Publications by authors named "Seyed Mohammadreza Hashemian"

59 Publications

The Prevalence and Outcome of Intensive Care Unit Acquired Weakness (ICUAW).

Tanaffos 2020 Jul;19(3):250-255

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

Background: Intensive care unit acquired weakness (ICUAW) is a known complication in ICU patients, especially in those with severe underlying diseases. The cause and pathogenesis of ICUAW are still unknown. This study examined the incidence rate of ICUAW in intensive care units (ICUs) of the Masih-Daneshvari Hospital.

Materials And Methods: This descriptive-comparative study was conducted on 160 patients admitted in the ICUs, including an acute respiratory infectious ICU (TB-ICU) and medical ICU. The total number of patients was 80 in each of the ICUs. Demographic information was obtained from the patients after the initial examination and Medical Research Council (MRC) score was done on daily basis. EMG was performed on the 2 and 8 days of the admission. ICUAW diagnosis was used in cases with MRC scores under 48.

Results: Among the patients, 68.6% were male and the mean age was 59.13±18. 68 years. The final outcomes were 48.4% mortality and 51.6% discharge, which were 41% and 59% in the TB-ICU and 56.7% and 43.3% in the medical ICU, respectively. By defining electromyography as the gold standard, the sensitivity and specificity of ICUAW diagnosis based on the MRC score definition were about 70% and 83%, respectively. The comparison ICUAW patients in the two ICUs in terms of mortality showed no significant difference between them.

Conclusion: It is concluded that nearly half of ICU-admitted patients develop ICUAW that causes a higher mortality rate. Therefore, new plans should be developed to reduce the rate of ICUAW and subsequent death, as well as other possible morbidities.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008407PMC
July 2020

Oxygenation Efforts for Iranian COVID-19 ARDS Patients: First 5-Day Crisis Experience Scenario.

Tanaffos 2020 Jul;19(3):173-175

Tobacco Prevention and Control 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/PMC8008411PMC
July 2020

Dapsone Ameliorates Colitis through TLR4/NF-kB Pathway in TNBS Induced Colitis Model in Rat.

Arch Med Res 2021 Apr 1. Epub 2021 Apr 1.

Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, 13145-784, Tehran, Iran. Electronic address:

Background: Crohn's disease (CD), a type of inflammatory bowel disease (IBD), emerges with severe gastrointestinal (GI) tract inflammation, sometimes known as hostile abdomen. Conventional treatment of CD has several limitations such as insufficient response to treatment, and intolerable side effects of drugs. In addition, the high cost of biologic drugs prevents patients from continuing their treatment. Dapsone showed vigorous anti-inflammatory effects on the skin diseases, lung diseases and inflammatory diseases of the nervous system. Hence, we decided to investigate the effect of dapsone on animal model of CD.

Methods: In this study, colitis was induced by instillation of 2,4,6-trinitrobenzenesulfonic acid (TNBS) 100 mg/kg. Rats were treated with daily gavage of dapsone (10, 12.5 and 20 mg/kg). Seven days after induction of colitis, specimens were collected for pathological and molecular assessments.

Results: Dapsone (12.5 and 20 mg/kg) preserved the histologic architecture of the colon and prevented crypts irregularity. Additionally, it decreased tissue edema and hindered inflammatory cells infiltration. Besides, all doses of dapsone decreased tissue concentration of tumor necrosis factor α (TNF-α) and interferon γ (INFγ). Western blot revealed that dapsone could attenuate inflammation via downregulation of toll-like receptor 4 (TLR4) and dephosphorylation of nuclear factor kB (NF-kB).

Conclusion: Based on these findings, dapsone attenuates inflammation and decreases TNF-α and INF-γ in animal model of CD. It acts through TLR4/NF-kB pathway to exert these effects.
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http://dx.doi.org/10.1016/j.arcmed.2021.03.005DOI Listing
April 2021

No clinical benefit of high dose corticosteroid administration in patients with COVID-19: A preliminary report of a randomized clinical trial.

Eur J Pharmacol 2021 Apr 16;897:173947. Epub 2021 Feb 16.

Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

The aim of this study was to evaluate the clinical effects of dexamethasone administration in patients with mild to moderate acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). The study included 50 patients who were randomly assigned to the dexamethasone group or control group. Dexamethasone was administered at a dose of 20 mg/day from day 1-5 and then at 10 mg/day from day 6-10. The need for invasive mechanical ventilation, death rate, duration of clinical improvement, length of hospital stay, and radiological changes in the computed tomography scan were assessed. The results revealed that 92% and 96% of patients in the dexamethasone and control groups, respectively, required noninvasive ventilation (P = 0.500). Among them, 52% and 44% of patients in the dexamethasone and control groups, respectively, required invasive mechanical ventilation (P = 0.389). At the end of the study, 64% of patients in the dexamethasone group and 60% of patients in the control group died (P = 0.500); the remaining patients were discharged from the hospital during the 28-day follow-up period. The median length of hospital stay was 11 days in the dexamethasone group and 6 days in the control group (P = 0.036) and the median length of hospital stay was 7 days in the dexamethasone group and 3 days in the control group (P < 0.001). No significant differences were observed in the other outcomes. This study showed that corticosteroid administration had no clinical benefit in patients with COVID-19-induced mild to moderate ARDS.
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http://dx.doi.org/10.1016/j.ejphar.2021.173947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885705PMC
April 2021

Epidemiological Characteristics, Ventilator Management, and Clinical Outcome in Patients Receiving Invasive Ventilation in Intensive Care Units from 10 Asian Middle-Income Countries (PRoVENT-iMiC): An International, Multicenter, Prospective Study.

Authors:
Luigi Pisani Anna Geke Algera Ary Serpa Neto Areef Ahsan Abigail Beane Kaweesak Chittawatanarat Abul Faiz Rashan Haniffa Seyed MohammadReza Hashemian Madiha Hashmi Hisham Ahmed Imad Kanishka Indraratna Shivakumar Iyer Gyan Kayastha Bhuvana Krishna Tai Li Ling Hassan Moosa Behzad Nadjm Rajyabardhan Pattnaik Sriram Sampath Louise Thwaites Ni Ni Tun Nor'azim Mohd Yunos Salvatore Grasso Frederique Paulus Marcelo Gama de Abreu Paolo Pelosi Nick Day Nick White Arjen M Dondorp Marcus J Schultz For The PRoVENT-iMiC Investigators Moru And The Prove Network Aaradhana Adhikari Osaree Akaraborworn Aftab Akhtar AKM Shamsul Alam Syed Muneeb Ali Janaki Arumoli Muhammad Asaduzzaman Siti Nur Suhaila Azauddin Debabrata Banik Sakibur Rahman Bhuiyan Rungsun Bhurayanontachai Sunisa Chatmongkolchart Shantanu Das Stanis Sutharsa Das Kesharie De Silva Y. A. Hasitha Dilhani Lakshman Dissanayake Anand Dongre Dharshinie Dorasamy Thuy Duong Bich Monju Lal Dutta Manoj Edirisooriya Ahmed Farooq Marie Fernando Asoka Gunaratne Tarikul Hamid Sadaf Hanif Mohd Shahnaz Hasan Muhammad Hayat Mozaffer Hossain Tanveer Hussain Farah Idrees Mohamad Fadhil Hadi Jamaluddin Sonia Joseph Kanokkarn Juntaping Saima Kamal Pranab Karmaker Chinni Krishna Kasi Mahazir Kassim Saleh Khaskheli Syeda Nafisa Khatoon Batoul Khoundabi Napplika Kongpolprom Bimal Kudavidanage Yen Lam Mihn Majid Malekmohammad Mohd Basri Mat Nor Sathiyamoorthy Mathanalagan Iqbal Memon Nimangee Mithraratne Maziar Mobasher Montosh Kumar Mondol Abu Hena Mostafa Kamal Ranjan Kumer Nath Asma Navasakulpong Suraiya Nazneed Ha Nguyen Thi Thanh Kinh Nguyen Van Navid Nooraei Mohamad Irfan Othman Jailani Raju Pangeni Tananchai Petnak Chamila Pilimatalawwe Visanthi Pinto Annop Piriyapatsom Prapaporn Pornsuriyasak Aayesha Qadeer Reza Raessi Estabragh Mohammed Abdur Rahman Chowdhury Kumudini Ranatunge Atta Ur Rehman Syed Tariq Reza Sabyasachi Roy Poulomi Roy Suthat Rungruanghiranya Mohammad Salim Upeka Samaranayake Loranthi Samarasinghe Sohel Ahmed Sarkar Jignesh Shah Chathurani Sigera Udomsak Silachamroon Pongsasit Singhatas Rozina Sultana Karjbundid Surasit Sheikh Mohammed Taher Li Ling Tai Pattraporn Tajarernmuang Viratch Tangsujaritvijit Taohidul Majid Taohid Arshad Taqi Kaushila Thilakasiri Poungrat Thungtitigul Konlawij Trongtrakul Manori Vaas Chern Min Voon Dat Vu Quoc Nurhafizah Zarudin

Am J Trop Med Hyg 2021 01 11. Epub 2021 Jan 11.

Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A) Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.

Epidemiology, ventilator management, and outcome in patients receiving invasive ventilation in intensive care units (ICUs) in middle-income countries are largely unknown. PRactice of VENTilation in Middle-income Countries is an international multicenter 4-week observational study of invasively ventilated adult patients in 54 ICUs from 10 Asian countries conducted in 2017/18. Study outcomes included major ventilator settings (including tidal volume [] and positive end-expiratory pressure [PEEP]); the proportion of patients at risk for acute respiratory distress syndrome (ARDS), according to the lung injury prediction score (LIPS), or with ARDS; the incidence of pulmonary complications; and ICU mortality. In 1,315 patients included, median was similar in patients with LIPS < 4 and patients with LIPS ≥ 4, but lower in patients with ARDS (7.90 [6.8-8.9], 8.0 [6.8-9.2], and 7.0 [5.8-8.4] mL/kg Predicted body weight; = 0.0001). Median PEEP was similar in patients with LIPS < 4 and LIPS ≥ 4, but higher in patients with ARDS (five [5-7], five [5-8], and 10 [5-12] cmHO; < 0.0001). The proportions of patients with LIPS ≥ 4 or with ARDS were 68% (95% CI: 66-71) and 7% (95% CI: 6-8), respectively. Pulmonary complications increased stepwise from patients with LIPS < 4 to patients with LIPS ≥ 4 and patients with ARDS (19%, 21%, and 38% respectively; = 0.0002), with a similar trend in ICU mortality (17%, 34%, and 45% respectively; < 0.0001). The capacity of the LIPS to predict development of ARDS was poor (ROC AUC of 0.62, 95% CI: 0.54-0.70). In Asian middle-income countries, where two-thirds of ventilated patients are at risk for ARDS according to the LIPS and pulmonary complications are frequent, setting of is globally in line with current recommendations.
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http://dx.doi.org/10.4269/ajtmh.20-1177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941813PMC
January 2021

Combination therapy of IFNβ1 with lopinavir-ritonavir, increases oxygenation, survival and discharging of sever COVID-19 infected inpatients.

Int Immunopharmacol 2021 Mar 26;92:107329. Epub 2020 Dec 26.

Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Interferon Beta-1a (IFN-β1-a), an immunomodulatory mediator with antiviral effects, has shown in vivo and in vitro activities especially on coronavirus including SARS-CoV-2. COVID-19 defined as the disease caused by infection with SARS-CoV-2. The virus has been illustrated inhibits the production of IFN-β1-a from inflammatory cells. We conducted a retrospective study of all adult confirmed COVID-19 hospitalized patients who received combination of three doses of 12 million international units of IFN-β1-a and Lopinavir 400 mg and Ritonavir 100 mg every 12 h (case group) for 14 days besides standard care and age- and sex- matched COVID-19 patients with receiving lopinavir/ritonavir (control group) at Masih Daneshvari Hospital as a designated hospital for COVID-19 between Feb 19 and Apr 30, 2020. Multivariate analysis was done to determine the impact of IFN-β1-a on outcome and all-cause mortality. 152 cases in IFN-β1-a group and 304 cases as control group were included. IFN-β1-a group stayed at hospital longer and required noninvasive ventilation more than control group (13 vs. 6 days, p = 0.001) and (34% vs. 24%, p = 0.04), respectively. During treatment, 57 (12.5%) patients died. The death rate in case and control groups was 11% and 13% respectively. In multivariate analysis, not receiving IFN-β1-a (HR 5.12, 95% CI: 2.77-9.45), comorbidity (HR 2.28, 95% CI: 1.13-4.60) and noninvasive ventilation (HR 2.77, 95% CI: 1.56-4.93) remained significantly associated with all-cause mortality. In this study, risk of death decreased by using IFN-β1-a in COVID-19 patients. More clinical study will be necessary to measure efficacy of IFN-β1-a in COVID-19 treatment.
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http://dx.doi.org/10.1016/j.intimp.2020.107329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762801PMC
March 2021

A review on favipiravir: the properties, function, and usefulness to treat COVID-19.

Expert Rev Anti Infect Ther 2020 Dec 29:1-9. Epub 2020 Dec 29.

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

Introduction: At this time, there is no specific therapeutic or vaccine for treatment of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hence, available drugs for treatment of other viral infections may be useful to treat COVID-19.

Areas Covered: The focus of the current review was studying the main characteristics of favipiravir and its usefulness to treat COVID-19. An electronic search was done by using Pubmed and Google scholar.

Expert Opinion: Based on the mechanism of action and safety of favipiravir, the drug may be a promising candidate for compassionate use against the SARS-CoV-2 infection. Favipiravir has a wide range of activity against many single-stranded RNA viruses, is well tolerated in humans and has a high barrier to resistance. However, high doses of the agent are necessary to obtain an efficient antiviral activity. Favipiravir is teratogen in pregnant women and associated with the hyperuricemia. Therefore, the administration of the drug should be well controlled. Investigating the antiviral prophylactic potency of favipiravir and search for its pro-drugs and/or analogs showing improved activity and/or safety are critical.
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http://dx.doi.org/10.1080/14787210.2021.1866545DOI Listing
December 2020

Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS).

Pulmonology 2020 Dec 4. Epub 2020 Dec 4.

Cell and Molecular Biology Group, Airways Disease Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK; Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.

Background: In December 2019, pneumonia associated with a novel coronavirus (COVID-19) was reported in Wuhan, China. Acute respiratory distress syndrome (ARDS) is the most frequently observed complication in COVID-19 patients with high mortality rates.

Objective Of Study: To observe the clinical effect of plasmapheresis on excessive inflammatory reaction and immune features in patients with severe COVID-19 at risk of ARDS.

Materials And Methods: In this single-center study, we included 15 confirmed cases of COVID-19 at Masih Daneshvari Hospital, in March 2020 in Tehran, Iran. COVID-19 cases were confirmed by RT-PCR and CT imaging according to WHO guidelines. Plasmapheresis was performed to alleviate cytokine-induced ARDS. The improvement in oxygen delivery (PaO/FiO, total number of T cells, liver enzymes, acute reaction proteins, TNF-α and IL-6 levels were evaluated.

Results: Inflammatory cytokine levels (TNF-α, IL-6), and acute phase reaction proteins including ferritin and CRP were high before plasmapheresis. After plasmapheresis, the levels of PaO/FiO, acute phase reactants, inflammatory mediators, liver enzymes and bilirubin were significantly reduced within a week (p < 0.05). In contrast, although the number of T helper cells decreased immediately after plasmapheresis, they rose to above baseline levels after 1 week. Nine out of fifteen patients on non-invasive positive-pressure ventilation (NIPPV) survived whilst the six patients undergoing invasive mechanical ventilation (IMV) died.

Conclusion: Our data suggests that plasmapheresis improves systemic cytokine and immune responses in patients with severe COVID-19 who do not undergo IMV. Further controlled studies are required to explore the efficacy of plasmapheresis treatment in patients with COVID-19.
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http://dx.doi.org/10.1016/j.pulmoe.2020.10.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834188PMC
December 2020

Clinical Manifestations of Patients with Coronavirus Disease 2019 (COVID-19) in a Referral Center in Iran.

Tanaffos 2020 Nov;19(2):122-128

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

Background: Following the recent epidemic of coronavirus disease 2019 (COVID-19) in Wuhan, China, a novel betacoronavirus was isolated from two patients in Iran on February 19, 2020. In this study, we aimed to determine the clinical manifestations and outcomes of the first confirmed cases of COVID-19 infection (n=127).

Materials And Methods: This prospective study was conducted on all COVID-19-suspected cases, admitted to Masih Daneshvari Hospital (a designated hospital for COVID-19), Tehran, Iran, since February 19, 2020. All patients were tested for COVID-19, using reverse transcription-polymerase chain reaction (RT-PCR) assay. Data of confirmed cases, including demographic characteristics, clinical features, and outcomes, were collected and compared between three groups of patients, requiring different types of admission (requiring ICU admission, admission to the general ward, and transfer to ICU).

Results: Of 412 suspected cases, with the mean age of 54.1 years (SD=13.4), 127 (31%) were positive for COVID-19. Following the patients' first visit to the clinic, 115 cases were admitted to the general ward, while ten patients required ICU admission. Due to clinical deterioration in the condition of 25 patients (out of 115 patients), ICU admission was essential. Based on the results, the baseline characteristics of the groups were similar. Patients requiring ICU admission were more likely to have multiorgan involvement (liver involvement, P<0.001; renal involvement, P<0.001; and cardiac involvement, P=0.02), low O saturation (P<0.001), and lymphopenia (P=0.05). During hospital admission, 21 (16.5%) patients died, while the rest (83.5%) were discharged and followed-up until March 26, 2020. Also, the survival rate of patients, who received immunoglobulin, was higher than other patients (60.87% vs. 39.13%).

Conclusion: The mortality rate of COVID-19 patients was considerable in our study. Based on the present results, this infection can cause multiorgan damage. Therefore, intensive monitoring of these patients needs to be considered.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680520PMC
November 2020

COVID-19 in Iran: A model for Crisis Management and Current Experience.

Iran J Pharm Res 2020 ;19(2):1-8

Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

In February 2020, the first sample test was confirmed as positive for corona virus in Masih Daneshvari Hospital that is the reference center in Iran for all pulmonary and respiratory diseases. The decisions made in a hospital or organization to manage a crisis is very vital. Success in managing any crisis requires a scientific and scholarly attitude. This paper was distilled from experiences gained in Masih Daneshvari Hospital in Tehran, capital of Iran, in March 2020 at the stubborn time of coping and managing corona virus crisis. This study was conducted using participatory action research, a methodology which identifies problems in practice, and finds methods to solve them. This Action research involves five stages: statement of the problem, planning, data interpretation and analysis, action, and evaluation of the research process during performing the study. The whole hospital was equipped for corona virus patients in 10 phases during one week and 250 active beds were equipped for these patients. Three models, namely, "corona virus crisis management model", "Pharmaceutical care management in coronavirus crisis model" and "nursing in coronavirus crisis model" were planned and implemented. During one month of implementing these three models, the supervision team monitored the accurate implementation of instructions and resolving or revising the possible deficiencies and faults. The Masih Daneshvari crisis management model in coronavirus, can be a useful and applicable model in other corona virus centers.
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http://dx.doi.org/10.22037/ijpr.2020.113365.14255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667532PMC
January 2020

Iran's Approach to COVID-19: Evolving Treatment Protocols and Ongoing Clinical Trials.

Front Public Health 2020 4;8:551889. Epub 2020 Sep 4.

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

The coronavirus disease 2019 (COVID-19) pandemic is challenging the health care systems around the world and compelling them to timely share their strategies, tactics and experiences. Since mid-January, a huge volume of instructions has been released by Iran's Ministry of Health and Medical Education (MOHME) covering diverse aspects of disease control and prevention. In this study, we aimed to review the instructions published either before or after COVID-19's transmission to Iran to depict the clinical approach and therapeutics used in Iran to battle the current pandemic. We retrospectively gathered and critically reviewed all official situation reports, guidelines, guidance, flowcharts, protocols, recommendations and advice released by Iranian scientific, or administrative arms of action against COVID-19. The ongoing clinical trials approved by MOHME and registered to the Iranian Registry of Clinical Trials (IRCT) have been reviewed as well. Our study resulted in the following mainstays of Iran's approach to COVID-19: (i) active clinical screening; preferably on-line or on-phone, (ii) management of limited paraclinical resources; by using them as diagnostic tools rather than epidemiological, (iii) a trend toward outpatient care of mild-to-moderate cases; either confirmed or suspicious, with active scheduled follow-up, and (iv) avoidance of pharmacotherapy, as far as possible. The therapeutic and administrative instructions are still being actively updated with some recommendations different from the previous ones. Nevertheless, a common approach in the background could be detected, It seems that the instructions are conceptually in line with the first "National Guideline for 2019-nCoV" published on 20 January 2020. The screening has mainly been clinically oriented rather than being based on laboratory tests and MOHME seems to be following the approach of "early detection of symptomatic cases followed by early source control."
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http://dx.doi.org/10.3389/fpubh.2020.551889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498537PMC
September 2020

A Fourteen-day Experience with Coronavirus Disease 2019 (COVID-19) Induced Acute Respiratory Distress Syndrome (ARDS): An Iranian Treatment Protocol.

Iran J Pharm Res 2020 ;19(1):31-36

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

COVID-19 is currently causing concern in the medical community as the virus is spreading around the world. It has a heavy global burden, particularly in low-income countries. The clinical spectrum of COVID-19 pneumonia ranges from mild to critically ill cases and Acute Respiratory Distress Syndrome. An expert panel was held and an internal protocol was developed to manage the COVID-19 induced ARDS according to WHO recommendations and NIH guidelines. Different therapeutic regimens were employed on this protocol based on the ARDS severity and the patients' special characteristics. The mortality rate, the rate of survivors, and non-survivors were reported. Of the 231 suspected cases of COVID-19 admitted to the hospital during two weeks, 72 patients were admitted to ICU with diagnosis confirmed by RT-PCR. In total, mortality in the ICU was 25% (n = 18) among ARDS patients over two weeks. COVID-19 induced ARDS is a major concern. The rapid progression of ARDS needs specific protocol based on patients' characteristics and rapid action.
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http://dx.doi.org/10.22037/ijpr.2020.113337.14239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462513PMC
January 2020

A Review on Remdesivir: A Possible Promising Agent for the Treatment of COVID-19.

Drug Des Devel Ther 2020 6;14:3215-3222. Epub 2020 Aug 6.

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

The novel coronavirus 2019 (2019-nCoV), formally named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a novel human infectious coronavirus. The disease caused by SARS-CoV-2 is named COVID-19. Development and manufacturing of specific therapeutics and vaccines to treat COVID-19 are time-consuming processes. At this time, using available conventional therapeutics along with other treatment options may be useful to fight COVID-19. In different clinical trials, efficacy of remdesivir (GS-5734) against Ebola virus has been demonstrated. Moreover, remdesivir may be an effective therapy in vitro and in animal models infected by SARS and MERS coronaviruses. Hence, the drug may be theoretically effective against SARS-CoV-2. Remdesivir is a phosphoramidate prodrug of an adenosine C-nucleoside. By entrance into respiratory epithelial cells in human, the prodrug is metabolized to a nucleoside triphosphate as the active form. The nucleoside analog inhibits the viral RNA-dependent RNA polymerase (RdRp) by competing with the usual counterpart adenosine triphosphate (ATP). The nucleoside analog is incorporated into the generating RNA strand and causes a delayed stop in the viral replication process. Knowledge about the potential efficacy of remdesivir against coronaviruses has been restricted to in vitro studies and animal models. However, information related to COVID-19 is rapidly growing. Several clinical trials are ongoing for the management of COVID-19 using remdesivir. In this study, characteristics of remdesivir and its usage for treatment of COVID-19 are reviewed based on an electronic search using PubMed and Google Scholar.
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http://dx.doi.org/10.2147/DDDT.S261154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425093PMC
August 2020

Prevalence and reversibility of smell dysfunction measured psychophysically in a cohort of COVID-19 patients.

Int Forum Allergy Rhinol 2020 10 19;10(10):1127-1135. Epub 2020 Aug 19.

Smell & Taste Center, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Background: Considerable evidence suggests that smell dysfunction is common in coronavirus disease-2019 (COVID-19). Unfortunately, extant data on prevalence and reversibility over time are highly variable, coming mainly from self-report surveys prone to multiple biases. Thus, validated psychophysical olfactory testing is sorely needed to establish such parameters.

Methods: One hundred severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-positive patients were administered the 40-item University of Pennsylvania Smell Identification Test (UPSIT) in the hospital near the end of the acute phase of the disease. Eighty-two were retested 1 or 4 weeks later at home. The data were analyzed using analysis of variance and mixed-effect regression models.

Results: Initial UPSIT scores were indicative of severe microsmia, with 96% exhibiting measurable dysfunction; 18% were anosmic. The scores improved upon retest (initial test: mean, 21.97; 95% confidence interval [CI], 20.84-23.09; retest: mean, 31.13; 95% CI, 30.16-32.10; p < 0.0001); no patient remained anosmic. After 5 weeks from COVID-19 symptom onset, the test scores of 63% of the retested patients were normal. However, the mean UPSIT score at that time continued to remain below that of age- and sex-matched healthy controls (p < 0.001). Such scores were related to time since symptom onset, sex, and age.

Conclusion: Smell loss was extremely common in the acute phase of a cohort of 100 COVID-19 patients when objectively measured. About one third of cases continued to exhibit dysfunction 6 to 8 weeks after symptom onset. These findings have direct implications for the use of olfactory testing in identifying SARS-CoV-2 carriers and for counseling such individuals with regard to their smell dysfunction and its reversibility.
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http://dx.doi.org/10.1002/alr.22680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436559PMC
October 2020

Mini-surgical Percutaneous Dilatational Tracheostomy (msPDT): Our Experience during the COVID-19 Pandemic.

Br J Surg 2020 Sep 5;107(10):e363. Epub 2020 Aug 5.

Chronic 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://dx.doi.org/10.1002/bjs.11799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436921PMC
September 2020

Nutritional adequacy in critically ill patients: Result of PNSI study.

Clin Nutr 2021 Feb 20;40(2):511-517. Epub 2020 Jun 20.

Biochemistry and Nutrition Department, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address:

Background & Aims: Critically ill patients are provided with the intensive care medicine to prevent further complications, including malnutrition, disease progression, and even death. This study was intended to assess nutritional support and its' efficacy in the Intensive Care Units (ICUs) of Iran.

Methods: This cross-sectional study assessed 50 ICU's patients out of 25 hospitals in the 10 major regions of Iran's health system and was performed using the multistage cluster sampling design. The data were collected from patient's medical records, ICU nursing sheets, patients or their relatives from 2017 to 2018. Nutritional status was investigated by modified NUTRIC score and food frequency checklist.

Results: This study included 1321 ICU patients with the mean age of 54.8 ± 19.97 years, mean mNUTRIC score of 3.4 ± 2.14, and malnutrition rate of 32.6%. The mean time of first feeding was the second day and most of patients (66%) received nutrition support, mainly through enteral (57.2%) or oral (37%) route during ICU stay. The patients received 59.2 ± 37.78 percent of required calorie and 55.5 ± 30.04 percent of required protein. Adequate intake of energy and protein was provided for 16.2% and 10.7% of the patients, respectively. The result of regression analysis showed that the odds ratio of mNUTRIC score was 0.85 (95% confidence interval [CI] = 0.74-0.98) and APACHE II was 0.92 (95%CI = 0.89-0.95) for the prediction of energy deficiency. Nutrition intake was significantly different from patient's nutritional requirements both in terms of energy (p < 0.001) and protein (p < 0.001). Also, mean mNUTRIC score varied notably (p = 0.011) with changing in energy intake, defined as underfeeding, adequate feeding, and overfeeding.

Conclusion: The present findings shown that, provided nutritional care for ICU patients is not adequate for their requirements and nutritional status.
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http://dx.doi.org/10.1016/j.clnu.2020.05.047DOI Listing
February 2021

Caspofungin: a review of its characteristics, activity, and use in intensive care units.

Expert Rev Anti Infect Ther 2020 12 23;18(12):1213-1220. Epub 2020 Jul 23.

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

Introduction: Candidemia is the fourth frequent reason of healthcare-related bloodstream infections in critically ill patients. For initial management of (suspected) invasive candidiasis in critically ill patients, usage of an echinocandin, e.g. caspofungin, has been recommended.

Areas Covered: In this study, characteristics of caspofungin and its use in intensive care unit (ICU) patients are reviewed based on an electronic search using PubMed and Google scholar.

Expert Opinion: Caspofungin is a semisynthetic derivative from pneumocandin B and the first member of the echinocandins that was approved by the U.S. Food and Drug Administration (FDA) to fight fungal infection. Caspofungin inhibits the enzyme β(1,3)-D-glucan synthase of the fungal cell wall resulted in inhibition of the synthesis of β(1,3)-D-glucan. For critically ill patients, inter- and intraindividual variations affect the caspofungin concentration. The incidence rates and densities of candidemia in surgical ICUs may be higher than medical ICUs resulting in a higher burden of candidemia in surgical ICUs. However, the mortality rate in surgical ICU patients with candidemia is higher than that medical ICU patients due to differences in their underlying conditions.
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http://dx.doi.org/10.1080/14787210.2020.1794817DOI Listing
December 2020

Subcutaneous administration of interferon beta-1a for COVID-19: A non-controlled prospective trial.

Int Immunopharmacol 2020 Aug 7;85:106688. Epub 2020 Jun 7.

Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Recently, a new coronavirus spreads rapidly throughout the countries and resulted in a worldwide epidemic. Interferons have direct antiviral and immunomodulatory effects. Antiviral effects may include inhibition of viral replication, protein synthesis, virus maturation, or virus release from infected cells. Previous studies have shown that some coronaviruses are susceptible to interferons. The aim of this study was to evaluate the therapeutic effects of IFN-β-1a administration in COVID-19.

Methods: In this prospective non-controlled trial, 20 patients included. They received IFN-β-1a at a dose of 44 µg subcutaneously every other day up to 10 days. All patients received conventional therapy including Hydroxychloroquine, and lopinavir/ritonavir. Demographic data, clinical symptoms, virological clearance, and imaging findings recorded during the study.

Results: The mean age of the patients was 58.55 ± 13.43 years. Fever resolved in all patients during first seven days. Although other symptoms decreased gradually. Virological clearance results showed a significant decrease within 10 days. Imaging studies showed significant recovery after 14-day period in all patients. The mean time of hospitalization was 16.8 ± 3.4 days. There were no deaths or significant adverse drug reactions in the 14-day period.

Conclusions: Our findings support the use of IFN-β-1a in combination with hydroxychloroquine and lopinavir/ritonavir in the management of COVID-19.

Clinical Trial Registration Number: IRCT20151227025726N12.
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http://dx.doi.org/10.1016/j.intimp.2020.106688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275997PMC
August 2020

Non-coding RNAs and Exosomes: Their Role in the Pathogenesis of Sepsis.

Mol Ther Nucleic Acids 2020 Sep 15;21:51-74. Epub 2020 May 15.

Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 40 Blossom Street, Boston, MA 02114, USA; Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa. Electronic address:

Sepsis is characterized as an uncontrolled host response to infection, and it represents a serious health challenge, causing excess mortality and morbidity worldwide. The discovery of sepsis-related epigenetic and molecular mechanisms could result in improved diagnostic and therapeutic approaches, leading to a reduced overall risk for affected patients. Accumulating data show that microRNAs, non-coding RNAs, and exosomes could all be considered as novel diagnostic markers for sepsis patients. These biomarkers have been demonstrated to be involved in regulation of sepsis pathophysiology. However, epigenetic modifications have not yet been widely reported in actual clinical settings, and further investigation is required to determine their importance in intensive care patients. Further studies should be carried out to explore tissue-specific or organ-specific epigenetic RNA-based biomarkers and their therapeutic potential in sepsis patients.
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http://dx.doi.org/10.1016/j.omtn.2020.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272511PMC
September 2020

Respiratory Distress in Postanesthesia Care Unit: First Presentation of Coronavirus Disease 2019 in a 17-Year-Old Girl: A Case Report.

A A Pract 2020 May;14(7):e01227

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

A 17-year-old healthy girl underwent an uneventful esthetic septorhinoplasty. She was easily extubated and transferred to the postanesthesia care unit (PACU) with oxygen saturation (SpO2) of 96%. About 30 minutes after arrival in the PACU, she developed dyspnea with SpO2 of 84% and promptly received oxygen with bilevel positive airway pressure in conjunction with low-dose corticosteroid. The subsequent chest computed tomography (CT) revealed bilateral patchy infiltrates similar to the radiologic findings of Coronavirus Disease 2019 (COVID-19). Finally, a reverse transcriptase polymerase chain reaction (RT-PCR) of a pharyngeal specimen confirmed the diagnosis of COVID-19.
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http://dx.doi.org/10.1213/XAA.0000000000001227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227797PMC
May 2020

Noninvasive Versus Invasive Ventilation in COVID-19: One Size Does Not Fit All!

Anesth Analg 2020 08;131(2):e114-e115

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

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http://dx.doi.org/10.1213/ANE.0000000000004943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219854PMC
August 2020

Continues renal replacement therapy (CRRT) with disposable hemoperfusion cartridge: A promising option for severe COVID-19.

J Glob Antimicrob Resist 2020 06 27;21:340-341. Epub 2020 Apr 27.

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

Cytokine release syndrome is prevalent in severe cases of COVID-19. In this syndrome, an uncontrolled response of immune system occurs. Extracorporeal blood purification has been proven to effectively remove the released inflammatory cytokines. Here, we reported a successful case to represent our experience of extracorporeal blood purification in a patient with severe COVID-19.
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http://dx.doi.org/10.1016/j.jgar.2020.04.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7185011PMC
June 2020

A review on modafinil: the characteristics, function, and use in critical care.

J Drug Assess 2020 4;9(1):82-86. Epub 2020 Apr 4.

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

In critically ill patients, sleep is generally interrupted. Some factors that lead to such sleep interruption include the intensive care unit (ICU) circumstance, primary medical disease itself, mental stress, and impacts of many drugs and other managements utilized to treat ICU patients. Another illness that may cause profound daytime somnolence is narcolepsy. Modafinil, methylphenidate and amphetamines are used as stimulants to treat symptoms, such as extreme daytime sleepiness, cataplexy and nocturnal sleep disruption. Such stimulants can increase awareness, improve perception and thinking, as well as assist in keeping people awake. The exact mechanism of action of modafinil is unclear. studies have demonstrated that binding of modafinil to the dopamine reuptake pump can prevent the reuptake of dopamine, resulting in a boost in extracellular dopamine. Modafinil is a racemic compound containing and isomers. Peak plasma concentrations of the drug occur at 2-4 h after administration; therefore, the absorption of modafinil is considered fast. Modafinil is properly distributed in tissues by binding to plasma proteins moderately. Despite the likely role of modafinil in improving cognition and arousal in critically ill patients, the available data on the use of modafinil in the ICU setting is limited. The aim of the study was to review the novel usage of modafinil for alleviation of fatigue, excessive daytime somnolence (EDS), and/or depression in critically ill patients.
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http://dx.doi.org/10.1080/21556660.2020.1745209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170336PMC
April 2020

Smell dysfunction: a biomarker for COVID-19.

Int Forum Allergy Rhinol 2020 08 18;10(8):944-950. Epub 2020 Jun 18.

Smell & Taste Center, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), is responsible for the largest pandemic since the 1918 influenza A virus subtype H1N1 influenza outbreak. The symptoms presently recognized by the World Health Organization are cough, fever, tiredness, and difficulty breathing. Patient-reported smell and taste loss has been associated with COVID-19 infection, yet no empirical olfactory testing on a cohort of COVID-19 patients has been performed.

Methods: The University of Pennsylvania Smell Identification Test (UPSIT), a well-validated 40-odorant test, was administered to 60 confirmed COVID-19 inpatients and 60 age- and sex-matched controls to assess the magnitude and frequency of their olfactory dysfunction. A mixed effects analysis of variance determined whether meaningful differences in test scores existed between the 2 groups and if the test scores were differentially influenced by sex.

Results: Fifty-nine (98%) of the 60 patients exhibited some smell dysfunction (mean [95% CI] UPSIT score: 20.98 [19.47, 22.48]; controls: 34.10 [33.31, 34.88]; p < 0.0001). Thirty-five of the 60 patients (58%) were either anosmic (15/60; 25%) or severely microsmic (20/60; 33%); 16 exhibited moderate microsmia (16/60; 27%), 8 mild microsmia (8/60; 13%), and 1 normosmia (1/60; 2%). Deficits were evident for all 40 UPSIT odorants. No meaningful relationships between the test scores and sex, disease severity, or comorbidities were found.

Conclusion: Quantitative smell testing demonstrates that decreased smell function, but not always anosmia, is a major marker for SARS-CoV-2 infection and suggests the possibility that smell testing may help, in some cases, to identify COVID-19 patients in need of early treatment or quarantine.
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http://dx.doi.org/10.1002/alr.22587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262123PMC
August 2020

Virtual screening for potential inhibitors of β(1,3)-D-glucan synthase as drug candidates against fungal cell wall.

J Drug Assess 2020 11;9(1):52-59. Epub 2020 Mar 11.

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

To enhance the outcome in patients with invasive candidiasis, initiation of an efficient antifungal treatment in a suitable dosage is necessary. Echinocandins (e.g. caspofungin) inhibit the enzyme β(1,3)-D-glucan synthase of the fungal cell wall. Compared to azoles and other antifungal agents, echinocandins have lower adverse effects and toxicity in humans. Echinocandins are available in injectable (intravenous) form. In this study, to identify the novel oral drug-like compounds that affect the fungal cell wall, downloaded oral drug-like compounds from the ZINC database were processed with a virtual screening procedure. The docking free energies were calculated and compared with the known inhibitor caspofungin. Four molecules were selected as the most potent ligands and subjected to hydrogen bonds analysis. Considering the hydrogen bond analysis, two compounds (ZINC71336662 and ZINC40910772) were predicted to better interact with the active site of β(1,3)-D-glucan synthase compared with caspofungin. The introduced compound in this study may be valuable to analyze experimentally as a novel oral drug candidate targeting fungal cell walls.
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http://dx.doi.org/10.1080/21556660.2020.1734010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144292PMC
March 2020

Diagnostic values of bronchodilator response versus 9-question questionnaire for asthma.

Adv Respir Med 2019 ;87(5):269-275

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

Introduction: Several studies have investigated different tools for asthma diagnosis in order to reduce the cost and improve its early recognition. The goal of this study is to establish ashort questionnaire to be used in practice for asthma screening and compare diagnostic values between this method and spirometric response to bronchodilators.

Material And Method: 208 patients presenting with chronic stable dyspnea (> 6 months) and definite clinical diagnosis of chronic obstructive pulmonary disease, bronchiectasis, pulmonary fibrosis or asthma, were enrolled. 9 questions out of 43 based on the literature search were selected by regression analysis. Patients were asked to complete the questionnaire and then their spirometric responses to bronchodilators were evaluated.

Results: Of all, 53.8% of cases were diagnosed clinically to have asthma. For establishing diagnosis of asthma, the bronchodilator test had 48.2% sensitivity, 78.1% specificity, 72% positive, 56.4% negative predictive values, 2.2 positive, 0.66 negative likeli-hood ratios, and false positive, false negative and accuracy of 21.9%, 51.8% and 62.01%, respectively. The revised 9 questions from the questionnaire had 97.3% sensitivity, 77.1% specificity, 83.2% positive, 96.1% negative predictive values, 4.24 positive, 0.03 negative likelihood ratios, 22.9% false positive, 2.7% false negative and 87.98% accuracy.

Conclusions: The 9-question questionnaire had better diagnostic values in defining asthma in patients with chronic dyspnea than reversibility of airway obstruction to salbutamol and can be used as auseful screening test for diagnosis of asthma in clinical practice and for investigational purposes.
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http://dx.doi.org/10.5603/ARM.2019.0048DOI Listing
April 2020

Nutritional status of patients hospitalized in the intensive care unit: A comprehensive report from Iranian hospitals, 2018.

J Crit Care 2019 12 6;54:151-158. Epub 2019 Aug 6.

Faculty of Critical Care Medicine, Lung Disease Research Center, Mashhad university of Medical Sciences, Mashhad, Iran.

Introduction And Aim: Malnutrition is a complication of hospitalization in critically ill patients. This event is occurred because of disease and therapeutic processes for curing the patients. Determination of nutritional status helps physicians and clinical nutritionists decide on the best regimen which should be prescribed for a patient. In the current study, we aimed to report the nutritional status ofpatientshospitalizedin the intensive care unit (ICU).

Method Of Study: We used three standard tolls, including Subjective global assessment (SGA), Nutrition Risk in the Critically Ill (NUTRIC) Score and nutrition risk screening (NRS) questionnaires via a multi-stage sampling for different ICU wards of 32 university hospitals in Iran. Frequencies and rates of nutritional scores, comparative studies, and determined agreement of scoring systems and nutritional status in any ward of hospitals were evaluated.

Results: There were 771 males and 540 female Cancer and trauma patients had the best and worst nutritional scores, respectively. Using NRS and NUTRIC, the low-risk scores were more frequent than thehigh-riskscores among ICU patients. SGA showed that most patients were in grades A (well nutritional status) or B (moderate nutritional status), andfew caseswere in grade C (poor nutritional status).The high-risk nutritional score wasobtained for older patients. NUTRIC and NRS had better agreement for diagnosis and differentiation of malnutrition than NUTRIC-SGA or NRS-SGA pairs. However, there was no strong agreement between the mentioned pairs.

Conclusion: Nutritional status of patients hospitalized in ICU wards in Iran wassomewhat better than other countries that this could be due to the highly observed guidelines of patient's care in Iran. Anyway,it is suggested that a more precise tool of nutritional scoresto be validated for patients hospitalized in ICU·In addition, better medical care needs a well evaluation of nutritional insufficiencies and what is necessary for compensation using complementary regimens.
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http://dx.doi.org/10.1016/j.jcrc.2019.08.001DOI Listing
December 2019

Study Protocol on Antimicrobial Stewardship in a Tertiary Respiratory Referral Hospital.

Tanaffos 2018 Mar;17(3):183-187

Clinical Tuberculosis and Epidemiology Research Center, NIRTLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Antimicrobial stewardship program is a comprehensive, longitudinal program designed to improve and measure the appropriateness of antimicrobial use while increasing patients' safety, decreasing cost of patients' care, and combating emerging antimicrobial resistance. Antimicrobial resistance, specially emerging multidrug-resistance and extremely drug-resistance gram negative bacteria, is an important concern in the modern world. This is particularly problematic since antimicrobials in production pipelines are not meeting the demand for the emerging resistance micro-organisms; in another word "we are running out of options". Indiscriminate use of antimicrobial may increase the risk for resistance, and drug toxicity. The aim of this study is to implement an evidence-based antimicrobial stewardship program in a tertiary referral hospital. This study will assure consistency of the stewardship program and measure outcomes to further assess the effectiveness of this program.

Materials And Methods: After establishment of antimicrobial stewardship committee and endorsement of policies the program will be conducted in all hospital medical wards. In an observational study, all patients receiving antimicrobials included in the program will be closely monitored for primary and secondary outcomes. Hospital's antimicrobial resistance patterns are monitored periodically to assess improvement. The quality indicators will be assessed to ensure proper execution of the program over time.

Results: As a study protocol, there are no results available to be reported at this time.

Conclusion: We are expecting to observe significant reduction in cost of antibiotic use shortly after program execution. By more appropriate utilization of antibiotics patients' safety will be increased. Furthermore, we are expecting to detect improvement in antimicrobial resistance patterns.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428375PMC
March 2018

Pulmonary Hypertension in Intensive Care Units: An Updated Review.

Tanaffos 2019 Mar;18(3):180-207

Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Pulmonary hypertension (PH) is a condition associated with high morbidity and mortality. Patients with PH who require critical care usually have severe right ventricular (RV) dysfunction. Although different groups of PH have different etiologies, pulmonary vascular dysfunction is common in these groups. PH can lead to increased pulmonary artery pressure, which can ultimately cause RV failure. Clinicians should be familiar with the presentations of this disease and diagnostic tools. The contributing factors, if present (e.g., sepsis), and coexisting conditions (e.g., arrhythmias) should be identified and addressed accordingly. The preload should be optimized by fluid administration, diuretics, and dialysis, if necessary. On the other hand, the RV afterload should be reduced to improve the RV function with pulmonary vasodilators, such as prostacyclins, inhaled nitric oxide, and phosphodiesterase type 5 inhibitors, especially in group 1 PH. Inotropes are also used to improve RV contractility, and if inadequate, use of ventricular assist devices and extracorporeal life support should be considered in suitable candidates. Moreover, vasopressors should be used to maintain systemic blood pressure, albeit cautiously, as they increase the RV afterload. Measures should be also taken to ensure adequate oxygenation. However, mechanical ventilation is avoided in RV failure. In this study, we reviewed the pathophysiology, manifestations, diagnosis, monitoring, and management strategies of PH, especially in intensive care units.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210574PMC
March 2019