Journal of Cardiovascular and Thoracic Research
Volume:5 Issue: 4, Dec 2013

An increased accumulation of fat in the intra-abdominal cavity is highly correlated with adverse coronary risk profiles. Cardiac rehabilitation (CR) produces a host of health benefits related to modifiable cardiovascular risk factors. Further research is needed to define better program for weight loss and risk improvement in coronary patients. The aim of this study was to determine the effect of supervised and unsupervised cardiac rehabilitation program on body composition and body fat distribution in a population with coronary artery disease. The study investigated 167 patients with coronary artery disease (73% males; mean age = 52.67±9.11 years) before and after a supervised protocol cardiac rehabilitation program, and 12-months later. Target variables included body fat distribution indices (waist and hip circumference and waist to hip ratio), weight and body mass index. Weight, waist circumference, waist to hip ratio and body mass index significantly decreased with 2 month supervised program (P<0.001), but hip circumference was not significantly changed. Males improved to a greater extent than the female patients. All of measurements relatively returned to baseline at the end of program (after 12 months). Supervised cardiac rehabilitation program results in improvements in body composition and body fat distribution. The effects of non-supervised program were minimal and the program needed to be reviewed.

The role of adhesion molecules in the development and progression of coronary atherosclerosis is inevitable. It is not clear yet whether these molecules increase or decrease in level after thrombolytic therapy. This study was designed to compare concentrations of soluble forms of adhesion molecules in patients with acute myocardial infarction before and after reperfusion by thrombolysis with streptokinase (SK). In this study, in 40 patients with acute myocardial infarction who were admitted in our Emergency Department undergoing thrombolysis with SK, plasma concentrations of six adhesion molecules [soluble L-selectin, P-selectin, E-selectin, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and platelet endothelial cell adhesion molecule-1 (PECAM-1)] were measured by enzyme linked immunosorbent assay (ELISA), before and 3 hours after intervention. While soluble E-selectin and PECAM-1 concentrations did not differ within the 3 hours after interventions (P> 0.05), the level of P-selectin, L-selectin, ICAM-1, VCAM-1 were significantly reduced after thrombolysis with SK (P< 0.05). Adhesion molecules which mediate the interactions in leukocyte endothelium vary in levels after reperfusion with SK. It was shown that 4 out of 6 adhesion molecules significantly reduced after thrombolysis with SK.

Lactate level is an important index for predicting cardiac events. There are some debates about time and type of sampling for defining of its prognostic values. To assess the prognostic importance of arterial lactate level in patients after cardiac surgery with regarding to operation factors serial arterial lactate levels during and after surgery was measured up to 24 hours, these data were processed by T-independent test and chi-square, P less than 0.01 was significant. 31 patients entered to study, high persistent arterial lactate level (1.5-4 mmol/L) can be seen in most patients (80%) during operation which returned to normal level (<1.5 mmol/L) up to12th hours post operation in 75% of cases. Persistent high level (>4 mmol/L) will occur unusually at 24th hour but can be associated with poor prognosis. Serial measurement of serum lactate level can be helpful for our management quality and very highly persistent arterial lactate level (>4 mmol/lit) up to 24 hours after operation will increase mortality rate in operated patients for congenital heart disease.

Blind nasotracheal intubation is an intubation method without observation of glottis that is used when the orotracheal intubation is difficult or impossible. One of the methods to minimize trauma to the nasal cavity is to soften the endotracheal tube through warming. Our aim in this study was to evaluate endotracheal intubation using endotracheal tubes softened by hot water at 50 °C and to compare the patients in terms of success rate and complications. 60 patients with ASA Class I and II scheduled to undergo elective jaw and mouth surgeries under general anesthesia were recruited. success rate for Blind nasotracheal intubation in the control group was 70% vs. 83.3% in the study group. Although the success rate in the study group was higher than the control group, this difference was not statistically significant. The most frequent position of nasotracheal intubation tube was tracheal followed by esophageal and anterior positions, respectively. In conclusion, our study showed that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during blind nasotracheal intubation; however it could not facilitate blind nasotracheal intubation.

The aim of this study was to analyze a PCR based approach for detection of infective endocarditis in Azerbaijan. Ten aortic valves, 8 mitral valves and 2 tricuspid valves, were analyzed for the presence of bacterial infective endocarditis using Gram staining, culture and PCR methods. Of the 20 valves, 5 and 4 cases were positive by Gram staining and culture assay, respectively. Bacterial DNA was positive in 12 of the 20 valves (60%) by broad-spectrum PCR. Direct sequencing for species identification was possible in 10 cases. PCR and direct molecular identification of the etiological agents responsible for infective endocarditis may enable specific treatment to begin at an earlier phase of the disease.

Delirium is defined as an acute cognitive disorder presenting with fluctuation in cognition, apathy and non-organized thinking. It may increase morbidity, mortality, ICU stay and cost. In patients who underwent heart surgery delirium may increase post-operative complications such as respiratory insufficiency, sternum instability and need to re-operation of the sternum. The aim of this study was to evaluate the prevalence and risk factors of delirium in patients admitted to cardiac surgery. 18 years or older patients who had undergone cardiac surgeries and stayed for more than 24 hours in ICU following surgery were recruited. All subjects were assessed for signs & symptoms of delirium using CAM-ICU and its risk factors. All data were analyzed by SPSS 16 at the end of the study. The prevalence of delirium in these patients was 23.5% (47 patients). The mean age of patients with delirium was more than other patients (P=0.001). The Incidence of delirium in the patients with cardiopulmonary bypass surgery (CPB) was higher than the patients without CPB (P=0.01). The Incidence of delirium in the patients with Atrial fibrillation was higher than patients without it (P=0.002). The Incidence of delirium in the patients with CVA history was higher than the patients without CVA history (P=0.032). The mean time of mechanical ventilation in the delirious patients was more than other patients (P=0.01). Older Age, CPB, history of CVA, Atrial Fibrillation, and prolonged mechanical ventilation are considered as the risk factors of delirium in cardiac surgery patients.

Although valve repair is applied routinely nowadays, particularly for mitral regurgitation (MR) or tricuspid regurgitation (TR), valve replacement using prosthetic valves is also common especially in adults. Unfortunately the valve with ideal hemodynamic performance and long-term durability without increasing the risk of bleeding due to long-term anticoagulant therapy has not been introduced. Therefore, patients and physicians must choose either bioprosthetic or mechanical valves. Currently, there is an increasing clinical trend of using bioprosthetic valves instead of mechanical valves even in young patients apparently because of their advantages. Seventy patients undergone valvular replacement using bioprosthetic valves were evaluated by ECG and Echocardiography to assess the rhythm and ejection fracture. Mean follow-up time was 33 months (min 9, max 92). Mortality rate was 25.9% (n=18) within 8 years of follow-up. Statistical analysis showed a significant relation between atrial fibrillation rhythm and mortality (P=0.02). Morbidities occurred in 30 patients (42.8%). Significant statistical relation was found between the morbidities and age over 65 years old (P=0.005). In follow-up period, 4 cases (5.7%) underwent re-operation due to global valve dysfunction. Our study shows that using biprosthetic valve could reduce the risk of morbidity occurrence in patient who needs valve replacement. However, if medical treatments fail, patients should be referred for surgery. This would reduce the risk of mortality because of lower incident of complications such as atrial fibrillation and morbidities due to younger patients’ population.

Effects of emotional stimuli on hemodynamics in patients with essential hypertension based on brain/behavioral systems have not been studied broadly.

Eighty five essential hypertensive male patients who had completed Carver-White BIS/BAS scale were enrolled to the study. Later, 25 BIS and 25 BAS patients were selected and their blood pressure and heart rate were recorded prior to stimuli induction. Participants were then exposed to stressor pictures. After that, 15 minutes of relaxation and cognitive tasks were performed. Finally, the participants were exposed to pleasant pictures. The blood pressure and heart rate were recorded after presenting of 2 stimuli.

Our study showed that BIS patients achieved higher scores in diastolic blood pressure and heart rate in comparison with BAS patients after presenting stressful stimuli. Also, BAS patients achieved lower scores in systolic blood pressure and heart rate in comparison with BIS patients after presenting pleasant stimuli.

In summary, BIS patients experience negative emotions more than BAS patients. Therefore, the role of induced mood states is important in relation to physical health

Critical illness is a life-threatening course of the disease affecting almost all human organs; unfortunately, it can lead to significant morbidity or mortality. Critical illness is mostly heralded by physiological deterioration. It is globally accepted that all clinical staff are extremely influential through their vigilance and intensive care provided for the critically-ill.1 Early-weaning systems and modes have contributed immensely to the prevention of deterioration and serious adverse events in these patients.2 Outcome depends vastly on prompt identification, diagnosis and treatment; hence, all doctors should have the knowledge to identify the critically-ill patient and initiate the situation management as soon as possible. The use of gloves and gowns for all contacts versus routine care among patients in medical and surgical ICUs has recently been shown not to be associated with a significant difference in the MRSA or VRE acquisition1. In their study, Harris et al. reported that all health care workers (nurses, physicians, respiratory therapist, etc.) wore gloves and gowns for all contacts with patients and when entering each patient’s room.3 Admission to an intensive care unit is per se a highly-stressful event for both patients and their relatives. Traditionally, infection control concerns and a belief that liberal visiting by patients’ relatives interferes with the provision of patient care has led many units to impose restricted visiting policies. However, recent studies suggest that partially-unrestricted vs. restricted visiting policy not only improves visitors’ satisfaction and reduces anxiety but also does not result in an increase in ICU-acquired infections.4,5 Hence, considering the increase in the popularity of open and partially-restricted visitor policies, provision of infection control (gowns and gloves) for visitors’ contacts with the patients seems to be of great important in decreasing infection in the critically-ill patients.

A 39-year-old woman was hospitalized in our center due to chest and left shoulder pain. Having a history of tamponade and tuberculosis, she was under treatment for the previous two months. Echocardiography, chest CT and MRI documented intramyocardial and pericardial hydatid cyst which was later confirmed by further pathological studies. Later, the cyst was removed surgically

Effects of emotional stimuli on hemodynamics in patients with essential hypertension based on brain/behavioral systems have not been studied broadly. Eighty five essential hypertensive male patients who had completed Carver-White BIS/BAS scale were enrolled to the study. Later, 25 BIS and 25 BAS patients were selected and their blood pressure and heart rate were recorded prior to stimuli induction. Participants were then exposed to stressor pictures. After that, 15 minutes of relaxation and cognitive tasks were performed. Finally, the participants were exposed to pleasant pictures. The blood pressure and heart rate were recorded after presenting of 2 stimuli. Our study showed that BIS patients achieved higher scores in diastolic blood pressure and heart rate in comparison with BAS patients after presenting stressful stimuli. Also, BAS patients achieved lower scores in systolic blood pressure and heart rate in comparison with BIS patients after presenting pleasant stimuli. In summary, BIS patients experience negative emotions more than BAS patients. Therefore, the role of induced mood states is important in relation to physical health