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Purpose: We investigate and compare responsiveness of the physical function subscales of patient-reported measures of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS), and performance-based measures of the timed up-and-go test and 6-min walk test and determine the minimal clinically important change (MCIC) values in knee osteoarthritis (OA) patients following physiotherapy intervention. Methods: One hundred patients were asked to complete the WOMAC and OKS and to perform the timed up-and-go test and 6-min walk test once pre-intervention and again after 4-week physiotherapy intervention (post-intervention). Responsiveness was determined by correlation analysis and receiver operating characteristics (ROC) curve. Results: The WOMAC-physical function subscale (WOMAC-PF), OKS-functional component score (OKS-FCS), timed up-and-go test, and 6-min walk test showed moderate-to-good relationships with the patients' global rating scale (Spearman correlation ranges = 0.51–0.56). All outcome measures of physical function showed the area under the curve (AUC) >0.70 (AUC ranges = 0.78–0.82). The MCIC values were 12.5 points for WOMAC-PF, 17.5 points for OKS-FCS, 2.82 s for timed up-and-go test, 61 m for 6-min walk test. Conclusions: All outcome measures have adequate responsiveness to detect clinical improvements over time in functional status following the physiotherapy intervention in patients with knee OA. The MCIC values can help clinicians and researchers to make a decision based on the clinical significance of improvements in patients' functional status. [ABSTRACT FROM AUTHOR]

Rupture of the anterior cruciate ligament (ACL) disturbs the stability of the knee, and increases the risk of subsequent meniscal damage and the risk of developing degenerative joint disease. Surgical ACL reconstruction (ACLR) is one of the most common orthopedic surgeries. This study aimed to investigate the effective factors on the rehabilitation rate in ACLR with hamstring autograft based on the Tegner activity scale (TAS) and Lysholm knee scoring scale (LKS) one year after the operation. In this descriptive-analytical study, 140 patients who underwent ACLR surgery with hamstring autograft were evaluated. Patients were evaluated based on TAS and LKS scores before and after the surgery and their responses were recorded. Then, the rehabilitation rate was calculated based on these two scales, and the association between the rehabilitation rate and pre-operative and post-operative parameters was investigated. Based on the findings, LKS scores after surgery were significantly associated with age, gender, education, injury mechanism, loss of full flexion ROM, analgesic consumption after surgery, surgical site infection, and BMI. Also, the LKS score was higher in people whose Tegner activity scale score was 8 before the injury. There was no significant association with smoking before surgery, hematoma at the graft site after surgery, knee meniscal lesions, and hemarthrosis formation during the first six hours of ACL injury. Determining the effective factors before and after surgery on the rehabilitation rate of patients undergoing ACLR who were treated with hamstring autograft may be useful in evaluating the rehabilitation rate of patients. [ABSTRACT FROM AUTHOR]

Background: People with knee osteoarthritis have a low quality of life due to joint pain and stiffness, severely limiting their daily activities. This study aims to investigate the impact of self-acupressure on the pain, joint stiffness, and physical functioning of patients with knee osteoarthritis. Methods: This randomized clinical trial was conducted on 78 patients aged 50 to 70 with knee osteoarthritis, referred to Imam Khomeini Hospital and private orthopedic clinics in Ahvaz City, Iran, in 2018. The patients were recruited based on the inclusion criteria and then randomly assigned to three groups: self-acupressure (n=26), sham (n=26), and control (n=26). Patients in the intervention group applied daily self-acupressure to 5 specific points around their knees for 8 consecutive weeks. The sham group applied pressure on the points different from those used by the intervention group. The control group received no intervention. The study data were collected using the Western Ontario and McMaster osteoarthritis index (WOMAC), visual analog scale (VAS), and a checklist for daily recordings of pain medication. The obtained data were analyzed using the chi-square test and analysis of variance in SPSS software, version 20. The significance level was set at P<0.05. Results: The comparison of changes within the group showed that the intensity of pain in the intervention group decreased over time (P<0.0001). Also, the joint stiffness, physical functioning, and total WOMAC score significantly decreased in the intervention group (P<0.0001). The frequency of analgesic use was also reduced in the intervention group over time (P=0.026). Conclusion: According to the results, self-acupressure effectively reduces the intensity of pain and joint stiffness and improves the physical performance of older adults with knee osteoarthritis. Overall, this easy and affordable intervention is recommended for this group. [ABSTRACT FROM AUTHOR]

Introduction: Anterior cruciate ligament (ACL) rupture compromises knee stability and increases the risk of meniscal injury and degenerative joint disease. ACL reconstruction is among the most common orthopedic surgeries. This study aimed to evaluate the impact of preoperative and postoperative physical therapy on the success of ACL reconstruction using hamstring autograft based on the eight parameters of the Lysholm Knee Scoring Scale (LKSS). Methods: This descriptive-analytical study included 140 patients who underwent ACL reconstruction using hamstring autograft from 2019 to 2023. The correlation between the number of preoperative and postoperative physical therapy sessions and the timing of postoperative physical therapy initiation with the LKSS score one year after surgery was analyzed using SPSS software version 22. Results: The study included 112 men and 28 women. There was no significant correlation between LKSS scores and the number of preoperative and postoperative physical therapy sessions, although patients with 1 to 10 preoperative sessions and those with fewer than 10 postoperative sessions scored higher on the LKSS. Additionally, patients who began physical therapy in the first week post-surgery had better outcomes. Conclusion: While the number of preoperative and postoperative physical therapy sessions did not significantly impact ACL reconstruction outcomes, patients who received preoperative physical therapy or began postoperative physical therapy earlier had better outcomes. [ABSTRACT FROM AUTHOR]

Background: There is evidence to demonstrate an association between fungal sensitization and asthma. Several studies have shown that saprophytic fungi such as Alternaria, Penicillium and Aspergillus species are the most prevalent fungal allergens worldwide. The main purpose of this study was to compare Alternaria alternata, Penicillium citrinum and Aspergillus fumigatus allergen bands by using the same patients and controls' sera in clinical investigations. Methods: Forty-eight patients with asthma (23 males, 25 females) and Forty-eight healthy controls (23 males, 25 females) were collected in 2017. Glass beads and liquid nitrogen were used to disrupt the cell wall of cultured fungi. SDS-PAGE was used to isolate protein fractions. IgE immunoblotting against the patients and controls sera were performed to isolate protein bands after electrotransfering into the nitrocellulose membrane. Results: Our findings demonstrated the most allergenic bands consist to A. alternata with 17 bands (44.7%) relative to P. citrinum and A. fumigatus, and we found that asthmatic patients in the age range of 41 to 70 years were more sensitive when compared to other age groups. Conclusion: Our results showed that A. alternata had more power in sensitizing the patients in comparison with P. citrinum and A. fumigatus. Also, the protein bands with high molecular weight can be considered as an index of sensitizing in immunoblotting assay. [ABSTRACT FROM AUTHOR]

Ultrasound (US) waves have recently shown therapeutic effects for different fractures including fresh, non-union, and delayed fractures shown promising potentials as alternative or adjunctive treatment for bone fractures. However, the mechanisms of actions of this technique in bone fractures healing are not fully understood. This paper aimed to comprehensively review the biological interactions and mechanism of action of US waves in the treatment of bone fractures. The databases of PubMed (1990-2016), EMBASE (1990-2016), Web of Sciences (1990-2016), and Google Scholar (1980-2016) were searched using the set terms. The title and abstract of the collected results were reviewed by two authors and the relevant papers were selected for further evaluations. The available evidence showed the therapeutic efficiency of US waves in bone fractures. The mechanisms of action depend on the US physical parameters as well as exposure factors including duration. The main mechanisms of US waves for enhancing the healing process of bone fractures healing are increasing fibroblasts and decreasing osteoclasts, stimulating the collagen formation, enhancing extensibility of collagen, circulation, and pain threshold. Low US frequencies show more therapeutic efficiency in bone fractures healing compared with high frequencies. [ABSTRACT FROM AUTHOR]

Femoral neck fracture is an emergency orthopedic condition that needs early and efficient management. Two common complications of this fracture are occurrence of non-union and avascular necrosis (AVN). The most damaging effect in femoral neck fracture is vascular damage that causes ischemic conditions which subsequently may induce ischemia cell necrosis. This study aimed to comparatively investigate the frequency of avascular necrosis and non-union in patients with ipsilateral femoral shaft and neck and with femoral neck fracture. This was a clinical study conducted on the patients admitted to Ahvaz (Khuzestan, Iran) referral hospitals during 2010 to 2014. A total of 60 patients were divided into two groups (n=30). Group A included patients with ipsilateral femoral shaft and neck fracture and Group B included patients with femoral neck fracture. The data on the frequencies of union and ANV in the broken bone were collected and compared. The mean age of the group A and group B was 40.05 and 39.83 years old, respectively. The age range of the patients was 17-60 years old. The duration of followup was two years. The results showed that the rate of non-union in the group of ipsilateral femoral shaft and neck fractures (group A) was more so that the difference was statistically significant (P= 0.01). In addition, the frequency of AVN in the group B was significantly higher than the group A (P= 0.01). The findings showed higher rate of nonunion in patients with ipsilateral femoral shaft and neck fractures and AVN in the patients with femoral neck fracture compared with the patients with ipsilateral femoral shaft and neck. [ABSTRACT FROM AUTHOR]

Objective: To evaluate pre and post acetabular index in patients with Developmental Dysplasia of Hip whom underwent Salter innominate osteotomy. Methodology: This cross sectional study was carried out on patients with CDH that underwent Salter innominate osteotomy. All cases with CDH admitted in Imam Khomeini and Razi Hospitals from November 2007 to August 2009 were included. Age, sex, number of involved limb, and affected side were recorded. Antero-posterior (AP) roentgenogram were done and acetabular index were calculated before and after surgery. Five months later after surgery, AP Roentgenogram were obtained from cases and acetabular index were calculated again. Before and after surgery acetabular index were compared for each cases. Dislocation of hip and avascular necrosis occurrence and grading were assessed for each case. Dislocation rate were assessed based on proposed criteria by author from 0 to 4. This criteria was based on percentage of head of femur, which was not covered by acetabulum. Our classification is as follows: Grade 0: No dislocation; grade I: 30% subluxation; grade II: 30-60% subluxation grade III: 60-90% subluxation; grade IV: Complete dislocation. Results: During two year period of the study, fourteen CDH patients were operated. From these cases, four hips were excluded because the patients did not come for follow up. Pre operative acetabular index was 34.40±1.22 and post operative acetabular index was 19.20±1.22. There was significant difference among pre- and post- acetabular index. Conclusion: This study showed that there was significant difference among pre and post operative acetabular index. Our limitations in this study were low sample size and short duration of follow-up. Another prospective study with more sample and long duration is recommended. [ABSTRACT FROM AUTHOR]

Abstract: Aflatoxin B1 (AFB1) is a highly toxic and carcinogenic metabolite produced by Aspergillus species on food and agricultural commodities. Natural products may regulate the cellular effects of aflatoxins and evidence suggests that aromatic organic compounds of spices can control the production of aflatoxins. With a view to controlling aflatoxin production, the essential oils from Rosmarinus officinalis and Trachyspermum copticum L. were obtained by hydrodistillation. Antifungal activities of the oils were studied with special reference to the inhibition of Aspergillus parasiticus growth and aflatoxin production. Minimal inhibitory (MIC) and minimal fungicidal (MFC) concentrations of the oils were determined. T. copticum L. oil showed a stronger inhibitory effect than R. officinalis on the growth of A. parasiticus. Aflatoxin production was inhibited at 450 ppm of both oils with that of R. officinalis being stronger inhibitor. The oils were analyzed by GC and GC/MS. The major components of R. officinalis and T. copticum L. oils were Piperitone (23.65%), α-pinene (14.94%), Limonene (14.89%), 1,8-Cineole (7.43%) and Thymol (37.2%), P-Cymene (32.3%), γ-Terpinene (27.3%) respectively. It is concluded that the essential oils could be safely used as preservative materials on some kinds of foods to protect them from toxigenic fungal infections. [Copyright &y& Elsevier]

Background: To assess the results of patellar fracture treatment by tension band wiring Materials and Methods: This retrospective study was performed to evaluate clinical and radiological results of patellar fracture during past 6 years Results: Twenty four patients were participated in follow-up. Union was occurred in the mean time of 2.67±0.61 months. Falling down and direct trauma were the most common cause of fracture. Most common complications were thigh muscle atrophy and pin irritation. Excellent and good results in 87.5% and fair results in 12.5% of the patients were seen. Conclusion: Fixation of patellar fractures with tension band wiring was associated with a high rate of union. [ABSTRACT FROM AUTHOR]

Objective: The fracture of the tibial shaft is the most common fracture of long bone in human. Considerable proportion of this fractures are open fractures. Treatment of open fractures is one of the orthopedic problems. In the developing country with economic problem, early mobilization and returning to work may be important for people. We compared result of treatment with addition of autogenus bone graft in two different time periods in two groups. Methodology: In this study, 144 patients with open tibial fracture were randomly divided in two groups and were treated with autogenus bone graft at two different time intervals, the first group in the end of third week and second group in the end of sixth week. All Patients were followed up periodically in first two month every month and then every two weeks. T-test was used for comparison. SPSS ver. 13.0 (SPSS Inc, Chicago, IL, USA) was used for analysis. Results: The mean fracture healing time in the first group (with bone graft in 3rd week) was 14.24±4.4 week and in the second group (with bone graft in 6th week) was 16.4±5.4 week and the difference was statistically meaningful. Differences in the rate of delayed union and none union in two groups were statistically insignificant. In addition to time of bone graft, the age, gender, injury mechanism, fixation method, cigarette smoking and drug abuse were studied in two groups. The difference as regards these factors in two groups was statically insignificant. Conclusions: Achievement of autogenus bone graft in open tibial fracture at the end of third week causes reduction of union time from 16.4 week to 14.4 week without increment of deep infection. [ABSTRACT FROM AUTHOR]

Background: Burnout is a well-known consequence of chronic stress. Orthopedic surgery is among the most desired specialty among Iranian medical students. The nature of the job, the income, and the ability to deal with stress can all be stressful factors for orthopedic surgeons. Nonetheless, little is known about how these medical doctors work and live in Iran. The present study aimed to assess job satisfaction, engagement, and burnout among Iranian orthopedists., Methods: A nationwide online survey was conducted in Iran. Job satisfaction, engagement, and burnout were evaluated using the job description index (JDI), Utrecht Work Engagement Scale, and Maslach Burnout Scale. They were also asked some additional questions related to career choice., Results: A total of 456 questionnaires (41% response rate) were retrieved. Overall, 56.8% of the participants experienced burnout. The burnout levels significantly differed based on age, years from graduation, working in public hospitals, operating more than 10 patients in a week, monthly income, having less than two children, and being single ( P<0.05 ). They scored higher on work questions on the present job and jobs in general but lower scores on pay and opportunities for promotion., Conclusion: In a national study of orthopedic surgeons, their primary concern in JDI was "pay and promotion." Burnout was substantially associated with respondents' characteristics, such as younger age and having fewer children. This will lead to impaired performance, increased patient complaints, and the tendency to immigrate., Competing Interests: All authors listed above mentioned that there is no conflict of interest in this study, and no benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Background: Pseudomonas aeruginosa is considered as the most severe cause of infections in burn patients and pneumonia infections., Objective: To study the protective effects of recombinant protein vaccine harboring the PcrV of P. aeruginosa in the mouse model of burn and respiratory infections., Methods: Recombinant protein vaccine harboring the PcrV was expressed in the E. coli BL-21 strain. Mice were immunized with the purified recombinant protein, and the antibody titer was measured in the sera obtained from the immunized mice. Immunized and control mice were challenged by active and passive immunization. The microbial counts in the lung, skin, liver, spleen, and kidney were compared with the control mice., Results: Bioinformatics analysis indicated that the PcrV protein was conserved in 1552 clinical and environmental isolates. Also, the isoelectric point (pI), molecular weight, and Grand Average of Hydropathy (GRAVY) score were analyzed. Mice were injected with recombinant protein, and serum from immunized mice reacted strongly with recombinant antigen at a dilution of 1:64000. The survival rate of mice infected with 5xLD50 of the P. aeruginosa increased significantly up to 75% in the standard strains (PAO1 and PAK), and the number of bacteria, especially in the internal organs (kidney, spleen, and liver) significantly reduced compared to the mice immunized with placebo., Conclusion: Our results demonstrated that the PcrV protein could be an effective candidate vaccine for the generation of antibody response against P. aeruginosa infection.

Background: Hallux valgus deformity is a common chronic problem with a reported prevalence of 28.4% and its chief complaint is pain. Thus far, different surgical procedures with their proposed indications have been introduced. This study compared three current procedures, namely the chevron and scarf osteotomies and the McBride procedure., Methods: This retrospective cohort was conducted at the Ahvaz University of Medical Sciences on 44 patients with moderate hallux valgus deformity from 2010 and 2013. All of the patients underwent one of the three procedures (chevron, scarf or McBride). Preoperative and follow up radiographies were evaluated in terms of hallux valgus and intermetatarsal angle correction. The Foot and Ankle Disability Index was filled out to assess the functional outcome and the Visual Analogue Scale was used to evaluate pain. Also, satisfaction, aesthetics and the rate of recurrence was evaluated., Results: Hallux valgus angle and intermetatarsal angle correction were significantly higher in scarf, but not in chevron and McBride. However, from amongst the three procedures, there was no significant difference in terms of the Foot and Ankle Disability Index score, aesthetics, satisfaction level, pain score and recurrence rate., Conclusions: Considering that scarf osteotomy had better results in this study, we think that scarf osteotomy can be considered as a first choice for the treatment of moderate hallux valgus deformity.

Femoral shaft fracture in child is a disabling injury. Different methods of treatment can be used for femoral shaft fracture and depends on patient condition.THE AIM OF THE STUDY was to evaluate lower limb discrepancy following different method of treatment and possible related factors especially type of fractures. MATERIAL AND METHODS. This retrospective cross sectional study was carried out in Imam Khomeini and Razi Hospital from 2003-2007 on children admitted to hospital with femur fracture. All children aged <12 years of age with diagnosis of femoral shaft fracture were included in this study. Different methods of treatment were flexible intramedullary nailing, rigid intramedullary nailing with Steinmann pin and spica casting, spica casting and closed reduction, and ORIF with plate and screw. Distance from hip to knee for each patient was determined in scanograms. Sex, age, side of involvement, type of fracture were recorded for each case. Analysis was done with SPSS ver. 16.0. ANOVAs, Chi-Square, and t-Test were used with CI=95%. RESULTS. In this study, 253 cases (M=182, F=71) were included. One hundred forty-six (57.7%) cases had right involvement and 107 (42.3%) of cases had left side involvement. From all cases, 135(53.4%) cases had no changes in lower limb length. Eleven (4.3%) cases had lower limb shortening and 107(42.3%) cases had lower limb lengthening. Type A1 and type A2 showed greatest lower limb discrepency among cases who underwent ORIF with screw & plate fixation, and spica casting with closed reduction respectively (p<0.05). CONCLUSIONS. There is significant difference among surgical and non surgical treatment for LLD. Spica casting and closed reduction has the least changes compared to other methods. Sex, side of involvement, type of fracture, and location had no effect in post operative length changes. Type of fracture, only, has a role in screw and plate fixation group and this is may be due to the differences between A1 and A3 fractures. Most of the changes were seen in the range of 60 through 120 months of age. Most of the changes were in the range +10 to +20 mm.