Relationship between plasma level of Vitamin D and post operative atrial fibrillation in patients undergoing CABG

Objective: Atrial fibrillation is the most common arrhythmia after cardiac surgery. Several studies have shown the impact of vitamin D on heart disease; however, there have been few studies for the incidence of AF and its relationship with vitamin D levels. According to the different results of these studies, we decided to evaluate the relation of plasma levels of vitamin D and postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery [CABG]

Methods: This cross-sectional study was performed on 50 patients after CABG surgery. Simple random sampling was done. Twenty five patients who developed AF within 48 hours after CABG with Cardiopulmonary bypass [CPB] were enrolled in the case group and 25 patients who did not develop AF within 48 hours after CABG with CPB were enrolled in the control group. Plasma levels of vitamin D in both groups of patients were recorded. Collected data were analyzed by the SPSS software version 17

Results: There was no significant difference in terms of demographic characteristics, comorbidities, lipid profile and kidney function between two groups. The mean plasma level of vitamin D was 27.4 +/- 2.22 ng/ ml in the case group and was 28.2 +/- 1.18 ng/ml in the control group it [p= 0.803]

Conclusions: Plasma levels of vitamin D were almost the same in both groups and there was no statistically significant difference between the groups with and without atrial fibrillation following CABG

Increased likelihood of arrhythmic events associated with increased anxiety in patients with implanted cardiac defibrillators after the Ahar-Varzegan Earthquake in East Azarbaijan, 2012

Objective: To determine the type and pattern of arrhythmic events following the 2012 Ahar-Varzegan Earthquake among patients implanted with cardiac defibrillators [ICDs] in East Azarbaijan province

Methods: In a prospective cohort study, conducted in East Azerbaijan Province of Iran, 132 patients were enrolled in two comparison groups according to the region of residence i.e., earthquake region [n=98] and non-earthquake [n=34] region in 2012. Data were collected for those meeting standard criteria for sustained ventricular arrhythmias [Vas], or supraventricular tachycardias [SVTs] and triggered ICD therapies, either shock or anti-tachycardia pacing [ATP]. The state version of the State-Trait Anxiety Inventory [STAI-S] was used to assess general symptoms of anxiety in both groups

Results: Males comprised 81.1% of the participants. Mean age of the participants was 59.7+/-15 years

The frequency of patients with sustained VAs increased significantly after the earthquake [p=0.008]

There were more VAs [mean 2.16 vs. 6.23; p=0.008] and they occurred earlier [6th vs. 16th day; p=0.01] in the earthquake area

The mean frequency of SVTs and the total number of delivered ICD therapies were similar between groups

Differences in anxiety levels were not significant between groups but there was a trend for presence of greater number of patients with anxiety [p=0.07] and the relative severity of anxiety [p=0.08] in the earthquake area

Conclusion: In the earthquake area, the mean frequency of VAs increased and they occurred earlier in the earthquake area. The stress of anxiety might have served as a trigger for these events

Idiopathic great saphenous phlebosclerosis

Arterial sclerosis has been extensively described but reports on venous sclerosis are very sparse. Phlebosclerosis refers to the thickening and hardening of the venous wall. Despite its morphological similarities with arteriosclerosis and potential morbid consequences, phlebosclerosis has gained only little attention. We report a 72 year old male with paralysis and atrophy of the right leg due to childhood poliomyelitis who was referred for coronary artery bypass surgery. The great saphenous vein, harvested from the left leg, showed a hardened cord-like obliterated vein. Surprisingly, harvested veins from the atrophic limb were normal and successfully used for grafting

impact of stepwise stent deployment on the angiographic and clinical outcome of coronary angioplasty in the setting of an acute myocardial infarction

To detect a reduction in the incidence of no-reflow, and a possible improvement in angiographic and clinical outcome after stepwise stenting in comparison with conventional method in the percutaneous coronary intervention [PCI] of patients with anterior ST elevation myocardial infarction. Between March 2007 and December 2009, patients with anterior acute myocardial infarction [AMI] treated with streptokinase less than 6 hours from presentation who underwent early PCI were enrolled in this multicenter randomized clinical trial. The study was carried out in the Cardiology Departments of Valiasr Hospital of Zanjan, Imam Reza, and Shahid Madani Heart Hospitals, Tabriz, Iran. Four hundred and three patients were enrolled in this study. Patients were randomly divided into 2 groups: Group I [n=202] with stepwise stent deployment [SSD], and Group II [n=201] with routine conventional stent deployment [CSD]. The patients' mean age was 57.7 +/- 10.7 years. After PCI, thrombolysis in myocardial infarction myocardial perfusion grade [TMPG] 0/1, suggestive of no-reflow was significantly higher in CSD group [p=0.0001]. In hospital based, death occurred in 15 patients [7.5%] from CSD group while 4 [2%] from the SSD group [p=0.01]. The TMPG was also significantly higher in SSD group [average 2.32 +/- 0.18] compared with CSD group, [average 1.66 +/- 0.24] [p=0.0001]. Conventional stenting technique was an independent predictor of no-reflow in multivariate logistic regression analysis [hazard ratio - 1.43; 95% confidence interval: 1.15-1.73; p=0.01]. The SSD was associated with improved angiographic reperfusion indices and reduced mortality in early PCI for AMI

Seasonal variation in enzymatic infract size and mortality in patients with ST-segment elevation myocardial infarction

To investigate any seasonal variation in enzymatic size, mortality rate, and localization of ST-segment elevation myocardial infraction [STEMI]. Between March 2003 and September 2006, all patients admitted to the Madani Heart Center, Tabriz, Iran with the diagnosis of acute myocardial infarction [AMI] were included in this observational prospective study. Cases were divided into 4 groups according to the season that MI occurred, and enzymatic size and location were determined for each patient. One thousand and two hundred six cases of AMI were analyzed during the study period. In our study, no seasonal difference was observed in demographic characteristics of patients. Also, no significant seasonal variation was found in enzymatic infract size, MI location, and in-hospital mortality rate. Our findings does not support the hypothesis that enzymatic size, mortality rates, and location of STEMI varies by seasons

Results of surgical treatment of coarctation of the thoracic aorta at Madani Heart Hospital: a ten year experience

To make a review of the immediate results of coarcation of the aorta [CoAo] operation between March 1993 and October 2003 at madani Heart center Tabriz Iran. The following data were investigated age at the time of surgery, gender, symptoms. Clinical and Paraclinical findings, associated cardiac lesions, and type of surgical technique, and immediate surgical outcome, particularly focusing on the presence of hypertension. Fifty three patents underwent surgical repair of CoAo. Enrolled patients had an age between 12 months to 49 years [mean 17 years], and 30 [56.6%] were male. Twenty five [47%] patients were asymptomatic. The most common presenting symptoms were palpitation [45%] and dyspnea on exertion early fatigue [41%]. The most common signs were a systolic murmur [96%], and weak lower limb pulses [86%]. In electrocardiogram, 96% had signs of LV hypertrophy. The chest-X-ray was normal in only 54%. The location of coarctation was post-ductal in 78% and pre-ductal in the rest. The associated defects were present in 30 [56.6% patients, most common being patent ductus arteriosus [26.4%] and aortic valve disease [22.4%]. Among the various surgical techniques employed end-to-end anastomosis was used in 26 [49%] and Dacron patch aortoplasty in 23 patients [43.3%]. During discharge BP was reduced in 75% and unchanged in 25% with respect to preoperative values. Fifteen percent of patients had some complications and one death was observed in the immediate postoperative period. There is a high rate of associated cardiac with CoAo and despite a delayed diagnosis in our region corrective surgery has a relatively good short term outcome with low morbidity and mortality

Tabriz experience in the management of extremity vascular trauma

Epidemiologic studies on civilian vascular trauma in developing countries are rather few Although Iran encounters vascular injury far more frequently than developed countries, the predominance of blunt trauma with associated complex injuries continues to pose problems for clinicians. The present paper retrospectively reviews a tertiary referral center experience of extremity vascular trauma. All individuals do presented to the Imam Khomeini Hospital, TabrizIran, with a vascular injury between March 1998 and February2000 were retrospectively identified from a trauma database. Be aim was to study the etiology, signs and symptoms, pattern of injuries, the implemented treatment strategies, and the mortality and morbidity rates due to vascular trauma in our population. During the study period 124 patients [5 female] with a mean age of 23 years [7-65 years] sustained vascular injuries. Be most common injury was arterial and isolated venous injuries were seen in only 15 cases. Penetrating injuries were the causes in 63% of patients, blunt trauma in 21%, and both in 16% of the rest. The commonest injured artery and vein was the female artery and the popliteal vein, respectively all of the patients underwent surgical repair in 1-48 hours [mean 9.5 hours] after trauma, with the most common procedure being the end-to-end anastomosis. Three underwent primary amputation and 3 required secondary amputation, mostly due to infection. The mortality rate was 3.2% [4 cases] with a median hospital stay of 13 days. Most vascular injuries due to limb trauma can be managed successfully unless associated with severe damage to bones, nerves or soft tissues. The injury patterns emerging from the present study will hopefully help all medical personnel to recognize the potential for vascular injury in a trauma setting

Relaxation therapy in the background of standard antihypertensive drug treatment is effective in management of moderate to severe essential hypertension

To evaluate the efficacy of relaxation technique as an adjunctive therapy for control of hypertension. From April 2004 to January 2005, with a single blinded randomized controlled design, 220 patients with newly diagnosed essential moderate to severe hypertension who needed drug therapy were included in the study. The study took place in the Hypertension Clinic, Sina Hospital, Tabriz, Iran. Patients were systematically randomized to receive standard plus relaxation therapy, 2 times per week, for 8 weeks, or standard therapy alone. We collected the demographic data, blood pressure measurements, and the data on prescribed drugs. The mean age of patients was 54 in the case group and 56 years in the control group. The mean blood pressure level [systolic and diastolic] was 192.86/105.16 and 192.09/102.25 mm Hg on admission in the case and the control groups, which decreased to 133.46/81.48 and 146.21/83.57 mm Hg, at the end of study. The difference of blood pressure on admission was not statistically significant, but became significant at the end of the study. Fifty-nine percent in the case group and 36% in the control group had good control of blood pressure. Relaxation therapy on the background of standard antihypertensive drug treatment results in better control of blood pressure