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Thyroid remnant after thyroidectomy is a major predictor for future recurrence of thyroid cancers; for which assessment, the accuracy of imaging is not optimal. To evaluate the value of the technetium uptake in the neck compared with neck ultrasonography, this application is used to predict future recurrence of differentiated thyroid cancer (DTC). The neck technetium uptake (NTU) value was acquired 20 min after injection of 1 mCi technetium by a camera. Patients were scheduled for forthcoming iodine ablation. Baseline risk factors were collected. Patients were followed for 10.5 (7 to 12) months when the records of the whole body scan, thyroglobulin, anti-thyroglobulin, neck ultrasonography, and the history of repeated iodine and surgical treatments were collected. The correlation of NTU and recurrence were studied. Out of 73 participants, 63 patients completed the study with established recurrence status and a valid NTU assessment. Baseline lymph node invasion (34.6% vs 80.0%; all 41.9%), extra-thyroid extension (17.0% vs 50.0%; all 22.2%), and tumor size (2.3 ± 2.1 vs 5.2 ± 2.4; all 2.7 ± 2.4) were higher in patients with future recurrence. But the NTU was similar in subjects with and without recurrence (−0.2 ± 0.7 vs 1.7 ± 6.3; all 59 ± 5.3). NTU was significantly lower in subjects with surgeries more extensive than thyroidectomy (P = 0.03). Recurrence cannot be predicted by NTU, but NTU may be used as a surrogate factor to determine the extent and completeness of the thyroidectomy surgery.

Objective: For preoperative radionuclide myocardial perfusion imaging, metabolic equivalent is one of the key factors to evaluate the appropriateness. Duke Activity Status Index is a practical method to calculate metabolic equivalents. We intended to validate Duke Activity Status Index in our population for the assessment of preoperative myocardial perfusion imaging appropriateness. Methods: A total of 542 patients referred for myocardial perfusion imaging were recruited. A questionary compiled from Duke Activity Status Index was filled out based on which metabolic equivalents were calculated. Demographic data and history of cardiac risk factors were also collected. Myocardial perfusion imaging was performed using a 2-day stress-rest protocol either by exercise tolerance test or by pharmacologic stress through injection of Tc-MIBI and imaging by a dual-head gamma camera. Results: Out of 542 patients, 369 (68.1%) were evaluated for preoperative risk assessment. Metabolic equivalents (oxygen consumption/min/kg) were calculated at 9.3 ± 5.1, 10.8 ± 4.8, and 8.7 ± 5.1 in total, preoperative patients and patients evaluated for ischemia due to nonsurgical purposes, respectively (p = 0.001). The myocardial perfusion imaging was rarely appropriate in 291 (79.5%), maybe appropriate in 67 (18.3%), and appropriate in 8 (2.2%) patients. The prevalence of abnormal myocardial perfusion imaging was 22.5%, 28.4%, and 12.5% in “rarely appropriate,” “maybe appropriate,” and “appropriate” scenarios, respectively. Metabolic equivalents were similar between patients with normal and abnormal myocardial perfusion imaging (8.7 ± 5.0 vs. 8.5 ± 5.4). Conclusion: Either Duke Activity Status Index is not a proper tool for calculation of metabolic equivalents or the appropriate use criteria is not operational in the population of Iranian preoperative patients in which cultural factors may contribute.

Aim: Respiratory viruses are the most common cause of hospitalization of pilgrims during Hajj. This study aimed to detect adenovirus genotypes among Iranian pilgrims with acute respiratory tract infection in Hajj season of 2015. Materials & methods: In this cross-sectional study, throat swab samples of 338 Iranian pilgrims with flu-like symptoms were screened for adenovirus by polymerase chain reaction, and virus genotypes were determined using sequencing method. Results: Seventy-seven cases were positive for adenovirus (22.78%). The adenovirus type 6 was the most frequently detected virus followed by type 5, 1, 2 and 57. Conclusion: The prevalence of adenovirus respiratory infection among Iranian pilgrims is considerable. Preparation and administration of an effective adenovirus vaccine is recommended.

Aim: In this study we aimed to find the rate of human adenovirus (HAdV) infections and identify HAdVs molecular epidemiology in children younger than 5 years old with clinical diagnosis of severe acute respiratory infections in Iran. Patients & methods: A semi-nested PCR with in-house designed primers for HAdV was performed on 200 oropharyngeal swabs collected within 5 days from the onset of symptoms. The positive samples were subjected to sequencing and a phylogenetic tree was drawn. Results: Out of 200 specimens, 71 (35.5%) cases were positive for HAdVs. Detected strains matched with HAdV species B (80.3%), C (15.5%), D (2.8%) and E (1.8%). HAdV- B14/55 and HAdV-B3 were the most prevalent types, respectively. Conclusion: This study showed that infections with HAdV species B, were common in children, who were clinically diagnosed as severe acute respiratory infection cases in Iran. The results could be useful for future epidemiological researches.

Resumen Objetivo La precision diagnostica de la imagen de perfusion miocardica (IPM) no es optima para predecir el resultado de la angiografia. El objetivo del presente estudio es investigar la aplicacion de la red neuronal artificial (RNA) para integrar los datos clinicos con el resultado y la cuantificacion de la IPM. Metodos De 923 pacientes con IPM, se reclutaron 93 que se sometieron a angiografia. Se recogieron los datos clinicos, incluidos los factores de riesgo cardiaco, y se registraron los resultados de la IPM y la angiografia coronaria. Se calculo la cuantificacion de las graficas polares IPM (es decir, los recuentos de 20 segmentos de cada una de las graficas polares de esfuerzo y de reposo) y la puntuacion de Gensini de las angiografias. La RNA fue disenada integrando datos clinicos y de cuantificacion para predecir el resultado de la angiografia (normal vs. anormal), la enfermedad coronaria no obstructiva u obstructiva (EAC) y la puntuacion de Gensini (≥ 10 y Resultados La precision de la IPM para predecir el resultado de la angiografia, la EAC obstructiva y la puntuacion de Gensini aumento del 81,7 al 92,9%, del 65,0 al 85,7% y del 50,5 al 92,9%, respectivamente, mediante la RNA con cuantificacion y factores de riesgo clinicos. Conclusion La precision diagnostica de la IPM podria mejorarse mediante la RNA, utilizando datos clinicos y de cuantificacion.

Magnetic resonance imaging (MRI) and computed tomography (CT) are not always conclusive for the detection of cerebral venous sinus thrombosis (CVST). 99mTc-HMPAO-labeled platelets may be useful in cases with high clinical suspicion. Three patients with headaches with or without intraparenchymal hemorrhage that were highly suspected to have CVST, despite inconclusive anatomical imaging, were selected for inclusion in the study. Platelets were extracted by two rounds of centrifugation from 49 ml of the patient’s whole blood. The platelets were labeled with 99mTc-HMPAO and any unbound 99mTc was removed by centrifugation. The re-suspension of 99mTc-HMPAO-labeled platelets in cell-free plasma was reinjected into the patients. After 2 h, planar and single photon emission computed tomography (SPECT) images of the head were obtained. Extensive clots were detected in all three patients, illustrated in the planar image and even clearer in the SPECT images. We propose that 99mTc-HMPAO-labeled platelet scan is a favorable imaging method for patients suspected to have CVST with inconclusive CT and MRI results.

Background. Scleroderma is a complex disease involving autoimmune, vascular, and connective tissues, with unknown etiology that can progress through any organ systems. Objective. Yet, no cure is available; the thorough treatment of scleroderma and current treatments are based on controlling inflammation. Nowadays, medicinal plants/natural-based formulations are emerging as important regulators of many diseases, including autoimmune diseases. Here, we provided an overview of scleroderma, also focused on recent studies on medicinal plants/natural-based formulations that are beneficial in scleroderma treatment/prevention. Methods. This study is the result of a search in PubMed, Scopus, and Cochrane Library with “scleroderma”, “systemic sclerosis”, “plant”, “herb”, and “phytochemical” keywords. Finally, 22 articles were selected from a total of 1513 results entered in this study. Results. Natural products can modulate the inflammatory and/or oxidative mediators, regulate the production or function of the immune cells, and control the collagen synthesis, thereby attenuating the experimental and clinical manifestation of the disease. Conclusion. Natural compounds can be considered an adjunct treatment for scleroderma to improve the quality of life of patients suffering from this disease.

Background: In recent decades, contaminations with heavy metals ions have adversely affected the environment, food safety, and human health. Heavy metals, leaching to water sources from the industrial effluents, can enter into the aquatic and food chains of humans and animals from a variety of anthropogenic sources. Scope and Approach: Heavy metal detection has been an intensive area of research today. Both laboratory-based analytical instruments and innovative sensor devices like the electronic nose, electronic tongue, and bio/chemical sensors have increasingly emerged to meet the demand for legislative actions on environmental pollution control and early warning. These evolving technology and developments particularly in the area of nanotechnology and sensors have become key contributing factors in heavy metal detection. Key Findings and Conclusions: This endeavor aims at exploring this field in detail to understand the key principles behind this flourishing science and summarize the recent development in heavy metal detection technologies. This article also gives a brief review of commercially available portable devices that has the potential to become the next gold standard instruments in heavy metal detection.

Psychotic disorders are a group of severe mental disorders that can remarkably affect brain functions by altering beliefs and perceptions. There are different types of psychotic disorders,including schizophrenia, delusional disorder, paraphrenia, etc. The symptoms of a psychotic disorder include delusions, mood swings, difficulty concentrating, unusual behavior, alteredfeelings, and so on. Symptoms may vary from person to person and change with time. Antipsychotic drugs and psychotherapy can be used in the treatment of psychotic disorders.In this case report, we describe a 39-year-old woman who suffered from methamphetamine-induced delusional parasitosis.

Erythema Multiforme (EM) is a hypersensitivity reaction that can be triggered by an infection or particular medications. Erythema multiforme minor (EM minor) represents localized skin lesions with minimal or no mucosal involvement. Only a few case of EM associated with risperidone are found in the scientific literature. In this case report, the administration of the risperidone resulted in the rapid appearance of skin lesions. Erythematous lesions were recovered upon discontinuation of the drug and no new skin lesion was observed. A 52-year-old male patient was admitted to the psychiatry hospital because of developing schizophrenic symptoms. At the time of admission, risperidone was added to her previous drug regimen. Two weeks later, the patient returned with a complaint of progressively increasing rashes over his body. The patient was diagnosed with EM minor. The prescribed risperidone was discontinued due to its side-effect profile and the patient’s drug regimen was changed entirely to the olanzapine, haloperidol, and topical clobetasol. At one month follow up visit, his skin lesions were satisfactorily controlled.

Aim: Bull's eye pattern recognition with artificial neural networks (ANNs) has the potential to assist interpretation of myocardial perfusion images (MPIs). We aimed to develop a model for interpretation of MPI based on the clinical variables and imaging data. Materials and Methods: The study included 208 patients referred to the department of nuclear medicine for 2-day stress-rest ECG-gated MPI. Several ANN models were designed with the following input variables: average count of 20 segments of the bull's eye images of stress and rest MPIs, gender, the constellation of coronary artery disease risk factors and scintigraphic cardiac ejection fraction. The procedure was repeated excluding the data of the rest phase scan. Data of 150 subjects were used for training, 21 subjects for cross-validation and 37 subjects for final operation testing. Several ANN models were examined with different hidden layers and processing elements and functions. The target output variable was the conclusion of the nuclear physician (i.e., normal vs. abnormal scan). Results: A multilayer perceptron (MLP) with two hidden layers trained with both stress and rest data demonstrated the best performance to classify the normal and abnormal MPIs. It showed an overall accuracy of 91.9%, sensitivity of 91.3% and specificity of 92.9%. The accuracy of the similar MLP trained using stress-only myocardial perfusion images reduced to 67.6%. Conclusion: The automated interpretation of MPIs with a 2 hidden layer MLP trained with stress and rest images could be an accurate support system either for the interpretation or quality assurance.

Objectives Clinical difficulty to discriminate between the Alzheimer disease (AD) and dementia with Lewy bodies (DLB) has led researchers to focus on highly sensitive functional imaging modalities. The aim of the present study was to assess 131I-MIBG cardiac imaging to distinguish between AD and DLB. Patients and methods Seventeen patients who were known cases of dementia underwent 131I-MIBG myocardial scintigraphy to differentiate AD from DLB. Planar and 131I-MIBG SPECT were obtained 2 h after the injection of 1 mCi 131I-MIBG on a dual head gamma camera. The visual assessment of the heart uptake compared with lungs and the quantification based on the heart to mediastinal ratio (HMR) were done. The cardiac receiver operating characteristic (ROC) curve was designed for the optimal HMR cut-off values to predict the diagnoses of the patients. The diagnoses were clinically confirmed during the follow up of 14 ± 8.2 months. Results Out of 17 patients (13 males; 76.5%), 10 patients had AD (7 males; 70%) and 7 patients had DLB (6 males; 85%). The pooled HMR was 1.74 ± 0.33 in the study population; with 1.95 ± 0.22 in the AD group and 1.43 ± 0.20 in the DLB group to demonstrate significantly different HMR scores between patients with AD and DLB (p value = 0.001). The visual interpretation was positive in 10 patients (accuracy of 88.2%). The shortest distance on the ROC curve to the optimal value corresponding to HMR = 1.57 identified 10 patients with a high HMR (positive cardiac uptake) and 7 patients with a low HMR (negative cardiac uptake), the accuracy calculated at 88.2%. Conclusion 131I-MIBG myocardial scintigraphy is a potential alternative diagnostic modality for discrimination between AD and DLB when 123I is not available.

Technetium thyroid uptake (TTU) is not inhibited by antithyroid drugs (ATD) and reflects the degree of thyroid stimulation. We intended to predict the relapse rate from hyperthyroidism based on TTU measurement.Out of 44 initially enrolled subjects, 38 patients aged 41.6 ± 14.6 with Graves disease (duration: 84 ± 78 months) completed the study. TTU was performed with 40-second imaging of the neck and mediastinum 20 minutes after injection of 1 mCi technetium-99m pertechnetate. TTU was measured as the percentage of the count of activity accumulated in the thyroidal region minus the mediastinal background uptake to the count of 1 mCi technetium-99m under the same acquisition conditions. Then methimazole was stopped and patients were followed. The optimal TTU cutoff value for Graves relapse prediction was calculated using Youden's J statistic.Hyperthyroidism relapsed in 11 (28.9%) patients 122 ± 96 (range: 15-290) days post-ATD withdrawal. The subjects in remission were followed for 209 ± 81 days (range: 88-390). TTU was significantly higher in patients with forthcoming relapse (12.0 ± 8.0 vs. 3.9 ± 2.0, P = .007). The difference was significant after adjustment for age, sex, history of previous relapse, disease duration, and thyroid-stimulating hormone (TSH) levels before withdrawal. The area under the receiver operative characteristic (ROC) curve was 0.87. The optimal TTU cutoff value for classification of subjects with relapse and remission was 8.7 with sensitivity, specificity, and positive and negative predictive value of 73%, 100%, 100%, and 90%, respectively (odds ratio [OR] = 10.0; 95% confidence interval [CI]: 3.4-29.3).TTU evaluation in hyperthyroid patients receiving antithyroid medication is an accurate and practical method for predicting relapse after ATD withdrawal.ATD = antithyroid drugs RIU = radio-iodine uptake TSH = thyroid-stimulating hormone TSI = thyroid-stimulating immunoglobulin TTU = technetium thyroid uptake.

Purpose Respiratory motion in the chest region during single photon emission computed tomography (SPECT) is a major degrading factor that reduces the accuracy of image quantification. This effect is more notable when the tumor is very small, or the spatial resolution of the imaging system is less than the respiratory motion amplitude. Small animals imaging systems with sub-millimeter spatial resolution need more attention to the respiratory motion for quantitative studies. We developed a motion-embedded four-dimensional (4D)-multi pinhole SPECT (MPS) reconstruction algorithm for respiratory motion correction. This algorithm makes full use of projection statistics for reconstruction of every individual frame. Methods The ROBY phantom with small tumors in liver was generated in eight different phases during one respiratory cycle. The MPS projections were modeled using a fast ray tracing method simulating an MPS acquisition. Individual frames were reconstructed and used for motion estimation. The Demons non-rigid registration algorithm was used to calculate deformation vector fields (DVFs) for simultaneous motion correction and image reconstruction. A motion-embedded 4D-MPS method was used to reconstruct images using all the projections and corresponding DVFs, simultaneously. The 4D-MPS reconstructed images were compared to the low-count single frame (LCSF) reconstructed image, the three-dimensional (3D)-MPS images reconstructed using individual frames, and post reconstruction registration (PRR) that aligns all individual phases to a reference frame using Demons-derived DVFs. The tumor volume relative error (TVE), tumor contrast relative error (TCE), and dice index (DI) for 2, 3, and 4 mm liver were calculated and compared for different reconstruction methods. Results For the 4D-MPS reconstruction method, TVE was reduced and DI was higher compared to PRR, 3D-MPS, and LCSF. The extent of the improvement was higher for the small tumor size (i.e. 2 mm). For the biggest tumor in contrast 3 (i.e. 4 mm) TVE for 4D-MPS, PRR, 3D-MPS and, LCSF were 1.33%, 8%, 8%, and 14.67%, respectively. Conclusions The results suggest that motion-embedded 4D-MPS method is an effective and practical way for respiratory motion correction. It reconstructs high quality gated frames while using all projection data to reconstruct each frame.

Background: Workers in the automotive industry due to the nature of the jobs are prone to musculoskeletal disorders (MSDs). The aim of this study was evaluating the prevalence of MSDs and inter-rater agreement in posture assessment with QEC method.

Diagnostic accuracy of myocardial perfusion imaging (MPI) is not optimal to predict the result of angiography. The current study aimed at investigating the application of artificial neural network (ANN) to integrate the clinical data with the result and quantification of MPI.Out of 923 patients with MPI, 93 who underwent angiography were recruited. The clinical data including the cardiac risk factors were collected and the results of MPI and coronary angiography were recorded. The quantification of MPI polar plots (i.e. the counts of 20 segments of each stress and rest polar plots) and the Gensini score of angiographies were calculated. Feed-forward ANN was designed integrating clinical and quantification data to predict the result of angiography (normal vs. abnormal), non-obstructive or obstructive coronary artery disease (CAD), and Gensini score (≥10 and10). The ANNs were designed to predict the results of angiography using different combinations of data as follows: reports of MPI, the counts of 40 segments of stress and rest polar plots, and the count of these 40 segments in addition to age, gender, and the number of risk factors. The diagnostic performance of MPI with different ANNs was compared.The accuracy of MPI to predict the result of angiography, obstructive CAD, and Gensini score increased from 81.7% to 92.9%, 65.0% to 85.7%, and 50.5% to 92.9%, respectively by ANN using counts and clinical risk factors.The diagnostic accuracy of MPI could be improved by ANN, using clinical and quantification data.

Introduction: Anxiety increases significantly during labor, especially among nulliparous women. Such anxiety may affect the progress of labor and physiological parameters. The use of essential oils of aromatic plants, or aromatherapy, is a non-invasive procedure that can decrease childbirth anxiety. This study examined the effect of inhalation of the aroma of geranium essential oil on the level of anxiety and physiological parameters of nulliparous women in the first stage of labor. Methods: In study, was carried out on 100 nulliparous women admitted to Bent al-Hoda Hospital in the city of Bojnord in North Khorasan province of Iran during 2012-2013. The women were randomly assigned to two groups of equal size, one experimental group (geranium essential oil) and one control (placebo) group. Anxiety levels were measured using Spielberger’s questionnaire before and after intervention. Physiological parameters (systolic and diastolic blood pressure, respiratory rate, pulse rate) were also measured before and after intervention in both groups. Data analysis was conducted using the x2 test, paired t-test, Mann-Whitney U test, and Wilcox on test on SPSS 11.5. Results: The mean anxiety score decreased significantly after inhalation of the aroma of geranium essential oil. There was also a significant decrease in diastolic blood pressure.Conclusion: Aroma of essential oil of geraniums can effectively reduce anxiety during labor and can be recommended as a non-invasive anti-anxiety aid during childbirth.

Rubella is a mild self-limiting contagious viral disease caused by the rubella virus (RV). Although symptoms are often mild, the concern is centralized around the possible effect on a fetus growth and development in case of primary infection during early months of pregnancy. Recently acquired rubella is commonly confirmed by RV-specific IgM antibody detection in the serum. However, rubella primary infection is not always the only cause of IgM positivity. Other possible causes of rubella IgM positivity may include IgM persistence following vaccination or naturally acquired infection or even re-infection. Moreover, nonspecific IgM reactivity can cause false-positive results. There are few articles to differentiate the aetiology of rash in rubella-like illnesses. However, limited studies have been conducted on clarifying the source of IgM positivity in these cases. This article reports the study of 10,896 clinical cases demonstrating rubella-like illness between 2011 and 2013 in Iran. The rate of IgM positivity among these cases was 0.52% (57 cases). As predicted based on the high coverage of vaccination in Iran fewer than 16% of cases with ELISA IgM positive result, were due to current rubella primary infections. The greater part of the positive IgM reactions occurred in cross reactivity with other viruses (31.6%) or in prolonged IgM response post vaccination (24.6%). This research confirmed that the positive result of rubella IgM assay in vaccinated individuals is mainly caused by prolonged IgM production, rubella re-infection, and false positivity due to infection with other viruses, rather than the rubella primary infection itself. J. Med. Virol. 87:1846–1852, 2015. © 2015 Wiley Periodicals, Inc.

Background The pilgrimage to Mecca and Karbala bring many Muslims to a confined area. Respiratory tract infections are the most common diseases transmitted during mass gatherings in Hajj, Umrah and Karbala. The aim of this study was to determine and compare the prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) and influenza virus infections among Iranian general population and pilgrims with severe acute respiratory infections (SARI) returning from Mecca and Karbala during 2013–2016. Methods During 2013–2016, a total of 42351 throat swabs were examined for presence of influenza viruses and MERS-CoV in Iranian general population and pilgrims returning from Mecca and Karbala with SARI by using one step RT-PCR kit. Results None of the patients had MERS-CoV but influenza viruses were detected in 12.7% with high circulation of influenza A/H1N1 (47.1%). Conclusion This study showed the prevalence of influenza infections among Iranian pilgrims and general population and suggests continuing surveillance, infection control and appropriate vaccination especially nowadays that the risk of influenza pandemic threatens the world, meanwhile accurate screening for MERS-CoV is also recommended.

Background: Acute respiratory tract infection is associated with significant morbidity, mortality, and economic loss worldwide. Viral infections seem to be responsible for 80% of the cases. There are several reports on the influence of dual or multiple respiratory viral infections on the severity of disease in childhood. Objectives: A limited number of studies have been conducted on co-infection of Adenovirus (AdV) with coxsackievirus, human bocavirus (HBoV) and Mycoplasma pneumoniae (MP) in Iran. To address this, the present article focuses on both the etiology and epidemiology of multiple microbial respiratory infections (coxsackievirus, HBoV, MP and influenza virus) and their clinical significance in young Iranian children with confirmed AdV infection. Patients and Methods: Molecular detection of HBoV, coxsackievirus, MP and influenza virus was performed by conventional PCR in 71 respiratory adenovirus-positive samples obtained from children younger than 5 years of age. Results: Among the 71 adenovirus-positive samples, 6 (8.4%) were co-infected, three were co-infected with MP and three of which were co-infected with influenza A/H3N2. Of the six patients with co-infection, four were male and two were female; three patients were less than 1 year of age and the remaining were 2, 3 and 4 years of age. Moreover, there were two inpatients and four outpatients. Conclusions: Although several studies have investigated viral respiratory co-infection, no study has evaluated the rate of respiratory co-infections in adenovirus-positive samples from children younger than 5 years. However, this study has filled this gap, the the number of co-infections were too small to draw any definite conclusions. Therefore, large-scale studies using bigger samples are required to understand the clinical significance of polymicrobial acute respiratory infections.

Please cite this paper as: Yavarian et al. (2012). Epidemiological aspects of pandemic influenza A(H1N1) virus from 2009 to 2011 in Iran. Influenza and Other Respiratory Viruses 6(601), e74–e76.

Imaging properties of a metal/nonlinear dielectric structure with nonequal thickness layers as a superlens have been investigated by using the optical transfer function (OTF) and the lateral intensity distributions at the imaging plane for a given object. It has been shown that even when permittivity of the metal and nonlinear dielectric are mismatched, both modulation transfer function (MTF) and phase transfer function (PTF) show high cutoff frequency at optical wavelength. This is the case of a superlens and also shows a good improvement rather than a metal/linear dielectric superlens.

Background: Viruses are the most common causes of respiratory tract infections in children. The implementation of rapid virology assays can identify the most common pathogens involved. This study was undertaken on Iranian children less than 6 years old with respiratory infection. Methods: A total of 202 specimens were tested for the presence of 9 respiratory viruses by developing 3 multiplex reverse transcription-polymerase chain reaction and 1 uniplex polymerase chain reaction assays. Results: Viral pathogens were detected in 92 samples (45.5%) with 5.4% having dual infections. Overall, respiratory syncytial virus was the most frequently identified virus (16.8%), followed by adenovirus (14.4%), influenza A virus (4.9%), parainfluenza virus-3 (4.4%), parainfluenza virus-I (2.9%), and both influenza B virus and hMPV (0.49). Conclusions: Respiratory tract infection is a frequent cause of pediatric morbidity and mortality and a common reason for admission in acute care hospitals and outpatients visits. Appropriate diagnostic testing is important for specific diagnosis at an early stage of the illness because of the similarity in clinical presentation of patients with different viral infections caused by several respiratory pathogens.

Imaging of the kidneys and urinary tract has a significant and critical role for diagnosis of genitourinary system diseases. Although technological progress goes toward less invasive approaches, some of the current methods are still invasive and annoying. Voiding cystourethrography (VCUG) is the best and most accurate method for diagnosis and grading of vesicoureteral refl ux. VCUG is a distressful procedure that gives serious anxiety and pain in a large proportion of children and fear for parents; therefore, using effective sedative drugs with the least side effects is necessary and should be considered. In this review article, importance and efficacy of different drugs before catheterization VCUG be compared in the base of literature survey on EMBASE, PubMed, and Cochrane source. We found that the treatment should be based on nonpharmacological and pharmacological methods; nonpharmacological treatment includes the psychological preparation before procedures as a safety precaution with little or no risk modality, as well as reassuring support. The presence of parents during painful procedures cannot alleviate children distress. Pharmacological methods include oral midazolam (0.5 mg/kg) and intranasal use (0.2 mg/kg) that had been used 10 min before the procedure can effect on anterograde amnesia and sedation without considerable effect on accuracy and grade of reflux. Nitric oxide has a shorter recovery time versus midazolam but has a potential risk for deep sedation and may interfere with the child’s voiding phase. In summary, oral midazolam of 0.5–0.6 mg/kg or 0.2 mg/kg intranasal is acceptable drug that can be used before VCUG. Key words: Children, cystourethrography, midazolam, sedative

Purpose: Respiration causes lesion smearing, image blurring and quality degradation, affecting lesion contrast and the ability to define correct lesion size. The spatial resolution of current multi pinhole SPECT (MPHS) scanners is sub-millimeter. Therefore, the effect of motion is more noticeable in comparison to conventional SPECT scanner. Gated imaging aims to reduce motion artifacts. A major issue in gating is the lack of statistics and individual reconstructed frames are noisy. The increased noise in each frame, deteriorates the quantitative accuracy of the MPHS Images. The objective of this work, is to enhance the image quality in 4D-MPHS imaging, by 4D image reconstruction. Methods: The new algorithm requires deformation vector fields (DVFs) that are calculated by non-rigid Demons registration. The algorithm is based on the motion-incorporated version of ordered subset expectation maximization (OSEM) algorithm. This iterative algorithm is capable to make full use of all projections to reconstruct each individual frame. To evaluate the performance of the proposed algorithm a simulation study was conducted. A fast ray tracing method was used to generate MPHS projections of a 4D digital mouse phantom with a small tumor in liver in eight different respiratory phases. To evaluate the 4D-OSEM algorithm potential, tumor to liver activity ratio was compared with other image reconstruction methods including 3D-MPHS and post reconstruction registered with Demons-derived DVFs. Results: Image quality of 4D-MPHS is greatly improved by the 4D-OSEM algorithm. When all projections are used to reconstruct a 3D-MPHS, motion blurring artifacts are present, leading to overestimation of the tumor size and 24% tumor contrast underestimation. This error reduced to 16% and 10% for post reconstruction registration methods and 4D-OSEM respectively. Conclusion: 4D-OSEM method can be used for motion correction in 4D-MPHS. The statistics and quantification are improved since all projection data are combined together to update the image.