What Every Cardiologist Should Know about H1N1?

The world is witnessing ever fastest growing pandemic with high morbidity and mortality that excessive volume of airline travels spread influenza infection; so physicians with various specialties should know and consider the impact of current pandemic on their daily practice. Among influenza A viruses that infect humans, an influenza A virus emerged that had shifted to H1N1. Primarily, the results of pandemic of H1N1 were in younger humans without preexisting immunity. Attack rates of swine influenza are relatively high, but mortality is relatively low and mortality rate is highest in the very young, the very old, and the immunosuppressed. In this new pandemic, there is not more evidence of the interface of H1N1 with chronic diseases; however, we expect that the Swine flu such as the previous influenza pandemics can change the course of many chronic diseases

Can doubling the maintenance dose of clopidogrel prevent from early stent thrombosis after the primary percutaneous coronary intervention?

<p class="abstract"><strong>BACKGROUND:</strong> Treatment of significant coronary artery disease with primary percutaneous coronary intervention (PCI) seems better than angioplasty balloon; because the incidence of restenosis is lower in this method, however, a serious complication of PCI is stent thrombosis which would lead to repeated myocardial infarction (MI) and increase the mortality and morbidity. One of the frequent medications which is used to prevent from stent thrombosis is clopidogrel, but, stent thrombosis was seen in many of the patients despite given the conventional dosage of this drug. This study aimed to evaluate the effect of doubling the maintenance dose of clopidogrel to prevent from early stent thrombosis, MI and mortality rate.</p> <p class="abstract"><strong>&nbsp;&nbsp; METHODS:</strong><strong> </strong>This was a clinical trial study which was done in Shahid Chamran Hospital in winter 2010 in Isfahan, Iran. A total of 400 patients with PCI were prospectively followed-up for 30 days. All the patients were randomly allocated into two groups. The control group received a maintenance dose of 75 mg clopidogrel while the case group received 150 mg clopidogrel after the initial dosage of 600 mg for 30 days after the PCI.&nbsp; The incidence of primary outcome such as total mortality was recorded during the study.</p> <p class="abstract"><strong>&nbsp;&nbsp; RESULTS:</strong> Early stent thrombosis was observed in 4 patients (1%) (One subject in the control group and 3 in the case group) during the first 30 days after PCI, but the difference was not significant between the two groups (p = 0.62). Mortality due to stent thrombosis occurred in 2 patients in the case group which showed no significant difference in this group (p = 0.5). In addition, MI occurred in 2 patients (1 in each group) which also showed no significant difference between the two groups (p = 1). Drug complication such as major bleeding had no significant difference between the two groups (p = 0.9).<strong></strong></p> <p class="abstract"><strong>&nbsp;&nbsp; </strong><strong>CONCLUSION:</strong> The present study showed that doubling dose of clopidogrel could not reduce the incidence of early stent thrombosis, mortality and myocardial infarction in comparison with conventional dosage; therefore it is recommended that more studies be done in Iranian and Asian race for clinical decision-making to prevent form stent thrombosis using high dose of clopidogrel.</p><p class="abstract"><strong>Keywords:</strong> Primary coronary intervention, Early stent thrombosis, Clopidogrel, Coronary stenting.</p

An interesting anomalous coronary artery: Right coronary artery arising from the mid part of the left anterior descending artery

A 48-year-old woman was admitted to the emergency department with complaints of typical chest pain, cold sweat, and dyspnea of 24 hours’ duration. She had a history of hypertension, hyperlipidemia, and diabetes mellitus for many years. On admission, her electrocardiogram (ECG) revealed normal sinus rhythm and dynamic T inversion in the precordial leads. Her enzyme levels were normal. Transthoracic echocardiography showed a left ventricular ejection fraction of 60%, with mild mitral regurgitation. Because of ST depression during the peak exercise test, cardiac catheterization was suggested and then performed. Coronary angiography demonstrated normal left main coronary artery courses with normal dominant left circumflex artery and left anterior descending artery (LAD). An anomalous right coronary artery (RCA) was seen, with a nondominant separate branch arising from the mid part of the LAD. It then coursed anteriorly down on the right atrioventricular groove (Figure 1). Attempts for the cannulation of the RCA were unsuccessful. Aortic root angiography did not show the presence of an independent-origin RCA from the ascending aorta (Figure 2 and Figure 3). We selected medical management of X syndrome (microvascular disease) and followed up the patient because of the nondominancy of the RCA. There was no need for revascularization or surgery.  She was discharged in good condition

Morphing Multiscale Textured Shells

p. 1767-1779Forming surface features in a shell, and combining this 'texture' with prestress, can lead to a range of distinctive multistable properties. This paper is concerned with describing the structural properties of shell surfaces where local indentation and corrugation are used to replace the isotropic behaviour of the shell, and studies the possibilities of using these shells as morphing and multistable structures. By taking advantage of the anisotropic properties of the textured shell structure and further prestressing the shell, a range of interesting multistable properties can be achieved. This study investigates the properties of a particular example of a textured shell surface using experimental and computational techniques. Remarkably, these results shown that dimpled textured shells can achieve an effective Poisson's ratio in bending of close to -1, providing interesting insights into the remarkable multistable properties that textured shell surfaces can achieve.Golabchi, MR.; Guest, SD. (2009). Morphing Multiscale Textured Shells. Editorial Universitat Politècnica de València. http://hdl.handle.net/10251/681

Evaluation of Leptin and Adiponectin Levels in Patients with Stable Angina Pectoris

<p class="abstract"><strong>BACKGROUND:</strong> Leptin and adiponectin are two adipose tissue hormones and their association with the incidence of cardiovascular diseases is under evaluation. The aim of this study was to determine the relationship of leptin and adiponectin with coronary artery diseases.</p> <p class="abstract"><strong>&nbsp;&nbsp; METHODS:</strong><strong> </strong>One hundred and seventy patients with angina pectoris and indications of coronary angiography underwent angiography. Serum levels of blood lipids, leptin, and adiponectin were measured. The gathered data was evaluated using SPSS software, V. 15, by multivariate variance analysis.</p> <p class="abstract"><strong>&nbsp;&nbsp; RESULTS:</strong> Analysis of the data demonstrated that 45.1% of the patients had positive angiographic findings. The serum levels of leptin and adiponectin were significantly lower than the minimum levels specified by the kit. However, the two groups, i.e., patients with positive angiographic findings and those with negative findings were not significantly different according to the serum levels of the hormones. Moreover, no significant correlation between the serum levels of the hormones and serum lipids was observed.<strong>&nbsp;</strong></p> <p class="abstract"><strong>&nbsp;&nbsp; </strong><strong>CONCLUSION:</strong> Various studies have demonstrated that high serum level of leptin and the incidence of coronary artery diseases are correlated. On the other hand, they have reported that adiponectin has cardioprotective role. Confirmation of these findings requires more detailed studies.</p> <p class="abstract">&nbsp;</p><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td width="35" height="12"><br /></td></tr> <tr><td><br /></td> <td>&nbsp;</td></tr></tbody></table><strong>Keywords:</strong> Leptin, Adiponectin, Coronary artery disease<br /

A simulation-based decision-support system for integration of human cognition into construction operation planning

The mental workload associated with work activities is a key factor affecting the performance of human resources in labor-intensive construction operations, in turn impacting work behavior. While most accidents in construction are caused by unsafe behavior, modeling behavior in construction projects remains challenging and relatively unexplored. Here, human cognition is incorporated into the design of construction operations to analyze the mental task demands associated with various designs. A framework that integrates cognitive modeling with a simulation-based decision-support system capable of analyzing existing and non-existing operations in a simple and automated manner is proposed. The superiority of the proposed framework is that it eliminates the need for prior knowledge of the underlying cognitive theories. Functionality of the developed framework was evaluated following its application to a case study of welding operations, where the proposed method was shown to successfully evaluate the trade-off between mental workload and productivity for different operation scenarios

Is Chiari malformation a cause of systemic hypertension and sinus bradycardia? A case report and literature review

Abstract A middle aged woman, having a history of diastolic hypertension and sinus bradycardia since one year ago, was referred to our center with a sudden occipital headache after shouting. To evaluate the cause of headache the brain MRI was performed reporting a slight cerebellar tonsillar herniation of about one centimeter below the foramen magnum. After the patient was diagnosed to have type I Chiari malformation, a surgery procedure was done and the symptoms were recovered after that. Type I Chiari malformation is a disease mostly caused by congenital displacement of cerebellar tonsils through the foramen magnum. The most common symptom is headache, rarely reported with hypertension or sinus bradycardia