Madani Hospital Research Articles

Comparison of the Effect of Cold Drink and Dexamethasone, and their Combined Effect on Children with Croup.

Croup is a clinical syndrome which included inspiratory stridor, coughing with a dog-like sound, noise obstruction and respiratory distress symptoms. This present study was conducted to compare the effects of cold drink and dexamethasone, and the effects of their co-administration on children's croup. In this study, all patients with croup admitted to the emergency ward of Madani Hospital Khorramabad were divided through the simple randomized method into 3 groups after informed consents were taken from their parents. The first group was given cold drink, second group with dexamethasone (DM), and the third group were given the combined treatment simultaneously. The patients in the first and second groups who did not show signs of improvement received the simultaneous treatment similar to the third group. The data were analyzed using the SPSS software through descriptive statistics and inferential statistics including multi-field variance analysis and co-variance analysis. The results of the study indicated a statistically significant between the 3 group in terms of improvement time-scale of croup clinical symptoms (P=0.001). There was no significant difference observed between the effects of other variables on improvement time-scale of croup clinical symptoms. The cold drink has less treating effect than DM and combined simultaneous treatment method. Also, DM had more influence than simultaneous treatment method. In addition, other variables including age, sex, birth weight, BMI, respiratory allergy and previous croup history did not influenced improvement time-scale and only type of intervention influenced improvement time-scale of croup clinical symptoms.

The relationship between moral sensitivity and its dimensions with demographic characteristics of nurses in Shahid Madani hospital of Khorramabad in 2017

The relationship between moral sensitivity and its dimensions with demographic characteristics of nurses in Shahid Madani hospital of Khorramabad in 2017

Effect of Advanced Trauma Life Support (ATLS) Program on Nurse's Performance in Simulated Trauma Model

Introduction: Since appropriate and initial methods in trauma care have a crucial role in patients outcome, we evaluated the effect of advanced trauma life support (ATLS) program on nursesr performance in ER in a simulated model. Methods: A descriptive and analytical study before and after training as conducted in 30 ER nurses in shahidn Madani Hospital, Karaj, Iran in (oct, 2016) on the first day, we assessed for nursesr clinical Knowledge and practical skill performance in confronting a simulated trauma patient. After two days of ATLS training we performed the same study and evaluated their performance again on the fourth day. findings of the above evaluations pre and post ATLS training program were compared by spssn software (version 15) and the p values significant. Results: The findings have shown that the ER nursesr ability in all three tasks improved notably after the training course. On the fourth day fallowed by training, there was a statically significant increase in ER nursesr knowledge of ATLS methods, the sequence of procedures and skill performance In trauma-facing situation ( p<0.001, p=0.016n and p=0.01 ).n Conclusion: ATLS course has a crucial role in increasing clinical knowledge and practical skills on trauma care in ER nurses.

Risk Factors of Resistance to Intravenous Immunoglobulin in Patients with Kawasaki : A Cross-Sectional Study over a 10 Year Period (2006 - 2016)

Abstract Introduction: Kawasaki is an acute vasculitis and is the most common cause of acquired heart disease in children. About 25% of patients remain infected and febrile despite receiving intravenous immunoglobulin and aspirin. The aim of this study was to investigate the clinical and laboratory predictive resistance factors for intravenous immunoglobulin in patients with Kawasaki hospitalized in Khorramabad Shahid Madani Hospital. Materials and Methods: Patients were divided into two groups: a) responders to IVIG treatment, consisting of 47 patients (90/4 %); and b) resistant to treatment, consisting of 5 patients (9.6%), and the difference between clinical manifestations and laboratory findings of the two groups were examined and the results were statistically analyzed. Results: 52 patients with Kawasaki diagnosis were gauged. In the treatment-resistant group (9.6%), the number of clinical symptoms was lower than that of KAU diagnosis criteria, but this difference was not statistically significant between the two groups. Laboratory tests evaluation showed that the mean of ESR and CRP were higher in the treatment-resistant group and the mean of serum sodium in this group was lower than that of the responder group. Discussion and Conclusion: High ESR and CRP and lower serum sodium levels can be considered as predictors of resistance to intravenous immunoglobulin therapy in patients with Kawasaki. Keywords Author Keywords:Kawasaki disease; immunoglobulin resistance; acute vasculitis KeyWords Plus:DISEASE; CHILDREN

Facial Soft Tissue Thickness of Midline in an Iranian Sample: MRI Study.

Background and Aim:To identify human skeletal remains, different methods can be used and using these techniques, important data can be obtained. However, facial reconstruction is the last method to indentify unknown human faces which requires knowledge about facial soft tissue thickness in the different positions of the face. The present study determined the facial soft tissue thickness in the different landmark points on the MRI images of patients referred to Radiology Department of Shahid Madani Hospital.Materials and Methods:In this descriptive cross-sectional trial, MRI images of 179 patients (61 males, 118 females) in the age range of 18-76 years old who did not show any pathologic lesions, were selected. The measurements of the facial soft tissue were done on 12 landmark points on the midline area by two radiologist observers using specific software on the images. The differences in the soft tissue thickness in these landmark points were statistically analyzed by Mann-Whitney U (in term of gender) and Kruskal-Wallis tests (in terms of Body Mass Index [BMI] and age groups). P value less than 0.05 was considered statistically significant. The data were compared with the results of other studies.Results:The results obtained in the present study were higher than Turkish and American studies in most of the landmark points. Facial soft tissue thickness in most of the landmarks was more in males than females. In some of the landmarks, significant differences were found between emaciated, normal and overweight patients while in most cases, soft tissue thickness increased with the increased BMI. In some cases, significant differences were noted between soft tissue thickness values among the different age groups, in which the thickness increased or thinned with the increased age.Statistical Analysis:There were statistically significant associations between the presence and surface area of Haller cells and the occurrence of ipsilateral maxillary sinusitis. Neither the angulation of the uncinate process nor the size of the maxillary sinus ostium significantly correlates with the formation of maxillary sinusitis.Conclusion:The data achieved in the present study can be used for the facial reconstruction purposes in the Iranian population; however, the slight differences existing between the studied population and other subgroup races must be considered for accurate reconstructions.

Identifikasi Drug Related Problems (DRPs) Pada Pasien Pediatri Pneumonia Komunitas di Instalasi Rawat Inap RSD Madani Provinsi Sulawesi Tengah

Drug Related Problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. DRPs may occur in the treatment of various diseases such as community acquired pneumonia (CAP). This study aims to determine the percentage of DRPs in pediatric inpatients with CAP. This is a descriptive and observational study design with prospective data conducted in November 2015 until February 2016 at Madani Hospital, Central Sulawesi. The results obtained from 28 patients showed that incidences of DRPs categories of inappropriate drug is 1 event (1,7%), inappropriate drug combination 35 events (58,3%), drugs dose too low 18 events (30%), drugs dose too high 6 events (10%), and no indication for drug 0 event (0%).

The Study of Implementation of Safety Regulation for Children in Radiology Department

During the last few decades in different areas of the world the cancer incidence in children has increased. Children are major users of imaging services. Since children are more sensitive to radiation therefore dose minimization for them is important. The aim of this study is to assessment of safety for children in diagnostic radiology units. This cross-sectional study was conducted in three public hospitals of Khoramabad Lorestan province. 385 check lists in Shohadaye Ashyer, Madani, Taaminegtemaei hospitals are investigated. The checklist has five items with various questions around radiation protection and safety related to patients. The information achieved by the checklists was recorded and entered into SPSS (version 22). Among the 385cases reviewed, 210 were boy (54.6%) and 175 girl (45.4%) patients. The mean age of patients was 6.14 years, ranging from 2 days to 12 years. Only Madani and Taaminegtemaei provided shield and warning posters. The use of shielding number in Shohaday eAshyer and Taaminegtemaeei hospitals is 87 (22.5%) and Madani hospital is 194 (50.3%). Patient dose reduction coincides with avoiding unnecessary exams, minimizing repeat images during exams, field size minimization and using appropriate shielding by performance this cases can be protect patient specially children. The use of gonad shielding in Shohadaye Ashyer hospital does higher rate than in Madani and Taaminegtemaeei hospitals.

The effect of exercise during hemodialysis on fatigue and self-efficacy in patients: a blind randomized clinical trial

Abstract Aim: Due to the increased prevalence of chronic diseases such as kidney failure, physical, mental and social needs of these patients have also increased and their well-being seems essential. The aim of this study was to investigate the effects of exercise during hemodialysis on fatigue and self-efficacy of hemodialysis patients. Method and Material: This study is a clinical trial; study sample consisted of 46 patients undergoing hemodialysis and who had referred to hemodialysis center of Sahid Madani Hospital in Tabriz; availability sampling method had been used based on the inclusion criteria and with a consent for participating in the study; the sample had been selected from research population and have been divided randomly into two groups of control and experiment. The measuring tools for collecting data included Fatigue Severity Scale (FSS) and Sherer General Self-efficacy scale (SGSES) which were used after determining validity and reliability. After collecting data, the results had been analyzed using SPSS 20 software. For describing quantitative data, the symmetry of the mean and standard deviation had been used and for qualitative data, frequency and percentage had been used and for comparing two groups, analysis of covariance had been used. Results: The results of the current study showed that all patients with chronic renal failure suffered from fatigue and their selfefficacy decreased. Self-Efficacy in patients from the experiment group significantly increased, but it was not significant (p-value = 0.06) and after treatment, fatigue was significantly reduced in the intervention group (p-value <05). Discussion: The results of this study showed that exercising during hemodialysis not only reduces fatigue of these patients, but also leads to improvement of self-efficacy and exercise is recommended in dialysis centers.

Investigating the impact of body mass index on the outcomes of coronary artery bypass graft surgery: A single referral center experience

The aim of this study is to evaluate the relationship between Body Mass Index (BMI) and the outcomes of isolated CABG (Coronary Artery Bypass Graft) performed in Shahid Madani Hospital of Khorramabad, Iran. Data was retrospectively collected from the medical records retrieved from the hospital records office. All patients who had undergone isolated CABG under cardiopulmonary bypass in the Cardiothoracic Unit from 2007 till 2013 were identified and their demographic and clinical data were collected. Clinical data included BMI, ejection fraction (EF), history of COPD, MI, CVA, diabetes mellitus, hyperlipidemia, hypertension and the main outcomes included pulmonary complications, renal complications, transfusion, duration of ventilation, reoperation, intensive care unit stay, hospital stay and death. Patients were divided into six groups according to the BMI as follows: group 1: (BMI 0.05).There was no statistically significant difference between the groups in terms of the mean duration of mechanical ventilation, mean extubation time, drainage rate from the chest tube, and the amount of blood transfusion (PV > 0.05). Moreover, in 99.4% of the patients, broad-spectrum antibiotics, in 99.5% of the patients, inotropic drugs, and in 5.4% of the patients, IABP were used. Re-intubation was done in 3.1% of the patients. The average duration of hospitalization was 5.45 ± 1.48. There was no statistically significant difference between the groups in terms of hospitalization time (PV>0.05). In this study, 3.55% of the patients died. Smirnov and Kolmogorov tests showed that the distribution of quantitative variables is not normal in all the patients (PV<0.001). Therefore, to study the relationship between these quantitative variables, the Spearman correlation coefficient was used, which showed that none of the relationships were statistically significant. Therefore, considering these results, it can be suggested that if there is enough time before surgery, changes in the lifestyle of the individual be recommended so that he/she can attain a better health status. So, proper training and education can be very effective.

Causes and risk factors of reintubation in Shahid Madani cardiac surgery ICU during 2012-2013

Background: Extubation failure rate is one of the criteria for assessing the quality of care in intensive care unit (ICU) and higher or lower extubation failure rates indicate longer mechanical ventilation or inappropriate weaning criteria of patients, respectively. The aim of the present study was to evaluate the rate and causes of extubation failure in the cardiac surgery ICU of Tabriz Shahid Madani hospital during 2012-2013. Methods: In a cross-sectional study during 2012-2013, all intubated adult patients (over 18 years old) after cardiac surgery admitted to ICU who were re-intubated within 72 hours after extubation were studied. Results: Overall, 31 patients had the inclusion criteria. Extubation failure rate during one year was 2.45%. Extubation failure causes were hypoxemia, cardiopulmonary arrest, sepsis, acute renal failure, re-operation, shock, acute respiratory distress syndrome, pneumonia, seizures, decreased level of consciousness, copious secretion, and severe agitation. Re-intubation risk factors included chronic obstructive pulmonary disease, diabetes mellitus, renal failure, heart failure, ARDS, pneumonia, intra-aortic balloon pump, acute coronary syndrome and shock. The mean duration of mechanical ventilation before extubation was 2.3±3.1 days. The overall mortality rate of studied patients was 26% with coronary artery bypass grafting surgery as the most common cause. Conclusions: During 2012 and 2013, the extubation failure rate in the cardiac surgery ICU was 2.45%. The most common causes of extubation failure in this setting were hypoxemia and pneumonia. Moreover, the most common risk factors for re-intubation were diabetes mellitus and renal failure. Keywords: Airway Extubation failure; Cardiac surgery; ICU

Survival After Long-Term Cardiopulmonary Resuscitation Through Receiving 55 Times of Defibrillation Shock

A 46-year-old man with severe chest pain without a clear medical history of cardiac ischemia was admitted to emergency ward of Ayatollah Madani hospital in Khoy city, Iran. The patient was diagnosed with possible acute coronary syndromes and located in the first level of triage. After early interventions in the emergency ward, he was transferred to the coronary care unit. After half an hour, the patient was suffering from primary ventricular fibrillation. Advanced cardiopulmonary resuscitation (CPR) was started without delay, then the patient survived after three hours of receiving CPR and 55 times of defibrillation shock.

Persistence of cardiovascular risk factors in patients with coronary artery diseases after percutaneous coronary interventions

Introduction: Coronary artery disease (CAD) is as a leading cause of death and disability all around the world. Multiple risk factors have a role in the development and progression of coronary heart disease (CHD). It is necessary to control risk factors, to achieve optimal results of treatment. The aim of present study was to evaluate the persistence of cardiovascular risk factors in patients with CADs after percutaneous cardiac interventions. Methods: In an analytical-descriptive study, 150 patient with CAD and percutaneous coronary intervention (PCI) were performed for them, and referred to Cardiology Clinic of Shahid Madani Hospital of Tabriz University of Medical Sciences, Tabriz, Iran, from September 2013 to September 2015, were studied. The persistence of coronary risk factors, 12-24 months after performing PCI, was evaluated. Results: The mean age of patients at time of PCI performing was 57.90 ± 12.26 years. 72.7% of patients were male and 27.3% were female and male to female ratio was 1 to 0.37. Dyslipidemia in 52.0% of patients, hypertension in 51.3% patients, and diabetes mellitus (DM) in 41.3% patients were the most common underlying comorbidities. In both before and after doing PCI, 26.7% were a smoker, and smoking rates after doing PCI also showed no significant change (P = 0.055), and also there were no significant changes in the physical activity of patients compared before and after performing PCI. Conclusion: Based on the findings of the present study, dyslipidemia, hypertension, and DM, was the most frequent underlying diseases in patients with CAD respectively. Risk factors such as smoking, and lack of exercise, had no significant changes after performing PCI.

Analysis of Cardiovascular Diseases Costs and Their Effective Factors in Tabriz Hospitalized Patients, 2015

Background: Cardiovascular diseases are the most important chronic diseases with significant negative effects on the individuals’ quality of life and communities’ economic productivity. Objectives: The present study aimed to analyze the costs of cardiovascular diseases and identify the related factors in hospitalized patients of Tabriz Shahid Madani hospital in 2015. Patients and Methods: This paper was a cross-sectional study. Cost information was obtained by a bottom-up approach from the patients and their families’ perspective. A number of 285 patients were randomly selected to participate in the study. For data collection, the study deployed a researcher-made questionnaire whose validity and reliability were confirmed by statistical tests. First, the collected data were analyzed using descriptive methods. And then, the researchers used t-test and ANOVA to analyze the relationship between demographic variables and the different types of cost. Tukey test was used to compare differences between groups groups, the researchers used. Results: The Study findings showed that the total cost of cardiovascular diseases was 13,074,700 Rials (US$462) per patient. The details of the costs of cardiovascular diseases also showed that direct medical costs, direct non-medical costs, and indirect costs were 10,909,100 Rials (US$386), 109’940 Rials (US$38.90), and 1,066,200 Rials (37.73 US$) which were 83.4%, 8.4% and 8.2% of the total costs, respectively. Statistical analyses indicated a significant relationship between gender, marital status, education, job status, location, type of disease, type of admission, and the reason for hospitalization and some types of assessed costs (P < 0.05). Conclusions: The study showed that the costs associated with cardiovascular diseases were not reasonable for many of these patients and their families. This certainly requires more consideration by managers and policy makers in the health care sector and the implementation of effective interventions.

Effect of Sleep Hygiene Education on Sleep Quality in Hemodialysis Patients.

Sleep is referred a regular, recurring and easily revocable state of organism which is characterized by relative immobility and significant increase in response threshold to environmental stimuli. Sleep disorders are common among haemodialysis patients. The aim of this study was to investigate the effect of sleep hygiene education on sleep quality in haemodialysis patients. This study is a randomized controlled clinical trial. The participants of this study were 60 haemodialysis patients admitted to the Dialysis Center of Shahid Ayatollah Madani Hospital of Khoy, affiliated with the Urmia University of Medical Sciences. Sampling was done randomly and the partcipants were randomly divided into intervention group (30 patients) and control group (30 patients). Sleep quality of participants was measured before and after the intervention by Pittsburgh Sleep Quality Index (PSQI). Training process for sleep hygiene behaviours was presented to the participants face-to-face. The data were analysed using SPSS 16. A significant difference in the mean (standard deviation) score for PSQI (p<0.001) was observed before and after intervention in the intervention group, while in the control group, the difference was not significant (p=0.704), In addition, a significant difference was observed in the mean (standard deviation) score for PSQI between the two, intervention and control groups after the educational intervention (p=0.034). Sleep hygiene education, alongside other appro-aches, is a low-cost, accessible and practical method which can be implemented within a short period of time.

The Association between Preoperative Plasma C-Reactive Protein (CRP) Level and Postoperative Adult Heart Surgery Outcome

Introduction: Careful history and physical examinations are the best ways for preoperative evaluation. Currently, we are recommended to rely on doing them rather than unnecessary and costly laboratory tests for confirmation or diagnosis of disease. The aim of study is the survey of CRP level association to decide further evaluation and expert consultation, newly diagnosed problems and possible effect on postoperative mortality and morbidity. Methods and Materials: In a descriptive retrospective study, hospital documentation of 620 patients older than 18 years undergone heart surgery in Tabriz Shahid Madani hospital was evaluated. Addition to plasma CRP level, patient’s demographic information, type of surgery, preoperative significant tests, delay time in surgery start time after anesthesiology visit, cause of requested specialty consultation and treatment recommendation, postoperative complications and mortality rate were recorded and analyzed. Patients were classified according to preoperative plasma CRP level to five groups as negative, +1, +2, +3 and not measured (i.e. they considered as normal (0 - 5 mg/l), mildly (5 - 40 mg/l), moderately (40 - 200 mg/L) or severely increased (>200 mg/l) groups). Results: Of 620 patients, 402 were male and 218 were female. There was not statistically significant correlation among demographic variables (gender, age, weight, and height), heart disease diagnosis and the type of surgery in five groups. In 79 individuals, they were done specialty consultations that most common of them were neurology consultation because of impaired renal laboratory tests. Only 2 cases were due to high CRP level. In any of cases, this preoperative consultation didn’t result from new disease cases. CRP plasma level hadn’t association with preoperative red blood cell sedimentation level. Prevalence of preoperative acute myocardium infarction was higher in patients with high CRP level. In group +1, delay time was lower than other groups. The most common causes were cardiac causes. There wasn’t statistically significant correlation between CRP level and different postoperative complications. There wasn’t significant association between ICU stay time and postoperative hospital stay time and plasma high CRP level. Conclusion: Probably, plasma CRP level increases before surgery in acute myocardial infarction and results in high mortality rate. It seems that routine measurement of CRP in candidates for heart operation is beneficial for mortality rate prediction, so its increasing level can’t help to diagnosis newly cases and it isn’t prudent to consult with specialist.

Effect of prophylaxis of magnesium sulfate for reduction of postcardiac surgery arrhythmia: Randomized clinical trial.

Background:Arrhythmia is a common complication after heart surgery and is a major source of morbidity and mortality.Aims:This study aimed to study the effect of magnesium sulfate (MgSO4) for reduction of postcardiac surgery arrhythmia.Setting and Design:This study is performed in the cardiac operating room and Intensive Care Unit (ICU) of Shahid Madani Hospital of Tabriz (Iran) between January 1, 2014, and September 30, 2014. This study is a double-blind, randomized controlled trial.Materials and Methods:In Group 1 (group magnesium [Mg]), eighty patients received 30 mg/kg MgSO4 in 500 cc normal saline and in Group 2 (group control), eighty patients received 500 cc normal saline alone.Statistical Analysis:The occurrence of arrhythmia was compared between groups by Chi-square and Fisher's exact test. In addition, surgical time, length of ICU stay, and length of hospital stay were compared by independent t-test. P < 0.05 was considered as significant.Results:There was a significant difference in the incidence of arrhythmia between two groups (P = 0.037). The length of ICU stay was 3.4 ± 1.4 and 3.73 ± 1.77 days in group MgSO4 and control group, respectively, and there was no statistically significant difference between two groups (P = 0.2).Conclusion:Mg significantly decreases the incidence of all type of postcardiac surgery arrhythmia and hospital length of stay at patients undergo cardiac surgery. We offer prophylactic administration of Mg at patients undergo cardiac surgery.

Assessment of Patient and Relatives Satisfaction in a Cardiac Surgery ICU Model

Introduction: Evaluation of patients’ and their families’ satisfaction regarding the quality of care in the ICU is an important concern that can identify deficiencies of this field and help to improve satisfaction of both patients and their families. Considering the fact that problems related to cardiac surgery ICUs differ from other ICUs, recognition of these problems and the factors that lead to patient or family dissatisfaction can not only improve the quality and quantity of services provided in this section but also lead to increased satisfaction in these groups and promote scientific and practical knowledge related to sectors at regional levels. The aim of this study was to evaluate the satisfaction of patients and their families from the quantity and quality of services provided in the cardiac surgical ICU of Madani hospital, Tabriz, Iran. Materials and Methods: In this descriptive study, satisfaction of patients and their relatives from cardiac surgery ICU of Shahid Madani Hospital was evaluated using Modified MISS questionnaire for patients and CCMFNA questionnaires for their relatives during one year (1391-1390). The obtained data were statistically analyzed using descriptive statistics (frequency, percentage, mean ± SD) and SPSS ver. 15. Results: Majority of patients expressed moderate to high satisfaction. The overall satisfaction of doctors was higher than nurses (27% vs. 22%). The lowest level of satisfaction related to the possibility of meeting relatives (14.3%). Most relatives were spouses of patients who contributed to the highest rate of satisfaction; however, the location and meets expectations were less satisfactory. Conclusion: Improving waiting room quality, increasing duration of family meetings and increasing nursing attention are the factors that could be associated with further satisfaction. Keywords: ICU; Patient satisfaction; Family satisfaction

Rasionalitas Penggunaan Antipsikotik pada Pasien Skizofrenia di Instalasi Rawat Inap Jiwa RSD Madani Provinsi Sulawesi Tengah Periode Januari-April 2014

Schizophrenia is a severe mental disorder, that antipsychotics was effective therapy to treat it. There are 50 million sufferers in the world, 50% did not receive appropriate treatment and 90% of patients who did not receive the proper treatment in developing country. This research is aimed to find out rationality of antipsychotic usage includes right indication, drug, patient, dosage, and frequency in Schizophrenia Patient Department of Mental health in Madani Hospital of Central Sulawesi, in the period of January-April 2014. This research is a descriptive study, prospectively done by collecting primary data which was observation and interview, and secondary data was from the schizophrenia patient medical record. Data analysis was done by descriptive quantitative to provide an overview of the characteristic of each study variables including patient characteristic, clinical characteristic, and rational use of drug. The obtained results in rationality treatment was as follows : 100% precise indications, 90.4% right drug, 87.8% right patient, 81.6% right dosage and 90.4% appropriate frequency of antipsychotic use. Antipsychotic usage in schizophrenia Patient at mental health department of Madani Hospital of Central Sulawesi cannot be stated as rational yet.

Activated clotting time level with weight based heparin dosing during percutaneous coronary intervention and its determinant factors.

Introduction: Percutaneous coronary intervention (PCI) may be associated with Thrombotic complications. Unfractionated heparin (UFH) is a potent and preferable antithrombotic agent during this procedure. Activated clotting time (ACT) is a good assay for accurate titration of UFH during PCI. The aim of this study was to evaluate ACT levels 10 minutes after administration of 100U/kg IV heparin and determining its associated factors. Methods: This study was performed in Madani hospital, Tabriz, Iran between January 2013 to January 2014. One hundred and two patients candidates for elective PCI were enrolled in the study. Data including demographic and risk factors were collected. Result: The range of ACT was between 165 to 750 seconds (mean 319.8 seconds), 52 (51%) patients had ACT levels lower than 300sec and 12 (11.8%) patients had ACT levels between 300 to 350 seconds which is known optimal range and 38 (37.2%) cases had ACT levels above this value. Major risk factors had no effect on ACT value, but there was a trend to higher levels with increasing age (P=0.06). There was no difference in the rate of major or minor bleeding with respect to ACT levels (P=0.52). There was a trend to higher rate of minimal bleeding in those with ACT >350 sec (P=0.06). Conclusion: Weight based UFH injection may result in suboptimal anticoagulation during the procedure. Routine ACT measurement may be necessary to ascertain adequate anticoagulation. Major risk factors had no effect on ACT level and it was not associated with the rate of bleeding.

A study on the mortality and complication rates following percutaneously adjustable pulmonary artery banding.

Introduction: Pulmonary artery (PA) banding is a procedure associated with high morbidity and mortality rates. It however can effectively palliate several forms of congenital heart lesions with increased pulmonary flow. Occasionally, to obtain an optimal degree of banding following operation, readjustment of the band is inevitable. We describe the technique of adjustable PA banding to prevent this problem. Methods: From June 2007 to 2008, 21 patients with congenital cardiac abnormalities including Single ventricle (1), transposition of great arteries (TGA) (4) and ventricular septal defect (VSD) (16) were operated via percutaneously adjustable PA banding in Madani Hospital (Tabriz, Iran). Results: The mean age and the mean weight of the patients were 12±.8 months and 61±.7 kg respectively. Seventeen (81%) patients survived the operation. Cause of death was heart failure in 2 (9.5%) patients, and arrhythmia in 2 (9.5%) patients. Later, patients were followed up for 6 months. Satisfactory band gradient was achieved between 48 and 240 hours. Mean PA gradient before and 1 and 6 months after adjusting was (55.3±7.1 mmHg), (54.7±5.1 mmHg), and (53.2±5.4 mmHg) respectively. In the follow up period, there were 2 deaths, one caused by aspiration pneumonia and one caused by poor mixing. Postoperative complications were observed in 28.5% of the cases including cardiac (10%), pulmonary (pneumothorax, pneumonia) (10%) and infectious complications (9%). Conclusion: The technique of percutaneously adjustable PA banding is simple and inexpensive and allows easy band adjustments without the need for multiple reoperations. Moreover, our assessment reveals that created gradient is constant and did not decrease with time.