The circulating level of interleukins 6 and 18 in ischemic and idiopathic dilated cardiomyopathy.

Introduction: By aging population, the heart failure and its life-threatening complications have become an enormous issue in public health. Regarding the inflammation as a major contributing pathological factor, the determination of most important inflammatory targets for immunomodulation is a problematic puzzle in the treatment of heart failure patients and the inflammatory pathways primarily involved in different underlying conditions contributing to heart failure can be an area which is worthy of focused research. Considering the dilated cardiomyopathy (DCM) as a relatively high-incident disease leading to heart failure, the aim of this study is to determine the difference in the expression level of interleukin (IL)-6 and IL-18 in patients with ischemic and idiopathic DCM. Methods: 39 non-diabetic patients with ischemic and 37 ones with idiopathic DCM were enrolled in the study. 48 healthy individuals were also considered as control group. For quantitative determination of the mRNA expression level of IL-6 and IL-18 genes, an in-house- SYBR Green real-time PCR was used and Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) was considered as internal control gene. The left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) was calculated by 2D echocardiographic assessment. Data were finally analyzed via SPSS statistical software version 19.0 using independent t test and 2-∆∆Ct method and P<0.05 were considered statistically significant. Results: The IL-6 was significantly higher expressed in patients with ischemic and idiopathic DCM than in healthy controls (274.3 and 168.8 times, respectively, both P values <0.001). The same higher expression of IL-18 was observed in ischemic DCM (48.5 times) and idiopathic DCM (45.2 times) compared with healthy individuals (both P values <0.001). Conclusion: Both ischemic and idiopathic DCM associates with IL-6 and IL-18 overexpression. However, no significant difference was observed between these two subtypes of DCM in either interleukin expression level. There is certainly need to further studies for evaluating the uniformity of results and also assessing other molecules in determining their roles in pathophysiology and probable utility for management.

Assessment of Subclinical Myocardial Changes in Non-Alcoholic Fatty Liver Disease: A Case-Control Study Using Speckle Tracking Echocardiography.

BACKGROUND: Considering the association between cardiac abnormalities and non-alcoholic fatty liver disease (NAFLD), the present study aimed to evaluate the relationship between biopsy-proven NAFLD and functional echocardiographic parameters, including left ventricular (LV) global longitudinal strain (GLS) in asymptomatic individuals. METHODS: Thirty asymptomatic patients with liver biopsy-proven NAFLD and the same number with no evidence of fatty liver in ultrasonography were enrolled in the study as cases and controls, respectively. The measured echocardiographic parameters included LV ejection fraction (LVEF), LV end-systolic and end-diastolic dimensions (ESD, EDD), LV end-systolic and end-diastolic volumes (ESV, EDV), E/e' ratio (early-diastolic mitral inflow velocity/early-diastolic myocardial velocity), E/A ratio (early-diastolic mitral inflow velocity/late-diastolic mitral inflow velocity), and GLS. Data were analyzed using the SPSS statistical software (version 18.0) by performing the independent t test, Chi-square, and non-parametric Mann-Whitney U tests. P values <0.05 were considered statistically significant. RESULTS: A significant difference in ESD (32.1±1.4 mm vs. 34±1.8 mm), EDD (41.9±1.7 mm vs. 45.2±3.1 mm), and E/e' ratio (8.4±0.8 vs. 7.4±1.2) was detected among individuals with NAFLD compared with those without NAFLD (P<0.001 for the first two parameters and P=0.002 for the last one). GLS was also significantly lower in NAFLD patients than in controls, but within normal levels (19.3%±2.0 vs. 21.2%±1.4, P<0.001). CONCLUSION: The findings support the presence of subclinical cardiovascular structural and functional changes in patients affected by NAFLD. It also indicates that the use of GLS is more sensitive than LVEF for the detection of LV systolic dysfunction in NAFLD patients.

Subclinical left ventricular systolic dysfunction in patients with metabolic syndrome: A case-control study using two-dimensional speckle tracking echocardiography.

BACKGROUND: The dramatic increase in the prevalence of metabolic syndrome is associated with more increased cardiovascular morbidity and mortality in this group. Some recent studies suggested that metabolic syndrome is associated with increased risk of subclinical left ventricular (LV) systolic dysfunction. In the present cross-sectional case-control study, the utility of two-dimensional speckle tracking echocardiography (STE) was examined to detect early LV systolic dysfunction in this population. METHODS: A total of 75 clinically asymptomatic subjects with left ventricular ejection fraction (LVEF) ≥ 55%, 39 without metabolic syndrome and 36 with metabolic syndrome, matched for gender and age, were enrolled in this case-control study. Metabolic syndrome was diagnosed using the National Cholesterol Education Program/Adult Treatment Panel III criteria. LV systolic function was assessed by STE-derived global and segmental longitudinal strain (εLL). RESULTS: Global εLL was significantly lower in patients with metabolic syndrome compared with normal population (-18.41 ± 2.20% vs. -21.2 ± 2.1%, P < 0.001). Segmental εLL was significantly lower in patients with metabolic syndrome in comparison to control group except for basal anteroseptal (-19.95 ± 2.90% vs. -21.15 ± 3.30%, P = 0.106), basal anterolateral (-17.5 ± 5.0% vs. -18.3 ± 4.1%, P = 0.437), and basal inferolateral segments (-18.1 ± 6.3% vs. -18.9 ± 4.1%, P = 0.526). CONCLUSION: STE-derived longitudinal LV strain (εLL), a marker of subclinical cardiovascular disease, is impaired in asymptomatic individuals with metabolic syndrome and normal LVEF.

Botulinum Toxin Injection for Treatment of Acute Traumatic Superior Oblique Muscle Palsy.

PURPOSE: To evaluate the outcomes of botulinum toxin injection into the inferior oblique (IO) muscle for management of unilateral acute traumatic superior oblique (SO) palsy. METHODS: In this prospective case series, 10-20 units of botulinum toxin A (Dysport, Ipsen, Biopharm Ltd., Wrexham, UK) was injected into the ipsilateral IO muscle of 13 consecutive patients with unilateral acute traumatic SO palsy. All patients received injections within four weeks of the incident. RESULTS: Mean age was 29 ± 15 years and 12 (92%) subjects were male. Mean amount of hypertropia (in primary position) was decreased from 10.0 ± 3.9(Δ) at baseline to 4.6 ± 8.9(Δ), one month after the injection, and to 1.5 ± 2.7(Δ) at final follow-up (P = 0.001). IO overaction improved from 2.7 ± 0.6 to 1.0 ± 1.2 and 0.6 ± 0.9 (P ≤ 0.001), and subjective torsion from 5.3 ± 3.9 to 3.2 ± 3.4 and 1.6 ± 2.5 degrees (P ≤ 0.001), at the same time intervals respectively. One month after the injection as well as at final follow-up, 10 (77%) patients were diplopia-free in primary and reading positions. Subgroup analysis showed that patients who recovered had less baseline hypertropia as compared to those who failed (8.3(Δ) vs. 15.7(Δ), respectively; P = 0.01). All patients with a favorable outcome had baseline hypertropia of 10(Δ) or less. CONCLUSION: A single injection of BTA into the IO muscle can rapidly and safely resolve symptomatic diplopia in patients with acute traumatic SO palsy, while waiting for spontaneous recovery.

A new brace for maintaining the neck in a suitable position following tracheal reconstruction.

Segmental resection and end-to-end anastomosis is the treatment of choice for patients suffering from tracheal stenosis for whom conservative management is not planned. A complication of this procedure is tension-induced anastomotic failure. To prevent this complication, maintaining the neck in full flexion by means of a suture between the chin and upper chest is a traditional approach. We have designed a new brace (Shiraz brace) that securely supports the neck in this position and decreases the bothersome use of the suture alone.

Initial Presentation of HIV Infection With Two Successive Acute Arterial Thromboses: A Case Report.

INTRODUCTION: One of the complications of HIV infection is greater risk of thromboembolic events. A variety of mechanisms has been found to be responsible for prothrombotic tendency in patients with HIV infection. CASE PRESENTATION: A 27-year-old heterosexual smoker man was referred to our center due to a sudden-onset severe left lower extremity pain and claudication since three days prior to admission. In physical examination, end extremity coldness and discoloration as well as left lower extremity pulselessness were found. Color-Doppler sonography revealed a large thrombus in the left common iliac artery and two thrombi in the distal halves of both anterior and posterior tibialis arteries, so the patient was transferred to the operating room for proximal thrombectomy where the blood flow was reestablished and all pulses were then detectable. Two days later, the patient developed another similar episode from knee down and underwent the second thrombectomy. In evaluation, HIV Ab had positive result by ELISA. CONCLUSIONS: This case inspires consideration of HIV infection as a leading cause of thromboembolic event in individuals affected by the first episode of unprovoked one in whom diagnosis of HIV infection has not been established yet.

A Late-onset Psoas Abscess Formation Associated with Previous Appendectomy: A Case Report.

Psoas abscesses could originate from an adjacent source of infection in the abdominopelvic cavity known as a secondary complication of acute appendicitis. However, it is considered as a very rare event when occurring late after the presentation of appendicitis. Whether it is the source or complication of acute appendicitis following appendectomy remains unclear. A 25-year-old man was admitted to our center with fever and abdominal pain. His past medical history was unremarkable except for having an acute appendicitis and complicated appendectomy 4 years before presenting illness. On admission, the patient was febrile with right lower quadrant abdominal tenderness and moderate leukocytosis. The Abdominopelvic CT- scan revealed a large right psoas muscle than the opposite site, that contained a hypodense mass measuring 6 cm in diameter with extension into right iliacus and internal oblique muscles..The patient underwent subsequent percutaneous abscess drainage under image guide and concurrent broad-spectrum antibiotic therapy.

Co-incidence of acute appendicitis and appendiceal transection after blunt abdominal trauma: a case report.

A 13-year-old boy with a history of bicycle handlebar injury to the left side of his abdomen was brought to the Emergency Department of our center. On admission, his vital signs were stable and abdominal examination revealed ecchymosis and tenderness of the injured areas. Mild to moderate free fluid and two small foci of free air in the anterior aspect of the abdomen, in favor of pneumoperitoneum, were detected in abdominopelvic sonography and CT-scan, respectively. In less than 6 hours, the patient developed generalized peritonitis. Therefore, exploratory laparotomy was promptly performed, which revealed appendiceal transection and rupture of the small bowel mesentery. Appendectomy and small bowel mesoplasty were done, with pathological diagnosis of acute appendicitis and periappendicitis. After surgery, the patient had a non-complicated hospital course. This rare case highlights the significance of the early management of appendiceal traumatic injuries in order to prevent further complicated events, especially in patients who are much more exposed to this risk due to their traumatic background.

Antepartum Uterine Rupture Occurring at the Site of a Peviously Repaired Dilatation and Curettage-Induced Perforation: A Case Report.

The uterine rupture during pregnancy is a catastrophic condition resulting in both maternal and perinatal morbidity and mortality. It occurs in nearly 1% of patients with previous cesarean sections. However, uterine rupture at the site of previous iatrogenic perforation which is spontaneously healed or repaired is less reported. We present a 29-year-old woman, gravida 3 para 1, at 20 weeks of gestation with abdominal pain of right half and hemodynamic instability whose laboratory evaluations revealed severe acute blood loss but still without any signs of peritonitis. The exploratory laparotomy revealed a uterine rupture at the site of fundus at the same location of previously repaired dilatation and curettage-induced perforation contributing to extrusion of whole pregnancy product in addition to severe intra-abdominal blood loss.

Asymptomatic Tuberculosis-Induced Ileal Perforation in an HIV- Infected Individual; A Case Report.

The co-existence of acquired immune deficiency syndrome (AIDS) and tuberculosis is a major cause of morbidity and mortality because of a widespread organ involvement. The gastrointestinal tract is a common site for localization of opportunistic microorganisms in AIDS. However, surgical abdominal emergencies such as intestinal perforation resulted from tuberculosis are uncommon in these patients. The asymptomatic occurrence of such intestinal perforation has not been reported our knowledge. We represent an HIV and HCV co-infected man with miliary tuberculosis and an incidentally detected free air under  diaphragm in the chest X-ray eventually resulting in exploratory laparotomy which then revealed two tubercular-induced intestinal perforations. It seems that as the tuberculosis is increasing in incidence, mostly due to reactivation in HIV-infected patients especially in developing countries, we should not underestimate its acute abdominal emergencies such as bowel perforation.