Right ventricular thrombus in a 36-year-old man with Factor v Leiden

Factor V Leiden deficiency is the most common hereditary hypercoagulable disease in the United States and involves 5 of the Caucasian population. Up to 30 of patients who present with deep vein thrombosis (DVT) or pulmonary thromboembolism present with this condition. This is a case report of a 36-year-old man who experienced one episode of DVT within the previous year and was admitted to our hospital due to productive coughs and hemoptysis. Paraclinical studies demonstrated a right ventricular thrombus. Additional investigation was done to find the underlying cause. Laboratory tests were positive for Factor V Leiden mutation. Other factors for hypercoagulability states were normal. Given that Factor V Leiden mutation is a life-threatening condition with a relatively high prevalence and considering its thrombogenesis, screening tests are necessary in young patients without obvious reasons for recurrent thrombus formation. It seems that medical noninvasive treatments can be an alternative therapy to surgery when a ventricular thrombus is suspected in these patients. � 2015 Tehran Heart Center. All rights reserved

Left ventricular mass index and pulmonary artery pressure in patients with the obstructive sleep apnea syndrome

Background: Sleep apnea is accompanied by some cardiovascular complications. It has even been hypothesized that sleep apnea, itself, can induce some of these complications. Given such controversies, we assessed the left ventricular mass index (LVMI) and systolic pulmonary artery pressure in patients with sleep apnea. Methods: Through convenience sampling, 56 patients with the obstructive sleep apnea syndrome (OSAS) were included in the present descriptive cross-sectional study. Patients with any past history of hypertension and diabetes mellitus were excluded. The apnea severity was assessed via the polysomnography-derived apnea-hypopnea index (AHI). All the patients underwent transthoracic echocardiography. In this cross-sectional study-data regarding age, gender, smoking, systolic and diastolic blood pressures, polysomnographic parameters (AHI, severity of disease, mean heart rate, mean oxygen saturation SaO2, lowest SaO2, and duration of SaO2 below 90% d.SaO2 < 90%), and echocardiographic parameters (systolic pulmonary artery pressure and LVMI) were accumulated and processed. Results: Fifty-two men and 14 women at a mean age of 49.29 ± 11.79 years participated in this study. Systolic and was significantly high in the severe group compared with the mild group (128.21 ± 9.73 mmHg vs. 119.23 ± 12.5 mmHg; p value = 0.007). The LVMI was increased parallel to an increase in the severity of the OSAS, but that increase was not statistically significant (p value = 0.161). The d.SaO2 < 90% was positively correlated with the LVMI, and this relationship remained true after adjustment for the body mass index (r = 0.27; p value = 0.042). Conclusion: Severe OSAS was accompanied by a higher blood pressure. The LVMI did not differ significantly between the patients with the OSAS and those who did not suffer from other risk factors of cardiac diseases. © 2016, Tehran Heart Center. All rights reserved

Decentralized Nonlinear Control of Redundant Upper Limb Exoskeleton with Natural Adaptation Law

The aim of this work is to utilize an adaptive decentralized control method called virtual decomposition control (VDC) to control the orientation and position of the end-effector of a 7 degrees of freedom (DoF) right-hand upper-limb exoskeleton. The prevailing adaptive VDC approach requires tuning of 13n adaptation gains along with 26n upper and lower parameter bounds, where $n$ is the number of rigid bodies. Therefore, utilizing the VDC scheme to control high DoF robots like the 7-DoF upper-limb exoskeleton can be an arduous task. In this paper, a new adaptation function, so-called natural adaptation law (NAL), is employed to eliminate these burdens from VDC, which results in reducing all 13n gains to one and removing dependency on upper and lower bounds. In doing so, VDC-based dynamic equations are restructured, and inertial parameter vectors are made compatible with NAL. Then, the NAL adaptation function is exploited to design a new adaptive VDC scheme. This novel adaptive VDC approach ensures physical consistency conditions for estimated parameters with no need for upper and lower bounds. Finally, the asymptotic stability of the algorithm is proved with the virtual stability concept and the accompanying function. The experimental results are utilized to demonstrate the excellent performance of the proposed new adaptive VDC scheme.acceptedVersionPeer reviewe

The association between subclinical hypothyroidism and diabetic retinopathy in the patient with type 2 diabetic

The present study aimed to determine the relationship between subclinical hypothyroidism and diabetic retinopathy in patients with type 2 diabetes mellitus. In this cross-sectional analytical study, 150 patients with type 2 diabetes mellitus were assessed. The eye fundus examination was performed using fundoscopy to confirm or rule out retinopathy. Thyroid hormones were also measured by special kits to diagnose subclinical hypothyroidism. The criteria for diagnosis of this disorder include the high serum thyrotropin concentration (� 4mIU/L) plus normal serum free thyroxin levels. Statistical analyses were done using IBM-SPSS. In the study, 34.66 suffered retinopathy. A total of 24.0 suffered subclinical hypothyroidism with higher prevalence rate in those with retinopathy as compared with the group without retinopathy (p = 0.001). Those with diabetic retinopathy also experienced longer duration of diabetes than those without this event. (p = 0.006). Analysis show a significant role for type 2 diabetes mellitus (OR = 1.121, P = 0.003), and high TSH level (OR = 1.342, P = 0.006) to predict diabetic retinopathy.This study showed an association between hypothyroidism, diabetes and increased TSH with retinopathy. Retinopathy is significantly predicable with the presence of subclinical hypothyroidism and longer duration of diabetes. © 2021, Institute of Medico-Legal Publications. All rights reserved

Association of plasma total testosterone level and metabolic syndrome in adult males

Introduction: Low testosterone level has strongly been correlated with body fat accumulation and abdominal obesity in men. Objectives: This study aimed to evaluate testosterone level in men with and without metabolic syndrome to determine the relationship between testosterone and metabolic syndrome. Patients and Methods: This case-control study was conducted on 172 cases of metabolic syndrome and 172 participants as a control group in Rasoul Akram hospital, Tehran, Iran. Demographic characteristics, fasting blood sugar (FBS), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, triglyceride (TG), and testosterone levels were recorded. SPSS version 21.0 and SAS version 9.1 were used for statistical analysis. Level of significance was considered 0.05. Results: The mean age of the two groups were 45.1 ± 9.3 years and 41.5 ± 11.2 years, respectively. There was a significant difference in serum testosterone levels between both groups and low testosterone levels were associated with metabolic syndrome (P < 0.001). Serum testosterone levels showed a significant negative correlation with age in the metabolic syndrome group (r =-0.16, P = 0.02). The relationship between metabolic syndrome and total plasma testosterone level using logistic regression model showed that, by increasing the total plasma testosterone level, the odds ratio for metabolic syndrome was 0.076 (95 CI: 0.027-0.216; P < 0.001). Conclusion: According to the results, low level of testosterone was related to the presence of metabolic syndrome in adult males. Future studies can investigate diagnostic value of testosterone level in this syndrome. © 2020 The Author(s)

Prasugrel results in higher decrease in high-sensitivity C-reactive protein level in patients undergoing percutaneous coronary intervention comparing to clopidogrel

Objectives: A growing body of clinical and laboratory evidence indicates that inflammation plays a crucial role in atherosclerosis. In the present study, we compared the effects of clopidogrel and prasugrel on high-sensitivity C-reactive protein (hs-CRP) in patients undergoing percutaneous coronary intervention (PCI). Methods: The present randomized, double-blind clinical trial included 120 patients who underwent PCI. Eligible patients were randomly assigned 2:1 to one of the two groups: 80 patients in the first group received clopidogrel (Plavix®; loading dose and maintenance dose of 300 and 75 mg daily, respec-tively) and 40 patients in the second group received prasugrel (Effient®; loading dose and maintenance dose of 60 and 10 mg, respectively) for 12 weeks. The hs-CRP levels between baseline and 12th week were compared.Results: Of the 120 patients, 69 patients (57.5) were male. Pretreatment hs-CRP level was statistically comparable in clopidogrel (median, 15.10 mg/dL; interquartile range IQR, 9.62-23.75 mg/dL) and prasugrel groups (median, 18 mg/dL; IQR, 14.25-22 mg/dL; P = 0.06). Patients taking clopidogrel showed a significant reduction in hs-CRP level compared with the baseline values (P < 0.001). Prasugrel administration also resulted in a significant reduc-tion in hs-CRP level (P < 0.001). A significant 73% overall reduction in the hs-CRP level was seen with prasugrel compared with 39% overall reduction in hs-CRP level with clopidogrel (P = 0.002). Conclusion: Prasugrel seems to be superior to clopidogrel in the reduction of hs-CRP in patients undergoing PCI. © the authors, publisher and licensee Libertas Academica Limited

Effective high compression of ECG signals at low level distortion

An effective method for compression of ECG signals, which falls within the transform lossy compression category, is proposed. The transformation is realized by a fast wavelet transform. The effectiveness of the approach, in relation to the simplicity and speed of its implementation, is a consequence of the efficient storage of the outputs of the algorithm which is realized in compressed Hierarchical Data Format. The compression performance is tested on the MIT-BIH Arrhythmia database producing compression results which largely improve upon recently reported benchmarks on the same database. For a distortion corresponding to a percentage root-mean-square difference (PRD) of 0.53, in mean value, the achieved average compression ratio is 23.17 with quality score of 43.93. For a mean value of PRD up to 1.71 the compression ratio increases up to 62.5. The compression of a 30 min record is realized in an average time of 0.14 s. The insignificant delay for the compression process, together with the high compression ratio achieved at low level distortion and the negligible time for the signal recovery, uphold the suitability of the technique for supporting distant clinical health care

ON THE COMPUTATION OF A PRECISE GEOID – TO – QUASIGEOID SEPARATION

In geodesy, orthometric and normal heights are considered as basic height systems on the earth. The reference surfaces for these heights are the geoid and quasigeoid respectively. Taking advantage of GNSS measurements, one can achieve a precise solution for the geoid and for the quasigeoid. Two methods, called direct and indirect, are worked out in this research for the computation of separation between geoid and quasigeoid in a mountainous region in the USA. The area selected for this purpose is mountainous and rough enough in order to be able to show the effect of roughness of topography in the sought quantity. The results of the two methods and testing them against GNSS-Levelling on 445 known points indicates an accuracy of 1.3 cm in RMS scale with the direct method, where there is 7 cm as an average difference between the observed geoid and quasigeoid separation and the same quantity derived from the direct method. Using Chi-squared goodness of fit test showed that the distribution of the residual quantities are normally distributed in the test area

Facial nerve motor evoked potentials during skull base surgery to monitor facial nerve function using the threshold-level method

Object During surgeries that put the facial nerve at risk for injury, its function can be continuously monitored by transcranial facial nerve motor evoked potentials (FNMEPs) in facial nerve target muscles. Despite their advantages, FNMEPs are not yet widely used. While most authors use a 50% reduction in FNMEP response amplitudes as a warning criterion, in this paper the authors' approach was to keep the response amplitude constant by increasing the stimulation intensity and to establish a warning criterion based on the "threshold-level" method. Methods The authors included 34 consecutive procedures involving 33 adult patients (median age 47 years) in whom FNMEPs were monitored. A threshold increase greater than 20 mA for eliciting FNMEPs in the most reliable facial nerve target muscle was considered a prediction of reduced postoperative facial nerve function, and subsequently a warning was issued to the surgeon. Preoperative and early postoperative function was documented using the House-Brackmann grading system. Results Monitoring of FNMEPs was feasible in all 34 surgeries in at least one facial nerve target muscle. The mentalis muscle yielded the best results. The House-Brackmann grade deteriorated in 17 (50%) of 34 cases. The warning criterion was reached in 18 (53%) of 34 cases, which predicted an 83% risk of House-Brackmann grade deterioration. Sensitivity amounted to 88% (CI 64%-99%) and specificity to 82% (CI 57%-96%). Deterioration of FNMEPs and a worse House-Brackmann grade showed a high degree of association (p < 0.001). The impact of FNMEP monitoring on surgical strategy is exemplified in an illustrative case. Conclusions In surgeries that put the facial nerve at risk, the intraoperative increase in FNMEP stimulation threshold was closely correlated to postoperative facial nerve dysfunction. Monitoring of FNMEPs is a valid indicator of facial nerve function in skull base surgery. It should be used as an adjunct to direct electrical facial nerve stimulation and continuous electromyographic monitoring of facial nerve target muscles

Investigation of frequency of hypogonadism in thalassemia major patients of hazrat-e rasool akram hospital during 2013-2017

Determining the frequency of hypogonadism in thalassemia major patients and clarifying factors affecting it can be helpful in reducing related complications and improving the prognosis. The objective of the present study was to establish the frequency of hypogonadism in thalassemia major patients of Hazrat-e Rasool Akram Hospital during 2013-2017. A descriptive and analytic cross-sectional observation was carried out for this study and 285 thalassemia major patients were selected via convenience sampling. The frequency of hypogonadism among samples was assessed and the relationship between hypogonadism and different factors was analyzed. One hundred forty-six patients (51/2) had hypogonadism. A statistically significant relationship was found between tallness and hypogonadism; taller patients suffered from hypogonadism more than shorter ones (P=0.025); but weight, Initial serum ferritin level, LH, FSH, testosterone, splenectomy and the type of Injectable product had no significant relationship with of hypogonadism occurrence in the studied patients (P > 0.05). Based on the results, it is inferred that hypogonadism can be found in half of thalassemia major patients and therefore proper measures must be taken in order to decrease its prevalence. © 2020, Japan International Cultural Exchange Foundation. All rights reserved