Does Gadolinium Deposition Lead to Metabolite Alteration in the Dentate Nucleus? An MRS Study in Patients with MS.

BACKGROUND AND PURPOSE: Repeat contrast-enhanced MR imaging exposes patients with relapsing-remitting MS to frequent administration of gadolinium-based contrast agents. We aimed to investigate the potential metabolite and neurochemical alterations of visible gadolinium deposition on unenhanced T1WI in the dentate nucleus using MRS. MATERIALS AND METHODS: This prospective study was conducted in a referral university hospital from January 2020 to July 2021. The inclusion criteria for case and control groups were as follows: 1) case: patients with relapsing-remitting MS, visible gadolinium deposition in the dentate nucleus (ribbon sign), >5 contrast-enhanced MR images obtained; 2) control 1: patients with relapsing-remitting MS without visible gadolinium deposition in the dentate nucleus, >5 contrast-enhanced MR images obtained; 3) control 2: patients with relapsing-remitting MS without visible gadolinium deposition in the dentate nucleus, <5 contrast-enhanced-MR images obtained; and 4) control 3: adult healthy individuals, with no contrast-enhanced MR imaging. Dentate nucleus and pontine single-voxel 12 × 12 × 12 MRS were analyzed using short TEs. RESULTS: Forty participants (10 per group; 27 [67.5%] female; mean age, 35.6 [SD, 9.6] years) were enrolled. We did not detect any significant alteration in the levels of NAA and choline between the studied groups. The mean concentrations of mIns were 2.7 (SD, 0.73) (case), 1.5 (SD, 0.8) (control 1), 2.4 (SD, 1.2) (control 2), and 1.7 (SD, 1.2) (control 3) (P = .04). The mean concentration of Cr and mIns (P = .04) and the relative metabolic concentration (dentate nucleus/pons) of lipid 1.3/Cr (P = .04) were significantly higher in the case-group than in healthy individuals (controls 1-3). Further analyses compared the case group with cumulative control 1 and 2 groups and showed a significant increase in lactate (P = .02), lactate/Cr (P = .04), and Cr (dentate nucleus/pons) (P = .03) in the case group. CONCLUSIONS: Although elevated concentrations of Cr, lactate, mIns, and lipid in the dentate nucleus of the case group indicate a metabolic disturbance, NAA and choline levels were normal, implying no definite neuronal damage.

Prevalence of asymptomatic COVID-19 infection using a seroepidemiological survey.

The prevalence of asymptomatic infection by coronavirus disease 2019 (COVID-19) as a critical measure for effectiveness of mitigation strategy has been reported to be widely varied. In this study, we aimed to determine the prevalence of asymptomatic infection using serosurvey on general population. In a cross-sectional seroprevalence survey in Guilan province, Iran, the specific antibody against COVID-19 in a representative sample was detected using rapid test kits. Among 117 seropositive subjects, prevalence of asymptomatic infection was determined based on the history of symptoms during the preceding 3 months. The design-adjusted prevalence of asymptomatic infection was 57.2% (95% confidence interval (CI) 44-69). The prevalence was significantly lower in subjects with previous contacts to COVID-19 patients (12%, 95% CI 2-49) than others without (69%, 95% CI, 46-86). The lowest prevalence was for painful body symptom (74.4%). This study revealed that more than half of the infected COVID-19 patients had no symptoms. The implications of our findings include the importance of adopting public health measures such as social distancing and inefficiency of contact tracing to interrupt epidemic transmission.

Motivational interviewing-based training vs traditional training on the uptake of cervical screening: a quasi-experimental study.

OBJECTIVES: Cervical cancer, a major health issue affecting women, is preventable and can be successfully treated. It is essential that measures are taken to improve the uptake of screening for this cancer. The aim of this study was to compare the effects of motivational interviewing (MI)-based training and traditional training on the frequency of cervical cancer screening tests in a group of working female teachers. STUDY DESIGN: This is a quasi-experimental study. METHODS: This research was conducted in 2017 among 134 teachers (aged 30-60 years) working in southeastern Iran. The participants were selected from among the eligible individuals and subsequently divided into MI-based training and traditional training groups (n = 67 for each group). Each group received a three-session training program, and 20 weeks after the end of the last training session, the information obtained from cervical cancer screening tests was documented. To analyze the data, independent t-test and Chi-squared test were run in SPSS, version 21. RESULTS: There was no significant difference between the two groups in terms of demographic characteristics such as age, age at the first pregnancy, age of marriage, the number of parities, and educational level. Twenty weeks after intervention, 20.9% of the MI-based training group underwent Pap smear screening test, while 9% of the women in the traditional training group took the test, indicating a statistically significant difference between the two groups (P < 0.0.5). CONCLUSION: MI-based training has a significant positive effect on women's compliance with cervical cancer screening tests. Therefore, it is recommended that this technique be adopted in women's health centers. TRIAL REGISTRATION NUMBER: IRCT2017100729954N4.

Comparison of quantitative and qualitative tests for glucose-6-phosphate dehydrogenase deficiency in the neonatal period.

INTRODUCTION: Considering the high prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among newborns, different screening methods have been established in various countries. In this study, we aimed to assess the prevalence of G6PD deficiency among newborns in Rasht, Iran, and compare G6PD activity in cord blood samples, using quantitative and qualitative tests. METHODS: This cross-sectional, prospective study was performed at five largest hospitals in Rasht, Guilan Province, Iran. The screening tests were performed for all the newborns, referred to these hospitals. Specimens were characterized in terms of G6PD activity under ultraviolet light, using the kinetic method and the qualitative fluorescent spot test (FST). We also determined the sensitivity, specificity, negative predictive value, and positive predictive value of the qualitative assay. RESULTS: Blood samples were collected from 1474 newborns. Overall, 757 (51.4%) subjects were male. As the findings revealed, 1376 (93.4%) newborns showed normal G6PD activity, while 98 (6.6%) had G6PD deficiency. There was a significant difference in the mean G6PD level between males and females (P = 0.0001). Also, a significant relationship was detected between FST results and the mean values obtained in the quantitative test (P < 0.0001). CONCLUSION: According to the present study, FST showed acceptable sensitivity and specificity for G6PD activity, although it appeared inefficient for diagnostic purposes in some cases.

Dynamic contrast-enhanced MRI for differentiation of major salivary glands neoplasms, a 3-T MRI study.

OBJECTIVES: Pre-operative differentiation of salivary gland neoplasms is of great importance. This study was designed to evaluate the use of dynamic contrast-enhanced MRI (DCE-MRI) for differentiation between malignant, Warthin and benign non-Warthin (BNW) neoplasms of major salivary glands. METHODS: 46 major salivary gland tumours (SGTs) underwent pre-operative DCE-MRI. Post-surgical histopathological evaluation showed 30 BNW, 6 Warthin and 10 malignant tumours. Time-signal intensity curves (TICs) were categorized as (a) Tpeak >43 s and washout ratio at 180 s (WR180) <4.6%; (b) Tpeak <43 s and WR >22%; (c) Tpeak >43 s and WR180 = 4.6-22.0% RESULTS: Accuracy of Tpeak was 98.9% for differentiation between BNW and Warthin tumours, 83.7% between BNW and malignant and 80% between malignant and Warthin tumours. All Warthin tumours showed Tpeak ≤43 s, while one BNW had Tpeak <43 s. A Tpeak <63.5 s differentiated 8/10 (80%) malignant tumours from BNW tumours, whereas 4/30 of BNW tumours had a Tpeak <63.5 s. Two malignant tumours had Tpeak <43 s. WR180 had an accuracy of 100% for differentiation between Warthin and BNW tumours, 87.3% between BNW and malignant, and 93.3% between Warthin and malignant tumours. 29 (96.7%) BNW tumours had a washout <4.60%, while 8 (80%) malignant tumours had a washout >4.60%. All Warthin tumours had a WR180 >22%, while two malignant tumours had a WR180 >22%. 29/30 of BNW tumours demonstrated TIC curve Type A and 1 tumour demonstrated Type C. 6/10 of malignant tumours had TIC Type C, 2 had TIC Type A and 2 Type B. All Warthin tumours were categorized as Type B. CONCLUSIONS: This study showed that DCE-MRI could be helpful in pre-operative differentiation of SGTs; especially for discrimination between Warthin and BNW tumours.

Effect of surface modification by nitrogen ion implantation on the electrochemical and cellular behaviors of super-elastic NiTi shape memory alloy.

The aim of this investigation was to enhance the biological behavior of NiTi shape memory alloy while preserving its super-elastic behavior in order to facilitate its compatibility for application in human body. The surfaces of NiTi samples were bombarded by three different nitrogen doses. Small-angle X-ray diffraction was employed for evaluating the generated phases on the bombarded surfaces. The electrochemical behaviors of the bare and surface-modified NiTi samples were studied in simulated body fluid (SBF) using electrochemical impedance and potentio-dynamic polarization tests. Ni ion release during a 2-month period of service in the SBF environment was evaluated using atomic absorption spectrometry. The cellular behavior of nitrogen-modified samples was studied using fibroblast cells. Furthermore, the effect of surface modification on super-elasticity was investigated by tensile test. The results showed the improvement of both corrosion and biological behaviors of the modified NiTi samples. However, no significant change in the super-elasticity was observed. Samples modified at 1.4E18 ion cm(-2) showed the highest corrosion resistance and the lowest Ni ion release.

The survey of diastolic function changes in end-stage renal disease patients before and 3 and 6 months after kidney transplantation.

INTRODUCTION: Left ventricular diastolic dysfunction, which is prevalent in end-stage renal disease, predicts morbidity and mortality among affected patients. The aim of this study was to evaluate diastolic function changes in end-stage renal disease patients before as well as 3 and 6 months after kidney transplantation. METHODS AND MATERIALS: This longitudinal study from November 2008 to November 2009, enrolled 27 consecutive kidney transplant patients. Systolic and diastolic blood pressures and echocardiograghic parameters such as ejection fraction, left ventricular mass, and diastolic functions were measured before, as well as 3 and 6 months after transplantation. Data were analyzed by repeated-measure analysis of variance and Friedman tests using SPSS version 18. RESULTS: The mean patients age was 39.47 ± 12.27 years with 55.6% males. The mean systolic and diastolic blood pressure and left ventricular mass decreased significantly in the first 3 (125.44 ± 11.35, 78.51 ± 6.32, 141.94 ± 3.32) and 6 months (121.48 ± 10.63, 72.96 ± 4.21, 138.25 ± 3.12) after renal transplantation compared to the values before the procedure (136.77 ± 14.09, 81.92 ± 9.01, 158.30 ± 3.58 respectively; P < .05). The left ventricular ejection fraction increased significantly at 3 (63.00 ± 6.49) and 6 months (66.11 ± 5.87) compared with preoperative (62.48 ± 5.74; P < .05). Step mean diastolic function also decreased significantly at 3 (1.94) and 6 months (1.81) compared with before transplantation (2.24; P < .05). CONCLUSION: According to our findings, transplantation can correct ejection fraction and systolic and diastolic blood pressure and lead to regression of left ventricular hypertrophy. Diastolic function was improved after transplantation.

1-hexyl n-cyanoacrylate compound (Neucrylate™ AN), a new treatment for berry aneurysm. III: Initial clinical results.

INTRODUCTION: As part of an institutionally approved research protocol, patients with cerebral berry aneurysm were enrolled in a clinical trial designed to evaluate the safety of the new moldable liquid embolic agent Neucrylate AN. METHODS: Twelve patients with aneurysms judged to be suboptimal for treatment by standard endovascular or surgical approaches were treated with Neucrylate AN. The agent was injected during temporary balloon occlusion at the neck of the aneurysm. The immediate angiographic percentage of aneurysm occlusion and periprocedural adverse events were assessed for each patient. Six-month follow-up angiographic studies were obtained for nine of the 12 patients. RESULTS: Ten of the 12 aneurysms treated (83%) were large to giant (>1.0 cm in diameter), nine (75%) were wide-necked (dome/neck ratio <2.0) and three (25%) were dissecting aneurysms. There were four (33%) periprocedural neurological events. Immediate aneurysm occlusion of >90% was obtained in nine of the 12 cases (75%). There were five recurrences (55.5%) at 6 months. CONCLUSION: This preliminary clinical series shows that it is feasible to achieve a high percentage of immediate aneurysm occlusion with limited patient morbidity and mortality in the setting of morphologically challenging aneurysms. These preliminary data support larger trials assessing the safety and efficacy of this agent.

Hematologic manifestations in a child with HIV; a Case Report.

BACKGROUND: Immune deficiency in human might be primary or secondary and could be seen with a wide variety of manifestations. In the following, we presented a Child with various complains that diagnosed to have HIV infection. CASE REPORT: A 2/5 y/o child was admitted to the hospital for FUO with prolonged cough, FTT, cervical lymphadenopathy, hepatosplenomegaly and bilateral optic neuritis. . He was hospitalized for fever, cytopenia and hepatosplenomegaly one year ago, and three months later in an outpatient visit, these signs improved, except thrombocytopenia. In evaluation, bicytopenia, elevated ESR, hyperlipidemia, hyperproteinemia, thrombosis of the transverse sinus of brain, antiphospholipid antibodies , decreased levels of protein S and factor V Leiden and increased level of anti thrombin III were detected. Consequently, the result of HIV antibody showed positive. In addition to warfarin and cotrimoxazole therapy, he was referred to special center for possible HARRT therapy. CONCLUSION: In approach to patients with various clinical presentations such as cytopenia, recurrent or persistent lymphadenopathy, unexplained hyperproteinemia or hyperlipidemia, evaluation of HIV infection is highly recommended for consideration and further therapy.

Preoperative vaginal preparation with povidone-iodine on post-caesarean infectious morbidity.

The commonest complication associated with caesarean section is infection. The aim of this study is to investigate the effect of vaginal preparation with povidone-iodine on post-caesarean infection. In this clinical trial, 568 patients were selected for two groups: a treatment group and a control group, each with 284 patients. A vaginal scrub was performed before the routine abdominal scrub, with two 4 × 4 cm sponge sticks saturated with povidone-iodine solution, rotated in the vagina for about 30 s. In the control group, only the abdominal scrub was performed. Patients received a single dose of prophylactic antibiotics, and were reviewed for 6 weeks to look for predefined variables. Post-caesarean endometritis occurred less frequently in the treatment group than in the control group (2.5% vs 1.4%). There was no significant difference for febrile morbidity and wound infection in the two groups. The adjusted odds ratio for endometritis after vaginal preparation was 0.03 (95% CI: 0.008-0.7). Vaginal preparation with povidone-iodine may decrease the risk of post-caesarean endometritis.

Combination of bolus dose vitamin D with routine vaccination in infants: a randomised trial.

INTRODUCTION: The present study was designed to compare two methods of vitamin D supplementation in infants: every two months as a routine vaccination versus a daily dose. METHODS: A randomised clinical trial was performed on 120 healthy breastfed infants between January and September 2007 in Yazd, Iran. The infants were randomly divided into three groups with different doses of vitamin D3 supplementation: 200 IU daily, 400 IU daily and a bolus of 50,000 IU every two months. A blood sample was taken and evaluated for 25-hydroxy vitamin D and calcium levels when the infants were six months old. The data was reported as the mean and standard deviation. RESULTS: No significant differences were observed between the serum level of 25-hydroxy vitamin D in the groups administered with 200 IU and 400 IU vitamin D daily. However, the serum level of 25-hydroxy vitamin D reached significance in the third group (p is less than 0.001). All the blood calcium measured was below 11 mg/dl in the bolus group. A few complications such as diarrhoea and agitation, all of which were self-limited, were seen in the bolus group. No other significant side effects were reported in the other groups. CONCLUSION: This study demonstrates that a bolus of 50,000 IU of vitamin D every two months with a routine child vaccination program provides the ideal serum level of vitamin D. This method produces no serious side effects and offers a highly convenient way to supply vitamin D, especially among non-compliant parents.

Evaluation of angiographic findings in spontaneous aneurysmal subarachnoid hemorrhage patients.

This paper describes the angiographic findings of spontaneous aneurysmal subarachnoid hemorrhage (SAH) patients, including frequency, anatomic location and multiplicity of cerebral aneurysms. We retrospectively reviewed the records of 796 SAH patients at our university affiliated hospital. After confirming SAH by lumbar puncture or CT scan, all patients underwent digital subtraction angiography to find the definite anatomic location. The male to Female ratio in SAH patients was 9:10. The mean (SD) age of all patients with SAH was 47.9±14.7 years. The mean (SD) age of men with SAH was 46.6 ±15.6 years and women with SAH was 49.3±13.5 years (P=0.015). 357 (44.8%) patients had aneurysms. The mean (SD) age of aneurysmal patients was 49.8±14.3 years. The mean (SD) age of men with aneurysm was 47.8 ±15.9 years and women with aneurysm was 51.3±12.9 years (P= 0.03). The male to female ratio in aneurysms was 0.72:1. The most common aneurysm location was in the anterior communicating artery (N=166, 39%). The second most common anatomic location was the middle cerebral artery bifurcation (66 left, 60 right). The total number of patients with single aneurysms was 303 (84.9%) while 54 (15.1%) patients had multiple aneurysms. Among these patients, 49 had two aneurysms, three had three aneurysms and two had four aneurysms. In all, 418 aneurysms were detected. Of 357 patients with aneurysms 150 (42%) had vasospasm during angiography. In conclusion, the most common aneurysm location was the anterior communicating artery and the rate of multiplicity was also higher in our patients.

Comparison of one-side and bilateral intracavernosal papaverine injection on a Doppler study of the penis.

Intracavernosal injection of a vasodilating agent, followed by color Doppler ultrasonography of the penis, is used to diagnose vascular impotence. The vasodilating agent is usually injected into one of the corpora cavernosa and the peak systolic velocity (PSV) of the cavernosal arteries is measured on both sides, presuming that the connection between the two cavernosal bodies will distribute the drug uniformly on both sides and will consequently affect the cavernosal arteries and sinusoids equally. According to our experience, the PSV of the injection side is higher than that of the contralateral side. This difference could affect the results of the evaluation. In this study, our objective was to compare the results of both-side injections with those of one-side injection. A total number of 60 patients with a normal Doppler study of the penis were enrolled in the study and were randomly divided into three groups. In the first and second group, 60 mg papaverine was injected into the right and left corpus cavernosa each. In the third group, half of the dose was injected into each side. The mean maximum PSV was measured and compared in each group. The mean maximum PSV in the group with the right-side injection was 47.7+/-10.8 and 40.3+/-9.2 on the right and left side, respectively. The mean maximum PSV in the group with the left side injection was 44.4+/-7.1 and 51.4+/-7.1 on the right and the left side, respectively. The mean maximum PSV in the group with bilateral injection was 47+/-9.9 on the right side and 46.7+/-10.7 on the left side. In the first two groups, there was significant difference between the mean maximum PSV of the right and left cavernosal arteries, but in the third group, there was no significant difference between the mean maximum PSV of both side cavernosal arteries. Injecting papaverine in only one corpus cavernosum, despite a perfect postinjection manipulation of the penis, will affect the sinusoids and cavernosal artery at the same side of the injection more than the contralateral side. This results in a higher increase in the blood flow and PSV on that side and results in an artifactual difference between the velocity of the right and left side, which could ultimately exaggerate or mask the actual difference between the two sides. Dividing the total dose of the vasodilating agent and injecting half of the dose into each corpus cavernosum separately prevents artifactual difference between blood flow and velocity on the right and left side.

The effect of water stress on the antioxidant content, protective enzyme activities, proline content and lipid peroxidation in wheat seedling.

An investigation was conducted to study the effect of water stress on the antioxidant content, protective enzyme activities, proline content and lipid peroxidation in wheat seedlings. Drought stress increases the amount of Reactive Oxygen Species (ROS), leading to metabolic disorders. It is now known that higher levels of activity-protective mechanisms render the cells more enduring against environmental stress including drought. Two widely cultivated cultivars of wheat in Iran, Sab. and N. Sar. were grown up according to the hydroponic method. Having reached the stage of 4-5 leaves growth; the plants were kept under 4, 8 and 12 bars potential resulting from using Polyethylene Glycol 8000 (PEG 8000). Hogland solution was used as the control. Then the amount of ascorbate, glutathione, superoxide dismutase and catalase activity, proline and lipid Peroxidation was measured in cut samples of the leaves. The result indicated an increase in the amount of Ascorbate and Glutathione as the stress was intensified in the case of Sab. Moreover, the reduced form of Ascorbate (ASC) and Glutathione (GSH) were higher in Sab. at 8 and 12 bars. The amount of Proline accumulation was considerably higher in Sab. than N. Sar. SOD activity, on the other hand, diminished at 8 and 12 bar levels. CAT activity is also regarded as a limiting factor. Lipid peroxidation was also geared up as the stress was intensified. These limiting factors rendered N. Sar. cultivar more sensitive to water stress resulting from PEG8000 compared to Sab.

Prognostic value of brain tissue pathological changes in patients with clinically isolated syndromes (CIS) suggestive of multiple sclerosis using magnetization transfer ratio (MTR).

The aim of this study is to investigate abnormalities in the brain tissue of patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). In this method, magnetization transfer ratio (MTR) parameter accompanied with segmentation regional measurements and histogram analysis were used to improve the evaluation of disease progression in CIS patients. Conventional MR imaging protocols such as T1-weighted, T2-weighted, T2-FLAIR as well as MT-2DSPGR were performed on four CIS patients and four normal subjects. White matter, gray matter and lesion masks were segmented from T2-weighted images and superimposed on MTR map using FSL software. Lesions were classified into isontense and severely hypointense according to their signal intensities relative to white matter on the T1-weighted images. MTR parameters of these two lesion types, normal appearing white matter (NAWM) and normal appearing gray matter (NAGM) were analyzed in comparison with those of normal controls. The MTR histograms of NAWM and NAGM were also generated for each segmented brain tissues. A significant reduction was found in mean white matter MTR and the histogram peak position between CIS patients and healthy subjects. The MTR histogram for NAWM showed also a total shift to the left. The MTR value for gray matter in CIS patients was similar to that of controls. Isointense lesions have significantly higher MTR values than severely hypointense lesions. Significant reduction in NAWM-MTR compared to normal subjects shows that pathological changes outside visible lesions on conventional MR images occur among patients with CIS at presentation. Quantitative MT imaging can help to evaluate the extent of global damage in the brain tissue.

Urinary tract infections in pregnant women with bacterial vaginosis.

Urinary tract infections (UTIs) and bacterial vaginosis are common problems in pregnancy and are associated with serious obstetric complications. We evaluated the risk of UTIs in pregnant women with bacterial vaginosis. A total of 322 pregnant women who presented for a prenatal visit were evaluated for bacterial vaginosis and UTIs, between March 2003 and September 2004. Bacterial vaginosis was diagnosed based on Amsel's criteria. Women using antibiotic or other vaginal cream, with specific vaginitis or vaginal bleeding were excluded. Data were analysed using chi(2), Student t-test and multiple logistic regression. A total of 76 women had bacterial vaginosis and 246 women did not; and 18 women (23.6%) with bacterial vaginosis had UTIs, compared with 24 (9.8%) of those without. Bacterial vaginosis was associated with an increased risk of UTIs (odds ratio (OR) 3.05; 95% CI: 1.47-6.33). Pregnant women with bacterial vaginosis are at increased risk for UTIs.

Biological control of Tiarosporella phaseolina the causal agent of charcoal rot of soybean.

Charcoal rot caused by Tiarosporella phaseolina (Tassi) Van der Aa is an important disease of soybean in Gorgan province of Iran. Experiments were carried out with 95 bactenal isolates that were collected from the rhizosphere of soybean plant. Among these bacteria only 50 isolates showed antagonistic effect on Tiarosporella phaseolina using dual culture test. Six highly effective bacteria were selected for subsequent studies. Based on biochemical physiological and morphological tests, isolates Pf-12 and Pf-63 were identified as Pseudomonas fluorescens, isolates B-13, B-42,B-126 and B-84 as Bacillus subtilis. The isolates of P. fluorescens produced antibiotics as well as volatile metabolites that inhibited mycelial growth of fungus. Bacillus subtilis isolates inhibited the fungal growth through volatile and non-volatile metabolites production. Only P. fluorescens isolates produced hydrogen cyanide. In greenhouse studies, the isolates B-13 and B-126 reduced 59% and 66% the intensity of charcoal rot of soybean respectively. The combinations of isolates B-13 and B-126 were also effective on reducing the intensity of disease.