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Given the nature of heart disease and the importance of continuing heart surgery during the pandemic and its aftermath and in order to provide adequate safety for the surgical team and achieve the desired result for patients, as well as the optimal use of ICU beds, the medical team, blood, blood products, and personal protective equipment, it is essential to change the usual approach during the pandemic. There are still a lot of evidences and experiences needed to produce the perfect protocol. Some centers may have a special program for their centers during this period of epidemics that can be respected and performed. Generally, in pandemic conditions, the use of non-surgical approaches is preferred if similar outcomes can be obtained.
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BACKGROUND AND PURPOSE: Candida endocarditis is an infrequent disease with a high mortality rate, which commonly occurs in immunosuppressed patients with cardiac valve replacement. We reported a 70-year-old woman diagnosed with Candida prosthetic valve endocarditis (PVE). This study also involved a review of all published cases of Candida PVE from 1970. CASE REPORT: Herein, we reported a 70-year-old woman with the history of severe mitral stenosis and myelodysplasia syndrome. She underwent mitral valve replacement for two times. The blood cultures were positive, and phenotypic identification of the isolates at the species level was performed based on microscopic and macroscopic characteristics. In the second prosthetic valve replacement, huge fungal white and creamy vegetation was observed which was identified as Candida albicans based on the conventional and molecular methods. Despite the administration of antifungal treatments, the patient passed away probably due to the multidrug-resistant Candida PVE. CONCLUSION: As PVE is a late consequence of prosthetic valve replacement, extended follow-up visits, early diagnosis, repeating valve replacement surgeries, and timely selective antifungal treatments are warranted.
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BACKGROUND: Hospitalization and surgery are crucial adverse life events that lead to considerable anxiety in patients. OBJECTIVES: The present study aimed to investigate stressors after coronary artery bypass graft surgery and identify stressors that predict anxiety. PATIENTS AND METHODS: This is a descriptive-analytical study that uses a non-random convenience sampling method on patients undergoing coronary artery bypass graft surgery at the cardiac surgery intensive care unit of Fatemeh Zahra Cardiac center in Sari, Iran. A total of 186 patients completed the post-surgical stressors questionnaire and the Spielberger State-Trait Anxiety Inventory on postoperative days 2 or 3 in the cardiac surgery intensive care unit. Data were analyzed using descriptive statistics including frequencies, means, and standard deviations. The Mann-Whitney U test was used to determine the relationship between the observed variables, and the logistic regression model was used to identify the relationship between stressors and anxiety after-surgery. RESULTS: Post-surgical anxiety predictors included insufficient sleep during hospitalization (Odds ratio [OR]: 5.42; 95% confidence interval [CI]: 1.46 - 20.00; P = 0.010), treatment not explained to the patient by the nurse (OR: 4.83; 95% CI: 1.82 - 12.84; P = 0.002), being away from family members (OR: 3.88; 95% CI: 1.46 - 10.26; P = 0.006), presence of a chest tube (OR: 3.27; 95% CI: 1.83 - 5.84; P = 0.000), and pain in any part of the body (OR: 1.95; 95% CI: 1.06 - 3.58; P = 0.031). CONCLUSIONS: Physical or physiological and psychological stressors impose greater stress and are predictors of anxiety. When preparing their nursing care plan, nurses should consider these stressors that affect anxiety levels in patients undergoing CABG surgery and those hospitalized in intensive care units.
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OBJECTIVE: To examine the relationship between proinflammatory cytokines, such as interleukin-6 (IL-6) and C-reactive protein (CRP) and atrial fibrillation after on-pump coronary artery bypass grafting (CABG). METHODS: Fifty-four patients with coronary artery disease undergoing elective CABG at the Mazandaran Medical University, Mazandaran, Iran were enrolled in our prospective study in the year 2007. Postoperatively, heart rate and rhythm were continuously monitored for 5 days. Fasting blood samples were taken from all patients to examine quantities of CRP and IL6 the day before surgery and on the second postoperative day in the intensive care unit. RESULTS: From 54 patients, 11 patients (20.4%) developed atrial fibrillation (AF) after CABG. The median age of patients with AF was 51.45 +/- 10.74 compared with 57.28 +/- 9.04 for patients with sinus rhythm (p=0.072). Cardioplegic time, cross clamp time, and pump time were higher in the AF group, but there was no significant difference between the 2 groups. Preoperative CRP and IL6 levels were higher in patients with AF. The CRP and IL6 increased after CABG in all patients, but it increased more in the AF group. CONCLUSION: There was a significant relationship between preoperative IL6 and AF in patients who underwent on-pump CABG, but there was no relationship between CRP and AF. Therefore, administration of glucocorticoids, which significantly reduce plasma levels of IL6 can reduce the incidence of AF after on-pump CABG.