The Impact of Preload Alteration on the Myocardial Performance Index through Implementing Positive End Expiratory Pressure

Load independent methods should be used for the assessment of ventricular function. Debate still exists regarding whether tissue Doppler imaging (TDI) indices are influenced by preload. Here, we evaluated the effect of positive end expiratory pressure (PEEP) related preload reduction on both conventional pulsed Doppler (PD) and TDI myocardial performance index (MPI). Thirty-eight mechanically ventilated patients of 3 months to 12 years old (mean ± SD age of 30 ± 11months) without overt heart disease were enrolled. Doppler mitral inflow velocities, isovolumetric contraction and relaxation times and aortic ejection time in addition to TDI peak systolic, early and late diastolic velocities from the basal segment of left ventricular lateral wall were determined for each patient before and after applying high PEEP (10 cmH(2) O).PD-MPI was load dependent (0.61 ± 0.22 vs. 0.78 ± 0.25, P = 0.002). However, TDI-MPI did not significantly change after the use of high PEEP declining the left ventricular volume loading (0.78 ± 0.21 vs. 0.84 ± 0.22, P = 0.23). Hence, regarding various interfering pathophysiologic factors particularly preload reduction, it seems that TDI-MPI would be a more reliable index for the assessment of ventricular function.     

Evaluating Possible Mechanisms Linking Obesity to COVID-19: a Narrative Review

Obesity Surgery - Currently, pneumonia caused by the coronavirus disease 2019 (COVID-19) is a pandemic. To date, there is no specific antiviral treatment for the disease, and universal access to...     

Correlation between lipoprotein(a) serum concentration and severity of coronary artery stenosis in an Iranian population according to Gensini score

OBJECTIVES: To investigate the correlation between serum lipoprotein(a) concentration and existence as well as severity of coronary atherosclerosis. DESIGN AND METHODS: A cross-sectional study was conducted on 826 patients who underwent angiography through measuring blood sugar, serum lipids, lipoprotein(a) and evaluation of coronary stenosis by Gensini score. RESULTS: Gensini score=6 was considered as a cut-off point for coronary disease and 40 mg/dL was determined as lipoprotein(a) cut-off point. Its higher concentration was significantly more frequent in patients with Gensini score>6 (OR: 2.50, p=0.001), independent of gender, smoking, diabetes mellitus and hyperlipidemia. This finding was significant in patients <55 years old. There was a significant relationship between severity of coronary stenosis and higher concentration of serum lipoprotein(a). CONCLUSION: LP(a) serum concentration is an independent risk factor for coronary atherosclerosis in the Iranian population especially at the ages below 55. Also it demonstrates a direct relationship between severity of coronary atherosclerosis (by Gensini score) and serum LP(a).     

Florid cemento‐osseous dysplasia mimicking apical periodontitis: A case report

Cemento‐osseous dysplasia may present as a focal, periapical or florid lesion in the mandible or maxilla. The lesion may sometimes appear similar to peri‐radicular lesions on a periapical radiograph. This report presents a case with irreversible pulpitis and root resorption as well as a mixed radiolucent/radiopaque lesion around a mandibular molar tooth root. Root canal treatment was performed and because of the radiographic signs of root resorption and the patient's fear of having a malignant disease, periapical surgery was also performed. The histopathology report confirmed the presence of florid cement‐osseous dysplasia which was mimicking apical periodontitis. Follow‐up radiography 12 months after the surgery illustrated complete healing of the radiolucent area.     

Assessment of Left Atrial Ejection Force in Mildly Asphyxiated Newborns

Objective

Asphyxia-induced cardiac insult is one of the major causes of mortality and morbidity in the course of perinatal asphyxia. Nowadays, a remarkable trend of interest is sensed introducing a plausible modality for early detection of cardiac insults at the beginning stages of asphyxia. In this study we aimed to evaluate diagnostic utility of transmitral Doppler–derived parameters as well as left atrial ejection force index as a marker of left atrial contractile function in these patients.

Methods

In a prospective study selected cases of 26 asphyxiated newborns with preserved systolic function underwent conventional transmitral Doppler flow echocardiographic assessment. Left atrial ejection force index was further calculated for all patients. Data was compared with normal ranges of healthy newborns in order to clarify the diagnostic utility of these parameters for determining minor cardiac insults in this age group.

Findings

We found that mildly asphyxiated newborns showed an increase in the values of left atrial ejection force index (5.44±2.12 kilodyne vs. 6.66±2.17 kilodyne, P= 0.02) and left atrial filling fraction (39%±10% vs. 45%±8%, P= 0.01). Furthermore, the acceleration and deceleration rate of early filling flow peak velocity were decreased in this group of asphyxiated newborns.

Conclusion

Assessment of left atrial ejection force in mildly asphyxiated newborns reveals that newborns with even mild asphyxia, although could not be categorized in conventional grading system, suffer to some extent from a ventricular filling abnormality. This type of latent ventricular filling abnormality could simply be unmasked by calculation of atrial ejection force index.