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BackgroundErythropoietin (EPO), in addition to its function as an erythropoiesis regulator has a regenerative activity on some nonhematopoietic tissues. Animal studies have suggested a role for erythropoietin in bone healing.ObjectivesThe present study aimed to evaluate the effects of local EPO injection in healing of tibiofibular fractures.Materials and MethodsIn a prospective double blind study, 60 patients with tibiofibular fracture were divided to equal EPO or placebo groups, randomly. Patients received local injection of either EPO or a placebo to the site of fracture two weeks after surgical fixation. Patients were followed by clinical and radiographic examination to determine the union rate. The period of fracture union and incidence of nonunion were compared between the two groups.ResultsThe demographic data and types of fractures were similar in the both groups. The mean duration of the fracture union was 2.1 weeks shorter in those treated with EPO (P = 0.01). Nonunion was observed in 6 patients of the control group and 2 receiving EPO (P = 0.02). No patient experienced any adverse effect from local EPO injections.ConclusionsEPO injection into the site of tibiofibular fractures may possibly accelerate healing.

BackgroundThere is controversy regarding routine prophylaxis for deep vein thrombosis (DVT) in patients treated via a short leg cast or splint following lower extremity trauma.ObjectivesThe main aim of this study is to evaluate the incidence of DVT and need for chemoprophylaxis in these patients.Materials and MethodsPatients with ankle sprains or stable foot/ankle fractures were entered in this cross-sectional study. Serum D-dimer levels were measured 2 weeks following fixation. If the D-dimer levels were above 0.2 micrograms/ml the test was considered positive and the patient was referred for Doppler ultrasound examination (DUE) to confirm or rule out the diagnosis of DVT. Finally, the incidence of DVT was calculated and the role of predisposing factors was investigated.ResultsThere were 95 patients with an average age of 38 ± 13.7 (77.9% males); 46 patients had at least one risk factor for DVT. The D-dimer test was positive in 21(22.1%) patients. DVT was confirmed by DUE in 3 patients (3.1%). The incidence of DVT significantly increased in the presence of 3 or more risk factors (P = 0.01).ConclusionsIt seems that DVT is not a common complication of below knee fixation and chemoprophylaxis is not necessary when the patient has less than 3 predisposing factors. With 3 or more risk factors chemoprophylaxis and periodic follow-ups must be considered.

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Equal distribution of healthcare facilities in order to increase the accessibility of the individuals to services is one of the main pillars in improvement of health. This study was aimed to examine the disparities in access to health care services across the cities of Lorestan province located in west of Iran. This study is a descriptive study. Data related to indicators of institutional and manpower was collected using statistical yearbook of Statistical Centre of Iran (SCI) and analyzed by Scaogram Analysis Model. The results revealed distinct regional disparities in health care services across Lorestan province. According to Scalogram analysis model, Khorramabad and Delfan towns were ranked as the first and the last according to access to health care services. Overally, 44% of the cities are undeveloped and only 22% are credited as developed. Taking the advantage of development-oriented programs, reduction of the gap in health care services in the must be considered in the health policy. Therefore, Delfan, Dorood, Koohdasht and Selseleh are characterized as the underdeveloped and consequently urgently should be considered in planning and deprivation programs.

Background: Iranian health system underwent a series of reforms entitled Health Transformation Plan (HTP) in 2014. The plan started with packages that have imposed financial burden and increased expenditure in the health system. This study aimed to identify strategies and solutions to reduce expenditures in HTP in Iran. Methods: To conduct this qualitative study, the researchers held 15 semi-structured interviews with prominent experts in the research arena in 2018. Content analysis was used to analyze the data using MAXQDA 10 software. Results: Data collection yielded 9 main topics, including purchase and provision medicine, prescription, purchase and use of equipment, diagnostic medical services, referral system, human resources, physical space, payment system, and modifying and increasing base salaries. Conclusion: In Iran’s health system, some aspects of HTP wasted resources, eg, the waste of resources in the service delivery system; thus, policymakers should consider proper strategies to control the costs based on the nature of their implementation.

BackgroundThere is considerable variation in the treatment of distal forearm torus fractures (DFTF), from soft bandaging to cast immobilization.ObjectivesThe present study aimed to show the result of removable wrist splint (RWS) in the treatment of these fractures.Materials and MethodsOne hundred forty two children aged less than 17 years old with DFTF were studied prospectively. These patients were randomly treated either by a short arm cast (SAC) or a RWS for three weeks. Finally the treatment results of the two groups were compared.ResultsThere were no significant differences regarding degree of pain, compliance or complications between RWS and SAC groups. Resource savings can be made with this approach also patients’ and parents’ satisfaction can be increased without compromising patients' care.ConclusionsRWS can be considered as an easy and acceptable treatment modality with very low costs and complications in the management of DFTF.

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