Third Ventricular Diameter is Inversely Related to Thalamic Massa Intermedia Thickness in Hydrocephalus Caused by Congenital Aqueductal Stenosis.

BACKGROUND AND PURPOSE: In fetuses with lateral ventriculomegaly and normal posterior fossa cerebrospinal spaces, third ventricular distention is a compelling clue that supports a diagnosis of aqueductal stenosis. However, this association assumes normal ventricular anatomy. Structural constraints can impair pressure-induced compliance. We aimed to determine how thalamic massa intermedia (TMI) size alterations may impact the size of the 3rd ventricle in the setting of congenital aqueductal stenosis (CAS). MATERIALS AND METHODS: This retrospective study was performed at a single academic pediatric hospital after IRB approval. We searched our brain MRI reports for all exams describing "aqueductal stenosis" and included all the patients who had both fetal and postnatal exams. Patients with interhypothalamic adhesions and hydrocephalus unrelated to CAS were excluded from this study. We evaluated all the MRIs for the presence of TMI and documented third ventricle diameters (supraoptic recess, central, and suprapineal recess) and the TMI circumference. Spearman correlation was used to identify the potential relationship between the TMI circumference and 3rd ventricle size in fetal and postnatal MRIs. Patients were also stratified into two groups based on the presence or absence of TMI. Mann-Whitney U tests were used to compare third ventricle diameters between these groups. RESULTS: The study included both fetal and postnatal studies from 59 patients. The overall third ventricular diameter was inversely proportional to the circumference of the TMI in both groups (fetal: p=0.001, rho=-0.422, CI=[-0.628-0.181]; postnatal: p<0.001, rho=-0.653, CI= [-0.782-0.479]). Nonetheless, dilation of anterior and posterior recesses still occurred when the mid third ventricle was non-dilated or less severely dilated in patients with an enlarged TMI. Third ventricular dilation was most severe in patients lacking a TMI compared to patients with a TMI (p<0.001). CONCLUSIONS: In patients with suspected congenital aqueductal stenosis, lack of significant third ventriculomegaly as conventionally measured can sometimes be explained by thickening of the TMI. In this circumstance, it is important to evaluate the extreme recesses of the 3rd ventricle for evidence of dilatation on fetal MRI.ABBREVIATIONS: TMI = Thalamic massa intermedia; CAS = Congenital aqueductal stenosis.

A Comparative Review of Imaging Journal Policies for Use of AI in Manuscript Generation.

RATIONALE AND OBJECTIVES: Artificial intelligence (AI) technologies are rapidly evolving and offering new advances almost on a day-by-day basis, including various tools for manuscript generation and modification. On the other hand, these potentially time- and effort-saving solutions come with potential bias, factual error, and plagiarism risks. Some journals have started to update their author guidelines in reference to AI-generated or AI-assisted manuscripts. The purpose of this paper is to evaluate author guidelines for including AI use policies in radiology journals and compare scientometric data between journals with and without explicit AI use policies. MATERIALS AND METHODS: This cross-sectional study included 112 MEDLINE-indexed imaging journals and evaluated their author guidelines between 13 October 2023 and 16 October 2023. Journals were identified based on subject matter and association with a radiological society. The authors' guidelines and editorial policies were evaluated for the use of AI in manuscript preparation and specific AI-generated image policies. We assessed the existence of an AI usage policy among subspecialty imaging journals. The scientometric scores of journals with and without AI use policies were compared using the Wilcoxon signed-rank test. RESULTS: Among 112 MEDLINE-indexed radiology journals, 80 journals were affiliated with an imaging society, and 32 were not. 69 (61.6%) of 112 imaging journals had an AI usage policy, and 40 (57.9%) of 69 mentioned a specific policy about AI-generated figures. CiteScore (4.9 vs 4, p = 0.023), Source Normalized Impact per Paper (1.12 vs 0.83, p = 0.06), Scientific Journal Ranking (0.75 vs 0.54, p = 0.010) and Journal Citation Indicator (0.77 vs 0.62, p = 0.038) were significantly higher in journals with an AI policy. CONCLUSION: The majority of imaging journals provide guidelines for AI-generated content, but still, a substantial number of journals do not have AI usage policies or do not require disclosure for non-human-created manuscripts. Journals with an established AI policy had higher citation and impact scores.

Multiple sclerosis is associated with worse COVID-19 outcomes compared to the general population: A population-based study.

BACKGROUND: We carried out the current study to compare COVID-19-related hospitalization and mortality rates between people living with multiple sclerosis (PLWMS) and MS-free controls from the Isfahan general population. METHOD: In this retrospective population-based study, we used available data from four datasets of Isfahan University of Medical Sciences from January 1, 2020, to August 22, 2021. Data on all PLWMS, SARS-CoV-2 polymerase chain reaction (PCR) and rapid antigen test, hospitalization, and death were included. We compared the odds of COVID-19-related hospitalization and mortality between PLWMS and the control group before and after adjustment for age and sex. We categorized all people into young (18-49 years) and old age (50-79 years) groups and compared the hospitalization rate between people with and without MS. RESULTS: In total, 829 PLWMS and 2494 MS-free controls with confirmed COVID-19 were included. Hospitalization rates among PLWMS and MS-free controls were 16.2% and 16.5% (crude OR= 0.978, 95%CI: 0.79, 1.21). In the adjusted model, PLWMS with COVID-19 had 56% increased odds of hospitalization (OR=1.56, 95%CI: 1.23, 1.97). During follow-up, there were 11 (1.3%) and 49 (2%) COVID-19-related deaths among PLWMS and MS-free controls, respectively. No significant difference between people with and without MS in COVID-19-related mortality rate was observed (crude OR= 0.678, 95%CI: 0.351, 1.31; adjusted OR=2.013, 95%CI: 0.95, 4.26). We found increased odds of hospitalization in young PLWMS compared to those without MS at the same age (OR=1.699, 95%CI: 1.289, 2.240). But, no difference between older people with and without MS was detected (OR=1.005, 95%CI: 0.662, 1.524). CONCLUSION: This study revealed higher odds of hospitalization and mortality due to COVID-19 among PLWMS in comparison to age- and sex-matched controls from the general population. Nevertheless, it remains unclear whether the elevated odds are directly associated with MS itself or if they are influenced by factors such as rituximab using, comorbidity, and disease severity.

Effect of serum magnesium levels on outcomes of patients hospitalized with COVID-19.

BACKGROUND:  The coronavirus disease 2019 (COVID-19) causes acute respiratory illness and multi-organ failure. The critical roles of magnesium in human health suggest that it could have an active role in the prevention and treatment of COVID-19. We measured magnesium levels in hospitalized COVID-19 patients concerning disease progression and mortality. MATERIALS AND METHODS:  This study was conducted in 2321 hospitalized COVID-19 patients. Clinical characteristics from each patient were recorded, and blood samples were collected from all patients upon their first admission to the hospital to determine serum magnesium levels. Patients were divided into two groups based on discharge or death. The effects of magnesium on death, severity, and hospitalization duration were estimated by crude and adjusted odds ratio using Stata Crop (version 12) software. RESULTS:  Mean magnesium levels in patients who died were higher than in discharged patients (2.10 vs 1.96 mg/dl, p 0.05). CONCLUSIONS: We found no relation between hypomagnesaemia on COVID-19 progression, although hypermagnesaemia could affect COVID-19 mortality (Tab. 4, Ref. 34).

Effectiveness of BBIBP-CorV vaccine in preventing SARS-CoV2 infection and severe outcomes in people living with multiple sclerosis: A population-based study.

BACKGROUND: The objective of the present study was to estimate the effectiveness of the BBIBP-CorV vaccine (VE) in preventing SARS-CoV-2 infection, related hospitalization, and death among people living with multiple sclerosis (PLWMS). METHODS: In this population-based retrospective observational study, data on all PLWMS, vaccination, SARS-CoV-2 tests, hospitalization, and deaths were collected in Isfahan, Iran between February 9, 2021, and November 4, 2021. We estimated the hazard ratio between vaccinated (partially and fully) and unvaccinated groups using the Andersen-Gill extension of the Cox proportional hazards model. We also performed Cox proportional hazards analysis to identify risk factors for breakthrough infection and COVID-19-related hospitalization in fully-immunized group. RESULTS: Of the 9869 PLWMS, 1368 were in partially-vaccinated group, 4107 were in the fully-vaccinated group, and 3794 were in the unvaccinated group. In the partially-vaccinated group, the estimated VE against COVID-19 infection was 39.3% (16%, 56.1%), hospitalization was 64.9% (1.3%, 87.5%), and mortality was 92.7% (88.8%, 100%). The respective results for the fully-vaccinated group were 63.9% (56%, 70.3%), 75.7% (57.5%, 86.1%), and 100%. Progressive MS was independently associated with a greater risk of breakthrough infection (HR=1.952, 95%CI: 1.174-3.246, p = 0.010). Older adults (≥50 years vs. 18-49 years, HR=3.115, 95%CI: 1.145-8.470, p = 0.026) and those on rituximab (HR=7.584; 95% CI: 1.864-30.854; p = 0.005) were at an increased risk of COVID-19-related hospitalization. CONCLUSION: This study showed that two doses of the BBIBP-CorV vaccine can effectively prevent COVID-19 infection and hospitalization among PLWMS. Old PLWMS and those who treating with rituximab are at increased risk of hospitalization after receiving two doses of the vaccine.

Anatomy education during COVID-19 era: Evaluation of an anatomy blended course for medical students.

BACKGROUND: The COVID-19 pandemic has prompted a need to change traditional teaching methods. This study was conducted to evaluate the educational quality of a blended anatomy course and measure student satisfaction and knowledge after completing the course. MATERIALS AND METHODS: Tyler's model was used to develop a new blended curriculum. The study guide for this curriculum was also developed using Association for Medical Education in Europe guide no. 16. A quasi-experimental study compared educational quality, students' satisfaction, and students' satisfaction using Students' Evaluations of Educational Quality (SEEQ), Borim Nejad's satisfaction survey, and multiple choice questions, respectively. Independent t-tests and Chi-square were used to compare the groups. RESULTS: A total of 122 students participated in this study, 62 and 60 in the intervention and control groups, respectively. The satisfaction score was significantly higher in the intervention group than in the control group (40.6 versus 38.6, P value = 0.03). The score of SEEQ was not significantly different (91.9 versus 91.08, P value = 0.52), but the subscales of learning (17.23 versus 16.32, P = 0.01), group interaction (16.87 versus 18.1, P = 0.01), and breadth (17.73 versus 16.65, P = 0.02) were significant. The knowledge score was also significantly higher in the intervention group than in the control group (18.13 versus 16.68, P value < 0.001). CONCLUSION: Using blended learning approaches for anatomy courses can increase students' satisfaction, improve the learning and breadth of educational quality subscales, but worsen group interaction. Although this study shows improvement in medical students' knowledge, further studies are needed because of the limitations of this study.

Clinical Breast Cancer Registry of IR. Iran (CBCR-IR): Study Protocol and First Results.

BACKGROUND: Breast cancer (BC), as a significant global health problem, is the most common cancer in women. Despite the importance of clinical cancer registries in improving the quality of cancer care and cancer research, there are few reports on them from low- and middle-income countries. We established a multicenter clinical breast cancer registry in Iran (CBCR-IR) to collect data on BC cases, the pattern of care, and the quality-of-care indicators in different hospitals across the country. METHODS: We established a clinical cancer registry in 12 provinces of Iran. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During this registry, we studied the clinical characteristics and outcomes of patients with cancer who were admitted from 2014 onwards. RESULTS: We registered 13086 BC cases (7874 eligible cases) between 1.1.2014 and 1.1.2022. Core needle biopsy from the tumor (61.25%) and diagnostic mammography (68.78%) were the two most commonly used diagnostic methods. Stage distribution was 2.03% carcinoma in situ, 12% stage I, 44.65% stage II, 21.32% stage III, and 4.61% stage IV; stage information was missing in 1532 patients (19.46%). Surgery (95.01%) and chemotherapy (79.65%) were the most common treatments for all patients. CONCLUSION: The information provided by this registry can be used to evaluate and improve the quality of care for BC patients. It will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran.

Risk and severity of SARS-CoV-2 reinfection among patients with multiple sclerosis vs. the general population: a population-based study.

BACKGROUND: We conducted this study to compare the risk of reinfection between multiple sclerosis (MS) patients and a control group without MS. METHOD: In this retrospective study, data of all SARS-CoV-2 tests (n = 793,301) and almost all MS patients (n = 10,639) in Isfahan province were collected from January 01, 2020 to August 22, 2021. Of the 2196 MS patients and 793,301 persons from the general population who had been tested at least once, 3 control for each MS patient were identified, leaving 1560 MS patients and 4680 controls without MS. We compared the risk of reinfection after 90 days of a primary infection between those with and without a previous positive COVID-19 test. RESULTS: 736 (47.2%) MS patients and 2013 (43.0%) control individuals had at least one positive test. A total of 17 (2.3%) and 22 (1.1%) possible reinfections in MS and control groups were observed. The estimated protection against reinfection in all MS patients, MS patients on rituximab, MS patients on DMTs rather than rituximab, and controls were 68.2% (46.2, 81.2%), 57.4% (- 0.1, 83.1%), 71.5% (45.5, 85.2%), and 82.1% (72.1, 88.5%), respectively. We found no statistically significant difference in estimated protection (p = 0.123) and odd of reinfection (adjusted OR: 2.01 [0.98, 4.08]) between all MS patients and control group. Two patients were hospitalized at first infection but none required hospitalization at reinfection event. CONCLUSIONS: MS patients on rituximab may be at a greater risk of reinfection. Further studies are required to assess the risk of the second reinfection among the MS population.

Vitamin D Level in Laboratory Confirmed COVID-19 and Disease Progression.

OBJECTIVE: There is no conclusive evidence to suggest vitamin D level can prevent or treat infection with the new coronavirus disease 2019. This study aimed to investigate the effects of serum level of vitamin D in patients with coronavirus disease 2019 on death, severity, and hospitalization duration. MATERIALS AND METHODS: Baseline characteristic of patients was extracted from the Isfahan coronavirus disease 2019 registry database (I-CORE). Blood samples were taken from all patients to measure the level of vitamin D (25-hydroxyvitamin D) and categorized. The effect of 25(OH) D on death, severity, and hospitalization duration was analyzed by logistic regression. RESULTS: Among our study patients, 5.5% had a severe deficiency of vitamin D, 23.7% deficiency, and 24.8% insufficiency. Of the 107 patients who died, 7.5% were severely deficient in vitamin D. We found that vitamin D deficiency had no significant effect on death, disease severity, and hospitalization (P > .05). However, having at least one comorbidity increased the odds of death five times after adjusting age > 60 years and gender (P < .0001). The results showed that among all comorbidities, diabetes has the greatest impact on the outcomes as it raised the odds of death, disease severity, and length of hospital stay by 2.23,1.72, and 1.48, respectively, after controlling the age > 60 and gender (P = .0002, P=.08, P=.012). CONCLUSIONS: The mortality, disease severity, and hospitalization of coronavirus disease 2019 patients seem to be not affected by the low levels of 25(OH)D. However, the synergy between vitamin D levels and comorbidities, age, and gender could affect the outcome of coronavirus disease 2019 patients.

Red Blood Cell Distribution Width (RDW) as a Predictor of In-Hospital Mortality in COVID-19 Patients; a Cross Sectional Study.

INTRODUCTION: Red blood cell distribution width (RDW) has been introduced as a predictive factor for mortality in several critical illnesses and infectious diseases. This study aimed to assess the possible relationship between RDW on admission and COVID-19 in-hospital mortality. METHOD: This cross-sectional study was performed using the Isfahan COVID-19 registry. Adult confirmed cases of COVID-19 admitted to four hospitals affiliated with Isfahan University of Medical Sciences in Iran were included. Age, sex, O2 saturation, RDW on admission, Intensive Care Unit admission, laboratory data, history of comorbidities, and hospital outcome were extracted from the registry. Cox proportional hazard regression was used to study the independent association of RDW with mortality. RESULTS: 4152 patients with the mean age of 61.1 ± 16.97 years were included (56.2% male). 597 (14.4%) cases were admitted to intensive care unit (ICU) and 477 (11.5%) cases died. The mortality rate of patients with normal and elevated RDW was 7.8% and 21.2%, respectively (OR= 3.1, 95%CI: 2.6-3.8), which remained statistically significant after adjusting for age, O2 saturation, comorbidities, and ICU admission (2.03, 95% CI: 1.68-2.44). Moreover, elevated RDW mortality Hazard Ratio in patients who were not admitted to ICU was higher than ICU-admitted patients (3.10, 95% CI: 2.35-4.09 vs. 1.47, 95% CI: 1.15-1.88, respectively). CONCLUSION: The results support the presence of an association between elevated RDW and mortality in patients with COVID-19, especially those who were not admitted to ICU. It seems that elevated RDW can be used as a predictor of mortality in COVID-19 cases.

The effect of teaching integrated course of physical examination and radiological anatomy in practical limb anatomy on medical students' learning outcomes.

BACKGROUND: In the last few decades, the need to change the curriculum of basic medical science has been further emphasized. The purpose of this study was to evaluate the effects of teaching integrated course of physical examination and radiological anatomy in practical limb anatomy on medical students' learning outcomes. METHODS: This was an experimental study. Medical students (of the 4th semester of medical education) were divided into intervention and control groups. Related topics of physical examination and radiological anatomy were added to the practical limb anatomy courses of the intervention group. Practical knowledge of anatomy, clinical applications of anatomical knowledge, students 'satisfaction, and students' attitude toward the anatomy course were assessed at the end of the study. Knowledge retention was assessed three months after the semester. RESULTS: The intervention group scored significantly higher mean scores in practical knowledge of anatomy test, clinical applications of anatomical knowledge test and knowledge retention test (P-value < 0.05). In evaluating students' satisfaction with the course, the intervention group was satisfied with the course and teacher performance and had appropriate attitude (Mean˃4, Max score = 5) towards the application of anatomy in medicine. CONCLUSIONS: The findings of this study showed that teaching practical anatomy with a clinical integrated approach can improve the practical knowledge of anatomy, knowledge retention, and clinical applications of anatomical knowledge. In addition, an integrated approach was associated with greater student satisfaction and it makes students have appropriate attitude towards the application of anatomy in medicine.

Web-Based Medical Examinations During the COVID-19 Era: Reconsidering Learning as the Main Goal of Examination.

Like other aspects of the health care system, medical education has been greatly affected by the COVID-19 pandemic. To follow the requirements of lockdown and virtual education, the performance of students has been evaluated via web-based examinations. Although this shift to web-based examinations was inevitable, other mental, educational, and technical aspects should be considered to ensure the efficiency and accuracy of this type of evaluation in this era. The easiest way to address the new challenges is to administer traditional questions via a web-based platform. However, more factors should be accounted for when designing web-based examinations during the COVID-19 era. This article presents an approach in which the opportunity created by the pandemic is used as a basis to reconsider learning as the main goal of web-based examinations. The approach suggests using open-book examinations, using questions that require high cognitive domains, using real clinical scenarios, developing more comprehensive examination blueprints, using advanced platforms for web-based questions, and providing feedback in web-based examinations to ensure that the examinees have acquired the minimum competency levels defined in the course objectives.

Challenges and opportunities of digital health in a post-COVID19 world.

Digital health as a rapidly growing medical field relies comprehensively on human health data. Conventionally, the collection of health data is mediated by officially diagnostic instruments, operated by health professionals in clinical environments and under strict regulatory conditions. Mobile health, telemedicine, and other smart devices with Internet connections are becoming the future choices for collecting patient information. Progress of technologies has facilitated smartphones, wearable devices, and miniaturized health-care devices. These devices allow the gathering of an individual's health-care information at the patient's home. The data from these devices will be huge, and by integrating such enormous data using Artificial Intelligence, more detailed phenotyping of disease and more personalized medicine will be realistic. The future of medicine will be progressively more digital, and recognizing the importance of digital technology in this field and pandemic preparedness planning has become urgent.

Model Prediction for In-Hospital Mortality in Patients with COVID-19: A Case-Control Study in Isfahan, Iran.

The COVID-19 pandemic has now imposed an enormous global burden as well as a large mortality in a short time period. Although there is no promising treatment, identification of early predictors of in-hospital mortality would be critically important in reducing its worldwide mortality. We aimed to suggest a prediction model for in-hospital mortality of COVID-19. In this case-control study, we recruited 513 confirmed patients with COVID-19 from February 18 to March 26, 2020 from Isfahan COVID-19 registry. Based on extracted laboratory, clinical, and demographic data, we created an in-hospital mortality predictive model using gradient boosting. We also determined the diagnostic performance of the proposed model including sensitivity, specificity, and area under the curve (AUC) as well as their 95% CIs. Of 513 patients, there were 60 (11.7%) in-hospital deaths during the study period. The diagnostic values of the suggested model based on the gradient boosting method with oversampling techniques using all of the original data were specificity of 98.5% (95% CI: 96.8-99.4), sensitivity of 100% (95% CI: 94-100), negative predictive value of 100% (95% CI: 99.2-100), positive predictive value of 89.6% (95% CI: 79.7-95.7), and an AUC of 98.6%. The suggested model may be useful in making decision to patient's hospitalization where the probability of mortality may be more obvious based on the final variable. However, moderate gaps in our knowledge of the predictors of in-hospital mortality suggest further studies aiming at predicting models for in-hospital mortality in patients with COVID-19.

The value of thoracic computed tomography scan comparing to reverse transcription-polymerase chain reaction for the diagnosis of COVID-19.

BACKGROUND: Novel coronavirus disease of 2019 (COVID-19) is the current pandemic causing massive morbidity and mortality worldwide. The gold standard diagnostic method in use is reverse transcription-polymerase chain reaction (RT-PCR) which cannot be solely relied upon. Computed tomography (CT) scan is a method currently used for diagnosis of lung disease and can play a substantial role if proved helpful in COVID-19 diagnosis. We conducted this study to evaluate the diagnostic value of CT scan compared to RT-PCR in the diagnosis of COVID-19. MATERIALS AND METHODS: We recruited 291 hospitalized patients suspicious of COVID-19 according to typical clinical findings during February-March 2020. The patients underwent CT-scan and RT-PCR procedures on the day of hospital admission. CT scans were reported by two radiologists as typical, indeterminate, negative, and atypical. Statistical indices were calculated twice: once considering "typical" and "indeterminate" categories as positive and the other time counting "typical" results as positive. RESULTS: The CT reports were classified as typical (64.95%), indeterminate (10.31%), atypical (11%), and negative (13.75%). Considering "typical" and "intermediate" as positive, sensitivity and specificity were 85.3% and 38.8%, respectively, and using the second assumption, the mentioned indices were 75.9% and 50.4%, respectively. CONCLUSION: According to our study, CT results do not create enough diagnostic benefit and could result in incorrect confidence if negative. Since widely available, CT integration in the clinical process may be helpful in screening of suspected patients in epidemics. Yet, suspected patients should be isolated till confirmed by (multiple) PCRs.