Improving Physical Fitness and Health of Office Workers in Iran

This paper reports on a study on improving the health and fitness of office workers in Iran using a comprehensive model. The research design was a randomized controlled trial involving 294 employees. The intervention was a 6-month program to promote physical activity. The primary outcome measure was their scores on the physical activity (PA) index recorded at 3 and 6 months. A statistically significantly increase in PA was found in the intervention group over the control group. In addition, the mean values of related health and physiological indices of the intervention group demonstrated a statistically significant increase compared to the control group. The conclusions of this study support research findings in multiple countries, that the physical activity and health of office workers can be improved in a short period.

The outcomes of marginal donor hearts compared with ideal donors: a single-center experience in Iran

Background

Heart transplantation has been considered the gold-standard treatment for patients with end-stage heart failure. This study assessed the survival outcomes of marginal donor hearts compared with ideal donor hearts in Iran.

Methods

This retrospective study is based on the follow-up data of heart donors and recipients in the Sina Hospital Organ Procurement Unit. Among the 93 participants, 75 were categorized as ideal donors (group A) and 18 as marginal donors (group B). Group C included heart recipients who received a standard organ, and group D included heart recipients who received a marginal one. To analyze differences in patient characteristics among the groups, posttransplant heart survival was assessed in all groups. All data were obtained from the hospital records.

Results

The mean age of the donors was 26.27±11.44 years (median age, 28 years). The marginal age showed a significant association with donor age. The age of recipients had a significant effect on survival days in the ideal group. Most patients survived for at least 1 year, with a median of 645 days in recipients from marginal donors and 689 days in recipients from ideal donors.

Conclusions

Considering the lack of organ availability in Iran, it may be possible to use marginal donors for marginal recipients, therefore reducing the number of people on the waitlist. We also recommend establishing a national marginal donor system specifically for Iranian patients to extend the donor pool.

A Very Rare Case of Isolated Spontaneous Pneumopericardium Secondary to COVID-19

Coronavirus disease 2019(COVID-19) is currently a pandemic. In addition to respiratory symptoms, involvement of other organs such as the pericardium is also seen. Pneumomediastinum in COVID-19 patients has rarely been reported. Isolated pneumopericardium without pneumomediastinum is even more uncommon. We described a case of COVID-19 in association with pneumopericardium. To the best of our knowledge, no case with isolated pneumopericardium has been reported thus far.

Surgical Repair of a Giant Right Atrium Aneurysm That was Incidentally Found in a Boy

Giant right atrial aneurysms are rare defects with different clinical presentations ranging from lack of symptoms to heart failure. They are diagnosed based on incidental findings. It is commonly found when echocardiography or chest X-ray is performed. Concurrent congenital heart disease and large atrial size are risk factors that may increase the risks of complications such as thromboembolism, fatal arrhythmias, aneurysm rupture, and sudden death. The best treatment has been controversial, with some patients managed surgically and others conservatively. We present a case of a giant right atrium aneurysm that was incidentally detected during a routine examination. The patient underwent successful surgical resection of the right atrial aneurysm.

Type B Interrupted Aortic Arch With a Very Large Right Subclavian Artery Aneurysm in an Adult

Interruption of the aortic arch and right subclavian artery aneurysm is a rare congenital malformation. Survival in adults depends on the formation of collaterals to supply the descending aorta. The interruption of the aortic arch must be taken into account, particularly in patients with hypertension and weak pulses in the lower extremities. We present a case of aortic arch interruption and a right subclavian artery aneurysm in a woman who survived to adulthood.

Incidentally Detected Asymptomatic Cardiac Myxoma in a Patient With COVID-19

Primary cardiac tumors, such as myxomas, are rare. About 75% of myxomas occur in the left atrium of the heart. Myxomas can have a broad clinical spectrum. The clinical presentation varies from asymptomatic to sudden cardiac death. Sometimes, a diagnosis is difficult. Cardiac myxoma can cause hemodynamic disturbances in the setting of pneumonia and hypercoagulable state in patients with Coronavirus disease 2019(COVID-19) and make treatment decisions difficult. We present a case of unusually huge left atrial mass discovered incidentally in a patient with COVID-19. Upon workup, an echocardiogram revealed an incidental 7 × 5 cm left atrial myxoma. Preoperatively, the patient was monitored closely in the ICU. After stabilization in the ICU, the patient was taken to surgery and the tumor was successfully removed. Pathohistological results after surgical removal of the tumor confirmed the diagnosis of cardiac myxoma. We consider our case extremely rare due to the asymptomatic course despite the large size of the tumor.

Percutaneous Removal of Intracardiac Retained Hemodialysis Catheter: A Rare Complication of a Commonly Used Procedure

Hemodialysis catheter fracture with distal embolization is a rare complication. The natural process of retained asymptomatic hemodialysis is unclear. This is a report of an iatrogenic fracture of the tip of the hemodialysis catheter in an adult patient who was successfully retrieved using an image-guided endovascular technique. In the event of catheter fracture with distal embolization, percutaneous retrieval is the treatment of choice.

Malachite Green, the hazardous materials that can bind to Apo-transferrin and change the iron transfer

Different groups of synthetic dyes might lead to environmental pollution. The binding affinity among hazardous materials with biomolecules necessitates a detailed understanding of their binding properties. Malachite Green might induce a change in the iron transfer by Apo-transferrin. Spectroscopic studies showed malachite green oxalate (MGO) could form the apo-transferrin-MGO complex and change the Accessible Surface Area (ASA) of the key amino acids for iron transfer. According to the ASA results the accessible surface area of Tyrosine, Aspartate, and Histidine of apo-transferrin significantly were changed, which can be considered as a convincing reason for changing the iron transfer. Moreover, based on the fluorescence data MGO could quench the fluorescence intensity of apo-transferrin in a static quenching mechanism. The experimental and Molecular Dynamic simulation results represented that the binding process led to micro environmental changes, around tryptophan residues and altered the tertiary structure of apo-transferrin. The Circular Dichroism (CD) spectra result represented a decrease in the amount of the α-Helix, as well as, increase in the β-sheet volumes of the apo-transferrin structure. Moreover, FTIR spectroscopy results showed a hypochromic shift in the peaks of amide I and II. Molecular docking and MD simulation confirmed all the computational findings.

Huge Hydatid Cyst of the Right Ventricular Outflow Tract

Hydatid disease is a common health problem in sheep-farming countries such as Iran. The liver and lungs are the most common primary sites of hydatid cysts in humans. Cardiac involvement is an uncommon manifestation, and the right ventricle outflow tract (RVOT) is rarely involved. This is a case report of a 34-year-old man who presented to the Heart Clinic, Tehran, Iran, in 2019 with a history of dyspnoea and fatigue. Following an imaging study, the patient was diagnosed with an RVOT hydatid cyst. He underwent surgical resection of the cyst. The post-operative course was uneventful.

P–691 How predictive is endometrial thickness for live birth after fresh and frozen-thawed embryo transfer when no cut-off is employed?

Study question

Does endometrial thickness (EMT) predict live birth (LB) after fresh and frozen-thawed embryo transfer (ET) and is there a lower EMT cut-off for ET?

Summary answer

Once intracavitary pathology and inadvertent progesterone exposure is excluded, EMT is not predictive for LB. EMT is not linearly associated with probability of LB.

What is known already

EMT is commonly used as a marker of endometrial receptivity and in turn, assisted reproductive technology treatment success. ET is often cancelled or postponed if EMT is below an arbitrary cut-off. However, the available evidence on the relationship between EMT and LB rates is conflicting and too dubious to hold such strong stance. An overwhelming majority of the studies on the subject are retrospective, they use different arbitrary cut off values ranging between 6 to 9 mm with heterogeneous stimulation and transfer protocols.

Study design, size, duration

Records of all women who underwent fresh or frozen-thawed ET in Koc University Hospital Assisted Reproduction Unit between October 2016 - August 2019 were retrospectively screened. All women who underwent fresh or frozen-thawed blastocyst transfer during the study period were included. Every woman contributed to the study with only one transfer cycle for each category, i.e., fresh ET and frozen-thawed ET.

Participants/materials, setting, methods

After ruling out endometrial pathology, EMT was measured on the day of ovulation trigger for fresh ET cycles, and on the day of progesterone commencement for frozen-thawed ET. ET was carried out, regardless of EMT, if there was no suspicion of inadvertent progesterone exposure, i.e., due to follicular phase progesterone elevation in fresh or premature ovulation in frozen ET cycles.

Main results and the role of chance

560 ET cycles, 273 fresh and 287 frozen-thawed, were analyzed. EMT varied from 4mm to 18mm. EMT were similar between women who achieved a LB and who did not after fresh ET [10.5 (9.2 – 12.2) mm and 9 (8 – 11) mm, respectively, p = 0.11]. Ovarian stimulation characteristics and proportion of women who received a single embryo were similar (69% vs 68.3%, respectively, p = 0.91). Women who achieved a LB was significantly younger than those who did not [35 (32–38) and 37 (33–41), respectively, p < 0.01]. Women who had a LB and who did not after frozen-thawed ET had similar EMT of 8.4 (7.4 – 9.7) mm and 9 (8 – 10) mm, respectively (p = 0.38). Women who achieved a LB were significantly younger than those who did not [32 (29–35) vs 34 (30–38) years, p = 0.04]. The proportion of women who received a single ET was similar between women who achieved a LB and who did not after a FET [86/95 (90.5%) vs 181/192 (94.3%), respectively, p = 0.26].

Area under curve values of EMT for predicting LB in fresh, frozen-thawed and all ET were 0.56, 0.47 and 0.52, respectively. EMT and LB rate were not linearly correlated in fresh or frozen-thawed ET cycles.

Limitations, reasons for caution

Although our study is retrospective, no women was denied ET due to EMT in our center. Only patients undergoing ET were included in the analysis, which may introduce bias due to the selection of couples who were competent enough to produce at least one blastocyst fit for transfer.

Wider implications of the findings: Since women with thin endometrium had reasonable chance for LB even in the absence of a cut-off for EMT in this unique dataset, delaying or denying ET for any given EMT value alone does not seem justified. Further studies in which ET is carried out regardless of EMT are needed.

Trial registration number

Not applicable

Inferior Vena Cava Agenesis in an Adult Organs Donor

The inferior vena cava is the main organ of venous return from the lower extremities and abdominal organs to the right atrium. Congenital atresia of inferior vena cava is very rare. This anomaly can be surprising for transplant surgeons. The anomaly, if unknown, can cause procedural complications during interventional procedures or organ harvesting.

Right Atrial Diverticulum in an Adult Woman with Left Bundle Branch Block

Right atrial diverticulum is a very rare anomaly. It is an outpouching arising from the right atrial free wall. Clinical presentations vary widely but some cases are associated with supraventricular tachycardia and atrial flutter/fibrillation. The incidence/prevalence of this anomaly is not available because only a few cases have been reported. We report a 38-year-old female patient who presented to the Heart Clinic, Tehran, Iran in 2019 with a history of dyspnea and chest pain. Electrocardiography revealed left bundle branch block. Following a magnetic resonance imaging study, the patient was diagnosed with a right atrial diverticulum. She underwent surgical resection of the diverticulum. The post-operative course was uneventful and no recurrence of the arrhythmia was detected during the six months of follow-up. To the best of the authors’ knowledge, this combination has not been described in the literature.

Warfarin-Induced Spontaneous Bilateral Breast and Extrathoracic Hematoma in an Elderly Woman

Warfarin- induced spontaneous breast hematoma is a very rare disease, with only a few cases having been reported in the literature so far. We describe an 80-year-old woman who had warfarin therapy due to deep vein thrombosis in a lower extremity. The patient was admitted with a history of swelling and red area on her bilateral breasts, chest wall, right arm, and right flank. She was treated conservatively with success. She was discharged after about 3 weeks without complications and was well at 6 months’ follow-up.

Huge Mediastinal Thymic Cyst in the Elderly Patient

Mediastinal thymic cysts are uncommon lesions. Thymic cysts are usually diagnosed incidentally, and their origin could be congenital or acquired. Herein we present the case of a patient who presented with dyspnea. Chest computerized scan showed a large cystic mass. Surgical excision was performed. Pathology findings were consistent with congenital thymic cyst.

Right Atrium Blood Cyst and Calcified Kernel in an Adult

Among benign cardiac tumors, cardiac blood cysts are rare. These congenital lesions may develop in any heart’s cavities and they are not often seen in adults. The present article is a report of a right atrium blood cyst and calcified kernel in an adult case.

Fatal Case of Pulmonary Invasive Aspergillus after Heart Transplant with a Rapidly Progressive Course

The incidence of invasive fungal infections is lower than that of bacterial infections in heart transplant recipients. However, they are always life-threatening. Clinical manifestations may range from asymptomatic colonization to disseminated infection. This complication is responsible for significant morbidity and mortality, particularly in heart transplant recipients. Herein, we present on a cardiac transplant recipient who presented with invasive pulmonary aspergillosis quickly leading to death, in spite of early diagnosis and aggressive therapy. It just took 10 hours from the diagnosis to death. In other reports, this period was at least 12 days.

Incidental thymic cyst in middle mediastinum during emergency coronary artery bypass grafting: case report

Congenital thymic cyst is a rare mass and usually located in the anterior mediastinum and neck. Congenital thymic cyst in the middle mediastinum are extremely rare, with only three previously reported case. We herein describe the fourth case of a thymic cyst in the middle mediastinum.

Heart and Lung Metastases From Endometrial Stromal Sarcoma in a Forty-Two-Year-Old Woman

Introduction:

Low-grade endometrial stromal sarcoma (LG-ESS) is a malignant intrauterine tumor that rarely presents with distant metastasis. Simultaneous lung and cardiac metastases from LG-ESS is also an extremely rare event.

Case Presentation:

A 42-year-old woman presented with dyspnea and exercise intolerance. She had a history of hysterectomy and left salpingoophorectomy. She underwent second laparotomy as well as right oophorectomy after new finding of vaginal mass with histopathologic diagnosis of LG-ESS. Cardiac imaging techniques demonstrated tumoral process in the right atrium and ventricle, coronary sinus, and pulmonary outlet tract as well as multiple metastases in the lung fields. Successful complete surgical resection of the metastatic tumor in the right side of the heart and then radiotherapy were done. After 28 months, follow-up examination revealed no abnormality.

Conclusions:

We describe the first documented case of isolated intracardiac and lung metastases of a LG-ESS without concurrent abdominal or caval metastasis.

Right-sided cervical aortic arch in Loeys-Dietz syndrome

Loeys-Dietz syndrome is an autosomal dominant connective tissue disorder that is characterized by skeletal abnormalities, craniofacial malformations, and predisposition for aortic aneurysm with tortuosity. We report a case of a right-sided cervical aortic arch associated with the Loeys-Dietz syndrome. To the best of our knowledge, this combination has not been described in the literature. .