Role of vitamin D3 in Treatment of Lumbar Disc Herniation—Pain and Sensory Aspects: Study Protocol for a Randomized Controlled Trial

BACKGROUND: Vitamin D receptors have been identified in the spinal cord, nerve roots, dorsal root ganglia and glial cells, and its genetic polymorphism association with the development of lumbar disc degeneration and herniation has been documented. Metabolic effects of active vitamin D metabolites in the nucleus pulposus and annulus fibrosus cells have been studied. Lumbar disc herniation is a process that involves immune and inflammatory cells and processes that are targets for immune regulatory actions of vitamin D as a neurosteroid hormone. In addition to vitamin D’s immune modulatory properties, its receptors have been identified in skeletal muscles. It also affects sensory neurons to modulate pain. In this study, we aim to study the role of vitamin D(3) in discogenic pain and related sensory deficits. Additionally, we will address how post-treatment 25-hydroxy vitamin D(3) level influences pain and sensory deficits severity. The cut-off value for serum 25-hydroxy vitamin D(3) that would be efficacious in improving pain and sensory deficits in lumbar disc herniation will also be studied. METHODS/DESIGN: We will conduct a randomized, placebo-controlled, double-blind clinical trial. Our study population will include 380 cases with one-level and unilateral lumbar disc herniation with duration of discogenic pain less than 8 weeks. Individuals who do not have any contraindications, will be divided into three groups based on serum 25-hydroxy vitamin D(3) level, and each group will be randomized to receive either a single-dose 300,000-IU intramuscular injection of vitamin D(3) or placebo. All patients will be under conservative treatment. Pre-treatment and post-treatment assessments will be performed with the McGill Pain Questionnaire and a visual analogue scale. For the 15-day duration of this study, questionnaires will be filled out during telephone interviews every 3 days (a total of five times). The initial and final interviews will be scheduled at our clinic. After 15 days, serum 25-hydroxy vitamin D(3) levels will be measured for those who have received vitamin D(3) (190 individuals). TRIAL REGISTRATION: Iranian Registry for Clinical Trials ID: IRCT2014050317534N1 (trial registration: 5 June 2014

Assessing the knowledge and attitude of general dentists concerning Infection control principles during preparing intra oral radiographic views in Marvdasht, Fasa and Kazeroon

Background & Objective: Both dental patients and workers are in high chance of exposure to infective diseases such as HIV and Hepatitis. In spite of the advances in infection control technologies, there are still many problems in both private and state dental centers. The purpose of this study was to assess the knowledge and attitude of general dentists of Marvdasht, Fasa and Kazeroon cities concerning infection control principles during preparing intra oral radiographic views. Material & Methods: This is a cross-sectional analytical study. Studied society was dentists of Fasa, Marvdasht and Kazeroon.15 dentists were collected randomly in each city. Data were collected using questionnaire. Results were analyzed using One-Way ANOVA (Analysis of variance), Student’s T-test and Pearson’s correlation coefficient tests. Results: Knowledge average scores were 5.66 in Fasa, 6.4 in Marvdasht, 4.06 in Kazeroon and 5.37 in total (out of 12). Attitude average scores were 6.2 in Fasa, 6.86 in Marvdasht, 5.06 in Kazeroon and 6.04 in total (out of 12). Knowledge of dentists in Marvdasht was significantly higher than Kazeroon. The knowledge and attitudes of dentists about infection control principles during preparing intra oral radiographic views was not in good range. Conclusion: More emphasis of the aspect of infection control principles is necessitated during preparing intra oral radiographic views In order to improve knowledge and correcting attitudes of dentists during dentistry training courses

Vertebral Hydatidosis

Hydatid disease is prevalent in the sheep-raising areas. Bone hydatidosis is rare and occurs in 1% to 4% of all cases of human hydatidosis. About 50% of cases of bone hydatidosis are spinal. In a retrospective study, 9 patients with hydatid disease of spine who had treated surgically were evaluated. There were 5 men and 4 women, with mean age of 31 years and a range of 19 to 50 years. Diagnosis was made by means of myelography, computerized tomography, and magnetic resonance imaging. The main surgical intervention was laminectomy in all cases. In a case of recurrent disease, vertebrectomy and anterolateral spinal fusion and instrumentation was performed through an anterior transabdominal approach. Surgical field was irrigated by 0.5% silver nitrate and 10% hypertonic saline. Albendazole was given as an adjuvant therapy in the cases of bony involvement. Location of the disease was thoracic in 6 cases, cervical in 2 cases, and lumbar in 1 case. Outcome was excellent in 3 cases, improvement in 1 case, no recovery in 1 case, and recurrence in 3 cases. Spinal hydatidosis is a locally malignant disease with high recurrence rate. Eradication of the disease cannot be achieved even after radical surgery and chemotherapy. Although role of the chemotherapy in the prevention of the disease is not specifically determined, it is recommended in almost all reports. The preferred management is the spinal decompression, vertebrectomy, and instrumentation in appropriate cases and postoperative Albendazole therapy as a chemotherapic drug of choice. The best and ideal treatment is the prevention of the disease by eradication of parasites from the hosts in the endemic areas

Extradural Epidermoid Tumor Mimicking Disc Herniation

Epidermoid tumors of the spine are rare and extradural location is very rare. We report 2 cases of extradural epidermoid cyst of spine. A 35-year-old man with T8/T9 disc space originated mass, and a 57 year-old-man with C6/C7 disc level mass. Magnetic resonance imaging of both patients revealed nonenhancing hypointense mass in both T1 and T2 sequences. Both of them based on a diagnosis of disc herniation underwent surgery, but epidermiod cysts were found. This is very rare presentation for the epidermoid tumors

Spinal Cord Compression Secondary to Extramedullary Hematopoiesis: Case Report and Summary

Extramedullary hematopoiesis is a common compensatory phenomenon to chronic hemolytic anemias. It may be seen in many other conditions including bloody dyscrasias such as leukemia, or as an incidental finding. Common locations of the extramedullary hematopoiesis are liver, spleen, lymph nodes. Spinal cord compression is a rare complication of this entity. We report a spinal cord compression due to extramedullary hematopoiesis. Clinical presentation, diagnosis, and therapeutic options are discussed

Serum Levels of Monocyte Chemoattractant Protein-1 Correlate with Poor Clinical Grades in Cerebral Aneurysms

ABSTRACT Background: Ruptured cerebral aneurysms (ICAs) are the most common non-traumatic cause of subarachnoid hemorrhage (SAH) that is associated with life threatening complications such as Vasospasm, Infarction, and Hydrocephalus (HCP). The active participation of macrophage/monocyte-mediated inflammatory response in the pathogenesis of cerebral aneurysm as labeled with Monocyte ChemoattractantProtein-1 (MCP-1) is suggested. Objective: To measure the serum level of MCP-1 in ruptured CAs in different time intervals. Methods: We measured the serum levels of MCP-1 in SAH patients who had CAs and compared it with that of MCP-1 in two control groups: including patients with SAH without CAs, and the normal population of blood donors. We also measured the MCP-1 levels in patients with CAs one week afterward to evaluate the effect of treatment. Serum level of MCP-1 was measured by a commercial ELISA assay. Results: Mean serum MCP-1 level in patients with SAH and CAs was 188.2168 Pg/ml and 331.3982 Pg/ml in the normal population. There was no statistically significant difference between serum levels of MCP-1 on the first (mean=188.2168 Pg/ml) and

Foramen Magnum Surgery: Experience With 22 Cases

The foramen magnum is one of the important anatomic structures in the craniovertebral junction. Various tumors and lesions may involve the foramen magnum. Surgery in this region is challenging and a variety of surgical approaches have been advocated for the operation in this area only recently has this surgery been done outside major centers. We report our experience with the surgery of the foramen magnum tumors. This clinical study was done on a series of 22 cases of foramen magnum tumors over a period of 8 years. Surgical approaches were classic midline posterior fossa in 20 cases and lateral approach in 2 cases. The most frequent clinical presentations were suboccipital neck pain, with complaints of weakness and sensory changes. The most frequent neurologic findings were weakness, hyperreflexia, sensory changes, cerebellar signs, and gait disturbance. Pathologies included 7 meningiomas, 4 neurofibromas, 3 schwannomas, 2 hydatid cysts, 2 astrocytomas, and 4 miscellaneous lesions (tuberculoma, syphilis, ependymoma, and choroid plexus papilloma). Gross total resection was performed in 14 (64%) cases, subtotal resection in 4 (18%) cases, and partial resection in 4 (18%) cases. There were 2 (9%) mortality and 4 (18%) patients who developed 6 complications including cerebrospinal fluid leakage, meningitis, lower cranial nerves palsy, gait disturbance, sensory and motor deficits. Foramen magnum tumors are diverse in pathology and clinical manifestations. With the modern diagnostic tools such as magnetic resonance imaging and advances in surgical techniques especially skull base approaches, resection of the lesions could be performed with acceptable and minimum morbidity and mortality. The posterior approach is adequate for the majority