A Hardware-Software System for Accurate Segmentation of Phonocardiogram Signal.

Background: Phonocardiogram (PCG) signal provides valuable information for diagnosing heart diseases. However, its applications in quantitative analyses of heart function are limited because the interpretation of this signal is difficult. A key step in quantitative PCG is the identification of the first and second sounds (S1 and S2) in this signal. Objective: This study aims to develop a hardware-software system for synchronized acquisition of two signals electrocardiogram (ECG) and PCG and to segment the recorded PCG signal via the information provided in the acquired ECG signal. Material and Methods: In this analytical study, we developed a hardware-software system for real-time identification of the first and second heart sounds in the PCG signal. A portable device to capture synchronized ECG and PCG signals was developed. Wavelet de-noising technique was used to remove noise from the signal. Finally, by fusing the information provided by the ECG signal (R-peaks and T-end) into a hidden Markov model (HMM), the first and second heart sounds were identified in the PCG signal. Results: ECG and PCG signals from 15 healthy adults were acquired and analyzed using the developed system. The average accuracy of the system in correctly detecting the heart sounds was 95.6% for S1 and 93.4% for S2. Conclusion: The presented system is cost-effective, user-friendly, and accurate in identifying S1 and S2 in PCG signals. Therefore, it might be effective in quantitative PCG and diagnosing heart diseases.

Artificial Intelligence Functionalities During the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led us to use virtual solutions and emerging technologies such as artificial intelligence (AI). Recent studies have clearly demonstrated the role of AI in health care and medical practice; however, a comprehensive review can identify potential yet not fulfilled functionalities of such technologies in pandemics. Therefore, this scoping review study aims at assessing AI functionalities in the COVID-19 pandemic in 2022. METHODS: A systematic search was carried out in PubMed, Cochran Library, Scopus, Science Direct, ProQuest, and Web of Science from 2019 to May 9, 2022. Researchers selected the articles according to the search keywords. Finally, the articles mentioning the functionalities of AI in the COVID-19 pandemic were evaluated. Two investigators performed this process. RESULTS: Initial search resulted in 9123 articles. After reviewing the title, abstract, and full text of these articles, and applying the inclusion and exclusion criteria, 4 articles were selectd for the final analysis. All 4 were cross-sectional studies. Two studies (50%) were performed in the United States, 1 (25%) in Israel, and 1 (25%) in Saudi Arabia. They covered the functionalities of AI in the prediction, detection, and diagnosis of COVID-19. CONCLUSIONS: To the extent of the researchers' knowledge, this study is the first scoping review that assesses the AI functionalities in the COVID-19 pandemic. Health-care organizations need decision support technologies and evidence-based apparatuses that can perceive, think, and reason not dissimilar to human beings. Potential functionalities of such technologies can be used to predict mortality, detect, screen, and trace current and former patients, analyze health data, prioritize high-risk patients, and better allocate hospital resources in pandemics, and generally in health-care settings.

Can anthropometric indices predict the chance of hypertension? A multicentre cross-sectional study in Iran.

OBJECTIVES: This study aims to assess the prevalence of hypertension (HTN), and determine the relationship between HTN and anthropometric indices including fat distribution, body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) in Shiraz Heart Study. SETTING: In this cross-sectional study, subjects were enrolled in 25 clinics in Shiraz. I.R. Iran between 2019 and 2021. PARTICIPANTS: A total number of 7225 individuals were selected, aged between 40 and 70 years of whom 52.3% were female. Among the people living in Shiraz, individuals living far from clinics, cases of mental or physical disabilitiy and documented cardiovascular diseases were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome: The association of body composition, WHR, WHtR and BMI with HTN. SECONDARY OUTCOME: The sensitivity and specificity of the WHtR for the prediction of HTN. RESULTS: HTN prevalence was 19.3%. Obesity prevalence was estimated to be 28.5%. WHR and lean body mass showed a significant association with HTN (p<0.05). Receiver operating characteristic for WHtR yielded an area under the curve of 0.62 (95% CI 0.61 to 0.64) and 0.63 (95% CI 0.62 to 0.65) for males and females, respectively. The optimal threshold value yielded 0.54 in men and 0.61 in women. The sensitivity was 72.3% and 73.9% in women and men, with specificity of 48.4% and 44.3%, respectively. CONCLUSION: HTN had a meaningful association with all the noted anthropometric indices. WHtR performed well as a predictor of HTN.

Antispasmodic effect of hydroalcoholic extract of Thymus vulgaris on the guinea-pig ileum.

The effects of Thymus vulgaris hydroalcoholic extract on the contractile responses of the isolated guinea-pig ileum were investigated. Contraction changes in the terminal ileum of guinea pigs were monitored using a force displacement transducer amplifier connected to a physiograph. Thymus vulgaris extract inhibited the contractile responses in a dose-dependent manner and also decreased the amplitude of peristaltic waves. It is concluded that T. vulgaris has an antispasmodic action on guinea pig ileum by decreasing the amplitudes of the muscle contractions during peristalsis. The EC50 was calculated as 1.7 mg mL(-1). In guinea-pig ileum the extract led to an antispasmodic effect, possibly by affecting the anticholinergic and serotoninergic pathways.

Opium addiction as a new risk factor of sphincter of Oddi dysfunction.

BACKGROUND: Sphincter of Oddi dysfunction (SOD) refers to an abnormality of SO contractility. It is a benign, non-calculus obstruction to the flow of bile or pancreatic juice through the pancreaticobiliary junction. Although morphine can cause an excitatory effect on SO motility, there are no comprehensive data about opium as a risk factor in inducing SOD in chronic opium abusers. The aim of the study was to assess potential risk factors, especially opium addiction (OA), in patients with SOD. MATERIAL/METHODS: In a case-control study, opium addiction, cigarette smoking, cholecystectomy, and periampullary diverticulum in patients with SOD were recorded and compared with healthy subjects. SOD was diagnosed by the Geenen-Hogan classification (type I). RESULTS: OA (p=0.001) and cholecystectomy (p<0.001) were two independent risk factors in patients with SOD. CONCLUSIONS: Chronic use of opiates by the oral or inhalational route may induce SOD, but whether chronic use of other morphine derivatives or i.v. drug abuse induce this disorder is not clear and needs further evaluation.

Role of clinical presentation in diagnosing reflux-related non-cardiac chest pain.

INTRODUCTION: Non-cardiac chest pain (NCCP) presents as a frequent diagnostic challenge, with patients tending to use a disproportionate level of health-care resources. Gastroesophageal reflux disease (GERD) is the most frequent cause of NCCP. Thus the typical symptoms of reflux, such as heartburn and regurgitation, when present as predominant symptoms are quite specific for diagnosing GERD but in patients with NCCP the clinical diagnosis of reflux is difficult, and invasive methods or the omeprazole test are required for its detection. The aim of the present study was to evaluate the role of clinical presentation when diagnosing GERD among patients with NCCP. METHODS: Patients with NCCP underwent upper endoscopy, Bernstein and omeprazole tests. The patients were divided into two groups based on GER- or non-GER-related chest pain, and clinical presentation was compared between these two groups. Gastroesophageal reflux disease was considered positive when at least two methods were positive. RESULTS: From 78 NCCP patients (41 male; mean age 50.4 +/- 2.3 years), the chest pain was related to GERD in 35 patients (44.8%). The two groups were the same based on sex and age. The chest pain severity, site, radiation and relation to food, exercise, and sleep were equal in the two groups, except for two symptoms: pain that was relieved by antacid (P < 0.031) and presence of classical reflux symptoms (P < 0.009), seen in the GERD patients. With regard to recent patient history, heartburn and regurgitation symptoms were seen more frequently in GERD patients (P < 0.036 and P < 0.002, respectively). DISCUSSION: Clinical presentation is important in diagnosing GERD in NCCP. Although the chest pain is the same in reflux- and non-reflux-related NCCP, the symptoms of heartburn or regurgitation in the present or recent patient history are diagnostic for GERD-related chest pain.

Antimotility effect of hydroalcoholic extract of yarrow (Achillea millefolium) on the guinea-pig ileum.

The use of medicinal herbs among the general population gives rise to the possibility of therapeutic or toxic effects in patients that use these plants. The effects of Achillea millefolium hydroalcoholic extract on the contractile responses of the isolated guinea-pig ileum were investigated. The effect of the Achillea millefolium extracts at five concentrations ranging form 0.05 to 5 mg mL(-1) was tested. The terminal ileum was removed. Segments were fixed in an organ bath containing in Tyrode solution. Contraction changes in the tissues were monitored using force displacement transducer amplifier connected to physiograph. Each segment served as its own control. Achillea millefolium inhibited the contractile response in a dose-dependent manner. The 50% effective concentration values (EC50) were calculated, which was 1.5 mg mL(-1). Regression analysis had shown that with increasing in extract concentration the effect of extract was increased. The coefficient of extract dose was 0.031 mg. Present results demonstrate that extract prepared from the plant of Achillea millefolium inhibited electrical induced contractions of the guinea-pig ileum when tested in vitro. This effect is dose dependent and reversible.

Azithromycin in one week quadruple therapy for H pylori eradication in Iran.

AIM: To investigate eradication rates, patient compliance and tolerability of a 1-wk Azithromycin-based quadruple therapy versus the 2-wk conventional therapy. METHODS: A total of 129 H pylori-positive patients were randomized to either omeprazole 20 mg, bismuth subcitrate 240 mg, azithromycin 250 mg, and metronidazole 500 mg, all twice daily for 1-wk (B-OAzM) or omeprazole 20 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, and metronidazole 500 mg all twice daily for 2-wk (B-OAM). H pylori infection was defined at entry by histology and rapid urease test and cure of infection was determined by negative urea breath test. RESULTS: H pylori eradication rates produced by B-OAzM and B-OAM were 74.1% and 70.4% respectively based on an intention to treat analysis, and 78.1% versus 75.7% respectively based on a per-protocol analysis. The incidence of poor compliance was lower, although not significantly so, in patients randomized to B-OAzM than for B-OAM (3.5% versus 4.3%) but intolerability was similar in the two groups ( 35% versus 33.3%). CONCLUSION: 1-wk azithromycin based quadruple regimen achieves an H pylori eradication rate comparable to that of standard 2-wk quadruple therapy, and is associated with comparable patient compliance and complications.

Cancer occurrence in old age: Results of a population-based cancer registry in Semnan, Iran.

INTRODUCTION: The proportion of elderly persons has increased in most countries during the last few decades, and will increase further in the coming years. A population-based study was here carried out to clarify the site-specific cancer-incidence rates in old age in Iran. AIMS AND METHODS: A comprehensive search was undertaken to survey and register all new cancer cases during a 5-year (1998-2002) period among the indigenous population of Semnan Province aged 65 years or over. Diagnosis of cancer was based on histopathology, clinical or radiological findings, and death certificates. RESULTS: A total of 791 patients were registered with cancers. Of these, 492 (62.1%) were males. Crude rates were 1,310 and 962 per 100,000 persons per year for males and females respectively, and age-standardized ratios (ASRs) were 1350 and 973. Gastric cancer was the most common tumor with incidence rates of 340 and 153 per 100,000 persons per year for elderly males and females respectively. In women breast cancer was the second most common cancer (ASR= 108). In men prostate cancer was the second most common cancer with ASR= 150. CONCLUSIONS: Based on the present standardized rates, cancer is almost 9 times and 7 times more frequent among the elderly compared with younger men and women (30-64). The highest incidence of cancers was in group 75-79 years in both sex and then decrease was noted with increasing age.

Prospective evaluation of a new "paper urease test" for ultra-rapid detection of Helicobacter pylori.

BACKGROUND: The purpose of this study was to determine the sensitivity, specificity, and positive and negative predictive values of a newly developed paper urease test (PUT) for ultra-rapid detection of helicobacter pylori (HP) in gastric mucosa. MATERIAL/METHODS: 100 patients (43 men) with a mean age of 57+/-6.8 years participated. Patients presenting for upper endoscopy with no recent exposure to HP-altering drugs were enrolled. Gastric biopsy specimens were tested by the PUT and histology methods, and then the patients underwent [13C] urea breath tests (UBT). HP was considered positive when either UBT or histology demonstrated it, and negative if HP was not detected in either UBT or histology. The PUT was reported at 15 minutes. RESULTS: 87 of 100 patients tested positive for HP. The PUT correctly identified 74 of 87 HP-positive and 13 of 13 HP-negative patients, yielding sensitivity, specificity, and positive and negative predictive values of 87%, 100%, 100% and 53.5%, respectively, in this population. CONCLUSIONS: Rapidly available and reliable results from the PUT can facilitate clinical decision prior to patient discharge from the endoscopy suite. We recommend PUT for screening of HP in endoscopy candidates, due to high specificity, rapid reaction, simplicity and low cost. A positive result shows a definite diagnosis, although a negative result needs further diagnostic methods.

Cancer occurrence in Semnan Province, Iran: results of a population-based cancer registry.

INTRODUCTION: suitable information of different cancers in special geographic areas can help define medical programs for treatment and screening of high-risk groups. AIMS AND METHODS: The provincial health authority reported a high mortality rate from upper GI cancer in the center of Iran. A comprehensive search was undertaken to survey and register all cases of cancer during a 5-year (1998-2002) period among the indigenous population of Semnan Province. Diagnosis of cancer was based on histopathology, clinical or radiological findings, and death certificates. RESULTS: A total of 1732 patients with cancers (mean age 59.41% +/-19.08% years) were found during the study. Of these, 936(54.86%) were in males. Crude rates were 124.8/100,000 and 112.1/100,000 for males and females, respectively. Age-standardized ratios (ASRs) for all cancers in males and females were 156/100,000 and 136/100,000 person-year, respectively. Gastric cancer was the most common tumor with an incidence rate of 19.7 per 100,000 people (ASR=27.5). In upper gastrointestinal cancers, gastric cancer was the most common (47.17%), followed by colon malignancies (8.1%, 9.5 per 100,000 populations), esophagus (6.8%, 7.9 per 100,000 populations), liver (2.4%, and 2.8 per 100,000 populations). In women, breast, uterine and ovary, stomach and skin were the most common cancers. In the child population the most common tumors were of the brain, acute lymphocytic leukemia, and bone. CONCLUSION: Gastric cancer alone constitutes one-sixth of all cancers in Semnan, with the highest ASR incidence rate reported from Iran up to now.

Role of overnight rifampin test in diagnosing Gilbert's syndrome.

BACKGROUND: Gilbert's syndrome (GS) is the most common inherited disorder of bilirubin metabolism. Recent data show that the rifampin test can be used as a diagnostic test but there is controversy about its effect on bilirubin level in normal individuals. We studied the effect of administration of rifampin on serum bilirubin level in patients with GS and in healthy individuals. METHODS: Serum total and unconjugated bilirubin levels were measured in 16 patients with GS and 15 healthy individuals before and after a single 600-mg oral dose of rifampin. RESULTS: In patients with GS, mean (SD) serum total and unconjugated bilirubin level increased from 2.15 (0.49) and 1.56 (0.41) mg/dL, respectively to 3.23 (0.72) (p< 0.001) and 2.52 (0.71) mg/dL (p< 0.001), respectively after rifampin administration, and in healthy subjects from 0.69 (0.13) and 0.34 (0.09) mg/dL, respectively to 1.68 (0.56) (p< 0.001) and 0.84 (0.23) mg/dL (p< 0.001), respectively. Elevation of these levels above the normal cut-off levels had poor accuracy for the diagnosis of GS. However, elevation of total serum bilirubin after rifampin above 2.4 mg/dL was 93.8% sensitive and 93.3% specific for the diagnosis of GS, and elevation of unconjugated bilirubin above 1.3 mg/dL was 100% sensitive and 100% specific. CONCLUSIONS: Rifampin elevates bilirubin level to above normal in GS and healthy subjects. Overnight rifampin test may be useful for the diagnosis of GS if cut-off levels for serum total and unconjugated bilirubin level of more than 2.4 and 1.3 mg/dL are used.