Pedunculated focal nodular hyperplasia of the liver in a healthy child born following in vitro fertilization: a case report and review of the literature

BACKGROUND

Focal nodular hyperplasia is a common nonmalignant liver mass. This nonvascular lesion is an uncommon mass in children, especially those with no predisposing factors, namely radiation, chemotherapy, and hematopoietic stem cell therapy. Exophytic growth of the lesion further than the liver margins is not common and can complicate the diagnosis of the lesion. This report observes a focal nodular hyperplasia as a pedunculated lesion in a healthy child.

CASE PRESENTATION

We describe a 9-year-old healthy Persian child who was born following in vitro fertilization complaining of abdominal pain lasting for months and palpitation. Employing ultrasound and computed tomography, a mass was detected in the right upper quadrant compatible with focal nodular hyperplasia imaging features. The child underwent surgery and the mass was resected.

CONCLUSION

Diagnosing focal nodular hyperplasia, especially pedunculated form can be challenging, although magnetic resonance imaging with scintigraphy is nearly 100% sensitive and specific. Thus, a biopsy may be needed to rule out malignancies in some cases. Deterministic treatment in patients with suspicious mass, remarkable growth of lesion in serial examination, and persistent symptoms, such as pain, is resection, which can be done open or laparoscopic.

The role of diabetic foot treatment in improving left ventricular function: Insights from global longitudinal strain echocardiography

We decided to evaluate the effect of treatment of diabetic foot ulcers in improving heart function by strain echocardiography than conventional transthoracic echocardiography. This prospective cross-sectional study included patients with diabetic foot ulcer (DFU). Conventional and two-dimensional strain echocardiography performed before and after three months diabetic foot treatment. Then, we compared the echocardiographic parameters including left ventricular ejection fraction (LV-EF), left ventricular global longitudinal strain (LV-GLS). Multivariate and univariate logistic regression analysis were performed to find which variable was mainly associated with LV-GLS changes. 62 patients with DFU were conducted. After echocardiography, all patients underwent surgical or non-surgical treatments. Three months after the treatment, LV-EF was not significantly different with its' primary values (P = 0.250), but LV-GLS became significantly different (P<0.05). In the multivariate logistic regression analysis, with the increase in the grade of ulcer, LV-GLS improved by 6.3 times. Not only the treatment of DFU helps to control adverse outcomes like infection, limb loss and morbidity but also it enhances cardiac function. Of note, strain echocardiography found to be a better indicator of myocardial dysfunction than LV-EF. These findings make a strong reason for the routine assessment of cardiac function in patients with DFU.

A case report of QTc prolongation: Drug induced or myocarditis in Severe Acute Respiratory Syndrome Coronavirus 2

Remdesivir is a nucleotide prodrug of an adenosine analog. It binds to the viral Ribonucleic Acid (RNA)-dependent RNA polymerase and inhibits viral replication by terminating RNA transcription prematurely. Remdesivir has demonstrated in vitro and in vivo activity against Severe Acute Respiratory Syndrome Coronavirus 2; it also acts in vitro neutralization activity against the Omicron variant and its subvariants. We reported a 54-years-old woman admitted with Coronavirus disease 2019. Considering to require a high fraction of inspired oxygen therapy (⩾0.6) and based on lung high resolution computed tomography, Remdesivir therapy was ordered for 5 days. She experienced palpitations and dizziness 2 days after starting Remdesivir therapy. Her QTc interval was prolonged on the electrocardiogram without any significant electrolyte abnormalities or concomitant use of medications. Although the cardiac side effects of Remdesivir therapy have been well documented, in a few cases reported the association between Remdesivir therapy and QTc interval prolongation. Since, QTc interval prolongation has the potential risk of sudden cardiac death, the clinicians should be aware of mentioned association and check electrocardiogram daily, as well as other laboratory exams.

Combined tracheoesophageal transection following a life-threatening clothesline-type blunt neck trauma: A case report

INTRODUCTION

Blunt neck trauma is an uncommon, life-threatening injury that may result in tracheoesophageal transection. The manifestations of these traumas are rather vague and nonspecific; therefore, the injury may be missed, if a careful attention is not paid.

CASE PRESENTATION

A 23-year-old young man presented with complete transection of the trachea and concurrent esophageal injury, caused by clothesline-type blunt neck trauma, while riding a motorcycle. On early examination, the patient was hemodynamically stable; however, after a few minutes, he manifested respiratory distress and progressive subcutaneous emphysema. The airway immediately was secured by inserting an endotracheal tube in distal part of the transected trachea. Afterward, the patient underwent primary repair of transected trachea and esophagus, and tracheostomy. The post-operative period was uneventful.

DISCUSSION

The blunt traumas to neck, which lead to complete transection of the trachea and the esophagus, are rare injuries. Clothesline-type injuries are the principal reasons for cricotracheal separation and further esophageal injuries. In most cases, subcutaneous emphysema is a sign of significant trauma to the aerodigestive tract. After securing the patient's airway, early surgical repair of the transected trachea and esophagus reduces the risk of further complications.

CONCLUSION

This report discusses a rare, life-threatening presentation of blunt neck trauma called clothesline-type injury, that led to complete transection of the trachea and concurrent esophageal rupture. Establishing a secure airway for those patients with tracheal injuries is required. Repairing the injured trachea and esophagus primarily at the earliest possible time can improve the patient prognosis and prevent further complications.

High versus low doses of rosuvastatin on postoperative outcomes of coronary artery bypass grafting; a double-blind clinical trial

Introduction: Statins are beneficial treatments for patients with cardiovascular disease; however the relation between dose and clinical outcomes has not been evaluated. Objectives: We compared the effects of high versus low-dose of rosuvastatin on postoperative outcomes in patients undergoing coronary artery bypass graft (CABG). Patients and Methods: In this randomized clinical trial study, patients undergoing open heart surgery were randomly divided into two groups of 76 (received 5 mg dose) and 84 (received 20 mg dose) in Heshmat hospital, in Rasht. The study was started during the hospitalization period and after discharge until one month. Data were obtained by demographic questionnaire, clinical and changes in laboratory tests based on pre- and post-surgery. To analyze the variables, paired sample t test was applied. P value ≤0.05 was taken as significant. Results: The ages of the participants were 58.36±7 and 59.5±9 years for the treatment with high and low dosages of rosuvastatin (20 mg and 5 mg) respectively (P = 0.28). AKI (acute kidney injury) as a primary outcome was not significantly different between the two groups (P>0.05). Secondary outcomes (changes in lipid profiles, new atrial fibrillation (AF), postoperative infection) were not significantly different between the two groups (P>0.05). However, the increased values of CK-MB were significantly more in high-dose rosuvastatin than in low-dose rosuvastatin treated group (P<0.05). Conclusion: In this study, we compared the effects of high versus low doses of rosuvastatin on postoperative outcomes such as AKI, new AF, infection and myocardial infarction (MI) in CABG surgery. We found rosuvastatin can associate with decreased occurrence of postoperative outcomes of CABG in which no significant differences between high versus low dose of this drug. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT20180113038329N1; https://irct.ir/trial/29938; ethical code# IR.GUMS.REC.1396.368).

Correlation of plasma vitamin D levels with coronary collateral circulation

Introduction: In patients with coronary chronic total occlusion (CTO), adequate coronary collateral circulation (CCC) supports myocardial tissue versus ischemia. Vitamin D deficiency is a risk factor for osteoporosis and other chronic diseases, including type 1 diabetes, hypertension, metabolic syndrome and ischemic heart disease. Objectives: In this study, we evaluated whether coronary CTO is associated with serum levels of vitamin D and CCC. Patients and Methods: Around 216 patients with coronary CTO at coronary angiography were incorporated in this investigation. Serum 25(OH)D level and low-density lipoprotein (LDL-C), triglyceride (TG), total cholesterol, fasting blood sugar (FBS), serum creatinine, high-density lipoprotein (HDL-C), were assessed before angiography. Patients were divided into a poor coronary collateral circulation group (Rentrop grades 0-1) or good coronary collateral circulation group (Rentrop grades 2-3). Results: A total of 216 patients (mean age 61.48±9.5 years) were included in this study. Regression analysis results displayed that serum 25(OH)D level had a significant correlation with CCC according to Rentrop scoring system (P<0.0001). We also found that variables such as gender (P=0.05), HDL-C (P=0.01) and serum creatinine (P=0.05) were a predictor for CCC. This model described 33% of the CCC’s variance in the study patients. Besides, in the analysis of clinical levels of vitamin D, it can be stated that the probability of having a high degree of Rentrop criterion in the patients with adequate level of vitamin D is 24.5 times higher than the patients with vitamin D deficiency (P<0.001). Conclusion: The results of this study emphasize the importance of informing patients with CTO commonly associated with serum vitamin D level.

Investigation of short-term prognosis of fragmented QRS complexes in patients with acute myocardial infarction in two groups that received invasive and fibrinolytic therapy

Background

Studies have shown that the primary causes of death in patients with acute coronary syndrome are arrhythmias and heart failure. The aim of this study is to evaluate the short-term prognosis of fragmented QRS (f-QRS) in patients with acute myocardial infarction (MI).

Methods

This study was a prospective and longitudinal analytic study performed on all patients with acute MI admitted to Rasht Heshmat Hospital Emergency during 2018–2019. Serial Electrocardiography (ECG) was performed in the emergency room after patient admission and was repeated 24 h after percutaneous coronary intervention and fibrinolytic therapy, as well as at the time of patient discharge. Short-term prognosis of f-QRS in patients was evaluated by a cardiologist within admission, 40 days after hospitalization and three months later again.

Results

In this study, 453 patients with MI were evaluated in two treatment methods of fibrinolytic and invasive with and without f-QRS. Based on the data of this study, the four study groups had no statistically significant difference in arrhythmia (p = 0.196). In addition, the effect of study groups on left ventricular ejection fraction index was not statistically significant (p = 0.597). The probability of adverse outcomes occurrence was not statistically significant among the four groups (p = 0.07).

Conclusion

The final results of this study showed that there was no significant difference between the four study groups and arrhythmia status. Therefore, f-QRS was not introduced as an independent predictor of arrhythmia in patients with acute MI.

Serum parameters and severity of coronary artery disease in patients with acute coronary syndrome

Introduction: Coronary artery disease (CAD) is one of the most common causes of morbidity and mortality in developed countries. SYNTAX (SX) score is a useful index that scores lesion severity during coronary angiography (CA) and can predict the patient’s outcome. Recent studies have associated a number of serum parameters with SX score, including platelet volume, and platelet-to-lymphocyte ratio (PLR). Objectives: We aimed to study the SX score in association with various serum parameters to find a valuable parameter for prediction of CAD severity. Patients and Methods: This study consisted of 363 patients referred to Heshmat hospital (Rasht) from March 2016 to October 2016 with acute coronary syndrome (ACS). Serum laboratory parameters were measured after 12 hours of fasting. Severity of CAD was evaluated during CA by SX score. The associations were analyzed using multinomial logistic regression model. Results: The mean age of patients was 63.68±11.03 years; since 26.2% of cases had severe, 43% had moderate, and 30.8% had mild CAD. Comparing to mild CAD, the multivariate adjusted model showed higher significant odds of severe CAD for one elevation of platelets (odds ratio [OR] =2.18 (95% CI: 1.35-3.50), white blood cells (WBCs) (OR=1.66, 95% CI: 1.17-2.35) RDW (red cell distribution width), (OR=1.59, 95% CI: 1.08-2.35) and serum creatinine (OR=1.75, 95% CI: 1.16-2.63). Conclusion: Plasma platelets, WBC and RDW and also serum creatinine were all independently correlated with severity of CAD.