Publications by authors named "Farshid Alaeddini"

42 Publications

Isolated tricuspid valve surgery; long-term outcomes based on Tehran Heart Center data bank report.

J Cardiothorac Surg 2021 Feb 23;16(1):19. Epub 2021 Feb 23.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Given that isolated tricuspid valve (TV) repair or replacement is performed relatively rarely, we sought to evaluate the rate of long-term mortality and readmission following this surgery.

Methods: The current study was conducted in Tehran Heart Center on patients who underwent isolated TV repair or replacement between 2010 and 2018. Totally, 197 patients (repair = 150 vs replacement = 47) were included in our study and were then followed right after surgery for a median of 8 years to assess the incidence of postoperative events, readmission, and all-cause mortality.

Results: The final analysis was conducted on 197 patients at a mean age of 44.4 ± 13.8 years. Most of the patients were female (56.9%). Ejection fraction, TAPSE, and right ventricular function improved in both groups after TV surgery. Length of stay in the intensive care unit per hour and hospitalization per day were higher in the replacement group and compared to the repair group (158.34 vs. 55.11 and 18.21 vs. 9.34, respectively). In-hospital mortality occurred in 20 patients, of whom 15 had TV replacement. Readmission occurred in five (2.5%) patients,all were in the repair group.

Conclusions: The result of this single-center study showed that TV replacement is associated with a higher rate of postoperative events and all-cause mortality compared to TV repair. Whereas, repair group had a higher rate of readmission. Therefore, the overwhelming tendency is toward repair; nonetheless, no hesitation is permissible if a replacement is adjudged to confer a better outcome for the patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-021-01394-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903743PMC
February 2021

The completeness of the registration system and the economic burden of fatal injuries in Iran.

Ulus Travma Acil Cerrahi Derg 2020 Sep;26(5):671-677

National Trauma Registry of Iran, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran-Iran.

Background: The present study aims to calculate completeness of the current registration system of fatal injuries in the legal Medicine Organization (LMO) and to estimate the economic burden of fatal injuries at the national level of Iran.

Methods: We estimated the completeness of registered fatal injuries using a three-source capture-recapture method among the Legal Medicine Organization, health departments and Traffic police in Hamedan County (HC) from June 22, 2015 to June 21, 2016. We also estimated the economic burden of fatal injuries using Years of Life Lost (YLL) during one year. Then, using appropriate statistical methods, we generalized the estimates to the national level.

Results: There were 487 registered fatal injuries in the LMO of HC. The male to female ratio was 2.89. Road Traffic Crashes (RTC) and suicide pertained 45 and 21 percent of deaths, respectively. The completeness of fatal injuries registration was estimated at 86.9%. Based on LMO information of HC, the percentage of fatal injuries numbering errors at the national level was estimated 1.1 times that was reported by LMO in the same period (41,936 vs. 36442). YLL and the economic burden of fatal injuries were estimated 1,706,373 years and 8,692,264,432 US$ at the national level, respectively.

Conclusion: The completeness of the current registration system of fatal injuries is good. The economic burden of fatal injuries, especially due to motor vehicle crashes in Iran, is substantial. Strategies, legislative actions, and preventive programs should be considered to decrease the number of fatal injuries in our country.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14744/tjtes.2019.34903DOI Listing
September 2020

Impact of Sex on Long-term Clinical Outcomes After Percutaneous Coronary Intervention.

Crit Pathw Cardiol 2017 12;16(4):161-166

From the *Tehran Heart Center, General Cardiology Department, Tehran University of Medical Sciences; †Tehran Heart Center, Interventional Cardiology Department, Tehran University of Medical Sciences; ‡Internal Medicine Department, Shariati Hospital, Tehran University of Medical Sciences; §Tehran Heart Center, Research Department, Tehran University of Medical Sciences; ¶University of Arizona, Tucson, AZ; ‖CareMore, Tucson, AZ; **Tabriz University of Medical Sciences, Tabriz, Iran; and ††Tehran Heart Center, Electrophysiology Department, Tehran University of Medical Sciences.

Aims: To evaluate the impact of sex on long-term clinical outcomes after percutaneous coronary intervention (PCI).

Methods: In a large prospective cohort, 5664 patients (1716 women and 3948 men) who underwent PCI in a tertiary cardiac center between March 2007 and March 2010 were enrolled. Patients were followed up for median of 74.3 months. We compared the occurrence of long-term mortality, myocardial infarction (MI), and repeated revascularization between 2 sexes. Major adverse cardiac events were defined as a composite end point consisting of occurrence of all-cause mortality, nonfatal MI, or target vessel revascularization during follow-up period.

Results: Women were older and had more conventional coronary artery disease risk factors, had smaller vessel diameter, and received drug-eluting stents more frequently than men. On the contrary, men were much more smokers and had higher frequency of acute coronary syndrome, multivessel disease, total coronary occlusion, and lower ejection fraction. After >6 years of follow-up, the all-cause mortality, nonfatal MI, target vessel revascularization, major adverse cardiac events, patient-oriented composite end point, and total repeat PCI were similar between 2 sexes. After adjusting for potential confounders, the total repeat PCI was the only observed difference that was significantly lower in women [11.2% in women vs. 12.4% in men, adjusted subdistributional hazard ratio=0.73 (95% confidence interval, 0.6-0.88); P = 0.001).

Conclusions: During >6 years of follow-up, no significant difference was observed in major clinical outcomes between 2 sexes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HPC.0000000000000126DOI Listing
December 2017

A Risk-Scoring Model to Predict One-year Major Adverse Cardiac Events after Percutaneous Coronary Intervention.

J Tehran Heart Cent 2015 Oct;10(4):167-75

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: The aim of the present study was to develop a scoring system for predicting 1-year major adverse cardiac events (MACE), including mortality, target vessel or target lesion revascularization, coronary artery bypass graft surgery, and non-fatal myocardial infarction after percutaneous coronary intervention (PCI).

Methods: The data were extracted from a single center PCI registry. The score was created based on the clinical, procedural, and laboratory characteristics of 8206 patients who underwent PCI between April 2004 and October 2009. Consecutive patients undergoing PCI between November 2009 and February 2011 (n= 2875) were included as a validation data set.

Results: Diabetes mellitus, increase in the creatinine level, decrease in the left ventricular ejection fraction, presentation with the acute coronary syndrome, number of diseased vessels, primary PCI, PCI on the left anterior descending artery and saphenous vein graft, and stent type and diameter were identified as the predictors of the outcome and used to develop the score (R² = 0.795). The models had adequate goodness of fit (Hosmer-Lemeshow statistic; p value = 0.601) and acceptable ability of discrimination (c-statistics = 0.63). The score categorized the individual patients as low-, moderate-, and high-risk for the occurrence of MACE. The validation of the model indicated a good agreement between the observed and expected risks.

Conclusion: An individual risk-scoring system based on both clinical and procedural variables can be used conveniently to predict 1-year MACE after PCI. Risk classification based on this score can assist physicians in decision-making and postprocedural health care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791644PMC
October 2015

A Risk-Scoring Model to Predict One-year Major Adverse Cardiac Events after Percutaneous Coronary Intervention.

J Tehran Heart Cent 2015 Oct;10(4):167-75

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: The aim of the present study was to develop a scoring system for predicting 1-year major adverse cardiac events (MACE), including mortality, target vessel or target lesion revascularization, coronary artery bypass graft surgery, and non-fatal myocardial infarction after percutaneous coronary intervention (PCI).

Methods: The data were extracted from a single center PCI registry. The score was created based on the clinical, procedural, and laboratory characteristics of 8206 patients who underwent PCI between April 2004 and October 2009. Consecutive patients undergoing PCI between November 2009 and February 2011 (n= 2875) were included as a validation data set.

Results: Diabetes mellitus, increase in the creatinine level, decrease in the left ventricular ejection fraction, presentation with the acute coronary syndrome, number of diseased vessels, primary PCI, PCI on the left anterior descending artery and saphenous vein graft, and stent type and diameter were identified as the predictors of the outcome and used to develop the score (R² = 0.795). The models had adequate goodness of fit (Hosmer-Lemeshow statistic; p value = 0.601) and acceptable ability of discrimination (c-statistics = 0.63). The score categorized the individual patients as low-, moderate-, and high-risk for the occurrence of MACE. The validation of the model indicated a good agreement between the observed and expected risks.

Conclusion: An individual risk-scoring system based on both clinical and procedural variables can be used conveniently to predict 1-year MACE after PCI. Risk classification based on this score can assist physicians in decision-making and postprocedural health care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791644PMC
October 2015

Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2).

BMJ Open 2015 12 15;5(12):e007786. Epub 2015 Dec 15.

Sanofi Iran Medical Department, Tehran, Iran.

Objectives: To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS).

Setting: 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran.

Participants: Patients aged ≥ 20 and ≤ 80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA).

Primary And Secondary Outcome Measures: Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds.

Results: A total of 1799 patients (25.7% STEMI and 74.3% HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6%), clopidogrel (91.8%), anticoagulants (93.4%), statins (94.3%) and β-blockers (89.3%). Reperfusion therapy was performed in 62.6% of patients with STEMI (46.3% thrombolytic therapy and 17.3% primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7% and 79.5% of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0% of all patients.

Conclusions: Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2015-007786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679985PMC
December 2015

Frequency distribution of gastro esophageal reflux disease in inhalation injury: A historical cohort study.

J Res Med Sci 2015 Jul;20(7):636-9

Department of Neurology, Shahid Behashti University of Medical Sciences, Tehran, Iran.

Background: There is no data on the prevalence and the association of gastro esophageal reflux disease (GERD) with toxic fume inhalation. Therefore, we aimed to evaluate the frequency distribution of GERD symptoms among the individuals with mild respiratory disorder due to the past history of toxic fume exposure to sulfur mustard (SM).

Materials And Methods: In a historical cohort study, subjects were randomly selected from 7000 patients in a database of all those who had a history of previous exposure to a single high dose of SM gas during war. The control group was randomly selected from adjacent neighbors of the patients, and two healthy male subjects were chosen per patient. In this study, we used the validated Persian translation of Mayo Gastroesophageal Reflux Questionnaire to assess the frequency distribution of reflux disease.

Results: Relative frequency of GERD symptoms, was found to be significantly higher in the inhalation injury patients with an odds ratio of 8.30 (95% confidence interval [CI]: 4.73-14.55), and after adjustment for cigarette smoking, tea consumption, age, and body mass index, aspirin and chronic cough the odds ratio was found to be 4.41 (95% CI: 1.61-12.07).

Conclusion: The most important finding of our study was the major GERD symptoms (heartburn and/or acid regurgitation once or more per week) among the individuals with the past history of exposure to SM toxic gas is substantially higher (4.4-fold) than normal populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/1735-1995.166199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638064PMC
July 2015

Alterations in auditory change detection associated with tinnitus residual inhibition induced by auditory electrical stimulation.

J Am Acad Audiol 2015 Apr;26(4):408-22

Department of Otorhinolaryngology, Hannover Medical University (MHH), Hannover, Germany.

Background: Residual inhibition (RI) is a temporary phenomenon that happens following offset of appropriate complete or partial acoustical and electrical masking stimulations in people who experience tinnitus. The biologic mechanisms associated with RI are not yet fully understood. Few studies have been focused on RI. Auditory mismatch negativity (MMN) as a change-detection tool may be an appropriate tool to explore the processing changes because of tinnitus and RI.

Purpose: The purpose of this study was to investigate alterations in auditory change detection and auditory sensory memory related to RI induced by auditory electrical stimulation (AES) using MMN brain mapping in participants with tinnitus.

Research Design: This investigation was a single-blind randomized controlled clinical trial study. Participants were randomly assigned into two groups: AES and placebo electrical stimulation (PES).

Study Sample: Twenty-eight participants with chronic subjective tinnitus aged 22- to 45-yr-old participated in the study.

Intervention: After randomization, all participants received both AES and PES for 1 min in different sessions.

Data Collection And Analysis: Brain mapping of multifeature MMN paradigm was recorded from 29 scalp electrodes pre- and post-AES and PES. Following AES, participants were categorized into two groups: RI and nonresidual inhibition (NRI). The grand average MMN waveforms and isopotential topographic maps were obtained in RI, NRI, and PES groups.

Results: Three MMN parameters for five deviants of frequency, intensity, duration, location, and silent gap were compared among three groups of RI, NRI, and PES. Statistical analyses revealed significant between-subject effects for AES on MMN amplitude of frequency and duration deviant, MMN area under the curve of frequency, intensity, and duration deviants.

Conclusions: Presence of RI can reestablish change-detection mechanisms in the central auditory pathways. It is suggested that MMN is reliable for assessment of change-detection system in people with tinnitus. It can be a useful technique in monitoring effects of treatments and rehabilitation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3766/jaaa.26.4.8DOI Listing
April 2015

Alterations in early auditory evoked potentials and brainstem transmission time associated with tinnitus residual inhibition induced by auditory electrical stimulation.

Int Tinnitus J 2013 ;18(1):63-74

Department of Otorhinolaryngology - Medical University of Hannover (MHH), Hannover, Germany.

Introduction: Residual inhibition (RI) is the temporary inhibition of tinnitus by use of masking stimuli when the device is turned off.

Objective: The main aim of this study was to evaluate the effects of RI induced by auditory electrical stimulation (AES) in the primary auditory pathways using early auditory-evoked potentials (AEPs) in subjective idiopathic tinnitus (SIT) subjects.

Materials And Methods: A randomized placebo-controlled study was conducted on forty-four tinnitus subjects. All enrolled subjects based on the responses to AES, were divided into two groups of RI and Non-RI (NRI). The results of the electrocochleography (ECochG), auditory brain stem response (ABR) and brain stem transmission time (BTT) were determined and compared pre- and post-AES in the studied groups.

Results: The mean differences in the compound action potential (CAP) amplitudes and III/V and I/V amplitude ratios were significantly different between the RI, NRI and PES controls. BTT was significantly decreased associated with RI.

Conclusion: The observed changes in AEP associated with RI suggested some peripheral and central auditory alterations. Synchronized discharges of the auditory nerve fibers and inhibition of the abnormal activity of the cochlear nerve by AES may play important roles associated with RI. Further comprehensive studies are required to determine the mechanisms of RI more precisely.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5935/0946-5448.20130009DOI Listing
May 2015

Community-based newborn hearing screening programme for early detection of permanent hearing loss in Iran: an eight-year cross-sectional study from 2005 to 2012.

J Med Screen 2014 Mar 12;21(1):10-7. Epub 2014 Feb 12.

Director of Screening Group, State Welfare Organization (SWO) of Iran.

Objectives: We here present the results of the first eight years of the newborn hearing screening programme in Iran, with a view to establishing the prevalence of hearing impairment among infants, and the efficacy of the programme.

Methods: A total of 3,350,995 infants were screened using the series method of transient evoked otoacoustic emissions (TEOAEs)/automated auditory brainstem responses (AABRs), between 2005 and 2012. The infants were first tested for TEOAEs (three times). Based on the results of this test, the positive cases were referred to the next stage, where they were tested for AABRs. If they also tested positive on AABRs, they were referred to the diagnostic and rehabilitation stages.

Results: Results of this study indicated an infant hearing impairment prevalence of 3 per 1000. Although this rate was as high as 5 per 1000 in the early years of the programme, it decreased to 2.6 per 1000 in the last year. The absolute referral rate was 14.5% in the first stage, which decreased to 0.9% and 0.2% in the second and the third stages, respectively. The follow-up rate was 70% in the first stage, which increased up to 73% and 85% in the second and the third stages, respectively.

Conclusion: The study results suggest that the prevalence of hearing impairment in infants in Iran is comparable with that in developed and developing countries, and that the series TEOAEs/AABRs method used in the screening programme in Iran is efficient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0969141314522992DOI Listing
March 2014

Low-dose dobutamine stress echocardiography cannot predict mitral regurgitation reversibility after coronary artery bypass grafting.

J Thorac Cardiovasc Surg 2014 Oct 2;148(4):1323-7. Epub 2014 Jan 2.

Department of Cardiac Surgery, Day General Hospital, Tehran, Iran.

Background: The ideal management of ischemic mitral regurgitation (MR) remains a clinical dilemma because of the suboptimal available therapeutic options. Recently, new concepts have emerged, pointing to the benefits of a patient selection approach when debating the management of moderate ischemic MR. We investigated the predictability of low-dose dobutamine stress echocardiography (DSE) in selecting candidates for CABG with moderate MR for valve repair.

Methods: From November 2002 to May 2010, 110 candidates for first-time CABG, who were admitted to the cardiac surgery department in Day General Hospital (Tehran, Iran), were enrolled in the present cross-sectional study. DSE was performed for each case before CABG. Those with positive findings underwent CABG alone and those with negative results underwent concomitant CABG and mitral valve repair. The patients were followed up for a minimum of 60 months.

Results: Of the 110 patients, 47 (42.72%) had positive test results and underwent CABG alone and 63 (57.28%) had negative DSE results and underwent concomitant CABG and mitral valve repair. The MR degree had decreased from 2.8±0.3 preoperatively to 1.46±0.6 early during the hospital stay and 1.9±0.7 during late follow-up in the CABG group. It had decreased from 2.84±0.4 preoperatively to 0.93±0.65 postoperatively but then increased to 1.41±0.9 during late follow-up, for a significant decrease in the combined group (P<.05).

Conclusions: Despite its utility in selecting CABG patients with moderate ischemic MR for valve repair from a short-term perspective, the use of DSE cannot predict the long-term outcomes of these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2013.12.028DOI Listing
October 2014

Low-dose dobutamine stress echocardiography cannot predict mitral regurgitation reversibility after coronary artery bypass grafting.

J Thorac Cardiovasc Surg 2014 Oct 2;148(4):1323-7. Epub 2014 Jan 2.

Department of Cardiac Surgery, Day General Hospital, Tehran, Iran.

Background: The ideal management of ischemic mitral regurgitation (MR) remains a clinical dilemma because of the suboptimal available therapeutic options. Recently, new concepts have emerged, pointing to the benefits of a patient selection approach when debating the management of moderate ischemic MR. We investigated the predictability of low-dose dobutamine stress echocardiography (DSE) in selecting candidates for CABG with moderate MR for valve repair.

Methods: From November 2002 to May 2010, 110 candidates for first-time CABG, who were admitted to the cardiac surgery department in Day General Hospital (Tehran, Iran), were enrolled in the present cross-sectional study. DSE was performed for each case before CABG. Those with positive findings underwent CABG alone and those with negative results underwent concomitant CABG and mitral valve repair. The patients were followed up for a minimum of 60 months.

Results: Of the 110 patients, 47 (42.72%) had positive test results and underwent CABG alone and 63 (57.28%) had negative DSE results and underwent concomitant CABG and mitral valve repair. The MR degree had decreased from 2.8±0.3 preoperatively to 1.46±0.6 early during the hospital stay and 1.9±0.7 during late follow-up in the CABG group. It had decreased from 2.84±0.4 preoperatively to 0.93±0.65 postoperatively but then increased to 1.41±0.9 during late follow-up, for a significant decrease in the combined group (P<.05).

Conclusions: Despite its utility in selecting CABG patients with moderate ischemic MR for valve repair from a short-term perspective, the use of DSE cannot predict the long-term outcomes of these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2013.12.028DOI Listing
October 2014

Low-dose dobutamine stress echocardiography cannot predict mitral regurgitation reversibility after coronary artery bypass grafting.

J Thorac Cardiovasc Surg 2014 Oct 2;148(4):1323-7. Epub 2014 Jan 2.

Department of Cardiac Surgery, Day General Hospital, Tehran, Iran.

Background: The ideal management of ischemic mitral regurgitation (MR) remains a clinical dilemma because of the suboptimal available therapeutic options. Recently, new concepts have emerged, pointing to the benefits of a patient selection approach when debating the management of moderate ischemic MR. We investigated the predictability of low-dose dobutamine stress echocardiography (DSE) in selecting candidates for CABG with moderate MR for valve repair.

Methods: From November 2002 to May 2010, 110 candidates for first-time CABG, who were admitted to the cardiac surgery department in Day General Hospital (Tehran, Iran), were enrolled in the present cross-sectional study. DSE was performed for each case before CABG. Those with positive findings underwent CABG alone and those with negative results underwent concomitant CABG and mitral valve repair. The patients were followed up for a minimum of 60 months.

Results: Of the 110 patients, 47 (42.72%) had positive test results and underwent CABG alone and 63 (57.28%) had negative DSE results and underwent concomitant CABG and mitral valve repair. The MR degree had decreased from 2.8±0.3 preoperatively to 1.46±0.6 early during the hospital stay and 1.9±0.7 during late follow-up in the CABG group. It had decreased from 2.84±0.4 preoperatively to 0.93±0.65 postoperatively but then increased to 1.41±0.9 during late follow-up, for a significant decrease in the combined group (P<.05).

Conclusions: Despite its utility in selecting CABG patients with moderate ischemic MR for valve repair from a short-term perspective, the use of DSE cannot predict the long-term outcomes of these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2013.12.028DOI Listing
October 2014

Combination therapy for airflow limitation in COPD.

Daru 2012 28;20(1). Epub 2012 Aug 28.

Research Center of Chemical Injuries, Baqiyatallah Medical Sciences University, Tehran, Iran.

Unlabelled: Background and the purpose of the study Existing evidence confirms that no pharmacologic agent ameliorates the decline in the lung function or changes the prognosis of chronic obstructive pulmonary disease (COPD). We tried a critical combination therapy for management of COPD.

Methods: Current or past smoker (passive or active) COPD patients with moderate to severe COPD who did not respond to primitive therapy (i.e., oral prednisolone (50 mg in the morning) for 5 days; with Beclomethasone Fort (3 puff q12h, totally 1500 micrograms/day), Salmeterol (2 puffs q12h, 50 micrograms/puff) and ipratropium bromide (4 puffs q8h) for two months, enrolled to study. Furthermore they were received N-Acetylcysteine (1200 mg/daily), Azithromycin (tablet 250 mg/every other day) and Theophylline (100 mg BD).

Results: The study group consisted of 44 men and 4 women, with a mean age and standard deviation of 63.6 ± 12.7 years (range 22-86 years). Thirteen of 48 patients (27.0%) was responder based on 15% increasing in FEV 1 (27.7 ± 7.9) after 6.7 ± 6.1 months (57.9 ± 12.9 year old). There were statistically significant differences in age and smoking between responders and non-responders (P value was 0.05 and 0.04 respectively). There was no difference in emphysema and air trapping between two groups (p = 0.13).

Conclusion: Interestingly considerable proportion of patients with COPD can be reversible using combination drug therapy and patients will greatly benefit from different and synergic action of the drugs. The treatment was more effective in younger patients who smoke less.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/2008-2231-20-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514536PMC
December 2012

Vascular endothelial growth factor in bronchoalveolar lavage fluid in sulfur mustard exposed lung patients.

Oman Med J 2011 Mar;26(2):118-21

Objectives: To determine the levels of vascular endothelial growth factor isoform consisting of 165 amino acids (VEGF165) in Bronchoalveolar Lavage Fluid from Mustard Exposed Patients.

Methods: Bronchoscopy with Bronchoalveolar Lavage was performed on sulphur mustard exposed patients. A total of 39 patients with documented exposure to Sulfur Mustard during the Iran-Iraq war participated in this study, of which 38 patients were males and one patient was female.

Results: The mean±SD age of patients was 41 ± 6.6 years. The mean time after exposure to sulfur mustard was 19 ±1.7 years. Eighteen patients had concomitant war injuries but they were not related to the respiratory system. While Twenty-two patients had a history of submassive persistent hemoptysis. There was no case with massive hemoptysis. Most of the patients had small airway obstruction (FEV1/FVC% = 78.14 ± 9.76 and FEV1% =82.79±18.23). Twenty-three patients had significant air trapping in the chest. High Resolution Computed Tomography was compatible with BOS. VEGF165 concentrations in BALF were 36.87 ± 34.68 pg/ml. When corrected to total protein of Bronchoalveolar Lavage Fluid (BALF) it was 0.76 ± 0.70 pg/mg. BALF of VEGF did not correlate with hemoptysis or air trapping in chest HRCT. Thus, there was also no correlation between level of VEGF165 in BALF and any of PFT indexes (FVC, FEV1, MMEF or PEF).

Conclusions: Although VEGF is one of the cytokines which has an important role in chronic pulmonary disorders, it seems that it has no essential role in the severity of Mustard Lung Disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5001/omj.2011.29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191674PMC
March 2011

A tailored educational intervention improves doctor's performance in managing depression: a randomized controlled trial.

J Eval Clin Pract 2013 Feb 30;19(1):16-24. Epub 2011 Aug 30.

Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Rational And Objectives: To assess the effects of a tailored and activating educational intervention, based on a three-stage modified Prochaska model of readiness-to-change, on the performance of general physicians in primary care (GPs) regarding management of depressive disorders.

Methods: Parallel group, randomized control trial. Primary hypothesis was that performance would improve by 20 percentage units in the intervention arm. The setting was primary care in southern Tehran. The participants were 192 GPs stratified on stage of readiness-to-change, sex, age and work experience. The intervention was a 2-day interactive workshop for a small group of GPs' at a higher stage of readiness-to-change ('intention') and a 2-day interactive large group meeting for those with lower propensity to change ('attitude') at the pre-assessment. GPs in the control arm participated in a standard educational programme on the same topic. The main outcome measures were validated tools to assess GPs' performance by unannounced standardized patients, regarding diagnosis and treatment of depressive disorders. The assessments were made 2 months before and 2 months after the intervention.

Results: GPs in the intervention arm significantly improved their overall mean scores for performance regarding both diagnosis, with an intervention effect of 14 percentage units (P = 0.007), and treatment and referral, with an intervention effect of 20 percentage units (P < 0.0001). The largest improvement after the intervention appeared in the small group: 30 percentage units for diagnosis (P = 0.027) and 29 percentage units for treatment and referral (P < 0.0001).

Conclusions: Activating learning methods, tailored according to the participants' readiness to change, improved clinical performance of GPs in continuing medical education and can be recommended for continuing professional development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1365-2753.2011.01761.xDOI Listing
February 2013

Six year Trend in Cataract Surgical Techniques in Iran.

Middle East Afr J Ophthalmol 2011 Apr;18(2):150-3

Department of Clinical Research, Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran.

Purpose: To determine the cataract surgery techniques performed in Iran from 2000 to 2005.

Materials And Methods: This study was part of the Iranian Cataract Surgery Survey (ICSS) which was a retrospective cross-sectional study. All major ocular surgery units and 10% of randomly selected minor units throughout Iran were included. Excluding the 2 week Iranian New Year holiday, 1 week per season between 2000 and 2005 (a total of 24 weeks) was selected for each center, and data on all cataract surgeries performed during these weeks were collected by reviewing patient records. The ANOVA repeated measure test was performed to determine longitudinal changes with a P<0.05 denoting statistical significance.

Results: Phacoemulsification with intraocular lens (IOL) implantation has become the surgical method of choice in Iran, increasing from less than 7% in 2000 to 57% in 2005 (P<0.0001). Extracapsular cataract extraction showed a reverse trend compared to phacoemulsification, decreasing from greater than 91% in 2000 to 41% in 2005 (P<0.0001). Intracapsular cataract extraction and lensectomy were rarely performed without significant changes over time (P>0.05).

Conclusion: Phacoemulsification with IOL implantation has become the preferred cataract surgery method in Iran during recent years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0974-9233.80704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119284PMC
April 2011

Long-term effect of papillary muscle approximation combined with ventriculoplasty on left ventricle function in patients with ischemic cardiomyopathy and functional mitral regurgitation.

Eur J Cardiothorac Surg 2011 Sep 20;40(3):756-60. Epub 2011 Feb 20.

Day General Hospital, Tehran, Iran.

Objective: One of the mechanisms of development of functional mitral regurgitation after myocardial infarction is the increased papillary muscle distance which results due to ventricle remodeling. The aim of this study was to investigate the long-term effect of papillary muscle approximation (PMA) on the cardiac function of patients with ischemic cardiomyopathy and increased papillary muscle distance.

Methods: Thirty patients (22 males; mean age: 57.0 ± 7.4 years) selected for coronary artery bypass grafting (CABG) underwent ventriculoplasty. Additionally, 50% of the study population also underwent PMA (group 1). All the patients had preoperative grade 3 or 4 mitral regurgitation with an inter-papillary muscle distance > 2.5 cm. In group 1, the papillary muscles were drawn together using an encircling loop. Mitral annuloplasty and the Dor procedure were performed in all the patients. Follow-up time was 41.5 ± 5.8 months and 42.7 ± 3.3 months in groups 1 and 2, respectively (p-value=0.49).

Results: The two groups had no significant difference regarding the annulus diameter, ring size, number of grafts, and concavity area. There was one case of in-hospital mortality in each group, and one patient in group 2 had expired by the last follow-up. Postoperative echocardiography revealed significant changes in the concavity area, ejection fraction, and sphericity index in the PMA group by comparison to group 2 (p-value < 0.05).

Conclusions: In patients with ischemic mitral regurgitation and increased papillary muscle distance, PMA as an adjunct to CABG results in better left ventricle function and shape, even at long-term follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejcts.2011.01.007DOI Listing
September 2011

Scoring system for predicting saphenous vein graft patency in coronary artery bypass grafting.

Tex Heart Inst J 2010 ;37(5):525-30

Department of Cardiovascular Surgery, Day General Hospital, Tehran 1434873111, Iran.

The initial and long-term benefits of coronary artery bypass grafting depend upon maintaining the coronary blood flow supplied by the graft. In order to devise a scoring system for predicting graft patency, we evaluated presumptive correlations between saphenous vein graft patency and the characteristics of saphenous veins that were used as conduits in coronary revascularization.We prospectively evaluated 1,000 saphenous vein segments that were implanted in 403 consecutive patients who underwent on-pump coronary artery bypass grafting at our hospital from January 2006 through February 2009. Branches, varicosity, diameter, and wall thickness were evaluated, and a scoring system was created in order to obtain a value for each characteristic. The patients were postoperatively monitored for 1 year, and graft patency was then evaluated with the use of 64-slice multidetector computed tomography.Lesions were found in 12.3% of the grafts. All of the evaluated characteristics of the grafts had a significant correlation with saphenous vein graft flow (P <0.0001). Using the venous characteristics in our statistical analysis, we devised a formula to obtain a score (range, 4-12) to predict the patency of each graft. A cutoff score of 7 yielded 87.8% sensitivity and 82.8% specificity.Our scoring system has good prognostic value. We believe that it can assist surgeons in choosing the most appropriate conduit and target vessel for coronary artery bypass grafting, especially in high-risk patients who are particularly dependent on blood flow through saphenous vein grafts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953219PMC
February 2011

Papillary muscle repositioning in valve replacement for left ventricular dysfunction: ischemic mitral regurgitation.

Ann Thorac Surg 2010 Aug;90(2):497-502

Day General Hospital, Tehran, Iran.

Background: The aim of this study was to investigate the feasibility of performing papillary muscle repositioning (PMR) for subvalvular-sparing mitral valve replacement procedures in patients with ischemic mitral regurgitation and to determine the early and late effects of this procedure on the clinical outcome and left ventricular mechanics.

Methods: We prospectively randomly allocated 50 patients with severe ischemic mitral regurgitation and left ventricle dysfunction who were candidates for coronary artery bypass graft surgery and mitral valve replacement into a total chordal-sparing mitral valve replacement group or a PMR group. Echocardiography was performed preoperatively, at discharge, and after 3 years to determine the left ventricular dimensions, shape, and function.

Results: The reduction in the left ventricle volumes and sphericity index in the PMR group was more significant than that in the other group. With regard to the left ventricular end-systolic and left ventricular end-diastolic volumes, sphericity index, and ejection fraction, the PMR group showed better results (p < 0.05), but the difference in New York Heart Association functional class after 3 years was not statistically significant between the two groups (p > 0.05).

Conclusions: The PMR technique described herein can dramatically help ischemic patients by affecting the left ventricular shape and function more efficiently compared with the complete retention of the mitral subvalvular apparatus if the mitral valve is to be replaced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2010.04.060DOI Listing
August 2010

Social disparities in prevalence, treatment and control of hypertension in Iran: second National Surveillance of Risk Factors of Noncommunicable Diseases, 2006.

J Hypertens 2010 Aug;28(8):1620-9

Scientific Research Centre, Iran bSchool of Public Health, Tehran University of Medical Sciences, Iran cPhysiology Research Centre, Kerman University of Medical Sciences, Kerman, Iran.

Objective: Assessing hypertension prevalence, treatment and control by sociodemographic factors in Iran.

Methods: We analyzed data from the 2006 National Surveillance of Risk Factors for Noncommunicable Diseases of Iran with a population-based sample of almost 30,000 people aged 15-64 years. Multiple logistic regression models were used to explore differences in hypertension prevalence, treatment and control, adjusting for sociodemographic factors, comorbidities and behavioral factors.

Results: Hypertension prevalence was 17.37%. Among hypertensive patients, 33.35% were under treatment, and, among treated people, 35.10% had hypertension controlled. In multiple-regression analysis, age, male sex, low level of education, Kurd ethnicity, overweight and obesity, diabetes mellitus, lower level of physical activity and high-Human Development Index provinces were independently associated with higher prevalence of hypertension. Income and living in rural or urban area were not related to hypertension prevalence. Treatment rates were lower in men, younger people and people of low education and low income, but there were no treatment rate disparities connected to living area, ethnicity and provinces (by Human Development Index). In addition, diabetic patients, obese people and past daily smokers had higher treatment rates. Lower control rates were independently associated with male sex, higher age and lower education, but not with other variables.

Conclusion: In Iran, there is comparatively higher prevalence of hypertension among people of Kurdish ethnicity, people of low education and in high-Human Development Index provinces; a lower treatment rate among men, younger people, people of low education and low income; and a lower control rate among men and people of low education. These disparities should be addressed by researchers and health policy makers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HJH.0b013e32833a38f2DOI Listing
August 2010

Helium:oxygen versus air:oxygen noninvasive positive-pressure ventilation in patients exposed to sulfur mustard.

Heart Lung 2011 May-Jun;40(3):e84-9. Epub 2010 May 23.

Research Center of Chemical Injuries, Baqiyatallah Medical Science University, Tehran, Iran.

Exposure to sulfur mustard (SM) causes a variety of respiratory symptoms, such as chronic bronchitis and constrictive bronchiolitis. This study assessed the effectiveness of noninvasive positive-pressure ventilation, adjunct with 79:21 helium:oxygen instead of 79:21 air:oxygen, in 24 patients with a previous exposure to SM presenting with acute respiratory failure. Both air:oxygen and helium:oxygen significantly decreased systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse rate, respiratory rate, dyspnea, and increased oxygen saturation (P values: .007, .029, .002, <.001, <.001, <.001, and .002 for air:oxygen, respectively, and <.001, .020, .001, <.001, <.001, <.001, and .002, for helium:oxygen, respectively). Moreover, helium:oxygen more potently improved systolic pressure, mean arterial pressure, pulse rate, respiratory rate, and dyspnea (P values: .012, .048, <.001, <.001, and .012, respectively). The results of our study support the benefit of using helium:oxygen adjunct with noninvasive positive-pressure ventilation in patients exposed to SM with acute respiratory decompensation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrtlng.2010.04.001DOI Listing
September 2011

Echo rejection score: new echocardiographic approach to diagnosis of heart transplant rejection.

Eur J Cardiothorac Surg 2010 Aug 30;38(2):176-80. Epub 2010 Mar 30.

Shariati General Hospital, Tehran, Iran.

Objective: The gold standard test in the diagnosis of heart transplant rejection is right ventricular (RV) myocardial biopsy, which is an invasive, time-consuming, expensive method. In an effort to find a reliable method to minimise the sequential use of myocardial biopsy, we assessed the main echocardiographic indices for the detection of allograft rejection.

Materials And Methods: Fifty myocardial specimens were examined in this prospective study, which assessed the prominent echocardiographic parameters propounded by previous studies as indicators of rejection. Prior to biopsy, all the patients underwent preoperative transthoracic echocardiography. The accuracy of the echocardiographic indices was compared with that of myocardial biopsy indices as the gold standard. At three myocardial segments, namely, RV base, interventricular septal (Sep) base and lateral left ventricular (Lat) base, peak systolic strain (RV-S, Lat-S and Sep-S) was measured. In addition, time to systole (TS) was measured at the same three segments, yielding the three variables of RV-TS, Sep-TS and Lat-TS.

Results: Our logistic regression model revealed that the four factors of Lat-S (%), Sep-TS (ms), posterior wall thickness (PWT; mm) and left ventricular mass index (LVMI; g m(-2)) could denote heart transplant rejection. We devised a new index, the echo rejection score, using the following formula: [(PWT+LVMI)-(Lat-S+Sep-TS)]. This new formula has an area under a curve of 0.932 and a cut-off point of 0; it yields a sensitivity of 100.0%, specificity of 71.0%, positive predictive value of 67.9% and a negative predictive value of 100.0%. If the echo rejection score is >0, there is a 67.9% possibility that a cardiac transplant patient is presenting with allograft rejection, while a score < or =0 denotes a 100% improbability of rejection.

Conclusion: Our proposed method for screening patients at risk of acute cardiac rejection with echo rejection score showed a good sensitivity in detection of graft rejection. However, further study is required to determine if it can be used as an adjunct to the myocardial biopsy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejcts.2009.12.045DOI Listing
August 2010

Echocardiographic approach to the decision-making process for tricuspid valve repair.

J Thorac Cardiovasc Surg 2010 Jun 11;139(6):1483-7. Epub 2009 Nov 11.

Day General Hospital, Tehran, Iran.

Objective: Commonly used procedures to repair functional tricuspid regurgitation have a high failure rate. The present study was designed to lower this failure rate by reducing leaflet tethering via pericardial patch augmentation when the preoperative probability of recurrence was high.

Methods: Between 2001 and 2007, 210 patients with severe functional tricuspid regurgitation underwent tricuspid valve repair at the Day General Hospital. With respect to the type of repair, the patients were randomly divided into 4 groups: (1) De Vega in 52 patients; (2) ring annuloplasty in 53 patients; (3) De Vega and, if indicated by the preoperative tethering index (tethering distance > 8 mm or tethering area > 16 mm(2)), pericardial patch augmentation in 53 patients; and (4) ring annuloplasty and, if indicated by the preoperative tethering index (tethering distance > 8 mm or tethering area > 16 mm(2)), pericardial patch augmentation in 52 patients. The results of 1-month and 1-year postoperative tricuspid regurgitation were evaluated.

Results: Fifteen patients in group 3 and 15 patients in group 4 met the criterion for the complementary procedure. Postoperative tricuspid regurgitation was different between the groups (P < .05): 16.0% and 28.0% of patients in the De Vega group, 8.0% and 14.0% of patients in the ring annuloplasty group, 4.0% and 10.0% of patients in the De Vega + pericardial patch augmentation group, and 2.0% and 8.0% of patients in the ring annuloplasty + pericardial patch augmentation group had postoperative tricuspid regurgitation at 1-month and 1-year follow-up, respectively.

Conclusion: An assessment of preoperative tricuspid valve tethering to select patients suitable for augmentation contributes to a good surgical outcome in patients with severe functional tricuspid regurgitation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2009.08.035DOI Listing
June 2010

Effects on knowledge and attitudes of using stages of change to train general practitioners on management of depression: a randomized controlled study.

Can J Psychiatry 2009 Oct;54(10):693-700

Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

Objective: To assess the impact on knowledge and attitudes of a tailored educational intervention on depression using a modified version of the Prochaska stages of change model, compared with standard continuing medical education, for general practitioners (GPs) in primary care in Iran.

Method: Using a randomized controlled trial, a total of 192 GPs were evenly randomized to intervention or control arm. The topic for the educational intervention was depressive disorders. The participants were divided in to small and large groups, depending on their initial stage of change. The GPs' knowledge and skills regarding management of depressive disorders were assessed through a questionnaire with 7 multiple choice questions, 11 Likert statements, 3 case vignettes, and 1 essay question. Attitudes toward management of depressive disorders were also assessed. Both questionnaires were validated.

Results: There was a significant improvement in knowledge mean scores regarding multiple choice and Likert questions (intervention effect 6%; P = 0.002), as well as for the case vignettes and essay question (intervention effect 12%; P = 0.011) in the intervention arm, in comparison with the control arm. There were significant changes in mean attitude scores in both study arms, but no difference between them.

Conclusions: A theoretical model of medical learning and behavioural change can be used to devise educational formats that suit different stages of learning. Such tailored educational formats can improve GPs' knowledge and skills regarding management of depressive disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/070674370905401006DOI Listing
October 2009

Prevention of atrial fibrillation after coronary artery bypass grafting via atrial electromechanical interval and use of amiodarone prophylaxis.

Interact Cardiovasc Thorac Surg 2009 Apr 14;8(4):421-5. Epub 2009 Jan 14.

Day General Hospital, Tavanir St, Vali Asr Ave, Tehran, Iran.

In our previous study, we defined a cut-off point of 120 ms for atrial electromechanical interval (AEMi) to determine the risk of atrial fibrillation (AF) occurrence. Accordingly, the present study sought to investigate whether or not a prophylactic perioperative administration of amiodarone could reduce the incidence of AF in a high-risk group (AEMi >120 ms) undergoing coronary artery bypass grafting (CABG). In this prospective, randomized study, 100 patients with AEMi >120 ms received either amiodarone (n=50) or placebo (n=50). The endpoints were AF occurrence after CABG and hospital and intensive care unit (ICU) lengths of stay after CABG. The incidence of postoperative AF was significantly higher in the placebo group than that of the amiodarone group (88% of patients in control group vs. 16% of patients in amiodarone group, P<0.0001). The prophylactic therapy with amiodarone significantly reduced the ICU length of stay (2.28+/-1.00 vs. 3.60+/-0.90 days, P<0.0001) and hospital length of stay (5.64+/-2.35 vs. 7.78+/-1.46 days, P<0.0001). The incidence of postoperative AF among patients with high AEMi was significantly reduced by a prophylactic amiodarone treatment, resulting in shorter ICU and hospital stays.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1510/icvts.2008.191403DOI Listing
April 2009

Interaction between two predictors of functional outcome after revascularization in ischemic cardiomyopathy: left ventricular volume and amount of viable myocardium.

J Thorac Cardiovasc Surg 2008 Oct 12;136(4):930-6. Epub 2008 May 12.

Day General Hospital, Tehran, Iran.

Objective: In patients with ischemic cardiomyopathy and substantial amounts of dysfunctional but viable myocardium, revascularization cannot always improve the left ventricular ejection fraction. We sought to investigate the interaction between the left ventricular volume and the amount of viable myocardium to predict the left ventricular ejection fraction increase after revascularization.

Methods: Eighty-five consecutive patients with a depressed left ventricular ejection fraction (mean: 27.3% +/- 5.2%) underwent coronary artery bypass grafting after a dobutamine stress echocardiography had determined that they had at least 4 viable segments. Six months after coronary artery bypass grafting, left ventricular ejection fraction and regional wall motion were reassessed.

Results: Although the left ventricular ejection fraction was expected to recover more than 5% in all 85 patients after coronary artery bypass grafting, it did not improve in 15 patients (17.6%) despite the presence of viable segments. The likelihood of the left ventricular ejection fraction recovery decreased proportionally with an increase in the left ventricular end-systolic volume. The nonimprovers had a higher left ventricular end-systolic volume (164.2 +/- 22.4 mL vs 125.6 +/- 23.4 mL, P = .0001). In addition, the number of viable segments during the dobutamine stress echocardiography had a significant correlation with the ejection fraction increase after 6 months (P < .0001). Patients with 6 viable segments showed a good outcome irrespective of their left ventricular end-systolic volume. In patients with fewer than 6 viable segments, left ventricular end-systolic volume was a major factor in the prognosis: Patients with left ventricular end-systolic volume of 145 or more had a poor left ventricular ejection fraction increase and vice versa.

Conclusion: The extent of left ventricular remodeling determines the rate of functional improvement after coronary artery bypass grafting. Patients with a high left ventricular end-systolic volume and fewer than 6 viable segments have a lower likelihood of improvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2007.11.061DOI Listing
October 2008

N-acetylcysteine improves the clinical conditions of mustard gas-exposed patients with normal pulmonary function test.

Basic Clin Pharmacol Toxicol 2008 Nov 17;103(5):428-32. Epub 2008 Sep 17.

Research Center of Chemical Injuries, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Administration of N-acetylcysteine may be effective in diseases caused by oxidative-antioxidative imbalance. We aimed to determine the effect administration for 4 months of N-acetylcysteine (1200 mg daily) on sulfur mustard-induced bronchiolitis obliterans in patients with normal pulmonary function test. In a double-blind clinical trial, 144 patients with bronchiolitis obliterans due to sulfur mustard and bronchiolitis obliterans syndrome class 0, randomly entered to group 1 (n = 72, N-acetylcysteine) and group 2 (n = 72, placebo). The changes in dyspnoea, wake-up dyspnoea, cough and sputum were measured after 4 months using a 'delta value' (i.e. symptom score after 4 months--symptom score before the trial). Spirometric findings were measured at the beginning of the trial, 2 months later and 4 months later. Dyspnoea (delta value: -0.78 (0.61), P < 0.001), wake-up dyspnoea (delta value: -0.57 (0.64), P < 0.001), and cough (delta value: -0.86 (0.63), P < 0.001) improved after 4 months of N-acetylcysteine administration compared to the control group. N-acetylcysteine reduced sputum from 76.9% (n = 40) of cases before the trial to 9.6% (n = 5) of cases after the trial. Spirometric components were significantly improved in N-acetylcysteine group compared to the placebo group: FEV1 (P < 0.0001), FVC (P = 0.014) and FEV1/FVC (P = 0.003). A 4-month trial with 1200 mg oral N-acetylcysteine per day can be used for treating bronchitis, but is also effective in treating bronchiolitis. It also prevents sulfur mustard-induced oxidative stress, and can be used in the treatment of sulfur mustard-induced pulmonary disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1742-7843.2008.00318.xDOI Listing
November 2008

Furosemide inhalation in dyspnea of mustard gas-exposed patients: a triple-blind randomized study.

Inhal Toxicol 2008 Jul;20(9):873-7

Research Center of Chemical Injuries, Baqiyatallah Medical Science University, Tehran, Iran.

Dyspnea is the hallmark symptom of some respiratory diseases such as chronic obstructive pulmonary disease and bronchiolitis and is a major reason for which these patients seek medical attention. We performed a randomized triple-blind controlled crossover clinical trial in which we compared the efficacy of inhaled furosemide (4 ml equal to 40 mg in 10 min) with placebo (4 ml of 0.9% saline solution) in 41 mustard gas-exposed patients. Dyspnea index, visual analog scale (VAS), and pulmonary function test results were obtained before and 4 h after treatments. Results showed that both furosemide and placebo significantly decreased VAS and dyspnea index and increased FEV(1), FVC, and FEV(1)/FVC, while there was no difference between the two drugs in these effects (p values .23, .61, .81, .36, and .27, respectively). Our results failed to address the previously reported effects of inhaled furosemide on dyspnea. In fact, we suggest that patients with a previous exposure to sulfur mustard, in which chronic bronchitis and bronchiolitis are the most suggested underlying mechanisms, may not benefit from furosemide to alleviate their dyspnea.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08958370701861520DOI Listing
July 2008

The effect of adding homeopathic treatment to rehabilitation on muscle tone of children with spastic cerebral palsy.

Complement Ther Clin Pract 2008 Feb 27;14(1):33-7. Epub 2007 Dec 27.

Department of Clinical Sciences, University of Welfare & Rehabilitation, Koodakyar Street, Daneshjoo Building, Evin 1985713834 Tehran, Iran.

Objective: To determine the effect of adding homeopathic treatment to routine rehabilitation techniques on muscle tone of children with spastic cerebral palsy (CP).

Methods: This study was a double-blind clinical trial. Twenty-four subjects were recruited from a developmental disorders clinic in Tehran in 2004. Subjects were divided into case and control groups. The routine rehabilitation techniques were carried out for 4 months on both the groups. The control group received placebo and the case group received homeopathy drugs. Both groups were evaluated and compared for muscle tone before and 4 months after treatment using the Modified Ashworth Scale.

Results: Showed no positive changes in the patients with homeopathy and occupational therapy at the end of treatment, and there were no statistically significant differences in tonicity of upper and lower limbs, trunk and neck in the case group in comparison with the control group.

Conclusion: Adding homeopathy to rehabilitation had no significant effect on spasm of CP children as measured by Ashworth test.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ctcp.2007.11.001DOI Listing
February 2008