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Cardiovascular disorders are significantly associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Herein, we describe a case of myopericarditis and subsequent transient constrictive pericarditis after coronavirus disease 2019 (COVID-19). Three weeks following a mild SARS-CoV-2 illness, a 53-year-old woman was referred to the hospital with acute pleuritic chest pain, which was not attributable to any known cause and was only temporarily relieved. The pain persisted for the next few weeks until her second COVID-19 infection, which occurred 5 months after her first affliction. This time, Transthoracic echocardiography (TTE) revealed mild pericardial effusion, and cardiac magnetic resonance imaging (CMR) confirmed myopericarditis, leading to the administration of anti-inflammatory therapy for the patient. Despite a relative resolution of symptoms, her second CMR performed 8 months later revealed active perimyocarditis with transient constrictive pericarditis (CP). Additionally, fluorescent antinuclear antibody (FANA) and antimitochondrial Ab M2 (AMA) were tested positive for the first time. Thereafter, the patient was started on concurrent anti-inflammatory and immunosuppressant therapies, which were effective after 3 months. The transient CP was resolved, and there was no sign of active pericarditis on her last echocardiography. Acute pericarditis and its subsequent constrictive pericarditis are infrequent adverse outcomes of COVID-19. The unique feature of this case is the uncertainty regarding the underlying reason for cardiac complications, whether it is the first presentation of systemic lupus erythematosus (SLE) or viral-induced myopericarditis followed by a consequent transient CP.
RESUMO
Adjusting the exact warfarin dose has always been challenging since it has a narrow therapeutic window. Numerous factors, including poor drug compliance, drug-drug interactions, and malabsorption syndromes, affect the warfarin plasma concentration, leading to oversensitivity or resistance to warfarin. Patients who need more than 15 mg/d of warfarin for maintained anticoagulant effects are considered warfarin resistant. We describe a 62-year-old man referred to our center with bruising on his feet in June 2021. The patient had a history of valve replacement (mechanical prosthetic valves in 2013), hypothyroidism, and atrial fibrillation. He presented with warfarin resistance (first noticed in 2013) and did not reach the desired warfarin therapeutic effect despite receiving 60 mg of warfarin daily. Upon admission, the patient was on warfarin (100 mg/d) with an international normalized ratio (INR) of 1.5. He underwent laboratory and molecular genetic tests, which showed no mutation in the CYP2C9 and VKORC1, the genes associated with warfarin resistance. A stepwise diagnosis is required to identify the underlying cause. Assessing the patient's compliance, drug history, dietary habits, malabsorption diseases, and genetics may be necessary. We evaluated these possible reasons for resistance and found no correlation. The patient's warfarin intake was monitored closely to reach the INR therapeutic target of 3-3.5. He decided to leave the hospital with personal consent. He was discharged with a cardiologist referral and 24 warfarin tablets daily (120 mg/d) with an INR of 1.8. The patient was followed up 6 months and 2 years after discharge and was on the same daily dose of warfarin as at discharge, with no complications.
RESUMO
Background: Although physical activity (PA) is essential, it is difficult to motivate people to take part in PA, especially the ones with high blood pressure (hypertension). One of the most commonly applied theoretical frameworks to change health behaviours is the Trans-Theoretical Model (TTM). The aim of this study was to examine the effectiveness of tailored, interactive multimedia software based on TTM for the promotion of PA behaviours among Iranian adults. Methods: This interventional study selected 120 healthy individuals aged 30 years old-50 years old from health centres in Delijan, Iran using multi-stage sampling. The participants were in the pre-contemplation and contemplation stages of PA behaviour. For the intervention, an active multimedia training (active life) based on TTM, like six training sessions of approximately 30 min (once a week) plus aerobic exercise videos were designed and provided to the intervention group. Data was collected using a valid and reliable questionnaire before and 6 months after the intervention and analysed using statistical tests. Results: The mean age of the participants was 38.20 (SD = 7.11) years old. Six months after the intervention, 61.7% of the individuals in the intervention group and 3.3% in the control group progressed to the action stage, which was significant only in the intervention group (P < 0.001). There was a significant increase in PA in both groups, yet this increase was significantly higher in the intervention group (36.02 [SD = 31.22] to 146.16 [SD = 90.43]; P < 0.001) compared to the control group (33.41 [SD = 28.33] to 54.41 [SD = 44.02; P < 0.001). Conclusion: The results obtained indicated that the implementation of educational intervention using multimedia designed based on TTM could be used as one of the effective strategies to promote PA to prevent hypertension in adults.
RESUMO
BACKGROUND: Clinical measurement of quality of life (QoL) for assessing reproductive problems should be considered as a standard investigation at the initial and continuing medical consultations with infertile people. OBJECTIVE: The purpose of this study was comprehensive testing the psychometric properties of the Iranian version of fertility quality of life (FertiQoL). MATERIALS AND METHODS: This cross-sectional study was conducted on300 women referred to infertility clinic. After linguistic validation, a semi-structured interview was conducted to assess face validity. Consequently exploratory factor analysis was performed to indicate the scale constructs. Discriminate validity was assessed using the known groups comparison. Convergent validity was evaluated by assessing the correlation between similar content on the 12-Item Short Form Health Survey (SF12), Hospital Anxiety and Depression Scale and FertiQol. In addition, reliability analysis was carried out with internal consistency. RESULTS: The reliability of the Iranian version of the FertiQoL was satisfactory in all dimensions (0.77-0.83). Six factors (emotional, mind/body, relational, social, environmental, and tolerability) were extracted from the results of exploratory factor analysis. Discrimination validity showed that FertiQoL can differentiate between female patients with differing duration of infertility and number of children. Moreover, the results of convergent validity showed a favorable correlation between the related dimensions of SF12 (0.43-0.68), Hospital Anxiety and Depression Scale (0.47-0.52) and FertiQoL. CONCLUSION: The Iranian version of FertiQoL is valid and reliable for assessing infertility problems and the effects of treatment on QoL of infertile patients referred for diagnosis and treatment at infertility clinic.
