Publications by authors named "Mehrdad Haghighi"

8 Publications

  • Page 1 of 1

Neurological features and outcome in COVID-19: dementia can predict severe disease.

J Neurovirol 2021 02 8;27(1):86-93. Epub 2021 Jan 8.

Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The COVID-19 pandemic has infected more than 22 million people worldwide. Although much has been learned about COVID-19, we do not know much about its neurological features and their outcome. This observational study was conducted on the patients of Imam Hossein Hospital, and 361 adult patients (214 males) with confirmed diagnosis of COVID-19 from March 5, 2020 to April 3, 2020, were enrolled. Data was gathered on age, sex, comorbidities, initial symptoms, symptoms during the disease course, neurological symptoms, and outcome. The mean age of the patients was 61.90 ± 16.76 years. The most common initial symptoms were cough, fever, and dyspnea. In 21 patients (5.8%), the initial symptom was neurological. History of dementia was associated with severe COVID-19 disease (odds ratio = 1.28). During the course of the disease, 186 patients (51.52%) had at least one neurological symptom, the most common being headache (109 [30.2%]), followed by anosmia/ageusia (69, [19.1%]), and dizziness (54, [15%]). Also, 31 patients had neurological complications (8.58%). Anosmia, ageusia, dizziness, and headache were associated with favorable outcome (P < 0.001), while altered mental status and hemiparesis were associated with poor outcome. The mortality rate of patients who had neurological complications was more than twice than that of patients without neurological complication (P = 0.008). Almost half of the patients experienced at least one neurological symptom, which may be the initial presentation of COVID-19. Dementia appears to be associated with severe COVID-19. Mortality was higher in patients with neurological complications, and these patients needed more intensive care.
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http://dx.doi.org/10.1007/s13365-020-00918-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792552PMC
February 2021

Low-Dose Whole-Lung Irradiation for COVID-19 Pneumonia: Final Results of a Pilot Study.

Int J Radiat Oncol Biol Phys 2021 03 2;109(4):859-866. Epub 2020 Dec 2.

Department of Clinical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Introduction: Radiation therapy (RT), commonly used in cancer management, has been considered as one of the potential treatments for COVID-19 pneumonia. Here, we present the results of the pilot trial evaluating low-dose whole-lung irradiation (LD-WLI) in patients with COVID-19 pneumonia.

Methods: Ten patients with moderate COVID-19 pneumonia were treated with LD-WLI in a single fraction of 0.5 or 1.0 Gy along with the national protocol. The primary endpoint was an improvement in Spo. The secondary endpoints were the number of days of hospital/intensive care unit stay, the number of intubations after RT, 28-day mortality, and changes in biomarkers. The response rate (RR) was defined as an increase in Spo upon RT with a rising or constant trend in the next 2 days, clinical recovery (CR) including patients who were discharged or acquired Spo ≥93% on room air, and 28-day mortality rate defined based on days of RT.

Results: The median age was 75 years (80% male). Five, 1, and 4 patients received single-dose 0.5 Gy, two-dose 0.5 Gy, and single-dose 1.0 Gy LD-WLI, respectively. The mean improvement in Spo at days 1 and 2 after RT was 2.4% (±4.8%) and 3.6% (±6.1%), respectively, with improvement in 9 patients after 1 day. Five, 1, and 4 patients were discharged, opted out of the trial, and died in the hospital, respectively. Two of 5 discharged patients died within 3 days at home. Among discharged patients, the Spo at discharge was 81% to 88% in 3 patients and 93% in the other 2 patients. Overall, the RR and CR were 63.6% and 55.5%, respectively. The RR, CR, and 28-day mortality of the single 0.5 Gy and 1.0 Gy WLI groups were 71.4% versus 50% (P = .57), 60% versus 50% (P = .64), and 50% versus 75% (P = .57), respectively.

Conclusion: LD-WLI with a single fraction of 0.5 Gy or 1 Gy is feasible. A randomized trial with patients who do not receive radiation is required to assess the efficacy of LD-WLI for COVID-19.
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http://dx.doi.org/10.1016/j.ijrobp.2020.11.065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709599PMC
March 2021

Comparison of Intravenous Ampicillin-sulbactam Plus Nebulized Colistin with Intravenous Colistin Plus Nebulized Colistin in Treatment of Ventilator Associated Pneumonia Caused by Multi Drug Resistant Randomized Open Label Trial.

Iran J Pharm Res 2019 ;18(Suppl1):269-281

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

The purpose of this study was evaluating the efficacy and safety of intravenous (IV) ampicillin-sulbactam plus nebulized colistin in the treatment of Ventilator-Associated Pneumonia (VAP) caused by MDR (MDRA) in ICU patients as an alternative to IV plus nebulized colistin. In this single-blinded RCT, one group received IV colistin and another group IV ampicillin-sulbactam (16 and 12 patients from total 28 patients, respectively) for 14 days or since clinical response. Both groups received nebulized colistin by mesh nebulizer. There were no statistically significant differences between the 2 groups in baseline characteristics and previous antibiotic therapy. In follow up period, no significant difference was observed between 2 groups in rate of microbiological eradication, clinical signs of VAP improvement, survival rate and length of hospital as well as ICU stays. Although we have found no significant differences in Acute Kidney Injury (AKI) incidence between two groups, comparison of cumulative patient-days with stages 2 and 3 AKI with days with no or stage 1 AKI, according to AKIN criteria, revealed significant difference in IV colistin versus IV ampicillin-sulbactam group ( = 0.013). The results demonstrated that the high dose IV ampicillin-sulbactam plus nebulized colistin regimen has comparable efficacy with IV plus nebulized colistin in the treatment of VAP caused by MDRA, with sensitivity to colistin only, with probably lower incidence of kidney injury.
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http://dx.doi.org/10.22037/ijpr.2019.112466.13775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393051PMC
January 2019

Correlation between Chest Computed Tomography Scan Findings and Mortality of COVID-19 Cases; a Cross sectional Study.

Arch Acad Emerg Med 2020 14;8(1):e57. Epub 2020 May 14.

Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Predicting the outcomes of COVID-19 cases using different clinical, laboratory, and imaging parameters is one of the most interesting fields of research in this regard. This study aimed to evaluate the correlation between chest computed tomography (CT) scan findings and outcomes of COVID-19 cases.

Methods: This cross sectional study was carried out on confirmed COVID-19 cases with clinical manifestations and chest CT scan findings based on Iran's National Guidelines for defining COVID-19. Baseline and chest CT scan characteristics of patients were investigated and their correlation with mortality was analyzed and reported using SPSS 21.0.

Results: 380 patients with the mean age of 53.62 ± 16.66 years were evaluated (66.1% male). The most frequent chest CT scan abnormalities were in peripheral (86.6%) and peribronchovascular interstitium (34.6%), with ground glass pattern (54.1%), and round (53.6%) or linear (46.7%) shape. There was a significant correlation between shape of abnormalities (p = 0.003), CT scan Severity Score (CTSS) (p <0.0001), and pulmonary artery CT diameter (p = 0. 01) with mortality. The mean CTSS of non-survived cases was significantly higher (13.68 ± 4.59 versus 8.72 ± 4.42; <0.0001). The area under the receiver operating characteristic (ROC) curve of CTSS in predicting the patients' mortality was 0.800 (95% CI: 0.716-0.884). The best cut off point of chest CTSS in this regard was 12 with 75.82% (95% CI: 56.07%-88.98%) sensitivity and 75.78% (95% CI: 70.88%-80.10%) specificity. The mean main pulmonary artery diameter in patients with CTSS ≥ 12 was higher than cases with CTSS < 12 (27.89 ± 3.73 vs 26.24 ± 3.14 mm; p < 0.0001).

Conclusion: Based on the results of the present study it seems that there is a significant correlation between chest CT scan characteristics and mortality of COVID-19 cases. Patients with lower CTSS, lower pulmonary artery CT diameter, and round shape opacity had lower mortality.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305634PMC
May 2020

Antibiotic Prescribing Trends Before and After Implementation of an Audit and Feedback Program in Internal Ward of a Tertiary Hospital in Tehran.

Iran J Pharm Res 2019 ;18(4):2136-2143

Department of Pulmonary and Critical Care Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

We implemented a post prescribing review and feedback program to investigate its effect on appropriateness of antimicrobial use and antimicrobial consumption rate. A pre-post interventional study conducted in internal ward of Imam Hossein teaching hospital. For nine months of intervention phase, medical file of all patients who received intravenous antibiotic were reviewed by a clinical pharmacy specialist. Discrepancies from international and local guidelines were discussed with physicians. Outcome measures included appropriateness of antimicrobial usage, length of stay, and broad-spectrum antimicrobial usage rate. A total of 198 antibiotic courses (154 in intervention phase and 44 in pre-intervention phase) were reviewed. One-hundred sixty-seven recommendations in treatment course of 75.3% of patients were made. The most common recommendations were discontinuing antibiotics and changing from intravenous to oral therapy (35% and 22%). The acceptance rate was 80.2%. Rate of discrepancies from guidelines was compared between pre-intervention and two last months of intervention period which showed a significant reduction in antibiotic choosing (47%, -value < 0.001), de-escalation (48%, -value < 0.001), on time changing intravenous to oral therapy (60%, -value < 0.001) and dosing schedule (30%, -value = 0.003). Hospital length of stay showed a significant reduction from 16.1 days to 11.6 days (-value < 0.05) between pre-intervention and post-intervention group. Mortality rate was not different in the patients that intervention in their treatment was accepted rejected (-value = 1.00). There was a reduction trend in consumption rate of Carbapenems, Vancomycin, and Ciprofloxacin. Therefore, prospective audit and feedback program effectively decreased inappropriate treatment and hospital length of stay with no effect on mortality.
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http://dx.doi.org/10.22037/ijpr.2019.1100833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059028PMC
January 2019

Interim Study: Comparison Of Safety And Efficacy of Levofloxacin Plus Colistin Regimen With Levofloxacin Plus High Dose Ampicillin/Sulbactam Infusion In Treatment of Ventilator-Associated Pneumonia Due To Multi Drug Resistant Acinetobacter.

Iran J Pharm Res 2018 ;17(Suppl2):206-213

Department of Clinical Pharmacy, school of pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Due to the emerging antibiotic resistance of Acinetobacter, which is the leading cause of ventilator-associated pneumonia (VAP) in critically ill patients, there is an urgent need for studies comparing various antibiotic regimens for its treatment. In this single blinded randomized clinical trial, adult patients with VAP due to multi drug resistant Acinetobacter (MDRA), were randomly assigned to receive 9×10 unit loading dose of colistin followed by 4.5×10 unit intravenously twice daily plus 750 mg intravenous levofloxacin daily or continuous infusion of ampicillin/sulbactam, 24g daily plus 750mg IV levofloxacin daily. Dose and dosing interval were adjusted according to serum creatinine levels during the study. Clinical and microbiological cure, inflammatory biomarkers, and possible adverse effects were recorded in participants. Twenty-nine patients were recruited (14 in colistin and 15 in ampicillin/sulbactam groups). Three patients were excluded in each group. Clinical response occurred in 3 (27%) and 10 (83%) in colistin and ampicillin-sulbactam arms, respectively (P = 0.007). Nephrotoxicity happened in 6 (54%) and 1 (8%) of cases in colistin and ampicillin-sulbactam groups, (P = 0.016). 14-day and 28-day survival rate were significantly higher in ampicillin-sulbactam group compared to colistin arm with P values of 0.002 and 0.049, respectively. This study revealed that levofloxacin plus high dose ampicillin/sulbactam as continuous infusion is more effective than levofloxacin plus colistin in patients with MDR Acinetobacter VAP with significantly lower risk of nephrotoxicity.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447873PMC
January 2018

Pharyngeal Aspiration of Complete Upper Denture in 90-Year-Old Man; a Case Report.

Emerg (Tehran) 2015 ;3(3):117-9

Clinical Research and Development Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Foreign body aspiration is unusual in adults, except those who are debilitated or have neuropsychiatric disorders. It can be a life-threatening situation and it often requires a high index of suspicion, because the diagnosis can be obscure. Prompt diagnosis and intervention through foreign body retrieval are critical to prevent significant morbidity and mortality. We present a case of denture aspiration by a debilitated 90 years old man. He had aspirated his complete upper denture to pharynx causing incomplete obstruction with pleasure whistling respiratory sound, dyspnea, dysphagia and dysphonia. He underwent successful retrieval of the dental plate manually by fingers with complete resolution of symptoms.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608337PMC
October 2015

Frequency and associated factors of proteinuria in Iranian HIV-positive patients.

Int J Infect Dis 2008 Sep 3;12(5):490-4. Epub 2008 Apr 3.

Clinical Research Department, Pasteur Institute of Iran, No. 69, Pasteur Ave., Tehran, Iran.

Background: Screening HIV-positive patients for proteinuria would result in early recognition of HIV-associated nephropathy (HIVAN). This would allow diagnosis and treatment of HIVAN at an early stage and hence prevent further disease progression. This study was undertaken to determine the frequency of proteinuria and its associated factors in Iranian HIV-positive patients.

Methods: In this study, 171 HIV-positive patients were screened for proteinuria. Proteinuria was defined as > or =1+ protein on the urine dipstick. A questionnaire was used to collect patient sociodemographic and clinical data. Hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV), serum albumin, and creatinine were tested in all patients. CD4 counts were obtained by flow cytometry.

Results: Out of 171 HIV-positive patients, 21 (12.3%) had proteinuria. There were no significant differences between patients with and without proteinuria with regard to age, sex, risk behaviors for HIV acquisition, stage of infection, concurrent antiretroviral therapy, systolic and diastolic blood pressure, serum albumin and creatinine, glomerular filtration rate (GFR), and presence of anti-HCV or HBsAg. Patients with proteinuria had a lower CD4 count and creatinine clearance than those without proteinuria.

Conclusion: Proteinuria was relatively high in Iranian HIV-positive patients. The group at higher risk was that of patients with lower CD4 counts and creatinine clearance.
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http://dx.doi.org/10.1016/j.ijid.2008.01.009DOI Listing
September 2008