Effects of Acetyl-L-Carnitine on Cardiac Arrhythmias and Infarct Size in Ischemic-Reperfused Isolated Rat Heart

This study aimed to examine whether acetyl-L-carnitine (ALC) was able to reduce cardiac arrhythmias and infarct size in the ischemic-reperfused isolated rat heart.Materials and MethodsThe isolated hearts were mounted on a Langendorff apparatus then perfused by a modified Krebs-Henseleit solution during 30 min regional ischemia and 120 min reperfusion (control) or by enriched Krebs solution with 0.375, 0.75, 1.5 and 3 mM of ALC (treatment groups). The ECGs were recorded and analyzed to determine cardiac arrhythmias. The infarct size was determined by using a computerized planimetry package.ResultsDuring ischemia, all used concentrations of ALC decreased number and duration of ventricular tachycardia (VT), total number of ventricular ectopic beats (VEBs) (P<0.01), incidence of total ventricular fibrillation (VF) and the time spent for reversible VF (P<0.05). At the reperfusion phase, duration of VT, incidence of total VF and reversible VF were significantly lowered by ALC (P<0.05). In addition, infarct size significantly was decreased in all treated groups. In the control group, the infarct size was 23±3.1%, however, ALC (0.375, 0.75 and 3 mM) reduced it to 8.7±2.3, 5.3±1.4, and 8±2.9%, respectively (P<0.01). ConclusionConsidering the results, it may be concluded that ALC has protective effects against cardiac ischemia-reperfusion (I/R) injuries by reduction of infarct size and arrhythmias in isolated rat heart. Among the potential cardioprotective mechanisms for ALC, increase in glucose oxidation and resulting reduced lactate production, reduction of toxic fatty acid metabolites and removing free radicals from the myocytes are more relevant

Effects of Chronic Oral Administration of Natural Honey on Ischemia/Reperfusion-induced Arrhythmias in Isolated Rat Heart

Objective(s)In this study, effects of chronic administration of oral natural honey against ischemia/reperfusion (I/R)-induced cardiac arrhythmias were investigated in isolated rat heart. Materials and MethodsMale Wistar rats were divided into four groups (n= 10-14 rats in each group) and fed with natural honey (1%, 2% and 4% dissolved in the drinking water) for 45 days except for the control group. After anesthesia, the rats’ hearts were isolated quickly, mounted on a Langendorff apparatus and perfused with a modified Krebs-Henseleit solution during stabilization, 30 min regional ischemia followed by 30 min reperfusion. The ECGs were recorded throughout the experiments to analyze cardiac arrhythmias based on the Lambeth conventions. ResultsIn the ischemic phase, honey (1%) significantly reduced (P<0.05) the number and duration of ventricular tachycardia (VT). Honey (1% and 2%) also significantly decreased number of ventricular ectopic beats (VEBs). In addition, incidence and duration of reversible ventricular fibrillation (Rev VF) were lowered by honey 2% (P<0.05). During reperfusion time, VT incidence was 73% in the control group, however natural honey (1%) decreased it to 22% (P<0.05). Honey also produced significant reduction in the incidences of total VF, Rev VF, duration and number of VT. ConclusionFor the first time, the results of present study demonstrated protective effects of chronic oral honey administration against I/R-induced arrhythmias in isolated rat heart. Antioxidant activity, the existence of energy sources such as glucose and fructose and improvement of some hemodynamic functions might be responsible for these effects

Association between Level of Vitamin D with Environmental and Bioelement Factors in Children with Attention Deficit Hyperactivity Disorder (ADHD)

Background: Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder. The exact pathophysiology of ADHD is not completely recognized. Previous studies have shown the role of different genetic and environmental factors in it. This study investigates the relationship between vitamin D and environmental factors in ADHD. Methods: In this study, 182 children from 2 to 18 years with confirmed ADHD were allocated in this cross-sectional study. Patients with a history of any chronic disease, anticonvulsants and corticosteroids consumption were excluded from the study. The ADHD severity was assessed by Conners’ parent scale test. The level of serum vitamin D, ferritin, iron, total iron binding capacity, zinc, magnesium, calcium and routine complete blood count (CBC) were measured. Results: Although the results showed a U shaped pattern between vitamin D levels and ADHD severity, the correlation between vitamin D level did not show any significant relation with ADHD symptoms severity (p=0.786). Our data showed significant relation between level of vitamin D and ferritin in patients with ADHD (p=0.003). The analysis demonstrates significant relation between vitamin D level and duration of daily TV watching in children with ADHD (p=0.002). Conclusion: The vitamin D supplementation may improve ADHD symptoms in patients with vitamin D deficiency. In addition, due to the proved effect of ferritin level in ADHD and significant relation with vitamin D level in this study, treatment of vitamin D deficiency is necessary in children with ADHD. Replacing TV watching by more outdoor activity may improve ADHD symptoms

Long and Short-term Metformin Consumption as a Potential Therapy to Prevent Complications of COVID-19

Purpose: The aim of the study is to evaluate the effect of metformin in complication improvement of hospitalized patients with COVID-19. Methods: This was a randomized clinical trial that involved 189 patients with confirmed COVID-19 infection. Patients in the intervention group received metformin-500 mg twice daily. Patients who received metformin before admission were excluded from the control group. Patients who were discharged before taking at least 2000 mg of metformin were excluded from the study. Primary outcomes were vital signs, need for ICU admission, need for intubation, and mortality. Results: Data showed that patients with diabetes with previous metformin in their regimen had lower percentages of ICU admission and death in comparison with patients without diabetes (11.3% vs. 26.1% (P=0.014) and 4.9% vs. 23.9% (P≤0.001), respectively). Admission time characteristics were the same for both groups except for diabetes and hyperlipidemia, which were significantly different between the two groups. Observations of naproxen consumption on endpoints, duration of hospitalization, and the levels of spO2 did not show any significant differences between the intervention and the control group. The adjusted OR for intubation in the intervention group versus the control group was 0.21 [95% CI, 0.04-0.99 (P=0.047)]. Conclusion: In this trial, metformin consumption had no effect on mortality and ICU admission rates in non-diabetic patients. However, metformin improved COVID-19 complications in diabetic patients who had been receiving metformin prior to COVID-19 infection, and it significantly lowered the intubation rates

A novel practical equation for treatment of emergent hypernatremia and dehydration phase in infants

Serum sodium (Na) concentration more than 145 mmol/L is defined as hypernatremia. Hypernatremia carries an acute morbidity and mortality, especially in neonates and infants. Rapid correction of hypernatremia leads to severe cerebral damages, and seizure is the most common neurological complication of hypernatremia. Selection and calculation of an appropriate fluid and its amount is one of the tremendous challenges. It is important to choose the correct amount of suitable fluid and adjust rehydration rate. In this study, we have suggested practical equation to determine the amount of fluid that should be administered to the neonates and infants with hypernatremia. In this equation, the amount of infusate volume will be calculated from changes in serum Na and total body water. However, serum Na and infusate Na will play an important role in equation structure, too. Our suggested equation will help physicians to manage hypernatremic dehydrated patients in a suitable manner with an adjustable rate

Stem cells-derived exosomes as cardiac regenerative agents

Heart failure is a root cause of morbidity and mortality worldwide. Due to the limited regenerative capacity of the heart following myocardial injury, stem cell-based therapies have been considered a hopeful approach for improving cardiac regeneration. In recent years, different kinds of cell products have been investigated regarding their potential to treat patients with heart failure. Despite special attention to cell therapy and its products, therapeutic efficacy has been disappointing, and clinical application is not affordable. In the past few years, a subset of small extracellular vehicles (EVs), commonly known as “exosomes,” was reported to grant regenerative and cardioprotective signals at a value similar to their donor cells. The conceptual advantage is that they may be ideally used without evoking a relevant recipient immune response or other adverse effects associated with viable cells. The evidence related to their beneficial effects in animal models of heart failure is rapidly growing. However, there is remarkable heterogeneity regarding source cells, isolation process, effective dosage, and delivery mode. This brief review will focus on the latest research and debates on regenerative potential and cardiac repair of exosomes from different sources, such as cardiac/non-cardiac stem, somatic cells, and progenitor cells.Overall, the current state of research on exosomes as an experimental therapy for heart diseases will be discussed

Effects of Chronic Oral Administration of Natural Honey on Ischemia/Reperfusion-induced Arrhythmias in Isolated Rat Heart

Abstract Objective(s) In this study, effects of chronic administration of oral natural honey against ischemia/reperfusion (I/R)-induced cardiac arrhythmias were investigated in isolated rat heart. Materials and Methods Male Wistar rats were divided into four groups (n= 10-14 rats in each group) and fed with natural honey (1%, 2% and 4% dissolved in the drinking water) for 45 days except for the control group. After anesthesia, the rats&apos; hearts were isolated quickly, mounted on a Langendorff apparatus and perfused with a modified Krebs-Henseleit solution during stabilization, 30 min regional ischemia followed by 30 min reperfusion. The ECGs were recorded throughout the experiments to analyze cardiac arrhythmias based on the Lambeth conventions. Results In the ischemic phase, honey (1%) significantly reduced (P&lt;0.05) the number and duration of ventricular tachycardia (VT). Honey (1% and 2%) also significantly decreased number of ventricular ectopic beats (VEBs). In addition, incidence and duration of reversible ventricular fibrillation (Rev VF) were lowered by honey 2% (P&lt;0.05). During reperfusion time, VT incidence was 73% in the control group, however natural honey (1%) decreased it to 22% (P&lt;0.05). Honey also produced significant reduction in the incidences of total VF, Rev VF, duration and number of VT. Conclusion For the first time, the results of present study demonstrated protective effects of chronic oral honey administration against I/R-induced arrhythmias in isolated rat heart. Antioxidant activity, the existence of energy sources such as glucose and fructose and improvement of some hemodynamic functions might be responsible for these effects

Evaluating the Potential Effect of Melatonin on the post-Cardiac Surgery Sleep Disorder

Background: Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery (CABG). Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG. Method: One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score (GSQS), and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance (ANCOVA) and independent t-test were used to compare the sleep and anxiety scores between the groups. P values ≤ 0.05 were considered statistically significant. Results: Totally, 137 patients at a mean age of 60 years completed the study (76% male). The analysis of the data showed that sleep was significantly disturbed after surgery in both groups. The patients in the Oxazepam group demonstrated significantly higher disturbance in their mean postoperative GSQS score than did their counterparts in the melatonin group (p value < 0.001). A smaller proportion of the participants experienced delirium in the melatonin group (0.06%) than in the Oxazepam group (0.12%); however, this difference was not statistically significant. Conclusion: The result of the present study revealed that melatonin improved sleep in post-cardiac surgery patients more than what was observed with Oxazepam. Therefore, melatonin may be considered an effective alternative for Benzodiazepines in the management of postoperative sleep disorder

Association between Perioperative Parameters and

Background: Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient’s life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery. Methods: One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change. Results: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change. Conclusion: Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients’ basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery