Publications by authors named "Katayoun Najafizadeh"

25 Publications

  • Page 1 of 1

Determinants of medical students for intention to organ donation: Application of theory of planned behavior.

Saudi J Kidney Dis Transpl 2019 Nov-Dec;30(6):1375-1380

Department of Health Education and Health Promotion, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Organ donation and transplantation save thousands of lives in the world. The aim of this study was identifying determinants of organ donation intention based on the Theory of Planned Behavior (TPB) among Iranian Medical Students. This cross-sectional study was performed during 2017 in Shahid Beheshti University of Medical Sciences. A sample of 438 students of Shahid Beheshti University of Medical Sciences was selected using multi-stage sampling method including stratified and random sampling. Data were collected by using a reliable and valid TPB-based questionnaire. All the participants filled the questionnaires and the data were extracted according to the previously described method. Data were analyzed by using the Statistical Package for the Social Sciences version 16.0 software. Descriptive statistic and Spearman correlation and Logistic regression were used for analyzing the data. Mean age of the participants was 20.92 ± 1.98 years. There was a significant linear positive correlation between behavioral intention and attitude, subjective norms, and perceived behavior control. Logistic regression analysis for assessing relation of TPB variables with behavioral intention showed that perceived behavioral control was more correlate with students' intention for getting organ donation card (odds ratio: 1.049, confidence interval: 1.062, P <0.000) perceived behavioral control, explain student's willingness to register as an organ donor. We must provide facilities so that students could register for organ donation easily.
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http://dx.doi.org/10.4103/1319-2442.275481DOI Listing
August 2020

Impact of Recruitment Maneuvers to Cover Adverse Effects of Donor Transfer.

Exp Clin Transplant 2020 08 29;18(4):429-435. Epub 2019 Nov 29.

From Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.

Objectives: Our aim was to investigate the negative effects of transferring brain-dead donors to the intensive care unit on the ratio of PaO₂ to inspired oxygen fraction and the benefits of recruitment maneuvers on its reversal.

Materials And Methods: In this randomized trial, we assigned 30 brain-dead donors to an intervention group and a control group. After transfer to the intensive care unit, donors in the intervention group received a lung recruitment maneuver according to protocol for 1 hour, whereas the control group did not receive this intervention. Arterial blood gas was drawn before transfer, immediately aftertransfer, and 3 hours after transfer.

Results: Before transfer to immediately after transfer, the PaO₂-to-inspired oxygen fraction ratio decreased from 281.30 ± 100.33 to 225.03 ± 95.72 mm Hg (P < .01). At 3 hours aftertransfer,the PaO₂-to-inspired oxygen fraction ratio in the intervention and control groups was 280.4 ± 120.4 and 213.4 ± 75.5 mm Hg (P = .017), respectively. The absolute difference in PaO₂-to-inspired oxygen fraction ratio from before to 3 hours after transfer was -16.9 ± 44.1 and 51.8 ± 61.4 mm Hg (P < .001), in the intervention and control groups,respectively. Increasing central venous pressure and/or transfer time further potentiated the decrease ofthe PaO₂-to-inspired oxygen fraction ratio.

Conclusions: The PaO₂-to-inspired oxygen fraction ratio decreased after transfer of brain-dead donors to the intensive care unit. This was partially reversible by standardized recruitment maneuvers.
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http://dx.doi.org/10.6002/ect.2019.0236DOI Listing
August 2020

Diagnostic values of bronchodilator response versus 9-question questionnaire for asthma.

Adv Respir Med 2019 ;87(5):269-275

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

Introduction: Several studies have investigated different tools for asthma diagnosis in order to reduce the cost and improve its early recognition. The goal of this study is to establish ashort questionnaire to be used in practice for asthma screening and compare diagnostic values between this method and spirometric response to bronchodilators.

Material And Method: 208 patients presenting with chronic stable dyspnea (> 6 months) and definite clinical diagnosis of chronic obstructive pulmonary disease, bronchiectasis, pulmonary fibrosis or asthma, were enrolled. 9 questions out of 43 based on the literature search were selected by regression analysis. Patients were asked to complete the questionnaire and then their spirometric responses to bronchodilators were evaluated.

Results: Of all, 53.8% of cases were diagnosed clinically to have asthma. For establishing diagnosis of asthma, the bronchodilator test had 48.2% sensitivity, 78.1% specificity, 72% positive, 56.4% negative predictive values, 2.2 positive, 0.66 negative likeli-hood ratios, and false positive, false negative and accuracy of 21.9%, 51.8% and 62.01%, respectively. The revised 9 questions from the questionnaire had 97.3% sensitivity, 77.1% specificity, 83.2% positive, 96.1% negative predictive values, 4.24 positive, 0.03 negative likelihood ratios, 22.9% false positive, 2.7% false negative and 87.98% accuracy.

Conclusions: The 9-question questionnaire had better diagnostic values in defining asthma in patients with chronic dyspnea than reversibility of airway obstruction to salbutamol and can be used as auseful screening test for diagnosis of asthma in clinical practice and for investigational purposes.
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http://dx.doi.org/10.5603/ARM.2019.0048DOI Listing
April 2020

Effects of Sirolimus on Lung function in patients with Lymphangioleiomyomatosis.

Caspian J Intern Med 2019 ;10(1):7-10

Yazd Diabetes Research Center, Shaheed Sadoughi University of Medical Sciences, Yazd, Iran.

Background: Lymphangioleiomyomatosis (LAM) is a progressive lungs disease that affects women at reproductive years. Sirolimus inhibits mammalian target of rapamycin (mTOR) and its administration in past studies was hopeful in treatment of patients with LAM. The aim of this study was to evaluate sirolimus therapy on lung function in LAM patients.

Methods: We conducted a trial to evaluate the effect of sirolimus on six patients with LAM who had severe or very severe obstructive lung disease, and one-year follow up. Maintenance level of Sirolimus was 10-15 ng/ml. Serial visits (including physical examination, evaluation of signs and symptoms of disease and adverse events due to treatment), spirometry, 6MWT done at baseline 3, 6, 9 and 12 months after. Spirometric parameters walk distance and O saturationbefore and after exercise at first and the end of treatment were measured.

Results: Four patients had TSC-LAM while the other 2 patients had S-LAM. The mean level of sirolimus was 13 ng/ml after one-year treatment. Mean FEV1 at enrollment and end of study was 1000cc (33% predict) and 1228cc (42% predict) respectively (P=0.674). The mean FVC at baseline and end of study was 1648cc (49% predict) and 1866cc (55% predict) (P=0.996). The mean FEV1/FVC at enrollment and the end of treatment was 58% and 62% respectively (P=0.753). The mean FEF25-75 at first and at the end of treatment was 16% and 26%, respectively (P=0.028). The mean walk distance in 6MWT at first and at the end of study was 315 meters (P=0.9). The mean percentage of O saturation at rest was 84% and 92% at first and at the end of study (P=0.104).

Conclusion: In LAM patients, sirolimus has been shown stabilizeto or improve lung function, rest and exertional O saturation. Sirolimus was effective in LAM patients who had severe or very severe physiological disorders.
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http://dx.doi.org/10.22088/cjim.10.1.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386328PMC
January 2019

Bronchiolitis Obliterans Syndrome and Death in Iranian Lung Transplant Recipients: A Bayesian Competing Risks Analysis.

Tanaffos 2016 ;15(3):141-146

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

Background: Bronchiolitis obliterans syndrome (BOS) is delayed allograft deterioration after lung transplant (LTX) that is clinically characterized by ≥ 20% decline from the baseline value of forced expiratory volume during the first second (FEV1). BOS is still a major obstacle limiting long-term survival post-LTX. The main aim of this study was to determine the predictors of BOS and death in Iranian LTX recipients.

Materials And Methods: This retrospective cohort study included 44 LTX recipients who survived ≥ 3 months post-LTX at the Masih Daneshvari Hospital, Tehran, Iran from 2000 to 2014. The outcome was time from lung transplantation to BOS and/or death (due to all causes except BOS). We used competing risks analysis to assess the effect of other factors on the cumulative incidence function of BOS and death. We applied a Fine and Gray model with Bayesian approach.

Results: The recipients' age (Mean ± SD) was 36.7 ± 14.5 yr. 11 (25%) recipients developed BOS as the first event within the first five years post-LTX and 13 (30%) died due to all causes except for BOS. Our results showed that CMV infection was associated with a significant increase in risk of developing BOS [hazard ratio (HR) 1.22 (95% credible set: (1.01, 3.2)] controlling for other variables. Bilateral transplantation [HR (95% credible set): 2.4(1.51, 4.05)] and CMV infection [HR (95% credible set): 2.02 (1.67, 2.55)] were predictors of the mortality risk.

Conclusion: CMV infection was a predictor of BOS risk in the studied patients. Moreover, bilateral transplantation and CMV infection were significant predictors of mortality in the present sample. Multi-center studies with larger sample sizes are required to better study the other risk factors, and the pathophysiologic mechanisms of BOS.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304957PMC
January 2016

Normothermic Ex Vivo Lung Perfusion in Brain-dead Donors Reduces Inflammatory Cytokines and Toll-like Receptor Expression.

Iran J Allergy Asthma Immunol 2016 Oct;15(5):340-354

Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Directors of Organ Transplantation and Special Diseases Office, Ministry of Health and Medical Education, Tehran, Iran.

Inflammatory responses and innate immunologic reactions play an important role in the respiratory system. Ex vivo lung perfusion (EVLP) is considered a novel method in the evaluation and reconditioning of donor lungs prior to transplantation. However, EVLP's effect on inflammatory and metabolic markers of human lung tissue is unknown.  This study investigated how the performance of EVLP on brain-dead (BD) donor lungs affects the production and release of inflammatory cytokines (IL-6, IL-8, and TNF-a), inflammatory cells and toll-like receptors (TLR) -2, 4. This study was conducted with an animal subject for qualification of EVLP team and then EVLP was performed on 4 human cases referred to Masih Daneshvari Hospital (Tehran,Iran), from May 2013 to July 2015. Two of these cases, who had acceptable lung function parameters, were enrolled in this study for immunologic investigations. Bronchoalveolar lavages (BAL) were taken before and after EVLP. Cytokines were quantitatively measured before lung retrieval, at the end of the lung removal, at the start of EVLP, and at the end of the each hour of EVLP. TLR expression was measured on the cells obtained by flow cytometry. TNF-a, IL-6 and IL-8 decreased in each stage of washing perfusate in both cases, and the level of cytokines in serum was in the normal range. Flow cytometry analysis revealed a decreasing expression of CD3, CD4/8, CD19, and CD16+56, as well as TLR-2 and TLR-4 in both cases. Intra-capillary pools of pro-inflammatory cytokines (IL-6, IL-8, and TNF-a) were determined to contribute to the lung injury during prolonged lung perfusion. This raises the possibility that EVLP donor lungs could be less immunogenic than standard lungs. However, to assess EVLP's effects on lung grafts and optimize recipient outcomes, further studies with a sufficient number of lungs are required.
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October 2016

Ex Vivo Lung Perfusion: Establishment and Operationalization in Iran.

Exp Clin Transplant 2017 Feb 14;15(1):82-88. Epub 2016 Oct 14.

From the Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: Although the number of lung transplants is limited because of general shortage of organ donors, ex vivo lung perfusion is a novel method with 2 main benefits, including better evaluation of lung potential and recovery of injured lungs. The main aim of this study was to establish and operationalize ex vivo lung perfusion as the first experience in Iran.

Materials And Methods: This was a prospective operational research study on 5 cases, including 1 pig from Vienna Medical University and 4 patients from Masih Daneshvari Hospital. All organ donations from brain dead donors were evaluated according to lung transplant or ex vivo lung perfusion criteria from May 2013 to July 2015 in Tehran, Iran. If a donor did not have any sign of severe chest trauma or pneumonia but had poor oxygenation due to possible atelectasis or neurogenic pulmonary edema, their lungs were included for ex vivo lung perfusion.

Results: A successful trend in the difference between the pulmonary arterial Po2 and the left atrial Po2 was observed, as well as an increasing pattern in other functional parameters, including dynamic lung compliance and a decreasing trend in pulmonary vascular resistance.

Conclusions: These initial trials indicate that ex vivo lung perfusion can lead to remarkable progress in lung transplant in Iran. They also provide several important pieces of guidance for successful ex vivo lung perfusion, including the necessity of following standard lung retrieval procedures and monitoring temperature and pressure precisely. The development of novel methods can provide opportunities for further research studies on lungs of deceased donors and lead to undiscovered findings. By keeping this science up to date in Iran and developing such new and creative methods, we can reveal effective strategies to promote the quality of donor lungs to support patients on transplant wait lists.
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http://dx.doi.org/10.6002/ect.2015.0354DOI Listing
February 2017

Role of Transcranial Doppler Sonography in Diagnosis of Brain Death: A Single Center Study.

Tanaffos 2016 ;15(4):213-217

Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Diagnosis of brain death relies on clinical and electroencephalographic (EEG) criteria. Waiting for 24 hours is mandatory to make definitive diagnosis of the condition in the Iranian protocol. Although it has been previously shown that oscillatory or spiked systolic or reversed diastolic flow patterns in transcranial Doppler sonography (TCD) are associated with faster brain death confirmation, it has not yet been approved in our protocol. Thus, the aim of this study was to assess the applicability of this method to our organ donation system.

Materials And Methods: This study was performed in Masih Daneshvari Organ Procurement Unit from July to December 2009. TCD from the middle cerebral and basilar arteries was attempted in 35 patients who fulfilled the clinical and EEG criteria for brain death. Extensive skull defects and hypotension (blood pressure < 80 mmHg) were the exclusion criteria. Examinations were made for about 30 minutes via temporal and occipital windows as soon as possible after diagnosis of brain death.

Results: The mean age of cases was 31.9±14.78 years and 18 (51.4%) were males. The most prevalent cause of brain death was trauma (in 19 or 54.2% of cases). We were unable to detect any intracranial artery in 2 (5.7%) cases. There were no false negative or false positive results in the remaining ones. Detected ultrasonic patterns of cerebral vascular flow were systolic spike and oscillating signal in 29 (87.9%) and 4 (12.1%) donors, respectively.

Conclusion: Our study showed that TCD results in brain dead cases were concordant with clinical and EEG criteria. Therefore, TCD, as a confirmatory test, can be applied for rapid diagnosis of brain death.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410117PMC
January 2016

Factors Affecting the Occurrence of Spinal Reflexes in Brain Dead Cases.

Exp Clin Transplant 2015 Aug;13(4):309-12

Telemedicine Research Center, Ministry of Health, San'at Square, Tehran, Iran.

Objectives: Brain death is defined as the permanent absence of all cortical and brain stem reflexes. A wide range of spontaneous or reflex movements that are considered medullary reflexes are observed in heart beating cases that appear brain dead, which may create uncertainty about the diagnosis of brain death and cause delays in deceased-donor organ donation process. We determined the frequency and type of medullary reflexes and factors affecting their occurrence in brain dead cases.

Materials And Methods: During 1 year, 122 cases who fulfilled the criteria for brain death were admitted to the special intensive care unit for organ procurement of Masih Daneshvari Hospital. Presence of spinal reflexes was evaluated by trained coordinators and was recorded in a form in addition to other information including demographic characteristics, cause of brain death, time from detection of brain death, history of craniotomy, vital signs, serum electrolyte levels, and parameters of arterial blood gas determination.

Results: Most cases (63%) included in this study were male, and mean age was 33 ± 15 y. There was > 1 spinal reflex observed in 40 cases (33%). The most frequent reflex was plantar response (17%) following by myoclonus (10%), triple flexion reflex (9%), pronator extension reflex (8%), and undulating toe reflex (7%). Mean systolic blood pressure was significantly higher in cases who exhibited medullary reflexes than other cases (126 ± 19 mm Hg vs 116 ± 17 mm Hg; P = .007).

Conclusions: Spinal reflexes occur frequently in brain dead cases, especially when they become hemodynamically stable after treatment in the organ procurement unit. Observing these movements by caregivers and family members has a negative effect on obtaining family consent and organ donation. Increasing awareness about spinal reflexes is necessary to avoid suspicion about the brain death diagnosis and delays in organ donation.
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August 2015

Home spirometry: Assessment of patient compliance and satisfaction and its impact on early diagnosis of pulmonary symptoms in post-lung transplantation patients.

J Telemed Telecare 2016 Mar 29;22(2):127-31. Epub 2015 May 29.

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

Telemedicine is useful in monitoring patients, and in particular those, such as lung transplant recipients, suffering from chronic illnesses. This prospective cohort study was conducted on 15 lung transplant recipients. The patients provided physicians with data from spirometry as well as their clinical respiratory symptoms via SMS messages. In cases where spirometry results or clinical symptoms required follow-up, the monitoring physician contacted the patient according to guidelines and gave appropriate instructions. Qualitative assessment of satisfaction showed that the sense of increased support from medical staff was rated highest (92.9%). Telespirometry is an efficient method of monitoring lung transplant recipients which leads to patient satisfaction, compliance, adherence to study and sense of security. Nevertheless, for optimal implementation of this method, thorough training of both medical staff and patients is required.
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http://dx.doi.org/10.1177/1357633X15587435DOI Listing
March 2016

Evaluation of the Effect of Ascorbic Acid Administration on Gene Expression Level of IL-6 and TNF-α Cytokines in Deceased Donors.

Iran J Allergy Asthma Immunol 2015 Apr;14(2):149-57

Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Brain death is associated with increased inflammatory cytokines levels and poor graft quality to transplant. We aimed to evaluate the impact of Ascorbic Acid (AA) on the inflammatory status of Brain-Dead Donors (BDDs). Forty BDDs were randomly divided into two groups. Donor treatment (n=20) consisted of 100 mg/kg AA infusion 6 hours before donor operation and subsequent infusion of 100 mg/kg/p6h until organ removal. Blood samples were taken at three times, 6 hours before donor surgery (TP(1)), immediately after laparotomy (TP(2)), and before organ removal (TP(3)). Gene expression level and serum concentration of IL-6 and TNF-α cytokines were assessed by real-time PCR and ELISA methods. To investigate transplanted liver function, serum values of Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), and Billirubin-Total were evaluated on the 1(st), 3(rd), and 10(th) postoperative days. We found a significant reduction in IL-6 mRNA expression ratio of TP(3) to TP(1) following AA application among BDDs. Despite the considerable decrease in treated donors regarding IL-6 mRNA expression ratio of TP(2) to TP(1), TP(3) to TP(2), and also TNF-α variations in these periods, the results were not significant. Regarding serum concentration of these cytokines, particularly IL-6, there was a decrease between TP(2) and TP(3) following AA application in the treated donors. Furthermore, a significant reduction was found in serum AST and ALT levels in the recipients of treated group on the 3(rd) day compared to the 1(st) day after transplantation. It seems that AA beneficially affects the inflammatory status of BDDs, resulting in improved primary allograft function.
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April 2015

Performance of QuantiFERON TB Gold test in detecting latent tuberculosis infection in brain-dead organ donors in Iran: a brief report.

Saudi J Kidney Dis Transpl 2014 Nov;25(6):1240-3

Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

With regard to the significant morbidity and mortality due to tuberculosis in lung transplant recipients, the identification of brain-dead organ donors with latent tuberculosis by use of the QuantiFERON TB Gold (QFT-G) test may be of help to reduce the risk of TB reactivation and mortality in lung recipients. This study was conducted in the National Research Institute of Tuber-culosis and Lung Diseases (NRITLD) in Iran, from January to March 2013. A total of 38 conse-cutive brain-dead donors, not currently infected with active tuberculosis, were recruited. The medi-cal records of all the study enrollees were reviewed. A whole-blood IFN- release assay (IGRA) in reaction to early secreted antigenic target 6 (ESAT-6), culture filtrate protein 10 (CFP-10), and TB7.7 antigens, was performed and the released Interferon- was measured via enzyme-linked immunosorbent assay (ELISA). The data was analyzed with QFT-G software which was provided by the company. The demographic, characteristics and other variables were entered into SPSS version 11.5. The QFT-G test results of three donors (7.9%) turned out to be positive, negative for 24 donors (63.1%), and indeterminate for 11 cases (28.9%). Our study revealed the potential advantages of QFT-G in lowering the incidence of donor-derived post-transplant tuberculosis among lung recipients. However, a high rate of indeterminate results restricted the performance of QFT-G in this study.
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http://dx.doi.org/10.4103/1319-2442.144258DOI Listing
November 2014

Imaging Findings of Isolated Bronchial Anthracofibrosis: A Computed Tomography Analysis of Patients With Bronchoscopic and Histologic Confirmation.

Arch Bronconeumol 2015 Jul 10;51(7):322-7. Epub 2014 Jul 10.

Department of Pulmonary Medicine, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Teherán, Irán.

Background: To evaluate the chest computed tomography (CT) findings of patients with isolated bronchial anthracofibrosis confirmed by bronchoscopy and histopathology.

Methodology: Fifty-eight patients with isolated bronchial anthracofibrosis (29 females; mean age, 70 years) were enrolled in this study. The diagnosis of bronchial anthracofibrosis was made based on both bronchoscopy and pathology findings in all patients. The various chest CT images were retrospectively reviewed by two chest radiologists who reached decisions in consensus.

Results: Central peribronchial soft tissue thickening (n=37, 63.8%) causing bronchial narrowing (n=37, 63.8%) or obstruction (n=11, 19%) was identified as an important finding on imaging. Multiple bronchial stenoses with concurrent involvement of 2, 3, and 5 bronchi were seen in 12 (21%), 9 (15%), and 2 (3.4%) patients, respectively. Segmental atelectasis and lobar or multilobar collapse were detected. These findings mostly occurred in the right lung, predominantly in the right middle lobe. Mosaic attenuation patterns, scattered parenchymal nodules, nodular patterns, and calcified or non-calcified lymph nodes were also observed.

Conclusions: On chest CT, isolated bronchial anthracofibrosis appeared as peribronchial soft tissue thickening, bronchial narrowing or obstruction, segmental atelectasis, and lobar or multilobar collapse. The findings were more common in the right side, with simultaneous involvement of multiple bronchi in some patients.
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http://dx.doi.org/10.1016/j.arbres.2014.04.018DOI Listing
July 2015

Risk factors associated with survival after lung transplant in iran.

Exp Clin Transplant 2014 Aug 19;12(4):290-4. Epub 2014 May 19.

From the Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.

Objectives: Limited information is available about risk factors associated with survival after lung transplant in Iranian recipients. This study evaluated the effect of recipient and donor characteristics on survival after lung transplant.

Materials And Methods: This retrospective study included 69 lung transplants (single, 31 patients [45%]; bilateral, 38 patients [55%]), from 2000 to 2013, at the National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The Kaplan-Meier method was used to calculate survival, and variables were evaluated with multivariate analysis.

Results: There were 54 male recipients (78%), and the most frequent indications for transplant included pulmonary fibrosis in 31 patients (45%) and bronchiectasis in 23 patients (33%). Recipient mean age was 36 ± 13 years and body mass index was 20 ± 4 kg/m2. Mean half-life (all recipients) was 2 ± 1 years and survival was 73% at 1 month, 67% at 1 year, and 40% at 5 years after transplant. For recipients who survived > 2 weeks after transplant half-life and survival were similar to previously international reported results. Recipient age, sex, type of transplant, body mass index, and pulmonary artery pressure were not associated with survival. Survival was significantly higher with recipient bronchiectasis, younger donors, and female donors.

Conclusions: Survival after lung transplant was better with recipients who had bronchiectasis and donors that were younger or female. Patient selection, invasive monitoring, and supportive techniques such as extracorporeal membrane oxygenation for unstable patients during surgery may be helpful.
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http://dx.doi.org/10.6002/ect.2014.0029DOI Listing
August 2014

Heart-lung transplantation in Iran: a case report.

Arch Iran Med 2013 Jul;16(7):431-5

Department of Anesthesiology and Critical Care, Lung Transplantation Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

We report our initial experience with a heart-lung transplant operation performed on a 12- year- old girl with Eisenmenger syndrome at Masih Daneshvari Teaching Hospital in Tehran, in 2009. We also outline the operative indications, anesthetic management, and postoperative complications of heart-lung transplantation. We hope that this issue on transplantation may provide an encouraging prospect for patients with end-stage cardiopulmonary disorders in Iran.
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http://dx.doi.org/013167/AIM.0014DOI Listing
July 2013

Using Home Spirometry for Follow up of Lung Transplant Recipients: "A Pilot Study".

Tanaffos 2013 ;12(1):64-9

Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of medical Sciences.

Background: Lung transplantation is considered the ultimate treatment for some patients, but due to the specific condition of patients undergoing it, follow up is a major concern. The aim of this study was to evaluate the role of home spirometry in follow up of lung transplant recipients and early detection of complications in these patients.

Materials And Methods: A PC-based portable spirometry set was used to evaluate the well being of two lung transplant recipients on a regular daily basis for a 6-month period. Patient satisfaction and compliance, and device sensitivity in detecting complications were evaluated. Results of follow up were compared with 2 matched control patients.

Results: Patient adherence to home spirometry was 80% in one and 61% in the other patient and both patients were satisfied with the method, although this satisfaction declined towards the end of the study period. The main reason for low adherence was insufficient internet access. This method succeeded in early detection of infectious complications.

Conclusion: Home spirometry seems to be a reliable method for follow up of lung transplant recipients, but further studies in a larger group of patients is recommended.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153232PMC
September 2014

Noninvasive assessment of acute cardiopulmonary effects of an oral single dose of sildenafil in patients with idiopathic pulmonary hypertension.

Heart Vessels 2010 Jul 31;25(4):313-8. Epub 2010 Jul 31.

Cardiovascular Department, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shaheed Beheshti University of Medical Sciences and Health Services, Darabad, Shaheed Bahonar Avenue, PO: 19575/154, Tehran 19556, Iran.

We aimed to assess the acute cardiopulmonary effects of a 100-mg oral single dose of sildenafil in patients with idiopathic pulmonary hypertension (IPAH) using a well-validated but less-used noninvasive echocardiographic method for the measurement of both systolic and diastolic pulmonary artery pressure (PAP), by tricuspid regurgitation (TR) velocity curve analysis. We studied 12 consecutive patients with IPAH (10 patients with New York Heart Association functional class III, and 2 patients with functional class II). A 100-mg oral single dose of sildenafil was added to previous medications of all patients and its immediate effects were evaluated 1, 5, and 12 h after treatment. Using paired analysis, administration of a 100-mg oral single dose of sildenafil led to a significant reduction in mean PAP and a remarkable increase in pulmonary acceleration time (PAT) 1 h after treatment (P = 0.000; 95% confidence interval [CI] 18.99-26.00 and P = 0.005; 95% CI -12.89 to -2.95, respectively). In addition, although the right heart dimensions (right atrium and right ventricle) showed a trend toward improvement, the differences were not statistically significant (P = 0.13 and P = 0.08, respectively). Our results demonstrated that Doppler examination of TR alone can be easily used for the estimate of systolic and diastolic PAP in patients with IPAH. This study also shows that sildenafil is the only drug given orally that can evaluate the vasodilatory capacity of the pulmonary vascular bed in patients with IPAH, with promising effects on mPAP and PAT in these patients.
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http://dx.doi.org/10.1007/s00380-009-1208-4DOI Listing
July 2010

Holy month of Ramadan and increase in organ donation willingness.

Saudi J Kidney Dis Transpl 2010 May;21(3):443-6

Lung Transplantation Research Center, National Research Institute of TB and Lung Disease, Shaheed Beheshti Medical University, Iran.

Organ shortage is the most significant factor in restricting the activities of transplantation systems. We herein report the positive impact of Muslims' holy month of Ramadan on willingness to donate organs in Iran. Data were derived from the database of Donation Willingness Registries, affiliated to the organ procurement unit of Masih Daneshvari Hospital during March 2007 till March 2008. The number of applications for organ donation was compared between Ramadan and its previous month, and the socio-economic characteristics of the applicants were compared between those who applied in Ramadan and those who did so in the previous month. In addition, the mean number of daily applications was compared between Ramadan and the other months of the same year. A total of 11528 applications for organ donation cards were registered for the Ramadan of 2007 as opposed to 4538 applications in the previous month, showing an increasing rate of 154%. The mean number of daily applications was significantly higher in Ramadan than that of the other months of the same year (P < 0.001). There was also a significant difference in terms of the socio-economic characteristics between the applicants in Ramadan and those in the previous month. The increase in organ donation willingness in Ramadan may be the result of the propagation of altruism by the mass media and religious organizations. Ramadan seems to provide a great opportunity to promote organ donation across the Muslim world.
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May 2010

Postlung transplant rehospitalization: a study of causes, health care burden, and outcomes.

Exp Clin Transplant 2009 Sep;7(3):192-6

Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shaheed Beheshti Medical University, Tehran, Iran.

Objectives: Rehospitalization is a significant burden for transplant systems, which use data on hospitalization to monitor practice outcomes. In this study, all rehospitalizations after successful lung transplant performed in our medical center during an 8-year period were assessed for cause, health care resource use, cost, and outcome.

Materials And Methods: We performed a retrospective chart review of all rehospitalizations of lung transplant recipients in Masih Daneshvari Hospital in Darabad, Tehran, between 2000 and 2008. Baseline data (each patient's age at transplant and rehospitalization, sex, primary lung disease, medications used), cause of rehospitalization (infection, graft rejection, surgical complications, type of infection), health care resources use (length of hospital stay, intensive care unit stay, physician visits, imaging), rehospitalization costs (accommodations, personnel, drugs, paraclinical [ie, laboratory] tests, supplies, procedures) and outcome (death, survival) were noted.

Results: In 69% of patients who were rehospitalized after having received a lung transplant, the cause was infection. Other causes were acute rejection in 31% and surgical complications in 6.9%. In 10.3% of those patients, the primary cause for rehospitalization could not be specified. The mean (SD) duration of rehospitalization was 12.8 -/+ 10.4 days. Treatment in the intensive care unit was necessary for 93.1% of the study subjects. The mean (SD) number of physician visits was 27.8 -/+ 27.7, and the fatality rate in the patients studied was 13.8%.

Conclusions: These data may guide the monitoring of the causes, burden, and outcomes of lung transplants performed in our medical center in Iran and in other medical centers.
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September 2009

Depression while on the lung transplantation waiting list.

Ann Transplant 2009 Apr-Jun;14(2):34-7

Lung transplantation Research Center, National Research Institute of Tuberclosis and lung Disease, Shaheed Beheshti Medical University, Tehran, Iran.

Background: Patients inflicted with severe illnesses are prone to depression, which tends to intensify the burden of the disease. Those awaiting organ transplantation cannot help but feel that they may not be fortunate enough to breathe through a new lung. Such sense of doom along with constraints imposed by the illness increases the likelihood of depression. We sought to investigate the presence of depression in a group of patients on the lung transplantation waiting list in Iran.


Material/methods: This cross-sectional study, conducted between August and September 2007, recruited 64 candidates from a single lung transplantation clinic. The Beck Depression Inventory was employed to identify the presence and severity of depression. This 21-item questionnaire has a total score ranging from 0 to 63, with higher scores denoting more severe depressive symptoms. In an Iranian population, scores from 0 to 15 signify no problem, while scores from 16 to 30 indicate mild, 31 to 46 moderate, and 47 to 63 severe depression.


Results: The patient population was composed of 70.3% men and 29.7% women at a mean age of 36.6+/-13.6 years. 40.6% were single and 59.4% were married. Whereas 43.8% had no abnormal depressive symptoms, 37.5% had mild and 18.7% had moderate symptoms.


Conclusions: More than half of the patients on the lung transplantation waiting list had a degree of depression. Given the risk of non-compliance with treatment in depressives, it is advisable that lung transplantation candidates be screened for depression and diagnosed cases be referred for the treatment of depression.

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July 2009

The cost of lung transplantation in Iran.

Ann Transplant 2009 Apr-Jun;14(2):30-3

Lung Transplantation Research Center, National Research Institute of Tuberclosis and lung Disease, Shaheed Beheshti Medical Sciences University, Tehran, Iran.

Background: Lung transplantation is one of the most complicated medical procedures. The aim of the present study is to report the average cost of lung transplantation in Iran.


Material/methods: We reviewed the hospital data of all lung transplantations performed in Masih Daneshvari Hospital, Tehran, Iran, from 2000 to 2008 and extracted information on the costs for hospitalization for the transplantation surgery. We excluded the patients who died shortly after the transplantation surgery.We then categorized the costs into seven distinct groups: accommodations, personnel, medication, paraclinics, supplies, procedures and other costs. Data was primarily extracted based on Iranian national currency (Rials) and then converted to US dollar (10,000 Rials = 1$). The mean of the costs are reported for each category.


Results: The mean total cost of lung transplantation was 13,801.6+/-7,752.3 USD (range: 6,104.9 to 26,888.7). This cost was related to the specified categories as followed: Expenditure tools = 35.55%, medications = 34.46%, personnel cost = 10.14%, accommodations = 8.14%, procedures = 5.66%, paraclinics = 5.49%, other costs = 0.56%.


Conclusions: The cost of lung transplantation is high. This could be due to the complexity of the procedure, the large number of specialists involved, long duration of hospital stay and high rate of complications that might occur following the surgery. The results of the present study also showed that the cost of lung transplantation in Iran is far below the reported costs from other countries.

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July 2009

Pulmonary artery stenosis shortly after lung transplantation: successful balloon dilation and stent insertion in one case.

Ann Transplant 2009 Jan-Mar;14(1):52-5

Lung transplantation Research Center, National Research Institute of Tuberclosis and lung Disease, Shaheed Beheshti Medical Sciences University, Tehran, Iran.

Background: Pulmonary artery stenosis after lung transplantation is a rare complication. It usually requires surgical correction but even after that the outcome is not favorable.


Case Report: The patient was a 53-years-old woman who was candidate for lung transplantation surgery due to pulmonary fibrosis. After 7 months on waiting list, with severe limitations in daily living activities, she received a single lung transplant in 2007. The surgery was performed without any complication. One day after surgery and after extubation, the patient needed oxygen supplementation through mask with reservoir bag. In bronchoscopy, black-and-white exudate and black membrane that blocked the main bronchus in the transplanted lung was observed. By bronchial lavage the membrane and exudate were successfully removed and patient received antibiotics for documented Aspergillus infection and methylprednisolone pulse therapy for evidences of graft rejection. Despite success in treatments of the mentioned complications, the condition of the patient deteriorated and she became totally dependent to supplemental oxygen. Oxygen consumption level had increase and pulmonary artery pressure was increasing gradually. With suspicion to pulmonary artery stenosis, bronchial CT-Scan with contrast was performed 13 days after transplantation surgery which showed a 50% stenosis. Trans-esophageal echocardiography also showed a stenosis with 40 mmHg gradient. 18 days after transplantation surgery, percutaneous balloon angioplasty was performed which was initially successful but re-stenosis occurred. Seven days later, another balloon angioplasty with stent insertion was performed. After the procedure, the gradient has been removed. Patient was discharged 30 days after transplantation. Follow-up after 10 months revealed no stenosis and the stent was working properly.


Conclusions: Stent angioplasty can be performed with no problem or complication if pulmonary artery stenosis is seen after lung transplantation.

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June 2009

Health status of the patients before lung transplantation: a report from Iran.

Ann Transplant 2009 Jan-Mar;14(1):5-9

Lung transplantation Research Center, National Research Institute of Tuberclosis and lung Disease, Shaheed Beheshti Medical University, Tehran , Iran.

Background: Breathing is essential for living. When someone is a lung transplantation candidate, it could be imagined that the breathing difficulties that he/she is experiencing has a great impact on his/her health status.

Material/methods: We asked all the patients on the lung transplantation waiting list at Masih Daneshvari Hospital to complete the validated Iranian version of Global Health Questionnaire (GHQ). It was the 28-item version of the questionnaire with scores ranging from 0 to 84. Patients filled the questionnaire while on routine out-patients visits. The higher scores represent greater distress.

Results: Seventy patients were requested to participate in the present study out of which 64 filled the questionnaire completely. Mean +/-SD (min-max) scores of the questionnaire subscales were as follows: somatic symptoms =8.2+/-4.2; anxiety =8.1+/-4.9; 8-14, depression =4+/-4.2; social dysfunction =10.4+/-4 and the overall score =30.6+/-9.5. There was no significant difference in the subscales of the questionnaire based on gender and disease type. Higher age was associated with less social dysfunction (r=-273, p=0.023). Higher level of prednisolone consumption and lower hemoglobin were associated with poorer somatic status (r=0.644, p=0.033; r=-0.410, 0.030 respectively).

Conclusions: Our findings indicate that lung transplantation candidates have extremely poor health state. It seems that pulmonary problems and activity limitations put more pressure on younger patients and causes social difficulties.
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June 2009