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

Impaired IL-23-dependent induction of IFN-gamma underlies mycobacterial disease in patients with inherited TYK2 deficiency

Human cells homozygous for rare loss-of-expression (LOE) TYK2 alleles have impaired, but not abolished, cellular responses to IFN-alpha/beta (underlying viral diseases in the patients) and to IL-12 and IL-23 (underlying mycobacterial diseases). Cells homozygous for the common P1104A TYK2 allele have selectively impaired responses to IL-23 (underlying isolated mycobacterial disease). We report three new forms of TYK2 deficiency in six patients from five families homozygous for rare TYK2 alleles (R864C, G996R, G634E, or G1010D) or compound heterozygous for P1104A and a rare allele (A928V). All these missense alleles encode detectable proteins. The R864C and G1010D alleles are hypomorphic and loss-of-function (LOF), respectively, across signaling pathways. By contrast, hypomorphic G996R, G634E, and A928V mutations selectively impair responses to IL-23, like P1104A. Impairment of the IL-23-dependent induction of IFN-gamma is the only mechanism of mycobacterial disease common to patients with complete TYK2 deficiency with or without TYK2 expression, partial TYK2 deficiency across signaling pathways, or rare or common partial TYK2 deficiency specific for IL-23 signaling.ANRS Nord-Sud ; CIBSS ; CODI ; Comité para el Desarrollo de la Investigación ; Fulbright Future Scholarshi

A MAN WITH A HYDATID CYST IN THE HEART

Infection with echinococcus has a world-wide distribution. This parasite affection almost all body organs (such as brain, lungs, spleen, billiary tract, liver, thyroid, parotid, tongue, bone, prostate, bladder, tonsile, pulmonary arteries and inferior vena cava). The other important body organ which also is infected by this parasite is the heart.
 The patient is a 32 year old man without any symptoms who referred for the evaluation of incidental cardiac murmur on physical examination. All findings in ECG and Chest X ray were normal. Echocardiography showed a large moblie cystic mass in left ventricular outflow tract.
 Because of the dangerous site of the cyst and probability of rupture and anaphylaxis, he was operated emergently and the cyst was removed successfully. He was discharged from the hospital without any residual LV dysfunction, heart block and cardiac problems

Analytically based photon scatter modeling for a multipinhole cardiac SPECT camera

Purpose: Dedicated cardiac SPECT scanners have improved performance over standard gamma cameras allowing reductions in acquisition times and/or injected activity. One approach to improving performance has been to use pinhole collimators, but this can cause position-dependent variations in att

SU‐FF‐T‐89: Comparison of RADPOS 4D in Vivo Dosimetry System with Phillips Bellows and Varian RPM Systems

Purpose: To present the latest data on the newly‐developed RADPOS 4D in vivo dosimetry system including comparisons with the Phillips Bellows and Varian RPM systems. Methods and Materials: A 4D Quasar phantom was set‐up on the couch of a Phillips Brilliance CT scanner and set to move in a sinusoidal pattern with amplitude of 1 cm. The Phillips Bellows belt was secured around the moving translation stage and was used to record the motion of the stage. The same motion was also measured by a RADPOS detector. This procedure was repeated on the couch of a PET/CT scanner using the Varian RPM system. A RADPOS detector and the RPM optical block were placed on top of the phantom's translation stage and the motion was recorded by both systems. The feasibility of using the RAPDOS system for in vivo dosimetry during daily external beam radiation therapy is also being studied. Results: When used to measure simulated breathing motion on a 4D Quasar phantom, the RADPOS‐measured displacements were on average within 0.13 and 0.05 mm of those recorded by the Phillips Bellows and Varian RPM systems, respectively. The correlation between the RADPOS displacements and those measured by the Bellows and RPM systems were 0.96 and 0.99, respectively. Initial results for clinical use in radiation therapy treatments show that the RADPOS system can be set‐up quickly, requiring minimal additional time for each scheduled treatment fraction. Conclusions: In conclusion, the RADPOS system agrees well with currently accepted position monitoring systems and provides sufficient information to identify changes in the patients breathing pattern and other patient motion. Acknowledgements: This project is supported by grants from HTX and ORCC Foundation. Financial and technical support from Best medical Canada is also acknowledged

Scatter correction improves concordance in SPECT MPI with a dedicated cardiac SPECT solid-state camera

Purpose: Correction for photon attenuation and scatter improves image quality with conventional NaI-based gamma cameras but evaluation of these corrections for novel solid-state dedicated cardiac cameras is limited. In this study, we assess the accuracy of dual-energy-window (DEW) scatter correction (SC) applied to clinically acquired 99mTc-tetrofosmin myocardial perfusion images obtained on a dedicated multi-pinhole camera with cadmium-zinc-telluride (CZT) detectors (GE Discovery NM530) compared to DEW scatter-corrected images from our conventional SPECT camera (GE Infinia Hawkeye 4; INF).Methods: A modified DEW SC method was formulated to account for the detection of primary photons in the lower energy window (120 keV ± 5%) with CZT detectors, in addition to estimating the scattered photons detected in the photopeak window (140 keV ± 10%). Phantom experiments were used to estimate the DEW correction parameters. Data from 108 patients, acquired using a standard rest/stress Tc-99m-tetrofosmin SPECT/CT protocol on both cameras, were reconstructed with no correction (NC), attenuation correction (AC), and AC with DEW-SC. Images were compared based on the summed stress/rest/difference scores (SSS/SRS/SDS) calculated by clinical software.Results: The correlation between SSS/SRS for the two cameras was excellent (r ≥ 0.94). The mean difference between cameras was  .1).Conclusions: DEW-SC on the CZT camera was feasible and produced images that are not significantly different from those acquired on the INF camera. Although use of SC on CZT images does increase noise, the resultant noise does not introduce bias relative to the INF camera