Publications by authors named "Morteza Hashemian"

13 Publications

  • Page 1 of 1

Amplatz versus Balloon for Tract Dilation in Ultrasonographically Guided Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

Biomed Res Int 2019 3;2019:3428123. Epub 2019 Jan 3.

Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences (KMU), Kerman, Iran.

Purpose: To compare balloon with Amplatz for tract dilation in totally ultrasonographically guided PCNL (UPCN).

Methods: We randomized 66 patients candidate for sonographically guided PCNL in the flank position in two study groups. In the first group, we used single step Amplatz dilation (AG) technique in which the 28- or 30-French Amplatz dilator is used for tract dilation. In the other group, we dilated the tract using balloon dilator (BG). We compared procedure time, success rate of dilation, and postoperative clinical outcomes and cost between two groups.

Results: The rate of short dilation was higher in the Amplatz group (57.6%) compared with Balloon group (36.4%) (P=0.08). When using Amplatz for lower pole access, short dilation occurred in 81% of cases compared with 44% in the BG (P=0.02). Overall operation was longer in the AG (80±21 versus 65±20 minutes P=0.02). Stone free rate was 87.9% in the AG compared with 72.7% in the BG (p=0.12). Mean cost of the surgery was 603±85 USD and 718±78 USD in the AG and BG, respectively (P=0.0001). Hemoglobin drop, transfusion rate, renal function alteration, duration of hospitalization, and complication rate based on Clavien classification were similar in both groups.

Conclusions: AG showed a higher rate of short dilation compared with BG; consequently, overall operating time was significantly longer in the AG whereas BG was significantly more expensive than AG. Bleeding and other complications were similar in two groups. We observed an advantage for balloon dilation over Amplatz when approaching the lower pole calyxes.
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May 2019

Impact of Ondansetron on Withdrawal Signs, Fentanyl Requirement and Pain Relief in Opioid-addicted Patients under General Anesthesia.

Curr Clin Pharmacol 2019 ;14(3):232-241

Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran.

Background: Serotonin 5-HT3 receptor antagonists such as ondansetron have been investigated to attenuate opioid withdrawal signs in studies.

Objective: Therefore, we designed a randomized double-blinded placebo-controlled trial to evaluate this effect on opioid-addicted patients who were admitted to the orthopedic department for surgery due to bone fractures.

Methods: Male adults who were addicted to opioids, aged 18 to 79 years were enrolled (n=96) and randomized into intravenous doses (4 & 8 mg) of ondansetron (n=32) and placebo (n=32). The vital signs, withdrawal symptoms and the frequency requirement of fentanyl were recorded during anesthesia, and opioid (pethidine) analgesic was received during the recovery period. Outcome parameters were analyzed for reduction of withdrawal symptoms in addicted adults.

Results: We indicated that ondansetron demonstrated significant differences with few vital outcomes including systolic blood pressure (SBP) 20 (SBP3) and 50 min (SBP4) after injection of ondansetron during the period of surgery. Ondansetron could also significantly reduce the frequency requirement of fentanyl at 20 min (dose 3) in general anesthesia. Furthermore, requirement for further administration of opioid analgesic drugs such as pethidine was significantly reduced in the ondansetron groups. Objective opioid withdrawal scale (OOWS) results indicated that few clinical parameters including tremor, hot and cold flushes and anxiety were significantly attenuated in addicted patients who received ondansetron.

Conclusion: This study demonstrated supporting evidence for the beneficial treatment of ondansetron for the control of withdrawal symptoms and pain in addicted patients, and more clinical studies are suggested in this regard.
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August 2020

Preoperative Oral Pregabalin Reduces Acute Pain after Thoracotomy.

Open Access Maced J Med Sci 2018 Sep 18;6(9):1606-1610. Epub 2018 Sep 18.

Department of Anesthesia, Afzalipoor Hospital, Kerman University of Medical Sciences, Iran.

Background: Nowadays pain control is one of the most important challenges for physicians, surgeons and anesthesiologists. New drugs and procedures to control pain have always been a major topic for researches.

Aim: In this study, we evaluated the effects of preoperative pregabalin administration on relieving postoperative pain after thoracotomy surgery.

Materials And Methods: This study is a randomised, double-blind clinical trial, performed on 60 patients who underwent thoracotomy at Afzalipour hospital in Kerman, Iran. They were divided into case and control groups. Two hours before surgery an oral capsule of 300 mg pregabalin or placebo was given to patients. All patients similarly underwent general anaesthesia. Pain, nausea and vomiting were evaluated based on the visual analogue scale (VAS) and frequency. This study was verified and obtained the ethics committee code of K/92/489 from Kerman University of Medical Sciences.

Results: The average age of the pregabalin group was 39.7 ± 5.8 years and the control group 41.3 ± 6.1 years. The average pain score after regaining consciousness was 6.1 ± 0.2 in the case group and 7.9 ± 0.1 in the control group, and there was a significant difference between the 2 groups (p-value = 0.002). In the control group, 2 patients and the intervention group 3 patients, experienced nausea and vomiting. There was a significant difference between the overall average pethidine consumption and the average visual analogue scale in both groups.

Conclusion: Pregabalin administration before thoracotomy is effective to reduce postoperative pain in patients. More research is needed to determine the optimal dose of pregabalin for preoperative administration.
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September 2018

Measuring serum albumin levels at 0 and 24h: Effect on the accuracy of clinical evaluations in the prediction of burn-related mortality.

Burns 2018 05 1;44(3):709-717. Epub 2018 Feb 1.

Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran. Electronic address:

Objectives: To evaluate whether measuring serum albumin levels in clinical assessments affects the accuracy of mortality predictions in large burns and to compare patients' serum albumin levels at hour 0(Alb0h) and hour 24(Alb24h) following their admission.

Methods: This prospective observational study was performed at an academic burn unit. Aged between 16 and 65, patients who presented with burns on more than 20% of total body surface area (%TBSA) were included. Patients with severe comorbidities, concomitant trauma or referred from other centres were excluded from the study. The main variables in the study were Alb0h, Alb24h and Abbreviated Burn Severity Index (ABSI) scores. The primary outcome was in-hospital mortality.

Results: In a population of 105 patients, %TBSA, being female, inhalational injury, Alb0h, Alb24h and ABSI score (p<0.001) and the presence of a full thickness injury (p=0.008) were associated with mortality. In the multivariable analysis, ABSI scores and Alb24h remained in the model (OR, 2.32 and 0.06, respectively). The area under curves (AUCs) were 0.94, 0.97 and 0.97 for ABSI, ABSI+Alb0h and ABSI+Alb24h, respectively. No significant difference among the AUCs was seen, but adding Alb0h and Alb24h improved the mortality predictions of ABSI by 5 (4.7%) and 4 (3.8%) patients, respectively. Alb0h (at 3.5g/dL) and Alb24h (at 2.4g/dL) showed 84-85% and 88-85% sensitivity-specificity for mortality, respectively.

Conclusion: Measuring serum albumin levels in clinical assessments slightly increases the accuracy of mortality predictions; however, different cut-off points for Alb0h and Alb24h needs to be considered to avoid interpretation errors.
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May 2018

Physician expertise and cultural issues may play role in the results of ultrasound guided inter-scalene brachial plexus block.

Am J Emerg Med 2018 04 4;36(4):718-719. Epub 2018 Jan 4.

Department of emergency medicine, Kerman University of Medical Sciences, Kerman, Iran; Bahonar Hospital, Gharani St, Kerman, Iran. Electronic address:

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April 2018

Impact of dexmedetomidine on hemodynamic changes during and after coronary artery bypass grafting.

Ann Card Anaesth 2017 Apr-Jun;20(2):152-157

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

Objective: To determine the effect of dexmedetomidine (Dex) on hemodynamic changes during cardiopulmonary pump and postoperative period in coronary artery bypass grafting (CABG).

Methods And Design: This study is designed as a double-blinded, randomized clinical trial.

Setting: University hospital and single center.

Participants: patients candidate for elective CABG.

Intervention: Dex 0.5 μg/kg/h or placebo was infused from the initiation of anesthesia up to extubation in Intensive Care Unit (ICU).

Measurements: Heart rate (HR) and blood pressure (BP), pain score, and total morphine dose requirement were monitored and compared during cardiac pump up to 12 h postoperative in ICU.

Results: Mean arterial pressure was significantly higher in Dex group in postoperation period at 1 (P = 0.010) and 2 h (P = 0.002) compared to control group. HR was significantly lower in Dex group in postcardiopulmonary bypass (CPB) time at 0 h (P = 0.001), 1 h (P = 0.0016), and 2 h (P = 0.001), and then in postoperative period in ICU at 1 h (P = 0.025), 2 h (P = 0.0012), and 4 h (P = 0.0025) compared to control group. Postoperative pain score was significantly lower during 12 h after surgery.

Conclusion: Dex could effectively blunt hemodynamic response to surgical stress, particularly during CPB pump and afterward. Infusion of Dex maintains BP at higher range and HR at lower range compared to placebo.
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November 2017

The Effect of Pre-Emptive Dexmedetomidine on the Incidence of Post-Thoracotomy Pain Syndrome in Patients Undergoing Coronary Artery Bypass Grafting.

Anesth Pain Med 2016 Jun 6;6(3):e36344. Epub 2016 Jun 6.

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

Background: Post-thoracotomy pain syndrome (PTPS) is pain that recurs or persists along a thoracotomy incision for at least two months following surgery. Dexmedetomidine (dex) is an α-2 agonist that also has analgesic, sedative-hypnotic, and sympatholytic properties.

Objectives: To determine the effect of pre-emptive dexmedetomidine on the incidence of PTPS in patients undergoing coronary artery bypass grafting (CABG).

Patients And Methods: This randomized clinical trial enrolled 104 candidates for elective coronary artery bypass grafting (CABG) and randomly assigned them to either a dex group or a control group. In the dex group, dexmedetomidine 0.5 µg/kg/hour was infused from the initiation of anesthesia until postoperative extubation in the intensive-care unit. Two months after surgery, the patients were contacted by telephone and interviewed to determine the presence of pain at the thoracotomy scars.

Results: Fifty-four patients were placed in the control group, and 50 patients were assigned to the dex group. The age, sex, and body mass index were not significantly different between the two groups of study (P > 0.05). The incidence of PTPS was 11/50 (22%) patients in the dex group and 28/54 patients (52%) in the control group. A chi-square test revealed a significant difference in the incidence of PTPS after two months between the dex and control groups (P = 0.032).

Conclusions: PTPS is a common problem following CABG, and pre-emptive therapy with dex may decrease neuropathic pain.
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June 2016

Survey on Hypothermia and Hyperthermia in Poisoned Patients in a Unique Referral Hospital, Tehran, Iran.

Iran Red Crescent Med J 2016 Apr 9;18(4):e35483. Epub 2016 Apr 9.

Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Background: Body temperature is a critical criterion of health. Drugs and a variety of poisons can affect body temperature in poisoned patients, causing hyperthermia and hyperpyrexia.

Objectives: Our previous study's findings in patients poisoned with organophosphate led us to the goal of this study: obtaining the initial tympanic temperature in patients poisoned by a variety of toxins.

Materials And Methods: A cross-sectional study reviewed the records of poisoned patients who were admitted to the toxicological intensive care unit (TICU) at Loghman Hakim hospital poison center (LHHPC) from February 2014 to February 2015. The data collected included gender, age, type of poisoning, the season during which poisoning occurred, vital signs, initial tympanic temperature (first four hours), presence of seizures, white blood cell (WBC) count, creatinine phosphokinase (CPK), length of stay and patient outcome. We determined the mean (SD) for normally distributed continuous variables, the median and interquartile range for non-normally distributed continuous variables, and the absolute and relative frequency (%) for categorical variables. All were determined using SPSS version 16.

Results: Data were collected from 310 eligible patients. The mean patient age was 32.65 (with a standard deviation of 14.40). Of the patients in the study, 183 (59%) were male. Intentional poisoning in an attempted suicide was documented in 253 (81.6%) patients. The most prevalent poisoning agent was aluminum phosphate (18.70%), followed by methadone (10%) and opium (10%). Seventy percent of the patients (n = 217) were diagnosed and classified with fever or hyperthermia. A temperature ≥ 40°C was detected in just three cases. The highest mean temperature was found in patients poisoned with amphetamine, organophosphate and tramadol. Patients with alcohol and phenobarbital poisoning were included in the sample, but these patients were not diagnosed with hypothermia. WBC ≥ 10,000 cells/mL and CPK ≥ 975 IU/L were recorded in 57.7% and 13.2% of subjects, respectively.

Conclusions: Body temperature changes in human poisonings are a matter in need of special attention. A literature review did not reveal any controversy over hypothermia, but poisoning cases exhibit a variety of patterns of fever and hyperthermia. If there are no limits to the diagnosis of fever and hyperthermia, all cases with a poor prognosis which fail to respond to treatment could be categorized as drug-induced hyperthermia. Therefore, a different approach is needed for poisoning cases.
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April 2016

Central Nervous System Depressants Poisoning and Ventilator Associated Pneumonia: An Underrated Risk Factor at the Toxicological Intensive Care Unit.

Iran Red Crescent Med J 2016 Jan 13;18(1):e30989. Epub 2016 Jan 13.

Plastic Surgery Department, 15 Khordad Hospital Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Background: Ventilator-Associated Pneumonia (VAP) is the main cause of nosocomial infection at intensive care units (ICUs), which causes high mortality and morbidity.

Objectives: The objective of the present survey was to identify the VAP risk and prognostic factors among poisoned patients, who were admitted to the toxicological ICU (TICU), especially central nervous system (CNS) depressants due to their prevalence and importance.

Patients And Methods: A case-control study was conducted at the Loghman Hakim hospital between March 2013 and March 2014. Among 300 poisoned patients with mechanical ventilator ≥ 48 hours, 150 patients, who had developed microbiologically-confirmed VAP were considered as the VAP group and 150 without VAP were defined as the control group. The following data were collected; age, gender, type of poisoning, glasgow coma score, Acute physiology and chronic health evaluation (APACHE) II score, length of hospital stay, previous antibiotic use, microbial culture of the trachea, body temperature, leukocyte count, and patients' outcome. Based on the type of poisoning, patients were divided into three groups including: opioid, CNS depressants and others. All data were expressed as means (SD) for continuous variables and frequencies for categorical variables. Logistic regression was used to determine the relationship between risk factors and VAP.

Results: The mean age of the patients was 33.9 ± 14.3 years. The probable VAP incidence and mortality were 22% and 18.6%, respectively. The rate of CNS depressant versus opioid use (odds ratio, 3.74; P < 0.027), APACHE II (odds ratio, 1.28; P < 0.000) and length of hospital stay (odds ratio, 2.15; P < 0.000) were the independent risk factors for VAP. While, the APACHE II score (odds ratio, 1.12; P < 0.044) and length of hospital stay (odds ratio, 2.15; P < 0.000) were the independent predictors of VAP mortality among these patients. The most common microorganisms in VAP cases were Methicillin-Resistant Staphylococcus aureus (MRSA) and Acinetobacter sp. (56.7% and 12.7%, respectively).

Conclusions: Central nervous system depressant was an important risk factor for VAP among poisoned patients. Hypoventilation due to CNS depression can lead to VAP. The APACHE II and length of hospital stay were shown as independent predictors of VAP and mortality among these patients.
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January 2016

VAP or poisoning; which one has more effect on patients' outcomes in toxicological ICU?

Acta Biomed 2015 Apr 27;86(1):63-8. Epub 2015 Apr 27.

Department of Anesthesiology, Bahonar Hospital, Kerman Medical University, Tehran, Iran.

Background: Ventilator-associated pneumonia (VAP) is the main cause of acquired infections in ICUs. Every year, millions of people suffer from poisoning by various substances. Our aim was to determine the association between VAP incidence and different kinds of toxicity among Toxicological ICU (TICU) patients. 

Materials And Methods: Poisoned patients with diagnosis of VAP were enrolled to our retrospective study at TICU of Loghman Hakim Hospital. Data was collected through the medical records. The statistical analysis was performed with SPSS (version 16, Chicago, IL, USA).

Results: Among 675 patients with MV > 48 h, 150 patients had the diagnosis of VAP.  Mean age was 36.6 years. 74.7% were males. Intentional poisoning was 70.3%. The incidence of VAP was 22%. The higher incidence of VAP was recorded in anti depressants and opioid toxicities. The majority of bacterial isolates (81.3%) were multi drug resistance. MRSA accounted for 50.7% of VAP cases. Non survivors' hospital length of stay (mean = 18.7days) was significantly higher than survivors (12.8). The hospital length of stay in VAP patients was highest in the Acinetobacter spp (mean > 20 days). Mortality rate of VAP cases was 18.6%.

Conclusion: No specific association was detected between incidence of VAP and different kinds of toxicity, while Anti Depressants and opioids had high VAP incidence, in a Quarter of this population. It is noticeable that pesticide had the lowest incidence for its short hospitalization. In our TICU, MRSA and Acinetobacter spp were the main agents leading to VAP and prolonged ICU stay, respectively. (
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April 2015

High Body Mass Index and Young Age Are not Associated with Post-Mastectomy Pain Syndrome in Breast Cancer Survivors: A Case-Control Study.

Iran J Cancer Prev 2015 Jan-Feb;8(1):29-35

Dept. of Clinical Nutrition and Dietetic, National Institute and Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Surgery is usually the first treatment for breast cancer which is followed by some complications such as chronic pain. Post mastectomy pain syndrome (PMPS) is a common complication among breast cancer survivors and is considered as a chronic neuropathic pain in the side of surgery which persists more than three months. The exact mechanisms and related risk factors of the chronic pain after breast surgery are unknown. The aim of this study was to investigate the association of body mass index (BMI) and age with PMPS.

Methods: In this case-control study, a total of 122 women were assessed; of these, 61 women were diagnosed with PMPS and selected as cases and 61 pain-free patients were selected as controls. The demographic and clinical characteristics of participants were collected through questionnaires and medical record of patients. Logistic regression model was used to determine the association of BMI and age with PMPS, adjusted for demographic and clinical characteristics.

Results: No significant differences were found in means of weight (68.02±8.80 vs. 68.67±11.82, p=0.726), BMI (26.38±3.28 vs. 27.10±6.03, p=0.410), and age (46.34±11.67 vs. 48.54±12.57, p=0.319) between those with PMPS and those not reporting PMPS. A non-significant slight increase in odds ratio of PMPS was observed in obese category compared to normal weight category [OR=1.152 (95% CI 0.405-3.275), p=0.908], but after adjusting the confounding factors, the risk of pain development was attenuated in obese subjects [OR=0.748 (95% CI 0.228-2.459), p=0.633]. Also, non-significant decrease in odds ratios of PMPS was found in 20-39 y, 40-49 y, and 50-59 y ages categories compared to oldest age category [adjusted OR= 0.781 (95% CI 0.213-2.866), p=0.576; adjusted OR=0.485 (95% CI 0.152- 1.554), p=0.183; adjusted OR=0.735 (95% CI 0.206-2.627), p=0.628; respectively].

Conclusion: In contrast with some observational studies, present study showed that high BMI and younger age might not be associated with increased risk of PMPS development. Further research is necessary to determine the main risk factors and directionality and causal mechanisms for associations of these risk factors with chronic pain after mastectomy.
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March 2015

Effect of pulsed radiofrequency in treatment of facet-joint origin back pain in patients with degenerative spondylolisthesis.

Eur Spine J 2014 Sep 6;23(9):1927-32. Epub 2014 Jul 6.

Department of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Fereshteh St, Tehran, Iran.

Background: Degenerative spondylolisthesis is a well-recognized source of low back pain mainly induced by facet joint pain. Pulsed radiofrequency (PRF) allows heat dissipation, thus producing a temporary injury that affects only type C fibers responsible for pain conduction.

Objectives: We attempted to test whether PRF is a better choice for facet pain due to spondylolisthesis compared to routine steroid injection.

Methods: Patients were randomly assigned to one of two groups: group one received pulsed RF, and group 2 received injection by steroids (triamcinolone) and bupivacaine.

Outcomes Assessment: Multiple outcome measures were utilized which included the numeric rating scale (NRS), the Oswestry Disability Index (ODI), satisfaction status, and analgesic intake with assessment at 3, 6, and 12 months post-treatment. Significant pain relief was defined as 50% or more, whereas significant improvement in disability score was defined as reduction of 40% or more.

Results: Eighty patients were enrolled in the study and were divided into the two groups of study. PRF significantly reduced NRS at 6-month follow-up compared to steroid + bupivacaine. 75.6 ± 14.3% at pre-treatment and 19.3 ± 9.5% at 6 months (p = 0.001) in PRF group. The mean ODI is depicted in two groups of study (Fig. 1). Interestingly, ODI% was significantly lower in PRF group at 12 weeks and 6 months compare to steroid + bupivacaine group (p = 0.022 and 0.03, respectively), but it was not significantly different at 6 weeks (p = 0.31). Proportion of patients who did not require analgesics were significantly higher in PRF group compared to other group (p = 0.001) in Log-rank (Mantel-Cox) test.

Conclusion: Our results demonstrated that the application of PRF might be more effective than steroid and bupivacaine injection in decreasing back pain due to degenerative facet pain and improvement in function of patients.
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September 2014

Long-term relapse of ultra-rapid opioid detoxification.

J Addict Dis 2014 ;33(1):33-40

a Department of Anesthesiology, Loghman Hakim Hospital , Shahid Beheshti University of Medical Sciences , Tehran , Iran.

Ultra-rapid opioid detoxification (UROD) and subsequently induction of naltrexone maintenance therapy can be regarded as a safe and effective detoxification method for use in patients with opiate addiction. Long-term efficacy, relapse time, and relapse rate of this method is not clear. The aim of this article was to assess UROD efficacy and estimate the relapse rate in the 2-year follow-up period. Opioid-addicted, self-reporting patients referred to our hospital center were enrolled. All demographic data were collected by direct interview and based on patients' official documents. Addiction information were obtained from the patients' own admission and the interviews. Patients then began the UROD process. Thereafter, patients were scheduled for follow-up visits every 3 months for a 2-year period. A total of 424 patients were enrolled in the study and entered the UROD program, of which 400 patients completed. Of the total patients, 303 (75.75%) were successful (successful group) and 97 (24.25%) relapsed (relapse group). The unemployment rate was significantly higher in the relapse group (76%) compared with those in the successful group (21%) (P = .02). No patients in the relapse group continued naltrexone maintenance at 6-month follow-up, which was significantly lower than successful group (75.8%) (P < .05). The relapse rate was 14% at the first month visit and 24% at the 6 month and thereafter. All patients who had a relapse incident discontinued use of naltrexone before relapse happened. UROD could be an effective method of detoxification in addicted patients, but case selection, sticking to the guidelines, and maintenance therapy accompanied with social support is necessary to minimize relapse and withdrawal symptoms.
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December 2014