مجله دانشکده پزشکی اصفهان
پیاپی 611 (هفته سوم فروردین 1400)

Hydatidosis is a zoonosis disease, and an important public health problem in many areas of the world including Iran. Sufficient epidemiological information is required for taking care, monitoring, and effective control of the disease. In the present study, we evaluated epidemiological, clinical, and paraclinical characteristics of hydatidosis in the Alzahra hospital in Isfahan University of Medical Sciences, Isfahan, Iran, over a 9-year period.

In a descriptive cross-sectional study, demographic information (age, sex, job, etc.), clinical signs, and diagnosis methods (imaging, sonography, and serology) were obtained from the medical record of hospitalized patients during the years 2008-2016.

Overall, from 698 patients, 352 men (50.4%) and 346 women (49.6%), 647 patients were diagnosed as having hydatid cyst by clinical and paraclinical findings, and pathologic documentation. Patients' age ranged from 3 to 87 years, and the peak prevalence of the disease was between 20 and 40 years (39% of cases). The involvement of liver was the most frequent (64.8%) site, and most cases of liver cysts (54.2%) were in the right lobe.

The results showed that some cases of hydatid cysts were not diagnosed before surgery by imaging and serology method; on the contrary, cases of diagnosis of hydatid that were determined to be non-hydatid cyst after surgery. This suggests that hydatid cyst diagnosis requires more reliable and accurate diagnostic methods.

Targeted radiopharmaceutical therapy is one of the most common methods for relieving pain in patients with bone metastasis. In this type of treatment, the bone marrow absorbed dose, as a critical organ, needs to be considered as a limiting factor. Until now, beta-emitter radiopharmaceuticals have been considered for this treatment modality, which one of the most commons is samarium-153-ethylene diamine tetramethylene phosphonate (153Sm-EDTMP), but recently the radium-223-dichloride (223Ra-Cl2) alpha emitter radiopharmaceutical has been approved by the US Food and Drug Administration (FDA). The aim of this study was to compare the bone marrow absorbed dose of 153Sm-EDTMP and 223Ra-Cl2 radiopharmaceuticals.

In this study, a lumbar vertebral bone phantom was used for simulation. The radiopharmaceuticals were distributed in the phantom, and the simulation was performed using the GATE Monte Carlo toolkit. After estimating the absorbed dose per decay in different parts of the phantom, the absorbed dose of radiopharmaceuticals in the bone marrow of a patient with 70 kg weight, was calculated using the Medical Internal Radiation Dosimetry (MIRD) method.

For 153Sm-EDTMP, the bone marrow absorbed dose was equal to 9.60 Gy for the administered activity of 2590 MBq. For 223Ra-Cl2, the bone marrow absorbed dose was calculated as 0.83 Gy for administered activity of 3.85 MBq.

Due to the lower bone marrow absorbed dose by 223Ra-Cl2 alpha emitter radiopharmaceutical, the use of this radiopharmaceutical as an alternative to 153Sm-EDTMP beta emitter radiopharmaceutical is recommended for palliative therapy of patients with bone metastasis.

Detection of coronavirus disease 2019 (COVID-19) in early stage is indispensible for outcome improvement and interruption of transmission chain. Clear understanding of the nature of the diagnostic tests for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and their challenges, collecting the most diagnostically valuable specimen at the right time from the right anatomic site, and interpretation of their findings is important. This review scrutinizes current challenges and interpretation of reverse transcriptase polymerase chain reaction (RT-PCR), as the reference method, loop-mediated isothermal amplification (LAMP), antibody and antigen detection, typical lung imaging characteristics and prominent abnormal changes in laboratory findings of patients with proven COVID-19, and describes how the results may vary over time. Bronchoalveolar lavage fluid and sputum specimens demonstrate the highest positive rates (93% and 72 %, respectively) in molecular diagnosis of COVID-19. Alternatively, repeated RT-PCR assays can be performed; as over time, it is an increase in the likelihood of the SARS-CoV-2 being present in the nasopharynx. Combining clinical evidence with results of chest computed tomography (CT) and RT-PCR can minimize the risk of diagnostic errors. Elevated levels of interleukin 6 (IL‐6) and D-dimer are thought to be closely associated with the occurrence of severe COVID‐19 in adults, and their combined detection can serve as early factors predicting the severity of COVID‐19. Moreover, elevated acute phase proteins are associated with a poor outcome in COVID-19. Serological diagnosis also is an important tool to understand the extent of COVID-19 in the community, and to identify individuals, who are immune. Antibodies begin to increase from the second week of symptom onset.