Enhanced external counterpulsation in rehabilitation of erectile dysfunction: a narrative literature review

Seyed Ahmad Raeissadat,1 Atefeh Javadi,2 Farzad Allameh3 1Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Physical Medicine and Rehabilitation Research Center and Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Background: Enhanced external counterpulsation (EECP) is a noninvasive treatment option widely applied in patients with erectile dysfunction (ED). The aim of this study is to review the efficacy of EECP in patients suffering from ED. Methods: PubMed, MEDLINE, Google Scholar, Tripdatabase, Scopus, and Cochrane library databases were searched for articles with the following search terms: enhanced external counterpulsation and erectile dysfunction. No restrictions with respect to study setting, date of publication, and language were imposed. Results: From an initial set of 208 records, 4 studies were selected after a final review. A total of 177 patients with a mean age of 59.98 years were included in these studies, with 20–35 hours per week of EECP treatment. Three studies used the International Index of Erectile Function questionnaire and one applied a four-item questionnaire and a peak systolic flow measurement. All of these parameters were significantly improved after the EECP treatment. Conclusion: To the best of our knowledge, this is the first study reviewing the clinical effectiveness of EECP in patients with ED. According to the articles reviewed in this study, an improvement in erectile function after EECP treatment courses has been observed in patients with and without coronary artery disease without any significant adverse effects. Keywords: coronary artery disease, enhanced external counter pulsation, erectile dysfunction, impotence, ischemic heart diseas

Diagnostic value of ultrasonography versus electrodiagnosis in ulnar neuropathy

Seyed Mansoor Rayegani,1 Seyed Ahmad Raeissadat,2 Elham Kargozar,3 Shahram Rahimi-Dehgolan,3 Elham Loni4 1Physical Medicine and Rehabilitation Department and Research Center, Shohada-e-Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Department and Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Physical Medicine and Rehabilitation Department, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran; 4Physical Medicine and Rehabilitation Department, Rofaydeh Rehabilitation Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Purpose: Ulnar neuropathy at elbow is the second-most common compression neuropathy. The main aim of this study was to assess the diagnostic value of ultrasonography (US) as an alternative method to electrodiagnosis (EDX), which had traditionally been used as the method of choice.Methods: This diagnostic study was conducted on 66 participants (32 patients` elbows and 34 normal elbows) referred for EDX. Both groups were reassessed by US to evaluate the consistency of the two tests. The quantitative parameters of US, such as cross-sectional area (CSA) of the ulnar nerve at three different levels around the medial epicondyle (ME) were compared between groups.Results: Our findings demonstrated that CSA at the ME and 2 cm distal to the ME were significantly larger in the patient group than normal participants. This higher nerve size was more prominent among those who had predominant axonal loss rather than demyelinating lesions (P<0.01). Finally, we evaluated US diagnostic value with the best singular feature (2 cm distal to ME) at a cutoff of 9 mm2, which revealed specificity of 80% and sensitivity 84%.Conclusion: Based on these results we can conclude that US is a sensitive and specific method in diagnosing ulnar neuropathy at the elbow and can be used as an acceptable complementary method, in particular when EDX is not available. Keywords: Cubital Tunnel Syndrome, elbow, diagnostic tests, nerve compression syndromes, electromyography &nbsp

Interesting effectiveness of ozone injection for carpal tunnel syndrome treatment: a randomized controlled trial

Mohammad Hasan Bahrami,1 Seyed Ahmad Raeissadat,2 Mohammadrasoul Nezamabadi,1 Fateme Hojjati,1 Shahram Rahimi-Dehgolan31Physical Medicine and Rehabilitation Department and Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran; 2Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Department and Research Center, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran; 3Physical Medicine and Rehabilitation Department, Tehran University of Medical Sciences (TUMS), School of Medicine, Tehran, IranPurpose: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper limb. Local injection of different substances has been increasingly used as an acceptable conservative treatment in non-severe cases. This study aimed to evaluate the efficacy and safety of local ozone injection in the management of non-severe CTS.Methods: In the current randomized controlled trial (RCT), 40 patients with mild or moderate CTS were included in two parallel groups. Both of them used the resting volar wrist splint for 8 weeks; while the intervention group received a single dose of local ozone injection, except for the same splinting protocol. The main outcome measures including visual analog scale (VAS) for pain; symptom severity or functional status, based on Boston questionnaire (BQ); and median nerve conduction study, were reassessed 10 weeks after the treatment.Results: All of the measures including VAS, symptom severity, functional status and EDX improved significantly in both groups with the maximal changes in VAS. The VAS reduction was more remarkable in the ozone group than the control group [64% versus 45.3%, respectively]. Moreover, both of the BQ subscales showed significantly higher improvement in the ozone group compared to the control group (P=0.01 and 0.02, respectively). Although the improvement of EDX parameters was slightly better in the ozone group, the difference was not significant. Neither minor nor major side effects were reported.Conclusion: Ozone therapy as a safe and low-cost method, could provide promising results among women with mild to moderate CTS, at least for short-term treatment.Clinical trial registration: IRCT2016040913442N9.Keywords: local corticosteroid injections, oxygen-ozone, wrist splint

An investigation into the efficacy of intra-articular ozone (O2–O3) injection in patients with knee osteoarthritis: a systematic review and meta-analysis

Seyed Ahmad Raeissadat,1 Elnaz Tabibian,2 Seyed Mansoor Rayegani,3 Shahram Rahimi-Dehgolan,3 Arash Babaei-Ghazani4 1Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Department and Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Radiology Department, Medical Imaging Center, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; 3Physical Medicine and Rehabilitation Department and Research Center, Shohada-e-Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran Purpose: This study aimed to review and pool the current literature on intra-articular ozone injection in knee osteoarthritis (OA) patients.Methods: A systematic review of three big databases was performed to identify all English-language randomized clinical trials (RCTs) that evaluated the efficacy of intra-articular ozone injection vs a control injection for knee OA sufferers, using the following two measuring tools: pain VAS and Western Ontario and McMaster Universities Arthritis Index (WOMAC).Results: A total of 428 patients in five RCTs were included, from which 53% (n=225) were in the ozone group and 47% in the control (hyaluronic acid [HA], dextrose, and air injection) group (n=203). The mean age of the patients in both groups was 64 years. Females were the majority. All studies had at least 2 months of follow-up (F/U). Mean difference (MD) between the groups for VAS in the first month was –0.23 with a P-value of 0.71 (negative value was in favor of ozone), whereas this difference in the third and sixth months reached 1.04 and 1.31, respectively, favoring the control group. These data demonstrated that control injection had a more prolonged pain relief period. A similar trend was seen regarding WOMAC scores; pooled results showed that ozone was slightly better than the control injections during the first month (MD =–7.84 [P=0.15]), but it declined to MD=2.55 and 8.23 at 2- to 3- and 4- to 6-month F/U, respectively, again in favor of control injections. Also, adverse events occurred homogeneously in both ozone (6/150 cases, 4%) and control groups (7/129 cases, 5.4%; P-value=0.31).Conclusion: Based on the current meta-analysis, intra-articular ozone injection efficacy was significantly superior to placebo and slightly lower to other control injections with non-significant difference. Therefore, ozone could be recommended as an efficient non-surgical treatment, durable for at least 3–6 months, in mild or moderate knee OA management. Keywords: ozone, hyaluronic acid, knee osteoarthritis, systematic review, meta-analysi

Intra-articular ozone or hyaluronic acid injection: Which one is superior in patients with knee osteoarthritis? A 6-month randomized clinical trial

Seyed Ahmad Raeissadat,1,2 Seyed Mansoor Rayegani,2 Bijan Forogh,3 Porya Hassan Abadi,4 Mahsa Moridnia,5 Shahram Rahimi Dehgolan6 1Clinical Development Research Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences,Tehran, Iran 2Shohada-e-Tajrish Hospital, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3College of Medical and Dental Sciences, Birmingham Medical School, Birmingham, UK; 4Physical Medicine and Rehabilitation Department, Iran University of Medical Sciences, 5Shahid Beheshti University of Medical Sciences, Deputy of Education, 6Physical Medicine and Rehabilitation Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Purpose: Knee osteoarthritis (OA) is a common disease, imposing a great burden through pain and decreased function. There are many therapeutic modalities including non-pharmacologic choices and oral, topical, and intra-articular medications. New studies have shown promising results for ozone application in knee OA. Our aim was to compare the effects of ozone therapy versus hyaluronic acid (HA) intra-articular injection in knee OA patients.Methods: In this randomized clinical trial, a total of 174 patients with more than 3 months of chronic pain or swelling in the knee joints along with consistent imaging findings were enrolled and randomly allocated into two groups of HA and ozone, which were planned to undergo 3 weekly injections of HA (Hyalgan®) and 10 mL of a 30 µg/mL ozone solution, respectively. Patients were evaluated at baseline and 6 months after the last injection for pain, stiffness, and function using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Results: No major adverse events were detected in this study. Total WOMAC score decreased from 40.8±9.8 to 20.4±4.9 (p<0.01) in the ozone group and from 38.5±7.9 to 17.1±4.2 (p<0.01) in the HA group. A similar trend was observed in pain improvement according to VAS. Pain, stiffness, and function significantly improved in both the groups, but no between-group difference was found.Conclusion: Although both ozone and HA can be effectively used for improving function and reducing pain in selected knee OA patients, neither of the two showed any superiority at 6-month follow-up. Keywords: ozone, hyaluronic acid, knee osteoarthritis&nbsp

The efficacy of electromyographic biofeedback on pain, function, and maximal thickness of vastus medialis oblique muscle in patients with knee osteoarthritis: a randomized clinical trial

Seyed Ahmad Raeissadat,1 Seyed Mansoor Rayegani,2 Leyla Sedighipour,1 Zeynab Bossaghzade,2 Mohamad Hesam Abdollahzadeh,2 Rojin Nikray,2 Fazeleh Mollayi3 1Physical Medicine and Rehabilitation Research Center and Department, Clinical Research Development Center, Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Physical Medicine and Rehabilitation Research Center and Department, Shohadaye Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Department of Sport Sciences, Payame Noor University, Tehran, Iran Introduction: The aim of this survey was to examine the effect of adding electromyographic biofeedback (EMGBF) to isometric exercise, on pain, function, thickness, and maximal electrical activity in isometric contraction of the vastus medialis oblique (VMO) muscle in patients with knee osteoarthritis (OA). Methods: In this clinical trial, 46 patients with a diagnosis of knee OA were recruited and assigned to two groups. The case group consisted of 23 patients with EMGBF-associated exercise, and the control group was made up of 23 patients with only isometric exercise. Data were gathered via visual analog scale (VAS) score, the Persian version of the Western Ontario and McMaster Universities Osteoarthritis Index and Lequesne questionnaires, ultrasonography of the VMO, and surface electromyography of this muscle at baseline and at the end of the study. Variables were compared before and after the exercise program in each group and between the two groups. Results: At the end of the study, there were no significant differences between the two groups regarding measured variables. Only the VAS score was significantly less in the case group. Although all assessed parameters, except for VMO muscle thickness, were found to be improved significantly in each group, the degree of change was not significantly different between the two groups, except for VAS score. VMO muscle thickness did not change significantly after exercise therapy in either of the groups. Conclusion: Isometric exercises accompanied by EMGBF and the same exercises without biofeedback for 2 months both led to significant improvements in pain and function of patients with knee OA. Real EMGBF was not superior to exercise without biofeedback in any of the measured variables, except for VAS score. Keywords: knee osteoarthritis, isometric quadriceps exercise, EMG biofeedbac

The comparison of the effectiveness between different doses of local methylprednisolone injection versus triamcinolone in Carpal Tunnel Syndrome: a double-blind clinical trial

Afshin Karimzadeh,1 Shahriar Bagheri,2 Seyed Ahmad Raeissadat,3 Shahab Bagheri,4 Seyed Mansoor Rayegani,4 Shahram Rahimi-Dehgolan,5 Farshad Safdari,2 Hashem Abrishamkarzadeh,2 Hadi Shirzad6 1Department of Physical Medicine and Rehabilitation, Clinical Research Development Center of Imam-Hossein Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Department of Orthopedic Surgery, Bone, Joint and Related Tissue Research Center, Akhtar Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Department and Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Physical Medicine and Rehabilitation Department and Research Center, Shohada-e-Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 5Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; 6Department of Medical Genetics, Tarbiat Modares University, Tehran, Iran Purpose: Local corticosteroid injection is one of the most prevalent methods in treating carpal tunnel syndrome (CTS). However, the most efficient substance and its appropriate dosage remain controversial. In the present double-blind randomized controlled trial, the efficacy and safety of local injection of two corticosteroids (triamcinolone and methylprednisolone) were compared at two different dosages, 20 and 40 mg. Patients and methods: We consecutively included 80 patients with mild or moderate CTS and randomly assigned them to four groups: 20 or 40 mg triamcinolone (T20 or T40) and 20 or 40 mg methylprednisolone (M20 or M40) groups; each patient received a single injection of steroid using conventional approach. The four groups were relatively comparable and did not show any significant difference initially in their baseline measurements including pain intensity measured using VAS, pain-free grip strength (PFGS), nerve conduction study (NCS), and two parts of Boston Carpal Tunnel Syndrome Questionnaire: symptom severity scale (SSS) and functional status scale (FSS); the latter was our primary outcome measure. Three months after injection, they were reassessed to evaluate the clinical and electrodiagnostic changes. Results: Almost all NCS parameters, VAS, and PFGS significantly improved after treatment in all the groups (P<0.05). Compound motor action potential amplitude significantly improved only in T40 group (P=0.032), while there was no significant improvement in other groups. Furthermore, SSS remarkably decreased in all the four groups, without any significant difference between the groups (P=0.87). A similar significant decrease was found in FSS, with a higher improvement in T40 group (P=0.009). There was no significant difference between the four groups in other variables after treatment. Conclusion: Based on the current data, the efficacy and safety of local injection of triamcinolone and methylprednisolone at doses of 20 and 40 mg were associated with a significant improvement in pain, functional status, and strength. Although, there was no remarkable superiority, 40 mg injection, especially for triamcinolone, yielded better NCS results and functional status Keywords: steroids, injections, conservative treatment, wris