Dietary intake, biomarkers and supplementation of fatty acids and risk of coronary events: a systematic review and dose-response meta-analysis of randomized controlled trials and prospective observational studies.

We aimed to review the association of dietary fats and risk of coronary events in adults. We searched PubMed, Embase, CENTRAL, Scopus, and Web of Sciences to April 2022 for prospective cohorts and randomized trials investigating the association of dietary intake and biomarkers of fats and fatty acid interventions and the risk of coronary events. We performed random-effects meta-analyses to estimate relative risk (RR) for the top versus bottom tertiles of exposures. One-hundered sixty-five prospective cohorts and randomized trials were included. Dietary intake and biomarkers of total fat and saturated, monounsaturated, and polyunsaturated fatty acids were not associated with the risk of coronary events. Dietary intake of trans fatty acids, palmitic acid, stearic acid, and saturated fatty acids from meat and unprocessed meat was modestly associated with a higher risk and, in contrast, intake of alpha-linolenic acid, long-chain omega-3 fatty acids, and linoleic acid was modestly associated with a lower risk. Supplementation with long-chain omega-3 fatty acids and increasing the consumption of alpha-linolenic and linoleic acids in place of saturated fats reduced the risk of coronary events. Existing evidence, in its totality, provides a modest support in favor of current recommendations suggesting replacement of saturated fats with polyunsaturated fats.

Importance of gut microbiota metabolites in the development of cardiovascular diseases (CVD).

Cardiovascular disease (CVD) remains the most common cause of death worldwide and has become a public health concern. The proven notable risk factors for CVD are atherosclerosis, hypertension, diabetes, dyslipidemia, inflammation, and some genetic defects. However, research has shown a correlation between metabolic health, gut microbiota, and dietary risk factors. The gut microbiota makes an important contribution to human functional metabolic pathways by contributing enzymes that are not encoded by the human genome, for instance, the breakdown of polysaccharides, polyphenols and vitamins synthesis. TMAO and SCFAs, human gut microbiota compounds, have respective immunomodulatory and pro-inflammatory effects. Choline and l-carnitine are abundant in high-fat diets and are transformed into TMA by gut bacteria. The liver's phase of metabolism then changes TMA into TMAO. In turn, TMAO promotes the activation of macrophages, damages vascular endothelium, and results in CVD-however, dysbiosis decreases SCFAs and bile acids, which raises intestinal permeability. Congestion in the portal vein, a drop in cardiac output, a reduction in intestinal perfusion, and intestinal leakage are all caused by heart failure. These factors induce systemic inflammation by increasing intestinal leakage. By raising CRP and pro-inflammatory reactions, human gut dysbiosis and elevated TMAO levels promote the development of arterial plaque, hasten the beginning of atherosclerosis, and raise the risk of CAD. A healthy symbiosis between the gut microbiota and host is a key factor in shaping the biochemical profile of the diet, therefore which are crucial for maintaining the intestinal epithelial barrier, growing mucosa, reducing inflammation, and controlling blood pressure.

A Case Report: Surgical Removal of Missing Guide Wire, Is it the Best Intervention?

Nowadays, the use of central venous catheter insertion (CVC), has abundantly increased. It is a common technique in critically ill patients who are admitted to intensive care and emergency departments in order to hemodynamic monitoring and fluid and medication administration. In this report, we express a 28-year-old man who has multiple trauma with decreased level of consciousness during a car accident three months ago and needs intensive care and monitoring by central venous catheter placing. A missed guide wire remaining inside the venous system after peripherally inserted in femoral vein that was incidentally diagnosed by taking a chest X-ray after three months. Although, guide wires are often retrieved by snaring catheter under fluoroscopic guidance and an interventional cardiologist, we have successfully extracted the lost wire through vascular surgery. Eventually, this report is supposed to increase awareness of this rare and preventable complication and to provide a solution to prevent this complication. Finally, the purpose of this report is to emphasize that surgical extracting is the best intervention to remove the missed guide wire (after 3 months) and this option could be developed, introduced and standardized in appropriate and controlled conditions.

Pregnant women with COVID-19: the placental involvement and consequences.

SARS-CoV-2, the leading cause of COVID-19 pandemic, was detected for the first time in Wuhan. In this study, we investigated the potential undesirable maternal and feto-neonatal consequences of COVID-19, and the related pathophysiological alterations in mother, neonate, and especially in the placenta as a vital organ, were reviewed. Also, the possibility of vertical transmission of virus and placental abnormalities were evaluated. The pregnant women were a vulnerable population for COVID-19, and several obstetric consequences were reported following SARS-CoV-2 infection. The higher risk of abruption, preterm labor, maternal death, stillbirth, intrauterine growth restriction, and newborns with fetal distress were adverse pregnancy and perinatal outcomes of COVID-19. Despite the ACE2 expression on placental components was confirmed, there is no agreement on the mother-child vertical transmission of this virus. Therefore, feto-neonatal consequences might be associated with placental abnormalities. The placental abnormalities are characterized by feto-maternal vascular malperfusion. Additionally, these adverse consequences lead to early termination of pregnancy in some cases, mostly via cesarean section. The pregnant women screening, coordination between healthcare personnel and neonatal unit, and infected women quarantine may decrease the risk of maternal and neonatal death after delivery.

Evaluation of the effect of metformin and insulin in hyperglycemia treatment after coronary artery bypass surgery in nondiabetic patients.

INTRODUCTION: Insulin therapy is the most commonly used treatment for controlling hyperglycemia after coronary artery bypass surgery in both diabetic and nondiabetic patients. Metformin has been indicated for critically ill patients as an alternate for the treatment of hyperglycemia. This study evaluated the effect of metformin and insulin in hyperglycemia treatment after coronary artery bypass surgery in nondiabetic patients. SETTINGS AND DESIGN: This study was a clinical trial comprising nondiabetic patients who had undergone coronary artery bypass surgery. Patients were randomly divided into the insulin group and the metformin group. METHODS: Patients in the insulin group received continuous infusion of insulin while those in the metformin group received 500 mg metformin tablets twice daily. All the patients were followed up for 3 days after stabilization of blood glucose levels. STATISTICAL ANALYSIS: Data were analyzed using Chi-square test and Mann-Whitney U-test. RESULTS: This study included a total of 56 patients. During the study period, the mean blood glucose levels decreased from 225.24 to 112.36 mg/dl (↓112.88 mg/dl) in the insulin group and from 221.80 to 121.92 mg/dl in the metformin group (↓99.88 mg/dl). There was no significant difference in the blood glucose levels of the patients between the two groups at any measurement times (P > 0.05). CONCLUSION: Using 500 mg metformin twice daily is similar to using insulin in nondiabetic patients undergoing coronary artery bypass graft. Therefore, the use of metformin can be considered as a treatment strategy for controlling hyperglycemia in this group of patients.

Prevalence of aspirin resistance in patients with type II diabetes: a descriptive-analytical study
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BACKGROUND: Aspirin resistance is one of the most important factors for arterial thrombotic events in diabetic patients. This study aimed to evaluate aspirin resistance in diabetic patients. METHODS: In this cross-sectional study, 180 patients who received 80 mg of aspirin daily for at least 10 days were studied, and their urinary 11-DH-TXB2 was measured. Those with 11-dehydro-thromboxane B2 above 1,500 pg/mg creatinine were considered aspirin resistant. Data with significance level of 5% were analyzed in SPSS-16. RESULTS: The mean ± SD of patient age was 60.22 ± 9.59 years and 50% (n = 90) were male. BMI was normal in 29.4% of the patients (n = 53), the others were overweight or obese. Aspirin resistance was observed in 33 (18%) patients. The relationship between aspirin resistance and gender, age, and BMI was not significant (p > 0.05). CONCLUSIONS: There is a high prevalence of aspirin resistance in diabetic patients and given that such patients are at risk of arterial thrombotic events, evaluation of aspirin resistance is suggested for those at a high risk of cardiovascular events or recurring events despite the use of aspirin.
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Performance, pain, and quality of life on use of central venous catheter for management of pericardial effusions in patients undergoing coronary artery bypass graft surgery.

Different pericardial catheters have been suggested as an effective alternative method for drainage of pericardial effusion. The aim of this study was to determine the performance, pain, and quality of life on use of central venous catheter (CVC) for drainage of pericardial effusion in patients undergoing open heart surgery. Fifty-five patients who had developed pericardial effusion after an open heart surgery (2012-2015) were prospectively assessed. Triple-lumen central catheters were inserted under echocardiographic guidance. Clinical, procedural, complication, and outcome details were analyzed. Intensity of pain and quality of life of patients were assessed using the numerical rating scale and Short-Form Health Survey. CVC was inserted for 36 males and 19 females, all of whom had a mean age of 58.5±15 years, and the mean duration of the open heart surgery was 8±3.5 hours. The mean central venous pressure catheter life span was 14.6 days. No cases of recurrent effusion and complication were reported. The technical success rate of procedure was 100%. Intensity of pain and quality of life of patients had improved during follow-up. CVC insertion is a safe and effective technique for the management of pericardial effusion in patients after open heart surgery.

An Extremely Rare Complication of Ureteral Pigtail Stent Placement: A Case Report.

Double-J (DJ) stents are the main tools used in urological practice for prevention and treatment of obstruction. Stenting is also mandatory after complicated ureteroscopy or TUL (Transureteral Lithotripsy). Known complications are upper migration of DJ stents into the kidney and lower migration to the bladder. In a man with an impacted right lower ureteral stone, a DJ stent was placed because the ureteroscope was not passed from an intramural ureter. We reported a very rare complication of DJ ureteral stent placement with intravascular migration to the pulmonary arteries, which was removed percutaneously through the right femoral vein under fluoroscopic guidance.

Pregnancy outcome using general anesthesia versus spinal anesthesia for in vitro fertilization.

BACKGROUND: There is a considerable rate of fertility failure and this causes a great burden of untoward effects for patients. Usually a considerable number of these patients undergo anesthesia for their treatment. OBJECTIVES: This study was designed to compare the effects of general and spinal anesthesia on these patients. PATIENTS AND METHODS: In a randomized clinical trial, after taking informed written consent from the patients, 200 patients entered the study; 100 in each. During a 2 year period, women aged 20 to 40 years entered the study (one group receiving spinal anesthesia and the other, receiving general anesthesia). Ovum retrieval protocols were the same. Nonparametric and parametric analyses were used for data analysis. P value less than 0.05 was considered significant. RESULTS: There was no difference between the two groups regarding demographic variables. 15 of 100 patients (15%) in the general anesthesia group and 27 of 100 patients (27%) in the spinal anesthesia group had successful pregnancy after IVF; so, spinal anesthesia increased significantly the chance of IVF success (P value < 0.001; Chi Square). CONCLUSIONS: The results of this study demonstrated that spinal anesthesia increased the chance of fertilization success.

Surgical application of fascia lata as a pericardial substitute in rabbits.

PURPOSE: To use fascia lata instead of pericardium and observe the presence of adhesions. METHODS: Twenty rabbits were divided into two group of ten. In group A, a 1×1 cm segment of pericardium was excised and resutured. In group B excised pericardium was substituted for autologous fascia lata. RESULTS: In the comparison of microscopic adhesion rate between two groups A, B after eight weeks, there was no significant statistical difference. CONCLUSION: Fascia lata is safe and it can be substituted for pericardium especially in repeat sternotomy in repairing congenital heart defects to avoid heart injury.

Surgical application of fascia lata as a pericardial substitute in rabbits / Aplicação cirúrgica de fascia lata como substituto do pericárdio em coelhos

PURPOSE: To use fascia lata instead of pericardium and observe the presence of adhesions. METHODS: Twenty rabbits were divided into two group of ten. In group A, a 1×1 cm segment of pericardium was excised and resutured. In group B excised pericardium was substituted for autologous fascia lata. RESULTS: In the comparison of microscopic adhesion rate between two groups A, B after eight weeks, there was no significant statistical difference. CONCLUSION: Fascia lata is safe and it can be substituted for pericardium especially in repeat sternotomy in repairing congenital heart defects to avoid heart injury.

OBJETIVO: Utilizar fascia lata em vez de pericárdio e observar a presencça de aderências. MÉTODOS: Vinte coelhos foram distribuidos em dois grupos de dez. No grupo A, um 1×1 cm de segmento de pericárdio foi retirado e resuturado. No grupo B pericárdio retirado foi substituído por fáscia lata autóloga. RESULTADOS: Na comparação da taxa de aderência microscópica entre dois grupos A, B, após oito semanas, não houve diferença estatisticamente significante. CONCLUSÃO: A fascia lata é segura e pode ser substituta do pericárdio, especialmente em nova esternotomia na reparação de defeitos cardíacos congênitos para evitar lesão cardíaca.