Publications by authors named "Rasoul Aliannejad"

23 Publications

  • Page 1 of 1

Letter to the Editor Regarding "Pre-HCT Lung Computed Tomography as an Alternative to PFT During the COVID-19 Pandemic".

Transplant Cell Ther 2021 Feb 11;27(2):188-189. Epub 2020 Dec 11.

Department of Respiratory and Critical Care Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.jtct.2020.10.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834529PMC
February 2021

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality Among Patients With COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial.

JAMA 2021 Mar 18. Epub 2021 Mar 18.

Cardiovascular Research Foundation (CRF), New York, New York.

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis.

Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU).

Design, Setting, And Participants: Multicenter randomized trial with a 2 × 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020.

Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up.

Main Outcomes And Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 ×103/µL). All outcomes were blindly adjudicated.

Results: Among 600 randomized patients, 562 (93.7%) were included in the primary analysis (median [interquartile range] age, 62 [50-71] years; 237 [42.2%] women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% [95% CI, -6.6% to 9.8%]; odds ratio, 1.06 [95% CI, 0.76-1.48]; P = .70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% [1-sided 97.5% CI, -∞ to 3.4%]; odds ratio, 1.83 [1-sided 97.5% CI, 0.00-5.93]), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% [95% CI, 0.4%-3.8%]; P = .01).

Conclusions And Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19.

Trial Registration: ClinicalTrials.gov Identifier: NCT04486508.
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http://dx.doi.org/10.1001/jama.2021.4152DOI Listing
March 2021

Spontaneous pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema in a patient with COVID-19.

Radiol Case Rep 2021 May 3;16(5):1158-1161. Epub 2021 Mar 3.

Department of Respiratory and Critical Care Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

In this paper, we describe a case of COVID-19 pneumonia complicated by alveolar air leakage syndrome without prior positive pressure ventilation. Our patient was a 55-year-old nonsmoker male with a previous history of marginal B-cell lymphoma diagnosed ten years ago who presented to the emergency department with cough, dyspnea, and respiratory distress. The COVID-19 diagnosis was confirmed based on a polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The unenhanced chest computed tomography (CT) obtained on the first day of admission demonstrated bilateral multifocal ground-glass opacities and consolidation, extensive pneumomediastinum, bilateral pneumothorax, a rim of pneumopericardium, and right-sided subcutaneous emphysema. Despite the initiation of supportive care, antiviral and antibiotic therapy, he passed away due to septic shock. In conclusion, spontaneous alveolar air leakage, characterized by spontaneous pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema, is a rare complication of COVID-19, which may be linked with a severe course of the disease.
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http://dx.doi.org/10.1016/j.radcr.2021.02.069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927643PMC
May 2021

Mesenchymal stem cells derived from perinatal tissues for treatment of critically ill COVID-19-induced ARDS patients: a case series.

Stem Cell Res Ther 2021 01 29;12(1):91. Epub 2021 Jan 29.

Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.

Background: Acute respiratory distress syndrome (ARDS) is a fatal complication of coronavirus disease 2019 (COVID-19). There are a few reports of allogeneic human mesenchymal stem cells (MSCs) as a potential treatment for ARDS. In this phase 1 clinical trial, we present the safety, feasibility, and tolerability of the multiple infusions of high dose MSCs, which originated from the placenta and umbilical cord, in critically ill COVID-19-induced ARDS patients.

Methods: A total of 11 patients diagnosed with COVID-19-induced ARDS who were admitted to the intensive care units (ICUs) of two hospitals enrolled in this study. The patients were critically ill with severe hypoxemia and required mechanical ventilation. The patients received three intravenous infusions (200 × 10 cells) every other day for a total of 600 × 10 human umbilical cord MSCs (UC-MSCs; 6 cases) or placental MSCs (PL-MSCs; 5 cases).

Findings: There were eight men and three women who were 42 to 66 years of age. Of these, six (55%) patients had comorbidities of diabetes, hypertension, chronic lymphocytic leukemia (CLL), and cardiomyopathy (CMP). There were no serious adverse events reported 24-48 h after the cell infusions. We observed reduced dyspnea and increased SpO2 within 48-96 h after the first infusion in seven patients. Of these seven patients, five were discharged from the ICU within 2-7 days (average: 4 days), one patient who had signs of acute renal and hepatic failure was discharged from the ICU on day 18, and the last patient suddenly developed cardiac arrest on day 7 of the cell infusion. Significant reductions in serum levels of tumor necrosis factor-alpha (TNF-α; P < 0.01), IL-8 (P < 0.05), and C-reactive protein (CRP) (P < 0.01) were seen in all six survivors. IL-6 levels decreased in five (P = 0.06) patients and interferon gamma (IFN-γ) levels decreased in four (P = 0.14) patients. Four patients who had signs of multi-organ failure or sepsis died in 5-19 days (average: 10 days) after the first MSC infusion. A low percentage of lymphocytes (< 10%) and leukocytosis were associated with poor outcome (P = 0.02). All six survivors were well with no complaints of dyspnea on day 60 post-infusion. Radiological parameters of the lung computed tomography (CT) scans showed remarkable signs of recovery.

Interpretation: We suggest that multiple infusions of high dose allogeneic prenatal MSCs are safe and can rapidly improve respiratory distress and reduce inflammatory biomarkers in some critically ill COVID-19-induced ARDS cases. Patients that develop sepsis or multi-organ failure may not be good candidates for stem cell therapy. Large randomized multicenter clinical trials are needed to discern the exact therapeutic potentials of MSC in COVID-19-induced ARDS.
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http://dx.doi.org/10.1186/s13287-021-02165-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844804PMC
January 2021

Sofosbuvir and daclatasvir compared with standard of care in the treatment of patients admitted to hospital with moderate or severe coronavirus infection (COVID-19): a randomized controlled trial.

J Antimicrob Chemother 2020 11;75(11):3379-3385

Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Currently no effective antiviral therapy has been found to treat COVID-19. The aim of this trial was to assess if the addition of sofosbuvir and daclatasvir improved clinical outcomes in patients with moderate or severe COVID-19.

Methods: This was an open-label, multicentre, randomized controlled clinical trial in adults with moderate or severe COVID-19 admitted to four university hospitals in Iran. Patients were randomized into a treatment arm receiving sofosbuvir and daclatasvir plus standard care, or a control arm receiving standard care alone. The primary endpoint was clinical recovery within 14 days of treatment. The study is registered with IRCT.ir under registration number IRCT20200128046294N2.

Results: Between 26 March and 26 April 2020, 66 patients were recruited and allocated to either the treatment arm (n = 33) or the control arm (n = 33). Clinical recovery within 14 days was achieved by 29/33 (88%) in the treatment arm and 22/33 (67%) in the control arm (P = 0.076). The treatment arm had a significantly shorter median duration of hospitalization [6 days (IQR 4-8)] than the control group [8 days (IQR 5-13)]; P = 0.029. Cumulative incidence of hospital discharge was significantly higher in the treatment arm versus the control (Gray's P = 0.041). Three patients died in the treatment arm and five in the control arm. No serious adverse events were reported.

Conclusions: The addition of sofosbuvir and daclatasvir to standard care significantly reduced the duration of hospital stay compared with standard care alone. Although fewer deaths were observed in the treatment arm, this was not statistically significant. Conducting larger scale trials seems prudent.
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http://dx.doi.org/10.1093/jac/dkaa334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454592PMC
November 2020

Case 281: Thoracic Air Leak Syndrome in a Patient with Hematopoietic Stem Cell Transplantation and Graft-versus-Host Disease.

Radiology 2020 Sep;296(3):710-714

From the School of Medicine (A.P.K.) and Department of Respiratory and Critical Care Medicine, Shariati Hospital (R.A.), Tehran University of Medical Sciences, Karegar Street North, Tehran, Iran 1416753955; and Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran (R.A.).

HistoryAn 18-year-old man was diagnosed with precursor B-cell lymphoblastic leukemia and underwent transplantation of hematopoietic stem cells from his human leukocyte antigen-matched sister 1 year prior to admission. He was admitted to evaluate progressive shortness of breath and dry cough of 1-month duration. He did not report fever, night sweats, or hemoptysis. Physical examination revealed he was afebrile and had normal pulse oxygen saturation. The examination revealed crepitation on palpation of the anterior neck, expiratory wheezes, and crackles heard at auscultation of bases of both lungs. Extensive maculopapular rash on the skin was consistent with graft-versus-host disease (GVHD). Laboratory tests revealed elevated liver transaminase and bilirubin levels that were attributed to liver GVHD. Nonenhanced thin-section CT of the chest was performed.
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http://dx.doi.org/10.1148/radiol.2020182477DOI Listing
September 2020

Case 281.

Radiology 2020 05;295(2):488-489

From the School of Medicine (A.P.K.) and Department of Respiratory and Critical Care Medicine, Shariati Hospital (R.A.), Tehran University of Medical Sciences, Karegar Street North, Tehran, Iran 1416753955.

History An 18-year-old man was diagnosed with precursor B-cell lymphoblastic leukemia and underwent transplantation of hematopoietic stem cells from his human leukocyte antigen-matched sister 1 year prior to admission. He was admitted to evaluate progressive shortness of breath and dry cough of 1-month duration. He did not report fever, night sweats, or hemoptysis. Physical examination revealed he was afebrile and had normal pulse oxygen saturation. The examination revealed crepitation on palpation of the anterior neck, expiratory wheezes, and crackles heard at auscultation of bases of both lungs. Extensive maculopapular rash on the skin was consistent with graft-versus-host disease (GVHD). Laboratory tests revealed elevated liver transaminase and bilirubin levels that were attributed to liver GVHD. Nonenhanced thin-section CT of the chest was performed (Figs 1-5).
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http://dx.doi.org/10.1148/radiol.2020182474DOI Listing
May 2020

Comment on "Bronchiolitis Obliterans and Pulmonary Fibrosis after Sulfur Mustard Inhalation in Rats".

Am J Respir Cell Mol Biol 2018 08;59(2):273-274

1 Tehran University of Medical Sciences Tehran, Iran.

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http://dx.doi.org/10.1165/rcmb.2018-0066LEDOI Listing
August 2018

Metabolomics diagnostic approach to mustard airway diseases: a preliminary study.

Iran J Basic Med Sci 2018 Jan;21(1):59-69

Department of Chemistry, Faculty of Science, University of Tehran, Tehran, Iran.

Objectives: This study aims to evaluate combined proton nuclear magnetic resonance (H NMR) spectroscopy and gas chromatography-mass spectrometry (GC-MS) metabolic profiling approaches, for discriminating between mustard airway diseases (MADs) and healthy controls and for providing biochemical information on this disease.

Materials And Methods: In the present study, analysis of serum samples collected from 17 MAD subjects and 12 healthy controls was performed using NMR. Of these subjects, 14 (8 patients and 6 controls) were analyzed by GC-MS. Then, their spectral profiles were subjected to principal component analysis (PCA) and orthogonal partial least squares regression discriminant analysis (OPLS-DA).

Results: A panel of twenty eight metabolite biomarkers was generated for MADs, sixteen NMR-derived metabolites (3-methyl-2-oxovaleric acid, 3-hydroxyisobutyrate, lactic acid, lysine, glutamic acid, proline, hydroxyproline, dimethylamine, creatine, citrulline, choline, acetic acid, acetoacetate, cholesterol, alanine, and lipid (mainly VLDL)) and twelve GC-MS-derived metabolites (threonine, phenylalanine, citric acid, myristic acid, pentadecanoic acid, tyrosine, arachidonic acid, lactic acid, propionic acid, 3-hydroxybutyric acid, linoleic acid, and oleic acid). This composite biomarker panel could effectively discriminate MAD subjects from healthy controls, achieving an area under receiver operating characteristic curve (AUC) values of 1 and 0.79 for NMR and GC-MS, respectively.

Conclusion: In the present study, a robust panel of twenty-eight biomarkers for detecting MADs was established. This panel is involved in three metabolic pathways including aminoacyl-tRNA biosynthesis, arginine, and proline metabolism, and synthesis and degradation of ketone bodies, and could differentiate MAD subjects from healthy controls with a higher accuracy.
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http://dx.doi.org/10.22038/IJBMS.2017.23792.5982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776438PMC
January 2018

Accuracy of a new rapid antigen detection test for pulmonary tuberculosis.

Iran J Microbiol 2016 Aug;8(4):238-242

Radiology Department, Cancer Institute, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Background And Objectives: Tuberculosis (TB) is a major problem in the world. Treatment and control of TB needs detection of the (MT) in the proper samples. While smear doesn't have enough sensitivity, culture and PCR are expensive, time consuming and unavailable in many centers. Recent development of a rapid TB antigen detection test (PrTBK) at Pasteur Institute of Iran could give a simple way for diagnosis of TB in about two hours. In this test the antigen-antibody complex will change color when gold conjugated mouse anti-rabbit antibody detects specific MT cell wall antigen in suspected samples.

Materials And Methods: We evaluated the diagnostic accuracy of PrTBK for diagnosis of pulmonary TB in comparison with smear, culture and PCR techniques in 56 consecutive samples (47 BAL and 13 sputum samples) obtained from patients with clinical suspicion of active TB.

Results: Twentynine patients (52%) were female and seven patients were HIV positive. PrTBK was positive in 17 culture positive and 4 culture negative samples (100% sensitivity, 89% specificity and 92% accuracy in comparison with culture method). In two out of four patients with negative culture who were positive for PrTBK, PCR and anti-tuberculosis drugs trial therapy responses were in favor of tuberculosis. If we take this finding into account, the accuracy of PrTBK will rise.

Conclusion: High sensitivity and accuracy of PrTBK test enable us to initiate treatment on the basis of this convenient and rapid test.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296937PMC
August 2016

NMR spectroscopy-based metabolomic study of serum in sulfur mustard exposed patients with lung disease.

Biomarkers 2017 Jul 18;22(5):413-419. Epub 2016 Jul 18.

f Department of Chemistry, Faculty of Sciences , Tarbiat Modares University , Tehran , Iran.

Sulfur mustard (SM) is a vesication chemical warfare agent for which there is currently no antidote. Despite years of research, there is no common consensus about the pathophysiological basis of chronic pulmonary disease caused by this chemical warfare agent. In this study, we combined chemometric techniques with nuclear magnetic resonance (NMR) spectroscopy to explore the metabolic profile of sera from SM-exposed patients. A total of 29 serum samples obtained from 17 SM-injured patients, and 12 healthy controls were analyzed by Random Forest. Increased concentrations of seven amino acids, glycerol, dimethylamine, ketone bodies, lactate, acetate, citrulline and creatine together with the decreased very low-density lipoproteins (VLDL) levels were observed in patients compared with control subjects. Our study reveals the metabolic profile of sera from SM-injured patients and indicates that NMR-based methods can distinguish these patients from healthy controls.
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http://dx.doi.org/10.1080/1354750X.2016.1203995DOI Listing
July 2017

NMR- and GC/MS-based metabolomics of sulfur mustard exposed individuals: a pilot study.

Biomarkers 2016 Sep 17;21(6):479-89. Epub 2016 Mar 17.

g Chemistry and Chemical Engineering Research Center of Iran , Tehran , Iran.

Sulfur mustard (SM) is a potent alkylating agent and its effects on cells and tissues are varied and complex. Due to limitations in the diagnostics of sulfur mustard exposed individuals (SMEIs) by noninvasive approaches, there is a great necessity to develop novel techniques and biomarkers for this condition. We present here the first nuclear magnetic resonance (NMR) and gas chromatography-mass spectrometry (GC/MS) metabolic profiling of serum from and healthy controls to identify novel biomarkers in blood serum for better diagnostics. Of note, SMEIs were exposed to SM 30 years ago and that differences between two groups could still be found. Pathways in which differences between SMEIs and healthy controls are observed are related to lipid metabolism, ketogenesis, tricarboxylic acid (TCA) cycle and amino acid metabolism.
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http://dx.doi.org/10.3109/1354750X.2016.1153725DOI Listing
September 2016

Pro-oxidant-antioxidant balance in Iranian veterans with sulfur mustard toxicity and different levels of pulmonary disorders.

Drug Chem Toxicol 2016 Oct 17;39(4):362-6. Epub 2015 Dec 17.

h Biochemistry and Nutrition Research Center, Department of Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran.

Objective: Sulfur mustard (SM) is a strong alkylating agent that primarily targets the skin, eye and lung. The current study evaluated the pro-oxidant-antioxidant balance (PAB) assay in human serum of SM-exposed patients.

Design And Methods: sera of 35 SM-exposed patients and 19 healthy volunteers were recruited. Both groups had nonsmoker and nonalcoholic people with no diseases such as diabetes, heart disease and other pulmonary diseases (COPD because of smoking, asthma and so on). All patients had documented exposure to SM. The PAB was measured.

Results: SM-exposed patients with normal values for pulmonary function test and severe obstructive pulmonary disease demonstrated a significant increase in PAB value in compared with healthy volunteers (the PAB values in healthy volunteers, normal and severe patients were 48.74 ± 21.07 HK, 101.45 ± 32.68 HK and 120.23 ± 31.55 HK, respectively). However, the level of oxidation is not related to the severity of disease defined by spirometry findings. A significant negative correlation was established between the PAB value and FEV1.

Conclusions: The increased PAB value in chemical casualties showed that these patients are exposed to oxidative stress.
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http://dx.doi.org/10.3109/01480545.2015.1122033DOI Listing
October 2016

Frequency distribution of gastro esophageal reflux disease in inhalation injury: A historical cohort study.

J Res Med Sci 2015 Jul;20(7):636-9

Department of Neurology, Shahid Behashti University of Medical Sciences, Tehran, Iran.

Background: There is no data on the prevalence and the association of gastro esophageal reflux disease (GERD) with toxic fume inhalation. Therefore, we aimed to evaluate the frequency distribution of GERD symptoms among the individuals with mild respiratory disorder due to the past history of toxic fume exposure to sulfur mustard (SM).

Materials And Methods: In a historical cohort study, subjects were randomly selected from 7000 patients in a database of all those who had a history of previous exposure to a single high dose of SM gas during war. The control group was randomly selected from adjacent neighbors of the patients, and two healthy male subjects were chosen per patient. In this study, we used the validated Persian translation of Mayo Gastroesophageal Reflux Questionnaire to assess the frequency distribution of reflux disease.

Results: Relative frequency of GERD symptoms, was found to be significantly higher in the inhalation injury patients with an odds ratio of 8.30 (95% confidence interval [CI]: 4.73-14.55), and after adjustment for cigarette smoking, tea consumption, age, and body mass index, aspirin and chronic cough the odds ratio was found to be 4.41 (95% CI: 1.61-12.07).

Conclusion: The most important finding of our study was the major GERD symptoms (heartburn and/or acid regurgitation once or more per week) among the individuals with the past history of exposure to SM toxic gas is substantially higher (4.4-fold) than normal populations.
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http://dx.doi.org/10.4103/1735-1995.166199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638064PMC
July 2015

Exertional-induced bronchoconstriction: comparison between cardiopulmonary exercise test and methacholine challenging test.

Ann Card Anaesth 2015 Oct-Dec;18(4):479-85

Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Introduction: Exertional-induced bronchoconstriction is a condition in which the physical activity causes constriction of airways in patients with airway hyper- responsiveness. In this study, we tried to study and evaluate any relationship between the findings of cardiopulmonary exercise testing (CPET) and the response to methacholine challenge test (MCT) in patients with dyspnea after activity.

Materials And Methods: Thirty patients with complaints of dyspnea following activity referred to "Lung Clinic" of Baqiyatallah Hospital but not suffering from asthma were entered into the study. The subjects were excluded from the study if: Suffering from any other pulmonary diseases, smoking more than 1 cigarette a week in the last year, having a history of smoking more than 10 packets of cigarettes/year, having respiratory infection in the past 4 weeks, having abnormal chest X-ray or electrocardiogram, and cannot discontinue the use of medicines interfering with bronchial provocation. Baseline spirometry was performed for all the patients, and the values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV/FVC were recorded. The MCT and then the CPET were performed on all patients.

Results: The mean VO 2 (volume oxygen) in patients with positive methacholine test (20.45 mL/kg/min) was significantly lower than patients with negative MCT (28.69 mL/kg/min) (P = 0.000). Respiratory rates per minute (RR) and minute ventilation in the group with positive MCT (38.85 and 1.636 L) were significantly lower than the group with negative methacholine test (46.78 and 2.114 L) (P < 0.05). Also, the O 2 pulse rate in the group with negative methacholine test (116.27 mL/beat) was significantly higher than the group with positive methacholine test (84.26 mL/beat) (P < 0.001).

Conclusion: Pulmonary response to exercise in patients with positive methacholine test is insufficient. The dead space ventilation in these patients has increased. Also, dynamic hyperinflation in patients with positive methacholine test causes the reduced stroke volume and O 2 pulse in these patients.
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http://dx.doi.org/10.4103/0971-9784.166443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881686PMC
July 2016

Comment on "Comparison of virtual bronchoscopy to fiber-optic bronchoscopy for assessment of inhalation injury severity".

Burns 2015 Nov 19;41(7):1613-5. Epub 2015 Sep 19.

Department of Pulmonary, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.burns.2015.05.030DOI Listing
November 2015

Noninvasive Ventilation in Mustard Airway Diseases.

Respir Care 2015 Sep 19;60(9):1324-9. Epub 2015 May 19.

Respiratory Diseases Research Center, Janbazan Medical and Engineering Research Center, Tehran, Iran. Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Background: Noninvasive ventilation (NIV) has been shown to improve numerous clinical measures in subjects with COPD, including gas exchange, exercise tolerance, dyspnea, hospitalizations, health-related quality of life (HRQOL), and functional status. Although useful for classical COPD, NIV has not been validated specifically as a treatment option for mustard airway disease. Our aim was to assess the efficacy of NIV in subjects with severe mustard airway disease.

Methods: This study was performed over the course of 12 months on 20 subjects with severe mustard airway disease (Global Initiative for Chronic Obstructive Lung Disease criteria). Subjects were selected from the pulmonary clinic of Baqiyatallah Hospital in Tehran, Iran. Body mass index, lung function, dyspnea, exercise tolerance, HRQOL, sleep quality, and hospitalization measures were assessed before and after NIV treatment.

Results: NIV improved HRQOL (P = .03) and sleep quality (P = .06) in very severe subjects and reduced hospitalizations (P = .003) and exacerbations (P = .01) in severe subjects. Chest imaging studies showed that these subjects had heterogeneous airway disease, the main finding of which was bronchiolitis obliterans.

Conclusions: NIV can be used as an effective new palliative method in the treatment of mustard airway disorders. Subjects with very severe and severe disease benefitted differently from NIV.
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http://dx.doi.org/10.4187/respcare.02900DOI Listing
September 2015

The metabolomics of airway diseases, including COPD, asthma and cystic fibrosis.

Biomarkers 2015 Feb 18;20(1):5-16. Epub 2014 Nov 18.

Faculty of Paramedical Sciences, Proteomics Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran .

Chronic obstructive pulmonary disease (COPD), asthma and cystic fibrosis (CF) are characterized by airway obstruction and an inflammatory process. Reaching early diagnosis and discrimination of subtypes of these respiratory diseases are quite a challenging task than other chronic illnesses. Metabolomics is the study of metabolic pathways and the measurement of unique biochemical molecules generated in a living system. In the last decade, metabolomics has already proved to be useful for the characterization of several pathological conditions and offers promises as a clinical tool. In this article, we review the current state of the metabolomics of COPD, asthma and CF with a focus on the different methods and instrumentation being used for the discovery of biomarkers in research and translation into clinic as diagnostic aids for the choice of patient-specific therapies.
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http://dx.doi.org/10.3109/1354750X.2014.983167DOI Listing
February 2015

Comment on incidence of cancer in Iranian sulfur mustard (SM) exposed veterans.

Inhal Toxicol 2013 Sep;25(11):651

Respiratory Diseases and TB Research Center, Guilan University of Medical Science , Rasht , Iran and.

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http://dx.doi.org/10.3109/08958378.2013.821563DOI Listing
September 2013

Cardiopulmonary exercise test findings in symptomatic mustard gas exposed cases with normal HRCT.

Pulm Circ 2013 Apr;3(2):414-8

Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran ; Respiratory Diseases and TB Research Center, Guilan University of Medical Science, Razi Hospital, Rasht, Iran.

Many patients with sulfur mustard (SM) exposure present dyspnea in exertion while they have a normal pulmonary function test (PFT) and imaging. The cardiopulmonary exercise test (CPET) has been used for evaluation of dyspnea in exertion among patients with different pulmonary disorders focusing on assessing gas exchange. We evaluated subjects who were exposed to SM with normal imaging compared to the controls with CPET. A case-control study was carried out on two groups in Tehran, Iran during 2010 to compare the CPET findings. The cases with a history of SM exposure and complaint of exertional dyspnea while they had normal physical examination, chest X-ray, PFT, and nonsignificant air trapping in lung high resolution computed tomography (HRCT) were included. A group of sex- and age-matched healthy people were considered as controls. One hundred fifty-nine male patients (aged 37 ± 4.3 years) were enrolled as a case group and ten healthy subjects (aged 35 ± 5.9 years) as the control group. There was no significant difference in the demographic and baseline PFT characters between the two groups (P > 0.05). Only peak VO2/kg, VO2-predicted, and RR peak were statistically different between cases and controls (P < 0.05). Despite the fact that abnormal gas exchange may be present in our cases, it does not explain the low VO2 in CPET. Also, impaired cell O2 consumption could be a hypothesis for low VO2 in these cases. It seems that routine assessment of lung structure cannot be effectively used for discrimination of the etiology of dyspnea in low-dose SM exposed cases.
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http://dx.doi.org/10.4103/2045-8932.113174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3757837PMC
April 2013

GERD related micro-aspiration in chronic mustard-induced pulmonary disorder.

J Res Med Sci 2012 Aug;17(8):777-81

Respiratory Diseases and TB Research Center of Guilan University of Medical Science, Razi Hospital, Rasht, Iran.

Background And Aim: Bronchiolitis obliterans (BO) is the main pulmonary involvement resulting from sulfur mustard (SM) gas exposure that was used against Iranian civilians and military forces during the Iran-Iraq war. The present study aimed to investigate the prevalence of gastro-esophageal reflux (GER) and gastric micro-aspiration in SM gas injured patients with chronic pulmonary diseases and recurrent episodes of exacerbations.

Materials And Methods: This cross-sectional study was done at Baqiyatallah University of Medical Sciences, Tehran, Iran. Gastric micro-aspiration and GER were assessed in the enrolled patients by assessing bile acids, pepsin and trypsin in their bronchoalveolar lavage fluid.

Results: Our result showed that bile acids were found to be high in 21.4% patients, and low in 53.6% of patients. Only in 16% patients, no bile was detected in the BALF. Trypsin and pepsin were detected in BAL fluid of all patients.

Conclusion: Most of BO patients after exposure to SM suffer GER, while none the etiologic factors of GER in post lung transplant BO are present. It would be hypothesized that GER per se could be considered as an aggregative factor for exacerbations in patients. Further studies will provide more advances to better understanding of pathophysiological mechanism regarding GER and BO and treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687886PMC
August 2012

Pepsin and bile acid concentrations in sputum of mustard gas exposed patients.

Saudi J Gastroenterol 2013 May-Jun;19(3):121-5

Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Background/aim: Gastro-esophageal reflux has been suggested to be associated with several pulmonary complications such as asthma, and post-transplant bronchiolitis obliterans (BO). Pepsin or bile salts in the sputum is shown to be an optimal molecular marker of gastric contents macro/micro aspiration. In this study, we investigated sputum pepsin as a marker of micro-aspiration in sulfur mustard (SM) exposed cases compared to healthy controls.

Materials And Methods: In a case controlled study, 26 cases with BO and 12 matched healthy controls were recruited and all cases were symptomatic and their exposure to SM was previously documented during Iran-Iraq conflict. Pepsin levels in sputum and total bile acids were measured using enzymatic assay. The severity of respiratory disorder was categorized based upon the spirometric values.

Result: The average concentration of pepsin in sputum was higher in the case group (0.29 ± 0.23) compared with healthy subjects (0.13 ± 0.07; P ± 0.003). Moreover, the average concentration of bile acids in the sputum cases was not significantly different in comparison to the controls ( P = 0.5).

Conclusion: Higher pepsin concentrations in sputum of SM exposed patients compared with healthy control subjects indicate the occurrence of significantly more gastric micro-aspiration in SM exposed patients.
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http://dx.doi.org/10.4103/1319-3767.111954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709374PMC
February 2014

Hepatitis C and pulmonary fibrosis: Hepatitis C and pulmonary fibrosis.

Hepat Mon 2011 Feb;11(2):71-3

Respiratory Diseases and TB Research Center of Guilan University of Medical Science, Razi Hospital, Rasht, IR Iran.

Background: Hepatitis C virus (HCV) is a hepatotropic and lymphotropic virus that causes hepatic and extrahepatic disease. Emerging clinical data suggest that chronic HCV infection can lead to many direct and indirect effects on the lung.

Objectives: This article discusses evidence on the relationship between HCV infection and pulmonary fibrosis to increase knowledge on this topic among clinicians and scientists and highlights the need for further study.

Methods: We searched the MEDLINE, ISI WEB OF KNOWLEDGE, OVID, ELSEVIER, and MDCONSULT databases and top respiratory journals, such as the American Journal of Respiratory and Critical Care, Chest, and Thorax for articles in English using the following keywords: hepatitis C, HCV infection, IPF, pulmonary fibrosis, and interstitial pneumonitis. We reviewed the reference lists of all identified studies.

Results: The evidence for a pathogenetic link between pulmonary fibrosis and HCV is: the higher frequency of HCV markers in IPF patients, an increase in lymphocyte and neutrophil numbers in bronchoalveolar lavage of chronic HCV infection patients, and the development of IPF in HCV-related chronic hepatitis that is treated with interferon. There is a discrepancy between studies on the frequency of HCV in IPF patients, which might be attributed to geographical differences of in the prevalence of HCV infection, selection bias in choosing the control group, and the HCV genome.

Conclusions: BAL studies in HCV infection are associated with increased counts of lymphocytes and neutrophils in BAL fluid. These studies show that HCV infection is associated with nonspecific pulmonary inflammatory reactions that are not compatible with IPF but that it can lead to pulmonary fibrosis. The other factor is interferon therapy. Interstitial pneumonia and sarcoidosis are well-documented complications of IFN therapy. More extensive cohort studies should be conducted to confirm an actual causal relationship between HCV infection and pulmonary fibrosis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206667PMC
February 2011