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Volume 65, Issue 6 (9-2007)
Background: Burns are a major cause of death and disability worldwide. Today biological dressings have become an integral part of modern burn care. Using this method, in otherwise healthy young adults, the size of burn relative to the total body surface area (TBSA) correlating with a 50% mortality rate has increased from 30% to 80%. Due to a lack of experience and an interest in using biological dressings in Iran, as a developing country, the aim of this study was to compare patient outcome using the biological dressing vs. conventional treatment in patients with massive burns.
Methods: In this clinical trial study, 118 burn patients (30 to 75% TBSA) were enrolled. The patients were divided in two groups. Those in the conventional treatment group had not accepted treatment with a biological dressing. The second group agreed to treatment with biological dressing, a pig skin xenograft known as Xenoderm. Significant differences were evaluated using the unpaired Student's t test, the Mann-Whitney U test and the χ2 test.
Results: Mortality rates in the conventional treatment group (n=53) and biological dressing group (n=65) were 35% (19) and 10.8% (7), respectively (p=0.001). Excluding those patients who died, the mean hospital stay was 31.3 days in the conventional treatment group versus 18.2 days in the biological dressing group (p=0.0005), and number of dressings was 22.1 versus 9.9 (p=0.0005), respectively. Three patients in the conventional treatment group were transferred to a tertiary-care hospital after three weeks of treatment. The most commonly burned areas were the upper limb, lower limb and trunk.
Conclusions: The results of this study indicate that biological dressings give a better outcome and decrease the hospital stay and the number of dressings. A randomized clinical trial is warranted.
Volume 66, Issue 9 (12-2008)
Background: Because of eventual side effects of chemical drugs, the efficacy of natural wound healing accelerators in long-term diseases and some situations is demanded to practitioners. The initial aim of our study was to assess full thickness excisional skin wound healing and inflammation diminution, Morphometrically and Histopathologically, after topical application of dried extract of Echinacea purpurea aerial part in rats, compared with zinc oxide.
Methods: Sixty wistar rats received four full thickness excisional wounds with the aim of surgical punch on the back skin under surgical anesthesia. All rats were randomly divided into groups 1, 2 and 3, of Echinacea purpurea, zinc oxide and control, respectively. All of them were treated topically once a day for 21 uninterrupted days. Healing of the wounds was daily measured by taking digital photographs and analysis. Histopathologic assessment was carried out in the 0th, 3rd, 7th, 14th, and 21st days of treatment period as well, and wound healing was assessed using 1 to 6 healing grades.
Results: According to Morphometric findings, the wound contraction rate in group 1 after 21 days of skin punching, with wound size of 0.18±0.03 mm2 in contrast with group 2, 2.81±0.21mm2, was much higher than that in other groups. Group 1 with wound contraction rate of 2.5 times in the day 7 and 3 times in the day 14 more than group 2, had the best wound contraction (p<0.01). histopathologic assessment revealed that, overall healing rate in the group 1 was highest (p<0.01).
Conclusion: Echinacea purpurea dried herbal extract could be a new capable remedy to accelerate skin wound healing because of its potential anti-phlogosis and wound healing stimulatory properties.
Volume 68, Issue 9 (12-2010)
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Background: Skin-derived
precursors (SKPs) are a type of progenitor cells extracted from mammalian
dermal tissue and can be differentiate to neural and mesodermal lineage in
vitro. These cells can introduce an accessible autologos source of neural precursor
cells for treatment of different neurodegenerative diseases. This research was done in order to set up isolation, culture,
proliferation and differentiation of human skin derived precursors (hSKPs).
Methods: Human foreskin
samples were cut into smaller pieces and cultured in proliferation medium after
enzymatic digestion. To induce neural differentiation, cells were cultured in
neural differentiation medium after fifth passage. We used immunocytochemistry
and RT-PCR for characterization of the cells. Neuron and glial
cell differentiation potential was assessed by immunofloresence using specific
antibodies. The experiments were carried out in triplicate.
Results: After
differentiation, βΙΙΙ- tubulin and neurofilament-M positive cells
were observed that are specific markers for neurons. Moreover, glial fibrillary acid protein (GFAP) and S100 positive cells were identified that are markers
specifically express in glial cells. Detected neurons and glials were also
confirmed by their morphologic characterizations.
Conclusion: Our results demonstrated that skin-derived precursors
obtained from human foreskin can exhibit neuronal and glial differentiation
potential in vitro, depending on the protocols of induction.
Volume 69, Issue 10 (1-2012)
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Background: Amphibian
skins possess various antibacterial compounds that are effective against some
microbial pathogens and are mostly released in response to environmental
stress. In fact, the skin of Rana ridibunda, a large green frog, is a
rich source of antimicrobial compounds that can be developed for therapeutic
use. In the present study, the skin extract of Iranian Rana ridibunda was
evaluated for its antimicrobial, hemolytic and cytototoxic activities.
Methods : The frog specimens were collected from Minoodasht located in Golesten
province in Iran, during 2009. Subsequently, their skins were removed and the intended compounds
were extracted. The crude extract was partially purified by gel filtration
chromatography. The antimicrobial effects of skin extract were assessed against
various microorganisms such as Escherchia coli, methicillin-resistant
and -sensitive Staphyloccus aureus, vancomycin-resistant and -susceptible
Enteroccus fecalis, Pseudomonas aeroginosa and Candida albicans. In
addition, its minimum inhibition concentration, cytotoxic and hemolytic
activities were determined.
Results : The crude extract of Rana ridibunda skin had valuable
antimicrobial effects against methicillin-resistant and -susceptible S. aureus in comparison with E.coli and vancomycin-resistant
and -susceptible E. fecalis. Besides, no
antimicrobial activities were seen against P. aeroginosa or C. albicans. Moreover, the hemolytic and cytotoxic activities of the skin
extract were minimal.
Conclusion: The
antimicrobial activity of Iranian Rana ridibunda was comparable to those
isolated from other Rana species. In conclusion, the skin extract of Rana
ridibunda had the potential for a new therapeutic agent against the emerging
drug-resistant bacteria, particularly methicillin-resistant and -sensitive S.
aureus.
Volume 70, Issue 8 (11-2012)
Background: Random pattern flap is a common reconstructive surgery procedure but its necrosis is a challenging problem. A lot of pharmacological agents and surgical procedures have been examined for the prevention of this complication to maximize the length to width ratio of these surgical flaps. Therefore, we designed an experimental study to evaluate the effects of aspirin, clopidogrel bisulfate (Plavix) and their combination on random skin flap survival in rats.
Methods: Forty male rats were randomly assigned to four equal groups. Surgery was done under general anesthesia. A random, rectangular 3×11 cm dorsal skin flap was designed, elevated and sutured back into its primary site. In group one, 100 mg/kg Aspirin and in group two, 25 mg/kg Plavix were administered orally for 7 days postoperatively. Aspirin and Plavix were co-administered in the third group for the same period of time while the control group received no medication. After 7 days, the total surface of flaps, the viable and also the necrotic parts were measured by Image J software. Mean standard deviation and analysis of variance were calculated to compare the results.
Results: The mean area of flap survival was 62.49% in the control, 64.04% in Aspirin, 65.09% in Plavix and 64.06% in combination groups. No statistically significant differences were found between treatment groups and control rats.
Conclusion: In this study, we found no significant differences between Aspirin, Plavix or their combination on the survival of random skin flaps.
Volume 70, Issue 9 (12-2012)
Background: The high number of breast cancer patients who receive radiation therapy after surgery has caused many to think about a shorter period of radiotherapy, which can significantly reduce the radiotherapy machine time, labor hours, and fewer patient visits. This study was designed to evaluate the acute skin effects and cosmetic outcomes of short course radiotherapy in early-stage breast cancer in comparison with the conventional treatment method.
Methods: Fifty-two patients with operable breast cancer (pT1-3pN0M0) who underwent breast conservation surgery in Tehran Cancer Institute during January 2011 to January 2012, were randomly assigned to undergo radiotherapy by either receiving conventional treatment (dose: 50 Gy in 25 fractions) with subsequent electron boost or a short-course hypofractionated radiotherapy (dose: 42.5 Gy in 16 fractions) and a subsequent electron boost.
Results: There were no skin changes during the first or the second week of treatment in the two groups. Cutaneous complications began after the third week as grade 1 skin toxicity after termination of the short-course radiotherapy but there were no difference in complication rate after four weeks of treatment. Six months and one year after treatment, there were no differences in terms of skin complications or cosmetic outcomes between the two groups.
Conclusion: Although the use of a whole-breast irradiation with a hypofractionated schedule was associated with desirable outcomes, in term of skin toxicity and cosmetics, but longer follow-up periods with larger sample sizes are needed to confirm these results.
Volume 71, Issue 3 (6-2013)
Background: Primary culture takes place following the cell isolation from tissues. Isolation and culture of melanocytes based on their roll in the protection of body against hazardous sun rays, production of skin, cornea and hair color is really important. This study was done to set isolation, culture and proliferation of melanocytes from children foreskin and adult eyelashes, and also comparison of two types of melanocyte culture medium.
Methods: Human foreskin and eyelash samples were used for melanocyte isolation and culture. After isolation of epidermis from dermis, epidermis cell suspensions were prepared by enzymatic digestion. The isolated cells were cultured in two melanocyte selective culture media. Immunocytochemistary and reverse transcription-polymerase chain reaction (RT-PCR) assays were used for confirmation of isolated and cultured melanocytes.
Results: Our results indicated that isolated melanocyte cultured in the selective medium without phorbol esters is better than the melanocytes cultured in selective medium cont-aining phorbol esters not only morphologically but also physiologically and from the aspect of cell adhesion. In addition, the results showed that isolated melanocyte from adult eyelashes are more dendritic than melanocytes isolated from children foreskin. Conversely, our results indicated that the number of cell passages in melanocyte isolat-ed from foreskin is more than melanocytes isolated from adult eyelashes.
Conclusion: Melanocytes cultured in selective medium containing convenient growth factors in absence of phorbol esters show more native physiological and adhesive properties. In addition, melanocyte isolated from younger tissues such as foreskin have better proliferative and sub-culturing properties so we suggest isolation and culture of younger tissues.
Volume 73, Issue 11 (2-2016)
Background: Graft survival has been considered the major problem in reconstructive surgery. Clinical studies have helped us to understand the role of PRP in increasing skin survival. Our goal in this study was to examine the treatment effects of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) on autologous full thickness skin graft survival in male rats.
Methods: This experimental study was performed on 36 rats of Sprague-Dawley race with weighing approximately 250 to 300 gr on May 2015 in animal laboratory of Hazrat Fatima Hospital. After anesthesia, rats were divided into 3 groups. We injected platelet-rich plasma (PRP) in the first group, platelet-rich fibrin (PRF) in the second and saline in the third group after removing the skin. Microscopic analysis was performed with camera (Canon powershot SX200, Tokyo, Japan) on days 7, 14, 21 and 28 after surgery. We used image analysis system (ImageJ, ver. 1.45) to examine necrosis and survival rate. Samples were studied with H&E staining on day 28 microscopically for histological analysis of vascular density and angiogenesis.
Results: Our findings showed the area of necrosis in animals injected with PRP on days 7 and 14, was meaningfully less than control group (P= 0.0001). There was no meaningful difference between control and PRP groups (P> 0.05). The area of necrosis in animals injected with PRF did not have any significant difference with control group from beginning to 21st day (P< 0.0001). there was no meaningful difference in vascular density between control and PRP group, whereas in animals injected with PRF the vascular density was significantly less than control group (P= 0.002).
Conclusion: According to our results in this study, we can conclude that using autologous PRP can enhance the process of healing soft tissue injury and be affective at increasing graft survival. This method is suggested to be conducted for patients highly at risk of graft loss and also for those who are in need of early treatments.
Volume 75, Issue 6 (9-2017)
Case presentation: A 37-years old woman was admitted in an University Hospital of Mashhad University of Medical Sciences, Iran, in 2016 two weeks after genital surgery. The chief complaints were fever, painful tenderness, ulcerative lesion and inflammatory papule on surgical site and thigh. She suffered of fever despite received oral and then wide spectrum intravenous antibiotic therapy. Blood cultures and wound culture were negative. In addition to two deferent intravenous antibiotics, topical wound debridement was performed. Despite this course of treatment which did not improve the lesion, biopsy was performed. Histopathology features of biopsy specimen indicated prominent neutrophils mixed inflammation and lymphocytic vasculitis indicated as pyoderma gangrenous. The patient's medical history included associated ulcerative colitis from 18 years ago and she was under irregular oral receiving of Asacol (mesalamine). Intravenous corticosteroid therapy was administered which led to response of skin of right thigh and surgical site inflammation. After 6-months follow-up, the patient is still in good condition.
| Conclusion: Based on major variable clinical manifestations and no diagnostic serologic test of pyoderma gangrenosum, diagnosis of this disease is difficult. Increased awareness about PG and exclusion of other etiologies such as inflammatory and immunologic disease will aid in prompting of pyoderma gangrenosum diagnosis and proper management of the disease. |
Volume 76, Issue 3 (6-2018)
Methods: This descriptive-analytic study was performed on all patients admitted for skin rashes in Hazrat Masoumeh Hospital in Qom, Iran from 2010 to 2015. In this study, the data of 317 patients who were admitted to the early diagnosis of rash were collected from patients' files and recorded in the checklist.
Results: According to our study, the most common causes of skin rashes in children were viruses with a share of 40.69% (129 cases), allergic causes being as prevalent as 21.77% (69 cases) and drug induced rashes that accounted for 20.50% (65 cases). Based on the site and type of rashes, the most common type of rashes were maculopapular rashes with 42% and hives with 31.9% prevalence, and the most common site of involvement was diffuse involvement that would account for 84% of the cases. In terms of drug use history, 35.6% had a history of antibiotic use prior to admission, and 14.5% had an antiepileptic drug use history. There was a significant relationship between the cause of rashes and the season of presentation (P< 0.05) as well as the age of presentation (P< 0.05).
Conclusion: This study showed that there is a significant relationship between the season and age of occurrence, but the use of these factors as a benchmark for the diagnosis of rash requires more studies. Paying attention to the causes of rash in children, knowing about these factors, and continuous evaluation of these patients can help in advancing a proper management of the problem of patients. The most frequent factors were viruses and then allergic and pharmaceutical agents, and the most common type was maculopapular.
Volume 77, Issue 6 (9-2019)
Methods: This was comparison study that involved patients admitted to a single-center burn unit who required a skin graft donor site. 10 burn patients with thermal injury and 10-30% of total body surface area (TBSA) who referred to Shahid Motahari Hospital, Tehran, in 2016 were studied. Each patient was compared to herself. After anesthesia, the site of the skin graft was randomly divided into three sections in each patient and was covered with Agicoat®, Mepitel and vaseline gauze. On the 4th and 8th of the day, the pain was recorded during the dressing change on the basis of the visual analogue scale (VAS). After 6 months, the patients were evaluated for the remainder of the scars based on VSS (Vancouver scar scale).
Results: The mean time to repair in both groups were similar and significantly shorter than that of vaseline (P=0.005). The pain comparison between groups showed that on the fourth day, the mean pain in the Agicoat group and Mepitel was significantly less than the Vaseline group (P=0.004). Also, the mean pain of the epileptic group was significantly lower than that of the Vaseline group (0.002). However, there was no significant difference between the duration of regeneration and pain between the two groups of Agicoat and Mepitel, but there was no significant difference between the mean pain on the 8th day and the mean VAS 6 months after the graft.
Conclusion: Agicoat dressing has been effective in reducing pain and increasing the repair speed, but this effect was similar to that of the silver-free Mepitel dressing. Expensive silver nano-crystal dressings limit their use. The silver nanocrystal did not have much effect on improving the remaining scar. However, more studies are needed in this regard.
Volume 78, Issue 3 (6-2020)
Methods: In this analytic study, the database of HAM10000 (human against machine with 10000 training images) dermoscopy images, 1000 melanocytic nevi and 1000 melanoma images were employed, where in each category 900 images were selected randomly and were designated as the training set. The remaining 100 images in each category were considered as the test set. A deep learning convolutional neural network (CNN) was deployed with AlexNet (Krizhevsky et al., 2012) as a pretrained model. The network was trained with 1800 dermoscope images and subsequently was validated with 200 test images. The proposed method removes the need for cumbersome tasks of lesion segmentation and feature extraction. Instead, the CNN can automatically learn and extract useful features from the raw images. Therefore, no image preprocessing is required. Study was conducted at Shahid Beheshti University of Medical Sciences, Tehran, Iran from January to February, 2020.
Results: The proposed model achieved an area under the receiver operating characteristic (ROC) curve of 0.98. Using a confidence score threshold of 0.5, a classification accuracy of 93%, sensitivity of 94%, and specificity of 92% was attained. The user can adjust the threshold to change the model performance according to preference. For example, if sensitivity is the main concern; i.e. false negative is to be avoided, then the threshold must be reduced to improve sensitivity at the cost of specificity. The ROC curve shows that to achieve sensitivity of 100%, specificity is decreased to 83%.
Conclusion: The results show the strength of convolutional neural networks in melanoma detection in dermoscopy images. The proposed method can be deployed to help dermatologists in identifying melanoma. It can also be implemented for self diagnosis of photographs taken from skin lesions. This may facilitate early detection of melanoma, and hence substantially reduce the mortality chance of this dangerous malignancy.
Volume 78, Issue 4 (7-2020)
Methods: In this analytic study, 327 AKIEC, 513 BCC, and 840 benign keratosis images from human against machine with 10000 training dermoscopy images (HAM10000) were extracted. From each of these three types, 90% of the images were designated as the training set and the remaining images were considered as the test set. A deep learning convolutional neural network (CNN) was developed for skin cancer detection by using AlexNet (Krizhevsky, et al., 2012) as a pretrained network. First, the model was trained on the training images to discriminate between benign and malignant lesions. In comparison with conventional methods, the main advantage of the proposed approach is that it does not need cumbersome and time-consuming procedures of lesion segmentation and feature extraction. This is because CNNs have the capability of learning useful features from the raw images. Once the system was trained, it was validated with test data to assess the performance. Study was carried out at Shahid Beheshti University of Medical Sciences, Tehran, Iran, in January and February, 2020.
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Results: The proposed deep learning network achieved an AUC (area under the ROC curve) of 0.97. Using a confidence score threshold of 0.5, a classification accuracy of 90% was attained in the classification of images into malignant and benign lesions. Moreover, a sensitivity of 94% and specificity of 86% were obtained. It should be noted that the user can change the threshold to adjust the model performance based on preference. For example, reducing the threshold increase sensitivity while decreasing specificity.
Conclusion: The results highlight the efficacy of deep learning models in detecting non-melanoma skin cancer. This approach can be employed in computer-aided detection systems to assist dermatologists in identification of malignant lesions. |
Volume 79, Issue 9 (12-2021)
Methods: This cross-sectional study was performed on 100 patients who were referred to the nephrology clinic of Baqiyatallah Hospital, Tehran, Iran and underwent kidney transplantation within a year (from the first working day of the Iranian Hijri calendar in April 2015 until the last working day in March 2016). Patients were referred to a dermatologist in case of any skin lesions. Patients' data were collected in a researcher-made questionnaire and were analyzed using SPSS software, version 18. The p values less than 5% were considered to be significant.
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Results: The mean and standard deviation (SD) of the patients' age was 50/4±11/8 years. The average time of incidence of skin lesion after transplantation has been 8/1 ± 5/7 weeks. The most common types of non-melanoma cancers were squamous cell carcinoma (2%) and Kaposi's sarcoma (4%) and there was no significant difference between men and women (p>0.05). Sixty-six percent of the patients had skin infections and the most common skin infections were wart (34%) and tinea versicolor (11%). The relative frequency of skin infections was significantly higher in male patients than in females (p=0.004). Considering all other confounding variables including smoking, hypertension, diabetes and other infectious diseases, the only noteworthy finding was the higher relative frequency of tinea versicolor in diabetic compared with non-diabetic patients (p=0.046).
Conclusion: This study showed that skin complications including various neoplastic (Sarcoma and Carcinoma), infectious (fungal and viral), and other (Acne and Hypertrichosis) diseases are common in patients with kidney transplantation who are taking immunosuppressive drugs. Informing these patients and medical staff about skin problems leads to an early referral of patients and increases their life expectancy and improves their quality of life. |
Volume 79, Issue 10 (1-2022)
Methods: An in-vitro interventional laboratory study was performed in the cell culture laboratory of Medical Laser Research Center, Yara Institute in 2020-2021 (July 2020 to July 2021). First, A375 skin cancer cells were cultured in DMEM with 10% FBS. After preparation and culture of A375 cell lines, different concentrations of vitamin A (1, 5, 50, 100 μM) and LLL energy doses (1, 2, 5, 10 J/cm2) as treatments were done. Combination research of these treatments was performed to eliminate skin melanoma cancer cells. The rate of viability was determined using the MTT test, and the rate of apoptosis was determined using flow cytometry.
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Results: The results indicated that a low-level laser with energy dosages of two and 5 J/cm2 and vitamin A treatment with a concentration of 50 μM in the A375 skin cancer cell line had the lowest viability and the highest induction of apoptosis. Furthermore, the results of the combination of Vitamin A and LLL treatments showed a synergistic effect with a greater reduction in the viability of skin melanoma cells and a greater amount of apoptosis.
Conclusion: In general, vitamin A and Low-level laser diminish the viability of cancer cells. Combination therapy of Low-level laser in the effective dose with vitamin A in optimal concentration provides anti-cancer effects. Further reductions in cancer cell viability caused by vitamin A and low-level laser radiation could pave the way for a novel approach in cancer treatment. |
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