Prophylactic Fibrinogen Decreases Postoperative Bleeding but Not Acute Kidney Injury in Patients Undergoing Heart Transplantation

The present study is the premier clinical attempt to scrutinize the practicability of prophylactic fibrinogen infusion in patients undergoing heart transplantation (HT). A total of 67 consecutive patients who had undergone HT between January 2012 and December 2014 were assessed. After exclusion of some patients, 23 patients were given preoperative 2 g fibrinogen concentrate over a period of 15 minutes after the termination of cardiopulmonary bypass pump and complete reversal of heparin, and 30 patients were not given. Some laboratories were measured before general anesthesia and at 6 and 24 hours after surgery. In addition, major adverse events were also evaluated during hospitalization. The mean age of the patients was 39.5 ± 11.4 years, with a predominance of male sex (77.4). All laboratories at baseline were comparable between groups. The length of hospital stay was longer in the control group compared to the fibrinogen group (20 16-22 vs 16 12-19 days; P =.005). There was a trend for patients in the fibrinogen group to have more acute kidney injury (AKI) after surgery (10% vs 30.4%) and less reoperation for bleeding (20% vs 8.7%). The amount of postoperative bleeding was significantly higher in the control group compared to the fibrinogen group (P <.001). The number of packed red blood cell transfused during 24 hours after surgery was significantly lower in the fibrinogen group (P <.001). The transfusion of fibrinogen in patients undergoing HT may be associated with reductions in postoperative bleeding, the number of packed red blood cells, and hospital length of stay; however, it may enhance postoperative AKI. © The Author(s) 2017

Effects of l-carnitine on serum lactate and cardiac complications in patients with heart failure undergoing coronary artery bypass grafting: A randomized clinical trial

Background: The effects of L-carnitine on serum lactate and its metabolism remain uncertain, particularly in candidates for revascularization with a high likelihood of a postoperative rise in lactate levels. The present study aimed to assess the effects of L-carnitine on lactate levels after coronary artery bypass graft surgery (CABG) in patients with grade I heart failure. Methods: in this randomized clinical trial, 64 consecutive patients suffering from mild heart failure (grade I) who were candidated for coronary revascularization were randomly divided into 2 groups (32 patients in each group) receiving L-carnitine (3 g orally 2 hours before surgery) or a placebo for the same duration before surgery. Postoperative adverse events, as well as the trend of the change in the levels of serum lactate, creatinine, and hemoglobin, within 24 hours after surgery were assessed. Results: No difference was revealed between the 2 groups in terms of serum lactate levels before surgery (1.51 ± 0.79 in the intervention group vs 1.35 ± 0.43 in the control group; P = 0.33), during intra-aortic balloon pumping (2.27 ± 1.28 in the intervention group vs 2.70 ± 1.42 in the control group; P = 0.20), and also after separating the pump (2.96 ± 1.61 in the intervention group vs 2.56 ± 0.87 in the control group; P = 0.22). No difference was also observed concerning postoperative complications, including atrial fibrillation (P = 0.42), delirium (P = 0.99), agitation (P = 0.88), intra-aortic balloon pump insertion (P = 0.99), atelectasis (P = 0.98), and respiratory distress (P = 0.99). Conclusions: Administrating L-carnitine had no protective effects on the rise in postoperative serum lactate levels following CABG in our patients with low-grade heart failure. © 2020, Iranian Heart Association. All rights reserved

SARS-Cov-2 and COVID-19, Basic and Clinical Aspects of the Human Pandemic: A Review

In the last two decades, we have witnessed three major epidemics of the coronavirus human disease namely, severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome, and more recently an ongoing global pandemic of coronavirus disease 2019 (COVID-19). Iran, a country of nearly 84 million, in the Middle East, severely involved with the COVID-19 disease. A documented multidimensional approach to COVID-19 disease is therefore mandatory to provide a well-balanced platform for the concerned medical community in our county and beyond. In this review, we highlight the disease status in Iran and attempt to provide a multilateral view of the fundamental and clinical aspects of the disease including the clinical features of the confirmed cases, virology, pathogenesis, epidemiology, and laboratory methods needed for diagnosis