Evaluation of the COVID-19 pandemic effect on the development of somatic symptoms in patients with mood disorders: a case-control study.

Somatic symptoms are one of the most common complaints among patients with psychiatric disorders and are considered as one of the most common psychiatric disorders in the new coronavirus pandemic. This study aimed to evaluate the effect of the COVID-19 pandemic on the physical symptoms in patients with mood disorders and compare it with healthy individuals. In this case-control study, 67 patients with mood disorders were referred to the psychiatric clinic of 5 Azar Hospital in Gorgan, who met the inclusion criteria, and 68 healthy individuals as control group were entered into the study. For all participants after informed consent, a demographic information questionnaire was completed along with Screening for Somatic Symptoms-7 (SOMS7) and Patient Health Questionnaire-15 (PHQ-15), and the data were analysed by SPSS software version 25. The mean score obtained for the SOMS-7 questionnaire for the group of patients with mood disorders and the control group was 32.37 ± 8.19 and 35.42 ± 11.3, respectively. The mean obtained for the PHQ-15 questionnaire for the mood disorders group and the control group was 8.56 ± 5.93 and 5.86 ± 4.63, respectively. In the mood disorder group, 26.9% of patients had no risk for physical symptoms, 31.3% of patients had a low risk, 25.4% of patients had a moderate risk, and 16.4% of patients had a high risk for physical symptoms. The statistical test showed that although the risk of physical symptoms was high in both groups, this rate was higher in the group with mood disorders, and there is a significant difference between the two groups (P < 0.05). The results also showed a significant and direct relationship between the two questionnaires (P < 0.05). According to the results, although the prevalence of somatic symptoms increased in both groups, the prevalence of somatic symptoms is significantly higher in the mood disorder group.

Wheelchair users' perceived exertion during typical mobility activities.

STUDY DESIGN: Each participant performed a series of wheelchair exercises equivalent in intensity to minimal functional speed (1 m s(-1)), functional walking speed (1.3 m s(-1)), a relatively challenging speed (1.6 m s(-1)) and a self-selected speed. Each participant also completed a graded exercise test (GXT) to volitional exhaustion (VO2peak). OBJECTIVES: The purpose of this study was (1) to assess the physical capacity of wheelchair users as they undertake typical mobility activities and (2) to investigate how closely the components of a differentiated model of perceived exertion mirror wheelchair users' own perception of exertion. METHODS: Eleven (eight males and three females) spinal cord-injured or congenitally impaired wheelchair-dependent participants volunteered for the study. Differentiated ratings of perceived exertion (RPE_arm and RPE_respiration) and oxygen uptake (VO2) and heart rate were recorded during each exercise. RESULTS: The mean comfortable speed at which the participants propelled their own wheelchairs on the wheelchair ergometer was 1.1±0.2 m s(-1). Speeds of 1 m s(-1) and 1.3 m s(-1) are typical of everyday functional propulsion. The corresponding RPE_respiration and RPE_arm ranged from 7 to 13 on the Borg scale; the %VO2peak measured in these trials ranged from 37 to 80% VO2peak. For propulsion intensities used in the present study-low, moderate, high and graded exercise intensity-no difference could be observed between RPE_respiration and RPE_arm. There were no significant differences between RPE_arm and RPE_respiration at the termination of the GXT. CONCLUSION: The current study showed potential for the use of RPE to assess and monitor daily wheelchair propulsion intensity in individuals with paraplegia.

Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience.

INTRODUCTION: Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. DESCRIPTION OF THE PROJECT: Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. LESSON LEARNED: A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country.

Computed tomography as a screening exam in patients with suspected blunt aortic injury.

BACKGROUND: Chest computed tomography (CT) screening of patients with blunt trauma for thoracic aortic injury is controversial. This study was undertaken to determine whether CT could exclude aortic injury and be used to select patients for aortography. METHODS: Computed tomography and aortography were used to evaluate 155 patients with blunt trauma. Computed tomography scans were reviewed separately by four attending radiologists who were unaware of the patients' clinical course and angiographic findings. RESULTS: Eight of 155 patients had aortic injuries requiring operation. Computed tomography scans in five patients were read as positive by all reviewers. One scan was read as positive by three reviewers and as negative by one. Two scans were read as positive by two radiologists and as negative by two. After poor scans were excluded, the combined sensitivity of CT for detecting aortic injury was 88%, specificity was 54%, positive predictive value was 9%, and negative predictive value 99%. CONCLUSIONS: The sensitivity of CT scan for indicating the need for aortography is observer dependent. As CT manifestations of aortic injury are often subtle, CT does not reliably exclude aortic injury.

The role of intrarectal ultrasound (IRUS) in staging of rectal cancer and detection of extrarectal pathology.

Intrarectal Ultrasound (IRUS) is rapidly becoming an effective tool in the staging of rectal cancer. Twenty-nine consecutive patients with adenocarcinoma of the rectum underwent both CT scanning and IRUS in the preoperative assessment of rectal cancer in an effort to correlate IRUS staging with surgical pathology, correlate tumor staging comparing IRUS with CT scan, and determine incidence of extrarectal pathology by IRUS. Patients were reviewed as to IRUS stage, results of CT scan, TNM stage of extirpated tumor, incidence of genitourinary pathology, and sonographic result of preoperative radiotherapy (RT). The mean age of all patients was 69 years; there were 25 males and four females. Twenty-four patients underwent proctectomy with either low pelvic anastomosis or end stoma; five underwent local surgical therapy. Thirteen patients received preoperative RT. CT scan correlated poorly with IRUS staging of tumors penetrating the muscularis propria. IRUS overstaged 40 per cent, understaged 5 per cent, and correctly staged 55 per cent of patients when compared with pathological specimens. Eleven of the 25 males (44 per cent) had abnormal prostates by IRUS. Five (20%) had further urologic intervention, resulting in two prostatic cancers found. Our data suggests that CT scan staging correlated poorly with IRUS staging. CT poorly determines depth of rectal tumor wall invasion. IRUS correlated well with pathology and understaged 5 per cent of patients before surgery. Genitourinary abnormalities were detected in a significant number of patients. IRUS is an effective modality for preoperative staging of rectal cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Jejunized colon: a rare complication of carcinoid tumor.

A 23-yr-old female with a history of dyspnea, palpitation, productive cough, occasional hemoptysis, intermittent diarrhea, and abdominal pain was found to have metastatic carcinoid tumor and a "jejunized colon." Carcinoid tumors are relatively rare neoplasms found throughout the gastrointestinal tract, the ovaries, and the lungs. Barium enema showed a normal rectum and a pattern identical to jejunum in the proximal colon. Endoscopic biopsies confirmed the presence of small intestinal mucosa in the colon. Foreshortening of the colon was probably due to a desmoplastic reaction secondary to the carcinoid tumor. Histologic confirmation of these findings has never been described before.

Villous adenoma of the common bile duct.

A villous adenoma of the common bile duct (CBD) causing obstructive jaundice was demonstrated by sonography and ERCP in a 34-year-old man. The radiological and clinical features of this rare tumor are herein presented.

Late onset renal allograft anastomotic pseudoaneurysm with absent Doppler signal.

A large extrarenal pseudoaneurysm, originating from the arterial anastomosis of a renal allograft, occurred spontaneously 7 years after transplantation in a 29-year-old diabetic patient. Although the scintigraphic examination was diagnostic of a pseudoaneurysm, pulsed Doppler and color coded Doppler ultrasound failed to demonstrate a Doppler signal, suggesting erroneously a nonvascular fluid collection. The role of scintigraphy combined with duplex ultrasound in this rare but potentially fatal complication of renal transplantation is discussed.

Assessment of renal allograft pathology by scintigraphic and ultrasound index-markers.

The efficacies of two scintigraphic and two sonographic techniques and resultant index values, as markers of renal allograft pathology, were assessed. Index values of 183 combined scintigraphic and sonographic examinations in 47 graft recipients were compared to the pathological diagnosis of transplant biopsies and subsequent clinical outcome. All recipients were studied with baseline imaging techniques postoperatively, again when indicated by predefined clinical criteria, and prior to graft biopsy. The scintigraphic technique involved the calculation of indices of thrombotic activity and cortical graft perfusion. Ultrasound involved determination of the Doppler resistance index of Pourcelot and estimations of graft volume from real time images. A decreased cortical perfusion index was, overall, the most sensitive index of acute or chronic graft pathology, but it lacked specificity. Increased thrombotic and resistance indices were 96% and 86% sensitive for acute vascular rejection and were 82% and 76% specific. Jointly increased thrombotic and resistance indices improved the specificity for acute vascular rejection to 98%. An increase in graft volume of more than 50% over stable values was 100% sensitive and 92% specific for acute interstitial rejection, and 95% specific when paired with a normal thrombotic index. A marked increase in the thrombotic index was 100% sensitive for cyclosporine-induced thrombotic microangiopathy, but only 49% specific. The specificity of a markedly increased thrombotic index for thrombotic microangiopathy improved to 93% when the Doppler resistance index remained normal or was only marginally elevated. None of the scintigraphic or ultrasound indices were helpful for the diagnosis of acute tubular necrosis, chronic rejection, recurrent glomerulopathy, or graft infection.

Pancreatic lymphangioma: CT, MRI, and angiographic features.

An unusual case of pancreatic lymphangioma presenting as a large mid-abdominal mass with sunburst pattern of calcification is herein described. The findings noted on computed tomography (CT), magnetic resonance imaging (MRI), and mesenteric angiography are illustrated.

Innocuous gas collections in pancreatic allografts demonstrated by computed tomography.

Over a 4-year period, 6 pancreatic abscesses were found in 37 patients who had combined renal and segmental pancreatic transplants. An additional 4 patients who were nontoxic at the time of their computed tomographic (CT) examinations had innocuous gas collections, either in the pancreatic allograft or the surrounding peripancreatic tissue. The possible etiology of this gas formation is discussed. These collections do not have the same ominous clinical significance as would be expected in abscess formation. Radiological evaluation should include examination of the gastrointestinal tract and voiding cystograms to detect fistula formation. Simultaneous percutaneous aspiration of this area should be performed to rule out an infective process. If this is negative in a nontoxic transplant patient, the radiologist will be in a position to obviate unnecessary surgical intervention.

Neutropenic colitis: evaluation with computed tomography.

The computed tomography findings of 10 patients with neutropenic colitis are described and illustrated. Seven of these patients had leukemia, one had lymphocytic lymphoma, and two had systemic lupus erythematosus. All patients had colon wall thickening which was either isodense with the normal bowel tissue or showed areas of intramural low density. Air in the thickened bowel wall was seen in six patients. These computed tomography findings in neutropenic patients with fever, abdominal pain, and diarrhea should suggest the diagnosis in most instances, resulting in prompt treatment of this usually life-threatening entity.

Radionuclide surveillance of the allografted pancreas.

To determine the value of scintigraphy to detect posttransplantation complications of the allografted pancreas, we retrospectively reviewed 209 scintigrams obtained with 99mTc-sulfur colloid (99mTc-SC) and 99mTc-glucoheptonate (99mTc-GH). The scintigraphic studies were performed in 37 recipients of simultaneous renal and pancreatic allografts harvested from the same donor. 99mTc-SC was used as an indicator of thrombotic vasculitis; pancreatic perfusion and blood-pool parameters were monitored with 99mTc-GH. In 11 of the 37 recipients, scintigraphic abnormalities suggested posttransplantation infarction. Recurrent episodes of acute rejection of the pancreatic allograft, which always coincided with acute rejection of the renal allograft, were monitored in 24 recipients. Rejection-induced ischemic pancreatitis was suggested in 12 of the 24 recipients and persisted in 10 recipients for several weeks after improvement of renal allograft rejection. Pancreatic atrophy was suggested scintigraphically in 16 of the 24 recipients with recurrent episodes of rejection. Spontaneous pancreatic-duct obstruction and obstructive pancreatitis were associated with a scintigraphic pattern similar to that of rejection-induced ischemic pancreatitis. We concluded that the specific radionuclides used in this series are useful for the surveillance and assessment of posttransplantation pancreatic infarction, acute rejection, pancreatitis, and atrophy.

Recurrent hemolytic uremic syndrome in a renal transplant recipient.

This case report presents clinical, scintigraphic, duplex sonographic, and biopsy findings in a 23-year-old female renal allograft (RAG) recipient, who had transplantation for chronic renal failure secondary to hemolytic uremic syndrome (HUS). She demonstrated acute and rapidly progressing RAG failure at 7 weeks after transplantation.

Experimental hemarthrosis in dogs: progressive synovitis monitored with technetium-99m pyrophosphate joint imaging.

We examined the time course of the development of hemorrhagic synovitis in response to repeated autologous blood injections into knee joints in mature dogs and the possible usefulness of joint imaging with technetium-99m pyrophosphate (Tc99m-PYP) in monitoring the early response of synovium to blood. Experimental hemarthrosis was induced in dogs by twice weekly injection of autologous blood into the knee joints. Sequential examination of the synovium at monthly intervals over a period of 12 weeks revealed early inflammatory cell infiltration and capillary neovascularization with eventual replacement of the normal fatty synovium by dense fibrous tissue. Serial Tc99m-PYP joint images demonstrated a progressive increase in isotope accumulation in the knees during the course of the study. Further isotope accumulation was observed after CO2 laser synovectomy. During the 24-week course of the entire study, no changes in joint cartilage or bone were observed by gross inspection or radiologic and light-microscopic examination. The findings indicate that the progressive proliferative, inflammatory, fibrotic changes in joint synovium associated with experimental hemarthrosis in dogs may be noninvasively and semiquantitatively assessed with the use of Tc99m-PYP scintigraphy. Evidence is also presented that the intensity of Tc99m-PYP joint accumulation (immediate static images) may not readily reflect synovial vascularity or synovial tissue mass.

Avascular bone necrosis in an untreated case of chronic myelogenous leukemia.

Hip pain due to aseptic necrosis of the femoral head was the first clinical manifestation of chronic myelogenous leukemia in a 9-year-old white female. An erroneous diagnosis of rheumatoid arthritis was first entertained. Physical examination showed splenomegaly, complete blood count revealed leucocytosis of 359,000. The initial radiograph of the involved hip was negative. Biopsy revealed aseptic necrosis of the femoral head. Chronic myelogenous leukemia (CML) was diagnosed on the basis of the peripheral blood smear and bone marrow biopsy. Two months later, radiograph, radionuclide bone scan, and magnetic resonance imaging (MR) of the involved hip were positive for aseptic necrosis of the femoral head.

Treatment of frostbite with i.v. streptokinase: an experimental study in rabbits.

Experiments were conducted in 32 rabbits to determine whether treatment with IV streptokinase can effectively limit the extent of tissue damage associated with frostbite injury of the hind limbs. Other variables studied were the temperature of the tissue during freezing, the time taken to rewarm the exposed limbs, and the delay between the initiation of treatment with streptokinase and cessation of freezing. A control group of 16 rabbits was not given streptokinase. The extent of tissue damage was estimated by sequential radionuclide perfusion scans of the exposed limbs. This estimate was based on the proportional loss of tissue perfusion on subsequent twice-weekly nuclear scans in comparison with that shown by scans performed immediately after thawing. Pathologic changes in exposed tissues were studied by histology. Streptokinase treatment and rapid rewarming both resulted in less tissue damage at all freezing temperatures. Streptokinase was most beneficial when given 12 hr after freezing, but was effective even when treatment was delayed up to 48 hr.

Frostbite: experimental assessment of tissue damage using Tc-99m pyrophosphate. Work in progress.

We designed an experimental model using a new method of freezing to study the pathogenesis and treatment of frostbite. Frostbite was simulated in a manner that closely resembles that which occurs in a natural environment. We used a radionuclide imaging technique to monitor the evolution and extent of tissue damage relative to temperature, rate of freezing, and controlled rewarming. Characteristic sequential changes were demonstrated on sequential nuclear scans. Nonperfusion, followed by perfusion, and finally again by nonperfusion occurred in all areas in which necrosis developed. The reappearance of nonperfusion corresponded to vascular injury and thrombosis evidenced at pathologic examination. We determined that lack of tissue perfusion corresponded to tissue injury. We believe that our experimental model provides an effective means of evaluating potential therapeutic regimens.