 0.007). CONCLUSION: lower injury level is a significant predictor of better QOL among individuals with SCI whereas other injury-related characteristics including completeness, time since injury and plegia type may not influence HR-QOL.

Relationship between leptin and adiponectin concentrations in plasma and femoral and spinal bone mineral density in spinal cord-injured individuals.

BACKGROUND CONTEXT: Previously, the associations between leptin and adiponectin levels with bone mineral density (BMD) have been reported in different populations, and occasionally, controversial results have been demonstrated. Until now, these relationships in spinal cord-injured individuals have not yet been described. PURPOSE: We tried to investigate the correlation between leptin and adiponectin concentrations in plasma and BMD in Iranian patients with spinal cord injury (SCI). STUDY DESIGN/SETTING: Cross-sectional investigation. PATIENT SAMPLE: Referred patients with SCI who did not meet our exclusion criteria such as pregnancy, lactation, amputation, history of diabetes, cancer, endocrinology disease, and use of special medications entered the study. OUTCOME MEASURES: Bone mineral density of femoral neck, trochanter, intertrochanteric zone, total hip, and lumbar vertebrae assessed by dual-energy X-ray absorptiometry and serum leptin and adiponectin levels measured by blood sample analysis using immunoassay techniques. METHODS: Patient demographic characteristics were measured during face-to-face visits. Injury level and Spinal cord Injury Association (ASIA) score were assessed by clinical examination and were confirmed by imaging aids. Measured levels of leptin and adiponectin and dual-energy X-ray absorptiometry results were analyzed with partial correlation analysis method after adjustment for weight, body mass index (BMI), and age. RESULTS: Total of 104 patients (19 females and 85 males) entered this investigation. Higher leptin concentration was significantly associated with higher BMD in femoral neck (p=.006, r=0.73), femoral intertrochanteric zone (p=.001, r=0.83), and hip (p=.001, r=0.81) only in female patients, whereas no such association was detected in male participants after adjusting for BMI and age. Leptin and adiponectin levels were not associated with lumbar spine BMD in both genders. Neither injury level nor ASIA score and plegia type (paraplegia or tetraplegia) influenced on leptin and adiponectin concentrations. CONCLUSIONS: We found no association between leptin concentration and BMD in male individuals, whereas a positive correlation between leptin and BMD of femoral neck, intertrochanter, and hip was observed in female patients that shows a sexual polymorphism in this relationship. However, by considering the low number of female participants, these results should be interpreted cautiously. Lumbar spine BMD was associated with neither leptin nor adiponectin level in both genders.