Dear Editor, Propionic acidemia is one of the intoxication type organic acidemias, which often present in the neonatal period with lethargy, feeding difficulties, hypotonia, vomiting and coma if not identified and treated appropriately. Patients with propionic acidemia can decompensate during periods of increased metabolic demand.

Epstein-Barr virus (EBV) is one of the most important causes of hemophagocytic syndrome. We report a 76-year-old man who presented with pneumonia like symptoms and pleural effusion following upper respiratory tract infection. He underwent thoracentesis and pleural fluid cytology revealed large number of histiocytic macrophages that had phagocytosed RBCs and other inflammatory cells like lymphocytes and neutrophils. Pleural fluid analysis showed Epstein-Barr virus Antigen (EBNA) as the causing agent and corticosteroid therapy was initiated. A few days later, pleural effusion subsided and further cytologic examinations revealed no trace of HEMOPHAGOCYTOSIS.

BACKGROUND: Kala-azar is a multisystem infection of the reticuloendothelial system. Various hematologic abnormalities have been described in kala-azar including hemophagocytic syndrome (HPS).METHODS: We reviewed bone marrow aspirate smears from 18 documented cases of kala-azar complicated by HPS.RESULTS: The bone marrow smears were hypercellular with erythroid hyperplasia. Megaloblastic changes, foamy macrophages, activated macrophages with cytoplasmic vacuoles and elongated cytoplasmic process, intra- and extracellular amastigotes, cytoplasmic fragments (blue bodies), plasma cells with inclusions and hemophagocytic cells were seen. Leishman bodies (amastigotes) were also found in some hemophagocytic cells.CONCLUSION: Kala-azar should be considered as an etiology of HPS, particularly in endemic areas.

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Purpose: Managers are one of the important elements of an organization, for this reason, in order to draw the future of the organization, it is necessary for the planners to specify the conditions of their selection and appointment. Therefore, the current research has been done with the aim of identifying and analyzing the components of selecting future principals.Method: In this research, comparative and benchmarking method is used as a prospective approach. This approach is based on the belief that today's advanced organizations/countries can be considered as a model for the future of another organization/countries in their respective subjects. For this, first, the fields of comparison and benchmarking were determined using Brody's four-step comparison method; then the countries of Canada, Finland, Australia, South Africa, and Japan were selected according to the qualitative balance value in the international advanced TEAMS test, human development index, life quality index(health, instruction, and welfare), education quality index, and other scientific-scholarly indexes; finally, by extracting the criteria for the selection and appointment of principals through content analysis and comparison with Iran, the proposed framework for Iran has been presented.Findings: A total of 61 components for the selection of SECONDARY school principals were identified from among the studies conducted in the selected countries in this article. By extracting the commonalities and differences of each of the components among the countries, it was found that the highest index of manager selection and appointment belongs to Japan and the lowest one is related to Finland.Conclusion: There are similarities between the components of selection of principals of SECONDARY schools in Iran and selected countries. In Iran, special attention should be paid to important components such as adherence to religious principles, appropriate personality traits, creativity and innovation, motivation to develop capabilities, professional growth, power of supervision and accountability, social image, leader skills, and purposefulness and foresight.

Hemophagocytic lymphohistiocytic syndrome is a rare, significant, and life-threatening disease. We are reporting this case with the hope that it may contribute to saving some patients if treated appropriately. A 4-year-old boy presented with fever and pancytopenia. He was treated based on the symptoms that matched the criteria of (HLH). Furthermore, the bone marrow biopsy report revealed the presence of Leishman’s bodies.Hemophagocytic lymphohistiocytic syndrome is a rare, important and life-threatening disease that we are reporting this case due to the hope of saving some patients if treated. A 4-year-old boy with fever and pancytopenia, who was treated according to the symptoms matching the criteria of HLH, as well as the bone marrow biopsy report showing Leishman’s bodies.HLH is a life-threatening disease based on cumulative increase and unrestricted excessive activity of T lymphocytes, cytokines and macrophages, which occurs in two primary and SECONDARY forms, which requires the rejection of all risk factors, symptoms similar to the disease, including infections, lymphoproliferative and autoimmune diseases and other causes, and after ruling out other causes, the patient should be treated quickly with the treatment protocol of this disease, which is reported.due to the rarity of this disease and the urgent need for timely diagnosis and treatment; we are trying to report this patient.

Griscelli syndrome (GS) is a rare disease first described in 1978. It is inherited in autosomal recessive pattern. This disease is characterized by partial albinism, pigmentation dilution, cellular immunodeficiency, neurological involvement & uncontrolled phases of macrophage & lymphocyte activation.We report a 5 months Old Iranian girl presenting with silver-gray hair, eyelashes and eyebrows, hepatosplenomegaly, pancytopenia, HEMOPHAGOCYTOSIS and progressive neurologic deterioration. Griscelli syndrome can be suggested according to her symptoms. The chemotherapy was not effective for her and she died due to multi organ failure.

SECONDARY Malignant Neoplasm (SMN) is one of the late effects of childhood cancer. Among SECONDARY malignancies, acute myeloid leukemia (AML) is the most common and life-threatening neoplasm. SECONDARY acute lymphoblastic leukemia (ALL) is rare and only 10% of SMN is ALL. Patients with Wilm's tumor are not protected from the SECONDARY cancers after the primary diagnosis.Among patients with this tumor the most common SMN is AML and ALL is very rare. In this paper, we report a case of ALL, four years after diagnosis of Wilm's tumor. The patient died nineteen months after the beginning of leukemia treatment due to multiple relapse arid resistance to treatment. With advances in the treatment of childhood cancer, more children are surviving long periods of time; therefore, careful follow-up and other examination sequels are necessary for early diagnosis of SMN.

Hemophagocytic syndrome (HPS) is an uncommon manifestation in systemic lupus erythematosus (SLE). Clinical features of HPS include fever, pancytopenia, abnormal liver enzyme, hepatosplenomegaly, lymphadenopathy, and coagulation disorder. HPS comprises primary and reactive forms. Herein, we describe a case of untreated SLE with HPS as one of the first manifestations of systemic Lupus.

Coronvirus desies and its consequences have caused concern among various segments of society. In particular, the change in teaching methods from online to face-to-face training and the damage caused by this process in some cases has made this educational process difficult. Thus, identifying students' concerns and understanding the predictions of anxiety in the reopening of educational institutions will allow us to address the roots of this factor after the Corona epidemic and the reopening of schools.. This research is a qualitative research and content analysis and its statistical population is high school students in Tehran at the time of reopening of schools after the Corona epidemic. From this statistical population, 40 male and female subjects who met the research criteria were selected. After interviewing the subjects and analyzing them, sub-themes and main themes have been identified and classified.