Frequency of inter- and intraventricular dyssynchrony in patients with heart failure according to QRS width.

AIMS: Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure patients with prolongation of QRS duration. Despite careful patient selection, some do not respond to CRT based on QRS complex duration. We sought to evaluate the presence of left ventricular dyssynchrony using tissue Doppler imaging (TDI) according to QRS duration in heart failure patients. METHODS AND RESULTS: Ninety-nine patients (mean age 52.6 +/- 15.3 years) with severe heart failure [left ventricular (LV) ejection fraction, <35%] were prospectively evaluated. On the basis of QRS width, the patients were divided into two groups. Forty-eight patients (48.5%) had a normal QRS duration (<120 ms), Group I, and 51 (51.5%) had a prolonged QRS duration, Group II. All patients underwent echocardiography coupled with TDI. Spectral displays of six basal and six middle LV segments with pulsed-wave TDI were obtained to assess the time to peak systolic point from R-wave on electrocardiogram (Ts). The standard deviation of Ts (Ts-SD) and the maximal temporal difference of Ts (Ts-diff) were measured. Interventricular dyssynchrony [defined as the presence of an interventricular mechanical delay (IVMD) >40 ms] and intra-LV mechanical delays (defined as Ts-SD >33.4 ms and Ts-diff >100 ms) were correlated with the QRS width and morphology. We found a greater IVMD in Group II patients, compared with patients in Group I (42.5 +/- 22.3 vs. 26.8 +/- 21, respectively, P < 0.001). Intraventricular dyssynchrony defined as Ts-SD > or =33.4 ms was found in 45.1% of patients in Group II compared with 23% of patients in Group I (P = 0.03). Similarly, the Ts-diff was prolonged in Group II patients compared with Group I (P = 0.02). By linear regression analysis, a weak relation was found between Ts-SD and QRS duration (P = 0.055). A substantial portion of patients with prolonged QRS did not exhibit ventricular dyssynchrony defined either as total asynchrony index > or =33.4 ms or as IVMD >40 ms. CONCLUSION: A substantial proportion of patients with prolonged QRS (32.1%) did not exhibit inter- or intraventricular dyssynchrony, which may represent a limitation in identifying the ideal QRS interval for the selection of patients for CRT.     

Formation of ultrafine deferasirox particles via rapid expansion of supercritical solution (RESS process) using Taguchi approach

The poor water solubility of many drugs is a challenge in pharmaceutical research. Recently, there have been great interests in finding environmentally friendly methods producing fine particles of pharmaceutical products for applications in pharmaceutical engineering. A promising method to improve the bioavailability of pharmaceutical agents is the rapid expansion of supercritical solutions. Deferasirox (DFS), a tridentate chelator, requires two molecules for iron (III) coordination. The bioavailability (the percentage of the drug absorbed compared to its initial dosage) is limited by this insolubility. The effect of four different RESS parameters including, extraction temperature (308-318K), extraction pressure (140-200 bar), effective nozzle diameter (500-1200 μm), with and without cosolvents were investigated on the size and morphology of the precipitated particles of deferasirox based on Taguchi design. The results show great reduction in the size of the precipitated particles of deferasirox (50 nm-5 μm) via RESS process compared with the original particles of deferasirox (5-500 μm).     

Case of possible encephalopathy following receiving the first dose of Iranian COVID‐19Vaccine; COVIran Barakat

We report a case of possible encephalopathy after receiving the first dose of Iran''s COVIran Barekat vaccine. The patient had no history of neurological or mental illness. Clinical examinations and radiology reports were performed and differential diagnoses were analyzed by the treatment team. Finally, the possible association between vaccination and encephalopathy was concluded.     

Effect of Abelmoschus esculentus (okra) on metabolic syndrome: A review

Metabolic syndrome is a disorder characterized by dyslipidemia, insulin resistance, abdominal fat, high blood pressure, hypertriglyceridemia, and diminished high density lipoprotein cholesterol. Okra (Abelmoschus esculentus L.), routinely called lady's finger, has belonged to the Malvaceae family. Okra is considered as a valuable crop due to the multiple functions of its leaves, buds, flowers, pods, stems, and seeds in traditional and modern medicines. Several bioactive components are presented in different parts of okra including polyphenolic compounds especially oligomeric catechins and flavonol derivatives such as quercetin. The antioxidant, anti‐inflammatory, anticancer, immunomodulatory, gastroprotective, neuroprotective, lipid lowering, and antidiabetic effects of okra have been established. Although different in vivo and in vitro studies revealed that okra has an ability to overcome metabolic syndrome symptoms, the lack of clinical studies is notable. So, further clinical trials should be accomplished to confirm the role of okra in metabolic syndrome. The aims of this review are to gather different studies regarding the potential efficacy of okra in metabolic syndrome.     

Pulmonary arterial elastance for estimating right ventricular afterload in systolic heart failure

Assessment of right ventricular afterload in systolic heart failure seems mandatory as it plays an important role in predicting outcome. The purpose of this study is to estimate pulmonary vascular elastance as a reliable surrogate for right ventricular afterload in systolic heart failure. Forty-two patients with systolic heart failure (ejection fraction <35%) were studied by right heart catheterization. Pulmonary arterial elastance was calculated with three methods: Ea(PV) = (end-systolic pulmonary arterial pressure)/stroke volume; Ea*(PV) = (mean pulmonary arterial pressure - pulmonary capillary wedge pressure)/stroke volume; and PPSV = pulmonary arterial pulse pressure (systolic - diastolic)/stroke volume. These measures were compared with pulmonary vascular resistance ([mean pulmonary arterial pressure - pulmonary capillary wedge pressure]/CO). All estimates of pulmonary vascular elastance were significantly correlated with pulmonary vascular resistance (r=0.772, 0.569, and 0.935 for Ea(PV), Ea*(PV), and PPSV, respectively; P <.001). Pulmonary vascular elastance can easily be estimated by routine right heart catheterization in systolic heart failure and seems promising in assessment of right ventricular afterload.