Effect of deep brain stimulation on postoperative body mass index: A systematic review and meta-analysis.

BACKGROUND: Deep Brain Stimulation (DBS) is FDA-approved for several movement disorders; such as Parkinson's disease, dystonia, and neuropsychiatric disorders. There are various reports of Body mass index (BMI) changes following different DBS targets in various disorders. AIM: A comprehensive systematic review and meta-analysis were conducted to investigate the impact of DBS on patients' Body Mass Index (BMI) and provide an in-depth overview of its underlying mechanisms. MATERIALS AND METHODS: We conducted research according to PRISMA guidelines. Our study assessed comprehensively electronic databases, including Pubmed, Scopus, Embase, web of science, and the Cochrane Library, up to May 2024. The random-effect model analysis was performed by the Comprehensive Meta-analysis software (CMA) version 3.0. As well, Cochran's Q test was used to determine the statistical heterogeneity of included studies. RESULT: This systematic review ultimately included 49 studies, 46 of which entered the meta-analysis. The total number of patients was 1478, consisting of Parkinson's disease (PD), dystonia, and the obsessive compulsive disorder (OCD) patients. The most common DBS target was subthalamic nucleus, followed by globus pallidus internus (GPi). Our meta-analysis depicted the BMI of participants significantly mount after DBS electrode implantation (SMD = -0.542, 95%CI: -0.678 to -0.406, and P-value < 0.001). However, moderate to high heterogeneity was detected among the studies (I2 = 67.566%). Additionally, the Daily energy intake (DEI) of patients significantly decreased after DBS (SMD: 0.457, 95%CI; 0.205 to 0.709, and P-value < 0.001). CONCLUSION: STN and GPi DBS can lead to weight gain through distinct central pathways in various movement and neuropsychiatric disorders, posing a potential risk for obesity, insulin resistance, and metabolic syndrome.

Risk Factors for Dislocation following Total Hip Arthroplasty in Developmental Dysplasia of the Hip: A Systematic Review and Meta-Analysis.

PURPOSE: This systematic review and meta-analysis aimed to identify risk factors of dislocation after total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). METHODS: A systematic literature review was performed on 18th August 2022 using Medline, Embase, Scopus, Web of Science electronic databases, and a manual search. The study was conducted according to the PRISMA guidelines and registered with PROSPERO. Statistical analysis includes assessment of heterogeneity and data synthesis using RevMan 5.4. RESULTS: Review of five studies including 2865 patients and 116 dislocated hips found that lower body mass index (BMI) (SMD = 0.22, p = 0.04, I2 = 0%), Crowe classification type IV versus I, II, and III (OR = 2.70, p = 0.004, I2 = 51%), higher cup inclination (SMD = 0.39 p = 0.0007, I2 = 0%), femoral head size < 28 mm (OR = 5.07, p = 0.003, I2 = 71%), lateral surgical approach (OR = 1.96, p = 0.02, I2 = 0%), and postoperative infection (OR = 6.26, p < 0.0001, I2 = 0%) were significant risk factors. However, age, gender, cup anteversion, femoral osteotomy, vertical (V-COR) centre of rotation, intraoperative fracture, preoperative and postoperative leg length discrepancy (LLD) and previous hip surgery were not found to be significant risk factors. CONCLUSION: This study underscores importance of these risk factors in THA planning for DDH patients to reduce dislocation risk. Further research needed to understand mechanisms.

Association of R279Q and C1562T polymorphisms of matrix metalloproteinase 9 gene and increased risk for myocardial infarction in patients with premature coronary artery disease.

BACKGROUND: A number of matrix metalloproteinase (MMP) gene polymorphisms has been identified which may be probably related to premature myocardial infarction (MI). OBJECTIVE: We assessed the relationship between the two polymorphisms of the MMP9 gene including R279Q and C1562T and occurrence of premature MI. METHODS: The study has two phases including a case-control study as the first phase and cohort study as the second phase. Initially, 1000 patients with premature coronary artery disease were classified into MI and non-MI groups. Genotyping of the polymorphism was conducted by PCRRFLP and high-resolution melting techniques. Given the two conditions of patients residing in Tehran and faced with their first episode of MI, 640 of 1000 study samples previously followed up with a median follow-up time of 45.74 months were assessed in a retrospective cohort phase regarding long-term major adverse cardiac events (MACE). RESULTS: The prevalence of wild, heterozygous, and mutant genotypes of R279Q polymorphism in MI group was 14.5%, 57.3%, and 28.2% and in non-MI group was 36.9%, 38.4%, and 24.7%, respectively, with a considerable difference (P<.001). There was a significant difference in the prevalence of wild, heterozygous, and mutant genotypes of C1562T polymorphisms in MI group (12.4%, 41.2%, and 46.4%, respectively) and in non-MI group (46.8%, 38.6%, and 14.7%, respectively; P<.001). No difference was found in total MACE-free survival rate between genotypes of R279Q and C1562T polymorphisms. CONCLUSION: C1562T and R279Q polymorphisms are associated with the susceptibility to premature MI, but cannot predict long-term cardiac events in these patients.

Effect of deep brain stimulation on sexual dysfunction among patients who had Parkinson's disease: a systematic review and meta-analysis.

BACKGROUND: Patients who have Parkinson's disease (PD) present several non-motor issues, such as sexual dysfunction. Deep brain stimulation (DBS) is a great treatment for PD and could affect both motor and non-motor symptoms of patients. AIM: The main goal of the current study is to evaluate the impact of DBS on the sexual dysfunction among patients with PD. METHODS: Five databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) were searched for records. Studies that measured the effect of DBS sexual function were included. The risk of bias assessment tool of non-randomized studies of interventions (ROBINS-I) was used to assess the quality of the included studies. The before and after data extraction and statistical analysis were performed using the Comprehensive Meta-analysis software (CMA) version 3.0. RESULT: Ten studies were included in the systematic review; six of them were eligible to perform a meta-analysis with a total sample size of 532 participants and a mean age of 62.21 ± 1.59 years. All participants performed STN-DBS. The sexual function of participants after STN-DBS implantation significantly increased (SMD = -0.124, 95% CI: -0.209 to -0.038, P-value = 0.005). It also did not have any publication bias. Additionally, their quality of life mounts significantly (SMD = -0.712, 95% CI: -1.002 to -0.422, p-value <0.001). CONCLUSION: Our systematic review highlights the potential effect of STN-DBS on reducing the sexual dysfunction of patients with PD and boosting their quality of life.

Statin use in total joint arthroplasty: a systematic review.

Introduction: There has been increased interest in the use of Statins in total hip and knee arthroplasty (THA and TKA) patients to improve outcomes and reduce postoperative complications. This study was performed to systematically review the evidence on Statin use in total joint arthroplasty, specifically its benefits and complications. Methods: Adhering to the PRISMA guidelines, a systematic review of PubMed, Embase, Scopus, Web of Science, and the Cochrane database was performed to find studies reporting on the effects of Statin use on outcomes of THA and TKA. Two authors independently selected relevant papers to include. Results: A total of 18 papers were included in the final analysis. Most were retrospective studies, with heterogeneous patient selection and outcome measures. The evidence on the risks and benefits of Statin use on outcomes of total joint arthroplasty was very limited and heterogeneous. Studies were focusing on perioperative cardiac outcomes, clinical outcomes and complications, renal, pulmonary, and gastrointestinal outcomes. Due to the heterogeneity of reported data, a formal meta-analysis was not possible. Conclusions: There is some evidence in the literature suggesting that perioperative use of Statins, especially in Statin-naïve patients, may reduce cardiac (e.g. atrial fibrillation) and noncardiac (e.g. delirium) complications, while not increasing the risk of muscle or liver toxicity. The authors also found low levels of evidence that Statin use may reduce the long-term risk for revision surgery and osteolysis.

Discriminative and diagnostic value of anti-cyclic citrullinated peptide antibodies in Iranian patients with rheumatoid arthritis.

Most studies on the diagnostic utility of the anti-cyclic citrullinated peptide antibody (anti-CCP) test in rheumatoid arthritis (RA) have been performed in developed countries, with only a few done in the developing world. We undertook a cross-sectional study to determine the diagnostic utility of the rheumatoid factor (RF) and anti-CCP tests in urbanized Iranians with early RA. One hundred and ninety-three serum samples were obtained from consecutive patients who were diagnosed with RA. Serum samples of 254 ones without RA, consisting of other inflammatory polyarthritis disorders, were also collected as controls. RF was measured for IgM by latex agglutination test, and titers higher than 1/80 were considered positive. Anti-CCP was also assayed using an ELISA with 6.25 RU/ml as the threshold for a positive result. The anti-CCP had sensitivity, specificity, positive predictive value, and negative predictive value for a diagnosis of RA of 47.2, 92.9, 83.5, and 69.8 %, respectively. Those for RF were 57.0, 83.9, 72.8, and 72.0 %, respectively. For anti-CCP antibodies in combination with RF, they were 38.9, 96.5, 89.3, and 67.5 %, respectively. Anti-CCP has higher specificity and predictive values compared with the RF parameter in diagnosing RA in Iranian patients, but their discriminative values were similar. Anti-CCP and RF in combination further increases the diagnostic value for RA.

Headache following vaccination against COVID-19 among healthcare workers with a history of COVID-19 infection: a cross-sectional study in Iran with a meta-analytic review of the literature.

BACKGROUND: There is evidence of the occurrence of headache after vaccination against COVID-19. However, only a few studies have examined the headache characteristics and related determinants, especially among healthcare workers with a history of COVID-19 infection. METHODS: We evaluated the incidence of headaches after injection of different types of COVID-19 vaccine to determine factors relating to the incidence of headache after vaccination among the Iranian healthcare workers who had previously contracted COVID-19. A group of 334 healthcare workers with a history of COVID-19 infection were included and vaccinated (at least one month after recovery without any COVID-19 related symptoms) with different COVID-19 vaccines. The baseline information, headache characteristics and vaccine specifications were recorded. RESULTS: Overall, 39.2% reported experiencing a post-vaccination headache. Of those with a previous history of headache, 51.1% reported migraine-type, 27.4% tension-type and 21.5% other types. The mean time between vaccination and headache appearance was 26.78 ± 6.93 h, with the headache appearing less than 24 h after vaccination in most patients (83.2%). The headaches reached its peak within 8.62 ± 2.41 h. Most patients reported a compression-type headache. The prevalence of post-vaccination headaches was significantly different according to the type of vaccine used. The highest rates were reported for AstraZeneca, followed by Sputnik V. In regression analysis, the vaccine brand, female gender and initial COVID-19 severity were the main determinants for predicting post-vaccination headache. CONCLUSION: Participants commonly experienced a headache following vaccination against COVID-19. Our study results indicated that this was slightly more common in females and in those with a history of severe COVID-19 infection.

Return to work following primary total hip arthroplasty: a systematic review and meta-analysis.

BACKGROUND: Total hip arthroplasty (THA) is increasingly common in younger patients, who are more likely to be working preoperatively. There is a need for an updated review of the literature regarding the rate and time to return to work (RTW), which is important when counseling patients, and also from an economic standpoint. METHODS: A systematic review and meta-analysis of the literature was performed on January 20, 2022, and studies reporting the rate and/or time to RTW after THA were included. Two authors independently selected relevant papers. RTW was extracted and analyzed using fixed-effects or random-effects models where appropriate. RESULTS: A total of 48 studies were included in the final analysis. We found that 70.7% of patients were working after primary THA. Among patients who were working before surgery, this rate increases to 87.9%, while 28.1% of patients who were not working preoperatively started working after surgery. Younger patients were more likely to RTW, while patients with a physically demanding job were less likely to RTW. Minimally invasive techniques were reported to yield a higher rate of RTW and an earlier time to RTW. CONCLUSION: We found that the majority of patients return to work after THA, and some patients are able to start working after surgery. Compared to previous reviews, patients seem to have a higher rate and earlier RTW. The overall trend of the literature suggests that patients are returning to work earlier and at a higher rate compared to previous reviews.

The use of low-dose etanercept as an alternative therapy for treatment of ankylosing spondylitis: a case series.

During recent decades, biological medications play a crucial role for treating rheumatologic disorders and thus are strongly recommended for initial treatment of ankylosing spondylitis. However, because of high cost of biological drugs, the use of these drugs has been limited. In current series, we tried to assess safety of low-dose etanercept as a common usable biological drug in patients with ankylosing spondylitis. In a case-series study, 4 men with ankylosing spondylitis were treated with low-dose etanercept (25 mg/2 weeks) plus methotrexate (10 mg/week). Safety was assessed by measuring rate of differences in severity of clinical manifestations and level of C-reactive protein (CRP). After the completion of treatment with low-dose etanercept, inflammatory low back pain and morning stiffness was reduced lower than 30 min in all patients. Only one patient had baseline high serum ESR and positive CRP that was changed to negative following treatment protocol. At one-year follow-up, all participants continued their regular treatment regimen with the etanercept survival rate 100%. Neither side effects related to drug nor clinical complications were observed within the follow-up period. Our findings suggest that low-dose etanercept (25 mg/2 weeks) has an acceptable safety and effectiveness profile in individuals with ankylosing spondylitis and can be good alternative instead of conventional therapy with etanercept (25 mg two times per week).

Simultaneous versus staged bilateral total hip arthroplasty: a systematic review and meta-analysis.

BACKGROUND: Total hip arthroplasty is a common orthopedic surgery for treating primary or secondary hip osteoarthritis. Bilateral total hip replacement could be performed in a single stage or two separate stages. Each surgical procedure's reliability, safety, and complications have been reported controversially. This study aimed to review the current evidence regarding the outcomes of simultaneous and staged bilateral total hip arthroplasty. METHODS: We conducted a meta-analysis using MEDLINE, EMBASE, Web of Science, and Scopus databases. Eligible studies compared complications and related outcomes between simultaneous and staged bilateral THA. Two reviewers independently screened initial search results, assessed methodological quality, and extracted data. We used the Mantel-Haenszel method to perform the meta-analysis. RESULTS: In our study, we included 29,551 patients undergoing simBTHA and 74,600 patients undergoing stgBTHA. In favor of the simBTHA, a significant reduction in deep vein thrombosis (DVT) and systemic, local, and pulmonary complications was documented. However, we evidenced an increased pulmonary embolism (PE) and periprosthetic fracture risk in simBTHA. In the simBTHA, total blood loss, length of hospital stay, and total cost were lower. CONCLUSION: This meta-analysis shows that simultaneous bilateral THA accompanies fewer complications and lower total cost. Well-designed randomized controlled trials are needed to provide robust evidence.

Content Validity and Reliability of the Persian Version of the Forgotten Joint Score Questionnaire in Patients Undergoing Total Hip Arthroplasty.

Background: Forgotten Joint Score (FJS) is a patient-reported outcome measurement that evaluates patients' ability to forget the replaced joint (knee or hip) in everyday activity. This study aimed to evaluate the validity and reliability of the Persian version of this questionnaire in Iranian patients who underwent total hip arthroplasty. Methods: A team of specialists reviewed this questionnaire and voted for its clarity and content validity. Then, the FJS was filled out by 100 randomly selected total hip arthroplasty patients between 2019 and 2021 with at least 6 months of follow-up. The reliability coefficient (Cronbach's alpha) was calculated. Results: A total of 95 patients who met the inclusion criteria, with the mean age 59.9 ± 11.6 years and 26.6% being female, participated in the study. Patients had no difficulty with the content and linguistic format of the Persian FJS-12. The mean FJS for these patients was 50.8 ± 4.6. The Cronbach's alpha was measured at 0.87. The mean content validity index was 0.93. Conclusion: FJS-12 can discriminate even patients with eximious pain and functional outcomes after joint reconstruction surgery. The Persian format of FJS-12 showed acceptable internal consistency using Cronbach's alpha and acceptable content validity. Therefore, it can be utilized in the Iranian population for future research studies.

Respiratory events and obstructive sleep apnea in children with achondroplasia: investigation and treatment outcomes.

PURPOSE: We report aspects of sleep-disordered breathing in a cohort of achondroplastic children who attended our hospital. METHODS: A retrospective chart review was conducted for a 15-year period to further evaluate the diagnosis and treatment of sleep-disordered breathing in children with achondroplasia. RESULTS: A review of the medical records was undertaken for 46 children (63%, mean age 3.9 years) with achondroplasia that had overnight polysomnography. Among them, 25 (54.3%) had obstructive sleep apnea (OSA). For 19 out of 46 patients (follow-up rate, 41.3%) with a mean follow-up of 31.3 months (range, 3 month to 11 years), 13 had undergone adenotonsillectomy, while nine were treated with continuous positive airway pressure. CONCLUSIONS: Prospective evaluation of our clinic population confirms a high incidence of SDB in achondroplastic children. OSA has been linked to raise intracranial pressure as well as neurocognitive deficits in children and we hypothesize that associations between neurological and respiratory abnormalities in this disorder are a consequence of the early onset of associated respiratory, rather than the neurological complications.

Predicting Risk Score for Mechanical Ventilation in Hospitalized Adult Patients Suffering from COVID-19.

BACKGROUND: COVID-19 has become a pandemic since December 2019, causing millions of deaths worldwide. It has a wide spectrum of severity, ranging from mild infection to severe illness requiring mechanical ventilation. In the middle of a pandemic, when medical resources (including mechanical ventilators) are scarce, there should be a scoring system to provide the clinicians with the information needed for clinical decision-making and resource allocation. OBJECTIVES: This study aimed to develop a scoring system based on the data obtained on admission, to predict the need for mechanical ventilation in COVID-19 patients. METHODS: This study included COVID-19 patients admitted to Sina Hospital, Tehran University of Medical Sciences from February 20 to May 29, 2020. Patients' data on admission were retrospectively recruited from Sina Hospital COVID-19 Registry (SHCo-19R). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify the predictive factors for mechanical ventilation. RESULTS: A total of 681 patients were included in the study; 74 patients (10.9%) needed mechanical ventilation during hospitalization, while 607 (89.1%) did not. Multivariate logistic analysis revealed that age (OR,1.049; 95% CI:1.008-1.091), history of diabetes mellitus (OR,3.216; 95% CI:1.134-9.120), respiratory rate (OR,1.051; 95% CI:1.005-1.100), oxygen saturation (OR,0.928; 95% CI:0.872-0.989), CRP (OR,1.013; 95% CI:1.001-1.024) and bicarbonate level (OR,0.886; 95% CI:0.790-0.995) were risk factors for mechanical ventilation during hospitalization. CONCLUSIONS: A risk score has been developed based on the available data within the first hours of hospital admission to predict the need for mechanical ventilation. This risk score should be further validated to determine its applicability in other populations.

Comparison of heart rate variability and cardiac arrhythmias in polluted and clean air episodes in healthy individuals.

OBJECTIVE: Pathophysiological mechanisms and pathways linking cardiovascular mortality and morbidity with air pollution were recently hypothesized. The present study evaluated association between air pollution and changes in heart rate variability as a marker of cardiac autonomic function in healthy individuals, and also determined the frequency of cardiac arrhythmias and QT interval changes on polluted compared to unpolluted days. METHODS: Continuous Holter electrocardiography (ECG) monitoring was conducted on 21 young healthy individuals in the two episodes of clean air and elevated air pollution in Tehran. All subjects underwent a medical history review, a physical examination and echocardiography in order to rule out structural heart diseases. Measured pollutants and parameters included NO(2), CO(2), O(3), SO(2), and PM10, which all showed significantly higher concentrations on polluted days. Holter parameters were measured for 24-h time segments and compared. RESULTS: Maximum heart rate was significantly lower in polluted air conditions in comparison with clean air conditions (115.1 ± 32.2 vs. 128.9 ± 17.7), and the square root of the mean of squared differences between adjacent NN intervals (r-MSSD) was higher in polluted air compared to clean air (99.0 ± 58.2 vs. 58.5 ± 26.4). Also, the occurrence of nonsustained supraventricular tachycardia was reported in 42.9% of participants in air pollution episodes, whereas this arrhythmia was not seen in clear air conditions (p = 0.001). CONCLUSION: Changes in air pollution indices may lead to the occurrence of nonsustained supraventricular tachycardia, a slight reduction in maximum heart rate, and an increase in r-MSSD in healthy individuals. Air quality monitoring in cities associated with a high exposure to air pollutants is recommended in order to prevent such events.

A Systematic Review and Bioinformatics Study on Genes and micro-RNAs Involving the Transformation of Endometriosis into Ovarian Cancer.

BACKGROUND: Along with the description of tumorigenesis processes in endometriosisrelated ovarian cancer, identifying dysregulated miRNAs, the target genes of these miRNAs, and the processes abnormally affected by dysregulated miRNAs is essential, which was our goal. METHODS: Two reviewers individually evaluated the articles which collected relevant information including genes and miRNAs involved in the transformation of endometriosis into ovarian cancer. To assess the mature sequence of miRNAs and also their chromosomal positions, miRPathDB software was employed. To determine the main target gene predicted for each considered miRNAs, the TargetScanS Web server was applied. The interaction of each gene with other genes associated with endometrial- related ovarian cancer was determined by GeneMANIA software. Finally, to design integrated model of miRNAs-targeted genes interaction network, the Cytoscape software was used. RESULTS: The final number of studies available for analysis was 6 manuscripts including 22 miRNAs described as involved in the transformation of endometriosis into different subtypes of ovarian cancers (14 miRNAs up-regulated and 8 miRNAs down-regulated). Three miRNAs of miR-141 (upregulated), miR-205 (down-regulated), and miR-125b (down-regulated) were revealed as the originator for genetic interactions leading to carcinogenesis. We could show some common loops and pathways including uncontrolled cell proliferation and abnormal apoptosis (mediated by PTEN gene induced by miR-21 and miR-214), and disaggregation and epithelialization (mediated by ZEB1 and ZEB2 genes induced by miR-200). CONCLUSION: According to our analysis, up-regulation of miR-141 and down-regulation of miR-205 and miR-125b have a central role in transforming endometriosis to ovarian cancer.

The evaluating of pregnancy-associated plasma protein-A with the likelihood of small for gestational age.

OBJECTIVE: Recently, strong evidences were obtained on the association between low pregnancy-associated plasma protein-A (PAPP-A) levels in the first trimester and poor outcomes of pregnancy. METHODS: This cross-sectional study was conducted on all pregnant women who were referred to the Obstetrics and Gynecology Clinic at Imam Hossein Hospital in Tehran, Iran in 2014. Women were asked to attend clinical examinations and screening at 11-14 weeks of gestation. RESULTS: Based on the definition, 14.5% of neonates found to be small for gestational age (SGA). There was a strong association between PAPP-A levels and birth weight. The mean PAPP-A level in the mothers of neonates who were SGA was significantly lower than those without this poor outcome. Based on the receiver operating characteristic curve analysis, serum PAPP-A level was a main determinant in the prediction of SGA neonates. CONCLUSION: The serum PAPP-A level at 11-13 weeks of gestation can effectively predict the increased risk for fetal growth retardation. In patients in this study, the best cutoff value for PAPP-A was 0.75 MOM, which signifies that lower levels of this marker can predict fetal growth restriction with high sensitivity and specificity.

Effects of sedation during upper gastrointestinal endoscopy on arterial oxygen saturation.

BACKGROUND/AIMS: Determination of optimal administered sedatives during endoscopy is vital and necessary for the minimization of their side effects. This study was designed to see the effect of sedation on endoscopy induced arterial oxygen desaturation and determination of sedatives safety during gastrointestinal endoscopy. METHODOLOGY: In this controlled clinical trial, 90 consecutive patients scheduled for diagnostic upper gastrointestinal endoscopy were categorized into 2 groups (45 in each group). The patients in the first group were sedated with midazolam 0.1 mg/kg, propofol 1 mg/kg and fentanyl 1 microg/kg intravenously, while the patients in the second group received saline as a placebo. In both groups, blood pressure, heart rate, and arterial oxygen saturation were measured before and one minute after endoscopy, and compared. RESULTS: No significant differences were found in arterial O2 saturation (p = 0.142) and heart rate (p = 0.154) between the two groups, one minute after endoscopy. Both systolic and diastolic blood pressures were higher in non-sedated group (p < 0.001). CONCLUSION: Concomitant administration of midazolam, propofol, and fentanyl do not cause arterial desaturation, however, it can lead to blood pressure changes one minute after the beginning of endoscopy.

Clinical features, diagnostic approach, and therapeutic outcome in myasthenia gravis patients with thymectomy.

PURPOSE: Thymectomy has been widely employed in the treatment of myasthenia gravis (MG). However, little data exist in Iran demonstrating the efficacy and morbidity of thymectomy. The aim of this study was to determine the clinical features, diagnostic approach, and therapeutic outcome in patients with MG who underwent thymectomy. METHODS: This historical cohort study was conducted in 3 university hospitals in Tehran. Preoperative and operative indices of 61 patients with MG who had been treated with thymectomy in these hospitals from September 2000 to July 2005 were reviewed. Among them, 20 patients were followed during one year after operation for determination of postoperative complications and one year mortality rate. RESULTS: The most common manifestations of MG were ptosis (77.0%) and upper limbs weakness (70.4%). CT scans of the thymus showed thymus enlargement, thymoma and thymus hyperplasia in 51.5% (22/43), 11.6% (5/43) and 2.32% (1/43) of patients, respectively. The postoperative complications were found in 13.1% of patients and one year mortality rate of thymectomy was 6.6%. CONCLUSION: Regarding to high one year mortality rate of thymectomy in patients of MG in this study, the assessment of the factors related to the mortality and outcome of patients who underwent thymectomy in Iran are necessary.

Iranian school teachers: knowledge and attitude toward ecstasy.

UNLABELLED: The drug ecstasy has been increasingly used for recreational purposes, especially among students. Teachers play an important role in altering student attitudes toward ecstasy. OBJECTIVE: The aim of this study was to access teacher knowledge and attitude toward ecstasy and its side effects. METHODS: In a cross-sectional study, 460 teachers from 20 public and 10 private schools were randomly invited to participate in the study between April 2005 and April 2006 and their knowledge and attitudes toward ecstasy were collected on the basis of a designed questionnaire. RESULTS: No significant correlation was found between knowledge about ecstasy and gender, whereas, there was a positive relation between knowledge and education level of the teachers (P = .033). Attitude was higher in female participants (P = .012), but was not related to the age of the teachers. We found no relation between attitude toward ecstasy and the teachers' education levels. CONCLUSION: Knowledge about ecstasy and its side effects was dependant on the teachers' education level, whereas their attitude toward ecstasy was dependent on the teachers' gender.