Publications by authors named "Mostafa Mohammadi"

42 Publications

Sensitization of A-549 lung cancer cells to Cisplatin by Quinacrine-loaded lipidic nanoparticles via suppressing Nrf2 mediated defense mechanism.

Naunyn Schmiedebergs Arch Pharmacol 2021 Mar 18. Epub 2021 Mar 18.

Department of Genetic and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, İstanbul, 34755, Turkey.

Nuclear factor erythroid 2-related factor 2 (Nrf2) is believed to be responsible for the control mechanisms of cellular defense response and master regulator of antioxidant system by adjustment of endogenous antioxidants, phase II detoxifying enzymes and transporters, so inhibition of Nrf2 could be considered molecule target to overcome drug resistance and cancer progression. By harnessing liposome as an advanced nanoparticles transporter, we formulated Quinacrine known as nrf2 inhibitor into nano-carrier, and sensitized A-549 lung tumor cells to Cisplatin. The aim of this work was to prepare liposome nano-carriers to enhance the bioavailability of Quinacrine and to improve passive targeting in A549 cells. Quinacrine formulation into liposome exposed a mean particle size of 80±5 nm in passive targeting and 110±3 after decoration with chitosan oligosaccharides (COS), respectively. The highest amount of cell death (p<0.05) occurred with the co-incubation of the A549 cells with new formulation and Cisplatin. Additionally, Quinacrine-loaded liposomes declined Nrf2 expression more than Quinacrine alone (p<0.05). Correspondingly, the expression of Nrf2 downstream genes, MRP1, Trx, and bcl2 decreased significantly. Taking all the data into consideration, liposomes containing Quinacrine could ameliorate the effectiveness of Cisplatin by raising the permeability of cancer cells to the abovementioned chemical treatment and might be then given as a candidate to boost the therapeutic protocols in cancer patients.
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http://dx.doi.org/10.1007/s00210-021-02079-1DOI Listing
March 2021

Interpretation of Hematological, Biochemical, and Immunological Findings of COVID-19 Disease: Biomarkers Associated with Severity and Mortality.

Iran J Allergy Asthma Immunol 2021 Feb 11;20(1):46-66. Epub 2021 Feb 11.

Department of Biostatistics and Social Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) spread rapidly all over the world in late 2019 and caused critical illness and death in some infected patients. This study aimed at examining several laboratory factors, especially inflammatory and immunological mediators, to identify severity and mortality associated biomarkers. Ninety-three hospitalized patients with confirmed coronavirus disease 2019 (COVID-19) were classified based on disease severity. The levels of biochemical, hematological, immunological, and inflammatory mediators were assessed, and their association with severity and mortality were evaluated. Hospitalized patients were mostly men (77.4%) with an average (standard deviation) age of 59.14 (14.81) years. The mortality rate was significantly higher in critical patients (85.7%). Increased serum levels of blood sugar, urea, creatinine, uric acid, phosphorus, total bilirubin, serum glutamic-oxaloacetic transaminase, serum glutamic-oxaloacetic transaminase, lactic dehydrogenase, C-reactive protein, ferritin, and procalcitonin were significantly prevalent (p=0.002, p<0.001, p<0.001, p=0.014, p=0.047, p=0.003, p<0.001, p<0.001, p<0.001, p<0.001, P<0.001, and p<0.001, respectively) in COVID-19 patients. Decreased red blood cell, hemoglobin, and hematocrit were significantly prevalent among COVID-19 patients than healthy control subjects (p<0.001 for all). Troponin-I, interleukin-6, neutrophil/lymphocyte ratio (NLR), procalcitonin, and D-dimer showed a significant association with the mortality of patients with specificity and sensitivity more than 60%. Age, sex, underlying diseases, blood oxygen pressure, complete blood count along with C-reactive protein, lactic dehydrogenase, procalcitonin, D-dimer, and interleukin-6 evaluation help to predict the severity and required management for COVID-19 patients. Further investigations are highly recommended in a larger cohort study for validation of the present findings.
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http://dx.doi.org/10.18502/ijaai.v20i1.5412DOI Listing
February 2021

Continuous tongue robot mapping for paralyzed individuals improves the functional performance of tongue-based robotic assistance.

IEEE Trans Biomed Eng 2021 Jan 29;PP. Epub 2021 Jan 29.

Individuals with tetraplegia have a challenging life due to the lack of independence and autonomy. Assistive robots have the potential to assist with the activities of daily living and thus improve the quality of life. However, an efficient and reliable control interface for severely disabled individuals is still missing. An intraoral tongue-computer interface (ITCI) for people with tetraplegia has previously been introduced and tested for controlling a robotic manipulator, in a study deploying discrete tongue robot mapping. To improve the efficiency of the interface, the current study proposed the use of virtual buttons based on the ITCI and evaluated them in combination with a joystick-like control implementation, enabling continuous control commands. Twelve able-bodied volunteers participated in a three-day experiment during which they controlled an assistive robotic manipulator by means of the tongue to perform two tasks: Pouring water in a cup (PW) and picking up a roll of tape (PUT). Four different tongue-robot mapping methods were compared. The results showed that using continuous commands reduced the task completion time by 16% and the number of commands of the PUT test by 20% compared with discrete commands. The highest success rate for completing the tasks was 77.8% for the PUT test and 100% for the PW test, both achieved by the control methods with continuous commands. Thus, the study demonstrated that incorporating continuous commands can improve the performance of the ITCI system for controlling robotic manipulators.
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http://dx.doi.org/10.1109/TBME.2021.3055250DOI Listing
January 2021

Comparison of Pharmaceutical Effect of Alemtuzumab and Natalizumab and Their Side Effects in Treatment of Various Stages of Multiple Sclerosis Patients.

CNS Neurol Disord Drug Targets 2021 Jan 29. Epub 2021 Jan 29.

Islamic Azad University of Central Tehran Branch, Department of Electrical Engineering, Tehran. Iran.

Background: Multiple sclerosis (MS) is an autoimmune and inflammatory disease in which the body mistakenly attacks the myelin, the sheath of nerve cells in the brain and spinal cord, causing ulcers. This damage to myelin disrupts the transmission of neural messages to the nervous system. This study aimed to compare the pharmacological effect of Alemtuzumab and Natalizumab in treating various stages of MS patients and the side effects of their use. Autologous hematopoietic stem cell transplantation has also been studied as the best current treatment for MS.

Methods: In this study, 425patients with MS were examined and categorized into different groups according to their disease stages. Among the people studied, 183 were men, and 242 were women. Patients with primary progressive MS (PPMS) has divided into groups A and B, patients with relapsing-remitting MS (RRMS) in groups C and D, and patients with secondary progressive MS (SPMS) in groups E and F. According to the classification, Alemtuzumab drug prescribed for patients in groups A and C and E, and Natalizumab for B and D and E groups. To more accurately examine patients' condition, a criterion called the large-scale disability status was defined, calculated before and after treatment. Hence, the relationship between the number of head magnetic resonance imaging with the lesions created in patients, recurrence time, and recurrence rate before and after treatment investigated.

Results: The EDSS the coefficient was significantly lower in RRMS patients than in PPMS and SPMS patients. After 12 months of treatment, The EDSS coefficient of RRMS patients treated with Natalizumab was significantly lower than patients treated with Alemtuzumab. Also, which was the difference between this coefficient before. Moreover, after treatment was significantly higher, Alemtuzumab, this result indicates the direct effect and a positive function of Natalizumab in this group of patients. Due to Natalizumab's use, the recurrence rate of RRMS-D was significantly lower than that of RRMS-C. After 12 months of treatment, there was a significant decrease in the lesion's number on magnetic resonance imaging of the head and the RRMS-D group time of recurrence.

Conclusion: According to the results, the efficacy of Natalizumab in treating RRMS patients was better than Alemtuzumab, while there were no significant differences between other stages of MS patients. Also, the autologous hematopoietic stem cell transplantation method is more effective than Alemtuzumab and Natalizumab to use as the best treatment for patients with MS can give a theoretical and clinical guide for various stages of MS treatment and provide them to specialists.
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http://dx.doi.org/10.2174/1871527320666210129121701DOI Listing
January 2021

Comparison of the Effect of Enteral Feeding through the Bolus and Continuous Methods on Serum Phosphorus and Glucose Levels in Patients with Mechanical Ventilation: A Randomized Clinical Trial.

J Nutr Metab 2020 8;2020:6428418. Epub 2020 Sep 8.

MSc in Biostatistics Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Patients who are under mechanical ventilation in intensive care units need to have nutritional support. Also, feeding methods affect serum phosphorus and glucose levels, which are very important in weaning patients off the ventilator. Thus, this study is to compare the effects of both bolus and continuous enteral feeding methods on serum phosphorus and glucose levels in patients with mechanical ventilation.

Methods: In this clinical trial study, 34 patients in the intensive care unit of Imam Khomeini Hospital affiliated to the Tehran University of Medical Sciences satisfied inclusion criteria and were randomly divided into control and intervention groups. Sampling was done between October and February 2018. The intervention group received continuous enteral feeding for one week, and the control group received nutrition by the bolus method. The blood glucose level was measured every six hours, and the serum phosphorus level was recorded at the beginning and the end of the intervention, based on the data entry form with respect to all ethical considerations. Data analysis was done by SPSS-20 software.

Results: The serum phosphorus level was significantly increased in the intervention group (=0.004) and in the control group ( < 0.001) and was compared with the previous intervention. No significant difference was found between the intervention and control groups before and after the intervention (=0.22) and also one week after the intervention (=0.14). There was also no significant difference between the glucose levels from day 1 to day 7 in the control group (=0.33) and the intervention group (=0.086). . Nutritional support in both bolus and continuous methods increased the serum phosphorus level. It indicates the importance of the nutritional method in controlling the phosphorus level in critically ill patients. However, there was no difference between the effects of dietary methods on blood glucose control.
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http://dx.doi.org/10.1155/2020/6428418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508222PMC
September 2020

Comparing outcomes of hospitalized patients with moderate and severe COVID-19 following treatment with hydroxychloroquine plus atazanavir/ritonavir.

Daru 2020 Dec 28;28(2):625-634. Epub 2020 Aug 28.

Department of Epidemiology and Biostatistics, School of Public health, Tehran University of Medical Sciences, Tehran, Iran.

Background: The role of the antiviral therapy in treatment of COVID-19 is still a matter to be investigated. Also efficacy and safety of antiviral regimens were not compared according severity of the disease. In this study the efficacy and safety of hydroxychloroquine plus atazanavir/ritonavir was compared in patients with moderate and severe COVID-19.

Methods: We prospectively evaluated the clinical outcomes of 213 patients with COVID-19 during the hospitalization course and up to 56 days after the hospital discharge. The disease was categorized to moderate and severe based on the severity of pneumonia and peripheral oxygen saturation (SpO2). The patients received the national treatment protocol containing hydroxychloroquine (400 mg BD in first day and then 200 mg BD) plus atazanavir/ritonavir (300/100 mg daily) for 7 days. Main outcomes included discharge rates at day 7, 14 and 28, 28-day mortality, rate of intensive care unit (ICU) admission and intubation, length of hospital and ICU stay and incidence of adverse events.

Results: The mean (SD) age of patients was 60(14) years and 53% were male. According to WHO definition, 51.64% and 48.36% of the patients had moderate (SpO2 ≥ 90%) and severe disease (SpO2 < 90%) at baseline, respectively. The discharge rate of the moderate group was significantly higher than the severe group at day 7, 14 and 28 (HR = 0.49; 95% CI: 0.35-0.69, p = < 0.001 at day 7, HR = 0.48; 95% CI: 0.35-0.66, p = < 0.001 at day 14 and HR = 0.49; 95% CI: 0.36-0.67, p = < 0.001at day 28). The 28-day mortality of the severe group was six times higher than the moderate group (HR = 6.00; 95% CI: 2.50-14.44), p = < 0.001). The need of admission in ICU for the severe group and the moderate group was 37.86% and 18.18% of the patients. Length of hospital stay was significantly shorter in the moderate group in comparison with the severe group (5 ± 4 vs. 8 ± 6 days, p < 0.001). Patients in the moderate group experienced the serious adverse events and complications less than the severe group. The discharged patients were followed up to 56 days after discharge. Some of the patients complained of symptoms such as exertional dyspnea, weakness and new-onset hair loss.

Conclusion: Our study did not support the use of hydroxychloroquine plus atazanavir/ritonavir in patients who had SpO < 90% at the time of hospital admission. SpO2 was the only predictor of clinical outcomes (duration of hospital stay, discharge from the hospital and mortality) in patients treated with hydroxychloroquine plus atazanavir/ritonavir.
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http://dx.doi.org/10.1007/s40199-020-00369-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453126PMC
December 2020

Early Hemoperfusion for Cytokine Removal May Contribute to Prevention of Intubation in Patients Infected with COVID-19.

Blood Purif 2021;50(2):257-260. Epub 2020 Jun 26.

Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Hemoperfusion (HP) was helpful to prevent the development and progression of acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), liver failure, and septic shock by removing cytokines and other inflammatory mediators and ultimately preventing progression toward multiple organ failure. A 54-year-old man diagnosed with COVID-19 was hospitalized in the intensive care unit. The patient's O2 saturation was 80% using an oxygen mask, which was gradually declining. After 4 sessions of HP/continuous renal replacement therapies (CRRT), O2 saturation reached to 95%, and the patient was transferred to the general ward. Performing HP/CRRT at the early stages of ARDS can obviate the need for intubating patients with COVID-19. Punctual and early use of HP and CRRT in the treatment of ARDS in patients with COVID-19 prevented the progression of ARDS and patient intubation, reduced respiratory distress and the patient's dependence on oxygen, prevented other complications such as AKI and septic shock in the patient, and reduced mortality and hospital length of stay.
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http://dx.doi.org/10.1159/000509107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360504PMC
March 2021

Thiamine for Prevention of Postoperative Delirium in Patients Undergoing Gastrointestinal Surgery: A Randomized Clinical Trial.

J Res Pharm Pract 2020 Jan-Mar;9(1):30-35. Epub 2020 Mar 28.

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

Objective: Postoperative delirium is a common complication after gastrointestinal surgery that is associated with adverse outcomes. Thiamine is an essential cofactor for the glycolysis, oxidative metabolism, production of neurotransmitters in the crebs cycle. In this study, efficacy of thiamine was assessed as a preventive strategy of delirium in patients undergoing gastrointestinal surgery.

Methods: In this randomized clinical trial, 96 adult patients admitted to the intensive care unit (ICU) following gastrointestinal surgery were included. Patients were allocated to receive either 200 mg intravenous thiamine daily or an equal volume of 0.9% saline for 3 days. Delirium was evaluated twice daily based on the confusion assessment method-ICU. The incidence of postoperative delirium was considered as the primary outcome, and total analgesic use and ventilation days has been defined as secondary outcomes of the study.

Findings: The incidence rate of delirium was significantly lower in the thiamine group than the placebo group on the first day (8.3% vs. 25%; Odds ratio: 0.27 [95% confidence interval (CI): 0.08-0.92]; P= 0.026) and on the second day (4.2% vs. 20.8%; or: 0.16 [95% CI: 0.03-0.81]; P= 0.014). No adverse effect related to thiamine was detected during the study course.

Conclusion: Study results suggest that thiamine is a safe option for the prevention of postoperative delirium in patients after gastrointestinal surgery.
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http://dx.doi.org/10.4103/jrpp.JRPP_19_124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235453PMC
March 2020

Effect of magnesium supplementation on lactate clearance in critically ill patients with severe sepsis: a randomized clinical trial.

Eur J Clin Pharmacol 2020 Feb 9;76(2):175-184. Epub 2019 Dec 9.

Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: In this study, changes in lactate clearance following magnesium supplementation were evaluated in critically ill patients with severe sepsis.

Methods: Fifty-eight patients with severe sepsis were randomly assigned to receive either magnesium (n = 30) or placebo (n = 28). Patients in the magnesium group received intravenous magnesium sulfate to maintain serum magnesium level around 3 mg/dL for 3 days. The placebo group received the same volume of normal saline. Change in lactate clearance was considered primary outcome of the study.

Results: Mean increase in the lactate clearance in the magnesium group was significantly higher than the placebo group on day 2 (27.53% vs. 23.79% respectively, p < 0.001) and day 3 (49.83% vs. 37.02% respectively, p < 0.001). Time to lactate clearance was also significantly shorter in the magnesium group than the placebo group (47.28 ± 20.59 vs. 61.20 ± 24.31 h respectively, p = 0.03). Sepsis-related mortality was not significantly different but median length of ICU stay was significantly shorter in the magnesium group than the placebo group (8 vs. 15 days respectively, p < 0.01).

Conclusions: Magnesium supplementation increased lactate clearance in critically ill patients with severe sepsis. Optimizing serum magnesium level near the upper limit of the normal range may improve severe sepsis outcomes.
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http://dx.doi.org/10.1007/s00228-019-02788-wDOI Listing
February 2020

Prediction of environmental effects in received signal strength in FM/TV station based on meteorological parameters using artificial neural network and data mining.

J Environ Manage 2019 Nov 9;250:109454. Epub 2019 Sep 9.

KhajehNasirToosi University, Tehran, Iran. Electronic address:

In this paper, meteorological parameters, electric field strength and transmitters' output power measured during six months in a TV/FM station. There are 13 frequencies in FM and UHF frequency bands in pilot broadcast station. The analysis of results were carried out using data mining techniques. In addition, a prediction model on the basis of a Neural Network is identified. The electric field is affected by distance between the antenna and the receiver point, transmitters' output power and meteorological constituents of air pressure, temperature and humidity. The meteorological parameters and transmitters' power are used as inputs and the electric field is used as the output. After data acquisition, preprocessing is performed and the Neural Network of a multilayer perceptron model is applied. In addition, Multi Linear Regression is performed. In evaluation, the performance of the proposed techniques is based on the root mean square error (RMSE) property. The least MSE obtained for the proposed model based on Neural Network amounted to 0.198 while the least MSE of Regression was 0.280. The results showed that for a given input of the atmospheric parameters as well as the transmitter power, the intensity of electric field can be predicted as well as the determining the relationship between the atmospheric parameters, transmitters' power and electric field strength. The statistical and correlation analysis used to assess the relation between each parameter and signal strength concluded that the temperature and wind direction have an inverted linear relationship with the signal level while the others have a direct linear relationship.
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http://dx.doi.org/10.1016/j.jenvman.2019.109454DOI Listing
November 2019

A high-resolution tongue-based joystick to enable robot control for individuals with severe disabilities.

IEEE Int Conf Rehabil Robot 2019 06;2019:1043-1048

Assistive robotic arms have shown the potential to improve the quality of life of people with severe disabilities. However, a high performance and intuitive control interface for robots with 6-7 DOFs is still missing for these individuals. An inductive tongue computer interface (ITCI) was recently tested for control of robots and the study illustrated potential in this field. The paper describes the investigation of the possibility of developing a high performance tongue-based joystick-like controller for robots through two studies. The first compared different methods for mapping the 18 sensor signals to a 2D coordinate, as a touchpad. The second evaluated the performance of a novel approach for emulating an analog joystick by the ITCI based on the ISO9241-411 standard. Two subjects performed a multi-directional tapping test using a standard analog joystick, the ITCI system held in hand and operated by the other hand, and finally by tongue when mounted inside the mouth. Throughput was measured as the evaluation parameter. The results show that the contact on the touchpads can be localized by almost 1 mm accuracy. The effective throughput of ITCI system for the multi-directional tapping test was 2.03 bps while keeping it in the hand and 1.31 bps when using it inside the mouth.
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http://dx.doi.org/10.1109/ICORR.2019.8779434DOI Listing
June 2019

Topical Nifedipine for the Treatment of Pressure Ulcer: A Randomized, Placebo-Controlled Clinical Trial.

Am J Ther 2021 Jan-Feb 01;28(1):e41-e51

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

Background: Effect of nifedipine on pressure ulcer (PU) healing has not been evaluated in the human subjects yet.

Study Question: In this study, the effect of topical application of nifedipine 3% ointment on PU healing in critically ill patients was investigated.

Study Design: This was a randomized, double-blind, placebo-controlled clinical.

Measures And Outcomes: In this study, 200 patients with stage I or II PU according to 2-digit Stirling Pressure Ulcer Severity Scale were randomized to receive topical nifedipine 3% ointment or placebo twice daily for 14 days. Changes in the size and stage of the ulcers were considered as primary outcome of the study. The stage of the ulcers at baseline and on day 7 and day 14 of study was determined by using 2-digit stirling scale. In addition, the surface area of the wounds was estimated by multiplying width by length.

Results: In total, 83 patients in each group completed the study. The groups were matched for the baseline stage and size of PUs. Mean decrease in the stage of PU in the nifedipine group was significantly higher than the placebo group on day 7 (-1.71 vs. -0.16, respectively, P < 0.001) and day 14 (-0.78 vs. -0.09, respectively, P < 0.001). Furthermore, the mean decrease in the surface area of PU was significantly higher in the nifedipine group compared with the placebo group on day 7 (-1.44 vs. -0.32, respectively, P < 0.001) and day 14 (-2.51 vs. -0.24, respectively, P < 0.001) of study.

Conclusions: Topical application of nifedipine 3% ointment for 14 days significantly improved the healing process of stage I or II PUs in critically ill patients.
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http://dx.doi.org/10.1097/MJT.0000000000000936DOI Listing
June 2019

Meropenem/colistin versus meropenem/ampicillin-sulbactam in the treatment of carbapenem-resistant pneumonia.

J Comp Eff Res 2018 09 7;7(9):901-911. Epub 2018 Sep 7.

Central Laboratory, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Aim: Efficacy of colistin and ampicillin-sulbactam have not been compared in treatment of ventilator-associated pneumonia due to A. baumannii. Efficacy of colistin and ampicillin-sulbactam in combination with meropenem were compared in treatment of ventilator-associated pneumonia due to carbapenem-resistant A. baumannii.

Method: 47 patients with ventilator-associated pneumonia due to carbapenem-resistant A. baumannii were randomized to receive meropenem/colistin or meropenem/ampicillin-sulbactam for 14 days. Clinical and microbiological responses and 28-day mortality were considered as outcomes.

Results: Clinical response (75 vs 69.6%; p = 0.75) and microbial eradication (87.50 vs 91.3%; p = 0.59) were comparable between meropenem/colistin and meropenem/ampicillin-sulbactam groups, respectively.

Conclusion: In this study, clinical and microbiological response were comparable between the meropenem/colistin and meropenem/ampicillin-sulbactam groups.
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http://dx.doi.org/10.2217/cer-2018-0037DOI Listing
September 2018

Topical pentoxifylline for pressure ulcer treatment: a randomised, double-blind, placebo-controlled clinical trial.

J Wound Care 2018 Aug;27(8):495-502

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

Objective: To evaluate the effectiveness of topical pentoxifylline (PTX) on pressure ulcer (PU) healing in critically ill patients.

Method: In this randomised, double blind, placebo-controlled clinical trial, patients with category I or II PUs were randomly assigned to receive either topical PTX 5% or a placebo twice daily for 14 days. Changes in PU characteristics (category and size) were assessed. The category of the PU was determined by the Stirling Pressure Ulcer Severity Scale (two-digit) at baseline (day zero), day seven and day 14 of treatment. PU length and width was measured with a disposable ruler and expressed as cm.

Results: A total of 112 adult patients were enrolled in the study. Median PU size and score at day zero were 32 (10.00-69.33)cm and 1(1.00-2.00) respectively. In the PTX group, the mean differences (95% confidence interval, CI) of all PU scores and sizes decreased significantly across the intervals (day seven versus day zero, day 14 versus day zero, and day 14 versus day seven), compared with the placebo group Conclusion: The severity and size of PUs improved significantly in patients who received topical PTX 5% ointment twice a day for 14 days compared with those in the placebo group. Topical PTX may be considered as a potential option in the treatment of categories I and II PUs in critically ill patients.
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http://dx.doi.org/10.12968/jowc.2018.27.8.495DOI Listing
August 2018

Evaluation of Wound Dressing Made From Spider Silk Protein Using in a Rabbit Model.

Int J Low Extrem Wounds 2018 Jun;17(2):71-77

5 Department of Biology and Anatomical sciences, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.

The aim of the present article was to study the healing of wounds using spider silk. Eight New Zealand female rabbits were selected as animal model. First, 3 identical wounds with length of 15 mm and a depth of 4 mm on the back of each rabbit were created. The first group, as standard control, did not receive any special treatment, they were treated only with saline and Vaseline locally. The second group, as positive control, received a thin film of phenytoin 1% ointment locally. The third group, as treated group, received a thin film of spider silk protein. At the end of the study, a biopsy of skin was done. After tissue preparation, all sections were evaluated. Some morphometrical parameters such as counting cells, fibroblasts, blood vessels, determination of the area of the wound closure, necrotic tissue, speed of wound healing, and epidermal thickness were done, and for data statistical analysis, SPSS software and Excel software were used. The results of this study showed that spider silk dressing may benefit as a possible effect of nanoparticles in the test preparation in wound healing.
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http://dx.doi.org/10.1177/1534734618782827DOI Listing
June 2018

Preventive Intervention to Prevent Delirium in Patients Hospitalized in Intensive Care Unit.

Iran J Psychiatry 2018 Apr;13(2):142-147

Director of Neuropsychiatry Section of Iranian Psychiatry Association, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Delirium is a clinical syndrome associated with multiple short- and long-term complications; therefore, prevention is an essential part of its management. This study was conducted to review the effective non-pharmacological interventions that can reduce the incidence or duration of delirium in critically ill patients. A search was made in PubMed, Scopus, Psych INFO and Google Scholar databases without any time constraints. The information available was collected and sorted, and a secondary study of narrative review was done. The views of specialists on this topic were received via email and included in the texts and recommendations. Delirium is a common, costly and potentially damaging illness in patients who are staying in hospitals, especially older patients in ICU. Thus, preventing delirium could be one of the most effective methods in preventing the complications. The present study aimed at conducting a review-validity study to generate a general view on the activities which might be effective in preventing delirium in patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6037578PMC
April 2018

Antibiotic stewardship program in Intensive Care Unit: First report from Iran.

Int J Crit Illn Inj Sci 2018 Apr-Jun;8(2):83-89

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

Introduction: Few data regarding antibiotic stewardship programs in critically ill patients are available. In the present study, the consequence of changing an empirical antibiotic regimen from a carbapenem (meropenem) to a noncarbapenem antibiotic (piperacillin-tazobactam) was evaluated in critically ill patients with a suspicion of sepsis.

Methods: This open-label randomized clinical trial was conducted during May 2015-January 2017 at the general Intensive Care Unit of the Imam Khomeini Hospital Complex, Tehran, Iran. In this study, a carbapenem (meropenem) or a noncarbapenem (piperacillin-tazobactam) antibiotic was considered as an empirical antibiotic regimen in 100 critically ill patients with a suspicion of sepsis. Clinical response and bacterial eradication were defined as primary and secondary outcomes of the study, respectively. Chi-square, Mann-Whitney, and independent sample -tests were used for comparing variables between the groups. ANOVA was used to compare changes in the mean differences of parameters between the groups. Meaningful difference was indicated as ≤ 0.05.

Results: During the first 72 h of the antibiotic course, the number of patients with clinical response was comparable between piperacillin-tazobactam and meropenem groups (21 [42%] and 25 [50%], respectively, = 0.31). Also, at this time, microbial eradication occurred in 13 (54.16%) and 9 (40.90%) patients in piperacillin-tazobactam and meropenem groups, respectively ( = 0.67).

Conclusions: Using a carbapenem (meropenem) instead of a noncarbapenem (piperacillin-tazobactam) as an empirical antibiotic regimen did not affect clinical response and bacterial eradication rates in critically ill patients with a suspicion of sepsis.
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http://dx.doi.org/10.4103/IJCIIS.IJCIIS_10_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018263PMC
July 2018

Adaptation of the Pharmacological Management of Delirium in ICU Patients in Iran: Introduction and Definition.

Iran J Psychiatry 2018 Jan;13(1):65-79

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

Delirium is a brain dysfunction syndrome. In most cases, this syndrome is neither diagnosed accurately nor treated properly. The incidence of delirium by itself increases hospitalization period, mortality rate and the cost in health spectrum. If appropriate attempts are not made to treat this complication, the outcomes could become worse. Thus, the present study aimed at conducting a review on medications which are prescribed to treat delirium and establishing a general view on their advantages and disadvantages. By searching Google Scholar, PsycINFO, Scopus, and PubMed databases as well as hand searching in key journals, data were collected without time and language limitation. After collecting the data, comparing the similar or contradictory information, and sorting them, the views of specialists were inquired and duly received via email. By acquiring consensus of opinions, the secondary manuscript was written in a narrative review form. This narrative review paper aimed at providing a general view on defining delirium, the pathologic factors that create it, and treating this syndrome based on its development. Authentic evidence regarding delirium management was reviewed and a treatment strategy was suggested for Iranian patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994234PMC
January 2018

Effect of Magnesium Loading Dose on Insulin Resistance in Patients With Stress-Induced Hyperglycemia: A Randomized Clinical Trial.

J Intensive Care Med 2020 Jul 22;35(7):687-693. Epub 2018 May 22.

Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: There is currently no evidence that whether magnesium supplementation would improve stress-induced hyperglycemia (SIH) in critically ill patients. In this study, effects of magnesium loading dose on insulin resistance (IR) indices were evaluated in critically ill patients without diabetes having SIH.

Methods: Seventy critically ill patients with SIH were assigned to receive a loading dose of magnesium (7.5 g of magnesium sulfate in 500 mL normal saline as intravenous infusion over an 8-hour period) or placebo. Changes in baseline of serum and intracellular magnesium and serum adiponectin (AD) levels, homeostasis model assessment of IR (HOMA-IR), and HOMA-AD ratio were assessed in this study.

Results: Serum and intracellular magnesium levels increased significantly in patients in the magnesium group ( < .001). At day 3, there were significant differences between the magnesium group and the placebo group in the mean changes from baseline in the HOMA (between-group difference: -0.11; 95% confidence interval [CI]: -0.19 to -0.01; = .02), the AD (between-group difference: 0.94; 95% CI: 0.41-1.48; = .04), and the HOMA-AD ratio (between-group difference: -0.03; 95% CI: -0.04 to -0.01; < .001).

Conclusion: In the present study, a single-loading dose of intravenous magnesium improved IR indices in critically ill patients with SIH.
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http://dx.doi.org/10.1177/0885066618777431DOI Listing
July 2020

Comparing efficacy of enteral nutrition plus ranitidine and enteral nutrition alone as stress ulcer prophylaxis.

J Comp Eff Res 2018 05 18;7(5):493-501. Epub 2018 May 18.

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

Aim: Adequacy of enteral nutrition (EN) alone as stress ulcer prophylaxis (SUP) is controversial. The aim of this study was to compare efficacy of EN alone and ranitidine plus EN as SUP.

Method: Critically ill adults with indications to receive SUP were randomized to ranitidine 50 mg IV every 8 h plus EN (SUP) or EN alone (non-SUP) group for 7 days. Besides, endoscopy was performed at the time of recruitment and on day 7.

Results: During the study period, only one patient in each group of SUP and non-SUP experienced gastrointestinal bleeding. At the time of recruitment, gastric erosion and erythema were the most endoscopic findings in the SUP and non-SUP groups. These findings did not significantly change at the end of the study (p = 0.21).

Conclusion: EN was at least effective as ranitidine plus EN as SUP.
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http://dx.doi.org/10.2217/cer-2017-0098DOI Listing
May 2018

Effect of Septimeb as a new natural extract on severe sepsis: A randomized clinical trial.

Caspian J Intern Med 2017 ;8(1):35-43

Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Science, Tehran, Iran.

Background: Septimeb as a herbal medicine has regulatory effects on inflammation. This study set to evaluate the effects of Septimeb among patients with sepsis on inflammatory biomarkers and survival rate.

Methods: In this randomized clinical trial, 51 patients with sepsis from the ICU and medical ward of Imam Khomeini Hospital were divided into two groups: Septimeb (n=25) and control group (n=26). In the control group, the patients received a standard treatment only for 7 days, while Septimeb group received Septimeb (6cc vial with 500cc serum glucose infusion 5% daily for one to two hours) plus standard treatment of sepsis for 7 days. Then, blood samples were analyzed. APACHE (Acute Physiologic and Chronic Health Evaluation), SOFA (Sequential Organ Failure Assessment), and GCS (Glasgow Coma Score) values were calculated daily.

Results: Treatment with Septimeb showed a significant decrease in SOFA value (1.54±0.83) compared to the control group (2.39±0.88) (P<0.001) and a significant increase in GCS value (14.46±0.88) compared to the control group (12.86±1.78) (P<0.001). Improvements of these values can confirm the potential of Septimeb in the reduction of severity of sepsis (P<0.05). There were significant decreases in lactate and blood sugar and WBC levels. In addition, inflammatory factors such as ESR (Septimeb group: 52.07±34.80, control group: 51.75±42.10, P=0.98) and CRP (Septimeb group: 48.86±23.21, control group: 49.93±36.22, P=0.92) decreased, but did not show a significant reduction.

Conclusion: Septimeb has positive effects on reduction of the severity of sepsis which leads to reduction of patients' mortality rates.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412247PMC
January 2017

Clinical response and outcome of pneumonia due to multi-drug resistant in critically ill patients.

Iran J Microbiol 2016 Oct;8(5):288-297

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

Background And Objectives: The frequency of multi-drug resistant . infections is increasing in Iran. Considering availability of limited therapeutic options, clinical response and outcome of ventilator-associated pneumonia due to multi-drug resistant were evaluated in critically ill patients.

Materials And Methods: In this prospective study, 29 patients with carbapenem resistance ventilator-associated pneumonia were enrolled. Endotracheal aspirate specimens were analyzed according to the clinical and laboratory standard institute instructions in the hospital's microbiology laboratory. Demographics, clinical, microbiological and laboratory findings were collected for each patient during the treatment course. Therapeutic empirical regimen, change in antibiotic regimen following receiving antibiogram results, clinical and microbiological responses, duration of ICU stay and outcome were collected for each recruited individual.

Results: All of isolates were resistant to pipracillin-tazobactam, ceftriaxon, amikacin and ciprofloxacin. The resistance rate of species was 41.4% for ampicillin/sulbactabm and 93.1% for meropenem. Patients received either meropenem/colistin (51.7%) or meropenem/ampicillin-sulbactam (48.3%) as the treatment regimens based on the antimicrobial susceptibility patterns of isolates. Ventilator-associated pneumonia clinical response, improvement and failure achieved in 15 (51.7%), 8 (27.6%) and 6 (20.7%) of the patients respectively. Microbiological eradication and intermediate status were observed in 9/29 (31%) and 11/29 (37.9%) of patients, respectively.

Conclusion: The antibiotic regimens showed comparable efficacy in treatment of VAP due to MDR but mortality rate was high. Considering widespread and high mortality rates associated with MDR infections, applying infection control and antibiotic stewardship programs in hospitals are essential.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5277596PMC
October 2016

Metoclopramide as intermittent and continuous infusions in critically ill patients: a pilot randomized clinical trial.

J Comp Eff Res 2017 Mar 24;6(2):127-136. Epub 2017 Jan 24.

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

Aim: Metoclopramide is commonly used as a prokinetic agent in critically ill patients with enteral feeding intolerance. In this study, noninferiority of metoclopramide as intermittent versus continuous infusion was examined in critically ill patients with enteral feeding intolerance.

Methods: Forty critically ill adults patients were assigned to receive metoclopramide as either intermittent (10 mg every 6 h) or continuous (2 mg/h) infusion. Frequency of feeding intolerance and adverse effects of metoclopramide were assessed during 7 days of study.

Results: Number of patients with feeding intolerance during different times of the course was not different between the groups. Although not statistically significant, diarrhea and cardiac rhythm were more common in continuous than intermittent infusion group.

Conclusion: Continuous and intermittent infusions of metoclopramide showed equivalent effectiveness in critically ill patients.
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http://dx.doi.org/10.2217/cer-2016-0067DOI Listing
March 2017

Atorvastatin for Prevention of Amikacin-induced Electrolytes Imbalances; a Randomized Clinical Trial.

Iran J Pharm Res 2016 ;15(2):627-34

Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Aminoglycosides are still widely used for treatment of gram-negative sepsis in critically ill patients. The most reported electrolyte abnormalities related to these drugs are hypokalemia, hypomagnesemia, and hypocalcemia.In this study potential benefit of atorvastatin in prevention of amikacin-induced electrolytes imbalances has been evaluated. In this trial 44 patients were assigned to the atorvastatin or placebo group based on the simple randomization method. Atorvastatin group received amikacinwith dose of 15 mg/kg/day in two equal divided doses every 12 h as intravenous infusion during 30 min and atorvastatin 40 mg tablet as daily oral dose for 7 days. Patients in the placebo group received same dose of amikacinand placebo tablet (Placebo group) for at least 7 days. Serum electrolytes (sodium, potassium, calcium, phosphor and magnesium) concentrations, blood urea nitrogen and serum creatinine levels were measured at day 0 and end of the study. Baseline mean ± SDof serum potassium concentration in the atorvastatin and placebo group was 4.07± 0.37 and 4.15 ± 0.53 meq/l respectively (p=0.88). Serum potassium concentration remained unchanged at the end of the study in the atorvastatin group (P=0.61) but significantly decreased from 4.15 ± 0.53 to 3.80 ± 0.55meq/l in the placebo group at day 7(P = 0.02).In this pilot study, atorvastatin as 40 mg daily oral dose prevented renal potassium loss during course of amikacin therapy in the critically ill patients. In the future well designed randomized clinical trials with adequate sample size,renoprotective effects of statins should be examined.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5018292PMC
September 2016

Radicular anatomy of permanent mandibular second molars in an Iranian population: A preliminary study.

Dent Res J (Isfahan) 2016 Jul-Aug;13(4):362-6

Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad University, Tehran, Iran.

Background: Root morphology is of utmost importance to endodontic sciences. Since there are a few studies on the morphology of mandibular second molars' roots, and some anatomical variables are not evaluated before, the aim of this study was to investigate thoroughly radicular anatomy of this tooth.

Materials And Methods: This ex vivo study was performed on 150 intact mandibular second molars. After access cavity preparation and ensuring canal patency, Indian ink was injected into root canals from the orifices. The teeth became transparent using methyl salicylate storage. Then, they were inspected by an endodontist under a ×10 stereomicroscope regarding numerous root morphological variables. Data were analyzed using chi-square test and analysis of variance (α = 0.05).

Results: About 86.7% of teeth had two roots and 13.3% were single-rooted (P = 0.0001), of which, 50% were C-shaped (6.7% of all teeth, P = 0.0001). 86.7% of mesial roots were double canalled, whereas 75.3% of distal roots were single canalled (P = 0.0001). 71.45% and 95.3% of the mesial and distal roots had one apical foramen, respectively (P = 0.0001). Apical foramens were mostly central followed by lingual in most cases. Distances between apical foramen and apical constriction ranged between 0.27 and 0.40 mm (P = 0.0545). Distances between apical foramen and root apices ranged between 0.30 and 0.47 mm (P = 0.0001). Vertucci classifications of mesial canals were Type II in 62.6% and Type IV in 37.4%. 86.2% of single-canal distal roots were Type I. 66.7% of double-canal distal roots were Type II and 33.3% were Type IV (P = 0.0001). The mean root lengths from cervical to apex of mesial, distal, and single roots were 14.02 ± 0.85 (95% confidence interval [CI] = 13.87-14.17), 13.35 ± 0.91 (95% CI = 13.19-13.50), and 14.25 ± 0.72 mm (95% CI = 13.91-14.58), respectively. The extents of canal curvatures varied between 20° and 31° buccolingually (P = 0.0000), and between 19° and 27° mesiodistally (P = 0.0000).

Conclusion: There was a considerable rate of eccentric apical foramen in mandibular second molars.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993065PMC
http://dx.doi.org/10.4103/1735-3327.187883DOI Listing
September 2016

Anti-inflammatory and Wound Healing Activities of Aloe vera, Honey and Milk Ointment on Second-Degree Burns in Rats.

Int J Low Extrem Wounds 2016 Sep 23;15(3):241-7. Epub 2016 May 23.

The Persian Gulf Marine Biotechnology Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran

The aim of the present study was morphological and morphometric investigation of burn healing impacts of an honey, milk, and Aloe vera (HMA) ointment on experimentally induced second-degree burns, to approve the medicinal basis of its use in Iranian traditional medicine. A total of 21 male Albino rats weighing 200 to 300 g were divided into 3 groups of 7, including (1) control group, (2) positive control group, and (3) the treatment group that were treated with eucerin, silver sulfadiazine 3% and HMA ointment 5% respectively.After anesthetizing, the second-degree burns (1 cm(2) areas) were made on the back of the animals using a digital controlled hot plaque, and each group was treated topically, based on the time scheduled. Then, skin punch biopsies were obtained on the 1st, 14th, and 28th days of post-burn induction; processed; and stained using hematoxylin and eosin and Masson's trichrome methods. The results showed that HMA ointment induces cell proliferation, increasing the wound closure rate, blood vessel counts, and collagen fiber density in treated animals. It also reduced the wound secretions, inflammation, and scar formation. According to the obtained morphological, morphometric results, we concluded that the traditional HMA ointment, which is rich in therapeutic biomaterials and minerals, has multiple healing effects on burn wounds in rats.
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http://dx.doi.org/10.1177/1534734616645031DOI Listing
September 2016

Effect of high-dose Ascorbic acid on vasopressor's requirement in septic shock.

J Res Pharm Pract 2016 Apr-Jun;5(2):94-100

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

Objective: Effects of ascorbic acid on hemodynamic parameters of septic shock were evaluated in nonsurgical critically ill patients in limited previous studies. In this study, the effect of high-dose ascorbic acid on vasopressor drug requirement was evaluated in surgical critically ill patients with septic shock.

Methods: Patients with septic shock who required a vasopressor drug to maintain mean arterial pressure >65 mmHg were assigned to receive either 25 mg/kg intravenous ascorbic acid every 6 h or matching placebo for 72 h. Vasopressor dose and duration were considered as the primary outcomes. Duration of Intensive Care Unit (ICU) stay and 28-day mortality has been defined as secondary outcomes.

Findings: During the study period, 28 patients (14 in each group) completed the trial. Mean dose of norepinephrine during the study period (7.44 ± 3.65 vs. 13.79 ± 6.48 mcg/min, P = 0.004) and duration of norepinephrine administration (49.64 ± 25.67 vs. 71.57 ± 1.60 h, P = 0.007) were significantly lower in the ascorbic acid than the placebo group. No statistically significant difference was detected between the groups regarding the length of ICU stay. However, 28-day mortality was significantly lower in the ascorbic acid than the placebo group (14.28% vs. 64.28%, respectively; P = 0.009).

Conclusion: High-dose ascorbic acid may be considered as an effective and safe adjuvant therapy in surgical critically ill patients with septic shock. The most effective dose of ascorbic acid and the best time for its administration should be determined in future studies.
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http://dx.doi.org/10.4103/2279-042X.179569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843590PMC
May 2016

Comparing effects of different routes of heparin administration on the serum biomarkers of thrombosis.

J Comp Eff Res 2016 05 19;5(3):249-57. Epub 2016 Apr 19.

Department of Pharmaceutical Biotechnology, Faculty of Pharmacy & Biotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Association between thrombosis pathogenesis and inflammatory conditions has been reported. Also inflammatory biomarkers have been proposed for prediction of thrombosis events.

Objectives: Effects of different methods of heparin administration (subcutaneous vs continuous infusion) as thromboprophylaxis on the biomarkers of thrombosis have been evaluated.

Methods: Serum levels of hsCRP, IL-10 and P-selectin as the biomarkers of thrombosis were measured at baseline, days 3 and 7 during the patients' hospitalization period.

Results: Changes in the serum levels of thrombosis biomarkers (hsCRP, IL-10 and P-selectin) were comparable between the subcutaneous and continuous infusion groups.

Conclusion: Both subcutaneous injection and continuous infusion of heparin as thromboprophylaxis showed same effects on the thrombosis biomarkers.
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http://dx.doi.org/10.2217/cer-2015-0013DOI Listing
May 2016

Cyproheptadine for the Prevention of Postoperative Delirium: A Pilot Study.

Ann Pharmacother 2016 Mar 24;50(3):180-7. Epub 2015 Dec 24.

Tehran University of Medical Sciences, Tehran, Iran.

Background: Postoperative delirium is a common neurobehavioral complication after major surgeries. There is no conclusive approach for prevention of delirium in these patients.

Objective: In this study, efficacy of cyproheptadine for prevention of postoperative delirium was evaluated.

Methods: Delirium status of surgical patients was evaluated postoperatively at the time of admission to the intensive care unit (ICU) using the Confusion Assessment Method (CAM-ICU) scale. Patients without delirium were assigned to the cyproheptadine or placebo group based on the simple randomization method. Patients received cyproheptadine or placebo tablet at a dose of 4 mg 3 times per day for 7 days. Patients were monitored daily for incidence of delirium.

Results: Changes in the incidence rates of delirium over time during the study phase (P = 0.04) and between the groups showed statistically significant differences (P = 0.029). However, severity of delirium was not significantly different between the cyproheptadine and placebo groups during the study period.

Conclusion: It seems that cyproheptadine with its diverse effects can be a potential option for prevention of postoperative delirium. In this pilot study, cyproheptadine significantly decreased the incidence but not severity of postoperative delirium.
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http://dx.doi.org/10.1177/1060028015624938DOI Listing
March 2016