Assessment of the Effect of Sub-Cutaneous Adalimumab on Prognosis of COVID-19 Patients: a Non-Randomized Pilot Clinical Trial Study in Iran

BACKGROUND

Adalimumab is an anti-inflammatory medicine used to treat a variety of disorders, although its effectiveness in improving the clinical status of COVID-19 patients is debatable. The goal was to evaluate the efficacy of adalimumab as an alternate treatment in COVID-19 patients.

METHODS

This non-randomized pilot clinical trial study included 18 patients with severe COVID-19 status hospitalized at the Afzalipour Hospital in Kerman from February 2022 to March 2022. Patients were divided into two groups: nine patients in the control group received dexamethasone, remdesivir, and heparin in addition to supportive therapies. The case group also included nine patients who received adalimumab injection (CinnoRA®, CinnaGen, Iran) in addition to the treatment administered to the control group.

RESULTS

Although the effect of adalimumab injection on clinical factors, including mechanical ventilation required, the number of days oxygen needed, the length of stay in the intensive care unit (ICU), and saturation of peripheral oxygen (SpO2) level and respiratory rate (RR), were not significantly different between groups, the intra-group SpO2 level before and after receiving oxygen was significantly different in the case group (p ≤ 0.001 and p = 0.002). In addition, laboratory tests for lactate dehydrogenase (LDH) and C-reactive protein (CRP) revealed no statistically significant differences between the two groups. Nonetheless, a positive intra-group effect of the medication was detected on these two parameters. No short-term side effects of drug injection were observed.

CONCLUSIONS

This study demonstrated the efficacy of adalimumab as an alternate medication for improving SpO2, LDH, and CRP levels in COVID-19 patients.

Investigation of Airway Obstruction Severity Based on Plasma Visfatin Level in Asthmatic Women

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:

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Comparison of Serum Procalcitonin Levels between Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) and Patients with Chronic Obstructive Pulmonary Disease

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:

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Right atrial thrombus and pulmonary thromboembolism related to ovarian hyperstimulation syndrome: A case report and literature review

A young lady with a history of infertility presented to the hospital with dyspnea and chest pain a few days after ovulation induction. Her manifestations were consistent with ovarian hyperstimulation syndrome (OHSS). Further investigations revealed right atrial thrombus and pulmonary thromboembolism. We successfully managed the condition with conservative therapy.

Pure Androgen-Secreting Adrenocortical Carcinoma Presenting with Hypoglycemia

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.

Chronic Skin Lesions as the Presentation of Diffuse Cutaneous Leishmaniasis in the HIV-Infected Woman: A Case Report and Review of Literatures

Background:

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

Case Report:

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.

Conclusion:

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.

Dementia Etiologies and Remedies in Traditional Persian Medicine; A Review of Medicinal Plants and Phytochemistry

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.

The concept of portal system obstruction in Avicenna's canon of medicine

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.

The Predictive Value of Repeated Abdominal Ultrasonography in Patients with Multiple Trauma and Decreased Level of Consciousness: The Experience of a Resource-Limited Centre

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.

Early Predictive Factors of Hypofibrinogenemia in Acute Trauma Patients

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.

A Comparison of the Effects of Topical Prolavacid Solution (a Polyhexamethylene Biguanide-Based Wound Cleanser) and Medihoney Ointment in a Rat Model of Cutaneous Wound

Objective: This experimental work examined the healing effect and probable adverse impact of topical Prolavacid^® solution (a polyhexamethylene biguanide-based wound cleanser) and topical Medihoney ointment in an animal model of cutaneous wound. Approach: We randomly divided 22 adult Sprague-Dawley rats (all were male) in two groups (n = 11): (1) those for which Prolavacid solution was poured on the skin wound surface; and (2) those animals for which Medihoney^® ointment was applied to the wounds. These two agents were applied daily throughout the study period (21 days). We photographically followed the wounds' contraction with imaging performed on days 0, 7, and 21 postwounding. The histopathologic features of the healing wounds were evaluated using skin biopsies taken on days 7 and 21 postwounding. Results: The difference in mean wound surface area between two groups was not statistically significant on the examined days. Histopathological assessment indicated no statistically significant difference between the Prolavacid- and Medihoney-treated groups on days 7 and 21. We did not detect tissue necrosis following the topical application of Prolavacid solution. Innovation: This was the first study to examine the efficacy and probable adverse consequences of topical Prolavacid on cutaneous wound healing process. Conclusion: Our work showed no statistically significant difference between the efficacy of daily topical application of Prolavacid and Medihoney products on the healing process of fresh cutaneous wounds in our rat model.

Comparison of the impact of applications of Targeted Transfusion Protocol and Massive Transfusion Protocol in trauma patients

Background

The current study assessed a recently developed resuscitation protocol for bleeding trauma patients called the Targeted Transfusion Protocol (TTP) and compared its results with those of the standard Massive Transfusion Protocol (MTP).

Methods

Per capita utilization of blood products such as packed red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrates was compared along with mortality rates during two 6-month periods, one in 2011 (when the standard MTP was followed) and another in 2014 (when the TTP was used). In the TTP, patients were categorized into three groups based on the presence of head injuries, long bone fractures, or penetrating injuries involving the trunk, extremities, or neck who were resuscitated according to separate algorithms. All cases had experienced motor vehicle accidents and had injury severity scores over 16.

Results

No statistically significant differences were observed between the study groups at hospital admission. Per capita utilization of RBC (4.76 ± 0.92 vs. 3.37 ± 0.55; P = 0.037), FFP (3.71 ± 1.00 vs. 2.40 ± 0.52; P = 0.025), and platelet concentrate (1.18 ± 0.30 vs. 0.55 ± 0.18; P = 0.006) blood products were significantly lower in the TTP epoch. Mortality rates were similar between the two study periods (P = 0.74).

Conclusions

Introduction of the TTP reduced the requirements for RBCs, FFP, and platelet concentrates in severely injured trauma patients.

Johannitius (809-873 AD), a medieval physician, translator and author

The medieval physician, translator and author Abū Zayd Ḥunayn ibn Isḥāq al-'Ibādī, best known in the West as Johannitius, is considered the best translator of Greek texts, particularly medical writings, into Arabic. He made great inroads in the art of translation in the Islamic world. In addition to his own translations, Johannitius put significant effort into training pupils and passing knowledge about translation to succeeding generations. He was also a great writer, compiling over 100 books on different subjects, especially medical. Among his own works, the illustrious Kitab al-Ashr Maqalat fil-Ayn (Ten Treatises on the Eye) contains the oldest known illustration of the structure of the eye. It served as the primary source for Galen's theory of vision and subsequent use by Western scholars.

Ibn al-Haytham (965-1039 AD), the original portrayal of the modern theory of vision

Abū ՙAlī al-Ḥasan ibn al-Ḥasan ibn al-Haytham, known in the West as Alhazen, was an Arab-Islamic scholar who helped develop the science of ophthalmology during the medieval era. He was the first to reject firmly the extramission theory of vision, which was prevalent during his time, and suggested that the eyes are the source of the light rays responsible for vision. Ibn al-Haytham in his book entitled Kitab al-Manazir (Book of Optics) explained vision based on light emanating from objects. In this study we review Ibn al-Haytham's life and introduce his major contribution to the field of ophthalmology, his theory of vision.

Overview of Agents Used for Emergency Hemostasis

CONTEXT

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.

RESULTS

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.

CONCLUSIONS

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.

Ibn al-Quff (1233-1286 AD), a medieval Arab surgeon and physician

Abū'l-Faraj ibn Ya'qūb ibn Isḥāq Ibn al-Quff al-Karakī (1233-1286 AD), best known as Ibn al-Quff in the West, was a 13(th) century Arab physician-surgeon. During his lifetime, Ibn al-Quff made some important contributions to the art of healing. He authored several books and commentaries in the field of medicine, in particular surgery. This paper aims to review Ibn al-Quff's life, career, and contributions to medical science.

The effect of CoolClot hemostatic agent on skin wound healing in rats

BACKGROUND

Hemostatic agents can play a key role in controlling severe hemorrhage after trauma. Previously, some criteria have been defined for improving the quality of these products; one of them is that the hemostat causes no further tissue injury. CoolClot is a recently introduced hemostatic agent that its effects on wound healing have not yet been examined, which this study aims to address.

MATERIALS AND METHODS

Thirty-four adult male Sprague-Dawley rats were assigned randomly to two groups (n = 17): a study group where CoolClot hemostatic agent was applied on their wounds, and a control group whose wounds were washed only with sterile saline. The rats underwent dorsal full-thickness skin excisional wounds (20 mm diameter). On day 12 after wounding, seven rats were chosen in a random manner from each of the groups of study and control, and their skin biopsies from the wound sites were sent for histologic examination. Skin samples of the remaining rats in each group were taken on the 21st d after wound creation. Wound healing was also monitored photographically. In addition, wound surface temperature after wounding, and the application of CoolClot was recorded.

RESULTS

There was no significant difference between the groups of study and control regarding the examined histopathologic parameters. The maximum increase in wound surface temperature was 1.56°C.

CONCLUSIONS

One-time topical usage of CoolClot has no significant negative effect on the wound healing process. In addition, no significant increase in wound surface temperature will occur after the application of this agent.

INSIGHTS INTO AVICENNA'S KNOWLEDGE OF GASTROINTESTINAL MEDICINE AND HIS ACCOUNT OF AN ENEMA DEVICE

Avicenna (980-1037 AD), also known as Sheikh or-Raeis, was an Muslim philosopher, physician, surgeon, astronomer, politician, encyclopedist, and mathematician. Avicenna's writings comprise of five books, know as the Al-Qanun fi al-Tibb (The Canon of Medicine) and the canon covers a wide variety of medical issues. This canon of medicine was the main reference for medical education in Western countries up until the 16th century and in the Middle East until the 19th century. Several chapters of the 3rd book of the Canon are devoted to a detailed description of gastrointestinal diseases including bowel obstruction, hemorrhoids anal fissures, perianal fistulas and perianal itching. Additionally, that same volume contains an illustration of an enema device. The aim of this paper was to present a brief review of Avicenna's 11th century views on bowel obstruction and to present his description of an enema device that has remained relatively unnoticed until now. Finally, this article illustrates similarities between Avicenna's explanation and modern medical science that celebrate Avicenna as an important contributor to medieval knowledge on gastrointestinal diseases, the science of which has been passed on to later generations.

THE ORIGIN OF THE CONCEPT OF NEUROPATHIC PAIN IN EARLY MEDIEVAL PERSIA (9TH-12TH CENTURY CE)

Neuropathic pain is supposed to be a post-renaissance described medical entity. Although it is often believed that John Fothergill (1712-1780) provided the first description of this condition in 1773, a review of the medieval Persian medical writings will show the fact that neuropathic pain was a medieval-originated concept. "Auojae Asab" [Nerve-originated Pain] was used as a medical term in medieval Persian medical literature for pain syndromes which etiologically originated from nerves. Physicians like Rhazes (d. 925 CE), Haly Abbas (d. 982 CE), Avicenna (d. 1037 CE), and Jorjani (d. 1137 CE) have discussed multiple aspects of nerve-originated pain including its classification, etiology, differentiating characteristics, different qualities, and pharmacologic and non-pharmacologic treatments. Recognizing medieval scholars' views on nerve-originated pain can lighten old historical origins of this concept.

HIGHLIGHTS IN THE DIAGNOSIS OF BREAST NEOPLASMS

Breast malignancies are one of the most prevalent and major causes of morbidity and mortality among women worldwide. According to the available data, neoplastic lesions of the breast are one of the main causes leading to heavy costs for both the healthcare system and the society. Based on these realities and the fact that different aspects of these malignancies remain unknown to date, and are essential to be determined, these issues make a vast area of research in medicine. Just like the present time, breast neoplasms were under the focus of scientists lived in the past, from all over the world. Accordingly, these malignancies are a group of disease with a long-standing historical background. As a result, it can be claimed that modern-day knowledge of these matters has burgeoned on the extraordinary discoveries and the development of diagnostic and therapeutic methods made through the ages, especially those of the post-medieval era. Recognizing the previous efforts that have been made in this regard will show our future way for us. For this reason, in this paper, we will review the key milestones and vital discoveries in the field of breast neoplasms and some other diseases involving this body organ.

The medieval origins of the concept of hypertension

Despite the well-known history of hypertension research in the modern era, like many other cardiovascular concepts, main points in the medieval concept of this disease and its early management methods remain obscure. This article attempts to make a brief review on the medieval origin of the concept of this disease from the Hidayat of Al-Akhawayni (?-983 AD). This article has reviewed the chapter of “Fi al-Imtela” (About the Fullness) from the Hidβyat al-Muta’allimin fi al-Tibb (The Students' Handbook of Medicine) of Al-Akhawayni.

The definition, symptoms and treatments presented for the Imtela are compared with the current knowledge on hypertension. Akhawayni believed that Imtela could result from the excessive amount of blood within the blood vessels. It can manifest with symptoms including the presence of a pulsus magnus, sleepiness, weakness, dyspnea, facial blushing, engorgement of the vessels, thick urine, vascular rupture, and hemorrhagic stroke. He also suggested some ways to manage al-Imtela'. These include recommendations of changes in lifestyle (staying away from anger and sexual intercourse) and dietary program for patients (avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar). Al-Akhawayni's description of “Imtela,” despite of its numerous differences with current knowledge of hypertension, can be considered as medieval origin of the concept of hypertension.

Rhazes (865-925 AD), the icon of Persian cardiology

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.

Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

INTRODUCTION

Cervical spine, thoracic and pelvic fractures are the main causes of devastation in patients who have suffered blunt trauma. Radiographic imaging plays an important role in diagnosing such injuries. Nevertheless, the present dominant approach, the routine use of X-ray studies, seems to have no cost-benefit justification for healthcare systems.

METHODS

This prospective cross-sectional study was performed over a 3-month period. During the determined time frame, all haemodynamically stable, high-energy blunt trauma patients were included. Based on the predefined criteria, selective radiographic images of the neck, chest and pelvis were obtained. Patients were followed during their hospital stay and for a 2-week period after discharge.

RESULTS

1002 cases were included in the final survey. 247/1002 (24.6%) cervical radiographic images, 500/1002 (49.9%) CXRs and 171/1002 (17%) pelvic radiographic images of the patients were taken on the first day of hospital admission. New X-ray images required during the patients' hospital stay resulted in 5/1002 (0.4%) cervical, 4/1002 (0.3%) chest and 8/1002 (0.7%) pelvic radiographies. In the 2-week period after discharge, 4/1002 cases (0.3%) needed to repeat neck radiography. Overall, 697.44 mSv X-ray radiation was potentially prevented and US$426,450 were potentially saved.

CONCLUSIONS

Selective radiographic imaging of the neck, chest and pelvis together with a precise history-taking and physical examination in cases of high-energy blunt trauma could eliminate unnecessary costs to patients and healthcare systems, and significantly save resources.

Differentiation between seizure and hysteria in a tenth-century persian text: Hidāyat of al-Akhawayni (d. 983 AD)

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.

Melancholia in medieval Persian literature: The view of Hidayat of Al-Akhawayni

“Melancholia” seems to be the oldest term used to describe the manifestations of depression. Throughout the history of medicine, melancholia has been the focus of consideration of many scholars who have provided varying definitions of this disorder and its manifestations. This continual process has resulted in the gradual development of the concept of melancholia over time. Persian scholars were among the scientists who have studied the melancholia and contributed to its concept. One figure, Al-Akhawayni Bukhari (?-983 AD), a Persian physician whose reputation was based on the treatment of patients with mental problems, investigated this disorder. He described Melancholia and explained its clinical manifestations and treatment methods. Al-Akhawayni provided an early classification of the patients suffering from this disorder. Since the medieval Persian concept of melancholia is not well-known, this paper aims to review Al-Akhawayni’s 10^th century knowledge on melancholia which can represent the early concept of this disorder in the Near East.

Al-Akhawayni and the early descriptions of meningitis

Abubakr Rabi-ibn Ahmad Akhawayni Bukhari, also known as Al-Akhawayni, was a Persian physician who lived in the Near East during an age in which medical knowledge blossomed in the Islamic world. This era, the "Islamic Golden Age," extended from the tenth to the twelfth centuries AD. During his lifetime as a physician, Al-Akhawayni was famous for his expertise in medicine, including disorders that would be considered neurological today. In his extant book Hidayat al-Muta`allemin fi al-Tibb [A Scholar's Guide to Medicine], he provided an early description of what is probably meningitis. He illustrated the membranes surrounding the brain tissue in detail and described manifestations resulting from their inflammation.

Rabies in medieval Persian literature - the Canon of Avicenna (980-1037 AD)

Ibn Sina (980–1037 AD), known by his full name Abu Ali al-Hussain ibn Abdallah ibn Sina and the Latin name ‘Avicenna’, was a Persian scholar who is primarily remembered for his contributions to the science of medicine. He authored Al-Qanun fi al-Tibb (The Canon of Medicine). Sections of his work are devoted to detailed descriptions of a number of infectious illnesses, particularly rabies. Avicenna described rabies in humans and animals and explained its clinical manifestations, route of transmission, and treatment methods. In this article, our goal is to discuss Avicenna’s 11^th-century points of view on rabies and compare them with modern medical knowledge.