Effect of combined Conventional Ultrafiltration and Modified Ultrafiltration on Serum Interleukin-6 and TNF-α Levels in Pediatric Cardiac Surgery Patients

AbstractBackground: Water retention occurs in most of the congenital heart surgery patients, especially in pediatrics. Ultrafiltration excretes water, electrolytes, many free radicals and inflammatory mediators. The aim of this study was to investigate the effect of modified ultrafiltration (MUF) on the serum levels of TNF-α and IL-6 in pediatrics patients undergoing congenital heart surgeries.Methods and Materials: A total of 91 pediatric congenital heart disease patients candidate for total correction were selected and divided randomly in two groups: CUF (Conventional Ultrafiltration) and CUF+MUF; 40 patients were allocated to CUF group and 51 patients to CUF+MUF group. Serum levels of TNF-α and IL-6 were assessed before CPB and 6 hours after the end of the operation in ICU. Postoperative levels of TNF-α and IL-6 were compared between the two groups.Results: In the MUF+CUF group, the preoperative and postoperative TNF-α levels were 2.5±5.6 and 1.4±3.0 respectively. However, IL-6 serum levels before and after operation were 4.8±8.9 and 41±56. In the CUF only group, the TNF-α level before and after surgery was 3.1±6.2 and 1.0±0.44; respectively; similarly, IL-6 serum levels were 3.3±8.2 and 34.8±37.7.Conclusion: MUF in congenital heart surgery could filtrate excess water and elevate hematocrit but does not have a definitive role in reducing TNF-α and IL-6 serum levels.Keywords: MUF, TNF-α, IL-6, CUF, cardiopulmonary bypas

Efficacy of Mindfulness-Based Stress Reduction Training on Social Adjustment and Self-Care Behaviors in Cardiac Patients with Signs of Depression (After Open Surgery)

The present study was conducted to investigate the efficacy of mindfulness-based stress reduction training on social adjustment and self-care behaviors in cardiac patients with signs of depression (after open surgery). The present study was a quasi-experimental design with a pretest, a posttest, a control group, and a 2-month follow-up period. The statistical population of the study included patients who had undergone open heart surgery and were admitted with depressive symptoms to specialized cardiac hospitals (Chamran, Sina, and Milad) in Isfahan in the second half of 2019. Thirty-five cardiac patients with signs of depression were selected by purposive sampling and randomly divided into experimental and control groups (16 patients in the experimental group and 19 patients in the control group). The experimental group received eight seventy-five-minute sessions of mindfulness-based stress reduction interventions for two months. The questionnaires used in this study included the Depression Questionnaire, the Social Adjustment Questionnaire, and the Self-Care Behaviors Questionnaire. The data of the study were analyzed by repeated measures ANOVA using SPSS-23 statistical software. The results showed that mindfulness-based stress reduction training had a significant effect on the social adjustment and self-care behaviors of cardiac patients with signs of depression (p<0.001). The results of the present study suggest that mindfulness-based stress reduction training can be used as an effective intervention to improve social adjustment and self-care behaviors in cardiac patients with signs of depression by using techniques such as mindful attitudes, mindful activities, confronting problematic feelings and emotions, and breathing exercises to manage anger

Clinical Outcomes of Methylprednisolone versus Dexamethasone in Prime Solution During Cardiopulmonary Bypass Pump after Coronary Artery Bypass Grafting

Background: The study was performed to compare clinical outcomes of methylprednisolone and dexamethasone in prime solution during cardiopulmonary pump after CABG. Methods: In this double-blind clinical trial, sixty-two patients who underwent CABG were divided into the control group consisted of 31 patients using dexamethasone in their prime solution and the test group consisted of 31 patients using methylprednisolone in their prime solution. Duration of mechanical ventilation, length of ICU stay, bleeding rate (chest tube volume), arrhythmia and need for inotropic intake were compared (IRCT20170620034666N2). Results: The mean age of patients was 55.7 years in the dexamethasone group and 53.09 years in the methylprednisolone group. Arrhythmia and inotropic agents were not observed in either group. The mean duration of mechanical ventilation and ICU stay in the dexamethasone group were significantly higher than the methylprednisolone group (p &lt;0.05). But the mean bleeding rate in the dexamethasone group was significantly lower than the methylprednisolone group (p &lt;0.05). Conclusion: The mean duration of mechanical ventilation and ICU stay in the dexamethasone group was higher than the methylprednisolone group, but the use of dexamethasone has the advantage of being associated with less bleeding

Surgical application of fascia lata as a pericardial substitute in rabbits Aplicação cirúrgica de fascia lata como substituto do pericárdio em coelhos

PURPOSE: To use fascia lata instead of pericardium and observe the presence of adhesions. METHODS: Twenty rabbits were divided into two group of ten. In group A, a 1×1 cm segment of pericardium was excised and resutured. In group B excised pericardium was substituted for autologous fascia lata. RESULTS: In the comparison of microscopic adhesion rate between two groups A, B after eight weeks, there was no significant statistical difference. CONCLUSION: Fascia lata is safe and it can be substituted for pericardium especially in repeat sternotomy in repairing congenital heart defects to avoid heart injury.<br>OBJETIVO: Utilizar fascia lata em vez de pericárdio e observar a presencça de aderências. MÉTODOS: Vinte coelhos foram distribuidos em dois grupos de dez. No grupo A, um 1×1 cm de segmento de pericárdio foi retirado e resuturado. No grupo B pericárdio retirado foi substituído por fáscia lata autóloga. RESULTADOS: Na comparação da taxa de aderência microscópica entre dois grupos A, B, após oito semanas, não houve diferença estatisticamente significante. CONCLUSÃO: A fascia lata é segura e pode ser substituta do pericárdio, especialmente em nova esternotomia na reparação de defeitos cardíacos congênitos para evitar lesão cardíaca

How to extract a losing intra-aortic balloon pump guide wire

Guidewire loss is a serious complication that in case of a complete wire loss could cause death in about 20% of cases. Although it is essential to retrieve an intravenous foreign body as soon as possible, there are only a few recommendations regarding the removal of an intra-arterial foreign body. This study reports on a rare complication of guidewire loss during the insertion of an Intra-Aortic Balloon Pump (IABP), which has not yet been reported in the literature. The approach to this problem has been described, including the extraction time and the technique

Mitral valve Z value in Iranian patients with tetralogy of Fallot

Background: Tetralogy of Fallot (TOF) refers to a condition in which left ventricular volume is normal or slightly less than normal. Given the differences observed in some Asian patients with TOF, the present study was conducted to investigate left heart by determining Z-scores for the mitral valve in Iranian patients with TOF. Methods: Eligible subjects in this prospective descriptive study comprised all patients with TOF presenting to Shahid Modarres Hospital in Tehran from March 2012 to March 2015 and diagnosed as the candidates for surgery. After determining the need for surgery and the therapeutic method required, the mitral valve size and Z-scores were calculated. We analyzed sex, age, body surface area (BSA), mitral size (in 2-chamber and 4-chamber view), mitral Z-score, other cardiac anomalies, number of surgery and previous surgery. Results: Of a total of 80 patients included in the study over 3 years, 29 (36.3%) were male and 51 (63.8%) were female. The mean age of the patients was 7.15&plusmn;3.37 years and their mitral size was found to be 10-27 mm (16.2&plusmn;5.99 mm) using echocardiography. Z-scores of the mitral valve were also obtained as -3.09&plusmn;2.11, ranging between -7.1 SD and +1.3 SD. 58 (72.5%) patients have only TOF and 22 (27.5%) with other cardiac anomalies. 45 patients were for first time underwent surgery and 22 patients for second time, 12 patients for three time and 1 for forth. Of a total of 35 patients had previous surgery, the most common were shunt 15 (42.9%) and then tetralogy of Fallot total correction (TFTC) in 12 (34.3%). Of a total of 80 patients, 59 (73.8%) underwent TFTC, 17 (21.3%) under pulmonary valve replacement and 4 (5%) shunt. Conclusion: Z-scores of the mitral valve were found to be significantly below the normal value, (i.e. 0&plusmn;2 SD), in the study patients, suggesting the risk of hypoplastic left heart syndrome in Iranian patients with TOF, nevertheless, the type of TOF examined in these patients might have been different from those observed in other races and regions. &nbsp

Tramadol Alleviates Myocardial Injury Induced by Acute Hindlimb Ischemia Reperfusion in Rats

Background: Organ injury occurs not only during periods of ischemia but also during reperfusion. It is known that ischemia reperfusion (IR) causes both remote organ and local injuries. Objective: This study evaluated the effects of tramadol on the heart as a remote organ after acute hindlimb IR. Methods: Thirty healthy mature male Wistar rats were allocated randomly into three groups: Group I (sham), Group II (IR), and Group III (IR + tramadol). Ischemia was induced in anesthetized rats by left femoral artery clamping for 3 h, followed by 3 h of reperfusion. Tramadol (20 mg/kg, intravenous) was administered immediately prior to reperfusion. At the end of the reperfusion, animals were euthanized, and hearts were harvested for histological and biochemical examination. Results: The levels of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were higher in Groups I and III than those in Group II (p < 0.05). In comparison with other groups, tissue malondialdehyde (MDA) levels in Group II were significantly increased (p < 0.05), and this increase was prevented by tramadol. Histopathological changes, including microscopic bleeding, edema, neutrophil infiltration, and necrosis, were scored. The total injuryscore in Group III was significantly decreased (p < 0.05) compared with Group II. Conclusion: From the histological and biochemical perspectives, treatment with tramadol alleviated the myocardial injuries induced by skeletal muscle IR in this experimental model