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Numerous studies have indicated the pharmacological properties of linalool, a volatile terpene alcohol found in many flowers and spice plants, including anti-nociceptive, anti-inflammatory, and neuroprotective activities. The aim of this study was to explore the mechanisms of neuroprotection provided by (±) linalool and its enantiomer, (R)-(−) linalool against oxygen, and glucose deprivation/reoxygenation (OGD/R) in PC12 cells. PC12 cells were treated with (±) linalool and (R)-(−) linalool before exposure to OGD/R condition. Cell viability, reactive oxygen species (ROS) production, malondialdehyde (MDA) level, DNA damage, and the levels of proteins related to apoptosis were evaluated using MTT, comet assay, and western blot analysis, respectively. IC50 values for the PC12 cells incubated with (±) linalool and (R)-(−) linalool were 2700 and 2600 μM after 14 h, as well as 5440 and 3040 μM after 18 h, respectively. Survival of the ischemic cells pre-incubated with (±) linalool and (R)-(−) linalool (100 μM of both) increased compared to the cells subjected to the OGD/R alone (p

Background Administration of an optimal dose of anesthetic agent to ensure adequate depth of hypnosis with the lowest risk of adverse effects to the fetus is highly important in cesarean section. Sodium thiopental (STP) is still the first choice for induction of anesthesia in some countries for this obstetric surgery. We aimed to compare two doses of STP with regarding the depth of anesthesia and the condition of newborn infants. Methods In this clinical trial, parturient undergoing elective Caesarian section were randomized into two groups receiving either low-dose (5 mg/kg) or high-dose (7 mg/kg) STP. Muscle relaxation was provided with succinylcholine 2 mg/kg and anesthesia was maintained with O2/N2O and sevoflurane. The depth of anesthesia was evaluated using isolated forearm technique (IFT) and bispectral index (BIS) in various phases. Additionally, infants were assessed using Apgar score and neurobehavioral test. Results Forty parturient were evaluated in each group. BIS was significantly lower in high-dose group at skin incision to delivery and subcutaneous and skin closure. Also, significant differences were noticed in IFT over induction to incision and incision to delivery. Apgar score was significantly lower in high-dose group at 1 min after delivery. Newborn infants in low-dose group had significantly better outcomes in all three domains of the neurobehavioral test. Conclusion 7 mg/kg STP is superior to 5 mg/kg in creating deeper hypnosis for mothers. However, it negatively impacts Apgar score and neurobehavioral test of neonates. STP seems to has dropped behind as an acceptable anesthetic in Cesarean section. Trial registration IRCT No: 2016082819470 N45, 13/03/2019.

Introduction: Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to the development of myocardial damage and dysfunction. It is assumed that propofol, a general anesthetic agent, has a protective role against oxidative stress. The aim of this study was to evaluate the effect of propofol on myocardial protection when added to cardioplegic solution in patients undergoing CABG. Methods: In this prospective and double-blind RCT study, 120 patients undergoing CABG surgery were randomly assigned into two equal groups. In one group, we added 1200 µg/min (ultimate dose 4 µg/ml) propofol to cardioplegic solution and in the control group, an equal volume of normal saline was added to cardioplegic solution. Serum levels of CPK-MB and Troponin I were checked at four time points, including: just after induction (T1) as baseline, after chest closure (T2), 6 hours after arrival to ICU (T3) and 24 hours after ICU admission (T4). Results: Cardiac enzyme levels had significant increase over time in both groups (p-value

Candiduria is common among patients admitted to intensive care units (ICUs); however, clinical and microbiological data are limited, which accounts for non-compliance with international guidelines, including over treatment of asymptomatic candiduria that promotes antifungal resistance. This prospective study included adult patients admitted to ICUs of five referral hospitals in Shiraz, Iran, during 2016-2018. Species were identified by MALDI-TOF MS, and antifungal susceptibility was assessed according to CLSI M27-A3/S4. Among 2086 patients, 162 and 293 developed candiduria and bacteriuria, respectively. In total, 174 yeast isolates were collected; 88.5% were Candida albicans (91/174; 52.2%), C. glabrata (38/174; 21.8%), and C. tropicalis (25/174; 14.3%). Antifungal resistance was rare; only two isolates (one C. tropicalis and one C. krusei) were fluconazole resistant. Symptomatic candiduria was noted in 31.4% of patients (51/162); only 37% (19/51) of them were treated and 36.82% (7/19) showed fluconazole therapeutic failure. Two symptomatic patients developed candidemia shortly after candiduria. Among asymptomatic patients, 31.5% (35/111) were overtreated with fluconazole. The mortality rate was 25.3% (41/162); it did not differ between symptomatic and asymptomatic patients. Our results indicate that deviation from standard-of-care treatment for candiduria is a matter of concern given the high rate of fluconazole therapeutic failure among patients with symptomatic candiduria.LAY SUMMARY: Candiduria is an underestimated clinical presentation among critically ill patients and detailed data are scarce in this regard. Given the high rate of fluconazole therapeutic failure and development of candidemia in some cases, the mistreatment of candiduria should not be overlooked by clinicians.

Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder, of unknown etiology, that affects 2.5% of the population. An appropriate therapeutic response to conventional treatment is seen. Some studies use augmentative treatment by antipsychotics, glutamatergic, lithium, buspirone, and others agents to improve the therapeutic response. In this study, we aimed to evaluate the efficacy and tolerability of aripiprazole and quetiapine as augmentative treatments in patients with selective serotonin reuptake inhibitor (SSRI) refractory OCD. The OCD patients were initially treated for 12 weeks with a SSRI. If after 12 weeks their Yale–Brown Obsessive-Compulsive Scale (Y-BOCS) score was more than 16, they were randomly assigned to either the aripiprazole or the quetiapine augmentation group for an additional 12 weeks. There were no significant differences in age, sex, education, marital status, or score of Y-BOCS and Clinical Global Impression-Severity Scale (CGI-S) between groups (p > 0.05) at the outset of the study. Significant differences were noted after 1 month when compared with results at 2, 3, and 4 months in both groups (p < 0.001). Both quetiapine and aripiprazole may be effective and well-tolerated augmentative agents in the treatment of SSRI-refractory OCD. Because of positive results, aripiprazole may be considered more effective and may have a more rapid onset in terms of therapeutic response.

Aim: Prophylaxis against stress ulcer in mechanically ventilated patients is one of the causes for ventilator-associated pneumonia (VAP). Our aim was evaluating the effect of intravenous pantoprazole and ranitidine in the incidence of VAP in critically ill patients. Materials and Methods: Patients with at least 48 h of expected mechanical ventilation were allocated randomly to receive either 50 mg ranitidine (R) every 8 h or 40 mg pantoprazole (P) every 12 h intravenously from admission. VAP diagnosis was according to the Clinical Pneumonia Infection Score and positive culture. Results: Eighty-six patients during a 15-month period were analyzed; the study showed a low difference between VAP incidence in the ranitidine and pantoprazole groups. No significant difference was observed in terms of gastrointestinal bleeding, intensive care unit, hospital length of stay, and mortality between the groups. Conclusion: VAP incidence is hardly related to the type of stress ulcer prophylaxis agent with a high rate of VAP and low utilization of VAP prophylaxis bundle.

Cardiopulmonary bypass has been recognized as one of the main causes of systemic inflammatory response syndrome, leading to post-operative complications. The aim of this study was to investigate the effect of melatonin on the serum levels of interleukin 6 (IL-6) and IL-9 in patients undergoing coronary artery bypass grafting surgery.Forty-four patients undergoing elective coronary artery bypass surgery were randomly allocated into two study groups of melatonin (n = 23) and placebo (n = 21). Patients in the melatonin group received two melatonin tablet, 5 mg daily for 3 days before surgery, 10 mg tablet (two doses of 5 mg) 1 h before induction of anesthesia and finally, 10 mg melatonin tablet in the intensive care unit, placebo group patients received placebo at the same time periods. Serum levels of IL-9 and IL-6 were measured as baseline (T1), before induction of anesthesia (T2), 6 and 24 h after off pump (T3, T4). Data were analyzed using SPSS 23 software (IBM Corp., Armonk, NY, USA).The mean serum level of IL-6 was significantly lower in the melatonin group at T3 and T4 (p ＜ 0.05). Also, in both groups, serum levels of IL-6 in T3 showed a significant increase compared to T1. Serum levels of IL-9 had no significant difference between the two groups at T1, T2, T3, and T4.The results of this study showed that pre-operative melatonin administration could modify inflammatory cytokines secretion such as IL-6 while it has no significant effect on the serum levels of IL- 9. Neither of the changes was clinically significant.

Safranal, isolated from saffron (Crocus sativus L.), is known to possesses neuroprotective effects. In this study, the neuroprotective potential of safranal against PC12 cell injury triggered by ischemia/reperfusion was investigated. PC12 cells were pretreated with safranal at concentration ranges of 10-160 μM for 2 h and then deprived from oxygen-glucose-serum for 6 h, followed by reoxygenation for 24 h (OGD condition). 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), 2,7-dichlorofluorescin diacetate (DCF-DA), and comet assays were used to measure the extent of cellular viability, reactive oxygen substances (ROS), and DNA damage, respectively. Also, propidium iodide (PI) flow cytometry assay and western blotting of bax, bcl-2, and cleaved caspase-3 were performed for assessment of apoptosis. OGD exposure reduced the cell viability and increased intracellular ROS production, oxidative DNA damage, and apoptosis, in comparison with untreated control cells. Pretreatment with safranal (40 and 160 μM) significantly attenuated OGD-induced PC12 cell death, oxidative damage, and apoptosis. Furthermore, safranal markedly reduced the overexpression of bax/bcl-2 ratio and active caspase-3 following OGD (p 0.05). The present findings indicated that safranal protects against OGD-induced neurotoxicity via modulating of oxidative and apoptotic responses.Graphical abstract The schematic representation of the mode of action of safranal against PC12 cells death induced by oxygen-glucose-serum deprivation and reoxygenation (OGD-R).

Although regional anesthesia is the most frequently used method for selected surgical approaches, general anesthesia (GA) is still common. Awareness and recall of events are among the main hazards during GA, particularly in Caesarean Section (C/S). In this study, we decided to compare depth of anesthesia, that was measured by Bispectral index (BIS) and isolated forearm technique (IFT) in GA, induced by propofol vs. thiopental for elective C/S. We also aimed to determine the incidence of postoperative recall using these two anesthetic medications.Ninety parturient were allocated to receive either thiopental (group T) or propofol (group P) with blocking on a 1:1 ratio. All patients underwent standard GA. BIS and IFT were used to monitor depth of anesthesia at different predetermined perioperative events. All patients were evaluated for recall of the events.No patient recalled the perioperative events during the follow up period. BIS scores were significantly lower in group P compared with group T after induction of GA until discontinuation of volatile anesthetics (p0.001). IFT values were signifi cantly higher in thiopental group in time interval of induction to skin incision comparing to propofol group (p0.050).The current study suggests regarding better effect of propofol on decreasing of awareness during anesthesia and surgery, it seems to be better to use propofol in cases where we are forced to use GA in cesarean section.

Transurethral resection of prostate (TURP) is the most common treatment for benign prostatic hyperplasia (BPH). Urinary tract catheter is inserted post-operatively which results in catheter-related bladder discomfort (CRBD) in many patients. The purpose of this study was to assess the preventive effect of hyoscine N-butyl bromide on CRBD caused by a urinary tract catheter after TURP surgery in patients with BPH. Twenty-four and twenty-six patients in the treatment and control groups were enrolled, respectively. At the end of the surgery, slow intravenous injection of 20 mg hyoscine N-butyl bromide was administered to the patients of treatment group. The severity of CRBD was followed up at five different time periods and up to 2 h after surgery. On arrival to PACU and after 30 min of injection, statistically significant less CRBD was seen in the treatment group comparing to the control group (P ≤ 0.05 and P ≤ 0.007). The total utilized meperidine dose during PACU stay and the time to discharge for the intervention group were significantly lower than those for the control group (P ≤ 0.0001) with no significant difference in adverse effects (P > 0.05). Hyoscine N-butyl bromide could reduce the severity of CRBD related to TURP in patients with BPH and their need for analgesic consumption either. It shortened the length of stay in the recovery room. Regarding its availability and low cost, it can be an effective pain relief drug for CRBD discomfort related to TURP in BPH patients.

Objectives: Acute renal failure is a common complication of major cardiovascular surgeries (One-third of patients). Adenosine release as a vascular vasodilator increases after cardiac surgery, which reduces renal and glomerular blood flow and subsequently causes kidney ischemic damage. The present study aimed at evaluating the impact of aminophylline as an adenosine receptor antagonist on renal function after cardiac surgery hoping to find an appropriate method to reduce acute kidney injury. Methods: The patients in the intervention group received 5 mg/kg aminophylline bolus after induction of anesthesia; then, 0.25 mg/kg/hr of the drug was administered intraoperatively and up to 48 hours after surgery in the ICU cardiac surgery. Similar volume of normal saline was injected to the patients of the second group. Serum BUN, Cr, and GFR were measured pre- and postoperatively and 3 days postsurgery. Patients’ 24- hour urine output and RIFLE were also calculated. Results: Those patients who received medication were extubated earlier (P = 0.018) and received lower amount of inotropic drugs (P < 0001). According to the RIFLE criteria, most of the patients experienced no change or even improved GFR and Cr amounts compared to the control group (p < 0.05). GFR and Cr value of all the patients with Cleveland score, less and more than 6, showed a significant difference between the 2 groups (P = 0.001 and P = 0.01, respectively). According to the RIFLE criteria, most of the patients experienced no change or even improved GFR. Conclusions: Aminophylline in cardiac surgery can reduce the frequency of acute kidney injury according to RIFLE criteria and could be used in the prevention of AKI as a safe and efficient modality in high-risk patients. Also, the use of this drug may reduce the need for inotropic medication at the time of surgery, intensive care unit stay length, and extubation time.

The present study investigated the protective effect of ethyl acetate fraction of lettuce (Lactuca sativa) against glucose/serum deprivation (GSD)-induced neurotoxicity, a model which simulates neuronal damage during ischemia.Two neuron-like cells, N2a and PC12, were cultivated for 12 hours in GSD condition in the absence or presence of the lettuce fraction. The cell viability, DNA damage, and proapoptotic or antiapoptotic proteins levels were determined using MTT, comet, and immunoblotting assays, respectively. In addition, the intracellular reactive oxygen species and lipid peroxidation levels were measured by fluorimetric methods.In both N2a and PC12 cells, GSD condition significantly decreased the cell viability which was accompanied by increased intracellular reactive oxygen species production, lipid peroxidation level, and oxidative DNA damage. All the GSD-induced neurotoxic changes were inhibited by the lettuce fraction. Lettuce also suppressed the elevated Bax and caspase-3 proteins and decreased Bcl-2 induced by GSD in PC12 cells.The present study revealed that lettuce exerts neuroprotective effect through decrease of oxidative stress and inhibition of proapoptotic pathways. Therefore, it has the potential to be used for the management of ischemia-induced neuronal damage.

Hexachlorobutadiene (HCBD) is a potent nephrotoxin which nowadays contaminates human foods and water. On the other hands, it has been reported that rutin is a chemopreventive flavonoid which exerts some protective effects on the kidney. Therefore, in this work, the possible effect of rutin on HCBD-induced nephrotoxicity was investigated in female rats. The animals were divided into five groups. Groups 1 and 2 were treated with vehicle and HCBD (100 mg/kg, i.p.), respectively. Groups 3-5 were pretreated with rutin (100, 500 and 1000 mg/kg, i.p.) 1 h before HCBD injection. The level of serum urea and creatinine as well as urinary glucose and protein were measured. Total thiol content and lipid peroxidation level were also determined in the kidney homogenate. When compared to control group, a significant increase in the level of serum creatinine and urea (p 0.001) as well as urine glucose and protein (p 0.001) were observed after 24 h of HCBD administration. HCBD also caused a significant decrease in total thiol content (p 0.001) and a significant increase in lipid peroxidation level (p 0.001). Pretreatment with rutin could decrease serum creatinine (p 0.001) and urea (p 0.001) as well as urine protein (p 0.001) concentrations when compared with HCBD treated rats. No significant modification on urine glucose was seen (p 0.05). Rutin also reversed the HCBD-induced depletion in thiol content (p 0.001) and elevation in lipid peroxidation (p 0.001) in the kidney. The results of present study showed that rutin clearly attenuated HCBD-induced nephrotoxicity and has the potential to be considered as a nephroprotective agent.

Ischemic cerebrovascular disease is one of the most common causes of death in the world. Recent interests have been focused on natural antioxidants and anti-inflammatory agents as potentially useful neuroprotective agents.Diospyros kaki(persimmon) has been shown to exert anti-inflammatory, antioxidant, and antineoplastic effects. However, its effects on ischemic damage have not been evaluated. Here, we used anin vitromodel of cerebral ischemia and studied the effects of hydroalcoholic extract of peel (PeHE) and fruit pulp (PuHE) of persimmon on cell viability and markers of oxidative damage mainly intracellular reactive oxygen species (ROS) induced by glucose-oxygen-serum deprivation (GOSD) in PC12 cells. GOSD for 6 h produced significant cell death which was accompanied by increased levels of ROS. Pretreatment with different concentrations of PeHE and PuHE (0–500 μg/mL) for 2 and 24 h markedly restored these changes only at high concentrations. However, no significant differences were seen in the protection against ischemic insult between different extracts and the time of exposure. The experimental results suggest that persimmon protects the PC12 cells from GOSD-induced injury via antioxidant mechanisms. Our findings might raise the possibility of potential therapeutic application of persimmon for managing cerebral ischemic and other neurodegenerative disorders.

In recent years, there is a growing interest in the application of nanoparticles like zirconium dioxide (zirconia

Today, special attention is paid to the use of zirconium dioxide nanoparticle (nano-ZrO2), a neutral bioceramic metal, particularly for drug and gene delivery in medicine. However, there are some reports implying that use of nano-ZrO2 is associated with cytotoxic effects like inhibiting the cell proliferation, DNA damage and apoptosis. In the present study, we examined whether nano-ZrO2 alters cell viability and glutathione peroxidase (GPx) activity in two neuronal cell lines. The PC12 and N2a cells were cultured in the absence or presence of varying concentrations (31.25-2000 µg/mL) of nano-ZrO2 for 12, 24 or 48 h. The cell viability was evaluated using 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay and GPx activity was determined by quantifying the rate of oxidation of the reduced glutathione to the oxidized glutathione. Nano-ZrO2 caused a significant reduction in cell viability and GPx activity after 12, 24 and 48 h, as compared with control group. These effects were concentration dependent and started from 250 µg/mL. The present study demonstrated that nano-ZrO2, at concentrations of > 250 µg/mL, has antiproliferative effects via reducing the cell defense mechanism against oxidative stress.

Oxidative stress, increase of lipid peroxidation and resultant DNA damage are associated with pathophysiology of many human diseases such as acute and chronic CNS injuries and diseases, cancer, and also aging. This work was done to investigate whether water fraction from the hydroalcoholic extract of green leaf lettuce (Lactuca sativa L.) can protect N2a cells against glucose/serum deprivation (GSD)-induced lipid peroxidation and DNA fragmentation. The cells were cultivated for 12 h in GSD condition in the absence or presence of the lettuce fraction. The total antioxidant ability of the lettuce water fraction was determined using ferric reducing antioxidant power (FRAP) assay. The intracellular lipid peroxidation was evaluated by malondialdehyde (MDA) level. DNA damage was determined using single cell gel electrophoresis. Using FRAP assay, the antioxidant activity of lettuce water fraction was found to be 574 micromol/g, which is equivalent to 64.1 mg of pure ascorbic acid. Exposure of the cells to GSD condition led to a significant increase of MDA level and DNA fragmentation. Lettuce extract at 400 microg/mL could decrease the elevated intracellular lipid peroxidation and DNA damage. The present study demonstrates that lettuce exerts genoprotective effect through inhibition of oxidative stress.

Mineral trioxide aggregate (MTA) has shown good biocompatibility in several studies. In the present study, the genotoxic and cytotoxic effects of calcium enriched mixture (CEM) were evaluated compared with MTA using MTT and single-cell gel (comet) assays with serial ascending concentrations (0 to 1,000 µg/mL) of tested materials. Cytotoxicity data indicated that there is no significant difference between CEM and MTA at all concentrations except for the full concentration (1,000 µg/mL); CEM had lower cytotoxicity. Genotoxic effects were more evident with CEM at concentrations of 15.6 and 250 µg/mL; however, was less than that of MTA at concentrations of 500 and 1,000 µg/mL. The cytotoxicity and genotoxicity effects of the two experimental groups generally increased with consistency. Under the conditions of this study, CEM is biocompatible in terms of cyto- and genotoxicity. It appears to be an alternative to MTA as an endodontic biomaterial offering several advantages.

Gentamicin, an important aminoglycoside, is used to treat many types of bacterial infections, particularly those caused by Gram-negative organisms. It is a nephrotoxic antibiotic, which causes acute tubular necrosis, and its toxicity remains a major problem in clinical use. This study investigates the effect of pomegranate seed oil (PSO) on gentamicin-induced nephrotoxicity in adult male rats. Animals were randomly divided into four groups. Group one was treated with saline (1 ml/kg, i.p.), group 2 received gentamicin 80 mg/kg/day for 6 days and groups 3 and 4 received PSO 0.32 and 0.64 mg/kg/day i.p. respectively, 1 h before gentamicin. Serum urea, creatinine levels, urinary glucose and protein concentrations were evaluated as the markers of acute renal failure. Renal antioxidant indicators such as thiobarbituric acid-reactive substance (TBARS), and total thiol contents, were also determined. A significant elevation of serum creatinine and urea levels as well as urine glucose and protein concentrations were observed in gentamicin treated group. Gentamicin also caused a significant decrease in total thiol content and a significant increase in TBARS levels in kidney homogenate samples. PSO pretreatment resulted in a significant and dose-dependent decrease in serum creatinine and urea levels as well as urine glucose and protein concentrations when compared with gentamicin treated alone. PSO also significantly reversed the gentamicin-induced depletion in total thiol content and elevation in TBARS in kidney homogenate samples. The results of the present study indicate that PSO clearly attenuated gentamicin-induced nephrotoxicity, but elucidation of the mechanism(s) of this protection needs more investigation.

This study was planned to investigate whether Lactuca sativa is capable of protecting neurons against glucose/serum deprivation (GSD)-induced cell injury, an in vitro model of brain ischemia. Two neuron-like cells, rat pheochromocytoma-derived cell line (PC12) and mouse neuroblastoma-like cell line (N2a), were cultivated for 24 h in standard media or for 6 and 12 h in GSD condition in the absence or presence of hydro-alcoholic extract (HAE), water fraction (WF), ethyl acetate fraction (EAF) or N-butanol fraction (NBF) of L. sativa. At the end of the experiments, the cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium (MTT) assay. The L. sativa exhibited no cytotoxicity under standard condition unless at very high concentrations. Exposure of PC12 cells to GSD condition for 6 and 12 h led to 44 and 90% decrease in cell viability, respectively. The NBF and especially EAF significantly attenuated GSD-induced cell death. Also, GSD caused a significant reduction in N2a cell viability after 6 h (28%) and 12 h (84%). On the other hand, treatment of N2a cells with EAF blocked the cytotoxic effects of GSD condition. The present study revealed that intermediate polarity fraction of L. sativa (EAF) exerts neuroprotection and has the potential to be used as a new therapeutic strategy for common neurodegenerative disorders such as stroke. Key words: Lactuca sativa, glucose/serum deprivation, brain ischemia, rat pheochromocytoma-derived cell line (PC12), mouse neuroblastoma-like cell line (N2a).

Background: Extra corporeal membrane oxygenation (ECMO) has been considered as a crucial modality for the management of acute respiratory distress syndrome (ARDS). Since ECMO is considered to be an invasive modality and may be associated with some complications, there are strict indications for its use. Here we report successful treatment of a case of severe ARDS with Veno-Venous ECMO. Case presentation: A 30 years old male was admitted to Nemazee Hospital in Shiraz with decreased level of consciousness due to cerebral hemorrhage following fibrinolytic therapy for myocardial infarction with ST elevation (STEMI). After diagnosis of moderate to severe ARDS, VV-ECMO was used for the management of ARDS. In this case, 5 days after starting ECMO, PaCO2 improved and O2Sat was maintained at 97-98%, so weaning was considered. Ventilator mode was BIPAP with FiO2 40% and sweep flow was 1.7L/min. We clamped the sweep flow and observed whether the patient was able to maintain O2 Sat at 97% with ventilation alone. Then, we decided to disconnect the patient from ECMO. The patient remained stable afterwards. Conclusion: Our case was intubated and was on MV from 10 days prior to ECMO administration.Moreover, our patient had simultaneous multi-organ involvement (nephrotic syndrome and sepsis) which decreased the benefits of ECMO. Despite all these problems, ECMO was started and patient was discharged from ICU with an acceptable health condition.