Application of Dose Area Product (DAP) to Estimate Entrance Surface Dose (ESD) in Pediatric Chest X-Rays

Introduction: Given the high radiation tissue sensitivity of pediatric patients, it is necessary to monitor their received dose to optimize radiation protection. The first aim of this study was to evaluate the entrance surface dose (ESD) in pediatric patients undergoing a chest X-ray at the main hospital of Dezful, Iran. The second aim was to compare our results with the established dose reference levels (DRLs). Materials and Methods: The studied population included 204 pediatric patients less than 15 years who were referred to as chest X-ray. A calibrated dose area product meter (DAP-meter) with permanent installation on the X-ray unit was used to radiation dose measurements. For each patient, the demographic data, exposure parameters and the dose read by DAP-meter were recorded and ESD was calculated using a standard mathematical formula. Results: The average value of ESD was 119 μGy in patients less than 15 years. This value was 51.3, 122.3, 131.5 and 171.2 μGy for the age groups for less than 1 year, 1 to 5 years, 5 to 10 years and 10 to 15 years, respectively. A statistically significant difference was seen between ESD values ​​in different age groups (P<0.001), whereas no statistical difference was seen between ESD values in ​ girls and boys (P =0.993). Conclusion: Pediatric patients in hospital investigated (except age group less than 1 year) are subjected to unnecessary radiation exposure, especially due to the use of non-optimize X-ray protocols

Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male

Empyema necessitans (EN) is a kind of empyema that diffuses to extrapleural space and can involve chest pain. Tuberculosis (TB) is the most common cause of EN. This disease can be found in both immunocompromised and immunocompetent individuals but is usually seen in the immunocompromised individuals. Because of long duration and ambiguous symptoms of the disease, diagnosis can be hard. The disease can be treated both medically and surgically. Missing the disease can lead to undesirable effects on patient’s condition and health care setting. This problem can be seen in endemic area in which controlling of TB is hard. Report of the disease in local health care center for desirable treatment and health maintenance is necessary. We explained a rare case of pulmonary TB in a patient that was healthy in other fields and just showed the minimum systemic symptoms. The patient came with a mass in lower part of back of chest cage, with a mild pain. The imaging survey showed EN. Smear and Ziehl-Neelsen stains from subcutaneous aspiration were positive for TB. This case showed importance of clinical view and awareness of this silent but serious disease in endemic area especially for TB

Epidemiological and Clinical Survey of Patients with Spondylitis

Background and purpose: Spondylitis is infection of the vertebrae and the intervertebral discs. Mycobacterium Tuberculosis, Brucella, and Pyogenic bacteria are among the major causes of this disease. There are reports on the epidemiology of this disease in Mazandaran, northern Iran. Evidence suggests differences between different types of spondylitis, but there is paucity of information on the differences between all types of spondylitis, especially Pyogenic spondylitis. The aim of this study was to investigate the clinical epidemiology of spondylitis in the region to make early diagnosis and appropriate treatments. Materials and methods: A descriptive study was done using the records of patients with spondylitis in Qaemshahr Razi Hospital, 2013-2017. Information including epidemiologic and demographic characteristics, main complaints and clinical symptoms, disease complications, radiological findings, and laboratory findings were extracted. Data were analyzed in SPSS V24. Results: The records of 39 patients (19 males and 20 females) were reviewed. Among the patients Brucellar spondylitis, tuberculous spondylitis, and pyogenic spondylitis were identified in 35.9%, 38.5%, and 25.6%. Conclusion: In current study, the rate of spondylitis was higher than that in other studies, which may be due to higher rates of tuberculosis in Mazandaran. Thoracic involvement was found to be more common in tuberculosis while Brucella and pyogenic spondylitis involved lumbar vertebrae. These findings could be of great help in distinguishing between the three conditions

Is cotoneaster manna improving the treatment of neonatal jaundice?

The aim of this systematic review is to evaluate the effects of cotoneaster manna on neonatal jaundice. The studies were selected from 1980 to 2017 using the main databases. Eight clinical trials with a total of 862 infants were selected from the 116 primary studies. All these trials had at least two groups for which the studied outcomes were measured before the intervention and at 12, 24, 36 and 48 hours after intervention. Generally, the meta-regression analysis showed a direct insignificant relationship between the baseline bilirubin level in the infants before the intervention and the estimated results. Although the findings confirm the effectiveness of cotoneaster manna products in the treatment of neonatal jaundice compared to the standard interventions or treatments (phototherapy), further clinical trials are strongly recommended, especially with larger sample sizes, more extensive geogra-phical areas, and a variety of subjects in different parts of the world