Marginal Zone Lymphoma Manifesting as Macrophage Activation Syndrome: A Case Report.

Macrophage activation syndrome (MAS) is a form of secondary hemophagocytic lymphohistiocytosis (HLH) when it occurs in the context of rheumatologic disorders. HLH is a rare and potentially life-threatening syndrome characterized by excessive immune system activation. It is mainly seen in children and can be genetic based or related to infections, malignancies, rheumatologic disorders, or immunodeficiency syndromes. MAS can present with nonspecific symptoms, leading to a delay in diagnosis. This report describes a case of a 64-year-old female with marginal zone lymphoma and systemic lupus erythematosus who presented with a purpuric rash and acute kidney injury. She underwent a kidney biopsy and was diagnosed with MAS. This case highlights the importance of promptly recognizing MAS's symptoms and signs, allowing timely diagnosis and early therapeutic intervention. This potentially fatal condition tends to respond well to rapid treatment initiation with corticosteroids and to address the underlying condition.

Contrast removal from coronary sinus for prevention of contrast-induced nephropathy: a review.

The occurrence of contrast-induced-nephropathy (CIN) is related to the amount of contrast administration. Any removal of contrast from systemic circulation before reaching the kidneys might be beneficial using a device that removes contrast from a coronary sinus (CS). This manuscript aims to review the available literature regarding contrast removal from CS during coronary angiography or intervention for the prevention of CIN.

Bilateral Adrenal Hemorrhage and Adrenal Insufficiency in the Context of Polycythemia Vera: A Case Report and Review of the Literature.

Background: Polycythemia vera (PV) is a myeloproliferative disorder presented with different manifestations. However, bilateral adrenal hemorrhage (BAH) and adrenal insufficiency (AI) are rare manifestations. Herein, we described a patient who suffered from BAH and AI in the context of PV. Case Presentation. A 60-year-old man with an underlying history of PV was admitted with severe abdominal pain, nausea, and loss of consciousness. Primitive computed tomography (CT) scan findings revealed bilateral adrenal masses (right: 40 ∗ 23 mm, left: 60 ∗ 35 mm) with the second scan showing quite similar results (right adrenal: 40 ∗ 29 mm, left adrenal: 48 ∗ 26 mm) suggesting BAH. The further adrenal assessment proved concurrent AI. Both adrenal masses resolved completely after 15 months. However, the patient still suffered from AI. Conclusion: BAH and AI in patients with PV should be considered rare complications requiring high clinical suspicion for early diagnosis and treatment to avoid life-threatening outcomes.

Translation, Cultural Adaptation, Validation, and Reliability of Persian-Revised Heart Failure Compliance Questionnaire.

Background: Compliance with health-related behaviors is a dilemma among heart failure (HF) patients. The present study aimed to assess the validity and reliability of a Persian translation of the revised heart failure compliance questionnaire (RHFCQ) in Iranian HF sufferers. Methods: This methodological study was performed on outpatient HF individuals referred to a heart clinic in Isfahan, Iran. The forward-backward translation method was used for translation. Twenty subjects were invited to express their opinions on the provided items concerning simplicity and understandability. Twelve experts were invited to rate the items regarding the content validity index (CVI). Cronbach's α was used to evaluate internal consistency. The patients were asked to complete the questionnaire for the second time after 2 weeks to investigate test-retest reliability using the intraclass correlation coefficient (ICC). Results: There were no obvious difficulties during the translation and assessment of the simplicity and comprehensiveness of the questionnaire items. The CVI of the items ranged from 0.833 to 1.000. Totally, 150 patients (age: 64.60±15.00 y, males: 58.0%) filled in the questionnaire twice with no missing data. The highest and lowest compliance rates were attributed to alcohol and exercise domains, respectively (83.00±7.70% and 45.55±12.00%, respectively). Cronbach's α was 0.629. After the omission of 3 items related to smoking and alcohol cessation, Cronbach's α rose to 0.655. The ICC showed an acceptable value of 0.576 (95% CI, 0.462 to 0.673). Conclusion: The modified Persian RHFCQ is a simple and meaningful tool with acceptable moderate reliability and good validity for assessing compliance in Iranian HF patients.

The Effect of 3-Month Growth Hormone Administration and 12-Month Follow-Up Duration among Heart Failure Patients Four Weeks after Myocardial Infarction: A Randomized Double-Blinded Clinical Trial.

BACKGROUND: The probable impact of growth hormone (GH) as a heart failure (HF) treatment strategy is still less investigated. Therefore, we aimed to evaluate the relation of 3-month GH prescription on left ventricular ejection fraction (LVEF), interventricular septum (IVS), posterior left ventricle (LV) thickness, end systolic and end diastolic diameters (ESD and EDD), and pulmonary arterial pressure (PAP) among Iranian individuals suffering from HF due to MI attack. METHODS: A total of 16 clinically stable participants with HF diagnosis and LVEF < 40% were selected for enrollment in this pilot randomized double-blinded study. They were randomly assigned equally to groups received 5 IU subcutaneous GH or placebo. Injections were done every other day for a total of 3-month duration. After termination of intervention and nine months afterwards, cardiac outcomes were assessed. RESULTS: Baseline and 12-month posttrial participants' characteristics were similar. LVEF was increased significantly by three months started from baseline in individuals receiving GH (32 ± 3.80% to 43.80 ± 4.60%, P = 0.002). During the next 9 months of follow-up concurrent with cessation of injections, LVEF was declined (43.80 ± 4.60% to 32.20 ± 6.97%, P = 0.008). LVEF and ESD were remarkably higher and lower in GH group compared with controls by the end date of injections (43.80 ± 4.60% vs. 33.14 ± 4.84%, P = 0.02 and 39.43 ± 3.45 mm vs. 33 ± 3.16 mm, P = 0.03, respectively). No other considerable association was found in terms of other predefined variables in neither GH nor placebo groups. CONCLUSIONS: GH administration in HF patients was associated with increased LVEF function. Several randomized clinical trials are necessary proving this relation. This trial is registered with IRCT201704083035N1.

High Sensitivity C-Reactive Protein Predictive Value for Cardiovascular Disease: A Nested Case Control from Isfahan Cohort Study (ICS).

Background: High sensitivity C-reactive protein (hs-CRP) was proven to be an independent risk factor for cardiovascular diseases (CVDs). The aim of this study was to investigate the benefits of assessing hs-CRP among individuals with different cardiovascular risk factors. Methods: This nested case-control study was obtained from the Isfahan Cohort Study (ICS). Anyone who has been suffering from any CVDs, including myocardial infarction, unstable angina, sudden cardiac death and stroke was put in the case group. Density sampling method was utilized to choose the control group who had no aforementioned CVDs during follow-up. Four quartiles of hs-CRP (Q1: 0.1-2.3, Q2: 2.4-3, Q3: 3.1-4 and Q4: 4.1-14 mg/l) were assessed defining odds ratios (OR) of CVDs prediction in different CVDs risk factor categories. Confidence intervals of 95% are put in brackets. Results: A total of 502 cases and 538 controls were recruited. All hs-CRP quartiles showed increased CVDs likelihood compared to normal subjects in terms of diabetes mellitus (DM) and hypertension (HTN). Second quartile showed a 1.93 [1.33-2.81] and 3.34 [1.36-8.17] increased risks in patients with hypertriglyceridemia or dyslipidemia, respectively. Smokers in the third quartile group revealed increased CVDs risk. The fourth quartile showed significant increased risks in patients suffering from hypercholesterolemia (OR = 1.91 [1.33-2.74]), high LDL-C (OR = 1.88 [1.33-2.66]), and hypertriglyceridemia (OR = 2.31 [1.57-3.41]). Conclusions: Our findings suggested that assessing hs-CRP is beneficial for predicting CVDs in patients with HTN and DM. Furthermore, specific patients with lipid abnormalities or history of smoking benefits from checking hs-CRP.

The transulnar approach in the patients with ipsilateral radial artery occlusion.

BACKGROUND: Transulnar approach (TUA) has been classified as an appropriate surrogate for the transradial approach (TRA), but the safety of TUA in the presence of ipsilateral radial artery occlusion (RAO) is not well studied. In this article, we aimed to assess the feasibility and occurrence of complications of this approach in Iranian individuals with ipsilateral RAO. METHODS: In this prospective double-center study, a total number of 70 participants from July 2017 to November 2018 with coexisting ipsilateral RAO due to prior RA angiography, severe arterial spasm, prominent vascular anomalies, or arterial harvesting for hemodialysis or graft procedures were enrolled and underwent TUA. Incidence of probable complications including pain, hematoma, arteriovenous fistula (AVF), pseudoaneurysm formation, any adverse events requiring immediate vascular surgery, life-threatening hand ischemia, infection, ulnar nerve palsy, major adverse cardiac events (MACE) including death, myocardial infarction (MI), or stroke plus ulnar artery (UA) obstruction and narrowing was evaluated both before discharge time and one month afterward. RESULTS: The mean age of the study population was 68.2 ± 12.8 years [men number: 41 (58.5%)]. Our success rate was 98.6% and 37.1% of subjects underwent further coronary intervention. No aforementioned adverse outcomes were reported in any individual except for pain (11.4%) and minor hematoma (grade I) (5.7%) as well as MACE (1.4%). Follow-up assessment revealed asymptomatic UA occlusion (UAO) and severe narrowing in 2.8% and 1.4% of participants, respectively. CONCLUSION: Our outcomes suggested that due to high safety and low complication rates, TUA could be tried safely in patients with concurrent ipsilateral RAO. Other appropriate cohort studies are required for assessing the incidence of TUA complications.

Diffuse and patchy intra-myocardial fat deposition in left ventricle: unclassified cardiomyopathy in an obese woman without pathological condition.

Fat deposition in the left ventricle in patients without proven myocardial diseases has not been sufficiently investigated. In this paper, a case of diffuse and patchy intramyocardial fat deposition in the left ventricular myocardium in a patient with no cardiac disease history has been detected by cardiac magnetic resonance imaging (CMRI). Such a finding would not be considered a usual cardiomyopathy and further studies are needed to investigate its prevalence, pathophysiological mechanisms, and prognosis.