Donot Ignore Pulmonary Hypertension Any Longer. It's Time to Deal with it!

<p>Pulmonary hypertension (PH) is a condition that,not only by itself causes many problems for those suffering from it,but also, it can exacerbate and complicate many other disease. PH can be responsible of mortality in many patients.</p><p>Tackling PH is not exclusively related to the field of cardiovascular diseases. Many other disease in other fields of medicine may interfere with PH. Pulmonary diseases ,renal,hepatic,collagen vascular disease,infectious and hematologic disease may be deal with PH. In patients&rsquo; suffering from aforementioned diseases, PH can exacerbate primary disorder and even cause mortality. Pregnant women afflicted with PH have 30%-50% mortality rate.(1) Newborns and children with pulmonary or cardiovascular disorder can be later afflicted by PH. PH drastically increases risk in surgeries and in anesthesia and can be the cause of mortalities.(2) or detoriated outcome of patients after surgery.(3)</p><p>According to the latest guidelines,(4) there are 5 categories of PH(table1):</p><p>&nbsp;1-Pulmonary arterial hypertension</p><p>&nbsp;2-Pulmonary venous hypertension(previously named pulmonary hypertension due to left heart disease)</p><p>&nbsp;3-Pulmonaey hypertension associated with hypoxemic lung disease</p><p>&nbsp;4- Pulmonary hypertension caused by chronic thromboembolic disease</p><p>&nbsp;5-Pulmonary hypertension from conditions with uncertain mechanisms</p><p>&nbsp;</p><p>For a long time, the science of medicine had no remedy for PH and physicians could only stand by and watch PH patients die .</p><p>After some time factors which complicate PH are known and it were shown that control of these factors are helpful. Patients are advised, for instance, to refrain from heavy exertion, to avoid pregnancy, and to be vaccinated against flu and pneumococcal infections. PH patients&rsquo; life expectancy has increased drastically as a result of this newly acquired knowledge.</p><p>As PH was becoming better known, symptomatic cures came to patients&rsquo; help. Diuretic drugs were used to control edema and anticoagulants were used to put tromboembolic attacks in check.</p><p>Then,It was time of revolution in pulmonary hypertension management,With the emergence of Advanced PH treatment science of medicine became able to seriously deal with &nbsp;PH.</p><p>This new strategy were showed to be able preventing mortality in PH patients&rsquo;(5),Figure1</p><p>Prostacycline showed that it is possible to enhance PH patients&rsquo; chance of survival. Phosphodiasterase inhibitor drugs, which were used for treating impotency for a long time, were demonstrated to be effective for reducing pulmonary pressure.</p><p>&nbsp;Eventually, endotheline receptors were targeted.</p><p>By the advent of endothelin receptor blockers such as Brosentan, physicians&rsquo; chances of helping PH patients were further improved.</p><p>Today, with advanced PH treatment, PH is not counted as before and the science of medicine as a failed discipline.</p><p>It is important to not forgetting PH in patients,especially ill patients or intractable to traditional treatment, in surgery wards or obstetric,pediatric,internal medicine,ICU or CCU wards of hospitals.</p><p>&nbsp;By timely diagnosis, it will be possible to control &nbsp;PH patients in an effective way and to enhance their chance of survival.</p><p><em>So,It is time now to pay more attention to PH,</em></p><p><em>Don&rsquo;t ignore it any longer and it&rsquo;s time to deal with it</em></p

Association Between Serum Homocysteine Concentration with Coronary Artery Disease in Iranian Patients

<p><strong>BACKGROUND</strong>: The role of novel biomarkers like homocystein as a risk factor of coronary artery disease (CAD) is being increasingly recognized. There is a marked geographical variation in plasma homocystein concentration. In spite of importance of hyperhomocysteinemia in CAD risk, there is a paucity of studies in Iran that evaluate it. Consequently, we evaluated the association between plasma total homocystein (tHcy) concentration and CAD risk in an Iranian population.</p><p><strong>METHODS:</strong> In a case-control study, we compared the level of tHcy of forty five patients with angiographically proved CAD with forty five age and gender matched subjects without CAD as control group. The patients with diabetes, hypertension, thyroid dysfunction, chronic renal failure, hyperlipidemia and obesity and other conventional CAD risk factors were excluded from the study. Plasma tHcy was measured using immunoturbidimetry.</p> <p><strong>RESULTS:</strong> Homocystein level was higher in men than women (16.7 &plusmn; 5.2 versus 14.3 &plusmn; 3.9 micromol/lit, P = 0.019). CAD patients had higher mean plasma tHcy than control group (17.1 &plusmn; 5.3 versus 14.2 &plusmn; 3.8 micromol/lit, P = 0.004).</p> <p><strong>CONCLUSION:</strong> This study denoted that high plasma homocystein concentration is associated with CAD risk in Iranian people.</p> Keywords: Coronary Artery Disease, Homocystein<strong>, Iran.<br /></strong

Para-cardiac Inflammatory Mass Compressing the Heart: A possible association with COVID-19

Infection with the SARS-CoV-2 virus causes coronavirus disease 2019 (COVID-19). COVID-19 usually affects the lungs but may also involve other organs such as the heart. We report a case of a para-cardiac mass in a previously healthy 45-year-old man who developed persistent dyspnea following SARS-CoV-2 infection. The patient underwent cardiac surgery since the mass was attached to the pericardium and was causing constrictive pericarditis. The pathology report indicated an inflammatory pattern for the mass. Based on our knowledge there has been no previous report of developing a para-cardiac inflammatory mass after SARS-CoV-2 infection. In conclusion, we would like to increase awareness regarding the possibility of developing a para-cardiac inflammatory mass following COVID-19. Keywords: SARS-CoV-2; Pericarditis; Constrictive pericarditis; COVID-19; Cardiac tumor; Mediastinal tumor

A finite element model for extension and shear modes of piezo-laminated beams based on von Karman's nonlinear displacement-strain relation

Piezoelectric actuators and sensors have been broadly used for design of smart structures over the last two decades. Different theoretical assumptions have been considered in order to model these structures by the researchers. In this paper, an enhanced piezolaminated sandwich beam finite element model is presented. The facing layers follow the Euler-Bernoulli assumption while the core layers are modeled with the third-order shear deformation theory (TSDT). To refine the model, the displacement-strain relationships are developed by using von Karman's nonlinear displacement-strain relation. It will be shown that this assumption generates some additional terms on the electric fields and also introduces some electromechanical potential and non-conservative work terms for the extension piezoelectric sub-layers. A variational formulation of the problem is presented. In order to develop an electromechanically coupled finite element model of the extension/shear piezolaminated beam, the electric DoFs as well as the mechanical DoFs are considered. For computing the natural frequencies, the governing equation is linearized around a static equilibrium position. Comparing natural frequencies, the effect of nonlinear terms is studied for some example

Prognostic significance of lung diffusion capacity and spirometric parameters in relation to hemodynamic status in heart transplant candidates

Introduction: Investigations have described a correlation between the severity of heart failure and the severity of pulmonary function abnormalities. In this study, we investigated the association of resting spirometric parameters, lung diffusion for carbon monoxide (DLCO), and the transfer coefficient (KCO) with hemodynamic variables and outcomes in a cohort of heart transplant candidates. Material and methods: Between January 2018 and January 2020, a total of 100 patients with advanced heart failure who were scheduled for right heart catheterization (RHC) as a pre-transplant evaluation measure were enrolled. Spirometry and DLCO were performed in all patients within 24 hours of their RHC. All selected patients were followed for a median (IQR) time of 6 (2–12) months. The end points of interest were heart failure-related mortality and a combined event involving HF-related mortality, heart transplantation (HTX), and need for the placement of a left ventricular assist device (LVAD).Results: Among 846 patients scheduled for RHC, a total of 100 patients (25% female) with a mean (SD) age of 38.5 (12.8) were enrolled. There was a significant correlation between FEV1/FVC and CVP (r = –0.22, p = 0.02), PCWP (r = –0.4, p &lt; 0.001), mPAP (r = –0.45, p &lt; 0.001), and PVR (r = –0.32, p = 0.001). The cardiac output correlated with DLCO (r = 0.3, p = 0.008). Spirometry parameters, DLCO parameters, and hemodynamic parameters did not correlate with the combined event. Among the several variables, only PVR had an independent association with the combined event.Conclusion: Both mechanical and gas diffusion parameters of the lung were not associated with outcomes in the homogeneous group of heart transplant candidates

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Dabigatran, a direct thrombin inhibitor, can be a life-saving treatment in heparin-induced thrombocytopenia

BACKGROUND: Several studies have emphasized thrombosis associated with thrombocytopenia as a potentially fatal complication of heparin. A number of agents are used for this condition. As a new oral, reversible direct thrombin inhibitor, dabigatran has been approved for short-term thromboprophylaxis after elective hip and knee replacement surgery. We present a case of dabigatran administration in a patient with femoral fracture. CASE REPORT: A 67-year-old woman referred to the orthopedic ward of Shariati Hospital (Isfahan, Iran) due to femoral fracture following an accident. Immediately after surgery, she was found to be suffering from deep vein thrombosis (DVT) in her lower extremity despite sufficient prophylaxis by enoxaparin. Laboratory data showed severe thrombocytopenia. Considering the clinical history, an initial diagnosis of heparin-induced thrombocytopenia was made. Doppler ultrasound confirmed the diagnosis. Heparin was thus replaced with dabigatran which increased platelet count to the normal range and improved DVT. CONCLUSION: Dabigatran can be a life-saving treatment in heparin-induced thrombocytopenia. However, it is contraindicated in patients with renal dysfunction since it may cause potentially catastrophic results. &nbsp; Keywords: Heparin Induced Thrombocytopenia, Heparin, Enoxaparin, Dabigatra

Benefits from the correction of vitamin D deficiency in patients with pulmonary hypertension

Background: Vitamin D (Vit D) is linked to various conditions including musculoskeletal, metabolic and&nbsp;&nbsp; cardiopulmonary diseases. However, it is not clear whether correction of vit D deficiency exerts any beneficial effect in patients with pulmonary hypertension. Methods: This study was a prospective uncontrolled longitudinal study. Patients with pulmonary hypertension and vit D deficiency were enrolled into this study. All patients in addition to standard treatment for pulmonary hypertension received cholecalciferol at a dose of 50,000 IU weekly plus calcicare (at a dose of 200 mg magnesium + 8 mg zinc + 400 IU vit D) daily for 3 months. Serum level of 25-hydroxy vit D, serum level of pro-brain natriuretic peptide, six minute walk test (6MWT), peak and mean pulmonary artery pressure, right ventricular size and function, ejection fraction (EF) and New York Heart Association (NYHA) functional class were measured at baseline and after 3 months of treatment. Results: Twenty-two patients with pulmonary hypertension and vit D deficiency were enrolled into the study. At endpoint, the serum vit D level increased significantly to 54.8 ng/ml, the mean of baseline distance of 6MWT increased significantly to 81.6 m and the RV size significantly improved. The mean pulmonary artery pressure also improved after the intervention, but their changes did not reach to statistically significant levels. Conclusion: Vit D replacement therapy in patients with pulmonary arterial hypertension and vit D deficiency results in significant improvement of right ventricular size and 6 MWT. Moreover, mean pulmonary artery pressure improves nonsignificantly. This issue requires further studies with long-term follow-up period