ARYA Atherosclerosis
Year:2018 | Volume:14 | Issue:6|Papers Count:7

BACKGROUND: Evidence-based clinical care guidelines effectively assists medical teams to increase the quality of clinical practice, and improve outcomes in patients. This study aimed to design and implement evidence-based care guidelines for removing arterial sheath in patients undergoing angioplasty of coronary artery. METHODS: This clinical trial study was performed on 200 patients (two groups of 100 patients) with mean age of 62. 5 ± 10. 8 years, from July 2014 to February 2014 in Baqiyatallah University of Medical Sciences (BUMS), Tehran, Iran. First, we designed a five-step guideline for removing arterial sheath. Then, the designed guideline (based on five-step Stetler model, i. e. preparation, validation, comparative study, implementation, and execution) in the current study, and the routine guideline were used for removing arterial sheath in patients in the intervention and the control groups, respectively. In both groups, the relevant outcomes including bleeding, vasovagal reactions, urinary retention, and pain were evaluated. RESULTS: There were significant differences between the two groups in terms of bleeding, hematoma, vasovagal reactions (n = 11 versus n = 24), urinary retention (n = 8 versus n = 31), and back pain after removing arterial sheath (P < 0. 050 for all). CONCLUSION: Based on the results of this study, the use of evidence-based care guidelines after removal of atrial sheath in patients undergoing angioplasty is recommended.

BACKGROUND: Syncope is a transient brief loss of consciousness accompanied with loss of postural tone. Of common places in which people experience syncope, military barracks can be named where training soldiers spend their military courses. The current study aimed to assess etiology and risk factors of syncope among military training soldiers. METHODS: This was a retrospective case-control study conducted on training soldiers of Army-501 hospital in Tehran, Iran, during the years 2017-2018. Cases were consisted of 50 soldiers who experienced syncope during military training, and controls were 150 soldiers who had not experienced syncope during their military training. Demographic data were recorded for cases and controls. RESULTS: Members of case and control groups were not statistically different regarding age (P = 0. 46) and height (P = 0. 70). Logistic regression test was performed and considering crude model, weight [odds ratio (OR): 0. 94; 95% of confidence interval (95%CI): 0. 90-0. 98], body mass index (BMI) (OR: 0. 72; 95%CI: 0. 61-0. 85), standing duration (OR: 1. 007; 95%CI: 1. 00-1. 01), history of syncope (OR: 15. 47; 95%CI: 4. 15-57. 60), positive family history of syncope (OR: 5. 94; 95%CI: 1. 66-21. 25), smoking (OR: 3. 5; 95%CI: 1. 54-7. 91), medical problems (OR: 7. 97; 95%CI: 1. 98-32. 17), anxiety (OR: 2. 02; 95%CI: 1. 13-4. 26), stress (OR: 6. 68; 95%CI: 3. 28-13. 57), and depression (OR: 4. 25; 95%CI: 2. 15-8. 39) were detected as significant predictors of syncope occurrence. CONCLUSION: Based on the findings of this study, lower BMI, positive history of syncope, smoking, depression, and stress were significant risk factors of syncope occurrence among training soldiers. Higher BMI has protective role in syncope occurrence.

BACKGROUND: Hypofibrinogenemia is an independent factor of excessive bleeding after congenital cardiac surgeries. Fresh frozen plasma (FFP) and fibrinogen concentrate are examples of recommended products for management of hypofibrinogenemic bleedings. Unfortunately, there is no study to compare these treatments in pediatric cardiac surgeries. Therefore, this study aimed to compare the effect of fibrinogen concentrate with FFP on postoperative bleeding and clinical outcome after congenital cardiac surgeries in pediatric population. METHODS: Phis prospective clinical trial study was carried out on 90 consecutive pediatric patients who underwent congenital cardiac surgeries. The eligible pediatrics who met our study criteria, randomly received FFP (10 ml/kg) or fibrinogen concentrate (70 mg/kg) to assess postoperative bleeding and blood-products requirements. RESULTS: Each of FFP and fibrinogen concentrate significantly reduced total chest tube drainage (CTD) at 3, 6, 12, and 24 postoperative hours (P = 0. 04). The analysis of time*intervention revealed that our intervention (fibrinogen group) significantly reduced CTD more (P = 0. 01). Moreover, fibrinogen group had a significantly higher plasma fibrinogen level in first 24 hours (P = 0. 02). CONCLUSION: Nowadays, both of fibrinogen concentrate and FFP product are widely used for management of hypofibrinogenic bleedings after cardiac surgeries. According to our results, we concluded that although the both product had a comparable effect on management of hypofibrinogenemic bleeding in pediatrics undergoing congenital cardiac surgeries, choosing better product depended on general condition of patients such as their body fluid status.

BACKGROUND: Previous studies revealed that the level of 25-hydroxyvitamin D [25(OH)D] could be consider as one the risk factors for the occurrence of cardiovascular diseases (CVDs). This study aimed to evaluate the relationship between serum 25(OH)D level and CVD events in individuals with and without metabolic syndrome (MetS) in an Iranian population. METHODS: In this nested case-control study conducted as a part of the Isfahan Cohort Study (ISC), 55 patients with CVD events were selected as case group, and 55 sex-and age-matched individuals without CVD events as control group. These participants were divided into the two main groups based on the presence of MetS at baseline. RESULTS: The level of 25(OH)D in individuals with and without MetS was significantly lower among patients with CVD compared to those without CVD events at the baseline of study and after the follow-up (P = 0. 036 and P = 0. 039, respectively). The level of 25(OH)D significantly decreased risk of incidence of CVD events in individuals without MetS after adjusting for age, sex, nutrition, and exposure to sunlight [0. 19 (0. 05-0. 73); P = 0. 016]. There was not any significant relationship between the amount of 25(OH)D at the baseline and CVD events in individuals with MetS. CONCLUSION: In individuals with MetS, the level of 25(OH)D is not related to CVD events; as MetS directly influence the pathophysiology of mechanisms which are responsible for CVD events, and maybe this effect obscure the effect of 25(OH)D.

BACKGROUND: Heart rate variability (HRV) declines after coronary artery bypass grafting (CABG). The purpose of this study was to evaluate the effect of low-volume high-intensity interval training (LV-HIIT) and moderate-intensity continuous training (MICT) on HRV as well as, hemodynamic and echocardiography indices. METHODS: Forty-two men after CABG (55. 12 ± 3. 97 years) were randomly assigned into LVHIIT, MICT, and control (CTL) groups. The exercise training in LV-HIIT consisted of 2-minute interval at 85-95 percent of maximal heart rate (HRmax), 2-minute interval at 50% of HRmax and 40-minute interval at 70% of HRmax in MICT for three sessions in a week, for 6-weeks. HRV parameters were evaluated by 24-hour Holter electrocardiography (ECG) recording, and echocardiography parameters at baseline and end of intervention were measured in all 3 groups. RESULTS: At the end of the intervention, left ventricular ejection fraction (LVEF) significantly increased in LV-HIIT group (58. 53 ± 7. 26 percent) compared with MICT (52. 26 ± 7. 91 percent) and CTL (49. 68 ± 7. 27 percent) groups (P < 0. 001). Furthermore, mean R-R interval, root mean square successive difference (RMSSD) of R-R interval, and standard deviation of R-R interval (SDRR) in LV-HIIT group considerably increased compared with MICT group (P < 0. 001). High-frequency power (HF) significantly increased in LV-HIIT and MICT groups compared with CTL group (P < 0. 001). On the other hand, low frequency (LF) and LF/HF ratio significantly decreased in LV-HIIT group in comparison with MICT group (P < 0. 010). CONCLUSION: These results suggest that LV-HIIT has a greater effect on improvement of cardiac autonomic activities by increasing R-R interval, SDRR, RMSSD, and HF, and decreasing LF and LF/HF ratio in patients after CABG.

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence increases with advancing age. Pulmonary vein isolation is a standard approach in drug refractory paroxysmal AF which could be performed by cryoballoon ablation (CBA). We tried to evaluate its efficacy and safety in Iranian patients with AF. METHODS: From 2015 to 2017, 97 patients with paroxysmal and persistent AF were enrolled in our observational historical cohort study. They were visited 1 and 6 months post-procedure in order to assess the efficacy (recurrence) and safety. Recurrence was defined as 30 seconds of arrhythmia on their 48-hours Holter monitoring. RESULTS: Ninety-seven patients enrolled in the study, 64 (66. 0%) of them were men, and their mean age was 55 ± 12 years. Hypertension was reported in 41 patients (42. 3%), as the most common cardiac risk factor. 71 patients (73. 2%) patients with paroxysmal AF and 15 patients (15. 5%) with persistent AF underwent the procedure. After 6 months, recurrence was documented in only 17 patients (17. 5%), and 82. 5% of the patients were free from the recurrence. Post-procedural complication was detected only in 3 patients (3. 1%). CONCLUSION: In our study, the mid-term success and safety of CBA in patients with paroxysmal AF was showed. CBA is a safe and effective method in paroxysmal AF, and even in some cases with persistent AF.

Obviously, cardiac rehabilitation (CR) services are very important in controlling morbidity and mortality caused by cardiovascular diseases (CVDs), and the usefulness of these programs has already been approved. 1 However, it appears that the common formats of these programs do not cover the needs of all patients and some patients are unwittingly more benefiting from it. 2 It is said that a number of patients not only have not an improvement in their health status after having participated in CR, but even suffer from increased anxiety and depression3, 4 and weight gain...