Serum cytokines, a diagnostic tool for herniated lumbar disc type

Inflammatory mediators such as cytokines have been suggested to be important in the pathophysiology of disc herniation. However, few studies have been ever conducted for evaluating the serum levels of these cytokines. This study aimed at assessing the agreement of serum and operation-field cytokines in diagnosis of herniated lumbar disc type. In this study, 43 patients with lumbar disc herniation were recruited in Tabriz Imam Reza Hospital during a 12-month period. According to the type of herniation, the patients were categorized in two groups: with excursion or sequestration (group A) and with bulging (group B) of disc, with 22 and 21 cases, respectively. The level of interleukin (IL)-1α, IL-6 and tumor necrosis factor (TNF)-α was determined in nucleus pulposus (NP) and serum of the patients by employing enzyme-linked immunosorbent assay (ELISA) method. Agreement rate between the two readings was determined. There was full agreement between the serum and NP readings for all the studied parameters. The optimal cut-off points for serum IL-1α, IL-6 and TNFα were ≤0.25, ≤0.05 and ≤0.7 pg/ml, respectively, for discrimination between the extrusion and bulging discs. Serum levels of IL-1α, IL-6 and TNFα may be applicable for preoperative diagnosis of the type of the herniated lumbar disc, especially TNFα, and IL-6 parameters which have a high sensitivity and specificity for differentiation between bulging and extrusion or sequestration discus.Key words: Intervertebral disk displacement, IL-1α, IL-6, TNFα, serum

Validity and Cross-Cultural Adaptation of the Persian Version of the Oxford Elbow Score

Oxford Elbow Score (OES) is a patient-reported questionnaire used to assess outcomes after elbow surgery. The aim of this study was to validate and adapt the OES into Persian language. After forward-backward translation of the OES into Persian, a total number of 92 patients after elbow surgeries completed the Persian OES along with the Persian DASH and SF-36. To assess test-retest reliability, 31 randomly selected patients (34%) completed the Persian OES again after three days while abstaining from all forms of therapeutic regimens. Reliability of the Persian OES was assessed by measuring intraclass correlation coefficient (ICC) for test-retest reliability and Cronbach's alpha for internal consistency. Spearman's correlation coefficient was used to test the construct validity. Cronbach's alpha coefficient was 0.92 showing excellent reliability. Cronbach's alpha for function, pain, and social-psychological subscales was 0.95, 0.86, and 0.85, respectively. Intraclass correlation coefficient (ICC) was 0.85 for the overall questionnaire and 0.90, 0.76, and 0.75 for function, pain, and social-psychological subscales, respectively. Construct validity was confirmed as the Spearman correlation between OES and DASH was 0.80. Persian OES is a valid and reliable patient-reported outcome measure to assess postsurgical elbow status in Persian speaking population

The clinical significance of biliary findings in magnetic resonance enterography of patients with inflammatory bowel disease

Purpose: Given the association of inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC), we aimed to investigate the clinical relevance of abnormal hepatobiliary findings on magnetic resonance enterography (MRE) of IBD patients considering the risk of over- or underestimation of PSC at MRE. Material and methods: Using the MRE dataset of patients referring to a tertiary hospital and the National Registry of Crohn’s and Colitis, 69 MREs, including 23 IBD-PSC, 23 IBD-without PSC, and 23 healthy controls (HC), were retrospectively reviewed by 2 experienced radiologists blinded to the clinical data, to evaluate hepatobiliary abnormalities. Sensitivity, specificity, and likelihood ratios were calculated. Results: Bile duct irregularities were the most common finding in the IBD-PSC group, with a frequency of 91%. Intra- and extrahepatic bile duct (IHBD and EHBD) irregularities were observed in 87% and 78% of PSC patients, respectively. Higher frequency of IHBD and EHBD wall thickening, bile duct dilation, EHBD stricture, and periportal oedema were observed in the IBD-PSC group. Peribiliary T2-weighted hyperintensities and contrast-enhancement were significantly more common in the IBD-PSC group than in the IBD and HC groups (48% and 35%, respectively) (p < 0.001). Detection of biliary irregularities on MRE had a specificity of 94% (95% CI: 82-99%), a sensitivity of 91% (95% CI: 72-99%), and a positive likelihood ratio of 14.0 (95% CI: 4.7-42.1) for the diagnosis of PSC. Conclusions: This study emphasizes the importance of assessing and reporting hepatobiliary abnormalities visible in the MRE of patients with IBD to avoid a delayed diagnosis of PSC

The Association between Serum Lactate Level and Hospital Outcome in Children with Multi-Trauma

Background: Trauma is an important cause of disability and death in young people.  This study aimed to investigate the association between serum lactate level and in-hospital mortality in multi-traumatic children. Method: In this cross-sectional study, all children with multi-trauma admitted to the emergency department in Shohada and Imam Reza hospitals of Tabriz/Iran were evaluated from 2018 to 2020. At the time of admission to the emergency department, serum lactate, PRISM (Pediatric risk of mortality) score, and other findings as well as outcome were checked and correlated with the outcomes for all patients. Patients were classified into two groups (based on outcome) and six groups (based on lactate levels) to evaluate associations between results. The Chi-square test, independent samples t-test, ANOVA, and multivariate logistic regression test were performed in SPSS.22. P-value<0.05 and OR with 95% confidence interval were considered statistically significant. Result: Out of 110 admitted children, 10 (9%) died in hospital. Mean lactate level was 3.2 mmol/l and 85 patients (77.2%) had lactate level>2 mmol/l (millimoles). The initial blood lactate level was directly correlated with mortality.  This relationship was confirmed even after adjusting for variables such as the PRISM score (OR = 1.27; 95% CI, 1.19-1.35; P <0.001). Multiple regression study showed that a high lactate level (OR =1.17; 95% CI, 1.07-1.29; P=0.001), high PRISM score (OR = 1.15; 95% CI, 1.11-1.20; P<0.001), and low albumin level (OR =0.92; 95% CI, 0.88-0.96; P<0.001) were independent risk factors for mortality. Conclusion: High blood lactate level was an independent factor in the increase of mortality rate in the emergency department

Global trends of hand and wrist trauma : a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study

Background As global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period. Methods The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations. Results The global incidence of hand trauma has only modestly decreased since 1990. In 2017, the age-standardised incidence of hand and wrist fractures was 179 per 100 000 (95% uncertainty interval (UI) 146 to 217), whereas the less common injuries of thumb and non-thumb digit amputation were 24 (95% UI 17 to 34) and 56 (95% UI 43 to 74) per 100 000, respectively. Rates of injury vary greatly by region, and improvements have not been equally distributed. The highest burden of hand trauma is currently reported in high SDI countries. However, low-middle and middle SDI countries have increasing rates of hand trauma by as much at 25%. Conclusions Certain regions are noted to have high rates of hand trauma over the study period. Low-middle and middle SDI countries, however, have demonstrated increasing rates of fracture and amputation over the last 27 years. This trend is concerning as access to quality and subspecialised surgical hand care is often limiting in these resource-limited regions.Peer reviewe

Global trends of hand and wrist trauma: A systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study

Background: As global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations. Results: The global incidence of hand trauma has only modestly decreased since 1990. In 2017, t

Antiphospholipid syndrome: A disease of protean face

Background: Antiphospholipid syndrome (APS) is a systemic disorder characterizes by recurrent arterial and venous thrombosis and/or pregnancy miscarriages and positive test for antiphospholipid antibodies. Case: Here we report a 31 year-old female whose main complain was symmetrical motor polyneuropathy and hand muscular weakness over a long period of time. Her clinical picture became more complex by Mitral valve regurgitation and renal dysfunction. Finally with the diagnosis of APS glucocorticoid therapy was started and her renal dysfunction improved profoundly, however her cardiac valvular involvement and peripheral neuropathy remained. Conclusions: APS is a disease with wide clinical presentations and it continues to confound the clinicians