The validity and reliability of the Persian version of the Athlete Sleep Screening Questionnaire.

Background: Sleep as a biological phenomenon is effective in the performance and recovery of athletes. Questionnaires can be used as a cost-effective initial assessment tool for sleep. The Athlete Sleep Screening Questionnaire (ASSQ) demonstrated a clinically valid instrument for screening relevant sleep issues in athletic populations. Due to the lack of validated tools for adequate screening for sleep difficulties in the Iranian athlete population, the present study was conducted to evaluate the validity and reliability of the Persian version of the ASSQ. Materials and Methods: The translation process was performed using instructions by Beaton et al. Content validity was assessed by a panel of experts. Exploratory and confirmatory factor analysis was performed for two 5-item sleep difficulty scores (SDS) and a 4-item chronotype score. Internal consistency based on Cronbach's alpha and McDonald's omega and stability reliability were used to evaluate reliability. Results: The ASSQ achieved conceptual and semantic equivalence with the original scale. The item-level content validity index (I-CVI) of each item ranged from 0.87 to 1, and the averaging scale-level CVI/average was 0.95. In factor analysis, one factor for SDS and one factor for chronotype score were identified and confirmed. The internal consistency of the SDS scale (α =0.77, Ω =0.83) and chronotype (α =0.74, Ω =0.77) was acceptable. Stability reliability was confirmed for SDS scale (intra-class correlation [ICC] =0.87) and for chronotype (ICC = 0.83). Conclusion: Persian ASSQ has acceptable psychometric measurement properties as a screening tool to assess sleep in Iranian athletes.

Did the COVID-19 pandemic change the weight reduction in patients with obesity after bariatric surgery?

BACKGROUND: The COVID-19 pandemic has significantly impacted healthcare services worldwide, including bariatric surgery. There is a concern that the pandemic-induced stay-at-home orders and social restrictions may negatively affect weight reduction outcomes post-bariatric surgery. This study aimed to examine the impact of the COVID-19 on weight loss up to six months after three types of bariatric surgeries including One-Anastomosis Gastric Bypass (OAGB), RY Gastric Bypass (RYGB), and Sleeve Gastrectomy (SG) before and two time periods during the COVID-19 pandemic. METHODS: We conducted a retrospective study using data from a comprehensive database of bariatric surgery patients in Iran. We recruited 882 patients who underwent bariatric surgery from the initiation of COVID-19 to 6 months before public vaccination (Time period 3); among them, 311 patients underwent surgery in the first six months of the pandemic (Time period 2). These patients were compared with 1368 ones in the control group who completed their 6 months follow-up before the pandemic. The study compared the BMI reduction, excess weight loss (EWL), and total weight loss (TWL) outcomes between these groups using Generalized Estimating Equations (GEE) with gamma distribution to adjust for factors that were unevenly distributed across the groups. RESULTS: The age of participants in time periods 2 and 3 had a mean (standard deviation) of 38.97 (10.99) and 38.84 (10.71), respectively. In all groups, the majority of patients were females, accounting for 76.02%, 71.06%, and 75.74% for the control group and time periods 2 and 3, respectively. There was no significant difference between the groups in terms of weight reduction, as measured by BMI reduction, EWL, and TWL (related P values: 0.283, 0.465 and 0.169). Regression analysis indicated that higher baseline BMI values were associated with greater BMI reduction (0.04, 95% CI: 0.03-0.05), but this did not translate to higher EWL or TWL. Males showed greater BMI reduction (0.33, 95% CI: 0.18-0.49) and EWL (1.58, 95% CI: 0.79-2.37) than females, while females achieved higher TWL compared to males. Among different types of surgery, the OAGB resulted in more weight reduction among patients in the study. CONCLUSION: In conclusion, our study reveals that bariatric surgery remains effective for weight reduction during the first 6 months of the pandemic in Iran. Implementation of pandemic protocols ensures comparable efficacy to non-pandemic times. However, caution is needed in generalizing results beyond our specific context due to study limitations. Further research is essential to comprehensively assess the pandemic's broader impact on bariatric surgery outcomes under varying conditions.

Efficacy of high-intensity laser therapy in comparison with conventional physiotherapy and exercise therapy on pain and function of patients with knee osteoarthritis: a randomized controlled trial with 12-week follow up.

Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders causing pain and functional impairment. The purpose of the study is to compare the effects of high-intensity laser therapy (HILT), conventional physical therapy (CPT), and exercise therapy (ET) on pain and function in patients with KOA. The study was designed as an assessor-blind randomized controlled trial. Ninety-three patients (aged between 50 and 75 years) with proved KOA were included and randomly allocated into three groups, and received 12 sessions of HILT, CPT, or ET. The outcomes were pain intensity measured by visual analog scale (VAS), knee flexion range of motion (FROM), timed up and go test (TUG), 6-min walk test (6MWT), and functionality of knee measured by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire. Statistical analyses were done to compare the amounts at the baseline, immediately after treatment and after 12 weeks. HILT was significantly more effective than the other groups in decreasing the VAS, increasing FROM and improving the scores of WOMAC (total and function subscale) both after treatment and after 12 weeks. The effect of HILT and CPT on the TUG, 6MWT, and WOMAC pain subscale was not significantly different after treatment, and both were better than ET. HILT was significantly better than the others after follow-up, particularly more effective on the stiffness subscale of WOMAC. HILT combined with exercise therapy, as a useful therapeutic approach, could have positive influences on KOA patients.

Downhill walking influence on physical condition and quality of life in patients with COPD: A randomized controlled trial.

Background: Chronic Obstructive Pulmonary Disease (COPD), in addition to its respiratory problems, is accompanied by several musculoskeletal consequences. The aim of this study is to investigate the effectiveness of eccentric exercise in the form of downhill walking (DW) on respiratory capacity, physical function and quality of life (QOL) in patients with COPD. Methods: The randomized controlled trial was carried out during 2014 - 2015 in Hazrat-e-Rasool Hospital in Tehran, Iran. The study design was as an assessor blind RCT on 32 patients with COPD that randomly assigned to the eccentric training (ET) and control (CON) groups. Patients in ET group received a 12-week DW exercise on the treadmill while the patients in the control group were only treated by COPD conventional medications and walked on paved surfaces. Functional tests, FEV1, FEV1 to FVC and St. George's Respiratory Questionnaire (SGRQ) were used to assess the subject's physical status and QOL pre and post-intervention. Results: The FEV1 (p=0.008), FEV1/FVC (p=0.002), six-minute walk test (p=0.029), timed up & go test (p=0.023), SGRQ symptom (p=0.022), SGRQ activity (p=0.007), SGRQ impact (p=0.033) and total score of SGRQ (p=0.013) improved significantly in the ET group compare to the CON group. Conclusion: DW could have positive influence on physical status and QOL of patients with COPD.

Is ultrasound-measured abdominal fat thickness a reliable method for predicting metabolic diseases in obese and overweight women?

Background: Central fat deposition seems to be a risk factor for developing metabolic and cardiovascular diseases in overweight and obese individuals. Ultrasound is an accurate and non-invasive tool for measuring abdominal fat thickness and can precisely separate subcutaneous from visceral fat. This study was conducted to apply ultrasonography as a simple and reliable method to measure subcutaneous and visceral abdominal fat thickness and evaluate the relationship between this measured abdominal fat thickness and metabolic risk factors. Methods: A total of 80 overweight and obese women were included in this study. Anthropometric indices and abdominal fat thickness were measured using ultrasound. The association between abdominal fat thickness and metabolic risk factors with anthropometric indices was assessed using correlation coefficient. Results: The mean (± SD) of subcutaneous and visceral fat thickness was 2.71±0.92 and 5.46±1.88, respectively. There was a relationship between waist circumference and visceral and subcutaneous fat thickness. Also, there was a relationship between ultrasound- measured visceral fat thickness and fasting blood glucose and triglyceride. Conclusion: Ultrasonography is a simple and reliable method to measure abdominal fat thickness as an important predictor of metabolic diseases.

Comparing minimally supervised home-based and closely supervised gym-based exercise programs in weight reduction and insulin resistance after bariatric surgery: A randomized clinical trial.

Background: Effectiveness of various exercise protocols in weight reduction after bariatric surgery has not been sufficiently explored in the literature. Thus, in the present study, we aimed at comparing the effect of minimally supervised home-based and closely supervised gym-based exercise programs on weight reduction and insulin resistance after bariatric surgery. Methods: Females undergoing gastric bypass surgery were invited to participate in an exercise program and were randomly allocated into 2 groups using a random number generator in Excel. They were either offered a minimally supervised home-based (MSHB) or closely supervised gym-based (CSGB) exercise program. The CSGB protocol constitutes 2 weekly training sessions under ACSM guidelines. In the MSHB protocol, the participants received a notebook containing a list of recommended aerobic and resistance exercises, a log to record their activity, and a schedule of follow-up phone calls and clinic visits. Both groups received a pedometer. We measured their weight, BMI, lipid profile, FBS, and insulin level at baseline and at 20 weeks after the exercises, the results of which were compared using t test or Mann-Whitney U test at the end of the study. All the processes were observed by 1 senior resident in sport medicine. Results: A total of 80 patients were recruited who were all able to complete our study (MSHB= 38 and CSGB= 42). The baseline comparison revealed that the 2 groups were similar. The mean change (reduction) in BMI was slightly better in CSGB (8.61 95% CI 7.76-9.45) compared with the MSHB (5.18 95% CI 3.91-6.46); p< 0.01. However, the 2 groups did not have a statistically significant difference in the amount of change in the other factors including FBS and Homa.ir. Conclusion: As we expected a non-inferiority result, our results showed that both MSHB and CSGB exercise methods are somewhat equally effective in improving lipid profile and insulin resistance in the 2 groups, but a slightly better effect on BMI was observed in CSGB group. With considerably lower costs of minimally supervised home- based exercise programs, both methods should be considered when there is lack of adequate funding.

Treatment of knee osteoarthritis with platelet-rich plasma in comparison with transcutaneous electrical nerve stimulation plus exercise: a randomized clinical trial.

BACKGROUND: Osteoarthritis is a disabling musculoskeletal disease with no definite treatment. This study compared the effect of Platelet-rich plasma (PRP) and Transcutaneous Electrical Nerve Stimulation (TENS) plus exercise in the treatment of patients with knee joint osteoarthritis. METHODS: 54 eligible patients with knee osteoarthritis were randomly allocated into two groups. (IRCT2012110611382N) Group A (27 patients) received 2 injections of PRP (4 weeks apart) and group B (27 patients) received 10 sessions of TENS as well as exercise during the study period. Clinical outcome was evaluated using the Knee injury and Osteoarthritis Outcome Scores (KOOS) questionnaire before the treatment, 4 weeks, and 8 weeks after that the treatment. Pain was also assessed using a visual analog scale (VAS). Time to an intolerable knee pain during treadmill workout was also evaluated using an objective test. RESULTS: In the PRP group, the mean KOOS symptom score improved significantly from baseline to the end of study, while the change was not significant over this period for the group B. In both groups, significant reductions were observed in VAS scores from baseline till the end of study. The mean time to feel intolerable knee pain during treadmill work out of PRP group increased significantly from baseline to week 4, but no significant changes were found in this parameter over the time of study in the group B. CONCLUSION: Intraarticular injection of PRP is an effective, safe method for short-term treatment of patients with knee joint osteoarthritis.

Safety and Efficacy of One Anastomosis Gastric Bypass in Children and Adolescents: a 5-Year Cohort Study.

BACKGROUND: Childhood obesity is an important worldwide issue of serious medical and social concern. One anastomosis gastric bypass (OAGB) is an approved, effective, and long-lasting procedure for weight loss and the remission of obesity-associated medical problems in the adult patients, but its efficacy and safety in children and adolescents are still on debate. This study aimed to evaluate safety and efficacy of OAGB compare to SG and RYGB during a 5-year follow-up. METHODS: A retrospective cohort study on children and adolescents with severe obesity who underwent primary OAGB, sleeve gastrectomy (SG), and Roux-e-Y gastric bypass (RYGB) at an academic hospital, between March 2016 and December 2020. RESULTS: Two hundred twenty-eight patients with 24 to 60 months of follow-up including 107 SG, 37 RYGB, and 84 OAGB were included in the final analysis. The mean age, preoperative weight, and BMI were 15.71 ± 2.09 years (range, 9-18 years), 126.3 ± 22.0 kg (74.5-215 kg), and 45.1 ± 6.9 kg/ m2 (36.4-79.3 kg/m2), respectively. The mean of follow-up was 30.05 ± 19.98 months. The mean of ∆BMI was 30.2 ± 5.1, 30.0 ± 5.4, and 31.1 ± 6.8 at 12th, 36th, and 60th months postoperative. At the 60-month follow-up, there were statistically significant differences in ΔBMI between SG and OAGB and SG and RYGB. CONCLUSION: OAGB is a safe and effective procedure for the treatment of obesity in children and adolescents in 24 to 60 months follow-ups.

The Prevalence of Genu Varum and Genu Valgum in Overweight and Obese Patients: Assessing the Relationship between Body Mass Index and Knee Angular Deformities.

BACKGROUND: Recent studies have shown evidence of a relationship between overweight and obesity with skeletal abnormalities, especially angular knee disorders. AIM OF THE STUDY: To reveal causal relationship between obesity and skeletal abnormalities. METHODS: This study was performed on 280 overweight or obese patients (with BMI > 25kg/m2) who referred to Rasoul Akram hospital in Tehran between 2017 and 2018. Several non-radiographic methods including measuring Q angle, inter-malleoli distance and distance between two knees were used to determine genu varum and genu valgum.  BMI was also calculated by dividing the weight by the square of the height. RESULTS: The prevalence of genu varumand genu valgum was 8.6% and 10.0% respectively. There was a significant adverse correlation between the Q angle and BMI. The mean BMI in patients with and without genu varum was 39.07 ± 6.41 kg/m2 and 42.1 ± 2.26 kg/m2, respectively, which was significantly lower in the genuvarum group (P = 0.008). Also, the mean BMI in patients with and without genu valgum was 43.39 ± 3.33 kg/m2 and 41.58 ± 4.61  kg/m2, respectively, which was significantly higher in the genuvalgum group (P = 0.044). Also, there was a direct correlation between BMI of patients with inter-malleoli distance and inverse correlation between BMI and two knees distance. CONCLUSION: There is a strong and significant relationship between incidence of obesity and genu valgum; therefore, the prevalence of this deformity in obese individuals is predictable. Also, the lower incidence of genu varum in obese people is predictable in our society.

The effect of adding homeopathic treatment to rehabilitation on muscle tone of children with spastic cerebral palsy.

OBJECTIVE: To determine the effect of adding homeopathic treatment to routine rehabilitation techniques on muscle tone of children with spastic cerebral palsy (CP). METHODS: This study was a double-blind clinical trial. Twenty-four subjects were recruited from a developmental disorders clinic in Tehran in 2004. Subjects were divided into case and control groups. The routine rehabilitation techniques were carried out for 4 months on both the groups. The control group received placebo and the case group received homeopathy drugs. Both groups were evaluated and compared for muscle tone before and 4 months after treatment using the Modified Ashworth Scale. RESULTS: Showed no positive changes in the patients with homeopathy and occupational therapy at the end of treatment, and there were no statistically significant differences in tonicity of upper and lower limbs, trunk and neck in the case group in comparison with the control group. CONCLUSION: Adding homeopathy to rehabilitation had no significant effect on spasm of CP children as measured by Ashworth test.

Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Controlled Trial.

BACKGROUND: Subacromial impingement syndrome (SAIS) is the most common disorder of the shoulder. The evidence for the effectiveness of treatment options is inconclusive and limited. Therefore, there is a need for more evidence in this regard, particularly for long-term outcomes. HYPOTHESIS: Platelet-rich plasma (PRP) would be an effective method in treating subacromial impingement. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: This was a single-blinded randomized clinical trial with 1-, 3-, and 6-month follow-up. Sixty-two patients were randomly placed into 2 groups, receiving either PRP or exercise therapy. The outcome parameters were pain, shoulder range of motion (ROM), muscle force, functionality, and magnetic resonance imaging findings. RESULTS: Both treatment options significantly reduced pain and increased shoulder ROM compared with baseline measurements. Both treatments also significantly improved functionality. However, the treatment choices were not significantly effective in improving muscle force. Trend analysis revealed that in the first and third months, exercise therapy was superior to PRP in pain, shoulder flexion and abduction, and functionality. However, in the sixth month, only shoulder abduction and total Western Ontario Rotator Cuff score were significantly different between the 2 groups. CONCLUSION: Both PRP injection and exercise therapy were effective in reducing pain and disability in patients with SAIS, with exercise therapy proving more effective.

Configuring a Better Estimation of Kidney Size in Obese Children and Adolescents.

BACKGROUND: Obesity ignites numerous health and psychosocial problems and is associated with various comorbidities. Body mass index (BMI) is also independently associated with improved risk for numerous kidney disorders. As renal length is considered a vital parameter in the clinical assessment of renal patients, normal renal length has to be defined in accordance to BMI. OBJECTIVES: The aim of this study was to define normal kidney length in obese children, comparing ultrasound measurements of the kidney length in obese and non-obese children and adolescents, in order to reduce unnecessary evaluations for nephromegaly. PATIENTS AND METHODS: Fifty obese children and adolescents and 50 non-obese children and adolescents, aged 1-19 years, were selected from patients of pediatric clinics in two hospitals (Rasoul-e-Akram and Shahid Fahmideh) in Tehran between June 2010 and 2012. After the nephrologist's and endocrinologist's approval, the largest longitudinal renal dimension was measured in deep inspiration position by abdomino-pelvic ultrasonography in both groups. RESULTS: It was revealed that both kidneys in obese group were significantly larger than in control group (P = 0.044 and 0.040, respectively). Obesity status, height and age were proven to be significant and independent predictors of length of both kidneys. In both groups length of left kidney was significantly larger than that of right kidney (P < 0.001). CONCLUSIONS: A specific standard cut-point limit or norm gram has to be formulated for obese children and adolescents in order to facilitate the diagnosis of kidney diseases, including organomegaly, in these patients.

Does Downhill Walking on Treadmill Improve Physical Status and Quality of Life of A Patient With COPD?

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is accompanied by several extra-pulmonary consequences, such as skeletal muscle weakness and atrophy which will have a negative impact on daily life in patients and lead to their debilitation; therefore, when treating COPD patients, protocols should be taken into account to improve function and quality of life (QoL). CASE PRESENTATION: The case was a 71- year-old woman suffering from chronic bronchitis and bronchiectasis for 30 years that has been faced with increased musculoskeletal disorders in recent months. The case was managed by downhill treadmill walking for four months with the aim of improving her functional ability and QoL. Functional tests, thigh girth measurement and St. george's respiratory questionnaire (SGRQ) were used to assess the physical status and QoL of the patient. The outcomes measures confirmed the improvement of the studied case. The improvements continued three months after the beginning of the treatment. CONCLUSIONS: The eccentric exercise therapy in the form of downhill walking had positive effects on functions and QoL of studied case, especially had an augmenting effect on the thigh muscles size.

Injuries in iran futsal national teams: a comparative study of incidence and characteristics.

BACKGROUND: Futsal is a growing sport with lots of fans in many countries including Iran, but there are few papers in the literature which report injuries in top level futsal. OBJECTIVES: The aim of this study is to record and analyze the incidence and characteristics of injuries in Iran futsal national teams from March 2011 to September 2012. PATIENTS AND METHODS: 55 Iranian national futsal players participated in this prospective cohort study. Before entering the study, all players took part in Pre-Competition Medical Assessment (PCMA) in accordance with FIFA protocol. Team physicians recorded the injuries throughout the match and trainings in a special form which was designed for this purpose. Finally, data analysis was done with the SPSS software. RESULTS: The total exposure time for all players was 24326 hours (21138 hours during training and 3188 hours during matches). During the study period, 32 of the 55 national players (58.2%) incurred 54 injuries (incidence rate = 2.22 injuries per 1000 players-hours). The incidence rate of injury in female players was significantly higher than male players (P = 0.001). The majority of injuries (85.2%) were located on the lower extremities. The ankle was the most frequent injury location (40.7%) and sprain was the most frequent type of injury. CONCLUSIONS: Injuries are common among futsal players and female players are more prone to injuries than male players. The ankle is the most frequent site and sprain is the most frequent type of injury among futsal players.