Efficacy and safety of cryotherapy, electrodesiccation, CO2 laser, and Er:YAG laser in the treatment of seborrheic keratosis.

Seborrheic keratosis (SK) is a common benign skin epidermal lesion. Different treatment modalities have been proposed for this lesion. This study aimed to compare the efficacy and safety of electrodesiccation, cryotherapy, CO2 laser, and Er:YAG laser in the treatment of SK. The study was carried out on 30 patients each with four similar facial SKs. Each lesion was assigned to be treated with cryotherapy, electrodesiccation, CO2 laser, and Er:YAG laser in a random fashion. Therapeutic results were evaluated 8 weeks after the interventions through clinical and dermatoscopic assessment. Treatment improvement criteria for each lesion included the texture of the lesion, severity of the pigmentation, and an overall assessment of the healing. The severity of burning, pain, erythema, and the duration of the erythema after the procedures were documented. A survey of the patients' satisfaction with the treatments was also performed. In the assessment of overall lesion healing by two dermatologists, the improvement rate was significantly higher in the CO2, Er:YAG lasers and electrodesiccation group compared to the cryotherapy (p < 0.001). However, the CO2 and Er:YAG laser and the electrodesiccation groups showed no significant difference (p > 0.05). Moreover, no significant difference was observed in posttreatment pigmentation and texture between the groups (p > 0.05). The pain and burning severity after the interventions were negligible in all four groups. Prolonged erythema was not observed in any of the cases; however, the duration of erythema in the Er:YAG laser group was significantly longer (p < 0.001). Patient satisfaction in the cryotherapy group was significantly lower than the other three groups (p < 0.001). The efficacy of treatment and patient satisfaction rate is highly comparable between electrodesiccation, CO2 laser, and Er:YAG laser but significantly higher than cryotherapy.

A rare case of plexiform schwannoma on the foot.

Plexiform schwannoma is an uncommon soft tissue tumor that could even rarely presented on the foot and toes.

Huge carbuncle leading to necrotizing fasciitis in the COVID-19 pandemic era.

Although Necrotizing fasciitis can evolve from a trivial lesion, whenever it develops it requires a prompt surgical intervention and broad-spectrum antibiotic therapy.

The Cost of Leaving the Emergency Department without Notice; a Cross-sectional Study.

INTRODUCTION: Leaving the hospital without notice is among the problems that can inflict financial and non-financial burdens on the health care system of a country. OBJECTIVE: The present study was carried out with the aim of evaluating the prevalence of leaving without notice cases in the emergency department (ED) of one of the major teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences and calculating the direct costs resulting from it. METHODS: This study was a retrospective cross-sectional one carried out during 1 year from 2016 to 2017 in one of the teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences. Sampling was performed via census method and the study population consisted of the profiles of all the patients who had left the hospital without notice or checking out after being admitted to the hospital. To gather the required data for this study, a checklist consisting of questions regarding sex, age, insurance coverage, and the amount of money they owed the hospital was used. Statistical analysis was performed using the software IBM Statistics for Windows v22 and P-value<0.05 was considered significant. RESULTS: Out of the total of 39946 patients visiting the ED of the studied hospital during 1 year, 1692 (4.2%) had left the hospital without checking out. Below 30 years age range was the most common age range with 46.9% (794 patients) and 72.9% of the patients leaving without notice were men. Based on the findings obtained, male patients without insurance coverage had attempted to leave the hospital without notice more than others (p<0.001). The total cost inflicted by leaving without notice throughout the studied year was 1,755,286,279 Rials, which is equal to 0.0059 of the total annual income of the ED. CONCLUSION: Throughout the year this study was performed, a total of 1.2% of all the visitors of the ED of a hospital affiliated with Shahid Beheshti University of Medical Sciences left the hospital without notice or checking out, which inflicted a considerable cost on the ED.

Upper Gastrointestinal Bleeding as Delayed Presentation of Traumatic Diaphragmatic Hernia; a Case Report.

INTRODUCTION: Traumatic diaphragmatic hernia (TDH) is one of the critical complications resulting from penetrating chest trauma. The rate of undiagnosed TDH equivocates 12-60%. The significant part of complications happens 1-4 years after the primary damage. Here, we report a case of delayed TDH presented with upper gastrointestinal bleeding (GIB) as an excuse to discuss this issue. CASE PRESENTATION: The patient was a 35-year-old man, admitted with objection of abdominal pain. A nasogastric tube was inserted and fixed that resulted in drainage of about 500cc dark blood. He was candidate for emergent endoscopy due to upper GIB. During resuscitation measures, he suddenly developed respiratory distress that could not be justified by upper GIB alone. Therefore, bedside sonography discovered some soft tissue apart from lung tissue in the left hemithorax. After performing diagnostic measures, with diagnosis of diaphragmatic herniation and strangulation he underwent emergent surgery. CONCLUSION: Small diaphragmatic lesions, which usually result from stab wounds, may develop into larger injuries if left untreated and they might lead to a diaphragmatic hernia with a potential risk of early or late complications and mortality. One of the rare complications is GIB, which should be considered in a patient with past history of trauma and presentation of GIB.

An Epidemiologic Study on Emergency Department Mortality.

INTRODUCTION: Epidemiologic evaluation generally starts with recording the raw data regarding mortality, and healthcare managers should have a national plan executed for this purpose. OBJECTIVE: The present study was planned and performed with the aim of epidemiologically evaluating mortality cases among patients admitted to the emergency department (ED) of a major hospital in Tehran, Iran in order to plan and provide proper equipment for decreasing the mortality of patients. METHOD: This cross-sectional study was performed in Shohadaye Tajrish Hospital, Tehran, Iran. All cases of mortality, recorded in the ED of the studied hospital from 20 March 2016 until 21 June 2016, were included in the study. A checklist was prepared for gathering data and the clinical profiles of all the considered patients were reviewed. Using this checklist, demographic data, chief complaint, history of underlying disease, pathologic findings of imaging modalities, and cause of death were extracted from the patients' profiles. RESULT: Over the mentioned period of time, in total, the data of 8420 admissions to the ED were recorded. Out of these patients, 76 (0.9%) had died, the mean age of whom was 67.66 ± 21.40 years. Based on these findings, among patients who had presented to the ED, 42.1% died due to the complications of heart attack and 13.2% died from complications caused by cancer. CONCLUSION: Based on the findings of the present study, cardiovascular complications were the most leading cause of mortality in the studied ED and complications resulting from malignancy were in the second place. Trauma and accidents leading to intracranial hemorrhage were in the next places.

The Risk of Venous Thromboembolism with Different Generation of Oral Contraceptives; a Systematic Review and Meta-Analysis.

INTRODUCTION: Oral contraceptives (OCs) are considered as one of the most common risk factor of venous thromboembolism (VTE) in childbearing age. Some of the recent researches indicate that the odds of VTE may be even higher with newer generations of OCs. The present meta-analysis was designed to evaluate the effect of different generation of OCs on the occurrence of VTE. METHODS: Two researchers independently ran a thorough search in Pubmed, ISI Web of Science, EMBASE, CINAHL and Scopus databases regarding study keywords including thromboembolic event, thromboembolism, embolism, thromboembolic, thrombotic and thrombosis, combined with oral contraceptive. The outcomes were the incidence of diagnosed thromboembolism, such as deep vein thrombosis, pulmonary embolism and cerebral venous thrombosis. Based on the heterogeneity of the studies, random effect model was used and pooled odds ratio was reported. RESULTS: Three cohort and 17 case-control studies with 13,265,228 subjects were entered into meta-analysis. Analysis showed that the odds of VTE in women taking OCs are more than three-fold (OR=3.13; 95% CI: 2.61-3.65). The risk of VTE in women taking first-, second- and third-generation OCs are 3.5 fold (OR=3.48; 95% CI: 2.01-4.94), 3 fold (OR=3.08; 95% CI: 2.43-3.74) and 4.3 fold (OR=4.35; CI: 3.69‒5.01), respectively. CONCLUSION: It seems that the risk of VTE is not same between different generations of OCs, so that third-generation has highest risk. Taking second and third-generation OCs increases the risk of VTE up to 3 and 4.3 fold, respectively. The researchers of the present study suggest that more trials be designed in relation to the effect of newer generations of OCs in different communities.

Interpretation of Computed Tomography of the Head: Emergency Physicians versus Radiologists.

BACKGROUND: Many patients are brought to crowded emergency departments (ED) of hospitals every day for evaluation of head injuries, headaches, neurologic deficits etc. CT scan of the head is the most common diagnostic measure used to search for pathologies. In many EDs the initial interpretation of images are performed by emergency physicians (EP). Since most decisions are made based on the initial interpretation of the images by emergency physicians and not the radiologists, it is necessary to assess the accuracy of interpretations made by the former group. OBJECTIVES: The objective of this study was to compare the findings reported in the interpretation of head CTs by emergency physicians and compare to radiologists (the gold standard). MATERIALS AND METHODS: This was a prospective cross sectional study conducted from March to May 2009 in a teaching hospital in Tehran, Iran. All non-contrast head CTs obtained during the study period were copied on DVDs and sent separately to a radiologist, 6 emergency medicine (EM) attending physicians and 14 senior EM residents for interpretation. Clinical information pertaining to each patient was also sent with each CT. The radiologist's interpretation was considered as the gold standard and reference for comparison. Data from EM physicians and residents were compared with the reference as well as with each other and statistical analysis was performed using SPSS 18.5. RESULTS: Out of 544 CT scans, EM physicians had 35 false negatives and 53 false positives compared with radiologist's interpretations (P < 0.0001). EM residents had 74 false negatives and 12 false positives compared with radiologist's interpretations (P < 0.0001). CONCLUSIONS: Both EPs and ER residents either missed or falsely called a significant number of pathologies in their interpretations. The interpretations of EPs and ER residents were more sensitive and more specific, respectively. These findings revealed the need for increased training time in head CT reading for residents and the necessity of attending continuing medical education workshops for emergency physicians.