Publications by authors named "Nasrin Shoar"

30 Publications

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Recurrent coronavirus diseases 19 (COVID-19): A different presentation from the first episode.

Clin Case Rep 2021 Feb 23. Epub 2021 Feb 23.

Department of Clinical Research Scientific Writing Corporation Houston TX USA.

A 31-year-old Caucasian male developed reinfection with SARS-CoV-2, 2 ½ months after an initial episode of ICU admission for respiratory support due to COVID-19. The second episode was in the form of malaise, aphthous gingival ulcer, and desquamating palmar lesion.
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http://dx.doi.org/10.1002/ccr3.3967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013608PMC
February 2021

Intrathoracic gastric fistula after bariatric surgery: a systematic review and pooled analysis.

Surg Obes Relat Dis 2021 Mar 7;17(3):630-643. Epub 2020 Nov 7.

Department of Surgery, Metropolitan Hospital Center, New York Medical College, New York, NY.

Even in the hands of highly experienced bariatric surgeons, perioperative complications are inevitable. Of these, leaks and fistulas are amongst the scariest complications. Intrathoracic gastric fistulas (ITGF) can be associated with serious morbidity, mostly when cases are misdiagnosed or detected with delay. This is a systematic review of the literature to investigate the clinical and surgical outcomes of morbidly obese adult patients with a confirmed diagnosis of ITGF following bariatric surgery. A pooled analysis of 25 articles, encompassing 76 patients with post-bariatric ITGF, showed that the clinical outcome depends on the initial presentation, timing of the diagnosis in relation to symptom onset, and prompt and effective treatment. Any septic or unstable patient must undergo urgent surgical intervention, while stable patients might tolerate a step-up approach and watchful waiting for nonsurgical treatment. Among those who undergo surgery, treatment failure and the mortality rate are substantially high. Contingent upon a prompt management strategy, patients with postbariatric ITGF can generally have a favorable outcome in the long term.
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http://dx.doi.org/10.1016/j.soard.2020.10.030DOI Listing
March 2021

Effect of pre-existing left bundle branch block on post-procedural outcomes of transcatheter aortic valve replacement: a meta-analysis of comparative studies.

Am J Cardiovasc Dis 2020 15;10(4):294-300. Epub 2020 Oct 15.

The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai NY, USA.

Background: As an established procedure for patients with aortic valve stenosis and a high surgical risk profile, transcatheter aortic valve replacement (TAVR) can be associated with conductance abnormalities. However, data regarding the impact of pre-existing left bundle branch block (LBBB) on post-TAVR outcome is scarce.

Objectives: We conducted this meta-analysis to pool available data in the literature on the impact of pre-existing LBBB on the clinical outcomes of patients undergoing TAVR.

Methods: We queried Medline/PubMed, Scopus, and Cochrane Library to identify comparative studies of patients with and without a pre-existing LBBB undergoing TAVR for aortic stenosis. Risk ratio (RR) and the corresponding 95% confidence interval (95% CI) were estimated to measure the effect of pre-existing LBBB on developing post-procedure stroke, permanent pacemaker implantation (PPM), or moderate/severe aortic regurgitation (AR).

Results: Data of three clinical trials encompassing 4,668 patients undergoing TAVR were included in this meta-analysis. Patients with pre-existing LBBB prior to TAVR had an increased risk of developing moderate/severe AR (RR = 1.04 [0.79-1.37]; P = 0.77), stroke (RR = 1.72 [0.61-4.85]; P = 0.31), and a need for PPM implantation (RR = 4.43 [0.43-45.64]; P = 0.21) following TAVR.

Conclusion: Preexisting LBBB seems to increase the risk of developing stroke, aortic regurgitation, and the need for a permanent pacemaker implantation. However, due to scarcity of data and high heterogeneity among the current studies, further clinical trials are warranted.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675150PMC
October 2020

Effect of pre-existing left bundle branch block on post-procedural outcomes of transcatheter aortic valve replacement: a meta-analysis of comparative studies.

Am J Cardiovasc Dis 2020 15;10(4):294-300. Epub 2020 Oct 15.

The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai NY, USA.

Background: As an established procedure for patients with aortic valve stenosis and a high surgical risk profile, transcatheter aortic valve replacement (TAVR) can be associated with conductance abnormalities. However, data regarding the impact of pre-existing left bundle branch block (LBBB) on post-TAVR outcome is scarce.

Objectives: We conducted this meta-analysis to pool available data in the literature on the impact of pre-existing LBBB on the clinical outcomes of patients undergoing TAVR.

Methods: We queried Medline/PubMed, Scopus, and Cochrane Library to identify comparative studies of patients with and without a pre-existing LBBB undergoing TAVR for aortic stenosis. Risk ratio (RR) and the corresponding 95% confidence interval (95% CI) were estimated to measure the effect of pre-existing LBBB on developing post-procedure stroke, permanent pacemaker implantation (PPM), or moderate/severe aortic regurgitation (AR).

Results: Data of three clinical trials encompassing 4,668 patients undergoing TAVR were included in this meta-analysis. Patients with pre-existing LBBB prior to TAVR had an increased risk of developing moderate/severe AR (RR = 1.04 [0.79-1.37]; P = 0.77), stroke (RR = 1.72 [0.61-4.85]; P = 0.31), and a need for PPM implantation (RR = 4.43 [0.43-45.64]; P = 0.21) following TAVR.

Conclusion: Preexisting LBBB seems to increase the risk of developing stroke, aortic regurgitation, and the need for a permanent pacemaker implantation. However, due to scarcity of data and high heterogeneity among the current studies, further clinical trials are warranted.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675150PMC
October 2020

Regarding the publication "Rivaroxaban versus warfarin in patients with non-valvular atrial fibrillation and stage IV-V chronic kidney disease".

Am Heart J 2020 05 6;223:110. Epub 2020 Mar 6.

Department of Surgery, Metropolitan Hospital Center, New York Medical College, Manhattan, NY.

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http://dx.doi.org/10.1016/j.ahj.2020.03.001DOI Listing
May 2020

Letter to the Editor Concerning "Glycosylated Hemoglobin as a Surrogate for the Prediction of Cardiovascular Events in Cardiovascular Outcome Trials Comparing New Antidiabetic Drugs to Placebo".

Cardiology 2020 30;145(6):388-389. Epub 2020 Apr 30.

Department of Surgery, Metropolitan Hospital Center, New York Medical College, Manhattan, New York, USA.

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http://dx.doi.org/10.1159/000507507DOI Listing
June 2020

Night eating syndrome: a psychiatric disease, a sleep disorder, a delayed circadian eating rhythm, and/or a metabolic condition?

Expert Rev Endocrinol Metab 2019 09 19;14(5):351-358. Epub 2019 Sep 19.

Clinical Research Scientist, ScientificWriting Corporation , Houston , TX , USA.

: Night Eating Syndrome (NES) refers to an abnormal eating behavior which presents as evening hyperphagia consuming >25% calorie intake and/or nocturnal awaking with food ingestion which occurs ≥2 times per week. Although the syndrome has been described more than seven decades ago, the literature has been growing slowly on its etiology, diagnosis, and treatment. : The proposed treatment options for NES are all at a case-study level. Moreover, our understanding of its etiology, comorbidities, and diagnosis is still premature. We performed a literature review in Medline/PubMed to identify all the studies proposing a management plan for NES and summarized all the existing data on its diagnosis and treatment. : To date, none of the proposed treatment options for NES have been promising and long-term data on its efficacy is lacking. The slow growth of evidence on this debilitating but underreported condition may be due to unawareness among clinicians, under-reporting by patients, and unrecognized diagnostic criteria. Objective screening of symptoms during office visits especially for patients at a high-risk for NES will identify more patients suffering from the syndrome.
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http://dx.doi.org/10.1080/17446651.2019.1657006DOI Listing
September 2019

Comment on long-term outcomes of metabolic and bariatric surgery in adolescents with severe obesity with a follow-up of at least 5 years: a systematic review.

Surg Obes Relat Dis 2019 02 14;15(2):349-350. Epub 2019 Jan 14.

Imam Khomeini Complex Cancer Institute, Division of Surgical Oncology, Department of Surgery, Tehran University of Medical Science, Tehran, Iran.

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http://dx.doi.org/10.1016/j.soard.2019.01.004DOI Listing
February 2019

Alteration Pattern of Taste Perception After Bariatric Surgery: a Systematic Review of Four Taste Domains.

Obes Surg 2019 05;29(5):1542-1550

Cancer Institute, Imam Khomeini Hospital Complex, Division of Surgical Oncology, Department of Surgery, Tehran University of Medical Science, Tehran, Iran.

Background: Efforts continue to understand the underlying mechanism of weight loss after bariatric surgery. Taste perception has shown to be a contributing factor. However, the alteration pattern in different taste domains and among bariatric procedures has not been sufficiently investigated.

Objectives: To study the alteration pattern in the perception of four taste domains after different bariatric procedures.

Settings: Private Research Institute, USA.

Methods: A systematic review was conducted to pool available data in the literature on post-operative changes in the perception of sensitivity to four taste domains after Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and adjustable gastric banding (AGB).

Results: Our study showed that bariatric surgery is associated with significant change in sensitivity to all four taste domains especially salt taste, sweetness, and sourness. LSG patients showed an increased sensitivity to all four taste domains. However, RYGB patients had a variable alteration pattern of taste perception but more commonly a decreased sensitivity to sweetness and an increased sensitivity to salt taste and sourness. Additionally, AGB patients had a decreased sensitivity to sweetness, salt taste, and sourness.

Conclusion: Bariatric surgery is associated with taste change in a way which results in less preference for high-calorie food and possibly reduced calorie intake. This may explain one of the mechanisms by which bariatric surgery produces weight loss. However, data are heterogeneous, the potential effect dilutes over time, and the alteration varies significantly between different procedures.
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http://dx.doi.org/10.1007/s11695-019-03730-wDOI Listing
May 2019

Letter to the editor on "Suspicious Index in Lyme Carditis (SILC): Systematic review and proposed new risk score".

Clin Cardiol 2018 12 5;41(12):1617-1618. Epub 2018 Dec 5.

Clinical Research Scientist and Consultant, ScientificWriting Corp, Houston, Texas.

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http://dx.doi.org/10.1002/clc.23122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489911PMC
December 2018

Single-Incision Laparoscopic Colectomy with Complete Mesocolic Excision Versus Multiport Laparoscopic Colectomy for Colon Cancer.

Dis Colon Rectum 2017 11;60(11):e631

1Division of Colorectal Surgery, Houston Methodist Hospital, Houston, Texas 2Department of Surgery, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, University of Medical Sciences, Tehran, Iran 3Department of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran.

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http://dx.doi.org/10.1097/DCR.0000000000000937DOI Listing
November 2017

Letter to the editor regarding "weight regain in patients with symptoms of post-bariatric surgery hypoglycemia".

Surg Obes Relat Dis 2017 11 19;13(11):1935-1936. Epub 2017 Jul 19.

Department of Bariatric and Metabolic Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, New York.

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http://dx.doi.org/10.1016/j.soard.2017.07.010DOI Listing
November 2017

Long-Term Outcome of Bariatric Surgery in Morbidly Obese Adolescents: a Systematic Review and Meta-Analysis of 950 Patients with a Minimum of 3 years Follow-Up.

Obes Surg 2017 12;27(12):3110-3117

Department of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran.

Background: Obesity in pediatric and adolescent population has reached a universal pandemic. This study aimed to summarize the literature on the longest available outcome of bariatric surgery in morbidly obese adolescents.

Methods: A systematic review was conducted to pool available data on the longest available (>3 years) weight loss and comorbidity resolution outcome in adolescent bariatric surgery.

Results: A total of 14 studies reporting the result of bariatric surgery after 3 years in 950 morbidly obese adolescents were included. Preoperative age and BMI ranged from 12 to 19 years and from 26 to 91 kg/m, respectively. Females were the predominant gender (72.8%). Laparoscopic roux-en-Y gastric bypass (n = 453) and adjustable gastric banding (n = 265) were the most common bariatric procedure performed. The number of patients at the latest follow-up was 677 (range from 2 to 23 years). On average, patients lost 13.3 kg/m of their BMI. Among comorbidities, only diabetes mellitus resolved or improved dramatically. Of 108 readmissions, 91 led to reoperation. There was a weight regain < 5 kg/m between 5 and 6 years of follow-up. Removal, exchange, or conversion of the previous band constituted the majority of the revisional procedures. Three deaths were reported. No long-term data was obtainable on nutritional deficiency or growth status of adolescents who underwent a bariatric procedure.

Conclusion: Although bariatric surgery is a safe and effective procedure in the treatment of adolescent morbid obesity, long-term data is scarce regarding its nutritional and developmental complication in this growing population of patients.
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http://dx.doi.org/10.1007/s11695-017-2738-yDOI Listing
December 2017

Bariatric surgery in morbidly obese patients with inflammatory bowel disease: A systematic review.

Surg Obes Relat Dis 2017 Apr 25;13(4):652-659. Epub 2016 Oct 25.

Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Backgrounds: With increased prevalence of obesity, the number of inflammatory bowel disease (IBD) patients suffering from morbid obesity has raised. It is not clear yet if bariatric surgery is a safe and effective option in this population.

Objectives: Our systematic review aims to summarize the available literature on the safety and efficacy of bariatric surgery in morbidly obese patients with IBD.

Setting: University hospital, Iran.

Methods: A PubMed/MEDLINE search was performed to identify studies reporting the outcome of morbidly obese IBD patients. Postoperative outcome of IBD patients after bariatric surgery were pooled for early and late complications, change of IBD status, and medication alteration.

Results: A total of 7 studies reported post-bariatric surgery outcomes of 43 morbidly obese IBD patients (31 females, 11 males) with an age ranging from 30 to 64 years and a body mass index from 35.7 to 71 kg/m. Of these, 25 suffered Crohn's disease (CD) (58.2%) and 18 were ulcerative colitis (UC) patients (41.8%). The small bowel was the most common involved gastrointestinal segment in 27.3% of patients. CD patients more commonly underwent sleeve gastrectomy (72%), while UC patients similarly underwent sleeve gastrectomy and Roux-en-Y gastric bypass (44.4%). After a follow-up of 8 to 77 months, IBD patients lost up to 71.4%±5.9% of excess weight and 14.3 kg/m±5.7 kg/m of body mass index. There were 9 early (21.4%) and 10 late (23.8%) postoperative complications related to the bariatric procedure. IBD remitted in 20 patients (47.6%), improved in 2 patients (4.8%), but exacerbated in 7 patients (16.7%).

Conclusions: Although available data on morbidly obese patients with IBD is scarce, bariatric surgery seems to be a safe and effective option for these patients with no added morbidity or mortality. Further studies are necessary to confirm this data.
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http://dx.doi.org/10.1016/j.soard.2016.10.017DOI Listing
April 2017

Length of second-order chordae as a predictor of systolic anterior motion of the mitral valve.

Interact Cardiovasc Thorac Surg 2016 08 19;23(2):280-5. Epub 2016 Apr 19.

Department of Cardiac Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: The aim of the present study was to ascertain whether the length of anterior mitral leaflet second-order chordae (SOC) could be considered as a predictor of the incidence of post-repair systolic anterior motion (SAM) and left ventricular outflow tract obstruction (LVOTO) in patients with myxomatous mitral valve disease.

Methods: With the implementation of preoperative transoesophageal echocardiography (TEE), the length of anterior mitral leaflet SOC, anterior leaflet (AL) and posterior leaflet (PL) as well as the distance from the coaptation point to the septum (C-S distance) before and after mitral valve repair (MVR) surgery were measured in 190 patients, comprising 12 who developed SAM and 178 who did not.

Results: The results revealed that, in patients who developed SAM, SOC were significantly higher (2.76 ± 0.15 vs 1.83 ± 0.32 mm, P < 0.001) and the C-S distance was significantly lower (2.18 ± 0.36 vs 2.91 ± 0.36 mm, P < 0.001) in comparison to the obtained results for those who did not develop SAM. SOC and the C-S distance were independent risk factors of developing SAM and had the largest area under the receiver operating characteristic (ROC) curve (P < 0.001). With application of a cut-off ROC curve analysis, the cut-offs selected for the two variables of C-S distance and SOC were 2.5 and 2.6, respectively. Sensitivity and specificity of SAM development were 100% [95% confidence interval (CI): 73.5-100] and 87.1% (95% CI: 81.0-91.4) for SOC ≥2.6 and 83.3% (95% CI: 51.6-97.9) and 73.6% (95% CI: 66.4-79.9) for the C-S distance ≤2.5.

Conclusions: The two variables of the second-order chordae and the distance from the coaptation point to the septum were associated with an increased risk of the post-repair systolic anterior motion after mitral valve repair.
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http://dx.doi.org/10.1093/icvts/ivw106DOI Listing
August 2016

Impacts of highly active antiretroviral therapy (HAART) on metabolic status of patients with AIDS: What happens from the initiation of AIDS to the initiation of treatment?

J Res Med Sci 2014 Mar;19(3):246-50

Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran ; School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.

Background: Our study aimed to determine if alteration of metabolic parameters is associated with the severity of human immunodeficiency virus (HIV) infection, progress to acquired immunodeficiency syndrome (AIDS), or with the type of antiretroviral treatment (ART).

Materials And Methods: In a cross-sectional study among 114 HIV infected patients, we measured hematological and biochemical parameters to assess metabolic alterations according to the disease process and anti-retroviral treatment.

Results: Of 114 HIV-positive patients, there were 82 AIDS patients receiving ART and 32 HIV patients without treatment. Alkaline phosphatase and parathyroid hormone (PTH) had lower serum levels in HIV patients with CD4(+) cell count ≤250 (P < 0.01). CD4(+) cell count was higher in patients receiving Protease Inhibitors (PI) and Nucleoside Reverse Transcriptase Inhibitors (NRTI) regimen compared with those treated with Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) and NRTI or NRTI alone. Calcium (Ca) serum level was lower in patients with only NRTI regimen while Phosphorus (P) serum level was higher in patients on NNRTI and NRTI (P < 0.05).

Conclusion: CD4(+) cell count ≤250 cells/μl in HIV-positive patients is associated with decreased level of triglyceride and PTH. Moreover, patients receiving NRTI regimen alone have lower Ca level while this regimen in combination with NNRTI or PI has a positive correlation with P serum level.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061647PMC
March 2014

Aortic root replacement using a modified composite valve graft.

J Card Surg 2014 Jul 6;29(4):523-5. Epub 2014 May 6.

Department of Cardiology, Day General Hospital, Tehran, Iran.

Objectives: We used a modified technique of a composite graft by moving the valve prosthesis away from the end into the inside of the tube and compared the effectiveness of this surgical method with the standard valved conduits.

Methods: Through a prospective nonrandomized clinical study between March 2011 and June 2012, we performed replacement of the aortic valve and ascending aorta in 30 consecutive patients using a valved composite graft with a mechanical valve prosthesis. A modified self-assembled valved composite graft was employed in 20 patients (Modified group), while the remaining 10 patients received the standard composite graft (Control group).

Results: There was significantly less bleeding in the patients with modified grafts (184 vs. 415 mL, p < 0.05). Moreover, the mean transvalvular gradient of the composite graft patients was lower in the modified group than in the control group (9 vs. 14 mmHg, respectively, p < 0.05).

Conclusions: The modified valve composite graft technique results in good hemodynamics and appears to limit blood loss.
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http://dx.doi.org/10.1111/jocs.12353DOI Listing
July 2014

Acupuncture in preventing postoperative nausea and vomiting: efficacy of two acupuncture points versus a single one.

J Acupunct Meridian Stud 2014 Apr 28;7(2):71-5. Epub 2013 Apr 28.

Development Association of Clinical Studies, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.

Despite recent advances in anesthesiology and postoperative care, postoperative nausea and vomiting are common complaints. Although acupuncture techniques have received attention in anesthesiology, the ideal technique and selection of the most appropriate acupuncture points are still under debate. This study compared the efficacy of two simultaneous acupuncture points with that of a single point in the prevention and treatment of postoperative nausea and vomiting following general anesthesia through a double-blind, randomized, controlled trial involving 227 surgical patients undergoing general anesthesia who were randomly assigned into two groups. The first group received acupuncture by stimulation only on the PC6 point (single group), and the second group underwent concomitant stimulation of the PC6 and the L14 acupuncture points (combined group) during surgery under general anesthesia. The prevalences of postoperative nausea and vomiting were compared between the two groups. No significant differences were observed between the two groups (p>0.05). Of 115 patients in the combined group, 80 (69.6%) complained about nausea and vomiting compared with 96 (85.7%) in the single group, a significantly lower proportion (p<0.05). Our findings favor a combination of PC6 and LI4 stimulation for the treatment of postoperative nausea and vomiting.
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http://dx.doi.org/10.1016/j.jams.2013.04.005DOI Listing
April 2014

Low-dose dobutamine stress echocardiography cannot predict mitral regurgitation reversibility after coronary artery bypass grafting.

J Thorac Cardiovasc Surg 2014 Oct 2;148(4):1323-7. Epub 2014 Jan 2.

Department of Cardiac Surgery, Day General Hospital, Tehran, Iran.

Background: The ideal management of ischemic mitral regurgitation (MR) remains a clinical dilemma because of the suboptimal available therapeutic options. Recently, new concepts have emerged, pointing to the benefits of a patient selection approach when debating the management of moderate ischemic MR. We investigated the predictability of low-dose dobutamine stress echocardiography (DSE) in selecting candidates for CABG with moderate MR for valve repair.

Methods: From November 2002 to May 2010, 110 candidates for first-time CABG, who were admitted to the cardiac surgery department in Day General Hospital (Tehran, Iran), were enrolled in the present cross-sectional study. DSE was performed for each case before CABG. Those with positive findings underwent CABG alone and those with negative results underwent concomitant CABG and mitral valve repair. The patients were followed up for a minimum of 60 months.

Results: Of the 110 patients, 47 (42.72%) had positive test results and underwent CABG alone and 63 (57.28%) had negative DSE results and underwent concomitant CABG and mitral valve repair. The MR degree had decreased from 2.8±0.3 preoperatively to 1.46±0.6 early during the hospital stay and 1.9±0.7 during late follow-up in the CABG group. It had decreased from 2.84±0.4 preoperatively to 0.93±0.65 postoperatively but then increased to 1.41±0.9 during late follow-up, for a significant decrease in the combined group (P<.05).

Conclusions: Despite its utility in selecting CABG patients with moderate ischemic MR for valve repair from a short-term perspective, the use of DSE cannot predict the long-term outcomes of these patients.
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http://dx.doi.org/10.1016/j.jtcvs.2013.12.028DOI Listing
October 2014

Attitudes of Obstetricians toward Cesarean Delivery in Challenging Cases.

J Obstet Gynaecol India 2013 Oct 15;63(5):301-5. Epub 2013 May 15.

Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences (TUMS), No. 54, Boostan e Qods (Shilat) Dormitory, Shahed Alley, Qods Street, Keshavarz Boulevard, Tehran, Iran.

Objective: To assess the behavior and preferred delivery method among Iranian obstetricians in challenging cases.

Method: Using the revised Jackson personality inventory questionnaire, the attitudes of obstetricians toward cesarean delivery were assessed in challenging childbirth cases. The study was conducted at the Mashhad University of Medical Sciences in Mashhad, Iran.

Result: Seventy-five obstetricians answered each item reflecting varying levels of preference and risk attitudes. However, a significant number of respondents avoided the risk of requesting a cesarean because of legislation and legal issues.

Conclusion: Iranian obstetricians prefer low-risk behavior for managing ambiguous delivery cases. Fear of legislation and medicolegal issues appear to be of great importance in this cohort primarily comprising female physicians.
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http://dx.doi.org/10.1007/s13224-013-0401-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3798444PMC
October 2013

Extrinsic and intrinsic coagulation pathway, fibrinogen serum level and platelet count in HIV positive patients.

Acta Med Iran 2013 Aug 7;51(7):472-6. Epub 2013 Aug 7.

Division of Pathology, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Infection with human immunodeficiency virus (HIV) is a progressive condition which may cause endothelial dysfunction and liver damage leading to coagulopathy. With adventure of highly active antiretroviral therapy (HAART), life expectancy has prolonged in HIV positive patients but several acquired immunodeficiency syndrome (AIDS)-related conditions such as coagulopathies are responsible for associated morbidity and mortality. This study aimed to evaluate the extrinsic and intrinsic pathways of coagulation, serum level of fibrinogen and platelet count in HIV positive patients and compare it with negative healthy individuals. Through a case-control study, 114 HIV seropositive patients were compared with 114 seronegative samples in terms of hematological and other coagulation parameters. Mean age of study patients was 37.48 years. Intra venous drug abuse was the most common route of infection transmission with a prevalence of more than 50%. HIV route of transmission had a direct relationship with PTT abnormal levels (P<0.0001). However, this relationship was not significant for PT values. Stages of HIV disease and administration of HAART did not reveal any significant relationship with PT and PTT. There was also a statistically significant correlation between CD4+< 200 and PT in case group (P=0.008). On the other hands, in control group, CD4+ had a weak relationship with PTT (P=0.02) and an inverse correlation with serum fibrinogen (P=0.013). Hematological parameters and serum fibrinogen are decreased in HIV positive patients especially in direct relation with CD4+ cell count<200 cell/µl. PT and PTT abnormal values are also more prevalent in this population.
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August 2013

Microorganisms' colonization and their antibiotic resistance pattern in oro - tracheal tube.

Iran J Microbiol 2013 Jun;5(2):102-7

Division of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences Tehran, Iran.

Background And Objectives: Recently, nosocomial infections have been discussed as a critical issue among intubated patients leading to significant morbidity and mortality. Hence, the pattern of microbiological colonization and antibiotic resistance are much valuable in this regard. We aimed to investigate the pattern of microorganism colonization and antibiotic resistance in patients with endotracheal tube or tracheostomy to propose a proper empirical antibiotic therapy in this setting.

Materials And Methods: This cross sectional study was conducted among 880 patients admitted in Imam Khomeini hospital between 2008 and 2011 who were subsequently intubated or underwent tracheostomy due to insufficient self ventilation. Samples for microbiological cultures were obtained after extubation and then sent to the central laboratory for further assessment. Antibiograms and microbiological cultures were obtained for each sample.

Results: Of 880 patients enrolled in this study, 531 (60.3%) were male and 349 (39.7%) were female. Nineteen different organisms were isolated including Acinetobacter (213, 24.2%), Pseudomonas aeruginosa (147, 16.7%), Staphylococcus aureus (106, 12%), Proteus mirabilis (90, 10.2%), and other organisms (324, 36.8%). Antibiotic resistance was mainly seen in Acinetobacter (ciprofloxacin, ceftazidim, cefepim, and penicillin), S. aureus (imipenem) and Klebsiella (pipracillintazobactam and ampicillin-sulbactam).

Conclusion: This study represents the most common microorganisms colonizing tracheal tube of hospitalized patients and their pattern of antibiotic resistance. Acinetobacter was the most common microorganism isolated from endotracheal tube. Hence, it may be possible to initiate the empiric antibiotic treatment before the results of culture are become available. Ciprofloxacin was also the most prevalent antibiotic revealing resistant pattern. Moreover, most of the microorganisms were sensitive to imipenem and pipracillin-tazobactam.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3696843PMC
June 2013

Acupuncture in preventing postoperative anaesthesia-related sore throat: a comparison with no acupuncture.

Acupunct Med 2013 Sep 10;31(3):272-5. Epub 2013 May 10.

Department of Anesthesiology and Intensive Care, AJA University of Medical Sciences, Tehran, Iran.

Background: Postoperative sore throat occurs frequently in surgical patients as a result of tracheal intubation. Despite advances in medical and anaesthetic care, the incidence of postoperative sore throat remains high. Our study aimed to assess the efficacy of acupuncture in the prevention of postoperative sore throat following general anaesthesia.

Methods: A non-randomised clinical study (NRS) was carried out in a tertiary care hospital in Tehran, Iran on 228 consecutive patients undergoing elective surgeries under general anaesthesia. Of these, 114 patients were assigned to the acupuncture group and treated with body acupuncture at the PC6 point, while the remaining 114 patients received no preventive care and were treated with routine medical treatment where necessary. The incidence of sore throat within the first 24 h postoperatively was then compared between the two study groups.

Results: Of the 114 patients in the acupuncture group, 16 patients (14%) experienced sore throat within the first 24 h postoperatively, which was significantly lower compared to the 34 patients (29.8%) with sore throat in the medical treatment group (p<0.05). However, the frequency of patients with severe sore throat requiring medical treatment did not differ significantly (12.3% vs 16.7%, p>0.05).

Conclusions: Our study suggests that acupuncture could be considered as an option in prevention of postoperative anaesthesia-related sore throat.
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http://dx.doi.org/10.1136/acupmed-2012-010249DOI Listing
September 2013

Acupuncture in preventing postoperative anaesthesia-related sore throat: a comparison with no acupuncture.

Acupunct Med 2013 Sep 10;31(3):272-5. Epub 2013 May 10.

Department of Anesthesiology and Intensive Care, AJA University of Medical Sciences, Tehran, Iran.

Background: Postoperative sore throat occurs frequently in surgical patients as a result of tracheal intubation. Despite advances in medical and anaesthetic care, the incidence of postoperative sore throat remains high. Our study aimed to assess the efficacy of acupuncture in the prevention of postoperative sore throat following general anaesthesia.

Methods: A non-randomised clinical study (NRS) was carried out in a tertiary care hospital in Tehran, Iran on 228 consecutive patients undergoing elective surgeries under general anaesthesia. Of these, 114 patients were assigned to the acupuncture group and treated with body acupuncture at the PC6 point, while the remaining 114 patients received no preventive care and were treated with routine medical treatment where necessary. The incidence of sore throat within the first 24 h postoperatively was then compared between the two study groups.

Results: Of the 114 patients in the acupuncture group, 16 patients (14%) experienced sore throat within the first 24 h postoperatively, which was significantly lower compared to the 34 patients (29.8%) with sore throat in the medical treatment group (p<0.05). However, the frequency of patients with severe sore throat requiring medical treatment did not differ significantly (12.3% vs 16.7%, p>0.05).

Conclusions: Our study suggests that acupuncture could be considered as an option in prevention of postoperative anaesthesia-related sore throat.
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http://dx.doi.org/10.1136/acupmed-2012-010249DOI Listing
September 2013

Sleep-related eating disorder: a case report of a progressed night eating syndrome.

Acta Med Iran 2012 ;50(7):522-4

Department of Clinical Studies, Student's Scientific Research Center, Tehran University of Medical Sciences, Iran.

Night eating syndrome is a common disorder in eating behaviors that occurs in close relation to the night time sleep cycle. Although eating disorders are common in society, night eating syndrome has been left neglected by health care professionals. In this report we present a case of eating disorder that exhibits some novel features of night eating syndrome. Our case was a progressed type of eating disorder which may increase awareness among physicians about sleep-related eating disorders.
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January 2013

Cerebral sinovenous thrombosis (CSVT) in a neonate with different manifestations.

Acta Med Iran 2012 ;50(6):444-6

Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Cerebral sinovenous thrombosis (CSVT) is increasingly diagnosed in neonates. Despite many studies which have addressed diagnosis and management of pediatric CSVT, diagnosis of CVSD in neonates is difficult. A female neonate born by natural vaginal delivery was diagnosed with CSVT after initiation of seizure. The seizure was stabilized and after performing diagnostic tests, the diagnosis of CSVT was made. This report describes diagnosis of this rare condition in a newborn baby in order to make awareness about this serious condition in neonates.
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November 2012