Prosthetic tricuspid valve thrombosis: three case reports and literature review

A common complication of prosthetic heart valves is thrombosis. Although the incidence of prosthetic valve thrombosis [PVT] in the tricuspid position is high, there are not enough data on the management of it, in contrast to left-sided PVT. Here, we describe three cases of tricuspid PVT with three different management approaches: thrombolytic therapy; close observation with oral anticoagulants; and surgery. The first case was a woman who suffered from recurrent PVT, for which we successfully used Tenecteplase for second and third episodes. We employed Tenecteplase in this case for the first time in the therapy of tricuspid PVT. The second case had fixed leaflets in open position while being symptomless. At six months' follow-up, with the patient having taken oral anticoagulants, the motion of the leaflets was restricted and she was symptom-free. The last case was a woman who had a large thrombus in the right atrium immediately after mitral and tricuspid valvular replacement. The patient underwent re-replacement surgery and a new biological valve was implanted in the tricuspid position. Also, we review the literature on the pathology, signs and symptoms, diagnosis, and management of tricuspid PVT

Frequency of iron deficiency anaemia and beta Thalassemia minor among adolescent school girls in Ahvaz, Iran

To investigate the frequency of causes of anaemia among adolescent school girls in Ahvaz in 2009. A cross-sectional study was conducted on 208 Adolescent girls aged 15-19 years from high schools in Ahvaz. Blood samples were taken from all patients and were sent to laboratory for determination of complete blood count [CBC] test, serum ferritin [SF], hemoglobin electrophoresis [Hb F, Hb A2] was done for all of the anaemic cases. Iron deficiency anaemia was defined as a situation where Hb is less than 12 g/dl and ferritin is less than 12 ng/ml. Beta-thalassemia were identified by high performance liquid chromatography [HPLC] analysis of hemoglobin and Hb A2>3.4. Of the 208 patients, 37 cases [17.8%] were anemic and Iron deficiency anaemia was found in only 11 from 208 children [5.3%], minor beta thalassemia was found in only five of 208 children [2.4%], mixed beta thalassemia and iron deficiency anaemia was found in four of 208 [1.9%] and other patient with anaemia 19 patient [9.1%] minor alpha thalassemia was considered, anybody of students were macrocytic anaemia. The results suggest that thalassemia and iron deficiency anaemia may be major contributing factors to the occurrence of anaemia in this area among schoolgirl population

child with Polyglandular autoimmune syndrome Type-1 and immune thrombocytopenic purpura

Polyglandular autoimmune syndrome type I [PGA I] is a rare disease. Its hallmarks are chronic mucocutaneous candidiasis, hypoparathyroidism and adrenal insufficiency. Immune thrombocytopenic purpura [ITP] is one of the most common autoimmune disease in children. Association of PGA I with ITP was not found in some previous studies, but, we report a child with PGA I and ITP

Survival at 1, 3, and 5 years in diabetic and nondiabetic patients on hemodialysis

We analyzed survival of 185 adult patients on maintenance hemodialysis [9 h/wk to 12 h/wk] at Emam Khomini Hospital in Ahvaz, Iran. Patient survival at 1, 3, and 5 years was 89.2%, 69.2%, and 46.8%, respectively. There was no significant difference between diabetic and nondiabetic patients in 1-year survival [87.1% versus 89.7%, P = .66]. But, 3- and 5-year survival rates of diabetic patients were significantly lower than those of nondiabetic patients [52.2% versus 73.8%, P = .04; zero versus 56.9%, P < .001; respectively]. Based on our findings, the survival of diabetic patients undergoing hemodialysis was much worse than survival of nondiabetic patients. Thus, prevention of diabetic nephropathy should be more emphasized; and if end-stage renal disease is present, other renal replacement therapies such as kidney transplantation must be considered as soon as possible

How to reach rapid diagnosis in sickle cell disease?

Sickle cell disease [SCD] is a common hereditary disease in Iran. In developed countries, newborn screening programs have been established to ensure early diagnosis, but in most developing countries, screening is not performed and the diagnosis is often delayed. The aim of the present work was to investigate the clinical presentation of SCO in Iran and comparison of its hematologic indices with normal children. The study included 44 pediatric patients [26 boys and 18 girls] with sickle cell anemia [SS], 27 sickle / beta °-thalassemia [S beta °], and 21 sickle /beta [+]-thalassemia [S beta[+]]. Fifty seven healthy individuals matched with the patients were randomly selected as controls. Mean age at diagnosis in SS group was 4.3 years. At the time of diagnosis all patients were anemic, 89% complained of painful crises. Hemoglobin[Hb] concentration, red blood cell [RBC] count and HbxRBC product in SS group was significantly lower than in control group [P<0.001], mean corpuscular volume [MCV] and mean corpuscular hemoglobin [MCH] showed no significant differences. HbxRBC product below 45 and MCH/RBC above 7 have the best sensitivity and specificity for differenting SS group and the control normal group [91 and 98% for HbxRBC arid 89 and 100% for MCH/RBC respectively]. Mean age at diagnosis in S beta [+] group was higher than in SS and Sp° groups [7.45 year vs 4.26 and 4.25 year] [P<0.001]. In addition, S beta ° and S beta[+] groups had significantly lower MCV, MCH, and HbxRBC indices compared with control group. We suggest that in an anemic patient with history of pain crises, normochrome normocytic anemia, HbxRBC <45 and MCH/RBC >/= 7, SCD should be considered and the patient evaluated accordingly to confirm the diagnosis