Comparative evaluation of ultrasonography and lateral radiography in nasal fractures diagnosis.

BACKGROUND: Nasal fractures are the most common type of trauma fracture. Conventional radiography is the primary method of choice. Ultrasonography is used as a new and non-invasive method for this purpose. The aim of this study is to compare the diagnostic values of ultrasonography with nasal X-ray. METHODS: This was a prospective study which was conducted during 2018-2019 at Bouali hospital, Sari, northern Iran. 130 patients who met our criteria enrolled our study. All patients underwent nasal X-ray and ultrasonography on a day of trauma. The physical examination during the reduction in operation room considered as gold standard for nasal bone fracture. The sensitivity, specificity, precision, positive predictive values, and negative predictive values, along with 95% confidence intervals, were determined by SPSS. RESULTS: The sensitivity, specificity, positive predictive values, negative predictive values, and precision of nasal X-ray were all reported to be 100% when compared to physical examination (the gold standard). Ultrasonography had a sensitivity of 78.13%, a specificity of 100%, a PPV of 100%, an NPV of 61.82%, and a precision of 83.85% in comparison to physical examination (the gold standard). CONCLUSION: The findings of this study suggest that ultrasonography can be utilized as a main diagnostic tool in the identification of nasal bone fractures in the vast majority of cases, avoiding the unwanted dangers and problems of X-rays. This is especially critical for expecting mothers and children.

Lymphopenia and lung complications in patients with coronavirus disease-2019 (COVID-19): A retrospective study based on clinical data.

A rapid outbreak of novel coronavirus, coronavirus disease-2019 (COVID-19), has made it a global pandemic. This study focused on the possible association between lymphopenia and computed tomography (CT) scan features and COVID-19 patient mortality. The clinical data of 596 COVID-19 patients were collected from February 2020 to September 2020. The patients' serological survey and CT scan features were retrospectively explored. The median age of the patients was 56.7 ± 16.4 years old. Lung involvement was more than 50% in 214 COVID-19 patients (35.9%). The average blood lymphocyte percentage was 20.35 ± 10.16 (normal range, 20%-50%). Although the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were high in more than 80% of COVID-19 patients; CRP, ESR, and platelet-to-lymphocyte ratio (PLR) may not indicate the in-hospital mortality of COVID-19. Patients with severe lung involvement and lymphopenia were found to be significantly associated with increased odds of death (odds ratio, 9.24; 95% confidence interval, 4.32-19.78). These results indicated that lymphopenia < 20% along with pulmonary involvement >50% impose a multiplicative effect on the risk of mortality. The in-hospital mortality rate of this group was significantly higher than other COVID-19 hospitalized cases. Furthermore, they meaningfully experienced a prolonged stay in the hospital (p = .00). Lymphocyte count less than 20% and chest CT scan findings with more than 50% involvement might be related to the patient's mortality. These could act as laboratory and clinical indicators of disease severity, mortality, and outcome.

Cerebrotendinous xanthomatosis revisited.

Cerebrotendinous xanthomatosis is a rare autosomal recessive lipid storage syndrome defined clinically by the triad of progressive neurodegeneration, juvenile cataracts and tendon xanthomas in adults. It is treatable, and a prompt diagnosis can improve outcomes. We describe a patient with this condition who presented with progressive ataxia.

High-resolution computed tomography finding in 552 patients with symptomatic COVID-19: first report from north of Iran.

PURPOSE: Due to the emergence of the new coronavirus 2019 and the lack of sufficient information about infected patients, this study was conducted to investigate the chest high-resolution computed tomography (HRCT) findings of patients infected with the new coronavirus 2019. METHODS: This cross-sectional study was performed on COVID-19 patients referred to Medical Imaging Centers of Sari, Mazandaran, Iran, on March 2020 for computed tomography (CT) scan. Symptomatic patients were referred to the Medical Imaging Center for diagnosis confirmation through CT scan. In addition to age and sex, HRCT findings were collected from the picture archiving and communication system (PACS) for further evaluations. RESULTS: Out of 552 patients with mean age of 51.2 ± 14.8 years, the male/female ratio was 1.38 to 1. The most common expressive findings in patients were ground-glass opacity (GGO) (87.3%), peripheral distribution (82.4%), and posterior distribution (81.5%). The most conflicting findings in patients were pleural effusion (7.6%), peribronchovascular distribution (7.6%), and lymphadenopathy (5.1%). The peripheral distribution (p = 0.034), round opacities (p = 0.02), single lobe (p = 0.003), and pleural effusion (p = 0.037) were significant in people under and over 50 years of age. CONCLUSION: In summary, the present study indicated that in addition to GGO, peripheral distribution findings could be a vital diagnostic choice in COVID-19 patients.

Pachydermoperiostosis in a Patient with Crohn's Disease: Treatment and Literature Review.

Pachydermoperiostosis (PDP) is a rare disorder characterized by pachydermia, digital clubbing, periostitis, and an excess of affected males. It is the primary form of hypertrophic osteoarthropathy (HOA) and there are some rare associations of PDP with other disorders. Here we describe a patient with Crohn's disease associated with PDP. A 26-year-old man, who was a known case of Crohn's disease, referred with diffuse swelling in the upper and lower limbs and cutis verticis gyrata since 7 years ago. PDP was suspected and endocrinological and radiological studies were conducted for the evaluation of underlying disease. He was prescribed celecoxib, low-dose prednisolone, and pamidronate to control the swelling, periostitis, azathiopurine, and mesalazine according to gastrointestinal involvement. In conclusion, it is important to identify this condition since a misdiagnosis might subject the patient to unnecessary investigations.

Metabolic and endocrine changes induced by cinnamon in women with polycystic ovarian syndrome: A pilot study.

Objective: Most polycystic ovary syndrome (PCOS) patients have metabolic abnormalities in which insulin resistance (IR) plays a pivotal role. Cinnamon is a herbal medicine with insulinotropic properties. This pilot study aimed to evaluate the effects of cinnamon on ovarian volume, androgenic profile, and metabolic and anthropometric parameters in women with PCOS. Materials and Methods: A single-center, double-blind, randomized, placebo-controlled trial was carried out on 39 overweight / obese women with PCOS. For six months, subjects in the cinnamon (500 mg) (n=19) and placebo (n=20) groups were given three capsules daily. Before and after the intervention, the variables were assessed. The data was analyzed using the GraphPad Prism software. Results: After the intervention, the two intervention and control groups had significant differences in abdominal subcutaneous fat and ovarian volume, but they did not differ significantly in terms of body mass index (BMI). Also, after the intervention, no significant difference was observed between the two groups in terms of lipid profile and the concentration of androgenic biomarkers of insulin resistance. Conclusion: Cinnamon supplementation improves ovarian volume and subcutaneous abdominal fat but has no effect on anthropometric parameters, lipid profile, insulin resistance, or androgen hormones.

Determining Serum Levels of IL-10 and IL-17 in Patients with Low Back Pain Caused by Lumbar Disc Degeneration.

BACKGROUND: Low Back Pain (LBP) is a common health problem that affects different aspects of a person's life. Degeneration of the intervertebral disc is a major cause of LBP. Interleukin- 17 (IL-17) is a pro-inflammatory cytokine. In contrast, interleukin-10 (IL-10) prevents the occurrence of immune over-stimulation by inhibiting inflammation. The purpose of this study was to evaluate the serum levels of these cytokines in LBP patients and in the control group. METHODS: In a case-control study, 87 patients, including 59 patients with low back pain and 28 healthy subjects, were examined after magnetic resonance imaging (MRI) approval. After recording demographic data, 5 ml of peripheral blood samples were obtained from the subjects, and enzyme- linked immunosorbent assays (ELISA) technique was performed to measure IL-10 and IL-17 in serum samples. All analysis was performed in the SPSS software version 20 at a significant level of 0.05. RESULTS: The case group consisted of 21 males and 38 females with mean age 49.6 yrs., and the control group consisted of 14 males and 14 females with a mean age of 36. The mean body mass index (BMI) was 26.5 in the patients and 25.4 in the control group (P>0.05). Serum levels of inflammatory cytokine IL-10 and IL-17 were significantly lower and higher in patients than controls, respectively (P=0.04, P=0.03). CONCLUSION: Differences in serum levels of IL-17 and IL-10 in the LBP group compared with the healthy group may indicate the role of inflammatory and autoimmune processes in causing disk damage. These findings could potentially be used by future studies to develop new LBP therapeutic strategies.

Diagnostic accuracy of resistive index of capsular and intratesticular branches of testicular arteries in infertile men with oligoasthenospermia: A case-control study.

INTRODUCTION: Male infertility accounts for nearly 50% of couples' infertility. Only a few studies evaluate the diagnostic accuracy of resistive index (RI) of testicular arteries using color Doppler imaging to identify male infertility. The aim of this study was to investigate the diagnostic accuracy of RI of the capsular and intratesticular branches of testicular arteries in infertile men with oligoasthenospermia and its comparison with normal men. MATERIAL AND METHODS: In a case-control study, 30 patients with oligoasthenospermia (case group) and 30 healthy controls who meet the inclusion criteria, were selected. For all patients, RI was measured using color Doppler ultrasonography in upper and lower testicular poles. Also, testicular volumes were measured for all participants. RESULTS: Mean RI of the intratesticular artery (0.624 ± 0.051 versus 0.509 ± 0.054; P < 0.001) and capsular artery (0.663 ± 0.057 versus 0.557 ± 0.055; P < 0.001) were significantly higher in the case group compared to control group. The frequency of abnormal RI of intratesticular artery in the control (13.3%) and case (66.7%) groups were significantly different (OR: 13.0; 95% CI: 3.44-47.59; P < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) of intratesticular artery RI were 66.67%, 86.67%, 83.33%, 72.22%, and 76.67%, respectively. The frequency of abnormal RI of capsular artery was 23.3% in the control group and 90.0% in the case group (OR: 29.57; 95% CI: 6.85-127.63; P < 0.001). The sensitivity, specificity, PPV, NPV and OA of capsular artery RI were 90.0%, 76.67%, 79.41%, 88.46% and 83.33%, respectively. CONCLUSION: The results of this study indicated that assessing testicular Doppler RI of capsular and intratesticular branches of the testicular arteries, as a bio-imaging biomarker, may be a valuable non-invasive and simple complementary diagnostic modality with a high diagnostic value in identifying infertile men with oligoasthenospermia.

Comparing the Accuracy of Radiography and Sonography in Detection of Knee Osteoarthritis: A Diagnostic Study.

BACKGROUND: Knee osteoarthritis (OA) is the most common degenerative disorder occurring in older people. Radiography and sonography are convenient techniques to detect diverse pathological features of knee OA. AIM: The aim of the present study was to evaluate the diagnostic efficacy of radiography and sonography in the detection of diverse features of knee OA. METHODS: In a prospective cross-sectional diagnostic accuracy study, 50 consecutive patients with suspected knee OA (40 women and 10 men, mean age 41.2 ± 6.1 years), referred to the rheumatology clinic of the Shohada Hospital of Khorramabad. All obtained magnetic resonance imaging (MRI), radiographic and sonography images were evaluated by two radiologists and rheumatologist with sufficient expertise in degenerative knee disorders. MRI has been considered as a gold standard test in evaluating other tests. The sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and accuracy with 95% confidence intervals of radiography and sonography in the diagnosis of knee OA were calculated. RESULTS: Prevalence of the marginal osteophyte, geode and decreased joint thickness were significantly higher in patients with age > 40 years compared to ≤ 40 years (P < 0.05). The incidence of diverse features of knee OA was not significantly different in terms of the patient's gender, except for decreased joint space. The specificity of radiography was higher than its sensitivity. CONCLUSION: Our study showed that both radiography and sonography are useful imaging modalities, especially to diagnosis the positive cases of knee OA. The specificity of radiography is higher than to its sensitivity for all pathological features of knee OA. The sensitivity of sonography to detect some features of knee OA such as decreased joint thickness is considerably higher than radiography.

Relationship Between Magnetic Resonance Imaging Findings and Clinical Symptoms in Patients with Suspected Lumbar Spinal Canal Stenosis: a Case-control Study.

INTRODUCTION: Despite the availability of many imaging and clinical criteria for diagnosis of lumbar spinal stenosis (LSS), its correct diagnosis is a challenge for clinicians and radiologists. AIM: The aim of this study was to examine the relationship between magnetic resonance imaging (MRI) findings and clinical symptoms in symptomatic and asymptomatic patients with suspected LSS in MRI. METHODS: This study is a case-control study. Two groups of 100 symptomatic and asymptomatic individuals (aged 20 to 84 years) with suspected lumbar spinal canal stenosis who referred to the imaging unit for lumbosacral MRI were included. The clinical symptoms and radiological parameters in MRI for all patients were recorded and relationship between them were evaluated. RESULTS: Among the quantitative imaging findings, only the anterior-posterior diameter of the canal at the level of the intervertebral disc, the central spinal canal cross-section area and lateral recesses cross-sectional area were valuable. Coefficient of stenosis was calculated for the case and control groups which had statistically significant difference (p<0.001). The difference between qualitative findings such as disc protrusion, extrusion, sequestration and Cauda Equine serpain or redundant was significant between the two groups. CONCLUSION: According to the results, among the quantitative criteria of MRI imaging findings, central spinal canal cross-section (less than 77.5 mm2 for central stenosis) and lateral recesses cross-section (less than 22.5 mm2 for lateral stenosis) had the highest sensitivity and specificity for LSS diagnosis in symptomatic and asymptomatic patients with suspected LSS. Strongest observed correlation was between neurogenic claudication and LSS diagnostic radiological markers.