MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2017 | Volume:60 | Issue:2|Papers Count:10

Introduction: Skin allograft is the gold standard for temporarily covering the burn injury. Even in partial thickness burns, skin allograft in comparison to topical antimicrobial dressing, can reduce morbidity and hospital stay in burn patients. However, there is not any study about the effects of skin allograft on survival of burn patients in this country. The aim of this study was to evaluate the impact of allograft usage on hospitalization period and mortality in Imam Reza (p) hospital referral burn center in the East of the country.Subjects& Methods: This case-control study was performed on major burn patients who underwent skin allografts in Imam Reza (p) hospital in Mashhad between September 23, 2010 and September 22, 2014. The control group comprised patients hospitalized in the burn ward who were not undergoing allograft surgery. They were matched for age, sex and percentage of burn with case group. Study outcome was the hospitalization period and the patient's status at discharge (alive, deceased). Data were analyzed by SPSS version 11.5 using Kaplan–Meier and Log-rank test. Cox -regression was used to find predictors of death.Results: Overal, 56 patients in the case group and 112 patients in the control group were studied. The death rate in the two groups was not statistically different (P=0.434), but hospitalization period in the case group (39 ± 13.9) was significantly longer than the control group (21.8 ± 14.5) (P<0.001). Mean survival time of cases (51 days, 95%CI=45-56) was higher than the control group (48 days, 95%CI=39-58) (P=0.017). Age (OR=1.03, CI95%=1.005-1.070) and number of allograft usage (OR=0.038, CI95%=0.142-0.945) were predictors of death.Conclusion: Although the use of allograft skin in extensive burns (over 50%) reduced the mortality of burn patients, but it was ineffective in burns less than 50 percent. Considering the shortage of skin allograft in most burn centers in this country, it is advisable to reserve this life-saving product for extensively burnt patients.

Background: Methadone is used for controling the chronic pain and treatment of opioid addiction. Prolonged QTc is a known cardiac complication of this drug. It seems that many factors affect the QT interval in methadone users. Several reports have suggested the role of sex hormones in QT prolongation. The objective of this study was to evaluate the effects of methadone in QTc prolongation in methadone users in comparison with healthy control groups and its relation with hormonal changes.Subjects& Methods: We selected 40 addicted patients who had used methadone as their opioid withdrawal for at least 6 months against 40 random healthy volunteers. For all subjects, assessment of hormonal parameters and ECG were done and two groups were compared.Results: No significant changes were shown in hormonal parameters except to FSH. QTc interval was significantly higher in methadone users than healthy control group (455.75±63.2 vs 426.25±22.2). PR interval was significantly shorter in methadone users (139.00±36.22 vs 158.25±24.48). QTc had significant inverse relation with testosterone level (r=-0.58, P=0.007).Conclusion: Prolonged QTc is an important complication of methadone that seems to be related to low testosterone level.

Background: In vitro and in vivo immunosuppressive properties have been described for Mesenchymal stem cells (MSCs), as they are able to modulate the function of all major immune cell populations. They represent important candidates for tissue regeneration and manipulation of the immune response in graft rejection, graft versus host disease, and autoimmune disorders. The aim of this study was to evaluate effect of autologous bone marrow stem cell on panel reactive Antibodies in patients with chronic and progressive renal failure.Subjects& Method: This is a pilot study on 17 patients with CFR (9 in intervention group and 8 in control group). Panel reactive Anti bodies before and after injections of stem cells from bone marrow that containing acceptable percentage of Mesenchymal stem cell in the intervention group compared with the control group. The 200 cc to 400 cc bone marrow aspirated then nucleated cells separated from red blood cells, then these cells injected to peripheral vein.Results: Mean age was 41.8±12.37 and 40.37±12.65 in intervention and control group respectively, with no significant differences were found between them (P=0.807). Mean panel antibody reaction was 69.86±6.24 and 70.25±13.46 in the intervention and control group respectively, no significant difference between them (P=0.956). After intervention, according to the pair T test there was a significant difference between before and after (51.55±26.44) panel antibody reaction (P=0.043).Conclusion: Infusion of allograft mesenchymal stem cells, might be an effective therapy for patients with high panel reactive Antibodies.

Introduction: Pentoxifylline has been effective in a group of diseases by its immunomodulatory effects and inhibition on TNF-a. In the pathogenesis of cutaneous leishmaniasis, cytokine-TNF has also been shown to be effective.The goal of this study was to show the increased therapeutic efficacy and reduced systemic dose of Glucantime by using oral pentoxifylline.Materials and Methods: Intramuscular Glucantime at a dose of 20mg/kg was given to 15 patients (group I) with cutaneous leishmaniasisfor 20 days.The remaining 16 patients (group II) were given 15mg/kg daily intramuscular Glucantime) maximum two ampoule) together with oral pentoxifylline at a dose of 20 mg/kg) maximum 400 mg, three times a day ( for 20 days. Lesions results were assessed 90 days after completion of the treatment.Results: A total of 7 patients in group I and 7 patients in group II had complete remission, and there was no significant difference between the two groups (p=0.87). Relative remission was not observed in any of the patients of the first group, while it was seen in 6 patients ofthe second group and the difference was significant (p=0.008). The number of patients without remission (less than 70%) was 8 patients in the first group and 6 patients in the second group without significant difference (p=0.37). The number of lesions with relative remission in group I was zero, and in group II was 1.4±0.7. (PV=0.01) Conclusion: pentoxifylline in combination with Glucantime with less than standard doses can cause good therapeutic effects especially in those over 60 kg of weight who needs higher doses of Glucantime due to their weight.

Introduction: Chronic obstructive pulmonary (COPD) is one of the common and Progressive diseases, which microbial factors contribute to its development. There is a 50- 70% possibility that it may cause infection. Ficolin-2 protein moves to eliminate infectious agent by activating the innate immune system via complement. Therefore, In this study we examined the relationship between serum levels of Ficolin-2 and treatment duration in (COPD) patients.Materials and Methods: In this study, the blood sample of 48 (COPD) patients and 30 healthy subjects that their blood and urine tests showed infection were taken, the control group. The serum levels of ficolin-2 protein were evaluated using ELISA method.Results: According to the research hypotheses (the relationship between the serum level and treatment duration and the relationship between lowness of serum levels and recurrence of disease) and the results of analyzes conducted by t-test in this study, there was a significant correlation between serum levels and duration of therapy in this disease.

Introduction: In Hypertension, the complications of target organs, including eye is move important. The hypertensive vasculopathy can be directly identified on the retinal vessels by ophthalmoscopy. This study was done to determine the prevalence of hypertensive retinopathy in high blood pressure patients. Materials & Methods: A total of 135 patients with hypertension that admitted in Khatam – al – anbia and Imam Hossein hospitals of Shahroud in 2014 were examined to determine the ophthalmologic stages of their retinopathy.Results: In this study 135 hypertensive patients (62 males and 73 females) in age range of 36-75 years old (mean age: 64.5±10.3 years), mean duration of diagnosed hypertension 6.7 ± 5.5 years and mean duration of medical treatment 7.1±4.7 years were evaluated. Overall 57.5% of patients had hypertensive retinopathy which was less common in women (57.5%) than in men (58.1%). Also, the highest percentage of hypertension retinopathy was grade I, 61.3% of patients with positive family history, 5.9% of patients had mild hypertension (HTN), 39.3% had moderate HTN and 54.8% had severe HTN. The most common ophthalmoscopic findings in hypertensive retinopathy were: arteriole narrowing (35.1%), artrial irregularity (17.1%) and cotton wool patch and hemorrhagy (9.3%).Conclusion: Early diagnosis and control of high blood pressure prevents ocular and other target organ hypertension complications. Positive family history of hypertension and also hypertensive complications of target organs especially cerebrovascular are risk factors for hypertensive retinopathy.

Background: Anal fissure is a painful wound in the anoderm due to spasm of internal anal sphincter. Surgery reduces the basal sphincter tone by partial or total incision of the internal anal sphincter. In this study, we compared partial and total sphincterotomy in patients with anal fissure.Materials& Methods: In this cohort, 100 patients with anal fissure referred to the Shahid Mohammadi hospital, Bandar Abbas, Iran were randomly assigned in partial or total Sphincterotomy (50 patients in each groups) and were operated. Then the complications including, pain, bleeding during and after surgery, incontinence to the flatus or stool soiling, infection and abscess, hematoma, postoperative sphincter incontinence, anal stenosis and recurrent anal fissure within one year after operation were compared between two groups.Results: The mean age of patients was 15.28 ± 43.34 years. The rate of recurrence and incontinence to the flatus and fecal in total technique was more than partial and the amount of bleeding and hematoma, infection, abscess and discharge in total group was lower than partial, but the difference was not significant. The flatus incontinence in total group was significantly more than partial, and the level of pain in total group was significantly lower than partial.Conclusion: The results showed that partial and total sphincterotomy techniques in patients with anal fissure were comparable; however, total sphincterotomy was related to lower pain and partial sphincterotomy showed lower flatus incontinence.

Background: The use of peripheral catheters is a common and invasive procedure in newborns, but several complications have been seen with it. Due to neonatal intensive conditions, catheters longevity is very important. The aim of this study was to compare effectiveness protective methods on peripheral venous catheter longevity in newborns hospitalized in neonatal intensive care unit in the Beheshti hospital. Subjects& Methods: this is a quasi-experimental study on 101 infants admitted to the neonatal intensive care unit of Isfahan Beheshti Hospital. The sampling was Sequential convenience, and randomly divided into three groups. For data collection we used record sheet. Area catheter complications were observed and recorded on it. The data were analyzed with descriptive and inferential statistical on SPSS software 18 Results: Analysis of variance showed that the average longevity had no significant difference between the three groups of peripheral venous catheter (p>05). And the Chi-square test showed that frequency of complications was not significantly differente among the three groups (p>05).Conclusion: To reduce the complications of immobility in newborns, Saving time and energy of nurse staffs and reduce damage to babies and keeping peripheral catheters, splint should be removed, and the adhesive should be used.