Ultra-low dose aprotinin effects on reducing the need for blood transfusion in cardiac surgery

To assess the effects of ultra-low dose one million kallikrein inhibitor units [KIU] of aprotinin on bleeding and the need for transfusion after cardiac surgery. We carried out this randomized clinical trial on 162 cardiac surgery patients in Shahid Madani Hospital, Tabriz, Iran from April 2004 to December 2005. The patients were randomly divided into 2 groups of 81 individuals. In the aprotinin group, 0.5 million KIU infused before and 0.5 million KIU during cardiopulmonary bypass. In the placebo group, 100 ml normal saline was infused as above. The need to use fresh frozen plasma [FFP], packed red blood cells [PRBCs] transfusion during, after operation, the rate of chest tubes drainage at 6, 12 and 24 hours after surgery were measured in 2 groups. Chest tubes drainage at 6 hours after surgery was 190 +/- 24 ml in the aprotinin group and 266 +/- 33 ml in the placebo group [p=0.066]. The amount of bleeding at 12 and 24 hours was significantly different between 2 groups [p=0.048, p=0.009]. The frequency of blood products transfusion in the aprotinin group was 68% and in the placebo group was 75% [p=0.02]. The number of PRBCs and FFP units transfused were significantly lower in the aprotinin group [p=0.000, p=0.005]. Total amount of blood and products transfusion in the aprotinin group was 2.56 +/- 0.27 units and in placebo group it was 4.37 +/- 0.27 units [p=0.0001]. Results indicate that the use of one million KIU of aprotinin in cardiac surgery is effective in reducing postoperative bleeding and transfusion requirements

Oxidative stress and homocysteine metabolism following coronary artery bypass grafting by on -pump and off- pump techniques

It is well documented that coronary artery bypass grafting [CABG] with cardiopulmonary bypass [CPB] causes ischemia and oxidative stress of the whole body. To compare the effect of on - pump and off -pump CABG on the induction of the oxidative stress and the metabolism of homocysteine which is involved in the synthesis of glutathione was investigated in the CABG patients during the early postoperative period. Plasma homocysteine, folate total antioxidant capacity [TAC] and malonedialdehyde [MDA] were determined by standard methods on blood samples obtained from 40 patients undergoing CABG, preoperatively and at 0, 12, 48, 120 hours and 6 months after surgery, The patients were divided into two matched groups. One of the groups underwent off - pump and the other on - pump CABG. A marked reduction of homocysteine, folate and significant elevation of MDA were noticed at 0, 12, 48 hours after operation in the both groups [P<0.05]. A negative and marked correlation between homocysteine and TAC but a positive and significant correlation between homocysteine and MDA were observed [P<0.05 in the both groups]. In CABG operation because of oxidative stress and consumption of GSH [Reduced Glutathione] immediate reduction in the plasma levels of homocyteine occurs in the both techniques. However using off pump CABG induction of oxidative stress and changes in plasma levels of homocysteine are not as high as on- pump CABG. The on-pump technique was correlated with a faster decrease in the homocysteine level during the first 12 hours and with a faster and higher elevation of the homocysteine concentration 12-48 hours postoperatively

Effects of Ramadan fasting on serum lipid profiles on 2 hyperlipidemic groups with or without diet pattern

The effects of Ramadan fasting, with low fat and low calorie diet, on blood lipid and lipoprotein levels were studied. Results revealed reduction of plasma lipid levels and anthropometric parameters in the hyperlipidemic cases. To find out whether such reductions were due to nutritional diet or Ramadan fasting, we conducted a study to evaluate effects of Ramadan fasting on 2 separate hyperlipidemic groups with or without nutritional diet regimen. This study was carried out at Madani Heart Hospital, Tabriz, Iran, during the year 1998. Thirty-eight hyperlipidemic healthy men voluntarily enrolled into 2 groups, group I, 22 men on low fat and low calorie diet and group II, 16 men without any special diet interference. The blood lipid profile tests were measured 4 times [3 weeks before, first week, last week and one month after Ramadan]. To evaluate nutritional composition, 12 times in non-successive days, 24 hour nutrition recalls were obtained from all individuals during the study. Analysis of data revealed that only triglyceride in both groups reduced in the beginning of Ramadan compared to 3 weeks before. During Ramadan, with a reduction of 300 Kcal/day in comparison to before Ramadan, no changes were seen concerning anthropometric parameters and serum lipids levels. It seems that the effect of Ramadan fasting on serum lipid levels may be closely related to the nutritional diet. For reduction of plasma lipid levels, it would be necessary to omit at least one term meal or reduce energy by 500 Kcal or more per day

Effects of low fat and low calorie diet on plasma lipid levels in the fasting month of Ramadan

In Ramadan, which is one month of the Hijra year, Muslims change their eating habits from 3 times to 2 times daily. The aim of this study was to evaluate the effects of fasting with low fat and low calorie diet on anthropometric parameters and plasma lipid profiles in hyperlipidemic men during the month of Ramadan. This study was carried out at the Madani Heart Hospital, Tabriz University of Medical Sciences, Tabriz, Iran during the year of 1997. Twenty-eight hyperlipidemic healthy men in a fasting group and 10 healthy men with top normal lipid levels in a non-fasting group were voluntarily enrolled for study. They were encouraged to use low fat and low calorie diet. The study started 20 days before and lasted one month after Ramadan. Laboratory tests including plasma total cholesterol, cholesterol-low density lipoprotein, cholesterol-high density lipoprotein and triglyceride were measured 4 times; 20 days before Ramadan, first day of Ramadan, on the last day of Ramadan and 30 days after Ramadan. Data analysis in fasting group revealed a significant reduction in energy intake and nutrient materials during Ramadan month [P<0.05] and plasma total cholesterol, cholesterol-low density lipoprotein and triglyceride levels decreasing towards the end of Ramadan [P<0.01]. In the non-fasting group, there were no significant changes in the above-mentioned parameters. It seems that Islamic fasting in Ramadan with low fat and low calorie diet leads to plasma lipids reduction in hyperlipidemic men