A case of recurrent osteomyelitis due to retained micro-catheter after cerebral angiography.

Infections associated with healthcare manipulations, particularly bloodstream infections stemming from catheters and medical devices, significantly heighten the probability of vertebral osteomyelitis. The diagnosis of infective endocarditis (IE) frequently overlaps with vertebral osteomyelitis (VO). In cases where individuals are suspected of having hematogenous vertebral osteomyelitis and have an intravascular catheter or device, it is recommended to undertake blood culture collection. We present a case of a 39-year-old male with a history of interventional AVM embolization and cerebral angiography, experiencing recurrent vertebral osteomyelitis. No definitive source of infection had been found, and transthoracic echocardiography (TTE) yielded negative results for IE. In Trans Esophageal Echocardiography (TEE), a retained micro-catheter extending from the aortic arch to the inguinal artery was discovered. Although we cannot definitively attribute the source of the osteomyelitis to the retained micro-catheter, no episodes of infection have been reported ever since. This case underscores the need to enhance our approaches and guidelines related to operating protocols in the surgical setting. Improving these guidelines can prevent similar occurrences in the future, emphasizing the importance of continuous improvement in healthcare practices.

Para-Cardiac Inflammatory Mass Compressing the Heart: A possible association with COVID-19.

Infection with the SARS-CoV-2 virus causes coronavirus disease 2019 (COVID-19). COVID-19 usually affects the lungs but may also involve other organs such as the heart. We report a case of a para-cardiac mass in a previously healthy 45-year-old male who developed persistent dyspnea following SARS-CoV-2 infection. The patient underwent cardiac surgery since the mass was attached to the pericardium and was causing constrictive pericarditis. The pathology report indicated an inflammatory pattern for the mass. Based on the authors' knowledge there has been no previous report of developing a para-cardiac inflammatory mass after SARS-CoV-2 infection. This report aimed to increase awareness regarding the possibility of developing a para-cardiac inflammatory mass following COVID-19.

Myocarditis following AstraZeneca (an adenovirus vector vaccine) COVID-19 vaccination: A case report.

Coronavirus disease-19 (COVID-19) vaccines are massively administered globally and some adverse events, such as myocarditis, are being reported. Most of the reported cases of post-vaccination myocarditis have occurred following mRNA vaccinations. However, there have also been recent reports of myocarditis following adenovirus vector vaccinations. We present a case of a 32-year-old female patient who developed myocarditis following the administration of the first dose of the AstraZeneca vaccine. The patient developed inappropriate exertional tachycardia and exertional dyspnea from Day 3 and was diagnosed with myocarditis by subsequent echocardiography about 3 months later. We are unable to confirm a direct association between myocarditis and AstraZeneca vaccination. However, we would like to increase awareness regarding the possibility of developing myocarditis following AstraZeneca vaccination.

Comparing outcomes of clonidine and captopril in patients with hypertensive urgency: A randomized clinical trial.

BACKGROUND: Hypertension (HTN) is the second leading risk factor for death and disability. One fourth of healthcare in Eastern Europe and Central Asia is being spent on blood pressure (BP)-related diseases. An important situation in patients with high BP is hypertensive crisis (BP > 180/120 mmHg), which is divided to hypertensive emergency and urgency. Therefore, here, we decided to compare the effect of captopril and clonidine in patients with hypertensive urgencies, and their side effects. METHODS: This was a parallel-group randomized clinical trial. Patients, who referred to emergency ward with any symptoms of hypertensive crisis, underwent a careful history taking and clinical examination. Individuals with systolic BP (SBP) ≥ 180 mmHg or diastolic BP (DBP) ≥ 110 mmHg with no evidence of end organ damage were randomly assigned into two interventions, clonidine and captopril. 25% decrease in BP was considered as ideal relief. RESULTS: Regarding the duration of response to treatment drugs, patients who received clonidine relieved significantly faster than those who received captopril (P = 0.016). Moreover, the frequencies of side effects such as headache, dizziness/vertigo, dry mouth, and drowsiness in the clonidine group were significantly lower than captopril group (P < 0.05). CONCLUSION: Patients in clonidine group relieved sooner and experienced fewer side effects. Therefore, this study suggests clonidine as a more effective therapeutic for hypertensive urgency compared with captopril.

Flow-Mediated Dilation, a Marker of Endothelial Cell Dysfunction, in Patients with Pulmonary Hypertension.

Background: Flow-mediated dilation (FMD) is considered a marker of endothelial cell dysfunction (ECD) and has been mostly evaluated in coronary artery disease. The role of ECD in the pathogenesis of pulmonary hypertension (PH) is not well-known. This study sought to evaluate the relationship between FMD and PH. Materials and Methods: In this cross-sectional study, the FMD of the brachial artery was measured in 40 confirmed PH patients. Meanwhile, echocardiographic findings, the 6-minute walk test (6MWT), and serum pro-brain natriuretic peptide (pro-BNP) level were evaluated. Overall, 20 patients accomplished all evaluations, and their data were analyzed using SPSS software (version 23). Results: There was an inverse relationship between pro-BNP and 6MWT (r<0, P<0.05). A significant direct relationship was observed between left ventricular ejection fraction and FMD (P=0.031). Right ventricular (RV) dilation was significantly correlated with pro-BNP (P=0.046). There was a significant direct correlation between RV function and FMD and a significant inverse relationship between pro-BNP and FMD (P=0.05). The independent t-test showed no relationship between FMD and syncope (P=0.75). Conclusion: Endothelial cell function, which can be evaluated by FMD, was involved in patients with PH. The FMD and 6MWT were helpful as objective prognostic markers in PH. Furthermore, pro-BNP was a noninvasive indicator in the diagnosis of RV systolic dysfunction.

The association between anthropometric parameters and cardiovascular risk indicators in women with polycystic ovarian syndrome.

BACKGROUND: In patients with polycystic ovarian syndrome (PCOS), this is now hypothesized that whether increased risk for cardiovascular disorders is related more to obesity than PCOS per se. This study aimed to compare cardiovascular risk factors between the lean and obese women with PCOS. METHODS: This case-control study was conducted on 86 (43 obese and 43 lean) women with PCOS. The presence of overweight and obesity was defined based on the body mass index (BMI) (> 25 kg/m2). The study objectives were first to compare mean levels of cardiovascular laboratory parameters between lean and obese patients with PCOS and then to assess the relationship between obesity indices and these laboratory parameters. RESULTS: Compared to the lean group, the obese group had significantly higher mean fasting blood sugar (FBS) (89.40 ± 10.73 versus 84.09 ± 7.87 mg/dl, P = 0.011), higher mean serum triglyceride (TG) (119.09 ± 60.66 versus 96.86 ± 27.23 mg/dl, P = 0.032), higher mean total cholesterol (147.70 ± 57.38 versus 126.79 ± 35.95 mg/dl, P = 0.045), and also higher mean low-density lipoprotein (LDL) (92.30 ± 13.53 versus 83.77 ± 17.61 mg/dl, P = 0.014). Using the Pearson's correlation test, positive correlations were found between BMI and waist circumference (WC) indices and study parameters including FBS, serum TG, serum total cholesterol, serum LDL, and also blood pressure (BP). CONCLUSION: Because of higher concentrations of FBS and lipid profiles in obese patients with PCOS and considering obesity as a more important risk factor for coronary artery disease (CAD) than PCOS, it is recommended to assess and monitor cardiovascular risk factors in these population to reduce the risk for cardiovascular disorders and metabolic syndrome. Also, by reducing body weight and normalizing BMI value, the cardiovascular and metabolic risk factors can be modified and prevented.

The Iranian Society of Echocardiography (ISE) Statement on Performing Echocardiography During the COVID-19 Pandemic.

Corona virus disease 2019(COVID-19) pandemic has caused a significant burden on the global health system. Considerable cardiovascular involvement has been reported among COVID-19 patients with higher ICU admission and mortality rates among patients with cardiovascular comorbidities. Consequently, diagnostic cardiovascular evaluations such as echocardiography are a crucial part of the disease management. On the other hand, providing safety for the patients and the healthcare personnel is a matter of great concern in the pandemic state. In this document, we have provided recommendations on performing echocardiography in hospital echocardiography labs and outpatient echocardiography clinics during the current COVID-19 (Coronavirus disease of 2019) outbreak.

The value of epicardial adipose tissue thickness for outcome prediction of patients undergoing coronary artery bypass grafting surgery.

BACKGROUND: The significant association between epicardial adipose tissue and cardiovascular risk factors as well as outcome of ischemic heart diseases has been recently proposed. We determined the association between epicardial adipose tissue thickness and in-hospital as well as 3-month outcome after coronary artery bypass grafting surgery (CABG). MATERIALS AND METHODS: This cross-sectional study was performed on 78 consecutive patients who underwent CABG in our heart center. Associations between epicardial adipose tissue thickness and in-hospital as well as 3-month outcome after CABG were measured by logistic regression and value of epicardial fat thickness evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: Patients in-intensive care unit (ICU) suffered a variety of events, which many of them were insignificant, but 23 events (29.4%) of 78 were considered as important. The most frequent complication occurred in ICU was atrial fibrillation (9%). The frequency of 3-month complications was 6.4%, including 3.8% rehospitalization, 1.3% reoperation, and 1.3% cardiac death. Ninety-day mortality rate was 1.3%. Mean epicardial adipose tissue thickness was significantly higher in those with in-ICU complications than those without complication (7.64 ± 2.80 mm vs. 6.16 ± 2.29 mm, P = 0.015); however, the difference for 90-day complications was statistically nonsignificant. According to ROC curve analysis, measuring epicardial adipose tissue thickness could moderately predict in-ICU complication (area under the curve = 0.65 8, 95% confidence interval: 0.536-0.779, P = 0.017). The best cut-off point of this adipose tissue thickness for predicting in-ICU complication was 6.5 mm with sensitivity of 65.9% and specificity of 58.8%. CONCLUSION: Epicardial adipose tissue thickness is a useful predicting parameter for in-ICU complications after CABG.

Selenium Level in Patients with Heart Failure versus Normal Individuals.

BACKGROUND: Despite many attempts to discover pathophysiologic mechanisms to explain chronic heart failure (CHF), no conceptual paradigms have been proved yet. Various studies have shown the role of trace elements on heart failure (HF). Among all trace elements, selenium deficiency is regarded as important risk factors for HF. Considering selenium deficiency in our society and high prevalence of HF, we compared selenium level in patients with HF with healthy individuals. METHODS: In all, 32 hospitalized patients with HF and 32 healthy controls were enrolled in a case-control study. Demographic characteristics as well as functional class and risk factors were recorded for all two groups. Echocardiography was conducted for patients and all provided data were registered. Then serum selenium levels were compared in case and control groups. RESULTS: The mean (±standard deviation) serum selenium was 92.5 ± 22.44 mg/dL in patients with HF and 109.3 ± 29.62 mg/dL in controls. The level of selenium was significantly lower and the frequency of risk factors was significantly higher in case group. Selenium level did not differ significantly in patients with different HF causes. There were a nonsignificant relationship between selenium level and left ventricular ejection fraction and a significant reverse relationship between selenium level and left ventricular volume and pulmonary artery pressure. CONCLUSIONS: Our results showed statistically significant lower level of serum selenium in patients with CHF in comparison to normal individuals. Moreover, selenium level had significant reverse relationship with left ventricular volume and pulmonary artery pressure.

Beneficial effects of the treatment of iron deficiency on clinical condition, left ventricular function, and quality of life in patients with chronic heart failure.

BACKGROUND: Anemia is now considered as an important contributing factor to the deterioration of chronic heart failure. The present study aimed to assess the effects of intravenous iron therapy on clinical condition, left ventricular function and also quality of life in patients who suffered of chronic heart failure and concomitant iron deficiency. METHODS: In this clinical trial, 25 consecutive patients with concomitant chronic heart failure and iron deficiency referred to Shariati hospital  in Isfahan, Iran in 2013. After initial clinical, laboratory, and echocardiography assessments, the patients administered 200 mg intravenous Iron per week until compensating iron deficit. Then, all study parameters were assessed again and compared to parameters before the therapeutic intervention. RESULTS: The NYHA class showed a significant improvement after the therapeutic approach. The prevalence of heart failure-related edema was also significantly reduced from 60% before treatment to 48% after that (p = 0.036). The rate of hospitalization was considerably reduced from 42% to 16% (P < 0.001). Moreover, mean 6 minute walk test (6MWT) was increased from 155.18 m to 187.40 m (P < 0.001). Comparing Left Ventricular Ejection Fraction (LVEF) after treatment to figures before the test indicated a significant improvement in this parameter (27.5% versus 33.0%, P = 0.007). The treatment of iron deficiency in this group of subjects got a significant improvement in SF36 total score. CONCLUSION: In patients with chronic heart failure, the treatment of iron deficiency results in a marked improvement in functional status, ejection fraction, and also quality of life as well as a reduction in need to re-hospitalization, however renal function was deteriorated and thus more pay attention to renal function is necessary.

Successful Retrieval of embolized atrial septal defect occluder and patent foramen ovale closure device using novel coronary wire trap technique.

The use of atrial septal device occluders can lead to device embolization. This major complication can occur due to loose margins, deficient aorta, or thin and floppy posterior rim. Device embolization most often occurs after device release, and retrieval is essential. Many devices, including snare and bioptome, have been utilized for retrieval. However, performing these procedures can be difficult and time consuming. Failure to retrieve the embolized device requires open heart surgery. We report a novel and easy to perform method, "coronary wire trap technique," in the event of retrieval failure using conventionally available devices and snare, thereby preventing open-heart surgery. © 2017 Wiley Periodicals, Inc.

Comparison of manual versus automated blood pressure measurement in intensive care unit, coronary care unit, and emergency room.

BACKGROUND: Accuracy of blood pressure (BP) measurement in clinical settings is one of the most concerns despite of promotion in techniques for the measurement of BP. Our aim was to compare automated versus manual BP measurement in intensive care unit (ICU), coronary care unit (CCU), and emergency room patients. METHODS: Totally, 117 patients in ICU, CCU, and emergency department were registered in the study. Demographic information was recorded. The cardioset heart monitoring device was used for measuring BP and mercury sphygmomanometer with appropriate cuffs was used for manual method. Then, the mean BP of two methods was compared based on different age, sex, weight, and disease findings. RESULTS: The mean systolic blood pressure (SBP) was 124.526 mmHg, with minimum and maximum of 123.111 and 125.940 mmHg, respectively (Cronbach's alpha = 0.893); furthermore, mean diastolic blood pressure (DBP) was 73.496 mmHg, with minimum and maximum of 72.718 and 74.247 mmHg, respectively (Cronbach's alpha = 0.852). SBP was significantly different between the two methods, and especially in patients below 60 years, hospitalized in ICU ward, overweight, mid-upper arm circumference below 27 cm, and with neurosurgery problems, it was higher by manual method (P < 0.050). Moreover, DBP was more in manual method in patients with female sex, below 60 years, hospitalized in ICU ward and with neurosurgery problems (P < 0.050). CONCLUSION: The results of this study suggested that manual method in measurement of BP frequently shows higher BP, especially in patients admitted to hospitals-affecting up to 15 mmHg higher, and this discrepancy is more in critical situations.

Severe mitral regurgitation, an unusual manifestation of chemotherapy-induced cardiotoxicity.

Cardiotoxicity is one of the most feared side effects of chemotherapy with enhanced morbidity and mortality in survivors. Arrhythmia, heart failure, myocardial ischemia, hypertension, and thromboembolism are commonly reported as side effects. Hereby, we are reporting a case of severe mitral regurgitation as a complication of chemotherapy.

Benefits from the correction of vitamin D deficiency in patients with pulmonary hypertension.

BACKGROUND: Vitamin D (Vit D) is linked to various conditions including musculoskeletal, metabolic and cardiopulmonary diseases. However, it is not clear whether correction of vit D deficiency exerts any beneficial effect in patients with pulmonary hypertension. METHODS: This study was a prospective uncontrolled longitudinal study. Patients with pulmonary hypertension and vit D deficiency were enrolled into this study. All patients in addition to standard treatment for pulmonary hypertension received cholecalciferol at a dose of 50,000 IU weekly plus calcicare (at a dose of 200 mg magnesium + 8 mg zinc + 400 IU vit D) daily for 3 months. Serum level of 25-hydroxy vit D, serum level of pro-brain natriuretic peptide, six minute walk test (6MWT), peak and mean pulmonary artery pressure, right ventricular size and function, ejection fraction (EF) and New York Heart Association (NYHA) functional class were measured at baseline and after 3 months of treatment. RESULTS: Twenty-two patients with pulmonary hypertension and vit D deficiency were enrolled into the study. At endpoint, the serum vit D level increased significantly to 54.8 ng/ml, the mean of baseline distance of 6MWT increased significantly to 81.6 m and the RV size significantly improved. The mean pulmonary artery pressure also improved after the intervention, but their changes did not reach to statistically significant levels. CONCLUSION: Vit D replacement therapy in patients with pulmonary arterial hypertension and vit D deficiency results in significant improvement of right ventricular size and 6 MWT. Moreover, mean pulmonary artery pressure improves nonsignificantly. This issue requires further studies with long-term follow-up period.

Isolated Left Ventricular Apical Hypoplasia: Reporting a Case With Mild Manifestations and Different Echocardiography Features.

INTRODUCTION: Isolated left ventricular apical hypoplasia is an unusual type of cardiomyopathy that presents with different clinical manifestations according to the age of the disease, ranging from no symptoms in children to congestive heart failure, pulmonary edema, or even malignant tachycardia in adults. To our knowledge, only a few cases of isolated left ventricular apical hypoplasia have been reported in Asian adults. CASE PRESENTATION: Herein, we described an adult case of isolated left ventricular apical hypoplasia referred to our heart center in Isfahan, Iran in 2015 with a complaint of mild dyspnea with the absence of obvious fatty tissue in the heart's apex and an absence of any shunt, which are common findings in patients with this phenomenon. CONCLUSIONS: Patients faced with isolated left ventricular apical hypoplasia should be monitored by echocardiography because of this disease's possible progressive trend to life-threatening consequences.

Role of Meticulous Observation: Successful Pregnancy in a 30-Year-Old Woman with Severe Pulmonary Hypertension.

Pregnancy is strongly discouraged in patients with pulmonary arterial hypertension (PAH). Herein, we report a successful delivery in a woman with PAH using a multidisciplinary approach. A 30-year-old pregnant woman with PAH was referred to us with a chief complaint of dyspnea. She was advised to terminate her pregnancy but she refused to do so despite several recommendations by healthcare professionals. She was scheduled for treatment with iloprost (brand name: Ilomedin) and heparin infusions for 3-4 days at 20-day intervals. She spent her last month of pregnancy in a hospital under close observation and received iloprost infusion. She underwent a successful cesarean section under general anesthesia at week 36 of gestation. Iloprost administration was continued for one week after delivery and was changed to bosentan after that. Meanwhile, heparin infusion was substituted by warfarin. However, treatment with bosentan led to a temporary interruption in breastfeeding. A few days later, she presented with severe dyspnea and pulmonary artery pressure of 110 mmHg. Treatment was restarted with iloprost, followed by stabilization with bosentan. A successful delivery was achieved in this situation by meticulous observation and aggressive treatment targeting PAH, along with long-term hospital stay and multidisciplinary management. Severe PAH is regarded as a contraindication to pregnancy. While physicians strongly recommend termination of pregnancy in such patients, some of them might refuse and insist on delivery of the baby. Similar pregnant cases with potential delivery are recommended to be evaluated for effective management of this condition.

Effects of Metformin Treatment on Homocysteine Levels and Metabolic Parameters of Women With Polycystic Ovary Syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women. Metformin is a biguanide commonly used to improve PCOS symptoms. Effect of metformin on the levels of serum homocysteine (Hcy) in PCOS women is unclear. The aim of this study is evaluating the effect of metformin administration on serum Hcy levels and metabolic parameters of PCOS patients. MATERIALS AND METHODS: Thirty three patients with PCOS were enrolled in this study who were selected randomly. All patients received metformin from the fifth day of menstrual cycle at a dose of 850 mg (one tablet daily) for 3 months. Body mass index, Triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting blood sugar and homocysteine levels were recorded at entry into the study and after 3 months treatment. RESULTS: BMI, plasma Homocysteine concentrations and fasting blood sugar levels were significantly (p < 0.05) decreased after the treatment period. No significant changes were observed in the lipid profiles of patients. There was a weak negative correlation between homocysteine and LDL cholesterol serum levels (p = 0.04, r = -0.27). CONCLUSION: Treatment with metformin in PCOS women may lead to beneficial effects in terms of BMI, plasma homocysteine concentrations and fasting blood sugar with no remarkable effect on lipid profile.

Beneficial effects of testosterone therapy on functional capacity, cardiovascular parameters, and quality of life in patients with congestive heart failure.

BACKGROUND: According to the present evidences suggesting association between low testosterone level and prediction of reduced exercise capacity as well as poor clinical outcome in patients with heart failure, we sought to determine if testosterone therapy improves clinical and cardiovascular conditions as well as quality of life status in patients with stable chronic heart failure. METHODS: A total of 50 male patients who suffered from congestive heart failure were recruited in a double-blind, placebo-controlled trial and randomized to receive an intramuscular (gluteal) long-acting androgen injection (1 mL of testosterone enanthate 250 mg/mL) once every four weeks for 12 weeks or receive intramuscular injections of saline (1 mL of 0.9% wt/vol NaCl) with the same protocol. RESULTS: The changes in body weight, hemodynamic parameters, and left ventricular dimensional echocardiographic indices were all comparable between the two groups. Regarding changes in diastolic functional state and using Tei index, this parameter was significantly improved. Unlike the group received placebo, those who received testosterone had a significant increasing trend in 6-walk mean distance (6MWD) parameter within the study period (P = 0.019). The discrepancy in the trends of changes in 6MWD between study groups remained significant after adjusting baseline variables (mean square = 243.262, F index = 4.402, and P = 0.045). CONCLUSION: Our study strengthens insights into the beneficial role of testosterone in improvement of functional capacity and quality of life in heart failure patients.

Dabigatran versus Enoxaparin in the prevention of venous thromboembolism after total knee arthroplasty: A randomized clinical trial.

BACKGROUND: Venous thromboembolism (VTE) and deep vein thrombophlebitis (DVT) is a serious problem with high mortality and morbidity rates. This study was conducted to compare efficacy and safety results of the two types of VTE preventing in patients underwent total knee arthroplasty (TKA). METHODS: Having considered exclusion criteria, 90 patients of 136 ones were registered in the study. Our patients of TKA were split randomly in two groups. Totally, 45 patients received enoxaparin, 40 mg 12 h before surgery and treated by 40 mg daily up to 15 days. The second group (45 patients) were treated by dabigatran 150 mg 4 h after surgery and 225 mg daily up to 15 days. Efficacy was evaluated by Doppler sonography after 15 days for the presence of DVT and safety was determined by 3 months follow-up for all-cause mortality and any major or minor bleedings. RESULTS: Two groups were similar in baseline characteristics. The efficacy outcome events occurred in 2.2% (2 of 90) of the patients (1 symptomatic VTE in dabigatran and 1 in the enoxaparin group) without significant statistical difference between groups (P = 0.64). In terms of safety, 3 patients (6.6%) in dabigatran and 2 patients (4.4%) in enoxaparin group had major bleeding (P = 0.66) and 8 patients (17.7%) in dabigatran and 7 patients (15.7%) in enoxaparin group had non-major bleeding event (P = 0.81). There were no death, pulmonary emboli, and cardiac events during follow-up. CONCLUSION: Three months follow-up did not show statistical difference in efficacy and safety between dabigatran and enoxaparin. Future studies with mentioning to later outcomes for checking safety are warranted.

Infectious endocardial intracardiac defibrillator lead, infectious pericarditis, and delayed constrictive pericarditis.

The usage of Implantable Cardiac Defibrillator (ICD) since 1980s is becoming more popular these days. The rate of both, endocarditis and constrictive pericarditis are low but it still needs attention. We are reporting a rare case of ICD endocarditis as a result of toe infection in a diabetic patient. This was followed by infectious pericarditis after device removal by open heart surgery and then delayed constrictive pericarditis.