Publications by authors named "Maryam Vasheghani"

12 Publications

  • Page 1 of 1

The relationship between QT interval indices with cardiac autonomic neuropathy in diabetic patients: a case control study.

Diabetol Metab Syndr 2020 Nov 19;12(1):102. Epub 2020 Nov 19.

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

Background: Long QT interval (QT) and abnormal QT dispersion (QTd) are associated with sudden death. The relationship between cardiac autonomic neuropathy (CAN) and QT indices in type 2 diabetic patients were investigated.

Methods: Totally 130 diabetic subjects (mean age 50.87 ± 13.9 years) were included (70 individuals with and 60 individuals without CAN). All participants had sinus cardiac rhythm. The patients who had diseases or take drugs that cause orthostatic hypotension (OH), cardiac arrhythmia and QT prolongation were excluded. After interview and examination, standard and continuous ECG was taken in supine position with deep breathing and standing up position. CAN diagnosis was based on Ewing's tests. QT, QT corrected (QTc), minimum QT (QT min), maximum QT (QT max) and mean ± SD of QT (QT mean) and QTd were assessed from standard ECG. QTc was calculated by Bazett's formula from V2 lead. QTc > 440 ms in men and QTc > 460 ms in women and QTd > 80 ms were considered abnormal.

Results: In patients with CAN, 21.5% were symptomatic. The prevalence of abnormal QTc and QTd was 11.3% and 28.7%, respectively. There was no significant difference between the patients with or without CAN in terms of long QTc and abnormal QTd. However, the mean ± SD of QT max, QT mean and QTd was higher in the patients with CAN (P value < 0.03). The used cut points for QTc and QTd have high specificity (79% for both) and low sensitivity (30% and 37%, respectively). To use QTc and QTd as screening test for CAN in T2DM patients, the cutoff points 380 and 550 ms are suggested, respectively.

Conclusion: The prevalence of asymptomatic CAN was 3.7 times that of symptomatic CAN. In patients with CAN the QT max, QT mean and QTd were higher than those without CAN. There was no association between CAN and long QTc and abnormal QTd.
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http://dx.doi.org/10.1186/s13098-020-00609-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678155PMC
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

An easily ignored factor for CAN-fine particulate exposure [Response to Letter].

Diabetes Metab Syndr Obes 2019 23;12:1571-1572. Epub 2019 Aug 23.

Endocrinology & Metabolism Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.2147/DMSO.S224846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711565PMC
August 2019

The association between cardiac autonomic neuropathy and diabetes control.

Diabetes Metab Syndr Obes 2019 30;12:581-587. Epub 2019 Apr 30.

Interventional Cardiology, Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Cardiac autonomic neuropathy (CAN) is one of major complications of diabetes mellitus (DM) that increases the risk of cardiovascular disorders, abnormal ventricular depolarization with poor prognosis as well as increased mortality and morbidity. Indeed, CAN has close relation with blood glucose level in diabetic patients. We investigated the relation of CAN with diabetes control. Totally, 115 diabetic patients (mean age 50.87±13.90 years old; 78 females) underwent study. All patients had DM and cardiac sinus rhythm. Nobody had sickness affecting cardiac rhythm and blood pressure. In addition, they did not take drugs that had effect on blood pressure, cardiac rhythm, and QT interval. Forty-six patients had tight and 69 patients had uncontrolled DM according to American Diabetes Association (ADA) criteria. The CAN was assessed based on heart rate variation during physical examination (at rest tachycardia and orthostatic hypotension) and standard Ewing's tests (deep-breathing and laying-to-standing tests) with bedside continuous ECG recording. The -value <0.05 is considered significant. Seventy-five patients (65.2%) had CAN. In patients with CAN, 13.9% were symptomatic and 51.3% were asymptomatic. Resting tachycardia and hypotension were found in 5.2%, 8.7% of patients, respectively. Abnormal deep-breathing and laying-to-standing tests were found in 73% and 71.3% of asymptomatic patients, respectively. CAN was more prevalence at uncontrolled DM (67.3% vs 63.7%) but the difference was not significant. The prevalence of CAN had direct association with duration of DM in both tight and uncontrolled groups (<0.05). The mean of age, sex, and type of treatment had no association with CAN prevalence. The prevalence of CAN, especially asymptomatic type, was high. Its prevalence was increased with prolonged duration of DM. But we did not find any relationship between CAN and glycemic control level.
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http://dx.doi.org/10.2147/DMSO.S196729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503183PMC
April 2019

Overtime trend of thyroid hormones and thyroid autoimmunity and ovarian reserve: a longitudinal population study with a 12-year follow up.

BMC Endocr Disord 2019 May 7;19(1):47. Epub 2019 May 7.

Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Ovarian reserve, vital for reproductive function, can be adversely affected by thyroid diseases. Despite alternations of thyroid hormones with ageing, data on interactions between the overtime trend of thyroid functions and ovarian reserve status has rarely been reported. We aimed to examine the overtime trend of thyroid hormones, thyroid peroxidase antibody (TPO Ab) and their associations with ovarian reserve status, identified by levels of age specific anti-mullerian hormone (AMH) in reproductive aged women, who participated in 12-year cohort of Tehran Thyroid Study (TTS).

Methods: Reproductive age women(n = 775) without any thyroid disease or ovarian dysfunction were selected from the Tehran Thyroid Study cohort. Participants were divided into four age specific AMH quartiles (Q1-Q4), Q1, the lowest and Q4, the highest. AMH was measured at the initiation of study and thyroid stimulating hormone (TSH), free T4 (FT4), and TPO Ab were measured at baseline and at three follow up visits.

Results: At baseline, there was no statistically significant difference in thyroid hormones between women of the four quartiles, although TPO Ab levels were higher in women of Q1. During the follow ups, FT4 was decreased in all quartiles (p < 0.05), whereas TPO Ab increased in Q1 (p = 0.02). Odds ratio of overall TPO Ab positivity in women of Q1 was 2.08 fold higher than those in Q4. (OR: 2.08, 95%CI: 1.16, 3.72; p = 0.01).

Conclusion: Women with the lowest ovarian reserves had higher levels of TPO Ab, with a positive trend of this antibody overtime in comparison to other quartiles, indicating that this group may be at a higher risk of hypothyroidism over time.
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http://dx.doi.org/10.1186/s12902-019-0370-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505305PMC
May 2019

Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: a case-control study.

Int J Gen Med 2017 13;10:423-429. Epub 2017 Nov 13.

Research Center for Health Sciences, Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Background: Community-acquired pneumonia (CAP) is a common disease with significant morbidity and mortality. There is evidence that vitamin D deficiency can be associated with infectious diseases. The aim of this study was to compare the levels of vitamin D between patients with CAP and healthy controls.

Methods: In a case-control study on 73 patients with CAP and 76 healthy controls, the serum concentration of 25-hydroxyvitamin D (25[OH]D) was measured. Severity and outcomes of disease and also duration of hospital stay were compared in patients with different levels of 25(OH)D. The severity of CAP was assessed using the CURB-65 score (confusion, uremia, respiratory rate, low blood pressure, age ≥65 years) and was also reflected by the length of hospital stay, admission to intensive care unit (ICU), and 30-day mortality.

Results: In total, 81.2% of the study population had vitamin D levels <30 ng/dL. The risk of pneumonia among subjects with deficient vitamin D levels was 3.69 (95% CI: 1.46, 9.31) times of those with sufficient vitamin D level (=0.006). Prevalence of severe deficiency of vitamin D in scores three and four of CURB-65 (59.38%), was far more than scores one and two (31.71%). Also, results indicated patients with severe deficiency had a higher risk for ICU admission, 30-day mortality, and longer hospitalization stay, but these were not statistically significant.

Conclusion: According to findings, a low level of 25(OH)D is associated with a higher incidence of CAP and more severe disease. It is recommended to pay more attention to vitamin D deficiency in infectious diseases, particularly in CAP patients.
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http://dx.doi.org/10.2147/IJGM.S149049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5692194PMC
November 2017

Short-term cohort study on sensorineural hearing changes in head and neck radiotherapy.

Med Oncol 2015 Jul 13;32(7):200. Epub 2015 Jun 13.

Department of Medical Physics, School of Medicine, Iran University of Medical Science, Tehran, Iran.

The aim of this study was to investigate the risk of sensorineural hearing loss (SNHL) and the relationship between SNHL and radiation dose to the cochlea and frequency range of hearing loss in patients with head and neck cancer. Pure tone audiometry at 250-12,000 Hz was performed on 29 patients diagnosed with head and neck tumours who were treated with 3-dimensional conformal radiation therapy and followed up for 6 months. Paired t test indicated that the mean air conduction threshold before and after radiotherapy was significantly different (paired t test, p < 0.001). SNHL was observed in 15 patients (51 %) according to CTCAE. SNHL increased to 77 % in patients who had received at least five concurrent cisplatin cycles. There was an increased risk of SNHL for ears receiving a mean dose of 5000 cGy compared to those receiving <5000 cGy. SNHL was more severe at higher frequencies of pure tone audiometry in patients with cisplatin-based chemoradiation. The ototoxicity effect of radiation and cisplatin must be considered in the treatment of head and neck tumours. Increasing the dose of cisplatin, radiation dose of cochlea and follow-up interval time may result in increasing severity and frequency of hearing loss incidences. However, characteristic of radiation-induced SNHL seems to be different from chemoradiation-induced SNHL.
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http://dx.doi.org/10.1007/s12032-015-0646-3DOI Listing
July 2015

Sexing based on measurements of the femoral head parameters on pelvic radiographs.

J Forensic Leg Med 2014 Mar 6;23:70-5. Epub 2014 Feb 6.

Forensic Medicine Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background And Aim: Previous studies have shown that the collo-diaphysial angle varies by race and sex in different populations. This study was performed to compare the femoral head parameters in the two sexes using pelvic radiography in Iranian adults during the August 2011 to August 2012 period.

Materials And Methods: This cross-sectional study was done on 100 male and 100 female. After taking hip radiography, collo-diaphysial angle, maximum femoral head diameters and minimum femoral neck width were measured on both sides. Dominant hand, height, weight and body mass index were also recorded. Data were analyzed using SPSS software. Sex differences were tested using independent t-test and ROC curve.

Results: The mean of the right and left maximum femoral head diameters and the minimum width of the femoral neck were significantly higher in men than in women (p < 0.001). The mean of the right collo-diaphysial angle of the femur was significantly higher in men than in women (p = 0.01), but there was no significant difference between the left collo-diaphysial angle in the two sex. The accuracy of sex prediction with the right and left maximum femoral head diameter was 78%. This figure is 77% for the right and left minimum femoral neck widths and 59% for the right collo-diaphysial angle.

Conclusion: If only the proximal part of the femur is available, the sex can be predicted with a relatively high accuracy by taking a radiograph. In our study, the evaluation of the collo-diaphysial angle was not very helpful in sexing.
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http://dx.doi.org/10.1016/j.jflm.2014.01.004DOI Listing
March 2014

Normal tissue complication probability modeling of radiation-induced hypothyroidism after head-and-neck radiation therapy.

Int J Radiat Oncol Biol Phys 2013 Feb 12;85(2):514-21. Epub 2012 May 12.

Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.

Purpose: To determine the dose-response relationship of the thyroid for radiation-induced hypothyroidism in head-and-neck radiation therapy, according to 6 normal tissue complication probability models, and to find the best-fit parameters of the models.

Methods And Materials: Sixty-five patients treated with primary or postoperative radiation therapy for various cancers in the head-and-neck region were prospectively evaluated. Patient serum samples (tri-iodothyronine, thyroxine, thyroid-stimulating hormone [TSH], free tri-iodothyronine, and free thyroxine) were measured before and at regular time intervals until 1 year after the completion of radiation therapy. Dose-volume histograms (DVHs) of the patients' thyroid gland were derived from their computed tomography (CT)-based treatment planning data. Hypothyroidism was defined as increased TSH (subclinical hypothyroidism) or increased TSH in combination with decreased free thyroxine and thyroxine (clinical hypothyroidism). Thyroid DVHs were converted to 2 Gy/fraction equivalent doses using the linear-quadratic formula with α/β = 3 Gy. The evaluated models included the following: Lyman with the DVH reduced to the equivalent uniform dose (EUD), known as LEUD; Logit-EUD; mean dose; relative seriality; individual critical volume; and population critical volume models. The parameters of the models were obtained by fitting the patients' data using a maximum likelihood analysis method. The goodness of fit of the models was determined by the 2-sample Kolmogorov-Smirnov test. Ranking of the models was made according to Akaike's information criterion.

Results: Twenty-nine patients (44.6%) experienced hypothyroidism. None of the models was rejected according to the evaluation of the goodness of fit. The mean dose model was ranked as the best model on the basis of its Akaike's information criterion value. The D(50) estimated from the models was approximately 44 Gy.

Conclusions: The implemented normal tissue complication probability models showed a parallel architecture for the thyroid. The mean dose model can be used as the best model to describe the dose-response relationship for hypothyroidism complication.
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http://dx.doi.org/10.1016/j.ijrobp.2012.03.034DOI Listing
February 2013

Thyroid autoimmunity role in the evolution of endemic goiter in rural area, Fars, Iran.

Arch Iran Med 2011 May;14(3):164-6

Endocrine and Metabolism Research Center, Shiraz University of Medical Science, Shiraz, Iran.

Background: WHO reports indicate no iodine insufficiency in Iran, however, goiter is still endemic in Fars Province. This study evaluates the role of thyroid autoimmunity in the evolution of endemic goiter.

Methods: A total of 516 permanent residents of Akbarabad County of the Kavar area in Fars Province, Iran were selected by simple random sampling. Patients with thyroid malignancy and dysfunction, and those who consumed drugs affecting thyroid function were excluded. After signing a written consent form and undergoing a thyroid examination, 5 cc of blood were drawn to measure free T3 and T4 (RIA), TSH (IRMA), and anti-thyroid peroxidase (competitive RIA) levels. Moreover, samples of 50 cc morning urine were collected for the measurement of urinary iodine excretion (UIE; chloridric acid digestion). Data were analyzed by SPSS (version 13). P<0.05 was significant.

Results: The prevalence of goiter was 38.4% by WHO classification. The prevalence of children with UIE 2-4.9 µg/dL was 5.8%, which indicated sufficient iodine intake. Goiter was more prevalent in females, as well as in patients with positive anti-TPO or higher TSH titers (P<0.01). The prevalence of positive anti-TPO was higher in goiterous patients than healthy persons (P=0.002), which increased with an increase in age, grade of thyromegaly or TSH (P<0.02). Regression analysis showed the odds ratio for diagnosing goiter in females was 2.4 (P<0.001), in those with positive anti-TPO it was 1.87 (P=0.03) and in those with TSH>5.2 mIU/mL the odds ratio was 2.74 (P=0.01). In adolescents compared to children the odds ratio was 0.36 (P=0.01) and the odds ratio in adults to children was 0.33 (P=0.001).

Conclusion: This study indicates that despite normal UIE, goiter is endemic in Akbarabad County. Some degree of goiter endemicity may be due to thyroid autoimmunity.
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http://dx.doi.org/011143/AIM.003DOI Listing
May 2011