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Background: Foot posture is proposed as an important factor that may affect the lower limb alignment. Variations from the normal foot posture may contribute to musculoskeletal injuries of the lower extremity especially knee joint. Considering variations in foot posture and knee joint alignment, this study aimed to assess and compare pennation angles of the vastus medialis oblique (VMO), vastus medialis (VM) and vastus lateralis (VL) in women with pronated foot posture and normal ones. Methods: This observational, case-control study was carried out on 31 women with pronated foot posture (foot posture index: 6-12) and 31 women with normal foot posture (foot posture index: 0-5) in the age range of 18 to 35 years old. Participants were recruited from female students of university communities using Non-probability Sampling method. Sampling was carried out from September 2019 up to February 2020 at the biomechanics laboratory of rehabilitation faculty of Tehran University of Medical Sciences. The pennation angle of VMO, VM and VL muscles was measured by using two dimensional. B-mode ultrasound imaging (USI) .A 7.5MHz linear transducer with 50mm footprint was used for the measurements. The ultrasound images were analyzed using Image J software. Three longitudinal scans were captured for each muscle pennation angle while the probe removed between each scan. Results: The results of this study showed that there is no statistical significant difference between the pennation angles of VMO, VM and VL in women’s foot posture compare to the normal ones (P>0.05). However, the results of intraclass correlation coefficient (ICC) of USI measurements showed “good” intrarater reliability for VMO (ICC=0.88), VM (ICC=0.87) and VL (ICC= 0.77) pennation angles. Conclusion: Based on the results of this study, the pennation angle of knee extensor muscles (VMO, VM, and VL), which was measured in non-weight bearing, is not different in young women with pronated foot compared to the normal ones. In addition, USI demonstrated good reliability for measuring VMO, VM and VL pennation angles.

Zhirong Yan,1,&ast; Huifen Lin,2,&ast; Ying Yang,3 Jialin Yang,3 Xueshan Li,2 Yusheng Yao3,4 1Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Anesthesiology, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, People’s Republic of China; 3Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China; 4Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yusheng Yao, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No.134 Dongjie Street, Fuzhou, People’s Republic of China, Tel +86-13559939629, Fax +86-591-88217841, Email fjslyys@126.comPurpose: This study aimed to examine the effectiveness of ultrasound-guided thoracic paravertebral block on postoperative quality of recovery in patients undergoing percutaneous nephrolithotomy.Patients and Methods: In this randomized, double-blind, placebo-controlled trial, we enrolled patients scheduled for unilateral percutaneous nephrolithotomy. Patients were randomly allocated to receive thoracic paravertebral block either with 20 mL of 0.5% ropivacaine (PVB group) or an equal volume of saline (control group). The primary outcome was the quality of patient recovery at 24 h postoperatively, assessed using the 15-item Quality of Recovery scale. The secondary outcomes included the area under the curve of pain scores over time, time to first rescue analgesia, and postoperative 24 h morphine consumption.Results: We analyzed the data of 70 recruited participants. The median Quality of Recovery-15 score at 24 h postoperatively was 127 (interquartile range, 117– 133) in the PVB group, which was significantly higher than 114 (interquartile range, 109– 122) in the control group, with a median difference of 10 points (95% confidence interval, 5– 14; P< 0.001). The area under the curve of pain scores over time was lower in patients receiving thoracic PVB than in those receiving saline block (P< 0.001). The median time to first rescue analgesia in the PVB group (10.8 h, interquartile range 7.1– 22.8 h) was longer than that in the control group (1.9 h, interquartile range 0.5– 4.3 h) (P< 0.001). Similarly, the median postoperative 24-hour morphine consumption was nearly half as low in the PVB group as in the control group (P< 0.001). The occurrence of postoperative nausea and vomiting, and pruritus were significantly higher in the control group (P=0.016 and P=0.023, respectively).Conclusion: Preoperative ultrasound-guided single injection of thoracic paravertebral block with ropivacaine improved the postoperative quality of recovery and analgesia in patients undergoing percutaneous nephrolithotomy.Keywords: pain management, quality of recovery, regional anesthesia, ultrasonography

Background: Prostate enlargement is a common issue amongst men, which causes significant side effects for aging men. Regarding the high prevalence of prostate enlargement and opium addiction and its derivatives, assessing the relationship between opium use with prostate enlargement may be an exciting issue. Methods: This was a cross-sectional study. There were two groups; the case group contained men with a history of at least one year of opium abuse. The control group was men in the same age range referred to university-affiliated hospitals for ultrasonography for other reasons except for prostate problems. The prostate size and demographic information of patients were recorded. The prostate volume of more than 20 ml was considered as an enlarged prostate. Results: 212 males participated in the study from December 2018 to March 2019 at Namazi Hospital of Shiraz University of Medical Sciences, including 78 drug abuse patients (mean age=39.08±6.52 years old) in the case group and 134 (mean age=40.69±6.28 years old) in the control group. The mean prostate size in the addict group was significantly higher than in the healthy group (P=0.005). There was a significant correlation between the size of the prostate and the age in both groups. However, there was no correlation between prostate size and body mass index. Conclusion: Due to a decrease in the sexual desire of addicted people, we first expected to face smaller prostates in addicted men; however, the study results proved the opposite. One explanation can be that the decreased libido increases the likelihood of fluid accumulation in the prostate, this might lead to chronic inflammatory reactions, hypertrophy, and prostate hyperplasia. Therefore, a more comprehensive study is needed to investigate the interaction between the drug and prostate tissue. Finally, it can be concluded that addiction to opium and its derivatives can increase the chance of prostate enlargement. Due to the lack of previous studies in this field, it seems necessary to conduct additional studies with larger sample sizes and control confounding factors.

Introduction: Metastatic spread of lung cancer to supraclavicular lymph nodes is considered distant metastasis for treatment purposes. Detection of supraclavicular lymph node metastasis in patients with lung cancer serves for tissue diagnosis by itself and also helps avoid more invasive biopsy from the primary lung mass itself. Ultrasonography of the lower neck can detect supraclavicular lymph nodes before they are palpable and can also be used for safe sampling of these lymph nodes. The aim of this study was to find out the prevalence of metastatic supraclavicular lymph nodes among patients with lung carcinoma in a tertiary care centre. Methods: A descriptive cross-sectional study done in a tertiary care center, carried out from 15 September 2019 to 14 September 2020. Ethical approval was obtained from the Institutional Review Committee (Reference number: 84(611)E2/076/077). The study was done among 92 patients with biopsy-proven lung cancer (lung mass or supraclavicular lymph node biopsy) who were referred for evaluation, and/or percutaneous transthoracic biopsy. Convenience sampling method was used. Point estimate and 90% Confidence Interval were calculated. Results: Among 92 patients with proven lung cancer, metastatic supraclavicular lymph nodes were seen in 13 patients (14.10%) (8.17- 19.73, 90% Confidence Interval). Among 13 patients with metastatic lymph nodes, 9 (69.23%) had palpable supraclavicular lymph nodes. The majority 11 (84.61%) had round-shaped lymph nodes. All metastatic lymph nodes showed loss of echogenic fatty hilum. A total of 12 (92.30%) metastatic lymph nodes showed a peripheral disorganized pattern of vascularity. Conclusions: The prevalence of metastatic supraclavicular lymph nodes was lower than in similar studies done in international settings.

Idiopathic intracranial hypertension is characterised by increased intracranial pressure of unknown aetiology. It is usually seen among obese women who are of childbearing age. With an incidence of 0.9 per 100,000 in women of childbearing age, the incidence in obese women is as high as 19.3 per 100,000. Here, we represent the case of a 31-year-old, non-obese primigravida with hypothyroidism which was diagnosed as idiopathic intracranial hypertension during pregnancy. This patient, was managed with multi-disciplinary considerations so as to avoid complications in perioperative period.

Background: The application of mesenchymal stem cells in the healing of chronic wounds is one of the most challenging issues in cell therapy. The present study investigated the efficacy of intradermal injection of umbilical cord Whartonchr('39')s Jelly-derived mesenchymal stem cells in diabetic wound healing using ultrasound imaging in an animal model. Methods: During this experimental laboratory study that was performed in the Skin and Stem Cell Research Center, Tehran University of Medical Sciences between October 2017 and October 2016, mesenchymal stem cells were isolated from umbilical cord Whartonchr('39')s jelly of 10 neonates. The cells were passage. The differentiation potential of cells to osteocyte and adipose cells was evaluated. The expression of specific markers of mesenchymal stem cells was evaluated using flow cytometry. The viability and quality of cells were evaluated before transplantation. The diabetes model was developed by intraperitoneal injection of streptozotocin in 42 male Wistar rats. The animals were randomly divided into two groups: normal saline injection (control) and cell injection. Cell transplantation was performed intradermally. Skin thickness and density were assessed using ultrasound imaging on days 7, 14 and 21. Finally, the data were analyzed using a t-test and analysis of variance. Results: Injection of mesenchymal stem cells caused faster closing of the wound. The results of biometric measurement of wound skin in rats showed that skin thickness and density on days 7, 14 and 21 in the Wharton jelly mesenchymal stem cell injection group had a significant increase compared to the control group. Conclusion: The results of cell analysis showed that the isolated cells are the same as mesenchymal stem cells. The cells were of the required health and quality. Intradermal injection of mesenchymal stem cells in diabetic wound area caused faster healing in diabetic rats, according to which, such stem cells can be considered in cell therapy, especially in the field of chronic wound healing.

Background: Surgery and accurate removal of the brain tumor in the operating room and after opening the scalp is one of the major challenges for neurosurgeons due to the removal of skull pressure and displacement and deformation of the brain tissue. This displacement of the brain changes the location of the tumor relative to the MR image taken preoperatively. Methods: This study, which is done from March to December 2019 in Tehran, is evaluated on the available database of RetroSpective Evaluation of Cerebral Tumors (RESECT) including pre-operative MR images, and intra-operative ultrasound from 22 patients with low-grade gliomas who underwent surgeries at St. Olavs University Hospital. This study is used for image registration of preoperative MR imaging and ultrasound imaging after resection of the skull to compensate for brain changes. By this method, we obtained a third image that resembles preoperative MR imaging but has the geometry of the brain shape changes. We used a combination of the two transformations named Affine and non-rigid Free Form Deformation (FFD) for hierarchically moving the pixels to compensate for global variations, and also nonlinear local and small variations. Also, by applying the mutual information function, we consider the entropy value as the criterion of similarity due to the non-similarity of the nature of the images. Also, Limited Broyden-Fletcher-Goldfarb-Shannon method is used for optimization. Results: The results of the proposed method were presented on the available database of RetroSpective Evaluation of Cerebral Tumors (RESECT) including images of 22 patients with glioma type 2 tumors and evaluated based on 15 landmarks per patient and also mutual information criteria. The mean target registration error for affine, FFD and the proposed method are 46.19, 42.85 and 38.01, respectively. It was shown that the proposed method achieved high accuracy by combining the two transformations of affine and FFD compared to the separate use of each of the two models. Conclusion: In image registration of preoperative MR and ultrasound images for compensation of brain shift, the combination of affine and FFD transformations had better results than the individual use of each of the transformations.

Background and purpose: Acute scrotum syndrome is one of the complaints in emergency departments which has several causes. This study was performed to determine the causes and symptoms of acute scrotal pain in patients attending emergency departments in Mazandaran province, Iran. Materials and methods: A cross-sectional study was done in all patients with acute scrotum syndrome in emergency departments affiliated to Mazandaran University of Medical Sciences, 2011- 2016. Patients’ medical records (clinical and paraclinical information, and diagnostic and therapeutic procedures) were investigated. Data analysis was done applying Chi- square test and t-test. Results: The study included 205 patients with a mean age of 34.10±17.34. Patients were diagnosed with testicular torsion (n=60, 29.3%), epididymo-orchitis (n= 63, 30.7%), inguinal hernia (n= 69, 33.7%), varicocele (n=11, 5.4%), and testicular torsion (n=2, 2.1%). In testicular torsion, the pain was most sudden (23.9%) and the duration of symptoms onset and arrival at emergency department was 3.62±4.38 hours. The definitive diagnoses were consistent with ultrasound findings in 91.7% of the cases with testicular torsion, 96.8% of those with epididymis orchitis, 95.7% of patients with hernia, and in 54.5% of cases with varicocele. Conclusion: Younger age, duration of pain, sudden pain, and cremaster reflex are helpful in differentiating testicular torsion from other causes of acute scrotum syndrome. Ultrasonography of the testis should be immediately performed as the main diagnostic measure for acute scrotum syndrome.

Introduction: Correct and prompt diagnosis is essential for the appropriate management of patients. Often, children and their caretakers cannot provide a reliable history to allow clinicians to determine the cause of the pain. This study's objective was to find out the prevalence of abnormal ultrasonographic findings among referred patients with pain abdomen in the radiology department of a tertiary care center of Nepal. Methods: A descriptive cross-sectional study was conducted among patients in the out-patient and emergency department with complaints of abdominal pain from 2021 April 5 to August 30 in a tertiary care hospital. Ethical clearance was taken from IRC (registration no: 423/2021). The convenience sampling method was used. Written informed consent was taken from each study participant. Collected data were entered and analyzed on Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 250 patients with pain abdomen referred to the department of radiology, 169 (67.6%) (61.80-73.40 at 95% Confidence Interval) had abnormal ultrasonographic findings. Mean age of the patients was 39.4±17.9 years. Initial clinical diagnosis was in agreement with the abdominal ultrasound diagnosis in 57 (22.8%) patients. For the remaining 193 patients, the diagnosis obtained from abdominal ultrasound differed from the initial clinical diagnosis. Conclusions: Most of the cases of pain abdomen showed abnormalities in ultrasound. Clinical evaluation should be used together with ultrasound abdomen in order to arrive at a correct diagnosis.

INTRODUCTION[|]In the present study, in thorax ultrasonography (USG) Doppler images obtained from cases with occult pneumothorax, we investigated the status of pulsatile pleural sounds over the pleural line and called these as the pleural sound sign (PSS). The purpose of the present study was to identify the efficacy of the proposed PSS in diagnosing pneumothorax and to compare it with the other USG findings including the sliding lung sign (SLS) and seashore sign (SSS). [¤]METHODS[|]The present study included 66 consecutive patients who were referred to the emergency unit with a blunt trauma from October 2009 to January 2010 at a tertiary university hospital. [¤]RESULTS[|]Of the 66 patients, 34 were in the patient group, and 32 were in the control group. Males accounted for 66.7% (n=44) of the study population. In predicting pneumothorax, the areas under receiver operating characteristic (ROC) curves of PSSmax and PSSdifference were 0.989 and 0.990, respectively. While the sensitivity of the SLS was 88% and the sensitivity of the SSS was 56%, the specificities of the SLS and SSS were 100%. Based on our findings, accuracy ranking was as follows: PSSmax = PSSdifference > SLS > SSS. [¤]DISCUSSION AND CONCLUSION[|]New applications of thorax USG are rapidly growing. Our findings have to be confirmed in a large patient series. PSS is not a novel method, but it enhanced the importance of USG in the diagnosis of pneumothorax. We can stipulate that it can replace thorax computed tomography imaging particularly for the diagnosis of occult pneumothoraxes. [¤]

Background: Laparoscopic cholecystectomy is the gold standard in the treatment of gallstones. It has proved to be an effective and safe procedure both in elective and emergency conditions; however, conversion to open surgery is inevitable in some cases. Hence the present study was carried out to identify various factors which can predict the difficult laparoscopic cholecystectomy so that an early conversion to open cholecystectomy can be considered. Material and Methods: A prospective st st study was conducted from 1 February 2011 to 31 January 2012 that included 63 patients of all age groups and both sexes who were found to have symptomatic gallstones and were scheduled for laparoscopic cholecystectomy at Nepalgunj Medical College and Teaching Hospital, Nepal. Age, sex, body mass index, previous abdominal surgery and past history of acute attack of cholecystitis of the patients were recorded. A pre-operative ultrasound was performed just prior to surgery, and three ultrasonographic parameters were analyzed, namely gall bladder wall thickness, number of stones and stone impacted in Hartmann's pouch. Intra-operative causes for difficult laparoscopic cholecystectomy like adhesions in Calot's triangle and gall bladder perforation with bile leak were also evaluated. Results: Total number of patients in this study was 63; out of which difficult laparoscopic cholecystectomy was seen in 25(39.7) patients and 7(11.1) patients required conversion to open cholecystectomy. Ultrasonography was good at predicting difficulty in each component with exception of gall bladder wall thickness which was not statistically significant. Conclusion: BMI, ultrasonographic finding of presence of multiple stone or stones impacted in Hartmann's pouch, adhesion in Calot's triangle and gall bladder perforations are predictors of difficult laparoscopic cholecystectomy.

Introduction: Abnormal uterine bleeding is one of the most common morbidity landing women to attend medical attention in gynecology outpatient department. This study aims to evaluate the hysteroscopy finding in diagnosis of AUB and its correlation with ultrasonography finding and histopathological reports. Methods:This was a prospective comparative study in which ultrasonography was performed in fifty patients with abnormal uterine bleeding attending OPD then hysteroscopy was performed. After removing hysteroscopy dilation and curettage was done and sample sent for histopathology. At the end reports of hysteroscopy finding were compared with sonograhic and pathological results. Results:In the study women aged from 45 to 64years with the symptoms duration of 15 days to 6months. Post menopausal women seek medical attention more early then the menstruating women. Common symptoms are menorrhagia, metrorrhagia and postmenopausal bleeding. Most common abnormality was menorrhagia (32%) followed by post menopausal bleeding 28 %. Ultrasonography showed 46% of abnormal finding in which 17 (47%)menstruating women and 6 (43%) women were postmenopausal women. Among 50 women 17 (34%) had negative finding and 43 (66%) had abnormal finding in which most common finding of hyperplastic endometrium. Hysteroscopy correctly diagnose atrophic endometrium, polyp and endometrial Ca which is also confirmed by histopathology finding. Conclusions: Hysteroscopy is reliable method for evaluating cases of AUB and it can be used as first line diagnostic method for benign lesions. Hysteroscopy guided biopsy has most accurate in diagnosing pathology. Keywords: AUB; D and ; Hysteroscopy,OPD; Ultrasonography. | PubMed

We The great majority of the curves and intrauterine charts for ultrasound used in our population are base don studies in diferents populations, in relation to race and socioeconomic conditions to ours.We know the importance of determining gestational age and fetal growth curve to make appropriate decisions in the management and detention of alterations in fetal development.Aim: the principal aim of this study was of constructing applicable tables of fetal growth for the local population, based on the date of last reliable menstruation or ultrasound scan of the first trimester.Methods: we selected a total of 357 patients with no maternal or fetal morbilidy and the data were compared with existing curve and table as reported by Snijders, Nicolaides and Hadlock.Results: significantly statistical differences observed in our values with the brought ones for Snijders and Nicolaides in abdominal circumference of the week 35 to 39 in the percentiles 5 and 95 (p = 0.0008 and 0.0001), The diameter biparietal (DBP) in the weeks 35 to 39 in the percentiles 50 and 95 (p = 0.001 and 0.0001) respectively and similar in the femoral length; with Hadlock’s curves significantly different values were observed in the percentiles 3 and 97 (p

El embarazo ectópico constituye una entidad patológica de gran incidencia en la actualidad, potenciada entre otras causas por el inicio cada vez más precoz de las relaciones sexuales. El embarazo cornual se debe a la implantación del blastocisto dentro del segmento de la trompa que penetra en la pared del útero o entre el ostium tubario y la porción proximal del segmento ístmico. Se presenta un caso de embarazo ectópico cornual donde la ultrasonografía jugó un papel preponderante en su diagnóstico, ya que se trataba de una paciente con anemia drepanocítica, donde clínicamente no se podía descartar como causa de dolor abdominal una crisis vasooclusiva. Se realiza histerectomía parcial del cuerno derecho. La paciente evoluciona satisfactoriamente.