Assessment of statistical relationship of ejection time and acceleration time with the severity of valvular aortic stenosis

Valvular aortic stenosis is a relatively common disease among valvular heart diseases and can be rheumatic, degenerative or congenital. Evaluation of the severity of the disease is sometimes challenging and problematic. Besides, the use of more parameters of non-invasive methods for the assessment of valvular disease and its severity seems attractive and helpful. Transthoracic echocardiography [TTE] is an appropriate modality for the evaluation of the aortic valve. In this study, TTE was performed for 80 patients with valvular aortic stenosis. The goals were to assess the statistical relationships between ejection time [ET] and acceleration time [AT] and their ratio [AT/ET] with the four traditional parameters of the echocardiographic severity of aortic valvular stenosis [aortic jet velocity, aortic valve area, mean pressure gradient and LVOT VTI/aortic VTI ratio]. There was a meaningful relationship between adjusted ET with the four above-mentioned parameters, d. ET [ET-adjusted ET according to heart rate and stroke volume] was inversely related with the aortic valve area [calculated with continuity equation]. AT/ET was significantly correlated with the four mentioned parameters. The regression equations were calculated. The cut-off value of AT/ET for the echocardiographic diagnosis of severe valvular stenosis was 0.36 [with 95% level of confidence]

Tumoral heart involvement in middle-aged woman with documented sternal chondrosarcoma

We describe the case of a 47-year-old woman with a history of sternotomy and insertion of a sternal prosthesis six months prior to admission due to sternal chondrosarcoma. The patient was admitted with dyspnea and chest discomfort, which had increased twenty days before admission. Echocardiography showed moderate pericardial effusion with moderate right ventricular enlargement and dysfunction and large gelatinous mass in the right atrium, which had protruded to the right ventricle through the inflow va!ve. Unfortunately, the patient died before any intervention. Final echocardiography revealed a reduction in the size of the mass, confirming that the patient's death occurred secondary to metastatic pulmonary emboli

[Assessment of facial and cranial development in Shirvanian Kurmanj population based on the mean biometric factors from birth to maturity age]

The aim of this study was to determine cranial and facial anthropometric Ratios and assessment of cranial and facial development in Shirvanian kurmanj population This cross sectional analytical study was conducted randomly on 137 boys from shirvan, with normal face patterns. Facial and cranial ratios was estimated and compared. Data were analyzed by SPSS software. The regression line and the growth coefficient were determined for each Parameter. Finally, the mean values of these parameters were determined. Furthermore, the mean anthropometric measurement of Iranians was compared with Canadians. Student-t test was used for comparing the measured values. Shirvanian kurmanj populations were have hypereuryprosopic Face and hypercephalic Cranium form. While getting older, peoples midface height increases, face becomes more prominent, chin becomes shorter and Face and Cranium change to Eurycephalic and hyperleptoprosopic form respectively. Approximately, all of the anthropometric measurements in Shirvanian kurmanj population, Fars race [Resident in Mashhad] and Canadians were significantly different. Considerable the differences in the facial and cranial anthropologic ratios and size among Shirvanian kurmanj population, Fars race [Resident in Mashhad] and Canadians, the results obtained from Canadian and Fars race, should not be applied as criteria for treatment plans. Due to the wide racial combinations in Iran, studies, covering wider scope, should be conducted among different Iranian races

Non-invasive assessment of left ventricular end-diastolic pressure in patients with chronic aortic regurgitation, comparison of the sensitivity and specificity of CW doppler echocardiography with angiography

Left ventricular end diastolic pressure could be estimated collectively using various measures of mitral valve and pulmonary venous flow velocities. In patients with aortic regurgitation, the AR velocity reflects the diastolic pressure difference between the aorta and the left ventricle. We sought to predict the left ventricular end diastolic pressure by a new Doppler index as aortic regurgitation peak early to late diastolic pressure gradient ratio. Fifty three patients with at least moderate aortic regurgitation were enrolled in this study. Physical examination, electrocardiography and echocardiography were performed one day before cardiac catheterization. The severity of AR was graded according to the recommendations of American society for echocardiography. The pressure half time, aortic regurgitation early diastolic velocity, aortic regurgitation early diastolic pressure gradient, aortic regurgitation end diastolic velocity, aortic regurgitation end diastolic pressure gradient, and early diastolic to end diastolic pressure gradient ratio of averaged three beats were measured and recorded. The results from cardiac catheterization and echocardiography were compared. The early diastolic to end diastolic pressure gradient ratio was very accurate [80%] for determining the left ventricular end diastolic pressure [P =0.01]. An early diastolic to end diastolic pressure gradient ratio of 1.5 has a sensitivity of 96% and a specificity of 32% for left ventricular end diastolic pressure 12 mmHg was higher than 2.0, with a sensitivity of 71% and specificity of 96% We found no significant correlation between the left ventricular end diastolic pressure with either left ventricular ejection fraction or aortic regurgitation severity in cardiac catheterization [P =0.5]. Doppler echocardiography is a viable alternative of cardiac catheterization for determination of the left ventricular end diastolic pressure. The early diastolic to end diastolic pressure gradient ratio is a simple, easy and new method for assessment of the LVEDP in patients with severe chronic aortic regurgitation

Quantification of aortic regurgitation severity by left ventricular to right ventricular stroke volume ratio

Echocardiography is the most common test used for the evaluation of aortic regurgitation [AR]. However, the role of echocardiography as an available and inexpensive method in the quantification of AR by the left ventricle to right ventricle stroke volume ratio [LV/RV SV ratio] has not been completely investigated. Between June 2005 and December 2007, 132 consecutive patients with AR [mean age: 44.7 +/- 14.6 years, 52.3% male] were enrolled in the study. All the patients underwent echocardiography; and aortography, if indicated, was performed as well. Fifty-two percent of the patients had severe AR. There was almost a perfect agreement between echocardiography and cardiac catheterization in determining the severity of AR [Kappa=0.81]. Associated valvular disease was found in 81.8% of the patients, the most common disease being mitral regurgitation [61%]. The results of our bivariate and multivariate analyses showed a significant relation between the LV/RV SV ratio and the AR severity via either echocardiography or cardiac catheterization [both P=0.001]. The receiver operating characteristic [ROC] curve analysis showed that the LV/RV SV ratio was very accurate in the detection of severe AR utilizing cardiac catheterization as the gold standard [AUC=0.71]. The cut point value of the LV/RV SV ratio

[Potential ability of probiotics isolated from Iranian local yogurts to produce lactacins]

Lactic acid bacteria are microorganisms with ability to produce a wide range of chemical compounds that affect the shelf-life of foods. The objective of this study was to determine the potential ability of probiotics isolated from Iranian local yogurts to produce lactacins and assess their antimicrobial activity. Samples were prepared from 20 kinds of local yogurts [Arak, Sarein, Shahandasht, and Damavand] to isolate and purify lactic acid bacteria in an MRS agar medium and compare them with 3 isolated probiotics strains, i.e., L. casei [PTCC 1608], L. reuteri [PTCC 1655] and L. rhamnosus [PTCC 1637]. The inhibition of growth zone was tested, by the well diffusion agar method, on 5 gram-positive and gram-negative bacterial strains. The maximum amount of antimicrobial substance produced was determined by comparing the growth curves, and extraction purification of the lactacins was done by dialysis. In each stage the amount of protein extracted was determined by the Lowry method, and the recovery percent, total protein, unit activity, specific activity, purification fold, and bacteriocin field were calculated. The molecular weight of the extracted protein was determined by the SDS-PAGE method. A total of 21 lactic acid bacterial strains were isolated. The maximum antimicrobial components were found to be produced by Ln11 and Ld17 during the logarithmic phase of growth curve. The results of SDS-PAGE showed lactacins with molecular weights ranging from 48 to 57 KD. Considering the antimicrobial properties of the bacterial strains isolated from the local yogurts, they can be used as local probiotic strains in production of fermented foods in preference to the 3 standard strains

Prevalence of left ventricular diastolic asynchrony in patient with systolic heart failure

To study the occurence of left ventricular [LV] diastolic asynchrony in patients with systolic heart failure [HP] and its relationship to diastolic function regardless of QRS duration. Recent work has demonstrated that intraventricular asynchrony is a common finding in patients with systolic heart failure. Little attention has been paid to diastolic asynchrony in patients with systolic heart failure. We have therefore decided to determine the extent to whuch patients with systolic heart failure have evidence of diastolic asynchrony and wheather or not diastolic asynchrony is correlated with diastolic dycfunction. Tissue Doppler echocardiography was performed in 50 HF patients [LV EF=23 +/- 8%]. Diastolic and systolic asynchrony was determined by tissue synchronization imaging using a 6 basal, 6 mid-segmental model. Systolic and diastolic asynchrony were assessed by the maximal difference in time to peak systolic and early diastolic velocities between any two of 12 LV segments, and the standard deviation of time to peak systolic and early diastolic velocities of the 12 LV segments. The mean +/- SD maximal difference in time to peak systolic velocity [controls: 17.2 +/- 9.6 ms versus narrow QRS: 66.7 +/- 38.0 ms versus wide QRS: 76.5 +/- 34.6 ms, both P<0.05 versus controls] and in standard deviation of time to peak systolic velocity of 12 LV segments [controls: 15 +/- 6.1 ms versus narrow QRS: 25.9 +/- 15.3 ms versus wide QRS: 28.6 +/- 14.4ms, both P<0.05 versus controls] was prolonged in both the narrow and wide QRS groups compared with normal controls. Similarly, the maximal difference in time to peak diastolic velocity [controls: 39 +/- 16.8 ms versus narrow QRS: 73.1 +/- 58ms versus wide QRS: 108.5 +/- 168 ms, both P<0.05 versus controls] and in standard deviation of time to peak early diastolic velocity of 12 LV segments [controls: 15.3 +/- 5.8ms versus narrow QRS: 25.1 +/- .13.8ms versus wide QRS: 25.5 +/- 14.9ms, both P<0.05 versus controls] was prolonged in both the narrow and wide QRS groups. The respective prevalence of systolic and diastolic asynchrony was 31.4% and 20%, in the narrow QRS group, and 40% and 28.6%, in the wide QRS group respectively.Stepwise multiple regression analysis showed that low ejection fraction and low mitral annular early diastolic velocity were independent predictors of both systolic and diastolic asynchrony. QRS complex duration was found to correlate only with diastolic asynchrony. LV systolic and diastolic mechanical asynchrony is common in patients with HF regardless of QRS duration. Selection for cardiac resynchronization treatment should also be based on information about systolic and diastolic synchronicity

Evaluation of regional myocardial systolic function in the early stage of acute myocardial infarction by strain rate imaging

We sought to evaluate the impact of different therapeutic strategies on longitudinal regional myocardial systolic function in the early phase of acute myocardial infarction using strain rate imaging. A total of 38 patients [34 males], with first acute myocardial infarction [AMI] were evaluated. Our patients were divided into 3 groups according to the kind of therapy. The mean age of the patients was 55 +/- 9.4 years [range: 39- 75 years]. Mean left ventricular ejection fraction [LVEF] in the patients was 41 +/- 10.7%. Primary percutaneous coronary intervention [PCI] was performed in 10 patients. Sixteen patients were treated by thrombolytic therapy using streptokinase [SK] and 12 were followed-up conservatively. All patients underwent a comprehensive echocardiography study including SR imaging within 3- 5 days after AMI. The parameters measured included peak systolic strain [peak epsilon] and strain rate [SRs], end-systolic strain [epsilon es], post systolic shortening [PSS], time to peak systolic strain rate [tSRs], time to end of shortening [teSRs], post systolic strain [PS epsilon], post-systolic strain index [PSI], PSS ratio [PSS/ epsilon [Max]] and peak postsystolic strain rate [SRPSS]. There was not any association either between WMSI and ta [P=0.4], or MI location and PSS ratio [P=0.13]. But there was an inverse relationship between WMSI and mean SRS, especially when WMSI was more pronounced. A significant relationship was found between t epsilon epsilon and teSRs with the kind of therapy [shorter in PCI group [P= 0.04]. Using a simple linear regression model, no association was found between PSS ratio and SRs [a=0.056, P =0.70], PSI and teSRs [beta= -0.772, P=0.12]. Simple linear regression model showed a weak but significant relationship between PSI and Median t epsilon [beta = -0.851, P =0.04; r =0.33]. Our study showed that PCI resulted in early recovery of regional systolic function of infarcted myocardium during the early stage of acute myocardial infarction

Prevalence of protozoa and gastrointestinal helminthes in stray cats in Zanjan province, north-west of Iran

Cats and other felines act as definitive hosts for many intestinal parasites, some of which are responsible for several zoonotic diseases. The aim of this study was to determine the type and prevalence of protozoa and gastrointestinal helminthes among stray cats. A cross sectional study was conducted. Digestive tracts of 100 stray cats in Zanjan Province, north-west of Iran were autopsied in order to recognize gastrointestinal helminthes and intestinal protozoan parasites. These cats were collected by baited cage trapped from October 2007 to September 2008. Gender and species of helminthes and protozoa were recognized using authentic diagnostic criteria. Statistical evaluation was performed by SPSS version 14. Forty-two percent of cats were infected with intestinal protozoan parasites, 33% were infected with cestodes and 39% infected with gastrointestinal nematodes. Four species protozoan parasites and eight gastrointestinal helminthes were recovered from the animals, including Taenia taeniaeformis, Dipylidium spp., Joyeuxiella pasqaulei, Toxocara cati, Phy-saloptera praeputialis, Rectalaria spp., Onicolla, Cystoisospora spp., Toxoplasma gondii, and Sarcocystis spp. The high infection rate of Toxoplasma and some gastrointestinal helminthes in stray cats is considered to be critical from the viewpoint of public health importance

Epidemiology and clinical manifestation of GOUT in Imam Khomeini Hospital in Tehran, Islamic Republic of Iran

Gout is an increasingly prevalent condition worldwide, creating a heavy economic burden. Acute gout can be effectively treated with non-steroidal anti-inflammatory drugs and recurrent episodes can be prevented with the uricostatic xanthine oxidase inhibitors. This study was conducted to determine the epidemiology and clinical manifestations of 100 patients with acute or chronic gout in Imam Khomeini Hospital in Tehran, Iran. One-hundred patients with gout who referred to the Rheumatology Department were reviewed. Their demographic data, family and drug history, comorbide diseases, body mass index, symptoms and signs at the time of referral to our clinic and lab data were collected. Among patients, 84 were men and 16 women [mean age=55.8 years and mean Body Mass Index=26.1 kg/m[2]. Thirty three percent of the patients were smokers and 10% drank alcohol. Seventy cases had previous gout attack of whom, 56 were in the first metotarso-phalangeal joint. The mean serum uric acid was 8.5 mg/dl. In our study, the mean age and mean body mass index of the patients were similar to those in others studies. Alcohol consumption was low in our study. Hypertension was found to be a risk factor for gout

Comparison of transesophageal echocardiographic assessment of right and left atrial appendage functions

To define right atrial appendage functional parameters and comparing them with those of left atrial appendage. A consecutive series of 154 patients [76 males and 78 females] with mean age of 42 years were referred for transesophageal echocardiography. Ejection and filling velocities of right and left atrial appendages were measured at 120 and 70 degrees respectively. The left and right ventricles size and function, right atrial size, tricuspid regurgitation severity, and pulmonary artery systolic pressure were prospectively measured and calculated during transthoracic echocardiography. Mean right and left atrial appendages velocities were 42 +/- 18 cm/s and 50 +/- 26 cm/s respectively [PV<0.001]. Statistically significant positive association [PV<0.001] was found between right atrial appendage velocity and right ventricle ejection fraction and statistically negative relationship was observed between right atrial appendage velocity and smoke pattern [PV<0.001]. Also, the results suggested marginally significant associations between right atrial appendage velocity and right atrium size [PV = 0.05] and pulmonary artery systolic pressure [PV = 0.07]. It was also found that right atrial appendage measures were relatively independent on right ventricle size and tricuspid regurgitation severity. Our study showed right atrial appendage measures were relatively dependent on right ventricle function, right atrium size and pulmonary artery systolic pressure and relatively independent on right ventricle size and tricuspid regurgitation severity. In patients with right atrium smoky pattern right atrial appendage velocity was significantly reduced

Fatal aortitis: a complication of aspergillus endocarditis following coronary artery bypass graft surgery

The most common fungal organism to cause endocarditis is Candida which is followed by Aspergillus. Aspergillus endocarditis can occur in either the native or prosthetic heart valves, usually occurring post operatively after cardiac surgery on implanted valves. The usual route of infection for invasive aspergillosis is through inhalation of organism into the lungs. Diagnosis is difficult because blood culture usually remains negative even with extensive disease. Long term survival is limited even with surgical intervention.Herein, we present a 49-year-old man with previous history of coronary artery bypass graft and aortic valve endocarditis which was diagnosed as Aspergillus endocarditis after the valve surgery. Unfortunately the patient died because of late occurrence of progressive aortic invasion caused by Candida and Enterococci

Myocardial viability assessment: comparison between resting two dimensional visual assessment of dobutamine stress echocardiography and strain rate imaging

Patients with ischemic left ventricular dysfunction are increasingly referred for the assessment of myocardial viability. The issue of identifying dysfunctional but viable myocardium has crucial clinical importance, since revascularization increases survival only in patients with viable myocardial tissue. The aim of this study was to compare resting two-dimensional visual assessment of myocardial viability with dobutamine stress echocardiography and strain rate imaging. In this cross-sectional study, thirty-two consecutive patients [age: 55.3 +/- 22.7, 4 females] with ischemic left ventricular dysfunction were referred for myocardial viability assessment. Viability was evaluated using resting two-dimensional echocardiograms, dobutamine stress echocardiography and strain rate imaging. Viability was defined by the absence of brightness and thinning [<6 mm thickness] in akinetic segments, improvement by at least one grade or a biphasic response during dobutamine stress echocardiography or an increase in the peak systolic strain rate [more than -0.23 1/s]. A total of 254 segments were studied. Seventy- nine segments by dobutamine stress echocardiography, 70 segments by two-dimensional visual assessment, and 63 segments by strain rate were classified as non-viable [P< 0.001]. There was an almost perfect agreement among these diagnostic methods. Two-dimensional visual assessment with measurement of wall thickness is simple and practical methods for viability assessment, with almost perfect agreement with dobutamine stress echocardiography and strain rate imaging

Employment status of Refsanjan Medical Sciences University graduates

One of the economical and social challenges of graduates of higher education is unemployment. To determine the employment status of students of Rafsanjan medical university. Through a descriptive study, out of 1168 questionnaires sent to graduated students of Rafsanjan medical university [1990- 1996] by mail, 410 questionnaires that were sent back, were analyzed. The results indicated that 60.5% of the research group were employed at one of the public or private organizations, 35.9% were unemployed and 3.6% were self- employed. Out of the employed population, 33.9% were officially hired, 20.2% were conventionally hired, 15.3% had contracts and 30.6% were in the plan of human resource. The interviewed samples [68.4%] stated that high salary was the motive behind occupation. The prevalence of employment were mostly in radiology [81.6%], nursing [79.7%], Medicine [76.7%] operation room [30.5%] an anesthesiology [46.6%]. Nearly half of the graduates were employed at public offices and the role of private section was not significant in this regard