Evaluation of iron overload by cardiac and liver T2* in β-thalassemia: Correlation with serum ferritin, heart function and liver enzymes

Introduction: In this study, we aimed to assess the relationship of cardiac and hepatic T2* magnetic resonance imaging (MRI) values as a gold standard for detecting iron overload with serum ferritin level, heart function, and liver enzymes as alternative diagnostic methods. Methods: A total 58 patients with beta-thalassemia major who were all transfusion dependent were evaluated for the study. T2* MRI of heart and liver, echocardiography, serum ferritin level, and liver enzymes measurement were performed. The relationship between T2* MRI findings and other assessments were examined. Cardiac and hepatic T2* findings were categorized as normal, mild, moderate, and severe iron overload. Results: 22% and 11% of the patients were suffering from severe iron overload in heart and liver, respectively. The echocardiographic findings were not significantly different among different iron load categories in heart or liver. ALT level was significantly higher in patient with severe iron overload than those with normal iron load in heart (P=0.005). Also, AST level was significantly lower in normal iron load group than mild, moderate, and severe iron load groups in liver (P<0.05). The serum ferritin level was significantly inversely correlated with cardiac T2* values (r = -0.34, P=0.035) and hepatic T2* values (r = -0.52, P=0.001). Conclusion: Cardiac and hepatic T2* MRI indicated significant correlation with serum ferritin level

Comparison of Laboratory Findings and Incidence Rate of Renal Failure With and Without Cardiopulmonary Bypass Machine After Coronary Artery Bypass Graft

Objectives: Acute kidney insuffciency is a prevalent and serious disease that follows coronary artery bypass graft (CABG). One of the important symptoms of acute renal failure (ARF) is the increased level of urea and serum creatinine. This study examined the rate of renal failure in patients undergoing on-pump and off-pump CABG. Materials and Methods: In this descriptive–comparative survey, we selected the patients undergoing heart surgery. Levels of urea, creatinine, sodium, potassium and urinary output were controlled and recorded in the frst days of admission and ICU discharge. Data collection tool was a checklist, the frst part included demographic information and the second part was related to the information on kidney function. The data were analyzed using SPSS version 21.0. Results: The fndings of this study showed a statistically signifcant difference in terms of age and the incidence of renal failure based on the increased levels of urea and serum creatinine before and after CABG (P0.05). Conclusions: Patients’ age was an important factor for kidney insuffciency following CABG. Type of the surgery (on- and off-pump) and gender had no influence on the incidence rate of ARF. Stronger measures to protect the kidneys in older patients may reduce this high-risk complication

Pregnancy outcome in a pregnant patient with idiopathic Pulmonary Arterial Hypertension: a case report and review of the literature

Abstract Background Idiopathic pulmonary arterial hypertension is a rare and progressive condition which is aggravated by the physiologic changes during pregnancy. Because of high mortality rate, most physicians recommend early termination of pregnancy in patients with idiopathic pulmonary arterial hypertension. Case presentation Here we describe a case of a 30-year-old primigravida Caucasian housewife with functional class 1 idiopathic pulmonary arterial hypertension and a positive vasoreactive response to adenosine who had a full-term non-complicated delivery. Right-sided heart catheterization before the pregnancy showed severe pulmonary hypertension with mean pulmonary arterial pressure of 60 mmHg, and pulmonary vascular resistance of 12.2 WU. Vasoreactivity was positive after infusion of 200 μg/kg per minute adenosine. During pregnancy, she did not receive medication other than prophylactic enoxaparin. She had an elective cesarean section under general anesthesia at 39 weeks of gestation without complication and delivered a healthy baby. After delivery, her hemodynamic status was stable. One month postpartum, she was in a stable clinical condition in functional class 1. Conclusions In pregnant patients with pulmonary arterial hypertension, decreased mortality has been observed over recent years particularly in patients with well-controlled pulmonary pressure and a positive vasoreactivity test

Thyrotoxicosis presenting as exertional dyspnea and pulmonary hypertension: Case report and review of literature

Objectives: In this case study, we describe a 35-year-old woman with pulmonary hypertension that was secondary to thyrotoxicosis who presented with exertional dyspnea. In the approach to exertional dyspnea, detailed physical examination and laboratory findings helped to get the diagnosis. Methods: Echocardiography showed right ventricular systolic pressure = 60 mmHg. A suppressed thyroid-stimulating hormone was seen in lab tests. The patient was treated with radioactive iodine. Results: Palpitations and shortness of breath improved, and both her thyroid-stimulating hormone and T4 levels decreased. Echocardiography and the pulmonary pressure were normal after treatment. Conclusions: Thyrotoxicosis is one of the etiologies of pulmonary hypertension, but the exact etiology and pathogenesis remain unknown. Some patients may have symptomatic pulmonary hypertension that can be resolved by hyperthyroidism treatment

Thyrotoxicosis presenting as exertional dyspnea and pulmonary hypertension: Case report and review of literature

Objectives: In this case study, we describe a 35-year-old woman with pulmonary hypertension that was secondary to thyrotoxicosis who presented with exertional dyspnea. In the approach to exertional dyspnea, detailed physical examination and laboratory findings helped to get the diagnosis. Methods: Echocardiography showed right ventricular systolic pressure = 60 mmHg. A suppressed thyroid-stimulating hormone was seen in lab tests. The patient was treated with radioactive iodine. Results: Palpitations and shortness of breath improved, and both her thyroid-stimulating hormone and T4 levels decreased. Echocardiography and the pulmonary pressure were normal after treatment. Conclusions: Thyrotoxicosis is one of the etiologies of pulmonary hypertension, but the exact etiology and pathogenesis remain unknown. Some patients may have symptomatic pulmonary hypertension that can be resolved by hyperthyroidism treatment

LC-MS/MS Estimation of Propranolol level in Exhaled Breath Condensate

Background: Exhaled breath condensate (EBC) could be used as a non-invasive and alternative specimen to urine and blood for monitoring propranolol levels. A simple, sensitive and selective liquid chromatography–tandem mass spectrometry (LC–MS/MS) method is employed for the determination of propranolol in EBC samples. Methods: Samples directly injected to a C18 analytical column and isocratically separated using a mobile phase composed of methanol + acetic acid (99:1 v/v). Detection was performed by positive electrospray ionization in multiple reaction monitoring and selected ion recording modes. Results: The chromatographic separation was obtained within 6.0 min and was linear over the concentration range of 5.6–224.0 ng/mL (R2 = 0.999). The accuracy and precision of the method were within 15% according to FDA guideline. The found concentrations of propranolol in EBC of two patients receiving 80 mg/day were 30 and 40 ng/mL. Conclusion: Developed method was applied to determine propranolol levels in three patients receiving propranolol in their medication. The obtained propranolol levels in EBC could be used to develop simpler, cheaper and more feasible analytical methods to be used in routine analysis of propranolol in biomedical analytical laboratories