Search

Background: Hyperuricemia is associated with an increased risk of cardio-and cerebrovascular disease (CVD) in general population. However, in the hemodialysis (HD) patients, low serum uric acid (SUA) increases the risk of mortality. Considering that CVD is the principal cause of death among maintenance HD patients, the present study aimed to determine the predictive value of SUA for CVD outcome in this population.

Acute pulmonary thromboembolism is a critical and sometimes fatal event that is difficult for clinicians to diagnose because of its various initial manifestations. Here, we report a previously healthy 50-year-old man without any history of seizures who presented to the emergency ward with the new-onset seizure. Neurology consult was performed, but found no focal neurological deficits. The diagnosis of massive pulmonary embolism was confirmed by echocardiography and pulmonary CT angiography. Alteplase and heparin with therapeutic dosage were started for the patient. After initiating treatment, patient's dyspnea, arterial O2 saturation, and general condition were significantly improved. Echocardiography was repeated and showed a smaller right ventricle size and lower pulmonary artery pressure than the first echocardiography. [ABSTRACT FROM AUTHOR]

Background: Inflammation has been considered as a possible mechanism for the initiation and recurrence of venous thromboembolism (VTE). Statins have anti‐inflammatory and potential immune‐modulatory effects, but their effect on plasmad‐dimer levels is controversial. Hypothesis: In this study, we aimed to evaluate the impact of rosuvastatin on D‐dimer and other inflammatory serum markers in VTE patients. Methods: We conducted a prospective, randomized study on 228 patients with VTE. Control group received conventional treatment (warfarin or rivaroxaban), whereas rosuvastatin‐intervention group received rosuvastatin 10 mg daily, in addition to their conventional treatment for 3 months. Serum markers were extracted from both groups at the baseline and 3 months after the beginning of treatment. Results: After 3 months, in patients of the intervention group, there was a statistically significant decrease in levels ofd‐dimer and mean platelet volume (MPV) but no significant change in neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio. Conclusions: Our results showed that a 3‐month treatment with 10 mg rosuvastatin daily can significantly decrease the plasma levels ofd‐dimer and MPV, which would support a potential role of statins to reduce activated systemic inflammation among VTE patients. Such effects can be used to reduce the rate of recurrent VTE in these patients. [ABSTRACT FROM AUTHOR]

As marijuana, the most widely-used illicit drug in adolescents and adults, has some unknown side effects, marijuana abuse has become a public health concern. Also, marijuana affects different organs such as heart in its rate, rhythm and coronary flow; it eventually leads to events such as myocardial infarction and rarely myocarditis. A 24-year-old man without any medical history or cardiovascular risk factors presented with chest pain after marijuana consumption. Based on electrocardiogram, myocardial cytolysis and transthoracic echocardiography acute myocarditis diagnosis was established. A few days later, transthoracic echocardiography showed a small clot in apex with reduced left ventricle ejection fraction, in the absence of local akinesia. The patient was discharged with oral anticoagulant stable and without any symptoms. The myocarditis after marijuana abuse is rare. The physicians should include acute myocarditis in differential diagnosis of a patient with chest pain after using marijuana. [ABSTRACT FROM AUTHOR]

Background: Accurate risk stratification is the most important step in the management of patients with acute pulmonary thromboembolism (PTE). Pulmonary embolism severity index (PESI) is a clinical tool for PTE risk stratification. CHA2DS2‐VASc score, a risk assessment tool in patients with atrial fibrillation, is recently considered for acute PTE. The presence of right ventricular (RV) dysfunction in imaging is more efficient in acute PTE risk evaluation. Hypothesis: This study aims to evaluate the association between CHA2DS2‐VASc and PESI score and each of them with RV dysfunction on computed tomography pulmonary angiography (CTPA). Methods: One hundred eighteen patients with a definite diagnosis of PTE were entered. The CHA2DS2‐VASc and PESI scores were calculated for all of them. RV dysfunction including an increase in RV to left ventricular diameter ratio, interventricular septal bowing, and reflux of contrast medium into the inferior vena cava was examined by CTPA. Results: PESI and CHA2DS2‐VASc scores were significantly associated with RV dysfunction. In addition, different classes of PESI scores were correlated with RV dysfunction. Moreover, this study showed that the CHA2DS2‐VASc score and PESI score had a positive correlation. The area under the curve value for the CHA2DS2‐VASc score was 0.625 with 61.54% sensitivity and 60.0% specificity for predicting RV dysfunction while for PESI score was 0.635 with 66.7% sensitivity and 60.0% specificity. Conclusion: This study showed that not only CHA2DS2‐VASc and PESI scores are positively correlated, but they are both associated with RV dysfunction diagnosed by CTPA. CHA2DS2‐VASc and PESI scores are able to predict RV dysfunction. [ABSTRACT FROM AUTHOR]

Objective. Novel inflammatory indices are a potential substitute for traditional markers which their correlation and clinical application in different autoimmune diseases are still in question. In this study, we evaluated the association of platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) with systemic lupus erythematosus (SLE) activity. Methods. We included 103 SLE patients in our study, compared to a matched pair of 103 healthy individuals. A blood sample was drawn to measure SII, PLR, NLR, C-reactive protein, erythrocyte sedimentation rate, autoantibodies, and complement levels. Independent sample t-test, chi-square, and Mann-Whitney U test were implemented for variables as appropriate. Linear regression was used to evaluate the factors that predict SLE activity. Results. Our study revealed that NLR, PLR, and SII between SLE patients and the control group were significantly different. SII and NLR were correlated with renal manifestations of SLE. PLR was correlated with SLEDAI, and an independent factor of SLE activity after adjusting for multiple factors, but not NLR and SII. Conclusion. We demonstrated that only PLR was an independent predictor of SLE activity. This may suggest that NLR and SII are more nonspecific inflammatory markers, compared to PLR being prognostic of SLE activity. [ABSTRACT FROM AUTHOR]

Background. Novel blood-derived indices are a potential substitute for traditional inflammatory markers which have disputable correlations and clinical applications in different immunological diseases. Hereby, we aimed to reveal the association of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) with disease activity score (DAS28) and clinically active disease according to simple disease activity index (SDAI). Methods. We included 250 patients and they were grouped equally based on SDAI into two groups of patients in remission and with active disease. A blood sample was drawn from our patients to measure NLR, PLR, SII, rheumatoid factor, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Independent samples t-tests, chi-square, and Mann-Whitney U test were used accordingly. Logistic regression evaluated the factors that affect active RA. Results. PLR, DAS28, rheumatoid factor, quantitative and qualitative ESR and CRP had a significant difference between patients with active RA and in remission. SII had significant correlation with DAS28 but PLR and NLR were not correlated with DAS28. Also, PLR was the only index to be correlated with clinically active disease based on SDAI. The logistic regression showed that NLR, SII, ESR, and CRP were independent factors predicting active RA. Conclusion. We demonstrated that SII was significantly correlated with DAS28 and PLR was correlated with active RA. NLR, SII, CRP, and ESR were independent risk factors for RA flare-ups. [ABSTRACT FROM AUTHOR]

Introduction: Mean Platelet Volume (MPV) has been revealed to be a risk factor for ischemic heart disease in the hemodialysis patients .The aim of present study is to investigate the association between MPV level with inflammatory and nutritional factors in patients requiring chronic hemodialysis.Methods: 100 patients who were on maintenance hemodialysis were included. Based on the median MPV (8.7 fL) patients were divided into two groups of low and high MPV level to assess and compare in terms of inflammatory (erythrocyte sedimentation rate, C-reactive protein, and transferrin), and nutritional (albumin, ferritin, uric acid, blood urea nitrogen, creatinine, triglyceride, cholesterol, low density lipoprotein, and high density lipoprotein) parameters.Results: The median MPV level in our patients was 8.7 ± 1.8 fl. There was no statistical difference in the level of inflammatory and nutritional markers between the two groups, and none of them were related to MPV level (P > .05). The prevalence of IHD was significantly higher in the high MPV group (P < .05). After adjustment for the age, no association was observed between different parameters and MPV level except for transferrin in patient's ≤ 60 years old. Mean transferrin levels were significantly lower in the high MPV group (P < .05).Conclusion: Present study did not show any association between inflammatory and nutritional markers with MPV level in hemodialysis patients except for the transferrin level in younger cases. [ABSTRACT FROM AUTHOR]

Background and Aims: A better identification of the role of vitamin D in the thrombotic process of acute coronary syndrome (ACS) will help increase the therapeutic options for this important clinical condition. There is little published evidence that 25-hydroxy vitamin D (25(OH)D) serum levels can associate with platelet function and risk of thrombosis., Materials and Methods: This prospective study was conducted on 200 patients with a diagnosis of ACS, including patients with unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). In addition to demographics and angiographic data, serum concentrations of 25(OH)D and MPV were recorded in all patients., Results: The types of ACS were STEMI (35%), NSTEMI (25%), and UA (40%). The concentrations of 25(OH)D in patients with UA, NSTEMI, and STEMI were 23.53 ± 13.26, 19.25 ± 8.09 and 14.60 ± 8.24 ng/mL respectively (P < 0.001), and the values of MPV were 9.83 ± 1.35, 10.30 ± 1.21, and 11.56 ± 1.38 fL, respectively (P < 0.001). There was a negative correlation between 25(OH)D and MPV (R = -0.320, P < 0.0001). ROC analysis illustrated a moderate predictive value (AUC 0.706; 95% CI, 0.63-0.72) in identifying the discrimination threshold of MPV (≥ 9.90 fL) for vitamin D deficiency (<20 ng/mL)., Conclusion: The current study shows an inverse association between MPV and vitamin D levels in ACS patients, especially in the subgroup of STEMI. These findings propose the effect of vitamin D on platelet size and function, suggesting its role in thrombosis and hemostasis, which might explain the link between vitamin D deficiency and cardiovascular diseases., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Marijuana is a widely used illicit substance among young adults and its abuse has been reported worldwide. Marijuana is a rare trigger of acute myocardial infarction and acute pancreatitis. We present a 25-year-old man with acute pancreatitis subsequently complicated by acute ST-elevation myocardial infarction (STEMI), which was associated with marijuana abuse. This case highlights the need and importance of awareness among public about this rare but potentially lethal adverse effect. Also, it draws attention when clinicians confront patients with history of substance abuse, they should be alert to the possibility of concurrent occurrence of serious medical conditions that may be adverse effects of substance use. Acute pancreatitis with concurrent acute STEMI is a rare situation but is a challenge for many emergency physicians, and it can lead to trouble outcomes if it not be quickly diagnosed and properly managed. We demonstrate successful management in this complicated patient with primary angioplasty.