Cardiac Function in Pediatric Patients with MIS-C Using Speckle Tracking and Conventional Echocardiography: A Longitudinal, Single-Center Study

Cardiovascular involvement in Multisystem Inflammatory Syndrome in Children (MIS-C), a potential consequence of coronavirus disease-2019 (COVID-19), is common. Conventional transthoracic echocardiography (TTE) provides primary data on the function of the left and right ventricles, while Speckle Tracking Echocardiography (STE) is more sensitive. This study aims to assess longitudinal cardiac function using STE in these patients. This longitudinal study was conducted from late 2021 to early 2022 at Imam Hossein Children's Hospital, Isfahan. Cardiac function was assessed by STE at the time of diagnosis and again two months later. Demographics, clinical characteristics, ECG interpretations, imaging studies, and serum cardiac marker levels were collected. Thirty-five pediatric patients with a mean age of 5.1 years (range: 4 months to 17 years) were included and prospectively followed. Twenty-nine of them, comprising 14 males (48.3%) and 15 females (51.7%), underwent STE and were compared with 29 healthy age- and sex-matched children. Factors related to adverse events included reduced myocardial function, enlarged left atrium or ventricle, and mitral regurgitation (MR). Patients with comorbidities affecting strain measurements were excluded from the strain analyses. A significant difference was observed between the groups in regional strains in the basal and apical septal and middle lateral regions. Global strain rate (GLS) and strain rates were not significantly different but were still lower than the control group. Twenty percent of patients had abnormal GLS but normal left ventricular ejection fraction (LVEF). All patients exhibited reduced segmental myocardial strain in at least one segment. Four out of 26 recovered patients without comorbidities had abnormal GLS at follow-up, despite normal LVEF. STE proves more useful than conventional echocardiography in patients with MIS-C, revealing subclinical cardiac injury in the acute and post-acute phases.

Acute neurological symptoms in multisystem inflammatory syndrome in children: A case series

Introduction

Severe acute respiratory syndrome coronavirus-2 infection mostly involves pediatrics lesser than adults; however, the multisystem inflammatory syndrome in children is shown to be the following condition in children infected with SARS-CoV-2, even asymptomatic ones. To date, there is few evidence of the association of multisystem inflammatory syndrome in children with acute neurological symptoms.

Case presentations

This case series was recorded demographic, clinical, laboratory, radiographic and EEG data of patients with the multisystem inflammatory syndrome in children who diagnosed simultaneously with acute neurological symptoms. Children with the multisystem inflammatory syndrome in children and evidence of central nervous system involvements participated in the study. Data are reported as median (interquartile ranges) for quantitative data without normal distributions. The present study was conducted at the children's referral hospital of Isfahan province, Iran between March 1, 2020, and December 28, 2021. Simultaneous diagnosis of multisystem inflammatory syndrome in children and acute neurological symptoms was made in 12 children. The median age of patients was 4.5 years (10-144 months). The most common symptoms were seizures (58%). Cerebrospinal fluid analysis showed that only one patient had pleocytosis. In addition, one patient had a low glucose level. Finally, 11 patients were discharged in good condition and one patient died after full recovery from acute neurological symptoms due to her underlying disease.

Conclusion

According to our series and other studies, children with MIS-C may present signs and symptoms of acute neurological symptoms. Although its pathophysiology is unclear, studies showed that immunomodulatory agents, i.e., intravenous immunoglobulins and corticosteroids, provide a relatively good prognosis.

Impaired IL-23-dependent induction of IFN-γ underlies mycobacterial disease in patients with inherited TYK2 deficiency

Human cells homozygous for rare loss-of-expression (LOE) TYK2 alleles have impaired, but not abolished, cellular responses to IFN-α/β (underlying viral diseases in the patients) and to IL-12 and IL-23 (underlying mycobacterial diseases). Cells homozygous for the common P1104A TYK2 allele have selectively impaired responses to IL-23 (underlying isolated mycobacterial disease). We report three new forms of TYK2 deficiency in six patients from five families homozygous for rare TYK2 alleles (R864C, G996R, G634E, or G1010D) or compound heterozygous for P1104A and a rare allele (A928V). All these missense alleles encode detectable proteins. The R864C and G1010D alleles are hypomorphic and loss-of-function (LOF), respectively, across signaling pathways. By contrast, hypomorphic G996R, G634E, and A928V mutations selectively impair responses to IL-23, like P1104A. Impairment of the IL-23-dependent induction of IFN-γ is the only mechanism of mycobacterial disease common to patients with complete TYK2 deficiency with or without TYK2 expression, partial TYK2 deficiency across signaling pathways, or rare or common partial TYK2 deficiency specific for IL-23 signaling.

Evaluation of methicillin-resistant Staphylococcus virulence genes and antibiotics susceptibility in Iranian population

Background

Methicillin resistance Staphylococcus aureus (MRSA) is one most important pathogens for human health. The ability of this organism for producing different kinds of disease is related to its virulence gene. The frequency of hemolysin alpha (hla), hemolysin beta (hlb), and exfoliative toxin A (eta) virulence genes of MRSA was evaluated, and the association of these genes with antibiotics susceptibility was investigated.

Materials and Methods

In a cross-sectional study, a total of 695 Staphylococcus clinical samples from seven different provinces of Iran were evaluated. MRSA was detected by cefoxitin disk. Virulence genes were detected by polymerase chain reaction. Susceptibility to clindamycin and ciprofloxacin was evaluated according to the Clinical and Laboratory Standards Institute guideline.

Results

From a total of 695 samples, 170 (24.46%) were found to be MRSA. 142, 82, and 132 samples of MRSA were hla, hlb, and eta positive, respectively. hla gene was significantly found more frequently in patients at least 18 years (P = 0.02). 105 (68.6%) and 93 (59.6%) of MRSA samples were resistance to ciprofloxacin and clindamycin, respectively. hlb gene was significantly more resistant to clindamycin (P = 0.04) and ciprofloxacin (P = 0.01). Logistic regression analysis displayed hlb-positive MRSA strains were significantly associated with ciprofloxacin (odds ratio [OR]: 3.6, 95% confidence interval [CI] = 1.637-8.00) and clindamycin (OR: 1.93, 95% CI 1.00-3.68).

Conclusion

MRSA strains from Staphylococcus aureus which isolated from hospitalized Iranian patients are significantly resistant to clindamycin and ciprofloxacin and it is may be because of hlb virulence gene. These samples consist of both community-acquired MRS) and health-care associated MRSA, so we could not use this finding as a guide for local antibiotics usage.

Reversible Cerebral Vasoconstriction Syndrome and Multisystem Inflammatory Syndrome in Children With COVID-19

BACKGROUND

Multisystem inflammatory syndrome in children (MIS-C) involves multiple organs and shows increased inflammatory markers. Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, several studies have reported the association between severe COVID-19 and MIS-C. Reversible cerebral vasoconstriction syndrome (RCVS) presents with thunderclap headaches and multifocal reversible vasoconstriction on imaging. RCVS is very rare in children. This article reports two cases of pediatric COVID-19 with severe MIS-C and clinical and imaging features indicative of RCVS.

METHODS

Clinical, laboratory, and imaging data of the patients were reviewed. The diagnosis of RCVS was confirmed based on clinical symptomatology and brain magnetic resonance imaging findings.

RESULTS

Two pediatric patients with clinical findings compatible with severe MIS-C and hemodynamic compromise presented to the hospital. During their hospitalization course, they developed thunderclap headaches and neurological deficits. Both were receiving vasoactive agents, intravenous immunoglobulin, and immunosuppressants. Imaging studies showed marked multifocal cerebral vasoconstriction in both cases and infarcts in one. The course and management of the patients will be presented. After controlling inflammation and elimination of triggers, both patients were ultimately symptom free upon discharge. Cerebral vasoconstriction had completely resolved on follow-up imaging.

CONCLUSIONS

Although a variety of symptoms including headaches may be seen in pediatric COVID-19 patients with MIS-C, RCVS should be considered as a differential diagnosis in cases of thunderclap headache accompanied by neurological signs in these patients. Imaging findings and follow-up are also key in establishing the diagnosis.

Evidence-Based Prediction of COVID-19 Severity in Hospitalized Children

OBJECTIVE

In this study, by using clinical and paraclinical characteristics, we have aimed to predict the severity of the disease in hospitalized COVID-19 children.

METHOD

This cross-sectional study was conducted on medical records about epidemiologic data, underlying diseases, symptoms, and laboratory tests from March to October, 2020, on 238 hospitalized confirmed COVID-19 paediatric cases in several children's hospitals of Tehran, Ahwaz, Isfahan, and Bandar Abbas.

RESULTS

From 238 patients, 140 (59%) were male and most of them were in the age group of 1 to 5 years (34.6%). Among all hospitalized patients, 38% had an underlying disease and in total, 5% of cases were expired.

CONCLUSION

Determining patient severity is essential for appropriate clinical decision making; our results showed that in hospitalized pediatric patients, by using several variables such as SGOT, CRP, ALC, LDH, WBC, O₂sat, and ferritin, we can use clinical and paraclinical characteristics for predicting the severity of COVID-19.

Clinical, laboratory and imaging characteristics, and outcomes of hospitalized children with suspected COVID-19 infection: A report from Isfahan-Iran

Background:

The aim of this study was to evaluate the clinical, laboratory and imaging characteristics, and outcomes of hospitalized children with suspected COVID-19 infection in Isfahan.

Materials and Methods:

In this cross-sectional study, all children aged < 15 years, who hospitalized as suspected case of COVID-19 were enrolled. During this study, all demographic, clinical, laboratory, and imaging characteristics as well as follow-up data and outcomes of the hospitalized children were recorded by pediatric residents using a questionnaire. The findings of studied populations in the two groups of definite/or suspected and negative COVID-19 patients were compared.

Results:

During 6 months’ period, 137 children with suspected COVID-19 infection were evaluated. Mean age of studied population was 4.3 (0.38) years. The most common symptoms in order were fever, cough, dyspnea and diarrhea. The most common computed tomography scan findings were bilateral ground glass and subpleural involvements. The rate of mortality was 7.3%. COVID-19 polymerase chain reaction test was positive in 22% of the patients. Based on the specialist's diagnosis, 30/25 patients were definite/or suspected to COVID-19 and reminder (79) were negative. O2 saturation <90%, was significantly higher in children with definite/or suspected diagnosis for COVID-19 (46.7% vs. 22.4%, P < 0.05). Dyspnea and shivering were significantly higher in children with definite/or suspected diagnosis for COVID-19 than those negative for COVID-19(P < 0.05). Mean duration of hospitalization was significantly associated with level of lactate dehydrogenase (P < 0.05).

Conclusion:

The clinical, laboratory, and imaging findings of our studied population were similar to other studies, but outcome was not similar which may be due to our studied population (inpatients cases). It is suggested that a better understanding of the infection in children may give important insights into disease pathogenesis, health-care practices, and public health policies.

Longitudinally extensive transverse myelitis as a sign of multisystem inflammatory syndrome following COVID-19 infection: A pediatric case report

COVID-19 infection can cause inflammatory reactions that could involve several organs. In the pediatric population, Multi-System Inflammatory Syndrome in Children (MIS-C) has been reported as one of the consequences of COVID-19. We report a unique pediatric COVID-19 patient with MIS-C, associated with paralysis of the extremities. MRI showed abnormal signal in the cervical spinal cord compatible with transverse myelitis. Methylprednisolone and IVIG were administered, without significant symptom improvement. As a next step, Infliximab was tried for her, and she responded remarkably well to this treatment. Infliximab may be considered as a treatment option in COVID-19 patients with transverse myelitis.

Successful treatment of plasmapheresis followed by interferon beta-1a in a child with severe COVID-19

COVID-19 outbreak has become a global health concern due to challenges in treatment and high mortality rate; therefore, its therapeutic approaches play an important role in reducing the mortality rate and resolving this concern. Different therapies have been introduced, including interferon beta-1a and purification methods, for instance, plasmapheresis. In this article, we reported a child with severe COVID-19 who fully recovered after receiving plasmapheresis and interferon beta-1a.

Case Report: Acute Intracardiac Thrombosis in Children With Coronavirus Disease 2019 (COVID-19)

We herein describe a case series of children with SARS-CoV-2 infection (COVID-19) complicated with acute intracardiac thrombosis. The diagnosis of COVID-19 was confirmed through the reverse transcription-polymerase chain reaction (RT-PCR). Transthoracic echocardiography of patients revealed large intracardiac mobile masses resected successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory state of the disease incurred by the SARS-CoV-2 virus.

Right Atrial Thrombus in a COVID-19 Child Treated Through Cardiac Surgery

We herein report a case of large intracardiac thrombus in a child with SARS-CoV-2 infection (COVID-19). The diagnosis of COVID-19 was confirmed through HRCT and RT-PCR. Transthoracic echocardiography revealed a large thrombus in the right atrium treated successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory condition incurred by the COVID-19 virus.

A Pediatric Case of Antibiotic-Associated Hemorrhagic Colitis Caused by Klebsiella Oxytoca

In recent decade the prevalence of antibiotic associated diarrhea was increased because of more antibiotic usage. Colstridum difficile is a microorganism which can cause mild to severe colitis. But the only cause of colitis related to Antibiotics is not colstridum difficle. In this case report we explain a child whit antibiotic associated colitis due to klebsiella oxtyoca.

Dental Caries and Gingival Evaluation in Children with Congenital Heart Disease

Background

Dental health is one of the most important health burdens of children health. The association between dental health and endocarditis has been already demonstrated, but there is controversy about different frequency of dental caries, periodontitis, and saliva microorganism in comparison to healthy population and children with congenital heart diseases (CHDs). In this study, we evaluated these differences.

Methods

Seventy-six healthy children and 68 CHD patients were enrolled in the present case-control study. Dental decay, periodontitis, oral microorganisms, serum calcium, phosphorus, and frequency of carbohydrate and protein consumption of all participants were evaluated by standards method.

Results

CHD patients experienced more periodontitis, but the difference was not significant (0.12 vs. 0.09, P = 0.2). In healthy children, the mean saliva colony counts of Streptococcus mutans were more significant (50639 ± 3324 vs. 35285 ± 27226, P = 0.03), which was diminished by adjusting the carbohydrate consumption. The mean colony count of Lactobacilli in children with CHD was nonsignificant higher than healthy children (P = 0.3).

Conclusions

Pediatric patients with CHD experience insignificantly higher dental decay, periodontitis, and saliva Lactobacilli colony counts. The frequency of decayed tooth and gingival diseases in healthy children is high, and hence, more dental care attention in our health system is needed for healthy children.

How far cardio metabolic and psychological factors affect salt sensitivity in normotensive adult population?

AIM

To evaluate the prevalence of salt sensitivity and the impact of cardiometabolic and psychological characteristics on salt sensitivity in normotensive population.

METHODS

Of all participants, anthropometric measurements and fasting venous blood samples were collected, and study questionnaires were completed. Salt Sensitivity was defined based on the difference in mean arterial pressure with infusion of 2 L of normal saline followed by a low sodium diet and administration of three doses of oral furosemide the day after.

RESULTS

Of 131 participants, 56 (42.7%) were diagnosed with salt sensitivity. Crude and age and sex adjusted regression analysis showed that low-density lipoprotein cholesterol and depression were positively associated with salt sensitivity (OR = 1.02, 95%CI: 1.01-1.04 and OR = 1.15, 95%CI: 1.00-1.34, respectively).

CONCLUSION

The high prevalence of salt sensitivity and its significant relation with prevalent risk factors necessitates considering its reduction actions at the population level and the need for further research.

Synbiotic containing Bacillus coagulans and fructo-oligosaccharides for functional abdominal pain in children

AIM

We evaluated the effectiveness of a synbiotic in the treatment of childhood functional abdominal pain (FAP).

BACKGROUND

Probiotics are effective in the treatment of functional gastrointestinal disorders in adult patients, but there is lack of information in children.

PATIENTS AND METHODS

Children with FAP, based on the Rome III criteria (n = 115, aged 6-18 years), were randomized to receive either synbiotic (Bacillus coagulans, Unique IS-2, 150 million spore plus FOS, 100 mg) twice daily or placebo for four weeks. Treatment response was defined as ≥ 2-point reduction in the 6-point self-rated pain scale or "no pain". Physician-rated global severity and improvement were also evaluated. Patients were followed for a total of 12 weeks.

RESULTS

Eighty-eight patients completed the trial (45 with synbiotic). Response rate was higher with synbiotic than placebo after medication (60% vs. 39.5%, P = 0.044), but was not different between the two groups at week 12 (64.4% vs. 53.4%, P = 0.204). Difference between the two groups regarding the physician-rated global severity over the study period was not statistically significant (z = -1.87, P = 0.062). There was no significant difference between the two groups in physician-rated global improvement (week 4, P = 0.437; week 12, P = 0.111). Receiving synbiotic (OR 2.608, 95% CI: 1.01-6.68) and baseline pain score (OR 2.21, 95% CI: 1.19-4.10) were predictors of treatment response after medication.

CONCLUSION

The synbiotic containing Bacillus coagulans and FOS seems to be effective in the treatment of childhood FAP. Further trials are recommended in this regard.

Citalopram for pediatric functional abdominal pain: a randomized, placebo-controlled trial

BACKGROUND

Antidepressants are effective in adults with pain-related functional gastrointestinal disorders. We investigated the effectiveness of citalopram in the treatment of childhood functional abdominal pain (FAP).

METHODS

Children with FAP, based on the Rome III criteria (n = 115, aged 6-18 years), were randomized to receive either citalopram 20 mg/day or placebo for 4 weeks. Treatment response was defined as ≥ 2 point reduction in the 6-point Faces pain rating scale or 'no pain'. Depression, anxiety, somatization, and physician-rated global severity and improvement were also evaluated. Patients were followed up for 8 weeks after medication period.

KEY RESULTS

Eighty-six patients completed the medication (43 in each group). Response rate in the citalopram and placebo groups based on per-protocol (intention-to-treat) analysis was 55.8% (40.6%) and 39.5% (30.3%) at week 4 (p = 0.097 [0.169]) and 72.0% (52.5%) and 53.4% (41.0%) at week 12 (p = 0.059 [0.148]), respectively. In per-protocol analysis, more reduction was observed in pain (F = 3.84, p = 0.024) and global severity scores (F = 4.12, p = 0.021) in the citalopram group compared with the placebo group over the study period. Such differences were not present in the intention-to-treat analysis. No difference was found between the two groups regarding change in depression, anxiety, or somatization score over the study.

CONCLUSIONS & INFERENCES

Overall, we found a trend toward the effectiveness of citalopram in the treatment of children with FAP. Trials with longer treatment duration in larger samples of patients are required in this regard.

Abdominal fat distribution and serum lipids in patients with and without coronary heart disease

 

OBJECTIVE

To investigate the association between obesity indices, abdominal fat distribution, and lipid profile in patients with stable angina (SA). 

METHODS

Body weight, height, waist circumference (WC), body mass index (BMI), and waist /height ratio (WHtR) of 123 patients with SA who underwent coronary angiography were measured. Fasting blood samples were taken to measure the levels of fasting blood sugar (FBS), total cholesterol (TC), low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), apolipoproteins A and B (apo A and apo B), and triglycerides (TG). According to angiography reports, the participants were divided into patients with or without coronary heart disease (CHD). All patients underwent an abdominal computerized tomography (CT) scan to measure the visceral, superficial, and deep subcutaneous fat. 

RESULTS

The mean ages of the patients with CHD (n = 73) and without CHD (n = 50) were 50.5 ± 7.6 and 53.7 ± 7.6 years, respectively (P = 0.03).  The patients with CHD had significantly higher levels of TC, TG, and superficial subcutaneous fat, while the patients without CHD had higher levels of apo A (P ≤ 0.05). Multivariate analyses showed a significant association of visceral fat with TC, LDL-C, TG, and apo B, in the patients without CHD, while significant inverse associations were found between WC and HDL-C, WHtR, and apo A as well as visceral fat and LDL-C in the patients with CHD. 

CONCLUSIONS

Among anthropometrics and imaging indices of obesity, WC and WHtR have shown better association between central obesity with dyslipidemia in the patients with CHD, while CT-measured visceral adipose tissue area was the best correlate of dyslipidemia in the patients without CHD. 

Association of apolipoprotein B, apolipoprotein A, and the its ratio with body fat distribution

BACKGROUND

To evaluate the association of apolipoprotein B (apoB), apolipoprotein A (apoA), and apoB/apoA ratio with the body fat indicators in patients with stable angina pectoris (SA).

MATERIALS AND METHODS

One hundred and twenty two participants aged 40-60 years old, with a mean age of 52.1 ± 7.2 years and SA, were recruited for the present study. Body weight, height, and waist circumference (WC) were measured, and waist to height ratio (WHtR) was calculated. After 12 hours of fasting, a blood sample was obtained and serum levels of apoB and apoA were measured and the apoB/apoA ratio was calculated. These patients underwent an abdominal computerized tomography scan (CTS) to assess visceral and subcutaneous adipose tissue (VAT, SAT). Linear regressions were computed to assess the relation of apoB, apoA, and their ratio with various measurements of adiposity (VAT, SAT, WC, and WHtR), with adjustment for age, sex, and BMI ≥ 25, WC ≥ 80 in women and WC ≥ 90 in men and WHtR ≥ 0.59.

RESULTS

From totally 123 patients with SA with a mean age of 52.1 ± 7.2 years, 44.7% male and 55.3% women were entered. Significant positive associations were found between visceral fat area and the apoB/apoA ratio (P = 0.02, β = 0.2), and significant negative correlations were observed between visceral fat area and apoA concentrations (P = 0.04, β = -0.2).

CONCLUSION

As abdominal fat accumulation is associated with other risk factors such as apolipoproteins in ischemic patients, then we most focus on control of these factors.

Barriers and facilitators of weight management in overweight and obese people: Qualitative findings of TABASSOM project

INTRODUCTION

Since weight management is affected by various factors, including social and behavioral ones, this study aimed to explore the peoples' experience of barriers and facilitators of weight management.

MATERIALS AND METHODS

This qualitative content analysis was conducted as the initial step of TABASSOM Study. Participants, who tried to reduce their weight at least once, were selected by purposeful sampling method from aerobic fitness clubs, parks, and public offices in Isfahan in 2010. Data saturation was reached after indepth unstructured interviews with 11 participants. Data analysis was done by conventional content analysis method.

FINDINGS

The participants have intermittently followed weight loss program. Barriers such as physical problems, lack of motivation, lack of work and family support and lack of time have resulted in their failures and outages. The main facilitator to start or restart after stopping such programs for a while was positive psychologic effect.

DISCUSSION AND CONCLUSION

Findings showed that many problems could prevent weight loss. It is important to identify obstacles that hinder weight management and regimen programs and to discuss them with people before planning for their weight management.

Is helicobacter pylori infection a risk factor for coronary heart disease?

BACKGROUND

There is still controversy about association of Helicobacter pylori (H. pylori) infection with coronary heart disease (CHD). This study designed to evaluate this association in a sample of Iranians Population.

METHODS

Medical and drug history as well as fasting blood samples of 112 consecutive patients who were candidate for coronary angiography were taken on catheterization day. Fasting blood samples were used to measure C-reactive protein (CRP), anti H. pylori immunoglobulin G (anti H. pylori IgG) and interlukine-6 (IL6). According to angiography reports, participants were divided into patients with (n = 62) or without CHD (n = 43). To compare the association between H. pylori infection with CHD, multivariate logistic regression tests were used by adjusting sex and age, age and sex plus history of diabetes mellitus (DM), Dyslipidemia (DLP), and/or hypertension (HTN), CRP status and IL-6 level.

RESULTS

Sixty two patients with CHD and 43 participants without CHD were enrolled in the present study. The mean ages of patients with and without CHD were 62.4 261 9.5 and 59.0 261 10.5 years respectively. Multivariate logistic regression analysis after adjusting for history of DM and/or DLP and/or HTN plus CRP status and IL-6 level showed significant association of H. pylori infection with CHD (OR 3.18, 95%CI 1.08-9.40).

CONCLUSION

H. pylori infection is one of the probable risk factors for CHD independent of history of DM, DLP, HTN, CRP status and IL-6 level.

Association of helicobacter pylori infection with severity of coronary heart disease

BACKGROUND

There are few literatures evaluating the association between cytotoxin-associated gene A (CagA) positive strains of Helicobacter pylori (HP) and the severity of coronary heart disease (CHD). This study was designed to investigate this association.

METHODS

Medical and drug history of 112 consecutive patients who were candidate for coronary angiography were taken. Fasting blood samples were obtained to measure C-reactive protein (CRP), anti Helicobacter pylori immunoglobulin G (anti-HP IgG), anti-CagA antibody (Ab) and interlukine-6 (IL6). According to angiography reports, participants were divided into patients with mild (n = 69) and with sever CHD (n = 36). To measure the association between CagA positive strains of HP with the severity of CHD, multivariate logistic regression tests were used by adjusting age, sex, history of diabetes mellitus (DM), dyslipidemia (DLP), and/or hypertension (HTN), CRP status and IL-6 level.

RESULTS

The analysis was concluded on 105 subjects. HP infection and CagA Ab were not significantly higher compared to the patients with severe and mild CHD (P = 0.28 and P = 0.68, respectively). Colonization of CagA positive HP did not significantly associate with severity of CHD (OR 1.05, 95% CI 0.33-3. 39).

CONCLUSION

Colonization of CagA positive HP was not an independent risk factor for severe coronary heart disease.

Psychological status and quality of life in relation to the metabolic syndrome: Isfahan Cohort Study

OBJECTIVE

Current study was designed to investigate the association of metabolic syndrome (MetS) with depression, anxiety, psychological distress, and quality of life (QoL).

DESIGN

Two hundred and fifteen contributors with MetS and 253 participants without MetS were randomly selected from 2151 participants of Isfahan Cohort Study who were residents of Isfahan city. Measurements consisted of fasting blood samples, anthropometrics, and self-reported data of 12-item General Health Questionnaire, Hospital Anxiety and Depression Scale, and European Quality of Life-5 Dimension. Binary logistic regression analysis was used to find the association between MetS and four psychological factors.

RESULTS

Participants mean age was 56.3 ± 9.8 years. Male/female ratio was 0.86 (217/251). Mean score of depression (P = 0.003), anxiety (P = 0.018), distress (P = 0.047), and QoL (P ≤ 0.001) was significantly higher in MetS group. There were significant increasing relationships between depression (OR 1.10, 95% CI 1.03-1.22), anxiety (OR 1.03, 95% CI 1.05-1.11), and QoL (OR 1.13, 95% CI 1.05-1.23) and MetS when associations were adjusted for other risk factors, but it was not the case for distress (OR 1.03, 95% CI 0.99-1.08).

CONCLUSION

It might be better to consider MetS as a combination of biological and psychological risk factors. Thus, a person with metabolic disease should be recognized as a patient with these factors and be screened for all of them.

Non-alcoholic Steatohepatitis in a Sample of Iranian Adult Population: Age is a Risk Factor

OBJECTIVES

Non-alcoholic Steatohepatitis (NASH) is a cause of cirrhosis. Detecting its preventable causes could be useful in decreasing the disease and its complications. This study aimed to assess the prevalence of NASH in adult population living in Isfahan city as a sample of Iranian population.

METHODS

Blood samples of 2030 individuals referring to Dr. Shariati Hospital for routine health checkup were collected. All individuals with high liver enzymes [aspartate aminotransferase (AST) and/or Alanine aminotransferease (ALT)] were included in the study. Known causes of altered liver enzymes were excluded. Second blood samples were obtained 6 months later and those cases with persistent enzyme elevation were surveyed with ultrasonography.

RESULTS

In the first survey, 234 individuals (11.5 %) had ALT levels of more than 40 U/L. By rechecking samples after 6 months, 50% of all high serum ALT individuals remained at high level. After conducting complementary biochemical tests, 3.3% of the population was considered to have NASH; 20% of NASH cases did not have any abnormal findings in ultrasonography. Hypercholesterolemia was the most coexisting risk factor in NASH cases. We found a reverse correlation between ALT level and age (P = 0.02).

CONCLUSIONS

The prevalence of NASH was comparable with other countries. According to the significantl correlation between ALT level and age, preventive interactions in younger individuals would decrease the incidence of NASH.

Ejection fraction and mortality rate of patients with isolated acute inferior myocardial infarction reperfused by streptokinase

BACKGROUND

This study aimed to evaluate the effects of streptokinase on left ventricular ejection fraction and mortality rate of patients with inferior acute myocardial infarction (AMI) without right ventricular myocardial infarction (RVMI).

METHODS

Fifty five consecutive patients with the diagnosis of inferior AMI without RVMI in the coronary care unit (CCU) of Shariati Hospital in Isfahan were selected for this study. Patients who had a history and/or electrocardiogram (ECG) evidence of previous myocardial infarction, evidence of bundle branch block, historical or clinical findings of valvular or other non-coronary heart diseases or heart failure were excluded. Participants were divided into two groups. Group one (n=28) had no contraindication for taking thrombolytic therapy and group two (n=27) had at least one contraindication for this treatment. Patients in group one took 1,000,000 units streptokinase for one hour. Three days later, LVEF of all participants was measured by an experienced cardiologist using 2-dimentiona1 echocardiography. Patients were followed up until four weeks to assess the mortality rate.

RESULTS

One death in the first 24 hours was reported in group one. However, no death was reported in any group until four weeks after discharge. There was no significant difference in mortality rate during the first 24 hours and four weeks after discharge between the two groups. Mean LVEF in the two groups did not show any significant difference (P=0.21).

CONCLUSION

Probably streptokinase has no effects on one-month mortality rate and LVEF in patients with inferior AMI without RVMI. Therefore, streptokinase side effects must be taken into consideration when being administered for this group of patients.

Association of gastroesophageal reflux disease symptoms with exacerbations of chronic obstructive pulmonary disease

BACKGROUND

Symptoms of gastroesophageal reflux disease (GERD) are common in various chronic respiratory diseases, but little is known about GERD in the setting of chronic obstructive pulmonary disease (COPD). The aim of this study was to determine the effect of GERD symptoms on COPD exacerbations and subsequent hospitalization and drug usage.

METHODS

This retrospective study was conducted from December 2008 to February 2009 in the Pulmonary Clinic of Dr. Shariati University Hospital, Isfahan, Iran. Consecutive patients who were diagnosed with COPD based on clinical features and pulmonary function tests were included. Patients were categorized in GERD positive and GERD negative groups based on the Mayo GERD questionnaire. Exacerbation of COPD, hospitalization, and drug usage were compared between the two groups.

RESULTS

During the study period, 110 patients with COPD (mean age = 68.0 +/- 8.4 years, 87.3% male) were included; 59 (53.6%) patients were GERD positive. There was no significant difference between the GERD positive and GERD negative patients in age, gender, tobacco use, or body mass index. GERD positive patients experienced significantly more acute exacerbations of COPD than patients who were GERD negative (p < 0.001). The rate of hospitalization due to COPD exacerbations was significantly higher in GERD positive patients and they had a more severe COPD (p < 0.05) and more concurrent use of multiple therapies as compared with GERD negative patients (p < 0.05).

CONCLUSION

Patients with GERD symptoms have more COPD exacerbations and subsequent hospitalizations and drug usage. Clinical trials and preventive strategies for GERD in patients with COPD are warranted.

Azithromycin effect on helicobacter pylori eradication: double blind randomized clinical trial

BACKGROUND/AIMS

To evaluate the efficacy of one- and two-week regimen of quadruple therapy containing azithromycin for Helicobacter pylori infection eradication.

METHODOLOGY

A total of 84 H. pylori-infected patients, were randomized into three groups: First group (n=31): 6 g AzOAB: Azithramycin 500 mg twice daily for 6 days and Omeprazole 20 mg, Amoxicillin 1 g, Bismuth 240 mg all twice daily for 2 weeks. Second group (n=28): 3 g AzOAB: Azithramycin 500 mg twice daily for 3 days and Omeprazole 20 mg, Amoxicillin 1 g, Bismuth 240 mg all twice daily for 1 week. Third group (n=25): 1.5 g AzOAB: Azithromycin 250 mg twice daily for 3 days and Omeprazole 20 mg, Amoxicillin 1 g, Bismuth 240 mg all twice daily for 1 week. Eradication was defined as a negative urea breath test, four weeks after the end of treatment.

RESULTS

The eradication rate in the first, second and third group was 92% (95% CI: 84-99.8%), 88.46% (95% CI: 84.47-84.74%), 80% (95% CI: 79.88-80.11%) respectively, based on per-protocol analysis. There was no significant difference between eradication rates (P=0.44). The frequency of drug side effects in the study groups was respectively 19.23%, 7.6% and 0%. There was no statistically significant difference between the three regimens (P=0.06). However, frequency of drug side effects between 6 g AzOAB and 1.5 g AzOAB was statistically significant (P=0.02).

CONCLUSIONS

According to the results of these 3 regimens, it seems that one week quadruple regimens of 3 g Azithromycin may be more favorable for H. pylori eradication.