Evolution and resolution of brain involvement associated with SARS- CoV2 infection: A close Clinical � Paraclinical follow up study of a case

The new severe acute respiratory syndrome- coronavirus 2 is reported to affect the nervous system. Among the reports of the various neurological manifestations, there are a few documented specific processes to explain the neurological signs. We report a para-infectious encephalitis patient with clinical, laboratory, and imaging findings during evolution and convalescence phase of coronavirus infection. This comprehensive overview can illuminate the natural history of similar cases. As the two previously reported cases of encephalitis associated with this virus were not widely discussed regarding the treatment, we share our successful approach and add some recommendations about this new and scarce entity. © 2020 Elsevier B.V

Neuropsychiatric manifestations of COVID-19 can be clustered in three distinct symptom categories

Several studies have reported clinical manifestations of the new coronavirus disease. However, few studies have systematically evaluated the neuropsychiatric complications of COVID-19. We reviewed the medical records of 201 patients with confirmed COVID-19 (52 outpatients and 149 inpatients) that were treated in a large referral center in Tehran, Iran from March 2019 to May 2020. We used clustering approach to categorize clinical symptoms. One hundred and fifty-one patients showed at least one neuropsychiatric symptom. Limb force reductions, headache followed by anosmia, hypogeusia were among the most common neuropsychiatric symptoms in COVID-19 patients. Hierarchical clustering analysis showed that neuropsychiatric symptoms group together in three distinct groups: anosmia and hypogeusia; dizziness, headache, and limb force reduction; photophobia, mental state change, hallucination, vision and speech problem, seizure, stroke, and balance disturbance. Three non-neuropsychiatric cluster of symptoms included diarrhea and nausea; cough and dyspnea; and fever and weakness. Neuropsychiatric presentations are very prevalent and heterogeneous in patients with coronavirus 2 infection and these heterogeneous presentations may be originating from different underlying mechanisms. Anosmia and hypogeusia seem to be distinct from more general constitutional-like and more specific neuropsychiatric symptoms. Skeletal muscular manifestations might be a constitutional or a neuropsychiatric symptom. © 2020, The Author(s)

Non-Standard Errors

In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty: Non-standard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for better reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants

Non-standard errors

In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence generating process (EGP). We claim that EGP variation across researchers adds uncertainty: Non-standard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for better reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants

Transient ischemic attacks and presence of an acute brain lesion in diffusion-weighted MRI: study of 50 patients

Background: Finding an acute brain lesion by diffusion-weighted (DW) MRI upon an episode of transient ischemic attack (TIA) is a predictor of imminent stroke in the near future. Therefore, exploring risk factors associated with lesions in DW-MRI of the brain is important in adopting an approach to TIA management. In the current study, we tried to determine the risk factors associated with lesions in DW-MRI of the brain in patients experiencing TIA episodes.Methods: Fifty patients with TIA were recruited consecutively in Sina Hospital, Tehran, Iran, over a 6-month period between July 2008 and January 2009. All of the patients underwent a complete neurological examination and laboratory tests. Brain DW-MRIs were performed for all the patients within 72 hours of a TIA episode.Results: DW-MRI revealed an acute lesion in 16% of the participants. There was a significant correlation between presence of an acute lesion in DW-MRI and TIA duration, history of diabetes mellitus and presence of unilateral facial palsy (P=0.0003, P=0.02 and P=0.008, respectively). Other variables such as age, hypertension, hyperlipidemia, past history of TIA, headache, vertigo, and sensory or visual disturbances had no significant relation with the presence of an acute lesion in DW-MRI.Conclusion: Duration of TIA, presence of diabetes mellitus and unilateral facial palsy are risk factors for an acute lesion in DW-MRI, meaning that patients with such risk factors are at risk for stroke in the near future

Applying Wells score to inconclusive perfusion only modified PIOPED II (Prospective Investigation of Pulmonary Embolism Diagnosis II) readings in order to optimize the lung scintigraphy diagnostic yield in acute pulmonary embolism detection

Objective: When using perfusion only modified PIOPED II criteria for PE detection, generated non-diagnostic scans are found to be the main diagnostic restriction. The objective of current study is to identify the role of Wells criteria added to inconclusive readings with the intent of enhancing the lung scintigraphy diagnostic yield. Methods: CTPA was performed in 34 suspected PE patients with inconclusive lung scintigraphy. They also were evaluated by Wells score and classified as low, intermediate and high probability. Overall prevalence and the rate of PE for each probability were calculated. Furthermore, NPV for scores 6 were computed. Results: Having a mean age of 59.75 ± 17.38 years, 7 (20.6), 23 (67.6) and 4 (11.8) of cases had total criteria point count 6, respectively. Using CTPA, 5 patients (14.7) were diagnosed with PE. None of the patients with scores 6 were diagnosed with PE, implying that the PPV of scores > 6 was 100. Conclusion: Adding Wells score to non-diagnostic scans allowed identification of PE to be done reliably, and provided further insight into how lung scintigraphy in conjunction with clinical assessment is a practical strategy not only for the patients unfit for performing CTPA but also in all the patients referred for PE evaluation. © 2020, The Japanese Society of Nuclear Medicine

Current and Future Challenges of Radiation Oncology in Iran: A Report from the Iranian Society of Clinical Oncology

Aims: Growth of the cancer incidence rate in Iran has been very high in recent years. Therefore, the Iranian health care system should be prepared for the treatment of a huge number of patients in the foreseeable future. One of the most important treatment options for cancer is radiation. However, there is no comprehensive information on infrastructure for radiation oncology in this country. Materials and methods: In 2015, a questionnaire was designed by the Iranian Society of Clinical Oncology (ISCO) and all radiation oncology centres in the country were visited to determine four important components of radiation oncology services, including facilities, equipment, personnel and patients. Results: In 2015, 94 radiotherapy centres were identified in Iran. Sixty-one centres were fully operational, six centres were commissioning, 26 centres were under construction and one was inactive. Among the fully operational radiotherapy centres, 54 offered three-dimensional conformal radiotherapy and two-dimensional radiotherapy, eight offered brachytherapy, two intensity-modulated radiotherapy, two intraoperative radiotherapy, ostereotactic radiosurgery, two hyperthermia and 59 chemotherapy. Moreover, the survey identified 110 linear accelerators, 25 cobalt-60, one gamma knife, 21 remote brachytherapy afterloaders and six orthovoltage units. Treatment planning equipment included 15 graphy simulators, 19 dedicated computed tomography simulators, 22 multileaf collimator and 12 electronic portal imaging devices. Moreover, in 2015, 243 clinical oncologists participated in the treatment of 42 350 cancer patients in need of radiotherapy, which is about one radiation oncologist for 175 patients. During 2010�2015, number of cobalt-60 reduced 70, from 25 units to 8 units. Conclusions: There is a significant gap between Iran's available facilities for radiation therapy and international standards. Moreover, during international economic sanctions against Iran this gap widened. © 2017 The Royal College of Radiologist

Current and Future Challenges of Radiation Oncology in Iran: A Report from the Iranian Society of Clinical Oncology

Aims: Growth of the cancer incidence rate in Iran has been very high in recent years. Therefore, the Iranian health care system should be prepared for the treatment of a huge number of patients in the foreseeable future. One of the most important treatment options for cancer is radiation. However, there is no comprehensive information on infrastructure for radiation oncology in this country. Materials and methods: In 2015, a questionnaire was designed by the Iranian Society of Clinical Oncology (ISCO) and all radiation oncology centres in the country were visited to determine four important components of radiation oncology services, including facilities, equipment, personnel and patients. Results: In 2015, 94 radiotherapy centres were identified in Iran. Sixty-one centres were fully operational, six centres were commissioning, 26 centres were under construction and one was inactive. Among the fully operational radiotherapy centres, 54 offered three-dimensional conformal radiotherapy and two-dimensional radiotherapy, eight offered brachytherapy, two intensity-modulated radiotherapy, two intraoperative radiotherapy, ostereotactic radiosurgery, two hyperthermia and 59 chemotherapy. Moreover, the survey identified 110 linear accelerators, 25 cobalt-60, one gamma knife, 21 remote brachytherapy afterloaders and six orthovoltage units. Treatment planning equipment included 15 graphy simulators, 19 dedicated computed tomography simulators, 22 multileaf collimator and 12 electronic portal imaging devices. Moreover, in 2015, 243 clinical oncologists participated in the treatment of 42 350 cancer patients in need of radiotherapy, which is about one radiation oncologist for 175 patients. During 2010�2015, number of cobalt-60 reduced 70, from 25 units to 8 units. Conclusions: There is a significant gap between Iran's available facilities for radiation therapy and international standards. Moreover, during international economic sanctions against Iran this gap widened. © 2017 The Royal College of Radiologist