Publications by authors named "Javad Salimi"

43 Publications

Cost-Effectiveness of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm: A Systematic Review.

Cardiovasc Drugs Ther 2021 Feb 9. Epub 2021 Feb 9.

Vascular Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: Abdominal aortic aneurysm (AAA) is a life-threatening condition which, in the absence of increasing diameter or rupture, often remains asymptomatic, and a diameter greater than 5.5 cm requires elective surgical repair. This study aimed to evaluate the cost-effectiveness of endovascular repair (EVAR) versus open surgical repair (OSR) in patients with AAA through a systematic review of published health economics studies.

Methods: Using a systematic review method, an electronic search was conducted for cost-effectiveness studies published on AAA (both in English and Persian) on PubMed, Embase, ISI/Web of Science (WoS), SCOPUS, Global Health databases, and the national databases of Iran from 1990 to 2020 including the keywords "cost-effectiveness", "endovascular", "open surgical", and "abdominal aortic aneurysms". The quality of the studies was assessed using the Quality of Health Economic Studies (QHES) checklist.

Results: In total, 958 studies were found, of which 16 were eligible for further study. All studies were conducted in developed countries, and quality-adjusted life years (QALY) and life years (LY) were used to measure the outcomes. According to the QHES checklist, most studies were of good quality. In European countries and Canada, EVAR has not been cost-effective, while most studies in the United States regard this technique as a cost-effective intervention. For example, incremental cost-effectiveness ratio (ICER) values ranged from $14,252.12 to $34,446.37 per QALY in the USA, while ICER was €116,600.40 per QALY in Portugal.

Conclusion: According to the results, the EVAR technique has been more cost-effective than OSR for high-risk patients, but the need for continuous follow-up, increased costs, and re-intervention over the long term and for low-risk patients has reduced the cost-effectiveness of this method. As the health systems vary among different countries (i.e. quality of care, cost of devices, etc.), and due to the heterogeneity of studies in terms of the follow-up period, time horizon, and threshold, all of which are inherent features of economic evaluation, generalizing the results should be done with much caution, and policymaking must be based on national evidence.
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http://dx.doi.org/10.1007/s10557-020-07130-6DOI Listing
February 2021

Human leukocyte antigen class I (A, B) and class II (DRB1) allele and haplotype frequencies in Iranian patients with Buerger's disease.

Immun Inflamm Dis 2020 09 21;8(3):434-440. Epub 2020 Jun 21.

Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran.

Objective: The aim of this study was to investigate the human leukocyte antigen (HLA) class I (HLA-A and HLA-B) and II (HLA-DRB1) allele and haplotype frequencies in a group of Iranian patients with Buerger's disease (BD) in comparison with a normal healthy control group.

Methods: A total of 70 unrelated male patients and 100 healthy controls from Sina Hospital, Tehran, Iran, belonging to the same ethnic background, were enrolled in this case-control study. HLA-A, B, and DRB1 typing were performed by polymerase chain reaction with sequence-specific primers (PCR-SSP).

Results: The results of this case-control study showed that the frequency of the HLA-A*03:01 (odds ratio (OR) = 2.88, P value (Pv) = .002), HLA-A*29:01 (OR = 15.31, Pv < .001), HLA-DRB1*04:02 (OR = 3.41, Pv < .001), and HLA-DRB1*16:01 (OR = 8.16, Pv < .001) was significantly higher in BD patients compared with healthy controls, whereas the frequency of the HLA-DRB1*01:01 (OR = 0.03, Pv < .001) was significantly lower in BD patients. The most frequent extended haplotypes in our patients were HLA-A*02:01-B*55:01-DRB1*04:03.

Conclusion: This study is the first study evaluating an association between the HLA pattern and BD in the patients with BD from North West and North Iran.
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http://dx.doi.org/10.1002/iid3.325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416031PMC
September 2020

Comparison of Coagulation Conditions in Patients With Liver Cirrhosis Due to Primary Sclerosing Cholangitis and Nonbiliary Causes of Cirrhosis Before Orthotopic Liver Transplant.

Exp Clin Transplant 2020 11 16;18(6):696-700. Epub 2020 Jun 16.

From the Liver Transplantation Research Center, Imam Khomeini Hospital Complex, and the Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Sina Hospital, Tehran, Iran.

Objectives: Orthotopic liver transplant can be accompanied by an obscure bleeding pattern in patients with severe hepatic malfunction. In the present study, coagulation conditions of patients with cirrhosis of the liver due to primary sclerosing cholangitis and nonbiliary causes of cirrhosis were compared using rotational thromboelastometry assays obtained before orthotopic liver transplant.

Materials And Methods: This case control study analyzed patients who were candidates for orthotopic liver transplant from 2010 to 2016. Eighty patients with cirrhosis of the liver (40 patients with primary sclerosing cholangitis and 40 with nonbiliary causes of cirrhosis) were randomly selected and enrolled into the study. Patients received rotational thromboelastometry assays under anesthesia just before the start of the operation, and results were compared between the 2 patient groups.

Results: Of 80 patients, 52 were men and 28 were women. In the assays, we found that maximum amplitudes in 10 and in 20 minutes and maximum clot firmness parameters were higher in patients with primary sclerosing cholangitis. The alpha angle and clot formation time were different in the intrinsic and extrinsic assay panels. In the intrinsic assay, we found clotting time to be shorter (P < .05). The average of all parameters in all 3 assays (intrinsic, extrinsic, and fibrinogen contribution) was lower in patients with nonbiliary causes of cirrhosis than in those with primary sclerosing cholangitis.

Conclusions: In contrast with previous studies that found that patients with primary sclerosing cholangitis are hypercoagulable, our study observed that they have normal coagulable results. Furthermore, we found that, although mean coagulation indexes in patients with primary sclerosing cholangitis were within normal ranges, in patients with nonbiliary causes of cirrhosis, these indexes were generally lower.
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http://dx.doi.org/10.6002/ect.2018.0374DOI Listing
November 2020

Impact of reperfusion with blood venting on liver transplantation outcomes; a prospective case-control study.

Gastroenterol Hepatol Bed Bench 2020 ;13(1):50-56

Liver Transplantation Research Centre, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Aim: This study aimed to evaluate the impact of two different reperfusion techniques on outcomes of LT patients.

Background: Post-reperfusion syndrome (PRS) during liver transplantation (LT) remains a serious issue for both the surgeon and anesthetist.

Methods: In this prospective study, all liver transplant recipients referred to the liver transplantation department of Imam Khomeini Hospital, Tehran, Iran, from January 2016 to June 2017 were enrolled in the study and were divided into two groups of vented (reperfusion with 300cc blood venting) and non-vented (reperfusion without blood venting) cases. Then, 30-minute intraoperative hemodynamic and biochemical changes, as well as 2-month complications and 6-month mortality, were compared between the groups.

Results: 57 LT cases (31 vented and 26 non-vented) were studied (50.9% female). The two groups had a similar age (p = 0.107), sex (p = 0.885), MELD score (p = 0.61), donor warm ischemic time (p = 0.85), recipient warm ischemic time (p = 0.36), cold ischemic time (p = 0.99), comorbid disease (p = 0.502), and etiology of end-stage liver disease (p = 0.281). PRS occurred in 3 (11.5%) patients in the vented group and 4 (12.9%) in the non-vented group (p = 0.69). One (3.8%) patient in the non-vented group and 4 (12.9%) patients in vented group died (p = 0.229).

Conclusion: Reperfusion with and without blood venting had the same outcome regarding intraoperative hemodynamic and biochemical changes, PRS rate, and postoperative complications, as well as 6-month survival. Thus, it seems that blood venting is not a necessary method for decreasing post-reperfusion complications following LT.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069539PMC
January 2020

Venoplasty and stenting in post-thrombotic syndrome and non-thrombotic iliac vein lesion.

Minim Invasive Ther Allied Technol 2020 Feb 22;29(1):35-41. Epub 2019 Feb 22.

Department of Vascular Surgery, Emam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran.

Venous outflow obstruction is a common condition among patients with chronic venous insufficiency. Endovascular treatment is favourable over open surgery. This study aimed to assess stent patency and clinical outcome in venous outflow obstruction of lower limbs, and also to compare it between post-thrombotic syndrome and non-thrombotic iliac vein lesions. The study was a historical cohort study. Patients with chronic deep venous insufficiency referred to our tertiary referral centre who underwent venoplasty were recruited. Patients were divided into two groups: non-thrombotic-iliac-vein-lesions and post-thrombotic syndrome. Stent patency rate, clinical improvement and risk factors were evaluated during a six-months course after venoplasty. One-hundred-sixty-four patients were included. Six-months primary, assisted primary and secondary patency rates were 98.86%, 100% and100% in the non-thrombotic-iliac-vein-lesions group and 88%, 93% and 96% in the post thrombotic syndrome groups (-value = .005, -value = .02, and -value = .09, respectively). Pain, claudication and edema were the most common symptoms in both groups and significantly improved after six months. Early thrombosis in the PTS group was more common (9 vs. 1, value = .007). Percutaneous stenting in patients with venous outflow obstruction is safe and effective with a high patency rate and significant decrease in clinical score in both post-thrombotic syndrome and non-thrombotic-iliac-vein lesions groups.
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http://dx.doi.org/10.1080/13645706.2019.1580748DOI Listing
February 2020

Liver Transplantation Status in Iran: A Multi-center Report on the Main Transplant Indicators and Survival Rates.

Arch Iran Med 2018 07 1;21(7):275-282. Epub 2018 Jul 1.

Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Iran's experience with liver transplantation (LT) began more than two decades ago. The purpose of this article is to present the status of LT in Iran, review specific characteristics of the programs, their outcomes, and their growth to become one of the largest LT programs in the world.

Methods: A questionnaire, asking for data on the number of transplants performed and specifics of the recipients and type of donors with focus on indications and outcomes was sent to LT programs.

Results: During a period of 23 years, 4,485 LTs were performed at 6 centers in the country. Of these, 4106 were from deceased donors and 379 were from living donors. There were 3553 adults and 932 pediatric recipients. Hepatitis B and biliary atresia were the most common etiologies in adult and pediatric patients, respectively. Overall survival rates at 1, 5, and 10 years were 85%, 77%, and 71% for adults and 76%, 67% and 56% for pediatric patients, respectively.

Conclusion: Approval of the brain death law in Iran and coordinated efforts by the transplant centers to build comprehensive LT programs has resulted in the ability to procure more than 700 deceased donors per year with acceptable long-term survival.
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July 2018

Health risk assessment of heavy metal intake due to fish consumption in the Sistan region, Iran.

Environ Monit Assess 2017 Oct 25;189(11):583. Epub 2017 Oct 25.

Department of Environmental Health Engineering, Gonabad University of Medical Sciences, Gonabad, Iran.

The heavy metal (Pb, Cd, Cr, and Ni) content of a fish species consumed by the Sistan population and its associated health risk factors were investigated. The mean concentrations of Pb, Cd, and Cr were slightly higher than the standard levels. The Ni content of fish was below the maximum guideline proposed by the US Food and Drug Administration (USFDA). The average estimated weekly intake was significantly below the provisional tolerable intake based on the FAO and WHO standards for all studied metals. The target hazard quotients (THQ) of all metals were below 1, showing an absence of health hazard for the population of Sistan. The combined target hazard quotient for the considered metals was 26.94 × 10. The cancer risk factor for Pb (1.57 × 10) was below the acceptable lifetime carcinogenic risk (10). The results of this study reveal an almost safe level of Pb, Cd, Cr, and Ni contents in the fish consumed by the Sistan population. Graphical abstract ᅟ.
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http://dx.doi.org/10.1007/s10661-017-6286-7DOI Listing
October 2017

Central Nervous System and Limb Embolism Concurrence due to Atrial Myxoma: A Case Report‏.

J Tehran Heart Cent 2017 Jul;12(3):145-148

Cancer Pharmacogenetics Research Group (CPGRG), Iran University of Medical Sciences, Tehran, Iran.

Cardiac myxomas are the most common cardiac tumors with diverse nonspecific clinical manifestations. A 78-year-old man presented to the emergency department with complaints of pain and coldness of the left lower extremity. The left femoral artery pulse was detected, while the pulses of the left popliteal, dorsalis pedis, and posterior tibialis arteries were absent. No blood inflow was detected in the superficial and deep femoral, popliteal, and anterior and posterior tibialis arteries. Thrombectomy was performed, and a fatty-like mass from the bifurcation of the common femoral artery and a thrombotic mass from the proximal portion of the superficial and deep femoral arteries were removed. The pulsatile inflow and palpable pulses of the left femoral, popliteal, dorsalis pedis, and posterior tibialis arteries were restored after surgery. The histological findings of the embolus were suggestive of a cardiac myxoma. The patient's consciousness and lower limb blood flow improved gradually. He was discharged from the hospital with full awareness and improved lower extremity muscle function 2 weeks after surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643875PMC
July 2017

Venoplasty and Venous Stenting in Patients with Chronic Venous Insufficiency in the Lower Extremities.

J Tehran Heart Cent 2016 Oct;11(4):174-180

Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Venoplasty and stenting is a minimally invasive therapy that can be used for patients with deep venous insufficiency in the lower extremities. This study aimed at investigating the effect of venoplasty and venous stenting in patients with chronic venous insufficiency in the lower limbs. : This prospective case-series study recruited patients with chronic deep venous insufficiency in the lower limbs candidated for venoplasty in the Vascular Clinic of Sina Hospital in Tehran, Iran. Venoplasty and stenting was done if the deep venous system in the lower extremities had stenosis or obstruction on venography. The patients were visited 1, 3, and 6 months after venoplasty to assess their symptoms, venous clinical severity, and venous disability. Primary and secondary patency was evaluated with Doppler ultrasound. : Seventy-three patients were included in the study. The follow-up of the patients' clinical symptoms showed significant improvement rates of about 90%, 88.7%, 92.5%, and 100% in claudication, edema, pain, and ulcers-respectively- only 1 month after the procedure. The stent patency rates were 93.2, 91.5, and 92.4 in the 1st, 2nd, 3rd, and 6th postprocedural months, correspondingly. The venous clinical severity score and the venous disability score before the procedure were 14.2 and 2.73, respectively, which were decreased to 5 and 1.1, correspondingly, at 6 months' follow-up (p value < 0.001). : Venoplasty and stenting in our patients with chronic deep venous insufficiency in the lower extremities conferred a significant improvement in clinical symptoms and a high percentage of patency.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421495PMC
October 2016

Modeling and optimization of nonylphenol removal from contaminated water media using a magnetic recoverable composite by artificial neural networks.

Water Sci Technol 2017 Apr;75(7-8):1761-1775

Department of Applied Chemistry, Faculty of Chemistry, University of Tabriz, Tabriz, Iran.

Herein, activated carbon impregnated iron oxide nanoparticles (FeO/AC) were synthesized to determine their potentials for the adsorption of nonylphenol (NP) in aqueous solution with different experimental variables, namely the pH of the solution, contact time, adsorbent dosage and the initial NP concentration. Additionally, an artificial neural network system was used to find the relative importance of each of the aforementioned input variables on NP adsorption efficiency. Experimental findings indicated that the optimum solution pH for NP adsorption was 3.0. The equilibrium time of the adsorption process was 30 min. According to the results of isotherm and kinetic studies, among all applied models, the Liu and pseudo-first-order models showed the best fit with the experimental data. The pH of the solution, compared to other input variables, had the maximum impacts on NP adsorption efficiency. Under optimum conditions, the adsorption percentage decreased insignificantly from 99.6 to 92.6% after the fifth cycle. Also, the adsorption efficiencies of 70.7, 73.5 and 67.3% were observed for river water, tap water and wastewater effluent, respectively. Ultimately, from the findings of this study, it can be postulated that FeO/AC nanoparticles can be recommended as a promising and novel adsorbent to remove NP from polluted groundwater.
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http://dx.doi.org/10.2166/wst.2016.523DOI Listing
April 2017

Efficacy and safety of lamivudine or tenofovir plus intramuscular hepatitis B immunoglobulin in prevention of hepatitis B virus reinfection after liver transplant.

Exp Clin Transplant 2015 Apr;13 Suppl 1:127-32

From the Department of Gastroenterology-Hepatology, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Hepatitis B immunoglobulin prophylaxis in combination with antiviral drugs is recommended for prevention of hepatitis B virus reinfection after liver transplant. However, there is no consensus on a standard prophylactic method, and controversy exists over the duration, dose, and route of administration. We conducted a prospective study to evaluate the safety and effectiveness of intramuscular hepatitis B immunoglobulin in combination with lamivudine and/or tenofovir and discontinuation of hepatitis B immunoglobulin after 1 year for prevention of hepatitis B virus reinfection.

Materials And Methods: Patients with hepatitis Brelated liver cirrhosis who had undergone primary liver transplants were enrolled. The prophylactic protocol involved intraoperative intramuscular hepatitis B immunoglobulin at 10 000 IU, tapering to 5000 IU daily for the first 6 days, weekly for a month, every 2 weeks for the next month, and monthly for a year after liver transplant, in combination with antiviral drugs.

Results: From January 2002 until March 2014, two hundred sixty-eight liver transplants were performed. Forty-four patients (16.4%) who underwent liver transplants due to hepatitis B-related liver failure were enrolled. Five patients had hepatocellular carcinoma; 20 had both hepatitis D and hepatitis B virus infection. The median age was 47 years (range, 26-59 y) with a median model for end stage liver disease score of 20. Thirty-three patients were men (76%). Sixty-one percent of patients were negative for hepatitis B virus DNA at the time of transplant. The median follow-up was 13.6 months (range, 0-142 mo). Only 1 patient (2.3%) experienced hepatitis B virus reinfection (at 44.7 months posttransplant), which was successfully treated with tenofovir. Five patients died (11.4%) during the follow-up from nonhepatitis B causes.

Conclusions: Intramuscular hepatitis B immunoglobulin in combination with lamivudine or tenofovir and discontinuation of hepatitis B immunoglobulin after 1 year posttransplant may provide safe and cost-effective protection against posttransplant hepatitis B reinfection.
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April 2015

Cervical sympathetic schwannoma: report of two cases and review of the literature.

Acta Med Iran 2014 ;52(7):569-74

Department of Vascular Surgery, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

This study describes two cases of cervical sympathetic schwannoma operated at department of vascular surgery and review the literature to clarify the demographic, diagnostic, and therapeutic features of these rare lesions for the first time. Two 32- and 59-year-old ladies both presenting with a painless cervical mass were referred to our service with the initial diagnosis of carotid body tumor. At the operation, mobile masses which could be easily dissected from the surrounding arteries and veins, except for the cervical sympathetic trunk were observed. Micro-surgical techniques helped us with removing the lesions with saving the sympathetic trunk in both cases. No permanent deficits were observed post-operatively in patients. Angiographic studies can provide the only pre-operative clues to diagnose a sympathetic schwannoma. Total removal of the lesion at the expense of sacrificing the sympathetic nerve is associated with minimal neurologic deficits which are well tolerated by the patient.
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July 2015

An Iranian scoring system for diagnosing Buerger's disease.

Acta Med Iran 2014 Feb 22;52(1):60-5. Epub 2014 Feb 22.

Department of Community and Preventive Medicine, Medical Faculty, Tehran University of Medical Sciences, Tehran, Iran..

Buerger's disease or thromboangiitis obliterans (TAO) seems to be common in IR Iran, The present study aimed to evaluate an Iranian population with Buerger's disease in order to suggest a diagnostic criterion for Buerger's disease based on the most frequent findings and to compare it with Papa diagnostic criteria. In a cross-sectional study, all patients with resting limb pain, limb ischemic ulcers, intermittent claudication and limb ischemia who referred to the Vascular Clinic of Sina Hospital during 2009-2011 were evaluated. The patients were allocated to Buerger's and non-Buerger's groups; Evaluating 122 patients (61 in each group), according to the model each clinical manifestations and risk factors in the patients with Buerger's disease obtained a score. Absent pulsation, abnormal distal Doppler sonography and ischemic ulcer were respectively present in 58 (95.1%), 58 (95.1%) and 49 (80.3%) individuals with Buerger's disease. Multivariate linear regression analysis and multivariate logistic regression analysis were used for modeling. Considering the model finding findings, diagnostic criteria including age, sex, smoking, Raynaud's phenomenon, abnormal proximal Doppler, diabetes mellitus and hyperlipidemia were suggested (R2=0.582); the sensitivity and specificity of the criteria was respectively 95.1% and 78.7%. Compared with Papa criteria, Kappa coefficient was measured at 0.66 with a P-value<0.001. It seems that the recommended criteria have an acceptable accuracy in diagnosing Buerger's disease, especially in the Iranian population; however, it is necessary to conduct more studies with larger sample sizes to evaluate the criteria, especially in other populations.
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February 2014

Patient outcomes in a liver transplant program in Iran.

Exp Clin Transplant 2014 Mar;12 Suppl 1:86-91

Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: The first liver transplant program in Tehran was started at Tehran University of Medical Sciences in 2002. The purpose of this study was to evaluate patient outcomes in this program.

Materials And Methods: From January 2002 to February 2013, there were 172 deceased-donor orthotopic liver transplants performed in 166 patients, including revision transplant in 6 patients. Outcomes were evaluated for 4 phases of the program: (1) phase 1 (2002 to 2005; 9 transplants); (2) phase 2 (2006 to 2009; 41 transplants); (3) phase 3 (2010 to 2011; 49 transplants); and (4) phase 4 (2012 to 2013; 73 transplants).

Results: The most frequent indications for liver transplant included cryptogenic cirrhosis, autoimmune hepatitis, and hepatitis B and C cirrhosis. During the progression from phase 1 to 4, there were significant decreases in median cold ischemia time, operative time, and transfusions (platelets, packed red blood cells, and fresh frozen plasma). The most frequent complications included infection and acute rejection. The overall median follow-up for all patients was 26 months (range, 9-144 mo). Frequency of 1-month, 3-month, 1-year, and 2-year survival increased from phase 1 to 4. Kaplan-Meier plots showed significant improvement in patient survival from phase 1 to 4 (P ≤ .001). The most common causes of death were sepsis and bleeding.

Conclusions: Clinical outcomes with deceased-donor liver transplant may be improved with a cooperative multidisciplinary team, coordinated care from different specialties, increased experience, and modifications of anesthetic and surgical techniques. Comprehensive unified written protocols for preoperative, perioperative, and postoperative treatment may help improve outcomes after sufficient experience is achieved.
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March 2014

Cytomegalovirus reactivation and preemptive therapy after liver transplant.

Exp Clin Transplant 2014 Mar;12 Suppl 1:72-5

Hepatobiliary and Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Cytomegalovirus is the most common viral infection after orthotopic liver transplant. The purpose of the present study was to determine the incidence of cytomegalovirus reactivation in Iranian liver transplant recipients at our center and to evaluate outcomes with preemptive therapy with ganciclovir for pp65 antigenemia.

Materials And Methods: There were 145 patients who had liver transplant and who survived > 2 weeks after transplant. All patients were evaluated for pp65 antigenemia weekly until 90 days after transplant. The diagnosis of cytomegalovirus reactivation was made when a recipient had pp65 antigenemia ≥ 1/50,000 leukocytes. In patients who had cytomegalovirus infection, preemptive therapy with ganciclovir (5 mg/kg, intravenous, twice daily) was started immediately after diagnosis and continued for ≥ 21 days and until cytomegalovirus antigen became undetectable on 2 consecutive tests.

Results: All patients in our study were seropositive for cytomegalovirus before transplant. Follow-up at mean 27 ± 20 months (range, 5.2 to 80.6 mo) after transplant showed that 46 patients (32%) had cytomegalovirus reactivation at mean 56 ± 67 days after transplant (range, 12 to 445 d). There was a higher frequency of female patients in the cytomegalovirus reactivation than non-reactivation group (odds ratio, 2.3; P ≤ .02). The most common causes of liver failure in the cytomegalovirus reactivation group were autoimmune hepatitis, cryptogenic cirrhosis, and hepatitis B virus cirrhosis. There was no significant relation between cause of liver failure, use of steroids before or after transplant, and frequency of acute rejection and cytomegalovirus reactivation. Only 1 patient (2%) developed cytomegalovirus disease at 22 days after transplant, and this patient was treated successfully. There were 6 patients (13%) who developed a second episode of cytomegalovirus reactivation at median 43 days (range, 10 to 176 d) after the first episode; all 6 patients were treated successfully with ganciclovir.

Conclusions: Preemptive treatment with ganciclovir may be an effective approach against cytomegalovirus in seropositive recipients after liver transplant.
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March 2014

Establishing a liver transplantation program at Tehran University of Medical Sciences, Iran: a report of ten years of experience.

Arch Iran Med 2014 Jan;17(1):81-3

Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran.

In 2001, a Liver Transplantation (LT) program was commenced in Imam Khomeini Hospital Complex as the first one in the capital city of Tehran which is the second liver transplantation center in Iran. This study presents the results of our 10-year experience with LT.
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http://dx.doi.org/0141701/AIM.0012DOI Listing
January 2014

Comparison of results of placement of cuffed -tunneled hemodialysis catheter in internal jugular vein with subclavian vein for long -term dialysis.

Pol Przegl Chir 2013 Mar;85(3):133-6

Aim Of The Study: was to comparison between internal jugular vs. subclavian vein cuffed tunnel catheter placement for dialysis.

Material And Methods: Cases who required central venous catheter for dialysis were included in this study. Forty cases were included in this study and divided to two groups. Catheters were placed randomly in internal jugular vein or subclavian. Patients were followed for 6 months. Early and late complications of catheter's placement were recorded. Analysis was done using Spss ver 13.0 (Chicago, IL, USA).

Results: There were no significant differences between subclavian and internal jugular vein regarding occurrence of infection resulted in extraction or treatment. Also there were no significant differences regarding occurrence of thrombosis resulted in extraction or treatment. Failure rate was significantly higher in cases with internal jugular vein catheter compared to cases with subclavian vein catheter (p=0.04).

Conclusion: Failure rate was significantly higher in cases with internal jugular vein catheter compared to subclavian cathether. Subclavian catheter is more appropriate route for catheter placement.
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http://dx.doi.org/10.2478/pjs-2013-0023DOI Listing
March 2013

Plasma levels of homocysteine in Buerger's sufferers and healthy heavy smokers and non-smokers.

Clin Lab 2013 ;59(1-2):93-6

Vascular Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Our aim of this study was to evaluate the possible association between homocysteine levels and Buerger's disease in a case-control study.

Methods: 25 patients with Buerger's disease based on Shionoya's clinical criteria, and 25 heavy smokers along with 25 healthy non-smokers (control) were recruited for this study. All groups were matched for age. Plasma homocysteine levels were measured in each patient and then compared between the three groups.

Results: The mean plasma concentration of homocysteine was 16.88 mmol/L in the Buerger sufferers; as for the smoker (group 2) and control (group 3) groups, the level was as low as 13.89 and 13.56 mmol/L, respectively.

Conclusions: Patients with thromboangiitis obliterans, especially those with a progressive course, benefit from the hyperhomocysteinemia screening test.
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http://dx.doi.org/10.7754/clin.lab.2012.110627DOI Listing
April 2013

Light-based solution for the dominating set problem.

Appl Opt 2012 Oct;51(29):6979-83

Department of Electrical and Computer Engineering, Tarbiat Modares University, Tehran, Iran.

In this paper, an optical solution for the dominating set problem is provided. The solution is based on long ribbon-shaped optical filters, on which some operations can be optically applied efficiently. The provided solution requires polynomial time, exponential length of filters, and exponential number of photons to solve the dominating set problem. The provided solution is implemented experimentally using lithographic sheets, on a graph with six vertices, to find all dominating sets with two vertices.
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http://dx.doi.org/10.1364/AO.51.006979DOI Listing
October 2012

Clinical characteristics and remedies in 45 Iranians with carotid body tumors.

Acta Med Iran 2012 ;50(5):339-43

Department of Vascular Surgery, Sina Trauma and Surgery Research Center, Sina Hospital,Tehran University of Medical Sciences, Tehran, Iran.

Carotid body tumors (CBTs) are rare, slow-growing tumors that should be considered in evaluating every lateral neck mass. This single center study was performed to define demographic features, clinical characteristics and remedies of Iranian patients with CBT. A retrospective review of prospectively collected data was done on 45 patients with 50 CBTs who have been referred to Sina Hospital, Tehran, Iran, during a 10-year period, were investigated in this study. The demographic characteristics, clinical and pathologic features, imagings, preoperative treatments, surgical approach and complications were analyzed. The study group predominantly consisted of females (82%). Age of diagnosis was 18 to 75 years old. Five patients had bilateral CBT. Family history of CBT was positive in seven patients. Most of CBTs were ≤ 3cm in size. All of the patients presented with a neck mass, mostly without pain (84%). Other symptoms included vertigo 4%, dysphasia 4% and tinnitus 2%. There was no patient with cranial nerve involvement at presentation. The most common imaging helping the diagnosis was color Doppler sonography. Three patients had preoperative embolization. All patients underwent surgery and seven patients had post-operative cranial nerve injury. Nine cases underwent external carotid artery ligation and four ones had external carotid repair. Post operative mortality rate was one patient. This study provides epidemiological data on patients with CBT in Iran, which could be useful for health care workers in prompt diagnosis and appropriate work ups for patient's families in bilateral CBTs.
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November 2012

Hematological profile of chronic kidney disease (CKD) patients in Iran, in pre-dialysis stages and after initiation of hemodialysis.

Saudi J Kidney Dis Transpl 2010 Mar;21(2):368-71

Nephrology Department, Shahed University, Mustafa Khomeini Hospital, Tehran, Iran.

Anemia is a common sequealae of chronic kidney disease (CKD), associated with significant morbidity. A cross-sectional study was conducted on 100 CKD patients (54 hemodialyzed, 46 pre-dialyzed). Data including, complete blood count, BUN, creatinine, creatinine clearance, underlying diseases and hemodialysis duration were collected by a questionnaire. The most frequent morphologic features were normochromic-normocytic (80%), hypochromic-microcytic (15%) and macrocytic (5%). The frequency of anemia in hemodialyzed and pre-dialyzed patients (with mean Hgb level of 10.27 and 11.11 g/dL) were 85% and 75%. Hemoglobin concentration was positively correlated to calculated creatinine clearance (P < 0.001). The severity of anemia among hemodialyzed patients was mild (Hgb > 10 g/dL) in 5%, moderate in 70% and severe (Hgb < 7 g/dL) in 25%, while in pre-dialyzed was mild in 45% and moderate in 55%. There was no correlation between the anemia and CKD causes or hemodialysis duration. In conclusion, data shows that anemia in our patients with CKD is a predominant manifestation, with high frequency but of moderate degree. The most likely cause is inadequate erythropoietin production.
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March 2010

Firework-related injuries in Tehran's Persian Wednesday Eve Festival (Chaharshanbe Soori).

J Emerg Med 2011 Mar 25;40(3):340-5. Epub 2010 Jan 25.

Department of Surgery, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Fireworks are the leading cause of injuries such as burns and amputations during the Persian Wednesday Eve Festival (Chaharshanbeh Soori).

Objectives: This study was designed to explore the age of the high-risk population, the type of fireworks most frequently causing injury, the pattern of injury, and the frequency of permanent disabilities.

Methods: This cohort study was performed by Tehran Emergency Medical Services at different medical centers all around Tehran, Iran, in individuals referred due to firework-related injuries during 1 month surrounding the festival in the year 2007. The following information was extracted from the patients' medical records: demographic data, the type of fireworks causing injury, the pattern and severity of the injury, the pre-hospital and hospital care provided for the patient, and the patient's condition at the time of discharge. In addition, information on the severity of the remaining disability was recorded 8 months after the injury.

Results: There were 197 patients enrolled in the study with a mean age of 20.94 ± 11.31 years; the majority of them were male. Fuse-detonated noisemakers and homemade grenades were the most frequent causes of injury. Hand injury was reported in 39.8% of the cases. Amputation and long-term disability were found in 6 and 12 cases, respectively. None of the patients died during the study period.

Conclusion: The fireworks used during a Chaharshanbe Soori ceremony were responsible for a considerable number of injuries to different parts of the body, and some of them led to permanent disabilities.
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http://dx.doi.org/10.1016/j.jemermed.2009.10.024DOI Listing
March 2011

Safety and efficacy of granulocyte-colony-stimulating factor administration following autologous intramuscular implantation of bone marrow mononuclear cells: a randomized controlled trial in patients with advanced lower limb ischemia.

Cytotherapy 2010 Oct;12(6):783-91

Department of Vascular Surgery, Tehran University of Medical Sciences, Tehran, Iran.

Background Aims: The aim was to investigate the therapeutic effect of granulocyte-colony-stimulating factor (G-CSF) administration following implantation of autologous bone marrow mononuclear cells (BM MNC) for patients with lower limb ischemia.

Methods: The design was a randomized controlled trial. Fifteen patients with severe chronic limb ischemia were treated with autologous BM MNC [without G-CSF (MNC-G-CSF) or combined with G-CSF administration for 5 days following transplantation (MNC+G-CSF)].

Results: All clinical parameters, including ankle brachial index, visual analog scale and pain-free walking distance, showed a mean improvement from baseline, which was measured at 4 and 24 weeks after transplantation in both groups. However, in three (20%) patients, the clinical course did not improve and limb salvage was not achieved. No significant difference was observed among the patients treated in the MNC-G-CSF and MNC+G-CSF groups. No severe adverse reactions were reported during the study period. No relationship was observed between both the numbers of viable MNC or CD34+ cells and the clinical outcome.

Conclusions: Autologous transplantation of BM MNC into ischemic lower limbs is safe, feasible and efficient for patients with severe peripheral artery disease. However, the administration of G-CSF following cell transplantation does not improve the effect of BM MNC implantation and therefore would not have any beneficial value in clinical applications of such cases.
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http://dx.doi.org/10.3109/14653240903518163DOI Listing
October 2010

A giant subclavian pseudoaneurysm following central venous catheterization.

J Anesth 2009 18;23(4):628-9. Epub 2009 Nov 18.

Department of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Tehran, Iran.

Inadvertent iatrogenic injury to an adjacent major artery is a rare but life-threatening complication of central venous cannulation. The present article reports the development of a large right subclavian artery pseudoaneurysm, presented as a rapidly growing mass at the site of injury, following attempted central venous catheterization.
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http://dx.doi.org/10.1007/s00540-009-0796-6DOI Listing
January 2010

Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients.

Chin J Traumatol 2009 Oct;12(5):259-62

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran 11364, Iran.

Objective: Today, trauma is a major public health problem in some countries. Abdominal trauma is the source of significant mortality and morbidity with both blunt and penetrating injuries. We performed an epidemiological study of abdominal trauma (AT) in Tehran, Iran. We used all our sources to describe the epidemiology and outcome of patients with AT.

Methods: This study was done in Tehran. The study population included trauma patients admitted to the emergency department of six general hospitals in Tehran during one year. The data were collected through a questionnaire that was completed by a trained physician at the trauma center. The statistical analysis was performed using the SPSS software (version 11.5 for Windows). The statistical analysis was conducted using the chi-square and P < 0.05 was accepted as being statistically significant.

Results: Two hundred and twenty-eight (2.8%) out of 8,000 patients were referred to the above mentioned centers with abdominal trauma. One hundred and twenty-five (54.9%) of the patients were in their 2nd and 3rd decades of life and 189 (83%) of our patients were male. Road traffic accidents (RTA) were the leading cause of AT with 119 (52.2%) patients. Spleen was the commonly injured organ with 51 cases. Following the analysis of injury severity, 159 (69.7%) patients had mild injuries (ISS < 16) and 69 (30.3%) patients had severe injuries (ISS equal to 16). The overall mortality rate was 46 (20.2%).

Conclusions: Blunt abdominal trauma is more common than penetrating abdominal trauma. Road traffic accidents and stab wound are the most common causes of blunt and penetrating trauma, respectively. Spleen is the most commonly injured organ in these patients. The mortality rate is higher in blunt trauma than penetrating one.
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October 2009

Clinical features, diagnostic approach, and therapeutic outcome in myasthenia gravis patients with thymectomy.

Acta Neurol Taiwan 2009 Mar;18(1):21-5

Department of Surgery, Medical Sciences/University of Tehran, Tehran, Iran.

Purpose: Thymectomy has been widely employed in the treatment of myasthenia gravis (MG). However, little data exist in Iran demonstrating the efficacy and morbidity of thymectomy. The aim of this study was to determine the clinical features, diagnostic approach, and therapeutic outcome in patients with MG who underwent thymectomy.

Methods: This historical cohort study was conducted in 3 university hospitals in Tehran. Preoperative and operative indices of 61 patients with MG who had been treated with thymectomy in these hospitals from September 2000 to July 2005 were reviewed. Among them, 20 patients were followed during one year after operation for determination of postoperative complications and one year mortality rate.

Results: The most common manifestations of MG were ptosis (77.0%) and upper limbs weakness (70.4%). CT scans of the thymus showed thymus enlargement, thymoma and thymus hyperplasia in 51.5% (22/43), 11.6% (5/43) and 2.32% (1/43) of patients, respectively. The postoperative complications were found in 13.1% of patients and one year mortality rate of thymectomy was 6.6%.

Conclusion: Regarding to high one year mortality rate of thymectomy in patients of MG in this study, the assessment of the factors related to the mortality and outcome of patients who underwent thymectomy in Iran are necessary.
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March 2009

Diagnostic accuracy of CT scan in abdominal blunt trauma.

Chin J Traumatol 2009 Apr;12(2):67-70

Sina Trauma and Surgery Research Center, Sina Hospital, Medical Sciences/University of Tehran, Tehran, Iran.

Objective: To evaluate the sensitivity and specificity of CT scan findings in patients with blunt abdominal trauma admitted to the university hospital.

Methods: All the patients with blunt abdominal trauma admitted at a tertiary teaching trauma center in Iran between 2005 and 2007 were enrolled in this study. In the absence of any clinical manifestations, the patients underwent a diagnostic CT scan. Laparatomy was performed in those with positive CT results. Others were observed for 48 hours and discharged in case no problem was reported; otherwise they underwent laparatomy. Information on patients?demographic data, mechanism of trauma, indication for CT scan, CT scan findings, results of laparotomy were gathered. The sensitivity, specificity and accuracy of the CT-scan images in regard with the organ injured were calculated. The sensitivity, specificity and accuracy of the CT scan were calculated in each case.

Results: CT scan had the highest sensitivity for detecting the injuries to liver (100%) and spleen (86.6%). The specificity of the method for detecting retroperitoneal hematoma (100%) and injuries to kidney (93.5%) was higher than other organs. The accuracy of CT images to detect the injuries to spleen, liver, kidney and retroperitoneal hematoma was reported to be 96.1%, 94.4%, 91.6% and 91.6% respectively.

Conclusion: The findings of the present study reveal that CT scan could be considered as a good choice, especially for patients with blunt abdominal trauma in teaching hospitals where the radiologic academic staff is not present in the hospital in the night shifts.
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April 2009

Analysis of 274 patients with extremity injuries caused by the Bam earthquake.

Chin J Traumatol 2009 Feb;12(1):10-3

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

Objective: The extremity injury pattern after a major earthquake is not well understood because data on this type of injury and management are limited. The aim of this study was to analyze the data of trauma patients with extremity injury in the earthquake of Bam Iran, registering 6.6 on the Richter scale.

Methods: We reviewed medical records of 486 patients admitted to hospitals of Tehran University of Medical Sciences. Among them, 274 patients sustained extremity injuries. This group was composed of 138 females (50.4%) and 136 males (49.6%) and 213 cases (77.7%) were under 40 years of age.

Results: Fracture was the major type of injury (58.4% of extremity injuries). The most common sites of injury were lower extremities (185 patients, 67.5% of all victims). Pelvic and rib fractures and abdominal injuries were the most frequently associated injuries. The mean ISS was 6.2+/-4.0, and 61% of the patients had ISS less than 7. Amputation and death occurred in 2.9% and 2.5% of cases, respectively.

Conclusions: Special attention should be given to dealing with orthopedic injuries in similar disasters in the future.
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February 2009

Patency rate and complications of vascular access grafts for hemodialysis in lower extremities.

Authors:
Javad Salimi

Saudi J Kidney Dis Transpl 2008 Nov;19(6):929-32

Surgery Department, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Placement of thigh grafts is an option in hemodialysis (HD) patients who have exhausted all upper extremity sites for permanent vascular access. To determine patency rate and complications of lower extremity grafts used for vascular access in patients on chronic HD in our center we studied prospectively the outcomes of 41 thigh grafts placed at a single institution during a 4-yr period (January 2000 and July 2003). Information was recorded on surgical complications and date of graft failure. The mean patient age was 55 +/- 12 years and 54% of the patients were males. The primary patency rates were, 76%, 67%, and 60% at 3, 9, and 12 months, respectively. There were 10 (24.4%) patients with thrombosis and 2 (4.8%) patients with bleeding. Graft infection and pseudoaneurism were observed in 2 patients each. No significant differences in infection rate or graft patency rates were found by patient age and gender. In our experiences, lower extremity vascular access graft is not associated with higher morbidity. Lower extremity polytetrafluoroethylene vascular graft (ePTFE) seems to be an appropriate vascular access when arteriovenous fistulas and upper extremity grafts cannot be constructed.
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November 2008