ARCHIVES OF IRANIAN MEDICINE
Year:2006 | Volume:9 | Issue:3|Papers Count:28

It is increasingly recognized that health care decision-making around the world needs to be informed by high quality and timely research evidence. The randomized controlled trial (RCT) has long been considered the “gold standard” in the hierarchy of evidence; randomized trials, involving sufficient numbers of participants, are essential to distinguish reliably between the effects of health care interventions and the effects of bias or chance. The synthesis of the results of these trials in systematic reviews can provide reliable evidence about the effects of these interventions. The Cochrane Collaboration is an international organization dedicated to improving health care for the world’s population by preparing, maintaining, and promoting the accessibility of Cochrane systematic reviews of the evidence of the effects of health care interventions. The validity of the results of a systematic review is highly dependent on the data included and a prerequisite is to include as unbiased and complete a set of relevant studies as possible. The Cochrane Collaboration has focused on the systematic electronic searching of MEDLINE and EMBASE and the systematic handsearching of currently over 2000 general and specialized health care journals for reports of RCTs. This handsearching involves reading each document in a journal to decide, according to the set Cochrane eligibility criteria, if it might be a report of a randomized trial. The efforts of the many volunteers working within The Cochrane Collaboration have added a substantial number of previously “buried” reports of RCTs to The Cochrane Central Register of Controlled Trials (CENTRAL) published in The Cochrane Library. Some of these reports of trials may have been “buried” as a result of inconsistencies in indexing (indexing bias), a lack of cover-to-cover indexing, or because they have been published in journals not indexed in the major health care databases such as MEDLINE and EMBASE (database bias) or in journals published in languages other than English (language bias).    

Over the past half century we have witnessed exponential growth of scientific research and its application in industry as well as daily life. Medicine is not an exception. The medical literature has grown dramatically with over 2 million articles published yearly in more than 20,000 journals. Keeping up with this is impossible for medical professionals, namely physicians. In addition to being unable to access all the relevant original articles published on a single topic, it has been shown that the main body of practicing and even academic and executive physicians, lack adequate method-ological knowledge and expertise to take care of the published research works, even if they have adequate access. Therefore, “review articles” have gained wide popularity among doctors. These “traditional reviews” are usually written by an expert in the field, either on a personal interest or more commonly on a contract by major journals. These “traditional reviews” provide useful information on general aspects of diseases or new progress. They usually have a general title, are extensively referenced, and reflect points of view of their author(s). The problem rises when you look at different major articles or major reviews on a single topic, which in many instances end up with different conclusions.1 What is the source of dispute, as these authors are expected to have looked at the same literature? Is there any difference in their resources? Have some of them missed some important publications? Are the authors biased towards their own research and points of view? Have they looked differently to the same research work? Are there research works not published in major English language journals, therefore not available to many who need it, i.e., is there some sort of publication bias? Can the statements in the review be generalized to other (especially our own) conditions? What can be done to minimize all these? So we know the following: 1) information is produced at a rapid rate, 2) summarizing the new information at a timely manner is essential to modern medical practice, 3) good reviews are necessary to update users (i.e., medical professionals), and 4) traditional reviews, despite their usefulness, suffer from several major and sometimes fatal drawbacks. “systematic reviews” have been born to respond to these needs.    

This article provides an update on the current status of blood supply in Iran.  Iran is a large country with an area of over 1,648,000 km2.  It is comprises of 28 provinces, 282 districts, 724 cities, 742 towns, and over 2260 villages. The population is estimated to be more than 67 million, with 50.4% under the age of 19 years, and 4.4% over 65 years. The population growth rate is 1.41%.1 The safety and adequacy of blood supply depend on the commitment of each national health authority to the establishment of a well organized, nationally coordinated blood donation program. This requires the official recognition of a specific organi­zation with the sole responsibility of blood transfusion services, an adequate budget, and a national blood policy and plan supported by a legislative and regulatory framework that governs all activities.    The Iranian Blood Transfusion Organization (IBTO) was established in May 1974 and is a nonprofit organization, attached to the Ministry of Health and Medical Education. From the onset, its mission has been to ensure effective and safe transfusion therapy throughout the country, with the objective of reaching the national self-sufficiency level. It is governed by a Supreme Council, which is comprises of five experts in hematology and related fields, appointed by the Minister of Health. The managing director, elected by the Supreme Council, ensures the proper implementation of the latter decisions. The financial resources of the  IBTO are covered by the  budget allotted to the IBTO by the government, as well as financial supports received from public and legal entities. IBTO is comprised of 30 functional regional centers distributed as a network across the country, active in donor recruitment, blood collection, component preparation, blood screening, storage, and distribution. Nine of the said centers are “educational,” and active in the field of education, research, and training of transfusion medicine, in addition to their routine activities. IBTO is responsible for establishing the National Blood Program, supported by the govern­ment. Blood collection is anticipated to come from voluntary, nonpaid basis and self-sufficiency is aimed at the provincial level. One of the key elements in donor screening is proper evaluation of donor’s medical history. The medical history is designed to identify potential donors, who are engaged in behaviors that put them in the high-risk category. Before dispatching, every single unit of blood is tested according to the set standards to maximize safety of the blood. The aim of this study is to report on the activities of IBTO during one year.  

Background: Health care workers are at increased risk of occupational exposure to hepatitis B virus (HBV) infection. Reassessment for revaccination of such high-risk persons after 10 years may be appropriate if anti-HBs antibody titers declined below 10 mIU/mL. This study was conducted to evaluate the long-term efficacy of HBV vaccine in health care workers and the need for their reassessment for revaccination. Methods: We interviewed 600 health care workers in a referral hospital in Shiraz, southern Iran. They were asked to complete a confidential questionnaire including information on their age, gender, vaccination date, number of doses of vaccine, their job description in hospital, previous history of needlestick injury, and educational level. Anti-HBs antibodies were determined by the ELISA method and titers of >10 mIU/mL were considered protective. Those with a positive HBsAg or anti-HBcAb were excluded from the study. Results: Among 600 health care workers interviewed, 339 subjects who accepted to participate in the study, were vaccinated with three doses of HBV vaccine. Anti-HBsAb titers were >100 mlU/mL in 211 subjects (62.2%), 10 – 100 mlU/mL in 85 (25.1%), and <10 mIU/mL in 43 (12.7%) persons. Among 339 subjects who received three doses of vaccine, 273 were vaccinated less than 5 years, 47 cases between 5 – 10 years, and 19 cases were vaccinated more than 10 years before the study. The majority of them had an antibody concentration above the protective level (88.1%, 88.9%, and 60.9%, respectively, P = 0.001). Conclusion: Reassessment for revaccination in health care workers should be considered according to their anti-HBsAb levels 10 years after vaccination. In our health care workers, we think that due to the existence of low immunity against HBV, reassessment for revaccination after 10 years is mandatory.  

Background: Tuberculosis (TB) continues to be a major health problem in developing countries. Contact investigation is the most appropriate strategy to interrupt transmission and subsequent development of TB. Methods: This cross-sectional study was conducted to assess the impact of contact screening on case-finding by using tuberculin skin test chest radiography. Contacts of smear-positive patients with pulmonary TB (index cases) were diagnosed and registered in our center during 2002 – 2004. Contacts, defined as household members living with index cases for >30 days, were screened by sputum examination, tuberculin skin test, and chest radiography. Results: Sixty-eight patients with smear-positive pulmonary TB were considered as index cases. A total of 224 close contacts with index cases (an average of 3 contacts for each index case) were detected. Age among contacts ranged from 6 months to 74 years. Eighty-three percent of contacts were Iranians and 17% were Afghans. Abnormal radiographs were seen in 49.6% of contacts. Sixteen point five percent of contacts had a positive tuberculin skin test of >10 mm; 7.6% had a positive sputum smear. The mean ± SD age of Iranian contacts (29.1 ± 16.6 years) was significantly (P < 0.001) higher than that of Afghans (18.6 ± 14.1 years). Cavitary formation, nodular pattern, and infiltration were found to have a strong association with a positive sputum smear for acid fast bacilli (100%, 100%, and 87%, respectively). Conclusion: The rate of TB in contacts was higher than other similar studies. Earlier detection and treatment of adults with TB could interrupt transmission and be a step towards eliminating childhood TB. Contact control and source-case investigations should be emphasized for TB control. Novel strategies are needed to maximize the number of contacts who are not only identified and evaluated, but also completely treated.  

Background: Bacterial vaginosis and Trichomons vaginalis are believed to be the risk factors for preterm labor birth and preterm prelabor rupture of membranes. The objective of this study was to investigate the association between bacterial vaginosis, T.vaginalis, and vaginal pH with preterm labor birth and preterm prelabor rupture of membranes after excluding other known risk factors. Methods: In this cohort study, we enrolled 1223 pregnant women with gestational age of 16 – 36 weeks from Amir-Almomenin G eneral Hospital in Semnan, Iran, who had no known medical risk factors for preterm labor birth. Bacterial vaginosis and T.vaginalis were determined on the basis of vaginal pH, saline wet mount, and Amsel tests. The principal outcome was delivery before 37 weeks of gestation and preterm prelabor rupture of membranes. Results: Bacterial vaginosis and T.vaginalis were detected in 16.0% and 5.5% of these women, respectively. Bacterial vaginosis was positive in 65 (33.1%) patients at 16 – 20 weeks of gestation and in 134 (66.9%) patients at 36 weeks of gestation or during labor (developing preterm labor birth or preterm prelabor rupture of membranes). The frequencies for T.vaginalis were 20 (29.9%) and 47 (70.1%) patients, respectively. All patients with bacterial vaginosis and T.vaginalis had a vaginal pH ≥5. There was a significant correlation between bacterial vaginosis and vaginal pH ≥5, with preterm labor birth (OR: 5.99; CI: 3.79 – 9.49) and preterm prelabor rupture of membranes (OR: 2.34; CI: 1.07 – 4.99). Moreover, a significant correlation was found between vaginal pH ≥5 with preterm labor birth (OR: 5.82; CI: 2.96 – 11.39) and preterm prelabor rupture of membranes (OR: 4.11; CI: 1.62 – 10.12). There was no significant correlation between T.vaginalis with preterm labor birth (OR: 0.73; CI: 0.22 – 2.17) and preterm prelabor rupture of membranes (OR: 1.22; CI: 0.29 – 5.05). Conclusion: The presence of bacterial vaginosis or vaginal pH ≥5 at 16 – 36 weeks of gestation is associated with an increased risk of preterm labor birth and preterm prelabor rupture of membranes.  

Background: The objective of this study was to determine the frequency of positive purified protein derivative (PPD) skin test in those infected with human immunodeficiency virus (HIV) and to investigate its association with CD4-positive T cell count, demographic factors, and possible routes of transmission in Iran. Methods: Fifty-one (36 males and 15 females) patients from an HIV clinic were selected and tested by a 5-tuberculin unit PPD. Results: The mean ± SD age of patients was 32.2 ± 7.9 years. The probable route of HIV transmission was intravenous drug using in 21 (41%, CI95%: 28 – 54%) and sexual transmission in 17 (33%, CI95%: 20 – 46%) patients. Thirteen (26%, CI95%: 14 – 38%) patients had other risk factors. There were 13 (25%; 10 males and 3 females) PPD-positive patients among HIV-infected patients when a cut-off value of 5 mm was used; there were 15 (29%; 11 males and 4 females) when a cut-off point of 2 mm was employed. In addition, there was no significant correlation between the PPD test using both cut-off values of 5 and 2 mm, and none of the three probable routes of HIV transmission including intravenous drug using, sexual, and others. The mean ± SD CD4+ T cell count was 674 ± 487/mm3 in men and 573 ± 327/mm3 in women (P > 0.05). No significant correlation could be demonstrated between the patient’s PPD positivity rate and CD4+ T cell count. Conclusion: Considering the high rate of tuberculin reactivity, more attention should be paid to the importance of PPD test and isoniazid preventive therapy against tuberculosis in HIV-infected patients.    

Background: Fungal keratitis is a suppurative, ulcerative, and sight-threatening infection of the cornea that sometimes leads to loss of the eye. The objectives of this study were to improve facilities for laboratory diagnosis, to determine the predominant causative microorganisms, and to identify the predisposing factors of mycotic keratitis patients. Methods: A prospective study of corneal ulcer was conducted in Sari between May 2004 and March 2005. Patients who presented with clinically suspected corneal ulcer to the Ophthalmology Department of Bou-Ali Sina University Hospital in Sari were included in this study. Each patient was examined with slit lamp. Data were collected by examining and questioning the patients. Using standard techniques, corneal scraping was performed by an ophthalmologist. The specimens collected were then smeared on two slides, which were stained with Gram stain (for bacterial keratitis) and 10% potassium hydroxide with or without Calcofluor white stain (for fungal keratitis), and studied under light microscope. The specimens were also inoculated directly on blood agar, Sabouraud dextrose agar, and potato dextrose agar in C-shaped streaks. Results: A total of 22 patients met the inclusion criteria of this study, among whom 10 (45.5%) were females and 12 (54.5%) were males. The mean ± SD age of patients was 61.5 ± 17.7 (range: 15 – 83) years. In direct microscopy, branching, and septate hyphae were identified in 7 (31.8%) patients. Two (28.6%) fungi (Aspergillus fumigatus and Fusarium spp.) were isolated. Five (31.8%) patients with fungal keratitis were males and 2 (28.6%) were females. The mean ± SD age of patients with fungal keratitis was 60.4 ± 12.1 (range:  39 – 73) years. Three (42.85%) patients with fungal keratitis were farmers. The mean interval between the onset of symptom and diagnosis was 26.4 (range: 1 – 93) days.  Trauma with plant debris and straws were noted in two (28.6%) patients with fungal keratitis. Five (71.4%) patients received topical antibiotics. Analyses, using potassium hydroxide with or without Calcofluor white as the gold-standard test, revealed a sensitivity of 71.4% for potassium hydroxide, and 42.9% for Gram stain. Conclusion: Infections of the cornea due to filamentous fungi are frequent causes of corneal damage and should always be kept in mind. The direct microscopy method is an essential tool in the diagnosis of fungal keratitis. Therefore, wet mount preparation with potassium hydroxide with or without Calcofluor white or only KOH can be relied upon as the single most important screening test for rapid diagnosis of fungal corneal ulcer.  

Background: Acne is a chronic inflammatory disease of pilosebaceous units. In addition to an unpleasant appearance, it may result in scarring in some cases. Despite the introduction of different treatments, oral isotretinoin is the most effective treatment and affects all the factors involved in the pathogenesis of this disease. This study was performed on patients with acne to examine the therapeutic effects, recurrence rate, and adverse effects of this drug. Methods: One hundred patients with acne, who were visited at the Bou-Ali Hospital during 2000 – 2001, and found eligible to take part in this study were selected. The severity of acne was graded at the beginning, during, and after a 6-month treatment course with oral isotretinoin. Necessary laboratory tests were done. Results: The data of 83 of 100 patients who continued the treatment for 6 months were analyzed. The mean ± SEM severity score of acne improved from 3.15 ± 0.10 to 0.58 ± 0.09 (P < 0.0001). Complete cure was achieved in 65% of patients. The mean ± SEM follow-up was 8.7 ± 2.3 months and the acne severity score was 1.04 ± 0.13 during the follow-up period. Overall, the recurrence rate was 19%; 4% of patients had to undergo retreatment. A rise in triglyceride level was the only significant laboratory alteration observed. Conclusion: Oral isotretinoin appears to have favorable results and the least adverse effects in treatment of carefully-selected patients with acne.  

Background: Previous studies have demonstrated that pharmacokinetic behavior of several drugs such as paracetamol, theophylline, and aminoglycosides are significantly altered in patients with spinal cord injury. So far, no study on pharmacokinetics of carbamazepine has been performed in patients or experimental models with spinal cord injury. The present study was designed to find the influence of experimental spinal cord injury on carbamazepine pharmacokinetics. Methods: Among 12 male albino rabbits, 6 were subjected to spinal cord injury at the 8th thoracic level by knife severance method and 6 rabbits underwent laminectomy alone (sham-lesioned control group). All received a single oral dose of carbamazepine (20 mg/kg) 24 hours after the injury. Blood samplings were done at predetermined times to 96 hours after drug administration. Carbamazepine concentration in serum samples was determined by high-performance liquid chromatography. Pharmacokinetic parameters including maximum concentration, time to reach maximum concentration, half-life, and area under the curve0–24 were directly determined from the concentration-time curve. Area under the concentration against time curve 24-infinity was calculated from the real data. Results: Maximum concentration was appeared at 2.8 hours after administration in sham-lesioned control group at a concentration of 2.3 µg/mL, whereas in spinal cord injury group it was appeared at 4.4 hours at a concentration of 2.7 µg/mL. In spinal cord-injured group, area under the curve and half-life were increased from 29.1 µg/mL.hr to 38.7 µg/mL.hr and from 7.7 hr to 14.1 hr as compared with the sham-lesioned control group, respectively. Statistical analyses of data showed that spinal cord injury does not induce significant changes in carbamazepine pharmacokinetics. Conclusion: We concluded that pharmacokinetic behavior of carbamazepine was not significantly changed by spinal cord injury, although its subtle pharmacokinetic changes could be resulted from alteration in gastrointestinal tract motility, blood perfusion, or metabolism.  

Background: This study was performed in children aged <15 years, at the Pediatric Neurology Clinic of Imam Reza Hospital affiliated to Mashhad University of Medical Sciences. The objective of this study was to recognize the main predisposing factors that result in uncontrolled seizures in patients so that we can start the treatment accurately. Methods: There were two groups of patients; group I, consisted of 51 patients, with minimum refractory seizures of one episode per month while taking at least two antieplieptic drugs, and group II, comprised of 80 well-controlled patients chosen at random, who had no fit within 6 months after starting the treatment. Results: Factors affecting the occurrence of refractory seizures included age <1 year, multiple seizures before starting the treatment, male gender, myoclonic seizures, neurologic defects, neonatal and daily seizures, and first abnormal electroencephalogram and brain computerized tomo­graphy scan. Conclusion: There are several factors that can predict development of uncontrolled seizures.  Knowledge of these factors helps us to discriminate our patients and pay more attention to those at risk of developing uncontrolled seizures.    

Background: Stroke in young adults causes morbidity in this socioeconomically-active age group. Etiologic frequency of ischemic stroke in young adults is different around the world. This study was conducted to determine the causes of stroke in Iranian young adults. Methods: The study population consisted of 314,000 young adult residents in the Southern Khorasan Province, East of Iran. All the patients with stroke, admitted to Vali-e-Asr Tertiary Care Hospital, entered this study. Demographic data, clinical presentation, and investigations of consecutive patients aged 15 – 45 years, presented with ischemic stroke, were registered in Southern Khorasan Stroke Database between 2000 and 2005. All the patients underwent a standard battery of diagnostic investigations by a stroke neurologist. Etiologic classification of stroke in the patients was made based on the Practical Iranian Criteria. Results: One hundred and twenty-four patients (60 females and 64 males) were prospectively investigated during a 5-year period. The incidence of ischemic stroke in young adults was 8/100,000 per year. Cardioembolic mechanism constituted 54% of all stroke etiologies in young adults. Rheumatic valvular heart disease was present in 32% of the patients and caused 2.5 preventable stroke cases per 100,000 young adults per year. Conclusion: Rheumatic valvular heart disease is the most common cause and a preventable etiology of stroke in Iranian young adults.      

Background: The use of endoscopic surgery for nasal and sinus pathologies has revolutionized our approaches towards the diseases of these areas. Objective: To report our experience with endoscopic surgery of benign tumors and tumor-like conditions of the nose and paranasal sinuses. Methods: The medical records of 105 patients with benign sinonasal tumor, who had undergone endoscopic surgery for removal of their neoplasm between 1997 and 2003, were retrospectively studied. Results: The studied patients included 32 with juvenile nasopharyngeal angiofibroma, 24 with inverted papilloma, 23 with benign fibroosseous lesions, 18 with pyogenic granuloma, 6 with intranasal hemangioma, and 2 with pleomorphic adenoma. The patients had a follow-up ranging from 9 to 73 (mean: 41) months. During the follow-up period, the patients were under close observation by performing serial endoscopy and yearly CT scan. Eight cases of recurrent tumor—2 angiofibroma, 4 inverted papilloma, 1 fibrous dysplasia, and 1 osteoma—were noted and managed endoscopically alone or in combination with Caldwell-Luc approach. The major complication encountered in this study was cerebrospinal fluid leakage (2 cases) that was sealed intra-operatively with local tissue flaps without any further sequela. Conclusion: Endoscopic surgery is a valuable tool for removal of benign tumors of the nose and paranasal sinuses in the hands of an experienced surgeon.     

Background: Expression of hormone receptors is routinely evaluated in predicting tumor response to hormone therapy in breast cancer patients.  Normal female genital organs show cyclic changes in the expression of estrogen and progesterone receptors. This study was designed to assess variations in estrogen and progesterone receptor expression rates in breast cancer patients, who were operated in different phases of the menstrual cycle. Methods: From 2001 through 2004, 161 premenopausal patients with breast cancer, who were operated on, were enrolled into this study.  Immunohistochemistry for the expression of estrogen and progesterone receptors was performed on their tumor paraffin blocks, using antibodies against estrogen and progesterone receptors. Results: Estrogen receptor expression was seen in 24 out of 30 cases (80%) in early luteal phase, which was significantly higher than that of those operated in early follicular (53%), late follicular (51%) and late luteal (49%) phases (P < 0.05). Progesterone receptor expression also showed a rising trend in the early luteal phase (87%), as compared with the other phases (P = 0.09). Conclusion: Expression of estrogen/progesterone receptor shows cyclic changes in breast cancer patients, being highest in the early luteal phase of the menstrual cycle. This variation implies that this phase of the cycle could be the golden time for evaluation of estrogen/progesterone receptor status.    

Background: The association of dental caries and diabetes mellitus has not received enough attention, in spite of the fact that both diseases are associated with the ingestion of dietary carbohydrates. This study was undertaken in Fars Province, southern Iran, to determine the prevalence rates of dental caries in a group of metabolically well-controlled patients with type I diabetes mellitus and in a control group. Methods: Fifty patients (22 boys and 28 girls) with type I diabetes mellitus under follow-up of the Endocrinology and Metabolism Research Center of Shiraz University of Medical Sciences, with a mean ± SD age of 11.72 ± 3.36 years and mean ± SD fasting blood sugar of 235.74 ± 103.61 mg/dL, entered this study. A similar study was conducted to determine the prevalence of dental caries in 12-year-old school children in Shiraz, Iran who served as the control group. After completing a questionnaire, the patients were examined separately by two dentists. Before the clinical examination, bitewing radiographies were performed. Student’s t- and Chi-square tests were used for statistical analysis in relation to sex, age of onset of diabetes mellitus, socioeconomic and nutritional status, family history of diabetes mellitus, and orohygiene status. Results: The mean ± SD DMFT for diabetic children was 9.64 ± 4.64 (decayed = 8.12 ± 3.90, missing = 0.62 ± 1.34, and filling = 0.90 ± 2.10). The lower permanent first molars were the most frequency decayed and the incisors were the healthiest teeth. DMFT score and the frequency of decayed teeth were higher in boys than in girls. However, the rate of filling and missing teeth was higher in girls. DMFT and the number of decayed teeth were higher in patients with poor oral hygiene. The number of healthy first permanent molars was much higher in the mixed dentition groups than in those with permanent teeth. A direct correlation was found between the health status of the first permanent molar tooth and having type I diabetes mellitus. Conclusion: Oral hygiene was somewhat poorer in diabetic patients than in the control group. Regular dental check-ups for preventive measures such as fluoride therapy, fissure sealant, regular medical follow-ups for proper control of metabolic abnormalities to decrease occurrence of xerostomia, omission of cariogenic substances from dietary regimen, fluoridation of drinking water, and individual and group education of diabetic patients regarding proper dental hygiene are recommended.  

Objective:To explore the multifocal electroretinogram in patients with nonproliferative diabetic retinopathy with clinically-significant macular edema. Methods: Forty-one eyes with clinically significant macular edema were tested. The latencies and amplitudes of average responses of 5 eccentric rings from 0 to 26 degrees relative to the fixation point were compared with normal values obtained from 13 nondiabetic subjects. Results: Local electroretinogram responses were significantly delayed and decreased in amplitude in patients with clinically-significant macular edema.  Conclusion: Multifocal electroretinogram can be used to quantify the visual function in clinically significant macular edema.  

Folic acid is a coenzyme for many important biochemical reactions including synthesis of purines, pyrimidines, and nucleoproteins. The recommended daily allowance of folic acid is 65 – 200 µg/day for infants and children. The recommended dose for deficiency states is 1000 µg/day; the effects of excess amounts of folic acid are unknown. The role of folic acid in preventing progression of arteriosclerosis is rather a new issue. Thrombotic events related to slightly elevated levels of homocystein in adults may be decreased by daily consumption of 1 mg of folic acid together with 5 – 100 mg of pyridoxine.

Sirenomelia is a very rare anomaly presented with fusion of the lower limbs. Genitourinary, neural tube, and vertebral anomalies are found in most cases. We report a case of sirenomelia with agenesis of corpus callosum, which has not been reported previously.      

Tissue expanders can be used over the dorsum of hand and fingers to increase available tissue for flap coverage after release of syndactyly. Herein, we presented an 18-year-old man who had an unusual complex syndactyly in the middle and ring fingers of his right hand. He had also complete fusion of the proximal phalanges. In this report, we described the application of tissue expander to cover separated exposed bones.              

Myelolipoma is a benign tumor originating from hematopoietic and adipose tissue. This tumor usually develops in the adrenal gland, but rare presentations of extraadrenal myelolipoma are also reported, which usually arise from the presacral region. Herein, we present a 6-year-old girl with myelolipoma with generalized involvement of her abdomen, pelvis, chest, and retroorbital region.  

Inflammatory myofibroblastic tumors are neoplasms characterized by spindle cell proliferation and a fiboinflammatory vascular stroma. Herein, we presented the successful treatment of a rectal inflammatory myofibroblastic tumor in an 11-year-old boy who presented with diarrhea and abdominal pain of 1½ months duration and an appendiceal inflammatory myofibroblastic tumor in a 29-year-old man presented with recurrent abdominal pain of two months duration with associated tenderness and rebound tenderness in the right lower abdomen. Histologically, our cases had inflammatory myofibroblastic tumors very similar to that of other sites; the spindle cells were positive for vimentin and muscle-specific actin.  

A 30-year-old man was referred to us with carpometacarpal joint dislocation of the thumb and fracture of the trapezium. The lesion was managed with closed reduction and percutaneous insertion of pin, resulting in good functional outcome.    

Infection-associated hemophagocytic syndrome is a life-threatening condition characterized by prolonged fever, hepatosplenomegaly, and cytopenia—most commonly, thrombo­cytopenia and anemia. It is characterized by proliferation and activation of benign histiocytes, causing dysfunction of various organs. Herein, we report on a 5-month-old boy whose clinical picture and laboratory findings were consistent with cytomegalovirus infection-associated hemophagocytic syndrome. The patient was successfully treated with intravenous administration of immune globulin and ganciclovir. He remained well 6 months later.  

History of science reveals the progress of civilization in different nations. Research on the history of science discloses the achievements of scientists to acquire knowledge and delve into the reality of the world of being. In the Global Voices essay series of the Science magazine, researchers from around the world are invited to provide a regional view of the scientific enterprise. In an article entitled “Science in the Arab World: Vision of Glories Beyond” (in Science, June 3rd, 2005, Volume 308, page 1416 – 1417), Dr. Wasim Maziak is charged with the task of describing the challenges facing the Arab world in their quest to accomplish scientific prosperity. ِِDr. Maziak has stated that “one of the knowledge shocks that ignited the Renaissance was delivered by Ibn-Sina (Avicenna 980 to 1037 AD), whose Kitab Al-Shifa (‘the book of healing’) introduced the medieval Europe to the principles of logic and their use to gain knowledge”. Dr. Maziak has accurately described many of the obstacles that have led to the decline of scientific achievements in the Arab world. There is a failure in Dr. Maziak’s analysis by calling Razi, Ibn-Sina, and Khawrazmi as Arab scientists. This false statement only widens the gap between the Middle-East and the western world. There could be no doubt on the fact that Razi (Rhazes), Ibn-Sina (Avicenna), and Khawrazmi (Khwarizmi) were Iranian (Persian) and not Arab scientists. Dr. Maziak’s sincere attempt to lump these scientists under the label of Arab-Islamic scholars is unfortunately flawed for a couple of reasons; a very important point is that, the Arabic language was the lingua franca of these scientists’ era and allowed for the free exchange of scientific knowledge from Greece and Rome to Iran, India, and even to places as far as China. There is no doubt that for this reason, scientists were writing in Arabic, while not being Arab, like in the present time, all scientists write in English. One could argue that it is as offensive to Iranians, as it would be to the English, if everyone claimed Sir Isaac Newton was a Frenchman. Not that there is anything wrong with being French, Arab, or from any other nations, but the incorrect label abolishes a significant part of Iranian contribution to the advancement of science.    

A 45-year-old housewife was referred to our center with a two-week history of moderate to severe pain and fullness of the epigastric and left upper quadrant area. She had no history of fever, jaundice, abdominal trauma, weight loss, or other symptoms. She gave a history of epigastric fullness and dyspepsia of one year duration, for which she was taking ranitidine on demand. Physical examination was normal except for the presence of a large, smooth, and nontender mass in the epigastric area extending to the left upper quadrant. Paraclinical investigations, including a complete blood count, liver and kidney function tests, serum lipase, blood chemistry, CA19-9, CEA, urinalysis, and stool examination for ova, parasites, and occult blood were reported normal except for an erythro­cyte sedimentation rate of 50 mm after the first hour and a serum amylase of 300 IU/dL. Chest X-ray was normal. Abdominal ultrasonography revealed a large cystic mass measuring about 15 cm in diameter compatible with a large pseudocyst of the pancreas. An abdominal computerized tomography (CT) scan was taken (Figure 1).      

 A16-year-old boy was visited because of a red, slightly elevated, and hairless 2 × 2 cm plaque on his occipital area that had appeared about 4 months before and enlarged gradually. The lesion caused no trouble for the patient. Examination for fungi had been negative. There was no improvement with administration of topical and systemic antibiotics. Physical examination showed no abnormal finding except the mentional lesion on scalp (Figure 1). Complete blood count, erythro­cyte sedimentation rate, and chest X-ray were all normal. A skin biopsy was performed from the lesion and sent for histopathologic examination (Figures 2 – 4).      

Shiraz Faculty of Medicine was officially inaugurated in 1952. Indeed, it replaced the former “Medical Auxiliary Training School” (Amouzeshgah-e Alee Behdari Shiraz) that was founded in 1946. The school was intended to run a four-year course, the so-called Behdar training. The graduates of the Medical Auxiliary Training School were allowed to work only in small areas with population of less than 10,000. They had to pass a final exam after their four-year training. The graduates could also continue their medical education at medical school after practicing few years in selected areas, to become a licensed physician. Therefore, the Medical Auxiliary Training School in Shiraz can be considered as the forerunner of the Faculty of Medicine at Shiraz University. The present article provides a brief history of the establishment of Medical Auxiliary Training School of Shiraz.