Publications by authors named "Hamidreza Abtahi"

30 Publications

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Suggesting a framework for preparedness against the pandemic outbreak based on medical informatics solutions: a thematic analysis.

Int J Health Plann Manage 2021 Jan 27. Epub 2021 Jan 27.

Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.

Background: When an outbreak emerged, each country needs a coherent and preventive plan to deal with epidemics. In the era of technology, adopting informatics-based solutions is essential. The main objective of this study is to propose a conceptual framework to provide a rapid and responsive surveillance system against pandemics.

Methods: A three-step approach was employed in this research to develop a conceptual framework. These three steps comprise (1) literature review, (2) extracting and coding concepts, and determining main themes based on thematic analysis using ATLAS.ti® software, and (3) mapping concepts. Later, all of the results synthesized under expert consultation to design a conceptual framework based on the main themes and identified strategies related to medical informatics.

Results: In the literature review phase, 65 articles were identified as eligible studies for analysis. Through line by line coding in thematic analysis, more than 46 themes were extracted as potential foremost themes. Based on the key themes and strategies were employed by studies, the proposed framework designed in three main components. The most appropriate strategies that can be used in each section were identified based on the demands of each part and the available solutions. These solutions were employed in the final framework.

Conclusion: The presented model in this study can be the first step for a better understanding of the potential of medical informatics solutions in promoting epidemic disease management. It can be applied as a reference model for designing intelligent surveillance systems to prepare for probable future pandemics.
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http://dx.doi.org/10.1002/hpm.3106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014158PMC
January 2021

Bronchoscope motion tracking using centerline-guided Gaussian mixture model in navigated bronchoscopy.

Phys Med Biol 2021 Jan 14;66(2):025001. Epub 2021 Jan 14.

Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran. Research Centre of Biomedical Technology and Robotics (RCBTR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Electromagnetic-based navigation bronchoscopy requires accurate and robust estimation of the bronchoscope position inside the bronchial tree. However, respiratory motion, coughing, patient movement, and airway deformation inflicted by bronchoscope significantly hinder the accuracy of intraoperative bronchoscopic localization. In this study, a real-time and automatic registration procedure was proposed to superimpose the current location of the bronchoscope to corresponding locations on a centerline extracted from bronchial computed tomography (CT) images. A centerline-guided Gaussian mixture model (CG-GMM) was introduced to register a bronchoscope's position concerning extracted centerlines. A GMM was fitted to bronchoscope positions where the orientation likelihood was chosen to assign the membership probabilities of the mixture model, which led to preserving the global and local structures. The problem was formulated and solved under the expectation maximization framework, where the feature correspondence and spatial transformation are estimated iteratively. Validation was performed on a dynamic phantom with four different respiratory motions and four human real bronchoscopy (RB) datasets. Results of the experiments conducted on the bronchial phantom showed that the average positional tracking error using the proposed approach was equal to 1.98 [Formula: see text] 0.98 mm that was reduced in comparison with independent electromagnetic tracking (EMT), iterative closest point (ICP), and coherent point drift (CPD) methods by 64%, 58%, and 53%, respectively. In the patient assessment part of the study, the average positional tracking error was 4.73 [Formula: see text] 4.76 mm and compared to ICP, and CPD methods showed 31.4% improvement of successfully tracked frames. Our approach introduces a novel method for real-time respiratory motion compensation that provides reliable guidance during bronchoscopic interventions and, thus could increase the diagnostic yield of transbronchial biopsy.
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http://dx.doi.org/10.1088/1361-6560/abca07DOI Listing
January 2021

Ventilator-associated Pneumonia: Multidrug Resistant Acinetobacter vs. Extended Spectrum Beta Lactamase-producing Klebsiella.

J Infect Dev Ctries 2020 06 30;14(6):660-663. Epub 2020 Jun 30.

Department of Infectious Diseases, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Ventilator-associated pneumonia (VAP) has been considered as a healthcare-associated infection with high mortality. Acinetobacter baumannii and Klebsiella pneumoniae are the common causes of VAPs around the world.

Methodology: This research was a retrospective observational study in the intensive care unit (ICU) in a tertiary referral collegiate hospital in Tehran between March 2016 and May 2018. Patients who fulfilled VAP due to documented Multidrug Resistant Acinetobacter baumannii (MDR-AB) or Extended Spectrum Beta Lactamase-producing Klebsiella pneumoniae (ESBL-KP) criteria were enrolled. General demographic features, duration of hospital stay, antimicrobial treatment regimens, duration of ICU admission, the period of mechanical ventilation (MV) and 30-day mortality were documented and compared.

Results: 210 patients were found with clinical, microbiological and radiological evidence of VAP. In total, 76 patients with MDR-AB and 76 patients with ESBL-KP infections were matched in the final analysis. Duration of hospitalization in the patients with MDR-AB was significantly more than that of patients infected with ESBL-KP (p-value: 0.045). Patients diagnosed with MDR-AB VAP had a 65.8% mortality rate compared to 42.1% in the ESBL-KP infection group (p = 0.003).

Conclusions: Results of the present study demonstrated that VAPs caused by MDR-AB may be more hazardous than ESBL-KP VAPs because they could be accompanied by a longer hospitalization course and even a higher mortality.
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http://dx.doi.org/10.3855/jidc.12889DOI Listing
June 2020

Whole exome sequencing identifies novel compound heterozygous pathogenic variants in the MYO15A gene leading to autosomal recessive non-syndromic hearing loss.

Mol Biol Rep 2020 Jul 4;47(7):5355-5364. Epub 2020 Jul 4.

Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Autosomal recessive non-syndromic hearing loss (ARNSHL) is a highly heterogeneous disease, for which more than 70 genes have been identified. MYO15A mutations have been reported to cause congenital severe-to-profound HL. In this study, we applied the whole exome sequencing (WES) to find the cause of HL in an Iranian family. A proband from an Iranian non-consanguineous family with hearing impaired parents, was examined via WES, after excluding GJB2 mutations as the most common ARNSHL gene via Sanger sequencing. Co-segregation analysis of the candidate variant was done in the family members. Interpretation of variants was according to the American College of Medical Genetics and Genomics (ACMG) guidelines. WES results showed novel compound heterozygous variants (p.Arg1507Ter and p.Val2815Valfs*10) in the MYO15A gene. These two variants, residing in highly conserved regions, were found to be co-segregating in the family and fulfill the criteria of being categorized as pathogenic, according to the ACMG guidelines. Here, we report successful application of WES to identify the molecular pathogenesis of ARNSHL in a patient with ARNSHL, as an example of an extremely heterogeneous disease. In agreement with previous studies, MYO15A is regarded to be important in causing HL in Iran.
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http://dx.doi.org/10.1007/s11033-020-05618-wDOI Listing
July 2020

A novel pathogenic variant in the LRTOMT gene causes autosomal recessive non-syndromic hearing loss in an Iranian family.

BMC Med Genet 2020 06 9;21(1):127. Epub 2020 Jun 9.

Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Hearing loss (HL) is the most common sensorineural disorder with high phenotypic and genotypic heterogeneity, which negatively affects life quality. Autosomal recessive non-syndromic hearing loss (ARNSHL) constitutes a major share of HL cases. In the present study, Whole exome sequencing (WES) was applied to investigate the underlying etiology of HL in an Iranian patient with ARNSHL.

Methods: A proband from an Iranian consanguineous family was examined via WES, following GJB2 sequencing. WES was utilized to find possible genetic etiology of the disease. Various Bioinformatics tools were used to assess the pathogenicity of the variants. Co-segregation analysis of the candidate variant was carried out. Interpretation of variants was performed according to the American College of Medical Genetics and Genomics (ACMG) guidelines.

Results: WES results showed a novel frameshift (16 bp deletion) variant (p.Ala170Alafs*20) in the LRTOMT gene. This variant, which resides in exon 6, was found to be co-segregating in the family. It fulfils the criteria set by the ACMG guidelines of being pathogenic.

Conclusion: Here, we report successful application of WES to identify the molecular pathogenesis of ARNSHL, which is a genetically heterogeneous disorder, in a patient with ARNSHL.
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http://dx.doi.org/10.1186/s12881-020-01061-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285524PMC
June 2020

A Novel Cadherin 23 Variant for Hereditary Hearing Loss Reveals Additional Support for a DFNB12 Nonsyndromic Phenotype of CDH23.

Audiol Neurootol 2020 2;25(5):258-262. Epub 2020 Jun 2.

Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,

Background And Objectives: Identification of the pathogenic mutations underlying hereditary hearing loss (HL) is difficult, since causative mutations in 60 different genes have so far been reported.

Methods: A comprehensive clinical and pedigree examination was performed on a multiplex family suffering from HL. Direct sequencing of GJB2 and genetic linkage analysis of 5 other most common recessive nonsyndromic HL (ARNSHL) genes were accomplished. Next-generation sequencing (NGS) was utilized to reveal the possible genetic etiology of the disease.

Results: NGS results showed a novel rare variant c.2977G>A (p.Asp993Asn) in the CDH23 gene. The variant, which is a missense in exon 26 of the CDH23 gene, fulfills the criteria of being categorized as pathogenic according to the American College of Medical Genetics and Genomics (ACMG) guideline. Electroretinography rejects the Usher syndrome in the family.

Conclusions: The present study shows that an accurate molecular diagnosis based on NGS technologies largely improves molecular-diagnostic outcome and thus genetic counseling, and helps to clarify the recurrence risk in deaf families.
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http://dx.doi.org/10.1159/000506500DOI Listing
June 2020

Systematic review of using medical informatics in lung transplantation studies.

Int J Med Inform 2020 04 5;136:104096. Epub 2020 Feb 5.

Ph.D. student in Medical Informatics, Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Lung transplantation is one of the advanced treatment options performed even in patients suffering from end-stage lung disease. Due to the positive results of medical informatics in other fields of medicine, lung transplant researchers have also conducted remarkable studies to improve transplant outcomes. The main objective of this article was to review the current studies of health information technology used in lung transplantation.

Methods: A systematic search was performed in four scientific databases (Web of Science, Scopus, Science Direct, and PubMed) from January 2000 to December 2018. The criteria for inclusion were included in any study describing the use of health information technology or medical informatics in terms of lung transplantation, English papers, and original researchers. The retrieved articles were accordingly screened based on the inclusion and exclusion criteria to select relevant studies. The survey and synthesis of included articles were conducted based on predefined classification.

Results: Out of 263 articles, 27 studies met our inclusion criteria. All included studies involved the application of health information technology in lung transplantation. The types of health information technology methods applied in reviewed articles included mhealth (11.1 %), DSS (7.4 %), decision aid tools (7.4 %), telemedicine (22.2 %), AI methods (11.1 %), data mining (37 %), and patient education (3.7 %). The majority of studies (88.9 %) showed the positive impact of health information technology to enhance lung transplantation outcomes. Finally, the main approaches in different phases of lung transplantation processes were interpreted and summarized in the visual model.

Conclusion: This systematic review provides new insights regarding the application of medical informatics in the lung transplantation domain. The missing areas of medical informatics in the lung transplantation domain were recognized through this study.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104096DOI Listing
April 2020

Whole Genome Sequencing Results Associated with Minimum Inhibitory Concentrations of 14 Anti-Tuberculosis Drugs among Rifampicin-Resistant Isolates of from Iran.

J Clin Med 2020 Feb 7;9(2). Epub 2020 Feb 7.

Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran 1417653911, Iran.

Accurate and timely detection of drug resistance can minimize the risk of further resistance development and lead to effective treatment. The aim of this study was to determine the resistance to first/second-line anti-tuberculosis drugs in rifampicin/multidrug-resistant (RR/MDR-MTB) isolates. Molecular epidemiology of strains was determined using whole genome sequencing (WGS)-based genotyping. A total of 35 RR/MDR-MTB isolates were subjected to drug susceptibility testing against first/second-line drugs using 7H9 Middlebrook in broth microdilution method. Illumina technology was used for paired-end WGS applying a Maxwell 16 Cell DNA Purification kit and the NextSeq platform. Data analysis and single nucleotide polymorphism calling were performed using MTBseq pipeline. The genome-based resistance to each drug among the resistant phenotypes was as follows: rifampicin (97.1%), isoniazid (96.6%), ethambutol (100%), levofloxacin (83.3%), moxifloxacin (83.3%), amikacin (100%), kanamycin (100%), capreomycin (100%), prothionamide (100%), D-cycloserine (11.1%), clofazimine (20%), bedaquiline (0.0%), and delamanid (44.4%). There was no linezolid-resistant phenotype, and a bedaquiline-resistant strain was wild type for related genes. The Beijing, Euro-American, and Delhi-CAS were the most populated lineage/sublineages. Drug resistance-associated mutations were mostly linked to minimum inhibitory concentration results. However, the role of well-known drug-resistant genes for D-cycloserine, clofazimine, bedaquiline, and delamanid was found to be more controversial.
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http://dx.doi.org/10.3390/jcm9020465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073636PMC
February 2020

Therapeutic effects of nebulized verapamil on chronic obstructive pulmonary disease: A randomized and double-blind clinical trial.

Clin Respir J 2020 Apr 20;14(4):370-381. Epub 2020 Jan 20.

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

Objectives: In this study, we assessed the clinical effect of inhaled verapamil on hospitalized COPD patients in a randomized and double-blind study.

Method: COPD patients randomly received 10 mg of inhaled verapamil or 4 cc nebulized distilled water (DW) as placebo.

Results: Twenty patients enrolled in each group with no difference in baseline characteristics. Mean age was 64.95 ± 8.9 and 66.9 ± 10.74 years in verapamil and control group; respectively, (P > 0.05). The mean dyspnea score was 6.4 ± 1.2 and 6.2 ± 1.8 in the verapamil and control group, respectively and decreased to 4.9 ± 1.3 and 5.7 ± 1.8 after the intervention. The mean change in the verapamil group was significantly higher, (22.43% ± 10.6% vs 8.7% ± 12.1%), P = 0.00. Unlike the control group, the FEV1 value in the verapamil group significantly increased and reached to 1.17 ± 0.4 L from 1.03 ± 0.4. There was a significant decrease in airway resistance in both groups after intervention. However, neither total lung capacity and residual volume nor forced vital capacity changed significantly. Moreover, oxygen saturation in the verapamil group changed 4.8% ± 2.5% and this improvement in the control group was 1.8 ± 1 (P = 0.00). Smoker subjects, ones with PAP more than 35 mm Hg and obese patients benefit from verapamil.

Conclusion: The beneficial impact of inhaled verapamil on the diminishing of dyspnea score along with its bronchodilatory effect would make this selective calcium blocker agent a therapeutic option in COPD.
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http://dx.doi.org/10.1111/crj.13142DOI Listing
April 2020

Screening of 10 DFNB Loci Causing Autosomal Recessive Non-Syndromic Hearing Loss in Two Iranian Populations Negative for Mutations.

Iran J Public Health 2019 Sep;48(9):1704-1713

Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Autosomal recessive non-syndromic hearing loss (ARNSHL), one of the global public health concerns, is marked by a high degree of genetic heterogeneity. The role of as the most common cause of ARNSHL, is only <20% in the Iranian population. Here, we aimed to determine the relative contribution of several apparently most common loci in a cohort of ARNSHL Iranian families that were negative for the mutations.

Methods: Totally, 80 Iranian ARNSHL families with 3 or more affected individuals from Isfahan and Hamedan provinces, Iran were enrolled in 2017. After excluding mutations in the gene via Sanger sequencing, 60 negative samples (30 families from each province) were analyzed using homozygosity mapping for 10 ARNSHL loci.

Results: Fourteen families were found to be linked to five different known loci, including DFNB4 (5 families), DFNB2 (3 families), DFNB7/11 (1 family), DFNB9 (2 families) and DFNB3 (3 families).

Conclusion: Despite the high heterogeneity of ARNSHL, the genetic causes were determined in 23.5% of the studied families using homozygosity mapping. This data gives an overview of the ARNSHL etiology in the center and west of Iran, used to establish a diagnostic gene panel including most common loci for hearing loss diagnostics.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825662PMC
September 2019

A Novel Pathogenic Variant in the CABP2 Gene Causes Severe Nonsyndromic Hearing Loss in a Consanguineous Iranian Family.

Audiol Neurootol 2019 29;24(5):258-263. Epub 2019 Oct 29.

Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,

Background And Objectives: Hereditary hearing loss (HL) can originate from mutations in one of many genes involved in the complex process of hearing. CABP2 mutations have been reported to cause moderate HL. Here, we report the whole exome sequencing (WES) of a proband presenting with prelingual, severe HL in an Iranian family.

Methods: A comprehensive family history was obtained, and clinical evaluations and pedigree analysis were performed in the family with 2 affected members. After excluding mutations in the GJB2 gene and 7 other most common autosomal recessive nonsyndromic HL (ARNSHL) genes via Sanger sequencing and genetic linkage analysis in the family, WES was utilized to find the possible etiology of the disease.

Results: WES results showed a novel rare variant (c.311G>A) in the CABP2gene.This missense variant in the exon 4 of the CABP2gene meets the criteria of being pathogenic according to the American College of Medical Genetics and Genomics (ACMG) interpretation guidelines.

Conclusions: Up to now, 3 mutations have been reported for the CABP2gene to cause moderate ARNSHL in different populations. Our results show that CABP2variantsalso cause severe ARNSHL, adding CABP2to the growing list of genes that exhibit phenotypic heterogeneity. Expanding our understanding of the mutational spectrum of HL genes is an important step in providing the correct clinical molecular interpretation and diagnosis for patients.
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http://dx.doi.org/10.1159/000502251DOI Listing
May 2020

Therapeutic Effect of Intratympanic Injection of Dexamethasone plus Hyaluronic Acid on Patients with Meniere's disease.

Iran J Otorhinolaryngol 2019 Jul;31(105):217-223

School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.

Introduction: Intratympanic therapy, as a widely used treatment for inner ear diseases, is regarded as a therapeutic method in controlling the vertigo of the patients with Meniere's disease. This study was designed to evaluate the effect of the Intratympanic dexamethasone-hyaluronic acid combination on patients suffering from Meniere's disease.

Materials And Methods: This study was a clinical trial on patients with Meniere's disease during 2016-2017. Patients received two Intratympanic injections of dexamethasone plus hyaluronic acid as a mixture within a month. Before and 2 weeks after the intervention, pure tone average (PTA) at 0.5, 1, 2, and 4 KHz frequencies, speech discrimination score (SDS), dizziness handicap inventory (DHI), and tinnitus handicap inventory (THI) scores were evaluated for each patient. The obtained scores were statistically analyzed.

Results: This study was conducted on a total number of 25 patients with Meniere's disease. The mean age of participants in this study was 44.71±4.92 years. Gender distribution among participants revealed that 36% of patients were male. The mean values of PTA, SDS, and THI were not significantly different before and after the intervention. However, the mean score of DHI decreased significantly after the intervention (P<0.001).

Conclusion: Intratympanic dexamethasone/hyaluronic acid had a positive effect on the vertigo of the investigated patients without any significant improvement in hearing impairment and tinnitus in the short term.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6666937PMC
July 2019

Molecular epidemiology of otomycosis in Isfahan revealed a large diversity in causative agents.

J Med Microbiol 2019 Jun 7;68(6):918-923. Epub 2019 May 7.

1 Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose: To elucidate the clinical and microbial epidemiology of otomycosis in Isfahan, Iran.

Methodology: From January 2016 to January 2017 all patients clinically suspected of otomycosis at Al-Zahra Hospital, Isfahan, Iran were recruited. Specimens were taken using sterile swabs by an otorhinolaryngologist and subjected to culture and microscopy using potassium hydroxide and Giemsa stain. Isolated fungi were identified based on morphological and molecular characteristics.

Results: Otomycosis was confirmed in 97/120 patients (80.8 %). Females (72.2 %) and patients aged 30-39 years (33 %) were more commonly affected than others. Manipulation of ear canal (62.9 %) was the most common predisposing factor. Pruritus was observed in 84.54  % of the patients followed by hearing impairment (81.4 %), and most episodes were detected over the summer (50.5 %). Culture was positive for 81 (83.5  %) of confirmed cases and molds were the most prevalent causative agents (n=51, 63 %) followed by yeasts (n=19, 23.4 %) and yeast/mold mixes (n=11, 13.6 %). For the 16 remaining patients, no growth was seen in culture despite a positive result on direct examination. In total, 92 isolates (63 molds and 29 yeasts) were recovered in culture. Application of molecular methods showed 18 fungal species and the vast majority of them belonged to Aspergillus (n=53, 57.6 %) and Candida genus. Among the species involved, Candida parapsilosis (n=22, 22.7 %) and Aspergillus tubingensis (n=15, 15.5 %) were the most encountered species.

Conclusion: Outcomes from this study showed a different picture of prevalence, where C. parapsilosis and A. tubingensis but not Aspergillus niger were the most species encountered from patients suffering from otomycosis.
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http://dx.doi.org/10.1099/jmm.0.000985DOI Listing
June 2019

GJB2 mutations causing autosomal recessive non-syndromic hearing loss (ARNSHL) in two Iranian populations: Report of two novel variants.

Int J Pediatr Otorhinolaryngol 2018 Apr 31;107:121-126. Epub 2018 Jan 31.

Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address:

Objective: Hereditary hearing loss (HL) is a noticeable concern in medicine all over the world. On average, 1 in 166 babies born are diagnosed with HL in Iran, which makes it a major public health issue. Autosomal recessive non-syndromic HL (ARNSHL) is the most prevalent form of HL. Although over 60 genes have been identified for ARNSHL, GJB2 mutations are the most prevalent causes of ARNSHL in many populations. Previous studies have estimated the average frequency of GJB2 mutations to be between 16 and 18% in Iran, but would vary among different ethnic groups. In the present study, we aimed to determine the frequency and mutation profile of 70 deaf patients from two different provinces (center and west) of Iran.

Methods: We enrolled 70 Iranian deaf patients with ARNSHL from Isfahan (40 family) and Hamedan (30 family) provinces. After extraction of genomic DNA, the entire coding region of GJB2 was directly sequenced in all patients. Multiplex PCR was used for detection of del(GJB6-D13S1830) and del(GJB6-D13S1854) in the GJB6 gene. In silico analyses were also performed by available software tools.

Results: A total of eleven different mutations were detected, nine of which were previously reported and the other two (c.130T > G and c.178T > G) were novel. Homozygous GJB2 mutations were observed in 22.5% and 20% of all the subjects from Isfahan and Hamedan provinces, respectively. c.35delG was the most frequent mutation. One compound heterozygous genotype (c.358_360delGAG/c.35delG) was observed for c.35delG. Screening for the two GJB6 deletions did not reveal any positive sample among heterozygous or GJB2 negative samples.

Conclusions: The present study suggests that mutations in the GJB2 gene specially c.35delG are important causes of ARNSHL in the center and west of Iran. Totally, 15% of the patients were heterozygous carriers. Further investigation is needed to detect the genetic cause of HL in the patients with monoallelic GJB2 mutations.
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http://dx.doi.org/10.1016/j.ijporl.2018.01.012DOI Listing
April 2018

Effect of transcranial direct current stimulation on short-term and long-term treatment of chronic tinnitus.

Am J Otolaryngol 2018 Mar - Apr;39(2):94-96. Epub 2018 Jan 6.

Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address:

Objective: This study was conducted to investigate the effectiveness of anodal and cathodal methods in reducing the intensity of tinnitus and to compare them with the control.

Methodology: This randomized double-blind clinical trial with case and control groups was conducted in Al-Zahra Hospital in Isfahan between 2015 and 2016. In this trial, 51 patients with tinnitus, for at least one year, were selected among those outpatients visiting the throat, nose and ear clinic within this period. Inclusion criteria were patients on electrical stimulation prohibition, with Ménière's disease, otosclerosis, chronic headache, and pulsatile tinnitus. Patients were randomly divided in three equal-sized groups: anodal stimulation group, cathodal stimulation group, and control group. The subjects received 20-min current stimulation (2 mA). Five subjects were selected from those with a significant difference between the stimulated states (anodal or cathodal) and/or control. They received weekly transcranial electrical stimulation for two months, and their long-term recovery from tinnitus was investigated. Data analysis was done with SPSS20.

Results: Findings showed no significant between-groups difference in mean scores of tinnitus before the intervention (p = .68); whereas, this difference was significant immediately after the intervention (p = .02) and 1 h after it (p = .03). The mean score of tinnitus in the anodal stimulation group was significantly lower than the control; whereas, no significant difference was observed between the anodal and cathodal stimulation groups, and between the cathodal and control groups (p < .05). Findings also showed that the mean scores of tinnitus in two cathodal stimulation groups (p = .24) and control group (p = .62) were not significantly different at three different points of time; whereas, this score was significantly different in the anodal group at these time points (p = .01).

Conclusion: In conclusion, anodal stimulation was more effective than the cathodal and control stimulation in reducing the intensity of tinnitus in the short term.
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http://dx.doi.org/10.1016/j.amjoto.2018.01.001DOI Listing
September 2018

Accuracy of a new rapid antigen detection test for pulmonary tuberculosis.

Iran J Microbiol 2016 Aug;8(4):238-242

Radiology Department, Cancer Institute, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Background And Objectives: Tuberculosis (TB) is a major problem in the world. Treatment and control of TB needs detection of the (MT) in the proper samples. While smear doesn't have enough sensitivity, culture and PCR are expensive, time consuming and unavailable in many centers. Recent development of a rapid TB antigen detection test (PrTBK) at Pasteur Institute of Iran could give a simple way for diagnosis of TB in about two hours. In this test the antigen-antibody complex will change color when gold conjugated mouse anti-rabbit antibody detects specific MT cell wall antigen in suspected samples.

Materials And Methods: We evaluated the diagnostic accuracy of PrTBK for diagnosis of pulmonary TB in comparison with smear, culture and PCR techniques in 56 consecutive samples (47 BAL and 13 sputum samples) obtained from patients with clinical suspicion of active TB.

Results: Twentynine patients (52%) were female and seven patients were HIV positive. PrTBK was positive in 17 culture positive and 4 culture negative samples (100% sensitivity, 89% specificity and 92% accuracy in comparison with culture method). In two out of four patients with negative culture who were positive for PrTBK, PCR and anti-tuberculosis drugs trial therapy responses were in favor of tuberculosis. If we take this finding into account, the accuracy of PrTBK will rise.

Conclusion: High sensitivity and accuracy of PrTBK test enable us to initiate treatment on the basis of this convenient and rapid test.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296937PMC
August 2016

Prognostic value of on admission arterial PCO in hospitalized patients with community-acquired pneumonia.

J Thorac Dis 2016 Oct;8(10):2765-2771

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Background: There is little data about the correlation between the outcome of community acquired pneumonia (CAP) and the hypercapnic type respiratory failure. In this study we prospectively investigated the prognostic significance of first arterial CO tension in patients hospitalized with CAP.

Methods: In this prospective study patients with CAP, admitted to a general hospital were included. PaCO was measured for each subject in an arterial blood sample drawn in the first 2 hours and its correlations with three major outcomes were evaluated: intensive care unit (ICU) admission, duration of admission and mortality in 30 days.

Results: A total of 114 patients (mean age: 60.9±18.3; male: 51.8%) diagnosed with CAP were included. Significant relationship was not found between PaCO and mortality (P=0.544) or ICU admission (P=0.863). However advanced age, associated CHF, high BUN levels, high CURB-65 scores, associated pleural effusion in chest X-ray and being admitted to the ICU (P=0.012, 0.004, 0.003, <0.001, 0.045 and <0.001 respectively) were all significant prognostic factors of higher mortality risks. Prognostic factors for ICU admission were a history of malignancy (P=0.004), higher CURB-65 (P<0.001) scores and concomitant pleural effusion (P=0.028) in chest X-ray. Hypercapnic patients hospitalized for longer duration compared with normocapnic subjects. Furthermore, patients with lower pH (P=0.041) and pleural effusions (P=0.002) were hospitalized longer than the others.

Conclusions: There was less prominent prognostic value regarding on-admission PaCO in comparison to other factors such as CURB-65. Considering the inconsistent results of surveys conducted on prognostic value of PaCO for CAP outcomes, further investigations are required to reach a consensus on this matter.
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http://dx.doi.org/10.21037/jtd.2016.10.21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107471PMC
October 2016

Long Term Follow-Up of Sulfur Mustard Related Bronchiolitis Obliterans Treatment.

Acta Med Iran 2016 Sep;54(9):605-609

Department of Pulmonary and Critical Care, Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pulmonary and Critical Care, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Bronchiolitis obliterans (BO) is the most remarkable pulmonary sequels of war-related sulfur mustard inhalation. There is little if any data about long-term efficacy of associated BO treatment. Five years spirometric records of three groups of patients with obstructive pulmonary diseases (asthma, COPD, BO) and documented sulfur mustard inhalation were evaluated. The BO patients were treated with inhaled Seretide 125-250/25 (2 puffs BID), azithromycin (250 mg, three times/week) and N-acetylcysteine (1200-1800/day). Asthma and COPD patients were treated according to existing guidelines. Seventy-three (38 asthma, 16 COPD and 19 BO) patients completed the 5 years follow-up. Basal and final FEV1 in BO patients (2.69±0.81 and 2.39±0.65 respectively) were not significantly different from COPD patients (2.46±0.56 and 1.96±0.76 respectively). There was also no significant difference between the yearly FEV1 decline in BO patients compared to COPD patients (60±84 cc vs. 99±79 cc respectively, P=0.163). The non-significant difference of FEV1 decline in BO compared to COPD patients suggests the effectiveness of azithromycin, inhaled steroid and N-acetyl cysteine in BO patients. Considering safety and possible effectiveness, this treatment is recommended until more data is available from controlled clinical studies.
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September 2016

Correlation of cardiopulmonary exercise testing parameters with quality of life in stable COPD patients.

J Thorac Dis 2016 Aug;8(8):2138-45

Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran;; Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background: The precise head to head relationships between Cardio-pulmonary exercise testing (CPET) parameters and patients' daily symptoms/activities and the disease social/emotional impact are less well defined. In this study, the correlation of COPD daily symptoms and quality of life [assessed by St. George's Respiratory Questionnaire (SGRQ)] and COPD severity index (BODE-index) with CPET parameters were investigated.

Methods: Symptom-limited CPET was performed in 37 consecutive COPD (GOLD I-III) subjects during non-exacerbation phase. The SGRQ was also completed by each patient.

Results: SGRQ-score correlated negatively with FEV1 (r=-0.49, P<0.01), predicted maximal work-rate (%WR-max) (r=-0.44, P<0.01), V'O2/WR (r=-0.52, P<0.01) and breathing reserve (r=-0.50, P<0.01). However it did not correlate with Peak-V'O2% predicted (r=-0.27, P=0.10). In 20 (54.1%) subjects in which leg fatigue was the main cause for stopping the test, Peak-V'O2, %WR-max, HR-Reserve and Breathing reserve were higher (P=0.04, <0.01, 0.04 and <0.01 respectively) than the others. There was also a significant correlation between BODE-index and ∆VO2/∆WR (r=-0.64, P<0.001) and breathing-reserve (r=-0.38, P=0.018).

Conclusions: The observed relationships between CPET parameter and daily subjective complaints in COPD were not strong. Those who discontinued the CPET because of leg fatigue were in the earlier stages of COPD. Significant negative correlation between ∆VO2/∆WR and BODE-index suggests that along with COPD progression, regardless of negative past history, other comorbidities such as cardiac/musculoskeletal problems should be sought.
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http://dx.doi.org/10.21037/jtd.2016.07.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999753PMC
August 2016

Topical Application of Honey on Surgical Wounds: A Randomized Clinical Trial.

Forsch Komplementmed 2016 9;23(1):12-5. Epub 2016 Feb 9.

Plastic and Reconstructive Surgery Division, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background: The antimicrobial and anti-inflammatory activity of honey and its ability to accelerate wound healing make it an attractive option in surgical wound care. We performed a randomized clinical trial to compare the efficacy of honey dressing with conventional dressing regarding the aesthetic outcome.

Patients And Methods: Bilateral symmetric incisions in randomly selected plastic surgical patients were randomly covered postoperatively with conventional dressing and honey dressing for five days. The aesthetic outcome of the two sides was rated on a Visual Analog Scale by the surgeon and the patient and compared at month three and six after surgery.

Results: Seventy two symmetrical incisions in 52 patients were evaluated during the study. The mean width of the scar after the third and the sixth month was 3.64 +/- 0.83 mm and 3.49 +/- 0.87 mm on the side that received honey dressing and 5.43 +/- 0.05 mm and 5.30+/- 1.35 mm in the control group. Wilcoxon signed-rank test showed significant difference between honey and conventional dressing outcomes at third and sixth month (p < 0.001).

Conclusion: The healing process of the surgical wound and its final aesthetic result could be improved by using honey dressing.
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http://dx.doi.org/10.1159/000441994DOI Listing
December 2016

Subsegmental pulmonary embolism: A narrative review.

Thromb Res 2016 Feb 8;138:55-60. Epub 2015 Dec 8.

Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Through the introduction of computed tomography pulmonary angiography (CTPA) for diagnosis of the pulmonary embolism (PE), the high sensitivity of this diagnostic tool led to detecting peripheral filling defects as small as 2-3mm, termed as subsegmental pulmonary embolism (SSPE). However, despite these substantial increases in diagnosis of small pulmonary embolism, there are minimal changes in mortality. Moreover, SSPE patients generally are hemodynamically stable with mild clinical presentation, lower serum level of biomarkers, lower incidence of associated proximal DVTs and less frequent echocardiographic changes compared to the patients with emboli located in more central pulmonary arteries. However, the pros and cons of anticoagulant therapy versus non-treating, monitoring protocol and exact long term outcome of these patients are still unclear. In this article we review existing evidence and provide an overview of what is known about the diagnosis and management of subsegmental pulmonary embolism.
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http://dx.doi.org/10.1016/j.thromres.2015.12.003DOI Listing
February 2016

Coil Embolotherapy of Unilateral Diffuse Pulmonary Arteriovenous Malformations in a Nineteen-Year-Old Woman.

Iran J Radiol 2015 Jul 22;12(3):e9632. Epub 2015 Jul 22.

Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran.

Pulmonary arteriovenous malformations (AVMs) are rare vascular malformations of the lung that usually led to a notable risk of serious and life-threatening complications. There is considerable debate about the best management of strategies for the group of patients with diffuse AVMs. Several therapeutic options have been reported for management of this abnormality among which coil embolization is currently the preferred ones. This report describes our experience with the use of coiling method for treatment of multiple AVMs in an adult patient.
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http://dx.doi.org/10.5812/iranjradiol.9632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623772PMC
July 2015

Approach to Patients with Severe Asthma: a Consensus Statement from the Respiratory Care Experts' Input Forum (RC-EIF), Iran.

Tanaffos 2015 ;14(2):73-94

Division of Pulmonology, Department of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Challenges in the assessment, diagnosis and management of severe, difficult-to-control asthma are increasingly regarded as clinical needs yet unmet. The assessments required to determine asthma severity, comorbidities and confounding factors, disease phenotypes and optimal treatment are among the controversial issues in the field. The respiratory care experts' input forum (RC-EIF), comprised of an Iranian panel of experts, reviewed the definition, appraised the available guidelines and provided a consensus for evaluation and treatment of severe asthma in adults. A systematic literature review followed by discussions during and after the forum, yielded the present consensus. The expert panel used the appraisal of guidelines for research and evaluation-II (AGREE-II) protocol to define an initial locally-adapted strategy for the management of severe asthma. Severe asthma is considered a heterogeneous condition with various phenotypes. Issues such as assessment of difficult-to-control asthma, phenotyping, the use of blood and sputum eosinophil count, exhaled nitric oxide to guide therapy, the position of anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty as well as the use of established, recently-developed and evolving treatment approaches were discussed and unanimously agreed upon in the panel. A systematic approach is required to ensure proper diagnosis, evaluate compliance, and to identify comorbidities and triggering factors in severe asthma. Phenotyping helps select optimized treatment. The treatment approach laid down by the Global Initiative for Asthma (GINA) needs to be followed, while the benefit of using biological therapies should be weighed against the cost and safety concerns.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629434PMC
November 2015

Fluticasone propionate in clinically suspected asthma patients with negative methacholine challenge test.

Clin Respir J 2017 Jul 10;11(4):433-439. Epub 2015 Sep 10.

Department of Epidemiology and Biostatistics, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Despite reports of response to steroid inhaler in some clinically suspected asthma patients with negative methacholine challenge test (CSA/MCT-), treatment in these patients has not been prospectively studied.

Objective: We studied the role of a 12 week high dose inhaled fluticasone trial in CSA/MCT- patients.

Methods: After a 2 week run-in period, CSA/MCT-patients were treated with 12 weeks of Fluticasone propionate 1000 µg/day. The Asthma Control Test (ACT), numeric cough score (NCS) and bronchodilator use were compared with their pretreatment values.

Results: Thirty-four of 42 CSA/MCT-patients completed the study. Mean pretreatment ACT score (pACT) was significantly increased after treatment (14.7 ± 3.37 to 20.9 ± 3.1, P < 0.001). Posttreatment values of daytime (1.0 ± 1.0) and night-time (0.6 ± 0.9) NCS decreased compared to their pretreatment values (2.8 ± 1.1 and 1.9 ± 1.3, respectively; P < 0.001). ACT score change (ΔACT) were significantly greater in those with pACT < 15 than in those ≥15 (P < 0.001) . Fifteen of 21 patients with ΔACT > 5 did not need to use bronchodilator for their symptom relief. Wheeze disappeared in all six patients with ΔACT > 5 after the trial. Six months after the study, steroid inhaler continued to be used by 72.2% of patients.

Conclusion: A significant portion of CSA/MCT- (especially those with pretreatment ACT score <15) respond to high dose fluticasone inhaler in terms of symptoms relief, disappearance of wheeze and need to bronchodilator use. ΔACT could not be predicted with any individual symptoms or signs before MCT, % FEV1 decline or symptoms during MCT and exhaled nitric oxide.
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http://dx.doi.org/10.1111/crj.12353DOI Listing
July 2017

Reflux esophagitis in war-related sulfur mustard lung disease.

Med J Islam Repub Iran 2014 7;28:30. Epub 2014 May 7.

6. Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Tehran University of Medical Sciences, Tehran, Iran.

Unlabelled: Background Sulfur mustard (SM) has acute and chronic effects on skin and mucosal surfaces. The aim of the study was to evaluate the frequency of esophagitis in a historical cohort of veterans who had been exposed to SM in Iran-Iraq war nearly 25 years ago.

Methods: One hundred two veterans with dyspepsia and/or heartburn underwent esophago-gastroduodenoscopy. Of them, 52 cases had been exposed to SM and had chronic mustard lung disease. Controls included 50 veterans without SM exposure. Esophagitis was defined according to standard criteria.

Results: 81.6% of cases and 70.6% of controls had heart burn and/or regurgitation (p= 0.224). Esophagitis was seen in 40% of cases and 26.5% of controls (p= 0.155).

Conclusion: Based on our findings, SM exposure seems not to be associated with increased esophagitis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153531PMC
September 2014

Accuracy of endotracheal tube cuff pressure adjustment by fingertip palpation after training of intensive care unit nurses.

Iran Red Crescent Med J 2013 May 5;15(5):381-4. Epub 2013 May 5.

Department of Pulmonary and Critical Care Medicine, Imam Khomeini Medical Center, Tehran University of Medical Sciences, and Thoracic Diagnostic and Therapeutic Research Center, Tehran University of Medical Sciences, Tehran, IR Iran.

Background: Untrained fingertip palpation has been shown to be unable to adjust endotracheal tube (ET) cuff pressure in most intubated patients.

Objective: We determined the impact of a training course of ETT cuff adjustment by palpation in attaining a safe cuff inflation pressure.

Patients And Methods: Twenty-five nurses were asked to adjust the ETT cuff pressure to 25 cmH2O by palpation on three different patients in seven sessions (S1-S7): before training, two hours and two days after first training session, and two hours, two days, one week, and eight months after second training session.

Results: Before training, 41.3% of the cuff pressures were adjusted to the safe range of 21-35 cmH2O. The pressures obtained in S2-S7 were lower and less variable than S1 (P = 0.02 to < 0.0001). After the first training session, all the ETT cuff pressures in the high range (36-50 cmH2O) and 87.5% in the very high range (> 50 cmH2O) changed to the safe range.

Conclusions: Using trained fingertip adjustment of the ETT cuff pressure throughout the nursing shift with protocols for the adjustment of out of range pressures at the beginning of each shift by cuff manometer could decrease the rate of ETT cuff over- and under-inflation.
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http://dx.doi.org/10.5812/ircmj.4164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838645PMC
May 2013

Recruitment bronchoscopy by trans-glottic approach successfully treated lung collapse in an intubated mechanically ventilated patient.

BMJ Case Rep 2013 Aug 7;2013. Epub 2013 Aug 7.

Pulmonary and Critical Care Department, Advanced Thoracic Research Center, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

Pulmonary lower lobe atelectasis/collapse is a common problem in patients undergoing mechanical ventilation. It also occurs in non-intubated patients with traumatic brain or spinal cord injuries, morbid obesities and chest wall disorders. Conventional manoeuvres such as chest physiotherapy, bronchodilators and positive-end expiratory pressure (PEEP) administration are frequently used in its management with variable success rates. However, despite the reported success of bronchoscopic recruitment manoeuvres, selective intrabronchial air insufflation during fiberoptic bronchoscopy to re-expand collapsed lungs is an underutilised practice. Here, we report an example of successful selective intrabronchial air insufflation in an intubated patient with bilateral lower lobe collapses after surgery for an incarcerated hernia. To our knowledge, this is the first successful report of recruitment manoeuvre by trans-glottic bronchoscopy in an intubated, mechanically ventilated patient.
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http://dx.doi.org/10.1136/bcr-2013-200177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762542PMC
August 2013

Hypoadrenal syndrome in a patient with amyloidosis secondary to familial Mediterranean fever.

BMJ Case Rep 2013 Jan 29;2013. Epub 2013 Jan 29.

Department of Pulmonary Medicine, Tehran University of Medical Sciences, Iran.

Amyloidosis is a common complication of poorly controlled familial Mediterranean fever (FMF). A variety of organs including kidneys, heart, liver, thyroid and adrenal glands may be clinically affected. However, involvement of adrenal glands leading to significant inefficiency is rarely seen in FMF patients with amyloidosis. The impairment of neuroendocrine immune system in FMF together with proteinuria in renal amyloidosis is a challenge while interpreting adrenal function tests. Here we present a case report of a 42-year-old man with FMF and renal failure due to amyloidosis whose disease course was complicated by adrenal insufficiency.
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http://dx.doi.org/10.1136/bcr-2012-007991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604423PMC
January 2013

Feasibility and safety of transglottic bronchoscopy in mechanically ventilated sheep.

J Anesth 2012 Aug 22;26(4):525-30. Epub 2012 Feb 22.

Cancer Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

Purpose: Although bronchoscopy can be safely performed through endotracheal tube in most intubated critically ill patients, sometimes it could lead to complications such as hypoxia and high airway pressures. Theoretically, transglottic bronchoscopy (TGB) does not interfere with mechanical ventilation and could avoid these complications. In a two-period crossover study, we compared this technique with trans-endotracheal tube bronchoscopy (TEB) in normal anesthetized sheep.

Methods: In five sheep, we did TGB first. The bronchoscope was introduced through the nasal nares and passed into the trachea via space between endotracheal tube and vocal folds. Heart rate, V(T), P(peak), and O(2) saturation were recorded. One week later, we did TEB. In another five sheep, we did TEB first and TGB later.

Results: P(peak) increased and V(T) and O(2) saturation decreased during TEB (53.2 ± 5.7 vs. 27.6 ± 0.6, P = 0.002; 210 ± 32 vs. 285 ± 26, P = 0.002; 94.3 ± 1.3 vs. 97.5% ± 0.5, P = 0.041, respectively), but not during TGB. The only statistically significant abnormal finding during TGB was a mild tachycardia (96.7 ± 5.7 vs. 94.7 ± 5.5, P = 0.034).

Conclusion: Although TGB is time consuming and less convenient than TEB, it has minimal interference with mechanical ventilation. Expertise with this technique could be useful in patients with anticipated significant hypoxia and high airway pressures during bronchoscopy.
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http://dx.doi.org/10.1007/s00540-012-1352-3DOI Listing
August 2012

Low-level laser for treatment of tinnitus: a self-controlled clinical trial.

J Res Med Sci 2011 Jan;16(1):33-8

Department of Otorhinolaryngology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.

Background: Despite the high prevalence and morbidity, tinnitus still remains an obscure symptom. We assessed the efficacy of low-level laser for treatment of tinnitus.

Methods: It was a self controlled clinical trial study on 61 outpatients with subjective tinnitus. The patients were irradiated with a 650-nm, 5-mW soft laser for twenty days and twenty minutes per day. The sensation of tinnitus was measured on a Visual Analog Scale (VAS) before and two weeks after treatment and they were compared by means of Wilcoxon signed ranktest.

Results: Thirty-eight (62.3%) patients were men and twenty-three (37.7%) were women. Fourteen patients (31.8%) worked in noisy environment. The VAS mean difference before and after the treatment was statistically significant (p < 0.0001). The best treatment effect was in the youngest group and there were significant differences between this group and the middle age and older groups (p = 0.018 and 0.001, respectively). The mean VAS score reduction was not statistically significant between male and female patients (p = 0.23). Also, the treatment outcome according to the noise level in patient's workplaces was not significantly different in women (p = 0.693), but it was significant in men (p = 0.029).

Conclusions: Transmeatal low-level laser irradiation is effective for the treatment of tinnitus and some variables like age and job can affect the treatment outcome.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063436PMC
January 2011