Impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on mortality of coronary artery bypass grafting

There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs] as regards the postoperative mortality of coronary artery bypass grafting [CABG]. This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB. Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 [46.38%] patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death. The mean age of the patients was 60.04 +/- 9.51 years and 7364 [73.23%] were male. Eighty-seven [0.86%] patients expired within 30 days. Multivariate analysis revealed that the administration of ACEI/ARB significantly protected against in-hospital deaths in as much as there were 33 [0.70%] vs. 54 [1.0%] deaths in the ACEI/ARB positive and negative groups, respectively [OR: 0.628; p value = 0.09]. Patients without ACEI/ARB were more likely to have a higher global ejection fraction. Preoperative ACEI usage in patients undergoing CABG can be associated with decreased in-hospital mortality. Large-scale randomized clinical trials are suggested

Etiological characteristics of people with intellectual disability in Iran

To describe the etiological characteristics of intellectual disability in one Iranian center. In a cross-sectional study, 64 cases with mental retardation [MR] were examined in the Intellectual Rehabilitation and Welfare Care Center of Vardavard, Iran between April and September 2008. Cases were diagnosed with MR or showed delay/regression of developmental milestones. We studied the records of patients and interviewed their families. A total of 64 cases were screened [most were children]. The number of male patients was 19 [29.7%] and the females was 45 [70.3%]. First degree relatives with mental retardation were found in the families of studied patients, among these relatives 48% were female and 52% were male. Up to 77% of the marriages were between relatives, approximately half between first cousins. The illiteracy rate reached 34% in the families of MR children. Hard labor, hypoxia during labor, mother's preexisting systemic disease, and maternal and neonatal infection were the most important factors for MR. Furthermore, most of the families were found to have low socioeconomic class. Cognitive disabilities in children are multifactorial. Consanguinity was the main risk factor for MR and considering its high rate in our country due to traditional marriages, it should be modified

Sonographic prediction of body fat volume [subcutaneous and visceral fat] in cardiovascular patients

Inappropriate body composition represents impaired energy and nutrient intake and can be a risk factor for many diseases, especially for cardiovascular disease. Different methods have been suggested for the estimation of body fat volume and its distribution. However, they may be either expensive or hazardous for some groups of patients. Sonography is a very accessible technique, which may be used for the evaluation of visceral and subcutaneous fat volume. The purpose of this study was to evaluate the sonographic prediction of body fat and its distribution in subcutaneous and visceral compartments. During a three-month period, we conducted sonographic evaluations for visceral and subcutaneous fat in 106 patients who were admitted to our hospital. The subcutaneous fat was measured at the para-umbilical region and visceral fat was measured in the right para-renal space. The results were compared with the data obtained from the body mass index [BMI] and bioelectric impedance analysis. The mean age of the patients was 58.8 years, and the mean BMI was 26.48 +/- 0.33. The mean values of fat percent and fat mass obtained by the electric-method were 31.07 +/- 0.81% and 22.12 +/- 0.68 kg, respectively. The respective mean values of subcutaneous and visceral fat obtained by sonography were 20.50 +/- 0.56 mm and 24.14 +/- 0.58 mm. The correlation between BMI and subcutaneous fat was 0.85 [p value<0.0001] and the correlation between BMI and visceral fat was0.46 [p value<0.0001]. Sonography is a reliable and available method for the estimation of body fat and its distribution in cardiovascular patients, in subcutaneous and visceral compartments

Ultrasonographic screening of the carotid artery in coronary artery bypass surgery

The incidence of stroke after coronary artery bypass grafting [CABG] is between 0.9% and 6.7%, which significantly increases in-hospital and out-hospital costs. This study was designed to evaluate the prevalence of significant carotid stenosis and its risk factors in CABG. In total, 2044 consecutive patients undergoing elective CABG were investigated through a pre-operative duplex scanning of the carotid arteries. The relation of age, sex, smoking, hypertension diabetes, dyslipidemia, and coronary disease with carotid stenosis was evaluated. The prevalence of carotid stenosis was 7.6%. The multivariate analysis showed that age over 55 and left main coronary disease were significant independent risk factors for carotid stenosis. Female gender, smoking hypertension, and diabetes were the risk factors in the univariate logistic regression model. Carotid stenosis is prevalent in CABG candidates. It seems that age >/= 55 years and left main coronary disease are the independent risk factors for carotid stenosis in CABG patients