Publications by authors named "Majid Malekmohammad"

28 Publications

  • Page 1 of 1

The Prevalence and Outcome of Intensive Care Unit Acquired Weakness (ICUAW).

Tanaffos 2020 Jul;19(3):250-255

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

Background: Intensive care unit acquired weakness (ICUAW) is a known complication in ICU patients, especially in those with severe underlying diseases. The cause and pathogenesis of ICUAW are still unknown. This study examined the incidence rate of ICUAW in intensive care units (ICUs) of the Masih-Daneshvari Hospital.

Materials And Methods: This descriptive-comparative study was conducted on 160 patients admitted in the ICUs, including an acute respiratory infectious ICU (TB-ICU) and medical ICU. The total number of patients was 80 in each of the ICUs. Demographic information was obtained from the patients after the initial examination and Medical Research Council (MRC) score was done on daily basis. EMG was performed on the 2 and 8 days of the admission. ICUAW diagnosis was used in cases with MRC scores under 48.

Results: Among the patients, 68.6% were male and the mean age was 59.13±18. 68 years. The final outcomes were 48.4% mortality and 51.6% discharge, which were 41% and 59% in the TB-ICU and 56.7% and 43.3% in the medical ICU, respectively. By defining electromyography as the gold standard, the sensitivity and specificity of ICUAW diagnosis based on the MRC score definition were about 70% and 83%, respectively. The comparison ICUAW patients in the two ICUs in terms of mortality showed no significant difference between them.

Conclusion: It is concluded that nearly half of ICU-admitted patients develop ICUAW that causes a higher mortality rate. Therefore, new plans should be developed to reduce the rate of ICUAW and subsequent death, as well as other possible morbidities.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008407PMC
July 2020

No clinical benefit of high dose corticosteroid administration in patients with COVID-19: A preliminary report of a randomized clinical trial.

Eur J Pharmacol 2021 Apr 16;897:173947. Epub 2021 Feb 16.

Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

The aim of this study was to evaluate the clinical effects of dexamethasone administration in patients with mild to moderate acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). The study included 50 patients who were randomly assigned to the dexamethasone group or control group. Dexamethasone was administered at a dose of 20 mg/day from day 1-5 and then at 10 mg/day from day 6-10. The need for invasive mechanical ventilation, death rate, duration of clinical improvement, length of hospital stay, and radiological changes in the computed tomography scan were assessed. The results revealed that 92% and 96% of patients in the dexamethasone and control groups, respectively, required noninvasive ventilation (P = 0.500). Among them, 52% and 44% of patients in the dexamethasone and control groups, respectively, required invasive mechanical ventilation (P = 0.389). At the end of the study, 64% of patients in the dexamethasone group and 60% of patients in the control group died (P = 0.500); the remaining patients were discharged from the hospital during the 28-day follow-up period. The median length of hospital stay was 11 days in the dexamethasone group and 6 days in the control group (P = 0.036) and the median length of hospital stay was 7 days in the dexamethasone group and 3 days in the control group (P < 0.001). No significant differences were observed in the other outcomes. This study showed that corticosteroid administration had no clinical benefit in patients with COVID-19-induced mild to moderate ARDS.
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http://dx.doi.org/10.1016/j.ejphar.2021.173947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885705PMC
April 2021

Epidemiological Characteristics, Ventilator Management, and Clinical Outcome in Patients Receiving Invasive Ventilation in Intensive Care Units from 10 Asian Middle-Income Countries (PRoVENT-iMiC): An International, Multicenter, Prospective Study.

Authors:
Luigi Pisani Anna Geke Algera Ary Serpa Neto Areef Ahsan Abigail Beane Kaweesak Chittawatanarat Abul Faiz Rashan Haniffa Seyed MohammadReza Hashemian Madiha Hashmi Hisham Ahmed Imad Kanishka Indraratna Shivakumar Iyer Gyan Kayastha Bhuvana Krishna Tai Li Ling Hassan Moosa Behzad Nadjm Rajyabardhan Pattnaik Sriram Sampath Louise Thwaites Ni Ni Tun Nor'azim Mohd Yunos Salvatore Grasso Frederique Paulus Marcelo Gama de Abreu Paolo Pelosi Nick Day Nick White Arjen M Dondorp Marcus J Schultz For The PRoVENT-iMiC Investigators Moru And The Prove Network Aaradhana Adhikari Osaree Akaraborworn Aftab Akhtar AKM Shamsul Alam Syed Muneeb Ali Janaki Arumoli Muhammad Asaduzzaman Siti Nur Suhaila Azauddin Debabrata Banik Sakibur Rahman Bhuiyan Rungsun Bhurayanontachai Sunisa Chatmongkolchart Shantanu Das Stanis Sutharsa Das Kesharie De Silva Y. A. Hasitha Dilhani Lakshman Dissanayake Anand Dongre Dharshinie Dorasamy Thuy Duong Bich Monju Lal Dutta Manoj Edirisooriya Ahmed Farooq Marie Fernando Asoka Gunaratne Tarikul Hamid Sadaf Hanif Mohd Shahnaz Hasan Muhammad Hayat Mozaffer Hossain Tanveer Hussain Farah Idrees Mohamad Fadhil Hadi Jamaluddin Sonia Joseph Kanokkarn Juntaping Saima Kamal Pranab Karmaker Chinni Krishna Kasi Mahazir Kassim Saleh Khaskheli Syeda Nafisa Khatoon Batoul Khoundabi Napplika Kongpolprom Bimal Kudavidanage Yen Lam Mihn Majid Malekmohammad Mohd Basri Mat Nor Sathiyamoorthy Mathanalagan Iqbal Memon Nimangee Mithraratne Maziar Mobasher Montosh Kumar Mondol Abu Hena Mostafa Kamal Ranjan Kumer Nath Asma Navasakulpong Suraiya Nazneed Ha Nguyen Thi Thanh Kinh Nguyen Van Navid Nooraei Mohamad Irfan Othman Jailani Raju Pangeni Tananchai Petnak Chamila Pilimatalawwe Visanthi Pinto Annop Piriyapatsom Prapaporn Pornsuriyasak Aayesha Qadeer Reza Raessi Estabragh Mohammed Abdur Rahman Chowdhury Kumudini Ranatunge Atta Ur Rehman Syed Tariq Reza Sabyasachi Roy Poulomi Roy Suthat Rungruanghiranya Mohammad Salim Upeka Samaranayake Loranthi Samarasinghe Sohel Ahmed Sarkar Jignesh Shah Chathurani Sigera Udomsak Silachamroon Pongsasit Singhatas Rozina Sultana Karjbundid Surasit Sheikh Mohammed Taher Li Ling Tai Pattraporn Tajarernmuang Viratch Tangsujaritvijit Taohidul Majid Taohid Arshad Taqi Kaushila Thilakasiri Poungrat Thungtitigul Konlawij Trongtrakul Manori Vaas Chern Min Voon Dat Vu Quoc Nurhafizah Zarudin

Am J Trop Med Hyg 2021 01 11. Epub 2021 Jan 11.

Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A) Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.

Epidemiology, ventilator management, and outcome in patients receiving invasive ventilation in intensive care units (ICUs) in middle-income countries are largely unknown. PRactice of VENTilation in Middle-income Countries is an international multicenter 4-week observational study of invasively ventilated adult patients in 54 ICUs from 10 Asian countries conducted in 2017/18. Study outcomes included major ventilator settings (including tidal volume [] and positive end-expiratory pressure [PEEP]); the proportion of patients at risk for acute respiratory distress syndrome (ARDS), according to the lung injury prediction score (LIPS), or with ARDS; the incidence of pulmonary complications; and ICU mortality. In 1,315 patients included, median was similar in patients with LIPS < 4 and patients with LIPS ≥ 4, but lower in patients with ARDS (7.90 [6.8-8.9], 8.0 [6.8-9.2], and 7.0 [5.8-8.4] mL/kg Predicted body weight; = 0.0001). Median PEEP was similar in patients with LIPS < 4 and LIPS ≥ 4, but higher in patients with ARDS (five [5-7], five [5-8], and 10 [5-12] cmHO; < 0.0001). The proportions of patients with LIPS ≥ 4 or with ARDS were 68% (95% CI: 66-71) and 7% (95% CI: 6-8), respectively. Pulmonary complications increased stepwise from patients with LIPS < 4 to patients with LIPS ≥ 4 and patients with ARDS (19%, 21%, and 38% respectively; = 0.0002), with a similar trend in ICU mortality (17%, 34%, and 45% respectively; < 0.0001). The capacity of the LIPS to predict development of ARDS was poor (ROC AUC of 0.62, 95% CI: 0.54-0.70). In Asian middle-income countries, where two-thirds of ventilated patients are at risk for ARDS according to the LIPS and pulmonary complications are frequent, setting of is globally in line with current recommendations.
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http://dx.doi.org/10.4269/ajtmh.20-1177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941813PMC
January 2021

Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS).

Pulmonology 2020 Dec 4. Epub 2020 Dec 4.

Cell and Molecular Biology Group, Airways Disease Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK; Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.

Background: In December 2019, pneumonia associated with a novel coronavirus (COVID-19) was reported in Wuhan, China. Acute respiratory distress syndrome (ARDS) is the most frequently observed complication in COVID-19 patients with high mortality rates.

Objective Of Study: To observe the clinical effect of plasmapheresis on excessive inflammatory reaction and immune features in patients with severe COVID-19 at risk of ARDS.

Materials And Methods: In this single-center study, we included 15 confirmed cases of COVID-19 at Masih Daneshvari Hospital, in March 2020 in Tehran, Iran. COVID-19 cases were confirmed by RT-PCR and CT imaging according to WHO guidelines. Plasmapheresis was performed to alleviate cytokine-induced ARDS. The improvement in oxygen delivery (PaO/FiO, total number of T cells, liver enzymes, acute reaction proteins, TNF-α and IL-6 levels were evaluated.

Results: Inflammatory cytokine levels (TNF-α, IL-6), and acute phase reaction proteins including ferritin and CRP were high before plasmapheresis. After plasmapheresis, the levels of PaO/FiO, acute phase reactants, inflammatory mediators, liver enzymes and bilirubin were significantly reduced within a week (p < 0.05). In contrast, although the number of T helper cells decreased immediately after plasmapheresis, they rose to above baseline levels after 1 week. Nine out of fifteen patients on non-invasive positive-pressure ventilation (NIPPV) survived whilst the six patients undergoing invasive mechanical ventilation (IMV) died.

Conclusion: Our data suggests that plasmapheresis improves systemic cytokine and immune responses in patients with severe COVID-19 who do not undergo IMV. Further controlled studies are required to explore the efficacy of plasmapheresis treatment in patients with COVID-19.
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http://dx.doi.org/10.1016/j.pulmoe.2020.10.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834188PMC
December 2020

Neurological Manifestations of COVID-19: A Case Report.

Tanaffos 2020 Nov;19(2):160-164

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

A novel coronavirus disease (COVID-19) was reported in Wuhan, China in December 2019 and spread rapidly around the world, causing high rates of mortality and morbidity. This disease is known for its respiratory manifestations. Also, there have been several reports of neurological involvement in patients with COVID-19. In this study, we present a 55-year-old Iranian male patient, who was referred from another medical center with a decreased level of consciousness. Upon admission, only respiratory signs of COVID-19 were observed, but later, some neurological manifestations were also observed, such as an alteration in mental status, disorientation, stupor, and finally coma. In radiological studies, a hemorrhagic encephalopathy pattern was detected. Despite improved oxygenation and alleviation of respiratory symptoms with antiviral and anti-inflammatory therapies, cerebral injuries progressed, and the patient died due to severe brain damage.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680512PMC
November 2020

Clinical Manifestations of Patients with Coronavirus Disease 2019 (COVID-19) in a Referral Center in Iran.

Tanaffos 2020 Nov;19(2):122-128

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

Background: Following the recent epidemic of coronavirus disease 2019 (COVID-19) in Wuhan, China, a novel betacoronavirus was isolated from two patients in Iran on February 19, 2020. In this study, we aimed to determine the clinical manifestations and outcomes of the first confirmed cases of COVID-19 infection (n=127).

Materials And Methods: This prospective study was conducted on all COVID-19-suspected cases, admitted to Masih Daneshvari Hospital (a designated hospital for COVID-19), Tehran, Iran, since February 19, 2020. All patients were tested for COVID-19, using reverse transcription-polymerase chain reaction (RT-PCR) assay. Data of confirmed cases, including demographic characteristics, clinical features, and outcomes, were collected and compared between three groups of patients, requiring different types of admission (requiring ICU admission, admission to the general ward, and transfer to ICU).

Results: Of 412 suspected cases, with the mean age of 54.1 years (SD=13.4), 127 (31%) were positive for COVID-19. Following the patients' first visit to the clinic, 115 cases were admitted to the general ward, while ten patients required ICU admission. Due to clinical deterioration in the condition of 25 patients (out of 115 patients), ICU admission was essential. Based on the results, the baseline characteristics of the groups were similar. Patients requiring ICU admission were more likely to have multiorgan involvement (liver involvement, P<0.001; renal involvement, P<0.001; and cardiac involvement, P=0.02), low O saturation (P<0.001), and lymphopenia (P=0.05). During hospital admission, 21 (16.5%) patients died, while the rest (83.5%) were discharged and followed-up until March 26, 2020. Also, the survival rate of patients, who received immunoglobulin, was higher than other patients (60.87% vs. 39.13%).

Conclusion: The mortality rate of COVID-19 patients was considerable in our study. Based on the present results, this infection can cause multiorgan damage. Therefore, intensive monitoring of these patients needs to be considered.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680520PMC
November 2020

Sleep Disorders and Mental Health in Menopausal Women in Tehran.

Tanaffos 2020 Jan;19(1):31-37

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

Background: Sleep complaints are common problems in the general population and insomnia and sleep disorders place significant economic and social burdens on the community. Postmenopausal women are 2.6 to 3.5 times more likely to develop obstructive sleep apnea (OSA) compared to non-menopausal women. In this study, we evaluated sleep disorders and mental health in postmenopausal women.

Materials And Methods: This study was a descriptive cross-sectional study and the samples were selected from postmenopausal women above 50 years who had participated in a survey entitled, "Evaluation of Sleep Disorders among Adults in Tehran" in 2017. Cluster sampling method was applied with proportional allocation. A total of 4021 samples were collected, 2075 of which belonged to women. In addition, 174 out of 2075 samples were related to postmenopausal women over the age of 50. The data were analyzed using the statistical package IBM SPSS version 22.0. P-values less than 0.05 were considered significant.

Results: In this study, 118 (67.8%) women had insomnia for less than three months, and 23 (13.2%) women had insomnia for more than three months. The prevalence of STOPBANG parameters in this group of postmenopausal women was 37% and significantly related to Body mass index (BMI) and neck circumference at P < 0.001 and 0.006, respectively. There was no significant relationship between social dysfunction and insomnia. However, anxiety in General Health Questionnaire (GHQ) was significantly associated with insomnia, sleepiness, sadness, and irritability.

Conclusion: Our results indicate that the impact of insomnia symptoms, OSA comorbidity and mental disorders could extend far beyond. The use of urgent health care and quality of life issues is essential for long-term mental and physical well-being; if there is no treatment in the menopause population, there will be serious mental and physical complications.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569498PMC
January 2020

The effect of acetazolamide on the improvement of central apnea caused by abusing opioid drugs in the clinical trial.

Sleep Breath 2020 Dec 5;24(4):1417-1425. Epub 2019 Dec 5.

Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Science, Tehran, Iran.

Purpose: Acetazolamide is utilized as a treatment which falls effective in treating some type of CSA. Hence, it might be effective as far as opium addicts who suffer from CSA are concerned.

Materials And Method: The current study was a double-blind, placebo-controlled, cross-over study ( clinicalTrials.gov ID: NCT02371473). The whole procedures were identical for both placebo and acetazolamide phases of clinical research. There were 14 CSA more than 5/h and more than 50% of apnea-hypopnea index (AHI). Out of these 14 patients, 10 volunteered to participate in the study. Fast Fourier transformation was used to separate heart rate variability (HRV) into its component VLF (very low frequency band), LF (low frequency band), and HF (high frequency band) rhythms that operate within different frequency ranges.

Result: There are significant results in terms of decreased mix apnea and central apnea together due to acetazolamide compared with placebo (P < 0.023). Time of SatO < 90% is decreased as well (P < 0.1). There is also decrease of SDNN and NN50 after treatment with acetazolamide respectively (P < 0.001). Regarding fast Fourier transformation, there is increase of pHF and decrease of pLF after acetazolamide treatment (P < 0.001).

Conclusion: Acetazolamide seems to be effective in improving oxygenation and a decrease of mixed and central apnea events together. In HRV analysis section, LF power has decreased significantly, which may more likely improve prognosis of the patients.
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http://dx.doi.org/10.1007/s11325-019-01968-3DOI Listing
December 2020

Correction to: Exhaled nitric oxide is not a biomarker for idiopathic pulmonary arterial hypertension or for treatment efficacy.

BMC Pulm Med 2019 11 5;19(1):197. Epub 2019 Nov 5.

Cell and Molecular Biology Group, Airways Disease Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK.

Following publication of the original article [1], the authors flagged that name of the author 'Batoul Khoundabi' had been provided with an incorrect spelling: 'Batoutl' was given in place of 'Batoul'.
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http://dx.doi.org/10.1186/s12890-019-0984-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829966PMC
November 2019

Exhaled nitric oxide is not a biomarker for idiopathic pulmonary arterial hypertension or for treatment efficacy.

BMC Pulm Med 2019 Oct 29;19(1):188. Epub 2019 Oct 29.

Cell and Molecular Biology Group, Airways Disease Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK.

Background: Idiopathic pulmonary arterial hypertension (IPAH) is a fatal illness. Despite many improvements in the treatment of these patients, there is no unique prognostic variable available to track these patients. The aim of this study was to evaluate the association between fractional exhaled nitric oxide (FeNO) levels, as a noninvasive biomarker, with disease severity and treatment outcome.

Methods: Thirty-six patients (29 women and 7 men, mean age 38.4 ± 11.3 years) with IPAH referred to the outpatient's clinic of Masih Daneshvari Hospital, Tehran, Iran, were enrolled into this pilot observational study. Echocardiography, six-minute walking test (6MWT), FeNO, brain natriuretic peptide (BNP) levels and the functional class of patients was assessed before patients started treatment. Assessments were repeated after three months. 30 healthy non-IPAH subjects were recruited as control subjects.

Results: There was no significant difference in FeNO levels at baseline between patients with IPAH and subjects in the control group. There was also no significant increase in FeNO levels during the three months of treatment and levels did not correlate with other disease measures. In contrast, other markers of disease severity were correlated with treatment effect over the three months.

Conclusion: FeNO levels are a poor non-invasive measure of IPAH severity and of treatment response in patients in this pilot study.
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http://dx.doi.org/10.1186/s12890-019-0954-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819396PMC
October 2019

The Relationship between Electrocardiographic Changes and Prognostic Factors in Severely Symptomatic Pulmonary Hypertension.

Tanaffos 2019 Jan;18(1):34-40

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

Background: The prognostic role of the electrocardiogram (ECG) in PH is not fully known. We aimed to evaluate ECG abnormalities in severe PH, the association of ECG patterns with known prognostic factors and to determine whether ECG abnormalities were associated with decreased survival in patients with severe PH.

Materials And Methods: Fifty-two patients with severe PH were included. Clinical assessment included basic demographics, complete physical examination, determination of WHO FC, measurement of N-terminal pro-BNP, 12-lead electrocardiography, transthoracic echocardiography, right heart catheterization (RHC) and six minute walk test (6MWT).

Results: Heart rate was correlated with NT-proBNP (r=0.54; p-value: 0.0001) and was higher in patients with severe RV dysfunction (93±12 vs. 83±4 bpm in moderate RV dysfunction). P-pulmonale was present in 51.9% of the patients and was significantly associated with severe RV dysfunction. qR in V1 (48.1%) was significantly associated with 6MWT and severe RV dysfunction. Overall, 10 patients died. Based on Kaplan-Meier results, median survival time was 38 months and estimated survival at 1 year, 3 years, and 5 years was 88%, 80% and 71 % respectively. In Cox regression analysis WHO FC, 6MWT, pericardial effusion, NT-pro BNP, heart rate, ST depression in V1 to V3, and presence of qR in V1 were predictors of mortality. After controlling for covariates, only NT-proBNP was independently associated with decreased survival.

Conclusion: ECG changes including P-pulmonale, qR pattern in V1, and heart rate indicative of right ventricular dysfunction are associated with prognostic factors in severe PH and may be a useful tool in the follow-up.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690322PMC
January 2019

Pulmonary Hypertension in Intensive Care Units: An Updated Review.

Tanaffos 2019 Mar;18(3):180-207

Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Pulmonary hypertension (PH) is a condition associated with high morbidity and mortality. Patients with PH who require critical care usually have severe right ventricular (RV) dysfunction. Although different groups of PH have different etiologies, pulmonary vascular dysfunction is common in these groups. PH can lead to increased pulmonary artery pressure, which can ultimately cause RV failure. Clinicians should be familiar with the presentations of this disease and diagnostic tools. The contributing factors, if present (e.g., sepsis), and coexisting conditions (e.g., arrhythmias) should be identified and addressed accordingly. The preload should be optimized by fluid administration, diuretics, and dialysis, if necessary. On the other hand, the RV afterload should be reduced to improve the RV function with pulmonary vasodilators, such as prostacyclins, inhaled nitric oxide, and phosphodiesterase type 5 inhibitors, especially in group 1 PH. Inotropes are also used to improve RV contractility, and if inadequate, use of ventricular assist devices and extracorporeal life support should be considered in suitable candidates. Moreover, vasopressors should be used to maintain systemic blood pressure, albeit cautiously, as they increase the RV afterload. Measures should be also taken to ensure adequate oxygenation. However, mechanical ventilation is avoided in RV failure. In this study, we reviewed the pathophysiology, manifestations, diagnosis, monitoring, and management strategies of PH, especially in intensive care units.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210574PMC
March 2019

Relationship between Serum Uric Acid Levels and the Severity of Pulmonary Hypertension.

Tanaffos 2017 Jun;16(4):283-288

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

Background: Right heart catheterization is the gold standard test for diagnosis and clinical assessment of the patients with pulmonary hypertension (PH). In recent years, the usefulness of cheaper and non-invasive tests in the follow-up of PH patients is being studied. The aim of the present study was to evaluate the relationship between serum uric acid level and severity of pulmonary hypertension in PH patients.

Materials And Methods: In a cross-sectional study, serum uric acid was measured in 110 patients with PH (63 women; mean age [±SD] was 52.83±17.88 years). Pulmonary arterial pressure and severity of right ventricular dysfunction were assessed using RHC and echocardiography, respectively.

Results: Serum uric acid was higher in PH patients with severe RV dysfunction, compared to mild and moderate dysfunction (7.8mg/dl [IQR: 5.8-9.2] in severe dysfunction, versus 4.7 mg/dl [3.87-5.82] in mild dysfunction and 5 mg/dl [3.5-6.95] in moderate dysfunction. Serum uric acid was significantly correlated with pulmonary artery systolic pressure (r=0.51, P<0.001). Serum uric acid level also had a significant positive correlation with the World Health Organization functional class of the patients (r=0.49, P<0.001). Serum uric acid level greater than 5.7 mg/dl was found to be the most sensitive and specific points for predicting severe RV dysfunction in PH patients (sensitivity 76.6%, specificity 71.4%; AUC=0.79, P<0.001) .

Conclusion: Serum uric acid is correlated with the severity of symptoms and RV dysfunction in patients with pulmonary hypertension. Further studies are recommended with larger sample size in this regard.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971759PMC
June 2017

Usefulness of pulmonary artery diameter in diagnosing pulmonary hypertension in patients admitted to tuberculosis intensive care unit.

Int J Mycobacteriol 2016 Dec 25;5 Suppl 1:S56. Epub 2016 Nov 25.

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

Objective/background: Pulmonary hypertension (PH) can be a complication of patients with severe pulmonary tuberculosis (TB). We aimed to study the correlation between pulmonary artery (PA) diameter (PAD) as measured by computed tomography (CT) and mean PA pressure (mPAP) as measured by echocardiography. We also aimed to determine the accuracy of PAD in diagnosing PH in patients with pulmonary TB.

Methods: We retrospectively investigated the correlation between PAD measured using CT and mPAP measured using echocardiography in 132 patients with TB and PH, and 68 patients with TB but without PH, admitted to the TB intensive care unit at Masih Daneshvari Hospital in Tehran, Iran. We used logistic regression analysis to determine the relationships between PAD, PA diameter to ascending aorta (AA) ratio, and area of PA to area of AA ratio with mPAP. Using receiver operating characteristic analysis, we examined the utility of the PAD in predicting PH (mPAP ⩾25mmHg).

Results: PAD had a significant correlation with mPAP (p<0.005 and r=0.47). Also, PA:AA ratio and area of PA to area of AA ratio had significant correlation with mPAP (r=0.48 and r=0.47, respectively; p<0.001). The threshold of 29mm for PAD was determined using ROC. This index had a sensitivity of 0.55, specificity of 70.2 and area under curve of 0.66.

Conclusion: Although PAD and PA:AA ratio are useful in assessing of presence of PH, we conclude that these CT parameters are not sufficient for ruling in or ruling out PH in this group of patients.
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http://dx.doi.org/10.1016/j.ijmyco.2016.10.032DOI Listing
December 2016

Prevalence of Obstructive Sleep Apnea in a High-Risk Population Using the Stop-Bang Questionnaire in Tehran, Iran.

Tanaffos 2017 ;16(3):217-224

Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Despite its significant morbidities and mortality, the majority of patients with OSA remain undiagnosed. The epidemiology of OSA is well studied in Western countries, while there is scarce information on its epidemiology in other countries. We examined the prevalence of high-risk for OSA in a large urban region of Tehran, Iran.

Materials And Methods: We randomly selected 4021 individuals above 18 years in clusters from different districts of Tehran and surveyed them using the Stop-Bang questionnaire. The questionnaire also incorporated the demographic characteristics, education level, history of coronary artery disease and diabetes, and women's menopausal status. A score of 3 or higher on the Stop-Bang questionnaire indicated the high risk of OSA.

Results: The study population consisted of 2075 (51.6%) females and 1946 (48.4%) males, with the mean age of 40.88 years (SD, 15.4) and mean body mass index (BMI) of 26.18 kg/m (SD, 4.43). Overall, 51.4% of males and 26.5% of females (total, 1513; 38.6%) were classified in the high-risk group, according to the Stop-Bang questionnaire. The risk of OSA was directly correlated with BMI, advanced age, and history of cardiovascular diseases and diabetes.

Conclusion: According to the Stop-Bang questionnaire, almost 1 out of every 3 individuals was classified in the high-risk group for OSA. Considering the significant morbidity and mortality of this disorder, it is considered a major health problem. Therefore, further detailed studies with confirmatory tests are recommended in order to plan strategies for the diagnosis, treatment, and rehabilitation of these patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960226PMC
January 2017

Outcome of Acute Kidney Injury in Critical Care Unit, Based on AKI Network.

Tanaffos 2016 ;15(2):89-95

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

Background: Acute Kidney Injury (AKI) is an unsolved clinical problem in critical care patients with a high mortality rate, increasing incidence, and no definitive therapy. We studied the incidence, risk factors, and mortality associated with AKI in ICU patients.

Materials And Methods: In a prospective study, patient demographics, reason for hospitalization, reason for ICU admission, Length of ICU stay, laboratory data, and Vital signs were recorded in prepared forms during the ICU stay. AKI was defined as an increase in serum creatinine (SCr) of ≥ 0.3mg/dl from the baseline.

Results: A total of 200 patients who were enrolled in our study; 134 (67%) did not develop AKI during their ICU stay while 66 (33%) developed AKI (SCr ≥ 0.3) according to the AKIN definition. Patients with AKI had higher APACHE II scores (12.3±5.6 vs. 6.9±3.6; P< 0.001), longer ICU stays (7.6±7.6 vs. 3.7±2.8 days respectively; P< 0.001), and higher mortality (19.7% vs. 0.7%; P< 0.001).

Conclusion: The AKIN criteria are clinically valid and can be a good predictor of mortality and patient outcome in addition to APACHE II score in ICU patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127620PMC
January 2016

Diagnosis of Obstructive Sleep Apnea Syndrome in Adults: A Brief Review of Existing Data for Practice in Iran.

Tanaffos 2016 ;15(2):70-74

Tobacco Prevention and Control Research Center, NRITLD, Shahid Beheshti University of Medical Sciences,Tehran, Iran.

Obstructive sleep apnea (OSA) is a common disorder associated with major comorbidities. It is estimated that 5-35% of the adult population in Iran are at high risk for OSA. This review article is designed to assist sleep medicine specialists as well as general practitioners in Iran to screen for OSA. It summarizes empirical data for diagnosing OSA including history taking, physical examination, diagnostic testing, and diagnostic criteria with regards to existing sleep medicine centers and availability of diagnostic tests in Iran.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127617PMC
January 2016

Eighty Kilograms Weight Reduction in a Case of Obstructive Sleep Apnea with Several Comorbidities: Did the Conditions Improve?

Acta Med Iran 2016 May;54(5):334-6

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

Obstructive sleep apnea (OSA) together with metabolic disorders is common in severely obese patients. Weight reduction is considered as a treatment modality in these cases while few of them can succeed in considerable weight loss. Here, we present a severely obese man with body mass index of 54 suffered from OSA, type 2 diabetes, hypothyroidism, and hypertension. He intentionally lost 80 kilograms weight during the 2-year follow-up. Diabetes and hypertension completely resolved with considerable improvement in OSA syndrome after this huge weight reduction.
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May 2016

Efficacy of Low-Dose Ciclesonide and Fluticasone Propionate for Mild to Moderate Persistent Asthma.

Tanaffos 2015 ;14(1):1-9

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

Background: The aim of this study was to compare the efficacy of ciclesonide (80 mg/day) and fluticasone propionate (200 mg/day) for mild to moderate persistent asthma.

Materials And Methods: Female and male patients older than 12 years with a history of persistent bronchial asthma for at least 6 months were enrolled. Patients were eligible to enter into a 2-week run-in period before randomization (baseline) if they had received inhaled corticosteroids (fluticasone propionate 250 μg/day or equivalent) at a constant dose during the last 4 weeks before the run-in period. In order to enter into the double blind 18-week treatment period, patients had to have a forced expiratory volume in 1s (FEV1) of 61-90% of predicted and a decrease in FEV1 throughout the run-in period of more than 10%. Patients (n =230) were assigned to ciclesonide 80 mg once daily or fluticasone propionate 100 mg twice daily group. The primary outcome variable was change in FEV1 compared to its baseline value. Secondary outcome variables were asthma-specific quality of life and asthma control.

Results: Both drugs significantly increased FEV1 and other lung function parameters compared to baseline (P< 0.0001, both groups, all variables). Progress in the percentage of days with no asthma symptoms and no use of rescue medication and asthma-specific quality of life were similar in the two treatment groups.

Conclusion: Ciclesonide at a dose of 80 μg once daily can provide efficient maintenance therapy for mild to moderate persistent asthma.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515324PMC
July 2015

Effect of pulmonary hypertension on outcome of pulmonary tuberculosis.

Braz J Infect Dis 2014 Sep-Oct;18(5):487-90. Epub 2014 Apr 27.

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

Background: This study performed at the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran, aimed to evaluate the effect of concomitant pulmonary hypertension on the outcome of pulmonary tuberculosis.

Methods: New cases of pulmonary tuberculosis were recruited for the study. Pulmonary hypertension was defined as systolic pulmonary arterial pressure ≥ 35 mm Hg estimated by transthoracic Doppler echocardiography. We assessed the relationship between pulmonary hypertension and mortality during the six-month treatment of tuberculosis.

Results: Of 777 new cases of pulmonary tuberculosis, 74 (9.5%) had systolic pulmonary arterial pressure ≥ 35 mm Hg. Ten of them (13.5%) died during treatment compared to 5% of cases with pulmonary arterial pressure less than 35 mm Hg (p=0.007). Logistic regression analysis showed that pulmonary hypertension and drug abuse remained independently associated with mortality (OR=3.1; 95% CI: 1.44-6.75 and OR=4.4; 95% CI: 2.35-8.17, respectively).

Conclusion: A significant association was found between mortality and presence of pulmonary hypertension and drug abuse among new cases of pulmonary tuberculosis.
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http://dx.doi.org/10.1016/j.bjid.2014.02.006DOI Listing
January 2015

The Effect of Amlodipine and Sildenafil on the NT-ProBNP Level of Patients with COPD-Induced Pulmonary Hypertension.

Iran J Pharm Res 2014 ;13(Suppl):161-8

Clinical Pharmacy Department, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ; Chronic Respiratory Disease Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Pulmonary hypertension (PH) is an important cause of heart failure in chronic obstructive pulmonary disease (COPD). The pro brain natriuretic peptide N-terminal (NT-proBNP) has been suggested as a noninvasive marker to evaluate ventricular function. However, there is no evidence to support the use of NT-proBNP in monitoring the benefits of vasodilators in COPD induced PH. Thus, we used NT-proBNP as a biomarker to evaluate the effect of oral vasodilators on cardiac function in COPD-induced PH. Forty clinically-stable PH patients were enrolled with history of COPD, normal left ventricular ejection-fraction (LVEF), right ventricular systolic pressure (RVSP) > 45 mmHg and baseline blood NT-proBNP levels >100 pg/mL. Patients were randomized into two groups, one group received sildenafil and second group were given amlodipine for two weeks. NT-proBNP and systolic pulmonary arterial pressure (systolic PA-pressure) were measured at the beginning and the end of study. Mean NT-proBNP level in the first group was 1297 ± 912 pg/mL before therapy and 554 ± 5 pg/mL after two weeks drug therapy, respectively. Similarly, in second group NT-proBNP level was 1657 ± 989 pg/mL and 646 ± 5 pg/mL before and after treatment. Amlodipine or sildenafil significantly reduced NT-proBNP levels in COPD-induced PH patients (p < 0.05). Our study shows that amlodipine and sildenafil have a similar effect on NT-proBNP levels. In both groups NT- proBNP levels were significantly reduced after treatment. Therefore, our findings support the potential benefits of treatment with vasodilators in COPD induced PH. Pulmonary hypertension, Chronic obstructive pulmonary disease, NT-proBNP, Amlodipine, Sildenafil.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977066PMC
April 2014

Oral l-citrulline malate in patients with idiopathic pulmonary arterial hypertension and Eisenmenger Syndrome: a clinical trial.

J Cardiol 2014 Sep 10;64(3):231-5. Epub 2014 Feb 10.

Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, PO Box 19575-154, Tehran 19569-444413, Iran.

Background And Purpose: Citrulline is an amino acid which is produced by the urea cycle and also a precursor for NO, that is, a vasodilator for normal function of pulmonary vasculature. Thereby, enhancing l-citrulline malate in patients with idiopathic pulmonary arterial hypertension and those with congenital heart disease identified as Eisenmenger Syndrome results in reduction of pulmonary hypertension.

Methods And Subjects: In this clinical trial before and after study, we assigned 25 patients with arterial pulmonary hypertension (idiopathic or Eisenmenger Syndrome) to receive l-citrulline malate 1g three times daily for two weeks. The primary measurement was the change in exercise capacity, as considered as a result of the total distance walked in six minutes, from baseline to week 2. We also assessed mean pulmonary artery pressure, the change in the quality of life, and the change in pro-brain natriuretic peptide (BNP) level. The study was not powered to evaluate mortality.

Results: The mean walking distance in six minutes was significantly increased by about 44m (p=0.005) after receiving l-citrulline malate. Mean pulmonary artery pressure significantly reduced from 83.34mmHg before receiving l-citrulline malate to 79.1mmHg after that (p=0.01). All dimensions of the quality of life had statistical differences after receiving l-citrulline malate except limit due to physical health, limit due to emotional health and social functioning (p>0.05). Finally, pro-BNP difference was not statistically significant (p=0.9).

Conclusion: l-Citrulline malate improves the distance walk in six minutes and also the quality of life of patients with idiopathic arterial pulmonary hypertension and Eisenmenger Syndrome and also reduced mean arterial pulmonary hypertension.
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http://dx.doi.org/10.1016/j.jjcc.2014.01.003DOI Listing
September 2014

Evaluation of bronchoscopy complications in a tertiary health care center.

Tanaffos 2014 ;13(4):48-50

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

Background: Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. This study was performed to determine the complications of bronchoscopy in a tertiary health-care center.

Materials And Methods: This study had as descriptive cross sectional design. Four hundred adult patients between 16 to 85 years, who underwent bronchoscopy with a same method and same device and had no underlying disease, were consecutively enrolled.

Results: Bronchoscopy complications were seen in 13 patients (3.25%) including bleeding (four cases), pneumothorax (three cases), collapse (four cases), and infection (two cases). There was no association between complications and age, sex, bronchoscopy indications and findings (P > 0.05).

Conclusion: According to the obtained results, it may be concluded that bronchoscopy can be performed safely whenever indicated. Complications occurred were minor and self limiting.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386015PMC
April 2015

Venous thromboembolism in medical critically ill patients: prevalence and incidence.

Acta Med Iran 2013 Apr 6;51(3):168-71. Epub 2013 Apr 6.

Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The objective of this study was to determine the prevalence and incidence of venous thromboembolism among critically ill medical surgical patients. In this cross sectional and retrospective study, we observed 243 patients who were first admitted at the intensive care unit. Patients who were diagnosed with deep venous thrombosis or embolism either by clinical or paraclinical methods were enrolled. Among 243 patients of ICU ward 12 cases of them were confirmed to have thromboembolism (prevalence of 9.4%).But the incidence of venous thromboembolism after 48 hour of ICU admission was 5.2%(6 cases). Among 6 VTE cases 3 of them didn't receive any anticoagulant prophylaxis, 2 patients received LDUH 5000 unit twice a day and one patient received LMWH 60 mg daily but all developed VTE although receiving prophylaxis. We found that the prevalence of proximal lower limb DVT among medical-surgical critically ill patients remaining in the ICU for ≥3 days is about 9.4% and the incidence of that is about 5.2%. Further studies should be performed in order to assess the benefits and risks of venous thromboprophylaxis in Iranian patients.
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April 2013

Evaluation of maximum O2 consumption: using ergo-spirometry in severe heart failure.

Acta Med Iran 2012 ;50(9):619-23

Chronic Respiratory Diseases Research Center, NRITLD, Massih Daneshvari Hospital, Tehran, Iran.

Although sport-physiologists have repeatedly analyzed respiratory gases through exercise, it is relatively new in the cardiovascular field and is obviously more acceptable than standard exercise test, which gives only information about the existence or absence of cardiovascular diseases (CVDs). Through the new method of exercise test, parameters including aerobic and anaerobic are checked and monitored. 22 severe cases of heart failure, who were candidates of heart transplantation, referring to Massih Daneshvari Hospital in Tehran from Nov. 2007 to Nov. 2008 enrolled this study. The study was designed as a cross-sectional performance and evaluated only patients with ejection fraction less than 30%. O2 mean consumption was 6.27±4.9 ml/kg/min at rest and 9.48±3.38 at anaerobic threshold (AT) exceeding 13 ml/kg/min in maximum which was significantly more than the expected levels. Respiratory exchange ratio (RER) was over 1 for all patients. This study could not find any statistical correlations between VO2 max and participants' ergonomic factors such as age, height, weight, BMI, as well as EF. This study showed no significant correlation between VO2 max and maximum heart rate (HR max), although O2 maximum consumption was rationally correlated with expiratory ventilation. This means that the patients achieved maximum ventilation through exercise in this study, but failed to have their maximum heart rate being led probably by HF-induced brady-arrhythmia or deconditioning of skeletal muscles.
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April 2013

Diagnostic yield of post-bronchoscopy sputum smear in pulmonary tuberculosis.

Scand J Infect Dis 2012 May;44(5):369-73

Clinical Tuberculosis and Epidemiology Research Centre, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The early definitive diagnosis of pulmonary tuberculosis (TB) is important for control of the disease in the community. We performed this study to evaluate the additional gain of post-bronchoscopy sputum in the diagnosis of pulmonary TB.

Methods: Bronchoscopy and bronchoalveolar lavage were performed for 126 patients suspected of pulmonary TB who either had 3 negative sputum smears for acid-fast bacilli or could not expectorate. After bronchoscopy the patients were asked to give sputum samples for 3 consecutive days. All of the obtained specimens were investigated for Mycobacterium tuberculosis by smear and culture.

Results: Pulmonary TB was confirmed in 56 patients. Among all confirmed cases, the sensitivity of bronchoalveolar lavage smear was 57.1% (32 of 56), sensitivity of post-bronchoscopy smear was 76.7% (43 of 56), and the yield of a combination of the 2 methods was 83.9% (47 of 56). Results of post-bronchoscopy sputum smears were not significantly related to sex, age, human immunodeficiency virus (HIV) infection, presence of cavitary lesions on chest X-ray, or the ability to expectorate before bronchoscopy (p > 0.05).

Conclusion: Evaluation of post-bronchoscopy sputum smears is helpful for earlier diagnosis of pulmonary TB and is an inexpensive and accessible assay.
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http://dx.doi.org/10.3109/00365548.2011.643820DOI Listing
May 2012

Improving the Practice of Nutrition Therapy in the NRITLD Critically Ill Patients: An International Quality Improvement Project.

Tanaffos 2011 ;10(4):31-7

Department of Medicine and Epidemiology at Queen's University, Director of Research for the Critical Care Program and the Director of the Clinical Evaluation Research Unit at the Kingston General Hospital, Kingston, Canada.

Background: In previous decades several studies have been performed demonstrating that providing appropriate nutritional support to intensive care unit patients affects complications, time of mechanical ventilation, length of ICU stay, and risk of death. In this study we provided a report of nutrition statuses in Masih Daneshvari's ICU as compared to 156 ICUs from 20 countries that participated in an international nutrition survey.

Materials And Methods: All patients admitted to an intensive care unit during a specified one-month period who required artificial nutrition were included in this study. Characteristics of patients, performance of nutrition practices, and ICU outcomes were registered for all patients and compared with data from 156 other intensive care units from various countries around the world.

Results: Twenty patients, of which 11(55%) were males and 9(45%) were females, were included in this study. The median age was 50.5 yrs (IQR: 40.5-56.0). Seventeen (85%) of them had EN nutrition only, 2(10%) had PN nutrition only, and 1(5%) had both EN and PN nutrition during their stay in the ICU. The adequacy of calorie intake was 67.6% (vs. 61.1% in all 157 ICUs) and the adequacy of protein intake was 84.9% (vs. 56.7% in 157 ICUs).

Conclusion: In our ICU, enteral feeding was superior to parenteral feeding. Also we considered early initiation of enteral feeding within 48 hours following ICU admission. We just used polymeric formula during this study. As a result of formula variation limits, we overestimated calories and protein needs. Glutamine and Selenium supplementations have not been used yet for patient in our ICU, regardless of their proven benefits in oxidative stress conditions like pulmonary diseases. Therefore, limited use of supplementations like selenium is inevitably among the disadvantages of Masih Daneshvari Hospital's ICU, which is a tertiary-care center for chronic pulmonary diseases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153167PMC
September 2014