The effect of fasting on spirometry indices and respiratory symptoms in asthmatic patients.

Introduction: Ramadan can alter the course of diseases by changing nutrition patterns, sleep habits, and medication-taking schedules. There are some concerns that patients with asthma may be affected by these alterations during Ramadan and experience deterioration of their symptoms. This study aimed to investigate the effect of fasting in Ramadan on the severity of the disease and spirometric parameters in patients with asthma. Methods: An overall 120 patients with moderate to severe asthma were investigated during Ramadan and categorized into two groups of fasting (60 cases) and non-fasting (60 cases) groups. Patients underwent spirometry before and after Ramadan and asthma control status was also assessed. The parameters measured in spirometry were compared in each group before and after Ramadan and also between the two groups. Results: Spirometric measurements including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and FEV1/FVC were not significantly different before and after Ramadan in both groups of fasting and non-fasting patients. Furthermore, there was no significant difference between the two groups in terms of these spirometric parameters changes from baseline. Nevertheless, FEV1 change in the fasting group was significantly higher than that in the non-fasting group (1.46±5.37 vs. -0.13±3.08, respectively; P=0.040). Conclusion: The results of this study demonstrated that fasting has no significant effect on the severity of asthma and spirometric findings in patients with moderate to severe asthma. Therefore, fasting during Ramadan can be considered safe for patients with asthma.

Upward spontaneous migration of ventriculoperitoneal shunt into the heart: A case report summary.

A male infant with a history of ventriculoperitoneal (VP) implantation due to congenital hydrocephalus presented with fever and lethargy at the age of 8 month-old. Pericardial effusion was detected in transthoracic echocardiography, and he underwent pericardial window operation and was discharged in a stable condition. At 11 months of age, he presented again with fever, lethargy, recurrent vomiting, and respiratory distress. In both plain chest radiography and transthoracic echocardiography, VP shunt migration to the heart cavity was observed. The VP shunt had entered into the right ventricle after perforating the diaphragm and pericardium. The patient underwent open-heart surgery due to vegetation at the tip of the VP shunt inside the right heart. Vegetation was removed and the tip of the shunt was returned to the peritoneal cavity. Two weeks after discharge, the patient presented again with symptoms of tachypnea and lethargy. The imaging revealed the entry of the VP shunt about two centimeters into the anterior mediastinum. The patient was transferred to the operation room and the VP shunt was shortened and re-inserted into the peritoneal cavity. Antibiotic treatment was continued for six weeks and the patient was discharged in stable condition. In follow-up visits after two years, the VP shunt functioned well and no particular complication was observed. This case demonstrates that in patients with VP shunt implantation presenting with pulmonary and cardiac symptoms such as respiratory distress, pericardial effusion, and cardiac tamponade after VP shunt implantation, the possibility of VP shunt catheter migration to the mediastinal cavity should be considered.

Role of Butyrate, a Gut Microbiota Derived Metabolite, in Cardiovascular Diseases: A comprehensive narrative review.

Cardiovascular diseases (CVD) are major causes of death worldwide. Recently, new roles for intestinal microbiota in pathology and treatment of CVD have been proposed. Butyrate, a bacterial metabolite, is synthesized in the gut and performs most of its functions in there. However, researchers have discovered that butyrate could enter to portal vein and interact with various organs. Butyrate exhibits a broad range of pharmacological activities, including microbiome modulator, anti-inflammatory, anti-obesity, metabolic pathways regulator, anti-angiogenesis, and antioxidant. In this article we review evidence supporting a potentially therapeutic role for butyrate in CVD and the mechanisms and pathways involved in the cardio-protective effects of butyrate from the gut and circulation to the nervous system. In summary, although butyrate exhibits a wide variety of biological activities in different pathways including energy homeostasis, glucose and lipid metabolism, inflammation, oxidative stress, neural signaling, and epigenetic modulation in experimental settings, it remains unclear whether these findings are clinically relevant and whether the molecular pathways are activated by butyrate in humans.

New solution for old challenge: Device closure of non-centrally positioned atrial septal defect.

Multiple interatrial defects, termed fenestrated ASDs that require closure are not uncommon. The problem arises when a centrally located defect or a patent foramen oval (PFO) is associated with another peripherally located defect. In cases like this, all attempts at crossing the true defect might totally fail or might be difficult because the wire or the catheter crosses the central defect repeatedly despite the use of a sizing balloon. In order to overcome such an issue, we introduce a new technique by which not only the procedure and the fluoroscopy time will be reduced, but also it ceases the mistakes about the number of defects, their size and location.

Effect of peripheral edema on oscillometric blood pressure measurement.

INTRODUCTION: Blood pressure (BP) measurement is essential for epidemiological studies and clinical decisions. It seems that tissue characteristics can affect BP results and we try to find edema effect on BP results taken by different methods. METHODS: BP of 55 children before open heart surgery were measured and compared according to three methods: Arterial as standard and reference, oscillometric and auscultatory methods. Peripheral edema as a tissue characteristic was defined in higher than +2 as marked edema and in equal or lower than +2 as no edema. STATISTICAL ANALYSES: data was expressed as Mean and 95% of confidence interval (CI 95%). Comparison of two groups was performed by T independent test and of more than two groups by ANOVA test. Mann-Whitney U and paired T-test were used for serially comparisons of changes. P less than 0.05 was considered significant. RESULTS: Fifty five children aged 29.4±3.9 months were divided into two groups: 10 children with peripheral edema beyond +2 and 45 cases without edema. Oscillometric method overestimated systolic BP and the Mean (CI 95%) difference of oscillometric to arterial was 4.8 (8/-1, P=0.02) in edematous and 4.2 (7/1, p=0.004) in non edematous. Oscillometric method underestimated diastolic BP as -9 (-1.8/-16.5, P=0.03) in edematous group and 2.6 (-0.7/+5, P= 0.2) in non edematous compared to arterial method. CONCLUSION: Oscillometric device standards cannot cover all specific clinical conditions. It underestimates diastolic BP significantly in edematous children, which was 9.2 mmHg in average beyond the acceptable standards.

A study on the mortality and complication rates following percutaneously adjustable pulmonary artery banding.

INTRODUCTION: Pulmonary artery (PA) banding is a procedure associated with high morbidity and mortality rates. It however can effectively palliate several forms of congenital heart lesions with increased pulmonary flow. Occasionally, to obtain an optimal degree of banding following operation, readjustment of the band is inevitable. We describe the technique of adjustable PA banding to prevent this problem. METHODS: From June 2007 to 2008, 21 patients with congenital cardiac abnormalities including Single ventricle (1), transposition of great arteries (TGA) (4) and ventricular septal defect (VSD) (16) were operated via percutaneously adjustable PA banding in Madani Hospital (Tabriz, Iran). RESULTS: The mean age and the mean weight of the patients were 12±.8 months and 61±.7 kg respectively. Seventeen (81%) patients survived the operation. Cause of death was heart failure in 2 (9.5%) patients, and arrhythmia in 2 (9.5%) patients. Later, patients were followed up for 6 months. Satisfactory band gradient was achieved between 48 and 240 hours. Mean PA gradient before and 1 and 6 months after adjusting was (55.3±7.1 mmHg), (54.7±5.1 mmHg), and (53.2±5.4 mmHg) respectively. In the follow up period, there were 2 deaths, one caused by aspiration pneumonia and one caused by poor mixing. Postoperative complications were observed in 28.5% of the cases including cardiac (10%), pulmonary (pneumothorax, pneumonia) (10%) and infectious complications (9%). CONCLUSION: The technique of percutaneously adjustable PA banding is simple and inexpensive and allows easy band adjustments without the need for multiple reoperations. Moreover, our assessment reveals that created gradient is constant and did not decrease with time.

Arterial lactate level changes in first day after cardiac operation.

Lactate level is an important index for predicting cardiac events. There are some debates about time and type of sampling for defining of its prognostic values. To assess the prognostic importance of arterial lactate level in patients after cardiac surgery with regarding to operation factors serial arterial lactate levels during and after surgery was measured up to 24 hours, these data were processed by T-independent test and chi-square, P less than 0.01 was significant. 31 patients entered to study, high persistent arterial lactate level (1.5-4 mmol/L) can be seen in most patients (80%) during operation which returned to normal level (<1.5 mmol/L) up to12(th) hours post operation in 75% of cases. Persistent high level (>4 mmol/L) will occur unusually at 24(th) hour but can be associated with poor prognosis. Serial measurement of serum lactate level can be helpful for our management quality and very highly persistent arterial lactate level (>4 mmol/lit) up to 24 hours after operation will increase mortality rate in operated patients for congenital heart disease.

ARC syndrome with complex renal problems: nephrocalcinosis, proximal and hyperkalemic distal RTA and nephrogenic diabetes insipidus.

We present a female neonate with arthrogryposis, renal tubular abnormalities and cholestasis syndrome and complex renal structural and functional abnormalities that include medullary nephrocalcinosis, hydronephrosis, nephrogenic diabetes insipidus, Fanconi syndrome, proximal and distal hyperkalemic renal tubular acidosis, near-nephrotic range proteinuria, hypercalciuria and severe hypovitaminosis D.

Pulmonary valve balloon valvuloplasty compared across three age groups of children.

The aim of this study was to investigate the characteristics and outcomes of treating pulmonary stenosis with percutaneous valvuloplasty, and to compare them among three childhood age groups. All children under 15 years of age who had undergone pulmonary valve balloon valvuloplasty in Madani Heart Center from 2005-2009 were enrolled in this study. Data were analyzed using IBM SPSS software (SPSS, Inc, Chicago, IL). Mean (± standard deviation) age of patients was 55.5 ± 47.4 months. Two-thirds of the subjects had moderate pulmonary valve stenosis. Balloon valvuloplasty failed in nearly one-fifth of the treated patients. There were 17 failures and two cases of mortality, descriptively less frequent among children >5 years; however, the observed difference was not statistically significant. Mild pulmonary valve insufficiency was a common finding.

Correlation Between Pediatric Open Heart Surgery Outcomes and Arterial-mixed Venous Oxygen Saturation Differences.

INTRODUCTION: Low Cardiac Output Syndrome (LCOS) contributes to postoperative morbidity and mortality. This article tries to find a predictive factor to interpret outcome after cardiac operation. METHODS: In a cross-sectional study, 100 children with congenital heart disease undergoing cardiovascular surgery with cardiopulmonary bypass (CPB) without significant left-to-right shunt were selected. Arterial and central venous oxygen saturation values were measured via blood samples simultaneously obtained in 6-hr intervals for a total of 24-hr during postoperative period at hours 0, 6, 12, 18, and 24. Postoperative ventilation support (intubation period) and cardiovascular support were also obtained from the hospital records. Statistical analysis was later performed comparing the arterial-mixed venous oxygen saturation differences and durations of required ventilatory and cardiovascular support, both for the complicated and non-complicated patient groups. The data was processed with correlation Pearson and Mann-Whitney U tests in SPSS 15 software, P less than 0.05 was significant. RESULTS: Mortality following cardiac operation is 6% and complications may happen in 45% of the cases. The highest Arterial-mixed venous oxygen saturation difference occurred immediately post operation (up to 57%). These measures were high up to 18 hours in complicated and non-complicated groups (36% vs. 31% ; P< 0.05). This factor cannot predict prolongation of intubation period in patients (P > 0.05). CONCLUSION: Arterial-mixed venous oxygen saturation difference may be high as much as 57% or as low as 23%.These different measures, being higher up to 18 hours in complicated to non-complicated groups after 18 hours, can be related to tissue ischemia during surgery and cannot be discriminative.

Inferior vena cava index in edematous patients.

INTRODUCTION: To find a relation between extracellular over fluid and inferior vena cava index as a noninvasive, cost effective and accessible method. METHODS: In a cross sectional study 54 cases (no edema 30, mild and moderate 13 and significant edema 11 cases) entered to study. Inferior vena cava index (IVCi) measured by difference of inspiration to expiration divided to maximum size multiply by 100, we also find delta ratio as difference of maximum to minimum size of inferior vena cava. All data expressed by rate and ratio, relation of edema severity to IVCi or delta ratio performed by mann whitney and regression test, P less than 0.05 was significant. RESULTS: IVCi in 30 cases with no edema ,13 cases with mild to moderate and 11 cases with significant edema were %46±16 , %42±16 , %38±17, there is a reverse relation of IVCi and edema severity but these relations were not significant (P>0.05 ).Averaged Delta ratio(millimeter) decreased in severe edema but it was not significant(3.7mm±2 vs. 2.8mm±1.6). CONCLUSION: In edematous conditions IVCi and delta ratio decrease but these changes are not significant for edema severity estimation.

Cardiac findings in congenital nephrotic syndrome.

INTRODUCTION: Congenital nephrotic syndrome is a severe debilitating problem associated with extra renal manifestation such as diverse cardiac findings. METHODS: During four years, 6 cases diagnosed as congenital nephritic syndrome in base of definitive criteria their documents reviewed and echocardiographic evaluation has been done for all with or without cardiac sign or symptoms, results gathered and expressed as incidence. RESULTS: All cases have some grades of structural or functional defects from simple form like as tricuspid regurgitation to complex defects. It may be run in consecutively in siblings of a family from non consanguine parents. CONCLUSION: Pulmonary stenosis may occur in all parts subvalvualr, valvular and peripheral parts of pulmonary artery, left ventricular hypertrophy and mitral regurgitation observed in some, moderate tricuspid regurgitation observed in half of cases due to pulmonary hypertension or right ventricular hypertrophy due to pulmonary stenosis.

Fatty liver in children.

AIMS: The aim of this study is to investigate the clinical and laboratory characteristics of nonalcoholic fatty liver disease (NAFLD) in a referral center of pediatrics in the northwest of Iran. METHODS: In this cross-sectional study all subjects aged between six months to 15 years that were referred to the sonography unit, were investigated for fatty liver from March 2005 to August 2006. Patients with fatty liver change underwent detailed clinical and laboratory evaluation. RESULTS: From 1500 children who were investigated, 34 subjects with sonographic evidence of fatty liver were enrolled in this study (2.3%). The mean age was 6.53 +/- 3.07 years. Elevated aspartate aminotransferase and alanine aminotransferase was detected in 38.2% and 47.1% of patients, respectively. The mean level of cholesterol was 461 +/- 182.23 mg/dl and 94.1% of patients had hypercholesterolemia. Total cholesterol level and serum aminotransferase levels had a significant positive correlation with severity of fatty liver (p < 0.05). Mean body mass index was significantly higher in patients with severe fatty liver (p < 0.05). CONCLUSION: The epidemiology of pediatric NAFLD should inform future attempts to develop evaluated screening protocols. Moreover, these data should guide efforts to delineate the pathophysiology of fatty liver in children.