Herpes zoster (Zona) is due to the reactivation of VZV in one dermatome. The disease begins with pain and burning in dermatome. After 48-72 hours maculopapular rashes appear that rapidly change to vesicular form. Incidence increases with aging. Some risk factors especially immunosuppression increase disease the aim of this study is evaluation of epidemiology and risk factors of Zona in Semnan.In this study 104 Herpes zoster patient evaluated based on clinical diagnosis. Information about age, sex, season, dermatome and risk factors registered.51.9% patients were male and 48.1% were female. Mean age of patients was 53 year and 65.4% were above 50 years old. The more common dermatomes in order of frequency were thoracic, trigeminal, cervical and lumbar. 74.1% of patients have no underlying problems, 11.5% have Diabetes mellitus, 7.7% Steroid consumption and 2.9% malignancy.Distributions of Zona based on sex, gender and dermatome was, like others studies.Season maybe have role in Zona distribution. Because a proportion of patients had Diabetes mellitus, suggest patients with zona evaluated for probability of diabetes mellitus.

Background: Predicting the spread of anesthesia after intrathecal injection of plain local anesthetics is challenging owing to both patient and anesthesiologist-related factors. Objectives: This study aimed to examine the initial patient-reported sensory changes during intrathecal injections and used multi-level analyses to examine the relationships between these changes and other major factors affecting the spread of anesthesia. Methods: The participants were 120 consecutive patients with the American Society of Anesthesiologists status I and II, who were scheduled for open repair of inguinal hernias under spinal anesthesia. Lumbar puncture was performed at the midline of the L3-L4 vertebrae and 3 mL of 0. 5% isobaric bupivacaine was administered at 0. 25 mL/s. The onset, dermatome, and side of the initial subjective sensory changes (ISSCs) were assessed by patient report. The extent of sensory loss to ice and pinprick stimuli, the degree of motor block in lower extremities, blood pressure, and heart rate were examined at 5-minutes intervals for 20 minutes after intrathecal injection. Results: All patients reported ISSCs after 9 (4, 18) seconds [median (minimum, maximum)] of the intrathecal injection onset. In 66. 7% of the patients, ISSCs occurred in the L1-L5 dermatomes. Three patients experienced pain during the early intraoperative period, and described ISSCs in the sacral dermatome. Height, mean blood pressure, and ISSCs were significantly correlated with sensory loss. Faster onset, lower dermatome, and floor-side of ISSCs predicted a narrower area of sensory loss, with dermatome as the most important indicator. Conclusions: Our findings demonstrate that ISSC, primarily based on dermatome, is a significant predictor for spinal anesthesia spread.

Herpes Zoster is rather a common skin disorder. It is the consequence of late reactivation of dormant varicella zoster virus in person who has already suffered from chickenpox. From the clinical point of view it is limited to one dermatome. the aim of this study was the survey of clinical and demographic features of Herpes Zoster patients who referred to the Department of Dermatology of Sina hospital of Hamadan between 1994-1998 . This is a kind of descriptive retrospective cross-sectional study which the essential information was gathered by referring to the patients file and then the obtained information was analyzed. From 10486 patients that referred to the hospital, 173 (16%) cases had Herpes Zoster. 54.9% of them were male and the rest were female. The most prevalence group were 60-69 year-old patients (20.2%). The distribution of lesions were more common in thorasic dermatome (41%) and then cervical dermatome (24.3%), lumbosacral (23.7%) and trigeminal (11.6%). 47.4% of the lesions were on the right and 48% were on the left and 4.6% in both side of the body. The highest frequency of the Herpes Zoster was in summer and the lowest one in spring. This study shows that the frequency of Herpes Zoster is higher among men than women. Also the number of patients in the young age group was considerable compared to the other study which carried out in the developed countries.

Deep vein thrombosis (DVT) occurs most commonly in the lower extremities and is related to the Virchow triad. While reactivation of the varicella-zoster virus (VZV) is rare when it occurs in the lower extremity dermatome, we present and discuss herpes zoster infection in immunocompromised individuals, which has similar manifestations yet can lead to unexpected, serious, life-threatening DVT complications. A 52-year-old woman with overweight and diabetes mellitus presented to the emergency department with 3 days of fever and a sudden, painful, swollen left leg. There was no history of chickenpox, trauma, surgery, or immobilization. She was using insulin glulisine and glargine. The physical examination was normal, except for a skin eruption characterized by a vesicle-pustule-blister group that followed the L4–L5 dermatome. Laboratory tests revealed leukocytosis and increased D-dimer levels. A duplex ultrasound was performed, which showed a thrombotic filling defect in the left common femoral vein and DVT in the left leg. The patient was treated with oral acyclovir, subcutaneous injection of fondaparinux, insulin glargine, and glulisine. Her symptoms improved within 7 days during her inpatient stay. After discharge, a follow-up duplex ultrasound evaluation revealed a reduced thrombus in the left common femoral vein. This case highlights that VZV reactivation in immunocompromised individuals can be complicated by DVT. It requires heightened clinical awareness of herpes zoster and related complications with similar manifestations, to provide precise and prompt treatment, and prevent worse outcomes.

Background: Herpes zoster occurs due to reactivation of varicella zoster-virus (VZV) that is latent in dorsal root ganglion cells after primary varicella infection. It can occur in any age but is very rare during infancy. Acquisition of this virus in utero or early after birth may result in infantile herpes zoster. Case report: Here, it is aimed to report an infant with herpes zoster whom his mother had developed varicella two years before pregnancy. Conclusion: Despite the rarity of shingles in infants after birth, any infant who has a vesicular lesion in a particular neurological dermatome should be aware of the disease.

Objective: Routine electrodiagnosis (EMG-NCS) has some shortcomings in the evaluation of peripheral nervous system, auch as autonomous nervous system evaluation, in pure sensory radiculopathies and acute hyperesthetic stages of neuropathies.Quantitative sensory testings such as current perception threshold (CPT) with electrical stimulations are suggested for above mentioned pathologies. Ttest results should be compared with a normal value of similar identical population. This study is conducted to determine normal value and reproducibility of CPT in the Iranian population. Materials & Methods: Fifty normal volunteers (32 men, 18 woman) in the range of 20-40 years without exclusion criteria (such as neuro- musculoskeletal disorders, diabetes mellitus and alcoholism) were recruited with simple randomized selection and CPT test was conducted on C8 (4th finger) and L5 (1st Toe) dermatomes. To determine test’s reproducibility, 6 persons (4 men, 2 women) were examined 3 times a day, 2 day per week.Collected data were analyzed to determine mean and standard deviation.Results: Normal values of CPT test was defined as one standard deviation from mean of our CPT data. These values are in C8 dermatome; 2000 Hz: 2.04±47; 250 Hz: 0.75±0.25; 5 Hz: 0.76±0.3 and for L5 dermatome; 2000 Hz: 2.83±0.73; 250 Hz: 1.24±45; 5 Hz: 0.76±0.3   To determine our results reproducibility and reliability, Alpha- cronbach (existed in SPSS software) was used and %98.5 & 99% were obtained for C8 & L5 dermatomes respectively.Conclusion: Our findings are about C8 & L5 dermatomes which could be used as a normal Values for such dermatomes. Regarding to its good correlation with international results we can use international references as a normal Valueswith consideration of each clinic’s reproducibility should be assessed individually.

Zosteriform metastasis is a rare clinical distribution from spreading neoplasms of every organ to the skin. Tumors most often arise from an internal or hematologic malignancy. We report a 69-year-old man, a known case of malignant melanoma of the left heel. In this case, multiple red brown metastatic nodules appeared four months after diagnosis. Distribution of metastatic lesions resembled a zosteriform configuration on his left thigh dermatome. Histological findings of a cut section of an excised nodule were compatible with a diagnosis of metastatic malignant melanoma. As we know this case report is the first case of zosteriform distribution of metastatic malignant melanoma that has been reported.

Background: The success of epidural analgesia hinges on the precise insertion of the needle within the epidural space; failure rates have been reported to reach 32%.Objectives: We report a new method using color Doppler to help verify the accurate location of the epidural needle tip. Methods: This is a randomized prospective study. Sixty patients undergoing hysterectomy were enrolled, with 30 patients in each group. Color flow Doppler (CFD) ultrasonography was employed to guide epidural catheter placement. The ultrasound-guided epidural technique was used for patients where challenges in identifying traditional landmarks for epidural space localization were anticipated. The procedure commenced with a spinal epidural technique. After sterile preparation and draping of the area, a curvilinear ultrasound transducer, encased in a sterile sheath, was used to locate the interspinous space. The primary outcome measure focused on flow visualization at different insertion levels. Secondary outcome measures included the duration of catheter implantation, intervertebral level of insertion, and dermatome sensory levels. The study also assessed the quality of epidural analgesia and patients' assessment of analgesic quality using a Verbal Numerical Rating Scale. Results: The study reported a successful and predominantly safe outcome, with high success rates in flow visualization and effective anesthesia coverage. Flow visualization at the insertion and surrounding levels demonstrated a 100% success rate at all observed points. The Visual Numeric Rating Scale (VNRS) results indicated a median pain score of 2 with an interquartile range (IQR) of 2 - 3, showcasing a generally low level of post-procedural pain among the subjects, reflecting good quality post-operative analgesia. Regarding dermatome sensory levels after 2 hours, the distribution across various levels, including T4, T6, T7, T8, T10, and T12, exhibited a favorable outcome. The highest proportion was observed at T10 (68.3%), suggesting effective anesthesia coverage in the targeted areas. The study demonstrated comparable efficiency between the CFD-guided and blind techniques in terms of procedural aspects. However, notable distinctions were observed in patients' reported pain levels, with the CFD group experiencing lower pain compared to the blind technique group. Additionally, the study highlighted the association between CFD and improved procedural accuracy and safety. Conclusions: This study advocates for the integration of CFD into routine clinical practice to enhance procedural outcomes and patient safety during hysterectomy surgeries.

Background: Nausea and vomiting during cesarean section are common under spinal anesthesia. The aim of the present study was to investigate the prevalence of nausea and vomiting and the related factors during elective cesarean under spinal anesthesia. Materials and Methods: A descriptive study was performed on 200 pregnant women who were candidates for elective cesarean section under spinal anesthesia in Taleghani Hospital between 2017-2018. For each participant, age, number of pregnancies, number of deliveries, history of previous cesarean section, nausea and vomiting in previous cesarean section(s), smoking during pregnancy, nausea and vomiting during the first trimester of pregnancy, premenstrual syndrome, and motion sickness were asked and BMI, duration of operation, the highest level of blocked dermatome, baseline pulse rate, and systolic pressure decreased by more than 20%, the incidence of nausea and severity, or vomiting during surgery, and the sex of the infant were recorded. Data were fed into SPSS column, version 21, and analyzed using descriptive statistics and independent t, Mann-Whitney, Chi-square, and Fisher exact tests. P-values less than 0. 05 were considered significant. Results: The prevalence of nausea and vomiting were 58% and 16%, respectively. The history of nausea and vomiting in the first trimester of pregnancy, pregnancy with the female fetus, and systolic pressure decreased by more than 20% in both groups of patients with nausea (P< 0. 001) and vomiting (P<0. 001) during cesarean section under spinal anesthesia were more prevalent than those without nausea and vomiting. Also, the prevalence of motion sickness (P <0. 047) and history of nausea and vomiting during the previous cesarean section were significantly different in the non-nauseous group after spinal anesthesia (P <0. 004) in patients with nausea during surgery. The highest level of blocked dermatome was significantly different in both groups with and without vomiting (p <0. 001). Conclusion: The currrent study showed once more that nausea and vomiting were common during cesarean section under spinal anesthesia. It seems that checking some factors in the medical history of a person may help in predicting this complication.

A 40-year-old man was visited at our clinic with a history of pruritic cutaneous papules in a zosteriform pattern from 3 months ago. The skin lesions were located unilaterally on the right side of his thorax. On examination, there were multiple shiny, erythematous, violaceous and slightlyscaly pdpules limited to right T7 dermatome (Figure.1). General physical examination was unremarkable and mucous membranes were intact. A biopsy was taken and the specimen exhibited hyperkeratosis, focal increases in the granular cell layer, and irregular acanthosis with a saw toothappearance, liquefactive degeneration of the basal cell layer and a band-like lymphocytic infiltrate at the dermo-epidermal junction and a number of Civatte bodies. He was treated with potent topical steroids. After 2 months, he came back with generalized lesions and typical mucosal lesions. Thistime, he was treated with systemic steroids. After 2 months, pruritus subsided and post inflammatory hyperpigmentation was formed, but mucosal lesions persisted….