Search

Key Clinical Message Systemic Lupus Erythematosus (SLE) can have an insidious onset and a fatal prognosis in children. Patients presenting without typical signs of SLE should undergo further evaluation if they are not responding to the initial diagnosis and treatment. This is especially true for patients with rapidly progressing symptoms and deterioration in spite of treatment. Abstract Pediatric Systemic Lupus Erythematosus is a chronic autoimmune disorder with various organ involvement pulmonary involvement in the course of this disorder is a rare yet potentially life‐threatening complication. In this case report we highlight the findings of a 16‐year‐old girl acutely and initially presenting with cough and fever, eventually complicating to diffuse alveolar hemorrhage and gradual loss of consciousness. Although the patient was started on immunosuppressive treatment after the diagnosis of lupus, based on renal and hematological impairment, was made and initially responded, she eventually deteriorated.

Purpose Idiopathic intracranial hypertension (IIH) is a clinical syndrome that mimics brain tumors with increased intracranial pressure. The present study is designed to investigate the diagnostic criteria of magnetic resonance imaging (MRI) and the severity of cerebrospinal fluid (CSF) pressure to understand the relationship and frequency of these criteria with the level of CSF pressure. Methods The present cross-sectional study was conducted on children diagnosed with IIH between the years 2011 and 2020, who were admitted to the pediatric neurology department of Ghaem Hospital, Mashhad, Iran. Clinical manifestations and imaging findings of the patients were recorded through a checklist. Results Forty-nine patients were included in the study; 27 (55.1%) were male, and 22 (44.9%) were female. The average CSF pressure was 40.64±20.63 cmH2O. The mean diameter distension of the perioptic subarachnoid space was 6.02±1.21 mm. Six (10.8%) patients had unilateral transverse sinus stenosis with an average CSF pressure of 20.47±36.80 cmH2O and 11 (21.4%) patients had bilateral transverse sinus stenosis with an average pressure of 48.22±21.04 cmH2O. In 22 (44.89%) patients, flattening of the posterior globe with the CSF pressure of 48.80±17.94 cmH2O was reported. Twenty-four (49%) patients had optic nerve tortuosity, with an average CSF pressure of 46.52±20.33 cmH2O. Among the diagnostic criteria, the pressure had a significant relationship with the flattening of the posterior globe (P

Casehardening (σi) is an internal stress-related phenomenon that develops in kiln-dried wood materials, causing shape distortion. This study focuses on the impact of drying schedule and wood parameters (e.g., density, moisture) on σi. Results indicated that the wood's final moisture content level has the highest impact when it is above 15%. However, the wood moisture gradient is the most influential factor when wood's moisture content is below 15%. Drying schedule aggressiveness and post-drying treatments also affect σi; an aggressive drying schedule followed by conditioning remarkably reduces σi occurrence.

Atomic spectral line filter is a narrow band pass optical filter which has many applications in quantum and laser systems. By engineering the system parameters like gas temperature and intensity of magnetic field, the filter with desired characteristics could be obtained. In this work, an atomic spectral line filter for Cesium D1 line (894.6nm) is implemented and characterized. The effect of system parameters on the filter transmission and its bandwidth is investigated. It is observed that by applying a magnetic field of 390 Gauss and adjusting the gas cell temperature on 40°C, a single peak filter with maximum filter transmission and FWHM of 0.24 GHz could be obtained.

None

Abstract The current study evaluates a rare case of parietal bone osteoid osteoma in pediatrics and review the differential diagnosis of button sequestrum sign in the literature. A 12‐year‐old girl expressed localized pain in the right parietal bone. MRI represented enhancing nodule with button sequestrum sign appearance.

Background: Knowing the conversion risk factors of laparoscopic cholecystectomy to open surgery, helps the surgeon to plan for surgery accordingly. This study aimed to determine the risk factors for converting laparoscopic cholecystectomy to open surgery. Methods: In this analytical study, the case information of 1104 patients who underwent laparoscopic cholecystectomy in Shahid Beheshti Hospital in Qom from April 2013 to April 2017 was evaluated. Inclusion criteria were all cases of acute cholecystitis, chronic cholecystitis, symptomatic gallstones, and biliary pancreatitis who underwent laparoscopic cholecystectomy. The exclusion criteria were patients who underwent laparoscopic cholecystectomy at the same time with other procedures. Data of all patients including age, sex, history of abdominal surgery, emergency or elective surgery, blood transaminase level, blood bilirubin level, white blood cell count, amylase level, and serum alkaline phosphatase were recorded. Finally, potential risk factors were compared between the two groups. Average, standard deviation, frequency and percentage indices were used to describe the data. Independent samples t‐test and Mann-Whitney U test were used for quantitative data analysis and Chi-square test was used for qualitative data analysis. P

Background: Identifying risk factors for conversion to open surgery laparoscopic cholecystectomy and factors are difficult to predict cholecystectomy surgery is required. The aim of this study was to evaluate the findings of preoperative ultrasound in predicting the length of laparoscopic cholecystectomy surgery. Methods: The present study was performed cross-sectional on 122 patients who underwent laparoscopic cholecystectomy in Shahid Beheshti, Forghani and Nekoei’s Hospital in Qom from September 2016 to September 2017. Inclusion criteria: All cases of acute cholecystitis, chronic cholecystitis, symptomatic gallstones and biliary pancreatitis underwent laparoscopic cholecystectomy. The exclusion criteria included patients undergoing laparoscopic cholecystectomy at the same time were other procedures. Before surgery patientschr('39') information such as age, sex, ultrasound findings including gallbladder wall thickness, compressed stone and the presence of fluid around the gallbladder were recorded in the checklist. Finally, the duration of cholecystectomy was divided into two degrees of easy operation (less than 60 minutes and without complications) and difficult operation (above 60 minutes with complications) according to the mentioned variables. Data were analyzed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA). In this study, a significance level of less than 0.05 was considered. Results: 28 (22.4 percent) males and 97 (77.6 percent) females with a mean age of 44.66 13 13.85 years were studied. There were 35 difficult cases (28 percent) and 90 easy cases (72 percent). Conversion to open surgery occurred in three cases. Among the sonographic findings, there was a significant relationship between the increase in gallbladder wall thickness and Impacted stone with the duration of operation (P≤0.05). But no significant relationship was found between the findings of Presence of pericholecystic fluid and the duration of operation (P>0.05). Conclusion: Overall, the findings of this study showed that preoperative ultrasound is able to provide valuable data in predicting the duration of laparoscopic cholecystectomy.

Neurological involvement in the coronavirus disease 2019 (COVID-19) infection is increasing all over the world. Neurological manifestations include headache, dizziness, stroke, seizure, encephalopathy, neuropathy, and skeletal muscle injury. While many patients with central nervous system involvement have normal neuroimaging, some show significant abnormalities. In this article, we report five patients with neurological manifestations of COVID-19 infection and its relevant abnormalities in brain magnetic resonance imaging.

Background and Objectives: Nasal bone hypoplasia is a rare hereditary disorder, which seems to be related to other anomalies. This disorder may clearly appear in the appearance of a person by increasing age, and in terms of nasal and psychological functions, which its manifestations are different depending on the severity of the disorder. Case Report: The case was a 36-year-old woman who was referred to Beheshti Hospital of Qom city in 2016 with a chief complaint of dissatisfaction of the shape her nose. The patient had no previous surgery internal diseases, and trauma of head and face. She had no respiratory complaints, sleep apnea, nasal congestion, or rhinorrhea, but she complaint of recurrent sinusitis in the past. In the examination, her nose was cartilaginous and nasal bone impalpable on both sides. This article discusses a case of nasal bone hypoplasia, which was repaired by temporalis muscle fascia in the operating room.

Background: Increased subcutaneous fat thickness and depth of target organs in over-obese patients, results in weak signals and inadequate images. Tissue harmonic imaging has been used widely in obese patients and is believed to result in higher quality images. This superiority is not proved in modern machines with improved image quality in conventional mode. Objective: To compare the image quality between conventional and tissue harmonic ultrasound images. Methods: This cross-sectional study was carried out from March 2015 to June 2016. Seventy-six over-obese patients referred to Ghaem Hospital (Mashhad, Iran) for weight-correction surgeries, were enrolled into the study. Conventional and tissue harmonic images of their kidneys were blinded and compared back-to-back by four expert radiologists. Data were analyzed by SPSS version 16, using Cochrane’s Q test. Results: All raters reported image quality to be better in tissue harmonic compared to fundamental frequency ultrasound (p=0.000, Cochrane’s Q test). Although better image quality in tissue harmonic mode was reported by the four raters, there was weak inter-observer agreement (p=0.081 for right kidney and p=0.21 for left kidney). Conclusion: Advances in ultrasound equipment and the introduction of tissue harmonic imaging can improve the diagnostic performance in over-obese patients and this mode of imaging should be used whenever evaluating over-obese subjects.

Extraosseous accumulation of technetium-99m-methyl diphosphonate (99mTc-MDP) on bone scan is not common. This phenomenon is often attributed to abnormality of calcium metabolism and has been reported in a variety of conditions including metabolic diseases and malignancies. A five years old boy is presented here, who was admitted to the pediatric emergency suffering from fatigue, respiratory symptoms, weight loss, intermittent fevers, anorexia, nausea and vomiting, edema of legs and abdominal distension for one month. The initial laboratory analysis revealed hypercalcemia. The patient was referred for whole body bone scan with suspicion of malignancy and bone metastasis. The bone scan revealed highly increased radiotracer uptake in both lungs in the perfusion and blood pool phases. Delayed images also showed increased activity in lungs and gastric wall. The skeleton was not seen clearly. Bone marrow aspiration was done and established the diagnosis of ALL. The patient deceased due to respiratory failure 20 days later. Diffuse lung uptake in this patient was consistent with respiratory failure and poor prognosis. It is reported that bone scan may be useful for assessment of the extent of metastatic calcification and may establish suitable management to prevent organ failure.

Contracts for oil and gas development projects are naturally complex, they are explained with some of maps and technical specifications. To supply the goals of contracts, it is necessary to construct by a team having owner, consulting engineer and contractor. The unique aspects of each project and team working are resulting to disagreements. It should be noted that the majority of team workers have not previously worked together. It may not be expected to forecast all project aspects in design and preparation of tender documents process. However, in some cases it will occur inconsistencies in contract documents and possibly may be disagreements on commentary of the cases which there are in the provisions of the contract. Every root of disagreement resulted in to claim and finally dispute. Lack of foresight and/or existing ambiguous texts in some provisions of contract, not being aware of components of the project to conditions and obligations and rules of contract will complex and sometimes impossible the agreement on implementation problems. Therefore, the claims will be resulted in disputes and inflict financial losses to contractors and/or owners and then the projects will not be completed. In Iran many activities have not been carried out about claims and disputes in different orientations especially in areas futures and hence, it was studied in this research. Firstly, research history was considered and the causes of claims and disputes were identified in process of different levels of oil projects construction from primary to exploitation and then a questionnaire was prepared using the comments of experts. Finally, the questionnaire was analysed by SPSS and the approved factors in creation of claims and disputes and in their roots were ranked.

Here, the population transfer between two specific levels of Cesium atomunder the influence of chirped laser source has been numerically investigated. The maingoal of this study is the engineering of the population transfer between the 62S1/2 and 62P1/2levels of Cesium which is corresponding to its D1 transition line using a chirped lasersource. Constructing the system Hamiltonian, as well as the initial and boundaryconditions, the time-dependent Schrödinger equations are numerically solved and thepopulation versus time for different physical parameters has been investigated. The finalpopulation of each state is calculated and discussed for changing the parameters such aslaser intensity, laser frequency and chirping parameter. The results show that using thechirped laser source with tuned parameters, we can arbitrarily control the population oflevels.

Canthariasis is a human disease caused by infestation of beetle larvae. We report here an unusual cause of urogenital in­fection due to Tenebrio molitor in a 10-year-old boy suffering from severe and intermittent suprapubic pain from Nehban­dan City, Northeastern Iran in 2018. After 9 months, three larvae were excreted. Keratinization of bladder wall was ob­served in histopathology. All laboratory evaluations were normal except for presence of microscopic hematuria. This re­port implicated that T. molitor could infest bladder accidentally and cause canthariasis and clinical symptoms that may lead to severe pain and bladder inflammation and hyperemia.

Introduction: This systematic review studies the prognostic value of two conventional imaging tools, sestamibi and gallium scans, for predicting how patients with Hodgkin lymphoma will respond to treatment.Methods: The PubMed database was searched for English-language articles that contained the following search terms: (Hodgkin AND [mibi OR sestamibi OR gallium OR spect] AND response). All articles that were identified during this search were included in the study, regardless of date published. The inclusion criteria were as follows: articles that described studies that were limited to Hodgkin patients and that reported the predictive value of conventional imaging tools. Articles about other types of lymphoma and/or those that focused on the diagnostic and staging accuracy of mibi and gallium scans were excluded.Result: In total, 14 articles were retrieved. Of these, the majority met the inclusion criteria of the systematic review with the exception of two, which were limited to an examination of the reliability of performing sestamibi scans to predict the response to treatment. All remaining 12 articles considered both the sestamibi scans and the gallium scintigraphy.The results of the systematic review indicate that positive gallium scan results can be proposed as a poor prognostic factor that is associated with partial or full recurrence of Hodgkin disease, a reduction in overall survival rate, and progression-free survival compared with patients with a negative scan.Discussion: Both sestamibi and gallium scans revealed high sensitivity and specificity in predicting the response to treatment including complete remission, partial remission, and recurrence of the disease.Conclusion:These imaging tools can appropriately assess how Hodgkin patients will respond to chemotherapy. As such, clinicians can use these tools to devise appropriate treatment strategies.

Purpose: Rib fractures are the most common skeletal thoracic injuries resulting from blunt chest trauma. Half of the rib fractures are not detected upon a precise physical evaluation and radiographs. Recently ultrasonography (USG) has been investigated to detect rib fractures. But based on literature the usefulness of USG varies widely. This study was conducted to investigate the role of USG in the detection of possible rib fractures in comparison with radiography. Methods: In this cross-sectional study, consecutive patients with minor blunt chest trauma and suspected rib fractures presenting in Imam Reza Hospital located in Mashhad-Iran, between April 2013 and October 2013 were assessed by USG and radiography. The radiography was performed in a posteroanterior (PA) chest projection and oblique rib view centered over the area of trauma. The time duration spent in taking USG and radiography were recorded. The prevalence and location of fractures revealed by USG and radiography were compared. Results: Sixty-one suspected patients were assessed. The male to female ratio was 2.4:1 (43 men and 18 women) with a mean ± SD age of (44.3 ± 19.7) years. There were totally 59 rib fractures in 38 (62.3%) patients based on radiography and USG, while 23 (37.7%) patients had no diagnostic evidence of rib lesions. USG revealed 58 rib fractures in 33 (54.1%) of 61 suspected patients and radiographs revealed 32 rib fractures in 20 (32.8%) of 61 patients. A total of 58 (98.3%) rib fractures were detected by USG, whereas oblique rib view and PA chest radiography showed 27 (45.8%) and 24 (40.7%) rib fractures, respectively. The average duration of USG was (12 ± 3) min (range 7–17 min), whereas the duration of radiography was (27 ± 6) min (range 15–37 min). The kappa coefficient showed a low level of agreement between both USG and PA chest radiography (kappa coefficient = 0.28), and between USG and oblique rib view (kappa coefficient = 0.32). Conclusion: USG discloses more fractures than radiography in most patients presenting with suspected rib fractures. Moreover USG requires significantly less time than radiography.

The effect of low-dose epsilon-aminocaproic acid (EACA) on the postoperative course of 46 patients was studied. Patients undergoing coronary artery bypass grafting were randomly selected in two groups. Group 1 (20 patients) received 5 g EACA upon initiation of cardiopulmonary bypass (CPB). Group 2 (26 patients) received no antifibrinolytic drugs prior to CPB. Neither group received antifibrinolytic drugs after CPB. There was no significant difference between the two groups' blood usage on CPB: 0.65 units in Group 1 and 0.60 units in Group 2. After CPB, blood usage significantly differed: 2.2 ± 1.7 (SD) units in Group 1 and 3.9 ± 3.0 units in Group 2 (p = 0.033). Significant difference was also demonstrated in postoperative blood loss in the first 24 hours: 1610 ± 531 ml in Group 1 versus 2025 ± 804 ml in Group 2 (p = 0.043). Pre-CPB administration of low-dose EACA significantly decreases blood loss and blood usage in the postoperative period. [ABSTRACT FROM PUBLISHER]

Patients with coagulation disorders present the entire open-heart surgical team with an increased challenge. A patient with a known history of moderately severe Factor IX deficiency (2.4% activity) was evaluated for coronary artery disease. Cardiac catheterization revealed a 99% right coronary artery lesion, a long 99% circumflex lesion and normal left ventricular function. Sextuple coronary artery bypass grafting was performed with the aid of aprotinin and Factor IX transfusions. The patient's platelet count after cardiopulmonary bypass was 65 000/mm3, down from a preoperative level of 172 000/mm3, requiring the transfusion of six units of pooled platelets immediately postoperation. The patient was extubated five and a half hours after arriving in the Intensive Care Unit, and his chest-tube drainage after the first 24 hours was 373 ml. Other than a transient episode of atrial fibrillation on the third postoperative day, the patient had an uneventful postoperative course and was discharged on the sixth postoperative day. With the use of aproptinin and the newer monoclonal antibody-purified Factor IX concentrates that have been developed, many of the added risks of performing open-heart surgery on patients with haemophilia B are greatly reduced if not eliminated. [ABSTRACT FROM PUBLISHER]

Bone involvement in hydatid disease is rare, and when it does occur, the most common sites of involvement are the spine and pelvis. A case of bone hydatid disease involving the sacrum is reported here.

A true estimation of gestational age (GA) plays an important role in quality maternity care and scheduling the labor date. This study aimed to evaluate the normal fetal kidney length (KL) and its correlation with GA. A cross-sectional study on 92 pregnant women between 8th and 10th week of gestation with normal singleton pregnancy underwent standard ultrasound fetal biometry and kidney length measurement. univariate and multivariate linear regression analysis was used to create a predictive equation to estimate GA on the KL and fetobiometry parameters. A significant correlation was found between GA and KL (r=0.83, P

Intraosseous pneumatocysts are benign gas-filled cavities within bones which are most commonly found in ilium, sacrum and vertebrae. The lesions are asymptomatic and found incidentally while evaluating for other injuries. Here, we present an intraosseous pneumatocyst of ilium in a 23-year-old male patient. Although once thought to be rare, intraossseous pneumatocyst are now believed to be more common. Thus, familiarity with their appearance is essential to avoid unnecessary workup. Intraosseous pneumatocysts are differentiated from more clinically significant differential diagnoses like osteonecrosis and osteomyelitis by their characteristic appearance of intraosseous air collections with sclerotic rim.

Objectives. The aim of this article is to represent the first reported case with cooccurrence of two rare alcohol related complications. Case Report. We report a 38-year-old man with chronic alcoholism who presented with both cranial and peripheral nerve palsy. On MRI examination characteristic findings of Marchiafava-Bignami disease were recognized. Discussion. Marchiafava-Bignami disease (MBD) is a rare complication of long-term, heavy alcohol abuse that has characteristic MRI findings. Acute alcohol related polyneuropathy (AARP) is another rare and not-well-understood complication of chronic alcohol abuse. We could not find any previous report of the cooccurrence of these two complications in the literature.

Objcctive(s): To determine age-specific rubella seroprevalence in the O to 45 years-old unvaccinated population in Uremia, Iran and also to propose a vaccination strategy against rubella this study designed. Material & Methods: A total of 770 unvaccinated persons O to 45 years old were selected for the study with cluster sampling. Sera from 392 females and 378 males were tested for rubella IgG antibody using enzyme linked immonosurbent assay (ELIZA) technique. Rubella seropositivity was defined as serum rubella IgG antibody level> or= I 3IU/ml. Results: Of the 770 cases, 58.1 % were seropositive. Due to maternal derived antibodies, 100% of the newborns was seropositive. This figure decreased with time until it became zero in children aged 9 months. Then from years 4 increased with age gradually until it peaked at 93.4% in the age group of 15- 19 years. The seropositivity decreased to 85.7% in the age group of >35 years. Of women in the reproductive age groups (15-45years old), 89.6% were seropositive. Conclusion:-. Because a substantial proportion of women in their childbearing years are susceptible to rubella, immunization efforts should be directed at infants and/or prepubertal children.

The simulation results for electromagnetic energy harvesters (EMEHs) under broad band stationary Gaussian random excitations indicate the importance of both a high transformation factor and a high mechanical quality factor to achieve favourable mean power, mean square load voltage, and output spectral density. The optimum load is different for random vibrations and for sinusoidal vibration. Reducing the total damping ratio under band-limited random excitation yields a higher mean square load voltage. Reduced bandwidth resulting from decreased mechanical damping can be compensated by increasing the electrical damping (transformation factor) leading to a higher mean square load voltage and power. Nonlinear EMEHs with a Duffing spring and with linear plus cubic damping are modeled using the method of statistical linearization. These nonlinear EMEHs exhibit approximately linear behaviour under low levels of broadband stationary Gaussian random vibration; however, at higher levels of such excitation the central (resonant) frequency of the spectral density of the output voltage shifts due to the increased nonlinear stiffness and the bandwidth broadens slightly. Nonlinear EMEHs exhibit lower maximum output voltage and central frequency of the spectral density with nonlinear damping compared to linear damping. Stronger nonlinear damping yields broader bandwidths at stable resonant frequency.

Golestan Province in northeastern Iran has one of the highest incidences of esophageal squamous cell carcinoma (ESCC) in the world with rates over 50 per 100,000 person-years in both sexes. We have analyzed TP53 mutation patterns in tumors from this high-risk geographic area in search of clues to the mutagenic processes involved in causing ESCC.Biopsies of 119 confirmed ESCC tumor tissue from subjects enrolled in a case-control study conducted in Golestan Province were analyzed by direct sequencing of TP53 exons 2 through 11. Immunohistochemical staining for p53 was carried out using two monoclonal antibodies, DO7 and 1801. A total of 120 TP53 mutations were detected in 107/119 cases (89.9%), including 11 patients with double or triple mutations. The mutation pattern was heterogeneous with infrequent mutations at common TP53 "hotspots" but frequent transversions potentially attributable to environmental carcinogens forming bulky DNA adducts, including 40% at bases known as site of mutagenesis by polycyclic aromatic hydrocarbons (PAHs). Mutations showed different patterns according to the reported temperature of tea consumption, but no variation was observed in relation to ethnicity, tobacco or opium use, and alcoholic beverage consumption or urban versus rural residence.ESCC tumors in people from Golestan Province show the highest rate of TP53 mutations ever reported in any cancer anywhere. The heterogeneous mutation pattern is highly suggestive of a causative role for multiple environmental carcinogens, including PAHs. The temperature and composition of tea may also influence mutagenesis.

This descriptive study was aimed to identify how provided nursing care related to physical problems caused by traction and cast in patients with fracture and dislocation in cervical spinal cord in educational hospitals of Tehran University of Medical Sciences. Samples, including 46 patients were recruited from neurosurgery and orthopedic wards, and also from Neurosurgical Intensive Care Units during 8 months period. Results showed that nursing care provided by nurses were in a proper level. There was no significant relationship between variables such as age, gender, level of education, kind of neurological lesions and provided nursing care. A significant relationship between cervical lesion and provided nursing care was found

For positive integers b and c, with c even, satisfying the inequalities b+1≤c≤2b, the minimum order of a connected cubic graph with b bridges and c cutpoints is computed. Furthermore, the structure of all such smallest cubic graphs is determined. For each positive integer c, the minimum order of a quartic graph with c cutpoints is calculated. Moreover, the structure and number of all such smallest quartic graphs are determined.

The bridge degree bdeg v and cycle degree cdeg v of a vertex v in a graph G are, respectively, the number of bridges and number of cycle edges incident with v in G. A characterization of finite nonempty sets S of nonnegative integers is given for which S is the set of bridge degrees (cycle degrees) of the vertices of some graph. The bridge-cycle degree of a vertex v in a graph G is the ordered pair (b,c), where bdeg v=b and cdeg v=c. Those finite sets S of ordered pairs of nonnegative integers for which S is the set of bridge-cycle degrees of the vertices of some graph are also characterized.

Effect of perfusion with low temperature Locke solution on the isolated hearts of adult rabbits and mongrel puppies was studied. The study showed no arrhythmias or myocardial fibrillation at low temperatures in the isolated mammalian heart.