RESUMO
The aim of current study was evaluating the frequency of clopidogrel resistance and its impact on clinical outcome of patients in Iranian patients. Patients undergoing percutaneous coronary intervention in Imam Hussein Medical center, Tehran, Iran, who received standard dosage of clopidogrel (Plavix®, Sanofi, France, 600 mg loading dose and 75 mg/day afterward) were recruited. Platelet aggregation was measured using light transmission aggregometer. The patients were categorized as responder (platelet aggregation less than 43%) and non-responder (platelet aggregation more than 43%). All patients were evaluated for major adverse cardio vascular events one month and 3 years after the angioplasty based on MACE criteria by phone contact. One hundred and five patients with average age of 60.30 ± 12.2 years entered the study of whom 26 (24.76%) did not respond to clopidogrel. None of patients experienced cardiac events one month after PCI. Three years after PCI, data were collected from 55 (69.62%) and 10 (38.46%) subjects in responder and non-responder groups, respectively. MACE criteria was positive in 4 patients, 3 (5.45%) in responder and 1 (10%) in non-responder group (p = 0.28). We did not find any significant differences between clopidogrel resistance and past medical history. In drug history 1 (1.26%) and 4 (15.38%) patients received omeprazole with clopidogrel in responder and none-responder group, respectively (p = 0.003). This study showed 24.76% resistance to clopidogrel in Iranian population but, we did not find any correlation between clopidogrel resistance and cardiac events in follow up maybe due to study limitations particularly missed follow-up in non-responder patients.
RESUMO
BACKGROUND: Ventilator-Associated Pneumonia (VAP) is an important cause of morbidity and mortality in patients admitted to Intensive Care Unit (ICU). The current study conducted to estimate VAP incidence, attributable mortality and case fatality rate, cost, so related factors can affect the outcome in patients. MATERIALS AND METHODS: In this descriptive longitudinal study, demographic, clinical and para-clinical data were collected and attributable mortality and case fatality rate was estimated. Multivariable analysis was done to predict the possible risk factors on the outcome of VAP patients. Also, patients' survival curve was plotted based on their length of ICU stay. Finally, the additional cost due to VAP in ICU was estimated. RESULTS: Totally, 8% ICU admissions were affected by VAP and 4% expired during the ICU stay. Further, the attributable mortality rate of VAP was high as compared with standard mortality rate. The most case fatality rate was for Acinetobacter sp. (n=17 60.7%). In multivariable logistic regression analysis, age greater than 40 years, more than 96 hours mechanical ventilation and uncontrolled diabetes mellitus were predictor factors of higher mortality. Inverse association between survival time and ICU length of stay was reported. Finally, the additional cost of VAP was estimated of about 700 US$ per patients. CONCLUSION: According to the results, strategies to prevent mortality by reducing the duration of ventilation and ICU length of stay should be performed. Also, mandatory fees for the family and the healthcare system should be planned.
