Dysphagia Management in Iran: Knowledge, Attitude and Practice of Healthcare Providers.

Despite the remarkable burden of dysphagia, appropriate multidisciplinary management is lacking in Iran and patients are often deprived of effective treatments. Obtaining a full understanding of knowledge, attitude and practice (KAP) of healthcare providers is necessary to determine the gaps in improvement of the quality of care for dysphagic patients. A questionnaire was designed covering demographic information and the parameters of KAP. Face and content validity were determined. Test-retest reliability confirmed that the questionnaire scores are stable over time (r = 0.77, p value < 0.01). Participants were healthcare providers employed in university-affiliated hospitals in three major cities of Iran; Tehran, Shiraz and Mashhad. In total, 312 healthcare professionals completed our survey. The majority (96.8%) were familiar with the term "dysphagia or swallowing disorders". Most of the participants believed their profession (88.5%), as well as other disciplines (92.3%) can play an important role in the management of dysphagia; and this problem should be recognized in a multidisciplinary manner (96.2%). Also, 60.9% had encountered a patient with dysphagia. 52.2% had used at least one assessment method, while 49.9% had applied at least one treatment method. However, very few participants were familiar with a standard test for screening and assessment of dysphagia (11.9%). 74.7% were willing to participate in a workshop on dysphagia. As the main pitfalls of care lie in diagnosis and treatment expertise, the policy of hospitals should prioritize educating and updating the skills of healthcare professionals, encourage multidisciplinary teamwork, establishing clear guidelines and facilitate access to advanced tools.

Effects of titanium nanoparticles on the photosynthesis, respiration, and physiological parameters in Dunaliella salina and Dunaliella tertiolecta.

The development of nanotechnology and the upsurge of interest in titanium dioxide (TiO2) nanoparticles, especially the anatase and rutile crystalline phases, in consumer products such as paint and sunscreen, has polluted the aquatic environment and had adverse effects on living organisms, especially algae. Microalgae help to preserve the aquatic ecosystem. Accordingly, the present study investigated the effects of anatase and rutile TiO2 nanoparticles on the growth, photosynthetic pigment (chlorophyll), photosynthesis, and respiration rate of two algae species, Dunaliella salina (at NaCl concentrations of 1.5 and 0.5 M) and Dunaliella tertiolecta (at NaCl concentrations of 0.5 and 0.17 M). Treatment with 50, 100, 150, and 200 ppm of TiO2 and nano-TiO2 revealed that nano-TiO2 inhibited the growth and decreased the specific growth rate, chlorophyll, and photosynthesis of both algal species. The rate of decrease was significantly lower at higher concentrations of NaCl in both species; however, the greatest significant difference was observed at lower concentrations of NaCl in the anatase phase. The respiration rate increased for 2 weeks but, especially at lower concentrations of NaCl, the rate of increase declined at higher concentrations after exposure to both substances, especially in the anatase phase. The findings reveal that nano-TiO2 has a toxic effect on Dunaliella algae and its effect depends on the concentration of NaCl. The toxic effect was shown to decrease at higher concentrations of NaCl.

A Randomized Control Trial of Comparing Ultrasound-Guided Ozone (O2-O3) vs Corticosteroid Injection in Patients With Shoulder Impingement.

INTRODUCTION: Ozone has been recently used as a safe alternative treatment in musculoskeletal disorders with fewer adverse effects than corticosteroids. The aim of this study was to compare the efficacy of a single injection of ozone with that of a corticosteroid in the treatment of shoulder impingement. DESIGN: Thirty patients with shoulder pain and clinical signs and symptoms of impingement were randomly assigned into two groups: ultrasound-guided injection with ozone or corticosteroid. Patients' symptoms were evaluated by visual analog scale, constant score, shoulder pain and disability scale, shoulder range of motion, and ultrasonographic measures before treatment, 2 wks, and 2 mos after injections. RESULTS: Patients' visual analog scale, shoulder pain and disability scale and constant score improved significantly in both groups (P < 0.001), but the benefits were in favor of corticosteroid group (P < 0.001). At intervals between the two follow-ups, an improvement was observed in the visual analog scale score among patients receiving ozone, whereas during the same interval, patients' pain slightly worsened in the corticosteroid group. The range of motion and ultrasonographic measures did not show statistical differences between the two groups. CONCLUSIONS: Corticosteroid injection improves the pain and disability scores more significantly than a one-time ozone injection. Ozone may serve as an alternative modality in treating shoulder impingement when the use of steroids is contraindicated.

Postural Balance Performance of Children with ADHD, with and without Medication: A Quantitative Approach.

tAtention Deficit Hyperactivity Disorder (ADHD) significantly impairs the performance of students during their early school years. However, the extent of the difference in postural stability between children with ADHD and Typically Developed (TD) children, are still not fully understood. Also, it is clinically important to investigate possible effects of medication on their performances. We recruited 38 children between the ages 6 to 12 with ADHD (15 medically naïve, 23 with current treatment history) and 25 age-matched as TD. Postural stability performance was assessed in four conditions: 1-eyes open, 2-eyes closed, 3-eyes open on foam and 4-eyes closed on foam. A cost-effective mobile force platform was used to evaluate postural performance quantitatively. Results revealed a lower stability performance in the medically-naïve participants especially in trials with eyes open on foam. No significant difference in performance was seen between children with medical treatment history and the TD group. Results suggest that using medication can effectively enhance postural stability for children with ADHD. We found portable balance assessment tools helpful in identifying changes in motor performances among children with ADHD. Our results indicate that further research is needed to understand the exact implications of ADHD on postural stability under different sensory stimuli.

Vasculitic Mononeuritis Multiplex May Be Misdiagnosed as Carpal Tunnel Syndrome.

Vasculitis is a group of disorders characterized by inflammation and destruction of blood vessels, resulting in ischemic injury to the involved tissue. Sometimes, peripheral neuropathy is one of the first symptoms of systemic vasculitis. Although the classic form of peripheral nervous system vasculitis is mononeuritis multiplex, it can also present as a mononeuritis. In this case report, the patient presented with progressive rapid onset numbness in her right hand for 2 months. She underwent carpal tunnel decompression surgery with initial diagnosis of acute carpal tunnel syndrome but failed to respond to the surgery, and two month later, she presented with foot drop. The final diagnosis was vasculitic mononeuritis multiplex. The present case report demonstrates the importance of identification of median mononeuritis as one of the first presentations of vasculitic disorders and distinction from acute carpal tunnel syndrome. The natural history of many of the systemic vasculitides is rapidly progressive, and they are likely to be fatal without early treatment. In this regard, timely diagnosis of vasculitis is critical because of the vital role of early immunosuppressive therapy in preventing multiorgan damage and decreasing mortality rate.

The Effectiveness of Radial Extracorporeal Shock Waves for Treatment of Carpal Tunnel Syndrome: A Randomized Clinical Trial.

This study examined the effectiveness of radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome (CTS). Forty patients with mild to moderate CTS were allocated to two groups: (i) shock wave + wrist splint and (ii) wrist splint. Patients used wrist splints followed by three sessions of low-energy shock wave therapy in the intervention group and wrist splints alone in the other group. The QuickDASH Questionnaire, visual analogue scale and nerve conduction studies were used to evaluate the patients before the study and at 3, 8 and 12 wk after the start of the treatment. At the end of the study, both groups saw the same clinical benefits. However, a significantly greater improvement in the median nerve distal sensory latency was noted in the shock wave group compared with the control group. We suggest that application of shock wave with alternative protocols may be effective in the treatment of CTS in future studies.