Publications by authors named "Masoud Aliyali"

22 Publications

  • Page 1 of 1

Cytokine profiling in Iranian patients with COVID-19; association with clinical severity.

Iran J Immunol 2021 03;18(1):54-64

Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Background: SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is recognized for the first time in Wuhan, China. The cytokine storm is a known factor causing major clinical symptoms leading to death in COVID-19 patients.

Objective: To investigate and compare the serum levels of different cytokines in COVID-19 patients with different clinical severity.

Methods: Concentrations of serum cytokines, including IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, IFN-γ, and GM-CSF, were measured in 61 COVID-19 patients and 31 normal controls with ELISA. We investigated the correlation between the levels of these cytokines and clinical severity, CRP level, neutrophil and lymphocyte count in patients with COVID-19.

Results: Our data indicated that the levels of IL-1β, IL-2, IL-4, IL-6, IL-8, TNF-α, IFN-γ, and GM-CSF, but not IL-10 were significantly increased in COVID-19 patients compared to normal controls. Statistical analysis showed that the level of IL-1β, IL-2, IL-4, IL-6, IL-8, TNF-α, IFN-γ, and GM-CSF were higher in severe COVID-19 than those of mild cases. The concentrations of all mentioned cytokines were negatively associated with the absolute count of lymphocytes, and positively correlated with the CRP level and the absolute count of neutrophils.

Conclusion: The current study suggests that high levels of various cytokines correlate with the disease severity and immunopathogenesis of COVID-19.
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http://dx.doi.org/10.22034/iji.2021.87630.1810DOI Listing
March 2021

Apoptosis and immunophenotyping of peripheral blood lymphocytes in Iranian COVID-19 patients: Clinical and laboratory characteristics.

J Med Virol 2021 03 28;93(3):1589-1598. Epub 2020 Sep 28.

Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

A novel member of human coronavirus, named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been recently recognized in China and rapidly spread worldwide. Studies showed the decreasing of peripheral blood lymphocytes in a majority of patients. In this study, we have reported the clinical features, laboratory characteristics, the frequency of peripheral blood lymphocyte subpopulations, and their apoptosis pattern in Iranian coronavirus infectious disease (COVID-19) patients. Demographic and clinical data of 61 hospitalized confirmed cases with COVID-19 at Imam Khomeini Hospital were collected and analyzed. Peripheral blood mononuclear cells were isolated from all samples and the apoptosis pattern was evaluated using Annexin V/propidium iodide method. The frequency of lymphocyte subsets, including T-CD4 , T-CD8 , NK, B cells, and monocytes, was measured in all patients and 31 controls by flow cytometry. Our findings demonstrated that the percentage of lymphocytes, CD4 , and CD8 T cells were decreased in COVID-19 patients compared with the control group. Regarding the clinical severity, the number of lymphocytes, CD4 , CD8 T cells, and NK cells were also decreased in severe cases when compared with mild cases. Finally, our data have also indicated the increase in apoptosis of mononuclear cells from COVID-19 patients which was more remarkable in severe clinical cases. The frequency of immune cells is a useful indicator for prediction of severity and prognosis of COVID-19 patients. These results could help to explain the immunopathogenesis of SARS-CoV-2 and introducing novel biomarkers, therapeutic strategies, and vaccine candidates.
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http://dx.doi.org/10.1002/jmv.26505DOI Listing
March 2021

A Bibliometric Analysis of Global Research on Lophomonas sp. in Scopus (1933-2019).

Infect Disord Drug Targets 2020 Jul 27. Epub 2020 Jul 27.

Toxoplasmosis Research Center, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, PO Box 48471-91971, Sari. Iran.

Background: This study was designed to analyze the global research on Lophomonas spp. using bibliometric techniques.

Methods: A bibliometric research was carried out using the Scopus database. The analysis unit was the research articles conducted on Lophomonas spp.

Results: Totally, 56 articles about Lophomonas spp. were indexed in the Scopus throughout 1933-2019 ( 87 years ) with the following information: (A) The first article was published in 1933; (B) 21 different countries contributed in studies related to Lophomonas spp.; (C) China ranked first with 16 publications about Lophomonas spp.; and (D) "Brugerolle, G" and "Beams, H.W." from France and the US participated in 4 articles respectively, as the highest number of publications in the Lophomonas spp. network.

Discussion: After 87 years, Lophomonas still remains unknown for many researchers and physicians around the world. Further studies with high quality and international collaboration are urgently needed to determine different epidemiological aspects and the real burden of the mysterious parasite worldwide.
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http://dx.doi.org/10.2174/1871526520666200727153142DOI Listing
July 2020

Relationship between spirometry results and colonisation of Aspergillus species in allergic asthma.

Clin Respir J 2020 Mar 26. Epub 2020 Mar 26.

Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Introduction And Objectives: Exposure to fungi in patients with asthma leads to the release of various fungal antigens, which can increase the severity of asthma. Regarding this, the present study was conducted to evaluate the relationship between the colonisation of Aspergillus species and spirometry results in allergic asthma.

Materials And Methods: Two hundred sixteen patients with mild to severe asthma and 30 healthy controls were included. All participants underwent pulmonary function tests. Furthermore, sputum samples were collected from each subject. Each sputum sample was subjected to direct microscopic examination and fungal culture. All cultured Aspergillus colonies were identified at species level by molecular methods. Finally, all available data from sputum culture and spirometry test were analysed.

Results: Out of 216 sputum samples, 145 (67.1%) were positive for fungal growth. Furthermore, out of 264 grown fungal colonies, 137 (51.9%) were Aspergillus species. Among the Aspergillus isolates, A. flavus (29.2%) was the most prevalent species, followed by A. fumigatus (27.7%). The mean forced expiratory volume in one second (FEV1) in the mild, moderate and severe asthmatic patients with a positive sputum culture for fungi were obtained as 90.0 ± 11.1, 71.1 ± 15.9 and 54.9 ± 16.4, respectively. In general, Aspergillus species colonisation had no statistically significant effect on spirometry results of study patients.

Conclusion: Our results showed that there is no difference in the FEV1 and forced vital capacity between Aspergillus positive and negative patients in any asthma severity group.
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http://dx.doi.org/10.1111/crj.13192DOI Listing
March 2020

Clinical effectiveness of high dose versus standard dose of meropenem in ventilator-associated pneumonia caused by multidrug-resistant bacteria: a randomized single-blind clinical trial.

Infect Disord Drug Targets 2020 Feb 26. Epub 2020 Feb 26.

Department of Clinical Pharmacy, Faculty of Pharmacy, Pharmaceutical Research Center, Mazandaran University of Medical Sciences, Sari. Iran.

Background: Meropenem standard doses are based on the minimum inhibitory concentration of sensitive pathogens and the pharmacokinetic parameter of not critically ill patients. We compared the efficacy of high versus standard dose of meropenem in ventilator-associated pneumonia (VAP).

Methods: 24 out of 34 eligible patients were randomized to receive meropenem 3 g q8h (high dose group, 11 patients) or 2 g q8h (standard dose group, 13 patients) as a 3h infusion. Primary outcome was considered as clinical success that was defined as stable hemodynamic, improved sequential organ failure assessment (SOFA) score, stable or improved PaO2/FiO2 after 7 days. A sputum culture was taken before intervention.

Results: Clinical success rate was not significantly different between the high and standard dose group (54.5% vs. 38.5%, P= 0.431). There was a significant difference in reduction of clinical pulmonary infection score (CPIS) compared to high dose with standard group (P=0.038). SOFA score declined significantly in high dose group through the study (P=0.006). A shorter duration of VAP treatment was recorded in high dose group (P=0.061). We did not observe any significant adverse event related to meropenem. Acinetobacter spp. (34.8%), Klebsiella spp. (32.6%) and, Pseudomonas aeruginosa (19.5%) isolated more frequently from sputum cultures.

Conclusion: Treatment with high dose of meropenem seems to be safe. However, it did not provide significantly higher clinical success rate in comparison with the standard dose, but could be considered as an appropriate empirical treatment in patients with severe infection due to reducing in SOFA and CPIS.
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http://dx.doi.org/10.2174/1871526520666200227102013DOI Listing
February 2020

A multi-centered study of colonization in patients with respiratory disorders: Is there a colonization trend in the elderly?

Curr Med Mycol 2019 Sep;5(3):19-25

Department of Molecular Pathology, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background And Purpose: colonization plays a key role in the progression of pulmonary infection. However, there are limited data regarding the colonization of these fungi in the patients residing in different regions of Iran. Regarding this, the present study was conducted to evaluate the prevalence of colonization in non-HIV-infected patients with respiratory failure introduced by physicians using nested polymerase chain reaction (PCR).

Materials And Methods: This study was conducted on 136 samples obtained from 136 patients with respiratory disorders referring to different hospitals in the capital and north of Iran during 2013-2015. The samples were collected using bronchoalveolar lavage (BAL; n=121) and sputum induction (n=15). Nested PCR method targeting mtLSU rRNA gene was used for the detection of DNA in the specimens.

Results: The nested PCR analysis resulted in the detection of DNA in 32 (23.5%) patients. The mean age of the participants was 49.04±11.94 years (age range: 14-90 years). The results revealed no correlation between colonization and gender. The studied patients were divided into two groups of immunocompromised and immunocompetent patients. In the regard, 25.4% of the patients with detectable DNA were immunocompromised and had cancer, organ transplantation, asthma, sarcoidosis, dermatomyositis, chronic obstructive pulmonary disease, bronchiectasis, and pulmonary vasculitis. On the other hand, DNA was detected in 21.8% of the immunocompetent patients. Frequencies of DNA detection in the patients with tuberculosis, hydatid cyst, and unknown underlying diseases were obtained as 20.8%, 25%, and 22%, respectively. The prevalence of colonization varied based on age. In this regard, colonization was more prevalent in patients aged above 70 years.

Conclusion: As the findings indicated, non-HIV-infected patients, especially the elderly, had a high prevalence of colonization. Therefore, these patients are probably a potential source of infection for others. Regarding this, it is of paramount importance to adopt monitoring and prophylactic measures to reduce this infection.
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http://dx.doi.org/10.18502/cmm.5.3.1742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910707PMC
September 2019

The Ability of Polyuria in Prediction of Weaning Outcome in Critically Ill Mechanically Ventilated Patients.

Tanaffos 2019 Jan;18(1):74-78

Internal Medicine Department, Mazandaran University of Medical Sciences, Sari, Iran.

Background: Fluid balance and oliguria influence outcome in critically ill patients. Although, osmotic dieresis with hypernatraemia is a predictor of mortality in critically ill patients, the purpose of this study was to demonstrate the effect of polyuria as an independent predictor on weaning outcome in mechanically ventilated patients.

Materials And Methods: This retrospective, single center, cohort study was carried out at Imam Teaching Hospital Intensive Care Unit (ICU) on 263 adult mechanically ventilated patients. We collected data of these patients during the mean seven consecutive days before weaning from mechanical ventilator. Patients with polyuria (sustained urine output greater than 3000 ml/day) were compared with patients without polyuria. The primary endpoint was successful weaning and the secondary endpoints were the mechanical ventilation duration, post weaning length of ICU stay, post weaning length of hospitalization and rate of mortality.

Results: In 93 patients with polyuria, the mean age was 45.14±19.47 years in comparison of 170 patients without polyuria with mean age of 52.9±21.37 years (P=0.004). Fluid intake, urine output and temperature were significantly higher in patients with polyuria, but there were no statistical differences in systolic and diastolic blood pressure, serum electrolytes, urea and creatinine. No significant differences were found in primary and secondary endpoints including successful weaning, post weaning length of ICU stay, post weaning hospital duration and mortality, except for duration of mechanical ventilation (P=0.014). The area under the ROC curve for variables showed only seven days mean creatinine level before weaning which may act as a predictor of successful weaning (ROCAUC=0.67, 95% CI 0.61-0.73, P=0.0002). Serum creatinine level of 0.8 provided best overall combination of sensitivity and specificity for successful weaning (sensitivity 72.22%, 95% CI 54.8-85.8; specificity 61.19%, 95% CI 54.1-68.0).

Conclusion: Polyuria cannot predict weaning outcome but maybe considered as a predictor of longer duration of mechanical ventilation and is probably associated with a subclinical renal dysfunction.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690324PMC
January 2019

First Molecular Diagnosis of Lophomoniasis: the End of a Controversial Story.

Acta Parasitol 2019 Jun 5;64(2):390-393. Epub 2019 Jun 5.

Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran.

Introduction: We report a case of lophomoniasis in an immunocompetent patient with acute paranasal sinusitis from the north of Iran whose disease was diagnosed by both microscopic and molecular methods.

Case Presentation: The patient, a 40-year-old woman, suffered from upper respiratory infection, was referred to the Iranian National Registry Center for Lophomoniasis (INRCL) at the Mazandaran University of Medical Sciences, Sari, Iran, for diagnosis. A direct wet mount of nasal discharge revealed the flagellate protozoa morphologically identified Lophomonas blattarum. Moreover, through a specific polymerase chain reaction (PCR) of nasal discharge, a 214-bp band was observed, confirming the genus Lophomonas spp. The patient was treated successfully with metronidazole 500 mg t.i.d for 1 week.

Conclusion: To the best of our knowledge, this is the first molecular detection of lophomoniasis in the literature. According to our preliminary study, a reliable PCR test is available now for detecting the Lophomonas parasite.
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http://dx.doi.org/10.2478/s11686-019-00084-2DOI Listing
June 2019

Comparison of the Diagnostic and Therapeutic Efficacies of Portable Recruited Chest Radiography with Conventional Portable Radiography in Mechanically Ventilated Patients.

Tanaffos 2019 Apr;18(4):351-354

Department of Radiology, Mazandaran University of Medical Sciences, Sari, Iran.

Background: In mechanically ventilated patients, portable chest radiography (CXR) can provide important information for selecting the optimal therapeutic approach. This study aimed to determine the diagnostic and therapeutic efficacies of portable recruited chest radiography with maximum inspiratory volume and pause in comparison with conventional portable radiography.

Materials And Methods: This diagnostic accuracy study was conducted on 75 mechanically ventilated patients admitted to the intensive care unit (ICU) of Imam Khomeini Hospital in Sari, Iran, during 2013-2015. For every patient, in addition to conventional portable CXR, another CXR was performed with mechanical ventilator adjustments (tidal volume up to 10-12 ml/kg to maintain the inspiratory plateau pressure below 35 cmHO and inspiratory time of 2-3 seconds). CXR was performed after 5-10 respiratory cycles, synchronized with the inspiratory pause. The radiographs were acquired using a Shimadzu portable radiography system in the anteroposterior supine position and randomly presented to two radiologists for reporting.

Results: The mean age of the patients was 63.5±14 years. Overall, 43 (57.3%) patients were male, and 32 (42.7%) were female. Therapeutic interventions were performed for only 8% of cases with conventional CXR versus 21.3% of cases with recruited CXR; the difference was found to be statistically significant (P<0.05). The diagnostic efficacy of portable recruited CXR versus conventional portable CXR was 45% versus 18.6%. Also, the therapeutic efficacy of portable recruited CXR versus conventional portable CXR was 21.3% versus 8%.

Conclusion: Portable recruited CXR seems to be a valuable diagnostic approach for clinical decision-making, with higher diagnostic and therapeutic efficacies in mechanically ventilated patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309883PMC
April 2019

Prevalence of specific immunoglobulin E and G against in patients with asthma.

Curr Med Mycol 2018 Dec;4(4):7-11

Invasive Fungi Research Centre, Mazandaran University of Medical Sciences, Sari, Iran.

Background And Purpose: as a ubiquitous fungus can be found in the respiratory tract of the asthmatic and healthy people. The inhalation of spores leads to an immune response in individuals with asthma and results in the aggravation of the clinical symptoms. The present study aimed to investigate the prevalence of specific immunoglobulin E and G IgE and IgG) against in asthmatic patients.

Materials And Methods: This study was conducted on 200 consecutive patients with moderate to severe asthma referring to Masih Daneshvari hospital Tehran, Iran, from January 2016 to February 2018. Skin prick test (SPT) was performed in all subjects with allergens. Moreover, all patients underwent specific IgE testing for using Hycor method. Enzyme immune assay was applied to measure total IgE and specific IgG.

Results: According to the results, the mean age of the patients was 45.8 years (age range: 18-78 years). The mean levels of total IgE and specific IgE in asthmatic patients were obtained as 316.3 (range: 6-1300 IU/ml) and 1.5 (range: 0.1-61.3 IU/ml), respectively. Out of 200 patients, 27 (13.5%), 65 (32.5%), 22 (11.0%), and 86 (43.0%) cases had positive SPT, total IgE of > 417 IU/ml, specific IgE, and IgG, respectively. The level of these variables in patients with severe asthma were 16 (16.5%), 36 (37.1%), 15 (15.5%), and 46 (47.4%), respectively.

Conclusion: As the findings indicated, reactivity to is a remarkable phenomenon in asthmatic patients. It is also emphasised that the climatic condition may affect the positive rate of hypersensitivity to .
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http://dx.doi.org/10.18502/cmm.4.4.380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386509PMC
December 2018

Invasive forms of Candida and Aspergillus in sputum samples of pulmonary tuberculosis patients attending the tuberculosis reference laboratory in Ghaemshahr, Northern Iran: An analysis of samples collected during the past 10years.

Int J Mycobacteriol 2016 Dec 20;5 Suppl 1:S179-S180. Epub 2016 Sep 20.

Central Laboratory of Health Center, Ghaemshahr City, Iran.

Objective/background: Tuberculosis (TB) continues to be a major public health problem worldwide. This is especially true in Northern Iran, which has high TB prevalence. The chronic nature of this disease is further exacerbated if it is accompanied by fungal infection, which usually remains undiagnosed and thus untreated. Thus, mycotic infections add fatal dimensions to pulmonary TB. Our objective was to determine the prevalence of invasive forms of fungal elements in sputum samples collected from patients with pulmonary TB at a reference laboratory in Ghaemshahr, Northern Iran, during the past 10years.

Methods: In this retrospective study, sputum samples collected from 430 patients were examined. Pulmonary TB in patients was confirmed in our laboratory, and samples obtained during the period from March 2006 to February 2016 were analyzed. The sputum samples were subjected to biological (bacterial) staining (Ziehl-Neelsen and fluorochrome) and mycological investigation using KOH Calcofluor White (Sigma-Aldrich, India) by fluorescent microscopy and fungal culture on Sabouraud dextrose agar (Sigma-Aldrich, India) and CHROMagar (Paris, France).

Results: Invasive forms of fungal pathogens were observed as co-infection with Mycobacterium tuberculosis in 28/430 cases (6.51%). The frequency of Aspergillus, both branching and dichotomous infection, accounted for 3.72% (16/430): Aspergillus flavus, 1.63%; Aspergillus fumigatus, 1.16%; Aspergillus niger, 0.69%; and Aspergillus oryzae, 0.23%, respectively. Blastoconidia and pseudohyphae forms of yeast were observed as co-infection with M. tuberculosis in 2.79% (12/430) of the cases: Candida albicans, 1.86%; Candida krusei, 0.46%; and other Candida species, 0.46%, respectively.

Conclusion: Northern Iran is a critical region in the TB world and multidrug-resistant TB is a serious problem in this region. Although it is believed that there exists a commensal relationship between fungus and TB infections, the invasive forms of fungal pathogens and their co-infection can be caused by increasing disability and failure of treatment. Diagnosis of secondary or co-existing fungal infections in TB is most important for reducing the mortality and morbidity of these patients.
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http://dx.doi.org/10.1016/j.ijmyco.2016.08.010DOI Listing
December 2016

High prevalence of clinical and environmental triazole-resistant Aspergillus fumigatus in Iran: is it a challenging issue?

J Med Microbiol 2016 Jun 23;65(6):468-475. Epub 2016 Mar 23.

Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

Triazole antifungal agents are the mainstay of aspergillosis treatment. As highlighted in numerous studies, the global increase in the prevalence of triazole resistance could hamper the management of aspergillosis. In the present three-year study, 513 samples (213 clinical and 300 environmental samples) from 10 provinces of Iran were processed and screened in terms of azole resistance (4 and 1 mg l-1 of itraconazole and voriconazole, respectively), using selective plates. Overall, 150 A. fumigatus isolates (71 clinical and 79 environmental isolates) were detected. The isolates were confirmed by partial sequencing of the β-tubulin gene. Afterwards, in vitro antifungal susceptibility tests against triazole agents were performed, based on the Clinical and Laboratory Standards Institute (CLSI) M38-A2 document. The CYP51A gene was sequenced in order to detect mutations. The MIC of itraconazole against 10 (6.6 %) strains, including clinical (n=3, 4.2 %) and environmental (n=7, 8.8 %) strains, was higher than the breakpoint and epidemiological cut-off value. Based on the findings, the prevalence of azole-resistant A. fumigatus in Iran has increased remarkablyfrom 3.3 % to 6.6 % in comparison with earlier epidemiological research. Among resistant isolates, TR34/L98H mutations in the CYP51A gene were the most prevalent (n=8, 80 %), whereas other point mutations (F46Y, G54W, Y121F, G138C, M172V, F219C, M220I, D255E, T289F, G432C and G448S mutations) were not detected. Although the number of patients affected by azole-resistant A. fumigatus isolates was limited, strict supervision of clinical azole-resistant A. fumigatus isolates and persistent environmental screening of azole resistance are vital to the development of approaches for the management of azole resistance in human pathogenic fungi.
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http://dx.doi.org/10.1099/jmm.0.000255DOI Listing
June 2016

Impact of Comorbid Ischemic Heart Disease on Short-Term Outcomes of Patients Hospitalized for Acute Exacerbations of COPD.

Tanaffos 2015 ;14(3):165-71

Departments of Biostatistics, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

Background: Ischemic heart disease (IHD) is a leading cause of mortality and morbidity in patients with COPD. The contribution of IHD to acute outcomes in patients with acute exacerbation of COPD (AECOPD) is not known in detail. The present study assessed the effect of comorbid IHD on length of stay (LOS), risk of intensive care unit (ICU) admission and death as indicators of the short-term outcomes for patients hospitalized for AECOPD.

Materials And Methods: Medical records of patients hospitalized for AECOPD from September 2008 to March 2014 were reviewed. Data extracted from patient records regarding the presence of comorbidities and the markers of disease severity were analyzed using logistic regression for ICU admission and mortality, the Kaplan-Meier method, log rank test and Cox regression for LOS.

Results: Of 507 separate admissions, 146 episodes (28.8%) occurred in patients with IHD. The median LOS was 7 days [interquartile range (IQR) 6, 11] in patients with IHD versus 6 days (IQR 5, 8) for patients without IHD. After adjustment for confounders, LOS was found to be 26% longer (p=0.033) for patients with IHD. The adjusted odds ratio for the risk of ICU admission and death in patients with IHD was 2.97 and 3.86, respectively.

Conclusion: Patients hospitalized for AECOPD with comorbid IHD had longer LOS, greater risk for ICU admission and death. It seems that this group is a particular COPD subtype with a more severe degree of COPD and poorer acute outcomes that may influence optimal management.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745184PMC
February 2016

Role of C-reactive Protein and Tumor Necrosis Factor-Alpha in Differentiating between Ventilator-Associated Pneumonia and Systemic Inflammatory Response Syndrome without Infectious Etiology.

Tanaffos 2016 ;15(4):205-212

Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.

Background: Differential diagnosis of systemic inflammatory response syndrome (SIRS) with or without infectious cause is critically important in terms of initiating antimicrobial agents in case of infectious etiology such as ventilator-associated pneumonia (VAP). The aim of this study was to determine the diagnostic and prognostic roles of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) in differentiating between ventilator-associated pneumonia and SIRS without infectious etiology.

Materials And Methods: In this prospective observational study, 91 adult intensive care unit (ICU) patients were enrolled. According to established diagnostic criteria, they were classified into three groups of "non-SIRS non-VAP", "SIRS non-VAP" and "SIRS-VAP". Serum CRP and TNF-α were measured on days 1, 3 and 7 of the study and compared using repeated measures ANOVA.

Results: With respect to diagnosis, there was no significant difference in the values of these biomarkers between groups (P>0.05). There was no statistically significant "time trend" for C-reactive protein and TNF-α (P>0.05). Considering both group effect and Time effect, the changes were not significantly different for CRP (P= 0.86) and TNF-α (P=0.69). In contrast, the clinical score and the clinical pulmonary infection score (CPIS) ≥ 6, had 100% specificity for diagnosing VAP. With respect to prognosis, only an unchanged or decreasing TNF-α from day 1 to day 3 was marginally associated with 28-day survival. However, day 1 and day 3 acute physiology and chronic health evaluation II (APACHE II) scores were highly associated with 28-day survival.

Conclusion: Unlike clinical scoring system including CPIS and APACHE II, TNF-α and CRP levels were not useful as diagnostic or prognostic biomarkers for differentiating between SIRS with VAP etiology and SIRS without infectious etiology.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410116PMC
January 2016

Coinfection of Pulmonary Hydatid Cyst and Aspergilloma: Case Report and Systematic Review.

Mycopathologia 2016 Apr 14;181(3-4):255-65. Epub 2015 Dec 14.

Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.

Aspergilloma infection consists of a mass of fungal hyphae, inflammatory cells, fibrin, mucus, and tissue debris and can colonize lung cavities due to underlying diseases such as tuberculosis, sarcoidosis, bronchiectasis, cavitary lung cancer, neoplasms, ankylosing spondylitis, bronchial cysts, and pulmonary infarction. Here we report coinfection of pulmonary hydatid cyst and aspergilloma in a 34-year-old female who had had history of minor thalassemia and suffered from chest pain, dyspnea, non-productive cough for at least five months, and hemoptysis for 20 days. Radiographic sign showed a large cavitary lesion (5 × 6 × 6 cm) involving left lower lobe (LLL). Dichotomous septate hyphae were observed in bronchoalveolar lavage and biopsy specimens from LLL. The patient subsequently improved after combined anti-helminth therapies with albendazole (400 mg/bd) and lobectomy. According to morphological and molecular characterization, Aspergillus niger was confirmed. In vitro antifungal susceptibility tests revealed that the MIC values for the antifungals used in this case in increasing order were posaconazole (0.125 µg/ml), itraconazole and voriconazole (0.5 µg/ml), and amphotericin B (1 µg/ml). The minimum effective concentration for caspofungin was 0.125 µg/ml. Subsequently, we systematically reviewed 22 confirmed cases of pulmonary hydatid cyst and aspergilloma during a period of 19 years (1995-2014) and discussed the epidemiology, clinical features, and treatment of this disease.
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http://dx.doi.org/10.1007/s11046-015-9974-2DOI Listing
April 2016

Approach to Patients with Severe Asthma: a Consensus Statement from the Respiratory Care Experts' Input Forum (RC-EIF), Iran.

Tanaffos 2015 ;14(2):73-94

Division of Pulmonology, Department of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Challenges in the assessment, diagnosis and management of severe, difficult-to-control asthma are increasingly regarded as clinical needs yet unmet. The assessments required to determine asthma severity, comorbidities and confounding factors, disease phenotypes and optimal treatment are among the controversial issues in the field. The respiratory care experts' input forum (RC-EIF), comprised of an Iranian panel of experts, reviewed the definition, appraised the available guidelines and provided a consensus for evaluation and treatment of severe asthma in adults. A systematic literature review followed by discussions during and after the forum, yielded the present consensus. The expert panel used the appraisal of guidelines for research and evaluation-II (AGREE-II) protocol to define an initial locally-adapted strategy for the management of severe asthma. Severe asthma is considered a heterogeneous condition with various phenotypes. Issues such as assessment of difficult-to-control asthma, phenotyping, the use of blood and sputum eosinophil count, exhaled nitric oxide to guide therapy, the position of anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty as well as the use of established, recently-developed and evolving treatment approaches were discussed and unanimously agreed upon in the panel. A systematic approach is required to ensure proper diagnosis, evaluate compliance, and to identify comorbidities and triggering factors in severe asthma. Phenotyping helps select optimized treatment. The treatment approach laid down by the Global Initiative for Asthma (GINA) needs to be followed, while the benefit of using biological therapies should be weighed against the cost and safety concerns.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629434PMC
November 2015

Co-infection of invasive pulmonary aspergillosis and cutaneous Fusarium infection in a patient with pyoderma gangrenosum.

J Res Med Sci 2015 Feb;20(2):199-203

Department of Medical Mycology and Parasitology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran ; Invasive Fungi Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

We report an unusual case of co-infection of invasive pulmonary aspergillosis (IPA) and fusarial skin infection in a patient with classic pyoderma gangrenosum with unknown causes, which were previously controlled with oral prednisolone, cyclosporine. The diagnosis was made on direct microscopy and culture of endobronchial washing, bronchoalveolar lavage and skin lesion biopsy. The treatment failed, and the patient expired 12 days following hospitalization. This report highlights the rarity of coexistence of IPA and a chronic fusarial skin infection and thereby reinforcing the physician's attention toward the possibility of invasive fungal infection in the immunosuppressed patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400718PMC
February 2015

A 50-year-old man with progressive dyspnea.

Tanaffos 2012 ;11(1):61-2

Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Iran.

Dental foreign body aspiration is a known complication in patients with maxillofacial trauma. Although diagnosis may be delayed, especially in elderly people with radiolucent dental appliances, clinician must be aware of dental tracheobronchial aspiration to minimize potentially serious consequences. We present a 50-year-old man with three months history of progressive dyspnea due to foreign body aspiration occluding distal trachea. The patient had a history of car accident with facial trauma and denture fracture two years before presentation. Fiberoptic bronchoscopy revealed almost totally obstructing mass-like lesion with nodular infiltration in distal trachea. The patient underwent rigid bronchoscopy and a piece of denture with three teeth was extracted.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153181PMC
September 2014

A 38-year-old woman with scimitar syndrome.

Tanaffos 2011 ;10(3):63-6

Department of Radiology, Mazandaran University of Medical Sciences, Sari, Iran.

Scimitar syndrome is a rare clinical syndrome which consists of anomalous right pulmonary venous return to the inferior vena cava. Scimitar syndrome classically involves the right lung and is most commonly reported in very early infancy. However, it is occasionally seen in adults. We present a 38 year-old woman complaining of dry cough and exertional dyspnea during moderate exercise with right lung scimitar syndrome. The chest radiography showed increased radiolucency of the left lung and heart dextroposition with a characteristic appearance of scimitar sign which is a curvilinear density in the right middle and lower pulmonary fields resembling a curved Turkish sword.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153151PMC
September 2014

Effect of fluid balance on alveolar-arterial oxygen gradient in mechanically ventilated patients.

Tanaffos 2011 ;10(2):20-4

Internal Medicine Department, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari-Iran.

Background: Fluid balance affects outcome in critically ill patients. We studied the effect of fluid balance on oxygen exchange by assessing alveolar-arterial oxygen gradient (PA-a O2) in mechanically ventilated patients. Our primary objective was to evaluate the difference in PA-aO2 and the secondary goal was to evaluate the differences in age and mortality rate.

Materials And Methods: This retrospective observational study was performed on patients who were admitted to medical and surgical ICUs of Sari Imam Hospital, Mazandaran University of Medical Sciences, from 2003 to 2009. Daily fluid balance was calculated by input minus output. Thirty patients with continuous positive fluid balance (PFB) and 30 subjects with continuous negative fluid balance (NFB) during 4 consecutive days were enrolled in this study. PA-a O2 was calculated in these two groups.

Results: The mean (±SD) age was 48.9±21.2 yrs. in PFB group (19 males and 11 females) and 37.1±15.7 yrs. in NFB group (25 males and 5 females) which showed a statistically significant difference in age between the two groups (p = 0.017). The 24h, 48h, and 96h fluid balances were 1226(cc)±881, 1311(cc)±751, and 957(cc)±661 in PFB group and -1122(cc)±692, -920(cc)±394, and -1164(cc)±695 in NFB group, respectively. The mean differences (±SD) of PA-a O2 in 24h, 48h, and 96h versus the same value in the admission day were 11.3±39.2, 1.69±51.1, and -1.50±64 in PFB subjects and -21.8±60.8, -27.8±84.9, and -19.3±68.7 in NFB patients. The difference was statistically significant only in the first day of admission (p = 0.015). However, no difference was detected in overall mean oxygen gradient during 96h among the two groups. Mortality rate was significantly higher in PFB patients (P < 0.0001).

Conclusion: Positive fluid balance had no significant effect on PA-a O2 but can be used as a predictor of mortality.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153143PMC
September 2014

Predictive value of ''jones morbidity index'' in northern Iranian asthmatic patients.

Iran J Allergy Asthma Immunol 2010 Jun;9(2):111-6

Department of Pharmacology and Physiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.

Asthma is the major chronic respiratory inflammatory disease in all ages. The validity and predictability of revised Jones Morbidity Index (JMI) as a simple and practical tool for asthma evaluation morbidity has not yet been tested in Iran. This study aimed to evaluate the predictability and validity of a revised JMI in northern Iran. As a one-year follow up study, 210 adult asthmatic patients were visited in an asthma clinic in the town of Babol (north of Iran) at two stages. At first stage, in addition to demographic information, 3 simple questions of revised JMI were asked and Pulmonary Expiratory Flow Rate (PEFR) for each patient was measured. Based on modified JMI, patients were categorized in three groups: Low, Medium, and High morbidity. At the second stage, after one year, patients were visited again and in addition to their last year medical records, the same questionnaires were filled. The validity of the index checked by PEFR values at two stages and its predictability was evaluated by morbidity factors during the last year. From hundred and seventy (170) patients who were able to fulfil the second stage of the study, 55 patients (32%) had been categorized as low, 88 patients (52%) as medium, and 27 patients (16%) as high morbidity. The percentages of patients PEFR to the estimated normal values in these three categories (90.8%, 74.7%, and 55.3% respectively) were significantly different which shows a good correlation between PEFR values and asthma morbidity (p<0.001). The relative risks of high morbidity group for hospitalization from asthma and needing oral steroids during the one year period were 4.1 (CI = 1.27 to 13.1), 1.96 (CI = 0.97 to 3.96) respectively which are significantly higher than the other two categories (P<0.05). Since the modified JMI showed an acceptable validity and predictability in northern patients of northern Iran, we recommend its use as a simple pragmatic tool for evaluating asthma morbidity in primary care in this region of Iran.
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http://dx.doi.org/09.02/ijaai.111116DOI Listing
June 2010

Effects of N-acetylcysteine on asthma exacerbation.

Iran J Allergy Asthma Immunol 2010 Jun;9(2):103-9

Department of Pulmonary, Imam Hospital, Mazandaran University of Medical Sciences, Sari, Iran.

Airway mucus hypersecretion and increased oxidative stress are clinical and pathophysiological features of asthma exacerbation. We studied effects of N-acetylcysteine (NAC) as a mucolytic and antioxidant agent in asthma exacerbation. In this randomized, single-blinded, placebo-controlled study 50 patients ( 17 male, 33 female, mean age 48.94+/-13.68) with asthma exacerbation were randomized to receive either oral 600 mg b.d. N-acetylcysteine or placebo in addition to standard treatment during 5 days hospitalization. Daily measurements of wheezing, dyspnea, cough, sputum, expectoration, night sleep scores and morning PEFR were performed. There was no significant difference in wheezing score between patients assigned NAC and those assigned placebo in day 5(0.84[SD 0.94] VS 0.87[SD 0.79]) and also in cough score (0.72[SD 0.84] VS 0.79[SD 0.97]), dyspnea score (0.84[SD 1.06] VS 0.91[SD 1.01]), sputum score(0.79[SD 0.83] VS 0.62[SD 0.71]), expectoration score(0.79[SD 0.97] VS 0.83[SD 1.09]), night sleep score(1[SD 1.17] VS 0.67[SD 0.98] and morning PEFR (256[SD 96.36] VS 282[SD 98.86]). We concluded that addition of N-acetylcysteine to usual asthma medication has no significant effect in treatment of asthma exacerbation.
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http://dx.doi.org/09.02/ijaai.103109DOI Listing
June 2010