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Transient ischemic attacks and presence of an acute brain lesion in diffusion-weighted MRI: study of 50 patients
Sabeti M, Naser Moghadasi A, Aloosh M, Paknejad Sm, Toghae M,
Volume 70, Issue 7 (10-2012)
Abstract

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.


Staphylococcal superantigens toxic shock syndrome toxin-1 and enterotoxins in pediatric otitis media effusion: a brief report
Noorbakhsh S, Farhadi M, Tabatabaei A,
Volume 70, Issue 12 (3-2013)
Abstract

Background: Staphylococcal superantigens (SAg&aposs) may have some role in otitis media with effusion (OME). The aim of this study was the search of staphylococcal SAg&aposs in middle ear effusion of children with OME. 
Methods: This cross sectional-analytic study was done in ENT & pediatric wards upon 64 children with otitis media with effusion (OME) between 1-15 years, (mean age=7.42+4 years) of Rasoul Akram University Hospital, Tehran, Iran in 2009-2011. Fifty six percent (36) of cases were male, 43.8% (28) were female. Staphylococcal SAg&aposs Toxic Shock Syndrome Toxin-1 (TSST-1), Staphylococcal enterotoxin A, B, C, D (Enzyme immune assay, AB Cam, USA) were detected in middle ear effusion samples after conventional culture.
Results: None type of SAg&aposs found in 39% of OME cases, enterotoxin B found in: 22% enterotoxin A: 17%, enterotoxin C: 15.6%, enterotoxin D: 12.5%, Toxic Shock Syndrome Toxin-1 (TSST-1): 7.8% Mean age of cases with positive TSST-1, enterotoxin A, B, C, and D was: 1, 5, 8.6, 9.6 and 9.6 years respectively. Positive TSST had no agreement with positive enterotoxin A and C but had weak agreement with type B and D. Mean age of cases with positive TSST was one years which had significant difference with (7.9 years) in cases with negative TSST test (P<0.0001).
Conclusion: At least one or more type of staphylococcal toxins had found in middle ear effusion of 70% of OME cases with negative culture for Staphylococcus aureus. Even in culture negative cases, staphylococcal toxins might have some immunologic role in middle ear effusion forming. Finding the SAg&aposs (at least one type) are important for treatment of immunosuppressive or corticosteroid in cases with resistant OME.


The value of diffusion weighted Magnetic Resonance Imaging in diagnosis of prostate cancer
Mahyar Ghafoori , Maryam Alizadeh , Jalil Kuhpayehzade ,
Volume 71, Issue 6 (9-2013)
Abstract
Background: Prostate cancer is the third leading cause of death and is the most common cause of cancer in elderly men. Regarding to the low accuracy of screening methods such as prostate-specific antigen (PSA), Digital Rectal Examination (DRE) and trans rectal ultrasound (TRUS) in detection and localization of tumor, Magnetic Resonance Imaging (MRI) and Diffusion Weighted Imaging (DWI) attracted many attentions in the past years. DWI reveals micro-molecular diffusion, which is the Brownian motion of the spins in biologic tissues. This technique can delineate pathologic lesions with high tissue contrast against generally suppressed background signal. In this paper, the value of DWI in detection of prostate cancer is studied.
Methods: In this cross-sectional study, the studied population are suspicious patients to prostate cancer based on high Prostatic Specific Antigen level or abnormal Digital Rectal Examination who refered for prostate biopsy to radiology department of Hazrat-e- Rasoul Hospital during the year 2011. The results of DWI are compared to biopsy results for all patients.
Results: Eighty five patients are selected. The DWI sensitivity in detecting of prostate cancer is 100%, specificity 97.1% and positive and negative predictive values are 89.5% and 100%, respectively. The results showed that if DWI reports the prostate cancer as negative, the result was highly reliable and if it reports as positive, although the report was not 100% reliable, but it still had high reliability, more than 90%.
Conclusion: DWI had high accuracy in detecting prostate cancer for patients with cancer. Also the accuracy of this method for patients without prostate cancer was acceptable compared to the other common methods.

Angiotensin II of paraventricular nucleus is exaggerated the renal ischemia-reperfusion injury
Behjat Seifi, Mehri Kadkhodaee , Enayatollah Bakhshi, Mina Ranjbaran , Parisa Ahghari , Bahareh Yasrebi ,
Volume 72, Issue 2 (5-2014)
Abstract
Background: The renal sympathetic nerve activity (RSNA) is enhanced in renal failure. Paraventricular nucleus in hypothalamus is an important central site to regulate sympathetic activity. There are angiotensin II (Ang) II receptors in this nucleus. The aim of this study was to evaluate the effects of angiotensin II in hypothalamic paraventricular nucleus (PVN) on renal ischemia-reperfusion injury and RSNA. Methods: This study was done at 2013 in Physiology department of Tehran University of Medical Sciences. One week before the induction of renal Ischemia-Reperfusion (IR) in Sprague-Dawley rats, a cannula was inserted into the right PVN for microinjection of different doses of Ang II (3, 30, and 300 ng). Then right nephrectomy was done. After one week recovery, renal IR injury was induced by clamping the left renal artery for 45 minute and then reperfusion for 3 or 24 hour. Ten minutes before the induction of renal ischemia-reperfusion, administration of different doses of angiotensin II were done in different groups. In all animals, left renal sympathetic activity was recorded before and during renal ischemia. After 3 or 24 hours reperfusion the blood, kidney and brain were collected to assay renal function and histology and oxidative stress indices Superoxide Dismutase, SOD and Malondialdehyde, MDA) in PVN. Results: Administration of different pharmacological doses of angiotensin II into PVN exaggerated the renal IR injury. Angiotensin II in different doses increased the plasma creatinine and BUN levels and renal histological markers in comparison to renal IR in-jury (P<0.05). Angiotensin II had detrimental effects on RSNA and oxidative stress in-dices Super Oxide Dismutase (SOD) and Malondialdehyde (MDA) in PVN as the dose was increased (P<0.05). Conclusion: These data showed that the PVN is a responsive site for central Ang II-induced damage in renal IR injury. We suggested the central effects of Ang II in the PVN on renal IR injury are mediated by oxidative stress in the PVN, and the peripheral effects by a sympathetic pathway.
Diagnosis of pleural effusion by portable ultrasound and chest radiography in intensive care unit
Mohammadreza Kasraei , Hamidreza Abtahi, Niloofar Eyoobi Yazdi, Enayat Safavi, Shahram Firoozbakhsh, Mostafa Mohammady,
Volume 72, Issue 7 (10-2014)
Abstract
Pleural effusion (PE) is common among ICU and acutely ill patients. Traditionally plain chest radiography (CXR) has been done for pleural effusion evaluation in ICU. However, better results have been reported by ultrasound for the diagnosis of this condition in ICU. In this study, we compared two methods of ultrasound and CXR in PE detection in ICU patients. Also we studied the percentage of thoracentesis by physician after detection of PE by ultrasonography or CXR. Methods: Portable supine CXR and chest ultrasound were done in Thirty-nine non-surgical patients who were admitted to the Medical and General ICUs of Imam Khomeini hospital in Tehran from Oct 2013 to Mar 2014. Ultrasound was done and interpreted by radiologist and CXR by patient' physician. Thoracentesis or CT-scan was used as gold standard for PE diagnosis. Results: Ultrasound in 29 patients (74.3%) showed PE. In 21 patients thoracentesis was done by patient’s physician and all had PE with mean volume of 447.2(417.6). In 13 of 18 patients without thoracentesis chest CT scan was available. It shows PE in 6 cases (all with positive PE in ultrasonography). CXR in 9 patients (23.1%) was positive for PE and in 30 patients (76.9%) was negative. The ability of chest ultrasound and CXR for diagnosis of PE was significantly different (P= 0.0.1). In 68.9 % of cases that ultrasound was positive, the CXR was negative and only in 34.5% of cases both methods had negative results. The sensitivity, specificity, positive and negative predictive values were 100% (87.1-100), 100% (58.9-100), 100% (87.1-100), 100% (58.9-100) respectively for ultrasonography. For CXR there were 33% (16.6-54.0), 100% (58.9-100), 100% (66.2-100), 28% (12.1-49.4) respectively. Conclusion: Ultrasonography for diagnosis of pleural effusion in ICU patients has better diagnostic performance than portable CXR
Study of polymorphism spa gene (encoding protein A) of Staphylococcus aureus in clinical isolates and nasal carriers
Hassan Mahmoudi , Mohammad Reza Arabestani , Seyed Fazlullah Mousavi , Safiyeh Ghafel , Mohammad Yousef Alikhani ,
Volume 73, Issue 1 (4-2015)
Abstract
Background: Staphylococcus aureus is the most important cause of nosocomial infections acquired in the community. Protein A is a major component of Staphylococcus aureus cell wall. In analysis of the nucleotide sequence Protein A encoding spa, locus x consists of 24 base pairs which repeat with high polymorphism. In this study, the spa gene of Staphylococcus aureus isolated from clinical specimens were obtained from patients admitted to the hospital and healthy carriers. Methods: In a cross-sectional study, a total of 200 samples were collected. One hundred fifty samples were obtained from hospitalized patients and 50 samples obtained from staff nasal swabs in Hamadan University Hospitals from October 2013 to August 2014. Disk diffusion antibiotic susceptibility tests performed. The antibiotics studied were Vancomycin (30 µg), Cefoxitin (15 µg) Gentamicin (10 µg), Tetracycline (30 µg), Trimethoprim/sulfamethoxazole (25 µg), Ciprofloxacin (5 µg), Erythromycin (15 µg), Clindamycin (2 µg), Rifampin (5 µg). The tests performed according to the guidelines of clinical and laboratory standards institute (CLSI). It also detect the mecA gene of Methicillin-resistant Staphylococcus aureus strains (MRSA) and genes spa which encodes the protein A by polymerase chain reaction (PCR). The PCR products using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method with enzyme Rsa I (Afa I) were prepared. Results: This methicillin-resistant Staphylococcus aureus strain (MRSA) had the highest sensitivity and resistance to ciprofloxacin and clindamycin. Totally, 8 amplicon with different sizes for the spa gene were identified. A total of 9 patterns polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) were found. Some of these patterns between Staphylococcus aureus isolated from clinical specimens and nasal carriers were common. Conclusion: There is a similar pattern of spa gene among patients admitted to the hospital and staff, according to our findings. Analysis of the patterns can reduced transmission of infection in both hospital staff and patients. Also it can help the physicians for correct management of infections.
Association between concentration of interleukin-6, 17 and 23 and Helicobacter pylori infection in otitis media with effusion
Mohammad Farhadi , Ahmad Daneshi , Shima Javadi-Nia, Mohammad Nabavi , Ramin Asgarian, Mahmood Faramarzi , Azardokh Tabatabaie ,
Volume 73, Issue 2 (5-2015)
Abstract
Background: Helicobacter pylori (H. pylori) cause various diseases especially gastrointestinal disorders. Clinical diagnosis of H. pylori infection can be done in different ways, and new diagnostic methods are under study .This study aimed to assess the levels of interleukin (IL) 6, 17 and 23 in the middle ear effusion of patients with otitis media, and the association between these levels with H. pylori infection. Methods: This cross-sectional study conducted in 40 patients who nominated for ventilation tube (VT) placement due to otitis media with effusion, and admitted to ear, nose, and throat (ENT) clinics of Tehran University of Medical Sciences from March 2012 to August 2013. All of patients underwent myringotomy with VT insertion, and then aspirated effusion sample was tested. H. pylori infection diagnosed by polymerase chain reaction (PCR) and bacterial culture. The concentration of IL-6, IL-17 and IL-23 measured by enzyme-linked immunosorbent assay (ELISA). The levels of each interleukins were compared between the two positive and negative PCR groups. Results: In all of samples, PCR test result was positive in 22.5%. The mean and standard deviation of IL-6 level was 10.11±2.95, IL-17 was 5.89±0.91 and IL-23 was 4.07±1.34. The mean±standard deviation (SD) of IL-6 level in patients with a positive PCR (H. pylori) was 22.29±6.40 and in patients with a negative PCR was 6.16±3.88 that difference was significant (P=0.01). The mean±SD of IL-17 level in patients with a positive PCR was 6.16±1.29 and in patients with a negative PCR was 5.81±1.13 that difference was not significant (P=0.42). The mean±SD of IL-23 level in patients with a positive PCR was 6.15±3.77 and in patients with a negative PCR was 3.42±1.33 that difference was not significant (P=0.27). Conclusion: According to finding, association between H. pylori infection and increased levels of IL-6 in the middle ear effusion was approved. It is recommended to conduct researches aimed to identify other cytokines as inflammatory markers.
Production of polyclonal antibody against Tehran strain influenza virus (A/H1N1/2009) hemagglutinin conserved domain (HA2): brief report
Somayeh Zamani, Fatemeh Fotouhi Chahouki, Zahra Nourmohammadi , Saeideh Sadeghi Neshat, Vahideh Mazaheri , Ali Torabi , Behrokh Farahmand ,
Volume 73, Issue 7 (10-2015)
Abstract

Background: The influenza virus is one of the most important factors for higher morbidity and mortality in the world. Recently, researchers have been focused on influenza conserved antigenic proteins such as hemagglutinin stalk domain (HA2) for vaccine production and serological studies. The HA2 plays a major role in the fusion of the virus with host cells membrane. The immunity system enables to produce antibody against HA2. The aim of this study is polyclonal antibody production against influenza HA2. Methods: This study was done in the Influenza Research Lab, Pasteur Institute of Iran, Tehran for one year from September 2013 to October 2014. In the present study, recombinant HA2 protein was produced in prokaryotic system and purified using Nickel affinity chromatography. The purified HA2 was mixed with Freund’s adjuvant (complete and incomplete) and injected into two New Zealand white rabbits by intramuscularly and subcutaneously routes. Immunization was continued for several months with two weeks interval. Before each immunization, blood was drawn by venous puncture from the rabbit ear. Function of rabbit's sera was evaluated using radial immunodiffusion (RID) in both forms, Single RID (SRID) and Double RID (DRID). Finally, antiserum activity against HA2 was evaluated using western blotting as serological assay. Results: Sedimentary line and zone was observed in RID assays (SRID and DRID) represent interaction between HA2 protein and anti- HA2 antibody. As well as, western blotting results was positive for HA2 protein. Therefore, these results showed that polyclonal antibody produced against HA2 protein can identify HA2 protein antigenic sites. Conclusion: These findings show that humoral immune responses have properly been stimulated in rabbits and these antibodies can identify HA2 protein and may be suitable for other serological methods.


Leukocytes and transfusion related adverse events: the effects of leuko-reduction process in the prevention of adverse reactions resulted from the transfusion of blood components: review article
Ehteramolsadat Hosseini , Amin Shahbaz Ghasabeh , Mehran Ghasemzadeh ,
Volume 75, Issue 2 (5-2017)
Abstract

Blood transfusion is commonly implemented to manage life and health-threatening conditions on a rapid and short-term basis. Over the years, ongoing technical advances have dramatically improved transfusion medicine to provide more safety and effectiveness. However, transfusion is still complicated with different adverse events that mainly induced by the presence of allogeneic leukocytes in the blood products. Several lines of evidence have shown that leukocytes in blood components are involved in the induction of febrile nonhemolytic transfusion reactions (FNHTRs), HLA alloimmunization and platelet refractoriness as well as the increased risk of the infectious diseases transmitted by leukotropic viruses including cytomegalovirus (CMV), human T-lymphotropic virus (HTLV)-I/II and Epstein-Barr virus (EBV). During current decades, introducing various leuko-reduction techniques have shown to be associated with less transfusion related adverse events and improved clinical outcomes. The lower incidence and severity of febrile transfusion reactions; reduced risk of transfusion related transmission of CMV or other leukocyte-associated infections, lowered incidence of alloimmune platelet refractoriness in addition to reducing risk of mortality and morbidity in patients are considered as clinical benefits of leuko-reduced products. Currently, by the use of 3rd and 4th generation of filters, the highest levels of leukoreduction in blood components have been achieved. Filtration techniques have also the advantages of being performed shortly after preparation of components (pre-storage) or post-storage even at the patient’s bedside. However, it seems that pre-storage depletion of leukocytes provides better protection than post-storage techniques due to the elimination of leukocyte-derived cytokines effects which are increasingly released during storage. Particularly in platelet products, the earlier depletion of leukocyte also favors less platelet-induced leukocyte activation which may be triggered by the interaction between either activated platelets or their released chemokines and residual leukocytes during storage. Despite the benefits attributed to leukoreduction of blood components, the global use of leukoreduced products is commonly hampered by its high cost especially in developing countries in which leukoreduction of blood components is usually limited to some patients with special conditions. In this review, after briefly introducing of some transfusion adverse events that are attributed to allogeneic leukocytes existed in blood products, the effects of leukoreduction process in the attenuation of these events will be discussed.


The prevalence and assessment of blood transfusions in newborns
Hajieh Borna , Shiva Rafati , Fathemeh Haj Ebrahim Tehrani , Someieh Gadimii ,
Volume 75, Issue 3 (6-2017)
Abstract

Background: Blood transfusion is common in infants. Due to the weakened immune system of newborns and the risk of blood transfusion complications, it is necessary to pay more attention following or after to blood transfusion. The aim of this study was to evaluate the frequency and risk factors of blood transfusions in hospitalized neonates.

Methods: A cross-sectional study was performed on 1106 infants admitted in the neonatal intensive care unit (NICU) of Mustafa Khomeini University Hospital, Tehran, Iran, from spring 2009 to 2012. Frequency and the reason for of blood components transfusion including fresh frozen plasma, platelets, whole blood, packed red blood cells, cryoprecipitate and relationship with gestational age, sex, birth weight, Apgar score, duration of hospitalization, use of mechanical ventilation were assessed. Statistical analysis was performed with SPSS statistical software, version 16 (IBM, Armonk, NY, USA) and statistical test, chi-square test, independent t-test and analysis of variance (ANOVA).

Results: Among 1106 infants admitted to the neonatal intensive care unit, 221 infants (%19.98) received blood products. 82 of all (37%) were female and 139 (%63) were female. 113 (51%) of neonate were preterm and 108 (48%) were term. From 361 times of blood transfusions, 121 infant (54.75%) received at least one blood product. The frequency of blood transfusion was between 39 and 1 times, with an average of 3.65 times per infant. Frequency of fresh frozen plasma infusion was 173 (47.9%), packed cell 122 (33%), platelet 32 (8.8%), cryoprecipitate 20 (5.1%) and whole blood 3 unit (0.83%). The most common causes for fresh frozen plasma transfusion was replacement therapy 140 (80%), for packed cell, to correct symptomatic anemia 68 (55.6%), for platelet transfusions was to prevent bleeding in  neonates with thrombocytopenia 20 (62.5%) and cryoprecipitate for bleeding caused by DIC in 18 infant (90%). There was significant relation between frequency of blood transfusions with gestational age (P=0.002), birth weight (P=0.01), cause of hospitalization (P=0.001) using of ventilator (P=0.002), and length of hospital stay (P=0.001).

Conclusion: With attention to the guidelines of blood transfusions and controlling factors affecting premature birth and low weight infants, reducing length of hospital stay and duration of mechanical ventilation, frequency and complications of blood transfusion can be effectively decreased.


Pathogen inactivation of blood derived biological medicines: review article
Shahnaz Nazari , Majid Shahabi , Kamran Mousavi Hosseini ,
Volume 75, Issue 4 (7-2017)
Abstract
One of the main sources of a wide range of biological products as starting material is the human blood. These biological human plasma derived medicines play essential role in prevention and treatment of a variety of life threatening diseases. Mention to the starting material of these medicines which is blood or in another word human plasma, possibility of contamination by blood borne viruses cannot be omitted.
In recent years possibility of contamination by blood borne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) is an important concern. Nowadays most of developed countries the risk is minimum, although in developing countries it is still a challenge. Despite measures for human plasma biological derived medicines safety, such as donor selection, testing of donations, and polymerase chain reaction (PCR) testing on pooled plasma, still more actions are needed to inactivate or remove viruses such as HBV, HCV and HIV. During the process of manufacturing of biological human plasma medicines, there is several production steps which may contribute to viral reduction. These steps consist of precipitation by centrifugation, ethanol, polyethylene glycol, octanoic acid, or ammonium sulphate, chromatographic methods such as immunoaffinity chromatography or ion exchange chromatography, adsorption by aluminum hydroxide, and separation by filtration. All these steps are considered to be weakly effective as viral reduction treatment, and more effective viral inactivation methods are needed to be implemented in line of production of human plasma derived biological medicinal products. These safety measures included virus inactivation by different techniques such as acidic pH, solvent/detergent method, pasteurization and heat treatment, beta-propiolactone plus U/V and also virus removal by nanofiltration, which all these virus inactivation or virus removal methods before implementation in line of production of plasma derived biological medicines, should undergo for validation study.
Nowadays by screening and testing of donations and implementation of different measures of virus inactivation or virus removal, a good level of safety of plasma derived biological medicines has been achieved. Due to the possibility of emerging new pathogens investigation in this subject should be continued. 

Different dose-dependent effects of hydrogen sulfide on ischemia-reperfusion induced acute kidney injury in rats
Fateme Azizi , Behjat Seifi , Mehri Kadkhodaee ,
Volume 75, Issue 9 (12-2017)
Abstract
Background: Renal ischemia reperfusion (RIR) injury is a common clinical syndrome that affects renal function and significantly increases morbidity and mortality. Hydrogen sulfide (H2S) is an endogenously gaseous mediator that exhibits many cytoprotective effects. Recently, studies have shown that H2S have opposite effects in different doses. Therefore, in the current study we investigated the effects of H2S at different doses on renal function after induced renal ischemia reperfusion injury model.
Methods: The present study is an experimental study in animals and was conducted in Tehran University of Medical Sciences in April 2014. Male Wistar rats were assigned to five main groups (n= 6): 1) Sham, 2) Ischemia reperfusion (IR), 3) Administration of 50 µmol/kg Sodium hydrosulfide (NaHS)+IR, 4) Administration of 75 µmol/kg NaHS+IR and 5) Administration of 125 µmol/kg NaHS+IR. Sham group underwent laparotomy without cross-clamping of renal pedicles. Renal ischemia (IR) was induced in rats by both renal arteries occlusion for 55 min followed by reperfusion. Rats in the NaHS groups received intraperitoneal injections of 50, 75, or 125 µmol/kg of NaHS 10 minutes before the onset of ischemia and immediately after the onset of reperfusion. After reperfusion, plasma was collected for functional evaluation.
Results: Compared to the sham, IR animals demonstrated a significant rise in plasma creatinine and BUN levels. Rats in the low-dose NaHS treated groups (H50, H75) had improved renal function by significantly decrease of creatinine and BUN levels. However, treatment with a high-dose of NaHS increased the levels of plasma creatinine and BUN levels as compared with these indices in the IR group.
Conclusion: Our study demonstrates that different doses of Sodium hydrosulfide (NaHS) can play diverse role in renal ischemia reperfusion injury. However, NaHS in the low-doses could protect the kidney from the RIR injury, in a higher dose NaHS exaggerated the renal function by increases plasma creatinine and BUN. Therefore, determining of the therapeutic doses of NaHS may be important in the protection of kidney from the RIR injury.

Differentiation of active tumor from edematous regions of glioblastoma multiform tumor in diffusion MR images using heterogeneity analysis method
Hamidreza Saligheh Rad , Anahita Fathi Kazerooni , Mahnaz Nabil , Mohammadreza Alviri , Mehrdad Hadavand, Meysam Mohseni ,
Volume 76, Issue 3 (6-2018)
Abstract
Background: Due to intrinsic heterogeneity of cellular distribution and density within diffusion weighted images (DWI) of glioblastoma multiform (GBM) tumors, differentiation of active tumor and peri-tumoral edema regions within these tumors is challenging. The aim of this paper was to take advantage of the differences among heterogeneity of active tumor and edematous regions within the glioblastoma multiform tumors in order to discriminate these regions from each other.
Methods: The dataset of this retrospective study was selected from a database which was collected at the medical imaging center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Iran. The quantification was performed as a part of a research study being supported by the Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran, between May and September 2017. Twenty patients with histopathologically-confirmed GBM tumors who had been imaged on a 3T MRI scanner prior to their surgery, were included. Conventional and diffusion weighted MR images had been carried out on the patients. The regions of interest including the regions of active tumor and edema were identified on MR images by an expert and overlaid on ADC-maps of the same patients. Histogram analysis was performed on each of these regions and 14 characteristic features were calculated and the best feature combination for discrimination of active tumor from edema was obtained.
Results: It was shown that by combining 8 out of 14 histogram features, including median, normalized mean, standard deviation, skewness, energy, 25th, 75th, and 95th percentiles, differentiation with accuracy of 96.4% and diagnostic performance of 100% can be achieved. Furthermore, by combining mean, energy, and 75th percentile features of histograms, the active tumor region can be discriminated from the edematous region by 92.7% of accuracy and 98.9% of diagnostic performance.
Conclusion: The present study confirms that the heterogeneity of cellular distribution can be a predictive biomarker for differentiation of edematous regions from active tumor part of GBM tumors.

The factors that affect blood and blood products usage in coronary artery graft surgery
Kianoush Saberi , Shahnaz Sharifi, Mehrdad Salehi , Paniz Mihandoost,
Volume 76, Issue 11 (2-2019)
Abstract
Background: Coronary artery bypass surgery is one of the surgeries in which high blood transfusions are needed. About 20% of all surgical operations require a blood transfusion. Packed cell administration increases perioperative morbidity and mortality. In the United States, from every 1000 people, one has undergone a coronary artery bypass graft surgery, and it is estimated that around 800,000 coronary artery bypass grafts undergo each year. Knowledge about relative blood administration during coronary artery bypass graft surgery improves the ability of blood transfusion centers in healthy and adequate blood donations. For this purpose, this study was conducted to determine the effective factors in the need for blood in a coronary artery bypass graft surgery.
Methods: This cross-sectional study was performed on 317 patients undergoing coronary artery bypass graft surgery in the heart surgery operating room of Imam Khomeini Hospital in Tehran, Iran, from September 2017 to February 2018. Sampling method has been available. The data of this study were extracted from patient files. The products analyzed in the study included packed cell, fresh frozen plasma and platelets. Demographic data, type of surgery, transfusion of blood and products, and hemoglobin level have been reported. P-value less than 0.05 was reported as meaningful.
Results: In this study, 317 patients underwent coronary artery bypass graft surgery. 236 cases (74.4%) were male and the rest were women. The mean of administration of packed cell in women was 2.74±1.3 and in men it was 2.29±1.09 (P<0.001). The mean packed cell administration in patients with hemoglobin levels less than 10 g/dl was 3.27±1.8 and in patients with hemoglobin levels greater than 10 g/dl was 0.99±2.25 (P<0.0001).
Conclusion: The present study showed that the mean transfusion of packed cells in women were more than men in coronary artery bypass graft surgery. Also, hemoglobin levels were the only factor that had a significant effect on infusion of packed cells.

Differentiation of benign and malignant breast lesions by apparent diffusion coefficient value in mass and non-mass lesions
Masoumeh Gity , Behnaz Moradi, Rasool Arami , Ali Arabkheradmand, Mohamad Ali Kazemi,
Volume 77, Issue 1 (4-2019)
Abstract
Background: Diffusion-weighted imaging (DWI) is one of methods in evaluation of breast lesions. We aimed to investigate the apparent diffusion coefficient (ADC) values in breast tumors and their accuracy in differentiating benign versus malignant lesions.
Methods: In this cross-sectional study, 72 patients with 88 breast lesions were investigated by 1.5-T breast MRI from 2015 to 2017 in Athari Imaging Center in Tehran, Iran. Nearly all patients has undergone histopathology evaluation. One small region of interest (ROI) were placed on the most restricted region inside the solid part on the ADC map. Care was taken to avoid cystic or necrotic, fatty regions and hematoma inside the mass. A large round ROIs were placed in healthy fibroglandular tissue of contralateral breast ADC values were measured and compared in normal breast tissue and in most restricted parts of breast lesions (mass and non-mass). After determining cut-off for differentiation of benign and malignant lesions, sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated.
Results: Mean age of patients was 43.3 years. The average tumor size of benign and malignant lesions were calculated 26.0 mm, 35.3 mm respectively and 23 mm and 46 mm in mass and non-mass respectively. Invasive ductal carcinoma include the majority of pathology result (in 37.5% of the patients). Our results revealed that the measured ADC values in normal breast tissue were higher than breast lesions (P≤0.01). Mean ADC value in benign lesions was 1.40×10-3 mm²/s and for malignant lesion was 1.08×10-3 mm²/s. ADC value in the normal breast tissue was 1.79×10-3 mm2/s and was significantly higher than ADC value of breast lesions (benign and malignant). Cut-off value in non-mass was not valid, but in mass was 1.19×10-3 mm²/s with sensitivity, specificity, positive predictive value, negative predictive and accuracy of 89.7%, 83.8%, 87.5%, 86.6%, and 87.1% respectively.
Conclusion: In DWI imaging, ADC value can differentiate benign and malignant masses with high sensitivity and specificity but not helpful in non-mass lesions.

A case report of ovarian fibroids torsion with ascites and pleural effusion: case report
Seyede Houra Mousavi Vahed , Maliheh Afiat, Fahimeh Alizadeh, Anahita Hamidi Laien , Zeynab Khademi, Azin Nikoozadeh,
Volume 77, Issue 2 (5-2019)
Abstract
Background: Ovarian fibroma is the most common benign solid tumor of the ovary. The most common symptoms are abdominal discomfort and pain. Ovarian fibroids are associated with Meigs syndrome in 1% to 10% of cases. The aim of study is report of a case of Meigs syndrome
Case presentation: A 65-year-old menopausal woman who complained of abdominal pain was referred to our academic hospital of Mashhad, Iran, in April 2018. In abdominal examination, a soft mass with size of 200×100 mm, was detected. Also leukocytosis and increase in CRP was observed. Marker CA125 was higher than 200. In CT scan in right adnexa heterogeneous mass 170×100 mm with enhancement was reveled. pleural effusion was reported in the both lungs and collapse of underlying lung tissue in Chest X-ray. Explorative laparotomy was performed. Ascites and inflamed omentum covered the surface of right ovary was detected. The huge solid-cystic hemorrhagic, irregular mass with a specific pedicle that enclosed in the capsule in right adnexa was seen. Right salpingo-oophorectomy was performed. The result of final pathologic was benign proliferative lesions of mitotic fibroblasts were reported according to ovarian fibroma.
Conclusion: In case of accompanying ovarian mass with ascites and pleural effusion, after the exclude of ovarian malignancies, Meigs syndrome should be considered in differential diagnosis.

Efficacy and complications of oral ibuprofen and intravenous acetaminophen in closure of patent ductus arteriosus of preterm neonates
Semira Mehralizadeh, Majid Mirmohammmadkhani, Aylin Kalantarzade ,
Volume 77, Issue 8 (11-2019)
Abstract
Background: Previous studies have considered patent ductus arteriosus (PDA) a common finding in premature infants, leading to complications such as intracranial hemorrhage, necrotizing enterocolitis and pulmonary dysplasia. The aim of this study was to assess and compare the efficacy of oral ibuprofen and intravenous acetaminophen in the closure of arterial duct in premature newborns. We also evaluated the complications of each drug.
Methods: A cross-sectional and analytical study was conducted at Amiralmomenin Hospital, Semnan City in Iran from April 2012 to December 2017. Subjects were selected through convenient sampling and consisted of all premature infants with patent arterial duct. All of the infants with the diagnosis of PDA were treated with either intravenous acetaminophen or oral ibuprofen. Cardiac echocardiographic findings were assessed in two study groups before and after each treatment course. The complications associated with the two treatment approaches were evaluated in two groups after treatment of each drug.
Results: In general, twenty-four neonates (62.5% females) with the average gestational age of 31.46±3.43 weeks were studied. There was no significant difference in the echocardiographic characteristics in the two treatment groups at the pre and post-treatment periods as well as the side effects of the medications. The average number of treatment cycles in newborns treated with oral ibuprofen (1.06±0.25) was not significantly different compared to those with intravenous acetaminophen (1.25±0.46) (P=0.190). There was no significant difference concerning closure status of the arterial duct in the two treatment groups at the end of the first period (P=0.112) as well as after the second period of treatment (P=0.386).
Conclusion: Our study indicated similar efficacy of oral ibuprofen and intravenous acetaminophen in the closure of the arterial duct. The incidence of complications was not significantly different between the two groups. The results of this study suggest the use of intravenous acetaminophen as a suitable drug for PDA closure, particularly in cases of ibuprofen contraindications.

Premedication drugs’ evaluation and incidence of infusion-related reactions in patients receiving amphotericin B
Shirinsadat Badri , Sara Etemadi-Moghaddam , Azadeh Moghaddas ,
Volume 77, Issue 12 (3-2020)
Abstract
Background: Amphotericin B is one of the most useful therapeutic modalities for the treatment of patients with invasive fungal infections, in spite of serious side effects, namely kidney injury, electrolyte imbalances, and infusion-related reactions. The goal of this study was to assess the different aspects of premedication practice and the incidence and types of infusion-related reactions in patients receiving amphotericin B.
Methods: This observational study was performed on 70 hospitalized patients who received amphotericin B in different departments of two university hospitals, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, from January 2017 to February 2018. Information on physicians’ performance regarding premedication administration for amphotericin B, including the types and doses of medications administered prior to amphotericin B infusion, as well as patients’ clinical data including infusion-related side effects were collected and then analyzed in comparison with the standard practice guidelines.
Results: The study population consisted of 70 patients with the mean age of 51.6±18.3 years, who received amphotericin B for 8.2±3.5 days. From 70 evaluated patients, 21 patients (30%) had encountered the infusion-related reactions, including chills, fever, urticaria, headache, and hypotension. These side effects were evident in 19 patients (27%) who received no premedication and 2 patients (3%) who received only one drug as premedication, before amphotericin B administration. Twenty patients (28%) experienced chills, fever and headache, while 7 patients (10%) had nausea and vomiting during amphotericin B infusion. Hydrocortisone 50-200 mg, was the most prescribed agent for premedication (in 67% of patients), while chlorpheniramine 10 mg (in 50% of patients) and promethazine 10 mg (in 35% of patients) were the second and third prescribed ones, respectively.
Conclusion: In this study, the patients who received no or only one drug as premedication experienced infusion-related side effects. This emphasizes the necessity for standard premedication practices to prevent this type of adverse reactions. Considering the higher price of liposomal form of Amphotericin-B, if prescribed correctly, even the conventional form would be an effective and tolerable treatment for invasive fungal infections.

Evaluating of the results of long fusion surgery in patients with degenerative lumbar scoliosis
Majid Rezvani, Soheil Falahpour, Amir Hossein Haghir, Tayeb Ramim,
Volume 79, Issue 3 (6-2021)
Abstract
Background: Degenerative scoliosis most commonly affects the lumbar spine in the elderly, resulting in facet and disc degeneration, leading to increased pain and progressive deformity. Due to the importance of the results of long fusion and the rate of coronary and sagittal correction of imbalance in patients with degenerative scoliosis, the present study was performed to evaluate the results of long fusion surgery in patients with degenerative lumbar scoliosis.
Methods: The present study was performed as a prospective cohort study in patients with degenerative scoliosis who were candidates for surgery at Al-Zahra Hospital in Isfahan. Basic patient information including age, sex, anatomical location of vertebral deviation and slip, degree of severity of deviation based on cobb angle and number of previous surgeries were reviewed and recorded. The surgical characteristics of the patient were extracted from the medical record including the approach used, the anatomical location of the fusion, whether or not to perform decompression, the number of decompression and fusion levels, the amount of bleeding during surgery, and the duration of surgery.
Results: Eleven female patients participated in this study. The mean age of patients was 55.64 years with a standard deviation of 7.67 years. The minimum age was 40 years and the maximum age was 66 years. Patients' symptoms included low back pain-leg pain (3 cases), back pain-lameness (2 cases) and back pain-leg pain-lameness (6 cases). All patients underwent two stages of surgery. Mean amount of bleeding and time of surgery in the second surgery were significantly reduced compared to the first surgery (p <0.05). Complications of surgery included proximal junctional vertebral fracture (PGK) in two patients.
Conclusion: Degenerative scoliosis is a complex clinical condition in which the patient's main problems are pain and disability. Long fusion surgery in patients with degenerative scoliosis significantly reduced the mean deviation, Patient’s pain and severity of disability 6 months after surgery.

The percentage of otitis types in patients being reffered to ENT clinic: a brief report
Ayeh Shamsadini, Maryam Amizadeh, Keramat Mozaffarnia, Nafiseh Fakharpour,
Volume 79, Issue 8 (11-2021)
Abstract
Background: Otitis is the most common infectious disease of the ear with internal and external cranial complications. If the infection is in the middle ear, it causes otitis media. If the infection is in the external ear, it’s along with otitis externa (OE). Different types of otitis media include acute otitis media (AOM), chronic otitis media (COM) and Otitis media with effusion (OME). This study aimed to investigate the different types of otitis and its symptoms.
Methods: This cross-sectional study was conducted from March 2019 to February 2020 for 200 patients who have been referred to the ENT center of Shafa hospital, Kerman, Iran. Sampling was conducted with ease and no need for specified sampling distribution. The type of otitis was written in a questionnaire by the physician after the examination. The present research investigated types of otitis along with its symptoms. Also, their demographic information was determined.
Results: This study was done among 200 patients. 106(53%) participants were diagnosed with external otitis and the most common symptoms include discharge from the ear, inflammation and pain of the ear. 53 patients (26.5%) had acute otitis media with the most common symptoms of tympanic membrane color change and otalgia. 22 patients (11%) were diagnosed with chronic otitis media. So, perforation of the tympanic membrane and otorrhea were considered as the most common symptoms for these patients. 9(9.5%) of participants had otitis media with effusion that aural fullness and reduction of hearing were the most common signs. In this research, most of the patients were between the age of 11 to 30.57% of patients in this study were men and 43% were women. Most of the patients were between the age of 30-40 and the least number of patients were over the age of 70. Among the 200 patients, most of them lived in cities and provinces rather than villages. 67.5% of patients didn’t have an academic certificate.
Conclusion: Considering the high prevalence of otitis among patients with ENT disorder, it was recommended that otitis should be recognized and cured.

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