aghdas shadmehr

Adjusting the exact warfarin dose has always been challenging since it has a narrow therapeutic window. Numerous factors, including poor drug compliance, drug-drug interactions, and malabsorption syndromes, affect the warfarin plasma concentration, leading to oversensitivity or resistance to warfarin. Patients who need more than 15 mg/d of warfarin for maintained anticoagulant effects are considered warfarin resistant.
We describe a 62-year-old man referred to our center with bruising on his feet in June 2021. The patient had a history of valve replacement (mechanical prosthetic valves in 2013), hypothyroidism, and atrial fibrillation. He presented with warfarin resistance (first noticed in 2013) and did not reach the desired warfarin therapeutic effect despite receiving 60 mg of warfarin daily.
Upon admission, the patient was on warfarin (100 mg/d) with an international normalized ratio (INR) of 1.5. He underwent laboratory and molecular genetic tests, which showed no mutation in the CYP2C9 and VKORC1, the genes associated with warfarin resistance.
A stepwise diagnosis is required to identify the underlying cause. Assessing the patient’s compliance, drug history, dietary habits, malabsorption diseases, and genetics may be necessary. We evaluated these possible reasons for resistance and found no correlation. The patient’s warfarin intake was monitored closely to reach the INR therapeutic target of 3-3.5. He decided to leave the hospital with personal consent. He was discharged with a cardiologist referral and 24 warfarin tablets daily (120 mg/d) with an INR of 1.8. The patient was followed up 6 months and 2 years after discharge and was on the same daily dose of warfarin as at discharge, with no complications.

Tricuspid valve stenosis (TS) is often combined with tricuspid regurgitation and most cases of TS have a rheumatic origin. TS is usually associated with other valvopathies when occurring in a rheumatic context. Rheumatismal tricuspid stenosis typically occurs with concomitant mitral and/or aortic involvement. Other causes are rare, including congenital, carcinoid, and drug-induced valve disease, Whipple`s disease, endocarditis, and large right atrial tumor.

Here, we present a 42-year-old symptomatic woman with isolated TS due to rheumatic heart disease.

Patients suffering from rheumatic heart disease should be on regular followups and periodically assessed with echocardiography. In the present case, the tricuspid valve was involved in isolation.

Falling is one of the most common events that threats physical and psychological safety in patients, as well a factor that increases duration of hospitalization and treatment costs. Unfortunately, there is a little relatively evidence of reports of factors contributing to inpatient falls or the effectiveness of hospital fall prevention programs. Therefore, this study was conducted to determine the most important factors affecting complaints of hospital beds during treatment referred to forensic medicine in Fars province during the years from 2011 to 2019. Material &

This study was a descriptive cross-sectional and retrospective study. All cases of complaining of falling out of a hospital bed during treatment referred to forensic medicine in Fars province during the years from 2011 to 2019 were reviewed and the information contained in them was collected and recorded based on the prepared checklist. After collecting the data, the information was converted into a sheet code and analyzed by SPSS software version 21 and descriptive statistical aspirations.

The results of the present study showed that more falls occurred in men and in the age group over 70 years. Also, most cases of bed falls occurred in the morning shift (45.9%) witnessed falls in the majority of cases, nurses (55.7%) and (55.7%) of patients after the fall alone was not able to ask.

Given the high rate of falling patients’ incidence, it is essential to offer effective management strategies to provide more safety situation for patients.

COVID-19 induced cardiac events are reported by a large number of papers; while psychophysiology of association of the COVID-19 and cardiac attacks are not fully understood yet.

Here we compared gene expression levels of heart autopsies of SARS-Cov-2 infected patients with the cardiac organoid model of human myocardial infarction and control healthy cardiac organoids to identify differentially expressed genes (DEGs). Gene Ontology (GO) biological processes were enriched in DEGs.

Results showed that smell perception genes were down-regulated in SARS-COV2 in comparison to myocardial infarction samples; while showing upregulated genes related to the immune system process in comparison to control healthy heart organoids. Our results are in agreement with theories of immune system reactions in COVID-19 infected patients’ hearts; while our analysis indicates different patterns of heart genes expression from myocardial infarction models.

our study suggests that there may be different pathways involved in MI appearance in COVID-19 patients rather than classic known atherosclerotic and inflammatory pathways.