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Fibrous hamartoma of infancy is a rare benign tumor that’s mainly detected in the upper trunk. In this study authors report a 1-year-old case of perianal fibrous hamartoma which was successfully managed without need to orchidectomy or urethral manipulation.

Key Clinical Message Etiology of urinary retention in pediatric age differs significantly from adults and the elderly. Therefore, a comprehensive diagnosis is crucial before specific treatment. Every effort must be made to minimize invasive procedures as far as possible in children.

Background: Appendicovesical fistula in patients suffering from cystic fibrosis is a rare condition. Although this situation is so rare it should be considered in the differential diagnosis, dealing with a patient with cystic fibrosis and chronic abdominal pain with no response to primary management. To the best of our knowledge, this is the third case of appendicovesical fistula in a patient with cystic fibrosis. Case presentation: In this paper, we are reporting a bladder lesion of a nine-year-old Iranian girl, a known case of cystic fibrosis, who was referred to pediatric urology clinic, Children’s Medical Center, Tehran University of Medical Sciences. The girl is a known case of cystic fibrosis on regular follow-up who had chronic abdominal pain for about one year. While primary management had been failed for her, further workups were done by her pediatric pulmonologist. In her pelvic sonography, the radiologist reported a bladder lesion so she was referred to our clinic. Cystoscopy was done for her, but transurethral biopsy/resection was impossible according to the lesion location. The non-papillary nature of the lesion raised our concern about the possibility of genital rhabdomyosarcoma with bladder invasion. So, an Abdominopelvic CT scan and a pelvic MRI were also done for her. Intact uterus and vagina with an enhancing lesion at the dome of the bladder with some degree of inflammation/attachment around the adjacent GI tract were detected on her images. The urachal inflammatory/tumoral process could not be ruled out. So open surgical exploration was planned. During the attempt for surgical exploration and partial cystectomy, at the Children’s Medical Center in December 2021, we found that the mass, is actually her appendix which has invaded the urinary bladder, and presented as a bladder lesion. Conclusion: Abdominal pain is a relatively common complaint of patients with cystic fibrosis. Every caregiver or physician should consider rare conditions, dealing with a cystic fibrosis patient whose abdominal pain does not respond to common management.

Since the outbreak of the Covid-19 pandemic, online education has gained more momentum. Despite its advantages, virtual learning has some drawbacks. To compensate for these shortcomings, the application of some innovative approaches has obtained more importance; one of them is Project-Based Learning (PBL). The present study aimed at investigating the effect of PBL on students’ performance in a general English course. The participants were 55 Iranian freshmen medical students who registered in the General English Course at the Birjand University of Medical Sciences. They were selected based on convenience sampling. The classes were held virtually, twice a week for 24 sessions during the spring semester of 2020. All the students in the class were asked to do a term project in the form of making English language videos about a medical topic. The recorded classes, observations, and semi-structured interviews with the students about the advantages of doing projects were the sources of data. The collected data were analyzed through thematic analysis and validated through member checking. The data analyses resulted in five main themes about the advantages of PBL in the areas of students' "autonomy", "engagement", "learning", "motivation", and "evaluation". PBL helped the students to be more autonomous and improved their engagement. Furthermore, it helped them learn new words about the diseases and improve their knowledge of their major. It also made the students more motivated and helped the teacher figure out how well they did during the term instead of just relying on the final exam.

Background and Aim: Although evaluation has been considered as an inseparable part of education, evaluating higher education curriculum in most of the university programs has not been adequately investigated. The purpose of the present study is to investigate the quality of general English language course curriculum and English language learning based on Tyler’s Model from the students’ perspective at Birjand University of Medical Sciences. Materials and Methods: This study was descriptive – analytic. The participants were students having General English course at Birjand University 180 students were randomly selected based of Medical Sciences. A total of on Krejcie and Morgan table. Data collection was done through a researcher-made questionnaire including 28 items. The validity of the questionnaire was confirmed by experts in medical and English language education and the reliability was estimated as 82% based on Cronbach's alpha. Data were analyzed in SPSS software using descriptive (frequency and percentage) and inferential statistics (one sample T-test). Results: The results indicated that the experimental mean score was higher than the theoretical one, and there was a significant difference (p < 0.05) between the two means in three aspects of ‘content’, ‘teaching methods’, and ‘evaluation’ in general English course. Also, the experimental mean in the aspect of ‘course goals’ was less than the theoretical mean and there was a significant difference between them (p > 0.05). Conclusion: Based on the results of this study, the goals of general English language course should be reevaluated so it can satisfy the students’ needs.

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Introduction: Cardiovascular disease is one of the public health priorities. Consumption of oral contraceptives increase the risk of cardiovascular disease and it still remains a concern. This study aimed to investigate the effect of exposure on pill contraceptive low-dose levels on homocysteine and nitric oxide. methods: In this cohort ( retrospective+ prospective) study, 100 women with normal menstrual cycle aged betwen 20-35 years old refered to health care centers of Yazd, Iran in 2015. This study was conducted through face to face interviews by the researcher who asked for demographic and anthropometric characteristics. Anthropometic indices was measured and the levels of homosysteine and nitric oxide was determined. The data were analyzed using t-test, chi- square test and ANOVA by SPSS 21. Results: The mean and standard deviation of homocysteine levels in the exposed group acompared to non-exposed group were (3/848±2/357 μmol/L) and (3/284±1/616 μmol/L) as well as the mean and standard deviation of nitric oxide in the exposed group were (p-value=0/41) and (181/360±90/44μM) and in the non-exposed group were (162/654±90/913 μM) and (p-value=0/29) , respectively.According to these results, there was not found any statistical significant difference among these results. Conclusion: Taking low dose oral contraceptives in healthy women did not change any differences in homocysteine and nitric oxide levels as a modifiable risk factors for cardiovascular disease.

Introduction: Pray and mention as two separate methods are spiritual care. This study was designed to compare two methods of prayer and mentioning on life expectancy in patient hospitalization in CCU Ward Social Security Golestan Hospitals in 1393. Method: The following experimental study was performed on 90 patient hospitalization in Khatam Al Anbia Hospital which were divided into prayer groups (n=30), mentioning (n=30) and control group (n=30). Intervention was performed in Prayer and mentioning group in 4 days and 2nd a day in 15 min, then the three groups were compared to each other. The questionnaire was Synder Life Expectancy Scale. Results were analyzed statistically by SPSS16. Results: Results after the test, showed life expectancy in prayer) were (34/2 ± 35/37) and mentioned group (15/2 ± 3/3). Statistical analysis showed a significant difference between three groups, the greatest life expectancy was found in the mentioning group (P=0/001). Tukey test's showed the difference between praying with the control group was (P=0/039) and the controls (P=0/00) showed. Conclusion: It seems that the spiritual experience along with other therapies would be effective and according to the guidelines it might be defined in the treatment of religious and spiritual care.

Introduction: The aim of this research is to examine the stickiness of operational costs and the cost price of sold product and some probable effective factors (such as assets, debts, free cash flow and Gross Domestic Product) on the stickiness of operational costs in the pharmaceutical companies listed on the Tehran Stock Exchange. Method: The research is applied in terms of purpose, and it has been conducted through Critical Incident Technique by the use of past information. In order to test the presented hypotheses, Time Series Analysis has been used. The statistical sample and population of the research involve 24 pharmaceutical companies listed on the Tehran Stock Exchange during 2003-2014 which have been active in the Pharmaceutical Industry. The applied statistical method in this research is multiple linear regression.In order to analyze the data, Excel Software Version 13 and Eviews Version 8 have been used. Results: The findings of the research indicate that the operational costs have sticky behavior in relation to sale income changes, but no evidence was found for the stickiness of the cost price of the sold product. Also, the results state a meaningful relationship between the rate of stickiness of operational costs and free cash flow in such a way that in the firms with higher free cash flow, stickiness of costs are higher. Additionally, the results suggest a direct and meaningful relationship between the rate of stickiness of operational costs and Gross Domestic Production, but the effectiveness of the assets and debts on the stickiness of the operational costs did not validate. Conclusion: In the case of predicting an increase in the future sale or in the economic growth periods, for a proper use of opportunities, and also because the achievement and further preparation of resources are in needs of time and double cost, managers protect the resources in the firm in order to gain a higher privilege by sale return to the previous level of sale which will lead to the stickiness of operational costs.

Introduction: There are many ideas concerning the etiology and pathogenesis of preeclampsia including endothelial dysfunction, inflammation and angiogenesis. Elevated levels of total homocysteine (Hcy) and lipoprotein (a) [Lp(a)] are risk factors for endothelial dysfunction. This study aimed to evaluate the effect of high dose folic acid (FA) on serum Hcy and Lp(a) concentrations with respect to methylenetetrahydrofolate reductase (MTHFR) polymorphisms 677C→T during pregnancy. Methods: In a prospective uncontrolled intervention, 90 pregnant women received 5 mg FA supplementation before pregnancy till 36th week of pregnancy. The MTHFR polymorphisms 677C→T, serum lactate dehydrogenase activity, urine protein and creatinine concentrations were measured before starting folic acid administration. Serum levels of Hcy and Lp(a) were determined before and after completion of folic acid supplementation period. Results: Supplementation of the patients with FA for 36 week decreased the median (minimum–maximum) levels of serum Hcy from 11.40 µmol/L (4.40-28.70) to 9.70 (1.60-20.80) µmol/L (p=0.001). There was no significant change in serum Lp(a) after FA supplementation (p=0.17). The overall prevalence of genotypes in pregnant women that were under study for MTHFR C677T polymorphism was 53.3% CC, 26.7% CT and 20.0% TT. There was no correlation between decreasing level of serum Hcy in the patients receiving FA and MTHFR polymorphisms. Conclusion: Although FA supplementation decreased serum levels of Hcy in different MTHFR genotypes, serum Lp(a) was not changed by FA supplements. Our data suggests that FA supplementation effects on serum Hcy is MTHFR genotype independent in pregnant women.

BACKGROUND: The present study aims to design and standardize the verbal fluency test (VFT) among bilingual (Turkish-Persian) adolescents in Tabriz, Iran. METHODS: In the designing stage, 190 adolescents who were already selected randomly from among the guidance and high school students in Tabriz were classified into three age groups (11-12, 13-15, 16-18). The screening test including 33 Persian letters and three ‘animal’, ‘fruit’, and ‘supermarket stuff’ categories, and SDQ was administered to them. The results were the three letters ‘M’, ‘D’, and ‘B’ for phonological fluency, and two ‘animal’ and ‘supermarket stuff’ categories for semantic fluency in the Persian language. In the standardization stage, the letters and categories specified in the designing stage were administered in the same order to 302 adolescents. Moreover, 28 adolescents diagnosed with ADHD were selected to estimate the discriminant validity of VFT. RESULTS: Pearson correlation coefficient between test-retest of the three letters ‘M’, ‘D’, and ‘B’ for phonological fluency were estimated at 0.67, 0.66, and 0.75, respectively. Furthermore, for the two categories of ‘animal’ and ‘supermarket stuff’ it was estimated to be 0.80 and 0.65, respectively. All these amounts were significant (P < 0.01). The discriminant validity, which was estimated through comparison between the scores of normal and ADHD adolescents, showed that the obtained t value for all indices except for the letter ‘B’ was meaningful. The results of MANOVA between two gender groups were significant at P < 0.05 for three ‘M’, ‘D’, and ‘B’ variables of verbal fluency and ‘animal’ semantic fluency. In both verbal and semantic fluency the mean of subjects’ performance scores showed that females outperformed males. CONCLUSIONS: The findings of the current study indicated that VFT is reliable in the studied sample group, and has a valid psychometric property in discrimination between ADHD adolescents and normal adolescents. Furthermore, ageand sex could affect VFT performance

Background: Major clinical manifestations of antiphospholipid syndrome (APS) in the central nervous system are generally arterial thrombotic events and a number of non-thrombotic neurologic syndromes. Antiphospholipid antibodies (APAs) are one of the important risk factors for cerebrovascular accidents (CVA). The aim of present study was to assess the relationship between APA titers and CVA in this clinically important age group.Methods: This case-control study was carried out on patients under 50 years old who had CVA (stroke or transient ischemic attack) in Shahid Sadoughi Hospital in Yazd (central Iran) from Dec 2003 until March 2005. In this study, 61 patients with CVA were compared with 68 age- and gender-matched control subjects. Lupus anticoagulant assay results and APA titers were assessed in both groups.Results: The mean value of IgM APA titers in patients with cerebrovascular accidents was 6.492 MPL (IgM antiphospholipid units) and 1.846 MPL in the control group. The difference between the two groups was significant (p-value: 0.000). In 12 (20%) of the patients with cerebrovascular accidents, IgM titers were higher than 10 MPL, one of whom had an IgM titer higher than 40 MPL. The mean value of IgG titers in the case group was 5.50 GPL (IgG antiphospholipid units) and 3.51 GPL in the control group. The difference between the two groups was significant (p-value: 0.012). Thirteen (21%) patients with cerebrovascular accidents had IgG titers higher than 10 GPL. The difference between the LA assay results was not significant between the two groups (p-value: 0.311).Conclusion: The present study showed a positive relationship between APL (IgM and IgG) titers and CVA in patients under 50 years old.