Publications by authors named "Maryam Heidarpour"

14 Publications

  • Page 1 of 1

Cardiogenic Shock and Guillain-Barré Syndrome as the First Manifestations of Pheochromocytoma.

Case Rep Endocrinol 2021 3;2021:6691095. Epub 2021 Jun 3.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Febrile congestive heart failure is a rare first manifestation of pheochromocytoma. Herein, the case of a 31-year-old female with febrile congestive heart failure and subsequent cardiogenic shock is presented. After intensive care unit (ICU) admission and further evaluating the right adrenal mass observed in abdominal ultrasonography, the diagnosis of pheochromocytoma was confirmed. Then, she was scheduled for the right adrenalectomy. Before surgery, she complained of acute-onset progressive muscle weakness in the lower limbs, followed by the upper limbs. After further investigation, she was diagnosed with Guillain-Barré syndrome and treated with intravenous immunoglobulin (IVIG). She recovered well after the right adrenalectomy, and during the subsequent 18 months, the follow-up did not reveal any complications, and left ventricular function recovered to normal.
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http://dx.doi.org/10.1155/2021/6691095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192183PMC
June 2021

Endothelial dysfunction in patients with lone atrial fibrillation.

ARYA Atheroscler 2020 Nov;16(6):278-283

Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Atrial fibrillation (AF) is the most common tachyarrhythmia in patients with cardiovascular diseases (CVDs) and may have significant complications such as stroke. The present study aims to evaluate endothelial dysfunction in patients with lone atrial fibrillation (LAF) through flow-mediated dilation (FMD) in the brachial artery, as a non-invasive method for evaluating functional and structural markers of endothelial dysfunction.

Methods: In this case-control study, 43 patients with LAF were selected. 51 age and sex-matched healthy individuals were selected as the control group. The brachial artery diameter of the subjects in both groups was measured through FMD. The obtained data were analyzed by SPSS software.

Results: Patients with LAF and healthy subjects did not have any difference in terms of gender, heart rate (HR), and systolic blood pressure (SBP) (P > 0.05 for all). FMD of the patients with AF was significantly lower (P = 0.04) than FMD of the healthy controls.

Conclusion: Our findings showed that LAF was associated with systemic endothelial dysfunction. AF plays an important and independent role in reducing FMD.
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http://dx.doi.org/10.22122/arya.v16i6.2095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172232PMC
November 2020

Rhabdomyolysis plus Hypocalcemia and Diabetic Ketoacidosis as Concurrent Rare COVID-19 Manifestations.

Case Rep Med 2021 8;2021:6625086. Epub 2021 Mar 8.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Common manifestations of coronavirus disease 2019 (COVID-19) from its initial official introduction are mostly related to the respiratory system. However, other rarer presentations are reported nowadays. . We reported three cases of COVID-19-infected patients with rhabdomyolysis as well as two other rarer simultaneous signs, including hypocalcemia (Case 1) and diabetic ketoacidosis (DKA) (Case 2).

Conclusion: Despite the fact that rhabdomyolysis is an infrequent manifestation of COVID-19, high clinical suspicion is required for proper diagnosis and management of this disease as well as other concurrent rarer presentations, including hypocalcemia and DKA for the prevention of further complications.
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http://dx.doi.org/10.1155/2021/6625086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7945673PMC
March 2021

Relation between Hemoconcentration Status and Readmission Plus Mortality Rate Among Iranian Individuals with Decompensated Heart Failure.

Int J Prev Med 2020 5;11:163. Epub 2020 Oct 5.

Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Hemoconcentration (HC) has been suggested to be a useful biomarker for determination of optimum diuretic therapy in acute heart failure (HF), but role of this factor in rehospitalization and death was still controversial. In this study, we aimed to define relation between HC and readmission and mortality rate among Iranian patients with acute HF.

Methods: This was a prospective cohort study done from March 2017 to March 2018 using data of a HF section of Persian Registry Of cardioVascular diseasE. From a total number of 390 registered HF individuals aged 18 years or older, 69 ones showed alterations in hemoglobin (Hb) levels. Hb levels were measured at admission and discharge time. HC was defined as any increased level in Hb during hospitalization. The relation of HC with readmission and death rate was done using multiple logistic regression and Cox proportional hazard model, respectively.

Results: The mean age of study population was 70.5 ± 11.9 years with the dominant percentage of male participants (66.9%). Patients showing HC during admission did not reveal any significant decreased likelihood of rehospitalization compared to negative ones. In comparison to HC negative patients, those showing increments in Hb levels had a borderline significant lower likelihood of mortality (hazard ratio: 0.82, 95% confidence interval, CI = 0.07-1.18, = 0.08).

Conclusions: Our data suggested that HC was associated marginally with reduced mortality rate 6 months post HF attack and could be utilized as a useful biomarker for risk stratification of HF patients. Several prospective longitudinal population-based studies are necessary proving these associations.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_45_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716610PMC
October 2020

Corona Virus Disease 2019 (COVID-19) and Its Effect on Renal System, A Systematic Review and Meta-analysis.

Iran J Kidney Dis 2020 12;14(6):419-438

Heart Failure Research Center, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Coronavirus disease 2019 (COVID-19) has been recently emerged with various manifestations, mainly on respiratory system. However, other organs might also be involved. Acute kidney injury has been reported as a complication with high variability and controversial results. We aimed to define the frequency of AKI as well as two specific renal biomarkers including BUN and serum Cr among individuals suffering from COVID-19 infection. We investigated Medline/PubMed, Scopus, and Google Scholar databases until 16th April 2020 and included all relevant peer-reviewed published studies without any language limitations. We further categorized patients according to their clinical status into severe, non-severe, and death groups. 18 records on 4528 individuals were assessed. The mean age of individuals were 52.5 ± 24.4 years (males: 55.6%). Prevalence of AKI was 4% (95% CI: 2% to 8%) and was significantly lower among non-severe patients in comparison to deceased ones (1%, 95% CI: 0% to 4%, vs. 31%, 95% CI: 19% to 47%). BUN mean was 5.14 mmol/L (95% CI: 4.60 to 5.69). Non-severe patients had remarkably lower means of BUN compared to deceased or those with severe infection (4.25 mmol/L, 95% Cl: 3.70 to 4.79, vs. 8.9 mmol/L, 95% CI: 7.94 to 9.86, vs. 6.63 mmol/L, 95% Cl: 5.62 to 7.65; respectively). The mean serum Cr was 71.60 mmol/L (95% Cl: 67.56 to 75.64). Our findings suggest that COVID-19 does not seem to involve renal system extensively and other possible mechanisms might be further investigated in this regard.
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December 2020

Acute Cardiac Injury in COVID-19: A Systematic Review and Meta-analysis.

Arch Iran Med 2020 11 1;23(11):801-812. Epub 2020 Nov 1.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Coronavirus disease 2019 (COVID-19) has been widespread since late December 2019, with several symptoms related to the upper and lower respiratory system. However, its cardiac manifestations are less frequently studied. We aimed to analyze the available COVID-19 data on acute cardiac injury, using troponin and brain natriuretic peptide (BNP) levels.

Methods: We performed a systematic review on Medline/PubMed, Scopus, and Google Scholar databases until March 25, 2020. Relevant records reporting the incidence of acute cardiac injury as well as troponin and BNP levels were collected from published peer-reviewed articles with further analysis according to the clinical status of the patients (severe, non-severe, and death).

Results: Eleven records of 1394 individuals were included. The mean age of patients with acute cardiac injury was 56.6 ± 33.4 years (males: 54.3%). The incidence of acute cardiac injury was 15% (95% CI: 11, 20%). Further analysis revealed that dead or severe patients had significantly higher percentages of myocardial injury, compared to non-severe ones (peer-reviewed: 44%, 95% CI: 16, 74% vs. 24%, 95% CI: 15, 34% vs. 5%, 95% CI: 1, 12%, respectively). Mean total troponin was 10.23 pg/mL (95% CI: 5.98, 14.47), while 13% (95% CI: 8%, 18%) of patients had elevated levels. Mean BNP was 216.74 pg/mL (95% CI: 3.27, 430.20).

Conclusion: Acute cardiac injury in COVID-19 patients is more frequent than what was expected at the beginning of the outbreak. Meanwhile, further studies are needed to investigate the utility of cardiac biomarkers as diagnostic and prognostic tools for long-term cardiac complications of this infection.
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http://dx.doi.org/10.34172/aim.2020.107DOI Listing
November 2020

Adrenal insufficiency in coronavirus disease 2019: a case report.

J Med Case Rep 2020 Aug 24;14(1):134. Epub 2020 Aug 24.

Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Novel coronavirus disease 2019 presents with fever, dry cough, fatigue, and shortness of breath in most cases; however, some rare manifestations in other organs have also been reported so far.

Case Presentation: Here, the case of a 69-year-old Iranian man with coronavirus disease 2019 is presented who suffered from frequent episodes of vasopressor-resistant hypotension during intensive care unit admission, which was finally attributed to the occurrence of acute adrenal insufficiency.

Conclusions: As this is a rare complication, adrenal insufficiency might be easily overlooked. However, early detection of this disease among critically ill patients infected with coronavirus disease 2019 could be lifesaving, especially among those unresponsive to vasopressor agents.
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http://dx.doi.org/10.1186/s13256-020-02461-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444179PMC
August 2020

Comparison of multiple blood pressure frequency methods with optimum blood pressure measurement among Iranian individuals.

J Res Med Sci 2020 13;25:40. Epub 2020 Apr 13.

Interventional Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Proper blood pressure (BP) measurement frequency method is less evaluated to optimize hypertension (HTN) status among different nations due to cultural patience variations. The aim of this study was to compare the first (BP), second (BP), and the mean of first and second (BP) and all the three (BP) with the second and third BP measurements in Iranian individuals.

Materials And Methods: This cross-sectional study was done on 2264 individuals aged 18 years or more living in Isfahan city, Iran. Their BPs were assessed from right arms by the standard tools and methods after 5 min of rest in a quiet room by a trained staff. The mean second and third readings were considered as reference, and the other aforementioned variables were compared with it.

Results: The mean age of total population was 40.9 ± 16.1 years (males: 52%). Men had significant higher means of systolic BP (SBP) and diastolic BP (DBP) with any measurement frequency methods than women ( < 0.001 and = 0.009). Considerable clinical significant (≥5 mmHg) ranges were mostly observed in BP compared with BP. SBP and DBP indices showed insignificant differences compared with reference mean. Moreover, abnormal BP levels (≥140/90 mmHg) were mostly observed in terms of BP measurement with no remarkable variability in BP reading in comparison to the reference.

Conclusion: Our considerable data suggested that BP could appropriately categorize BP status similar to BP and it may be rational for physicians considering this mean and excluding the first BP measurement as a sole criterion for HTN assessment in Iranian adults. Multiple researches are necessary quantifying appropriate frequencies of BP reading.
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http://dx.doi.org/10.4103/jrms.JRMS_129_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306238PMC
April 2020

Design and methodology of heart failure registry: Results of the Persian registry of cardiovascular disease.

ARYA Atheroscler 2019 Sep;15(5):228-232

Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Heart failure (HF) resulted from ultimate pathway of many cardiovascular diseases (CVDs) or as a separate entity poses a considerable increasing prevalence and economic burden, but its registry for better management is less frequently done. In this study, we aimed to design and implement HF registry.

Methods: Persian Registry Of cardioVascular diseasE (PROVE) was initiated from March 2015 and continuously collected information of patients suffering from HF, ST-elevation myocardial infarction (STEMI), atrial fibrillation (AF), percutaneous coronary intervention (PCI), stroke, familial hypercholesterolemia (FH), congenital heart disease (CHD), chronic ischemic cardiovascular disease (CICD), and acute coronary syndrome (ACS) from 18 different cardiac centers. Data of patients with HF were collected from their medical forms and recorded in a registry system of PROVE/HF plus telephone follow-up survey of 1, 6, and 12 months after the date of HF attack.

Results: Assessment of all related questions led to definition of a final questionnaire including 27 items regarding demographic information, underlying disorders and their complications, patients' symptoms and signs, and laboratory and relevant para-clinic data at admission time, during hospitalization, and post discharge. Follow-up information was mostly based on patients' general status and medication usage.

Conclusion: PROVE execution was a successful and hopeful project providing data of major CVDs in order to design appropriate preventive actions and better management and treatment strategies plus a valuable data center being utilized in multiple future comprehensive projects.
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http://dx.doi.org/10.22122/arya.v15i5.1950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954358PMC
September 2019

Acromegaly and papillary thyroid carcinoma: A case series.

J Res Med Sci 2019 30;24:81. Epub 2019 Sep 30.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Acromegaly is a rare chronic disease and associated with an increased risk of malignancy. The issue of the risk of thyroid cancer in these patients is a topic of debate, and the number of large case-control studies is very limited. Several studies indicated that a chronic excess insulin-like growth factor-1 stimulates the proliferation of various cell types and induces an antiapoptotic effect in thyroid follicular cells. In the literature, the risk of thyroid cancer was reported greater than five-fold. In this review, we will briefly summarize the studies available regarding thyroid cancer in patients with acromegaly and present three case reports.
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http://dx.doi.org/10.4103/jrms.JRMS_969_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788175PMC
September 2019

Effects of somatostatin analog treatment on cardiovascular parameters in patients with acromegaly: A systematic review.

J Res Med Sci 2019 26;24:29. Epub 2019 Apr 26.

Max-Planck-Institute of Psychiatry, Internal Medicine/Endocrinology and Clinical Chemistry, Munich, Germany.

Background: There is a belief that in patients with acromegaly, first-generation somatostatin analogs (SSAs) might improve cardiovascular (CV) structure and function. However, most published clinical trials involved only a few patients and their results are rather variable. We aimed to conduct a systematic review on available studies on the impact of these drugs on CV parameters.

Materials And Methods: A literature search was conducted in MEDLINE (OVID), EMBase, Cochrane, and ISI Web of Science for citations published until April 30 2018 to identify studies on our objective that considered changes in CV parameters. For this search, we established a Boolean search strategy using keywords related to "acromegaly," "Somatostatin analog," and "cardiovascular diseases and parameters." All study types except for case reports or conference abstracts were included. Twenty-four studies ( = 558) fulfilled the inclusion criteria and were selected for final analysis.

Results: In 12 studies ( = 350), decrease in heart rate (HR) and in 4 studies ( = 128), decrease in blood pressure (BP) was significant. In 15 studies ( = 320), left ventricular mass index (LVMi) changes were significant. In 9 studies ( = 202), the early diastole to peak velocity flow in late diastole (E/A ratio) was evaluated, and in 5 of them ( = 141), the improvement was significant. Eighteen studies ( = 366) examined changes in left ventricular ejection fraction (LVEF), 5 of which ( = 171) reported that these changes were significant. Decrease of left ventricular end-diastolic diameter was reported in only 2 studies ( = 27).

Conclusion: We found that first-generation SSAs have a beneficial effect on cardiac parameters such as HR and LVMi. For other parameters such as LVEF, BP, LV diameter, and E/A ratio, we were not able to draw a firm conclusion.
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http://dx.doi.org/10.4103/jrms.JRMS_955_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521613PMC
April 2019

Two rare manifestations of primary hyperparathyroidism: paralysis and peptic ulcer bleeding.

Endocrinol Diabetes Metab Case Rep 2017 10;2017. Epub 2017 Jul 10.

Isfahan University of Medical Sciences Isfahan Endocrine and Metabolism Research Center Ringgold Standard Institution, IsfahanIran.

Primary hyperparathyroidism revealed by thoracic spine brown tumor and peptic ulcer bleeding is rare. We presented a case of 33-year-old male patient who was admitted with paraplegia. Thoracic spine magnetic resonance imaging (MRI) showed extradural lesion at T4 level. He underwent surgical decompression in T4. According to histopathologic finding and elevated serum parathormone (PTH) and hypercalcemia (total serum calcium 12.1 mg/dL), the diagnosis of brown tumor was down. Ultrasonography of his neck showed a well-defined lesion of 26 × 14 × 6 mm. The day after surgery, he experienced 2 episodes of melena. Bedside upper gastrointestinal endoscopy showed gastric peptic ulcer with visible vessel. Treatment with intragastric local instillation of epinephrine and argon plasma coagulation was done to stop bleeding. After stabilization of the patient, parathyroidectomy was performed. Histologic study showed the parathyroid adenoma without any manifestation of malignancy. At discharge, serum calcium was normal (8.6 mg/dL). On 40th day of discharge, standing and walking status was normal.

Learning Points: Thoracic spine involvement is a very rare presentation of primary hyperparathyroidism.The issue of whether primary hyperparathyroidism increases the risk of peptic ulcer disease remains controversial. However, gastrointestinal involvement has been reported in association with classic severe primary hyperparathyroidism.The treatment of brown tumor varies from case to case.
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http://dx.doi.org/10.1530/EDM-17-0059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510439PMC
July 2017

A novel luminol chemiluminescent method catalyzed by silver/gold alloy nanoparticles for determination of anticancer drug flutamide.

Spectrochim Acta A Mol Biomol Spectrosc 2013 Dec 8;116:594-8. Epub 2013 Aug 8.

Faculty of Chemistry, Mazandaran University, Babolsar 47416-95447, Iran. Electronic address:

It was found that silver/gold alloy nanoparticles enhance the chemiluminescence (CL) of the luminol-H2O2 system in alkaline solution. The studies of UV-Vis spectra, CL spectra, effects of concentrations luminol, hydrogen peroxide and silver/gold alloy nanoparticles solutions were carried out to explore the CL enhancement mechanism. Flutamide was found to quench the CL signals of the luminol-H2O2 reaction catalyzed by silver/gold alloy nanoparticles, which made it applicable for the determination of flutamide. Under the optimum conditions, the CL intensity is proportional to the concentration of the flutamide in solution over the range 5.0 × 10(-7) to 1.0 × 10(-4)mol L(-1). Detection limit was obtained 1.2 × 10(-8)mol L(-1)and the relative standard deviation (RSD) γ5%. This work is introduced as a new method for the determination of flutamide in commercial tablets. Box-Behnken experimental design is applied to investigate and validate the CL measurement parameters.
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http://dx.doi.org/10.1016/j.saa.2013.07.060DOI Listing
December 2013

The effect of in-service English education on medical professionals' language proficiency.

J Res Med Sci 2012 Feb;17(2):190-6

Associate Professor, Department of Applied Linguistics at the English Language, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Despite its inevitable significance, the effect of in-service English education on medical professionals has rarely been studied longitudinally. The reason can be issues such as physicians' heavy workload, commuting problems, inappropriate class times, and inexperienced teaching staff.

Materials And Methods: A needs assessment worksheet was administered to faculty members of Shahid Beheshti University of Medical Sciences in Tehran and the responses were analyzed. A project for the promotion of faculty members' English proficiency was formulated. Then, following a placement test, 235 applicants from the university colleges and hospitals were classified into 28 homogeneous groups. After four terms of instruction, the participants' scores on the pre- and post- assessments were analyzed.

Results: There was significant improvement in participants' total scores on different communicative skills (P<0.001). Regarding individual skills also, they achieved meaningful gains on listening (P<0.001), writing (P = 0.038), and grammar (P<0.001), but failed to progress significantly on reading comprehension (P = 0.523).

Conclusion: The administration of in-service education for skill-oriented courses, over a long period, can be quite encouraging and should be further strengthened. Regular instructions on each individual skill on the one hand and on their combination on the other are essential for success in such education.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525041PMC
February 2012
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