Arya Atherosclerosis
Volume:18 Issue: 5, May 2022

Dyslipidemia is an established risk factor for coronary artery disease (CAD). Despite this, only half of CAD patients present with fasting dyslipidemia. Some reports have linked postprandial lipemia to atherosclerosis. We aimed to test the relationship between postprandial lipid profile (after fat loading) and CAD severity assessed by the SYNTAX score.

We included 53 patients with documented CADs. We checked both fasting and postprandial (2 hours) lipograms after fat loading with 17 g/body surface area (m2). Then we assessed CAD severity via coronary angiography using the SYNTAX score. Our study is registered in clinicaltrials.gov (NCT03175393).

*53 patients with age 57.92 ± 7.82 were recuirted. 36 (68% ) of them were male .We observed a significant increase in postprandial triglycerides (TGs); TGs (154.30 ±73.23 vs. 128.07 ± 69.40 mg/dl; P < 0.001), very-low-density lipoproteins (VLDL) (30.85 ± 14.65 vs. 25.60 ± 13.93 mg/dl; P < 0.001) as well as a significant decrease in the postprandial level of total cholesterol (162.37 ± 45.86 vs. 168.26 ± 45.96 mg/dl; P = 0.03) in comparison to their fasting level.We found that the SYNTAX score had a significant positive moderate correlation with 2-hour postprandial TGs (r = 0.55; P < 0.001) and 2-hour postprandial VLDL (r = 0.50; P < 0.001). Based on the current study, predictors of high Syntax score were older age OR: 1.23( 1.11-3.47); P< 0.001, post-prandial triglyceride OR: 2.34 (1.89-5.66); P< 0.001 and post-prandial VLDL OR: 1.76( 1.50-3.49); P< 0.001

Postprandial lipograms, especially TGs, are significantly and positively related to CAD severity.

Enterococci are responsible for 5% to 18% of infective endocarditis (IE) cases. We aimed to determine demographic data, predisposing factors, clinical presentations, complications and echocardiographic findings concerning enterococcal endocarditis.

Since 2006, all adult patients with a possible or definite diagnosis of IE based on the modified Duke criteria have been enrolled in the Iranian Registry of Infective Endocarditis. In this study, patients with IE of enterococcal origin were detected and their demographic characteristics, predisposing factors, complications, laboratory data and echocardiographic findings were assessed.

Out of 731 patients diagnosed with endocarditis. Enterococci were found in 60 patients: 32 men (53.3%) and 28 women (46.7%) at a mean age of 55.21 ± 17.9 years. Definite IE was diagnosed in 57 (95%) patients, and possible IE was suspected in 3 patients (5%). The most frequent predisposing factor was the prosthetic valve (n=28, 46.7%), followed by a history of previous endocarditis (n=12, 20%). An acute course (<6 wk) was reported in 38 patients (63.3%). Fever (n=58, 95%) and loss of appetite (n=17, 28.3%) were the most frequent symptoms. The most frequent location of involvement was the aortic valve (n=22, 36.7%), followed by the mitral valve (n=20,33.3%). Vegetation was detected in 53 patients (88.3%), abscess formation in 8 (13%). Fifteen patients (25%) had heart failure, and 11 (18%) had central nervoussystem complications. The mortality rate was 20%.

Given the serious complications and the high mortality rate in the patients with IE of enterococcal origin, which may be due to these organisms’ intrinsic resistance to many antibiotics, we suggest further studies to determine more effective antibiotic regimens and even individualized antibiotic therapies for enterococcal endocarditis.

Oxidative stress caused by various components in cigarette smoke can induce endothelial dysfunction. Black cumin (Nigella sativa) has an oxidative stress inhibition capability by increasing antioxidant enzyme production and decreasing lipid peroxidation.

This is an in vivo study with a post-test only design using Wistar rats as subjects. Rats were randomly assigned into five groups: negative control (NC) group without any treatment, positive control (PC) group exposed to cigarette smoke only, and treatment groups (T1, T2, and T3) which received exposure of cigarette smoke and administration of black cumin extract with doses of 0.3 g/kg BW/day (T1), 0.6 g/Kg BW/day (T2), and 1.2 g/kg BW/day (T3). After four weeks, samples were sacrificed with the aortas taken to measure superoxide dismutase (SOD)activity and malondialdehyde (MDA) level.

A significant reduction in SOD activity (p=0.022) was found between the NC and PC groups but not in MDA level (p=0.394). SOD activity increased significantly in T2 when compared to PC (p=0.007). MDA levels significantly increased at T1 (p=0.002), T2 (p=0.005), and T3 (p=0.006) when compared to PC.

Black cumin ethanolic extract increased SOD activity in Wistar rats exposed to cigarette smoke. However, no reduce of MDA level was observed.

It has been previously shown that Implantable Cardioverter-Defibrillator (ICD) shocks are associated with subsequent increased mortality risk in patients with heart failure. We designed this study to assess the factors related to ICD shocks in patients with ischemic cardiomyopathy (ICM).

Eighty consecutive patients with ICM underwent primary or secondary preventive ICD implantation, and experienced shocks were recruited in this cross-sectional study between March 2018 and March 2019. Patients were grouped based on the presence of appropriate or inappropriate ICD therapy. Data on demographic, clinical, laboratory and medications of eligible patients were assessed to identify ICD shocks related factors with univariate and multiple adjusted models.

The mean age of the total population was 65.4 ± 9.8 years (males: 86.3%). Eleven patients (13.7%) experienced inappropriate shocks. The presence of sinus tachycardia was 7.38 (95% confidence interval (CI): 1.78-30.56, P= 0.006), which was associated with higher likelihood of inappropriate shock occurrence. Moreover, patients with atrial fibrillation (AF) had significantly elevated odds of inappropriate shock frequency (odds ratio (OR): 4.32, 95% CI: 1.15-16.13, P= 0.02).

Our findings indicate that the presence of sinus tachycardia and prior AF could significantly increase the likelihood of inappropriate shock frequency among patients with ICM using ICDs. Further large-scale studies are required to prove our outcomes.

There is still a controversy about the best method for preoperative skin preparation (skin cleaning).The main antiseptic solution used in the cardiac surgery room is Povidone Iodine (PI), which is used to prepare the area to be operated on.This study aimed to determine the urinary iodine level in children (newborns, infants, and toddlers) undergoing (open and closed) heart surgery, in whom preoperative skin preparation was performed using PI solution.

This study was conducted over eight years on a total of 212 children who underwent cardiac surgery. A form was developed for each patient in which all their details, condition, and type of surgery were recorded. A urine sample was taken after the patients were anesthetized and before they were painted with PI through the urinary catheter that had to be attached to them for the cardiac surgery. The patients were then prepped with PI and draped and the surgery was performed. Afterwards, the second and third urine samples were taken 24 and 48 hours after the surgery from the urine collection bag. The samples were transferred to polyethylene tubes with screw caps in a cold box at -20 °C and sent to the iodine reference laboratory of the Endocrinology Research Center of Shahid Beheshti University. The samples were measured using the kinetic colorimetric reaction proposed by Sandell and Kolthoff after the acid digestion of urine.

total of 212 patients (newborns, infants, toddlers) who underwent (open and closed) cardiac surgery entered the study, including 104 (49.1%) males and 108 (50.9%) females. The patients ranged in age from 1 day to 14 years (mean = 168 months).The urinary iodine level was 40.6±21.9 μgr/dl in the first stage (pre-surgery),204.1±92.5 μgr/dl in the second stage (24 hours’ post-surgery), and 130.3±56.2μgr/dl in the third stage (48 hours’ post-surgery).

Urinary iodine levels increased dramatically after PI use, and the second-stage urinary iodine changes (24 hours’ post-surgery) were in the excessive range according to the WHO classification, and they decreased gradually over the next 24 hours, but did not reach normal levels until 48 hours’ post-surgery. The difference between the samples was significant (P<0.05). The samples were also separately analyzed by age group (groupA:0-2 years and group B: 2-14 years), which showed that transcutaneous iodine absorption and urinary iodine excretion were high in both age group.

In children, transcutaneous iodine absorption following preoperative skin preparation with PI (for cardiac surgery) is so high that its urinary excretion reaches an excessive level 24 hours after surgery and remains higher than normal until 48 hours’ post-surgery. Furthermore, the transcutaneous absorption of iodine is similar in the 0-2 and 2-14-year-old age groups, and the iodine level following its transcutaneous absorption isexcessive in both age groups.

There are some clinical conditions described in literature which limit the application of full endovascular aneurysm repair, and the most important of these limitations are inappropriately short and angled aneurysm neck, narrow terminal aorta, and curved and very small diameter or highly calcified iliac arteries that make access difficult, and unilateral iliac artery occlusion is another one of these limitations, which is less frequently observed.Case report: In our case report, we present a patient whose abdominal aortic aneurysm was considered to be high risk for classical open surgical repair. Our patient has a unilateral iliac artery occlusion co-existing with abdominal aortic aneurysm and the occluded left common iliac artery and severely stenotic external iliac artery segment was applied percutaneous transluminal balloon dilatation and after which abdominal aortic aneurysm was successfully treated with standard endovascular aneurysm repair.

A standard successful endovascular aneurysm repair procedure was applied for the patient who did not develop any intraoperative complications. The left iliac artery blood flow was also ensured by the dilatation of occluded iliac artery segment, simultaneously. When there are such limitations related to the iliac artery as iliac artery occlusion, the standard endovascular aneurysm repair procedure combined with invasive techniques for iliac artery revascularization is a practical and safe treatment option which reduces the procedural morbidity and mortality compared to the other treatment options.

Endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs) has been marked as standard practice during the past decades. We aimed to investigate the shortand long-term outcomes of EVAR in patients with AAAs in Isfahan, Iran. .

This retrospective study conducted on 50 patients with AAAs who have undergone EVAR procedure consequently in four different hospitals (Chamran hospital, Asgarieh hospital, Sepahan hospital and Saadi hospital) in Isfahan, Iran, between 2017 to 2020. We followed patients for one year and recorded short-term and one-year outcome include Endoleak, Aorta-iliac expansion, and mortality in hospital records during one year and telephone follow up. Data was entered in SPSS (ver.25) and analyzed with Univariate Linear Regression and Chi-Square Test.

The mean age of participants was 66.6±11.7 years old, in which 88%(n=44) of them were male. Elective EVAR was performed in 88% of patients. Regarding the complications one year after EVAR, endoleak and CIN (contrast-induced nephropathy) were occurred in 6%(n=3) and 6%(n=3) of patients, respectively. We also reported the rate of in-hospital mortality and one-year mortality as 2%(n=1) and 8%(n=4), respectively. Univariate regression analysis revealed no significant difference regarding one-year mortality in patients who underwent EVAR. In patients who underwent spinal anesthesia in comparison with general and regional anesthesia before EVAR, there were lower rate of vascular complications [0% (n=0) versus 23.5% (n=4) and 20.0% (n=2), P=0.053], level of blood urea nitrogen (BUN) [9.8 ± 13.9 versus 17.0 ± 13.1 and 14 ± 6.2, P=0.031] and creatinine (Cr) [0.6±1.1 versus 1.1±0.6 and 1.3±0.5, P=0.005], respectively.

Desirable short- and long-term outcomes as expected, combined with a reduction in hospital length of stay and mortality and one-year mortality allowed EVAR to become the favorable therapeutic strategy for AAAs in Iran especially in high-risk patients. Lower rate of vascular complications, ICU length of stay and lower level of BUN and Cr were observed using spinal anesthesia in patients who underwent EVAR in our centers.

A 56-year-old woman with past medical history of uterine liomyosarcoma for 4 years ago, referred us for echocardiography to evaluate cardiac function. She was on chemotherapy regimen, but dropped out her treatment 11 months ago due to fear of COVID infection.According to her past medical documents, she also had a history of lung metastasis about 3 years ago that resolved completely with chemotherapy (ifosfamide) and after that, she had been undergone regular interval of chemotherapy until she dropped it. She had no clinical evidence of systemic emboli and just complained of exertional dyspnea.