Effect of dietary habits on the risk of metabolic syndrome: Yazd Healthy Heart Project.

OBJECTIVE: Metabolic syndrome (MetS) refers to a group of risk factors that increase the risk of cardiovascular mortality and morbidity. Dietary habits are among the most important risk factors for MetS. The current study aimed at assessing the effect of dietary habits on the risk of MetS in a 10-year follow-up study in central Iran. DESIGN: Cohort study. SETTING: Yazd, Iran. SUBJECTS: Participants aged 20-74 years without any history of MetS, who were originally recruited for Yazd Healthy Heart Project (YHHP) during 2005-2006, were revisited during 2015-2016. At phase I of YHHP, demographic data, anthropometric measurements, five components of MetS, biochemical tests and dietary habits were evaluated; and the same data were collected in phase II. RESULTS: A total of 1092 participants were eligible to be included in the present study. After follow-up, the 10-year cumulative incidence of MetS was 56·1 %. After adjustment for potential confounders, increased risk of MetS (hazard ratio; 95 % CI) was found in those who did not try to control their body weight (1·57; 1·06, 2·35), did not usually eat salad (1·91; 1·22, 3·00) and added salt to their food (1·57, 1·06, 2·33). These associations were stronger in men than in the total population after subgroup analysis, but were not present in women. CONCLUSIONS: Dietary habits affect the risk of MetS in the Iranian population. Lifestyle interventions are needed to improve dietary habits to reduce the risk of MetS. Future studies are highly recommended to confirm our results in other populations.

Large In-transient Left Ventricular Thrombus due to Anabolic Steroid-induced Cardiomyopathy.

The presence of small or moderate size thrombosis is not uncommon in left ventricle (LV) as results of basic co-moribund disease, but huge LV thrombosis that protrudes to aortic valve in the LV outflow tract (LVOT) tract is an exceptionally rare phenomenon. We report a 34-year-old bodybuilder athlete with cardiomyopathy and massive LV thrombosis. The thrombosis extended to LVOT and protruded through the aortic valve in systole and posed a high risk of systemic emboli. The patient underwent open heart surgery, and the clot was removed. The operation was complicated by low cardiac output syndrome that managed by intra-aortic balloon pump and high dose of inotropic drugs and hemodialysis. The patient died on the 15th day after surgery with multiorgan failures.

Ostium secundum atrial septal defect endocarditis caused by brucella infection.

The most common cardiovascular presentation of brucellosis (a zoonotic infection) in Iran is aortic valve endocarditis. Brucellosis is a systemic infection and may involve any congenital heart defect with various clinical signs and symptoms. We report brucella endocarditis in an atrial septal defect (ASD) in a 55-year-old man who presented with fever and hemiplegia. Echocardiography showed a secundum ASD with large vegetations of 0.5×1 cm arising from the rim of the ASD. Serological analysis was positive for Brucella agglutinin, thus confirming the diagnosis. The brain CT scan revealed a large ischaemic zone in the left hemisphere. At surgery, large vegetations were excised and the defect was closed with fresh pericardium. After surgery the patient was treated with a 4- week course of antibiotics. His recovery was uneventful except for the neurological deficit (hemiplegia); he was discharged on postoperative day 35.

Preoperative Emboli in a Pregnant Woman with Myxoma.

The left atrium is the most common location of myxomas, which are benign tumors. Only a few cases of myxomas in pregnancies have been reported. Our thorough medical literature search showed only 17 reported cases in the course of pregnancy. Myxomas during pregnancy and in the preterm period constitute a serious phenomenon that can mimic an early sign of a life-threatening pathology like severe mitral stenosis. We describe a 33-year-old woman, who presented with acute dyspnea to a gynecology center and was referred to our hospital for further evaluation of pulmonary embolism. Transthoracic echocardiography showed a huge left atrial myxoma, and computed tomography scan illustrated paradoxical pulmonary embolism in the left upper lung lobe via a large patent foramen ovale. The tumor required urgent cardiac surgery. In this article, we review causes of dyspnea in pregnancy and the cardiovascular effects of myxomas in pregnancy. We also describe the pathophysiological effects of cardiopulmonary bypass on the mother, fetus, and the feto-placental system during open-heart surgery. We performed a successful surgical resection of a myxoma in a pregnant woman. Given the rarity of such cases, individual multidisciplinary assessment and management strategies are essential.

Hydatid cyst of the interventricular septum causing complete heart block and postoperative ventricular septal defect.

Cardiac involvement is seen in 0.5-2% of patients with hydatid disease, and involvement of the interventricular septum (IVS) is even rarer. We report surgical treatment of a large cardiac hydatid cyst in the IVS. A 55-year-old woman presented with dyspnea and bradycardia. Transthoracic echocardiography revealed a large cyst in the mid to apical part of the IVS. The patient was placed on cardiopulmonary bypass. Through an incision to bulging part of cyst into right atrium, and without opening adjacent cardiac chambers, we aspirated the entire contents of the cyst, removed its germinative membrane, and washed the cavity with 96% alcoholic solution. The patient recovered uneventfully. She had begun taking albendazole 5 days preoperatively, and this therapy was continued for 12 weeks postoperatively. A permanent pace maker was implanted because she was dependent on temporary pace maker and after 1 year follow-up, complete heart block had not recovered to normal conduction rhythm.

A rare case of prosthetic aortic valve endocarditis complicated with multiple fistula to peri aortic structure.

Multiple aorto-cardiac cavity communications is very rare but important complication of prosthetic aortic valve endocarditis. The case below illustrates multiple aorto-cardiac cavity fistula formation following prostethic aortic valve endocarditis presented with slowly progressive symptoms of heart failure. A brief review of surgical reconstruction and the existing literature are presented, including emphasis on pre and intra operative echocardiographic diagnosis and treatment.

Budd-Chiari syndrome following abdominal trauma.

We report a case of Budd-Chiari syndrome (BCS) in a 44-year-old man with inferior vena cava (IVC) thrombosis and nephrotic syndrome. This case was complicated by right atrial clot and pulmonary emboli. Endothelial injury of the IVC was the likely mechanism, following a kick from a donkey. Abdominal ultrasonography revealed a large thrombosis located in a segment of IVC near its orifice in the right atrium. Transthoracic echocardiography (TTE) revealed IVC thrombosis that extended to the right atrium; however, pulmonary emboli (PE) were not documented in TTE. Intraoperative exploration revealed multiple clots in the main and left pulmonary artery branches. The patient recovered well after open-heart surgery with resection of the right atrium, IVC, and pulmonary artery emboli. BCS should be routinely considered for patients with nephrotic syndrome.

Traumatic fracture of central venous catheter.

Central venous catheter (CVC) placement is frequently essential for the management of critically ill patients. This report describes a case involving the surgical retrieval of an embolized fragment of a CVC, originally intended for dialysis, following an unsuccessful removal attempt by a nurse due to catheter malfunction. The decision to remove and replace the malfunctioning catheter was made by the patient's physician. However, during the removal process, both the retaining suture and the catheter were inadvertently severed. This report also discusses the complications and management strategies associated with the embolization of a central line.

Clinical symptoms, pathogenesis and postoperative course of non-specific constrictive pericarditis with dumbbell-shaped heart.

Non-specific chronic constrictive pericarditis is a rare and debilitating chronic infection in developed countries and its rapid diagnosis and treatment has not affected its outcome and complication. A 15-year-old male, well nourished, negative HIV test, and without a history of previous pulmonary tuberculosis, was admitted to our hospital for exertional dyspnea (New York Heart Association, NYHA, functional class II). Our patient had had no pulmonary tuberculosis during childhood, had received anti-tuberculosis treatment, and was referred to our center for further surgical pericardiectomy.

A giant hydatid cyst in the interventricular septum with papillary muscle involvement.

We present here a 44-year-old male patient with hydatid disease who was referred to our hospital due to dyspnea and chest pain for the last 2 month before admission. Using echocardiography and contrast-enhanced computed tomography the heart hydatid was diagnosed. However, hydatid disease of the interventricular septum is rare; particularly, the involvement of mitral apparatus with mitral regurgitation (MR) is an exceptionally rare presentation. Early diagnosis and an integrated treatment strategy are crucial. Surgical excision was performed and the patient had an uneventful recovery and follow-up at 3 months.

Combined chest wall and liver hydatid cyst.

BACKGROUND: Hydatid cysts (HC) are primarily found in the liver, with secondary occurrences in the lungs and other organs. The presence of HCs in the anterior chest wall is notably rare, and even more so when associated with HCs in the liver. CASE PRESENTATION: A 53-year-old male reported to our facility with a non-painful lump on his chest's front wall. A thoraco-abdominal CT scan identified cysts within the chest wall's subcutaneous layer, showing no spread to nearby soft tissues or involvement of the lungs and ribs. Despite an echinococcal test returning negative, the initial diagnosis leaned towards a dermoid cyst. After surgical removal and detailed examination, the cysts were confirmed as HCs. Further investigation revealed an additional liver HC. The patient was referred for surgery where he underwent laparotomy and drainage of cyst content. CONCLUSION: This case underscores the importance of considering HCs when diagnosing palpable lesions on the chest wall, particularly in regions where HCs are endemic.

Genomic characterization and phylogenetic evolution of the canine parvoviruses in Iranian dogs, a nationwide study: CPV evolutionary analysis in Iran.

Canine Parvo Virus 2 (CPV-2) culminated in lots of fatalities in domestic dogs since its emergence in 1978. Mainly, it is responsible for severe hemorrhagic diarrhea, vomiting, and dehydration. CPV-2 has three main variants known as 2a, 2b, and 2c. Due to the necessity of monitoring the evolutionary parameters of the virus, and also the lack of comprehensive study of CPV2 in Iran, this study is done for the first time in this country not only to characterize Iranian CPV genomes but also to study the evolutionary parameters and phylodynamics of CPV. The phylogenetic trees were constructed using the Maximum Likelihood (ML) method. By the use of the Bayesian Monte Carlo Markov Chain (BMCMC) method, evolutionary analysis and phylodynamics of the virus were investigated. Phylogenetic results showed that all Iranian isolates were classified in the CPV-2a variant. The central part of Iran was suggested to be the origin of the virus, especially the Alborz province. Before its prevalence throughout the country, the virus circulated in the central part, in Thran, Karaj, and Qom. Mutational analysis showed a positive selection pressure of CPV-2a. Investigating the evolutionary parameters of the virus proposed 1970 to be the date of birth of the virus, with a 95% credible interval between 1953 and 1987. The effective number of infections increased dramatically from 2012 to 2015, then faced a slightly decreasing trend from 2015 to 2019. A considerable up warding pattern was witnessed from the middle of 2019, which can be taken as a concern about the risk of vaccination failure.

Correlation of Ponticulus Posticus with Dentofacial Skeletal Patterns.

Background: This study aimed to assess the correlation of ponticulus posticus (PP) with dentofacial skeletal patterns on lateral cephalograms of an Iranian population. Methods: This retrospective study evaluated 1000 lateral cephalograms of 690 females and 310 males. Demographic information of patients was recorded, and two observers evaluated all radiographs for the presence of PP. The dentofacial skeletal pattern was also determined as Class I, II, or III. Disagreements were resolved by discussion with a third observer. Data were analyzed using the Chi-square test. Results: The mean age of patients was 19.47 ± 8.37 years (range 7-64 years). The prevalence of PP was 38.3%. PP had a significant correlation with gender (P = 0.022) such that PP was more common in males (43.5%). No significant correlation was noted between PP and age or dentofacial skeletal pattern (P > 0.05). Conclusions: PP was relatively common in our study population. PP had no correlation with age or dentofacial skeletal pattern of patients.

Detection of canine circovirus in dogs infected with canine parvovirus.

Since the first detection of canine circovirus (CanineCV), several reports have been published over the last decade about the worldwide distribution of this emerging virus of dogs. In order to investigate the prevalence and genomic features of CanineCV in Iranian dogs, a total of 203 dog faecal samples was collected between February and November 2018 from five different geographical regions and screened by real-time PCR (qPCR). Thirteen dogs (6.4%) tested positive for CanineCV DNA, all being detected in co-infections with the highly virulent canine parvovirus (CPV). Three partial replicase nucleotide sequences of the detected CanineCV strains were obtained and compared with the reference sequences deposited in the GenBank database. The Iranian CanineCV sequences had a nucleotide identity of 96.4-98.2% each to other and of 88.3-98.2% with other sequences available on the GenBank. Phylogenetic analysis showed that the Iranian sequences are more closely related to Turkish strains than to strains reported from other countries. The present study provides new insights into the CanineCV molecular epidemiology and its possible role as a co-infectious pathogen.

Detection and Genomic Characterization of Canine Circovirus in Iran.

Canine circovirus (CaCV) is a single-stranded DNA virus that globally circulates in dogs and wild carnivores. Although the pathogenic potential of the virus has not been fully understood yet, CaCV has been suggested to exacerbate the clinical course of other canine viral infections but also to circulate in dogs without clinical signs. In this study, we carried out real-time PCR assays to detect enteric pathogens from 156 canine rectal swabs collected from dogs without enteritis in 3 different regions in Iran. A total of 14 samples tested positive for CaCV and full-length genome sequences were obtained from 6 of the detected strains. Sequence and phylogenetic analyses showed that, despite the distance between the different sample collection sites, all Iranian CaCV strains were closely related and formed a separate clade from extant CaCVs. The present study shows that CaCV is circulating in non-diarrheic dogs in Iran, thus highlighting the need for further epidemiological investigations in Iranian domestic and wild carnivores.

A rare case of volvulus after off-pump coronary artery bypass graft surgery in an opium addict patient revised.

BACKGROUND: Volvulus of colon is a very rare phenomenon in post cardiac surgery course, and their predicting factor in most patients is unknown. Between colonic volvulus, splenic flexure is the rarest site for torsion in general population. The main symptoms are vague abdominal pain, vomiting and distension. The primary diagnostic images include plain chest x-ray, CT scan and colonoscopy. CASE PRESENTATION: We report the case of a 57-year -old opium male addict, who was. Admitted for abdominal pain, nausea, and vomiting five days after off-pump coronary artery bypass surgery (OPCAB). An abdominal x-ray reported a colonic volvulus. Exploratory laparotomy showed acute abdomen resulting from a gangrene of long segment of splenic flexure caused by volvulus. CONCLUSION: Gastrointestinal complication such as volvulus is an exceedingly rare complication of OPCAB, despite the absence of anatomic abnormalities only complete colonic malrotation as the result of mega colon and constipation, the main pathogenetic causes. This patient was unique because of careful literature search revealed that this case was the first reported volvulus that has been described so far.

HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) versus adult T-cell leukemia/lymphoma (ATLL).

OBJECTIVES: Human T cell leukemia virus-1 (HTLV-1) infection may lead to one or both diseases including HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) or adult T cell leukemia lymphoma (ATLL). The complete interactions of the virus with host cells in both diseases is yet to be determined. This study aims to construct an interaction network for distinct signaling pathways in these diseases based on finding differentially expressed genes (DEGs) between HAM/TSP and ATLL. RESULTS: We identified 57 hub genes with higher criteria scores in the primary protein-protein interaction network (PPIN). The ontology-based enrichment analysis revealed following important terms: positive regulation of transcription from RNA polymerase II promoter, positive regulation of transcription from RNA polymerase II promoter involved in meiotic cell cycle and positive regulation of transcription from RNA polymerase II promoter by histone modification. The upregulated genes TNF, PIK3R1, HGF, NFKBIA, CTNNB1, ESR1, SMAD2, PPARG and downregulated genes VEGFA, TLR2, STAT3, TLR4, TP53, CHUK, SERPINE1, CREB1 and BRCA1 were commonly observed in all the three enriched terms in HAM/TSP vs. ATLL. The constructed interaction network was then visualized inside a mirrored map of signaling pathways for ATLL and HAM/TSP, so that the functions of hub genes were specified in both diseases.

The Ruptured Pericardial Cyst to the Right Atrium: A Case Report.

The pericardial cysts (PC) are rare congenital anomaly. They are usually asymptomatic or incidentally found during surgery or by an imaging modality. We report a 35-yr-old man referred to Imam Ali Hospital, Kermanshah, western Iran in 2017, with palpitation, chest pain and dyspnea and physical exam revealed sign and symptoms of right atrial compression and tamponade.