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Background: Blood pressure control is one of the basic steps in preventing stroke and cerebrovascular events. Calcium channel blockers are the first-line drugs in hypertension control. On the other hand, the stroke recovery phase depends on activating calcium channels and N-methyl-D-aspartate (NMDA) receptors. Considering these issues, one of the interdisciplinary challenges of neurology and cardiology is the use of these drugs in hypertensive patients with cerebrovascular accident (CVA) risk and their uses after these events. Objectives: This study's primary goal is to evaluate the effects of calcium channel blockers on reducing the risk, mortality, morbidity, and long-term outcomes of cerebrovascular events. Material and Methods: We conducted this systematic literature review by searching PubMed, Scopus, and Google Scholar databases. Our inclusion criteria were randomized clinical trials, cohort studies, case-cross-over studies, case reports, and in-vitro and animal studies in which they evaluated the effects of calcium channel blockers on the CVA risk and mortality, morbidity, and long-term outcomes of stroke. Our exclusion criteria were review studies with no adequate data and non-English articles. Articles that met our criteria were included in the initial search. After the title and abstract screening, 56 human and animal studies were selected to be discussed in this article. Results: Among 56 selected studies, 33 were human studies, 23 were animal experiments, and one study was carried out both on animals and humans. A total of 1,860,234 patients were enrolled in 24 human studies. A total of 717,131 patients in 22 studies received CCBs. Two studies did not report the number of patients who underwent treatment with CCBs. Among 24 studies, 11 reported favorable outcomes following CCB administration, and two studies reported neuroprotective effects for CCBs without any adverse outcome in stroke patients. Five studies demonstrated that CCBs were associated with adverse outcomes. One study showed favorable and unfavorable outcomes compared to other antihypertensive agents. Stroke was reported in two studies following CCB overdose. Three studies have reported that CCBs had no significant effect on stroke risk, mortality, or long-term outcomes. In animal studies, a total of 813 animals were enrolled in 19 studies. Two studies were in vitro using mammalian cells and enzymes, and one study was ex-vivo. Among 24 studies, 18 (75 %) reported beneficial outcomes following treatment with CCBs, three (12.5 %) revealed both favorable and unfavorable results, two (8.3 %) demonstrated adverse outcomes, and one (4.2 %) showed no effect. Conclusion: Based on the evidence from human and animal studies, authors conclude that CCBs are associated with a lower risk of stroke, lower mortality risk, and improved long-term neurological and other clinical outcomes.

Background: This descriptive study aimed to assess preoperative pulmonary function test (PFT) results and pulse oximetry readings in patients recovered from COVID-19 who were candidates for elective surgery. Materials and Methods: This is a descriptive study. A total of 110 patients (men = 51) with a mean age of 52.6 years were enrolled in the study. The study protocol was presented to the ethics committee and received approval. Participants included patients with a positive SARS-CoV-2 PCR test history, with a recovery period of at least 6-8 weeks for symptomatic patients and four weeks for asymptomatic patients. Data collection involved a random selection, obtaining informed consent, and conducting a history and physical examination. Pulmonary function capacity and oxygen saturation were assessed, and frailty was evaluated using the Edmonton Frail Scale. Echocardiography and electrocardiography were performed on all patients. Results: The study participants mainly underwent trans-ureteral lithotripsy (TUL), laparoscopic cholecystectomy (LC), and percutaneous nephrolithotomy (PCNL). Symptomatic patients exhibited lower pulse oximetry readings than asymptomatic patients (91.18% vs. 96.13%, p-value = 0.005). Although the average ejection fraction was slightly lower in symptomatic patients (44.25%) compared to asymptomatic patients (48.18%), the difference was insignificant. Symptomatic patients also had higher rates of abnormalities in chest X-rays, electrocardiograms, pulmonary function tests, and fasting blood sugar levels, as well as a higher rate of ICU admission. Conclusion: Comprehensive preoperative evaluations, including pulmonary function and oxygenation assessment, are crucial for COVID-19 survivors undergoing elective surgery. Symptomatic patients showed lower pulse oximetry readings and higher respiratory and cardiovascular abnormalities rates. These findings emphasize the importance of optimizing perioperative management and minimizing complications by thoroughly assessing patients' preoperative health status.

Background: Alterations in the kynurenine pathway (KP) metabolite can contribute to the pathogenesis and progression of many psychiatric and neurodegenerative illnesses, including Alzheimer disease (AD) and Huntington disease (HD), primarily through neuroinflammatory pathways and generating neurotoxic metabolites. Objectives: This systematic review highlights the evidence obtained by in vivo animal studies on alterations in KP metabolites and enzymes in AD and HD. Materials & Methods: We searched PubMed, Scopus, Web of Science, and EMBASE databases from the beginning of 2000 to January 2024 and included English-language in vivo articles comparing levels of KP metabolites or enzymes in rats or mice AD or HD models with controls. Results: A total of 19 studies, comprising 93 experimental and 95 control animals, were included. In AD models compared to controls, the following changes were reported: higher levels of tryptophan (TRP) in blood; higher kynurenine (KYN) levels in the cortex, hippocampus, hypothalamus, and prefrontal cortex; higher quinolinic acid (QUIN) levels in the hippocampus and cerebrum; higher indoleamine 2,3-dioxygenases levels in the cerebrum, prefrontal cortex, and hippocampus; and a higher KYN/TRP ratio in the hippocampus, cortex, and cerebellum. Reports on HD models compared to controls showed higher 3-hydroxykynurenine levels in the striatum and cortex and lowered TRP levels in the striatum. Conclusion: According to the primary outcomes, KP alterations may lead to the progression of AD and HD. These two diseases can also change the KP pathway factors. Here, we highlighted that changes in the KP metabolites and enzyme levels can help diagnose and treat these diseases.

Introduction: Vascular access for dialysis is considered the biggest challenge for chronic dialysis patients, and arteriovenous fistula (AVF) is still the best way to provide vascular access for dialysis. In the present study, survival and quality of AVF was compared between local anesthesia and regional block techniques. Methods: The present study recruited patients with end-stage renal disease (ESRD) undergoing hemodialysis through AVF in 2014-2015. The subjects were randomly divided into local anesthesia (A) and axillary block (B) groups, and received AVF in the antecubital region. The AVF patency and flow were compared between the two groups both long-term and short-term. Data was analyzed in SPSS software. Results: In the present study, 60 patients with ESRD and candidates for AVF creation were divided into local anesthesia (A) and axillary block (B) groups of 30 people. Patients' mean age was 54.28 [standard deviation (SD) = 14.45] years. No significant difference was observed between the two groups in mean AVF flow and patency 24 hours, 10 days, and 6 months after the surgery. Gender had no effect on AVF flow in the two groups. However, AVF flow was significantly lower in patients with diabetes and ischemic heart disease (IHD). Conclusion: The results obtained showed no significant difference in AVF flow and patency between local anesthesia and axillary block both in the short-term and long-term. Diabetes and IHD significantly reduced AVF flow.

As the cases of kidney transplant are increasing, the need to apply the factors to increase the success of transplant seems necessary. Mannitol increases the osmotic pressure and urine volume as a protective agent on renal tubules. We aimed to evaluate the effect of mannitol on short-term outcome of kidney transplantation by comparing two groups based on prescribing mannitol to donors. In a randomized clinical trial, 60 kidney recipients were assigned in two groups (30 in each), except that in one group donors received mannitol. They were studied with respect to age, gender, weight, blood urea nitrogen (BUN), creatinine (Cr), sodium (Na), potassium (K) and arterial blood gas (ABG) before and after surgery, and their pulse rate (PR) and blood pressure (BP) before, during and after surgery. Their urine volume was assessed in the operation room and the first 24 h after surgery. The short-term outcome, including BUN and Cr in the first 10 days after transplant, have been charted. Both the case (mannitol-positive donor patient) and the control (mannitol negative) groups were the same regarding the results gained for pre- and post-operative parameters. Follow-up assessments showed no significant differences in renal function. Based on this, we conclude that mannitol administration to donors does not have a beneficial effect on the prognosis and short-term outcome of transplantation on recipients; therefore, we feel that it should not be advised for kidney donors.

Background: In spite of several efforts for decreasing blood loss, our experience sometimes shows that some patients bleed more profusely during rhinoplasty. Patient position could have deep impact on bleeding amount during surgical procedures. Objective: In this study, we aimed to compare reverse trendelenburg position and head-up position on intra-operative bleeding of elective rhinoplasty. This was to check the effects of reverse trendelenburg position and head up position on the intraoperative bleeding of elective rhinoplasty. Methods: In this study, 30 ASA I (American Society of Anesthesiology physical condition classification) patients between 18 and 40 years of age who were candidate to rhinoplasty operations for first time were included. Patients were randomly assigned to reverse trendelenburg or head-up position. Exclusion criteria was any history or lab indicating coagulation problems or using any drug. All gauzes used and the blood that accumulated in the aspirator throughout the operation were calculated. Results: Our results showed that the mean amount of blood loss in reverse trendelenburg was lower (77.00 ΁ 13.20 ml) than head-up position (83.33 ΁ 21.18 ml), although, there was no statistical difference between two groups. However, there was no significant differences among two groups in different aspects of hemodynamic determinants and bleeding amount during and after rhinoplasty. Conclusions: Our results showed that patient bleeding is not increased because of positioning per se. In conclusion, perhaps in the future reverse trendelenburg will be given more often during rhinoplasry.

Background: Pneumoperitoneum results in respiratory and hemodynamic changes. It is unknown whether hemodynamic changes that last to the recovery room could change recovery criteria.To determine the effect of decrease in intra-abdominal pressure on discharge criteria after laparascopic cholecystectomy. Methods: Patients with age 25-65 who were candidated for elective laparascopy cholecystectomy were enrolled in the study. In high pressure group, intra-abdominal pressure was maintained at 12, and in low pressure group at 8 mmHg. Intra-abdominal insufflation was performed using CO2. After surgery, patients were transferred to recovery room. Heart rate, blood pressure, and pulse oxymetery monitoring were continued in recovery room and modified Aldrete scores were measured every 4 minutes. Patients were discharged from recovery if they had Aldrete score> 9. Results: Aldrete scores were lower in high pressure group compared to low pressure group at 4 and 8 minutes in recovery room, however this difference was not significant (p=0.17, 0.44; respectively). At 12, 16, 20 and 24 minutes Aldrete scores were not significantly different between two groups (p> 0.05). Conclusion: The effect of decreasing intraabdominal pressure from 12 to 8 mmHg during insufflations of CO2 in laparascopy induces only minor non-significant decrease in discharge time and criteria.