abdulrasool alaee
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Background
In mechanically ventilated patients, portable chest radiography (CXR) can provide important information for selecting the optimal therapeutic approach. This study aimed to determine the diagnostic and therapeutic efficacies of portable recruited chest radiography with maximum inspiratory volume and pause in comparison with conventional portable radiography.
Materials and MethodsThis diagnostic accuracy study was conducted on 75 mechanically ventilated patients admitted to the intensive care unit (ICU) of Imam Khomeini Hospital in Sari, Iran, during 2013-2015. For every patient, in addition to conventional portable CXR, another CXR was performed with mechanical ventilator adjustments (tidal volume up to 10-12 ml/kg to maintain the inspiratory plateau pressure below 35 cmH2O and inspiratory time of 2-3 seconds). CXR was performed after 5-10 respiratory cycles, synchronized with the inspiratory pause. The radiographs were acquired using a Shimadzu portable radiography system in the anteroposterior supine position and randomly presented to two radiologists for reporting.
ResultsThe mean age of the patients was 63.5±14 years. Overall, 43 (57.3%) patients were male, and 32 (42.7%) were female. Therapeutic interventions were performed for only 8% of cases with conventional CXR versus 21.3% of cases with recruited CXR; the difference was found to be statistically significant (P<0.05). The diagnostic efficacy of portable recruited CXR versus conventional portable CXR was 45% versus 18.6%. Also, the therapeutic efficacy of portable recruited CXR versus conventional portable CXR was 21.3% versus 8%.
ConclusionPortable recruited CXR seems to be a valuable diagnostic approach for clinical decision-making, with higher diagnostic and therapeutic efficacies in mechanically ventilated patients.
Keywords: Portable chest radiography, CXR, Recruited chest radiography, Mechanical ventilation, ICU -
Context
Pediatric optic neuritis can occur in isolation or association with neuroinflammatory disorders. We reviewed the abnormal orbital and cranial magnetic resonance imaging in literature diagnosed as pediatric optic neuritis, which was primarily presented with visual problems.
Evidence AcquisitionA PubMed literature search was accomplished using the following key terms: “Neuroimaging", “Pediatric", “Optic Neuritis", “Multiple Sclerosis", and “Magnetic Resonance Imaging".
ResultsPoorly demarcated changes in white and or gray matter, well-demarcated white matter changes, confluent lesions in white matter, and small nonspecific lesions or nothing in some areas of the brain are the most common patterns of children with optic neuritis. The thin, fat suppression imaging technique can reveal optic nerve lesions. Contrast-enhanced sequences, especially by short tau inversion recovery, allow differentiation of particular high-signal intensity foci in the optic nerve and newly formed active lesions from inactive lesions.
ConclusionsBrain imaging should be performed in all patients, if possible, during the two weeks after the initial diagnosis. The cranial neuroimaging can predict multiple sclerosis development in pediatric patients with demyelinating brain lesion
Keywords: Pediatric Optic Neuritis, Neuroimaging, Magnetic Resonance Imaging -
Background
The parieto-frontal integration theory of intelligence revealed a novel scope of investigation examining how performance networks are related to structural networks in the brain.
ObjectivesThese investigations highlighted the role of brain commissures, but no evaluation has been performed examining the anterior commissure (AC) in determining the level of intelligence.
Patients andMethodsA total of 100 healthy volunteers were selected, and their brain MRIs were acquired. Measurements were performed for the AC and the corpus callosum (CC) on MRI. Intelligence quotient (IQ) was calculated using the Wechsler Adult Intelligence Scale-R (WAIS-R). P < 0.05 was considered significant.
ResultsThe average age of men was 32.58 ± 8.84 years, and the average age of women was 32.88 ± 7.83 years. The average IQ of volunteers in the study was 103.57 ± 4.178. Partitioning the subjects by gender did not lead to significant results. No significant correlation was determined between the dimensions of AC and IQ. The height of the CC had a positive correlation with IQ. However, the thickness of the genu, body, and splenium of the CC demonstrated no significant relation to IQ.
ConclusionThe AC had no clear relationship with IQ, although it may have a role in women. The height parameter of the CC had a significant correlation with IQ, suggesting the interference between the anterior and posterior parts of the brain in the human intelligence process.
Keywords: MRI, Brain, IQ, Gender, ommissure, Corpus Callosum Fiber Development -
سابقه و هدفلکومالاسی اطراف بطن (PVL) فرم نوروپاتولوژیک اصلی آسیب مغزی در نوزادان نارس است. هدف از این مطالعه بررسی کاربرد اندازه گیری های حجم پونز و طول کورپوس کالوزوم در پیش بینی شدت اختلال حرکتی در کودکان مبتلا بوده است.مواد و روش هادر مطالعه مورد-شاهدی با استفاده از MRI، 91 کودک (57 پسر و 34 دختر) مبتلا به PVL و 91 کودک شاهد همسن (50 پسر و 41 دختر) طی سال های1392 تا 1393مورد بررسی قرار گرفتند. کودکان مبتلا بر اساس شدت اختلال حرکتی خود با توجه به سیستم طبقه بندی عملکرد حرکتی درشت طبقه بندی شدند. حجم پونز و طول کورپوس کالوزوم با استفاده از تصاویر اندازه گیری شد و هر یک از پارامترها بین گروه شدت اختلال حرکتی و کنترل مقایسه گردید.یافته هامیانگین حجم پونز در گروه PVL (mm3 71/1769±93/3837) به طور قابل توجهی کم تر از گروه کنترل (mm3 48/1593 ± 70/4350) بود (014/0p=). همبستگی معنی داری بین حجم پونز و طول کورپوس کالوزوم در گروه PVL (49/0 r= و 001/0p=) و گروه کنترل(60/0r= و 001/0=p) مشاهده شد. پس از مقایسه گروه ها تفاوت معنی داری در کاهش حجم پونز بین سطح یک اختلال حرکتی با سطوح سه، چهار و پنج اختلال حرکتی و سطح پنج اختلال حرکتی با گروه کنترل مشاهده شد.
استنتاج: در این مطالعه برای اولین بار گزارش می شود بیومارکرهای حجم پونز و طول کورپوس کالوزوم با شدت اختلال حرکتی ناشی از PVLمرتبط هستند..کلید واژگان: پونز, کورپوس کالوزوم, لکومالاسی اطراف بطنی, شدت اختلال حرکتیBackground andPurposePeriventricular leukomalacia (PVL) is the major neuropathologic form of brain injury in premature infants. This study aimed at evaluating the use of pons volume and corpus callosum length measurements in predicting the severity of motor impairment in affected children.Materials And MethodsUsing MR imaging, we examined 91 children (57 boys and 34 girls) with PVL and 91 age-matched control children (50 boys and 41 girls), 2013-2014. Affected children with PVL were stratified according to the severity of motor impairment based on Gross Motor Function Classification System (GMFCS). The pons volume and the corpus callosum length were measured using the images and different parameters were compared between both groups.ResultsMean pons volumes were significantly smaller in the PVL group than that in the control group (3837.93 ± 1769.71 vs. 4350.70 ± 1593.48 mm3; P = .041). A significant correlation was observed between pons volumes and corpus callosum length in the PVL group (r= 0.49; P= 0.001) and the control group (r= 0.60; P= 0.001). Significant differences were seen in reduction of the size of pons between level I motor impairment and levels III, IV, and V motor impairment. Also, a similar pattern was observed between patients at level V motor impairment and the control group.ConclusionIn this study, for the first time, pons volume and length of the corpus callosum biomarkers were found to be associated with the severity of motor impairment caused by PVL.Keywords: pons, corpus callosum, severe motor impairment, periventricular leukomalacia -
مقدمههیدرونفروز یافته ی به نسبت شایعی در بررسی های داخل رحمی است. حدود نیم تا دو درصد از سونوگرافی های داخل رحمی، آنومالی سیستم ادراری را در جنین نشان می دهد. در این مطالعه، شیوع سنگ های ادراری و عوامل خطرساز ایجاد آن، در بیماران مبتلا به هیدرونفروز مادرزادی، مورد بررسی قرارگرفت.روش هاکلیه ی نوزادانی که در طی فاصله ی زمانی اسفندماه 1382 تا اسفندماه 1392 به علت هیدرونفروز قبل از تولد، به بیمارستان بوعلی سینای ساری مراجعه کرده، در سونوگرافی های سریال شواهدی از سنگ کلیه یا مجاری ادراری داشتند، مورد بررسی قرار گرفتند. برای کودکان مبتلا به سنگ دستگاه ادراری، بررسی از نظر علل متابولیک و عفونی ایجاد سنگ انجام گرفت.یافته هااز 285 نوزاد با هیدرونفروز مادرزادی، 52 مورد (18 درصد) مبتلا به سنگ های کلیه و مجاری ادراری بودندکه از این بین، 40 نفر پسر و 12 نفر دختر بودند. اندازه ی سنگ ها از 3 تا 9 میلی متر بود. سنگ های ادراری در 10 درصد بیماران مبتلا به رفلاکس و 25-20 درصد بیماران مبتلا به انسدادهای ادراری مشاهده شد. شایع ترین اختلال متابولیک موجود، هایپرکلسیوری بود که بیش از همه، در بیماران مبتلا به دریچه ی پیشابراه خلفی بروز داشت. تنها یک مورد هیپراگزالوری و دو مورد هیپوسیتراتوری وجود داشت و موردی از سیستینوری مشاهده نشد. 29 درصد از بیماران دچار رفلاکس و 13 درصد از بیماران مبتلا به انسداد محل اتصال حالب به لگنچه، دچار عفونت ادراری بودند ولی هیچ یک از بیماران مبتلا به دریچه ی پیشابراه خلفی، سابقه ای از عفونت ادراری قبل از تشکیل سنگ نداشتند. در 23 بیمار (58 درصد) هیچ اختلال متابولیک یا عفونی یافت نشد.نتیجه گیریسنگ کلیه، عارضه ی مهم و شایعی در بیماران مبتلا به هیدرونفروز قبل از تولد است. هرچند در حدود دوسوم بیماران هیچ فاکتور مساعد کننده ی عفونی یا متابولیک یافت نمی شود، ولی عفونت ادراری و هیپرکلسیوری به عنوان فاکتورهای مساعدکننده ی ایجاد سنگ کلیه در بیش از یک سوم بیماران موجود است.
کلید واژگان: هیدرونفروز قبل از تولد, سنگ کلیه, رفلاکس مثانه به حالب, انسداد حالب به مثانه, انسداد لگنچه به حالبBackgroundAntenatal hydronephrosis (AH) is found in 0. 5-2% of neonates. The aim of the study was to assess the frequency of nephrolithiasis in infants with antenatal hydronephrosis and the risk factors of stone development.MethodsIn this study، neonates with a history of prenatal hydronephrosis were enrolled during March 2002 until March 2012. Those with any evidence of urinary tract stone were assessed for infectious and metabolic risk factors of stone formation.FindingsFrom 285 studied neonates، 52 (18%) had nephrolithiasis on ultrasound studies and were enrolled into the study. The male to female ratio was 40 to 12. The stone diameter was 3-9 mm; only 1 patiens had bladder stone and all other stones were located in kidneys، more in left kidney. The stone was observed in 10% of patients with vesicoureteral reflux (VUR) and in 20-25% of infants with obstructive urinary disorders. Hypercalciuria was the most common metabolic abnormality. 6 patients (15%) had urinary tract infection (UTI) before detection of stone and 5 (13%) had UTI after diagnosis of nephrolithiasis. The frequency of UTI in patients with VUR and ureteropelvic junction obstruction was 29% and 13%، respectively. There was no history of UTI in patients with posterior urethral valve (PUV) before diagnosis of nephrolithiasis. There were no infectious or metabolic risk factors in 23 patients (58%).ConclusionsUrolithiasis in a common and important complication in infants with prenatal history of hydronephrosis. 64% of the patients had no risk factor other than hydronephrosis for stone formation.Keywords: Antenatal hydronephrosis, Urolithiasis, Ureteropelvic junction obstruction, Ureterovesical junction obstruction, Vesicoureteral reflux -
BackgroundPrevious studies have proven the development of white matter hyperintensities (WMH) in methamphetamine and opioid users. Opiates and methamphetamines (MA) are the most common addictive agents in Iran. The adverse effects of drugs on the CNS is of concern to specialists and researchers, and given that the neurotoxicity associated with methamphetamine is greater than opioids, it is hypothesized that the severity of WMH in patients with methamphetamine dependence is more than opioid drug-dependent individuals..ObjectivesTo our knowledge, this is the first research comparing the effect of methamphetamine and methadone (M) on the brain..Patients andMethodsIn a historical cohort study, we compared WMH in the brain MRI of 50 methamphetamine-dependent patients, 50 methadone-dependent patients and 50 healthy volunteers who were matched for age, sex and dominant hand..ResultsWMH was detected in 18 methamphetamine users, in 12 methadone users and in seven controls (P = 0.038). The site of brain lesions in MA users was mostly in the frontal lobe in 17 cases, in M users in the frontal lobe in 12 cases and in the control group, it was in the parietal lobe in four cases (P = 0.001). The frontal lobes were the predominant locations of WMH in MA and M groups (P = 0.001). The frequency of brain lesions was mostly in the deep WM in 18 cases in MA users, in 12 cases in M users and in two cases in the control group (P=0.007). Hyper-signal foci of deep WM in the MA group were grade I (punctuate) in 12 cases, grade II (beginning confluence) in five cases and grade III (large confluent) in four cases. In the M group, there were six cases in grade I, three cases in grade II and one case in grade III. In the control group, there were three grade I cases, two grade II cases, and no grade III cases. Except for periventricular WMH (P = 0.13), there were statistical significant differences in the deep WMH (P = 0.007) and subcortex WMH (P = 0.01) between the three groups. The history of using other drugs and the duration of MA and M consumption were similar. The prevalence of brain lesions was generally higher in both drug user groups compared with the healthy controls. Increased WMH in the MA group was higher than the M group..ConclusionsA greater number of blood flow defects and ischemic lesions in the brain of MA users compared to opiate users may explain the prevalence of psychiatric disorders in these patients..Keywords: Methamphetamine, Methadone, White Matter Hyperintensitiess, Magnetic Resonance Imaging
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Appendiceal intussusception is a very rare cause of abdominal colic in childhood. This paper reports a reducible appendiceal intussusception in the barium enema in a girl and reviews articles in PubMed.Keywords: Appendiceal, Intussusception, Barium reduction
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