Background: Non-alcoholic fatty liver disease (NAFLD) is a common cause of elevated liver enzyme levels and is increasing in parallel with the global obesity epidemic in adults and children. Objectives: This study examined the association between liver stiffness and serum uric acid, high-density lipoprotein cholesterol (HDL), and the uric acid-to-HDL ratio (UHR) in patients with NAFLD-related fibrosis. Methods: This cross-sectional study was conducted using hospital and clinic data after ethical approval was obtained from Ahvaz Jundishapur University of Medical Sciences. Patients referred to a specialized liver center for liver fibrosis assessment who met the inclusion criteria, including liver steatosis and abnormal liver function tests, were enrolled. Data were analyzed using SPSS version 26.0. Univariable analyses were performed first. Subsequently, two generalized linear models were developed to evaluate the associations of uric acid, HDL, and UHR with elastography values after adjustment for age and sex. Results: A total of 44 participants were included in the final analysis; 23 (52.3%) were male, and the mean age was 43.97 +/- 7.65 years. The mean elastography value was 8.21 +/- 2.55 kPa, the mean HDL level was 39.45 +/- 11.34 mg/dL, and the mean uric acid level was 5.25 +/- 1.54 mg/dL. In univariable analyses, aspartate aminotransferase (AST), alanine aminotransferase (ALT), the AST/ALT ratio, uric acid, and UHR were positively associated with elastography values, whereas HDL showed an inverse association. The UHR was higher in males (P 5 0.01). In generalized linear models adjusted for age and sex, UHR (B =15.71, P = 0.001) and uric acid (B = 0.608, P = 0.028) remained significantly associated with elastography values, whereas HDL showed a non-significant inverse trend. However, after additional adjustment for AST, ALT, and platelet count, these associations were attenuated and were no longer statitically significant. Conclusions: Elastography values were significantly associated with uric acid and HDL levels, indicating that liver stiffness is related to metabolic factors. The inverse association between uric acid and HDL emphasizes the pro-inflammatory role of uric acid and the protective effects of HDL in the liver.
Background: Medical errors in cardiac surgery remain a major challenge for patient safety. These errors often arise from the interaction of individual fatigue, team communication problems, and organizational constraints. Exploring these factors qualitatively provides a deeper understanding for designing effective interventions. Objectives: The primary objective of this study is to identify and analyze the underlying factors of medical errors in cardiac surgery and to propose practical solutions for their reduction. Methods: This qualitative study was conducted in cardiac surgery departments of selected hospitals in Iran between March and September 2025. Semi-structured interviews were performed with cardiac surgeons only. Data were analyzed using thematic analysis, resulting in four main themes: individual factors, team-related factors, organizational factors, and consequences and solutions. A circular conceptual model was developed to illustrate the dynamic relationships among these domains. Results: Errors were found to be embedded within team dynamics and organizational structures rather than being solely individual. Participants emphasized fatigue, communication gaps, and restrictive policies as key contributors. The conceptual model demonstrated how these domains converge toward consequences and solutions, highlighting the systemic nature of medical errors. Conclusions: Preventing errors in cardiac surgery requires a multidimensional approach that integrates personal training, team communication, and organizational reforms. Sustainable improvement depends on systemic and cultural transformation within hospitals.
Context: Coronary angiography is a crucial diagnostic procedure, yet it often induces significant anxiety in patients. Various non-pharmacological interventions have been proposed to alleviate anxiety in patients undergoing coronary angiography. Despite existing methods, comprehensive comparative reviews on their effectiveness are lacking. Objectives: This systematic review aimed to evaluate the effectiveness of various non-pharmacological interventions in reducing anxiety for patients preparing for coronary angiography. Evidence Acquisition: In this systematic review, articles published in both Persian and English were collected from various databases, including Web of Science, PubMed, Scopus, Medlib, Magiran, SID, Iranmedex, and Google Scholar. The search used keywords related to coronary angiography, cardiac catheterization, anxiety, and non-pharmacological methods. The search was limited to studies published between 2009 and 2024. Articles that met the inclusion criteria were then selected for review. Out of the 1,457 articles retrieved, 33 were thoroughly examined and analyzed. To ensure data accuracy, two experienced researchers simultaneously reviewed the articles while the research team's faculty members independently assessed each article's quality. This collaborative approach was implemented to enhance the validity and reliability of the study. Results: Thirty-three articles were reviewed, revealing several effective interventions for reducing anxiety before angiography. These interventions included educational programs such as video-based education, virtual networks, and familiarization tours, as well as complementary medicine approaches like aromatherapy, herbal medicine, massage therapy, relaxation techniques, and emotional expression. Each of these methods showed promise in reducing anxiety levels among patients scheduled for coronary angiography. Conclusions: This review concludes that educational programs and orientation tours are the most practical, cost-effective, and side-effect-free approach for reducing anxiety before coronary angiography. Aromatherapy was noted as the second most effective intervention. Additionally, acupressure and muscle relaxation are also commonly used. Limited studies exist on guided imagery and emotional expression, highlighting the need for future research to standardize methodologies and further assess the effectiveness of these interventions in reducing pre-angiography anxiety.
Context: Post-operative fever in pediatric congenital heart surgery is a common and challenging complication that can affect recovery, hospitalization duration, and healthcare costs. Objectives: This systematic review aimed to investigate the prevalence, associated factors, and management approaches of this condition. Data Sources: A comprehensive search was conducted across Persian (SID, Magiran, IranMedex) and English (PubMed, Scopus, Web of Science) databases. Search keywords included "Post-operative fever", "Congenital heart surgery", and their Persian equivalents. Study Selection: Out of 860 identified articles, 25 studies were selected for the final analysis after screening. The quality of the articles was assessed using the Critical Appraisal Skills Programme (CASP) and AMSTAR tools. Data Extraction: Data were analyzed using RevMan software. Results: The prevalence of post-operative fever in pediatric congenital heart surgeries ranged from 10% to 25%, influenced by factors such as surgery duration, the complexity of congenital defects, patients' nutritional status, and quality of care. More complex and prolonged surgeries showed higher rates of fever. Additionally, biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) were identified as predictive tools for fever risk. Effective management through the use of prophylactic antibiotics, proper nutrition, and close monitoring of patient conditions helped reduce the incidence of this complication. Fever-related outcomes, such as prolonged hospital stays and elevated healthcare costs, were frequently observed. Conclusions: This study highlights the need for multifaceted management of post-operative fever in pediatric congenital heart surgeries. Reducing surgery duration, standardizing management protocols, and improving care quality can help decrease its prevalence. Furthermore, developing comprehensive research in resource-limited areas is recommended to enhance treatment quality and mitigate the negative outcomes of fever.
Introduction: Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is exceedingly rare and represents one of the most demanding percutaneous coronary interventions (PCIs) due to the large ischemic territory involved. This report describes two unique LMCA CTO cases successfully treated via distinct retrograde collateral routes, one through the conus branch artery (CBA) and another through septal collaterals, highlighting the technical feasibility of individualized pathway selection in situations where antegrade wiring is not possible. Patient Information and Clinical Findings: Case 1: A 65-year-old woman with Canadian Cardiovascular Society (CCS) class III stable angina and isolated ostial LMCA CTO supplied by the CBA from the right coronary artery (RCA). Case 2: A 68-year-old man with hypertension and diabetes presented with CCS III angina; angiography revealed LMCA CTO perfused via septal collaterals from the left anterior descending artery. Both patients declined coronary artery bypass grafting (CABG). Diagnostic Assessment, Intervention, and Outcomes: In both cases, diagnostic angiography precisely mapped collateral pathways enabling retrograde revascularization. Contemporary guidewires, microcatheters, and drug-eluting stents (DES) were used to restore distal flow Successful retrograde PCI was achieved with final TIMI 3 perfusion and complete resolution of angina. On scheduled follow-up (1 week, 1 month, 3 months), both patients remained asymptomatic with normal electrocardiogram (ECG) and preserved left ventricular function [left ventricular ejection fraction (LVEF) case 1: Fifty-five percent, LVEF case 2: Fiftyfive percent]. Conclusions: These cases demonstrate that careful identification and utilization of collateral anatomy, particularly the conus branch and septal channels, can allow safe and effective retrograde revascularization of LMCA CTO when standard antegrade PCI is unfeasible. Understanding distinct collateral patterns expands treatment options for high-risk, CABG-refusing patients and supports the role of tailored retrograde strategies in complex coronary interventions.
Background: Carotid artery atherosclerosis tends to progress more rapidly among dialysis-dependent patients; however, the contribution of selected dialysis modality - specifically hemodialysis (HD) versus peritoneal dialysis (PD) - has yielded inconsistent findings in the literature. Objectives: This study seeks to analyze carotid artery calcification (CAC), stenosis, and intima-media thickness (CIMT) using Doppler ultrasound, as well as newly emerged atherogenic indices in patients undergoing regular HD versus PD. Methods: A comparative cross-sectional study design was utilized, involving thirty-two randomly selected patients undergoing either HD or PD (16 HD and 16 PD), conducted from January to May 2024 at dialysis centers associated with Shiraz University of Medical Sciences in Iran. Data were analyzed using IBM SPSS Statistics (version 27) employing Mann-Whitney U, Fisher's exact test, and regression models. Results: Four atherogenic indices were evaluated, namely the total cholesterol to high-density lipoprotein (HDL)-C ratio, low-density lipoprotein (LDL)-C to HDL-C ratio, Lipoprotein Combined Index, and remnant cholesterol. Notably, all indices were significantly elevated among PD patients (P = 0.002, 0.020, 0.001, and 0.008, respectively). Conversely, CAC was more common in HD patients, especially in the right carotid artery (50% vs. 12.5%, P = 0.027). Additionally, carotid artery stenosis was exclusively identified among HD patients (31.3%, P = 0.022). No significant disparities were found in average CIMT or the CIMT measurements of the right or left carotid arteries across the groups. These findings remained consistent regardless of age, gender, underlying causes of kidney failure, and serum biochemistry, particularly serum calcium, phosphorus, vitamin D, and parathyroid hormone (PTH) levels. Conclusions: Patients undergoing HD had worse structural carotid disease, while patients undergoing PD had a worse atherogenic lipid profile. These disparities between modalities make it even more important to have personalized cardiovascular risk assessment and monitoring plans. Additionally, the limitations of CIMT suggest the need for integration with more sensitive imaging modalities to better evaluate medial calcification, thereby informing clinical decision-making and personalized care strategies for end-stage kidney disease patients.
Introduction: Pericardial effusion frequently arises as a complication of systemic or cardiopulmonary disorders, and progressive accumulation may result in cardiac tamponade and multi-organ dysfunction. Although uncommon, acute kidney injury (AKI) associated with pericardial effusion is typically reversible when managed appropriately. Timely recognition of pericardial effusion in patients with unexplained respiratory distress and AKI is essential for prompt therapeutic interventions and prevention of irreversible kidney damage. Objective: To report the development, management, and follow-up of AKI in critically ill patients with tamponade-inducing pericardial effusion in this case report. This case occurred at Hazrat Vali-Asr Hospital in Borujen, Iran, in 2025. Case Presentation: A 77-year-old male with a history of chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), and diabetes mellitus was admitted one week after starting amiodarone for atrial fibrillation, presenting with weakness, dyspnea, cough, and decreased O2 saturation. Investigations included chest computed tomography (CT, revealing bilateral pleural effusions), blood tests (metabolic acidosis, urea 135 mg/dL, creatinine 2.9 mg/dL), and kidney ultrasound (normal). Despite supportive care and temporary hemodialysis, the patient's respiratory status deteriorated, and creatinine levels continued to rise. Discussion: This case highlights the importance of early detection of pericardial effusions in patients with unexplained respiratory distress and acute renal impairment. The underlying pathophysiology of acute renal impairment in this setting is predominantly hemodynamic. Elevated right atrial pressure combined with systemic venous congestion compromises blood flow to the kidneys, and the development of tamponade compounds these effects. Often, supportive therapy alone is not sufficient; however, timely pericardiocentesis can rapidly restore kidney function by reducing the pressure in the heart and improving cardiac output. This is an example of cardiorenal type 1 syndrome, where acute cardiac dysfunction leads to reversible acute renal impairment. Conclusions: Pericardial drainage can improve renal function secondary to pericardial effusion by reducing right atrial pressure, relieving venous congestion, and enhancing renal perfusion. Therefore, in patients presenting with unexplained AKI and respiratory distress, pericardial effusion should be considered in the differential diagnosis.
Background: Dyadic coping is one of the methods that couples use to cope with stressful factors such as surgery. Objectives: This study aimed to explain dyadic coping in couples undergoing open heart surgery. Methods. The present study was conducted using a qualitative method with the participation of 18 couples with a history of open-heart surgery in 2024 2025. Participants underwent in-depth and semi-structured interviews (individual-couple). The interviews were immediately transcribed and content analyzed using the conventional method. MAXQDA2022 software was used to classify the information, and data analysis was performed using the method proposed by Griesheim and Lundman (2004). Results: The results of the present study showed that open-heart surgery can create positive couple coping among couples. Positive couple coping can be observed in confronting fears, creating positive couple processes, adapting to the disease over time, maintaining couple integrity, and protecting the patient in the couple's family and social relationships. Conclusions: The results of the present study emphasize the necessity of integrating assessment and strengthening of positive couple coping in nursing care programs. This can lead to the improvement of important clinical outcomes such as adherence to treatment regimens, reduction of postoperative complications, and acceleration of recovery. Therefore, it is suggested that hospitals should also pay attention to the role of spouses in their educational, counseling, and rehabilitation programs and design and implement effective psychological interventions as standard protocols for use at the level of hospitals and cardiaq rehabilitation centers.
Background: Atrial septal defect (ASD) is one of the most common congenital heart diseases in adults, and the treatment method involves closing these defects with intracardiac devices through angiographic or surgical techniques. So far, detailed and extensive studies on the long-term effects of these treatments, especially in older ages, have not been conducted and published. Objectives: The present study aimed to investigate the effect of ASD closure by surgical and device methods in improving echocardiographic and clinical parameters in patients over 40 years of age from 2016 to 2019 at Shahid Rajai Heart and Vascular Center. Methods: In this retrospective cohort study, the statistical population included all ASD patients over 40 years of age who visited Shahid Rajai Hospital between 2016 and 2019 and underwent ASD device closure (180 patients). To collect data, in addition to demographic information such as age, gender, clinical status, and underlying diseases, the patients' echocardiographic parameters were collected at 3-6 and 12 months after the procedure, which were available in their files. Chisquare and ANOVA were used to analyze the collected data. Results: The results of the present study showed that clinical symptoms improved significantly during the 3 to 6 months and 12-month follow-up in each ASD device closure group. Most echocardiographic parameters, including left ventricular ejection fraction (LVEF), left ventricular (LV) diastolic dysfunction, right ventricular (RV) function, LV size, RV size, left atrial (LA) size, right atrial (RA) size, mitral regurgitation (MR), tricuspid regurgitation (TR), and systolic pulmonary artery pressure (PAP), improved significantly during the 3 to 6 months and 12-month follow-up in the ASD device closure group. Conclusions: In general, the device method leads to improvement in clinical symptoms, although echocardiographic parameters improved more in the ASD device closure group. Therefore, in second-order ASD that meet the intrusion conditions, the choice of device closure method is preferable to open-heart surgery.
Background: In the digital age, the virtual escape room exam represents an innovative, technology-driven assessment method that integrates gamification with active learning to enhance student engagement, motivation, and critical thinking. As the demand for interactive and student-centered assessment grows, evaluating the educational effectiveness of such game-based models has gained increasing importance. Objectives: This study aimed to investigate the effect of virtual escape room game-based assessment on the learning of cardiovascular diseases (CVDs) among undergraduate nursing students at Abadan University of Medical Sciences. Methods: This cross-sectional interventional study was implemented in six phases: (1) Design of escape room scenarios; (2) validation and reliability testing; (3) pilot implementation; (4) student familiarization; (5) main execution of the escape room exam; and (6) post-exam evaluation and satisfaction assessment Participants included 62 fifth-semester nursing students in the second semester of the 2024-2025 academic year, recruited via census sampling. The escape room consisted of five virtual rooms, each focusing on CVD-related topics. Each room contained five clinical questions, with correct answers unlocking the next level. Students' scores in the virtual escape room were compared with their performance in an online multiple-choice exam. Data analysis was conducted using SPSS version 26 through descriptive statistics, paired t-test, Wilcoxon signed-rank test, and Pearson's correlation coefficient. Results: The mean score in the virtual escape room exam (16.93 +/- 1.53) was significantly higher than in the multiple-choice exam (15.03 +/- 2.52; P = 0.002). A strong positive correlation was observed between the two exams (r = 0.921, P = 0.001). The Difficulty Index was slightly higher for escape room questions (0.914 vs. 0.902). Despite similar difficulty, students performed better in the escape room exam (16.12 +/- 1.53 vs. 15.62 +/- 1.66). Additionally, 70%- 92% of participants reported high or very high satisfaction with various aspects of the escape room experience. Conclusions: Using an escape room exam to assess the learning of CVDs enhances learning and increases motivation among students. It can also be regarded as a valuable alternative or complement to traditional exams. Therefore, it is recommended that the design and implementation of this type of exam be expanded in educational programs.
Background and Objectives: This study employed an integrated approach combining network pharmacology andbioinformatics to systematically elucidate the multitarget mechanisms of tetramethylpyrazine (TMP) in amelioratingmyocardial ischemia-reperfusion injury (MIRI), with a specific focus on its potential association with ferroptosis regulation. Methods: The Traditional Chinese Medicine Systems Pharmacology Database (TCMSP), PharmMapper, SwissTarget Prediction,and TargetNet databases were used to combine the data, which were subsequently used to identify TMP-related targets.Ferroptosis-associated targets were retrieved from the FerrDb database, whereas MIRI-related targets were screened via theGeneCards and DisGeNET databases. Venn diagram analysis was applied to identify overlapping targets among TMP, ferroptosis,and MIRI. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional annotation pathwayenrichment analyses were conducted via R software to elucidate the underlying mechanisms involved. The protein-proteininteraction (PPI) network was constructed via the STRING database, and topological analysis was performed via Cytoscapesoftware to identify key targets. AutoDock Vina and PyMol were used to validate molecular docking. For experimentalvalidation, an in vitro MIRI model was established using H9C2 cardiomyocytes subjected to hypoxia/reoxygenation (4h/2h). Thecells were treated with 20 mu M TMP or the ferroptosis inhibitor ferrostatin-1 (Fer-1, 20 mu M). Intracellular reactive oxygen species(ROS) levels were detected using the 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) fluorescent probe and visualized byfluorescence microscopy, while the expression of the key ferroptosis-related protein GPX4 was assessed by Western blotting. Results: Twenty shared targets linked to ferroptosis were identified. Molecular docking validation revealed four importanttargets, namely, PPARG, MDM2, SIRT1, and GSK3B, which have favorable binding affinities for TMP (binding energy < -5.0kcal/mol). The GO analysis indicated that TMP primarily regulates biological processes such as positive modulation of proteinphosphorylation and activation of the MAPK cascade. The KEGG enrichment analysis highlighted key pathways, includingproteoglycan (PG) signaling in cancer, lipid metabolism dysregulation, and efferocytosis. Consistently, in vitro experimentsdemonstrated that TMP treatment significantly attenuated the ischemia-reperfusion (I/R)-induced overproduction of ROS andcounteracted the downregulation of GPX4 protein expression, exhibiting a protective effect comparable to Fer-1. Conclusions: These results suggest that TMP may reduce MIRI via synergistic and multipathway mechanisms, which may berelated to the regulation of ferroptosis. Furthermore, this study provides new theoretical knowledge about the cardioprotectiveproperties of TMP by validating its anti-inflammatory efficacy
Background and Objectives: This study aimed to investigate the cardiovascular links to intensive care unit (ICU) admission and mortality in COVID-19 patients. Methods: A retrospective study of 216 COVID-19 patients admitted to Shahid Faghihi Hospital was conducted. The study examined their lab results, heart tests, and cardiovascular complications. Data were analyzed using SPSS (v.26) software with ttests, chi-square tests, and logistic regression models. Results: Out of 216 patients, 41.2% were male and 58.8% were female, with a mean age of 61.56 years. Of these, 23.1% required ICU admission, and 14.81% of the total died. Patients needing ICU care had higher age, LDH, and D-dimer levels, while deceased patients showed elevated LDH, D-dimer, troponin, and various ECG abnormalities. A normal ECG had a protective effect against ICU admission. Conclusions: COVID-19 patients can develop cardiovascular complications such as myocarditis, stroke, and pulmonary thromboembolism (PTE), which increase morbidity and mortality. Therefore, careful cardiovascular monitoring is crucial.
Background: Coronary artery ectasia (CAE) is a rare vascular abnormality characterized by the dilation of a segment of a coronary artery. The pathogenesis of CAE remains unclear; it may involve an inflammatory pathway distinct from that observed in stenotic coronary artery disease (CAD). Objectives: This study aimed to compare inflammatory biomarkers among patients with CAE, patients with CAD, and individuals with normal coronary angiography. Methods: Forty-eight patients undergoing diagnostic coronary angiography were enrolled in this study and divided into three groups based on their angiographic findings: (1) The CAE/aneurysmal dilation group (10 patients), (2) stenotic CAD group (19 patients), and (3) a control group. All participants underwent blood assays immediately after coronary angiography to evaluate high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β). Results: There were no differences in baseline demographic or cardiovascular risk profiles among the three groups. There were no significant differences in the levels of TNF-α (P = 0.891), IL-6 (P = 0.440), or hsCRP (P = 0.367) across the groups. However, IL-1β levels were significantly higher in the stenotic CAD group (35.08 ± 13.30 pg/mL) compared to both the CAE group (17.53 ± 6.20 pg/mL) and the control group (19.78 ± 8.67 pg/mL, P < 0.001). Conclusions: The IL-1β levels were significantly elevated in patients with CAD compared to both CAE patients and controls, suggesting its role in the pathogenesis of atherosclerosis. In contrast, the lack of elevated IL-1β and other inflammatory markers in CAE challenges the proposed role of systemic inflammation in the pathophysiology of this condition.
Background: Right ventricular pacemakers (RVPs) are widely used to manage advanced atrioventricular blocks, significantly improving patient survival and quality of life. However, pacing-induced cardiomyopathy (PiCM) remains a prevalent and under-recognized complication. Objectives: The present study aims to assess the prevalence of PiCM in an Iranian population with RVPs and to identify associated risk factors. Methods: This prospective observational study included 105 patients who received right ventricular apical pacemakers from March 2021 to March 2023. Transthoracic echocardiography was performed before pacemaker implantation and six months post-implantation. The PiCM was defined as either a left ventricular ejection fraction (LVEF) 5 40% if baseline LVEF was >= 50%, or a reduction of >= 10% in LVEF. Results: At six months, 17.1% (n =18) of patients developed PiCM. A higher prevalence of diabetes mellitus (DM), ischemic heart disease (IHD), and chronic kidney disease (CKD) was observed among the PiCM group. Diabetes mellitus (OR = 3.53; 95% CI 1.78-6.45; P = 0.012), IHD (OR = 8.07; 95% CI 5.20-29.64; P < 0.001), CKD (OR= 5.29; 95% CI 1.47-11.29; P = 0.028), baseline LVEF <5 0% (OR = 5.67; 95% CI 1.15-16.38; P = 0.017), paced QRS duration (pQRSd) (OR = 1.01; 95% CI 1.001-1.08; P = 0.038), and increased pacing burden (OR = 1.06; 95% CI 1.008-1.26; P = 0.036) were identified as independent risk factors for PiCM. Receiver operator curve analysis demonstrated that a pacing burden > 65% can accurately predict PiCM (AUC = 0.651; P = 0.033). Conclusions: The prevalence of PiCM among Iranian patients with RVPs aligns with global reports. These findings underscore the importance of routine echocardiographic surveillance and risk stratification in patients with RVPs. Early recognition of high-risk individuals, particularly those with comorbidities or elevated pacing burden, may inform pacing strategies and guide follow-up to reduce the incidence of PiCM.
Background: Due to the possibility of occurrence and exacerbation of mitral regurgitation (MR) in the context of mitral valve prolapse (MVP) in a significant portion of patients, early and non-invasive prediction of this complication based on clinical and echocardiographic parameters is important and vital. This prediction can essentially be based on the provision of efficient grading systems. Objectives: We aimed to achieve this goal by identifying factors predicting the exacerbation of MR and classifying them in the form of a new scoring system. Methods: One hundred and five patients with suspected MVP were included in this cross-sectional study and assessed by echocardiography. The patients underwent echocardiography, and the severity of the MR, as well as structural changes of valves due to prolapse (leaflets and scallops involvements), was determined. Results: In a multivariable logistic regression model, age > 40 years, posterior mitral valve leaflet (PMVL) involvement, and P2 or A2P2 scallop involvement were identified as the main risk determinants for moderate to severe MR. These factors were structured as a new scoring system (scaled 3 to 10), where a total risk score of less than 6, between 6 to 8, and higher than 8 was considered low, moderate, and high risk for moderate to severe MR, respectively. Conclusions: The scoring system provided for predicting the exacerbation of mitral insufficiency in patients with a prolapsed valve can potentially guide early intervention.
Background: The effectiveness of the dietary approaches to stop hypertension (DASH) diet in reducing blood pressure (BP) is well-established. However, its potential to prevent coronary artery disease (CAD) is still up for debate. Objectives: Our goal was to investigate the correlation between the DASH diet and the severity of CAD in young patients undergoing coronary disease angiography. Methods: The cross-sectional research was conducted at Razi Hospital Center between May 2019 and March 2020. Four hundred fifteen individuals undergoing a coronary angiography procedure were allocated to participate in the investigation using the convenience sampling method. Patients with constriction in at least one vein over 75% were placed in the patient group, while those with normal veins were placed in the normal group. The data were obtained by administering a Food Frequency Questionnaire (FFQ), and the collection of anthropometric indices and blood specimens was conducted after a period of fasting. Statistical analysis was performed using SPSS software (version 22.0). Results: Individuals following the DASH diet in the lower tertile had higher CAD and waist-to-hip ratio (WHR) than those following it in the higher tertile (P < 0.05). Also, low-density lipoprotein (LDL) and total cholesterol (TC) levels significantly decreased (P < 0.01) in individuals who followed a DASH diet compared to those in the first tertile. Conclusions: Reduced severity of coronary artery stenosis was linked to high intake of vegetable protein, fruits, and vegetables while maintaining the Body Mass Index (BMI), waist circumference, and WHR within acceptable limits. Furthermore, an increased severity of coronary stenosis is linked to a high intake of meat, sugar, salt, and saturated fats.
Background: A key factor in deciding the surgical approach and predicting outcomes for tetralogy of Fallot (ToF) is the size of the pulmonary arteries. Objectives: The present study aims to compare the diagnostic accuracy of echocardiography with catheterization by calculating Nakata and McGoon indices for surgical decision-making in patients with ToF. Methods: This analytical epidemiological study, using a purposive (non-random) sampling method, was conducted on 120 patients with ToF. The patients underwent angiography and echocardiography. Subsequently, the Nakata and McGoon indices were calculated. Statistical analysis included both descriptive (frequency, mean, median, and interquartile range) and inferential methods. The Wilcoxon signed-rank test was used for comparing paired non-parametric measurements, and Spearman's rank correlation was used to evaluate the strength of association between imaging modalities. A P-value < 0.05 was considered statistically significant. Results: A significant correlation was found between the results of echocardiography and angiography (P = 0.009). A statistically significant positive correlation was observed for the right pulmonary artery (RPA) (rho = 0.418; P = 0.004), descending aorta (rho = 0.652; P = 0.041), and cross-sectional area of the right pulmonary artery (CSA-R) (rho = 0.418; P = 0.004). No significant correlation was found for the McGoon ratio (rho = 0.067; P = 0.855) or for left pulmonary artery (LPA) and crosssectional area of the left pulmonary artery (CSA-L) measurements. Conclusions: In patients with ToF, echocardiography alone may not be sufficient for definitive surgical decision-making. While echocardiography remains a safe, accessible, and cost-effective modality, its limitations necessitate the use of cardiac catheterization when precise anatomical measurements are required. However, in cases where echocardiographic images are unclear or equivocal, other methods such as CT angiography should be considered.
Background: The involvement of various functional systems in the pathological process of COVID-19 has been extensively studied. Nevertheless, significant uncertainties persist regarding the effects on various organs and systems in children. Recent literature reviews underscore the polymorphic nature of extrapulmonary clinical manifestations, with cardiovascular disorders being the most prevalent. Objectives: The aim of the research is to study the clinical and functional state of the cardiovascular system in children with a history of COVID-19. Methods: The research was carried out in three stages: Stage 1 – a retrospective study of 400 pediatric medical records with PCR-confirmed COVID-19. The age range of the patients is 1 - 18 years, who were undergoing inpatient treatment in the Regional Infectious Diseases Hospital of Aktobe, Kazakhstan, from October to December 2020. Stage 2 involved clinical, laboratory, and instrumental cardiovascular assessments 24 - 36 months post-infection. Stage 3 included an in-depth evaluation of 40 children with abnormalities identified in stage 2 [persistent cardiovascular symptoms, electrocardiogram (ECG), and blood pressure (BP) issues]. Follow-ups, conducted in 2023 - 2024, used strict selection, standardized methods, and independent interpretation; social factors were omitted. The obtained data were processed using IBM SPSS, version 25. Descriptive statistics were used to characterize clinical variables. Normality was assessed with the Shapiro-Wilk test; group differences with the Mann-Whitney U test. Results were considered statistically significant at P < 0.05 and P < 0.001. Results: The retrospective study revealed a notable gender imbalance with boys predominating. The clinical course was predominantly mild-to-moderate; a severe course was documented in 6.5% of cases. According to ECG interpretation, P wave and QT interval changes were observed in the acute period of COVID-19. A prospective laboratory and instrumental examination identified increased immunoglobulin G (IgG) levels in all age groups and long-term changes in ECG. The group of school-age children with cardiac complaints suffered from insufficient BP reduction at night. They also exhibited various heart rhythm disorders (35%). Conclusions: Significant cardiac changes in adolescents post-COVID-19 indicate the risk of cardiovascular complications and the need for long-term follow-up. The findings warrant further investigation, especially with regard to cardiovascular and immune changes and their long-term consequences in children who have undergone COVID-19.
Background: Psychological consequences following coronary artery bypass graft (CABG) surgery, such as anger, depression, anxiety, spousal intimacy, and sexual satisfaction, significantly impact patients' quality of life (QOL). Given the increasing prevalence of heart disease, understanding these factors is essential for post-surgical care and recovery. Objectives: This study aimed to investigate the predictive role of psychological and relational factors in determining the QOL of patients undergoing CABG. Methods: A cross-sectional study was conducted with 130 patients who had recently undergone CABG at Ayatollah Taleghani Hospital in Tehran. Standardized self-report questionnaires assessed psychological and relational factors, including the Quality of Life Scale (SF-36), Aggression Questionnaire (AGQ), Depression Anxiety Stress Scale-21 (DASS-21), Walker-Thompson Intimacy Scale (MIS), and Larson's Sexual Satisfaction Questionnaire (LSSQ). Pearson's correlation and multiple regression analyses examined the relationships among variables, controlling for demographic factors such as age and education level. Results: Depression (R = -0.637), anxiety (R = -0.669), and sexual satisfaction (R = 0.59) were significant predictors of QOL, while anger (R = -0.371) and spousal intimacy (R = 0.459) did not demonstrate a significant impact. The regression model accounted for 59.5% of the variance in QOL (P < 0.01). Findings suggest that psychological distress plays a stronger role in predicting QOL than relational factors in post-CABG patients. Conclusions: Findings indicate that depression, anxiety, and sexual satisfaction significantly play key roles in determining the QOL of CABG patients. Implementing psychological interventions aimed at reducing depression and anxiety while enhancing sexual satisfaction may significantly improve postoperative well-being. Integrating these strategies into patient care could enhance recovery and QOL after CABG.
Background: Atherosclerosis is among the primary causes of mortality globally due to its ability to induce cardiovascular and cerebrovascular events. Osteopontin (OPN) is a pro-inflammatory cytokine that plays an important role in the development of atherosclerosis. Simvastatin, a lipid-lowering drug belonging to the statin class, is known to decrease plasma OPN levels. However, its unfavorable pharmacokinetic profile, characterized by extensive first-pass metabolism leading to poor bioavailability, has restricted its clinical use. Objectives: The present study aimed to assess the efficacy of a nano-formulation of simvastatin [folate-conjugated simvastatin silver (Ag) nano-formulation] in a cellular model of atherosclerosis. Methods: This interventional study was performed on adventitial fibroblasts obtained from rat aorta. The cell viability of aldosterone-stimulated adventitial fibroblasts was evaluated in the presence of simvastatin and its nano-formulation using the MTT (3-[4,5-dimethylthiazole-2-yl]2,5-diphenyltetrazolium bromide) assay and microscopic observation. The expression and quantification of OPN were performed using qPCR and ELISA, respectively. The presence of reactive oxygen species (ROS) was estimated using a fluorescent probe, dihydroethidine (DHE). Variation among data was computed using one-way ANOVA followed by post hoc analysis (Bonferroni post hoc test) using SPSS software (version 19.0, SPSS Inc., Chicago, IL). Results: The nano-formulation of simvastatin was most effective (P < 0.05) in retaining the viability of fibroblasts (300% at 10 μM, P < 0.001), which was significantly decreased (50% at 10 μM, P < 0.001) after aldosterone treatment. Additionally, the formulation prevented the aldosterone-induced increase in OPN expression in fibroblasts. However, ROS levels remained unaltered in all groups. Conclusions: The nano-formulation of simvastatin demonstrated a protective effect in a cellular model of atherosclerosis, likely due to its ability to prevent the increase in aldosterone-induced OPN expression. Assuming a favorable pharmacokinetic profile, owing to its reduced size and folate conjugation, the formulation warrants further investigation in the anti-atherosclerosis drug discovery program.
