Venous thromboembolism in medical critically ill patients: prevalence and incidence

The objective of this study was to determine the prevalence and incidence of venous thromboembolism among critically ill medical surgical patients. In this cross sectional and retrospective study, we observed 243 patients who were first admitted at the intensive care unit. Patients who were diagnosed with deep venous thrombosis or embolism either by clinical or paraclinical methods were enrolled. Among 243 patients of ICU ward 12 cases of them were confirmed to have thromboembolism [prevalence of 9.4%]. But the incidence of venous thromboembolism after 48 hour of ICU admission was 5.2% [6 cases]. Among 6 VTE cases 3 of them didn't receive any anticoagulant prophylaxis, 2 patients received LDUH 5000 unit twice a day and one patient received LMWH 60 mg daily but all developed VTE although receiving prophylaxis. We found that the prevalence of proximal lower limb DVT among medical-surgical critically ill patients remaining in the ICU for >/= 3 days is about 9.4% and the incidence of that is about 5.2%. Further studies should be performed in order to assess the benefits and risks of venous thromboprophylaxis in Iranian patients

Successful surgical intervention in an unusual case of Aspergillus endocarditis with acute myeloid leukemia

Endocarditis due to Aspergillus infection is a rare complication in patients with hematological malignancies. Here, we present a case of aspergillus endocarditis in a patient with acute myeloid leukemia [AML] successfully treated with antifungal therapy and surgical treatment. The patient was a 51 years old male, a known case of AML who was admitted to our medical center for evacuating his valvular vegetations and repairing his atrial septal defect. He underwent an open heart surgery to relinquish his thromboses and also received an antifungal regimen. The patient tolerated the procedure well and eight months after his surgery, the patient remains asymptomatic. Successful treatment of this severe case of aspergillus endocarditis justifies a multidisciplinary method to be as a safe and effective approach to manage these patients

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

Predicted values of cardiopulmonary exercise testing in healthy individuals [a pilot study]

Cardiopulmonary exercise testing evaluates the ability of one's cardiovascular and respiratory system in maximal exercise. This was a descriptive cross-sectional pilot study conducted at Masih Daneshvari Hospital in order to determine predicted values of cardiopulmonary exercise testing in individuals with normal physical activity patterns. Thirty four individuals [14 women, 20 men] between 18-57 years of age were chosen using simple sampling method and evaluated with an incremental progressive cycle-ergometer test to a symptom-limited maximal tolerable work load. Subjects with a history of ischemic heart disease, pulmonary disease or neuromuscular disease were excluded from the study. Smokers were included but we made sure that all subjects had normal FEV1 and FEV1/FVC. This study aimed to compare measured values of VO[2], VCO[2], VO[2]/Kg, RER, O[2]pulse, HRR, HR, Load, Ant, BF, BR, VE, EQCO[2], and EQO[2] with previously published predicted values. We found that our obtained values for VO[2] max, HRR max and HR max were different from standard tables but such difference was not observed for other understudy variables. Multiple linear regression analysis was done for height, weight and age [due to the small number of samples, no difference was detected between males and females]. VO[2] max and load max had reverse correlation with age and direct correlation with weight and height [P<0.05] but the greatest correlation was observed for height. Due to the small number of samples and poor correlations it was not possible to do regression analysis for other variables. In the next study with a larger sample size predicted values for all variables will be calculated. If the future study also indicates a significant difference between the predicted values and the reference values, we will need standard tables made specifically for our own country, Iran

Disseminated Mycobacterium kansasii in an HIV-negative patient

Disseminated Mycobacterium kansasii infection is a rare infection in non-HIV patients. This research has uncovered a very rare manifestation of disseminated M. kansasii infection in a non-HIV patient with lung and pericardial involvement

Effects of obstructive sleep apnea syndrome on serum aminotransferase levels and insulin resistance

Patients with obstructive sleep apnea [OSA] are at risk of developing the fatty liver as a result of being overweight. Several studies suggest that OSA per se could be a risk factor for liver injury; and ischemic hepatitis with OSA. The OSA is an independent risk factor for Insulin resistance. Therefore, we investigated liver enzymes and insulin resistance in patients with OSA, and compared with controls. Eighty-one consecutive patients with clinical suspicion of OSA were referred to the Sleep Unit of Masih Daneshvary hospital. On the basis of Polysomnography results patients were divided into two groups. The OSA and non-OSA cases, and also patients without OSA were used as internal controls. The Serum levels of liver enzymes were measured in all patients and abdominal ultrasound examination performed for screening the fatty liver and its grading. Insulin resistance was calculated via homeostasis model assessment [HOMA]. The OSA was present in 41 and absent in 40 patients. Age, sex and body mass indices were not significantly different in two groups. The mean of alanine aminotransferase [ALT] was 31.24 +/- 14.05 IU/L in OSA and 29.97 +/- 8.9 IU/L in non-OSA [p= 0.349] and aspartate aminotransferase [AST] was 29.07 +/- 9.6 IU/L in OSA and 26.85 +/- 6.7 IU/L in non-OSA [p= 0.389]. The mean of HOMA was 2.05 +/- 18.2 in OSA and 1.5 +/- 0.54 in non-OSA [p< 0.001]. This study shows that OSA, independent of overweight conditions, is not a risk factor for abnormal liver enzymes. However, the OSA per se seems to be associated with increase in insulin resistance and severity of fatty liver

clinicopathologic study of lung cancer cases in Iran

Lung cancer remains the leading cause of cancer-related deaths in the world. In Iran, lung cancer is the fifth leading cancer and its prevalence rate has been increasing steadily. In this study, the clinicopathological aspects of lung cancer are discussed. Between October 2002 and November 2005, 242 [178 men, 64 women] patients with histologically confirmed lung cancer were interviewed according to a questionnaire. Women developed the disease at an earlier age than men [55.9 +/- 14.2 versus 61.3 +/- 12.3 years; p=0.004]; 66.5% of lung cancer patients [85.4% of men and 14.1% of women] were smokers [p<0.0001]; 76.3% of participants, who had exposure to secondhand smoke, were females. Among the environmental carcinogens, the most exposures were to inorganic dusts [49.8%] and chemical compounds [34.9%].Most male and female patients suffered from adenocarcinoma [28.9%] and non small cell carcinoma [28.5%]. The prevalence of adenocarcinoma was higher in the non-smoker group, whereas incidence of squamous cell carcinoma and small cell carcinoma was higher among smokers [p<0.0001]. In this study, most patients [74.0%] presented with an advanced-stage tumor [IIIB or IV]. Our results suggest that in addition to cigarette smoking, other environmental, occupational and socioeconomic factors may play a role in the development of lung cancer

Assessment of wells criteria in patients with pulmonary embolism

Pulmonary embolism [PE] is one of the most important emergencies in internal medicine. Wells criteria are used to predict the presence of pulmonary embolism on the basis of clinical manifestations. The aim of this study was to assess Wells criteria in patients with pulmonary embolism. Materials and Ninety-nine patients with the diagnosis of PE underwent anticoagulant therapy during 2002-2006. Data were collected using a questionnaire and then analyzed by using SPSS software. The most common symptoms were dyspnea [70.7%] and chest pain [60.6%]. Wells criteria included "an alternative diagnosis less likely than PE" [84%], hemoptysis [34%], leg pain or swelling [30%], tachycardia [29%], recent surgery or immobilization [27%], previous deep vein thrombosis [22%] and malignancy [2%]. Eight percent, 69% and 23% of patients had Wells scores less than 2 points, 2-6 and >6 points, respectively. Among the patient group with modified Wells criteria, 36 patients [36.4%] had scores <4 points and 63 [63.6%] had scores greater than 4 points. The majority of patients with PE had Wells score of 2-6 points and those patients with Wells score less than 4 had a positive CT-angiogram

Respiratory disturbance index and severity of airway obstruction in COPD patients

Chronic obstructive pulmonary disease [COPD] is a common disease and concomitant occurrence with obstructive sleep apnea [OSA] has been reported in some studies. This coincidence can result in exacerbation of common complications like exacerbated hypoxemia, hyperpnea and right-sided heart failure. Thus, we decided to evaluate and compare respiratory disturbance index [RDI] and sleep apnea in COPD patients. For this purpose, 50 COPD patients with OSA were studied between 2003 and 2004. OSA criteria included obstructive apnea and clinical symptoms of snoring, sleep disorder and RDI >/= 5. The patients were divided in to two groups: group 1 consisted of 11 patients [22%] with FEV1/FVC<70 with the mean age of 36.18 +/- 14 and group 2 was included 39 patients [78%] with FEV1/FVC >/= 70 with the mean of 84.75 +/- 6.6%. RDI was compared between the two groups using independent sample t-test. Multiple regression analysis was also used for comparing other variables like height, weight, age, etc. The understudy patients were included 19 females [38%] and 31 males [62%] with the mean age of 53.7 +/- 14.8 yrs. There were statistically significant differences in RDI and height between the two groups [p=0.028 and p=0.00, respectively]. However, no significant difference was detected between the two groups in terms of weight and body mass index [BMI]. The possibility of concomitant occurrence of COPD and OSA should be considered due to co-occurrence of significant respiratory symptoms [like dyspnea, sleepiness, etc.] and assessed by adding RDI to important indices like height and so on

Effect of nutrition on inspiratory muscles and FEV1 in patients with emphysema

Malnutrition is an effective factor in respiratory muscles dysfunction in patients with chronic obstructive pulmonary disease [COPD]. The present study was performed to evaluate the effect of improved nutrition on inspiratory muscles in patients with advanced COPD. Total of 33 patients suffering from emphysema were studied during a 3-year period using a quasi experimental [before- after study] method. All of them had forced expiratory volume in one second [FEV1] < 30% and had received Atrovent, Salmeterol, Becotide [in maximum doses] and oxygen therapy for at least one year. Initially, FEV1 and airways resistance of patients were measured using body plethysmography .After a 35 Kcal/kg diet including 20-40% fat, 40% protein and 20% carbohydrates, these patients were followed by monthly scheduled visits. Spirometric parameters were measured again 3 and 6 months later and the results were analyzed using Freedman method. Pulmonary function tests of the under study patients at the beginning, 3 and 6 months later were as follows respectively; FEV1; 18.3%, 19.57%, 20.95%, airways resistance; 65.3%, 63.7%, 64.9% and maximal inspiratory pressure [MIP]; 2.59, 3.062 and 3.29 cmH2O. There was a significant difference in FEV1 and MIP of patients in 3 and 6 months period [P < 0.05]. Meanwhile, there was no significant difference in airways resistance of patients [P=0.08]. Improved nutrition results in increased MIP and FEV1 without changing in other indices [i.e. constant airways resistance indicates constant treatment status of the patient]. Thus, an appropriate nutritional diet including sufficient calorie with small frequent meals at least for six months can increase FEV1 by reinforcing inspiratory muscles resulting in improved pulmonary function