Canon Journal of Medicine
Volume:3 Issue: 2, Spring 2022

Russia’s invasion of Ukraine on February 24th shocked the world. After so many peaceful years since the second world war, now there is a severe threat to humanity. Wars are the most horrible of incidents in the history of human nature; throughout history since the ancient era, wars have only been symbols of ruination and death. Estimating harms caused by war is challenging because its effect does not summarize the number of causalities or destroyed infrastructures. The effect can be global in different aspects. First, the most apparent result of war is its causalities and the living situation of people in conflict areas. A couple of months after the start of the invasion, as of June 14th, based on OHCHR, 4452 civilians died, 280 of whom were children among them, besides 5531 injured civilians (1). As of June 21st, about 5 million people fled the country, and many more fled their homes and relocated to Ukraine’s borders (2). Ukraine’s infrastructure is being destroyed in different sectors, including the health sector. On June 2nd, WHO reported 267 verified attacks on Ukraine’s medical facilities (3). The pressure on Ukraine’s medical sector is not only because of the destruction of medical facilities or war casualties but also because of the lack of medicine and drugs in conflicted areas. All this unjustified pressure on the medical sector will directly affect civilians' health. After the war and the official numbers' existence, the hidden death due to this war can be calculated. However, the truth is that the world in the 21st in much more interconnected than one can think that a regional war’s influence will just be focused on the region of the conflict. In the nested global society that we have today, much of the medical research is done by collaboration between different countries. For instance, based on FDA’s clinical trial database, about 320 clinical trials in Ukraine are part of them (4). The war is in total jeopardy to these studies and even the safety of the patients in these studies. So this war can influence the health care system globally, but the influence of this war isn’t going to be finished at this level. Ukraine is one of the few regions worldwide that supply most grains. Recently Russians blockaded the Black Sea ports; exports are impossible for Ukraine. The estimations suggest that about 20 million tons of wheat are stalled in Ukraine’s inventory. World already faced an increase in grains price even before the start of the war, and this war is causing more problems in that matter, and this will affect the African countries the most. The increase in the price of grains makes them unaffordable for African countries, which can cause a food crisis in the world, as the director general of WTO urged on June 12th (5). The food crisis is another cause of severe health problems for humans globally, and at this moment, this war is fueling it. To sum up, there are pieces of evidence that such an invasion can affect humans globally. In the 21st century, such an invasion is unjustifiable. Such a war can cause millions of people to suffer regionally and globally. Also, this war triggered a chain of actions and reactions, which may result in de-globalization. In this letter, we examined the effects of this war on people’s health regionally and globally. Nevertheless, the damages caused by such war will not be summarized with these few points, and only time will depict the actual hidden cost of such a catastrophe.

Behçet’s syndrome (BS) is a systemic vasculitis characterized by skin involvement, uveitis, and arthritis. Azathioprine is an effective therapy among other immunosuppressive drugs for this disease but there is no clear data about all aspects of its side effects in BS patients with ocular manifestations. we want to determine the prevalence and types of adverse effects related with azathioprine in ocular BS patients. the study is  cross-sectional with 165 confirmed diagnosis of BS patients who had ocular involvement. Data were collected retrospectively with medical records of the BS clinic. Of 165 enrolled patients, Adverse events of treatment with azathioprine occurred in 11 patients (6.67%). side effects included: elevated of liver enzymes in four patients (2.43%), hypersensitive reaction in 2 patients (1.21%), leukopenia in 2 patients (1.21%), nausea in 1 patient (0.61%), skin tumor in 1 patient (0.61%), and t pancreatitis and hepatitis in one patient (0.61). azathioprine reduced the rate of adverse effects and resolution of the ocular manifestations in patients with BS and has few side effects so, it is good choice to treat patients with BS.

Malnutrition or risks of malnutrition can be detected with the Patient-Generated Subjective Global Assessment (PG-SGA), a tool widely used to detect malnutrition. Debilitating diseases such as cancer cause serious physical, mental, and social harm. This study aimed to determine the relationship between malnutrition or risks of malnutrition based on PG-SGA score and esophageal and gastric cancers. A case-control study was conducted, including 120 patients with upper GI cancers as cases and 120 patients with orthopedic, ear-nose-throat (ENT), and neurologic disorders as controls group. These patients have been newly diagnosed using endoscopy, imaging, or biopsy techniques. The general and PG-SGA questionnaires were completed by the participants. The mean ± SD of PG-SGA score was 69.2% and 43.3% in cases and controls, respectively. Cancer was significantly associated with the higher PG-SGA score, family history of cancer, poor economic level, and lower household employed people (P<0.05). These results suggest that a higher PG-SGA score may contribute to the incidence of upper GI cancers.

Euthanasia legalization in Islamic societies is still under debate. Iran is an Islamic country, and the values of Iran's society are rooted in Islamic beliefs. In the present study, we decided to have a narrative-literature review on euthanasia in Iran, as a religious country. For the mentioned purpose, the literature search was performed on Google Scholar and PubMed in order to elicit all the possible data. Results were limited to research on euthanasia in Iran. Euthanasia research which included patients' data, was assessed for ethics committee approval. After the mentioned procedure, a total of 17 documents were retrieved. All of the retrieved research projects were conducted to assess the attitude toward euthanasia and its acceptability by proper questionnaire. A survey of the retrieved documents determined that Iran's society has not yet supported the legitimacy of euthanasia as a social demand. However, it is essential to perform more research projects on various aspects of euthanasia [such as DNR (Do Not Resuscitate)].

Hypertrophy of labia minora can result in uncomfortable sexual or physical activity as well as aesthetic concerns. Currently, labiaplasty is the only treatment of choice which is performed by various techniques. We introduce a new laser-assisted technique for concurrent aesthetic labia minora and clitoral hood reduction. This experimental study was conducted between July and August 2021 on patients with hypertrophic labia minora. Patients were randomly selected using random number table. We included patients with esthetic concern, uncomfortable sexual intercourse or symptoms of local discomfort. Labia minora was completely resected using laser cuts (laser model), sparing only a thin layer at the base of labia minora. Then, clitoral hood was resected using laser cuts, leaving a tiny triangle-shaped remnant in the central area. This triangle-shaped area is then sutured to the surrounding tissues using a 3-0 monofilament suture. All the patients completed the Rosenberg self-esteem scale (RSEs), female sexual function index (FSFI) and genital appearance satisfaction scale questionnaires before and two weeks after the operation. We analyzed 15 female patients with a mean age of 32.86±9.97 years. The mean RSEs score was 13±5.22 before and 23.93±3.91 after the intervention (p=0.001). All the patients had a significantly improved genital appearance after the operation (p<0.05). No complications were reported in patients. the introduced laser-assisted technique for labiaplasty has no significant complications and is also associated with significant improvements in self-esteem and genital appearance satisfaction scores.

Papillary Serous Cervical Carcinoma (PSCC) is a very rare type of primary adenocarcinoma of the cervix. Herein, we report such a case of PSCC and describe its presentation and treatment.Our patient was a 65-year-old woman presented with vaginal spotting 14 years after menopause. Vaginal examination was not remarkable; however, transvaginal ultrasound showed cervical irregularity. A Pap smear was done for her that revealed atypical cells. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pathologic examination and Immunohistochemical study disclosed PSCC. Metastatic evaluations including abdomen and pelvic MRI and chest CT scan were negative. Therefore, pathologic stage was IB1. Due to inadequate lymph node dissection, the patient received adjuvant external beam radiotherapy (45 Gy in 25 fractions). Subsequently, adjuvant endocavitary brachytherapy (3 fractions of 4 Gy) was delivered; however, she refused to receive any adjuvant chemotherapy. After 12 months she is well and is doing her regular daily life. PSCC is a rare case and although Radiotherapy is usually done for patients, its treatment is not well known.