Granulomatous fasciitis followed by morphea profunda: Is granulomatous fasciitis part of a spectrum of deep morphea? A case report and review of the literature.

Although eosinophilic fasciitis is known to be part of the deep morphea spectrum, this first report of the coexistence of granulomatous fasciitis and morphea profunda suggests that granulomatous fasciitis may also be a part of the spectrum of deep morphea

Seat Belt Usage in Injured Car Occupants: Injury Patterns, Severity and Outcome After Two Main Car Accident Mechanisms in Kashan, Iran, 2012

Background: Road traffic accidents (RTAs) are the main public health problems in Iran. The seat belts, which are vehicle safety devices, are imperative to reduce the risk of severe injuries and mortality. Objectives: The aim of the study was to evaluate injury patterns, severity and outcome among belted and unbelted car occupants who were injured in car accidents. Patients and Methods: This cross-sectional prospective study was performed on all car occupants injured in RTAs (n = 822) who were transported to hospital and hospitalized for more than 24 hours from March 2012 to March 2013. Demographic profile of the patients, including age, gender, position in the vehicle, the use of seat belts, type of car crashes, injured body regions, revised trauma score (RTS), Glasgow coma score (GCS), duration of hospital stay and mortality rate were analyzed by descriptive analysis, chi-square and independent t-test. P < 0.05 was considered significant. Results: A total of 560 patients used seat belts (68.1%). The unbelted occupants were younger (28 years vs. 38 years) and had more frequently sustained head, abdomen and multiple injuries (P = 0.01, P = 0.01 and P = 0.009, respectively). Also, these patients had significantly lower GCS and elongated hospitalization and higher death rate (P = 0.001, P = 0.001 and P = 0.05, respectively). Tendency of severe head trauma and low RTS and death were increased in unbelted occupants in car rollover accident mechanisms (P = 0.001, P = 0.01 and P = 0.008, respectively). Conclusions: During car crashes, especially car rollover, unbelted occupants are more likely to sustain multiple severe injuries and death. Law enforcement of the seat belt usage for all occupants (front and rear seat) is obligatory to reduce severe injuries sustained as a result of car accidents, especially in vehicles with low safety

Pre-Hospital Trauma Care in Road Traffic Accidents in Kashan, Iran

Background: Iran has one of the highest rates of road traffic accidents (RTAs) worldwide. Pre-hospital trauma care can help minimize many instances of traffic-related mortality and morbidity. Objectives: The aim of this study was to assess the characteristics of pre-hospital care in patients who were injured in RTAs, admitted to hospital. The focus was mainly directed at evaluating pre-hospital trauma care provided in city streets and roads out of the city. Patients and Methods: This retrospective study was carried out on all trauma patients, transported by the emergency medical service (EMS) system, who were admitted to Kashan Shahid-Beheshti hospital during the period from March 2011 to March 2012. The patients’ demographic data, location of accident, damaged organs, mechanism of injury, injury severity, pre-hospital times (response, scene, transport), pre-hospital interventions and outcomes, were extracted from the data registry and analyzed through descriptive statistics using SPSS 18 software. Results: Findings of this study showed that, 75% of RTAs occurred on city streets (n = 1 251). Motor-car accidents were the most frequent mechanism of RTA on city streets (n = 525) (42%), while car rollover was the most frequent mechanism of RTA on roads out of the city (n = 155) (44.4%). The mean pre-hospital time intervals (min); response, scene, and transport for all patients were 6.6 ± 3.1, 10.7 ± 5 and 13 ± 9.8, respectively. The mean pre-hospital time intervals (response, scene, transport) in roads out of the city were higher than those in city streets. There was a significant difference (P = 0.04) in the mortality rates due to RTAs between city streets (n = 46) and roads out of the city (n = 32). Conclusions: In comparison with road traffic accidents on city streets, trauma patients in RTAs on roads out of the city have longer pre-hospital time intervals and more severe injuries; therefore this group needs more pre-hospital resuscitation interventions

The prevalence of staphylococcus aureus contamination in the ambulances and on-call emergency medical service personnel of kashan city in iran

Objective: Emergency medical services systems are at the first line of dealing with patients who suffer from various infections. Conducting investigations on the bacterial contamination of emergency ambulances play a crucial role to improve the occupational health of staff as well as the quality of patient care. Therefore, the aim of the present study was to investigate the presence of Staphylococcus aureus and other life treating bacteria in the urban and rural ambulances and their on-call emergency medical service personnel. Methods: This descriptive cross-sectional study was conducted on 12 front line pre-hospital emergency urban and rural ambulances in Kashan, Iran, in 2015. A total of 18 sites were sampled in each ambulance and from the nose of personnel. Grown colonies were confirmed based on colony morphology on mannitol salt agar plates, gram stain reaction and biochemical characteristics reactions. Results: The S. aureus contamination was only isolated from the nose of on-call emergency medical service providers of 12 urban and road ambulances, while no sign of contamination was found in 18 sampling sites of these front-line ambulances. Also, further evaluation of these sampling sites revealed the contamination with coagulase-negative staphylococci in all of them and oxygen tank was introduced as the most contaminated site inside the ambulances. Moreover, the prevalence of equipment contamination was significantly higher in urban ambulances. Conclusion: Identifying the rate of pathogens in clinical settings like the pre-hospital ambulance setting is an important issue which should be carefully considered. © 2020 The Author(s)

Isotretinoin therapy for the treatment of acne in patients with cystic fibrosis: a case series and review of the literature

Background: Cystic fibrosis (CF) is the most common severe autosomal recessive disorder in Caucasians. Viscous secretionstypically obstruct the lungs, pancreas, and gastrointestinal tract. As disease management improves, patients will increasingly seek care for conditions such as acne. Isotretinoin therapy for acne in patients with CF is controversial owing to concerns that the medication may exacerbate CF-related hepatic, pulmonary, and ocular complications.Purpose: We describe two patients with CF treated with isotretinoin from our clinic and also provide a literature review of 11 similar cases. We describe patient outcomes, common complications, and the risks for severe adverse effects.Materials and methods: The clinical courses of two patients with CF who were treated with isotretinoin for moderate-severe acne are presented. Using PubMed, we analyzed previous case reports of patients with CF who were prescribed isotretinoin and review complications associated with systemic retinoids.Results: Based on a synthesis of the literature and our own experience, it appears that isotretinoin therapy for CF patients with moderate-severe acne may be an appropriate option when clinically indi ated. If dermatologists monitor lab values and adverseeffects carefully, patients with CF can benefit from isotretinoin therapy

The Mediterranean Diet: A Protective Effect on Coronary Heart Disease

Coronary heart disease (CHD) is the leading cause of death in the United States as well as in many developing and developed countries. However, several studies studying the epidemiology of CHD across the world have found that there is a significantly lower incidence in Japan and Mediterranean Southern Europe, a difference which was found to be independent of serum cholesterol levels. The traditional Mediterranean diet consists of a high intake of olive oil as an important fat source, resulting in a high intake of monounsaturated fatty acids (MUFA) and a low intake of saturated fatty acids (SFA). Studies have shown that MUFA or PUFA, as opposed to SFAs, decrease plasma total cholesterol levels as well as low density lipoprotein (LDL) cholesterol concentrations. In addition, MUFAs, because they only have one double bond, are more resistant to oxidative modification and entrance into the oxLDL atherogenic pathway. Recent studies on the Mediterranean diet show that adherence to the diet is associated with a 33-39% lower mortality rate from CHD as well as drops in inflammatory markers of endothelial function. This data supports the Mediterranean diet tangible lifestyle modification patients can make in order to lower their risk of coronary artery disease

Rituximab in the management of juvenile pemphigus foliaceus

BackgroundPemphigus foliaceus (PF) is a blistering disorder most commonly presenting in middle age. As PF is restricted to the superficial epidermis, it is considered more benign than other pemphigus diseases. However, progression to severe disease is not uncommon. Although rituximab’s efficacy has been well-documented in adults with refractory PF, little data is available on its role in adolescents.PurposeWe describe a patient with juvenile PF treated with rituximab and review the literature for similar cases.MethodsPubMed was searched for the terms: antibody, B cells, blistering, CD20, foliaceus, juvenile, pemphigus, rituximab, immunosuppression. As the first reported case of rituximab treated pemphigus was in 2001, only cases from 2001 and after were included. Juvenile PF was defined as disease diagnosis between ages 12-17.ResultsFive cases have been reported. The indication for rituximab in most cases was refractory PF unresponsive to systemic glucocorticoids and non-steroidal adjuvant therapies. All cases demonstrated significant improvement or complete remission and most experienced no adverse events.ConclusionsRituximab appears to be both well tolerated and efficacious for refractory juvenile PF. Therefore, it may be considered for severe cases of PF to avoid side effects associated with conventional glucocorticoid therapy

Isotretinoin therapy for the treatment of acne in patients with cystic fibrosis: a case series and review of the literature

Background: Cystic fibrosis (CF) is the most common severe autosomal recessive disorder in Caucasians. Viscous secretionstypically obstruct the lungs, pancreas, and gastrointestinal tract. As disease management improves, patients will increasingly seek care for conditions such as acne. Isotretinoin therapy for acne in patients with CF is controversial owing to concerns that the medication may exacerbate CF-related hepatic, pulmonary, and ocular complications.Purpose: We describe two patients with CF treated with isotretinoin from our clinic and also provide a literature review of 11 similar cases. We describe patient outcomes, common complications, and the risks for severe adverse effects.Materials and methods: The clinical courses of two patients with CF who were treated with isotretinoin for moderate-severe acne are presented. Using PubMed, we analyzed previous case reports of patients with CF who were prescribed isotretinoin and review complications associated with systemic retinoids.Results: Based on a synthesis of the literature and our own experience, it appears that isotretinoin therapy for CF patients with moderate-severe acne may be an appropriate option when clinically indi ated. If dermatologists monitor lab values and adverseeffects carefully, patients with CF can benefit from isotretinoin therapy

Evaluating the corrosive and scale-forming indices of water in the villages under the coverage of Kashan rural water and wastewater company during 2007-9

Background: Kashan rural water and wastewater company (KRWWC) in Iran is facing a multitude of problems including some potential health risks associated with pipe corrosion byproducts, their early deterioration, the occasional interruption of the water supplies and also huge operation costs. Therefore, this study aimed to evaluate the corrosive and scale-forming properties of water in Kashan villages.Materials and Methods: This descriptive study was carried out on 151 water samples taken from 39 rural water supplies in 4 stages during 2007-9. All samples were analyzed for total hardness, calcium, alkalinity, total dissolved solids (TDS), bicarbonate, temperature and pH according to the last edition of the Standard Methods Book and then Ryznar, Langelier and Puckorius indices were calculated. Data were analyzed using Fisher's exact test and Paired t-test followed by Bonferroni correction.Results: According to Ryznar, Puckorius and Langelier indices, 95, 97 and 74 of the water supplies in all seasons were corrosive, respectively. Moreover, according to the three above-mentioned indices, 18 villages (46.15) under the coverage of Kashan rural water and wastewater company have always had corrosive water and there was also no significant difference in water quality between the seasons.Conclusion: Results showed that most water supplies are corrosive and a few of them are scale-forming. Hence, application of suitable plumbing utensils, turn on/off bypass pumps and valves and if necessary, appropriate water treatment are recommended