Journal of Isfahan Medical School
Year:2016 | Volume:34 | Issue:369|Papers Count:8

Background: Inhibition of the renin-angiotensin system in patients with diabetic nephropathy can reduce proteinuria and slow down renal impairment. In this study, we aimed to evaluate the preventive effects of prescribing both angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) for renal disease progression compared with administrating each of these two medications alone in patients with type 2 diabetes.Methods: 90 patients with diabetic nephropathy were randomized into three groups: receiving captopril, losartan, and losartan in combination with captopril. Proteinuria was measured before, 2, 6 and 12 months after intervention, and creatinine clearance was measured before and after intervention. Repeated measures ANOVA, Fisher's least significant difference (Fisher's LSD), and t-test were used for data analysis by SPSS software.Findings: Proteinuria was improved in all groups who received medication (P<0.001). This reduction in the group who received losartan in combined to captopril was more than other groups (P=0.026). Creatinine clearance was not significantly different between all groups.Conclusion: Administration of ACEI or ARBs reduced proteinuria in patients suffering from diabetic nephropathy (due to type 2 diabetes) but prescribing both drugs had a significantly better outcome. However, creatinine clearance was not significantly improved in any of the groups.

Background: Hemorrhage after cardiopulmonary bypass is one of the most important complications of pediatric heart surgery and fresh frozen plasma (FFP) infusion is the first intervention to compensate for the lost blood. Some studies show that injecting combined fibrinogen and albumin can also compensate for this lost blood. Thus, the aim of this study was to compare the effect of synthetic fibrinogen plus albumin with fresh frozen plasma for the prevention of coagulation disorders in pediatric heart surgery.Methods: In this clinical-trial study 90 candidates for pediatric heart surgery were selected and randomly divided in two groups. The first group received fresh frozen plasma and the second group received combined fibrinogen and albumin. Serum hemoglobin, serum platelets count, serum fibrinogen level, prothrombin time, partial thromboplastin time, activated clotting time, arterial blood gas were measured before and after the surgery and compared between the two groups.Findings: Before undergoing the surgery, mean serum level of hemoglobin in FFP and fibrinogen/albumin groups was 10.6±1.9 and 11.9±3.3, respectively and no statistical difference between the two groups were reported (P=0.29). one hour after surgery this number was 12.9±2.2 and 12.3±2.3 in the two groups respectively (p=0.18) and 24 hour after surgery it was reported as 12.9±1.7 and 13.1±2.6 respectively which was not statistically different between the two groups (P=0.69). Also, no statistical difference was reported between the two groups in changes of mean hemoglobin level before and after the study (P=0.75).Conclusion: According to the results of this research, using a combination of fibrinogen and albumin had the same effect for prevention of post-surgical coagulation disorders and is suitable for children undergoing pediatric heart surgery if there are not any other contraindications for their use.

Background: Shivering is one of the most common post-operative complications and there are several recommended preventive methods. In this study the preventive effect of adding pethidine or sufentanyl for postoperative shivering in herniated disk surgery was evaluated.Methods: In this clinical-trial study 126 candidates for herniated disk surgery were selected and randomly divided in three groups.0.5 ml normal saline, 0.5 ml sufentanyl and 0.5 ml pethidine were added to marcaine in the first, second and third groups, respectively and post-operative shivering was compared between the three groups.Findings: the mean score of post-operative shivering in the three groups of normal saline, sufentanyl and pethidine was 2.40±0.66, 1.88±1.10 and 1.07 ± 0.34, respectively and this difference was statistically different (P=0.002). Also, according to LSD post Hoc test report, the difference between normal saline and sufentanyl group (P<0.001) and between pethidine and normal saline (P<0.001) was statistically different.Conclusion: Considering the results of this study, adding sufentanyl to marcaine does not decrease the incidence of post-operative shivering in herniated disk surgery compared to adding pethidine. But, the incidence and severity of shivering is lowered when compared to the control group. Hence, because of its availability, low cost and small effects of Sufentanyl on patients’ hemodynamics, it can be used in order to prevent post-operative shivering, pain, vomiting and nausea.

Background: The unique properties of mesenchymal stem cells (MSCs) have made them powerful tools in cell therapy and genetic engineering and Murine Mesenchymal stem cells are a suitable model for study in this field.Compared with human mesenchymal stem cells, murine mesenchymal stem cells have different features such as heterogeneity and slow growth rate. Several reports have shown that microRNAs are involved in many cell regulatory processes such as hypoxia. In this study, the effect of hypoxia was investigated on the expression of hypoxia related microRNA in murine mesenchymal stem cells isolated from adipose tissue (AD-MSC).Methods: AD-MSCs were cultured in two hypoxic and normoxic conditions. The expressions of mir-21 and mir-130a in the primary and immortality phase of AD-MSC were evaluated by using Real-time PCR technique.Also, the expression of MSCs surface markers were investigated by flow cytometry in the two mentioned phases.Findings: Our study showed the expression of mir-21 and mir-130a was increased in hypoxic conditions compared to normoxia. Also expressions of surface markers were different in primary and immortality phase.Conclusion: Considering that stem cells are sensitive to environmental oxygen levels, over-expression of mir-21 and mir-130a could promote the survival of MSCs exposed to hypoxia.

Background: Although there has been a significant reduction in morbidity and mortality of gynecological patients due to new advancement in medical sciences, post caesarean section hemorrhage is still a major cause of maternal mortality and the reason for half postpartum deaths.Case Report: A 37 years old woman, 37 week gestation, with a history of two previous caesarean sections and two curettages and placenta accrete was being treated for pulmonary embolism. In sonography, placenta accrete with diffusion to bladder was diagnosed. She was rushed to operation room because of pulmonary hypertension and underwent caesarean section. Massive hemorrhage happened after the fetus was delivered, so hysterectomy was performed with bilateral hypogastric artery ligation because of placental penetration into bladder and lateral side of pelvis and two big-size drains were placed due to diffuse oozing. The infused volume of crystalloid and blood components to the patient was increased but disseminated intravascular coagulation happened as a complication of dilution coagulopathy and massive transfusion which was managed with fresh frozen plasma (FFP) and platelet transfusion. By the end of surgery, the patient underwent cardiac arrest, but was resuscitated in less than five minutes and the heart rate went back to normal and vital signs became stable. The patient was transferred to intensive care unit with tracheal tube in-place. One week later, the patient underwent acute respiratory distress syndrome but her condition improved after two weeks and she was discharged.Conclusion: Placenta precreta surgery is associated with severe bleeding and high volume of fluid and blood may be required to stabilize the vital signs. Infusion rate should be reduced afterwards and patient's systolic pressure be kept between 70 and 100 mm Hg so that possible dilution coagulopathy would not happen as a complications of this massive transfusion.