Publications by authors named "Seyedeh Maryam Hosseini"

37 Publications

Sex Disparities in Organ Donation: Finding an Equitable Donor Pool.

J Am Heart Assoc 2021 Sep 24:e020820. Epub 2021 Sep 24.

Division of Cardiology Department of Medicine Sarver Heart Center University of Arizona Tucson AZ.

Background The majority of living organ donors are women, but few are deceased organ donors, which increases risks associated with sex mismatched organs. We sought to identify reasons for sex disparities in organ donation and strategies for equity. Methods and Results Using Amazon's Mechanical Turk, we examined US adults' perceptions regarding donation in a mixed-methods survey study. Results were compared by sex with Fisher's exact test and T-tests for quantitative results and qualitative descriptive analyses for write-in responses. Among 667 participants (55% women), the majority of men (64.8%) and women (63.4%) self-identified as registered donors. Women's willingness to donate their own organs to family members (=0.03) or strangers (=0.03) was significantly higher than men. Donors from both sexes were guided by: desire to help, personal experience, and believing organs would be useless to deceased donors. Non-donors from both sexes were guided by: no reason, medical mistrust, contemplating donation. When considering whether to donate organs of a deceased family member, women were equally guided by a family member's wishes and believing the family member had no further use for organs. Men had similar themes but valued the family member's wishes more. Among non-donors, both sexes would consider donation if more information was provided. Conclusions In a national survey, both sexes had similar reasons for becoming and not becoming an organ donor. However, compared with men, women were more willing to donate their organs to family members and strangers. Improving education and communicating wishes regarding organ donation with direct relatives may increase sex equity in deceased organ donation.
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http://dx.doi.org/10.1161/JAHA.121.020820DOI Listing
September 2021

Pachychoroid Spectrum Disorder Findings in Patients with Coronavirus Disease 2019.

Case Rep Ophthalmol Med 2021 13;2021:4688764. Epub 2021 Sep 13.

Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: To report the occurrence of acute, bilateral, central serous chorioretinopathy (CSC), and pachychoroid spectrum disorder findings in patients with coronavirus disease 2019 (COVID-19).

Methods: In recovered cases of COVID-19 with visual disturbances, complete ocular examinations with multimodal retinal and choroidal evaluation, including enhanced depth imaging optical coherence tomography, fluorescein or indocyanine green angiography, and blue autofluorescence, were obtained.

Results: Four COVID-19 recovered patients presented with bilateral blurred vision. Ocular examination and imaging revealed pachychoroid and pachyvessels associated with choroidal hyperpermeability without any obvious intraocular inflammation. Bilateral localized serous retinal detachment was obvious in three cases compatible with pachychoroid associated with CSC manifestation and pachychoroid pigment epitheliopathy in one patient. CSC was resolved with treatment by steroidal antimineralocorticoid (Eplerenone) in two patients and by photodynamic therapy in one patient. None of the patients reported emotional stress and history of corticosteroid consumption.

Conclusion: Hyperpermeability of the choroid, pachychoroidopathy, or choroidal vessel congestion can be observed or exacerbated in association with COVID-19.
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http://dx.doi.org/10.1155/2021/4688764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455221PMC
September 2021

Frequency of Toxocara Antibodies in Patients Clinically Suspected to Ocular Toxocariasis, Northeast of Iran.

Iran J Parasitol 2021 Apr-Jun;16(2):305-311

Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Human toxocariasis is a neglected parasitic disease in most countries including Iran. Among different clinical forms of toxocariasis, ocular toxocariasis (OT) is an important disease resulting in severe vision loss. However, the prevalence and incidence of OT are currently unclear in Iran. This study aimed to determine the prevalence of ocular toxocariasis among patients with uveitis in the Northeast of Iran.

Methods: From 2015 to 2017, 510 patients with uveitis referred to Khatam-al-Anbia, a tertiary eye hospital at Mashhad, Iran were examined for OT. Serum samples of the suspected patients were obtained and evaluated for IgG against using ELISA test. Anti- IgG positive serums were further investigated using confirmatory Western blotting (WB) analysis.

Results: Twenty patients had pathologic changes and clinical presentations in the anterior and posterior segments of their eyes and they were clinically diagnosed ocular toxocariasis. Among the 20 patients, 2 (10%) patients showed IgG antibody against on ELISA as well as on WB test. The calculated prevalence of ocular toxocariasis was about 0.4%.

Conclusion: Ocular toxocariasis can be diagnosed both clinically and serologically in Mashhad, northeastern Iran. Although OT is a rare pathologic eye disease, it should be considered as one of the important cause of infectious posterior uveitis.
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http://dx.doi.org/10.18502/ijpa.v16i2.6312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418656PMC
July 2020

Central Retinal Artery Occlusion Associated with Sildenafil Overdose.

Case Rep Ophthalmol Med 2021 4;2021:2006271. Epub 2021 Sep 4.

Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: To report a patient with central retinal artery occlusion (CRAO) associated with sildenafil overdose. . A forty-two-year-old male presented three hours after sudden painless visual loss in the right eye. BCVA was counting finger in two meters, and relative afferent pupillary defect was positive. Fundus examination revealed retinal whiteness except in a limited area of papillomacular bundle and cherry red spot. He consumed two 100 mg film-coated sildenafil tablet (Vizarsin, Krka, d.d., Novo mesto, Slovenia) twelve hours apart, and the last one was six hours before visual loss. He was diagnosed with CRAO with cilioretinal artery sparing. Although we did not find any emboli, anterior chamber paracentesis was done. Four weeks later, BCVA improved to 20/80, with resolving of retinal edema. Cardiovascular, carotid arteries, and neurologic evaluations were negative for any predisposing factor.

Conclusion: CRAO is a vision threatening condition that might be associated with the overdose of sildenafil.
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http://dx.doi.org/10.1155/2021/2006271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437635PMC
September 2021

Local and systemic gene expression levels of IL-10, IL-17 and TGF-β in active ocular toxoplasmosis in humans.

Cytokine 2021 Oct 28;146:155643. Epub 2021 Jul 28.

Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address:

Background: To compare mRNA expression of interleukin 10 (IL-10), interleukin 17 (IL-17) and Transforming Growth Factor-β (TGF-β) in aqueous humor (AH) and peripheral blood mononuclear cells (PBMCs) in human ocular toxoplasmosis (OT) and controls.

Method: RNA isolation, cDNA synthesis and real-time polymerase chain reaction were performed on AH sediments and PBMCs of 16 patients with active OT and 21 controls at the Khatam-al-Anbia Eye Hospital, Iran. For comparison, Mann Whitney U test was used at a discrimination level of p < 0.05. Pearson and Spearman rank correlation test were applied for correlation with clinical parameters.

Results: The expression for IL-10 and IL-17 in the AH was 3.7- and 88.0-fold higher in OT than in controls (P = 0.04 and P = 0.03, respectively) whereas that of TGF-β was 7.7-fold lower (P < 0.001). The expression levels for these cytokines in PBMC followed a similar pattern (IL-10 13.8-fold down-regulated (P = 0.001), IL-17 with 1.9-fold insignificantly upregulated (p = 0.43), TGF-β 452.8-fold down-regulated (P = 0.002). Compared to PBMC, IL-10 coding mRNA was 1876-fold higher in the almost cell-free AH in OT (39.2-fold in controls), IL-17 coding mRNA was 9.4-fold higher (17.7-fold down-regulated in controls), and that coding for TGF-β 207-fold higher in OT (7x10-fold in controls). The expression for IL-10, IL-17 and TGF-β in AH thus followed an opposite pattern compared to that in PBMC.

Conclusion: OT induces a highly-specific local immunoregulatory process as evidenced by an intraocular up-regulation of IL-10 and down-regulation of TGF-β mRNA. This could indicate an attempt to prevent unnecessary tissue damage which is in line with a moderate local mRNA up-regulation for IL-17 which seems sufficient to control parasite proliferation. That this regulation is opposite to that in PBMC may be linked to intraocular immune deviation in the course of disease.
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http://dx.doi.org/10.1016/j.cyto.2021.155643DOI Listing
October 2021

Expanded Spectrum of Optical Coherence Tomography Findings in Patients with Ocular Toxoplasmosis.

Ocul Immunol Inflamm 2021 Jul 8:1-8. Epub 2021 Jul 8.

Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

: To describe the optical coherence tomography (OCT) findings of toxoplasmic retinochoroiditis at different stages of activity.: Observational case series.: A total of 32 eyes of 31 patients were included; 43 sets of OCT were reviewed. A total of 14 lesions were classified as active, 13 as partially active, and 16 as inactive. All active lesions demonstrated increased retinal thickness and reflectivity with blurring of details of retinal layers. Choroidal granuloma was detected in eight (61.5%) and serous retinal detachment in nine (64%). In partially active lesions, sustained thickening and/or attachment of posterior hyaloid face with fine epiretinal membrane was the hallmark. Scarified lesions showed decreased retinal and choroidal thickness starting from the periphery. Characteristic signs for decreased activity of a lesion seen in majority of both partially active and inactive lesions were RPE changes and retina-RPE approximation. We called this unique feature 'hourglass configuration'.: Features in OCT are helpful to specify and monitor the activity of toxoplasmic retinochoroiditis.
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http://dx.doi.org/10.1080/09273948.2021.1933065DOI Listing
July 2021

Foveal reorganization after treatment of acute foveal toxoplasmic retinochoroiditis.

J Ophthalmic Inflamm Infect 2021 Jun 21;11(1):18. Epub 2021 Jun 21.

Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Blvd, Mashhad, 9195965919, Iran.

Purpose: To report a patient with impaired vision due to foveal involvement of toxoplasmic retinochoroiditis, who was successfully treated with intravitreal clindamycin and dexamethasone and oral therapy with azithromycin, trimethoprim-sulfamethoxazole, and prednisolone and led to successful visual and anatomic recovery.

Case Presentation: A 32-year-old man presented with three-day history of gradually decreasing visual acuity, redness, pain and photophobia of the right eye. Anterior chamber cellular reaction, vitritis and a white retinochoroiditis patch with adjacent retinal vasculitis in the fovea was suggestive of the toxoplasmic retinochoroiditis. He was treated with intravitreal clindamycin and dexamethasone injection followed by six-week regimen of azithromycin, trimethoprim-sulfamethoxazole, and prednisolone. In serial optical coherence tomography imaging, retinitis patch changed to cavitary foveal destruction. Fovea reorganized gradually, and visual acuity concurrently improved from counting finger 3 m to 20/25.

Conclusion: In foveal toxoplasmic retinochoroiditis lesions, timely treatment is associated with retinal reorganization and visual improvement.
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http://dx.doi.org/10.1186/s12348-021-00246-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215007PMC
June 2021

Evaluation and Comparison of Choroidal Thickness in Patients with Behçet Disease with versus without Ocular Involvement.

J Ophthalmic Vis Res 2021 Apr-Jun;16(2):195-201. Epub 2021 Apr 29.

Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: To assess the subfoveal choroidal thickness (SFCT) in patients with Behçet disease (BD) and compare the SFCT in patients with and without ocular BD (OBD) and between patients with active and quiescent phases of the Behçet's posterior uveitis.

Methods: This prospective cross-sectional study was conducted on patients with BD ( = 51) between October 2016 and October 2018. Complete ocular examinations including slit lamp biomicroscopy and fundus examination with dilated pupils were performed for all patients. The SFCT values were compared between patients with and without OBD. Enhanced depth imaging optical coherence tomography (EDI-OCT) was done to measure the SFCT, and wide field fundus fluorescein angiography (WF-FAG) was performed to evaluate the ocular involvement and determine the active or quiescent phases of the Behçet's posterior uveitis. The correlation between the changes of SFCT and the WF-FAG scores was assessed.

Results: One hundred and two eyes of 51 patients with BD, aged 29 to 52 years were studied. Of these, 23 patients were male. The mean age standard deviation in patients with OBD and patients without ocular involvement was 38.71 7.8 and 36.22 10.59 years ( = 0.259) respectively. The mean SFCT in patients with OBD was significantly greater than in patients without OBD (364.17 93.34 vs 320.43 56.70 µm; = 0.008). The difference of mean SFCT between the active compared to quiescent phase was not statistically significant when only WF-FAG criteria were considered for activity (368.12 104.591 vs 354.57 58.701 µm, = 0.579). However, when the disease activity was considered based on both WF-FAG and ocular exam findings, SFCT in the active group was higher than the inactive group (393.04 94.88 vs 351.65 58.63 µm, = 0.060). This difference did not reach statistical significance, but it was clinically relevant.

Conclusion: Choroidal thickness was significantly increased in BD patients with ocular involvement; therefore, EDI-OCT could be a noninvasive test for evaluation of ocular involvement in patients with BD. The increased SFCT was not an indicative of activity in OBD; however, it could predict possible ocular involvement throughout the disease course.
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http://dx.doi.org/10.18502/jovr.v16i2.9083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126733PMC
April 2021

Retinoprotective Effects of Crocin and Crocetin via Anti-angiogenic Mechanism in High Glucose-Induced Human Retinal Pigment Epithelium Cells.

Curr Mol Pharmacol 2021 Apr 19. Epub 2021 Apr 19.

Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Diabetic retinopathy (DR) is one of the most common side effects of diabetes. We aimed to investigate the effects of crocin and crocetin (as a deglycosylated form of crocin in blood stream) in gene expression or protein levels of vascular endothelial growth factor (VEGF), vascular endothelial growth factor-receptor1 (VEGFR-1), matrix metalloproteinases2 (MMP-2), matrix metalloproteinases9 (MMP-9) and thrombospondin-2 (TSP-2) in high glucose cell culture media.

Methods: The retinal pigment epithelium (RPE) cells were exposed to high glucose (HG, 30 mM glucose concentration) and normal glucose (NG, 24.5 mM mannitol + 5.5 mM glucose) for six days. RPE cells were treated in four treatment groups (crocin, crocetin, Bevacizumab, and crocin + Bevacizumab). Gene expressions were measured using quantitative real-time PCR, and proteins level was evaluated by western blot.

Results: Findings showed that VEGF gene expression and protein level significantly decreased in all treatment groups. In addition, reduction in VEGFR1 gene expression was significantly higher in Bevacizumab and crocin + Bevacizumab groups than other groups. Only, crocin and crocetin could reduce the gene levels of MMP-2 and MMP-9. In addition, TSP-2 protein levels increased when HG cells were exposed crocin or crocin + Bevacizumab groups.

Conclusion: Our data showed that crocin and crocetin have anti-VEGF function similar to Bevacizumab, act as an anti-angiogenic agent. Also, crocin and crocetin could decrease MMP-2 and MMP-9 gene levels, as inflammatory and angiogenesis factors. As a result, crocin and crocetin have protective effects against angiogenesis and inflammation in DR.
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http://dx.doi.org/10.2174/1874467214666210420111232DOI Listing
April 2021

Symptomatic Supraventricular Tachycardia Resistant to Adenosine Therapy in a Patient with Chronic Theophylline Use.

Case Rep Cardiol 2021 27;2021:2806193. Epub 2021 Mar 27.

Carondelet Medical Group, USA.

Theophylline is a potent adenosine receptor antagonist with indirect adrenergic effects that can lead to arrhythmias and metabolic abnormalities such as hypokalemia. Therapeutic toxicity cases have declined over the years mainly due to decreased recommended therapeutic doses and overall decreased usage of this medication due to newer available COPD treatment options. We present a clinical case of symptomatic supraventricular tachycardia resistant to adenosine therapy in a patient with theophylline use. This case highlights the importance of comprehensive medication review in acute settings to aid in identifying the underlying etiologies and initiating prompt treatments. It also signifies the importance of reviewing chronic medications in each outpatient visits to ensure continued indication for their use and be able to change them to newer agents per guidelines whenever possible.
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http://dx.doi.org/10.1155/2021/2806193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019626PMC
March 2021

Acute Bilateral Neuroretinitis and Panuveitis in A Patient with Coronavirus Disease 2019: A Case Report.

Ocul Immunol Inflamm 2021 Apr 8:1-4. Epub 2021 Apr 8.

Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

: Herein, we report a case of bilateral neuroretinitis and panuveitis in a patient recovered from coronavirus disease 2019 (COVID-19).: A 37-year-old male patient with a history of recovered COVID-19, which was confirmed with nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR) for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), about one-month ago was referred with one-week history of bilateral severe vision loss. Visual acuity was counting fingers, and bilateral retinitis and panuveitis were revealed in ocular examination. The result of the vitreous sample using RT-PCR was positive for SARS-CoV-2 and negative for viruses and . The patient was successfully treated with corticosteroid.: We report a case of bilateral neuroretinitis and panuveitisin a recovered COVID-19 patient and positive RT-PCR of the vitreous sample. It is suggested to apply intraocular sampling and evaluation for COVID-19 in patients with the new-onset of uveitis and/or retinitis during the pandemic.
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http://dx.doi.org/10.1080/09273948.2021.1894457DOI Listing
April 2021

Persumed sympathetic Ophthalmia after scleral buckling surgery: case report.

J Ophthalmic Inflamm Infect 2021 Feb 22;11(1). Epub 2021 Feb 22.

Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Boulevard, Mashhad, 9195965919, Iran.

Background: Scleral buckling (SB) is usually considered an extraocular operation premeditated to have a low risk of sympathetic ophthalmia (SO). Here we report a rare case of presumed SO in a young female patient following SB.

Case Presentation: A nineteen-year-old female patient was referred for visual loss in her left eye due to macula off inferior long-standing rhegmatogenous retinal detachment (RRD). The best corrected visual acuity (BCVA) was 20/400 in the left eye. SB with 360 degrees encircling band, an inferior segmental tire with one spot cryoretinopexy at the break site, and subretinal fluid drainage was performed. BCVA was improved to 20/80 and the retina was totally attached 1 week after the operation. The patient referred to the hospital 6 weeks later with severe visual loss in both eyes as counting finger 1 m. Patient examination indicated bilateral multifocal serous retinal detachment (SRD) and vitreous cells. The patient, diagnosed with SO, received intravenous corticosteroid pulse therapy and mycophenolate mofetil for treatment. The inflammation was controlled and SRD resolved after a 5-day intravenous treatment without being relapsed after 6 months. Consequently, BCVA became 20/20 and 20/50 in the right and left eye, respectively, after 6 months. The findings of systemic workup were negative for any extraocular disease or systemic involvement.

Conclusion: Since SB is a procedure without manipulating intraocular tissues, it is considered to impose a low risk for SO. This report presented SO occurrence after successful SB. Some factors may induce SO, including inciting the choroid and retinal pigment epithelium with cryoretinopexy or perforating for drainage.
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http://dx.doi.org/10.1186/s12348-020-00233-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897590PMC
February 2021

Primary Idiopathic Frosted Branch Angiitis.

J Ophthalmic Vis Res 2020 Jul-Sep;15(3):424-427. Epub 2020 Aug 6.

Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

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http://dx.doi.org/10.18502/jovr.v15i3.7462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431713PMC
August 2020

Focal Choroidal Excavation in a Case of Choroidal Osteoma Associated with Choroidal Neovascularization.

J Ophthalmic Vis Res 2020 Jul-Sep;15(3):419-423. Epub 2020 Aug 6.

Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: To report a case of choroidal osteoma associated with reactivation of choroidal neovascularization (CNV) and development of focal choroidal excavation (FCE).

Case Report: A 34-year-old woman with choroidal osteoma complicated by CNV in the right eye for two years presented with deterioration of visual acuity in her right eye. A small retinal hemorrhage accompanied by subretinal fluid (SRF) was seen in the macular area of the right eye. Optical coherence tomography (OCT) showed that the inner retina was intact, and the outer retinal layers had outward displacement. SRF and a wedge-shaped choroidal depression were also seen. This choroidal excavation was not present on previous OCT images. The integrity of the inner retinal layers was maintained, and an optically clear space was present between the neurosensory retina and the retinal pigment epithelium.

Conclusion: Choroidal osteoma can be complicated by CNV and FCE could occur as a consequence. Again, FCE can lead to CNV development. This cascade can deteriorate vision and sometime lead to permanent visual loss.
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http://dx.doi.org/10.18502/jovr.v15i3.7461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431724PMC
August 2020

Unilateral Presentation of Vogt-Koyanagi-Harada Syndrome.

J Ophthalmic Vis Res 2020 Jan-Mar;15(1):99-103. Epub 2020 Feb 2.

Eye Research Center, Matini Eye Hospital, Kashan University of Medical Sciences, Kashan, Iran.

Purpose: To report a case of acute Vogt-Koyanagi-Harada (VKH) disease with unilateral clinical manifestations followed by late fellow eye involvement.

Case Report: This case report reviews the 12-month follow-up observation of a 44-year old woman who presented to the emergency department with unilateral progressive and painless visual blurring. Ophthalmoscopic findings, best-corrected visual acuity (BCVA), fluorescein angiography (FAG), enhanced-depth optical coherence tomography (EDI-OCT), indocyanine green angiography, and response to treatment were evaluated. Her BCVA was 20/50 (logMAR: 0.4) in the right eye and 20/20 (logMAR: 0) in the left eye. Eye examination revealed optic disc swelling and multiple serous retinal detachments in the right eye and a normal left eye. She had headache, dysacusia, and mild hearing problem. Her past ocular and drug histories were unremarkable. Retinal imaging revealed characteristic features of VKH in the right eye. All laboratory testing results were inconclusive. VA and OCT findings significantly improved following the treatment with methylprednisolone 1 g/day continued by tapering dose of oral prednisolone. Two months after the presentation and during prednisolone tapering, VA of the left eye decreased and fundus examination revealed multiple serous retinal detachments in this eye.

Conclusion: Ophthalmologists should recognize unilateral and asymmetrical VKH disease with subtle systemic involvement.
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http://dx.doi.org/10.18502/jovr.v15i1.5954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001015PMC
February 2020

A Novel Frameshift Mutation Associated with Hurler's Syndrome: A Case Report.

J Pediatr Genet 2019 Dec 3;8(4):212-217. Epub 2019 Apr 3.

Department of Pediatric Endocrinology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Mucopolysaccharidosis 1 (MPS1) is a rare inherited lysosomal storage disorder resulting from the absence or reduction of lysosomal alpha-l-iduronidase due to mutations in the gene. Three major clinical manifestations have been established including Hurler's or severe type (OMIM 607914), Hurler-Scheie or intermediate type (MIM 607914) and Scheie's or attenuated type (MIM 607016). In the present study, a patient whose disease was diagnosed by biochemical and enzymatic assay was studied in our laboratory. Molecular analysis implemented by PCR-sequencing of all 14 exons and exon-intron junctions confirmed a novel deleterious mutation in a homozygous state. The result of this study has broadened the genotypic spectrum of MPS1 patients, assisting in a more effective approach for carrier testing and counseling.
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http://dx.doi.org/10.1055/s-0039-1685190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824898PMC
December 2019

IgG Avidity Test for Ocular Toxoplasmosis Diagnosis at a Tertiary Center, Northeast of Iran.

Iran J Immunol 2019 Sep;16(3):258-264

Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: The diagnostic methods which are used for acute ocular toxoplasmosis are very important; if the treatment is delayed, it sometimes leads to loss of vision. Few studies have been performed to evaluate serological tests used in the diagnosis of acute ocular toxoplasmosis.

Objectives: To evaluate the immunoglobulin (Ig) M, G and IgG avidity tests for diagnosis of acute ocular toxoplasmosis in the northeast of Iran.

Methods: A cross-sectional study was carried out from January 2014 to December 2016. After an opthalmic examination was conducted by a retina specialist, 16 typical acute and 34 typical chronic ocular toxoplasmosis cases were included in this study. Information on clinical manifestations, age and occupation was recorded. Anti-Toxoplasma IgG, IgM and IgG avidity tests were administered on serum samples using the ELISA method.

Results: Blurring of vision in all patients was the most clinical presentation. The IgG avidity test could diagnose all acute and recent cases. However, three false positive and one false negative result occurred using the IgM test by ELISA. The false negative result in all likelihood occurred because the patient was at the beginning stage of the infection.

Conclusion: The result of this study showed that IgM is not a reliable marker of acute disease. Repetition of the serology tests was proposed in cases with clinical manifestations without detectable antibody titer after approximately two weeks. IgG avidity testing results coincided with clinical diagnosis and it could therefore considered to be a reliable method to differentiate between recently acquired and chronic ocular toxoplasmosis.
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http://dx.doi.org/10.22034/IJI.2019.80276DOI Listing
September 2019

Reply.

Am J Ophthalmol 2019 08 21;204:142-143. Epub 2019 Jun 21.

Mashhad, Iran.

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http://dx.doi.org/10.1016/j.ajo.2019.03.022DOI Listing
August 2019

Author's Reply.

J Ophthalmic Vis Res 2018 Oct-Dec;13(4):524

Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

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http://dx.doi.org/10.4103/jovr.jovr_218_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210868PMC
November 2018

Bilateral Panuveitis and Keratitis as First Presentation of Relapsing Polychondritis.

Ocul Immunol Inflamm 2019 7;27(8):1267-1269. Epub 2018 Sep 7.

Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

: To report a rare case of relapsing polychondritis with bilateral panuveitis as the first presentation of systemic disease : A 26-year-old female presented with bilateral decreased vision, red eye and ocular pain underwent complete ocular examination, retinal imaging and systemic investigation. : Investigations revealed bilateral panuveitis associated with keratitis, retinal hemorrhages and retinal vasculitis. Following systemic work-ups and the pinna cartilage biopsy, diagnosis of relapsing polychondritis was made. : Owing to debilitating and even life-threatening consequences of enigmatic relapsing polychondritis, high suspicion of the disease is of paramount importance in cases of retinal vasculitis and uveitis.
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http://dx.doi.org/10.1080/09273948.2018.1517893DOI Listing
May 2020

Visual prognosis, clinical features, and predisposing factors in non-HIV patients with cytomegalovirus retinitis.

Int Ophthalmol 2019 Aug 20;39(8):1709-1715. Epub 2018 Jul 20.

Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: To study the characteristics and visual outcome of cytomegalovirus retinitis in patients of a tertiary referral ophthalmology center.

Methods: This retrospective cross-sectional study included 16 patients who presented with CMV retinitis between February 2014 and January 2017. Demographics, clinical signs, course of treatment, and visual and anatomical results were analyzed.

Results: Twenty five eyes of 16 patients were included. Eleven (68.8%) were females. The mean age was 29.37 ± 17.12 (range 11-73) years. Involvement was bilateral in 9 (56.2%) cases. HIV serology was negative in all patients. Best-corrected visual acuity was 0.57 ± 0.55 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation and decreased to 0.69 ± 0.55 LogMAR on final visit (P = 0.332). None of the patients participating in this study was HIV-positive.

Conclusion: CMV retinitis is a devastating complication in immunosuppressed. The visual acuity usually decreases despite aggressive appropriate treatment. This observation supports the increasing incidence of CMV infection in non-HIV patients.
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http://dx.doi.org/10.1007/s10792-018-0991-2DOI Listing
August 2019

Correction to: Assessment of ocular toxoplasmosis patients reported at a tertiary center in the northeast of Iran.

Int Ophthalmol 2018 12;38(6):2535

Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Unfortunately, in the original publication of the article, given name and family name of the first and fourth author names were mentioned incorrectly. The exact given name and family name of those author names have been provided in the erratum.
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http://dx.doi.org/10.1007/s10792-018-0888-0DOI Listing
December 2018

Patterns of Uveitis at a Tertiary Referral Center in Northeastern Iran.

J Ophthalmic Vis Res 2018 Apr-Jun;13(2):138-143

Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: To describe the demographic and clinical patterns of patients with uveitis referred to a tertiary center in northeastern Iran.

Methods: This cross-sectional retrospective study included 235 patients with uveitis who had been referred to the uveitis clinic of Khatam-Al-Anbia eye hospital, affiliated to Mashhad University of Medical Sciences, from February 2013 to March 2014. Data regarding patient age, sex, anatomical location of the disease, and etiologic and clinical features were analyzed.

Results: Mean patient age at the onset of uveitis was 35.75 ± 16.3 (range: 3-82) years. The ratio of females to males was 1.5 to 1. Sixty-four percent had bilateral involvement. The predominant type of inflammation was non-granulomatous (76%). Panuveitis (46.8%, 110 cases) was the most common form of uveitis followed by anterior (37%, 87 cases), intermediate (11.9%, 28 cases), and posterior uveitis (4.25%, 10 cases). The most common diagnoses were "idiopathic" in anterior and intermediate uveitis cases, toxoplasmosis in posterior uveitis group, and Behçet and Vogt-Koyanagi-Harada diseases in panuveitis cases. Overall, noninfectious causes (80.42%) of uveitis were more frequent than infectious causes (19.57%). The proportion of noninfectious uveitis was 82.75% in anterior uveitis, 78.18% in panuveitis, 92.85% in intermediate uveitis, and 50% in posterior uveitis. The most common associated systemic disease was Behçet disease.

Conclusion: In contrast to most epidemiologic studies of uveitis, the clinical and etiologic patterns of uveitis were different in a tertiary referral center in northeastern Iran. Panuveitis was the most common clinical pattern in this study, and the most common associated systemic disease was Behçet disease.
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http://dx.doi.org/10.4103/jovr.jovr_67_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905306PMC
May 2018

Vitreous changes after intravitreal bevacizumab monotherapy for retinopathy of prematurity: a case series.

Int J Retina Vitreous 2018 19;4:10. Epub 2018 Mar 19.

3Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: Reporting a special clinical finding after intravitreal bevacizumab monotherapy for retinopathy of prematurity.

Methods: In a retrospective case series, the clinical courses of five premature infants with similar vitreous changes after a single dose of intravitreal bevacizumab (IVB) injection without additional laser therapy were reported.

Results: The mean post-conceptional age at IVB injection was 39.8 ± 2.2 (range 37-43) weeks. Localized vitreous syneresis and linear fibrotic vitreous condensation occurred 8.2 ± 2.3 weeks after IVB monotherapy in our patients (15.5% of injections). The mean last post injection visit was 61.6 ± 5.3 weeks (post-conceptional age). Further regression and complete retinal vascularization occurred in all patients.

Conclusions: Thread-like vitreous condensation with localized vitreous liquefaction may be related to involutional ROP disease itself, combined to anti VEGF therapy and may be a predictor factor for further regression and retinal vascularization. The case series describes a successful response to anti-VEGF monotherapy with no further complications.
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http://dx.doi.org/10.1186/s40942-018-0113-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859723PMC
March 2018

Effects of Crocin on Diabetic Maculopathy: A Placebo-Controlled Randomized Clinical Trial.

Am J Ophthalmol 2018 06 14;190:89-98. Epub 2018 Mar 14.

Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.

Objective: Diabetic macular edema (DME) is one of the most important sight-threatening complications in patients with diabetes. Owing to neuroprotective properties, crocin, as the main constituent in saffron, is thought to be useful in the treatment and prevention of diabetic maculopathy. The aim of this trial was to evaluate the effects of crocin as a supplement on reducing inflammation in patients with diabetic maculopathy.

Design: Double-masked, placebo controlled, phase 2 randomized clinical trial.

Methods: Participants: In this study, 101 eyes of 60 patients with refractory diabetic maculopathy to conventional therapy including macular photocoagulation and intravitreal injection of anti-vascular endothelial growth factor agent (bevacizumab) with or without steroid (triamcinolone) were studied in 3 groups.

Intervention: Patients in the crocin groups received 5 mg or 15 mg crocin tablets per day for 3 months, whereas patients in the placebo group received 1 placebo tablet per day during the study. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured before, every month during, and 3 months after intervention. Biochemical blood tests were also evaluated before and after trial.

Main Outcome Measures: The BCVA and CMT were evaluated as the primary outcomes, whereas HbA1c and fasting blood sugar (FBS) were studied as the secondary outcomes in this trial.

Results: One hundred and one eyes were enrolled in this trial and were divided into 3 groups (crocin 5 mg, n = 34; crocin 15 mg, n = 33; and placebo, n = 34). According to our data, administration of crocin 15 mg tablet per day could significantly decrease HbA1c (P value = .024; 95% confidence interval [CI] 0.3-0.96), and CMT (P value = .005; 95% CI, 32.75-126.99) and improve BCVA (logMAR changes; P value = .012; 95% CI, 0.23-0.69) compared to the placebo group. Although administration of crocin 5 mg tablet per day could clinically improve HbA1c, FBS, CMT, and BCVA, the difference was not significant compared to the placebo group.

Conclusion: This study indicated the effect of crocin as a potent antioxidant and neuroprotective for treatment of refractory DME in the short term; however, the clinical significance is yet to be proved in a study with larger sample size and longer duration of follow-up and also in treatment-naïve patients.
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http://dx.doi.org/10.1016/j.ajo.2018.03.007DOI Listing
June 2018

Assessment of ocular toxoplasmosis patients reported at a tertiary center in the northeast of Iran.

Int Ophthalmol 2018 Dec 15;38(6):2527-2533. Epub 2018 Jan 15.

Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: Ocular toxoplasmosis, which is caused by the single-cell parasite Toxoplasma gondii, is currently the most significant cause of posterior uveitis in the world. No previous studies have described the prevalence and clinical features of ocular toxoplasmosis in the northeast of Iran. The purpose of the current study was to address this gap.

Methods: In this retrospective study, the medical records of 488 uveitis patients who presented to the Khatam-al-Anbia Eye Hospital of Mashhad University of Medical Sciences, a tertiary ophthalmology center in the northeast of Iran, between January 2013 and December 2015 were evaluated. The clinical features and risk factors of 99 (20%) consecutive patients with ocular toxoplasmosis were extracted.

Results: Ninety-nine including 53 (53.5%) female and 46 (46.5%) male patients with ocular toxoplasmosis were included in the analysis. Reduced vision (77%) and floaters (15.2%) were the most common presenting symptoms. The age category that was most affected by ocular toxoplasmosis was 20-40 years (range: 11-65 years) with a mean age of 27.2. All patients had retinochoroiditis, but just two had anterior uveitis. All of the extracted patients, with the exception of three patients, had unilateral involvement. None of the patients had any other medical disorders with the exception of one woman, who had diabetes. Only four recurring ocular toxoplasmosis patients were referred to the education hospital during the study. Serology data were available for just 32 patients, of which 31 (96.8%) were IgG positive, and 1 (3.2%) was IgM positive.

Conclusion: Toxoplasma gondii was responsible for 20% of the patients of uveitis that presented to the largest ophthalmology center in the northeast of Iran. There is a high incidence of patients of ocular toxoplasmosis in the northeast of Iran, and it is a significant cause of uveitis and visual impairment in this area.
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http://dx.doi.org/10.1007/s10792-017-0764-3DOI Listing
December 2018

Evaluating the Effectiveness of Using a Progressive Muscle Relaxation Technique on the Self-Efficacy of Breastfeeding in Mothers With Preterm Infants.

J Nurs Res 2017 Aug;25(4):283-288

1MSN, RN, Lecturer, Department of Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran 2MSN, RN, Lecturer, Department of Nursing, Isfahan University of Medical Sciences, Isfahan Iran 3MS, RN, Lecturer, Shiraz University of Medical Sciences, Shiraz, Iran 4BSN, RN, Department of Nursing, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran 5MSN, RN, Lecturer, Department of Nursing, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran 6PhD, RN, Assistant Professor, Department of Nursing, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran.

Background: Breast milk is a God-given gift that conveys a mother's love and compassion and that is made according to the needs and age of the child. Mothers who are interested in the welfare of their newborns tend to breastfeed their children. Training programs have been shown to improve breastfeeding self-efficacy in terms of both duration and amount.

Purpose: The aim of this study was to evaluate the effect of using the progressive muscle relaxation (PMR) technique on the self-efficacy of breastfeeding in mothers with preterm infants.

Methods: A clinical trial approach was used. Sixty mothers with preterm infants were randomly assigned to either the intervention or control group. The clinical trial ran for a period of 2 months for both groups. At 24-72 hours postpartum, the researcher used the Jacobson method to provide 30-45 minutes of individual training to the intervention group participants on PMR. Under the Jacobson method, mothers contract the 16 groups of muscles until they experience the feeling of pressure and then relax these muscles. The tools used in this study were the standard questionnaire of Dennis breastfeeding self-efficacy, which was completed by the participants at baseline, at the end of the fourth week, and during the eighth week. Data were analyzed using SPSS software.

Results: No significant difference was observed between the intervention and control groups in terms of demographic variables (p > .05). Independent t tests found no significant difference between the two groups (p = .45) in terms of mean score of maternal breastfeeding self-efficacy at pretest and significantly higher scores for the intervention group than the control group at both 4 (p = .001) and 8 (p < .001) weeks posttest. Furthermore, the analysis of variance test showed significant differences in the mean score of breastfeeding self-efficacy for the intervention group between pretest and the first posttest and between the first posttest and the second posttest, respectively (p < .001).

Conclusions/implications For Practice: Considering the effect of relaxation training on the breastfeeding self-efficacy of mothers with preterm infants, training and performing these exercises as an effective and low-cost method to improve the health of mothers, particularly mothers of preterm infants, are recommended. The PMR technique facilitates the self-efficacy of breastfeeding in mothers with preterm infants and should be considered as an effective strategy to improve nursing care and the provision of better support services for mothers who breastfeed their infants.
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http://dx.doi.org/10.1097/JNR.0000000000000217DOI Listing
August 2017

Endogenous Endophthalmitis after Severe Burn: A Case Report.

J Ophthalmic Vis Res 2017 Apr-Jun;12(2):228-231

Department of Community Medicine and Public Health, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: This report describes a rare ocular complication in a burned patient.

Case Report: A 12-year-old girl was admitted to our burn center because of full thickness burn of 46% of her total body surface area. On the 23 day of her stay, she complained of pain and decreased visual acuity in the right eye. Examination of this eye revealed panuveitis, dense vitritis, and a large chorioretinal abscess in the macular area; her best corrected visual acuity (BCVA) in this eye was hand motion. The left eye was completely normal. A smear and culture of the vitreous biopsy revealed the presence of . With a diagnosis of endogenous endophthalmitis due to fungal infection, the patient was treated with systemic fluconazole, intravitreal injection of Amphotericin B, and pars plana deep vitrectomy. After 6 months, the patient's final ocular examination revealed BCVA of counting fingers at two meters, a large macular scar, and quiescence of the intraocular infection.

Conclusion: Burn patients treated with broad-spectrum antibiotics are at risk of candidemia and its complications, including endogenous endophthalmitis. Early diagnosis of endogenous endophthalmitis in high risk patients could prevent visual loss.
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http://dx.doi.org/10.4103/jovr.jovr_144_15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423380PMC
May 2017

Bilateral cytomegalovirus retinitis in a healthy infant.

J Curr Ophthalmol 2017 Mar 23;29(1):66-68. Epub 2016 Dec 23.

Eye Research Center, Khatam-al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: To report a case of bilateral cytomegalovirus (CMV) retinitis in an otherwise healthy infant.

Methods: A four-month-old, healthy, male infant was evaluated for visual inattention.

Results: This full-term infant with a normal birth weight and an uneventful gestational period was referred with symptoms of visual inattention, fever, and agitation one week prior to admission. Ocular involvements were detected in the form of bilateral pan uveitis with diffuse bilateral retinitis and vasculitis with hemorrhage in the peripheral retina and posterior pole. CMV DNA was detected in the patient's ocular sample and cerebrospinal fluid by polymerase chain reaction (PCR). He was treated with intravitreal and systemic ganciclovir. Unfortunately, the infant died because of CMV encephalitis. Therefore, bilateral CMV retinitis (CMVR), which was probably transmitted from the mother, was diagnosed in this immunocompetent infant.

Conclusions: The present case highlights the possibility of CMVR in immunocompetent infant associated with systemic CMV infection, even during the postnatal period. Therefore, a high index of clinical suspicion and prompt treatment may be life-saving in similar cases.
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http://dx.doi.org/10.1016/j.joco.2016.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362388PMC
March 2017

The spectrum of Vogt-Koyanagi-Harada disease in Iran.

Int Ophthalmol 2018 Apr 4;38(2):443-449. Epub 2017 Mar 4.

Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti Medical University, Tehran, Iran.

Purpose: To report the spectrum of Vogt-Koyanagi-Harada (VKH) disease in Persians.

Materials And Methods: This is a retrospective chart review of patients diagnosed with VKH disease at four referral centers in Iran. Patients' demographics, ocular and extraocular manifestations, treatment modalities, complications, and visual outcomes were collected and analyzed.

Results: Eighty-eight patients with a mean age of 32.1 ± 12.6 years (range 7-79 years) were studied. Fifty-nine patients (67.0%) were female. Sunset glow fundus was seen in 40.9%, and nummular peripheral chorioretinal scars in 55.7% of eyes. Integumentary findings were noticed in 14.8% of the patients. In patients with acute presentation, exudative retinal detachment was the most common ocular finding (87.8%) followed by optic disk swelling (71.4%). Anterior uveitis and vitritis each were found in about half of the studied eyes. Auditory symptoms were reported by 38.8% of the patients. Overall, immunomodulatory agents were used in 72.7% of the patients. Ocular complications occurred in 36.4% of eyes (mean follow-up 3.8 years, range 6-228 months). Final visual acuity was 20/40 or better in 73.3% of eyes. Four patients (4.5%) were classified as having 'complete' type of the disease, 36 (40.9%) 'incomplete' type, and 48 (54.5%) 'probable' type.

Conclusion: In our series, there are clinical features that differ from those reported in other studies. While auditory symptoms occurred in more than one-third of patients, integumentary findings were rather rare. Most patients exhibited the 'probable' type of VKH disease. The overall visual prognosis was favorable.
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http://dx.doi.org/10.1007/s10792-017-0478-6DOI Listing
April 2018
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