Relationship between coping/attachment styles and infertility-specific distress in Iranian infertile individuals: A cross-sectional study.

BACKGROUND: Infertility has been recognized as a stressful clinical condition, significantly affecting couples' emotional functioning. OBJECTIVE: To investigate the relationship between coping/attachment styles and infertility-specific distress (ISD) in infertile participants. MATERIALS AND METHODS: Atotal number of 240 infertile participants (120 women and 120 men) who attend the Outpatient Infertility Clinic in Sari, Iran between February and October 2017 were selected using the convenience sampling method. Data were collected using a questionnaire addressing sociodemographic variables. In addition, coping and attachment styles were evaluated via the Coping Strategies Questionnaire and the Revised Adult Attachment Scale by Collins and Read (1990); respectively. Ultimately, the Infertility Distress Scale was used to assess ISD. RESULTS: The mean ISD score was 42.53 ± 9.63. Secure and insecure attachment styles were observed in 37.9% and 62.1% of the cases, respectively. There was a significant difference among ISD and different groups of attachment styles (p = 0.001) and emotion-focused coping style (p = 0.021). However, no significant relationship was found between problem-focused coping style and ISD (p = 0.985). CONCLUSION: Considering the relationship between coping/attachment styles and ISD, it was recommended to implement stress prevention and coping education within the framework of coping/attachment theories for infertile individuals.

Peripheral Neuropathy in Multiple Sclerosis: An Electrophysiologic Study in Iranian Patients.

Multiple sclerosis (MS) is the most common cause of disability after trauma in young adults in Northern Hemisphere; it imposes a major burden on the affected young people. A significant association between MS and demyelinating peripheral neuropathy which might be due to common pathogenesis for the central and peripheral nerves demyelination has been reported in several studies. We aimed to assess if there is any peripheral nervous system involvement in a sample of Iranian MS population. Extensive nerve conduction studies (NCS) were conducted in 20 MS patients according to McDonald criteria, and 20 age and gender matched healthy appearing controls. The F-wave ratio was calculated through placing the minimum amount of F-wave proximal latency after 10 stimuli and median or tibial nerves compound motor action potential (CMAP) proximal latency in the corresponding formula. Data were compared between groups. Finally, we found the significantly lower median and tibial nerves conduction velocities (NCV) in MS patients than healthy controls (P=0.008 and 0.003 respectively, Independent Samples t-test). Also, tibial NCV had a significant statistical correlation with Kurtzke's expanded disability scale score (EDSS) as patients with higher EDSS had lower tibial NCV (Pearson's correlation coefficient, r2=0.8). No statistical relationship was found between MS subtypes and NCS parameters. Although we found some electrodiagnostic abnormalities in Iranian MS patients in comparison to the healthy participants, these differences were small and inconclusive. More extensive well-designed electrodiagnostic studies for evaluation of peripheral nervous system involvement and its probable pattern in these patients seems to be needed.

Correlation between Female Sex Hormones and Electrodiagnostic Parameters and Clinical Function in Post-menopausal Women with Idiopathic Carpal Tunnel Syndrome.

OBJECTIVES: To investigate the role of sex-hormonal changes in idiopathic carpal tunnel syndrome (CTS) among post-menopausal women through measuring estrogen receptor (ER) expression in their transverse carpal ligament (TCL) and serum estrogen level, as well as determine the correlation between these factors and electrodiagnostic parameters and Boston score. METHODS: Biopsy samples of TCL were collected from 12 postmenopausal women who had undergone surgery for severe idiopathic CTS; control specimens were collected from 10 postmenopausal women without CTS who had undergone surgery for the other hand pathologies. To determine the distributions of ER in TCL, histological and immunohistochemical examinations were performed. Serum estrogen level was also measured. Electrodiagnosis and Boston questionnaire were used for CTS severity and determination of the patients' function. RESULTS: ER expression in TCL and serum estrogen level were not significantly different in the case group compared to the control group (P = 0.79 and P = 0.88, respectively). Also, there was no correlation between ER expression or serum estrogen level and electrodiagnostic parameters or Boston score. CONCLUSIONS: Sex hormones cannot still be considered as the etiology of idiopathic CTS in postmenopausal women. The role of other factors such as wrist ratio and narrower outlet in females compared to the males should be considered along with hormonal changes.

Effect of Motor Imagery on the F-Wave Parameters in Hemiparetic Stroke Survivors.

OBJECTIVE: To assess the effect of motor imagery, as a rehabilitation method in stroke, on F-wave parameters that undergo changes during upper motor neuron involvement. METHODS: Twenty-one fully conscious hemiparetic stroke survivors with a completely plegic hand (power 0/5) and a minimum interval of 72 hours since stroke were recruited into this study. The mean F-wave latency, amplitude, and persistence in the median and ulnar nerves were measured in both the affected and non-affected sides at rest and in the paretic hand during a mental task. Comparison was made between data from the affected hand and the non-affected hand as well as between data from the affected hand at baseline and during motor imagery. RESULTS: Patients had significantly different F-wave persistence between the affected and non-affected sides (paired t-test, p<0.001). Motor imagery could improve F-wave persistence in both the investigated nerves (paired t-test, p=0.01 for ulnar nerve and p<0.001 for median nerve) and F-response amplitude in the median nerve (paired t-test, p=0.01) of the affected limb. CONCLUSION: The amplitude and persistence of F-wave were improved during motor imagery, representing F-wave facilitation. This result suggests that motor imagery can restore motor neuron excitability, which is depressed after stroke.

Sympathetic Skin Response and Vasomotor Symptoms in Postmenopausal Osteoporotic Women.

BACKGROUND: Osteoporosis is a common disease characterized by reduction in bone mass, due to depletion of calcium and bone protein. A pivotal role of the sympathetic nervous system in bone remodeling has been considered. On the other hand, elevated central sympathetic activation in postmenopausal women is involved in the creation of vasomotor symptoms. Also, sympathetic skin response (SSR) has been performed for evaluation of the peripheral and central autonomic nervous system dysfunctions. Therefore, to determine the association of the autonomic nervous system and osteoporosis, we evaluated the correlation between the bone mineral density (BMD) with the frequency of vasomotor symptoms and also sympathetic skin responses. METHODS: This is a cross-sectional study in which thirty-three postmenopausal osteoporosis women, as the case group, and 31 age-matched postmenopausal women with normal BMD, as the control group, were included in our study. To evaluate the autonomic function, we assessed the frequency of vasomotor symptoms with a questionnaire and performed SSR test for the two groups. According to the parametrical or the nonparametrical distribution of the data, Independent Samples t-test or Mann Whitney test, respectively, were used to compare group differences. RESULTS: The onset latencies of SSR recorded from both hands and feet were significantly prolonged in the case group compared with the control group (P<0.001). Amplitudes of SSR in the case group were significantly less than those of the control group (P<0.001). The postmenopausal osteoporotic women reported a significantly higher frequency of hot flashes and night sweats when compared with non-osteoporotic women (P<0.001). CONCLUSION: The higher frequency of vasomotor symptoms and impaired sympathetic skin responses in postmenopausal osteoporotic women suggests a role of autonomic dysfunction in osteoporosis.

The efficacy of intramuscular calcitonin injection in the management of lumbar spinal stenosis.

STUDY DESIGN: A prospective, cross-sectional, non-randomized study. PURPOSE: To assess the effectiveness of intramuscular calcitonin injection in the treatment of lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: LSS, manifesting as chronic low back pain and neurogenic claudication, is a chronic condition with an increasing incidence in the elderly population having inadequate effective conservative treatment options. METHODS: In this study, 36 patients with LSS who were diagnosed based on the clinical findings and magnetic resonance imaging were included. Patients received 100 IU of calcitonin per week for one month and were evaluated before and after treatment using the Oswestry disability index (ODI) questionnaire and visual analogue scale (VAS). Before treatment, the patients were divided into two subgroups based on their ODI results: patients with mild to moderate low back pain (disability, 0%-40%) and patients with severe or very severe low back pain (disability, 40%-100%). RESULTS: In patients with mild to moderate low back pain, there were no significant changes in the ODI and VAS after calcitonin injection. But in patients with severe or very severe low back pain, pain severity, personal functions, ability to lift and carry objects, time interval between standing and initiation of pain, social life, disability percentage, and VAS were significantly improved after treatment with calcitonin. CONCLUSIONS: It seems that an intramuscular injection of low dose of calcitonin may have some beneficial effects on the pain due to LSS, especially in patients who suffer from severe or very severe low back pain.

Correlation between Radiologic Sign of Lumbar Lordosis and Functional Status in Patients with Chronic Mechanical Low Back Pain.

STUDY DESIGN: A cross-sectional study. PURPOSE: To describe the correlation between lumbar lordosis angle and functional status of patients with chronic mechanical low back pain (CMLBP). OVERVIEW OF LITERATURE: There are different and conflicting opinions regarding the relationship between the degree of lumbar lordosis and functional status of patients with low back pain. Nonetheless, the severity of lordosis is still one of the routine physical exams considered in rehabilitation clinics. METHODS: The degree of lumbar lordosis of 150 patients with CMLBP was measured by means of Cobb's method using sagittal standing spinal radiographs. Subjects with probable secondary causes of low back pain (trauma, congenital anomaly, spinal infection, rheumatologic problems and history of spinal surgery) were excluded. Besides recording demographic data, their score of functional disability was estimated using Oswestry Disability Questionnaire, one of the most useful and reliable questionnaires. Comparison between these data was made regarding different age and gender groups. RESULTS: In this study, 119 subjects were female and 31 male, with an age range of 19-85 years. The average degree of lumbar lordosis was 44.69±11.43 and that of Oswestry disability index (ODI) 30.52%. Although we found a significant direct relationship between age and degree of lumbar lordosis (Pearson's correlation coefficient, p=0.016, r=0.197), while insignificant correlation was seen between the degree of lumbar lordosis and ODI (p=0.129). CONCLUSIONS: There was no significant correlation between the degree of lumbar lordosis and the score of functional disability with regards to different age groups and gender.

Sympathetic skin response in patients with vascular erectile dysfunction.

PURPOSE: We aimed to investigate the utility of sympathetic skin response (SSR) test for evaluating vasculogenic erectile dysfunction (ED) which is the most common type of impotence. MATERIALS AND METHODS: Men in the age group of 28 to 60 years and suffering from vasculogenic ED, as confirmed by a papaverin test and color Doppler sonography, at least for 6 months referred from our university urology department were included. We used the International Index of Erectile Function (IIEF-5) for grading severity of dysfunction and recorded the SSR of every patient from the median, tibial, and dorsal nerves of the penis. One-way analysis of variance (ANOVA), independent t-test and Pearson's correlation coefficient were used for comparing quantitative variables, and Fisher's Exact test was used for comparing qualitative variables. The Mann-Whitney U Test and the Kruskal-Wallis test were performed for analysis of data that were not normally distributed. A p value of less than 0.05 was considered significant. RESULTS: Forty-two patients were recruited for the study. We found a strong statistical relationship between the IIEF score and the pathologic SSR registered from every mentioned nerve. Patients with abnormal SSR had more severe ED according to IIEF score (p<0.001). In addition, the IIEF score had a significantcorrelation with diabetes mellitus and cardiovascular disease (t-test; p<0.05). CONCLUSIONS: Our results confirmed the presence of autonomic dysfunction in patients with vasculogenic impotence via an SSR test. We suggest evaluating the efficacy of the SSR test in patients with vascular impotence for treatment response monitoring in future studies.

Correlation between Degree of Radiologic Signs of Osteoarthritis and Functional Status in Patients with Chronic Mechanical Low Back Pain.

BACKGROUND: Osteoarthritis is the most intervening factors in producing mechanical low back pain (LBP). We aimed to evaluate the correlation between radiologic signs of osteoarthritis and functional status in patients with chronic mechanical LBP. METHODS: Severity of osteoarthritis and disability were evaluated with Kellgren and Lawrence Grading Scale (K&L) by simple lumbar X-ray and Oswestry Disability Questionnaire (ODQ) respectively. RESULTS: Although there was no significant correlation between ODQ and K&L score in general, the correlation was seen in female group (P = 0.024, r = 0.207). CONCLUSION: Mechanical LBP provides more disability in females suffering from more advanced osteoarthritis.

Comparison the effect of lateral wedge insole and acupuncture in medial compartment knee osteoarthritis: a randomized controlled trial.

BACKGROUND: There is lack of well-designed trials evaluating structural benefits of non-pharmacologic therapies in knee osteoarthritis (OA). In this parallel-group randomized controlled trial, we aim to compare the possible advantages of lateral wedge insole and acupuncture in patients with medial knee OA. METHOD: Patients with grade two or three of medial knee OA were randomly allocated to group one who received an in shoe lateral wedge and group two who underwent acupuncture. We assessed patients' pain, function and knee joint cartilage thickness before and after intervention. Paired t-test and independent samples t-test were used for in group and between group analyses. ( LEVEL OF EVIDENCE: 2.) RESULTS: Twenty patients in each group were recruited in the study. Pain significantly decreased after therapy in both groups one and two (paired t test, P<0.001, 95% CI: 1.62-3.25 and 1.58-3.20 respectively). Function improved in each group (paired t test, P=0.001, 95% CI of 0.94-2.38 in group one and 0.97-2.43 in group two). A non-clinically statistically significant difference regarding the femoral and tibial cartilage thickness was obtained in both groups one (P=0.005, CI: -0.43-0.82 and P=0.037, CI: -0.44-0.80 respectively) and two (P=0.025, CI: -0.45-0.79 and P=0.035, CI: -0.29-0.96 respectively). Between groups analysis showed no significant difference regarding abovementioned measures. CONCLUSION: Both lateral wedge insole and acupuncture can be effective in the treatment of medial knee osteoarthritis without any superiority of one over the other. Iranian Registry of Clinical Trials: IRCT201201108235N1. URL: http://irct.ir/searchen.php.

A study of interpolation method in diagnosis of carpal tunnel syndrome.

CONTEXT: The low correlation between the patients' signs and symptoms of carpal tunnel syndrome (CTS) and results of electrodiagnostic tests makes the diagnosis challenging in mild cases. Interpolation is a mathematical method for finding median nerve conduction velocity (NCV) exactly at carpal tunnel site. Therefore, it may be helpful in diagnosis of CTS in patients with equivocal test results. AIM: The aim of this study is to evaluate interpolation method as a CTS diagnostic test. SETTINGS AND DESIGN: Patients with two or more clinical symptoms and signs of CTS in a median nerve territory with 3.5 ms ≤ distal median sensory latency <4.6 ms from those who came to our electrodiagnostic clinics and also, age matched healthy control subjects were recruited in the study. MATERIALS AND METHODS: Median compound motor action potential and median sensory nerve action potential latencies were measured by a MEDLEC SYNERGY VIASIS electromyography and conduction velocities were calculated by both routine method and interpolation technique. STATISTICAL ANALYSIS USED: Chi-square and Student's t-test were used for comparing group differences. Cut-off points were calculated using receiver operating characteristic curve. RESULTS: A sensitivity of 88%, specificity of 67%, positive predictive value (PPV) and negative predictive value (NPV) of 70.8% and 84.7% were obtained for median motor NCV and a sensitivity of 98.3%, specificity of 91.7%, PPV and NPV of 91.9% and 98.2% were obtained for median sensory NCV with interpolation technique. CONCLUSIONS: Median motor interpolation method is a good technique, but it has less sensitivity and specificity than median sensory interpolation method.

Epidemiology of oral cavity cancers in a country located in the esophageal cancer belt: a case control study.

INTRODUCTION: As one of the most common cancers among head and neck malignancies, cancer of the oral cavity probably has some variations in countries with a high prevalence of esophageal cancer. MATERIALS AND METHODS: Patients with oral cavity cancer who were treated at two tertiary referral centers from January 1999 to January 2009 were included in this study. In addition to demographic data, information regarding personal and family history of head and neck cancer, use of dentures, presence of immune deficiency, consumption of alcohol, and incidence of cigarette smoking was collected. Additionally, a history of opium usage was obtained from the participants in this study. Moreover, an appropriately matched control group was selected for comparisons between the risk factors. RESULTS: A total of 557 patients were entered into this study over a 10-year period, of whom 219 (39.3%) were female and the remaining 338 (60.7%) were male. The tongue was the most common site of cancer and 9% of the patients had a history of opium abuse, but more than half of the patients did not have any recognized risk factors. The incidence and stage of cancer had a significant relationship with cigarette smoking (P= 0.013). CONCLUSION: Tongue cancer in non-smokers is the predominant pattern of oral cavity cancer in Iran.