مجله دانشکده پزشکی اصفهان
پیاپی 126 (هفته دوم فروردین 1390)

Different types of natural and synthetic materials are now available for treatment of thermal injuries in children and adult patients, all of which have their own advantages and disadvantages. Human amniotic membrane is considered as an influential method of treatment due to its availability and low cost. This study has been conducted to survey the long term (six month) effects of human amniotic membrane on deep second degree burns of children as a primary wound dressing in comparison with skin graft. Over a period of one year, sixty six patients under 18 with less than 30% second degree and minuscule margins of third degree burn (less than 1 cm) were collected and randomly distributed in two groups. The first group including 34 patients treated with human amniotic membrane and the second group (control group) consist of 32 patients were treated with skin graft. Considering Vancouver scale score as an index of long term wound healing the control group was superior to amnion group (5.9 ± 2.8 vs. 6.8 ± 1.2, P = 0.027). Mean hospitalization days in amnion group significantly decreased (12.4 ± 7.6 vs. 20.2 ± 10.3 P = 0.006). The number of admissions and treatment costs dominantly declined in amnion group. Primary dressing of burn wounds with amnion membrane is a cost-effective and available method for burn wounds treatment, it also has comparable long term effects in comparison with skin graft. So having an amnion membrane bank in burn centers and widespread use of amnion membrane graft in management of partial thickness thermal wounds in children is recommended.

This study aimed to evaluate the changes of posterior corneal curvature after photorefractive keratectomy (PRK) in patient with myopia greater than 6 diopters.

The study was conducted on 107 eyes of 57 patients with the preoperative spherical equivalent refractive error of at least minus six diopters. Subjects underwent PRK for treatment of myopia or myopic astigmatism and were followed 4 months later to evaluate their refractive error. The posterior corneal curvature was evaluated by orbscan II topography preoperatively and 4 months after PRK.

The diameter of posterior corneal best-fitted sphere (BFS) in 3, 5, 7 and 10 millimeter zones before surgery was 6.089 ± 0.2666, 6.137± 0.253, 6.299 ± 0.268, and 6.506± 0.312 millimeters respectively and after surgery these values had changed to 5.673± 0.362, 5.809± 0.341, 6.056± 0.309, and 6.347± 0.334 millimeters respectively.

PRK for treatment of high myopia makes significant changes in the diameter of all measured zones of posterior cornea. The amount of alteration changed with regard to the selected zone, with the maximum effect in 3 and minimum effect in 10 millimeter zones.

Antibody production in patients with end-stage kidney disease impairs due to several mechanisms. There are different ways to improve response rate to Hepatitis B (HB) vaccine. In this study we evaluated the effect of Tetanus-diphtheria toxoid (Td) vaccine on HBS Antibody (Ab) level while being given simultaneously with HB vaccine. We recruited 43 hemodialysis and 20 peritoneal dialysis patients who had HBS Ab titer less than 10 IU/L after first schedule of HB vaccination. The patients were divided into two groups: A (30 patients) and B (33 patients). Both received 3 dose HB vaccination schedule of 40 µg intramuscularly in the left deltoid muscle at 0, 1 and 6 months while group A, received Td vaccine intramuscularly simultaneous with first dose of HB vaccine, too. HBS Ab was measured in periods of 1 and 6 months after completion of vaccination. Group A had better but not significant response rate than group B in one month (96% vs. 83.9%) (P = 0.07) and six months (87.5% vs 83.3%) (P = 0.34) after completion of vaccination. Patients with HCV infection had lower response rate than the ones who did not have HCV infection (33.3% vs. 92.5%) (P= 0.02). Response rate was better in younger patients (r= 0.339 and P= 0.005). The use of Td vaccine simultaneous with HB vaccination does not have any role in the persistence of immune response. Age and HCV infection negatively affect the response to HB vaccination in dialysis patients.

Helicobacter pylori is a fastidious microorganism and therefore standard phenotypic susceptibility tests can take at least 10-14 days. Molecular based diagnostic assays offer an alternative approach to obtain susceptibilities to antibiotics and detection of point mutations with greater accuracy. The aim of this study was the assessment of Clarithromycin resistance and its point mutations by using real-time PCR assay. This cross-sectional descriptive study was performed on 200 gastric biopsy specimens obtained from patients undergoing upper gastrointestinal endoscopy at Hajar hospital in Shahrekord. Initially Helicobacter pylori were identified by rapid urease test (RUT) and polymerase chain reaction (PCR). Then clarithromycin resistance and its point mutations were evaluated by using specific probes and real-time PCR technique. Of total samples, 164 (82%) were Helicobacter pylori positive. Overall, a clarithromycin susceptible strains were detected in 105 (64.02%) patients and resistance strains were detected in 59 (35.98%) which were identified as 4 (2.44%) A 2144G, 26 (15.85%) A2143G, 15 (9.15%) A2143C, and 20 (12.19%) A2142G point mutations. Genotype of 5 (8.47%) strains was not detected. Purely resistant strains were detected in 38 (23.17%), while heteroresistant were found in the remaining 16 cases (9.76%). Results showed that real-time PCR assay has high accuracy to simultaneously identify Helicobacter pylori and clarithromycin resistance types directly in gastric biopsy specimens in short time.

Actinomycosis is an indolent, slowly progressive infection caused by non acid fast,gram positive, anaerobic or microaerophilic bacteria. The most common site of actinomycosis infection is cervicofacial region. Bacteriologic identification from infected site or detection of sulfur granules confirms the diagnosis. We report a rare case of simultaneous infection of larynx and lungs actinomycosis with various radiologic manifestations including diffuse right lung cavitation as a very rare finding.Case report: A 77-year-old man was admitted with complaints of fever and productive cough andweight loss, for one month, from the time he had been undergone open heart surgery.On that time, after surgery, he had been intubated for a long time because of decreased level of o2 saturation. Respiratory failure reason was not determined, so laryngeal CT scan was done with suspicious to a pathological lesion; it showed a mass in the larynx. Pathological findings of the laryngeal biopsy showed sulfur granule formation of actinomyces. Lung spiral CT scan revealed speculated margin pulmonary nodules with fibrotic changes and cavitary lesion. Pathology of lung biopsy showed; multiple granuloma consist of epithelioid and mononuclear cells with fibrosis, there were no sign of caseous necrosis or fungal infection in PAS staining and no acid fast bacilli were seen. Cytological evaluation for malignancy was also negative.He was treated with high dose of penicillin and in his follow up, he clinically and paraclinically gotbetter. Although pulmonary and laryngeal actinomycosis is rare, but should be considered in recurrent and persistent infections specially in patients with history of long stay hospitalization. It is in differential diagnosis with the all chronic lung infections and malignancies. Because of good response to appropriate antibiotic therapy and preventable complications, early diagnosis is mandatory.