Letters to the Editor

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Announcement of the Sina Trauma Data Bank (STDB)

Sir

Injuries are the most common cause of death among people 1 to 34 years of age, a leading cause of disability and years of life lost, and a major contributor to health care costs [1,2]. Injuries occur in all regions and countries. The magnitude of the problem however varies considerably by age, sex, region and income group [3].

In recent years, there has been a steady increase in occurrence of injury and injury-related mortality in the Islamic Republic of Iran [4]. Road traffic accidents and falling are the main causes of injury in the country [5,6]. Road traffic accidents are also the most common injury-related mortality followed by burns and drowning [4,7]. Disasters such as earthquake are other events that can cause injury and result in high casualties and losses [8]. The presence of land-mines in the Iranian borders with Iraq and Afghanistan is other important source of injury and death [9].

The amount of research in the field of trauma has been growing in the country. The results of such research are mainly published in Iranian journals not indexed in the Medline and thus are not readily available to other researchers with similar interests. Recognizing this deficiency, we at Sina Trauma and Surgery Research Center (STSRC), the first and leading trauma research centre in the country, have developed a database of published abstracts as a step towards addressing this shortcoming. Although the database mainly includes trauma research in the Islamic Republic of Iran, it can be of benefit for other researchers with similar interests. English abstracts of more than 800 articles from 99 Iranian medical journals, most since 2000, in the field of trauma have been made available for free at http://www.sinatrc.ac.ir/_databank/. The inclusion criteria for these abstracts relate to of trauma or injury as defined by Baker et al. [10]. Although the quality of the papers is variable and there may be some shortcomings in the English translation, we believe that they are worth including in the database. We hope that standards will improve with time. Article searching is provided through a variety of terms including title, abstract, author(s), journal name, keyword(s), ISSN, publication type and language. It is possible to search for single or multiple items within any specific category.

Questions about the STDB or submission of papers to be included can be addressed to This email address is being protected from spambots. You need JavaScript enabled to view it..

References

1. Rivara FP, Grossman DC, Cummings P. Injury prevention. Medical progress, 1997, 337(8):543–8.
2. World report on road traffic injury prevention. Geneva, World Health Organization, 2004.
3. Peden M, McGee K, Krug E, eds. Injury a leading cause of the global burden of disease, 2000. Geneva, World Health Organization, 2002.
4. Health and Biomedical Information Network. Ministry of Health and Medical Education, Islamic Republic of Iran (http://www.hbi.ir/english/en_hbi/en_hbi.htm, accessed 30 August 2006).
5. Zargar M, Modaghegh MH, Rezai-shiraz H. Urban injuries in Tehran: demography of trauma patients and evaluation of trauma care. Injury, 2001, 32(8):613–7.
6. Zargar M et al. Pediatric transport related injuries in Tehran: the necessity of implementation of injury prevention protocols. Injury, 2003, 34(11):820–4.
7. Montazeri A. Road-traffic-related mortality in Iran: a descriptive study. Public health, 2004, 118(2):110–3.
8. Akbari ME, Farshad AA, Asadi-Lari M. The devastation of Bam: an overview of health issues 1 month after the earthquake. Public health, 2004, 118(6):403–8.
9. Jahunlu HR, Husum H, Wisborg T. Mortality in land-mine accidents in Iran. Prehospital disaster medicine, 2002, 17(2):107–9.
10. Baker SP, O’Neill B, Karpf RS. The injury fact book. Lexington, MA, Lexington Books, 1984.

Ali Khaji (This email address is being protected from spambots. You need JavaScript enabled to view it.) 
Behzad Eftekhar (This email address is being protected from spambots. You need JavaScript enabled to view it.)
Sina Trauma and Surgery Research Center (STSRC)
Sina General Hospital
Tehran University of Medical Sciences
Tehran
Islamic Republic of Iran

Efficacy of paromomicin and gentamicin patches in the treatment of cutaneous leishmaniasis

Sir

In spite of many different treatments used for cutaneous leishmaniasis [1–10], there is no single effective drug treatment. In 2001–02 we studied the effect of topical paromomycin and gentamicin applied to leishmanial lesions using adhesive patches at the Leishmaniasis Research Centre of Sedigheh Hospital in Isfahan, Islamic Republic of Iran.

Eligible patients (n = 100) were all those attending the centre with smear-confirmed leishmaniasis for up to 4 months. The diameter of lesions was less than 5 cm and the lesions were at least 3 cm away from the eyes. Exclusion criteria were pregnancy, nursing, history of previous treatment and history of allergy to aminoglycosides.

After cleansing the lesions, plasters were applied containing 0.1% gentamicin sulfate and 10% paromomycin enclosed in a polypropylene adhesive plaster with inert characteristics (Isfahan Faculty of Pharmacy). The dressings were changed every 4 days by the researcher, and the patients were asked about their compliance.

Patients were followed clinically and parasitologically about monthly at 28, 56 and 88 days after treatment and if the patient had any recurrences, another treatment was used. The maximum duration of treatment was 28 days but if the lesion was cured clinically and parasitologically, treatment was discontinued and the patient was followed up. To determine the efficacy of treatment, lesions were examined clinically and parasitologically. Complete cure of lesions was defined as return to normal texture of the lesion and epithelialization of the surface with a negative parasitological smear. Partial cure of lesions was defined as a decrease in the size and height of the lesion with or without a negative parasitological smear.

At the end of treatment, on day 28 of the study, 86 out of 100 patients (86.0%) in the showed complete cure of lesions and 8 (8.0%) showed partial cure (Table 1).

The results of this study are very encouraging and show topical paromomycin and gentamicin sulfate therapy is effective in about 80% of the patients, with a cosmetically acceptable scar. Applying paromomycin as a plaster is likely to decrease the rate of adverse reactions, enhance penetration and is easy to apply. The main disadvantage is allergy to plasters that can be avoided by using anti-allergy plasters. It is hoped that new plasters will be developed that release the drug slowly and absorb exudates in order to improve the topical treatment of cutaneous leishmaniasis.

References

1. Urcuyo F, Zaias N. Oral ketoconazole in the treatment of leishmaniasis. International journal of dermatology, 1982, 21:414–6.
2. El-On J et al. Topical treatment of cutaneous leishmaniasis. British medical journal, 1985, 261:1280–81.
3. Convit J et al. Immunotherapy of localized, intermediate, and diffuse forms of American cutaneous leishmaniasis. Journal of infectious diseases, 1989, 160:104–15.
4. Herwaldt BL, Berman JD. Recommendations for treating leishmaniasis with sodium stibogluconate (Pentostam) and review of pertinent clinical studies. American journal of tropical medicine and hygiene, 1992, 46:296–306.
5. Vannier-Santos MA et al. Alterations induced by the antifungal compounds ketoconazole and terbinafine in Leishmania. Journal of eukaryotic microbiology, 1995, 42:337–46.
6. Dogra J et al. Cutaneous leishmaniasis in India. Clinical experience with itraconazole. International journal of dermatology, 1990, 29:661–2.
7. Pfaller MA, Marr JJ. Antileishmanial effect of allopurinol. Antimicrobial agents and chemotherapy, 1974, 5:469–72.
8. Mishra M et al. Amphotericin versus sodium stibogluconate in first-line treatment of Indian kala-azar. Lancet, 1994, 344:1599–600.
9. Murray HW, Hariparashad J, Fichtl RE. Treatment of experimental visceral leishmaniasis in a T-cell-deficient host: response to amphotericin B and pentamidine. Antimicrobial agents and chemotherapy, 1993, 37:1504–5.
10. Momeni AZ, Aminjavaheri M. Treatment of recurrent cutaneous leishmaniasis. International journal of dermatology, 1995, 34:129–33.

A. Asilian, G. Faghihi
Department of Dermatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran (Correspondence to G. Faghihi: This email address is being protected from spambots. You need JavaScript enabled to view it.)
A.H. Siadat, H. Hejazi
Sedigheh Tahereh Skin Research Centre, Isfahan University of Medical Science, Isfahan, Islamic Republic of Iran
M. Shahtalebi, G. Sadeghian
Faculty of Pharmacy, Isfahan University of Medical Science, Isfahan,
Islamic Republic of Iran
M. Mostaghim, M.R. Radan
Private general practitioner office, Isfahan, Islamic Republic of Iran

Encouraging letters to the editor in EMHJ

Sir

Being an author in and a reader of peer-reviewed medical journals, I am always interested to express my views freely. Scientific discourse occurs in many forms: among colleagues, at scientific meetings, during peer review and after publication. Such discourse is essential to interpreting studies and guiding future research. Thus the letter section of a scientific journal is an essential part of post-publication peer review [1]. Through the letters section, scientific articles published in a peer-reviewed journal are subject to continuing scrutiny. This section is therefore a forum for scientific discourse and essential in interpreting studies and guiding future research. Moreover, it helps make a journal accountable to the medical community [2].

Because of the aforementioned and my wish to play a role in improving the quality of articles published in the journals of our Region, I made a PubMed search of 5 medical journals on the total number of publications and the proportion which were letters. PubMed is not only a simple search engine for biomedical citations, but also a powerful tool to conduct certain statistical analyses [3]. A search strategy with a one-hour limit (11 December 2005) was performed including the names of the British medical journal, Journal of the American Medical Association, Saudi medical journal, Singapore medical journal and Eastern Mediterranean health journal. The search was limited to the last 5 years (01/01/2000 to 31/12/2004) to find the total number of publications for each journal and then limited to “Letter” as a type of publication.

The proportion of letters to total number of articles published in the aforementioned journals was 33.74%, 29.76%, 7.73%, 2.93%, 0.56% respectively. The search revealed that during the last 5 years only 3 letters had been published in the Eastern Mediterranean health journal. Although I recognize the limitation of comparing different types of journals, this is clearly a small number of letters. It serves as a crude indictor of the importance of encouraging the submission of letters in the Eastern Mediterranean health journal in the future.

Journals should welcome letters addressed to the editor [4], especially as they are the only form of discourse that becomes part of the permanent biomedical record, linked with the scientific article through its citation in databases such as MEDLINE [1].

References

1. Winker MA, Fontanarosa PB. Letters: a forum for scientific discourse. Journal of the American Medical Association, 1999, 281(16):1543.
2. Brown CJ. Unvarnished view points and scientific scrutiny. Letters to the editor provide a forum for readers and help make a journal accountable to the medical community. Canadian Medical Association journal, 1997, 157(6):792–4.
3. Tadmouri GO, Tadmouri NB. Biomedical research in the Kingdom of Saudi Arabia (1982–2000). Saudi medical journal, 2002, 23:20–4.
4. Peh WCG. Writing letters to the Singapore medical journal: keep’em comin’! Singapore medical journal, 2005, 46(12):665.

Mustafa Afifi
(This email address is being protected from spambots. You need JavaScript enabled to view it.)
Department of Research & Studies
Directorate General Planning
Ministry of Health
Muscat
Oman