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.

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.

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.

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.

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 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.

Age-, sex-, and height-based blood pressure reference charts, Yazd children 6-18 years, Iran.

BACKGROUND: Pediatric hypertension is the main cause of morbidity and mortality in pediatric populations. PURPOSE: To examine pediatric hypertension in a clinical setting, we used the percentile rank approach and defined hypertension as that above the 95th percentile. METHODS: The present study was linked to the a national analytical cross-sectional community-based Iranian Children and Adolescents' Psychiatric Disorders (IRCAP) survey. The survey was nationwide and funded by the National Institute of Medical Research Development. The IRCAP survey included 31,000 children and adolescents aged 6-18 years in all 31 Iran provinces. The current study included 1,035 children and adolescents and linked the data of the risk factors of cardiovascular disease only in Yazd province via random cluster sampling. RESULTS: Of the total participants, 456 (44.1%) were male and 579 (55.9%) were female. The mean age was 11.2±3.8 years (11.7±3.7 years for males, 11.0±3.6 years for females), while mean height was 146±20.0 cm overall, 147.2±22.0 cm for males, and 144.6±17.0 cm for females (P=0.009). The blood pressure distributions and percentiles were evaluated. CONCLUSION: Here we determined age- and height-specific 50th, 90th, 95th, and 99th percentiles of systolic and diastolic blood pressures in Yazd boys and girls using 10-cm height intervals.

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.

Combined association of liver and renal injury by intra-aortic balloon pump malposition.

BACKGROUND: We report an unusual visceral complication of intra-aortic balloon pump (IABP) due to the malpositioning of the catheter in the aorta. CASE REPORT: A 55-year-old man with severe left ventricular dysfunction underwent coronary artery bypass grafting (CABG) with the preoperative use of an intra-aortic balloon pump. Postoperative course was complicated by renal and hepatic failure. The early occurrence of complications during 36 hours after operation exhibited a serious vascular complication. The combination of acute renal and hepatic failure led to the suspension to occlusive effect of intra-aortic balloon pump catheter on ostium of the aforementioned organs. The intra-aortic balloon pump was removed, and urine output immediately restored. Thereafter, daily slop dawn serum levels of aminotransferases were started, and became normal at the 10th day of operation. CONCLUSION: This is an exceptional case that shows how intra-aortic balloon pump may be contributed to mechanical aortic side branches obstruction. A high index of suspension is mandatory in the diagnosis of such bizarre complications.

Congenital combined atresia of the left main coronary with supravalvar aortic stenosis.

Congenital atresia of the left main coronary artery (LMCA) is an exceedingly rare phenomenon, and in the most of them, coronary artery bypass graft is required. We here describe a rare case of this anomaly that concomitantly was associated with supravalvar aortic stenosis and coronary-pulmonary fistula without the presence of conventional collateral circulation in a 16-year-old boy. The patient was admitted to our center with chest pain and dyspnea. Echocardiographic examinations showed supravalvar aortic stenosis with normal function of the aortic valve. Coronary angiography revealed atresia of LMCA with poorly developed left anterior descending coronary artery and well-developed circumflex coronary artery and diagonal artery that perfused by dominant and lengthy right coronary artery. The patient underwent coronary artery bypass grafting with repair of supravalvar aortic stenosis. The postoperative course was uneventful. The 6-month follow-up revealed normal diameter of the ascending aorta with symptomatic relief of preoperative chest complaint.

Minimal Invasive Technique in Atrial Septal Defect Surgery.

BACKGROUND: Median sternotomy with minimal skin incision (MSWMSI) and modified anterior mini-thoracotomy (MAMT) approach that both are innovative techniques modified from previous documented techniques are important alternative to conventional median sternotomy in atrial septal defect (ASD) repair. Our aim is to explain the details of two performed techniques in our center and explain the results. METHODS: Totally 54 children with ASD (20 female and 34 male) were operated with two different techniques i.e. MAMT and MSWMSI in Imam Ali heart surgery center between May 2010 and May 2013. Intra and postoperative variables such as cardiopulmonary bypass time and aortic cross-clamp time, intensive care unit stay time, length of incision, postoperative hematoma and seroma, dehiscence mortality, exploration for postoperative bleeding, neurologic complication, infection and amount of blood transfusion were recorded. RESULTS: Mean cardiopulmonary bypass time was 30 ± 11 min, and mean aortic cross-clamp time was 7 ± 2 min. The mean amount of blood transfusion was 150 ± 39 mL, and the mean chest tube drainage after surgery was 140 ± 57 mL. Superficial skin infection occurred in three patients. Subcutaneous hematoma and seroma were founded in six patients. In 50 cases the defect was secundum type, in two patients it was sinus venosus type, and in two with associated perimembranous ventricular septal defect repair. CONCLUSION: Both approaches are safe and may be the surgical techniques of choice for secundum ASD repair in all age groups; and we can also utilize these techniques for more complicated kinds of surgery, for instance, sinus venosus type ASD with or without partial anomalous defect.

Molecular Diagnosis of Bacterial Definite Infective Endocarditis by Real-Time Polymerase Chain Reaction.

Infective endocarditis (IE) can be diagnosed using the Duke criteria, which cannot be conclusive especially when the results of blood cultures are negative. This study aimed at using real-time polymerase chain reaction (PCR) technique to isolate bacteria present in whole blood samples of patients with definitive IE on the basis of the method designed in this study. This laboratory and test study was conducted on 20 whole blood samples taken from patients with definitive IE. Real-time PCR of the 16s rRNA was utilized to directly analyze whole blood samples to diagnose bacterial IE. Of 20 whole blood samples with definitive IE, only one blood culture (5%) was positive and the isolated bacterium belonged to Streptococci viridans group. Also, 13 whole blood samples were positive using real-time PCR technique. The isolated bacteria were Enterococcus faecalis with seven (35%) cases, Streptococcus gallolyticus with two (10%) cases, Streptococcus mutans with one (5%) case, Streptococcus sanguinis with one (5%) case, Streptococcus salivarius with one (5%) case, and Staphylococcus aureus with one (5%) case. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using real-time PCR technique were 65%, 100%, 100%, and 74%, respectively. The developed real-time PCR method allows us to detect bacteria in whole blood samples and is much more sensitive than culturing method. It also permits the differentiation of the main group of bacteria within a few hours for IE.

A Survey of Coping Strategies With Stress in Patients With Acute Myocardial Infarction and Individuals Without a History of Fixed Myocardial Infarction.

BACKGROUND: This study aimed at investigating the coping strategies with stress in patients with acute myocardial infarction (MI) and individuals without a history of fixed MI and cardiovascular disorders. METHODS: This case-control crossover study was conducted from March 2015 to February 2016 on 220 patients with acute MI (MI patients) as case group and 220 patients without any history of MI and cardiovascular diseases as the control group using availability sampling method. To collect the required data, demographic information questionnaire, Holms-Raheh life stress inventory, perceived stress questionnaire, and coping inventory for stressful situations (CISS) were applied. RESULTS: On the basis of our findings, 118 patients (53.6%) with MI used emotion-focused coping strategy. Ninety-seven patients (82.2%) with MI who used emotion-focused coping strategy had negative perceived stress. Additionally, 71 patients (60.2%) with MI who had used emotion-focused coping strategy suffered from very high level of stress. CONCLUSION: The most MI patients had very high level of stress while most people in control group had high level of stress. Most MI patients that had very high level of stress cope with it in emotion-focused coping strategy and it proves that people with higher levels of stress are more likely to use inefficient coping strategies.

The diagnosis of microorganism involved in infective endocarditis (IE) by polymerase chain reaction (PCR) and real-time PCR: A systematic review.

Broad-range bacterial rDNA polymerase chain reaction (PCR) followed by sequencing may be identified as the etiology of infective endocarditis (IE) from surgically removed valve tissue; therefore, we reviewed the value of molecular testing in identifying organisms' DNA in the studies conducted until 2016. We searched Google Scholar, Scopus, ScienceDirect, Cochrane, PubMed, and Medline electronic databases without any time limitations up to December 2016 for English studies reporting microorganisms involved in infective endocarditis microbiology using PCR and real-time PCR. Most studies were prospective. Eleven out of 12 studies used valve tissue samples and blood cultures while only 1 study used whole blood. Also, 10 studies used the molecular method of PCR while 2 studies used real-time PCR. Most studies used 16S rDNA gene as the target gene. The bacteria were identified as the most common microorganisms involved in infective endocarditis. Streptococcus spp. and Staphylococcus spp. were, by far, the most predominant bacteria detected. In all studies, PCR and real-time PCR identified more pathogens than blood and tissue cultures; moreover, the sensitivity and specificity of PCR and real-time PCR were more than cultures in most of the studies. The highest sensitivity and specificity were 96% and 100%, respectively. The gram positive bacteria were the most frequent cause of infective endocarditis. The molecular methods enjoy a greater sensitivity compared to the conventional blood culture methods; yet, they are applicable only to the valve tissue of the patients undergoing cardiac valve surgery.

Right atrial fibroma in an adult patient.

Left atrial fibroma as a benign tumor is an exceedingly rare left atrial mass. It has various clinical signs and symptoms and sometimes leads to serious complications such as lethal arrhythmia and death. We report a case of right atrial fibroma in a 40-year-old male who presented with dyspnea and atrial fibrillation. Transthoracic echocardiography revealed a large sessile mass attached to interatrial septum near the coronary sinus valve in the right atrium. The patient underwent surgical resection of tumor through the right atrium. The postoperative course was unremarkable. Histopathological examination showed that it was a fibroma. The 6-month follow-up revealed that the patient was in well condition with no evidence of tumor recurrence.

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.