Confusion at the beginning of sexual intercourse, the challenge of patients after coronary artery bypass graft surgery in Iran: A qualitative study.

BACKGROUND: Many patients suffer from sexual dysfunction after coronary artery bypass graft surgery, but they refuse to propose and follow up on the problem due to the cultural structures prevailing in Iranian society. Untreated sexual dysfunction will disturb the quality of life of these patients. This study was performed to explain the experiences of male patients from sexual problems after coronary artery bypass graft surgery. MATERIALS AND METHODS: This qualitative study was performed with the approach of conventional content analysis in Tehran in 2020. The data were collected through semi-structured interviews with 12 men after coronary artery bypass graft surgery at the hospital's cardiac surgery clinic, as well as the surgeon's clinic. Participants were selected by the targeted sampling method. After obtaining informed consent, the collected data were written word by word, and the content analysis approach was used to name the data, create analytical codes, and determine subcategories and categories. The data were analyzed by MAXQDA 10 software. RESULTS: The findings of this study show that the dimensions of confusion in patients' sexual intercourse after coronary artery bypass graft surgery in four subcategories of challenges of the first intercourse after surgery, ambiguity in how to obtain information, the ambiguity of sexual issues after surgery, and spouse are concerned about having sexual intercourse. CONCLUSION: The results of this study show that male patients who have undergone coronary artery bypass graft surgery have many ambiguities in the process of sexual intercourse, which passes the beginning of sexual intercourse with fear and avoidance of intercourse. Postoperative patients do not propose these problems with the medical staff when they suffer from sexual dysfunction or ambiguity due to the taboo of talking about sexual intercourse. Eventually, the patient and his or her partner become confused about sexual intercourse after surgery. Therefore, it is recommended that policymakers in the field of health create the culture and planning for solving the ambiguities created in the path of sexual intercourse of these patients.

Effects of supplementation with Heracleum persicum fruit extract on serum lipids in patients undergoing coronary angiography: a pilot trial.

Heracleum persicum Desf. Ex Fischer (Apiaceae) is a native medicinal plant in the Iranian traditional medicine and also a safe and common dietary spice. The present pilot study aimed to investigate the impact of supplementation with H. persicum fruits on serum lipid concentrations in a group of patients with minimal coronary artery disease. Subjects who were diagnosed with <50% luminal narrowing in any of the major coronary arteries in coronary angiography were recruited for this trial and were randomized to receive either H. persicum hydroalcoholic fruit extract (n=15; 300 mg/day) or placebo (n=12) for a period of 6 months. Serum concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were measured at baseline and at the end of study. No significant difference in concentrations of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol was observed between H. persicum extract and placebo groups (p>0.05). However, serum triglycerides levels were reduced after H. persicum extract supplementation in a borderline significant manner (p=0.063). Short-term supplementation with H. persicum fruit extract might be used as an adjunctive treatment for patients with hypertriglyceridemia.

Heart hydatid cyst close to the left descending artery in a thirteen-year-old boy.

INTRODUCTION: Hydatid cyst is a significant health problem in underdeveloped and developing countries, particularly among sheep breeders. Although cardiac involvement is seen only in 0.2% to 3% of the cases, early diagnosis and treatment are important. CASE PRESENTATION: A 13-year-old boy with dyspnea and atypical pericardial type chest pain for three months was referred to us. Chest X-ray revealed linear calcification in the left side of the heart. Computed tomography demonstrated a cyst with peripheral calcification and without internal septation in the lateral left ventricle (LV) myocardium. Serologic IgG test was positive for Echinococcosis. No other cyst was seen in the other organs such as the lungs and liver. By midline sternotomy on pump, an incision was made 2-cm lateral to the left ascending artery through the LV myocardium and without entering any cardiac chamber. After injecting hypertonic (5%) saline, the cyst was punctured and its fluid contents were aspirated, the cyst was enucleated, and the cavity marsupialization was done for protection of the myocardium. LV ejection fraction before operation was 40% but after operation and repairing LV myocardium, ejection fraction increased to 50% in. Histopathologic examination confirmed a hydatid cyst. CONCLUSIONS: In myocardial hydatid cysts, we recommend a direct approach without entering the cardiac chambers to avoid dissemination of the infection. We recommend excision of the germinative membrane without capitonnage to avoid impairment of myocardial contraction.

The effect of systemic arterial-line leukocyte filtration on the outcome of adult patients undergoing cardiac surgery.

BACKGROUND: It is known that cardiopulmonary bypass causes an inflammatory reaction with associated morbidity and mortality. Several anti-inflammatory strategies have been implemented to reduce this response, including leukocyte removal from the circulation using specialized filters. OBJECTIVES: The aim of this randomized clinical study was to assess the impact of arterial-line systemic leukocyte filtration on the postoperative outcome of adult patients undergoing elective cardiac surgery. PATIENTS AND METHODS: 114 patients undergoing CABG or valve replacement in Baqiyatallah hospital, Tehran, Iran from May to August 2011 were randomly assigned to two groups: with and without leukocyte filtration and their outcomes were compared. RESULTS: The postoperative intubation time was significantly shorter in patients with leukocyte filters (0.014). There was no significant difference between two groups regarding other outcome relatedvariables. CONCLUSIONS: Systemic arterial leukocyte filtration reduces the intubation time but has no other beneficial effect on the outcome of patients undergoing CABG or valve surgery.

Lutembacher's Syndrome Associated with Meningioma.

A 49-year-old man with Lutembacher's syndrome associated with frontal meningioma referred to our hospital. He also suffered from exertional dyspnea. Transthoracic echocardiography demonstrated mitral valve area of 1.48 cm2, moderate mitral stenosis, and left atrial dimension (LAD) of 5.6 cm with no clot. TEE revealed severe mitral stenosis, mitral valve area of 1.05 cm2 with wilkins 8-10 score, ejection fraction of 50%, and enlarged left atrium (LAD = 5.8 cm) with no clot. Induction of anesthesia was commenced taking into account the patient's specific circumstances, which meant the risk of surgery was high. During surgery, the mitral valve was replaced and the atrial septal defect was repaired without a patch. This case underscores the significance of the adoption of an appropriate therapeutic strategy in the treatment of Lutembacher's syndrome with meningioma before meningioma surgery.

Quality of life among veterans with war-related unilateral lower extremity amputation: a long-term survey in a prosthesis center in Iran.

OBJECTIVE: To determine the factors that have an adverse effect on the long-term health-related quality of life (HRQOL) of veterans who have lost their extremities on the battlefield. DESIGN: Cross-sectional study. SETTING: Tertiary prosthesis center. PARTICIPANTS: One hundred forty-one male Iranian veterans who have sustained unilateral lower extremity amputation during the Iran-Iraq War (1980-1988) were evaluated after an average of 21.6 years (range, 20-27 years) after amputation. INTERVENTION: No intervention. MAIN OUTCOME MEASUREMENTS: Physical and mental HRQOL according to the Short Form-36 (SF-36) Health Survey. A cutoff point to define poor versus good HRQOL was calculated using the first quartile of SF-36 physical and mental component scores. RESULTS: Poor physical HRQOL was positively associated with transfemoral amputation, phantom movement, low back pain, and a lower Barthel Index [odds ratios (ORs): 4.1, 7.8, 9.1, and 0.9, respectively). Poor mental HRQOL was associated with education level lower than high school diploma and the articular pain of the sound leg (OR = 2.9 and 6.5, respectively). Being employed or receiving disability was a factor that had a lower OR to associate with poor mental HRQOL (OR = 0.2). CONCLUSIONS: Alleviation of complaints such as low back pain and articular pain of the sound leg through appropriate medical management, granting facilities for continuing education, and employment are issues that should be considered by authorities and rehabilitative centers to increase HRQOL in amputee veterans.

Mortality pattern according to autopsy findings among traffic accident victims in Yazd, Iran.

OBJECTIVE: To describe mortality pattern and to determine undiagnosed fatal injuries according to autopsy findings among road traffic accident victims in Yazd, Iran. METHODS: In this retrospective study, 251 victims of road traffic accidents who were admitted to a tertiary trauma hospital over a two-year period (2006 and 2007) and received medical cares were included. Hospital records were reviewed to gather demographic characteristics, road user type, and medical data. Autopsy records were also reviewed to determine actual causes of death and possible undiagnosed injuries occurred in the initial assessment of the emergency unit or during hospitalization. RESULTS: There were 202 males (80.5%) and 49 females (19.5%). The mean (+/-SD) age of fatalities was 34.1 (+/-21.5) years. Pedestrian-vehicle accidents were the most common cause of trauma (100 cases, 39.8%). The most common cause of death was central nervous system injury (146 cases, 58.1%). The other causes were skull base fractures (10%), internal bleeding (8%), lower limb hemorrhage (8%), skull vault fractures (4%), cervical spinal cord injury (3.6%), airway compromise (3.2%), and multifactor cases (5.1%), respectively. Thirty-six fatal injuries in 30 victims (12%) mainly contributed to death according to autopsy, but were not diagnosed in initial assessments. The head (72.2%) and cervical spine (13.8%) regions were the two most common sites for undiagnosed injuries. CONCLUSION: Training courses for emergency unit medical staff with regard to interpreting radiological findings of head and neck and high clinical suspicion for cervical spine injuries are essential to improve the quality of early hospital care and reduce the mortality and morbidity of traffic accident patients.