Mucosal vs. cutaneous advancement flaps for the treatment of chronic anal fissures: a randomized clinical trial.

PURPOSE: The aim of this study was to compare two surgical treatment methods for chronic anal fissures (CAF), mucosal advancement flap anoplasty (MAFA) and cutaneous advancement flap anoplasty (CAFA). METHODS: A randomized, blinded clinical trial was conducted on patients with CAF refractory to medical treatment referred to a tertiary-level hospital between January 2021 and December 2022. The patients were assigned to two groups by block randomization and were compared in terms of outcome, pain reduction, and complications. RESULTS: There were 30 patients (male to female ratio 2:3, median age 42 years [range 25-59 years]). Both techniques reduced anal pain significantly (p = 0.001); however, there were no significant differences between MAFA and CAFA groups in recurrence, duration of healing, postoperative pain, and postoperative bleeding. No patient suffered from fecal incontinence (Wexner score = 0) or flap necrosis postoperatively. Only two patients in the MAFA group (1 and 3 months after surgery) and one patient in the CAFA group (2 months after surgery) had recurrence (total recurrence rate = 10%, healing rate = 90%). All of the patients were satisfied with their surgical results. CONCLUSION: Mucosal and cutaneous anal advancement flap techniques are effective and comparable surgical procedures for the treatment of chronic anal fissures with minimal complications, fast healing process, and minimal postoperative pain and complications. CLINICAL TRIAL ID: IRCT20120129008861N4 ( www.irct.ir ).

Assessment of Mouse Ileal loop Protection against Clinically Isolated Vibrio cholerae Outer Membrane Vesicles as a Vaccine Candidate.

Cholera, a life-threatening disease caused by the Gram-negative bacterium Vibrio cholera, remains a concern in developing countries. The present study investigated the immunogenicity and protective immunity of outer membrane vesicles (OMVs) and combination of OMV and killed whole cells (WC) of a local strain isolated from the last outbreak in Iran in addition to reference and local strains of V. cholerae El Tor O1 in comparison to Dukoral vaccine in mice model. The protein content, morphology, and size of extracted OMVs were evaluated by electrophoresis and microscopic analyses, respectively. The serum titers of total immunoglobulin G (IgG), IgG1, IgG2a, and immunoglobulin A (IgA) in addition to secretory IgA and total IgG in different mice groups were determined by enzyme-linked immunosorbent assay (ELISA). In addition, fluid accumulation (FA) assay regarding the resistance to live strain of V. cholerae in ligated ileal loops was carried out to determine immunogenicity by OMV or combination of OMV and WC in comparison to that reported for Dukoral vaccine. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of purified OMVs indicated protein profiles within the range of 34-52 kDa. Furthermore, transmission electron microscopy demonstrated the spherical shaped vesicles of 50-200 nm. The results of ELISA showed significant titers of systemic and mucosal immune anti-OMV IgGs in immunized BALB/c mice with different vaccine regimens. Additionally, a notable increase in the FA ratio was demonstrated in this study. The obtained results of the present study revealed that the WC-OMV combination of local strain can induce a high level of antibody response indicating more protection than OMV or WC separately. Moreover, it can be considered an effective immunogen against V. cholerae.

Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study.

Government and nongovernmental organizations need national and global estimates on the descriptive epidemiology of common oral conditions for policy planning and evaluation. The aim of this component of the Global Burden of Disease study was to produce estimates on prevalence, incidence, and years lived with disability for oral conditions from 1990 to 2017 by sex, age, and countries. In addition, this study reports the global socioeconomic pattern in burden of oral conditions by the standard World Bank classification of economies as well as the Global Burden of Disease Socio-demographic Index. The findings show that oral conditions remain a substantial population health challenge. Globally, there were 3.5 billion cases (95% uncertainty interval [95% UI], 3.2 to 3.7 billion) of oral conditions, of which 2.3 billion (95% UI, 2.1 to 2.5 billion) had untreated caries in permanent teeth, 796 million (95% UI, 671 to 930 million) had severe periodontitis, 532 million (95% UI, 443 to 622 million) had untreated caries in deciduous teeth, 267 million (95% UI, 235 to 300 million) had total tooth loss, and 139 million (95% UI, 133 to 146 million) had other oral conditions in 2017. Several patterns emerged when the World Bank's classification of economies and the Socio-demographic Index were used as indicators of economic development. In general, more economically developed countries have the lowest burden of untreated dental caries and severe periodontitis and the highest burden of total tooth loss. The findings offer an opportunity for policy makers to identify successful oral health strategies and strengthen them; introduce and monitor different approaches where oral diseases are increasing; plan integration of oral health in the agenda for prevention of noncommunicable diseases; and estimate the cost of providing universal coverage for dental care.

Laboratory studies on effect of fiber content on dynamic characteristics of municipal solid waste.

The dynamic characterization of municipal solid waste (MSW), especially in regions with high seismicity, is of considerable importance in the stability assessment of landfills. Additionally, findings indicated that the response of MSW under dynamic loadings is significantly affected by fibrous material. Therefore, a comprehensive strain-controlled cyclic triaxial testing program was performed on MSW samples retrieved from a landfill in the Kahrizak area, Tehran province. The tests were conducted on fresh MSW specimens (with a diameter of 100 mm) with different percentage of fibers in the consolidated undrained condition. The potential reinforcing capability of fibers and their impacts on changes in the MSW composition were investigated under variations of different factors including confining pressure, loading frequency, Poisson's ratio, and loading cycles. From the results of the study, increasing fiber content in specimens resulted in improved elastic behavior of MSW under dynamic loadings, irrespective of the test conditions, such that the normalized shear modulus reduction curves shifted to the right, while the damping ratio curves exhibited no specific trend. However, it is necessary to simultaneously consider the impact of fiber contents, confining stress and shear strain on the variation rates of normalized shear modulus reduction values. This trend is attributed to the greater values of stiffness from changing the composition when compared with the one generated by obtained reinforcement within the studied strain range. Given the lack of systematic evaluations on the effect of the fibrous waste materials on the dynamic response of MSW, the results of this study provide additional insight into the seismic analysis of landfills.

SERUM LEVELS OF FIBROBLAST GROWTH FACTOR 21 IN TYPE 2 DIABETIC PATIENTS.

BACKGROUND AND PURPOSE: Fibroblast growth factor 21 (FGF21) has recently been identified as a metabolic regulator, but its physiological role is still not completely known. The aim of this study was to evaluate serum FGF21 levels in an Iranian population with type 2 diabetes. MATERIALS AND METHODS: This cross-sectional study was conducted in patients with type 2 diabetes. All patients were evaluated for fasting serum levels of glucose, glycated hemoglobin (HbA1c), lipids, urea and creatinine. Participants were divided into two groups with poorly-controlled and well-controlled diabetes based on their HbA1c levels. Healthy non-diabetic subjects (matched with patients in terms of age, sex and body mass index [BMI]) were also recruited as control group. Serum FGF21 concentrations were determined in all subjects using ELISA. RESULTS: Of the evaluated 141 subjects, 49 (34.8%) were categorized as having well-controlled diabetes, 66 (46.8%) had poorly-controlled diabetes, and there were 26 subjects in the normal control group. Mean serum FGF-21 concentration was 337.89±283.67 ng/L in the diabetic group and 237.25±43.22 ng/mL in the non-diabetic group (p<0.001). Mean serum FGF21 level was 237.25 ± 43.22 ng/mL in the control group, 309.81 ± 301.68 ng/mL in the well-controlled diabetic group, and 358.73 ± 269.98 ng/mL in the poorly controlled diabetic group. Serum FGF21 level in the poorly controlled diabetic group was significantly higher than that in the well-controlled diabetic and the healthy control groups (p=0.02) but there was no significant difference between the well-controlled and healthy groups. There was no significant association between serum FGF21 levels with lipid levels, presence of diabetic complications and BMI (p > 0.05). CONCLUSIONS: The present results suggested an association between elevated serum levels of FGF21 and poor control of diabetes. Future studies are warranted to elucidate the prognostic role of these elevated levels of FGF21 in diabetic subjects.

How to repair the surgical defect after excision of sacrococcygeal pilonidal sinus: a dilemma.

OBJECTIVE: Although there are various therapeutic modalities to manage patients suffering from sacrococcygeal pilonidal sinus disease, there remains controversy over a standard method to treat such patients. In this study the postoperative outcomes after three different surgical methods of wound repair in patients with sacrococcygeal pilonidal sinus were compared. METHOD: Patients were divided randomly into three different groups. All of the patients underwent a wide excision of their pilonidal sinus; the subsequent surgical wound was left open in the first group (lay open group) whereas it was repaired with a simple primary closure and a rhomboid flap in the second and third groups. Variables including length of hospitalisation, time for wound healing, time off work, recurrence and surgical complications were evaluated. RESULTS: A total of 60 patients with an average age of 27.61 years were studied, including 47 (78.3%) men and 13 (21.7%) women. Postoperative hospitalisation time was significantly shorter in patients who were treated using the simple primary closure method than those with the rhomboid flaps. However, there were no differences in terms of postoperative hospitalisation time between the lay open and simple primary groups or the lay open and rhomboid groups. The period of absence from work was significantly shorter in patients who were managed by a simple primary closure or rhomboid flap technique comparing to those whose wound was left open (p<0.05). Complete wound healing had a significantly shorter course in the rhomboid flap and the simple primary closure techniques compared to those within the lay open group. In terms of complications, postoperative infection and haemorrhage were more common in the lay open group than in the other two. Recurrence was about 5% in patients who were treated with the lay open method in an 18-month follow-up period; however, no recurrence was observed in the other two groups. CONCLUSION: Considering the earlier wound healing period, less days absent from work, lower complication levels and recurrence rates, the simple primary closure or rhomboid flap techniques appear to be better options to treat the subsequent wound after a wide excision of pilonidal sinus when compared to the lay open method. The simple primary closure method causes no cosmetic disfiguration and the most promising option among the three techniques assessed. DECLARATION OF INTEREST: The authors have declared that no conflict of interest exists.

Occupational lead poisoning in workers of traditional tile factories in Mashhad, Northeast of Iran.

BACKGROUND: Occupational lead poisoning is a health problem in Iran. It has not previously been studied in traditional tile makers. OBJECTIVE: To determine the prevalence of lead poisoning and its complications in traditional tile workers in Mashhad, Northwest of Iran. METHODS: We visited workers in two traditional tile factories and collected data by direct history taking and physical examination. Blood and urine lead concentrations were measured by heated graphite atomization technique. RESULTS: Overall, 108 men with mean±SD age of 37±7.8 years were studied. The mean±SD length of daily lead exposure was 9.8±6 years. The mean±SD blood lead concentration was 520.5±323.2 µg/L. The main objective clinical findings were the presence of lead line (64.8%), peripheral neuropathy of the upper extremities (37%), depressed deep tendon reflexes in the upper extremities (25.7%), tremor (23.3%), peripheral neuropathy of the lower extremities (17%) and abdominal tenderness (15.1%). The subjective findings were mainly attributed to the central nervous system and included loss of memory (57%), moodiness (56.1%), agitation (47.7%), drowsiness (36.4%) and headache (29.9%). There was no statistically significant correlation between the blood lead concentration and glomerular filtration rate. However, there were significant correlations between the blood lead concentration and each of the urine lead concentration (p<0.001), diastolic blood pressure (p = 0.04), serum triglyceride level (p = 0.043), high density lipoprotein level (p = 0.012), and basophilic stippling (p = 0.048). Blood lead level, however, did not have any significant correlation with the presence of lead line. CONCLUSION: In traditional tile workers, lead toxicity is not uncommon and the toxic effects of lead were found more often on the teeth (bone), central and peripheral nervous system, hematological and lipid profiles than on the renal function.