Mojtaba Mansouri

Isfahan University of Medical Sciences, Isfahan, Ostān-e Eşfahān, Iran

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Publications (10)2.98 Total impact

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    ABSTRACT: Cardiovascular events are common in patients with diabetes mellitus (DM), which make coronary artery bypass graft (CABG) a highly demanded surgery in this population. Tight control of blood glucose in patients with DM is beneficial in reducing postoperative complications; however, the adequate range has not been determined yet. This study aimed to investigate the effect of semi-tight (moderate) control of DM on complications and serum glucose levels during and after CABG. In this prospective clinical trial, 18 and 31 patients with and without DM, respectively, who were referred to Shahid Chamran Hospital, Isfahan, Iran, for elective CABG surgery, were enrolled. For DM group, patients with controlled DM (i.e. glycosylated hemoglobin levels [HgA1C] ≤ 7%) were recruited. Blood glucose level (blood sugar, BS) was measured after anesthesia, during pumping, warming, off pumping, six and 12 hours after Intensive Care Unit (ICU) admission, and at discharging from the hospital. The hemodynamic state of the patients, bleeding, need of blood transfusion, infection, and duration of hospitalization were also monitored and recorded. None of the BS measurements (FBS, after anesthesia, on-pump, warming, off pump, six and 12 hours after ICU admission, and at discharge) were significantly different between study groups (P > 0.05). Frequency of surgery site bleeding and blood transfusion need were not significantly different between these groups (P > 0.05). Semi-tight control of DM with insulin infusion during operation did not led to any difference in the type and rate of CABG complications between patients with well-controlled and those without DM; however, BS levels in patients with well-controlled DM could be more easily controlled.
    05/2014; 3(2):e17861. DOI:10.5812/cardiovascmed.17861
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    ABSTRACT: Coronary artery bypass grafting (CABG) is one of the common surgeries in patients with coronary artery disease (CAD). It is more probable for patients with diabetes to undergo surgeries due to CAD and they have a higher mortality rate compared to the others. The aim of the present study was to assess the effects of insulin infusion therapy on blood gas parameters in two groups of patients, eligible for CABG, defined as A: well controlled diabetes (HbA1C < 7%) and B: non-diabetic patients. We followed two groups of patients, defined as patients with and without diabetes who were candidates for CABG, between March 2010 and March 2012. Patients with diabetes underwent moderate or semi-tight glycemic control, using continuous intravenous insulin infusion. There were 13 male and 18 female subjects in the on-diabetic group and 11 male and 7 female patients in the controlled diabetic group. There was no significant difference between the studied participants regarding age, cardiac ejection fraction, blood pH and PO2 and PCO2 levels. CABG surgery adversely affects arterial blood gas (ABG) determinations. On the other hand, findings showed there is no significant difference in the ABG parameters between patients with well controlled diabetes and the ones without.
    05/2014; 3(2):e17857. DOI:10.5812/cardiovascmed.17857
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    ABSTRACT: Bleeding diathesis and allogenic transfusion after complex heart surgery, such as heart valve surgery, may result in complications such as transfusion reaction, viral infection, postoperative infection, haemodynamic disturbance, prolonged stay in the intensive care unit and hospital, renal and respiratory failure and mortality. In this prospective, double-blind, randomized, placebo-controlled clinical trial, 90 patients were randomly divided into three groups: aprotinin, tranexamic acid and control. Chest-tube drainage, transfusion requirements and renal and neurological complications were evaluated. We found that chest-tube drainage during the first (P < 0.0001) and second 24 h (P = 0.001) after admission to the intensive care unit were significantly lower in the aprotinin group. The amounts of transfused packed red blood cells (P < 0.0001) and platelets (P = 0.02) were significantly lower in the aprotinin and tranexamic acid groups. The quantity of transfused fresh frozen plasma (P = 0.034) was significantly lower in the aprotinin group only. We did not find any neurological complications or renal failure in the three groups. Our data suggest that in valvular heart surgery, low-dose aprotinin is significantly better than tranexamic acid or a placebo for reduction of postoperative bleeding and allogenic transfusion, without increasing adverse outcomes.
    Interactive Cardiovascular and Thoracic Surgery 04/2012; 15(1):23-7. DOI:10.1093/icvts/ivs114 · 1.11 Impact Factor
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    ABSTRACT: The aim of this study was to determine the efficacy of bilateral intrapleural block with bupivacaine as a preemptive analgesic for postoperative pain in coronary artery bypass graft surgery. In a double-blind prospective clinical trial, 70 patients were randomly divided into a bupivacaine group (20 mL bupivacaine 0.25% and 0.5 mL adrenaline 1/200,000 each side) and a control group (20.5 mL normal saline each side). Evaluation of the severity of pain was performed using the visual analog scale at 12 and 24 h after entering the intensive care unit and again during chest tube removal. Pain scores at 12 and 24 h after intensive care unit admission were significantly lower in the bupivacaine group. There were no side-effects related to intrapleural block, such as pneumothorax or emphysema. In coronary artery bypass graft candidates, preemptive analgesia with bilateral intrapleural block using bupivacaine provided relatively less painful conditions during the first 24 h after surgery, but it did not improve the clinical outcome.
    Asian cardiovascular & thoracic annals 04/2011; 19(2):133-8. DOI:10.1177/0218492311400921
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    ABSTRACT: Postsurgical pain usually results in some complications in the patients. This study has tried to investigate the effects of parasternal single injection of bupivacaine on postoperative pulmonary and pain consequences in patients after open heart surgery. In a prospective double blind clinical study, 100 consenting patients undergoing elective open heart surgery were randomized into two groups. In case group, bupivacaine was injected at both sides of sternum, immediately before sternal closure. In the control group, no intervention was performed. Then, the patients were investigated regarding intubation period, length of ICU stay, arterial blood gas (ABG) parameters, morphine requirement, and their severity of postoperative pain using a visual analogue scale (VAS) device. No differences were found between the two groups regarding to age, sex, pump time, operation time, and body mass index and preoperative cardiac ejection fraction. Mean intubation length in case group was much shorter than that in control group. Mean PaO(2) in case group was lower in different checking times in postoperative period. The patients in the case group needed less morphine compared to those in the control group during the 24-hour observation period in the ICU. Finally, mean VAS scores of pain in case group were significantly lower than those in control group at 6, 12, and 24 hours postoperatively. Patients' pain relief by parasternal single injection of bupivacaine in early postoperative period can facilitate earlier ventilator weaning and tracheal extubation after open heart surgery as well as achieving lower pain scores and narcotic requirements.
    Journal of research in medical sciences 04/2011; 16(4):477-83. · 0.61 Impact Factor
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    ABSTRACT: This paper proposes an approach for quantifying Depth of Anesthesia (DOA) based on correlation dimension (D2) of electroencephalogram (EEG). The single-channel EEG data was captured in both ICU and operating room while different anesthetic drugs, including propofol and isoflurane, were used. Correlation dimension was computed using various optimized parameters in order to achieve the maximum sensitivity to anesthetic drug effects and to enable real time computation. For better analysis, application of adaptive segmentation on EEG signal for estimating DOA was evaluated and compared to fixed segmentation, too. Prediction probability (PK) was used as a measure of correlation between the predictors and BIS index to evaluate the proposed methods. Appropriate correlation between DOA and correlation dimension is achieved while choosing (D2) parameters adaptively in comparison to fixed parameters due to the nonstationary nature of EEG signal.
    Fractals 12/2009; 17(04). DOI:10.1142/S0218348X09004594 · 0.63 Impact Factor
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    ABSTRACT: This paper proposes an approach for quantifying Depth of Anesthesia (DOA) based on correlation dimension (D2) of electroencephalogram (EEG). The single-channel EEG data was captured in both ICU and operating room while different anesthetic drugs, including propofol and isoflurane, were used. Correlation dimension was computed using various optimized parameters in order to achieve the maximum sensitivity to anesthetic drug effects and to enable real time computation. For better analysis, application of adaptive segmentation on EEG signal for estimating DOA was evaluated and compared to fixed segmentation, too. Prediction probability (PK) was used as a measure of correlation between the predictors and BIS index to evaluate the proposed methods. Appropriate correlation between DOA and correlation dimension is achieved while choosing (D2) parameters adaptively in comparison to fixed parameters due to the nonstationary nature of EEG signal. Read More: http://www.worldscientific.com/doi/abs/10.1142/S0218348X09004594?journalCode=fractals
    Fractals 06/2009; · 0.63 Impact Factor
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    ABSTRACT: This paper proposes a novel approach to estimating level of unconsciousness based on Principal Component Analysis (PCA). The Electroencephalogram (EEG) data was captured in both Intensive Care Unit (ICU) and operating room. Different anesthetic drugs, including propofol and isoflurane were used. Assuming the central nervous system as a 20-tuple source, the window length of 20 seconds is applied to electroencephalogram (EEG). The mentioned window is considered as 20 nonoverlapping mixed-signals (epoch). The PCA algorithm and more precisely Eigenvector Decomposition (EVD) is applied to these twenty 1-second length epochs, and the related eigenvalues were extracted. Largest remaining (LRE) and smallest remaining eigenvalue (SRE) reveal a sensible behavior due to changing depth of anesthesia (DOA). The correlation between LRE and DOA was measured with Prediction probability (Pk)- The same was done for SRE and DOA. The results show the superiority of SRE than LRE in predicting DOA in the case of ICU and isoflurane. Conversely, the results reveal the superiority of LRE than SRE in propofol induction. Moreover, the result of LRE indicates no obvious diference between ICU and the drugs, while in the case of SRE, the result of ICU was better than that of drugs. Finally, a mixture model containing both LRE and SRE could predict DOA as well as Relative Beta Ratio (RBR), which expresses the high capability of the proposed PCA based method in estimating DOA.
    Bioinformatics and Biomedical Engineering, 2008. ICBBE 2008. The 2nd International Conference on; 06/2008
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    ABSTRACT: Monitoring the depth of anesthesia is important to prevent undesirable events during surgery. According to direct effect of anesthetic drugs on synaptic activity of neurons and after presentation of anesthesia depth monitor (BIS) in 1996, there was a great interest on electroencephalogram analysis to investigate depth of anesthesia. Now there are large numbers of methods and algorithms in this field and every new method is compared with BIS index. BIS algorithm is based on three sub-parameters including time, frequency and higher order statistics domain parameters but the detailed algorithm is not in the public domain. In this paper, proper methods are presented for calculating three sub-parameters. Results of applying these methods to collected clinical data are presented. Efficiency of these methods will be evaluated based on appropriate statistical analysis.
    ICSP2008, published at IEEEexplore.; 01/2008
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    ABSTRACT: This paper proposes a combined method including adaptive segmentation and time-series Shannon entropy of electroencephalograms (EEG) to monitor depth of anesthesia (DOA). The entropy of a single channel EEG was computed through various methods of quantization. These methods are different in number of bins associated to the whole range of amplitude. The EEG data was captured in both ICU and operating room and different anesthetic drugs, including propofol and isoflurane were used. Due to the non-stationary nature of EEG signal, adaptive segmentation methods seem to have better results. Our adaptive windowing methods consist of variance and auto correlation (ACF) based methods. We have compared the results of fixed and adaptive windowing in different methods of calculating entropy in order to estimate DOA. Coefficient of determination (R ) was used as a measure of correlation between the predictors and BIS index to evaluate our proposed methods. The results show that entropy decreases with decreasing DOA. In ICU, our proposed method reveals better performance than previous works. In both ICU and operating room, the results indicate the superiority of our method, especially applying adaptive segmentation. The mixture of adaptive windowing methods with different methods of calculating entropy would result in an outstanding performance.
    Information Technology Applications in Biomedicine, 2007. ITAB 2007. 6th International Special Topic Conference on; 12/2007