Short-term Efficacy of Ultrasonographic Guidance for Intra-articular Corticosteroid Injection in Hallux Rigidus: A Single-Blind Randomized Controlled Trial.

BACKGROUND: Multiple considerations should be taken before standardizing a clinical procedure such as efficacy, safety, or the cost. The aim of this study was to compare the effects of landmark-guided vs ultrasonography-guided intra-articular injection of corticosteroid into the first metatarsophalangeal joint cavity to reduce pain and dysfunction in patients with hallux rigidus. METHODS: We carried out a single-blind randomized controlled trial with 2 parallel arms in an outpatient clinic affiliated with a medical university. In total, 50 participants (35 women) with the mean (SD) age of 49.8 (10.3) years were randomly allocated to landmark-guided or ultrasonography-guided groups (each n = 25). Each patient received a single intra-articular injection of 40-mg methylprednisolone plus 1 mL lidocaine into the affected first metatarsophalangeal joint. The primary outcome was joint pain and the secondary outcome was the American Orthopaedic Foot & Ankle Society score. We measured the outcomes at baseline and 2 and 6 weeks after the intervention. RESULTS: Six weeks after the injections, there were no statistically significant differences between the study groups in pain reduction and increase in the American Orthopaedic Foot & Ankle Society scores (P = .131 and .241, respectively). We did not find any complications for the injections in both groups. There were statistically significant changes within each group in pain and the scores for the landmark (P < .001, and P = .007), and ultrasonography groups (both P < .001). CONCLUSION: Landmark guidance is as effective as ultrasonographic guidance for intra-articular injection in patients with hallux rigidus. A single intra-articular injection of 40 mg methylprednisolone plus 1 mL lidocaine is an efficient and safe therapeutic measure for decreasing joint pain and maintaining its function, at least for 6 weeks. LEVEL OF EVIDENCE: Level I, high-quality prospective randomized study.

Factors affecting tea consumption pattern in an urban society in Isfahan, Iran.

OBJECTIVE: To determine the tea consumption pattern in an urban society in Isfahan. METHODS: A descriptive, cross-sectional survey was carried out using questioner among 664 households who were selected by two steps cluster sampling. A questionnaire was developed including demographic questions, information on the quantity of tea intake by every member of the family, tea type, and tea brand preference. RESULTS: The individuals who prioritized black tea as their 1(st) choice were 90.1% of the total surveyed community. The average amount of tea consumed was calculated as 1243 ± 530 ml/day. The individuals who were between 36 and 45 and <15 years old were shown as the highest and the lowest tea consumers, respectively. Men significantly consumed more amount of tea than women did and married participants significantly used more amount of tea than singles (P < 0.05). The number of the family members, though, had no impact on tea consumption (P > 0.05). Brand preference of tea showed that the individuals who prioritized Ahmed brand as their 1(st) choice constituted 44% of the total participants. CONCLUSION: Tea consumption pattern in an Iranian sample is specific. Despite of the huge evidence on the green tea benefits, this type of tea has very low popularity and among the available black tea brands, the imported ones are the most preferred.

Cisternostomy for Management of Intracranial Hypertension in Severe Traumatic Brain Injury; Case Report and Literature Review.

Main goal in the management of patients with severe traumatic brain injury (TBI) is control of intracranial pressure (ICP). Decompressive craniectomy is an accepted technique for control of refractory intracranial hypertension in patients with severe TBI. Because of high complication rate after decompressive craniectomy, new techniques such as basal cisternostomy have developed. We herein report a case of severe TBI in a 13-year-old boy treated by cisternostomy. The patient was admitted following a motor vehicle accident. Brain CT scan showed diffuse brain edema, left frontal contusion and posterior interhemispheric subdural hematoma. The patient underwent ICP monitoring. Subsequently, with 26 mmHg mean-value of ICP, he was treated surgically by cisternostomy technique. A progressive improvement of the neurological conditions in the following hours. After 5 days the boy was discharged and in the 3-months follow-up he was completely recovered. Cisternostomy could be an appropriate alternative to decompressive craniectomy for management of intracranial hypertension in patietns with sever TBI.

A Systematic Review on Exposure to Toxic and Essential Elements through Black Tea Consumption in Iran: Could It be a Major Risk for Human Health?

BACKGROUND: Tea is the most popular nonalcoholic beverage worldwide. In recent years, some Iranian studies have shown the occurrence of toxic elements in fresh or dried tea leaves as well as in brewed tea. The present study aimed to ascertain the health risks associated with exposure to toxic and essential element through black tea consumption in Iran by systematically reviewing the accredited articles in the field. METHODS: In order to obtain the relevant articles and academic databases, the search engines covering the specific disciplines were searched for the keywords, including tea, elements, heavy metals and determination. Having provided the complete list of sound articles, being conducted in Iran was considered as the inclusion criteria. Exclusion criteria were established as failure to provide information on the validity parameters and accuracy in the analytical methods. Choosing well conducted, reliable studies, analytical results for the concentration of each element in black tea were utilized in the determination of the hazard quotient (HQ) for the given element and the hazard index (HI) was then determined for all of the elements in each study. RESULTS: Among the total studies, two were considered to be reliable. Aluminum was found to be the most abundant element in black tea marketed in Iran. Although the HQ for manganese was the highest among the studied elements, HQ and HI values for both toxic elements and essential elements were calculated as less than 1. CONCLUSIONS: The hazard of excessive element intake through black tea consumption should be considered as negligible in Iran. However, related risk for manganese appeared to be more than toxic metals.