Association between 2D trans-perineal ultrasound and physical examination in evaluation of ani function.

PURPOSE: To compare the correlation between 2D transperineal ultrasonography and physical examination (intravaginal palpation) for assessing pelvic floor and levator ani function. METHODS: Due to symptoms of pelvic floor disorder, 40 women between the ages of 29 and 75 were enrolled in this study as candidates for urodynamic and structural evaluation of the pelvic floor. A pelvic floor gynaecologist and radiologist assessed the levator ani function via physical examination (graded based on the Oxford Grading System) and transperineal 2D ultrasound, respectively. RESULTS: The ultrasound parameters for calculating the Levator Ani Index (LAI) demonstrate a difference between the anteroposterior dimension of the levator hiatus (r = 0.691, p < 0.001) and the cranial shift of muscle (r = 0.499, p < 0.001) at rest and during a squeezing manoeuvre in the mid-sagittal plane. Reduced anteroposterior diameter of the hiatus and increased cranial shift were associated with a higher Oxford Physical Examination Score (OPES). The association between LAI and OPES was independent of baseline variables such as age, BMI, number of births, and the presence of incontinence symptoms. CONCLUSION: Measures such as the LAI can be used to quantify the function of the levator ani muscle, which may be useful for evaluating the efficacy of pelvic floor physiotherapy and exercise.

Fetal corpus callosum abnormalities: Ultrasound and magnetic resonance imaging role.

The corpus callosum (CC) is the major interhemispheric commissure and its abnormalities include agenesis, hypoplasia, and hyperplasia. The CC anomalies are typically related to other central nervous system (CNS) or extra-CNS malformations. The antenatal diagnosis of complete CC agenesis is easy after mid-trimester by ultrasound (US) even in the axial plane. The non-visualization of cavum septum pellucidum and colpocephaly are critical signs in the axial view. More subtle findings (i.e., hypoplasia and partial agenesis) might also be recognized antenatally. In this review, the focus was given on the prenatal diagnosis of CC abnormalities in US and magnetic resonance imaging.

Clinical, Laboratory and Imaging Characteristics of Hospitalized COVID-19 Patients with Neurologic Involvement; a Cross-Sectional Study.

Introduction: Although neurologic involvement and neuroimaging abnormalities have been frequently identified in COVID-19 patients, the underlying factors remain unclear. In this study, we assessed the association of the neurological manifestations and neuroimaging features of hospitalized COVID-19 patients with their clinical, laboratory, and imaging characteristics. Methods: This multicenter cross-sectional study was conducted between September 2020 and March 2021 at two large academic hospitals in Tehran, Iran. We used census sampling from medical records to enroll hospitalized patients with a positive COVID-19 Polymerase chain reaction (PCR) test who underwent brain imaging due to presenting any acute neurologic symptom during hospital stay. Results: Of the 4372 hospitalized patients with COVID-19, only 211 met the inclusion criteria (35.5% with severe infection). Central nervous system and psychiatric manifestations were significantly more common in severe cases (p ≤ 0.044). Approximately, 30% had a new abnormality on their neuroimaging, with ischemic (38/63) and hemorrhagic (16/63) insults being the most common. The most frequent reasons that provoked cranial imaging were headache (27%), altered consciousness (25.6%), focal neurologic signs (19.9%), and delirium (18%). Analysis revealed a positive correlation for age, neutrophilia, lymphopenia, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) with the emergence of neuroimaging abnormalities (p ≤ 0.018). In addition, patients with new neuroimaging abnormalities had a significantly higher lung CT score than those without any pathologic findings (11.1 ± 4.8 vs. 5.9 ± 4.8, p < 0.001). Conclusion: Approximately 30% of the study population had various acute neuroimaging findings. The lung CT score, neutrophil count, and age were strong predictors of acute neuroimaging abnormalities in hospitalized COVID-19 patients.

Serious events following COVID-19 vaccination with ChAdOx1 nCoV-19 vaccine (Vaxzevria): A short case series from Iran.

In 2020, the SARS-COV-2 disease (COVID-19) imposed huge challenges on the health, economic, and political systems, and by the end of the year, hope had been born with the release of COVID-19 vaccines aimed at bringing the pandemic to an end. However, the COVID-19 vaccination programs have sparked several concerns and ongoing debates over safety issues. Here, we presented three cases of patients with serious adverse events, encephalopathy, vaccine-induced thrombotic thrombocytopenia, and leukocytoclastic vasculitis, after receiving the ChAdOx1 nCoV-19 vaccine. Therefore, it is critical to investigate and report the occurrence of adverse reactions following vaccination, particularly serious ones, as it contributes to the growing body of research and assists clinicians in better diagnosing and managing them.

Neurological Manifestations and their Correlated Factors in COVID-19 Patients; a Cross-Sectional Study.

INTRODUCTION: COVID-19 might present with other seemingly unrelated manifestations; for instance, neurological symptoms. This study aimed to evaluate the neurologic manifestations and their correlated factors in COVID-19 patients. METHODS: This retrospective observational study was conducted from March 17, 2020 to June 20, 2020 in a tertiary hospital in Iran. The study population consisted of adult patients with a positive result for COVID-19 real-time reverse transcriptase polymerase chain reaction (RT-PCR) using nasopharyngeal swabs. Both written and electronic data regarding baseline characteristic, laboratory findings, and neurological manifestations were evaluated and reported. RESULTS: 727 COVID-19 patients with the mean age of 49.94 ± 17.49 years were studied (56.9% male). At least one neurological symptom was observed in 403 (55.4%) cases. Headache (29.0%), and smell (22.3%) and taste (22.0%) impairment were the most prevalent neurological symptoms, while seizure (1.1%) and stroke (2.3%) were the least common ones. Patients with neurological manifestations were significantly older (p = 0.04), had greater body mass index (BMI) (p = 0.02), longer first symptom to admission duration (p < 0.001) and were more frequently opium users (p = 0.03) compared to COVID-19 patients without neurological symptoms. O2 saturation was significantly lower in patients with neurological manifestations (p = 0.04). In addition, medians of neutrophil count (p = 0.006), neutrophil-lymphocyte ratio (NLR) (p = 0.02) and c-reactive protein (CRP) (p = 0.001) were significantly higher and the median of lymphocyte count (p = 0.03) was significantly lower in patients with neurological manifestations. CONCLUSION: The prevalence of neurological manifestations in the studied cases was high (55.4%). This prevalence was significantly higher in older age, grated BMI, longer lasting disease, and opium usage.

Clinical and Epidemiological Characteristics of Postdischarge Patients With COVID-19 in Tehran, Iran: Protocol for a Prospective Cohort Study (Tele-COVID-19 Study).

BACKGROUND: COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19. OBJECTIVE: We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients' clinical profiles. METHODS: All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire. RESULTS: Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded. CONCLUSIONS: The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23316.

Prognostic value of inflammatory biomarkers for predicting the extent of lung involvement and final clinical outcome in patients with COVID-19.

BACKGROUND: Inflammation plays a major role in coronavirus disease (COVID-19). Factors that convey information about the status of inflammation could predict disease severity and help identify patients prone to clinical deterioration. Here, we aimed to evaluate the predictive value of inflammatory markers on the extent of lung involvement and survival of patients with COVID-19. MATERIALS AND METHODS: Eighty patients with confirmed COVID-19 were enrolled. Demographic, clinical, and laboratory data were collected at admission. All patients underwent chest computed tomography (CT); the extent of lung involvement was assessed by a scoring system. Patients were followed up until death or discharge occurred. Logistic regression analysis was performed to evaluate the association of investigated variables with COVID-19-related death. The association between different variables and CT score was assessed using linear regression model. Receiver operator characteristic curve analysis was applied to identify the predictive value of inflammatory markers and CT score on survival. RESULTS: The mean age of patients was 54.2 ± 15.2 years; 65% were male. Increased neutrophil-to-lymphocyte ratio (ß =0.69, odds ratio [OR] =1.50), platelet-to-lymphocyte ratio (ß =0.019, OR = 1.01), and decreased lymphocyte to C-reactive protein ratio (LCR) (ß = -0.35, OR = 0.62) were significantly associated with a higher CT score and increased odds of death (P < 0.05). Lactate dehydrogenase level was also positively related with extensive lung involvement and death (ß =1.15, OR = 1.52, P < 0.05). The LCR threshold for identifying survivors from nonsurvivors was 0.53 (area under curve [AUC] =0.82, 78% sensitivity and 74% specificity). Lung involvement ≥50% on chest CT was an excellent predictor of death (AUC = 0.83, 81% sensitivity and 79% specificity). CONCLUSION: Daily-performed laboratory tests that represent inflammation have great value for predicting the amount of disease burden and risk of mortality. Moreover, their cost-effectiveness and feasibility turn them into ideal prognostic markers.

Possible association of vitamin D status with lung involvement and outcome in patients with COVID-19: a retrospective study.

PURPOSE: Vitamin D deficiency has been reported as a key factor in the development of infectious diseases such as respiratory tract infections and inflammatory processes like acute respiratory distress syndrome. However, the impact of vitamin D on the severity and outcome of COVID-19 is still not fully known. Herein, we aimed to evaluate the prognostic role of serum vitamin D concentration on the extent of lung involvement and final outcome in patients with COVID-19. METHODS: Seventy-three subjects with confirmed diagnosis of COVID-19 were investigated in this study. The patients had been admitted to our academic hospital from February 28, 2020 to April 19, 2020. Demographic and clinical data, serum 25(OH)D levels, and findings of initial chest computed tomography were recorded. Linear and binary logistic regression, cox regression and ROC curve tests were used for statistical analysis. RESULTS: The mean age of patients was 55.18 ± 14.98 years old; 46.4% were male. Mean serum 25(OH)D concentration was significantly lower in the deceased (13.83 ± 12.53 ng/ mL compared with discharged patients (38.41 ± 18.51 ng/mL) (P < 0.001). Higher levels of 25(OH)D were associated with significantly less extent of total lung involvement (ß = - 0.10, P = 0.004). In addition, vitamin D deficiency [25(OH) D < 25 ng/mL] was associated with a significant increase in the risk of mortality (hazard ratio = 4.15, P = 0.04). CONCLUSION: This study suggests that serum vitamin D status might provide useful information regarding the clinical course, extent of lung involvement and outcome of patients with COVID-19. However, further studies with larger sample size are needed to confirm these findings.

COVID-19-related strokes in adults below 55 years of age: a case series.

BACKGROUND: Coronavirus infection is a novel respiratory disease affecting people across the world. Although the majority of patients present with fever, dyspnea, cough, or myalgia, various signs and symptoms have been reported for this disease. Recently, neurological symptoms have been noticed in patients with COVID-19 with unknown etiology. However, the occurrence of strokes in young and middle aged patients with COVID-19 is not fully explained. METHODS: In this series, six patients younger than 55 years of age with diagnosis of stroke and a confirmed diagnosis of COVID-19 were evaluated for symptoms, lab data, imaging findings, and outcomes from March 2020 to the end of April 2020 from all stroke cases in a tertiary academic hospital. Patients older than 55 and all others who had evidence of cardiac abnormalities (arrhythmia/valvular) were excluded. RESULTS: Fever, myalgia, cough, and dyspnea were the most common clinical symptoms noted in 66.66% (4/6), 66.66% (4/6), 50% (3/6), and 50% (3/6) of the patients, respectively. The mean ± standard deviation (SD) of National Institutes of Health Stroke Scale (NIHSS) for the patient was 10.16 ± 7.13 (ranged 5-24). The most involved area was middle cerebral artery (MCA) (five in MCA versus one in basal ganglia) and the majority of our patients had a low lung involvement score (mean ± SD: 13.16 ± 6.49 out of 24). Finally, one patient was deceased and rest discharged. CONCLUSION: Stroke may be unrelated to age and the extent of lung involvement. However, different factors may play roles in co-occurrence of stroke and COVID-19 and its outcome. Future studies with long-term follow-up and more cases are needed to assess prognostic factors.

Clinical Course, Imaging Features, and Outcomes of COVID-19 in Kidney Transplant Recipients.

Coronavirus disease 2019 (COVID-19) is a novel and highly contagious disease caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older adults and patients with comorbidities and immunosuppressive conditions may experience severe signs and symptoms that can lead to death. This case series assesses the clinical course, imaging features, and outcomes for 12 patients with COVID-19 and a history of kidney transplantation. Patients were evaluated for symptoms, laboratory data, imaging findings, and outcomes from February 2020 to April 2020. Fever, cough, and dyspnea were the most common clinical symptoms, noted in 75% (nine/12), 75% (nine/12), and 41.7% (five/12) of the patients, respectively. Most of the patients had a normal white blood cell count, while 33.3% (four/12) had leukopenia and 8.3% (one/12) had leukocytosis. A combination of consolidation and ground glass opacity was the most predominant (75%) pattern of lung involvement on computed tomography (CT). Eight patients died of severe COVID-19 pneumonia and acute respiratory distress syndrome and four were discharged. All recovered cases had a unilateral peripheral pattern of involvement limited to only one zone on initial chest CT. It seems that CT imaging has an important role in predicting COVID-19 outcomes for solid organ transplant recipients. Future studies with long-term follow up and more cases are needed to elucidate COVID-19 diagnosis, outcome, and management strategies for these patients.

A 21-year-old Pregnant Trauma Patient with Asymptomatic Fat Embolism; a Case Report.

INTRODUCTION: Fat embolism syndrome (FES) is most often associated with orthopedic trauma that typically presents 24-72 hours after the trauma with a classic triad. Only few cases of fat embolism due to lower extremity venous system had been reported. CASE PRESENTATION: The current case report presents a pregnant woman who was referred to our emergency department with bilateral femoral open fracture. After detecting fetal demise by abdominopelvic ultrasound, an area of fat density in right external iliac vein was detected in abdominopelvic contrast enhanced computed tomography (CT) scan which was considered as the probable diagnosis of fat embolism. While the patient did not show signs and symptoms of FES, the fat embolism was confirmed in further evaluations. CONCLUSION: In summary, although detection of fat embolus in CT scan in the emergency department is very rare, evaluation of lower extremity venous system in a posttraumatic patient seems to be crucial because early diagnosis of fat embolism can help the clinicians to prevent FES.

Diagnostic value of diffusion-weighted magnetic resonance imaging in discriminating between metastatic and non-metastatic pelvic lymph nodes in endometrial cancer.

BACKGROUND: Researchers have recently focused on assessing the accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in predicting pelvic lymph node metastases in gynecological malignancies. PURPOSE: To evaluate the diagnostic value of DW-MRI in discriminating between metastatic and non-metastatic pelvic lymph nodes in endometrial cancer patients. MATERIAL AND METHODS: This retrospective database study was conducted with 33 women aged 30-84 years with pathologically proven endometrial cancer that had been assessed by DW-MRI before their first treatment initiation at our referral hospital from March 2016 to April 2019. The diffusion technique (b = 50, 400, and 1000 mm2/s) was used in the imaging, and continuous apparent diffusion coefficient (ADC) metrics (ADCmin, ADCmax, ADCmean, ADCSD, and rADC) were compared between the metastatic and non-metastatic lymph nodes. RESULTS: In total, 48 lymph nodes from 33 patients were assessed. All metastatic lymph nodes were restricted, while among the non-metastatic lymph nodes, only 19.3% were restricted. Considering pathological reports of metastatic and non-metastatic lymph nodes as the gold standard, DWI-related restricted and non-restricted features had a sensitivity of 80.6%, a specificity of 100%, and an accuracy of 87.5% to discriminate between a metastatic and non-metastatic pattern. ADC metrics of ADCmin, ADCmax, ADCmean, ADCSD, and rADC showed high values enabling differentiation between metastatic and non-metastatic lymph nodes. The best cut-off values were 0.7 × 10-3, 1.2 × 10-3, 1.01 × 10-3, 123, and 0.78, respectively. CONCLUSION: DW-MRI is a useful quantitative tool for differentiating between metastatic and benign lymph nodes in endometrial cancer patients.

Successful Nonsurgical Treatment of a Radial Artery Pseudoaneurysm Following Transradial Coronary Angiography.

Transradial coronary angiography has been known as an alternative to the transfemoral approach with fewer serious complications. Radial artery pseudoaneurysms present as a rare complication of transradial catheterization. Although some methods have been applied for the obliteration of pseudoaneurysms, the use of radial bands such as the TR Band® (Terumo Medical Corporation, Somerset, NJ) is a novel efficient technique only suggested by a few reports. We describe a 34-year-old man, who underwent transradial primary coronary angiography due to ST-elevation myocardial infarction. Two months later, he noticed a pulsatile mass on his hand where the catheterization was done. Ultrasonography proved the diagnosis of a pseudoaneurysm. Consequently, a TR Band® was applied to compress the mass. Interestingly, 24 hours later, ultrasonography confirmed a thrombosed pseudoaneurysm and the pulsatile mass had completely disappeared gradually without recurrence at 2 months' follow-up. Hence, this case report aims to propose the TR Band® as an effective noninvasive method for the treatment of pseudoaneurysms following catheterization.

Correlation of MRI findings and cognitive function in multiple sclerosis patients using montreal cognitive assessment test.

BACKGROUND: Magnetic resonance imaging (MRI) has improved the diagnosis and management of patients with multiple sclerosis (MS). Montreal Cognitive Assessment (MoCA) is a brief, sensitive test that has been recommended by National Institute of Neurological Diseases and Stroke and Canadian Stroke Network (NINDS-CSN) as a reliable tool to detect mild cognitive impairments. This study aimed to evaluate the relationship between MoCA test and its sub-items with brain abnormalities in MRI of MS patients. METHODS: Based on MRI scans of 46 MS patients, third ventricle and white matter lesions volumes were measured. Disease duration and expanded disability status scale (EDSS) were recorded in each patient. In addition, cognitive domains of the patients were evaluated by Montreal cognitive assessment (MoCA) test. We analyzed data using t-test or Mann-Whitney U test, Pearson correlation coefficient, and non-parametric Spearman test. Furthermore, multiple linear regression model was applied to evaluate the association between cognitive indices and MRI characteristics. RESULTS: Among MRI indices, only severity of atrophy showed a significant difference between cognitively impaired and cognitively preserved patients. Third ventricular volume was significantly correlated with total MoCA score (p=0.003, r=-0.42), but none of the juxtacortical or periventricular lesions volume revealed significant relation with total MoCA score. However, using multivariate linear regression after adjustment for educational level and disease duration, there was a significant negative association between juxtacortical lesions volume and total MoCA score as well as naming and attention sub-items. Also, memory score was adversely associated with the third ventricular volume (p=0.03, r=0.31). CONCLUSION: Cognitive disturbances detected by MoCA, may be associated with some pathological changes including atrophy, third ventricular volume, and juxtacortical lesion. MoCA, as a brief test, is not correlated with brain lesions volume in MS patients.