Omental Torsion After Repeated Abdominal Blunt Trauma

Omental torsion is caused by the rotation of the greater omentum on its axis which may lead to tissue infarction and necrosis. It is a rare cause of acute abdomen. Signs, symptoms and paraclinical data are not specific. The patients usually undergo laparotomy for acute abdomen of poorly defined origin. High index of suspicious is required for the diagnosis of this entity. The diagnosis is usually confirmed after an explorative laparotomy. We present clinical characteristics and imaging findings of omental torsion in a young man following repeated blunt abdominal trauma

Raman spectroscopic analysis to identify chemical changes associated with different subtypes of breast cancer tissue samples

Breast cancer incidence rates are increasing in women worldwide with the highest rates reported in developed countries. A combination of screening approaches, Immuno-histopathology and gene profiling analyses are currently used for diagnosis and typing but have their own limitations in understanding disease and its subtypes. Raman spectroscopy (RS) has attained great attention from biomedical researchers due to its non-invasive and non-destructive detection approach. Chemometrics is one of the powerful tools used in spectroscopic research to enhance its sensitivity. RS was used to characterise and differentiate two breast cancer and one normal breast cell lines (MDA-MB-436, MCF-7 and MCF-10A) and spectra of the cell lines have revealed basic differences in the concentration of biochemical compounds such as lipids, nucleic acids and proteins Raman peaks were found to differ in intensity and principal component analysis (PCA) was able to identify variations that lead to accurate and reliable separation of the three cell lines. Linear discriminant analysis (LDA) model of three cell lines was predicted with 100% sensitivity and 91% specificity. RS studies were extended from single cells to multiple cell spheroids. Human breast cancer cell lines (T-47D) were grown as spheroids and a combination of RS and Cluster analysis were employed to understand biochemical fingerprint and differentiation of normal proliferating, hypoxic and necrotic regions of spheroids. These variations may be useful in identifying new spectral markers and further understanding of cancer metabolism. Finally, Human breast biopsies on Tissue microarray (TMA) slide were analysed using RS and Chemometrics approaches. Biopsies were classified as luminal A, luminal B, HER2 and triple negative subtypes to understand chemical changes associated with breast cancer subtypes. Supervised and unsupervised algorithms were applied on biopsy data to explore intra and inter dataset biochemical changes associated with lipids, collagen and nucleic acid content. In summary, RS has offered great potential understanding breast cancer from cell line level to multicellular spheroid to higher architecture of tissue. This study has explored new area to understand biochemical fingerprint of breast biopsies, which is complementary to current trends of molecular profiling and immuno histopathological approaches

Intensive Care Nurses' Knowledge of Radiation Safety and Their Behaviors Towards Portable Radiological Examinations

Background: Radiological examinations for patients who are hospitalized at intensive care units are usually performed using portable radiography devices. However they may require knowledge and safety precautions of nurses. Objectives: The aim of the study was to investigate ICU nurses’ knowledge of radiation safety and their behaviors towards portable radiological examinations. Materials and Methods: In total, 44 intensive care nurses were recruited for this cross-sectional descriptive study using census sampling during April and May 2014. The study setting was at intensive care units of Shahid Beheshti Hospital of Kashan, Iran. An eleven-item questionnaire and a five-item checklist were used for evaluating nurses’ radiation protection knowledge and behaviors, respectively. An expert panel consisting of ten nursing and radiology faculty members confirmed the content validity of the questionnaire and the checklist. Moreover, a Geiger-Müller counter was used for measuring ionizing radiation during portable radiological examinations. Study data were analyzed using the SPSS software version 13.0. Mean, standard deviation, frequency and one-sample t test were used for description of the data. The level of significance was set at below 0.05. Results: The mean of participants’ radiation protection knowledge was 4.77 ± 1.38. The most prevalent radiation protection behavior of nurses was leaving the intensive care unit during portable radiological examinations. Only 6.8% of nurses stayed at the nursing station during radiological examinations. The highest dose of radiation was 0.11 micro Sievert per hour (μSv/h), which was much lower than the highest permitted level of radiation exposure i.e. 0.25 μSv/h. Conclusions: Portable radiological examinations did not expose healthcare providers to high doses of ionizing radiation. Nurses’ radiation protection knowledge was limited and hence, they require in-service education programs

Correlation Between Intra-Abdominal Free Fluid and Solid Organ Injury in Blunt Abdominal Trauma

Background: In previous studies, the diagnostic value of Focused Assessment with Sonography for Trauma (FAST) has been evaluated but few studies have been performed on the relationship between the amount of free intra-abdominal fluid and organ injury in blunt abdominal trauma. To select patients with a higher probability of intra-abdominal injuries, several scoring systems have been proposed based on the results of FAST. Objectives: The aim of this study was to determine the prognostic value of FAST according to the Huang scoring system and to propose a cut-off point for predicting the presence of intra-abdominal injuries on the Computed Tomography (CT) scan. The correlation between age and Glasgow Coma Scale (GCS) and the presence of intra-abdominal injuries on the CT scan was also assessed. Patients and Methods: This study was performed on 200 patients with severe blunt abdominal trauma who had stable vital signs. For all patients, FAST-ultrasound was performed by a radiologist and the free fluid score in the abdomen was calculated according to the Huang score. Immediately, an intravenous contrast-enhanced abdominal CT scan was performed in all patients and abdominal solid organ injuries were assessed. Results were analyzed using Kruskal-Wallis test, Mann-Whitney test and ROC curves. The correlation between age and GCS and the presence of intra-abdominal injuries on CT-scan was also evaluated. Results: The mean age of the patients was 29.6 ± 18.3 years and FAST was positive in 67% of the subjects. A significant correlation was seen between the FAST score and the presence of organ injury on CT scan (P < 0.001). Considering the cut-off point of 3 for the free fluid score (with a range of 0-8), sensitivity, specificity, positive predictive value and negative predictive value were calculated to be 0.83, 0.98, 0.93, and 0.95, respectively. Age and GCS showed no significant correlation with intra-abdominal injuries. Conclusions: It seems that FAST examination for intra-abdominal fluid in blunt trauma patients can predict intra-abdominal injuries with very high sensitivity and specificity. Using the scoring system can more accurately determine the probability of the presence of abdominal injuries with a cut-off point of three

Routine Chest Computed Tomography and Patient Outcome in Blunt Trauma

Background: Computerized Tomography (CT) scan is gaining more importance in the initial evaluation of patients with multiple trauma, but its effect on the outcome is still unclear. Until now, no prospective randomized trial has been performed to define the role of routine chest CT in patients with blunt trauma. Objectives: In view of the considerable radiation exposure and the high costs of CT scan, the aim of this study was to assess the effects of performing the routine chest CT on the outcome as well as complications in patients with blunt trauma. Patients and Methods: After approval by the ethics board committee, 100 hemodynamically stable patients with high-energy blunt trauma were randomly divided into two groups. For group one (control group), only chest X-ray was requested and further diagnostic work-up was performed by the decision of the trauma team. For group two, a chest X-ray was ordered followed by a chest CT, even if the chest X-ray was normal. Injury severity, total hospitalization time, Intensive Care Unit (ICU) admission time, duration of mechanical ventilation and complications were recorded. Data were evaluated using t-test, Man-Whitney and chi-squared test. Results: No significant differences were found regarding the demographic data such as age, injury severity and Glasgow Coma Scale (GCS). Thirty-eight percent additional findings were seen in chest CT in 26% of the patients of the group undergoing routine chest CT, leading to 8% change in management. The mean of in-hospital stay showed no significant difference in both groups with a P value of 0.098. In addition, the mean ICU stay and ventilation time revealed no significant differences (P values = 0.102 and 0.576, respectively). Mortality rate and complications were similar in both groups. Conclusions: Performing the routine chest CT in high-energy blunt trauma patients (with a mean injury severity of 9), although leading to the diagnosis of some occult injuries, has no impact on the outcome and does not decrease the in-hospital stay and ICU admission time. It seems that performing the routine chest CT in these patients may lead to overtreatment of nonsignificant injuries. The decision about performing routine CT scan in a trauma center should be made cautiously, considering the detriments and benefits

Detection of Drug Resistance Gene in Cutaneous Leishmaniasis by PCR in Some Endemic Areas of Iran

Background: Cutaneous leishmaniasis is still a health problem in many rural and urban regions of Iran and drug resistance has emerged as a major impediment in the treatment of leishmaniasis. This study aims to determine the drug resistance gene in cutaneous leishmaniasis by PCR in some endemic areas of Iran. Methods: Ninety seven samples were collected from ulcers of leishmaniasis patients from some endemic areas of Iran. The Giemsa stained samples were examined microscopically and cultured in NNN and RPMI 1640 mediums for parasite detection. After DNA extraction, PCR was done by a pair of specific primers. For detection of mutation in DNA, first PCR products were electrophoresed on CSGE gel. The suspected samples were compared by sequencing and RFLP results were demonstrated. Comparison of DNA derived from a wild type cell and mutant cell was undertaken by CSGE and sequencing methods. Results: Among 90 isolates (92.8) examined for detection of mutation in gene with CSGE and RFLP, 10 (11.1) revealed a disorder in sequencing selection for unresponsive to drug. Conclusion: Drug resistance in cutaneous leishmaniasis to sodium stiboglocanat is probably due to a mutation in a genome. A field study is needed to determine the distribution of drug resistance and other gene mutations involved in unresponsiveness to drugs in leishmaniasis endemic areas of Iran. © Iranian Red Crescent Medical Journal

BOOSTing Patient Mobility and Function on a General Medical Unit by Enhancing Interprofessional Care

Low mobility during hospitalization remains prevalent despite associated negative consequences. The goal of this quality improvement (QI) project was to increase patient mobility and function by adding a physical therapist (PT) to an existing interprofessional care team. A mobility technician assisted treatment group patients with mobility during hospitalization based on physical therapist recommendations. Change in functional status and highest level of mobility achieved by treatment group patients was measured from admission to discharge. Observed hospital length of stay (LOS), LOS index, and 30-day all cause hospital readmission comparisons between treatment group and a comparison group on the same unit, and between cross-sectional comparison groups one year prior were used for Difference in Difference analysis. Bivariate comparisons between the treatment and a cross-sectional comparison group from one year prior showed a statistically significant change in LOS Index. No other bivariate comparisons were statistically significant. Difference in Difference methods showed no statistically significant change in observed LOS, LOS Index, or 30-day readmission. Patients in the treatment group had statistically significant improvements in functional status and highest level of mobility achieved. Physical function and mobility improved for patients who participated in mobility sessions. Mobility technicians may contribute to improved care quality and patient safety in the hospital

A Case Report of Neuroleptic Malignant Syndrome during Methadone Therapy

Background and Objective: Methadone is an opioid agonist used for the treatment of addiction to opioid drugs. Toxic leukoencephalopathy can cause serious problem and even be life-threatening. Methadone-induced leukoencephalopathy is a rare condition of this toxicity. Because of the importance of this situation and its treatment, we aim to report a case who is diagnosed as Methadone-induced leukoencephalopathy. Case Report: A 63-year-old man referred with non-persistent fever, drowsiness, rigidity and suspected of neuroleptic malignant syndrome (NMS). He was addicted to opioid from young age. He was on maintenance therapy with 80 mg methadone syrup from 2 months ago. After the appearance of symptoms including delirium, impaired attention and consciousness, treatment was performed with half a tablet of haloperidol 0.5 mg twice a day before rigidity and fever. Multiple lesions were seen in baseline CT-Scan and MRI. Toxic laboratory examination showed methadone was positive and other toxins and opioids were negative. After two weeks, second MRI showed rapid progressive lesions in white matter. Thus, it was diagnosed as Methadone-induced leukoencephalopathy in addition to NMS. Hydration, bromocriptine tablets 2.5 mg twice a day, methadone tapering and haloperidol discontinuation were performed. After two months, the patient's consciousness was better and his CPK and LDH tests were normal. Conclusion: Methadone-induced leukoencephalopathy is a very rare condition, but it is important for physicians to consider this diagnosis in patients using methadone, especially when they show neurological and psychiatric signs and symptoms. That’s because early methadone tapering can reduce and stop toxicity on the white matter of the brain

Nanoscale mapping of semi-crystalline polypropylene

We reveal nanoscale information of semi-crystalline polypropyl-ene with the use of a new secondary electron hyperspectral imag-ing technique. The innovative combination of cryo-SEM and low voltage allows for the optimised imaging of these beam-sensitive materials. Through the collection of secondary electron hyper-spectral imaging data mapping of molecular order on the nano-scale in the scanning electron microscope (SEM) can be achieved

A low-dose chest CT protocol for the diagnosis of COVID-19 pneumonia: a prospective study

Purpose: The increasing trend of chest CT utilization during the COVID-19 pandemic necessitates novel protocols with reduced dose and maintained diagnostic accuracy. We aimed to investigate the diagnostic accuracy of 30-mAs chest CT protocol in comparison with a 150-mAs standard-dose routine protocol for imaging of COVID-19 pneumonia. Methods: Upon IRB approval, consecutive laboratory-confirmed positive COVID-19 patients aged 50 years or older who were referred for chest CT scan and had same-day normal CXR were invited to participate in this prospective study. First, a standard-dose chest CT scan (150 mAs) was performed. Only if typical COVID-19 pneumonia features were identified, then a low-dose CT (30 mAs) was done immediately. Diagnostic accuracy of low-dose and standard-dose CT in the detection of typical COVID-19 pneumonia features were compared. Results: Twenty patients with a mean age of 64.20 ± 13.8 were enrolled in the study. There was excellent intrareader agreement in detecting typical findings of COVID-19 pneumonia between low-dose and standard-dose (intraclass correlation coefficient ICC = 0.98–0.99, P values &lt; 0.001 all readers). The mean effective dose values in standard- and low-dose groups were 6.60 ± 1.47 and 1.80 ± 0.42 mSv, respectively. Also, absolute cancer risk per mean cumulative effective dose values obtained from the standard- and low-dose CT examinations were 2.71 × 10−4 and 0.74 × 10−4, respectively. Conclusions: According to our study, it was found that proposed low-dose CT chest protocol is reliable in detecting COVID-19 pneumonia in daily practice with significant reduction in radiation dose and estimated cancer risk. © 2020, American Society of Emergency Radiology