سید جلیل میر حسینی

Oxidative stress is involved in the pathogenesis of many diseases, including atherosclerosis. Lipid profile conditions, oxidative stress and antioxidant imbalances play a major role in the development of the disease. The purpose of this study was to compare the different time course of concurrent training on lipid profile and total antioxidant capacity of cardiac patients.

The present study was a quasi-experimental study. Twenty male patients, mean age 56  ± 9.75, were voluntarily divided into the control and combination training groups The concurrent training group performed aerobic and resistance training for eight and three days a week. Aerobic exercise was performed for 15-20 minutes at 50-80% of maximal heart rate and resistance training program consisted of three upper extremity movements and two lower extremity movements with three sets and 10 repetitions. Blood samples were taken before and after four and eight weeks, and lipid profile and total antioxidant capacity were measured. Data were analyzed by repeated measures ANOVA using SPSS version 16 software.

Concurrent training has reduced the significant levels in LDL, cholesterol and triglycerides after four and eight weeks, and has also reduced a significant increase level in HDL. Concurrent exercise had a significantly effect on the amount of total antioxidant after eight weeks (P <0.05).

According to the findings of the study, it can be concluded that with eight weeks of concurrent training, there is a significant difference in the levels of lipid profiles and total antioxidant capacity of cardiac patients.

The present study aimed to investigate the effect of spousal support and companionship intervention on quality of life, marital intimacy and stress of cardiovascular patients.

Supportive care and attention to the psychological factors along with medical care in people with heart disease can help therapies to be more effective. Providing an appropriate emotional atmosphere in the family, along with attention to medical care such as medication and diet control, is one of the supports that people with heart disease can receive after coronary artery bypass graft surgery (CABG).

This study was a semi-experimental research which was based on multiple baseline single-case study. The sample included 2 married male patients who had CABG and their wives which were selected among those referred to cardiac rehabilitation centers of Yazd City, Iran. The participants received 8 sessions of spousal support and companionship intervention. The participants answered to the questionnaires quality of life; stress, anxiety and depression; and marital intimacy, before, during, at the end and one month after intervention. The data were analyzed using visual analysis, improvement percentage and reliable change index.

Spousal support and companionship intervention increased the quality of life and decreased stress of patients, after intervention and in follow-up phases, but the patients’ marital intimacy did not change significantly after intervention.

The quality of life and stress of patients may be improved if the wives appropriately support and accompany their husbands after CABG.

Hypertension is a chronic disease that causes a great deal of harm to the individual, which is the leading cause of disability and death worldwide, accounting for one eighth of all deaths. This disease is not treatable but it is manageable. Therefore, this study aimed to investigate factors related to hypertension based on health belief model in Yazd.

This descriptive cross-sectional study was performed on 400 people over 30 years old in Yazd city. Sampling was done by cluster method. Subjects were included in the study according to the address of the headers. Questionnaires were completed by self-report and interview. Data collection tools were demographic questionnaire, awareness questions and health belief model. SPSS 15 software was used for data analysis. Statistical indices, Mann-Whitney U test, Kruskal-Wallis and Spearman correlation were used to analyze the results.

The mean and standard deviation of age were 44.08 ±11.6 years. There was a significant relationship between demographic variables of age, gender, occupation, education, marital status and history of hypertension in relatives. Among the constructs of health belief model, only the perceived barriers showed a significant relationship with blood pressure (P <0.01).

Since there is a significant relationship between perceived barriers and hypertension, it is suggested that future interventions be designed to reduce perceived barriers (No need to change lifestyles, lack of time for physical activity, cost of regular blood pressure control, and no family accompanying diet changes) and blood pressure control.

Cardiovascular disease, including atherosclerosis, has an inflammatory background on a molecular scale. In the immune system, various factors activate macrophages, which ultimately lead to various macrophage activities in inflammatory and non-inflammatory conditions. The aim of the present study was to investigate the effect of eight weeks of combined training on serum macrophage phenotype after cardiac arrhythmias and coronary artery bypass graft surgery.

The present study was a quasi-experimentalstudy performed in the Heart Rehabilitation Center of Afshar Hospital in Yazd. 20 male patients after coronary artery bypass graft surgery were divided into the control and combined exercise groups. Functional capacity, body mass index, muscle strength, and waist-to-hip ratio were estimated before training.The combined program was included aerobic and resistance training for eight weeks, three sessions per week. Aerobic training was performed for 15-20 minutes with maximum intensity of 50-80% of maximum heart rate and resistance training program included three upper limb and two lower limb movements with three sets and 10 repetitions. Blood samples were taken before and after eight weeks and macrophage phenotypes were measured by the ELISA method. Data were analyzed through independent t-test and paired t-test using SPSS Inc., Chicago, IL; version 16 software.

The combined exercise resulted in a significant decrease in the M1 macrophage (P<0.05) and a significant increase in the M2 macrophage (P<0.05).

The results of this study emphasize the usefulness of this training protocol as a means to reduce inflammation and decreasing the mortality and morbidity rates.

The results of this study emphasize the usefulness of this training protocol as a means to reduce inflammation and decreasing the mortality and morbidity rates.

Background and Many studies have investigated the cardioprotective effects of olive leaf extract (OLE). None, however, has reported its antiarrhythmic role for in vivo model arrhythmia. This study aimed at investigating the antiarrhythmic effect of OLE andassessing the duration of its use inanesthetized rats. Forty eight male Wistar rats were divided into six groups of eight. All groups-except group one (the control group)- received OLE (200 mg/kg/day, orally) for 1, 3, 7, 14 and 28 days, respectively. Then, their left anterior descending coronary artery (LAD) was occluded for 30 min under general anesthesia and artificial respiratory support. Direct blood pressure and electrocardiogram (ECG) were continuously monitored before and during the ischemia. The data showed that severity of arrhythmia including ventricular ectopic beats, incidence of ventricular tachycardia (VT), and ventricular fibrillation (VF) reduced significantly in groups that received OLE for at least 14 days. Also, the number and duration of VT and VF episodes decreased significantly in groups five and six, especially the group that received OLE for 28 days. These results show that oral administration of OLE could induce antiarrhythmic effect, if used for more than seven days. Further studies are required to determine the effects of different doses and durations and cellular mechanisms of OLE.

Smoking contributes to more than 5million deaths in the world annually. More than 70% of these deaths occurs in the developing and 30% in the developed countries. the important way to stop these deaths, is to quit smoking. Despite the perceived risk, more than 40% of smokers that had heart attack, began smoking after leaving the hospital. This indicates that inadequacy of awareness in them. The aim of this study was to study Routine or verbal-illustrative Education on nicotine dependency in men after Coronary Artery Bypass Graft (CABG) This was a clinical trials study,conducted on 100 patients that were candidates for heart surgery at Afshar hospital in Yazd. The participants were randomly divided into two groups. The data were collected by two questionnaires before and after the heart surgery. The first questionnaire included questions about demographic variables, such as date of surgery, address, telephone number, standard test of nicotine dependence (Fagerstrom) and standard test of self – efficacy (Prochaska- DiClemente). After collecting the data at the begining, the case group was treated on routine and verbal education of quit smoking by three pictures about clogging of arteries in 5 minutes. The control group was treated with the routine education. Then the questionnaires were completed 3 months after surgery. The questions of these questionnaires were about quitting smoking, and date of the onset of smoking after surgery. All the registered data were transferred into SPSS software and analyzed. Before intervention the two the groups were same in terms of demographic variables. The mean ages the of case and control groups were 53.55±8.9 and 55.6±8.4 respectively. Their mean age of beginning with smoking was 21.6±6. The extent of nicotine in dependency in the case group was 5.25 and in the control groups 4.86. after 3 months of surgery the extent of quit smoking in case group turned out to be 79.6% and in control groups 66%. There was no significant difference between two groups in quitting smoking. The data indicated that the effect of education through showing picture is more than the routine education.

Proper drainage of the mediastinal and pleural spaces following Off-Pump Coronary Artery Bypass (OPCAB) surgery is essential for the prevention of pleural and pericardial effusions, cardiac tamponade and late complications such as constrictive pericarditis. Drainage tubes themselves may induce some complications which can negatively affect the result of the surgery. In this study we assessed a new technique for chest drainage following OPCAB.

One of the most important components of coronary artery bypass graft surgery is need for blood transfusion that increases morbidity and mortality.

Up to 12% of patients undergoing coronary artery bypass graft have pulmonary complications. Smoking can cause a six-time increase in pulmonary complication after major surgery. The most common pulmonary changes after CABG are decrease in FRC, VC and atelectasis. In this study, the effect of oral N-acetyl-cystein in reduction of severity of hypoxemia and atelectasis in current smokers who smoked more than 10 packs/year and had undergone CABG was evaluated. In the study, 54 current smoker patients were selected randomly and allocated to two drug and placebo groups. In the study group, 300mg N-acetyl-cystein (ACC long) containing vitamin C was prescribed two times a day from 4 days before operation up to 3 days after surgery and in control group, effervescent vitamin C tablet was prescribed as placebo. Patients with body mass index more than 35, NYHA class IV, those who needed intra aortic balloon pump and those who needed reoperation due to bleeding were excluded from the study. In all patients, spirometry was done in the preoperative visit and FEV1/FVC was determined. Induction and maintenance of anesthesia was similar in all patients. Arterial blood gas samples were obtained immediately after anesthesia induction and 4 to 6 hours after extubation. Chest X ray was taken before, 6 to 10 hours after extubation and 3rd postoperative day. Severity of atelectasis was also measured. Quantitative & qualitative data was analyzed by ANOVA and Chi-square tests, respectively. Pvalue<0.05 was considered as statistically significant. Both groups were similar with respect to demographic data including ejection fraction, NYHA class, FEV1/FVC, cigarette smoking and Lima harvesting. The ratio of arterial oxygen pressure to fraction of inspiratory oxygen Pao2/FIo2 was not significantly different after induction but this difference was strongly significant (Pvalue<0.005) after extubation. Duration of mechanical ventilation was significantly shorter in patients who had N-acetyl-cystein, but duration of ICU stay was similar. Linear and segmental atelectasis was significantly less in the study group. N-acetyl-cystein can improve oxygenation and ventilatory parameters in pathological lungs, but further studies with different doses and different situations are needed.

Control of post thoracotomy pain is particularly important in prevention of post operative respiratory complications. Several methods are proposed for control of postoperative pain. Cryoanalgesia by freezing of intercostal nerves is able to providing long term pain relief in post operative period which probably results in cutaneous sensory changes. This clinical trial study was done on 124 patients who underwent CABG surgery. Patients were randomly divided in two groups; control group (group I) and study group (group II). In study group cryoanalgesia was applied intraoperatively on the intercostal nerves. All of the patients received appropriate analgesia on demand in postoperative period. Pain in LIMA harvesting site and sternum was measured by visual analogue pain score before discharge, one and three months following cryoanalgesia. In all of the patient’s, presence of paresthesia was evaluated. The amount of administered analgesics (narcotic, opium, indomethacin) was noted daily. Data of this investigation was analyzed and evaluated using SPSS 11.5 software. Pain score of sternum was higher in study group before discharge and was lower at one and three months after operation than the control group that was statistically significant (P=0.01). Pain score of LIMA region before discharge was higher, at one month post operation was equal and at three months post operative was lower than the control group (P=0.045). Use of morphine and opium was lower (P=0.017) and use of indomethacin was higher in the cryoanalgesia group that was statistically significant (P=0.001). Incidence of paresthesia was lower in the study group (P=0.001). It is proposed that cryoanalgesia is a safe and effective method for reduction of pain and paresthesia and need for analgesics following CABG operation.

onset tracheotomy complication: A Case report Tracheo-innominate artery fistula (TIF) is a rare, life threatening and catastrophic complication, which may occur 7 to 14 days after surgery. The Incidence Rate of TIF is 0.1-1% and survival rate of patient is 14.3%. Herein, we describe TIF in a patient 50 days post tracheotomy, based on our research, it appears that our case is the first finding with the latest onset of TIF after tracheotomy, which now has been improved by early diagnosis and surgical treatment.

Doppler ultrasonography (DUS) is the most preferable method for screening of carotid artery disease in patients undergoing CABG. The purpose of this study was to investigate the frequency of carotid artery disease and determine the relation between known risk factors of atherosclerosis and rate of carotid artery narrowing in order to identify high-risk groups among patients scheduled for isolated elective coronary artery bypass grafting (CABG) procedures.

Two-hundred ninety-one patients (222 males and 69 females) undergoing isolated coronary artery bypass grafting were preoperatively evaluated by carotid artery Doppler ultrasomography and the morphology of carotid artery was determined. Age, sex, cervical bruit, diabetes mellitus (DM), hypertension, hyperlipidemia, smoking, history of cerebrovascular event (CVE) and coronary angiographic findings were investigated to define the high-risk group for carotid artery disease. Data were analyzed by SPSS software and P<0.05 was considered significant.

Patients ages ranged from 35 to 95 years (mean of 57.6 + 10.4 years). Eleven patients (3.8%) had history of cerebrovascular events (CVE). 13 patients (4.5%) had cervical bruit. Left main coronary artery involvement was observed in 19 patients (6.4%). In 127 patients (43.6%) carotid scanning was normal, fifty nine patients (20.4%) had less than 50% stenosis (mild stenosis), ninty seven patiens (33.3%) had 50-70% stenosis (moderate stenosis), and eight patiens (2.7%) had more than 75% stenosis (severe stenosis). Calcified plaque was observed in 109 patients (37.5%). Previous cerebral ischemic events (P=0.297), diabetes mellitus (P=0.467), hypertension (P=0.110), hyperlipidemia (P=0.08), smoking (P=0.401), age >60 years (P=0.84), female sex (P=0.730), and left main coronary disease (P=0.390) were not identified as high-risk factors for carotid artery stenosis greater than 50%. But positive MI history (P=0.025), and cervical bruit (P=0.002), were significantly related to 50% carotid artery stenosis.

Based on the results of this study, we can not suggest DUS as a routine screening method in all patients undergoing CABG, except for patients with history of MI and cervical bruit. Another important finding was that 56.4% of patients posted for CABG had different degrees of carotid artery stenosis which requires a long term CVA prophylaxis program.

Post operative pain is an unpleasant experience following various stimuli resulting in a response by the body. This process causes physiological disturbances in all of the systems of the body. Methods and Materials: In this clinical trial , 60 upper abdominal surgery patients were selected post operatively and divided into two groups of 30 patients each. In one group, bupivacaine intrapleural injection and in the other group, opioid injections were administered in the recovery room. Pain intensity with visual analogous scale was measured 6 hours after the operation.

There was no difference in VAS according to patient's age, sex, and type of operation, but in the Bupivacaine injected group, VAS score was significantly lower.

Intrapleural injection of bupivacaine is more useful and reliable than opioids for controlling post operative pain.