Devastating fungal endocarditis involving ascending aorta in a patient with a history of aortic valve replacement: a case report.

BACKGROUND: Fungal endocarditis is a rare but serious condition associated with high mortality rates. Various predisposing factors contribute to its occurrence, such as underlying cardiac abnormalities, cardiac surgeries, prosthetic cardiac devices, and central venous catheters. Diagnosing fungal endocarditis, particularly Aspergillus, poses challenges, often complicated by negative blood cultures. CASE PRESENTATION: This report details a case of extensive ascending aorta involvement in Aspergillus endocarditis (AE) in a 24-year-old man with a history of bioprosthesis aortic valve replacement (AVR). Three months post-AVR, he presented with pericardial effusion and aortic rupture, leading to a redo biological valved conduit aortic root replacement (Bentall surgery). Despite the intervention, the tubular graft exhibited extensive Aspergillus involvement, resulting in graft disruption and significant peri-aortic infection. A second redo procedure involving aortic homograft root replacement was performed. Unfortunately, the patient succumbed two days after the surgery. CONCLUSION: A combined approach of medical and surgical therapies is recommended to manage fungal endocarditis. Despite efforts, the mortality rate associated with Aspergillus endocarditis remains unacceptably high, with no significant difference observed between combination therapy and antifungal treatment alone. Further research is essential to explore novel therapeutic strategies and improve outcomes for patients with this challenging condition.

Congenital tunnel-shaped ventricular septal defect.

We report a 47-year-old man who presented with right-sided heart failure. Transthoracic echocardiography revealed a tunnel-shaped communication (ventricular septal defect) between the left ventricle and the right ventricle with a significant left-to-right shunt. The VSD is connected to the lateral wall of the right ventricle by a large tunnel.

Extensive right-sided endocarditis in double-chamber right ventricle presented with leukocytoclastic vasculitis.

Congenital heart disease is a risk factor for infective endocarditis (IE). Ventricular septal defects and ventricular outflow tract obstructions are this population's most common causes of endocarditis. We present a patient diagnosed with leukocytoclastic vasculitis, renal, and pulmonary involvement with right-sided IE as an etiology for vasculitis.

Re-emphasis on the role of echocardiography in diagnosis of aortic root surgery complications.

BACKGROUND: Aortic pseudoaneurysm is an infrequent complication of ascending aorta surgery. CASES: This is a report of two cases that underwent the Bentall procedure that presented with large pseudoaneurysms. CONCLUSION: Use of multimodality imaging after Bentall surgery has been advocated for the detection of surgical complications. Although 3D CT angiography has the highest diagnostic accuracy, familiarity with transthoracic echocardiographic finding in these patients will lead to earlier diagnosis.

The Association between Cobalt Deficiency and Endemic Goiter in School-Aged Children.

BACKGROUND: In Iran, an iodine deficiency control program was initiated in 1989 by iodizing salt. Despite this program, goiters have remained an endemic condition in most parts of Iran. Thus, it is possible that other factors aside from iodine deficiency may contribute to endemic goiter. The aim of this study was to investigate the association between cobalt deficiency and endemic goiter in a region of Iran with a high prevalence of goiter. METHODS: A cross-sectional study was conducted among school children aged 9 to 11 years in the city of Kerman, Iran. In the first phase of the study, a multistage, proportional-to-size, cluster sampling method was used to screen 5,380 out of 29,787 students. After the screening phase, 170 students (130 goitrous and 40 nongoitrous) were randomly selected, and serum and urine specimens were obtained. We measured thyroid function, serum cobalt level, and urinary iodine excretion. Univariate and multiple logistic regression analyses were performed. RESULTS: The prevalence of grade 2 goiters was 34.8% (95% confidence interval [CI], 31.5 to 42.5), with both sexes being equally affected. The weight and body mass index of goitrous subjects was significantly lower (P<0.001) than those of nongoitrous subjects. The serum cobalt levels were lower in goitrous subjects than in nongoitrous subjects (4.4±2.9 µg/L vs. 6.4±2.7 µg/L). The urinary iodine levels were also lower in goitrous subjects than in nongoitrous subjects (198.3±108.3 µg/L vs. 270.2±91.1 µg/L). Multiple regression analysis showed that only cobalt deficiency, not iodine deficiency, significantly contributed to the presence of goiter (odds ratio, 0.78; 95% CI, 0.61 to 0.99; P=0.042). CONCLUSION: Cobalt deficiency may be an important independent predicator for goiter in endemic regions, especially areas in which goiters persist despite salt iodization programs.

Evaluation of effect of acarbose consumption on weight losing in non-diabetic overweight or obese patients in Kerman.

BACKGROUND: High prevalence of obesity and the importance of this issue as a risk factor for chronic diseases such as severe cardiovascular diseases, diabetes, and cancer necessitate the need for treatment. The aim of this study was the evaluation of acarbose effect on the weight loss in non diabetic overweight or obese patients in Kerman. MATERIALS AND METHODS: A double blind randomized controlled clinical trial was performed on 66 patients with the body mass index (BMI) between 25 and 35 kg/m(2). Patients were divided in treatment and control groups using the randomization. The treatment group took 100 mg acarbose 3 times a day for 20 weeks in combination with the low calorie diet and exercise. Control group was given placebo, low calorie diet, and exercise. BMI was measured after 20 weeks. The analyses were carried out using t-test and repeated measured ANOVA. RESULTS: Patients in acarbose and placebo group had a non significant difference in BMI at baseline. Reducing in weight was considered in every month in both groups, but this reduction was higher in the treatment group. At the 5(th) month, the difference of BMI in the treatment group was significantly lower than the placebo group (2.31 ± 0.6 vs. 0.76 ± 0.6 kg/m(2), P < 0.001). CONCLUSION: Acarbose, especially in combination with the low calorie diet and exercise, seems to lose weight effectively in obese and overweight patients in communities that have a high carbohydrate intake (like Persian diet).

Insulin-induced hypoglycemia and stress oxidative state in healthy people.

The purpose of this study is to assess the immediate effects of insulin-induced hypoglycemia on the natural antioxidant superoxide dismutase activity, malondialdehyde concentration, total antioxidative capacity and total thiol group concentration in young healthy subjects. In this clinical trial, 16 healthy men with the mean age of 29.3 ± 5.3 years (range 21-39 years) became volunteers to participate the study. Hypoglycemia was induced by intravenous administration of regular insulin 0.1 U/kg. Before and after inducing hypoglycemia, SOD activity was determined in red blood cells, whereas the MDA concentration was determined by thiobarbituric acid reactive substance method, total thiol groups by high-performance liquid chromatography method and total antioxidant capacity by ferric reducing/antioxidant power. A significant increase was seen in the TBARS levels following insulin-induced hypoglycemia (0.19 ± 0.07 vs. 0.38 ± 0.16 nmol/g, P < 0.001), while a significant decrement occurred in the antioxidant power (FRAP value) (321.4 ± 63.4 vs. 231.4 ± 57.5, P < 0.001), total thiol concentration (2.3 ± 0.8 vs. 1.3 ± 0.5, P = 0.001) and SOD enzyme activity (29.4 ± 8.2 vs. 23.1 ± 6.1, P < 0.001) subsequent the hypoglycemia with insulin.

Knowledge of Dentistry, Medicine, and Pharmacy Students about Psychedelic Drugs in Kerman University of Medical Sciences.

BACKGROUND: Psychedelic drugs can cause one to get out of normal status and permanent cerebral defects, via affecting central nervous system. Consumption of theses drugs seems to be increasing nowadays especially among the youth and university educated population. We conducted a study to evaluate the awareness of medical science students of Kerman University of medical science who are going to be the future medical population. METHODS: This cross-sectional study was carried out on 471 of students of medicine, dentistry and pharmacy which were in the first to forth year of their education about psychedelic drugs (Ecstasy, LSD, Ice, crack and Yaba). To evaluate the students' awareness of drugs we used questionnaire with reliability and validity proven via pilot study. Statistics analysis was performed using SPSS13 software. FINDINGS: Average of their age was 3.2 ± 20.4. Overall among the students, 56.7% were in the low level of insight, 34.3% in medium and 6.9% in good level and 2.2% had best insight of the drugs. Also only 32.2% of students had the full information about the name of drug, 25.7 % had information about the form of them, 24% about the addiction with them, 7% about their complication and only 5% about the origin of drugs. The information about all psychedelic drugs was higher among pharmacy students, students of the third year and males. CONCLUSION: Our study showed a low insight about psychedelic drugs like Ecstasy, LSD, Ice, Crack, and Yaba among the students. According to this lack of information of these groups, it is suggested that educational courses about the complication, signs and symptoms of these drugs be held.