فهرست مطالب behnam dalfardi

 Several coronavirus disease 2019 (COVID-19) vaccines, utilizing different platforms, have successfully obtained emergency clinical use authorization to prevent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections. Most published data from COVID-19 vaccine trials have frequently observed mild-to-moderate side effects, with varying severity depending on various vaccine types.

 This study aimed to estimate the prevalence of side effects associated with four types of COVID-19 vaccines among vaccinated healthcare workers following the first and second vaccine doses and to identify possible risk factors for COVID-19 vaccine side effects.

 This cross-sectional study was conducted from April 2021 to March 2022 by administering a questionnaire and conducting direct interviews with healthcare workers in Kerman, southeastern Iran, who had received 2 or more doses of COVID-19 vaccines.

 Out of 861 individuals enrolled in the study, 38.7% received Sputnik, 32.4% AstraZeneca, 19.6% Covaxin, and 9.3% Sinopharm vaccines. Overall, the most common side effects after the first and second doses included general symptoms, fever and chills, injection site reactions, neurological symptoms, and gastrointestinal symptoms. Furthermore, the frequency of symptoms significantly reduced after the second dose.

 General symptoms and injection site reactions were significantly more common after receiving the first dose of vaccines compared to the second dose. No severe vaccine side effects were observed in this study. However, further research is required to evaluate the long-term symptoms and safety profiles of COVID-19 vaccines.

This study aimed to investigate the possible side effects and short-term safety of coronavirus disease 2019 (COVID-19) vaccines in pregnant women.

This cross-sectional study was conducted on a sample of 500 pregnant women who had received various types of COVID-19 vaccines between June and August 2022. The participants were selected using convenience sampling until the desired sample size was achieved. Data analysis was performed using SPSS software (version 20).

The mean age of the participants was 30 years, and 34.2% of them had a history of COVID-19 infection. Furthermore, 40 of the participants had underlying hypothyroidism, and 13 cases were smokers. The most commonly reported side effects were abdominal pain, fatigue, headache, and fever; nevertheless, the lowest frequency was associated with localized swelling (0%) and ageusia, localized pruritus, and urticaria (0.4%).

There was no increase in miscarriage or serious side effects observed as a result of COVID-19 vaccination in pregnant women.

End-stage kidney disease (ESKD) is a global issue. Although the use of kidney replacement therapy measures has improved outcomes for patients with ESKD, the mortality rate remains significant. Identifying modifiable factors that affect patient outcomes can help improve their survival. The aim of this study was to investigate the factors affecting the clinical outcome of peritoneal dialysis patients.  

This prospective cohort study was conducted between 2018 and 2021.Participants: Patients aged between 18 and 75 years with a history of peritoneal dialysis (PD) for at least six months were included. Demographic data, kt/v ratio, medical history, serum levels of albumin, creatinine, triglycerides, total cholesterol, calcium, phosphorus, parathyroid hormone, hemoglobin, and ferritin were recorded before starting PD and during the follow-up period, along with clinical outcomes. To describe the data, the central index of mean, frequency, and relative frequency was used, and for analytical statistics, Chi-square test, analysis of variance, and Kruskal-Wallis were used.  

A total of 64 patients with a mean age of 51.78 ± 15.31 years were included. Of these, 27 (42.18%) had a history of diabetes mellitus, and 38 (59.37%) had a history of hypertension (HTN). 48 (75%) patients survived until the end of the study, while 47 (73.4%) participants experienced peritonitis. Our findings indicate that variables such as sex, marital status, weight, history of HTN, and serum levels of hemoglobin and ferritin significantly affect outcomes.  

We found that factors including sex, marriage, normal weight, HTN, normal hemoglobin, and ferritin can lead to better survival in PD patients. Recurrent peritonitis was the most crucial cause of PD to HD shifts.

This paper offers a historical exploration of how death was diagnosed in Persian medicine, highlighting the evolution of diagnostic criteria and the contributions of key scholars. In the post-medieval era, defining death and establishing diagnostic criteria underwent significant development, albeit with ongoing debates. Notably, medieval Persian scholars, such as Qutb al-Din al-Shirazi, played a crucial role in this discourse. Qutb al-Din al-Shirazi, a prominent Persian polymath, synthesized earlier knowledge to provide a comprehensive set of diagnostic criteria for death in traditional Persian medicine. These criteria encompassed physical examinations like assessing nail shininess, feeling pulsatile vessels in specific areas, observing pupillary reactions to light, and even monitoring the movement of a thread near the mouth and nose. His mention of the pupillary light reflex is one of the earliest known references to this phenomenon in medical history. Medieval Persian practices also involved placing a water container on the chest of the individual to detect the absence of chest wall motion associated with respiration as a sign of death. Furthermore, scholars like Ibn-e Sina (Avicenna) stressed the importance of monitoring pulse and respiration as vital signs, especially when administering potentially lethal drugs. In cases of uncertain diagnosis, such as stroke, medieval Persians postponed burials for up to three days. These historical insights provide a fascinating glimpse into the evolving understanding of death in Persian medicine and the intricate methods used for its diagnosis.

Patients with Coronavirus disease 2019 (COVID-19) pneumonia are at risk of hypoxemic respiratory failure. Hence, many patients may require noninvasive positive pressure ventilation (NIPPV) during their hospital course. Using mechanical ventilation such as bilevel positive airway pressure or a ventilator to provide NIPPV may result in adverse events, including barotrauma.

Case Report: 

We reported two cases (40- and 43-years-old men) of severe COVID-19 pneumonia and hypoxemic respiratory failure who underwent NIPPV for respiratory support. These cases were complicated with barotrauma in their course of hospital admission that manifested with pneumoscrotum.

In the cases of pneumoscrotum, it is crucial to understand its underlying etiology and origin since this clinical finding may be the outcome of life-threatening illnesses requiring urgent treatment.

 Sarcoidosis is a granulomatous inflammatory disorder characterized by the presence of non-caseating granulomas in affected tissues, such as lungs and lymph nodes. The precise etiology of sarcoidosis is not known yet. There are some reports on the association of sarcoidosis and other disorders that may similarly have an immunological basis, such as inflammatory bowel disease. In this study, we introduce a patient with ulcerative colitis (UC), whose disease was in remission for about 20 years, before presentation of her sarcoidosis.

 A 48-year-old woman, a known case of UC for a period of 20 years, presented to the Adult Pulmonology Clinic with complaints of chronic non-productive cough, episodic night sweats, progressive dyspnea (initially on exertion, then at rest), fatigue, and significant weight loss. Her clinical manifestations began since about 1 year ago and aggravated over time. She was on regular follow-up by a gastroenterologist, and her UC was in remission. At the first visit, the patient’s physical examination showed stable hemodynamics, and normal breath sounds, and cardiac auscultation. Also, no significant finding was noted in her abdominal examination.

 Patients with UC who possess HLA-A*01 phenotype may possibly be more susceptible to developing sarcoidosis.

The predictive equation of the six-minute walk test designed for one population cannot reliably be used for another population. Despite introducing multiple prediction equations, there is no local such equation for our country, Iran, presently.

In this cross-sectional study, we included 116 (65 males) healthy Iranian adult subjects to measure six-minute walk distance (6MWD), define influential factors, and formulate a native predictive equation. All the studied cases aged between 20 to 50 years old. We performed 6MWT according to the guideline of American Thoracic Society.

The mean value of 6MWD was 629.98 ± 81.38 meters, (ranged 421 to 729). On average, men walked 114.29 meters more than women that was statistically significant. Moreover, 6MWD had a direct correlation with subjects’ height (r = 0.627, P < 0.001); however, it had an inverse correlation with their age (r = -0.303, P < 0.001) and weight (r = -0.218, P = 0.019). Multiple regression equation derived this formula: 6MWD = 485.25 – (99.42 × sex male = 0, female = 1) + (2.791 × height cm) – (1.614 × weight) – (1.273 × age year), which explained 61% of variability. We observed that most other countries’ predictive equations could not be reliably applied to our population.

In this study, we measured 6MWD in a healthy middle-aged Iranian population and proposed a native predictive equation, which might trigger further research and application of this simple and inexpensive test in our country.

COVID-19 is a widespread viral disease that has severely affected our world. Although beneficial effects of vitamin D on immune system are well known, there are ongoing discussions about its role in patients suffering from SARS-CoV-2 infection. In this study, we examined the relationship between risk of COVID-19 infection and plasma vitamin D level. This case-control study was conducted on 133 participants in Kerman city, Iran. SARS-CoV-2 infection was confirmed by positive RT-Real time PCR test in 69 cases and another 64 participants were considered as - non-infected - control group. Plasma vitamin D levels were measured among all, and compared. Sub-normal plasma vitamin D level were reported in about 51% of participants; however, there was no significant difference in the mean plasma vitamin D levels between COVID-19 and control groups. Mean plasma levels of vitamin D were significantly higher in females than males (P-value: 0.017). According to our results, risk of COVID-19 infection does not correlate with plasma level of vitamin D.

The COVID-19 pandemic, caused by SARS-Cov-2, has affected the care of patients with hemophilia, indicating the necessity of their vaccination. Nevertheless, there are concerns about using anti-SARS-Cov-2 virus vaccines for hemophilic patients, particularly concerning bleeding adverse events.

Following a cross-sectional design, all adult hemophilic patients who received two doses of Sinopharm anti-SARS-Cov-2 virus vaccine in Afzalipour Hospital, Kerman, Iran, during May and June 2021 were recruited. The participants were followed for two weeks after receiving each dose of vaccine.

Fifty-one patients with a mean age of 37.07 ± 11.45 years were included, of whom 27 (61.4 %) patients experienced at least one adverse reaction. Pain was the most frequent local adverse event (occurred in 20 (39.2%) and 15 (29.4%) cases after 1st and 2nd doses, respectively). Menometrorrhagia and epistaxis were reported by two and one patients, respectively.

Overall Sinopharm anti-SARS-Cov-2 virus vaccine seems to be safe for patients with hemophilia in the short term

 Pulmonary thromboembolism (PTE) is a leading cause of maternal mortality. However, diagnosis of PTE can be challenging during pregnancy, and there is no consensus regarding the best diagnostic approach.

 The current study aimed to evaluate the applicability of clinical symptoms and diagnostic tests in ruling in or ruling out PTE during pregnancy.

 In this one-year, cross-sectional, descriptive study, we evaluated pregnant or postpartum (six weeks postpartum) women suspected of PTE, who were admitted to the internal medicine intensive care units (ICUs) of hospitals (Namazi and Shahid Faghihi hospitals), affiliated with Shiraz University, Shiraz, Iran, during August 2016-July 2017. The participants underwent electrocardiography (ECG), serum troponin-I and D-dimer measurements, chest X-ray, color-doppler sonography (CDS) of the lower extremity venous system, transthoracic echocardiography, pulmonary perfusion scan, or pulmonary computed tomography angiography (CTA). The participants’ clinical manifestations were also assessed.

 A total of 103 women, with the mean age of 30.37 ± 5.35 years, were included in this study. Seventy-seven women underwent pulmonary CTA or pulmonary perfusion scan. PTE was documented in nine cases. Dyspnea was the most common symptom. The respiratory rate, cough, dizziness, and fever on admission had significant correlations with the final diagnosis of PTE (P = 0.01, 0.03, 0.007, and 0.04, respectively). The ECG study of one case with PTE showed right axis deviation, while the ECG findings of the other eight cases showed no specific pattern. The chest X-ray findings had no significant correlation with the final diagnosis of PTE. Overall, 38 women underwent CDS, one of whom presented with deep vein thrombosis. The serum D-dimer level was positive in three cases with documented PTE (normal in one patient with PTE), and the serum troponin-I level was positive in one case with the final diagnosis of PTE (normal level in two patients with PTE).

 Based on the findings, clinical symptoms and biochemical tests alone are not reliable for ruling in or ruling out PTE during pregnancy, and CTA and pulmonary ventilation/perfusion scan should be performed for these cases.

Catheter-related bloodstream infection (CRBI) is one of the main causes of mortality and morbidity among hemodialysis patients. Thus, documenting its prevalence and risk factors in each center will help control them and improve patients’ prognosis.

This one-year cross-sectional study was performed in the educational hospitals of Shiraz University of Medical Sciences. Patients were selected using the census method. The included cases aged more than 18 years and had hemodialysis using a double lumen catheter. Finally, data were analyzed by SPSS analytical software.

In general, 345 patients with a mean age of 57.90±16.59 were included (192 men and 153 women) in this study. In addition, 138 (40%) patients had the elementary education and 127 (36.8%) study participants were housekeepers. Further, the subclavian vein was the most used site for the catheter (228 cases, 66.10%). Further, 187 (54.20%) cases had CRBI of whom, 181 patients had a previous history of CRBI. Furthermore, fever and chills at the time of hemodialysis were the most prevalent manifestations. Eventually, patients’ age, job, level of education, location of the catheter, previous history of CRBI, hand washing (patient and health-care personnel), use of gloves (health-care personnel), oral administration of antibiotics, use of topical antibiotic ointment, and the pattern of dressing change had a significant impact on the risk of CRBI (P<0.001).

The prevalence of CRBI is still high. Accordingly, it is needed that interventions be conducted to reduce modifiable risk factors for this issue and prevent hemodialysis patients’ morbidity and mortality.

Cutaneous leishmaniasis (CL) is the most form of leishmaniasis that caused by intracellular parasites, Leishmania.

A 39-year-old woman, known case of HIV infection, presented with a 6-month history of skin lesions initially on her face, then extending onto the chest, abdomen, and extremities. Laboratory examinations revealed leukopenia and a CD4 cell count of 280 cells / mm3. A biopsy was taken from skin lesions, and histopathological studies showed aggregates of macrophages filled with numerous Leishman bodies, the diagnosis of diffuse CL was confirmed. Consequently, she received liposomal amphotericin B (total dose of 40 mg/kg) as a case of diffuse CL. The skin lesions showed significant improvement after completion of treatment.

Diffuse CL should be considered as a differential diagnosis in all patients with diffuse skin lesions mainly in the cases that suffer from disorders of cell-mediated immunity.

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Most patients present with steroid hormone excess or abdominal mass effect. Pure androgen-secreting ACCs are rare, while hypoglycemia is an unusual presentation of this malignancy. We present a 26-year-old woman with hypoglycemia and history of adrenalectomy due to a large adrenal mass which was diagnosed as nonfunctional adrenal adenoma. She was admitted in our hospital 10 days after her fetal loss with repeated episodes of severe hypoglycemia. She had a high serum dehydroepiandrosterone sulfate (DHEA-S) and her hypoglycemia was associated with low insulin and C-peptide levels. Imaging revealed liver metastasis and immunohistochemical studies of the biopsied lesions confirmed the diagnosis of ACC.

To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness (LOC).
This prospective cross-sectional study was conducted over a six-month period at Shahid Rajaee Trauma Hospital, Shiraz, Iran. We included hemodynamically stable blunt abdominal trauma patients with a decreased LOC (Glasgow Coma Scale ≤ 13) who were referred to the neurosurgery ICU ward. Included cases underwent 1 contrast-enhanced CT scan and two-time ultrasonographic study of the abdomen with an interval of 48 hours. The diagnostic accuracy of the ultrasonography was determined according to the CT-scan results.
Overall 80 patients with mean age of 37.75 ± 18.67 years were included. There were 17 (21.3%) women and 63 (78.8%) men among the patients. Compared with the CT-Scan, the first ultrasonography showed a sensitivity of 60%, specificity of 80%, PPV of 16.60%, NPV of 96.80%, and a diagnostic accuracy of 70%. The same values for the second ultrasonographic study were 80%, 79%, 20%, 98%, and 79%, respectively. In 4 (5%) patients whose first ultrasonography and CT scan results were negative, the second ultrasonography was positive for injury.
In patients with blunt trauma to the abdomen, when the only indication of abdominal CT scan is a decreased LOC, two ultrasonographic studies can replace a CT imaging.

Sexual activity makes up a significant portion of anybody’s life: it plays a crucial role when it comes to having full physical, mental, and psychological health. This part of life-style has been emphasized as an essential need in Persian Medicine (PM) literature [1]. PM sages –such as Rhazes (865-925 AD)– have discussed different types of sexual disorders in their books, offering their own therapeutic methods [2]. Nevertheless, the recent increasing trend of sexual disorders and related complications e.g., infertility, has posed a serious challenge to the physicians and a growing burden to health care systems.
Putting emphasis on having a healthy sex life, PM underlines proper regimen and normal digestive system without which negative consequences on both potency and fertility may occur [3]. Moreover, accomplishment of sexual desire and normal sexual function is conditioned upon the well-being of vital organs i.e., heart, brain, liver, and genital system. Not only in traditional literature but also in current studies the relation between cardiovascular diseases and sexual disorders has been mentioned [4].
Avicenna (980-1037 AD) (Figure 1), the great Persian scholar of the Islamic Golden Age, is known as one of the pioneers of modern science of cardiology. He has discussed sexual disorders in the third volume of his masterpiece, Canon of Medicine.
In the chapter on “noghsan-e-bah” (sexuality weakness), Avicenna discusses different sexual disorders and their proper remedies. For instance, he goes on to cover erectile dysfunction, mentioning its cardiovascular origin [5]. Avicenna precisely describes the clinical features of impotence/infertility with cardiovascular origin: “…If the decrease in the stamina of intercourse is from a cardiac origin, erection would happen less, and ejaculation may occur in a non-erectile state. The pulse would be soft and weak –body temperature drops under the normal degree…” [6].
Avoidance of grief and improving body weakness using meat juice are the basic treating approaches in this case. As for the pharmacotherapy, application of fragrant herbs such as sandalwood, rose, and musk has been emphasized. Apple, lemon balm, and borage drinks are repeated prescriptions of Iranian physicians in this regard. In addition, pearls, amber, coral, silk, cloves, white behen, mastic, valerian, and cinnamon are the most common components that are used in combination forms for treating cardiogenic infertility/impotency [7].
Establishing such a link in between cardiac diseases and infertility in PM is not far from the current evidence. For instance, it has been revealed that serum testosterone level is significantly decreased in men with chronic heart failure [8]; this could inevitably pose negative effects on fertility. On the other hand, some clinical evidences have shown that using a formulation (Loboob) which increases the cardiac [and other vital organs’] stamina is effective in treatment of infertility [9]. In addition, at least some –if not all– of the medicinal plants used for managing sperm abnormalities in PM have cardiotonic properties [10]. With this regard, we suggest more rigorous investigations to well understand the concept of cardiac infertility and its underlying mechanisms.

In modern medicine, Albrecht von Haller is often known as the first figure who described obstructive jaundice in 1764.1 However, our investigations support the fact that Islamic Medicine Golden Age (9th to 12th centuries AD) physicians were able to differentiate obstructive jaundice and other forms of this medical issue, as the descriptions provided by Haly Abbas (? 930-994 AD).2 Interestingly, our new studies have revealed that Akhawayni (?-983 AD) of Persia provided a more comprehensive approach to Icterus and its causes in his survived manual of medicine, entitled Hidayat al-Mutaallimin Fi al-Tibb (A Guide to Medical Pupils).3 Akhawayni Bukhari (?–983 AD) (known as Joveini in Latin), with the full name of Abubakr Rabi-ibn Ahmad Akhawayni Bukhari, was a medieval Persian scholar who was born in the city of Bukhara in Old Persia.4 He learned the art of medicine under the guidance of Abu Al-Qasem Taher-ibn Mohammad-ibn Ibrahim Maqaeni, a Rhazes’ scholar. He was one of the impressive figures of Islamic Golden Age.5 About the general etiology of jaundice, Akhawayni says: “Be aware that the cause of jaundice is excess amount of bile that distributes to all parts of the body and causes yellowish discoloration of the body …”.6 He noted the inflammation of the liver and inability to excrete the bile as the causes of the jaundice. Akhawayni described foods and drugs as other causes of jaundice (known as drug-induced liver injury in modern terminology).7 He mentioned snake bite as a cause of Icterus (corresponding to the snake-bite-induced intravascular hemolysis in modern medicine).8 Considerably, Akhawayni was able to differentiate obstructive and non-obstructive jaundice. He explains: “… if the obstruction occurs within the duct located between gallbladder and intestine (connects them), … inevitably the stool becomes whitish [clay-colored stool] and urine becomes reddish [tea-colored urine] … . If the obstruction does not occur and the cause is the liver, both urine and stool are colorful [no clay-colored stool]…”.

Persian scholars greatly influenced the advancement of medical sciences during the Middle Ages. As a review of the books surviving from that time shows, infectious diseases was one main field of interest for these scientists. Among this group of health problems, rabies was specifically described by Persian physicians, particularly by Avicenna (980 – 1037 A.D.) in his famous “Canon of Medicine.”The current study aimed to examine these physicians’ brilliant views and innovations on the manifestations, diagnosis, and management of rabies, a subject not comprehensively assessed until now.

Craniosynostoses is defined as a condition of premature fusion in one or more cranial sutures leading to a number of significant complications, mainly raised intracranial pressure which can itself cause other neurodevelopmental complications. Copper beaten skull appearance is a well-known presentation of craniosynostoses made by the strong impression of the brain’s gyri on the inner layer of the skull. It may also represent an increase in ICP. We report a 1-month-old infant with the diagnosis of craniosynostoses, confirmed by conventional radiologic studies and a three dimensional CT scan, presenting as copper beaten skull appearance. After diagnosis, the patient underwent a successful neurosurgical intervention.

In today’s modern world, despite the multiple advances made in the field of medicine, hemorrhagic shock is still the main cause of battlefield mortality and the second most prevalent cause of mortality in civilian trauma. Hemostatic agents can play a key role in establishing hemostasis in prehospital situations and preventing hemorrhage-associated death. In this respect, this article aims to review different aspects of known hemostatic agents. Evidence Acquisition: A comprehensive search of the academic scientific databases for relevant keywords was conducted; relevant articles were compiled and assessed.

Hemostatic agents can establish hemostasis by means of different mechanisms, including concentrating coagulation factors, adhesion to the tissues, in which traumatic hemorrhage occurred, and delivering procoagulant factors to the hemorrhage site. Presently, these hemostatics have been significantly improved with regard to efficacy and in adverse consequences, resulting from their use. Several hemostatic dressings have been developed to the degree that they have received FDA approval and are being used practically on the battlefield. In addition, there are currently several case reports on the use of such hemostatics in the hospital setting, in conditions where commonly known approaches fail to stop life-threatening bleeding.

The use of hemostatic dressings and agents is one of the main advancements achieved in recent decades. However, it can be claimed that the ideal hemostatic has not been recognized yet; therefore, this topic needs to be brought into focus and further addressed.

Abū l-Ḥasan Alī ibn al-‘Abbās al-Majūsī Ahvazi (? 930-994 AD), best known as Haly Abbas in the West, was a 10th century Persian physician whose lifetime coincided with the flourishing of medical science in the Near East, the Islamic Medicine Golden Age, an era extending from the 9th to the 12th centuries AD. Haly Abbas, in his extant book Kāmil al-Sinā‘ah al-Tibbīyah (The Perfect Book of the Art of Medicine), provided a detailed description of the pulse and its features. He practiced the evaluation of the pulse cycles to distinguish between the state of well-being and various diseases. These 10th century views on the pulse are explored in this text through a discussion of Haly Abbas’ surviving book, the Kāmil al-Sinā‘ah al-Tibbīyah (The Perfect Book of the Art of Medicine).