Publications by authors named "Payam Mohammadinejad"

49 Publications

Automated radiomic analysis of CT images to predict likelihood of spontaneous passage of symptomatic renal stones.

Emerg Radiol 2021 Mar 1. Epub 2021 Mar 1.

Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.

Purpose: To evaluate the ability of a semi-automated radiomic analysis software in predicting the likelihood of spontaneous passage of urinary stones compared with manual measurements.

Methods: Symptomatic patients visiting the emergency department with suspected stones in either kidney or ureters who underwent a CT scan were included. Patients were followed for up to 6 months for the outcome of a trial of passage. Maximum stone diameters in axial and coronal images were measured manually. Stone length, width, height, max diameter, volume, the mean and standard deviation of the Hounsfield units, and morphologic features were also measured using automated radiomic analysis software. Multivariate models were developed using these data to predict subsequent spontaneous stone passage, with results expressed as the area under a receiver operating curve (AUC).

Results: One hundred eighty-four patients (69 females) with a median age of 56 years were included. Spontaneous stone passage occurred in 114 patients (62%). Univariate analysis demonstrated an AUC of 0.83 and 0.82 for the maximum stone diameter determined manually in the axial and coronal planes, respectively. Multivariate models demonstrated an AUC of 0.82 for a model including manual measurement of maximum stone diameter in axial and coronal planes. The same AUC was found for a model including automatic measurement of maximum height and diameter of the stone. Further addition of morphological parameters measured automatically did not increase AUC beyond 0.83.

Conclusion: The semi-automated radiomic analysis of urinary stones shows similar accuracy compared with manual measurements for predicting urinary stone passage. Further studies are needed to predict clinical impacts of reporting the likelihood of urinary stone passage and improving inter-observer variation using automatic radiomic analysis software.
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http://dx.doi.org/10.1007/s10140-021-01915-4DOI Listing
March 2021

Ultrasound for Intubation Confirmation: A Randomized Controlled Study among Emergency Medicine Residents.

Ultrasound Med Biol 2021 Feb 18;47(2):230-235. Epub 2020 Nov 18.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

Confirmation of endotracheal tube (ETT) placement during intubation is a critical skill for emergency medicine (EM) residents; airway ultrasonography has been suggested as an accessible and accurate method of ETT confirmation. Here, we investigated the accuracy with which EM residents could identify ETT location in cadavers using different ultrasound modes. EM attendings intubated either the trachea or the esophagus of a cadaver, and blinded residents identified ETT position using either B-mode or B-mode plus color Doppler. Residents correctly identified ETT location in 1075 of 1203 trials (89.4%); performance improved with post-graduate year (residents in post-graduate year 3 had 97.8% accurate identifications). There were 556 (91.7%) correct identifications made with B-mode and 519 (86.9%) with B-mode plus color Doppler (p value = 0.007); thus, accuracy did not improve with addition of color Doppler to B-mode. Further research is needed on the efficacy of different ultrasound modes in confirming ETT placement in live intubations.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2020.10.012DOI Listing
February 2021

Benefits of iterative metal artifact reduction and dual-energy CT towards mitigating artifact in the setting of total shoulder prostheses.

Skeletal Radiol 2021 Jan 29;50(1):51-58. Epub 2020 Jun 29.

Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.

Objective: To determine the utility of iterative metal artifact reduction and 130 keV dual-energy virtual monoenergetic images to improve bone and soft tissue visualization in CT scans affected by metal artifacts.

Material And Methods: Thirteen females and 6 males with a history of total shoulder prosthesis who underwent dual-energy shoulder CT were included. Four sets of images were reconstructed for each patient: (1) original polychromatic kV images reconstructed with weighted filtered back projection; (2) polychromatic kV images with iterative metal artifact reduction; (3) 130 keV dual-energy virtual monoenergetic; (4) combined iterative metal artifact reduction and 130 keV dual-energy virtual monoenergetic. Three readers blindly reviewed all image sets and graded the extent of artifact and image quality.

Results: Mean artifact score and median overall image quality score were better in 130 keV dual-energy virtual monoenergetic with iterative metal artifact reduction compared with those in original polychromatic kV images (3.02 vs 4.28, P < 0.001 and 3.00 vs 4.33, P < 0.001, respectively). The median difference in CT numbers between regions affected by artifacts and normal regions was lowest in 130 keV dual-energy virtual monoenergetic with iterative metal artifact reduction compared with that in original polychromatic kV images (72.28 vs 252.08, P < 0.001 for bony regions and 15.09 vs 324.38, P < 0.001 for soft tissue).

Conclusion: In patients with metal artifacts due to shoulder replacement surgery, the use of dual-energy monoenergetic images and iterative metal artifact reduction reconstruction significantly improves both subjective and objective indicators of image quality.
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http://dx.doi.org/10.1007/s00256-020-03528-3DOI Listing
January 2021

Prior iterative reconstruction (PIR) to lower radiation dose and preserve radiologist performance for multiphase liver CT: a multi-reader pilot study.

Abdom Radiol (NY) 2020 01;45(1):45-54

Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.

Purpose: Prior iterative reconstruction (PIR) spatially registers CT image data from multiple phases of enhancement to reduce image noise. We evaluated PIR in contrast-enhanced multiphase liver CT.

Methods: Patients with archived projection CT data with proven malignant or benign liver lesions, or without lesions, by reference criteria were included. Lower-dose PIR images were reconstructed using validated noise insertion from multiphase CT exams (50% dose in 2 phases, 25% dose in 1 phase). The phase of enhancement most relevant to the diagnostic task was selected for evaluation. Four radiologists reviewed routine-dose and lower-dose PIR images, circumscribing liver lesions and rating confidence for malignancy (0 to 100) and image quality. JAFROC Figures of Merit (FOM) were calculated.

Results: 31 patients had 60 liver lesions (28 primary hepatic malignancies, 6 hepatic metastases, 26 benign lesions). Pooled JAFROC FOM for malignancy for routine-dose CT was 0.615 (95% CI 0.464, 0.767) compared to 0.662 for PIR (95% CI 0.527, 0.797). The estimated FOM difference between the routine-dose and lower-dose PIR images was + 0.047 (95% CI - 0.023, + 0.116). Pooled sensitivity/specificity for routine-dose images was 70%/68% compared to 73%/66% for lower-dose PIR. Lower-dose PIR had lower diagnostic image quality (mean 3.8 vs. 4.2, p = 0.0009) and sharpness (mean 2.3 vs. 2.0, p = 0.0071).

Conclusions: PIR is a promising method to reduce radiation dose for multiphase abdominal CT, preserving observer performance despite small reductions in image quality. Further work is warranted.
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http://dx.doi.org/10.1007/s00261-019-02280-0DOI Listing
January 2020

A New Formula for Confirmation of Proper Endotracheal Tube Placement with Ultrasonography.

Adv J Emerg Med 2019 16;3(3):e25. Epub 2019 May 16.

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

Background: Endotracheal intubation is an important procedure in critical care and emergency medicine settings. Optimal depth of the tube placement has been a serious concern because of several complications associated with its malposition.

Objective: The aim of the current study was to find a new formula to estimate the proper endotracheal tube depth when using ultrasonography or lighted stylet device in order to increase the accuracy of determining Endotracheal tube (ETT) depth and decrease the side effects of ETT misplacement.

Method: Patients older than 18 years of age admitted to Imam emergency department who needed tracheal intubation were included. Tube's length at the angle of the mouth while the tube passed the suprasternal notch, ETT depth after insertion and the distance from ETT's tip to carina were recorded. Ultrasonography and portable chest x-ray were used as tools for measuring these lengths.

Results: A total number of 91 patients including 55 men and 36 women were eligible for inclusion in the study. Not placing the tube at proper depth was considered as the failure of intubation. This failure rate was 9.9% in the standard method which would have been 1.1% if our proposed formula was used.

Conclusion: The findings of this study suggest that the use of this new formula may help in predicting the proper intubation tube placement. Further studies are warranted to confirm these findings.
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http://dx.doi.org/10.22114/ajem.v0i0.154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683597PMC
May 2019

Calculation of corrected flow time: Wodey's formula vs. Bazett's formula.

J Crit Care 2018 04 8;44:154-155. Epub 2017 Nov 8.

Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.jcrc.2017.10.046DOI Listing
April 2018

Comparison of Saffron and Fluvoxamine in the Treatment of Mild to Moderate Obsessive-Compulsive Disorder: A Double Blind Randomized Clinical Trial.

Iran J Psychiatry 2017 Jul;12(3):154-162

Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

There are different pathophysiological mechanisms for obsessive- compulsive disorder (OCD) as suggested by the serotonergic, dopaminergic, and glutamatergic hypotheses. The present study aimed at comparing the efficacy and safety of saffron (stigma of Crocus sativus) and fluvoxamine in the treatment of mild to moderate obsessive- compulsive disorder. In this study, 50 males and females, aged 18 to 60 years, with mild to moderate OCD, participated. The patients were randomly assigned to receive either saffron (30 mg/day, 15 mg twice a day) or fluvoxamine (100 mg/day) for 10 weeks. Using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Adverse Event Checklist, we assessed the patients at baseline, and at the second, fourth, sixth, eighth, and tenth week. Finally, the data were analyzed using general linear repeated measures. In this study, 46 patients completed the trial. General linear repeated measures demonstrated no significant effect for time-treatment interaction on the Y-BOCS total scores [F (2.42, 106.87) = 0.70, P = 0.52], obsession Y-BOCS subscale scores [F (2.47, 108.87) = 0.77, p = 0.49], and compulsion Y-BOCS subscale scores [F (2.18, 96.06) = 0.25, P = 0.79]. Frequency of adverse events was not significantly different between the 2 groups. Our findings suggest that saffron is as effective as fluvoxamine in the treatment of patients with mild to moderate OCD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640576PMC
July 2017

A new modality for the estimation of corrected flow time via electrocardiography as an alternative to Doppler ultrasonography.

Ann Noninvasive Electrocardiol 2018 Jan 22;23(1). Epub 2017 Apr 22.

Tehran University of Medical Sciences, Tehran, Iran.

Background: Evaluation of corrected flow time (FTc) via ultrasonography is one of the suggested modalities for the assessment of intravascular volume status. This study aimed to compare the results of FTc of carotid artery measured via ultrasonography, as a measure of mechanical outcome of the cardiac cycle, with the results of FTc estimation from a new modified formula via electrocardiography (ECG), as a measure of electrical function of the cardiac cycle.

Methods: Healthy volunteers were evaluated before and after a passive leg raising (PLR) maneuver. FTc was measured concurrently before and after PLR via a modified method from ECG and via ultrasonography of the carotid artery.

Results: A total number of 98 healthy volunteers (51 women and 47 men) with a mean age of 30.69 ± 6.28 years were included. There was a significant correlation between FTc measured by ultrasonography and estimated by ECG both before PLR and after PLR (r = .878, p < .0001 and r = .797, p < .0001, respectively). Changes in FTc were slightly higher in measurements by ultrasonography compared to estimations by ECG (22.33 ± 17.15 ms vs. 15.86 ± 14.25 ms , p = .001).

Conclusion: Estimation of FTc via ECG is potentially an effective and feasible method for the assessment of volume status at the clinical settings. Further investigations should determine the significance of differences that may be observed between ultrasonography and ECG in patients with either dehydration or volume overload and in the need of real-time volume status assessment.
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http://dx.doi.org/10.1111/anec.12456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931549PMC
January 2018

Cilostazol adjunctive therapy in treatment of negative symptoms in chronic schizophrenia: Randomized, double-blind, placebo-controlled study.

Hum Psychopharmacol 2017 07 18;32(4). Epub 2017 Apr 18.

Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objective: To evaluate the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase III, as an adjunctive to risperidone in alleviating the negative symptoms of schizophrenia.

Methods: Eighty-four in-patients with diagnosis of chronic schizophrenia participated in a randomized, placebo-controlled trial and underwent 8 weeks of treatment with either cilostazol (50 mg twice a day) or placebo as an adjuvant to risperidone. Participants were assessed using the positive and negative syndrome scale (PANSS) at baseline and at weeks 2, 4, 6, and 8. The primary outcome measure of the trial was to evaluate the efficacy of cilostazol compared to placebo in improving the PANSS negative subscale score.

Result: General linear model repeated measures demonstrated significant effect for time × treatment interaction on negative subscale scores (p < .001) and PANSS total (p = .006) but did not demonstrate significant effect on the PANSS positive (p = .37) and general (p = .06) subscales. Frequency of adverse events was not significantly different between the 2 treatment groups. No serious adverse event was observed.

Conclusion: An 8-week course of treatment with cilostazol as an adjunct to risperidone showed a favorable safety and efficacy profile in patients with schizophrenia.
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http://dx.doi.org/10.1002/hup.2583DOI Listing
July 2017

A Randomized, Double-Blind Placebo-Controlled Trial on Effectiveness and Safety of Celecoxib Adjunctive Therapy in Adolescents with Acute Bipolar Mania.

J Child Adolesc Psychopharmacol 2017 Aug 14;27(6):494-500. Epub 2017 Apr 14.

Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences , Tehran, Iran .

Objective: Recent studies have focused on the role of inflammatory cascades as one of the possible etiologic factors of bipolar disorder. We hypothesize that celecoxib, through its anti-inflammatory properties, may have a therapeutic role in acute bipolar mania.

Patients And Methods: Forty-two adolescent inpatients with the diagnosis of acute bipolar mania participated in a parallel, randomized, double-blind controlled trial, and 40 patients underwent an 8-week treatment with either celecoxib (100 mg twice daily) or placebo as an adjunctive treatment to lithium and risperidone. Patients were evaluated using Young Mania Rating Scale (YMRS) at baseline and weeks 2, 4, and 8. The primary outcome measure was to assess the efficacy of celecoxib compared with placebo in improving mania symptoms.

Result: General linear model repeated measures showed significant effect for time × treatment interaction on YMRS scores [F (2.54, 96.56) = 3.21, p = 0.03]. Significantly greater improvement was observed in YMRS scores in the celecoxib group compared with the placebo group from baseline YMRS score at week 8 (p = 0.04). Although a 35% greater response to treatment (considering a Clinical Global Impressions-Improvement score of ≤2, very much/much improved) was observed in the celecoxib group compared with the placebo group, the difference did not reach the statistical significance level (p = 0.09). No serious adverse event was reported.

Conclusions: Celecoxib may be an effective adjuvant therapy in treatment of manic episodes (without psychotic features) of adolescents with bipolar mood disorder. The mood-stabilizing role of this drug might be mediated through its action on inflammatory cascades.
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http://dx.doi.org/10.1089/cap.2016.0207DOI Listing
August 2017

Assessment of corrected flow time in carotid artery via point-of-care ultrasonography: Reference values and the influential factors.

J Crit Care 2017 08 14;40:46-51. Epub 2017 Mar 14.

Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objective: Assessment of Corrected Flow Time (FTc) in carotid artery has been suggested recently as a measure of intravascular volume status. This study aimed to determine the reference values of FTc in carotid artery in a normal population.

Methods: A total number of 142 healthy volunteers (73 females and 69 males) with a mean age of 36.65±10.52years were included.

Results: The mean FTc in carotid artery was 325.18±22.15ms. The mean value of FTc differed significantly between females and males both before and after passive leg raise (PLR) (330.18±21.61ms vs. 319.88±21.62, P=0.005 before PLR, and 336.89±22.95ms vs. 326.51±21.21, P=0.006 after PLR).

Conclusion: This study would potentially pave the way to determine clinically significant cutoff points in order to assess the diagnostic accuracy of FTc in predicting intravascular volume status and fluid therapy responsiveness.
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http://dx.doi.org/10.1016/j.jcrc.2017.03.009DOI Listing
August 2017

Magnetic Resonance Enterography in 300 Known Cases of Crohn's Disease: An Initial Report from a Referral Center in Iran.

Middle East J Dig Dis 2016 Oct;8(4):273-281

Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

BACKGROUND Magnetic resonance enterography (MRE) has become the modality of choice in assessment of patients with Crohn's disease (CD). We aimed to present our experience on 300 patients with CD who underwent MRE during the first 30 months after setting up MRE for the first time in a referral center in Iran. METHODS Patients with a definite diagnosis of CD based on either ileocolonoscopy or histopathological studies were included in the final report and categorized into four phenotypes of inactive, active, stricturing, and penetrating disease. RESULTS This was a case series study on 300 patients with known CD out of 594 referred subjects. The most prevalent phenotype was inactive observed in 162 (54.0%) patients followed by stricturing in 44 (14.7%), active in 40 (13.3%), penetrating in 27(9%), and active on chronic in 27 (9%) cases. The number of referred patients increased from 51 cases in the first 6 months to 165 in the last 6 months. CONCLUSION This study presents the first report on the application of MRE in Iran as superb modality for management of CD. The growing number of referred patients indicates that MRE has been successful in addressing the most critical concerns of clinicians on determining the dominant disease phenotype.
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http://dx.doi.org/10.15171/mejdd.2016.36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5145294PMC
October 2016

Central Obesity and Liver Iron Content: A Noninvasive Assessment in General Population by Magnetic Resonance Imaging.

Ann Nutr Metab 2016 18;69(3-4):181-189. Epub 2016 Nov 18.

Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background/aim: Existing evidence points to an altered status of iron metabolism in obesity. We aimed to investigate whether central obesity is independently associated with estimated liver iron content (liver T2* value) in general population that used the noninvasive assessment method by MRI.

Methods: The study was carried out on 200 subjects randomly selected from the Golestan Cohort Study who underwent abdominal MRI. Quantitative T2* maps of entire cross-sectional area of liver were calculated using a semi-automated software for estimating the levels of iron content. Segmentation and calculation of visceral (VFA) and subcutaneous fat area (SFA) were also performed.

Results: There was no significant difference in mean liver T2* values between obese (body mass index, BMI >30 kg/m2) and non-obese (BMI ≤30 kg/m2) subjects. After controlling for other covariates, no statistically significant association was detected between liver T2* values and VFA, SFA and VFA/SFA ratio. The drop in the relative signal intensity as an indicator of steatosis and serum ferritin predicted liver T2* values that almost had the same strength (standardized β of -0.41 and -0.41, respectively).

Conclusions: Central obesity indices are not correlated with estimated liver iron content by MRI. Hepatic steatosis and serum ferritin seem to be the best predictors of hepatic T2* value. Since central obesity indices were not direct predictors of hepatic T2* value after the adjustment for confounding factors, it is possible that lipid accumulation in the liver locally, but not systematically, influences hepatic iron metabolism.
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http://dx.doi.org/10.1159/000453111DOI Listing
January 2018

Agomelatine as a Treatment for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Double-Blind, Randomized Clinical Trial.

J Child Adolesc Psychopharmacol 2016 08 10;26(6):513-9. Epub 2016 Jun 10.

1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences , Tehran, Iran .

Objective: Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Due to lack of response to the medication and significant side effects of the treatment with stimulants, alternative medications should be considered. The aim of this study is to evaluate efficacy of agomelatine in treatment of ADHD.

Methods: Fifty-four outpatients, children 6-15 years old, with diagnosis of ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria participated in a 6-week, parallel, double-blind, randomized clinical trial. Fifty patients completed 6 weeks of treatment with either ritalin (methylphenidate hydrochloride [MPH]) (20 mg/day in participants below 30 kg and 30 mg/day in patients with weight ≥30 kg) or agomelatine (15 mg/day in patients with weight ≥30 kg and 25 mg/day in patients with weight ≥45 kg). Participants were assessed using Parent and Teacher ADHD Rating Scale-IV at baseline and at weeks 3 and 6.

Results: General linear model repeated measures showed no significant differences between the two groups on Parent and Teacher Rating Scale scores (F = 1.13, df = 1.26, p = 0.305, and F = 0.95, df = 1.25, p = 0.353, respectively). Changes in Teacher and Parent ADHD Rating Scale scores from baseline to the study end were not significantly different between the agomelatine group (9.28 ± 8.72 and 24.12 ± 7.04, respectively) and the MPH group (6.64 ± 11.04 and 25.76 ± 7.82, respectively) (p = 0.46 and p = 0.44, respectively). There was a trend for less insomnia in the agomelatine group versus MPH-treated group (4% vs. 24%, p = 0.09).

Conclusions: A treatment course of 6 weeks with agomelatine demonstrated a favorable safety and efficacy profile in children and adolescents with ADHD. Nonetheless, larger controlled studies with longer treatment periods are necessary.
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http://dx.doi.org/10.1089/cap.2016.0024DOI Listing
August 2016

Primary ciliary dyskinesia in six patients with bronchiectasis.

Pneumonol Alergol Pol 2016 ;84(2):109-15

Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Primary ciliary dyskinesia [PCD] is generally considered as a rare autosomal recessive disorder. Previous studies reported various prevalence of PCD among patients with bronchiectasis.

Material And Methods: Six PCD patients who were diagnosed during the investigation of 40 patients with bronchiectasis were enrolled in this study. Ultra structural studies for both epithelium and cilia were performed, and the deformities in detailed electron microscopic images confirmed the diagnosis of PCD.

Results: Four patients experienced the first symptoms shortly after the birth, 1 by the age of 1 and 1 by the age of 4 years. Except of 1 case that was diagnosed 2 months after the onset of disease, diagnosis delay was longer than 5 years in all patients. Consanguineous marriage was observed in the parents of all patients. Upper respiratory tract infections were documented for all patients.

Conclusions: PCD should be considered as a probable underlying disorder in patients with bronchiectasis. Past medical history of otitis media and history of similar clinical findings in family members should raise suspicion toward PCD.
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http://dx.doi.org/10.5603/PiAP.2016.0009DOI Listing
April 2017

Value of CT scan-assessed tibial tuberosity-trochlear groove distance in identification of patellar instability.

Radiol Med 2016 Sep 19;121(9):729-34. Epub 2016 May 19.

Department of Radiology, 501 Hospital, AJA University of Medical Sciences, Shahid Etemadzadeh Av., West Fatemi St, P.O. Box: 14117-18541, Tehran, Iran.

Purpose: Tibial tuberosity-trochlear groove (TTTG) distance is currently considered as one of the main factors in decision-making for surgical intervention in patients with patellar instability. The current study aimed to provide a valid comparison of TTTG distance in the healthy knees with those with patellar instability.

Materials And Methods: Patients with a history of two or more episodes of patellar dislocation in the same knee who were referred to our department for the assessment of TTTG distance were included. Asymptomatic knees of patients as well as both knees of 21 healthy individuals were used as controls.

Results: A total number of 42 patients, including 14 (33.3 %) male and 28 (66.7 %) female, with a mean age of 28.6 ± 12.3 years were included. Twenty-one controls with no significant difference of personal characteristics with patients were also enrolled. The mean TTTG distance in symptomatic and asymptomatic knees of patients were 18.71 ± 3.96 mm and 17.35 ± 4.39 mm with no significant difference (P = 0.298). The mean TTTG distances of both symptomatic and asymptomatic knees of patients were significantly higher than in knees of controls (P < 0.001).

Conclusion: The findings of the current study are not in favor of considering TTTG distance independently in decision-making for surgical interventions. However, greater TTTG in both asymptomatic and symptomatic knees of patients compared to controls indicates that this measure could still be considered as an indicator of knee instability and even the need for surgery if considered in addition to other factors.
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http://dx.doi.org/10.1007/s11547-016-0647-0DOI Listing
September 2016

Minocycline as Adjunctive Treatment to Risperidone in Children with Autistic Disorder: A Randomized, Double-Blind Placebo-Controlled Trial.

J Child Adolesc Psychopharmacol 2016 11 29;26(9):784-791. Epub 2016 Apr 29.

1 Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences , Hamadan, Iran .

Objective: This is an investigation of minocycline efficacy and safety as an adjuvant to risperidone in management of children with autism.

Methods: Forty-six children with diagnosis of autistic disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR) criteria and a score of ≥12 on the Aberrant Behavior Checklist-Community (ABC-C) irritability subscale, who were already drug-free for at least 6 months participated in a randomized controlled trial and underwent 10 weeks of treatment with either minocycline (50 mg twice per day) or placebo in addition to risperidone titrated up to 2 mg/day (based on bodyweight). Patients were evaluated using ABC-C at baseline and at weeks 5 and 10.

Results: General linear model repeated measures showed significant effect for time × treatment interaction on the irritability [F(2, 88) = 3.94, p = 0.02] and hyperactivity/noncompliance [F(1.50, 66.05) = 7.92, p = 0.002], but not for lethargy/social withdrawal [F(1.61, 71.02) = 0.98, p = 0.36], stereotypic behavior [F(1.34, 58.80) = 1.55, p = 0.22], and inappropriate speech subscale scores [F(1.52, 66.88) = 1.15, p = 0.31]. By week 10, 21 (91.3%) patients in the minocycline group and 15 (65.5%) patients in the placebo group achieved at least partial response (p = 0.03). Frequencies of adverse events were not significantly different between groups.

Conclusions: Minocycline seems to be a safe and effective adjuvant in management of patients with autistic disorder. Future studies with larger sample sizes, longer follow-ups, and inflammatory cytokine measurements are warranted to confirm these findings and provide insight into minocycline mechanism of action in autistic disorder.
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http://dx.doi.org/10.1089/cap.2015.0175DOI Listing
November 2016

Riluzole in augmentation of fluvoxamine for moderate to severe obsessive-compulsive disorder: Randomized, double-blind, placebo-controlled study.

Psychiatry Clin Neurosci 2016 Aug 26;70(8):332-41. Epub 2016 May 26.

Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Aim: The aim of the present randomized, double-blind, placebo-controlled, 8-week trial was to assess the efficacy and tolerability of riluzole augmentation of fluvoxamine in treatment of patients with moderate to severe obsessive-compulsive disorder.

Methods: Patients were randomized into two parallel groups to receive fluvoxamine plus placebo or fluvoxamine plus riluzole (50 mg twice daily). All patients, regardless of their treatment group, received fluvoxamine at 100 mg/day for the initial 4 weeks of the study followed by 200 mg/day of fluvoxamine for the rest of the trial course. A total of 50 patients (25 in each group) were evaluated for response to treatment using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline and at weeks 4, 8 and 10. Side-effects were recorded using predesigned checklists in each visit. Repeated-measure analysis of variance showed a significant effect for time × treatment interaction in the Y-BOCS total score and a significant effect for time × treatment interaction in the Y-BOCS Compulsive subscale score between the two groups.

Results: Repeated-measure analysis of variance showed a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 4.07, d.f. = 1.22, P = 0.04) in the Y-BOCS total score and a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 4.45, d.f. = 1.33, P = 0.028) in the Y-BOCS Compulsive subscale score between the two groups. Riluzole augmentation therapy demonstrated higher, partial or complete treatment response according to the Y-BOCS total scores.

Conclusion: Riluzole may be of clinical use as an adjuvant agent to fluvoxamine in treatment of moderate to severe obsessive-compulsive disorder.
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http://dx.doi.org/10.1111/pcn.12394DOI Listing
August 2016

Positive Correlation of Serum Adiponectin with Lipid Profile in Patients with Type 2 Diabetes Mellitus is Affected by Metabolic Syndrome Status.

Arch Iran Med 2016 Apr;19(4):269-74

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Type-2 diabetes mellitus (DM) and Metabolic syndrome (MetS) are both associated with dyslipidemia which may lead to development of vascular complications. Adiponectin is an anti-inflammatory protein synthesized by the adipose tissue. There is controversy regarding the association of adiponectin with lipid profile.

Aim: To evaluate the correlation between serum adiponectin concentration and metabolic profile in patients with type-2 DM.

Methods: A single center cross-sectional study was conducted on 173 patients with type-2 DM (82 males and 91 females). Plasma adiponectin concentration, lipid profile, glucose profile, and anthropometric features were investigated. Insulin resistance was determined using Homeostasis model assessment (HOMA). Correlation of serum adiponectin with lipid profile of patients with type-2 DM was assessed.

Results: Adiponectin was negatively correlated with waist circumference (r = -0.16, P = 0.06) and positively with HbA1c (r = 0.19, P = 0.032), total cholesterol (r = 0.23, P = 0.017), LDL (r = 0.30, P = 0.001), SD-LDL (r = 0.41, P < 0.001), and SD-LDL/LDL (r = 0.22, P = 0.023). We found a positive correlation between adiponectin and total cholesterol (r = 0.27, P = 0.055), LDL (r = 0.34, P = 0.026) and SD-LDL (r = 0.41, P = 0.006) in patients with at least 3 components of MetS criteria. Correlation of adiponectin with LDL and SD-LDL remained positively significant with increasing the number of MetS components. In patients with 5 components of MetS, serum adiponectin was significantly correlated with serum triglyceride (r = 0.89). Significant interaction was observed between adiponectin and metabolic syndrome in relation to serum lipid profile.

Conclusion: The results of the present study suggest that in patients with type-2 DM and MetS, lipid profile is strongly correlated with blood concentration of adiponectin. The strongest association was observed between serum adiponectin and LDL.
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http://dx.doi.org/0161904/AIM.008DOI Listing
April 2016

Internal jugular vein/common carotid artery cross-sectional area ratio and central venous pressure.

J Clin Ultrasound 2016 Jun 30;44(5):312-8. Epub 2016 Mar 30.

Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To investigate the accuracy of the sonographic assessment of internal jugular vein/common carotid artery (IJV/CCA) cross-sectional area ratio in predicting central venous pressure (CVP) in critically ill patients.

Methods: In adult patients who underwent central venous catheterization for monitoring of hemodynamic status, we used bedside sonography for diameter and cross-sectional area measurement of IJV and CCA. The IJV/CCA ratio was then calculated, and its correlation with CVP as well as its sensitivity, specificity, and positive and negative predictive values were analyzed.

Results: We enrolled 52 patients with a mean age of 58.8 ± 10.7 years. The mean IJV/CCA ratio was 1.89 ± 0.83 and 1.90 ± 0.83, respectively, at inspiration and expiration. A significant correlation was observed between IJV/CCA ratio and CVP (r = 0.728, p < 0.0001 at inspiration, and r = 0.736, p < 0.0001 at expiration). Sensitivity was 90%, specificity 86.36%, positive predictive values 90%, and negative predictive values 86.36% for the prediction of CVP <10 cm H2 O.

Conclusions: Assessing the IJV/CCA ratio with a portable sonographic device could be a noninvasive alternative for central venous catheterization in order to evaluate the hemodynamic status of critically ill patients. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:312-318, 2016.
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http://dx.doi.org/10.1002/jcu.22339DOI Listing
June 2016

The effects of pioglitazone adjuvant therapy on negative symptoms of patients with chronic schizophrenia: a double-blind and placebo-controlled trial.

Hum Psychopharmacol 2016 Mar 8;31(2):103-12. Epub 2016 Feb 8.

Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objective: The evident central role of inflammation, oxidative stress, and metabolic derangement in pathophysiology of negative symptoms of schizophrenia has opened new insights into probable pharmacological options for these symptoms. Pioglitazone is an antidiabetic agent with anti-inflammatory and antioxidant properties. In this study, we evaluated the efficacy of pioglitazone as an adjunct to risperidone for reduction of negative symptoms in schizophrenia.

Methods: In this randomized, double-blind, placebo-controlled trial, 40 patients with chronic schizophrenia and a minimum score of 20 on the negative subscale of Positive and Negative Syndrome Scale (PANSS) were randomly allocated to receive risperidone plus either pioglitazone (30 mg/day) or placebo for 8 weeks. Patients' symptoms and adverse events were rated at baseline and weeks 2, 4, 6, and 8. The difference between the two groups in decline of PANSS negative subscale scores was considered as the primary outcome of this study.

Results: At the study endpoint, patients in the pioglitazone group showed significantly more improvement in PANSS negative subscale scores (p < 0.001) as well as PANSS total scores (p = 0.01) compared with the placebo group.

Conclusion: These findings suggest the probable efficacy of pioglitazone as an augmentation therapy in reducing the negative symptoms of schizophrenia.
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http://dx.doi.org/10.1002/hup.2517DOI Listing
March 2016

Riluzole combination therapy for moderate-to-severe major depressive disorder: A randomized, double-blind, placebo-controlled trial.

J Psychiatr Res 2016 Apr 7;75:24-30. Epub 2016 Jan 7.

Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Recent evidences suggest that glutamatergic dysregulation implicated in neural plasticity and cellular resilience may contribute to the pathophysiology of Major Depressive Disorder (MDD). Riluzole, which exerts its effect by targeting glutamate neurotransmission, has shown antidepressant effect in recent preclinical, observational and open label studies. This study aimed to assess the efficacy and tolerability of riluzole in patients with MDD. Sixty-four inpatients with diagnosis of moderate to severe major depressive disorder participated in a parallel, randomized, controlled trial, and sixty patients underwent 6 weeks treatment with either riluzole (50 mg/bid) plus citalopram (40 mg/day) or placebo plus citalopram (40 mg/day). All participants were inpatients for the whole duration of the study. Patients were assessed using Hamilton depression rating scale (HDRS) at baseline and weeks 2, 4 and 6. The primary outcome measure was to assess the efficacy of riluzole compared to placebo in improving the depressive symptoms. General linear model repeated measures demonstrated significant effect for time × treatment interaction on HDRS [F (1.86, 107.82) = 8.63, p < 0.001]. Significantly greater improvement was observed in HDRS scores in the riluzole group compared to the placebo group from baseline HDRS score at weeks 2, 4 and 6 (p < 0.001, p = 0.001, p = 0.002, respectively). Significantly greater response with greater speed to treatment was observed in the riluzole group than the placebo group. No serious adverse event occurred. This study showed a favorable safety and efficacy profile in patients with major depressive disorder. Larger controlled studies with longer treatment periods are needed to investigate long term safety, efficacy and optimal dosing.
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http://dx.doi.org/10.1016/j.jpsychires.2016.01.003DOI Listing
April 2016

Comment on: "Development of a sleeve gastrectomy risk calculator".

Surg Obes Relat Dis 2016 11 31;12(9):1766. Epub 2015 Oct 31.

Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1016/j.soard.2015.10.082DOI Listing
November 2016

The Epidemiology of Migraine Headache in General Population of Tehran, Iran.

Neuroepidemiology 2016 19;46(1):9-13. Epub 2015 Nov 19.

Sports Medicine Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background: Migraine as one of the most common types of headache is known to cause serious intervention with routine activities of affected individuals due to the devastating nature of attacks. The aim of this study was to provide epidemiological data of migraine in Iranian general population.

Methods: In this cross-sectional general population study, migraine diagnoses (both episodic and chronic) were based on the International Classification of Headache Disorders. Face-to-face interviews were performed by 5 trained medical interns on a sample size of 2,300 people aged 12-65 years.

Results: A total number of 2,076 subjects were enrolled for final analysis. The mean age of the subjects at the time of the study was 36.27 ± 14.56 years (age range 12-65 years). The 1-year prevalence of migraine was 27.6%. The prevalence of migraine among female subjects was significantly higher than among male subjects (36.7 vs. 21.6%, p < 0.001). The mean age of the subjects with migraine was 35.9 ± 12.96 years. Totally, 49.9% of migraine sufferers experienced at least one episode of aura. The most prevalent type of aura was numbness reported in 32.4% of migraine subjects.

Conclusions: Despite the higher prevalence of migraine among Iranian general population compared to most of the other populations investigated by previous studies, these individuals experience a less severe course of disease.
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http://dx.doi.org/10.1159/000441146DOI Listing
October 2016

Therapeutic effects of minocycline on mild-to-moderate depression in HIV patients: a double-blind, placebo-controlled, randomized trial.

Int Clin Psychopharmacol 2016 Jan;31(1):20-6

aDepartment of Infectious Diseases, Imam Hospital bPsychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Patients with the HIV infection are at high risk for developing depression. The aim of this study was to investigate the safety and efficacy of antidepressant effects of minocycline on HIV patients with depression. Forty-six HIV patients, with mild-to-moderate depression and a Hamilton Depression Rating Scale (HDRS) up to 18, participated in a parallel, randomized, double-blind, placebo-controlled trial and underwent 6 weeks of treatment with either minocycline (100 mg twice daily) or placebo in the same manner. Patients were assessed using HDRS at baseline and at weeks 3 and 6. The primary outcome measure was to evaluate the efficacy of minocycline in improving depressive symptoms. General linear model repeated measures showed significant effect for time × treatment interaction on the HDRS score during the trial course [F(2, 88)=7.50, P=0.001]. There was no significant difference between the two groups regarding adverse events. No serious adverse event was reported. The administration of 100 mg minocycline twice daily seems to be safe and effective in improving depressive symptoms in HIV/AIDS patients with mild-to-moderate depression.
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http://dx.doi.org/10.1097/YIC.0000000000000098DOI Listing
January 2016

Report on the First Survey of Iranian Patients with Hereditary Angioedema.

Iran J Immunol 2015 Sep;12(3):209-18

Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, e-mail:

Background: Hereditary angioedema (HAE) is a rare autosomal dominant primary immunodeficiency with complement system defect characterized by recurrent episodes of angioedema involving the skin or mucosa of the upper respiratory and gastrointestinal tracts.

Objective: To characterize the clinical and laboratory data of hereditary angioedema in Iran.

Methods: Patients with probable diagnosis of angioedema were enrolled in this study. Demographic and clinical data were documented in the designed questionnaire including history of attacks, triggering factors and laboratory data such as C4, C1 esterase inhibitor level and function.

Results: Among 63 patients who were clinically suspicious for angioedema (23 males and 40 females), 8 cases (12.7%) were diagnosed with HAE. Among these 8 HAE patients, 3 were diagnosed with HAE type 1 and five patients were diagnosed with HAE type 2. The mean ages of HAE type 1 and type 2 patients were 25.6 ± 13.5 and 22.4 ± 12.32 years. The mean age of onset in HAE type 1 group was 8 ± 5 years and in HAE type 2 group was 18.8 ± 11.84 years. The mean diagnosis delay was 17.6 years in HAE type 1 patients and 2.6 years in HAE type 2. The most common clinical manifestation was facial swelling presented in all HAE patients followed by swelling of extremities which was present in 7 patients with HAE.

Conclusion: The clinical criteria of the Iranian patients with HAE were consistent with the known clinical patterns of the disease.
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http://dx.doi.org/IJIv12i3A6DOI Listing
September 2015

Carotid artery corrected flow time measurement via bedside ultrasonography in monitoring volume status.

J Crit Care 2015 Dec 22;30(6):1199-203. Epub 2015 Aug 22.

Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: The purpose of this study is to investigate the possible correlation between corrected flow time (FTc) in carotid artery and changes in volume status.

Materials And Methods: Ninety-three patients with end-stage renal failure who underwent fluid removal via hemodialysis were enrolled prospectively. The volume of fluid removed as well as prehemodialysis and posthemodialysis measures of FTc in the carotid artery, heart rate, and mean arterial pressure was evaluated. All imaging measurements were performed with patients at supine position, 15 minutes before and after the hemodialysis session, by evaluating the right common carotid artery at the level of the lower border of thyroid cartilage.

Results: The mean FTc before fluid removal was 345.07±37.19 milliseconds. This measure decreased significantly after the volume removal with a posthemodialysis mean of 307.77±31.76 milliseconds (P<.0001). There was a statistically significant and negative association between the volume of fluid removed by hemodialysis and the changes in FTc (Pearson correlation, -0.39; P<.0001).

Conclusion: The assessment of changes in FTc of carotid artery via Doppler waveform analysis may predict the changes in intravascular volume. The use of this diagnostic modality may be an accurate and noninvasive alternative to currently available methods.
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http://dx.doi.org/10.1016/j.jcrc.2015.08.014DOI Listing
December 2015

Celecoxib adjunctive therapy for acute bipolar mania: a randomized, double-blind, placebo-controlled trial.

Bipolar Disord 2015 Sep 20;17(6):606-14. Epub 2015 Aug 20.

Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Recent research has focused on the inflammatory cascade as a key culprit in the etiology of bipolar disorder. We hypothesized that celecoxib, via its anti-inflammatory properties, may have a therapeutic role in mood disorder.

Methods: Forty-six inpatients with the diagnosis of acute bipolar mania without psychotic features participated in a parallel, randomized, double-blind, placebo-controlled trial, and underwent six weeks of treatment with either celecoxib (400 mg daily) or placebo as an adjunctive treatment to sodium valproate. Patients were evaluated using the Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS). The primary outcome measure with respect to efficacy was the mean decrease in YMRS score from baseline to the study endpoint, which was compared between the two groups.

Results: A significant difference was observed in the change in YMRS scores on Day 42 compared to baseline in the two groups (p < 0.001). The changes at the endpoint compared to baseline were -29.78 ± 21.78 (mean ± standard deviation) and -21.78 ± 7.16 for the celecoxib and placebo groups, respectively. A significantly higher remission rate was observed in the celecoxib group (87.0%) than the placebo group (43.5%) at Week 6 (p = 0.005). General linear model repeated measures demonstrated a significant effect for the time × treatment interaction on the YMRS scores [F(2.27,99.98) = 6.67, p = 0.001].

Conclusions: Celecoxib is an effective adjuvant therapy in the treatment of manic episodes (without psychotic features) of bipolar mood disorder. The mood-stabilizing role of the drug might be mediated via its action on the inflammatory cascade.
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http://dx.doi.org/10.1111/bdi.12324DOI Listing
September 2015

Antibiotic resistance in patients with primary immunodeficiency disorders versus immunocompetent patients.

Expert Rev Clin Immunol 2015 2;11(10):1163-72. Epub 2015 Aug 2.

a 1 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: We aimed to investigate the antimicrobial susceptibility among bacterial isolates of patients with primary immunodeficiency disorders (PID) in comparison with immunocompetent patients.

Methods: Patients' antibiotic sensitivity profiles were extracted from their medical records. In order to compare the antibiotic sensitivity profiles of PID patients with immunocompetent patients, the results of antibiograms of patients who did not have a known or suspected immunodeficiency and were hospitalized during the same period were obtained and used as control subjects.

Results: A total number of 257 isolates were obtained from 86 PID patients. Antimicrobial susceptibilities of several organisms isolated from PID patients were significantly lower compared to that of immunocompetent patients.

Conclusion: Antibiotic resistance seems to be higher among PID patients compared to immunocompetent patients. This indicates a need for further investigations for the possible factors responsible for antibiotic resistance in PID patients.
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http://dx.doi.org/10.1586/1744666X.2015.1075396DOI Listing
June 2016