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Introduction: Bronchial asthma is a chronic disorder with high prevalence among women. Visfatin as a pro-inflammatory adipokine has been linked to inflammatory lung diseases such as asthma and can be used as a forthcoming biomarker target to diagnose and treat asthmatic patients. background: Bronchial asthma is a chronic disorder with high prevalence among women. Visfatin as a pro-inflammatory adipokine has been linked to inflammatory lung diseases such as asthma and can be used as a forthcoming biomarker target to diagnose and treat asthmatic patients. Aim: The aim of this study is to evaluate plasma visfatin level and its correlation with pulmonary function of female asthmatic patients. objective: To evaluate plasma visfatin level and its correlation with pulmonary function of female asthmatic patients. Methods: This cross-sectional study was conducted on all female asthmatic patients referred to the Be'sat Pulmonary Clinic of Kerman from 1 November 2019 to 20 February 2020. Patients with confirmed diagnosis of asthma were included. The data were collected through a checklist and the corresponding author conducted all face-to-face interviews in the physician’s office of the pulmonary clinic. Then, blood samples (5 cc) were taken from the patients to determine the plasma level of visfatin. Data was analyzed by SPSS Software. Results: 113 women with asthma were studied. The mean ± SD age of patients was 46.71 ± 13.91 years (range: 13 to 75). The mean ± SD of visfatin plasma levels was 26.30 ± 6.98 mg/dl (range: 8.50 to 46.88). The forced expiratory volume in the first second (FEV1) had a significant and negative correlation with plasma visfatin concentrations (P-value=0.03). method: This cross-sectional study was conducted on all female asthmatic patients referred to the Be''sat Pulmonary Clinic of Kerman from 1 November 2019 to 20 February 2020. Patients with confirmed diagnosis of asthma were included. The data were collected through a checklist and the corresponding author conducted all face-to-face interviews in the physician’s office of the pulmonary clinic. Then, blood samples (5 cc) were taken from the patients to determine the plasma level of visfatin. Data was analyzed by SPSS Software. Conclusion: The results of this study indicated that plasma visfatin levels were correlated inversely with FEV1 among asthmatic women. Further studies with large samples are recommended to evaluate the role of visfatin in asthma pathogenesis. result: 113 women with asthma were studied. The mean ± SD age of patients was 46.71 ± 13.91 years (range: 13 to 75). The mean ± SD of visfatin plasma levels was 26.30 ± 6.98 mg/dl (range: 8.50 to 46.88). The forced expiratory volume in the first second (FEV1) had a significant and negative correlation with plasma visfatin concentrations (P-value=0.03). conclusion: The results of this study indicated that plasma visfatin levels were correlated inversely with FEV1 among the asthmatic women. Further studies with large samples are recommended to evaluate the role of visfatin in asthma pathogenesis. other:

Background: This study aimed to compare the serum levels of procalcitonin in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the patients with chronic obstructive pulmonary disease (COPD) in the emergency ward of Afzalipour Hospital in Kerman. background: This study aimed to compare the serum levels of procalcitonin in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the patients with chronic obstructive pulmonary disease (COPD) in the emergency ward of Afzalipour Hospital in Kerman. Methods: This cross-sectional study was conducted on 45 patients with stable COPD and 45 patients with AECOPD. Patients were divided into four groups based on COPD severity assessment. Serum procalcitonin levels were measured using an ELISA kit. Results: The mean age of patients in the exacerbation and the stable group was 60.97±12.61 and 62.53±11.04 years, respectively. Serum procalcitonin levels in two exacerbation groups (215.22±19.84) were higher than stable groups (127.92±8.97) (P=0.001). The accuracy of this test for diagnosing acute attack in terms of AECOPD was 77%, and the serum procalcitonin level of 132.6 was found to be the best cut-off point to diagnose acute disease. The mean serum procalcitonin levels of stage D patients in the acute attack group were substantially higher than those of stages D and B patients in the stable group (P = 0.001). Serum procalcitonin levels were related to body mass index (P=0.01), post-bronchodilator FEV1/FVC (P=0.028), and the number of hospitalizations per year (P=0.001). By increasing the serum procalcitonin levels, BMI and number of admissions per year increase, and post-bronchodilator FEV1/FVC decreases. method: This cross-sectional study was conducted on 45 patients with stable COPD and 45 patients with AECOPD. Patients were divided into four groups based on COPD severity assessment. Serum procalcitonin levels were measured using an ELISA kit. Conclusion: The mean serum levels of procalcitonin in the group with attacks due to COPD was significantly higher than the stable group. result: The mean age of patients in the exacerbation and the stable group was 60.97±12.61 and 62.53±11.04 years, respectively. Serum procalcitonin levels in two exacerbation groups (215.22±19.84) were higher than stable groups (127.92±8.97) (P=0.001). The accuracy of this test for diagnosing acute attack in terms of AECOPD was 77%, and the serum procalcitonin level of 132.6 was found to be the best cut-off point to diagnose acute disease. The mean serum procalcitonin levels of stage D patients in the acute attack group were substantially higher than those of stages D and B patients in the stable group (P = 0.001).Serum procalcitonin levels were related to body mass index (P=0.01), post-bronchodilator FEV1/FVC (P=0.028), and the number of hospitalizations per year (P=0.001). By increasing the serum procalcitonin levels, BMI and number of admissions per year increase, and post-bronchodilator FEV1/FVC decreases. conclusion: The mean serum levels of procalcitonin in the group with attacks due to COPD was significantly higher than the stable group. other:

Mucormycosis is a lethal and life-threatening fungal infection. Several cases describing the association of COVID-19 and mucormycosis have been reported. In this article, we report a 58-year-old female with a history of diabetes mellitus type 2 who presented by diabetic ketoacidosis, rhino-orbital mucormycosis, and COVID-19. The patient was treated with liposomal amphotericin B and debridement of necrotic tissue of the rhino-orbital area and paranasal sinuses. Unfortunately, she passed away a few days after orbital surgery. We also conducted a review of the literature and reported 3 other similar cases that suffered from mucormycosis in association with COVID-19 and diabetic ketoacidosis and discussed the importance of this association.

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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Background: 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. Methods: 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. Results: 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. Conclusions: Overall Sinopharm anti-SARS-Cov-2 virus vaccine seems to be safe for patients with hemophilia in the short term.

Background: 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. Methods: 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. Results: 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

Background: 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. Objectives: The current study aimed to evaluate the applicability of clinical symptoms and diagnostic tests in ruling in or ruling out PTE during pregnancy. Methods: 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. Results: 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). Conclusions: 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.

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.

Historical literature on portal hypertension is mainly focused on the contemporary advances in therapeutic methods, especially surgical ones. However, it seems that the origin of the human knowledge on the portal system, its association with the caval system, obstructive pathologies in this system and the gastrointestinal bleeding due to hepatic diseases might be much older than previously believed. Avicenna provided a detailed anatomy of the portal venous system and its feeding branches in the Canon of Medicine. Soddat al-Kabed va al-Masarigha (liver and mesenteric occlusion) is also a disease presented by Avicenna with clinical, etiological and therapeutic descriptions suggesting the fact that Soddat al-Kabed va al-Masarigha has multiple similarities with the currently identified concept of “portal hypertension”. He presented sense of heaviness in the liver area with or without mild pain, anemia, pale and inappropriate body color, and loose stool which can be complicated with ascites, infection, fever and abdominal pain as clinical manifestations of this disease. He has also suggested therapeutic approaches including laxative and diuretic herbs to help excreting the obstructive material into stool or urine., Povijesna literatura o portalnoj hipertenziji uglavnom je usredotočena na suvremeni napredak u terapijskim metodama, posebice kirurškim. Čini se, međutim, da ljudsko znanje o portalnom sustavu, njegovo povezivanje sa sustavom šuplje vene, patologije opstrukcija u tom sustavu i gastrointestinalno krvarenje zbog bolesti jetre može biti znatno starije nego što se prije vjerovalo. Avicenna je dao detaljnu anatomiju portalnoga venskog sustava i njegovih grana u Kanonu medicine. Soddat al-Kabed va al-Masarigha (jetra i okluzija mesenterijskih žila) bolest je koju je Avicenna predstavio kliničkim, etiološkim i terapeutskim opisima koji upućuju na to da ima puno sličnosti s identificiranim pojmom “portalne hipertenzije”. Avicenna je istaknuo osjećaj težine u području jetre s blagom boli ili bez nje, anemiju, blijedu i neodgovarajuću boju tijela te mekanu stolicu koja se može zakomplicirati ascitesom, infekcijom, groznicom i bolovima u trbuhu kao kliničkim manifestacijama ove bolesti. Predložio je i terapeutske pristupe, uključujući laksativ i diuretičke trave, kako bi se izbjeglo izlučivanje opstruktivnih tvari u stolici ili urinu.

Background: Uncontrolled hemorrhage still remains a major cause of trauma-associated mortality. The events resulting in acute traumatic coagulopathy, particularly hypofibrinogenemia, make control of bleeding difficult. It is essential to timely predict, diagnose, and manage trauma-induced coagulopathy. Aims: The aim of this study is to determine clinical and easily available laboratory variables that are predictive of hypofibrinogenemia in acute trauma patients. Settings and Design: This 2-year retrospective work examined the data of major trauma patients that were referred to Shahid Rajaee Hospital's emergency room in hemorrhagic shock condition. Materials and Methods: Fibrinogen level was assessed for these patients on their arrival at our facility. Along with clinical and routine paraclinical variables, we evaluated the predictive value of these variables for a fibrinogen level below 100 mg/ml. Results: A total of 855 cases were included (females: 16.4%; and males: 83.6%) in the study. The mean ± SD age was 36 ± 17.9 years, and the mean ± SD injury severity score was 12.2 ± 9. Motor vehicle accident was the most common cause of injury. Three factors, including arterial pH (cut off point = 7.34; area under the curve [AUC]: 0.59), base excess (cutoff point = −4.3; AUC: 0.60), and patients' gender had a significant association with the fibrinogen level under 100 mg/ml. When three factors of pH, BE, and patients' gender are being assessed simultaneously, the AUC became 0.62 (the predictive ability improved). Conclusions: Variables, including arterial pH, BE level, and patients' gender have predictive value for fibrinogen transfusion in trauma.

Objective: To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness (LOC). Methods: 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. 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. Conclusion: 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.

“In riding his hobby very hard, he has fallen down through a gully hole and has never since been able to get out again” “Has he any facts to show in proof? No!”* * From an Editorial on John Snow’s theories published in the Lancet in 1855 Biography John Snow, the famous physician, epidemiologist and anesthetist, was born on March 15th, 1813 in York, England (Image 1). He was the eldest of nine children born to William and Frances Snow in their North Street home. His first 12 years of life were spent in a poor and unsanitary area in Michaelgate. River Ouse, which provided the drinking water for the people and often contaminated with excreta, was in the vicinity of his home. This exposed him and his family to the danger of flooding and contamination with excrements of drinking water (1). After financial status of his father improved, they moved to a more wholesome area which was appropriate for the children's education. When he was 14, he was apprenticed to William Hardcastle, a surgeon in Newcastle upon Tyne School of Medicine. Later, he attended in lectures and visited the different wards of the local infirmary (2). His apprenticeship was finished in 1833. Between 1833 and 1836 Snow worked as an assistant to a colliery surgeon. He returned to London after completing his education to get a London degree and became a student in the Royal College of Surgeons and began working at the Westminster Hospital. Snow finished his education in 1844. Then he was elected as the chancellor of the London Medical Society. Snow suffered a stroke while working in his London office on June 10th, 1858. He was 45 years old at the time. This valuable and memorable researcher and scientist died in London on June 16th, 1858 aged 45 years from a stroke. He was buried in Brompton Cemetery (3). Many books, papers, and letters to journals on various topics such as rickets, chest deformities, the circulation of the blood, lead poisoning, and scarlet fever have been written by Snow during his short life (4).

With the advent of constitutional revolution in Iran and the increase in people’s knowledge, women’s status changed and ultimately improved. Publishing newspaper was one of the women’s attempts to keep their rights. Lady Somayyeh Kahhal was the first woman in this field, as well as ophthalmology in Iran. She published the first specialized newspaper for women in Iran under the title of Danesh (Knowledge). Lady Kahhal tried to disseminate information on women’s rights, moral issues and also health and hygiene in her weekly-published newspaper. In this paper, we will review the remaining biographical information about Kahhal and will introduce her newspaper, Danesh. [GMJ.2015;4(2):129-32]

For many long centuries, the function of the human cardiovascular system was an important issue among scholars of different eras and areas. Abubakr Muhammad ibn Zakariyya al-Razi (865-925 AD), known by the Latin name Rhazes, was one of the scholars concerned with this issue. This physician is recognized as the first great scientist of the Golden Age of Islamic Medicine (9th-12th centuries AD). He authored Kitab al-Mansuri (Liber Al-Mansuri), a ten-volume medical encyclopedia that covers a large number of medical subjects. The first chapter of this book is allocated to human anatomy and functions. In this article, we review the chapter from Al-Mansuri that deals with Rhazes' views on the cardiovascular system.

Background Dementia is a chronic neurodegenerative disease causing progressive and gradual impairment of different brain's cognitive functions. The prevalence of dementia is about 3 to 7% in different parts of the world. Objective The aim of this study was to determine the etiologies of dementia according to the Traditional Persian Medicine scientists' viewpoint and introduce their recommended herbal remedies for this disease. Method The authors explored six main Traditional Persian Medicine textbooks for the disease of dementia, its etiologies and related recommended herbal treatments. Two main keywords of "Lisarghes" and" Nesyan" were searched for this purpose. Medical databases, including PubMed, Scopus, Google Scholar, and Science Direct were searched for related articles published between 1966 and 2016 to review the pharmacological components and active ingredients of suggested herbal medicines. Results According to the Traditional Persian Medicine, dementia is resulted from brain dystemperament, a condition caused by cold and moist or cold and dry tempers. To treat this disease, Traditional Persian scientists recommended various herbal remedies. Current studies have demonstrated that some of these medicinal plants have beneficial effects for the aforementioned disease, including acetyl cholinesterase inhibitory function, neuroprotective effects, and memory enhancing role. Conclusion The Traditional Persian Medicine literature suggested different herbal remedies for treating dementia. Modern studies support the usefulness of some of these medicines. However, the effect of a large number of these remedies has remained unexamined, a matter which needs to be investigated in future researches.

Although hysteria is associated largely with the nineteenth century, we find the subject treated in a tenth-century Persian medical text, the Hidayat al-Muta`allemin Fi al-Tibb [A Guide to Medical Learners] by al-Akhawayni Bukhari (d. 983 AD), a prominent physician in the Persian history of medicine. In this article, we discuss al-Akhawayni's views on seizure and hysteria and his differentiation between the two conditions, and we place it in a historical context.