Prostatic bed calcification with MDP uptake: Easy to miss on planar images

A 65 years old man with high-risk prostate adenocarcinoma underwent bone scintigraphy with 99mTc-methylene diphosphate (99mTc-MDP). The scan revealed a focus of radiotracer uptake in the left pubic region, which was suspicious for metastatic involvement. Additional imaging with single photon emission computed tomography (SPECT/CT) confined the uptake to be extra-osseous and contributed to the calcified zone in the prostate bed. Prostatic bed calcification with 99mTc-MDP uptake mimics metastasis and can be easily missed on planar images

Survey on Etiology of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis in Pediatric Patients: A Six-Year Study from Iran

Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are among the most severe dermatologic reactions to the drugs. Data about SJS and TEN among pediatric population especially in Iran is limited. This study aimed to investigate the clinical and para-clinical characteristics of pediatric patients with SJS/TEN. Materials and Methods From 2010 to 2016, all SJS and TEN children from three teaching hospitals in Mashhad-Iran with age less than 15 years were included in the study. Patients’ catechistic, history, physical examinations, progress notes, laboratory findings, medical consults, treatments taken and the final outcome were extracted from medical records by researcher. Data were further analyzed by SPSS (version 17.0). Results Among 165 records, 48 children (58.3% male; mean age of 9.1 years) were among the SJS and TEN spectrum. Anticonvulsants (50%; including lamotrigine, phenobarbital, phenytoin, carbamazepine, valproate and clobazam) were the most common drugs followed by antibiotics (38.1%; including cefixime, penicillin, azithromycin, co-amoxiclav, cephalexin, co-trimoxazole and ceftriaxone), and analgesics (9.5%; including acetaminophen, ibuprofen and naproxen). Infectious agents were the possible cause of SJS/TEN in two patients. WBC counts, liver function tests, renal and electrolyte tests were significantly different in SJS and TEN groups. Conclusion The main suspected medications found in this study were anticonvulsants and antibiotics and the mortality rate was 12.5%. The main suspected medications found in this study were anticonvulsants and antibiotics and the mortality rate was 12.5%

Accumulation of 99m-Tc Phytate in the pyelocalyceal system in a patient with chylous ascites — a pitfall resolved by SPECT/CT

We reported 99m-Tc phytate accumulation in the pyelocalyceal system of the kidney in the lymphoscintigraphic images of a 3.5months-old male infant with chylous ascites, which was mistaken with the site of lymph leakage. SPECT/CT localized activityin the para-aortic region to the renal pelvis and on delayed images, this was disappeared. Our case illustrates the added valueof SPECT/CT for the differentiation of possible false-positive findings in lymphoscintigraphy

[68Ga] Ga-Pentixafor diffuse bilateral Adrenal & Breast uptake in a patient with High-grade Glioma: A note of caution on normal variants

[68Ga] Ga-labeled C-X-C motif receptor4 as a novel radio-ligand using PET/CT has been investigated for tracing various kinds of solid and hematopoietic malignancies in recent years. High-grade Glioma (WHO classification 2016 grade III and IV) shows elevated levels of CXCR4 ligand expression in the affected tumoral cells. Healthy and non-affected organ cells express low-level CXCR4 ligands density. We performed [68Ga] Ga-Pentixafor (Pars-Cixafor™) PET/CT in a patient with high-grade Glioma (anaplastic oligodendroglioma WHO grade III) with no other documented medical condition and history. In addition to the Pentixafor-avid tumor remnant in the PET/CT images, we observed mild symmetrical bilateral uptake in the fibro glandular tissue of the breasts and moderate CXCR4(Pentixafor) avidity in both adrenal glands without any discernable pathology and abnormal density changes in the CT component of the study. Attention should be paid to the interpreting [68Ga] Ga-Pentixafor PET/CT examination and its normal uptakes and variants

How did the COVID-19 pandemic affect the referral patterns for SPECT myocardial perfusion? A single center experience

Objective(s): We evaluated the impact of the COVID-19 pandemic on the number of referrals for SPECT myocardial perfusion imaging (SPECT-MPI) as well as changes in the clinical and imaging characteristics.Methods: We respectively reviewed 1042 SPECT-MPI cases performed in a 4-month period during the COVID-19 pandemic (PAN; n=423) and compared their findings with those acquired in the same months before the pandemic (PRE; n=619).Results: The number of stress SPECT-MPI studies performed during the PAN period significantly dropped compared to the number of studies carried out in the PRE period (p = 0.014). In the PRE period, the rates of patients presenting with non-anginal, atypical and typical chest pain were 31%, 25% and 19%, respectively. The figures significantly changed in the PAN period to 19%, 42%, and 11%, respectively (all p-values <0.001). Regarding the pretest probability of coronary artery disease (CAD), a significant decrease and increase were noticed in patients with high and intermediate pretest probability, respectively (PRE: 18% and 55%, PAN: 6% and 65%, p <0.001 and 0.008, respectively). Neither the rates of myocardial ischemia nor infarction differed significantly in the PRE vs. PAN study periods.Conclusion: The number of referrals dropped significantly in the PAN era. While the proportion of patients with intermediate risk for CAD being referred for SPECT-MPI increased, those with high pretest probability were less frequently referred. Image parameters were mostly comparable between the study groups in the PRE and PAN periods

Study on Bacteria Associated with White Coats of Healthcare Workers in Two Tertiary Hospitals, Mashhad, Iran

Background: Health care-associated infections are an important cause of morbidity and mortality in hospitals. Reports have shown that nurses’ uniforms are sources of health care-associated infection transmission. The present study assessed the rate of bacterial contamination of healthcare worker’s white coats in two tertiary hospitals in Mashhad, Iran. Methods: 300 healthcare workers participated in the study from July to October 2011. Samples were obtained with a sterile swab from the outer surfaces of three sites of the white coat including the cuff, pocket mouth of the dominant hand and abdominal region. The samples were examined according to standard procedures. Results: Overall, 1220 microorganisms belonging to 13 different genera were isolated from a total of 900 samples. All 300 white coats were contaminated by bacteria of which 282 (94%) were pathogenic. The abdominal region had significantly higher number of isolates than the pocket and sleeve (p = 0.02). The white coats of “cardiac surgery ICU” and “surgery ward” had the mean highest number  of  isolates.  Gram-positive  Bacilli  (36.1%)  were  the  most  common isolates followed by Staphylococcus aureus (28%) and coagulase-negative Staphylococci (24.8%). Conclusion: Health care workers’ white coats are contaminated with a variety of bacteria. In order to reduce cross contamination from white coats to patients, re- educational programs and stricter rules of laundering and changing white coats are suggested

High-Level Vancomycin-Resistant Staphylococcus aureus (VRSA) in Iran: A Systematic Review

Background: Staphylococcus aureus is a major human pathogen worldwide. Vancomycin has been used for decades to treat multidrug resistant S. aureus. Ten years has passed since the first report of van­comycin resistant S. aureus (VRSA). The objective of this systematic review was to determine the total number of VRSA isolates that have been reported from Iran. Methods: Search terms reflected “Iran”, “vancomycin” and “S. aureus” were searched in the ISI web of knowledge, PubMed, SciVerse, and Google scholar. Also two Persian scientific databases and 13 recent national congresses were investigated. Articles / abstracts working on S. aureus in Iran, evaluating vancomycin MIC and/or PCR of vanA/B were included in this systematic review. Results: Out of the 3484 records found in mentioned resources, 13 re­lated studies were included in the final analysis. The result showed that at least 24 VRSA isolates which have been reported from Iran up to September 2012. Conclusion: It seems that many Iranian researchers did not follow a specific guideline for reporting and confirming VRSA. Establishing an Iranian reference center where studies on VRSA can be registered, evaluated and confirmed is strongly recommended. </strong

Inducible Clindamycin Resistant Staphylococcus aureus in Iran: A Systematic Review and Meta-analysis

<p><strong><em>Introduction</em></strong>: <em>S</em><em>taphylococcus aureus </em>is a prominent human pathogen. One of the drugs used in the treatment of staphylococcal infections (particularly infections of skin and soft tissue), is clindamycin. Resistance to clindamycin includes two types: inducible and constitutive. Routine laboratory methods of antibiotic susceptibility testing cannot detect the inducible type and D- test is required for its detection. The purpose of this systematic review was to determine the relative prevalence of this type of resistance in Iran.</p><p><strong><em>M</em></strong><strong><em>e</em></strong><strong><em>thods</em></strong>: Search terms "inducible clindamycin resistant", "D-test", "<em>Staphylococcus aureus</em>" and "Iran" were used to find relevant articles in PubMed, Google Scholar and two Persian search engines. Also, the abstracts of the recent national microbiology congresses were checked.All studies used D-test to find iMLSB  (inducible macrolide, lincosamide and streptograminB resistance) phenotype among clinical isolates (not nasal swabs) of <em>S. aureus</em>, were included. In order to perform meta-analysis, we used “comprehensive meta-analysis” software (ver. 2).</p><p><strong><em>Results</em></strong>: In total, 9 articles and 8 abstracts related to the topic of the study were found. Random effects meta-analyses showed a pooled estimate for percentage of iMLSB  phenotype among 2683 samples of <em>S. aureus </em>was about 10% (95% confidence interval: 0.07-0.12). Using the fixed effect model, the odds of positive iMLSB  in methicillin-resistant <em>S. aureus </em>was about 5 times more likely to occur in comparison with methicillin-susceptible <em>S. aureus </em>(95% CI: 3.49 to 7.76).</p><p><strong><em>Conclusion</em></strong>: Fortunately, the relative frequency of inducible resistance to clindamycin in our country is relatively low. However, we believe that D-test should be performed for all erythromicin-resistant  isolates  in  order  to  identify  inducible  resistance  to  clindamycin.Moreover, reevaluation of inducible reistance to clindamycin in forthcoming years is highly recommended.</p

Frequency and Antimicrobial Resistance Patterns of Methicillin-Resistant Staphylococcus aureus in Tehran

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) is the one of most commonly isolated organisms from clinical samples which can cause life- threatening infections. The emergence and spread of antibiotic resistance makes the treatment of these infections more complicated. In this study, we aimed to determine  the  patterns  of  antibiotic  resistance  among  MRSA  isolates  from Tehran, Iran. Methods: From December 2012 to April 2014, 120 clinical samples were collected. MRSA was identified by cefoxitin disc diffusion. Antimicrobial susceptibility testing was performed on MRSA isolates for eight other antibiotics by disc diffusion method according to CLSI (2013) recommendations. Also, the minimum inhibitory concentration (MIC) was determined for vancomycin by MIC test strips. Results: According to disc diffusion, 60 (50%) isolates showed resistance to cefoxitin. Among these isolates, the rate of resistance to nitrofurantoin, vancomycin, teicoplanin, doxycycline, trimethoprim, erythromycin, clindamycin, and ciprofloxacin were 0%, 0%, 0%, 28.3%, 28.3%, 58.3%, 63.3%, and 70%, respectively. All isolates were susceptible to vancomycin according to disc diffusion and MIC. Conclusion: Compared to other reports from Iran, our study indicated a moderate rate  for  MRSA.  However,  the  rates  of  resistance  to  generally  prescribed antibiotics in these isolates were high. In this situation, it is recommended to monitor the antibiotic resistance in these hospitals

A crying liver: a scan pattern mimicking spontaneous perforation of the biliary ducts

A 2-month-old infant was referred for hepatobiliary scintigraphy due to ascites of unknown cause. The top differential diagnosis was spontaneous perforation of the biliary ducts. Delayed images up to 4 hours were against this diagnosis showing normal distribution of the radiotracer throughout the bowel. However, on delayed images, the scan showed mild tracer retention in the ascites confirmed by SPECT/CT images. Surprisingly, the exploratory abdominal surgery revealed an intact hepatobiliary system, pointing toward other possible etiologies. Second-review surgery was performed due to uncontrolled progressive ascites showing congestive hepatopathy and biliary leak from the hepatic surface suggestive of the “crying liver”