[Correlation between findings of CT pulmonary angiography and outcome of diseases in patients with acute pulmonary embolism]

Background and Objectives: right ventricle failure and massive pulmonary artery occlusion are the main causes of mortality in patients with acute pulmonary embolism. Although pulmonary CT angiography could be helpful in these patients there are some controversies. In current study we want to investigate correlation between pulmonary artery obstruction score and right ventricular dysfunction with mortality rate in patients with acute pulmonary embolism

Methods and Materials: pulmonary CT angiography of 76 patients with acute pulmonary embolism and no previous comorbidity were reviewed at this prospective study. Maximum short axis dimensions of the right ventricle [RVD] and the left ventricle [LVD] and their ratio were measured. The pulmonary artery obstruction score [PAOS] was determined according to Qanadli. At the end the correlation between these findings and mortality at first 60 days were evaluated

Results: the 60-days mortality rate was 19.7%. The expired and survived groups were comparable for PAOS, whereas both the median age and RVD/LVD ratio were significantly higher in the first group. In multivariate analysis, however, age was the only significant, independent predictor of 60-day mortality [p=0.02]

Conclusion: without pre-existing morbidities, neither the RVD/LVD ratio nor PAOS is not an independent predictor of mortality in hemodynamically stable patients with acute PE

Experiences of infertile women seeking assisted pregnancy in Iran: a qualitative study

Assisted reproductive technologies [ARTs] are complicated and stressful techniques and the social and cultural norms are major obstacles against their use. Many qualitative studies have been done in the field of women's experiences of infertility, but less is known about the experiences of infertile women seeking assisted pregnancy. The aim of this study was to understand and describe the experience of women who have used assisted reproductive technologies for their current pregnancy. This qualitative study was conducted based on a content analysis approach. With purposive sampling, 12 pregnant women who were using ART were recruited from Avicenna Fertility Center in Tehran. Women were selected purposefully and with maximum variation. Interviews were performed after a positive test of pregnancy and women were introduced to researchers in their first visit of pregnancy in the prenatal clinic. Interviews were recorded, transcribed verbatim and analyzed concurrently. Semi-structured interviews were coded, categorized and the themes were also identified. Four main themes were uncovered which included struggle to achieve pregnancy, fear and uncertainty, escape from stigma and the pursuit to achieve husband satisfaction. It is essential for these women to be counseled and prepared by their health care providers after the use of ARTs. Distress can be reduced for infertile women seeking assisted pregnancy when they are prepared for possible failures, empowered to deal with stigma, and have their partners' involvement in counseling sessions

Inferior vena cava index in edematous patients

To find a relation between extracellular over fluid and inferior vena cava index as a noninvasive, cost effective and accessible method. In a cross sectional study 54 cases [no edema 30, mild and moderate 13 and significant edema 11 cases] entered to study. Inferior vena cava index [IVCi] measured by difference of inspiration to expiration divided to maximum size multiply by 100, we also find delta ratio as difference of maximum to minimum size of inferior vena cava. All data expressed by rate and ratio, relation of edema severity to IVCi or delta ratio performed by mann whitney and regression test, P less than 0.05 was significant. IVCi in 30 cases with no edema, 13 cases with mild to moderate and 11 cases with significant edema were%46 +/- 16,%42 +/- 16,%38 +/- 17, there is a reverse relation of IVCi and edema severity but these relations were not significant [P>0.05]. Averaged Delta ratio [millimeter] decreased in severe edema but it was not significant[3.7mm +/- 2 vs. 2.8mm +/- 1.6]. In edematous conditions IVCi and delta ratio decrease but these changes are not significant for edema severity estimation.

Investigation of QF-PCR application for rapid prenatal diagnosis of chromosomal aneuploidies in Iranian population

G-Banding followed by standard chromosome analysis is routinely used for prenatal detection of chromosomal abnormalities. In recent years, molecular cytogenetic techniques have been developed for rapid diagnosis of chromosomal abnormalities. Among these methods Quantitative Florescence Polymerase Chain Reaction [QF-PCR] has been widely used for this purpose. Heterozygosity of short tandem repeat [STR] markers which leads to informativity is the most critical requirement for feasibility of QF-PCR. In this study we analyzed several short tandem repeats on chromosomes 13, 18, 21, X and Y on amniotic fluid samples obtained from PND candidates to diagnose conditions such as Down, Edward and Patau syndromes and also numerical sex chromosome abnormalities such as Klinefelter and Turner syndromes. Most of the analyzed STRs had acceptable heterozygosity [66.3-94.7] to be used in QF-PCR based prenatal diagnosis. Moreover, results obtained from both methods [standard karyotype and QF-PCR] for all samples were in accordance with each other. In case of using appropriate STR markers, and in certain clinical indications, QF-PCR could be used as useful technique for prenatal diagnosis even in consanguine populations such as Iranians

Is karyotyping and Y chromosome microdeletion study necessary in men candidate for ICSI?

The sperm count and function may be affected by karyotype abnormalities or microdeletion in Y chromosome. These genetic abnormalities can probably transmit to the children. In this study, we tried to determine the frequency of karyotype abnormalities and Y chromosome microdeletions in severe oligospermic or azoospermic men who fathered sons by ICSI. This study comprised of fathers who had at least a son with ICSI due to severe oligospermia or azoospermia. General examinations were done and blood sample were obtained for karyotype and Y chromosome studies. The total of 60 fathers was evaluated along with their 70 sons. The mean duration of infertility was 8.7 years and the sons were 2.4 years in average at the time of examination. The mean age of neonates at the time of delivery was 33 weeks; 42.9% were delivered prematurely; and 40.5% of them were twins. 8.6% of the sons had hypspadiasis and 7.1% had UDT. Most of the side effects were due to prematurity. In total 6 of fathers had karyotype anomaly without affected father. No case of Y chromosome microdeltion was found in the fathers. Y chromosome microdeletion is not prevalent in fathers with successful ICSI and it is not necessary to be analyzed before ICSI performance. Karyotype anomaly may transmit to the sons. All together ICSI is reliable and safe. Most of the complications are the result of premature delivery

Subclinical pulmonary hypertension in children with obstructive adenotonsillar hypertrophy

Adenotonsillar hypertrophy [ATH] is the most common cause of upper airway obstruction and obstructive sleep symptoms in children. The aim of this study is to compare pre-adentonsillectomy echocardiographic findings with postoperative findings. Fifty five children with adnotonsillar hypertrophy and obstructive-sleep apnea symptoms [aged 4 to14 years, 35 males, 20 females] were randomly selected from Aug 2007 to November 2008. Preoperatively echocardiography was performed for all patients by the same pediatric cardiologist. Patients with positive findings were followed and again echocardiography was performed separately one month and six months after operation. All the patients' parents complained about severe open mouth snoring, agitated sleep and hyperpnoea. No complaints of apnea were reported. Tonsillar grades of all cases were of Ill or N. The preoperative mean pulmonary arterial pressure levels of the 4[7.3%] children were higher than normal range [25mmhg] and it significantly decreased after operation [P<0.0001 Npar test] [Preoperative MPAP = 32 +/- 3 mmHg, and six months postoperative follow up, MPAP=11 +/- 5 mmHg]. The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation [p 0.0001 preoperative TR=34 +/- 8 mmHg postoperative TR=19 +/- 6mmhg] Acceleration time /Ejection time [AC/ET] in these 7patient were lower than 0.4. This study showed that chronic symptomatic obstructive hypertrophy of adenotonsillar tissue results in higher tricuspid regurgitation pressure and mean pulmonary arterial pressure, which could be relieved by adenotonsillectomy

Right atrial pressure significance in renal function indices

With attention to association of right atrial pressure to renal venous hypertension, we try to review renal function indices changing due to congenital heart disease as base of right atrial pressure and cyanosis condition. Forty five children without preexisting renal disease, diagnosed as pulmonary hypertension due to congenital heart disease with or without cyanosis entered to this study their renal function indices besides to their right atrial pressure measured by angiographic documents .The effects of right atrial pressure and cyanosis on renal function indices evaluated by appropriate statistical methods. Right atrial pressure is not a common problem but it is more frequent in cyanotic than acyanotic patients. In addition significant proteinuria occurs in cyanotic patients with high right atrial pressure [above 5 mmHg]. There is not any difference between renal function as glomerular filtration rate or creatinine in either groups of cyantic or acyanotic with a high or normal right atrial pressure. In cyanotic congenital heart disease patients who have pulmonary hypertension measuring of right atrial pressure seems essential; in high risk group including those with high right atrial pressure and cyanosis, significant proteinuria may happen in up to 30% of cases independent of age or gender

Microdeletion study in children with selective congenital heart disease; an Iranian multicenter study

Determining the frequency of chromosome 22q11.2 microdeletion in children with congenital cardiac conotruncal abnormalities using Fluorescence in-situ Hybridization [FISH] technique and estimating relation between DiGeorge Syndrome and cardiac conotruncal abnormalities. One-hundred and eighty cases [106 Males, 74 Females] with selective congenital heart disease [conotruncal abnormalities] referred to the hospitals affiliated to Tehran University during 2004-2007 were evaluated by pediatric cardiologists. All patients were assessed for chromosome 22q11.2 microdeletion using FISH technique. Consequently, patients with 22q microdeletion were studied for T cell abnormalities. Median age of the patients at the time of study was 18 months [3d-16y]. The microdeletion of chromosome 22q11.2 was detected in 17 [9.5%] patients with conotruncal abnormalities, including 5 [29.4%] Tetralogy of Fallot plus Supravalvular Pulmonary Stenosis, 4 [23%] Truncus Arteriosus, 5 [29.4%] Pulmonary Artesia with Ventricular Septal Defect, 2 [11.8%] CO AO+Intrrupted Aortic Arch and one case of Valvular Pulmonary Stenosis. Five of uncorrelated cases had crananiofacial dysmorphism. Chromosome 22q11.2 microdeletion FISH study should be considered in patients with cardiac lesions particularly conotruncal abnormality with or without syndromic problems [craniofacial dysmorphism and developmental delay] to provide an appropriate genetic counseling with more accurate estimation of recurrence risk and ultimately prenatal diagnosis in affected families

Association of proteinurai in children with acyanotic congenital heart disease and pulmonary hypertension in a Tertiary University Hospital in Northwest Iran

This study was performed to detect the severity of proteinuria in children with cyanotic pulmonaryhypertension. Twenty children suffering from pulmonary hypertension due to acyanotic heart disease evaluated for proteinuria. They were divided into two groups of equal less than two amd more than two years old, because of the difference in proteinuria ratio in these two groups. Association of proteinuria with age, hematocrit, mean pulmonary arterial pressure and tricuspid regurgitation were evaluated. Although there was not any case of proteinuria in nephrotic range but significant roteinuria was observed in 2 out of 11 children aged below 2 years of age, and 3 out of 9 in children above 2 years old. However there was no relationship between ages, mean pulmonary. Arterial pressure, hemoglobin, hematocrit, tricuspid regurgitation and proteinuria. There was not any relationship between proteinuria and the severity of pulmonary artery pressure, tricuspid 1-egurgitation, age and hematocrit in this group of children Significant proteinuria in children with acyanotic congential heart disease was present in 25% of cases [5 out of 20]. Nephrotic syndrome is uncommon in children with acyanotic pulmonary hypertension congenital heart disease

Recurrent acute kidney failure due to mcardle disease

We present an adolescent with McArdle disease and recurrent acute kidney failure due to rhabdomyolysis. The patient was admitted with acute kidney failure for 3 times and due to a history of proximal weakness, fatigue, and muscular cramps after physical activities a glycogen-storage disease was suspected. Serum creatine phosphokinase and urine myoglobin were found to be elevated. McArdle disease was diagnosed based on pathologic examination of muscle tissue specimen. Patients presenting with rhabdomyolysis following strenuous exercise should be evaluated for McArdle disease

Fucosidosis and anesthesia

storage disorder caused by a severe deficiency of a-L-facosida.se. Patients usually have some problems with glycoprotein storage in the brain and other organs, and some structural abnormalities that need special consideration in anesthesia. It has 2 types, the early onset or infantile, and the juvenile. Here we present an 8-year old girl with deformities in the maxillofacial region, with big tongue, small and retracted chin, saddle nose, and short neck that could not be extended, causing difficult intubation, and congenital cardiac problems requiring a special anesthetic strategy

evaluation of the possible effect of positive end expiratory pressure [PEEP] on pharmacokinetics of phenytoin in patients with acute brain injury under mechanical ventilation

Positive ventilation has shown to have an influence on pharmacokinetic and disposition of some drugs.Beacause phenytoin with a narrow therapautic range, is the most commonly used drug for prophylaxis and treatment of early seizures after acute brain injuries, in the present study the effect of short term PEEP [5-10 cm H2O for at least 8 hours] on phenytoin serum concentration and pharmacokinetic parameters such as Vmax and clearance in brain injured patients under mechanical ventilation was examined. Ten patients with moderate to severe acute brain injury who were placed on mechanical ventilation with an initial PEEP level of 0-5 cm H2O were included in the study. Patients received phenytoin loading dose of 15 mg/kg followed by a maintenance daily dose of 3-7 mg/kg initiated within 12 hours of loading dose. Sampels were taken on two different occasions before and after PEEP elevation. Total phenytoin serum concentrations were determined by HPLC method. A time invarient Michaelis-Menten pharmacokinetic model was used to calculate Vmax and clearance for each patient.Derrived variables were calculated as follows: Vmax, 3.5-6.8 and 3.7-8.2 mg/kg/day; Clearance, 0.1-0.7 and 0.1-1.2 l/kg/day [before and after PEEP elevation, respectively]. Our data have shown a wide range of variability [2.6-32.5 mg/l] in phenytoin serum concentrations. There were no statistically significant differences in the measured total concentrations [p=0.721] and calculated Vmax and clearance [p=0.285]before and after PEEP elevation. Administration of fluid and inotropic agents, limitation in application of higher levels of PEEP and drug interactions, shall be considered as possible explanations for these findings