Grafting with cryopreserved amniotic membrane versus conservative wound care in treatment of pressure ulcers: a randomized clinical trial

Objective: to compare the healing process of pressure ulcers treated with cryopreserved human amniotic membrane allograft and routine pressure ulcer care in our hospital

Methods: from January 2012 to December 2013, in a prospective randomized clinical trial [IRCT201612041335N2], 24 patients with second and third stage of pressure ulcers were enrolled in this study. All patients needed split thickness skin grafts for pressure ulcer-wound coverage. Selected patients had symmetric ulcers on both upper and lower extremities. The patients were randomly divided into two groups: amnion and control. In the amnion group, the ulcer was covered with cryopreserved amniotic membrane and in the control group it was treated with local Dilantin powder application. The duration and success rate of complete healing was compared between the two groups

Results: the study group was composed of 24 pressure ulcers in 24 patients [19 males and 5 females] with a mean age of 44+/-12.70 years. The demographic characteristics, ulcer area, and underlying diseases were similar in both groups. The early sign of response, such as decrease in wound discharge, was detected 12-14 days after biological dressing. Complete pressure ulcer healing occurred only in the amnion group [p<0.001]. Partial healing was significantly higher in the amnion group [p<0.03]. Healing time in this group was faster than that the control group [20 days versus 54 days]. No major complication was recorded with amniotic membrane dressing

Conclusion: cryopreserved amniotic membrane is an effective biologic dressing that promotes reepithelialization in pressure ulcers

Cost-utility analysis of IEV drug regimen versus ESHAP drug regimen for the patients with relapsed and refractory Hodgkin and non-Hodgkin's lymphoma in Iran

Background: Chemotherapy for lymph nodes cancer is often composed of several drugs that are used in a treatment program

Objectives: The aim of this study was to perform a cost-utility analysis of IEV regimen [ifosfamide, epirubicin and etoposide] versus ESHAP regimen [etoposide, methylprednisolone, high-dose cytarabine, and cisplatin] in patients with lymphoma in the south of Iran

Patients and Methods: This was a cost-utility analysis done as a cross-sectional study in the south of Iran. Using decision tree, expected costs, quality -adjusted life years [QALYs] and the incremental cost-effectiveness ratio [ICER] were estimated. In addition, the robustness of results was examined by sensitivity analysis

Results: The results of this study indicated that the total lymphoma patients were about 65 people that 27 patients received IEV regimen and 38 patients ESHAP [43 patients with Hodgkin's and 22 with non-Hodgkin lymphoma]. The results of decision tree showed that in the IEV arm, the expected cost was dollar 20952.93 and the expected QALYs was 3.89 and in the ESHAP arm, the expected cost was dollar 31691.74 and the expected QALYs was 3.86. Based on the results of the study, IEV regimen was cost-effective alternative to the ESHAP regimen

Conclusions: According to the results of this study, it is recommended that oncologists use IEV instead of ESHAP in the treatment of patients with lymphoma and because of high costs of IEV drug costs, it is suggested that IEV drugs should be covered by insurance

Prolonged hemoptysis caused by primary pulmonary epithelioid hemangioendothelioma; a case report and review of the literature

Epithelioid hemangioendothelioma is a vascular tumor with an intermediate malignant potential. This tumor is very rare in the lung parenchyma, and most of the previously reported cases have been asymptomatic. There is no standard therapy for this tumor and prognosis in the previous reports has been variable. Herein we report our experience with a 60-year-old woman presenting with hemoptysis and multiple lung consolidation, leading to a diagnosis of epithelioid hemangioendothelioma after surgical resection and pathological examination. After surgery and chemotherapy, the patient had an acceptable course

Correlation between transcranial doppler findings, neuroimaging and functional status in the first days of acute intracerebral hemorrhage

To have an appropriate and accessible modality for monitoring of patients with intracerebral hemorrhage [ICH] that have a correlation with Computed tomography [CT] scan data, we conducted a study to compare Transcranial Doppler finding with CT data in the first and 5th day after ICH and clear their relations with functional status [FS] of patients. We prospectively studied 50 patients with supratentorial ICH evaluated in less than 24 hours of its onset. All selected patients underwent emergent CT scan and TCD on admission. Doppler parameters of middle cerebral arteries [including systolic, diastolic and mean velocities, Pulsatility index [PI], Diastolic flow velocity [DFV]] were recorded in first and fifth days of admission by TCD. FS of patients was measured using National Institutes of Health Stroke Scale [NIHSS] score in these days. Twenty six female patients and 24 male entered the study with NIHSS score average of 14 +/- 6.5 in first and 13.7 +/- 7.3 in 5th days. Their hematoma volume was 13.5 +/- 1.7 millimeter in average. There was a significant reverse relation between DFV of 1st day and NIHSS score in unaffected hemisphere in first and 5th days [First day: P= 0.03 and 5th day: P < 0.001]. Also there was a positive relation between PI and NIHSS score in unaffected hemisphere in 5th day [P=0.03]. PI had no difference in the patients with intraventricular hemorrhage [IVH] and patients without the IVH, even though PI cannot predict the site of hematoma but DFV in 5th day, in unaffected hemisphere can be a predictive factor for intraventricular hemorrhage. Most of TCD parameters were correlated with functional status and some of them [DFV, PI] had prediction value for intraventricular hemorrhage in acute phase of ICH. Also they had a high correlation with CT scan findings.

Traumatic left anterior descending coronary artery-right ventricle fistula: a case report

Traumatic coronary artery-cameral fistulas [TCAF] are rare and may present secondary to penetrating injuries [80%] or iatrogenic traumas. Early operative intervention remains the recommended treatment modality for accidental traumatic coronary artery fistulas. We report the case of a 17-year-old man who presented with left anterior descending coronary artery-right ventricle fistula following penetrating cardiac trauma, which was successfully repaired surgically

Evaluation of plasma interleukin-8 concentration in patients with prostate cancer and benign prostate hyperplasia

Prostate specific antigen [PSA] has been used as a screening test for the early detection of prostate cancer [PC] for many years. Although the introduction of PSA test led to a considerable increase in reported prostate cancer cases, there is still some controversy over the sensitivity and specificity of this marker in distinguishing PC patients from those with benign prostate hyperplasia [BPH], the most common benign prostate condition. An attempt is made to elucidate if the plasma level of Interleukin 8 [IL-8] could be used effectively as a marker for the detection of prostate cancer. Plasma levels of IL-8 and PSA were measured in two groups of 40 BPH and PC patients using enzyme-linked immunosorbent [ELISA] and radioimmunoassay [RIA] techniques, respectively. In addition IL-8 levels in PC3 and DU145 cell line supernatants were measured by ELISA technique. The concentration of IL-8 in the plasma of PC patients was not significantly higher than the BPH subjects. Although, a correlation between plasma IL-8 concentration and the Gleason score of PC patients was found, no indicated correlation was detected between the concentration of IL-8 or PSA and age of the patients in both groups. DU145 and PC3 cell lines produced and secreted IL-8 in the media. Data of this investigation collectively conclude no correlation between IL-8 concentration in PC and BPH patients

Sonographic fetal weight estimation using femoral length: honarvar equation

Fetal growth is the result of interactions between various factors and can be estimated by ultrasonic measurements. Fetal femur length is a scale for estimating the fetal weight in individual races because fetal growth patterns differ among different races. This was a prospective study involving 500 pregnant women at 36 weeks of gestational age. Real-time sonography was done to measure the femoral length and then the weight of the fetus was estimated by the Honarvar 2 equation. The correlation between estimated fetal weight [EFW] and real weight was tested by Pearson correlation coefficient and relationships with the age and BMI of the mother, the sex of the neonate and parity were tested by multiple regression. EFW by the Honarvar 2 equation correlated significantly with the actual birthweight. Therefore, this equation is valid for fetal weight estimation. It also does not depend on the age and BMI of the mother, sex of neonate, or parity. Ethnicity potentially plays an important role in the fetal weight estimation. The Honarvar formula produced the best estimate of the actual birthweight for Iranian fetuses, and its use is recommended

relation between the position and length of uterus and pregnancy rate in ivf and embryo transfer treatment cycles

Background: Embryo transfer has received little clinical attention and has been the most inefficient step in in-vitro fertilization [IVF]. Recent reports have suggested that an awareness of the position and length of the uterus during embryo transfer might be helpful in improving pregnancy rate

Objectives: The main objective of the present study was to determine the relation between the length and position of the uterus during embryo transfer and pregnancy rate

Materials and Methods: Patients were randomly allocated to two groups. In case group A [n=40] length of uterus was measured at the day of oocytes collection and the position of uterus was determined. In the control group, Group B, [n=40] the length and position of uterus were not investigated. The embryo transfer catheter was advanced to 5 mm from uterine fondues based on the previously determined cavity length in group A. The embryo transfer procedures [IVF/ICSI] at 48 hours after oocytes collection was done. The outcome of the treatment cycle in two groups was investigated. Data analysis was performed by using chi-square, fisher-exact and ANOVA tests. The statistical significant was defined [P<0.05]

Results: There were no significant differences in the mean age [28,5+4.4, 27.8+6.2], and duration of infertility [7+3.4, 8.7+5.4] The pregnancy rate was not significantly different with respect to position and length of uterus. The pregnancy rate in case groups was 25% and in control group was 22.5%, the difference was not significant [P= 0.792]. In both groups, there were ectopic peregnancy and in fact he incidence of ectopic pregnancy, per reported clinical pregnancy, was highest in group A [14.9%] in comparison with group B [1.8%]

Conclusion: The pregnancy rate was not significantly different in the two groups. Misdirecting the embryo transfer can not be avoided by an accurate knowledge of the position or length of uterine at the time of oocytes retrieval. Further studies are required to evaluate the role of length and position of uterus related to the pregnancy rate