Mohammad Bagher Sharif Kazemi, Esmaeil Mehdinejad and Mohammad Yasin Karami
Introduction: Echocardiography is used as a useful and common method to assess Left Ventricular and Right Ventricular (LV and RV) systolic and diastolic functions. Valsalva Maneuver (VM) with the increase in the intra-thoracic and intra-abdominal pressure is often used as an uncomplicated, cost-effective and non-invasive technique for diagnosing clinical conditions such as heart murmurs. However, in terms of echocardiography, the use of VM has been limited to only a few parameters for many years. In contrast, blood level of N-Terminal Pro-BType Natriuretic Peptide (NT Pro-BNP) indirectly discriminates normal or high ventricular Filling Pressure (FP). This study aimed at providing a comprehensive review of the technique as well as comparing the VM effect in ACS patients; with and without elevated FP on either RV or LV diastolic and systolic echocardiographic parameters. Methods: Thirty-eight patients, who were diagnosed with possible ACS; unstable angina pectoris, NSTEMI and STEMI, underwent coronary angiography enrolled in this double-blinded clinical trial study. The mild Coronary Artery Disease (CAD) with normal NT Pro-BNP levels were included in study group one and cases with significant CAD and high level of NT Pro-BNP who underwent PCI were included in study group two. All the systolic and diastolic indicators of both ventricles, totaling twenty-four parameters which have been previously mentioned in the academic literature, have been evaluated; once before valsalva and once during second stage of the maneuver. Echocardiography is performed by an advanced echo machine and by an expert cardiologist-echocardiographer; the recorded images were reviewed by the second echocardiographer separately.Results: Between the two groups, LV parameter analysis showed significant difference in LV EF pre and post VM. However, there was a statistically insignificant difference regarding other systolic as well as diastolic parameters. Between the two groups, RV parameters analysis indicated no significant difference regarding systolic and diastolic parameters pre and post VM.Conclusion: This research for the first time assessed post VM changes in four chambers as well as mitral and tricuspid valves parameters in ACS patients with normal versus high level of FP. Previously, LV diastolic dysfunction and Doppler mitral inflow pattern correlation with VM were verified. In the present study, in addition to those known findings from before-except the LV Ejection Fraction (LVEF) that showed there was statistically significant difference in pre-and post-VM-other systolic parameters, as well as diastolic indicators in either RV and LV, were identical. Therefore, we do not recommend conducting valsalva maneuver on the rest of the other parameters to diagnose systolic and diastolic dysfunction in ACS patients with mild versus significant CAD who were assumed to have normal or elevated filling pressures.
Hanan Albackr*, Abdulaziz Backer Albacker and Deema H. AlGhufaili
Cardiovascular Disease (CVD) is the leading cause of death in women worldwide. The burden of CVD is rising among Arab Middle Eastern (ME) women. Information regarding the prevalence and incidence of CVD and its risk factors in women in Arab ME is scares and may be lacking in some countries. One of the reasons is low participation of Arab women in cardiovascular trials and research. The underlying reasons for the under-representation of women in clinical trials are complex and exploration of additional causes, such as socioeconomic and psychological factors is crucial to help us to address the gap in scientific evidence on women with cardiovascular disease in the Arab region.
Elyas Irankhah*
Modular associations are structures in complex networks that are defined based on the communication density between the network elements. The difference in these structures in a complex network of human brain signals (EEG) can be used as a factor in the diagnosis of diseases. In this study, with the focus on modular associations, attempts to achieve the differences between a complex two-group of network of Normal Case (NC) and Autistic of Spectrum Disorder (ASD). Eventually, using real EEG signals, the tested groups, with no use of the pre-processing signaling, have an accuracy of 88.37% in detecting Autism Spectrum Disorder (ASD).
Anna Wiedemann and Gudrun Gröppel*
Introduction: A normal Heart Rate Variability (HRV) is the result of a balanced relation between the sympathetic and parasympathetic system. A decreased HRV can be an indicator for cardiac diseases or an increased stress level. Changes in HRV might identify diseases that affect the heart rhythm via the autonomic nervous system. This applies to diseases that directly damage the autonomic nervous system and to diseases that influence the autonomic nervous system indirectly, e.g. through permanently increased metabolic stress. However, methods measuring the HRV are varying between the studies and normal values especially in infants are lacking. The current study is aimed to create reference values for the HRV in children aged younger than 18 months.
Methods: A normal Heart Rate Variability (HRV) is the result of a balanced relation between the sympathetic and parasympathetic system. A decreased HRV can be an indicator for cardiac diseases or an increased stress level. Changes in HRV might identify diseases that affect the heart rhythm via the autonomic nervous system. This applies to diseases that directly damage the autonomic nervous system and to diseases that influence the autonomic nervous system indirectly, e.g. through permanently increased metabolic stress. However, methods measuring the HRV are varying between the studies and normal values especially in infants are lacking. The current study is aimed to create reference values for the HRV in children aged younger than 18 months.
Results: We found no significant differences in the different age groups regarding the HRV. By means of linear regression, it was also shown that there were no other significant differences in HRV in children under 18 months of age. But compared to older children in the literature, HRV was found to be significantly lower.
Conclusion: Our results also indicate age-dependent differences when compared to previous findings in the literature and shows that it is important to have age-matching normal values.
DOI: 10.37421/2329-9517.2023.11.563
Background: Over 1 billion people worldwide suffer from the common chronic medical condition of hypertension. A hypertensive crisis occurs when blood pressure exceeds 180/110 mmHg. Depending on whether the target organ is harmed, the situation may be presented as a hypertensive emergency or urgency.
Objective: To assess the prevalence and risk factors of patients with hypertensive crises who visited the Emergency Outpatient Department (EOPD) at Adama hospital medical college in Adama, Oromia, Ethiopia, between August 10 and August 30, 2021, G.C.
Methodology: A cross-sectional, prospective study on hypertensive crisis was conducted at Adama Hospital Medical College from August 10 to August 30, 2021 G.C. The data was collected using a standardized questionnaire, validated for completeness, and analyzed using SPSS. The findings were tabulated, and conclusions and recommendations were conveyed.
Result: A total of 74 individuals with hypertension in crisis were identified. Of these, 56.8% were men, resulting in an M:F ratio of 1.31:1. Those between the ages of 66 and 75 were the most affected. At presentation, 91.9% of the study participants were known hypertensive patients. Of the known hypertensive patients, the majority (33.8%) were known to have been hypertensive for 5-10 years. Of the known hypertensive patients, 48.6% were found to be adherent. Hypertensive urgency was discovered to be far more common than hypertensive emergencies (63.5% vs. 36.5%). Headache was the most common presenting symptom, and most of the patients (36.5%) presented to the health setup in less than 24 hours. The main risk variables identified were drug discontinuation, family history of hypertension, salt consumption, and alcohol usage. The main excuse for non-adherence was the cost of the medications. More than half of the patients do not have any additional comorbidities, and of those who do have, diabetes mellitus is the most prevalent. Stroke was identified as a major complication.
Conclusions and Recommendations: Hypertensive crises are one of the most prevalent reasons for EOPD admission and are linked with significant consequences. At presentation, most of the study subjects were known hypertension patients. Diabetes mellitus was discovered to be a comorbid condition in one-quarter of them. Although more than half of the patients have improved, the death rate remains high. Infrastructure and capacity building to provide hospitals with the requisite baseline investigations are among the recommendations of the government. Health practitioners are expected to make improvements, such as educating the public about the need for lifestyle changes and evaluating and managing any hypertension problems.
Lida Ameli Kalkhoran, Majid Mirmohammadkhani, Sajjad Rahimi Pordanjani, Soodeh Hooshmandi* and Hamed Abbasizadeghoroghchi
Objective: The aim of this study was to compare echocardiographic findings in neonates born to mothers with COVID-19 and neonates born to healthy mothers referred to Amir Al-Momenin Hospital of Semnan in 2021.
Methods: This case-control study was conducted on 60 neonates born to mothers with COVID-19 (case group; n=30) and neonates born to healthy mothers (control group; n=30) referred to Amir Al-Momenin Hospital of Semnan in 2021. The sampling method was random and the data collection tool was a checklist including sex, birth weight, gestational age, heart rate, mitral valve E wave, mitral valve A wave, TAPSE and LVEF. The evaluation of echocardiographic parameters performed using Philips Affinity 50 Ultrasound Machine. Finally, data analysis was applied by SPSS 24 at 5% significant level.
Results: There was no statistically significant difference between the two groups in terms of birth weight, gestational age, heart rate, mitral valve E wave, mitral valve a wave, left ventricular function, TAPSE and LVEF. In addition, the means TAPSE and LVEF according to sex were not significant in the two groups. We observed a significant Positive correlation between gestational age with TAPSE and LVEF in the two groups, however, the correlation between the left ventricular function and gestational age was negative in newborns of infected mothers. Also, a significant positive correlation between birth weight with TAPSE and LVEF in the two groups.
Conclusion: This study showed the echocardiographic findings in neonates born to mothers with COVID-19 and neonates born to healthy mothers were not significantly different, however, cohort studies with higher sample size are recommended.
Hamed Abbasizade Ghoroghchi*, Soodeh Hooshmandi, Amir Khaujuei, Seyed Mohammad Hoseini and Mohsen Soosanabadi Farahani
Tetralogy of Fallot (TOF) is the most common cyanotic disease in the world. Anatomic heart defects that occur in this disease cause hypoxia and shortness of breath in the patient. Early diagnosis and treatment by surgery is necessary for infants. Snijders Blok Syndrome is a rare syndrome that affects nose, skull bones, ears and development of CNS, etc. Patients with this syndrome are often at the risk of seizure, FTT, etc. This case report emphasizes the importance of recognizing and managing the coexistence of Snijders Blok syndrome and TOF. The unique clinical presentation and genetic findings in this patient provide valuable insights into the complexity of overlapping genetic disorders and congenital heart defects. Further studies are needed to expand our knowledge and improve clinical management strategies for individuals with similar comorbidities. This comorbidity was not report before according to our best knowledge.
Soodeh Hooshmandi*, Sina Habibzadeh, Hamed Abbasizadehghoroghchi and Majid Sadeghi
Background: Neonatal Marfan Syndrome (nMFS) is an autosomal dominant fibrous connective tissue disorder caused by a mutation in the Fibrillin-1 gene (FBN1). This condition mostly affects the cardiovascular, ophthalmic, and skeletal systems. The most specific symptom of nMFS is a rapidly progressive cardiovascular disease that, the majority cases of which lead to mortality in the first years of life.
Case report: We present a new case of nMFS that led to the death of the patient within the first months of her life. A post-study was conducted based on the suspicion of nMFS after the patient’s death. Genetic studies revealed mutations in FBN1 Exon 26, FLVCR1 Exon 4, ARSB Exon 1, LARS1 Exon 32, and SCO2 Exon 2. Mutation in FBN1 leads to nMFS, which explained the symptoms of the patient. Severe cardiorespiratory distress was the reason for the patient’s death.
Discussion: Based on the study findings, it can be stated that examining other gene mutations in nMFS will be necessary in case of unusual findings that do not match nMFS.
Soodeh Hooshmandi*, Amir Khaujuei, Hamed Abbasizade Ghoroghchi, Farideh Moakkedi and Sajjad Rahimi Pordanjani
Nausea and vomiting are common symptoms in children, and antiemetic drugs such as ondansetron and Kytril are commonly used to prevent serious complications. However, based on previous research limitations, this study aimed to investigate the changes in cardiac parameters following the administration of these two drugs in pediatric patients.
Methods: This case-control study was conducted on children admitted to Amiralmomenin Hospital in Semnan, Iran, between 2022-2023. Prior to drug administration, Electrocardiograms (ECGs) were obtained. The patients were divided into two groups: Group 1 received Kytril, consisting of 47 male patients (47%) and 53 female patients (53%), while group 2 received ondansetron, consisting of 52 male patients (52%) and 48 female patients (48%). ECGs were obtained again half an hour after drug administration. The collected data, including PR and QTc intervals before and after drug administration, as well as post-drug Heart Rate (HR), were analyzed using SPSS software and statistical tests including chi-square, independent t-test, paired-sample t-test, and two-sample t-test.
Results: The two groups were similar in terms of mean age, weight, gender distribution, and mean PR and QTc intervals before drug administration. However, there was a significant increase in the mean PR and QTc intervals after drug administration in both the ondansetron and Kytril groups, indicating their prolonging effect on these intervals. The mean PR and QTc intervals after drug administration were comparable between the two groups, suggesting a similar effect of Kytril and ondansetron in increasing these intervals. The mean HR after drug administration was similar in both groups and within the normal range.
Conclusion: Based on this study, the use of Kytril and ondansetron for the control of nausea and vomiting in pediatric patients is associated with an increase in PR and QTc intervals.
Mohammad Hossein Mozafary Bazargany*, Mehdi Sheibani, Hadis(th) Rastad, Jamal Moosavi, Niloofar Gholami and Hamed Talakoob
SARS-CoV-2 may establish a hypercoagulable state and disrupts hemostasis, predisposing patients to thrombotic events.
A 64-year-old man with a history of diabetes, hypertension, and coronary artery bypass surgery presented with lethargy, terminated ventricular tachycardia, and acute left upper limb ischemia (ALI). His ECG demonstrated anterior Acute Myocardial Infarction (AMI).
We diagnosed COVID-19 according to typical chest Computed Tomography (CT) scan findings (peripheral ground-glass opacities) alongside common clinical features and a history of recent contact with coronavirus disease 2019 (COVID-19) patient. His AMI, unlike his ALI, did respond to fibrinolytic therapy.
Thereby, the patient underwent an emergent embolectomy, which saved his limb. He was under COVID-19 treatment and limb physiotherapy for 12 days. He was discharged on day 13 of admission and recovered from AMI, ALI, and COVID-19 with a 25%ejection fraction.
We reported this case to emphasize the extent of thrombotic events in COVID-19 patients and the emergent multi-disciplinary care they may need. Thrombolytic therapy could be an option in prolonged ischemia if advanced interventional equipment is not available.
Cardiovascular Diseases & Diagnosis received 427 citations as per Google Scholar report
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