Explore the vast range of titles available.

Background Prosthetic valve Endocarditis (PVE) is an uncommon but potentially life-threatening infection involves a valve prosthesis or annuloplasty ring. Streptococci, including Streptococcus mitis and enterococci are major etiological agents, with studies indicating their significant role in late-onset PVE in some regions of world, staphylococci have surpassed streptococci as the most frequent causative organism. Despite challenges in diagnosis, molecular methods offer high sensitivity. Case presentation A 30-year-old female patient, Iranian, with a history of hypothyroidism, tetralogy of Fallot, and a bioprosthetic valve replacement and weakness after two months from exprience upper respiratory tract infection (URTI), was admitted with complaints of epistaxis, fever and worsening of shortness of breath. She exhibited symptoms of anemia, thrombocytopenia, elevated WBC, LDH, and D-dimer levels, along with splenomegaly, pleural effusions, and pulmonary congestion. Echocardiography revealed significant valve vegetation and RV failure. Despite comprehensive treatment, including cardiac surgery and antifungal therapy, her condition deteriorated, leading to cardiac arrest and death. Posthumous molecular analysis identified S. mitis as the causative agent, despite negative blood cultures. Conclusions This case highlights the challenges of diagnosing and treating complex PVE, particularly when conventional cultures are negative. The detection of S. mitis through molecular methods underscores the importance of early and accurate identification of pathogens in guiding effective treatment.

Percutaneous valve implantation or surgical replacement with mechanical or biological valves are standard therapies for severe valvular heart diseases. Prosthetic valve thrombosis, though rare, is a serious complication, particularly with mechanical prostheses. This study aimed to investigate the predictive value of platelet volume parameters, including mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR), for valvular thrombosis risk in patients undergoing valve replacement therapy. A retrospective cross-sectional study was conducted from May 2002 to May 2020, involving 108 patients with a history of mitral or aortic valve replacement and valvular thrombosis, and 216 controls with a history of valve surgery without valvular malfunction. PDW was significantly associated with an increased risk of thrombosis after adjusting for confounders, while MPV showed a clinical difference but did not reach statistical significance. P-LCR did not exhibit a significant association. These findings suggest PDW as a potential predictor of valvular thrombosis in such patients. The ease of measuring platelet volume parameters suggests their utility in routine hematological analysis for identifying patients at higher risk of valvular thrombosis post-replacement surgery. Further studies are warranted to validate these findings and explore additional laboratory markers, such inflammatory markers, for thrombotic risk assessment in this population.

Background Although several studies are available regarding baseline Electrocardiographic (ECG) parameters and major and minor ECG abnormalities, there is considerable controversy regarding their age and gender differences in the literature. Methods Data from 7630 adults aged ≥ 35 from the Tehran Cohort Study registered between March 2016 and March 2019 were collected. Basic ECG parameters values and abnormalities related to arrhythmia, defined according to the American Heart Association definitions, were analyzed and compared between genders and four distinct age groups. The odds ratio of having any major ECG abnormality between men and women, stratified by age, was calculated. Results The average age was 53.6 (± 12.66), and women made up 54.2% ( n  = 4132) of subjects. The average heart rate (HR) was higher among women( p  < 0.0001), while the average values of QRS duration, P wave duration, and RR intervals were higher among men( p  < 0.0001). Major ECG abnormalities were observed in 2.9% of the study population (right bundle branch block, left bundle branch block, and Atrial Fibrillation were the most common) and were more prevalent among men compared to women but without statistical significance (3.1% vs. 2.7% p  = 0.188). Moreover, minor abnormalities were observed in 25.9% of the study population and again were more prevalent among men (36.4% vs. 17% p  < 0.001). The prevalence of major ECG abnormalities was significantly higher in participants older than 65. Conclusion Major and minor ECG abnormalities were roughly more prevalent in male subjects. In both genders, the odds of having major ECG abnormalities surge with an increase in age.

Pulmonary thromboembolism (PTE) is the third most common cause of acute cardiovascular disease, which can lead to high morbidity and mortality if left untreated. Anatomical and electrophysiological variations and obesity may complicate timely diagnosis and delay required management. While computed tomography pulmonary angiography (CTPA) remains the most accurate diagnostic tool, initial assessments using electrocardiography (ECG) or echocardiography can be helpful in early suspicion. However, anatomical and electrophysiological variations, like dextrocardia and a permanent pacemaker (PPM), can obscure key ECG findings like right ventricular (RV) strain patterns. Moreover, obesity can distort echocardiographic estimations, particularly of RV function, due to increased chest wall thickness and suboptimal acoustic windows. We report a case of a 52-year-old obese woman with situs inversus dextrocardia and a PPM who presented with dyspnea. Diagnostic challenges were significant, as both echocardiography and ECG were compromised due to her obesity, anatomical variation, and PPM device, leading to an initial misdiagnosis and treatment for decompensated heart failure (DHF) with diuretics and vasodilators. Given her worsening condition and elevated D-dimer levels, a CTPA was performed, revealing PTE. Due to delayed PTE treatment, the patient experienced hemodynamic deterioration and impaired organ perfusion, leading to acute kidney injury requiring dialysis. Following PTE management and a few dialysis sessions, her hemodynamics and overall condition improved, with recovery of urine output. The patient was ultimately discharged in stable condition. This case emphasizes the diagnostic complexities in patients with rare anatomical conditions (e.g., dextrocardia with PPM) presenting with nonspecific symptoms like dyspnea. In such cases, clinicians should maintain a high index of suspicion for urgent conditions like PTE, especially when factors like obesity, anatomical variations, and device-related artifacts hinder conventional diagnostic tools. Enhancing clinical vigilance, developing tailored algorithms for unique populations, using advanced imaging modalities earlier (such as CTPA), and engaging in interdisciplinary consultations are critical in these complex cases to help avoid delays in definite diagnosis and treatment.

NRC publication: Yes

Introduction: Insulinoma is the most common functional neuroendocrine tumor of the pancreas. There are different methods for the preoperative localization of insulinoma, such as Computed Tomography (CT) scan, Magnetic Resonance Imaging and Endoscopic Ultra Sonography (EUS). In this study, we report on the clinicopathological features of insulinoma in 43 patients. Methods: The hospital records of 43 patients with suspicion of insulinoma based on biochemical diagnostic criteria, referred to İmam Khomeini Complex Hospital, Tehran, Iran between 2006 and 2016, were reviewed retrospectively. Results: Of the 43 studied patients, 28 were female. The mean age of the patients was 45.4±13.3 years. The most frequent clinical presentation of insulinoma was neurogenic and neuroglycopenic symptoms (81.4%). Mean glucose, insulin, and C-peptide in patients with hypoglycemic crisis were 39.13±13.15 mg/dL, 32.15±32.53 μUI/mL, and 4.77±2.88 ng/mL, respectively. Mean tumor size was 2.13±1.22 cm. The most common site of insulinoma was the tail of the pancreas. Surgery was the treatment of choice and performed in 31 patients. Of 21 tumors studied microscopically, 7 were invasive. Conclusion: In non-diabetic patients with manifestations of hypoglycemia, a diagnosis of insulinoma should be considered. During the past decade, the diagnostic delay for insulinoma has been reduced in our country by improving imaging technologies. EUS and CT scan are the best modalities for localization and size measurement of insulinoma. Tumor size has decreased compared with previous decades, probably due to a reduced delay in diagnosis.

Background and Aims In the current study, we aimed to identify the association between major and minor electrocardiographic abnormalities and cardiovascular risk factors. Methods We used the Tehran cohort study baseline data, an ongoing multidisciplinary, longitudinal study designed to identify cardiovascular disease risk factors in the adult population of Tehran. The electrocardiograms (ECGs) of 7630 Iranian adults aged 35 years and above were analyzed. ECG abnormalities were categorized into major or minor groups based on their clinical importance. Results were obtained by multivariable logistic regression and are expressed as odds ratios (ORs). Results A total of 756 (9.9%) participants had major ECG abnormalities, while minor abnormalities were detected in 2526 (33.1%). Males comprised 45.8% of the total population, and 41.8% of them had minor abnormalities. Individuals with older age, diabetes (OR = 1.35; 95% CI: 1.11–1.64), and hypertension (OR = 2.21; 95% CI: 1.82–2.68) had an increased risk of major ECG abnormalities. In contrast, intermediate (OR = 0.69; 95% CI: 0.57–0.84) and high physical activity levels (OR = 0.66; 95% CI: 0.51–0.86) were associated with a lower prevalence of major abnormalities. Male sex, older age, hypertension, and current smoking were also associated with an increased prevalence of ECG abnormalities combined (major or minor). Conclusion Major and minor ECG abnormalities are linked with important cardiovascular risk factors such as diabetes and hypertension. Since these abnormalities have been associated with poor outcomes, screening patients with cardiovascular risk factors with an ECG may distinguish high‐risk individuals who require appropriate care and follow‐up.

While the traditional risk factors of atherosclerotic cardiovascular disease (ASCVD) have been well-established, the evolving role of nontraditional risk factors is not apparent. This study aimed to evaluate the association between nontraditional risk factors and the calculated 10-year ASCVD risk in a general population. This cross-sectional study was conducted using the Pars Cohort Study data. All inhabitants of the Valashahr district in southern Iran, aged 40-75 years, were invited (2012-2014). Patients with a history of cardiovascular disease (CVD) were excluded. The demographic and lifestyle data were collected using a validated questionnaire. Multinomial logistic regression analysis was used to evaluate the association between the calculated 10-year ASCVD risk and the nontraditional risk factors of CVD, including marital status, ethnicity, educational level, tobacco and opiate consumption, physical inactivity, and psychiatric disorders. Of 9264 participants (mean age =52.2±9.0 y; 45.8% male), 7152 patients met the inclusion criteria. In total, 20.2%, 7.6%, 36.3%, 56.4%, and 46.2% of the population were cigarette smokers, opiate consumers, tobacco consumers, ethnically Fars, and illiterate, respectively. The prevalence rates of low, borderline, and intermediate-to-high 10-year ASCVD risks were 74.3%, 9.8%, and 16.2%, respectively. In multinomial regression, anxiety (adjusted odds ratio [aOR], 0.58; P<0.001) was significantly associated with a lower ASCVD risk, whereas opiate consumption (aOR, 2.94; P<0.001) and illiteracy (aOR, 2.48; P<0.001) were significantly associated with a higher ASCVD risk. Nontraditional risk factors are associated with the 10-year ASCVD risk and, thus, might be considered besides traditional ones for ASCVD in preventive medicine and health policies.

Introduction. Hydronephrosis, a condition that is mostly congenital, is considered as the most common type of pediatric urinary tract disorder. The aim of this study was the evaluation of the prognosis and outcomes of hydronephrosis in cases of congenital hydronephrosis. Methods. In a cross-sectional study, run in a tertiary clinic of pediatric nephrology, from 2015 to 2020, patients with fetal hydronephrosis were selected. Ultrasonography, urinalysis and kidney function tests were ordered for all patients and in the presence of hydronephrosis, repeated ultrasonography, voiding cystourethrography and dimercaptosuccinic acid scan were performed. In cases with evidence of obstruction, a diethylenetriamine pentaacetic acid scan and relative surgical procedures were performed. Results. Among 141 cases, mean age was 8 ± 1.4 years and 80.9% were male. Partial or complete obstruction in the right and left kidney was found in 16.3 and 24.8% of patients, respectively. The degree of hydronephrosis was mild in 46.1%, moderate in 39%, and severe in 9.2% of the patients. At the last follow-up period, hydronephrosis recovered in 46% of the patients, while 54% experienced persistence or exacerbation of the disease. Meanwhile, 7.1% of patients showed neurogenic bladder, 19.1% urinary tract infection and 22.7% urinary stones. Conclusion. Our study revealed that fetal hydronephrosis ends in complete recovery following birth in 46% of the cases. However, in cases experiencing persistent or exacerbating hydronephrosis, optimized treatment and/or surgical intervention are required.DOI: 10.52547/ijkd.6516

Background: In collaboration with clinical domain experts, we have developed a prototype of immersive VR cognitive remediation for major depressive disorder, bWell-D. In the development of a new digital intervention, there is a need to determine the effective components and clinical relevance using systematic methodologies. From an implementation perspective, the effectiveness of digital intervention delivery is challenged by low uptake and high non-compliance rates. Gamification may play a role in addressing this since it can boost adherence. However, careful consideration is required in its application in order to promote user motivation intrinsically. Objective: We aimed to address these challenges with an iterative process for development that involves co-design for developing content as well as in the application of gamification, while also taking into consideration behavioural change theories. This effort followed the methodological framework guidelines outlined by an international working group for development of VR therapies. Methods: Following best practice guidelines, we collected qualitative data from patients and care providers to understand end-user perceptions on the use of VR technologies for cognitive remediation, reveal insights on the drivers for behavioural change, and obtain suggestions for changes specific to the VR program. These findings were translated into concrete representative software functionalities/features and evaluated against behavioural theories to characterize gamification elements in terms of factors that drive behavioural change and intrinsic engagement. Results: The results indicated that feedback from end-users centred around using gamification to add artificial challenges, personalization/customization options and artificial assistance while focusing on Capability as the behavioural change driver. It was also found that in terms of promoting intrinsic engagement, the need to meet Competence was most frequently raised. Feedback was obtained from users to evaluate the impact of the implemented changes. It was found that bWell-D was well tolerated, and that the improvements led to an increase in user experience ratings with high engagement reported throughout the duration of an 8-week training program. Conclusions: Here, we present a process for the application of gamification that includes characterizing what was applied in a standardized way and identifying the underlying mechanisms that are targeted. Typical gamification elements, such as points/scoring and rewards/prizes, target Motivation in an extrinsic fashion. In this work, it was found that modifications suggested from end users resulted in the inclusion of gamification elements less commonly observed and tended to focus more on individual ability. It was found that the incorporation of end-user feedback can lead to the application of gamification in broader ways with the identification of elements that are potentially better suited for mental health domains.