Publications by authors named "Seyed Amir Mohajerani"

39 Publications

Budesonide facilitates weaning from mechanical ventilation in difficult-to-wean very severe COPD patients: Association with inflammatory mediators and cells.

J Crit Care 2018 04 31;44:161-167. Epub 2017 Oct 31.

Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.

Introduction: Mechanical ventilatory support is life-saving therapy for patients with respiratory failure in intensive care units (ICU) but is linked to ventilator-associated pneumonia and other nosocomial infections. Interventions that improve the efficiency of weaning from mechanical ventilation may improve patient outcomes.

Objective: To determine whether inhaled budesonide decreases time-to-weaning in COPD stage 4 difficult-to-wean patients and reduces the release of pro-inflammatory cytokines in ICU patients.

Materials And Methods: We recruited 55 difficult-to-wean COPD patients (Stage 4) within the ICU of the Masih Daneshvari Hospital. Subjects were randomly assigned to receive inhaled budesonide (0.5mg/day) or placebo (normal saline). Dynamic compliance and BAL cytokines were measured.

Results: Budesonide significantly reduced the number of days on MV (days-to-weaning=4.6±1.6days) compared to that seen in the control group (7.2±2.7days, p=0.014). Dynamic compliance was significantly improved in the budesonide group on days 3 (p=0.018) and 5 (p=0.011) The levels of CXCL-8 and IL-6 diminished on days 3-5 after start of budesonide (p<0.05).

Conclusion: In COPD patients on MV, nebulized budesonide was associated with reduced BAL CXCL8 and IL-6 levels and neutrophil numbers as well as an improvement in ventilatory mechanics and facilitated weaning.
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http://dx.doi.org/10.1016/j.jcrc.2017.10.045DOI Listing
April 2018

Carbamazepine effects on pain management and serum IL-6, IL-10 evaluation in addicted patients undergoing surgery.

Eur J Pharmacol 2017 Oct 8;812:184-188. Epub 2017 Jul 8.

Department of Pharmacology & Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Postoperative pain control remains an important issue in the field of surgery. Assessing and managing patients with acute pain who are addicted to opioids are often challenging. It has been shown that, addicted patients are less tolerant to pain. There is limited evidence to guide the management of acute pain in these patients. Here we studied the effect of preemptive use of carbamazepine on pain behavior and serum IL-6, IL-10 levels in the addicted patients. 90 male patients (25-45 years, BMI 20-27), were divided into 3 group of 30 patients: 1- control, 2- addicted, 3- addicted patients receiving carbamazepine 400mg before surgery. The visual analog pain scale and serum levels of IL-6 and IL-10 were evaluated at time 0 (before surgery), 1 and 12h postoperatively. Compared with control and carbamazepine groups, addicted patients exhibited exaggerated pain behavior before and after surgery, however, postoperatively, a significant increase in pain behavior was seen in control compared to carbamazepine group. A decrease in serum IL-10 and an increase in IL-6 concentrations were observed in addicted patients. In the morphine abuser, a decrease in pain threshold, an increase in IL-6 and a decrease in IL-10 levels were evident compared with non-abuser subjects. Addition of carbamazepine improved pain sensation and serum IL-6 levels and a reduction in serum IL-10 level in control patients was paralleled to their recovery. It seems that, preemptive use of low dose of carbamazepine can improve postoperative pain and cytokine activities in the addicted patients.
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http://dx.doi.org/10.1016/j.ejphar.2017.07.011DOI Listing
October 2017

Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis.

J Pain Res 2017 17;10:1179-1187. Epub 2017 May 17.

Department of Anesthesiology and Pain Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences.

Background: Osteoarthritis (OA) is a degenerative disease that can lead to painful and dysfunctional joints. Prolotherapy involves using injections to produce functional restoration of the soft tissues of the joint. Intra-articular injections are controversial because of the introduction of needles into the articular capsule.

Objectives: To compare the effect of periarticular versus intra-articular prolotherapy on pain and disability in patients with knee OA.

Study Design: Randomized double-blind controlled clinical trial.

Setting: Single center, university hospital (Imam Hossein Hospital, Tehran, Iran).

Methods: A total of 104 patients with chronic knee OA were enrolled. In the intra-articular group, 8 mL of 10% dextrose and 2 mL of 2% lidocaine were injected. Injections were repeated at 1 and 2 weeks after the first injection. In the periarticular group, 5 mL of 20% dextrose and 5 mL of 1% lidocaine were injected subcutaneously at 4 points in the periarticular area. Pain and disability, as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), were recorded at each follow-up visit at 1, 2, 3, 4, and 5 months post-injection.

Results: The visual analog scale score was significantly lower in the periarticular compared with the intra-articular group at the 2-, 3-, 4-, and 5-month visits but not at 1 month. Morning stiffness and difficulty in rising from sitting were improved in both groups and were not signifi-cantly different in the peri- and intra-articular groups. Pain, joint locking, and limitation scores were all improved in both groups. Difficulty in walking on flat surfaces or climbing stairs, and sitting and standing pain, were all improved in both groups from 1 to 5 months after treatment.

Limitations: WOMAC scores are subjective and could be a limitation of the study.

Conclusion: Periarticular prolotherapy has comparable effects on pain and disability due to knee OA to intra-articular injections, while avoiding risks of complications.
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http://dx.doi.org/10.2147/JPR.S127633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439936PMC
May 2017

Impact of dexmedetomidine on hemodynamic changes during and after coronary artery bypass grafting.

Ann Card Anaesth 2017 Apr-Jun;20(2):152-157

Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: To determine the effect of dexmedetomidine (Dex) on hemodynamic changes during cardiopulmonary pump and postoperative period in coronary artery bypass grafting (CABG).

Methods And Design: This study is designed as a double-blinded, randomized clinical trial.

Setting: University hospital and single center.

Participants: patients candidate for elective CABG.

Intervention: Dex 0.5 μg/kg/h or placebo was infused from the initiation of anesthesia up to extubation in Intensive Care Unit (ICU).

Measurements: Heart rate (HR) and blood pressure (BP), pain score, and total morphine dose requirement were monitored and compared during cardiac pump up to 12 h postoperative in ICU.

Results: Mean arterial pressure was significantly higher in Dex group in postoperation period at 1 (P = 0.010) and 2 h (P = 0.002) compared to control group. HR was significantly lower in Dex group in postcardiopulmonary bypass (CPB) time at 0 h (P = 0.001), 1 h (P = 0.0016), and 2 h (P = 0.001), and then in postoperative period in ICU at 1 h (P = 0.025), 2 h (P = 0.0012), and 4 h (P = 0.0025) compared to control group. Postoperative pain score was significantly lower during 12 h after surgery.

Conclusion: Dex could effectively blunt hemodynamic response to surgical stress, particularly during CPB pump and afterward. Infusion of Dex maintains BP at higher range and HR at lower range compared to placebo.
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http://dx.doi.org/10.4103/aca.ACA_76_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408518PMC
November 2017

Long term outcome of cystic fibrosis patients with multisystem evaluation.

Adv Respir Med 2016 ;84(6):310-315

Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Cystic fibrosis is a chronic disease with multiple organ involvement and chiefly results in chronic respiratory infections, pancreatic insufficiency and associated complications. The age at diagnosis, clinical presentation, rate of disease progression and prognosis is variable among patients. This study is designed to evaluate the behavior of disease to provide epidemiologic data for early recognition and proper management.

Material And Methods: The study was designed as an active surveillance of 192 patients diagnosed with cystic fibrosis in a tertiary lung disease centre between 2008 and 2015. The diagnosis of cystic fibrosis was established in all patients accordingly to conventional criteria, including two positive sweat chloride tests and clinical signs and symptoms. Demographic, clinical and laboratory data were obtained from these patients in each hospitalization and also every follow-up visit and carefully evaluated for complications of this chronic disease.

Results: The majority of patients showed positive culture for Pseudomonas aeroginosa. Bronchiectasis was the most prevalent finding in chest CT scan. 44.3% of patients had been treated for allergic bronchopulmonary aspergillosis and all had sinus disease. Increased pulmonary artery pressure was observed in 40% of patients with cystic fibrosis. 33 patients died which consisted 17.1% of all the patients.The mean age of mortaliy was 18.15 year.

Conclusions: The clinical outcome of cystic fibrosis is variable in different countries which may reflect environmental influences and the role of early diagnosis on long term outcomes. However, the role of early diagnosis in long-term outcomes of the disease can not be ignored.
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http://dx.doi.org/10.5603/ARM.2016.0040DOI Listing
January 2016

Outcome of Acute Kidney Injury in Critical Care Unit, Based on AKI Network.

Tanaffos 2016 ;15(2):89-95

Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Acute Kidney Injury (AKI) is an unsolved clinical problem in critical care patients with a high mortality rate, increasing incidence, and no definitive therapy. We studied the incidence, risk factors, and mortality associated with AKI in ICU patients.

Materials And Methods: In a prospective study, patient demographics, reason for hospitalization, reason for ICU admission, Length of ICU stay, laboratory data, and Vital signs were recorded in prepared forms during the ICU stay. AKI was defined as an increase in serum creatinine (SCr) of ≥ 0.3mg/dl from the baseline.

Results: A total of 200 patients who were enrolled in our study; 134 (67%) did not develop AKI during their ICU stay while 66 (33%) developed AKI (SCr ≥ 0.3) according to the AKIN definition. Patients with AKI had higher APACHE II scores (12.3±5.6 vs. 6.9±3.6; P< 0.001), longer ICU stays (7.6±7.6 vs. 3.7±2.8 days respectively; P< 0.001), and higher mortality (19.7% vs. 0.7%; P< 0.001).

Conclusion: The AKIN criteria are clinically valid and can be a good predictor of mortality and patient outcome in addition to APACHE II score in ICU patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127620PMC
January 2016

Preemptive Oral Clonidine Provides Better Sedation Than Intravenous Midazolam in Brachial Plexus Nerve Blocks.

Anesth Pain Med 2016 Jun 23;6(3):e28768. Epub 2016 Apr 23.

Department of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Preemptive analgesia is the blocking of pain perception afferent pathways before noxious painful stimuli. Clonidine is an alpha agonist drug that is partially selective for α-2 adrenoreceptors. Clonidine is used as anti-anxiety medication and an, analgesic, and it prolongs the duration of the block in the brachial plexus block.

Objectives: To compare the effect of preemptive clonidine with midazolam on intraoperative sedation, duration of block, and postoperative pain scores

Patients And Methods: In a randomized clinical trial, 80 patients with orthopedic fractures of an upper extremity who underwent supraclavicular nerve block were randomly assigned to receive 0.2 mg oral clonidine or 2 mg oral midazolam. Intraoperative sedation was measured at one hour after the start of urgery and again in the PACU (Post-Anesthesia Care Unit) using the Ramsay scale. The duration of sensory blockade was measured. Postoperative pain scores were measured using the VAS (Visual Analogue Scale) after entrance to recovery up to 2 hours.

Results: The percentages of patients in the calm and sedated scale were significantly higher in clonidine group (35 and 42.5%, respectively), compared to the midazolam group (17.5 and 17.5%, respectively) (P = 0.042, 0.029; respectively). Those administered fentanyl in the clonidine group 105 ± 30.8 was significantly lower than that for the midazolam group 165 ± 34.5 (P = 0.0018). The percentages of patients in the calm scale were significantly higher in the clonidine group (52.5), compared to the midazolam group (17.5) (P = 0.001) in the post-operative period. VAS scores were significantly lower at one (P = 0.01) and two hours (P = 0.001) after operation in the clonidine group, compared to the midazolam group.

Conclusions: Preemptive clonidine has many marvelous advantages over midazolam, including better sedation inside the operating room and then in the post-operative care unit, lower fentanyl doses are required during surgery, more stable heart rate and blood pressure are observed during the procedure, and patients report lower post-operative pain scores.
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http://dx.doi.org/10.5812/aapm.28768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055753PMC
June 2016

The Effect of Pre-Emptive Dexmedetomidine on the Incidence of Post-Thoracotomy Pain Syndrome in Patients Undergoing Coronary Artery Bypass Grafting.

Anesth Pain Med 2016 Jun 6;6(3):e36344. Epub 2016 Jun 6.

Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Post-thoracotomy pain syndrome (PTPS) is pain that recurs or persists along a thoracotomy incision for at least two months following surgery. Dexmedetomidine (dex) is an α-2 agonist that also has analgesic, sedative-hypnotic, and sympatholytic properties.

Objectives: To determine the effect of pre-emptive dexmedetomidine on the incidence of PTPS in patients undergoing coronary artery bypass grafting (CABG).

Patients And Methods: This randomized clinical trial enrolled 104 candidates for elective coronary artery bypass grafting (CABG) and randomly assigned them to either a dex group or a control group. In the dex group, dexmedetomidine 0.5 µg/kg/hour was infused from the initiation of anesthesia until postoperative extubation in the intensive-care unit. Two months after surgery, the patients were contacted by telephone and interviewed to determine the presence of pain at the thoracotomy scars.

Results: Fifty-four patients were placed in the control group, and 50 patients were assigned to the dex group. The age, sex, and body mass index were not significantly different between the two groups of study (P > 0.05). The incidence of PTPS was 11/50 (22%) patients in the dex group and 28/54 patients (52%) in the control group. A chi-square test revealed a significant difference in the incidence of PTPS after two months between the dex and control groups (P = 0.032).

Conclusions: PTPS is a common problem following CABG, and pre-emptive therapy with dex may decrease neuropathic pain.
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http://dx.doi.org/10.5812/aapm.36344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027128PMC
June 2016

Radiologic manifestations of pulmonary tuberculosis in patients of intensive care units.

Int J Mycobacteriol 2015 09 19;4(3):233-8. Epub 2015 Jun 19.

Mycobacteriology Research Center Virology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Tuberculosis (TB) is a serpent disease with various pulmonary manifestations, and timely diagnosis of the disease is paramount, since delayed treatment is associated with severe morbidity, particularly in intensive care units (ICU). Therefore, it is imperative that intensivists understand the typical distribution, patterns, and imaging manifestations of TB.

Aim: To describe different manifestations of pulmonary TB in patients in the ICU.

Methods: In a retrospective study, all patients with a clinical and a laboratory-confirmed diagnosis of TB who were admitted to the ICU were entered in the study. All patients had a confirmatory laboratory diagnosis of TB including positive smears. The patterns of parenchymal lesions, involved segments and presence of cavity, bronchiectasis and bronchogenic spread of the lesions with computed tomography (CT) and chest/X-ray (CXR) were recorded and analyzed.

Results: Data of 146 patients with TB were entered in the study. The most common finding in CT was acute respiratory distress syndrome (ARDS)-like radiologic manifestations (17.1%), followed by parenchymal nodular infiltration (13.6%) and cavitation (10.9%), consolidation (10.2%), interstitial involvement (9.5%), calcified parenchymal mass (8.3%), ground-glass opacities (7.5%), and pleural effusion or thickening (6.9%). Radiologic evidence of lymphadenopathy was seen in up to 43% of adults. Miliary TB was observed in 2.3% of patients, mostly in those older than 60years of age. ARDS-like (64.5%) manifestations on CT and miliary TB (85.5%) had the highest mortality rates among other pulmonary manifestations.

Conclusion: ARDS, interstitial involvement, and Parenchymal nodular infiltration are the most common manifestations of pulmonary TB. Various features of TB in ICU patients could be misleading for intensivists.
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http://dx.doi.org/10.1016/j.ijmyco.2015.05.008DOI Listing
September 2015

Intrathecal Dexmedetomidine and Fentanyl as Adjuvant to Bupivacaine on Duration of Spinal Block in Addicted Patients.

Anesth Pain Med 2016 Feb 31;6(1):e26714. Epub 2016 Jan 31.

Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Addicted patients have innate tolerance to local anesthetics in both neuraxial and peripheral blocks. Dexmedetomidine (Dex) is a highly selective α2 adrenergic receptor agonist used as additive to increase quality and duration of peripheral nerve blocks.

Objectives: The current study aimed to compare the effect of dexmedetomidine and fentanyl additives on bupivacaine to prolong the duration of block and minimizing side effects.

Patients And Methods: Patients were candidates for elective surgery less than three hours of lower abdomen or lower extremities surgeries. Patients were randomly allocated to receive dexmedetomidine 5 µg added to 12.5 mg (2.5 mL) of 0.5% hyperbaric bupivacaine (DEX group), or 25 µg (0.5 mL) fentanyl added to 12.5 mg (2.5 mL) of 0.5% hyperbaric bupivacaine (F group) or only 12.5 mg of 0.5% hyperbaric bupivacaine. Data were recorded based on sensory block. Motor block was tested using modified Bromage scale every 30 minutes until the end of block. Time to return of sensory block to 4 dermatomes below and time to return of Bromage scale to 0 were recorded. All vital measurements (oxygen saturation, heart rate, electrocardiogram, and non-invasive blood pressure) were performed at 0, 30, 60, 90, 120 and 180 minutes in all three groups of the study. Group DEX received dexmedetomidine additive and group F received fentanyl additive and group C (control) received normal saline.

Results: Totally, 84 patients were randomly divided into three groups of 28 patients. Onset of sensory block in DEX group was significantly lower than those of fentanyl (P = 0.012) and control groups (P = 0.001). Duration of sensory block was significantly longer in DEX group compared to Fentanyl (P = 0.043) and control (P = 0.016) groups. Duration of motor block in the DEX group was significantly longer than those of the fentanyl (P = 0.014) and control groups. Heart rate and mean arterial pressure were significantly higher in the DEX group at 30, 60, 90,120, and 180 minutes compared to those of the other two groups (P < 0.05).

Conclusions: Dexmedetomidine added to bupivacaine in spinal anesthesia is more effective to increase duration of block, providing more appropriate sedation and less postoperative pain scale and post-operative nausea and vomiting (PONV) compared to fentanyl additive.
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http://dx.doi.org/10.5812/aapm.26714DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837787PMC
February 2016

Pulmonary and extra-pulmonary manifestations of sarcoidosis.

Niger Med J 2015 Jul-Aug;56(4):258-62

Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Sarcoidosis is a systemic multi-organ granulomatous disease of unknown etiology that is characterized by the presence of granuloma in various organs. The clinical features of sarcoidosis are heterogeneous but pulmonary involvement is cardinal manifestations. The aim of this study was to determine radiologic, clinical and laboratory findings of patients with sarcoidosis.

Patients And Methods: In a cross-sectional study, all patients visiting sarcoidosis clinic were enrolled in the study. Computed tomography (CT) scan was obtained and lab exams were obtained from patient and reports were recorded in data sheet.

Results: Total of 55 patients with sarcoidosis were enrolled in the study. The average of age was 44.6 (range 25-62) years. Thirty-seven patients were male and 18 were female. The most common extra-pulmonary manifestation was arthritis (in 18% of cases) and then lupus pernio (12.8%) and uveitis (10.9%). Bilateral hilar adenopathy and para tracheal lymphadenopathy was observed in 39(70%) and 22 (40%) of patients. Parenchymal nodules (30%), bronchiectasia (25%), ground-glass opacification (18%) were the most common findings. Percentages of patients with dyspnea were 29% and percentages of patients with cough were 21%. Among abnormal lab tests, high urine calcium (Ca) were positive in 21% and high angiotensin-converting enzyme (ACE) in 16% of patients.

Conclusion: Pulmonary involvements are both fibrosis and granulomatosis and the most common manifestations are parenchymal nodules, bronchiectasia and high-grade fibrosis. The most common extra-pulmonary involvement is arthritis. Lab tests are non-specific and have no correlation with duration or severity of disease.
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http://dx.doi.org/10.4103/0300-1652.169702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697213PMC
January 2016

A 14-Year-Old Patient with Chest Pain.

Tanaffos 2016 ;15(4):249

Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410123PMC
January 2016

Magnesium Versus Bupivacaine Infiltration in Controlling Postoperative Pain in Inguinal Hernia Repair.

Anesth Pain Med 2015 Dec 5;5(6):e30643. Epub 2015 Dec 5.

Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Postoperative pain is one of the most common problems after hernia repair. Decrease in postoperative pain accelerates functional recovery, decreases duration of hospital stay and postoperative morbidity.

Objectives: To compare postoperative analgesic effect of infiltration of magnesium versus bupivacaine into incision of inguinal hernia repair.

Patients And Methods: In a double blind clinical trial, 80 patients' candidates for elective inguinal hernia repair were enrolled. Right before closure of incision, in Bupivacaine group 5 mL Bupivacaine 0.5% added to 5 mL normal saline and in Magnesium group, 10 mL Magnesium sulfate 20% was infused subcutaneously. Pain score was measured using numeric rating score (NRS) at 1, 3, 6, 12 and 24 hours postoperatively. If NRS was above 3, 1 mg morphine was administered as rescue analgesic until patient felt comfortable or NRS < 3.

Results: Postoperative pain scores at 1 and 3 hours were not significantly different between bupivacaine and magnesium groups (P = 0.21, 0.224; respectively). However, at 6 (P = 0.003), 12 (P = 0.028) and 24 (P = 0.022) hours postoperative, pain score (NRS) was significantly lower in bupivacaine group. Number of patients needed at least 1 dose of rescue morphine (P = 0.001), mean number of episodes asked for morphine during next 24 hours (P = 0.001) and total dose of morphine requirement (P = 0.01) were significantly lower in bupivacaine group.

Conclusions: Magnesium infiltration did not decrease total dose and number of episodes needed for morphine rescue analgesic. Bupivacaine infiltration into surgical site was more effective than magnesium sulfate infiltration in postoperative pain control.
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http://dx.doi.org/10.5812/aapm.30643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688822PMC
December 2015

Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain.

Anesth Pain Med 2015 Oct 10;5(5):e26652. Epub 2015 Oct 10.

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

Background: Epidural steroid injection (ESI), including transforaminal (TF) epidural injections and interlaminar (IL) epidural steroid injections are commonly performed procedures for the management of lumbosacral radicular pain. Parasagittal interlaminar (PIL) approach could enable higher ventral epidural spread, with fewer complications than TF.

Objectives: This study aims to compare the effectiveness of PIL and TF ESI in relieving the pain and disability of patients with lumbosacral pain.

Patients And Methods: This prospective study enrolled 64 patients, aged between 18 to 75 years, with a diagnosis of low back pain and unilateral lumbosacral radicular pain. The patients were randomized to receive fluoroscopically guided epidural injection, through either the PIL or TF approach. Patients were evaluated for effective pain relief [numerical rating scale (NRS) < 3] by 0 - 10 numeric rating scale (NRS) and functional improvement by the Oswestry Disability Index (ODI).

Results: Effective pain relief [numeric rating scale (NRS) < 3] was observed in 77.3% (95% CI: 67‒90.5%) of patients in PIL group and 74.2% (95% CI: 62.4 - 89.4%) of patients in the TF group (P = 0.34), at 4 weeks. Mean NRS score was not significantly different between the PIL group compared to the TF group, at 4 weeks (P = 0.19). Number of patients with improved disability (measured by ODI < 20%) was not significantly different in PIL group (78% of cases) compared to the TF group (76% of cases), at 4 weeks (P = 0.21). There were no adverse effects observed in any of our patients.

Conclusions: The PIL epidural injection is as effective as TF epidural injection in improving pain and functional status, in patients with chronic lumbosacral low back pain, due to disc degeneration.
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http://dx.doi.org/10.5812/aapm.26652v2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644318PMC
October 2015

Effect of Ondansetron on Postoperative Shivering After Craniotomy.

World Neurosurg 2015 Dec 3;84(6):1923-8. Epub 2015 Sep 3.

Department of Neurosurgery, Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Postoperative shivering (POS) is an early complication after craniotomy. Preventive pharmacologic drugs are the mainstay of treatment. Meperidine is the drug of choice but with increased risk of apnea, nausea, and increased intracranial pressure. Some reports have suggested that ondansetron and meperidine have similar anti-shivering effects.

Objectives: To assess the preventive effect of ondansetron on POS after craniotomy.

Methods: In a randomized, double-blind, placebo-controlled trial, 80 patients with American Society of Anesthesiologists status I to II between 20 and 60 years of age scheduled for elective craniotomy were enrolled in the study. Patients received either intravenous ondansetron 4 mg (n = 40) or saline (n = 40) 10 minutes before the end of surgery.

Results: POS was observed in 3 patients (7.5%) in the ondansetron group, significantly lower than in the control group (6 patients [15%]; P =0.048). Ondansetron decreased the relative risk of occurrence of POS after craniotomy from 4.42 (95% confidence interval [CI], 2.3-8.5; P = 0.0021) in the control group to 1.05 (95% CI, 0.76-2.20; P = 0.074). In the ondansetron group, the mean (± standard deviation) core temperature in the preoperative phase (36.6°C ± 0.66°C) was significantly higher than in the postoperative phase (34.2°C ± 0.56°C) (P = 0.001). In addition, the mean (± standard deviation) peripheral temperature in the preoperative phase (36.5°C ± 0.72°C) was significantly higher than in the postoperative phase (34.4°C ± 0.51°C) (P = 0.001).

Conclusions: Ondansetron can effectively decrease POS after craniotomy. This effect is not mediated through maintenance of the core or peripheral temperature. Ondansetron probably acts by a central inhibitory mechanism on POS through 5-hydroxytryptaminergic pathways, not by changing thermoregulatory set points.
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http://dx.doi.org/10.1016/j.wneu.2015.08.034DOI Listing
December 2015

Anatomical Flow Pattern of Contrast in Lumbar Epidural Space: A Human Study with a Midline vs. Parasagittal Interlaminar Approach under Fluoroscopy.

Pain Physician 2015 Jul-Aug;18(4):317-24

Assistant Professor, Pain Fellow, Program Director of Pain Fellowship, Department of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Anesthesiology, Shahid Beheshti University of Medical Science.

Background: Epidural injections for managing chronic back pain are one of the most commonly performed interventions; however, controversy continues regarding the most effective method of epidural injections. A ventral distribution of epidural injected drug plays a significant role in its effectiveness.

Objective: To determine the distribution of a drug in the epidural space after parasagital and midline epidural injection.

Setting: Academic hospital.

Study Design: In randomized double-blind clinical trial, patients with a diagnosis of low back pain (LBP) and unilateral lumbosacral radicular pains were randomized to receive drug through either parasagital or midline approach.

Methods: Patients were assessed for anterior epidural spread of contrast under fluoroscopy in anteroposterior and lateral views. After epidural space confirmation, triamcinolone (80 mg) plus bupivacain was injected and patients were followed up for 2 weeks.

Results: Fifty-six patients enrolled in the study. Successful infiltration of the drug into the ventral epidural space was successfully achieved in 75% of cases in the parasagital group but in only 25% of the cases in using a midline approach. Effective pain relief (numeric rating scale [NRS] < 3) was observed in 76.5% of patients in the parasagital group and 24.5% of patients in the midline group (P = 0.001) at 2 weeks. Number of patients with improved disability (measured by Oswestry Disability Index [ODI] < 20%) was significantly higher in the parasagital group (78%) compared to the midline group (26%) at 2 weeks (P = 0.002).

Limitations: The results of the current study should be interpreted in relation to the study design and future studies should include larger patient numbers and longer follow-up time. However, the results are consistent with previous studies.

Conclusion: Parasagital epidural injection showed higher infiltration of the drug to the ventral epidural space compared to the midline approach. The higher infiltration of the ventral epidural space provides better improvement of clinical disability and pain in the parasagital group.
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February 2016

Subclavian Vein Cannulation Success Rate in Neonates and Children.

Anesth Pain Med 2015 Jun 22;5(3):e24156. Epub 2015 Jun 22.

Department of Anesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Central vein cannulation allows the administration of large volumes of fluids in short times and at high osmolarities for rehydration, volume replacement, chemotherapy, and parenteral nutrition. Percutaneous central venous line insertion has replaced peripheral venous cut-down as the primary mode of short-term venous access in children.

Objectives: The aim of our study was to delineate some aspects of this procedure as well as its success rate and relative risk in pediatrics.

Patients And Methods: Totally, 3264 subclavian vein cannulations in neonates and children were analyzed regarding successful catheterization attempts and early complication rates after the procedure retrospectively in Mofid Hospital (Tehran, Iran).

Results: There were 1340 newborn patients (first 28 days of life) in our study population. In these newborns, only 55 cannulations failed; one patient was complicated with pneumothorax; guide wires malfunctioned in 21 cases; and first- attempt cannulation success was reported in only 981 cases. In the remaining 1924 patients, between one month and 8 years old, only 14 attempts at the cannulation of the subclavian vein failed and 1655 cases had first-attempt cannulation success.

Conclusions: The cannulation of the central vein in neonates and children in a skilled hand would be performed with great success rate and low complications.
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http://dx.doi.org/10.5812/aapm.24156v2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493728PMC
June 2015

Magnesium and Ketamine Gargle and Postoperative Sore Throat.

Anesth Pain Med 2015 Jun 22;5(3):e22367. Epub 2015 Jun 22.

Department of Anesthesiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Postoperative sore throat is one of the most common complications after endotracheal intubation. Both Ketamine and magnesium can block N-methyl-D-aspartic acid (NMDA) receptors and provide central and local analgesia.

Objectives: To compare the effect of magnesium sulfate and ketamine gargle on the incidence and severity of postoperative sore throat.

Patients And Methods: A total of 100 patients candidate for emergency acute appendicitis surgery were enrolled in the study. Patients in ketamine group received ketamine gargle (0.5 mg/kg) and magnesium group received magnesium sulfate gargle (20 mg/kg up to 30 mL dextrose water 20%) 15 minutes before the operation. Patient complaint of postoperative sore throat, and its severity measured by visual analogue scale (VAS) were recorded at baseline in recovery room, and then 2, 4, and 24 hours after operation.

Results: There were no significant differences between age, sex, and body mass index (BMI) between two groups of patients. Hemodynamics of patients, including blood pressure, respiratory rate, oxygen saturation %, and conscious state were not significantly different (P > 0.05). Number of patients with sore throat were significantly lower in magnesium group compared to ketamine group at 2 (P = 0.032), 4 (P = 0.02), and 24 hours (P = 0.01) after the operation. Sore throat pain score (VAS) was significantly lower in magnesium group compared to ketamine group at 2 (P = 0.019), 4 (P = 0.028), and 24 hours (P = 0.014) after the operation.

Conclusions: Magnesium at low dose decreases sore throat and pain severity more effectively compared to ketamine gargle.
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http://dx.doi.org/10.5812/aapm.5(3)2015.22367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493740PMC
June 2015

Ultra fast-track extubation in heart transplant surgery patients.

Int J Crit Illn Inj Sci 2015 Apr-Jun;5(2):89-92

Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran.

Background: Heart transplant surgeries using cardiopulmonary bypass (CPB) typically requires mechanical ventilation in intensive care units (ICU) in post-operation period. Ultra fast-track extubation (UFE) have been described in patients undergoing various cardiac surgeries.

Aim: To determine the possibility of ultra-fast-track extubation instead of late extubation in post heart transplant patients.

Materials And Methods: Patients randomly assigned into two groups; Ultra fast-track extubation (UFE) group was defined by extubation inside operating room right after surgery. Late extubation group was defined by patients who were not extubated in operating room and transferred to post operation cardiac care unit (CCU) to extubate.

Results: The mean cardiopulmonary bypass time was 136.8 ± 25.7 minutes in ultra-fast extubation and 145.3 ± 29.8 minutes in late extubation patients (P > 0.05). Mechanical ventilation duration (days) was 0 days in ultra-fast and 2.31 ± 1.8 days in late extubation. Length of ICU stay was significantly higher in late extubation group (4.2 ± 1.2 days) than the UFE group (1.72 ± 1.5 days) (P = 0.02). In survival analysis there was no significant difference between ultra-fast and late extubation groups (Log-rank test, P = 0.9).

Conclusions: Patients undergoing cardiac transplant could be managed with "ultra-fast-track extubation", without increased morbidity and mortality.
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http://dx.doi.org/10.4103/2229-5151.158394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477402PMC
July 2015

Injection of intradiscal o2-o3 to reduce pain and disability of patients with low back pain due to prolapsed lumbar disk.

Anesth Pain Med 2014 Dec 21;4(5):e19206. Epub 2014 Nov 21.

Department of Anesthesiology and Pain Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Disk herniation (DH) is one of the most common disk lesions, inducing low back pain (LBP). Various therapeutic options have been proposed for treatment of disk herniation (DH). Intradiscal injection of ozone has been suggested for treatment of DH.

Objectives: To determine the effect of intradiscal ozone injection on pain score and disability in patients with LBP from disk prolapsed.

Patients And Methods: Patients with LBP diagnosed with DH were enrolled in this clinical trial study. After prep and drape the area and under the fluoroscopy guide (c-arm), intradiscal injection of ozone/oxygen mixture (4 mL, 40 µg/mL) was performed. Pain score and functional ability of the patients according to Oswestry Disability Index (ODI) were measured prior to the injection (baseline) and then at 2 and 4 weeks and then at 3 and 6 months after the injection.

Results: Thirty patients (17 females, 13 males) with the mean age of 58.6 y (range, 42-73 y) enrolled in the study. The mean ± standard deviation (SD) of pain score before intervention was 8.1 ± 0.8. After two weeks, it was reduced to 3.2 ± 0.6 (P < 0.001) and finally dropped to 2.0 ± 0.6 sixth months after intervention (P = 0.0001). Functional status of ODI was 28.5 ± 2.1 before intervention and showed significant reduction after two weeks (with the mean of 12.3), and it was almost sustained till sixth months after intervention, with the mean of 11.4 (P = 0.001).

Conclusions: Altogether, ozone had significant positive effects on patients with disk herniation unresponsive to other conservative and minimally invasive treatments.
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http://dx.doi.org/10.5812/aapm.19206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358330PMC
December 2014

Low dose aminophylline effectively decreases the risk of post-operative apnea in premature infants.

Tanaffos 2014 ;13(3):31-7

Department of Anesthesiology, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Retinopathy of prematurity (ROP) is the most common reason behind surgical procedures in premature newborns. Anesthesia in these patients is life-threatening due to post-operative apnea of prematurity (POA). This study aimed to determine the predisposing factors to POA in premature infants and to explore the role of prophylactic aminophylline in decreasing the incidence of POA.

Materials And Methods: Fifty patients with prematurity who were candidates for elective eye surgery (less than one hour) were selected and received aminophylline (3 mg/kg) 5 minutes after the induction of anesthesia with sevoflurane. Patients were kept in the recovery room for 2 hours post-operation in an incubator and were monitored for SPO2, apnea, bradycardia and other signs of desaturation and apnea.

Results: There were no statistically significant differences in the gestational age and weight, sex, postconceptual age and weight and other demographic characteristics between the experimental and control groups. Gestational age<28 weeks, postconceptual age<60 weeks, birth weight, operation weight and anemia (OR=1.91; 95% CI: 1.24-3.73; P=0.012) were the predisposing factors associated with postoperative apnea. Treatment with aminophylline as compared with the placebo was associated with a significantly decreased risk of post-operative apnea (OR=0.53; 95% CI 0.28-0.98; P=0.034).

Conclusion: Aminophylline can be used prophylactically to decrease the risk of postoperative apnea with no major adverse effects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338050PMC
February 2015

Critical care medicine education in Middle East, FCCS/BASIC course, common purpose, different method.

Int J Crit Illn Inj Sci 2014 Oct-Dec;4(4):318-9

Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.4103/2229-5151.147543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296337PMC
January 2015

Secondary infection and clinical aspects after pandemic swine-origin influenza a (H1N1) admission in an Iranian critical care unite.

Int J Crit Illn Inj Sci 2014 Oct-Dec;4(4):309-13

Mycobacteriology Research Center Virology Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: A new flu virus (H1N1) swine origin and cause of human infection with acute lung disease was published in the world and led to many patients were admitted in intensive care unit (ICU).

Materials And Methods: In a prospective descriptive study, all ICU patients in a pulmonary disease specialist hospital between April 2010 and July 2011 with confirmed infection (H1N1) were evaluated. Information including demographic, clinical and microbiology using Statistical Package for Social Sciences (SPSS) software version 16 was studied and classified.

Results: Of 46 patients hospitalized with confirmed diagnosis of swine flu pneumonia (H1N1), 20 cases (43.7%) admitted in ICU out of which 10 cases were males (50%), the mean age was 36.9 and the range was 21-66 years. Nine patients (45%) had underlying diseases. Most underlying disease was respiratory disease in which four cases (20%) were of asthma and one patient had chronic obstructive pulmonary disease (COPD). No admission of pregnant patient with swine flu was reported in the ICU. Cough and sputum were the most frequent symptoms (19 patients equal 95%). Four patients (20%) were admitted with decreased level of consciousness and five cases (25%) died during hospitalization.

Conclusion: It seems, swine flu with high mortality and transfer rates is a worldwide health problem. Because of limited treatment regimen, the risk of secondary infection and high need to intensive care in H1N1 pneumonia, environmental control, including vaccination of high risk people and public announcement, make determining role in controlling of this disease.
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http://dx.doi.org/10.4103/2229-5151.147536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296334PMC
January 2015

Comparison of i-gel™ and laryngeal mask airway in anesthetized paralyzed patients.

Int J Crit Illn Inj Sci 2014 Oct-Dec;4(4):288-92

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

Background: The i-gel™ is a new device introduced recently. It differs from other supraglottic airway devices. It has a non-inflatable, gel-made cuff. Previously used devices, have some disadvantages which are claimed to be absent in i-gel™. In this study we aimed to compare the performance of the laryngeal mask airway (LMA)-Classic™ and i-gel™ during anesthesia in paralyzed patients.

Materials And Methods: A total of 64 anaesthetized patients with paralysis were enrolled in a single-blind, randomized control trial to be intubated with one of the devices. We compared the device insertion parameters, some ventilatory parameters, and adverse effects after device insertion.

Results: Vital signs were not significantly different between groups. Regarding duration of insertion attempts, the difference between groups was significant (P < 0.05); while the number of insertion attempts was insignificant (P = 0.265). There was no significant difference between both groups regarding postoperative complications (cough, sore throat, and blood on the cuff) (P > 0.05). Airway leak was assessed in both groups and data showed no significant difference (P = 0.662). Additionally, end-tidal CO2 change regarding the baseline value was significantly different after 10 and 15 min of anesthesia (P < 0.05).

Conclusions: Successful insertion time was shorter significantly for i-gel™. As i-gel™ has easy application, it is advantageous to be used during cardiopulmonary resuscitation by non-anesthetists in which time is very important. We concluded that i-gel™ can be an alternative to LMA-Classic™ for controlled ventilation during anesthesia as it is easier to be placed.
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http://dx.doi.org/10.4103/2229-5151.147520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296330PMC
January 2015

Cotinine level is associated with asthma severity in passive smoker children.

Iran J Allergy Asthma Immunol 2015 Feb;14(1):67-73

Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Asthma environmental triggers play important roles in severity of disease. Passive smoking could exacerbate asthma symptoms and enhance the decrease in lung function. Cotinine levels could be a reflection of passive exposure to the cigarette both in adults and pediatrics. The aim of this study was to determine degree of association of asthma severity and cotinine level as a marker of passive smoking. In a cross-sectional study, 100 pediatric patients (under 10 years old) with asthma were enrolled, 50 of whom, had been exposed to passive smoking and 50 others included as controls. A complete clinical history, lab exam, and spirometry were performed. A sample of urine, serum and saliva was collected from all attendant patients and controls in the study after confirmation of diagnosis and determination of severity of asthma. The results revealed that age, sex, age of onset of asthma, family history and allergic history were not significantly different between two groups of patients. According to GINA classification, percentage of patients with severe asthma was significantly higher in passive smoker group (p=0.001). Cotinine was significantly higher in passive smoker group compared to control group in serum (p=001), saliva (p=0.001), and urine (p=0.0014). In passive smoker group, cotinine levels were significantly higher in serum (p=0.001), urine (p=0.007), and saliva (p=0.01) of patients with severe asthma than moderate and mild asthma. Serum cotinine (OR: 1.81, 95% CI: 1.35-2.32, p=0.024), urine cotinine (OR: 3.56,95% CI = 1.29-5.53, p=0.01) and saliva cotinine (OR: 1.66, 95% CI: 1.23-1.98, p=0.031) were also significantly associated with higher risk of severe asthma. Cotinine levels were higher in passive smokers compared to non-passive smokers. Besides, cotinine was a predictive risk factor for severe asthma.
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February 2015

Comparison of the incidence of sore throat after rapid sequence intubation with succinylcholine and cisatracurium.

Anesth Pain Med 2014 Aug 13;4(3):e20030. Epub 2014 Aug 13.

Department of Anesthesiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Postoperative sore throat is a common complication of endotracheal intubation and can lead to dissatisfaction after surgery. Airway management has the strongest influence on the incidence of sore throat and improving endotracheal intubating conditions can reduce this complaint. Type of induction agent used during anesthesia can contribute to variances in the degree of post-operative sore throat.

Objectives: We aimed to compare the incidence of postoperative sore throat after rapid sequence induction with Succinylcholine and high dose Cisatracurium.

Patients And Methods: The study was carried out on patients admitted to Shohada-e-Tajrish hospital for emergent abdominal surgery. Of the 80 patients who were enrolled in the study, 40 were randomly assigned to receive Succinylcholine while the remaining patients received Cistracurium during induction. Sore throat, muscle ache, hoarseness, dry throat and pain were assessed in each patient at baseline in recovery and at 2, 4, 12 and 24 hours post-operation.

Results: Number of patients who developed sore throat was significantly higher in the Succinylcholine group (75%) compared to Cisatracurium group (27.5%) at the time of entrance to the recovery room (P = 0.001). These numbers decreased at 2 hours post-operation (42% versus 17.5%) but the difference was still statistically significant (P < 0.05). At 12 (P = 0.062) and 24 (P = 0.14) hours post operation, the difference was no longer significant.

Conclusions: Use of high dose Cisatracurium for induction during rapid sequence intubation carries a lower chance of developing sore throat compared to Succinylcholine. Studies comparing other adverse effects of these two agents are required to guide physician's choice of induction agent.
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http://dx.doi.org/10.5812/aapm.20030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4183082PMC
August 2014

Allergic and nonallergic asthma in children: are they distinct phenotypes?

Iran J Allergy Asthma Immunol 2014 Oct;13(5):370-4

Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The aim of current study is to describe clinical similarities and differences between atopic and non-atopic asthma in children. In a cross-sectional study, 95 asthmatic children (75 allergics and 20 nonallergics) were included in the study. Demographic, clinical, and familial history were compared between two groups. There was no significant differences between variables like sex, age of onset (p=0.75), severity (p=0.70), and family history among the two groups (p=0.42). Patients with allergic asthma were significantly older than those with non- allergic asthma (11.28 ± 3.19 and 9.75 ± 2.35 years, respectively, p=0.02). The controversy lingers over the presence of a completely distinct phenotype of non-atopic asthma in children. Our study suggested that phenotypes of allergic and non-allergic asthma in children were not entirely distinct.
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October 2014

Ultrasound as a screening tool for performing caudal epidural injections.

Iran J Radiol 2014 May 15;11(2):e13262. Epub 2014 May 15.

Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The caudal approach to the epidural space has been used for decades to treat low back pain caused by lumbosacral root compression. The use of fluoroscopy during epidural steroid injection is the preferred method for placing the needle more accurately in the sacral hiatus, but it carries the risk of radiation hazard.

Objectives: The aim of the study was to assess the anatomical structure of the sacral hiatus and the feasibility of caudal epidural injections under ultrasound guidance.

Patients And Methods: Two hundred and forty patients (male = 100, female = 140) with low back pain and sciatica who were candidates for caudal epidural injection were enrolled into this study. Ultrasound images of the sacral hiatus and bilateral cornua were obtained by a real-time linear array ultrasound transducer. The distance between bilateral cornua and the anterior and posterior wall of the sacrum were measured at the base (sacral hiatus). Under the guide of ultrasonography, we defined the injection successful if turbulence of medication fluid was observed in the sacral canal, but correct placement of the needle and injectant was confirmed on fluoroscopic view as the gold standard technique.

Results: The epidurogram showed that the injection was successful in 230 of the 240 patients (95.8%). In eight patients, the injection was not in the correct place in the sacral canal. The sacral hiatus could not be identified by ultrasound images in only two patients who had a closed sacral hiatus identified by fluoroscopy. The mean distance of the sacral hiatus was 4.7 ± 1.7 mm and the mean distance between bilateral cornua was 18.0 ± 2.8 mm. The mean duration of the procedure was 10.8 ± 6.8 minutes. No major complication was observed in the next month.

Conclusions: In conclusion, ultrasound could be used as a safe, fast and reliable modality to observe the anatomic variation of the sacral hiatus and to perform caudal epidural injections.
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http://dx.doi.org/10.5812/iranjradiol.13262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090639PMC
May 2014

Effect of pulsed radiofrequency in treatment of facet-joint origin back pain in patients with degenerative spondylolisthesis.

Eur Spine J 2014 Sep 6;23(9):1927-32. Epub 2014 Jul 6.

Department of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Fereshteh St, Tehran, Iran.

Background: Degenerative spondylolisthesis is a well-recognized source of low back pain mainly induced by facet joint pain. Pulsed radiofrequency (PRF) allows heat dissipation, thus producing a temporary injury that affects only type C fibers responsible for pain conduction.

Objectives: We attempted to test whether PRF is a better choice for facet pain due to spondylolisthesis compared to routine steroid injection.

Methods: Patients were randomly assigned to one of two groups: group one received pulsed RF, and group 2 received injection by steroids (triamcinolone) and bupivacaine.

Outcomes Assessment: Multiple outcome measures were utilized which included the numeric rating scale (NRS), the Oswestry Disability Index (ODI), satisfaction status, and analgesic intake with assessment at 3, 6, and 12 months post-treatment. Significant pain relief was defined as 50% or more, whereas significant improvement in disability score was defined as reduction of 40% or more.

Results: Eighty patients were enrolled in the study and were divided into the two groups of study. PRF significantly reduced NRS at 6-month follow-up compared to steroid + bupivacaine. 75.6 ± 14.3% at pre-treatment and 19.3 ± 9.5% at 6 months (p = 0.001) in PRF group. The mean ODI is depicted in two groups of study (Fig. 1). Interestingly, ODI% was significantly lower in PRF group at 12 weeks and 6 months compare to steroid + bupivacaine group (p = 0.022 and 0.03, respectively), but it was not significantly different at 6 weeks (p = 0.31). Proportion of patients who did not require analgesics were significantly higher in PRF group compared to other group (p = 0.001) in Log-rank (Mantel-Cox) test.

Conclusion: Our results demonstrated that the application of PRF might be more effective than steroid and bupivacaine injection in decreasing back pain due to degenerative facet pain and improvement in function of patients.
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http://dx.doi.org/10.1007/s00586-014-3412-xDOI Listing
September 2014