Background: The incidence of prosthetic tricuspid valve (TV) thrombosis is the highest among heart valves. It can lead to high morbidity and mortality without proper treatment. In this study, we sought to report the management and clinical outcomes of patients with mechanical TV thrombosis.Methods: The current study was conducted in Rajaei Heart Center on 42 patients with mechanical TV thrombosis from 2006 to 2017. The baseline characteristics and the rates of adverse events during the follow-up period were assessed.Results: A total of 67 episodes of mechanical TV thrombosis in 42 patients were observed. The mean age of patients was 45.5 ± 14.3 years (19-77), and overall two-thirds were female. Thrombolytic therapy was used in 41 (61.1%), anticoagulant intensification in 16 (23.9%), and surgery as the first approach in 10 (14.9%) episodes; subsequently, surgery as the final approach was implemented in 20 (29.8%) episodes. In-hospital mortality occurred in two (2.98%) patients. The rates of freedom from recurrent thrombosis were 84%, 61%, and 21% at the end of 1, 4, and 10 years, respectively. Survival rates and freedom from chronic valve dysfunction were 93%, 82%, and 75% after 1, 4, and 10 years. Conclusions:The results of the present study showed that recurrent thrombosis requiring intervention is a major complication of mechanical TV, which underscores individual-approached therapy and close follow-up.
In the Coronavirus disease 2019 (COVID-19) pandemic, underlying diseases such as cardiovascular disease, respiratory illness, liver and kidney disease or malignancies, have a critical prognostic role for these patients. Due to the increased risk of mortality in patients with established or new-onset comorbidities, we decided to conduct a study to further investigate the possible comorbidities and treatment recommendations of COVID-19. All articles published by March 25, 2020, on the new coronavirus infection were reviewed and for cutaneous manifestation as a new emerging concern, by April 25, 2020. ScienceDirect, Google Scholar, Scopus, PubMed databases were searched, and keywords such as "COVID-19", "2019- nCoV", "Coronavirus2019", "SARS-CoV-2”, and "comorbidity" have been used. The most important comorbidity in elderly patients with confirmedCOVID-19 was cardiovascular disease, followed by diabetes and chronic respiratory disease, respectively, and on the other hand, COVID-19 itself could cause acute heart, lung, liver, kidney, and skin disease. Also, the prevalence of underlying diseases in dead patients or patients with severe COVID-19 is higher than the others. Considering treatment, drug interactions, and careful drug adjustment based on hepatic and renal metabolism are essential. The results of this study showed that the mortality rate and ICU admission in people with the underlying disease is higher than in other people. Also, we must pay attention to the possible multi-organ damages and comorbidities for the protection and successful treatment of COVID-19. There are some comorbidities like primary cutaneous manifestations that may have diagnostic or prognostic values in the COVID-19 course.
Glycoprotein IIb/IIIa inhibitors play a key role in the treatment of patients who have acute coronary syndromes and undergone percutaneous coronary intervention. However, its serious complication is diffused alveolar hemorrhage. A 73-year-old diabetic woman presented with chest pain and dynamic ST elevation in ECG and positive troponin. She had occlusion in two coronary arteries and underwent percutaneous coronary intervention. The eptifibatide was administered. After hours, she showed respiratory symptoms, as well as drop of blood pressure and hemoglobin. All differential diagnoses suggested for her clinical presentation were evaluated, and finally, on the sixth day diffuse alveolar hemorrhage was diagnosed. Although respiratory symptoms such as hemoptysis and dyspnea may occur as complications of pulmonary edema and/or pneumonia, assumed clinical suspicion for pulmonary hemorrhage leading to early detection of it. Moreover, there is no definitive guideline for decreased bleeding complications and treatment of alveolar hemorrhage caused by glycoprotein IIb/IIIa receptor inhibitors.
Background Heart transplantation has been considered the gold-standard treatment for patients with end-stage heart failure. This study assessed the survival outcomes of marginal donor hearts compared with ideal donor hearts in Iran. Methods This retrospective study is based on the follow-up data of heart donors and recipients in the Sina Hospital Organ Procurement Unit. Among the 93 participants, 75 were categorized as ideal donors (group A) and 18 as marginal donors (group B). Group C included heart recipients who received a standard organ, and group D included heart recipients who received a marginal one. To analyze differences in patient characteristics among the groups, posttransplant heart survival was assessed in all groups. All data were obtained from the hospital records. Results The mean age of the donors was 26.27±11.44 years (median age, 28 years). The marginal age showed a significant association with donor age. The age of recipients had a significant effect on survival days in the ideal group. Most patients survived for at least 1 year, with a median of 645 days in recipients from marginal donors and 689 days in recipients from ideal donors. Conclusions Considering the lack of organ availability in Iran, it may be possible to use marginal donors for marginal recipients, therefore reducing the number of people on the waitlist. We also recommend establishing a national marginal donor system specifically for Iranian patients to extend the donor pool.
Background: Coronary artery disease (CAD) and nonalcoholic fatty liver disease (NAFLD) are 2 common diseases around the globe. This investigation aimed to evaluate NAFLD prevalence in patients with CAD and the potential association between NAFLD and CAD. Methods: This case-control study was performed between January 2017 and January 2018 at Ziaeian Hospital, Tehran, Iran. All patients aged between 35 and 5 years and referred for myocardial perfusion imaging were selected for the study. Totally, 180 participants were divided into CAD+ and CAD− groups. CAD was defined as stenosis of greater than 50.0% in at least 1 coronary artery. Afterward, all the patients underwent abdominal sonography and laboratory tests for NAFLD evaluation. Patients with a history of liver diseases, alcohol consumption, and drug-induced steatosis were excluded. Results: The study population consisted of 122 women (67.8%) and 58 men (32.2%) at a mean age of 49.31±5.42 years. NAFLD was detected in 115 patients. NAFLD prevalence in the CAD+ group was 78.9%. NAFLD was determined as an independent risk factor for CAD (OR, 3.9). Conclusions: NAFLD prevalence was high in the CAD+ group. The incidence of steatosis is on the rise in the general population. Hence, considering the high prevalence of abdominal obesity, all patients with NAFLD should be evaluated for CAD.
Role of frailty in prediction of hospitalized older adult patient's outcomes: a prospective study Background/aim: Frailty is associated with an increased risk of negative short-term and longterm hospital outcomes. This study aimed to evaluate the role of frailty in predicting readmission, length of stay, and quality of life in the hospitalized older adults. Materials and methods: This observational study was conducted at Ziaiyan Hospital, Tehran, Iran. 304 participants (65-85 years), were enrolled through the inclusion criteria from August to December 2019. The Frailty Index (FI) was assessed by the Minimum Data Set-Home Care. Readmission was obtained through telephone interviews. The length of stay was gathered by the patient's hospital records, and the EuroQol questionnaire was used for assessing the quality of life. Data were collected by a researcher nurse at the admission time, 30, 60, and 90 days after discharge. The logistic regression model and repeated measures ANOVA were employed to analyze the association between frailty and outcomes.Results: According to FI, 102 (33.55%) participants were pre-frail, whereas 35 (11.51%) were frail. In the fully-adjusted model for readmission, the pre-frail participants had a higher risk of readmission at the hospital in comparison with the non-frail and frail groups (OR=1.88, 95% CI =1.90-3.26), and also for GP visits, frail patients showed nearly significant differences (OR =2.45, 95% CI =0.99-6.06) but there were no differences between frail and pre-frail patients in readmissions in the emergency ward. In a fully-adjusted prolonged stay model, pre-frail patients had a higher probability to stay longer in hospital (OR =2.28,. The fullyadjusted model for QoL showed, frail patients were more prone to the declined levels of QoL in comparison with pre-frail patients (OR =10.77, 95% CI: 3.97 -29.18).Predicting frailty in hospitalized older adults Conclusions: The findings indicated that frailty worsened negative outcomes and declined QoL.Early diagnosis in hospital settings could be beneficial for designing optimal care plans for the frail and pre-frail patients.
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