Pediatric dose assessment in common CT examination towards establishment of related regional DRL in Mazandaran, Iran

Background: Computed Tomography [CT] is main contributor of population dose from diagnostic X-ray examinations. Children are more radiosensitive than adults, thus optimization of CT examination in these patients is essential. The purpose of this study was to evaluate dose delivered to pediatric patients' undergoing CT examination of the common examinations and also establishing local Diagnostic Reference Levels [DRLs]. Materials and Methods: Questionnaires were designed for data collection at seven public hospitals and information about patient, protocol and CT system were recorded during 2013 and 2014. Dose measurement was performed in four age groups: 0-1, 1-5, 5-10 and 10-15 years old and two CT dose quantity including CTDIw and DLP were calculated. Results: Values of 40, 48, 59.5, 59.5 mGy; 16.9, 16.9, 17.14, 17.14 mGy; 17, 17, 17, 17 mGy; 17, 17, 19.2, 19.2 mGy in terms of CTDIw and 448, 538, 758, 758 mGy cm; 129, 129, 154, 167 mGy cm; 184, 225, 306, 315 mGy cm; 289, 408, 595, 670 mGy cm in terms of DLP as regional DRL for brain, sinus, chest, abdomen and pelvic examinations were obtained respectively. Conclusion: The variations in dose of some examination were considerable. As the role and usage of CT technology continues to expand, it is important that all practitioners adapt optimized protocols, especially for pediatrics scanning, following proposed reference levels

[ case report of a rare variation in arising branches of brachial artery]

Variations in the arterial pattern of the upper limb are abundant and diverse and have been observed frequently either in cadaver dissection or in clinical practice and reports. In the most of these reports, radial or ulnar arteries were commonly involved, which can be damaged during surgical procedures. This report presents a case of a rare variation in arising branches of brachial artery. During routine anatomical dissection of a cadaver about 65-years-old Caucasian male, in anatomy department of Birjand University of Medical Sciences a variation in ulnar artery was observed. This variant artery arose from the lower third of the brachial artery, passed subcutaneously in the forearm. In the hand, this artery coursed over the flexor retinaculum and anastomosed with the superficial palmar branch of the radial artery to create the superficial palmar arch. Common interosseus and ulnar recurrent branches, arose from the radial artery, instead of, the ulnar artery in cubital fossa. As the radial and the ulnar arteries are widely used in cardiac catheterization, coronary angiography, arterial injections in the forearm, as well as cardiac surgery and kidney transplantation, hence, awareness of their variations are important clinically

Internet infidelity: exploration of attitudes towards partners internet behaviors

Today, the Internet has become a part of our everyday life and online communications have made it easy for people to develop interpersonal relationships. However, certain problems and difficulties have arisen from this issue. One of these problems, which have been prevalent among couples and families, is extramarital internet relationships or internet infidelity. The present research has been done to study people's attitudes towards this phenomenon. A 43-item Internet Infidelity Questionnaire [IIQ] was presented on a website designed for this purpose. 481 Iranian users who were members of Farsi language forums and chat rooms were selected through available community sampling and enrolled in the study. To analyze research data, descriptive statistics and the t-test were used. The results showed that either women or men considered online sexual activities of their partners as traitorous compared with friendly and emotional activities in cyberspace. In addition, women in comparison with men had a more negative attitude towards their partners' internet activity [especially online sexual activities]. This study expanded our understanding of the traditional concept of infidelity that had merely limited it to face-to-face sexual and emotional behavior. The results also showed that women had more negative attitudes towards such activities compared to men.

[Diagnostic accuracy of ultrasonography in comparison with magnetic resonance imaging in patients with knee trauma]

Internal derangement of knee [IDK] is a common problem following knee trauma. Magnetic resonance imaging [MRI] extensively is used to diagnose the ligamentous and meniscal injuries, but the use of ultrasonography remains controversial. Previous studies showed different results about the usefulness of sonography [IDK]. This study was done to determine diagnostic accuracy of ultrasonography in comparison with magnetic resonance imaging in patients with knee trauma. This descriptive study was done on internal knee disorders of 73 patients with knee trauma who referred to MRI center of Imam Khomeini hospital in Sari, Iran during 2009-10. Three radiologists independently reported the ultrasonography and MRI of the patients. The study population comprised of 61 [83.6%] men and 12 [16.4%] women, 91.9% of patients were less than 40 years old. The joint pain was the most common complaint [89%]. The sensitivity, specificity, positive and negative predictive value of ultrasonography for the lateral meniscus was 100%, 97.14%, 60%, 100%, for the medial meniscus were 61.90%, 94.23% ,81.25%, 85.96%, for the anterior cruciate ligament [ACL] was 65%, 100%, 100%, 70.21% and for the medial collateral ligament [MCL] was 100%, 94.28,%42.86 and 100%.This study showed that the high specificity of ultrasonography as a noninvasive and inexpensive method to exclude the ACL and meniscal lesion. Ultrasonography can reasonably be applied for screening of internal derangement of knee in the absence of MRI, especially in urgent conditions. In clinical setting of highly suspicious of ACL and meniscal tear, MRI is preferred due to low sensitivity of sonography

[Comparison of general health in adolescent boys and girls and its relationship with personality characteristics]

The importance of the mental processes and their role in people's health and disease have been demonstrated by several studies. Although diverse affect people's health, for the realization of their general health, and the role of personality factors that determine the individuals' rules of conduct, further studies are required. Exploration and comparison of general health in adolescent girls and boys and its relationship with personality characteristics. We selected for this cross-sectional study, 4342 male and female students in high schools and pre-university across 11 provinces of Iran through multistage cluster sampling. General Health Questionnaire [GHQ] and Five- factor Personality Traits[NEO] were filled. In order to analyze the data, descriptive statistics parameters such as frequency, mean and standard deviation and for inferential analysis, Correlation Coefficient, Regression Analysis and multivariate analysis of variance [MANOVA] were used. According to the results, there was a significant difference between adolescent girls and boys in terms of general health. The results also showed that there was a significant positive correlation between neuroticism and general health and a significant negative correlation between extroversion, conscientiousness, and openness and general health [p<0/01]. Also it was shown that neuroticism, extroversion, conscientiousness, and openness to experience can be considered respectively as the predictors for measuring the probability of adolescents' general health status. Considering the results, it seems that by examining the personality characteristics of adolescents we can measure the likelihood of changes in various aspects of their general health conditions. Also, as the results demonstrated, we can conclude that the general health of the girls are more at risk than the boys

[Alterations to chloride cells of the secondary lamella and gill branches of spotted scat [Scatophagus argus L.] in different salinities]

Estuarine euryhaline teleosts as reared spotted scat will be continnously encounterd with alterations to water salinities. The aim of the present study was to evaluate osmoregulatory capacity of the spotted scat in response to different salinities. 120 fish were categorized into 4 groups of 30 fish each. The fish were transferred from the freshwater to different salinities [5, 10, 20, and30 g/L] and kept for one month. Tissue sections of the secondary lamella and gill branches were staind using hematoxyline eosin and studied by the light microscope. Transfer from freshwater to different salinities made significant increase [p<0.05] in total chloride cells of the secondary lamella. Furthermore, while chloride cells alterations have been accompanied with decrease in the chloride cell numbers of the lamella such changes made an increase in chloride cell numbers of the gill branches. It can be concluded that the mentioned species has limited osmoregulatory capacity when encountering abrupt salinity changes.

Estimation of external natural background gamma ray doses to the population of Caspian coastal provinces in North of Iran

The effect of natural background radiation on health is still controversial. However, it is clear that it depends on the dose received by the population. The estimation of external natural background gamma rays received by the population of Caspian coastal provinces in the northern part of Iran was the main goal of this study. Gamma rays was measured using calibrated radiation survey meter in 51 urban and rural health centers randomly to estimate the exposure to population [Total population=6888118 persons] in residential areas of Gilan, Mazandaran and Golestan [Total area 59240 Km2] as Caspian coastal provinces, North of Iran. Results showed that the average dose rate in the areas under study was about 60.37 +/- 14.88 nSv/h or 0.53 mSv/yr [Range 30 to 90 nSv/h or 0.26 to 0.79 mSv/yr]. The data from Ramsar was excluded from the estimation because of its very high natural background radiation [Max. 240 mSv/yr]. No significant difference was found among the doses of the provinces [P=0.237]. The external natural background gamma ray dose to the population of Caspian coastal provinces, North of Iran, was found to be almost equal to the average value in the world [0.5 mSv/yr]

Evaluation of the correlation between non-alcoholic fatty liver disease and insulin resistance

Non-alcoholic fatty liver disease [NAFLD] is one of the most prevalent liver diseases, being associated with type II diabetes mellitus, obesity and dyslipidemia. It seems that insulin resistance observed in those with type II diabetes or in obese persons plays an important role in the pathogenesis of NAFLD. The aim of this study was to evaluate the relationship between NAFLD and insulin resistance, disregarding obesity and diabetes. This case-control study was performed on those patients with NAFLD referring to Sari Imam Khomeini Hospital in 2007 after obtaining informed consent from patients. After repeated sonography and proved fatty liver, 80 patients were enrolled [34 cases and 46 controls] matched for age, gender and body mass index [BMI]. NAFLD was documented in the case group, using ultrasonographic indices. Those in the control group were healthy. ALT and AST were normal in both groups. Fasting plasma glucose, fasting insulin, 2-hour oral glucose tolerance test [OGTT] and insulin-resistance were compared between the two groups. Insulin resistance was calculated using HOMA-IR formula. There were 20 men [58.8%] and 14 women [41.2%] in the case group with the mean age of 38.0 +/- 9.4 years. Those in the control group were 27 men [58.7%] and 19 women [41.3%] with the mean age of 39.4 +/- 10.5 years. There was no significant difference between the two groups concerning their age, gender or BMI. The mean level of FPG was 91.8 +/- 8.4 mg/dl in the case and 92.5 +/- 10.1 mg/dl in the control group. The mean level of OGTT was 110.9 +/- 18.8 mg/dl in the case group and 103.1 +/- 25.8 mg/dl in the control group and the difference was not significant. The mean levels of fasting insulin were 16.1 +/- 4.2 mg/dl and 10.3 +/- 4.8 mg/dl in the case and control groups, respectively [p<0.001]. Insulin resistance was 3.6 +/- 0.8 micro u/l.mmol/l in the case and 2.3 +/- 1.2 micro u/l.mmol/l in the control group. Since the intervening factors were identical in both groups, we can conclude that the role of insulinresistance in the pathogenesis of NAFLD is not dependent on age, gender and BMI

Assessment of myocardial viability with contrast-enhanced magnetic resonance imaging and technetium scintigraphy

In patients with coronary artery disease [CAD], assessment of viable myocardium has important prognostic implications. The aim of this study was to compare contrast-enhanced magnetic resonance imaging [ce-MRI] with single-photon emission computed tomography [SPECT], using [99m]TC-sestamibi for detection of myocardial viability. Twenty-seven patients with coronary artery disease and an ejection fraction [EF] <40% were enrolled. For the ce-MRI, the segmental extent of hyperenhancement [SEH] was quantified after the administration of a gadolinium-based contrast agent, and for the SPECT a 4-hour redistribution protocol was used. For the assessment of EF, we used echocardiography. Comparison of viability assessment was performed in 1458 segments. Agreement between two modalities was obtained in 1332 [91.4%] segments, resulting in a kappa value of 0.8. In 126 segments, we had discordant results. 102 SPECT viable segments were non-viable according to ce-MR I and 24 ce-MRI viable segments were described as non-viable by SPECT. SPECT was comparable to ce-MRI for myocardial viability assessment, but we were not able to define which of them was superior

Interleukin- 18 gene polymorphism in patients with and without atherosclerotic coronary artery disease

Several studies have revealed that inflammation plays an important role in development of Coronary Artery Disease [CAD] and its other manifestations. IL-18 is a pleiotropic cytokine that enhances Th1 [T helper 1] or Th2 [T helper 2] immune response depending on its cytokine milieu and genetic background. It strongly induces formation of plaques in patients with CAD. Variation in the Il-18 gene found to influence both levels of IL-18 and clinical outcomes in individuals with history of heart disease. To investigate the association of two IL-18 promoter gene polymorphisms at -607C/A and - 137 G/D positions with CAD, and some CAD risk factors such as diabetes, arterial hypertension, hypercholesterolemia, cigarette smoking and obesity. Genomic DNA was extracted by the salting out method from the peripheral arterial blood of 280 patients with CAD documented by coronary angiography [143 with a documented history of myocardial infarction termed positive MI and 137 without myocardial infarction designated negative MI] and 140 age- sex matched persons with a normal coronary angiography [control group]. The genotype of both CAD and control groups were assessed by ASP-PCR method. Arlequin program was used for gametic phase estimation and haplotype analysis. There was no significant difference between patient and control groups either allelic, genotypic, and haplotypic for both variants[p>0.05]. Furthermore, no significant correlation was found between IL-18 genotypes and CAD risk factors in the patient group [P>0.05]. There results suggest that the investigated IL-18 gene promoter polymorphisms at -607 C/A and -137G/C positions are not associated with genetic susceptibility to CAD in southern Iran

[ efficacy examination of healthy relationship instructing with social learning perspective instructing on increasing awareness about boys and abusive relationships among girls]

Purpose of this research was to eaxamine the healthy relashionship instructing efficacy on increasing awarness about abusive relationships among girls and boys. The research was quassi-exprimental. The population sample of research consisted of all girls in dormitory of Isfahan University [3000]. For sampling, at first Awarness about Abusive Relationships Scale was randomly administered among 100 of them, then 30 persons were selected who their awarness about abusive relationship were low. Finally, they were randomly assigned in control and expreimental groups. Both groups were evaluated with Awarness about Abusive Relationships Scale by meams of pre and post test. The experimental group was recieved-instructing intervention while control group was in waiting list. the results of Man cova showed healthy relationship instructing are effective on increasing awareness about abusive relationships and different aspects of it. [p<0.5]. the results showed the insrtructing format could use as instructing model for healthy and abusive relationship for increasing awareness and knowledge among girls in this field

[Utility of magnetic resonance cholangiography, ultrasonography and liver function test in preoperative assessment of patients with symptomatic cholecystolithiasis and suspected biliary obstruction [a comparative study]]

Evaluation of suspected biliary obstruction is performed by common old methods such as Ultrasound, CT, and invasive cholangiography. These techniques have limitations due to the poor visualization of intraductal stones [US, CT] and the need for an invasive procedure [ERCP, PTC]. Magnetic resonance cholangiography [MRC] is noninvasive imaging modality that provides good visualization of the hepatobiliary system. The aim of the present study was to determine the utility of Magnetic resonance cholangiography, Ultrasonography and Liver function test in preoperative assessment of patients with symptomatic cholecystolithiasis and suspected biliary obstruction. Patients selected for elective open cholecystectomy with risk factors of common bile duct stones as suspected biliary obstruction underwent MRC, US, and Liver function test preoperatively. All patients underwent open cholecystectomy and intraoperative cholangiography in Imam Khomeini Hospital, Academic Medical Center of Medicine School, Mazandaran University of Medical Sciences, Sari, Iran from January 2003 to February 2006. 30 patients [11 male, 19 female] with the mean age 53.93 +/- 13.32 years in a range of 38-75 years underwent all preoperative and operative assessments. 81.81% Sensitivity, 87.5% specificity and 83.33% efficacy in MRC; 18.18% Sensitivity, 87.5% specificity and 36.66% efficacy in US, and 54.54% Sensitivity, 37.50% specificity and 50% efficacy in Liver function test were the results obtained for biliary stones. MRC has excellent diagnostic accuracy in the detection of biliary disease. Due to its non-invasive nature, MRI may have advantages over invasive cholangiography when diagnosis is the major goal of the procedure

Repeat analysis program in radiology departments in Mazandaran province-Iran. Impact on population radiation dose

The rejected films in radiography may be responsible for an unnecessary increase in the radiation dose to the population. The effective dose to population is a very important factor in estimation of stochastic risk in radiology. The main goal of this study was to determine the effective dose to members of the public due to rejected films in diagnostic radiology departments in the Northern Province Mazandaran- of Iran. A repeat analysis program was set in all radiology departments in Mazandaran province [population = 2976219 person] to determine the total number and type of rejected films. All repeat and discarded films were collected and separated into types according to the etiology leading to their being discarded. Considering technical data about various radiological procedures and using the standard dosimetry tables, the annual effective dose per caput as well as annual gonadal dose per caput due to image retake was estimated. The total number of rejected radiographs in one year period was 73857 [overall reject rate tilde 11.15%] which led to 34.91 micro Sv and 37.17 micro Gy as annual average effective dose to a member of the public and annual average gonadal dose per caput respectively. The main reason of retaking the images was improper exposure factors. The reject rate was in the middle range of similar values in other studies; whereas in the present study the main reason for rejection was improper exposure factors [67.11%], the main reason for radiography repeat film was different in various countries. Comparing to the estimated 2.4 mSv from natural background radiation, the average annual effective dose and annual average gonadal dose per caput due to repeat/retake films are negligible. However, reducing the reject films is economically rewarding. Further national studies are suggested

estimation of ratiation effective dose from diagnostic medical procedures in general population of Northern Iran

The risks of low-dose ionizing radiation from radiology and nuclear medicine are not clearly determined. Effective dose to population is a very important factor in risk estimation. The study aimed to determine the effective dose from diagnostic radiation medicine in a northern province of Iran. Data about various radiologic and nuclear medicine procedures were collected from all radiology and nuclear medicine departments in Mazandaran Province [population = 2,898,031]; and using the standard dosimetry tables, the total dose, dose per examination, and annual effective dose per capita as well as the annual gonadal dose per capita were estimated. 655,730 radiologic examinations in a year's period, lead to 1.45 mSv, 0.33 mSv and 0.31 mGy as average effective dose per examination, annual average effective dose to member of the public, and annual average gonadal dose per capita, respectively. The frequency of medical radiologic examinations was 2,262 examinations annually per 10,000 members of population. However, the total number of nuclear medicine examinations in the same period was 7074, with 4.37 mSv, 9.6 micro Sv and 9.8 micro Gy, as average effective dose per examination, annual average effective dose to member of the public and annual average gonadal dose per caput, respectively. The frequency of nuclear medicine examination was 24 examinations annually per 10,000 members of population. The average effective dose per examination was nearly similar to other studies. However, the average annual effective dose and annual average gonadal dose per capita were less than the similar values in other reports, which could be due to lesser number of radiation medicine examinations in the present study