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Tacrolimus (FK506) is the most widely used anti-rejection drug in kidney transplantation, especially its extended release Tacrolimus formulation (ER-Tac, Advagraf), which is used when target blood levels can be difficult to reach in high metabolizer patients. In this retrospective monocentric study, we analyzed the effect of a switch from ER-Tac to LifeCycle Pharma Tacrolimus (LPCT, Envarsus) on the dose/level ratio of FK506 in high metabolizer patients that cannot achieve target blood levels in the first 6 months after transplantation. We observed a statistically significant improvement in the level to dose ratio after the switch. Renal function remained stable. We also observed a reduction in the development of tremors. Our data suggest that LPCT can be used in a safer way in high metabolizer kidney transplant recipients.

Hepatitis C virus (HCV) causes increased mortality and morbidity in kidney transplant patients. Interferon-based therapies are poorly tolerated and involve the risk of rejection. The new direct-acting antiviral drugs (DAAs) have revolutionized the treatment of HCV infection in transplant patients. This observational study evaluates changes in immunosuppressive therapy during treatment with DAA in renal transplant recipients. In our transplant center, we selected seven HCV-positive patients at the time of transplantation , four men and three women, with an average age of 61 ± 7 years, in therapy with DAA. The dose and the blood levels of the immunosuppressive drugs were evaluated at the beginning and end of antiviral therapy, together with creatinine and proteinuria. Viremia was negativized in all patients within the initial 8 weeks of therapy. Currently, the number of patients is too limited to perform a sta-tistical analysis and obtain significant results. In one patient, the dose of Cyclosporine was lowered to 10 mg, while for the remaining patients it was not necessary to change the dose of immunosuppressive drugs. DAAs give encouraging results in the eradication of HCV in renal transplant recipients, although they are associated with potential adverse drug interactions. The preliminary data of our study suggest that it is not necessary to change the dose of immunosuppressive drugs during therapy and that creatinine and proteinuria remain stationary. We will achieve more significant results in the future, adding more patients to our study. However, further randomized trials are necessary to confirm the safety of DAAs.

Background: In recent years, the rise of workplace racial discrimination and microaggressions has decreased the efficiency and productivity of organizations and institutions, and realization of organizational goals globally. Accordingly, it was decided to conduct a systematic review and meta-analysis in the present study with the aim of investigating the prevalence of microaggression and racial discrimination in the workplace. Methods: The PubMed, Scopus, Web of Science, ScienceDirect and Google Scholar databases were systematically searched for studies that had reported the effects of work stress among managers. The search did include a lower time limit and was conducted in June 2023. The heterogeneity of the studies was investigated using the I2 index, and accordingly random effects method was adopted for meta-analysis. Data analysis was conducted with the Comprehensive Meta-Analysis (v.2) software. Results: In the review of seven studies with a sample size of 2998 people, the overall prevalence of microaggression and racial discrimination in the workplace was found to be 73.6% and 18.8%, respectively. Publication bias within the selected studies was examined with the Egger's test, which indicated the absence of publication bias for the pooled prevalence of workplace microaggression (p: 0.264) and for the pooled prevalence of workplace racial discrimination (p: 0.061). Conclusion: The results obtained from this report indicate the high impact of micro-aggression and racial discrimination in the workplace. Considering the negative effects of such behaviours, the findings from this study will be helpful to managers and health policymakers.

Abstract Background Isolated pulmonary valve endocarditis (IPE) accounts for less than 2% of all infective endocarditis patients. It is commonly associated with several predisposing factors, including intravenous drug use (IVDU) and congenital heart disease. The most common causative pathogens of IPE are Staphylococcus aureus and Streptococcus viridans. We report a Down’s syndrome patient with IPE and with no standard risk factors caused by the rare pathogen Acinetobacter spp. This led to respiratory failure and systemic infection due to septic pulmonary emboli. Early elective surgery was decided upon as the patient was no longer responding to medical therapy, and his clinical condition was worsening over time. Case presentation A 15-year-old male with Down syndrome and no underlying heart defect presented with a 3-month history of episodic fever, nausea, vomiting, and diarrhea. Transthoracic echocardiography (TTE) revealed large vegetation on the pulmonary valve leaflet, another mobile mass at the pulmonary artery bifurcation, and severe pulmonary regurgitation. Serial blood cultures isolated Acinetobacter spp. Despite initial antibiotic therapy, the patient continued to have sepsis, unresolved vegetations, and developed life-threatening complications and respiratory distress, which convinced us to perform a pulmonary valve replacement surgery with a homograft. After surgery, the patient recovered and was discharged on the ninth postoperative day (POD). Conclusion This report highlights IPE’s diagnostic and therapeutic challenges, alongside the importance of a comprehensive cardiopulmonary workup in patients with unexplained fever, sepsis, and pulmonary symptoms, even without typical risk factors. Based on the patient’s aggravating condition despite medical treatment, early surgical intervention and pulmonary valve replacement were deemed crucial. However, there still needs to be a definitive guideline on when and how surgery should be performed in patients with complicated IPE, especially in pediatric patients.

End-stage renal disease (ESRD) is a progressive chronic condition that is strongly associated with cardiovascular mortality. ESRD patients usually benefit significantly from kidney transplantation. Pulmonary hypertension (PH) is a common finding in ESRD patients that adversely affects their survival. It has also been associated with adverse increased mortality and morbidity following kidney transplantation. However, PH has also been thought to improve following kidney transplantation. The exact underlying pathophysiology of PH in ESRD patients is unknown. However, it has been believed to be multifactorial, involving endothelial dysfunction, volume overload, and arteriovenous fistula. Management of PH in kidney transplant candidates and ESRD patients is remarkably understudied. Several treatment options are available for the treatment of PH. However, studies conducted on treating PH in ESRD patients are scarce. There is an increased need for studies on ESRD patients with PH.

Abstract Background Obesity is a known risk factor for atherosclerosis and cardiac disease. Hypothesis This study evaluated the effect of significant weight loss following bariatric surgery on myocardial deformation indices and right ventricular size (RV). This was a prospective cohort study. Morbid obese patients scheduled for bariatric surgery from July 2017 to February 2018 at Firoozgar Hospital were included in our study and referred for transthoracic echocardiography at Rajaie Cardiovascular Medical and Research Center. Results Thirty-four patients entered the study. The absolute value of global longitudinal strain (GLS) at baseline, 3, and 6 months after surgery was 17.42 ± 2.94%, 18.24 ± 3.09%, and 19.52 ± 2.78%, respectively, with a statistically significant difference from baseline to after six months (P value

Abstract Background Fungal endocarditis is a rare but serious condition associated with high mortality rates. Various predisposing factors contribute to its occurrence, such as underlying cardiac abnormalities, cardiac surgeries, prosthetic cardiac devices, and central venous catheters. Diagnosing fungal endocarditis, particularly Aspergillus, poses challenges, often complicated by negative blood cultures. Case presentation This report details a case of extensive ascending aorta involvement in Aspergillus endocarditis (AE) in a 24-year-old man with a history of bioprosthesis aortic valve replacement (AVR). Three months post-AVR, he presented with pericardial effusion and aortic rupture, leading to a redo biological valved conduit aortic root replacement (Bentall surgery). Despite the intervention, the tubular graft exhibited extensive Aspergillus involvement, resulting in graft disruption and significant peri-aortic infection. A second redo procedure involving aortic homograft root replacement was performed. Unfortunately, the patient succumbed two days after the surgery. Conclusion A combined approach of medical and surgical therapies is recommended to manage fungal endocarditis. Despite efforts, the mortality rate associated with Aspergillus endocarditis remains unacceptably high, with no significant difference observed between combination therapy and antifungal treatment alone. Further research is essential to explore novel therapeutic strategies and improve outcomes for patients with this challenging condition.

Abstract Background Mechanical heart valve replacement is a standard treatment for severe valvular disorders. The use of mono-leaflet valves has decreased recently. Recognizing the echocardiographic features of mono-leaflet and bileaflet valves is crucial for accurate complication diagnosis and proper management. Case Presentation A 65-year-old female with mono-leaflet mitral and bileaflet tricuspid valves underwent an echocardiographic assessment. This simple educational case provides a unique opportunity to compare the echocardiographic features of these valves within a single patient. Conclusion There is a crucial need for clinicians, particularly those in training, to differentiate between mono-leaflet and bileaflet mechanical heart valves adeptly. With mono-leaflet valves decreasing in prevalence, proficiency in recognizing the echocardiographic nuances of each type is imperative. Failure to do so may result in misdiagnoses and inappropriate management. This underscores the significance of continuous education and vigilance in echocardiographic assessments to ensure optimal patient care.

Key Clinical Message Rudimentary left atrial appendage (LAA) is an extremely rare condition with an unclear association with cerebrovascular events. This case report discusses a patient with an unexplained cerebrovascular accident (CVA), where the diagnosis of rudimentary LAA was made using transesophageal echocardiography (TEE) and subsequently confirmed by computed tomography angiography (CTA). Abstract Rudimentary left atrial appendage (LAA) is extremely rare. This report presents the case of a 50‐year‐old woman who experienced a cerebrovascular accident (CVA) and was found to have a rudimentary LAA. The patient had a history of diabetes mellitus (DM), hypertension, and dyslipidemia. An electrocardiogram (ECG) showed sinus rhythm, and Holter monitoring did not detect any atrial fibrillation (AF). Transesophageal echocardiography (TEE) and computed tomography angiography (CTA) were performed to identify the source of cardiac emboli, revealing a rudimentary LAA with no thrombus present.

This paper aims to contribute reliable information to promote the pharmacological utilization of Papaver bracteatum by analyzing its wild population in Iran. For this purpose, 27 Iranian poppy specimens from 7 provinces of Iran were analyzed. The highest thebaine concentrations were detected in the capsules, whereas they were relatively lower in the flowering stems. Maximal concentration (more than 53 mg/g d.w.) was present in the P. bracteatum plant capsules growing in the Zanus region of Mazandaran province. Surprisingly, the thebaine concentration varies drastically excessively among the tested specimens, ranging from 5 to more than 53 mg/g d.w. Up to now, it is not known whether these drastic differences are due to clonal variations or the differences in the growth conditions, e.g., due to different stress levels of the plants. There is no doubt that the Iranian poppy represents an important alternative source for thebaine, yet, further studies and research are required to promote the farming of this auspicious pharmaceutical plant. In this context, it is of special interest to elucidate the effects of potential genotypes, the impact of the growing conditions as well as seasonal effects.

Abstract Background Echocardiographic estimation of left ventricular filling pressure in heart transplant (HTx) recipients is challenging. The ability of echocardiography to detect elevated left ventricular end-diastolic pressure (LVEDP) in HTx patients was assessed in this study. Results This descriptive cross-sectional study included 39 HTx recipients who were candidates for endomyocardial biopsy as a part of their routine post-transplantation surveillance. Doppler transthoracic echocardiography was done before the procedure, and left heart catheterization was done during the endomyocardial biopsy. Thirty-nine patients (15 female, 24 male), with a mean age of 39.6 years (range 13–70), were enrolled. A strong relation was observed between lateral E/e′ and LVEDP (R = 0.64, P value

Abstract Background Cardiac involvement is common in end-stage renal disease patients. The presenting study aimed to evaluate the global and segmental longitudinal strain in patients with advanced uremic cardiomyopathy (AUCM) and compare it to dilated cardiomyopathy (DCM). Results The mean global longitudinal strain (GLS) was significantly lower in AUCM (P value = 0.045). Comparing segmental strain showed a lower strain in mid inferoseptal (P value = 0.048), base and mid anterolateral (P value = 0.026, 0.001 respectively), base and mid anteroseptal (P value = 0.005, 0.009 respectively), base and mid inferior (P value = 0.015, 0.034 respectively) and mid anterior (P value = 0.015) in patients with AUCM compared with DCM. In both groups, the segmental strain increased from base to apex. Conclusions Segmental and GLSs in advanced uremic cardiomyopathy were significantly lower than those of dilated cardiomyopathy. In both groups, the segmental strain increased from base to apex.

Abstract Background Preoperative cardiovascular risk assessment is one of the main principles before noncardiac surgeries. Cardiac stress imaging, such as myocardial perfusion scan (MPS), is a proposed cardiovascular risk evaluation method according to the latest guidelines. Yet, its efficacy, along with the cost-effectiveness of the method, has been questioned in previous studies. Our study aims to evaluate the utility of N-terminal pro-b-type natriuretic peptide (NT-proBNP) level measurement in predicting postoperative cardiovascular complications in candidates who have undergone an MPS before surgery and compare the results. Methods A cohort of 80 patients with a revised cardiac risk index score of one or more who were scheduled for moderate to high-risk noncardiac surgeries and met the criteria to undergo an MPS for risk assessment were included in the study. All of them underwent an MPS one week before surgery. Their preoperative NT-proBNP, troponin levels, and electrocardiograms were obtained one day before surgery and again on day three postoperative. The predictive efficacy of NT-proBNP levels and MPS were compared. Results Seventy-eight patients underwent surgery, three of which exhibited a rise in troponin level, six showed changes on electrocardiogram, and pulmonary edema was detected in one, three days after surgery. There was no mortality in our patients. The sensitivity and specificity of the MPS for predicting postoperative cardiovascular complications were 100% and 66%, respectively. MPS also had a positive predictive value of 20% and a negative predictive value of 100% in our study. A 332.5 pg/ml cut-off value for NT-proBNP level yielded a sensitivity of 100%, specificity of 79.2%, positive predictive value of 40%, and negative predictive value of 100%. Conclusions Our study reveals the incremental specificity and positive predictive value of NT-proBNP level measurement in preoperative cardiovascular risk evaluation compared to MPS. Given the low feasibility, high costs, and disappointing predictive value of MPS, preoperative NT-proBNP level assessment can be substituted. This method can assist anesthesiologists and surgeons with precisely detecting at-risk patients resulting in taking proper measures to reduce the morbidity and mortality of the proposed patients before and during surgeries.

Objective(s): The prevalence of coronary artery disease (CAD) is high in patients with epilepsy using antiepileptic drugs (AED). Epilepsy, AED, or the type and duration of AED use , may contribute to higher CAD risk.In this study, myocardial perfusion imaging (MPI) was compared between patients using carbamazepine and valproate.Method: Out of 73 patients receiving carbamazepine or valproate monotherapy for more than 2 years, visited at a tertiary referral clinic, 32 patients participated in a 2-day stress and rest phases MPI. For each phase, 15-25 mCi 99mTc-MIBI was injected, at peak exercise or by pharmacologic stimulation for the stress phase. SPECT with cardiac gating was done by a dual-head gamma camera and processed and quantified. Scans with at least one definite reversible hypo-perfusion segment were considered abnormal.Results: Seventeen patients received carbamazepine monotherapy and 15 valproates. Age and duration of AED use were similar between the groups. Two scans were abnormal (6.3%) both in valproate group (13.3%). Duration of AED use was higher in patients with abnormal scans. In patients receiving monotherapy >2 years, the frequency of abnormal MPI was similar between groups (P-value=0.12). In patients receiving monotherapy > 5 years, prevalence of abnormal MPI was higher in the valproate group (28.6% vs. 0.0%; P-value=0.042). Considering valproate subgroup, ischemic patients had higher duration of AED use, comparing with the normal patients (17.0±4.2 vs. 6.4±4.8, P-value=0.014).Conclusion: MPIs were abnormal in patients receiving valproate after 5 years compared to patients receiving carbamazepine. Long-term valproate use may increase the risk of CAD.

Abstract Background In acute myocardial infarction (AMI), timely recognition of symptoms and early hospital presentation positively affect patient morbidity and mortality. Due to the high burden of ischemic heart disease in Iran, this study aimed to identify factors affecting the level of knowledge, responses at the time of AMI onset, and sources of health information among the Iranian population. Method This cross-sectional study was conducted in three tertiary hospitals in Tehran, Iran. An expert-validated questionnaire was used to obtain data. A total of 400 individuals were enrolled. Result Among the respondents, 285 people(71.3%) considered “chest pain or discomfort,” and 251 (62.7%) regarded “pain or discomfort in the arm or shoulder” as MI symptoms. Approximately 288 (72.0%) respondents had poor knowledge of the AMI symptoms. Knowledge of symptoms was higher among those with higher levels of education, those with medical-associated jobs, and those who resided in the capital areas. Major risk factors identified by the participants were: anxiety (340)(85.0%), obesity (327)(81.8%), an unhealthy diet (325)(81.3%), and the presence of high LDL levels (258)(64.5%) and Diabetes Mellitus (164)(41.0%) were less appreciated. Calling an ambulance (286)(71.5%) was the most common treatment-seeking behavior in the case of a suspected heart attack. Conclusion It is vital to educate the general population about AMI symptoms, particularly those with comorbidities at the greatest risk for an AMI episode.

Abstract Background Nearly half of the patients with hypereosinophilic syndrome (HES) have cardiovascular involvement, a major cause of mortality. COVID-19 infection can lead to cardiac involvement, negatively impacting the clinical course and prognosis. We reported two patients with HES complicated by COVID-19, with cardiac involvement and valve replacement. Case presentation Our first patient was a 27-year-old woman admitted due to dyspnea and signs of heart failure. She had severe mitral stenosis and mitral regurgitation on the echocardiogram. Corticosteroid therapy improved her symptoms initially, but she deteriorated following a positive COVID-19 test. A repeated echocardiogram showed right ventricular failure, severe mitral regurgitation, and torrential tricuspid regurgitation and, she underwent mitral and tricuspid valve replacement. Our second patient was a 43-year-old man with HES resulted in severe tricuspid stenosis, which was improved with corticosteroid treatment. He underwent tricuspid valve replacement due to severe valvular regurgitation. He was admitted again following tricuspid prosthetic mechanical valve thrombosis. Initial workups revealed lung involvement in favor of COVID-19 infection, and his PCR test was positive. Conclusion COVID-19 infection can change the clinical course of HES. It may result in a heart failure exacerbation due to myocardial injury and an increased risk of thrombosis in prosthetic valves or native vessels due to hypercoagulability.

Key Clinical Message Cardiac hydatidosis is a relatively rare complication of echinococcosis. Understanding the atypical manifestations, potential associated risk factors, and epidemiology leads to optimal and timely management. Abstract Cardiac hydatidosis is a relatively rare complication of echinococcosis, with a potentially life‐threatening condition. Here, we reported a large interventricular septal hydatid cyst bulging in the left ventricle accompanied by a huge cervical lamp with recurrent hepatic cysts that underwent cardiac surgery to excise the cyst uneventfully.

Abstract Atrial fibrillation is one of the major predisposing factors in developing left atrial thrombosis, leading to morbidity and mortality. Echocardiography plays a paramount role in this condition's detection and subsequent treatment.

Purpose: Defining normative aortic echocardiographic values in each geographical district is crucial as aortic valve area (AVA) may vary across races, genders, and ages. Notably, variations in normal values can have implications for clinical decision‐making, and available data on the Middle East population is also scarce. We sought to establish normal ranges for aortic valve echocardiographic parameters in the Iranian population and assess the effect of age, gender, weight, height, BMI, BSA, and blood pressure on them. Methods: Our data were provided from the web‐based echocardiographic data registry of Imam Khomeini Hospital Complex (IKHC). A total of 3251 healthy subjects older than 18 years old without any valvular stenosis were included in our study. Results: AVA's normal range was estimated at 1.92–4.52 and 1.67–3.80 cm2 in men and women, respectively. The annulus, AVA, AV VTI, and LVOT VTI were significantly larger in males, and this association remained significant after indexing AVA for weight, height, BMI, and BSA. Also, smaller AVA was associated with lower height, weight, BMI, and BSA in both men and women. Obese and hypertensive subjects had significantly larger AVA and annulus diameters. Conclusion: Our study provided region‐specific normal reference values for AV echocardiographic parameters and compared them across genders, ages, BMI, and blood pressure groups in the Iranian population. [ABSTRACT FROM AUTHOR]

Abstract Congenital heart disease is a risk factor for infective endocarditis (IE). Ventricular septal defects and ventricular outflow tract obstructions are this population's most common causes of endocarditis. We present a patient diagnosed with leukocytoclastic vasculitis, renal, and pulmonary involvement with right‐sided IE as an etiology for vasculitis.

Solid-organ transplantation recipients were assumed highly vulnerable to coronavirus disease 2019 (COVID-19). However, the results of previous studies in patients with orthotopic heart transplantation (OHT) under immunosuppressive therapy are contradictory. Therefore, we aimed to assess the prevalence of COVID-19 infection and associated risk factors, along with the six-month outcomes in COVID-19 positive OHT patients. This single-center telephone-based survey was conducted on OHT patients. Using a detailed questionnaire, exposure to COVID-19, related symptoms, and preventive self-care measures were collected. Outcomes of COVID-19-positive patients were reassessed using another survey six months later. 118 OHT patients (male: n=87, 73.7%) were included with a mean age of 45.3±13.1 years. Sixteen patients (13.5%) reported one or more symptoms compatible with COVID-19, of whom 12 (10.2%) tested positive. Our results indicated no statistically significant association between COVID-19 and comorbidities. Poor adherence to self-care measures and contact with positive index cases were both significantly associated with COVID-19 infection (P

Background: Indexed left ventricular end‐diastolic volume (LVEDVi) is a left ventricle (LV) size marker. The "Recommendations for Chamber Quantification" guideline was published in 2006 and updated in 2015. Although the previous guideline maintained uniform cutoff points for both men and women, the latest revision introduced new thresholds that vary between genders. We evaluated the extent of change in labeled indexed LV diastolic volumes in men and women following the adoption of the 2015 guideline. Methods: Data were extracted from a web‐based registry from March 2020 to October 2022. LV indexed volume variables were categorized on the basis of the 2006 and 2015 guidelines. Results: Among the 7598 individuals, the classification of LVEDVi differed in 910 (12.0%) individuals. In 213 (5.5%) female subjects, substantial reclassification (i.e., transitioning from normal to moderate LV enlargement to mild to severe LV enlargement) occurred on the basis of the 2015 guideline. All females classified as having moderately abnormal LVEDVi according to the 2006 guideline were reclassified as having severely abnormal LVEDVi according to the 2015 guideline. Age, LV ejection fraction (LVEF), and significant aortic regurgitation (AR) were common factors contributing to the observed discrepancy in both men and women. Significant mitral regurgitation (MR) and regional or global motion abnormality were correlated with the reclassification of LVEDVi to higher abnormal partitions only in women. Conclusion: The observed disparities underscore the importance of ongoing dedicated research to reassess the range of indexed echocardiographic parameters, considering various outcomes and differences in countries. [ABSTRACT FROM AUTHOR]

Objective: Although the adverse effects of smoking are well-established, evidence shows a longer survival rate following an acute myocardial infarction (MI) among smokers or the so-called "smoker's paradox". This study aimed to determine the impact of smoking on the one-year clinical outcomes of ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) in a large registry of the Iranian population. Methods: A total of 3087 patients diagnosed with acute STEMI who underwent PPCI between 2013 and 2018 were enrolled in the study. Patients' smoking status was determined based on self-reported history and categorized into two groups: current smokers and non-smokers. Clinical and angiographic data were collected from the Tehran Heart Center (THC) registry. The primary outcome was one-year of major adverse cardiac and cerebrovascular events (MACCE). The effect of smoking on MACCE was evaluated using a Cox model. Results: From the study population, 1967 (63.7%) were non-smokers, and 1120 (36.3%) were current smokers. Non-smokers had higher rates of prior CABG (5.3%) as well as a higher history of co-morbidities, including a history of diabetes mellitus (46.0%), hypertension (52.7%) and hyperlipidemia (55.4%) than smokers (2.3%, 30.4%, 35.7%, and 49.8% respectively). Smokers had a higher reference vessel diameter than non-smokers (P=0.005). The unadjusted hazard ratios (HRs) for MACCE within one year were significantly lower in smokers than nonsmokers (0.73, 95% CI: [0.58,0.92]; P=0.009); however, after adjustment for confounders, the HRs for MACCE in smokers were similar to non-smokers (HR: 1.00, 95% CI: [0.73,1.38]). Conclusion: The study found that smoking had no significant impact on the one-year clinical outcomes of STEMI patients after PPCI in the Iranian population. This study is the first of its kind to assess the effect of smoking on STEMI patients in Iran and highlights the need for further research in this area. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate and compare the characteristics of abdominal pain after bariatric surgery with two techniques of Laparoscopic One-Anastomosis Gastric Bypass (LOAGB) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) in patients with morbid obesity. Methods: This prospective descriptive-analytical study was conducted on 114 patients who were candidates for bariatric surgery. Patients were entered to study in one of two groups of LOAGB and LRYGB by convenient and continuous sampling. The characteristics of abdominal pain of patients were investigated and compared at certain periods (24 and 48 hours and 10, 20, 30, and 90 days after surgery) using McGill Pain Questionnaire. Findings: The frequency of severe abdominal pain in the LOAGB group within 48 hours after surgery was significantly higher than the LRYGB group (P < 0.05). The highest abdominal pain distribution at the first 5 time periods in the two groups was in the left lower quadrant of the abdomen. The frequency of description of ambiguous pain within 48 hours and 10 days in the LOAGB group was significantly higher than LRYGB. The frequency of pattern of periodical (intermittent) pain at the periods of 48 hours and 10 and 20 days after surgery in the LOAGB group was significantly higher than LRYGB. Conclusion: The results of this study showed that there was no significant difference in the frequency of abdominal pain and its distribution between LOAGB and LRYGB groups. However, the definitive decision to choose a bariatric surgery technique for lower abdominal pain requires further study.

Background and Aim: Cardiovascular diseases and medication errors are among the leading causes of morbidity and mortality around the world. Electronic prescribing and Medication Administration(ePMA) systems can prevent medication errors to some extent. This study aimed to determine the information requirements of ePMA systems. Materials and Methods: This descriptive study was conducted in Imam Khomeini Hospital of Tehran and School of Allied Medical Sciences affiliated to Tehran University of Medical Sciences (TUMS) in the summer of 2019 in two phases: literature review and survey-based questionnaire. Information items obtained from reviewing the texts of 100 articles were organized in three questionnaires. In the survey phase, questionnaires were distributed among physicians, nurses, and the experts of health information management(HIM) and medical informatics, using census sampling method. The reliability of the questionnaires was measured using Cronbachchr('39')s coefficient alpha. Statistical analysis was done using SPSS. Results: The findings showed that based on specialists’ point of view, patientschr('39') demographic information items and unique identifiers gained the highest average, above 4.7. Physicians agreed most with clinical information, including medication history and generic names. From the nurses’ point of view, the information items of the patients’ problems and the procedures performed and the types of drug doses obtained a complete average of 5. Conclusion: The need for information items varies among different users of ePMA systems, but there may be items that are common for them. Future studies should further investigate financial and pharmaceutical information requirements based on the perspectives of other hospital pharmacy and accounting staff.

Background: Cardiac electronic device implantation may be associated with complications. Case Summary: This is a report of inadvertent implantation of implantable cardioverter-defibrillator lead through an unrecognized sinus venosus atrial septal defect into the left ventricle that was not diagnosed early after implantation. Six months later chest x-ray showed an abnormal lead course that was confirmed with echocardiography as to be in the left ventricle. Surgical removal of the implantable cardioverter-defibrillator lead, repair of atrial septal defect, and correction of abnormal pulmonary venous connections were performed. Meanwhile, follow-up of the patient receiving a new dual chamber permanent pacemaker from the contralateral side and discussion of the aforementioned complication are addressed. Conclusion: Early diagnosis of device implantation complication is of paramount importance and prevents potential catastrophic complications. This is a report of a middle-aged woman who received a heart battery (pacemaker) without proper initial indication and faced unnecessary consequences/complications. The wire was supposed to be implanted in the right side of the heart, but due to the congenital heart disease of the patient (that was not diagnosed), the wire was erroneously passed through the congenital defect to the left side of the heart. After the diagnosis of the problem, we referred her to a heart surgeon to correct the congenital heart defect and also pull the wire out. After open surgery, a new pacemaker (with two wires) was implanted in the patient without any additional complications. Article highlights Transient loss of consciousness (syncope) may be related to cardiac causes. Adherence to guidelines-directed indications for cardiac implantable electronic devices (CIED) implantation is recommended and may obviate the need for unnecessary interventions. Venous or congenital cardiac defects may pose the physician with some challenges during the implantation of CIED. Adherence to protocols for follow-up of patients with CIED is necessary. Implantation of leads into the left side of the heart although rare should be kept in mind. This problem may remain asymptomatic or be diagnosed after a systemic embolism. Transvenous or surgical lead extraction is needed for the removal of lead erroneously implanted in the left side of the heart. Early diagnosis of complications prevents probable catastrophic complications. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Rudimentary left atrial appendage (LAA) is an extremely rare condition with an unclear association with cerebrovascular events. This case report discusses a patient with an unexplained cerebrovascular accident (CVA), where the diagnosis of rudimentary LAA was made using transesophageal echocardiography (TEE) and subsequently confirmed by computed tomography angiography (CTA). Rudimentary left atrial appendage (LAA) is extremely rare. This report presents the case of a 50‐year‐old woman who experienced a cerebrovascular accident (CVA) and was found to have a rudimentary LAA. The patient had a history of diabetes mellitus (DM), hypertension, and dyslipidemia. An electrocardiogram (ECG) showed sinus rhythm, and Holter monitoring did not detect any atrial fibrillation (AF). Transesophageal echocardiography (TEE) and computed tomography angiography (CTA) were performed to identify the source of cardiac emboli, revealing a rudimentary LAA with no thrombus present. [ABSTRACT FROM AUTHOR]