Combined Open-Heart Coronary Artery Bypass Surgery and Subtotal Thyroidectomy in a 54-year-old patient: A Case Report

BACKGROUND: Combined open-heart surgery and thyroidectomy is a rare procedure. However, some difficulties will occur for cardiac surgery when thyromegaly extends into the retrosternal space.CASE DETAILS: A 54-year-old woman suffering from dyspnea, chest pain and decreased left ventricular function (EF=40%) was diagnosed with coronary artery disease (3 vessel disease) and became candidate for coronary artery bypass grafting (CABG). Also, she had multinodular goiter with normal thyroid function test. After midsternotomy, a huge goiter was seen in the upper mediastinum. Because the mass had covered the ascending aorta and involved the posterior aspect of the innominate vein making access to aorta impossible, thyroidectomy was performed at first followed by CABG. Post-operation course was satisfactory. Fourteen months later, the patient was euthyroid and in NYHA class 1.CONCLUSION: The evidence of the case showed that combined CABG and thyroidectomy can be performed safely.KEYWORDS: Coronary Artery Bypass Grafting, Subtotal Thyroidectomy, Surger

Serum free testosterone level in coronary artery disease in candidates for coronary artery bypass graft surgery: A cross-sectional study

Background: Due to the controversy over the effect of serum testosterone levels on coronary artery diseases, this survey explores the serum levels of free testosterone, luteinizing hormone, and follicle-stimulating hormone in candidates for coronary artery bypass graft compared with an age-matched control group and evaluates the associated factors in these participants. Objective: To determine the testosterone level in elective coronary artery bypass grafting participants. Materials and Methods: In this cross-sectional study, all male patients aged > 40 yr as candidates for elective coronary artery bypass grafting, who were referred to the Afshar Hospital, Yazd, Iran, from March 2018 to March 2019, were included. In total, 100 men were enrolled (50 cases and 50 controls). Their serum levels of free and total testosterone, luteinizing hormone, and follicle-stimulating hormone were measured and the results were compared. Results: The findings indicated a significant difference between the two groups in total and free testosterone (both p < 0.001); they were lower in the case group. There was also a significant difference in the total testosterone of the participants with diabetes mellitus compared with no-diabetic individuals (p = 0.007). Free testosterone of diabetic subjects taking insulin was lower compared with those taking no insulin (p = 0.04). There was also an association between the body mass index and free testosterone, left ventricular ejection fraction and total testosterone, and a significant and negative relation between the duration of hospital admissions and free testosterone (p < 0.05). Conclusion: This study illustrates that participants with coronary artery disease bear a significantly low testosterone level in comparison with the healthy control group. Key words: Coronary artery disease, Testosterone, Coronary artery bypass graft surgery

Manufacturing a modified carbon paste electrode with catalase enzyme-Au nanoparticles for electrochemical sensing of hydrogen peroxide and their electrocatalytic properties

To find hydrogen peroxide, different techniques applied, recently. In this practice we decided to produce a modified carbon paste electrode by catalase enzyme-Au nanoparticles for electrochemical sensing hydrogen peroxide and their electroactivity characteristics. Cyclic voltammetry were done electrochemical researches. A three-electrode method including a modified carbon paste electrode with catalase enzyme-Au nanoparticles as the operant electrode, a platinum string electrode as a counter electrode, and saturated calomel electrode as a reference electrode, was applied. Cyclic voltammetric assays were done with different scan speed area from of 50 mV s−1 to 500 mV s−1. Transmission electron microscopy was checked external morphological characteristics of Au nanoparticles. H2O2 in 100 μM to 450 μM area could find out by designed biosensor. By perform assays in two weeks regular interval, the resistance of modified carbon paste electrode with catalase enzyme-Au nanoparticles biosensor has been determine and it has been discovered that after 14 days, modified carbon paste electrode with catalase enzyme-Au nanoparticles keeps its 97% activity. Keywords: electrochemical sensing, hydrogen peroxide, catalase enzyme, Au nanoparticle

Association of NFKB1 gene polymorphism (rs28362491) with cardiometabolic risk factor in patients undergoing coronary angiography

Introduction: Genetic and environmental factors are involved in the pathogenesis of cardiovascular diseases (CVDs). The aim of the study was to investigate between the genotype of the NFKB1 gene and the cardiometabolic risk factor in patients undergoing coronary angiography. Methods: This cross-sectional study was conducted on 462 adults (male and women) aged between 35 and 75 years who referred to Afshar Hospital for coronary angiography in 2021- 2022. The polymerase chain reaction restriction fragment length polymorphism method was used to detect the genotype of rs28362491. Biochemical parameters were measured using commercial kits. Gensini and Syntax scores were calculated using the angiography result to assess the extent of coronary artery stenosis. We used multivariate logistic regression analysis to examine the relationship between genotype variants and cardiometabolic risk factors. Results: There was no association between variant genotypes and abnormally levels of serum alanine aminotransferase (ALT) (P value=0.51), aspartate aminotransferase (AST) (P value=0.99), triglyceride (TG) (P value=0.48), total cholesterol (P value=0.79), low density lipoprotein-cholestero (LDL-C) (P value=0.31), high-density lipoprotein-cholesterol (HDL-C) (P value=0.53), fast blood sugar (FBS) (P value=0.39), systolic blood pressure (P value=0.14), diastolic blood pressure (P value=0.64), Gensini score (P value=0.48) and syntax score (P value=0.74) in the crude model even after adjustment for confounding factors. Conclusion: We found no association between the ATTG polymorphism and cardiometabolic risk factors in patients who had coronary angiography. Further investigations are needed to assess the association between variants of 28362491 and cardiometabolic markers

Effect of Crataegus Extract on the Relief of Heart Palpitation and Anxiety in Teenagers: An Interventional Quasi-Experimental Study

Background: Heart palpitation is a common complaint defined as an unpleasant or abnormal heartbeat feeling. This study aimed to investigate the effectiveness of Crataegus extract on the relief of heart palpitations and anxiety in adolescents. Methods: This is an interventional quasi-experimental study performed from February 19, 2016 to February 19, 2017 on 120 adolescents aged 13 to 19 years with a complaint of heart palpitations, referring to heart clinic in Afshar Hospital of Yazd. The participants' demographic information, heartbeat feeling, Hamilton anxiety scaling, blood pressure, heartbeat rate, and electrocardiogram (ECG) were recorded. Patients were first treated with 20 drops every 8 hours for three days and then 25 drops every 8 hours for one month with Crataegus edible drops. They were then re-evaluated for heart palpations and anxiety. Results: Of 120 adolescents referring to Afshar Hospital with heart palpitations, 98 of participants (81.7%) experienced improvement. Mean differences in systolic blood pressure, heart rate, and anxiety scores before and after treatment with Crataegus extract decreased significantly by 1.71, 8.52, 6.55, respectively, but the mean difference in diastolic blood pressure increased by 1.46 (P<0.05). Conclusion: According to the results, Crataegus extract might be effective in reducing palpitation and anxiety in adolescents.  Further studies are suggested to approve the results of the study

Comparison of the Effectiveness of Continuous versus Intermittent Cefazolin for the Prevention of Infection after Off-Pump Coronary Artery Bypass Graft

Background: Surgical site infection is known as a common complication after cardiac surgery, and Cefazolin is the best prophylactic antibiotic to prevent this complication. The goal of this study was to evaluate the effect of continuous and intermittent Cefazolin for the prevention of superficial surgical site infection following off-pump coronary artery bypass (OPCAB). Methods: This prospective randomized clinical trial study was conducted on 141 patients candidated for OPCAB and divided into two groups. This study was performed between February 2011 and February 2012 in the Iranian city of Yazd. Patients in both groups received 2 g of Cefazolin as a starting dose and at 30 minutes before incision. Definition of surgical site infections was according to the Centers for Disease Control and Prevention Criteria (CDC-criteria). In the continuous infusion group (n = 74), 3 g of Cefazolin was infused over a 24-hour period after surgery. In the intermittent group (n = 67),1 g of Cefazolin was administered at 3, 11, and 19 hours after the starting dose. Hyperlipidemia, diabetes, hypertension, smoking, history of heart disease, and incidences of superficial infection were compared between the two groups. Duration of follow- up was 4 weeks. Results: The mean age of the patients was 60.49 ± 10.63 years. The patients were 30.5% female and 69.5% male. There were no significant differences in age, body surface area, duration of operation, number of distal grafts, number of proximal grafts, and duration of hospital stay before heart surgery between two groups. The incidence of infection in intermittent group was (7.5%) and in continuous groups was (2.7%). There was no significant difference in the incidence of infection between the two groups (p value = 0.26). Conclusion: Our findings in this study showed no significant differences between continuous and intermittent Cefazolin for the prevention of superficial surgical site infections after OPCAB

Endovascular Treatment of Post-Traumatic Pseudoaneurysms of Ulnar and Radial Artery

Aneurysm can develop in all arteries of the human body. Pseudoaneurysm induced by trauma is known as a rare condition in peripheral arteries. This complication is known as late sequelae of trauma. The incidence of pseudoaneurysm in upper extremities artery is less than lower extremities. Atherosclerotic aneurysms are often seen in large arteries and by aging, but pseudoaneurysm can be seen in penetrating or blunt trauma in patients of every age or every location. Delayed treatment of pseudoaneurysm leads to bleeding, venous edema at the extremities and compression on the adjacent nerve as a result of pseudoaneurysm enlargement. Early diagnosis of pseudoaneurysm is very important, because this complication can induce disabilities such as upper extremities and finger loss. Peripheral arteries pseudoaneurysm in distal locations especially in brachial artery and forearm can cause a thrombotic complication in hands and fingers

Comparing the effects of nicotine replacement therapy and nursing counseling on smoking cessation among the candidates for coronary artery bypass graft surgery: A clinical trial

Background: There is limited data about the effects of smoking cessation (SC) strategies among the candidates for coronary artery bypass graft (CABG) surgery. Objectives: This study aimed to compare the effects of nicotine replacement therapy (NRT) and nursing counseling (NC) on SC among the candidates for CABG. Methods: This randomized controlled trial was made in the heart center of Afshar hospital, Yazd, Iran. Sixty candidates for elective bypass graft were recruited and were randomly allocated either to a NC or a NRT group. Study interventions were implemented from 3 weeks before to 3 weeks after the surgery. Before and after hospitalization for the surgery, patients in the counseling group received telephone counseling while during their 1-week hospital stay, they received face-to-face counseling. Patients in the NRT group received nicotine gums before and after hospitalization and were treated with nicotine patches during their 1-week hospital stay. Data were collected through three questionnaires. The Chi-square and the independent-sample t tests were run to analyze the data. Results: SC rate in the counseling group was significantly higher than the NRT group (63.3 vs. 33.3; P = 0.038). Moreover, cessation rate among the participants with lower nicotine dependency was significantly greater than those with moderate-to-severe dependency (P = 0.01). Conclusion: NC is more effective than NRT in improving SC rate among the candidates for CABG

Correlation between medication errors with job satisfaction and fatigue of nurses

Background: Medication errors which can cause several medical malfunctions, have been in the spotlight recently. Job satisfaction and fatigue seems to be related to the increase of medication errors in nursing. Objective: This study aimed to determine the correlation between the amount and type of medication errors with job satisfaction and fatigue of nurses working in Shahid Sadoughi hospital in Yazd-Iran. Methods: This is a descriptive study by a cross-sectional and correlational approach conducted on all the nurses working in an educational hospital who have characteristics of samples. Participants were 170 nurses working in Shahid Sadooghi hospital in Yazd, Iran in 2012. The questionnaires of demographic characteristics, medication administration error and nurses' job satisfaction and fatigue by purposive sampling were used for gathering data. Validity and reliability were checked for internal consistency and stability. Data were analysed by SPSS version 17 using Pearson correlation coefficient and Independent-samples t-test. Results: The findings did not illustrate a significant relationship between job satisfaction and fatigue with medication errors. Among the demographic characteristics, age of nurses was significantly associated with the frequency of medication errors (p=0.037). However, others were not significantly correlated (p>0.05). Conclusion: In spite of the findings, based on no significant statistical relationship between job satisfaction and fatigue with the type and amount of medication errors in nursing, the effect of these variables on medication errors cannot be disregarded; thus further studies in this area are suggeste

Effect of family members′ voice on level of consciousness of comatose patients admitted to the intensive care unit: A single-blind randomized controlled trial

Background: Coma is one of the most important complications of brain injury. Comatose patients in the intensive care units are exposed to sensory deprivation. This study aims to survey the effect of family members′ voice on level of consciousness of comatose patients hospitalized in the intensive care units. Materials and Methods : In this single-blind randomized controlled trial, 40 comatose patients with brain injury with acute subdural hematoma in intensive care units were randomly assigned into two groups. The intervention group was stimulated twice a day each time 5-15 min with a recorded MP3 from family members′ voice for 10 days. The patients′ level of consciousness was measured with Glasgow Coma Scale before and after auditory stimulations. In the control group, GCS was measured without auditory stimulation with the same time duration like intervention group. Data analysis in software SPSS version 15 and using Chi-square test, independent t-test, paired t- test and analysis of variance with repeated measures was done. Results: On the first day before the intervention, there was no a statistically significant difference between the mean of GCS in both groups (P = 0.89), but on the tenth day after the intervention, there was a significant difference (P = 0.0001) between the mean GCS in both control and intervention groups. Also, there was a significant difference between the mean daily GCS scores in two groups (P = 0.003). The findings during ten days showed the changes in the level of consciousness in the intervention group from the 4 rd day of the study were more in the mean daily GCS scores than control group. Conclusion : This study indicated that family members′ voice can increase level of consciousness of comatose patients with acute subdural hematoma