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A 54-year-old female patient was presented with upper extremity ischemia. Further investigation revealed ulcerated atherosclerosis plaque in aorta with intramural hematoma and clot formation. The subject underwent a successful resection of mass with the assistance of cardiopulmonary bypass and total circulatory arrest. [ABSTRACT FROM AUTHOR]

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Pulmonary hypertension (PH) is an important cause of heart failure in chronic obstructive pulmonary disease (COPD). The pro brain natriuretic peptide N-terminal (NT-proBNP) has been suggested as a noninvasive marker to evaluate ventricular function. However, there is no evidence to support the use of NT-proBNP in monitoring the benefits of vasodilators in COPD induced PH. Thus, we used NT-proBNP as a biomarker to evaluate the effect of oral vasodilators on cardiac function in COPD-induced PH. Forty clinically-stable PH patients were enrolled with history of COPD, normal left ventricular ejection-fraction (LVEF), right ventricular systolic pressure (RVSP) > 45 mmHg and baseline blood NT-proBNP levels >100 pg/mL. Patients were randomized into two groups, one group received sildenafil and second group were given amlodipine for two weeks. NT-proBNP and systolic pulmonary arterial pressure (systolic PA-pressure) were measured at the beginning and the end of study. Mean NT-proBNP level in the first group was 1297 ± 912 pg/mL before therapy and 554 ± 5 pg/mL after two weeks drug therapy, respectively. Similarly, in second group NT-proBNP level was 1657 ± 989 pg/mL and 646 ± 5 pg/mL before and after treatment. Amlodipine or sildenafil significantly reduced NT-proBNP levels in COPD-induced PH patients (p < 0.05). Our study shows that amlodipine and sildenafil have a similar effect on NT-proBNP levels. In both groups NT- proBNP levels were significantly reduced after treatment. Therefore, our findings support the potential benefits of treatment with vasodilators in COPD induced PH. [ABSTRACT FROM AUTHOR]

Abstract  Ethambutol is an oral anti-tuberculosis agent with chelating effects owing to its chemical structure which is similar to that of penicillamine. Copper (Cu) is an essential trace element that has important roles in physiological function of the body organs. The aim of present study was to determine (1) whether ethambutol usage can alter serum Cu concentration in patients with tuberculosis and (2) whether there is any relationship between age, sex, and smoking habit of patients with changes in serum Cu levels. Sixty patients with diagnosis of pulmonary tuberculosis were enrolled the study. Blood samples were obtained before treatment (baseline) and 10 days after starting anti-tuberculosis therapy. The amounts of serum Cu were determined in all samples by atomic absorption. Mean ± SD levels of Cu at baseline and on the 10th day of ethambutol use were 0.94 ± 0.24 and 0.64 ± 0.24 μg/mL, respectively. Statistical analysis confirmed a significant difference (p  [ABSTRACT FROM AUTHOR]

Abstract  Hexaploid bread wheat (Triticum aestivum L. ssp. aestivum) is assumed to have originated by natural hybridization between cultivated tetraploid Triticum turgidum L. and wild diploid Aegilops tauschii Coss. This scenario is broadly accepted, but very little is known about the ecological aspects of bread wheat evolution. In this study, we examined whether T. turgidum cultivation still is associated with weedy Ae. tauschii in today’s Middle Eastern agroecosystems. We surveyed current distributions of T. turgidum and Ae. tauschii in northern Iran and searched for sites where these two species coexist. Ae. tauschii occurred widely in the study area, whereas cultivated T. turgidum had a narrow distribution range. Traditional durum wheat (T. turgidum ssp. durum (Desf.) Husn.) cultivation associated with weedy Ae. tauschii was observed in the Alamut and Deylaman-Barrehsar districts of the central Alborz Mountain region. The results of our field survey showed that the T. turgidum–Ae. tauschii association hypothesized in the theory of bread wheat evolution still exists in the area where bread wheat probably evolved. [ABSTRACT FROM AUTHOR]

Clinicians must pay attention to the clinical presentation and consequences of hydatid cysts in rare sites. Cysts close to the aorta require planning and assistance of a cardiac or vascular surgeon before surgical intervention can be considered. [ABSTRACT FROM AUTHOR]

A 69-year-old woman presented with a 2-week history of chest pain and mitral and aortic valve replacement 15 and 5 years earlier. Transthoracic echocardiography revealed a well-seated monoleaflet mitral valve and a bileaflet aortic valve with normal function. Cardiac catheterization showed 3-vessel coronary artery disease and an abnormal cluster of new vessels derived from the left atrial circumflex and posterior ventricle branches. Two- and 3-dimensional transesophageal echocardiography identified a semi-mobile oval left atrial mass with multiple internal cystic spaces, attached to the fossa ovalis region in the interatrial septum. The mass was resected. The pathological diagnosis was atrial myxoma. [ABSTRACT FROM PUBLISHER]

Background and Aims: Zinc (Zn) has various significant roles in physiological functions of the liver. Furthermore, it has been reported that the administration of zinc has an important role in pharmacotherapy of viral hepatitis. Cirrhotic patients with decrease in plasma zinc level have been covered in previous studies. It is seemingly necessary to assess the zinc level, in Iranian cirrhotic patients, as a distinct population, Because of the large phytate amounts in Iranians diet. Regarding to etiology, disease progress, and treatment, there are some differences in the 2 most common causes of cirrhosis in the Iranian population (hepatitis B and hepatitis C) and it is possible that the zinc level may be different between the two. This study was done to shadow some lights on the subject. Methods: Between April 2008 and November 2008, plasma zinc level was determined, by atomic absorption method, in 60 cirrhotic inpatients treated due to hepatitis B or hepatitis C in Talighani hospital (a referral center for gastrointestinal and liver diseases in Tehran, Iran). Results: Mean ± standard deviation (SD) plasma zinc levels determined 0.34±0.22 mg/L and 0.37±0.22 mg/L in hepatitis B and hepatitis C patients respectively. Analysis of t-test showed there is no significant difference between 2 groups regarding to plasma zinc level (P = 0.745). Conclusions: It is concluded that zinc level of studied cirrhotic patients is less than half of the normal range. Moreover, there is no difference in plasma zinc level between cirrhotic patients due to hepatitis B or hepatitis C. Regarding to this result, supplementation with complementary zinc, may be recommended in both groups in order to optimize the nutritional support and probably better the treatment response. [ABSTRACT FROM AUTHOR]

Medication errors are among the most common medical errors in the hospitals. Transcription error is a specific type of medication errors and is due to data entry error that is commonly made by the human operators. This study was designed to detect transcription errors in a teaching hospital in Tehran. Direct observational method was used in this study. Error was defined as any deviation in transcribing medication order from the previous step (order on the order sheet, administration nursing note and/or cardex, documentation of the order in the pharmacy database). A total of 287 charts with 558 opportunities for error were reviewed. Of those opportunities for error 167 (29.9%) resulted in an error. Omission (the patient did not receive the medication that was ordered) was the highest (52%) transcription error type seen in this study. The evaluation clearly showed that errors at transcription stage were not infrequent. To cut these errors down we suggest implementation of surveillance systems, which might help to decrease medication errors. [ABSTRACT FROM AUTHOR]

Median sternotomy is the most common procedure in child and adult cardiac surgery so, 75000 sternotomy is operating in America. Despite that patients receive antibiotic prophylaxis, sternal wound infections are the most serious and most important complications of open-heart surgery. 1% to 2% of patients who undergo sternostomy are suffering from this condition. Other surgical complications of open-heart surgery can be named sternal dehiscence and mediastinitis can increase risk of morbidity and mortality. Sternal dehiscence usually occurred in patients with osteoporosis, age>75 or morbid obesity and with renal failure, chronic obstructive pulmonary disease, diabetes mellitus and sternal wound infection. Healing of sternum is a complex process so the process of bone fracture healing and the chemical factors that involve are not fully known. Consequently, finding methods to reduce the effects of openheart surgery is necessary. Traditional medicine with a long history can provide effective treatment of various diseases. Considering the properties of traditional medicine such as low adverse effects, public confidence and availability, World Health Organization has suggested the use of medicinal plants. Medical plants play an important role in folk medicine so todays use of herbal medicine increase substantially. Mummy, Mumnaye or Shilajit is a blackish brown exudate found in cracks and fractures of mountains. This herbomineral drug is resulting from oxidizing oil and traditionally has been used in treatment of various diseases. Many studies have indicated diverse therapeutic effects of Mummy. stimulates the immune system, antioxidant and anti-inflammatory activities also improve symptoms of stomach disorders, inflammation of joints, nervous and cardiovascular issues, and strains of muscles and tendons and urinary tract infections are the part of the benefits of this herbal drug. But what is important in the study is its role of Mummy in wound healing and improvement of bone fracture in open-heart surgery. In traditional medicine, Mummy utilize in reduction of pain and improve of bone fracture so todays research confirm positive effects of Mummy in clinical trial and in-vivo system. Also studies showed no side effect or complication of Mummy and as a result use of Mummy is safe. Mummy not only reduce time of healing but also decrease risk of infection in medial sternotomy. Finally, it seems Mummy as a herbal medicine can decrease complication of sternotomy due to improve of wound healing, reduce pain and duration of bone fracture healing and decrease of risk of infection although further clinical trial studies are necessary. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) is one of the most important causes of death in the world. Coronary artery bypass grafting (CABG) is a surgical procedure, which reduces mortality rate among CAD patients. Although CABG is commonly performed around the world, and the overall risk of mortality has decreased relatively, many patients may experience preoperative stress and anxiety before this surgery. Several studies have indicated that stress could influence surgical outcomes, while decreasing the prognoses of CABG. Some of the complications caused by CABG are atrial fibrillation, cardiac failure, posttraumatic stress disorders and fatal cardiac arrest. One study claimed that even mild levels of stress could increase the risk of mortality about two fold after CABG. Therefore, effective methods are required as to reduce anxiety in cardiac patients. Today, preoperative methods, such as the use of anti-anxiety drugs, meditation and music, are known to reduce stress among cardiac patients; however, usual anxiety treatments may not be effective in some cases. In this regard, medicinal herbs could be used as alternative treatments due to their solid history and effective mechanisms. Citrus aurantium (bitter orange) is a medicinal plant used for the treatment of insomnia, urinary infections, headaches, muscular pain, nausea, vomiting and reduction of anxiety. Antioxidant and antimicrobial properties of citrus aurantium have been confirmed by several studies. The main component of the essential oil of this herb is limonene. Anti-anxiety mechanism of citrus aurantium involves the mild stimulation of β-3 adrenoceptor. In one research, this plant was reported to reduce blood pressure, heart rate and stress with its vasodepressor properties. Furthermore, Akhlaghiet al. indicated that citrus could decrease preoperative stress among different patients. It seems that in addition to its cardiovascular effects, citrus could reduce the complications of CABG, as well as the preoperative stress and postoperative complications caused by this surgical procedure. [ABSTRACT FROM AUTHOR]

Load frequency control (LFC) is a well-established issue in design and operation of power systems considering to the extension, restructuring, and complexity of the interconnected power systems and also the emergence utilization of renewable energy resources. This paper studies the frequency control of multi-area multi-source power system based on the importance of the LFC in the stability of the power system which includes various generation units of thermal, hydroelectric, wind, natural gas and diesel under the restructured environment. In this system, non-linear physical constraints, governor dead band (GDB) and generation rate constraint (GRC) are considered. In this paper, a new Predictive Functional Modified PID (PFMPID) controller is proposed that the effectiveness of this controller is verified compared to the traditional one. In order to optimize and demonstrate the superiority of the proposed control method, Grasshopper Optimization Algorithm (GOA) is proposed as a suitable solution. To further improve the performance of the under study system, the use of the Redox Flow Battery (RFB) energy storage unit has also been proposed. Since the operation evaluation of the proposed process is necessary in different system conditions, the performance of the proposed method is studied under various disturbances and simulation results are presented. • A new PFMPID controller using an appropriate optimization algorithm is proposed for LFC. • The wind and diesel generation units are proposed in some areas to improve the LFC performance. • The Grasshopper Optimization Algorithm is proposed to optimize the control parameters. • In order to further improve the LFC performance, the Redox Flow Battery units are considered. • The effectiveness of the proposed method is investigated under various possible disturbances. [ABSTRACT FROM AUTHOR]

Situs inversus with levocardia and congenitally corrected transposition of the great arteries represents a relatively very rare congenital condition and most patients are diagnosed in infancy or early age. This case report describes a 35-year old man with congenitally corrected transposition of the great arteries which presented with a five month history of exertional dyspnea. A diagnosis was confirmed by transesophageal echocardiogram, showing situs inversus, levocardia, atrioventricular and ventriculoarterial discordance. He underwent physiologic repair, and was discharged thirty five days after the operation, in a good general condition. Although management of the corrected transposition of the great arteries patients remains controversial, the recommendation is that physiologic repair may be the procedure of choice for some patients, particularly complicated cases. [ABSTRACT FROM AUTHOR]

Persistent pneumothorax is a life-threatening complication that can occur after congenital cardiac surgery. Traditional treatment such as chest tube drainage may not be effective in managing this condition. This study presents a new minimally invasive method for treating persistent pneumothorax using platelet-rich plasma-fibrin glue (PRP-FG). The method has been successful in treating postoperative chylothorax in previous studies, and its use has decreased morbidity, mortality, and hospital stay in chylothorax patients. Ten patients with persistent pneumothorax following cardiothoracic surgery (3 TAPVC, 2 d-TGA, 2 VSD + IAA,1 TRUNCUS + TAPVC, 1 VSD + COA, 1 GLENN), who did not respond to conservative management, underwent treatment with PRP-FG. Follow-up was done for a period of 1-4 years. The age and diagnoses of pneumothorax after surgery were 85.5 ± 36.0 days and 62.4 ± 34.3 h, respectively. Persistent pneumothorax of 8 patients (80%) was cured completely after PRP-FG injection. PRP-FG therapy was failed in two patients who died. All cured patients had a normal life without any complications during follow-up. After PRP-FG injection, 3 patients stopped bubbling at one-time injection, 3 patients stopped bubbling at two-time injection, and 2 patients stopped bubbling at three-time injection. Two patients died during treatment; in these cases, one-time injections were done which was not successful. Persistent pneumothorax after congenital-cardiac surgery can be treated successfully with PRP-FG. This bedside minimal-invasive procedure may significantly decrease the morbidity and mortality rate. Further research is needed to confirm the efficacy of this promising treatment through multicentre clinical trials., (© 2023. Italian Society of Surgery (SIC).)

Background: Arrhythmia occurring during and after surgery is one of the major complications in open-heart surgery. Dexmedetomidine is an intravenous alpha-2 agonist and very specific short-acting drug to protect the various organs against ischemic injuries and blood reflow. However, the effect of dexmedetomidine for preventing intraoperative heart arrhythmias has not been recognized., Objective: This study aimed to determine the effect of dexmedetomidine on the incidence rate of heart arrhythmias and anesthetic required in off-pump coronary artery bypass surgery., Methods: This randomized clinical trial was conducted on patients who were candidates for off-pump coronary artery bypass referring to Imam Reza Hospital of Mashhad, Iran, from July 2016 through January 2017. The patients were randomly assigned to two groups of intervention (infusion of 0.5 mcg/kg/h dexmedetomidine together with induction followed by infusion of 0.5 mcg/kg/h by the end of the surgery) or control (saline infusion). Mean arterial pressure (MAP) and heart rate (HR) were measured before induction, during surgery operation and ICU admission. Data were analyzed by SPSS version 18 using Chi Square and independent-samples t-test., Results: A total of 76 patients with a mean age of 59.8 ± 8.2 years (in two groups of 38) were studied. The two groups had no statistically significant difference in terms of background variables. The MAP and HR values before induction, during surgery and ICU admission were significantly higher in the control group than in the intervention group (p=0.001). Out of the studied arrhythmias, the values of PAC (55.2% vs. 15.7%), PVC (81.5% vs. 21.0%), AF (26.3% vs. 7.8%), VTAC (21.0% vs. 2.6%) were significantly lower in dexmedetomidine group (p=0.001)., Conclusion: It seems that dexmedetomidine administration during induction and surgery can cause significant reduction in most of the common arrhythmias in off-pump coronary bypass surgery. The use of dexmedetomidine maintains MAP and HR at significantly lower values, and changes compared to the control group as well as reduces the need for anesthetic compounds., Trial Registration: The present study has been registered at the Iranian Registry of Clinical Trials (www.IRCT.IR) with a code of IRCT2016072413159N9 before starting the study., Founding: This study was fully sponsored by the Research Deputy at Mashhad University of Medical Sciences, Iran (grant number 941413)., Competing Interests: Conflict of Interest: There is no conflict of interest to be declared.

We present a 29-year-old woman who was admitted to the emergency department with shortness of breath. Using echocardiography, a giant multi-cystic mass was detected in the right ventricle, attached to the septal leaflet of the tricuspid valve and basal portion of the interventricular septum. Serologic tests (hydatid cyst antibody) confirmed Echinococcus infection. Lung computed tomography with intravenous contrast showed involvement of the pulmonary vasculature. The patient underwent cardiac surgery and the large cardiac cyst and the one in the right pulmonary artery branch were both removed. The tricuspid valve was also replaced by a bioprosthetic one. Albendazole was started preoperatively and was continued for six months after surgery. The patient recovered uneventfully and was followed up for one year. This is a report of a rare case of a very large cardiac hydatid cyst complicated by pulmonary embolism with attachments to both the tricuspid valve and interventricular septum.