5504 Paseo Gilberto
Yorba Linda CA 92886
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Surgery for lumbar disc herniation: Analysis of 500 consecutive patients treated in an interdisciplinary spine centre. - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
Surgical removal of a symptomatic herniated lumbar disc is performed either with or without the support of a microscope. Up to the time of writing, the literature has reported similar clinical outcomes for the two procedures. Five hundred consecutive patients, operated upon for primary single-level lumbar disc herniation in our University Spine Center between 2003-2011, with (n=275), or without (n=225), the aid of a microscope were included. Data were retrospectively analyzed, comparing the primary endpoint of clinical outcome and the secondary endpoints of complications, surgical time and length of hospitalization. Clinical outcomes and reoperation rates were comparable in both groups. Surgical time was significantly shorter with a mean time of 47minutes without use of the microscope compared to the mean time of 87minutes (p<0.001) with the use of the microscope. Mean length of hospitalization was shorter in those operated with the microscope (5.3days) compared to those without (6.1days, p=0.004). There was no difference in rates of complications. Microdiscectomy versus open sequestrectomy and discectomy for surgical treatment of lumbar disc herniation is associated with similar clinical outcomes and reoperation rates. Open sequestrectomy is associated with shorter operation times. Microdiscectomy is associated with shorter hospitalization stays.Copyright Â© 2015 Elsevier Ltd. All rights reserved.
Peutz-Jeghers Syndrome With Diffuse Gastrointestinal Polyposis: Three Cases in a Family With Different Manifestations and No Evidence of Malignancy During 14 Years Follow Up. - Iranian Red Crescent medical journal
Peutz-Jeghers syndrome (PJS) is a rare disorder characterized by mucocutaneous perioral pigmentation, gastrointestinal hamartomatous polyposis, and an increased risk of malignancy. Families with PJS may show a variable spectrum of manifestations in spite of their consecutive generations. A probable explanation is novel mutations in contributing genes.This report describes 3 cases of a family. Two daughters presented the classic PJS, while their father only manifested mucocutaneous perioral pigmentation. The junior daughter was underwent 3 and the eldest daughter 2 laparotomies for intussusception. The patients were visited annually and their medical findings were recorded during a follow-up period of 14 years. They were periodically examined in our hospital and despite conveying diffuse polyposis from the esophagus throughout the rectum in these three cases, even a simple hyperplasia was not found in obtained specimens.The patients with diffuse PJS may be asymptomatic and without gastrointestinal or extragastrointestinal malignancies.
Occupational Health Services Integrated in Primary Health Care in Iran. - Annals of global health
A healthy workforce is vital for maintaining social and economic development on a global, national and local level. Around half of the world's people are economically active and spend at least one third of their time in their place of work while only 15% of workers have access to basic occupational health services. According to WHO report, since the early 1980s, health indicators in Iran have consistently improved, to the extent that it is comparable with those in developed countries. In this paper it was tried to briefly describe about Health care system and occupational Health Services as part of Primary Health care in Iran.To describe the health care system in the country and the status of occupational health services to the workers and employers, its integration into Primary Health Care (PHC) and outlining the challenges in provision of occupational health services to the all working population.Iran has fairly good health indicators. More than 85 percent of the population in rural and deprived regions, for instance, have access to primary healthcare services. The PHC centers provide essential healthcare and public-health services for the community. Providing, maintaining and improving of the workers' health are the main goals of occupational health services in Iran that are presented by different approaches and mostly through Workers' Houses in the PHC system.Iran has developed an extensive network of PHC facilities with good coverage in most rural areas, but there are still few remote areas that might suffer from inadequate services. It seems that there is still no transparent policy to collaborate with the private sector, train managers or provide a sustainable mechanism for improving the quality of services. Finally, strengthening national policies for health at work, promotion of healthy work and work environment, sharing healthy work practices, developing updated training curricula to improve human resource knowledge including occupational health professionals are recommended.Copyright Â© 2015 The Authors. Published by Elsevier Inc. All rights reserved.
Assessment of the living and workplace health and safety conditions of site-resident construction workers in Tehran, Iran. - International journal of occupational safety and ergonomics : JOSE
The purpose of this study was to assess living and workplace safety conditions of construction workers in Tehran, Iran.This cross-sectional study was conducted among 410 construction sites in a municipal area of Tehran whose municipal building permits were issued in 2011. Data on ventilation, workplace safety and hygiene were collected by direct observation and interviews with site foremen. Noise levels were estimated from 10 sound-level-meter stations in the municipality area.Lack of ventilation in the workers' rooms was abundant. Bathrooms were unhygienic and minimum requirements such as lighting and ventilation did not exist in 80% of the cases. In nearly 50% of large construction sites, sewage and garbage disposal were inappropriate. Elevator safety was poor at all sites and no measures for fall prevention were present in over 88% of active construction sites. This study showed that the mean 24-h equivalent continuous sound level Leq was over 70â€…dB in 80% of the sites during weekdays.The results of this study revealed poor health and safety living and working conditions of construction workers in Tehran.
Educational intervention for reducing work-related musculoskeletal disorders and promoting productivity. - International journal of occupational safety and ergonomics : JOSE
Work-related musculoskeletal disorders (WMSDs) are the main causes of pain, suffering, absenteeism, disability and reduction in productivity. This research aims to determine the role of training intervention based on protection motivation theory in reducing WMSDs and promoting productivity.The conducted study was based on a quasi-experimental design (control) that was carried out on 158 employees of the Kabl Khodro factory which were divided into two groups of 79 people. After splitting the 158 workers, an experimental and control group was formed. The data collection instruments were made up of two questionnaires and were analysed using a quick exposure check (QEC) method.Before intervention in both the experimental and control groups, there were no significant differences among the average protection motivation theory constructs, productivity and QEC scores (pâ€‰<â€‰0.05). However, following training intervention there was a significant increase in these factors within the investigated group apart from the perceived response costs and efficacy.The conducted study shows that ergonomic training based on the protection motivation theory is effective in reducing musculoskeletal risk factors and that increased knowledge of the subject can lead to an increase in productivity.
The Impact of Obesity on the Outcome of Decompression Surgery in Degenerative Lumbar Spinal Canal Stenosis: Analysis of the Lumbar Spinal Outcome Study (LSOS)-A Swiss Prospective Multicenter Cohort Study. - Spine
Prospective, multicenter cohort study including 8 medical centers of the Cantons Zurich, Lucerne, and Thurgau, Switzerland.The aim of the study was to assess whether obese patients benefit after decompression surgery for degenerative lumbar spinal stenosis (DLSS).Lumbar decompression surgery has been shown to improve quality of life in patients with DLSS. In the existing literature, the efficacy of lumbar decompression in the obese population remains controversial.Baseline patient characteristics and outcomes were analyzed at 6 and 12 months follow-up with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). Body mass index (BMI) was classified into 3 categories according to the WHO. Minimal clinically important differences (MCIDs) in SSM for different BMI categories were considered as main outcome.Of the 656 patients in the Lumbar Spinal Outcome Study database as of end of October 2014, 166 patients met the inclusion criteria. Fifty (30.1%) had a BMI less than 25 (underweight and normal weight group), 72 (43.4%) had a BMI between 25 and less than 30 (preobesity group), and 44 (26.5%) patients had a BMI at least 30 (obese group). We found for the main outcome that in obese patients 36% reached MCID at 6 months, and 48% at 12 months. The estimated odds ratios for MCID in the obese group were 0.78 (0.34-1.82) at 6 months and 0.99 (0.44-2.23) at 12 months in a logistic regression model adjusting for levels of laminectomy. In the additional outcomes, SSM, NRS, FT, and RMDQ showed statistically significant mean improvements in the 6 and 12 months follow-up.Obese patients can expect clinical improvement after lumbar decompression for DLSS, but the percentage of patients with a meaningful improvement is lower than in the group of patients with underweight, normal weight, and preobese weight at 6 and 12 months.
The Effect of Aloe Vera, Pomegranate Peel, Grape Seed Extract, Green Tea, and Sodium Ascorbate as Antioxidants on the Shear Bond Strength of Composite Resin to Home-bleached Enamel. - Journal of dentistry (ShiÌ„raÌ„z, Iran)
Immediate application of bonding agent to home- bleached enamel leads to significant reduction in the shear bond strength of composite resin due to the residual oxygen. Different antioxidant agents may overcome this problem.This study aimed to assess the effect of different antioxidants on the shear bond strength of composite resin to home-bleached.Sixty extracted intact human incisors were embedded in cylindrical acrylic resin blocks (2.5Ã—1.5 cm), with the coronal portion left out of the block. After bleaching the labial enamel surface with 15% carbamide peroxide, they were randomly divided into 6 groups (n=10). Before performing composite resin restoration by using a cylindrical Teflon mold (5Ã—2 mm), each group was treated with one of the following antioxidants: 10% sodium ascorbate solution, 10% pomegranate peel solution, 10% grape seed extract, 5% green tea extract, and aloe vera leaf gel. One group was left untreated as the control. The shear bond strength of samples was tested under a universal testing machine (ZwickRoell Z020). The shear bond strength data were analyzed by one-way ANOVA and post hoc Tukey tests (p< 0.05).No significant difference existed between the control and experimental groups. Moreover, there was no statistically significant difference between the effects of different antioxidants on the shear bond strength of bleached enamel.Different antioxidants used in this study had the same effect on the shear bond strength of home-bleached enamel, and none of them caused a statistically significant increase in its value.
Amputated Lower Limb Fixation to the Fracture Table. - Orthopedics
Fractures of the proximal and diaphyseal femur are frequently internally fixed using a fracture table with fracture reduction obtained by traction and adequate rotation exerted on the slightly abducted extremity. Although rare, these fractures may occur on an amputated limb. If so, standard use of a fracture table is not possible. To address this situation, the authors describe a simple novel technique allowing rigid fixation of the amputated limb to the traction device of the fracture table that provides accurate control of reduction in all planes. [Orthopedics. 2015; 38(11):679-682.].Copyright 2015, SLACK Incorporated.
Radiographic measurement error of the scoliotic curve angle depending on positioning of the patient and the side of scoliotic curve. - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
The Cobb angle measurement is well established for the measurement of coronal deformity aspect of scoliotic curves. The effect of positional differences in relation to the apex side of the scoliosis is not yet fully quantified. While theoretically plausible that positioning error with rotation toward the apex of the scoliosis would decrease the Cobb angle, the relations are not investigated yet and were object of this study.Multiple measurements of the Cobb angle were performed, while turning a spine-pelvic cadaveric specimen with a right-sided thoracic scoliosis of 47Â° (in neutral position) from 45Â° to -45Â° in steps of 5Â° using biplanar radiography. Statistical methods were applied to find the critical position, in which measurement errors potentially become clinically relevant (Cobb angle deviation >5Â°).Turning the specimen to the right (toward the apex of the scoliosis) produced during the first -15Â° of rotation, a Cobb angle ranging from 47Â° to 45Â°. At -20Â°, the Cobb angle was 42Â°, at -25Â° rotation 37Â° and at -30Â° rotation 36Â°. Above -30Â° rotation, the measured Cobb angle decreased to 36Â° (77Â % of the original Cobb angle). No relevant differences were found by rotating the specimen to the left (away from the apex) (47Â° at neutral rotation and 44Â° at maximal error rotation of +45Â°).The influence of rotational misplacement of the patient at the time of image acquisition on Cobb angle measurements is negligible for a rotational misplacement of Â±20Â° of rotation for a idiopathic right-sided thoracic scoliosis of 47Â°. Over 20Â° of rotational misplacement of the patient toward the apex of the scoliosis falsely decreases the Cobb angle.
MR imaging of degenerative disc disease. - European journal of radiology
Magnet resonance imaging (MRI) is the most commonly used imaging modality for diagnosis of degenerative disc disease (DDD). Lack of precise observations and documentation of aspects within the complex entity of DDD might partially be the cause of poor correlation of radiographic findings to clinical symptoms. This literature review summarizes the current knowledge on MRI in DDD and outlines the diagnostic limitations. The review further sensitizes the reader toward awareness of potentially untended aspects of DDD and the interaction of DDD and endplate changes. A summary of the available classifications for DDD is provided.Copyright Â© 2015 Elsevier Ireland Ltd. All rights reserved.
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