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BACKGROUND: Several heat indices have been developed in industrial health, but each has its limitations. OBJECTIVE: The objective of this article is to determine the validity and applicability of a temperature-humidity index, named Humidex compared with the Standard Wet-Bulb Globe Temperature (WBGT) index (ISO 7243). METHOD: This cross-sectional study was conducted in the summer of 2019, in a tile factory in the west of Iran. 59 measurements were performed in 8 different workstations. Environmental parameters including natural wet bulb temperature (Tnw), dry bulb temperature (Ta), globe bulb temperature (Tg), and heat stress (WBGT) were measured. Humidex was calculated according to an equation. SPSS software (version 16) was used for data analysis. RESULTS: There was a high correlation between Humidex and WBGT in the estimation of heat stress (R=0.912, P<0.001). The Kappa Coefficient between Humidex and WBGT was 0.298, P=0.001. CONCLUSION: Humidex is highly correlated with WBGT. Humidex can be used instead of the WBGT index, especially in hot and humid environments.

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BACKGROUND: Several researchers have investigated the clinical outcomes in patients with rotator cuff tear who compared open and arthroscopic surgeries; however, there are limited studies that have compared the outcomes of arthroscopic and open rotator cuff repair. This study was aimed to compare the clinical outcomes of the patients who underwent rotator cuff repair using either arthroscopic or open repair techniques. MATERIALS AND METHODS: This is a prospective cohort study in which 51 patients who underwent either open or arthroscopic rotator cuff repair were studied. Twenty-six patients underwent open repair, and 25 patients had an arthroscopic repair. Patients were followed for 6-36 months. The outcome of the two groups was evaluated using the Universal California Los Angles (UCLA) score. RESULTS: The mean tear size was 4.93 ± 2.3 cm2 in the open surgery group and 4.99 ± 2.3 cm2 in the arthroscopic group (P = 0.93). All patients showed significant improvement in their scores for pain, active forward flexion, active abduction, and function at the time of follow-up. Improvement in scores within each group was significant, but the comparison of the two techniques was not statistically significant in pain, active abduction, active forward flexion, and UCLA, but in function, the open surgery group was superior (P < 0.05). CONCLUSION: This study revealed that short-term outcomes for arthroscopic and open cuff repair are similar, except in function, which was significantly better in the open surgery.

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BACKGROUND: The main purpose of this study was to determine the relationship between serum vitamin D and the status of bone mineral density in patients with low-energy hip and distal radius fracture. METHODS: This retrospective case-control study was performed between January 2013 and January 2014. Participants aged 55 years or older were divided to case group including 85 patients with low-energy hip fracture and 83 patients with low-energy distal radius fractures, and 82 subjects as a matched control group. Bone mineral density was measured with dual energy X-ray absorptiometry and serum sample was obtained to check vitamin D, calcium, phosphorus, alkaline phosphatase, and protein. RESULTS: Study subjects for final evaluation consisted of 78 in hip and distal radius fracture groups and 80 in control group. There were no significant differences in the mean serum levels of calcium, phosphorus and alkaline phosphatase between the three groups. The overall mean serum level of vitamin D3 was significantly different among the three groups. Similar results were observed with hip and spine t-score between the groups. CONCLUSION: There is not only a direct relation between serum vitamin D and the risk of low energy hip and distal radius fractures, but also a significant relation between low bone density in hip and spine area with low serum calcium was observed.

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PURPOSE: Severe post-operative pain is one of the main problems after total knee arthroplasty. In this study, we investigated the effect of a peri-articular multimodal drugs injections pre-emptively on post-operative pain control and knee functions following total knee arthroplasty. METHODS AND MATERIALS: This study was a double-blind randomized clinical trial. Eligible cases including 137 patients-aged 30 to 80 years old-were randomly divided into one of two groups: the drug group received a cocktail consisting of bupivacaine hydrochloride, morphine sulphate, epinephrine, and ketorolac. The control group received epinephrine only. The injections were given 15 minutes before incision. Joint range of motion (ROM) and the severity of pain by using visual analog scale (VAS) of 1 to 10 and patient's facial expression, were assessed in the pre-operative visit, after 24 hours, 48 hours, and six weeks after operation. Knee Society score (KSS) was recorded before the operation, six weeks, and six months after the operation for each patient. RESULTS: The data of VAS showed no significant difference between the groups before operation but there was statistically significant difference between the two groups at 24 hours, 48 hours, and six weeks after the operation. In KSS, difference was not significant between the two groups before the operation and six months after surgery while our results showed a statistically significant difference between groups six weeks after the operation. In ROM, there was no significant difference between the groups before operation. There was a statistically significant difference between the two groups at 24 hours, 48 hours and six weeks after the operation. Complications were recorded at six weeks after surgery. CONCLUSION: Peri-articular multimodal injection including bupivacaine, morphine, and ketorolac preferably with pre-emptive injection method provided proper post-operative pain relief, less opioid consumption, and better early rehabilitation following TKA at 48 hours after surgery. LEVEL OF STUDY: Level I.

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INTRODUCTION: Fournier's gangrene is an infective necrotizing fasciitis of external genital and perineal region. Hematologic malignancies and immunocompromised status are predisposing factors. Simultaneous occurrence of Fournier's gangrene and congenital leukemia in neonates is extremely rare. CASE PRESENTATION: We present a case of Fournier's gangrene in a 4-day-old female infant with a necrotic lesion in perineum and no history of trauma or other predisposing condition. Focusing on high blast percentage in blood cell count she was affected by acute myeloid leukemia (M4 type). Pseudomonas aeruginosa was isolated from the blood and wound culture. She was treated with broad spectrum antibiotics and supportive care. The parents refused chemotherapy and the patient was discharged from hospital. Bleeding and DIC was the cause of death in a local hospital few days later. CONCLUSIONS: High index of suspicion is essential for diagnosis and appropriate treatment. Congenital leukemia should be considered in the differential diagnosis of a newborn with clinical features of sepsis and necrotizing fasciitis.