Role of omega-3 fatty acids in the prevention of delirium in mechanically ventilated patients.

BACKGROUND: Inflammation is an important mechanism in the pathogenesis of delirium. Since delirium might reduce by anti-inflammatory effects of omega-3 fatty acids. Based on this respect, a study was conducted to indicate the effect of omega-3 fatty acids in the prevention of delirium in mechanically ventilated patients. MATERIALS AND METHODS: This study is a randomized, double-blind, placebo-controlled clinical trial. One hundred and sixty-eight mechanically ventilated patients were selected in the investigation. Patients were randomly allocated to receive either 2 g of omega-3 syrup or placebo once a day. Twice daily delirium was assessed due to Confusion Assessment Method and the Richmond Agitation-Sedation Scale. The number of days with delirium during the first 10 days of admission was the primary outcome. Secondary outcomes had been included duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mortality. RESULTS: Patient-days with delirium (P = 0.032), the number of ICU stay (P = 0.02), and mechanical ventilation (P = 0.042) days in omega-3 group significantly were lower than control group. Mortality was not significantly different between two groups. CONCLUSION: Omega-3 fatty acids can reduce the risk of delirium in mechanically ventilated patients.

Simvastatin's effects on survival and outcome in traumatic braininjury patients: a comparative study.

BACKGROUND/AIM: Mortality and morbidity still remain high in patients with traumatic brain injuries. Understanding the role of new treatments in these patients is critical. The aim of this study was to determine the effect of simvastatin on survival and outcome in traumatic brain injury patients. MATERIALS AND METHODS: Forty-four patients were assigned to receive either simvastatin or a placebo. The serum interleukin-6 and C-reactive protein levels were measured at the first 24 h and 48 h after trauma. All data, including the Glasgow Coma Scale score, survival at discharge, length of intensive care unit stay, and duration of mechanical ventilation, were collected. The effect of simvastatin on the collected data was then investigated. RESULTS: The Glasgow Coma Scale level at discharge was significantly higher in the simvastatin group. The overall mortality rate, duration of mechanical ventilation, and length of intensive care unit stay were similar between the 2 groups. The C-reactive protein concentration 48 h after trauma was significantly lower in the simvastatin group, but there was no significant difference according to the interleukin-6 level 48 h after trauma between the 2 groups. CONCLUSION: Simvastatin could be suggested as an adjunctive therapy in traumatic brain injury patients.

Comparison between intrathecal and intravenous betamethasone for post-operative pain following cesarean section: a randomized clinical trial.

OBJECTIVE: Inadequate postoperative pain relief after cesarean section can increase complications. In this study, we evaluated the effect of intrathecal betamethasone as an adjunct to bupivacaine on postoperative pain in patients undergoing cesarean section. METHODOLOGY: Ninety-nine patients undergoing cesarean section were assigned to one of three groups. Group 1 (Control) patients received intrathecal bupivacaine, Group 2 patients received intrathecal bupivacaine plus preservative free betamethasone and Group 3 patients received betamethasone intravenously with intrathecal bupivacaine. After surgery, diclofenac in suppository form was administered as needed for analgesia. Postoperative diclofenac requirements, time to first analgesic administration and visual analogue scale pain scores were recorded by a blinded observer. RESULTS: Supplemental analgesic dose requirement with diclofenac for the first 24 hours were significantly less in both groups that received betamethasone compared to the control group (P <0.0001). The mean duration of postoperative analgesia was 336.8±86 min in Intrathecal group and 312.4±106 min in Intravenous group compared with 245.4±93 min in control group (P =0.001). Visual analogue scale scores were significantly less at 4 hours (P<0.0001) and 6 hours (P<0.0001) after surgery in groups that received betamethasone in comparison to control group. The pain scores at 6 hours after surgery were higher in the Intravenous group compared with the Intrathecal group (P = 0.001); However visual analogue scale was not different at 12 and 24 hours after surgery between groups (p > 0.05). CONCLUSION: Intrathecal betamethasone reduced pain and decreased the required dose of diclofenac in 24 hours after cesarean section.

Association between Hypoadiponectinemia and Low Serum Concentrations of Calcium and Vitamin D in Women with Polycystic Ovary Syndrome.

Objective. To investigate the possible association of calcium and vitamin D deficiency with hypoadiponectinemia in women with PCOS. Subjects and Methods. In this case-control study, 103 PCOS cases and 103 controls included. The concentrations of calcium, 25-OH-vitamin D (25OHD), adiponectin, insulin, glucose, total cholesterol, HDL-cholesterol, triglyceride (TG), and androgens were measured in fasting blood samples. Results. Adiponectin (8.4 ± 2.7 ng/mL versus 13.6 ± 5 ng/mL in control group, P : 0.00), calcium (2 ± 0.1 mmol/L versus 2.55 ± 0.17 mmol/L in controls, P : 0.00), and 25-OH-Vit D (30 ± 2.99 nmol/L versus 43.7 ± 5.2 nmol/L in control group, P : 0.00) levels were decreased in women with PCOS. Subjects with PCOS had higher concentrations of TG (1.4 ± 0.77 mmol/L versus 1.18 ± 0.75 mmol/L in control group, P : 0.019) and dehydroepiandrosterone sulfate (DHEA-S) (10.7 ± 11 mmol/L versus 9.7 ± 10.4, P : 0.02 in control group). There were significant correlations between adiponectin concentrations with calcium (r : 0.78, P : 0.00) and 25OHD levels (r : 0.82, P : 0.00). The association of hypoadiponectinemia and PCOS was not significant considering 25OHD as a confounding factor. Conclusion. The present findings indicate that the association of hypoadiponectinemia with PCOS is dependent on vitamin D. A possible beneficiary effect of vitamin D on the metabolic parameters in PCOS may be suggested.

Serum magnesium concentrations in polycystic ovary syndrome and its association with insulin resistance.

OBJECTIVE: It has been revealed that low serum magnesium (Mg) is often associated with insulin resistance (IR), cardiovascular problems, diabetes mellitus, and hypertension. Patients with polycystic ovary syndrome (PCOS) are known to have a high incidence of insulin resistance. This study was designed to determine whether women with PCOS exhibit serum magnesium deficiency and its potential association with IR. SUBJECTS AND METHODS: In this cross-sectional study, 103 cases with PCOS and 103 normal women who were matched for their age and body mass index (BMI) were included. Blood samples were collected after an overnight fast and concentrations of calcium, magnesium, testosterone, dehydroepianderosterone sulfate, insulin, fasting plasma glucose (FPG), triglyceride, total cholesterol, and HDL-cholesterol were measured. RESULTS: The risk of PCOS for subjects with Mg deficiency was 19 times greater than those who had normal serum Mg concentrations (p ≤ 0.0001). No correlation was found between Mg and insulin sensitivity or secretion, FPG, dyslipidemias, and also androgen concentrations. After adjustment for calcium concentration the role of magnesium to predict PCOS attenuated and became non-significant (ß:-1.9, p: 0.7). CONCLUSION: The present study provides the first evidence showing that magnesium deficiency is not associated with IR in PCOS. According the evidences of this study, serum calcium concentration is more potent predictor of PCOS than serum Mg and only calcium, not Mg, is related to insulin resistance in PCOS.