Association of Anthropometric Indexes With Disease Severity in Male Patients With Chronic Obstructive Pulmonary Disease in Qazvin, Iran

Malnutrition is one of the most important factors that lead to lower quality of life in patients suffering from chronic obstructive pulmonary disease (COPD). There are several methods for assessing malnutrition including anthropometric indexes. The aim of this study was to determine the association of anthropometric indexes with disease severity in male patients with COPD in Qazvin, Iran. This cross-sectional study was conducted on 72 male patients with COPD in Qazvin, Iran, from May to December 2014. Spirometry was performed for all participants. Disease severity was determined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline. Body mass index (BMI), mid-arm muscle circumference (MAMC), and triceps skinfold thickness (TSF) were measured. MAMC and TSF were categorized into three subgroups as <25th P, between 25th P and 75th P, and >75th P (Where P is the abbreviation for percentile.). Data were analyzed using ANOVA and logistic regression analysis. Mean age was 60.23 ± 11.39 years. Mean BMI was 23.23 ± 4.42 Kg/m2, mean MAMC was 28.34 ± 3.72 cm2, and mean TSF was 10.15 ± 6.03 mm. Mean BMI and MAMC in the GOLD stage IV were significantly lower than other stages. Of 72, 18.1 were underweight while 6.9 were obese. The GOLD stage IV was associated with 16 times increased risk of underweight and nine times increased risk of MAMC < 25th P. Disease severity was associated with BMI and MAMC as indexes of malnutrition in patients with COPD in the present study. The GOLD stage IV was associated with increased risk of underweight and low MAMC. © 2018, The Author(s)

Association of Anthropometric Indexes With Disease Severity in Male Patients With Chronic Obstructive Pulmonary Disease in Qazvin, Iran

Malnutrition is one of the most important factors that lead to lower quality of life in patients suffering from chronic obstructive pulmonary disease (COPD). There are several methods for assessing malnutrition including anthropometric indexes. The aim of this study was to determine the association of anthropometric indexes with disease severity in male patients with COPD in Qazvin, Iran. This cross-sectional study was conducted on 72 male patients with COPD in Qazvin, Iran, from May to December 2014. Spirometry was performed for all participants. Disease severity was determined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline. Body mass index (BMI), mid-arm muscle circumference (MAMC), and triceps skinfold thickness (TSF) were measured. MAMC and TSF were categorized into three subgroups as <25th P, between 25th P and 75th P, and >75th P (Where P is the abbreviation for percentile.). Data were analyzed using ANOVA and logistic regression analysis. Mean age was 60.23 ± 11.39 years. Mean BMI was 23.23 ± 4.42 Kg/m2, mean MAMC was 28.34 ± 3.72 cm2, and mean TSF was 10.15 ± 6.03 mm. Mean BMI and MAMC in the GOLD stage IV were significantly lower than other stages. Of 72, 18.1 were underweight while 6.9 were obese. The GOLD stage IV was associated with 16 times increased risk of underweight and nine times increased risk of MAMC < 25th P. Disease severity was associated with BMI and MAMC as indexes of malnutrition in patients with COPD in the present study. The GOLD stage IV was associated with increased risk of underweight and low MAMC. © 2018, The Author(s)

Clinical outcomes and electrolyte balance factors in complex cardiac operations in adults; del nido versus custodiol cardioplegia solutions: A randomized controlled clinical trial

Background: Cardioplegia is used for protection of myocardium during cardiac operations. Del Nido (DN) and Custodiol cardioplegia solutions are used for prolonged protection of the myocardium during cardiopulmonary bypass (CPB). Custodiol cardioplegia (CC) solution is gaining popularity for myocardial protection during cardiopulmonary bypass. Objectives: This study aimed to compare the effects of Custodiol with another cardioplegia solution, Del Nido, on myocardial protection during cardiopulmonary bypass. Methods: In a randomized controlled clinical trial, forty patients were randomly allocated to DN and Custodiol (CC) groups. Patients in both groups received a normal anesthesia protocol. For cardioplegia, in the DN group, the DN solution was administered every 90 minutes by the antegrade route. In the Custodiol group, the Custodiol solution was administered in the same way at the beginning of the cardioplegia. Demographic information, blood chemistry parameters and other related perioperative and postoperative clinical indices were recorded. Results: Frequency of female patients was 14/21 (66.66) in the DN and 12/19 (63.15) in the CC group (P = 0.816), age was 57.14 ± 12.48 years in the DN and 59.47 ± 11.96 years in the CC group (P = 0.551), weight was 70.95 ± 9.56 kilograms in the DN and 69.63 ± 7.64 kilograms in the CC group (P = 0.635), CPB time was103.19 ± 23.43 minutes in the DN versus 97.36 ± 16.7 minutes in the CC group (P = 0.376), and cross-clamp time was 73.76 ± 19.66 minutes in the DN and 83.95 ± 16.14 minutes in the CC group (P = 0.083). Blood chemistry and blood gas analysis revealed a similar trend between the two groups in these parameters (P > 0.05) except for higher sodium levels after cardioplegia (P = 0.016) and end of CPB (P = 0.002), potassium levels after cardioplegia (P = 0.029), and bicarbonate anions at the end of bypass (P = 0.03) in the custodiol group. Conclusions: In conclusion, CC and DN offer effective myocardial protection during cardiopulmonary bypass. It is recommended to restrict the use of CC in patients susceptible to electrolyte disturbances. © 2018, Author(s)

Evaluation of the correlations between sodium fluctuations and clinical outcomes in children undergoing cardiopulmonary bypass

Introduction: Sodium abnormalities constitute some of the most common electrolyte disorders during cardiopulmonary bypass (CPB), and they exhibit a rise for various reasons during CPB. The use of CPB for correcting congenital heart diseases in infants has profound physiological effects on most organs. The devastating effects of CPB are often more pronounced in infants. This study aimed to determine the relationship between sodium fluctuations and clinical outcomes in infants undergoing CPB. Methods: This cross-sectional study (correlational) was conducted on 473 children who underwent CPB in 2016 according to our inclusion criteria. The samples were divided into 2 groups according to sodium fluctuations with a cutoff point of 15 mEq/L, and the clinical outcomes were compared between the 2 groups. The data were analyzed by SPSS, version 16, and presented as descriptive and inferential statistics. Results: The incidence of cardiac (P<0.001), pulmonary (P=0.005), renal (P=0.02), neurologic (P=0.001), and hemorrhagic (P=0.02) outcomes were significantly different between the 2 groups. Gastrointestinal outcomes, infection outcomes, intubation time, intensive care unit stay, hospital stay, and mortality were not significantly different between the 2 groups. Conclusions: Sodium fluctuations of 15 mEq/L or higher, as an independent factor, exacerbated cardiac, pulmonary, neurologic, renal, and hemorrhagic outcomes. © 2021, Iranian Heart Association. All rights reserved

Postoperative serum amylase levels and the mean arterial pressure during cardiopulmonary bypass: An observational study

Background: Postoperative gastrointestinal complications are important in that they lead to increased lengths of hospitalization in the intensive care unit (ICU) and mortality among patients undergoing surgery on cardiopulmonary bypass (CPB). It appears that such gastrointestinal complications may be correlated with the postoperative serum level of amylase among patients. We aimed to determine the relationship between the mean arterial pressure (MAP) during CPB and changes in the postoperative serum level of amylase. Methods: In this observational study, 164 adult patients who underwent cardiac operations and were transferred into the ICU of Rajaie Cardiovascular Medical Research Center (Tehran, Iran) were enrolled via convenience sampling. The patients� demographic and clinical data, as well as hemodynamic parameters including MAP, were measured during and after CPB in the ICU. Serum amylase levels were assessed after anesthesia induction, after CPB, 12 and 24 hours after CPB. Results: The mean serum level of amylase significantly increased after CPB and continued 24 hours after ICU admission. There was no statistically significant relationship between MAP during CPB and the serum amylase level immediately after CPB and at 12 and 24 hours after ICU admission. A significant relationship was found between gender and age and a serum level of amylase of greater than 125 IU/L at 12 and 24 hours after CPB. Conclusions: The serum level of amylase increased after CPB up to 24 hours following ICU admission. There was no significant relationship between MAP during CPB and the serum amylase level after cardiac surgery. © 2020, Iranian Heart Association. All rights reserved

Effects of dexmedetomidine on clinical outcomes and renal function after CABG

Background: This study was carried out to determine the effects of dexmedetomidine on clinical outcomes and renal function after coronary artery bypass grafting (CABG) to address the increased rate of CABG? and the importance of modification in stress responses and control of adverse effects on renal function and with the aim of cost reduction. Materials and Methods: This double-blind randomized clinical trial was carried out with the participation of 129 subjects under elective CABG in Rajaei Heart Center, Tehran, Iran in 2017. Patients were randomly assigned to four groups with simple randomization including one placebo (normal saline infusion) group and three dexmedetomidine groups; 0.5 µg/kg/h on CPB, 0.5 µg/kg/h in 24 hours, and 0.75 µg/kg/h in 24 hours. The blood pressure, blood urea nitrogen (BUN), serum creatinine, transfused blood volume, urine volume, and hemofiltration on pump and lactate were assessed at different time intervals. Results: Results showed more stability especially in central venous pressure (CVP) (p=0.001) and systolic blood pressure (p=0.006) in the groups receiving dexmedetomidine 0.75 µg/kg/h per 24 hours. But diastolic blood pressure and heart rate were the same across the groups (p>0.05). All other variables including hepatic and renal function tests were the same across the groups (P>0.05). Conclusion: Overall, according to the obtained results in the current study, it may be concluded that dexmedetomidine would have some promising effects on hemodynamic stability but there are no obvious renoprotective effects for this medication. © 2021 Journal of Cellular and Molecular Anesthesia. All rights reserved

Serum levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α, renal function biochemical parameters and clinical outcomes in pediatric cardiopulmonary bypass surgery

Background: Cardiopulmonary bypass causes detrimental effects on remote organs due to inflammatory response. One of these organs is kidney that is frequently affected by cardiac surgery. Acute kidney injury is a post-cardiopulmonary bypass complication, which may result in increased post-operative morbidity and mortality. Post-cardiopulmonary bypass inflammatory response may contribute to remote organ dysfunction. In the present study, we investigated the relation between cytokines including interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α, and renal function tests such as creatinine and blood urea nitrogen (BUN). Methods: In total, 91 patients between the ages of 4 and 60 months were enrolled for elective cardiac surgery with cardiopulmonary bypass after informed consent. Data regarding renal function tests and clinical outcomes were carefully recorded until 24 hours after admission to intensive care unit and analyzed. Results: Our findings support that there is a direct correlation between cytokines including interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α and cardiopulmonary bypass time, duration of operation, and intensive care unit stay. Longer cardiopulmonary bypass time was associated with higher interleukin-8 at cross-clamp removal and 24 hours post- intensive care unit as well as higher interleukin-10 at declamp time. Higher interleukin-6 at declamp time was directly correlated with higher post-operative BUN. Interleukin-8 level after anesthesia induction was directly correlated with intensive care unit stay duration. Higher blood interleukin-6 and tumor necrosis factor-α levels following 24 hours of admission to intensive care unit were associated with longer mechanical ventilation time. Conclusion: Higher circulatory pro-inflammatory cytokine level is associated with adverse outcomes such as increased intensive care unit stay and longer mechanical ventilation time in pediatric patients. It is also correlated with unfavorable biochemical parameter of renal function, BUN. Findings hint that proper control of the inflammatory response is vital for the control of unfavorable clinical and pathological outcomes. © The Author(s) 2019