Adnexal mass with extremely high levels of CA-125 and CA19-9 but normal human epididymis protein 4 [HE4] and risk of ovarian malignancy algorithm [ROMA]: Endometriosis or ovarian malignancy?

Background: It has been shown that Carbohydrate antigen [CA] 125 and CA 19-9 tumor markers are useful for diagnosis and follow up of ovarian carcinoma

Case: In this case, we reported the high level of CA-125 and CA 19-9 with large right ovarian intact endometrioma and extensive involvement of omentum

Conclusion: Human Epididymis protein [HE4] and Risk of ovarian malignancy algorithm [ROMA] can be useful in differentiation between malignancies and benign pathologies with a good sensitivity and specificity value

Designing and conducting MD/MPH dual degree program in the Medical School of Shiraz University of Medical Sciences

Introduction: Many studies have focused on the need of health systems to educated physicians in the clinical prevention, research methodology, epidemiology and health care management and emphasize the important role of this training in the public health promotion. On this basis, Shiraz University of Medical Sciences [SUMS] has established MD/MPH dual degree program since the year 2012

Methods: In the current study, Delphi technique was used. Both qualitative and quantitative methods were applied in the Delphi process. The Delphi team members including experts with extensive experience in teaching, research and administration in the field of educational management and health/medical education reached consensus in almost 86% of the questionnaire items through three Delphi rounds. MD/MPH program for SUMS was designed based on the items agreed and thematic analysis used in these rounds

Results: The goals, values, mission and program requirements including the period, the entrance condition, and the number of units, and certification were determined. Accordingly, the courses of the program are presented in parallel with the MD education period. MPH courses consist of 35 units including 16 obligatory and 15 voluntary ones

Conclusion: Designing MD/MPH program in SUMS based on the existent models in the universities in different countries, compatible with educational program of this university and needs of national health system in Iran, can be a beneficial measure towards promoting the students' knowledge and theoretical/practical skills in both individual and social level. Performing some additional research to assess the MD/MPH program and some cohort studies to evaluate the effect of this program on the students' future professional life is recommended

Chiropractic: is it efficient in treatment of diseases? review of systematic reviews

Chiropractic is a complementary medicine that has been growing increasingly in different countries over recent decades. It addresses the prevention, diagnosis and treatment of the neuromusculoskeletal system disorders and their effects on the whole body health. This study aims to evaluate the effectiveness of chiropractic in the treatment of different diseases. To gather data, scientific electronic databases, such as Cochrane, Medline, Google Scholar, and Scirus were searched and all systematic reviews in the field of chiropractic were obtained. Reviews were included if they were specifically concerned with the effectiveness of chiropractic treatment, included evidence from at least one clinical trial, included randomized studies and focused on a specific disease. The research data including the article's first author's name, type of disease, intervention type, number and types of research used, meta-analysis, number of participants, and overall results of the study, were extracted, studied and analyzed. Totally, 23 chiropractic systematic reviews were found, and 11 articles met the defined criteria. The results showed the influence of chiropractic on improvement of neck pain, shoulder and neck trigger points, and sport injuries. In the cases of asthma, infant colic, autism spectrum disorder, gastrointestinal problems, fibromyalgia, back pain and carpal tunnel syndrome, there was no conclusive scientific evidence. There is heterogeneity in some of the studies and also limited number of clinical trials in the assessed systematic reviews. Thus, conducting comprehensive studies based on more reliable study designs are highly recommended

Comparison of leishmanin skin test and direct smear for the diagnosis of cutaneous leishmaniasis

Cutaneous leishmaniasis [CL] is an endemic disease in some parts of Iran and it has high morbidity in some areas of the country. The disease is detected by parasitological examinations including direct microscopic and culture tests. This comparative study aimed to evaluate the relationship between positivity of the leishmanin skin test [LST], microscopically examination and clinical forms of CL for the diagnosis of human cutaneous leishmaniasis. This study was performed on 66 patients suspected to cutaneous leishmaniasis. CL cases evaluated by both microscopical examination and leishmanin skin test. In this study, 1 ml of leishmanin fluid [lot no 121/1, produced in Pasteur institute of Iran] was injected intradermally in forearms of all patients and indurations were measured after 72 hours. Induration of 5 mm and higher was considered as positive results. The collected data were statistically analyzed using the SPSS version 13.5. From 66 CL patients who were evaluated in this study, 30 [45.5%] of them had positive microscopically results while 28 [42/4%] of them had showed positive leishmanin skin test [>/=5mm diameter]. From 36 [54.5%] patients who had negative microscopical examination, only 6 [16/6%] of them had positive leishmanin skin test. The agreement between two tests was 87.9% by kappa analysis [p< 0.01]. In attention to the results of this study, it seems the LST would be used as an alternative diagnosis method when there is a strong clinical doubt to cutaneous leishmaniasis even there is no parasite in direct smear

Inflammatory myofibroblastic tumor of the lung: case series

Inflammatory myofibroblastic tumor is a rare occurrence in general practice. Its biologic nature, natural history and response to different treatment modalities are obscure. We retrospectively reviewed clinical and pathological features of 5 patients with inflammatory myofibroblastic tumor of the lung observed between 1999 and 2006. Under-study patients were 3 women and 2 men with a median age of 32.6 years. All patients were symptomatic. Computed tomography [CT] scan demonstrated a mass in all cases. Four patients underwent surgery [tumor resection in 1, lobectomy in 1, bilobectomy in 1 and lobectomy with mediastinal mass debulking also in 1]. Complete resection was achieved in 2 patients who are currently alive with no evidence of disease. One died due to progressive disease. Another is alive with disease after incomplete resection, and one refused any kind of surgery. There was no operative mortality. All patients were under follow-up [range, 5 to 60 months; median 39 months]. This study illustrates that some inflammatory myofibroblastic tumors behave aggressively and have a poor prognosis. It also confirms that radical resection is the treatment of choice for this malignancy