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  Background & Objectives : Scalp defects have various etiologies which included scalp cancers, trauma, burns, congentital vascular lesions (Hemangioma & arteriovenous malformations), acquired & congenital skin defect such as aplasia cutis and infections. These defects need different reconstructive methods. The aime of this study was to determine the etiology of scalp defects and out come of various reconstructive methods.

  Methods : This was a descriptive study and based on the patient’s files during two years from 2004 to 2006. All patients operated for scalp defects were included in the study. Different methods of reconstructive surgery were considered and results analyzed using descriptive statistics.

  Results : The study included 75 patients, (52 males and 23 females) with the mean age of 42 years old. In most cases the scalp defect was in the temporoparietal region and most defects were reconstructed using tissue expander (TE). The most common cause of scalp defects was Basal cell corconoma (primary and recurrence) and the most common primary reconstructive method was skin graft. The second cause of scalp defects was burn scar and in these cases the most common reconstructive method was TE. Operative complications in this study were partial necrosis of the graft or distal flap that was repaired by using the repeated skin graft. In one case there was infection of tissue expander that was extracted.

  Conclusion: The most common cause of scalp defect were Basal Cell Carcinoma and burn respectively and in these cases the skin graft and TE were the most common reconstructive methods respectively .

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Background & objectives: Local systemic filling pressure measurement can be used to determine other hemodynamic parameters such as venous return and the stressed volume. The aim of the present study was to evaluate the relationship between local systemic filling pressures and central venous pressure.
Methods: In this study, candidate patients of cardiac surgery in Imam Khomeini hospital of Ardabil, in the first half of the 1397, were chosen and studied by their satisfaction, then an intra-arterial catheter inserted to the upper limb, a tourniquet closed to the same arm.  The arterial pressure measured during the surgery. Central vein pressure was also measured simultaneously. Finally, other variables obtained from transesophageal echocardiography and demographic data were recorded in each patient's checklist.
Results: 43 patients (71.7%) were man and 17 (28.3%) were women. The Mean CVP, MSFP, CO, and CI were 8.3±4.5 mmHg, 17.0±6.1, 3.27±1.1, and 1.89±0.7, respectively. Ten patients (16.7%) had mild heart failure, 42 patients (70%) had a moderate heart failure and 8 patients (13.3%) had severe heart failure. There were positive and significant relationship between CVP and MSFP (r=0.478: p=0.001). The EF status has no significant effects on CVP with SBP, DBP, MAP, CO and CI. There was significant and reverse correlation between PSF value with CO, and CI in severe heart failure (p<0.05).
Conclusion: we concluded that the local MSFP is a good and valuable substitute for CVP measurement, especially in severe heart failure

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Background & objectives: Endoscopy is an invasive and painful procedure. The use of sedatives, especially in children, is expanding. The aim of this study was to compare the sedative effects of ketofol and the combination of midazolam-ketamine in upper endoscopy in children aged 1 to 14 years who referred to Taleghani Hospital in Gorgan.
Methods: In this study, 55 children entered the study 1 to 14 years after obtaining parental consent. They were then divided into two groups, ketamine-propofol (KP) and ketamine-midazolam (KM), by simple randomization. At all stages of the work, patients underwent cardiac and respiratory monitoring. All hemodynamic parameters and ramsy sedation score (RSS) were recorded for all participants in the 5 time periods before, during and after endoscopy. ANOVA test and bonferroni tracking test were used in spss software to analyze and compare data.
Results: 54.5% were male patients. The ANOVA test showed that the scores of the two groups at the time of the study had a statistically significant difference (p=0.02). In the KM group, the mean blood pressure and heart rate of patients increased at all times compared to before the intervention (p=0.005). Blood pressure in the KP group had a steady trend over time (p<0.001).
Conclusion: There was a statistically significant difference between the scores of the two groups and the group (KM) had higher scores, but the use of two drug regimens Propofol-Ketamine and Ketamine-Midazolam caused a good sedation in pediatric endoscopy. The propofol-ketamine compound resulted in greater hemodynamic stability in cardiovascular parameters during and after endoscopy

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Background & Objective: Bleeding is a common complication during heart surgery, and management of heparin and protamine consumption during operation affects hemeostasis. The dosage of protamine sulfate is variable based on the amount of heparin used and studies have reported different results. The aim of this study was to evaluate the effect of protamine sulfate administration after cardiac surgery on the drainage of the patient's blood secretions.
Methods: In this retrospective cross- sectional study, required data from 120 medical records patients, from 2011 to 2020 undergoing heart surgery, for example CABG, was extracted and examined. Patients were grouped (60 people in each group) and compared based on protamine sulfate intake and not receiving it, in the intensive care unit and body mass index, age, sex, ACT values ​​and blood drainage rate.
Results: 76 (63.37%) patients were male and 44 (36.66%) patients were female. Most patients were in the age range of 50-70 years and most patients were overweight. Blood drainage in the protamine group was significantly lower than the control group. There was no statistically significant difference between the two groups in terms of ACT values. Blood drainage in the protamine group was significantly lower in normal BMI and overweight individuals than in the control group. The amount of blood drained in the protamine group in women and in people over 70 years was significantly lower than the control group.
Conclusion: despite previous studies, our study showed a reduction in the amount of postoperative bleeding following re-prescribing of protamine sulfate in the intensive care unit, which eliminated the effect of heparin and the coagulation disorder caused by heparin. The limitations of the present study included patients under 12 years of age, patients weighing more than 120 kg, and patients requiring hypothermia treatment less than 28 Cº.
 

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Background & objectives: Evidence suggests that microRNAs (miRNAs) are essential for immune cell differentiation and function. In addition, miRNAs play an essential role in regulating the expression of pro-inflammatory genes in neurons. Therefore, we investigated the relationship between miRNA expression and inflammatory markers in the CSF of patients with multiple sclerosis.
Methods: RT-PCR analysis was performed on CSF samples from patients with multiple sclerosis (MS) and a control group to measure the expression level of miRNA-21, miRNA-155, miRNA-182, and miRNA-437. In addition, the levels of the inflammatory cytokines including IL-1β, IL-6, and TNF-α in CSF were measured using ELISA. A quantitative turbidimetric method was also used to measure high-sensitivity C-reactive protein (hs-CRP).
Results: A significant difference was found in the expression level of miRNAs and inflammatory factors in the CSF of patients with MS compared with the control group (p<0.05). The results of receiver operating characteristic (ROC) analysis showed the area under the curve for miRNA-21 (AUC=0.97, p<0.0001), miRNA-182 (AUC=0.97, p<0.0001), and miRNA-155 (AUC=0.96, p<0.0001). The miRNA-155 level in CSF played a very important role in the accurate diagnosis of MS. Significant correlations were found between inflammatory cytokines and miRNA-21, miRNA-155, and miRNA-182, as well as an indirect and moderate correlation between miRNA-437 and hs-CRP.
Conclusion: In MS patients, CSF levels of IL-1, IL-6, TNF-α, hs-CRP, and selected miRNAs can be used as biomarkers of CNS inflammation and neurodegenerative processes.