Thrombolytic Therapy Up-regulates Inflammatory Mediators Compared to Percutaneous Coronary Intervention (PCI).

The important role of reperfusion therapies in the treatment of acute myocardial infarction is well documented. However, reperfusion therapies can initiate inflammatory response and may damage the myocardium. The purpose of current study was to compare the effects of percutaneous coronary intervention and thrombolytic therapy on inflammatory markers in the setting of ST elevation myocardial infarction (STEMI). Eighty three patients with STEMI were enrolled in this study. 40 patients underwent percutaneous coronary intervention (PCI), and 43 patients received streptokinase (1.5 million IU) as a main medical reperfusion therapy. Monocyte expression of Toll-like receptor 4 (TLR4),  serum levels of TNF-α and IL-1ß, red cell distribution width (RDW) and C- reactive protein (CRP) were compared between groups at admission time, two hours and four hours after termination of treatment. p<0.05 was considered as statistically significant for all tests. Compared to baseline, both treatments increased monocyte expression of TLR4, serum levels of cytokines and CRP. Compared to PCI, medical reperfusion therapy significantly raised both monocyte expression of TLR4 (39.8±4.7 % vs 49.1±3.6 %, p<0.01), and serum levels of TNF-α (13.2±3.7 pg/ml vs 25.1±2.6pg/mlp<0.05). No effect was seen on RDW levels. Moreover, medical reperfusion therapy caused significant rise in CRP levels (p<0.01). The present study demonstrates that thrombolytic therapy is associated with higher inflammatory responses compared to PCI. Our findings suggest that thrombolytic therapy may increase the likelihood of detrimental effects of reperfusion therapy on the myocardium.

Prevalence of pulmonary hypertension in patients undergoing hemodialysis.

INTRODUCTION: Pulmonary hypertension (PH) is one of the most important accompanying comorbidities with hemodialysis in patients with end-stage renal disease. The prevalence of hemodialysis-induced PH is still a subject of debate. The goal of the present work was to determine the prevalence of PH in patients undergoing hemodialysis. MATERIALS AND METHODS: This study was carried out on patients undergoing hemodialysis for at least 6 months. Pulmonary artery pressure (PAP) was measured by a cardiologist using echocardiography, and a value equal to or higher than 35 mm Hg was considered PH. The relationship of a high PAP with demographic and clinical characteristics of the patients was assessed. RESULTS: A total of 102 patients were included in the study. The mean of age was 59 +/- 18 years. The most common cause of end-stage renal disease was diabetes mellitus (35%). The mean duration of hemodialysis was 24 +/- 17 months. The mean ejection fraction and PAP were 57 +/- 5% (range, 44% to 73%) and 39 +/- 9 mm Hg (range, 25 mm Hg to 70 mm Hg), respectively. Overall, 66% of the patients had PH. These patients were more likely to be on dialysis for a longer duration and to have low ejection fractions. They were also older than other patients. CONCLUSION: Our findings show that PH is associated with duration of dialysis, age, and ejection fraction. Due to the high prevalence of PH among hemodialysis patients, it is necessary to screen this disorder and minimize its effects.

Assessment of rapid shallow breathing index as a predictor for weaning in respiratory care unit.

BACKGROUND: At present, air way support plays pivotal role in management of patients in the ICU (Intensive Care Unit) and also RCU (Respiratory Care Unit). Ventilator weaning is an important step in the care of ICU and RCU patients. It is the gradual removal of mechanical ventilatory support. Different predictors are used for initiation of weaning. This study was designed to investigate the rapid shallow breathing index (RSBI) as a predictor for successful weaning. MATERIALS AND METHODS: This cross-sectional study was conducted on 70 patients who had mechanical ventilation for more than 48 hours in a respiratory care unit in Tehran Labbafi Nejad Hospital. They were clinically stable and had the criteria for weaning from the ventilator. We measured RSBI, and then evaluated the value of RSBI for successful extubation. RSBI was calculated when patients were on spontaneous breathing mode with PSV=0 and PEEP=0 for one minute. RESULTS: A total of 70 patients were included in this study; 63(90%) patients had RSBI ≤105 (breath/min/L), among them 49 (77%) patients had successful weaning and did not need re-intubation while the remaining had unsuccessful weaning (P=0.001). The mean weaning index for patients with successful extubation was 66 ± 57.2 and 76.9 ± 28.1 for patients with unsuccessful extubaion. We could not find a significant difference between the means (P=0.433). CONCLUSION: Although RSBI <105 is a helpful index for weaning, application of RSBI alone may mislead the physicians. General status of the patient, concomitant diseases and duration of hospital stay should all be considered for successful weaning.

Association between COPD Assessment Test (CAT) and Disease Severity Based on Reduction of Respiratory Volumes in Chemical Warfare Victims.

BACKGROUND: This study aimed to find an association between the short validated patient-completed questionnaire, the COPD Assessment Test (CAT) and disease severity according to spirometric findings in chemical warfare victims. MATERIALS AND METHODS: A total of 55 patients referred to Sasan Hospital (special complex for chemical warfare victims) were included in this survey. They completed CAT questionnaire and then spirometry was performed. According to GOLD criteria, the subjects were divided into four severity groups. All candidates were non-smoker males. They all had FEV1/FVC < 70%. RESULTS: CAT scores varied from 5 to 39, with a mean score of 22.25. FEV1 varied from 17.5% to 89% with a mean of 53.14, and FVC ranged from 22.9% to100% with a mean of 61.12. Data analysis revealed a significant relationship between CAT and FEV1 (P = 0.01). There was also a significant relationship between CAT and FVC (P = 0.05). CONCLUSION: Our findings show a significant association between CAT and disease severity obtained by lung function in chemical warfare victims.