Isfahan University of Medical SciencesJournal of Isfahan Medical School1027-75953436920160320IndexIndex14864FAJournal Article20160716Click to download the index of this issue.Click to download the index of this issue.https://jims.mui.ac.ir/article_14864_e2cc88bcc7302f28d93e2d31c511986b.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75953436920160320The Combined Effect of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on the Progressing of Kidney Disease in Patients with Type 2 Diabetes Compared to Single Administration of Each of These Two DrugsThe Combined Effect of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on the Progressing of Kidney Disease in Patients with Type 2 Diabetes Compared to Single Administration of Each of These Two Drugs11014865FAHoushangSanadgolProfessor, Department of Nephrology, School of Medicine AND Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran0000-0003-1673-5741Mohammad RezaTamadonAssociate Professor, Department of Nephrology, School of Medicine, Semnan University of Medical Sciences, Semnan, IranAlirezaDashipourInstructor, Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IranHusseinGhazanfariResident, Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IranSamanehKhodadadiDepartment of Biology, Falavarjan Branch, Islamic Azad Uiniversity, Falavarjan, IranHamidNasriProfessor, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0003-1673-5741Journal Article20151014Background: 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: 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.https://jims.mui.ac.ir/article_14865_305ec2f907e0fcbb74f06fef40c9a4ac.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75953436920160320Comparing the Efficacy of Synthetic Fibrinogen Plus Albumin to Fresh Frozen Plasma in the Prevention of Coagulation Disorders in Pediatric Heart SurgeryComparing the Efficacy of Synthetic Fibrinogen Plus Albumin to Fresh Frozen Plasma in the Prevention of Coagulation Disorders in Pediatric Heart Surgery111914866FASeyed GholamrezaMasoumiAssociate Professor, Department of Anesthesiology and Critical Care, School of Medicine AND Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, IranHamidBigdelianAssistant Professor, Department of Cardiosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranSeyed MasoudMousavianStudent of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, IranAsgharMirzaeiDepartment of Anesthesiology, Chamran Hospital, Isfahan, IranHosseinAbediDepartment of Nursing, Chamran Hospital, Isfahan, IranMohsenZiaeifardAssistant Professor, Department of Anesthesiology and Critical Care, School of Medicine, Iran University of Medical Sciences, Tehran, IranJournal Article20151019Background: 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: 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.https://jims.mui.ac.ir/article_14866_4b77dd47a0fdceb8afde02dd6cae9ddf.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75953436920160320The Effect of Adding Sufentanyl or Pethidine to Intrathecal Marcaine for Prevention of Post-Operative Shivering in Patients Undergoing Herniated Disk SurgeryThe Effect of Adding Sufentanyl or Pethidine to Intrathecal Marcaine for Prevention of Post-Operative Shivering in Patients Undergoing Herniated Disk Surgery202714867FAMohammadaliAttariAssociate Professor, Anesthesiology and Critical Care Research Center, Isfahan, IranAmirZibaeianStudent of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20151019Background: 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 post-operative 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: 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 post-operative 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. https://jims.mui.ac.ir/article_14867_c113d499cd1461d6bc2f2db7c99fcd47.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75953436920160320Effect of Hypoxia on mir-21 and mir-130a Expression in Murine Adipose-Derived Mesenchymal Stem Cells in Primary and Immortality PhasesEffect of Hypoxia on mir-21 and mir-130a Expression in Murine Adipose-Derived Mesenchymal Stem Cells in Primary and Immortality Phases283414868FAShaghayeghHaghjooy-JavanmardAssociate Professor, Applied Physiology Research Center AND Department of Physiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranNajmiyehPakyariDepartment of Biology, School of Sciences, Islamic Azad University, Arsanjan Branch, Arsanjan, IranLalehRafieePhD student, Applied Physiology Research center, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20151019Background: 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: 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.https://jims.mui.ac.ir/article_14868_f277335b0fda4885798095b94a3d0bc8.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75953436920160320Case Report: Saving a Pregnant Woman from Pulmonary Embolism and Massive Hemorrhage due to Placenta Precreta with Invasion to BladderCase Report: Saving a Pregnant Woman from Pulmonary Embolism and Massive Hemorrhage due to Placenta Precreta with Invasion to Bladder354014869FABehzadNazemroayaAssistant Professor, Anesthesiology and Critical Care Research Center AND Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0001-6208-9053HatavGhasemi-TehraniAssistant Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0003-3112-8085Journal Article20151010Background: 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.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.https://jims.mui.ac.ir/article_14869_14d2bc475177e1dde633b4ca1972d53c.pdf