The prevalence of substance use among drivers with traffic injuries in Mazandaran Province, Northern Iran.

Background: Motor vehicle accidents (MVAs) are one of the main causes of mortality in developing countries. Although the association between alcohol and the risk of MVA has been known for a long time, only a few studies have been conducted on driving following substance consumption in a short period of time. This is while narcotic and stimulant use seems to be a threat to traffic safety and a serious health concern for substance users. In this study, we investigated the prevalence of substance use (narcotics and stimulants) in drivers with traffic injuries admitted to the orthopedic ward of Imam Khomeini Hospital between October 2020 and June 2021. Methods: The current research is a cross-sectional, descriptive-analytical study. The statistical population consisted of 77 patients admitted to the orthopedic ward of a training hospital (Imam Khomeini) in Mazandaran Province, northern Iran. The Shapiro-Wilk test was used to determine the quantitative variables. The sampling method is random and consecutive. The method of data collection was through questionnaire tools. The software used was SPSS 26 with an independent t-test, Mann-Whitney U test, Chi-square or Fisher's exact test. Results: In this study, the frequency of substance use was 18.18%. The prevalence of opioid usage was 35.7% and for stimulants it was 64.28%. There was no case of concomitant use of opioids and stimulants. In the opioid group, 60% of patients used opium, 20% methadone, and 20% tramadol. In the stimulant and alcohol groups, 12.12% utilized methamphetamine and 88.88% drank alcohol. The average age of consumers was 39 years, which was significantly higher in the opioid group (P = 0.040). The education level of substance users was remarkably lower (P < 0.05) and, occupationally, there was no statistically significant difference between groups of substance users (P = 0.290). Considerably, the unemployed population consumed more substances (P = 0.001). Multiple fractures (P < 0.05) and surgical treatment (P = 0.012) were more common in the user group. Conclusion: Users of stimulants and alcohol were younger than opioid users, according to our results. There is an association between drug use and the incidence of traffic accidents, as well as lower educational levels, masculinity, fracture type, and patient complication type.

Effectiveness of Pistacia atlantica on older adult knee osteoarthritis, a randomized triple blind clinical trial.

Osteoarthritis is the most common cause of disability and aging is the major risk factor. One of the low-risk herbal medicines for reducing pain and inflammation in persian medicine is Pistacia atlantica gum. A triple-blind placebo-controlled clinical trial was performed in order to evaluate the efficacy of P. atlantica gum ointment on knee osteoarthritis in elderly people. A total of 60 patients were randomly allocated to two groups. The intervention group used 4% P. atlantica ointment and the control group used placebo, topically applied three times a day, for 8 weeks. The patients were evaluated before and after the intervention using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. There were significant differences (p < .001) between two the groups in terms of joint stiffness and pain as well as function. Within groups, regarding the effect size (EF) in joint stiffness was 2.82 and 0.74 in the Pistacia and placebo groups, respectively. Regarding pain, the effect size of the intervention and placebo groups were 3.90 and 0.99, respectively. In addition, regarding function, the effect size of the intervention and the placebo groups were 4.33 and 1.17, respectively. Therefore, it seems that topical P. atlantica is significantly better than the placebo in the old patients with knee osteoarthritis.

A Monte Carlo study for optimizing the detector of SPECT imaging using a XCAT human phantom.

BACKGROUND: Acquiring a high quality image has assigned an important concern for obtaining accurate diagnosis in nuclear medicine. Detector is a critical component of Single Photon Emission Computed Tomography (SPECT) imaging system for giving accurate information from exact pattern of radionuclide distribution in the target organ. The images are strongly affected by the attenuation, scattering, and response of the detector. The conventional detector is mainly made from sodium iodide activated by thallium [NaI(Tl)] in nuclear medicine imaging. THE AIM OF THE STUDY: This study has planned to introduce a suitable for an optimized SPECT imaging. SIMIND Monte Carlo program was utilized for simulating a SPECT imaging system with a NaI(Tl) detector, and a low-energy high-resolution (LEHR) collimator. MATERIAL AND METHODS: The Planar and SPECT scans of a 99mTc point source and also an extended Cardiac-Torso (XCAT) computerized phantom with the experiment and simulated systems were prepared. After verification and validation of the simulated system, the similar scans of the phantoms were compared from the point of view of image quality for 7 scintillator crystals including: NaI(Tl), BGO, YAG:Ce, YAP:Ce, LuAG:Ce, LaBr3 and CZT. The parameters of energy and spatial resolution, and sensitivity of the systems were compared. Images were analyzed quantitatively by SSIM algorithm with Zhou Wang and Rouse/Hemami methods, and also qualitatively by two nuclear medicine specialists. RESULTS: Energy resolutions of the mentioned crystals obtained were: 9.864, 9.8545, 10.229, 10.221, 10.230, 10.131and10.223 percentage for 99mTc photopeak 140 Kev, respectively. Finally, SSIM indexes for the related phantom images were calculated to 0.794, 0.738, 0.735, 0.607, 0.760 and 0.811 compared to the NaI(Tl) acquired images, respectively. Medical diagnosis of the SPECT images of the phantom showed that the system with BGO crystal potentially provides a better detectability for hot and cold lesions in the liver of XCAT phantom. CONCLUSIONS: The results showed that BGO crystal has a high sensitivity and resolution, and also provides a better lesion detectability from the point of view of image quality on XCAT phantom.

Knee Laxity Variations in the Menstrual Cycle in Female Athletes Referred to the Orthopedic Clinic.

BACKGROUND: Anterior cruciate ligament (ACL) rupture is the biggest concern for orthopedic surgeons who are involved in sports injuries, so most of ACL reconstruction surgeries are sports related. ACL injuries in female athletes are 2 - 8 times more common than male athletes in similar sport injuries. OBJECTIVES: The aim of this study was to compare knee laxity changes in the menstrual cycle in female athletes referred to the orthopedic clinic of Imam Khomeini hospital in the north of Iran, Sari, 2013. PATIENTS AND METHODS: The present descriptive study was conducted on 40 female athletes that were referred to the orthopedic clinic. Hormone levels, such as estrogen and progesterone were assessed by one laboratory in 3 phases of the menstrual cycle. We used Lachman test and anterior drawer test for knee laxity rate. The descriptive statistics were calculated as indices of central distribution of bonds (x ± SD) and relative frequency distribution was used for qualitative variables. RESULTS: The results of the current study showed that there is no significant difference in ACL laxity in female athletes in three phases of menstrual cycle; namely menstruation time, ovulation time and mid-luteal phase. CONCLUSIONS: Despite numerous studies and research in the field of knee laxity and effects of female hormones, many researchers do not agree about the effect of female hormones on knee laxity. The current study also reported no relationship between female hormones and knee laxity, while statistics show fundamental difference between male and female athletes.

Success Rate and Complications of Comminuted Intra-Articular Distal Radius Fracture Treatment via Closed Reduction and Use of a Mini-External Fixator.

BACKGROUND: Intra-articular fracture of the distal radius is extremely common; however, the management of this fracture is controversial. OBJECTIVES: With regard to the importance of intra-articular fracture of the distal radius and the best treatment method for the fracture, we sought to assess the success rate following the treatment of comminuted intra-articular fractures of the distal radius via closed reduction and use of a mini-external fixator. PATIENTS AND METHODS: This longitudinal retrospective study was undertaken at our department of orthopedics via assessment of radiographs and patient files of those referred from 2006 to 2013. Radiographic criteria included the degree of angulation and shortening of the radius. Data were analyzed using SPSS 18 software and were presented as mean ± standard deviation (SD). The significance level was set at P ≤ 0.05. RESULTS: Overall, ≥ 2 mm shortening of the radius was seen in 28% of the patients, 53% had 2 - 5 mm radial shortening and 19% of the patients had more than 5 mm shortening of the radius. Most of the participants had acceptable outcomes. The mean angulation was 6.28 ± 2.85 degrees and the mean shortening was 3.92 ± 2.22. Thirty-nine percent of the patients had an angulation of less than 5 mm, 56% and 5% had an angulation of 5 - 10 mm and more than 10 mm, respectively. CONCLUSIONS: The results of our study showed that the mini-external fixator is a good and effective treatment option for obtaining radial length, angulation and bony union in intra-articular fractures of the distal radius.

Comparison of surgical complications of intertrochanteric hip fractures between non-osteoporotic and osteoporotic patients.

OBJECTIVE: To determine the role of bone quality in post-treatment complications among patients of intertrochanteric fracture. METHODS: The cross-sectional descriptive study was done on 61 patients who presented with intertrochanteric hip fractures to two affiliated hospitals of Mazandaran University of Medical Science, Sari, Iran between February 2009 and December 2010. All the patients went through open reduction and internal fixation using 4-hole dynamic hip screw. The patients were followed up from 2 to 60 months. Data was analysed using SPSS 18. RESULTS: The final rate of malunion, nail protrusion and mortality was 8.3% (n=3), 5.6% (n=2) and 8.4% (n=3) respectively. There was no significant difference between osteoporatic (n=36; 59%) and non-osteoporatic (n=25; 41%) groups regarding the surgical complications of intertrochanteric hip fracture. CONCLUSION: The quality of bone made no significant difference among patients who were treated for intertrochanteric fracture.

Anterior shoulder dislocation and ipsilateral humeral shaft fracture.

Simultaneous dislocation of shoulder and humeral shaft fracture is a rare injury, and there is no clear protocol for its treatment. Herein we present a case of a 15-year-old boy, who suffered from a job-related accident and sustained fracture of humeral shaft associated with ipsilateral anterior shoulder dislocation and fracture of greater tuberosity 15 years ago. He received closed reduction of both injuries and coaptation plaster splint for four weeks, followed by Sarmiento splint at that time. Fifteen years after the injury, he has no problem related to the previous injury, and does not experience any episode of shoulder instability.

Kienbock's Disease in a Child.

Kienbock's disease, which is an idiopathic osteonecrosis and collapse of the lunate bone, is an uncommon disease in children. This report describes a case of an 11-year-old girl, who presented with avascular necrosis of lunate bone confirmed by radiographic and magnetic resonance imaging evidence. After a short period of casting, the case was fully recovered within one year. The signal change was confirmed by magnetic resonance imaging, and the deformity of lunate that was demonstrated by avascular necrosis. The patient wore a long arm cast for six weeks, and after one year radiographic pattern was normalized.

Surgical intervention for treatment of septic arthritis in infancy and childhood; a retrospective study.

Septic arthritis is a fearful condition because of its mortality and the potentially late sequels on immature skeleton including limb shortening, osteomyelitis, destruction of joint surface, severe limitation of motion, and dislocation.This study was performed to reveal the final outcome of our patients and find out the possible risk factors of poor result. The case records of 243 children who were admitted with the diagnosis of septic arthritis in Imam Khomeini and Bu Ali Sina Hospitals, Mazandaran Province, were studied between 1996 and 2005. The diagnosis was based on clinical and ultrasound findings in all patients and positive smear in 67% of them. Among these patients, we had access to 162 cases who had definitely septic arthritis and went through surgical interventions because of the involvement of the hip joint or uncertain response to medical treatments. As four out of six poor outcome cases were related to hip sepsis, hip was the main site of involvement and complications.Six cases of severe complications out of 162 showed the favorite result due to early diagnosis and intervention and highlighted the grave prognostic factors which were delayed diagnosis, infantile age and hip sepsis.

Low back pain in 1,100 Iranian pregnant women: prevalence and risk factors.

BACKGROUND: Low back pain (LBP) is a common and costly problem in pregnancy. It is one of the main reasons for disability, absence from work, and responsible for huge direct and indirect economical impact. PURPOSE: The purpose of this study was to determine the prevalence and risk factors of LBP during pregnancy. STUDY DESIGN: A cross-sectional study was carried out on Iranian pregnant women. PATIENT SAMPLE: Eleven hundred randomly selected pregnant women. OUTCOME MEASURES: A structured questionnaire including demographic, lifestyle, as well as prevalence and characteristics of LBP was used. Visual Analog Scale and Oswestry low back disability questionnaires were also used to assess the pain intensity and functional disability, respectively. METHODS: After ethical approval from Medical Ethics Board at the Mazandaran University of Medical Sciences and Health Services, a cross-sectional study was conducted on 1,100 pregnant women from 18 health centers in Sari district, at northern Iran. RESULTS: Point, last-month, last 6-month, last-year, and lifetime prevalence of LBP were 40.2%, 55.9%, 59.4%, 76.2%, and 84.1%, respectively. Prolonged standing and rest were found to be the most significant aggravating and relieving factors (76.3% and 87.7%, respectively). LBP was significantly correlated with history of previous LBP and LBP in previous pregnancy (p=.000 in both cases). CONCLUSION: The prevalence of LBP in pregnant women appears to be high and future research should focus on different preventive strategies during pregnancy.

Nonspecific low back pain in 5000 Iranian school-age children.

Low back pain (LBP) is common in adult population, and it is becoming a serious health concern in adolescents. The purpose of this study was to determine the prevalence of nonspecific LBP and associated risk factors in school-age children. After ethical approval, a cross-sectional study was conducted on 5000 randomly recruited secondary schoolchildren aged 11-14 years in the north of Iran. A structured questionnaire including questions concerning demographic, mechanical, and lifestyle data as well as the prevalence and characteristics of LBP was used. Of the original sample, 4813 (96.2%) children returned the questionnaire. Point, last month, last 6 months, and annual prevalence were 15%, 14.4%, 15.6%, and 17.4%, respectively. No association was found between school bag weight and prevalence of LBP (P=0.824). Low back pain was significantly correlated with age (P=0.000), position and time spent watching television (P=0.028 and P=0.002, respectively), position and duration of homework (P=0.021 and P=0.012, respectively). There was no association between LBP and body mass index (P=0.596) or between LBP and sex (P=0.412). The results indicated that the prevalence of LBP in schoolchildren is relatively high. Further studies focusing on the effect of different preventive strategies to reduce the impact of such a problem in schoolchildren is strongly recommended.

The effect of Benson Relaxation Technique on rheumatoid arthritis patients: extended report.

Rheumatoid arthritis (RA) is a chronic disease and has the highest rate of prevalence among rheumatic inflammatory diseases. The purpose of this study was to determine the effect of Benson Relaxation Technique (BRT) combined with medication on disease activity in patients with RA. Following ethical approval, 50 consecutive matched patients were selected and allocated into two groups, either an experimental or a control group. Patients in the experimental group received BRT combined with medication and patients in the control group were given only medication. Clinical symptoms, laboratory findings, anxiety, depression and feeling of well-being were measured before and after intervention to evaluate the effect of BRT. There was a significant difference between the two groups in anxiety, depression and feeling of well-being. Changes in clinical symptoms and laboratory findings were not large enough to be statistically significant between the two groups, but they indicated decline in disease progress. The results demonstrate that BRT can be an effective technique in reducing disease process in patients suffering from RA. However, in order to support the findings of this trial, studies with large sample size and > 8-week intervention are recommended.