Management of Alveolar Proteinosis by Bronchopulmonary lavage under Extra Corporeal Membrane Oxygenation (ECMO)

The gold standard of treating Pulmonary Alveolar Proteinosis (PAP) is bronchopulmonary lavage (BPL). We describe a rare case of BPD for PAP, who underwent extracorporeal membrane oxygenation (ECMO) due to hypoventilation in the setting of one-lung ventilation. First, the clinical course of the patient is presented; furthermore, the biomolecular basis of PAP and new treatment approaches is discussed. &nbsp

Seizure following removal of Swan Ganz Catheter

Venous air embolism (VAE) is an infrequent incident with fatal consequences during insertion or removal of central venous catheters. It is befalling when air or gas arrives at the vascular system. In this case report, we present a case of a 38-year-old female patient with an air embolism after removal of the Swan Ganz catheter that caused the seizure and cardiac arrest. There is an overview of the causes and ways to prevent VAE in the patien

Effect of Prophylactic Vasopressin on Hemodynamic Parameters after Coronary Artery Bypass Graft Surgery

Background: As common complications of Coronary artery bypass grafting (CABG), low vascular resistance and hypotension could be life threatening . The aim of present study was to investigate the effect of low-dose vasopressin on hemodynamics in CABG patients.Material &Methods: In this randomized double-blinded clinical trial, 80 patients undergoing selective CABG were randomly divided into two equal case and control groups (n=40). Case group was received vasopressin 0.03 IU/min 30 minute before the end of cardio-pulmonary bypass (CPB) until one hour after that. Control group was received normal saline in the same manner. Dopamine requirement, ICU stay, heart rate (HR), mean arterial blood pressure (MAP), central venues pressure (CVP) and atrial blood acidity (PH) were recorded and compared between groups  in 5 phases ( 0,30,60,90,120 min) after separation of CPB.Results: There was no significant difference between two groups in number of patients with severe hypotension (11 vs. 12 patients in case and control group respectively). CVP was corrected and then dopamine administration was compared in both group. In vasopressin and placebo group, 3 vs 11 patients need to dopamine administration immediately after separation from CPB (p= 0.018) and 4 vs 12 patients later in ICU (p=0.024) respectively. The mean needed dose of dopamine in vasopressin and placebo group immediately after separation from CPB were 7.63±3.42 vs 9.21±2.08 µg/kg/min (p=0.031) and later in ICU were 7.42±2.02 vs 8.66±4.08 µg/kg/min (p=0.045) respectively, which was significantly lower in vasopressin group in comparison with placebo group.Conclusion: Based on our results low-dose vasopressin administration significantly reduced the mean needed dose of required dopamine, 24 hours urinary output, Duration of mechanical ventilation and patient’s heart rate

Bilateral Pulmonary Artery, Inferior Vena Cava, and Cardiac Echinococcosis: A Rare Presentation of Zoonotic Diseases

Introduction:Cystic hydatidosis is a zoonoticdisease thatis mostly observedin the Mediterranean region. This infectious disease may present throughdifferent manifestations that may delay the diagnosis and cause various complications for the patients. Most of the cases are usually diagnosed by imaging studies and the related management could be medical or surgical depending on the patient’s clinical condition and disease severity. Case presentation:In the present report, we present the case ofa 50-year-old female patient with a positive history of liver and splenichydatid cysts with hemoptysis and dyspnea. The diagnosis of pulmonary and cardiac involvement wasmade usingcomputed tomography angiography. Despite the immediate surgery, the patient died from hemorrhage after 3 days. Conclusion:Themanagement of pulmonary embolism due to Echinococcus highly depends on the clinical judgment and the outcomes are subject to the history and extent of the involvement

Pulmonary Alveolar Proteinosis: AVery Rare Disease and the Role of the Cardiac Surgeon in its Treatment

Letter to the Edito

The The potential role of clinical pharmacist in the practice of heart transplantation

Due to the complexity of heart transplant procedure and risk of organ rejection, most heart transplant patients receive multiple medications such as antibiotics, antifungals, and immunosuppressants. Since some medications have narrow therapeutic indexes, more attention is needed by the clinical pharmacists to solve and reduce medication-related problems. Pharmacists can play an essential role in assisting patients and physicians in receiving better treatment with the lowest risk of medication errors. The purpose of this study was to investigate the types and quality of clinical pharmacist recommendations, the recommendations acceptance rate, and the outcomes related to clinical pharmacist interventions in heart transplant patients. The study was conducted at National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Dr.Masih Daneshvari Hospital, a university affiliated hospital, Tehran, Iran. Main outcome measures included determination of the quality of clinical pharmacist recommendations, physician acceptance rate and the effects of recommendations on patients’ clinical outcomes. Clinical pharmacist recommendations were divided into ten categories, and physicians’ acceptance rate for each recommendation was recorded. The quality of pharmacist recommendations was also classified into six categories. The total number of recommendations that were recorded for 46 patients was 344, about 7.47 recommendations per patient. Dose adjustment recommendations were the most recommendations that were made (n=100, 29.06 %). However, this type of recommendation had the lowest physician acceptance rate (62%). Antibiotics had the least acceptance rate in dose adjustment recommendations (40%). Clinical pharmacist recommendations in the drug interaction category prevented 265 moderate and 28 severe interactions, respectively. Clinical pharmacist made 27 (7.84%) extreme significant recommendations and 88 (25.58%) significant recommendations. Clinical pharmacists could have a critical role in optimizing medication regimens and minimizing drug interactions as well as adverse reactions in transplant patient care and their treatment programs

Successful Surgical Intervention in An Unusual Case of Aspergillus Endocarditis with Acute Myeloid Leukemia

Endocarditis due to Aspergillus infection is a rare complication in patients with hematological malignancies. Here, we present a case of aspergillus endocarditis in a patient with acute myeloid leukemia (AML) successfully treated with antifungal therapy and surgical treatment. The patient was a 51 years old male, a known case of AML who was admitted to our medical center for evacuating his valvular vegetations and repairing his atrial septal defect. He underwent an open heart surgery to relinquish his thromboses and also received an antifungal regimen. The patient tolerated the procedure well and eight months after his surgery, the patient remains asymptomatic. Successful treatment of this severe case of aspergillus endocarditis justifies a multidisciplinary method to be as a safe and effective approach to manage these patients

H1N1 Influenza Patient Saved by Extracorporeal Membrane Oxygenation: First Report from Iran

Respiratory failure is a serious complication of H1N1 influenza that, if not properly managed, can cause death. When mechanical ventilation is not effective, the only way to save the patient’s life is extracorporeal membrane oxygenation (ECMO). A prolonged type of cardiopulmonary bypass, ECMO is a high-cost management modality compared to other conventional types and its maintenance requires skilled personnel. Such staff usually comprises the members of open-heart surgical teams.  Herein, we describe a patient with H1N1 influenza and severe respiratory failure not improved by mechanical ventilation who was admitted to Masih Daneshvari Medical Center in March 2015. She was placed on ECMO, from which she was successfully weaned 9 days later. The patient was discharged from the hospital after 52 days. Follow-up till 11 months after discharge revealed completely active life with no problem. There should be a close collaboration among infectious disease specialists, cardiac anesthetists, cardiac surgeons, and intensivists for the correct timing of ECMO placement, subsequent weaning, and care of the patient. This team work was the key to our success story. This is the first patient to survive H1N1 with the use of ECMO in Iran.