Publications by authors named "Mahdi Zangi"

17 Publications

  • Page 1 of 1

The validity of recognition of stroke in the emergency room (ROSIER) scale in the diagnosis of Iranian patients with acute ischemic stroke in the emergency department.

Turk J Emerg Med 2021 Jan-Mar;21(1):1-5. Epub 2020 Dec 1.

Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: In this study, we aimed to investigate the accuracy of recognition of stroke in the Emergency Room (ROSIER) Scale in the diagnosis of patients with acute ischemic stroke (AIS) transferred to the emergency department (ED).

Methods: The present study was a multicenter study. Records from patients suspected of stroke, who referred to the ED were reviewed. Demographic, clinical, and diagnostic data were extracted and then entered in checklists. ROSIER Scale was used to evaluate the possible diagnosis in this study. The definitive diagnosis of a stroke was made based on neurologist's assessment and clinical and neuroimaging findings, mainly brain magnetic resonance imaging (MRI). Receiver operating characteristic (ROC) curve analysis was conducted for assessing the accuracy of ROSIER in discrimination of stroke.

Results: The data of 356 suspected stroke patients were analyzed. Of all, 186 patients (52.2%) were male, and the mean age was 65.2 (standard deviation = 14.0) years ranging from 26 to 95 years. One hundred and fifty-one patients (42.4%) had AIS based on the final diagnosis. The area under the ROC curve was 0.85. The best cutoff point for ROSIER scale was ≥1 with a sensitivity of 85.4% (95% confidence interval [CI]: 78.8, 90.6%) and specificity of 65.8% (95% CI: 58.9, 72.3%).

Conclusion: Based on the findings, although the best cutoff point was the same as the original (derivation) study, its sensitivity (85.4% vs. 92%) and specificity (65.8% vs. 86%) were considerably lower.
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http://dx.doi.org/10.4103/2452-2473.301914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864127PMC
December 2020

Postintubation Multisegmental Tracheal Stenosis, a 24-Year Experience.

Ann Thorac Surg 2020 Nov 21. Epub 2020 Nov 21.

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

Background: Management of Multisegmental Tracheal Stenosis (MSTS) is challenging. In this 24-year longitudinal single-center study, we present an algorithmic treatment approach.

Methods: A retrospective analysis of 2167 patients with post-intubation tracheal stenosis indicated 83 (3.83%) patients with MSTS. Patients were assigned to four management groups according to the length, location, and severity of stenoses, tracheal infection/mucositis, laryngeal function, symptoms, general condition, and comorbid diseases. Type-1 (n=13): one-stage resection of both strictures, Type-2 (n=6): two-stage resection of both strictures, Type-3 (n=40): resection of one stricture and non-resectional management of the other one, Type-4 (n=24): non-resectional management of both strictures. Outcomes were categorized as Good, Acceptable, or Poor. Univariate analyses for factors predictive of recurrence and outcome were performed.

Results: Follow-ups were completed in 70 (84.34%) patients (median 22.5 months). Outcome was assessed as Good in 56 (82.35%), Acceptable in 10 (14.71%), Poor in 2 (2.94%), and mortality in 2 (2.94%) patients. The median length of airway resection was 46, 67.5, and 40 mm in Types 1-3, respectively. Only 11 (13.25%) patients had no history of tracheostomy or tracheal surgery. By univariate analysis, a shorter intubation period was associated with Good outcome (p=0.017). No factors predictive of recurrence or outcome were ascertained.

Conclusions: MSTS, generally caused by performing an inappropriate tracheostomy, is an iatrogenic disease that can be prevented. Although resection of both strictures may be feasible and is associated with Good results, in the majority of cases, a combination of surgical resection and non-resectional methods are sufficient to achieve Good results.
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http://dx.doi.org/10.1016/j.athoracsur.2020.10.026DOI Listing
November 2020

Transcutaneous Columellar Strut for Correcting Caudal Nasal Septal Deviation.

Indian J Otolaryngol Head Neck Surg 2018 Sep 7;70(3):346-350. Epub 2018 Apr 7.

4Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Correction of caudal septal deviation is a challenging issue because of its significant role in tip support mechanisms. Some interventions especially aggressive resection of caudal septum to correct deviation, may compromise external nasal valve, tip ptosis and persistence of nasal obstruction. Many surgical techniques have been suggested to correct this type of nasal septal deviation. This study presents a technique to correct caudal septal deviation without weakening of tip support mechanisms. To evaluate the efficacy of insertion of a transcutaneous columellar strut during correction of caudal septal deviation. The study was performed in patients complaining from nasal obstruction with caudal septal deviation. After intranasal incision and elevation of mucoperichondrial flap, Caudal septum released from anterior nasal spine (ANS) and a band of cartilage removed from inferior and caudal part of septum and septum again fixed to ANS. Through a vertical transcutaneous incision, a cartilaginous strut is placed in columella, between medial crurae. Preoperative and postoperative NOSE score determined and photographs were taken. In 14 patients we performed this technique, the postoperative NOSE score showed significant improvement, ( = 0.001). Nasal breathing improved in all patients without any complication or tip ptosis or worsening of nasal appearance. This septoplasty technique along with placement of transcolumellar strut, is an easy, efficient and complication free method for simultaneously correction of caudal deviation of nasal septum, reinforcing external nasal valve and prevents tip ptosis.
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http://dx.doi.org/10.1007/s12070-018-1339-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127060PMC
September 2018

Effect of Adding Magnesium Sulphate to Epidural Bupivacaine and Morphine on Post-Thoracotomy Pain Management: A Randomized, Double-Blind, Clinical Trial.

Basic Clin Pharmacol Toxicol 2018 Nov 9;123(5):602-606. Epub 2018 Jul 9.

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

Post-thoracotomy pain is very severe and may cause pulmonary complications. Thoracic epidural analgesia can greatly decrease the pain experience and its consequences. However, finding new methods to decrease the amount of administered opioids is an important issue of research. We aimed to evaluate the effect of adding epidural magnesium sulphate to bupivacaine and morphine on pain control and the amount of opioid consumption after thoracotomy. Eighty patients undergoing thoracotomy at a tertiary cardiothoracic referral centre were enrolled in a randomized, double-blind trial. Patients were randomly allocated to two groups. Bupivacaine (12.5 mg) and morphine (2 mg) were administered epidurally to all patients at the end of operation. Patients in the magnesium (Mg) group received epidural magnesium sulphate (50 mg), and patients in the control (C) group received normal saline as an adjuvant. Visual analogue scale (VAS) score and the amount of morphine consumption were measured during 24 hr post-operation. Thirty-nine patients in the Mg group and 41 patients in the C group completed the study. Patients in the Mg group had significantly less VAS score at recovery time (p < 0.05), 2 hr (p < 0.01) and 4 hr (p < 0.05) after surgery. The patient-controlled analgesia pump was started earlier in the C group than in the Mg group (p < 0.05). The amount of morphine needed in the Mg group was significantly lower than in the C group (5.64 ± 1.69 mg/24 hr versus 8.44 ± 3.98 mg/24 hr; p < 0.001). Pruritus was seen in the C group (9.7%) and absent in the Mg group (p < 0.05). Co-administration of magnesium sulphate with bupivacaine and morphine for thoracic epidural analgesia after thoracotomy leads to a reduction in post-operative pain score and the need for opioid administration.
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http://dx.doi.org/10.1111/bcpt.13047DOI Listing
November 2018

Population-based epidemiology of non-fatal injuries in Tehran, Iran.

Health Promot Perspect 2018 18;8(2):127-132. Epub 2018 Apr 18.

Department of Neurobiology, Care Sciences and Society, Unit for Family Medicine, Karolinska Institute, Stockholm, Sweden.

Our aim in this survey was to explore descriptive epidemiology of injuries in Tehran in 2012 and to report the recalled estimates of injury incidence rates. A population survey was conducted in Tehran during 2012, within which a total of 8626 participants were enrolled. The cluster sampling was used to draw samples in 100 clusters with a pre-specified cluster size of 25 households per cluster. Data were collected on demographic features, accident and injury characteristics based on the International Classification of Diseases (ICD10). A total of 618 injuries per 3 months were reported, within which 597 cases (96.6%)were unintentional injuries. More than 82% of all injuries were those caused by exposure to inanimate mechanical forces, traffic accidents, falls and burns. Above 80% of the traffic injuries happened among men (P<0.001). About 43% of the unintentional injuries were mild injuries.After the age of 40, women, unlike men, had higher risks for being injured. The estimated annual incidence rate for all types of injuries was 284.8 per 1000 (95% CI: 275.4-294.4) and for unintentional injuries was 275.2 per 1000. Injuries are major health problems in Tehran with a highly reported incidence. The status is not substantially improved over the recent years which urges the need to be adequately and emergently addressed. As the incidence rate was estimated based on participant recalls, the real incidence rate may even be higher than those reported in the current study.
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http://dx.doi.org/10.15171/hpp.2018.16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935816PMC
April 2018

Herbal Supplements for Prostate Enlargement: Current State of the Evidence.

Urology 2018 Feb 26;112:145-150. Epub 2017 Oct 26.

Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address:

Objective: To provide a comprehensive review of the current state of herbal supplement market for lower urinary tract symptoms (LUTS) and correlate the ingredients of each product with available scientific evidence.

Materials And Methods: Twenty-seven products from Amazon.com that were advertised as herbal supplements for LUTS and had listed their active ingredients were selected. Active ingredients were reviewed on Google Scholar. Product price, warranty, and consumer review information were also collected.

Results: A total of 58 unique active ingredients were identified. The mean number of ingredients was 8.26 (standard deviation 5.25). Whereas 17 (63%) products had an ingredient with a systematic review to support their use, 20 (74%) had an ingredient with conflicting evidence based on systematic reviews. Out of the supplements that contained ingredients supported by literature, all (100%) products simultaneously had other ingredients with no, conflicting, or refuting evidence. There was no (0%) product that contained only scientifically proven ingredients. There is no scientific study to evaluate these supplements as a whole.

Conclusion: Despite the widespread use of herbal supplements for LUTS, there is scant scientific evidence to support their safety and efficacy. Lack of adequate regulation and government support for research and development are some of the factors that disincentivize researchers to study safety and efficacy of these products. We encourage physicians to warn their patients on the lack of adequate evidence to support the safety and efficacy of many of these supplements.
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http://dx.doi.org/10.1016/j.urology.2017.10.021DOI Listing
February 2018

An Overview of Tracheal Stenosis Research Trends and Hot Topics.

Arch Iran Med 2017 Sep;20(9):598-607

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

Background: Tracheal stenosis remains a challenge in the thoracic surgery field. Recognizing the hot topics and major concepts in this area would help the health policy makers to determine their own priorities and design the effective research plans. The present study analyzed and mapped the topics and trends of tracheal stenosis studies over time as well as authors' and countries' contributions.

Materials And Methods: Search results were obtained employing Bibexcel. To determine cold and hot topics, co-occurrence analysis was applied using three international databases 'Web of Science', 'PubMed' and 'Scopus'. Appropriately, different categories in the articles such as keywords, authors, and countries were explored via VOSviewer and NetDraw. Afterward, the trends of research topics were depicted in four time-intervals from 1945 to 2015 by ten co-occurrence terms.

Results: The majority of articles were limited to case series and retrospective studies. The studies had been conducted less frequently on prevention, risk factors and incidence determination but extensively on treatment and procedures. Based on the articles indexed in WOS, 45 countries and 8,260 authors have contributed to scientific progress in this field. The highest degree of cooperation occurred between the USA and England with 15 common papers.

Conclusions: Most of the published literature in tracheal stenosis research field was about surgical and non-surgical treatments. Conducting the screening and prevention studies would diminish the burden of this disease on the health system as well as the patients and their families' well-being.
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http://dx.doi.org/0172009/AIM.008DOI Listing
September 2017

Colopharyngoplasty in Patients with Severe Pharyngoesophageal Corrosive Injury: A Complicated but Worthwhile Procedure to Restore GI Tract Continuity, A Case Series.

Tanaffos 2017 ;16(1):68-75

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

Background: Pharyngoesophageal strictures (PES) after corrosive injury impose a problematic condition for both physicians and patients in terms of their management and patients' quality of life. Colopharyngoplasty is a complex procedure, which is used to restore swallowing in these severely disabled patients. We describe our experience in treating nine patients with severe PES after corrosive injuries in a referral center.

Materials And Methods: A retrospective analysis of our database from 2009 to 2014 showed nine patients (seven men; age range: 18 to 47 years) with severe PES who underwent colopharyngoplasty ∼6 months (range: 4-10) after caustic material ingestion. All patients had a feeding jejunostomy tube before reconstruction. Esophagectomy with or without gastrectomy was performed in all patients, except for one; thereafter, an isoperistaltic segment of the left colon was pulled up, and a pharyngocolic anastomosis was performed. Eight patients had a tracheostomy created either before reconstruction due to respiratory symptoms or at the time of definitive surgery to prevent aspiration in the early post-operative period.

Results: Almost all survivors had a satisfactory swallowing at the end of the follow-up (range: 4-60 months). The jejunostomy tube could be removed in all of the patients after a median of 5 months. One patient died of sepsis due to graft necrosis in the immediate post-operative period. Another patient died 5 months after the first surgery following a revision surgery for intractable dysphagia. At the end of the follow-up, only one patient tolerated tracheostomy tube decannulation. Two patients required laryngotracheal dissociation because of massive aspiration and recurrent episodes of pneumonia. Five patients still had a tracheostomy because of an severely destroyed larynx (two patients) and aspiration (three patients).

Conclusion: Colopharyngoplasty is considered a complicated but trustworthy procedure to restore gastrointestinal tract continuity after severe corrosive injury. Undeniably, laryngeal involvement adversely affects the functional outcome. The post-operative course is frequently protracted, accompanied with several problems. Aspiration is nearly the most problematic event in the early post-operative period, which mandates a multidisciplinary approach to manage it.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473385PMC
January 2017

Item Selection and Content Validity of the Risk Factors of Post-Intubation Tracheal Stenosis Observation Questionnaire for ICU-Admitted Patients.

Tanaffos 2017 ;16(1):22-33

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

Background: Laryngotracheal stenosis as a late complication of prolonged endotracheal intubation is a life-threatening event. In order to determine the related risk factors for this complication, which may vary among different countries, designing a valid questionnaire is necessary. The aim of this study was to select the items and evaluate the face and content validities of a questionnaire developed for assessment of risk factors of post-intubation tracheal stenosis (PITS) in patients admitted in the intensive care unit.

Materials And Methods: A mixed method study design was used in four steps in 2015, i.e., 1) a literature review, 2) focus groups with five experts in the field, 3) consultations with intensive care unit (ICU) specialists and thoracic surgeons, and 4) evaluation of content and face validity with 15 experts in a scientific panel using two self-administered questionnaires. Content validity index (CVI) was computed for individual items as well as the overall scale.

Results: We extracted the items from different sources of information. An initial version of the 52-item questionnaire was developed and classified into four domains including patient characteristics, intubation features, equipment-drugs, and complications. The items with an excellent modified kappa were included in the questionnaire. Five questions received more criticism instead of support and were removed (Item-CVI<0.55, fair modified kappa). The ones with an Item-CVI > 0.60 and a good modified kappa were revised, merged, or retained. The new 43-item questionnaire found a scale-level CVI, averaging (Scale-CVI/Ave) of 0.91.

Conclusion: The PITS risk factors questionnaire was developed and validated through item selection, expert opinions, and content validity index.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473379PMC
January 2017

Incidence Rate of Post-Intubation Tracheal Stenosis in Patients Admitted to Five Intensive Care Units in Iran.

Iran Red Crescent Med J 2016 Sep 2;18(9):e37574. Epub 2016 Aug 2.

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

Background: Tracheal stenosis is one of the worst complications associated with endotracheal intubation and it is the most common reason for reconstructive airway surgeries. Due to various local risk factors, the incidence rate of tracheal stenosis may vary in different countries. In order to estimate the incidence rate of post-intubation tracheal stenosis (PITS) in patients admitted to an intensive care unit (ICU), a follow-up study was planned. As there was no similar methodological model in the literature, a feasibility step was also designed to examine the whole project and to enhance the follow-up rate.

Objectives: To estimate the PITS incidence rate in patients admitted to ICUs, as well as to evaluate the feasibility of the study.

Methods: This prospective cohort study was conducted in five hospitals in two provinces (Tehran and Arak) of Iran from November 2011 to March 2013. All patients admitted to ICUs who underwent more than 24 hours of endotracheal intubation were included. Upon their discharge from the ICUs, the patients received oral and written educational materials intended to ensure a more successful follow-up. The patients were asked to come back for follow-up three months after their extubation, or sooner in case of any symptoms developing. Those with dyspnea or stridor underwent a bronchoscopy. The asymptomatic patients were given a spirometry and then they underwent a bronchoscopy if the flow-volume loop suggested airway stenosis.

Results: Some seventy-three patients (70% men) were included in the study. Multiple trauma secondary to motor vehicle accidents (52%) was the most common cause of intubation. Follow-ups were completed in only 14 (19.2%, CI = 0.109 - 0.300) patients. One patient (7%, CI = 0.007 - 0.288) developed symptomatic tracheal stenosis that was confirmed by bronchoscopy. The barriers to a successful follow-up were assessed on three levels: ineffective oral education upon discharge, improper usage of educational materials, and difficulties to attending follow-up visits. There were also some important obstacles in terms of human, time, material, and cost resources, as well as data management.

Conclusions: To enhance the follow-up rate, three strategies were proposed: patient-focused strategies such as emphasizing patient education upon discharge and providing rewards; structural-focused strategies such as scheduling home visits and uploading questionnaires onto the research center's website; and provider-focused strategies such as selecting coordinators with good communication skills. All necessary resources should also be re-arranged for a multicenter national study.
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http://dx.doi.org/10.5812/ircmj.37574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253460PMC
September 2016

The Role of Systemic Steroids in Postintubation Tracheal Stenosis: A Randomized Clinical Trial.

Ann Thorac Surg 2017 Jan 29;103(1):246-253. Epub 2016 Jul 29.

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

Background: Most patients with postintubation tracheal stenosis are not ideal candidates for airway resection at presentation and their airways must be temporarily kept open by repeated bronchoscopic dilation (RBD). Meanwhile, some sufficiently recover by RBD without further airway resection requirement. We hypothesized whether systemic corticosteroids could lengthen RBD intervals, decrease the number of patients who eventually need airway resection, and shorten the required length of airway resection.

Methods: Between February 2009 and November 2012, a randomized double-blind clinical trial with a 1:1 ratio (corticosteroids group [group C], prednisolone 15 mg/day; placebo group [group P]) was conducted on 120 patients without tracheostomy or T tube and in no ideal situation for airway resection at presentation, whose precipitating injury had occurred recently. All underwent RBD until they became asymptomatic or prepared for airway resection. Asymptomatic patients received the capsules (prednisolone or placebo) for 6 months; others discontinued them before surgery. Those requiring RBD at short intervals underwent tracheostomy or T tube placement and were then excluded. Follow-up terminated 6 months after airway resection or capsule discontinuation.

Results: There were 105 patients (72 male; 50 in group C), aged 15 to 64 years, who completed their follow-up. There was no significant difference between the two groups in age, sex, history of tracheostomy, intubation cause and duration, time interval between intubation and initial bronchoscopy, length of stenosis, and subglottic involvement. Our study showed a trend for RBD with longer intervals (22 days), and fewer operations, 17% (28 of 50 versus 40 of 55) in group C, although statistically insignificant. Furthermore, the required airway resection length became significantly shorter (5.3 mm) in group C.

Conclusions: Early low-dose systemic corticosteroids can be beneficial in postintubation tracheal stenosis management.
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http://dx.doi.org/10.1016/j.athoracsur.2016.05.063DOI Listing
January 2017

Outpatient surgery for lower urinary tract symptoms/benign prostatic hyperplasia: truth or myth?

Curr Opin Urol 2015 Jan;25(1):27-31

Massachusetts General Hospital, Boston, Massachusetts, USA.

Purpose Of Review: Worldwide, lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) is a common medical problem for aging men. Of patients who seek help with their symptoms, almost one-third do not respond to the medical therapy. These patients need a procedure that is safe, efficient, and durable, and at the same time carries minimal risk of side-effects. Many new technologies are introduced to our medical practice with the promise of being the ideal office-based procedure. In this review, we intend to review and discuss the role of three surgical procedures in an office setting. These include thermotherapy, 532-nm laser photo-selective vaporization of prostate, and bipolar plasma vaporization of prostate.

Recent Findings: There are a few recent thermotherapy studies regarding the outcome of thermotherapy in LUTS/BPH patients. Data regarding the use of 532-ng laser photo-selective vaporization of prostate are scant but promising. The use of bipolar plasma vaporization is not well studied in an office setting.

Summary: In a select group of patients, thermotherapy and laser prostate surgery could be safely used to treat LUTS/BPH patients. Bipolar plasma vaporization is a promising technology, but its use in an office setting has not been completely evaluated yet.
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http://dx.doi.org/10.1097/MOU.0000000000000127DOI Listing
January 2015

Epidemiology of injuries in metropolitan Tehran, Iran: a household survey.

Int J Inj Contr Saf Promot 2015 22;22(3):224-31. Epub 2014 Apr 22.

a Department of Public Health , Karolinska Institutet , Stockholm , Sweden.

A household survey was conducted to determine the epidemiological characteristics of injuries among people living in Tehran, the mega capital of Iran. Using cluster random sampling in April 2007, survey was conducted seeking information about injuries occurred within families in past Persian year. All injury patterns and causes were classified according to ICD-10 and analysed using SPSS version 16. Out of 9173 household participants, 765 ones (8.3%) had injuries during the past Persian year, frequently open wounds and burns with a male to female ratio of 0.54 : 1. They occurred mostly due to 'exposure to the inanimate mechanical forces', followed by 'contact with heat or hot substances' and 'falls'. The common locations were home, and then streets. Approximately 15% of injuries required medical attention and the incidence rate was 175.5 per 10,000 person-year with male to female ratio of 2.37 : 1. They were frequently fractures and open wounds and mostly associated with falls and transport accidents that had been transpired on streets or at workplace. This study evidences the high rate of injuries in Tehran city and prevention priorities should be given to traffic and home injuries.
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http://dx.doi.org/10.1080/17457300.2014.908220DOI Listing
May 2016

Media mix for awareness and health promotion in lung cancer patients.

Tanaffos 2013 ;12(4):42-7

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

Background: Lung cancer is the most common cause of death due to malignancy. The media as a source of information about cancer especially lung cancer could make substantial contribution to help physicians and patients in terms of prevention, treatment and follow up. This study aimed to obtain in depth understanding of the role of media in the context of clinical knowledge and recognize its effect on behavior of patients.

Materials And Methods: Using lung cancer patients' records admitted to Masih Daneshvari Hospital, we conducted a structured interview with them via telephone to collect information. The transcript of interviews was prepared. The transcript was then coded and analyzed using MaxQDA based on "theme method". Due to the structured basis of the study, the primary frameworks were considered as conceptual categories in coding.

Results: The majority of lung cancer patients did not receive any information before the awareness about their disease unless having a family with a history of cancer. Following awareness of disease, they mostly received their information from physicians. In spite of the large amount of medical information available in the media, insufficient use of media by cancer patients indicated the absence of appropriate communication between the media and patients. Television was the mass media commonly used by patients and as a result of no access to Internet and medical books as well as lack of proficiency in English language they were deprived of specialized resources of information.

Conclusion: Mass media should focus on raising awareness about prevention and treatment of lung cancer. This study can be a preliminary step in health communication research and may be used by researchers in terms of methodology and vision.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153263PMC
September 2014

Office evaluation of male patients with lower urinary tract symptoms.

Curr Urol Rep 2012 Dec;13(6):474-81

Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, 02114, USA.

Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) are one of the most common urologic disorders in men. Accurate history-taking and focused physical examination allows us to diagnose the majority of cases. A better understanding of risk factors helps us tailor our treatment and predict outcomes more accurately. Population studies are crucial in our understanding of LUTS/BPH natural history. Temporary prostatic urethral stents that are used for the management of urinary retention may also be used for evaluation of patients with detrusor hypo-contractility. The use of ultrasound to measure intravesical prostatic protrusion (IPP) and the Doppler study for prostate capsular artery resistive index are promising. Near-infrared spectroscopy (NIRS) examines the tissue oxygenation that may be affected by bladder outlet obstruction. The mathematical algorithm needs some fine-tuning, and its reproducibility is debatable. Serum and urinary biomarkers may help us to diagnose the disorder, and more effectively monitor patients' response to therapy. Among all, IPP is clinically more applicable at this time.
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http://dx.doi.org/10.1007/s11934-012-0283-8DOI Listing
December 2012

The role of T-tubes in the management of airway stenosis.

Eur J Cardiothorac Surg 2013 May 18;43(5):934-9. Epub 2012 Sep 18.

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

Objectives: When the T-tube is inserted as a temporary stent, it is unclear whether keeping it longer in place has any benefit on the outcome.

Methods: Among 1738 patients with airway stenosis (1996-2011), 134 underwent T-tube placement (mean duration = 14.3 months); temporarily while waiting for an appropriate time for surgery in 53 (Group 1), as an adjunct after a complex laryngotracheal resection in 27 (Group 2), after surgical failure in 43 (Group 3) and permanently in 11 unresectable strictures (Group 4). A logistic regression model was used for statistical analysis.

Results: Seventy percent of patients were males (age = 33.6 ± 17 years). The main cause was postintubation/post-tracheostomy stenosis in 87% of patients. The stenosis (29.6 ± 14 mm, 5-80 mm) was located in the subglottis in 33%, trachea in 47% and both in 20% of cases. To assess the effect of T-tubes on stabilizing the airway after decannulation, 50 patients who still had a T-tube at the end of follow-up or for <1.5 months were excluded. Of the remaining 84, 31.5, 91.5 and 32.5% of patients in Groups 1, 2 and 3 were stable at least 3 months after decannulation. Moreover, 70% of those who were decannulated at or before 6 months and 53.7% of those who were decannulated after 6 months underwent another intervention (P = 0.17). The age, sex, cause, site of stenosis and even duration of T-tube insertion (P = 0.07) showed no significant effect on the decannulation outcome.

Conclusions: Although it seems that keeping the T-tube in place for >6 months may increase the chance of successful decannulation, it was not confirmed in our study.
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http://dx.doi.org/10.1093/ejcts/ezs514DOI Listing
May 2013

Thyroid cancers with laryngotracheal invasion.

Eur J Cardiothorac Surg 2012 Mar 14;41(3):635-40. Epub 2011 Dec 14.

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

Objectives: Management of thyroid cancers with laryngotracheal invasion is controversial.

Methods: A retrospective analysis of our database found 69 patients (38 females, mean age 59.6 ± 11.6) between March 1995 and July 2010; of them 42 (61%) were managed by non-resectional methods due to the extensive airway or regional involvement, severe co-morbidities, diffuse metastases or patient's preference. Segmental airway resection was performed in 27 (39%) patients; concurrent with thyroidectomy in 17 (Immediate group (IG)), and as a delayed procedure in 10 referred patients (Delayed group (DG)), who had previously undergone thyroidectomy with conservative airway management, like shaving procedures. Follow-up was completed in 81% of patients with a mean duration of 30 months.

Results: Tracheal or laryngotracheal resection and reconstruction was performed in 18, laryngectomy in eight and pharyngolaryngectomy in one patient. There were two anastomotic dehiscence (11.1%), one resulted in mortality (3.7%). One or a combination of bronchoscopic core-out, laser, tracheostomy and stent placement was performed in 42 non-resected patients with two mortalities (4.7%). Overall 1-, 2-, 3- and 5-year survival was 85, 85, 68 and 49% in resected group, as well as 56, 46, 40 and 31% in non-resected group (P = 0.049), respectively. Among resected group, the overall 1-, 2-, 3- and 5-year survival was 92, 92, 76 and 61% in the IG as well as 75, 75, 56 and 28% in the DG (P = 0.43).

Conclusions: Complete segmental airway resection during or even after thyroidectomy could be safely performed, might be curative and may be associated with improved survival.
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http://dx.doi.org/10.1093/ejcts/ezr131DOI Listing
March 2012