Thrombocytopenia in the intensive care unit

Thrombocytopenia is a frequent finding in intensive care unit especially among adults and medical ICU patients.Thrombocytopenia is defined as a platelet count less than 100×109/l in ICU setting. Platelets are made in the bone marrow from megakaryocytes. Although not fully understood, proplatelets transform into platelets in the lung. The body tries to maintain platelet count relatively constant throughout life. Pathophysiology of thrombocytopenia can be defined by hemodilution, elevated levels of platelet consumption, compromise of platelet production, increased platelet sequestration and increased platelet destruction. Unlike in other situations, absolute platelet count alone does not provide sufficient data in characterizing thrombocytopenia in ICU patients. In such cases, the time course of changes in platelet count is also pivotal. The dynamics of platelet count decrease vary considerably between different ICU patient populations including trauma, major surgery and minor surgery/medical conditions. There are strong evidences available that delay in platelet count restoration in ICU patients is an indicator of a bad outcome

effect of bilateral intrapleural infusion of lidocaine with fentanyl versus only lidocaine in relieving pain after coronary artery bypasses surgery

Background and Objective: Pain control during surgery in order to cause analgesia and reduce the somatic and autonomic response may decrease the morbidity. Intrapleural catheter embedding during surgery under direct vision of surgeon is safe and easy and without potential risk of thoracic epidural block. The aim of this study was to investigate the effect of bilateral intrapleural infusion of lidocaine with fentanyl versus only lidocaine in relieving pain after coronary artery bypass surgery

Methods: In this prospective randomized double blind clinical trial,130 adult patients undergoing elective CABG with age range of 20 to 60 years were divided into two groups receiving either lidocaine and fentanyl [group A] or lidocaine [group B]. The analgesia was evaluated every two hours in all intubated and non-intubated patients using Visual analog scale [VAS] and data were analyzed using SPSS software package

Results: Of all patients, 67 [51.5%] were males and 63 [48.5%] were females. The average age of subjects was 53.49 +/- 5.099 years. Mean pain score six hours after the surgery was statistically different between the groups at all times

Conclusion: The pain in patients receiving combination of lidocaine and fentanyl is less than patients receiving only lidocaine

Relationship between plasma level of Vitamin D and post operative atrial fibrillation in patients undergoing CABG

Objective: Atrial fibrillation is the most common arrhythmia after cardiac surgery. Several studies have shown the impact of vitamin D on heart disease; however, there have been few studies for the incidence of AF and its relationship with vitamin D levels. According to the different results of these studies, we decided to evaluate the relation of plasma levels of vitamin D and postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery [CABG]

Methods: This cross-sectional study was performed on 50 patients after CABG surgery. Simple random sampling was done. Twenty five patients who developed AF within 48 hours after CABG with Cardiopulmonary bypass [CPB] were enrolled in the case group and 25 patients who did not develop AF within 48 hours after CABG with CPB were enrolled in the control group. Plasma levels of vitamin D in both groups of patients were recorded. Collected data were analyzed by the SPSS software version 17

Results: There was no significant difference in terms of demographic characteristics, comorbidities, lipid profile and kidney function between two groups. The mean plasma level of vitamin D was 27.4 +/- 2.22 ng/ ml in the case group and was 28.2 +/- 1.18 ng/ml in the control group it [p= 0.803]

Conclusions: Plasma levels of vitamin D were almost the same in both groups and there was no statistically significant difference between the groups with and without atrial fibrillation following CABG

Association between diabetic retinopathy and left ventricular dysfunction in diabetic patients with unstable angina

Diabetes mellitus [DM] is associated with serious complications including macro- and microvascular problems such as diabetic retinopathy. Coronary involvement in diabetic patients is believed to be a consequence of microvascular complications. However, the available data are inconclusive and scarce. This study aimed to evaluate the probable association between diabetic retinopathy and left ventricular dysfunction in diabetic patients with unstable angina [UA]. In this cross-sectional study, 200 diabetic patients with UA [100 cases with diabetic retinopathy and 100 cases without diabetic retinopathy] were enrolled in a teaching hospital. Left ventricular ejection fraction [LVEF] as well as the frequency of cases with left ventricular dysfunction [LVEF<50%] were compared between the two groups and different degrees of diabetic retinopathy [proliferative and non-proliferative]. Patients' demographic variables were comparable between the two groups. Mean diagnosis time of DM was significantly higher in the patients with diabetic retinopathy [8.40 +/- 6.60 vs. 3.81 +/- 3.58 years; P=0.001]. Mean LVEF was significantly lower in the retinopathy group [50.50 +/- 6.91% vs. 53.07 +/- 4.87%; P=0.003]. Frequency of cases with left ventricular dysfunction was significantly higher in the group with diabetic retinopathy [31% vs. 12%; P=0.001, OR=3.33, 95%CI: 1.58-7.14]. The frequency of cases with left ventricular dysfunction was significantly yet independently higher in patients with proliferative vs. non-proliferative diabetic retinopathy. Left ventricular dysfunction is more common in diabetic patients with unstable angina and diabetic retinopathy compared with their counterparts without diabetic retinopathy