A report of fifty cases with incidental diagnosis of anomalous origin of the right coronary artery from the left sinus of Valsalva.

INTRODUCTION: Anomalous origin of the right coronary artery from the left sinus of Valsalva (R-ACAOS) is a relatively rare condition that can potentially lead to devastating outcomes. The current study aims to investigate the cardiac-related disorders among patients with incidental R-ACAOS diagnosis through computed tomography angiography (CTA). METHODS: The current cross-sectional study has been conducted on 50 patients diagnosed with R-ACAOS who underwent CTA. Based on CTA, the patients' were categorized as R-ACAOS with interarterial course and non-interarterial course. The demographic and medical characteristics, any history of cardiac intervention and New York Heart Association (NYHA) Functional Classification at the time of diagnosis were recruited. Patients were revisited to assess cardiac-associated variables, including symptoms, the presence of heart failure and current NYHA function class. RESULTS: The variables including the history of cardiac intervention (P-value<0.001), the presence of heart failure (P-value = 0.010) and NYHA function class at the time of diagnosis (P-value = 0.006) were remarkably higher among those with interarterial course of R-ACAOS; while, the other variables including chest pain at rest (P-value = 0.55) or on exertion (P-value = 0.12), current NYHA function class, current cardiac-associated symptoms except for dyspnea at rest (P-value = 0.012), mortality and coronary calium score did not differ (P-value>0.05). coronary interventions led to significantly improved NYHA function class (P-value<0.05). CONCLUSION: Based on the findings of the current study, R-ACAOS with interarterial course leads to significantly higher rates of atherosclerotic-related symptoms and events compared with the other types of RCA anomalies. Moreover, coronary interventions led to significantly improved NYHA functional class regardless of R-ACAOS category.

The impact of platelet-to-lymphocyte ratio on clinical outcomes in heart failure: a systematic review and meta-analysis.

BACKGROUND: Inflammation has been suggested to play a role in heart failure (HF) pathogenesis. However, the role of platelet-to-lymphocyte ratio (PLR), as a novel biomarker, to assess HF prognosis needs to be investigated. We sought to evaluate the impact of PLR on HF clinical outcomes. METHODS: English-published records in PubMed/Medline, Scopus, and Web-of-science databases were screened until December 2023. Relevant articles evaluated PLR with clinical outcomes (including mortality, rehospitalization, HF worsening, and HF detection) were recruited, with PLR difference analysis based on death/survival status in total and HF with reduced ejection fraction (HFrEF) patients. RESULTS: In total, 21 articles (n = 13,924) were selected. The total mean age was 70.36 ± 12.88 years (males: 61.72%). Mean PLR was 165.54 [95% confidence interval (CI): 154.69-176.38]. In total, 18 articles (n = 10,084) reported mortality [either follow-up (PLR: 162.55, 95% CI: 149.35-175.75) or in-hospital (PLR: 192.83, 95% CI: 150.06-235.61) death rate] and the mean PLR was 166.68 (95% CI: 154.87-178.50). Further analysis revealed PLR was significantly lower in survived HF patients rather than deceased group (152.34, 95% CI: 134.01-170.68 versus 194.73, 95% CI: 175.60-213.85, standard mean difference: -0.592, 95% CI: -0.857 to -0.326, p < 0.001). A similar trend was observed for HFrEF patients. PLR failed to show any association with mortality risk (hazard ratio: 1.02, 95% CI: 0.99-1.05, p = 0.289). Analysis of other aforementioned outcomes was not possible due to the presence of few studies of interest. CONCLUSION: PLR should be used with caution for prognosis assessment in HF sufferers and other studies are necessary to explore the exact association.

Platelet to lymphocyte ratio and heart failureInflammation plays a role in heart failure (HF), and a blood test called the platelet-to-lymphocyte ratio (PLR) might be helpful in predicting patients' outcomes. We found that deceased HF patients had higher PLR values in comparison to those who survived, irrespective of cardiac pump function, with similar pattern for patients with decreased cardiac function (HF with reduced ejection fraction). However, this biomarker failed to show any significant association with death risk. In conclusion, PLR may have some potential to help predict HF prognosis, but it needs more research and physicians should probably be cautious about using PLR alone in clinical settings.

Alemtuzumab-induced petechiae and epistaxis in a patient with relapsing-remitting multiple sclerosis: A case report.

Here, we present a case of relapsing-remitting multiple sclerosis that experienced petechiae and epistaxis following treatment with second dose of alemtuzumab. This study highlights such effects, emphasizing the need for vigilance as alemtuzumab usage increases. Timely recognition and management are vital for patient care.

Neutrophil to lymphocyte ratio (NLR) prognostic effects on heart failure; a systematic review and meta-analysis.

BACKGROUND: Neutrophil to lymphocyte ratio (NLR), as a recent inflammatory index, has been reported to be a prognostic tool in different diseases. However, implication of this ratio in heart failure (HF) is less investigated. In this systematic review and meta-analysis, we aimed to assess the potential impact of NLR on HF clinical outcomes. METHODS: Relevant English published records in PubMed, Scopus, Embase, and Web of Science were screened up to July 2023. Articles reporting clinical outcomes (follow-up or in-hospital mortality, readmission, HF prediction, extended hospital stay length, pulmonary vascular resistance, atrial fibrillation, renal disease and functional capacity) in HF sufferers were collected for further analysis with addition of NLR difference stratified by death/survived and HF status. RESULTS: Thirty-six articles (n = 18231) were finally selected which reported NLR in HF sufferers (mean: 4.38, 95% confidence interval (CI): 4.02-4.73). We found 25 articles reported NLR and total mortality (either follow-up death (N = 19): 4.52 (95% CI: 4.03-5.01) or in-hospital death (N = 10): 5.33 (95% CI: 4.08-6.57)) with mean NLR of 4.74 (95% CI: 4.28-5.20). NLR was higher among deceased patients compared to survived ones (standard mean difference: 0.67 (95% CI: 0.48-0.87), P < 0.001)). NLR was found to be related with higher mortality risk (continuous variable: hazard ratio (HR): 1.12, 95% CI: 1.02-1.23, P = 0.013), categorical variable: HR: 1.77, 95% CI: 1.27-2.46, P = 0.001, T2 vs. T1: HR:1.56, 95%CI: 1.21-2.00, P = 0.001, T3 vs. T1: HR:2.49, 95%CI: 1.85-3.35, P < 0.001). Other aforementioned variables were not feasible to analyze due to presence of few studies. CONCLUSIONS: NLR is a simple and acceptable prognostic tool for risk stratification and prioritizing high risk patients in clinical settings, especially in resource limited nations.

Prognostic impact of monocyte-to-lymphocyte ratio in coronary heart disease: a systematic review and meta-analysis.

OBJECTIVE: Inflammatory biomarkers are novel tools to assess the prognosis of different cardiovascular diseases. We evaluated the impact of the monocyte-to-lymphocyte ratio (MLR) on clinical outcomes in patients with coronary heart disease (CHD). METHODS: We systematically screened English-language articles in PubMed, Scopus, and Web of Science to 31 August 2022. Relevant articles reporting the MLR and its association with clinical outcomes (major adverse cardiovascular events (MACE), coronary artery disease (CAD) severity, mortality, cardiac rupture, subclinical CAD, acute coronary syndrome (ACS) prediction, thin-cap fibroatheroma, no-reflow phenomenon, MLR-related differences in percutaneous coronary intervention, heart failure hospitalization, and depression) in patients with CHD were collected for further analysis. RESULTS: Nineteen articles were selected. The mean MLR was 0.34. A higher MLR was significantly associated with an increased risk of MACE among patients with CHD. The MLR was an independent predictor of MACE in patients with ACS. No significant association was found for CAD severity. A complementary analysis was not performed because of few studies focusing on the other predefined endpoints. CONCLUSIONS: The MLR is a simple and widely available tool to predict MACE in patients with CHD. This biomarker can be utilized in emergency settings to prioritize high-risk patients and optimize therapeutic interventions.

Translation, cultural adaptation, validation and reliability of Persian version of Edmonton frailty score questionnaire among Iranian heart failure individuals.

Background: Frailty is a common problem in elderly individuals. However, this issue is not well investigated among heart failure (HF) patients with appropriate scales. We aimed to translate and evaluate Edmonton frailty scale (EFS) validity and reliability in Iranian HF adults. Methods: We implemented this methodological study on stable HF patients referred to an outpatient heart clinic in Isfahan, Iran. The translation was done using the forward-backward method. Ten individuals were asked to comment about all items in terms of understandability and simplicity. Fifteen experts were invited, and their ratings on each item were collected to measure the content validity index (CVI) and content validity ratio (CVR). Cronbach's alpha was used for the assessment of internal consistency. After completing the scale for the second time with a two-week interval, test-retest reliability with intraclass correlation coefficient (ICC) measurement was done. Results: The translation process was performed uneventfully. All items were reported to be simple and meaningful. CVI of items ranged from the minimum of 0.80 to a maximum of 1.00 plus an acceptable CVR of at least 0.60. Fifty HF patients (age: 67.2±14.1 years, males: 56%) completed the questionnaire twice without missing data. Cronbach's alpha was first to be 0.550. After omitting three items about social support, drug usage, and nutrition, the value was raised to 0.711. Test-retest reliability showed a good index of consistency (ICC: 0.693, 95% confidence interval: 0.527-0.810). Conclusion: Modified Persian EFS is a simple and meaningful tool with high validity and acceptable reliability for assessing frailty in HF individuals irrespective of age.

Prognostic utility of shock index and modified shock index on long-term mortality in acute decompensated heart failure; Persian Registry of cardioVascular diseasE/Heart Failure (PROVE/HF) study.

BACKGROUND: Shock index (SI) and modified SI (MSI) are used for prognosis in patients with cardiovascular diseases (CVDs), especially myocardial infarction. However, the utility of these indices in heart failure(HF) is less frequently investigated. We aimed to evaluate the long-term prognostic capability of SI and MSI among Iranian HF patients. METHODS: This retrospective cohort study was implemented in the context of the Persian Registry Of cardioVascular diseasE/HF (PROVE/HF). A total of 3896 acute decompensated HF (ADHF) patients were enrolled from March 2016 to March 2020. SI and MSI were assessed at admission. Receiver operating characteristic (ROC) and Kaplan-Meier curves were used to define optimum SI and MSI cut-off points and depict mortality during follow-up, respectively. The association of CVD death according to different SI and MSI cut-off points and quartiles was assessed through univariate and multivariate regression hazard models. RESULTS: Mean age of participants was 70.22 ± 12.65 years (males: 62.1%). We found 0.66 (sensitivity:62%, specificity: 51%) and 0.87 (sensitivity: 61%, specificity: 51%) as optimised cut-off points for SI and MSI, respectively. Mean follow-up was 10.26 ± 7.5 months and 1110 (28.5%) deaths occurred during this time. Multivariate adjusted models revealed patients had SI ≥ 0.66 or within the third and fourth quartiles had higher likelihood of mortality compared to reference group (hazard ratio(HR): 1.58, 95%CI: 1.39-1.80, p < 0.001, HR: 1.38,95%CI:1.14-1.66, p = 0.001 and HR:2.00,95%CI:1.68-2.38, p < 0.001, respectively). MSI outcomes were similar (MSI ≥ 0.87: HR: 1.52,95%CI: 1.34-1.72, p < 0.001, third quartile (0.89 ≤ MSI < 1.00):HR:1.23,95%CI:1.009-1.50, p = 0.041, fourth quartile (MSI ≥ 1.00): HR: 1.80,95%CI: 1.53-2.13, p < 0.001). Kaplan-Meier curves showed patients with higher SI and MSI cut-off values and quartiles had lower survival rates. CONCLUSION: Higher SI and MSI values were associated with increased mortality risk, and these two bedside indices could be appropriately considered for long-term prognosis in ADHF patients.

Translation, Cultural Adaptation, Validation and Reliability of Persian Left Ventricular Dysfunction-36 Questionnaire.

BACKGROUND: The left ventricular dysfunction 36 (LVD-36) questionnaire is considered to be a tool to assess the impact of left ventricle impairment on patients' daily life. This methodological study was aimed to translate and assess the validity and reliability of the Persian draft of the LVD-36 questionnaire among Iranian heart failure (HF) patients. METHODS: We recruited stable HF patients who referred to an outpatient heart clinic in Isfahan, Iran. The LVD-36 questionnaire was translated using the forward-backward method. Twenty HF patients were recruited for content validity assessment and were asked to express their opinions about the comprehensibility and meaningfulness of each item. We invited 14 experts to assess validity through content validity index (CVI) and content validity ratio (CVR). Reliability was assessed by Cronbach's alpha and intraclass correlation coefficient (ICC), with the latter evaluated after invitation of the participants to complete the questionnaire for the second time. RESULTS: The translation process was performed uneventfully without any significant alterations. A total of 150 HF patients were recruited to assess the reliability of the questionnaire in this study (age: 64.6±16 years, males: 58.6%). All items had acceptable CVI and CVR, ranging 0.85-1.00 and 0.57-1.00, respectively. Cronbach's alpha was 0.971. All participants completed the questionnaire for the second time with no missing data. Test-retest reliability revealed an excellent ICC value of 0.981 (95% CI: 0.977-0.985). CONCLUSION: The Persian version of the LVD-36 questionnaire is a simple, valid and reliable tool for evaluating the impact of left ventricle impairment on the well-being of Iranian HF patients.

Predictors of survival rate in patients with pancreatic cancer: A multi-center analytical study in Iran.

BACKGROUND: Pancreatic cancer (PC) is among the deadliest cancers of the gastrointestinal tract worldwide and a growing global health concern. AIM: This study was aimed to evaluate the survival rate and prognostic factors of survival in patients with PC. METHODS: In this retrospective cohort study, the records of 556 patients with PC registered in the hospital cancer registration system from September 2007 to September 2020 were evaluated. In this regard, demographic data, tumor characteristics, received treatments, and patients' final status were analyzed. Kaplan-Meier and Cox's regression were used for univariate and multivariate analyses, respectively. RESULTS: The 5-year survival rate was found to be 4.3%. The median survival time was 12.4 ± 6.6 months. Univariate analysis showed that age, BMI (kg/m2 ), blood transfusions, differentiation, tumor stage, tumor size, number of involved lymph nodes, lymph node ratio (LNR), and type of treatment received were significantly associated with patient survival (p < .05). Multivariate Cox regression indicated that the age ≥60 years [Hazard Ratio (HR) = 1.25, 95% confidence interval (CI) = 1.03-1.49], BMI <18 (kg/m2 ; HR = 1.56, 95% CI = 1.13-2.14), poor differentiation (HR = 2.12, 95% CI = 1.75-2.49), tumor size >2.5 cm (HR = 4.61, 95% CI = 3.30-6.78), metastasis presence (HR = 1.97, 95% CI = 1.49-2.60), more than two involved lymph nodes (HR = 1.52, 95% CI = 1.31-1.77), LNR <0.2 (HR = 0.56, 95% CI = 0.36-0.77), and adjuvant therapy with surgery and chemotherapy (HR = 0.44, 95% CI = 0.28-0.61) are the most important prognostic factors of survival in patients with PC (p < .05). CONCLUSIONS: This study showed that the survival rate of patients with pancreatic cancer varies based on the characteristics of the tumor and the type of treatment received.

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.

Corona Virus Disease 2019 (COVID-19) and Its Effect on Renal System, A Systematic Review and Meta-analysis.

Coronavirus disease 2019 (COVID-19) has been recently emerged with various manifestations, mainly on respiratory system. However, other organs might also be involved. Acute kidney injury has been reported as a complication with high variability and controversial results. We aimed to define the frequency of AKI as well as two specific renal biomarkers including BUN and serum Cr among individuals suffering from COVID-19 infection. We investigated Medline/PubMed, Scopus, and Google Scholar databases until 16th April 2020 and included all relevant peer-reviewed published studies without any language limitations. We further categorized patients according to their clinical status into severe, non-severe, and death groups. 18 records on 4528 individuals were assessed. The mean age of individuals were 52.5 ± 24.4 years (males: 55.6%). Prevalence of AKI was 4% (95% CI: 2% to 8%) and was significantly lower among non-severe patients in comparison to deceased ones (1%, 95% CI: 0% to 4%, vs. 31%, 95% CI: 19% to 47%). BUN mean was 5.14 mmol/L (95% CI: 4.60 to 5.69). Non-severe patients had remarkably lower means of BUN compared to deceased or those with severe infection (4.25 mmol/L, 95% Cl: 3.70 to 4.79, vs. 8.9 mmol/L, 95% CI: 7.94 to 9.86, vs. 6.63 mmol/L, 95% Cl: 5.62 to 7.65; respectively). The mean serum Cr was 71.60 mmol/L (95% Cl: 67.56 to 75.64). Our findings suggest that COVID-19 does not seem to involve renal system extensively and other possible mechanisms might be further investigated in this regard.