Comparison of High Frequency and Low Frequency Tympanometry Findings in Normal Neonates

Abstract Background: Tympanometry is one of the most important audiological tests for the assessment of neonatal hearing screening programs. This test is usually done using a 226 Hertz probe tone; however, in infants less than 6 months of age, using this probe tone frequency is not reliable due to the different characteristics of the middle ear compared to adults. The purpose of this study was to assess the obtained tympanometric data in neonates 1 to 14 days with normal hearing using 226, 678, 800 and 1000 Hertz frequency probes tones. Materials and Methods: In this cross-sectional study, 30 neonates aged 1 to 14 days who were diagnosed as normal in hearing aspect with using otoacoustic emissions test, were assessed by tympanometry. Tympanometric tests were performed using 226, 678, 800 and 1000 Hertz frequency probe tones for both ears. For data analysis, the T-paired method has been used. Results: With using 226 Hertz frequency probe tone, incidence of unusual double peak tympanograms was observed in 65% of cases, which with increasing frequency of the probe tone, this percentage was decreased. There was also a statistically significant difference between the static admittance peak compensated in two 226 and 1000 Hertz frequency probes tones. Conclusion: In neonates with normal hearing and without any risk factors for hearing loss, the 1000-Hertz Tympanogram shows a better middle ear status than the 226-Hertz tympanogram

Safety and efficacy of mavacamten for treatment of hypertrophic cardiomyopathy: a systematic review and meta-analysis of randomized clinical trials

Abstract Background Mavacamten, an allosteric myosin inhibitor, is considered to be a promising drug for the treatment of hypertrophic cardiomyopathy (HCM). This meta-analysis aimed to explore the safety and efficacy of mavacamten in HCM patients. Main body A total number of 539 patients were enrolled in four randomized clinical trials. The mean age of patients was 57.9 years and was followed for 29.3 weeks. Pooled analysis showed a significant improvement in clinical response (Log OR = 0.65; p = 0.01) and the number of patients with a reduction of ≥ 1 NYHA function class (Log OR = 0.64, p = 0.00). It was found that mavacamten did not significantly affect the Kansas City Cardiomyopathy Questionnaire (KCCQ) (SMD = 0.43, p = 0.08), peak oxygen uptake (PVO2) (SMD = 0.24, p = 0.42), and ejection fraction (EF) (SMD = − 0.65, p = 0.13) as compared with placebo. However, KCCQ (SMD = 0.65, 95% CI 0.44–0.87) and PVO2 (SMD = 0.49, 95% CI 0.24–0.74) improvements were statically significant in the hypertrophic obstructive cardiomyopathy subgroup (HOCM), and a significant decrease in EF (SMD = -− 1.14, 95% CI − 1.86 to − 0.42) was found in the HOCM subgroup. No significant difference was observed in the incidence rate of serious adverse events between mavacamten and placebo group (Log OR = − 0.23, p = 0.56). Conclusions Mavacamten proved to be effective and well-tolerated for the treatment of HCM. Mavacamten improved the signs and symptoms of HOCM and decreased EF in these patients without serious adverse events in the clinical trials

Myocarditis and Meningitis during Early Sepsis in a Neonate with Streptococcus pseudopneumoniae: A Case Report

Although myocarditis is uncommon in neonates, a wide variety of infectious pathogens can result in myocarditis, including viruses, bacteria, rickettsia, fungi, and protozoa. Viruses are most often the infectious disease found to cause acute myocarditis. On the other hand, bacterial myocarditis (BM) is an unusual cause of infectious myocarditis. BM is commonly seen in the context of sepsis or as part of a bacterial syndrome. Streptococcus pseudopneumoniae has mostly been isolated from the respiratory tract specimens. This infection is not prevalent in neonates. In this case report, a 5-day-old male neonate was admitted with the signs of fever, jaundice, and poor feeding. Moreover, he was lethargic and hypotonic with reduced neonatal reflexes and obvious tachycardia. Clinical and physical examinations were performed in addition to chest X-rays, echocardiography, cerebrospinal fluid (CSF) analysis, and other laboratory tests. The final diagnosis was confirmed as myocarditis and meningitis. The patient was treated with antibiotics and intravenous immunoglobulin (IVIG). On the sixth day of hospitalization, fever of the neonate fever resolved. On the 24th day, the CSF analysis was normal and the CSF, as well as blood culture were negative. The patient was discharged on the 30th day in good general and physical condition. The subsequent echocardiography performed four months’ post-hospitalization was normal

Evaluation of left ventricular function in obese children without hypertension by a tissue Doppler imaging study

Background : The prevalence of obesity is increasing worldwide. Obese children without hypertension are becoming an important health challenge. Aims : Complications of obesity in adults are well established, but in obese children, cardiac dysfunction has not been reported clinically. Settings and Design : The present crosssectional study investigates subclinical systolic and diastolic dysfunction using echocardiographic modalities. Materials and Methods : Twentyfive youngsters with body mass index (BMI) >30 and 25 healthy children with BMI <25 were assigned into case and control group, respectively. In all participants, complete cardiovascular examination, electrocardiography, and echocardiography were fulfilled. Echocardiography surveys included standard, pulsed wave Doppler (PWD), and tissue Doppler imaging (TDI). Statistical Analysis Used : SPSS software, version 24. Results : The two groups were matched for age and sex. The resting heart rate and blood pressure were markedly higher in the obese group (P = 0.0001) though they were within the normal range in either category. Ejection fraction in the two groups was similar. Left ventricular (LV) mass (P = 0.0001), LV mass index (P = 0.029), left atrialtoaortic diameter ratio (P = 0.0001), and LV enddiastolic diameter (P = 0.008) were significantly greater in the case group, indicating cardiomegaly and subclinical systolic and diastolic dysfunction. Except for the aortic velocity, all PWD variables were considerably lower in the case group, suggesting subclinical diastolic dysfunction. All TDI parameters varied significantly between the two categories. There was a direct correlation between isovolumetric relaxation time and BMI. Conclusions : Obesity in children without hypertension is associated with subclinical systolic and diastolic cardiac dysfunction. We propose the evaluation of blood pressure as well as myocardial performance using PWD and TDI in all obese children without hypertension, regularly

Determination of Relations between Systolic Blood Pressure and Heart Attack in Patients with Type 2 Diabetes with Association Rules

Abstract Background: Today, the high prevalence of diabetes and its complications are one of the most important public health issues worldwide. For this reason, finding relations between diabetes risk factors is very effective in preventing and reducing complications. For discovering these relations, the data mining methods can be used. By extracting association rules, which is one of the data mining techniques, we can discover the relations between a large numbers of variables in a disease. Materials and Methods: The population of this study was 1046 patients with type 2 diabetes, whose data had recorded between 2011 and 2014 at the Special Clinic for Diabetes in Tehran's Imam Khomeini Hospital. After pre-processing step with SPSS19 software, 573 people entered the analysis phase. The FP-Growth algorithm was applied to the data set to discover the relations between heart attack and other risk factors using Rapid miner5 software. Relations, after extraction, were given to the doctor to confirm clinical validation. Results: The obtained results of studying these 573 people (Including 292 (51%) women and 281 (49%) men, with age range 27 to 82 years) showed that the lack of blood pressure, creatinine and diastolic blood pressure at its normal level, despite higher systolic blood pressure level than normal, doesn't increase the probability of heart attack. Conclusion: Using association rules is a good way of identifying relations between the risk factors of a disease. Also, it can provide new hypotheses to do epidemiological studies for researchers

Frequency of Congenital Cardiac Malformations in the Neonates with Congenital Hypothyroidism

Background: Congenital hypothyroidism (CH) is a prevalent disorder, which is associated with several other congenital anomalies, especially cardiac diseases. The present study aimed to determine the prevalence of congenital heart disease (CHD) in the neonates with CH.Methods: This cross-sectional study was conducted on two groups of 79 subjects to compare the type and frequency of congenital cardiac anomalies between the neonates with the confirmed diagnosis of CH (TSH≥10 mlU/ml) and healthy infants. The study was performed in Kowsar Clinic affiliated to Arak University of Medical Sciences, Iran. Level of thyroid-stimulating hormone (TSH) was measured within days 3-7 of birth using the samples collected from the soles of the neonates. In addition, all the subjects were evaluated for the presence of CHD using echocardiography before day 30 of life.Results: In total, 79 neonates were enrolled in the study. The case group consisted of 34 females (43.04%) and 45 males (53.96%), and the control group consisted of 43 females (54.43%) and 36 males (45.57%). The groups were matched in terms of age and gender. Cardiac involvement was only detected in the case group (CH infants) with the prevalence of 22.7%. Among the non-cyanotic malformations observed in the case group, one infant had ventricular septal defect (1.3%), eight infants had atrial septal defect (10.1%), three infants had patent ductus arteriosus (3.8%), three neonates had endocardial cushion defect (3.8%), two neonates had pulmonary stenosis (2.5%), and one infant had dilated cardiomyopathy (1.3%). Moreover, six neonates were diagnosed with Down syndrome. All the infants with endocardial cushion defect (n=3) had Down syndrome, and no significant association was observed between TSH and thyroxine (T4) in the presence of CHD.Conclusion: According to the results, the high prevalence of cardiac malformations in the neonates with CH necessitated cardiac examinations using echocardiography

Atrial and Ventricular Electrocardiographic Dromotropic Disturbances in Down Syndrome Patients with Structurally Normal Heart: A Cross-Sectional Study

Background: We designed a cross-sectional study to determine electrocardiographic disorders in Down syndrome patients with congenitally normal hearts in a bid to predict fatal cardiac arrhythmia in the future. Materials and Methods: We investigated 60 children with DS without congenital abnormal hearts. Sixty healthy juveniles were also included in the study as a control group. Physical examination, electrocardiography, and echocardiography were performed in all subjects. Corrected QT interval (QTc) was measured according to Bazett’s formula. Results: Patients with DS consisted of 32 males (53.33%), and 28 females (46.66%), aged 6–13 (9.21 ± 6.24) years old. Healthy subjects comprised 31 males (51.66%), and 29 females (48.33%) with a mean age of 9.15 ± 5.01. The two groups were significantly different in terms of heart rate (P=0.006), maximum P-wave duration (P=0.001), and P-wave dispersion (PWd, P=0.0001). There was no statistically significant difference regarding minimum P-wave duration (P=0.176). The patients with DS had a greater maximum QTc interval, QT dispersion, and corrected QT interval dispersion (QTc-d) than the healthy control subjects (P=0.001). However, there was no difference in maximum QT interval and minimum QTc interval between the two groups (P=0.67 and P=0.553, respectively). A positive correlation was found between age, heart rate, and all electrocardiographic variables. Conclusion: All DS patients, even in the absence of concomitant congenital heart disease should be followed up carefully by electrocardiography, looking for increased PWd and QTc-d to detect predisposed cases to arrhythmia

Comparison of Outcomes between Two Methods of Referring to Hospital in Patients with Acute Myocardial Infarction; a Cross-Sectional Study

مقدمه: شیوع سکته حاد قلبی در جوامع شهری به سرعت رو به افزایش است و ضرورت انجام اقدامات به موقع و مناسب احساس می‌شود. عملکرد اورژانس پیش بیمارستانی می‌تواند یک راهکار در واکنش سریع به این مسئله باشد. لذا هدف از انجام این مطالعه بررسی و مقایسه پیامد دو روش مراجعه به بیمارستان در بیماران مبتلا به سکته حاد قلبی می باشد. روش اجرا: تحقیق حاضر به صورت مقطعی بر روی بیمارانی با تشخیص سکته قلبی در دو گروه تماس گیرنده با اورژانس 115 و مراجعه کننده حضوری، از ابتدای سال 1397 تا پایان شهریور 1398 در مرکز آموزشی درمانی قلب شهید چمران اصفهان انجام شده است. پس از ثبت اطلاعات پرونده‌های بیماران، به منظور مقایسه دو شیوه اعزام به بیمارستان از آزمون‌های آماری کای اسکوئر و تی مستقل استفاده شده است. &nbsp;یافته‌ها: پرونده 281 بیمار بررسی شد. بیش از 80 درصد مبتلایان مرد بودند. در بین این افراد تنها 21 نفر (5/7 درصد) فوت کره بودند که بیشتر آن‌ها (17 نفر) در گروه مراجعه حضوری بودند که از نظر آماری تفاوت معنی‌دار بود (002/0=p). علاوه براین، متغیرهای ارزیابی اولیه (044/0=p)، بیماری فشار خون (039/0=p)، کراتینین (010/0=p) و فشار خون سیستولیک (031/0=p) در دو گروه اعزام با 115 و حضوری تفاوت داشته‌اند. نتیجه‌گیری: وجود ارتباط بین تعداد فوتی‌ها و نوع اعزام، گواه تاثیر خدمات اورژانس پیش بیمارستانی در جلوگیری از عوارض ناگواری بعدی می‌باشد. بر اين اساس شايد بتوان گفـت نحـوه انتقـال بـه بيمارسـتان و نوع خدمت پيش بيمارسـتاني ارائه شده به بيمـار&nbsp; موثر و مهم است. &nbsp;Introduction: The prevalence of acute myocardial infarction in urban communities is rapidly increasing and the need for timely and appropriate actions is felt. Pre-hospital emergency service can aid in providing a quick response to this problem. Therefore, the aim of this study was to investigate and compare outcomes between hospital visits via hospital emergency services (ambulance) and patients visiting the hospital on their own (private car) among those with myocardial infarction. Methods: The present cross-sectional study was performed on patients diagnosed with myocardial infarction in two groups of those who called the emergency services and those who visited the hospital themselves, from March 2018 to September 2019, in Shahid Chamran Heart Training Medical Center in Isfahan. After recording patients' profile information, Chi-Square and independent T-test were used to compare the two methods of referring to the hospital. Results: The records of 281 patients were reviewed. More than 80% of the patients were men. Among them, only 21 (7.5%) died, most of whom (17 patients) were in the group visiting using private cars (p = 0.002). In addition, the initial evaluation variables (p = 0.044), hypertension (p = 0.039), creatinine (p = 0.010) and systolic blood pressure (p = 0.031) were different between the two groups of presenting via ambulance and via private car. Conclusion: The correlation between death outcome and type of hospital referral is a testament to the effectiveness of pre-hospital emergency services in preventing secondary adverse events. Based on this finding, it could be said that the type of transfer to the hospital and pre-hospital services provided for patients are impactful and important. &nbsp