Publications by authors named "Robabeh Soleimani"

23 Publications

  • Page 1 of 1

Pharmacological Treatments of Bell's Palsy in Adults: A Systematic Review and Network Meta-Analysis.

Laryngoscope 2021 07 6;131(7):1615-1625. Epub 2021 Jan 6.

Doctor of Pharmacy, Pharmacy Faculty, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran.

Objective: We aimed to simultaneously compare all available medical treatments for Bell's palsy using both direct and indirect data.

Methods: The literature was searched from January 1, 1990, until March 1, 2020, with no language restrictions. Randomized clinical trials comparing pharmacological interventions were included in the current network meta-analysis. We estimated summary risk ratios (RRs), 95% credible interval (CrI), and the surface under the cumulative ranking curve (SUCRA) using network meta-analyses with random effects in a Bayesian framework. The primary outcomes were complete recovery in short-term (≤3 months) and intermediate/long-term (>3 months) after randomization. The secondary outcome was synkinesis.

Results: In total, 21 trials comprising 2,839 participants were retrieved. In terms of good recovery, corticosteroids plus antivirals were the most effective treatment compared to placebo, with RRs ranging between 1.25 (95% CrI: 1.10, 1.43) for the short-term and 1.26 (95% CrI: 1.11, 1.45) for the intermediate/long-term recovery. For synkinesis, only corticosteroids plus antivirals (RR 0.35; 95% CrI: 0.19, 0.65) were associated with fewer synkinesis rates than placebo. The certainty of the evidence for good recovery and synkinesis was very low-low and moderate-high, respectively.

Conclusions: This network meta-analysis showed that combined therapy remains the best regimen for a good recovery outcome and the only efficacious regimen for synkinesis. More research is needed to confirm these findings. Laryngoscope, 131:1615-1625, 2021.
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http://dx.doi.org/10.1002/lary.29368DOI Listing
July 2021

Electroconvulsive Therapy-Related Anxiety: A Survey in an Academic Hospital in the North of Iran.

Anesth Pain Med 2020 Feb 12;10(1):e99429. Epub 2020 Feb 12.

Guilan University of Medical Sciences, Rasht, Iran.

Background: Electroconvulsive therapy (ECT) is a medical treatment most commonly used in the most severe psychiatric diseases; however due to unreal anxiety, it is not widely accepted by patients and their families.

Objectives: The present study aimed to investigate the main causes of ECT-related anxiety (ERA) in an academic hospital in the north of Iran.

Methods: In this study, the participants were hospitalized psychiatric patients with proper communication skills. A 12-item questionnaire encompassing four sections (namely ECT side-effects, procedure factors, medical team communication, and familial, social, and economic factors) were filled out by a responsible psychiatric resident through a face-to-face interview. The participants' demographic information, including gender, age, psychiatry disorder, level of education, and history of ECT, were also recorded.

Results: In this study, 353 cases were analyzed, among whom 329 patients (93.2%) reported at least one item for ERA, and 143 patients (85.6 %) had the history of ECT. All the participants (100%) had no experience in this regard (P = 0.0001). The most common cause of ERA was ECT-related side effects (70.7%) such as memory impairment (60.4%), disablement (24.9%), and death (14.7%) followed by procedure factors (27.2%), general anesthesia (GA) (73.2 %), and electric current (26.8 %). A significant relationship was observed between gender and the history of ECT with the patients' anxiety reasons (P = 0.0001); however, the other variables, including age (P = 0.72), type of disease (P = 0.144), and the level of education (P = 0.012) had no impact on the results.

Conclusions: In this paper, the main causes of ERA were general anesthesia, memory impairment, and electric current. Obviously, a multidisciplinary approach is required to help these patients to handle their fear and anxiety successfully.
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http://dx.doi.org/10.5812/aapm.99429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158242PMC
February 2020

Psychometric Properties of the Persian Version of Dizziness Handicap Inventory.

Iran J Otorhinolaryngol 2019 Nov;31(107):359-367

Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Introduction: The present study was designed to investigate the psychometric properties of the Persian version of the Dizziness Handicap Inventory (P-DHI). In addition, this research was targeted toward assessing the association of P-DHI with Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). The current study also involved a comparison of the scores of patients and healthy participants and implementation of a factor analysis.

Materials And Methods: This cross-sectional study was conducted on 113 patients with dizziness and 30 healthy individuals referring to tertiary centers for otolaryngology and neurology, affiliated to Guilan University of Medical Sciences, Rasht, Iran. The mean age of the patients was 44.5±13.6 years. All patients re-completed the P-DHI after 2 weeks. Internal consistency and reproducibility of the inventory were evaluated using the Cronbach's alpha coefficient, Bland-Altman limits of agreement, and intraclass correlation coefficients. In addition, the relationships of the P-DHI with SF-36 and HADS were evaluated using the Spearman correlation coefficient. An exploratory factor analysis was also run to determine the factor structure of the questionnaire.

Results: The Cronbach's alpha coefficient of P-DHI scale was obtained as 0.86. In addition, the functional, physical, and emotional subscales of this instrument had the Cronbach's alpha coefficients of 0.76, 0.52, and 0.80, respectively. The limits of agreement were 16 points for the total scale, and the range of intraclass correlation coefficients was 0.90-0.96. The P-DHI showed a fair correlation with vertigo severity which assesses functional disability subscale. This scale also demonstrated a moderate correlation with SF-36 and HADS. Factor analysis revealed a 2-factor solution which was different from the factor structure of the original DHI.

Conclusion: As the findings indicated, the P-DHI had good psychometric properties; therefore, it could serve as a useful tool for measuring disability in patients with dizziness and unsteadiness.
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http://dx.doi.org/10.22038/ijorl.2019.38094.2252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6914327PMC
November 2019

Predictors of Fear of Falling among Iranian Older Adults with Hip Fracture and Controls.

Clin Gerontol 2020 Jul-Sep;43(4):391-399. Epub 2019 Dec 16.

Department of Orthopedics, School of Medicine, Shahid Beheshti University of Medical Sciences , Tehran, Iran.

Objectives: To investigate predictors of fear of falling (FOF) among older people with or without hip fracture.

Methods: The FOF was assessed by the Visual Analogue Scale (VAS-FOF), anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). The modified Berg Balance Scale (mBBS) to evaluate functional balance was used. All people were asked to complete the dizziness Handicap Inventory (DHI) and the 36-item Short Form Health Survey (SF-36) for evaluating quality of life.

Results: Eighty-eight older adults (44 cases; 44 controls) took part in this study. The case group had received surgical intervention for femoral neck or trochanteric fracture resulting from a fall. The results showed significantly more intensity of FOF in hip fracture patients than controls ( < .001). The FOF was significantly correlated with anxiety, DHI, mBBS, and SF-36. The results of the multiple linear regression showed that four predictors explained about 44% of the variance of the FOF. It was found that mBBS and DHI significantly predicted FOF ( < .001 and < .001, respectively).

Conclusions: The hip fracture patients had a high degree of the fear of falling, low quality of life and low functional capacity. The mBBS and DHI were significant predictors of the FOF in older adults.

Clinical Implications: It may be useful to employ an inter-disciplinary approach to addressing fear of falling to best understand physiological and psychological contributions.
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http://dx.doi.org/10.1080/07317115.2019.1704958DOI Listing
December 2019

Systematic Review and Meta-Analysis of the Effects of Soy on Glucose Metabolism in Patients with Type 2 Diabetes.

Rev Diabet Stud 2019 24;15:60-70. Epub 2019 Oct 24.

Otorhinolaryngology Research Center, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran.

Objective: This study aimed to assess the effects of soy consumption on glucose metabolism in patients with type 2 diabetes.

Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. Literature published between 1990 and 2019 was searched. Primary outcomes were the effect of soy on fasting plasma glucose (FPG), insulin, and HbA1c. The data were pooled using random effects models. Heterogeneity was assessed using Cochran's Q and I statistics. Also, the Cochrane Collaboration's tool for assessing risk of bias was used, and sensitivity analysis and meta-regression were conducted. Publication bias was evaluated using Egger and Begg tests.

Results: Sixteen randomized clinical trials (RCTs) with a total of 471 participants were regarded as eligible and included in the study. Soy consumption had no significant effects on FPG, insulin, and HbA1c. After the "trim-and-fill" method was applied, soy revealed a significant effect size on FPG (adjusted Cohen's d: -0.18; p = 0.03). Also, subgroup analyses using studies with parallel design showed a significant improvement (moderate effect size) in FPG and insulin. Sensitivity analysis indicated the robustness of our findings. Among secondary outcomes, the results showed a significant effect of soy on HOMA-IR and total cholesterol levels.

Conclusions: Although this systematic review and meta-analysis indicated no beneficial effects of soy consumption on FPG, insulin, and HbA1c in patients with type 2 diabetes, pooling of parallel studies showed different results from crossover studies. The quality of evidence revealed low levels of confidence for primary outcomes. Therefore, further research is recommended.
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http://dx.doi.org/10.1900/RDS.2019.15.60DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946090PMC
July 2020

Olfactory Identification among Various Subtypes of Parkinson Disease.

Eur Neurol 2019 10;81(3-4):167-173. Epub 2019 Jul 10.

Otorhinolaryngology Research Center, Department of Otolaryngology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Introduction: This study is aimed at investigating the olfactory function among different subtypes of Parkinson disease (PD) and the impact of sex on smell identification test.

Methods: In this cross-sectional study, we used Iran-smell identification test (Iran-SIT). PD severity was determined using a Hoehn and Yahr (H&Y) scale. We used analysis of covariance (ANCOVA) to compare the olfactory function among different PD subtypes. All analyses were performed using SPSS software version 16.0.

Results: In total, 66 males and 38 females participated in this study. The most common PD subtype was postural instability and gait difficulty (38.5%). Severe hyposmia and anosmia were found in 44.6 and 19.6% of participants, respectively. Women had a higher score in olfactory function than men (p = 0.44). The score of subjects with stage 1 in the H&Y scale was about 3 points higher than the score with stage 4. The ANCOVA showed a statistically significant effect of subtypes PD on Iran-SIT score after controlling for the effects of covariates (p = 0.03). There is a significant difference between tremor-dominant Parkinson disease (TDPD) and other subtypes of PD (p < 0.05). However, Iran-SIT scores failed to show a significant difference between men and women (p = 0.13).

Discussion/conclusion: Our results confirmed that PD is heterogeneous and there is significant variability in odor identification ability in these patients. We observed more olfactory impairment in TDPD, and subjects with higher H&Y stage. We recommended future studies with repeated measurements of different aspects of smell function to characterize the temporal relationship of olfactory dysfunction with PD.
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http://dx.doi.org/10.1159/000501551DOI Listing
June 2020

Correction to: An investigation into the prevalence of cognitive impairment and the performance of older adults in Guilan province.

J Med Life 2018 Oct-Dec;11(4):395

Guilan University of Medical Sciences, Rasht, Iran.

[This corrects the article on p. 247 in vol. 11, PMID: 30364719.].
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6418322PMC
March 2019

Add-on probiotics in patients with persistent allergic rhinitis: A randomized crossover clinical trial.

Laryngoscope 2019 08 22;129(8):1744-1750. Epub 2019 Feb 22.

Department of Otolaryngology, Guilan University of Medical Sciences, Rasht, Iran.

Objectives: Current medications for allergic rhinitis (AR) may have undesirable side effects that could affect quality of life (QoL). Probiotics could be an alternative in these patients. The aim of this study was to assess the impact of add-on probiotics on symptoms and QoL of patients.

Methods: In this randomized crossover clinical trial, patients with persistent AR were included. Each subject received budesonide with probiotic supplements (BP) or budesonide with placebo for 8 weeks (B), then vice versa for a further 8 weeks. There was an 8-week washout. The primary outcome was the change of the Short Form 36-Item Health Survey (SF-36) score. The secondary outcomes were assessed by the Sinonasal Outcome Test-22 (SNOT-22) and the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaires.

Results: A total of 152 subjects (30.1 ± 7.6 years) completed the study. The SF-36 score in both groups showed improvement compared with baseline values. Treatment BP was more effective than that of B. The Cohen's d and the number needed to treat for Physical Component Scales of SF-36 were 0.40 and 10.77, respectively. These values for Mental Component Scales were 0.33 and 12.61, respectively. Also, treatment BP showed more reduction in the score of SNOT-22 and CARAT.

Conclusion: This study showed that the addition of probiotics to budesonide significantly improved QoL in persistent AR patients. However, the clinical situation of these patients may be not very representative of AR patients in general population. Further studies are recommended.

Level Of Evidence: 1b Laryngoscope, 129:1744-1750, 2019.
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http://dx.doi.org/10.1002/lary.27858DOI Listing
August 2019

An investigation into the prevalence of cognitive impairment and the performance of older adults in Guilan province.

J Med Life 2018 Jul-Sep;11(3):247-253

Guilan University of Medical Sciences, Rasht, Iran.

The escalating rate of old people with a functional impairment in Iran and the weakness of the family support due to the diminishing of family size have increased the demand for long-term care for the elderly with cognitive impairment (CI). The purpose of this research is to explore the frequency of cognitive impairment in the elderly and its association with their daily functional impairment and disability. This is a cross-sectional and descriptive-analytic study conducted in 2016-2017. The study sample consisted of 393 elderly people who were 60 years old or older who live in of Guilan different counties. Samples were selected by using multi-stage cluster sampling. Subsequently, data were analyzed by using the Chi-square test and correlation and regression analysis conducted in SPSS 22. It was observed that 4.3, 28.6, and 37% of the subjects suffered from severe, moderate, and mild cognitive impairment, respectively. Cognitive impairment had a significant relationship with daily functioning and activities requiring special tools. Moreover, cognitive impairment in women, people with low education, and those over 70 years old was more common, and the difference between them was significant (p <0.001). Also, disability was significantly greater in the elderly with cognitive impairment. Many old people need to be cared for after the appearance of cognitive impairment. Therefore, appropriate screening of cognitive impairments is conducive to early diagnosis and prevention of executive functioning problems.
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http://dx.doi.org/10.25122/jml-2018-0017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197520PMC
December 2018

Auditory function and motor proficiency in type 1 diabetic children: A case-control study.

Int J Pediatr Otorhinolaryngol 2018 Jun 19;109:7-12. Epub 2018 Mar 19.

Otolaryngologic Resident, Rhino-Sinus Ear Skull Base Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran. Electronic address:

Objectives: The aim of the study was to evaluate the auditory and motor functions in children with insulin dependent diabetes mellitus (IDDM).

Methods: This case-control study, 65 diabetic children, receiving care in Diabetes Center of 17 Sharivar Hospital, were enrolled. 130 controls were matched to cases by age and sex. The authors performed audio-vestibular tests, including pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), bedside head-impulse test and dynamic visual acuity test. Motor function was evaluated using of Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2).

Results: The results showed higher thresholds of air conduction PTA and a prolonged peak latency of wave V (ABR) in diabetic children as compared to controls (all Ps < 0.001). The odds of normal response in DPOAE of cases decreased by 0.44-0.82 - fold. Although clinical vestibular outcomes were worse in cases, differences were not significant. In BOT-2, the cases had statistically significant lower scores (standard score = -0.58, P < 0.05) than the controls for the Total Motor Composite. Also diabetic girls had more skill motor impairment compared to boys with IDDM.

Conclusion: Based on our study, metabolic disturbances present in Type I diabetes cause disturbances in different parts of auditory and balance functions.
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http://dx.doi.org/10.1016/j.ijporl.2018.03.017DOI Listing
June 2018

SLC6A3 polymorphism and response to methylphenidate in children with ADHD: A systematic review and meta-analysis.

Am J Med Genet B Neuropsychiatr Genet 2018 04 24;177(3):287-300. Epub 2017 Nov 24.

Otolaryngology, RhinoSinus diseases Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran.

Methylphenidate (MPH) is the most commonly used treatment for attention-deficit hyperactivity disorder (ADHD) in children. However, the response to MPH is not similar in all patients. This meta-analysis investigated the potential role of SLC6A3 polymorphisms in response to MPH in children with ADHD. Clinical trials or naturalistic studies were selected from electronic databases. A meta-analysis was conducted using a random-effects model. Cohen's d effect size and 95% confidence intervals (CIs) were determined. Sensitivity analysis and meta-regression were performed. Q-statistic and Egger's tests were conducted to evaluate heterogeneity and publication bias, respectively. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Sixteen studies with follow-up periods of 1-28 weeks were eligible. The mean treatment acceptability of MPH was 97.2%. In contrast to clinical trials, the meta-analysis of naturalistic studies indicated that children without 10/10 repeat carriers had better response to MPH (Cohen's d: -0.09 and 0.44, respectively). The 9/9 repeat polymorphism had no effect on the response rate (Cohen's d: -0.43). In the meta-regression, a significant association was observed between baseline severity of ADHD, MPH dosage, and combined type of ADHD in some genetic models. Sensitivity analysis indicated the robustness of our findings. No publication bias was observed in our meta-analysis. The GRADE evaluations revealed very low levels of confidence for each outcome of response to MPH. The results of clinical trials and naturalistic studies regarding the effect size between different polymorphisms of SLC6A3 were contradictory. Therefore, further research is recommended.
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http://dx.doi.org/10.1002/ajmg.b.32613DOI Listing
April 2018

The Impact of Methylphenidate on Motor Performance in Children with both Attention Deficit Hyperactivity Disorder and Developmental Coordination Disorder: A Randomized Double-Blind Crossover Clinical Trial.

Iran J Med Sci 2017 Jul;42(4):354-361

School of Medicine, Guilan University of Medical Sciences, Guilan, Iran.

Background: Children with attention deficit hyperactivity disorder/developmental coordination disorder (ADHD/DCD) suffer from problems associated with gross and fine motor skills. There is no effective pharmacological therapy for such patients. We aimed to assess the impact of methylphenidate (MPH) on motor performance of children with ADHD/DCD.

Methods: In this double-blind placebo-controlled, 17 children (12 boys) with ADHD/DCD with a mean age of 7 years 6 months were recruited in Shafa Hospital, Rasht, Iran. The response was defined as ≥25% reduction in the total score of ADHD rating scale-IV from the baseline. Sixteen boys entered phase 2 of the study in which the impact of MPH on motor function was determined through a crossover randomized clinical trial. Eligible individuals were scheduled for baseline and two assessment visits after a one-week period of intervention. We used the short form of Bruininks-Oseretsky test (BOT-2) to identify the disability of motor function. Children were randomly assigned to receive MPH or inert ingredients (placebo). In the second period, medication (MPH/placebo) was crossed over. The effects of MPH were analyzed using χ test for related samples to compare the performance during baseline, placebo, and MPH trials. The results were analyzed using the SPSS software version 16.0.

Results: The mean minimal effective dose of MPH per day was 17.3 mg (0.85 mg/kg). Children with higher ADHD rating scale had a significantly lower standard score in BOT-2 (P=0.03). Following MPH intake, 26.6% of the children showed clinically significant improvement in motor function. However, the improvement was not statistically different between the MPH and placebo.

Conclusion: Although MPH improved ADHD symptoms, problems with motor performance still remained. Further work is required to determine the probable effects of MPH in a higher dosage or in different subtypes of ADHD.

Trial Registration Number: IRCT201107071483N2.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523042PMC
July 2017

Health consequences of intimate partner violence against married women: a population-based study in northern Iran.

Psychol Health Med 2017 08 14;22(7):845-850. Epub 2016 Dec 14.

c Kavosh Behavioral, Cognitive and Addiction Research Center , Guilan University of Medical Sciences , Rasht , Iran.

The effects of different types of intimate partner violence (IPV) on mental health are understudied. The aim of this study was to analyse the association between women's mental health and physical, psychological and sexual IPV. We invited subjects of a population-based survey conducted in 2015 in Rasht, Iran, on IPV against women to complete the General Health Questionnaire (GHQ-28). The present research study is a secondary study based on these data and archival data from the 2015 study. For analysis, multivariate analysis of covariance was used. Additionally, predictors of IPV were evaluated using linear regression. A total of 2091 married women were surveyed. The participants were divided into abused women (n = 512, 24.5%) and non-abused women (n = 1579, 75.5%). The pattern of IPV among our patients showed more instances of psychological aggression than physical assault, sexual coercion or injury. Our results show that the non-psychotic psychiatric disorders of the victims were significantly impaired in all aspects, including somatic symptoms, anxiety/insomnia, social dysfunction, and depression. Except social dysfunction, the psychological and sexual abuse were significant predictors of other aspects of mental health. Our findings suggest that risk of IPV is high in this population. They also indicate that various forms of abuse are different from each other in terms of predicting a victim's mental health. Different strategies may be required to reduce and prevent this violence. Additional research is needed to confirm and expand upon our findings.
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http://dx.doi.org/10.1080/13548506.2016.1263755DOI Listing
August 2017

Comparison of cartilage with temporalis fascia tympanoplasty: A meta-analysis of comparative studies.

Laryngoscope 2017 09 9;127(9):2139-2148. Epub 2016 Dec 9.

Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Objective: To systematically review the results of type 1 tympanoplasty with temporalis fascia (TF) versus cartilage in patients with chronic otitis media (COM) for graft integration and hearing improvement.

Data Sources: The English language literature (until June 1, 2016) was searched, using Medline (via PubMed), Scopus, ProQuest, Ovid, Cochrane database, and Google Scholar.

Review Methods: A comprehensive review of the literature was performed. Prospective and retrospective studies enrolling patients with COM were included. Relevance and validity of selected articles were evaluated. Heterogeneity was assessed using I statistics. For dichotomous variables, absolute rate differences, and number needed to treat (NNT) were calculated. For continuous variables, standard mean differences were calculated.

Results: A total of 11 prospective and 26 retrospective studies involving 3,606 patients were included. In general, the overall graft integration rates of cartilage and fascia tympanoplasty were 92% and 82%, respectively (NNT = 11.1, P < 0.001). Although there was no significant difference in the air-bone gap (ABG) closure of < 10 dB between the two groups, the subanalysis of prospective studies showed that patients in the TF group had less mean postoperative ABG (P = 0.02). Subgroup analysis of palisade grafts compared with that of TF graft revealed a significant difference in the graft integration rate favoring cartilage tympanoplasty (P = 0.01).

Conclusion: Cartilage grafting seemed to show a higher graft integration rate compared with TF grafting. Both cartilage and fascia tympanoplasty provided similar improvements in the hearing outcome postoperatively. Large prospective trials are necessary to collect high-quality data.

Level Of Evidence: NA. Laryngoscope, 127:2139-2148, 2017.
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http://dx.doi.org/10.1002/lary.26451DOI Listing
September 2017

Association of intimate partner violence with sociodemographic factors in married women: a population-based study in Iran.

Psychol Health Med 2017 08 27;22(7):834-844. Epub 2016 Sep 27.

d Shafa Hospital , Guilan University of Medical Sciences , Rasht , Iran.

Intimate partner violence (IPV) is a neglected public health issue in Iran. This study was conducted among married women residing in urban Rasht (northern Iran), to estimate the prevalence and frequency of different forms of IPV from husband and their associations with socio-demographic factors. We carried out a population-based cross-sectional survey with cluster sampling design from February to October 2015. The samples consisted of married women aged ≥ 18 years with total household in Rasht city (north Iran) as the sample frame. We administered the Revised Conflict Tactics Scale (CTS-2) to estimate prevalence of past-year IPV. Of 2091 women, 57.1% had suffered psychological aggression, 27.6% physical abuse, 26.6% sexual abuse, and 6.9% injury. A significant association with IPV was found for women with, age ≤ 40 years, unemployed, low education, husband's addiction and rented-householders. Women who experienced physical abuse, had less age at marriage than women without violence. Also women with sexual coercion had less length of marriage than other non-abused women. On logistic regression, the strongest predictor of psychological, physical and sexual abuse was unemployment of spouse, whereas for injury it was low educational level (<12 years) of women. Our findings suggest that risk of IPV is high in our population. There is an obvious need of preventive and treatment activities. Our findings point at that various forms of abuse are different from each other in terms of differing characteristics of the perpetrators and it might be that also different strategies are needed to reduce and prevent these violence. Confirmation by further research is needed.
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http://dx.doi.org/10.1080/13548506.2016.1238489DOI Listing
August 2017

The Effect of Cognitive Behavior Therapy in Insomnia due to Methadone Maintenance Therapy: A Randomized Clinical Trial.

Iran J Med Sci 2015 Sep;40(5):396-403

Clinical Psychologist, Addiction and Behavioral Sciences Research Center, Shafa Hospital, Guilan University of Medical Sciences, Iran.

Background: Sleep disturbance is a common complaint of patients undergoing methadone maintenance therapy (MMT). There are limited studies about the effect of different treatments on insomnia due to MMT. In this study, we evaluated the effect of cognitive-behavioral treatment for insomnia (CBTI) on sleep disorders in patients undergoing MMT.

Methods: Twenty-two patients with insomnia due to MMT (aged 18-60 years) participated in this randomized double-blind clinical trial. The intervention group received CBTI from a clinical psychologist for 8 weeks, whereas the control group received behavioral placebo therapy (BPT). The duration of individual sessions was 45 minutes, which was conducted once a week. The primary outcome was sleep disturbance assessed with Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using SPSS software version 19.

Results: Eleven patients were assigned to each group. Two groups were matched according to demographic characteristics (age, marital status, education, and daily methadone doses). Although PSQI score was significantly reduced during weeks 5 and 8 after both interventions, there was a significant difference in intervention versus time interaction (P<0.02). The effects of CBTI versus placebo were significantly different (P<0.001). The time course was also significant (P<0.001).

Conclusion: This study showed that CBTI is more effective than BPT in overall sleep quality. We recommend further studies, with a larger sample, on CBTI in patients undergoing MMT.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567598PMC
September 2015

The Evaluation of Olfactory Function in Patients With Schizophrenia.

Glob J Health Sci 2015 Apr 23;7(6):319-30. Epub 2015 Apr 23.

.

The aim of this study was to compare olfactory threshold, smell identification, intensity and pleasantness ratings between patients with schizophrenia and healthy controls, and (2) to evaluate correlations between ratings of olfactory probes and illness characteristics. Thirty one patients with schizophrenia and 31 control subjects were assessed with the olfactory n-butanol threshold test, the Iran smell identification test (Ir-SIT), and the suprathreshold amyl acetate odor intensity and odor pleasantness rating test. All olfactory tasks were performed unirhinally. Patients with schizophrenia showed disrupted olfaction in all four measures. Longer duration of schizophrenia was associated with a larger impairment of olfactory threshold or microsmic range on the Ir-SIT (P=0.04, P=0.05, respectively). In patients with schizophrenia, female subjects' ratings of pleasantness followed the same trend as control subjects, whereas male patients' ratings showed an opposite trend. Patients exhibiting high positive score on the positive and negative syndrome scale (PANSS) performed better on the olfactory threshold test (r=0.37, P=0.04). The higher odor pleasantness ratings of patients were associated with presence of positive symptoms. The results suggest that both male and female patients with schizophrenia had difficulties on the olfactory threshold and smell identification tests, but appraisal of odor pleasantness was more disrupted in male patients.
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http://dx.doi.org/10.5539/gjhs.v7n6p319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803875PMC
April 2015

Therapeutic impact of repetitive transcranial magnetic stimulation (rTMS) on tinnitus: a systematic review and meta-analysis.

Eur Arch Otorhinolaryngol 2016 Jul 13;273(7):1663-75. Epub 2015 May 13.

Medical Faculty, Guilan University of Medical Sciences, Rasht, Iran.

In this study, we conducted a systematic literature review and meta-analysis on the effect of repetitive transcranial magnetic stimulation (rTMS) compared with sham in chronic tinnitus patients. We searched databases, from their onset up to August 2014, for randomized controlled trials (RCT) in English that assessed the effectiveness of rTMS for chronic tinnitus. RCTs were selected according to inclusion/exclusion criteria before data were extracted. For the meta-analysis weighted mean differences (and standard deviations) of Tinnitus Questionnaire (TQ) and Tinnitus Handicap Inventory (THI) scores were determined. Therapeutic success was defined as difference of at least 7 points in the THI score between baseline and the follow-up assessment after treatment. The odds ratio (OR) for this variable was assessed. Results from 15 RCTs were analyzed. The mean difference for TQ score at 1 week after intervention was 3.42. For THI, the data of mean difference score in two groups, 1 and 6 month after intervention, was 6.71 and 12.89, respectively. The all comparisons indicated a significant medium to large effect size in follow-up which is in favor of the rTMS. The pooled OR of therapeutic success of the studies which used THI at 1 month after intervention was 15.75. These data underscore the clinical effect of rTMS in the treatment of tinnitus. However, there is high variability of studies design and reported outcomes. Replication of data in multicenter trials with a large number of patients and long-term follow-up is needed before further conclusions can be drawn.
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http://dx.doi.org/10.1007/s00405-015-3642-5DOI Listing
July 2016

Psychometric Properties of the Persian Version of the Tinnitus Handicap Inventory (THI-P).

Iran J Otorhinolaryngol 2015 Mar;27(79):83-94

Department of Psychiatry, Shafa Hospital, Guilan University of Medical Sciences, Guilan, Iran.

Introduction: Tinnitus can have a significant effect on an individual's quality of life, and is very difficult quantify. One of the most popular questionnaires used in this area is the Tinnitus Handicap Inventory (THI). The aim of this study was to determine the reliability and validity of a Persian translation of the Tinnitus Handicap Inventory (THI-P).

Materials And Methods: This prospective clinical study was performed in the Otolaryngology Department of Guilan University of Medical Sciences, Iran. A total of 102 patients aged 23-80 years with tinnitus completed the (THI-P). The patients were instructed to complete the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Audiometry was performed. Eight-five patients were asked to complete the THI-P for a second time 7-10 days after the initial interview. We assessed test-retest reliability and internal reliability of the THI-P. Validity was assessed by analyzing the THI-P of patients according to their age, tinnitus duration and psychological distress (BDI and STAI). A factor analysis was computed to verify if three subscales (functional, emotional, and catastrophic) represented three distinct variables.

Results: Test-retest correlation coefficient scores were highly significant. The THI-P and its subscales showed good internal consistency reliability (α = 0.80 to 0.96). High-to-moderate correlations were observed between THI-P and psychological distress and tinnitus symptom ratings. A confirmatory factor analysis failed to validate the three subscales of THI, and high inter-correlations found between the subscales question whether they represent three distinct factors.

Conclusion: The results suggest that the THI-P is a reliable and valid tool which can be used in a clinical setting to quantify the impact of tinnitus on the quality of life of Iranian patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409952PMC
March 2015

Balance performance in older adults and its relationship with falling.

Aging Clin Exp Res 2015 Jun 7;27(3):287-96. Epub 2014 Oct 7.

Department of Otolaryngology, Otolaryngology Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, 41396-38459, Rasht, Iran,

Background And Aims: A normal consequence of aging is a general deterioration in a number of musculoskeletal and sensory systems that affect postural control and balance. The aim of this study was to evaluate history of falls among active older individuals in Iran, and estimate the risk factors for falls among this population.

Methods: A total of 448 active older subjects from rural region of Rasht city, Iran, were included. They were divided into three groups depending on their age: young-old (n = 266); middle-old (n = 154) and oldest-old (n = 28). We assessed balance performance by One-Leg Balance (OLB), Functional Reach (FR), Timed Up and Go (TUG) and Romberg tests.

Results: The fall rate (>2 in the last year) was 27.0 %. The cut-off point 13.75 s for TUG test showed 84.7 % sensitivity and 56 % specificity. Also the best cut-off point for OLB test was 12.7 s (63 % sensitivity and 83.5 % specificity). Logistic regression analysis revealed that age, BMI, diabetes, and failure in OLB, FR, and Romberg tests predicted fall risk. The decision tree classification of older individuals showed three categorical variables, which in their order of importance included diabetes, Romberg test, and OLB test.

Conclusions: This study revealed the value of history taking about diabetes as a predictor for existing falling. Decision tree technique showed that Romberg and OLB tests help in identifying older adults with balance problems. Given the incidence and consequences of falls among older adults, large-scale prospective studies on older individuals to identify those prone to falls are warranted.
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http://dx.doi.org/10.1007/s40520-014-0273-4DOI Listing
June 2015

Electroconvulsive therapy-related cognitive impairment and choice of anesthesia: the tipping point.

J ECT 2015 Jun;31(2):101-4

From the *Guilan University of Medical Science Anesthesiology Research Center; †Shafa Hospital; ‡SHKUMS Department of Anesthesiology; and §Department of Psychiatry, Guilan University of Medical Science.

Introduction: Electroconvulsive therapy (ECT) is among the most effective treatments of several life-threatening psychiatric disorder. Despite effective therapy, ECT-induced seizure could cause several adverse effects including cognitive disorders and memory impairment. Drugs such as thiopental, which have been prescribed for anesthesia required for ECT, are known as drugs with cognitive effects. This pilot randomized clinical trial tried to assess the feasibility of using a lower dose of thiopental in combination with remifentanil instead of a higher challenging dose of a single drug with cognitive side effects such as thiopental. We evaluated post-ECT cognitive impairment in patients who received remifentanil-thiopental compared with thiopental-placebo group.

Patients And Methods: One hundred twenty patients with psychiatric disorders between the ages of 18 and 60 years were enrolled. The patients were randomized into 2 groups who received either thiopental sodium (4 mg/kg) and remifentanil (1 μg/kg) or thiopental sodium (3 mg/kg, placebo). The psychiatric patients were examined using mini-mental state examination in terms of the cognitive deficits before ECT as well as 5 and 24 hours after ECT. Statistical analyses were done using Statistical Package for the Social Sciences version 16. Unpaired t test, χ2 test, and analysis of variance were used to determine the association of variables.

Results: All the patients completed the trial. There were no reports of adverse effects. In terms of depth of anesthesia measured by bispectral index, no significant difference was observed. Regarding mini-mental state examination scores, the difference was not statistically significant.

Conclusions: Depth of anesthesia was similar between the groups.
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http://dx.doi.org/10.1097/YCT.0000000000000187DOI Listing
June 2015

Melatonin for prevention of metabolic side-effects of olanzapine in patients with first-episode schizophrenia: randomized double-blind placebo-controlled study.

J Psychiatr Res 2014 Jun 24;53:133-40. Epub 2014 Feb 24.

Department of Psychiatry, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran. Electronic address:

Unlabelled: We aimed to determine the efficacy of melatonin 3 mg/day in prevention of olanzapine-induced metabolic side-effects. In a randomized double-blind placebo-controlled study, 48 patients with first-episode schizophrenia who were eligible for olanzapine treatment, were randomly assigned to olanzapine plus either melatonin 3 mg/day or matched placebo for eight weeks. Anthropometric and metabolic parameters as well as psychiatric symptoms using The Positive and Negative Syndrome Scale (PANSS) were assessed at baseline, week 4, and 8. Primary outcome measure was the change from baseline in weight at week 8. Data were analyzed using t-test, Mann-Whitney U test, and mixed-effects model. Thirty-six patients had at least one post-baseline measurement. At week eight, melatonin was associated with significantly less weight gain [mean difference (MD) = 3.2 kg, P = 0.023], increase in waist circumference [MD = 2.83 cm, P = 0.041] and triglyceride concentration [MD = 62 mg/dl, P = 0.090 (nearly significant)] than the placebo. Changes in cholesterol, insulin, and blood sugar concentrations did not differ significantly between the two groups. Patients in the melatonin group experienced significantly more reduction in their PANSS scores [MD = 12.9 points, P = 0.014] than the placebo group. No serious adverse events were reported. To summarize, in patients treated with olanzapine, short-term melatonin treatment attenuates weight gain, abdominal obesity, and hypertriglyceridemia. It might also provide additional benefit for treatment of psychosis. The study was registered in the ClinicalTrials.gov (

Registration Number: NCT01593774).
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http://dx.doi.org/10.1016/j.jpsychires.2014.02.013DOI Listing
June 2014

The effects of alprazolam on tinnitus: a cross-over randomized clinical trial.

Med Sci Monit 2009 Nov;15(11):PI55-60

Otolaryngology Department, ENT-HandN Surgery Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Background: Tinnitus remains a phenomenon with an unknown pathophysiology and for which few therapeutic measures are available. To date there has been insufficient evidence to support the use of alprazolam in the treatment of tinnitus. We sought to evaluate the efficacy of alprazolam for relief of tinnitus.

Material/methods: Thirty-six tinnitus sufferers participated in this cross-over, randomized, triple-blind, placebo-controlled trial. Inclusion criteria included patients between ages 21 and 65, with a complaint of non-pulsatile tinnitus of more than 1 year duration. Patients with depressive or anxiety disorders were excluded, as were those using hearing aids. Participants received alprazolam 1.5 mg daily versus placebo in each period. Primary outcome variables included the Tinnitus Handicap Inventory (THI), a Visual Analog Scale (VAS), and tinnitus loudness.

Results: Thirty patients completed the study. The average age of patients was 47.58+/-7.65 years. Alprazolam in comparison with placebo did not result in statistically significantly greater relief in THI score and tinnitus loudness. There was a significant improvement in VAS score in the alprazolam group compared with the placebo group (p<0.001).

Conclusions: These results suggest that although alprazolam did not improve the THI score or sensation level of loudness significantly, it has a desirable effect on VAS. Further work is needed to determine the beneficial effects of alprazolam in distressed or depressed patients.
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November 2009