Journal of Isfahan Medical School
Year:2017 | Volume:35 | Issue:451 |Papers Count:7

Background: Atrophic scars and skin damage are of the problems in plastic surgery for which several treatment methods including dermofat and fat injections have been used so far; but the results vary and are sometimes contradictory. This study aimed to compare the effect of dermofat and fat injections on the treatment of atrophic scars.Methods: In a clinical trial during 2015 and 2016 in Alzahra and Imam Musa Kazim hospitals, Isfahan, Iran, 50 patients with atrophic scars were distributed in two groups of 25 treating by fat and dermofat injection, respectively. The two groups were evaluated and compared 6 and 12 months after treatment and their scar condition, recovery, and complications were examined.Findings: In dermofat graft and fat injection groups, 8 (32%) and 7 (28%) patients had a good recovery, and the condition of the scar on their skin resembled the skin of the adjacent area; but no significant difference was observed between the two groups (P = 0.760). The scar condition compared to before treatment and six months after the treatment in both groups was more favorable.Conclusion: Both fat injection and dermofat graft have relative effectiveness in the treatment of atrophic scars and more studies are recommended.

Background: Upper gastrointestinal endoscopy is one of the most common outpatient diagnostic and therapeutic interventions in children. Present study aimed to compare the sedative effect of intravenous dexmedetomidine premedication versus midazolam in children undergoing upper gastrointestinal endoscopy.Methods: This was a double-blind randomized trial in which 72 patients were allocated in two groups of 36 undergoing premedication with intravenous (IV) midazolam and dexmedetomidine, respectively. Sedation scale, mean arterial pressure, heart rate, recovery time, and respiratory complications were recorded and compared.Findings: Sedation score was significantly higher with midazolam at 15 minutes following injection (P = 0.005), on admission to recovery (P < 0.001), and 30 minutes after admission to recovery (P = 0.001). Recovery time was significantly longer in midazolam premedication (P < 0.001). Respiratory complications were significantly more frequent with midazolam (P = 0.030).Conclusion: Although dexmedetomidine premedication was associated with lower mean arterial pressure and heart rate, intra-operative and recovery sedation scores were significantly higher with midazolam premedication.

Background: Staphylococcus aureus is one of the most commonly diagnosed infections in hospitals. Increased infections caused by this bacterium and its resistance to many antibiotics is leading to increasing morbidity and mortality in the hospital setting. The aim of this study was to investigate the molecular status of methicillinresistant Staphylococcus aureus (MRSA) isolated from patients admitted to intensive care units (ICUs) of hospitals in Tehran City, Iran.Methods: This cross-sectional study was performed by analyzing 125 MRSA strains isolated from hospitalized patients in ICUs. In vitro antibiotic susceptibility testing of isolates was assessed using Kirby-Bauer disk diffusion method. MRSA strains were genetically typed by agr typing and virulence and adhesion genes profile via conventional polymerase chain reaction (PCR) method.Findings: Of 443 clinical studied samples, 125 MRSA strains were observed. The highest resistance rates were observed for penicillin antibodies (122, 97.6%), kanamycin (105, 84.0%), and gentamicin (95, 76.0%). Frequency of pvl and tst genes was 67.2% and 20%, respectively. Type I was the most prevalent agr type (52.0%), followed by type III (34.4%), type II (9.6%), type I 5(5.3%), and type IV (4%). All the isolates carrying Panton-Valentine leukocidin (PVL)-encoding genes and high-level mupirocin-resistance (HLMUPR)-MRSA strains corresponded exclusively to agr type I.Conclusion: This study demonstrates the increased resistance of Staphylococcus aureus to different antibiotics, which is a serious warning for the treatment of Staphylococcus aureus infection in the region. Therefore, in order to avoid resistance to other antibiotics, uncontrolled and unnecessary administration of antibiotics should be avoided.

Background: Succinylcholine is the most common muscle relaxant but its side effects resulted in researches for a drug as alternative. The aim of present study was to compare the effects of succinylcholine and remifentanil on intubating conditions in elective cesarean section.Methods: Patients undergoing elective cesarean (n = 200) were enrolled in a double-blinded clinical trial study in Ali Ibne Abitaleb hospital, Zahedan, Iran. Patients were divided in 2 groups of control, received succinylcholine (1.5 mg/kg), and case, received remifentanil (1 mg/kg). Statistical analysis was performed using Fischer’s exact and chi-square tests via SPSS software at the significant level of P < 0.050. Findings: In the succinylcholine group, 92 patients (92%) and in the rhymifentanil group, 76 patients (76%) had good intubation (P < 0.050). Apgar score of 1st minute was less than 7 in 2 (2%) and 14 (14%) newborns in succinylcholine and rhymifentanil groups, respectively (P < 0.050). In case group, Apgar score of 5th minute was seen in 6 newborns (6%), while there was not any case in control group.Conclusion: Our results suggest that with respect to the effect of remifentanil on Apgar, it could be used only in contraindications of succinylcholine in suitable conditions of monitoring and effective resuscitation of neonates.

Background: Hemostasis is a hemodynamic process in which the platelet and vessel wall play a major role. Platelet therapy is a standard care for patients with thrombocytopenia. However, some studies reported a progressive decline in platelet elevation after 1, 18, and 24 hours.Methods: In this retrospective study, 35 cases of patients over 40 years of age undergoing platelet injections were enrolled. Blood platelet levels were measured before and after platelet transfusion, and platelet elevation levels were determined according to patients' demographic and clinical variables.Findings: The average platelet count after platelet injection was significantly higher than the mean before it (P<0.001). Factors such as gender, splenomegaly, fever, and heparin had significant effect on the changes in platelet count (P<0.050); but the bleeding factor has no significant effect on it.Conclusion: The incidence of thrombocytopenia and death in patients admitted to intensive care unit is high and should be worrying. Our results indicate that platelet injection is effective in patients requiring it, and may increase platelet levels in these patients after injection. In addition, several factors, such as sex, splenomegaly, fever, and heparin affect platelet levels after injection.

Background: Nowadays, beta-lactams are the most common antimicrobial agents used for treatment of bacterial infections. On the other hand, the production of beta-lactamase enzymes including AmpC is one of the reasons for bacterial resistance to antibiotics. The aim of this study was to determine the frequency of AmpC-type betalactamase genes in Escherichia coli isolated from patients with urinary tract infections. Methods: In this cross-sectional study, 75 isolates of Escherichia coli were collected from the urine specimen of patients with urinary tract infections admitted to internal wards of Yazd hospitals, Iran. After culturing of specimens and isolation, identification of isolates was performed using biochemical tests and polymerase chain reaction (PCR) method. Disk diffusion method according to protocols of Clinical and Laboratory Standards Institute (CLSI-2016) was used for the susceptibility testing of isolates. AmpC genes were detected using PCR method and specific primers. The data were analyzed via SPSS software.Findings: The highest and the lowest antibiotic resistance were observed for amoxicillin and imipenem, respectively. Out of 75 isolates, 19 isolates (25.3%) produced AmpC genes. blaCITM and blaDHAM genes were present in 13 (17.4%) and 2 (7.2%) Escherichia coli isolates, respectively. The blaFOXM gene was not detected in any of the isolates.Conclusion: Our results indicate that AmpC genes are present in beta-lactamase-producing specimens, which is a serious threat for prescribing third-generation cephalosporins. In order to prevent the spread of these resistance, molecular methods-based studies should be performed to identify routine beta-lactamases such as AmpC.

Insulin-like growth factor-binding protein 3 (IGFBP-3) is the most abundant IGFBP in circulation, interacts with high affinity to IGFs altering their function. Emerging evidence has indicated that IGFBP3 mostly involved in human disease such as diabetes, Alzheimer's disease, and cancer. It has been determined that IGFBP3 expression is decreased in various cancer cell lines by promoter methylation and proteases digestion. Therefore, bioavailable form of IGF-I increases in circulation promoting the tumorigenesis and progression of cancer. IGFBP3 function in cancer suppressing can be divided in two ways: IGF-dependent, and IGF-independent action. Recently it has been shown that IGFBP3 has vital roles independent of IGFs. Despite decades of unremitting research, this function of IGFBP-3 has not been clarified. However, it has been suggested that IGFBP3 independently can bind to its receptors in the nucleus including retinoid receptors (RXRs) peroxisome proliferator activated receptors (PPARg), Nur77 vitamin D response (VDR), and/or cell surface receptors such as transmembrane protein 219 (TMEM219), low-density lipoprotein receptor-related protein 1 (LRP-1), and epidermal growth factor receptor (EGFR) inducing apoptosis. In this review, we described further mechanisms of IGF-independent action of IGFBP3.