Coronavirus disease (COVID-19) pandemic around the world has some adverse effects on the human body, and there is limited data about the impacts of this pandemic disease on embolic brain stroke.
...Fifty-two COVID-19 patients with embolic brain stroke were included in this study. The COVID-19 patients were diagnosed according to their clinical findings. The patients underwent diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) values of different points of their brain were calculated using MRIcro software.
The embolic strokes were mostly diagnosed in the medial temporal lobe for both COVID-19 and others. In addition, a combination of COVID-19 with other inflammations and infections was not diagnosed in the studied patients. The mean ADC values of the central region were significantly lower than other regions of the brain stroke for the COVID-19 and other patients. Moreover, the maximum and minimum ADC values of the central region for COVID-19 and other patients were significantly different compared to the other regions. Whereas, the mean and minimum ADC values of the brain's normal regions were not significantly different in the edge regions for both groups, while in the COVID-19 and other patients the maximum ADC value of the edge regions was considerably lower compared to the normal regions.
The embolic stroke of COVID-19 patients is likely to occur in the medial temporal lobe of the brain. Moreover, the ADC and relative ADC (rADC) values of embolic brain stroke in COVID-19 patients are not significantly different compared to others.
Background: Doppler ultrasonography (Doppler US) plays an important role in evaluating patients with liver cirrhosis. This study aims to investigate the hemodynamic alterations of hepatic artery and ...portal vein among children with liver cirrhosis and portal hypertension (esophageal varices). Materials and Methods: We conducted an analytical cross-sectional study in Imam Hossein Children's Hospital, Isfahan, Iran, in 2016. A number of 33 cirrhotic children with or without esophageal varices were selected through convenience sampling method to be compared with 19 healthy children as controls using color and spectral Doppler US. Results: Portal vein mean velocities were 15.03 ± 7.3 cm/s in cirrhotics, 16.47 ± 6.4 cm/s in controls (P = 0.51), 11.6 ± 4.7 cm/s in patients with varices, and 17.9 ± 7.3 cm/s in patients without varices (P = 0.015). Mean diameters of caudate lobe, portal vein, and splenic vein, as well as the mean values of liver and spleen span, were significantly higher in cirrhotic children. The frequency of flow reversal (hepatofugal flow) was not detected significantly different in cirrhotics. Peak systolic velocity, end diastolic velocity, pulsatility index, and resistive index for hepatic artery as well as liver vascular index were not significantly different in cirrhotics in comparison with controls. Conclusion: Alterations in Doppler parameters of portal vein including diameter and velocity may be the helpful indicators of liver cirrhosis and esophageal varices in children, respectively. Parameters of hepatic artery may not differentiate children with liver cirrhosis.
Currently, it is shown that pregnancy may have an impact on the thyroid that can be leading to pregnancy complications such as abortion, preeclampsia, and preterm delivery. The objective was to ...compare the thyroid volume, number and characteristics of thyroid nodules, and prevalence of diffuse thyroid diseases in a sample of Iranian pregnant women in the first trimester to nonpregnant women.
This case-control study was conducted on 298 pregnant and 290 nonpregnant women. Thyroid volume, maximum diameter of thyroid nodules and prevalence of moderate to highly suspicious thyroid nodules, Hashimoto's appearance and goiter were assessed using thyroid ultrasonography. Antithyroperoxidase (TPO) antibodies were measured if the sonographic features were highly suggested for Hashimoto's thyroiditis.
The mean of total thyroid volume in pregnant and nonpregnant women was 6 and 6.5 ml, respectively (
= 0.053), and the median (interquartile range) was 6.2 and 5.5, respectively. Nodules were observed in 16.4% of pregnant and 16.6% of nonpregnant women (
= 0.845). Hashimoto's thyroiditis was detected in 6.7% of pregnant and 12.4% of nonpregnant women (
= 0.013). Anti-TPO antibodies were detected in 5% of pregnant and 9.3% of nonpregnant women (
= 0.034).
The thyroid volume and nodule characteristics in the first trimester of pregnancy were similar to nonpregnant women. Hashimoto's thyroiditis and anti-TPO antibodies in pregnant women were significantly lower than in nonpregnant women.
Background: Constipation is a common disorder in pediatrics, although the underlying pathogenesis is not fully understood. The current study aimed at evaluating the efficacy of different colonic ...transit time (CTT) indices for differentiating normal from nonnormal sensation in children with chronic functional constipation identified by anorectal manometry (ARM). Materials and Methods: In this cross-sectional study, 47 children with chronic idiopathic constipation, aged 5-15 years, were studied. The total and segmental CTTs were estimated by administering multiple radiopaque markers for 6 days and performing a single abdominal radiograph on day 7. Anorectal function was evaluated using manometry with an Arhan probe. The predictive value of CTT indices was evaluated by receiver operating characteristic curve analysis. Area under the curve (AUC) along with 95% confidence interval (CI) as well as sensitivity and specificity was calculated. Results: The mean age of the participants was 8.30 ± 2.99 years, with a mean constipation duration of 2.90 ± 0.46; 28 children were identified with nonnormal sensation. The mean values of CTT indices were statistically significantly longer in the nonnormal sensation patients than that in the normal group (P < 0.001). In addition, the mean values of manometry parameters were statistically significantly higher in nonnormal sensation patients than that in normal group (P < 0.01). Among CTT indices, rectosigmoid CTT (AUC 95% CI =0.999 0.99-1; P < 0.001) with sensitivity = 100% and specificity = 94.7% and total CTT (AUC 95% CI =0.972 0.93-1 P < 0.001) with sensitivity = 82.3% and specificity = 100% had the highest predictive values for differentiating nonnormal from normal sensation patients. Conclusion: CTT is a simple and noninvasive technique for classifying patients with constipation. It can be used for identifying children suffering from chronic constipation with nonnormal sensation reliably, instead of ARM. Colonic inertia may be a manifestation of global motility dysfunction. Children with delayed distal colonic transits are more likely to have abnormal defecation dynamics.
The celiac axis, superior mesenteric artery (SMA), and hepatic artery are the most important branches of abdominal aorta due to their vascularization field. The aim of our study was to evaluate the ...prevalence of different anatomical variation of celiac axis, SMA, hepatic artery, and its branches with multidetector computed tomography (MDCT) angiography of upper abdomen arteries.
MDCT of 607 kidney donor and traumatic patients that referred to MDCT unit at Al Zahra Hospital in Isfahan from 2012 to 2015 were retrospectively evaluated. We excluded patients with history of abdominal vascular surgery and hepatic or pancreatic surgery. Computed tomography images of the patient were obtained with 64-row MDCT scanner and anatomical variations were analyzed.
Three hundred and eighty-eight (63.9%) of the 607 patients had classic arterial anatomy and 219 (36.1%) patients had variant types. The most common type of variation was the origin of the right hepatic artery (RHA) from SMA (9.6%), and the next common variation was the origin of the left hepatic artery (LHA) from the left gastric artery (6.9%). Variations in the origin of the common hepatic artery (CHA) were seen in 16 (2.6%) patients. Buhler arc was identified in two patients. The RHA originated from the celiac axis in 11 (1.8%) patients and from the aorta in 8 (1.3%) patients. Trifurcation of CHA into gastroduodenal artery, RHA, and LHA was detected in 11 (1.8%) patients.
The results of the present study showed that anatomical variation occurs in a high percentage of patients. Detection of these variations can guide surgical and radiological interventional planning.
Background: Breast cancer is considered one of the most prevalent cancers among females worldwide. The aim of this study was to assess the magnetic resonance imaging (MRI) patterns of female breast ...cancer, and also the prevalence of mass-like and nonmass-like lesions among these patients. Materials and Methods: 32 patients with proven breast cancer (based on their pathologic findings and background parenchymal enhancement BPE of their magnetic resonance MR images) were included in this cross-sectional study which was performed from 2017 to 2019 in Isfahan, Iran, using a1.5 Tesla (Achieva Philips, Netherland) MRI scanner system. The MR sequences (noncontrast image and at least two contrast-enhanced images) were done in the prone position for studied patients. Results: It was found that 68.8% ( n = 44) and 31.2% ( n = 20) of breast cancers were suffered from moderate and severe BPE, respectively. Furthermore, the prevalence of mass-like nonmass-like and both tumors were 43.8%, 43.8%, and 12.4%, respectively. Pathological studies indicated that 50%, 37.5%, and 12.5% of cancers were ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), and DCIS, respectively. In addition, a significant relationship between MRI characteristics and pathologic findings was found for IDC and DCIS ( P = 0.03). Conclusion: Based on the results of this study, the relationship between BPE level and MRI finding including mass-like or nonmass-like lesions in biopsy-proven breast cancers was not significant.
Malignancy in thyroid nodules is a common clinical problem, and epidemiological studies have shown that it is increasing. Since malignancy is a very important problem in treating patients and ...misdiagnosis leads to many physical and financial damages, the importance of diagnostic methods becomes more important. Hence, the aim of this study was to investigate the sensitivity and specificity of the two dimensional-shear wave elastography (2D-SWE) diagnostic method in comparison with fine-needle aspiration (FNA) in determining the malignant thyroid nodules.
This study is cross-sectional which was performed on 57 thyroid nodules are proven by conventional ultrasound. Afterward, 2D-SWE images were taken with the help of a superSonic ultrasound machine. Then, FNA was performed from the thyroid nodules and the specimens were evaluated in a single specialized thyroid pathology center. The results of conventional sonography and 2D-SWE were compared with histopathologic results as a gold standard method. The elasticity quantity was recorded by measuring the amount of the appropriate quantities by a recording machine and analyzed using the SPSS and MedCalc software.
From 57 nodules studied, 50 nodules were evaluated with benign diagnosis and 7 nodules with the malignant diagnosis. Among all the parameters recorded by the machine, SWE. ratio provided the highest surface area under the curve and the highest sensitivity and specificity with 0.94, 100% and 84%, respectively, and a cut-off point of 1.7.
The 2D-SWE method and the conventional ultrasound can be good references for decision making about with the thyroid nodules.
Background: We assess the potency of different Doppler indices in the differentiation of obstructive and nonobstructive hydronephrosis. Materials and Methods: In this study, infants and children who ...were referred for the evaluation of unilateral hydronephrosis were enrolled. Ultrasonography for the assessment of the degree of hydronephrosis and a voiding cystourethrogram for the exclusion of vesicoureteral reflux was performed. Then, Doppler ultrasonography was done for both kidneys of each patient using four classic Doppler indices as well as the difference (delta) of each index between to kidneys. Diuretic renography with 99 mTc-ethylene dicysteine (99 mTc-EC) was performed for each patient. Results: Thirty-nine patients met the inclusion criteria. After diuretic renography, 29 (74.35%) patients had shown a nonobstructive pattern, and ten (25.65%) patients had a partial (intermediate) or complete obstruction. Using receiver operating characteristic (ROC) curve, none of the classic indices of Doppler duplex (i.e., resistive index RI, resistance index, end diastolic velocity, and peak systolic velocity) had the ability to make a difference between obstructive and nonobstructive hydronephrosis. However, by calculating the difference (delta) of these indices between two kidneys of each patient, delta RI could differentiate the nonobstructive condition, significantly (P = 0.006). A cutoff value of 0.055 has 60% sensitivity and 82.8% specificity. The area under the ROC curve for delta RI is 0.795 (standard error: 0.086, 95% confidence interval CI: 0.626, 0.964). Furthermore, RI ratio between two kidneys of each patient could differentiate the nonobstructive condition, significantly (P = 0.012). A cutoff point of 1.075 has 70% sensitivity and 82.8% specificity. The area under the ROC curve for RI ratio was 0.769 (standard error: 0.104, 95% CI: 0.565, 0.973). Conclusion: This study shows that RI ratio and delta RI with a high specificity could differentiate nonobstructive hydronephrosis and therefore it is a promising way to use especially in the follow-up of children with hydronephrosis.
Background: Germinal matrix-intraventricular hemorrhage (IVH) is the most common brain hemorrhage in preterm neonates. The importance of this hemorrhage lies in its severe complications. There is no ...definite treatment for IVH in neonates; therefore, the prevention of IVH should be considered. Some studies have shown that Vitamin E can probably decrease the risk of IVH and the other study has not shown its efficacy. The aim of this study is to evaluate the effects of Vitamin E on incidence and severity of IVH in preterm neonates. Methods: This study is a randomized clinical trial conducted on 76 neonates with gestational age of ≤30 weeks in the Isfahan University of Medical Science. The neonates were divided into two groups. The group one was administered with 10 units of Vitamin E for 3 days and the second group with placebo. In the 4th and 7th days after birth, brain sonography was conducted to evaluate IVH. The presence of sepsis, incidence of necrotizing enterocolitis, and hypotension were examined. Results: In this study, 76 neonates with the mean age of 28.49 ± 1.46 weeks participated. The incidence of hemorrhage in the 4th day was 26.3% in cases and 42.1% in controls with no significant difference (P = 0.3). The findings of the second sonography reported the incidence of IVH in 17.1% of cases and 36.8% of control group. Conclusions: Based on findings of the current study, Vitamin E use did not significantly decrease IVH in neonates. Further studies with larger sample size are needed.
Background: To evaluate the correlation of magnetic resonance imaging (MRI) features of breast lesions of Breast Imaging Reporting and Database System (BI-RADS) category 4 with histopathologic ...results. Materials and Methods: In a prospective study between December 2013 and April 2015, patients with suspicious mammographic and/or ultrasound findings referred for Breast MRI were evaluated. Patients with lesions of BI-RADS category 4 were enrolled with a written informed consent. In each patient, mass lesion (ML) or nonmass lesion (NML) was determined, and different characteristics of the lesions were recorded. A follow-up program was taken with mean 3-12 months. Patients who underwent core needle biopsy or open biopsy were summoned. Results: Seventy-eight females aged 24-67 years (mean 43.1 ± 8.8) met the inclusion criteria and had adequate samples for histopathologic study. Twenty-nine (37.2%) patients had ML and 49 (62.8%) patients had NML. Tissue sampling in 63 (80.7%) patients was through core needle biopsy and in 15 (19.2%) patients through surgery. A wide spectrum of benign and malignant pathologic diagnoses was seen. In statistical analysis, none of the MRI features has a significant correlation with any specific histopathologic diagnosis (P = 0.185). However, the relation between the MRI category (ML or NML) and pathology results was significant at level of 0.1 (P = 0.06). Conclusion: This study showed that a wide spectrum of histopathologic results is seen in BI-RADS category 4. However, in this sample volume, none of the MRI features in this BI-RADS category has a significant correlation with any specific histopathologic diagnosis.
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