Efficacy of Glucose-Insulin-Potassium Infusion on Left Ventricular Performance in Type II Diabetic Patients Undergoing Elective Coronary Artery Bypass Graft.Dy

BACKGROUND: Glucose-insulin-potassium (GIK) may improve cardiovascular performance after coronary artery bypass graft surgery (CABG). Our study investigated whether an infusion of GIK during elective CABG surgery in type II diabetic patient improved left ventricular performance.    METHODS: We measured left ventricular ejection fraction and troponin (Tn), a myofibrillar structural protein. In this research, after ethics committee approval, 50 patients with type 2 diabetes mellitus (DM) were enrolled into a randomized simple sampling, prospective, double-blind clinical trial study. In the case group, 500 cc dextrose water 5% plus 80 IU regular insulin and 40 mEq KCL were infused at the rate of 30 cc/hr. Patients in control group received 5% dextrose solution at the rate of 30cc/hr. Venous blood samples were taken before induction of anesthesia, after removal of the aortic clamp and before discharging from hospital. The Mann-Whitney-test was used to test for differences in Tn concentration between the groups. Fisher’s exact test was used to determine whether there was a difference in the proportion of patients with a low ejection fraction (<45%) in the case group compared with that in the control group. Changes in potassium and glucose concentrations over time within the groups were examined by ANOVA and paired t-tests. P<0.05 was regarded as significant level for all tests.    RESULTS: In this study, 50 patients with type 2 DM were evaluated in case and control groups. The mean age ± SD in the case group was 57.7 ±9.9 years and in the other group was 61.2 ± 8.4 years. The groups were well-matched for age, sex and number of bypass grafts. Randomization did not give an equal distribution of male and female patients. There wasn’t any significant difference in ejection fraction between the case and control groups before and after CABG (P>0.05). Tn concentration in the case group was 3.3 ± 5.0 and in the control group was 3.9 ± 5.1. There was no significant difference in Tn between the two groups before and after CABG (P>0.05). There was not any significant difference in hospitalization time between the two groups.     CONCLUSION: The results suggested that GIK can’t improve left ventricular performance in routine CABG surgery.      Keywords: Cardiovascular surgery, Glucose-Insulin-Potassium, Cardiac troponin

Cross Sectional Study of Burn Infections and Antibiotic Susceptibility Pattern for the Improvement of Treatment Policy

Introduction: Burn is a devastating form of trauma, and based on its condition, it could run the risk of infections. Infection of wound is a major cause of morbidity and mortality in burn cases. The current study investigates the prevalence of infectious agent in three years and antibiotic resistant pattern to improve and predispose a good policy of treatment in our environment. Materials and Methods: In the present study, a total number of 3330 samples from 713 patients were evaluated for detection of the most prevalent infections and for finding out the antibiotic susceptibility pattern with routine microbiology procedures. Results: Based on the results, 598 samples were reported positive. According to the results Pseudomonas aeruginosa, Coagulase Negative Staphylococcus and Acinetobacter sp. were the three most prevalent bacteria with a prevalence rate of 42.1%, 22.1% and 18.4% respectively. Furthermore, based on the results of distribution and diversity of bacterial infections, wound samples were the most infected samples with 73.6% of total infections. Finally, during these three years, there were no significant changes in the resistance pattern of Gram positive and Gram negative infectious agents. Conclusion: By evaluating the infectious agents during the period of the study, it was found that due to the focus on treatment of Gram negative bacteria, Gram positive bacteria especially Staphylococcus aureus and Coagulase Negative Staphylococcus have at least doubled. This increase in two important nosocomial infections is a next threat of infection and septicemia for burn victims

Applicator Attenuation Effect on Dose Calculations of Esophageal High-Dose Rate Brachytherapy Using EDR2 Film

Introduction Interaluminal brachytherapy is one of the important methods of esophageal cancer treatment. The effect of applicator attenuation is not considered in dose calculation method released by AAPM-TG43. In this study, the effect of High-Dose Rate (HDR) brachytherapy esophageal applicator on dose distribution was surveyed in HDR brachytherapy. Materials and Methods A cylindrical PMMA phantom was built in order to be inserted by various sizes of esophageal applicators. EDR2 films were placed at 33 mm from Ir-192 source and irradiated with 1.5 Gy after planning using treatment planning system for all applicators. Results The results of film dosimetry in reference point for 6, 8, 10, and 20 mm applicators were 1.54, 1.53, 1.48, and 1.50 Gy, respectively. The difference between practical and treatment planning system results was 0.023 Gy