Right to Left Cardiac Power Output- New Prognosticator in STEMI Patients With Cardiogenic Shock (R-Shock).

ST elevation myocardial infarction (STEMI) is a leading cause of cardiogenic shock (CS) and carries substantial mortality. Cardiac power output (CPO) is the strongest predictor of clinical outcome in CS, and worse outcomes result from concomitant right and left ventricular failure. Right ventricular performance is calculated using right sided CPO.

Evidence-Based Approach to Out-of-Hospital Cardiac Arrest.

Purpose Of Review: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. Despite improvements in the cardiac disease management, OHCA outcomes remain poor. The purpose of this review is to provide information on the management of OHCA survivors, evidence-based treatments, and current gaps in the knowledge.

Laser Lead Extraction Complicated by Avulsed Tricuspid Subvalvular Apparatus with Severe Tricuspid Regurgitation.

The use of laser lead extraction (LLE) to remove pacemaker or implantable cardioverter-defibrillator leads has become increasingly prevalent. This advanced technique has been shown to be highly effective and safe. We report a rare case of severe traumatic tricuspid regurgitation after LLE that led to death.

Examining the "Repletion Reflex": The Association between Serum Potassium and Outcomes in Hospitalized Patients with Heart Failure.

Background: In patients hospitalized with heart failure (HF) exacerbations, physicians routinely supplement potassium to maintain levels ≥4.0 mEq/L. The evidence basis for this practice is relatively weak.

Derivation and Validation of an In-Hospital Mortality Prediction Model Suitable for Profiling Hospital Performance in Heart Failure.

Background: Comparing heart failure (HF) outcomes across hospitals requires adequate risk adjustment. We aimed to develop and validate a model that can be used to compare quality of HF care across hospitals.

Methods And Results: We included patients with HF aged ≥18 years admitted to one of 433 hospitals that participated in the Premier Inc Data Warehouse.

Implementation of an Early Discharge Protocol and Chest Pain Clinic for Low-Risk Chest Pain in the Emergency Department.

Background: Most of the patients presenting to emergency department with chest pain are at low risk of adverse events. Identifying high-risk patients can be challenging and resource intensive.

Methods: We created a protocol to assist early discharge of low-risk adults with chest pain from emergency department.

Ruptured Sinus of Valsalva Aneurysm Associated with Situs Ambiguus, Isolated Levocardia, and Polysplenia.

Aneurysm of the sinus of Valsalva, a rare cardiac condition, results from dilation of an aortic sinus. Sudden aneurysm rupture can trigger rapidly progressive heart failure. We discuss the case of a 57-year-old woman with situs ambiguus, isolated levocardia, and polysplenia who presented with acute-onset heart failure.

Quality of Care of Hospitalized Infective Endocarditis Patients: Report from a Tertiary Medical Center.

Objective: There have been no recent studies describing the management and outcomes of patients with infective endocarditis (IE).

Patients And Methods: We conducted a retrospective cohort study of adult patients admitted to a tertiary medical center from 2007 to 2011 with a Duke criteria consistent discharge diagnosis of IE. We examined concordance with guideline recommendations.

Not So EASE-Y: How Often do Hospitalized Infective Endocarditis Patients Meet Criteria for Early Surgery?

Infective endocarditis (IE) has historically caused significant morbidity and mortality. Valve surgery reduces systemic embolization and mortality, but the optimal timing is controversial. The EASE (Early Surgery Versus Conventional Treatment for Infective Endocarditis) trial, which employed strict inclusion and exclusion criteria, showed that early surgery could reduce the risk of embolic events for a subset of patients.

Validation and Comparison of Seven Mortality Prediction Models for Hospitalized Patients With Acute Decompensated Heart Failure.

Background: Heart failure (HF) inpatient mortality prediction models can help clinicians make treatment decisions and researchers conduct observational studies; however, published models have not been validated in external populations.

Methods And Results: We compared the performance of 7 models that predict inpatient mortality in patients hospitalized with acute decompensated heart failure: 4 HF-specific mortality prediction models developed from 3 clinical databases (ADHERE [Acute Decompensated Heart Failure National Registry], EFFECT study [Enhanced Feedback for Effective Cardiac Treatment], and GWTG-HF registry [Get With the Guidelines-Heart Failure]); 2 administrative HF mortality prediction models (Premier, Premier+); and a model that uses clinical data but is not specific for HF (Laboratory-Based Acute Physiology Score [LAPS2]). Using a multihospital, electronic health record-derived data set (HealthFacts [Cerner Corp], 2010-2012), we identified patients ≥18 years admitted with HF.

Predictors of Medical Management in Patients Undergoing Elective Cardiac Catheterization for Chronic Ischemic Heart Disease.

Background: Compared with medical therapy, percutaneous coronary intervention (PCI) does not reduce mortality or myocardial infarction in patients with stable angina. Therefore, PCI should be guided by refractory anginal symptoms and not just lesion characteristics.

Hypothesis: We hypothesized that angiographic lesion characteristics and stress test results would have a greater role in the decision to proceed with PCI than would symptom severity.

The effect of information presentation on beliefs about the benefits of elective percutaneous coronary intervention.

Importance: For stable angina, the benefits of percutaneous coronary intervention (PCI) are limited to symptom relief, but patients often believe that PCI prevents myocardial infarction (MI). Whether presenting accurate information about the benefits of PCI would dispel these beliefs remains unknown. We hypothesized that explanatory information would be more effective for influencing volunteers' beliefs.

The impact of the distance from the interventional cardiologist's home to the hospital during off hours.

Objectives: The impact of the distance from the interventional cardiologist's home to the hospital and door to balloon time (DTBT) BACKGROUND: The importance of DTBT is highlighted by its inclusion as one of the core quality measures collected by the center for Medicare and Medicaid services and by the Joint commission on Accreditation of Healthcare organizations. We investigated the effect of time of day on the DTBT in patients having primary percutaneous coronary intervention (pPCI) and the impact of distance of the on call interventional cardiologist from the hospital on the DTBT and major adverse cardiac events (MACE) in patients undergoing pPCI during the off hours

Methods: Patients enrolled in the study presented with STEMI either in the field or to the emergency department (ED) and underwent pPCI from October 2007 to July 2009 RESULTS: Significant predictors of DTBT included a history of prior MI (P = 0.001), prior percutaneous coronary intervention (P = 0.

PDCD1, CTLA-4 and p53 gene polymorphism and susceptibility to gestational trophoblastic diseases.

Objective: Gestational trophoblastic neoplasms (also termed gestational trophoblastic diseases [GTDs]) encompass a spectrum of interrelated tumors originating from trophoblasts. The search is ongoing for identification of the culpable gene defects in GTDs. Considering the role of PDCD1, CTLA-4 and p53 genes in immune regulation and tumor progression, we explored the association of single-nucleotide polymorphisms (SNPs) corresponding to each gene and GTDs.

Interleukin-18 gene promoter and serum level in women with ovarian cancer.

IL-18, initially defined as a potent inducer of IFN- gamma production, is a systemic, multifunctional cytokine with both pro-cancerous and anti-cancer activities. The contribution of the IL-18 promoter polymorphisms at positions -607 (C/A) and -137 (G/C) to cancer development has been reported. We sought to examine IL-18 serum level and its polymorphisms in Iranian women with ovarian cancer.

Interleukin-18 gene promoter polymorphisms in women with gestational trophoblastic diseases.

Objective: Gestational trophoblastic diseases (GTDs) consist of a spectrum of disorders characterized by an abnormal proliferation of trophoblastic tissue. IL-18 is a pleiotropic cytokine with a capacity for both ThI and Th2 polarization. Considering the association of IL-18 promoter polymorphisms at positions -607 (A/C) and -137 (C/G) with pregnancy events and some cancers, we sought to examine these polymorphisms in Iranian patients with GTD, their association with disease subtypes, and IL-18 serum level.

Investigation of soluble HER2 and transforming growth factor Beta-1 serum levels in gestational trophoblastic disease.

HER2/neu and TGF-beta1 are over-expressed in various types of malignancies. It appears that they play an important role in the biologic behavior of tumors and have prognostic value. Gestational tropoblastic diseases (GTDs) comprise of a heterogeneous group characterized by abnormally proliferating trophoblastic tissues, ranging from benign to malignant.

Lack of association between interleukin-13 gene polymorphisms (-1055 C/T and +2044 G/A) in Iranian patients with lung cancer.

Lung cancer is one of the leading causes of death from cancer. Both immune cells and tumor cells play a key role in lung cancer immunity by secretion of cytokines and developing type-2 cell-mediated immune response. IL-13 is an immunoregulatory cytokine affecting tumor immunosurveillance by deviation of immune response from Th1 to Th2.

Bone mineral density in children wth systemic lupus erythematosus and juvenile rheumatoid arthritis.

Background: Although there is increasing in bone metabolism in patients with rheumatic disorders, few data exist on bone mineral density (BMD) in children with rheumatic disorders or on the association of BMD with disease-related variables. We determined BMD in Iranian children with systemic lupus erythematosus (SLE) and juvenile rheumatoid arthritis (JRA) to evaluate the relationship between disease-related variables and BMD.

Patients And Methods: Twenty patients (13 girls and 7 boys) with SLE (n=15) and JRA (n=5) with a mean age of 13.

Agreement rate of skin prick test with tissue eosinophil count in patients with nasal polyps.

The pathogenetic mechanism of nasal polyps remains unknown, although allergy has been cited as an important factor in the etiology of nasal polyposis. Currently there is no definite histological criterion for differentiation of allergic from inflammatory nasal polyp. However, in a few studies, tissue eosinophil count has been used for this.

Prevalence of aeroallergens in allergic rhinitis in shiraz.

Allergic rhinitis is an extremely common disease worldwide. Aeroallergens are very often involved in allergic rhinitis and their prevalence may vary in different regions. The causative allergens of allergic rhinitis in our area are unknown.

Combined use of growth hormone and gonadotropin-releasing hormone analogue in short normal adolescent girls: a survey from Iran.

Combined therapy with gonadotropin-releasing hormone (GnRH) analogue and growth hormone (GH) has been used to increase the height of adolescents who are not GH deficient and who have normally timed puberty. Its use, however, is still controversial. For 2 years simultaneously, we treated eight healthy girls with very low predicted adult height (PAH < 145 cm) who were entering into normally timed puberty.

Hodgkin lymphoma developing in a 4.5-year-old girl with hyper-IgE syndrome.

The authors report a case of Hodgkin lymphoma developing in a 4.5-year-old female child with hyper-IgE syndrome. This is one of the few cases of malignancy reported in this syndrome.