ABSTRACT
BACKGROUND: Perivalvular and valve involvement are prevalent in patients with end-stage renal disease (ESRD), especially in younger patients compared with normal population. Kidney transplantation improves the prognosis of these patients. Patients with cardiac valvular disease is also be improved following kidney transplantation. OBJECTIVE: To evaluate the impact of renal transplantation on the severity of mitral regurgitation (MR). METHODS: We studied 95 kidney transplantation candidates in Sina Hospital. The patients underwent echocardiography preoperatively and at the 3rd, 6th, and 12th months post-operatively. RESULTS: Pre-operatively, the average MR fraction was 30%; MR volume 30 mL/beat; mitral valve mean gradient 1.8 mm Hg; mitral valve area 4.6 cm2; and mitral annular size 3 cm. No significant difference was observed among the measurements made at the 3rd, 6th, and 12th months post-operatively. CONCLUSION: There was no significant association between the variables measured pre- and post-operatively. The reason might be the fact that patients with ESRD in Iran do not have to expect long transplant waiting lists and dialysis cannot affect their heart adversely.
ABSTRACT
BACKGROUND: Reperfusion injury and the acid-base status of the transplant are important factors affecting post-transplantation graft function. OBJECTIVE: We hypothesized that infusing hypertonic saline (HS) or tight control of acid-base status of the blood rushing through renal graft using sodium bicarbonate may have beneficial effects on early graft function. METHODS: Candidates for deceased-donor kidney transplant were randomized into three groups. HS group (n=33) received 50 mL/kg normal saline (NS) titrated during operation plus 4 mL/kg of 5% HS just within graft reperfusion phase; bicarbonate group (n=37) was administered 60 mL/kg NS while their metabolic acidosis (base excess ≤5 mEq/L) was tightly corrected every 30 min with sodium bicarbonate; and a control group (n=36) that received 60 mL/kg normal saline while they were administered sodium bicarbonate only, if they encountered severe metabolic acidosis (base excess ≤15 mEq/L). The primary outcome was defined as early post-operative renal function evaluated based on serial serum creatinine levels. The study was registered in Iranian Registry of Clinical Trials (IRCT2013122815841N19). RESULTS: Post-operative early graft function improved significantly during the first 3 days in the intervention groups (p<0.05). However, that beneficial effect no longer remained at the same level after the day four. CONCLUSION: Timely administration of HS or tight control of metabolic acidosis with sodium bicarbonate infusion improve early renal function during renal transplant surgery.
ABSTRACT
BACKGROUND: This study was designed to assess the effectiveness of a series of journal clubs held for anesthesiology residents in promoting their awareness of research methods and statistical analysis, as well as their skills in critical thinking and appraisal. MATERIAL AND METHODS: Twenty-four journal club sessions were held between September 2006 and August 2007 for 16 residents of anesthesiology. A 31 multiple-choice question (MCQ) was taken as pretest and posttest to evaluate the participants' level of awareness in research methodology and statistical analysis. Their competence in critical thinking and appraisal was also evaluated by evaluating a randomized controlled trial paper using the CONSORT checklist before and after the course. RESULTS: Residents' awareness in the application of information improved (P = 0.012), as well as research methodology (combined study design and application of information, P = 0.017). Their ability in critical appraisal did also significantly rise at the end of the course (P < 0.001). CONCLUSION: Journal clubs can enable residents to develop the knowledge, expertise and enthusiasm needed to undertake research plans and can also enhance their ability in critical thinking and scientific reading.
