Medical Journal of The Islamic Republic of Iran (MJIRI)

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The remarkable evolution of surgical management of cerebral hydatidosis towards an earlier diagnosis and proper treatment is evident from this 22-year retrospective study of our experience with 19 cases seen at Shiraz University Medical Institutions. Both cases of iatrogenically-induced infected cysts were seen during the pre-CT era. The optimistic view of being able to remove all the cysts intact seems to be elusive because six cysts ruptured during extraction even with application of the Dowling technique. These cases were followed for a mean of 44 months and in only one case was the patient referred again with subarachnoid cysts of the lumbosacral region after two years. In six cases we had involvement of other organs also. There were two cases of multiple cysts in the brain, a case with de novo infection of the cyst contents, and one in which the cyst was epidural in the parieto-occipital region. One patient died pre-operatively and three were lost to follow-up however, fifteen patients were followed for a mean of27 months with eleven being neurologically intact and four with focal neurological deficits. One patient with a tapped cyst before extraction was readmitted two years later with paraplegia due to drop parasitic infestation of the thoracolumbar region.

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Of about 40 million people with epilepsy, who live in developing countries, the majority do not

receive appropriate treatment. Nonetheless, there are striking disparities among the so-called developing countries,

however generally speaking, access to and availability of epilepsy management programs in developing

countries are very limited and therefore, the issue of developing epilepsy centers in resource-limited settings in a

large scale is very essential. The surgery for epilepsy, including temporal lobotomy, lesionectomy and corpus

colostomy, for patients with medically-refractory seizures, defined as failure of adequate trials of two tolerated,

appropriately chosen and using antiepileptic drug to achieve sustained freedom, from seizure has been proved to

be feasible and cost-effective in developing countries. However, the success of epilepsy surgery depends upon

the accurate identification of good surgical candidates based on the available resources and technologies without

jeopardizing safety. In the current paper, we will share our experiences of establishing an epilepsy surgery program

in Iran, despite all short-comings and limitations and try to provide some answers to those challenges,

which helped us establish our program.

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  Background :Falls have been strongly associated with decreased physical activity and impaired mobility. Reduced range of motion, as a consequence of muscle stiffness, has been indicated to assume a positive relationship to fall incidence. Also clinical observations suggest that maintaining the normal spinal curves is associated with the prevention of spinal, knee and hip disorders. Thus, the aim of this study was to compare hip and ankle range of motions and thoracic and lumbar curves between young and old persons

  Methods :Using a nonprobability sampling 30 elderly persons at average of 68.14 ±4.03 years of age and 30 young people (age 23.37 ± 2.31 years) through a case – control design participated in the study. Maximal hip extension and ankle dorsiflexion range of motions were measured by a standard goniometer. Thoracic and lumbar curvatures were measured by a flexible ruler in both groups. Independent t test were used to statistically analyze differences between groups.

  Results :Compared with the young group, the elderly group had decreased hip extension and ankle dorsiflexion motions (p<0.01). The result of independent t test showed that the mean of lumbar curve was higher in young group (31.29± 6.37)than elderly subjects (27.93±8.11) ,however, no significant difference was found between two groups(p=0.08). The result also showed increasing thoracic curvature with aging (young group=34.43±13.27, old group= 36.19±8.97), however, no significant difference was found between two groups(p=0.55).

  Conclusion :Findings suggest decreased ankle and hip joint range of motions should be considered in rehabilitation of elderly people.

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Background: Firoozgar Comprehensive Stroke Center started up as the first organized care unit in the country in 2014; this study was performed to investigate quality indicators such as reduction in mortality, morbidity and hospital stay.

  Methods: Two groups of ischemic stroke patients were compared. The first group had been admitted in general neurology ward (non-stroke unit patients) and the second one received specialized stroke care in the stroke unit within a period of two years (stroke unit patients). Non-stroke unit patients were selected from a pool of patients admitted two years before establishment of stroke unit. Variables compared were factors such as modified Rankin Scale (mRS), confinement days in stroke unit or Intensive Care Unit, total days of hospitalization, history of prior stroke, receiving recombinant tissue plasminogen activator (rtPA) and the stroke category indicating anterior or posterior circulation infarct. Quantitative testing was conducted using independent t-test as well as “Mann-Whitney U Test”; Chi-squared test was used for qualitative testing.

  Results: A total number of 129 patients enrolled in the study (66 cases of non-stroke unit patients and 63 cases of stroke unit patients). The average total days of hospitalization were 17.32 (95% CI: 0.15-36.1) in non-stroke unit patients and 21.19 (95% CI: 4.99 - 38.1) in stroke unit patients (p=0.2). Results for stroke unit patients showed a lower mRS score (OR=1.48, p=0.01).

  Conclusion: It was concluded that stroke unit patients tend to have a better outcome and a lower mRS score at discharge. No significant difference in hospitalization period was noted between the two groups.

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Background: Social networking has a dramatically increasing trend among adolescents. By creating novel models of content production, distribution, and reception, this space has introduced opportunities and threats for adolescents, which must be understood in relation with their health status. This study was conducted with the aim of describing the psychosocial experiences of Iranian adolescents in the Internet's virtual space.
Methods: The present qualitative formal content analysis was conducted in Mashhad a city Iran. The participants included 32 adolescents of 13-18 years of age. Data were collected through 32 semi-structured individual and group interviews with maximum variation. The data were recorded, transcribed, and then analyzed via MAXQ 10 software. 
Results: In this study, 2 main themes of “moving towards constructiveness” and “perceiving social and psychological tensions” were formed. Accordingly, 9 subcategories were formulated including: increasing the social capital, a good feeling in life, escaping loneliness, being seen in the social network, intelligent selection of content, perceived threats, temptation, decline of behavioral values and principles, and emotional and social helplessness.
Conclusion: Adolescents’ positive and negative experiences in the Internet form based on personal and environmental factors. These experiences affect the mental and social dimensions of their health. These factors call for the attention of scholars and policymakers for developing enabling strategies for adolescents, and their families and for experts for promoting adolescents’ health. 
 
 

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Background: Writing, designing, and conducting a clinical trial research proposal has an important role in achieving valid and reliable findings. Thus, this study aimed at critically appraising fundamental information in approved clinical trial research proposals in Mashhad University of Medical Sciences (MUMS) from 2008 to 2014.
   Methods: This cross-sectional study was conducted on all 935 approved clinical trial research proposals in MUMS from 2008 to 2014. A valid and reliable as well as comprehensive, simple, and usable checklist in sessions with biostatisticians and methodologists, consisting of 11 main items as research tool, were used. Agreement rate between the reviewers of the proposals, who were responsible for data collection, was assessed during 3 sessions, and Kappa statistics was calculated at the last session as 97%.
   Results: More than 60% of the research proposals had a methodologist consultant, moreover, type of study or study design had been specified in almost all of them (98%). Appropriateness of study aims with hypotheses was not observed in a significant number of research proposals (585 proposals, 62.6%). The required sample size for 66.8% of the approved proposals was based on a sample size formula; however, in 25% of the proposals, sample size formula was not in accordance with the study design. Data collection tool was not selected appropriately in 55.2% of the approved research proposals. Type and method of randomization were unknown in 21% of the proposals and dealing with missing data had not been described in most of them (98%). Inclusion and exclusion criteria were (92%) fully and adequately explained. Moreover, 44% and 31% of the research proposals were moderate and weak in rank, respectively, with respect to the correctness of the statistical analysis methods.
   Conclusion: Findings of the present study revealed that a large portion of the approved proposals were highly biased or ambiguous with respect to randomization, blinding, dealing with missing data, data collection tool, sampling methods, and statistical analysis. Thus, it is essential to consult and collaborate with a methodologist in all parts of a proposal to control the possible and specific biases in clinical trials.