Publications by authors named "Koorosh Ahmadi"

38 Publications

Geographical distribution of COVID-19 in the World and Iran; Investigation of possible transmission roots.

J Family Med Prim Care 2020 Aug 25;9(8):4473-4475. Epub 2020 Aug 25.

Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.

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http://dx.doi.org/10.4103/jfmpc.jfmpc_733_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586559PMC
August 2020

Diagnostic value of standard electrocardiogram in acute right ventricular myocardial infarction.

Eur J Transl Myol 2019 May 22;29(2):8184. Epub 2019 May 22.

Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.

Myocardial infarction (MI) (i.e., heart attack) is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia) which accounts for a large number of deaths in the hospital. Diagnosis of myocardial infarction is confirmed based on clinical manifestations and electrocardiographic changes along with increased cardiac enzymes. Electrocardiogram (ECG) is one of the safest and easiest methods in the first place. Therefore, this study aimed to investigate the diagnostic value of standard electrocardiogram in the diagnosis of acute right ventricular infarction following lower cardiac infarction. This research was carried out at a time interval of one and a half years to diagnose acute primary infarction. In this method, the diagnostic value of ST↓ in lead I, ST↓ in lead aVL and I ST↓ + aVL, compared with ST↑ in lead V4R was investigated for diagnosis of right ventricular infarction. ST↑ in the lead V4R is a gold standard for the detection of right ventricular MI. All the patients who had the inclusion criteria were allowed to participate in the study. A total of 66 patients participated in the study. Accordingly, 58 (87%) were male and 8 (13%) were female. The mean age of the population was 54.9 ± 11.41. According to the ST↑ standard in lead V4R, 26 patients (39%) had right ventricular myocardial infarction. There was no significant relationship between angina pectoris and premature infarction (P-Value = 0.869). In this study, the right ventricular was most commonly involved in right coronary artery (78%). There was no significant relationship between the occlusion of right coronary artery and right ventricular infarction in 60 patients (P-Value = 0.94). The results showed that electrocardiogram manifestations help determine the occlusion site and the area at risk (ST↓ in lead aVL and aVL + I, sensitivity = 96%). In myocardial infarction, symptoms such as the ST-Segment elevation in lead aVR and ST-Segment depression in the lower leads are possible. Accordingly, in the lower infarction, ST changes in the leads V1-V6 are helpful in detecting patients at risk. Thus, the use of electrocardiogram in acute myocardial infarction helps detect more invasive patients and prevents extensive myocardial damage and other complications.
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http://dx.doi.org/10.4081/ejtm.2019.8184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615066PMC
May 2019

Use of Fentanyl Patch and Intravenous Morphine for Treatment of Leg Bone Fracture: Treatment Profile, and Clinical Effectiveness.

Open Access Maced J Med Sci 2018 Dec 10;6(12):2301-2305. Epub 2018 Nov 10.

Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran.

Background: Severe pain is one of the major problems in patients with leg bone fracture. Various methods have been proposed to relieve pain. Opioids are one of the most important available medications to control these types of pain. Among the opioids available, fentanyl can be applied for its unique properties as transdermal patches.

Aim: Therefore, the current study aimed to investigate the effect of intravenous morphine and fentanyl skin patch in patients with a lower leg fracture.

Methods: We entered 60 patients in this randomised, one-blind randomised clinical trial among patients referring to the emergency department of Vali-e-Asr Hospital in Arak with a fracture of the leg. Demographic and clinical data were recorded for patients. The case group (n = 30) received the fentanyl patch in the same area. Patients in the control group (30) received 0.1mcg/kg of morphine intravenously. In both groups, the severity of pain was measured every 20 minutes within two hours after onset of treatment based on VAS criteria and subsequently recorded in the checklist. Data were analysed by SPSS v.22 software package.

Results: The results of the present study demonstrated that the mean visual analogue scale (VAS) pain score at minutes 20, 40, 60 and 80 were statistically lower in intervention group when compared with the control group (p = 0.000).

Conclusion: Our results indicated a considerable risk-benefit profile for the treatment of pain in patients suffering from dysphagia, nausea and vomiting, or resistance to other opioids. The use of fentanyl patch is also suitable for patients who are not able to take their medication at their scheduled time.
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http://dx.doi.org/10.3889/oamjms.2018.413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311492PMC
December 2018

The Effects of Filgrastim on Complications of Patients with Cerebral Hemorrhage Due To Head Trauma.

Open Access Maced J Med Sci 2018 Nov 8;6(11):2030-2034. Epub 2018 Nov 8.

Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran.

Background: Filgrastim, a neopogen brand, is a blood-forming agent and a natural protein in the body that plays a role in stimulating the growth of white blood cells and protecting them against infectious agents. To the best of knowledge, human and animal specimens have shown the effect of Filgrastim on treating brain injuries regarding bone marrow transfusion into the blood, neuroprotection, stimulation of neurons for forming new neural networks and reducing the risk of bacterial infections.

Aim: This study aimed to investigate the effect of Filgrastim on the prognosis of a cerebral haemorrhage in patients with traumatic brain injury.

Methods: This study was conducted as a clinical trial, in which the initial diagnosis of patients with cerebral haemorrhage due to head trauma was performed with a clinical examination and CT scan. After the patient arrives at the emergency room, the patient's initial examination is performed, and blood tests are taken from the patient. Moreover, CBC values (Hb, Platelet, Hematocrit) were checked and recorded in the checklist. The intervention group received 150 mcg/day Filgrastim injected subcutaneously for 4 days. Furthermore, patients in the control group received the same amount of sterile water. At the end of the treatment period, blood tests were performed again in all patients, and their results were then recorded. All data were analysed by SPSS v.21 software package.

Results: Our findings revealed that the mean volume of bleeding in the intervention group based on CT scan was significantly reduced after four days as compared to the control group. Moreover, the mean score of consciousness and muscular strength of patients in the intervention group was significantly higher than the control group. Also, WBCs in the intervention group exhibited a significant increase after four days of intervention, while platelet and hematocrit levels in the intervention group decreased significantly compared to the control group.

Conclusion: Regarding the results, the therapeutic application of filtration is considered to be effective. Given the lack of serious complications of the proposed dosages, the use of this drug can be suggested.
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http://dx.doi.org/10.3889/oamjms.2018.412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290401PMC
November 2018

Surgical outcome and clinicopathological characteristics of emergency presentation elective cases of colorectal cancer.

Arch Med Sci 2018 Jun 9;14(4):826-829. Epub 2016 Aug 9.

Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.

Introduction: The aim of this study was to evaluate the significance of clinicopathological characteristics of colorectal cancer patients undergoing emergency and elective surgery.

Material And Methods: In total, 116 tumors from patients treated surgically for colorectal cancer at four hospitals in Tehran between 2008 and 2013 were analyzed in the current study.

Results: Our findings revealed that the emergency cases were significantly more likely to have an advanced TNM stage ( = 0.027) and histologic grade ( = 0.01) compared with the elective patients. Furthermore, the nature of surgery was significantly associated with vascular and perineural invasion ( = 0.021; = 0.001). We also evaluated the association of gender, age, and tumor location with the nature of surgical presentation. However, no association was found between these parameters and the nature of surgery. Emergency was also correlated with greater length of hospital stay and higher rate of admission to the intensive care unit. The mortality rate was 20% in emergency cases, while patients with elective surgery had 5.63% perioperative mortality ( = 0.001). The emergency patients had a higher rate of mortality.

Conclusions: Our data indicated that colorectal cancer patients undergoing emergency surgery showed an advanced stage. The emergency patients had a higher rate of mortality than elective cases.
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http://dx.doi.org/10.5114/aoms.2016.61706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040124PMC
June 2018

The Effects of Injected Vitamin D on Prognosis of Patients with Urosepsis.

Horm Metab Res 2018 May 5;50(5):383-388. Epub 2018 Apr 5.

Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.

The aim of this study was to evaluate the effect of prescribing vitamin D on improving the symptoms of patients diagnosed with urosepsis. The participants were randomly divided into two equal groups (each consisting of 50 patients). The patients in the first group received standard treatment with 300 000 units of injected vitamin with a volume of 1 cc. As for the patients in the second group, they received standard treatment along with 1 cc normal saline injected to them as placebo. Vital signs of the patients were checked every 6 h, while their CBC, EXR, CRP, creatinine, urea, and uric acid were checked 0, 24, 48, and 72 h following the interventions. Calcium, phosphorus, and vitamin D levels were measured 72 h following injection of the medicine. A significant difference was observed between the two groups in terms of the number of WBC's in 24th, 48th, and 72nd hours. A similarly significant difference was reported between the case and control group in terms of the average BUN within 24th, 48th, and 72nd hours. The difference observed between the two groups in terms of average Cr within the 0th, 24th, 48th, and 72nd hours and in terms of days of hospitalization was also significant. Considering these results and keeping in mind the fact that no particular side effects were reported as a result of utilizing muscular injections of vitamin D and the easy and cheap use of this medicine, it can be used in auxiliary treatment of patients with urosepsis.
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http://dx.doi.org/10.1055/a-0595-7731DOI Listing
May 2018

Investigation of clinicopathological parameters in emergency colorectal cancer surgery: a study of 67 patients.

Arch Med Sci 2017 Oct 20;13(6):1394-1398. Epub 2016 Jul 20.

Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.

Introduction: The aim of the present study was to establish, having adjusted for case mix, the size of the differences in postoperative mortality and 5-year survival between patients presenting as an emergency with evidence of obstruction and perforation and the association of clinicopathological factors with mortality (bivariate analyses).

Material And Methods: The study included 67 patients who presented with colorectal cancer (CRC) between 2009 and 2013 in Iran. The mean age of the patients was 59.7 years. Of the 67 patients, 37 (55.22%) were male and 30 (44.77%) were female. Certain parameters that correlated with CRC and surgical treatment were investigated.

Results: Our results showed that 46 (68.65%) patients had obstruction, while perforation was observed in 21 (31.34%) cases. Among the patients with obstruction, obstruction of the right colon was observed in 29 (43.28%) cases. There was no significant difference in mortality rate between right and left colonic obstruction. Based on the bivariate analyses, our findings showed that death of patients was significantly related to tumor grade ( = 0.02) and TNM staging ( = 0.026), but no association was found between other parameters and death, including age, sex, and tumor site.

Conclusions: Compared with patients who undergo elective surgery for colon cancer, those who present as an emergency with evidence of obstruction or perforation have higher postoperative mortality rates and poorer cancer-specific survival. Also, colorectal cancer patients with emergency surgery showed aggressive histopathology and an advanced stage.
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http://dx.doi.org/10.5114/aoms.2016.61385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701685PMC
October 2017

Comparison of ultrasonography and radiography in diagnosis of rib fractures.

Chin J Traumatol 2017 Aug 26;20(4):226-228. Epub 2017 May 26.

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

Purpose: Rib fractures are the most common skeletal thoracic injuries resulting from blunt chest trauma. Half of the rib fractures are not detected upon a precise physical evaluation and radiographs. Recently ultrasonography (USG) has been investigated to detect rib fractures. But based on literature the usefulness of USG varies widely. This study was conducted to investigate the role of USG in the detection of possible rib fractures in comparison with radiography.

Methods: In this cross-sectional study, consecutive patients with minor blunt chest trauma and suspected rib fractures presenting in Imam Reza Hospital located in Mashhad-Iran, between April 2013 and October 2013 were assessed by USG and radiography. The radiography was performed in a posteroanterior (PA) chest projection and oblique rib view centered over the area of trauma. The time duration spent in taking USG and radiography were recorded. The prevalence and location of fractures revealed by USG and radiography were compared.

Results: Sixty-one suspected patients were assessed. The male to female ratio was 2.4:1 (43 men and 18 women) with a mean ± SD age of (44.3 ± 19.7) years. There were totally 59 rib fractures in 38 (62.3%) patients based on radiography and USG, while 23 (37.7%) patients had no diagnostic evidence of rib lesions. USG revealed 58 rib fractures in 33 (54.1%) of 61 suspected patients and radiographs revealed 32 rib fractures in 20 (32.8%) of 61 patients. A total of 58 (98.3%) rib fractures were detected by USG, whereas oblique rib view and PA chest radiography showed 27 (45.8%) and 24 (40.7%) rib fractures, respectively. The average duration of USG was (12 ± 3) min (range 7-17 min), whereas the duration of radiography was (27 ± 6) min (range 15-37 min). The kappa coefficient showed a low level of agreement between both USG and PA chest radiography (kappa coefficient = 0.28), and between USG and oblique rib view (kappa coefficient = 0.32).

Conclusion: USG discloses more fractures than radiography in most patients presenting with suspected rib fractures. Moreover USG requires significantly less time than radiography.
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http://dx.doi.org/10.1016/j.cjtee.2016.04.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555243PMC
August 2017

Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional study of a trauma center in Iran.

Chin J Traumatol 2017 Apr 6;20(2):75-80. Epub 2017 Feb 6.

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

Purpose: To accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center.

Methods: Patients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, Iran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score (ISS) > 9 were included in this study. Data analysis was performed by SPSS software (Version 11.5) and P values less than 0.05 were considered as significant differences.

Results: Among the 6306 hospitalized trauma patients during this period, 148 had ISS>9. The male female ratio was 80%. The mean age of the patients was (33.5 ± 19.3) years. And 71% of the patients were younger than 44 years old. There were 19 (13%) deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was (55 ± 26) minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases (75%).

Conclusion: Motorcycle crashes have high frequency in Iran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries.
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http://dx.doi.org/10.1016/j.cjtee.2016.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392716PMC
April 2017

Diagnostic Value of Fine-Needle Aspiration Biopsies and Pathologic Methods for Benign and Malignant Breast Masses and Axillary Node Assessment

Asian Pac J Cancer Prev 2017 02 1;18(2):541-548. Epub 2017 Feb 1.

Department of Surgery, Alborz University of Medical Sciences, Karaj, Iran. Email:

Bacground: The goal of this study was to evaluate the fine needle aspiration (FNA) preoperatively together with Touch Print, Crush Print, frozen section and pathologic methods to reach a diagnosis for patients with breast and axillary masses. Methods: This study was conducted on 107 patients, and included 111 samples of breast and 43 of axillary masses taken at surgery. Data on epidemiological and clinical features of the patients were collected using a questionnaire. The results of the methods of FNA, Touch Print, and Crush Print were compared with the results of pathology after operations. Results: Comparison between the diagnosis values of FNA with pathology for breast cancer showed sensitivity, sensitivity, positive predictive values, negative predictive values, positive mendacious percentages, and negative mendacious percentages of 80.4%, 98%, 97.3%, 87.6%, 2%, and 19.6% , respectively, and for metastatic axillary lymph nodes, 80%, 95.6%, 94.1%, 84.6%, 4.4%, and 20%. Comparison of diagnosis values of FNA with Touch Print and Crush Print for breast cancer gave values of 82.2%, 89%, 97.3%, 89%, 1.6%, and 17.8%, respectively, and for metastatic axillary lymph nodes 84.2%, 95.8%, 94.1%, 88.4%, 14.2%, and 15.8%. Conclusion: Use of these methods, compared with pathology, can decrease cost, time, and a need for a second surgery and related complications.
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http://dx.doi.org/10.22034/APJCP.2017.18.2.541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454756PMC
February 2017

The effect of tranexamic acid in traumatic brain injury: A randomized controlled trial.

Chin J Traumatol 2017 Feb 20;20(1):49-51. Epub 2017 Jan 20.

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage (ICH) secondary to TBI is associated with a high risk of coagulopathy which leads to increasing risk of hemorrhage growth and higher mortality rate. Therefore, antifibrinolytic agents such as tranexamic acid (TA) might reduce traumatic ICH. The aim of the present study was to investigate the extent of ICH growth after TA administration in TBI patients.

Methods: This single-blind randomized controlled trial was conducted on patients with traumatic ICH (with less than 30 ml) referring to the emergency department of Vali-Asr Hospital, Arak, Iran in 2014. Patients, based on the inclusion and exclusion criteria, were divided into intervention and control groups (40 patients each). All patients received a conservative treatment for ICH, as well as either intravenous TA or placebo. The extent of ICH growth as the primary outcome was measured by brain CT scan after 48 h.

Results: Although brain CT scan showed a significant increase in hemorrhage volume in both groups after 48 h, it was significantly less in the TA group than in the control group (p = 0.04). The mean total hemorrhage expansion was (1.7 ± 9.7) ml and (4.3 ± 12.9) ml in TA and placebo groups, respectively (p < 0.001).

Conclusion: It has been established that TA, as an effective hospital-based treatment for acute TBI, could reduce ICH growth. Larger studies are needed to compare the effectiveness of different doses.
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http://dx.doi.org/10.1016/j.cjtee.2016.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343096PMC
February 2017

A Comparison between the Tie-over and Closed Suction Drainage Therapeutic Strategies in Patients Suffering from Sacral Pilonidal Sinus.

Int J Biomed Sci 2016 Dec;12(4):149-154

Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.

Background And Objectives: Pilonidal sinus is a disease in the sacrococcygeal region diagnosed through the purulent discharges of the above-said region. Although the exact pathology and etiology of those suffering from pilonidal is not clear yet, the presence of hair seemingly plays a major role in the process of infection and the granulation tissue. Several techniques have been identified for pilonidal surgery. These techniques primarily fall within two categories: Primary repair and Lay open. One of the setbacks of the primary repair method is the creation of a dead area under the wound which can result in blood accumulation and seroma. To solve the problem of removing the dead space, there are two solutions. The first method utilizes a close suction drain, when the wound discharges are over, the drain is removed. The second technique is called Tie-over where different layers of the wound are pushed close to one another and the dead region vanishes. The present research seeks to compare Tie-over and Closed Suction Drainage methods through random clinical trial in order to introduce the superior technique for faster recovery and reduction of the economic load on the patient.

Methods: Some 64 patients suffering from sacral plonidal sinus aging from 15 to 50 in Shohadaye Ashayer Hospital of Khoram Abad in 2013 were selected for the research based on the inclusion criteria. The demographic information of them was collected through questionnaires. The patients were randomly divided into two groups undergoing (A) Tiover and (B) Closed Suction Drainage surgeries. Other information such as return to normal activity and total recovery time was also completed through the questionnaire. SPSS software was used to conduct statistical analysis.

Results: The results of the statistical analysis showed that the two groups were similar to one another in terms of age, gender, marital status, job, and literacy. A significant difference was observed only between the level of satisfaction (-value = 0.035) in groups A and B concerning the factors studied after the operation. The post-operation recurrence of pilonidal sinus among those who smoked cigarettes and had undergone Closed Suction Drainage was significantly greater than the non-smokers (-value=0.011). As of the group undergoing Tie-over surgery, the difference between the patients' satisfaction in terms of their age was statistically significant and the highest level of satisfaction was observed among those aging 25 to 34 (90%) (-value=0.023).

Conclusion: In sacrococcygeal pilonidal cyst surgery, no difference was observed except for the difference in the level of satisfaction. More satisfaction was observed using the Tiover method.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5267626PMC
December 2016

A Rare Case of Hamartoma Chest Wall Following Trauma in a 42-year-old Man.

Med Arch 2016 Oct 25;70(5):398-400. Epub 2016 Oct 25.

Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.

Background: Chest wall mesenchymal hamartoma (CWH) is a distinct and extremely rare tumor-like lesion of the thorax. It usually presents in the neonatal period or in infancy. The common presentation is in the form of a visible chest wall mass with or without respiratory distress.

Case Presentation: A 42-year-old man with a history of chest wall trauma since 5 years ago was admitted with a swelling of the anterior of the chest wall and during this period has grown slowly. Physical examination showed a left anterior chest wall deformity. Chest radiographs and chest CT showed a left anterolateral chest wall mass involving the fourth and fifth ribs. Thoracotomy was performed. The tumor and involved ribs were resected with a 5cm safe margin. The histopathologic examination showed hamartoma. The patient has been fallowed up since 60 month ago, and has not had any complaints in this time.

Result: Despite the rarity of chest wall hematoma, this side effect must always be taken into consideration while studying the chest wall injuries especially in the case of trauma history due to other differential diagnosis and her side effects such as respiratory problems.

Conclusion: Although rare, this condition ought to be kept in mind while dealing with hamartoma Chest wall following trauma in order to avoid its complications such as respiratory problems. Surgical excision is usually curative in combination with conservative therapy if possible.
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http://dx.doi.org/10.5455/medarh.2016.70.398-400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5136429PMC
October 2016

Antibiotic Resistance Properties of Isolated From Cases of Superficial Infections at the Emergency Unit.

Jundishapur J Microbiol 2016 01 23;9(1):e27646. Epub 2016 Jan 23.

Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.

Background: , a ubiquitous opportunistic pathogen, is one of the main causative agents of human superficial infections. Infections due to these bacteria are difficult to heal and cause serious economic issues.

Objectives: The present study was carried out to investigate the antibiotic resistance pattern of isolated from cases of superficial infections referred to the emergency health care units of Iranian Hospitals.

Materials And Methods: Three hundred swab samples were collected from patients with superficial infections. Samples were cultured and those that were positive were analyzed by the disk diffusion method.

Results: One hundred and seventy-two out of 300 swab samples (57.3%) were positive for . The results of the culture technique were also confirmed using the polymerase chain reaction (PCR). Females had a higher prevalence of than males, patients older than 70 years were the most infected age group and finally burn infections had the highest prevalence of bacteria. strains had the highest levels of resistance against ampicillin (93%), gentamycin (89.5%), ciprofloxacin (82.5%) and amikacin (77.3%). The most effective drugs were meropenem (2.3%, imipenem (2.9%), polymyxin B (21.5%) and cotrimoxazole (31.9%).

Conclusions: It is logical to primarily prescribe meropenem, imipenem, polymyxin B and cotrimoxazole in the cases of superficial infections caused by . Medical practitioners should be aware of the presence of such levels of antibiotic resistance in cases of superficial infections in Iran.
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http://dx.doi.org/10.5812/jjm.27646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102493PMC
January 2016

The Prognostic Value of Using Ultrasonography in Cardiac Resuscitation of Patients with Cardiac Arrest.

Int J Biomed Sci 2016 Sep;12(3):110-114

Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Cardiopulmonary arrest is the final result of many diseases and therefore, need for a careful implementation of cardiopulmonary resuscitation (CPR) protocols in these cases is undeniably important. The introduction of ultrasound into the emergency department has potentially allowed the addition of an extra data point in the decision about when to cease cardiopulmonary resuscitation (CPR). The aim of this study is to evaluate the ability of cardiac ultrasonography performed by emergency physicians to predict resuscitation outcome in adult cardiac arrest patients. Ultrasonographic examination of the subxiphoid cardiac area was made immediately after admission to the emergency department with pulseless cardiac arrest. Sonographic cardiac activity was defined as any detectable motion within the heart including the atria, ventricles or valves. Successful resuscitation was defined as: return of spontaneous circulation for ≥ 20 min; return of breathing; palpable pulse; measurable blood pressure. The present study includes 159 patients. The presence of sonographic cardiac activity at the beginning of resuscitation was significantly associated with a successful outcome (41/49 [83.7%] versus 15/110 [13.6%] patients without cardiac activity at the beginning of resuscitation). Ultrasonographic detection of cardiac activity may be useful in determining prognosis during cardiac arrest. Further studies are needed to elucidate the predictive value of ultrasonography in cardiac arrest patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5080409PMC
September 2016

The Diagnostic Value of MRI in Brucella Spondylitis With Comparison to Clinical and Laboratory Findings.

Acta Inform Med 2016 Apr 26;24(2):107-10. Epub 2016 Mar 26.

Internal Medicine Resident, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Brucellosis is an endemic zoonotic disease, especially in the Middle East and Mediterranean regions and can involve many organs and tissue. Osteoarticular involvement is the most common complication. Spondylitis is its most prevalent clinical form in adults, and there may be difficult in diagnosis and treatment. In present study, we aimed to assess these diagnostic value of MRI, in patients with spondylitis due to brucella, comparing with clinical and laboratory findings.

Method: Patients with low back pain who were admitted to Sheikhol-raees MRI center were included in this study. None of these patients had any documented infectious disease. Diagnosis of brucellosis was made, based on MRI findings, which would be approved by serology. After confirmation with serology, the group with positive serology were compared with the negative group, in sex, age, MRI findings level of vertebral involvements, signal intensity in T1 weighted and T2 weighted.

Results: Among 53 patients with diagnosis of brucella spondylitis, 33 underwent serology study, 20 were positive and 13 were negative and the others consider out of study. From these 20, 3 had tuberculosis spondylitis, whose mean age was 56 and the 67% of them were male. Mean age in the positive brucella spondylitis were 46 and 67% of them were male. In negative group mean age was 55, and of whom 57% were male. There was no statistically significant difference in MRI findings such as changes in signal intensity, disk space narrowing, Intracanalicular mass, Abscess formation. Level of invlovment in vertebrae.

Conclusion: The results of this study shows that although MRI is Modality of choice in diagnosis of spondylitis, it is not enough specific to diagnosis the reasons of spondylitis.
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http://dx.doi.org/10.5455/aim.2016.24.107-110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851511PMC
April 2016

THE ROLE OF LACTATE CLEARANCE AS A PREDICTOR OF ORGAN DYSFUNCTION AND MORTALITY IN PATIENTS WITH SEVERE SEPSIS.

Mater Sociomed 2016 Feb 30;28(1):57-60. Epub 2016 Jan 30.

Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.

Background: Little is known about biomarkers which are used to classification of patients in order to diagnosis severity of sepsis among clients of emergency units. It seems that Lactate's clearance can be used in this regard. This study aimed to determine the relationship between Lactate's clearance, mortality and organ's dysfunction with severe sepsis.

Materials And Methods: In this study 90 patients with severe sepsis, were visited and examined exactly. Para clinical tests, serum venous lactate, organ's dysfunction scores, Acute Physiology and Chronic Health Evaluation II (APACHE-II) and Sequential Organ Failure Assessment (SOFA) were applied upon admission and 6 hours after it. According to clinical and laboratory criteria, dysfunction in main organs were examined and Lactate's Clearance was accounted. All the patients were cured according to early goal-directed therapy protocol.

Results: Among the participants 49 and 41 were male and female respectively. The mean age of the group was 49.37±1.41. The patients were classified to groups, less or more than 10% lactate's clearance. Mortality rate of the patients was 18.9% (17 people). Mean age of the dead group was 49.71±13.33. The mean of dysfunctional organs which is assessed in terms of clinical, laboratory and SOFA criteria was significantly higher among the dead group than other. The Lactate's clearance in the dead group was significantly lower than the other group (p<.05).

Conclusion: It was concluded that patients with severe sepsis is a marker which is related to tissue hypoxia, also lactate's clearance increasing is related to drastic reduction in biomarkers, mortality, and incidence of organ's dysfunction. Overall, patients with lower lactate's clearance are counted a high risk group for mortality and organs' dysfunction.
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http://dx.doi.org/10.5455/msm.2016.28.57-60DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789646PMC
February 2016

Bedside ultrasonography for verification of shoulder reduction: A long way to go.

Chin J Traumatol 2016 ;19(1):45-8

Emergency Department, Alborz University of Medical Sciences, Karaj, Iran.

Purpose: Shoulder dislocation is a common joint dislocation managed by the emergency physicians in the emergency departments. Pre- and post-reduction radiographic examinations have long been the standard practice to confirm the presence of dislocation and the successful reduction. However, shoulder ultrasonography has recently been proposed as an alternative to the radiographic examination. This study aimed to assess the accuracy of ultrasonography in evaluating proper reduction of the dislocated joint.

Methods: This was a prospective observational study. All patients with confirmed anterior shoulder dislocation were examined by both ultrasonography and radiography after the attempt for reduction of the dislocated joint. The examiners were blinded to the result of the other imaging modality. Results of the two methods were then compared.

Results: Overall, 108 patients with confirmed anterior shoulder dislocation were enrolled in the study. Ninety-one (84.3%) of the patients were males. Mean age of the participants was (30.11 ± 11.41) years. The majority of the patients had a recurrent dislocation. Bedside ultrasonography showed a sensitivity of 53.8% (95% CI: 29.1%-76.8%) and a specificity of 100% (95% CI: 96.1%-100%) in detecting inadequate reductions. The results of ultrasonography had a statistically significant agreement with the results of radiography (Kappa = 0.672, p < 0.001).

Conclusion: The results suggest that the sensitivity of post-reduction ultrasound is not sufficient for it to serve as a substitute for radiography.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897826PMC
http://dx.doi.org/10.1016/j.cjtee.2015.07.009DOI Listing
March 2017

Overexpression of ubiquitin-specific protease 2a (USP2a) and nuclear factor erythroid 2-related factor 2 (Nrf2) in human gliomas.

J Neurol Sci 2016 Apr 2;363:249-52. Epub 2016 Mar 2.

Department of Neurosurgery, AJA University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Gliomas are among the most frequent adult primary brain tumors. Recent studies have shown that there are novel opportunities for developing therapeutics by targeting the differentiation and self-renewal features of glioma.

Objective: The aim of this study was to evaluate the expression levels of USP2a an Nrf2 in patients with glioma and their association with prognosis of gliomas that was detected with immunohistochemical staining.

Methods: In this study, 40 patient's tissue samples with primary gliomas were collected between January 2009 and December 2013. MRI of patients was done before and within 24 h after surgery. USP2a and Nrf2 expression levels were examined by immunohistochemistry. Data were analyzed using the SPSS 16.0, X(2) test, log-rank test and Kaplan-Meier method.

Results: Immunohistochemistry indicated that USP2a expression was increased in glioma cells than normal brain tissues. The increased USP2a staining was markedly correlated with advanced tumor grade (P=0.02) and age (P=0.016). Our result showed that Nrf2 expression was significantly higher in glioma cells as compared to normal brain tissues. The high expression level of Nrf2 was markedly linked to age (P=0.007), and tumor grade (P=0.03). Kaplan-Meier survival and log-rank analysis indicated that patients with low expression of USP2a had longer overall survival than those with high levels (log-rank test P<0.001). Moreover, patients with high Nrf2 expression had shorter overall survival than those with low levels (log-rank test P<0.001). In the univariate analysis, the high expression of Nrf2 and USP2a (P=0.004; P=0.006), age (P=0.025), and tumor grade (P=0.001) were correlated with poor survival. Multivariate Cox proportional hazards model indicated that, high Nrf2 and USP2a staining (P=0.001; P=0.003), advanced tumor grade (P=0.01) and age (P=0.033) were independent predictor of overall survival.

Conclusion: In summary, the result of this study showed USP2a and Nrf2 may be as prognostic marker in patients with gliomas.
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http://dx.doi.org/10.1016/j.jns.2016.03.003DOI Listing
April 2016

Vancomycin-Resistant Pseudomonas Aeroginosa in the Cases of Trauma.

Med Arch 2016 Feb 31;70(1):57-60. Epub 2016 Jan 31.

Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.

Background: One of the main problems in the treatment of cases of P. aeruginosa especially in the orthopedic infections is the occurrence of high antibiotic resistance. The present study was carried out in order to investigate the prevalence of vancomycin-resistant P. aeruginosa in the cases of trauma in Iran.

Methods: Two hundred and fifty swab samples were collected from the site of trauma from the patients who referred to the orthopedic wards of the Iranian health centers. Samples were cultured immediately and those that were P. aeruginosa-positive were analyzed by the disk diffusion method.

Results: Of 250 swab samples collected, 43 were positive for P. aeruginosa (17.2%). The results of the culture technique were also confirmed by the PCR reaction. Of 43 P. aeruginosa isolates, 32 strains (74.41%) were resistant to vancomycin. Total prevalence of bacteria in Tehran and Mashhad hospitals were 18.46% and 15.83%, respectively. Statistically significant difference was seen for the prevalence of vancomycin-resistant P. aeruginosa between the samples collected from Tehran and Mashhad (P =0.027). More than 55 years old and less than 10 years old patients had the highest prevalence of P. aeruginosa. P. aeruginosa strains of male and more than 55 years old patients harbored the highest levels of resistance against vancomycin.

Conclusions: It is logical to primary identification of type of bacteria causing infection in the site of trauma and then using from the disk diffusion method to choose the best antimicrobial agent. Highest levels of health care should be performed for the patients less than 10 years and more than 55 years old patients.
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http://dx.doi.org/10.5455/medarh.2016.70.57-60DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779343PMC
February 2016

ECG changes of cardiac origin in elderly patients with traumatic brain injury.

Med J Islam Repub Iran 2015 13;29:306. Epub 2015 Dec 13.

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

Background: Simultaneous electrocardiographic (ECG) changes are seen in hemorrhagic brain events even in the absence of associated myocardial infarction (MI). This study was designed to assess the role of ECG changes to predict true MI in patients with hemorrhagic brain trauma.

Methods: Data of 153 patients with traumatic brain injury and concomitant ECG changes were recorded. Enzyme study was performed for the patients, and a cardiologist confirmed the diagnosis of MI.

Results: Overall, 83 females and 70 males older than 50 years of age were enrolled in the study. The most common type of hemorrhagic brain event was subarachnoid hemorrhage, and the most common ECG change was an inverted T wave. MI was confirmed in 15 (9.8%) patients. Patients with intracranial hemorrhage had significantly (p= 0.023) higher rates of associated MI than other types of brain hemorrhages. ST segment elevation was found to have a positive predictive value of 71.4% in males and 25% in females in terms of diagnosing a true MI associated with hemorrhagic brain events.

Conclusion: Although simultaneous cardiac changes are seen after sympathetic over- activity in brain hemorrhages, regular ECG screening of elder patients with traumatic brain injury is suggested, particularly in patients with intracranial hemorrhages.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764264PMC
February 2016

Incidence and Risk Factors of an Intraoperative Arrhythmia in Transhiatal Esophagectomy.

Iran Red Crescent Med J 2015 Dec 26;17(12):e22053. Epub 2015 Dec 26.

Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, IR Iran.

Background: Transhiatal esophagectomy (THE) is a widely used technique for carcinoma of the esophagus and other conditions, such as benign strictures and motility disorders.

Objectives: The aim of our study was to quantify the incidence, predisposing factors, as well as types of arrhythmias in transhiatal esophagectomy.

Patients And Methods: In this prospective study, we selected 61 patients undergoing transhiatal esophagectomy during 2012 - 2013 in our hospital. The demographic information, site of the tumor, cardiopulmonary function, transfusion, preoperative and postoperative complications (i.e. arrhythmias, hypotension), operation time, duration of mediastinal manipulation, amount of hemorrhage, volume loss, volume intake, mean systolic and diastolic pressure, and death rate were evaluated by chi-square, Fisher's exact test, ANOVA, and t-tests.

Results: The mean age of patients was 61.24 ± 11.48. In the study group, 8.2% of the patients before, 50.8% during, and 11.2% after mediastinal manipulation showed arrhythmia. Tumor location, the need for transfusion, pathology of the tumor, presence of arrhythmia before the operation, FEV1 (Forced Expiratory Volume) > 2 liters, and mean volume intake were significantly different between the patients with and without arrhythmia. Hypotension was shown in 8.2% of the patients before and 57.7% during mediastinal manipulation. Manipulation times, volume loss, mean systolic and diastolic blood pressure before the operation, and FEV1 > 2 liters were statistically significant in occurrence of hypotension.

Conclusions: Our data showed that the amount of hydration, transfusion, pre-manipulation arrhythmia, and pulmonary function should be controlled to decrease the risk of arrhythmias. Minor mediastinal manipulation, few intraoperative hemorrhages, improvement of pulmonary function, and careful blood pressure monitoring can reduce the risk of hypotension.
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http://dx.doi.org/10.5812/ircmj.22053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706980PMC
December 2015

GlideScope Video Laryngoscope for Difficult Intubation in Emergency Patients: a Quasi-Randomized Controlled Trial.

Acta Med Iran 2015 Dec;53(12):738-42

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

Macintosh direct laryngoscope has been the most widely used device for tracheal intubation. GlideScope video laryngoscope (GVL) has been recently introduced as an alternative device for performing intubation; however, its validity in emergency settings has not been thoroughly evaluated. The aim of this study was to compare Macintosh direct laryngoscope versus GVL for emergency endotracheal intubation. This quasi-randomized clinical trial was performed on 97 patients referred to Imam Reza Hospital whom all needed emergency intubation in 2011. Patients were divided into two groups of the easy airway and difficult airway; intubation was performed for patients with direct laryngoscopy or GVL. Then, the patients were evaluated in terms of demographic characteristics, successful intubation rate and intubation time. Data was analyzed by SPSS software 16. There was no significant difference in demographic characteristics of the patients in both easy airway and difficult airway groups who intubated with direct laryngoscopy and GVL methods (P>0.05). In difficult airway group, a significant difference was found in successful intubation at the first attempt (60.9% vs. 87.5%; P=0.036), overall intubation time (32.7 ± 14.58 vs. 22.5±7.88; P<0.001) and first attempt intubation time (28.43 ± 12.51 vs. 21.48±7.8; P=0.001) between direct laryngoscopy and GVL. These variables were not significantly different between two methods in easy airway group. According to the results, GVL can be a useful alternative to direct laryngoscopy in emergency situations and especially in cases with a difficult airway.
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December 2015

Overexpression of interleukins IL-17 and IL-8 with poor prognosis in colorectal cancer induces metastasis.

Tumour Biol 2016 Jun 17;37(6):7501-5. Epub 2015 Dec 17.

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

Current evidences indicated that a group of soluble mediators called chemokines is involved in tumor growth and metastasis. The association of IL-8 with tumor cell migration was previously found, and its expression was related to angiogenesis, tumor progression, and metastasis in many kinds of carcinomas in human and animal models. Furthermore, it has been showed that IL-17 plays its role as either a proteome of tumor progression or antitumor indifferent cancer models. To investigate the messenger RNA (mRNA) expressions of IL-8 and IL-17 in patients with colorectal cancer (CRC) and non-tumor tissue, quantitative real-time PCR was used in the study. Our results showed that expression of IL-8 mRNA was significantly increased in tumor tissues (mean ± SD 3.84 ± 0.08) compared with adjacent normal mucosa (mean ± SD 1.17 ± 0.75, P = 0.001). Furthermore, a higher expression of IL-17 mRNA was found in tumor tissues (mean ± SD 2.73 ± 0.69) when compared with normal tissues (mean ± SD 1.06 ± 0.07, P = 0.001). Our findings indicated that advanced tumor-node-metastasis (TNM) stage (P = 0.024) and histological grade (poorly differentiated, P = 0.013) and distant metastasis (P = 0.001) were correlated with expression of IL-8. Moreover, high expression of IL-17 showed significant association with early stage CRC (TNM) (P = 0.038). In conclusion, the expression of IL-8 and IL-17 mRNAs was significantly increased in tumor tissues compared with adjacent normal tissues. We found that advanced TNM stage and histological grade and distant metastasis were correlated with expression of IL-8, while high expression of IL-17 showed significant association with early stage CRC (TNM) stage and overexpression of IL-8 may be associated with progression of CRC.
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http://dx.doi.org/10.1007/s13277-015-4628-zDOI Listing
June 2016

Expression and prognostic value of the aldehyde dehydrogenase 1 (ALDH1) and N-myc downstream regulated gene 2 (NDRG2) as potential markers in human astrocytomas.

Tumour Biol 2016 May 30;37(5):6261-5. Epub 2015 Nov 30.

Department of Neurosurgery, Bou Ali Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.

In this study, immunohistochemical analysis was used to evaluate the expression of ALDH1 and NDRG2 in astrocytoma tissue samples and normal brain tissues. ALDH1 protein staining displayed that AlDH1 expression was not detectable in eight astrocytoma tissues (8/36) and in all of normal brain tissues. There was a significant difference between ALDH1 expression and WHO grades (P = 0.03). Furthermore, no correlation was determined between expression levels of ALDH1 and other clinicopathological characteristics including age, sex, and tumor size. Immunohistochemistry showed that a high level of NDRG2 protein expression was markedly detected in normal brain tissues and expression of NDRG2 protein was significantly decreased in astrocytoma tissues. There was a significant association between pathological grading and NDRG2 expression level (P < 0.001, Table 1), but no correlation was determined between expression levels of NDRG2 and other clinicopathological characteristics including age, sex, and tumor size. We also obtained detailed follow-up data and evaluated the association of ALDH1/NDRG2 expressions with overall survival. Kaplan-Meier survival and log-rank analysis indicated that the patients with high proportion of ALDH1-positive cells and low proportion of NDRG2-positive had shorter overall survival (P < 0.001; P = 0.001). Univariate analysis indicated that the high proportion of ALDH1-positive cells (P < 0.001), the low proportion of NDRG2-positive cells (P = 0.009), and the advanced grade (P < 0.005) were markedly linked to the prognosis in patients. Furthermore, in the multivariate analysis, ALDH1 cells' expression (P = 0.012), low proportion of NDRG2-positive cells (P = 0.025), and advanced grade (P < 0.03) were linked to poor overall survival. Our results suggest that NDRG2 expression is related to decreased survival rates and NDRG2 may be a potential marker in the astrocytoma prognosis. NDRG2 may be a potential marker in the astrocytoma prognosis. ALDH1 expression was related to advanced pathological grade and survival rate in astrocytoma patients.
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http://dx.doi.org/10.1007/s13277-015-4491-yDOI Listing
May 2016

Lunate Dislocation Followed by Non-Traumatic Swimming: A Case Report.

Iran J Public Health 2015 Oct;44(10):1418-9

Dept. of Orthopedic and Trauma Center, Mashhad University of Medical Sciences, Mashhad, Iran.

A few numbers of patients admitted to the emergency department due to the lunate dislocation can cause a direct injury to the wrist ligament, which mainly occurs after wrist trauma, and often diagnosis is far from the mind. A 32 years old man due to severe pain and tenderness of the wrist started the previous day during swimming, referred to Emergency Department of Imam Reza Hospital of Mashhad, 2012. He did not recall any history of direct trauma to the wrist. However, he was prescribed NSAID and wrist splint, but the pain did not improve. In physical examination, the localized tenderness of the dorsal wrist without erythema and warmness was clearly evident and paresthesia of the skin was observed in the 4th and 5th fingers. Plain X-ray detected no fractures. The combination of these signs and symptoms prompted clinical suspicion of lunate dislocation confirmed by imaging. This patient was admitted to the orthopedic service with lunate dislocation diagnosis for the proper treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644588PMC
October 2015