Epidemiology of infective endocarditis in patients referred to Ardabil city hospital, 2010-2015

Background: Infectious endocarditis is caused by bacterial or fungal infections of the endocardial surface of the heart, with high morbidity and mortality. Information on infective endocarditis is low in a developing country, and in Iran, the situation is similar, and so far no accurate research on the epidemiology of endocarditis has been carried out. The aim of study is to epidemiological evaluation of Infective endocarditis.Methods: This cross-sectional study was done on 32 patients with infectious endocarditis who referred during 2011-20166 in Ardabil city Hospital. Data from blood culture, urine test, and other diagnostic procedures were extracted from the records. Information on age, sex, the most common cause of referral, culture and positive culture, mitral valve, tricuspid and pulmonary valve involvement, underlying condition of injecting drug addiction, duration of hospitalization, clinical symptoms, type of treatment, response to Treatment, status of hospital discharge and mortality rate of patients were collected and then analyzed.Results: Of all patients, 14 (43.75%) were male and 18 (56.25%) were female. The mean age of patients was 55.6±9.4 years with a range of 21-72 years old. Patients were treated at an average of 2.2±1.4 weeks. 9 patients (28.12%) had skeletal-muscular manifestations. 26 patients (81.25%) had fever. The most prevalent microorganism was klebsiella with 71.87% that was sensitive in 13 patients (56.5%) to methicillin.Conclusions: Fever with musculoskeletal manifestations in young men with a history of injectable addiction is a common manifestation of infectious endocarditis

Intra-hospital mortality and morbidity and six-month follow up of patients with myocardial infarction

Background: Cardiovascular disease is one of the leading causes of disability and premature death worldwide. Adjustment of risk factors has been shown to reduce morbidity and mortality in people with diagnosed or even undiagnosed cardiovascular disease. In this study, we examined mortality and morbidity over a six-month period among patients with MI.Methods: This cross-sectional study was done on 322 patients admitted to Imam Khomeini Hospital in Ardabil during September 2020 to February 2020 with the diagnosis of acute myocardial infarction and their mortality and morbidity rates and their relationship with age, gender, risk factors (diabetes, hypertension, family history) and the type of treatment performed. The data of all patients will be collected in special forms and will be analyzed using SPSS software.Results: Of all patients, 27 died, all of whom were older (over 59 years), and about 125 had morbidity during 6 months, the majority (78%) being older. In terms of gender, mortality and morbidity rates were lower in men than in women. Risk factors lie diabetes, hypertension and positive family history had a significant impact on mortality and morbidity at first glance and findings showed that streptokinase injection was superior to primary coronary intervention with mortality and morbidity.Conclusions: Findings showed that mortality and morbidity rate in acute myocardial infarction was directly related to the type of treatment (primary coronary intervention versus streptokinase injection), age, sex, being diabetic, having hypertension and having a positive family history

Compare the effect of high and low doses of atorvastatin on the levels of high-sensitivity C-reactive protein in patients with acute coronary syndrome

Background: Findings of other researches indicate that inflammation process is one of the most important molecular interactions mediated in atherosclerosis and the inflammation indexes of plasma level such as high-sensitivity C-reactive protein (hs-CRP) is regarded to predict the risk of cardio-vascular diseases. According to various studies, statins are certainly effective in the prevention of atherosclerosis and anti-inflammatory role of atorvastatin by lowering effect on hs-CRP can be considered. The aim of this study was to compare the effect of high and low doses of atorvastatin on levels of hs-CRP in patients with acute coronary syndrome.Methods: This is a clinical trial study that has been done on 180 patients with acute coronary syndrome who referred to Imam Khomeini hospital in Ardabil. Patients were divided in 2 groups randomly. Atorvastatin with low dose (20mg) and high dose (40mg) with routine treatments were given to first and second groups, respectively. The hs-CRP level was evaluated for all patients in hospitalized time and third month late. Data were collected and analyzed by statistical methods in SPSS.19.Results: Of all patients, 40 patients (22.2%) was assayed with STEMI, 8 patients (4.4%) with N/Q WMI and132 patients (73.3%) with U/A. 125 patients (69.4%) were male and rest of them were female. The age average of patients was 59.1±8.1 years. 74 (41.1%) of patients had blood pressure and 35 (19.4%) use smoke. After three months, in group with low dose, 81 patients (90%) and in group with high dose 85 patients (94.4%) improved. The atorvastatin with high dose could significantly decrease the hs-CRP ratio with 40% more than other group with 13.3%.Conclusions: In this study high dosage of atorvastatin could lessen significantly the hs-CRP and LDL ratio compared to atorvastatin with low dosage

Cerebral Venous Thrombosis in Neonates: Two Case Reports

Cerebral venous thrombosis is an uncommon disorder in children however it can be associated with serious clinical consequences. As it is a rare condition without any specific clinical presentation, it is usually undiagnosed. Clinical manifestation of cerebral thrombosis in children is relatively different from adult because of age-related differences in the vascular and neurologic systems. We present a case of a twenty days boy with a history of one-week lethargy and poor feeding and grand mal seizure. He had hypernatremia and severe dehydration. Non-contrast CT scan of the brain revealed superior sagittal and both transverse and sigmoid sinus thrombosis. The patient was treated in neonatal ICU with a favorable clinical response. We also present a fourteen days girl who presented with three days of fever, poor feeding, tachycardia, respiratory distress, and grand mal seizure. She had hypernatremia and severe dehydration. Non-contrast CT scan of the brain revealed superior sagittal sinus thrombosis and right temporal lobe infarction. She was also treated in neonatal ICU with noticeable improvement in symptoms. These cases demonstrate the importance of dehydration in neonatal and clinical suspicion of cerebral venous thrombosis (CVT). We present these two cases to enhance the awareness of clinical practitioners. CVT is an unusual and serious condition in neonates and due to its nonspecific clinical presentation often remains unrecognized. Early neuroimaging, including transfontanel doppler ultra-sonography, and non-contrast CT scan in all neonates with neonatal seizures will improve detection

Compare the effect of high and low doses of atorvastatin on the levels of high-sensitivity C-reactive protein in patients with acute coronary syndrome

Background: Findings of other researches indicate that inflammation process is one of the most important molecular interactions mediated in atherosclerosis and the inflammation indexes of plasma level such as high-sensitivity C-reactive protein (hs-CRP) is regarded to predict the risk of cardio-vascular diseases. According to various studies, statins are certainly effective in the prevention of atherosclerosis and anti-inflammatory role of atorvastatin by lowering effect on hs-CRP can be considered. The aim of this study was to compare the effect of high and low doses of atorvastatin on levels of hs-CRP in patients with acute coronary syndrome.Methods: This is a clinical trial study that has been done on 180 patients with acute coronary syndrome who referred to Imam Khomeini hospital in Ardabil. Patients were divided in 2 groups randomly. Atorvastatin with low dose (20mg) and high dose (40mg) with routine treatments were given to first and second groups, respectively. The hs-CRP level was evaluated for all patients in hospitalized time and third month late. Data were collected and analyzed by statistical methods in SPSS.19.Results: Of all patients, 40 patients (22.2%) was assayed with STEMI, 8 patients (4.4%) with N/Q WMI and132 patients (73.3%) with U/A. 125 patients (69.4%) were male and rest of them were female. The age average of patients was 59.1±8.1 years. 74 (41.1%) of patients had blood pressure and 35 (19.4%) use smoke. After three months, in group with low dose, 81 patients (90%) and in group with high dose 85 patients (94.4%) improved. The atorvastatin with high dose could significantly decrease the hs-CRP ratio with 40% more than other group with 13.3%.Conclusions: In this study high dosage of atorvastatin could lessen significantly the hs-CRP and LDL ratio compared to atorvastatin with low dosage

Emotional and Behavioral Problems of Afghan Refugees and War-Zone Adolescents

"nObjective: Wars' stress and violence can have tremendous effects on children's and adolescents' health and general well being; it may result in patterns of bio-psychosocial problems. The goal of this study was to compare emotional and behavioral problems in Afghan refugees and war-zone adolescents. "n Method: One hundred and eighty high school students (90 students in the refugee group and 90 in the war-zone group) in Harat were included in this research. All participants completed the Youth Self-Report (YSR). War zone and refugee adolescents were compared based on their scores on different scales of behavioral and emotional problems. "n Results: War-zone adolescents scored significantly higher on Anxious/Depression, Withdrawn, Somatic Complaints, Attention Problems, and Internalizing Problems scales than refugee adolescents. In this study, no significant difference was found between the two groups on Social Problems, Thought Problems, Delinquent Behavior, Aggressive Behavior, and Externalizing scales. "nConclusion: Findings revealed that although asylum is not an ideal condition for children's and adolescents' psychological development and prosperity, it can have a protective role in comparison with war zone's circumstances. Further investigation is needed, however, to elucidate the lack of significant differences in externalizing scales among war zone and refugee adolescent

A rare case of primary adult cardiac rhabdomyosarcoma with lower extremity metastasis

Primary cardiac tumors are uncommon. Rhabdomyosarcomas are among the rarest type of cardiac sarcomas. Echocardiography, cardiac MRI, and computed tomography scan can help the diagnosis and presurgical management. In this article, we report a rare case of primary cardiac rhabdomyosarcoma originating from the mitral valve with left femoral metastasis in a patient in her 60s. The diagnosis was made using transesophageal echocardiography and cardiac MRI. A metastatic lesion was found in an extended PET scan in one of her clinical follow-ups due to her leg pain. Based on this report, we suggest that extending PET scan to the lower extremities could be helpful in the early diagnosis and treatment of remote metastases of cardiac rhabdomyosarcomas

Impact of Side-Branch Flow in Coronary Bifurcation Intervention

Background: The optimal strategy in percutaneous coronary intervention (PCI) for coronary artery bifurcation lesions has yet to be agreed upon. We compared a strategy for stenting the main vessel to provide a complete perfusion flow in the side branch, namely thrombolysis in myocardial infarction (TIMI) - III, with a strategy for intervention in both the main vessel and the side branch (MV + SB). Methods: This retrospective study utilized data on 258 consecutive patients with bifurcation lesions scheduled for PCI at Tehran Heart Center between March 2003 and March 2008. The patients were followed up for 12 months, and the primary end point was a major adverse cardiac event (MACE), i.e. cardiac death, myocardial infarction, target-vessel revascularization, and target-lesion revascularization during the 12-month follow-up period. Results: A total of 52.7% of the patients underwent PCI on the main vessel of the bifurcation lesions (MV group) and 47.3% with a similar lesion type received a percutaneous intervention on both the main vessel and the side branch (MV + SB group). The total rate of MACE during the follow-up was 4.3% (11 patients); the rate was not significantly different between the MV and MV + SB groups (3.7% vs. 4.9%, respectively; p value = 0.622). Conclusion: There was no association between MACE in performing a simple or complex interventional strategy to treat coronary bifurcation lesions when drawing the TIMI- III flow as a goal in a simple technique

One-year prevalence and the association between SARS-CoV-2 cycle threshold, comorbidity and outcomes in population of Babol, North of Iran (2020-2021)

Background: The present study aimed to investigate the one-year prevalence of SARS-CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran. Methods: This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran. Results: Out of the 19232 suspected to COVID-19 patients, 7251 (37.7) had a positive rRT-PCR result; 652 (9), 4599 (63.4) and 2000 (27.6) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8 cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5) (p<0.001). Conclusion: In summary, 37.7 of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9 were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate. © The Author(s)