مجله دانشکده پزشکی اصفهان
پیاپی 532 (هفته چهارم امرداد ماه 1398)

Recently, the prevalence of metabolic syndrome in societies is increasing. In this study, we investigated the association between metabolic syndrome and the severity of chronic obstructive pulmonary disease (COPD) based on the Global Initiative for Chronic Obstructive Lung Disease 2017 (GOLD 2017) criteria for outpatients.

In this cross-sectional study, 96 patients with COPD to Alzahra hospital in Isfahan, Iran, during the years 2016 and 2018 were enrolled. The severity of COPD in patients was determined based on the GOLD 2017 criteria, as well as the frequency of metabolic syndrome. Other factors such as lipid profiles, anthropometric characteristics were evaluated, and the association between severity of COPD and metabolic syndrome with other variables were studied.

The frequency of metabolic syndrome in patients with COPD was 86.5%. The mean of waist circumference, fasting blood sugar (FBS), systolic (SBP) and diastolic blood pressure (DBP), body mass index (BMI), and triglyceride in patients with metabolic syndrome and COPD were significantly higher than patients with COPD without metabolic syndrome (P < 0.050). Moreover, there was no significant relationship between COPD severity and metabolic syndrome (P > 0.050).

Metabolic syndrome was not associated with severity of COPD based on our findings, and further studies are needed.

Postoperative nausea and vomiting (PONV) is the most common and unpleasant postoperative complication. It seems that fluid-therapy during the surgery is effective on the onset of this complication. The aim of this study was to compare the effect of 30 and 10 ml/kg crystalloid infusion on PONV after laparoscopic cholecystectomy under general anesthesia.

In this study, 146 patients who were randomly divided into two equal groups were evaluated. One group received 30 ml/kg and the other 10 ml/kg Ringer solution as a preoperative intravenous bolus. The incidence and intensity of PONV, and the need for a rescue antiemetic were recorded by anesthesiologist in recovery, and 6, 12, and 24 hours after surgery.

The incidence of PONV was not significantly difference between the two groups. The intensity of vomiting in group 30 ml/kg was significantly lower 12 hours after surgery (P < 0.01). The antiemetic drugs were used significantly less in group 30 ml/kg than other group.

Preoperative intravenous administration of 30 ml/kg crystalloid compared with crystalloid 10 ml/kg in patients undergoing laparoscopic cholecystectomy did not reduce the incidence of nausea and vomiting, but reduced the intensity of vomiting 12 hours after surgery, and antiemetic use 24 hours after surgery.

This study aimed to compare the preventive effect of local infiltration of magnesium sulfate and bupivacaine on postoperative pain in lumbar fusion surgery under general anesthesia.

In a double-blind clinical trial study, 60 candidates for lumbar fusion surgery during 2018-19 in Alzahra hospital, Isfahan, Iran, were randomly divided into three groups. In the first group, magnesium sulfate, in the second group, bupivacaine, and in the third group, normal saline was infiltrated at surgery site. The severity of the pain, the amount of morphine received, and hemodynamic data were recorded and compared before and after operation, immediately after surgery, every 15 minutes until the end of recovery, and 1, 2, 6, 12, 18, and 24 hours after recovery.

The mean pain severity was not significantly different in the preoperative groups at 12, 18, and 24 hours after the test; but, at 2, 6, and 8 hours after the operation, the pain severity was significantly less in magnesium sulfate group compared to the other two groups. The median morphine obtained in 24 hours after surgery was significantly less, and the first time to receive morphine was in magnesium sulfate group more in magnesium sulfate group compared to the other two groups.

It seems that infusion of magnesium sulfate at the site of fusion surgery has been associated with prolongation of the first time to receive morphine by patients, reducing the amount of morphine received, and pain intensity up to 24 hours after surgery.

Nowadays, electroconvulsive therapy (ECT) is an efficient treatment of psychological disorders. The basis of a successful ECT is induction of a seizure with purposeful intensity, quality, and duration. Thus, an appropriate anesthetic agent is required. The current study compared the efficacy of remifentanil versus ketamine add-on therapy to propofol on hemodynamic change and seizure duration in ECT.

The current cross-sectional clinical trial study was conducted on 40 patients under ECT in years 2017-18. Patients were randomly treated with each of the combination therapies as they were randomly treated with one for the first session of ECT, and with the later for the second session. Combinations of anesthesia included treatment with propofol-remifentanil versus propofol-ketamine. Furthermore, all patients received 0.5 mg/kg of succinylcholine and 0.5 mg/kg of propofol. Blood pressure, pulse rate, oxygen saturation, recovery duration, and time of spontaneous respiration following ECT, as well as complications, were recorded and compared.

Two assessed groups were not statistically different regarding systolic (P = 0.180) and diastolic blood pressure (P = 0.920), mean arterial pressure (P = 0.360), oxygen saturation (P > 0.999), and spontaneous respiration in recovery (P = 0.950). Tachycardia incidence (P < 0.001) and duration of recovery stay (P = 0.040) was significantly higher in propofol-ketamine group. Furthermore, nausea and vomiting was more in propofol-ketamine group (8 cases versus 2 cases; P = 0.080). The mean seizure duration was 36.12 ± 7.74 seconds propofol-ketamine and 30.07 ± 5.13 seconds in propofol-remifentanil group with a significant difference (P < 0.001).

Based on findings of the current study, combination of propofol-remifentanil was superior to combination of propofol-ketamine regarding seizure duration, hemodynamic stability, and less adverse effects. Due to limited number of studies comparing mentioned remedies, further studies are recommended.

Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The irregularities in miRNA expression have been reported in many pulmonary diseases, including CF. An increase or a decrease in miRNA levels has important influences on innate immune responses in respiratory tract of the patients with CF, such as impaired function of the inflammatory responses caused by neutrophils and macrophages, as well as chronic inflammation, which can lead to degradation and fibrosis of the lung tissue in these patients. The presence of a specific biomarker for diagnosis of pulmonary disease, inflammation, and cellular function can be a good candidate for diagnosis of CF. For example, sputum miRNAs can be ideal for checking pulmonary function. Although miRNA is not currently used for treatment or clinical diagnosis of CF, many studies have suggested miRNAs as potential biomarkers for the disease. miRNA-based treatments, that enhance the expression of CFTR, can be a very suitable option for adjusting CFTR levels in clinical trials on patients with CF. In this review article, after describing different miRNA groups, and its mechanism of action for regulation of protein expression, various studies related to miRNA in CF were investigated. In addition, the possibility to apply miRNA as a biomarker in CF, and its role in different miRNA-based therapeutic approaches were discussed.</div>