Background Patent foramen ovale closure in the setting of stroke was debatable until the recent data from the long-term follow-up of multiple randomized control trials. These recent data have led to increase the number of the procedure worldwide. To our knowledge, there was no previous formal structured program in Egypt between cardiologists and neurologists for investigation and management of patients with cryptogenic stroke. The first Egyptian-dedicated stroke team was created in two large tertiary centers with collaboration between cardiologists, dedicated cardiac imagers, and neurologists for investigation and management of patients with cryptogenic stroke. Results Sixty-three patients with cryptogenic stroke were identified from a total of 520 patients admitted to the stroke units between 2016 and 2019. Twenty-five patients had a proven PFO-related stroke. Three patients were referred for surgical closure, 19 patients underwent transcatheter PFO closure, and procedural success was met in 18 patients (94.7%). We did not experience any major procedure-related complication. Complete closure was achieved in 83.3% of patients at 6 months. One patient had a single attack TIA within the first 3 months after device closure; one patient had a device-related thrombosis; both were managed successfully. Conclusion Our initial experience in collaboration between cardiologist and neurologist with the establishment of a dedicated cryptogenic stroke team added significantly to the management of patients with stroke. The results of the first Egyptian cohort who underwent transcatheter PFO closure demonstrated procedural feasibility, safety, and efficacy with very low incidence of major complications. A nationwide program is needed to reduce the ischemic stroke disease burden and the risk of recurrence.
It was published lately in 2016 that there are approximately 3.7 million of deaths caused by communicable diseases annually. Unfortunately, currently there is no automated method for the detection and tracking of communicable diseases progression. In this paper, a framework is proposed, that is based on social network analysis, different biological sensors, and big data analytics as for predicting and analyzing communicable disease and to facilitate the process of managing, preventing and predicting risks of communicable disease progression. The proposed framework is largely based on graph theory and social network analysis algorithms to model and dynamically predict communicable disease risk for diagnosed and non-diagnosed patients. In this research, a global graph structure that maps a whole friendship network is proposed, and the suitable algorithms to identify and continuously monitor a certain communicable disease progression rate. This research can potentially be useful for forming a methodology for early intervention and prevention policies targeted at patients that can potentially divert them from the disease pathway. The interpretation and dynamic utilities offered by the framework and its predictive capability are considered a remarkable and promising broad model highlighting potential pathways linking social support, biological sensors and data sciences to physical health.
Background:Ischemic heart diseaseis one of the heaviest health-related burdens worldwide.We aimed to identify the common hub mRNA and pathways that are involved in pathological progression of ischemic cardiomyopathy(ICM). Methods:To explore potential differentially expressed genes (DEGs) of all ischemic heart disease stages, we used chipster and GEO2R tools to analyze of retrieved eight high throughput RNA datasets obtained from GEO database. Gene Ontology functional annotation and Pathways enrichment analyses were used to obtain the common functional enriched DEGs which were visualized in protein–protein interactions (PPI) network to explore the hub mRNA according to the interaction scores. Validation qRT-PCR was carried out for blood and cardiac biopsies compared with controls to validate the determined four hub mRNAs and subsequently reviewed inside comprehensive published meta-analysis database. The validated mRNAs were visualized in two interaction modules. Finally screening of approved drugs was applied. Results: 15 common DEGs with p value ≤ 0.01 were identified and carbohydrate &amino acids metabolism and inflammatory responses were significantly enriched. STAT3, CEBPD, GLUL and CD163 were hub enriched mRNAs with interaction score ≥ 0.50. Our qRT-PCR analysis showed increased expression of STAT3 over all patients groups and CD163 mainly in cardiac samples with remarked ascending manner. Interaction modules showed co-regulators supporting high STAT3-CD163 connectivity providing potential role of STAT3-CD163 crosstalk mediated inflammatory responses in ICM progression. We determined two reported drugs targeting STAT3. Conclusion:Post analysis of the used GEO datasets and qRT-PCR data pointed that STAT3-CD163 crosstalk was potential biomarkers for ICM progression. Clinical trial registration: www.clinicaltrials.gov, Identifier: NCT05508269
Background Secundum atrial septal defect (ASD) closure leads to electrical and mechanical remodeling that occurs early after shunt disappearance. The relationship between electromechanical remodeling using electrocardiogram (ECG) and cardiac magnetic resonance (CMR) after percutaneous and surgical closure has not yet been recorded in prospective studies. Objective We thought to study right atrium (RA) and right ventricle (RV) changes by CMR 3 months after transcatheter and surgical closure and their comparison with electrical remodeling by ECG. Results We prospectively evaluated 30 consecutive adult patients with isolated secundum ASD who were referred for (transcatheter and surgical) ASD closure. There was significant reduction in all of the electrical parameters within the same group as compared to the baseline values, except P wave dispersion (Pd). (P max was 97.33 ± 16.67 (pre closure) to 76 ± 15.49 (post closure) in the device group and 97.33 ± 12.79 (preclosure) to 73.33 ± 16.32 (post closure) in the surgical group, QRS complex was 104 ± 18.82 (preclosure) to 80 ± 18.51 (post closure) in the device group and 106.67 ± 14.47 (preclosure) to 86.67 ± 17.99 (post closure) in the surgical group. QTc maximum was 478.53 ± 36.79 (preclosure) to 412.53 ± 38.03 (post closure) in the device group and 470.53 ± 65.70 (preclosure) to 405.93 ± 63.08 (post closure) in the surgical group, and QTc dispersion was 70.33 ± 24.04 (preclosure) to 60.26 ± 28.56 (post closure) in the device group and 80.73 ± 30.38 (preclosure) to 60.27 ± 28.57 (post closure) in the surgical group).There was no significant difference between two groups indicating that transcatheter and surgical closure had led to equivalent value of electrical remodeling. In CMR study, we measured RA maximal volume and right ventricle end diastolic volume (RVEDV), RA maximal volume decreased significantly as compared to the base line values post closure in both groups (P value < 0.001). The reduction in RA max volume was more in the transcatheter closure group; however, this difference was not statistically significant when compared with the surgical arm (P value = 0.5).RVEDV decreased significantly in both groups as compared to the baseline values (P value < 0.001). Transcatheter closure resulted in more significant reduction in the RVEDV than the surgical closure (P value = 0.03). Conclusion Our study showed early significant electromechanical reverse remodeling in most of the study parameters from the baseline values after ASD closure. We found no significant differences in all of the electrical and RA mechanical remodeling parameters with significantly better mechanical remodeling of RV in the device group.
Right pulmonary artery (RPA) to left atrium fistula (LA) is an extremely rare congenital malformation with less than 100 cases of PA-to-LA fistula reported. It causes central cyanosis and may present with heart failure. This is the first case to be closed under 2D and 3D TEE guidance inside cath lab. We present a case of a 12-year-old student who complained of exertional dyspnea and easy fatigability over the past few months. His mother reported mild cyanosis since birth which increased with exertion. On examination, he had central cyanosis with grade II clubbing in both fingers and toes, silent precordium with no audible murmur over his back). ECG showed normal sinus rhythm with no abnormality. CXR showed an abnormal shadow related to right cardiac border with prominent pulmonary artery and otherwise normal pulmonary vasculature. His complete blood count showed erythrocytosis with hemoglobin concentration of 16.4 g/dl and hematocrit value of 69.2%. Transthoracic echocardiography showed dilated left atrium with dilated right pulmonary artery. Patient was diagnosed to have a right pulmonary AV malformation. Invasive cardiac catheterization was done to identify size and number of this pulmonary AV malformation. Right pulmonary angiography showed a right pulmonary artery to left atrium fistula (type I) measuring 11 mm in its narrowest diameter with free shunting of blood. TEE guidance inside our cath lab showed normal pulmonary venous drainage into the left atrium, dilated right pulmonary artery opening into left atrium through an opening 10 mm with systolic flow across of low gradient (15 mmHg). A balloon was advanced across the fistula for sizing. Stretched diameter of fistula measured 13 mm. An Amplatzer ventricular septal occluder 14 was successfully positioned across the fistula. Right pulmonary angiography assured patent right lower pulmonary artery. TEE assured normal pulmonary veins flow into the left atrium. Patient saturation rose from 75% to 95%. Complete cure can be accomplished by transcatheter closure of direct pulmonary artery to left atrium communication. Systematic approach in assessment of patients with rare congenital anomalies can help their management despite of difficult clinical diagnosis. 2D and 3D TEE can guide RPA to LA fistula transcatheter closure as in ASD closure.
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