Can preoperative serum level of creatinine predict new-onset atrial fibrillation in non-diabetic male patients undergoing open heart surgery? A retrograde view

Renal dysfunction is a risk marker in patients who candidate for coronary artery bypass graft [CABG]. Renal disorder is associated with prolonged stays in intensive care unit and hospital, morbidity and mortality. Aim of this study is specific evaluation of association between preoperative creatinine [Cr] with atrial fibrillation [AF] after elective off-pump CABG in non-diabetic male patients with normal ejection fraction. Two hundred non-diabetic male patients with normal ejection fraction undergoing elective off pump CABG surgery enrolled in this cross-sectional study and were stratified by present or absence of postoperative atrial fibrillation: patients with postoperative new-onset atrial fibrillation [n=100] as group 1 and patients without new-onset postoperative atrial fibrillation as group 2 [n=100]. Preoperative serological test of the participants, such as serum creatinine, were recorded in their medical dossiers. Data were analyzed in SPSS-16 software and tested for association between atrial fibrillation with creatinine level by using student t test, chi-square test or logistic regression. Cr level in patients with and without AF three days before surgery were 1.8 +/- 0.3 and 1.0 +/- 0.4 respectively [P value for Cr=0.00]. On surgical day, mean Cr level in patients with and without AF were 1.6 +/- 0.2 and 1.1 +/- 0.5 respectively [P value for Cr = 0.00]. Of the 100, male patients with postoperative AF, duration and frequency of recurrence of AF were not associated with Cr at three days before surgery and on surgical days [P>0.05]. Patients with postoperative AF had unsuitable status of renal function compare to patients without AF; however, preoperative serum creatinine cannot associate with duration and frequency of recurrence of AF

efficacy and safety of a high dose of vitamin D in mothers with gestational diabetes mellitus: a randomized controlled clinical trial

During pregnancy and lactation outstanding changes occur in mother's vitamin D metabolism. This study was carried out to evaluate the efficacy of 300,000 IU vitamin D given intramuscularly on body status in new cases of gestational diabetes mellitus [GDM]. This is a randomized clinical trial with the follow-up period of 3 months. Totally 45 participants were randomly divided into intervention group [IG] and control group [CG]. The IG received an IM injection of 300,000 IU of vitamin D, whereas CG did not. The glycosylated hemoglobin A1C [HBA1C], serum 25-OH-D, parathyroid hormone [PTH], serum calcium and phosphorus were measured. Results: Forty five patients including 24 with the mean age of 30.7 +/- 6.2 years in the IG and 21 with the mean age of 29.5 +/- 4.0 years in the CG participated in the study. The median concentration of serum 25[OH]D3 in the IG was to 62.10 nmol/l after the intervention, showing an increase of around 158%, compared to before intervention [24.25 nmol/l] whereas the CG showed a decrease of around 4.5%. Of the patients, 79.2% of IG and 81.9% of CG suffered to some degree from vitamin D deficiency. These figures were 4.2% and 71.4% for the IG and CG, respectively after the intervention.For the IG, the PTH was significantly lower and Ca was significantly higher after the intervention. The serum Phosphorus before and after the intervention in each group or between the two groups was not significant. The single 300,000 IM dose of vitamin D is regarded as an effective and safe to promptly improve vitamin D status in GDM

Preoperative C-reactive protein can predict early clinical outcomes following elective off-pump CABG surgery in patients with severe left ventricle dysfunction

Atrial fibrillation [AF] is the most common type of arrhythmia following elective off-pump coronary bypass graft [CABG] surgery, occurring on the 2[nd] or 3[rd] postoperative day. Postoperative atrial fibrillation and early complications may be the cause of long term morbidity and mortality after hospital discharge. High sensitive C-reactive protein [hsCRP] seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate whether preoperative hsCRP [>/=3 mg/dl] can predict post-elective off-pump CABG, AF, and early complications in patients with severe left ventricle dysfunction [Ejection Fraction [EF] < 30%]. This study was conducted on 104 patients with severe left ventriclar dysfunction [EF < 30%], undergoing elective off-pump CABG surgery during April to September 2011 at the Afshar Cardiovascular Center in Yazd, Iran. Patients undergoing emergency surgery and those with unstable angina, creatinine higher than 2.0 mg/dl, malignancy, or immunosuppressive disease were excluded from the study. The subjects were divided into two groups: Group I with preoperative increased hsCRP [> 3 mg/dl] [n=51] and group N with preoperative normal hsCRP [< 3 mg/dl] [n=53]. We evaluated post-CABG variables including incidence, duration, and frequency of AF, early morbidity [bleeding, infection, vomiting, renal and respiratory dysfunctions], ICU or hospital stay and early mortality. Data were then analyzed by Analysis of Variance [ANOVA], Chi-square and Fisher exact test for quantitative and qualitative variables. The average age of the patients was 62.5 years, 75 cases [72.1%] were male, and 39 [37.5%] were female. Postoperative AF occurred in 19 cases [18.2%]; 17 cases [33.3%] had hsCRP >/= 3 mg/dl and 2 cases [3.8%] had hsCRP 0.05]. Preoperative hsCRP >/= 3 mg/dl can predict incidence of postoperative atrial fibrillation and early complications such as midsternotomy infection, respiratory dysfunction, and hospital stay following elective off-pump CABG