BACKGROUND:Understanding any factors which influence the morbidity and mortality in patients with obstructive jaundice in each society will better guide appropriate management and lead to improved survival This study ...BACKGROUND:Understanding any factors which influence the morbidity and mortality in patients with obstructive jaundice in each society will better guide appropriate management and lead to improved survival This study aimed to assess baseline etiologies,clinical manifestations,diagnostic results,and morbidity and mortality related to obstructive jaundice in Iranian patients. METHODS:The hospital recorded files of 133 patients with the final diagnosis of obstructive jaundice who had been admitted to the Taleqhani Hospital in Tehran between January 2001 and September 2004 were reviewed. RESULTS:The most common etiologies of obstructive jaundices were neoplasia and then common bile duct stone in the two genders.The results of ultrasonography were positive in less than half of the patients.However,the most positive results were related to endoscopic retrograde cholangiopancreatography(ERCP).The in-hospital mortality rate in patients less than 50 years old and elderly patients was 0%and 6.76%,respectively.The in-hospital morbidity rate was 2.25%and 7.51%,respectively in both patients and it was commonly related to infection of ulcer (44.46%),pneumonia(14.75%),myocardial infarction (14.75%),and subdiaphragmatic abscess(11.29%).In patients with a diagnosis of benign obstruction,only one patient died of severe sepsis.In malignant group preoperative characteristics,such as weight loss(P=0.015) and serum bilirubin concentration more than 16 mg/dl and postoperative complications,such as sepsis(P<0.001) cardiac arrest(P<0.001),and hepatic coma(P<0.001)were main predictors for the in-hospital mortality rate.CONCLUSION:Although the mortality and morbidity of obstructive jaundice in our study are less than those in other studies,the determination of preoperative clinical and laboratory indices and postoperative complications of patients is needed for the control of mortality and morbidity rate.展开更多
AIM To study survival in isolated coronary artery bypass graft(CABG) patients and to evaluate the impact of preoperative chronic opium consumption on long-term outcome.METHODS Cohort of 566 isolated CABG patients as T...AIM To study survival in isolated coronary artery bypass graft(CABG) patients and to evaluate the impact of preoperative chronic opium consumption on long-term outcome.METHODS Cohort of 566 isolated CABG patients as Tehran Heart Center cardiac output measurement was conducted. Daily evaluation until discharge as well as 4- and 12-mo and 6.5-year follow-up information for survival status were fulfilled for all patients. Long-term 6.5-year overall and opium-stratified survival, adjusted survival curves based on opium consumption as well as possible predictors of all-cause mortality using multiple cox regression were determined by statistical analysis.RESULTS Six point five-year overall survival was 91.8%; 86.6% in opium consumers and 92.7% in non-opium consumers(P=0.035). Patients with positive history of opium consumption significantly tended to have lower ejection fraction(EF), higher creatinine level and higher prevalence of myocardial infarction. Multiple predictors of all-cause mortality included age, body mass index, EF, diabetes mellitus and cerebrovascular accident. The hazard ratio(HR) of 2.09 for the risk of mortality in opium addicted patients with a borderline P value(P=0.052) was calculated in this model. Further adjustment with stratification based on smoking and opium addiction reduced the HR to 1.20(P=0.355).CONCLUSION Simultaneous impact of smoking as a confounding variable in most of the patients prevents from definitive judgment on the role of opium as an independent contributing factor in worse long-term survival of CABG patients in addition to advanced age, low EF, diabetes mellitus and cerebrovascular accident. Meanwhile, our findings do not confirm any cardio protective role for opium to improve outcome in coronary patients with the history of smoking. Further studies are needed to clarify pure effect of opium and warrant the aforementioned findings.展开更多
Although red blood cells(RBCs) transfusion is sometimes associated with adverse reactions,anemia could also lead to increased morbidity and mortality in highrisk patients. For these reasons,the definition of periopera...Although red blood cells(RBCs) transfusion is sometimes associated with adverse reactions,anemia could also lead to increased morbidity and mortality in highrisk patients. For these reasons,the definition of perioperative strategies that aims to detect and treat preoperative anemia,prevent excessive blood loss,and define "optimal" transfusion algorithms is crucial. Although the treatment with preoperative iron and erythropoietin has been recommended in some specific conditions,several controversies exist regarding the benefit-to-risk balance associated with these treatments. Further studies are needed to better define the indications,dosage,and route of administration for preoperative iron with or without erythropoietin supplementation. Although restrictive transfusion strategies in patients undergoing cardiac surgery have been shown to effectively reduce the incidence and the amount of RBCs transfusion without increase in side effects,some high-risk patients(e.g.,symptomatic acute coronary syndrome) could benefit from higher hemoglobin concentrations. Despite all efforts made last decade,a significant amount of work remains to be done to improve hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery.展开更多
Background:Most children in need of cardiac pacemakers remain dependent on the function of the permanent from childhood to adulthood.We sought to evaluate and compare the function between epicardial and endocardial pa...Background:Most children in need of cardiac pacemakers remain dependent on the function of the permanent from childhood to adulthood.We sought to evaluate and compare the function between epicardial and endocardial pacemakers in pediatric groups with different conditions.Methods:Between 2012 and 2018,this single-canter study evaluated 44 pediatric patients with indications for epicardial or endocardial pacemakers.Results:The 2 groups,at a median age of 5(0.1–16)years,were compared concerning the characteristics of the leads used(n=80:bipolar,unipolar,steroid-eluting,and non–steroid-eluting),survival data,and complications.The reason for pacemaker implantation was congenital complete heart block in 11(25%)cases and postoperative heart block in 33(75%)cases.The commonest congenital heart disease accompanied by postoperative block was the ventricular septal defect.In the endocardial lead group,the mean ventricular pacing threshold immediately after the implantation and during the follow-up was less than that in the epicardial lead group(0.75 vs.0.81 V;P=0.01 and 0.8 vs.2.4 V;P=0.001).During the follow-up,the mean battery longevity was better in the endocardial group(last visit:6.7 endocardial vs.3.3 years epicardial).Lead failure was commoner in the epicardial pacemaker,and chronic high-pacing threshold pattern was seen in 14 patients in this group.After 3 years,freedom from lead failure was 94%and 63%in the endocardial and epicardial leads.Conclusions:Pacemakers with endocardial bipolar steroid-eluting leads showed better lead characteristics regarding survival and battery longevity than epicardial pacemakers without these lead characteristics.An appropriate pacemaker type should be selected based on the patient’s condition.展开更多
Waterpipe(WP),a less common method of tobacco smoking than cigarette smoking(CS),has become increasingly popular over the last decade.Contrary to popular belief,WP smoking is far from harmless and has multiple health ...Waterpipe(WP),a less common method of tobacco smoking than cigarette smoking(CS),has become increasingly popular over the last decade.Contrary to popular belief,WP smoking is far from harmless and has multiple health risks similar to,or even exceeding,those seen in CS[1,2].展开更多
Objective: To investigate the relationship between depression, fatigue, disability and cognitive skills of patients with multiple sclerosis in a cohort of patients with multiple sclerosis in a single center in Tehran,...Objective: To investigate the relationship between depression, fatigue, disability and cognitive skills of patients with multiple sclerosis in a cohort of patients with multiple sclerosis in a single center in Tehran, Iran. Methods: One hundred and forty-seven patients with multiple sclerosis with mean age of 33 years, mean disease duration of 20.20 months, mean EDSS of 2.13, and F to M ratio of 76.5% over 23% were recruited for the purpose of this study. Cognitive function was compared with healthy control subjects (n = 100). Depression was measured by Beck Depression Inventory (BDI), fatigue was assessed using Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS), disability was evaluated by Expanded Disability Status Scale (EDSS), and cognitive function was assessed by Brief Repeatable Battery of Neuropsychological tests (BRB-N). All data were analysed using Pearson correlation. Results: Age and disability level generally correlated negatively and significantly with task performance, whereas a higher level of education was associated with better task performance. While the correlation between BDI, FSS, and MIFS was significantly positive, BDI was negatively correlated with the two subscales of BRB, namely PASAT and WLG. Higher levels of depression in patients with MS are associated with lower cognitive performance in tasks requiring higher-order working memory (WM) processes. FSS showed the strongest negative correlation score with BRB, however, the same parameter displayed significant positive correlation with MFIS. Moreover, the global EDSS scores were negatively correlated with BRB. Relative to controls, cognitive performance of MS patients was deficient in all BRB-N measures except Symbol Digit Modalities Test which is a measure of attention and processing speed. Conclusions: Depression, fatigue, and disability (the most common problems observed in MS patients) are clearly related with cognitive impairment in MS patients. Also, MS patients exhibit a pattern of cognitive impairment running across the studied cognitive domains in comparison to healthy subjects.展开更多
BACKGROUND Despite the controversies about the effectiveness of the current drug regimens for coronavirus disease 2019(COVID-19),these drugs are still the only options available.Moreover,the safety of these drugs is y...BACKGROUND Despite the controversies about the effectiveness of the current drug regimens for coronavirus disease 2019(COVID-19),these drugs are still the only options available.Moreover,the safety of these drugs is yet to be confirmed.A serious concern is the occurrence of various cardiac arrhythmias,particularly QT prolongation.AIM To summarize the incidence and estimate the risk of QT interval prolongation in patients scheduling for conventional treatment(hydroxychloroquine alone or in combination with azithromycin)for COVID-19.METHODS We comprehensively searched Medline,Web of Knowledge,Google Scholar,Scopus,and Cochrane Central Register of Controlled Trials databases until October 31,2020 for all eligible studies under the considered keywords COVID19,arrhythmia,QT interval,therapy,azithromycin,and hydroxychloroquine until.The study protocols were established in compliance with PRISMA-P guidelines(Preferred Reporting Items for Systematic Review and Meta-Analysis–Protocols),and a nine-star Newcastle-Ottawa Scale scoring system was used to assess the methodological quality of all eligible studies.Outcome measures were corrected QT(QTc)prolongation,cardiac arrhythmias,or sudden cardiac death.RESULTS Fifteen studies enrolling 8298 patients with targeted COVID-19 therapeutic regimes were included.The eligible studies found a significant increase in the mean QTc interval following treatment with the described medications compared to baseline QTc with weighted standard differences in means of 0.766.The pooled prevalence rate of QTc prolongation was estimated to be 9.2%(95%confidence interval:4.5%to 18.1%).CONCLUSION Hydroxychloroquine±azithromycin regimen can significantly increase the risk of developing QTc prolongation.展开更多
文摘BACKGROUND:Understanding any factors which influence the morbidity and mortality in patients with obstructive jaundice in each society will better guide appropriate management and lead to improved survival This study aimed to assess baseline etiologies,clinical manifestations,diagnostic results,and morbidity and mortality related to obstructive jaundice in Iranian patients. METHODS:The hospital recorded files of 133 patients with the final diagnosis of obstructive jaundice who had been admitted to the Taleqhani Hospital in Tehran between January 2001 and September 2004 were reviewed. RESULTS:The most common etiologies of obstructive jaundices were neoplasia and then common bile duct stone in the two genders.The results of ultrasonography were positive in less than half of the patients.However,the most positive results were related to endoscopic retrograde cholangiopancreatography(ERCP).The in-hospital mortality rate in patients less than 50 years old and elderly patients was 0%and 6.76%,respectively.The in-hospital morbidity rate was 2.25%and 7.51%,respectively in both patients and it was commonly related to infection of ulcer (44.46%),pneumonia(14.75%),myocardial infarction (14.75%),and subdiaphragmatic abscess(11.29%).In patients with a diagnosis of benign obstruction,only one patient died of severe sepsis.In malignant group preoperative characteristics,such as weight loss(P=0.015) and serum bilirubin concentration more than 16 mg/dl and postoperative complications,such as sepsis(P<0.001) cardiac arrest(P<0.001),and hepatic coma(P<0.001)were main predictors for the in-hospital mortality rate.CONCLUSION:Although the mortality and morbidity of obstructive jaundice in our study are less than those in other studies,the determination of preoperative clinical and laboratory indices and postoperative complications of patients is needed for the control of mortality and morbidity rate.
文摘AIM To study survival in isolated coronary artery bypass graft(CABG) patients and to evaluate the impact of preoperative chronic opium consumption on long-term outcome.METHODS Cohort of 566 isolated CABG patients as Tehran Heart Center cardiac output measurement was conducted. Daily evaluation until discharge as well as 4- and 12-mo and 6.5-year follow-up information for survival status were fulfilled for all patients. Long-term 6.5-year overall and opium-stratified survival, adjusted survival curves based on opium consumption as well as possible predictors of all-cause mortality using multiple cox regression were determined by statistical analysis.RESULTS Six point five-year overall survival was 91.8%; 86.6% in opium consumers and 92.7% in non-opium consumers(P=0.035). Patients with positive history of opium consumption significantly tended to have lower ejection fraction(EF), higher creatinine level and higher prevalence of myocardial infarction. Multiple predictors of all-cause mortality included age, body mass index, EF, diabetes mellitus and cerebrovascular accident. The hazard ratio(HR) of 2.09 for the risk of mortality in opium addicted patients with a borderline P value(P=0.052) was calculated in this model. Further adjustment with stratification based on smoking and opium addiction reduced the HR to 1.20(P=0.355).CONCLUSION Simultaneous impact of smoking as a confounding variable in most of the patients prevents from definitive judgment on the role of opium as an independent contributing factor in worse long-term survival of CABG patients in addition to advanced age, low EF, diabetes mellitus and cerebrovascular accident. Meanwhile, our findings do not confirm any cardio protective role for opium to improve outcome in coronary patients with the history of smoking. Further studies are needed to clarify pure effect of opium and warrant the aforementioned findings.
文摘Although red blood cells(RBCs) transfusion is sometimes associated with adverse reactions,anemia could also lead to increased morbidity and mortality in highrisk patients. For these reasons,the definition of perioperative strategies that aims to detect and treat preoperative anemia,prevent excessive blood loss,and define "optimal" transfusion algorithms is crucial. Although the treatment with preoperative iron and erythropoietin has been recommended in some specific conditions,several controversies exist regarding the benefit-to-risk balance associated with these treatments. Further studies are needed to better define the indications,dosage,and route of administration for preoperative iron with or without erythropoietin supplementation. Although restrictive transfusion strategies in patients undergoing cardiac surgery have been shown to effectively reduce the incidence and the amount of RBCs transfusion without increase in side effects,some high-risk patients(e.g.,symptomatic acute coronary syndrome) could benefit from higher hemoglobin concentrations. Despite all efforts made last decade,a significant amount of work remains to be done to improve hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery.
文摘Background:Most children in need of cardiac pacemakers remain dependent on the function of the permanent from childhood to adulthood.We sought to evaluate and compare the function between epicardial and endocardial pacemakers in pediatric groups with different conditions.Methods:Between 2012 and 2018,this single-canter study evaluated 44 pediatric patients with indications for epicardial or endocardial pacemakers.Results:The 2 groups,at a median age of 5(0.1–16)years,were compared concerning the characteristics of the leads used(n=80:bipolar,unipolar,steroid-eluting,and non–steroid-eluting),survival data,and complications.The reason for pacemaker implantation was congenital complete heart block in 11(25%)cases and postoperative heart block in 33(75%)cases.The commonest congenital heart disease accompanied by postoperative block was the ventricular septal defect.In the endocardial lead group,the mean ventricular pacing threshold immediately after the implantation and during the follow-up was less than that in the epicardial lead group(0.75 vs.0.81 V;P=0.01 and 0.8 vs.2.4 V;P=0.001).During the follow-up,the mean battery longevity was better in the endocardial group(last visit:6.7 endocardial vs.3.3 years epicardial).Lead failure was commoner in the epicardial pacemaker,and chronic high-pacing threshold pattern was seen in 14 patients in this group.After 3 years,freedom from lead failure was 94%and 63%in the endocardial and epicardial leads.Conclusions:Pacemakers with endocardial bipolar steroid-eluting leads showed better lead characteristics regarding survival and battery longevity than epicardial pacemakers without these lead characteristics.An appropriate pacemaker type should be selected based on the patient’s condition.
基金supported by the National Natural Science Foundation of China[82003401&81972981]the Key Projects of Colleges and Universities of Henan Education Department[21A330006]the Opening Foundation of National Health Commission Key Laboratory of Birth Defects Prevention and Henan Key Laboratory of Population Defects Prevention[ZD202001]。
文摘Waterpipe(WP),a less common method of tobacco smoking than cigarette smoking(CS),has become increasingly popular over the last decade.Contrary to popular belief,WP smoking is far from harmless and has multiple health risks similar to,or even exceeding,those seen in CS[1,2].
文摘Objective: To investigate the relationship between depression, fatigue, disability and cognitive skills of patients with multiple sclerosis in a cohort of patients with multiple sclerosis in a single center in Tehran, Iran. Methods: One hundred and forty-seven patients with multiple sclerosis with mean age of 33 years, mean disease duration of 20.20 months, mean EDSS of 2.13, and F to M ratio of 76.5% over 23% were recruited for the purpose of this study. Cognitive function was compared with healthy control subjects (n = 100). Depression was measured by Beck Depression Inventory (BDI), fatigue was assessed using Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS), disability was evaluated by Expanded Disability Status Scale (EDSS), and cognitive function was assessed by Brief Repeatable Battery of Neuropsychological tests (BRB-N). All data were analysed using Pearson correlation. Results: Age and disability level generally correlated negatively and significantly with task performance, whereas a higher level of education was associated with better task performance. While the correlation between BDI, FSS, and MIFS was significantly positive, BDI was negatively correlated with the two subscales of BRB, namely PASAT and WLG. Higher levels of depression in patients with MS are associated with lower cognitive performance in tasks requiring higher-order working memory (WM) processes. FSS showed the strongest negative correlation score with BRB, however, the same parameter displayed significant positive correlation with MFIS. Moreover, the global EDSS scores were negatively correlated with BRB. Relative to controls, cognitive performance of MS patients was deficient in all BRB-N measures except Symbol Digit Modalities Test which is a measure of attention and processing speed. Conclusions: Depression, fatigue, and disability (the most common problems observed in MS patients) are clearly related with cognitive impairment in MS patients. Also, MS patients exhibit a pattern of cognitive impairment running across the studied cognitive domains in comparison to healthy subjects.
文摘BACKGROUND Despite the controversies about the effectiveness of the current drug regimens for coronavirus disease 2019(COVID-19),these drugs are still the only options available.Moreover,the safety of these drugs is yet to be confirmed.A serious concern is the occurrence of various cardiac arrhythmias,particularly QT prolongation.AIM To summarize the incidence and estimate the risk of QT interval prolongation in patients scheduling for conventional treatment(hydroxychloroquine alone or in combination with azithromycin)for COVID-19.METHODS We comprehensively searched Medline,Web of Knowledge,Google Scholar,Scopus,and Cochrane Central Register of Controlled Trials databases until October 31,2020 for all eligible studies under the considered keywords COVID19,arrhythmia,QT interval,therapy,azithromycin,and hydroxychloroquine until.The study protocols were established in compliance with PRISMA-P guidelines(Preferred Reporting Items for Systematic Review and Meta-Analysis–Protocols),and a nine-star Newcastle-Ottawa Scale scoring system was used to assess the methodological quality of all eligible studies.Outcome measures were corrected QT(QTc)prolongation,cardiac arrhythmias,or sudden cardiac death.RESULTS Fifteen studies enrolling 8298 patients with targeted COVID-19 therapeutic regimes were included.The eligible studies found a significant increase in the mean QTc interval following treatment with the described medications compared to baseline QTc with weighted standard differences in means of 0.766.The pooled prevalence rate of QTc prolongation was estimated to be 9.2%(95%confidence interval:4.5%to 18.1%).CONCLUSION Hydroxychloroquine±azithromycin regimen can significantly increase the risk of developing QTc prolongation.
