Publications by authors named "Afshin Amini"

77 Publications

Portal Vein Thrombosis and Intra-Abdominal Hypertension Presenting as Complications of Hypertriglyceridemia-Induced Severe Acute Pancreatitis.

Cureus 2020 Aug 20;12(8):e9889. Epub 2020 Aug 20.

Gastroenterology and Hepatology, St. Luke's Hospital, Chesterfield, USA.

A 44-year-old male without any significant past medical history presented to the emergency department (ED) with the chief complaint of severe constant epigastric pain for three hours. On physical examination, the abdomen was distended and tender, particularly in the epigastric region. The lab work showed an elevation of the lipase (12,405 U/L) and triglycerides (5,837 mg/dL). An abdominal CT scan with contrast was ordered, which revealed non-necrotic pancreatitis. In addition, the liver ultrasound showed no evidence of gallstones. Subsequently, fluid infusion, meropenem, pain medication, and an insulin drip were started, and the patient was transferred to the intensive care unit (ICU). After six hours in the ICU, he complained of abdominal pain despite taking a high hydromorphone dose. On further physical examination, the abdomen was tender and distended but without rebound tenderness. The gastric distention on kidneys, ureter, and bladder (KUB) and a bladder pressure of 34 mmHg raised the suspicion for intra-abdominal hypertension (IAH), which led us to place a nasogastric tube (NGT) and consult the surgical team. The patient's symptoms and bladder pressure were closely followed and showed significant improvement. On day seven in the ICU, the patient responded well to medications; feeding through the Dobhoff tube was started, and his triglycerides decreased to approximately 1,000 mg/dL. Despite his general improvement and meropenem regimen, the patient spiked a fever of 38.5 °C. Due to the possibility of pancreatitis complications, a CT abdomen with contrast was ordered, which showed partial portal vein thrombosis (PVT). Subsequently, enoxaparin was started, and the patient was closely observed for gastrointestinal bleeding. Eventually, after 17 days in the ICU, the patient was transferred to the floor and then discharged from the hospital with normal lab tests and without evidence of portal thrombosis on abdominal CT. In this report, we illustrate and discuss a case of hypertriglyceridemia (HTG)-induced pancreatitis (HTGP), which progressed to PVT and IAH. Physicians should be aware that patients with HTG are inclined to have severe pancreatitis. In addition, the degree of triglyceride elevation is correlated with the severity of acute pancreatitis.
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http://dx.doi.org/10.7759/cureus.9889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502419PMC
August 2020

Mepolizumab as Possible Treatment for Allergic Bronchopulmonary Aspergillosis: A Review of Eight Cases.

Cureus 2020 Aug 12;12(8):e9684. Epub 2020 Aug 12.

Internal Medicine, St. Luke's Hospital, Chesterfield, USA.

Allergic bronchopulmonary aspergillosis (ABPA) is an eosinophilic pulmonary disorder caused by a hypersensitivity reaction to Aspergillus fumigatus that manifests with uncontrolled asthma, peripheral blood eosinophilia, and radiological findings, such as mucus plugging. Early diagnosis and proper treatment of ABPA are essential to prevent irreversible lung damage such as pulmonary fibrosis and bronchiectasis and improve the quality of life of patients. Beside inhaled medication for asthma, anti-inflammatory agents (i.e., systemic glucocorticoids) and antifungal agents are the mainstay treatment of ABPA. The goal of therapy using glucocorticoids and antifungal agents is to suppress the immune hyperreactivity to A. fumigatus and attenuate the fungal burden. Since the systemic glucocorticoid therapy may lead to serious adverse effects including osteoporosis, avascular necrosis, myopathy, cushingoid appearance, hypertension, insomnia, and increased risk of infection, a glucocorticoid-sparing agent could be considered. Mepolizumab is a humanized monoclonal antibody that binds to interleukin-5, which is the key mediator for eosinophil differentiation, activation, migration, and survival. We review eight cases of ABPA treated successfully with mepolizumab. Treatment with mepolizumab was not restricted to the total immunoglobulin E level, the limiting factor for omalizumab in ABPA. In addition, mepolizumab therapy improved forced expiratory volume in one second, radiological findings, and patient quality of life.
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http://dx.doi.org/10.7759/cureus.9684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486017PMC
August 2020

Duodenal angiosarcoma can be misdiagnosed as a Dieulafoy's lesion.

Gastroenterol Hepatol Bed Bench 2020 ;13(3):268-271

Department of Medicine, St. Luke's Hospital, Chesterfield, MO, USA.

Angiosarcomas are soft-tissue neoplasms that originate from the vascular epithelium. The most commonly involved sites include the skin and subcutaneous tissues. In the GI tract, generally, angiosarcomas involve the spleen and liver, although locations in the small intestine and colon have been very occasionally reported. In the present study we report the unusual case of a man with duodenal epithelioid angiosarcoma, presenting with anemia and recurrent upper gastrointestinal bleeding, which was initially misdiagnosed as a Dieulafoy's lesion. It is important to consider the diagnosis of gastrointestinal malignancy, including unusual neoplasms such as angiosarcomas, in the setting of anendoscopic appearance such as hemorrhagic nodule, purpuric mass and/or recurrent bleeding lesions that are persistent despite repeat interventions. In such cases, a biopsy should be considered to confirm the diagnosis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417484PMC
January 2020

Nintedanib-Induced Colitis Treated Effectively With Budesonide.

Cureus 2020 Jul 31;12(7):e9489. Epub 2020 Jul 31.

Internal Medicine/Gastroenterology and Hepatology, St. Luke's Hospital, Chesterfield, USA.

A 68-year-old male with a past medical history of interstitial pulmonary fibrosis (IPF) on nintedanib and chronic nintedanib-induced diarrhea for three years presented with hematochezia and worsening diarrhea. Diarrhea had persisted despite the use of cholestyramine and oral antidiarrhea medications. As part of the evaluation of diarrhea, he had undergone colonoscopy two years prior, which had shown non-specific moderate diffuse colitis. No significant abnormalities had been noted on physical exam and lab tests. On the present admission, colonoscopy showed diffuse erythematous, friable, and granular mucosa throughout the entire colon. Biopsies were taken and pathology was reported as acute superficial inflammation and possible nintedanib-induced colitis. Since the patient wanted to continue nintedanib as a part of IPF treatment, 9 mg oral budesonide was started, and the patient was followed up after four months. At his follow-up visit, the patient reported that diarrhea had completely resolved. In this report, we illustrate and discuss a case of nintedanib-induced colitis, which can be resistant to oral antidiarrhea medication and cholestyramine. The mechanism of this side effect is not completely understood; however, it may be related to direct inflammation of the intestinal epithelium, given that nintedanib metabolites are excreted primarily in the stool. As a result, it has been hypothesized that steroids could potentially treat this diarrhea by relieving this inflammation. In our patient, we elected to use budesonide due to less associated systemic side effects and possible similarity of inflammation between nintedanib-associated colitis and inflammatory bowel disease.
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http://dx.doi.org/10.7759/cureus.9489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398725PMC
July 2020

Two unusual sites of metastases of esophageal adenocarcinoma.

Gastroenterol Hepatol Bed Bench 2020 ;13(2):184-187

Department of Medicine, St. Luke's Hospital, Chesterfield, MO, USA.

The most common sites of metastasis for esophageal cancers include the liver, lungs, and bones. We report a rare case of esophageal adenocarcinoma with metastasis to the subcutaneous perianal region as well as to the small bowel. Physicians should consider the possibility of metastasis in a patient with esophageal adenocarcinoma even after the onset of remission. It is essential to examine these patients and maintain a high index of suspicion for possible metastases. Early recognition helps in the accurate staging of the disease and enables the initiation of life-prolonging therapy and achieving meaningful palliation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149818PMC
January 2020

"Obscure" Appendiceal Orifice Polyps Can Be Challenging to Identify by Colonoscopy.

Case Rep Gastroenterol 2020 Jan-Apr;14(1):15-26. Epub 2020 Jan 20.

Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri, USA.

The primary purpose of screening colonoscopy is the detection and subsequent removal of precancerous polyps. However, effective recognition of appendiceal lesions with a standard endoscope is often challenging and is limited to the base of the cecum and appendiceal orifice. The majority of appendiceal polyps are found incidentally following an appendectomy, though rarely they may be discovered during a colonoscopy. Despite being visualized by colonoscopy, most of these polyps are generally referred for surgical resection. The risk of developing carcinoma in patients with appendiceal polyps is likely similar to that of other colonic polyps, so it is essential for the endoscopist to examine and visualize the appendiceal orifice thoroughly. Various techniques are available to the endoscopist that can increase the accuracy of colonoscopic evaluation. These include luminal inflation and deflation, looking behind and pressing haustral folds, and repetitive passage of the scope over poorly visualized areas. To our knowledge, only 3 cases have been reported in the literature describing the discovery of obscure appendiceal polyps using colonoscopic techniques. Here we describe three cases of appendiceal orifice polyps missed on initial visualization but subsequently protruded into the cecum following prolonged examination and gentle deflation in the cecum. The endoscopist should consider the possibility of an appendiceal neoplasm, especially if other colonic polyps have been found. Endoscopists should spend adequate time examining the cecum during a screening colonoscopy to expose and thoroughly examine the appendiceal region.
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http://dx.doi.org/10.1159/000505482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011709PMC
January 2020

Does the Presence of Giant Pseudopolyps in a Patient with Newly Diagnosed Inflammatory Bowel Disease Increase the Risk of Major Thrombotic Events?

Case Rep Gastroenterol 2019 Sep-Dec;13(3):468-474. Epub 2019 Nov 13.

Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri, USA.

Giant inflammatory polyp and thromboembolism are uncommon complications in inflammatory bowel disease (IBD) patients. Colon mucosal inflammation is possibly the main mechanism of pathogenesis for these two complications. IBD has long been associated with hypercoagulability and thromboembolism. In fact, thromboembolism has been noted in 0.7% to 7.7% of IBD patients, with the deep veins of the legs and the pulmonary veins accounting for 90% of the cases. The proposed mechanism of this hypercoagulability involves the promotion of hemostasis that results from the inflammatory process underlying the IBD, as well as the loss of proteins, including antithrombotic factors, resulting from the inflamed bowel and increased permeability of the colonic mucosa. This process may be exacerbated by the presence of giant inflammatory polyps, which are defined as polyps in the setting of IBD with dimensions greater than 1.5 cm. The presence of these polyps leads to an increase in inflamed colonic surface area, which can accelerate the rate of protein loss, leading to an increased incidence of thrombosis. Here, we report the case of a 21-year-old female with inferior vena cava and left renal vein thromboses secondary to a newly diagnosed IBD and the presence of severe giant inflammatory polyposis. These thromboses were detected incidentally in this patient after 1 week of hospitalization. She had presented with hypoalbuminemia and elevated inflammatory markers, which raised the suspicion for possible giant inflammatory polyposis as a potential risk for her major thromboembolic events. More studies are required to explore this plausible correlation further.
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http://dx.doi.org/10.1159/000504407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902221PMC
November 2019

Capecitabine induced fingerprint changes.

J Clin Pharm Ther 2019 Oct 29;44(5):780-787. Epub 2019 Jun 29.

Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

What Is Known And Objective: Fingerprinting is recognized as an easily accessible means of personal identification; however, fingerprints can be damaged after administration of some chemotherapy agents that result in hand and foot syndrome (HFS). Fingerprint loss may also be due to reasons unrelated to HFS. This study evaluated the incidence of fingerprint changes in patients treated with capecitabine-containing chemotherapy regimens and its relations to various grades of HFS.

Methods: Seventy-one patients who received chemotherapy with or without capecitabine as part of their regimen were enrolled in the study. Fingerprints were collected once before the initiation of chemotherapy and once after the third course of chemotherapy. The fingerprints were examined by the Iranian Society of Forensic Physicians, for probable changes in the post-chemotherapy states.

Results And Discussion: Thirty-seven patients were enrolled in the capecitabine group and 34 in a comparison group. Fingerprint changes were observed in 25 (67.6%) of the 37 patients in the capecitabine group and none in the comparison group. There was no correlation between the occurrence or severity of HFS and fingerprint changes (P = 0.880). In capecitabine group, the total dose and course numbers of capecitabine were not significant in patients with and without fingerprint changes.

What Is New And Conclusion: Based on our findings, we recommend notifying patients who are considered for capecitabine therapy about the risk of fingerprint changes before the initiation of treatment, as this may have legal implications.
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http://dx.doi.org/10.1111/jcpt.13003DOI Listing
October 2019

Impact of Education on Trauma Patients' Handover Quality; a Before-After Trial.

Arch Acad Emerg Med 2019 27;7(1):e7. Epub 2019 Jan 27.

Cardiology Department, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Poor handover and inadequate transmission of clinical information between shifts cause a lot of problems in patient care and result in significant risks for physicians and patients. This study was designed to evaluate the impact of education and application of handover checklist on trauma patients' handover quality.

Methods: In this before-after trial, handover process of trauma patients in an educational hospital was evaluated before and after education and application of a handover checklist, abbreviated as "WHO MISSED IP?", using a questionnaire that consisted of 10 necessary items, which should be delivered during handover of trauma patients. A total score of 10 was considered for each patient handover, the score 10 out of 10 indicating that all 10 important pieces of patient information were correctly delivered.

Results: 52 pre and post-intervention handover sessions were evaluated (438 patients). Prior to intervention, 18% of patients were not delivered to the next shift, most of which were in the night shift handover (p < 0.001). From the pre-intervention to the post-intervention period, significant improvements were detected in all items except for diagnosis and consulting items. The mean duration of handover changed from 1.22 ± 0.24 minutes to 1.58 ± 0.23 minutes after intervention (p < 0.01). In the pre-intervention period, the score equal or greater than 9 was observed in 7.5% of patients, while after intervention, 63.6% of patients had score ≥ 9 regarding complete handover (p < 0.01).

Conclusion: Based on the findings of the present study, teaching handover standards and application of handover checklist could be helpful in improving the quality of information delivery between emergency medicine residents and improve trauma patients' handover indices.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377215PMC
January 2019

The Effect of Oxygen Therapy on Oxidative Stress Index in Patients with Acute Myocardial Infarction; a Letter to the Editor.

Arch Acad Emerg Med 2019 1;7(1):e2. Epub 2019 Jan 1.

1. Emergency Department, Imam Hossein Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377221PMC
January 2019

Low-Dose Fentanyl, Propofol, Midazolam, Ketamine and Lidocaine Combination vs. Regular Dose Propofol and Fentanyl Combination for Deep Sedation Induction; a Randomized Clinical Trial.

Emerg (Tehran) 2018 2;6(1):e57. Epub 2018 Oct 2.

Introduction: Need for procedural sedation and analgesia (PSA) is felt in emergency department (ED) more and more each day. This study aimed to compare the effectiveness of low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination with regular dose of propofol and fentanyl combination for induction of deep sedation.

Methods: In this single-blind clinical trial, candidate patients for sedation and analgesia aged more than 15 and less than 60 years old, with pain score ≥6 were allocated to one of the groups using block randomization and were compared regarding onset of action, recovery time, and probable side effects.

Results: 125 patients with the mean age of 37.8 ± 14.3 years were randomly allocated to each group. 100% of the patients in group 1 (5 drugs) and 56.5% of the patients in group 2 (2 drugs) were deeply sedated in the 3 minute after injection. The 2 groups were significantly different regarding onset of action (p = 0.440), recovery time (p = 0.018), and treatment failure (p < 0.001).

Conclusion: Low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination was more successful in induction of deep sedation compared to regular dose of propofol and fentanyl combination. Recovery time was a little longer in this group and both groups were similar regarding drug side effects and effect on vital signs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289150PMC
October 2018

Comparing Diagnostic Accuracy of Direct Questioning Versus Schematic Evaluation of Chronic Pain Localization.

Acta Clin Croat 2017 Dec;56(4):689-697

Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.

None of the previous studies localized pain in comparison with graphic scheme. Our aim was to investigate the validity of direct questioning about the main pain localization in comparison with schematic evaluation. In this cross-sectional study, 331 patients, mean age 49.4±10.72 years, localized their main pain site anatomically with manikin and by direct questioning. Two methods were employed to localize pain: direct questioning and schematic evaluation (manikin). Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and odds ratio (OR) were used to compare these two methods. Study patients answered in both methods. The sensitivity and PPV were mostly in a weak range, while accuracy, specificity and NPV were mostly in good range. Kappa index was in the marginal reproducibility range. Pain in the left part of the body had a higher OR (OR=9). PLR for pain in the right part of the body was 28.03. NLR for all questions was located in the small and rarely important change probability group. Negative answer in direct questioning was more reliable than a positive one. Pain localization in the left side of the body was more reliable.
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http://dx.doi.org/10.20471/acc.2017.56.04.16DOI Listing
December 2017

Normalized Weight of Iranian Newborns According to Gestational Age: A Nationwide Study.

Arch Iran Med 2017 Oct;20(10):626-632

Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: By organizing birth weights according to gestational age at birth, reference weight values for different sex-gestational ages are provided.

Methods: Data of 1,090,779 mothers and their neonates were gathered from 30 provinces of Iran. Pregnancy complications, maternal risk factors, type of delivery, maternal outcome, neonatal sex and APGAR score were determined. Birth weights were quantified into 3rd, 50th and 97th centile. Regression analysis was used to estimate birth weight of neonates.

Results: Birth weight showed an enhancing trend with age; boys weighed more, multiparous women had higher neonatal birth weight, mothers with cardiovascular disease and diabetes mellitus had heavier infants, and mothers aged below 20 years had lower estimated infant birth weight. Gestational age (beta = 147.3) and male sex (beta = 114.9) were the most important independent variables, respectively for predicting birth weight (R-square = 0.512 and P < 0.001). In other words, with each unit increase in gestational age, birth weight would increase by 147.3 grams. Male fetuses were also 114.9 grams heavier than females of the same gestational age. Value of R-square shows relatively acceptable goodness of this statistical model.

Conclusion: A national reference for fetal growth patterns and related factors was determined in this study.
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October 2017

Effect of Positive End-Expiratory Pressure on Central Venous Pressure in Patients under Mechanical Ventilation.

Emerg (Tehran) 2017 8;5(1):e1. Epub 2017 Jan 8.

Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Finding the probable governing pattern of PEEP and CVP changes is an area of interest for in-charge physicians and researchers. Therefore, the present study was designed with the aim of evaluating the relationship between the mentioned pressures.

Methods: In this quasi-experimental study, patients under mechanical ventilation were evaluated with the aim of assessing the effect of PEEP change on CVP. Non-trauma patients, over 18 years of age, who were under mechanical ventilation and had stable hemodynamics, with inserted CV line were entered. After gathering demographic data, patients underwent 0, 5, and 10 cmHO PEEPs and the respective CVPs of the mentioned points were recorded. The relationship of CVP and PEEP in different cut points were measured using SPSS 21.0 statistical software.

Results: 60 patients with the mean age of 73.95 ± 11.58 years were evaluated (68.3% male). The most frequent cause of ICU admission was sepsis with 45.0%. 5 cmHO increase in PEEP led to 2.47 ± 1.53 mean difference in CVP level. If the PEEP baseline is 0 at the time of 5 cmHO increase, it leads to a higher raise in CVP compared to when the baseline is 5 cmHO (2.47 ± 1.53 vs. 1.57 ± 1.07; p = 0.039). The relationship between CVP and 5 cmHO (p = 0.279), and 10 cmHO (p = 0.292) PEEP changes were not dependent on the baseline level of CVP.

Conclusion: The findings of this study revealed the direct relationship between PEEP and CVP. Approximately, a 5 cmHO increase in PEEP will be associated with about 2.5 cmHO raise in CVP. When applying a 5 cmHO PEEP increase, if the baseline PEEP is 0, it leads to a significantly higher raise in CVP compared to when it is 5 cmHO (2.5 vs. 1.6). It seems that sex, history of cardiac failure, baseline CVP level, and hypertension do not have a significant effect in this regard.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325877PMC
January 2017

Mediastinal lymphadenopathy in pediatric tuberculosis in computed tomography scan.

Int J Mycobacteriol 2016 Dec 25;5 Suppl 1:S242-S243. Epub 2016 Nov 25.

Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background/objectives: Pediatric tuberculosis is usually a primary infection presenting mainly as mediastinal or hilar adenopathy in computed tomography (CT) scan. In this study, we study the distribution and other CT scan characteristics of mediastinal lymphadenopathy in childhood tuberculosis.

Methods: Chest CT scans of 75 cases of pediatric tuberculosis at Masih Daneshvari Hospital in Tehran, Iran, from 2009 to 2013 were studied regarding characteristics of mediastinal lymphadenopathy.

Results: Mean±standard deviation age of cases was 11.2±4.6years. Lymphadenopathy (mediastinal/hilar) was detected in 94.7% of cases. Most of the lymphadenopathies were located in the lower paratracheal (81.7%), upper paratracheal (69.1%), hilar (53.5%), and subcarinal (47.9%) stations. Perilymph node fatty stranding, lymphadenopathy conglomeration, bronchial pressure by the lymph nodes, and lymph node calcification were noted in 74.6%, 52.11%, 4.23%, and 5.6% of cases, respectively. Bilateral, right, and left lung parenchymal involvement were reported in 45%, 25%, and 8% of cases, respectively. Lung parenchymal involvement was significantly correlated with lymphadenopathies in subcarinal (p<0.001), hilar (p<0.001), subaortic (p=0.03), lower paratracheal (p=0.037), and axillary (p=0.006) stations. Right- and left-sided pleural effusions were observed in 12.7% and 7% of cases, respectively.

Conclusion: Attention to distribution and characteristics of mediastinal lymphadenopathy can help differentiate tuberculosis from other causes of pediatric mediastinal lymphadenopathy.
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http://dx.doi.org/10.1016/j.ijmyco.2016.11.019DOI Listing
December 2016

Fingerprint changes among cancer patients treated with paclitaxel.

J Cancer Res Clin Oncol 2017 Apr 17;143(4):693-701. Epub 2016 Dec 17.

Endocrine Research Center, Institute of Endocrinology and Metabolism, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.

Background: Fingerprints have long been used for personal identification; however, some case reports suggested that some chemotherapy agents such as paclitaxel lead to fingerprints loss due to hand-and-foot syndrome (HFS).

Methods: This case-control study was performed on 65 patients who received chemotherapy regimens with/without paclitaxel. Patients with the history of receiving any drugs with significant HFS adverse effect or patients with any conditions that affect fingerprints were excluded. Baseline and post-chemotherapy images of fingerprint examples were referred to the Iranian Society of Legal Medicine to compare changes in the fingerprints.

Results: Thirty-one patients entered in the paclitaxel and 34 subjects in the control groups. Seventeen patients (54.8%) in the paclitaxel group experienced fingerprint changes, whereas no patient had fingerprint changes in the control group. By physical examination, no patients in the two groups experienced HFS. After adjusting for age, sex, occupation, and cancer type, there was a significant difference between the two groups regarding fingerprint changes (P = 0.002, OR 13.69, 95% CI 2.05 to infinite).

Conclusions: Considering that fingerprint recognition has been utilized in both government and civilian investigation, patients taking paclitaxel and centers necessitating fingerprint identification should be informed about possible fingerprint changes by paclitaxel.
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http://dx.doi.org/10.1007/s00432-016-2314-1DOI Listing
April 2017

Determining the lymphadenopathy characteristics of the mediastinum in lung CT scan of children with tuberculosis.

Int J Mycobacteriol 2016 09 15;5(3):306-312. Epub 2016 Jul 15.

Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective/background: Most tuberculosis cases in children are primary infection, with difficult and imprecise diagnosis mainly based on the existence of mediastinal lymphadenopathy. Here, we investigated the characteristics of mediastinal lymphadenopathy in lung computed tomography (CT) scans of children with tuberculosis.

Methods: This cross-sectional study was performed on 75 children with tuberculosis referred to Masih Daneshvari Hospital in Tehran, Iran, from 2009 to 2013. Their medical records were investigated, and CT-scan characteristics were extracted by a radiologist.

Results: Mean±standard deviation age of cases was 11.2±4.6years. CT-scan results indicated 94.7% of cases had lymphadenopathy, with lower paratracheal, upper paratracheal, hilar, and subcarinal forms observed in 81.7%, 69.1%, 53.5%, and 47.9% of cases as the most involved stations in lymph nodes, respectively. In 74.6% of patients with mediastinal lymphadenopathy, perilymph node fat inflammation (matting) was observed, with 52.11% exhibiting conglomeration. Bronchial pressure was observed in 4.23% of children with tuberculosis, and bilateral-, right-, and left-parenchymal involvement was observed in 42.7%, 25.3%, and 8% of these cases, respectively. Left- and right-pleural effusion and calcification was reported in 6.7%, 12%, and 5.6% of patients, respectively. Additionally, nearly 80% of patients exhibited mediastinal lymphadenopathy and lung-parenchyma involvement simultaneously. Lung-parenchyma involvement was significantly correlated with subcarinal (p<.001), hilar (p<.001), subaortic (p=.030), lower paratracheal (p=.037), and axillary (p=.006) stations.

Conclusion: Situation of mediastinal lymphadenopathy and its synchronicity with lung-parenchyma involvement can help in differential diagnosis of pulmonary tuberculosis from other lung diseases.
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http://dx.doi.org/10.1016/j.ijmyco.2016.06.015DOI Listing
September 2016

The Accuracy of Plain Radiography in Detection of Traumatic Intrathoracic Injuries.

Emerg (Tehran) 2016 Nov;4(4):184-187

Safety promotion and injury prevention research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Rapid diagnosis of traumatic intrathoracic injuries leads to improvement in patient management. This study was designed to evaluate the diagnostic value of chest radiography (CXR) in comparison to chest computed tomography (CT) scan in diagnosis of traumatic intrathoracic injuries.

Methods: Participants of this prospective diagnostic accuracy study included multiple trauma patients over 15 years old with stable vital admitted to emergency department (ED) during one year. The correlation of CXR and CT scan findings in diagnosis of traumatic intrathoracic injuries was evaluated using SPSS 20. Screening characteristics of CXR were calculated with 95% CI.

Results: 353 patients with the mean age of 35.2 ± 15.8 were evaluated (78.8% male). Age 16-30 years with 121 (34.2%), motorcycle riders with 104 (29.5%) cases and ISS < 12 with 185 (52.4%) had the highest frequency among patients. Generally, screening performance characteristics of chest in diagnosis of chest traumatic injuries were as follows: sensitivity 50.3 (95% CI: 44.8 - 55.5), specificity 98.9 (95% CI: 99.5 - 99.8), PPV 97.8 (95% CI: 91.5 - 99.6), NPV 66.4 (95% CI: 60.2 - 72.03), PLR 44.5 (95% CI: 11.3 175.3), and NLR 0.5 (95% CI: 0.4 - 0.6). Accuracy of CXR in diagnosis of traumatic intrathoracic injuries was 74.5 (95% CI: 69.6 - 78.9) and its area under the ROC curve was 74.6 (95% CI: 69.3 - 79.8).

Conclusion: The screening performance characteristics of CXR in diagnosis of traumatic intrathoracic injuries were higher than 90% in all pathologies except pneumothorax (50.3%). It seems that this matter has a great impact on the general screening characteristics of the test (74.3% accuracy and 50.3%sensitivity). It seems that, plain CXR should be used as an initial screening tool more carefully.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007908PMC
November 2016

Nutritional Assessment in Critically Ill Patients.

Iran J Med Sci 2016 May;41(3):171-9

Department of Anesthesia, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Vice Chancellor for Clinical Affairs, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Malnutrition is an important factor in the survival of critically ill patients. The purpose of the present study was to assess the nutritional status of patients in the intensive care unit (ICU) on the days of admission and discharge via a detailed nutritional assessment.

Methods: Totally, 125 patients were followed up from admission to discharge at 8ICUs in Shiraz, Iran. The patients' nutritional status was assessed using subjective global assessment (SGA), anthropometric measurements, biochemical indices, and body composition indicators. Diet prescription and intake was also evaluated.

Results: Malnutrition prevalence significantly increased on the day of discharge (58.62%) compared to the day of admission (28.8%) according to SGA (P<0.001). The patients' weight, mid-upper-arm circumference, mid-arm muscle circumference, triceps skinfold thickness, and calf circumference decreased significantly as well (P<0.001). Lean mass weight and body cell mass also decreased significantly (P<0.001). Biochemical indices showed no notable changes except for magnesium, which decreased significantly (P=0.013). A negative significant correlation was observed between malnutrition on discharge day and anthropometric measurements. Positive and significant correlations were observed between the number of days without enteral feeding, days delayed from ICU admission to the commencement of enteral feeding, and the length of ICU stay and malnutrition on discharge day. Energy and protein intakes were significantly less than the prescribed diet (26.26% and 26.48%, respectively).

Conclusion: Malnutrition on discharge day increased in the patients in the ICU according to SGA. Anthropometric measurements were better predictors of the nutritional outcome of our critically ill patients than were biochemical tests.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876294PMC
May 2016

Potentiation of chemotherapeutics by bromelain and N-acetylcysteine: sequential and combination therapy of gastrointestinal cancer cells.

Am J Cancer Res 2016 15;6(2):350-69. Epub 2016 Jan 15.

Department of Surgery, St George Hospital, The University of New South Wales Gray Street, Kogarah, Sydney NSW 2217, Australia.

Intraperitoneal chemotherapy together with cytoreductive surgery is the standard of care for a number of peritoneal surface malignancies. However, this approach fails to maintain the complete response and disease recurs due to microscopic residual disease. Although safer than systemic chemotherapy regimens, locoregional treatment with chemotherapeutics can induce toxicity which is a major concern affecting the patient's treatment protocol and outcome. For an enhanced treatment efficacy, efforts should be made to maximize cytotoxic effects of chemotherapeutic agents on tumor cells while minimizing their toxic effects on host cells. Bromelain and N-acetylcysteine are two natural agents with good safety profiles shown to have anti-cancer effects. However, their interaction with chemotherapeutics is unknown. In this study, we investigated if these agents have the potential to sensitize in vitro gastrointestinal cancer models to cisplatin, paclitaxel, 5-fluorouracil, and vincristine. The drug-drug interaction was also analyzed. Our findings suggest that combination of bromelain and N-acetylcysteine with chemotherapeutic agents could give rise to an improved chemotherapeutic index in therapeutic approaches to peritoneal surface malignancies of gastrointestinal origin so that maximum benefits could result from less toxic and more patient-friendly doses. This represents a potentially efficacious strategy for the enhancement of microscopic cytoreduction and is a promising area for future research.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859666PMC
May 2016

Disclosing a diagnosis of acute coronary artery disease.

Indian J Med Ethics 2015 Oct-Dec;12(4):212-5

Department of Emergency Medicine,.

The disclosure of bad news is one of the most difficult tasks of a physician. This study explores how physicians prefer to disclose bad news to patients with acute coronary disease in emergency centres in Iran, and to their families.
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http://dx.doi.org/10.20529/IJME.2015.056DOI Listing
December 2016

Erythrocyte Sedimentation Rate Measurement Using as a Rapid Alternative to the Westergren Method.

Emerg (Tehran) 2015 ;3(2):50-3

Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Erythrocyte sedimentation rate (ESR) remains as one of the most reliable tests in clinical practices. Yet its use is time consuming and requires a large blood sample. The aim of this study was assessing a faster and reliable method of ESR estimation.

Methods: An ESR estimation method was described and performed on 108 patients using capillary tube (micro ESR) and capillary peripheral blood. Micro ESR results at different intervals were measured and compared with Westergren ESR (conventional ESR) estimation by Pearson and Spearman's coefficients. A regression equation was derived to predict conventional ESR values based on micro ESR results. The agreement of two measurements was demonstrated using the Bland-Altman plot.

Results: Micro ESR results at 20 minutes showed the earliest close correlation with conventional ESR results at one hour (r = 0.987). The presented regression equation was able to closely predict ESR values (r(2) = 0.974) and the Bland-Altman plot showed an acceptable agreement between converted and conventional ESR measurements.

Conclusion: Using capillary tube and capillary blood sample (micro ESR) appears to be a faster, cheaper, more reliable, and precise tool for ESR measurement in the ED. The results have acceptable correlation with conventional ESR, especially at 20 minutes of measurement.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614602PMC
October 2015

Depletion of mucin in mucin-producing human gastrointestinal carcinoma: Results from in vitro and in vivo studies with bromelain and N-acetylcysteine.

Oncotarget 2015 Oct;6(32):33329-44

Department of Surgery, St George Hospital, The University of New South Wales, Kogarah, Sydney NSW 2217, Australia.

Aberrant expression of membrane-associated and secreted mucins, as evident in epithelial tumors, is known to facilitate tumor growth, progression and metastasis, and to provide protection against adverse growth conditions, chemotherapy and immune surveillance. Emerging evidence provides support for the oncogenic role of MUC1 in gastrointestinal carcinomas and relates its expression to an invasive phenotype. Similarly, mucinous differentiation of gastrointestinal tumors, in particular increased or de novo expression of MUC2 and/or MUC5AC, is widely believed to imply an adverse clinicopathological feature. Through formation of viscous gels, too, MUC2 and MUC5AC significantly contribute to the biology and pathogenesis of mucin-secreting gastrointestinal tumors. Here, we investigated the mucin-depleting effects of bromelain (BR) and N-acetylcysteine (NAC), in nine different regimens as single or combination therapy, in in vitro (MKN45, KATOIII and LS174T cell lines) and in vivo (female nude mice bearing intraperitoneal MKN45 and LS174T) settings. The inhibitory effects of the treatment on cancer cell growth and proliferation were also evaluated in vivo. Our results suggest that a combination of BR and NAC with dual effects on growth and mucin products of mucin-expressing tumor cells is a promising candidate towards the development of novel approaches to gastrointestinal malignancies with the involvement of mucin pathology. This capability supports the use of this combination formulation in locoregional approaches for reducing the adverse effects of the aberrantly secreted gel-forming mucins, as in pseudomyxoma peritonei and similar pathologies with ectopic production of mucin.
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http://dx.doi.org/10.18632/oncotarget.5259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4741769PMC
October 2015

Sprouty2 protein in prediction of post-treatment ascites in epithelial ovarian cancer treated with adjuvant carbotaxol chemotherapy.

Am J Cancer Res 2015 15;5(8):2498-507. Epub 2015 Jul 15.

Department of Surgery, St George Hospital, The University of New South Wales Kogarah, Sydney NSW 2217, Australia.

Ascites development and resistance to chemotherapy with carbotaxol are common clinical problems in epithelial ovarian cancer, partly due to the activation of MAPK/ERK signaling. Sprouty proteins are negative modulators of MAPK/ERK pathway, but their role in predicting resistance to carbotaxol chemotherapy and ascites development is unknown. In this study, we evaluated the expression of Sprouty protein isoforms by immunohistochemistry. The associations between the Sprouty expression and the clinicopathological features, including chemoresistance and the presence of ascites, were then explored. We found that the decreased expression of Spry2 was correlated with the post-treatment development of ascites and represented an independent predictor of this condition in carbotaxol-treated patients. However, no association was observed between the Sprouty expression and chemoresistance. In conclusion, our results suggest that Spry2 may be useful for patient follow-up and monitoring as it predicts the development of ascites in epithelial ovarian cancer cases treated with carbotaxol.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568786PMC
September 2015

Histamine Antagonists for Treatment of Peripheral Vertigo: A Meta-Analysis.

J Int Adv Otol 2015 Aug;11(2):138-42

Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: Vertigo, the hallucination of movement of oneself or one's surroundings, can have substantial adverse effects on the quality of life of affected patients. It is essential to decrease the frequency, severity, and duration of vertigo attacks using effective medications with minimal debilitating adverse effects. We performed a meta-analysis of available clinical trials to evaluate the efficacy of histamine antagonists in the treatment of vertigo compared to the rate of resolution in untreated control groups.

Materials And Methods: A systematic search of articles in any language from January 1970 to March 2015 was performed through the following databases: the Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, the Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Allied and Complementary Medicine Database, Web of Science, ClinicalTrials.gov, and Google. Randomized controlled trials comparing each kind of antihistamine to untreated control participants in the treatment of vertigo (blinded/unblinded) were screened for inclusion. Three reviewers separately performed data extraction from the included trials using a standard data abstraction form. Three other researchers read the final list of all articles retained. Discrepancies were settled by mutual consensus between the authors. Random effects models were applied to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) using the Review Manager software. The evaluation of publication bias was performed by Egger's test and Begg's funnel plot.

Results: We identified 13 eligible citations. The pooled OR was 5.370, 95% CI (3.263-8.839), and I2=56.0%, with no obvious evidence of publication bias.

Conclusion: Our results provide clarification of the effectiveness of several categories of histamine antagonists compared with placebos in controlling peripheral vertigo.
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http://dx.doi.org/10.5152/iao.2015.1169DOI Listing
August 2015

Intratumoral interleukin-6 predicts ascites formation in patients with epithelial ovarian cancer: A potential tool for close monitoring.

J Ovarian Res 2015 Aug 19;8:58. Epub 2015 Aug 19.

Department of Surgery, St George Hospital, The University of New South Wales, Gray Street, Kogarah, Sydney, NSW 2217, Australia.

Background: The implication of IL-6 in the pathogenesis of epithelial ovarian cancer (EOC) is well documented. Accordingly, the clinicopathological significance of this cytokine in patients' ascites fluid or serum has largely been investigated. Since the main source of IL-6 secreted into the biological fluids is the tumor tissue, this study was designed to investigate the status and possible clinical relevance of the IL-6 expression in an array of EOC tissue specimens.

Methods: Tissue samples obtained from ninety-eight consecutive patients with EOC were studied using immunohistochemistry. Clinicopathological characteristics and treatment related factors were collected from patient files. The relationship between the expression of the protein of interest and the study endpoints of disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. For evaluating the predictive value of IL-6, logistic regression and cox proportional hazards models were employed.

Results: An upregulation of IL-6 expression was observed in EOC tissues as compared with the normal samples (p < 0.0001). As regards the clinical relevance, IL-6 failed to predict OS, DFS and response to the platinum-based chemotherapy in EOC patients. In multivariate analysis, however, IL-6 was identified as an independent predictive factor for the development of post-treatment ascites (p:0.033).

Conclusions: Having the capability to predict the ascites formation, IL-6 might serve as a biomarker and a useful tool in EOC for monitoring purposes. IL-6 targeting for the prevention of the ascites development is a potential avenue for further investigation.
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http://dx.doi.org/10.1186/s13048-015-0183-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539669PMC
August 2015