mohammad amir amirkhani

 Vitiligo poses a significant challenge, particularly in treatment-resistant areas such as acral regions. This study aimed to evaluate the effectiveness and safety of combining fractional CO2 laser and microneedling with conventional therapies for non-segmental vitiligo in resistant areas.

 A randomized clinical trial with a paired design was conducted on 84 individuals with non-segmental vitiligo and treatment-resistant lesions. Participants in two separate groups received various combinations of interventions, including narrowband ultraviolet B (NB-UVB) and topical steroid (Clobetasol ointment) as conventional treatments, with fractional CO2 laser or microneedling as add-ons for four symmetrical treatment-resistant lesions. The treatment duration was 16 weeks, followed by observation until six months post-intervention for each patient, and it focused on assessing the percentage of repigmentation, safety, patient satisfaction, and potential adverse effects.

 The results of the study revealed a significant difference in average efficacy, with treatments involving fractional CO2 laser and microneedling compared with other interventions without them showing a higher percentage of repigmentation. No notable distinction in repigmentation patterns was observed, except for slightly higher marginal repigmentation with microneedling. Side effects, including pain, burning sensation, and erythema, were more frequent, with no significant difference between the groups. Itching and crusting had a substantial difference in the two groups. Patient satisfaction levels were comparable, with the first group slightly more than the second.

 In conclusion, combining NB-UVB and topical steroid therapies with the fractional CO2 laser or microneedling seems to be effective for vitiligo treatment in resistant areas. Attention to variations in patients’ characteristics and specific body locations is necessary when applying these modalities. This study provides valuable insights into novel approaches to managing vitiligo and highlights the potential benefits of these innovative treatments in combination with conventional therapy.

Nowadays, skin grafts use to replace lost or damaged skin around the world. Natural contaminants can exist on the skin and this contamination can be a threat to graft recipients. In this study, after obtaining human full thickness skin graft sample and culturing it in-vitro condition, skin samples were evaluated for cell viability and the presence of bacterial contamination during 72 hr. The amount of microbial contamination in the presence and absence of antibiotic gentamicin 0.02% was also investigated by standard methods. High cell viability during 72 hr in normal skin tissue samples was confirmed by the acridine orange staining. Electron scanning microscope observations, hematoxylin-eosin, and Masson's trichrome staining images clearly showed the difference between the two experimental groups. Skin graft samples lost the layers of dermis and epidermis (except the stratum corneum layer), in the absence of gentamicin due to contamination with bacteria which can be seen in the obtained images. Finally, the obtained results clearly showed the effect of high microbial contamination on the skin tissue structure, which can be caused by various factors.

There are various types of treatment targeting healing traumatic or accidental skin scars. Transplantation of skin grafts and surgical alternatives, including autologous transplantation of melanocyte-keratinocyte suspension, have also been suggested previously. This study is representing a case of previous skin graft transplantation, complaining of scar formation and discoloration on the transplanted segment.

The patient was a 37-year-old lady. This patient underwent melanocyte-keratinocyte suspension transplantation and narrow-band ultraviolet B (NUVB) therapy and could reach 40% re-pigmentation enhancement. This method could be introduced as an efficient and safe method of approaching facial scarring.

This method could be introduced as an efficient and safe method of approaching facial scarring.

Coronavirus disease 2019 (COVID-19) pandemic has had a great impact on reducing organ transplantation activities.

The aim of this study was to determine the donation and transplantation activities before and after COVID-19 outbreak in Iran.

This retrospective study compared the donation and transplantation activities in two specific 9-month periods (Average period of March - Dec 2018-2019 Vs. March - Dec 2020). The questionnaire included the numbers of brain death confirmations, family consents, organ recoveries, and transplanted solid organs. The questionnaire was sent by email to the chief executive of the organ procurement unit.

A total of 15 organ procurement units responded to the survey. The largest reduction was seen in tissue transplantations (62.5%) during two time intervals. Brain death due to head trauma significantly decreased in two time intervals and suicide increased by 14.44% during the COVID-19 pandemic compared to 2018-2019 period. Significant reductions between the median of donation (P = 0.0187), median of potential donor (P = 0.005), median of family consent (P = 0.002), and median of eligible donor (P = 0.009) were observed during the two time periods.

A significant reduction was observed in organ donation and transplantation during COVID-19 pandemic. Developing protocols and establishing new strategies for evaluation of organ donation to ensure the safety of organ recipients and medical staff is necessary.

Skin graft is standard therapeutic technique in patients with deep ulcers but as every surgical procedure has complications. Although several modern dressings are available to enhance comfort of donor site, using techniques that accelerate wound healing may enhance patient’s satisfaction.
Low Level Laser Therapy (LLLT) has been used in several medical fields, especially for wound healing but for treating large ulcers, it may last several months to heal completely.
The protocols and informed consent were reviewed according to Medical Ethics Board of Shahid Beheshti University of Medical Sciences (IR.SBMU.REC.1394.363) and Iranian Registry of Clinical Trials (IRCT2016020226069N2). Nine patients with bilateral similar grade 3 burn ulcer in both hands or both feet, candidate for Split Thickness Skin Graft (STSG) were selected. One side was selected for laser irradiation and the other side as control, randomly. Laser area was irradiated by red, 655 nm laser light, 150 mW, 2 J/Cm2 for the bed of the ulcer and infra red 808 nm laser light, 200 mW for the margins, every day for 7 days.
The rate of wound dehiscence after skin graft surgery was significantly lower in laser treated group in comparison to control group which received only classic dressing (P=0.019).
In the present study for the first time we evaluate the effects of LLLT on the healing process of skin grafted area in burn patients. The results showed LLLT is a safe effective method which improves graft survival and wound healing process and decreases the rate of wound dehiscence in patients with deep burn ulcer.

Context: After about 40 years from the discovery of bone marrow stem cells, the adipose stem cells (ASCs) were identify and the applications of these cells in different fields including the medical and biomedical fields have always attracted the attention of the scientists. The great quantity of stem cells obtained from adipose tissue allows the scientists to rapidly apply these primary cells without culture expansion..
Evidence Acquisition: Human has different types of fat tissues and each has its own applications, which means that the ASCs are harvested from different niches and each could be applied for different purposes. There are also specific biomarkers on the surface of the stem cells which is specific for every kind of these cells and the ASCs have also their own surface markers which help to easily detect..
Already the ASCs are clinically applied in many other purposes but the first clinical application of ASCs was reported in 2004 for the treatment of traumatic calvarial deficiency in a 7-year-old girl. However in the last decade a huge number of studies has been done on ASCs and the ASCs are used for different reasons and in different medical fields including the treatment of cardiovascular and immune diseases, for healing the wound scars and also is applied for skin rejuvenate, radiation injury, scar remodeling, and skin engineering..
This review was to focus on the roles of ASCs in different applications and also provide the researcher general information about the history and current applications of ASCs. We found that the ASCs have a potential role to be used for the treatment of different sorts of disorders, with the less side effects and is also a new approach toward new remedies..

Much attention has been paid to the idea of cell therapy using stem cells from different sources of the body. Fat-derived stem cells that are called adipose derived stem cells (ADSCs) from stromal vascular fraction (SVF) are the subject of many studies in several cell therapy clinical trials. Despite production of some GMP-grade enzymes to isolate SVF for clinical trials, there are critical conditions like inconsistency in lot-to-lot enzyme activity, endotoxin residues, other protease activities and cleavage of some cell surface markers which significantly narrow the options. So we decided to develop a new method via sonication cavitation to homogenize fat tissue and disrupt partially adipose cells to obtain SVF and finally ADSCs at a minimum of time and expenses.
The fat tissue was chopped in a sterile condition by a blender mixer and then sonicated for 2 s before centrifugation. The next steps were performed as the regular methods of SVF harvesting, and then it was characterized using flow cytometry.
Analysis of the surface markers of the cells revealed similar sets of surface antigens. The cells showed slightly high expression of CD34, CD73 and CD105. The differentiation capacity of these cells indicates that multipotent properties of the cells are not compromised after sonication. But we had the less osteogenic potential of cells when compared with the enzymatic method.
The current protocol based on the sonication-mediated cavitation is a rapid, safe and cost-effective method, which is proposed for isolation of SVF and of course ADSCs cultures in a large scale for the clinical trials or therapeutic purposes.

To determine the impact of a national intervention program on some pregnancy complications in Iran.This multicenter study was conducted in governmental sector in 14 provinces in Iran between 2003 and 2005. Intervention included education of all maternal health care providers including gynecologists, general physicians, and midwifes in the governmental sector. Time interval between the pre- (of 3,978 and 3,958 pregnancies) and post- (3,958 pregnancies) measurements were 18 months. Self reported data on pregnancy complications were registered. Interviews were conducted by trained personnel. Participants were interviewed when admitted for delivery or at the time attending for vaccination of their 2 month infants.The following pregnancy complications were reduced significantly as compared to before intervention: 1) bleeding or spotting, 2) urinary tract complications, 3) blurred vision and severe headache, 4) premature labor pain, 5) anemia, 6) severe vomiting, 7) inappropriate weight gain, 8) endometritis, 9) urinary incontinence, 10) breast abscess or mastitis, 11) wound infection, and 12) bleeding was significantly reduced after intervention, compared to before intervention. Premature rupture of membrane showed a significant increase. These complications did not show a significant change: 1) hypertension, 2) fever and chills, 3) convulsion, shock, and loss of consciousness, and 4) obstetric fistula.National programs may be proved to be largely effective by decreasing some of the pregnancy complications in developing countries.

Visual impairments affect child development and limit their social activity, education and future life. In this study, the prevalence of visual impairments was determined among school-aged children in a screening program. All first and third grade students in primary schools, first grade students in secondary and high schools related to Iranian universities of medical science were selected. The data were gathered by universities in 2007. The prevalence of visual impairments was 4.7% and 3.8% in first grade and third grade students in primary schools. It was 5.8% and 4.1% in first grade students in secondary and high schools respectively. The highest prevalence (10.59%) was reported from Kermanshah University of Medical Sciences. It is considered more detailed interventions are necessary, especially in high prevalence regions, to determine the different types of visual impairments and their risk factors.

Abdominal obesity is a predictor for many cardio-metabolic disorders in different age groups. The use of available information on factors associated with abdominal obesity has been proposed as an effective way of identifying at-risk individuals. This study aimed to assess the effectiveness of a risk scoring system for abdominal obesity in a large and representative population of youths. Waist-to-height ratio (WHtR) is an effective surrogate measure of abdominal obesity in children. This analysis was performed to find out the normal cut off value for WHtR by calculating the risk score.To develop a risk score to identify high-risk individuals for abdominal obesity, we analyzed data from a national survey, entitled CASPIAN Study, that was conducted on a nationally - representative sample of Iranian students aged 6-18 years. The risk equation was determined by a multiple logistic regression analysis, and Receiver Operator Characteristics (ROC) analysis was used to determine the cut-off value for the risk equation. The independent risk factors associated with abdominal obesity were living in rural area, attending public school, positive family history of diabetes and obesity in first and second degree relatives, lower mother’s education level, number of household members; whereas physical activity decreased this risk. The area under curve (AUC) for the ROC was 63% (95% CI: 0.612, 0.643).A CASPIAN study population value ≥ 39 had optimum sensitivity (64%) and specificity (54%) for determining abdominal obesity score. This method can be helpful in screening and prevention of abdominal obesity by identifying those at-risk individuals in a timely manner.

Anemia affects child development and limits their social activity, education and future life. In this study, the prevalence of anemia is determined among school aged children in a screening program.All first and third grade students in primary schools, first grade students in secondary schools related to Iranian universities of medical science were selected. The data were gathered by universities in 1386.The prevalence of anemia was 1.8% and 2.4% in first grade and third grade students in primary schools. It was 1.6% in first grade students in secondary schools. The high prevalence was reported from Tehran, Shahid beheshti and Iran Universities of medical science.ConclusionIt is considered more detailed interventions are necessary especially in high prevalence regions to determine the different types of anemia and their risk factors.

School readiness evaluation before entering elementary schools is now accepted in many of countries. Various methods has been used also evaluated factors are different. School readiness pays attention to children ability for accommodation with educational necessities and learning of their contents. In this study the mean of score obtains by Iranian children before entering elementary schools and some related factors assessed.

Study sample were 899035 children with 6 years of old that registered for elementary schools in 800 stations in 565 cities in 31 provinces in all over Iran. Sampling methods was census. They were examined for physical, psychological and social fitness, language and cognitive skills and general information's knowledge. Every of 5 sections had 20 scores and total score was 100 in sum.

From these 899035 children the most frequency was in Tehran (88735) and the lowest from Kohkilooye-va-Boyer Ahmad (7516). Mean of total score for all of children was 58.19. Mean of score in girls were more than boys. The most referral rate for special examinations was in Hamedan (15.9%) and the lowest rate was in Ghazvin (3.2%). In this study 63198 children were referred to more specific centers for detailed ruled out.ConclusionEarly detection of disorders and diseases in children is a priority for each program that intended to reduce them and promote towards better situation. Finally we can hope for better future on health, education and school successful.