Comparison of aspirin plus heparin with heparin alone on asymptomatic perioperative deep vein thrombosis in candidates for elective off-pump coronary artery bypass graft: A randomized clinical trial

Background: Symptomatic or asymptomatic deep vein thrombosis (DVT) is a commoncomplication following coronary artery bypass graft (CABG), in which less than 1% of thesepatients suffer from clinically evident pulmonary embolism (PE). DVT and PE can increaseother morbidities of coronary revascularization from short to long period, but no clear consensusstill exists regarding proper thromboprophylaxis strategy in the literatures. This study wasdesigned to compare the anti-platelet prophylaxis of aspirin plus heparin with heparin alone onasymptomatic perioperative DVT in patients that are candidates for elective off-pump CABG.Methods: One hundred and twenty patients, who are candidates for elective off-pump CABG, wererandomly assigned to two groups: the aspirin plus heparin group (Group 1, n = 60) that received80 mg daily aspirin orally and 5000 U unfractionated heparin per 8 h subcutaneously fromadmission to discharge time, and the heparin group (group 2, n = 60) that received same doseof heparin alone. All patients underwent right and left leg venous ultrasound examinationduring hospitalization, after which post-operative off-pump CABG complications such as deepvein thrombosis, bleeding and pulmonary embolism were evaluated in this study cases.Results: The mean age of the patients was 62.10 ± 10.71 years with a male to female ratioof 2.24. Asymptomatic DVT occurred in 12 (10%) patients who underwent electiveoff-pump CABG. DVT was found more in Group 2 (16.6%) as compared to Group 1 (3.3%)with statistical signifi cant difference (p = 0.015). Bleeding was detected in 5 (4.1%) cases inthe patients sampled in this study (p = 0.34), 4 cases of which are from Group 1 and 1 casefrom Group 2. However, PE was shown in none of this study cases.Conclusions: The incidence of DVT decreased more with aspirin plus heparin as comparedto heparin alone in patients who underwent elective off-pump CABG. As regards the resultsobtained in this study, more studies need to be conducted to establish this strategy for prophylaxisof DVT in CABG

The Relationship between Caring Burden and Quality of Life in Caregivers of Type 2 Diabetes

Background: Taking care of patients with chronic diseases such as diabetes exerts great tiredness and stress on the caregivers. The aim of this study was to determine the extent of the caring burden and its relationship with the quality of life of caregivers of diabetic patients. Methods: In this cross-sectional study, 154 caregivers of patients with type 2 diabetes referred to Imam Hossein hospital in Shahroud city were evaluated. The data collection tools included a demographic questionnaire, SF-36 standard quality of life questionnaire, and Novak & Guest care burden questionnaire. The accessible sampling was used and the data were collected by self-reporting. The data was analyzed using descriptive and inferential statistics (Pearson correlation coefficient and regression analysis). Significant level was set at 0.05. Results: The mean age of caregivers was 41.86 ± 12.78 years old. The mean scores of care burden and quality of life of the participants were 53.21 ± 49.61 and 61.02 ± 20.71 respectively. There was a significant inverse correlation between the mean score of care burden and caregivers’ quality of life. Conclusions: According to the results of this study, providing social and informational support for caregivers is recommended to reduce the care burden and subsequently improve the quality of life. Key words: Caring pressure, Quality of life, Diabetes, Caregiver

Storage stability of jackfruit (Artocarpus heterophylus) power packaged in aluminium laminated polyethylene and metallized co-extruded biaxially oriented polypropylene during storage

Total colour difference (ΔE), rates of adsorbed moisture and sensory attributes of drum-dried jackfruit powder packaged in aluminium laminated polyethylene (ALP) and metallized co-extruded biaxially oriented polypropylene (BOPP/MCPP) pouches stored at accelerated storage (38 °C, with 50%, 75% and 90% relative humidity (RH)) were determined over 12 weeks period. The changes in total colour followed zero order reaction kinetics. Packaging materials, storage temperature and RH values significantly (p < 0.05) influenced the rates of adsorbed moisture of jackfruit powder. There was a significant (p < 0.05) decrease in the intensities of the fruity odour, taste and increase in the lumpiness of the jackfruit powder stored at 38 °C with 90% RH. The shelf life of jackfruit powder stored at 38 °C and 90% RH was limited by overall acceptability and the intensity of fruity odour, taste and lumpiness at week 8 of storage. Jackfruit powder stored at 28 °C remained stable and acceptable throughout the storage period for all RH values. The powder packaged in ALP significantly (p < 0.05) reduced total colour change, rates of adsorbed moisture, lumpiness intensity of jackfruit powder and was rated higher in terms of overall acceptability over BOPP/MCPP. Results of this study suggested that ALP packaging with storage conditions of 28 °C and RH less than 75% was better suited for keeping jackfruit powder

Evaluation of anti-biofilm activity of Lactobacillus rhamnosus GG and Nisin on the expression of aap, ica-A and ica-D as biofilm-associated genes of Staphylococcus epidermidis

Background and Objectives: In the present study, the anti-biofilm activity of Lactobacillus rhamnosus GG and Nisin was investigated on biofilm-forming abilities of Staphylococcus epidermidis strains and the expression of the biofilm-associated genes. Materials and Methods: In this study, the standard strain of L. rhamnosus GG (ATCC 53103) and Nisin were used to assess their anti-microbial and anti-biofilm effects on S. epidermidis (RP62A). Results: The MIC and MBC analysis showed that Nisin at 256 μg/mL and 512 μg/mL, and L. rhamnosus GG at 1×107 CFU/mL and 1×108 CFU/mL have anti-microbial activity compared to the negative control respectively. L. rhamnosus GG bacteria and Nisin inhibited the biofilm formation of S. epidermidis based on optical density of at 570 nm (P 0.05). In addition, the relative expression of aap and icaA genes, but not icaD (P>0.05), was significantly lower than the negative control (0.62 and 0.7 fold, respectively) (P>0.05), after exposure to the sub MIC of L. rhamnosus GG. Conclusion: Nisin and L. rhamnosus GG exhibit potent activity against biofilm-forming abilities of S. epidermidis and these agents could be utilized as an anti-biofilm agents against S. epidermidis infections

Administration of low molecular weight and unfractionated heparin during percutaneous coronary intervention

AbstractThis systematic review with meta-analysis sought to determine the efficacy and safety of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) on clinical outcomes following percutaneous coronary intervention. Medline, Embase, Elsevier, and web of knowledge as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design. After screening 445 studies, a total of 23 trials (including a total of 43,912 patients) were identified that reported outcomes. Pooled analysis revealed that LMWH compared to UFH could significantly increase thrombolysis in myocardial infarction grade 3 flow (p<0.001), which was associated with similar target vessel revascularization (p=0.6), similar incidence of stroke (p=0.7), and significantly lower incidence of re-myocardial infarction (p<0.001), major bleeding (p=0.02) and mortality (p<0.001). Overall, LMWH was shown to be a useful type of heparin for patients with MI undergoing PCI, due to its higher efficacy and lower rate of complication compared to UFH. It is also associated with increased myocardial perfusion, decreased major hemorrhage, and mortality

Air pollution perception in ten countries during the COVID-19 pandemic

NTNU Norwegian University of Science and TechnologypublishedVersionPaid Open AccessUNIT agreemen

Intra‑operative grading of coronary artery atherosclerosis associated with homocysteine levels in postmenopausal women undergoing elective off‑pump CABG surgery

Background: Atherosclerosis is one of the common causes of morbidity and mortality, in postmenopausal women. Homocysteine, a sulfur‑containing amino acid product of methionine metabolism, may play an important role in the development of cardiovascular diseases. This study was designed to evaluate the relationship between intra‑operative grading of coronary artery atherosclerosis and homocysteine level in postmenopausal women who were candidates for off‑pump coronary bypass graft surgery (CABG). Materials and Methods: In this cross‑sectional study, 136 postmenopausal women (with the mean age of 54.9±4 years) were enrolled as candidates for elective off‑pump CABG. For each patient the extent and severity of atherosclerosis was assessed by intra‑operative grading (IOG) and Gensini score system. Total homocysteine was determined with ELISA method after 12 hours of fasting. The patients were classified into two groups (diffuse vs. discrete) based on intra‑operative findings. Finally the relation between age, IOG, and Gensini score with homocysteine level was assessed by ANOVA, T‑test, and Tukey HSD test. Results: There was a positive correlation between intra‑operative grading and homocysteine level in both groups (P=0.005). The association between Gensini score and homocysteine was significant in higher levels of hyperhomocysteinemia (P &lt; 0.05). The homocysteine level also increased with age; therefore, patients were classified into two categories (&lt;54 years and ≥54 years) by Levene test. Statistical analysis indicated no relationship between IOG, Gensini score, and homocysteine level in the patients who were younger than 54 years (P=0.3, P=0.2), but significant relation was detected between IOG, Gensini score, and homocysteine in the patients who were older than 54 years with diffuse or discrete lesions in coronary arteries (P=0.001, P=0.001). Conclusion: According to our findings, homocysteine level increases in post‑menopausal women that can be an important risk factor for atherosclerosis and cardiovascular diseases.Keywords: Coronary artery atherosclerosis, homocysteine, intra‑operative grading, menopause, off‑pump coronary bypass surgeryNigerian Medical Journal | Vol. 53 | Issue 4 | October-December | 201

Effect of Prophylactic Low Dose of Methylprednisolone on Postoperative New Atrial Fibrillation and Early Complications in Patients with Severe LV Dysfunction Undergoing Elective Off-Pump Coronary Artery Bypass Surgery

Atrial fibrillation (AF) is the most common arrhythmia after cardiothoracic surgery. AF following coronary artery bypass graft (CABG) is associated with an increase in morbidity, mortality, hemodynamic instability, thromboembolic events, severity of heart failure and ICU and hospital stay. Corticosteroids have a variety of beneficial effects on recovery after elective surgery. This study was designed to test the hypothesis that low dose of Methylprednisolone (MP) can affect post-CABG AF and early complications in patients with severe left ventricle dysfunction who underwent elective off-pump coronary artery bypass. A total of 120 patients with LV dysfunction undergoing elective off- pump CABG randomly received either MP or placebo. Diabetic patients and those who were receiving corticosteroids were excluded. The MP group received 5mg/kg of MP intravenously after induction of anesthesia and the placebo group received an equal volume of normal saline. We evaluated Post-CABG variables including incidence, duration and frequency of AF recurrence and early morbidity such as bleeding, infection, vomiting, renal and respiratory dysfunctions, ICU or hospital stay and early mortality. The mean age of patients was 62.11 ± 12.34 years with the 2.4 male to female ratio. AF occurred in 23(19.2%) patients. No significant difference in the incidence of new AF was found between the placebo (21.7%) and MP group (16.7%) (P=0.47). MP did not affect postoperative bleeding, infection, vomiting, renal and respiratory dysfunction and mortality; however, MP significantly reduced ICU and hospital length of stay. MP did not affect the incidence, duration and frequency of AF recurrence in patients with severe LV dysfunction undergoing off-pump CABG. However, MP could reduce ICU and hospital stay significantly in these patients