Associations between short-term exposure to fine particulate matter and acute myocardial infarction: A case-crossover study

BACKGROUND

Previous studies evaluated the impact of particle matters (PM) on the risk of acute myocardial infarction (AMI) based on local registries.

HYPOTHESIS

This study aimed to evaluate possible short term effect of air pollutants on occurrence of AMI based on a specific case report sheet that was designed for this purpose.

METHODS

AMI was documented among 982 patients who referred to the emergency departments in Tehran, Iran, between July 2017 to March 2019. For each patient, case period was defined as 24 hour period preceding the time of emergency admission and referent periods were defined as the corresponding time in 1, 2, and 3 weeks before the admission. The associations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2 .5 ) and particulate matter with an aerodynamic diameter ≤10 μm (PM10 ) with AMI were analyzed using conditional logistic regression in a case-crossover design.

RESULT

Increase in PM2.5 and PM10 was significantly associated with the occurrence of AMI with and without adjustment for the temperature and humidity. In the adjusted model each 10 μg/m3 increase of PM10 and PM2.5 in case periods was significantly associated with increase myocardial infarction events (95% CI = 1.041-1.099, OR = 1.069 and 95% CI = 1.073-1.196, and OR = 1.133, respectively). Subgroup analysis showed that increase in PM10 did not increase AMI events in diabetic subgroup, but in all other subgroups PM10 and PM2 .5 concentration showed positive associations with increased AMI events.

CONCLUSION

Acute exposure to ambient air pollution was associated with increased risk of AMI irrespective of temperature and humidity.

HEART versus GRACE Score in Predicting the Outcomes of Patients with Acute Coronary Syndrome; a Systematic Review and Meta-Analysis

Introduction

Several scoring systems have been proposed to predict the outcomes of patients with ischemic heart disease. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores are two of the more widely used risk prediction tools in patients with acute coronary syndrome (ACS). The present systematic review and meta-analysis aimed to compare the value of GRACE and HEART scores in the outcome prediction of ACS patient.

Method

The online databases of Medline, Embase, Web of Science, and Scopus were search until September 2022 for articles directly comparing GRACE and HEART scores value in prediction of outcome in patients with ACS. GRACE score cut-offs were categorized into two groups of less than and equal to 100 and more than 100, and HEART score cut-offs were categorized into three groups of less than 4, equal to 4, and more than 4. Investigated outcomes were major adverse cardiovascular events (MACE), acute myocardial infraction (AMI) and all-cause mortality.

Results

25 articles were included. The sensitivity and specificity of the GRACE score for prediction of MACE were 0.96 and 0.26 for cut-offs of ≤ 100, and 0.58 and 0.69 for cut-offs of >100, respectively. The sensitivity and specificity of the HEART score for prediction of MACE were 0.99 and 0.16 for cut-offs less than 4, 0.93 and 0.47 for equal to 4, and 0.77 and 0.78 for cut-offs greater than 4. GRACE score was shown to be predictive of AMI with sensitivity and specificity of 0.95 and 0.29, respectively. The analysis for the value of HEART score in the prediction of AMI a sensitivity and specificity of 0.94 and 0.48, respectively. The risk scores were not found to be suitable predictors of all-cause mortality.

Conclusion

The results demonstrated the low specificity of GRACE and HEART scores in predicting the MACE, AMI and all-cause mortality, irrespective of the utilized cut-off. Considering the acceptable sensitivity of two scores in predicting the MACE and AMI, these scores were more suitable to be used as a rule-out tool for identification of ACS patients with low risk of developing adverse outcomes.

The value of Coronary Artery Disease - Reporting and Data System (CAD-RADS) in Outcome Prediction of CAD Patients; a Systematic Review and Meta-analysis

Introduction

Coronary computed tomographic angiography (CCTA) reporting has traditionally been operator-dependent, and no precise classification is broadly used for reporting Coronary Artery Disease (CAD) severity. The Coronary Artery Disease Reporting and Data Systems (CAD-RADS) was introduced to address the inconsistent CCTA reports. This systematic review with meta-analysis aimed to comprehensively appraise all available studies and draw conclusions on the prognostic value of the CAD-RADS classification system in CAD patients.

Method

Online databases of PubMed, Embase, Scopus, and Web of Science were searched until September 19th, 2022, for studies on the value of CAD-RADS categorization for outcome prediction of CAD patients.

Results

16 articles were included in this systematic review, 14 of which had assessed the value of CAD-RADS in the prediction of major adverse cardiovascular events (MACE) and 3 articles investigated the outcome of all-cause mortality. Our analysis demonstrated that all original CAD-RADS categories can be a predictor of MACE [Hazard ratios (HR) ranged from 3.39 to 8.63] and all categories, except CAD-RADS 1, can be a predictor of all-cause mortality (HRs ranged from 1.50 to 3.09). Moreover, higher CAD-RADS categories were associated with an increased hazard ratio for unfavorable outcomes among CAD patients (p for MACE = 0.007 and p for all-cause mortality = 0.018).

Conclusion

The evidence demonstrated that the CAD-RADS classification system can be used to predict incidence of MACE and all-cause mortality. This indicates that the implementation of CAD-RADS into clinical practice, besides enhancing the communication between physicians and improving patient care, can also guide physicians in risk assessment of the patients and predicting their prognosis.

Femoral tripod arteries: Surgical anatomic variants

AIM

To describe the surgical anatomy of the femoral tripod arteries and their anatomical variants.

MATERIALS AND METHODS

Patients who underwent vascular surgery by external arciform approach of the Scarpa between May 2022 and July 2022 were selected. The surgical anatomy was assessed by direct observation. The origin and the course of major branches of the femoral artery (FA) were studied. Diameters and the distance of the origin of the femoral profunda artery (FPA) from the midpoint of the inguinal ligament was measured in millimeters and recorded. The observed anatomical variations were photographed and compared to those in the literature.

RESULTS

A total of 40 patients (34 men, 85%) were included. The median diameter of the common femoral artery (CFA) was 9mm (IQR: 7-12mm). The Modal bifurcation was noted in 95% of cases. The collateral branches of the CFA were found to be distributed as follows: the superficial circumflex iliac artery (SCIA) in 34 cases (85%), the superficial epigastric artery (SEA) in 22 cases (55%), the deep external pudic artery in 16 cases (40%), and the superficial external pudic artery in 18 cases (45%). The median diameter of the FPA was 5mm (IQR: 4-6mm). The FPA originated from the posterolateral side of the CFA in 90% of cases, from the posterior side in 5% of cases and from the medial side in 5% of cases. The median diameter of the SFA was 6mm (IQR: 4-9mm).

CONCLUSION

The anatomic variants of the femoral tripod arteries are extremely frequent. Therefore, it is important to recognize the anatomy in order to avoid possible diagnostic errors and to minimize the risk of per and post procedural complications.

Six-Month Follow-up of COVID-19 Patients: Mortality and Related Factors

BACKGROUND

Currently, there is lack of evidence regarding the long-term follow-up of coronavirus disease 2019 (COVID-19) patients. The aim of this study is to present a 6-month follow-up of COVID-19 patients who were discharged from hospital after their recovery.

METHODS

This retrospective cohort study was performed to assess the six-month follow-up of COVID-19 patients who were discharged from the hospital between February 18 and July 20, 2020. The primary outcome was 6-month all-cause mortality.

RESULTS

Data related to 614 patients were included to this study. Of these 614 patients, 48 patients died (7.8%). The cause of death in 26 patients (54.2%) was the relapse of COVID-19. Also, 44.2% of deaths happened in the first week after discharge and 74.4% in the first month. Risk factors of all-cause mortality included increase in age (odds ratio [OR]=1.09; P<0.001), increase in neutrophil percentage (OR=1.05; P=0.009) and increase in heart rate (OR=1.06; P=0.002) on the first admission. However, the risk of all-cause death was lower in patients who had higher levels of hematocrit (OR=0.93; P=0.021), oxygen saturation (OR=0.90; P=0.001) and mean arterial pressure (OR=0.93; P=0.001). In addition, increase in age (OR=1.11; P<0.001) was an independent risk factor for COVID-19-related death, while higher levels of lymphocyte percentage (OR=0.96; P=0.048), mean arterial pressure (OR=0.93; P=0.006) and arterial oxygen saturation (OR=0.91; P=0.009) were protective factors against COVID-19-related deaths during the 6-month period after discharge.

CONCLUSION

Death is relatively common in COVID-19 patients after their discharge from hospital. In light of our findings, we suggest that elderly patients who experience a decrease in their mean arterial pressure, oxygen saturation and lymphocyte count during their hospitalization, should be discharged cautiously. In addition, we recommend that one-month follow-up of discharged patients should be take place, and urgent return to hospital should be advised when the first signs of COVID-19 relapse are observed.

Supervision by direct observation with video recording in the operating room: educational tool for learning and formative evaluation

Funding Acknowledgements

Type of funding sources: None.

Introduction

Directly observed supervision with video recording (DOSVR) is used as a learning method in several countries. This technique has proven itself, but remains little used in Tunisia. On the other hand, the use of DOSVR in surgery is rarely described. The objectives of our work were to describe the development and experimental implementation of DOSVR in surgery and to evaluate the feedback from residents and teachers.

Methods

This is a prospective, observational and descriptive study concerning the experimentation of DOSVR in five surgical procedures performed by residents of cardiovascular surgery department. These video recordings were followed by a backscatter with self and heteroevaluation.

We based ourselves on the methodology of teaching by simulation for the design of the protocol: the Briefing, the scenario and then the debriefing.

Results

A total of ten took part in this experiment. The average age was 28.5 years [26 -33 years] with a sex ratio F/M of 4. All residents declared that the protocol provided was easy to understand and apply. After obtaining the consent of the patients, five interventions were filmed in whom three were in emergency. Seven residents said that using a smartphone to vdeo recording was not easy and 8 easily got rid of the presence of the camera. All the learners denied having to change their operating techniques because they were being filmed. All the residents agreed that a minimum number of six DOSVR sessions in each residency year is appropriate and praised the technique as a powerful tool for the development of their practical training.

Conclusions

Our study showed that the application of Directly observed supervision with video recording in vascular surgery is feasible. It is a promising educational tool for the practical learning of residents as well as a tool for the continuous formative evaluation of their progress.

Risk Factors of Readmission in COVID-19 Patients; a Retrospective 6-Month Cohort Study

Introduction

The available literature regarding the rate of readmission of COVID-19 patients after discharge is rather scarce. Thus, the aim in the current study was to evaluate the readmission rate of COVID-19 patients and the components affecting it, including clinical symptoms and relevant laboratory findings.

Methods

In this retrospective cohort study, COVID-19 patients who were discharged from Imam Hossein hospital, Tehran, Iran, were followed for six months. Data regarding their readmission status were collected through phone calls with COVID-19 patients or their relatives, as well as hospital registry systems. Eventually, the relationship between demographic and clinical characteristics and readmission rate was assessed.

Results

614 patients were entered to the present study (mean age 58.7±27.2 years; 51.5% male). 53 patients were readmitted (8.6%), of which 47 patients (7.6%) had a readmission during the first 30 days after discharge. The reasons for readmission were relapse of COVID-19 symptoms and its pulmonary complications in 40 patients (6.5%), COVID-19 related cardiovascular complications in eight patients (1.3%), and non-COVID-19 related causes in five patients (0.8%). Older age (OR=1.04; 95% CI: 1.01, 1.06; p=0.002) and increased mean arterial pressure during the first admission (OR=1.04; 95% CI: 1.01, 1.08; p=0.022) were found to be independent prognostic factors for the readmission of COVID-19 patients.

Conclusion

Readmission is relatively frequent in COVID-19 patients. Lack of adequate hospital space may be the reason behind the early discharge of COVID-19 patients. Hence, to reduce readmission rate, extra care should be directed towards the discharge of older or hypertensive patients.

Is cardiac Troponin I Considered as A Predictor of In-hospital Mortality among COVID-19 Patients? A Retrospective Cohort Study

Objective:

To describe the levels of troponin I in COVID-19 patients and its role in the prediction of their in-hospital mortality as a cardiac biomarker.

Methods:

The current retrospective cohort study was performed on the clinical records of 649 COVID-19-related hospitalized cases with at leat one positive polymerase chain reaction (PCR) test in Tehran, Iran from February 2020 to early June 2020. The on admission troponin I level divided into two groups of ≤0.03ng/mL (normal) and >0.03ng/mL (abnormal). The adjusted COX-regression model was used to determine the relationship between the studied variables and patient’s in-hospital mortality.

Results:

In this study, the median age of subjects was 65 years (54.8% men) and 29.53% of them had abnormal troponin I levels. Besides, the in-hospital mortality rate among patients with abnormal troponin I levels was found to be 51.56%; whereas, patients with normal levels exhibited 18.82% mortality. Also, the multivariable analysis indicated that the risk of death among hospitalized COVID-19 patients displaying abnormal troponin I levels was 67% higher than those with normal troponin I levels (Hazard ratio=1.67, 95% confidence interval=1.08-2.56, p=0.019).

Conclusion:

It seems that troponin I is one of the important factors related to in-hospital mortality of COVID-19 patients. Next, due to the high prevalence of cardiac complications in these patients, it is highly suggested to monitor and control cardiac biomarkers along with other clinical factors upon the patient’s arrival at the hospital.

Dual antiplatelet therapy before coronary artery bypass grafting in patients with myocardial infarction: a prospective cohort study

BACKGROUND

Dual antiplatelet therapy (DAPT) in patients with MI who are candidates for early coronary artery bypass grafting (CABG) can affect intraoperative and postoperative outcomes. Therefore, the aim of this study was to evaluate the effect of DAPT up to the day before CABG on the outcomes during and after surgery in patients with MI.

METHODS

In this prospective cohort study, 224 CABG candidate patients with and without MI were divided into two groups: (A) patients without MI who were treated with aspirin 80 mg/day before surgery (noMI-aspirin group; n = 124) and (B) patients with MI who were treated with aspirin 80 mg/day before surgery and clopidogrel (Plavix brand) at a dose of 75 mg/day (MI-DAPT group; n = 120). Dual or mono-antiplatelet therapy continued until the day before surgery. Patients were followed to assess in-hospital and 6-months outcomes.

RESULTS

The in-hospital mortality in MI-DAPT group was similar with noMI-aspirin group (OR 4.2; 95% CI 0.9-20.5; p = 0.071). The prevalence of CVA (p = 0.098), duration of hospital stay (p = 0.109), postoperative ejection fraction level (p = 0.693), diastolic dysfunction grade (p = 0.651) and postoperative PAP level (p = 0.0364) did not show difference between two groups. No mild or severe bleeding was observed in the patients. Six-month follow up showed that number of readmissions (p = 0.801), number of cases requiring angiography (p = 0.100), cases requiring re-PCI (p = 0.156), need for re-CABG (p > 0.999) and CVA (p > 0.999) did not differ between the two groups. During the 6-month follow-up, out-hospital mortality did not differ significantly between the two groups (p = 0.446).

CONCLUSIONS

A 6-month follow-up showed that DAPT with aspirin and clopidogrel before CABG in patients with MI has no effect on postoperative outcomes more than mono-APT with aspirin. Therefore, DAPT is recommended in the preoperative period for these patients.

Factors Related To The Loneliness Of Older Women With Hypertension In Tehran

Older women have longevity and face with common chronic diseases such as hypertension longer than men. In addition the refusal to accept older women into the mainstream of society can affect the loneliness of older women particularly in developing countries such as Iran. This study was conducted to describe factors related to loneliness of older women with hypertension in Tehran. This descriptive, correlational study was conducted on a sample of 300 older women above age 60 in five regions of Tehran in 2020. A socio-demographic questionnaire and the Russell Loneliness Scale were used for data collection. Content validity and Cronbach’s alpha were used for evaluating the validity and reliability of questionnaires. 61% of older women were widowed and 37.3% lived alone with a mean age of 72.16(± 8.5) year. The mean score for loneliness was 66.26 (±13.44) on a 20 to 80-point scale. The scores of loneliness were influenced significantly by not having an income source, no living companion, chronic diseases, hospitalization in last year, family history of hypertension, and duration of hypertension. The best predictors of loneliness were hospitalization in last year, duration of hypertension, family history of hypertension, and chronic diseases. The findings of this study showed that loneliness is very common in older women with hypertension and is related to a number of factors. Monitoring modifiable factors such as hospitalization in the last year and non-modifiable factors such as duration of hypertension will help us to prevent or reduce loneliness in older women with hypertension.

COVID-19 related hospitalization costs; assessment of influencing factors

Objective: Our aim is to assess the effective factors on hospitalization costs of COVID-19 patients. Methods: Data related to clinical characteristics and cost of hospitalized COVID-19 patients from February 2020 until July 2020, in a public teaching hospital in Tehran, Iran was gathered in a retrospective cohort study. The corresponding factors influencing the diagnostic and therapeutic costs were evaluated, using a generalized linear model. Results: The median COVID-19 related diagnostic and therapeutic costs in a public teaching hospital in Iran, for one hospitalized COVID-19 patient was equal to 271.1 US dollars (USD). In patients who were discharged alive from the hospital, the costs increased with patients’ pregnancy (P<0.001), loss of consciousness during hospitalization (P<0.001), a history of drug abuse (P=0.006), history of chronic renal disease (P<0.001), end stage renal disease (P=0.002), history of brain surgery (P=0.001), history of migraine (P=0.001), cardiomegaly (P=0.033) and occurrence of myocardial infarction during hospitalization (P<0.001). In deceased patients, low age P<0.001), history of congenital disease (P=0.024) and development of cardiac dysrhythmias during hospitalization (P=0.044) were related to increase in therapeutic costs. Conclusion: Median diagnostic and therapeutic costs in COVID-19 patients, hospitalized in a public teaching hospital in Iran were 271.1 USD. Hoteling and medications made up most of the costs. History of cardiovascular disease and new onset episodes of such complications during hospitalization were the most important factors contributing to the increase of therapeutic costs. Moreover, pregnancy, loss of consciousness, and renal diseases are of other independent factors affecting hospitalization costs in COVID-19 patients.

Aortic Coarctation of the newborn and infant: predictors of morbidity and mortality

Funding Acknowledgements

Type of funding sources: None.

Introduction

Aortic coarctation represents 8% of all congenital heart disease. Whether isolated or associated with an intra or extra cardiac anomaly, newborns or infants coarctation could lead to early heart failure. this specific form can be associated with peri-operative difficulties and subsequent complications especially recoarctation and late hypertension.

Objective : our objective is to determine the predictive factors of morbi-motality in this disease.

Methods

It’s a monocentric and restrospcetive study of 34 newborns and infants operated on for aortic coarctation between January 2010 and december 2019. Clinical, paraclinical and therapeutic data have been collected.

Results

Our study include 23 newborns and 11 infants, with sex ratio of 2,4. The diagnosis was retained at an average age of 2 months and  2/3 of which before the age of 1 month. The main clinical signs were an abnormality of the femoral pulses in 92% of cases (abolished in 15 babies), tachycardia with polypnea in 68% of cases and hypertension in 48% of patients. Other signs are less common, such as hepatomegaly (44%), left side-sternal murmur (38%) and hypotrophy (20.6%). The mean gradient in blood pressure between the upper and lower limbs was 22 mm Hg [17-38mmHg]. Eight patients required mechanical ventilation. Biological examinations showed metabolic acidosis in 8 patients hepatic failure and renal failure in five patients each one. On the chest x-ray, 60% had cardiomegaly and 42% had pulmonary edema. The trans-thoracic echocardiography detect coarctation in all cases which was preductal in 70.6% of cases. The averge of trans-isthmic gradient was 37mmHg. The main associated cardiac abnormalities were: IVC in 7 patients and aortic bicuspid in 6. However, persistent ductus arteriosus was in 27 cases (79.4%). Cardiac catheterization was used in 5 babies aged between 4 and 9 months with a mean trans-isthmic hemodynamic gradient of 65 mmHg [45-100] and MRI and Ct scann was done in 3 patients each one.

The average weight at the time of the operation was 4.780 kg [2.4-9.8]. 3 newborns were operated between the 9th and 20th days of life. The first approach was a posterolateral thoracotomy in the left 4th intercostal space in 33 patients and a vertical midline sternotomy in a single infant with a total abnormal pulmonary venous return. The modified Crafoord technique (extended-anastomosis) was performed in the majority of cases (97.05%) and 4 patients with unrestricted IVC required also pulmonary artery banding. The overall mortality rate was 29.4%. Prematurity, a birth weight &lt;2.5 kg, an operative age &lt;120 days and  complex heart disease were significantly associated with mortality (P&lt; 0.05).

Conclusion

Coarctation of the aorta in newborns and infants is a surgical emergency in some cases, with still high mortality despite the surgical and anesthetic progress.

Post cardiac surgery Mediastinitis : Risk factors and therapeutic management

Funding Acknowledgements

Type of funding sources: None.

Background : Despite the progress in therapy and patient management in cardiac surgery, postoperative mediastinitis remains an serious complication. Our study aims to study the incidence of mediastinitis after cardiac surgery and to identify the risk factors.

Methods

We conducted a retrospective, descriptive study including patients who had undergone cardiac surgery by sternotomy during a period of 5 years ( 2015 – 2019)and who meet the definition of mediastinitis proposed by the "Centers of disease control and disease". We collected the demographic characteristics of the patients and operative operative data of the first intervention as well as those relating to mediastinitis.

Results

 25 patients ( 2.93%)  among 1042 patients operated for cardiac surgery during the cited period presented mediastinitis. The main clinical signs were : surgical wound infection (80%), fever (40%) and sternal instability (30%). Biological tests showed : hyperleukocytosis and high C-Reactive Protein  in 22.7 % and 58.1 % of cases respectively. Gram-positive cocci are largely predominant and one case of Candida mediastinitis was found. type 1 diabetes and coronary artery bypass grafting were significantly associated with the occurrence of mediastinitis with P &lt;0.01. The mean duration of intra venous antibiotic therapy was 21 days.

92 % of patients operated on for mediastinitis are cured, 4 % had a recurrence of infection and 4 % died.

CONCLUSION

Mediastinitis after heart surgery is rare but serious. The main risk factors are  insulin-dependent diabetes and coronary bypass surgery. The curative treatment is heavy and it is based on a rigorous and long medico-surgical care.

Electrocardiographic Findings and In-Hospital Mortality of COVID-19 Patients; a Retrospective Cohort Study

Background:

Although current evidence points to the possible prognostic value of electrocardiographic (ECG) findings for in-hospital mortality of COVID-19 patients, most of these studies have been performed on a small sample size. In this study, our aim was to investigate the ECG changes as prognostic indicators of in-hospital mortality.

Methods:

In a retrospective cohort study, the findings of the first and the second ECGs of COVID-19 patients were extracted and changes in the ECGs were examined. Any abnormal finding in the second ECG that wasn’t present in the initial ECG at the time of admission was defined as an ECG change. ECGs were interpreted by a cardiologist and the prognostic value of abnormal ECG findings for in-hospital mortality of COVID-19 patients was evaluated using multivariate analysis and the report of the relative risk (RR).

Results:

Data of the ECGs recorded at the time of admission were extracted from the files of 893 patients; likewise, the second ECGs could be extracted from the records of 328 patients who had an initial ECG. The presence of sinus tachycardia (RR = 2.342; p <0.001), supraventricular arrhythmia (RR = 1.688; p = 0.001), ventricular arrhythmia (RR = 1.854; p = 0.011), interventricular conduction delays (RR = 1.608; p = 0.009), and abnormal R wave progression (RR = 1.766; p = 0.001) at the time of admission were independent prognostic factors for in-hospital mortality. In the second ECG, sinus tachycardia (RR = 2.222; p <0.001), supraventricular arrhythmia (RR = 1.632; p <0.001), abnormal R wave progression (RR = 2.151; p = 0.009), and abnormal T wave (RR = 1.590; p = 0.001) were also independent prognostic factors of in-hospital mortality. Moreover, by comparing the first and the second ECGs, it was found that the incidence of supraventricular arrhythmia (RR = 1.973; p = 0.005) and ST segment elevation/depression (RR = 2.296; p <0.001) during hospitalization (ECG novel changes) are two independent prognostic factors of in-hospital mortality in COVID-19 patients.

Conclusion:

Due to the fact that using electrocardiographic data is easy and accessible and it is easy to continuously monitor patients with this tool, ECGs can be useful in identifying high-risk COVID-19 patients for mortality.

Post cardiac surgery Mediastinitis : Risk factors and therapeutic management

Funding Acknowledgements

Type of funding sources: None.

Background : Despite the progress in therapy and patient management in cardiac surgery, postoperative mediastinitis remains serious complication. Our study aims to study the incidence of mediastinitis after cardiac surgery and to identify the risk factors.

Methods

We conducted a retrospective, descriptive study including patients who had undergone cardiac surgery by sternotomy during a period of 5 years ( 2015 – 2019)and who meet the definition of mediastinitis proposed by the "Centers of disease control and disease". We collected the demographic characteristics of the patients and operative operative data of the first intervention as well as those relating to mediastinitis.

Results

 25 patients ( 2.93%)  among 1042 patients operated for cardiac surgery during the cited period presented mediastinitis. The main clinical signs were : surgical wound infection (80%), fever (40%) and sternal instability (30%). Biological tests showed : hyperleukocytosis and high C-Reactive Protein  in 22.7 % and 58.1 % of cases respectively. Gram-positive cocci are largely predominant and one case of Candida mediastinitis was found. type 1 diabetes and coronary artery bypass grafting were significantly associated with the occurrence of mediastinitis with P &lt;0.01. The mean duration of intra venous antibiotic therapy was 21 days.

92 % of patients operated on for mediastinitis are cured, 4 % had a recurrence of infection and 4 % died.

CONCLUSION

Mediastinitis after heart surgery is rare but serious. The main risk factors are  insulin-dependent diabetes and coronary bypass surgery. The curative treatment is heavy and it is based on a rigorous and long medico-surgical care.

Changes in the hearing threshold of workers in a steel industry: 5-year follow-up

Introduction: noise is one of the most important harmful factors in the workplace. The physiological effects of noise on humans are gradual in the long run. Despite industrial advances, exposure to excessive noise is one of the health problems of workers in the world's steel industry. This study aimed to investigate the effect of noise on hearing loss in steel industry workers. Materials and Methods: This descriptive cross-sectional study was designed and conducted. The study population was 121 workers in a steel rolling industry whose 5-year audiometry was studied from 1391 to 1395. An audiometer performed the audiometric test of these workers in 5 years. Their audiometric results were extracted from their medical records and examined under ethical principles. Data were analyzed using SPSS software version 21, and T-Test and Wilcoxon Signed Ranks Test was used for statistical analysis. Results: The mean age of participants was 38.88 ± 4.92 years and the mean work experience was 10.94 ± 3.57 years. In this study, a gradual increase in the average hearing threshold at different frequencies in both ears was seen from 2012 to 2016. Conclusion: noise as a detrimental factor in the steel industry causes a gradual increase in exposed workers' hearing threshold.

Tuberculosis lymphadenopathy: A rare etiology of the superior vena cava syndrome

Superior vena cava syndrome is the clinical expression of the obstruction of the superior vena cava reducing the blood flow. Malignant etiologies are the most common. Its management is multidisciplinary and despite the progress of endovascular procedures, conventional surgery retains its place in certain indications. Mediastinal fibrosis secondary to tuberculosis lymphadenopathy may be associated with superior vena cava syndrome. In the presence of symptomatic SVCS associated with extensive mediastinal fibrosis compressing the superior vena cava with sub occlusive thrombosis, conventional surgery remains a treatment option, with cavo-venous derivation by prosthetic bypass.

[Arterial trauma of the upper limbs: Particularities of the population in Tunisia and risk factors for amputation]

AIM OF THE STUDY

The purpose of our study was to review the population at risk of upper limb arterial injury, to determinate the rate of upper limb salvage and the predictive factors of limb loss.

METHODS

This was a retrospective study, involving 128 patients with upper extremity arterial trauma operated between January first, 2006 and June 30, 2017. Exclusion criteria were arterial ligation, primary limb amputation and arterial iatrogenic injuries. End points were immediate technical success, primary patency and limb salvage rate.

RESULTS

The average age was 27.7 years with a sex ratio M/F=41, causes of trauma were self-inflicted wounds (51%), assaults (23%), road traffic accidents (10%), work accidents (9%) and domestic accidents (7%). Injured arteries were brachial (66.5%) usually because of self-inflicted injuries; arteries of the forearm (31%) and axillery arteries (2.5%). The techniques of arterial repair were vein graft interposition in 52% of cases, end-to-end anastomosis in 23%, primary arterial repair in 21% and venous patch in 4%. Eight reconstructions occluded during the first week (6.25%). Four patients required secondary amputation and limb salvage rate was 96.8%. After a median follow-up time of 62 days, only 21% were followed at 3 months. Mechanism of injury, soft tissue loss and arterial reconstruction thromboses were selected as factors influencing the rate of limb salvage. One death occurred at day 14 secondary to multi-component poly-trauma.

CONCLUSION

Prompt diagnosis, appropriate multidisciplinary management of the upper extremity arterial trauma and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage. Associated soft tissue injury is a poor limb salvage factor.

[Conservative aneurysmorrhaphy for hemodialysis arteriovenous fistula]

The aim of this study was to evaluate the results of conservative surgical treatment of the aneurysmal complications of arteriovenous hemodialysis fistulae and to determine the factors predictive of long- and mid-term patency of treated fistulae. The surgical treatment was mainly based on caliber reduction and reconstruction.

METHODS

This was a descriptive retrospective study with a five-year duration, going from January 2013 to December 2018. This study included 40 patients presenting aneurysmal complications of their hemodialysis vascular access who were treated with aneurysmorrhaphy.

RESULTS

The mean age of the aneurysmal-complicated hemodialysis vascular access was 42 months. The indications for treatment were puncture-related difficulties in 42.5% of cases, rapid increase of the aneurysmal diameter in 27.5%, skin thinning in 25% and aneurysmal rupture in 5%. The mean aneurysmal course was 6.6 months with an average diameter of 3.25cm at the moment of management. The initial technical success rate was 100%. Twenty patients had complications in the postoperative period. Patency rates at 3, 6, 12 and 24 months were 89.5%, 81.6%, 71% and 63.1%, respectively. Factors predictive of thrombosis were diabetes (P=0.001), peripheral arterial disease (P=0.003), number of punctures per week (P=0.003) and context of emergency presentation (P=0.001).

CONCLUSION

Aneurysmorrhaphy seems to be the best conservative surgical treatment for aneurysmal complications of hemodialysis vascular access fistulae. This surgical approach allows us to conserve the native autologous vascular access and spare the patient's venous network.

[Endovascular treatment of chronic mesenteric ischemia]

INTRODUCTION

Atherosclerosis occurring in the digestive arteries is rare and often asymptomatic. When it becomes symptomatic, surgical care is indicated. Conventional procedures are giving way to improved endovascular techniques applied to the mesenteric arteries. The aim of this single-center study was to evaluate short- and mid-term outcome after endovascular revascularization of the mesenteric arteries.

METHODS

We report a retrospective study about patients who underwent endovascular treatment of chronic mesenteric ischemia between 2013 and 2018.

RESULTS

Our population consisted of 10 patients. The average age was 60 years [range 45-78]. Clinical symptomatology associated abdominal pain and weight loss. All patients underwent computed tomographic angiography (CTA). Severe stenosis (>70%) involved the superior mesenteric artery (SMA) in ten cases, the celiac trunk in four cases and the inferior mesenteric artery in three. The procedure was performed under local anesthesia in all cases. The superior mesenteric artery was revascularized in all cases and the celiac trunk in two. Transluminal angioplasty was followed by deployment of a stent in all cases. The postoperative course was satisfactory. Outcome was good with all patients being symptom-free at one month. Our average follow-up was three years [range 1-5]. All patients underwent a Duplex ultrasound every six months. Recurrence of symptomatology was reported in two patients at 18 months and 24 months. The first patient underwent CTA that showed superior mesenteric artery and celiac trunk stent stenosis. The patient underwent a second transluminal angioplasty with a drug eluting balloon. The second patient was admitted to the emergency room for acute mesenteric ischemia related to acute thrombosis of the superior mesenteric artery stent. Laparotomy enabled extensive resection of the small bowel and aorto-mesenteric venous antegrade bypass, but the patient died the same day.

CONCLUSION

Endovascular treatment has an important role to play in the management of chronic mesenteric ischemia. It is associated with a high rate of technical success. Patients should be carefully followed-up because of the mid-term risk of recurrent symptoms associated with intra-stent restenosis or thrombosis.

Design, synthesis and biological activity of novel tacrine-isatin Schiff base hybrid derivatives

A series of novel tacrine-isatin Schiff base hybrid derivatives (7a-p) were designed, synthesized and evaluated as multi-target candidates against Alzheimer's disease (AD). The biological assays indicated that most of these compounds displayed potent inhibitory activity toward acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) and specific selectivity for AChE over BuChE. It was also found that they act as excellent metal chelators. The compounds 7k and 7m were found to be good inhibitors of AChE-induced amyloid-beta (Aβ) aggregation. Most of the compounds inhibited AChE with the IC₅₀ values, ranging from 0.42 nM to 79.66 nM. Amongst them, 7k, 7m and 7p, all with a 6 carbon linker between tacrine and isatin Schiff base exhibited the strongest inhibitory activity against AChE with IC₅₀ values of 0.42 nM, 0.62 nM and 0.95 nM, respectively. They were 92-, 62- and 41-fold more active than tacrine (IC₅₀ = 38.72 nM) toward AChE. Most of the compounds also showed a potent BuChE inhibition among which 7d with an IC₅₀ value of 0.11 nM for BuChE is the most potent one (56-fold more potent than that of tacrine (IC₅₀ = 6.21 nM)). In addition, most compounds exhibited the highest metal chelating property. Kinetic and molecular modeling studies revealed that 7k is a mixed-type inhibitor, capable of binding to catalytic and peripheral site of AChE. Our findings make this hybrid scaffold an excellent candidate to modify current drugs in treating Alzheimer's disease (AD).

Tetrahydroquinolinone derivatives as potent P-glycoprotein inhibitors: design, synthesis, biological evaluation and molecular docking analysis

P-glycoprotein (P-gp) is a transmembrane efflux pump that has been associated with ineffective cancer chemotherapy and multidrug resistance (MDR). Chemical inhibitors of P-gp could have potential cancer therapeutic applications by preventing or reversing MDR. To exploit this, we designed twenty-five tetrahydroquinolinone analogs bearing pyridyl methyl carboxylate at C₃ and different substituents at C₄ as MDR reversal agents. The inhibitory effects of the synthesized compounds against P-gp were assessed by flow cytometric determination of rhodamine 123 accumulation in P-gp over-expressing MES-SA/DX5 cells. Fluorescence imaging of intracellular rhodamine 123 accumulation in MES-SA/DX5 cells was also performed. Furthermore, the effect of active derivatives on the reduction of doxorubicin's IC₅₀ in MES-SA/DX5 cells was evaluated using MTT assay. Molecular docking was used to confirm the binding mode of some of the synthesized compounds. Five compounds in group A, bearing a 2-pyridyl methyl ester substituent at the C₃ position, significantly increased rhodamine accumulation at 25 μM comparable to verapamil, a well-established P-gp inhibitor, while only 2 compounds in group B bearing 3-pyridyl methyl ester at the same position had this effect. This study shows that tetrahydroquinolinones containing methyl pyridine esters could represent an attractive scaffold for the discovery of P-gp inhibitors as MDR reversal agents in cancer cells.

[Femoropopliteal angioplasty: Short- and mid-term results]

BACKGROUND

Percutaneous endovascular therapy is becoming a primary option for managing femoropopliteal occlusive disease. The purpose of this study was to evaluate the mid-term results of endovascular treatment of femoropopliteal arterial disease.

METHODS

Femoropopliteal percutaneous transluminal angioplasty was performed on 162 consecutive limbs (160 patients) from January 2006 to January 2016.

RESULTS

In our study, 87.6% of patients had critical limb ischemia. Lesions were classified as Trans-Atlantic Inter-Society Consensus (TASC) A (43%), B (43%), C (7%), and D (7%). Femoropopliteal interventions included angioplasty only in 70 cases (43.2%), and the remaining 92 (56.8%) received at least one stent. Technical success was achieved in 98.7% of patients, with three deaths and a major morbidity rate of 15%. The actuarial primary patency at 12 and 36 month was 65.4% and 40.2%, respectively, 33 peripheral reinterventions were performed after femoropopliteal axis occlusion, resulting in an actuarial primary limb preservation rate of 94.4 at 12 months. Comparison between angioplasty only and the use of stent show no difference in primary patency (P=0.832) and limb salvage (P=0.67). Negative predictors of primary patency determined by univariate analysis included popliteal location (P<0.001) and TASC D (P<0.001). However, diabetes mellitus (P=0.001) and poor run off (P<0.001) were the principal predictive factors of limb loss.

CONCLUSION

Femoropopliteal angioplasty can be performed with a low morbidity and mortality. Intermediate primary patency is directly related to TASC classification and popliteal localization.

Intravenous Amiodarone versus Digoxin in Atrial Fibrillation Rate Control; a Clinical Trial

INTRODUCTION

Treatment of rapid ventricular response arterial fibrillation (rapid AF) varies depending on the decision of the in-charge physician, condition of the patient, availability of the drug, and the treatment protocol of the hospital. The present study was designed aiming to compare IV digoxin and amiodarone in controlling the heart rate of patients presenting to emergency department with rapid AF and relative contraindication for first line drug in this regard.

METHOD

In the present clinical trial, patients presented to the ED with rapid AF and relative contraindication for calcium channel blockers and beta-blockers were treated with either IV amiodarone or IV digoxin and compared regarding success rate and complication using SPSS version 22. P < 0.05 was considered as statistically significant.

RESULTS

84 patients were randomly allocated to either amiodarone or digoxin treatment groups of 42 (53.6% male). The mean age of the studied patients was 61.8 ± 11.14 years (38 - 79). No significant difference was present regarding baseline characteristics. The rate of treatment failure was 21.4% (9 cases) in amiodarone and 59.5% (25 cases) in digoxin groups (p < 0.001). The mean onset of action was 56.66 ± 39.52 minutes (10 - 180) in amiodarone receivers and 135.38 ± 110.41 minutes (25 - 540) in digoxin group (p < 0.001). None of the patients showed any adverse outcomes of hypotension, bradycardia, and rhythm control.

CONCLUSION

Based on the findings of the present study, rapid AF patients with relative contraindication for calcium channel blockers or beta-blockers who had received amiodarone experienced both higher (about 2 times) treatment success and a more rapid (about 2.5 times) response compared to those who received IV digoxin.

Relationship between metabolic syndrome and angiographic severity of coronary artery disease

BACKGROUND

There are a few literature data on the correlation between metabolic syndrome (MetS) and coronary disease among Iranian population. This study aimed to find relationship between MetS and severity of coronary artery disease (CAD) in presence of diabetes.

METHODS

Total of 192 patients were consecutively enrolled in the study who were admitted to coronary care unit because of acute coronary syndrome (ACS) and then underwent coronary angiography. MetS was defined by Iranian criteria. A coronary atherosclerosis score was used to quantify the extent of atherosclerotic involvement. The relationship between MetS and angiographic CAD severity or clinical presentation was compared between them after adjusting for diabetes.

RESULTS

Individuals with MetS (n = 125) had a higher prevalence of ST-elevation myocardial infarction (71% vs 30%, P < 0.001), multi-vessel disease (50% vs. 34%, P = 0.003), decreased ejection fraction (P = 0.001) and more severe angiographic stenosis based on both modified Gensini (P = 0.081) and syntax (P = 0.008) scores, compared to those without MetS. Syntax score showed statistically significant difference between two groups before (P = 0.021) and after adjustment for diabetes (P = 0.005).

CONCLUSION

MetS was related to the severity of CAD both clinically and by angiographic scores but diabetes was a challenging factor and may independently increase the severity of CAD.

Stereoselective reduction of prochiral ketones by plant and microbial biocatalysts

Chiral alcohols are the key chiral building blocks to many enantiomerically pure pharmaceuticals. The biocatalytic approach in asymmetric reduction of corresponding prochiral ketones to the preparation of these optically pure substances is one of the most promising routes. The stereoselective reduction of different kinds of prochiral ketones catalyzed by various plants and microorganisms was studied in this work. Benzyl acetoacetate, methyl 3-oxopentanoate, ethyl 3-oxopentanoate, and ethyl butyryl acetate were chosen as the model substrates for β-ketoesters. Benzoyl acetonitrile, 3-chloro propiophenone, and 1-acetyl naphthalene were chosen as aromatic aliphatic ketones. Finally, 2-methyl benzophenone and 4-chloro benzophenone were selected as diaryl ketones. Plant catalysis was conducted by Daucus carota, Brassica rapa, Brassica oleracea, Pastinaca sativa, and Raphnus sativus. For microbial catalysis, Aspergillus foetidus, Penicillum citrinum, Saccharomyces carlbergensis, Pichia fermentans, and Rhodotrula glutinis were chosen. Chiral alcohols were obtained in high yields and with optical purity. A superiority in the microorganisms' performance in the bioreduction of prochiral ketones was detected. Among microorganisms, Rhodotrula glutinis showed remarkable results with nearly all substrates and is proposed for future studies.

Association between metabolic syndrome and coronary heart disease in patients on hemodialysis

BACKGROUND

The metabolic syndrome (MeS) is a common risk factor for coronary heart disease (CHD) in the general population.

OBJECTIVES

We examined the association between MeS and its risk in terms of CHD in patients on hemodialysis (HD).

PATIENTS AND METHODS

This study was conducted on 300 patients on HD in six HD centers during March 2012. Patients were divided in two groups regarding presence of MeS. The rate of CHD were evaluated in each group and compared with each other.

RESULTS

A total of 300 patients on HD, 173 males and 127 females with mean age of 61.7 ± 14.2, were enrolled in the study. Prevalence of MeS was 50.3%; hypertension, 83.7%; diabetes mellitus, 52%; high triglyceride level, 34%, low HDL cholesterol, 48.3%; and abdominal obesity, 41.3%. During the study, the CHD was more frequent in patients with MeS (27.8%) than was in those without MeS (14.1%) (P = 0.004). In addition, stroke happened more frequently in the MeS group than in those without MeS (30.5% vs. 17.4%; P = 0.008). The mean number of criteria for MeS was not significantly associated with mortality causes (CHD, 2.7 ± 1.3; stroke, 2.8 ± 0.9; other causes, 2.9 ± 1.3 P = 0.78). However, hypertension (89.3%) and diabetes mellitus (53.8%) were associated with increased risk for mortality. In the group of MeS, CHD were not significantly associated with serum albumin, calcium, phosphate, blood urea nitrogen, creatinine, ferritin, C-reactive protein, and KT/V; but there was significant association with white blood cells count (P < 0.0002).

CONCLUSIONS

These findings suggested MeS might be an important risk factor for CHD, but not for mortality due to CHD in patients on HD.

Hydroxycinnamic acid as a novel scaffold for the development of cyclooxygenase-2 inhibitors

The most active hydroxycinnamic acid derivative, caffeic acid diethyl ester (CA-DE), demonstrated 88.5/30.5% inhibition at 100/20 μM against COX-2 and negligible COX-1 inhibitory effect. CA-DE showed preferred interactions with COX-2 active site.

Short-Term Outcome of Discharged Low-Risk Chest Pain without Provoke Ischemia Study

INTRODUCTION

Chest pain is a common problem in patients referring to emergency units. The present study was undertaken to evaluate the short-term outcome of patients presenting with a low risk chest pain and discharging without provoke ischemia study during emergency department admission.

METHODS

In the present prospective cohort study, patients with low-risk chest pain, referring to the emergency department of Imam Hossein Hospital, Tehran, during the first half of 2012, were evaluated. All the patients underwent electrocardiogram (ECG) and cardiac enzyme tests, including cardiac isoenzymes creatine kinase MB and troponin I. One week after referring to the emergency department, the patients underwent an exercise test and were followed for a month. Data were analyzed with chi-squared test at a significant level of P<0.05.

RESULTS

A total of 252 patients were included. The mean and standard deviation of patient ages was 56±7.7 years (47.5% male). The results of exercise tests for 47 (26.3%) subjects were positive [32 (28.8%) patients in the 41-60 year age group and 15 (22.7%) over 60 years of age].The angiography examination results of 5 patients (2.8%) were abnormal. There were no significant relationships between the age and gender and the results of exercise test and angiography (P>0.05). During the one-month follow-up no cases of mortality, cardiac problems, or referring again to the hospital were recorded.

CONCLUSION

Based on the results of the present study, prevalence of cardiac etiology in patients with low risk chest pain was 2.8% and one-month follow-up did not reveal any complications or serious problems in such cases.

Relationship between dietary approaches to stop hypertension score and presence or absence of coronary heart diseases in patients referring to Imam Hossein Hospital, Tehran, Iran

BACKGROUND

The dietary approaches to stop hypertension (DASH) dietary pattern reduces blood pressure. However, there is little information about the relationship between DASH and coronary heart diseases. This study aimed to assess the relationship between a DASH-style diet adherence score and coronary heart diseases (CHD) in patients referring for coronary angiography.

METHODS

In this study, 201 adults (102 males, 99 females) within the age range of 40-80 years who referred for coronary angiography were selected. Diet was evaluated using a validated food frequency questionnaire. DASH score was calculated based on 8 food components (fruits, vegetables, whole grains, nuts and legumes, low fat dairy, red/processed meats, soft drinks/sweets, and sodium). The relationship between DASH score and CHD was assessed using logistic regression analysis.

RESULTS

Mean of DASH score was 23.99 ± 4.41. Individuals in the highest quartile of DASH score were less likely to have CHD [odds ratio (OR) = 0.38, 95% confidence interval (CI): 0.16-0.86]. However, after adjustment for gender or smoking, there was little evidence that coronary heart disease was associated with DASH diet score. There was a significant negative correlation between DASH score and diastolic blood pressure (P ≤ 0.05).

CONCLUSION

In conclusion, having a diet similar to DASH plan was not independently related to CHD in this study. This might indicate that having a healthy dietary pattern, such as DASH pattern, is highly related to gender (dietary pattern is healthier in women than men) or smoking habit (non-smokers have healthier dietary pattern compared to smokers).

Preparation and assessment of chitosan-coated superparamagnetic Fe3O4 nanoparticles for controlled delivery of methotrexate

In this study, Fe3O4 superparamagnetic nanoparticles were synthesized and stabilized by chitosan. Then the nanoparticles were characterized by Fourier transform infrared spectroscopy and transmission electron microscopy (TEM). Particle size distribution and Zeta potential of the particles also was assessed using Malvern Zetasizer. The paramagnetic behaviors of the uncoated and chitosan coated nanoparticles were measured using vibrating scanning magnetometry Particles morphology and size ranges of uncoated iron oxide nanoparticles were evaluated by TEM, showing uniform and narrow size distribution about 10 nm. After coating nanoparticles with chitosan and loading of methotrexate (MTX), the change in size was assessed using Zetasizer. Considerable increase in size was observed following the coating of the particles with chitosan and loading with MTX (the average size was 152 nm). Paramagnetic properties of the uncoated and chitosan-coated particles were assessed showing significant decrease in paramagnetic behavior after coating with chitosan, but it was enough to respond to the magnetic field. Finally loading efficiency, release rate and cytotoxicity of MTX were assessed indicating slow release behavior with the same levels of cell toxicity in SK-BR-3 cell lines, suggesting this formulation as a good candidate for the controlled delivery of MTX.

Differences in cardiovascular disease risk factors associated with maximum and mean carotid intima-media thickness among hemodialysis patients

INTRODUCTION

Carotid intima-media thickness (CIMT) could be used as a surrogate marker of atherosclerosis in hemodialysis patients. Since different mechanisms are involved in the atheroma formation and arterial wall thickness, we assessed the relationship between the maximum and the mean CIMT with different cardiovascular risk factors in dialysis patients.

MATERIALS AND METHODS

The mean and the maximum CIMT were measured using a B-mode ultrasonography in 75 hemodialysis patients, and the correlation between CIMT and cardiovascular risk factors were assessed.

RESULTS

The mean and maximum CIMT measurements were 0.5 mm (range, 0.2 mm to 1 mm) and 3.4 mm (1.4 mm to 5.6 mm), respectively. Among all the studied variables, age (P = .04, r = 0.238), HS-CRP (P = .01, r = 0.284), mean arterial blood pressure (P = .003, r = 0.343), and DM (P = .02) had significant correlations with the mean CIMT, while only age (P = .02, r = 0.473) and serum creatinine levels (P = .02, r = -0.493) were significantly associated with the maximum CIMT. A positive nonsignificant correlation was observed between the mean and maximum CIMT values (P = .08, R2 linear = 0.214).

CONCLUSIONS

These findings suggest that in dialysis patients, effects of cardiovascular risk factors on the mean and maximum CIMT might be different. Further studies are recommended to evaluate the prediction impact of each risk factor in end-stage renal disease patients compared with otherwise healthy individuals.

Antioxidant therapy: current status and future prospects

Reactive oxygen species (ROS) are widely believed to cause or aggravate several human pathologies such as neurodegenerative diseases, cancer, stroke and many other ailments. Antioxidants are assumed to counteract the harmful effects of ROS and therefore prevent or treat oxidative stress-related diseases. In this report, recent human studies exploring the efficiency of antioxidants in prevention and treatment of various diseases are reviewed. Few antioxidants including edaravone (for ischemic stroke in Japan), Nacetylcysteine (for acetaminophen toxicity), alfa-lipoic acid (for diabetic neuropathy) and some flavonoids (polyphenolic compounds present in dietary plants), such as micronized purified flavonoid fraction (diosmin and hesperidin) and oxerutins (for chronic venous insufficiency) as well as baicalein and catechins (for osteoarthritis) have found accepted clinical use. However, despite much enthusiasm in the 1980s and 1990s, many well-known agents such as antioxidant vitamins and also more recently developed compounds such as nitrones have not successfully passed the scrutiny of clinical trials for prevention and treatment of various diseases. This has given rise to a pessimistic view of antioxidant therapy, however, the evidence from human epidemiological studies about the beneficial effects of dietary antioxidants and preclinical in vitro and animal data are compelling. We have probably wasted too much time on agents like antioxidant vitamins instead of focusing on more disease specific, target-directed, highly bioavailable antioxidants. We here discuss possible reasons for the lack of success in some clinical trials and seek to provide some suggestions to be considered if antioxidant therapy is to succeed as an effective therapeutic strategy.

Association of sterile pyuria and coronary artery aneurysm in Kawasaki syndrome

Kawasaki disease (KD) is an inflammatory multiorgan disease of unknown etiology. The most dramatic organ involved is the heart. There were a few studies about cardiac involvement and sterile pyuria. This study guides to determine if sterile pyuria is associated with coronary artery aneurysm (CAA) in KD patients and to consider it as a predicting factor for coronary artery involvement. Forty seven patients with KD were studied by echocardiography in admission and one month later. Urine analysis, complete blood count, erythrocyte sedimentation rate and C-reactive protein were measured in admission. Data were analyzed using SPSS-14 software. Patients' age was ranged from 13 month to 7 years old (mean age of 3.43 ± 1.54 years). Thirty patients (63.8%) were male and 17 patients (36.1%) were female. Cardiac involvement was detected in 32 patients (68%) using echocardiography, of which CAA was reported in 8 cases (17%). Six of CAA (75%) were in association with sterile pyuria, although it was statistically insignificant (P>0.05). Although the majority of patients with CAA had sterile pyuria, this association is not statistically significant, thus it couldn't be considered as a predicting factor for CAA.