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Introduction: Foreign body insertion is a common and important cause of pre-pubertal vaginal bleeding. Case Presentation: We present a three-year-old girl who referred to our clinic with abnormal vaginal bleeding without any other symptoms. The primary assessment revealed a radio-opaque round solid mass in the pelvic cavity. Following vaginoscopy, the button battery was finally removed under general anesthesia. The vagina was washed by normal saline irrigation and some necrotic tissue was evacuated. Digital rectal exam confirmed intact rectal wall. The patient was asymptomatic in the follow up and there was no sign of recto-vaginal fistula. Discussion: Vaginal bleeding in children may have various etiologies such as foreign bodies. Foreign bodies in the vagina lead to severe inflammation and result in vaginal bleeding or blood-stained and foul-smelling discharge. Other sequel may include infections, fibrosis and recto-vaginal fistula.

Objective: To determine the prevalence of HIV infection among homeless men and women and the related risk behaviors in Tehran, Iran. Methods: In 2007–2008, Tehran municipality stacked up 10672 homeless men and women for assessment of HIV and began collaboration with Iranian Research Center for HIV/AIDS (IRCHA) departments to conduct HIV infection prevalence surveys in homeless populations. The results were analyzed for associations with demographic information, family support, status of drug abuse and relation with family and friends. Results: Overall HIV prevalence was 1.7% (95% confidence interval 1.4–1.9). Factors independently associated with HIV infection included history of using drugs [AOR 8.15 (4.86–13.67)], older age [AOR 1.80 (1.08–2.99) for 40–55 yr], occupation [AOR 1.64 (1.19–2.24) for unemployed], and no relation with family [AOR 1.82 (1.30–2.54)]. Conclusions: This study supports the idea that injection drug use is contributing to the increased spread of HIV among Iranian homeless. Harm reduction programs should be expanded, particularly among homeless injection drug users.

Voiding dysfunction is a common entity in pediatric urology. It is believed to have a multifactorial etiology. The aim of this study was to investigate whether there is an increased prevalence of generalized joint hypermobility (GJH) in children with voiding dysfunction compared to normal children. Moreover, the prevalence of voiding complaints in patients with and without GJH was assessed. A total of 226 children—aged 5 to 14 years—including 113 patients diagnosed with voiding dysfunction and 113 sex/age/body mass index-matched normal children were recruited. GJH was evaluated in both groups using the Beighton score (4 or more = hypermobile). In the patient’s group, GJH was significantly more frequent than in controls: 51/113 (45 %) versus 19/113 (17 %) (P = 0.001). In addition, in both groups, GJH was more prominent in girls than boys (P

At the end of 2011, more than 8 million People Living with HIV (PLWH) were receiving Anti-retroviral Therapy (ART) in lowand middle-income countries [1]. Accordingly, the advent and extensive use of Highly Active Anti-retroviral Therapy (HAART) has dramatically reduced the mortality and morbidity associated with the HIV infection worldwide [2]. However, many factors such as missing doses of medications, interruptions in ART and mono-therapy in the pre-HAART era may ultimately result in clinical drug resistance and virologic failure [3-8].

International audience; Crimean-Congo haemorrhagic fever (CCHF) is a tickborne viral zoonosis with up to 50% mortality in humans caused by CCHF virus belonging to the genus Nairovirus, family Bunyaviridae. The geographical distribution of CCHF cases corresponds closely with the distribution of principle tick vectors that is species of Hyaloma. The disease presents with non-specific febrile symptoms, but progress to a serious haemorrhagic syndrome that, soon after, a full blown multi organ failure may develop with prominent features of liver damage and bleeding diathesis. The authors present a case of a 39-year-old man with severe CCHF with retroperitoneal haemorrhage that recovered without ribavirin administration. The case was confirmed for CCHF by serological and molecular tests.

Infections of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are among the grave health concerns confronting global public health. These infections spread via similar routes (e.g. parenteral, sexual and vertical); leading to the anticipation of high prevalence rates of HBV and HCV co-infections among HIV infected patients. HBV and HCV co-infections in HIV-positive patients lead to severe liver disease by means of rapid progression to hepatocellular carcinoma and severe chronic hepatitis. Consequently, the co-infection of these viruses is strongly associated with reduced survival of HIV patients. Various studies have been conducted among Iranian HIV-positive patients to identify HBV/HIV, HCV/HIV and HBV/HCV/HIV co-infection prevalence rates and their correlations. These surveys have been conducted in many cities and a variety of settings throughout the country. These studies have shown that the alarming high rates of HBV/HCV co-infection among HIV patients highlight the need for a timely and systematic assessment of these patients. It is evident that early diagnosis and early start of appropriate treatments could increase the length of life for co-infected HIV patients; therefore, comprehensive identification of risk factors and underlying conditions, as well as HIV treatment, are highly recommended to prevent HBV/HCV co-infection among HIV-positive patients. Key words: HIV/AIDS, hepatitis B virus (HBV) infection and hepatitis C virus (HCV) infection, co- infection, prevalence, correlation, Iran.

Dermatological conditions are observed in an estimated 90% or more of all HIV infected people worldwide. Microbial infections, inflammatory conditions and neoplasms are the three main causes for the development of dermatological findings in HIV patients. A total of 276 HIV patients were examined by a dermatologist to identify skin, hair and nail pathologies. CD4 count was measured; Liver function test (LFT) and complete blood count (CBC) were also done. Skin biopsies were obtained and sent for pathological study. Analysis showed 90 (32.6%) of patients had at least one identifiable dermatological ailment. The most common dermatologic manifestations were dermatitis (22.3%), seborrheic dermatitis (13.8%), folliculitis (6.7%), dermatophytosis (6.7%), oral candidiasis (6.7%), warts (6.7%) and Herpes Zoster (3.6%). CD4 count was positively and significantly associated with occurrence of a dermatologic manifestation. Moreover, the type of antiretroviral drug was correlated with these manifestations. Due to high prevalence of skin diseases, severity of complications and overall influence on the patient’s quality of life, considerations should be given to timely diagnosis and treatment of dermatologic complications among HIV/AIDS patients. Key words: Dermatologic, HIV/AIDS, prevalence.

The purpose of this cross-sectional study on 191 HIV/AIDS patient was to prepare the first Persian translation of complete WHOQOL-HIV instrument, evaluate its reliability and validity, and apply it to determine quality of life and its associated factors in Tehran, Iran. Student'st-test was used to compare quality of life between groups. Mean Cronbach’sαof facets in all six domains of instrument were more than 0.6 indicating good reliability. Item/total corrected correlations coefficients had a lower limit of more than 0.5 in all facets except for association between energy and fatigue facet and physical domain. Compared to younger participants, patients older than 35 years had significantly lower scores in overall quality of life (P= 0.003), social relationships (P= 0.021), and spirituality/religion/personal beliefs (P= 0.024). Unemployed patients had significantly lower scores in overall quality of life (P= 0.01), level of independence (P= 0.004), and environment (P= 0.001) compared to employed participants. This study demonstrated that the standard, complete WHOQOL-HIV 120 instrument translated into Farsi and evaluated among Iranian participants provides a reliable and valid basis for future research on quality of life for HIV and other patients in Iran.

Background: Extant literature finds that 80% of HIV-infected patients present with otorhinolaryngological symptoms during the course of the infection. To date, no studies have defined HIV-associated ENT manifestations in Iran. To fill this gap in the literature, this study characterizes ENT signs and symptoms in HIV-infected individuals in Tehran, Iran. Methods: The cross-sectional study consisted of 98 HIV infected patients who were referred to a Voluntary Counseling and Testing (VCT) center of Imam Khomeini hospital, Tehran from September 2007 to September 2008. A detailed history and physical examination was conducted for each patient. A questionnaire based on ENT manifestations was designed for the study. Para clinical assessments were carried out if any ENT manifestation was present. Analysis included calculations of mean values of quantitative associations between ENT symptoms and otological and nasopharyngeal complaints as well as ENT symptoms and demographic characteristics. Statistical analysis was estimated using either Chi-square test or t- test. Results: Among ENT manifestations, otological and nasopharyngeal complaints were most common. Hearing loss (61%), post-nasal discharge (23.5%), xerostomia (39.8%) and voice change (23.5%) were the most frequently cited complaints by participants. In clinical examination, external otitis (6%), mucosal dryness of nasopharynx (6.1%), candidiasis (9.2%), posterior (7.1%) and anterior (6.1%) lymphadenopathies were also common findings. Lower CD4 count was associated with increased prevalence of oropharyngeal conditions. In addition, the duration of HIV infection was significantly associated with oropharyngeal conditions. Conclusion: ENT evaluations are highly recommended for early diagnosis, especially in patients with specific symptoms in unusual locations.

Purpose This study was conducted to compare the efficacy and safety of naproxen 500 mg twice daily (BID) versus naproxen 500 mg as needed (PRN) for treatment of ankle sprain. Methods In this seven-day, randomized, parallel group trial, 135 patients with ankle sprain occurring less than 48 hours prior to the first dose of study medication were randomized to receive naproxen 500 mg BID (67 patients) and naproxen 500 mg as needed (PRN) (68 patients). The ankle pain was assessed at rest and on full weight bearing using Numeric Rating Scale (NRS) from 0 (no pain) to 10 (the worst imaginable pain). Ankle swelling was assessed as a 4-point scale ranging from 0 (no swelling) to 3 (severe swelling) rated by the investigator. The primary efficacy end point was the patient's assessment of ankle pain via NRS and the degree of swelling on day seven. Results Results showed a significant decrease in pain on weight bearing, pain at rest and the extent of swelling (P0.05) after seven days. Assessing the safety profile of the two different dosing, 13.3% of the naproxen BID group and 6.7% of the as needed group had adverse events, showing that the as needed regimen was safer (P