[Effectiveness of oral n-acetyl-cystein in reduction of pulmonary complications in smokers undergoing coronary artery bypass surgery]

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 3 rd postoperative day. Severity of atelectasis was also measured. Quantitative and qualitative data was analyzed by ANOVA and Chi-square tests, respectively. P value <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 [P value<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

[ effect of active learning method on stability of information and satisfaction of physiopathology students in Yazd university of medical sciences]

Active Learning Method [ALM] is a model in which students are active in the class. This aim of this study is to compare stability of information and satisfaction of students in classic method of lecture and active learning method. This descriptive cross-sectional study was performed on 48 medical students [29 females and 19 males] selected through census sampling method and spending their physiopathology courses in Yazd Shahid Sadoughi University of Medical Sciences. Some sessions from the courses of "respiratory, digestive, and urinary diseases" were selected. Two forms for assessing students' satisfaction were used as pretest and post-test. The stability of information was assessed by 8 essay questions one month after teaching. SPSS software was used for data analysis using descriptive statistics, Mann Whitney and McNemar tests. Fifty six percent of students were generally satisfied with the project implementation. The median for stability assessment exam in classes held using ALM was 5 while it was 3.42 for classes using lecture method which had a significant difference [P=0.00]. Active learning method increases information stability in students' mind after the teaching session

[Guillain-barre syndrome following surgery]

Thymoma is the most common neoplasm of anterior mediastinum with incidence peaks during the fourth, fifth and sixth decades of life. Two-thirds of patients are asymptomatic and identified accidentally by chest x-rays Of the total, 40-70% of patients have one of more parathymic syndromes of which Myasthenia Gravis [MG] is the most common and reported in 10-50% Gullain-Barre Syndrome [CBS] has not been reporterd as a parathymic presentation in present literature. We report a 37 years old woman who presented with CBS after thymoma resection. There is one question: Is there any association between thymoma and CBS or is it a complication of surgery [thymectomy]?