The Effects of Zataria multiflora Cream on Split-Thickness Skin Graft Donor-Site Management: A Randomized, Blinded, Placebo-Controlled Study

Purpose: The wound healing process involves a complex series of biological events. Skin grafts have several uses as a reconstructive method. There are several dressings for the skin graft donor site, but the optimum dressing agents that provide all the requirements at the same time are unclear. This prospective, randomized, placebo-controlled clinical trial aimed to evaluate the therapeutic effect of Zataria multiflora cream in the wound healing process of partial-thickness skin graft donor sites and compared it with a placebo. Materials and Methods: This clinical trial study was performed on patients who underwent split-thickness skin grafts. Enrolled patients applied Z. multiflora cream and placebo controlled (petrolatum ointment) twice a day, from the day of intervention at the skin graft donor sites in two parts, separately. On 7, 14, 21, and 28 days after surgery, the wound healing process was evaluated, photographed, and scored according to the Bates-Jensen assessment tool. Evidence of infection was evaluated. The main agent and placebo were compared during the wound healing process. Results: Decreases in wound surface area and total score were significantly greater in the Z. multiflora group (p < 0.05). The wounds of 30% of patients in the second week and 90% of patients in the third week were completely epithelialized in the Z. multiflora group. These values were 3.3% and 36.7% for the control group, respectively, and so, the healing rate was ∼9-fold in the second week and 2.45-fold in the third week in the Z. multiflora group compared with the control group (p < 0.05). Conclusion: Wound healing and reepithelialization accelerated significantly in the first, second, third, and fourth week after intervention in the Z. multiflora treatment group, due to modulating the inflammatory phase and improving the proliferative phase. Clinical Trial Registration Number: IRCT20210624051695N1.

Efficacy and Safety of 0.25% Timolol Gel in Healing Split-Thickness Skin Graft Site

As a common intervention among burn patients, skin graft has some risks such as infections and delay of wound healing. The aim of this study was to assess the efficacy and safety of topical 0.25% Timolol Gel (TG) in promoting wound healing in split-thickness skin graft donor sites. We conducted a double-blind, randomized clinical trial to assess re-epithelialization time, the level of pain based on the Visual Analog Scale (VAS), and the wound infection incidence. The scar status was also evaluated by the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Totally, 64 patients were randomly assigned to the study groups. The two groups showed a significant difference in healing time (14.5 ± 3.2 vs. 11.5 ± 2.3 days, P < 0.001). No infection occurred in either group, and 3 cases of transplant rejection were observed in the placebo group. The VAS was significantly different on days 1, 2, 3, 4, and 7 (P < 0.05). In the third month, the results showed a significant difference in terms of VSS (P = 0.005). Topical TG, due to its favorable effects on wound healing and pain reduction, can be administered as a therapeutic agent in patients with a skin graft.

A methylation signature at the CpG island promoter of estrogen receptor beta (ER-β) in breasts of women may be an early footmark of lack of breastfeeding and nulliparity

Although little is known regarding the mechanisms behind the onset of breast cancer (BC) through reproductive risk factors, new researches have highlighted some early tumor-related methylation footmarks in the breast tissue of apparently clinically healthy women as their potential epigenetic mechanism. Previous evidence supports that the estrogen receptor beta (ER-β), whose anti-cancer roles had already been revealed in BC, is downregulated in the breasts of healthy nulliparous women. Nevertheless, data on such a link about its methylation alterations have not been reported. The goal of current study was to determine possible methylation alterations at CpG island promoter of the ER-β gene, including promoter 0 N and exon 0 N, in relation to aspects of reproductive history in the healthy breasts. The DNA was extracted from the breasts of 120 subjects undergoing cosmetic mammoplasty. Thereafter, the methylation levels of targeted regions in ER-β gene were determined by using MeDIP-qPCR assay. The results revealed that ER-β exon 0 N had no methylation in 84.2 % of the women, whereas the rest, comprising 2.5 % and 13.3 % of the samples, showed a lower and higher of its methylation, respectively. Interestingly, nulliparous women were found to have an elevated methylation level of the ER-β exon 0 N than parous women (P = 0.036). Moreover, we observed a high methylation of the ER-β exon 0 N in the breasts of non-breastfeeding women compared to breastfeeding subgroup (P = 0.048). Likewise, the non-breastfeeding subgroup showed exon 0N high methylation in comparison to women with breastfeeding >24 months (P = 0.023). Finally, although we found that 6.67 % of the samples had a high methylation level at the promoter 0N, no any relationship was found between its methylation and reproductive history. These results may provide key clues to revealing the epigenetic mechanism through which the nulliparity and lack of breastfeeding influencing the risk factor of BC as well as introducing the potential new early prediction and prevention strategies. Although further investigations need to be done in order to gain a better understanding the roles of these epigenetic signatures.

Febuxostat therapy in outpatients with suspected COVID-19: A clinical trial

BACKGROUND

The aim of this clinical trial was to evaluate the effects of febuxostat (FBX) in comparison with hydroxychloroquine (HCQ) on clinical symptoms, laboratory tests and chest CT findings in outpatients with moderate symptoms of COVID-19 infection.

METHODS

We conducted a clinical trial involving adult outpatients with the moderate respiratory illness following COVID-19 infection. Patients were randomly assigned to receive either FBX or HCQ for 5 days. The measured variables were needs to hospitalisation, clinical and laboratory data including fever, cough, breathing rate, C-Reactive Protein level, lymphocytes count at onset of admission and was well as at 5 days of treatments. In addition, CT findings were evaluated on admission and 14 days after initiation of treatment.

RESULTS

Sixty subjects were enrolled in the study with a 1 to 1 ratio in FBX and HCQ groups. On admission, fever (66.7%), cough (87%), tachypnoea (44.4%), dyspnoea (35%), elevated CRP value (94.4%) and lung involvement according to chest CT (100%) were documented in enrolled patients with insignificant difference between FBX and HCQ groups. Fever, cough and tachypnoea were significantly mitigated in both groups after five days of treatments without any significant differences between groups. The mean percentages of lung involvement were significantly reduced to 7.3% and 8% after 14 days of treatment with FBX and HCQ, respectively. In adult outpatients with moderate COVID-19 infection, the effectiveness of FBX and HCQ was not different in terms of resolution of clinical manifestations, laboratory tests and lung CT findings.

CONCLUSION

This trial suggests that FBX is as an alternative treatment to HCQ for COVID-19 infection and may be considered in patients with a contraindication or precaution to HCQ.

The Hemostatic Effect of Desmopressin on Bleeding as a Nasal Spray in Open Septorhinoplasty

BACKGROUND

Rhinoplasty is associated with intraoperative bleeding which affects the quality of the operation and may increase the time of surgery. The aim of this study was to assess the role of nasal spray of desmopressin on reduction in intraoperative bleeding during elective open rhinoplasty.

METHODS

Conducting an interventional study in our hospital, all patient data including demographic information, medical history and laboratory tests before surgery were collected. Patients who were randomly divided into two study groups, received nasal desmopressin spray or placebo spray, 60 min before starting open septorhinoplasty. The measured variables included: bleeding volume, the operative field quality in regard to bleeding (Boezaart score), the surgeons' satisfaction in regard to bleeding during surgery (Likert scale), postoperative bruising, postoperative bleeding and menstruation.

RESULTS

Thirty cases were studied; 13 (46.3%) people received placebo and 17 (56.7%) received desmopressin. The Boezaart score, satisfaction scores, bleeding volume, upper eyelid ecchymosis in the group receiving desmopressin were significantly better than the control group. Postoperative bleeding was also less in the desmopressin group, but not significant as other variables. In women of each group, menstruation had no effect on the amount of bleeding, surgical field quality and surgeon satisfaction compared with non-menstruation women.

CONCLUSION

Nasal desmopressin use is an effective method for reducing intraoperative and postoperative bleeding and diminished postoperative ecchymosis which improves surgeons' satisfaction. So using the nasal form of desmopressin could be considered as method of controlling bleeding and ecchymosis in open rhinoplasty.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Early Parity Epigenetic Footprint of FOXA1 Gene Body in Normal Breast Tissue of Iranian Women

BACKGROUND

Young age at first full-term pregnancy (FFTP) is an important factor in breast cancer risk reduction. It is postulated that this protective effect is the result of stable molecular signatures imprinted by physiological process of pregnancy, but the molecular mechanism of this protective role is unclear. The aim of the current study was to identify the effect of early FFTP on methylation status of FOXA1 gene body. FOXA1 is an essential transcription factor for mammary gland development and estrogen responsiveness of breast tissue.

METHODS

Fresh frozen normal breast tissues (n = 51) were collected from Iranian women who underwent cosmetic mammoplasty (27 nulliparous women and 24 parous women who have experienced first pregnancy before the age of 25). DNA was extracted and then methylated DNA immunoprecipitation (MeDIP) real-time PCR was used to assess FOXA1 gene body methylation.

RESULTS

Our results revealed that FOXA1 methylation level is significantly higher in early parous compared with nulliparous group (p = 0.041).

CONCLUSION

Our study provides new hint about the association between early FFTP and epigenetic modifications within gene body of FOXA1 in normal breast tissue. More investigation is required for clarifying molecular mechanisms underlying this association in order to develop breast cancer prevention strategies.

The effects of Alkanna tinctoria Tausch on split-thickness skin graft donor site management: a randomized, blinded placebo-controlled trial

BACKGROUND

A prospective, randomized, placebo-controlled clinical trial was conducted to compare the healing effectiveness of Alkanna tinctoria (L.) Tausch (Boraginaceae) with standard dressing on wound healing at the donor site after removal of the skin graft.

METHODS

Enrolled patients were randomly allocated to receive topicalA. tinctoria extract ointment (20%) or standard dressing (dressing with base ointment) daily. Wound healing was assessed using the Bates-Jenson assessment tool at the 2^nd and 4^th weeks after intervention.

RESULTS

Decreases in wound score were significantly greater in the A. tinctoria group compared with the placebo group (P <0.05). The surface areas of graft donor sites in the A. tinctoria group were significantly reduced as compared with the control group at day 28 of the intervention (P < 0.05). The proportion of patients in the A. tinctoria group achieving complete wound healing within 2 to 4 weeks was 50% and 96.66%, respectively, significantly higher than in patients receiving standard care: 0% and 23.3%, respectively.

CONCLUSIONS

This clinical study showed that A. tinctoria dressing accelerates wound healing after graft harvesting.

TRIAL REGISTRATION

IRCT ID: IRCT201511165781N2 .

Effect of botulinum toxin A and nitroglycerin on random skin flap survival in rats

BACKGROUND

A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive.

OBJECTIVE

To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model.

METHODS

The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline.

RESULTS

BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P<0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45).

CONCLUSIONS

BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.

Effect of botulinum toxin a and nitroglycerin on random skin flap survival in rats

Background

A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive.

Objective

To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model.

Methods

The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline.

Results

BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P<0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45).

Conclusions

BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.

Topical Application of Honey on Surgical Wounds: A Randomized Clinical Trial

BACKGROUND

The antimicrobial and anti-inflammatory activity of honey and its ability to accelerate wound healing make it an attractive option in surgical wound care. We performed a randomized clinical trial to compare the efficacy of honey dressing with conventional dressing regarding the aesthetic outcome.

PATIENTS AND METHODS

Bilateral symmetric incisions in randomly selected plastic surgical patients were randomly covered postoperatively with conventional dressing and honey dressing for five days. The aesthetic outcome of the two sides was rated on a Visual Analog Scale by the surgeon and the patient and compared at month three and six after surgery.

RESULTS

Seventy two symmetrical incisions in 52 patients were evaluated during the study. The mean width of the scar after the third and the sixth month was 3.64 +/- 0.83 mm and 3.49 +/- 0.87 mm on the side that received honey dressing and 5.43 +/- 0.05 mm and 5.30+/- 1.35 mm in the control group. Wilcoxon signed-rank test showed significant difference between honey and conventional dressing outcomes at third and sixth month (p < 0.001).

CONCLUSION

The healing process of the surgical wound and its final aesthetic result could be improved by using honey dressing.

The Effects of Aloe Vera Cream on Split-thickness Skin Graft Donor Site Management: A Randomized, Blinded, Placebo-controlled Study 

 Purpose. Split-thickness skin graft donor site management is an important patient comfort issue. The present study examined the effects of aloe vera cream compared to placebo cream and gauze dressing on the rates of wound healing and infection at the donor site.

METHODS

Forty-five patients were enrolled in this randomized clinical trial and divided into three groups: control (without topical agent), placebo (base cream without aloe vera), and aloe vera cream groups. All patients underwent split-thickness skin grafting for various reasons, and the skin graft donor site wounds were covered with single-layer gauze without any topical agent, with aloe vera, or with placebo cream. The donor sites were assessed daily postoperatively until complete healing was achieved.

RESULTS

Mean time to complete re-epithelization was 17 ± 8.6, 9.7 ± 2.9, and 8.8 ± 2.8 days for control, aloe vera, and placebo groups, respectively. Mean wound healing time in the control group was significantly different from the aloe vera and placebo groups (P < 0.005). The healing rate was not statistically different between aloe vera and placebo groups.

CONCLUSION

This study showed a significantly shorter wound care time for skin graft donor sites in patients who were treated with aloe vera and placebo creams. The moist maintenance effect of these creams may contribute to wound healing.

Effect of aloe cream versus silver sulfadiazine for healing burn wounds in rats

The management of burn injury remains a problem and it is the major cause of death and disability. The aim of this study was to evaluate the efficacy of Aloe vera cream in the treatment of thermal burn wounds and to compare these results with silver sulfadiazine in rats. Animals were divided into four groups. Animals were administered topical cream (Aloe vera powdered gel 0.5% and silver sulfadiazine) at 24 h of burn injury induced by hot water. On special days, according to study protocol, wound size was determined and skin sample histopathology performed in animal groups administered topical therapies. On day 25, the mean wound size was 5.5, 4, 0.78 and 4.1 cm2 in control, base, aloe and silver group, respectively. The wound size was significantly smaller in aloe group as compared with other groups. Histologic comparison showed aloe to increase reepithelialization in burn wounds significantly as compared with other cream-treated wounds. The results of this study showed aloe cream to significantly increase reepithelialization in burn wounds as compared with silver sulfadiazine.

Time-related Concordance Between Swab and Biopsy Samples in the Microbiological Assessment of Burn Wounds

 The aim of this study was to investigate the concordance between swab and tissue biopsy samples in terms of microbiological isolates and their time-related changes. A total of 156 samples (78 swab and 78 biopsy) were collected from 39 cases of partial- or full-thickness burns and compared at days 7 and 14 after admission regarding the type of microorganisms and their time-related changes. Pseudomonas aeruginosa and Citrobacter freundii were the two most common microorganisms found by both sampling methods. While the majority of swab and biopsy samples were concordant in day 7, the rate of concordance in day 14 was less than day 7-87.1% versus 66.6%, respectively. After comparing the ratio of P aeruginosa and C freundii in positive swab and biopsy cultures on days 7 and 14, unlike the swab samples, the biopsy samples yielded similar results both times (75% P aeruginosa and 25% C freundii, respectively). The results of this study show that the swab is a sufficient tool for burn wound monitoring during the first week and could defer the need for invasive biopsy sampling. For patients who remain in the burn unit for a longer period, biopsy samples are justified for monitoring the bacterial activity in burn wounds.

Results of the national program for prevention of beta-thalassemia major in the Iranian Province of Mazandaran

Prevention programs are considered to be a top priority in Iran because beta-thalassemia (beta-thal) major (TM) is the most common autosomal disorder in Iran, and in the Mazandaran Province in particular. The main strategies comprise providing appropriate information for the public and professionals, screening and counseling of families at-risk and screening of general population prior to marriage. Providing laboratories for prenatal diagnosis was the most recent step in the program. We report the results of our prevention campaign for the period 1993-2006 in order to assess the effectiveness of all actions in controlling thalassemia major. In 1993, 500 TM patients were registered at the clinic of the Boo Ali Sina Hospital, Sari, Mazandaran, Iran. From 1993 to 1996, on average of 50 new cases were added to the cohort annually, whereas from 1995 to 2005 the number of new cases declined to 35 per year. Furthermore, the patients' average age increased. Overall, 51% of couples at-risk, who received genetic counseling, decided not to marry. All at-risk couples who are married were counseled for prevention of unplanned pregnancies. Currently, 64% are using safe contraceptive methods of family planning, and 14% are no longer at-risk for further pregnancies, the rest remained at-risk for unplanned pregnancies. In conclusion, at the relatively low cost of premarital screening and genetic counseling, we have offered at-risk couples the possibility of preventing the birth of at least 600 undesired TM patients. Thus, a great deal of suffering and an unbearable financial burden has been prevented to patients and their families.

The alteration of plasma's zinc and copper levels in patients with burn injuries and the relationship to the time after burn injuries

INTRODUCTION

Burn injury is a medical problem as well as a social burden on the national health services in developing countries. Trace elements have important roles in wound healing and act as antioxidants. In this study, zinc (Zn) and copper (Cu) levels in plasma of burned patients and their relationship with the burn surface area and time-related pattern are determined in the admitted patients after burn injury.

METHODS

37 patients were divided into two groups: Group 1 consisted of 16 patients with burn injuries less than 20 percent of the total burn surface area, and Group 2 consisted of 21 patients with burn injuries between 20 and 40 percent of the total burn surface area. The control group consisted of 20 subjects. The Zn and Cu levels were determined one, three, seven and 14 days after the occurrence of burn injury. These trace elements were determined using atomic absorption spectrophotometer.

RESULTS

These trace elements in plasma significantly decreased on all days after admission and the levels were lower than those of the control group. There was no significant relationship between Groups 1 and 2 in Cu and Zn concentrations on different days. We did not find any difference between burn surface area and Zn and Cu concentrations in these groups.

CONCLUSION

Based on the critical role of plasma's Zn and Cu rate in wound healing and their relationship in decreasing the burn injury, it is important that patients having burn types II and III take Zn and Cu supplements continuously as micronutrients after burn injury.

Profile of microorganisms and antimicrobial resistance at a tertiary care referral burn centre in Iran: emergence of Citrobacter freundii as a common microorganism

Infection and antimicrobial resistance are important issues in severe burn. The aims of this prospective study were to investigate the profile of microorganisms and resistance to antimicrobial agents in a tertiary referral burn centre; 113 people aged >10 years, with partial- or full-thickness burns, were included in the study. A total of 733 samples including 275 swabs, 164 tissue biopsies, 258 urine samples, 26 blood samples and 10 sputum samples were collected, from which 124 microorganisms were isolated. Pseudomonas aeruginosa and Citrobacter spp were the most prevalent isolates (57.3% and 35.5%, respectively); 95.5% of Citrobacter. isolates were Citrobacter freundii. Antibiogram results obtained from 15 antimicrobial agents demonstrated that imipenem was the most effective agent against P. aeruginosa, followed by ciprofloxacin and piperacillin/tazobactam (67.9%, 43% and 37.5% sensitive, respectively). At least 60% of all Citrobacter isolates were sensitive to various antimicrobial agents, the highest sensitivity being obtained by ceftazidime and cefepime (81.6% and 78.4%, respectively). Sensitivity of P. aeruginosa isolates to the agents of each antimicrobial class was significantly different (p<0.001). The incidence of C. freundii and the resistance of P. aeruginosa to anti-pseudomonas agents were exceptionally high.