Association of preoperative hemoglobin a1c with in-hospital mortality following valvular heart surgery

Abstract Objective: To determine the association between the preoperative level of hemoglobin A1c (HbA1c) and in-hospital mortality in patients who underwent valvular heart surgery in our center in a retrospective cohort. Methods: In this retrospective consecutive cohort study, patients with type 2 diabetes mellitus who were referred to our center for elective valvular surgery were enrolled and followed up. The endpoint of this study was in-hospital mortality. Based on the level of HbA1c, patients were dichotomized around a level of 7% into two groups: exposed patients with HbA1c ≥ 7% and unexposed patients with HbA1c < 7%. Then, the study variables were compared between the two groups. Results: Two hundred twenty-four diabetic patients who were candidates for valvular surgery were enrolled; 106 patients (47.3%) had HbA1c < 7%, and 118 patients (52.6%) had HbA1c ≥ 7%. The duration of diabetes was higher in patients with HbA1c ≥ 7% (P=0.007). Thirteen (5.8%) patients died during hospital admission, of which nine patients were in the high HbA1c group. There was no significant difference between the groups regarding in-hospital mortality (P=0.899). Both the unadjusted and adjusted logistic regression models showed that HbA1c was not a predictor for in-hospital mortality (P=0.227 and P=0.388, respectively) Conclusion: This study showed no association between preoperative HbA1c levels and in-hospital mortality in candidates for valvular heart surgery.

Factors related to the acceptance of radio frequency identification technology in health information management departments of hospitals affiliated to Iran University of medical ýsciences

Introduction: Radio Frequency Identification [RFID] technology has been implemented in a wide variety of industries including healthcare field. Due to the introducing RFID technology in the healthcare industry, it is necessary to determine the factors influencing acceptance of this technology. Therefore, in the present study, the factors associated with the acceptance of RFID technology in Health Information Management hospitals affiliated to Iran University of Medical Sciences were studied

Methods: The current applied research was descriptive-analytic. A questionnaire was distributed among all health information management staff of the hospitals affiliated to Iran University of Medical Sciences [n=138] and finally, 135 questionnaires were completed. The results of the study were analyzed through SPSS16 and using descriptive statistics, inferential statistics, and regression

Results: The mean scores of factors were as follow: social effects [4.24 out of 5], management support [4.34 out of 5], expected performance [4.20 out of 5], expected effort [4.09 out of 5], facilitating conditions [3.47 out of 5], security [3.83 out of 5] and intention [4.3 out of 5]. The coefficients of influence of social effects [0.125], management support [0.210], expected performance [0.244], expected effort [0.148] and facilitating conditions [0.135] showed positive significant relationships with intention to use RFID. However, security was not an influential factor on use of RFID

Conclusion: Based on the findings, providing general education, facilitating the use of this technology by vendors and developing adequate infrastructure may increase the willingness to accept RFID

Effect of Caparis spinosa root extract on promastigotes and amastigotes of Leishmania major

This study was carried out to identify the efficacy of Caparis spinosa root extract on promastigotes and amastigotes of Leishmania major. Caparis spinosa extracts were prepared. Promastogotes of L.major [1×10[6] parasites/ml]were incubated at 26 degree C for 24,48 and 72hours in fresh medium[NNN], in absence or presence of different concentrations [0.1,0.3,0.5,0.7,0.9 mg/ml] of Caparis spinosa methanolic root extract. It was determined that anti-protozoal activity of Caparis extract [0.9 mg/ml] was similar to glucantime as a gold standard drug [p<0.05] and both were able to kill 97.8 % of promastigotes after72 hours. Microscopic observation showed that mainly complete lyses of promastigotes after treating with0.9 mg/ml of Caparis spinosa for72hours. Higher extract concentrations had more effect on promastigote population [p<0.05]. It was demonstrated that Caparis sponosa root extract has positive effect on amastigotes of leishmania major. It was determined 0.7 mg/ml and 0.9 mg/ml Caparis root extract concentrations were more effective than other concentrations on amastigots of Leishmania in ulcers. The mean of ulcer size of the mice that received 50 micro l of 0.7 mg/ml and 0.9 mg/ml Caparis root extract were less than mice receiving 0.1, 0.3 and 0.5. The mean of ulcer size of the mice that received 50 micro l of 0.9 mg/ml Caparis spinosa root extract were significantly smaller than control group after six weeks[p<0.05] ,but the mean of ulcer size in mice which had been received glucantime [150 mg/ml]and Caparis root extract were not significantly different [p>0.05]. The results were suggestive that Caparis root extract had significantly similar effect in reduction of ulcer size as compared to glucantime [p<0.05]

Acceleration of skin wound healing with tragacanth [Astragalus] preparation: an experimental pilot study in rats

Gum tragacanth is a natural complex mixture of polysaccharides and alkaline minerals extracted from species of Astragalus plant, which is found widely in arid regions of the Middle East. In a pilot experimental study we examined the effects of its topical application on wound healing in ten albino adult male rats. Two similar parasagittal elliptical full-thickness wounds [control vs. test samples] were created on the dorsum of each animal. Test group samples were fully covered by a thin layer of gum tragacanth daily. The extent of wound healing was evaluated by planimetric analysis on multiple occasions during the 10-day study period. On the 7[th] day of the study, the percent of wound closure was significantly higher in gum tragacanth-treated specimens compared to the control samples [87% +/- 2% vs. 70% +/- 4%, P<0.001]. The majority of wounds in the test group were completely closed by the 10[th] day of the study. The difference in wound healing index measured by histological examination on day 10 of the study was also statistically meaningful between the two groups [0.624 +/- 0.097 vs. 0.255 +/- 0.063, P<0.05]. The results of this study clearly showed the useful effects of topical application of gum tragacanth in acceleration of skin wound contraction and healing. More studies are encouraged to identify the implicating agents and precisely understand the mechanism by which they exert their wound healing effects

Central venous line and acute neurological deficit: a case series

Central venous catheter [CVC] insertion is a practical way to assess patients hemodynamic specially in cardiovascular surgery but this relatively simple junior level procedure is not risk free and its common reported complications include; pneumothorax, hydrothorax, hemothorax, local hematoma, cardiac tamponade, vascular injury, thrombosis, embolism, and catheter disruption. Here in this article we are going to present 6 patients with very unusual presentation of CVC complication which was neurological deficit presented by agitation, unconsciousness, disorientation to time and place and hemiparesis. All patients undergone neurologic consult and brain computed tomography. Final diagnosis was brain ischemic damage and finally we kept them on conservative management; fortunately we did not have any permanent damage

Positive family history as the single traditional risk factor for developing extensive very premature coronary artery disease: a case report

Although coronary artery disease [CAD] is not common among individuals younger than 40-45 years of age, a small percentage of this age group needs to undergo surgical revascularization because of CAD. Why some people are at higher risk of developing premature CAD is not clearly known. Increased number of traditional risk factors or genetic predisposition may play significant roles in this regard. A 22-year-old man with a negative history for all traditional risk factors except for a family history of premature CAD referred to our center due to an episode ofmyocardial infarction of one month s duration. He had no congenital heart disease and no hypercoagulable state, and there was a negative history of drug abuse. His coronary angiography showed extensive CAD. He underwent coronary artery bypass grafting and he left the hospital in good healthy condition. One year after surgery, his follow-up showed that he was symptom free and he still had no new traditional risk factor. It seems that a positive family history of premature CAD is an important and independent risk factor for developing premature CAD and individuals with this type of history should be treated more cautiously

Successful surgical intervention in an unusual case of Aspergillus endocarditis with acute myeloid leukemia

Endocarditis due to Aspergillus infection is a rare complication in patients with hematological malignancies. Here, we present a case of aspergillus endocarditis in a patient with acute myeloid leukemia [AML] successfully treated with antifungal therapy and surgical treatment. The patient was a 51 years old male, a known case of AML who was admitted to our medical center for evacuating his valvular vegetations and repairing his atrial septal defect. He underwent an open heart surgery to relinquish his thromboses and also received an antifungal regimen. The patient tolerated the procedure well and eight months after his surgery, the patient remains asymptomatic. Successful treatment of this severe case of aspergillus endocarditis justifies a multidisciplinary method to be as a safe and effective approach to manage these patients

Prosthetic tricuspid valve thrombosis: three case reports and literature review

A common complication of prosthetic heart valves is thrombosis. Although the incidence of prosthetic valve thrombosis [PVT] in the tricuspid position is high, there are not enough data on the management of it, in contrast to left-sided PVT. Here, we describe three cases of tricuspid PVT with three different management approaches: thrombolytic therapy; close observation with oral anticoagulants; and surgery. The first case was a woman who suffered from recurrent PVT, for which we successfully used Tenecteplase for second and third episodes. We employed Tenecteplase in this case for the first time in the therapy of tricuspid PVT. The second case had fixed leaflets in open position while being symptomless. At six months' follow-up, with the patient having taken oral anticoagulants, the motion of the leaflets was restricted and she was symptom-free. The last case was a woman who had a large thrombus in the right atrium immediately after mitral and tricuspid valvular replacement. The patient underwent re-replacement surgery and a new biological valve was implanted in the tricuspid position. Also, we review the literature on the pathology, signs and symptoms, diagnosis, and management of tricuspid PVT

Post-traumatic chordae rupture of tricuspid valve

Blunt injury to the chest can affect any one or all components of the chest wall and thoracic cavity. The clinical presentation of patients with blunt chest trauma varies widely and ranges from minor reports of pain to florid shock. Traumatic tricuspid valve regurgitation is a rare cardiovascular complication of blunt chest trauma. Tricuspid valve regurgitation is usually begotten by disorders that cause the right ventricle to enlarge. Diagnosis is made by physical examination findings and is confirmed by echocardiography. We report two cases of severe tricuspid regurgitation secondary to the rupture of the chordae tendineae of the anterior leaflet following non-penetrating chest trauma. Both patients had uneventful postoperative courses

comparative study of recombinant human basic fibroblast growth factor [bFGF] and erythropoietin [EPO] in prevention of skin flap ischemic necrosis in rats

Impaired wound healing in ischemic tissues such as skin flaps resulting from inefficient perfusion is one major cause of complications in plastic surgery. In present experimental study, we investigated the effects of fibroblast growth factor-2 [FGF-2 or bFGF] and erythropoietin [EPO] in prevention of skin flap necrosis in rats. 30 adult albino rats were randomized into 3 groups: in control group, normal saline solution; in EPO group, erythropoietin [100U/ kg/day]: and in FGF-2 group, fibroblast growth factor-2 [2,5 microg/day] were injected subcutaneously in 3 daily consecutive doses in the designated flap areas before creating 4:1 random pattern skin flaps on the dorsum of animals. Areas of ischemic [S] and necrotic [S[N]] zones were measured and compared in all groups one week after the flap creations. The necrotic zone [S[N]], as well as the ratio of the necrotic zone to the total discolored zone [S[N]/[S[I]+S[N]]] were substantially larger in the control group [41% +/- 7%, 90% +/- 6%] compared to the EPO [20% +/- 2%,42% +/- 4%] and the FGF-2 [8% +/- 2%,19% +/- 3%] groups [p < 0.001]. The differences in these values were also meaningful between the EPO and FGF-2 groups [p < 0.001].Vascular density in ischemic area of the control group was less than those in the EPO and the FGF-2 groups; however, the differences were not statistically significant between any of the groups [p > 0.05]. Local administration of erythropoietin or fibroblast growth factor-2 in skin flaps could remarkably increase tissue viability and accelerate the wound healing process. However, the therapeutic effect of fibroblast growth factor-2 in preventing the necrotic event in, ischemic zones of skin flaps is much more considerable than that of erythropoietin

Knowledge management in cardiac surgery: the second Tehran heart center adult cardiac surgery database report

The Adult Cardiac Surgery Databank [ACSD] of Tehran Heart Center was established in 2002 with a view to providing clinical prediction rules for outcomes of cardiac procedures, developing risk score systems, and devising clinical guidelines. This is a general analysis of the collected data. All the patients referred to Tehran Heart Center for any kind of heart surgery between 2002 and 2008 were included, and their demographic, medical, clinical, operative, and postoperative data were gathered. This report presents general information as well as in-hospital mortality rates regarding all the cardiac procedures performed in the above time period. There were 24959 procedures performed: 19663 [78.8%] isolated coronary artery bypass grafting surgeries [CABGs]; 1492 [6.0%] isolated valve surgeries; 1437 [5.8%] CABGs concomitant with other procedures; 832 [3.3%] CABGs combined with valve surgeries; 722 [2.9%] valve surgeries concomitant with other procedures; 545 [2.2%] surgeries other than CABG or valve surgery; and 267 [1.1%] CABGs concomitant with valve and other types of surgery. The overall mortality was 205 [1.04%], with the lowest mortality rate [0.47%] in the isolated CABGs and the highest [4.49%] in the CABGs concomitant with valve surgeries and other types of surgery. Meanwhile, the overall mortality rate was higher in the female patients than in the males [1.90% vs. 0.74%, respectively]. Isolated CABG was the most prevalent procedure at our center with the lowest mortality rate. However, the overall mortality was more prevalent in our female patients. This database can serve as a platform for the participation of the other countries in the region in the creation of a regional ACSD.

Five-year follow-up of the local autologous transplantation of CD133+ enriched bone marrow cells in patients with myocardial infarction

The implantation of a CD133+ bone marrow cell population into an ischemic myocardium has emerged as a promising therapeutic modality for myocardial regeneration and restoration of ventricular contractility. While previous studies have documented the short-term safety and efficacy of CD133+ cell transplantation in patients with acute myocardial infarction, there are few reports of long-term follow-up results. Here, we present the results of long-term follow-up of our acute myocardial infarction patients who were treated with intra-myocardial injection of CD133+ cells after coronary bypass graft. After five years, 13 patients in the cell transplantation group and 5 patients in the control group underwent safety and efficacy investigations by New York Heart Association classification and two-dimensional echocardiography [2D echo]. During the five-year study period, no major cardiac adverse events were reported among patients who received CD133+ stem cells. Regarding efficiency, we observed no statistically significant treatment effects for the echocardiographic parameters [left ventricular end-diastolic and end-systolic volumes, and resting ejection fraction] measured during the follow-up period. However, detailed analysis of regional wall motion revealed an improvement in the Wall Motion Score Index from baseline to the six month follow-up, which was maintained during the follow-up period. Taken together, the long-term results of the present study indicate that transplantation of CD133+ is a safe and feasible procedure; however, we could not show any major benefits in our patients. Thus, this issue needs to be addressed by conducting other studies with more patients

Mulibrey nanism in a 35 year-old iranian female with constrictive pericarditis

Mulibrey nanism is a rare autosomal recessive disorder characterized by severe growth retardation and pericardial constriction associated with muscle, liver, brain, and eye abnormalities. More than 80% of previously reported cases are Finnish. We report a 35-year-old Iranian female who presented with classic phenotypic features of Mulibrey nanism with symptomatic constrictive pericarditis and underwent pericardiectomy .Our case is one of the rare examples of Mulibrey nanism outside Finland that has been reported so far

Screening of carotid artery stenosis in coronary artery bypass grafting patients

We sought to evaluate the routine echo-Doppler screening of carotid artery stenosis in patients undergoing coronary artery bypass grafting. A total of 2179 consecutive patients who underwent coronary artery bypass grafting alone or with other cardiac surgery at Tehran Heart center, Tehran-Iran, between January 2005 and January 2006 were included in this retrospective study. Carotid Doppler was performed for 1604 [81.48%] of these patients. The patients' age ranged between 20 and 84 years [mean: 58.33, SD: 10.08 years]. Of the 1604 patients studied, 1186 [73.9%] were men, 592 [36.9%] had diabetes, 598 [37.3%] were smokers, and 194 [12.1%] cases had significant left main stenosis. Twenty-one [1.3%] patients had significant carotid stenosis [> 60% stenosis], which constituted 0.9% of all the bypass surgery candidates. Post-operative cerebrovascular accident was not detected in any of the patients with significant carotid stenosis, but cerebrovascular accident occurred in 22 [1.4%] of the patients without carotid stenosis. Magnetic resonance angiography [MRA] was conducted in 15 patients. In our univariate analysis, female gender [p value = 0.023], hypertension [p value 0.055], peripheral vascular disease [p value < 0.001], and age [p value = 0.001] were significant in the development of carotid stenosis. Pre-operative duplex carotid screening seems to be necessary in patients when there is hypertension, peripheral vascular disease, .female gender, and advanced age

Left-sided endocarditis associated with multi-drug resistance acinetobacter Lwofii

Acinetobacter lwoffii, and important nosocomial pathogen, is a gram-negative aerobic bacillus that is a component of the normal flora on the skin, oropharynx, and perineum of about 20-25% of healthy individuals. We herein present a case of a 66-year-old man with combined mitral and aortic valve endocarditis associated with multi-drug resistance acinetobacter lowffii bacteremia

Molecular spectrum of beta-globin mutations in transfusion-dependent patients with thalassemia in Qazvin province, Iran

Beta thalassemia is a common inherited disease, resulting from one or more of 200 different mutations in the beta-globin gene. Qazvin province has attracted migrations of several different populations due to industrialization during the past five decades. The aim of this study was to define the molecular spectrum of beta-thalassemia mutations in Qazvin province Ethylen diamin acetic acid-containing venous blood samples were collected from 100 patients with transfusion-dependent beta-thalassemia from the department of Pediatrics in Qods hospital. Age, sex, history, and consanguinity between the parents were recorded by reviewing the patients' files. DNA was isolated from leukocytes using the standard procedure. Amplification refractory mutation system [ARMS] technique was used for molecular detection of mutations. Direct sequencing analysis was applied for DNA samples when no mutation was detected with ARMS. Of the 200 chromosomes investigated, 11 types of mutations were identified by ARMS technique while direct sequencing revealed the remaining alleles [9 types of mutations]. Total 20 different mutations discovered by this two-step approach. Abundant alleles [IVS II-1, IVS I-10, FSC 8/9] accounted for 59.3% of the mutations. IVS II-1 with a frequency of 31.3% was the most common while HbS, Cd 74/75 and Cd 15, each with a frequency of 0.55%, had the least frequencies. Beta thalassemia mutations are very heterogeneous in Qazvin province. Extensive ethnic and genetic admixture has resulted in unexpectedly high number of different mutations, most of them similar to that of north and north-western provinces of Iran. Different mutations in this region suggest migration of chromosomes from distant places and genetic admixture

Determinant factors of renal failure after coronary artery bypass grafting with on-pump technique

The aim of the present study was to investigate the determinant factors of acute renal failure [ARF] after isolated on-pump coronary artery bypass grafting [CABG]. This was a retrospective study of 13, 315 adult patients who underwent isolated CABG with cardiopulmonary bypass [CPB] in Tehran Heart Center from May 2002 to May 2007. The exclusion criteria were age <18, concomitant cardiac and/or noncardiac surgical operations, history of renal failure before surgery, and chronic renal failure requiring dialysis. Preoperative and operative variables were measured, and a multivariate logistic regression model was constructed to identify the independent risk factors for developing renal failure after on-pump CABG. Of the 13,315 patients, 3,347 [25.4%] and 90,883 [74.6%] were females and males, respectively, with a mean age of 58.63 +/- 9.48 years. ARF was detected in 85 [0.6%] of the patients with isolated on-pump CABG. The mean age of the patients was 58.63 +/- 9.48 years, and 25.5% of them were female. The multivariate logistic regression analysis identified age [OR = 1.035; p = 0.002], female gender [OR = 1.622; p = 0.037], history of peripheral vascular disease [PVD] [OR = 2.579; p = 0.042], diabetes mellitus [OR = 1.918; p < 0.001], emergent and urgent surgery [OR = 1.744 and OR = 7.901, respectively; p = 0.003], CPB time >70 min [OR = 1.944; p = 0.007], and intra-aortic balloon pump [IABP] insertion [OR = 10.181; p < 0.001] as the independent risk factors for ARF. The data showed that age, female gender, positive history of diabetes and PVD, urgent and emergent surgery, CPB time >70 min, and need for IABP were the independent determinant factors of ARF after on-pump CABG

Impact of diabetes mellitus on peripheral vascular disease concomitant with coronary artery disease

The aim of this study was to evaluate the impact of diabetes mellitus [DM] on peripheral vascular disease [PVD] in patients with coronary artery disease [CAD]. A total of 13702 consecutive patients who underwent coronary artery bypass grafting [CABG] at Tehran Heart Center between January 2002 and March 2007 were included in this study. The demographic data, PVD, and outcome of these patients were reviewed. CABG patients before surgery were detected for PVD [stenosis >/= 70% in the abdominal aorta; renal, carotid, and iliac arteries; or any other peripheral vascular system] with physical examination and past medical history. The suspected cases of PVD were, thereafter, confirmed via Doppler sonography or invasive angiography. This study recruited 4344 diabetic patients [mean age 59.30 +/- 8.7 years] and 9358 non-diabetic patients [mean age 58.42 +/- 9.9 years]. The diabetics were significantly older and had a higher incidence of PVD [2.7% vs. 1.8%], female gender, hypertension, renal failure, smoking, and dyslipidemia than the non-diabetics [P < 0.05]. There was no significant difference between the two groups with regard to family history and left main disease. Also, the mean ejection fraction [EF] was 48.85% +/- 10.4 and 49.35% +/- 10. In the patients with and without DM, respectively; and the difference was significant [P = 0.008]. The in-hospital mortality rate [mortality over a 30-day post-operative period] was 1.8% in the diabetics and 0.7% in the non-diabetics [P < 0.001]. In the multivariate analysis, PVD, left main disease, age, female gender, and EF were significant in the development of mortality amongst the diabetic patients with a respective odds ratio of 4.17, 5.54, 1.03, 2.86, and 0.95 [P

Prosthetic valve endocarditis: early outcome following medical or surgical treatment

Prosthetic valve endocarditis [PVE] is an important cause of morbidity and mortality associated with heart valve replacement surgery. The aim of the present study was to describe the early outcome of treatment in patients with PVE in a single center. The data of all the episodes of PVE registered at our institution between 2002 and 2007 were collected and analyzed retrospectively. The patients were assessed using clinical criteria defined by Durack and colleagues [Duke criteria]. The analysis included a detailed study of hospital records. The continuous variables were expressed as mean +/- standard deviation, and the discrete variables were presented as percentages. Thirteen patients with PVE were diagnosed and treated at our center during the study period. In all the cases, mechanical prostheses were utilized. The patients' mean age was 46.9 +/- 12.8 years. Women made up 53.8% of all the cases. Early PVE was detected in 6 [46.2%] patients, and late PVE occurred in 7 [53.8%]. Eleven [84.6%] patients were treated with intravenous antimicrobial therapy, and the other two [15.4%] required surgical removal and replacement of the infected prosthesis in addition to antibiotic therapy. Blood cultures became positive in 46.2% of the patients. Mortality rate was 15.4% [2 patients]. It seems that in selected cases with PVE, i.e. in those who remain clinically stable and respond well to antimicrobial therapy, a cure could be achieved by antimicrobial treatment alone with acceptable morbidity and mortality risk