Diagnostic Evaluation of 99mTc-TRODAT-1 SPECT in Parkinsonism

Background Parkinsonism as a group of movement disorders, exhibit similar clinical presentation. Therefore, clinically differentiating these diseases is difficult. We investigated the diagnostic value of 99m Tc-TRODAT-1 SPECT in this setting. Due to the fact that this modality has some limitations in imaging small organs like the sub-regions of basal ganglia, we also evaluated the use of anatomical MR imaging along with functional SPECT imaging in parkinsonism. Methods This follow-up diagnostic test evaluation study was performed with 40 patients with the clinical presentation of parkinsonism, and 10 healthy subjects as controls. After administration of the radiopharmaceutical, SPECT images were acquired, then co-registered on MRI. Uptake values were evaluated in basal ganglia semi-quantitatively. Results In this study, 99mTc-TRODAT-1 SPECT was able to differentiate essential tremor and healthy subjects from progressive supranuclear palsy (PSP) and Parkinson’s disease (PD) with a sensitivity of 76.47% and specificity of 100% at a cut-off of 0.53; however, findings were not significant in differentiation of PD from PSP (p ˃0.05), and the results were similar in SPECT and co-registered MRI/SPECT images. In evaluation of the uptake pattern in basal ganglia, the lateralization of decreased uptake was only seen in PD; and in PSP, the dysfunction was bilateral in all patients. Conclusion 99mTc-TRODAT-1 SPECT is sensitive and specific in diagnosing basal ganglia dysfunction; however, 99mTc-TRODAT-1 SPECT alone or co-registration on MRI are not adequate in differentiation of the etiologies of basal ganglia dysfunction.

Knowledge, attitudes and practices of intensive care unit nurses towards nutritional care in critically ill patients: A descriptive cross-sectional study

Introduction: In recent years, there has been a growing concern about the lack of adequate nutrition Knowledge among nurses. Nutrition training in the medical curriculum and for healthcare professionals is contradictory, inadequate, and weak. Nurses are one of the most reliable sources of nutritional information for patients; and yet, little research has been done so far on nurses’ information regarding their important role in nutritional care. Our study is designed to assess the current level of Knowledge, attitudes, and practices of nurses in intensive care units (ICUs). Methods: A four-part questionnaire was used in this study. This descriptive cross-sectional study was conducted from July 2019 to July 2020. The sample size consisted of 110 nurses based on the statistical data obtained from the nursing offices of two hospitals of Tabriz University of medical science including all the nurses working in the ICUs. Thereafter, all questionnaires were re-collected and data were finally analyzed. Results: Results showed that from 110 nurses which were included in this study, 73.6% had high Knowledge, 45.5% had moderate practices, and 58.2% had a positive attitude about nutritional support. Age and level of education had a significant correlation with their knowledge (P=0.005 and P=0.001, respectively). Nursing attitude had a significant correlation with age and the level of education (P=0.03 and P=0.003). And also, nursing practice had a significant relationship with age, work experience in the ICU, and the level of education (P=0.001, P=0.001 and P=0.004, P<0.05). Conclusion: Nurses surveyed in this study had a high knowledge, moderate practice and a positive attitude regarding nutritional care in patients admitted to the ICU.

COVID-19 infection complicated by Guillain-Barre Syndrome: a systematic review of clinical features, pathogenic mechanism, and respiratory failure

Background: The World Health Organization (WHO) declared a pandemic in March 2020 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the neurotropism feature of the coronavirus and growing number of COVID-19 associated neurological disorders, including Guillain Barre syndrome (GBS), we conducted a systematic review to thoroughly describe the clinical features, diagnostic workup, and clinical outcome of COVID-19 associated GBS in 78 cases. Methods: We identified case reports and case series of COVID-19 associated GBS by conducting a search in the PubMed/MEDLINE and EMBASE databases. We assessed the quality of studies using an appraisal checklist presented by Cochrane Murad et al. Extracted data included demographic characteristics, clinical presentation, diagnostic workup, and outcome. Results: The systematic search yielded a total of 60 articles reporting 78 patients with a diagnosis of COVID-19 associated GBS. The patients were mainly male (65.3%) with an average age of 57 years. The ascending symmetrical paresis was the most common presentation (79.4%), with demyelinating pattern in 54 patients (79.4%). The CSF analysis showed albuminocytologic dissociation in 48 patients (75%). The mortality of COVID-19 associated GBS was estimated as 6.4% attributable to progressive respiratory failure. Conclusion: Given the associated morbidities such as respiratory failure in patients with COVID-19 associated GBS, its timely detection is crucial to prevent poor clinical outcomes. On the other hand, clinicians must be vigilant to identify the clinical findings of SARS-CoV-2 infection in newly diagnosed GBS patients, as this might be a neurological complication of the subclinical viral infection.

Ocular wavefront aberrations in acute central serous chorioretinopathy

Background: Central serous chorioretinopathy (CSCR) is a condition of choroidal and retinal pathologies that may affect vision, so we assessed vision by the ocular wavefront in the acute form of CSCR. Methods: This cross-sectional study included 21 cases (16-male, 5-female) of acute onset CSCR was referred to the retina clinic of Nikookari Eye Hospital. Visual acuity and ocular examination with and without pupillary dilation record. Central macular thickness and sub-foveal fluid height of all patients measured by spectral-domain optical coherence tomography (SD-OCT). All of them fulfilled binocular visual function analyzer by Tracy Technology after complete pupillary dilation. The items such as spherical equivalent, total root mean square, total lower-order aberration, total higher-order aberration, defocus, astigmatism, secondary astigmatism, coma, spherical aberration, trefoil, Strehl ratio in point spread function, the average height in the modulation transfer function, and root mean square error registered. Generalized Estimation Equations (GEE) were used to compare two groups of affected CSCR and normal contralateral eyes. Results: The mean uncorrected distance visual acuity in the CSCR eyes is (Decimal Notation) 0.82±0.17 and in the contralateral eyes is 0.95±0.09 (P=0.002). Analysis of macular OCT data CSCR group represents: central foveal thickness 485.9±165.12 μm and mean fluid height 284.3±165.42 μm. The mentioned optical parameters of ocular wavefront aberrations do not have significantly different results in the two groups. Conclusion: Our study showed CSCR reduced uncorrected visual acuity but it did not detect significant ocular wavefront changes in acute CSCR

Available Chemical Constituents and Activities of Ganoderma Lucidum (Lingzhi or Red Reishi) Utilizing in Disease Treatment: A mini review

Medicinal mushrooms are known and used to be nutraceuticals for centuries to enhance health benefits as well as to treat several diseases. Among them, Ganoderma Lucidum (i.e.: G. Lucidum, or red Reishi, or Lingzhi) is appreciated as a medicinal mushroom or significant herbal food for treating diseases, extending life and developing drug. It is detected in different locations, likely contributed confusing concerning its classification. Concomitantly, it has utilized as tea, in alcoholic drinking, and as a complementary medicine to bestow numerous health benefits. Thereby, it is truly important to identify chemical constituents and provide its activities in health benefits regarding these products. Herein, we hope that it is likely a good and right approach for utilizing and encouraging this product, as well as its advantages will be shortly summarized in disease treatments.

Treating Umbilical Granuloma with Topical Corticosteroid: A Systematic Review and Meta-analysis

Background: Umbilical granuloma so far can be treated with surgery or with silver nitrate. In limited facilities such as in remote areas where the surgeon is limited, pharmacological therapy with silver nitrate or topical steroid can be given. However, treatment with silver nitrate requires medical personnel and has unfavorable adverse effects if done by improper technique. This systematic review aimed to evaluate the effectiveness of topical steroid for treating an umbilical granuloma compared to silver nitrate therapy. Method: The literature search was done using search engines including PubMed, Embase, and Google Scholar. Literature selection was performed with limitations from 2000 to 2020 to get the novelty and written in the English language with a target population of infants less than 6 months were included. To retrieve the articles, topical corticosteroids, topical steroids, and umbilical granuloma were used as keywords. Results: The findings from the included studies show similar sample characteristics. The study conducted by Brodsgaard et al. had an older mean sample age than the study of Ogawa et al. (53.4 vs 31 days). The risk of topical steroid treatment failure on an individual study conducted by Brodsgaard et al. and Ogawa et al. was 3.0 (0.33–27.23, p = 0.33) and 0.94 (0.40–2.21; p = 0.33), respectively. Overall analysis, the risk of treatment failure was 1.09 (0.49–2.43, p = 0.82), there was no difference between the two interventions. Conclusions: One of the umbilical granuloma treatment options that can be considered is topical steroids, such as clobetasol proprionate 0.05% or betamethasone valerate 0.12%. When compared to silver nitrate, topical steroids have a longer therapeutic healing time but with a better safety profile. The non-inferiority study of topical steroids to silver nitrate has not been met yet.

A cutaneous tuberculosis mimic presented with recurrent soft tissue infection: A case report

Recurrent cellulitis is one of the cutaneous tuberculosis mimickers. As the skin lesion can mimic other skin diseases, the diagnosis can easily be missed especially in immunocompetent patients without any other risk factors. We present a case of a 62-year-old lady with history of right hand extensor tenosynovitis presented with right hand and forearm swelling and pain, associated with fever. Clinically, her right hand and forearm were erythematous with a small nodule at the right elbow. She was treated for recurrent right upper limb cellulitis and thrombophlebitis complicated by septic shock needing several courses of antibiotics. However, she did not show any significant response to the treatment. Multiple septics work up were carried out and all were negative, except aspiration of her right elbow nodule was positive for Mycobacterium tuberculosis. Anti-tuberculous treatment was started but unfortunately, she succumbed due to nosocomial infection.

Diagnostic value of serum IgG by Eliza to detecting Mycobacterium tuberculosis, Original Article

Introduction: In developing countries, which is an endemic region in terms of tuberculosis, there is an urgent need for fast, accurate, and inexpensive serological testing. The aim of this study was to determine the diagnostic value of patient serum IgG antibodies by ELISA in the diagnosis of Mycobacterium tuberculosis. Method: This case-control study was performed on patients with pulmonary tuberculosis in 2017-2020. After selecting the case (n = 30) and control (n = 30) subjects according to inclusion criteria, their blood samples were obtained and analyzed in the reference laboratory by standard kits for immunoglobulin G against 16, 36, and 40 kDa antigens of mycobacterium tuberculosis. Results: The mean age of the subjects was 47.07 (15.57%). The majority of participants were 46 (51.1%) women. There was no significant difference between the two groups regarding sex and age. serological examination of patients with pulmonary tuberculosis showed 25 positive results and only 4 of the control group had a positive result. Sensitivity, specificity, positive and negative predictive values of serology test were 83.3%, 86.67%, 86.20% and 87.88% respectively. Conclusion: Despite the acceptable sensitivity of the serologic immunoglobulin G test, according to the statement of World health organization (WHO), it did not possess an acceptable specificity. It is recommended that a a wider range of different antigens to be studied also it is essential to evaluate the diagnostic value of the other immunoglobulins inpatient in different stages of the disease.

A short review: Characterization and Heath Effects of Saffron Utilizing in Disease Treatment and Prevention

With current technological development, finding and exploring novel chemical compounds from natural material sources can be one of significant purposes for researchers. Especially, saffron is known to be the highest-cost medicinal plant, a high-grade spice, and an outstanding dye. Concomitantly, the final saffron products truly affect much their quality to protect the rights for the consumer, as well as its available healthy benefits can be utilized for treating or preventing various diseases. Herein, the chemical characterization and health effects of saffron are shortly introduced and summarized through treatment and prevention of different diseases (i.e.: cancer, liver, ocular, diabetes, antidepressant, Alzheimer and gastrointestinal diseases), which can favor readers understanding clearly the saffron advantages through this short review. Moreover, it can provide relatively for choosing an effective drying method to maintain the product qualities and facilitate the industrial production of saffron.

Qualitative And Quantitative Magnetic Resonance Imaging Assessment Of Focal Liver Lesions: A Study To Evaluate The Role Of Different MRI Sequences.

Background: Focal liver lesions have a broad differential diagnosis. MRI with its improved soft tissue characterization and newer sequences can significantly narrow the differentials especially when discriminating benign from malignant lesions. Methods: T1, T1 IN AND OUT OF PHASE, T2, LONG TE T2 AND Diffusion Weighted Imaging was done in 159 patients with USG documented focal liver lesion. Qualitative and quantitative assessment of ADC values and long TE images was done and a threshold for differentiating benign from malignant lesions was obtained. The MRI diagnosis was compared with final diagnosis obtained from histopathology in most cases or follow up and other tests (markers and RBC scan) were histopathology was not available. Sensitivity, specificity and accuracy of MRI sequences in differentiating various focal lesions were obtained. Results: T1 weighted images were useful for identifying fat, hemorrhage and iron within the lesions. T2 weighted imaging was able to correctly classify 82.0% lesions as malignant and 83.7% lesions as benign. Long TE T2 images were highly accurate in distinguishing haemangiomas and cysts from solid lesions. On diffusion-weighted (DW) imaging, 89.5% (i.e. 60 out of 67) lesions were correctly classified as malignant and 88.0% (i.e. 81 out of 92) lesions were correctly classified as benign. Threshold ADC value of 1.37 × 10-3 mm2/s is highly accurate for differentiating malignant from benign lesions. Conclusion: DWI is a sine qua non in liver lesion assessment allowing improved detection and characterization. Long TE T2 weighted imaging can accurately detect haemangiomas and cysts and rule out metastasis.