The Preconditioning Effect of Sevoflurane on Coronary Artery Bypass Surgery Patients

Background: One of the most important issues in the field of surgery is ischemic preconditioning (IPC) of the myocardium during the coronary artery bypass grafting (CABG). The current study attempted to reevaluate the issue to find a potential approach to diminish morbidity, inotrope administration, ischemia and possibly intensive care unit stay after CABG in adult patients.Materials and Methods: Through randomized single-blind clinical trial, all elective coronary bypass surgeries in 40 to 80 years-old patients enrolled the study. Atrioventricular (AV) block (mobitz2); complete heart block; left bundle branch block (LBBB); acute heart failure (ejection fraction (EF) <30%); re-exploration due to surgical complications and MI cases in the last 7 days were excluded. In all patients, induction (sufentanil, cis-atracurium and etomidate) and maintenance phase (sufentanil, midazolam, cis-atracurium) of anesthesia were done following the same protocol. After cross-clamp of aorta in intervention group, the patients received oxygen (2Lit/min) and sevoflurane (4%) during coronary bypass surgery. After rewarming of the patients, sevoflurane was discontinued. Main outcome measures were troponin 4, 8, 24, 48 hours after surgery with charting the electrocardiogram (ECG) changes, need for inotrope agents and hemodynamic indices during and after CABG in ICU.Results: 58 CABG candidates enrolled the current study: 29 in intervention group and 29 in control group. There were no statistical differences between the groups concerning hemodynamic issues, Central Venous Pressure (CVP), hematocrit (HCT), ECG changes, demands for inotrope, or ICU stay between the groups.Conclusion: No significant relationship between application of 4% sevoflurane and IPC was found in adult CABG patients. However, the effect of Sevoflurane on IPC might be dose-related.Keywords: Ischemic preconditioning (IPC); Sevoflurane; Coronary Artery Bypass Surgery (CABG

Comparison between Infusion Pumps: Fentanyl/Ketamine and Fentanyl/Paracetamol in Pain control Following Tight and Leg Surgeries

Background: Adjuvants such as ketamine, promethazine and paracetamol could bring up patients satisfaction and control harmful effects of opioids besides lessening their needed doses, as seen by fentanyl/paracetamol and fentanyl/ketamine combination before. The current study headed to compare paracetamol and ketamine in addition to fentanyl applied by infusion pumps in order to pain relief following major surgery.Methods: Through a double blinded randomized clinical trial, patients between18 and 65 with elective surgery for tight or leg fractures with ASA Class 1 and 2 referring to a university hospital in Arak, a town in central region of Iran, were recruited and used infusion pump for their postoperative pain control. The participants were divided into cases and controls regarding using ketamine/fentanyl (KF) or paracetamol/fentanyl (PF) infusion pumps.Results: The mean pain score was totally 3.87 with higher value in KF (5.06) and lower in PF (4.5) immediately after finishing surgery and getting conscious when started using infusion pump. There was no statistical difference between the groups in this regard. Concerning the side effects of the applied medications, blood pressure and heart rate had no differences comparing the groups.Conclusion: This study showed that paracetamol used in infusion pump can be brilliant in pain control after major surgeries like what done in lower extremities and joint replacement while lessens opioid use. Although paracetamol was more effective than ketamine in the current trial, more qualified studies at bigger size and in other fields of surgery beside orthopedic ones would be useful to support the effects if applicable.Keywords: Infusion pump, Ketamine, Paracetamol, Fentanyl, Postoperative pai

Cardiopulmonary Exercise Test in Advanced Heart Failure Among Heart Transplantation Candidates

Cardiopulmonary exercise test has been raised through recent decades as a brilliant prognostic tool in a wide field of diseases and clinical conditions which makes it valuable to be used in prognostic assessment during the current study among chronic heart failure (CHF) patients. This study recruited 71 patients with severe CHF who were candidates for heart transplantation. Bicycle-protocol Cardiopulmonary Exercise Test was done, and several parameters were measured and compared between four groups of patients based on their VO2/kg to show four grades of the disease from G1 to G4. Total 71 CHF subjects from 18 to 46 year of age enrolled in the study. Statistically significant correlations were determined between HRR, VE/VCO2, VE/VO2, BR and the severity of CHF. VO2max, HRR, VE/VO2, VE/VCO2, BR, and AT were the most prominent factors of CPET which showed their validity and reliability in terms of prognosis of CHF. It seems that combination of CPET and other cardiac prognostic tools like echocardiography and measurement of the pressure in cardiac chambers can improve the prognosis in CHF

Evaluating the role of vitamin D receptor polymorphisms on susceptibility to tuberculosis among Iranian patients: a case-control study

receptor polymorphisms o

A new ataxia-telangiectasia mutation in an 11-year-old female

Ataxia-telangiectasia (A-T), a rare inherited disorder, usually affects the nervous and immune systems, and occasionally other organs. A-T is associated mainly with mutations in the ataxia telangiectasia mutated (ATM) gene, which encodes a protein kinase that has a major role in the cellular response to DNA damage. We report here a novel ATM mutation (c.3244_3245insG; p.His1082fs) in an 11-year old female. This subject presented with typical features, with the addition of chest manifestations including mediastinal lymphadenopathy and diffuse bilateral micronodular infiltration of the lungs, along with a high EBV titer. The subject died as a result of rapid B-cell lymphoma progression before chemotherapy could be initiated. This case highlights the need for the rapid diagnosis of A-T mutations and the detection of associated life-threatening outcomes such as cancers