Effects of Panax Ginseng on Health-Related Quality of Life in Patients with Non-Metastatic Breast Cancer: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Ginseng for HRQOL in Breast Cancer.

Being diagnosed with cancer and chemotherapy impose distressing symptoms on patients' Health-Related Quality of Life (HRQOL). This study evaluated ginseng efficacy on improving multiple aspects of HRQOL in breast cancer patients. Forty women with non-metastatic early breast cancer were enrolled in the study. Participants received ginseng (1 g/day) or placebo with standard chemotherapy. HRQOL was evaluated via in-person interviews at baseline, two weeks after the second and last chemotherapy cycles. The FACT-B, a 37-item questionnaire composed of five subscales including physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and Breast Cancer Subscale (BCS) was employed to assess HRQOL. A considerable decreasing trend in the mean scores of all subscales, as well as the total score, was observed in the placebo group; nevertheless, the ginseng group experienced a slight decrease in the PWB subscale and a constant or even increasing trend in other subscales and total score. The differences in the mean change of scores during the study period were statistically significant in all domains between the two groups (all p-values < 0.001). Regular ginseng supplementation may provide beneficial effects on enhancing different aspects of HRQOL including PWB, SWB, EWB, FWB, and BCS in breast cancer patients.This study was registered in the Iranian Registry of Clinical Trials (IRCT, IRCT20141227020441N7) in Jan 2020.

Impact of vitamin D receptor gene polymorphisms (TaqI and BsmI) on the incidence and severity of coronary artery disease: a report from southern Iran.

BACKGROUND: The association of vitamin D level and vitamin D receptor (VDR) gene polymorphisms with the prevalence of coronary artery disease (CAD) has been evaluated in various studies; however, the reported results were inconsistent. Hence, we aimed to investigate the impact of two VDR gene polymorphisms, TaqI (rs731236) and BsmI (rs1544410), on the incidence and severity of CAD in Iranian population. METHODS: Blood samples were collected from 118 CAD patients underwent elective percutaneous coronary intervention (PCI) and 52 control subjects. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed for genotyping. SYTNAX score (SS) was calculated as a grading tool for complexity of CAD by an interventional cardiologist. RESULTS: TaqI polymorphism of VDR was not associated with the incidence of CAD. A significant difference was observed between CAD patients and controls regarding BsmI polymorphism of VDR (p < 0.001). GA and AA genotypes was significantly associated with a decreased risk of CAD (p = 0.01, p-adjusted = 0.01 and p < 0.001, p-adjusted = 0.001 respectively). A allele of BsmI polymorphism was shown to have a protective effect against CAD (p < 0.001, p-adjusted = 0.002). No association was found between TaqI and BsmI polymorphisms of VDR and SS as a measure of CAD severity. CONCLUSION: Association of BsmI genotypes with the incidence of CAD revealed that the genetic variation of VDR might play a role in the pathogenesis of CAD.

An Overview of Pharmacological and Clinical Aspects of Spirulina.

Spirulina or Arthrospira, a Cyanobacterium from the class Cyanophyceae, with a wide range of properties, has been applied for over 400 years. The present study aimed to review available investigations surrounding the clinical and pharmacological properties of Spirulina that have been carried out so far. Databases including Scopus, PubMed, Google Scholar, and Web of Science were searched for relevant literature using the keywords: (Spirulina), (pharmacology), and (clinical). About 130 papers that studied the pharmacological characteristics of Spirulina in animal models, as well as clinical trials, were selected from the beginning to 29 July 2021. According to this review, antioxidative, anti-inflammatory, anti-neoplastic, hypolipidemic, antiviral, immunomodulatory, antimicrobial, anti-atherogenic, anti-diabetic, and radio-protective functions are attributed to Spirulina. Moreover, Spirulina's positive influence on several organs, including hair, skin, liver, CNS, lung, and genitourinary tract, are ascribed to different components of various species of Spirulina such as Spirulina platensis, Spirulina fusiformis, and Spirulina maxima. Although so many studies have been accomplished on every aspect of Spirulina in recent years, the lack of a comprehensive investigation surrounding this microalga encouraged us to prepare this paper. Therefore, the present study could be considered an up-to-date overview of the clinical, pharmacological, and molecular aspects of Spirulina, resulting in more occupational research on this valuable organism.

Genetic polymorphisms of glucocorticoid receptor and their association with new-onset diabetes mellitus in kidney transplant recipients.

INTRODUCTION: The variability in developing New-onset Diabetes Mellitus After Transplantation (NODAT), together with previously well-established interindividual variation in glucocorticoid sensitivity, led us to hypothesize that polymorphisms in the NR3C1 gene encoding glucocorticoid receptor may alter glucose balance in kidney transplant recipients. This study aimed to evaluate the association of three functional polymorphisms, BclI, N363S, and ER22/23EK, on the NR3C1 gene with NODAT in kidney allograft recipients. METHODS: From Jun 2020 to July 2022 in Shiraz, 52 patients with NODAT (case group) and 52 non-diabetic kidney transplant recipients (control group) were randomly screened and recruited in this case-control study. The PCR-RFLP technique determined the genotypes of BclI, N363S, and ER22/23EK polymorphisms. RESULTS: The allelic frequencies of the mutant alleles of BclI, N363S, and ER22/23EK polymorphisms in all patients were 0.36, 0.03, and 0.009, respectively. BclI mutant genotypes (CG and GG) were significantly associated with an increased risk of NODAT (P = 0.016), while the two other polymorphisms disclosed no significant association with NODAT development. In the case group, no significant association was detected between the onset time of NODAT and studied polymorphisms, including BclI (P = 0.43), N363S (P = 0.30), and ER22/23EK. P value was not reported for the last polymorphism because all patients with NODAT had the wild-type genotype (GG/GG) and performing statistical analysis was not feasible. Among studied demographic/clinical/paraclinical variables, factors such as higher mean trough level of tacrolimus during the first month after transplantation and higher mean daily dose of prednisolone significantly linked with NODAT development. CONCLUSION: Our data suggested that BclI polymorphism significantly affects NODAT development among Iranian kidney allograft recipients.

Protective effects of Panax ginseng against doxorubicin-induced cardiac toxicity in patients with non-metastatic breast cancer: A randomized, double-blind, placebo-controlled clinical trial.

INTRODUCTION: Anthracycline-based chemotherapy increases the risk of cancer therapeutics-related cardiac dysfunction. Recently, evidences from in vitro experiments and animal studies have shown that ginsenosides may exert cardiovascular protection against cancer therapeutics-related cardiac dysfunction. Here, we aimed to evaluate this effect in a clinical situation. METHODS: In this randomized, double-blind, placebo-controlled clinical trial, women with non-metastatic breast cancer whose left ventricular ejection fraction was ≥ 50% were randomly assigned in 1:1 ratio to receive ginseng (1 g/day) or placebo besides standard chemotherapy. Echocardiographic measurements were performed at baseline, after the fourth, and eighth chemotherapy cycles. High-sensitive cardiac troponin I was assessed at baseline and after the 4th cycle. The primary endpoint of the study was change in left ventricular ejection fraction. Cancer therapeutics-related cardiac dysfunction was defined as a drop in left ventricular ejection fraction of ≥ 10% from baseline. RESULTS: Results from 30 patients were included in the final analysis (15 patients in each group). In the intervention and control groups, left ventricular ejection fraction was dropped from 62.0 ± 0.9% to 60.7 ± 1.0% (difference = -1.3 ± 1.1%) and from 63.27 ± 1.1% to 58.0 ± 1.3% (difference = -5.27 ± 0.8%), respectively (difference = 3.97%, p = 0.006) at the end of the fourth cycle of chemotherapy. After the eighth cycle of chemotherapy, the mean left ventricular ejection fraction was increased by 0.8 ± 1.3% from baseline in the intervention group, whereas the placebo group experienced a reduction of -7.3 ± 1.4% (difference = 8.1%, p-value < 0.001). None of the patients in the ginseng group in comparison to 1(6.7%, p-value = 0.5) and 5 (33.3%, p-value = 0.02) patients in the placebo group developed cancer therapeutics-related cardiac dysfunction after the fourth and eighth cycles, respectively. High-sensitive cardiac troponin I levels were not significantly different between groups. CONCLUSIONS: Prophylactic ginseng supplementation may protect against doxorubicin-induced early cancer therapeutics-related cardiac dysfunction and early decline in left ventricular ejection fraction in breast cancer patients.

Association between Fok1 and TaqI polymorphisms of vitamin D receptor gene with the severity of stenosis and calcification in carotid bulb in patients with ischemic stroke.

BACKGROUND AND AIMS: There have been plenty of reports regarding the association between Vitamin D (Vit D) and carotid atherosclerosis and stroke. We aimed to assess the association between FokI and TaqI polymorphisms of vitamin D receptor (VDR) gene and the severity of carotid bulb stenosis and the incidence of carotid bulb calcification in patients with ischemic stroke. METHODS: This prospective study conducted at Shiraz University of Medical Sciences between February 2020 and August 2020. All consecutive patients with ischemic stroke with more than 50% carotid bulb stenosis in color doppler sonography underwent cervical CT angiography (CTA). Demographics, risk factors of ischemic stroke, serum calcium, phosphate, creatinine, serum 25-hydroxyvitamin D (Vit D) level were investigated by High-Performance Liquid Chromatography (HPLC) method. The severity of stenosis and presence of calcification in carotid bulb ipsilateral was studied in CTA to ischemic stroke. VDR genotypes of FokI and TaqI polymorphisms were determined by the Restriction FragmentLength Polymorphism (RFLP) method. RESULTS: A total of 122 patients were recruited in this study (mean age: 59.1, 66.4% males, 17.2% with carotid artery stenosis of 70-99%. 57% with carotid bulb calcification). There was a significant association between calcification of carotid bulb with FokI CC polymorphisms of VDR gene (P value = 0.037). There was no significant relationship between the severity of carotid bulb stenosis and Fok1 and TaqI polymorphisms of vitamin D receptor gene and their alleles. CONCLUSIONS: There may be a biological association between the FokI VDR gene and carotid bulb calcification.

Cardiovascular implications of the COVID-19: Management of complications and drug safety concerns.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has rapidly spread worldwide and has been infected more than 219 million individuals with 4.55 million deaths worldwide as of September 2021, causing a pandemic. Preexisting cardiovascular (CV) comorbidities such as hypertension, diabetes, and coronary artery disease seem to be associated with greater severity of infection, worse prognosis, and higher mortality. Moreover, COVID-19 can contribute to CV complications, including acute myocardial injury, arrhythmia, acute coronary syndrome, and venous thromboembolism, emphasizing the importance of precocious detection and implementation of optimal therapeutic strategies. This review provides an overview of evidence-based data of CV complications of COVID-19, focusing on their management strategies, as well as potential cardiac adverse effects and drug interactions, due to off-label and investigational drugs used for the treatment of COVID-19.

The association between estrogen receptor 2 gene polymorphism and complexity of coronary artery disease: an analysis in elective percutaneous coronary intervention patients.

BACKGROUND: One of the most common causes of death in the world is coronary artery disease (CAD). Estrogen, the most important early sex hormones in women, plays an important role in the risk reduction of cardiovascular disease (CVD). Expression of estrogen as well as its receptors including estrogen receptor alpha (ER1) and estrogen receptor beta (ER2) might have an association with the severity or the complexity of CAD. Since most articles have focused on the relationship between ER1 gene polymorphism and CAD, in this study, we aimed to evaluate the association of two ER2 gene polymorphisms, rs4986938 (AluI) and rs1256049 (RsaI), with the severity of CAD. METHODS: 148 patients with confirmed CAD who underwent elective percutaneous coronary intervention (PCI) were included in this study. Blood samples were collected before coronary angiography and ER2 gene polymorphisms were analyzed by the PCR-RFLP method. The STNTAX Score (SS), grading system for CAD complexity, was evaluated by an interventional cardiologist who was blinded to other data. RESULTS: 110 men and 38 women were participated in this study. Our results revealed a statistically significant relationship between SS and rs4986938 polymorphism of ER2 in men. In contrast, there was no association between rs1256049 genotypes and SS after performing regression analysis. CONCLUSIONS: Besides to the estrogen level, the genetic variation of its receptors might play an important role in the severity or the complexity of CAD. According to our results, rs4986938 polymorphism of ER2 gene may assert a pivotal role in the severity of CAD in men; however, this assumption needs to be proved in studies with a larger population.

A pharmacology-based comprehensive review on medicinal plants and phytoactive constituents possibly effective in the management of COVID-19.

Arisen in China, COVID-19 (SARS-CoV-II) is a novel coronavirus that has been expanding fast worldwide. Till now, no definite remedial drug or vaccine has been identified for COVID-19 treatment. Still, for a majority of infected patients, supportive therapy is the cornerstone of the management plan. To the importance of managing the COVID-19 pandemic, this article proposed to collecting capable medicinal plants and bioactive components in both treat and supportive therapy of this novel viral infection. Clinical points in the pathogenesis, symptoms, and complications of COVID-19 were considered. The effective plants and bioactives that may play a role in supportive therapy/management of COVID-19 were searched, collected through the "Scopus" database and listed in three sections. Numerous medicinal plants such as Citrus Spp., Camellia sinensis, and Glycyrrhiza glabra can interference with COVID-19 pathogenesis via inhibition of virus replication and entry to its host cells. Also, some anti-inflammatory herbal medicine such as Andrographis paniculata, Citrus spp., and Cuminum cyminum can relieve fever and cough in COVID-19 patients. Medicinal plants such as G. glabra, Thymus vulgaris, Allium sativum, Althea officinalis, and Panax ginseng may modulate the immune system and possess prevention and supportive therapy. However, more clinical data are required to confirm these hypotheses.

Impact of Supplementation with Omega-3 in the Prevention of Contrast-Induced Nephropathy Following Elective Percutaneous Coronary Intervention in Patients with Chronic Kidney Disease: A Randomized Placebo-Controlled Trial.

BACKGROUND: Anti-oxidants were investigated in several studies as a preventive strategy for prevention of contrast-induced nephropathy (CIN). Omega-3 polyunsaturated fatty acids have antioxidant properties; however, their role in the prevention of CIN is still unknown. Therefore, in this study, we aimed to evaluate the efficacy of omega-3 supplementation in the prevention of contrast-induced nephropathy following elective percutaneous coronary intervention in patients with chronic kidney disease. METHODS: This is a double-blinded and randomized clinical trial. Eighty eligible patients with glomerular filtration rate of 30-60 mL/min/1.73 m2, scheduled to undergo elective PCI, were randomly divided into omega-3 (a single dose of 2500 mg omega-3 12 hours before PCI plus hydration therapy) or control (placebo plus hydration therapy) groups. Blood specimens for measuring serum creatinine and cystatin C were collected from each patient at baseline and 24 h after PCI. RESULTS: Omega-3 did not show any significant effect on post-PCI serum creatinine and cystatin C compared to the controls. In addition, serum creatinine analysis showed that CIN occurred in 6 (16.2%) patients of the omega-3 and 4 (9.3%) patients of the control group (P = 0.50). CONCLUSIONS: Our results could not support the protective effect of a single dose of omega-3 in decreasing serum creatinine, serum cystatin C, and the incidence of CIN in patients with CKD undergoing PCI. To better evaluate the effect of omega-3, future studies with higher and/or multiple doses of omega-3 are highly recommended.

Association between Serum Vitamin D Concentration Status and Matrix Metalloproteinase-9 in Patients Undergoing Elective Percutaneous Coronary Intervention.

Cardiovascular diseases (CVD) have become increasingly life-threatening during recent decades. Several studies have shown that matrix metalloproteinase-9 (MMP-9) plays an important role in the process of atherosclerosis and heart remodeling. On the other hand, Vitamin D deficiency has been recognized as a risk factor for CVD. According to the prevalence of vitamin D deficiency in our country, Iran, we aimed to evaluate the relationship between vitamin D status and the level of MMP-9 in patients undergoing percutaneous coronary intervention. In this prospective cross-sectional study, the patients who were candidates for elective coronary angioplasty were included. Baseline serum MMP-9 and vitamin D levels were measured before intervention. The patients were categorized into three groups: Vitamin D-severely deficient (≤ 10 ng/mL), vitamin D-moderately deficient (11-20 ng/mL), and vitamin D-insufficient/sufficient (> 21 ng/mL). Totally, 150 patients were assessed. The analysis showed that serum MMP-9 levels were higher in patients with lower vitamin-D concentrations. A significant inverse correlation was found between MMP-9 concentration and 25 (OH) vitamin D level (P = 0.039). According to our results, it may be concluded that low levels of vitamin D may lead to more vulnerable atherosclerotic plaques and consequently more cardiovascular adverse effects in post-PCI patients.

Association between high sensitivity C-reactive protein (hs-CRP) levels and the risk of major adverse cardiovascular events (MACE) and/or microembolic signals after carotid angioplasty and stenting.

BACKGROUND: To evaluate the association between pre/post-procedural high sensitive C-reactive protein (hs-CRP) level and hs-CRP difference, and the risk of major adverse cardiovascular events (MACE) or new diffusion-weighted MRI lesions after carotid angioplasty and stenting (CAS). METHODS: In this study, conducted in 2016 in Shiraz (Iran), patients who underwent diagnostic angiography and CAS were recruited. CAS was performed with distal embolic protection device on patients with both standard and high risk of endarterectomy. Pre/post-procedural hs-CRP, and hs-CRP difference were determined by immunoenzymometric assay method. RESULTS: A total of 50 patients with diagnostic angiography and 60 patients with CAS were enrolled. No death, myocardial infarction, ischemic or hemorrhagic stroke, and need to revascularization occurred during the 30-days of the post-procedural period. Accordingly, the statistical evaluation in associating MACE and hs-CRP levels was impossible. Angioplasty was associated with higher frequency of elevated post-procedural hs-CRP in comparison to angiography (P=0.003). The higher age, symptomatic lesions, negative history of hypertension, and hs-CRP difference had significant association with the presence of new DWI lesions in univariate analysis (all P<0.05). Angioplasty of left carotid bulb and post-procedural hs-CRP levels was very close to the level of significance (P=0.06). But only left sided lesions had positive association (P=0.037) and hypertension had negative association (P=0.037) in multivariate regression analysis. There were significant association between post-procedural hs-CRP level (P=0.02) and hs-CRP difference (P=0.003), and the number of new lesions; and the hs-CRP difference and the accumulated lesion surface area (P=0.009). CONCLUSION: Post-procedural hs-CRP and hs-CRP difference may predict embolic complications of CAS.

Omega-3 Supplementation in the Prevention of Contrast Induced Nephropathy in Patients Undergoing Elective Percutaneous Coronary Intervention: A Randomized Placebo-Controlled Trial.

Purpose: Contrast-induced nephropathy (CIN) is the third cause of hospital-acquired renal failure and is associated with significant morbidity and mortality. Several studies have revealed the protective role of omega-3 in prevention and treatment of some kidney injuries. This study was conducted to examine the effect of omega-3 supplementation on the markers of renal function and to evaluate its potential in the prevention of CIN in patients undergoing elective percutaneous coronary intervention (PCI). Methods: In this double-blind, randomized clinical trial, 85 eligible patients scheduled for PCI was randomly divided into omega-3 (a single 3750 mg dose of omega-3 as well as routine hydration therapy within 12 hours before PCI) or control (placebo plus routine hydration therapy) groups. Serum creatinine (SCr) and cystatin C levels were measured at baseline and 24 hours after PCI. Results: Our results indicated that post- PCI cystatin C levels were significantly decreased in the omega-3 group compared to the control group (P < 0.001). Although less upward manner was seen in the level of 24-hour creatinine in the omega-3 group, it did not reach the significance level (P = 0.008). Conclusion: The positive effect of omega-3 on cystatin C levels showed that it may have a protective role in the prevention of CIN in post-PCI patients with normal kidney function. However, to better assess this effect, it is highly recommended to design future studies with higher doses and longer duration of therapy with omega-3 plus long-term follow up.

Circulating Serum Amyloid A, hs-CRP and Vitamin D Levels in Postmenopausal Osteoporosis.

BACKGROUND: Both vitamin D and inflammation were investigated as important players in the pathogenesis of postmenopausal osteoporosis. This study compared vitamin D, inflammatory the biomarkers serum levels and their association with bone mineral density (BMD) in case and control groups to evaluate the possible immune-regulatory effect of vitamin D in this population. MATERIALS AND METHODS: Participants in post-menopausal age, were categorized to 44 osteoporotic vs. 44 healthy aged-matched women according to WHO criteria. Total BMD, T- scores, Z-scores as well as fracture risk were measured in both groups, using Hologic system Dual-energy X-ray absorptiometry (DEXA). Serum 25-OH vitamin D, high sensitive CRP (hs-CRP) and serum amyloid A (SAA) were compared between groups. The association between serum biomarkers level and BMD were also investigated. The same evaluations were performed for vitamin D deficient (<20 ng/mL) and non-deficient (≥20 ng/mL) subgroups. RESULTS: Vitamin D deficiency was higher in the osteoporotic group (32.6%) in comparison with the control group (25.6%), but the differences were not significant (P=0.47). There were no significant differences in serum levels of hs-CRP and SAA (P=0.83 and P=0.39) as well. No significant association between serum inflammatory biomarkers, vitamin D, and BMD were detected (P≥0.05). The results were the same for vitamin D deficient and non-deficient subgroups (P≥0.05). CONCLUSION: In the current study, the beneficial effects of vitamin D as a result of its immune-regulatory mechanisms was not reached. Larger scale studies might pave the way to define vitamin D benefits in postmenopausal osteoporosis.

Impact of Spirulina Supplementation on Semen Parameters in Patients with Idiopathic Male Infertility: A Pilot Randomized Trial.

PURPOSE: To evaluate the efficacy of therapy with spirulina supplement on semen parameters in patients with idiopathic male infertility. MATERIALS AND METHODS: A total of 40 men with idiopathic infertility were randomly assigned into two groups. Group A received 2 g spirulina supplement as well as conventional regimen for the treatment of infertility selected by their physician (220 mg/day zinc sulfate, 500mg/day L-carnitine, and 50 mg/day clomiphene) during 12 weeksof the study, while group B received placebo plus conventional therapy during the study period. Semen parameters were analyzed at baseline and at the end of the study as a primary endpoint. The secondary endpoint was the rate of pregnancy occurring in the patients. wives. RESULT: No significant differences in semen parameters were observed between the spirulina and control groups [count (16.43 vs. 46.00, P = .164), motility (51.00 vs. 48.7, P = .008), and morphology (47.50 vs. 15.00, P = NA)]. Our results showed a pregnancy rate of 5% in the spirulina group versus 0% in the control group. CONCLUSION: This pilot randomized trial provides initial evidence on the possible beneficial effects of spirulina mainly in patients with impaired sperm motility or morphology. Due to the limited sample size, further larger randomized trials not only at the level of semen parameters but at the scope of paternity are required to confirmthese potential benefits.

Impact of Omega-3 Supplementation on High Sensitive C-Reactive Protein Level and 30-Day Major Adverse Cardiac Events After the Implementation of Coronary Stent in Patients with Chronic Kidney Disease: A Randomized Clinical Study.

Purpose: Studies have revealed that patients with chronic kidney disease (CKD) are more susceptible to adverse effects of percutaneous coronary intervention (PCI). In addition, the role of elevated high sensitive C-reactive protein (hs-CRP) in the prediction of adverse cardiac outcomes after coronary stent implantation has already been shown. Therefore, in this study, we aimed to evaluate the effect of omega-3 supplementation on hs-CRP and 30-day major adverse cardiac events (MACE) in patients with CKD undergoing elective PCI. Methods: In this randomized trial, 80 CKD patients who were candidates for elective PCI, were randomly assigned to two groups; the first group received a single dose of omega-3 (2500 mg, 12 h before PCI) as well as the standard drug regimen of PCI and the second group received placebo plus the standard therapy (325 mg loading dose of aspirin, 600 mg loading dose of clopidogrel, and weight-adjusted intravenous heparin). Hs-CRP levels were measured at baseline and 24 h after the intervention as a primary endpoint. The secondary endpoint was the incidence of MACE over a 30-day period after PCI. Results: Omega-3 did not significantly decrease post-PCI serum level of hs-CRP; however, the overall 30-day MACE was significantly lower in the omega-3 group compared to the control group (p=0.05). Conclusion: Our results revealed the positive effect of the omega-3 supplement on decreasing 30-day MACE; hence, omega-3 may be considered as an effective adjunctive therapy to the standard drug regimen used before PCI. The evaluation of the effect of omega-3 on long-term MACE is recommended for future studies.

Effectiveness and safety of omega-3 fatty acids for the prevention of ischemic complications following carotid artery stenting: An early terminated pilot study.

Background: We aimed to study the possible beneficial effects of omega-3 polyunsaturated fatty acids (PUFAs) in carotid artery stenting (CAS) procedure for decreasing post-procedural ischemic complications. Although previous evidence demonstrated that omega-3 PUFAs, present in fish oil, can significantly enhance platelet response to antiplatelet agents after percutaneous coronary intervention (PCI), it is unknown whether they can be used in patients undergoing CAS. Methods: The single-blind, case-control, pilot randomized trial study was planned to perform on 60 patients undergoing CAS (30 in case and 30 in control group). Patients in both groups were pretreated with dual antiplatelet therapy (aspirin 80 mg/day with a loading dose of 325 mg, and clopidogrel 75 mg/day after a loading dose of 600 mg) at least 48 hours before the CAS. 30 patients randomly received 3000 mg loading dose of omega-3 fatty acids 12 hours before the procedure and 1000 mg omega-3 capsule the day after the procedure. All subjects were planned to be visited by neurologist for any peri- and post-procedural complications immediately after the procedure and on first, seventh, and thirtieth days. Results: We ended the study after the enrollment of 18 patients because of an unexpected hemorrhagic transformation in case group. Two patients in this group developed hemorrhagic symptoms less than 12 hours after the procedure. One of the failures occurred in a patient with small vessel disease. Except these two cases, no one showed any neurological deficit symptoms in both groups. Conclusion: In patients already receiving dual antiplatelet treatment before CAS, adding omega-3 PUFAs would increase the incidence of hemorrhagic transformation.

Investigating the Use of Human Albumin in a Non-Teaching Hospital in Iran.

Albumin is an expensive drug which imposes relatively high cost on the health care system. Doing ABC analysis in Shahid Motahari Hospital, it was revealed that albumin is categorized in class A. Therefore, the present study aimed to evaluate the pattern of albumin use and the physicians' adherence to evidenced-based albumin guidelines in this large general non-teaching hospital in Shiraz, Iran. This study is an observational retrospective research on drug utilization. All patients admitted to Shahid Motahari hospital that had received albumin during the study period of one year (December 2013 to December 2014), were included in the study. To evaluate the appropriate use of albumin, an internal guideline was prepared using several evidence-based guidelines. Prescriptions were considered correct and appropriate if they were compliant with the standard guideline. The result of this study indicated that about 87.3% of patients had received albumin improperly. Nephrotic syndrome without hypoalbuminemia (23.6%) was the most prevalent reason for albumin misuse and internal ward was the most consuming unit. The findings of this study, similar to those of previous investigations in Iran, revealed the high percentage of inappropriate albumin usage in Iranian teaching and non-teaching hospitals. Regarding the high cost and short supply of this drug, educating physicians through educational programs to best implement the standard guidelines is highly recommended.

Effect of Pretreatment with Omega-3 Supplement on Cardiac Necrosis Markers in Chronic Kidney Disease Patients Undergoing Elective Percutaneous Coronary Intervention.

OBJECTIVE: Studies have demonstrated the direct relation between elevation in cardiac necrosis markers and increased risk of cardiovascular complications after percutaneous coronary intervention (PCI) in chronic kidney disease (CKD) patients. In this study, we sought to evaluate the effect of omega-3 on creatine kinase-MB (CK-MB) and troponin-I in CKD patients undergoing elective PCI. METHODS: Eighty CKD patients, candidate for elective PCI, were randomly assigned into two groups: Group A - receiving omega-3 (2.5 g, 12 h before PCI) plus standard treatment (n = 37) and Group B - control group, receiving only standard therapy (aspirin 325 mg and clopidogrel 600 mg loading dose and weight-adjusted intravenous heparin) (n = 43). Blood samples were collected before and 24 h after PCI for measuring CK-MB and troponin-I. The primary endpoint was considered to be postprocedural variations of CK-MB and troponin-I levels in both groups. The secondary endpoint was the percentage of pre-procedural myocardial infarction (PMI) occurrence, defined as the elevation of post-PCI troponin-I, between study groups. FINDINGS: Both the baseline and 24-h CK-MB were significantly higher in omega-3 group. Although 24-h troponin-I increased less in omega-3-treated arm compared to the control group, no statistically significant variation was observed between the two groups. With regard to PMI occurrence, no significant difference was detected among study groups. CONCLUSION: Despite the beneficial but nonsignificant effects of omega-3 on decreasing post-PCI elevation of troponin-I and PMI occurrence, further investigations with bigger study population, higher doses of omega-3 and longer duration of treatment, and long-term follow-up of patients are required to better test the potential effects of omega-3 in improving clinical outcomes in CKD patients undergoing PCI.