Comparing the effect of administering gelatin-low dose albumin versus albumin on renal function in liver transplantation: A randomized clinical trial.

BACKGROUND: Acute kidney injury (AKI) is a common complication after liver transplantation (LT) that is independently associated with an increased risk of morbidity and mortality. This study aimed to evaluate the effects of administering gelatin-low dose albumin versus albumin on renal function and other early outcomes in LT. METHODS: This randomized controlled clinical trial was conducted on 140 patients undergoing LT from brain death donors. Patients were randomly assigned to two groups: albumin or modified gelatin with albumin. Blood samples were collected before (T0) and on the first (T1), second (T2), third (T3), fifth (T4), and last day of hospitalization (T5) after LT for the detection of laboratory parameters, including renal and liver function tests. RESULTS: The incidence of AKT on the basis of RIFLE criteria was 31.42% in the gelatin group (R: 59.10%, I: 36.40%, and F: 4.50%) and 25.71% in the albumin group (R: 66.70%, I: 27.80%, and F: 5.50%) (p = .845). Two patients in the gelatin and one in the albumin groups required renal replacement therapy (RRT). There was no significant difference between groups when the trends of changes in renal and liver function parameters were assessed during the study period (T0-T5). Furthermore, the incidence of complications was similar across groups. CONCLUSION: This study showed that modified gelatin could be used without inappropriate outcomes on renal function in patients with normal preoperative kidney function tests undergoing LT.

Risk factors of the post-reperfusion syndrome during orthotopic liver transplantation: a clinical observational study.

BACKGROUND: Post reperfusion syndrome (PRS) is a relatively common and life-threatening complication during orthotopic liver transplantation (OLT). It is associated with poor patient and transplanted liver outcomes. OBJECTIVE: This study aimed to compare the risk factors of PRS during OLT. DESIGN: Clinical-epidemiological observational retrospective study. SETTING: We gathered the records of patients who underwent OLT in 3 years, from May 22, 2016, to May 22, 2019, in Namazi and Bu-Ali Sina organ transplantation hospitals. PATIENTS: In this study, we assessed 1182 patients who underwent OLT. Patients were divided into two groups based on the presence or absence of PRS. MAIN OUTCOME MEASURES: Diagnosing the predictors of PRS was the primary outcome of this study. RESULTS: Results showed that age > 60 years, Child-Pugh scores C, higher Model End Stage liver disease score, and preoperative sodium < 130 mmol/l (parameters of the liver recipient), increase in cold ischemic time (the donors' parameters), and the classical technique (the surgical parameters) were the strong predictors of PRS. CONCLUSIONS: The results indicated that underlying liver disease was not the predictor of PRS in the presence of other risk factors; therefore, clinicians have to consider these risk factors in patients undergoing OLT.

Oleuropein improves glucose tolerance and lipid profile in rats with simultaneous renovascular hypertension and type 2 diabetes.

Oleuropein mediates most of the beneficial effects of olive products. This study examined the role of oxidative stress in the effects of oleuropein on lipid profile and blood glucose in rats with simultaneous renovascular hypertension and type 2 diabetes. Eight groups (n = 7-9 each) of male Sprague-Dawley rats including a control, a type 2 diabetic, a renovascular hypertensive, a sham, a simultaneously hypertensive diabetic receiving vehicle, and 3 simultaneously hypertensive-diabetic receiving 20, 40, or 60 mg/kg/day oleuropein were used. Four weeks after treatment, blood glucose, lipid profile, and biomarkers of oxidative stress were measured, and glucose tolerance test (GTT) was performed. Simultaneously hypertensive diabetic rats had significantly higher blood pressure, blood glucose, and serum total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglyceride and malondialdehyde. They also had lower serum high-density lipoprotein cholesterol, erythrocyte superoxide dismutase, and impaired glucose tolerance. Oleuropein significantly reduced blood pressure, blood glucose, and serum total cholesterol, LDL-C, triglyceride and malondoaldehyde. It also increased serum high-density lipoprotein cholesterol, erythrocyte superoxide dismutase, and improved glucose tolerance. The findings show that the model is associated with impaired glucose tolerance, and adverse lipid profile. They also show that oleuropein, partly by an antioxidant mechanism, improves glucose tolerance and changed lipid profile favorably.

An unusual case of metastatatic renal cell carcinoma presenting as melena and duodenal ulcer, 16 years after nephrectomy; a case report and review of the literature.

Renal cell carcinoma comprises about 2% of adult tumors. The overall 10-year survival rate of patients with RCC after nephrectomy is about 18-27%. The incidence of metastasis of initial RCC is about 24-28%, but this rate after nephrectomy is as high as 51%. The most common site of recurrence is the lung, however liver and bone metastases are common. There are many reported cases with late metastasis, however isolated late metastasis in the gastrointestinal tract especially duodenum is very rare. Herein we report our experience with a case of gastrointestinal bleeding secondary to metastatic renal cell carcinoma to duodenum, 16 years after nephrectomy. To the best of our knowledge, about 30 of such cases have been reported in the English literature. Many of the previous cases have been part of disseminated disease and isolated duodenal metastasis is very rare. The longest reported duration between nephrectomy for renal cell carcinoma and duodenal metastasis has been 13 years, thus it seems our case to be also unique because of very late duodenal metastasis.

Effect of mannitol on postreperfusion cardiac output and central venous oxygen saturation during orthotopic liver transplant: a double-blind randomized clinical trial.

CONTEXT: Attenuating postreperfusion syndrome during orthotopic liver transplant is very important for transplant anesthesiologists because of the syndrome's complications. Oxygen-derived free radicals play an important role in the genesis of postreperfusion syndrome, but the effect of mannitol (a free radical scavenger) on attenuating the syndrome is unclear.OBJECTIVES-To investigate the effectiveness of infusing mannitol during the anhepatic phase in preventing postreperfusion syndrome, as indicated by postreperfusion cardiac output and central venous oxygen saturation. DESIGN: In a randomized clinical trial, 53 patients who had undergone orthotopic liver transplant were allocated to 2 groups. During the anhepatic phase, patients in the mannitol group received 1g/kg mannitol, whereas those in the control group received physiological saline. Mean arterial pressure, cardiac output, and central venous oxygen saturation were measured before and after the portal vein was declamped. Serum levels of sodium and potassium were recorded at baseline and after portal vein declamping.Setting-Shiraz Organ Transplant Center, Shiraz, Iran. RESULTS: In the mannitol group, no significant change was found in mean arterial pressure, cardiac output, and central venous oxygen saturation before and after declamping of the portal vein (P= .78, P= .59, and P= .83, respectively). However, after declamping in the control group, mean arterial pressure, cardiac output, and central venous oxygen saturation were significantly lower than before declamping (P=.003, P=.001, and P<.001, respectively). No significant change in serum levels of sodium and potassium from baseline to after declamping were found in either group. CONCLUSION: Infusion of mannitol 1 g/kg during the anhepatic phase was effective in attenuating postreperfusion syndrome without stress about hyperkalemia or hyponatremia during anesthesia.

Effects of oleuropein in rats with simultaneous type 2 diabetes and renal hypertension: a study of antihypertensive mechanisms.

The mechanism of oleuropein's antihypertensive effects was examined in rat model of simultaneous type 2 diabetes and renal hypertension (diabetic hypertensive). Five groups of male Sprague-Dawley rats including a control, a diabetic-hypertensive group receiving vehicle, and three diabetic-hypertensive groups receiving oleuropein at 20, 40, or 60 mg/kg/day were used. The duration of diabetes was 10 weeks; during the last 4 weeks of which, animals were hypertensive and received vehicle or oleuropein. Systolic blood pressure, glucose and malondialdehyde, heart rate, and maximal response to phenylephrine (PE) in the absence of nitro-L-arginine methyl ester (L-NAME) of oleuropein-treated groups were significantly lower than those of vehicle-treated group. Erythrocyte superoxide dismutase, maximal response to PE in the presence of L-NAME, and maximal response to acetylcholine (Ach) of oleuropein-treated groups were significantly higher than those of vehicle-treated group. The findings indicate that antihypertensive effects of oleuropein might be partly mediated by improving the release of nitric oxide, and antioxidant and sympathoplegic activities.

The effects of Aminophylline on clinical recovery and bispectral index in patients anesthetized with total intravenous anaesthesia.

OBJECTIVE: Aminophylline, which is clinically used as a bronchodilator, antagonizes the action of adenosine, so it can be used to shorten the recovery time after general anesthesia. Therefore, we wanted to test the hypothesis that the administration of aminophylline leads to an increase in bispectral index (BIS) and clinical recovery in patients anesthetized with total intravenous anesthesia (TIVA). Methods : Ninety two patients who were scheduled for elective inguinal herniorrhaphy were enrolled in this study. All patients were premedicated with midazolam and morphine. Anesthesia was induced with propofol 2.5 mg /kg and remifentanil 2.5 µg/kg without muscle relaxant. For maintenance of anesthesia we used propofol 100µg/kg/min, remifentanil 0.2µg/kg/min and 100% oxygen with stable BIS readings in the range 40-60. After skin closure, aminophylline 4mg/ kg was given to Group A and an equivalent volume of normal saline to Group P. BIS values, heart rate, blood pressure, oxygen saturation and End tidal CO2(ETco2) were determined. Time to eye opening, extubation time and response to command were measured. Results : There were no significant differences in SpO2, ETco2 and anesthesia time. Heart rate and systolic blood pressure were found to be statistically higher (p<0.001) in Group A. Time to eye opening, hand grip and extubation were significantly shorter (p<0.001) in Group A. Bispectral index scores were significantly higher in group A. CONCLUSIONS: Injection of aminophylline at emergence time led to significant increase in BIS and shortening recovery time from anesthesia.

Effects of Short-term Renovascular Hypertension and Type 2 Diabetes on Cardiac Functions in Rats.

BACKGROUND: The cardiac effects simultaneously occurring during experimental hypertension and diabetes have rarely been investigated. This study aimed at examining the effects of short-term renovascular hypertension and type 2 diabetes on cardiac functions. METHODS: Five groups (7 each) of male Sprague-Dawley rats, including a control group, a diabetes (induced by Streptozocin and Nicotinamide) group, a renovascular hypertensive (induced by placing Plexiglas clips on the left renal arteries) group, a sham group, and a simultaneously hypertensive-diabetic group, were used. The animals' hearts were used for isolated heart studies, and the indices of cardiac functions and coronary effluent creatine kinase MB were measured. The results were analyzed using One-way Analysis of Variance, followed by the Duncan Multiple Range test. RESULTS: The diabetic group had a significantly lower rate of rise (-29.5%) and decrease (-36.18%) in ventricular pressure, left ventricular developed pressure (-28.8%), and rate pressure product (-35%), and significantly higher creatine kinase MB (+166%) and infarct size (+36.2%) than those of the control group. The hypertensive group had a significantly higher rate of rise (+12.17%) and decrease (+16.2%) in ventricular pressure, left ventricular developed pressure (+16%), and rate pressure product (+24%), and significantly lower creatine kinase MB (-30%) and infarct size (-27%) than those of the sham group. Simultaneously, the diabetic and hypertensive rats had a significantly higher rate of rise (+32%) and decrease (+30.2%) in ventricular pressure, left ventricular developed pressure (+17.2%), and rate pressure product (+22.2%), and significantly lower creatine kinase MB (-24%) and infarct size (-16.2%) than those of the diabetic group. CONCLUSION: The findings indicated that the simultaneity of hypertension with type 2 diabetes attenuated diabetes-induced cardiac impairment.

The Effect of Intraoperative Restricted Normal Saline during Orthotopic Liver Transplantation on Amount of Administered Sodium Bicarbonate.

BACKGROUND: Severe metabolic acidosis occurs during orthotopic liver transplantation (OLT) particularly during the anhepatic phase. Although NaHCO3 is considered as the current standard therapy, there are numerous adverse effects. The aim of this study was to determine whether the restricted use of normal saline during anesthesia could reduce the need for NaHCO3. METHODS: In this study we enrolled 75 patients with end-stage liver disease who underwent OLT from February 2010 until September 2010 at the Shiraz Organ Transplantation Center. Fluid management of two different transplant anesthetics were compared. The effect of restricted normal saline fluid was compared with non-restricted normal saline fluid on hemodynamic and acid-base parameters at three times during OLT: after the skin incision (T1), 15 min before reperfusion (T2), and 5 min after reperfusion (T3). RESULTS: There were no significant differences in demographic characteristics of the donors and recipients (P>0.05). In the restricted normal saline group there was significantly lower central venous pressure (CVP) than in the non-restricted normal saline group (P=0.002). No significant differences were noted in the other hemodynamic parameters between the two groups (P>0.05). In the non-restricted normal saline group arterial blood pH (P=0.01) and HCO3 (P=0.0001) were significantly less than the restricted normal saline group. The NaHCO3 requirement before reperfusion was significantly more than with the restricted normal saline group (P=0.001). CONCLUSION: Restricted normal saline administration during OLT reduced the severity of metabolic acidosis and the need for NaHCO3 during the anhepatic phase. TRIAL REGISTRATION NUMBER: IRCT2013110711662N5.

Successful bilateral lung transplantation in pulmonary alveolar microlithiasis: A case report and review of literature.

BACKGROUND: Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive genetic disorder with approximately 1000 known cases worldwide, in which calcium phosphate microliths deposit in the alveolar air spaces. As of writing this report, no definitive conventional therapy exists, and many PAM cases may progress to severe respiratory failure and potential death. Bilateral lung transplantation (BLx) seems to be the most optimal solution; however, this procedure is challenging along with limited reports regarding the outcome in PAM. We report a case of PAM successfully treated with BLx for the first time in Iran. METHOD: We present the case of a 42-year-old female with a longstanding history of cough, not responding to conventional antitussive medication, who was diagnosed as a case of PAM following a hospitalization due to coughing, dyspnea on exertion, and hemoptysis. Despite treatment with corticosteroid and medical treatment, no improvement was achieved and she subsequently developed respiratory and right ventricular failure, with oxygen ventilation dependence. Eventually, she was scheduled for BLx. The operation was successful and during her 2-year follow-up, no recurrence or significant postoperative complications has been reported. CONCLUSION: This case presentation and literature review confirm the effectiveness of BLx as a promising treatment for PAM-diagnosed patients, improving both life expectancy and quality of life.

Adequate Anesthesia and More Effective Analgesia by Adjusted Doses of Bupivacaine during Cesarean Section: A Randomized Double-blind Clinical Trial.

Background: Several adjuvants, added to local anesthetics, were suggested to induce an ideal regional block with high-quality analgesia. The purpose of this study was to evaluate the particular blocking properties of low-dose bupivacaine in combination with meperidine and fentanyl in spinal anesthesia during Cesarean sections. Methods: A randomized, double-blind clinical trial was conducted at Hafez Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from February 2015 to February 2016. A total of 120 pregnant women, who underwent spinal anesthesia during elective Cesarean section were enrolled in the study. Based on block-wise randomization, the patients were randomly assigned to three groups, namely "B" group received 2 mL bupivacaine 0.5% (10 mg), "BM" group received 8 mg bupivacaine and 10 mg meperidine, and "BF" group received 8 mg bupivacaine and 15 µg fentanyl intrathecally. The block onset, the duration of analgesia, and the time of discharge from the post-anesthesia care unit (PACU) were all assessed. Data were analyzed using SPSS software version 21, and P<0.05 were considered statistically significant. Results: The mean duration of motor blocks in the B group (150 min) were significantly higher than the BM (102 min) and BF (105 min) groups (P<0.0001). In both the BM and BF groups, the duration of sensory and motor blocks was the same. The length of stay in the PACU was significantly longer in the B group (P<0.001) than the BM and BF groups. When meperidine or fentanyl was added to bupivacaine, the duration of the analgesia lengthened (P<0.001). Conclusion: Intrathecal low-dose spinal anesthesia induced by bupivacaine (8 mg) in combination with meperidine and/or fentanyl for Cesarean section increased maternal hemodynamic stability, while ensuring effective anesthetic conditions, extending effective analgesia, and reducing the length of stay in PACU.Trial Registration Number: IRCT2015013119470N14.

Simultaneous renal hypertension and type 2 diabetes exacerbate vascular endothelial dysfunction in rats.

Despite the high rate of occurrence of both diabetes and hypertension in humans, the cardiovascular effects of the two conditions have not been investigated when they occur simultaneously. Thus this study examined the vascular effects of simultaneous type 2 diabetes and renal hypertension on endothelial function. Serum malondialdehyde and systolic blood pressure (SBP) were measured, glucose tolerance test (GTT) was performed, and concentration-response to phenylephrine (PE) in the absence and presence of nitro-l-arginine methyl ester (l-NAME), acetylcholine and sodium nitroprusside were conducted on aortic rings from diabetic control, type 2 diabetes, sham-operated, renal hypertensive, and simultaneous type 2 diabetes plus hypertension rats respectively. Hypertension, diabetes, and simultaneous diabetes and hypertension were associated with either increased or decreased maximal responses (E(max)) of PE dependent on in the presence or absence of l-NAME. There was also increased serum malondialdehyde and decreased E(max) of acetylcholine. Thus simultaneous hypertension and diabetes caused a greater decrease in E(max) of acetylcholine compared to that seen with either diabetes or hypertension alone higher than that seen in hypertension. The blood glucose during GTT was lower than that seen in diabetes groups. Thus simultaneous type 2 diabetes and the SBP was renal hypertension is associated with improved glucose tolerance, but with further deterioration of endothelial dysfunction compared with either condition alone.

Tracheal myoepithelioma resected by using rigid bronchoscopy: a case report and review of the literature.

BACKGROUND: Endotracheal tumors are rare in the respiratory system. Myoepitheliomas are benign tumors, which are rarely reported in the respiratory system. Herein, we report a rare case of endotracheal myoepithelioma, which was resected by rigid bronchoscopy. CASE PRESENTATION: A 36-year-old man, presenting with chest pain, dyspnea, stridor, and hemoptysis, was referred to our center with radiological features of near-total tracheal obstruction due to mass. Fiberoptic bronchoscopy with argon plasma coagulation and rigid bronchoscopy with grasper forceps was utilized to resect the mass. Pathological evaluation of the mass demonstrated myoepithelioma. The patient was discharged in good condition. Now, after 6 months, the patient is symptom-free with no evidence of tumor recurrence or re-growth. CONCLUSIONS: Despite being extremely rare, myoepithelioma should be considered a possible differential diagnosis for endotracheal tumors. Fiberoptic and rigid bronchoscopy management is an effective method for the resection of endotracheal tumors.

Intestinal Transplantation in a Country Without Home Parenteral Nutrition: The Largest Report from the Middle East.

BACKGROUND: Many regions of the world, especially middle- and low-income countries, lack facilities for home parenteral nutrition and thus cannot follow existing guidelines for intestinal transplantation. Herein, we report our experiences with treatment protocols, intraoperative management, and early postoperative outcomes among patients undergoing either isolated intestinal transplantation or multivisceral transplantation in our center. METHODS: During a 1-year period from March 2019 to March 2020, a total of 9 intestinal transplantations including 6 isolated intestinal transplantations and 3 multivisceral transplantations were performed in our center. We reported on donor selection strategies, surgical treatment, anesthesiology care and protocols for total parenteral nutrition, immunosuppression regimen, and pathology evaluation. RESULTS: Mean (standard deviation) age of patients was 37.5 ± 12.5 years. The majority of patients were females (7/9). The median (interquartile range) waiting time for patients from diagnosis to transplantation was 79 (34, 164) days. Our 7-day survey of the amount of fluid therapy after transplantation revealed that the greatest need for fluid therapy was seen on the second postoperative day. After transplantation, 2 patients showed a total of 3 episodes of severe rejection, 1 of which was antibody-mediated. The 1-year survival was 66.6% and the 2-year survival was 44.5% in our study population. The median (interquartile range) time to death was 157 (26.5, 382) days. The most common cause of death was sepsis in our series (3/5). CONCLUSION: Acceptable outcomes can be obtained with intestinal transplantation in countries without home parenteral nutrition by application of specific treatment protocols.

Evaluation of high-dose atorvastatin pretreatment influence in patients preconditioning of post coronary artery bypass graft surgery: A prospective triple blind randomized clinical trial.

Context: Atorvastatin is considered as lipid reductive drugs with anti-inflammatory and pleotherapic effects in coronary artery bypass graph (CABG). Aim: This study is conducted to evaluate the effects of atorvastatin in CABG. Setting and Design: Patients with a coronary bypass graph procedure in Nemazee hospital in Shiraz were divided into two 50-groups receiving high-dose (80 mg) and low-dose (20 mg) atorvastatin. Materials and Methods: Troponin I, creatinine kinase-MB (CK-MB), atrial fibrillation (AF) after CABG, duration of mechanical ventilation, inotrope duration of consumption, blood sugar profile, liver and renal function, death during 30 days of CABG, MACE (major advance cardiac events) during admission in ICU, and 1 month follow up were surveyed. Statistical Analysis: Collected data were analyzed by independent and paired t-test and Chi square. Results: AST was increased, ALT, ALK-P after CABG were decreased, and urine volume in the second day of admission in ICU was increased in the high-dose group. There was an increase and following decrease in blood sugar of patients in the high-dose after CABG. An inflammatory marker after CABG was raised in both groups, ck-mb had an increase, and then followed by a reduction. Troporin had no significant differences between groups. Patients with high-dose atorvastatin had better glomerular filtration rate and renal performance. Along with decreasing AF in the case group, hemodynamics' disorder reduced and there was less bleeding. Conclusion: According to the above, it seems that a short-time prescription of high dose of atorvastatin in CABG can lead to better renal function, decreasing of arrhythmia and AF.

Cystic Echinococcosis/Hydatid Cyst Coinfection with HIV: A Report from Shiraz, Iran.

HIV coinfected with other parasitic diseases may cause a serious problem for the patients. A few case reports describing echinococcosis with human immunodeficiency virus (HIV) infection have been reported in the world; however, it has not been reported in Iran, so far. Here, the first case of liver hydatid cyst coinfected with HIV in Iran is reported. The patient is a 46-year-old female HIV-positive based on the laboratory report. Her clinical symptoms included abdominal pain, abdominal enlargement, and anorexia. Ultrasound showed three large hepatic hydatid cysts with hundreds of daughter cysts. Ultrasonography of the cyst revealed it as a CE2 stage according to the WHO classification. The patient went under complete anesthesia followed by complete cyst removal by surgery. Observation of the hydatid cyst fluid using eosin 0.1% revealed more than 70% viable protoscoleces. Histopathology examination, polymerase chain reaction (PCR), and viable protoscoleces confirmed the diagnosis of echinococcosis. The IgG ELISA test with native AgB for E. granulosus infection was also positive. mtDNA amplification using PCR and sequencing showed the cyst as E. granulosus sensu stricto genotype. Our observations show that huge, large, and high-pressure cysts with hundreds of daughter cysts are difficult to be completely removed, and drug treatment has not been able to reduce their size. Therefore, in HIV coinfection with hydatid cyst, surgery is preferable to other treatments.

Magnesium Therapy Improves Rotational Thromboelastometry Findings Prior to Liver Transplantation: A Randomized Clinical Trial.

An important challenge during orthotopic liver transplantation (OLT) is optimal coagulation management. There are diverse studies regarding effect of Mg sulfate on coagulation system. This study evaluates the impact of Mg sulfate on the coagulation parameters of the rotational thromboelastometry (ROTEM) in patients about to undergo OLT. In this randomized clinical trial, 60 patients who were going to undergo OLT were randomly allocated into two groups. In the Mg group, the patients received a 1.5 g infusion of Mg 5 min before the surgical incision. In the control group, patients received a physiological saline instead of Mg. Plasma Mg levels before and after the infusions were measured in both groups. Also, three ROTEM tests: EXTEM, INTEM and FIBTEM were performed before and after the infusions. Baseline mean plasma magnesium levels were within normal range in the control and Mg groups: 2.06 and 2.18 mg/dl, respectively. After magnesium therapy, the mean plasma Mg level in the Mg group increased to 2.78 mg/dl in compared to the control group that was 2.01 mg/dl (P < 0.000). Mean value of the clotting time (CT) in the magnesium group were significantly decreased from 129.50 ± 7.76, 381.86 ± 8.51 and 114.26 ± 6.80 to 86.13 ± 3.4, 209.33 ± 6.68 and 81.56 ± 5.01 in the EXTEM, INTEM, and FIBTEM respectively after intervention in the Mg group (P = 0.001). Among patients with end-stage liver diseases who have ROTEM evidence of hypocoagulability, magnesium could correct CT parameter of the ROTEM tests.

Educating Health Science Students About Peace through Health Topic; A Panel Discussion.

This report describes an experience of the first international health for peace conference held in November 2018 in Shiraz University of Medical Sciences. This paper discusses the panel on peace education in medical and paramedical schools and the way for the future.

Preconditioning Effect of Remifentanil Versus Fentanyl in Prevalence of Early Graft Dysfunction in Patients After Liver Transplant: A Randomized Clinical Trial.

OBJECTIVES: One of the most prevalent complications of orthotopic liver transplant is primary graft dysfunction. Recent studies have shown the preconditioning effect of remifentanil on animal livers but not human livers. Here, we compared the preconditioning effects of remifentanil and fentanyl in orthotopic liver transplant in human patients. MATERIALS AND METHODS: In this double-blind clinical trial, 100 patients who underwent liver transplant from deceased donors were randomly allocated into 2 groups. Patients in the remifentanil group received remifentanil infusion, and those in the fentanyl group received fentanyl infusion during maintenance of anesthesia. Serum aminotransferase levels, prothrombin time (international normalized ratio), partial thrombin time, arterial blood gas levels, and renal function tests were evaluated over 7 days posttransplant. Intensive care unit stay and hospitalization were also recorded. RESULTS: The median peak alanine aminotransferase level during 7 days after transplant was 2100 U/L (interquartile range, 1230-3220) in the remifentanil group and 3815 U/L (interquartile range, 2385-5675) in the fentanyl group (P = .048). Metabolic acidosis, renal state, prothrombin time (international normalized ratio), and partial thrombin time were similar in both groups (P > .05). Durations of stay in the intensive care unit and hospital were not significantly different between the 2 groups (P = .75 and P = .23, respectively). Overall, the clinical outcomes were similar in the remifentanil and fentanyl groups (P > .05). CONCLUSIONS: We found that remifentanil and fentanyl were not different with regard to their preconditioning effects and graft protection in orthotopic liver transplant recipients.