ABO and Rh blood groups in patients with lupus and rheumatoid arthritis

Background: Systemic lupus erythematous (SLE) and rheumatoid arthritis (RA) are autoimmune diseases in which the antigen-antibody system plays an important role. As blood group and Rh are determined by the presence or absence of antigens on the surface of red blood cells (RBCs), we aimed to determine the distribution of ABO and Rh blood groups in SLE and RA patients and its association with disease manifestations. Methods: This short communication is based on a study that was conducted on 434 SLE and 828 RA patients. We evaluated the distribution of ABO and Rh blood groups in RA and SLE patients. Results: This study projected that in lupus patients, Coombs-positive autoimmune hemolytic anemia and arthritis were more common among the B blood type and Rh-positive group, respectively. Furthermore, there was no relation between ABO and Rh blood group and rheumatoid factor (RF) and anti-Cyclic Citrullinated Peptide (anti-CCP) seropositivity. Moreover, there was no difference in distribution of blood groups in RA and SLE patients. Conclusion: The higher frequency of blood group B in hemolytic anemia, and positive Rh in arthritis in lupus patients, develop the hypothesis of probable role of ABO blood group antigen in some manifestations of lupus. Keywords: Rheumatoid arthritis (RA); Systemic lupus erythematosus (SLE); ABO blood group, Rh blood group

Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy

Introduction: Regarding to the recent advances in assisted reproductive techniques (ART), twin and multiple pregnancies have increased during past years. Objective: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy. Materials and Methods: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group (n=96) and ART group (n=31). Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications (preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation (IUGR), postpartum hemorrhage), neonatal outcomes (weight, first and fifth minuteP PApgar score, Neonatal Intensive Care Unit (NICU) admission, mortality, respiratory distress, and icterus) were recorded using a questionnaire. Results: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death (IUFD) were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes (weight, 1PstP and 5PthP min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus). Conclusion: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART

Prediction of the ischemic origin of functional mitral regurgitation in patients with systolic heart failure through posterior mitral leaflet angle

BACKGROUND: Differentiating ischemic from non-ischemic functional mitral regurgitation‎ (FMR) in patients with cardiomyopathy is important in terms of the therapeutic decision-making and prognosis, but might be clinically challenging. In this study, the deformation of mitral valve (MV) indices in the prediction of the etiology of FMR was assessed using 2D transthoracic and tissue Doppler echocardiography.METHODS: This case-control study was conducted from April 2015 to January 2016 in Imam Reza Hospital in Mashhad, Iran. The participants consisted of 40 patients with ischemic cardiomyopathy (ICM) and 22 with non-ischemic dilated cardiomyopathy (DCM) who referred to the heart failure clinic. Transthoracic echocardiography was performed using the conventional 2D and tissue Doppler imaging (TDI). MV tenting area (TA), coaptation distance (CD), anterior and posterior mitral leaflet angles (AMLA and PMLA), and regional systolic myocardial velocity (Sm) were measured.RESULTS: There were no significant differences in echocardiographic indices between the two groups, besides Sm and PMLA which were significantly lower and higher, respectively, in ICM subjects in comparison with DCM patients (P = 0.002). PMLA ≥ 40 degrees and Sm ≤ 4 cm/second have a relatively high value for discriminating the ischemic from non-ischemic origin of functional MR in subjects with systolic heart failure (sensitivity: 80.0% and 70.0%, specificity: 73.0% and 77.3%; P = 0.001 and P &lt; 0.001; respectively). Multivariable logistic regression identified PMLA and anterior Sm as major determinants for ischemic MR {Odds ratio (OR) [95% confidence interval (CI)] = 0.89 (0.82-0.96), P = 0.003, OR (95% CI) = 0.29 (0.14-0.60), P = 0.001, respectively}.CONCLUSION: The present study showed that PMLA and Sm had an independent significant association with the mechanism of FMR. These findings are suggestive of the predictive role of mitral deformation echocardiographic indices in the determination of the etiology of FMR in systolic heart failure.</div

Indications, Results and Mortality of Pulmonary Artery Banding Procedure: a Brief Review and Five- year Experiences

Background Pulmonary artery banding (PAB) is a technique of palliative surgical therapy used by congenital heart surgeons as a staged approach to operative correction of congenital heart defects. Materials and Methods We report 5- year experiences from January 2011 to January 2016 of Imam Reza Hospital center (a tertiary referral hospital in Mashhad city, North East of Iran) that consist of 50 patients with congenital heart disease with left to right shunt that pulmonary artery banding procedure was performed for them were studied. Results Age of patients (n=50) was 1to 9 months (mean=4.6 + 1.3). In this study, the most common disease that need to PAB procedure was Ventricular septal defect (VSD) with twenty-eight patients (56%). Mean of extubation time (hour) was 10.4 + 0.8 and mean of hospital stay (day) was 13.3 + 2.4 respectively. Conclusion Although the number of pulmonary artery banding palliation surgery was decreased, but in selected group of congenital heart disease, this palliation to reduce over circulation of Pulmonary system, can use successfully with acceptable results and low mortality. We suggest pulmonary artery banding palliative surgery in these selected patients

Comparison of Echocardiographic Abnormalities in Psoriasis Patients with the Control Group

Introduction: Psoriasis is a chronic inflammatory skin disease characterized by plaques covered with silvery scales. Psoriasis is highly prevalent in different countries in the world, including Iran. Several studies have reported a significant association between psoriasis and cardiovascular diseases. This study aimed to evaluate the relationship between psoriasis and cardiac disease using echocardiography.Materials and Methods: This cross-sectional study was conducted in Imam Reza Hospital of Mashhad, Iran during 2013-2014 on patients with clinical diagnosis of psoriasis confirmed via biopsy. In addition, healthy volunteers homogenous in terms of age and gender were selected as the control group. Echocardiography was performed on patients and control subjects. Size of the left and right ventricles, left ventricle ejection fraction, diastolic function, and pulmonary artery pressure were recorded. In addition, patients were assessed in terms of the presence of valve regurgitation and disease severity.Results: In total, 23 patients with psoriasis and 23 control subjects were enrolled in this study. Mean duration of psoriasis was 7.0±9.1 years (range: 1-25 years), and disease severity ranged between moderate and severe. Left ventricular end-diastolic and systolic diameters were significantly higher in patients with psoriasis (P=0.030 and P=0.016, respectively). Moreover, left ventricular diastolic dysfunction was observed in 14 psoriasis patients (60.8%) and 3 control subjects (13.4%) (

Diastolic Function Changes during Stress Echocardiography in Hypertensive Patients

Background Some hypertensive patients experience dyspnea with exercise due to rise in filling pressures. So, exercise is helpful to determine left ventricular filling tension. Objectives This study aims to evaluate the effect of dobutamine stress echocardiography on diastolic function in hypertensive patients with normal ejection fraction. Methods In this study, 30 hypertensive patients (52.7 ± 3.6 years) and 30 sex and age matched healthy controls (50.8 ± 7.6 years) were examined. Exclusion criteria were patients with coronary artery disease, significant valvular heart disease, hypertrophic cardiomyopathy, left ventricular systolic dysfunction (EF (ejection fraction) < 50%), atrial fibrillation and bad echogenic view. We performed complete echocardiography and dobutamine stress echocardiography with pulsed wave Doppler tissue imaging at rest and during peak stress to measure primary mitral inflow diastolic wave rate (E), late mitral inflow diastolic wave rate (A), E/A ratio, primary diastolic myocardial wave rate (E′) and late diastolic myocardial wave velocity (A’). Results At rest, E’ was significantly lower in patients than controls (8.2 ± 1.6 vs 14.7 ± 2.6 P value < 0.001) and E/E (early mitral inflow diastolic wave rate/early myocardial diastolic wave rate) was significantly higher in patients (7.6 ± 1.2 vs 4.8 ± 1.0 P value <0.001). At peak stress, E/A ratio was significantly lower in patients (P < 0.001) while E/E′ was significantly higher in patients than controls (8.3 ± 2.1 vs 4.7 ± 0.7 P value < 0.001). Conclusions Dobutamine stress echocardiography with Doppler tissue study is effective in the evaluation of hypertensive patients with dyspnea on exertion with normal resting echocardiography

Scleroderma and Mitral Stenosis: A New Cardiac Involvement or an Association by Chance

Systemic Sclerosis (SSc) is an autoimmune disorder with unknown etiology, which presents with vascular lesions and fibrosis of the skin and internal organs. Cardiac, renal, and pulmonary involvements are major causes of death in systemic sclerosis. Although a major cause of scleroderma deaths is cardiac failure, scleroderma rarely causes valvular disease. We report the case of a 48-year-old woman with severe mitral stenosis who was diagnosed with scleroderma 6 months before. Echocardiographic assessments had revealed no clinical manifestation of heart involvement in her previous visits. We used cardiac surgical treatment with successful outcome. The present case confirms the data from the currently available literature, indicating that mitral valve involvement in systemic sclerosis is a rare occurrence. Awareness of this uncommon association and adequate management to prevent complications of the underlying disease are prerequisites for successful mitral valve repair or replacement in such patients

Down syndrome and consanguinity

Background: Among the genetics disorders, Down syndrome (DS) is the major cause of mental retardation, congenital heart and intestinal disease. So far, no certain therapeutic method has been suggested for the treatment of this syndrome. The aim of the current survey was to investigate the frequency of parental consanguinity, maternal age in the patients with DS. Materials and Methods: This study was conducted on 38 consecutive patients with clinically and laboratory confirmed DS who referred to the genetic lab of a referral University Hospital. The G-banding method for karyotyping was employed. Results: The patients were 21 males and 17 females within the age of 16 days to 28 years old. Free trisomy (92.1%, n = 35) was the most common chromosomal abnormality. The frequency of DS was higher among the non-consanguine marriages (71.1%) in comparison with the consanguine marriages (28.9%). Mean age of the mothers in the consanguine marriages (mean = 27.1 ± 6.3) was lower than in the non-consanguine marriages (mean = 31.1 ± 7.7). Conclusion: Higher frequency of DS among the non-consanguine marriages in comparison with the consanguine marriages, may suggest that DS diagnostic tests might be done on all embryos regardless of the parents′ familial relationship

Upper Extremity Ischemia Complicating Ulcerative Plaque in Descending Aorta

A 54-year-old female patient was presented with upper extremity ischemia. Further investigation revealed ulcerated atherosclerosis plaque in aorta with intramural hematoma and clot formation. The subject underwent a successful surgical resection of mass with the assistance of cardiopulmonary bypass and total circulatory arrest

Call to action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE)

Background and purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic.Methods: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center.Conclusion: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities