Effects of Liberal Versus Restrictive Fluid Therapy on Renal Function Indices in Laparoscopic Bariatric Surgery

Background: Earlier studies have suggested the liberal administration of fluids in favor of reducing the risk of rhabdomyolysis in obese patients, but the results are conflicting. Objectives: The present study aimed at comparing the effects of liberal and restrictive fluid therapy on renal indices in laparoscopic gastric bypass surgery. Methods: In a double-blinded randomized clinical trial, 72 candidates of bariatric surgery were randomly assigned into two groups of restrictive and liberal fluid therapy. Indices, including BUN, creatinine, creatine kinase, GFR, and urine output were measured before and 24 hours after the surgery. The clinical trial was registered at IRCT.ir under code IRCT20170109031852N3. Results: There was no significant difference in BUN, creatinine, creatinine kinase, and GFR indices between the two groups of liberal and restrictive fluid therapy both before and 24 hours after surgery (P > 0.05). Intragroup comparisons before and after surgery revealed that BUN decreased in both groups after the surgery (P < 0.05). Also, creatinine and GFR values improved in patients who received a liberal fluid regimen, whereas these indices remained statistically unchanged in the restrictive group before and 24 hours after the surgery (P > 0.05). Conclusions: Two methods of liberal and restrictive fluid therapy have comparable effects on traditional renal functional indices in laparoscopic bariatric surgery. The clinical significance of observed differences in outcomes should be investigated in further studies. The use of early biomarkers of acute kidney injury is warranted.

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A comparative study on the effect of calcitriol and cinacalcet on hyperparathyroidism in hemodialysis patients; a double-blinded randomized clinical trial

Journal of Nephropharmacology ◽

10.34172/npj.2022.12 ◽

2021 ◽

Vol 11 (1) ◽

pp. e12-e12

Author(s):

Saeed Mardani ◽

Faranak Sadat Filsouf

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Hemodialysis Patients ◽

Significant Difference ◽

Before And After ◽

Calcium Phosphorus ◽

Stage Renal Disease ◽

Double Blinded ◽

End Stage ◽

Calcium And Phosphate Metabolism

Introduction:Chronic kidney disease (CKD) has lots of complication like calcium and phosphate metabolism disorders, hyperparathyroidism, vitamin D deficiency and metabolic acidosis. Objectives: The aim of this study was to determine and compare the effect of calcitriol and cinacalcet on hyperparathyroidism in hemodialysis patients due to end-stage renal disease (ESRD). Patients and Methods: This study was a double-blinded randomized clinical trial, which was conducted on 60 hemodialysis patients in 2017-2018. The patients were randomly assigned to two groups of 30 patients, which one group was treated with cinacalcet and the other group was treated with calcitriol. During this study, phosphorus, calcium and iPTH were measured. Results: The results showed that in the group treated with cinacalcet, the amount of calcium [t(22)=0.294, P>0.05] and the amount of phosphorus [t(22)=1.87, P>0.05] did not change significantly while iPTH values before and after the study had statistically significant difference [t(22)=4.37, P<0.05]. In group treated with calcitriol, the calcium, phosphorus and iPTH values did not change significantly (P>0.05). Calcium changes in the cinacalcet group compared to the calcitriol group [t (47) =-1.14, P>0.05] and also, the amount of phosphorus changes [t (47) =-1.022, P>0.05] was not statistically significant. The iPTH changes were not statistically significant between the two groups however iPTH in the calcitriol group was higher than the cinacalcet group [t (47) =-1.13, P>0.05]. Conclusion: In contrast to calcitriol, cinacalcet significantly reduced iPTH and did not significantly change calcium and phosphorus levels. Trial Registration: The trial was registered by Iranian Registry of Clinical Trials (IRCT) (identifier: IRCT20190702044076N1; https://en.irct.ir/trial/40547, Ethical code# IR.SKUMS.REC.1397.026).

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Efficacy of midazolam administration to control blood pressure in patients diagnosed with ‘Hypertensive crisis’: a Randomized Clinical Trial

10.21203/rs.3.rs-34962/v1 ◽

2020 ◽

Author(s):

Mohammad Reza Khorsand ◽

Mostafa Enayatrad ◽

Seyed Meysam Yekesadat ◽

Maryam Khodayar ◽

Amir Noyani

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Hypertensive Crisis ◽

Repeated Measure ◽

Chi Square ◽

Significant Difference ◽

Before And After ◽

Double Blinded

Abstract Introduction: Hypertensive crisis defines as a sudden rise in blood pressure that can adversely affect the vital organs. As such, it is recommended to take midazolam to lower the blood pressure in patients of hypertensive crisis. This study aims to investigate the midazolam efficacy as an emergency care to control the blood pressure in patients diagnosed with hypertensive crisis. Methods The current paper represents a double-blinded clinical trial study that examines the patients of the hypertensive crisis who referred to Imam Hossein Hospital of Shahroud, 2018. Patients with systolic/diastolic blood pressure greater than 180/110 mm Hg and with healthy vital organs were selected randomly and divided into three groups of 43 participants. All patients’ blood pressure in both arms, and after a period of 10 minutes in the left arm, was checked and was checked again after administering the medication for 4 times of 15 minutes till 1 hour complete. IBM SPSS Amos 23 was implemented. One-way ANOVA, Chi-Square and Repeated measure tests were performed to carry out statistical analysis. The level of significance of 0.05 was considered. Results in the group of midazolam, it was observed a reduction of 20.6% (P = 0.024), 17.4% (P = 0.001), and 19.1% (P = 0.009) for the systolic blood pressure, diastolic blood pressure, and blood pressure average, respectively. In such case, it was also indicated to be a significant difference of the reduction before and after the treatment. The group of captopril showed a decrease of 19.9% (P = 0.001), 13.5% (P = 0.008), and 16.7% (P = 0.001) for the systolic blood pressure, diastolic blood pressure, and blood pressure average, respectively. It was also observed to be a significant difference in reducing the blood pressure before and after the treatment. The group of midazolam and captopril showed the greatest reduction of blood pressure before, in the middle, and after carrying out the treatment methods. As such, systolic blood pressure, diastolic blood pressure, and the blood pressure average changed to the reduction of 23.5% (P = 0.047), 17.4% (P = 0.021), and 20.5% (P = 0.031), respectively. No significant difference was observed among these three groups (P = 0.239).

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Mortality and Recovery of Renal Function in Acute Kidney Injury Patients Treated with Prolonged Intermittent Hemodialysis Sessions Lasting 10 versus 6 Hours: Results of a Randomized Clinical Trial

International Journal of Nephrology ◽

10.1155/2018/4097864 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10

Author(s):

Bianca Ballarin Albino ◽

Mariele Gobo-Oliveira ◽

André Luís Balbi ◽

Daniela Ponce

Keyword(s):

Clinical Trial ◽

Acute Kidney Injury ◽

Renal Function ◽

Kidney Injury ◽

Volume Overload ◽

Complete Recovery ◽

Treatment Discontinuation ◽

Intermittent Hemodialysis ◽

Significant Difference ◽

Before And After

Purpose. This trial aimed to compare mortality and recovery of renal function in acute kidney injury (AKI) patients treated with different durations of prolonged hemodialysis (PHD) sessions (6 h versus 10 h). Methodology. We included patients with sepsis-associated AKI, >18 years, who are in use of a norepinephrine (lower than 0.7 ucg/kg/min). Results. One hundred and ninety-four patients were treated with 531 sessions of PHD (G1=104 and G2=90 patients). The two groups were similar in age and SOFA. There was no significant difference in hypotension, hypokalemia, and anticoagulation during PHD sessions. The two groups showed differences in filter clotting, hypophosphatemia, and treatment discontinuation (12.3 versus 23.1%, p=0.002; 15.5 versus 25.8%, p=0.005; and 7.9 versus 15.6%, p=0.008, respectively). There was no difference in fluid balance (FB) before and after PHD sessions. Death and complete recovery of renal function were similar (81.3 versus 82.2%, p=0.87 and 21 versus 31.2%, p=0.7, respectively). At logistic regression, the positive FB before and after dialysis was identified as risk factor for death, while volume overload after three PHD sessions and predialysis creatinine were negatively associated with recovery of renal function in 28 days. Conclusion. There was no difference in the mortality and recovery of renal function of AKI patients submitted to different durations of PHD and sessions lasting 10 h presented higher filter clotting, hypophosphatemia, and treatment discontinuation. ISRCTN Registry number is ISRCTN33774458.

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Restrictive versus Liberal Fluid Therapy for Post-Cesarean Acute Kidney Injury in Severe Preeclampsia: a Pilot Randomized Clinical Trial

Clinics ◽

10.6061/clinics/2020/1797 ◽

2020 ◽

Vol 75 ◽

Author(s):

Wallace Andrino da Silva ◽

Carlo Victor A. Varela ◽

Aline Macedo Pinheiro ◽

Paula Castro Scherer ◽

Rossana P.V. Francisco ◽

...

Keyword(s):

Clinical Trial ◽

Acute Kidney Injury ◽

Randomized Clinical Trial ◽

Fluid Therapy ◽

Kidney Injury ◽

Severe Preeclampsia

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The Effect of Urtica Dioica Extract on Blood Lipids Profile in Patients with Type 2 Diabetes: A Randomized Double-blinded Clinical Trial

Journal of Nutrition and Food Security ◽

10.18502/jnfs.v6i4.7615 ◽

2021 ◽

Author(s):

Roya Khajeh Mehrizi ◽

Hassan Mozaffari-Khosravi ◽

Parisa Aboee

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Clinical Trial ◽

Total Cholesterol ◽

Density Lipoprotein ◽

Urtica Dioica ◽

Significant Difference ◽

The Mean ◽

Double Blinded

Background: Diabetes is an endocrine disorder that is strongly associated with cardiovascular disease. The use of alternative therapy has recently increased and medicinal plants are one of the alternative therapies for diabetic patients. This study aimed to evaluate the protective effect of Urtica dioica (Nettle) on lipid profile in patients with type 2 diabetes (T2D). Method: This parallel randomized double-blinded clinical trial was conducted on 60 men and women with T2D for an 8-week period. The participants were randomly assigned to received 100mg/kg/day extract of Urtica Dioica (UG) and the placebo group (PG). Blood triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDLc) and high density lipoprotein cholesterol (HDLc) were measured at baseline and end of the study. The data were analyzed using SPSS 16.0 and P < 0.05 was considered significant. Results: The mean difference of total cholesterol showed no significant difference in the UG compared to the PG which were -10.56±40.5 and -19.5± 35.9 (P = 0.14), respectively. The study also showed no significant difference between TG and LDLc in the UG compared to the PG (-39.8±171.5 vs. -23.37±72.3 (P = 0.68) and -3.16±33.4 vs. -11.2±35.6 (P = 0.15), respectively). The mean difference of HDLc in the UG and PG were -2.68±8.11 and 2.62±10.6 (P = 0.05), respectively, indicating a significant increase in the UG compared to the PG. Conclusion: The results demonstrated that consumption of 100mg/kg/day extract of UD for 8 weeks by increasing HDL concentration can decrease the risk of cardiovascular disease in patients with T2D.

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Preventive Efficacy of Dried Lime (Citrus aurantifulia) in Common Cold Among Hajj Pilgrims: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

Galen Medical Journal ◽

10.31661/gmj.v9i0.1462 ◽

2020 ◽

Vol 9 ◽

pp. e1462

Author(s):

Mehdi Pasalar ◽

Seyed Hamdollah Mosavat ◽

Hossein Molavi Vardanjani ◽

Mohsen Keshavarz ◽

Maryam Mosaffa-Jahromi ◽

...

Keyword(s):

Clinical Trial ◽

Placebo Group ◽

Common Cold ◽

Primary Outcome Measure ◽

Drug Group ◽

Controlled Clinical Trial ◽

Significant Difference ◽

Preventive Efficacy ◽

Double Blinded ◽

Self Administered Questionnaire

Background: Dried lime (Citrus aurantifulia) is one of the herbal preparations used especially by Iranian pilgrims as a preventative agent and self-remedy for respiratory tracts symptoms in folklore medicine. Therefore, we evaluated the preventive efficacy of dried lime preparation in common cold among Iranian pilgrims. Materials and Methods: In this randomized, double-blinded, clinical trial patients in the drug group received dried lime capsules, 500 mg in a single dose per day for four weeks. In the placebo group, the patients received placebo capsules using the same method. The primary outcome measure in this trial was the severity of cold symptoms assessed by a self-administered questionnaire. Results: There were no significant differences between the two groups in terms of the trend of cold symptoms severity during the study period. However, in the second week, the severity of all the cold symptoms in the drug group was less, compared to the placebo, but at the end of the study, comparison of the two groups revealed no significant difference in any of the investigated options. Conclusion: The findings revealed that although the severity of all the cold symptoms in the drug group was less as compared to the placebo group, the dried lime capsule showed no statistically significant effect on the control of these symptoms in Iranian pilgrims. [GMJ.2020;9:e1462]

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Sleeve Gastrectomy vs. Fundus Resection in Bariatric Surgery (Animal Study)

Shiraz E-Medical Journal ◽

10.5812/semj.95198 ◽

2020 ◽

Vol 21 (6) ◽

Author(s):

Alimohammad Bananzadeh ◽

Seyed Vahid Hosseini ◽

Hajar Khazraei ◽

Mohammad Mehdi Lashkarizadeh ◽

Leila Ghahramani ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Sleeve Gastrectomy ◽

Body Weight Loss ◽

Test Results ◽

Significant Difference ◽

Before And After ◽

Total Ghrelin ◽

The Difference ◽

High Level

Background: Bariatric surgery has resulted in body weight loss, which claimed by surgery removal specific parts of the stomach with enzyme or sleeve gastrectomy. Objectives: The aim of this study is to determine weight loss and endocrine changes by 12-week fundus resection and sleeve gastrectomy in rabbits. Methods: Twenty-one rabbits, weighing 2.5 - 3.5 kg, were divided into three groups (n = 7): sleeve gastrectomy, experimental fundus resection, and sham group. The weight of rabbits and total ghrelin and leptin levels in the plasma before and after surgery were measured in 12 weeks. Statistical analyses were performed using the Kruskal-Walis test for comparison of the means between the groups, and the difference after months in one group was assayed by Friedman test. Results: The results showed sleeve gastrectomy had a significant weight loss after one month when compared to fundus resection and sham-operated controls (P = 0.008). There was no significant difference in the ghrelin levels after these surgeries, but leptin levels decreased significantly after the fundectomy (P = 0.025). Conclusions: Sleeve gastrectomy is more efficient than the fundus resection in weight loss. It could be suggested as a new option in metabolic disorders due to the high level of leptin.

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Outcome of Anticoagulant Therapy Following Bariatric Surgery

QJM ◽

10.1093/qjmed/hcaa050.068 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A M Yousef ◽

A F Mohamed ◽

B H Elshayeb ◽

G M Abdelmalak

Keyword(s):

Bariatric Surgery ◽

Effective Means ◽

Cost Benefit ◽

Morbidly Obese ◽

Laparoscopic Bariatric Surgery ◽

Obese Patients ◽

University Hospitals ◽

Coagulation Therapy ◽

Anticoagulant Drugs ◽

Significant Difference

Abstract Background Bariatric surgery remains the most effective means of treating severe obesity. The number of severely obese patients is increasing and, consequently, more people are seeking bariatric surgery. Aim of the Work The Aim of This Study is to Outcome of Anticoagulant during Bariatric Surgery and Relation of Bariatric Surgery to Coagulopathy Disease. Patients and Methods This prospective study was conducted on 50 morbidly obese patients admitted to Hospital (Ahmed Maher Teaching Hospital and Ain Shams University Hospitals), for a primary one-stage laparoscopic bariatric surgery procedure over a 6-month period. The study is performed on 50 Patients, Who met all Inclusion criteria and none of Exclusion criteria. Results The study revealed no statistically significant difference between Enoxaparin and Rivaroxaban according to outcome of anti-coagulation therapy following bariatric surgery. Conclusion a high protective value of Chemical Thromboprophylaxis combined to Mechanical Thromboprophylaxis in preventing DVT safely. New Oral Anticoagulant drugs showed equal and may be superimposed the other traditional anticoagulant, but it needs more studies regarding its prophylactic dose, number of patient and its cost benefit in comparison with other Anticoagulant drugs were used in our study or other studies we mentioned above.

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