Original Articles

Anti-Hemorrhagic Effect of Horsetail, Ortie, Alfalfa, Chêne, and Aleppo oakin an Experimental Model of Rats - a Potential Theoretic Approach for Traumatic Bleeding

Sina Ahmadianfar, Soroush Sabiza, Ali Sobhanizadeh, Ali Noroozi-Aghideh

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 111-118

Background: Prompt bleeding control in civil accidents, incidents, and combat casualties is critically essential. Preparing efficient, portable, and low-cost local anti-hemorrhagic products with minimum side effects is one of the main challenges of using them in hemorrhage control. Anti-hemorrhagic effect of some medicinal plants, including Horsetail (H), Ortie (O), Alfalfa (A1), Chêne (C), and Aleppo oak (A2), were evaluated in the femoral arterial bleeding rat model. Materials and Methods: After plant extraction by the maceration method, forty male rats received general anesthesia, and the left femoral artery was surgically transected. Bleeding was treated with direct gauze pressure, in both the control (without treatment) and test groups added with the mixture of five herbal extracts at 200 g/l concentration (M-200), the mixture of five herbal extracts at 400 g/l concentration (M-400), and individual extracts at 400 g/l concentration). Bleeding stoppage time (BST), blood loss volume (BLV) was defined and some blood coagulation tests were assessed. Results: There was no statistically significant difference of BLV between mix-200 and control groups, though it was significantly lower for mix-400 than that the control and mix-200 groups (P<0.05). The bleedig was statistically lower for group C compared to groups H, O, A1, and A2 (P<0.05). However, the difference between groups A2, O, H, and A1 was not significant (P>0.05). The results of BST showed no statistically significant difference between the mix-200 and control groups, while it was significantly shorter for the mix-400 group than the control and mix-200 groups (P<0.05). BST was shorter in group C than groups H, O, A1, and A2 (P<0.05). Conclusion: According to the results, Chêne extract, as well as a mixture of five mentioned herbal extracts at 400g/l concentration, were influential in bleeding control. Our results showed that the anti-hemorrhagic effect of the mentioned plant extracts was superior to the mixed form.

Clinical Significance and Different Expression of Dipeptidyl Peptidase IV and Procalcitonin in Mild and Severe COVID-19

Hamidreza Jamaati, Payam Tabarsi, Naghmeh Bahrami, Fatemeh Yasari , Mohammad Varahram, Mehdi Kazempour Dizaji, Seyed MohammadReza Hashemian, Mahya Daustani, Maral Emami , Sadegh Shirian, Ladan Masumi , Amir Rasouli, Armita Narimani, Nasser Ahmadian, Abdolreza Mohamadnia, Ali Akbar Velayati

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 119-124

Background: Coronavirus has become a global concern in 2019-20. The virus belongs to the coronavirus family, which has been able to infect many patients and victims around the world. The virus originated in the Chinese city of Wuhan, which eventually spread around the world and became a pandemic.

Materials and Methods: A total of 60 Patients with severe (n=30) and mild (n=30) symptoms of COIVD-19 were included in this study. Peripheral blood samples were collected from the patients. Real-time PCR was used to compare the relative expression levels of Procalcitonin and dipeptidyl peptidase IV (DPPIV) in a patient with severe and mild Covid-19 infection.

Results: Procalcitonin and dipeptidyl peptidase IV markers in the peripheral blood of patients with severe symptoms, were positive in 29 (96.60%) and 26 (86.60%), respectively (n=30); however, positive rates in the mild symptoms patients group were 27 (90%) and 25 (83.30%), respectively. There was a statistically significant difference between these two groups in terms of DDPIV and Procalcitonin (p<0.001).

Conclusion: Procalcitonin and DPPIV increase in patients with COVID-19 infection, significantly higher in the patients with more severe clinical symptoms than those with milder ones. More studies will be needed to verify the reliability of the current findings.

Keywords: Procalcitonin, DPPIV, Severe symptoms, Mild symptoms, COVID-19

Comparison of Two Preoperative Doses of Pregabalin for Attenuation of Postoperative Pain after Laparoscopic Cholecystectomy

Pratibha S, Ranjan Ramakrishna, Sunil VasudevaRao

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 125-131

Background: Pregabalin is a novel drug used as an adjunct to multimodal analgesia for reducing post-operative pain. We aimed to compare the efficacy and side effects of two different pre-emptive doses of pregabalin (75 mg vs. 150 mg) for attenuation of postoperative pain following laparoscopic cholecystectomy.
Materials and Methods: This was a prospective randomized study where 70 patients planned for elective laparoscopic cholecystectomy (LC) were enrolled and received a pre-emptive dose of oral pregabalin. Group A received 75 mg and Group B received 150 mg of Pregabalin (PGB) 1 hour before surgery. Assessment of static and dynamic pain was done at 0, 0-4, 4-8, 8-12, 12-16, 16-24 hours post-surgery using Visual Analog Scale (VAS) Score. Adverse effects like postoperative nausea and vomiting (0-6 hr), headache, sedation, and respiratory depression (0-24 hr) were assessed at regular intervals.
Results: There was no significant difference in static and dynamic pain perception at different timed intervals between the two groups. Even the total analgesic requirement in both groups was comparable. The incidence of Postoperative Nausea Vomiting (PONV) (p-value 0.04 ) and headache (P-value 0.034) were statistically significant in Group B when compared to Group A.
Conclusion: Preemptive PGB (75 mg) had a lesser incidence of PONV and headache. Therefore, from our results, we can conclude that a lower dose of PGB has lesser adverse effects, although the analgesic effects are comparable.

Predicting Patient Length of Stay in the Neurosurgical Intensive Care Unit of an Academic Medical Center

Behrooz Alizadeh Savareh, Ahmad Alibabaei, Soleiman Ahmady, Majid Mokhtari, Mohammadreza Hajiesmaeili, Saeedeh Nateghinia

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 132-140

Background: The intensive care unit (ICU) has the highest mortality and admission rates compared to other wards. Therefore, to increase the performance of hospital services, it is very important to evaluate indicators such as mortality and length of stay of patients in ICU. The present study aimed to investigate the neural network analysis method and Particle Swarm Optimization - Support Vector Machine to predict the length of stay in the neurosurgical intensive care unit.
Materials and Methods: This descriptive research deals with data mining and modeling of intensive care unit processes, leading to a practical example of the application of health systems engineering knowledge, using MATLAB software. Data of 1200 patients admitted during the years 2017 to 2019 in the intensive care unit of neurosurgery. Then we evaluated all data with SVM + PSA and NCA.
Results: Identifying the important features and using them has gradually reduced the LOS prediction error from 40% to 7%. Using the NCA technique makes better results for predicting ICU LOS.
Conclusion: PSO + SMV in addition to NCA is a good predictor of ICU LOS screening in patients after neurosurgery and can provide more accurate prognostic factors.


Predicting microRNAs as Anti-viral Agents in SARS-CoV-2 Infection Based on the Bioinformatics Approach: A Systematic Review

Mona Fani, Hasan Namdar-Ahmadabad, Amir Azimian, Hamed Ghasemzadeh-Moghaddam

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 141-147

Purpose: The beginning of 2020, the World health organization (WHO) declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as responsible for the coronavirus disease 2019 (COVID-19) outbreak. Previous studies showed that microRNAs (miRNAs) are able to inhibit pathogenesis of DNA or RNA viruses by binding the genome. The purpose of the current study is an overview of the anti-viral role of cellular miRNAs against the COVID-19 infection. Methods: Our search was limited to all published original papers in the English language from 2019 to 2021 using several databases including PubMed, Google scholar, Scopus, and Science Direct. A manual search of references for included articled was also performed. Among 66 electronically searched citations, 17 papers met the inclusion criteria. Results: The presence of miRNAs during the COVID-19 infection, reported by several studies, predicts the possibility of using miRNAs as potential tools to eradicate the SARS-CoV-2 infection. In some studies, miRNAs have presented as a tool for targeting SARS-CoV-2 encoded genes which are essential in viral biogenesis, entrance, replication, and infection. Conclusion: The comparison of miRNA between SARS-CoV-2 with other human coronaviruses will help the better understanding of distinct clinical characteristics of them.

Spike Protein Mutations and the Effects on SARS-CoV-2 Pathogenesis

Milad Zandi, Saber Soltani, Samira Sanami, Azadeh Rasooli

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 148-153

The severe acute respiratory syndrome coronavirus 2 spike (S) glycoprotein facilitates receptor binding to initiate cell entry that is the critical initial step in the infection cycle. Due to S glycoprotein's pivotal role, in this review, we pointed to show potential functional and structural consequences of S glycoprotein and its variants, which has been related with increased viral load in humans with SARS-CoV-2 infection.

The Readability of Online Health Information on Middle East Respiratory Syndrome Coronavirus Disease

Shahabedin Rahmatizadeh, Saeideh Valizadeh-Haghi

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 154-163

Objectives: The study aims at exploring the readability of health websites on Middle East respiratory syndrome coronavirus (MERS‐CoV).

Methods: The term "MERS" was searched in Google, Yahoo, and Bing search engines. The readability of the first 30 results for each search engine was evaluated by using the five readability scales, including Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease (FRE), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI) and Gunning Fog. Moreover, the official HONcode toolbar was used to identify websites that had been officially certified by the HON foundation.

 Results: Almost half of the retrieved websites were governmental (44.2%). All the surveyed websites were written above the recommended level and so, their readability is suitable for those with a high school or a college degree. The mean grade level for the MERS related websites was in a similar range across the five readability scales. Furthermore, there was no association between the search rank, credibility, and readability

Discussion: The readability level of MERS information available through search engines results, exceeds the recommended 6th-grade level, and they do not currently adhere to the recommended readability guidelines. Even credible websites have provided the contents that are not readable enough for the public.

Conclusion: Considering the lack of a specific policy about the providing of readable health information on the web, it is recommended for healthcare providers to advise their patients to use the online information after consulting with the physicians.

Brief Communications

Efficacy of High Dose Vitamin C, Melatonin and Zinc in Iranian Patients with Acute Respiratory Syndrome due to Coronavirus Infection: A Pilot Randomized Trial

Mahboubeh Darban, Farhad Malek, Mohammad Memarian, Ali Gohari, Arda Kiani, Alireza Emadi, Samaneh Lavvaf, Bahador Bagheri

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 164-167

INTRODUCTION: Our aim was to investigate the efficacy of vitamin C, melatonin, and zinc in patients with severe Covid-19.

METHODS:  Twenty-one adult patients were randomized 1:1 to standard care alone or standard care plus IV vitamin C (2 g, q6hr), oral melatonin (6 mg, q6hr), and oral zinc sulfate (50 mg, q6hr) for 10 days. Patients were monitored for changes in hypoxemia and inflammatory markers.

RESULTS: Both treatment modalities were effective to improve PaO2/FiO2 and oxygen saturation. However, there were no significant differences between 2 groups (P > 0.05). There were reductions in CRP, ESR, and LDH levels in both study groups, although not significant. No significant difference was noted in length of ICU stay between 2 groups (P = 0.3).

CONCLUSION: Our study suggests that addition of vitamin C, melatonin, and zinc to standard care is not associated with considerable improvement in patients with severe Covid-19. 

The Effect of Stretching Exercises and Caffeine Tablets on Reducing Headache after Spinal Anesthesia; A Randomized Clinical Trial

Mohammadreza Moshari, Nilofar Massoudi, Mohammad Fathi, Nima Saeedi

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 168-173


Introduction: We performed this study to compare the effect of Caffeine and stretching exercise on Post Dural Puncture Headache (PDHP).

Methods: In this Randomized Clinical Trial, 160 candidates for elective inguinal hernia surgery or varicocele surgery in Shahid Modares Hospital in Tehran, were assigned into the following groups using a computer-generated randomization table: caffeine group received Caffeine tablet (200 mg TDS); exercise group received stretching exercise; caffeine combine exercise group received Caffeine tablet (200 mg TDS ), and stretching exercise and control group received placebo tablets. After the end of the surgery, up to 48 h, the Visual analog scale (VAS) was recorded every 6hours by the same clinician.

Results: The occurrence of PDPH was less in the caffeine and exercise combined group than in the control group. Also, the headache was more severe in the control group than in the caffeine group. Furthermore, the need for rescue analgesics was more in the control group than in the caffeine group.

Conclusion: caffeine and exercise combined had better outcomes than placebo regarding PDHP.


Comparative Study of Clinical Outcomes of Methylprednisolone and Dexamethasone in Prime Solution during Cardiopulmonary Pump after Coronary Artery Bypass Grafting

Tahmineh Tahmasbi, Mehran Shahzamani , Somayyeh Babamir Satehi , Foziyeh Khodadadi

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 174-180

Background: The study was performed to compare clinical outcomes of methylprednisolone and dexamethasone in prime solution during cardiopulmonary pump after CABG.

Methods: In this double-blind clinical trial, sixty-two patients who underwent CABG were divided into the control group consisted of 31 patients using dexamethasone in their prime solution and the test group consisted of 31 patients using methylprednisolone in their prime solution. Duration of mechanical ventilation, length of ICU stay, bleeding rate (chest tube volume), arrhythmia and need for inotropic intake were compared (IRCT20170620034666N2).

Results: The mean age of patients was 55.7 years in the dexamethasone group and 53.09 years in the methylprednisolone group. Arrhythmia and inotropic agents were not observed in either group. The mean duration of mechanical ventilation and ICU stay in the dexamethasone group were significantly higher than the methylprednisolone group (p <0.05). But the mean bleeding rate in the dexamethasone group was significantly lower than the methylprednisolone group (p <0.05).

Conclusion: The mean duration of mechanical ventilation and ICU stay in the dexamethasone group was higher than the methylprednisolone group, but the use of dexamethasone has the advantage of being associated with less bleeding.

Intra-articular Along with Subacromial Corticosteroid Injection in Diabetic Patients With Adhesive Capsulitis

MohammadAmin Aslani, Fateme Mirzaee, Arvin Najafi, Mohamad Javad Moghaddam; Zohreh Zafarani; Hamidreza Aslani

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 181-187

Background: To compare intra-articular plus subacromial corticosteroid injection with a single intra-articular injection in diabetics with adhesive capsulitis.
Materials and Methods: A total of fifty-four diabetic patients were randomized into corticosteroid injection in both intra-articular and subacromial sites (group A) and one intra-articular injection (group B). Pain by a visual analog scale (VAS), shoulder range of motion, and functional state by the American Shoulder and Elbow Score was assessed before injection, and at follow-up months.
Results: The pain VAS scores of group A were considerably lower than group B at the first-month follow-up visit (P=0.01). The range of motion in forward-elevation and internal rotation at three-month follow-up visits was significantly higher in group A than in group B (P=0.035, P=0.04, respectively). No notable differences in the range of motion in forward-elevation, internal rotation, and external rotation between groups at the final follow-up visit were seen. Though a significant difference in the ASES between groups at the third-month follow-up visit (P=0.03), the ASES score at the final sixth-month follow-up was similar in both groups (P=0.7).
Conclusion: In diabetic adhesive capsulitis of the shoulder, subacromial combined with intra-articular steroid injections has superior subjective outcomes compared to single intra-articular corticosteroid injection.

Case Report

COVID-19-Related Spontaneous Pneumomediastinum: An Atypical Manifestation

Nasser Malekpour Alamdari, Faezeh Shams, Maryam Abbasi, Mohammad Ali Azizi Nadian, Mohammad Fathi, Sara Besharat

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 188-191

COVID-19 is has been an emerging healthcare challenge during the last months. Herein we explain two cases with spontaneous pneumomediastinum as an atypical manifestation of COVID-19 disease; these two patients had confirmed COVID-19, leading to spontaneous pneumodeiastimun as an atypical manifestation during the course of hospital stay, presenting by abrupt deterioration in O2 saturation and symptoms. Spontaneous pneumomediastinum should be considered as a potential reason for the disease exacerbation in patients without previous history of mechanical ventilation.


COVID-19 Treatment in Medan, Indonesia: A Case Report

Wulan Fadinie

Journal of Cellular & Molecular Anesthesia, Vol. 6 No. 2 (2021), 2 July 2021, Page 192-196

In the past decades, two known zoonotic coronaviruses, SARS-CoV and MERS-CoV, have been reported to damage the respiratory tract and cause severe outbreaks. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly discovered coronavirus, which was first discovered in Wuhan, China in December 20191. Coronaviruses are enveloped, positive single-strandedlarge RNA viruses that infect humans, but also a widerange of animals. Coronaviruses were first described in 1966 by Tyrell and Bynoe, who cultivated the viruses from patients with common colds2

SARS-CoV-2, which belongs to a unique clade of the Sarbecovirus subgenus of the Orthocoronavirinae subfamily, was identified as the pathogen of Coronavirus disease 2019 (COVID-19) in January 2020 3. A majority (67-85%) of critically ill patients admitted in intensive care units with confirmed infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) developed the acute respiratory distress syndrome (ARDS)4

The maximum incubation period is assumed to be up to 14 days, whereas the median time from onset of symptoms to intensive care unit (ICU) admission is around 10 days. Recently, WHO reported that the time between symptom onset and death ranged from about 2 weeks to 8 weeks5. The severity of patient’s symptoms was categorized as mild, severe, or critical. Mild included non-pneumonia and mild pneumonia cases. Severe was characterized by dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation ≤93%, PaO2/FiO2ratio <300, and/or lung infiltrates >50% within 24–48hours. Critical cases were those that exhibited respiratory failure, septic shock, and/or multiple organ dysfunction/failure6,7

Coronavirus disease 2019 (COVID-19) is associated with high morbidity and mortality. It has been a significant impact on the surgical care of the patients. There is still no consensus on elective surgeries under time epochs with national partial control of the disease. The objective is to report the clinical course of the surgical patient who was eventually diagnosed with COVID-19 despite preoperative screening. A 69 years old woman was referred to the surgical ward for elective low anterior resection (LAR). The complete preoperative workup was performed with acceptable results. Reverse transcriptase-polymerase chain reaction (RT-PCR) of SARS-COV-2 was not performed because the patient was asymptomatic and the surgical procedure was scheduled during the time of country's partial pandemic control; the nadir of the curve in daily reported COVID-19 patients. Following the surgery, the patient’s clinical status was stable for about 8 hours; however, the patient became anuric and hypotensive, receiving a variety of treatments for a list of differential diagnosis, including fresh lung CT scan and RT-PCR test; both of the latter were positive for COVID-19. Despite COVID-19 management and respiratory support, the patient died on day 15 of hospitalization. It seems that postponing elective surgeries if possible and general screening with RT-PCR in situations where delay in surgeries is not possible, are rationale strategies for surgical management of the patients during the COVID-19 pandemic, even when daily situation of the pandemic seems stable.

Letter to the Editor