Comparing the Effect of Vitamin E and N-Acetylcysteine on Prevention of Contrast-Induced Nephropathy in Diabetic Patients under Coronary Angiography

Introduction:  Considering the incidence of contrast  induced  nephropathy  (CIN) as well as  its  complications  and    costs,  prevention  and  reducing  the  risk  of  CIN  is  an  essential  issue.  The  present  study  aimed  to  evaluate  the  efficacy  of  vitamin  E  and  N-acetylcysteine  (NAC)  on the prevention  of  CIN  in  diabetic  patients  undergoing  coronary  angiography. Materials and Methods:  360  patients  with  diabetes  who  required  angiography,  including  patients  with  stable  angina  susceptible  to  acute  myocardial  infarction  and  patients  with  acute  coronary  syndrome  were  included  and  randomized  into  three  groups .  Group  1  received  serum  therapy  (Normal Saline)  plus  NAC  and  placebo  of  vitamin  E,  group  2  received  serum  therapy  plus  vitamin  E  and  placebo  of  NAC,  and  group  3  only  received  serum  therapy  with  two  placebos  of  NAC  and  vitamin  E.  The groups were compared considering CIN after angiography. Results:  A  total  of  93  patients  were  studied  in  group  1,  94  in  group  2,  and  113  in  group  3.  CIN  occurred  in  4  patients  (4.3%),  4  patients  (4.3%),  and  8  patients  (7.1%)  in  groups  1,  2,  and  3,  respectively  (P=0.58).  There was  a  significant  difference  in  mean  difference  of  creatinine  levels  before  and  after  study  in  groups  1  and  2  (both  P<0.001).  In  the  subgroup  of  patients  with  chronic  kidney  disease,  NAC  significantly  reduced  CIN  (P=0.03). Conclusion:  The results  suggested  efficacy  of  both  interventions,  considering  reduction  of  mean  Serum creatinine ( Scr) after  the  study,  while  lack  of  significant  difference  in  the  incidence  of  CIN  could  be  because  of  the  low  number  of  CIN  in  our  study.  The second  important  finding  of  this  study,  probably the  reduced  risk  of  CIN  in  diabetic  patients  with  chronic  kidney  disease  receiving  NAC,  recommends  the  use  of  NAC  for  prevention  of  CIN,  especially  in  this  subgroup  of  patients  undergoing  angiography

Evaluation of the acute effects of smoking on cardiac electrical function and hemodynamic indices in smokers

Background: Smoking is one of the most important risk factors for cardiovascular diseases. Although numerous studies have evaluated the long-term consequences of smoking, few studies have assessed the short-term effects of smoking, especially on the electrical activity of the heart. The aim of this study was the evaluation of the acute effect of smoking on cardiac electrical function and hemodynamic indices in smokers. Materials: In this single-arm pretest-posttest study, 130 healthy smokers participated if they had smoked at least 100 cigarettes in their lifetime and were smoking daily. After considering the exclusion criteria, participants were monitored before and 10 minutes after smoking by electrocardiography (ECG) to measure QT dispersion (QTD) and P-wave dispersion (PWD), systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and respiration rate (RR). Finally, the data obtained before and after smoking were compared. Results: The mean age of the participants was 40.3 ± 10.6 years (range 19 to 71 years). 55 (42.3%) participants smoked between 10-15 years and 67 (51.5%) smoked 10 to 20 pack-years. After smoking, SBP (127.3 ± 10.4 vs. 138.4 ± 12.8 mmHg), QTD (33.5 ± 9.6 vs. 43.9 ± 10.7 ms) and PWD (28.9 ± 6.6 vs. 34.5 ± 7.4 ms), HR (80.1±9.8 vs 87.6±9.9) increased significantly (P value <0.001). In other parameters, no significant differences were observed. Conclusions: Smoking is associated with an acute increase in QTD and PWD, and thus an increased risk of ventricular arrhythmias (e.g. Torsade’s de pointes), atrial fibrillation, sudden death, and other heart problems