Rasoul Azarfarin

Abstract: Abstract BACKGROUND: We assessed the prevalence of substance use among patients undergoing coronary artery bypass graft and valve surgery in northwest Iran. We evaluated the postoperative complications and in-hospital mortality of patients with substance dependence and abuse. METHODS: In this prospective, observational study, we interviewed 600 patients during the preoperative visit in a tertiary referral educational hospital in northwest Iran. The definition of substance abuse and dependence was according to DSM-IV criteria. Postoperative complications and in-hospital mortality of patients with substance (cigarette, opium, and alcohol) dependence and abuse were compared with those in control patients who did not use these substances. RESULTS: In 600 studied patients, the prevalence of cigarette smoking was 42.1% (ex-smokers 26.0% and current smokers 16.1%), prevalence of opium use was 12.0% (opium abuse 7.0% and opium dependence 5.0%), and alcohol consumption was 8.1% (alcohol abuse 7.4% and alcohol dependence 0.7%). The prevalence of cigarette smoking was 58.9% in men and 7.6% in women (P = 0.001). Postoperative cardiac complications in current smokers (21.5%) and ex-smokers (20.5%) were not significantly different from the control group (28.2%). Also, pulmonary complications were not different in current smokers (24.7%) and ex-smokers (17.9%) from the control group (26.8%; P = 0.196). However, in men, pulmonary complications in current smokers were more prevalent than in the control group (P = 0.044). In opium and alcohol dependents and abusers, postoperative complications were not statistically different from the control group (all P values >0.05). No increase was observed regarding in-hospital mortality in patients with substance use. CONCLUSIONS: In cardiac surgery patients in northwest Iran, the prevalence of cigarette smoking is relatively low (very low in women), as is alcohol use, compared with Western countries; however, opium use is twice as prevalent. We found higher pulmonary complication rates in men who smoked, but no increase in postoperative cardiopulmonary complications and in-hospital mortality rates in patients who abused opium and consumed alcohol.

Abstract: Abstract Patients with coronary artery disease (CAD) and concomitant left bundle branch block (LBBB) have increased cardiovascular mortality rates in comparison with those with CAD but without LBBB. In patients with LBBB, therefore, the delineation of the presence and severity of CAD may be helpful in providing prognostic information. In this cross-sectional study 219 patients with LBBB and suspected CAD that underwent coronary angiography, assessed for having CAD and left ventricular (LV) dysfunction. CAD was present in 124 (56.3%) patients and left ventricular ejection fraction <50% was seen in 147 (67.1%) patients. Advanced age (p=0.001), male gender (p=0.027, OR=1.94), history of chest pain (p=0.015, OR=2.08) and LVEF <50% (p=0.026, OR=3.04) were predictors of CAD and older age (p=0.004), male gender (p=0.017, OR=2.11), history of diabetes mellitus (p=0.043, OR=1.45) and angiographically documented CAD (p=0.001, OR=3.41) were predictors of LV dysfunction.

Abstract: Abstract OBJECTIVE: To study the prevalence and severity of hyperglycemia in nondiabetic patients undergoing cardiac operation. METHODS: In an observational prospective study, 282 non-diabetic patients underwent elective off-pump (n=101) or on-pump (n=181) coronary artery bypass grafting (CABG) surgery from March 2006 to July 2007 in Madani Heart Hospital, Tabriz, Iran. Blood glucose (BG) levels were measured during and 24 hours after operation. Frequencies of hyperglycemia (BG>or=126 mg/dl) and severe hyperglycemia (BG>or=180 mg/dl) and postoperative complications were compared in the 2 study groups. RESULTS: Prevalence of at least one episode of severe hyperglycemia was 54.6% (154/282) in our patients during, and 24 hours after operation. Intra-operative hyperglycemia was slightly higher in on-pump group. Frequency of post-operative hyperglycemia was higher, although not significantly different between the 2 groups. The 2 study groups were not significantly different in frequency of severe hyperglycemia during operation, although were different within 24 hours postoperative period. CONCLUSION: Prevalence of hyperglycemia especially severe hyperglycemia was high during, and after operation in both off-pump and on-pump CABG in non-diabetic patients. There was a borderline difference in blood glucose level between on-pump and off-pump CABG patients. It may be prudent to consider glycemic control protocols in these patients especially in early post-operative period.

Abstract: Abstract OBJECTIVE: To assess the effects of ultra-low dose one million kallikrein inhibitor units (KIU) of aprotinin on bleeding and the need for transfusion after cardiac surgery. METHODS: We carried out this randomized clinical trial on 162 cardiac surgery patients in Shahid Madani Hospital, Tabriz, Iran from April 2004 to December 2005. The patients were randomly divided into 2 groups of 81 individuals. In the aprotinin group, 0.5 million KIU infused before and 0.5 million KIU during cardiopulmonary bypass. In the placebo group, 100 ml normal saline was infused as above. The need to use fresh frozen plasma (FFP), packed red blood cells (PRBCs) transfusion during, after operation, the rate of chest tubes drainage at 6, 12 and 24 hours after surgery were measured in 2 groups. RESULTS: Chest tubes drainage at 6 hours after surgery was 190 +/- 24 ml in the aprotinin group and 266 +/- 33 ml in the placebo group (p=0.066). The amount of bleeding at 12 and 24 hours was significantly different between 2 groups (p=0.048, p=0.009). The frequency of blood products transfusion in the aprotinin group was 68% and in the placebo group was 75% (p=0.02). The number of PRBCs and FFP units transfused were significantly lower in the aprotinin group (p=0.000, p=0.005). Total amount of blood and products transfusion in the aprotinin group was 2.56 +/- 0.27 units and in placebo group it was 4.37 +/- 0.27 units (p=0.0001). CONCLUSION: Results indicate that the use of one million KIU of aprotinin in cardiac surgery is effective in reducing postoperative bleeding and transfusion requirements.