[Epidemiological study of patients with endocarditis in Qom city between 2004-2013]

Background: Understanding the epidemiology and main leading factors of endocarditis, accelerate the process of diagnosis and treatment, and reduce mortality from this disease. This study was performed due to uncertain epidemiological situation of endocarditis in different parts of Iran, especially city of Qom.

Materials and Methods: In this cross-sectional study, epidemiological status of hospitalized patients with endocarditis in Qom city hospitals between 2004-2013 was reviewed. In this study, 74 patients who had duke criteria for infective endocarditis, were studied. Demographic data and the disease information were recorded on a Check list. Data collection method was the patients' hospital records. Data were analyzed using SPSS software version 16.

Results: In this study, 74 patients, including 49 males and 25 females were studied. The patients' mean age +/- SD was 28 +/- 15/78. According to information obtained, age range 20-23 years with 29 patients [39/1%], was the most affected. The most common cause of hospital admission was fever with 80% [59 patients]. Tricuspid valve involvement was 67.5% [29 patients]. The most common underlying disease was heart diseases by as much as 44/5% [33 patients]. 42/4 % [14 patients] had a history of mitral valve replacement. Among those who had positive cultures, 85/7% [12 patients] Staphylococcus aureus, and 14/2% [2 paients] Klebsiella were reported. Mortality rate was 7.5%.

Conclusion: Fever, if accompanied with a heart murmur, or a history of mitral valve replacement in young men who have had a history of intravenous drug abuse, strongly suspected endocarditis.

Very late effects of postoperative atrial fibrillation on outcome of coronary artery bypass graft surgery

Atrial fibrillation [AF] after coronary artery bypass graft [CABG] is a common complication with potentially higher risk of adverse outcome and prolonged hospital stay. To determine the impact of postoperative AF [POAF] on long-term outcome in a large cohort of patients who underwent CABG. We conducted an observational cohort study of 989 patients who underwent isolated CABG with more than 5-year follow-up. Patient divided in two groups: patients with and without POAF. In this study, atrial fibrillation developed after CABG in 156 patients [15.8%]. Patients with POAF were generally older [P = 0.001] and presented more often with comorbidities including congestive heart failure [P = 0.001], hypertension [P = 0.001], peripheral vascular disease [P = 0.001], hyperlipidemia [P = 0.009], and renal failure [P = 0.001]. Five-year mortality was observed in 23 [2.3%] patients. Patients with POAF had higher five-year mortality rate than those without POAF. Multivariate logistic analysis showed that AF after surgery has a strong effect on mortality [HR, 3.3; 95% CI, 0.04-10.8, P = 0.04] and morbidity rates [HR, 4.0; 95% CI, 2.35-6.96, P = 0.001]. Postoperative atrial fibrillation strongly predicts higher long-term mortality and morbidity following coronary artery bypass graft

Survival after in-hospital cardiopulmonary resuscitation in a major referral center

This study was undertaken to assess the demographics, clinical parameters and outcomes of patients undergoing cardiopulmonary resuscitation [CPR], by the code blue team at our center to compare with other centers. Data were collected retrospectively from all adult patients who underwent CPR at our hospital from 2007 to 2008. CPR was performed on 290 patients and it was given 313 times. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from the hospital. Factors associated with survival were evaluated via binomial and chi square-tests. Of the 290 patients included, 95 patients [30.4%] had successful CPR. However, only 35 patients [12%] were alive at discharge. The majority requiring CPR were above 60 years of age [61.7%]. Males required CPR more than females. There were 125 women [43.1%] and 165 males [56.9%] aged 3 to 78 [average 59.6] years. Majority [179] of the cases [61.7%] were above 60 years of age. Regarding the various wards, 54 cases [17.3%] were in the internal medicine ward, 63 cases [20.1%] in the surgery ward, 1 case [0.3%] in the clinic, 11 cases [3.5%] in the paraclinic, 116 cases [37.1%] in the emergency [ER], 55 cases [17.5%] in the Intensive Care Unit [ICU] and Coronary Care Unit [CCU], and 13 cases [4.2%] were in other wards. Cardiac massage was done in 133 cases [42.5%], defibrillation only via electroshock 3 cases [1%], and both were used in177 cases [56.5%]. The ER had the most cases of CPR. Both cardiac massage and electroshock defibrillation were needed in most cases. In-hospital CPR for cardiopulmonary arrest was associated with 30.4% success at our center at the end of CPR but only 12% were alive at discharge. Duration of CPR >10 minutes was predictive of significantly decreased survival to discharge