Effect of pulmonary rehabilitation program on patients admitted to ICU: a comparative cross sectional study

Generally ICU patients are in critical status and need long stay in ICU. Pulmonary rehabilitation program [PRP] is considered as an important tool to improve outcome and shorten the length of stay in ICU. The aim of this study was to investigate whether PRP can affect outcome and duration of hospitalization in ICU patients. This study was performed in medical ICU of Labafi Nejad hospital, Tehran, Iran during 2012 and 2013. All of patients who had more than one day stay in ICU were included in the study. They underwent PRP. We compared length of stay, mortality rate and number of hospitalized patients within 2 years in patients with PRP and patients without PRP. In 2012, 155 patients and in 2013, 173 patients were admitted in ICU. Admission period was 15 +/- 2.7 and 11 +/- 2.1 days, respectively [p< 0.001]. Pulmonary physiotherapy showed no effect on patients' outcome in which during 2012, 94 patients were discharged and 61 patients were died and in 2013, 98 patients were discharged and 64 patients were died [p=0.9]. Our study shows that PRP can shorten hospitalization time which can indirectly decrease hospitalization costs but there is no effect on overall survival

Different Anatomical Distribution of Basal Cell Carcinoma Subtypes in Iranian Population: Association between Site and Subtype

BACKGROUND: Basal cell carcinoma (BCC) is the most common type of human cancer. Despite the high prevalence of these tumors, there is a lack of reliable epidemiological data in some regions including Iran. OBJECTIVE: To assess the relationship between BCC subtypes and anatomical distribution in the Iranian population. METHODS: There were 876 patients with a single BCC enrolled in this study (March 2007 to March 2010; Razi Dermatology Center, Tehran, Iran). RESULTS: Among 876 patients, 544 were males and 332 females. Of the lesions, 43% were nodular, 32.4% mixed type, 3% superficial and rest of other subtypes. In the lesion location, 58.2% were on the face, 29.2% on scalp, 6.2% on ears, 2.3% on neck, 1.7% on trunk and 1.3% on the extremities. There was no significant difference between male and female in the BCC subtypes, but anatomical distribution of the tumor was different (p=0.002). Most of the trunk-arising BCCs were superficial, and most of the facial BCCs were nodular subtype. Also, most of the BCC subtypes occurred in patients between 40 to 80 years old and mostly on the face and scalp (p=0.04). However, superficial BCCs mostly occurred in younger patients over others (p=0.001). CONCLUSION: Subtype is associated with a site, independent of gender or age. Also BCCs occurring on the trunk are mostly of the superficial subtype.

Prevalence of different electrocardiographic patterns in Iranian athletes

To explore the abnormalities in Iranian athletes' electrocardiogram and find any relation with body fat. 239 international athletes were involved in this cross sectional study. Body-fat percentage and resting 12-lead ECGs were recorded from all participants. Of 239 participant athletes, 212 were male and 27 female. 60% of participants had sinus bradycardia. A total of 84% of the athletes demonstrated at least 1 abnormal ECG finding. Average values for the PR, QRS and QT intervals, P-wave duration and QRS axis were in normal range. Frequencies of various ECG abnormal findings in all athletes were as follows: right axis deviation 4.2%, left ventricular hypertrophy 6.2%, sinus arrhythmia 5.8%, right bundle branch block [RBBB] 24.2% [incomplete RBBB 16.8%, complete RBBB 7.4%], ST elevation 72.5%, prolonged QT interval 1.7%, T inversion 3.1% and Mobitz type I 1.2%. The athletes' ECG response to treadmill stress test was normal with no ischemia or arrhythmia. The means of BMI and body-fat percentage were 24.04 +/- 3.5 kg/m[2] and 9.15 +/- 2.12%, respectively. Pearson correlation coefficient between body-fat percentage and ST changes was 0.65 [P=0.008] in anterior leads and 0.198 [P=0.017] in lateral leads. Also, the correlation coefficient between the body fat percentage and right bundle branch block was 0.36 [P=0.013]. The results of current study support the inclusion of ECG in athletes' cardiac screening before they engage in vigorous exercises in order to detect the potentially fatal arrhythmias.

Correlation between the degree of air trapping in chest HRCT and cardiopulmonary exercise test parameters: could HRCT be a predictor of disease severity?

The purpose of this study was to examine whether the degree of air trapping in high resolution computed tomography [HRCT] of patients with histories of sulfur mustard gas exposure during suspended full expiration correlated with various parameters of the cardiopulmonary exercise test as the gold standard for assessment of pulmonary function. In this analytic study 75 male patients, each with a history of sulfur mustard gas exposure, were investigated. Each participant underwent an incremental cardiopulmonary exercise test, pulmonary function test and arterial oxygen saturation for hemoglobin measurement. For HRCT examination, both lungs were divided into three parts [upper, middle, and lower] and in each part images were separately observed from the involved area point of view [<25% = 6/24; >/= 25%= >/= 6/24]. A total of 49.3% of the patients of >/= 25% or < 25% were 41.1 +/- 6.8 and 39.7 +/- 4.0 years, respectively [P=0.281]. In our study there was no significant difference in pulmonary function test findings [FEV1, FVC and FEV1/FVC] between the two groups. There was no significant correlation with air trapping of >/= 25% and any of the exercise test parameters. Also, no correlation was found between significant air trapping and exercise test finding in maximum exercise and anaerobic situations. No correlation was found between HRCT and cardiopulmonary exercise test findings. HRCT is neither pathognomic of the disease nor a good predictor of disease severity but it might be suggestive of mustard lung injuries

Estimation of glomerular filtration rate with creatinine-based versus cystatin C-based equations in kidney transplant recipients

Serum cystatin C is more sensitive for glomerular filtration rate [GFR] measurement, but it is not available for clinical use in all laboratories. Regarding the importance of accurate estimation of GFR in kidney transplant recipients, we compared cystatin C-based equations with creatinine-based formulas to estimate GFR as precisely and simply as possible in kidney transplant recipients. Seventy living donor kidney transplant recipients with stable kidney function were enrolled in our study. The patients' GFRs were estimated by 3 creatinine-based equations [the modification of diet in renal disease [MDRD], abbreviated MDRD, and Cockcroft-Gault] and 5 cystatin C-based equations [Filler, Le Bricon, Rule, Hoek, and Larsson], and the results were analyzed. The mean age of the recipients was 38.7 +/- 13.4 years. The mean GFRs were 67.1 +/- 25.9 mL/min/1.73 m[2], by the Cockcroft-Gault; 61.0 +/- 17.7 mL/min/1.73 m[2], by the abbreviated MDRD; and 60.0 +/- 18.6 mL/min/1.73 m[2], by the MDRD formulas. Cystatin C-based GFR estimations were 43.6 +/- 16.2 mL/min/1.73 m[2], 44.0 +/- 13.2 mL/min/1.73 m[2], 33.8 +/- 14.1 mL/min/1.73 m[2], 35.6 +/- 13.7 mL/min/1.73 m[2], and 36.9 +/- 13.6 mL/min/1.73 m[2] by the Filler, Le Bricon, Larsson, Rule, and Hoek equations, respectively. The estimates by creatinine-based and cystatin C-based equations were significantly different and the MDRD estimate was the closest to the cystatin C-based GFRs. Our findings revealed the MDRD equation could be provide a closer estimate of GFR to the cystatin C-based equations than other creatinine-based GFR calculations in kidney transplant recipients

Posttransplant diabetes mellitus in kidney allograft recipients at Shaheed Hasheminejad Hospital

Our aim was to evaluate the frequency and risk factors of posttransplant diabetes mellitus [PTDM] at our kidney transplant center, and to compare graft and patient outcomes between the kidney recipients with and without PTDM. We studied 203 kidney transplant recipients with a negative history of diabetes mellitus before transplantation. We examined them for PTDM and made diagnosis on the basis of the American Diabetes Association criteria. Measurements of plasma glucose were carried out from 3 months to 24 months after transplantation. All data including recipient and donor demographics, cause of end-stage renal disease, cytomegalovirus and hepatitis C virus antibody tests, and patient and graft outcomes were assessed in relation to PTDM. High fasting plasma glucose was seen in 24 [11.8%], 19 [9.4%], 16 [7.9%], and 13 [6.4%] patients at 3, 6, 12, and 24 posttransplant months, respectively. Moreover, impaired glucose tolerance was seen in 17 [8.4%], 16 [7.9%], 17 [8.4%], and 19 [9.4%] patients at the corresponding times, respectively. Accordingly, 39 patients [19.2%] were diagnosed to have PTDM. The mean age of the kidney recipients with PTDM was 46.5 +/- 12.3 years as compared to 38.6 +/- 13.4 years in nondiabetic kidney recipients [P = .02]. The 5-year patient and graft survival rates were not significantly different between the kidney recipients with and without PTDM. This study showed that PTDM is a common metabolic disorder in our kidney transplant patients. We recommend a less diabetogenic immunosuppressive protocol, especially for our older recipients