Publications by authors named "Arvin Najafi"

15 Publications

  • Page 1 of 1

Minimally Invasive Repair of Acute Achilles Tendon Rupture Using Gift Box Technique.

Arch Bone Jt Surg 2019 Sep;7(5):429-434

Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: This study aimed to introduce a modified technique for minimally invasive Achilles tendon (AT) rupture repair using gift box sutures. The preliminary clinical and functional outcomes were investigated among a number of patients.

Methods: In a consecutive case series study, 24 patients with acute AT rupture underwent modified minimally invasive AT repair using two mini-incisions and gift box sutures. The patients were followed up for 24 months. The AT rupture score (ATRS) and the American Orthopedic Foot and Ankle Society (AOFAS) measure score were obtained from all patients. The other measured variables included pain intensity and satisfaction using a visual analog scale (VAS), calf atrophy, the range of sagittal ankle motion, development of wound complications, sural nerve injury, and re-rupture.

Results: After two years, the mean scores of AOFAS and ATRS were obtained at 83±4 and 81.9±6.3, respectively. Approximately 87.5 % of the patients regained their previous level of activity. The mean VAS score was 7.7±0.9 regarding the satisfaction with the outcomes. Moreover, isokinetic testing of plantar flexion and dorsiflexion strength were 82.7±5.8 and 87.7±4.1%, respectively, compared to those of the normal side. The calf atrophy was not statistically significant. In total, five patients reported pain during their activities. The range of operated ankle motion decreased significantly, compared to that of the other side; however, the differences were not significant functionally. There was no patient with wound complications, nerve injury, or complaint about problem with footwear.

Conclusion: Minimally invasive repair of acute AT rupture using two mini-incisions and gift box sutures offers good functional and clinical outcomes without wound complications which can be usually observed following open repair of AT ruptures.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802554PMC
September 2019

National Joint Registry of Iran.

Arch Bone Jt Surg 2019 Jan;7(1):75-78

Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Joint replacement is currently on the rise with a high community burden. A registry was designed to evaluate the costs, possible complications, and rate of revisions as well as finding the most effective techniques, risk factors associated with poor results, indications for revision surgeries, and also demographic evaluation of patients undergoing joint replacement surgery in Iran.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372271PMC
January 2019

Ponseti Casting Method in Idiopathic Congenital Clubfoot and Its Correlation with Radiographic Features Abstract.

Arch Bone Jt Surg 2017 May;5(3):168-173

Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: The aim of this study was to evaluate the idiopathic congenital clubfoot deformity treated by Ponseti method to determine the different factors such as radiological investigations that may have relations with the risk of failure and recurrence in mid-term follow-up of the patients.

Methods: Since 2006 to 2011, 226 feet from 149 patients with idiopathic congenital clubfoot were treated with weekly castings by Ponseti method. Anteroposterior and lateral foot radiographies were performed at the final follow-up visit and the data from clinical and radiological outcomes were analysed.

Results: In our patients, 191(84.9%) feet required percutaneous tenotomy. The successful correction rate was 92% indication no need for further surgical correction. No significant correlation was found between the remained deformity rate and the severity of the deformity and compliance of using the brace (=0.108 and 0.207 respectively). The remained deformity rate had an inverse association with the beginning age of treatment (=0.049). No significant correlation was found between the percutaneous tetonomy and passive dorsiflexion range (=0.356).

Conclusion: According to our results treatment with the Ponseti method resulted in poor or no correlation. The diagnosis of clubfoot is a clinical judgment; therefore, the outcome of the treatment must only be clinically evaluated. Although the Ponseti method can retrieve the normal shape of the foot, it fails to treat the bone deformities and eventually leads to remained radiologic deformity. Further studiesare suggested to define a different modification that can address the abnormal angles between the foot and ankle bones to minimize the risk of recurrence.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466861PMC
May 2017

Management of postoperative pain after Lumbar surgery-pregabalin for one day and 14 days-a randomized, triple-blinded, placebo-controlled study.

Clin Neurol Neurosurg 2016 Dec 17;151:37-42. Epub 2016 Oct 17.

Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran.

Objectives: Despite the progress in understanding acute pain physiology during recent decade, eighty percent of patients still suffer from post-operative discomfort. Pregabalin is an anticonvulsant agent that is approved for painful neuropathies in diabetic patients and post herpetic neuralgia. The main objective of the present study was to compare the improvement in post-operative pain management and patient lifestyle in 3 groups, as first group received placebo, second who received Pregabalin for one day and the last group those who received it for 14 days.

Methods: This was a prospective single center, randomized, triple-blind, 3-arm, parallel group study. In this triple-blind study, patients were randomized to 1 of 3 groups using computer-generated random number table. 1) The first group received placebo for 14 days, the second group received Pregabalin 300mg 8h preoperatively and 150mg 12 and 24h postoperatively and for the rest of 13days received placebo and the third group received Pregabalin 300mg eight hours preoperatively and 15mg every 12h postoperatively for 14 days. Name, age, gender, height, weight, education, duration of pain, past medical history, drug history,total morphine requirement at the time of discharge and MRI findings of all the patients were recorded, also they Numerical scale system (NRS) and Oswestry low back pain disability index (ODI) questionnaire were completed for them. All the patients were operated based on standard surgery techniques, bilateral foramenotomy and interlaminar discectomy.

Results: Of the 105 patients who entered the run-in period, 47 patients (44.8%) were female and 58 (55.2%) were male. The Patients radicular pain mean score based on NRS estimated before surgery was 7.22±1.95 in pregabalin14, 7.71±1.84 in pregabalin1 and 7.45±1.9 in control group. There were no statically significant differences between three groups (P-Value>0.05). The Patients back pain mean score based on NRS was 5.2±2.87 in pregabalin14, 5.11±3.23 in pregabalin1 and 6.4±3.06 in control group. This means that there were no significant differences in the overall score among those three groups (P-Value>0.05). In comparison to their preoperative pain, the average radicular pain in each group of patients improved significantly 4, 8, 12 and 24h after the operation (P-Value<0.001), but there were no significant differences in radicular pain improvements comparing three groups.

Conclusion: The results of this study indicate that 1day and 2 weeks post-operative 300mg pregabalin administration may not improve acute pain, morphine consumption and quality of life of patients after surgery. It seems that the diseases cause chronic pain that requires long-term treatment with higher doses.
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http://dx.doi.org/10.1016/j.clineuro.2016.10.007DOI Listing
December 2016

Neglected Alkaptonuric Patient Presenting with Steppage Gait.

Arch Bone Jt Surg 2016 Apr;4(2):188-91

Joint Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Even though intervertebral disc degeneration can be found in the natural course of alkaptonuria, detection of the disease by black disc color change in a patient without any other presentation of alkaptonuria is an exceptionally rare condition. We have reported a very rare case of alkaptonuria presented with low back pain and steppage gait in a 51-year-old male with a complaint of chronic low-back pain and steppage gait who was operated on for prolapsed lumbar disc herniation. Intraoperatively his lumbar disk was discovered to be black. The alkaptonuria diagnosis was considered after histopathological examination of the black disc material and elevated urinary concentration of homogentisic acid confirmed the diagnosis. To our knowledge, this presentation has not been reported previously in literature.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852050PMC
April 2016

Assessment of the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft surgery in a group of Iranian patients.

Indian J Crit Care Med 2015 Oct;19(10):576-9

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

Background And Aims: Previous studies around the world indicated validity and accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk scoring system we evaluated the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft (CABG) surgery in a group of Iranian patients.

Materials And Methods: In this cohort 2220 patients more than 18 years, who were performed CABG surgery in Massih Daneshvari Hospital, from January 2004 to March 2010 were recruited. Predicted mortality risk scores were calculated using logistic EuroSCORE and Acute Physiology and Chronic Health Evaluation II (APACHE II) and compared with observed mortality. Calibration was measured by the Hosmer-Lemeshow (HL) test and discrimination by using the receiver operating characteristic (ROC) curve area.

Results: Of the 2220 patients, in hospital deaths occurred in 270 patients (mortality rate of 12.2%). The accuracy of mortality prediction in the logistic EuroSCORE and APACHE II model was 89.1%; in the local EuroSCORE (logistic) was 91.89%; and in the local EuroSCORE support vector machines (SVM) was 98.6%. The area under curve for ROC curve, was 0.724 (95% confidence interval [CI]: 0.57-0.88) for logistic EuroSCORE; 0.836 (95% CI: 0.731-0.942) for local EuroSCORE (logistic); 0.978 (95% CI: 0.937-1) for Local EuroSCORE (SVM); and 0.832 (95% CI: 0.723-0.941) for APACHE II model. The HL test showed good calibration for the local EuroSCORE (SVM), APACHE II model and local EuroSCORE (logistic) (P = 0.823, P = 0.748 and P = 0.06 respectively); but there was a significant difference between expected and observed mortality according to EuroSCORE model (P = 0.033).

Conclusion: We detected logistic EuroSCORE risk model is not applicable on Iranian patients undergoing CABG surgery.
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http://dx.doi.org/10.4103/0972-5229.167033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637956PMC
October 2015

Outcome Assessment of Operative Treatment of Humeral Shaft Fractures by Antegrade Unreamed Humeral Nailing (UHN).

Indian J Surg 2015 Jun 29;77(3):186-90. Epub 2012 Sep 29.

Shahid Beheshti University of Medical Sciences, Velenjak St, Tehran, Iran.

The purpose of this study was to assess the outcome of humeral shaft fractures treated with Unreamed Humeral Nailing (UHN) system. Fixation of the humeral shaft fractures in this study was performed by minimal incision UHN system, without using its distal locking properties. Forty one patients were treated this way. Functional status of shoulder and elbow were evaluated using Society of the American Shoulder and Elbow Surgery (SASES) scoring system. During follow up period, no superficial or deep infections were observed. Mean union time was 13 weeks. Shoulder and elbow functions using SASES scale were excellent or good in 93 % of the patients. Complications included delayed union in 3(7.3 %), nonunion in 2(4.8 %) and radial nerve palsy in 1(2.4 %). Antegrade unreamed humeral Nailing is an acceptable, safe and reliable treatment for humeral shaft fractures.
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http://dx.doi.org/10.1007/s12262-012-0756-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522247PMC
June 2015

Efficacy of Low-Dose Ciclesonide and Fluticasone Propionate for Mild to Moderate Persistent Asthma.

Tanaffos 2015 ;14(1):1-9

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

Background: The aim of this study was to compare the efficacy of ciclesonide (80 mg/day) and fluticasone propionate (200 mg/day) for mild to moderate persistent asthma.

Materials And Methods: Female and male patients older than 12 years with a history of persistent bronchial asthma for at least 6 months were enrolled. Patients were eligible to enter into a 2-week run-in period before randomization (baseline) if they had received inhaled corticosteroids (fluticasone propionate 250 μg/day or equivalent) at a constant dose during the last 4 weeks before the run-in period. In order to enter into the double blind 18-week treatment period, patients had to have a forced expiratory volume in 1s (FEV1) of 61-90% of predicted and a decrease in FEV1 throughout the run-in period of more than 10%. Patients (n =230) were assigned to ciclesonide 80 mg once daily or fluticasone propionate 100 mg twice daily group. The primary outcome variable was change in FEV1 compared to its baseline value. Secondary outcome variables were asthma-specific quality of life and asthma control.

Results: Both drugs significantly increased FEV1 and other lung function parameters compared to baseline (P< 0.0001, both groups, all variables). Progress in the percentage of days with no asthma symptoms and no use of rescue medication and asthma-specific quality of life were similar in the two treatment groups.

Conclusion: Ciclesonide at a dose of 80 μg once daily can provide efficient maintenance therapy for mild to moderate persistent asthma.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515324PMC
July 2015

Arthroscopic posterior cruciate ligament reconstruction by using hamstring tendon autograft and transosseous screw fixation: minimal 3 years follow-up.

Arch Orthop Trauma Surg 2014 Dec 4;134(12):1723-30. Epub 2014 Sep 4.

Shahid Beheshti University of Medical Sciences, Velenjak St, Tehran, Iran.

Background: The aim of this trial is to prospectively evaluate the outcomes of PCL reconstruction by means of quadruple hamstring tendon autograft with a double-fixation method at minimal 3-year follow-up.

Materials And Methods: Only patients who underwent PCL reconstruction without any other concomitant injury were included in this study. A hamstring tendon graft is composed of a quadruple-stranded gracilis tendon and semitendinosus tendon about 10 cm in length. An arthroscopic technique via a two incision and a double-fixation method was applied. Clinical evaluations were performed for 52 patients. Clinical assessment of patients included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, thigh muscle evaluation, and radiographic investigation.

Results: On the Lysholm knee score, 90 % of the patients displayed good or excellent rating in the final assessment. In the IKDC rating analyses, 60 % of the patients demonstrated 3-5-mm ligament laxity. For the IKDC final rating, 81 % were normal or nearly normal. Seventy-nine percent of the cases revealed less than a 10-mm difference in thigh girth between their reconstructed and contra lateral limbs.

Conclusion: Arthroscopic PCL reconstruction using quadruple hamstring tendon autograft provides acceptable outcomes at a minimum 3-year follow-up. The four-stranded hamstring tendon graft is suitable in graft size and results in minimal harvesting morbidity. We recommend that quadruple hamstring tendon graft be chosen for PCL reconstruction to achieve good ligament reconstruction. A double-fixation method which has been applied in this trial can be used to provide rigid fixation.
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http://dx.doi.org/10.1007/s00402-014-2082-9DOI Listing
December 2014

Comparison of morphologic consequences of open and endoscopic carpal tunnel release.

Clin Neurol Neurosurg 2014 May 7;120:96-8. Epub 2014 Mar 7.

Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Objectives: The objective of this study is to evaluate the carpal canal morphologic consequences following endoscopic carpal tunnel release compared with open approach.

Methods: 48 Patients with CTS were enrolled in our prospective trial. Participants were classified in 2 groups: 24 patients underwent open surgery technique and 24 underwent endoscopic carpal tunnel decompression. Carpal canal shape and volume, configuration and position of contents, were analyzed by using imaging techniques.

Results: Preoperative carpal canal volume in endoscopic patient group averaged 5.7±1.4 cc and 7.3±2.9 cc at 6 weeks postoperatively (28%±7%, p=0.018). In contrast preoperative carpal canal volume in open carpal tunnel release group averaged 4.9±1.1 cc (and increased to 6.2±1.7 cc at 6-week follow up investigation (36%±5%, p=0.002). Preoperative carpal arch width calculation in endoscopic carpal tunnel release group averaged 21.7±1.1mm and 21.5±1.9mm in open carpal tunnel release patients (p=0.6575). Postoperative carpal arch width measurements in endoscopic carpal tunnel decompression group averaged 22.6±4.1mm and 22.1±2.9mm in open carpal tunnel release patient population at 6-week follow-up investigation (p=0.628).

Conclusion: Endoscopic approach causes an increment in carpal canal volume comparable to open technique and provides equivalent anatomic outcomes and will produce at least equivalent long-term clinical relief.
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http://dx.doi.org/10.1016/j.clineuro.2014.02.025DOI Listing
May 2014

Venous thromboembolism in medical critically ill patients: prevalence and incidence.

Acta Med Iran 2013 Apr 6;51(3):168-71. Epub 2013 Apr 6.

Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The objective of this study was to determine the prevalence and incidence of venous thromboembolism among critically ill medical surgical patients. In this cross sectional and retrospective study, we observed 243 patients who were first admitted at the intensive care unit. Patients who were diagnosed with deep venous thrombosis or embolism either by clinical or paraclinical methods were enrolled. Among 243 patients of ICU ward 12 cases of them were confirmed to have thromboembolism (prevalence of 9.4%).But the incidence of venous thromboembolism after 48 hour of ICU admission was 5.2%(6 cases). Among 6 VTE cases 3 of them didn't receive any anticoagulant prophylaxis, 2 patients received LDUH 5000 unit twice a day and one patient received LMWH 60 mg daily but all developed VTE although receiving prophylaxis. We found that the prevalence of proximal lower limb DVT among medical-surgical critically ill patients remaining in the ICU for ≥3 days is about 9.4% and the incidence of that is about 5.2%. Further studies should be performed in order to assess the benefits and risks of venous thromboprophylaxis in Iranian patients.
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April 2013

Continuous versus intermittent administration of piperacillin-tazobactam in intensive care unit patients with ventilator-associated pneumonia.

Indian J Crit Care Med 2012 Jul;16(3):141-7

Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Tehran, Iran.

Background And Aims: Ventilator-associated pneumonia (VAP) is one of the most common Intensive Care Unit (ICU)-acquired infection. The aim of this study was to compare the clinical outcome of continuous and intermittent administration of piperacillin-tazobactam by serial measurements of the Clinical Pulmonary Infection Score (CPIS).

Subjects And Methods: Groups were designed as parallel and the study was designed as quasi-experimental and conducted at a semi-closed ICU between September 2008 and May 2010. Patients received 3.375 g (piperacillin 3 g/tazobactam 0.375 g) either through intermittent infusion every 6 h for 30 min [Intermittent Infusion (II) group; n = 30] or through continuous infusion every 8 h for 4 h [Continuous Infusion (CI) group; n = 31]. CPIS was used to assess the clinical diagnosis and outcome of VAP patients.

Results: Sex, age, Acute Physiology and Chronic Health Evaluation II II score on ICU admission, diagnosis and underlying disease of VAP patients were not significantly different in the CI (n = 31) and II (n = 30) groups. Duration of mechanical ventilation, length of stay, total number of antibiotics used per patient and duration of piperacillin/tazobactam treatment were similar in both groups. Mortality rates of VAP patients were similar between both groups during hospitalization.

Conclusion: There was no significant difference in clinical outcomes of patients receiving piperacillin-tazobactam via CI or II when measured by serial CPIS score.
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http://dx.doi.org/10.4103/0972-5229.102083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506071PMC
July 2012

Prospective outcomes of arthroscopic treatment of dorsal wrist ganglia.

Orthopedics 2012 Mar 7;35(3):e365-70. Epub 2012 Mar 7.

Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The purpose of this study was to assess the results of arthroscopic resection of dorsal wrist ganglia. Between November 2002 and September 2007, all patients with dorsal wrist ganglia underwent arthroscopic resection in our institution. Average follow-up was 39.2 months (range, 24-71 months). Fifty-two patients (40 women and 12 men; mean age, 29.8 years) were treated with our operative technique. Symptoms at presentation were unpleasant appearance in 15 patients (28.8 %), pain in 30 (57.6%), and unpleasant appearance and pain in 7 (13.5%). The ganglion cyst site was in front of the midcarpal joint in 41 patients (78.8%), in front of the radiocarpal joint in 6 patients (11.5%), and in front of the radiocarpal and midcarpal joints in 5 patients (9.6%). Our surgical technique resulted in a significant improvement in flexion, extension, and grip strength (P≤.005). In patients with painful ganglia, treatment also had a significant effect. Nine (17.3%) recurrences were observed. Mean time off work was 14 days, but 19 patients returned to work immediately. According to the results of this study, we recommend the use of arthroscopy as the primary treatment method for dorsal wrist ganglion excision.
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http://dx.doi.org/10.3928/01477447-20120222-13DOI Listing
March 2012

Intraosseous ganglion cyst of the lunate.

Trauma Mon 2012 Jan 15;16(4):198-200. Epub 2012 Jan 15.

Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

Intraosseous ganglia can affect the carpal bones of the hand and must be considered in the differential diagnosis of wrist pain. A 38-year-old female presented with a 14-month history of left wrist pain and a radiolucent cystic lesion was seen computed tomography (CT) scanning. Characteristic radiographic findings of a cyst in association with a fine sclerotic rim was apparent. We report an unusual presentation of a ganglion cyst in the lunate bone with excellent treatment outcome.
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http://dx.doi.org/10.5812/kowsar.22517464.2705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3989574PMC
January 2012

Improving the Practice of Nutrition Therapy in the NRITLD Critically Ill Patients: An International Quality Improvement Project.

Tanaffos 2011 ;10(4):31-7

Department of Medicine and Epidemiology at Queen's University, Director of Research for the Critical Care Program and the Director of the Clinical Evaluation Research Unit at the Kingston General Hospital, Kingston, Canada.

Background: In previous decades several studies have been performed demonstrating that providing appropriate nutritional support to intensive care unit patients affects complications, time of mechanical ventilation, length of ICU stay, and risk of death. In this study we provided a report of nutrition statuses in Masih Daneshvari's ICU as compared to 156 ICUs from 20 countries that participated in an international nutrition survey.

Materials And Methods: All patients admitted to an intensive care unit during a specified one-month period who required artificial nutrition were included in this study. Characteristics of patients, performance of nutrition practices, and ICU outcomes were registered for all patients and compared with data from 156 other intensive care units from various countries around the world.

Results: Twenty patients, of which 11(55%) were males and 9(45%) were females, were included in this study. The median age was 50.5 yrs (IQR: 40.5-56.0). Seventeen (85%) of them had EN nutrition only, 2(10%) had PN nutrition only, and 1(5%) had both EN and PN nutrition during their stay in the ICU. The adequacy of calorie intake was 67.6% (vs. 61.1% in all 157 ICUs) and the adequacy of protein intake was 84.9% (vs. 56.7% in 157 ICUs).

Conclusion: In our ICU, enteral feeding was superior to parenteral feeding. Also we considered early initiation of enteral feeding within 48 hours following ICU admission. We just used polymeric formula during this study. As a result of formula variation limits, we overestimated calories and protein needs. Glutamine and Selenium supplementations have not been used yet for patient in our ICU, regardless of their proven benefits in oxidative stress conditions like pulmonary diseases. Therefore, limited use of supplementations like selenium is inevitably among the disadvantages of Masih Daneshvari Hospital's ICU, which is a tertiary-care center for chronic pulmonary diseases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153167PMC
September 2014