Side effects of COVID-19 vaccines among Iranian healthcare workers: a retrospective cohort study.

INTRODUCTION: This study assessed the incidence and severity of side effects associated with coronavirus disease 2019 (COVID-19) vaccination among healthcare workers registered with the Medical Council of the Islamic Republic of Iran. METHODOLOGY: A retrospective cohort study was conducted on the healthcare workers focusing on the side-effects of COVID-19 vaccines from March to June 2021. Data were collected using online questionnaires. Multivariable logistic regression was used to assess the association between side effects of the vaccines and demographic variables, comorbidities, vaccine type, and history of COVID-19. RESULTS: Out of 42,018 people who were included, 55.85% reported at least one side effect after receiving the first vaccine dose. 4.59% of those with side effects sought diagnostic intervention or were referred to treatment centers. Multivariable logistic regression indicated that being a woman, higher education, having a history of COVID-19 infection, and having comorbidities increased the risk of side effects. The AstraZeneca vaccine significantly increased the risk of side effects compared to the Sputnik vaccine, while the Sinopharm vaccine decreased this risk. The risk of developing a side effect decreased with age. The risk of moderate and severe side effects was significantly associated with gender, younger age, comorbidities, and a history of COVID-19 infection. Moderate and severe side effects were less reported by those who received the Sinopharm vaccine. CONCLUSIONS: Clinical complications after COVID-19 vaccination, directly or indirectly caused by the vaccines, are common. However, the benefits of COVID-19 vaccines greatly outweigh the risk of reversible side effects, especially among the high-risk population.

Prediction of hamstring tendon autograft diameter using preoperative measurements with different cut-offs between genders.

PURPOSE: Studies have suggested some predictors for hamstring tendon (HT) autograft diameter based on anthropometric factors and preoperative magnetic resonance imaging (MRI) with variable results. Some authors have attributed the variability to gender differences. This prospective cohort reports the sensitivity and specificity of anthropometric and MRI predictors in males and females separately to determine the difference. METHODS: Forty-two eligible patients who underwent anterior cruciate ligament reconstruction (ACLR) and MRI in our center were included. ACLR was performed by the senior surgeon using a 4-stranded HT autograft for all patients. A blinded musculoskeletal radiologist measured the cross-sectional area (CSA) of gracilis and semitendinosus tendons using the free-hand region of interest tool for all patients. An orthopaedic resident (PGY4) collected anthropometric factors and measured intraoperative autograft diameter. RESULTS: Mean intraoperative autograft diameter was 8.0 mm. Females had a significantly lower autograft diameter (7.4 vs. 8.2, P < 0.001), smaller gracilis (6.9 vs. 7.9, P = 0.003) and semitendinosus CSA (11.5 vs. 12.8, P = 0.014) compared to males. ROC curve analysis resulted different cut-off values with high sensitivity and specificity for semitendinosus and combined CSA regarding gender. CONCLUSION: Based on the results of this study, CSA of either isolated or combined HTs on preoperative axial MRI, height, and weight are the strongest predictors of intraoperative autograft diameter. It is suggested to consider different cut-offs for males and females to have a better clinical guide for surgeons. LEVEL OF EVIDENCE: Level II.

Changes in diffusion tensor imaging indices in basal ganglia and thalamus of patients with Relapsing-Remitting Multiple Sclerosis and relation with clinical conditions: A case-control study.

Background: Multiple sclerosis (MS) is recognized as the most prevalent autoimmune abnormality of the CNS. T1WI, T2WI, and FLAIR are limited in the quantification of tissue damage and detection of tissue alterations in white and grey matter in MS. This study aimed to the evaluation of changes in DTI indices in these patients at the thalamus and basal ganglia. Methods: 30 relapsing-remitting MS (RRMS) cases and 30 normal individuals were included. Conventional MRI (T2, FLAIR) was acquired to confirm NAGM in MS patients. A T1 MPRAGE protocol was used to normalize DTI images. FSL, SPM, and Explore DTI software were employed to reach Mean Diffusivities (MD), Axial Diffusivities (AD), Fractional anisotropy (FA), and Radial Diffusivity (RD) at the thalamus and the basal ganglia. Results: The FA and RD of the thalamus were decreased in healthy controls compared to MS cases (0.319 vs. 0.296 and 0.0009 vs. 0.0006, respectively) (P < 0.05). The AD value in the thalamus and the FA value in the caudate nucleus were significantly lower in MS cases than in controls (0.0009 vs. 0.0011 and 0.16 vs. 0.18, respectively) (P < 0.05). MD values in the thalamus or basal ganglia were not significantly different between groups. Conclusions: DTI measures including FA, RD, and AD have a good diagnostic performance in detecting microstructural changes in the normal-appearing thalamus in cases with RRMS while they had no significant relationship with clinical signs in terms of EDSS. Availability of data and material: Not applicable.

Second and third lumbar vertebral parameters for prediction of sex, height, and age in the Iranian population.

In this study, we aimed to assess the association between different parameters of the second and third lumbar vertebra with age, sex, and height in the Iranian population. A total of 14 parameters of the L2 and L3 vertebra were measured from three-dimensional lumbar topography. The measured parameters included vertebral length, foramen diameter, foramen width, endplate depth, endplate width, spinal process height, spinal process length, transverse process distance, the height of the vertebral body, articular process height inferior, articular process height superior, pedicle height, pedicle width, and maximum distance between articular processes. A total of 100 patients, including 46 males (46%) and 54 females (54%), were enrolled in this study. Our findings showed that most L2 and L3 parameters could differentiate males from females, with the area under the curve between 0.620 and 0.888. The majority of L2 and L3 parameters were positively associated with height in both males and females. Regarding age, there was a significant positive association between the spinal process length of L2 and vertebral length, spinal process height, and spinal process length of L3 with age in males. Also, several parameters of L2 and L3 were associated with age in females. In conclusion, we demonstrated that the parameters of the second and third lumbar vertebra could be valuable in the determination of the age, height, and sex of the Iranian population. Our results could have practical implications in forensic anthropology in serious events like earthquakes.

Assessing the Changes of Cortical Thickness in Alzheimer Disease With MRI Using Freesurfer Software.

Introduction: In this study, we intend to determine the correlation between the thickness of the cerebral cortex and the severity of the cognitive disorder in Alzheimer disease (AD). Methods: A total of 20 (14 women and 6 men) patients diagnosed with AD with a Mean age of 72.95 years, and 10 (7 women and 3 men) cognitively normal (CN) subjects with a Mean age of 70.50 years were included in the study. Of the AD patient and CN subjects, 70% were female, and 30% were male. All individuals underwent 1.5 T Magnetic resonance imaging (MRI). The MRI scanning protocol included 3D MPRAGE (3D-T1W) sequence. All images were analyzed using Freesurfer v5.3, and then the brain cortical thickness in 7 cortical areas (inferior temporal, middle temporal, superior temporal, parahippocampal, pars triangularis, rostral middle frontal, and superior frontal) was calculated. Results: The analysis of covariance (ANCOVA) was conducted to compare the mean thickness of each region between the patient and the control group. There was a significant difference in the mean cortical thickness in all regions. In all cases, the mean cortical thickness in CN subjects was greater than in AD patients. However, the mean thickness of pars triangularis left hand in CN subjects was not significantly greater than that in AD patients. The receiver operating characteristic system (ROC) was designed to evaluate the predictive power of the patients and the healthy people. We have selected a thousand cut-off points from 1.5 to 3.5 mm for cortical thickness. When the cut-off points were within 2.276878-2.299680 mm in the left hemisphere, Youden's index was maximum. The sensitivity and specificity, in this case, were 80%. Also, when the cut-off points were within the range of 2.263278-2.282278 mm in the right hemisphere, the sensitivity and specificity were 90% and 80%, respectively. Conclusion: This study demonstrates the importance of quantifying the cortical thickness changes in the early diagnosis of AD. In addition, examining the pattern of changes and quantifying the reduction in the thickness of the cortex is a crucial tool for displaying the local and global atrophy of the brain. Also, this pattern can be used as an alternative marker for the diagnosis of dementia. Finally, to the best of our knowledge, our study is the first to report finding on the cortical thickness that would help the clinician have a better differential diagnosis. Also, this study has checked the possibility of early diagnosis of the disease. Highlights: The correlation between the thickness of cerebral cortex and the severity of cognitive disorder in Alzheimer's disease was determined.The cortical thickness change is an important factor in early diagnosis of Alzheimers disease.The pattern of reduction in the thickness changes is a crucial tool for displaying the local and global atrophy of the brain. Plain Language Summary: The neurodegenerative disorder Alzheimer's disease (AD) is a fast-growing epidemic in aging populations worldwide. In 2050, one new case of AD is estimated to increase up to every 33 seconds. So the diagnosis of AD in the early stage considerably decreases the progress of dementia and helps identify a correct treatment approach. The cortical thickness measured by structural neuroimaging has received a significant surrogate biomarker that could provide powerful tools for the early diagnosis of AD. Since the sensitivity and specificity of MRI are higher, it offers essential advantages for identifying brain atrophy patterns. The manual cortical thickness measurement methods are time-consuming and require experienced anatomists compared with automated methods. In this regard, Freesurfer software, which is a freely available program and provides information for quantifying the functional and structural features of the brain, is used. The current study demonstrates examining the pattern of changes and quantifying the reduction in the thickness of the cortex. This can also be used as an alternative marker for the early diagnosis of dementia using cortical thickness measurment that would help the physicians.

Treatment and outcomes of pediatric patients with cancer and COVID-19 at MAHAK pediatric cancer treatment and research center, Tehran, Iran.

The COVID-19 pandemic has been particularly devastating for Iran. Children with cancer are generally immunosuppressed and especially vulnerable to SARS-CoV-2 infections. We report the treatment and outcomes of pediatric oncology patients with COVID-19 at the MAHAK Pediatric Cancer Treatment and Research Center (MPCTRC) in Tehran. We enrolled pediatric oncology patients who experienced SARS-CoV-2 infections from March 18, 2020, to January 28, 2021. The COVID-19 diagnostic criteria at MPCTRC were based on imaging and clinical presentation because of specific challenges diagnosing SARS-CoV-2 infections with molecular testing, which was locally developed and conducted at centers other than MPCTRC. We enrolled nine outpatients and eight inpatients (mean age = 9 years), seven of whom had a diagnosis of leukemias, and five who had brain tumors. COVID-19 symptoms were mild in fourteen patients, and three patients were asymptomatic. Of twelve patients who received molecular testing for SARS-CoV-2 infection, eight were negative and four were positive. Of nine patients tested for IgG and IgM antibodies, one was positive. Three patients died of COVID-19, all of whom were hospitalized. Mild COVID-19 symptoms did not appear to affect the outcomes of the pediatric patients with cancer who received treatment at MPCTRC during the study period.

Evaluation of combining Alberta Stroke Program Early CT Score (ASPECTS) with mean platelet volume, plateletcrit, and platelet count in predicting short- and long-term prognosis of patients with acute ischemic stroke.

BACKGROUND: There is controversy regarding Alberta Stroke Program Early CT Score (ASPECTS) and platelet indices as predictors of outcome in patients with acute ischemic stroke (AIS). We aimed to assess the prognostic value of ASPECTS, mean platelet volume (MPV), plateletcrit (PCT), and platelet count (Plt) in 3-month and 1-year functional outcomes of AIS patients, both independently and in combination. METHODS: This prospective study was conducted in Shams Al-shomuos and Ghaem hospitals of Mashhad, Iran from June 2019 to January 2021. Overall, 553 patients above 18 years old with first-ever anterior circulation AIS met the eligibility criteria and were included. Clinical, hematologic, radiologic, and demographic data of patients were recorded at baseline. The 3-month and 1-year functional outcome was evaluated by modified Rankin Scale (mRS). Multivariate logistic regression was used to determine the independent predictors of poor functional outcome (mRS>2) and mortality. RESULTS: The mean age of the patients was 65.50 ± 14.41 years and 282 patients (51%) were male. ASPECTS ≤ 7 was an independent predictor of both poor function (OR=1.94, 95%CI=1.04-3.62, P = 0.04) and mortality (OR=2.02, 95%CI=1.14-3.58, P = 0.02) at 1 year. MPV was also a strong predictor of 3-month (OR=3.88, 95%CI=2.04-7.38, P = 0.02) and 1-year (OR=3.32, 95%CI=1.91-5.78, P = 0.01) mortality, as well as 3-month (OR=3.25, 95%CI=1.80-5.86, P < 0.001) and 1-year (OR=4.35, 95%CI=2.36-8.02, P < 0.001) poor function. For 1-year poor function (OR=9.33, 95%CI=2.19-39.73, P = 0.003) and mortality (OR=6.40, 95%CI=2.09-19.64, P = 0.001), ASPECTS combined with all platelet indices found to be a more robust independent predictor compared to each variable alone. CONCLUSION: Although MPV is an independent predictor of both 3-month and 1-year poor function and mortality in AIS patients, ASPECTS ≤ 7 was found to be a risk factor for 1-year poor function and mortality. Moreover, the prognostic value of both platelet indices and ASPECTS are greater when they are combined together in AIS patients.

The Radioprotective Effects of Melatonin and Nanoselenium on DNA Double-Strand Breaks in Peripheral Lymphocytes Caused by I-131.

BACKGROUND: One of the treatment modalities for thyroid cancer and hyperthyroidism is radioiodine-131 (I-131) therapy. The use of this therapeutic modality is not completely safe and can lead to oxidative stress, eventually DNA damages. However, these radiation-induced damages can be reduced by antioxidants. This study aimed to investigate the potential radioprotective effects of melatonin and selenium nanoparticles (SeNPs) on DNA double-stranded breaks (DSBs) caused by I-131. MATERIALS AND METHODS: After obtaining informed consent, 6 ml blood was taken from each volunteer. The samples were divided into two general groups of control (without I-131) and with I-131. Each group was also divided into three subgroups, including without antioxidant, melatonin, and SeNPs. The samples of control group were incubated for 2 h after adding the antioxidants. The samples of I-131 group were first incubated for 1 h with the antioxidants and then the samples re-incubated for another 1 h after adding the I-131. Then, the samples were prepared for γH2AX assay. RESULTS: The findings showed that after 1 h of incubation with 20 µCi I-131/2 mL, the DSB levels increased by 102.9% in comparison with the control group. In the I-131 group, there were significant reductions of the DSB levels after incubation with melatonin (P < 0.001) and SeNPs (P < 0.001) in comparison with the without antioxidant subgroup. Furthermore, the DSB levels at the melatonin + I-131 and the SeNPs + I-131 subgroups decreased to 38% and 30%, respectively, compared to the I-131 subgroup. CONCLUSION: According to the obtained findings, it can be concluded that the use of melatonin and SeNPs (as radioprotector agents) can reduce the DSB levels induced by I-131 in peripheral lymphocytes.

Thalamic shape abnormalities in patients with multiple sclerosis-related fatigue.

Thalamus plays an important role in the pathogenesis of multiple sclerosis-related fatigue (MSrF). However, the thalamus is a heterogeneous structure and the specific thalamic subregions that are involved in this condition are unclear. Here, we used thalamic shape analysis for the detailed localization of thalamic abnormalities in MSrF. Using the Modified Fatigue Impact Scale, we measured fatigue in 42 patients with relapsing-remitting multiple sclerosis (MS). The thalamic shape was extracted from T1w images using an automated pipeline. We investigated the association of thalamic surface deviations with the severity of global fatigue and its cognitive, physical and psychosocial subdomains. Cognitive fatigue was correlated with an inward deformity of the left anteromedial thalamic surface, but no other localized shape deviation was observed in correlation with global, physical or psychosocial fatigue. Our findings indicate that the left anteromedial thalamic subregions are implicated in cognitive fatigue, possibly through their role in reward processing and cognitive and executive functions.

Vitamin B12-loaded polycaprolacton/gelatin nanofibrous scaffold as potential wound care material.

The current study aimed to develop a potential wound dressing using vitamin B12-loaded polycaprolacton/gelatin nanofibrous scaffold. In order to produce wound dressings, 1000 mcg of vitamin B12 was added to polycaprolacton/gelatin solution and the nanofibrous scaffolds were fabricated through electrospinning method. The obtained scaffolds were studied regarding their hydrophobicity, microstructure, amount of water absorption, water vapor permeability, tensile strength, release test, and cellular proliferation assay. In vitro studies revealed that the incorporation of vitamin b12 into polycaprolacton/gelatin scaffolds could significantly augment L929 cells proliferation at 1 and 3 days post-seeding. However, there was not statistically significant difference between Vitamin B12-containing and polymer-only scaffolds in tensile strength study, surface wettability measurement, water vapor transmission test, the capacity for water absorption, and nanofiber's diameter. Both vitamin containing and free dressings were applied on the full-thickness excisional wound in rat model to compare their healing potential. Our results showed that after 14 days, vitamin B12 containing dressing could significantly enhance wound closure compared to vitamin B12 free scaffolds (92.27 ± 6.84% vs. 64.62 ± 2.96%). Furthermore, histopathological examinations showed significantly greater epithelial thickness in polycaprolacton/gelatin/vitamin B12 group compared to other experimental groups. This preliminary study suggest potential applicability of the proposed dressing to treat skin wounds in clinic.

Predictive Factors Associated with Anterolateral Ligament Injury in the Patients with Anterior Cruciate Ligament Tear.

BACKGROUND: The earlier studies did not assess the associated factors of anterolateral ligament injury, comprehensively. We sought to evaluate the independent predictive factors of anterolateral ligament injury in the patients with anterior cruciate ligament tear. Ultrasound scan has an emerging role in the diagnosis of anterolateral ligament injury. MATERIALS AND METHODS: We included 198 patients with anterior cruciate ligament tear in this study. All the patients underwent knee ultrasound scan to diagnose the anterolateral ligament injury. The potential predictive factors of anterolateral ligament injury were compared between the patients with anterolateral ligament injury and the patients with the intact anterolateral ligament. RESULTS: In all the patients, the anterolateral ligament was seen in the tibial and femoral portions using the ultrasound scan. One hundred and ten patients (55.6%) had anterolateral ligament injury and the anterolateral ligament was intact in 88 patients (44.4%). The lateral collateral ligament injury was significantly associated with the anterolateral ligament injury (p < 0.001). In addition, the iliotibial band injury had a significant relationship with the anterolateral ligament injury (p = 0.001). An increased lateral tibial slope was significantly associated with the anterolateral ligament injury (p = 0.031). Furthermore, the bone contusion of the lateral femoral condyle had a significant relationship with the anterolateral ligament injury (p = 0.004). CONCLUSION: The independent predictors of anterolateral ligament injury included the lateral collateral ligament injury, iliotibial band injury, bone contusion of the lateral femoral condyle, and an increased lateral tibial slope.

Mitigation of Radiation-Induced Gastrointestinal System Injury by Melatonin: A Histopathological Study.

AIMS: The current study aimed to investigate the potential role of melatonin in the mitigation of radiation-induced gastrointestinal injury. BACKGROUND: Organs of the gastrointestinal system such as the intestines, colon, duodenum, ileum etc. are sensitive to ionizing radiation. Mitigation of radiation-induced gastrointestinal injury is an interesting topic in radiobiology and a life-saving approach for exposed persons after a radiation event or improving the quality of life of radiotherapy patients. OBJECTIVE: The study aimed to find the possible mitigation effect of melatonin on radiation-induced damage to the small and large intestines. METHODS: 40 male mice were randomly assigned into four groups namely G1: control, G2: melatonin treatment, G3: whole-body irradiation, and G4: melatonin treatment after whole-body irradiation. A cobalt-60 gamma-ray source was used to deliver 7 Gy to the whole body. 100 mg/kg melatonin was administered orally 24 h after irradiation and continued for 5 days. Thirty days after irradiation, histopathological evaluations were performed. RESULTS: The whole-body irradiation led to remarkable inflammation, villi shortening, apoptosis and damage to goblet cells of the small intestine. Furthermore, moderate to severe inflammation, apoptosis, congestion, crypt injury and goblet cell damage were reported for the colon. Treatment with melatonin after whole-body irradiation led to significant mitigation of radiation toxicity in both small and large intestines. CONCLUSION: Melatonin could mitigate intestinal injury following whole-body exposure to radiation. Treatment with melatonin after an accidental exposure to radiation may increase survival via mitigation of damages to radiosensitive organs, including the gastrointestinal system.

Molecular detection of Propionibacterium acnes in biopsy samples of intervertebral disc with modic changes in patients undergoing herniated disc surgery.

BACKGROUND AND OBJECTIVES: Recent studies have hypothesized that sterile disc infection with the anaerobic Propionibacterium acnes, recently renamed Cutibacterium acnes, occurs in people with intervertebral disc (IVD) herniation. This study aimed to examine the presence of P. acnes in patients who have Low back pain (LBP) with Modic changes observed in their Magnetic Resonance Imaging (MRI). MATERIALS AND METHODS: Thirty-seven patients who were candidates for surgery due to disc herniation and demonstrated Modic changes in MRI were included in the study. Before the surgery, the level of pain in patients was assessed using the visual analog score (VAS). All patients were asked to fill in the Oswestry Low Back Pain Disability Questionnaire. Intervertebral disc changes observed in MRI were recorded for all patients. Then, during surgery, sterile intervertebral disc samples were taken. P. acnes detection was performed using PCR in the laboratory. Data analysis with Chi-squared test, independent samples t-test, and Mann-Whitney U test in SPSS 18.0. RESULTS: The mean age of 37 patients equaled 43.64 years and the mean duration of symptoms was 11.05 months. In molecular examination, of the 37 individuals, the genome of P. acnes was positive in 23 cases (62.2%) and negative in 14 (37.8%). The relationship between VAS, disability score, changes in MRI, and patients' age with the positivity of the intervertebral disc sample was also assessed. Of these variables, only age was significantly correlated with the positive molecular finding, such that with an increase in age, the probability of positive findings was increased (p = 0.022). CONCLUSION: Based on the results, lumbar disc infection with P. acnes may play a significant role in causing Modic changes and the progression of the disease in patients with LBP.

Investigating the association between chronological age and thyroid cartilage ossification using CT imaging.

Background: Thyroid cartilage ossifies through time. In addition to different methods for age estimation, ossified volume can be a valuable index for age estimation. In this study, anthropometric characteristics and ossified volume were measured using CT scan imaging to find potential correlations between measures and age. Methods: In this study, 100 thyroid cartilage of Iranian corpses (60 men and 40 women) were studied. Corpses from Kahrizak hall of Tehran Legal Medicine Organization were included in this study. After obtaining required consent from their family, their thyroid cartilage was separated by an expert, and anthropometric properties of the cartilage were recorded. A 64-slice Siemens CT scan machine was used to measure specimen ossified volume and Hounsfield score by 3D reconstruction of images. Pearson's correlation test was used to measure the correlation between thyroid calcified volume and chronological age. Repeated measurement ANOVA test was also used to measure the correlation of the ossified volume and Hounsfield score with different age groups. SPSS version 22 was used for statistical analysis, and significance level was set at than 0.05. Results: All thyroid cartilage measures were higher in men than in women, except for thyroid angle, and the differences were statistically significant. Height of the laminae (R=0.23, p=0.023) and depth of the thyroid notch (R=0.198, p=0.049) were correlated with age. Mean ossified volume (6.1±1.7 cc) and Hounsfield score (308.8±53.5 HU) were directly correlated with age (R=0.205; p=0.040 and R=0.219; p=0.029, respectively), but none of these two radiologic parameters were correlated with age groups (p=0.331 and 0.063, respectively). No specific ossification pattern was obtained from CT images in different age groups. Conclusion: A combination of anthropometric measures such as the height of the laminae and depth of the thyroid notch with CT scan imaging measures such as ossified volume and the Hounsfield score are useful to estimate age with low precision. In addition, thyroid cartilage measures are useful for sex determination.

Point of Care Ultrasound in Detection of Brain Hemorrhage and Skull Fracture Following Pediatric Head Trauma; a Diagnostic Accuracy Study.

INTRODUCTION: Head trauma is a common reason for emergency department visits worldwide; many of which involve young children. We sought to determine if head ultrasound (US), as a portable, fast and safe modality, can guide diagnosis and treatment of children in emergency settings. METHODS: In this cross-sectional study, brain computed tomography (CT) scan and emergency head US were performed on head trauma children who were referred to the emergency departments of Firouzgar and Besat Hospitals, Tehran, Iran, from September 2018 to May 2019. The findings of the two modalities were separately evaluated, and used to estimate the diagnostic accuracy of US. RESULTS: 538 patients with the mean age of 5.6 ± 4.9 (0-18) years were studied (54.8% male). Sensitivity and specificity of bedside US in detection of hemorrhage were 85.71% (42.13%-99.64%) and 97.99% (94.23%-99.58%) for children below the age of 2. These measures were 80.00% (51.91%-95.67%) and 97.97% (94.88%-99.44%), respectively, for those between 2 and 6 years old and 46.67% (21.27%-73.41%) and 92.90% (87.66%-96.40%), respectively, for those above the age of 6. Sensitivity and specificity were 92.31% (84.01%-97.12%) and 95.87% (93.62%-97.50%), respectively, in diagnosing skull fractures. Cohen's kappa coefficient varied greatly for different findings, ranging from 0.363 to 0.825, indicating different agreement rates for each. CONCLUSION: Based on our findings, emergency US can play a greater role in the initial management of head trauma children, especially as a triage test.

Measurement of the contralateral breast photon and neutron dose in breast cancer radiotherapy: A Monte Carlo study.

INTRODUCTION: This study aimed to calculate the photon and neutron doses received to the contralateral breast (CB) during breast cancer radiotherapy for various field sizes in the presence of a physical wedge. MATERIALS AND METHODS: Varian 2100 C/D linear accelerator was simulated using a MCNP4C Monte Carlo code. Then, a phantom of real female chest was simulated and the treatment planning was carried out on tumoral breast (left breast). Finally, the received photon and neutron doses to CB (right breast) were calculated in the presence of a physical wedge for 18 MV photon beam energy. These calculations were performed for different field sizes including 11 cm × 13 cm, 11 cm × 17 cm, and 11 cm × 21 cm. RESULTS: The findings showed that the received doses (both of the photon and neutron) to CB in the presence of a physical wedge for 11 cm × 13 cm, 11 cm × 17 cm, and 11 cm × 21 cm field sizes were 9.87%, 12.91%, and 27.37% of the prescribed dose, respectively. In addition, the results showed that the received photon and neutron doses to CB increased with increment in the field size. CONCLUSION: From the results of this study, it is concluded that the received photon and neutron doses to CB in the presence of a physical wedge is relatively more, and therefore, they should be reduced to as low as possible. Therefore, using a dynamic wedge instead of a physical wedge or field-in-field technique is suggested.

Internal Jugular Vein Waveform; A New Insight to Detect Early Stage of Hemorrhagic Shock.

OBJECTIVE: To evaluate the accuracy of internal jugular vein waveform to detect early stage of hemorrhagic shock. METHODS: Forty-three volunteers enrolled in our study between November and December 2018. After blood donation of 450cc, the blood donors in the case group underwent color Doppler sonography of internal Jugular Vein. Besides, the clinical and laboratory indicators of shock were evaluated. The same clinical, laboratory and sonographic data was also obtained from the volunteers in the control group, then Chi-square and Student t-test were applied to make comparison between mentioned groups. RESULTS: After excluding five volunteers, eighteen subjects were included in the blood donor group (mean of age: 35.81±8.05) and 20 healthy volunteers enrolled in the control group (mean of age: 34.95± 6.86). The Jugular pulsatility index was significantly smaller in the case group (0.47 ± 0.27 vs. 0.77 ± 0.52). The jugular pulsatility index above 0.91 excluded blood loss (sensitivity=100%). The combination of clinical, laboratory and sonographic data were also represented as two other indices; Jugular Pulsatility-Shock index and Jugular Pulsatility-Shock-Base Deficit index (JPSBDI). These indices were also accurate enough to detect early blood loss (p=0.011 and <0.001, respectively). JPSBDI below 0.38 was highly accurate to rule out blood loss. (Area under the curve: 0.868, sensitivity=95% and specificity=76.47%). CONCLUSION: The internal Jugular vein waveform is accurate to detect early stages of shock. The combination of clinical, laboratory and sonographic data is more promising than each of them, separately.

A Comparison Study of Efficacy and Safety of a Biosimilar Form of Intramuscular Βeta-interferon I-a Versus the Reference Product: A Randomized Controlled Clinical Trial in Iran.

We compared the efficacy and safety of a biosimilar form of beta-interferon-1a (Actovex) versus the reference product in the treatment of relapsing remitting multiple sclerosis (RRMS). In a double blind, randomized phase 3 clinical trial, we evaluated 138 patients with RRMS that were allocated to receive the biosimilar medication and the reference treatment (30 µg intramuscular, weekly for one year). We investigated changes in EDSS, relapse rate and MRI changes within one year. In sixty-nine patients who were allocated to each arm and analyzed mean age and its standard deviation was 32.4 ± 8.8 and 31.5 ± 8 for the biosimilar medication and the reference arm respectively. One-year follow-up revealed a mean difference of 0.084 in EDSS (95% CI: 0.069-0.237) between the two groups in favor of the biosimilar medication. This value did not exceed the predefined non-inferiority margin of 0.1. There were no statistically significant differences in relapse rate and systemic and local adverse events of the two groups. The results show that the biosimilar interferon 1-a is non-inferior to the reference product in terms of efficacy while it demonstrates comparable safety. In conclusion the biosimilar interferon 1-a can be considered as an effective and safe alternative to the reference product due to lower cost and more availability.

Protection Against Radiation-Induced Micronuclei in Rat Bone Marrow Erythrocytes by Curcumin and Selenium L-Methionine.

BACKGROUND: The search for potent radioprotective agents for the amelioration of radiation side effect is an important aim in radiobiology. The present study aimed to evaluate the effects of curcumin and seleno-L-methionine against radiation-induced micronucleus formation in rat bone marrow. METHODS: In total, 40 male rats were divided into 8 groups (n=5 each), including control, curcumin or seleno-L-methionine treated alone or in combination, 2 Gy irradiation, irradiation of treated groups with curcumin or seleno-L-methionine or their combination. Curcumin was administrated orally and seleno-L-methionine was injected intraperitoneally 24 hours before irradiation. The frequency of micronucleated normochromatic erythrocytes (MnNCEs) and micronucleated polychromatic erythrocytes (MnPCEs) was scored in 5,000 polychromatic erythrocytes (PCEs) and the cell proliferation ratio [(PCE/(PCE+NCE); NCE=normochromatic erythrocytes] was calculated for each treatment group. Data were analyzed by the SPSS software version 16.0 and P<0.05 was considered as statistically significant differences. RESULTS: Pretreatment with curcumin and seleno-L-methionine before irradiation reduced the frequency of MnPCEs and MnNCEs (P=0.01) and increased the cell proliferation ratio. Moreover, the results showed that this pretreatment reduced the frequency of MnPCEs with a protection factor (PF) of 1.2 and 1.6, respectively. The combination of curcumin and seleno-L-methionine in reducing MnPCEs and MnNCEs was not more effective than each agent alone, while improved cell proliferation ratio. CONCLUSION: Both curcumin and seleno-L-methionine showed potent protection against radiation induced MN in bone marrow cells. The combination of the two agents further ameliorates this activity, thus leading to improve bone marrow protection.

Preoperative Evaluation of Tumor Adhesion to Adjacent Brain Tissue in Patients with Meningioma with BSMI Method and Its Comparison with the Width of Edema Around Tumor

Background: This study aims to investigate the ability of BSMI, to preoperative evaluation of tumor adhesion to adjacent brain tissue in patients with meningioma and comparing this method to the width of edema around tumor, using surgery findings as the reference standard. Methods: Thirty patients with meningioma brain tumor who underwent surgery at Loghman hospital were selected for the study between November 2016 and January 2018. The level of edema according to the classification of Ide et al., (u1995) was compared with the surgical findings with blinded results, and neurosurgeons made a qualitative assessment of tumor adhesion at the time of resection. The ability of BSMI and level of edema to predict the surgical assessment of adhesion was tested using the Fisher Exact Test. Results: BSMI method was conducted on patients with meningioma brain tumor, which judged 22 (73.3%) patients as adhesion (+) and 8 (26.66%) patients as adhesion (-). In this case, there was a significant relationship between BSMI judgment and surgical findings (p-value<0.0001). The sensitivity, specificity, precision and accuracy was high, at 91.30%, 85.71%, 95.45% and 90%, respectively. Using T2-Weighted SPACE sequence, of the 30 patients, 13 (43.3%) were judged as adhesion (+) and 17 (56.7%) as adhesion (-) from edema, whereas surgical findings evaluated 23 (76.7%) as adhesion (+) and 7 (23.3%) as adhesion (-).The sensitivity was moderate but the specificity was high, at 52.17% and 85.71%, respectively. Other criteria such as precision and accuracy were 62.31% and 60%, respectively. Conclusions: BSMI evaluated adhesion of the tumor to the adjacent brain tissue with high-accuracy prior to surgery. This method was more effective than Edema method in evaluating adhesion between meningioma and the brain.