Purpose: It has been reported that cobalamin and folate deficiency is related to delirium in persons with dementia. We evaluated the association of admission serum levels of cobalamin, folic acid, and homocysteine with the occurrence of acute delirium after coronary artery bypass surgery. Methods: In this prospective cohort study, serum levels of cobalamin, folic acid, and homocysteine were measured for 296 patients upon admission. Delirium was defined by the confusion assessment method for the intensive care unit. Results: Postoperative delirium was detected in 23% (n=68) of patients. Cobalamin deficiency, folate deficiency, and hyperhomocysteinemia were observed in 29% (n=86), 6% (n=18), and 68% (n=200) of patients, respectively. The mean ± SD serum levels of folic acid were 10.77±5.39 ng/mL and 12.86±6.51 ng/mL in delirium and non-delirium patients, respectively ( P =0.008). The median (interquartile range [IQR]) serum levels of cobalamin were 280 (216–351) and 247 (195.5–336) in delirium and non-delirium patients, respectively ( P =0.09). The median (IQR) serum levels of homocysteine were 18.5 (14.5–22.1) µmol/L and 17.33 (14.2–23.2) µmol/L in delirium and non-delirium patients, respectively ( P =0.94). Multivariate regression analysis adjusted by other risk factors indicated that serum homocysteine, folate, and cobalamin levels had no association with the occurrence of delirium. Conclusion: There was no relationship between the preoperative levels of cobalamin, folate, and homocysteine, and acute occurrence of delirium observed after cardiac surgery.

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Background: We investigated the impact of a home-based exercise intervention (HBEI) on cardiac biomarkers, liver enzymes, cardiometabolic outcomes, and health-related quality of life (HRQL) in clinically stable patients after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Materials and Methods: The study was a nonrandomized clinical trial conducted in Tehran, Iran, from July 2019 to January 2020. Forty cardiac patients (after the cardiac intervention, CABG, n = 32; PCI, n = 8) were recruited based on the study inclusion criteria and were allocated consecutively to one of two groups: (1) HBEI ( n = 18) and (2) conventional center-based exercise program (CBEP, n = 22). The CBEP group performed the routine exercise program of Sadr Heart Clinic, and the HBEI group performed a home-based remotely monitored exercise protocol, both three times per week, for 8 weeks. The following variables were assessed before and after the intervention: anthropometric measures; blood pressure; lipid profile; cardiac biomarkers including cardiac troponin I, creatine kinase, and total and Mb isozyme; liver enzymes including aspartate aminotransferase and alanine aminotransferase; creatinine; urea; exercise capacity; and HRQL. Results: In comparison with pretest in both CBEP and HBEI groups, a significant improvement in all of the measured variables ( P < 0.05), but not in ejection fraction was observed ( P > 0.05). Moreover, in the CBEP group, a more significant decline in troponin I levels ( P = 0.03), and in the HBEI group, a greater reduction in weight ( P = 0.01) and body mass index ( P = 0.04) occurred. Conclusion: The findings suggest that a properly designed and monitored HBEI may be as effective as conventional center-based cardiac rehabilitation (CR) exercise programs and should be encouraged in those cardiac patients who are unable or uninterested in conventional center-based CR exercise programs.

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Conclusions:The smart hand grip ball can provide those patients who need vascular access rehabilitation the grip strength and pressing frequency during training course and maintain the long term patency of vascular access. On the other hand, medical team can monitor the patient's rehabilitation progress through our design and improve vascular access care. Therefore, this system is capable of developing into the application for healthcare.