Average values for real-time two and three-dimensional echocardiographic parameters of mitral and tricuspid valves in a healthy Iranian population

Background: The reliability and validity of echocardiography are critical issues. Day and age, defining normal cases necessitates expressing natural physiological differences, including ethnicity. OBJECTIVE: We are persuaded to evaluate average values in mitral and tricuspid valves in the Iranian population because only a few studies have been conducted to obtain average measures in echocardiography.Methods: This six-month study was conducted in a tertiary center’s echocardiography lab. This study included 87 healthy Iranian volunteers who had no health issues. The tricuspid and mitral valves were examined using three and two-dimensional echocardiography. The investigated indicators produced normal data. The cases were divided into six age groups with a 12-year age gap. Results: The participants ranged in age from 18 to 90, with 35 males (40/2 %) and 52 females (59/8%). By comparing tricuspid and mitral valve indices, this study found a difference between men and women (P-value<0.05). Furthermore, a difference in MV3D1, MV2CH1, MVPLAX1, MV3D2, MV4CH1, MV2CH1, MV ALAX2, MV2CH2, MV TENTING AREA, MV AREA indices at the mitral valve, and SAX2 TV4CH1, TV4CH2, TVSAX1, TVRVIF2 indices at the tricuspid valve was observed in various age groups (P-value<0.05).Conclusions: Our findings confirmed that gender and age impacted echocardiographic parameters, with a trend of decreasing measurements after 65 years of age and the most significant dimensions obtained after 42 years of age

Arterial Stiffness and its Correlation with the Extent of Coronary Artery Disease

Introduction: Coronary artery disease secondary to atherosclerosis is the most common cause of mortality. Coronary angiography is the most precise method for determining the extent of disease in the coronary vascular bed. Arterial stiffness has been proposed as a marker of atherosclerosis in some studies. One of the noninvasive methods for the determination of arterial stiffness is Doppler echocardiography. In this study, we aimed to find the correlation between arterial stiffness as measured by echocardiography and the extent of coronary artery disease as evaluated through angiography. Materials and Methods: Aortic pulse wave velocity (APWV) was measured by using the Doppler method in 70 patients, who were candidates for coronary angiography. The extent of coronary artery disease was determined quantitatively in terms of Friesinger index and semi-quantitatively as the number of vessels with stenosis of over 50%. Then, the correlation between arterial stiffness and these factors was evaluated. Results: The mean APWV was 9.1±5 m/s. There was a direct relationship between APWV and Friesinger index, which was not statistically significant (P=0.67). The mean APWV for patients with one-vessel disease was 4.4±1.8 m/s, while it was 9.9±3.6 m/s in patients with two and 7.9±4 m/s in three-vessel disease which did not show statistically significant difference. Conclusion: Doppler echocardiography to measure APWV was not considered as a promising tool to predict the extent of coronary artery disease

Knowledge and Attitude of Pediatricians and Pediatric Residents Regarding Child Abuse and Neglect

Introduction:Child abuse and neglect is a public health challenge with lifelong consequences for survivors. Physicians’ knowledge regarding child abuse and neglect is essential for diagnosis, treatment, and timely referral to legal authorities. This study aimed to determine pediatric residents’ and pediatricians’ knowledge and attitude regarding child abuse and neglect.Methods: In this cross-sectional study, pediatric residents› and pediatricians› knowledge and attitude regarding child abuse and neglect were measured using a standard questionnaire with confirmed validity and reliability. In this questionnaire, knowledge score ranged from 0 to 17, and attitude score ranged from 10 to 50. After collecting the questionnaires and calculating the scores, the information was entered into the SPSS software (version 22), and statistical analysis was performed.Results: A total of 80 participants, including 38 pediatric residents and 42 pediatricians, participated in this research. Among them, 71.3% were female, and 28.8% were male. The mean score of knowledge and attitude in all participants was 14.05 ± 1.88 out of 17 and 41.39 ± 4.36 out of 50, respectively. The mean score in the pediatric residents and pediatricians was 13.42 ± 2.02.  and 14.62 ± 1.57 for knowledge and 40.66 ± 4.32 and 42.05 ± 4.35 for attitude, respectively. Regarding knowledge, 19 participants (23.8%) had a good score, 35 (43.8%) had a moderate score, and 26 (32.5%) had a poor score (p=0.24). There was a significant difference in terms of knowledge score among four academic groups (first-year resident, second-year resident, third-year resident, and pediatrician) (p=0.031), as the score wassignificantly higher in pediatricians than in residents (p=0.004). However, no significant difference was observed for attitude score (p=0.056). In general, and regarding all participants, no significant relationship was observed between attitude score and knowledge score (p=0.059).Conclusion: Most pediatric residents and pediatricians participating in the present study had moderate knowledge and attitude toward child abuse and neglect, and less than a quarter of the participants had good knowledge in this regard. Also, the pediatricians had significantly higher knowledge scores than the pediatric residents. These results emphasize the importance of more education for pediatric residents regarding child abuse and neglect and continuing education programs for pediatricians

Primary Angle Closure Glaucoma-associated Genetic Polymorphisms in Northeast Iran

Purpose: To evaluate the association of five different polymorphisms from a genomewide- associated study with susceptibility to glaucoma in the northeast Iranian population. Methods: Hundred and thirty patients with primary angle closure glaucoma (PACG) and 130 healthy controls were genotyped for the polymorphic regions with the aid of tetraamplification refractory mutation system-polymerase chain reaction. The association of these variants with the disease susceptibility was measured statistically with the logistic regression method. Results: Hundred and thirty patients with PACG (53 males, 77 females) with a mean age of 64.5 ± 6.2 years and 130 healthy control subjects (51 males, 79 females) with a mean age of 64.0 ± 5.7 years were selected for evaluation. There was a significant association between rs3816415 (P = 0.005), rs736893 (P &lt; 0.001), rs7494379 (P &lt; 0.001), and rs1258267 (P = 0.02) with PACG susceptibility. This association could not be shown for rs3739821. Conclusion: It was revealed that studied variants in GLIS3, EPDR1, FERMT2, and CHAT genes can contribute to the incidence of PACG. Additional studies in other populations are needed to evaluate DPM2-FAM102A

A National Survey: Desire of Dermatology Residents to Train in Cosmetic Dermatology and Its Association With Learning Medical Dermatology

The main challenge for training in cosmetic dermatology is the difference in the attitudes of residency programs and residents about the necessity and amount of education during the residency period. A national online survey conducted between September 6th and November 21st, 2017. Residents, members of the Iranian Board of Dermatology, faculty members and program directors (PDs) were asked to participate in the survey.174 participants from 12 residency programs participated in this study and the response rate of residents, professors, and Dermatology Board Directory Members (Boardmans) and PDs was 89.8%, 61.7%, and 81.8%, respectively. Residents declared greater tendency towards practicing medical dermatology (mean score, 5.165±0.8335) over the five years after graduation than that of was perceived by professors (4.043±1.2988), and Boardmans and PDs (4.059±1.0290) (P˂0.001). The first residents’ priority was practicing in medical dermatology (5.165±0.8335) during 5-years after graduation. However, professors (5.261±0.8282) and Boardmans and PDs (5.176±0.7276) predicted residents' first priority would be practicing cosmetic dermatology (P˂0.001). Forty one (60.3%) of the professors, Boardmans, and PDs agreed or strongly agreed that residents’ desire to learn more about cosmetic procedures resulted in their decreased interest in learning medical procedures (P=0.18). Medical dermatology is still clearly the basis for training in residency programs,and even for residents who have a high tendency to practice cosmetic dermatology, there is a strong tendency to work in the field of medical dermatology as well

Investigating the Manifestation of Coronary Artery Disease and Determining the Role of Effective Factors in the Need for Pacemaker Insertion in These Patients

BACKGROUND: Many patients who are candidates for a pacemaker are also at the same time risk factors for coronary artery disease such as high blood pressure, hypertension, diabetes, and hyperlipidemia, and therefore the probability of having coronary artery disease is significant. Effective diagnostic measures can be taken to prove the factors affecting the incidence of CAD in patients undergoing pacemakers at high-risk, including angiography. Therefore, it can prevent complications during and after pacemaker implantation, which leads to an increase in the quality of treatment in patients requiring pacemaker implantation. AIM: Therefore, the purpose of this study was to determine the predictive factors of significant coronary artery disease in patients with pacemaker implantation to identify patients in need of coronary angiography at the time of pacemaker implantation. METHODS: This retrospective study was carried out to examine the patients' files that were placed at the heart of Imam Reza Hospital during the period between March 2017 and September 2017. Demographic data, risk factors, echocardiography findings, and angiography, were collected and then recorded using a checklist. Statistical analysis was performed using SPSS software version 22 and Chi-square, and Mann-Whitney tests were used for determining significates variables. RESULTS: A group of 102 patients who had undergone a permanent cardiac pacemaker insertion due to an atrioventricular (AV) Block were included in the study, and also coronary anatomy was determined coronary angiography. Based on the results, 13.7% of patients with cardiac pacemaker had obstructive coronary artery disease (stenosis &gt; 70%). Factors affecting coronary artery stenosis on angiography include gender, chest pain, history of myocardial infarction, angioplasty, diabetes, smoking, history of aspirin intake, calcium blocker and Plavix, high hematocrit, ST elevation and ST depression in the ECG, and severe mitral regurgitation. CONCLUSION: It seems that in most patients requiring permanent pacemaker insertion because of the atrioventricular (AV) Block, angiography does not change the patient's fate, and so can be ignored. However, in patients who have several risk factors from the listed above, coronary angiography is recommended during admission

Evaluation of the validity and reliability of the Persian version of Iowa Satisfaction with Anesthesia Scale in Iran

Introduction: The interaction between the doctor and the patient achieved when the physician is able to communicate effectively with the patient. Iowa Satisfaction with Anesthesia Scale is a tool for this purpose. Given that ISAS is originally in English and understudy in Iran, we decided to translate this scale into Persian and evaluate its validity and reliability.Purpose: Our aim in this study is translating, validity and reliability of ISAS.Methods: This study is an observational study with a correlational design that adopts an analytical approach. The population consisted of all patients undergoing surgery at Imam Reza Hospital out of whom 162 patients met the inclusion criteria, i.e. aged 18 years and above, transferred from the OP to ICU, exposed to general anesthesia and signed the consent form.Results: Patients completed the questionnaire in 5 minutes. The mean (maximum-minimum) age of the patients was 57.39 (18-87). As for gender, 102 (63%) of patients were male and 56 (34.6%) were female. About 4 (2.5%) of the data went missing. Cronbach's Alpha was 0.85. The correlation analysis showed that Iowa scale was significantly correlated with RP (P = 0.007), BP (P = 0.002), RE (P = 0.007) and GH (P = 0.012). The PSQ questionnaire had a significant correlation with the LOWA questionnaire (p < 0.001).Conclusion: Validity and reliability of the Persian version of Iowa Satisfaction with Anesthesia Scale (ISAS) in Iran are excellent

Methylene Blue for Treatment of Hospitalized COVID-19 Patients, Randomized, Controlled, Open-Label Clinical Trial, Phase 3

Funding: This work was supported by a grant from Mashhad University of Medical Sciences (Grant number: 990096, 990845). Acknowledgements: The authors gratefully acknowledge the nurses in Iamm Reza Hospital, Shariati Hospital, Hasheminejad Hospital for their excellent cooperation.Peer reviewedPublisher PD

The Risk Factors of Prolonged Mechanical Ventilation after Isolated Coronary Artery Bypass Graft Surgery

Background: Failure to wean a patient from mechanical ventilation after cardiac surgery is associatedwith poor outcome.Aim: The present study was performed aimed to investigate the risk factors of prolonged mechanicalventilation (PMV) following isolated coronary artery bypass graft (CABG) surgery.Method: This retrospective cohort study was performed on 2155 consecutive adult patientsundergoing isolated coronary artery bypass graft surgery (May 2012 to November 2016 at Imam Rezahospital, Mashhad, Iran). The subjects were assessed for duration of weaning from mechanicalventilation, predictive risk factors for prolonged mechanical ventilation and associated outcomesincluding intensive care unit (ICU) and hospital length of stay (LOS), and mortality. Data wereanalyzed by SPSS (version 22). P<0.05 was considered statistically significant.Results: The median (25 -75 percentile) duration of mechanical ventilation was 360 (225-540)minutes. Also, 51.20%, 45.80% and 2.30% patients were weaned from mechanical ventilation in lessthan 6 hours, 7 to 24 hours, and more than 24 hours, respectively. Cerebral vascular accident was themost common cause of PMV (34.04%). After adjustment for confounder variables, on-pump CABG(P<0.05), duration of surgery (P<0.01), preoperative renal failure (P<0.05) and New York HeartAssociation (NYHA) class 4 were associated with PMV (P <0.05). PMV was associated withincreased length of ICU and hospital stay (P<0.01). There was a higher mortality rates in patients withPMV (P<0.001).Implications for Practice: Most patients are weaned from mechanical ventilation within 24 hoursuneventfully after isolated CABG. Furthermore, on-pump CABG, prolonged surgery, preoperativerenal insufficiency, and NYHA class 4 were independent predictors of prolonged mechanicalventilation. Identifying the risk factors causing PMV can prevent its adverse consequences

Effects of Changing GnRH Agonist to Antagonist or Vice Versa on M2 Oocytes, Clinical Pregnancy and Live Birth Rates in Two Consequent IVF Cycles

Objectives: The objective of this study was to investigate the impact of changing the ovarian stimulation protocol from gonadotropinreleasing hormone (GnRH) agonists to antagonists, or vice versa, on the outcomes of in vitro fertilization (IVF) in the same groups of patients. Materials and Methods: This study was a cohort study of women with infertility who had a history of two consequent IVF cycles due to an unsuccessful previous attempt and were recruited between 2016 and 2019. The patients were treated with either an agonist or antagonist protocol in the first or second round. They were categorized into two groups based on whether the second round was the same as the first one or different. The primary outcomes included the number of M2 oocytes, the number of transferred embryos, the chemical pregnancy rate, and the clinical pregnancy rate. The secondary outcome was the live birth rate. Statistical analyses were performed using SPSS version 26 software. Results: A total of 39 women and 78 cycles with a history of infertility, with a mean age of 29.72 (5.36, SD), were evaluated in two groups: same (17, 43.6%) and different (22, 56.4%) protocols. Primary infertility was the most frequent type of infertility, recorded in 31 (79.6%) individuals. No significant differences were found between the two groups in terms of mean endometrial diameter (P=0.820), HCG administration (P=0.069), mean stimulation duration (P=0.931), mean total dose of administered gonadotropins (P>0.05), and embryo transfer types (P= 0.051). Also, no significant differences were found in the primary outcomes between the same and different protocol groups (P>0.05). The live birth rate also showed no significant difference as a secondary outcome (P = 0.954). Conclusions: This study found no significant difference in IVF outcomes when switching between GnRH agonist and antagonist protocols or using the same protocol for consecutive rounds