khalil rostami

Keloid and hypertrophic scars (HTS) caused by an imbalance between the production and destruction of collagen during wound healing with an unknown underlying pathophysiological mechanism. This study was designed to evaluate the histamine level in the Keloid and HTS and comparison of results with normal skin.

This pilot study included 36 participants, aged from 18 to 70 years with keloid (n=11), HTS (n=13) and normal (n=12) skin. The level of histamine in the skin samples was measured using enzyme-linked immunosorbent assay (ELISA).

Histamine level in keloid samples was significantly higher than in the normal (p=0.0012) or HTS (p=0.0028) groups. However, there was no significant difference between the normal and HTS samples (p=0.92).

The increased histamine level in the keloid tissue may contribute to its pathogenesis and the application of anti-histamines could be of benefit for the prevention and treatment of keloids.

Several methods have been used to decrease the periorbital edema and ecchymosis after rhinoplasty. In this study, we evaluated the efficacy of hirudoid and dexamethasone in reduction of the periorbital edema and ecchymosis.

Sixty patients who underwent primary rhinoplasty were randomly divided into 3 groups. Group H received hirudoid cream, 3 times per day for 5 days from postoperative-day (POD). Group D received 10 mg of dexamethasone IV, immediately before surgery; and group C (control) received neither dexamethasone nor hirudoid. Two surgeons who were unaware of administered medications rated the severity of edema and intensity of ecchymosis, on 2nd, 5th, and 7th POD.

On 2nd POD, the edema in group D was significantly lower than groups H and C; but there was no significant difference in severity and intensity of ecchymosis between 3 groups. On 7th POD, the intensity of ecchymosis was significantly lower in group H in comparison to group C. When the difference between 2nd and 7th POD was evaluated, the resolution of severity of edema and intensity of ecchymosis was significantly better in group H (p<0.001).

Hirudoid was shown to be effective in reducing edema and ecchymosis after rhinoplasty. The use of dexamethasone was effective in prevention of periorbital edema at early postoperative days, but it was not effective on resolution of ecchymosis.

  Ischemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the efficacy of topical vitamins A and E on improving flap survival. Twenty-four white-albino male rats were randomly divided into two groups of treatment and control. Standard rectangular, distally based dorsal random pattern skin flap was elevated. Intra-peritoneal cephazoline was administered to prevent any unexpected infection. No pharmaceutical agent was administered for the control group, but pure vaseline ointment. In treatment group, vaseline plus vitamins A and E were administrated daily after surgery for 10 days. The rats were evaluated on the 10th day after surgery for viable and necrotic portions of the flaps. The mean values of necrosis in the flaps were 625±189.56 and 920.00±247.31 in the treatment and control groups, respectively. Vaseline plus vitamins increased flap survival significantly. Topical vitamins A and E may be effective pharmaceutical agents to increase viability of random skin flaps in rats. They can be added to vasoactive topical agents to reach better results.

Ischemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the effectiveness of eutectic mixture of lidocaine and prilocaine (EMLA) and capsaicin on improving flap survival.
A number of 39 white albino male rats were divided randomly into three groups: EMLA, capsaicin, and control groups. A standard rectangular, distally based dorsal random pattern skin flap was elevated on each rat. Intraperitoneal cefazolin was administered to prevent infection. No pharmaceutical agent was administered for the control group except for pure Vaseline cream. In EMLA group, EMLA cream was administrated daily after surgery for 10 days. In capsaicin group, capsaicin cream was rubbed on the flap surface daily. The rats were evaluated 10 days after the operation for viable and necrotic portions of flaps.
The mean values of necrosis in the flaps were 603.33 ± 116 mm2, 665.00 ± 220.26 mm2, and 920.00 ± 247.31 mm2 in the EMLA, capsaicin, and control groups, respectively. Both EMLA and capsaicin were effective on flap survival significantly (P = 0.002 and P = 0.011, respectively). Despite advantages, EMLA was not significantly better than capsaicin (P = 0.739).
EMLA and capsaicin are effective pharmaceutical agents that significantly increase the viability of random skin flaps in rats. They can be added to other vasoactive topical agents to reach better results and be used as a medical workhorse in reconstructive wards.

Ischemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the effectiveness of eutectic mixture of lidocaine and prilocaine (EMLA) and capsaicin on improving flap survival.

A number of 39 white-albino male rats were divided randomly into three groups: EMLA, capsaicin, and control groups. A standard rectangular, distally based dorsal random pattern skin flap was elevated on each rat. Intraperitoneal cefazolin was administered to prevent infection. No pharmaceutical agent was administered for the control group except for pure Vaseline cream. In EMLA group, EMLA cream was administrated daily after surgery for 10 days. In capsaicin group, capsaicin cream was rubbed on the flap surface daily. The rats were evaluated 10 days after the operation for viable and necrotic portions of flaps.

The mean values of necrosis in the flaps were 603.33 ± 116.00 mm2, 665.00 ± 220.26 mm2, and 920.00 ± 247.31 mm2 in the EMLA, capsaicin and control groups, respectively. Both EMLA and capsaicin were effective on flap survival significantly (P = 0.002 and P = 0.011, respectively). Despite advantages, EMLA was not significantly better than capsaicin (P = 0.739).

EMLA and capsaicin are effective pharmaceutical agents that significantly increase the viability of random skin flaps in rats. They can be added to other vasoactive topical agents to reach better results and be used as a medical workhorse in reconstructive wards.

Occupational musculoskeletal injuries are among the greatest problems of staff occupational health. Job stress is one of the important causes of musculoskeletal disorders. The purpose of this study was to investigate the relationship between rate and sources of job stress with low back, shoulder, and neck pains in the staff of one hospital in Tehran city.
This research was conducted as a descriptive-analytical study on 264 individuals (out of 700 individuals) of the staff of one hospital in Tehran city (2014). The samples were selected randomly. To collect the data, personal-occupational information, rate and sources of job stress, and Music questionnaires, were used, which had appropriate reliability and validity. Data analysis was performed using t-test.
In this study, the mean occupational stress among the staff was 20.55 and a majority of subjects (66.7%), were compatible in terms of stress levels. The frequency of low back pain was more than other parts of the body. Half (48.9%) of the staff suffered from low back pain and the remaining (26.1%) suffered from shoulder pain and 25% had neck pain. There was a significant relationship between rate and sources of job stress. Also, there was a significant difference between rate and sources of job stress with low back, shoulder, and neck pains.
The results of this study indicated that the prevalence of musculoskeletal disorders is very high in stressful jobs, and chronic and severe pain in the staff is associated with severe disability and low quality of life. Therefore, intervention programs for the prevention of musculoskeletal disorders, should be focused on physical and psychological needs of employees as well as job stress management.

Nowadays, Patient Safety is considered as a fundamental concept of the healthcare system. Hence, recognizing the effective factors such as: illegible orders, dosage errors, and drug usage can contribute to reducing the serious side effects leading to the patient's disability, prolonged hospitalization, and even death.
as a descriptive-analytical study, this research was cross-sectionally conducted with a sample of 1800 inpatient records in a teaching hospital during one year. The primary physician orders were examined through a self-managed checklist, including the items, such as: physicians’ ID and workshifts, and variables of legibility and recorded dosage. Data were processed via SPSS, regarding the descriptive statistics (like: frequency, …) and analytical statistics (like: chi-square, …).
of 1800 inpatient's records, 66.3% recorded by male, 17.6% records were illegible, 3.2% without stamping, 8.2% without signing, 11.9% without time, 4.9% without dating, 23% were not coherence and logical sequence 69.5% had not indicated to the 7 primary items, 17.8% without medicine dosage, 21.8% without pharmaceutical forms, 11.5% without usage time, 25.9% without usage method, 14.3% had scribbles and 13% lacked numbering also there were relation between demographic variables and medical recording errors .
it seems necessary for the physicians to try to improve the documentation of the patient records, such as: educating the newly arrived resident, considering commendatory techniques, and evaluating the records periodically.

Giant condylomata are not usually seen nowadays in developed nations, but such cases are still seen in the under-resourced countries. Condylomata acuminata are commonly transmitted through sexual intercourse. Generally diagnosed based on their appearance. Giant condyloma acuminata also named Buschke- Löwenstein tumour (BLT) is a slow growing cauliflower-like tumor, locally aggressive and destructive, with possible malignant transformation. Common clinical treatment of anogenital warts is conservative, however, in extreme cases conservative therapy is insufficient and surgical excision is required. A case of common presentation of giant condylomata in a 50 years old, divorced, multiparous woman is presented and the literature is reviewed. She presented with 15 years history of slowly progressive vulval lesion and associated itching, contact bleeding, malodorous vaginal discharge and difficulty in walking. She had previously been treated with podophyllin and cryosurgery without success. The growth measured 30×10 cm in each side and was successfully excised with no evidence of malignancy concomitant and reconstruction also done.

Cutaneous flaps are frequently used in plastic surgery and ischemic necrosis is still a complication as a clinical problem. Different methods have been attempted in order to enhance flap survival including: hyperbaric oxygen, angiogenesis therapy (FGF, VEGF), pharmacologic agents such as sympatholitic, vasodilators, calcium channel blockers, hormonal agents, prostaglandin inhibitors, anticoagulants, oxygen-derived free radical scavengers, corticosteroids, delayed flap surgery, etc. In an experimental study it has been observed that topical application of oleic acid postoperatively on random skin flap increases survival of the flap. We have investigated the effect of prophylactic use of oleic acid on the survival of the rabbits’ random skin flap. A total of 46 adult white New Zealand rabbits having a 3×10.5cm dorsal thoracic skin flap were selected. Flaps were assigned in 3 groups: for the first group topical oleic acid 75% (10% by volume) was applied ipsilaterally, while for the second group it was applied contralaterally and in the third group (control) the dorsal flap was treated with a basic ointment (a medical pure Vaseline). Having elevated each flap, it was sutured into its bed. On the 6th postoperative day, area of flap survival was measured based on clinical evaluation. The average of total skin flap survival was 11 cm2 in the first, 13.2 cm2 in the second (p=0.65), and 20.7cm2 in third group (control) (p<0.05). Although skin flap survival increases when topical oleic acid is used after surgery and flap elevation, prophylactic use of topical oleic acid decreases flap survival in the rabbits’ random skin flap.

With respect to the importance of observing principles of documentation of medical records for educational, treatment, research, legal and statistical uses, the correct, complete and timely registration of this information can play a crucial role in the production of necessary data for these kinds of researches. This study was performed to investigate the process of documentation of medical records of the patients in hospitals under Ardabil university of medical sciences. In this research 370 medical records from eight hospitals under Ardabil university of medical sciences were studied. In each hospital samples were selected randomly based on the number of patients hospitalized in one year. Then according to admission and discharge sheets a certain checklist was completed. The information under study included dignosis, treatment, surgery, cause of the accident, patient condition on dircharge, postdischarge advice and cause of death (whether recorded or not) which were identified in the check list. The data were analyzed by SPSS using descriptive statistics. The findings showed that primary, interim and final diagnosis and treatment measures were recorded 71.9%, 58.9%, 60.8% and 52% respectively in the records studied. Althougt 12.7% of these patients were hospitalized dueto accidents, damage and poisoning, only in 8.5% of them the external causes were recorded. In 68% of the records, condition on discharge and in 76.3% of them recommendation on discharge had not been recorded. 3.5% of the records were related to dead patients, but only in 31% of them the main cause and in 8% underlying cause of death was recorded. In general, in 5 2.4% of these records the correct methods of medical recording were not observed by physicians. The results indicated that the process of documentation of medical record by physicians as the main presenters of health care services was performed incompletely. This can lead to the loss of valuable information about the hospitalized patients. It can also have negative impacts on the course of therapy. As a result, the authorities, physicans and specialists in medical recording should pay special attention to this problem.

Serious vascular complications of IV drug abuse are being encountered with increasing frequency. These patients often present with cellulitis, abscess and endocarditic. Due to having viral infections these people can be a hazard to health care workers. Medical intervention is usually conducted after the emergence of one of the dreadful complications of IV drug abuse. The subject is a 40-year old male prisoner who referred to Emergency Department with 24 hours history of chill and fever, intermittent bleeding from a painful ulcerated lump in right groin along with hypotension and severe edema of right lower extremity necessitating packing and initial resuscitative measures. It was clinically diagnosed as ruptured infected pseudo aneurysm and urgent exploration was undertaken. Excision of common femoral artery was conducted by interpositioning of saphenous graft between external iliac and superficial femoral artery along with ligation of deep femoral artery drainage of abscess and debridment of necrotic tissue. The patient recovered with limb salvage except seroma on original site of vein graft.

Inpatient information is the best source for researches, medical education, process of patient treatment and legal organizations. Moreover, correct, complete and ontime registration of this information can play a crucial role in the production of necessary data for these kinds of researches. Regarding the importance of the issue, in this study we evaluated the quality and quantity of these data in the hospitals under Ardabil University of Medical Sciences. In this research 370 rcords from eight hospitals of Ardabil were studied. In each hospital samples were selected randomly based on the number of patients hospitalized in one year. Then according to admission and discharge sheets a certain check list, was completed. The information under study including demography, admission and discharge, inter-hospital and inter-ward transfer, diagnosis, treatment, surgery, death of the patients and authentications (recorded or not) were identified in the check list. The data were analyzed using descriptive statistics. The results showed that sex, marital status, date and place of birth had not been recorded in 5.9%, 15.7%, 2.4%, 51.6% of records respectively. Primary, interim and final diagnosis and treatment measures were not recorded about 28.1%, 41.1%, 39.2% 48% of the patients respectively. Although 13% of these patients were hospitalized due to accidents, impairments and poisoning, only in 8.5% of them the external causes were recorded. At 68.6% of the records, condition on discharge and at 76.3% of them recommendation on discharge had not been recorded. 3.5% of records related to dead patients, but only in 31%, main cause and in 8% underlying couse of death was record. 25% of the studied records were not coded. 13.7% of existing codes did not match the final diagnosis. At 52.4% of these records the correct method of writing diagnosis was not observed by physicians and at 36.5% coding had not been done carefully. The results indicated that the process of medical recording by health care services was performed deficiently and this leads to the loss of valuable information about the hospitalized patients. As a result, the authorities, physicians and specialists in medical recording should pay special attention to this problem. Physicians and specialitists of medical record to this problem were necessary.

Bell ’ s palsy (BP) is a relatively common disease characterized by the sudden onset of facial paralysis. In this disease, the facial muscle is paralyzed and the patient cannot close the eye or control the saliva in the involved side. The incidence rate of this disease in the world is between 11.5-40.2 cases per 100,000. The cause of this disease is yet to be found. This study is an attempt to investigate the demographic. Characteristics of these patients as well as the environmental factors involved in this disease in Ardabil. In this cross-sectional study which was cauducted in Ardabil province during a 2-year period (2001-2003) all the patients referring to neurology clinics were evaluated by a questionuaire in terms of demographic features and whether they were affected by the disease. 140 cases (out of 6550) were affected by Bell ’ s palsy. The incidence rate was high among 20-30 year-olds (17.85%) and was equal among females and males. Incidence of BP was higher in cold seasons. A high incidence was also observed among farmers, who sweat abundantly due to their job nature. The results are consistent with hypotheses regarding viral etiologies [e.g., reactivation of herpes simplex] of Bell ’ s palsy and it can be activated by cold exposure. The results also indicated that the disease is more prevalent in cold seasons.

Hydatic cyst is caused by Echinococus worm, that involves any part of the body, sometimes it is presented in organs such as thyroid, breast and other organs. Axillary that may be consider adenopathy or metastasis and do biopsy, which so there is danger of leakage, anaphylaxis or relaps. The reported case was 39 years old female presented with painless axillary mass without inflammation since 19 years ago that slowly enlarged. Physical findings suggested hydatid cyst which was confirmed with ultrasonography and IHA for Echinococus granolosus and other diseases ruled out. She was operated and she had no relapses after 1.5 years follow up.