Background:Leukemia is a hematological malignancy characterized by uncontrolled proliferation of immature white blood cells, influenced by both genetic and environmental factors. Benzene is a recognized leukemogenic agent associated with hematopoietic toxicity following prolonged exposure. This study investigated the protective effects of Withania somnifera (ashwagandha), Camellia sinensis (green tea), and curcumin against benzene-induced leukemic alterations in rats. Materials and Methods:Adult male albino rats received intravenous benzene (99.9%) every two days for 3 weeks to induce leukemic changes. Following induction, rats were divided into three groups (n=6/group), 1:a combination-treated group receiving oral Withania somnifera (200 mg/kg), Camellia sinensis extract (250 mg/kg), and curcumin (200 mg/kg) daily for 30 days; 2:a Withania somnifera-treated group receiving 300 mg/kg daily for 30 days; and 3:a control group. Hematological, histopathological, and molecular analyses were performed using blood, bone marrow, spleen, and liver samples. Results:Both treatment regimens reduced several benzene-induced hematological, histopathological, and molecular alterations. Hematological parameters in treated groups were maintained within near-normal ranges. Histopathological examination demonstrated partial preservation of liver and spleen architecture in both treatment groups, with reduced inflammatory and degenerative changes compared with untreated benzene-exposed rats. Molecular analysis showed restoration of Nrf2 expression and modulation of Caspase-3 expression following treatment, particularly in the combination-treated group. Blast cell counts were reduced in both treatment groups compared with untreated benzene-exposed animals. Conclusion:Withania somnifera, alone or in combination with curcumin and green tea extract, demonstrated protective effects against benzene-induced hematological, histopathological, and molecular alterations in rats. The combination treatment showed greater improvement in molecular markers associated with oxidative stress and apoptosis. These findings support further investigation of these botanical compounds as potential supportive agents in leukemia-related disorders.
Background:Children with special health care needs and disabilities experience a disproportionate burden of preventable oral disease, unmet dental needs, behavioral barriers to treatment, and fragmented access to specialist dental services. Materials and Methods:This scoping review mapped contemporary evidence on pediatric dental management strategies for children with special health care needs, with emphasis on prevention, behavior guidance, interdisciplinary care, teledentistry, and service delivery. A structured search was planned across PubMed/MEDLINE, Scopus, Web of Science, Embase, the Cochrane Library, Google Scholar, ClinicalTrials.gov, and grey-literature sources for English-language evidence published from January 2015 to August 2025. Evidence was charted using a population-concept-context framework and synthesized narratively according to source type and clinical theme. Results:The final evidence map comprised 20 topic-relevant sources, including systematic reviews, observational studies, qualitative studies, educational program reports, narrative reviews, textbooks, and expert consensus documents. No randomized controlled trial was verified among the cited sources; therefore, the manuscript was framed as a scoping review rather than an effectiveness-focused systematic review. Four major themes were identified: preventive and caregiver-mediated oral-health support, individualized behavior guidance and sensory adaptation, interdisciplinary medical-dental collaboration, and technology-enabled access, including teledentistry. Conclusion:Current evidence supports integrated, family-centered, function-based, and prevention-oriented dental care for children with special health care needs and disabilities. However, the evidence base remains limited by heterogeneous designs, provider-centered outcomes, small samples, narrative sources, and limited comparative child-outcome data. Future research should prioritize prospective multicenter studies using standardized clinical, behavioral, access-related, and quality-of-life outcomes.
Background:Student self-assessment is emphasized in dental education because it promotes reflective practice, self-regulated learning, and clinical competence. However, its educational value depends on students' engagement and faculty members' consistent use of self-assessment in feedback and evaluation. Materials and Methods:This cross-sectional survey assessed perceptions and practices related to self-assessment among 108 dental students and 46 faculty members. Structured questionnaires collected demographic data, student self-assessment practices, faculty attention to self-assessment forms, perceived influence on final evaluation, and student-reported barriers. Data were analyzed descriptively using frequencies and percentages. Results:Among students, 31 (28.7%) reported always completing self-assessment forms, 58 (53.7%) completed them frequently, and 19 (17.6%) completed them rarely. Among faculty members, 18 (39.1%) always paid attention to students' self-assessment forms, 11 (23.9%) frequently did so, 12 (26.1%) occasionally did so, and five (10.9%) rarely did so. Sixty students (55.6%) and 19 faculty members (41.3%) agreed or strongly agreed that self-assessment influenced final evaluation. The most frequently reported barrier was lack of time, reported by 34 students (31.5%). Conclusions:Self-assessment was commonly used and generally valued, but implementation was inconsistent. Lack of time and uncertainty regarding faculty consideration were important barriers. Clearer integration into clinical assessment is recommended.
Background:Knee osteoarthritis (KOA) is the most common form of osteoarthritis and is associated with pain and functional impairment. Mesotherapy, which involves localized intradermal or subcutaneous injection of active agents, may provide targeted pain relief. This study aimed to compare the effects of intradermal and subcutaneous mesotherapy on pain and function in patients with KOA. Materials and Methods:A single-center, randomized, assessor-blinded clinical trial was conducted in Isfahan, Iran, between 2023 and 2024 among patients with mild-to-moderate KOA. Each patient received six sessions of intradermal or subcutaneous piroxicam-lidocaine mesotherapy at six acupuncture points over three weeks (two sessions per week). Pain and function were assessed at baseline, immediately after treatment, and one month after treatment. Statistical analyses included chi-square tests for qualitative variables, independent-samples t-tests for quantitative variables, and repeated-measures analysis of variance to assess changes over time. Statistical significance was set at P<0.05. Results:A total of 50 patients were included. The demographic characteristics and baseline pain and function scores did not differ significantly between the two groups. At the one-month follow-up, the intradermal group showed significantly greater improvement, with a mean difference in pain score reduction of 1.6 points (95% CI: 0.57 to 2.67, P=0.003) compared to the subcutaneous group. For dysfunction scores, the intradermal group demonstrated immediate post-treatment benefits (mean difference: 9.4 points, 95% CI: 1.36 to 17.44, P=0.02), with sustained improvement at the one-month post-treatment follow-up (mean difference: 15.5 points, 95% CI: 7.95 to 23.01, P<0.001). Repeated measures ANOVA showed that pain and dysfunction scores significantly changed over time in both groups (P<0.001). Conclusion:Both subcutaneous and intradermal mesotherapy appeared to be effective short-term treatments for patients with KOA. However, intradermal mesotherapy demonstrated greater effectiveness at the one-month follow-up, with superior pain reduction and functional improvement compared with subcutaneous mesotherapy.
Background:Benzene is a well-established leukemogen associated with hematotoxicity, oxidative injury, inflammation, and genotoxic alterations, particularly in relation to acute myeloid leukemia (AML). Melatonin has antioxidant and anti-inflammatory properties that may exert protective effects against benzene-induced pre-leukemic alterations. Materials and Methods:This study evaluated melatoninergic modulation in a benzene-induced pre-leukemic rat model. Rats were assigned to five groups (n=8): control, benzene-only, benzene + melatonin (10 mg/kg), benzene + agomelatine (10 mg/kg), and benzene + melatonin + luzindole (0.2 mg/kg). Benzene was administered intravenously as a benzene:2-propanol: distilled water mixture (1:5:5, v/v/v) every 48 h for 4 weeks. Melatonin and agomelatine were administered orally once daily, while luzindole was used to assess melatonin receptor blockade. Hematological indices, leukocyte ratios, platelet parameters, bone marrow micronucleus endpoints, Activin A, Follistatin, MDA, 8-OHdG, CAT, and SOD were assessed. Results:Benzene exposure induced hematological disruption, altered leukocyte and platelet-related indices, increased micronucleus formation, and disturbed oxidative stress markers. Melatonin and agomelatine attenuated several benzene-induced alterations, including changes in erythropoietic indices, micronucleus frequency, leukocyte distribution, platelet-related parameters, MDA, and CAT activity. Luzindole partially reduced selected protective effects, suggesting that some responses may involve melatonin receptor-related pathways. However, inconsistent Activin A trends and unchanged Follistatin levels require cautious interpretation. Conclusion:Melatonin and agomelatine attenuated several hematological, genotoxic, and oxidative alterations in benzene-exposed rats. Luzindole partially modified these effects, suggesting possible melatonin receptor involvement alongside non-receptor antioxidant and anti-inflammatory actions.
Background: Contrast agents are used in percutaneous coronary intervention (PCI), yet differences in adverse event profiles between ionic and non-ionic agents remain incompletely characterized. This study aimed to evaluate patient demographics, adverse event patterns, and seriousness of outcomes associated with contrast agents reported in the U.S. FDA Adverse Event Reporting System (FAERS). Materials and Methods: Data were extracted from FAERS for reports involving contrast agents used during PCI, including both ionic (low- and high-osmolar) and non-ionic agents. Datasets were cleaned for duplicates and incomplete records, and product names, patient demographics, and adverse reactions were standardized. Descriptive statistics were calculated for continuous (age, weight) and categorical (sex, seriousness, adverse reactions) variables. Comparative analyses between ionic and non-ionic groups were performed using t-tests for continuous variables and chi-square tests for categorical outcomes. Data visualization was performed using Python libraries. Results: A total of 72 cases were identified, including 18 ionic (25%) and 54 non-ionic (75%) reports. Mean patient ages ranged from 52.8 to 71.0 years across individual agents, with weight varying from 69.7 to 92.9 kg. Adverse events differed by agent type: ionic agents were primarily associated with renal failure and hypersensitivity reactions, while non-ionic agents exhibited broader nephrotoxic and hemodynamic complications, including nephropathy toxic, anaphylaxis, and blood pressure decreases. All products were linked to serious outcomes, with non-ionic agents showing a significantly higher association with serious events (χ²(1, N=72) = 5.92, P = .015). No significant differences in age or weight were observed between ionic and non-ionic groups. Temporal trends varied by agent, with sporadic case reporting over the years; while Ultraist has shown increased trend till 2025. Conclusion: Ionic and non-ionic contrast agents used in PCI demonstrate distinct adverse event profiles. These findings show the importance of tailored patient monitoring and risk assessment when selecting contrast agents for PCI procedures.
Modern neurosurgery clearly relies on evidence-based medicine. The integrity, interpretation, and application of research depended on a solid understanding of the statistical methods used. This review highlights the important need for neurosurgeons and trainees to gain proficiency in basic statistical concepts. We emphasize this need throughout the research process—from forming hypotheses and defining variables to selecting tests, analyzing power, and interpreting key indices. Also, we provide practical guides for choosing suitable statistical tests and translating research findings into useful clinical metrics. We believe that statistical literacy is not an extra skill but a key part of clinical expertise and academic success. It allows neurosurgeons to evaluate literature, conduct valid research, and effectively apply evidence in patient care.
Intravascular imaging has emerged as a critical adjunct to percutaneous coronary intervention (PCI), providing detailed insights into coronary anatomy, plaque morphology, and stent optimization beyond conventional angiography. Despite advances in PCI, adverse outcomes such as stent thrombosis and restenosis persist, often related to suboptimal lesion assessment and stent deployment. This review critically evaluates contemporary evidence from randomized controlled trials, large registries, and meta-analyses comparing intravascular imaging–guided and angiography-guided PCI. Current data consistently demonstrate that imaging guidance, particularly with intravascular ultrasound (IVUS), improves procedural optimization and reduces adverse cardiovascular events, with the greatest benefit observed in complex coronary lesions. Optical coherence tomography (OCT) provides superior spatial resolution and enhances detection of stent-related complications, although its impact on clinical outcomes appears more context-dependent. While recent guidelines strongly endorse intravascular imaging in complex PCI, real-world adoption remains limited due to economic, procedural, and training-related barriers. Variation in study design and variability in imaging protocols further complicate interpretation of existing evidence. Intravascular imaging–guided PCI represents a transition toward precision-guided coronary revascularization. Future research should focus on standardized imaging strategies, long-term outcomes, and integration with emerging technologies to optimize patient selection and procedural outcomes.
Background: Clonidine, a potent α2-adrenoceptor agonist, is used in anesthesia for its sedative and analgesic properties, but its administration requires careful monitoring due to potential risks of hypotension and bradycardia. As there are increasing number of trials on clonidine, this study aimed to synthesize a conclusion on unwanted consequences of clonidine use in the perioperative period. Materials and Methods: This umbrella review synthesizes evidence on adverse events associated with perioperative prescription of clonidine, following the PRIOR guidelines using three prominent databases of Scopus, PubMed, and Web of Science with a strategic combination of keywords. Studies included were systematic reviews, meta-analyses, and network meta-analyses published in English; studies reviewing prescribing systematic clonidine perioperative; and reporting adverse events. Primary outcomes were cardiovascular events, respiratory, neurological, and gastrointestinal complications. Data were extracted systematically by two independent reviewers and analyzed using random effects models in Stata. Pooled odds ratios and mean differences were calculated, with heterogeneity assessed using the I² statistic. Results: Our umbrella review of 8 systematic review studies including 223 studies from 1980 till now; all of which included only randomized controlled trials (RCTs). The bradycardia analysis, comprising four studies, shows a significant increased risk of bradycardia compared to control (OR: 1.653, 95% CI: 1.013 to 2.700) with some heterogeneity (P=0.0609). Hypotension meta-analysis (four studies) reveals a substantial increased risk (exp(theta): 3.281, 95% CI: 1.696 to 6.347), albeit with moderate heterogeneity (I^2=62.37%, P=0.0355). Heart rate reduction (two studies) and MAP reduction (two studies) meta-analyses indicate significant effects of clonidine, with substantial heterogeneity. Conclusion: Our comprehensive umbrella review highlights significant associations between perioperative clonidine and complications such as bradycardia and hypotension, suggesting the need for careful consideration and further investigation in clinical practice.
Infertile couples can try assisted reproductive technology (ART) interventions to become pregnant. Repeated implantation failure (RIF) is diagnosed when pregnancy is not achieved after three or more transfers of high-quality embryos. Despite the psychological research indicating that repeated ART failure is strongly associated with negative psychological consequences for both men and women, there are currently no studies addressing the potentially traumatic aspects of the experiences of RIF women. Thereby, we present a summary of the current research to emphasize the intersections between traumatic experiences and RIF, particularly the different features of RIF women in ART programs potentially more at risk for trauma. The aim of this study is to examine the role of psychological factors in RIF and to emphasize the need for further research to better understand these processes in ART treatments for women with RIF.
Background: The high turnover rate among newly graduated nurses (NGNs) is a significant concern globally, particularly in medical-surgical units (MSUs). Identifying the key facilitators and barriers to their professional role adaptation is crucial for improving retention and facilitating a smoother transition into clinical practice. This study explored facilitators and barriers to professional role adaptation among NGNs in MSUs. Materials and Methods: A qualitative study was conducted using inductive content analysis. Twenty-one NGNs with less than one year of clinical experience were purposively selected from teaching hospitals affiliated with Tehran University of Medical Sciences. Data were gathered through semi-structured in-depth interviews and analyzed using Graneheim and Lundman’s five-step approach with MAXQDA software. Results: The findings revealed that multiple interacting factors shape role adaptation at three levels: individual, interpersonal, and organizational. Facilitating factors included personal motivation, clinical preparedness, supportive colleagues, and structured organizational support. In contrast, barriers such as stress, lack of structured orientation programs, negative work culture, and excessive workload hindered adaptation. Conclusion: This study revealed that the adaptation of NGNs to professional roles in MSUs is shaped by individual, interpersonal, and organizational factors. Enhancing structured support at all three levels — through targeted educational programs, professional communication, and organizational infrastructure — can improve transition outcomes, reduce early turnover, and promote workforce retention in healthcare settings.
Background: Benzene is a well-established leukemogen associated with hematotoxicity, oxidative injury, inflammation, and genotoxic alterations, particularly in relation to acute myeloid leukemia (AML). Melatonin has antioxidant and anti-inflammatory properties that may exert protective effects against benzene-induced pre-leukemic alterations. Materials and Methods: This study evaluated melatoninergic modulation in a benzene-induced pre-leukemic rat model. Rats were assigned to five groups (n=8): control, benzene-only, benzene + melatonin (10 mg/kg), benzene + agomelatine (10 mg/kg), and benzene + melatonin + luzindole (0.2 mg/kg). Benzene was administered intravenously as a benzene:2-propanol: distilled water mixture (1:5:5, v/v/v) every 48 h for 4 weeks. Melatonin and agomelatine were administered orally once daily, while luzindole was used to assess melatonin receptor blockade. Hematological indices, leukocyte ratios, platelet parameters, bone marrow micronucleus endpoints, Activin A, Follistatin, MDA, 8-OHdG, CAT, and SOD were assessed. Results: Benzene exposure induced hematological disruption, altered leukocyte and platelet-related indices, increased micronucleus formation, and disturbed oxidative stress markers. Melatonin and agomelatine attenuated several benzene-induced alterations, including changes in erythropoietic indices, micronucleus frequency, leukocyte distribution, platelet-related parameters, MDA, and CAT activity. Luzindole partially reduced selected protective effects, suggesting that some responses may involve melatonin receptor-related pathways. However, inconsistent Activin A trends and unchanged Follistatin levels require cautious interpretation. Conclusion: Melatonin and agomelatine attenuated several hematological, genotoxic, and oxidative alterations in benzene-exposed rats. Luzindole partially modified these effects, suggesting possible melatonin receptor involvement alongside non-receptor antioxidant and anti-inflammatory actions.
Background: Intracanal medicaments are used to eliminate residual microorganisms and provide a suitable environment for the healing of periapical tissues. The present study aimed to compare the antibacterial effect of nano-calcium hydroxide and nano-chlorhexidine as intracanal medicaments against Enterococcus faecalis. Materials and Methods: In this in vitro study, 170 single-rooted mandibular premolars were included. After crown removal, canal preparation was performed. Five teeth were randomly selected as the negative control group. Nano-intracanal medicaments were synthesized using the encapsulation method. Drug release tests were carried out, and particle sizes were determined using electron microscopy and dynamic light scattering analysis. Samples were inoculated with E. faecalis for 21 days. Subsequently, five teeth were randomly selected as the positive control group. The remaining samples were randomly divided into four groups of 40 teeth each (20 for day 3 and 20 for day 7). The intracanal medicaments used in each group were: calcium hydroxide, nano-Ca(OH)(2) -PLGA, 2% chlorhexidine gel, and 2% nano-chlorhexidine gel (MCM-41), respectively. After 3 and 7 days, microbial biofilm samples were collected, and bacterial colony-forming units (CFU) were counted. Two-way ANOVA was used to compare the mean CFU counts among the groups at different time intervals. The significance level was set at 0.05. Results: Based on statistical analysis, on day 3, the 2% nano-chlorhexidine gel (MCM-41) and nano-Ca(OH)(2) -PLGA groups showed a significantly greater reduction in CFU/ml (P<0.05) compared to the other groups. On day 7, the 2% nano-chlorhexidine gel (MCM-41) and 2% chlorhexidine gel groups demonstrated significantly greater reductions in CFU/ml (P<0.05) than the remaining groups. Over time, the antibacterial efficacy of the nano-formulations declined, whereas the effectiveness of the 2% chlorhexidine gel and calcium hydroxide increased. Conclusion: According to the findings of the present study, nano-formulated medicaments were more effective in eliminating E. faecalis biofilm from the root canal only in short-short term.
Background: To investigate the effects of stress related to the pandemic on the medical faculty's well-being. Materials and Methods: This study investigated the impact of pandemic-related stress on the well-being of medical faculty at King Abdulaziz University. Using a mixed-methods approach, 82 faculty members completed online surveys, including the GAD-7 and PHQ-9 scales to measure anxiety and depression, and participated in focus group discussions. The analysis explored the relationship between these psychological stress factors and self-reported academic performance across different demographics. Results: A high prevalence of psychological distress was found: 89.6% of faculty reported at least mild anxiety, and 84.4% reported at least mild depressive symptoms. Most participants self-rated their academic performance as good (54.5%) or excellent (36.4%), and 80.5% reported missing no crucial deadlines. Regression analyses revealed a significant positive association between depression severity and higher self-reported academic performance (beta = 1.48, p = 0.025). Male gender (OR = 0.20, p = 0.022) and longer weekly working hours (OR = 0.53, p = 0.019) were associated with significantly lower odds of missing deadlines. Anxiety, depression, and other covariates were not significant predictors of overall quality of life. Conclusion: While the pandemic was associated with a high burden of anxiety and depression among faculty, this distress did not translate into widespread self-perceived declines in academic output. The counterintuitive link between higher depression scores and self-reported performance, alongside the protective effect of male gender and increased work hours against missed deadlines, suggests complex coping mechanisms and potential resilience or presenteeism. [GMJ.2026;15:e4139] DOI:10.31661/gmj.v15i.4139
Background: Surgery harms the gastrointestinal (GI) tract barrier and changes intestinal microbiota composition, disrupting the balance of gut flora. Synbiotics, which are mixtures of beneficial bacteria and chemicals that promote gut flora growth, are particularly important for recovery after GI surgery. We aimed to assess the effect of consumption of synbiotics prior to the gastrointestinal surgeries on complications. Materials and Methods: 40 patients who planned to undergo elective gastrointestinal surgery randomized in a double-blinded, placebo-controlled, phase 3 trial to a single dose perioperative and seven-day postoperative intervention with a synbiotic, LactoCare®, or placebo provided by knowledge-based spin-off company, Zist Takhmir. Randomisation was performed by a computer algorithm. Results: 42.5% of participants were men. Nausea and vomiting occurred in eight patients in the placebo group, and seven patients in the synbiotic group, and the two groups were not statistically significant (P>0.99). Other complications, such as (surgical site infection, fever, surgical site infection, pneumonia, and anastomosis site leakage) were not observed in the placebo or synbiotic groups. In assessing variables dependent on time, the mean time to start oral feeding in the synbiotic group was 32.35±28.84 hours after surgery, and in the placebo group was 28.45±24.91 hours (P=0.796). The first gas passing time was 13.00±15.81 hours in the synbiotic group and 9.65±13.90 hours in the placebo group after surgery(P=0.406). The hospitalisation length of patients in the synbiotic group was 2.6±1.27 days, and for patients in the placebo group was 2.35±1.08 days(P=0.42). Conclusion: Administration of synbiotics as a single dose before surgery and seven days postoperatively did not have a significant effect on infectious complications and time-dependent variables in patients with abdominal surgery.
Background: Pedicle screw fixation is a standard technique for spinal stabilization in patients undergoing laminectomy for decompression. This study aims to compare the outcomes of pedicle screw fixation performed before versus after laminectomy, focusing on its effects on spinal stability, recovery outcomes, and complication rates. Materials and Methods: This retrospective cohort study, conducted from July 2017 to July 2020 at the Neurosurgery Departments of Imam Reza and Shohada Hospitals in Tabriz, Iran, assessed outcomes of two approaches to pedicle screw fixation in 104 patients undergoing laminectomy for degenerative spinal conditions. The patients were equally divided into two groups of 52: one group receiving pedicle screw fixation before laminectomy, and the other following laminectomy. Key intraoperative parameters-such as blood loss, operative time, and screw placement accuracy-were evaluated and compared between groups. Data were analyzed using SPSS software, employing Independent Samples T-Tests and Chi-square tests, with statistical significance defined at P<0.05. This retrospective cohort study compares two surgical sequences-pedicle screw fixation before versus after laminectomy-in patients undergoing lumbar decompression, aiming to evaluate intraoperative efficiency and short-term outcomes. Results: The laminectomy-first group had a lower infection rate (5.76% vs. 9.61%) and required fewer blood transfusions (96.1% vs. 90.3%) than the screw-first group, though these differences were not significant (P>0.05). Blood loss and drain output were significantly higher in the laminectomy-first group (P<0.05), but surgery duration was shorter (P=0.01), with similar hospital stays between groups. The laminectomy-first approach also required fewer screw path corrections and fluoroscopy uses, indicating greater intraoperative efficiency (P=0.001). Conclusion: This study demonstrates that pedicle screw fixation after laminectomy demonstrated greater intraoperative efficiency with fewer adjustments and reduced fluoroscopy use. However, due to the retrospective nature of the study and lack of systematic documentation of baseline stability and symptom dominance, future prospective or randomized controlled trials are needed to confirm these findings and guide evidence-based surgical decision-making.
Background: Perioperative use of allogeneic blood products is associated with increased mortality, morbidity, and postcardic therapy. The effectiveness of blood preservation strategies such as acute isovolemic hemodilution (ANH) has been demonstrated with varying degrees of success. This study presents an analysis of the effects of isovolemic hemodilution on blood transfusion in patients undergoing cardiopulmonary bypass. Material and Methods: We tested the efficacy of ANH in reducing cardiac morbidity during anesthesia prior to cardiopulmonary bypass using a randomized trial. They were divided into two groups: ANH (88 patients) and standard control (88 patients), both selected as CS. The ANH group aimed to achieve a hematocrit level of 28% by performing full blood exchange with colloids. Patients underwent myocardial protection procedures, including cold blood cardioplegia and anesthesia preconditioning. Outcomes were evaluated by measuring cardiac enzymes, including serum troponin I and creatinine phosphokinase. Changes in demand for cardiovascular and cerebrovascular drugs were also taken into account. Results: Intraoperative fluid balance (crystalloids, colloids, and urine), postoperative fluid balance (crystalloids plus colloids, urine, and chest tube fluid), and RBC concentrate were not statistically different between the two groups (P>0.05). However, the results showed that the hematocrit level was more stable in the ANH group than in the control group. Conclusion: Preoperative ANH provides better hematocrit stability and better cardio protection in patients receiving a myocardial perfusion pump; but does not affect water and urine treatment.
Background: Chronic kidney disease (CKD) is a progressive and irreversible loss of kidney function that may progress to end-stage renal disease requiring hemodialysis. While hemodialysis is an established life-saving therapy, simple methods to assess its adequacy are needed. Saliva analysis is a non-invasive alternative to serum testing. This study evaluated changes in urea, creatinine, and uric acid levels in serum before and after hemodialysis and compared them with salivary levels to assess the adequacy of hemodialysis. Materials and Methods: A case-control study was conducted on 32 patients undergoing hemodialysis and 30 healthy controls. Blood and saliva samples were collected immediately before and after dialysis from patients and controls. Serum and salivary levels of markers were analyzed by biochemical methods. Serum and salivary levels of markers were compared between the patient group (before and after dialysis) and the control group by t-test and the diagnostic accuracy of salivary markers compared to serum markers was evaluated by the receiver-operating characteristic (ROC) curve and area under the curve (AUC). Results: There were significant differences between the serum and salivary levels of urea, creatinine, and uric acid in patients before and after hemodialysis, and also with the control group (P<0.05). There was a positive correlation between the serum and salivary levels of urea, creatinine and uric acid before hemodialysis, and creatinine after hemodialysis. The AUC for salivary urea and creatinine was 0.87 and 0.88, respectively, and the cut-off point for urea and creatinine was 55 mg/dL and 0.5 mg/ dL, respectively. The ROC analysis for uric acid was not significant. Conclusion: This study showed that before hemodialysis, the changes in salivary urea, creatinine, and uric acid in CKD patients (in the fasting state) were similar to serum. Additionally, after hemodialysis, changes in salivary creatinine levels were similar to serum. Therefore, saliva analysis is suggested as a non-invasive alternative to serum analysis for assessment of the efficacy of hemodialysis.
