Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Concurrent Use of Crocin During Chemoradiation for Esophageal Squamous Cell Carcinoma.

Crocin is the major active carotenoid of saffron (Crocus sativus L.). Its pluripotent effects have led to a growing body of literature investigating its antitumor properties as well as its diverse potentials for mood stabilization, normal tissue protection, and inflammation reduction; However, there is a gap in clinical trials testing this substance in cancer patients. In this randomized, double-blind, placebo-controlled clinical trial, patients with newly diagnosed esophageal squamous cell carcinoma were randomly assigned to either 30 mg/day of crocin or placebo, prescribed during the neoadjuvant chemo-radiotherapy. The primary endpoints were pathological response and toxicity, and secondary endpoints were depression and anxiety levels and survival analysis.

Topical versus low-dose systemic tranexamic acid in pediatric cardiac surgery: A randomized clinical study.

OBJECTIVES: The current study aimed to compare the benefits of topical and low-dose systemic tranexamic acid administration in pediatric cardiac surgery. METHODS: A total of 117 children undergoing cardiac surgery for congenital heart disease were assigned into three groups. Patients in the systemic group received 20 mg/kg-1 tranexamic acid through the cardiopulmonary bypass followed by another dose of 20 mg/kg-1 after cardiopulmonary bypass separation. Patients in the topical group were administered with 50 mg/kg-1 tranexamic acid poured into the pericardium, while the control group received no antifibrinolytics. The outcome measures of bleeding and blood products transfusion were recorded over the first 48 h postoperatively. RESULTS: Chest tube drainage was significantly lower in both topical and systemic groups than the control group, but it did not differ between the case groups. Blood products requirement did not show a difference between groups. Neurological or thromboembolic events did not variate among the groups, and no deaths occurred in this study. CONCLUSION: Topical or systemic tranexamic acid administration reduced postoperative blood loss effectively without adding an extra risk.

Chest Pain in a Young Male with Carbon Monoxide Poisoning and Substance Abuse: A Case Report and Literature Review.

BACKGROUND: Carbon monoxide (CO) poisoning is the leading cause of poisoning-related deaths in the United States. In addition, myocardial infarction (MI) due to CO poisoning in a young, healthy adult is rare. On the other hand, smokeless tobacco, processed in various forms, is a controversial coronary heart disease (CHD) risk factor. CASE REPORT: In this study, we describe a 29-year-old man who presented with acute chest pain following a night of smoking tobacco and using smokeless tobacco in the presence of carbon monoxide poisoning. ST-segment elevation was observed on an electrocardiogram, and echocardiography revealed akinesia. In addition, cardiac markers were elevated. In this particular instance, thrombolytic therapy demonstrated successful outcomes. CONCLUSIONS: We believe the case and discussion could shed light on the emergency department management of such individuals. We advise clinicians to consider the possibility of coronary heart disease in carbon monoxide poisoning patients and to obtain a baseline electrocardiogram and cardiac markers.

Meier-Gorlin syndrome with prenatal ultrasound findings and successful growth hormone therapy: Six years follow-up of a rare case.

Meire-Gorlin syndrome (MGS) is a rare autosomal recessive disorder characterized by a triad of short stature, microtia, and absent or hypoplastic patella. We report a 5-year-old male affected with the subtype MGS1, secondary to c.c2292t mutation of ORC1 gene. Our patient's features included a triangular face, micrognathia, and delayed motor development. To the edge of our knowledge, this is the first diagnosed Iranian MGS patient and sixth case in the middle east. MGS1 subtype has never shown improvement to growth hormone therapy, therefore underlying molecular defect was suggested to be responsible for patients' short stature rather than growth hormone deficiency. However, our patients' growth velocity was improved by growth hormone. We recommend more studies to specify the role of ORC1 gene in this syndrome. In addition, this case report describes the prenatal investigations and sonographic examinations of MGS1 for the first time.

Evaluation of Normal Renal Size and its Influencing Factors: A Cross-Sectional Study on the Adult Population of Mashhad.

Background: The normal range of kidney size is a controversial issue among different populations given to its impressibility by multiple factors, therefore, this study aimed to provide valid reference ranges for kidney dimensions in the adult population of Mashhad. Also, we assessed the association of kidney size characteristics with some personal predisposing factors. Methods: This cross-sectional study was conducted on 938 healthy individuals. Ultrasound measurement, physical examination, and laboratory analysis were performed. Demographic, dietary, and anthropometric data were obtained. The variables were categorized into 5 groups each, and data analysis were performed using the following statistical tests: Pearson correlation test, variance analysis, t-test, and chi-square test. A value of p<0.05 was considered statistically significant. Results: Weight had the most association with kidney size followed to a lesser extent by height and age. Even after adjustment for other confounding variables, weight remained as an independent factor, while this effect was resolved for height and age. Also, all values for renal function, body bio-impedance, blood pressure components, and water intake were notably correlated with kidney size. Conclusion: This study determined the normal kidney size in healthy adults. We also declared the normal range of kidney size is a dynamic concept and should be assessed for each individual separately according to their personal determinative factors.

Evaluating the Performance of Unenhanced Computed Tomography in the Diagnosis of Pulmonary Embolism.

Background: Computed tomography pulmonary angiography (CTPA) as the gold-standard examination in the detection of pulmonary embolism (PE) is contraindicated or unavailable in certain cases. The current study aimed to assess the accuracy of unenhanced CT in the diagnosis of PE. Methods: This cohort study was conducted between October 2020 and March 2021 in Birjand, Iran, on 195 participants with clinical suspicion of PE examined with multidetector computed tomography (MDCT) scanning and CTPA. The patients were categorized into 2 groups based on the diagnosis PE in CTPA results. Imaging variables in unenhanced CT scans, including hyper/hypodense intraluminal signs, pulmonary trunk enlargements, peripheral wedge-shaped opacities, and pleural effusions, were independently reviewed by 2 radiologists and then compared between the groups. Results: There were 82 men (42.1%) and 113 women (57.9%) at a mean age ± standard deviation of 56.00±0.24 years. Based on CTPA results, PE was diagnosed in 24.1% of the study population (47/195). However, only 20 cases (42.5%) were detected by MDCT: 17 cases (85.0%) with central PE and 3 cases (15.0%) with peripheral PE. Concerning the intraluminal clot density, 12 patients (60.0%) had hyperdense signs, 3 (15.0%) had hypodense signs, and 5 (25.0%) had mixed hyper/hypodense signs. There was a significant difference between central PE and peripheral PE detected by MDCT. Intraluminal signs had the highest specificity and sensitivity (98.6% and 42.5%, area under the curve =0.734). Conclusion: Unenhanced MDCT has a remarkable performance in detecting PE, specifically central clots, and can, therefore, be considered an alternative modality when CTPA is not available or indicated.

Twenty Years' Follow-up of a Family with Marfan Syndrome: A Case Series.

Marfan syndrome is a rare connective tissue disorder manifesting with cardiovascular pathologies which are also the leading cause of death. Herein, we present the past 20 years follow up of a family with 17 members afflicted with Marfan syndrome. 3 members of the family were deceased and none were due to cardiovascular events. We assume to some extent traumas are a neglected cause for a part of mortality in Marfan syndrome.

Characteristics and outcomes of hospitalized patients with cardiovascular complications of COVID-19.

Introduction: To address cardiovascular (CV) complications and their relationship to clinical outcomes in hospitalized patients with COVID-19. Methods: A total of 196 hospitalized patients with COVID-19 were enrolled in this retrospective single-center cohort study from September 10, 2020, to December 10, 2020, with a median age of 65 years (IQR, 52-77). Follow-up continued for 3 months after hospital discharge. Results: CV complication was observed in 54 (27.6%) patients, with arrhythmia being the most prevalent (14.8%) followed by myocarditis, acute coronary syndromes, ST-elevation myocardial infarction, cerebrovascular accident, and deep vein thrombosis in 15 (7.7%), 12 (6.1%), 10(5.1%), 8 (4.1%), and 4 (2%) patients, respectively. The proportion of patients with elevated high-sensitivity troponin I, N-terminal pro-B-type natriuretic peptide, left ventricular diastolic dysfunction, and heart failure with preserved ejection fraction was greater in the CV complication group. Severe forms of COVID-19 comprised nearly two-thirds (64.3%) of our study population and constituted a significantly higher share of the CV complication group members (75.9%vs 59.9%; P =0.036). Intensive care unit admission (64.8% vs 44.4%; P =0.011) and stay (5.5days vs 0 day; P =0.032) were notably higher in patients with CV complications. Among 196patients, 50 died during hospitalization and 10 died after discharge, yielding all-cause mortality of 30.8%. However, there were no between-group differences concerning mortality. Age, heart failure, cancer/autoimmune disease, disease severity, interferon beta-1a, and arrhythmia were the independent predictors of all-cause mortality during and after hospitalization. Conclusion: CV complications occurred widely among COVID-19 patients. Moreover,arrhythmia, as the most common complication, was associated with increased mortality.

Emerging mechanisms for the new coronavirus-related myocardial injury and ischemia: A review of the literature.

A history of cardiovascular comorbidity or experiencing acute cardiac injury during the coronavirus disease 2019 is accompanied by a poor prognosis. Also, it seems myocardial ischemia (or infarction) accounts for a major part of the cardiac involvement observed in this disease. Therefore, particular consideration is needed to protect the cardiovascular system during this pandemic. The gaps highlighted in this review are an issue to be explored through future research.

Survival after left ventricular free wall rupture due to acute myocardial infarction.

BACKGROUND: Left ventricular free wall rupture is a frequent catastrophic complication of acute myocardial infarction (AMI) and occurs in 1-3% of patients with acute myocardial infarction; it is the third most common cause of death caused by acute myocardial infarction, too. CASE REPORT: We describe acute left ventricular free wall rupture due to acute myocardial infarction in a 60-year-old man. He was survived after urgent surgical intervention. CONCLUSION: The long-term survivors of free wall rupture repair have not been extensively reported; early diagnosis is very critical and immediate surgical repair is the treatment of choice.