Publications by authors named "Azita Hajhossein Talasaz"

46 Publications

Efficacy and Safety of the Fixed-Dose Versus Variable-Dose of 4-PCC for Vitamin K Antagonist Reversal: A Comprehensive Systematic Review and Meta-Analysis.

Cardiovasc Drugs Ther 2021 Apr 17. Epub 2021 Apr 17.

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background: The optimal dosing strategy of four-factor prothrombin complex concentrate (4F-PCC) for vitamin K antagonists (VKAs) reversal is unknown.

Methods: We conducted systematic search on the PubMed, SCOPUS, and Embase databases from inception to December 2020 for clinical studies that compared the fixed-dose versus variable-dose of 4-PCC for VKAs reversal with at least one reported clinical outcome. The treatment effects were expressed as relative ratios (RR) with 95% confidence intervals (CIs) and pooled by a random-effects model.

Results: Ten studies, including 988 patients, were included. Fixed-dose 4-PCC was associated with lower rate of mortality (RR= 0.65, 95% CI 0.47 to 0.9, p= 0.009), comparable rate of thromboembolic event (TEE) (RR= 1.10, 95%CI 0.44 to 2.80, p= 0.826), and lower goal INR reached (RR= 0.87, 95%CI 0.78 to 0.96, p= 0.007). Less 4-PCC cumulative dose, shorter duration of order-to-needle time, similar hospital length of stay, the comparable time required for INR reversal, higher post-4-PCC INR, and a higher need for additional dose were observed in fixed-dose.

Conclusions: The use of a fixed-dose of 4-PCC may be considered an effective and safe dosing strategy for VKAs reversal in various clinical situations. However, further well-designed, controlled studies should be conducted focusing on clinical outcomes to determine the optimal dose of 4-PCC for VKAs reversal.
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http://dx.doi.org/10.1007/s10557-021-07192-0DOI Listing
April 2021

Effect of COVID-19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey.

Int J Clin Pract 2021 Mar 24:e14182. Epub 2021 Mar 24.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: There are some data showing that repurposed drugs used for the Coronavirus disease-19 (COVID-19) have potential to increase the risk of QTc prolongation and torsade de pointes (TdP), and these arrhythmic side effects have not been adequately addressed in COVID-19 patients treated with these repurposed medications.

Methods: This is the prospective study of 2403 patients hospitalised at 13 hospitals within the COVID-19 epicentres of the Iran. These patients were treated with chloroquine, hydroxychloroquine, lopinavir/ritonavir, atazanavir/ritonavir, oseltamivir, favipiravir and remdesivir alone or in combination with azithromycin. The primary outcome of the study was incidence of critical QTc prolongation, and secondary outcomes were incidences of TdP and death.

Results: Of the 2403 patients, 2365 met inclusion criteria. The primary outcome of QTc ≥ 500 ms and ∆QTc ≥ 60 ms was observed in 11.2% and 17.6% of the patients, respectively. The secondary outcomes of TdP and death were reported in 0.38% and 9.8% of the patients, respectively. The risk of critical QT prolongation increased in the presence of female gender, history of heart failure, treatment with hydroxychloroquine, azithromycin combination therapy, simultaneous furosemide or beta-blocker therapy and acute renal or hepatic dysfunction. However, the risk of TdP was predicted by treatment with lopinavir-ritonavir, simultaneous amiodarone or furosemide administration and hypokalaemia during treatment.

Conclusion: This cohort showed significant QTc prolongation with all COVID-19 medications studied, however, life-threatening arrhythmia of TdP occurred rarely. Among the repurposed drugs studied, hydroxychloroquine or lopinavir-ritonavir alone or in combination with azithromycin clearly demonstrated to increase the risk of critical QT prolongation and/or TdP.
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http://dx.doi.org/10.1111/ijcp.14182DOI Listing
March 2021

Cardiovascular Complications of COVID-19: Pharmacotherapy Perspective.

Cardiovasc Drugs Ther 2021 Apr 15;35(2):249-259. Epub 2020 Jul 15.

Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Coronavirus disease of 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading rapidly the world over. The disease was declared "pandemic" by the World Health Organization. An approved therapy for patients with COVID-19 has yet to emerge; however, there are some medications used in the treatment of SARS-CoV-2 infection globally including hydroxychloroquine, remdesivir, dexamethasone, protease inhibitors, and anti-inflammatory agents. Patients with underlying cardiovascular disease are at increased risk of mortality and morbidity from COVID-19. Moreover, patients with chronic stable states and even otherwise healthy individuals might sustain acute cardiovascular problems due to COVID-19 infection. This article seeks to review the latest evidence with a view to explaining possible pharmacotherapies for the cardiovascular complications of COVID-19 including acute coronary syndrome, heart failure, myocarditis, arrhythmias, and venous thromboembolism, as well as possible interactions between these medications and those currently administered (or under evaluation) in the treatment of COVID-19.
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http://dx.doi.org/10.1007/s10557-020-07037-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360896PMC
April 2021

S2P peptide-conjugated PLGA-Maleimide-PEG nanoparticles containing Imatinib for targeting drug delivery to atherosclerotic plaques.

Daru 2020 Jun 9;28(1):131-138. Epub 2020 Jan 9.

Nanotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background: Imatinib is a platelet-derived growth factor receptor (PDGFR) inhibitor with very low water solubility. Previous studies in atherosclerosis have shown that PDGFR activity has an egregious effect on vascular disease and progression of atherosclerosis. Specific ligands of atherosclerotic plaques can be used for targeting of nanoparticles. Studies in atherosclerosis proved that stabilin-2 is a glycoprotein which exists abundantly in atherosclerotic plaques and it is produced from both macrophages and endothelial cells.

Objectives: The objective of this study is the targeting drug delivery to atherosclerotic plaques by using imatinib-loaded nanoparticles modified by S2P peptide.

Methods: The imatinib-loaded nanoparticles were fabricated through a modified emulsion/solvent evaporation technique. After fabricating PLGA nanoparticles, maleimide PEG was used as linker between PLGA nanoparticles and S2P peptide. Because of presence cysteine in both side of S2P peptide, maleimide formed a thiolether linkage by thiol group of cysteine. Then the physicochemical analysis like H-NMR, FT-IR, DSC, SEM, particle size, zeta potential, and drug release were studied.

Results: Stabilin-2 peptide with sequence of CRTLTVRKC is a specific ligand to stabilin-2, so it was synthesized for using as the targeting agent for atherosclerosis. S2P peptide conjugation to the surface of nanoparticles was proved by H-NMR and FT-IR, and the percentage of S2P peptide in nanoparticles was 1.3%. The final nanoparticles were spherical and their size were 183 nm. The loading capacity of the imatinib-loaded nanoparticles was 5.05%. The sustained release profile was observed for peptide targeted nanoparticles.

Conclusion: The chosen method was simple, reproducible, and specific in peptide conjugation of nanoparticles for targeting delivery to atherosclerotic regions. Graphical abstract .
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http://dx.doi.org/10.1007/s40199-019-00324-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214550PMC
June 2020

Potential Role of Vitamin C Intracoronary Administration in Preventing Cardiac Injury After Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction.

J Res Pharm Pract 2019 Apr-Jun;8(2):75-82

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Objective: The aim of the present study was to determine the effects of intravenous (IV) and intracoronary administration of Vitamin C on the incidence of periprocedural myocardial injury in patients undergoing primary percutaneous coronary intervention (PCI).

Methods: In this prospective, double-blind, randomized clinical trial, that was conducted in Tehran Heart Center, Iran, between October 2016 and March 2017, 252 patients undergoing primary PCI were enrolled to receive either 3 g of IV Vitamin C before PCI and 100 mg of intracoronary Vitamin C during PCI in addition to the routine treatment ( = 126) or just the routine treatment ( = 126). Cardiac biomarkers were measured before and then 6 and 12 h postprocedurally. We determined the occurrence of contrast-induced acute kidney injury (CI-AKI), according to the levels of serum creatinine, neutrophil gelatinase-associated lipocalin, and platelet activation biomarker (P-selectin) in a subset of 119 patients before and 6 h after PCI.

Findings: In the patients who received Vitamin C, the serum levels of troponin T after 12 h and creatine kinase-MB after 6 h were significantly lower than those in the placebo group ( = 0.003 andP = 0.00, respectively). CI-AKI occurred in 6 (4.7%) patients in the study group and 8 (6.3%) patients in the control group; there was no significant reduction in CI-AKI in the study group. In addition, the two groups were statically similar as regards the changes in the level of P-selectin.

Conclusion: In primary PCI patients, the prophylactic use of IV and intracoronary Vitamin C can confer additional clinical benefits such as cardioprotection.
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http://dx.doi.org/10.4103/jrpp.JRPP_18_78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636420PMC
August 2019

Relationship between Vitamin D Levels and the Incidence of Post Coronary Artery Bypass Graft Surgery Atrial Fibrillation.

J Tehran Heart Cent 2018 Oct;13(4):159-165

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Postoperative atrial fibrillation (POAF) is probably a consequence of inflammation. Vitamin D is known for its anti-inflammatory properties. The aim of this study was to evaluate the effects of vitamin D levels on the incidence of POAF. In a prospective cohort study, patients were monitored for the occurrence of POAF during the first 5 days after coronary artery bypass grafting surgery in Tehran Heart Center. Those with concomitant valvular surgeries were excluded. Thereafter, they were divided into 2 groups: with or without POAF. Vitamin D levels were assessed in all the patients. The relationship between the vitamin D level and the incidence of POAF was evaluated and compared between the groups using the Mann-Whitney U test. The study population comprised of 156 patients. The mean age was 62.8±8.6 years, and 105 (67.3%) patients were male. Of the 156 patients, 29 (19%) developed POAF. The median preoperative vitamin D level was 15.3 in the group with POAF and 25.3 in the group without POAF (P=0.07). Our results demonstrated no significant relationship between vitamin D levels and the occurrence of POAF.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450811PMC
October 2018

Comparison of the Effects of Melatonin and Oxazepam on Anxiety Levels and Sleep Quality in Patients With ST-Segment-Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention: A Randomized Clinical Trial.

Ann Pharmacother 2018 10 11;52(10):949-955. Epub 2018 May 11.

1 Tehran University of Medical Sciences, Tehran, Iran.

Background: Anxiety and sleep disorders are prevalent problems in patients presenting with ST-segment-elevation myocardial infarction (STEMI). Usually, these problems are managed by benzodiazepines, which-albeit effective-could cause adverse effects and drug interaction.

Objective: This study was designed to compare the effects of melatonin and oxazepam in the management of anxiety and insomnia on patients following primary percutaneous coronary intervention (PCI) with a view to providing a safer alternative.

Methods: This study was designed as a randomized clinical trial. STEMI patients managed with primary PCI were enrolled and randomized into 2 groups through the permuted block randomization. The patients received either oxazepam (10 mg) or melatonin (3 mg) every night. Autoimmune disease or previous use of psychoactive medications was considered the exclusion criterion. Levels of anxiety and sleep quality were evaluated using the Hamilton Anxiety Rating Scale (HAM-A) and the Groningen Sleep Quality Score and compared between the groups.

Results: Each group contained 20 patients. Melatonin showed a significant advantage over oxazepam in improving sleep quality ( P = 0.040). Comparisons of the efficacy of both medications in lowering the anxiety levels when considering all the items of the HAM-A, including those related to cardiovascular disease, were significantly in favor of melatonin ( P = 0.019).

Conclusions And Relevance: The results of this study suggest that melatonin, a drug with more favorable drug interaction and adverse effect profile, could be more effective than oxazepam in improving the sleep quality and anxiety levels of patients presenting with STEMI, and it could be considered a new alternative to benzodiazepines in this setting.
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http://dx.doi.org/10.1177/1060028018776608DOI Listing
October 2018

Two-year Follow-up of Patients With Unstable Angina/Non-ST Segment Elevation Myocardial Infarction Undergoing Early Invasive Strategy: Predictors of Normal or Near-Normal Coronary Angiography and Mortality.

Crit Pathw Cardiol 2018 03;17(1):47-52

Background: Predictors of normal or near-normal coronary angiography (NONCAG) in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) and their importance regarding the prognosis are not understood. Accordingly, we determined these predictors as well as mortality risk factors at 2-year follow-up of UA/NSTEMI patients managed by the early invasive strategy.

Methods: We prospectively studied consecutive patients with UA/NSTEMI managed with the early invasive strategy at Tehran Heart Center, in 1-year period. Echocardiography was performed before coronary angiography (CAG) for all the patients. Baseline characteristics, laboratory parameters, echocardiographic findings, invasive treatment modalities, and survival status after 2 years of follow-up were collected. We identified the predictors of NONCAG in the first phase of the study and then the risk factors of mortality in the second phase.

Results: In the study period, 298 patients including 211 (71%) males, with the age of 59.31 ± 10.72 years were enrolled. The following factors were predictors of NONCAG: the female sex (P < 0.001); negative family history of CAD (P = 0.028); Thrombolysis in Myocardial Infarction (TIMI) risk score (P < 0.001); and early transmitral flow velocity/mean mitral annular velocity (E/E'mean) (P = 0.003). The following items were significant protective factors against mortality: percutaneous coronary intervention (PCI) (P = 0.012), age (P = 0.001), and E/E'mean (P = 0.020).

Conclusion: Patients' baseline characteristics as well as echocardiographic data could help in predicting those with NONCAG and PCI can be considered as the treatment of strategy with the most protection against mortality.
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http://dx.doi.org/10.1097/HPC.0000000000000108DOI Listing
March 2018

Protection from Reperfusion Injury with Intracoronary N-Acetylcysteine in Patients with STEMI Undergoing Primary Percutaneous Coronary Intervention in a Cardiac Tertiary Center.

Am J Cardiovasc Drugs 2018 Jun;18(3):213-221

Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, P.O. Box: 1411713138, Tehran, Iran.

Background: Evidence suggests that oxidative stress plays a principal role in myocardial damage following ischemia/reperfusion events. Recent studies have shown that the antioxidant properties of N-acetylcysteine (NAC) may have cardioprotective effects in high doses, but-to the best of our knowledge-few studies have assessed this.

Objectives: Our objective was to investigate the impact of high-dose NAC on ischemia/reperfusion injury.

Methods: We conducted a randomized double-blind placebo-controlled trial in which 100 consecutive patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly assigned to the case group (high-dose NAC 100 mg/kg bolus followed by intracoronary NAC 480 mg during PCI then intravenous NAC 10 mg/kg for 12 h) or the control group (5% dextrose). We measured differences in peak creatine kinase-myocardial band (CK-MB) concentration, highly sensitive troponin T (hs-TnT), thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and corrected thrombolysis in myocardial infarction frame count (cTFC).

Results: The peak CK-MB level was comparable between the two groups (P = 0.327), but patients receiving high-dose NAC demonstrated a significantly larger reduction in hs-TnT (P = 0.02). In total, 94% of the NAC group achieved TIMI flow grade 3 versus 80% of the control group (P = 0.03). No significant differences were observed between the two groups in terms of changes in the cTFC and MBG.

Conclusions: In this study, NAC improved myocardial reperfusion markers and coronary blood flow, as revealed by differences in peak hs-TnT and TIMI flow grade 3 levels, respectively. Further studies with large samples are warranted to elucidate the role of NAC in this population. ClinicalTrials.gov identifier: NCT01741207, and the Iranian Registry of Clinical Trials (IRCT; http://irct.ir ) registration number: IRCT201301048698N8.
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http://dx.doi.org/10.1007/s40256-017-0258-8DOI Listing
June 2018

Effect of memantine on post-operative cognitive dysfunction after cardiac surgeries: a randomized clinical trial.

Daru 2017 Nov 21;25(1):24. Epub 2017 Nov 21.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Post-operative cognitive dysfunction (POCD) is an important complication of cardiac surgeries. Glutamate plays a critical role in physiologic and pathologic conditions in the brain. Due to the role of glutamate in ischemia, this study is designed to identify the effect of memantine in prevention of POCD early and late after cardiac surgeries.

Methods: In this randomized clinical trial, 172 patients with ages 45-75 years old who underwent elective cardiac surgery were enrolled. For patients in memantine group, 5 mg of memantine per day administered at least 48 h before surgery and increased to 10 mg per day during the first 24 h after surgery and continued for 3 months. A brief Wechsler memory test (WMT) was administered before, three to 5 days after, and 3 months after surgery for both groups.

Results: Both groups demonstrate standard pattern of cognitive dysfunction after surgery and in follow up. Pre- and post-operative WMT score showed significant improvement in memantine compared to control group (P < 0.001) both in unadjusted and adjusted with confounding factor analysis. Unadjusted pre-, post-operative, and follow up WMT score improved significantly after 3 months in memantine group (P = 0.006).

Conclusion: Pre-operative administration of memantine protects patients from POCD following cardiac surgeries. In addition, it improves cognitive function 3 months after surgery.

Trial Registration: The trial was registered in the Iranian Registry of Clinical Trials (registration number: IRCT201303168698N12 ). Memantin effect on POCD.
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http://dx.doi.org/10.1186/s40199-017-0190-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5696736PMC
November 2017

Effect of High-Dose Allopurinol Pretreatment on Cardiac Biomarkers of Patients Undergoing Elective Percutaneous Coronary Intervention: A Randomized Clinical Trial.

Am J Ther 2017 Nov/Dec;24(6):e723-e729

1Department of Cardiology, Rajaiee Heart Center, Iran University of Medical Sciences, Tehran, Iran; 2Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; 3Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; 4Resident of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Departments of 5Research; 6Epidemiology and Biostatistics, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; and 7Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Increased accumulation of reactive oxygen species contributes to pathophysiologic states such as endothelial dysfunction, metabolic and functional impairment, inflammatory activation, and other features of cardiovascular pathophysiology. Allopurinol acts as a xanthine oxidase inhibitor that reduces the amount of free radicals after reactive oxygen species generation.

Methods And Results: In this placebo-controlled randomized clinical trial, all patients admitted with coronary artery disease who are candidates for elective percutaneous coronary intervention (PCI) were included. The 254 patients were randomly divided into 2 groups. Blood samples for cardiac biomarkers (creatine kinase [CK]-MB and troponin T [cTnT]) were collected from all patients after admission (the day before PCI), and also 8 and 16 hours after intervention. In group 1 (133 patients), 600 mg allopurinol was orally administered on the day before PCI, and another same dose on the day of PCI, and the elective PCI was performed. In group 2 (121 patients), elective PCI was performed without pretreatment with allopurinol. In an unadjusted model, the serum levels of both CK-MB and cTnT, 16 hours after PCI were higher in the placebo group as compared with the allopurinol group, although it was statistically insignificant. We compared the maximum levels of CK-MB and cTnT (8 or 16 hours after PCI) and their maximum changes in both groups. After adjustment for confounders, use of allopurinol did not have any statistically significant association with the rise of cardiac-spec-fic enzymes.

Conclusions: Allopurinol could not be effective significantly, in patients undergoing elective PCI, to decrease cardiac-specific enzymes, and seems not to be of use before PCI.
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http://dx.doi.org/10.1097/MJT.0000000000000411DOI Listing
June 2018

Randomized Trial of Carnitine for the Prevention of Perioperative Atrial Fibrillation.

Semin Thorac Cardiovasc Surg 2018 24;30(1):7-13. Epub 2017 Aug 24.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Atrial fibrillation (AF) is one of the most common complications in patients who undergo coronary artery bypass graft surgery (CABG). The aim of this study was to evaluate the effect of L-carnitine administration on postoperative AF and the levels of C-reactive protein (CRP) following CABG. The effects of L-carnitine on the incidence of acute kidney injury after CABG were also assessed. One hundred thirty-four patients undergoing elective CABG, without a history of AF or previous L-carnitine treatment, were randomly assigned to an L-carnitine group (3000 mg/d L-carnitine) or a control group. CRP levels, as a biomarker of inflammation, were assessed in all the patients before surgery as baseline levels and 48 hours postoperatively. Neutrophil gelatinase-associated lipocalin, as a kidney biomarker, was also measured in the patients before surgery and 2 hours thereafter. The incidence of AF was 13.4% in our population. The incidence of AF was decreased in the L-carnitine group (7.5% in the L-carnitine group vs 19.4% in the control group; P = 0.043) and the postoperative CRP level (8.79 ± 6.9 in the L-carnitine group, and 10.83 ± 5.7 in the control group; P = 0.021). The postoperative neutrophil gelatinase-associated lipocalin concentration demonstrated no significant rise after surgery compared with the preoperative concentration (72.54 ± 20.30 in the L-carnitine group vs 67.68 ± 22.71 in the placebo group; P = 0.19). Our study showed that L-carnitine administration before CABG might inhibit and reduce the incidence of AF after CABG. It seems that a rise in the CRP level, as an inflammation marker, may be associated with the incidence of AF. Inflammation as measured by CRP was also reduced in the carnitine group, compared with the control group.
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http://dx.doi.org/10.1053/j.semtcvs.2017.08.006DOI Listing
October 2018

Nephroprotective Effects of L-Carnitine against Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention: A Randomized Open-Labeled Clinical Trial.

J Tehran Heart Cent 2017 Apr;12(2):57-64

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

L-carnitine may prevent the incidence of AKI by its antioxidant effects and improving circulation in ischemic conditions. The goal of this trial was to evaluate the impact of L-carnitine on contrast-induced nephropathy in patients undergoing elective PCI. Totally, the patients were randomly allocated to 2 groups. The treatment group received 1 g of L-carnitine orally 3 times a day, 24 hours before the procedure (3 g before PCI) and 2 g after PCI, whereas the control group did not receive L-carnitine. In both groups, the plasma level of neutrophil gelatinase-associated lipocalin (NGAL) was measured at baseline and 12 hours after PCI. Our study was conducted on 202 patients (including 91 vs. 111 patients in the treatment and the control group; 31 (34.1%) vs 33 (29.7%) female in carnitine and control group; and ages include 62.0 ± 9.0 vs 57.0 ± 11.2 years). The median plasma levels of NGAL were not different between the carnitine and control groups at baseline (57 [IQR: 22 - 255] vs. 54 [IQR: 29 - 324]; p value = 0.155) and 12 hours after PCI (71 [IQR: 52 - 129] vs. 70 [IQR: 46 - 153]; p value = 0.925), but the changes in the plasma NGAL from baseline to 12 hours after PCI were different between the 2 groups (5 [IQR:-147 - 30] vs. 17 [IQR: -21 - 41]; p value = 0.010). Our results showed that oral L-carnitine was able to prevent an increase in NGAL following contrast medium administration in patients undergoing PCI. More studies should be performed to fully elucidate the nephroprotective effects of L-carnitine.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558056PMC
April 2017

The Role of N-Acetylcysteine in Platelet Aggregation and Reperfusion Injury in Recent Years.

Curr Clin Pharmacol 2017 ;12(2):83-91

Department of Medicinal Chemistry, School of Pharmacy-International Campus, Iran University of Medical Sciences, Tehran, Iran.

Background: N-acetylcysteine (NAC) is an amino acid that contains a cysteine group and is currently used widely in various fields of medical research especially in cardiology. In this review, potential benefits of NAC in the aggregation of platelet and reperfusion injury are evaluated.

Methods: The available evidence was collected by searching Scopus, Pub-Med, Medline, Cochrane central register of controlled trials, and Cochrane database systematic reviews. Our searching was performed without time limitation and only English language articles were included in this review. Key words used as search terms included "N-acetylcysteine", "platelet aggregation", "reperfusion injury".

Results: Over the past decade, several investigations were carried out to ascertain reperfusion injury and antiplatelet properties of NAC, and in this article the results of investigations in both models (human and animal) were addressed in detail. The results revealed that NAC has an important antiplatelet property in animal models while this effect is not very significant in human models and needs more investigations. However, its reperfusion injury in both models is worth noticing.

Conclusion: Due to the limited data about effectiveness of NAC in both human and animal as antiplatelet agent, more investigation is needed to evaluate NAC efficacy in platelet aggregation and reperfusion injury especially in human studies in the future.
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http://dx.doi.org/10.2174/1574884712666170704145842DOI Listing
April 2019

Potential Role of Allopurinol in Preventing Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention: A Randomized Placebo-Controlled Trial.

Clin Drug Investig 2017 Sep;37(9):853-860

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Contrast-induced nephropathy (CIN) is a major drawback in percutaneous coronary intervention (PCI). Significant uricosuria has been reported following contrast exposure. Allopurinol-a xanthine oxidase inhibitor-has been suggested to prevent the formation of oxygen-free radicals, which may contribute to CIN. The aim of the present study was to evaluate the possible efficacy of allopurinol in preventing CIN.

Methods: In this double-blind placebo-controlled trial, patients with an estimated glomerular filtration rate ≥60 mL/min who were admitted for elective PCI, were randomized to receive either allopurinol 600 mg or a placebo administered 24 h before the procedure, and again immediately before the procedure. Blood samples were drawn at 24 h before and 24 h after contrast exposure to measure serum creatinine (SCr), uric acid, and serum cystatin-c.

Results: The baseline characteristics were almost similar between the placebo and allopurinol groups. The overall change in SCr and the rate of CIN, which is defined as ≥25% increase in serum cystatin-c relative to baseline, failed to show a significant difference between the two groups. When adjusted on the baseline cystatin-c, SCr, sex, and positive family history, the difference in the overall increase in serum cystatin-c was statistically significantly lower in the allopurinol group.

Conclusions: Allopurinol administration in patients undergoing PCI failed to show efficacy in preventing CIN. Nevertheless, this effect should be further evaluated in the patient population with chronic kidney disease.
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http://dx.doi.org/10.1007/s40261-017-0542-zDOI Listing
September 2017

Preventive effect of l-carnitine and its derivatives on endothelial dysfunction and platelet aggregation.

Clin Nutr ESPEN 2016 Oct 27;15:1-10. Epub 2016 Jun 27.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background And Aim: Oxidative stress plays an important role in platelet activation and endothelial dysfunction. Exogenous and endogenous reactive oxygen species are associated with platelet activation and vascular dysfunction. Antioxidants have been shown to attenuate oxidative stress and consequently endothelial dysfunction by preventing inflammation, regulating vascular tone, and promoting antiadhesive and antithrombotic properties. l-carnitine and its derivatives have been demonstrated to improve endothelial and platelet function against oxidative stress by several mechanisms, some of which cannot be found in other antioxidants. The role of l-carnitine and its derivatives in endothelial dysfunction and platelet activation will be reviewed here from the perspective of basic and clinical research.

Method: This study reviews in vitro and in vivo studies, clinical trials, and abstracts in the English language that have examined the protective effects of l-carnitine and its derivatives on endothelial dysfunction and platelet aggregation in pathological conditions. We searched experimental studies, clinical trials, and other review articles to obtain the materials.

Conclusions: Although in vitro physiological models, animal studies on vascular and platelet function, and some human studies on these systems are in favor of the preventive effects of l-carnitine and its derivatives on endothelial dysfunction and platelet aggregation, more clinical trials are needed to clarify the clinical importance of l-carnitine as a supportive option to maintain the normal homeostatic function of the vasculature and to prevent platelet activation.
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http://dx.doi.org/10.1016/j.clnesp.2016.06.009DOI Listing
October 2016

Evaluating the Potential Effect of Melatonin on the post-Cardiac Surgery Sleep Disorder.

J Tehran Heart Cent 2015 Jul;10(3):122-8

Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background: Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery (CABG). Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG.

Method: One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score (GSQS), and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance (ANCOVA) and independent t-test were used to compare the sleep and anxiety scores between the groups. P values ≤ 0.05 were considered statistically significant.

Results: Totally, 137 patients at a mean age of 60 years completed the study (76% male). The analysis of the data showed that sleep was significantly disturbed after surgery in both groups. The patients in the Oxazepam group demonstrated significantly higher disturbance in their mean postoperative GSQS score than did their counterparts in the melatonin group (p value < 0.001). A smaller proportion of the participants experienced delirium in the melatonin group (0.06%) than in the Oxazepam group (0.12%); however, this difference was not statistically significant.

Conclusion: The result of the present study revealed that melatonin improved sleep in post-cardiac surgery patients more than what was observed with Oxazepam. Therefore, melatonin may be considered an effective alternative for Benzodiazepines in the management of postoperative sleep disorder.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685367PMC
July 2015

Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery: A randomized, placebo-controlled trial.

Am Heart J 2015 Dec 3;170(6):1195-201. Epub 2015 Oct 3.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Pericardial effusion (PE), a common complication after open-heart surgery, accounts for 50% to 85% of patients. Although reversible in most of the cases, it could be life threatening in the occurrence of tamponade in large effusions. We aimed to determine the therapeutic efficacy of colchicine on PE after open-heart surgery.

Methods: The study is a prospective, randomized, triple-blind, placebo-controlled single-center trial at Tehran Heart Center. A total of 149 patients with mild or moderate PE in transthoracic echocardiography were randomly assigned to receive 1 mg/d colchicine (n = 74) or 1 tablet of placebo (n = 75) for 2 weeks and then underwent follow-up echocardiography.

Results: Baseline and clinical characteristics were not significantly different between the 2 study groups except for age (P = .02) and graft numbers (P = .005). There was no significant difference in pretreatment and posttreatment PE sizes between the 2 study groups (P = .440 and .844, respectively). Median (25th-75th percentiles) of effusion changes was 5 mm (1-7.6 mm) in the colchicine group and 5 mm (1-6.6 mm) in the placebo group (P = .932). Intervention had no significant impact on pretreatment and posttreatment effusion values and changes in isolated coronary artery bypass graft surgery patients (P = .607, .539, and .628, respectively). After adjustment for possible confounders, there was still no significant difference in postoperative PE between the 2 study groups (t = -0.285, P = .776).

Conclusion: We concluded that prescription of colchicine does not seem to be effective in treatment of asymptomatic postoperative PE. This could be justified in case that the etiology of most of the PEs might be contribution of noninflammatory factors which are better to be dealt with observational approaches.
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http://dx.doi.org/10.1016/j.ahj.2015.09.020DOI Listing
December 2015

Effect of Melatonin on Cardiac Injury after Primary Percutaneous Coronary Intervention: a Randomized Controlled Trial.

Iran J Pharm Res 2015 ;14(3):851-5

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. ; Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Several studies have reported that the antioxidant properties of melatonin can provide cardiac protection through scavenging of free radicals. This study sought to investigate the efficacy of melatonin on cardiac biomarkers, myocardial-specific protein high sensitive troponin-T (hs-TnT) and creatine kinase-MB (CK-MB), in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). In this randomized clinical trial, a total of 40 patients with STEMI planned to undergo pPCI were randomly assigned to two groups of receiving melatonin plus standard treatment [n=20] and control group, receiving only standard therapy [n=20]. The following parameters including hsTnT and CK-MB were assessed preoperatively (baseline) and at 6 hours after procedure. Melatonin could significantly reduce the level of CK-MB (118.2 ± 21.09 IU/L in the treated group versus 198.24 ± 20.94 IU/L in the control group; p-value = 0.01). However, there was no difference in the mean hs-TnT level between two groups (2491 ± 664 μg/L vs. 2801 ± 620 μg/L; p value = 0.73). Our results revealed that melatonin can be considered as a safe adjunctive medication to the standard regimen after pPCI for the aim of decreasing cardiovascular events. Meanwhile, this was a pilot study with a small number of patients and further studies are needed to confirm the beneficial effect of melatonin in patients with STEMI.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518113PMC
September 2015

Evaluating the Effect of Intracoronary N-Acetylcysteine on Platelet Activation Markers After Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction.

Am J Ther 2016 Jan-Feb;23(1):e44-51

1Department of Pharmacology and Toxicology, Faculty of Pharmacy-International Campus, Iran University of Medical Sciences, Tehran, Iran; 2Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; 3Department of Pharmaceutical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; 4Department of Clinical Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 5Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; 6Cardiology Department, Kermanshah University of Medical Sciences, Kermanshah, Iran; 7Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; and 8Department of Molecular Pathology, Tehran Heart Center, Tehran, Iran.

During percutaneous coronary intervention (PCI), trauma occurs in the arterial endothelium, resulting in platelet activation and aggregation. As platelet aggregation may lead to coronary thrombosis, antiplatelet agents are essential adjunctive therapies in patients undergoing PCI. The aim of this study was to determine the effect of the intracoronary administration of high-dose N-acetylcysteine (NAC) for the evaluation of its antiplatelet effects in human subjects. In this triple-blind trial, 147 patients undergoing primary PCI were enrolled. Finally, 100 patients were randomized to receive high-dose intracoronary NAC (100 mg/kg bolus, followed by 10 mg·kg⁻¹·h⁻¹ intracoronary continued intravenously for 12 hours) (n = 50) or dextrose solution (n = 50). Platelet activation biomarkers were measured before and 24 hours after the procedure. Secondary end points, comprising all-cause death, reinfarction, and target-vessel revascularization, were assessed at 30 days and 2 years. In comparison with the placebo, NAC could not reduce the level of platelet activation biomarkers within a 24-hour period after its prescription. Major adverse clinical events at 30 days and 2 years were infrequent and not statistically different between the 2 groups. Our results revealed that NAC, compared with the placebo, did not provide an additional clinical benefit as an effective antiplatelet agent after PCI.
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http://dx.doi.org/10.1097/MJT.0000000000000309DOI Listing
October 2016

Association between Perioperative Parameters and Cognitive Impairment in Post-Cardiac Surgery Patients.

J Tehran Heart Cent 2015 Apr;10(2):85-92

Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran.

Background: Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient's life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery.

Methods: One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change.

Results: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change.

Conclusion: Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients' basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477092PMC
April 2015

Potential Effect of L-Carnitine on the Prevention of Myocardial Injury after Coronary Artery Bypass Graft Surgery.

J Tehran Heart Cent 2015 Apr;10(2):74-9

School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background: L-carnitine has been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluates the effects of L-carnitine administration on cardiac biomarkers after coronary artery bypass graft (CABG) surgery.

Methods: One hundred thirty-four patients undergoing elective CABG surgery, without a history of myocardial ischemia or previous L-carnitine treatment, were enrolled and randomly assigned to an L-carnitine group ([n = 67], 3000 mg/d, started 2 days preoperatively and continued for 2 days after surgery) or a control group (n = 67). CK-MB (creatine kinase, muscle-brain subunits) and troponin T (TnT) levels were assessed in all the patients before surgery as baseline levels and at 8 and 24 hours postoperatively.

Results: Our study included 134 patients (99 [73.8%] males) at a mean ± SD age of 59.94 ± 8.61 years who were candidates for CABG and randomized them into control or L-carnitine groups. The baseline demographic characteristics, including age (60.01 ± 9.23 in the L-carnitine group vs. 59.88 ± 7.98 in the control group) and sex (54 [80.6%] in the L-carnitine group vs. 45 [67.2%] in the control group) did not show any significant differences (p value=0.93 and 0.08, respectively). Patients in the L-carnitine group had lower levels of CK-MB (mean ± SD, 25.06 ± 20.29 in the L-carnitine group vs. 24.26 ± 14.61 in the control group), but the difference was not significant (p value = 0.28). TnT levels also showed no significant differences between the two groups (399.50 ± 378.91 in the L-carnitine group vs. 391.48 ± 222.02 in the control group; p value = 0.34).

Conclusion: In this population of intermediate- to high-risk patients undergoing CABG surgery, L-carnitine did not reduce CK-MB and TnT levels.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477090PMC
April 2015

The Effect of High-Dose Vitamin D3 on Soluble P-Selectin and hs-CRP Level in Patients With Venous Thromboembolism: A Randomized Clinical Trial.

Clin Appl Thromb Hemost 2016 Jul 19;22(5):483-9. Epub 2015 Jan 19.

Department of Oral Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.

High plasma level of P-selectin is associated with the development of venous thromboembolism (VTE). Furthermore, supplementation of vitamin D could decrease thrombotic events. Hence, this study was designed to examine whether the administration of vitamin D can influence the plasma level of P-selectin in patients with VTE. In the randomized controlled trial, 60 patients with confirmed acute deep vein thrombosis and/or pulmonary embolism (PE) were randomized into the intervention (n = 20) and control (n = 40) groups. The intervention arm was given an intramuscular single dose of 300 000 IU vitamin D3 Plasma level of 25-hydroxy vitamin D, P-selectin, and high-sensitive C-reactive protein (hs-CRP) was measured at baseline and 4 weeks after. The plasma level of P-selectin (95% confidence interval = -5.99 to -1.63, P = .022) and hs-CRP (P = .024) significantly declined in vitamin D-treated group, while only hs-CRP was significantly decreased in the control group (P = .011). However, the magnitude of these reductions was not statistically significant. This study could not support the potential benefit of the high-dose vitamin D on plasma level of P-selectin and hs-CRP in patients with VTE.
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http://dx.doi.org/10.1177/1076029614568715DOI Listing
July 2016

Study of the possible medical and medication explanatory factors of angiographic outcomes in patients with acute ST elevation myocardial infarction undergoing primary percutaneous intervention.

Adv Biomed Res 2014 4;3:186. Epub 2014 Sep 4.

Department of Radiology, Tabriz University of Medical Science, Tabriz, Iran.

Background: Myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) and corrected TIMI frame count (cTFC) are indices of successful angiographic reperfusion. This study sought to determine the predictors of angiographically successful reperfusion including demographic, clinical and angiographic factors in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).

Materials And Methods: A cross-sectional study of patients with a confirmed diagnosis of STEMI undergoing pPCI was designed. Eligible patients referring to a university heart center were enrolled in the study from March 2012 to December 2012. Successful epicardial reperfusion was defned as TIMI flow grade 3 or cTFC<= 28 frames and successful myocardial reperfusion as MBG 2 or 3.

Results: The study population consisted of 100 patients, including 74 males and 26 females, with mean ± standard deviation age of 58.27 ± 11.60 years. Achieving open microvasculature (MBG 2/3) was positively associated with a history of nitrate intake (P = 0.03) and history of calcium channel blocker (CCB) intake (P = 0.005). Hyperglycemia was inversely associated with achieving a final cTFC ≤ 28 frames (r = -0.32, P = 0.001).

Conclusions: Our findings suggest that patients with a history of nitrate and CCB intake had a higher likelihood of successful PCI. In addition, patients with a higher blood glucose level on admission may have a reduced rate of reperfusion success. Future studies with a larger sample size are recommended to investigate the significant relationships observed in this study.
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http://dx.doi.org/10.4103/2277-9175.140096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166209PMC
September 2014

Comparison of the effects of N-acetyl-cysteine and ginseng in prevention of noise induced hearing loss in male textile workers.

Noise Health 2014 Jul-Aug;16(71):223-7

Department of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Previous studies revealed the role of antioxidant agents in prevention of noise induced hearing loss (NIHL). The aim of this study was to compare the protective effect of N-acetyl-cysteine (NAC) and ginseng on protection of NIHL in textile workers exposed to continuous noise in daily working. In this study, 48 participants were randomly allocated to three groups; Group I received NAC 1200 mg/day, Group II received ginseng 200 mg/day, and Group III (control group) received no supplement. Pure tone audiometry and high frequency audiometry were performed preshift before and after 14 days (on day 15). Linear regression analysis results showed reduced noise-induced temporary threshold shift (TTS) for NAC and ginseng groups at 4, 6 and 16 kHz (P < 0.001) in both ears. Furthermore, the protective effects were more prominent in NAC than ginseng. Our results show that NAC and ginseng can reduce noise induced TTS in workers exposed to occupational noise. Further studies are needed to prove antioxidants benefits in hearing conservation programs.
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http://dx.doi.org/10.4103/1463-1741.137057DOI Listing
October 2014

Distortion Product Otoacoustic Emission (DPOAE) as an Appropriate Tool in Assessment of Otoprotective Effects of Antioxidants in Noise-Induced Hearing Loss (NIHL).

Indian J Otolaryngol Head Neck Surg 2014 Sep 17;66(3):325-9. Epub 2014 Apr 17.

Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Distortion product otoacoustic emission (DPOAE) appears to be an objective sensitive test of cochlear function. The aim of this study was to investigate whether DPOAE is an appropriate tool for assessment of minute changes in cochlea due to usage of antioxidant material. 48 workers exposed to continuous noise in a textile factory were randomly assigned into three groups: (1) The Control group (n = 16) received no antioxidant drugs, (2) The N-acetyl-cysteine (NAC) group (n = 16) received oral antioxidant NAC (1200 mg/day), (3) The Ginseng group (n = 16) received oral antioxidant Ginseng (200 mg/day). All three groups had a follow-up period of 2 weeks. The cochlear changes were assessed using DPOAE test before starting the daily work shift on first and 15th day. The associations between groups and DPOAE amplitudes after 2 weeks were analyzed using linear regression analysis. Four separate models were fitted by side of ears and frequency. All models were adjusted for baseline amplitude. Reduced (better) amplitude at DPOAE test was found for NAC and Ginseng groups at high frequencies (4 and 6 kHz) in both ears after 2 weeks compared to control group. Moreover, NAC group showed better DPOAE amplitude than Ginseng group. In conclusion, DPOAE seems to be an appropriate tool in assessing minute changes in the cochlea after antioxidant drugs administration.
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http://dx.doi.org/10.1007/s12070-014-0721-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071438PMC
September 2014

Plasma Vitamin D Status and Its Correlation with Risk Factors of Thrombosis, P-selectin and hs-CRP Level in Patients with Venous Thromboembolism; the First Study of Iranian Population.

Iran J Pharm Res 2014 ;13(1):319-27

Department of Clinical pharmacy, faculty of Pharmacy and Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.

Low plasma level of vitamin D is linked to the increased risk of cardiovascular diseases such as hypertension, diabetes, dyslipidemia and peripheral vascular diseases. Vitamin D deficiency is a worldwide problem that involves Iranian population. To the best of our knowledge, this was the first investigation on venous thromboembolism (VTE) subjects that assessed the correlation of vitamin D level with plasma P-selectin, hs-CRP, and risk factors of thrombosis. In this prospective pilot study, patients with diagnosis of acute deep vein thrombosis and/ or pulmonary embolism were enrolled. All patients' clinical data, demographics and risk factors of thrombosis were evaluated. Plasma level of P-selectin and hs-CRP were measured by ELISA method. Radio immune assay method was used to determine plasma level of 25-hydroxy vitamin D (25(OH) D). In this study, 60 subjects were included. The mean ± SD plasma 25-hydroxy vitamin D level (25(OH) D) of participants was 21.4 ± 14.6 ng/mL. The vitamin D deficiency was detected in 60% of patients. No significant relation was found between the plasma 25(OH)D level and P-selectin and hs-CRP. In multiple regression analysis, there was a significant relationship between the level of 25(OH)D and the patients' age (beta = 0.452; p = 0.001), diabetes (beta = 0.280; p = 0.036) and positive family history of cardiovascular diseases (beta = 0.373; p = 0.003). Vitamin D deficiency is a frequent problem in Iranian VTE patients. Moreover, Plasma level of vitamin D is not associated with P-selectin and hs-CRP in VTE patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985233PMC
April 2014

Evaluating the frequency of errors in preparation and administration of intravenous medications in orthopedic, general surgery and gastroenterology wards of a teaching hospital in tehran.

Iran J Pharm Res 2013 ;12(1):229-34

Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ; Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The aim of this study was to determine the frequency of medication errors happened during the preparation and administration of intravenous (IV) drugs. This study was designed as prospective cross-sectional evaluations by direct unconcealed observation in a setting consisted of orthopedic, general surgery and gastroenterology wards of a teaching hospital. Participants were those patients hospitalized in these wards along with nurses responsible for preparation and administration of IV medications. Medication errors occurred in the process of preparation and administration of IV drugs, were recorded by a pharmacist. The frequency of medication errors with suggesting a solution to overcome was the main outcome of this study. Details of the preparation and administration stages of the observed drugs were compared to an instructed checklist prepared by an expert clinical pharmacist. From a total of 357 preparation and administration episodes, the most common type of error (%20.6) was the injection of bolus doses and infusion faster than the recommended rate. Metronidazole had the highest rate of error (%24.3). IV rounds conducted at 12 p.m. had the most rate of error (%26.3). Errors happened in the administration process were more prevalent than those in the preparation. No significant correlation was found between the frequency of errors and nurses' demographic data. This study revealed that the errors happened in the preparation and administration of IV drugs is prevalent. Improving the medication safety by the implementation of clinical pharmacists' prepared protocols at the point of care is an important concern.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3813204PMC
November 2013

Plasma zinc level in hepatitis C patients with or without Beta thalassemia major; is there any difference?

Hepat Mon 2013 12;13(8):e11138. Epub 2013 Aug 12.

Department of Clinical Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Background: Zinc deficiency has been reported frequently in hepatitis C patients in the literature. Furthermore, a decrease in zinc level has been shown in beta thalassemia major as well. Iranians consume a large amount of phytate in their regimens which can bind with zinc and decrease its gastrointestinal absorption.

Objectives: This study was designed to determine plasma zinc level in an Iranian sample with the diagnosis of hepatitis C with or without concomitant beta thalassemia major.

Patients And Methods: Between April 2011 and April 2012, plasma zinc level was determined via atomic absorption method, in 130 hepatitis C patients with or without beta thalassemia major in a known referral center of hepatic diseases in Tehran, Iran.

Results: Mean ± standard deviation (SD) of plasma zinc levels was determined as 0.78 ± 0.22 mg/L. Also zinc level was 0.76 ± 0.19 mg/L and 0.80 ± 0.24 mg/L in thalassemic and non thalassemic patients, respectively. T-test analysis showed that there is no significant difference between these two groups regarding plasma zinc level (P = 0.235).

Conclusions: It is concluded that zinc level of studied patients is less than which is reported in normal Iranian population. Moreover, there is not a significant difference in plasma zinc levels between thalassemic and non thalassemic patients and it seems to be a common problem in both ones. Addition of zinc supplement may be recommended in both groups in order to optimize the nutritional support and probably improve the treatment response.
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http://dx.doi.org/10.5812/hepatmon.11138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796196PMC
October 2013

Effects of N-acetylcysteine on the cardiac remodeling biomarkers and major adverse events following acute myocardial infarction: a randomized clinical trial.

Am J Cardiovasc Drugs 2014 Feb;14(1):51-61

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, P.O.Box 14155/6451, 1417614411, Tehran, Iran.

Aims: The aims of this study were to evaluate the effects of N-acetylcysteine (NAC) on cardiac remodeling and major adverse events following acute myocardial infarction (AMI).

Methods: In a prospective, double-blind, randomized clinical trial, the effect of NAC on the serum levels of cardiac biomarkers was compared with that of placebo in 98 patients with AMI. Also, the patients were followed up for a 1-year period for major adverse cardiac events (MACE), including the occurrence of recurrent myocardial infarction, death, and need for target vessel revascularization.

Results: In patients who received NAC, the serum levels of matrix metalloproteinase (MMP)-9 and MMP-2 after 72 h were significantly lower than those in the placebo group (p = 0.014 and p = 0.045, respectively). The length of hospitalization in patients who received NAC was significantly shorter than that in the placebo group (p = 0.024). With respect to MACE, there was a significant difference between those who received NAC (14 %) and those patients on placebo (25 %) (p = 0.024). Re-infarction took place in 4 % of patients in the NAC group as compared with 16.7 % in patients who received placebo (p = 0.007).

Conclusion: NAC can be beneficial in preventing early remodeling by reducing the level of MMP-2 and MMP-9. Moreover, NAC decreased the length of hospital stays in patients after AMI. By decreasing MACE, NAC could possibly be introduced as a 'magic bullet' in the pharmacotherapy of patients with AMI. Further studies are needed to elucidate NAC's role in this population.
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http://dx.doi.org/10.1007/s40256-013-0048-xDOI Listing
February 2014