Publications by authors named "Saeed Hesam"

17 Publications

  • Page 1 of 1

Evaluation of efficacy of nebulized low molecular weight heparin as an adjunctive extra treatment for acute mild-moderate asthma attack; a randomized clinical trial study.

Pulm Pharmacol Ther 2021 06 11;68:102037. Epub 2021 May 11.

Epidemiology and Statistics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Asthma is the most common chronic disorders of the respiratory tract. This study aimed to evaluate the effect of low-molecular-weight heparins (LMWHs) in the treatment of acute asthma.

Methods: In this randomized clinical trial, patients with acute asthma attacks were enrolled. The patients were divided randomly into two groups. Patients in the intervention group received nebulized LMWH (1 mg/kg) with albuterol (2.5 mg) every 20 min for 10 min. The patients in the control group received nebulized albuterol with the same dose. Then peak expiratory flow rates (PEFR) and forced expiratory volume in 1 s (FEV1), and hemodynamic parameters in both groups were assessed for every 20 min.

Results: In total 70 patients enrolled in this study. We found that the mean PEFR at 40 min was higher in the LMWH group than the control group (202.51 L/min and 180.2 L/min) (p = 0.001). Moreover, this difference remains significant in the 60th minute (p < 0.001). Further, FEV1 was significantly higher in the LMWH group after 60 min (1.82 L/min vs 1.48 L/min, p < 0.001). Moreover, we found that the hemodynamic parameters were sustainable in the intervention group.

Conclusion: The study suggests that LMWH in mild-moderate asthma attacks may be beneficial in the short term and could be prescribed in addition to standard albuterol therapy.
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http://dx.doi.org/10.1016/j.pupt.2021.102037DOI Listing
June 2021

Does atorvastatin have augmentative effects with sodium valproate in prevention of migraine with aura attacks? A triple-blind controlled clinical trial.

J Pharm Health Care Sci 2021 Apr 1;7(1):12. Epub 2021 Apr 1.

Clinical Research Center, Department of Internal Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran.

Background: Migraine is a painful and disabling nervous disorder which negatively affects the quality of life. Migraineurs may suffer from a generalized vasomotor dysfunction. Statins improve vasomotor and vascular function, with their pleiotropic effects. We aimed to assess efficacy and safety of adding Atorvastatin to prophylactic regimen in better control of migraine with aura.

Methods: This triple-blind controlled clinical trial was on 68 patients with migraine with aura. An interval of at least 1 month was given to evaluate vitamin D3 level and eligibility. In patients with vitamin D3 deficiency, the correction with vitamin D supplementation was provided. The patients were randomly assigned to receive atorvastatin 20 mg plus sodium valproate 500 mg or placebo plus sodium valproate 500 mg once a day for 2 months. The patients were evaluated based for the number of attacks and pain severity based on Visual Analogue Scale.

Results: There was a significant (p = 0.0001) improvement in severity of pain and number of migraine attacks by adding Atorvastin to the prophylactic regimen of patients with migraine with aura. After controlling for variable parameters, the differences between two arms of the study was yet statistically significant (p = 0.0001). A significant number of participants in intervention group were satisfied by their treatment (p = 0.001) with no remarkable side effects (P = 0.315).

Conclusions: Adding atorvastatin to migraine with aura preventive regimen may help reduce the number of acute attacks and pain severity without causing considerable side effects and led to a better patient satisfaction.

Trial Registration: IRCT20180106038242N1 . Registered: 7 February 2018.
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http://dx.doi.org/10.1186/s40780-021-00198-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015063PMC
April 2021

Decreased lipoprotein (a) and serum high-sensitivity C-reactive protein levels in male patients with atherosclerosis after supplementation with ginger: A randomized controlled trial.

ARYA Atheroscler 2020 Jul;16(4):153-160

Cellular and Molecular Research Center AND Department of Clinical Biochemistry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Although the antioxidant properties of ginger have been revealed, there is little available information on the effectiveness of ginger on inflammatory disorders such as atherosclerosis. This study was carried out to examine the effect of ginger on improving the complication of atherosclerosis.

Methods: This study was a double-blind, placebo-controlled, randomized clinical trial conducted on patients with atherosclerosis. Participants in the ginger and control groups received 1600 mg of powdered ginger or placebo (wheat flour) in capsules daily for 8 weeks. Weight, body mass index (BMI), fasting blood sugar (FBS), cholesterol, triglyceride (TG), low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), high-density lipoprotein (HDL), lipoprotein (a) [Lp(a)], high-sensitivity C-reactive protein (hs-CRP), and total anti-oxidant capacity (TAC) were assessed before and after the intervention.

Results: Ginger consumption in the intervention group significantly reduced serum Lp(a) level (27.25 ± 1.30 ng/ml vs. 23.57 ± 0.97 ng/ml) (P = 0.040) and also the level of hs-CRP in the intervention group was 1.90 ± 0.33 µg/ml and 1.24 ± 0.15 µg/ml (P = 0.010) before and after intervention, respectively, but the levels of Lp(a) and hs-CRP were not decreased significantly in the placebo group. The level of TAC in the ginger group was 0.71 ± 0.05 mM and after the trial was 0.57 ± 0.04 mM (P = 0.050); no significant differences were seen in TAC when ginger was administered at 1600 mg/daily for 60 days. Also the level of Lp(a) and hs-CRP but not TAC reduced significantly in ginger group compared to placebo group after intervention.

Conclusion: This study showed that ginger had anti-atherosclerosis and anti-glycemic properties associated through a significant decreased Lp(a) and FBS in patients with atherosclerosis supplemented with ginger.
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http://dx.doi.org/10.22122/arya.v16i4.2011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867307PMC
July 2020

Bronchodilatory effects of B-type natriuretic peptide in acute asthma attacks: a randomized controlled clinical trial.

Adv Respir Med 2020 ;88(6):531-538

Biostatistics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khouzestan, Iran.

Introduction: B-type natriuretic peptide (BNP) regulates different physiological processes such as blood pressure, cardiac growth, and neural and skeletal development. Thus, the aim of this study w as to evaluate the effect of BNP in the treatment of acute asthma attacks.

Material And Methods: In this randomized clinical trial, patients with acute asthma attacks were enrolled. The patients were divided randomly into two groups. Patients in the interventional group received BNP via intravenous infusion. Two µg/kg of BNP was injected as a bolus in 60 seconds. Then, infusion of BNP immediately began and was given in 0.01, 0.02, and 0.03 µg/kg/min doses every 30 minutes for the first 1.5 hours. The patients in the control group received nebulized salbutamol. Afterwards, peak flow meter findings, hemodynamic parameters, and estimation of the clinical severity of asthma in both groups were checked every 30 minutes.

Results: In total, 40 patients were included in this study. The values of PEFR in the 60th and 90th minutes in the control group were lower than those in the interventional group. In the 60th minute, the mean of PEFR was 377.3 in the BNP group but 335.95 in the control group (P = 0.049). Moreover, this difference remained significant in the 90th minute (P = 0.021). However, forced expiratory volume in one second (FEV1) did not differ between the groups at any time (p > 0.05).

Conclusion: Although a large experimental study is needed to verify our hypothesis, it seems that BNP might be a therapeutic option in asthma exacerbations, particularly in those with b2 agonist receptor polymorphism.
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http://dx.doi.org/10.5603/ARM.a2020.0178DOI Listing
October 2021

Effects of Virtual Reality vs Conventional Balance Training on Balance and Falls in People With Multiple Sclerosis: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2021 02 5;102(2):290-299. Epub 2020 Nov 5.

Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Objective: To assess the efficacy of virtual reality (VR)-based vs conventional balance training on the improvement of balance and reduction of falls in people with multiple sclerosis (PwMS).

Design: Single-blinded, randomized, controlled trial.

Setting: Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences.

Participants: PwMS (N=39), randomized into VR (n=19) and control (n=20) groups.

Intervention: The VR group performed exergames using Kinect, while the control group accomplished conventional balance exercises. Both groups received 18 training sessions for 6 weeks.

Main Outcome Measures: Limits of stability, timed Up and Go (TUG) test, and 10-m walk tests with and without cognitive task and their dual-task costs (DTCs), Berg Balance Scale, Multiple Sclerosis Walking Scale-12, Fall Efficacy Scale-International, Activities-specific Balance Confidence Scale, and fall history were obtained pre- and post intervention and after a 3-month follow-up.

Results: At both post intervention and follow-up, TUG and DTCs on the TUG were significantly lower and the 10-m walk was significantly higher in the VR group. At follow-up, reaction time and the number of falls demonstrated significant differences favoring the VR group, whereas the directional control revealed significant difference in favor of the control group (P<.05). The other outcomes showed no statistically significant difference at post intervention or follow-up.

Conclusions: Both the VR-based and conventional balance exercises improved balance and mobility in PwMS, while each acted better in improving certain aspects. VR-based training was more efficacious in enhancing cognitive-motor function and reducing falls, whereas conventional exercises led to better directional control. Further studies are needed to confirm the effectiveness of recruiting VR-based exercises in clinical settings.
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http://dx.doi.org/10.1016/j.apmr.2020.09.395DOI Listing
February 2021

Assessing agreement between the three common clinical measurement methods of HbA1c.

J Diabetes Metab Disord 2020 Jun 11;19(1):273-279. Epub 2020 Feb 11.

Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Reliable measurement of hemoglobin A1c (HbA1c) has great importance in the diagnosis and monitoring of diabetes mellitus. The aim of the present study was to compare the performance parameters of the three common methods of HbA1c assay, including the Roche, Sebia and TOSOH G8 systems. We studied 120 patients referred to a clinical laboratory for HbA1c assay. The blood samples were analyzed with the Roche, Sebia and TOSOH G8 systems based on immunoassay, capillary electrophoresis, and ion-exchange chromatography techniques, respectively. The Spearman and the Passing-Bablok regression,as well as the Bland-Altman plots, were used to compare these methods. For each assay, the patients' classification was evaluated at the three cut-points of 6.5, 7, and 8% and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the methods were estimated. Our results showed that there were good correlations and agreement between the methods. We found a mean difference of 0.07% for the TOSOH G8 vs. Roche, 0.06% for the TOSOH G8 vs. Sebia and - 0.01% for the Roche vs. Sebia. The methods represented very low bias, indicating the good accuracy of the results. The sensitivity and specificity of the methods were comparable as well. The three methods also performed similarly in the classification of patients at the proposed cut-off points. Based on our results, the Roche, Sebia and TOSOH G8 systems showed a very high level of agreement with comparable performance parameters and yielded similar and accurate classification of diabetic patients. Therefore, these methods can be used interchangeably.
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http://dx.doi.org/10.1007/s40200-020-00503-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270288PMC
June 2020

Dexmedetomidine versus Midazolam-Fentanyl in Procedural Analgesia Sedation for Reduction of Anterior Shoulder Dislocation: A Randomized Clinical Trial.

Rev Recent Clin Trials 2019 ;14(4):269-274

Department of Biostatistics and Epidemiology, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Shoulder joint dislocation is the most common dislocation of joints in the body. To reduce the anterior shoulder dislocation, it is necessary to have analgesia and sedation.

Methods: In this randomized clinical trial, patients were divided into two equal groups. Group I received midazolam-fentanyl (0.05 mg/kg fentanyl at a dose of 1 µg/kg) for 10 minutes and group II received dexmedetomidine (1 µg/kg in the initial dose and then 0.2 µg/kg/h) for 10 minutes. The levels of analgesia according to VAS criteria and the time to reach desired sedation were compared between the two groups.

Results: A total of 60 patients participated in this study. The time to reach the desired sedation was 8.60 ± 2.3 minutes in the dexmedetomidine group and 11.27 ± 3.57 minutes in the midazolamfentanyl group (p= 0.001). Also, the VAS score in both midazolam-fentanyl and dexmedetomidine groups was 3.3 ± 1.24 and 2.57 ± 0.9, respectively. The differences were statistically significant (p=0.015). There was significant relationship between the time to reach desired sedation and the level of analgesia. Moreover, there was no significant difference between patient age and the time to reach the desired level of analgesia. During this study, no side effect was observed.

Conclusion: The findings of this study show that dexmedetomidine provides a higher level of analgesia than midazolam-fentanyl. Moreover, it was also shown that dexmedetomidine causes quicker procedural sedation than midazolam-fentanyl.
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http://dx.doi.org/10.2174/1574887114666190809160419DOI Listing
May 2020

The effect of lupus disease on the pregnant women and embryos: a retrospective study from 2010 to 2014.

Clin Rheumatol 2019 Nov 27;38(11):3211-3215. Epub 2019 Jul 27.

Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background And Aims: Pregnancy in women with systemic lupus erythematosus (SLE) is one of the challenges of recent studies. Women should prevent the onset of relapses with medications before and after pregnancy, and on the other hand, the effect of these medicines considers the health and development of the fetus. In this retrospective study, the effects of anti-phospholipid syndrome and the use of common drugs such as methotrexate, cyclosporine, and azathioprine and their side effects on maternal health and ultimately the development of the fetus have been investigated.

Material And Methods: This study is a descriptive and retrospective epidemiologic study that was conducted in 2016 to investigate maternal and fetal complications in SLE patients. We prepared forms of data recording, including age, occupation, and other important information and then analyzed them in SPSS version 22.

Result: The results showed that the presence of anti-phospholipid syndrome in pregnant women can lead to abnormalities such as preterm, IUGR, abortion, and fetal death (P value 0.0001). It also leads to complications such as nephritis, arthritis, and preeclampsia in the mother (P value 0.003). This study suggests that methotrexate and cyclosporine medications could cause fetal developmental disorders. The P value of cyclosporine was 0.0001 and the P value of methotrexate was 0.001.

Conclusion: Anti-phospholipid syndrome in women with SLE who intend to become pregnant can disrupt the development of the embryo. The consumption of methotrexate and cyclosporine medications before and during the pregnancy can have irreparable effects on fetal growth. Key Points • Anti-phospholipid syndrome can disrupt the development of the embryo in women with SLE who intend to become pregnant. • Methotrexate and cyclosporine consumption before and during pregnancy can affect fetal growth. • 7 to 33% of patients whose disease had been suppressed and controlled 6 months before pregnancy seams to relapse during the pregnancy. • Taking medications to control the disease during pregnancy plays an important role in the progression of pregnancy and fetus health.
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http://dx.doi.org/10.1007/s10067-019-04682-3DOI Listing
November 2019

COMPLICATIONS AFTER TRANSABDOMINAL SOAVE'S PROCEDURE IN CHILDREN WITH HIRSCHSPRUNG'S DISEASE.

Arq Bras Cir Dig 2019 Feb 7;32(1):e1421. Epub 2019 Feb 7.

Department of Biostatistics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khouzestan, Iran.

Background: Hirschsprung's disease is a congenital disorder that causes functional obstruction of large bowel.

Aim: To evaluate complication and bowel function score of children with Hirschsprung's disease who underwent transabdominal Soave's procedure.

Methods: In this study all the children with Hirschsprung's disease who underwent transabdominal Soave procedure were evaluated regarding bowel function and complication of trans-abdominal Soave's procedure.

Results: Were enrolled 160 children. Enterocolitis and constipation were seen in 15% of the cases. Fecal incontinency was the least frequent study which was seen in 1% of the children.

Conclusion: Constipation and enterocolitis was the most frequent complication following transabdominal Soave technique.
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http://dx.doi.org/10.1590/0102-672020180001e1421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368151PMC
February 2019

Evaluating the Relationship Between Serum Level of Interleukin-6 and Rheumatoid Arthritis Severity and Disease Activity.

Curr Rheumatol Rev 2020 ;16(3):249-255

Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Aim: The aim of this study was to evaluate the relationship between Interleukin-6 (IL-6) serum level and the severity and activity of Rheumatoid Arthritis (RA).

Methods: In this cross-sectional study, 120 RA patients referred to the rheumatology clinic, the patients were diagnosed by rheumatologists according to ACR / EULAR 2010 criteria. Based on DAS28 score the patients were divided into 4 groups: Remission, Mild, Moderate and Severe. Each group contained 30 patients. Serum levels of Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), anti-Cyclic Citrullinated Peptide (anti-CCP) and Rheumatoid Factor (RF) and serum levels of IL-6, were measured. The relationship between these factors was measured and compared to the relationship between IL-6 and these factors, and the activity of the disease was evaluated based on DAS-28.

Results: This study showed that the serum level of IL-6 has a significant relationship with RA activity according to DAS-28 (P value <0.001). There is also a significant relationship between the ESR level, the number of painful joints, and the number of swollen joints, and the severity of the disease based on VAS.

Conclusion: Generally the findings of this study indicate that serum level of IL-6 plays an important role in the severity and activity of RA disease and can be considered as a determining factor in evaluating the severity of RA in RA patients and it is a good guide for a step up or down of treatment.
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http://dx.doi.org/10.2174/1573397115666190206144223DOI Listing
August 2021

A Spatial Survival Model in Presence of Competing Risks for Iranian Gastrointestinal Cancer Patients

Asian Pac J Cancer Prev 2018 Oct 26;19(10):2947-2954. Epub 2018 Oct 26.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Email:

Background: Gastrointestinal cancer is one of the common causes of death from cancer in Iran. Survival analysis is usually used to detect prognostic factors of time to death from gastrointestinal cancers. The use of ordinary survival models, in the presence of competing risks and/or when data is collected within geographic areas, may lead to distorting the results. Therefore, the aim of this study is to use the spatial survival models in the presence of competing risks to assess the risk factors affecting the survival time of gastrointestinal cancer patients. Methods: The data in this study was collected from 602 patients who were diagnosed with gastrointestinal cancer in Golestan and Mazandaran provinces registered in Iran’s National Institute of Health Research from 2002 through 2007 and were followed up to July 2017. The data was analyzed using the cause-specific hazard frailty model with multivariate conditional autoregressive distribution for frailties in the presence of competing risks (death from gastrointestinal cancer, heart disease, and other causes) via OpenBUGS software. Results: The hazard of death from gastrointestinal cancer in men patients, patients who lived in rural areas, patients whose relatives did not have a history of cancer, patients who did not undergo surgery, and patients with gastric cancer was significantly higher than others. Based on the deviance information criterion (DIC), frailty models and spatial frailty models seemed better than no-frailty model and non-spatial frailty model, respectively. Conclusions: This study showed that the use of the spatial frailty term in the model helps better fit the model. Also, the spatial pattern in the figures suggests the necessity of presence of some still missing, spatially varying covariates relevant for time to death from gastrointestinal cancer, heart disease, or other causes.
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http://dx.doi.org/10.22034/APJCP.2018.19.10.2947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291038PMC
October 2018

Risk factors associated with diabetic foot ulcer-free survival in patients with diabetes.

Diabetes Metab Syndr 2018 Nov 26;12(6):1039-1043. Epub 2018 Jun 26.

Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Aims: This study was done to assess the risk factors associated with diabetic foot ulcer-free survival in patients with diabetes.

Materials And Methods: Based on a prospective cohort study, ADFC (Ahvaz Diabetic Foot Cohort) study, carried out in a university hospital, all of the patients with diabetes were followed up for new diabetic foot ulcer (DFU). The time of ulcer development was final outcome during two years in the present study. To analyze the data, the variables were first evaluated by univariate analysis. Subsequently variables with P value <0.2 were tested in multivariate analysis, using backward elimination multiple Cox regression.

Results: From among 605 eligible patients of ADFC study, 566 patients without foot ulcer were included for a 2- years follow-up. Thirty subjects (5.3%) developed DFU during the study course none of whom underwent amputation. The DFU-free survival rate was 0.945 over two years of follow-up. In final multivariate Cox regression analysis, the variables which remained in the model and had a statistically significant relationship with time to develop foot ulcer were: dyslipidemia, history of DFU or amputation, nephropathy callus formation in the feet and diabetes duration. Foot deformity and patients' training about self-care of their feet were statistically borderline significant.

Conclusions: The DFU-free survival rate was 0.945 over two years of follow-up. In this study, independent risk factors associated with ulcer-free survival in diabetic foot patients were dyslipidemia, prior history of DFU or amputation, diabetic nephropathy, callus formation in the feet and diabetes duration.
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http://dx.doi.org/10.1016/j.dsx.2018.06.020DOI Listing
November 2018

Amniotic Membrane Extract Eye Drop Promotes Limbal Stem Cell Proliferation and Corneal Epithelium Healing.

Cell J 2019 Jan 1;20(4):459-468. Epub 2018 Aug 1.

Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran. Electronic Address:

Objective: Human amniotic membrane (HAM) is used as a supporter for limbal stem cell (LSC) expansion and corneal surgery. The aim of study is to use HAM extracts from healthy donors to enhance proliferation of LSCs in vitro and in vivo.

Materials And Methods: In this interventional experimental study, the effective and cytotoxic doses of the amniotic membrane extract eye drops (AMEED) was assessed by adding different concentrations of AMEED (0-2.0 mg/ml) to LSC cultures for 14 days. Subsequently, the expression levels of ATP-binding cassette sub-family G member 2 (ABCG2, a putative stem cell marker), cytokeratin 3 (K3, corneal maker), K12 and K19 (corneal-conjunctival cell makers) were assessed by real-time polymerase chain reaction (PCR). In the second step, the corneal epithelium of 10 rabbits was mechanically removed, and the right eye of each rabbit was treated with 1 mg/ml AMEED [every 2 hours (group 1) or every 6 hours (group 2)]. The left eyes only received an antibiotic. The corneal healing process, conjunctival infection, degree of eyelid oedema, degree of photophobia, and discharge scores were evaluated during daily assessments. Finally, corneal tissues were biopsied for pathologic evidences.

Results: In comparison to the positive control [10% foetal bovine serum (FBS)], 0.1-1 mg/ml AMEED induced LSC proliferation, upregulated ABCG2, and downregulated K3. There were no remarkable differences in the expression levels of K12 and K19 (P>0.05). Interestingly, in the rabbits treated with AMEED, the epithelium healing duration decreased from 4 days in the control group to 3 days in the two AMEED groups, with lower mean degrees of eyelid oedema, chemosis, and infection compared to the control group. No pathologic abnormalities were observed in either of the AMEED groups.

Conclusion: AMEED increases LSCs proliferation ex vivo and accelerates corneal epithelium healing in vivo without any adverse effects. It could be used as a supplement for LSC expansion in cell therapy.
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http://dx.doi.org/10.22074/cellj.2019.5423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6099140PMC
January 2019

A Comparative Study of the Amount of Bleeding and Hemodynamic Changes between Dexmedetomidine Infusion and Remifentanil Infusion for Controlled Hypotensive Anesthesia in Lumbar Discopathy Surgery: A Double-Blind, Randomized, Clinical Trial.

Anesth Pain Med 2018 Apr 28;8(2):e66959. Epub 2018 Apr 28.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: The aim of this study was to compare the volume of blood loss and hemodynamic changes in patients undergoing lumbar discopathy, after continuous infusions of dexmedetomidine versus remifentanil during anesthesia with controlled low blood pressure.

Methods: In this randomized double-blind clinical trial, 60 patients aged 20 to 65 years were randomly assigned to control and intervention groups. The intervention group received a continuous infusion of dexmedetomidine at 0.3 - 0.7 µg/kg/hour plus propofol at 50 - 100 µg/kg/minute. The control group was given a continuous infusion of remifentanil at 0.1 to 1 µg/kg/minute plus the same dose of propofol as above. The primary outcome was the amount of patient's bleeding during surgery, and secondary outcomes were changes in the patient's systolic blood pressure, diastolic blood pressure, mean arterial pressure, and urinary output.

Results: Univariate and multivariate analyses of the main outcome in the control and intervention groups showed that there was no significant difference between the two drugs with regards to the volume of blood loss, mean arterial pressure, and systolic and diastolic blood pressure. Postoperative side effects were significantly lower in the intervention group (P = 0.002).

Conclusions: Administration of dexmedetomidine plus propofol in comparison with remifentanil plus propofol did not show any significant difference regarding blood loss and hemodynamic changes; however, it reduced some side effects after surgery and decreased analgesic requirement in the postoperative period. Taken together, the findings of this study do not support strong recommendations for dexmedetomidine infusion for all patients and the decision should be taken with caution on basis of the anesthesiologist's expert opinion and the patient's condition during surgery.
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http://dx.doi.org/10.5812/aapm.66959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035495PMC
April 2018

Evaluation of psychological resistance to insulin treatment in type II diabetic patients.

Diabetes Metab Syndr 2018 Nov 19;12(6):929-932. Epub 2018 May 19.

Department of Psychiatry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address:

Aims: Various studies have demonstrated that the majority of the factors affecting the reluctance of individuals to insulin injections are rooted in psychological factors. Present study aimed to determine relationships between main causes of refusal to insulin injection in diabetic patients and factors such as age, gender, and educational degree of patients.

Material & Methods: This was a descriptive study which was conducted on diabetic patients (n = 505) who need insulin therapy. The data were collected with a questionnaire in following steps. First, the most important causes of patients' reluctance, in the patients' opinion, to insulin therapy were determined using the data of the previous studies. In the second step, the patients were asked to express their opinion on each of these factors and the recorded responses were analyzed.

Results: The results of the study showed that fear of ampoules, fear of pain caused by insulin and the embarrassment of patients from injections in public significantly depended on the gender of the patients, so that these factors were much lower in men than women. In addition, these factors in the patients with higher degrees of education led to lower level of refusal to insulin injections. Another factor influencing the reluctance to insulin injections was the forming of a sense of addiction due to daily insulin injections, which was significantly lower among the patients with higher education, but did not have a significant relationship with sex of the patients. In this regard, another factor was fear of hypoglycemia and insulin side effects, which did not have a significant relationship with gender and educational degree. In addition, there was no significant relationship between the patient's age and any of the factors effective in patients' reluctance to insulin injections.

Conclusion: Psychological factors seem to be effective in the emergence of the sense of reluctance to insulin injections. Therefore, not only patients but also the entire society need to receive training and appropriate services to improve their attitude to this issue with a psychological approach and help to solve this problem.
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http://dx.doi.org/10.1016/j.dsx.2018.05.017DOI Listing
November 2018

Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)-Two-Year Follow-Up Study.

Int J Endocrinol 2018 15;2018:7631659. Epub 2018 Mar 15.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Aim/introduction: This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU).

Materials And Methods: In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression.

Results: Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89-8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13-43.78), value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37-14.07), value < 0.01], gender [OR = 3.23, 95% CI (1.33-7.83), value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40-8.09), value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10-8.29), value = 0.032] had a statistically significant relationship with DFU incidence.

Conclusion: Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.
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http://dx.doi.org/10.1155/2018/7631659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875034PMC
March 2018

Accelerated versus Conventional Corneal Collagen Cross-Linking for Progressive Keratoconus.

Med Hypothesis Discov Innov Ophthalmol 2017 ;6(4):110-117

Department of Biostatistics, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

We aimed to compare the effect of accelerated and conventional corneal collagen cross-linking (CXL) on visual, refractive, and topographic parameters in patients with progressive keratoconus. Between December 2014 and February 2016, at Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Iran, we compared 37 eyes of 21 patients treated by conventional CXL (CCXL; 3 mW/cm2 in 30 minutes) with 34 eyes of 18 patients treated by accelerated CXL (ACXL; 18 mW/cm2 in 5 minutes) based on generalizing estimation equation analysis in terms of corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), corneal endothelial cell indices, and topographic parameters before and at 3, 6 and 12 months after the operation. The mean UDVA and spherical equivalent changes were similar in the two groups, but an improvement in CDVA was only observed in the CCXL group (P = 0.003). Keratometry (minimum and maximum) was significantly decreased in the CCXL group (P = 0.043 and P = 0.008, respectively). Indices of keratoconus progression-surface asymmetry index (SAI), keratoconus prediction index (KPI), and keratoconus index (KCI)-were significantly lower in the CCXL group than in the ACXL group (P = 0.002, P < 0.001, and P < 0.001, respectively). The thinnest corneal thickness (TCT) was not significantly different between the two groups (P = 0.15). The reduction of corneal endothelial cell density was also similar between the two groups; however, polymorphism and polymegethism were significantly lower in the ACXL group than in the CCXL group. In conclusion, we showed that although ACXL at 18 mW/cm2 slowed keratoconus progression safely during a 1-year follow-up, CCXL at 3 mW/cm2 may be superior in the prevention of keratoconus progression.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847305PMC
January 2017
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