Assessment of liver function test change after open heart surgery

Open heart surgery requires using cardiopulmonar bypass [CPB]. CPB stimulates complement, coagulation and immune systems and non-pulsatile flow has an important effect on body organs, like liver. Activation of this system produces severe inflammatory reaction with subsequent organ damage. This study was designated to examine the influence of CPB on simple liver function test. A total of 100 patients with coronary artery disease [CAD] and valvular heart disease were scheduled for surgery and entered in a clinical study to assess the effects of intra-operative variables on simple liver function tests [SGOT, SGPT, alkaline phosphatase, and bilirubin] measured after three consecutive days with an auto-analyzer device. Patients with a past medical history of right heart failure, jaundice or hepatitis were excluded from our study. Independent and continuous variables, such as age, gender, pump time, temperature in pump, transfusion, were measured and recorded, and effect of these variables on mean values of liver function test after operation was evaluated by generalized linear method [GLM] and two way methods. This test entered to model as dependent variables and other variables as fixed or co-variables. The mean values of liver function test before and after operation were compared by ANOVA and Turkey's post hoc test and p-value <0.05 was considered significant. The pump hypotension [BP<50mmHg] had an effect on SGPT 1 and SGOT 2 and SGOT 3 [P<0.004]. Change of SGOT 2 test was significant in the pump time longer than 100 minutes. SGOT 1, SGOT 3, SGPT 1, alkaline phosphatase 1 changes related to CPB temperature was seen in temperature less than 28, rise of alkaline phosphatase 1,2, 3 was significant [P<0.01] with long anesthesia time. Type of operation had a significant effect on direct bilirubin 2, 3 and type of pump had an effect on SGOT 2 and direct bilirubin 1. Sex had effect on SGOT 2 but age did not have any effect on liver function test. Transfusion volume raised SGOT 1 and alkaline phosphatase 1 and direct bilirubin 2 and long pump time raised SGOT 2. Age had no influence on liver function test. The most sensitive tests to find hepatic injury with hypothermia were SGPT 1 and alkaline phosphstase 1 and SGOT 1. In CPB hypotension, SGPT 1, 2 tests were significant and in long pump time, SGOT 2 was sensitive for knowing hepatic cell damage

Relationship between chlamydia pneumonia and helicobacter pylori with atherosclerosis

Atherosclerosis is the most common cause of deaths in the developed countries and causes one million mortalities per year in the USA. Smoking, hypertension, diabetes, obesity, hyperlipidemia, stress, and low activity are known to be the causes of atherosclerosis. The objective of this study is to confirm the relationship between Chlamydia pneumonia [Cpn], as well as helicobacter pylori [Hp] and atherosclerosis. In this analytical case-control study two groups of patients were studied. The first group including 30 patients over 30 years old with coronary artery disease were operated using coronary artery bypass graft. The control group included 30 persons assessed with angiography and having normal coronary arteries. The data were collected and analyzed using statistical methods. The two groups were similar in terms of IgA and IgG anti-Cpn, and IgG anti- Hp but they were statistically different concerning IgA anti-Hp which had more positive cases in the case group in comparison with the control group [p<0.003]. Additionally, 6 and 8 positive findings in immunohistochemistry [IHC] of the aortic punch biopsy were observed in Cpn and Hp respectively. When the serologic and histological findings were compared, it was revealed that the two bacteria had different behaviors in local invasion and systemic reactions. This study confirmed that Hp could cause atherosclerosis by activating systemic reactions while Cpn could not cause it. Moreover, in 20% and 26.7% of the cases Cpn and Hp respectively revealed invasions to the aortic tissues which could result in atherosclerosis. It is recommended that this study must be repeated with large numbers of patients and control groups, and the control groups must be cadavers so that their aortic tissues can be biopsied

Predicting factors for the outcomes of coronary artery bypass graft operation

Observations have shown that women undergoing coronary artery bypass graft [CABG] surgery appear to have more complications compared with men. In this respect, factors such as small body size, body mass index [BMI], narrow coronary arteries, hormonal changes, and high incidence of diabetes and it's associated complications are believed to be effective. This study was designed to answer the question whether such differences in the clinical outcomes exist between men and women. An analysis of 500 consecutive patients undergoing CABG was performed in Imam Ali Hospital during 1382-1384. Categorical and continuous variables were compared using chi-squared and t-test, respectively. Binary logistic regression was performed, with death as dependent and gender as independent factor. Odds ratio of significant variables was calculated, and p less than 0.05 was considered as significant. Women represented 36.7% of patients. Compared with men, values of variables such as smoking, BMI, weight and hematocrit, were lower in women [p<0.05]. Other factors such as low ejection fraction, infection, hypertension, ICU stay and myocardial infarction were higher in women than man [p<0.05]. In binary logistic regression, low ejection fraction and use of inotrope predicted death in women, and congestive heart failure and inotrope use did so in men. In univariate analysis, diabetes was more common in women than men. After removal of confounding factors, postoperative MI, use of balloon pump, diabetes and inotrope use were more common in women. Using multivariate regression analysis, female gender was a predictor for hospital stay and morbidity

[Blood level anti-HBS due to HB vaccine in health care personnel of Shahid Sadoughi Hospital-Yazd]

Objective: about 3% of the Iranian general population are carriers of hepatitis B virus, and about 15% of infected persons will be prone to chronic hepatitis and get cirrhosis and liver carcinoma. Up to now no therapeutic regimen has been introduced to eradicate completely this infection

Material and Method: this cross-sectional study was performed on 204 health care personnel of Shahid Sadoughi Hospital [Yazd]. At first, a questionnaire including information about sex, age, vaccination, etc was completed. Anti-HBs were examined by Radim [ELISA method]

Results: from 204 subjects, 162 persons were female. The mean age of studied cases was 32.38 +/- 8.86 years. The mean titer of anti-HBs was 255.2+/- 300.6 mlU/ml, and with consideration of Anti-HBs = 10 mlU/ml as a cut-off value, 88.8% of subjects were immunized against hepatitis B

Conclusion: according to the results and decrease of immunity in health care personnel after years, it is suggested that the Anti-HBs titer should be examined one month after vaccination and be controlled every 5-10 years, and then booster vaccine be injected after reducing Anti-HBs titer to below protective level