Serum levels of tumor necrosis factor-a and interleukins in children with congenital heart disease

Background: Levels of anti-inflammatory cytokines in blood have a positive relationship with congenital heart disease [CHD]. We sought to assess the difference in serum cytokines levels between children with and without CHD

Methods: We recruited 60 patients with CHD and 30 healthy children, from 2013 to 2014. Patients with primary pulmonary hypertension; metabolic diseases; renal, endocrine, and chronic inflammatory diseases; fever; infection in the preceding 3 weeks; and malnutrition were excluded. Participants' demographic data were measured, and their cardiac diseases were diagnosed via echocardiography. Serum levels of tumor necrosis factor [TNF]-alpha, interleukin [IL]-6, andIL-18 were measured via ELISA

Results: Mean age of the participants was 4.28 +/- 3.44, 3.12 +/- 3.87, and 3.30 +/- 3.61 years in the cyanotic, acyanotic, and control groups, respectively [p value = 0.414]. Mean values of TNF-alpha [p value < 0.001], IL-6 [p value < 0.001], IL-18 [p value = 0.030], right ventricular pressure [p value < 0.001], and pulmonary pressure [p value = 0.015] were higher in the case group, while the BMI was higher in the controls [p value < 0.001]. Mean values of TNF-alpha [p value < 0.001], IL-6 [p value < 0.001], and right ventricular pressure [p value < 0.001] were significantly higher in the cyanotic children, whereas the BMI was higher in the controls [p value < 0.001]. Levels of TNF-alpha and IL-6 had significant correlations with right ventricular pressure

Conclusion: The present study showed a differed serum cytokines levels between children with and without CHD

Does airway pressure release ventilation mode make difference in cardiopulmonary function of ICU patients?

Introduction: Mechanical ventilation is essential in intensive care unit [ICU] patients who are unable to maintain adequate gas exchange without support. Different ventilation modalities have been introduced to imitate normal respiratory pattern but there are some disadvantages in each modality. The aim of present study was to compare the cardiopulmonary and airway pressure changes in ICU patients undergoing pressure controlled ventilation [PCV], one of the basic modalities with airway pressure release ventilation [APRV], an advanced ventilation mode which allows spontaneous breathing in any time of respiratory cycle

Materials and Methods: In this cross over study, 18 patients were randomized to receive either PCV or APRV ventilation for 30 minutes then after washout period, switched to another group. Cardiopulmonary and arterial blood gas variables and airway pressure were recorded prior to study and after 30 minutes of starting each modalities and compared between groups

Results: Airway pressure were significantly higher in APRV mode [9.3 +/- 3.3 vs. 6.9 +/- 1.5, p=0.044 in PCV group and 9.1 +/- 3.4 vs. 6.6 +/- 1.4, p=0.021 in APRV group] and arterial blood gas in PCV mode was insignificantly higher than APRV mode in both protocols. There was no significant difference in other cardiopulmonary variables

Conclusion: This study has shown no hemodynamic change's difference due to two studied protocol. The mean airway pressure in APRV mode was more than PCV mode with lower arterial blood O2 pressure in both protocols

Comparison of right and left side heart functions in patients with thalassemia major patients with thalassemia intermedia, and control group

Heart disease is the main cause of mortality and morbidity in patients with beta thalassemia, rendering its early diagnosis vital. We studied and compared echocardiographic findings in patients with beta thalassemia major, patients with beta thalassemia intermedia, and a control group. Eighty asymptomatic patients with thalassemia major and 22 asymptomatic cases with thalassemia intermedia [8-25 years old] were selected from those referredto All Asghar Hospital [Zahedan-Iran] between June 2008 and June 2009. Additionally, 80 healthy individuals within the same age and sex groups were used as controls. All the individuals underwent echocardiography, the data of which were analyzed with the Student t-test. The mean value of the pre-ejection period/ejection time ratio of the left ventricle during systole, the diameter of the posterior wall of the left ventricle during diastole, the left and right isovolumic relaxation times, and the right myocardial performance index in the patients with beta thalassemia major and intermedia increased significantly compared to those of the controls, but the other parameters were similar between the two patient groups. The mean values of the left and right pre-ejection periods, left ventricular endsystolic dimension, and left isovolumic contraction time in the patients with thalassemia intermedia increased significantly compared to those of the controls. In the left side, myocardial performance index, left ventricular mass index, isovolumic contraction time, and deceleration time exhibited significant changes between the patients with thalassemia major and those with thalassemia intermedia, whereas all the echocardiographic parameters of the right side were similar between these two groups. The results showed that the systolic and diastolic functions of the right and left sides of the heart would be impaired in patients with thalassemia major and thalassemia intermedia. Consequently, serial echocardiography is suggested in asymptomatic patients with beta thalassemia for an early diagnosis of heart dysfunction and proper treatment

Diagnostic value of electrocardiography compared with echocardiography in measuring left ventricular mass index in major thalassemia patients over 10 years of age

Patients suffering from major beta thalassemia need frequent blood transfusions and, if not treated well, would be at risk of heart dysfunction. This study was performed to determine the diagnostic value of electrocardiography versus echocardiography in measuring the left ventricular mass index in these patients. Between July 2010 and June 2011, 82 asymptomatic patients over 10 years of age with major thalassemia [42 men with a mean age of 17.65 +/- 3.39 years and 40 women with a mean age of 16.9 +/- 3.38 years] were enrolled in this study. For all the patients, standard electrocardiography [to measure R in aVL and S in V3 and calculate left ventricular mass index by electrocardiography] and echocardiography [to measure interventricular septum diameter in diastole, left ventricular posterior wall diameter in diastole, and left ventricular diameter in diastole in order to calculate left ventricular mass index by echocardiography] were performed, at least one week after transfusion. The calculated left ventricular mass indices were thereafter compared between the two methods [electrocardiography and echocardiography]. Sensitivity, specificity, positive predictive value, and negative predictive value in the two techniques in determining the left ventricular mass index were 67%, 25%, 89%, and 7% in the females, 65%, 33%, 92%, and 6% in the males, and 67%, 14%, 89%, and 3% in the total population, respectively. Furthermore, this study demonstrated that the average left ventricular mass index by echocardiography and electrocardiography was 104.86 +/- 21.65 gr/m[2] and 91.69 +/- 12.03 gr/m[2], respectively. Echocardiography was much more accurate than electrocardiography in determining the left ventricular mass index [p value = 0.0001]. The findings of this study demonstrated that echocardiography was more accurate and more reliable than electrocardiography in determining the left ventricular mass index in major thalassemia patients