Intraductal papillary mucinous neoplasm of the biliary tract (B-IPMN) is an intraductal growing mucin producing tumor that is precursor of cholangiocarcinoma. Dilation of both upstream and downstream biliary ducts is the radiological key feature that is respectively caused by intraductal obstructive growth and massive mucin production. Although B-IPMN is rare, if the radiologist is familiar with its manifestation, can lead to early diagnosis when surgical resection can be curative. Here, we report a long standing pathologically proved case of B-IPMN with emphasis on radiological manifestation during a long time of 13 years across different imaging modalities.

BACKGROUND: Ethical attitude of paramedic personnel is one of the most important factors in their effective and useful performance. Therefore, according to the importance of this issue and immense effect of religious culture on the formation of ethics, this study aimed to effect bio-ethical principles teaching on moral attitude of paramedic emergency personnel in Iran. MATERIAL AND METHODS: The present study was an experimental study carried out in 2020 on 60 of paramedic emergency personnel. Samples were available, randomly selected and assigned to two groups of control and intervention. The intervention was performed for a 2-h workshop of bioethical principles in 4 day based on Quran verses. Moral attitude of both groups was studied before and after each intervention. Data were analyzed using Kolmogorov–Simonov, Chi-square, t -test, one-way, and paired t -test with SPSS version 16 ( P ≤ 0/05). RESULTS: Ethical attitude means for both groups of control and intervention demonstrated that ethical attitude has meaningfully increased after the workshop. Demographic variables such as age, gender, and work experience of participants in workshops were not different between these two groups ( P < 0/05). The study of these two groups showed that there is no relationship among work experience, gender, marital status, age, and ethical attitude. CONCLUSION: Prehospital emergency is quite different from the other occupations in health-care system and the ethical issues of this field are more important. Therefore, teaching in workplace and through ethical principles based on religious teachings will have a profound effect on improving biological ethics of paramedic prehospital staffs.

The high incidence of coronavirus disease (COVID-19) and the resulting increase in data and information in this area have led medical centers to use different methods to manage them due to the huge amount of information. One of the best ways to avoid confusion in documenting and managing health information is to use new information tools such as ontology. Researchers have used a tool around the world since the late 1990s to support decision-making in various fields. In this regard, the National Center for Biomedical Ontology has established a medical ontology database called BioPortal. In the present research, published ontologies in the field of Covid-19 in this database have been explored.

Paraquat has been recognized as a highly toxic agent for pest removal and is used worldwide. In adults, paraquat poisoning for suicidal attempts is much more common than accidental exposure poisoning. Approximately 20% of patients with paraquat poisoning develop pneumomediastonium as a complication with a mortality rate of approximately 100%. A 19-year-old man patient was admitted to the poisoning emergency department of Khorshid hospital, who had ingested paraquat. He had nausea and vomiting and had normal vital signs and examination in admission. Initial treatment for the patient was done. The patient signs got worsened on the 21 st day of hospitalization and had severe emphysema of the superficial and deep spaces of the neck, followed by bilateral pneumothorax, and severe pneumomediastinum. Unfortunately, the patient died on the 27 th day of hospitalization. Purpose of the current study is to raise awareness of rare paraquat toxicity complications, treatment, and especially its lethal complications, including pneumomomediastonium.

Prolactinoma is a rare tumor of childhood. Clinical presentations of prolactinoma include amenorrhea, delayed puberty, and galactorrhea. For the first time, in this case, elevated prolactin levels were associated with unexpected premature pubarche. We describe an 8-year, 7-month-old boy with acne and gradual appearance of pubic hair, corresponding to tanner stage 2. Hormonal tests showed severe hyperprolactinemia (prolactin = 246.8 μg/L and pooled prolactin = 175 μg/L and macroprolactin = 5 μg/L) and mildly elevated level of dehdroepiandrostenedion sulfate (DHEAS) and testosterone. Magnetic resonance imaging (MRI) findings confirmed the presence of a pituitary macroprolactinoma, measuring 14 mm × 12 mm × 8 mm on the right side of the pituitary gland. Cabergoline therapy was commenced (0.5 mg/week) and after 3 months, no evidence of pubarche progression was observed. Prolactin level and tumor size markedly reduced. At the 9-month follow-up visit, a normal MRI was reported. This case highlights that even when facing premature pubarche, careful examination is mandatory, and if no obvious etiology is found for premature pubarche, clinicians should consider prolactinoma.