Role of imaging modalities in evaluation of stroke; towards molecular imaging probes

MRI scanners show a spatial resolution of 250 μm in-plane (small lenticel empirical devices permit for 50 μm isotropic voxels for in vivo evaluation) infinite profundity infiltration along with significant good soft tissue contrast. Extracting any new epitomizing technology to the imaging of children has a number of safety interests that must be aimed. However the lack of ionizing radiation makes MRI particularly suitable for a stroke patient. These treatments must be tailored to the individual biochemical set-up or disease stage of each respective patient with the support of diagnostic data. Equipped with these patient-specific data, a therapy regime is selected, taking into account the different molecular defects for each disease as well as the particular clinical history and condition of a patient. Neuroradiological tools such as CT or MRI have become an indispensable part of the examination and work-up of patients with acute cerebrovascular insults

Role of dynamic contrast-enhanced magnetic resonance imaging in staging of bladder cancer

Introduction: Dynamic Contrast Enhanced (DCE)-Magnetic Resonance Imaging (MRI) is a useful technique in which rapid enhancement of tumour by uptake of the contrast agent compared to bladder wall. Aim: To evaluate the accuracy of dynamic gadolinium-en­hanced MRI in staging of bladder cancer through differentiating superficial tumours from invasive tumours and organ-confined tumours from non-organ-confined tumours. In addition, the benefits of DCE-MRI in diagnosis of tumour progression steps were investigated. Materials and Methods: This was a quasi-experimental study in which 45 patients (95.55% men and 4.45% women) were enrolled. Patients with confirmed transitional cell carcinoma by histopathology findings were imaged using 1.5 Tesla MRI systems. Pathology results were considered as the standard reference. Tumour stage was determined by imaging findings and compared with pathologic findings after radical cystectomy. Data were analysed by SPSS version 16 and the level of significance in all tests was considered p<0.001. Results: The most common stage that was seen in pathology and MRI findings was T3b. Kappa agreement coefficient between MRI and pathology was 0.7 (p<0.001). The accuracy of MRI in differentiating superficial tumours (≤T1) from invasive tumours (≥ T2a), and organ-confined tumours (≤T2b) from non-organ-confined tumours (≥T3b) was 0.97 and 0.84, respectively. The overall accuracy of MRI was 0.77 (p<0.001). Totally, 10 cases of disagreement between MRI and pathological staging were found, eight (80%) of which were overestimated and two cases (20%) underestimated. MRI detection rate was 0% in stage Ta, 100% in stage T1, 66.7% in stage T2, 86.7% in stage T3, and 100% in stage T4. The sensitivity and specificity of MRI in differentiating superficial tumours from invasive tumours were 0.97 and 1, respectively, and in differentiating organ-confined tumours from non-organ-confined tumours were 0.94 and 0.77, respectively. The Spearman's correlation coefficient between the signal enhancement slope of time-intensity curves and tumour stages was 0.88 (p<0.001). Conclusion: Gadolinium-enhanced MRI is an appropriate and useful modality with a high accuracy in determining the stage of the bladder cancer. In addition, this method shows extension and progression of tumour and tumour invasion depth. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved

Prevention of contrast-associated acute kidney injury in cancer patients undergoing radiologic investigation using contrast media; a short-review to current knowledge

Contrast agents are non-biologically active substances required for various diagnostic imaging procedures. Exposure to contrast materials, predispose some patients to renal disturbances entitled as contrast-associated acute kidney injury. Nephropathy of contrast medium is a deterioration of renal function which happens within 24 to 72 hours after iodinated contrast medium injection. Cancer individuals have several risk factors for contrast-associated acute renal failure, consisting of administration of chemotherapy regimen, which are mainly nephrotoxic, presence of diabetes or chronic renal failure, hypertension, taking of non-steroidal anti-inflammatory drugs, simultaneous use of nephrotoxic drugs, aminoglycosides, cisplatin, cyclosporine A or amphotericin B, increases the risk of contrast-associated acute renal failure. Similarly, age more than 65 years old and anemia is an independent risk factor for contrast-associated acute kidney injury and also timing of CT within 45 days after last chemotherapy and low fluid intake, as the common risk factors in cancer individuals

Association of retinopathy and intima media thickness of common carotid artery in type 2 diabetic patients

Background: This study was carried out in order to evaluate the relationship between retinopathy and carotid intima-media thickness (CIMT). Materials and Methods: In a cross-sectional study, 154 diabetic patients who had a history of diabetic disease were evaluated in two equal groups of 77 patients with and without retinopathy, respectively. CIMT was evaluated in all of the patients. Results: Mean age of the patients was 59.65 +/- 9.37 years. Mean CIMT of all patients was 0.84 +/- 0.18. CIMT of patients with retinopathy was significantly greater than patients without retinopathy (P < 0.001). CIMT also correlated with age, duration of diabetes, systolic blood pressure, blood urea nitrogen, and serum creatinine. Conclusion: CIMT may be used as a simple, available and noninvasive method for screening of macro and microvascular complication of diabetic patients

Relationship between demographic characteristics, spinal impairment, and interventional strategies in the clinical outcome of spinal cord injury patients

Background and aims: The aim of the present study was to investigate the main causes of traumatic spinal cord injury (TSCI), along with the relationship between SCI patients’ demographic characteristics and related treatments. Methods: In general, 608 patients suffering from TSCI and referring to Ayatollah Kashani hospital, Shahrekord in 2016-2017 were enrolled in this cross-sectional study. Patients’ demographic characteristics, level of injury, the severity of the injury, injury cause, and duration of hospitalization (DOH) were obtained according to their files and medical records. Several months after discharge, the patients were examined by a neurosurgeon, and the treatment outcome was recorded in specific checklists. Results: The mean age of the injured individuals was 34.2±16.9 years and the majority of the injured (70.2%) were males. ASIA grades E and D were also reported in 50.3% and 25% of the injured at admission, respectively. Further, grade E injury was observed in 77.1% of the injured at discharge. Medicinal, non-surgical, and surgical treatments were used for 53.8%, 25.8%, and 20.4% of patients, respectively. The levels of injury, treatment strategy, and clinical outcomes were significantly different based on the ASIA grades at admission (P<0.001, for all items). There was a significant difference among DOH (day) in terms of the level of injury, ASIA grades during admission, treatment strategy, and treatment outcomes in different individuals (P<0.001, for all items). Conclusion: Regarding the relationship between the treatment strategy, the ASIA grade, and the outcome of the treatment, it seems necessary to perform surgical or rehabilitative interventions for each person in accordance with demographic characteristics. Keywords: Injuries, Spinal cord injuries, Rehabilitation, ASIA scal

Comparison of the value of multidetector-row computed tomography in diagnosis of biliary obstruction reasons with the results obtained from invasive procedures

زمینه و هدف: تصویر برداری تشخیصی نقش اساسی در تشخیص غیر تهاجمی علل انسداد صفراوی و غربالگری بیماران با ریسک بالا را دارا می باشد. این مطالعه با هدف مقایسه ارزش سی تی اسکن مولتی اسلایس در تشخیص علل انسداد صفراوی با یافته های حاصل از روش های تهاجمی انجام شده است. روش بررسی: در این مطالعه توصیفی ـ تحلیلی به روش سرشماری، کلیه بیمارانی که از بهمن ماه 1388 تا خرداد ماه 1390، (50 بیمار)، دارای تشخیص انسداد صفراوی، بر مبنای یافته های کلینیکی و سونوگرافیک بودند، با روش سی تی اسکن مولتی اسلایس (MDCT) بررسی شدند و گزارش رادیولوژی آن ها با یافته های حاصل از سایر روش های تهاجمی شامل تکنیک کلانژیوگرافی معکوس از طریق آندوسکوپ (ERCP)،PTC (Percutaneous transhepatic cholangiography) و یا جراحی مورد مقایسه قرار گرفت. یافته ها: یافته ها نشان داد که حساسیت، ویژگی و دقت سی تی اسکن مولتی اسلایس در تشخیص علل بدخیم انسداد صفراوی به ترتیب 100، 4/88 و 94، در تشخیص علل خوش خیم انسداد صفراوی به ترتیب 75، 100 و 96، در تشخیص سنگ صفراوی به ترتیب 4/94، 100 و 98 بود و رابطه معنی داری بین شدت اتساع مجاری صفراوی و خوش خیم بودن یا بدخیم بودن عامل انسدادی وجود داشت (001/0>P). نتیجه گیری: بر مبنای یافته های این مطالعه، سی تی اسکن مولتی اسلایس روشی سریع ،غیر تهاجمی و با دقت بالا در تشخیص علل انسداد صفراوی و افتراق عوامل انسدادی خوش خیم از عوامل بدخیم بوده و برنامه ریزی قبل از عمل جراحی مفید می باشد

Efficiency of treatment with vitamin D on biochemical indexes, lipid profile, and fatty liver indexes in type 2 diabetic patients with vitamin D deficiency and nonalcoholic fatty liver

Prevalence of metabolic syndrome, type 2 diabetes, and non alcoholic fatty liver has been recently on rise in worldwide. This study was conducted to explore the association between vitamin D deficiency and incidence of fatty liver disease in type 2 diabetes patients and also to examine the efficacy of treatment with vitamin D in type 2 diabetes patients with vitamin D deficiency and non alcoholic fatty liver referring a specialty clinic in Shahrekord. In the first step (cross-sectional phase) of this two-step study, 108 patients with type 2 diabetes were examined for vitamin D level, biochemical indexes, lipid profile, and fatty liver indexes. In the second step (clinical trial phase), individuals with nonalcoholic fatty liver and vitamin D deficiency as treatment group underwent treatment with 50000 vitamin D units a week for 12 weeks. 3.96% of patients had fatty liver and 1.61% of patients had vitamin D deficiency of different severities. There was no significant association found between vitamin D deficiency and presence or severity of nonalcoholic fatty liver in patients (P > 0.05). Treatment with vitamin D had no significant effect on biochemical indices, liver function, fasting blood sugar, and hemoglobin A1c (P > 0.05), but serum level of cholesterol and low density lipoprotein (LDL) decreased in treatment patients compared to control group (P < 0.001). No significant association was found between vitamin D deficiency and presence or severity of nonalcoholic fatty liver; but treatment of type 2 diabetes patients with vitamin D supplementation decreased the serum level of cholesterol and LDL

Multivariable analysis of clinical and laboratory data manifestations predicting severity and mortality risk in patients with Coronavirus disease 2019 in the mountainous west of Iran: a retrospective single-center study

Background Few reports have addressed the clinical and laboratory features of patients with coronavirus disease-2019 (COVID-19) in mountainous areas, especially in Iran. Objectives To report the clinical and laboratory data and manifestations predicting mortality of patients with COVID-19 in the west of Iran. Methods We conducted a retrospective cohort study of 286 patients hospitalized with COVID-19 between 25 February 2020 and 12 May 2020 to describe their clinical symptoms and laboratory test findings when they were admitted at the Hajar Hospital affiliated with the Shahrekord University of Medical Sciences, and a multivariable analysis of factors that predict their disease severity and mortality. Results After hospital admission, 18 patients died and 268 were discharged. Older age [odds ratio (OR) = 1.02, 95% confidence interval (CI) = 1.01-1.04, P = 0.001], presence of underlying diseases (OR = 1.86, 95% CI = 1.01-3.45, P = 0.04), elevated hematocrit (OR = 1.08, 95% CI = 1.03-1.13, P = 0.002), and increase in red blood cell distribution width (RDW) coefficient of variation (OR = 1.18, 95% CI = 1.02-1.36, P = 0.02) were significantly associated with disease severity. Older age (OR = 1.00, 95% CI = 1.00-1.07, P = 0.03), hypocalcemia (OR = 0.20, 95% CI = 0.09-0.58, P = 0.002), hypophosphatemia (OR = 0.50, 95% CI = 0.26-1.02, P = 0.04), and increase in platelet-larger cell ratio (P-LCR; OR = 1.10, 95% CI = 1.00-1.15, P = 0.04) were significantly associated with mortality. The areas under the receiver operating characteristic curves were as follows: calcium 0.759; lactate dehydrogenase (LDH) 0.731; phosphorus 0.725; bilirubin 0.689; C-reactive protein 0.679; and RDW - standard deviation (RDW-SD) 0.624. Conclusions Those who did not survive tended to be elderly and had a greater incidence of comorbidities. Elevated LDH, decreased levels of calcium and phosphorus, and anemia at diagnosis were associated with greater risk of death for these Iranian patients hospitalized with COVID-19. Regular assessment of these markers would help to manage patients with COVID-19

Role of CT scan in theranostic and management of traumatic spinal cord injury

Traumatic spinal cord injury (TSCI) is a condition with suffering of neural structures from acute trauma with short-term or permanent sensory and motor problems. This study was conducted with the aim of determining the prevalence of TSCI in Tehran with emphasis on demographic characteristics of patients and to evaluate the effect of computed tomography (CT) in determining fracture type and severity grade of injury among TSCI patients. In a cross-sectional study, all TSCI and spinal fracture patients (N = 520) who referred to the main trauma center in Tehran, Iran, in 2013 and 2014 were selected. Radiography and CT scan were prepared and reported blindedly by two radiologists. Majority of the patients was 21–30 years male, married and their most common occupation was car driver. A significant difference was observed between gender and etiology (P = 0.001). The main etiology was traffic accident followed by falling from height. While the most common location of injury for males was thoracic vertebrae followed by lumbar vertebrae; for females it was lumbar followed by thoracic. Majority of patients had ASIA (American Spinal Injury Association) impairment scale of E (normal), followed by B (sensory incomplete). Most of the cases were hospitalized less than one week. Age of the patient and duration of hospitalization had a significant association (P = 0.015). The results showed that in traumatic spinal cord events, traffic accident and falling from height are the main etiologies; hence, authorities in Iranian health system could consider preventive policies to decline the load and TSCI effects in hospitals and population. Keywords: Trauma, Spine, CT, Spinal cor

Structural and Mechanical Evaluation of a Nanocrystalline Al–5 wt %Si Alloy Produced by Mechanical Alloying

High energy mechanical milling followed by hot-pressing consolidation has been used to produce nanostructured Al–5 wt %Si alloy. X-ray diffraction (XRD), scanning electron microscopy equipped with energy dispersive X-ray detector (SEM-EDX), Vickers hardness, and compression measurements were used to examine the effect of milling duration on microstructure and mechanical properties of the nanostructured consolidated alloys. Crystallite sizes and lattice strains were determined by X-ray peak broadening analysis using the Williamson-Hall (W-H) method. Increasing the milling time reduced the crystallite size, and the minimum crystallite size of about 33 nm was achieved for both consolidated and powdered samples after 50 h of milling. Based on the SEM-EDX observations, the best distribution of silicon into Al matrix was obtained after 20 h of milling and remained unchanged afterwards. Hardness of both consolidated and powder samples increased with milling time, which can be attributed to the reduction of crystallite size and the better distribution of silicon in the aluminum matrix. Similarly, increased milling time increased the yield and compressive strengths of consolidated samples