Publications by authors named "Fatemeh Javaherforoosh Zadeh"

11 Publications

  • Page 1 of 1

The role of exogenous Fibrinogen in cardiac surgery: stop bleeding or induce cardiovascular disease.

Mol Biol Rep 2020 Oct 7;47(10):8189-8198. Epub 2020 Oct 7.

Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

The surgical treatment contributes to broad variety of cardiovascular diseases (CVD). Due to many involved factors in preoperative bleeding, it is almost difficult to perform better Haemostatic approach. Fibrinogen is a major blood glycoprotein and a coagulation factor which decreases postoperative bleeding. It has a potential role in platelet activation and bleeding inhibition; it may reflect the inflammatory responses and be related to the endothelial dysfunction. Fibrinogen can act as a pro-inflammatory element via increasing some inflammatory markers including IL-6, tumor necrosis factor-α (TNF-α), monocyte chemo attractant protein (MCP-1), macrophage inflammatory protein-1 (MIP-1a and b), matrix metalloproteinase (MMP-1 and MMP-9) and Toll-like Receptors (TLRs); through activation of these factors, fibrinogen may induce some inflammatory mechanisms such as focal adhesion kinase (FAK), mitogen-activated protein kinases (MAPK) and nuclear factor κB (NF-κB) pathways. It may cause endothelial dysfunction by increasing P and E-selection, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) levels which activate MAPK and NF-κB pathways. This factor is also associated with increased exocytosed von Willebrand factor (vWF) as well as activation of Rho-GTPase mechanism. All of these data demonstrate the dual role of fibrinogen in cardiac surgeries, bleeding inhibition and CVD. Therefore, identifying the CVD factors is helpful for designing preventive strategies and alternative drugs.
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http://dx.doi.org/10.1007/s11033-020-05880-yDOI Listing
October 2020

The role of molecular mechanism of Ten-Eleven Translocation2 (TET2) family proteins in pathogenesis of cardiovascular diseases (CVDs).

Mol Biol Rep 2020 Jul 22;47(7):5503-5509. Epub 2020 Jun 22.

High Institute for Education and Research in Transfusion Medicine, Tehran, Iran.

Cardiovascular disease (CVD) is one of the most common diseases worldwide. The underlying pathogenesis of the disease has not yet been determined, but many factors have been identified. Tet methylcytosine dioxygenase 2 (TET2) is one of the epigenetic factors involved in regulating many genes. Therefore, based on the studies shown, this factor plays an important role in preventing the occurrence of CVD. TET2 has been shown to increase angiogenesis by expressing Robo4. It also increases the activity of Matrix metalloproteinases (MMPs) and stimulates the secretion of Vascular endothelial growth factor angiogenesis. On the other hand, it has been shown that TET2 regulates the expression of several genes and the development of the heart during the embryonic period due to its oxygenating role. TET2 has been shown to regulates the expression of the genes such as Ying Yang1 (YY1), Sox9b, Inhbaa and many other genes that ultimately lead to the differentiation of cardiomyocytes. On the other hand, it has been shown that some Long non coding RNA and MicroRNAs reduce TET2 expression and CVD. Finally, it is concluded that inducing TET2 expression can be a good therapeutic strategy to prevent or improve CVD.
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http://dx.doi.org/10.1007/s11033-020-05602-4DOI Listing
July 2020

Correction to: Adjusted tight control blood glucose management in diabetic patients undergoing on pump coronary artery bypass graft. A randomized clinical trial.

J Diabetes Metab Disord 2020 Jun 7;19(1):665. Epub 2020 Feb 7.

Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

[This corrects the article DOI: 10.1007/s40200-020-00494-4.].
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http://dx.doi.org/10.1007/s40200-020-00500-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270298PMC
June 2020

Adjusted tight control blood glucose management in diabetic patients undergoing on pump coronary artery bypass graft. A randomized clinical trial.

J Diabetes Metab Disord 2020 Jun 20;19(1):423-430. Epub 2020 Jan 20.

Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Many of the patients who are undergoing Coronary Artery Bypass Graft have diabetes mellitus or metabolic syndrome and are at risk for hyperglycemia events.

Objective: The present study aimed to compare conventional glucose control with adjusted tight control in patients undergoing on-pump CABG.

Methods: This double -blind randomized clinical trial study was conducted in Shiraz, Iran, from September 2017-March 2018. Two consecutive groups of 75 patients undergoing elective on- pump coronary artery bypass graft surgery.

Intervention: The patients were divided into adjusted tight control of the blood glucose between 100 and 120 mg/dl and conventional method that the blood glucose maintained ≤200 mg/dl.

Primary Outcomes Were: mortality, sternal wound infection, cardiac arrhythmia, cerebrovascular attack, and acute renal failure.

Secondary Outcomes Included: duration of mechanical ventilation and length of ICU staying. The same main outcomes were evaluated after one month.

Statistical Analysis: The data were analyzed using SPSS version 20(SPSS, Chicago, IL). Group comparisons were performed using t-tests and Chi-square tests. Repeated measurement test was used for comparing blood glucose in two groups. Mann Whitney U test was compared duration of the mechanical ventilation and length of ICU staying. Statistical significance was defined as a value <0.05.

Results: There were no significant differences between main and secondary outcomes. About late outcomes, sternal wound infection was in the control group (7 patients) more than intervention (1 patient) ( < 0.05). No differences between other complications in both groups were observed. The occurrence of hypoglycemia was low in both groups. Hypokalemia was significantly higher in the intervention than in control ( < 0.001).

Conclusions: The findings showed using adjusted tight glycemic control to a level that is nearby to normal values during cardiac surgery may reduce episodes of hypoglycemia and thus reduces its side effects. As well as reduce hyperglycemic complications such as sternal wound infection.

Trial Registration Number: IRCT2013041713052N1). 2013-07-09.
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http://dx.doi.org/10.1007/s40200-020-00494-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270305PMC
June 2020

Do exosomes play role in cardiovascular disease development in hematological malignancy?

Mol Biol Rep 2020 Jul 21;47(7):5487-5493. Epub 2020 Apr 21.

High Institute for Education and Research in Transfusion Medicine, Tehran, Iran.

Exosomes play a role in the pathogenesis and treatment of malignancies as a double-edged sword. Recently, researchers discussed about two new roles, cardiomyocyte function impairment and cardiovascular disease (CVD) genesis. Data were collected from PUBMED at various time points up to the 2019 academic year. The related key words are listed as following; "Arsenic trioxide", "acute promyelocytic leukemia" and "cardio toxicity" and "molecular pathway" and "biomarker". This study has shown that exosomes secreted substances stimulate angiogenesis and cardiomyocytes repairment; cited process depended on the kinds of released substances. Generally, exosomes may involve in the pathogenesis of CVD; although CVD can prevented by identifying the pathways that induce angiogenesis.
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http://dx.doi.org/10.1007/s11033-020-05453-zDOI Listing
July 2020

Investigating the Effect of Fibrinogen Injection on Bleeding in Coronary Artery Bypass Surgery: A Clinical Trial.

Anesth Pain Med 2019 Aug 27;9(4):e92165. Epub 2019 Aug 27.

Department of Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Prevention and optimal treatment of postoperative bleeding are of great clinical importance in various types of surgeries including coronary artery bypass graft (CABG). Reducing the amount of bleeding will reduce the complications subsequent to blood transfusion. The positive effects of coagulation factors, especially fibrinogen, after cardiovascular bypass could have beneficial effects due to reduced bleeding and less need for blood transfusion. However, different studies have reported controversial findings.

Objectives: The present study aimed to evaluate the effect of prophylactic administration of fibrinogen on blood loss in patients undergoing CABG surgery to achieve more accurate clinical outcomes.

Methods: This was a double-blind randomized clinical trial conducted on 36 patients hospitalized in Ahvaz Imam Khomeini Hospital for coronary artery bypass graft. Patients were randomized to receive either fibrinogen concentrate (n = 18) or placebo (n = 18). Hemoglobin, hematocrit, international normalized ratio, prothrombin time, partial thromboplastin time, and fibrinogen were checked preoperatively. The transfusion of allogeneic blood components and the volume of blood loss were recorded and compared between the groups.

Results: Prophylactic fibrinogen injection reduced the need for blood transfusion, blood products, and postoperative hypotension in the fibrinogen group when compared to the control group (P ≤ 0.005). There was a significant difference between the two groups in terms of the amount of bleeding during operation (P ≤ 0.005).

Conclusions: Fibrinogen plays a key role in preventing and stopping the bleeding. Accordingly, fibrinogen decreases bleeding and the need for paced cell in patients in CABG. Given the adverse outcomes of bleeding and coagulopathy in patients undergoing surgery, we conclude that the use of fibrinogen could be beneficial as a prophylactic in hemorrhagic surgery.
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http://dx.doi.org/10.5812/aapm.92165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825327PMC
August 2019

The Effect of Fibrinogen on Blood Loss After Lumbar Surgery: A Double-Blind Randomized Clinical Trial.

Anesth Pain Med 2019 Jun 1;9(3):e91199. Epub 2019 Jun 1.

Department of Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Spinal surgeries often have a high risk of hemorrhage during and after surgery, thus most patients require blood transfusions and blood products. Fibrinogen is used in different forms to control hemorrhage.

Objectives: The present study aimed to evaluate the outcomes of prophylactic fibrinogen administration in reducing hemorrhage after lumbar surgery.

Methods: This was a randomized clinical trial conducted on 30 patients undergoing lumbar surgery. The levels of fibrinogen, as well as hemoglobin (HB), hematocrit (HCT), prothrombin time (PT), partial thromboplastin time (PTT), and INR, were assessed preoperatively as the baseline values. The patients were divided into two groups: intervention (N = 15) and control (N = 15) groups. The intervention group received 1 g fibrinogen dissolved in 50 cc distilled water with surgical incision and the control group received 50 cc distilled water with the surgical incision. At the end of the operation, the volume of hemorrhage transfused blood products (fresh frozen plasma, packed cell, and platelet) was measured. In addition, at 0, 6, and 24 hours after the end of surgery and transfer to recovery, serum levels of fibrinogen, HB, HCT, INR, PT, PTT, and hemovac drain volume were measured.

Results: The hemorrhage during and after the operation in the control group was significantly higher than that of the intervention group (P < 0.05). There were no significant differences between hemoglobin and serum level of fibrinogen before and after surgery between the two groups. The postoperative hypotension showed no significant difference between the two groups.

Conclusions: The findings showed the effectiveness of fibrinogen in reducing acute hemorrhage. Considering the adverse consequences of hemorrhage and coagulopathy in patients undergoing surgery, using fibrinogen as prophylaxis is recommended in surgeries with high risks of hemorrhage.
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http://dx.doi.org/10.5812/aapm.91199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712358PMC
June 2019

Comparing the Effect of Clonidine and Dexmedetomidine on Intraoperative Bleeding in Spine Surgery.

Anesth Pain Med 2019 Feb 24;9(1):e83967. Epub 2019 Feb 24.

Department of Anesthesia, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Discopathy is one of the most common spinal surgeries. Hemodynamic control is important in bleeding reduction during the surgery. Clonidine and dexmedetomidine both are α agonists that help stabilize hemodynamics and prevent the increase of intraoperative bleeding.

Objectives: In this study, the effects of clonidine and dexmedetomidine were compared in bleeding reduction during spinal surgery.

Methods: This randomized, double-blind clinical trial was conducted in 120 patients aged 20 to 50 years with ASA class I or II, undergoing spinal surgery. Patients were randomly divided into three groups. Group C received oral clonidine 0.2 mg, 90 minutes before entering the room. Group D received dexmedetomidine 0.5 µ/kg 15 minutes before anesthesia induction and 0.25 µ/kg/h infusion during operation. Group P received placebo as the control group.

Results: There was a significant reduction in intraoperative blood loss in patients who received clonidine (289 ± 130) and dexmedetomidine (344 ± 145) compared to the control group (462 ± 15) (P < 0.05), with a more dramatic reduction in the clonidine group (P < 0. 001).
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http://dx.doi.org/10.5812/aapm.83967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408748PMC
February 2019

The Comparison of the Effect of Mannitol and N Acetyl Cysteine on Liver Function in Partial Hepatectomy.

Anesth Pain Med 2018 Oct 22;8(5):e79677. Epub 2018 Sep 22.

Department of Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

The alterations in liver function in patients after major liver resection are complex. Partial hepatectomy surgery is considered as a selective therapeutic approach in many benign and malignant liver tumors, secondary metastases, and liver trauma. According to surgical techniques most often based on vascular control and hepatic venous closure (Pringle maneuver), related complications such as ischemia and decreased venous return during and after surgery can be seen. In this study, the effects of Mannitol and N-acetylcysteine, on liver function, after hepatectomy surgery, were compared. This study was shown that infusion N-acetylcysteine next to mannitol, in partial hepatectomy surgeries, was not the significant difference to improve liver function, hemodynamic status, and laboratory tests.
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http://dx.doi.org/10.5812/aapm.79677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240830PMC
October 2018

Effect of Remote Ischemic Preconditioning on Troponin I in CABG.

Anesth Pain Med 2017 Aug 21;7(4):e12549. Epub 2017 Aug 21.

Assistant Professor of Anesthesia, Department of Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Elective open heart surgery is associated with troponin release in some cases due to myocyte necrosis.

Objectives: The aim of this study was to measure cardiac troponin I (cTnI) preoperatively in elective CABG after remote ischemic preconditioning.

Methods: Twenty-eight patients were selected for elective CABG. They were randomized to receive remote ischemic preconditioning (induced by three 5-min cycles of inflation with a pneumatic tourniquet and 5-min deflation between inflation episodes as reperfusion).

Outcomes: Primary outcomes were cardiac troponin I levels at 6 and 24 hours after the procedure, and the secondary outcomes included creatine phosphokinase, lactate dehydrogenase, and serum creatinine levels. Hemodynamic changes were evaluated between the treatment and control groups.

Results: Cardiac troponin I at 6 hours after preconditioning was significantly lower compared to the control group (P = 0.036), and after 24 hours, there was still a significant difference between the two groups (P < 0.05).

Conclusions: Remote ischemic preconditioning reduces ischemic biomarkers during coronary artery bypass graft and attenuates procedure-related cardiac troponin I release and eventually reduces cardiovascular events such as myocardial infarction, chest pain, and hemodynamic changes after cardiac surgery.
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http://dx.doi.org/10.5812/aapm.12549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797663PMC
August 2017

Sequential compression pump effect on hypotension due to spinal anesthesia for cesarean section: A double blind clinical trial.

Electron Physician 2017 May 25;9(5):4419-4424. Epub 2017 May 25.

M.D., Anesthesiologist, Associate Professor, Department of Anesthesia, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Spinal anesthesia (SA) is a standard technique for cesarean section. Hypotension presents an incident of 80-85% after SA in pregnant women.

Objective: To determine the effect of intermittent pneumatic compression of lower limbs on declining spinal anesthesia induced hypotension during cesarean section.

Methods: This double-blind clinical prospective study was conducted on 76 non-laboring parturient patients, aged 18-45 years, with the American Society of Anesthesiologist physical status I or II who were scheduled for elective cesarean section at Razi Hospital, Ahvaz, Iran from December 21, 2015 to January 20, 2016. Patients were divided into treatment mechanical pump (Group M) or control group (Group C) with simple random sampling. Fetal presentation, birth weight, Apgar at 1 and 5 min, time taken for pre-hydration (min), pre-hydration to the administration of spinal anesthesia (min), initiation of spinal to the delivery (min) and total volume of intravenous fluids, total dose of ephedrine and metoclopramide were recorded. Data were analyzed by SPSS version 19, using repeated measures of ANOVA and Chi square test.

Results: Heart rate, MPA, DAP and SAP changes were significantly higher in off-pump group in the baseline and 1st-minute (p<0.05), and in the other times, this change was significantly different with control groups.

Conclusion: This research showed the suitability of the use of Sequential Compression Device (SCD) in reducing hypotension after spinal anesthesia for cesarean section, also this method can cause reducing vasopressor dosage for increased blood pressure, but the approval of its effectiveness requires repetition of the study with a larger sample size.

Trial Registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2015011217742N3.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
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http://dx.doi.org/10.19082/4419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498709PMC
May 2017