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Post-stroke dysphagia is a prevalent, life threatening condition. Scientists recommended implementing behavioral therapies with new technologies such as transcranial direct current of stimulation (TDCS). Studies showed promising TDCS effects, and scientists suggested the investigation of the effectiveness of different montages. Supramarginal gyrus (SMG) is important in swallowing function. Our study aimed to investigate the effectiveness of stimulating SMG in improving post-stroke dysphagia. Forty-four patients finished the study (a randomized, double-blind one). All of them received behavioral therapy. The real group received anodal (2 mA, 20 min) stimulation on the intact SMG, and the sham group received the same for 30 s (5 sessions). Patients were assessed with Functional Oral Intake Scale (FOIS) and Mann Assessment of Swallowing Ability (MASA) after treatment and at one-month follow-up. The results showed that the difference between groups at baseline was not significant. According to MASA both groups improved significantly during the time (p-value 0.001). The improvement in the real group was significantly higher than in the sham group after treatment (p-value = 0.002) and after one-month follow-up (p-value 0.001). According to FOIS, most of the patients in the real group (72.70%) reached level 6 or 7 after one-month follow-up which was significantly higher than the sham group (31.80%, p-value = 0.007). In conclusion, TDCS applied to the scalp's surface associated with SMG localization may improve swallowing function in the stroke patients with dysphagia.

Background: Some patients with a confirmed diagnosis of carpal tunnel syndrome (CTS) on clinical examination and electrodiagnostic testing (EDX) may also have one or more clinical features of pronator syndrome (PS). However, the EDX is negative for PS. We label these patients as suspected concurrent carpal tunnel and pronator syndrome (CCPS). We suspect that this is a presentation of reverse double crush syndrome that occurs when a symptomatic distal compression neuropathy converts an asymptomatic proximal compression into a symptomatic one. We believe both compressions can be relieved by decompressing the median nerve only at the wrist. The aim of our study is to determine whether carpal tunnel release (CTR) is an effective treatment for patients suffering from CCPS. Methods: This is a prospective, cohort study of the outcomes of CTR in two matched groups with 37 patients in each group. Group A included patients with suspected CCPS and group B included patients with isolated CTS. All patients were evaluated pre-operatively and 1 year after surgery using the Boston Carpal Tunnel Questionnaire (BCTQ). At one year, patients were also assessed for residual symptoms and positive provocative tests. Results: A significant improvement in the symptom and functional severity scales (SSS and FSS) of the BCTQ was noted in both groups. The degree of improvement in SSS was similar in both groups; however, group A showed a greater improvement in FSS. This could be attributed to higher pre-operative values in some items of FSS in group A. No patients in either group had residual symptoms severe enough to necessitate further treatment. Conclusion: The outcomes of CTR are similar in patients with isolated CTS and suspected CCPS and a CTR may be sufficient to address symptoms of CTS and PS in patients with CCPS. Level of Evidence: Level II (Therapeutic)

Lumbosacral Spinal Stenosis (LSS) is a degenerative spine disease and a major cause of pain and disability, especially in geriatrics. Primary symptom control in patients with LSS includes conservative treatment and non-surgical methods. In this study, we aimed to compare the effect of steroid injection via epidural and gluteal trigger point techniques.Patients aged 40-75 years old who had pain and other clinical signs of spinal stenosis in the last 6 months were included in our study and divided into two groups of gluteal trigger point (TP) or epidural steroid injection (ESI). The patients were evaluated based on the visual analog scale (VAS), Roland-Morris Disability Questionnaire (RDQ), Oswestry Disability Index (ODI), and the Quebec back pain disability scales during their pre-injection period and 2 weeks after follow-ups till 8 weeks. A P value of less than 0.05 was considered significant.A total of 44 patients were included in our study. The TP group had a significant decrease in comparison with their follow-ups; however, in the epidural group, the significant decrease was only observed compared to the pre-injection period and the scores did not have any significant decreases after the second week regarding the ODI, RQM, and VAS scales. The TP group demonstrated significantly higher scores of decreases of ODI and Quebec score compared to the epidural group at weeks 4 and 8. Regarding RQM, the TP groups demonstrated significantly higher scores of decreases compared to the epidural group at weeks 2, 4 and 8. (Both epidural and TP steroid injection significantly reduced the patients' pain and improved their QoL and function; however, more satisfactory results were observed in the TP group during the patients' follow-ups, while the epidural group demonstrated only statistically significant improvement during the short-term follow-up.

Muscular hypotonia is a feature of Down syndrome (DS), and it affects the tongue and lips. A study on oral dysfunction in children with DS concluded that most of them did not have the tongue strength for completing the oral phase of swallowing. Recognizing the weakness of the oral muscles and improving its motor function positively affects mastication and swallowing, and prevents complications. This cross-sectional study aimed to measure the lip and tongue strength and endurance of children with DS and their typical peers, and compare these two groups with each other using Iowa Oral Performance Instrument (IOPI). Eight children with DS and 33 typical children aged 8–13 years were enrolled in this study. To examine the effect of age on the tongue strength and endurance, we divided the children into three groups of 8–9, 10–11, and 12–13 years old. The results showed that both anterior and posterior tongue strength were significantly lower in children with DS (p = 0.004 and 0.003). But, it was not the case with tongue endurance. Also, in 10–11 years old age group, the mean posterior tongue strength and in 12–13 years old age group the lip endurance was significantly lower in children with DS (p = 0.05 for both). Lips strength and endurance were both remarkably lower in children with DS (p = 0.004 and 0.02). In this study, tongue, and lip strength and endurance in both children with DS and typical ones were measured with IOPI for the first time. Moreover, it provided quantitative data on the strength and endurance of the muscles of the tongue and lips, which can contribute to future studies.

Lumbosacral spinal stenosis (LSS) is the narrowing of the lumbar spinal canal. LSS usually happens in older people who do not have the proper physical condition to undergo surgery. Therefore, minimally invasive methods such as Ozone therapy and epidural injection can be used in these patients.The objective this study was to compare the effect of caudal epidural steroid-hyaluronidase injection with paravertebral intramuscular Ozone injection on reducing pain in patients with LSS.A total of 30 patients suffering from LSS randomized to two groups. Group A (Within-group changes showed significant improvement in VAS, ODI, RMQ, and QBPDS scores in both groups from pre-treatment to end of follow-up (allBoth intramuscular injection Ozone and caudal epidural injection steroid- hyalaz significantly reduce pain. The existing data suggested 8 weeks improvements in pain severity are more significant for paravertebral Ozone injection, compared to caudal epidural steroid-hyaluronidase injection.

Introduction. Knee osteoarthritis (KOA) is one of the most common degenerative diseases that lead to pain and disability. Oral NSAIDs are effective drugs used to alleviate symptoms in patients with KOA, but they have several important complications, especially in the elderly. In this study, we evaluated the effectiveness of mesotherapy on pain reduction and improvement of functioning in patients with KOA. Methods. Sixty-two patients with KOA, grade 2-3 of the Kellgren–Lawrence scale, were randomized into two groups: the mesotherapy group, in which two injections were applied with piroxicam at a 10-day interval, and the oral group, in which piroxicam was prescribed for 10 days. The patients were evaluated before the treatment and 2, 4, and 8 weeks after it using the Visual Analogue Scale (VAS), Oxford Knee Scare (OKS), and Western Ontario McMaster University Osteoarthritis Index (WOMAC, Persian version). Results. There was no significant difference in demographic characteristics and baseline pain and function scores between the two groups. After 2, 4, and 8 weeks of follow-up, VAS, WOMAC, and OKS scores significantly improved in both groups (in the mesotherapy group: p value p value p value p value p value p value Conclusion. Mesotherapy is an effective and safe treatment modality in patients with mild-to-moderate KOA in the short term. This trial is registered with IRCT2017052434113N1.

Background Etiological factors involved in chronic prostatitis (CP) type IIIb and chronic pelvic pain are not sufficiently understood; however, the nervous system has a significant role in the generation and maintenance of chronic pelvic pain. This study was designed to evaluate the sympathetic skin response (SSR) in men with CP type IIIb compared to normal population. Patients and Methods For two years, about 14 patients suffering from CP type IIIb according to NIH-CPSI and 26 healthy control men were enrolled in this study. SSR was performed in all the subjects with a standard method. Bilateral palmar and plantar latency and amplitude of SSR were recorded in response to the median and tibial nerve electrical stimulations. SSR is considered abnormal when the latency is prolonged, and the amplitude reduced. Results SSR latency in the left and right median nerve was significantly prolonged in the patient with CP type IIIb group compared to the control group (p=0.039 and 0.006, respectively). Additionally, the amplitude was reduced in patients with CP type IIIb group compared to the control group in the right tibial nerve (p=0.017). Conclusion Sympathetic skin response may be a helpful diagnostic test for men with chronic prostatitis type IIIb. However, this observation needs to be validated in a large sample cohort study with long-term follow-up.

Purpose. The high prevalence of knee osteoarthritis (KOA) is a major cause of disability among elders. NSAIDs are recommended to reduce KOA patients’ symptoms, but their adverse side effects limit their consumption. In this study, we evaluated the effectiveness of Harpagophytum procumbens compared to a routine NSAID (meloxicam) on pain reduction and functional improvement of KOA patients. Patients and Methods. Sixty patients aged 40–60 years, with painful knee osteoarthritis (grades 1-2 of Kellgren–Lawrence scale) for at least one month, were randomized into two groups with different routine medication periods. Group A consisted of daily administration of two Harpagophytum procumbens (Teltonal) tablets (2 ∗ 480 mg) for one month, and group B consisted of daily administration of meloxicam (15 mg) for ten days. The visual analogue scale (VAS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), Oxford Knee Scale (OKS), and patient satisfaction were evaluated at the baseline and after 2, 4, and 8 weeks. Results. There were no statistically significant differences between demographic characteristics, pain intensity, and function scores before the treatment. VAS, OKS, and WOMAC scores improved in both groups p < 0.001 over time, but no significant superiority was shown; after 8 weeks: VAS (Teltonal (4.80 ± 1.80) vs. meloxicam (5.06 ± 1.43)), OKS (34.06 ± 4.38, 34.00 ± 7.87, Teltonal vs. meloxicam, respectively), and WOMAC scores (25.73 ± 10.11 Teltonal vs. 26.20 ± 13.94, meloxicam). Conclusion. Teltonal is an effective and safe treatment in patients with mild KOA in the short term. However, no significant superiority was shown in using Teltonal or meloxicam, in people who cannot take NSAIDs, it can be a good alternative, although difference in medication periods should be considered.

Background: Carpal tunnel syndrome (CTS) is a common work-place musculoskeletal disorder, and dentists are a high-risk group due to their work conditions. This study aims to obtaining a full understanding of knowledge, attitude and practice (KAP) of CTS among Dentists in Shiraz, Iran. Methods: Between Jun,2019 and Dec,2019; A researcher-made questionnaire was developed for this cross-sectional pilot study in order to evaluate the KAP of dentists regarding CTS. Participants were recruited to fill out the questionnaire. The participants were recruited using convenient sampling from dentists working. A 51 dentists were completed the survey. Ethical approval to conduct this study was obtained. Results: About 31 (60.8%) respondents were female and 20(39.2%) were male. 54.9%. of the participants were aged below 33 years. 66.7%. of dentists had less than 10 years of work experience. No statistically significant correlation was observed between age, and number of years of work experience and KAP scores. But there was significant correlation between gender and knowledge (p =0.04). The mean scores of knowledges were 3.7 ±1.3 which was low to average regarding the prevention and treatment of CTS. The mean scores of attitudes and practice were 10.9 ±3.2 and 7.9 ± 2.1, respectively. Which represent a positive attitude and practice towards regarding the prevention and treatment of CTS. There was a significant correlation between attitude and practice among dentists with p =0.001Conclusions: Most dentists in this study had low to average knowledge, high attitudes, and high practice scores of the prevention and treatment of CTS.

Background: General practitioners (GP) are the keystones in the process of referring patients in Iran. To refer patients to rehabilitation experts effectively and accurately, GPs need to be equipped with knowledge and understanding of physical medicine and rehabilitation (PMR) and its roles and have a positive attitude toward collaborating with rehabilitation teams. Objectives: The current study aimed at evaluating the knowledge, attitude, and practice (KAP) of GPs in Shiraz, Iran, toward the rehabilitation field and teamwork. Methods: The current cross sectional study assessed the KAP of GPs working in public and private health sectors in Shiraz, Iran, in 2018 via a researcher-made questionnaire. Participants were recruited using the stratified random sampling method. Results: A total of 200 GPs completed the study. The mean score of knowledge was 13.54 ± 2.68 (ranging from 0 to 24), and the mean score of attitude 10.84 ± 2.47 (ranging from 0 to 20). Regarding practice, none of the participants (0%) had a monthly average of more than five referrals to a physiatrist. Thirty-eight (19%) respondents were interested in choosing PMR as a specialty. Conclusions: According to the current study findings, GPs in Shiraz, Iran, are not equipped with adequate knowledge of rehabilitation and have a moderate attitude toward collaborating with a rehabilitation team. GPs rarely use PMR consultations for their patients’ complications. Policymakers should advocate for a higher level of collaboration between GPs and rehabilitation teams and find ways to better familiarize healthcare providers with PMR.

Background. Knee osteoarthritis is a common disease that is associated with chronic pain and disability in patients. Prolotherapy is a complementary therapeutic approach for improving pain and function in patients with osteoarthritis. We aimed to compare the effect of hypertonic saline with ozone plus hypertonic saline in improving the symptoms of osteoarthritis in the patients. Materials and Method. In this clinical trial, thirty-four adults with painful primary knee osteoarthritis for at least three months were randomized to two groups: ozone plus hypertonic saline 5% and hypertonic saline 5% alone. Prolotherapy and thrice follow-up with two-week intervals were done. The outcome measures included Oxford Knee Scale (OKS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS), which were obtained from the patients before the injection and after the 2nd and 4th weeks after the start of the study. Results. The mean age of the participants was 60.12 ± 7.54 years. There were no statistically significant differences between demographic characteristics before the injection between the two groups ( p > 0.05). The results showed that VAS and OKS values decreased over time ( p p = 0.734 and p = 0.734, respectively). Both interventions improved the mean values of WOMAC pain, WOMAC stiffness, WOMAC act, and WOMAC total. However, there was no significant difference in WOMAC pain reduction rate ( p = 0.465), WOMAC stiffness rate ( p = 0.656), WOMAC act rate ( p = 0.376), and WOMAC total rate between the two methods ( p = 0.528). Conclusion. The results showed that intra-articular prolozone therapy and hypertonic saline injection can lead to improvement of pain and function in patients with knee osteoarthritis at the same status without any significant difference.

Muscular hypotonia is a feature of Down syndrome (DS), and it affects the tongue and lips. A study on oral dysfunction in children with DS concluded that most of them did not have the tongue strength for completing the oral phase of swallowing. Recognizing the weakness of the oral muscles and improving its motor function positively affects mastication and swallowing, and prevents complications. This cross-sectional study aimed to measure the lip and tongue strength and endurance of children with DS and their typical peers, and compare these two groups with each other using Iowa Oral Performance Instrument (IOPI). Eight children with DS and 33 typical children aged 8-13 years were enrolled in this study. To examine the effect of age on the tongue strength and endurance, we divided the children into three groups of 8-9, 10-11, and 12-13 years old. The results showed that both anterior and posterior tongue strength were significantly lower in children with DS (p = 0.004 and 0.003). But, it was not the case with tongue endurance. Also, in 10-11 years old age group, the mean posterior tongue strength and in 12-13 years old age group the lip endurance was significantly lower in children with DS (p = 0.05 for both). Lips strength and endurance were both remarkably lower in children with DS (p = 0.004 and 0.02). In this study, tongue, and lip strength and endurance in both children with DS and typical ones were measured with IOPI for the first time. Moreover, it provided quantitative data on the strength and endurance of the muscles of the tongue and lips, which can contribute to future studies.

Dysphagia is a term that is used for the difficulty in moving liquid/food from mouth to the stomach. Dysphagia is very common in elders, which makes them susceptible to malnutrition, infection, institutionalization, and death. Consequently, it is categorized as a geriatric syndrome. Therefore, multidisciplinary teams need to work together to determine the correct etiology and implement an appropriate care plan. Oral care is crucial in managing dysphagia and dental hygienists and dentists serve as the key members. In some regions, the roles of dental professionals are not fully understood. Hence, the aim of this article is to review oral problems that are prevalent in older people and their relationship to dysphagia as well as the roles of dental professionals in dysphagia diagnosis and management.

Background. Multiple sclerosis (MS) threatens the patients’ independency and ability to effectively participate in the society. The aim of this study was to determine the correlation between using social networks on the general health of multiple sclerosis patients. Methods. This study was performed on 80 MS patients referring to Shiraz University of Medical Sciences, Chamran, and Imam Reza Hospital in 2017, whose condition had improved and were treated by a specialist physician. Tools for data collection were general health questionnaire (GHQ-28) and social networks use questionnaires. Results. Amongst the 80 individuals with MS, 65 (81.3%) were female and 15 (18.8%) were male. Our results suggest that patients with higher levels of education had higher levels of health (P=0.01). Telegram and WhatsApp, respectively, had a positive correlation with general health (P=0.007, P=0.007), anxiety (P=0.003, P=0.028), and social dysfunction (P=0.007, P=0.007). WhatsApp with 33.64% was the most popular application among MS patients. The correlation between general health and duration of using social networks was not statistically significant (r=0.22, P=0.06). Also, no significant correlation was found between the duration of using social networks and the general health (P=0.62). Conclusion. Our findings suggest that social networks, especially Telegram and WhatsApp, had a positive correlation with general health, anxiety, and social dysfunction of patients. Therefore, the use of social networks can be considered as a suitable option in reducing the aforementioned concerns among patients with MS. On the other hand, general health and mood status might as well influence the use of social network in MS patients.

Introduction The proportion of elderly people around the world is increasing. One of the key factors of this longer life is healthy aging. Iran is one among many countries with a changing demographic profile, due to the rapid increase in the aging population. One of the health threatening problems of elderly people is dysphagia. Dysphagia can affect between 13–91% of elderly people around the world. The purpose of this article is to review the status of oropharyngeal dysphagia and its related health problems in Iran. Methods Databases in the English and Farsi languages were used. The inclusion criteria were relevant articles to dysphagia which had available online abstract or full text, were carried out in Iran and participants were aged ≥50 years. All duplicate articles, those restricted to esophageal dysphagia and case reports were excluded. Results A total of 2482 documents were screened. Only 3 articles were identified that were related to dysphagia in elderly people in Iran. There was very limited information about the swallowing status of the elderly in Iran. The data in this population showed: 41.2% of nursing home residents, 50% of stroke patients suffer from dysphagia. Conclusions The health status of elderly people in Iran, and dysphagia related health problems such as malnutrition and oral health is poor. Therefore, there is a need to consider this problem in a systematic multidisciplinary manner. Hence, policymakers, researchers, health care providers, industries and society should work together to improve the quality of care for these people.

Despite the remarkable burden of dysphagia, appropriate multidisciplinary management is lacking in Iran and patients are often deprived of effective treatments. Obtaining a full understanding of knowledge, attitude and practice (KAP) of healthcare providers is necessary to determine the gaps in improvement of the quality of care for dysphagic patients. A questionnaire was designed covering demographic information and the parameters of KAP. Face and content validity were determined. Test–retest reliability confirmed that the questionnaire scores are stable over time (r = 0.77, p value

Background and aim: Peripheral neuropathy is a disorder with often unknown causes. Some drugs, including statins, are proposed to be among the causes of peripheral neuropathy. This study aimed at evaluating this condition by electrodiagnostic study among patients who had received statins. Methods: This case-control study was conducted in Shiraz, Iran in 2015, and included 39 patients aged 35-55 who had received statins for at least 6 months, and 39 healthy matched controls. Using electrodiagnosis, the sensory and motor wave features (amplitude, latency and nerve conduction velocity) of the peripheral nerves (Median, Ulnar, Tibial, Sural, and Peroneal) were evaluated among the subjects. Data were analyzed using SPSS software and p

Background: Osteoarthritis is a common degenerative disease. Prolotherapy is an alternative therapy used in multiple musculoskeletal disorders. Objective: To compare the effectiveness of intra-articular dextrose injection versus peri-articular prolotherapy in patients with knee osteoarthritis (KOA). Methods: Fifty-two adults with painful primary knee osteoarthritis for at least three months were randomized to intra- and peri-articular injection groups. Prolotherapy was done twice with two week intervals. The outcome measures included the Oxford Knee Scale (OKS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), and Visual Analogue Scale (VAS), which were obtained from patients before the first injection at the base line and after the second injection at the fourth and eighth weeks. Results: There were no statistically significant differences between demographic characteristics; before the injection, pain intensity, OKS, and WOMAC scores were approximately equal between the two groups. After dextrose prolotherapy, VAS, OKS, and WOMAC scores improved from baseline through the fourth and eighth weeks in both groups without any superiority between the two methods of injections (p

Introduction: Restless leg syndrome (RLS) is a neurological disorder that causes an irresistible urge to move the legs often associated with an unpleasant sensation. Due to some common presentation...

This letter is written according to stoichiometric calculation doubt about the article entitled "effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia" by Sdravou et al.

Objective: The focus of attention was the prevalence of depression among cancer patients using social networks. An attempt was made to determine if social media could help cancer patients overcome their stress and depression, causes of serious emotional and mental problems for them and their families. Methods: To ascertain the prevalence of depression among cancer patients with reference to use of social networks, 316 cancer patients in the Association of Cancer Patients and cancer-related centers in Tehran at 2015 were evaluated. Depression was measured using the Beck Depression Inventory. Data were analyzed by the Chi-square test with SPSS software. Results: Using the Beck criteria, 61% (N=192) of patients were depressed. Interestingly, a significant difference was observed between depression in users and non-users of social networks (p=0.001), 33.9% and 66.1% being affected, respectively. Conclusion: These results verified a high incidence of depression in cancer patients, but a beneficial effect of social network use. Therefore access to social networks should be promoted for prevention and amelioration of depression. Moreover, it is recommended that particular attention be paid to the patient sex and educational level in designing counseling and psychological skill training programs.

The diagnostic gap for rare neurodegenerative diseases is still considerable, despite continuous advances in gene identification. Many novel Mendelian genes have only been identified in a few families worldwide. Here we report the identification of an autosomal-dominant gene for hereditary spastic paraplegia (HSP) in 10 families that are of diverse geographic origin and whose affected members all carry unique truncating changes in a circumscript region of UBAP1 (ubiquitin-associated protein 1). HSP is a neurodegenerative disease characterized by progressive lower-limb spasticity and weakness, as well as frequent bladder dysfunction. At least 40% of affected persons are currently undiagnosed after exome sequencing. We identified pathological truncating variants in UBAP1 in affected persons from Iran, USA, Germany, Canada, Spain, and Bulgarian Roma. The genetic support ranges from linkage in the largest family (LOD = 8.3) to three confirmed de novo mutations. We show that mRNA in the fibroblasts of affected individuals escapes nonsense-mediated decay and thus leads to the expression of truncated proteins; in addition, concentrations of the full-length protein are reduced in comparison to those in controls. This suggests either a dominant-negative effect or haploinsufficiency. UBAP1 links endosomal trafficking to the ubiquitination machinery pathways that have been previously implicated in HSPs, and UBAP1 provides a bridge toward a more unified pathophysiology.