Publications by authors named "Mojtaba Akbari"

98 Publications

Robotic Ultrasound Scanning With Real-Time Image-Based Force Adjustment: Quick Response for Enabling Physical Distancing During the COVID-19 Pandemic.

Front Robot AI 2021 22;8:645424. Epub 2021 Mar 22.

Telerobotic and Biorobotic System Group, Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada.

During an ultrasound (US) scan, the sonographer is in close contact with the patient, which puts them at risk of COVID-19 transmission. In this paper, we propose a robot-assisted system that automatically scans tissue, increasing sonographer/patient distance and decreasing contact duration between them. This method is developed as a quick response to the COVID-19 pandemic. It considers the preferences of the sonographers in terms of how US scanning is done and can be trained quickly for different applications. Our proposed system automatically scans the tissue using a dexterous robot arm that holds US probe. The system assesses the quality of the acquired US images in real-time. This US image feedback will be used to automatically adjust the US probe contact force based on the quality of the image frame. The quality assessment algorithm is based on three US image features: correlation, compression and noise characteristics. These US image features are input to the SVM classifier, and the robot arm will adjust the US scanning force based on the SVM output. The proposed system enables the sonographer to maintain a distance from the patient because the sonographer does not have to be holding the probe and pressing against the patient's body for any prolonged time. The SVM was trained using bovine and porcine biological tissue, the system was then tested experimentally on plastisol phantom tissue. The result of the experiments shows us that our proposed quality assessment algorithm successfully maintains US image quality and is fast enough for use in a robotic control loop.
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http://dx.doi.org/10.3389/frobt.2021.645424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019797PMC
March 2021

C1QTNF4 gene p.His198Gln mutation is correlated with early-onset systemic lupus erythematosus in Iranian patients.

Int J Rheum Dis 2020 Nov 2;23(11):1594-1598. Epub 2020 Oct 2.

Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-communicable Disease and Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with multifactorial etiology. Several studies show that genetic factors have an important part in the incidence of SLE. The C1QTNF4 gene is involved in the regulation of the inflammatory pathways by pro-inflammatory function. In the present study, we have evaluated the association between C1QTNF4 gene p.His198Gln mutation and risk of SLE.

Methods: Forty SLE patients and 40 control subjects were recruited in this case-control study. Genotyping of C1QTNF4 p.His198Gln mutation was performed using real-time polymerase chain reaction high resolution melting method.

Results: We found a significant association between this mutation (GG + GC) with the risk of SLE (odds ratio = 6.33, 95% CI = 1.28-31.11). Furthermore, we observed that in the patient group, this mutation leads to early-onset SLE (19.7 ± 4.34 years for mutation carriers compared to 27.7 ± 11.4 years for wild type carriers; P = .003).

Conclusion: Our results suggest that this mutation (p.His198Gln) potentially has an important role in SLE risk in the Iranian population.
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http://dx.doi.org/10.1111/1756-185X.13981DOI Listing
November 2020

What is the preferred hemostasis method for coronary angiography through the palmar artery access?

Cardiovasc Interv Ther 2020 Sep 10. Epub 2020 Sep 10.

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

Trans-palmar catheterization has been considered to be safe and feasible and choosing a reliable hemostasis method is essential to confirm it. The aim of our study was to compare the efficacy and safety of three hemostasis approaches containing ulnar TR band, manual compression and wrist hyperextension in patients undergoing trans-palmar coronary angiography (CAG). In a non-randomized clinical trial, a total of 106 patients undergoing diagnostic CAG by tarns-palmar access were divided into three groups: ulnar TR band, manual compression and wrist hyperextension. Duration of primary hemostasis, patient satisfaction, puncture site pain severity, hospitalization time and local neuro-vascular complication were evaluated and compared in hospital and 30 days follow-up. The mean age of the patients was 62.9 ± 7.4 years and 72 patients (67.9%) were male. Primary hemostasis time was significantly shorter in hyperextension (11.5 ± 2.10 min) and manual compression groups (12.3 ± 2.20 min) than with TR band group (24.7 ± 10.25 min) (p value < 0.0001). Patient's satisfaction was higher in hyperextension approach (9.4 ± 0.65) than manual compression (8.8 ± 0.79) and TR band group (8.2 ± 0.90) (p value < 0.0001). The most pain was seen in the TR band and the less in hyperextension group until 4 h after the procedure (p value < 0.0001). Hematoma, numbness and ulnar artery occlusion as well as hospitalization time did not have significant statistical differences (p value > 0.05). In conclusion, between three methods of hemostasis in trans-palmar catheterization, hyperextension approach is the preferred method because of effectiveness, safety and less time consuming hemostatic method compared others.
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http://dx.doi.org/10.1007/s12928-020-00707-wDOI Listing
September 2020

Thyroid volume and nodular and diffuse thyroid diseases by ultrasonography in pregnant women: A case-control study.

J Res Med Sci 2020 20;25:13. Epub 2020 Feb 20.

Department of Medicine, Southend University Hospital, Southend-on Sea, United Kingdom, Southend University Hospital, Westcliff-on-Sea, England, UK.

Background: Currently, it is shown that pregnancy may have an impact on the thyroid that can be leading to pregnancy complications such as abortion, preeclampsia, and preterm delivery. The objective was to compare the thyroid volume, number and characteristics of thyroid nodules, and prevalence of diffuse thyroid diseases in a sample of Iranian pregnant women in the first trimester to nonpregnant women.

Materials And Methods: This case-control study was conducted on 298 pregnant and 290 nonpregnant women. Thyroid volume, maximum diameter of thyroid nodules and prevalence of moderate to highly suspicious thyroid nodules, Hashimoto's appearance and goiter were assessed using thyroid ultrasonography. Antithyroperoxidase (TPO) antibodies were measured if the sonographic features were highly suggested for Hashimoto's thyroiditis.

Results: The mean of total thyroid volume in pregnant and nonpregnant women was 6 and 6.5 ml, respectively ( = 0.053), and the median (interquartile range) was 6.2 and 5.5, respectively. Nodules were observed in 16.4% of pregnant and 16.6% of nonpregnant women ( = 0.845). Hashimoto's thyroiditis was detected in 6.7% of pregnant and 12.4% of nonpregnant women ( = 0.013). Anti-TPO antibodies were detected in 5% of pregnant and 9.3% of nonpregnant women ( = 0.034).

Conclusion: The thyroid volume and nodule characteristics in the first trimester of pregnancy were similar to nonpregnant women. Hashimoto's thyroiditis and anti-TPO antibodies in pregnant women were significantly lower than in nonpregnant women.
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http://dx.doi.org/10.4103/jrms.JRMS_42_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053162PMC
February 2020

Interferon-induced protein 44-like gene promoter is differentially methylated in peripheral blood mononuclear cells of systemic lupus erythematosus patients.

J Res Med Sci 2019 27;24:99. Epub 2019 Nov 27.

Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The objectives of this study were to compare the interferon-induced protein 44-like (IFI44L) promoter methylation level between systemic lupus erythematosus (SLE) patients and healthy controls and to evaluate its diagnostic value in SLE.

Materials And Methods: The IFI44L promoter methylation level was measured in 49 patients with SLE and 50 healthy controls. Quantitative analysis of promoter methylation IFI44L gene in genomic DNA samples extracted from peripheral blood mononuclear cells was examined in SLE patients and healthy controls. The level of DNA methylation was compared between SLE patients and healthy controls as well as within SLE patient groups based on the presence of renal involvement. Moreover, diagnostic values of IFI44L were calculated.

Results: The IFI44L promoter methylation level in SLE patients was significantly lower than healthy controls (median, 43.8 vs. 57, respectively; = 0.008). The level of IFI44L promoter methylation was not significantly different between SLE patients with renal involvement and SLE patients without renal involvement (84.6% vs. 92.7%, respectively; = 0.774). The IFI44L promoter methylation level ≤94.3% was the best cutoff point with a sensitivity of 91.8% and a specificity of 38% to distinguish patients with SLE from healthy individuals.

Conclusion: The level of IFI44L promoter methylation from whole peripheral blood in Iranian SLE patients was significantly lower than healthy controls. Furthermore, the DNA methylation level of IFI44L promoter was not associated with renal damage in patients with SLE.
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http://dx.doi.org/10.4103/jrms.JRMS_83_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906918PMC
November 2019

Relationship between personality type and musculoskeletal disorders among office staff.

Med Lav 2019 Aug 26;110(4):293-303. Epub 2019 Aug 26.

Student Research Committee, Shiraz University of Medical Sciences/Department of Occupational Health Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran..

Background: Musculoskeletal disorders (MSDs) have been recognized as common health-related problems in the workplace. Accordingly, poorly-designed workstations and assigned tasks can lead to exposure to risk factors inducing MSDs among office staff. Accompanied by physical risk factors, psychological ones in working environments can also contribute to MSDs occurrence. Thus, the purpose of this study was to examine the relationship between personality types as a psychological factor and MSDs occurrence among office staff.

Methods: This cross-sectional study was carried out on office staff working at Shiraz University of Medical Sciences (SUMS) in 2016. The participants included 339 employees recruited using multi-stage simple random sampling method. The required data were likewise collected via a demographic characteristics information checklist, the Personality Pattern Questionnaire (PPQ), as well as the standardized Nordic Musculoskeletal Questionnaire (NMQ).

Results: The findings revealed that the participants' mean±standard deviation (SD) age were 36.4±7.8 years. As well, the most prevalent MSDs complaints were reported in lower back, knee, and neck regions with relative frequencies of 35%, 30%, and 25% respectively. Moreover, the results demonstrated that 0.6% of the participants were determined as individuals having a strong tendency for type A personality, 26.8% of them showed tendency for type A personality, 63.1% of these employees were categorized into those having a tendency for type B personality, and 9.4% of them were identified as participants who showed a strong tendency for type B personality. Additionally, statistically significant relationships were observed between personality types and MSDs occurrence (p=0.023). Furthermore, musculoskeletal symptoms were reported more prevalent among individuals having tendency for type A personality.

Conclusion: Personality types and MSDs occurrence seemed to be associated. It was thus suggested to take account of psychological factors (e.g., personality types) in macro policy-making, employee selection, and professional staff training programs.
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http://dx.doi.org/10.23749/mdl.v110i4.7820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809998PMC
August 2019

Designing and Manufacture of Training Simulator for Injecting and Fluid Removing of Knee Joint.

Adv Biomed Res 2019 12;8:28. Epub 2019 Apr 12.

Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.4103/abr.abr_198_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477831PMC
April 2019

Ascites-tap Simulator for Abdominal Examination and Removal of Ascites Fluid.

Adv Biomed Res 2019 10;8:26. Epub 2019 Apr 10.

Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.4103/abr.abr_197_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477830PMC
April 2019

Survival and associated factors among people living with HIV/AIDS: A 30-year national survey in Iran.

J Res Med Sci 2019 31;24. Epub 2019 Jan 31.

HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The survival in Iranian HIV/AIDS patients based on data from Iran National HIV/AIDS Case Registry System has not been evaluated. This study assessed the survival rates and associated factors among people living with HIV/AIDS in Iran.

Materials And Methods: The population in this observational study included 32168 patients diagnosed with HIV/AIDS registered in Iran disease registry system between 1986 and 31 December 2015. Data until June 2016 (the cutoff date of our last data linkage) were investigated to estimate survival and related factors following HIV diagnosis.

Results: Of registered patients, 17.7% were diagnosed at AIDS stage. By June 2016, 27.2% of study population progressed to AIDS, and 8081 (25.1%) of patients died. The survival rate was 88%, 85%, 77%, and 67% for 1, 2, 5, and 10 years, respectively. Cumulative proportion surviving was significantly lower in males than in females ( = 0.0001). A higher rate of survival was seen in female patients, who diagnosed after 2010, infected in sexual route, and had CD4 cell count more than 500, nonconfected patients with tuberculosis (TB), and those who received antiretroviral therapy (ART). Based on multivariate model, the mortality risk in female patients, those with CD4 cell count more than 500, patients who received ART, and those with TB and injection drug uses (IDUs) was higher.

Conclusion: The survival in studied patients increased in recent time periods, and ART reduced AIDS-related mortality in these patients. The survival can be increased by focus on improvements in patient care among male patients, IDUs, and patients with TB coinfection.
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http://dx.doi.org/10.4103/jrms.JRMS_630_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383342PMC
January 2019

Magnetic resonance imaging and electroencephalography findings in a sample of Iranian patients with epilepsy.

J Res Med Sci 2018 28;23:106. Epub 2018 Dec 28.

Isfahan Neurosciences Research Centre, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The present study is aimed to evaluate the magnetic resonance imaging (MRI) and electroencephalography (EEG) findings based on characteristics variables in patients with epilepsy.

Materials And Methods: In this cross-sectional study, all patients with epilepsy who referred between March 2016 and March 2017 to Al-Zahra and Kashani Hospitals in Isfahan, Iran, were enrolled. The completed files of 199 patients were assessed to collect information about characteristic data and MRI and EEG findings. MRI and EEG findings were recorded as normal or abnormal. The characteristic data and risk factors in patients with normal MRI and EEG were compared with those patients with abnormal MRI and EEG.

Results: History of seizures and trauma are reported in 84 (42.2%) and 47 (23.6%) of patients, respectively. The most frequent type of seizures was generalized. MRI finding in 51 patients (25.6%) was abnormal, and EEG finding in 124 patients (62.3%) was abnormal. Patients with abnormal MRI were significantly older than those with normal MRI (37.3 vs. 31.4, respectively, = 0.024). Abnormal MRI in men patients was significantly more frequent than women (31.2% vs. 18.9%, respectively, = 0.048). In patients with abnormal EEG, seizure was more frequent than patients with normal EEG (50.8% vs. 28%, respectively, = 0.002). Other characteristics and risk factors were not significant differences between patients with normal or abnormal MRI or EEG findings.

Conclusion: In patients with epilepsy, older age and being a male were the risk factors of having abnormal MRI, and seizure was the risk factor of having abnormal EEG.
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http://dx.doi.org/10.4103/jrms.JRMS_163_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327682PMC
December 2018

Cardiovascular disease risk prediction among Iranian patients with diabetes mellitus in Isfahan Province, Iran, in 2014, by using Framingham risk score, atherosclerotic cardiovascular disease risk score, and high-sensitive C-reactive protein.

ARYA Atheroscler 2018 Jul;14(4):163-168

General Practitioner, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Risk assessment in clinical practice plays an important role in classifying population for appropriate preventive medicine for each category. Several multivariable risk predictor algorithms and inflammatory biomarkers are developed for assessing risk for cardiovascular diseases (CVDs). We aimed to depict a picture of the cardiovascular risk profiles in the Iranian population with diabetes mellitus (DM) through three risk predictors for the first time, as the patients with DM have an increased risk for CVDs.

Methods: In this cross-sectional study, the sample size consisted of 418 patients with DM from Diabetes Clinic of Shariati hospital, Isfahan, Iran, in February to July, 2014. We collected the latest information, and then calculated the 10-year CVD risk using Framingham risk score (FRS) and atherosclerotic cardiovascular disease (ASCVD) risk score; while high-sensitivity C-reactive protein (hs-CRP) was measured for them based on their physicians' prescription. Finally, all data were analyzed using SPSS software.

Results: The mean 10-year risk prediction of CVDs in the 30- to 74-year-old Iranian patients with DM was high in all three predictors based on their cut-off points, 16.31%, 12.39%, and 3.46 mg/l for FRS, ASCVD risk score, and hs-CRP level, respectively. Although the mean FRS and ASCVD risk scores were significantly higher among men than women (P < 0.0500), the mean hs-CRP level was slightly lower in men than women (P > 0.0500).

Conclusion: Mean FRS and ASCVD risk scores and hs-CRP in patients were high, and a considerable proportion of patients with DM in our study were at intermediate and high risk for CVDs in the next 10 years. Future cohort studies would investigate the accuracy of different predictors in upcoming years, and also help to derive a specific model or recalibrate existing predictors with characteristic of Iranian populations and specific target groups.
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http://dx.doi.org/10.22122/arya.v14i4.1685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312566PMC
July 2018

Prevalence, Awareness, Treatment, and Control of Hypertension in an Isfahan State Institution Sample.

J Tehran Heart Cent 2018 Apr;13(2):65-72

Department of Occupational Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Hypertension is a major risk factor for premature disability and death and is the leading risk factor for global disease burden. The present study aimed to assess the rates of prevalence, awareness, treatment, and control of hypertension in a sample of teachers, staff, and students at Isfahan University of Medical Sciences (IUMS). This cross-sectional survey was conducted from January to September 2015 on the staff, teachers, and students at IUMS. A total of 1500 subjects were randomly selected and were invited to participate in the survey. Hypertension was defined as an average of 2 blood pressure measurements of at least 140/90 mmHg. The rate of awareness was determined based on self-reports, treatment was defined as the regular use of blood pressure-lowering medications, and control was defined as the maintenance of blood pressure below 140/90 mmHg. The study population comprised 1317 individuals (45.9% female) at a mean age of 41.4±9.5 years. The prevalence rate of hypertension was 17.5% (231 of 1317 participants), and the rate of awareness was 54.5% (126 of 231 hypertensive patients). Seventy-nine (62.7%) patients were undergoing treatment, and 51.9% (41 of 79) controlled their disease. Institutional position (P<0.017), age (P<0.001), body mass index (P<0.001), education level (P<0.001), smoking status (P<0.001), and history of diabetes mellitus (P<0.001) were the most frequent risk factors associated with hypertension. The percentage of the hypertensive subjects who were aware, treated, and controlled was unacceptably low in our sample at IUMS. Hypertension is, therefore, a major health problem in this state institution.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246434PMC
April 2018

Left Ventricle Segmentation in Cardiac MR Images Using Fully Convolutional Network.

Annu Int Conf IEEE Eng Med Biol Soc 2018 Jul;2018:1275-1278

Medical image analysis, especially segmenting a specific organ, has an important role in developing clinical decision support systems. In cardiac magnetic resonance (MR) imaging, segmenting the left and right ventricles helps physicians diagnose different heart abnormalities. There are challenges for this task, including the intensity and shape similarity between the left ventricle and other organs, inaccurate boundaries, and presence of noise in most of the images. In this paper, we propose an automated method for segmenting the left ventricle in cardiac MR images. We first automatically extract the region of interest and then employ it as an input of a fully convolutional network. We train the network accurately despite the small number of left ventricle pixels in comparison with the whole image. Thresholding on the output map of the fully convolutional network and selection of regions based on their roundness are performed in our proposed post-processing phase. The Dice score of our method reaches 87.24% by applying this algorithm on the York dataset of heart images.
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http://dx.doi.org/10.1109/EMBC.2018.8512536DOI Listing
July 2018

Polyp Segmentation in Colonoscopy Images Using Fully Convolutional Network.

Annu Int Conf IEEE Eng Med Biol Soc 2018 Jul;2018:69-72

Colorectal cancer is one of the highest causes of cancer-related death, especially in men. Polyps are one of the main causes of colorectal cancer, and early diagnosis of polyps by colonoscopy could result in successful treatment. Diagnosis of polyps in colonoscopy videos is a challenging task due to variations in the size and shape of polyps. In this paper, we proposed a polyp segmentation method based on the convolutional neural network. Two strategies enhance the performance of the method. First, we perform a novel image patch selection method in the training phase of the network. Second, in the test phase, we perform effective post-processing on the probability map that is produced by the network. Evaluation of the proposed method using the CVC-ColonDB database shows that our proposed method achieves more accurate results in comparison with previous colonoscopy video-segmentation methods.
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http://dx.doi.org/10.1109/EMBC.2018.8512197DOI Listing
July 2018

Classification of Informative Frames in Colonoscopy Videos Using Convolutional Neural Networks with Binarized Weights.

Annu Int Conf IEEE Eng Med Biol Soc 2018 Jul;2018:65-68

Colorectal cancer is one of the common cancers in the United States. Polyps are one of the major causes of colonic cancer, and early detection of polyps will increase the chance of cancer treatments. In this paper, we propose a novel classification of informative frames based on a convolutional neural network with binarized weights. The proposed CNN is trained with colonoscopy frames along with the labels of the frames as input data. We also used binarized weights and kernels to reduce the size of CNN and make it suitable for implementation in medical hardware. We evaluate our proposed method using Asu Mayo Test clinic database, which contains colonoscopy videos of different patients. Our proposed method reaches a dice score of 71.20% and accuracy of more than 90% using the mentioned dataset.
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http://dx.doi.org/10.1109/EMBC.2018.8512226DOI Listing
July 2018

Acute vision loss in multiple sclerosis: Optic neuritis or central serous chorioretinopathy?

Mult Scler Relat Disord 2019 01 2;27:147-150. Epub 2018 Oct 2.

Isfahan Eye Research Center (IERC), Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Ophthalmology, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Medical Students Research Center (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.msard.2018.09.034DOI Listing
January 2019

Distal accesses in the hand (two novel techniques) for percutaneous coronary angiography and intervention.

ARYA Atheroscler 2018 Mar;14(2):95-100

Department of Biostatistics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Trans-radial and trans-ulnar accesses have been practiced and recommended as default and alternative techniques for coronary angiography and angioplasty in recent years. In this study, we present new innovative approaches using more distal access points, i.e. trans-snuff box and trans-palmar approaches.

Methods: We conducted dorsal hand access (trans-snuff box) for angiography and/or angioplasty on 235 patients, and trans-palmar access (superficial palmar branch of ulnar artery) on 175 patients in 3 hospitals in Isfahan City, Iran.

Results: In 221 patients out of 235 ones (94.1%) [men: 76.5%, age: 57.4 ± 10.4 (years); women: 23.5%, age: 62.4 ± 9.5 (years)], our procedure through snuff box (dorsal hand) was successfully performed. In 159 patients out of 175 ones (90.8%) [men: 76.0%, age: 58.1 ± 10.5 (years); women: 24.0%, age: 61.2 ± 9.6 (years)], our procedure through palmar artery was successfully performed. In total, the evaluated patients had mild pain (3.4% for snuff box, and 4.5% for palmar), ecchymosis in distal forearm (5.1% for snuff box, and 2.8% for palmar), with no major complications even one (amputation, infection, thrombosis, need for surgery, hand dysfunction, nerve palsy, and so forth). In addition, percutaneous coronary intervention (PCI) was done in 28.9% and 18.2% of cases via snuff box and palmar approaches, respectively. Meanwhile, hemostasis was very fast and easy with discharge time equivalent to other upper limb accesses.

Conclusion: Although our procedures are at their early stages with about a follow-up period of 3-15 months, more researches are recommended to be conducted in forthcoming months and years, and this new innovative approaches could be suggested safe, feasible, and reliable with low complications.
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http://dx.doi.org/10.22122/arya.v14i2.1743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087626PMC
March 2018

Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report.

Int J Endocrinol Metab 2018 Jan 20;16(1):e62591. Epub 2017 Dec 20.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Factitious hypoglycemia, caused by the surreptitious use of insulin and sulfonylureas, is one of the most challenging differential diagnoses of hypoglycemia. Diagnosis is usually established via exclusion with respect to the special patterns of plasma insulin and C-peptide during hypoglycemic episodes.

Case Presentation: We report a case of recurrent hypoglycemic episodes and confusing patterns of insulin and C-peptide levels. In the primary evaluations, insulinoma was suspected considering the high plasma concentrations of insulin and C-peptide, besides negative urine and plasma sulfonylureas during hypoglycemic episodes. Considering the normal imaging studies and refractory hypoglycemia to medical therapy, distal pancreatectomy was performed. The patient had no episodes of hypoglycemia after the surgery. Five months later, similar episodes recurred. Further investigations revealed different plasma concentrations of insulin and C-peptide in each hypoglycemic episode. Regarding various biochemical patterns during hypoglycemia and absence of evidence supporting other differential diagnoses, we suspected factitious causes. Close observation revealed that the patient had a history of intermittent glyburide consumption and analog insulin injection.

Discussion: Most commercial insulin immunoassays can only detect human insulin and lack the ability to identify synthetic analog insulin. In addition, common detection methods for sulfonylureas and meglitinides are of low diagnostic value in the human plasma and urine. These laboratory defects can lead to the misdiagnosis of insulinoma or noninsulin-mediated hypoglycemia due to the surreptitious use of insulin secretagogues or analog insulin, respectively. Therefore, due to the lack of any definitive laboratory findings, clinical suspicion is the best strategy for diagnosis.
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http://dx.doi.org/10.5812/ijem.62591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5961186PMC
January 2018

High Prevalence of Vitamin D Deficiency among Iranian Population: A Systematic Review and Meta-Analysis.

Iran J Med Sci 2018 Mar;43(2):125-139

Health Policy Research Center, Institute of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The prevention and correction of vitamin D deficiency requires a precise depiction of the current situation and identification of risk factors in each region. The present study attempted to determine these entities using a systematic review and meta-analysis in Iran.

Methods: Articles published online in Persian and English between 2000 and November 1, 2016, were reviewed. This was carried out using national databases such as SID, IranMedex, Magiran, and IranDoc and international databases such as PubMed, Google Scholar, and Scopus. The heterogeneity index among the studies was determined using the Cochran (Q) and I test. Based on the heterogeneity results, the random-effect model was applied to estimate the prevalence of vitamin D deficiency. In addition, meta-regression analysis was used to determine heterogeneity-suspected factors, and the Egger test was applied to identify publication bias.

Results: The meta-analysis of 48 studies identified 18531 individuals with vitamin D deficiency. According to the random-effect model, the prevalence of vitamin D deficiency among male, female, and pregnant women was estimated to be 45.64% (95% CI: 29.63 to 61.65), 61.90% (95% CI: 48.85 to 74.96), and 60.45% (95% CI: 23.73 to 97.16), respectively. The results of the meta-regression analysis indicated that the prevalence of vitamin D deficiency was significantly different in various geographical regions (β=4.4; P=0.023).

Conclusion: The results obtained showed a significant prevalence of vitamin D deficiency among the Iranian population, a condition to be addressed by appropriate planning.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5936844PMC
March 2018

Comparison consequences of Jackson-Pratt drain versus chest tube after coronary artery bypass grafting: A randomized controlled clinical trial.

J Res Med Sci 2017 26;22:134. Epub 2017 Dec 26.

Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Chest tubes are used in every case of coronary artery bypass grafting (CABG) to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG.

Materials And Methods: This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum.

Results: The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group ( = 0.001), but the trend of pain score between groups was not significantly different ( = 0.097). The frequency of tamponade and atrial fibrillation (AF) were significantly lower in Jackson-Pratt drain group ( < 0.05).

Conclusion: The Jackson-Pratt drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF.
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http://dx.doi.org/10.4103/jrms.JRMS_739_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767813PMC
December 2017

Is there any link between tumor-induced osteomalacia and psoriasis? A case report.

J Diabetes Metab Disord 2017 23;16:34. Epub 2017 Aug 23.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Tumor-induced osteomalacia is an uncommon paraneoplastic syndrome caused by Fibroblast growth factor-23-secreting tumors. It is characterized by phosphaturia, hypophosphatemia, and a high plasma level of alkaline phosphatase.

Case Presentation: We report a young patient with psoriasis who had suffered from bone pain and muscle weakness for more than 6.5 years. He was finally diagnosed with tumor-induced osteomalacia. However, mistakenly attributing the patient's signs and symptoms to psoriatic arthritis for a long time had resulted in multiple complications for the patient. Finally, the tumor was localized and surgically resected. This resulted in clinical improvements and the resolution of all biochemical abnormalities.

Conclusion: To our knowledge, this is the second case of tumor-induced osteomalacia accompanied by psoriasis. There is growing evidence to suggest that Fibroblast growth factor-23 has a role in regulating immune function while an increased level of it may play a role in the pathogenesis of psoriasis. As a result, tumor-induced osteomalacia may affect the psoriasis clinical course by secreting a high amount of Fibroblast growth factor-23. On the other hand, several studies have showed an increased risk of malignancy among patients with psoriasis. Consequently, long-term psoriasis may predispose patients to Fibroblast growth factor-23-secreting tumors. Finally, as psoriasis is a common disease, this presentation may simply be a coincidence.
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http://dx.doi.org/10.1186/s40200-017-0315-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567474PMC
August 2017

Effect of Extracorporeal Shock Wave Therapy on Lower Limb Spasticity in Stroke Patients.

Arch Iran Med 2017 Jun;20(6):338-343

Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: This study aims to evaluate the effect of extracorporeal shock wave therapy (ESWT) on lower limb spasticity in stroke patients.

Methods: Twenty-eight eligible patients with ankle plantar flexor spasticity were randomly assigned to two groups. ESWT group received 1 session per week for 3 weeks of ESWT along with oral anti-spastic medications and stretching exercises. The control group received only oral anti-spastic medications and stretching exercises similar to ESWT group. At baseline, weeks 1, 3 and 12, spasticity was assessed and compared between the two groups using Modified Ashworth Scale (MAS), clonus score, passive range of motion (ROM) of joint, pain score, 3-m walk duration and lower extremity functional score (LEFS). Three patients were lost during follow-up; 25 patients completed the study and were analyzed.

Results: After one session of ESWT treatment, MAS, pain, ROM and LEFS improved significantly compared to baseline. After three weeks of ESWT treatment, MAS, pain and 3-m walk duration improved significantly compared to week 1. At week 12, MAS, pain, ROM, 3-m walk duration and LEFS improved significantly compared to the control group after controlling baseline values. The trend of decrease in pain score and MAS was significantly different between the groups. The trend of increase in ROM and LEFS was significantly different between the groups.

Conclusion: ESWT significantly improved lower limb spasticity, pain, passive ROM, 3-m walk duration and LEFS immediately and 12 weeks after treatment. So, ESWT in combination with oral anti-spastic medications and stretching exercises could be useful for improvement of spasticity in stroke patients.
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http://dx.doi.org/0172006/AIM.004DOI Listing
June 2017

Investigation of Prognostic Factors and Survival without Recurrence in Patients with Breast Cancer.

Adv Biomed Res 2017 17;6:42. Epub 2017 Apr 17.

Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: One of the major consequences of breast cancer is the recurrence of the disease. The objective of present study was to estimate the 7-year survival without recurrence as well as the effective prognostic factors in recurrence.

Materials And Methods: This historical cohort survival analysis was conducted on 1329 patients diagnosed with breast cancer in Motahari Breast Clinic, Shiraz, Iran between 2004 and 2011. We estimated the rate of survival without recurrence through the Kaplan-Meier method and the difference between the survival curves was investigated using the log-rank test. Furthermore, Cox regression model was used to model the effective factors in local recurrence as well as metastasis.

Results: The mean age of the patients was 54.8 ± 11.4 years. Estrogen receptor positive, progesterone receptor positive, and human epidermal growth factor receptor-2 positive were observed in 70.6%, 66.6%, and 34.4% of the cases, respectively. The mean of the follow-up period was 3.7 ± 1.8 years in all patients. The results of the Kaplan-Meier method revealed 1-, 3-, 5-, and 7-year rate of survival without recurrence as 96.4%, 78.4%, 66.3%, and 54.8%, respectively. There was a significant relationship between survival without recurrence and histology grade (hazard ratio [HR] = 1.66, = 0.009), neural invasion (HR = 1.74, = 0.006), and progesterone receptors (HR = 0.69, = 0.031).

Conclusion: In this study, the rate of survival without recurrence in breast cancer was 54.8%. Among factors, histology grade and neural involvement at the time of diagnosis increased the chance of recurrence and progesterone receptors caused a longer interval between diagnosis and recurrence.
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http://dx.doi.org/10.4103/2277-9175.204595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414407PMC
April 2017

Socioeconomic Status and Satisfaction with Public Healthcare System in Iran.

Int J Community Based Nurs Midwifery 2017 Jan;5(1):22-29

Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The users' satisfaction is a method for evaluating the efficacy of healthcare system. We aimed to evaluate the association between the users' socioeconomic status (SES) and satisfaction with the healthcare system in Shiraz, Iran.

Methods: This cross-sectional study was conducted from December, 2013 to March, 2014, in Shiraz, Iran. 3400 households were recruited by multi-stage cluster random sampling. Information about demographic, insurance status, and users' satisfaction was derived from face-to-face interviews. Satisfaction with healthcare system was assessed by using 5-point Likert scale statements, which ranged from "very dissatisfied" to "very satisfied". All statistical analyses were performed using SPSS-21.

Results: Overall, 1.6% (55) of the respondents were very satisfied, while 6% (203) were very dissatisfied with healthcare system. Participants were classified into high SES (26.3%), middle SES (47.9%) and low SES (25.8%). It was discovered that the better the SES, the more frequent were the respondents dissatisfied with healthcare system (P<0.001). Also, dissatisfied respondents were significantly older (P=0.036). Moreover, women were more dissatisfied with healthcare system (P=0.005). Also, dissatisfied respondents had significantly a higher level of education than satisfied ones (P<0.001). Furthermore, logistic regression revealed that age (P=0.04), marital status (P=0.01), insurance status (P<0.001), SES (P<0.001), and having supplemental insurance (P=0.02) were determinant factors of satisfaction with healthcare system.

Conclusion: This study demonstrated that users' sex, age, educational level, and SES were related to dissatisfaction with healthcare system. Meanwhile, clients' age, SES, insurance status and marital status were recognized as determinant factors.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5219562PMC
January 2017

Socioeconomic Status and Satisfaction with Public Healthcare System in Iran.

Int J Community Based Nurs Midwifery 2017 Jan;5(1):22-29

Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The users' satisfaction is a method for evaluating the efficacy of healthcare system. We aimed to evaluate the association between the users' socioeconomic status (SES) and satisfaction with the healthcare system in Shiraz, Iran.

Methods: This cross-sectional study was conducted from December, 2013 to March, 2014, in Shiraz, Iran. 3400 households were recruited by multi-stage cluster random sampling. Information about demographic, insurance status, and users' satisfaction was derived from face-to-face interviews. Satisfaction with healthcare system was assessed by using 5-point Likert scale statements, which ranged from "very dissatisfied" to "very satisfied". All statistical analyses were performed using SPSS-21.

Results: Overall, 1.6% (55) of the respondents were very satisfied, while 6% (203) were very dissatisfied with healthcare system. Participants were classified into high SES (26.3%), middle SES (47.9%) and low SES (25.8%). It was discovered that the better the SES, the more frequent were the respondents dissatisfied with healthcare system (P<0.001). Also, dissatisfied respondents were significantly older (P=0.036). Moreover, women were more dissatisfied with healthcare system (P=0.005). Also, dissatisfied respondents had significantly a higher level of education than satisfied ones (P<0.001). Furthermore, logistic regression revealed that age (P=0.04), marital status (P=0.01), insurance status (P<0.001), SES (P<0.001), and having supplemental insurance (P=0.02) were determinant factors of satisfaction with healthcare system.

Conclusion: This study demonstrated that users' sex, age, educational level, and SES were related to dissatisfaction with healthcare system. Meanwhile, clients' age, SES, insurance status and marital status were recognized as determinant factors.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5219562PMC
January 2017

Satisfaction Rate Regarding Health-care Services and Its Determinant Factors in South-West of Iran: A Population-based Study.

Int J Prev Med 2016 28;7:122. Epub 2016 Nov 28.

Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The aim of this study was to evaluate clients' satisfaction regarding health-care services and its determinant factors in South-West of Iran.

Methods: Totally, 3400 households were randomly selected for this cross-sectional study, carried out in Shiraz, Iran, from December 2013 to March 2014. Data were collected using a checklist that includes insurance status of the household, enrollment in family physician program, and client's satisfaction level with received health services. The level of statistical significance was set at < 0.05.

Results: The mean age of the interviewees was 51.71 (±14.01) years, including 2427 (71.4%) females. 9.4% were insured while 72.3% had registered in family physician program. With respect to the family physician and governmental clinics, most subjects were "satisfied" or "very satisfied" with distance, time for admission, time spent at the clinic, privacy, and cost. As for private clinics, specialist clinics, and private hospitals, the studied subjects were more "dissatisfied" with cost but were more satisfied with other items. Living in higher socioeconomic regions ( = 0.001), dissatisfaction with family physician ( < 0.001, odds ratio [OR] = 2.3), scarcity of prescribed medication ( = 0.02, OR = 1.6), medication cost ( < 0.001, OR = 1.9), and existing chronic diseases in the household ( = 0.03, OR = 1.4) had determinant role in dissatisfaction with health system.

Conclusions: Results of the present study demonstrated a high level of satisfaction with the health-care system and family physician in Shiraz, Iran. Moreover, dissatisfaction with family physicians, socioeconomic status, scarcity and cost of drugs, and existing chronic disease(s) were important predictors for dissatisfaction with the health-care system.
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http://dx.doi.org/10.4103/2008-7802.194798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139453PMC
November 2016

Age at Natural Menopause and Related Factors in Isfahan, Iran.

J Menopausal Med 2016 Aug 30;22(2):87-93. Epub 2016 Aug 30.

Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: This study was aimed to evaluate the age at natural menopause and related factors among women in a population based study in 2015 in Isfahan, Islamic Republic of Iran.

Methods: In this cross-sectional study 960 menopausal women were selected by cluster sampling. Demographic, socioeconomic, lifestyle behavior and reproductive history aspects were collected using a structured questionnaire. Woman and her husband's educational level and occupation with family income were the variables to construct socioeconomic status using principal component analysis.

Results: Mean and median of natural menopause age were 48.66 and 48 years, respectively. Women body mass index (BMI) more than 30 kg/m(2) had significantly higher menopausal age than women with lower BMI (P value = 0.022). The mean of menopausal age was not statistically significant in regard to marital status, physical activity, smoking status, menarche age, age at first pregnancy and history of abortion. Menopause age with pregnancy numbers and age at last pregnancy had a significant positive association. Women with better socioeconomic status had significantly higher natural menopause age. Multiple linear regression shows significant relationship between lower age at menopause with higher age at marriage, higher number of pregnancy and lower socioeconomic status.

Conclusion: Age at menopause in our studied sample is similar to previous estimates reported for other Iranian populations. Age at marriage, higher number of pregnancy and lower socioeconomic status were the significant factors in relations to age at menopause.
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http://dx.doi.org/10.6118/jmm.2016.22.2.87DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016509PMC
August 2016

One year follow-up effect of renal sympathetic denervation in patients with resistant hypertension.

ARYA Atheroscler 2016 Mar;12(2):109-13

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

Background: Resistant hypertension is a common clinical problem of blood pressure that is not controlled despite the simultaneous application of multiple antihypertensive agents. Ablation of renal afferent nerves has been applied and proved to decrease hypertension and injuries produced by severe sympathetic hyperactivity. The main objective of this study was to investigate the long-term effect of renal artery sympathetic ablation and its complications in patients with treatment-resistant hypertension.

Methods: In this prospective study which done between March 2012 and November 2013, 30 patients with resistant arterial hypertension despite treatment with ≥3 antihypertensive drugs-were randomly enrolled in this self-control clinical study in Isfahan, Iran. The patients were treated with the renal denervation procedure; the femoral artery was accessed with the standard endovascular technique and the Symplicity catheter was advanced into the renal artery and connected to a radiofrequency generator. Before and 12 months after renal denervation procedure waist, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), metabolic syndrome, fasting blood sugar (FBS), high-density lipoprotein (HDL), and triglyceride were measured in all patients.

Results: Both mean SBP and DBP were significantly decreased, 12 months after renal denervation (P < 0.001). The frequency of metabolic syndrome was not significantly different after renal denervation in compare to baseline (P = 0.174). Furthermore, a significant decreased in FBS and triglyceride was observed in compare to baseline (P = 0.001).

Conclusion: This study highlighted the role of renal sympathetic denervation as a modern and secure catheter-based method for sustained reduction hypertension in treatment-resistant cases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933751PMC
March 2016

Caesarean section in Iran.

Lancet 2016 Jul;388(10039):29-30

Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Science, Shiraz, Iran.

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http://dx.doi.org/10.1016/S0140-6736(16)30899-6DOI Listing
July 2016

Pentoxifylline treatment in patients with cancer cachexia: A double-blind, randomized, placebo-controlled clinical trial.

Adv Biomed Res 2016 22;5:60. Epub 2016 Mar 22.

Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Cachexia can occur as part of many end-stage or chronic diseases, and chronic obstructive pulmonary disease. This study was aimed to evaluate the effect of Pentoxifylline in patients with cancer cachexia.

Materials And Methods: The present study was conducted as a double-blind randomized controlled trial on 70 patients with advanced malignancy who loss of >5% of ideal or preillness body weight in the previous 2 months. Patients were assessed in two groups: case group, under treatment, using Pentoxifylline (400 mg) three times a day, for 2 months, and in the control group, patients received placebo. Age, sex, weight change, change in arm circumference and quality of life were assessed at baseline, week-4 and week-8.

Results: The mean age of the patients was 56 ± 17.3 years and 47% were female. Weight and arm circumference decreased during follow-up in both groups, but these differences between case and controls were not statistically significant. Quality of life (QOL) score in the case group improved after 4 weeks then decreased at the end of treatment but in the control group QOL score decreased during 2 month treatment. In week-4 patients in the case group significantly reported higher score of QOL compare to patients in the control group (P = 0.029).

Conclusion: Results of this study demonstrated that Pentoxifylline in the treatment of cancer cachexia did not have any effect in weight gain and arm circumference in cachectic patients. But in short-term (1 month) treatment, QOL was improved in these patients. And after 2 month treatment this was not effective compared to placebo.
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http://dx.doi.org/10.4103/2277-9175.179182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832883PMC
May 2016