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Background. A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been affecting almost all nations around the world. Most infected patients who have been admitted to intensive care units show SARS signs. In this study, we aimed to achieve a better understanding of pathological alterations that take place during the novel coronavirus infection in most presumed affected organs. Methods. We performed postmortem core needle biopsies from lung, heart, and liver on 7 deceased patients who had died of coronavirus disease 2019. Prepared tissue sections were observed by 2 expert pathologists. Results. Diffuse alveolar damage was the main pathologic finding in the lung tissue samples. Patients with hospitalization durations of more than 10 days showed evidence of organization. Multinucleated cells in alveolar spaces and alveolar walls, atypical enlarged cells, accumulation of macrophages in alveolar spaces, and congestion of vascular channels were the other histopathologic alteration of the lung. None of our heart biopsy samples met the criteria for myocarditis. Liver biopsies showed congestion, micro- and macro-vesicular changes, and minimal to mild portal inflammation, in the majority of cases. Conclusions. Similar to the previous coronavirus infection in 2003, the main pathologic finding in the lung was diffuse alveolar damage with a pattern of organization in prolonged cases. The SARS-CoV-2 infection does not cause myocarditis, and the ischemia of myocardium is the most probable justification of the observed pathologic changes in the heart. Liver tissue sections mostly showed nonspecific findings; however, ischemia of the liver can be identified in some cases. [ABSTRACT FROM AUTHOR]

Background: Poisoning with carbamazepine is the third most common reason for status epilepticus seizure in the poisoning ward of Nour Hospital (Isfahan, Iran). No survey has been performed on the frequency of seizure among patients poisoned with carbamazepine. The relationship of such toxicity and other effective variables and treatment outcome have not been studied either. This study aimed to identify factors affecting seizure due to carbamazepine toxicity in order to help physicians make the correct decisions. Methods: In a retrospective study, information of every patient with carbamazepine toxicity who had been admitted in Nour Hospital was collected by census sampling method. Patients were then divided into two groups of with and without seizures. The two groups were compared using independent-t and Fisher's exact tests in SPSS15. Findings: During 1 year, 114 cases were admitted and 7% of cases experienced seizures. The mean dose of drugs and pH levels were significantly different between the two groups. The frequency of patients who were discharged with a complication or died was higher in the seizure group. Conclusion: Using high doses of carbamazepine increases the risk for seizure among poisoned individuals. In addition, patients with seizure are at higher risk for acidosis, complications, and death. [ABSTRACT FROM AUTHOR]

Objective: Epicardial fat is an indirect contact with coronary arteries. There are some studies about the relationship between this fat and metabolic syndrome and it has considered as an indicator of cardiovascular risk. Several studies have addressed the association between epicardial fat thickness (EFT) and coronary artery disease (CAD) with conflicting results. The aim of our study was to evaluate the hypothesis that echocardiographic EFT thickness could be a marker severe CAD. Methods: Overall, 315 cases who underwent coronary angiography were classified in two groups: Normal and CAD. Measurement of EFT was done with echocardiography. The difference between mean EFT in two groups was analyzed. Califf scoring considered for severity of CAD. Then the relationship between EFT and age, sex, body mass index (BMI), serum lipids and severity of CAD was evaluated. The obtained data were compared by using ANCOVA test, Pearson and Spearman's partial correlation analyses. Results: The EFT in CAD group was significantly higher than in normal group (5.4±1.9 mm vs 4.4±1.8mm, p=0.0001). EFT had a positive relationship with Califf scoring of diseased coronary arteries (r=0.158 p=0.04), low-density lipoprotein cholesterol (p=0.04), female gender (p=0.02), BMI (p=0.001) and serum triglyceride levels (p=0.04). Conclusion: This study shows an association between EFT thickness and severity of CAD. [ABSTRACT FROM AUTHOR]

Background: Epicardial fat tissue is known as a risk factor in cardiovascular diseases. This study was designed to compare the epicardial fat thickness in patients with cardiovascular diseases and normal patients. It also tried to find a correlation between epicardial fat thickness and severity of coronary stenosis. Methods: This study was conducted from September 2010 to April 2011 at two university hospitals (Noor and Chamran Referral centers) associated to Isfahan University of Medical Sciences, Isfahan, Iran. A total number of 196 subjects were allocate to three groups of control (n = 68), acute coronary syndrome (n = 64) and chronic stable angina (n = 64). After registering demographic data, all individuals underwent echocardiography in diastolic subcostal view to determine the epicardial fat thickness. Angiography was also conducted to assess the severity of coronary stenosis. The thickness of epicardial fat was compared between groups and its correlations with age, sex, hypertension, hypercholesterolemia, diabetes, waist circumference, body mass index and severity of coronary stenosis were evaluated. Findings: The mean age of participants was 59.54 ± 11.01 years. There were statistical differences between age, sex, smoking and severity of coronary stenosis (P < 0.001, P = 0.03, P = 0.04, and P < 0.001, respectively). The mean of epicardial fat thickness in acute coronary syndrome, chronic stable angina and control groups were 5.7 ± 2.1, 6.2 ± 2.0 and 4.6 ± 1.9 mm (P < 0.001). There were no independent correlation between predicting factors and epicardial fat thickness (P > 0.05). Conclusion: This study indicated the thickness of epicardial fat to be more in cardiovascular diseases compared with normal persons. Future studies for evaluating the sensitivity and specificity of this diagnostic method are warranted. [ABSTRACT FROM AUTHOR]

Background: Melanin, secreted hormone from the pituitary gland, has anti-oxidative activity and beneficial effects on sleep disorders, depression, cancer treatment and it is a cardioprotective hormone. In this study we investigated its effect on left ventricular function in patients with congestive heart failure. Methods: This study was a clinical trial among 60 patients with heart failure admitted to the training centers of Shahid Chamran and Noor hospitals of Isfahan, Iran. The studied patients were divided randomly on two groups: melatonin and control group. The patients in melatonin group received 3 mg melatonin daily and the control group received placebo for 2 months. The changes in functional class (FC) and left ventricular ejection fraction (LVEF) were cpmpared between 2 groups. Data was analyzed by SPSS version 18.and Paired t-test, Student t-test, Repeated-measures ANOVA and χ2. Findings: In the control group 60% of patients were male and 40% were female and in melatonin group 77.3% were male and the others were female. Mean age in control group was 67.1 ± 11.8 years and in melatonin group was 63.5 ± 6.7 years (P = 0.24). The LVEF in the control group has no significant change before and after the intervention (P = 0.24). But a significant difference on LVEF was seen in the melatonin group (P < 0.001). Conclusion: If the further studies approve our results melatonin can be used in treatment of heart failure along with other drugs. [ABSTRACT FROM AUTHOR]

A letter to the editor with response to the article "Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction" is presented.

1. Integrate telehealth strategies in their palliative care approach for heart failure patients, as demonstrated by the development of individualized care plans and effective use of remote monitoring tools. 2. Utilize telehealth technologies effectively in delivering palliative care education and support to heart failure patients, thereby expanding their capacity to reach and impact a broader patient population. The feasibility and acceptability of a nurse-led telehealth palliative care intervention for heart failure patients in Iran show promise in improving quality of life. This study lays the groundwork for future trials, highlighting the potential for enhancing care in a region with limited palliative care options for non-cancer patients. Integrating palliative care in the management of heart failure is widely recommended as a best practice worldwide. In Iran, there is currently no standardized integrative palliative care program specifically designed for heart failure patients. To determine the feasibility and acceptability of a telehealth palliative care intervention to improve the quality of life in patients with heart failure in Iran. Single-site, pilot randomized clinical trial of a telehealth palliative care intervention versus usual care. Under the supervision of a nurse interventionist, intervention participants received 6 weekly educational webinars and concurrent WhatsApp® group activities, with 6 weeks of follow-up. Feasibility was assessed by measuring recruitment, attrition, and questionnaire completion rates; acceptability was assessed via telephone interviews asking about satisfaction and attitudes. Secondary outcomes measured at baseline and 6 weeks included quality of life (PKCCQ and FACIT-Pal-14), anxiety and depression (HADS), and emergency department visits. We recruited and randomized 50 patients (mean age 47.5 years, 60% men). Among those approached for consent, 65% agreed to participate; study attrition was 10%. 68% of patients successfully completed at least 4 out of the 6 webinar sessions. Acceptability: 78% of patient participants expressed willingness to participate in the present study again or recommend other patients to participate. There was preliminary evidence for improvements in quality of life (PKCCQ= mean difference -1.54 [95% CI, -2.14 to -0.94, p< 0.001]), FACIT PAL-14= mean difference, -2.69 [95% CI, -1.16 to -4.22, p=0.001]) but not for anxiety (HADS-Anxiety= mean difference, 0.31 [95% CI, 1.20 to -0.57, p=0.45]), depression (HADS Depression= mean difference, 0.28 [95% CI, 1.23 to -0.65, p=0.54]), and emergency department visits [95% CI, -0.57 to 0.91, p=0.45]. This feasibility trial provided valuable information for the design of a future randomized controlled trial of a nurse-led telehealth palliative intervention to improve the care of people with heart failure. The study's findings could encourage policymakers to invest in the development and implementation of similar interventions and to prioritize palliative care as an essential component of healthcare services for heart failure patients in Iran. [ABSTRACT FROM AUTHOR]