Background: Considering the role of higher blood urea nitrogen and lower serum albumin (SA) levels in deceased coronavirus disease 2019 patients, an increased blood urea nitrogen to SA (B/A) ratio may help to determine those at higher risk of critical illness. This study aimed to evaluate the correlation of the B/A ratio with severity and 30-day mortality in COVID-19 patients.Methods: A total of 433 adult patients with COVID-19 were enrolled. The laboratory markers were measured on admission. Disease severity was categorized into mild disease, severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis, and septic shock.The mortality was followed for 30 days after admission. χ 2 test, Fisher's exact test, and Mann-Whitney U test were performed, as appropriate. Also, logistic regression and the receiver operating characteristic (ROC) curve for the B/A ratio are included.Results: Thirty-day mortality rate was 27.25%. The frequency of mild, severe pneumonia, ARDS, sepsis, and septic shock was 30.72%, 36.95%, 24.02%, 6.00%, and 2.31%, respectively. B/A ratio and SA levels were statistically different between alive and deceased patients. The mean B/A ratio was different among classified disease severities, except for mild disease. Logistic regression revealed the B/A ratio as an independent risk factor for sepsis after adjusting for age and sex. ROC analysis showed B/A ratio had an area under the curve (AUC) of 0.733 for mortality at the cutpoint of 4.944. AUC for sepsis was 0.617 which was greater than other disease severities. Conclusion:The results showed that B/A ratio and SA levels are associated with mortality of COVID-19 patients. A higher B/A ratio is, additionally, associated with COVID-19 severity, except in mild cases and it can act as an independent risk factor in sepsis. However, a greater B/A ratio is not a significant predictor of COVID-19 severity, but it can predict mortality. Therefore, we suggest this marker for clinical assessment of patients with severe COVID-19.

Background Inflammation has been considered as a possible mechanism for the initiation and recurrence of venous thromboembolism (VTE). Statins have anti‐inflammatory and potential immune‐modulatory effects, but their effect on plasma d ‐dimer levels is controversial. Hypothesis In this study, we aimed to evaluate the impact of rosuvastatin on D‐dimer and other inflammatory serum markers in VTE patients. Methods We conducted a prospective, randomized study on 228 patients with VTE. Control group received conventional treatment (warfarin or rivaroxaban), whereas rosuvastatin‐intervention group received rosuvastatin 10 mg daily, in addition to their conventional treatment for 3 months. Serum markers were extracted from both groups at the baseline and 3 months after the beginning of treatment. Results After 3 months, in patients of the intervention group, there was a statistically significant decrease in levels of d ‐dimer and mean platelet volume (MPV) but no significant change in neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio. Conclusions Our results showed that a 3‐month treatment with 10 mg rosuvastatin daily can significantly decrease the plasma levels of d ‐dimer and MPV, which would support a potential role of statins to reduce activated systemic inflammation among VTE patients. Such effects can be used to reduce the rate of recurrent VTE in these patients.

Key Clinical MessageA female with massive PTE and absolute contraindication for thrombolytic did not meet guidelines due to unavailability of catheter or surgical embolectomy and giving thrombolytic as a last resort to save a life. In such cases, physicians should consider to act outside of the guidelines to save a life.

Introduction; the aim of this study was to employ phase analysis to diagnose left ventricular mechanical dyssynchrony (LVMD)in asymptomatic patients with diabetes mellitus type 2 and normal perfusion study to prevent diabetic cardiomyopathy.Methods & materials; Ninety-three consecutive patients with known type 2 diabetes and 81 age-and gender-matched patients without diabetes who were candidates for SPECT-MPI were considered as the control group. The presence of LVMD as an indicator of cardiomyopathy-was determined using phase analysis for each scan with quantitative gated SPECT (QGS) and corridor4DM (4DM) software. All outcomes such as phase bandwidth (PBW) and phase standard deviation (PSD) were compared between the two groups.Results; A total of 174 patients were included in the study. There were no statistically signi cant difference regarding demographic factors between the two groups (P>0.05). PBW showed statistically signi cant differences (increased in diabetics) between the control and diabetic patients (P < 0.05).Kruskal Wallis analysis revealed that as the duration of diabetes is prolonged, especially more than 15 years, the probability of LVMD is increased as well (p=0.021).Discussion; Fraction of asymptomatic diabetic patients with normal ejection fraction and gated SPECT MPI-especially those with prolonged diabetes-might have some degrees of LVMD. Phase analysis can detect this which in turn would prevent progress into heart failure.

Hypertension is a medical problem during pregnancy and one of the types of hypertensions during pregnancy is eclampsia-preeclampsia. The aim of this study was to compare inflammatory markers between women with eclampsia -preeclampsia and pregnant women with normal blood pressure admitted to the gynecology ward of Shahada Tarnish and Mehrieh hospitals in 1998-99. This descriptive-analytical study was performed with a cross-sectional design. The study population consisted of all patients diagnosed with eclampsiapreeclampsia and pregnant mothers in Shohada-e-Tajrish and Mahdieh Hospitals in Tehran during 2019 to 2020. The study sample consisted of 400 patients who were selected by convenience or convenience sampling method and 200 patients with a diagnosis of eclampsia-preeclampsia were in the experimental group and 200 pregnant women were in the control group. The subjects completed pre-prepared forms for study variables, i.e. information on maternal age, maternal weight, infant weight, gestational age, neutrophil count and lymphocytes. To analyze the collected data, tests such as Pearson correlation coefficient and independent t-test were used and analyzed by SPSS software version 23. The results showed that a statistically significant difference was found between NLR and PLR MPV. Finally, the results of this study showed that platelet count; MPV, NLR, PLR were significantly different in the two groups of preeclampsia patients and pregnant women with normal blood pressure and that these indicators can be used to predict preeclampsia.

Type A aortic dissection is a catastrophic event that requires prompt diagnosis and intervention to save the patient. It seems that type A aortic dissection in COVID‐19 patients has increased severity, and even with immediate diagnosis, it has a high mortality.

A 58-year-old man who presented with syncope, dyspnea, and hemodynamic compromise was found to have large free-floating right atrial thrombuses on echocardiogram. Decision was made to transfer the patient for emergent atriotomy. Cardiothoracic surgeons declared the patient as inoperable and recommended to use a lytic agent. Alteplase was administered with subsequent near-complete resolution of symptoms and near-normalization of echocardio-graphic parameters. The post-thrombolytic course was complicated by saddle pulmonary emboli requiring embolectomy. Catheter embolectomy was not available and cardiothoracic surgeon in other center considered the patient to be very high risk for transferring between hospitals and surgical intervention. Ultimately, the critical decision was made, despite the patient having been administered thrombolytic therapy within the previous 48 hours. Alteplase was given, but was not effective and the patient required surgical intervention. Surgical embolectomy was done successfully in another hospital and the patient was discharged with warfarin.

A 59-year-old female with a history of mitral valve replacement presented to emergency department, complaining of sudden-onset retrosternal chest pain since 4 hours ago. Electrocardiogram, laboratory tests, and computed tomography (CT) angiography of aorta were performed and ruled out aortic dissection and cardiovascular events. However, new complaint of odynophagia, dysphagia, and incidental findings in CT angiography proposed esophageal pathologies. After initial workup including upper gastrointestinal endoscopy, intramural esophageal hematoma was diagnosed. Laboratory tests revealed significant reduction in the hemoglobin level. Management of warfarin-induced major bleeding in a patient whom anticoagulation was necessary for the prevention of mechanical heart valve thrombosis was challenging. The patient recovered fully with conservative treatment and was discharged on hospital day 14 with low molecular weight heparin. We described a case of intramural esophageal hematoma as a rare condition that could be misdiagnosed as a cardiovascular emergent disease and would be worsened by antiplatelet and anticoagulation therapy. Accordingly, it is important to differentiate intramural esophageal hematoma from cardiac ischemic events. Another challenge was correction of coagulation in the presence of mechanical mitral valve. Fortunately, we had a favorable outcome following conservative management.