Acta Medica Iranica
Volume:50 Issue: 9, Sep 2012

Silymarin, an extract from Silybum marianum, has been shown to have antioxidant properties. However, there is no scientific report on wound healing activity of the silymarin. The purpose of this study was to evaluate the effect of topical administration of silymarin on excision wound healing in rats. Excision wounds were made on the back of rats. Rats were divided into three groups, as control, vehicle, and treatment. Vehicle and treatment groups received polyethylene glycol and silymarin dissolved in polyethylene glycol, respectively. The control group did not receive any treatment. The wound tissues were removed on 5th, 10th and 15th day for histopathological analysis and total collagen determination by hydroxyproline assay. Results showed that silymarin increased epithelialization and decreased inflammation but did not have any effect on percentage of wound contraction, collagenization and hydroxyproline levels. It was concluded that silymarin can significantly stimulate epithelialization and reduce inflammation in full-thickness wounds in rats.

The present study was conducted to investigate the histological changes and wound healing effect of aqueous extract of Elaeagnus angustifolia. After creating full-thickness skin wounds on the back of 45 male Sprague-Dawley rats they were randomly divided into three groups. Treated group received the extract, positive control group were treated with mupirocin ointment 2% and control group did not receive any treatment. Wound healing rates were calculated on days 3, 5, 8, 10, 12 and 15 post-wounding and the wound tissues were harvested at 5, 10, and 15 days for histological analysis and hydroxyproline content measurement. The results indicated a significant increase in the percentage of wound contraction and hydroxyproline content in the treated group comparing to the control and positive control groups. A significant increase in the assigned histological scores was observed at 10 and 15 days in the treated and positive control groups compared to the control group. The results demonstrate that aqueous extract of Elaeagnus angustifolia accelerates cutaneous wound healing, and its effect may be due to the increased re-epithelialization and collagen deposition in wound and so it can be considered as a therapeutic agent for wound healing.

The role of oxygen free radicals in the initiation, promotion and progression of carcinogenesis and the protective role of anti-oxidant defenses has been the subject of much speculation in the recent past with conflicting reports in the literature. In recent years, increasing experimental and clinical data have provided compelling evidence for the involvement of oxidative stress in a large number of pathological states including cancers. The aim of this study was to measure the concentration of serum total proteins and albumin as potent anti-oxidants in the sera of patients diagnosed with speckled leukoplakia, one of the oral pre-cancerous lesions reported to have significantly high malignant transformation rates and well-differentiated oral squamous cell carcinoma. The study consisted of sera analysis of total protein and albumin levels in patients with speckled leukoplakia and histologically proven, well-differentiated oral squamous cell carcinoma. One way analyses of variance (ANOVA) was used to test the difference between groups. To find out which of the two groups'' means were significantly different; post-hoc test of Scheffe was used. The study revealed variations in sera levels of albumin to be statistically significant. The results obtained emphasize the need for more studies with larger sample sizes to be conducted before a conclusive role for sera levels of total protein and albumin could be drawn as markers of transition from the various oral pre-cancerous lesions and conditions to frank oral squamous cell carcinoma.

We aimed to evaluate clinical, high resolution computed tomography (HRCT) and pulmonary function test (PFT) findings after 18-23 years of exposure in veterans of sulphur mustard (SM) exposure. We performed a cross-sectional study of 106 patients. Inclusion criteria were 1: documented exposure to SM as confirmed by toxicological analysis of their urine and vesicular fluid after exposure 2: single exposure to SM that cause skin blisters and subsequent transient or permanent sequel. Cigarette smoking and pre-exposure lung diseases were of exclusion criteria. After taking history and thorough respiratory examination, patients underwent high resolution computed tomography and spirometry. Clinical diagnoses were made considering the findings. More than 85% of the patients were complaining of dyspnea and cough. Obstructive pattern (56.6%) was main finding in spirometry followed by restrictive and normal patterns. HRCT revealed air trapping (65.09%) and mosaic parenchymal attenuation patterns (58.49%) as most common results. Established diagnoses mainly were chronic obstructive pulmonary disease (COPD) (54.71%), bronchiolitis obliterans (27.35%) and asthmatic bronchitis (8.49%). There were not any significant association between the clinical findings and results of PFT and HRCT imaging and also between PFT and HRCT findings (P-values were more than 0.05). Considering debilitating and progressive nature of the respiratory complications of SM exposure, attempts are needed for appropriate diagnosis and treatment.

Propofol is a widely used anesthetic drug because of its minor complication and also its fast effect. One of most popular complication in using this drug is pain during injection that is more sever in new generation of its components (lipid-free microemulsion). Other complications of propofol are bradycardia and hypotension. This study compares 3 drugs with placebo in control of these complications of propofol. In this double blinded randomized placebo controlled trial 140 patient who were candidates for elective surgery were divided in 4 groups (35 patients in each groups) and drugs (ephedrine, lidocaine, ketamine and NaCl solution (as placebo) were tried on each group by a blinded technician and responses to drugs were evaluated under supervision of a blinded anesthesiologist. Pain after injection, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured 5 times during anesthesia process of each patient. All gathered data were analyzed using t-test and Chi-square under SPSS software. Our data shows that in pain management all tested drugs can decrease pain significantly comparing with placebo (P=0.017). In control of hemodynamic parameters ephedrine could efficiently control SBP, DBP, MAP at the time 1 min after intubation. Based on our study ephedrine can be an appropriate suggestion for control of both pain and hemodynamic changes induced by propofol, although because of inconsistent result in other studies it is recommended to design a systematic review to draw a broader view on this issue.

Diabetic mellitus (DM) is a major risk factor of morbidity, mortality and economic cost to society. Diabetic patients are at risk of having microvascular or macrovascular disorders of diabetes. Postoperative anemia have wide spectrum of some early complications that require more care in hospitalization stays. Therefore, this study was designed to evaluate effect of preoperative anemia on short-term clinical outcomes in diabetic patients undergoing elective off-pump CABG. This study conducted on 86 diabetic patients underwent elective off-pump CABG surgery from August to October 2011, in Afshar Cardiovascular Center, Yazd, Iran. The patients had hemoglobin concentration between 10-12 mg/dl, patients with preoperative atrial fibrillation and renal and respiratory dysfunction were excluded from this study. Participants were randomly assigned into two groups; the normal group (n=42) that had hemoglobin concentration ~ 12-15 g/dl and the anemic group (n=44) had hemoglobin concentration~7-10 g/dl. We evaluated post-CABG variables including incidence of atrial fibrillation and early morbidity such as infection, vomiting, renal and respiratory dysfunctions, ICU or hospital stay and early mortality. Data were analyzed by ANOVA, Chi-square and Fisher''s exact test for quantitative and qualitative variables. The mean age of the patients was 52.51±6.9 years, from all of patients 64 cases (74.4%) were male and 22 cases (445.6%) were female. Postoperative atrial fibrillation was observed in 17 cases (19.8%), 7 cases (16.7%) of whom were in normal group and 10 cases (22.7%) of whom were in anemia group. anemia could significantly increase hospital stay (P=0.0001) but no ICU stay. Preoperative anemia did not affect the incidence of atrial fibrillation and early complications and mortality in patients undergoing off-pump CABG. However, anemia could increase postoperative hospital stay and renal dysfunction significantly.

Although sport-physiologists have repeatedly analyzed respiratory gases through exercise, it is relatively new in the cardiovascular field and is obviously more acceptable than standard exercise test, which gives only information about the existence or absence of cardiovascular diseases (CVDs). Through the new method of exercise test, parameters including aerobic and anaerobic are checked and monitored. 22 severe cases of heart failure, who were candidates of heart transplantation, referring to Massih Daneshvari Hospital in Tehran from Nov. 2007 to Nov. 2008 enrolled this study. The study was designed as a cross-sectional performance and evaluated only patients with ejection fraction less than 30%. O2 mean consumption was 6.27±4.9 ml/kg/min at rest and 9.48±3.38 at anaerobic threshold (AT) exceeding 13 ml/kg/min in maximum which was significantly more than the expected levels. Respiratory exchange ratio (RER) was over 1 for all patients. This study could not find any statistical correlations between VO2 max and participants'' ergonomic factors such as age, height, weight, BMI, as well as EF. This study showed no significant correlation between VO2 max and maximum heart rate (HR max), although O2 maximum consumption was rationally correlated with expiratory ventilation. This means that the patients achieved maximum ventilation through exercise in this study, but failed to have their maximum heart rate being led probably by HF-induced brady-arrhythmia or deconditioning of skeletal muscles.

Errors prevention and patient safety in transfusion medicine are a serious concern. Errors can occur at any step in transfusion and evaluation of their root causes can be helpful for preventive measures. Root cause analysis as a structured and systematic approach can be used for identification of underlying causes of adverse events. To specify system vulnerabilities and illustrate the potential of such an approach, we describe the root cause analysis of a case of transfusion error in emergency ward that could have been fatal. After reporting of the mentioned event, through reviewing records and interviews with the responsible personnel, the details of the incident were elaborated. Then, an expert panel meeting was held to define event timeline and the care and service delivery problems and discuss their underlying causes, safeguards and preventive measures. Root cause analysis of the mentioned event demonstrated that certain defects of the system and the ensuing errors were main causes of the event. It also points out systematic corrective actions. It can be concluded that health care organizations should endeavor to provide opportunities to discuss errors and adverse events and introduce preventive measures to find areas where resources need to be allocated to improve patient safety.

Hemorrhoidectomy is the treatment of choice for patients with third or fourth-degree hemorrhoids. Although the majority of surgeons believe that surgical hemorrhoidectomy is the most effective approach with excellent results in the management of hemorrhoid disease, but hemorrhoidectomy is not a simple procedure. One of the complications of this surgery is an injury to anal sphincters that can lead to incontinency in some patients. In this study, we aimed to reveal the percentage of external and internal anal sphincter injuries in surgical hemorrhoidectomy. We prospectively enrolled 128 patients from April 2006 to February 2007. They underwent hemorrhoidectomy in three general hospitals in Tehran. All patients were in grade III or IV and underwent open hemorrhoidectomy (Milligan-Morgan). After surgery, all resected material was histopathologically examined by two expert pathologists and the results confirmed by other one if there is any discrepancy. From all specimens which sent to the pathology department 15.8% (21 Pts.) had muscle fibers that Smooth muscle fibers were seen in 80.5% (17 Pts.) of them and striated muscle fibers were found in 19.5% (4 Pts.). Although hemorrhoidectomy is a safe and effective method for treatment of hemorrhoid, but the inadvertent removal of smooth and striated muscle during open hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function.

Musculoskeletal disorders are an important occupational health problem in dentistry. Few studies have compared these disorders in dentists with other occupational groups. We assessed musculoskeletal disorders in female dentists in comparison with female pharmacists. A cross-sectional study by means of Musculoskeletal Nordic Questionnaire was performed among 191 female general dentists and 211 female general pharmacists who were at least one year in clinical practice and selected using the random sampling method. Those with a history of a traumatic event causing fracture in spinal column or extremities and connective tissue diseases excluded. The data were analyzed by univariate and multivariate logistic regression analyses. 91.6% of the female dentists and 87.7% of the female pharmacists reported having at least one musculoskeletal symptom in the previous 12 months. 12-month period prevalence symptoms of neck (OR=3.17), upper back (OR=2.19) and upper extremity (OR=1.99) had the most ORs in comparison of dentists to pharmacists. In summary, female dentists are at risk of developing musculoskeletal disorders particularly in the neck, upper back and upper extremities.

To study and compare the attitudes, concerns, perceived impact and coping strategies for avian influenza (AI) among the first year medical students (FYMS) ‎and interns in Tehran University of Medical Sciences. This was a cross sectional study carried out on FYMS (n=158) and interns (n=158) in 2008. The data collection tool was a questionnaire containing 37 questions in five parts. The three choices including «agree, disagree and unsure» were considered for all questions. We used Chi-square and Fisher''s exact tests for analysis. Most of FYMS and interns (78. 2%) believed their health would be depended on the care of their selves. Most of them (95. 3%) believed that if they knew avian flu better, they could be more prepared for it. The majority were concerned about risk to their health from their work (62. 7%). Most (67. 7%) accepted the risk and only 5 (1. 6%) would consider stopping work. For non-work concerns, 70. 9% were concerned about their spouses/sexual partners and 65. 8% about their children. For perceived impact, most (66. 5%) believed that they would feel stressed at work and the majority (74. 4%) expected an increased workload. FYMS and interns have positive attitudes but major concerns about contracting AI and its relation to medical practice.

Sarcoidosis is multi organ disease with cutaneous manifestation in 20%-35% patients. Cutaneous sarcoidosis has variable manifestations that make it difficult to diagnose. So clinical, histopathologic and laboratory evaluation is needed for diagnosis. Most of cutaneous lesions presents as nodul, maculopapule and plaque. Morpheaform lesion is a rare presentation of cutaneous sarcoidosis. This case had multiple indurated scaly plaques resemble morphea with granulomatous pattern in histopathologic examination. The patient responded to prednisolone in addition to hydroxychloroquine.

Endotracheal tube (ETT) cuff herniation is a rare, and often difficult to diagnose, cause of bronchial obstruction. We present a case of outside cuff herniation of an endotracheal tube that caused pulmonary right lung atelectasis. A 29-year-old man, a case of car accident with multiple fractures, was admitted to the emergency ward and transferred to the operating room(OR) for open reduction and internal fixation (ORIF) of all fractures. The procedures were done under general anesthesia (G/A). The past medical history of the patient did not indicate any problem. Anesthesia was induced with thiopental, atracurium and then maintained by propofol and remifentanyl infusions and 100% O2 via orally inserted ETT. The patient was positioned in left lateral decubitus position for operation. Two hours after induction of anesthesia, the oxygen saturation level dropped to 85 % and the breath sounds in the right side of the chest were weakened. The chest x-ray images showed right lung atelectasis especially in the upper lobe. The problem was disappeared after removal of the ETT. In this case, we observed that an ETT cuff herniation can be a cause of airway obstruction. If there is a decreased unilateral breath sounds, we recommend replacement or repositioning of ETT.