Repository of Research and Investigative Information Isfahan University of Medical Sciences
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Survey of CT radiation doses and iodinated contrast medium administration: an international multicentric study
No full textObjective: To assess the relationship between intravenous iodinated contrast media (ICM) administration usage and radiation doses for contrast-enhanced (CE) CT of head, chest, and abdomen–pelvis (AP) in international, multicenter settings. Methods: Our international (n = 16 countries), multicenter (n = 43 sites), and cross-sectional (ConRad) study had two parts. Part 1: Redcap survey with questions on information related to CT and ICM manufacturer/brand and respective protocols. Part 2: Information on 3,258 patients (18–96 years; M:F 1654:1604) who underwent CECT for a routine head (n = 456), chest (n = 528), AP (n = 599), head CT angiography (n = 539), pulmonary embolism (n = 599), and liver CT examinations (n = 537) at 43 sites across five continents. The following information was recorded: hospital name, patient age, gender, body mass index BMI, clinical indications, scan parameters (number of scan phases, kV), IV-contrast information (concentration, volume, flow rate, and delay), and dose indices (CTDIvol and DLP). Results: Most routine chest (58.4%) and AP (68.7%) CECT exams were performed with 2–4 scan phases with fixed scan delay (chest 71.4%; AP 79.8%, liver CECT 50.7%) following ICM administration. Most sites did not change kV across different patients and scan phases; most CECT protocols were performed at 120–140 kV (83%, 1979/2685). There were no significant differences between radiation doses for non-contrast (CTDIvol 24 16–30 mGy; DLP 633 414–702 mGy·cm) and post-contrast phases (22 19–27 mGy; 648 392–694 mGy·cm) (p = 0.142). Sites that used bolus tracking for chest and AP CECT had lower CTDIvol than sites with fixed scan delays (p < 0.001). There was no correlation between BMI and CTDIvol (r2 ≤ − 0.1 to 0.1, p = 0.931). Conclusion: Our study demonstrates up to ten-fold variability in ICM injection protocols and radiation doses across different CT protocols. The study emphasizes the need for optimizing CT scanning and contrast protocols to reduce unnecessary contrast and radiation exposure to patients. Clinical relevance statement: The wide variability and lack of standardization of ICM media and radiation doses in CT protocols suggest the need for education and optimization of contrast usage and scan factors for optimizing image quality in CECT. Key Points: There is a lack of patient-centric CT protocol optimization taking into consideration mainly patients’ size. There is a lack of correlation between ICM volume and CT radiation dose across CT protocol. A ten-fold variation in iodine-load for the same CT protocol in sites suggests a lack of standardization. © The Author(s), under exclusive licence to European Society of Radiology 2024
Protective Potential of Sodium-Glucose Cotransporter 2 Inhibitors in Internal Medicine (Part 2)
No full textSodium-glucose cotransporter 2 inhibitors (SGLT2i) are now uncovering new possibilities in the field of internal medicine owing to their diverse protective effects. In the second part of the literature review, we explore potential applications of SGLT2i in hepatology, neurology, ophthalmology, and oncology, mechanisms of action of such drugs as dapagliflozin, empagliflozin, canagliflozin, etc, and their effect on different organs and systems. © Ashot A. Avagimyan, Mohammad Sheibani, Artem I. Trofimenko, Evgenii E. Lysov, Farida M. Khamidova, Anahit Z. Aznauryan, Lilit M. Sukiasyan, Karmen T. Sahakyan, Tamara R. Gevorgyan, Marina R. Tatoyan, Gayane L. Mkrtchyan, Goharik L. Meltonyan, Anna R. Petrosyan, Ludmila A. Martemyanova, Ruzanna R. Petrosyan, Olga I. Urazova, Nana V. Pogosova, Nizal Sarrafzadegan
Evaluation of Sleep Disorders in the Elderly with Vestibular Vertigo
No full textBackground: Vestibular vertigo and decreased sleep quality are prevalent issues that significantly affect the life expectancy, quality of life, and mental health of the elderly. Evidence from human and animal studies suggests a link between sleep disorders and vertigo. However, this association has not been sufficiently explored in the elderly population. The present study investigates the associations between vertigo-induced handicap and sleep quality in older people. Methods: This cross-sectional study included individuals aged 60–70 with vestibular vertigo. The participants completed two questionnaires—the Dizziness Handicap Inventory (DHI) and the Pittsburgh Sleep Quality Index (PSQI)—in the presence of one of the authors. Results: In this study, 96 of participants exhibited some degree of poor sleep quality. Correlation analysis revealed positive relationships between PSQI subcategory scores and specific domains of the DHI. Subjective sleep quality was significantly associated with DHI-Total (DHI-T), DHI-Emotional (DHI-E), and DHI-Functional (DHI-F) scores. Sleep disturbance showed significant links with the DHI-E and DHI-F domains. The use of sleeping medication was significantly correlated with DHI-T, DHI-E, and DHI-F scores, while daytime dysfunction was associated with DHI-T and DHI-F scores (P0.05). Conclusion: This study demonstrated that, in elderly individuals with vestibular vertigo, there is a correlation between the degree of vertigo-induced handicap and various dimensions of sleep quality. Specifically, as the handicap worsens, sleep quality deteriorates. These findings underscore the importance of assessing sleep quality when evaluating elderly patients with vestibular vertigo. Copyright: © Journal of Health Sciences and Surveillance System
Investigating the Psychological Effects of Caring for Patients Infected with the Coronavirus on the Occurrence of Clinical Errors among Nurses Working in COVID-19 Referral Hospitals
No full textBackground: With the emergence of the coronavirus disease 2019 (COVID-19) virus in December 2019, nurses on the frontlines of the fight against this disease faced an immense burden. The present study was conducted to investigate the psychological effects of caring for patients with COVID-19 on the incidence of clinical errors among nurses. Methods: This study was a case-control study conducted on 120 nurses divided into two groups: case and control. To carry out the research, we utilized the Expanded Nursing Stress Scale (ENSS), Cognitive Failures Questionnaire (CFQ), and a questionnaire to document the frequency of clinical errors over the past six months, in addition to a cognitive ergonomics test. Data analysis was performed using SPSS software. Findings: The average age of the participants was 32.99 ± 7.23 years, and there was no significant difference between the two groups regarding the occurrence of clinical errors over the past six months (P = 0.609). The statistical analysis of the ENSS and CFQ indicated no significant differences between the two groups in any of the assessed areas (ENSS: P = 0.652, CFQ: P = 0.372). Additionally, in the initial trials of the digital stability maze test, a significant difference was observed between the two groups in terms of both time taken and the number of errors. However, after retesting, a significant difference was noted only in the duration of the test between the two groups. Conclusion: Cognitive failures and errors in stability maze tests among nurses working in the inpatient ward for patients with COVID-19 were lower than those observed in other nurses. This finding may be attributed to the fact that the burden associated with certain unknown diseases diminishes over time, and increased knowledge about the disease can alleviate stress. In contrast, the burden and stress levels in other departments remain constant due to their workload. Additionally, the transfer of staff to other departments contributes to an increase in stress levels. © 2025, Isfahan University of Medical Sciences(IUMS). All rights reserved
Introduction to the Stir Bar Sorptive Extraction Method and its Applications in Occupational Toxicology
No full textSample preparation is a crucial step in chemical analysis. Stir Bar Sorptive Extraction (SBSE) is one of the sample preparation methods employed in this field. This article provides an overview of the SBSE method and reviews its applications in toxicology. It discusses the extraction mechanism, factors influencing extraction efficiency, advantages, and disadvantages, and various applications of this method in pesticides, environmental cases, pharmaceuticals, food samples, forensic medicine, and more. The SBSE is an attractive alternative to traditional extraction methods, as it reduces solvent consumption, desorption costs, and extraction time. Its advantages include operational simplicity, good reproducibility, high recovery rates, and minimal use of organic solvents. In this review, 52 articles were selected for final analysis, with a portion of the results focusing on biological samples relevant to occupational toxicology. It can be concluded that this method is still in the early stages of widespread application, and many issues require further research. © 2025, Isfahan University of Medical Sciences(IUMS). All rights reserved
Comparison of Dose Distribution in Breast Cancer Radiation Therapy: Risk Assessment of Mastitis
No full textBackground: Breast cancer is one of the most common cancers in women. Radiation therapy is used as one of the main methods of treatment for this type of cancer. Breast radiation therapy can cause various side effects, including mastitis. Evaluation and comparison of dosimetry in this field can help to improve treatment planning. Methods: In this cross-sectional analytical study, 40 breast cancer patients were evaluated at Milad Hospital, Isfahan, in 2023. Mastitis incidence was assessed during treatment and up to 40 days post-treatment. Mean maximum, minimum, and average doses were compared between patients with and without mastitis. Findings: The results indicated that the number of patients with mastitis increased gradually during the first six weeks of treatment (1, 3, 5, 6, 10, and 13 patients, respectively). The highest incidence of mastitis was observed in the sixth week. Moreover, 12 patients (30) developed mastitis within the first month post-treatment. Dosimetric parameters were significantly higher in breast cancer patients with mastitis compared to those without. Conclusion: The findings of this study suggest that precise optimization of treatment protocols using dosimetric parameters can effectively reduce the incidence of breast inflammation in patients undergoing breast cancer radiotherapy. © 2025 Isfahan University of Medical Sciences(IUMS). All rights reserved
Investigating the Effect of RTMS on Tinnitus Patients
No full textBackground: Tinnitus is the perception of sound in the absence of an auditory stimulus and is a common symptom of auditory system disorders. Ear causes adverse effects on the quality of sleep and lifestyle, concentration in daily activities, social relations, and emotional balance of sufferers. To eliminate tinnitus, in this research, an RTMS device, which is a tool used for electrical brain stimulation, is used. Methods: The statistical population includes all people (both men and women) who came to Al-Zahra Hospital and Ayatollah Kashani Hospital in 2023 with complaints of tinnitus. The sample size of 30 people is selected using the available sampling method. People are compared in the beginning and before the RTMS method (pre-test) and then after the implementation of the RTMS method again and as a post-test. The instrument used is the Tinnitus Questionnaire (THI), administered as a pre-test and post-test, a 25-item self-report questionnaire that quantifies the effect of tinnitus on daily life by evaluating functional, emotional, and catastrophic responses in response to tinnitus. Findings: The findings showed a significant difference between the pre-test and the post-test, and the average tinnitus scores in the post-test are lower than the pre-test (P < 0.01). Conclusion: It is concluded that repetitive magnetic brain stimulation (RTMS) is effective in tinnitus, and this method can be used as an effective treatment method. © 2025 Isfahan University of Medical Sciences(IUMS). All rights reserved
Exploring Monogenic, Polygenic, and Epigenetic Models of Common Variable Immunodeficiency
No full textCommon variable immunodeficiency (CVID) is the most frequent symptomatic inborn error of immunity (IEI). CVID is genetically heterogeneous and occurs in sporadic or familial forms with different inheritance patterns. Monogenic mutations have been found in a low percentage of patients, and multifactorial or polygenic inheritance may be involved in unsolved patients. In the complex disease model, the epistatic effect of multiple variants in several genes and environmental factors such as infections may contribute. Epigenetic modifications, such as DNA methylation changes, are also proposed to be involved in CVID pathogenesis. In general, the pathogenic mechanism and molecular basis of CVID disease are still unknown, and identifying patterns of association across the genome in polygenic models and epigenetic modification profiles in CVID requires more studies. Here, we describe the current knowledge of the molecular genetic basis of CVID from monogenic, polygenic, and epigenetic aspects. Copyright © 2025 Tayebeh Ranjbarnejad et al. Human Mutation published by John Wiley & Sons Ltd
The Association of the Mode of Delivery and Maternal Postpartum Readmission: A Systematic Review and Meta-analysis
No full textBackground: Postpartum readmission is one of the metrics for assessing the quality of health services. There is inconsistent evidence about postpartum readmission and complications by mode of delivery. Objective: We applied a meta-analysis to investigate whether the mode of delivery is associated with postpartum readmission or complications. Methods: We systematically searched main English databases for studies published up to June 2022. The Newcastle–Ottawa scale (NOS) was used to assess the quality of observational studies. The heterogeneity of included studies was determined using the I2 statistic and Begg’s and Egger’s tests for publication bias, respectively. Results of the random-effects meta-analysis were presented using odds ratio (OR) estimates with 95 confidence intervals (CI). The Stata software version 16 was used for data analysis. Results: In total, 18 studies with 514,577 subjects were suitable for reviewing maternal postpartum readmission by mode of delivery. Our findings show that cesarean delivery is a risk factor for increasing postpartum readmission than the vaginal delivery method (overall OR =1.42, CI 95 1.22, 1.63, I2= 99.7, p = 0.001). This chance was increased in primary cesarean (OR=2). Postpartum hemorrhage and breast infection did not have risk factors for postpartum readmission. While cardiopulmonary condition, deep vein thrombosis (DVT), genitourinary condition, and wound complication were risk factors among causes. Conclusion: Cesarean delivery is one of the most important risk factors for postpartum readmission, especially both childbirth-related/non-related complications causes. Therefore, it is necessary to revise the schedule of postpartum visits based on the type of delivery. © 2025 Bentham Science Publishers
Pseudoaneurysm of the lower pole segmental artery of the kidney following open nephrolithotomy using an avascular approach: a case report
No full textAneurysms are abnormalities in blood vessels that can be categorized as true aneurysms or pseudoaneurysms. Pseudoaneurysms occur when one or more layers of the blood vessel wall rupture, often as a result of trauma or medical procedures, such as nephrolithotomy. This case study discusses a pseudoaneurysm of the lower pole segmental artery of the kidney that developed after an open nephrolithotomy despite an avascular surgical plan. The patient experienced intermittent gross hematuria, highlighting the potential complications associated with renal surgeries. The diagnosis was challenging, necessitating a high suspicion index and imaging modalities such as ultrasound, CT scans, and angiography. Treatment options varied from conservative management to angioembolization, which is preferred for its minimally invasive nature and ability to preserve renal parenchyma. This study aims to demonstrate that the risk of pseudoaneurysm should be considered even in an atrophic nephrolithotomy performed without vascular invasion