The effect of chronic obstructive pulmonary disease’s severity on complications after coronary artery bypass graft surgery

Background and aims: Smoking is an important etiologic factor for cardiac and pulmonary diseases. Chronic Obstructive Pulmonary Disease (COPD) is common in candidates for Coronary Artery Bypass Graft (CABG) surgery. Severity of COPD is determined with spirometry. The aim of this study was comparison of complications after CABG in COPD patients with different severity and without COPD. Methods: This study is a cross sectional research. We divided 125 CABG patients more than 40 years old based on preoperative spirometry to four groups: without COPD (60), mild (29), moderate (24) and severe (12). Spirometry was done using spirometer MIR, made in Italia. Mortality and postoperative complications including cardiovascular and respiratory were recorded until 30 days after the surgery. Data were analyzed by SPSS, fisher exact test and 2χ, and P˂0.05) was considered significant. Results: Complications with significant difference between groups were atrial fibrillation (AF) and delirium. Frequency of AF was: Without COPD 6 (10%), mild COPD 6 (20.70 %), moderate COPD 7 (29.20%), and severe COPD 5 (41.70%) (P=0.02), and delirium was: Without COPD 3 (5%), mild COPD 1 (3.40%), moderate COPD 3 (12.5%), and severe COPD 5 (41.70%) (P=0.003). Conclusion: Based on our results, COPD even moderate and severe is not contraindication of CABG. These patients should be carefully evaluated before surgery and must be treated preoperative completely by the specialist. Under this condition, patients can tolerate and benefit from surgery with acceptable risk

Pulmonary function tests in ulcerative colitis

Background: Pulmonary impairment in patients suffering ulcerative colitis (UC) has been suggested by several investigators using standard pulmonary function tests (PFTs). This changes in pulmonary function associated with minimal respiratory symptoms have been documented, especially in patients with active disease. The aim of this prospective study was to determine airway resistance and lung volumes in patients with UC who have no respiratory symptoms in comparisons to a healthy control group. Materials and Methods: We evaluated a total of 30 patients with UC by means of spirometry, body plethysmography, and impulse oscillometry. The patients were not complaining of any pulmonary symptoms and did not present any history of previous respiratory diseases. As controls we examined 30 healthy subjects matched for gender, age, and smoking status. The relationship between PFT, lung volume, and airway resistance; and the activity, localization, and duration of the UC disease were analyzed. Results: There was a significant difference between airway resistances (kPa/L/s) measured by body plethysmography in patients with UC and those of the controls (R5hz; 0.60 +/- 0.44 vs. 0.39 +/- 0.13; P 0.05). Conclusion: Despite the lack of pulmonary symptoms, increased airway resistance was found in UC patients. We also have not found correlation between PFT, lung volume and airway resistance values and scoring of UC activity

Is Admission Serum Sodium Concentration a Clinical Predictor for the Outcome of Therapy in Critically Ill Poisoned Patients?

BACKGROUND Disorders of serum sodium concentration are some of the most electrolyte abnormalities in the intensive care unit (ICU) patients. These disorders adversely affect the function of vital organs and are associated with increased hospital mortality. PURPOSE In the present study we aimed to evaluate the effects of serum sodium concentration abnormalities at the time of hospital admission on the clinical outcome of therapy in a cohort of critically ill poisoned patients. METHODS In this cross-sectional study, 184 critically ill poisoned patients aged >18 years and in the first 8 hours of their poisoning, hospitalized in the ICU of a tertiary care university hospital (Isfahan, Iran) between 2010-2012, were evaluated at the admission time and 24 hours later for serum sodium concentration abnormalities and its relationship with age, gender, consciousness status, ingested drugs and clinical outcome of therapy. The clinical outcome was considered as recovery and mortality. Logistic Regression analysis was performed for predictive variables including serum sodium concentration abnormalities in patients' clinical outcome. FINDINGS On admission, 152 patients (82.6%) were eunatremic, 21 patients (11.4%) were hyponatremic and 11 patients (6%) were hypernatremic. In the second day eunatremia, hyponatremia and hypernatremia was observed in 84.4%, 13% and 2.2% respectively. Age (OR=1.92; CI=1.18-3.12) and severity of toxicity (OR=1.32; CI=1.12-2.41) were predicting factors of mortality in ICU poisoning patients. CONCLUSIONS Serum sodium concentration abnormalities are prevalent in critically ill poisoned patient but do not seem to have a predictive value for the clinical outcome of therapy

ST-T segment changes in patients with tricyclic antidepressant poisoning.

OBJECTIVE Tricyclic antidepressant (TCA) poisoning is among highly prevalent and potentially dangerous toxicities. ST-T changes are observed in the electrocardiogram (ECG) of most of TCA poisoned patients. We aimed to study ST-T segment changes in TCA toxicity and its probable relationship with other ECG findings. METHODS This retrospective study was carried out in Noor and Ali Asghar University Hospital, Isfahan (Iran) in 2012. Patients with TCA toxicity based on the patients' history who had not consumed any cardio-active drugs and did not have a past medical history of cardiovascular disease in the recent 5 years, were randomly selected and investigated. Their demographic and medical data on admission including ECG, age, sex, type and amount of ingested TCA, poisoning severity score, QRS changes, QT interval, heart axis position and R-wave were all recorded. ST-T changes and their relation with other ECG parameters have been determined using statistical analysis. FINDINGS Medical records of 272 patients were analyzed. In symptomatic patients, ST change prevalence was 40.8% and T change prevalence was 9.5%. In asymptomatic patients, the frequency of ST and T changes were 4.8% and 0.8%, respectively (P < 0.05). The most common ST and T changes in baseline (on admission) ECG were non-significant elevation (15.4%), significant elevation (11%) in pre-cordial leads, and T-wave flattening (6.6%). A statistically significant correlation was documented between ST segment changes with QRS and R-wave in aVR. The correlation between T-wave changes and R-wave in aVR lead was also significant. CONCLUSION ST-T changes in TCA poisoned patients are more prevalent in symptomatic patients. Obviously for a more definite conclusion, it is necessary to design a prospective study with the control group. This may facilitate a better understanding of ST-T segment changes