Evaluation of left ventricular function by tissue Doppler and speckle-derived strain rate echocardiography after percutaneous ductus closure.

The aim of this study was to evaluate the left ventricular systolic and diastolic function before and after transcatheter percutaneous patent ductus arteriosus (PDA) closure. 21 children (age >6 months old) diagnosed with hemodynamically significant PDA underwent percutaneous PDA closure. Conventional, Doppler and tissue Doppler imaging and speckled-derived strain rate echocardiography were done at pre-closure, 1 day (early) and 1 month (late) post-closure. Mean age of the patients (female/male: 1.3) was 17.54 ± 24.7 months with the mean PDA diameter of 3.6 ± 0.8 mm. Systolic measures (ejection fraction, shortening fraction) reduced significantly early after PDA closure (P < 0.05). After 1 month, both improved significantly; ultimately, after 1 month no change was observed in systolic function measures compared with the pre-closure status. Early and late diastolic flow velocities of mitral (E M and A M) reduced considerably in early and late post-closure time (P < 0.05). Both early tissue Doppler early velocity of lateral mitral annulus (E'M) and early to late velocity ratio (E'M/A'M) of lateral mitral annulus decreased significantly (P = 0.02) in early post-closure. After 1 month, E'M increased considerably. (P = 0.01) but E'M/A'M had an insignificant rise (P > 0.05). E M/E'M ratio did not change in early post-closure but it had a considerable reduction in the subsequent month compared with the pre- and early post-closure (P < 0.001 for both occasions). Global and segmental longitudinal strain measures reduced significantly early after PDA closure (P < 0.05) but it improved remarkably in the subsequent month. Transcatheter PDA closure causes a significant decrease in left ventricular performance early after PDA closure which recovers completely within 1 month. Also PDA size can affect post-closure left ventricular function.

Role of speckle tracking echocardiography in the assessment of post-repair left ventricular function in patients with late presentation of anomalous origin of the left coronary artery from the pulmonary artery.

The aim of this study was to determine the left ventricular myocardial deformation and segmental myocardial dysfunction by speckle tracking echocardiography and tissue Doppler imaging among the operated patients with anomalous origin of the left coronary artery from the pulmonary artery. The study was conducted on 12 patients diagnosed with anomalous origin of the left coronary artery from the pulmonary artery, who had been operated upon between 2001 and 2013 at the medical centres of Shiraz University of Medical Sciences, Shiraz, Iran. The mean age of the patients at the time of surgical correction was 12.6 years ranging from 6 months to 43 years, and the duration of postoperative follow-up was between 1 and 12 years. Comparison of the strain rate between the patients with acceptable ejection fraction and the control group by tissue Doppler imaging showed significant differences between the two groups regarding the lateral wall (p<0.001), but not the septal wall of the left ventricle (p=0.65). Moreover, the strain values by the speckle tracking method revealed significant differences between the patient and the control group regarding the global strain (p=0.016) and anterior, lateral, and posterior segments of the left ventricle. Although postoperative conventional echocardiography revealed normal global left ventricular function with acceptable ejection fraction, abnormal myocardial deformation of the variable segments of the left ventricle with regional and global myocardial dysfunction were well defined by speckle tracking echocardiography.

Investigating the role of uric acid and uric acid-to-creatinine ratio as a predictive factor of chronic obstructive pulmonary disease exacerbation in 2019.

INTRODUCTION: Serum uric acid has been suggested as an independent marker of oxidative metabolism in chronic obstructive pulmonary disease (COPD), a disease with significant social, health, and economic burden. Therefore, we aimed to investigate the role of this factor in COPD exacerbation. METHODS: We investigated 20- to 70-year-old patients who were admitted due to COPD exacerbation (acute phase) or presented to the pulmonary clinic for follow-up (non-acute phase). Correlation of uric acid and uric acid-to-creatinine ratio (UCR) with multiple factors and their predictive performance for more exacerbations and acute phase of COPD was investigated (receiver operating characteristic [ROC] analysis). RESULTS: Overall, 63 patients were enrolled in this study, of whom 79.4% were men. Acute-phase group encompassed 79.4% of the population with a greater rate of heavy smoking and average exacerbation in a year (p-value = 0.009 and <0.001). The mean of uric acid and UCR was 5.6 (SD, 2.35) and 4.4 (SD, 1.9) in the total population, respectively, and were significantly higher in the acute phase and patients with frequent exacerbations (FE ≥ 3 exacerbations a year), p-value <0.05. The area under the curve (AUC) of ROC analysis showed a high performance of uric acid and UCR for predicting acute phase (0.84 [95%CI, 0.73-0.96] and 0.86 [0.74-0.98]), FE (0.72 [0.60-0.85] and 0.75 [0.63-0.87]), and FE among acute-phase patients (AUC, 0.63 [0.46-0.79] and 0.66 [0.50-0.81], respectively). CONCLUSION: Uric acid and UCR could be invaluable predictors of frequent exacerbation and the acute phase of COPD. Therefore, they might be applicable in evaluating the severity and progress of the disease.

Barriers and factors associated with the use of helmets by Motorcyclists: A scoping review.

Road Traffic Injuries (RTIs) have imposed a great global burden on public health. Motorcyclists and pedestrians comprise the most significant proportion of this burden. Several studies have demonstrated a link between helmet wearing and a decline in the impact of RTIs in motorcyclists. In this study, we aimed to review the barriers to helmet utilization by motorcyclists. This scoping review has been conducted in accordance with the guidelines for the systematic review of observational studies and the PRISMA Checklist. The search was conducted by using related keywords in EMBASE, PubMed, Scopus, and Cochrane Library. Four independent reviewers carried out the screening. The main outcomes of interest were barriers to helmet usage among motorcyclists, drawn from the finally included studies. Fifty-three records were selected for data extraction. According to these reports, the barriers and factors associated with helmet usage among motorcyclists were categorized into five entities as: legislations/enforcement strategies, helmet disadvantages (discomfort, visual/auditory blockage, and thermal dysregulation), risky behaviors (riding while drunk or high on drugs), sex and/or age factors, and the location and time of the injury event (rural vs. urban locations, day vs. night riding). From the perspective of policymakers, the findings of this review are of utmost importance and could be used in addressing the challenge of inadequate compliance with helmet use.

Numerical investigation of the effects of cannula geometry on hydraulic blood flow to prevent the risk of thrombosis.

Despite significant advances in left ventricular assist devices and the cannula, unfavorable events leading to the death of patients, including bleeding, infection, neurological disorders, hemolysis, and thrombosis, are still being reported. Local parameters of blood flow, including static flow, vorticity and critical values of shear stress on the wall of ventricle and cannula, increase the risk of thrombosis. Therefore, the analysis of blood flow domains inside the ventricle and cannula is necessary to investigate the probability of forming thrombosis in the cannula of left ventricular assist devices. In this study, blood flow is investigated in a Medtronic DLP 16F clinical cannula by using computational fluid dynamics through three-dimensional modeling of the left ventricle and cannula based on real geometry. Apart from the fact that blood is considered non-Newtonian fluid, the effect of heart movement in the left ventricle is also applied. In this research, blood flow in the cannula has been examined and some problems resulting from the use of the cannulas have been investigated. The results indicate that changing the geometry of input holes, such as their number and size, on the tip of the cannula, alter the probability of forming thrombosis and the standard mode shows a better performance.

Numerical study of drug delivery through the 3D modeling of aortic arch in presence of a magnetic field.

Magnetic drug delivery known as smart technique in medicine is basically according to combining the drug inside capsules with the magnetic property or attaching the drug with magnetic surfaces at the micro- and nanoscale. In the present study, magnetic drug delivery in the aortic artery has been investigated. To approach the more realistic problem conditions of blood flow rheology, the effect of parameters such as non-Newtonian viscosity and oscillating input has been put into consideration. Also, the investigated geometrical parameters of arteries of the aortic arch have been chosen similar to the real size. The results indicate that an increase in the diameter of microparticles rises the efficiency of particles absorption. In addition, the influence of changing the direction of the wire carrying electricity and thus changing the direction of magnetic field on magnetic drug delivery has been examined in the geometry of the aortic arc and it is found that the highest particle absorption efficiency takes place in the case that the wire is parallel to the direction of y-axis. As an example, the results show that the rate of absorption efficiency for particles with 3 µm dia is 26.83% and 19.39% when the wire generating magnetic field is parallel to the direction of y-axis and z-axis, respectively, and this value is 10.91% for the case without a magnetic field. The number of particles released from different part of the aortic arch also is affected by the direction of magnetic field. This value illustrates that the percentage of particles released from different states, is equal when the magnetic field is absent and the wire carrying electricity is parallel to y-axis and z-axis. However, the number of particles released from the 2 outputs of the left carotid and left subclavian is less than the other 2 states (i.e., the state when there is not a magnetic field, and the state when the electric current direction is parallel to the y-axis direction) for the state when the wire carrying current is parallel to the z-axis.

Numerical investigation of drug delivery by using magnetic field in a 90-degree bent vessel: a 3D simulation.

Magnetic drug delivery as a potential method to treat diseases such as cancer tumors has attracted the attention of many researchers. One of the problems in conventional and ineffective therapies is the spread of drug in the circulatory system. The method of magnetic drug delivery aims at directing the drug to the localized area of disease by using a magnetic field. Considering the effects of parameters such as non-Newtonian viscosity, oscillatory input, motion and the presence of atherosclerosis, the present study examines the magnetic drug delivery, which is under the influence of magnetic field, in a 90-degree bent in three situations of without atherosclerosis, a moderate atherosclerosis of 45% and severe atherosclerosis of 75% in two states of fixed vessel and moving vessel arising from the expansion and contraction of the heart. The magnetic field is in the range of [Formula: see text] T, and the diameter of magnetic particles varies from 1 to 6 µm. The comparison of particle absorption percentage for different atherosclerosis revealed that the presence of atherosclerosis increases the value of particle absorption percentage. The results of comparison between fixed vessel and moving vessel indicate that the percentage of particle absorption is higher when the vessel is moving. In the presence of magnetic field, the maximum value of absorption percentage is 76.93% for the moving vessel with 75% atherosclerosis and the particles with the diameter of 6 µm and this value is equal to 75.65% when the vessel is considered fixed. Regardless of the size of particle, this value is approximately 15.8% and 3% for the moving vessel and the fixed vessel, respectively, when no magnetic force is applied to the vessel.

High-Dose Oral Ibuprofen in Treatment of Patent Ductus Arteriosus in Full-Term Neonates.

BACKGROUND: Patent ductus arteriosus (PDA) is an important risk for heart failure due to left to right shunt in term neonates. OBJECTIVES: In this study, we evaluated the effect of high dose ibuprofen in closure of PDA in term neonates. PATIENTS AND METHODS: We used double dose ibuprofen (20 mg/kg, 10 mg/kg, and 10 mg/kg) for 3 - 30 day old term neonates with PDA who were admitted in the neonatal wards of Shiraz University of Medical Sciences. The results of this study were compared to the data of the previous study in our center which used the low dose of ibuprofen (10 mg/kg, 5 mg/kg, and 5 mg/kg). RESULTS: 29 full term neonates received high-dose ibuprofen, in 18 neonates, PDA was closed after 4 days (62.1% versus 43.3% for the standard dose and 4.7% for the control group in the previous study) (P = 0.001). The results showed no significant correlation between the closure rate and gestational age, postnatal age, sex, and weight. In the 4(th) day of treatment, size of the pulmonic end of ductus arteriosus decreased from 2.09 mm to 0.77 mm compared to 1.68 mm to 0.81 mm in the standard dose of oral ibuprofen and 2.1 mm to 1.4 mm in the control group (P = 0.046). CONCLUSIONS: This study indicated that high-dose oral ibuprofen was more effective in closing or decreasing the size of PDA.

Acute hemodynamic effects of single oral dose of bosentan in patients with pulmonary arterial hypertension related to congenital heart disease.

BACKGROUND: Endothelin-1 is a potent endogenous vasoconstrictor and an important remodeling factor in the pathogenesis of pulmonary arterial hypertension (PAH). Bosentan, a nonselective and active dual endothelin receptor antagonist, is used as a vasodilator in treatment of such patients. This study aimed to evaluate acute response to a single oral dose of bosentan as a vasodilator agent in comparison with nasal oxygen (O2) in patients with PAH related to congenital heart disease (CHD). MATERIALS AND METHODS: We enrolled 20 patients with PAH-CHD, with a mean age of 5.45 ± 4.5 years. Hemodynamic variables were measured at baseline state, after administration of nasal O2 (5 L/min) for 20 minutes, and then when hemodynamic variables returned to the baseline, the measurements were repeated for the third time 3 hours after administration of a single oral dose of bosentan (2 mg/kg). RESULTS: Mean pulmonary vascular resistance was 9.92 ± 2.97 Wood units · m(2) at baseline and was lowered by O2 to 6.17 ± 2.71 Wood units · m(2) (P = .001) and by bosentan to 5.90 ± 2.69 Wood units · m(2) (P = .0001). Mean pulmonary artery pressure was 71.2 ± 15.4 mm Hg at baseline and was reduced to 62.6 ± 15.2 mm Hg (P = .001) by O2 and to 61.6 ± 14.8 mm Hg (P = .0003) by bosentan. CONCLUSION: A single oral dose of bosentan has the same acute vasodilatory effect on the pulmonary vascular bed as nasal O2 in patients with PAH related to CHD. Such patients may benefit from long-term therapy with this novel medication.

Cardiovascular involvement in children with osteogenesis imperfecta.

OBJECTIVE: Osteogenesis imperfecta is a hereditary disease resulting from mutation in type I procollagen genes. One of the extra skeletal manifestations of this disease is cardiac involvement. The prevalence of cardiac involvement is still unknown in the children with osteogenesis imperfecta. The present study aimed to investigate the prevalence of cardiovascular abnormalities in these patients. METHODS: 24 children with osteogenesis imperfecta and 24 normal children who were matched with the patients regarding sex and age were studied. In both groups, standard echocardiography was performed, and heart valves were investigated. Dimensions of left ventricle, aorta annulus, sinotubular junction, ascending and descending aorta were measured and compared between the two groups. FINDINGS: The results revealed no significant difference between the two groups regarding age, sex, ejection fraction, shortening fraction, mean of aorta annulus, sinotubular junction, ascending and descending aorta, but after correction based on the body surface area, dimensions of aorta annulus, sinotubular junction, ascending and descending aorta in the patients were significantly higher than those in the control group (P<0.05). Two (8.3%) patients had aortic insufficiency and five (20%) patients had tricuspid regurgitation, three of whom had gradient >25 mmHg and one patient had pulmonary insufficiency with indirect evidence of pulmonary hypertension. According to Z scores of aorta annulus, sinotubular junction and ascending aorta, 5, 3, and 1 out of 24 patients had Z scores >2 respectively. CONCLUSION: The prevalence of valvular heart diseases and aortic root dilation was higher in children with osteogenesis imperfecta. In conclusion, cardiovascular investigation is recommended in these children.