OTHERS_CITABLE Factors Affecting the Outcome of Lumbar Canal Stenosis Surgery: A Two-year Follow-up Study Background: Lumbar Canal Stenosis (LCS) is the most common reason for spinal surgery in older patients. Identifying factors influencing the outcome of surgical management is important in clinical research. Objectives: This study aims to identify the factors affecting the outcome of surgical management for LCS. Materials & Methods: This prospective non-randomized cohort study was conducted at the spine center of Imam Khomeini Hospital in Tehran, Iran from March 2017 to January 2019 on 135 patients with symptomatic LCS, confirmed by MRI. Clinical and functional outcomes were measured using the 12-Item Short form Health Survey (SF-12), Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) the day before surgery, and 12 and 24 months after surgery. Radiographical parameters was assessed by measuring lumbar lordosis, sacral slope, pelvic tilt and pelvic incidence.  Results: Of 135 patients, 120 completed the follow-up. Patients treated surgically had significantimprovement in SF-12, ODI and VAS scores after 2 years of follow-up. Higher values of BMI(P=0.031), symptom duration >1 year (P=0.045 for SF-12, P=0.031 for ODI), and smoking(P=0.033 for SF-12, P=0.028 for ODI) were associated with poor outcome. Patients with higher pre-operative SF-12, ODI and VAS scores (P=0.007 for SF-12, P=0.003 for ODI, P=0.050 for VAS) and lower lumbar lordosis (P=0.055) showed significant improvement after surgery. Conclusion: Patients with LCS showed significant improvement in outcomes afterdecompression surgery. Higher values of BMI, symptom duration >1 year, and smokingare associated with poor outcome, while higher pre-operative disability score and lowerlumbar lordosis are associated with better outcome after surgery. http://cjns.gums.ac.ir/article-1-544-en.pdf 2022-07-01 143 148 10.32598/CJNS.8.30.4 Lumbosacral region Surgery Spine Disease Management Babak Mirzashahi 1 Department of Orthopedic Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0001-9246-1880 Furqan Mohammed Yaseen Khan 2 Department of Orthopedic Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0002-1280-6760 Saied Besharaty 3 Department of Orthopedic Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0002-1291-3670 Nima Bagheri 4 Department of Orthopedic Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0002-6458-1700 Amir Kian Moaveni 5 Department of Neurosurgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0003-0005-8328 Sadegh Hasani Satehi 6 Department of Orthopedic Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0003-2778-2965 Mohammad Zarei 7 Department of Orthopedic Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000‑0003‑1495‑7033
OTHERS_CITABLE Association Between Serum Electrolyte Disturbances and Glasgow Coma Scale Score in Patients With Diffuse Axonal Injury Background: Appropriate clinical measures to prevent secondary brain damage in traumatic brain injury are of critical importance. Objectives: This study aims to investigate the relationships between serum electrolyte disturbances and Glasgow Coma Scale (GCS) score in patients with Diffuse Axonal Injury (DAI) at the time of admission and discharge. Materials & Methods: In this retrospective cross-sectional study, we evaluated 101 patients with DAI having GCS score <15 admitted to Poursina Hospital in Rasht, Iran from 2019 to 2020. Based on the presence or absence of serum potassium (K), sodium (Na), magnesium (Mg), and zinc (Zn), disturbances on the first day of hospitalization, patients were divided into two study groups of with and without abnormal electrolyte levels. The GCS scores of the two groups at the time of admission and discharge were recorded and the relationship between electrolyte disturbances and GCS score was evaluated. Results: There were no significant differences in the mean GCS score at the time of admission and discharge between patients with and without disturbances in serum Na, K, Zn and Mg levels based on the crude analysis. Regarding the simultaneous effects of the study variables on the GCS score, only Mg serum level exerted a significant impact on the GCS score at the time of admission (P=0.041) and discharge (P=0.017). Conclusion: The GCS score in patients with DAI at the time of admission and discharge has an association with the Mg serum level but not with Na, K, and Zn levels. http://cjns.gums.ac.ir/article-1-545-en.pdf 2022-07-01 149 155 10.32598/CJNS.8.30.9 Diffuse axonal injury Electrolytes Glasgow Coma Scale Hamid Behzadnia 1 Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0001-7067-2409 Mesbah Dibavand 2 Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0001-7091-4498 Mohammadreza Emamhadi 3 Brachial Plexus and Peripheral Nerve Injury Center, Department of Neurosurgery, Guilan University of Medical Sciences, Rasht, Iran. AUTHOR https://orcid.org/0000-0002-9155-2702 Sasan Andalib 4 Department of Clinical Research, University of Southern Denmark, Odense, Denmark AUTHOR https://orcid.org/0000-0003-0904-0925 Mahsa Pakseresht Mogharab 5 Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. AUTHOR https://orcid.org/0000-0001-6812-872X Naghmeh Khoshsima 6 Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-8605-3220 Zoheir Reihanian 7 Guilan Road Trauma Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-8249-6614
OTHERS_CITABLE Comparison of Cognitive Function in Different Trimesters of Pregnancy Background: Although pregnancy is a normal function in women, it is considered as a stressful experience which is associated with many psychological and physical changes in pregnant women. Objectives: This study aims to investigate and compare cognitive function in different trimesters of pregnancy. Materials & Methods: This was a longitudinal cohort study. Participants were 76 pregnantwomen with a mean age of 30.09±6.23 years referred to Al-Zahra Hospital in Rasht, Iran during 2019-2020. Participants were assessed in three trimesters of pregnancy using the Wechsler Memory Scale (WMS) and Mini-Mental State Exam (MMSE). The multilevel mixed-effects linear regression and repeated measures ANOVA were used for data analysis. All analyses were done in SPSS software v. 19 and Stata v. 14. Results: The mean score of WMS was significantly lower in the third trimester (84.95±12.07) than in the first and second trimesters (89.34±13.13 and 88.72±13.24, respectively) (P=0.001). The results of linear regression analysis showed no significant difference in MMSE score between different trimesters of pregnancy (P>0.05), while the WMS score was significantly different between different pregnancy trimesters; the change in WMS score was statistically significant only in the third trimester (P= 0.04). Conclusion: No impairment in general cognitive function occur during pregnancy, but memory impairment may occur. In the third trimester, pregnant women have the poorest memory function. http://cjns.gums.ac.ir/article-1-546-en.pdf 2022-07-01 156 162 10.32598/CJNS.8.30.3.5 Cognition Pregnant women Pregnancy trimesters Memory Robabeh Soleimani 1 Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0003-1463-0380 Maryam Asgharnia 2 Mehr Fertility Research Center, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/: 0000-0002-6950-7542 Mir Mohammad Jalali 3 Otorhinolaryngology Research Center, Department of Otolaryngology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-7030-7070 Fatemeh Eslamdoust-Siahestalkhi 4 Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-7715-8389 Seyyed Mousa Kafi Masule 5 Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran AUTHOR https://orcid.org/0000-0001-8094-6725 Rahman Iranidoost-Haghighi 6 Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-4721-5514 Maryam Kousha 7 Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-8101-8258
OTHERS_CITABLE Atracurium as an Alternative to Succinylcholine in Electroconvulsive Therapy: A Randomized Clinical Trial Background: Electroconvulsive Therapy (ECT) is a successful treatment option for various psychiatric disorders. It is performed under general anesthesia where succinylcholine is the preferred muscle relaxant in this process. However its several contraindications and potential adverse effects, and the fact that it is not always available should be considered. Therefore, finding an effective and safe alternative is crucial. Objectives: This study aims to assess the safety and efficacy of atracurium in ECT. Materials & Methods: This single-blind clinical trial was conducted at Shafa hospital affiliated to Guilan University of Medical Sciences from November 2020 to April 2021. Participants were 67 eligible patients with ECT, randomly assigned into two groups receiving succinylcholine (0.5 mg/ kg), and atracurium (0.2 mg/kg). Seizure duration, hemodynamic parameters, the time to return to spontaneous breathing, and recovery time were assessed and compared between the two groups. Results: Seizure duration was longer in the succinylcholine group (P=0.071), while the time to return to spontaneous breathing (P=0.0001) and the recovery time (P=0.0001) were significantly longer in  the atracurium group. The trend of changes in the Mean Arterial Pressure (MAP) and Heart Rate (HR) were significant over time; however, the difference between the two groups was significant only in HR one minute after the seizure induction (P=0.001). None of patients was reported serious adverse effects. Conclusion: When succinylcholine can't be used, atracurium can be a safe alternative in the ECT process. http://cjns.gums.ac.ir/article-1-547-en.pdf 2022-07-01 163 170 10.32598/CJNS.8.30.2 Atracurium Electroconvulsive therapy Succinylcholine Abbas Sedighinejad 1 Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-3466-5751 Hossein Khoshrang 2 Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-9554-8495 Soheil Soltanipour 3 Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0001-7768-1121 Seyed Mahmood Rezvani 4 Student Research Committee, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran AUTHOR Robabeh Soleimani 5 Department of Psychiatry, Kavosh behavioral, cognitive and addiction research center, Shafa hospital, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0003-1463-0380 Mohammad Haghighi 6 Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0003-0331-1683 Siamak Rimaz 7 Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-5268-5297 Gelareh Biazar 8 Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-4571-6059
OTHERS_CITABLE Olfactory Dysfunction and Phantosmia in Patients With COVID-19 in Northern Iran Background: One of the most common symptoms of COVID-19 infection is Olfactory Dysfunction (OD). Objectives: This study aims to investigate OD and phantosmia in COVID-19 cases from northern Iran. Materials & Methods: In this cross-sectional study, participants were 400 patients with COVID-19 infection in Rasht, Iran from March 2019 to September 2020. All the patients were evaluated in terms of OD and then followed up for 3 months face-to-face, by telephone call, or online. Results: Among 400 patients, 37.75% had OD (19% hyposmia, 10.75% primary phantosmia, and 8% anosmia) during the initiation of the disease, but 121 (30.25%) including nearly 65% of anosmic and/or hyposmic cases reported phantosmia at different time intervals of followup visits. Moreover, 65.38% of patients reported acute onset of OD. The prevalence of OD was significantly higher in patients aged <40 years (P=0.001) and in females (P=0.002). OD improved in about 90% of patients within 3 months. Peripheral oxygen saturation was better in anosmic cases and C-reactive protein level was higher in normosmic cases at their first visit. No significant difference was found in terms of other laboratory results. Conclusion: OD is a common complication of COVID-19 infection, but seems not to be permanent. It is more common in young patients, females, and those with mild COVID-19 infection. http://cjns.gums.ac.ir/article-1-548-en.pdf 2022-07-01 171 177 10.32598/CJNS.8.30.8 Anosmia COVID-19 Olfaction Dysfunction Shadman Nemati 1 Oto-Rhinolaryngology Research Center, Department of Otorhinolaryngology, Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-5246-1023 Ali Faghih Habibi 2 Oto-Rhinolaryngology Research Center, Department of Otorhinolaryngology, Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0001-8386-5664 Makan Shalchizadeh 3 Oto-Rhinolaryngology Research Center, Department of Otorhinolaryngology, Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0001-6416-669x Tofigh Yaghubi Kalurazi 4 Department of Health, Nutrition and Infectious Diseases, School of Medicine Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-6042-2331 Heydar Ali Balou 5 Department of Internal Medicine, School of Medicine, Gastrointestinal and Liver Disease Research Center, Guilan University of Medical, Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0003-0562-3859 Mehryar Mashouf 6 International Fellow of the American Association of Neurological Surgeons, Arya Hospital, Rasht, Iran AUTHOR https://orcid.org/0000-0002-4245-4495 Seyed Hamidreza Bagheri 7 Oto-Rhinolaryngologist, Pars Hospital, Rasht, Iran AUTHOR https://orcid.org/0000-0002-6211-2118 Vahid Aghsaghloo 8 Oto-Rhinolaryngology Research Center, Department of Otorhinolaryngology, Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0003-4631-9917 Yasaman Hosseinzadeh Lakhani 9 Oto-Rhinolaryngology Research Center, Department of Otorhinolaryngology, Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran AUTHOR https://orcid.org/0000-0002-7277-1686
OTHERS_CITABLE Functional Balance Tests for Patients with Multiple Sclerosis: A Review Study Background: Knowledge of the functional balance tests for the patients with Multiple Sclerosis (PwMS) may provide useful and accurate information about the balance function of these patients under different situations. Objectives: This study aims to review the functional balance tests for PwMS. Materials and Methods: This is a systematic review. The search was conducted in PubMed, Scopus, LILACS, CINAHL, CENTRAL, Web of Science, PEDro, and Google Scholar databases on relevant studies published until November 2021. Results: Twenty-five articles and 25 different tests were found to evaluate the functional balance of PwMS. It was found that the studies used 6 tests to assess the static balance, 13 tests to assess dynamic balance, and 6 multi-item tests to assess functional balance in PwMS. Single-leg stance test, balance error scoring system test and steady stance test is a test battery for static balance; six-spot step test, timed up and go test, and figure-of-8 hop test are better for dynamic balance, and the balance evaluation systems test is a better multiitem test to assess the balance of PwMS by examining the postural control components. Conclusion: Single-limb standing test, balance error scoring system (BESS) test and steady stance test provide accurate data on static balance; six spot step test, Timed Get up and go test and figure-of-8 hop test provide valuable data on the dynamic balance and Balance Evaluation Systems Test (BESTest) is a valid test to assess the balance of PwMS from the perspective of the review of posture control components.   http://cjns.gums.ac.ir/article-1-549-en.pdf 2022-07-01 178 187 10.32598/CJNS.8.30.7 Multiple Sclerosis Postural balance Neuropsychological tests Parisa Sedaghati 1 Department of Corrective Exercises and Sports Injury, Faculty of Physical Education & Sport sciences, University of Guilan, Rasht, Iran AUTHOR https://orcid.org/0000-0003-3105-7520 Gita Asgharzadeh 2 Department of Corrective Exercises and Sports Injury, Faculty of Physical Education & Sport sciences, University of Guilan, Rasht, Iran AUTHOR https://orcid.org/0000-0002-3992-7140 Hamed Zarei 3 Department of Corrective Exercises and Sports Injury, Faculty of Physical Education & Sport sciences, University of Guilan, Rasht, Iran AUTHOR https://orcid.org/: 0000-0001-9138-9346
CASE_STUDY Multiple Sclerosis Diagnosed in a Woman With Von-Willebrand Disease: A Case Report Background: Von-Willebrand Disease (VWD) is the most common inherited bleeding disorder with an autosomal inheritance pattern. Multiple Sclerosis (MS) is a neurological disease, causing neurodegeneration and demyelination of the central nervous system through autoimmune mechanisms, and is a major cause of non-traumatic disabilities in youths. Some studies have shown the higher plasma activity of Von-Willebrand Factor in the active phase of MS. However, we could not find any study reporting co-occurrence of VWD and MS. Case Presentation and Intervention: In this case report, we present a woman with VWD who had optic neuritis 8 years ago and a new onset right-side hemiparesis. She was finally diagnosed as a new case of MS. Conclusion: There is a case of both VWD and MS; however, further investigation is needed regarding the association of VWD and MS. http://cjns.gums.ac.ir/article-1-550-en.pdf 2022-07-01 188 191 10.32598/CJNS.8.30.3 Von-Willebrand diseases Multiple sclerosis Von-Willebrand Factor Mohsen Farjoud Kouhanjani 1 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran AUTHOR https://orcid.org/0000-0001-5877-7865 Shirin Haghighat 2 Department of Hematology and Medical Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran AUTHOR https://orcid.org/0000-0002-3847-9577 Maryam Poursadeghfard 3 Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran AUTHOR https://orcid.org/0000-0003-2375-6014
CASE_STUDY Immune-mediated Necrotizing Myopathy With Increased Creatine Phosphokinase and Positive Signal Recognition Particle: A Case Report Background: Knowledge about Immune-Mediated Necrotizing Myopathy (IMNM) has received significantly attention in recent years. In this study, we report a rare case of IMNM with increased Creatine Phosphokinase (CPK) and positive Signal Recognition Particle (SRP). Clinical Presentation and Intervention: The case was a 67-year-old male patient referred to Firozgar hospital affiliated to the Iran University of Medical Science, Tehran, Iran in June 2018 with a chief complaint of pain in the proximal lower extremity. According to Medical Research Council Scale for muscle strength, the motor function of proximal upper extremities was 4/5 and for the proximal of the lower extremities, it was 3/5. Laboratory findings showed an increase in CPK, CK-MB, lactate dehydrogenase, creatinine, alanine aminotransferase, aspartate aminotransferase and aldolase levels. Six days after admission, autoantibody test was requested which showed positive SRP. In muscle biopsy, the myopathic atrophy with multiple necrotic and many degenerative/regenerative fibers was associated with mild endomysial fibrosis, and no inflammation was observed. Two g/kg dose of Intravenous Immunoglobulin (IVIG) was administrated after diagnosis of IMNM. Prednisone 50 mg/day orally, calcium vitamin D daily, pantoprazole 40 mg/day, physiotherapy, and occupational therapy were administrated for after discharge. Conclusion: Reporting a case of anti-SRP associated IMNM and reviewing its pathophysiology, diagnosis and treatment options can help increase the physicians’ knowledge of this rare and debilitating condition. http://cjns.gums.ac.ir/article-1-551-en.pdf 2022-07-01 192 195 10.32598/CJNS.8.30.1 Muscular diseases Creatine kinase Signal recognition particle Seyed Mohammad Masoud Hojati 1 Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran AUTHOR https://orcid.org/0000-0002-6925-6632 Payam Saadat 2 Clinical Research Development Unite of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran AUTHOR https://orcid.org/0000-0002-5150-4757 Shayan Alijanpour 3 Students Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0001-7970-8009