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عضویت
فهرست مطالب نویسنده:

haleh ashraf

  • Houshang Bavandpour Karvane, Haleh Ashraf, Maryam Aghakouchakzadeh, Hossein Navid, Ali Bozorgi
    Background

    Acute heart failure is a common clinical syndrome leading to hospital admission, with few evidence-based therapies for managing congestion. This trial aims to assess the efficacy of acetazolamide combined with loop diuretics in achieving decongestion among patients who fail to respond to oral diuretics and progress to acute decompensated heart failure in the absence of injectable furosemide.

    Methods

    This single-center, double-blind randomized controlled trial with a 1:1 allocation ratio aims to evaluate 130 patients admitted to the infusion ward. Participants will receive standard furosemide treatment and be randomized to either oral acetazolamide (250 mg twice daily) or placebo for 3 consecutive days. The primary objective is to assess the efficacy of combined oral acetazolamide and furosemide therapy in achieving decongestion. The prespecified secondary outcomes include the following: N-terminal pro-B-type natriuretic peptide levels on day 30, readmission rates within 3 months, health-related quality of life as assessed by the Heart Failure Quality of Life Questionnaire at 3 months, and changes in weight, creatinine levels, urinary sodium excretion, potassium levels, and hematological indices from the complete blood count on day 3 of the trial.

    Conclusion

    Diuretic resistance commonly occurs in patients with heart failure, underscoring the urgent need for innovative interventions that can effectively address the limitations of current diuretics, including diuretic resistance and electrolyte imbalances, while enhancing their efficacy in this patient population.

    Keywords: Acetazolamide, Heart Failure, Diuretics, Chloride, Decongestion
  • Danesh Soltani, Azar Hadadi, Shahrokh Karbalai Saleh, Alireza Oraii, Azadeh Sadatnaseri, Mostafa Roozitalab, Zahra Shajari, Shima sadat Ghaemmaghami, Haleh Ashraf *
    Background

     The present study aimed to investigate the association between acute cardiac injury (ACI) and outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19) in Iran.

    Methods

     The current cohort study enrolled all consecutive hospitalized patients with COVID-19 (≥ 18 y) who had serum high-sensitivity cardiac troponin-I (hs-cTnT) measurements on admission between March 2020 and March 2021. ACI was determined as hs-cTnT levels exceeding the 99th percentile of normal values. Data on demographics, comorbidities, clinical and laboratory characteristics, and outcomes were collected from Web-based electronic health records.

    Results

     The study population consisted of 1413 hospitalized patients with COVID-19, of whom 319 patients (22.58%) presented with ACI. The patients with ACI had a significantly higher mortality rate than those without ACI (48.28% vs 15.63%; P<0.001) within a mean follow-up of 218.86 days from symptom onset. ACI on admission was independently associated with mortality (HR, 1.44; P=0.018). In multivariable logistic regression, age (OR, 1.034; P<0.001), preexisting cardiac disease (OR, 1.49; P=0.035), preexisting malignancy (OR, 2.01; P=0.030), oxygen saturation reduced to less than 90% (OR, 2.15; P<0.001), leukocytosis (OR, 1.45; P=0.043), lymphopenia (OR, 1.49; P=0.020), reduced estimated glomerular filtration rates (eGFRs) (OR, 0.99; P=0.008), and treatment with intravenous immunoglobulin during hospitalization (OR, 4.03; P=0.006) were independently associated with ACI development.

    Conclusion

     ACI occurrence on admission was associated with long-term mortality in our hospitalized patients with COVID-19. The finding further underscores the significance of evaluating ACI occurrence on admission, particularly in individuals more prone to ACI, including older individuals and those with preexisting comorbidities, reduced oxygen saturation, and increased inflammatory responses.

    Keywords: COVID-19, SARS-CoV-2, Troponin, Mortality
  • Reza Saei, Nasim Naderi *, Haleh Ashraf, Baran Hashemi, MohammadMehdi Peighambari
    Background

    Malnutrition is a common condition related to poor prognosis in patients with heart failure (HF). The present study aimed to investigate the impacts of nutritional indices on short-term clinical outcomes and elucidate risk factors associated with the need for nutritional supplementation in patients with acute decompensated heart failure (ADHF).

    Methods

    To evaluate the nutrition index at the beginning of hospitalization, we completed the Mini Nutritional Assessment (MNA) questionnaire and calculated the Nutritional Risk Index (NRI) and the Controlling Nutritional Status (CONUT) score in patients with ADHF.

    Results

    Over 40% of hospitalized patients with ADHF had moderate-to-severe nutritional disturbances determined by the NRI, the MNA, and the CONUT score. During a 1-month follow-up, hospitalization was reported in 8 patients, of whom 3 died.  Twenty-five of 58 patients (43%) were categorized as needing nutritional support. Lower body mass indices and total albumin levels were independent predictors of the need for nutritional support (OR, 0.35; 95% CI, 0.13 to 0.97; P=0.044 and OR, 0.36; 95% CI, 0.15 to 0.88; P=0250, respectively).

    Conclusions

    Over 40% of hospitalized patients with ADHF had moderate-to-severe nutritional disturbances and needed nutritional support. The assessment of nutritional status may provide additional prognostic information and, thus, could be useful in the risk stratification of patients with ADHF.

    Keywords: Malnutrition, Heart failure, Prognosis
  • Abbas Soleimani, Sepehr Nayebi, Haleh Ashraf, Azadeh Sadat Naseri, Alireza Oraii, Sina Kazemian, Roya Tayeb, Fazeleh Majidi, Mommadreza Fatahi, Saeed Nateghi, Shahrokh Karbalai Saleh *
    INTRODUCTION
    This study aimed to investigate the clinical and angiographic characteristics of patients with ST-elevation myocardial infarction who experienced primary percutaneous coronary intervention failure.
    METHOD
    This retrospective observational study was derived from the Primary Angioplasty Registry of Sina Hospital (PARS). A total of 548 consecutive patients with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention between November 2016 and January 2019 were evaluated. Percutaneous coronary intervention failure was defined as Thrombolysis in Myocardial Infarction (TIMI) flow ≤ 2 or corrected TIMI frame count (cTFC) ≥ 28.
    RESULTS
    The study population consisted of 458 (83.6%) males and 90 (16.4%) females with a mean age of 59.2 ± 12.49 years. TIMI flow 3 was achieved in 499 (91.1%) patients after the procedure, while 49 (8.9%) patients developed TIMI ≤ 2. The findings showed that cTFC ≥ 28 was present in 50 (9.1%) patients, while 489 (89.2%) patients had cTFC < 28. Multiple regression analysis shows that age 1.04 (1.01, 1.07), duration of pain onset to first medical contact time 1.04 (1.00, 1.18), and left anterior descending artery involvement 3.15 (1.21, 8.11) were independent predictors of TIMI ≤ 2.
    CONCLUSION
    Even though TIMI ≤ 2 was uncommon among the study population, it was associated with adverse in-hospital outcomes. The results indicate that earlier emergency medical service arrival and shorter transfer time to the referral center can dramatically reduce the primary percutaneous coronary intervention failure rate.
    Keywords: primary percutaneous coronary intervention, ST-elevation myocardial infarction, Thrombolysis in Myocardial Infarction
  • Azar Hadadi, Sina Kazemian, Mahan Shafie, Arezoo Ahmadi, Abbas Soleimani, Haleh Ashraf*
    Introduction

     Since the coronavirus disease 2019 (COVID-19) pandemic, the use of angiotensin II receptor blockers (ARBs) in hypertensive patients with COVID-19 has been controversial. Following our previous study, after one year, we intended to extend our sample size and results to investigate the effects of ARBs with both in-hospital outcomes and 7-month follow-up results in patients with COVID-19.

    Methods

     Patients with a diagnosis of COVID-19 who were admitted to Sina Hospital, Tehran, Iran, from February to October 2020 participated in this follow-up cohort study. The COVID-19 diagnosis was based on a positive polymerase chain reaction test or chest computed tomography scan according to guidelines. Patients were followed for disease severity, incurring in-hospital mortality, complications, and 7-month all-cause mortality.

    Results

     We evaluated 1413 patients with COVID-19 in this study. After excluding 124 patients, 1289 including 561(43.5%) hypertensive patients, entered the analysis. During the study, 875(67.9%) severe disease, 227(17.6%) in-hospital mortality, and 307(23.8%) 7-month all-cause mortality were observed. After adjusting for possible confounders, ARB was not associated with severity, in-hospital and 7-month all-cause mortality, and in-hospital complications except for acute kidney injury. Discontinuation of ARBs was significantly associated with higher in-hospital mortality and 7-month all-cause mortality (both P values<0.006). We observed a better 7-month outcome in those who continued their ARBs after discharge.

    Conclusion

     The results of this study, along with the previous studies, provide reassurance that taking ARBs is not associated with the risk of mortality, complications, and poorer outcomes in hypertensive COVID-19 patients after adjustment for possible confounders.

    Keywords: Angiotensin-Converting Enzyme Inhibitors, COVID-19, Hypertension, Renin-Angiotensin System, SARS-CoV-2
  • Amirali Karimi, Parham Ghafouri, Sanam Alilou, Nima Rezaei, Shaghayegh Ashraf Talesh, Haleh Ashraf*
    Context

    Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 can involve multiple organs, especially the heart, in some children with prior COVID-19 infection. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) guidelines provide valuable case definitions for MIS-C, as utilized in this study. We aimed to identify and summarize the echocardiographic findings of MIS-C based on these case definitions.

    Evidence Acquisition

    We performed a systematic search in PubMed, Embase, Scopus, and Cochrane databases. An additional source was also utilized to extend the identified records. The articles underwent a two-step screening process. Then, eligible articles were included in the qualitative synthesis.

    Results

    We identified 33 eligible studies, recruiting 1,392 patients with MIS-C. Male patients were the majority, with 791 (56.8%) cases. The mean age of the patients was 8.3 ± 5.9 years, while 28.5% of the children were identified with underlying conditions. The most common echocardiographic findings were left ventricular systolic dysfunction (34.91%), valvular regurgitation (29.08%), pericardial involvement (22.58%), and coronary abnormalities (18.0%).

    Conclusions

    MIS-C is a rare complication of COVID-19 in children. Early cardiologic investigations, especially echocardiography, can reveal manifestations, including myocardial dysfunction, coronary abnormalities, valvular pathologies, and pericardial involvement

    Keywords: Cardiology, COVID-19, Echocardiography, MIS-C, Multisystem Inflammatory Syndrome, Pediatrics, SARS-CoV-2
  • Mahnaz Montazeri, Mohammad Keykhaei, Sina Rashedi, Shahrokh Karbalai Saleh, Marzieh Pazoki, Azar Hadadi, Seyyed Hamidreza Sharifnia, Mehran Sotoodehnia, Sanaz Ajloo, Samira Kafan*, Haleh Ashraf*
    Introduction

    Owing to the imposed burden of the coronavirus disease 2019 (COVID-19),the need for stratifying the prognosis of patients has never been timelier. Hence, we aimed to ascertain the value of CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-M (one point for male instead of female) scores to predict unfavorable outcomes in COVID-19 patients.

    Methods

    We enrolled consecutive patients above 18 years of age with confirmed COVID-19,who were admitted between February 16 and November 1, 2020. The primary endpoint of this study was three-month all-cause mortality. The secondary endpoints were considered four major in-hospital clinical features, including acute respiratory distress syndrome, cardiac injury,acute kidney injury, and mechanical ventilation.

    Results

    A total of 1,406 hospitalized COVID-19 patients were studied, among which 301(21.40%) patients died during the follow-up period. Regarding the risk scores, CHADS 2≥1,CHA2DS2-VASc≥2, and CHA2DS2-VASc-M≥2 were significantly associated with mortality. The performance of all risk scores for predicting mortality was satisfactory (area under the curve:0.668, 0.668, and 0.681, respectively). Appraising secondary endpoints, we found that all three risk scores were associated with increased risk of acute respiratory distress syndrome, cardiac injury, acute kidney injury, and mechanical ventilation. Lastly, we revealed that all risk scores were significantly correlated with serum levels of laboratory biomarkers.

    Conclusion

    Our analysis illustrated that the CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-Mscores could aid prognostication of unfavorable outcomes in COVID-19 patients. Therefore,these easily calculable methods could be integrated into the overall therapeutic strategy to guide the COVID-19 management more accurately.

    Keywords: Acute Kidney Injury, Acute Respiratory Distress Syndrome, Cardiac Injury, COVID-19, Mortality
  • Marzieh Pazoki, Pooya Payandemehr, Mahnaz Montazeri, Samira Kafan, Mehrdad Sheikhvatan, Mehran Sotoodehnia, Ahmad Salimzadeh, Mehdi Ebrahimi, Atabak Najafi, Reza Shariat Moharari, MohammadReza Khajavi, Mohammad Talebpour, Haleh Ashraf, Seyed MohammadKazem Aghamir, Shahrokh Karbalai Saleh, Ali Shakouri Rad, Hedieh Moradi Tabriz, Farhad Najmeddin, Pantea Arya, Niloufar Peirovi, Sina Kazemian, Mehdi Kashani, Sorya Babaei, Azar Hadadi *
    Background

     Since the outbreak of coronavirus 2019 (COVID-19), identifying risk factors associated with in-hospital mortality has been a global priority. In this study, the purpose was to evaluate the clinical, laboratory, and radiological characteristics of hospitalized patients with COVID-19 to develop a predictive model and scoring system for in-hospital mortality.

    Methods

    In this retrospective cohort study, 611 adult patients with COVID-19, admitted to Sina hospital were enrolled and followed up.

    Results

    Out of the total number of 611 patients, 104 patients (17%) deceased during hospitalization, including 75 (12.2%) deaths in ICU and 29 (4.7%) deaths in the wards. After multivariate logistic regression analysis, several characteristics including age >55 years, previous history of malignancy, history of cerebrovascular accident, tachypnea on admission, CRP>54 on admission, D-dimer>1300, and bilateral pulmonary consolidation on chest Computed Tomography (CT) were shown to be the main determinants for stratifying the risk for in-hospital death. The factors were finally considered for introducing a new predictive scoring system for COVID-19 related death. 

    Conclusion

    In-hospital mortality rate in patients with COVID-19 is estimated to be 17%. A new scoring system for predicting in-hospital mortality in such patients was structured based on determinant factors of advanced age, history of malignancy, cerebrovascular accident, tachypnea, raised CRP, raised D-dimer on admission, and bilateral pulmonary consolidation on chest CT scan.

    Keywords: COVID-19, mortality, risk factors, SARS-CoV-2
  • Atie Moghtadaie, Seyed Amir Miratashi Yazdi, Haleh Ashraf, Abbas Soleimani *

    Coexisting myocardial infarction (MI) and diabetic ketoacidosis (DKA) are the most common causes of death in diabetic patients. We report a patient with ischemic heart disease manifestations who was finally diagnosed to have DKA as a predisposing factor. The case we present in this paper is a 57-year-old man who was found unconscious in a hotel and presented with complaints of vomiting, abdominal pain, and diarrhea. He had severe dyspnea and chest pain radiating to his back. He had ST-segment elevation in anterior leads on electrocardiogram (ECG), with non-obstructive coronary artery disease in the subsequent heart catheterization. MI patients should be treated with primary percutaneous coronary intervention (PCI) or fibrinolytic agents, but pseudoinfarction due to DKA responds to medical treatment. Thus, it is also important to know that coexistence of both DKA and MI is possible, and neglecting such situations can lead to lethal consequences.

    Keywords: Diabetic Ketoacidosis, Myocardial Infarction, Pseudoinfarction, Signs, Symptoms, Systolic HeartFailure
  • Reza Hajebi, Ali Ajam, Shahrokh Karbalai, Haleh Ashraf, MohammadReza Ostadali Dehaghi, Hedieh Moradi Tabriz, Marzieh Pazoki, Fatemeh Khalili

    In the last days of 2019, a new coronavirus emerged in Wuhan, China, and less than three months its disease, now called COVID-19, was announced a global pandemic by WHO. COVID-19 usually causes respiratory symptoms and can lead to more severe conditions like ARDS. HLA has a crucial role in regulating the immune system; thus, different HLA allele types can be a protective or risk factor for some diseases, so we aimed to find such associations to determine whether some alleles can predict susceptibility or resistibility to COVID-19 and finally facilitate vaccine development. In this case-control study, 15 admitted COVID-19 cases with severe symptoms and ten individuals with mild COVID-19 symptoms were enrolled in the case and control groups, respectively. They were genotyped for HLA A/B/DR loci using a low-resolution HLA typing test. These alleles were more prevalent in case (severe COVID-19) group: A*24 (53.33% vs 10%), B*50 (20% vs 10%), B*55 (20% vs 10%), DRB1*04 (40% vs 20%) and DRB1*11 (53.33% vs 30%) but the difference was only statically significant in A*24 allele (P=0.027; odd ratio=10.286). A*24 was also more prevalent in all patients than the general population in Iran. A*24 was the only allele more prevalent in severe COVID-19 cases with statistical significance. This allele was reported to be a risk factor for such autoimmune diseases as type 1 diabetes, myasthenia gravis, and systemic lupus erythematosus, which may be related to reported immune system hyperresponsiveness in severe COVID-19 cases.

    Keywords: Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), Human leukocyte antigen (HLA)
  • Fatemeh Rasooli, Farideh Bagheri, Azadeh Sadatnaseri, Haleh Ashraf, Maryam Bahrein*
    Introduction

    Early detection of regional wall motion abnormality (RWMA) can be a reliable tool for rapid dis-position of patients with acute coronary syndrome (ACS) in the emergency department. In this study, the di-agnostic accuracy of point-of-care echocardiography performed by a trained emergency medicine resident wasevaluated in comparison with board-certified cardiologists.

    Methods

    A prospective, cross-sectional study wasimplemented on adult patients with ACS. A trained emergency medicine (EM) PGY-3 resident performed point-of-care echocardiography under the supervision of two cardiologists and the reports were compared with car-diologists as a reference test.

    Results

    100 patients with the mean age of 54.1 ± 11.5 years were recruited (65%male). Based on Thrombolysis in Myocardial Infarction (TIMI) and History, EKG, Age, Risk factors, and troponin(HEART) scores, 43.0% and 25.0% of patients were categorized as low-risk for ACS, respectively. The absolutemeasure of agreement between cardiologists to determine ejection fraction (EF) was 0.829 (95% CI: 0.74-0.89)based on intraclass correlation coefficient (ICC) estimation. The measurements of agreement between special-ists and the EM resident based on the analysis of Kappa coefficient were 0.677 and 0.884 for RWMA and peri-cardial effusion, respectively. Moreover, 25 patients were in the-low risk group according to the HEART scorewith an agreement rate of 92% for the lack of RWMA between the EM resident and cardiologists.

    Conclusion

    This study found acceptable agreement between the EM resident and cardiologists in assessing RWMA in differ-ent ACS risk groups. In addition, there was acceptable agreement between the EM resident and cardiologists indetermining left ventricular ejection fraction (LVEF) and pericardial effusion.

    Keywords: Emergency medicine, Cardiologists, Patient Discharge, Ultrasonography, Point-of-Care Systems
  • Haleh Ashraf, Azadeh Sadatnaseri, Arya Aminorroaya, Zahra Kuhi, Nadia Zandi, Shahrokh Karbalai Saleh*
    Introduction

    Pseudoaneurysm may occur as a rare complication of myocardial infarction (MI) when a hemorrhagic process is covered by adherence of the visceral or parietal pericardium or of both, preventing the formation of cardiac tamponade. Pseudoaneurysm is prone to rupture because they are not easy to diagnose. 

    Case presentation

    Here, we report three cases of left ventricular pseudo-aneurysm (LVP) that all were related to MI. Two patients were managed conservatively, one of them was lost to follow-up, and the other one expired one month later. One patient underwent surgery, but he expired during post-operation period. 

    Conclusions

    High mortality rate of LVP emphasizes the importance of looking for it in cardiac evaluation of patients with history of MI. Due to available non-invasive modalities, the ability to differentiate LVP from other cardiac pathologies is improving. Still, the most recommended management of LVP is early surgery.

    Keywords: Case Reports, FalseAneurysm, Myocardial Infarction, Post-Infarction Heart Rupture
  • Shahrokh Karbalai Saleh, Alireza Oraii, Abbas Soleimani, Ehsan Saraee, Haleh AshraF*

    Cardiovascular diseases, especially ST-elevation myocardial infarction (STEMI), are among the major health concerns in Iran. Although primary percutaneous coronary intervention (pPCI) is performed as the treatment of choice in Iranian hospitals, there is limited data on its efficacy, safety, procedural variations, and clinical outcomes after implementation of the new Protocol-247, which transfers patients with STEMI directly to pPCI-capable hospitals. The Primary Angioplasty Registry of Sina (PARS) is an ongoing prospective hospital-based registry enrolling patient with STEMI undergoing pPCI in Sina Hospital, which is a high-volume referral PCI-capable general hospital in Tehran, Iran. This registry aims to gather high-quality data on patient characteristics, hospital-based quality of care, coronary interventions, and in-hospital as well as long-term clinical outcomes of patients undergoing pPCI due to STEMI. In addition, the findings will be used to identify independent predictors of mortality and adverse events and form the basis of future clinical trials and quality improvement strategies.

    Keywords: Myocardial Infarction, Percutaneous Coronary Intervention, Registries, ST ElevationMyocardial Infarction
  • Mohammad Talebpour, Azar Hadadi, Alireza Oraii, Haleh Ashraf*

    Coronavirus disease 2019 (Covid-19) is caused by the novel coronavirus resulting in a highly contagious respiratory tract infection with an increased risk of acute respiratory distress syndrome (ARDS), which was first seen in Wuhan, China. Thus far, this virus has spread to many countries worldwide, including Iran. Multiple studies have assessed disease characteristics, viral genetics, and complications of Covid-19 in the Chinese population. However, there is limited data regarding patient characteristics and outcomes of infected cases outside of China. Besides, risk factors of adverse outcomes are poorly identified in different populations. Due to limited data in the Iranian population affected by the virus, we aimed to design a registry of patients with Covid-19 at Sina Hospital in Tehran, Iran [Sina Hospital Covid-19 Registry (SHCo-19R)] in this regard, to assess patient characteristics, imaging features, laboratory findings, management strategies, and adverse outcomes of Iranian patients with Covid-19 and their differences with other populations.

    Keywords: Covid-19, Iran, Registries, Severe Acute Respiratory Syndrome Coronavirus 2
  • Raika Jamali, Saeed Pourhassan*, Nastaran Maghbooli, Haleh Ashraf, Amir Ali Sohrabpoor
    Background

    Non-alcoholic steatohepatitis (NASH) is increasing worldwide due to the metabolic syndrome epidemy. According to the current evidence, a higher cardiovascular disease risk (CVDR) is observed in NASH individuals than the general population.

    Objective

    The relationship between liver fat content (LFC) and CVDR in a cohort of NASH patients was evaluated in this research.

    Methods

    Consecutively selected patients with increased aminotransferase levels and fatty change in liver ultrasonography were enrolled in the study. Those with known causes of viral hepatitis, any hepatotoxic medications or alcohol consumption, autoimmune hepatitis, cigarette smoking, and ischemic heart disease were excluded from the project. The remaining was presumed to have NASH. The Framingham risk score (FRS) and LFC were calculated by means of an online calculator and a valid formula, respectively. The correlation between LFC and independent variables was measured using the Pearson correlation test. The P-value of less than 0.05 was considered significant. The statistical analysis was performed using SPSS program version 18.

    Results

    Finally, two hundred NASH patients were included in the study. Considering diabetes mellitus as a confounder, there was a fair relationship between LFC and FRS (R=0.26 and 0.23, respectively, p<0.05) in the second and third visits. Even after adjustment for known cardiovascular risk factors, LFC was associated with increased CVDR (OR=9.181; 95% CI: 2.00-42.14, p=0.01). The cut-off value of 9.1% for LFC had a sensitivity of 92% and a specificity of 87% for discrimination of the FRS >20% and <20%.

    Conclusion

    LFC might independently be correlated with CVDR in NASH patients. If further research confirmed this relationship, the inclusion of LFC into the FRS formula would provide an appropriate CVDR estimation tool in NASH.

    Keywords: Non-alcoholic fatty liver disease, Cardiovascular disease, Fatty liver, Coronary artery disease
  • Reza Safaeian, Valiollah Hassani *, Masood Mohseni, Aslan Ahmadi, Haleh Ashraf, Gholamreza Movaseghi, Mahzad Alimian, Elham Mohebi, Zahra Sadat Koleini, Shayesteh Pourkand
    Background

    Children with sensorineural hearing loss are at risk of cardiac electrophysiologic abnormalities. Inhalational Sevoflurane induction in these children can cause QT prolongation.

    Objectives

    In order to evaluate the safety of inhalational induction of anesthesia with sevoflurane in children with sensorineural hearing loss, who are candidates for cochlear implant, its electrophysiologic effects was compared with intravenous induction of anesthesia with propofol.

    Methods

    In this double-blind randomized clinical trial, 61 children aged between one and eighteen years old, who were candidates for cochlear implantation, were randomly allocated to groups receiving anesthesia with sevoflurane (n = 32) or propofol (n = 29) for induction of anesthesia. Two 12-leads ECG were taken from all of patients before and after induction and QTc, Tp-e interval, and JTc were measured and compared.

    Results

    Two cases, who had pre-induction QTc longer than 500 ms were excluded from the study. Patients had similar age (102.58  87 versus 101.46  67 months, P = 0.95) and gender (males: 48.3% versus 56.3%, P = 0.53) distribution. The researchers observed significant post induction difference in QTc values between these groups (propofol 422.5  40, sevoflurane 445.0  29, P = 0.016). There was no significant difference in the percent QTc and Tp-e changes in propofol and sevoflurane groups. Greater percentage of patients with increased Tp-e interval (> 100 ms) in the sevoflurane group than the propofol group was also seen. There was no significant long QTc difference (QTc > 500msor more than 60msincrease from baseline) after induction of anesthesia in the sevoflurane group compared to the propofol group (15.6% versus 13.8%, P = 0.84).

    Conclusions

    After electrophysiological evaluations in children with sensorineural hearing loss, in patients whose pre-induction QTc is not longer than 500 ms, propofol seems safer than inhalational sevoflurane for induction of anesthesia.

    Keywords: Sevoflurane, Propofol, Cochlear Implantation, Long QT
  • Ali Vasheghani-Farahani, Fatemeh Kazemnejad, Khosro Sadeghniiat-Haghighi, Soleil Saadat, Parya Tavakoli Poor, Tahereh Yazdani, Mohammad Alidoosti, Vahid Ghasem Amooeian, Haleh Ashraf
    Background
    It has been implicated that obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular disease including stroke, myocardial infarction, coronary artery disease (CAD) and hypertension. The aim of this study was to investigate the correlation between OSA and severity of atherosclerosis assessed by angiography.
    Methods
    This study included 337 patients undergoing diagnostic coronary angiography at Tehran Heart Center, Iran. The Gensini score was obtained from each patient for coronary angiogram, and OSA were assessed by using Multivariable apnea prediction (MAP) risk index on the day of cardiac catheterization. The Gensini scores increased in accordance with increases in the MAP value.
    Results
    The prevalence rates of three-vessel disease were 68.0% in OSA group and 32.0% in non-OSA group. The MAP index was the most significant independent determinant for the Gensini score.
    Conclusions
    The independent association between OSA and CAD, even after adjustment for traditional confounders, suggests that, OSA should be taken into account when considering risk factors for CAD.
    Keywords: Atherosclerosis, coronary angiography, coronary artery disease, Gensini score, Obstructive sleep apnea
  • Behnam Sobouti, Samileh Noorbakhsh, Haleh Ashraf, Shaghayegh Ashraf -Talesh *
    Background And Objective
    Despite consistent evidence that probiotics reduce the duration of diarrhea, there is only weak evidence for their efficacy in reducing the duration of hospitalization. Another source of heteroge-neity for probiotic trials is the type of probiotic being assessed; also, information about combined products is scarce.
    Methods
    This is a randomized, single-blind controlled clinical trial performed in children hospitalized with acute rotavirus diarrhea carried out at a university hospital in Tehran, Iran. Children were randomly assigned to receive rehydration therapy or the same plus a multi-strain probiotic preparation. The primary outcome was the duration of hospitalization.
    Findings: A total of 60 patients with acute diarrhea secondary to rotavirus infection were included; baseline characteristics were similar in both groups. A statistically significant difference in the duration of hospitalization was observed (p
    Conclusion
    Results of this study support the use of multi-strain preparation probiotics in treating rotavirus acute diarrhea.
    Keywords: Probiotics, Rotavirus, Diarrhea, Children
  • Akram Sardari, Haleh Ashraf, Mani Khorsand, Arezou Zoroufian, Mohammad Sahebjam, Arash Jalali, Hakimeh Sadeghian
    Background
    Several competing geometric and hemodynamic factors are suggested as contributing mechanisms for functional mitral regurgitation (MR) in heart failure patients. We aimed to study the relationships between the severity of MR and the QRS duration and dyssynchrony markers in patients with ischemic or dilated cardiomyopathy.
    Methods
    We prospectively evaluated 251 heart failure patients with indications for echocardiographic evaluation of possible cardiac resynchronization therapy. All the patients were subjected to transthoracic echocardiography and tissue Doppler imaging to evaluate the left ventricular (LV) synchronicity. The patients were divided into two groups according to the severity of MR: ≤ mild MR and ≥ moderate MR. The effects of different dyssynchrony indices were adjusted for global and regional left ventricular remodeling parameters.
    Results
    From the 251 patients (74.5% male, mean age = 53.38 ± 16.68 years), 130 had ≤ mild MR and 121 had ≥ moderate MR. There were no differences between the groups regarding the mean age, frequency of sex, and etiology of cardiomyopathy. The LV systolic and diastolic dimensions were greater in the patients with ≥ moderate MR (all p values < 0.001). Among the different echocardiographic factors, the QRS duration (150.75 ± 34.66 vs. 126.77 ± 29.044 ms; p value = 0.050) and interventricular mechanical delay (41.60 ± 29.50 vs. 35.00 ms ± 22.01; p value = 0.045) were significantly longer in the patients with ≤ mild MR in the univariate analysis. After adjusting the effect of these parameters on the severity of MR for the regional and global LV remodeling parameters, no significant impact of the QRS duration and dyssynchrony indices was observed.
    Conclusion
    Our results showed that the degree of functional MR was not associated with the QRS duration and inter- and intraventricular dyssynchrony in our patients with cardiomyopathy. No association was found between the severity of MR and the ischemic or dilated etiology for cardiomyopathy.
  • Ali Vasheghani-Farahani, Maryam Tahmasbi, Hossein Asheri, Haleh Ashraf, Saharnaz Nedjat, Ramin Kordi
    Purpose
    To translate long form, interview-administered International Physical Activity Questionnaire (IPAQ) from English to Persian and evaluate its validity, reliability and reproducibility.
    Methods
    A forward-backward translation procedure was followed to develop the Persian version of the IPAQ. A total of 218 respondents (53.7% women, aged 22-76 yr) completed the Persian version in Tehran, Iran. To examine the test-retest reliability, 48 healthy volunteers completed the IPAQ twice during a 7-day period.. The PA indicators derived from the IPAQ were assessed for reliability and were compared with aerobic fitness and body mass index (BMI) for construct validity.
    Results
    In general, the questionnaire was received well and all domains met the minimum reliability standards (intra-class correlation [ICC]> 0.7), except for Leisure-time physical activity (PA). Aerobic fitness showed a weak positive correlation with all of the PA results derived from the IPAQ. A significant correlation was observed between the IPAQ data for total PA and both aerobic fitness (r=0.33, P<0.001) and BMI (r=0.26, P<0.001). Performing a known group comparison analysis, the results indicated that the questionnaire was discriminated well between the subgroups of the study samples expected to be different in their physical activity.
    Conclusions
    The Persian version of the long form, interview-administered IPAQ had an acceptable reliability and validity for assessing total PA in our Iranian sample of individuals. It may be a useful instrument for generating internationally comparable data on PA.
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