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BACKGROUND: Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. MATERIALS AND METHODS: This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation. RESULTS: The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was no significant difference between two treatment groups (P = 0.82). CONCLUSION: Our results show that while nucleoplasty is as effective as open discectomy in the treatment of lumbar disc herniation, it is also less invasive with higher patient compliance. Taking factor such as decreased cost and duration of the surgery, as well as faster recovery in patients into account; we suggest considering nucleoplasty as an effective method of treatment in patients with single-level disc herniation.
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BACKGROUND: the aim of this study was to determine the relation between serum and filter paper thyroid-stimulating hormone (TSH) levels in neonates with congenital hypothyroidism (CH). We also tried to determine an appropriate cutoff point of filter TSH for recalling screened neonates. MATERIALS AND METHODS: in this descriptive-analytic study, records of 2283 neonates who had been recalled during CH screening program in Isfahan (Iran) were studied. The relation between serum and filter paper TSH levels in the studied neonates was assessed and the best cutoff point of filter TSH and its sensitivity and specificity for proper diagnosis of CH were determined. RESULTS: among the studied neonates, 103 (4.5%) were diagnosed with CH. Using receiver operating characteristic (ROC) curve, the best cutoff point for diagnosing CH was 7.5 with a sensitivity of 74.8% and specificity of 71.3%. The rates of false positive and false negative diagnoses at this cutoff point were28.7% and 25.2%, respectively. There was a significant relationship between serum and filter paper TSH levels. CONCLUSION: the cutoff point for recall should be changed to 7.5 for appropriate screening outcome. On the other hand, considering the low cost of filter paper and importance of missing any case of CH, changing the cutoff point is not necessary. However, further studies in different parts of Iran are required to obtain more accurate results and consider all related factors.
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BACKGROUND: Surgery is a stressful condition for both patient and family members. This anxiety may interfere with the adequate family functioning and in providing positive support for the patient. Thus, specialized assessment and interventions to reduce anxiety level of family members are essential. The aim of this study was to assess the effect of watching movie on anxiety level of family members during their relatives' surgery. MATERIALS AND METHODS: This was a before-after trial study conducted in Alzahra Medical Center, Isfahan, Iran. Between February 2010 and November 2010, 164 eligible family members in the surgical waiting room who met the inclusion criteria entered in the study. Before and after watching movie, the anxiety level was evaluated using the State-Trait Anxiety Inventory (STAI). Chi-squares, ANOVA and paired-t test were used for analysis using the Statistical Package for Social Sciences (SPSS, Version 14) for Microsoft Windows. RESULTS: The study population were 164 people, of whom 87 (53%) were female and 77 (47%) were male. The mean age of participants was 36.6 (SD: 8.4) years ranging from 18 to 67 years. After watching movie, the mean STAI score reached from 46.06 (SD: 9.26) to 39.15 (SD: 11.81) and this difference was statistically significant (p = 0.003). CONCLUSIONS: The results of this study indicated that watching movie could reduce family members' anxiety during surgery. The findings suggested that movie might be a simple and cost-effective tool to help family members to manage anxiety during surgery of their relatives.
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BACKGROUND: Early diagnosis of infection with the use of valuable markers leads to decreased mortality and morbidity. The aim of this study was to evaluate the value of procalcitonin (PCT) and C-reactive protein (CRP) for detecting nosocomial infection in hospitalized patients without localizing signs. METHODS: We conducted a prospective observational study on 150 hospitalized patients with fever > 38°C emerging 48-72 hours after their admission at Alzahra Hospital, Isfahan, Iran. The subjects did not have any localizing sign of infection. PCT and CRP values were determined using rapid tests and were compared with results of blood culture as the standard test. The sensitivity, specificity, positive and negative predictive values (PV) and likelihood ratios (LRs) were calculated for both PCT and CRP. Receiver operating characteristic (ROC) curves were also used to evaluate the diagnostic value of the PCT and CRP for detecting nosocomial infections. Finally, the areas under the resulting curves were compared. RESULTS: PCT had a sensitivity of 57.1%, a specificity of 89.1%, a positive PV of 46.2%, and a negative PV of 92.7% while the corresponding percentages for CRP test were 76.2%, 48%, 19.3%, and 92.5%. PCT marker also had a higher positive LR and lower negative LR than did CRP marker. The observed areas under the ROC curves were 0.73 for CRP (95% CI, 0.63-0.82; p = 0.023) and 0.80 for PCT (95% CI, 0.68-0.91; p = 0.001). The optimal cut-off values (best diagnostic accuracy) were 39 mg/L for CRP and 7.5 ng/mL for PCT. CONCLUSIONS: Determination of PCT and CRP is a valuable tool for identifying nosocomial infections. PCT showed better specificity, negative and positive PV. However CRP showed significantly better sensitivity compared with PCT. Therefore, these tests should be considered as part of initial work-up for patients with unknown source of infection.