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

Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: The Iranian Project for Assessment of Coronary Events 2 (IPACE2)

Objectives: To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS). Setting: 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran. Participants: Patients aged �20 and �80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA). Primary and secondary outcome measures: Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds. Results: A total of 1799 patients (25.7 STEMI and 74.3 HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6), clopidogrel (91.8), anticoagulants (93.4), statins (94.3) and β-blockers (89.3). Reperfusion therapy was performed in 62.6 of patients with STEMI (46.3 thrombolytic therapy and 17.3 primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7 and 79.5 of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0 of all patients. Conclusions: Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications

Vitamin D supplementation and serum heat shock protein 60 levels in patients with coronary heart disease: A randomized clinical trial

Background: The aim in this study was to investigate the effect of vitamin D (25(OH)D3) supplementation on heat shock protein 60 (HSP 60) and other inflammatory markers (IL-17, TNF-α, PAB) in patients with coronary heart disease (CHD). Methods: In this double-blind, randomized clinical trial, we recruited 80 male and female patients aged 30-60 with CHD and 25(OH)D3 serum levels < 30 ng/ml from Rasool-e-Akram Hospital in Tehran, Iran. Serum levels of HSP 60 as primary outcome, and 25(OH)D3, IL-17, TNF-α, PAB, lipid profiles and parathyroid hormone (PTH) as secondary outcomes were measured at baseline and post-intervention. We randomly assigned eligible participants to a placebo group (N = 40) or an intervention group (N = 40) (50,000 IU/wk. vitamin D supplement) for eight weeks. Results: The results demonstrated that vitamin D supplementation resulted in a significant increase in 25(OH) D3 serum levels in the intervention group compared to the placebo group (46.86 vs. 7.28 ng/ml). PTH levels decreased in the intervention group compared to the placebo group (- 19.81 vs. 2.92 pg/ml) after eight weeks of supplementation. Furthermore, we observed a significant change in waist circumference (- 0.97 vs. -0.26 cm), fat percentage (-.13 vs. 0.1), systolic blood pressure (- 3.85 vs. -2.11 mmHg) and diastolic blood presure (- 4 vs. -1.86 mmHg) in the vitamin D group compared to the placebo group (all P values < 0.05). Other variables did not significantly change after the intervention. Conclusion: Based on our findings, weekly vitamin D supplementation of 50,000 IU for eight weeks in patients with CHD resulted in decreased systolic and diastolic blood pressure, waist circumference and fat percentage. No significant effect on HSP 60, inflammatory markers or lipid profiles was observed. Trial registration: IRCT, IRCT201612122365N14. Registered 12 December 2016. © 2018 The Author(s)

Intermediate versus standard-dose prophylactic anticoagulation and statin therapy versus placebo in critically-ill patients with COVID-19: Rationale and design of the INSPIRATION/INSPIRATION-S studies

Background: Microvascular and macrovascular thrombotic events are among the hallmarks of coronavirus disease 2019 (COVID-19). Furthermore, the exuberant immune response is considered an important driver of pulmonary and extrapulmonary manifestations of COVID-19. The optimal management strategy to prevent thrombosis in critically-ill patients with COVID-19 remains unknown. Methods: The Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) and INSPIRATION-statin (INSPIRATION-S) studies test two independent hypotheses within a randomized controlled trial with 2 � 2 factorial design. Hospitalized critically-ill patients with reverse transcription polymerase chain reaction confirmed COVID-19 will be randomized to intermediate-dose versus standard dose prophylactic anticoagulation. The 600 patients undergoing this randomization will be screened and if meeting the eligibility criteria, will undergo an additional double-blind stratified randomization to atorvastatin 20 mg daily versus matching placebo. The primary endpoint, for both hypotheses will be tested for superiority and includes a composite of adjudicated acute arterial thrombosis, venous thromboembolism (VTE), use of extracorporeal membrane oxygenation, or all-cause death within 30 days from enrollment. Key secondary endpoints include all-cause mortality, adjudicated VTE, and ventilator-free days. Key safety endpoints include major bleeding according to the Bleeding Academic Research Consortium definition and severe thrombocytopenia (platelet count 3 times upper normal limit and clinically-diagnosed myopathy. The primary analyses will be performed in the modified intention-to-treat population. Results will be tested in exploratory analyses across key subgroups and in the intention-to-treat and per-protocol cohorts. Conclusions: INSPIRATION and INSPIRATON-S studies will help address clinically-relevant questions for antithrombotic therapy and thromboinflammatory therapy in critically-ill patients with COVID-19. © 2020 Elsevier Lt

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality among Patients with COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis. Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU). Design, Setting, and Participants: Multicenter randomized trial with a 2 � 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020. Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up. Main Outcomes and Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 �103/µL). All outcomes were blindly adjudicated. Results: Among 600 randomized patients, 562 (93.7) were included in the primary analysis (median interquartile range age, 62 50-71 years; 237 42.2% women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% 95% CI,-6.6% to 9.8%; odds ratio, 1.06 95% CI, 0.76-1.48; P =.70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% 1-sided 97.5% CI,-� to 3.4%; odds ratio, 1.83 1-sided 97.5% CI, 0.00-5.93), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% 95% CI, 0.4%-3.8%; P =.01). Conclusions and Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19. Trial Registration: ClinicalTrials.gov Identifier: NCT04486508. © 2021 American Medical Association. All rights reserved

Basal Cell Adenoma of the Parotid Gland: A Case Report and Review of the Literature

Salivary gland tumors are among the pathologies in the head and neck that may be challenging in diagnosis and treatment. Most benign tumors occur in the parotid gland. Pleomorphic Adenoma is the most common type. Basal Cell Adenoma is a subtype of the Monomorphic Adenoma with rare occurrence. Proper diagnosis and clinical evaluation by the use of radiography can lead the physician to the best treatment plan for this neoplasia. Many surgical treatment modalities have been described in the literature ranging from total parotidectomy to dissection of the tumoral area alone. Extensive surgery will lead to malfunction and unacceptable esthetics due to resection of the parotid gland. One of the best approaches for treating the encapsulated and well-circumscribed pathologies is extra-capsular dissection without invading the major salivary gland. A rare case of Basal Cell Adenoma of the parotid gland in a 47-year-old female will be discussed

High Dose Oral Calcium Treatment in Patients with Vitamin D-dependent Rickets Type II

BACKGROUND AND OBJECTIVE: Vitamin D-dependent rickets type II (VDDR2) is a rare genetic disorder caused by mutations in vitamin D receptor (VDR) and leads to resistance to biological effects of calcitriol. Based on the type of mutation, this disease is resistant to calcitriol even at high doses of calcitriol and successful treatment of these patients requires hypocalcemic modification through administration of high doses of calcium and bypassing the intestinal defect in VDR signaling. In addition to the need for frequent hospitalization and high costs, intravenous administration of calcium is associated with complications and problems such as arrhythmia and sepsis, venous catheter infection and hypercalciuria. This study aims to report the positive treatment effects of high doses of oral calcium in 4 patients with vitamin D-dependent rickets type II. CASE REPORT: In this study, 4 patients with vitamin D-dependent rickets type II, diagnosed based on clinical and biochemical symptoms of rickets with alopecia, underwent therapy using high doses of oral calcium (300 mg/kg/day) in pediatric endocrinology and metabolism center of Imam Reza hospital. After a short period, increased growth rate in height, strength and elasticity of muscles was observed in addition to biochemical improvements without serious side effects and even one patient started walking independently within the first week of therapy for the first time. Patients were regularly followed up in terms of height and weight, growth rate and biochemical factors including calcium, phosphorus and alkaline phosphatase every 3 months for one year. CONCLUSION: Regardless of the type of mutation in vitamin D receptor, it is suggested that a 3-6 months trial of high dose oral calcium be started in each patient with vitamin D-dependent rickets type II, particularly for patients whose disease was diagnosed at lower ages

Comparison of Implant Stability in Sinus Lift Surgery Using Autogenous Versus Allogeneic Bone Grafts

Background and aim: The most common method of increasing implant stability in the posterior maxilla comprises the reinforcement of bone height using bone grafts in sinus lift surgery. The purpose of the present study was to compare autogenous and allogeneic bone grafts in implant stability after open sinus lift surgery. Materials and methods: This split-mouth clinical trial compared the implant stability in 10 patients who needed bilateral open sinus lifts, including 8 men and 2 women. Each side of each patient's jaw was assigned to either case or control groups. Open sinus lift was performed on both sides of the jaw: autogenous bone graft was used on the side considered as the control, while allogeneic bone graft was used on the side assigned to the case group. After four months, the implant stability was evaluated and recorded in each group using the Periotest® system. Results: The mean value related to implant stability was -2.78±2.31 in the control group and -3.19±2.51 in the case group. The values below zero (negative values) indicate an acceptable stability. According to Mann-U-Whitney test, there were no statistically significant differences between the two groups (P>0.05); however, the intragroup analysis using Wilcoxon test showed statistically significant results with regard to implant stability in each group (P<0.05). Conclusion: Based on the results, autogenous and allogeneic bone grafts have similar effects on implant stability after open sinus lift surgery, and both bone grafts provide a suitable implant durability

Anthropometric and Biochemical Measures in Bariatric Surgery Candidates: What Is the Role of Inflammatory Potential of Diet?

Background: The present study aimed to assess dietary total antioxidant capacity (TAC), dietary phytochemical intake (PI), and dietary inflammatory index (DII) in patients with morbid obesity who are candidates of bariatric surgery and their association with anthropometric and biochemical parameters. Methods and Materials: One hundred seventy patients with morbid obesity who were referred to surgery clinic of Firoozgar Hospital were enrolled in the study. Ideal body weight and adjusted ideal body weight were calculated. The dietary data were collected using a food frequency questionnaire. Anthropometrics and biochemical parameters were assessed. A p-value of <0.05 was considered significant. Results: The strongest correlations of DII with dietary intakes and anthropometric and biochemical biomarkers were found for iron (p<0.0001). Significant association was also observed for ferritin (p=0.02) and transferrin (p=0.02). In terms of PI, The strongest associations were also found for iron (p<0.0001). Additionally, the value of body mass index (BMI) showed significant correlation with PI (p=0.04). The correlations of dietary total antioxidant indices with dietary intakes and anthropometric and biochemical biomarkers were assessed. Non-significant correlation was found between fasting blood sugar (FBS), hemoglobin A1C (HbA1C), vitamin B12, and vitamin D3 with ORAC index. Significant strong correlation showed for the value of iron in both ferric reducing ability of plasma (FRAP) and Oxygen Radical Absorbance Capacity (ORAC) indices (p<0.0001). Conclusion: We find statistical significance correlation for dietary PI and BMI. The inflammatory and antioxidant properties of diet were not related to biochemical markers associated with obesity. Figure not available: see fulltext. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature