Publications by authors named "Ramin Sami"

21 Publications

  • Page 1 of 1

Case Report: Barotrauma in COVID-19 Case Series.

Am J Trop Med Hyg 2021 May 18. Epub 2021 May 18.

2Isfahan University of Medical Science, Isfahan, Iran.

Severe acute respiratory syndrome coronavirus 2 can cause pulmonary complications, such as increased risk of barotrauma (BT), but its prevalence and risk factors are not known. In this case series, the course of BT and its related risk factors were discussed in patients with COVID-19 who were admitted to the intensive care unit. Medical records of the patients with COVID-19 and BT and hospitalized in the intensive care unit for 5 months were extracted. The course of BT and its possible associated risk factors are descriptively presented. Among 103 patients with COVID-19 who were intubated, 13 patients (12.6%) had BT. One patient developed BT before intubation. All patients with BT were male. Half of them developed BT in the first 5 days of intubation. Eight patients (61.53%) had a positive culture for Klebsiella pneumoniae. Nine patients (69.9%) died. High positive end-expiratory pressure, coinfection with bacterial pneumonia, and history of lung disease may affect BT incidence. The treatment team should increase their upervision on the ventilator setting, especially in the first week of intubation.
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http://dx.doi.org/10.4269/ajtmh.21-0080DOI Listing
May 2021

Case Report: Barotrauma in COVID-19 Case Series.

Am J Trop Med Hyg 2021 May 18. Epub 2021 May 18.

2Isfahan University of Medical Science, Isfahan, Iran.

Severe acute respiratory syndrome coronavirus 2 can cause pulmonary complications, such as increased risk of barotrauma (BT), but its prevalence and risk factors are not known. In this case series, the course of BT and its related risk factors were discussed in patients with COVID-19 who were admitted to the intensive care unit. Medical records of the patients with COVID-19 and BT and hospitalized in the intensive care unit for 5 months were extracted. The course of BT and its possible associated risk factors are descriptively presented. Among 103 patients with COVID-19 who were intubated, 13 patients (12.6%) had BT. One patient developed BT before intubation. All patients with BT were male. Half of them developed BT in the first 5 days of intubation. Eight patients (61.53%) had a positive culture for Klebsiella pneumoniae. Nine patients (69.9%) died. High positive end-expiratory pressure, coinfection with bacterial pneumonia, and history of lung disease may affect BT incidence. The treatment team should increase their upervision on the ventilator setting, especially in the first week of intubation.
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http://dx.doi.org/10.4269/ajtmh.21-0080DOI Listing
May 2021

Clinical Determinants of the Six-Minute Walk Test (6MWT) in Stable Non-Cystic Fibrosis Bronchiectasis Patients.

Tanaffos 2020 Dec;19(4):385-391

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

Background: The six-minute walk test (6MWT) is a suitable tool for the assessment of functional capacity in patients with chronic pulmonary diseases. This study aimed to assess the clinical determinants of the six-minute walk distance (6MWD), exercise-induced desaturation (EID), and pretest saturation of arterial oxygen (SatO) in patients with diffuse non-cystic fibrosis (CF) bronchiectasis.

Materials And Methods: In this cross-sectional study, a total of 57 clinically stable patients with diffuse non-CF bronchiectasis were enrolled. Anthropometric measurements (body mass index [BMI], mid-arm muscle circumference [MAMC], and triceps skinfold thickness [TSF]), spirometric indices (forced expiratory volume in one second [FEV1], forced vital capacity [FVC], and FEV1/FVC ratio), imaging assessment (CT scan), and bacteriological sputum studies were performed, and then, 6MWT was carried out.

Results: The mean 6MWD was measured to be 447.11±94.59 m. The average walked distance in patients with severe, moderate, and mild bronchiectasis was 427.73±92.07, 439.63±102.65, and 485.87±80.47 m, respectively, with no significant difference. The pretest SatO was 88.92±5.59%, 93.75±3.36%, and 94.87±2.88% in the severe, moderate, and mild bronchiectasis groups (P<0.001). A significant inverse correlation was observed between the distance walked and BMI (r=-0.434, P=0.001).

Conclusion: The predictors of 6MWD in stable non-CF bronchiectasis patients were FVC, SatO at rest, BMI, and MAMC. The FEV1, FEV1/FVC, and BMI were independent predictors of SatO at rest. The extension of bronchiectasis was the only predictor of EID during the test.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088139PMC
December 2020

Validity and Reliability of COPD-6 Device for Detecting Chronic Obstructive Pulmonary Disease in High-Risk Individuals.

Tanaffos 2020 Jul;19(3):201-207

Department of Community Medicine, Isfahan University of Medical Science, Isfahan, Iran.

Background: The current study was done to evaluate the validity and reliability of the Vitalograph COPD-6 portable device for detecting chronic obstructive pulmonary disease (COPD) in high-risk individuals in Iran.

Materials And Methods: This research was a cross-sectional descriptive study. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC using standard spirometer and FEV1, FEV6, and FEV1/FEV6 with COPD- 6 device were measured and recorded. Descriptive analysis was done.

Results: 19 of 122 patients (15.6%) were diagnosed with COPD. The COPD-6 had an acceptable performance for detecting COPD as assessed by the area under the receiver operating characteristic (ROC) curve (0.72 ; 95% CI: 0.42-0.86), with an average sensitivity of 84% and specificity of 98%, positive predictive value of 89%, and negative predictive value of 97%. The positive likelihood ratio resulted was 42 and the negative likelihood ratio was 0.16.

Conclusion: COPD-6 is a validate and reliable device for detecting COPD in non-specialized health care settings and the best cut-off point for FEV1/FEV6 ratio is 0.72.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008408PMC
July 2020

Effect of COVID-19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey.

Int J Clin Pract 2021 Mar 24:e14182. Epub 2021 Mar 24.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: There are some data showing that repurposed drugs used for the Coronavirus disease-19 (COVID-19) have potential to increase the risk of QTc prolongation and torsade de pointes (TdP), and these arrhythmic side effects have not been adequately addressed in COVID-19 patients treated with these repurposed medications.

Methods: This is the prospective study of 2403 patients hospitalised at 13 hospitals within the COVID-19 epicentres of the Iran. These patients were treated with chloroquine, hydroxychloroquine, lopinavir/ritonavir, atazanavir/ritonavir, oseltamivir, favipiravir and remdesivir alone or in combination with azithromycin. The primary outcome of the study was incidence of critical QTc prolongation, and secondary outcomes were incidences of TdP and death.

Results: Of the 2403 patients, 2365 met inclusion criteria. The primary outcome of QTc ≥ 500 ms and ∆QTc ≥ 60 ms was observed in 11.2% and 17.6% of the patients, respectively. The secondary outcomes of TdP and death were reported in 0.38% and 9.8% of the patients, respectively. The risk of critical QT prolongation increased in the presence of female gender, history of heart failure, treatment with hydroxychloroquine, azithromycin combination therapy, simultaneous furosemide or beta-blocker therapy and acute renal or hepatic dysfunction. However, the risk of TdP was predicted by treatment with lopinavir-ritonavir, simultaneous amiodarone or furosemide administration and hypokalaemia during treatment.

Conclusion: This cohort showed significant QTc prolongation with all COVID-19 medications studied, however, life-threatening arrhythmia of TdP occurred rarely. Among the repurposed drugs studied, hydroxychloroquine or lopinavir-ritonavir alone or in combination with azithromycin clearly demonstrated to increase the risk of critical QT prolongation and/or TdP.
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http://dx.doi.org/10.1111/ijcp.14182DOI Listing
March 2021

Safety and efficacy of Favipiravir in moderate to severe SARS-CoV-2 pneumonia.

Int Immunopharmacol 2021 Jun 11;95:107522. Epub 2021 Mar 11.

Department of Internal Medicine, School of Medicine, Qom University of Medical sciences, Qom, Iran.

Background: We examined the safety and efficacy of a treatment protocol containing Favipiravir for the treatment of SARS-CoV-2.

Methods: We did a multicenter randomized open-labeled clinical trial on moderate to severe cases infections of SARS-CoV-2. Patients with typical ground glass appearance on chest computerized tomography scan (CT scan) and oxygen saturation (SpO) of less than 93% were enrolled. They were randomly allocated into Favipiravir (1.6 gr loading, 1.8 gr daily) and Lopinavir/Ritonavir (800/200 mg daily) treatment regimens in addition to standard care. In-hospital mortality, ICU admission, intubation, time to clinical recovery, changes in daily SpO after 5 min discontinuation of supplemental oxygen, and length of hospital stay were quantified and compared in the two groups.

Results: 380 patients were randomly allocated into Favipiravir (193) and Lopinavir/Ritonavir (187) groups in 13 centers. The number of deaths, intubations, and ICU admissions were not significantly different (26, 27, 31 and 21, 17, 25 respectively). Mean hospital stay was also not different (7.9 days [SD = 6] in the Favipiravir and 8.1 [SD = 6.5] days in Lopinavir/Ritonavir groups) (p = 0.61). Time to clinical recovery in the Favipiravir group was similar to Lopinavir/Ritonavir group (HR = 0.94, 95% CI 0.75 - 1.17) and likewise the changes in the daily SpO after discontinuation of supplemental oxygen (p = 0.46) CONCLUSION: Adding Favipiravir to the treatment protocol did not reduce the number of ICU admissions or intubations or In-hospital mortality compared to Lopinavir/Ritonavir regimen. It also did not shorten time to clinical recovery and length of hospital stay.
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http://dx.doi.org/10.1016/j.intimp.2021.107522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951885PMC
June 2021

Healthcare workers' sleep and mood disturbances during COVID-19 outbreak in an Iranian referral center.

Sleep Breath 2021 Feb 13. Epub 2021 Feb 13.

Université Laval, École de Psychologie, Pavillon F.A.S., Québec, Québec, G1K 7P4, Canada.

Purpose: This study aimed to assess the frequency of sleep and mood disturbances, and their association with COVID-like symptoms in healthcare workers (HCWs) with and without positive Coronavirus RT-PCR in a corona referral center.

Methods: This study was a cross-sectional, anonymous survey of adult HCWs. Data collection was performed in May and June 2020, while governmental restrictions were in place. The participants completed the forms including six separate parts: personal and occupational information, Insomnia Severity Index (ISI), Generalized Anxiety Disorder-7 (GAD-7), Patient's Health Questionnaire (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), and COVID-like symptoms and Coronavirus RT-PCR status.

Results: Among the 372 HCW participants, 245 (66%) were women and  mean age was 34.5 ± 7.1 years (age range 23 to 58). The mean scores of all questionnaires except ISI were significantly higher in the HCWs with positive Coronavirus RT-PCR than another group (PSQI, 9 ± 3.4 vs. 6.9 ± 3.1; GAD-7, 9.8 ± 3.6 vs. 7.9 ± 5.3; PHQ-9, 12.8 ± 6.1 vs. 9.5 ± 6.4, P < 0.05; and ISI, 13.8 ± 5.3 vs. 12.3 ± 6 P = 0.163). Positive association between COVID-like symptoms and sleep and mood disturbances was found in the group without a positive test result. Analysis of questionnaires showed higher scores in the group directly involved except for ISI (P < 0.001 and P = 0.053 respectively).

Conclusions: During the COVID-19 pandemic, the HCWs in this sample experienced a high rate of sleep and mood disturbances. There was also a strong association between sleep and mood disturbances and COVID-like symptoms in the group without a positive RT-PCR result. With all this considered, effective psychological support for HCWs during crisis seems to be necessary.
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http://dx.doi.org/10.1007/s11325-021-02312-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881749PMC
February 2021

Risk factors associated with intensive care unit (ICU) admission and in-hospital death among adults hospitalized with COVID-19: a two-center retrospective observational study in tertiary care hospitals.

Emerg Radiol 2021 Feb 3. Epub 2021 Feb 3.

Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Hezarjerib Avenue, Isfahan, Iran.

Background: The COVID-19 pandemic is straining the health care systems worldwide. Therefore, health systems should make strategic shifts to ensure that limited resources provide the highest benefit for COVID-19 patients.

Objective: This study aimed to describe the risk factors associated with poor in-hospital outcomes to help clinicians make better patient care decisions.

Material And Methods: This retrospective observational study enrolled 176 laboratory-confirmed COVID-19 patients. Demographic characteristics, clinical data, lymphocyte count, CT imaging findings on admission, and clinical outcomes were collected and compared. Two radiologists evaluated the distribution and CT features of the lesions and also scored the extent of lung involvement. The receiver operating characteristic (ROC) curve was used to determine the optimum cutoff point for possible effective variables on patients' outcomes. Multivariable logistic regression models were used to determine the risk factors associated with ICU admission and in-hospital death.

Result: Thirty-eight (21.5%) patients were either died or admitted to ICU from a total of 176 enrolled ones. The mean age of the patients was 57.5 ± 16.1 years (males: 61%). The best cutoff point for predicting poor outcomes based on age, CT score, and O saturation was 60 years (sensitivity: 71%, specificity: 62%), 10.5 (sensitivity: 73%, specificity: 58%), and 90.5% (sensitivity: 73%, specificity: 59%), respectively. CT score cutoff point was rounded to 11 since this score contains only integer numbers. Multivariable-adjusted regression models revealed that ages of ≥ 60 years, CT score of ≥ 11, and O saturation of ≤ 90.5% were associated with higher worse outcomes among study population (odds ratio (OR): 3.62, 95%CI: 1.35-9.67, P = 0.019; OR: 4.38, 95%CI: 1.69-11.35, P = 0.002; and OR: 2.78, 95%CI: 1.03-7.47, P = 0.042, respectively).

Conclusion: The findings indicate that older age, higher CT score, and lower O saturation could be categorized as predictors of poor outcome among COVID-19-infected patients. Other studies are required to prove these associations.
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http://dx.doi.org/10.1007/s10140-021-01903-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856446PMC
February 2021

Characterizing the immune responses of those who survived or succumbed to COVID-19: Can immunological signatures predict outcome?

Cytokine 2021 04 15;140:155439. Epub 2021 Jan 15.

Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran. Electronic address:

Background: Immunodeficiency has pivotal role in the pathogenesis of coronavirus disease 2019 (COVID-19). Several studies have indicated defects in the immune system of COVID-19 patients at different disease stages. Therefore, this study investigated whether alters in immune responses of COVID-19 patients may be considered as predicting factors for disease outcome.

Methods: The percentages of innate and adoptive immune cells in the recovered and dead patients with COVID-19, and healthy subjects were determined by flow cytometry. The levels of pro- and anti-inflammatory cytokines and other immune factors were also measured by enzyme-linked immunosorbent assay.

Results: At the first day of hospitalization, the frequencies of CD56 CD16 NK cells and CD56 CD16 NK cells in patients who died during treatment were significantly increased compared to recovered and healthy individuals (P < 0.0001). The recovered and dead patients had a significant increase in monocyte number in comparison with healthy subjects (P < 0.05). No significant change was observed in Th1 cell numbers between the recovered and dead patients while Th2, Th17 cell, and Treg percentages in death cases were significantly lower than healthy control and those recovered, unlike exhausted CD4 + and CD8 + T cells and activated CD4 + T cells (P < 0.0001-0.05). The activated CD8 + T cell was significantly higher in the recovered patients than healthy individuals (P < 0.0001-0.05). IL-1α, IL-1β, IL-6, and TNF-α levels in patients were significantly increased (P < 0.0001-0.01). However, there were no differences in TNF-α and IL-1β levels between dead and recovered patients. Unlike TGF-β1 level, IL-10 was significantly increased in recovered patients (P < 0.05). Lymphocyte numbers in recovered patients were significantly increased compared to dead patients, unlike ESR value (P < 0.001-0.01). CRP value in recovered patients significantly differed from dead patients (P < 0.001).

Conclusion: Changes in frequencies of some immune cells and levels of some immune factors may be considered as predictors of mortality in COVID-19 patients.
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http://dx.doi.org/10.1016/j.cyto.2021.155439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837287PMC
April 2021

A one-year hospital-based prospective COVID-19 open-cohort in the Eastern Mediterranean region: The Khorshid COVID Cohort (KCC) study.

PLoS One 2020 5;15(11):e0241537. Epub 2020 Nov 5.

Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

The COVID-19 is rapidly scattering worldwide, and the number of cases in the Eastern Mediterranean Region is rising. Thus, there is a need for immediate targeted actions. We designed a longitudinal study in a hot outbreak zone to analyze the serial findings between infected patients for detecting temporal changes from February 2020. In a hospital-based open-cohort study, patients are followed from admission until one year from their discharge (the 1st, 4th, 12th weeks, and the first year). The patient recruitment phase finished at the end of August 2020, and the follow-up continues by the end of August 2021. The measurements included demographic, socio-economics, symptoms, health service diagnosis and treatment, contact history, and psychological variables. The signs improvement, death, length of stay in hospital were considered primary, and impaired pulmonary function and psychotic disorders were considered main secondary outcomes. Moreover, clinical symptoms and respiratory functions are being determined in such follow-ups. Among the first 600 COVID-19 cases, 490 patients with complete information (39% female; the average age of 57±15 years) were analyzed. Seven percent of these patients died. The three main leading causes of admission were: fever (77%), dry cough (73%), and fatigue (69%). The most prevalent comorbidities between COVID-19 patients were hypertension (35%), diabetes (28%), and ischemic heart disease (14%). The percentage of primary composite endpoints (PCEP), defined as death, the use of mechanical ventilation, or admission to an intensive care unit was 18%. The Cox Proportional-Hazards Model for PCEP indicated the following significant risk factors: Oxygen saturation < 80% (HR = 6.3; [CI 95%: 2.5,15.5]), lymphopenia (HR = 3.5; [CI 95%: 2.2,5.5]), Oxygen saturation 80%-90% (HR = 2.5; [CI 95%: 1.1,5.8]), and thrombocytopenia (HR = 1.6; [CI 95%: 1.1,2.5]). This long-term prospective Cohort may support healthcare professionals in the management of resources following this pandemic.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241537PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644058PMC
November 2020

Immune system changes during COVID-19 recovery play key role in determining disease severity.

Int J Immunopathol Pharmacol 2020 Jan-Dec;34:2058738420966497

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

Coronavirus disease 2019 (COVID-19), an acute respiratory infection, is largely associated with dysregulation and impairment of the immune system. This study investigated how the immune system changes were related to disease severity in COVID-19 patients. The frequencies of different immune cells and levels of pro- and anti-inflammatory cytokines in whole blood of participants were determined by flow cytometry and enzyme-linked immunosorbent assay, respectively. The values of other inflammatory agents were also studied. In the late recovery stage, unlike CD56 CD16 NK cells and monocytes, CD56 CD16 NK cell numbers were increased ( < 0.0001-0.05). Th1, Th2, and Th17 cell percentages were significantly lower in patients than healthy control ( < 0.0001-0.05), while their frequencies were increased following disease recovery ( < 0.0001-0.05). The numbers of Tregs, activated CD4+ T cells, and exhausted CD8+ T cells were significantly decreased during a recovery ( < 0.0001-0.05). No significant change was observed in exhausted CD4+ T cell number during a recovery ( > 0.05). B cell showed an increased percentage in patients compared to healthy subjects ( < 0.0001-0.05), whereas its number was reduced following recovery ( < 0.0001-0.05). IL-1α, IL-1β, IL-6, TNF-α, and IL-10 levels were significantly decreased in the late recovery stage ( < 0.0001-0.05). However, TGF-β1 level was not significantly changed during the recovery ( > 0.05). Lymphocyte numbers in patients were significantly decreased ( < 0.001), unlike ESR value ( < 0.001). Lymphocyte number was negatively correlated to ESR value and Th2 number ( < 0.05), while its association with monocyte was significantly positive at the first day of recovery ( < 0.05). The immune system changes during the disease recovery to improve and regulate immune responses and thereby may associate with the reduction in disease severity.
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http://dx.doi.org/10.1177/2058738420966497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594220PMC
October 2020

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia in a young man with hypoxia: a case report and review of the literature.

Acta Biomed 2019 12 23;90(4):560-562. Epub 2019 Dec 23.

Isfahan University of Medical Science, Isfahan, Iran.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare lung disease, which usually affects older women. This disease is often asymptomatic. For patients who are symptomatic, symptoms usually include cough and dyspnea. In this paper, we reported a 38-year-old man who suffered from chest pain for 3 months. CT scan findings revealed scattered nodules that were less than 1 cm. Spirometry was normal and the arterial oxygen saturation at room air was 85%. Open lung biopsy revealed DIPNECH. Patients with DIPNECH are mainly elderly women with symptoms including cough and dyspnea. However, we reported a young man with chest pain and hypoxia without dyspnea. DIPNECH can occur in male and female individuals at any age. (www.actabiomedica.it).
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http://dx.doi.org/10.23750/abm.v90i4.7413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233775PMC
December 2019

Adult onset still disease associated with endogenous lipoid pneumonia.

Adv Respir Med 2019 4;87(1):50-53. Epub 2019 Mar 4.

Department of Pathology, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Cholesterol pneumonia or endogenous lipid pneumonia (ELP) is a rare disease that can occur in the context of a systemic disease or following a bronchial obstruction. It is characterized by a wide range of diverse symptoms and various disease course. The present report introduces a young woman diagnosed with adult onset still disease three years ago, who has been referred with macrophage activation syndrome (MAS). She underwent biopsy due to dyspnea and a crazy paving pattern in HRCT of the lungs, leading to the diagnosis of lipoid pneumonia based on the interstitial lymphocytic inflammation and cholesterol granulomas. So far, there has been no report indicating MAS associated with cholesterol pneumonia. This is the second case reporting ELP in the adult onset still disease.
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http://dx.doi.org/10.5603/ARM.a2019.0008DOI Listing
February 2020

Crazy-Paving Pattern Due to Herpetic Pneumonia in a Patient with Mycosis Fungoides: A Case Report.

Tanaffos 2017 Jun;16(4):309-312

Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Herpetic pneumonia in immune deficient patients could be fatal if not treated. Considering the low prevalence of this disease, computed tomography (CT) scan findings of this condition are not well elucidated. This report describes the CT scan findings of a patient with immune system deficiency due to mycosis fungoides, and pneumonia caused by herpes simplex virus 1 (HSV-1). Bilateral alveolar infiltration with crazy-paving pattern was observed on CT scan of the lungs. The scattered crazy-paving pattern noted in the CT scan of the lungs could be suggestive of herpetic pneumonia in immunocompromised patients presenting with lung infections.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971763PMC
June 2017

Association of Anthropometric Indexes With Disease Severity in Male Patients With Chronic Obstructive Pulmonary Disease in Qazvin, Iran.

Am J Mens Health 2018 07 14;12(4):1023-1028. Epub 2018 Mar 14.

2 Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.

Malnutrition is one of the most important factors that lead to lower quality of life in patients suffering from chronic obstructive pulmonary disease (COPD). There are several methods for assessing malnutrition including anthropometric indexes. The aim of this study was to determine the association of anthropometric indexes with disease severity in male patients with COPD in Qazvin, Iran. This cross-sectional study was conducted on 72 male patients with COPD in Qazvin, Iran, from May to December 2014. Spirometry was performed for all participants. Disease severity was determined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline. Body mass index (BMI), mid-arm muscle circumference (MAMC), and triceps skinfold thickness (TSF) were measured. MAMC and TSF were categorized into three subgroups as <25 P, between 25 P and 75 P, and >75 P (Where P is the abbreviation for percentile.). Data were analyzed using ANOVA and logistic regression analysis. Mean age was 60.23 ± 11.39 years. Mean BMI was 23.23 ± 4.42 Kg/m, mean MAMC was 28.34 ± 3.72 cm, and mean TSF was 10.15 ± 6.03 mm. Mean BMI and MAMC in the GOLD stage IV were significantly lower than other stages. Of 72, 18.1% were underweight while 6.9% were obese. The GOLD stage IV was associated with 16 times increased risk of underweight and nine times increased risk of MAMC < 25 P. Disease severity was associated with BMI and MAMC as indexes of malnutrition in patients with COPD in the present study. The GOLD stage IV was associated with increased risk of underweight and low MAMC.
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http://dx.doi.org/10.1177/1557988318760053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131466PMC
July 2018

Cross-Cultural Adaptation, Reliability and Validity Study of the Persian Version of the Clinical COPD Questionnaire.

Acta Med Iran 2016 Aug;54(8):518-524

Department of PTRS, School of Medicine, University of Maryland Baltimore, Baltimore MD, USA.

The clinical COPD questionnaire (CCQ) has been developed to measure the health status of COPD patients. The aim of this study was to translate CCQ into the Persian language and assess the validity and reliability of the translated version. We used a forward-backward procedure to translate the questionnaire. In a cross-sectional study 100 COPD patients and 50 healthy subjects over 40 years old were selected to assess the reliability and construct validity of the instrument. The face and content validity were used for the questionnaire validity. Validity was examined in a population of patients with COPD, using the Persian validated version of the St George's Respiratory Questionnaire (PSGRQ). In order to assess the questionnaire's reliability, the Intraclass correlation coefficient (ICC) and Cronbach's alpha were calculated. Test-retest reliability was tested by re-administering the Persian version of the CCQ (PCCQ) after 1 week. Test-retest carry out of data demonstrates that the PCCQ has excellent reliability (ICC for all 3 domains were higher than 0.9). Internal consistency was found by Cronbach's alpha to be 0.96, 0.94, 0.97, and 0.98 for the symptom, mental state, functional state and total scores respectively. In addition, the correlation between the components of PCCQ and PSGRQ showed satisfactory construct validity. Analyzing the data from healthy subjects and patients divulged that the PCCQ has acceptable discriminant validity. In general, the PCCQ had satisfactory reliability and validity for assessing health-related quality of life status of Iranian COPD patients.
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August 2016

Approach to Patients with Severe Asthma: a Consensus Statement from the Respiratory Care Experts' Input Forum (RC-EIF), Iran.

Tanaffos 2015 ;14(2):73-94

Division of Pulmonology, Department of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Challenges in the assessment, diagnosis and management of severe, difficult-to-control asthma are increasingly regarded as clinical needs yet unmet. The assessments required to determine asthma severity, comorbidities and confounding factors, disease phenotypes and optimal treatment are among the controversial issues in the field. The respiratory care experts' input forum (RC-EIF), comprised of an Iranian panel of experts, reviewed the definition, appraised the available guidelines and provided a consensus for evaluation and treatment of severe asthma in adults. A systematic literature review followed by discussions during and after the forum, yielded the present consensus. The expert panel used the appraisal of guidelines for research and evaluation-II (AGREE-II) protocol to define an initial locally-adapted strategy for the management of severe asthma. Severe asthma is considered a heterogeneous condition with various phenotypes. Issues such as assessment of difficult-to-control asthma, phenotyping, the use of blood and sputum eosinophil count, exhaled nitric oxide to guide therapy, the position of anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty as well as the use of established, recently-developed and evolving treatment approaches were discussed and unanimously agreed upon in the panel. A systematic approach is required to ensure proper diagnosis, evaluate compliance, and to identify comorbidities and triggering factors in severe asthma. Phenotyping helps select optimized treatment. The treatment approach laid down by the Global Initiative for Asthma (GINA) needs to be followed, while the benefit of using biological therapies should be weighed against the cost and safety concerns.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629434PMC
November 2015

Different protocols for cryobiopsy versus forceps biopsy in diagnosis of patients with endobronchial tumors.

Pneumologia 2012 Oct-Dec;61(4):230-3

Tracheal Diseases Research Center, National Research Institute of Tuberlosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Forceps biopsy is the standard procedure to obtain specimens in endobronchial lesions. New studies have proposed flexible cryoprobe as an accepted alternative method for this technique. Although diagnostic use of the cryobiopsy is confirmed in few studies, there is paucity of data with regard to an optimum protocol for this method since one of the main considerations in cryobiopsy is the freezing time.

Objectives: To evaluate diagnostic yield and safety of endobronchial biopsies using the flexible cryoprobe. Moreover, different freezing times were assessed to propose an optimized protocol for this diagnostic modality.

Patients And Methods: For each patient with a confirmed intrabronchial lesion, diagnostic o value of forceps biopsy, cryobiopsy in three seconds, cryobiopsy in five seconds and combined results of cryobiopsy in both timings were recorded.

Results: A total of 60 patients (39 males and 21 females; Mean age 56.7 +/- 13.3) were included. Specimens that were obtained by cryobiopsy in five seconds were significantly larger than those of forceps biopsy and cryobiopsy in three seconds (p < 0.001). We showed that the achieved diagnostic yields for all three methods were not statistically different (p > 0.05). Simultaneous usage of samples produced in both cryobiopsies can significantly improve the diagnostic yield (p = 0.02). Statistical analysis showed that there were no significant differences in case of bleeding frequency among the three sampling methods.

Conclusions: This study confirmed safety and feasibility of cryobiopsy. Additionally, combination of sampling with two different cold induction timings would significantly increase sensitivity of this emerging technique..
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April 2013

Hemophagocytic [corrected] lymphohistiocytosis associated with nephrotic syndrome and multi-organ failure.

Iran J Kidney Dis 2012 Nov;6(6):467-9

National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Hemophagocytic lymphohistiocytosis (HLH) is still an important elusive and misdiagnosed condition despite of improved knowledge. Nephrotic syndrome associated with HLH is not a common feature and has been rarely reported in hemophagocytic syndrome. We report a 27-year-old man with HLH who progressed to multi-organ failure as well as nephrotic-range proteinuria, generalized edema, and hypoalbuminemia.
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November 2012

Lymphomatoid granulomatosis with splenomegaly and pancytopenia.

Zhongguo Fei Ai Za Zhi 2010 Jan;13(1):84-6

Department of Internal Medicine, Shaheed Sadoughi Hospital, Shaheed Sadoughi University of Medical Sciences, Safaeieh, Yazd, Iran.

Lymphomatoid granulomatosis (LG) is an angiocentric lymphoproliferative disease. It usually involves lung, skin, and central nervous system, but splenomegaly and pancytopenia are the rare manifestations of the disease. We report a 15-year-old boy presented with fever, dry cough and dyspnea from two months ago, after admission patient had nodular lesions on the left leg and hepatosplenomegaly. Then he manifested neurologic signs such as seizure, aphasia and right-sided hemiplegia. Chest X-ray and CT scan revealed bilateral pulmonary nodules predominantly in lower lobes and peripheral lung fields. Laboratory exams showed pancytopenia. Skin biopsy was done, and histopathological examination and immunohistochemistry evaluation confirmed lymphomatoid granulomatosis. He was treated with steroid and cyclophosphamide but succumbed by neurologic involvement.
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http://dx.doi.org/10.3779/j.issn.1009-3419.2010.01.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000673PMC
January 2010

Evaluation of secondary hyperparathyroidism in patients undergoing hemodialysis.

Saudi J Kidney Dis Transpl 2008 Jan;19(1):116-9

Department of Medicine, Division of Nephrology, Shahid Rahnemoon Hospital, Yazd Medical University, Iran.

Renal osteodystrophy is a complication of chronic kidney disease (CKD) that present in low and high turnover patterns. This disorder has a key role in the disability of CKD patients in whom early diagnosis and treatment can result in better outcome. We studied hyperparathyroidism prevalence and its relationship with renal osteodystrophy in our advanced CKD population. We included 80 patients (of whom 44 (55%) were diabetic) during 6 months period. The patients answered a questionnaire about symptoms related to bone disease and blood levels of parathormone (PTH), calcium, phosphorus, and alkaline phosphatase were obtained, in addition to hand and skull radiographs in all the study patients. Prevalence of clinically evident hyperparathyroidism in our patients was 45%. Hyperparathyroidism had significant relationship with alkaline phosphatase and radiological findings, but did not have a significant relationship with dialysis duration, age, sex, familial history, diabetes mellitus, or hypertension. We conclude that secondary hyperparathyroidism is prevalent in our dialysis population and has high correlation with serum alkaline phosphatase levels and radiological changes.
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January 2008