Postoperative atrial fibrillation and mortality after coronary artery bypass surgery

OBJECTIVES: We sought to determine if the occurrence of postoperative atrial fibrillation (AF) affects early or late mortality following coronary artery bypass surgery (CABG). BACKGROUND: Atrial fibrillation is the most common arrhythmia seen following CABG. METHODS: The Texas Heart Institute Cardiovascular Research Database was used to identify all patients that developed AF after isolated initial CABG from January 1993 to December 1999 (n = 994). This population was compared with patients who underwent CABG during the same period but did not develop AF (n = 5,481). In-hospital end points were adjusted using logistic regression models to account for baseline differences. Long-term survival was evaluated using a retrospective cohort design, where Cox proportional hazards methods were used to adjust for baseline differences, and with case-matched populations (n = 390, 195 per arm). RESULTS: Atrial fibrillation was diagnosed in 16% of the population. Postoperative AF was associated with greater in-hospital mortality (odds ratio [OR] 1.7, p = 0.0001), more strokes (OR 2.02, p = 0.001), prolonged hospital stays (14 vs. 10 days, p < 0.0001), and a reduced incidence of myocardial infarction (OR 0.62, p = 0.01). At four to five years, survival was worse in patients who developed postoperative AF (74% vs. 87%, p < 0.0001 in the retrospective cohort; 80% vs. 93%, p = 0.003 in the case-matched population). On multivariate analysis, postoperative AF was an independent predictor of long-term mortality (adjusted OR 1.5, p < 0.001 in the retrospective cohort; OR 3.4, p = 0.0018 in the case-matched population). CONCLUSIONS: The occurrence of AF following CABG identifies a subset of patients who have a reduced survival probability following CABG. The impact of various strategies, such as antiarrhythmics and warfarin, aimed at reducing AF and its complications deserves further study.     

Identifying and prioritizing industry-level competitiveness factors: evidence from pharmaceutical market

Background

Pharmaceutical industry is knowledge-intensive and highly globalized, in both developed and developing countries. On the other hand, if companies want to survive, they should be able to compete well in both domestic and international markets. The main purpose of this paper is therefore to develop and prioritize key factors affecting companies’ competitiveness in pharmaceutical industry. Based on an extensive literature review, a valid and reliable questionnaire was designed, which was later filled up by participants from the industry. To prioritize the key factors, we used the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS).

Results

The results revealed that human capital and macro-level policies were two key factors placed at the highest rank in respect of their effects on the competitiveness considering the industry-level in pharmaceutical area.

Conclusion

This study provides fundamental evidence for policymakers and managers in pharma context to enable them formulating better polices to be proactively competitive and responsive to the markets’ needs.     

Cryoablation of incessant ventricular tachycardia: case report and long-term follow-up

We report the case of a 52-year-old man who had incessant ventricular tachycardia despite treatment with antiarrhythmic agents. Placement of an implantable cardioverter/defibrillator, radiofrequency ablation, and antitachycardia pacing were ineffective. He underwent intraoperative arrhythmia mapping and cryoablation at our institution. Eighteen months later, he remained free of arrhythmia. He was in New York Heart Association functional class II with an ejection fraction of 30%.     

Interleukin-10 gene polymorphisms and susceptibility to brucellosis in Iranian patients

Background: Interleukin-10 (IL-10) is a Th2-type cytokine that inhibits macrophage activation. It is known that production of IL-10 is affected by its gene promoter polymorphisms. Objective: To investigate the relationship between IL-10 gene promoter polymorphisms and susceptibility to brucellosis. Methods: One hundred and ninety patients with brucellosis and 81 healthy animal husbandmen who owned infected animals and consumed their contaminated dairy products were included in this study. All individuals were genotyped for three bi-allelic IL-10 gene promoter polymorphisms at positions -1082(G/A), -819(T/C), and -592(A/C) using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: The distribution of C alleles at positions -592 and -819 of IL-10 were significantly higher in patients than in the healthy animal husbandmen (p=0.034 and p=0.0086, respectively). IL-10 ATA single and double haplotypes were significantly higher in controls, compared to the patients (p= 0.0278 and p=0.013, respectively). Conclusion: According to the results higher frequency of C alleles at positions -592 and -819 of IL-10 in patients may be considered as genetic factors for susceptibility to brucellosis.     

Effect of selenium on plasma glucose of rats: role of insulin and glucocorticoids

The effects of acute treatment (i.p.) of selenium (Se) on glucoregulation and on plasma levels of glucose, insulin and corticosterone were determined in both fed and 24-hour-fasted rats. In this experiment animals were treated with saline (control) or 1.3, 1.6 and 3.8 mg/kg doses of Se. Blood samples were collected before, 30, 60 and 90 min following injection. The results obtained show that acute intraperitoneal (i.p.) administration of Se (1.6 mg/kg or more) causes hyperglycemia in rats. It was found that Se does not change levels of plasma insulin in either fasted or fed animals. Se did, however, significantly increase the plasma levels of corticosterone in all Se-treated groups. In order to confirm the role of corticosterone and thus support the significance of adrenal glands in this hyperglycemic response, animals were subjected to bilateral adrenalectomy. Blood samples were collected before, 30, 60 and 90 min following intraperitoneal treatment with Se. The results indicate that bilateral adrenalectomy abolishes the hyperglycemic response to Se. It can be concluded that adrenal glands play a role in Se-induced hyperglycemia. The increase in corticosterone levels suggest the possibility of gluconeogenesis in contributing to this hyperglycemic response.     

Biofeedback treatment of narcotic addiction: A double-blind study

This is a report on the double-blind study on EMG biofeedback for 37 narcotic addicts in an outpatient methadone clinic. Patients were randomly assigned to either the experimental group (N = 24) receiving a contingent EMG biofeedback or a control group (N = 13) receiving non-contingent preaped “pseudo-biofeedback”. All patients were stabilized on a study dose of methadone and the mean daily amount did not differ between groups. All were experiencing a significant degree of anxiety at the time of evaluation. The evaluation consisted of the patient's self-report, which comprised the Beck Depression Inventory, anxiety checklist, withdrawal sickness rating, drug references, and the psychiatrist's rating of depression, namely the Hamilton Depression Scale, Hamilton Anxiety Scale, and BPRS. In addition, an evaluation of progress was obtained from the patient and his counselor which included the current job or school status and brief ratings of drug use, psychiatric symptoms, social adjustment, and illegal activity. All patients had at least one urine sample analyzed weekly for illicit drug use. Evaluation was done at the beginning, and at the end of the treatment and at a follow-up one month later.Termination status was assessed only for subjects who completed the course of 15 biofeedback sessions (N = 19). Patients attended five sessions per week for thirty minutes just prior to receiving the methadone. Fifteen sessions were scheduled over a three-week period. The results indicated that the two study groups did not differ and there was a significant improvement (p < 0.05) on several variables for the total patient sample. All the psychiatric ratings of anxiety, depression, psychopathology were significantly reduced. In addition, self-rated craving for narcotics and self-rated anxiety were lower and there were fewer drug avoidance responses on the sentence completion test. But there were no meaningful differences in the two groups in improvement as reflected in the psychometric instruments.     

Sleep architecture and obstructive sleep apnea in obese children with and without metabolic syndrome: a case control study

Purpose

Obesity and biochemical parameters of metabolic disorders are both closely related to obstructive sleep apnea (OSA). The aim of this study was to compare sleep architecture and OSA in obese children with and without metabolic syndrome.

Methods

Forty-two children with metabolic syndrome were selected as case group and 38 children without metabolic syndrome were matched for age, sex, and BMI as control group. The standardized Persian version of bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep, snoring (BEARS) and Children’s Sleep Habits Questionnaires were completed, and polysomnography (PSG) was performed for all study subjects. Scoring was performed using the manual of American Academy of Sleep Medicine for children. Data were analyzed using chi-square test, T test, Mann–Whitney U test, and logistic regression analysis.

Results

Non-rapid eye movement (NREM) sleep and N1 stage in the case group were significantly longer than the control group, while REM sleep was significantly shorter. Waking after sleep onset (WASO) was significantly different between two groups. Severe OSA was more frequent in the control group. Multivariate logistic regression analysis showed that severe OSA (OR 21.478, 95 % CI 2.160–213.600; P = 0.009) and REM sleep (OR 0.856, 95 % CI 0.737–0.994; P = 0.041) had independent association with metabolic syndrome.

Conclusions

Obese children with metabolic syndrome had increased WASO, N1 sleep stage, and severe OSA. But the results regarding sleep architecture are most likely a direct result of OSA severity. More longitudinal studies are needed to confirm the association of metabolic syndrome and OSA.