Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24475220170601Early Effectiveness of Noninvasive Positive Pressure Ventilation on Right Ventricular Function in Chronic Obstructive Pulmonary Disease Subjects with Acute Hypercapnic Respiratory Failure558563881710.22038/jctm.2017.23099.1129ENSharzad LariPulmonologist, Lung Disease research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran0000-0001-6678-9217Davood AttaranPulmonologist, Lung Disease research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran0000000188136487Farveh VakiliaCardiologist, Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-7514-6683Mostafa KamandiFellow of Hematology and Oncology, Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranHamideh Feiz DisfaniEmergency Medicine, Lung Disease Research Center, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20170424<strong>Introduction:</strong> Noninvasive positive pressure ventilation (NIPPV) has become an integral tool in the management of acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD). This study was performed to evaluate the early effects of NIPPV on pulmonary artery pressure (PAP), serum N-terminal pro BNP<br clear="all" /> (NT-proBNP), and ventilatory parameters in the COPD patients with AHRF.<br /> <strong>Materials & Methods:</strong> This quasi-experimental study was conducted on 20 COPD patients with AHRF. The participants received the standard treatment in addition to NIPPV. There was no contraindication for NIPPV. Arterial blood gas analysis, Doppler echocardiography (for measuring PAP), and plasma NT-proBNP measurements were performed before and after NIPPV.<br /> <strong>Results:</strong> According to the results, the mean age of the participants was 54.57±15.43 years. Furthermore, the mean pressures of carbon dioxide (PCO<sub>2</sub>), NT-proBNP levels, and PAP were 72.33±13.96 mmHg, 4333.90±6542.20 pg/ml, and 47.5±6.38 mmHg, respectively. After one week of NIPPV, there were statistically significant differences among the mean pH, PaCO<sub>2</sub>, PAP, and NT-proBNP (P<0.001, P=0.003, P<0.001, and P<0.001, respectively).<br /> <strong>Conclusion:</strong> As the findings of the present study indicated, the application of NIPPV in the COPD patients with AHRF can not only improve arterial blood pH and carbon dioxide tension, but also instantly decrease<br clear="all" /> NT-proBNP levels and PAP.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24475220170601The Lipid Profile Parameter in Chronic Obstructive Pulmonary Disease Patients and Correlation with Severity of Disease564568881810.22038/jctm.2017.22983.1128ENBhupendra JainPulmonologist, Department of Respiratory Medicine, Modern Institute of Medical Sciences, Indore, IndiaNikhilesh PasariPulmonologist, Department of Respiratory Medicine, Sri Aurobindo Institute of Medical Sciences and Pg Institute, Indore, IndiaAshwin SongraPulmonologist, Department of Respiratory Medicine, Sri Aurobindo Institute of Medical Sciences and Pg Institute, Indore, IndiaAshok BajpaiPulmonologist, Department of Respiratory Medicine, Sri Aurobindo Institute of Medical Sciences and Pg Institute, Indore, IndiaJournal Article20170419<strong>Introduction:</strong> More than 90% of the deaths caused by chronic obstructive pulmonary disease (COPD) occur in the low- and middle -income countries. The main aim of this study was to investigate the lipid profile levels in COPD patients and examine the correlation of total cholesterol, triglycerides, low-density lipoproteins, high density lipoproteins, and LDL/HDL risk ratio with COPD stages that are developed by the global initiative for chronic obstructive lung disease (GOLD)<br /> <strong>Materials & Methods:</strong> A total of 100 COPD patients including 25 COPD non-smokers were enrolled in this study. The diagnosis of COPD was carried out by using the spirometry following the GOLD guidelines (post-bronchodilator forced expiratory volume (FEV<sub>1</sub>)/forced vital capacity (FVC) ratio < 70% predicted). Accordingly, the patients were divided into four groups based on the severity of their disease in accordance with the GOLD guidelines, including mild COPD (stage I, FEV<sub>1</sub> ≥ 80% predicted), moderate COPD (stage II, 50% ≤ FEV<sub>1</sub> < 80% predicted), severe COPD (stage III, 30% ≤ FEV<sub>1</sub> < 50% predicted), and very severe COPD (stage IV, FEV<sub>1</sub> < 30% predicted). The fasting blood samples of lipid profile were collected. The four COPD groups were compared using the ANOVA test.<br /> <strong>Results:</strong> According to the results, the majority 53 patients (53%) were in age group 40 to 60 years with mean age of 60.46 +/-11.56. Most of the patients had moderate to severe airflow obstruction (GOLD stages II and III). The severity of COPD had no significant correlation with the triglycerides, LDL, HDL, and LDL/HDL risk ratio. The mean total cholesterol levels in the stages I and IV were 151.92±32.82 and 128.50 ±21.46 mg/dL, respectively, which was statistically significant (P=0.04).<br /> <strong>Conclusion:</strong> The present study indicates that there was no significant correlation between various lipid profile parameters and severity of COPD.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24475220170601Comparison the Outcomes of Open Thoracotomy and Minimally Invasive Thoracoscopic Esophagectomy in Esophageal Cancer569574874610.22038/jctm.2017.22852.1126ENReza BagheriThoracic Surgeon, Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-6785-1016Seyed Ziaollah HaghiThoracic Surgeon, Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, IranNazanin HazratiMedical Student, Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, IranMahdi Silanian ToosiRadiotherapist, Cancer Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranMitra AhadiGastroenterologist, Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20170405<strong>Introduction:</strong> Surgery is the first therapeutic option for esophageal cancer. There is controversy over the selection of the best surgical approach. Regarding this, the present study aimed to compare the minimally invasive and open esophagectomy in terms of their short-term outcomes and preoperative complications.<br /> <strong>Materials & Methods:</strong> This randomized clinical trial was conducted on 61 patients in Ghaem Hospital, Mashhad, Iran, within 2011-2013. The patients were assigned into two groups based on the type of therapeutic approach they received. The minimally invasive esophagectomy (MIE) and open esophagectomy (OE) groups consisted of 31 and 30 patients, respectively. For the purpose of the study, we collected such data as age, gender, site of lesion, bleeding, duration of surgery, rate of switch to open approach, post-operative morbidity, duration of hospital stay, and mortality rate.<br /> <strong>Results:</strong> According to the results of the study, 60.7% of the participants were male. The mean age of the patients was 62.39±11.91 years. There was no significant difference between the two groups regarding the site of lesion (P=0.014) and stage of tumor (P=0.108). No significant difference was observed between the MIE and OE groups in terms of the blood transfusion (P=0.981). Considering the complications, there was one case of fistula in the MIE group; furthermore, one and two cases of wound infection and pleural effusions were observed in the OE group, respectively. There were no significant differences between the two groups in terms of the post-operative complications, namely fistula, pleural effusions, and wound infection (P=0.492, P=0.238, and P=0.492, respectively). The MIE group had longer operation time (P≤0.001). There was one patient in the MIE group converted to open approach. The duration of hospitalization was significantly longer in the OE group, and there was no mortality.<br /> <strong>Conclusion:</strong> As the findings of the present study demonstrated, the MIE outcomes were comparable with those of the OE with improved short-term outcomes.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24475220170601Urgent Surgical Intervention for Embolized Cardiac Occluder Devices: A Case Series575578874710.22038/jctm.2017.23165.1130ENAshish Avinash BaviskarDepartment of Cardiovascular and Thoracic Surgery, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, IndiaChandan Kumar Ray MohapatraDepartment of Cardiovascular and Thoracic Surgery, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, India0000-0002-3163-6488Chaitanya RautDepartment of Cardiovascular and Thoracic Surgery, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, India0000000191743114Jayant KhandekarDepartment of Cardiovascular and Thoracic Surgery, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, IndiaJournal Article20170427<strong>Introduction</strong><strong>:</strong> In this study, we sought to illustrate our experience in urgent surgical management for embolized cardiac septal occlude devices resulting from trans-catheter closure of atrial septal defect and ventricular septal defect.<br /> <strong>Mathrials and Methods:</strong> We retrospectively reviewed four patients aged 2–10 years who underwent urgent surgery due to cardiac septal occluder embolization between December 2015 and December 2016. Congenital defects were atrial septal defect (n=2) and ventricular septal defect (VSD) (n=2). Risk factors for device embolization and the need for urgent surgical retrieval/definitive management techniques for embolized device removal are discussed.<br /> <strong>Results</strong><strong>:</strong> Removal of embolized devices was performed in all the cases. Inevitably, in three patients the primary defect was closed, while in one case of VSD the device was removed without closing the defect. All the operations were completed successfully and no hospital mortality or morbidity was encountered.<br /> <strong>Conclusions:</strong> Although closure of left to right shunting defects by percutaneous occluder devices has several advantages, device embolization is still a major complication. If embolized device retrieval fails with percutaneous intervention attempts, surgical management is the only method to remove embolized devices. In this circumstance, to provide an uneventful perioperative course, urgent management strategies should be well planned.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24475220170601A Case Report of Recurrent Rheumatic Fever: Considerations and Comments579582826210.22038/jctm.2017.19845.1120ENRamin Khamene BagheriInterventional cardiologist, Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranFaeze KeihanianClinician Scientist of Cardiology, Pharmaceutical Research Division, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, IranMostafa AhmadiInterventional cardiologist, Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranSamane HasanzadehCardiology Resident, Department, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20161030Rheumatic fever (RF) is a prevalent healthcare problem in the developing countries. Recurrence of this disorder is often observed in childhood and adolescence. RF can mimic the presentations of infective endocarditis, and clinicians are not really familiar with this issue. Herein, we present a case of recurrent acute rheumatic fever in a patient suspicious of acute bacterial endocarditis due to her previous RF. Finally, she was definitively diagnosed and underwent valvular replacement surgery and received prophylaxis antibiotics besides regular follow-upMashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24475220170601High-risk Coronary Artery Bypass Grafting and Mitral Valve Replacement in a HIV Positive Patient583586881910.22038/jctm.2017.13001.1082ENJuan SiordiaResearch Assistant, University of Arizona College of Medicine, Tucson, Arizona, United StatesSreekumar SubramanianSurgeon, University of Arizona College of Medicine, Tucson, Arizona, United StatesJournal Article20151104Certain subsets of high-risk mitral valve patients are not suitable candidates for transcatheter therapies. The objective of this report is to present a young patient with combined mitral valve and coronary artery disease to illustrate these challenges.In this report, we present a 47-year-old man with longstanding HIV infection who was referred with severe mitral regurgitation (MR) and profound cardiomyopathy to highlight the importance of decision-making and perioperative management.A 47-year-old HIV positive man with New York Heart Association class IV congestive heart failure was found to have severe MR (mixed Carpentier Type I and IIIB pathologies). The last viral load titer of the patient was undetectable. Cardiac catheterization revealed a chronic total occlusion of the middle of left anterior descending artery, ostial obtuse marginal and 70% posterior descending artery lesion, as well as severe pulmonary hypertension (PAP of 70/30 (mean: 43)), and a pulmonary vascular resistance of 4.6 Woods units. Preoperative cardiac magnetic resonance imaging showed left ventricular ejection fraction of 20%, right ventricular ejection fraction of 30%, nonviable circumflex distribution and scattered viability in the anterior and inferior cardiac walls. He underwent a high-risk coronary artery blood grafting plus mitral valve (MV) replacement (with intra-aortic balloon pump support). The postoperative course was complicated by gastrointestinal bleeding requiring transfusion, aspiration pneumonitis, atrial flutter and difficile colitis. However, the patient recovered appropriately, and remained asymptomatic and healthy in three months follow-up postoperatively. Application of transcatheter MV or device-assisted therapies for high-risk patients with severe MR might be limited due to financial, medical or social situations. In these instances, high-risk mitral valve surgery may still be the choice treatment in the selected patients.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24475220170601The Five Years Survival after Surgery of Primary Tracheal Squamous Cell Carcinoma: A Case Report and Review of the Literature587590882010.22038/jctm.2017.10862.1067ENSeyed Hossein Fattahi MasoomThoracic Surgeon, Endoscopy Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IranAmir Mohammad Hashem AsnaashariPulmonologist, Lung Diseases Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranSeyed Hossein Ahmadi HoseiniPulmonologist, Lung Diseases Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranYavar Shams HojjatiFellowship Plastic Surgeon, Lung Diseases Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranAida Shams HojjatiEmergency Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20150627Unlike the primary tracheal tumors, squamous cell carcinoma of trachea is common, especially in smokers. This type of tumor has a low rate of survival and it is diagnosed too late on account of late presentation of its signs. The treatment of choice is surgical removal followed by adjuvant radiotherapy; Primary radiotherapy is the appropriate treatment in inoperable cases. In this study, we present the case with a long history of smoking, who was suffering from cough and dyspnea for a long time. During diagnostic evaluations a vegetated tumor was observed about 5 centimeters below the vocal cords. Pathologists reported the tumor as a squamous cell carcinoma, and the patient underwent an operation for resection of involved trachea<strong>.</strong><br /> Through presenting this patient, we aimed to draw attention to this uncommon malignancy and recommend considering it as a probable diagnosis when evaluating a patient with treatment-resistant respiratory symptomsMashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24475220170601Individual Psychosexual Counseling Is One of the Educational Necessities for Cardiac Rehabilitation of Patients in Iran591592874810.22038/jctm.2017.22274.1125ENMozhgan SaeidiPhD Candidate in Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences. Kermanshah, IranAli SoroushLifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IranBehzad HeydarpourCardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences. Kermanshah, IranSaeid KomasiMaster of Clinical Psychology, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.Journal Article20161024Cardiovascular diseases (CVDs) are debilitating conditions with long-term physical and psycho-logical consequences (1). After a cardiac event or procedure, the patient encounters several problems, two of the most important of which are psychosexual dysfunction and difficulty in resuming sexual activity (2-4). The World Health Organization (WHO) defines sexual health as a state of physical, emotional, psychological, and social well-being related to sexual interaction and sexuality (2).<br /> Resuming sexual activity is a common concern among patients, such that in nearly half of patients resuming sexual activity is associated with fear (5). In the developed countries, despite cultural constraints and shame, numerous cardiac patients frequently request information on how to resume sexual activity (2). However, the evidence suggests that information on sexual issues is not easily available to patients, which can lead to misper-ceptions among patients on how to resume sexual activity (2, 6). According to the available evidence, 37-76% of cardiac patients experience changes in their sexual activity, only in 42% of whom these issues are raised with the treating physician (7, 8). However, in the developing countries, only 11% of patients receive information about sexual life after a cardiac event (7) and Iran is no exception in this regard. Barriers to sexual activity include lack of need for patients by health professionals, lack of experience of care providers, time constraints, linguistic and cultural barriers, as well as fear and shame (6).<br /> After cardiac event or procedures, doubt about resuming sexual activity, fear of sudden death during sexual intercourse, inadequate knowledge about when and how to resume sexual activity, as well as sexual anxiety and depression are the main obstacles cardiac patients face (9, 10). Based on the repeated recommendations of professionals and researchers on this issue, psychosexual counseling and rehabilitation is one of the educational needs of this group of patients (2, 3, 6, 8, 11), and the focus of sexual counseling strategies should be on assuaging patients' anxiety and the healthy resumption of sexual activity (3). Counseling and psychosexual education can be presented to patients in the form of verbal (face to face counseling), written (books and pamphlets), and visual (photos and videos) information (2, 6).<br /> The content of sexual education and psych-osexual counseling with a focus on psychosocial homework, including cognitive behavioral therapy and social support, can be effective in reducing patient anxiety and problems (6). In addition, in relation to delivery format of psychosexual counseling to cardiac patients, various approaches were proposed and it seems that culture plays an important role in choosing the appropriate format. Based on pair, group, or one-on-one teaching methods and seminars despite being used in different parts of the world (2, 6), it seems that one-on-one approach is more appropriate for the Iranian culture.<br /> Our experience in Kermanshah center of cardiac rehabilitation showed that patients do not welcome pair and group meetings and they generally refuse to participate in meetings and ask their questions. However, creating a private and safe environment with a same-sex counselor can facilitate participation of patients.<br /> Given that the sexual problems of men and women, and consequently, their needs are different (4), content of interventions should be defined according to the needs of each sex. Therefore, we recommend providing one-on-one psychosexual counseling, as one of the educational requirements of patients, in cardiac rehabilitation centers of Iran.