Comparison of antimicrobial and wound-healing effects of silver nanoparticle and chlorhexidine mouthwashes: an in vivo study in rabbits.

The objective is to formulate a silver nanoparticle mouthwash and then evaluate its antimicrobial and wound-healing effects in rabbit animal models. Microbial samples were collected from the oral cavity of 60 rabbits. Thereafter, standardized wounds were created in the lateral border of the tongue on the right side for all rabbits. After surgery, digital photographs were obtained from the wounds with standardized settings. To characterize the silver nanoparticles used in the synthetic mouthwash, transmission electron microscopy (TEM) and digital light scattering analysis were used. The animal models were then randomly divided into 4 groups: group 1 received 9.80 wt% silver nanoparticle mouthwash; group 2 received all the ingredients of the formulated mouthwash except for silver nanoparticles; group 3 received chlorhexidine 2.0% mouthwash; and the negative control group did not receive any postoperative mouthwash. Microbial samples were collected from oral cavity of the rabbits each day for four postoperative days. Colony-forming unit (CFU) counts were compared post-operatively with the pre-operative counts. In addition, standardized digital photographs were taken each day from the wounds and the area of the wounds was compared in postoperative and pre-operative images. Data were statistically analyzed using one-way ANOVA and repeated measures variance analysis (α = 0.05). TEM revealed spherical morphology of silver nanoparticles and digital light scattering showed an average size of 5 nm and optimal distribution of the nanoparticles. CFU count significantly decreased in groups 1 and 3 (P < 0.001), while it significantly increased in groups 2 and 4 (P < 0.001). Moreover, a significant difference was observed between the experimental groups (P < 0.001). In addition, wound area decreased significantly in all groups (P < 0.001). However, the difference between wound areas in the groups was not significant, except for the 4th postoperative day (P < 0.001). However, the antibacterial effects and the wound-healing characteristics of the synthetic silver nanoparticle and chlorhexidine mouthwashes were not significantly different (P > 0.05). Silver nanoparticle mouthwash possesses favorable antibacterial and wound-healing effects. The formulated 9.80 wt% silver nanoparticle mouthwash with a particle size of 5 nm can be a promising alternative for application after oral surgical procedures.

Cartilage Curvature Reshaping: A Quantitative Assessment.

BACKGROUND: Horizontal mattress suturing is frequently performed during rhinoplasty and otoplasty procedures to control the curvature of the cartilages. Despite the popularity of this technique, there are no quantitative methods for determining the effects of mattress sutures in the cartilage reshaping. OBJECTIVES: The aim of this experimental study was to quantify the straightening effect of mattress suturing on the convexity of ear cartilage in a rabbit model. METHODS: Eleven young adult male New Zealand white rabbits were used in this study. A horizontal mattress suture with spacing 3 mm × 6 mm was placed in a rectangle demarcated on the left ear in the area with maximum convexity. Preoperative and postoperative photographs were taken before and immediately after surgery, respectively. The radius of curvature (ROC), the first-order derivative (FOD), and the second-order derivative (SOD) were calculated to quantify the net cartilage reshaping, the changes in each point, and the homogeneity of the newly shaped cartilage, respectively. RESULTS: The mean ROCs were 1.112 cm and 2.169 cm before and after surgery, respectively, and this increase was statistically significant. The mean FOD for each point slope index was statistically lower after surgery (0.269 before surgery vs 0.135 after surgery). The mean SOD also significantly decreased after surgery (0.007 before surgery vs 0.003 after surgery). The values of the SOD remained positive after surgery, indicating that changes in the curvature were homogeneous. CONCLUSIONS: A quantitative measurement method was introduced to directly quantify the controlling effect of a mattress suture. This method makes it possible to achieve the important task of comparing the effect of horizontal mattress suturing with that of other cartilage-reshaping techniques.

One-Month Follow-Up of Patients with Unspecified Abdominal Pain Referring to the Emergency Department; a Cohort Study.

INTRODUCTION: About one third of patients referring to emergency department (ED) with abdominal pain, are discharged without a definite diagnosis. This study aimed to investigate the one-month outcome of patients with unspecified abdominal pain. METHODS: This cohort study was conducted on subjects who were evaluated in ED with unspecified abdominal pain and were referred to the gastroenterology clinic and followed for one month. Finally, they were divided into two groups of cases with clear cause of abdominal pain and unclear cause of abdominal pain and patients' characteristics were compared between the groups. RESULTS: 150 cases with the mean age of 40.68 ± 18.34 years were studied (53.3% female). After one month, 67 (44.7%) patients still complained of abdominal pain. A definitive cause of abdominal pain was established in 88 (58.7%) cases. There was not any significant difference between groups regarding, sex distribution (p = 012), duration of pain (p = 0.11), history of previous similar pain (p = 0.136), pain radiation (p = 0.737), length of hospital stay (p = 0.51), and presence of anorexia (p = 0.09), nausea and vomiting (p= 0.50), fever (p = 1.0), diarrhea (p = 0.23), and constipation (p = 0.07). There was a significant difference between the groups regarding location of pain (p = 0.017), age (p = 0.001) and history of comorbid diseases (p = 0.046). The predictive factors of finding a clear cause for abdominal pain in one-month follow-up, were leukocytosis (OR: 5.92 (95% CI: 2.62 - 13.39); p < 0.001), age (OR: 2.78 (95% CI: 1.15 - 6.71); p = 0.023), and outpatient follow-up (OR: 1.04 (95% CI: 1.02 - 1.07); p < 0.001). CONCLUSION: Approximately, 40% of patients who were discharged with unspecified abdominal pain did not receive a clear diagnosis after one month of follow-up. Older age, leucocytosis in initial evaluations, and outpatient follow-up increased the probability of finding a clear cause for abdominal pain in the mentioned cases.

Prognostic Value of Cardiac Troponin I and T on Admission in Mortality of Multiple Trauma Patients Admitted to the Emergency Department: a Prospective Follow-up Study.

INTRODUCTION: The relationship between increased levels of cardiac troponins and morbidity and mortality of traumatic patients is not still well recognized. AIM: The aim of this study was to investigate the prognostic value of cardiac troponin I and T on admission in mortality of multiple trauma patients admitted to the emergency department. METHODS: In this prospective follow-up study, the cardiac troponin I and T levels were measured in patients with multiple trauma referring to the emergency department (ED) between March 2014 and February 2015 at Imam Khomeini Hospital, Sari, Iran. Patients were followed prospectively until discharge from hospital or death. RESULTS: The levels of cardiac troponins I and T in patients with multiple trauma were significantly associated with their mortality, especially at the level of 0.5 and 1.2 µg/dl (p<0.05). Multivariate regression analysis showed association of level of cardiac troponin I and T with patients' mortality, after controlling for patients' age, vital signs and GCS on admission. The sensitivity and specificity of troponin I at levels greater than 0.4 µg/dl in predict mortality in this study were as 65.5% and 55.3%, while the values for troponin T were 65.1% and 54.9%, respectively. CONCLUSION: Elevated cardiac troponin I and T levels provide excellent prognostic information regarding mortality in patients with multiple-trauma, independent of age, hemodynamic variables and GCS score.

Evaluation of Dentin Adaptability of Fluoride Varnish as a Root Canal Sealer Using Scanning Electron Microscopy.

OBJECTIVES: This study aimed to assess the dentin adaptability of a certain type of fluoride varnish, as a novel root canal sealer, in comparison with AH-Plus sealer. MATERIALS AND METHODS: Twenty-four extracted single-rooted, single-canal human permanent teeth with straight and fully formed roots and no internal calcification, resorption or cracks, were selected and decoronated such that the remaining root length was 14 mm in all teeth. Root canals were prepared using the Mtwo rotary file system according to the manufacturer's instructions and filled with gutta-percha and either AH-Plus (n=12) or fluoride varnish (n=12) via the lateral compaction technique. Each root was then sectioned at 4 and 8 mm distances from the apex for evaluation under a scanning electron microscope (SEM). The gap size between the sealer and dentin was measured. Statistical analysis was performed using the Kolmogorov-Smirnov test and t-test with the significance level set at 0.05. RESULTS: The mean gap size was 14.407±1.402 µm and 8.342±0.694 µm in the roots obturated with AH-Plus and fluoride varnish sealers, respectively. The t-test revealed a statistically significant difference (P<0.001) in this regard between the two groups. CONCLUSION: Fluoride varnish, as a root canal sealer, has a superior adaptation to dentinal canal walls compared to the AH-Plus sealer.

Effect of Basic Fibroblast Growth Factor on Achilles Tendon Healing in Rabbit.

BACKGROUND: Tendon injuries are common and it takes a long time for an injured tendon to heal. Adverse phenomena such as adhesion and rupture are associated with these injuries. Finding a method to reduce the time required for healing which improves the final outcome, will lead to decreased frequency and intensity of adverse consequences. This study was designed to investigate the effects of basic fibroblast growth factor on the healing of the Achilles tendon in rabbits. METHODS: In 10 New Zealand white rabbits, Achilles tendon was cut at the intersection of the distal and middle thirds on both hind legs. One microgram of recombinant basic fibroblast growth factor (bFGF) was injected in the proximal and distal stumps of the cut tendon on the right side (study group). Normal saline of equal volume was injected on the left side in the same way (control group). Then the tendons were repaired with 5/0 nylon using modified Kessler technique. A cast was made to immobilize each leg. On day 42, rabbits were euthanized and both hind legs were amputated. Tensometry and histopathologic examination were done on specimens. RESULTS: In tensometric studies, more force was required to rupture the repair site in study group. In histopathologic examination, collagen fibers had significantly better orientation and organization in the study group. No difference was noted regarding number of fibroblast and fibrocytes, and degree of angiogenesis in the two groups. CONCLUSION: Application of basic fibroblast growth factor at tendon repair site improves the healing process through improvement of collagen fiber orientation and increase in biomechanical resistance.

Serum Uric Acid Level in Relation to Severity of the Disease and Mortality of Critically Ill Patients.

AIM: This study was conducted to evaluate the validity of serum uric acid (UA) in prediction of mortality among patients in the emergency department. MATERIALS AND METHODS: This is a prospective cohort study which was conducted during 2014. In this study, 120 critically ill patients who required Intensive Care Unit care services were included. For evaluation of severity of the disease, mortality in emergency department score (MEDS) in the first 24 h of admission, the requirement of using mechanical ventilation, taking vasopressor during the hospitalization time and severity of the disease based on MEDS score were measured. The patients were divided into two groups: Patients with serum UA level lower than 7.3 mg/dl and patients with serum UA level of equal or more than 7.3 mg/dl. For comparison of the mortality rate in groups, Chi-square and fisher exact tests were applied. RESULTS: In patients, who needed mechanical ventilation, average of serum UA was 7.82 ± 2.82; however, in the patients who did not need mechanical ventilation this amount was 6.16 ± 2.7, a difference was statically significant. We found a statically meaningful difference between serum UA level with requiring mechanical ventilation and the predictive level of UA 6.95 ± 0.73 (F = 8.52; P ≤ 0.004). In the evaluation of MEDS, most patients with serum UA levels lower than 7.3 mg/dl had lower MEDS points (on average 4.6 ± 3.21) in compared to patients with serum UA level higher than 7.3 mg/dl (on average 12 ± 2.99). This difference was found to be statistically significant which indicates the patients whose serum UA was 7.3 mg/dl or higher, were at higher risk of mortality. CONCLUSION: The serum UA level in the 1st day of hospitalization of a critically ill patient is not an independent indicative factor in relation to mortality. High level of UA reveals critical status of the patient and requires mechanical ventilation.

Patients' Attitude toward Breaking Bad News; a Brief Report.

INTRODUCTION: Delivering bad news is a stressful moment for both physicians and patients. The purpose of this investigation was to explore the patients' preferences and attitudes toward being informed about the bad news. METHODS: This cross-sectional study was done on patients admitted to Imam Khomeini Hospital, Sari, Iran, from September 2014 to February 2015. Patient attitude regarding breaking bad news was evaluated using a reliable and valid questionnaire. RESULTS: 130 patients were evaluated (61.5% male, mean age = 46.21 ± 12.1 years). 118 (90.76%) participants believed that the patient himself/herself should be informed about the disease's condition. 120 (92.30%) preferred to hear the news from a skillful physician and 105 (80.76%) believed that emergency department is not a proper place for breaking bad news. CONCLUSION: Based on the results of the present study, most participants believed that the most experienced and skillful physician should inform them completely regarding their medical condition. At the same time they declared that, it is best to hear bad news in a calm and suitable place and time rather than emergency department or hospital corridors during teaching rounds.

Effect of Heparin on Post-Operative Adhesion in Flexor Tendon Surgery of the Hand.

Flexor tendon laceration is a common hand injury. Timely and correct diagnosis of this defect is an important factor for restoring hand function. Post-operative adhesion is a frequent problem after tendon repair and its prevention is difficult in some types of tendon lacerations. There have been some controversial studies on the positive effect of some materials and substances on prevention of these adhesions. This study aims to evaluate effects of the Heparin in postoperative tendon adhesions. In this clinical trial, 100 patients with laceration of flexor tendons in zone II of the hand were enrolled. The patients were randomly divided into two groups. In the first group, 0.5 cc Heparin (5000 IU/cc) was injected into each tendon ends before tendon repair. In the control group, repair was carried out without any heparin injection. After 3 months the total active range of motion (TAROM), mean extension gap (MEG) and mean flexion gap (MFG) were measured and compared between these two groups. The TAROM and MEGs were not significantly different between two groups; but MFGs were significantly better in Heparin treated group (P < 0.02). However rupture rate was significantly higher in heparin treated group (P = 0.003). Heparin may improve the tendons function and reduce the postoperative adhesions in zone II of the hand; however there is a significant risk of tendon rupture.

Evaluation of Amniotic Membrane Effectiveness in Skin Graft Donor Site Dressing in Burn Patients.

Although the recipient site in burn wounds is dressed with universally accepted materials, the ideal management of split-thickness skin donor sites remains controversial. The aim of our study is to compare two methods of wound dressing in donor sites of split-thickness skin graft in patients undergoing burn wound reconstructive surgery. Forty-two consecutive patients with second- and third-degree burns with a total body surface area between 20 and 40 % were enrolled in this randomized clinical trial conducted in Motahari Burn Hospital in Tehran, Iran. In each patient, two anatomic areas with similar features were randomly selected as intervention and control donor sites. The intervention site was dressed with amniotic membrane, whereas the control site was treated with Vaseline-impregnated gauze. Wounds were examined daily by expert surgeons to measure the clinical outcomes including duration of healing, severity of pain, and infection rate. The mean ± SD age of patients was 31.17 ± 13.72 years; furthermore, burn percentage had a mean ± SD of 31.19 ± 10.56. The mean ± SD of patients' cooperation score was 1.6 ± 0.79 in the intervention group compared with 2.93 ± 0.71 in the control group, revealing a statistically significant difference (P < 0.05). Duration of wound healing was significantly shorter (P < 0.05) in the intervention group (17.61 ± 2.56 days) compared with the control group (21.16 ± 3.45 days). However, there was no significant difference in terms of wound infection rate between donor sites in the control and intervention groups (P > 0.05). Amniotic membrane as an alternative for dressing of skin graft donor sites provides significant benefits by increasing patients' comfort via diminishing the number of dressing changes and facilitating the process of wound healing.

The effect of levamisole on mortality rate among patients with severe burn injuries.

BACKGROUND: Burn injuries are one of the main causes of mortality and morbidity throughout the world and burn patients have higher chances for infection due to their decreased immune resistance. Levamisole, as an immunomodulation agent, stimulates the immune response against infection. MATERIALS AND METHODS: This randomized clinical trial was conducted in Motahari Burn Center, Tehran, Iran. Patients who had second- or third-degree burn with involvement of more than 50% of total body surface area (TBSA) were studied. The levamisole group received levamisole tablet, 100 mg per day. Meantime, both the levamisole and control groups received the standard therapy of the Burn Center, based on a standard protocol. Then, the outcome of the patients was evaluated. RESULTS: 237 patients entered the study. After excluding 42 patients with inhalation injury, electrical and chemical burns, and the patients who died in the first 72 h, 195 patients remained in the study, including 110 patients in the control group and 85 in the treatment group. The mean age of all patients (between 13 to 64 years) was 33.29 ± 11.39 years (Mean ± SD), and it was 33.86 ± 11.45 years in the control group and 32.57 ± 11.32 years in the treatment group. The mean percentage of TBSA burn was 64.50 ± 14.34 and 68.58 ± 14.55 for the levamisole and control groups, respectively, with the range of 50-100% and 50-95% TBSA. The mortality rate was 68 (61.8%) patients in the control group and 50 (58.8%) patients in the treatment group (P = 0.8). CONCLUSION: According to this study, there was no significant relationship between improvement of mortality and levamisole consumption.

Survival of block and fascial-wrapped diced cartilage grafts: an experimental study in rabbits.

INTRODUCTION: Cartilage grafts have become an integral part in plastic surgery. Classic autogenous cartilage harvesting techniques are associated with significant donor- and recipient-site morbidity. The use of cartilage micrografts wrapped in a sleeve was first developed to decrease the complication rates of block cartilage grafts. The aim of this study was to compare the resorption rate of solid block cartilage graft and diced cartilage wrapped in fascia graft in rabbits. MATERIALS AND METHODS: In 12 rabbits, 1 solid block cartilage and 1 diced graft wrapped in fascia were implanted in subcutaneous pockets. By the end of the fourth month, the cartilage implants were dissected free and photographed and weighed exactly. Then specimens were stained with hematoxylin and eosin to determine their architectural characteristics. RESULTS: In the solid block cartilage graft group, the means ± standard deviation preimplant weight values were 5.34 ± 1.68. The weight was changed to 7.74 ± 3.26. The change was not statistically significant. In diced cartilage grafts wrapped in fascia, the means ± standard deviation preimplanted weight values were 8.13 ± 1.83. These values were changed to 2.79 ± 1.97, meaning statistically significant resorption of diced cartilage grafts wrapped in fascia (P < 0.001). In histologic examination, block cartilage grafts showed viable cartilage but diced cartilage grafts wrapped in fascia yielded fibrosis and inflammatory cell infiltration. CONCLUSION: The amplitude of resorption of the diced cartilage wrapped in fascia is considerable compared with one-piece block grafts. It may be anticipated that the enthusiasm for this technique will decline once the long-term results of pertaining clinical studies are available.

The effect of enoxaparin and clopidogrel on survival of random skin flap in rat animal model.

BACKGROUND: Necrosis of skin flaps is considered as an important complication in reconstructive surgery. We conducted an experimental study to investigate the efficacy of low-molecular weight heparin, clopidogrel and their combination to improve the flap survival. METHODS: Forty male, adult Sprague-Dawlay rats were divided randomly into 4 groups. Standard rectangular, distally based dorsal random pattern skin flap was elevated. To prevent the graft effect, a sterile sheet was put under the flap. No pharmacological agent was administered for the control group. In group 2, single subcutaneous dose of enoxaparin (3.2 mg/kg) was immediately administrated after surgery. In group 3, clopidogrel (25 mg/kg) was given orally for 7 days. In group 4, both enoxaparin and clopidogrel were administrated. The rats were evaluated on post-operative day 7 for viable and necrotic portions of flaps. RESULTS: The mean and SD of necrosis was 17.79+2.5 cm in the control group, 16.20±3.1 cm in low-molecular weight heparin, 15.25+3.8 cm in combined therapy group and 13.69+2.7 cm in clopidogrel group. Clopidogrel was the only pharmaceutical agent that produced a significant increase in the flap survival area. CONCLUSION: Clopidogrel may be an effective pharmaceutical agent that significantly increases viability of random skin flaps in rats, but low-molecular weight heparin and their combination did not have any significant beneficial effects.

Comparison of divided sciatic nerve growth within dermis, venous and nerve graft conduit in rat.

BACKGROUND: Considering the common origin of skin and peripheral nervous system, a tube of dermal layer of skin hypothetically can be an ideal conduit for nerve reconstruction. An experimental study performed to evaluate the nerve regeneration of efficacy into a dermal tube. METHODS: Sixty male Wistar rats were used. A 10 mm gap was produced in right sciatic nerves. In group A the autogenous nerve grafts were used to bridge the defects. In group B vein conduit were use to reconstruct the gaps. In group C dermal tube were used to bridge the defects. Morphologic studies were carried out after 3 month. RESULTS: The density of nerve fibers was significantly higher in autogenous nerve graft group. The efficacy of nerve growth into the dermal tube group was significantly poor in comparison to other groups. CONCLUSIONS: In the present study, dermis was used as the nerve conduit for the first time. This study indicates that the dermal tube is not a suitable conduit for nerve regeneration till further studies to resolve the problems before clinical application.