naser mozafari

We aimed to investigate the effects of nerve repair by setting a side-to-side (H-shaped) nerve graft on the most distal part of the damaged nerve to the adjacent intact nerve to accelerate its regeneration in the end organ.

This pure experimental study was done on the lower extremities of two groups of rabbits in Animal Laboratory Department, 15 Khordad Hospital Tehran, Iran. In both groups, the sciatic nerve at the proximal part of the extremity below the superficial femoral branch was first cut and then repaired. In the investigation group, side-to-side H-shaped nerve grafts were applied between the sciatic and superficial femoral nerves (i.e., two branches) at the most distal to the cut site of the sciatic nerve below the superficial femoral branch at the lower extremity. The sciatic nerve was conventionally repaired in the control group.

None of the rabbits’ feet in the control group respond to pain stimulation (were without senses) and had ulcers. They had numb legs and went lame. All had muscular atrophy and lacked nerve growth (regeneration) according to pathology. In the investigation group, 86.7% of the rabbits responded to pain stimulation and only 13.3% of them had ulcers. In addition, in pathology report, 13.3% had suffered muscular atrophy and lacked nerve regeneration. Therefore, nerve regeneration was successful in 86.7% of rabbits who underwent H-shaped nerve grafts.

Side-to-side H-shaped nerve graft at the most distal part of an injured nerve may cause successful recovery of high (proximal) nerve injury.

Congenital cleft lip and palate represent the prevailing craniofacial birth anomalies on a global scale. Notably, a substantial proportion of patients within remote regions of Iran defer corrective surgery until later stages of life, often in childhood or adulthood, primarily due to intricate financial and cultural constraints. In response to this pressing healthcare challenge, a dedicated collective of volunteer plastic surgeons was established in 2009 with the explicit aim of providing medical care to these underserved patients. Over the subsequent years, this compassionate team embarked on 31 meticulously planned missions to underprivileged areas scattered across the country. Through these organized endeavors, a remarkable total of 20,579 medical visits were conducted, coupled with the performance of 2,303 essential surgeries, thus offering a lifeline of healthcare to these disadvantaged individuals.

The management of deformities of the nasal soft triangle (ST) is a difficult and very sensitive discussion in rhinoplasty. So far, the standard method for correcting these deformities has yet to be introduced. We aimed to introduce a new technique using modified fine graft (MMG) for correcting nasal ST triangle deformity and evaluate the effects of using this method.

This prospective study was conducted on 20 rhinoplasty candidates who underwent surgery at 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran between August 2021 to the February 2022 with the new technique of using an MMG to correct nasal ST triangle deformities. Follow-up was performed immediately after surgery, 3 and 6 months after surgery. Post-operative findings included ST deformity correction, graft exposure, graft visibility, recurrence rate, and the need for revision were evaluated by photography for all patients.

The mean age of patients was 33.65± 11.047 years, 85% of the cases were female and 90% of surgeries were primal rhinoplasties. The ST triangle deformity was not corrected in 2 cases (10%). Both patients were women with primary rhinoplasty, and cartilage was removed from the septum in both. Graft exposure, recurrence, and visibility were not reported in any cases.

MFG was highly effective in correcting the deformity of the nasal ST triangle and did not cause serious complications in patients. This method is a suitable method with high efficiency for correcting nasal ST triangle deformity.

Most patients with traumatic brain injury (TBI) admitted to the intensive care unit experience pain. Nurses have a major role in pain management in patients with TBI.

This study was performed aimed to investigate the effect of white noise on pain in unconscious patients with TBI.

This single-blind clinical trial study was performed in 2019 on 52 unconscious patients with TBI admitted in neurological intensive care unit in Ardabil. They were randomly assigned to the control and intervention groups. In the intervention group, patients received 30 minutes white noise for 3 consecutive days. In the control group, patients rested only on the bed at the same time. The demographic characteristics form and behavioral pain scale were used to collect data. P<0.05 was considered statistically significant.

The mean difference of behavioral pain score during three consecutive days 10 minutes before and 30 minutes after the intervention was 0.82 ± 0.1 in the intervention group and 0.18 ± 0.01 in the control group. Data analysis showed that the behavioral pain score in the intervention group significantly reduced compared to the control group (P <0.001).

Implications for Practice: 

The results of this study showed that white noise could relieve the behavioral score of pain in unconscious patients with TBI. Therefore, it is recommended to use white music noise along with routine treatments to reduce the pain of unconscious patients with traumatic brain injury in the neurological intensive care unit.

Complete or total arhinia, in which nasal soft tissue is absent, is an extremely rare disease. The embryological origin of the defect is thought to be the maldevelopment of paired nasal placodes. In this article, we introduce nasal reconstruction with two forehead flaps. The reconstruction was done with two forehead flaps in a 20-year-old male patient with arhinia. Using one frontal flap of the forehead as the inner layer and the other one as the outer layer. The postoperative care was uneventful. He was able to breathe through the nose. No chest pain or any difficulty was mentioned in daily activities. The principal advantage of this technique over previous techniques is that the operation is performed in two stages and at the end of the procedure the patient has the final shape of the nose and is able to breathe normally. Furthermore, this technique could be performed for all age groups.

Brucellosis is a zoonotic disease, which is mainly transmitted from animals to human through ingestion of unpasteurized dairy products or direct contact with infected animal secretions. Since the people in contact with animals are considered to be at risk of Brucellosis, the aim of this study was to estimate the seroprevalence of this disease in staff of cattle farms and slaughterhouses in Tehran in 2012.
This analytical cross-sectional study was performed on 430 staff of cattle farms and slaughterhouses (regular and specialized slaughterhouses for slaughtering animals suspected to brucellosis) in Tehran, 2012. Serum samples were prepared and evaluated through Rose Bengal, Wright, and 2-Mercaptoethanol tests. Demographic information and occupational characteristics of the participants were collected using a questionnaire. Data were analyzed using descriptive statistics and Poisson regression via Stata 12.
The serologic test for brucellosis were positive in 5 patients and brucellosis seroprevalence rate was 1.16%. All participants in this study were male and 97.4 % of them were Iranian. The participant's mean age was 34.45 ± 9.46 years. The results showed that there was no significant relationship between a positive test and independent variables (including age, education, workplace, dangerous occupational exposure, past dangerous occupational exposure, consumption of unpasteurized dairy products, occupational background, and keeping livestock at home).
Continuing implementing prevention programs such as educational programs and using personal protective equipment in at-risk groups are necessary.

Lactate level is known to increase among the majority of patients with toxicity. This study aimed to determine whether lactate level upon admission is higher among patients with ventilator-associated pneumonia (VAP)..
We aimed to determine whether serum lactate level is associated with the increased risk of VAP in intensive care unit (ICU)-admitted patients with toxicity..
This retrospective study was conducted in a training medical poisoning center in Iran, using convenience sampling. A total of 157 poisoned patients, aged ≥ 13 years, who were admitted to the ICU over the past seven months, were included in the study. Subjects were categorized into two groups, based on their VAP diagnosis (VAP-positive and non-VAP) and the outcomes (surviving or non-surviving). The VAP-positive patients were compared with others with regard to the mean level of serum lactate level upon admission. Additionally, non-surviving patients were compared with their surviving counterparts..
Overall, 71 (45.2 %) VAS-positive cases were reported, in addition to 36 cases of mortality. Alkaline phosphatase (ALP) was the most common toxic agent (36%), followed by methanol. Significant differences were noted between the groups in terms of Simplified Acute Physiology Score-II (SAPS-II), Glasgow Coma Scale (GCS) score, length of ICU stay, and percentage of ventilation process. The mean levels of lactate at admission were 3.71 ± 3.35 and 4.19 ± 4.09 among VAP-positive and non-VAP patients, respectively; the difference was not statistically significant. Also, non-surviving patients had a longer ICU stay (12.20 days), compared to surviving patients (5.39) (P = 0.008). Moreover, admission lactate level was 7.06 ± 5.29 mmol/L among non-surviving patients and 3.01 ± 2.53 among surviving cases (P Based on the findings, the mortality rate was 22.9% among poisoned patients with an elevated serum lactate level. We can conclude that mortality is associated with toxicants, but not the occurrence of VAP; in fact, VAP scenarios do not elevate serum lactate level..

Vancomycin is a first-line therapy for infections due to Methicillin-Resistant Staphylococcus aureus (MRSA). Nephrotoxicity subsequent to vancomycin administration has been discussed in many previous researches.
The present study aimed to determine the nephrotoxic potential of vancomycin among ventilator-associated pneumonia (VAP) poisoned patients after restricting the effect of risk factors such as rhabdomyolysis and other nephrotoxicants.
This two-year cross-sectional retrospective study was conducted among VAP patients, who received vancomycin at the toxicological intensive care unit of Loghman Hakim hospital of Iran from 2013 to 2015. Baseline and laboratory data of eligible patients were extracted from medical records. Nephrotoxicity was defined based on the risk, injury, failure, loss, and end state (RIFLE) criteria.
One hundred and fifty-four VAP patients’ profiles were reviewed, of whom 110 were eligible. The median age was 33.50 (12 to 94) years and 73.6% were male. The median time interval between poisoning and admission was four (0 to 48) hours. The most common cause of poisoning was opioids (33%). Ten patients developed new-onset nephrotoxic event, including four in risk, four in injury and two in failure class. Median vancomycin treatment time until a nephrotoxic event was three days. There was no significant difference between those who developed nephrotoxicity compared to those who did not except median vancomycin trough level (14.5 in nephrotoxic versus 13.7 in non-nephrotoxic, P = 0.007).
The result of this study indicated that nephrotoxicity rate among patients treated with vancomycin is under the influence of the poisoning by nephrotoxicants. Higher vancomycin trough level was associated with increasing nephrotoxicity rate..

Blindness is a serious condition, which can affect mental balance and general organized personality of blind person. This study was carried out with the purpose of explaining the lived experience of self-care in blind individuals.
in this study, interpretive phenomenology was used to conduct the study. Through a purposeful sampling, 8 in-depth semi structured interviews were performed for 8 participants, which their duration was between 50-120 minutes. The method introduced by van Manen was used to perform the research and extract the concepts.
Analysis of the data led to three concepts, including “Being through discipline”, “independent through discipline”, and “protection of discipline”, which finally caused the appearance of the main concept, “self-care through a disciplined life”.
Blind individuals benefit from a disciplined lifestyle to have an independent life, and also expect this kind of discipline from others. Therefore, it is necessary that family members and health care providers consider the concept of disciplined life.

Body temperature is a critical criterion of health. Drugs and a variety of poisons can affect body temperature in poisoned patients, causing hyperthermia and hyperpyrexia.
Our previous study’s findings in patients poisoned with organophosphate led us to the goal of this study: obtaining the initial tympanic temperature in patients poisoned by a variety of toxins.
A cross-sectional study reviewed the records of poisoned patients who were admitted to the toxicological intensive care unit (TICU) at Loghman Hakim hospital poison center (LHHPC) from February 2014 to February 2015. The data collected included gender, age, type of poisoning, the season during which poisoning occurred, vital signs, initial tympanic temperature (first four hours), presence of seizures, white blood cell (WBC) count, creatinine phosphokinase (CPK), length of stay and patient outcome. We determined the mean (SD) for normally distributed continuous variables, the median and interquartile range for non-normally distributed continuous variables, and the absolute and relative frequency (%) for categorical variables. All were determined using SPSS version 16.
Data were collected from 310 eligible patients. The mean patient age was 32.65 (with a standard deviation of 14.40). Of the patients in the study, 183 (59%) were male. Intentional poisoning in an attempted suicide was documented in 253 (81.6%) patients. The most prevalent poisoning agent was aluminum phosphate (18.70%), followed by methadone (10%) and opium (10%). Seventy percent of the patients (n = 217) were diagnosed and classified with fever or hyperthermia. A temperature ≥ 40°C was detected in just three cases. The highest mean temperature was found in patients poisoned with amphetamine, organophosphate and tramadol. Patients with alcohol and phenobarbital poisoning were included in the sample, but these patients were not diagnosed with hypothermia. WBC ≥ 10,000 cells/mL and CPK ≥ 975 IU/L were recorded in 57.7% and 13.2% of subjects, respectively.
Body temperature changes in human poisonings are a matter in need of special attention. A literature review did not reveal any controversy over hypothermia, but poisoning cases exhibit a variety of patterns of fever and hyperthermia. If there are no limits to the diagnosis of fever and hyperthermia, all cases with a poor prognosis which fail to respond to treatment could be categorized as drug-induced hyperthermia. Therefore, a different approach is needed for poisoning cases.

Ventilator-Associated Pneumonia (VAP) is the main cause of nosocomial infection at intensive care units (ICUs), which causes high mortality and morbidity.. The objective of the present survey was to identify the VAP risk and prognostic factors among poisoned patients, who were admitted to the toxicological ICU (TICU), especially central nervous system (CNS) depressants due to their prevalence and importance..Patients and A case-control study was conducted at the Loghman Hakim hospital between March 2013 and March 2014. Among 300 poisoned patients with mechanical ventilator ≥ 48 hours, 150 patients, who had developed microbiologically-confirmed VAP were considered as the VAP group and 150 without VAP were defined as the control group. The following data were collected; age, gender, type of poisoning, glasgow coma score, Acute physiology and chronic health evaluation (APACHE) II score, length of hospital stay, previous antibiotic use, microbial culture of the trachea, body temperature, leukocyte count, and patients’ outcome. Based on the type of poisoning, patients were divided into three groups including: opioid, CNS depressants and others. All data were expressed as means (SD) for continuous variables and frequencies for categorical variables. Logistic regression was used to determine the relationship between risk factors and VAP.. The mean age of the patients was 33.9 ± 14.3 years. The probable VAP incidence and mortality were 22% and 18.6%, respectively. The rate of CNS depressant versus opioid use (odds ratio, 3.74; P < 0.027), APACHE II (odds ratio, 1.28; P < 0.000) and length of hospital stay (odds ratio, 2.15; P < 0.000) were the independent risk factors for VAP. While, the APACHE II score (odds ratio, 1.12; P < 0.044) and length of hospital stay (odds ratio, 2.15; P < 0.000) were the independent predictors of VAP mortality among these patients. The most common microorganisms in VAP cases were Methicillin-Resistant Staphylococcus aureus (MRSA) and Acinetobacter sp. (56.7% and 12.7%, respectively).. Central nervous system depressant was an important risk factor for VAP among poisoned patients. Hypoventilation due to CNS depression can lead to VAP. The APACHE II and length of hospital stay were shown as independent predictors of VAP and mortality among these patients..

The burned face involved with lip, chin and upper neck causes many problems in natural appearance. The treatment of drooped lip and disturbed cervicomental angle is difficult. The aim of this article is to introduce a new technique for recreation of this angle. In a clinical research 14 patients underwent to use a triangular fatty dermal flap and full thickness skin graft (FTSG) after releasing scar tissue. Wilcoxon test used to determine for correcting neck face angle. This study was conducted on 14 patients involved lower face, upper neck scar contracture. These patients gained a good functional and aesthetic result without complication. This study revealed a simple and reliable method in burned lower face, neck. It provides to restore movement and contour in spite of sever tissue deficiency for reconstruction.

Entering to the university and starting of student’s living can be named as a beginning of dreaming or complex of unknowns, exchanges, evolutions of any case, that with no doubt it has some effects such as depression, adjustment, behavior and morals disorders and anxiety feelings. For the reason that praying, worship and devotion in Islamic culture is a mention and scriptural, mentions can be as support against the difficulties and misfortunes. This research is done to emphasis on this fact. The study was descriptive analytical in design, that carried out on 403 students with stratified sampling from medical university of Ardabil. two questionnaire for data collecting were used that included For analyzing the data, we used the descriptive and inferential statistics. the prevalence of depression in students was 50/8. There was a significant relation (p< 0/05) between economic states with depression. Students have positive attitude to prayer and there was a statistical relation between sex, education, marital states, local occupancy, education level of mother, model semester, with prayer and inverse relation between prayer and depression. regarding to this research results and importance of other that reducing mean of depression range. Researchers recommended to access physical and spiritual prayer benefits and cure of depression it is necessary to ‍َي®— the culture pray in university and socials.

Burning is a problem that occurs quite frequently every day, and brings about a lot of psychophysical problems for both the burnt individual and his family. Hospital infection,burn infection and lack of the precsie care on the part of nursing staff is one of the hospital insufficiencies.This increases the duration of hospitalization and leads to the wastage of costs and as a result is very life threatening. This study was conducted to determine the quality of burn wound dressing in burn ward of Fatemi hospital. In this descriptive-analytical research, 100 cases of burn wounds were selected using simple sampling method, and were studied in terms of dressing quality.The data were collected using questionnaire and observation cards. The questionnaire included 9 questions regarding demographic specification and the observation card had 14 questions about the patient, 20 questions for attentive persons and 16 questions regarding equipment and solutions and 16 questions about the environment.This collected data was analysed using descriptive and inferential test. The findings indicated that the dressing quality of burn wound regarding the patients was weak (73%),average (27%) and good (0%). The equipment and solutions used were weak (52%), average (35%) and good (13%). In relation to environment weak (92%) average (8%), good (0%) and regarding attentive person weak(73%), average (27%), good (0%). There was a signnificant correlation among working experience, marital status and age of attentive personnel, and quality of burn wound caring. The findings indicated that the dressing quality of burn wound caring was weak. It is also recommended that more attention should be given to caring burn wounds by nursing staff.