Among the blistering (vesicant) chemical warfare agents (CWA), sulfur mustard is the most important since it is known as the “King of chemical warfare agents”. The use of sulfur mustard has caused serious damages in several organs, especially the eyes, skin, respiratory, central and peripheral nervous systems after short and long term exposure, incapacitating and even killing people and troops. In this review, chemical properties, mechanism of actions and their effects on each organ, clinical manifestations, diagnostic evaluation of the actions triage, and treatment of injuries have been described.

Tuberous sclerosis is a neurocutaneous syndrome characterized by a clinical spectrum varying from severe mental retardation and incapacitating seizures to normal intelligence and lack of seizures, often within the same family(1). The younger the patients present with symptoms and signs of TSC (tuberous sclerosis complex), the greater are the likelihood of mental retardation (2). Skin features are very characteristic of the disease and help in the early diagnosis of the disease. Shagreen patch is one of the major diagnostic features of the disease. It is a less common skin lesion consisting of an excess amount of fibrous tissue similar to that found in scar tissues (3). It is a section of thickened, elevated pebbly skin like an orange peel. The name is derived from the French phrase “peau chagrinee”. It is usually found on the lower back, buttock, thigh and the nape of the neck commonly. In this case report we report a characteristic skin lesion, the shagreen patch in a six-year-old child with TSC at an unusual site (the cheek) never reported before with the best of our knowledge.

Liver transplantation (LT) for polycystic liver disease (PLD) has evolved to be an option for treating these patients. Patients with PLD suffer from incapacitating symptoms because of very large liver volumes but liver function is preserved until a late stage.Objective/ Herein, we reviewed the outcome of adult patients with PLD who underwent LT in the US comparing pre-MELD (1990–2001) to MELD era (2002–2009). During this period, only 309 patients underwent LT for PLD. The number of LT for PLD is very low comparing the two eras. The percentage of patients who had combined liver and kidney transplantation (CLKT) for this disease has not changed during MELD era (42.8% vs 38.6%). The waiting time for LT (337 vs 272 days) and CLKT (289 vs 220) has increased in MELD era (p<0.001). In MELD era, 53.4% of LT and 31.2% of CLKT were done as MELD exceptional cases. The allograft and patent survival have significantly improved in MELD era. Patients with PLD had marked improvement of their outcomes after LT in MELD era.

Drug dependency is counted as one of the serious flaws that could incapacitate the armed forces. Accordingly, this research aimed to compare problem-solving styles in normal and dependent soldiers in a cross sectional form of study in 2010. It is a descriptive-comparative study with a sample of 100 subjects (50 drug-dependent soldiers accompanied by 50 normal ones). The tools in this study were scale of problem solving (Long and Cassidy) plus demographic questionnaire. Then, the data were analyzed using methods of descriptive statistics (frequency, percentage, mean, standard deviation) and inferential statistics (mean comparison, ANOVA) using SPSS software. Findings showed that two groups were different in all domains of problem-solving styles and drug-dependent group got higher means in the areas of helplessness, problem-solving control and avoidance style. The mentioned group had lower means in creative problem-solving style, problem-solving confidence and approach style (p<0/001). According to the results, it is recommended training the youth prone to danger in skills of increasing self-esteem, resistance against psychological pressures and finally relaxation and coping with stress for better interpersonal relationships.

The world is urgently looking for ways to flatten the coronavirus disease 2019 (COVID-19) curve, and many governments have resorted to implementing strict lockdowns, as researchers show the effectiveness of China’s approaches in containing the virus. However, this paper argues that the draconian lockdowns instituted in Wuhan, Hubei, China, may have actually contributed to intensifying patient surges and incapacitating local health systems. Medical aids were rushed to Hubei and new hospitals were rapidly built, however, the healthcare system was still unable to match the staggering increase of patients in the early stages of the lockdowns. The paper proposes using patient evacuation to enhance sustainable COVID-19 mitigation during lockdowns. It demonstrates that patients in Hubei could have been transported to other Chinese provinces where hospitals were under-utilized. This could have theoretically saved thousands of lives by reducing inequities between Hubei and the rest of China in healthcare capacity for treating COVID-19 patients.

Ethics and law studies examine several issues in the field of medicine, one of which is the legal aspects related to patients living with mental disability. In a previous article, we introduced a 24-year-old female patient living with mental disability, diagnosed with large tumor growth in her right breast. Inadequate self-care as well as lack of breast self-examination were the causes of delayed referral and late diagnosis. The patient's family stated that no periodic breast examination was performed by the family or health centers. The patient's family did not have sufficient knowledge about caring for patients with mental disabilities. The question that will then arise under such circumstances is, will the legal system protect the incapacitated individuals if they or their family cannot provide for themselves? In this article, we discuss this issue and the existing legal vacuum.

Background and One of the dangerous complications after E.N.T surgery with general anesthesia is fleeding during surgery. Intravenous and inhalated anesthesia will cause hypotension and reduce bleeding. The purpose of this study was comparing the Halothane and propofol effects on bleeding in surgery. This research is a selective clinical study for comparing the range of bleeding after using the inhalating Halothane and intravenous propofol anesthesia. It was done on post surgery in Bahman 1382, in Department of car, nose and throat, Emam Reza hospital. Our cases were 38 male and 22 female patients after rhinoplasty and septorhinoplasty. One group used halothane and another used propofol. Head and neck of patients were 15-30 degree upper than trunk and pharyngeal. Pack used for all of them. The range of bleeding was explained by the amount of bloody pads and suctioned blood. Independent T test and k2 and Pearson tests were used for data analysis. The majority of cases were ladies in 1-30 years old (8108%) and 6802% had rhinoplasty. The range of bleeding in propofol group was lesser than halothane group (2304%). This study incapacitate that both halothane and propofol can cause hypotension and reduce bleeding.

Children suffering from Cerebral Palsy (CP), exhibit movement limitations and physiological abnormalities as compared to normal individuals.The objective of this study was to assess mechanical efficiency and certain cardiovascular indices before and after an exercise-rehabilitation program in children with dipelegia spastic cerebral palsy (experimental group) in comparison with able-bodied children(controls).In this study, 15 spastic cerebral palsy (dipelegic) children participated in an exercise-rehabilitation program, three days a week for three months with an average 144bpm of heart rate. The mechanical efficiency (net, gross), rest and submaximal heart rate and maximal oxygen consumption(VO2max) weremeasured before (pretest) and after (posttest) exercise program on the cycle ergometer according to the Macmaster ergometer protocol. Then control group, of 18 normal children underwent the exercise program and were assessed, following which results of the 2 groups were compared using SPSS for statistical analysis (P<0.05).Mechanical efficiency (net, gross) increased significantly in CP patients after the exercise-rehabilitation program; reults did not alter significantly for the controls.Rest and submaximal heart rate in CP patients decreased significantly after exercise program. Maximal oxygen consumption, which remained unchanged in patients following the exercise program, was similar in patients and controls after the program.Cerebral palsy patients, because of their high muscle tone, severe degree of spasticity, and involuntary movements are physically more incapacitated and need more energy than normal able-bodied individuals.Rehabilitation and aerobic exercise can be effective in improving their cardiovascular fitness and muscle function and increasing their mechanical efficiency.

Knee joint osteoarthritis (OA) is one of the most incapacitating diseases affecting older population, which is associated with pain and functional limitation. Various kinds of conservative treatment have been used to decrease knee pain and to improve the quality of life of the subjects suffering from this disease. There are discrepancies in the clinical effects reported for the use of lateral wedge insole in spite of being used as one of the first conservative mechanical treatments for patients with medial compartments of knee OA. A total of 36 subjects with medial knee compartment OA were recruited in this research project. Subjects were randomized into two groups to receive 3- and 7-mm lateral wedge insoles based on the date of birth of the participants. Some parameters such as severity of knee pain, Tibiofemoral angle (TFA), severity of OA, and quality of life were selected in this research project. The use of both 3-mm and 7-mm lateral wedge insole improves the quality of life and decreases knee joint pain. However, the effect of 7 mm lateral wedge insole was more than that of 3 mm. Using lateral wedge insole is a simple, inexpensive therapy for decreasing pain and improving quality of life; however, most research must be carried out to find the effects of lateral wedge on severity of knee joint OA and aligning TFA.

Knee joint osteoarthritis (OA) is one of the most incapacitating diseases affecting older population، which is associated with pain and functional limitation. Its prevalence is significantly higher among women than men. Osteoarthritis is a degenerative disease usually involves medial intra-articular space. Various kinds of conservative treatment have been used in order to decrease knee pain and to improve the quality of life for subjects suffering from OA. Although one of the first conservative mechanical treatments is the use of laterally wedged insole، there are discrepancies regarding to clinical effects reported for the use of this method. Thirty six subjects with medial knee compartment osteoarthritis were recruited in this study. Participants were randomly classified into two groups to receive 3 and 7mm lateral wedge insoles. Pain and the quality of life were measured by WOMAC scale and radiologic method was used to record and calculate OA severity and tibiofemoral angle. The use of both 3 and 7mm lateral wedge insole significantly improved the quality of life and knee pain (P < 0. 5). There was no difference in OA severity before and after using the lateral wedge insole (P > 0. 5). Also، result showed 7mm laterally wedged insoles were more effective than 3mm in pain improvement (P < 0. 5). Using lateral wedge insole could be a simple and inexpensive method to decrease pain and correct tibiofemoral angle، and also، improve knee joint function.