Right Atrial Thrombus in a COVID-19 Child Treated Through Cardiac Surgery

We herein report a case of large intracardiac thrombus in a child with SARS-CoV-2 infection (COVID-19). The diagnosis of COVID-19 was confirmed through HRCT and RT-PCR. Transthoracic echocardiography revealed a large thrombus in the right atrium treated successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory condition incurred by the COVID-19 virus

The Yin and Yang of Sodium Lauryl Sulfate Use for Oral and Periodontal Health: A Literature Review

Sodium lauryl sulfate (SLS) is an anionic surfactant, which has a wide range of usage in the health sector and in dental pharmaceutical products, especially in toothpastes. The objective of this review was to investigate the effects of SLS containing dentifrices on oral and periodontal health, possible side effects, and its benefits. A thorough literature search was done using databases of PubMed and Google Scholar and finally, 40 articles were included in the study. This narrative review revealed the sources of discrepancy and conflicting results regarding the impact of SLS on oral cavity as well as a lack of sufficient evidence in most topics. Hence, the evidence suggests improved drug bioavailability when used as a solubilizer, improved plaque control, and reduction in bad breath. On the other hand, SLS can serve as a risk indicator of prolonged oral wound healing time, recurrent aphthous stomatitis

Report of a Coarctation of Aorta Stenting in an Infant

Coarctation of aorta (CoA) is a congenital heart disease that can lead to heart failure during infancy and neonatal period. Several treatments have been proposed for this disease, including surgery and balloon angioplasty. The experiences of using stents in small infants or neonatal patients are very low. In this article, we report a 3 months old age infant who after balloon angioplasty, his CoA symptoms had return and stenting of CoA was performed for him

Relationship between echocardiographic findings and laboratory serum biomarkers in patients with and without low cardiac output

Abstract BACKGROUND: Cardiac dysfunction is seen in many patients and could be evaluated with echocardiography and serum biomarkers. The aim of this study was evaluation of the relationship between echocardiographic findings and laboratory serum biomarkers in children with and without low cardiac output

Comparison of short head-up tilt test with conventional protocol after omission of nonmedicated phase in children and young adults

Background: Syncope is an important and common clinical condition, and the neurally mediated syncope is the most frequent type of syncope. Tilt testing is considered as a first-line diagnostic test. Materials and Methods: We conducted the conventional and modified tilt test on 200 subjects in the age range of 5-20 years. In conventional protocol, the patient was tilted for up to 15 min without medication. If syncope did not develop, the patient received 0.1 mg/kg sublingual isosorbide dinitrate. Then, the patient was continued to be tilted for another 15 min. In modified tilt test, before starting the test, the patient received 0.1 mg/kg isosorbide dinitrate sublingually in supine position. Then, the table was tilted for a maximum of 25 min or until the test became positive. Results: In conventional tilt test group 79.13% and in modified tilt test group 87.06% of subjects showed positive results. In conventional tilt test, the mean of response time was 17.67 ± 4.74 min. The mean of the total time of conventional tilt test was 49.81 ± 5.57 min. In modified tilt test, the mean of response time was 7.24 ± 4.83 min. The mean of the total time of modified tilt test was 35.09 ± 7.58 min. Furthermore, the means of both response and total times between two groups were significantly different (P < 0.001). Conclusions: Our study showed that we can save about 15-20 min in total test time which may increase the cooperation and compliance of young patients and decrease their anxiety with this new protocol

Congenital cardiac malformations in congenital hypothyroid patients in Isfahan

BACKGROUND: Congenital hypothyroidism (CH) often seems to be associated with other congenital abnormalities, mostly cardiac in nature. The aim of this study was to determine the prevalence of cardiac malformations in patients with CH diagnosed during CH screening program in Isfahan.&#13; METHODS: In this cross-sectional study, cardiac malformations were determined in CH patients were compared to controls using echocardiography. The association between cardiac malformations and mean T4 and TSH concentrations, etiology of CH according to radiologic findings and permanent and transient CH were studied in CH patients.&#13; RESULTS: Overall, 96 and 59 subjects were included in the case and control groups, respectively. Cardiac malformations were present in 30.2% (n = 29) and 15.2% (n = 9) of case and control groups, respectively; i.e. a higher prevalence in CH patients than in controls (P = 0.03). The prevalence of cardiac malformations without patent foramen oval was 6.25% (n = 6) in CH patients and 1.7% (n = 1) in control group (P = 0.1). There was no significant association between the presence of cardiac malformations and the aforementioned variables.&#13; CONCLUSIONS: High prevalence of cardiac malformations in CH patients strongly suggests the potential involvement of genetic factors in the pathogenesis of CH. This emphasizes on the necessity of genetic studies involving CH patients.&#13; KEY WORDS: Congenital hypothyroidism, cardiac malformations, genetics

Midterm follow-up results of transcatheter interatrial septal defect closure

Objectives: We studied immediate and midterm results of transcatheter closure of atrial septal defects (ASDs) using the Amplatzer septal device closure. Methods: The study included one hundred and thirty-seven patients (31 men, 106 women; mean age 8 ± 7.3 years; range 1–65 years) who underwent transcatheter closure of secundum ASD between October 2014 and October 2016 in our center. All the patients were evaluated by transthoracic echocardiography before and during the procedure and in adult patients; transesophageal echocardiography was performed before the procedure. Closure of ASDs was performed under general anesthesia with transthoracic echocardiographic guidance. Follow-up controls were done on the day after procedure, 1 week, 1, 3, 6, and 12 months, and annually thereafter. The median follow-up periods of ASD was 15 months. Results: The mean ASD and device size were 13.5 ± 2.3 and 14.3 ± 3.2 mm, respectively. The mean procedural and fluoroscopy times were 21.3 ± 4.7 and 5.1 ± 1.9 min. Immediate complications such as mortality, bleeding, fatal arrhythmia, and device embolization did not occur in any patient during and after the procedure. Cardiac arrhythmias were seen in 4 patients during the 1st month after the procedure. Late device embolization did not occur during the follow-up. No residual shunts were seen after the procedure. Transient ischemic attack was seen in one patient during the procedure and in one patient 2 days after the procedure without long-term complication. Conclusion: Transcatheter closure of ASDs using the Amplatzer devices is an efficacious and safe therapeutic option

Efficacy of treatment in children and adolescents with vasovagal syncope in the long term: an 8-year follow-up study

Background: Syncope is a temporary loss of consciousness with a loss of postural tone. Medicinal treatment of reflex syncope has shown to have no significant effect in reducing the recurrence of syncope. A 36-month follow-up of our pilot cohort showed that non-pharmacological treatments alone were effective in reducing relapse rates. The purpose of this study is to investigate long-term results and 8-year follow-up of previous patients. Methods: The current study is a continuation of a prospective pilot cohort which was done between August 2013 and 2014 in two academic hospitals in Isfahan (Dr. Chamran heart center and Imam Hossein children hospitals). This current study examines the 8-year follow-up results of children with reflex syncope who were treated with non-pharmacological treatments alone or with drugs. Therefore, the patients who participated in the pilot study were enrolled (30 patients in the pharmacologic group and 40 patients non-pharmacological group). Finally, on 26 patients in the pharmacologic group and 31 patients in the non-pharmacological group (after applying the exclusion criteria), the incidence of syncope and pre-syncope attacks was compared between these two groups of patients using the Chi-square test. Results: Our study showed that within 5 years after the last follow-up, the incidence of syncope and pre-syncope in patients with a history of vasovagal syncope who did not continue the diet or tilt exercises was different between the two groups of patients (without medication and drug recipient) was not significantly different, even the incidence of presyncope increased significantly again in both groups. The incidence of syncope in the period of 5 years after the last follow-up from the previous study was slightly increased in the group of patients without medication compared to the previous periods, but in the group of patients receiving medication, this incidence decreased slightly. Conclusion: In order to prevent recurrence, the use of non-pharmacological methods is effective, but for the stability of this recovery, follow-up and continuation of these methods is necessary

Problems and challenges in providing feedback to clinical teachers on their educational performance: A mixed-methods study

INTRODUCTION: Given the importance of feedback to improve teachers' educational performance, the current study aimed to identify the challenges and problems involved in providing feedback to clinical teachers on their educational performance. MATERIALS AND METHODS: In the first phase of this mixed-methods study, the clinical teachers, students, and university officials were interviewed on feedback problems and challenges. After an inductive content analysis, and based on the problems enlisted, a ten-item questionnaire was developed. Subsequently, 25 clinical teachers completed the questionnaire by scoring the importance and urgency of each problem. RESULTS: Overall, 18 individual and group interviews were conducted with 24 people. A total of ten themes and five categories emerged, including “lack of transparency of feedback system,” “absence of criticizability culture,” “lack of motivation to improve performance,” “failure to consider factors affecting teacher's performance,” “lack of formative evaluation,” “inappropriate data obtained on teacher's performance,” “inappropriate feedback providers,” “inappropriate feedback recipients,” “inappropriate feedback provision,” and “no feedback follow-up.” Three items of priority involved “inappropriate feedback providers,” “inappropriate data,” and “failure to consider factors affecting the teacher's performance.” CONCLUSIONS: All the raised problems obtained high scores; nevertheless, the interviewees had more problems with the feedback provider, the data collected on the performance, and inattention of university officials to the factors influencing performance than feedback presentation methods. Hence, gaining the trust of teachers on the collected data, providing feedback by their trustworthy individuals, and paying attention to the factors influencing teachers' performance are associated with an increased possibility of feedback acceptance

The Effect of Vitamin C on Endothelial Function of Children with Type 1 Diabetes: An Experimental Study

Background: Considering the importance of improvement of endothelial function in patients with type 1 diabetes mellitus (DM) and to prevent its related micro- and macro-vascular complications; in this study, the effect of vitamin C administration on improving endothelial function of children with type 1 diabetes was investigated. Methods: In this analytic-experimental study, children with type 1 DM aged 6-18 years and a group of healthy children enrolled. Vitamin C (250 mg/daily) administrated for the two studied groups for 1-month. Endothelial function evaluated by flow-mediated dilatation (FMD) and intima-media thickness (IMT) measurement using vascular Doppler ultrasonography, before and after trial. Results: In this study, 18 patients with type 1 diabetes (DM) and 19 normal children as the control group were studied. After vitamin C administration IMT reduced in all studied groups (P 0.05). Mean differences of IMT 2 - IMT 1, FMD 2 - FMD 1, LV mass 2 - LV mass 1 and BP were not significantly different in patients with HbA1c ≤ 7 g/dl and those with HbA1c >7 g/dl and control group (P > 0.05). Conclusions: The findings of the current study indicated that vitamin C may have a protective effect on endothelial dysfunction, but regarding its effectiveness among the high-risk population such as diabetic patients with and without appropriate glycemic control the study was not sufficiently powered due to its small sample size