Evaluation of maximum o[2] consumption: using ergo-spirometry in severe heart failure

Although sport-physiologists have repeatedly analyzed respiratory gases through exercise, it is relatively new in the cardiovascular field and is obviously more acceptable than standard exercise test, which gives only information about the existence or absence of cardiovascular diseases [CVDs]. Through the new method of exercise test, parameters including aerobic and anaerobic are checked and monitored. 22 severe cases of heart failure, who were candidates of heart transplantation, referring to Massih Daneshvari Hospital in Tehran from Nov. 2007 to Nov. 2008 enrolled this study. The study was designed as a cross-sectional performance and evaluated only patients with ejection fraction less than 30%. O[2] mean consumption was 6.27 +/- 4.9 ml/kg/min at rest and 9.48 +/- 3.38 at anaerobic threshold [AT] exceeding 13 ml/kg/min in maximum which was significantly more than the expected levels. Respiratory exchange ratio [RER] was over 1 for all patients. This study could not find any statistical correlations between VO2 max and participants' ergonomic factors such as age, height, weight, BMI, as well as EF. This study showed no significant correlation between VO[2 max] and maximum heart rate [HR [max]], although O[2] maximum consumption was rationally correlated with expiratory ventilation. This means that the patients achieved maximum ventilation through exercise in this study, but failed to have their maximum heart rate being led probably by HF-induced brady-arrhythmia or deconditioning of skeletal muscles

Efficacy of nicotine patch in combination with trazodone in smoking cessation

Treatment for tobacco dependency involves a combination of behavioral therapy, antidepressants, and nicotine replacement therapy. This study was conducted in order to compare the outcome of smoking cessation by using each of the four forms of nicotine replacement therapy [NRT] among participants using Trazodone tablet 50 mg. In this non-randomized quasi-experimental study the efficacy of four mentioned forms of nicotine replacement therapy [NRT] including patches, gums and microtabs and two forms of NRT together was evaluated. Smoking cessation while using Trazodone was also studied. All the smokers who referred to the smoking cessation clinic of Iranian National Research Institute of Tuberculosis and Lung Diseases [NRITLD], Tehran, Iran from Oct. 2005 to Oct. 2007 entered the study. They attended 4 weekly sessions followed by 2 sessions in the next 12 months. A total of 286 subjects participated in this study. Trazodone was prescribed for them and 253 used at least one form of NRT. There were 181 [74.6%] males. The mean age was 42.43 +/- 13.4 yrs. Thirty three cases selected nicotine patches, 99[39.4%] used nicotine gums, 64[25%] chose microtabs and 57[23%] preferred using two types of NRT simultaneously. A total of 152 participants [60%] quit smoking at the fourth session. At the fourth session, it was proved that nicotine patches had the highest success rate and were most efficient for quitting smoking [94%]. Also, after 6 and 12 months follow-up it was found that nicotine patches were most effective for abstinence. Nicotine patches used in combination with Trazodone tablets could result in higher success rates for smoking cessation

Comparison between the preventive effects of ranitidine and omeprazole on upper gastrointestinal bleeding among ICU patients

Critically ill patients may develop visible gastric mucosal injury and stress ulcer soon after admission to an intensive care unit causing upper gastrointestinal bleeding as an important complication. Histamine-2 receptor antagonist [H2RA] prophylactic therapy has been documented to significantly decrease the incidence of upper GI bleeding in critically ill patients. This study was carried out in order to compare the effects of intravenous doses of ranitidine and enteral form of omeprazole suspension on preventing GI bleeding among ICU patients. This study was a double-blind randomized clinical trial conducted on patients admitted to the ICU at the Imam Hossein Hospital in Tehran, Iran. The patients were randomly divided into two groups of A and B. In group A, ranitidine was used as the prophylactic drug against GI bleeding with the dosage of 50 mg two times a day accompanied by placebo gavages through nasogastric tube. In group B, 20 mg of a suspension of omeprazole two times a day was gavaged in addition to 2[cc] of a parenteral placebo drug. Of 198 patients admitted to the ICU, 69 patients did not meet the inclusion criteria and a total of 129 patients enrolled in this study. During the study 14[20.58%] cases in the ranitidine group and 3[4.9%] in the omeprazole group developed significant GI bleeding. Incidence of GI bleeding showed a significant difference between the two groups using the chi-square test. Of the 68 patients receiving ranitidine, 44 [67.7%] died. This rate was 38 in those receiving omeprazole [62%]. Of the patients given ranitidine who faced overt GI bleeding, 12 [85.7%] died. This rate was 3 in the omeprazole group [100%].This study showed a statistically significant difference between omeprazole and ranitidine in preventing overt GI bleeding among ICU patients; but it failed to indicate any difference in prophylaxis of clinically important GI bleeding between the two drugs

Effects of heparin and dalteparin on oxidative stress during hemodialysls in patients with end-stage renal disease

Dialysis-induced oxidative stress is one of the mechanisms of atherosclerotic changes. Heparin, used in hemodialysis, is an anticoagulant drug with anti-inflammatory and antioxidant effects. This study was planned in order to evaluate the antioxidant effects of heparin and dalteparin [low-molecular weight heparin]. Twenty-two patients underwent 3 hemodialysis sessions with 48-hour intervals. They underwent hemodialysis with heparin, with a bolus dose of 1000 U followed by 1000 U/h during the procedure. The second hemodialysis was done using hypertonic saline solution instead of heparin, and the third, using dalteparin, 4000 U, infused during hemodialysis. Before and after each dialysis session, we measured serum levels of total blood cholesterol, triglyceride, high- and low-density lipoprotein cholesterols and oxidized low-density lipoprotein cholesterol, in addition to total antioxidant capacity and paraoxonase 1 activity. Serum concentrations of triglyceride, cholesterol, and oxidized low-density lipoprotein cholesterol, as well as paraoxonase activity and total antioxidant capacity equally increased after the three hemodialysis sessions. Heparin and daltepain increased total antioxidant capacity, but they did not change the ratio of paraoxonase 1 to high-density lipoprotein cholesterol after hemodialysis. No significant differences were found through the study between the two heparin products in their antioxidant activities. Regarding these findings and considering higher price and less availability of dalteparin in comparison to conventional heparin, we recommend using conventional heparin during hemodialysis as the anticoagulant-antioxidant agent

Radiographic patterns in patients diagnosed with acute pulmonary emobolism

Pulmonary embolism [PE] results in significant morbidity and mortality. Due to lack of awareness among physicians in this regard or non-availability of objective tests the diagnosis of PE is difficult. Clinical features are nonspecific and all diagnostic tests have certain limitations. The purpose of this study was to evaluate chest radiographic findings in diagnosed cases of acute pulmonary embolism. We conducted a retrospective, chart review study on chest radiographs of all patients admitted to Masih Daneshvari Hospital in Tehran, Iran with a diagnosis of acute PE from April 2005 to February 2006. Fifty-one consecutive patients were diagnosed with acute pulmonary embolism by single detection CT scan, perfusion scan and echocardiography. Three radiologists interpreted the chest radiographs. We found only 2 normal chest radiographs [4%] and the other 48 [96%] were abnormal. The most common abnormalities were pleural effusion [60%], pulmonary artery enlargement [56%], and parenchymal pulmonary infiltration [54%]. Although chest radiography cannot be used for diagnosing or excluding PE, it contributes to non-invasive diagnostic assessment of PE through the exclusion of diseases that may mimic PE

Churg strauss syndrome after introducing oral steroid to inhaler - a report of three cases

The tetrad of bronchial asthma, severe sinusitis, nasal polyp, eosinophilia, and systemic vasculitis is the main feature of allergic granulomatosis and angitis [Churg- Strauss Syndrome]. This vasculitis is usually seen idiopathic in patients with a long history of asthma; oral steroids using steroid inhalers, vaccination and desensitization might be triggering factors. Drugs such as leukotriene receptor antagonists [LTRAS], penicillin, sulphonamides, anticonvulsants and thiazides have also been implicated. By presenting the cases in this article, the authors suggest that some cases of CSS may be partially or totally suppressed by corticosteroid therapy of asthma for long periods and replacing oral steroid by inhaler will reveal a pathologic condition of CSS, called frustes CSS forms. We report three subjects with asthma who had been receiving previously multiple corticosteroid courses for control, but when systemic corticosteroids were discontinued or switched over to steroid inhaler, the patients developed a similar syndrome

Short outcome and evaluation of hemoptysis in patients with old pulmonary TB

Data concerning the evaluation of hemoptysis in patients affected by Tuberculosis backs to 1940-1960. Remarkable advances in anti TB agents together with effective treatment strategies such as DOTS [Directly Observed Treatment Short Course] has made the feature of the disease to be less associated with severe complications like hemoptysis due to bronchiectasis or fibrocavernous lesions. The objective of this study was to evaluate the short outcome of the patients with hemoptysis due to old tuberculosis and also the relation of the severity of hemoptysis with length of stay [LOS] in hospital and the severity of the pulmonary lesion in high quality imaging techniques. Forty-five patients with old TB and cardinal sign of hemoptysis were evaluated and after excluding the mycetoma and suggestive tumor formation, the coefficient correlation between the severity of hemoptysis and the LOS and also the correlation of the severity of hemoptysis and different pictures of pulmonary lesions in CT- scan were evaluated with Spearman's rho statistical analysis. All patients were discharged except one who had died because of the reasons other than asphyxia due to hemoptysis. One patient had undergone bronchial artery embolization. Pulmonary resection had been performed in none of the patients. According to the non-parametric coefficient correlation analysis, there were significant correlations between age and the first evidence of residual TB in the lung parenchyma [P=0.00, Spearman rho 0.00] and also between severity of hemoptysis and pulmonary lesions in CT scan at the level of 0.05; but no correlation was observed between the LOS and the severity of hemoptysis [P=0.0769] Hemoptysis due to old destructive pulmonary TB usually has a benign course. This is probably due to lung fibrosis and scarring caused by a prolonged inflammatory process which has led to an increase in vascular anastomosis. In old TB the source of bleeding is usually brochiectatic lesions which are directly correlated with the radiologic features found in chest- x- ray. The authors believe that although pulmonary resection in patients with life threatening hemoptysis is of considerable attention, conservative management of hemoptysis associated with arrested pulmonary TB is the first option