The effect of intravenous vitamin C on the phosphorus level reduction in hemodialysis patients: A double blind randomized clinical trial

Aim The majority of hemodialysis patients are hyperphosphate-mic. Hyperphosphatemia in these patients can lead to renal oste-odystrophy, vascular calcifcation, cardiovascular events, and is independently associated with mortality risk. The aim of this study was to evaluate the effect of intravenous vitamin C on phosphorus level in hemodialysis patients. Methods Using a double blind randomized clinical trial, a total of 60 qualified hemodialysis patients were randomly allocated in two intervention and control groups and serum phosphorus, CRP, calcium, albumin and PTH levels were measured. At the end of each hemodialysis session, intervention group received vitamin C vial (500mg/5cc) intravenously three times a week for 8 weeks and control group received normal saline in the same way. Data were collected before and after two months of treatment. Data were analyzed using independent t-test, paired t-test and chi-square test. Results Vitamin C treated group had a significant decrease in phosphorus (p=0.01), CRP level (p=0.01) and Ca�P product (p=0.03). In contrast, there was no significant difference in phosphorous (p= 0.5) and CRP levels (p= 0.6) and Ca�P product (p=0.7) in the control group. In addition, there was no statistically significant change in calcium (p=0.1), PTH (p=0.4) and albumin (p=0.4) levels in both groups. Conclusion Intravenous vitamin C can significantly decrease phosphorus level in hemodialysis patients

Metformin as an adjunct to insulin for glycemic control in patients with type 2 diabetes after CABG surgery: A randomized double blind clinical trial

Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing Coronaiy Arteiy Bypass Graft (CABG) surgery and there is a direct relation between postoperative hyperglycemia and mortality rate in these patients. The aim of the present study is to determine the efficacy of metformin on glycemic control in diabetic patients after CABG surgery. In a randomized double blind clinical trial, 100 patients with type 2 diabetes admitted in open heart ICU after CABG surgeiy in Mazandaran Heart Center were enrolled. They were randomly assigned to two intervention and control groups. Three hours after extubation, therapeutic antiglycemic regimens were applied in these two groups and continued for three days. Intervention group received regular insulin infusion along with two metformin 500 mg tablets per twelve hours while control group received regular insulin infusion with two placebo tablets per twelve hours. Blood glucose level and other parameters were measured andrecorded in determined intervals. To analyze the data, independent T-test, paired T-test, Mann-Whitney and repeated measure ANOVA tests were employed. Mean blood glucose level was not significantly different in the two groups at the beginning of the ICU admission; however, mean glucose level in insulin-metformin group, twelve hours after the initiation of the study, was significantly lower than insulin group (p<0.05). In addition, mean doses of potassium and insulin demand as well as mean number of episodes of hyperglycemia, hypoglycemia and glucose levels out of the accepted range were significantly lower in insulin-metformin group (p<0.05). Alterations in mean levels of lactate, BE, pH and creatinine were not statistically significant in these two groups. It seems that adding metformin to insulin leads to a better glycemic control in type two diabetic patients undergoing CABG surgeiy without causing metabolic acidosis. Therefore, it might be a potential option in blood glucose control protocol in this group of patients. © 2011 asian network for scientific information

Cognitive deficit in first-time coronary artery bypass graft patients: A randomized clinical trial of lidocaine versus procaine hydrochloride

Introduction: Cognitive dysfunction increasingly has been recognized as a complication after cardiac surgery. Different methods have been considered for the reduction of cognitive dysfunction after cardiac surgery. One of these methods is by using lidocaine during surgery. The aim of this study was to determine the effects of adding lidocaine to the cardioplegia solution on cognitive impairment after coronary artery surgery. Design and methods: In a prospective, randomized, double-blind trial, 110 patients aged between 20-70 years, scheduled for elective CABG surgery using cardiopulmonary bypass, were recruited into the study. They were randomized into two groups who received either cardioplegia solution containing lidocaine 2 mg/kg or procaine hydrochloride 5 mg/kg. The neurocognitive test used in this study was the Mini Mental State Examination (MMSE) or Folstein test. The test was done on the day before and 10 days and 2 months after the operation. Results: In the procaine group, the total score after 10 days decreased significantly compared to the preoperative score (mean difference 0.68; 95% CI: 0.20 to 1.17, p=0.006). Comparison between mean differences after 10 and 60 days of operation between the lidocaine and procaine groups were statistically significant, p-value 0.017 and 0.013, respectively. There was no cognitive impairment in the lidocaine group, but, in the procaine group, four patients (7.7%) after 10 days and one patient (1.9%) after both 10 and 60 days had cognitive impairment, p=0.051. Conclusions: Administration of lidocaine compared to that of procaine through the cardioplegia solution had a better effect on cognitive function after coronary artery bypass graft surgery. © The Author(s) 2012