Publications by authors named "Alireza Salimi"

30 Publications

  • Page 1 of 1

Clinical Features and Outcomes of ICU Patients with COVID-19 Infection in Tehran, Iran: a Single-Centered Retrospective Cohort Study.

Tanaffos 2020 Dec;19(4):300-311

Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The clinical characteristics of the novel coronavirus disease (COVID-19) were diverse and unspecific. Here, we identified the associated factors with surviving of COVID-19 ICU patients based on the clinical characteristics of patients admitted to one of the Corona Centre Hospitals of Iran.

Materials And Methods: This cohort study was performed retrospectively from February to June 2020 on 133 COVID-19 patients admitted to 4 intensive care units of Masih Daneshvari Hospital in Tehran, Iran. Demographic, medical, clinical manifestation at admission, laboratory parameters and outcome data were obtained from medical records. Also the SOFA and APACHE II scores were calculated. All data were analyzed using SPSS (version 23, IBM Corp.) software.

Results: The median (IQR) age of the patients was 62.0 (54.0-72.0) years in total. RT-PCR of throat swab SARS-CoV-2 in 80 patients (60.2%) was positive. Total mortality rate was 57.9 percent (77 patients). Dyspnea, hypertension and chronic pulmonary diseases were significantly common in non-survivors than survivors (p<0.05). Both SOFA and APACHE II scores were significantly higher in the non-survivors (p<0.05). Also other significant differences were observed in other parameters of the study.

Conclusion: The mortality rate of COVID-19 patients admitted to ICU is generally high. Dyspnea as initial presentation and comorbidity, especially hypertension and pulmonary diseases, may be associated with higher risk of severe disease and consequent mortality rate. Also, higher SOFA and APACHE II scores could indicate higher mortality in patients admitted to ICU.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088143PMC
December 2020

Allergic rhinitis impairs working memory in association with drop of hippocampal - Prefrontal coupling.

Brain Res 2021 May 11;1758:147368. Epub 2021 Feb 11.

Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Institute for Brain Sciences and Cognition, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Electronic address:

Allergic rhinitis (AR) is a chronic inflammatory disease frequently associated with a deficit in learning and memory. Working memory is an important system for decision making and guidance, which depends on interactions between the ventral hippocampus (vHipp) and the prelimbic prefrontal cortex (plPFC). It is still unclear whether AR influences the activity and coupling of these brain areas, which consequently may impair working memory. The current study aimed to examine alterations of the vHipp-plPFC circuit in a rat model of AR. Our results show decreased working memory performance in AR animals, accompanied by a reduction of theta and gamma oscillations in plPFC. Also, AR reduces coherence between vHipp and plPFC in both theta and gamma frequency bands. Cross-frequency coupling analyses confirmed a reduced interaction between hippocampal theta and plPFC gamma oscillations. Granger causality analysis revealed a reduction in the causal effects of vHipp activity on plPFC oscillations and vice versa. A significant correlation was found between working memory performance with disruption of functional connectivity in AR animals. In summary, our data show that in AR, there is a deficit of functional coupling between hippocampal and prefrontal network, and suggest that this mechanism might contribute to working memory impairment in individuals with AR.
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http://dx.doi.org/10.1016/j.brainres.2021.147368DOI Listing
May 2021

Rhythmic air-puff into nasal cavity modulates activity across multiple brain areas: A non-invasive brain stimulation method to reduce ventilator-induced memory impairment.

Respir Physiol Neurobiol 2021 05 28;287:103627. Epub 2021 Jan 28.

Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Institute for Brain Sciences and Cognition, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Electronic address:

Mechanical ventilation (MV) can result in long-term brain impairments that are resistant to treatment. The mechanisms underlying MV-induced brain function impairment remain unclear. Since nasal airflow modulates brain activity, here we evaluated whether reinstating airflow during MV could influence the memory performance of rats after recovery. Rats were allocated into two study groups: one group received rhythmic air-puff into the nasal cavity during MV and a control group that underwent ventilation without air-puff. During MV, air-puffs induced time-locked event potentials in OB, mPFC and vHPC and significantly increased the oscillatory activity at the air-puff frequency. Furthermore, in mPFC and vHPC, (but not in OB), delta and theta oscillations were more prominent during air-puff application. After recovery, working memory performance was significantly higher in the air-puff group compared to control. Our study thus suggests a promising non-invasive brain stimulation approach to alleviate the neurological complications of prolonged mechanical ventilation.
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http://dx.doi.org/10.1016/j.resp.2021.103627DOI Listing
May 2021

Extracorporeal Hemoperfusion as a Potential Therapeutic Option for Severe COVID-19 patients; a Narrative Review.

Arch Acad Emerg Med 2020 22;8(1):e67. Epub 2020 Aug 22.

Department of Anesthesiology and Critical Care, Qom University of Medical Sciences, Qom, Iran.

The 2019 novel coronavirus (officially known as severe acute respiratory syndrome coronavirus 2, SARS-CoV2) was first found in Wuhan, China. On February 11, 2020, the World Health Organization (WHO) has declared the outbreak of the disease caused by SARS-CoV2, named coronavirus disease 2019 (COVID-19), as an emergency of international concern. Based on the current epidemiological surveys, some COVID-19 patients with severe infection gradually develop impairment of the respiratory system, acute kidney injury (AKI), multiple organ failure, and ultimately, death. Currently, there is no established pharmacotherapy available for COVID-19. As seen in influenza, immune damage mediated by excessive production of inflammatory mediators contributes to high incidence of complications and poor prognosis. Thus, removal or blocking the overproduction of these mediators potentially aids in reducing the deleterious cytokine storm and improving critically ill patients' outcomes. Based on previous experience of blood purification to treat cytokine storm syndrome (CSS) in severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), here we aimed to review the current literature on extracorporeal hemoperfusion as a potential therapeutic option for CSS-associated conditions, with a focus on severe COVID-19.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587998PMC
August 2020

Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak in Iran.

Med J Islam Repub Iran 2020 15;34:62. Epub 2020 Jun 15.

ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.

The occurrence of anosmia/hyposmia during novel Coronavirus disease 2019 (COVID-19) may indicate a relationship between coincidence of olfactory dysfunction and coronavirus disease 2019 (COVID-19). This study aimed to assess the frequency of self-reported anosmia/hyposmia during COVID-19 epidemic in Iran. This population-based cross sectional study was performed through an online questionnaire from March 12 to 17, 2020. Cases from all provinces of Iran voluntarily participated in this study. Patients completed a 33-item patient-reported online questionnaire, including smell and taste dysfunction and their comorbidities, along with their basic characteristics and past medical histories. The inclusion criteria were self-reported anosmia/hyposmia during the past 4 weeks, from the start of COVID-19 epidemic in Iran. A total of 10 069 participants aged 32.5±8.6 (7-78) years took part in this study, of them 71.13% women and 81.68% nonsmokers completed the online questionnaire. The correlation between the number of olfactory disorders and reported COVID-19 patients in all provinces up to March 17, 2020 was highly significant (Spearman correlation coefficient = 0.87, P< 0.001). A sudden onset of olfactory dysfunction was reported in 76.24% of the participations and persistent anosmia in 60.90% from the start of COVID19 epidemic. In addition, 80.38% of participants reported concomitant olfactory and gustatory dysfunctions. An outbreak of olfactory dysfunction occurred in Iran during the COVID-19 epidemic. The exact mechanisms by which anosmia/hyposmia occurred in patients with COVID-19 call for further investigations.
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http://dx.doi.org/10.34171/mjiri.34.62DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500422PMC
June 2020

Coordination chemistry of mercury(ii) halide complexes: a combined experimental, theoretical and (ICSD & CSD) database study on the relationship between inorganic and organic units.

Dalton Trans 2020 Sep 17;49(34):11859-11877. Epub 2020 Aug 17.

Department of Chemistry, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran.

From the viewpoint of inorganic crystal engineering (ICE), the coordination sphere of the metal centre can be affected by two main parts of inorganic and organic units in complexes. Database study can play a significant role in the explanation of the relationship between various parameters related to these parts. For the first time, we have investigated this relationship through the concomitant studies of the inorganic crystal structure database (ICSD) and the cambridge structural database (CSD) for mercury(ii) halide compounds. The results of CSD analysis are divided into two categories of metal halide complexes (MHC or mercury halide compounds with ligands) and metal halide only (MHO or mercury halide compounds without ligands). MHC (970, 460, and 521 metal centres as HgCl, HgBr, and HgI, respectively) and MHO (419, 141, and 201 metal centres as HgCl, HgBr, and HgI, respectively) were structurally investigated. The coordination number, polymerization mode, coordination geometry of the metal centre, type of donor atom in ligands, and the chelation mode of the ligand for all MHC and MHO compounds were extracted as effective factors in inorganic and organic units. To rationalize the effect of ICE in the design of the coordination sphere, eleven new mercury halide complexes, including the ester ligands of L, naphthalene-5-yl nicotinate (complexes 1-3), L, naphthalene-6-yl nicotinate (complexes 4-6), L, naphthalene-5-yl pyrazine-2-carboxylate (complexes 7-9), and L, naphthalene-6-yl pyrazine-2-carboxylate (complexes 10-11) were synthesized and fully characterized. The various parameters of substitution, C-H to nitrogen replacement, counteranion, and symmetry effects were investigated for all of the complexes. The results show that there is a meaningful relationship between inorganic and organic units. According to the findings of the CSD and ICSD analyses, most of the complexes obeyed the same relationship. Despite the predominant role of the inorganic unit in determining the coordination geometry, the organic unit can also change the coordination sphere of complexes with one major effect or the cooperativity of minor effects.
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http://dx.doi.org/10.1039/d0dt01541eDOI Listing
September 2020

Stress and burnout in health care workers during COVID-19 pandemic: validation of a questionnaire.

Z Gesundh Wiss 2020 Jun 6:1-6. Epub 2020 Jun 6.

Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: To validate a questionnaire to assess stress and burnout in healthcare workers during COVID-19 pandemic.

Subjects And Methods: In this study, content validity, Cronbach's alpha, and test-retest reliability method were utilized among 60 HCWs to evaluate the validity, internal consistency, and reliability of the questionnaire respectively. The final questionnaire was composed of four parts asking for the background information, questions about the stress caused by the COVID-19, the Depression, Anxiety and Stress Scale - 21 (DASS-21), and six questions from the Copenhagen Burnout Inventory (CBI).

Results: The CVR of 46 questions was equal to 1, making them acceptably valid (CVR > 0.78), so that the items could be arranged into a final questionnaire. Moreover, all items could successfully attain CVI values above 0.79, confirming the content validity of the questionnaire. The Cronbach's alpha was between 0.80-0.95 for different sections of questionaire, confirming the stable reliability and high repeatability of the questionnaire.

Conclusion: The results of this study showed that the DASS-21 offers adequate levels of validity and reliability for assessing the stress, anxiety, and depression among the HCWs engaged with the COVID-19 pandemic. Moreover, the six items adapted from the Copenhagen burnout inventory (CBI) were found to provide a good instrument for investigating the job burnout among the HCWs at Masih Daneshvari Hospital during the outbreak of the COVID-19 epidemic.
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http://dx.doi.org/10.1007/s10389-020-01313-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275852PMC
June 2020

Regarding "Understanding the 'Scope' of the Problem: Why Laparoscopy Is Considered Safe during the COVID-19 Pandemic".

J Minim Invasive Gynecol 2020 Sep - Oct;27(6):1423. Epub 2020 Apr 25.

Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1016/j.jmig.2020.04.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194688PMC
September 2020

Mental health advice for frontline healthcare providers caring for patients with COVID-19.

Can J Anaesth 2020 08 6;67(8):1068-1069. Epub 2020 Apr 6.

Department of Anesthesiology and Critical Care, Shahid Beheshti Medical University, Tehran, Iran.

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http://dx.doi.org/10.1007/s12630-020-01650-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7155151PMC
August 2020

Lidocaine during intubation and extubation in patients with coronavirus disease (COVID-19).

Can J Anaesth 2020 06 16;67(6):759. Epub 2020 Mar 16.

Department of Anesthesiology and Critical Care, Qom University of Medical Sciences, Qom, Iran.

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http://dx.doi.org/10.1007/s12630-020-01627-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090453PMC
June 2020

Effect of Intrapleural Meperidine on Post-Operative Pain after Open Cholecystectomy.

Tanaffos 2019 Jan;18(1):79-83

Anesthesiology Research Center, Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Post-operative pain after open cholecystectomy can result in increased oxygen consumption, atelectasis, pneumonia, decreased vital capacity, and increased morbidity and mortality. The aim of this study was to compare the analgesic effects of intrapleural meperidine and intravenous morphine in controlling post-cholecystectomy pain.

Materials And Methods: In a double-blinded randomized clinical trial, 72 patients who were candidate for elective open cholecystectomy, were divided randomly into two groups based on accidental randomized numbers. Anesthesia technique was precisely the same for all patients. At the end of surgery, 50 mg of meperidine (diluted in 20 cc normal saline) was injected intrapleurally for meperidine group patients; whereas, 0.1 mg/kg intravenous morphine was injected intravenously in control group. Onset of pain and total dose of rescue analgesic were measured.

Results: In order to obtain a Numerical Rating Scale (NRS) <3, the difference in morphine consumption up to 12 hours in two groups (4.4 ±1.7 mg in meperidine group & 5±2 mg in control group) was not statistically different. However, the first request for analgesia in meperidine group was delayed significantly longer than the control group (146.6 ±6.8 minutes in meperidine group & 40 ±1.8 minutes in control group).

Conclusion: A single injection of intrapleural meperidine can delay the first request for analgesia in open cholecystectomy compared to intravenous morphine.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690319PMC
January 2019

High-Frequency Jet Ventilation in Nonintubated Patients.

Turk Thorac J 2018 Jul 1;19(3):127-131. Epub 2018 Jul 1.

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

Objectives: High-frequency jet ventilation (HFJV) is a convenient method for providing ventilation during fiberoptic bronchoscopy. We describe an incipient approach of high-frequency jet ventilation via the working channel of a flexible bronchoscope for nonintubated patients who suffer from hypoxemia during bronchoscopy. The aim of this study was to test the efficacy of this incipient approach and determine the possible complications related to it.

Materials And Methods: Sixteen patients who had oxygen saturation below 70% that did not resolve with nasal oxygen for 20 s during interventional bronchoscopy were included in the study. High-frequency jet ventilation was administrated via the working channel of a bronchoscope for 3 min. Arterial blood gas circumscriptions were compared before and after jet ventilation.

Results: Oxygen saturation increased to >90% in all patients 30 s after jet ventilation. Mean arterial oxygen saturation pressure increased from 54.84 to 111.98 mmHg with jet ventilation (p=0.0001). Arterial carbon dioxide tension decreased after jet ventilation. The body mass index had no consequential effect on arterial carbon dioxide pressure after jet ventilation in our patients (p=0.1). Complications such as pneumothorax and working channel damage were not observed.

Conclusion: High-frequency jet ventilation via the working channel of the bronchoscope is a novel method that can provide optimal ventilation with minimal complications to nonintubated patients suffering from hypoxemia during bronchoscopy. This method also reduces the duration of bronchoscopy procedures.
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http://dx.doi.org/10.5152/TurkThoracJ.2018.17025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077008PMC
July 2018

A novel class of human 15-LOX-1 inhibitors based on 3-hydroxycoumarin.

Chem Biol Drug Des 2018 06 26;91(6):1125-1132. Epub 2018 Feb 26.

Department of Chemistry, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran.

Inflammations, sensitivities, and some cancers in mammals are intimately linked to the activity of lipo-oxygenase enzymes. Owing to the importance of these enzymes, mechanistic studies, product analysis, and synthesis of inhibitors have expanded. In this study, a series of hydroxycoumarins, methoxy-3-hydroxy coumarins, and 7-alkoxy-3-hydroxy coumarins were synthesized and evaluated as potential inhibitors of human 15-LOX-1. Among the synthetic coumarins, 7-methoxy-3-hydroxycoumarin derivative demonstrated potent inhibitory activity and the compound, 5f, showed the best result. Radical scavenging assessment, IC , HNMR, and DPPH bleaching results indicate that the electronic properties are the major factors for the lipo-oxygenase inhibition potency of the synthetic coumarins. Based on the theoretical studies, it was suggested that the mesomeric effect of the substituent at the seventh position of the benzene ring is one of the major factors in the stability of the oxy-radical intermediate.
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http://dx.doi.org/10.1111/cbdd.13174DOI Listing
June 2018

Carbamazepine effects on pain management and serum IL-6, IL-10 evaluation in addicted patients undergoing surgery.

Eur J Pharmacol 2017 Oct 8;812:184-188. Epub 2017 Jul 8.

Department of Pharmacology & Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Postoperative pain control remains an important issue in the field of surgery. Assessing and managing patients with acute pain who are addicted to opioids are often challenging. It has been shown that, addicted patients are less tolerant to pain. There is limited evidence to guide the management of acute pain in these patients. Here we studied the effect of preemptive use of carbamazepine on pain behavior and serum IL-6, IL-10 levels in the addicted patients. 90 male patients (25-45 years, BMI 20-27), were divided into 3 group of 30 patients: 1- control, 2- addicted, 3- addicted patients receiving carbamazepine 400mg before surgery. The visual analog pain scale and serum levels of IL-6 and IL-10 were evaluated at time 0 (before surgery), 1 and 12h postoperatively. Compared with control and carbamazepine groups, addicted patients exhibited exaggerated pain behavior before and after surgery, however, postoperatively, a significant increase in pain behavior was seen in control compared to carbamazepine group. A decrease in serum IL-10 and an increase in IL-6 concentrations were observed in addicted patients. In the morphine abuser, a decrease in pain threshold, an increase in IL-6 and a decrease in IL-10 levels were evident compared with non-abuser subjects. Addition of carbamazepine improved pain sensation and serum IL-6 levels and a reduction in serum IL-10 level in control patients was paralleled to their recovery. It seems that, preemptive use of low dose of carbamazepine can improve postoperative pain and cytokine activities in the addicted patients.
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http://dx.doi.org/10.1016/j.ejphar.2017.07.011DOI Listing
October 2017

2-Prenylated m-dimethoxybenzenes as potent inhibitors of 15-lipo-oxygenase: inhibitory mechanism and SAR studies.

Chem Biol Drug Des 2016 09 6;88(3):460-9. Epub 2016 Jun 6.

Department of Chemistry, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran.

15-lipo-oxygenases are one of the iron-containing proteins capable of performing peroxidation of unsaturated fatty acids in animals and plants. The critical role of enzymes in the formation of inflammations, sensitivities, and some cancers has been demonstrated in mammals. The importance of enzymes has led to the development of mechanistic studies, product analysis, and synthesis of inhibitors. In this study, a series of allyl and prenyl dimethoxybenzenes were synthesized and their inhibitory potency against soybean 15-Lipo-oxygenase (L1; EC 1,13,11,12) was determined. Among the synthetic compounds, 2,6-dimethoxy-1-isopentenyl-4-methylbenzene, 2,6-dimethoxy-1-geranyl-4-methylbenzene, and 2,6-dimethoxy-1-farnesyl-4-methylbenzene showed the most potent inhibitory activity with IC50 values of 7.6, 5.3, and 0.52 μm, respectively. For some of the compounds, SAR studies showed acceptable relationship between inhibitory potency and enzyme-ligand interactions. Radical scavenging assessment results apart from the SAR studies indicate that electronic properties are the major factors for lipo-oxygenase inhibition potency of the mentioned compounds. Based on the theoretical studies, it was suggested that CH…O intramolecular hydrogen bond between ortho-methoxy oxygen and methine hydrogen atoms is one of the major factors in the stability of 2,6-dimethoxyallyl(or prenyl)benzenes radical via the planarity fixation between phenyl and allyl (or prenyl) pi orbitals.
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http://dx.doi.org/10.1111/cbdd.12779DOI Listing
September 2016

VAP or poisoning; which one has more effect on patients' outcomes in toxicological ICU?

Acta Biomed 2015 Apr 27;86(1):63-8. Epub 2015 Apr 27.

Department of Anesthesiology, Bahonar Hospital, Kerman Medical University, Tehran, Iran.

Background: Ventilator-associated pneumonia (VAP) is the main cause of acquired infections in ICUs. Every year, millions of people suffer from poisoning by various substances. Our aim was to determine the association between VAP incidence and different kinds of toxicity among Toxicological ICU (TICU) patients. 

Materials And Methods: Poisoned patients with diagnosis of VAP were enrolled to our retrospective study at TICU of Loghman Hakim Hospital. Data was collected through the medical records. The statistical analysis was performed with SPSS (version 16, Chicago, IL, USA).

Results: Among 675 patients with MV > 48 h, 150 patients had the diagnosis of VAP.  Mean age was 36.6 years. 74.7% were males. Intentional poisoning was 70.3%. The incidence of VAP was 22%. The higher incidence of VAP was recorded in anti depressants and opioid toxicities. The majority of bacterial isolates (81.3%) were multi drug resistance. MRSA accounted for 50.7% of VAP cases. Non survivors' hospital length of stay (mean = 18.7days) was significantly higher than survivors (12.8). The hospital length of stay in VAP patients was highest in the Acinetobacter spp (mean > 20 days). Mortality rate of VAP cases was 18.6%.

Conclusion: No specific association was detected between incidence of VAP and different kinds of toxicity, while Anti Depressants and opioids had high VAP incidence, in a Quarter of this population. It is noticeable that pesticide had the lowest incidence for its short hospitalization. In our TICU, MRSA and Acinetobacter spp were the main agents leading to VAP and prolonged ICU stay, respectively. (www.actabiomedica.it).
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April 2015

(2-Aminopyrimidine-κN(1))aqua(pyridine-2,6-dicarboxylato-κ(3)O(2),N,O(6))copper(II): X-ray and DFT calculated structure.

Acta Crystallogr C Struct Chem 2015 May 15;71(Pt 5):386-93. Epub 2015 Apr 15.

School of Chemistry, College of Science, University of Tehran, Tehran, Iran.

In the title compound, [Cu(C7H3N2O4)(C4H5N2)(H2O)], (I), pyridine-2,6-dicarboxylate (pydc(2-)), 2-aminopyrimidine and aqua ligands coordinate the Cu(II) centre through two N atoms, two carboxylate O atoms and one water O atom, respectively, to give a nominally distorted square-pyramidal coordination geometry, a common arrangement for copper complexes containing the pydc(2-) ligand. Because of the presence of Cu...Xbridged contacts (X = N or O) between adjacent molecules in the crystal structures of (I) and three analogous previously reported compounds, and the corresponding uncertainty about the effective coordination number of the Cu(II) centre, density functional theory (DFT) calculations were used to elucidate the degree of covalency in these contacts. The calculated Wiberg and Mayer bond-order indices reveal that the Cu...O contact can be considered as a coordination bond, whereas the amine group forming a Cu...N contact is not an effective participant in the coordination environment.
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http://dx.doi.org/10.1107/S2053229615005331DOI Listing
May 2015

Effects of dexmedetomidine versus ketorolac as local anesthetic adjuvants on the onset and duration of infraclavicular brachial plexus block.

Anesth Pain Med 2014 Aug 2;4(3):e17620. Epub 2014 Aug 2.

Anesthesiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Infraclavicular brachial plexus block is an appropriate approach for distal arm and forearm surgeries. Local anesthetic adjuvant agents are used to improve the quality of nerve blocks. Dexmedetomidine and ketorolac are two different types of adjuvants, which have been used in some studies.

Objectives: The purpose of this study was to examine the effects of dexmedetomidine and ketorolac as local anesthetic adjuvants on the onset and duration of infraclavicular brachial plexus block under ultrasound guide technique.

Patients And Methods: In a clinical trial study, 111 ASA class I and II patients who were candidates for elective distal arm and forearm surgeries under ultrasound guided infraclavicular brachial plexus block divided into three 37 patient groups. In dexmedetomidine group, 25 mL of lidocaine 1.5% plus 4 ml of normal saline and 100 mcg of dexmedetomidine was injected. Ketorolac group received 25 mL of Lidocaine 1.5% plus 5 mL of ketorolac, and placebo group received 25 mL of lidocaine 1.5% plus 5 mL of normal saline as local anesthetic solution. Sensory and motor onset blocks, duration of sensory and motor blocks and first time to analgesic request and hemodynamic parameters were all recorded.

Results: There were no significant differences in sensory block onset between three groups (P = 0.177). Motor block onset was statistically less in dexmedetomidine compared to ketorolac and placebo groups (both Ps < 0.001). Sensory block duration in dexmedetomidine group was significantly longer than ketorolac and placebo groups (both Ps < 0.001). Motor block duration in dexmedetomidine group was significantly longer than ketorolac and placebo groups (both Ps < 0.001). Time to first analgesic request after the procedures was longer in ketorolac compared to dexmedetomidine and placebo groups (P = 0.016, P < 0.001 respectively), but it was longer in dexmedetomidine compared to placebo group (P = 0.003). The differences of diastolic blood pressure in-between the 5th to 140th minutes after local anesthetic injection among the 3 groups were statistically significant and dexmedetomidine group shows the most reduction in diastolic blood pressure (P < 0.001). Dexmedetomidine showed the lowest mean arterial pressure (P = 0.016) and heart rate in dexmedetomidine group was significantly lower than ketorolac and placebo groups (P = 0.043).

Conclusions: Our study showed that dexmedetomidine had better effects on sensory and motor block duration and motor block onset in comparison with ketorolac, as lidocaine adjuvants in infraclavicular brachial plexus block were present in both protocols. However, the first time to analgesic request by ketorolac was longer than dexmedetomidine.
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http://dx.doi.org/10.5812/aapm.17620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165032PMC
August 2014

Dexmedetomidine could enhance surgical satisfaction in Trans-sphenoidal resection of pituitary adenoma.

J Neurosurg Sci 2017 02 27;61(1):46-52. Epub 2014 May 27.

Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Loghman Hospital, Tehran, Iran -

Background: Excessive bleeding is an unwanted complication of trans-sphenoidal resection of pituitary adenoma due to increases in intracranial pressure (ICP) and hemodynamic instability. Dexmedetomidine (Dex) anα2-agonists is the drug of choice in intensive care units (ICU) and cardiac surgeries to control abrupt changes in hemodynamic. Severe cardiovascular responses occur during trans-sphenoidal resection (TSR) of the pituitary adenoma despite adequate depth of anesthesia. The aim of this paper was to determine the effect of Dexmedetomidine on bleeding as primary outcome, and surgeon's satisfaction and hemodynamic stability as secondary outcomes in patients undergoing trans-sphenoidal resection of pituitary adenoma.

Methods: Total numbers of 60 patients between 18-65 years old and candidate for elective trans-sphenoidal resection of pituitary adenoma were randomLy allocated to two groups; Dexmedetomidine infusion (0.6µg/kg/hour) or normal saline infusion. Mean arterial pressure (MAP), heart rate (HR), dose of hypnotics and narcotics during surgery, bleeding, and surgeon's satisfaction were recorded.

Results: Propofol maintenance dose (µg/kg/min) and total Fentanyl use (µg) were significantly lower in Dex group compare to control group (P=0.01 and 0.003, respectively). Total bleeding amount during operation in Dex group was significantly lower than control group (P=0.012). Surgeon's satisfaction was significantly higher in Dex group at the end of surgery. MAP and heart rate throughout surgery were significantly lower in Dex group compare to control group (P=0.001).

Conclusions: Dexmedetomidine infusion (0.6µg/kg/hour) could reduce bleeding and provide surgeon's satisfaction during trans-sphenoidal resection of pituitary adenoma.
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http://dx.doi.org/10.23736/S0390-5616.16.02792-2DOI Listing
February 2017

Multidrug-resistant Acinetobacter baumannii infection in intensive care unit patients in a hospital with building construction: is there an association?

Korean J Anesthesiol 2014 Apr 28;66(4):295-9. Epub 2014 Apr 28.

Department of Anesthesiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Acinetobacter baumannii (A. baumannii) has emerged globally as a significant pathogen in hospitals. It is also present in soil and water. In a previous study, we discovered that the A. baumannii class 2 integron occurred most frequently. Here, we determined whether the A. baumannii class 2 integron is in the soil around our hospital, and if the soil is the cause for increasing numbers of A. baumannii infections in our intensive care unit (ICU) patients.

Methods: This cross-sectional prospective study was conducted in two ICUs at Loghman-Hakim Hospital, Tehran, Iran, from November 2012 to March 2013. Patient, soil, and hospital environment samples were collected. All isolates were identified using standard bacteriologic and biochemical methods. The phenotypes and genotypes were characterized. The standard disc diffusion method was utilized to test antimicrobial susceptibility. Integron identification was performed by multiplex polymerase chain reaction.

Results: A total of 42 A. baumannii clinical strains were isolated, all from patient samples; 65% of the isolated species were classified as class 2 integrons. The strains were 100% resistant to piperacillin, piperacillin-tazobactam, ceftazidime, ceftriaxone, cotrimoxazole, cefepime, ceropenem, and cefotaxime. However, all of the strains were sensitive to polymyxin B. A. baumannii was detected around the lip of one patient.

Conclusions: Further research is necessary to establish a relationship between A. baumannii and soil, (especially in regards to its bioremediation), as well as to determine its importance in nosocomial infections and outbreaks in the ICU.
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http://dx.doi.org/10.4097/kjae.2014.66.4.295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028557PMC
April 2014

Reduction in labor pain by intrathecal midazolam as an adjunct to sufentanil.

Korean J Anesthesiol 2014 Mar 28;66(3):204-9. Epub 2014 Mar 28.

Department of Anesthesiology, Loghman Hospital, Tehran, Iran.

Background: Anesthesia today has strived to decrease labor pain in a tolerable and controllable fashion. Intrathecal midazolam has been introduced as an adjunct to analgesics. The study was planned to assess the efficacy, safety and duration of analgesia produced by intrathecal midazolam adjunct to sufentanil in decreasing labor pain.

Methods: In a randomized clinical trial 80 parturient included in the study. The two groups were matched for age, cervical dilation, gravid, gestational age, and other demographic characteristics. Combination of sufentanil and midazolam administered intrathecally to experimental group and compared to sufentanil group. Time to reach maximum block, and pain score was measured and recorded.

Results: Groups were matched for age and weight and other demographic characteristic. No significant adverse effect was seen in both groups including decrease in Apgar score. Duration of analgesia was 92.0 ± 12.7 in sufentanil group and 185.2 ± 15.2 minutes in midazolam and sufentanil group which was significantly different (P = 0.002). Numeric rating scale score was significantly lower in midazolam group compare to sufentanil group at 120 min (P = 0.01), 150 min (P = 0.0014), and 180 min (P = 0.001).

Conclusions: Intrathecal midazolam as an adjunct to opioid could significantly enhance analgesia in labor pain with no significant adverse effect. Intrathecal injection of midazolam is an appropriate alternative to parenteral or epidural analgesia in small hospital settings.
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http://dx.doi.org/10.4097/kjae.2014.66.3.204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983416PMC
March 2014

Long-term relapse of ultra-rapid opioid detoxification.

J Addict Dis 2014 ;33(1):33-40

a Department of Anesthesiology, Loghman Hakim Hospital , Shahid Beheshti University of Medical Sciences , Tehran , Iran.

Ultra-rapid opioid detoxification (UROD) and subsequently induction of naltrexone maintenance therapy can be regarded as a safe and effective detoxification method for use in patients with opiate addiction. Long-term efficacy, relapse time, and relapse rate of this method is not clear. The aim of this article was to assess UROD efficacy and estimate the relapse rate in the 2-year follow-up period. Opioid-addicted, self-reporting patients referred to our hospital center were enrolled. All demographic data were collected by direct interview and based on patients' official documents. Addiction information were obtained from the patients' own admission and the interviews. Patients then began the UROD process. Thereafter, patients were scheduled for follow-up visits every 3 months for a 2-year period. A total of 424 patients were enrolled in the study and entered the UROD program, of which 400 patients completed. Of the total patients, 303 (75.75%) were successful (successful group) and 97 (24.25%) relapsed (relapse group). The unemployment rate was significantly higher in the relapse group (76%) compared with those in the successful group (21%) (P = .02). No patients in the relapse group continued naltrexone maintenance at 6-month follow-up, which was significantly lower than successful group (75.8%) (P < .05). The relapse rate was 14% at the first month visit and 24% at the 6 month and thereafter. All patients who had a relapse incident discontinued use of naltrexone before relapse happened. UROD could be an effective method of detoxification in addicted patients, but case selection, sticking to the guidelines, and maintenance therapy accompanied with social support is necessary to minimize relapse and withdrawal symptoms.
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http://dx.doi.org/10.1080/10550887.2014.882727DOI Listing
December 2014

Teicoplanin as an anti-methicillin resistant Staphylococcus aureus agent in infections of severely poisoned intensive care unit patients/ Tehran- Iran.

Acta Biomed 2014 Jan 23;84(3):189-95. Epub 2014 Jan 23.

Department of Microbiology, Islamic Azad University , Fars Science and Research Branch, Shiraz-Iran.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is related to high morbidity and mortality. Glycopeptide antibiotic is the choice of treatment in MRSA infections. Teicoplanin is a semi synthetic glycopeptide antibiotic with a spectrum of activity similar to vancomycin.  Our objective is the evaluation of efficacy and safety of Teicoplanin in MRSA infections among severely poisoned intensive care unit (ICU) patients.

Method: During a 6 months period, in a prospective cross sectional study 54 eligible patients from 80 clinically suspicious with MRSA infections were recruited. The efficacy and safety of Teicoplanin was evaluated 5 times. The clinical findings, laboratory data, and bacteriologic responses were defined as cure, improvement and failure.

Results: The mean age of the patients was 36.3 years (range, 20-72, SD = 13.3). 75.9% were male. Suicidal attempts were recorded in 63%. The most common poisoning was TCAs, BZDs, tramadol and opium. 94.4% were unconscious and under mechanical ventilation. Tracheal cultures were positive in 98.1% by VAP diagnosis. Length of stay in the ICU was between  4-54 days. Total clinical effectiveness was 90.4%, and failure 9.6%. Mortality rate of the patient, was 9/54 (16.6 %) which 3 of them were for lack of a clinical response. On the fourth visit, the adverse effects included: rash (11.10%), anemia (36.17%), nephrotoxicity (17.02%) and thrombocytopenia < 150000 (100%). Other side effects such as: leucopenia, severe thrombocytopenia (< 50000), pancytopenia and red man syndrome were not detected.

Conclusions: Teicoplanin is suggestible for MRSA infections among severely poisoned patients according to its efficacy, safety, half life and tolerance.
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January 2014

Syntheses, structures, properties and DFT study of hybrid inorganic-organic architectures constructed from trinuclear lanthanide frameworks and Keggin-type polyoxometalates.

Dalton Trans 2014 Jan;43(4):1906-16

Department of Chemistry, Ferdowsi University of Mashhad, 917751436 Mashhad, Iran.

In this paper we report the synthesis and X-ray characterization of four novel hybrid inorganic-organic assemblies generated from H4SiW12O40 as Keggin-type polyoxometalates (POM) and, in three of them, a trinuclear lanthanide cluster of type {Na(H2O)3[Ln(HCAM)(H2O)3]3}(4+) is formed, where Ln metal is La in compound 1, Ce in compound 2, and Eu in compound 3 (H3CAM = chelidamic acid or 2,6-dicarboxy-4-hydroxypyridine). These compounds represent the first POM-based inorganic-organic assemblies using chelidamic acid as an organic ligand. The thermal stability of the organic ligand is crucial, since pyridine-2,6-bis(monothiocarboxylate) instead of chelidamic acid is used (compound 4) under the same synthesis conditions, the decomposition of the ligand to pyridine was observed leading to the formation of colorless crystals of a pseudo hybrid inorganic-organic assembly. In compound 4 the hybrid inorganic-organic assembly is not formed and the organic part simply consists of four molecules of protonated pyridine acting as counterions of the [SiW12O40](4-) counterpart. The luminescent properties of compounds and have been investigated and their solid state architectures have been analyzed. Whereas compound only shows ligand emission, the Eu(3+) emission in compound 3 is discussed in detail. We have found that unprecedented anion-π interactions between the POM, which is a tetra-anion, and the aromatic rings play a crucial role in the crystal packing formation. To the best of our knowledge, this is the first report that describes and analyzes this interaction in Keggin-type POM based inorganic-organic frameworks. The energetic features of these interactions in the solid state have been analyzed using DFT calculations in some model systems predicted by us.
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http://dx.doi.org/10.1039/c3dt51971fDOI Listing
January 2014

Opioid-sparing effect of preemptive bolus low-dose ketamine for moderate sedation in opioid abusers undergoing extracorporeal shock wave lithotripsy: a randomized clinical trial.

Anesth Analg 2013 Jan 7;116(1):75-80. Epub 2012 Dec 7.

Anesthesiology Research Center, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Ketamine has been used as part of a multimodal analgesia regime in opioid abusers undergoing general anesthesia. We studied the opioid-sparing effect of a very low-dose bolus of ketamine as part of moderate sedation for opioid abuse patients undergoing extracorporeal shock wave lithotripsy.

Methods: In this randomized, placebo-controlled clinical trial, 190 opioid abusers were enrolled. They were stratified into 2 blocks based on their daily opioid consumption. Both blocks were then randomized to receive 0.1 mg/kg IV ketamine (group K) or placebo (group P). Lithotripsy was performed under moderate sedation with intermittent bolus doses of remifentanil (0.2 µg/kg) to alleviate pain. The total remifentanil dose (primary outcome) and respiratory adverse events (secondary outcome) were compared in the 2 groups.

Results: Remifentanil administration in the group with low-opioid consumers was 1.6 ± 0.4 µg/kg (group P) compared with 1.0 ± 0.2 µg/kg in group K (confidence interval [CI](of difference) 95%, 0.4-0.7; P < 0.001). Patients who had high-opioid consumption received 2.0 ± 0.5 µg/kg (group P) vs 1.5 ± 0.3 µg/kg (group K) remifentanil (CI(of difference) 95%, 0.40-0.75; P < 0.001). Ready to discharge time was statistically longer in high-consumption opioid abusers who received placebo compared with group K (55 ± 13 minutes vs 44 ± 8 minutes, CI(of difference) 95%, 6-15; P < 0.001). The incidences of bradypnea, apnea, nausea, vomiting, and hemodynamic changes were not statistically different between the ketamine and placebo groups.

Conclusion: Preemptive low-dose ketamine (0.1 mg/kg) as a bolus has opioid-sparing effects in opioid abusers undergoing moderate sedation.
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http://dx.doi.org/10.1213/ANE.0b013e31826f0622DOI Listing
January 2013

Persian translation of perception of psychiatry survey questionnaire and evaluation of its psychometric properties.

Iran J Psychiatry 2012 ;7(3):135-9

Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran ; Psychiatry and Psychology Research center, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Test the psychometric properties of the Persian version of the Perception of Psychiatry Survey questionnaire, which is being used in a large multi-site international study, of which we were part. This instrument was designed to measure the attitudes of medical educators to psychiatry.

Method: We used World Health Organization guideline as the methodological model for Persian translation. The Persian version of Perception of Psychiatry Survey questionnaire was administered to a convenience sample of 100 medical teachers at Tehran University of Medical Sciences and Azad University. The content validity, internal consistency, and test-retest reliability of the instrument were assessed.

Results: No item changed completely during the process of translation and cultural adaptation. The content validity of translation and back translation was 0.74 and 0.86 according to Feliss Kappa Statistic. The Cronbach's α coefficient was 0.76 for the Persian version and for its subdivisions ranged from 0.59 to 0.81. The inter class correlation (ICC) coefficient for test-retest reliability of the whole instrument was 0.89.

Conclusion: The Persian version of Perception of Psychiatry Survey questionnaire could be considered as a good cross-cultural equivalent for original English version. The instrument is a reliable instrument in terms of internal consistency and test-retest reliability.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488869PMC
November 2012

Epidural anesthesia as a thromboembolic prophylaxis modality in plastic surgery.

Aesthet Surg J 2011 Sep 8;31(7):821-4. Epub 2011 Aug 8.

Tehran University of Medical Sciences, St. Fatima Hospital, Tehran, Iran.

Background: Epidural anesthesia (EA) is known to reduce postoperative thromboembolic complications, but the mechanisms are poorly understood. Review of the literature revealed no reports about the ability of epidural anesthesia (EA) to reduce the risk of venous thromboembolism (VTE) in abdominal contouring surgery and/or liposuction. Most medical publications in this field are based on orthopedic cases.

Objectives: The authors investigate the hypothesis that the differential nerve-blocking effect of bupivacaine, which spares motor function and permits leg movement during the operation, is the most important mechanism by which EA prevents thromboembolism.

Methods: From June 1992 to August 1995, 24 cases of abdominoplasty were performed under general anesthesia (Group 1). From September 1995 to December 2009, 371 cases of concurrent abdominoplasty and liposuction were performed under EA (Group 2). Eighteen cases (4.8%) from Group 2 were ultimately excluded from the study because of unsuccessful EA. All surgeries were performed by the senior author (FH).

Results: One thromboembolic event (pulmonary embolism [PE]) occurred in Group 1 (4%). No cases of deep vein thrombosis (DVT) or PE occurred among Group 2 patients.

Conclusions: Together, differential epidural nerve blocks and purposeful intraoperative movement of lower-limb muscles represent an effective prophylactic mechanism that may prevent devastating DVT and resultant PE.
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http://dx.doi.org/10.1177/1090820X11417424DOI Listing
September 2011

Effect of ultra-rapid opiate detoxification on withdrawal syndrome.

J Addict Dis 2010 Oct;29(4):449-54

Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The aim of study was determine the effect of ultra-rapid opiate detoxification (UROD) on the presence or absence of withdrawal syndrome in a group of patients with opiate dependency. In this study, withdrawal syndrome of 173 patients with opiate addiction was evaluated before and after UROD using the Objective Opioid Withdrawal Scale. Hence, each patient was observed for 5 minutes before UROD and at different hours afterward to observe any withdrawal sign. The most prevalent withdrawal sign before UROD was anxiety. Restlessness was the most prevalent finding at 1, 3, and 6 hours. After 12 hours, yawning was reported as the most prevalent finding in 39 participants. Anxiety was reported as the most prevalent finding in 61 participants after 24 hours. Patients with opioid dependency who underwent UROD showed the highest rate of withdrawal symptoms at one hour after anesthesia. Most of these symptoms subsided after 24 hours. UROD can be applied for detoxification of patients with opioid dependency with safety.
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http://dx.doi.org/10.1080/10550887.2010.509278DOI Listing
October 2010

Comparison of the upper lip bite test with measurement of thyromental distance for prediction of difficult intubations.

Acta Anaesthesiol Taiwan 2008 Jun;46(2):61-5

Department of Anesthesiology, Loghman-Hakim Hospital, Shahid Beheshti University, M.C., Tehran, Iran.

Background: The upper lip bite test (ULBT) introduced in 2003 is a simple method for predicting difficult intubations. According to this test, the higher a patient can bite the upper lip with the lower incisors, the lower the risk of difficult intubation. Given the necessity for evaluation and re-evaluation of a newer predictive method, this study was conducted to compare the ULBT with another method for difficult airway prediction, the measurement of thyromental distance (TMD).

Methods: In this prospective, observational, single-blind study, 350 patients who required inhaled general anesthesia with endotracheal intubation for elective surgery were enrolled for evaluation of the accuracy in predicting difficult intubation by TMD measurement and ULBT. In the ULBT, the capacity of biting the upper lip is categorized into three classes: class I, a patient is able to raise the lower incisors above the vermilion line; class II, a patient is able to bite the upper lip below the vermilion line; and class III, a patient is unable to bite the upper lip. After induction of anesthesia with a standard protocol, the patient's grade of laryngeal view by the Cormack-Lehane classification was documented by an anesthesiologist with at least 3 years' experience who was unaware of prior evaluations. A TMD equal to or less than 4 cm and a class III ULBT were considered to be predictive of difficult intubation. A Cormack-Lehane class III or IV was considered a difficult intubation.

Results: Only 20 (5.7%) of the patients were considered to have difficult intubations. Sensitivity, specificity, positive and negative predictive values, and accuracy were 70%, 93.3%, 39%, 98.1%, and 92.6%, respectively, for the ULBT, and 55%, 88%, 22%, 97%, and 86.3%, respectively, for TMD. Specificity and positive predictive value were found to be significantly higher for the ULBT than for TMD (p < 0.05). The sensitivity, negative predictive value, and accuracy were not significantly different between the two methods.

Conclusion: The findings suggest that the sensitivity of the ULBT and TMD for predicting difficult intubations may not be significantly different, but the specificity of the ULBT is significantly higher. The positive predictive value of the ULBT was significantly higher than that of TMD, signifying that a positive ULBT is more predictive of a difficult airway than is a positive TMD.
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http://dx.doi.org/10.1016/S1875-4597(08)60027-2DOI Listing
June 2008

Analysis of opium use by students of medical sciences.

J Clin Nurs 2006 Apr;15(4):379-86

Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran.

Aims And Objectives: To investigate the prevalence of opium use in university students.

Background: University health professionals and authorities are very concerned about substance use among university students.

Design: A survey with a representative sample of 2519 (1126 men and 1393 women) university students and opium use disorders assessed by means of DSM-IV criteria (Diagnostic Statistical Manual-IV Axis I during the year 2003).

Findings: Mean age of the sample was 23.8 year and SD was 3.9. Of the students, 110 (4.4%) admitted using of opium once or more during their lives (9.1% of men and 0.6% of women; P < 0.01). Fifty (2%) were occasional opium user (4.2% of men and 0.2% of women; P < 0.01). Nineteen (0.8%) were current opium user (1.4% of men and 0.2% of women; P = 0.001). Mean age of opium users was higher than the remainder. Opium use was significantly related to gender (P = 0.001), and life stress (P = 0.04).

Conclusion: These findings can be considered for preventive and therapeutic programmes, because early intervention during the formative university years may present an opportunity to reduce the risk of long-term problems, to decrease social and individual harm and also to promote public health of society.

Relevance To Clinical Practice: These findings can be considered in clinical practice for detection and treatment of opioid abuse.
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http://dx.doi.org/10.1111/j.1365-2702.2006.01157.xDOI Listing
April 2006