masoud eslami

Cardiac resynchronization therapy (CRT) is a safe and effective method to treat heart failure (HF) in selected patients after failed medical therapy. We aimed to compare the effects of left ventricular (LV) lead position on the clinical, electrocardiographic (ECG), and echocardiographic parameters in patients with nonischemic cardiomyopathy (NICM) considering the absence of a large regional scar.
 
Thirty consecutive patients with NICM referred to the Imam Khomeini Hospital Complex for CRT implantation were enrolled in this study. Clinical, ECG, and echocardiographic parameters at baseline and 6 months of follow-up in patients whose left ventricular lead (LV) was implanted in the anterolateral (AL) vs posterolateral (PL) branch of the coronary sinus were compared.
 
The majority of the patients were women (16, 53%). In both groups, functional class improved significantly after CRT implantation, but this decrease was not related to the position of the LV lead. The QRS width in ECG was significantly reduced in the AL group after CRT implantation (from 157.7: 95% CI, 156.13 to 158.27 to 137.3: 95% CI, 133.37 to 141.24; P =0.000). This decrease was also seen in the PL group (from 157.6: 95% CI, 154.26 to 160.01 to 137.6: 95% CI, 133.46 to 141.84; P =0.000), but the decrease was not related to the LV lead position.
 
Our data showed no significant differences in clinical, ECG, or echocardiographic outcomes between PL and AL lead positions in patients receiving CRT. (Iranian Heart Journal 2023; 24(3): 70-76)

In patients with Non-Ischemic Cardiomyopathy (NICM), Cardiac Resynchronization Therapy (CRT) has been shown to improve Left Ventricular Ejection Fraction (LVEF) and NYHA functional class. However, in some patients who received CRT, the results were not satisfying.

This study aimed to evaluate echocardiographic features as a predictor of positive response to CRT in patients with NICM.

This case series study was conducted on 11 consecutive patients with NICM who were eligible for CRT at Imam Khomeini Hospital Complex. The patients’ basic demographic and echocardiographic data including Septal Flash (SF), Sphericity Index (SI), and Global Longitudinal Strain (GLS) were recorded and followed for six months. Data analysis was done using the SPSS software, and paired t-test was used for comparison of the study variables.

The results revealed an improvement in the median NYHA functional class from 3 (interquartile range: 2 - 4) to 1 (interquartile range: 1 - 2) (P < 0.001) at the follow-up. Assessment of LVEF through the Simpson method also showed a significant improvement from 28.25% to 39.31% (P < 0.001). Moreover, GLS improved and SI and SF decreased post CRT implantation.

The results demonstrated that a GLS of less than -10.48 before device implantation, but not SI or SF, might be a predictor of a positive response to CRT in patients with NICM. In these patients, higher GLS at baseline might add data to the existing criteria for selecting suitable patients for CRT implantation.

J wave syndrome is an electrical disease of the heart due to pathologic early repolarization. It encompasses a clinical spectrum from aborted sudden cardiac death due to ventricular arrhythmia (VA) usually in young affected patients to self-terminating ventricular ectopies, and finally, asymptomatic relatives of probands detected during electrocardiography acquisition (early repolarization pattern). This syndrome consists of 2 phenotypes, early repolarization and Brugada syndrome. Herein, we first describe 2 patients with early repolarization and Brugada syndrome, then, discuss their definition, epidemiology, genetics, cellular mechanism, diagnosis, risk stratification, and finally, therapeutic challenges and options one by one in detail.

Cutaneous T-cell lymphomas constitute a rare category of non-Hodgkin lymphomas, which may involve the heart in the timeline of their natural course as an infrequent picture with a poor prognosis. Syncope, either due to outflow obstruction or conduction block, is also an uncommon presentation of cardiac metastasis. We herein describe a 35-year-old man, who presented with weight loss, dyspnea of 6 months’ duration, an indolent skin ulcer in the left flank, lower limb deep vein thrombosis (DVT), and recurrent syncope. He underwent implantation of a permanent pacemaker due to a complete heart block and received anticoagulants for the DVT. Skin biopsy demonstrated a T-cell lymphoma. The syncopal episodes ceased thereafter. Echocardiography and computed tomography scan revealed cardiac metastasis, which responded to systemic chemotherapy. In the first follow-up visit after 3 months, he was still pacemaker-dependent. However, the DVT was partially resolved, and the symptoms had disappeared.

Neurodegenerative dysfunction is an improvement defeat of construction and utility of neurons. Parkinson, Alzheimer, central stroke, anxiety, and depression are examples of such disorders. To improve the quality of life in people with neurodegenerative diseases, Yoga therapy is operative. Yoga has valuable properties through direct influence on the sympathetic and parasympathetic activity in the autonomic nervous system. It decreases expressively neurotransmitters that are involved in these illnesses. Mind’s relaxation and diaphragmatic respiration (MRDR) on basis of scientific Yoga progresses social interactions, quality of life, and helps individuals approach life with new positivity and ability. The aim of this study was to improve the significant role of NRDR techniques as complementary medicine in prevention and control of neurodegenerative disorders.

Trans-septal puncture (TSP) is a safe and effective method to approach left atrium and ventricle. Nowadays, cardiac electrophysiologists perform this procedure routinely to treat left-sided arrhythmias.
CASE REPORT: A 45-year-old man was referred to our center due to Wolff-Parkinson-White (WPW) syndrome. After trans-septal puncture, contrast injection into the sheath showed that it was in the left ventricle (LV) rather than left atrium. Trans-esophageal echocardiography confirmed left ventricle outflow tract to right atrial (RA) jet. Follow-up echocardiography showed that the tract was present up to 18 months, but considering that the patient was asymptomatic, endovascular or surgical closure was not done.
Our case with an 18-month follow-up period, highlights the conservative approach in asymptomatic patients with this complication.

What are the political and legal issues between Iran and Canada? What are the grounds for their formation and continuation? Are there any solutions for them? This paper studies the political and legal issues between Iran and Canada and presents some possible solutions for them. The author hypothesizes that the formation of legal issues between Iran and Canada is rooted in political issues between the two countries and therefore their resolution is also dependent on the resolution of political issues. Despite this, the political and legal issues between the two countries are so interwoven that their absolute separation and prescription of distinct solutions for each of them is impossible. Here, I explore the political and historical context of the two countries relations and recognize three main factors that have led to the formation of sever political issues between the two countries. These three factors are: idealism in the two countries foreign policies and their ideological link to domestic politics, the role third parties have played and finally the politicians’ radicalism. The major legal issues between Iran and Canada at a bilateral level are: imposition of unilateral sanctions, removal of state immunity and Canada’s domestic judicial decisions against Iran. On the international level, the legal issues between Iran and Canada include international sanctions related to the Iranian nuclear energy dossier and issues pertaining to human rights and terrorism. After a thorough explanation of these factors, I have concluded that there are some solutions for the existing problems between Iran and Canada that can be classified as the rebuilding and establishing of political relations, improving economic and trade interactions, and enhancing scientific and cultural cooperation.

The early repolarization pattern (ERP) has been considered a normal variant in electrocardiography (ECG) for a long time. Nevertheless, increasing evidence has demonstrated its association with adverse outcomes.
The present study aimed to evaluate the prevalence of ERP in the Iranian general population and demonstrate its clinical and ECG correlates.
A cross sectional study, comprising 1424 consecutive healthy adult individuals, was conducted at two university based hospitals in Tehran, Iran in 2012-2013. The ERP prevalence, clinical characteristics and ECG morphology were investigated in volunteers.
ERP was present in 136 out of 1,424 people (9.6%). Slurring comprised the most frequent morphology (41.2%) followed by notching. ERP was predominantly positive in inferior leads (47.8%) followed by lateral leads (30.1%). There was also a significant male preponderance in the ERP positive group (81.6%). The mean diastolic pressure was significantly lower in the ERP positive group versus the ERP negative group (77.3 7.9 mmHg vs. 78.8 10.5 mmHg) (P = 0.03). However, despite a lower systolic blood pressure in the ERP positive subjects (120.9 12.6 mmHg vs. 123.1 14.8 mmHg), the difference was not statistically significant (P = 0.06).
ERP was present in 9.6% of healthy Iranian individuals with a higher frequency in inferior leads and slurring as the most prevalent morphology. Additionally, there was a male preponderance and middle-aged trend for ERP.

A 29-year-old woman was referred to our hospital due to exacerbation in dyspnea on exertion and easy fatigability. A known case of congenitally corrected transposition of the great vessels and congenital complete heart block, she had already received a permanent single-chamber pacemaker. Decision was made to implant a biventricular pacemaker for the treatment of the failing heart. Excellent coronary sinus lead implantation was done, conferring amelioration of symptoms, QRS narrowing in the electrocardiogram, and improvement of systemic ventricular systolic function in echocardiography. Over a 15-month follow-up period, she had no dyspnea on exertion. This case highlights the significance of upgrading pacemakers in patients with heart failure.

Atmospheric emissions from industrial establishments are one of the major sources of environmental pollution. One type of industry that causes particle pollution is the cement industry that Heavy metals are among the most relevant substances emitted during the process of cement manufacture. The aim of the study is to determine the major source and extent of metal pollution in soils vicinity of the cement factory in Behbahan city. Therefore, sixty one soil samples were collected from around the cement factories in Bebahan area. The samples were obtained at the depth 5-10 cm and were analyzed for Al, Pb, Cd and Ni by Inductively Coupled Plasma (ICP). In the samples of the studied soil, the average of the recorded concentration of elements for Al, Pb, Cd and Ni are 83.26, 64.69, 75.29 and 64 (ppm), respectively. The order of the average frequency of the heavy metals concentration is of Al>Cd>Pb>Ni. The results further revealed that the metal distribution were in a fluctuating manner considering various distances and directions from the cement facility, as it was observed that the mean metal concentrations of the soil decrease as distance from the cement facility increased for most metals. In this study, three contamination indexes have been used to express the distribution of soil pollution in the area. The result of the present study showed that all the metals were deficiency to minimal enriched in all distances, since the EF values of the metals are smaller than 1.5. Geoaccumulation index of the soil sampling can explain that the Cd element is lying with extremely contaminated area and the Pb element is lying with low contaminated area. The PLI was calculated for the overall distances and showed uncontaminated area than heavy metals in background value.

Proponents of the idea of lex petrolea generally claim that there is a specific genre of rules and procedures that governs transnational contracts, arbitrations, and transactions germane to the petroleum industry. The existing literature on this idea is far from being coherent and consistent. While some scholars have approached the subject with understandable caution referring to lex petrolea as not yet a mature set of legal regulations for international petroleum industry, others have imprudently considered lex petrolea as an autonomous transnational petroleum world order. Regardless of internal theoretical inconsistencies, the essential point with respect to the legal validity of lex petrolea and lex mercatorea is the claim of their autonomy and independence from national and international legal orders. This article provides a critical review of the certain existing literature on lex mercatorea, in general; and on lex petrolea, in particular. It will explain that both ideas lack the requisite elements of a legal system/order, hence both cannot be considered as independent or autonomous legal systems. They will rather continue to function as sorts of legal regimes confined to the rules and principles of national and international legal systems.

During the past decades the prevalence of tuberculosis (TB) has declined and its prognosis has changed dramatically due to chemotherapy; however, cases of tuberculous pericarditis are still reported worldwide. The study population included 19 men and 11women aged 12-76 years admitted to the hospital for acute pericardial disease. The diagnosis of tuberculous pericarditis was verified based on the adenosin deaminase activity (ADA), culture on Lowenstein-Jensen media, Ziehl Neelsen staining, biopsy of pericardial tissue and evaluation of tuberculin test. Of 30 patients, 13 (43.3%) had tuberculous pericarditis. All of whom had clinical TB manifestations. The culture of pericardial fluid in 6 patients (46%), staining in 3 (23%), and the culture of pericardial tissue in 6 patients (46%) were positive. The caseating granuloma w identified in 46% of cases. Ten case (77%) had positive PPD reaction. All tuberculous pericarditis patients had ADA level of >45U/l. Results have revealed that measurement of ADA level may prove a good screening test for early diagnosis of tuberculous pericarditis.

Abstract: This study was designed to find possible relationship between QTc prolongation and erythrocyte or plasma lithium concentrations. Fifty-six patients with bipolar disorder entered this case- control study. Subjects were between 17 to 63 years of age and were receiving lithium alone, or lithium plus haloperidol or lithium plus thioridazine. The exclusion criteria were past history of cardiovascular, hepatic, renal or metabolic disorders or using other medications known to cause rhythm disturbances. The case group included males with QTc 450ms and females with QTc470ms while the control group included males and females with QTc<450 and QTc< 470ms, respectively. Serum sodium and potassium levels, erythrocyte and plasma lithium concentrations as well as lithium ratio were determined for all subjects and compared between the case and control groups by independent sample t-test. The mean of these levels were not different between the case and control groups. Additionally, no correlations were found between QTc and erythrocyte or plasma lithium concentration, lithium ratio, serum sodium or potassium levels. Analyzing the data for patients treated with lithium alone showed no significant correlations between QTc prolongation and erythrocyte or plasma lithium concentration, lithium ratio or serum potassium level. However, a significant correlation was found between serum sodium concentration and QTc prolongation. It should be noted that QTc prolongation occurred six times more in patients who were taking thioridazine and lithium concomitantly. This study noted no influence of sex or co-administration of haloperidol with lithium on QTc prolongation. It is concluded that plasma or erythrocyte lithium levels may not be able to predict QTc prolongation and its consequences.

Sublingual captopril was shown to be effective to control hypertensive urgencies however, there exist controversies regarding the true dosage. In this study, we have compared 2 dosage (12.5 and 25 mg) of sublingual captopril to find out which is more effective. In a randomized clinical trial subjects with blood pressure of 180/110 mmHg who had no finding compatible with major organ damage were distributed in 2 groups (20 patients in each one) systolic and diastolic blood pressure were determined at minutes 5, 10, 20, 30, 45, 60, 90 and 120 following the drug administration. Data analysis was achieved using chi-square and ANOVA. There was no significant difference regarding the age, sex, previous history of hypertension, previous history of captopril intake, and systolic and diastolic blood pressure prior to the study. In the group receiving 12.5mg captopril, the mean diastolic and systolic blood pressure dropped from 121±3 and 210±4 mmHg to 97±4 and 163±6 mmHg, respectively, after 120 minutes. For the second these figures dropped form 123±2 and 202±3 to 96±1 and 165±4 mmHg, respectively (P<0.0001). At minutes 60 and 120, 80 and 75% of the first group (Receiving 12.5mg captopril) and 80 and 90% of the second group (Receiving 25mg captopril) had diastolic blood pressure of less than 110 mmHg, (NS). There was no side effect. Captopril has shown similar therapeutic effect in dosage of 12.5mg and 25mg.