Degradation of reactive red 198 dye from aqueous solutions by combined technology advanced sonofenton with zero valent iron: Characteristics/ effect of parameters/kinetic studies.

Dyes are one of the most common contaminants in industrial effluents, whose continuous release into the environment has become an increasing global concern. In this work, nanoparticles of zero-valent iron (NZVI) were synthesized using the chemical regeneration method ،and were utilized for the first time as a catalyst in the advanced Sono-Nano-Fenton hybrid method for the decomposition of Reactive Red 198 (RR198). The properties of zero-valent iron nanoparticles were analyzed using SEM and XRD. The effect of pH, initial dye concentration, nanoparticle dosage, zero-valent iron and H2O2 concentration on the decomposition efficiency of Red Reactive 198 was investigated. Comparing the efficiency of Reactivate 198 dye degradation in Sonolysis, Sono-NZVI, Sono-H2O2 and Sono-Nano Fenton processes showed that 97 % efficiency was achieved by the Sono-Nano Fenton process in 60 min. The kinetics of the removal process showed that this process follows pseudo-first-order kinetics and the Langmuir-Hinshelwood model. The results indicate that the effectiveness of the ultrasonic process in removing resistant organic pollutants such as dyes increases tremendously with the synergy of the Fenton process.

Combination of Serologic Tests and Sputum Culture Results as the Best Diagnostic Method of Pseudomonas aeruginosa Infection in Cystic Fibrosis Patients.

Background: One of the most common reasons for mortality in patients with cystic fibrosis (CF) is lung infections, among which Pseudomonas aeruginosa (Pa) infection has the largest share. Diagnosis of Pa can be assessed by various methods such as sputum culture results and IgG antibody level via measuring the specific anti-Pa antibodies. This study aimed to select the best predictive technique in the diagnosis of Pa in CF patients through spirometry, sputum culture, and serum IgG antibody levels. Materials and Methods: In this cross-sectional study, blood and sputum or pharyngeal samples were taken from 68 patients with cystic fibrosis. Because spirometry was not possible in all patients, 34 patients could do the spirometry. The samples were studied concerning Pa infection. The data including variables such as age, sex, and spirometry results were obtained. Then, in the serologic method, 3 serum-specific antibody levels were determined by enzyme-linked immune sorbent assay (ELISA). Results: The average age of children was 7.4 ± 5.6 (ranging from 0.5 to 23) years. Generally, the percentage of Pa infection increased in CF patients with higher ages. A statistically direct significant relationship was observed between the concentration of serum IgG antibodies in patients with CF and Pa-positive sputum culture results (p<0.05). Conclusion: Serum IgG antibodies against specific Pa antigens could be a diagnostic method against Pa infection, especially in patients who cannot expectorate. However, because of the positive and negative predictive value of both serum IgG antibody levels and the results of the sputum culture, we suggested that utilizing the combination of these methods could be beneficial in earlier diagnosis of Pa.

Health risk assessment of BTEX compounds (benzene, toluene, ethylbenzene and xylene) in different indoor air using Monte Carlo simulation in zahedan city, Iran.

The presence of benzene, toluene, ethylbenzene, and xylene compounds (BTEX) in the breathing air outside and inside buildings is one of the most significant problems related to human health today. This study was performed to determine the concentration of BTEX pollutants in indoor environments. PhoCheck was used to detect the concentration of BTEX compounds. In this study, the concentration (BTEX pollutant) was assessed in four indoor spaces, including restaurants, laundries, hair salons, and photocopying centers. The results showed that the average concentration of all four searched compounds was higher than the recommended limit of the Environmental Protection Agency (EPA). The results of carcinogenic risk assessment by benzene and ethylbenzene compounds show 2153 × 10-4 and 913 × 10-5 respectively. The HQ values for toluene and xylene were 1.397 and 0.505, respectively, indicating that exposure to toluene alone may have adverse effects on human health, while exposure to xylene alone has no adverse effects. The hazard index (HI) for toluene and xylene pollutants was higher than one. An HI value higher than one means that the two contaminants toluene and xylene in the air we breathe may have adverse effects on human health. As a result, the necessary control measures should be taken to prevent the unfavorable effects of these two pollutants.

Angina Pectoris as a Manifestation of ALCAPA Syndrome in a 20-Year-Old Female: A Case Report and Review of Literature.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is considered a rare congenital heart disease where the take-off of the left coronary artery abnormally originates from the pulmonary artery instead of left aortic sinus. It is associated with a high mortality rate in the first year of life and sudden death in adults if left untreated. We report an adult form of ALCAPA syndrome in a 20-year-old female who presented with anginal pain for the previous few months. Unfortunately, the patient was hesitant to have surgery at the time. LEARNING POINTS: The abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is rare and potentially fatal coronary congenital disease, accounting for 0.5% of all congenital heart diseases; it is associated with poor outcomes if left untreated.ALCAPA is classified into infantile and adult forms. The prevalence of adult individuals with ALCAPA syndrome has significantly increased as a result of recent developments in non-invasive cardiac imaging.The prevalence of sudden mortality in childhood and the early stages of adulthood makes surgery the preferred treatment, and coronary reimplantation surgery is considered the surgical procedure of choice.

Cardiac Hydatid Disease with Palpitations as the Only Presenting Complaint: The Egg in the Nest.

Hydatid disease, also known as cystic echinococcosis, is a parasitic infection caused by the larval stage of Echinococcus granulosus. It usually invades organs such as the liver and the lungs but can affect any organ. Isolated cardiac involvement is a rare manifestation. We present a case of isolated left ventricle hydatid cyst with negative serological tests, which was treated with surgical removal and confirmed by histopathological examination. LEARNING POINTS: Isolated cardiac hydatid disease is rare and accounts for only 0.5-2% of cases among infected patients.Cardiac hydatidosis may present with a wide variety of clinical manifestations ranging from no symptoms to sudden death; palpitations may be the only complaint.Surgical excision is the treatment of choice for cardiac hydatid disease to avoid high-risk complications.

Antioxidant activity in off and on-pump coronary artery bypass grafting and valve replacement surgery.

OBJECTIVES: Cardiac surgeries initiate oxidative stress, increasing organ dysfunction development and mortality. The present study investigated the superoxide dismutase (SOD) activity, as an antioxidant enzyme, in patients undergoing coronary artery bypass (CABG) and heart valve replacement surgeries. METHODS: A prospective study was performed on patients with proven coronary artery disease (CAD) or valvular heart disease (VHD) candidates for on- or off-pump CABG and valve replacement surgery. Serum SOD activity was measured preoperatively, at 24 h postoperatively, and at the time of discharge. In addition, echocardiography was performed before surgery and at discharge. RESULTS: A total of 48, 51, and 47 patients were enrolled in the on-pump, off-pump CABG, and valve replacement groups, respectively. Baseline serum SOD activity showed no significant association with BMI, age, and blood pressure in either CAD or VHD patients. The SOD values decreased at the 24 h postoperative time and then increased at the time of discharge in all groups, except for a slight decrease in the on-pump group. The changes in serum SOD values were not significantly different for the three surgical groups. CONCLUSIONS: The serum SOD activities fell significantly after CABG and valve replacement surgery. Further investigation is emphasized for the role of SOD in oxidative stress after cardiac surgery.

Changes in serum zinc and copper concentrations in patients with cardiovascular disease following cardiac surgery.

The trace elements copper (Cu) and zinc (Zn) are essential for maintaining oxidative balance, and cardiac surgery is known to provoke an increase in oxidative stress. We investigated the variations in serum Zn and Cu concentrations before and after surgery in patients undergoing on- and off-pump CABG and heart valve replacement. We performed a prospective study on patients undergoing on- or off-pump CABG, or heart valve replacement surgery (48, 51, and 47 patients, respectively). Venous blood samples were obtained, and serum Cu and Zn concentrations were measured preoperatively, 24 h postoperatively, and the time of discharge. In addition, echocardiography was carried out on all patients before surgery and again on the day of discharge. We found the temporal changes in Cu, Zn, and Zn/Cu ratio were significantly different in all three groups of surgery (p < 0.05). In each group, Cu and Zn values and Zn/Cu ratio decreased at the 24-h postoperative time and rose at the discharge time. There were no significant differences between surgery groups in the changes induced in Zn or Cu values (p > 0.05). In conclusion, the concentrations of Cu and Zn were markedly reduced after on- and off-pump CABG and valve replacement surgery. This may suggest that supplementary Zn and Cu administration could be beneficial during open-heart surgeries. However, more long-term studies with more patients are needed to confirm this hypothesis.

A comparative study on the results of beating and arrested heart isolated tricuspid valve surgery: A cross-sectional study.

Background and Aims: The isolated tricuspid valve surgery is performed using beating or arrested heart surgery. The present study aimed to evaluate and compare the results of patients who underwent isolated tricuspid valve surgery using the beating and arrested heart techniques. Methods: In this retrospective observational study, all patients undergoing isolated tricuspid valve surgery between 2011 and 2018 were included. The patient's demographic information, echocardiographic, surgery, and hospitalization results were collected, and the EuroSCORE was calculated from the patient's medical records. Results: Fifty-three patients were included in the study of which 21 (39.63%) and 32 (60.37%) underwent a beating heart and arrested heart surgeries, respectively. There were no significant differences between the two studied groups in the echocardiographic results before and after the surgery, total hospitalization days (p = 0.56), and the mortality in the first 30 days after the surgery (p = 0.152). However, the duration of surgery (p < 0.001), EuroSCORE (p = 0.005), and patients who underwent lateral thoracotomy (p = 0.007) were notably lower in the arrested heart than in the beating heart group. In contrast, the duration of cardiopulmonary bypass and hospitalization in an intensive care unit after the surgery was remarkably lower in the beating heart than in the arrested heart group (p < 0.001 for both cases). Conclusion: Although there were some significant differences between the two kinds of surgery techniques, it seems superficial that made a particular decision to consider each method's superiority. Therefore, further studies with larger populations and meta-analyses are required to recommend the preferred method for the surgeons certainly.

Mesenteric ischemia following large left ventricular fibroid thrombosis due to myocardial infarction: A case report.

INTRODUCTION: Left ventricular thrombosis is a common complication of acute myocardial infarction, usually occurring after anterior ST-elevation myocardial infarction, akinesis, and extensive dyskinesia of the apex, anterolateral, or anteroseptal. In this article, we report a case of myocardial infarction with left ventricular thrombosis. CASE PRESENTATION: A 45-year-old man was referred to our hospital with complaints of severe epigastric pain, sweating, fever, and tachycardia. In laboratory tests, findings for triose phosphate isomerase enzyme were negative, but on electrocardiography, the Q wave in the V1 and V2 leads and the biphasic T wave in the V2, V3, and V4 leads were evident. In Akinesian echocardiography, apical segmentation with a large organic, mobile, pedunculated thrombosis measuring 1.7 × 1.9 cm2 and an ejection fraction of 40% were reported. The patient then underwent emergency open cardiac surgery through a central sternotomy to remove the thrombosis. CLINICAL DISCUSSION: The clinical manifestations of left ventricular thrombosis include cerebral thromboembolism and systemic distal embolization, which are dangerous despite surgery. The echocardiography revealed that the left ventricular keratosis had been surgically removed through ventriculotomy. The patient experienced mesenteric ischemia during hospitalization, and due to the initial presentation of severe abdominal pain, it is not uncommon for the patient to be diagnosed with mesenteric ischemia before referral. The patient had the following vital signs: SPO2, 98%; BP, 96/63; PR, 91; RR, 19; and GCS, 10/15 and was treated in the intensive care unit. CONCLUSION: Our case highlights the importance of diagnosis and on-time treatment of post-large left ventricular fibroid thrombosis complications.

Monitoring of polycyclic aromatic hydrocarbons and probabilistic health risk assessment in yogurt and butter in Iran.

This study was conducted to determine the polycyclic aromatic hydrocarbons (PAHs) levels and health risk of yogurt and butter samples collected from Tehran using MSPE/GC-MS (magnetic solid-phase extraction/gas chromatography-mass spectrometry). The results revealed that the limit of detection (LOD) and limit of quantification (LOQ) were ranged from 0.040 to 0.060 and 0.121 to 0.181 µg/kg, respectively; with recoveries ranged from 86.1% to 100.3%. The highest mean of total PAHs was higher in butter (6.87 ± 1.21 µg/kg) than in yogurt (3.82 ± 0.54 µg/kg). The level of benzo (a)pyrene in all samples was lower than of standard levels of the European Union (EU). The highest value of all PAHs in samples was recorded in the winter season and also in the expiration date. The percentile 95% of the total hazard quotient (THQ) due to the consumption of yogurt and butter recorded 1.33E-02 and 3.69E-04 in adults and 6.12E-02 and 1.75E-03 in children, respectively. The percentile of 95% incremental lifetime of cancer risk (ILCR) due to the ingestion of yogurt and butter recorded 1.17E-06 and 2.02E-08 for adults and 5.51E-06 and 9.46E-08 for children, respectively. The rank order of 7 PAHs in adult and children based on P95% Hazard Quotient (HQ) in all samples was benzo(a)anthracene (BaA) > pyrene (P) > fluorene (F) > fluoranthene (Fl) > acenaphthylene (Ace) > anthracene (A) > naphthalene (NA). According to the Monte Carlo Simulation (MCS) method, health-risk assessment showed that children and adults are not at significant health risk.

A global systematic review, meta-analysis and health risk assessment on the quantity of Malathion, Diazinon and Chlorpyrifos in Vegetables.

It is widely believed that an increasing trend in the production and consumption of vegetables has led to a dramatic rise in the use of pesticides potentially threatening the health of consumers around the world. This systematic study along with meta-analysis has mainly centered on the evaluation of the quantity of three well-known pesticides namely, Malathion (MLT), Diazinon (DZN) and Chlorpyrifos (CPF) in vegetables. In this regard, a comprehensive literature search has been performed over the last decade (January 1, 2011 to June 21, 2020) within the scientific databases including PubMed, Web of Science, and Scopus. Of 1239 articles identified through the database screening, 22 plus 37 data report were retained and included in the meta-analysis phase. Additionally, the probabilistic human health risks for the consumers due to the intake of CPF, DZN and MLT from eating vegetables were estimated by the Monte Carlo Simulated (MCS) method. According to the findings, the maximum quantities of MLT, DZN and CPF in the vegetables were observed in Pakistan (222 µg/kg, 95%CI = 214.94-229.08), Thailand (245.00, 95% CI = 235.2-254.8) and South Korea (440 µg/kg, 95% CI = 437.19-442.81), while the lowest concentration levels were reported in China (1.7 µg/kg, 95% CI = 1.56-1.84), Poland (0.57, 95% CI = 0.46-0.68) and Poland (5.78 µg/kg, 95% CI = 4.40-7.12), respectively. The results of the Egger's and the Begg's tests revealed that no bias with regard to the potential publication was observed. Finally, non-carcinogenic risk assessment results demonstrated that the exposure to the studied pesticides thorough vegetables consumption could not threaten the health of consumers.

Green preparation of activated carbon from pomegranate peel coated with zero-valent iron nanoparticles (nZVI) and isotherm and kinetic studies of amoxicillin removal in water.

In present research, the activated carbon was prepared by a green approach from pomegranate peel coated with zero-valent iron nanoparticles (AC-nZVI) and developed as adsorbent for the removal of amoxicillin from aqueous solution. The physicochemical properties of the AC-nZVI were investigated using XRD, FTIR, and FESEM techniques. The optimal values of the parameters for the best efficiency (97.9%) were amoxicillin concentration of 10 mg/L, adsorbent dose of 1.5 g/L, time of 30 min, and pH of 5, respectively. The adsorption equilibrium and kinetic data were fitted with the Langmuir monolayer isotherm model (qmax 40.282 mg/g, R2 0. 0.999) and pseudo-first order kinetics (R2 0.961). The reusability of the adsorbent also revealed that the adsorption efficiency decreased from 83.54 to 50.79% after five consecutive repetitions. Overall, taking into account the excellent efficiency, availability, environmental friendliness, and good regeneration, AC-nZVI can be introduced as a promising absorbent for amoxicillin from aquatic environments.

Isolated cardiac hydatid cyst presented as myopericarditis: A case report.

Hydatidosis commonly affect the liver and lungs but in rare cases, it can involve heart tissue. A 42-year-old man from urban areas of Khorasan Razavi province, northeastern Iran, was referred to the cardiac clinic with palpitation, and atypical chest pain in 2018. Large pericardial effusion, reduced left ventricle systolic function was found. A cystic-like lesion was also seen in inter-ventricular septum in echocardiography and high-resolution computed tomography (HRCT). Urgent cardiac surgery was done because of echocardiographic evidence of tamponade. Although the serologic analysis was negative for hydatidosis, surgical excision of cyst and the subsequent histopathological findings revealed a hydatid cyst. In endemic areas, hydatidosis should be considered in differential diagnosis of any cystic-like lesions, even if the serological analysis is negative.

Prevalence and probabilistic health risk assessment of aflatoxins B1, B2, G1, and G2 in Iranian edible oils.

The prevalence of aflatoxins (AFs) B1, B2, G1, and G2 in Iranian edible oils were assessed by immunoaffinity column cleanup and HPLC equipped with a fluorescence detector (HPLC-FLD). Ninety-seven samples including sunflower, canola, refined olive, unrefined olive, frying, and blend oils were collected from eight provinces (n = 15 samples of refined olive oil, n = 15 samples of unrefined olive oil, n = 15 samples of sunflower oil, n = 15 samples of canola oil, n = 17 samples of frying oil, and n = 20 samples of blend oil). Also, cancer risk of aflatoxins in the adults and children due to ingestion of edible oils was estimated via margin of exposure (MOE) estimation in the Monte Carlo simulation (MCS) model. Considering the limit of detection (LOD) of the current study, two unrefined olive oil samples from Zanjan Province were contaminated with AFB2 in the concentrations of 0.2 and 0.4 ng/g while other samples were free from AFB1, AFB2, AFG1, and AFG2. This study revealed that about 98% of the collected samples were free from AFs and the concentrations of AFs in the polluted samples were within the standard range suggested by European Commission regulation (20 µg/kg). However, health risk assessment indicated that both adult and children in the Zanjan Province are at considerable liver cancer risk (percentile 95% of MOE < 10,000 value). Therefore, national plan to address this issue and strict inspection of edible oil products by the regulatory bodies are suggested.

Determination of heavy metal content of processed fruit products from Tehran's market using ICP- OES: A risk assessment study.

In this study, the levels of Cd, Hg, Sn, Al, Pb and As of 72 samples (36 samples for fruits juices and 36 samples for fruits canned) of three different brands including of Peach, Orange, Cherry, and Pineapple (18 samples of each fruits) marketed in Tehran, Iran (2015) were evaluated using Inductively Coupled Plasma-Optical Emission Spectrometry (ICP-OES) technique. Also, Probabilistic risk assessment (non-carcinogenic and carcinogenic risks) was estimated by models include target hazard quotient (THQ) and cancer risk (CR) in the Monte Carlo Simulation (MCS) model. However, all samples were contaminated with the heavy metals investigated, most of them not surpassed established standards. The range of concentration for Al, Sn, As, Cd, Hg, and Pb as average in fruit juices were reported as 340.62 (65.17-1039.2), 72.33 (49.76-119.4), 3.76 (1.137-18.36), 2.12 (0.89-3.44), 0.351 and 40.86 (27.87-66.1) µg/kg, respectively. The level of heavy metals measured in different kinds of fruit juices was ranked as Al > Sn > Pb > As > Cd > Hg, and for fruits canned this rank was Pb > Al > Sn > As > Cd > Hg. The range of concentration for Al, Sn, As, Cd, Hg, and Pb in fruits canned were reported as 361.23 (43.15-1121.2), 101.42 (71.45-141.61), 3.92 (1.279-19.50), 2.78 (1.09-5.56), 0.35 and 690.54 (470.56-910.14) µg/kg, respectively. The lead (Pb) concentration in 97.22% (35 out of 36 samples) of fruit juices samples surpassed Codex limit (0.05 mg/kg) and in all samples of FC was lower than the legal limit of Codex limit (1 mg/kg). All of the samples had Tin (Sn) lower than the legal limit of Codex (fruit juices 100 mg/kg and FC 250 mg/kg). The MCS indicated that the rank order of heavy metals in both adults and children based on THQ was Al > Sn > As > Pb > Cd > Hg. The THQ of Al and Sn in the FJ and FC, for both adults, and children, was considerably higher than 1 value. Also, CR of As in both adults and children were higher than 1E-6 value. Although the mean concentration of heavy metal in the FJ and FC was lower than the standard limit, the MCS indicated that adults and children are at considerable non-carcinogenic and carcinogenic risks.

Investigation of outdoor BTEX: Concentration, variations, sources, spatial distribution, and risk assessment.

The aim of this study was to measure BTEX (benzene, toluene, ethylbenzene, and xylenes) concentrations in the ambient air of Tehran, the capital of Iran, and investigate their seasonal variations, probable sources, spatial mapping, and risk assessment. The concentrations of BTEX were measured using a continuous monitoring device installed in seven stations around the city. Spatial mapping procedure was conducted using the inverse distance weighting (IDW) method. Monte Carlo simulation was used to assess the carcinogenic and noncarcinogenic risks imposed by BTEX. The highest and lowest annual mean concentrations of toluene and ethylbenzene were recorded as 16.25 and 3.63 µg m(-3), respectively. The maximum (6.434) and minimum (3.209) toluene/benzene (T/B) ratio was observed in summer and winter, respectively. The spatial distribution of BTEX pollution indicated that the highest concentrations were found along the major roads because of heavy traffic. Spearman's rank correlation coefficients and concentration ratios showed that BTEX were produced by the multiemission sources. The mean of inhalation lifetime cancer risk (LTCR) for benzene was 3.93 × 10(-7), which is lower than the limits recommended by the United States Environmental Protection Agency (US EPA) and the World Health Organization (WHO). The hazard quotient (HQ), noncarcinogenic risk index, for all BTEX compounds was <1. The obtained results showed no threat of BTEX concentrations to human health. However, as the concentrations of BTEX will increase due to the rapid growth of vehicles and industrial activities, much effort is required to control and manage the levels of these compounds in the future.

The study of non-linear kinetics and adsorption isotherm models for Acid Red 18 from aqueous solutions by magnetite nanoparticles and magnetite nanoparticles modified by sodium alginate.

Azo dyes are widely used in various industries. These substances produce toxic byproducts in aquatic environments in addition to their mutagenic and carcinogenic potential effects. In this study, the effect of magnetite nanoparticles and magnetite nanoparticles modified by sodium alginate in batch systems and nonlinear kinetic and adsorption isotherm models were investigated. Magnetite nanoparticles were synthesized by chemical co-precipitation method and then modified and used as adsorbent to adsorb Acid Red 18. After determining the optimum pH and adsorbent dose, non-equilibrium models for kinetic adsorption were tested with concentrations (25-100 mg/L) and at eight different periods of time (1-15 min) and the pseudo-first-order and pseudo-second-order non-linear models were used to describe the results. For adsorption isotherm, a contact time of 120 min was studied in different concentrations (25-100 mg/L) and the residual concentration of Acid Red 18 was obtained. The results are described by non-linear Langmuir, Freundlich and Dubinin-Radushkevich isotherm models. The optimum amounts of pH for magnetite nanoparticles and for modified ones were 3 and 5, respectively, the efficiencies were 0.75 and 0.2 g/L, respectively. According to the results sodium alginate has a high performance in adsorption of Acid Red 18. Adjusted correlation coefficients and chi-square test showed that Freundlich isotherm and then Langmuir isotherm can well describe the experimental results. In Freundlich, the value of (Kf) was 3.231 (L/g) for magnetite nanoparticles and 21.615 (L/g) for modified adsorbent. In Langmuir, the value of (qm) was 16.259 (mg/g) for magnetite nanoparticles and 73.464 (mg/g) for modified adsorbent. Comparing the Langmuir maximum calculated adsorption capacity indicated that modified adsorbent can adsorb the pollutants 6.5 times more than the other one.

Surgical embolectomy in the management of massive and sub-massive pulmonary embolism: The results of 30 consecutive ill patients.

BACKGROUND: Despite the improvement in the diagnosis and treatment of acute pulmonary embolism, it is yet a common clinical problem. The actual role of open embolectomy has not been well understood. The present report aimed to extrapolate the outcome of early open pulmonary embolectomy in a number of patients with acute (sub) massive pulmonary embolism (AMPE/ASMPE). METHODS: A prospective study was performed on 30 patients who underwent emergency embolectomy at Ghaem Hospital, Mashhad, Iran during January 2005 to November 2012. All patients with an indication for pulmonary embolectomy according to recent American Heart Association guideline were enrolled in this study. Echocardiographic features, pulmonary artery pressure, and right ventricular (RV) diameter were recorded. The patients were followed up monthly by two cardiologists. RESULTS: Indications for operation in descending order consisted of contraindication for fibrinolytic therapy (30%), failure to respond to fibrinolysis (26.66%), cardiopulmonary arrest (20%), patent foramen ovale (20%), right atrium clot (10%), and cardiogenic shock (10%). Mean pulmonary artery pressures were 52.26 ± 6.54 and 29.43 ± 2.87 mmHg before and after the operation, respectively (P < 0.0001). RV function and diameter improved significantly after surgery (P < 0.0001 and < 0.0001, respectively). Complete follow-up was performed in all surviving patients. All patients survived the operation, except one who died 2 days after surgery due to profound hypotension. CONCLUSION: Short and long-term outcomes of early open embolectomy seemed to be satisfactory in high-risk patients presenting high clot burden in central pulmonary arteries. This study demonstrated that pulmonary embolectomy may play a promising role in the management of AMPE and ASMPE and recommended for future clinical trials.

Malondialdehyde-Modified LDL IgG Antibody Levels and Indices of Cardiac Function in Valvular Heart and Coronary Artery Disease Patients.

OBJECTIVE: To compare the changes in anti-malondialdehyde-modified low-density lipoprotein (MDA-LDL) IgG levels among patients undergoing off-pump and on-pump coronary artery bypass grafting (CABG) or valvuloplasty. SUBJECTS AND METHODS: A total of 38, 39 and 34 patients who underwent off-pump CABG, on-pump CABG and valvuloplasty, respectively, were enrolled in this study. Serum anti-MDA-LDL IgG values were measured 24 h before and after the operative procedures and at discharge. Echocardiography was also done before surgery and before discharge. The results were compared with values from 50 healthy controls. RESULTS: In all patients, a reduction in antibody titers was observed post-operatively. However, the decrease was significant only in the off-pump CABG - before surgery: 42.33 (25.83-58.51), after surgery: 30.86 (16.36-51.33) and at discharge: 10.96 (6.82-23.57; p = 0.027). There was a significant positive association between anti-MDA-LDL IgG levels and ejection fraction (r = 0.248, p = 0.036) and a negative association with E/E', a marker of pulmonary capillary wedge pressure, in the coronary patients (r = -0.345, p = 0.012), but no significant associations were found in patients with valvular heart disease. CONCLUSIONS: Serum anti-MDA-LDL IgG levels were associated with cardiac function indices in coronary patients undergoing CABG.

Surgical embolectomy versus thrombolytic therapy in the management of acute massive pulmonary embolism: Short and long-term prognosis.

OBJECTIVE: Comparison between surgical embolectomy and thrombolytic therapy in patients suffering from acute massive pulmonary embolism (AMPE). BACKGROUND: Prompt treatment of AMPE is necessary, although optimal management is a matter of debate. METHODS: Patients with AMPE were assigned to either thrombolytic therapy or pulmonary surgical embolectomy. Early and late mortality, systolic pulmonary artery pressure (SPAP), right ventricular diameter (RVD) and bleeding complications were evaluated. RESULTS: Seventy eight patients were treated with thrombolytic therapy and 30 patients underwent surgery. The difference between pre-intervention and third-day post-intervention in terms of RVD and SPAP was significantly greater in patients under surgical embolectomy (P < 0.001). There was a significant decline in RVD and SPAP in both groups during follow-up (P < 0.001). Mortality rate in the surgical embolectomy group was lower than the thrombolytic group although not significantly. CONCLUSION: Early surgical treatment was associated with fewer complications in comparison to thrombolytic therapy.