THE EFFECTS OF BODY MASS INDEX CATEGORY ON EARLY OUTCOMES OF CORONARY ARTERY BYPASS GRAFT

&nbsp; Abstract INTRODUCTION: Deviation from normal body size, particularly extreme obesity is associated with increased postoperative morbidity and mortality. Obesity is often perceived to be a risk factor for adverse outcomes following coronary artery surgery bypass graft. The aim of this study was to evaluate the effect of body mass index on the early outcomes in patients undergoing coronary artery bypass graft (CABG). methods: In a retrospective study, 772 patients undergoing CABG between 2005 and 2006 were evaluated in shiraz university affiliated medical centers. The patients&rsquo; body mass index (BMI) was measured and classified as underweight, normal-weight, obese and severely obese. The clinical data were evaluated with respect to early postoperative outcomes and mortality. The main early outcomes were postoperative myocardial infarction, sternal wound infection, respiratory and renal problems, atrial arrhythmia, bleeding, longer duration of mechanical ventilation, prolonged hospital stay, and increased operative mortality. The data were gathered using a demographic information form and a checklist to determine the number of main early outcomes. The forms were completed with data from the patients and their records. The effect of BMI on the early outcomes in patients undergoing coronary artery bypass graft (CABG) was assessed using odds ratio and the logistic regression model. results: The results showed that of 772 patients, 13.6%, 2.6%, 75.4%, and 8.4% were obese, severely obese, normal-weight, and underweight, respectively.. Obesity and severe obesity increased the risk of sternal wound infection (odds ratio=9.761, P&lt;0.001 and odds ratio=34.441, P&lt;0.001, respectively). Obesity increased the risk of atrial arrhythmia (odds ratio=5.173, P&lt;0.001). Obesity and severe obesity were significantly associated with respiratory problems and postoperative stay longer than 14 days. Severe obesity increased the risk of operative mortality (odds ratio=15.390, P&lt;0.001). There was no difference between obese and severely obese patients in respect of the incidence of myocardial infarction, renal failure, and bleeding following operation. CONCLUSIONS: Obesity and severe obesity are associated with increased early complications and operative mortality after CABG, and the degree of obesity plays a key role in adverse outcomes of this procedure.. Hence, weight loss can contribute to reduction of postoperative CABG complications and mortality. &nbsp; &nbsp; Keywords: Body mass index, coronary artery bypass graft, obesity, morbidity, mortality.</div

The association of plasma high-sensitivity C-reactive protein level with rheumatic heart disease: The possible role of inflammation

Background: Currently, it is not clear whether recurrent traumatic events lead to progression of rheumatic heart disease (RHD) after the incident of acute rheumatic fever or a persistent inflammatory state at the site of the valves. The aim of this study was to assess the possible association between plasma high sensitive C Reactive Protein (hs-CRP) level as an indicator of inflammation and RHD. Materials & methods: Ninety patients with RHD and 90 healthy controls who had undergone complete echocardiographic examination were enrolled in this cross-sectional study. A score was given to each patient according to the severity of valvular involvement. Plasma hs-CRP level was checked for each patient by ELISA method twice with two-week interval, and the mean hs-CRP was calculated. Results: The mean plasma hs-CRP level in the case group was significantly higher compared to its level in the control group (2.59 ± 4.82 and 0.55 ± 0.43 in the case and control groups respectively, p < 0.001). There was also a strong association between the level of plasma hs-CRP and the severity of rheumatic valvular involvement (p < 0.001). Conclusion: The mean plasma hs-CRP level seems to have a significant association with RHD and its severity. Further studies are needed to determine the cause and effect relationship. Keywords: Rheumatic heart disease (RHD), hsCRP, Inflammatio

Comparison of medical treatments in cryptogenic stroke patients with patent foramen ovale: A randomized clinical trial

Background: This randomized clinical trial compared rates of stroke or transient ischemic attack recurrence or death in patients with cryptogenic stroke and patent foramen ovale (PFO) who received medical treatment with aspirin or warfarin. Materials and Methods : Forty-four Iranian patients with cryptogenic stroke and patent foramen ovale participated in this randomized, single-blind trial between July 2007 and June 2010. All patients underwent transesophageal echocardiography and contrast-transcranial Doppler sonography to confirm the presence of patent foramen ovale. The patients were randomly assigned to receive aspirin or warfarin and were followed for 18 months for the recurrence of ischemic events or death. The principal investigator was blind to the group assignment. This trial is registered under number IRCT138805192323N1. Results: Five (11.4%) patients had a stroke, 2 (4.5%) had a transient ischemic attack and 2 (4.5%) died. There was no difference in the rate of ischemic events or death between the aspirin- and warfarin-treated groups (hazard ratio: 0.45; 95% CI: 0.1-1.8; P = 0.259). Conclusion: There was no difference in ischemic event recurrence, death rates or side-effects between patients with cryptogenic stroke and patent foramen ovale who were treated with aspirin vs. warfarin

Pulmonary artery stenosis caused by a large aortic arch pseudoaneurysm detected 10 years after a minor trauma

Pseudoaneurysm of aorta is a rare condition usually seen after aortic surgeries or serious accidents. Here we report a 60 years old man without any previous medical condition who presented with non-specific symptoms and underwent different investigations for more than 1 year, until the presence of a continuous murmur raised suspicion toward his cardiovascular system. In echocardiographic and computed tomography (CT) angiographic studies a large pseudoaneurysm of aortic arch with compression effect on pulmonary artery was detected. At this stage he remembered having suffered a minor trauma 10 years ago. He finally underwent operation and his aortic wall was repaired successfully with a patch. This case highlights the importance of thorough history taking and physical examination in patients irrespective of symptoms and high index of suspicion to detect this life-threatening condition