Oropharyngeal colonization of bacteria is one of the most important risk factors for ventilator a... more Oropharyngeal colonization of bacteria is one of the most important risk factors for ventilator associated pneumonia. One of the ways to prevent accumulation of bacteria in the throat is to use mouthwash. Among the oral rinse, chlorhexidine has been introduced as the gold standard but has a variety of side effects. The aim of this study is to determine and compare the antibacterial effects of persica® mouthwash 10% (miswak extract) and chlorhexidine gluconate 0.2% in mechanically ventilated patients in intensive care unit (ICU). In this double blind randomized clinical trial, 60 patients who were admitted in a surgical ICU and met the inclusion criteria were enrolled and were randomly divided in two equal intervention and one control groups. In the first intervention group, chlorhexidine gluconate mouthwash 0.2% was used, in the second one, the researchers used persica® herbal mouthwash 10% and finally in the control group, normal saline was used. In order to culture Staphylococcus aureus and Streptococcus pneumoniae, immediately before and after 6 minutes of mouth washing, saliva samples were taken without any stimulation. Data were analyzed using Chi-square and ANOVA tests in SPSS 17 software. Decrease of bacterial counts was significant in all three groups after intervention (p<0.001). Unlike normal saline, chlorhexidine and persica® mouthwashes had significant antibacterial effects on Staphylococcus aureus (respectively p <0.001 and P = 0.008) and Streptococcus pneumoniae (p <0.001 and p <0.001). The findings of this study indicated that herbal persica® mouthwash can be considered as an alternative for chlorhexidine in ICU patients due to high resistance of the bacteria to synthetic mouthwashes and side effects of these drugs.
Some studies have indicated that the use of luspatercept may be a novel and efficient treatment f... more Some studies have indicated that the use of luspatercept may be a novel and efficient treatment for β-thalassemia patients. In this article, we aimed to review the current evidence related to luspatercept prescription and its clinical effectiveness in patients with β-thalassemia. PubMed, Web of Science, Scopus, Trip and CENTRAL were searched up to June 2020. The inclusion criteria were English-language articles that studied the effects of luspatercept on improving anemia severity in patients with β-thalassemia in a clinical setting. The search strategy yielded 273 potentially relevant articles. After searching the databases, scanning of titles, abstracts and full texts for relevancy was performed to identify suitable articles. A total of 77 articles were confirmed for full text analysis. The estimated number of patients needed to treat (NNT) for luspatercept treatment, using data derived from conducted clinical trials, according to a reduction in transfusion need of ≥ 33% or ≥ 50 from baseline, during week 13–24/week 37–48/any 12- and 24-week intervals as outcomes, was 3–5 in patients with β-thalassemia. Based on the conducted studies, the effectiveness of luspatercept on transfusion burden and hemoglobin levels was outstanding in β-thalassemia patients. Further large and well-designed clinical studies are needed to identify any unforeseen complications subsequent to use of luspatercept, particularly when used with other treatments with potentially serious adverse effects such as anti-osteoporotic and iron chelator agents.
Background: Major thalassemia prevention project in Iran began in 1997. Mazandaran Province in no... more Background: Major thalassemia prevention project in Iran began in 1997. Mazandaran Province in northern Iran took effective steps in preventing the birth of patients with thalassemia major in the country. We report on the demographic status of patients with thalassemia major registered in the electronic system of Mazandaran Province in Iran.Methods: The web-based application of the Mazandaran Thalassemia Registry (THRegistry) was designed based on the Net Framework platform in VB.Net and the 2014Sql Server database. The information source included clinical records in 14 thalassemic wards of the Mazandaran province hospitals. Epidemiological data of patients and date of transfusion, blood group, educational status, employment, marital status and having children were recorded.Results: The study population was 1,725 patients including 889 (51.5%) women and 836 (48.5%) men with a mean age of 30±9.6 years. A total of 188 patients born have been identified after the launch of the country&...
Background: Ventilator-associated pneumonia (VAP) is one of the most important causes of mortalit... more Background: Ventilator-associated pneumonia (VAP) is one of the most important causes of mortality in intubated traumatic patients admitted in ICU. The aim of current study was to determine correlation between blood products transfusion with incidence of VAP in traumatic patients under mechanical ventilation in ICU. Materials and Methods: This study was a prospective descriptive-analytical study. Current study was carried out on traumatic patients under mechanical ventilation admitted to Imam Khomeini hospital ICU wards of Sari city, from September 2015 to September 2016. In addition to demographic data, patients' clinical information were daily recorded. Results: Of total of 2304 patients admitted to ICU, 186 traumatic patients under mechanical ventilation longer than 48 hours were reviewed and analyzed. Among patients infected with VAP, 36 persons(87.8%) had transfusion of blood products before VAP incidence. Blood products transfusion (before and / or after 48 hours) had the ...
Introduction: Thalassemia is a hereditary hemolytic disease spread throughout India, Arabian Peni... more Introduction: Thalassemia is a hereditary hemolytic disease spread throughout India, Arabian Peninsula, Iran, Turkey, and Southeast Asia. Diabetes mellitus (DM) is a common complication of patients with β-thalassemia major (β-TM) due to iron sediment in the pancreas. The purpose of this study was to survey the prevalence of DM in patients with β-TM. Material and Methods: Demographic, clinical information, and some biological tests in conjunction with the proportion of T2DM were retrieved from the Mazandaran Thalassemia Registry (MTR) affiliated to the Mazandaran University of Medical Science. The data belong to December 2017 until December 2019. Results: The results are as follows: Use of iron chelators like deferiprone should be with caution and with respect to the patients' metabolic state to avoid complications like diabetes. 2024 ꞵ-TM patients have registered in MTR (Mazandaran Thalassemia Registration). Data were completed for 597 cases including 72 patients (12.1%)...
Numerous problematic disorders such as vitamin D (Vit-D) deficiency subsequent to large iron load... more Numerous problematic disorders such as vitamin D (Vit-D) deficiency subsequent to large iron loading can be developed in patients with β-thalassemia. The study aimed to estimate Vit-D insufficiency and its risk factors in patients with β-thalassemia. In this multicenter and observational study, all β-thalassemia patients, who referred to 14 hospital-based thalassemia divisions or clinics in Mazandaran province, Iran were included in the study. The data belong to December 2015 until December 2019. The study population was made of transfusion dependent thalassemia (TDT) and non-transfusion-dependent thalassemia (NTDT) patients. Serum levels of 25-OHD3 have been measured by high performance liquid chromatography (HPLC) method as ng/mL. Demographic and clinical information along with some biological tests, as well as the results of T2*-weighted magnetic resonance imaging were analyzed. Of 1959 registered patients, 487 (24.9%) patients had Vit-D-related data. The prevalence of Vit-D insu...
Background: In β-thalassemia major (β-TM) patients, iron overload is one of the main causes of in... more Background: In β-thalassemia major (β-TM) patients, iron overload is one of the main causes of inflammation. This study investigated whether use of silymarin could improve inflammatory status in patients with β-TM and iron overload, through a placebo-controlled, crossover study. Methods: Silymarin (140 mg, 3 times a day) or placebo were prescribed to all patients (n = 82) for 12 weeks, and after a 2-week washout period, patients were crossed over to the other group. The efficacy of silymarin was assessed by measuring serum C-reactive protein (CRP) (mg/dL), interleukin (IL)-6 (pg/mL), and IL-10 (pg/mL). Results: Sixty-nine patients completed the study. Data analysis showed that compared to the placebo, silymarin could decrease CRP, IL-6, and raise IL-10 significantly (the p values for all variables were <0.001). Cohen’s d for CRP adjusted according to the baseline CRP value was –1.72, the 95% confidence interval (CI) –2.12 to –1.33. The adjusted Cohen’s d equal to –1.12, 95% CI –1....
Background: Electronic registry system of beta-thalassemia patients was run by Thalassemia Resear... more Background: Electronic registry system of beta-thalassemia patients was run by Thalassemia Research Center (TRC) in 2017. The aim of the current study was presentation of therapeutic status in these patients at Mazandaran Province, Iran. Methods: Therapeutic status variables including: Name of cities and hospitals, age and sex of patients, dependent and non-transfusion-dependent, starting age of the blood transfusion and iron-chelating agents, blood group and Rh, washed blood transfusion, abnormal antibody, transfusion reactions, mean hemoglobin during the last 3 months, type of iron chelators, iron chelators dosage, serum ferritin, and the use of hydroxyurea. Results: Overall, 1831 patients were registered [891 male (48.7%)]. Mean age of patients was 30±9.7 yr. Average of hemoglobin levels for female and male were 9.1±5.1 and 9.4±6.3 gr/dl, respectively. Seventy-six percent of transfusion-dependent patients (1385) have received iso-group PRBC (packed red blood cells), after crossma...
Abstract Diabetes mellitus (DM) is one of the potential complications in patients with transfusio... more Abstract Diabetes mellitus (DM) is one of the potential complications in patients with transfusion-dependent β-thalassemia major (β-TM). In this case-controlled study, we examined the pancreatic iron levels in outpatients with β-TM. In this study, cases of patients with β-TM and DM were gender- and age-matched with control subjects, who were non-diabetic and had normal blood glucose on standard oral glucose tolerance (OGTT) tests. One of four diagnoses [normal, pre-diabetes, impaired glucose tolerance (IGT), DM] was made according to the American Diabetes Association (ADA) criteria. The T2*-weighted magnetic resonance imaging (T2*-weighted MRI) of the heart, liver, and pancreas was performed using a 1.5 Tesla scanner. The study enrolled 26 diabetic cases, 17 non-diabetic cases, and eight cases of IGT or pre-diabetes cases. The severity of pancreatic and cardiac iron siderosis was significantly different between the groups. We found a statistically significant difference at 5.6 ms in the T2*-weighted MRI values for the pancreas between patients with normal vs. abnormal glucose metabolism [p < 0.009; odds ratio (OR): 11.2; 95% confidence interval (95% CI): 1.32-94.4)]. The receiver operating characteristic (ROC) curve for the 5.6 ms cutoff led to an area under the curve (AUC) of 0.69 (95% CI: 55.0-84.0; p < 0.02), with sensitivity and specificity of 94.0 and 42.0%, respectively. There was a moderate positive correlation between pancreatic and cardiac T2*-weighted MRI (r = 0.4; p < 0.001), and a weak correlation between the pancreas and the liver (r = 0.38; p < 0.005). To conclude, we have introduced a cutoff of 5.6 ms on T2*-weighted MRI of the pancreas for prediction of abnormal glucose metabolism in β-TM patients.
Cognitive impairment and dementia are major neurocognitive disorders that cause a noticeable decl... more Cognitive impairment and dementia are major neurocognitive disorders that cause a noticeable decline in cognitive abilities, including memory and thinking skills. The effectiveness of using folic acid as an adjuvant for management of neurocognitive disorders is not well-known. This paper explains the role of folic acid, including its usefulness, effectiveness, adverse side effects, and active mechanisms on cognitive functions of the elderly. In the current study, we reviewed clinical and experimental studies investigating the use of folic acid prior to November 2017, using PubMed, ISI Web of Knowledge, Science Direct, Scopus, Ovid, and Cochrane Library databases. A total of 142 articles were retrieved by electronic search. Based on the preset inclusion and exclusion criteria, a total of 36 articles were retrieved for full text analysis. According to data obtained from the review, it seems that folic acid supplementation may improve cognitive function by decreasing homocysteine (Hcy), vascular care, attenuating inflammatory status, modification of cerebral folic acid deficiency, and antioxidant responses. Specifically, people with high levels of Hcy have a better response to folic acid supplementation, which may arise from low serum folate concentration.
Introduction: Pulmonary arterial hypertension (PAH) is relatively prevalent in patients with thal... more Introduction: Pulmonary arterial hypertension (PAH) is relatively prevalent in patients with thalassemia. PAH treatment is necessary as the prevalence of Doppler-estimated PAH and the resultant mortality is high in such patients. Materials and methods: This study aimed at evaluating the effect of bosentan therapy on patients with thalassemia suspected of PAH. Based on pulsed Doppler echocardiography, all the cases were suspected of severe PAH. Consequently, bosentan was initiated at a dose of 62.5 mg twice a day for 4 weeks, which was increased to 62.5-125 mg twice a day, if no adverse side effects were observed. Results: The results of this study showed that pulmonary artery pressure (PAP) decreased after the administration of bosentan in three cases, from 160 to 120, 110 to 65, and 60 to 25 mmHg; in other words, the PAP reduced in the mentioned cases by 25%, 36.4%, and 58.4%, respectively. Conclusion: In this study, PAP improved after bosentan therapy in patients with β-thalassemia suspected of PAH; however, further studies are required to confirm the findings.
Background: Despite advances in pain management, several patients continue to experience severe a... more Background: Despite advances in pain management, several patients continue to experience severe acute pain after lumbar spine surgery. The aim of this study was to assess the safety and effectiveness of single ultra-low-dose intrathecal (IT) naloxone in combination with IT morphine for reducing pain intensity, pruritus, nausea, and vomiting in patients undergoing lumbar laminectomy with spinal fusion. Materials and Methods: In this double-blind trial, patients scheduled for lumbar laminectomy with spinal fusion were randomly assigned to receive single ultra-low-dose IT naloxone (20 μg) and IT morphine (0.2 mg) (group M+N) or IT morphine (0.2 mg) alone (group M). The severity of postoperative pain, pruritus and nausea, and frequency of vomiting were assessed at recovery from anesthesia and, subsequently, at 1, 3, 6, 12, and 24 hours postoperatively using an 11-point (0-10) visual analogue scale. Results: A total of 77 patients completed the study, and there were significant differences in postoperative pain, pruritus, and nausea visual analogue scale between the groups (P < 0.05). After adjusting for body mass index and surgery duration, IT naloxone administration reduced the pain score (coefficient = 1.84; 95% confidence interval [CI], 1.05-2.63; P < 0.001), and the scores of pruritus and nausea (coefficient = 0.9; 95% CI, 0.44-1.37; P < 0.001 and coefficient = 0.71; 95% CI, 0.12-1.31; P = 0.02, respectively) compared with IT morphine alone. No serious adverse effects were observed. Conclusions: The addition of ultra-low-dose IT naloxone to IT morphine provides excellent postoperative pain management and effectively controls pruritus and nausea in patients undergoing laminectomy with spinal fusion.
Introduction: The benefit of annual administration of zoledronic acid in the management of thalas... more Introduction: The benefit of annual administration of zoledronic acid in the management of thalassemia-associated osteoporosis is unknown. Aim: The aims of this study were to evaluate the efficacy of treatment with two different dosing regimens of IV zoledronic acid (annually versus every 3 months) for increasing low bone mineral density (BMD) in patients with osteoporosis associated with β-thalassemia as annually and 3-monthly on bone density in patients. Materials and Methods: This retrospective, single-center study analyzed patients' clinical records and bone density measurements. Those enrolled in the study were 14 to 53 years of age, had documented β-thalassemia, and were treated with IV zoledronic acid on either an annual or every 3 months dosing regimen. Dual-energy X-ray absorptiometry was used to obtain the z-score for BMD in the lumbar spine and femoral neck. Results: Thirty-four patients were enrolled in the study; 15 (44.1%) had been treated annually, and 19 (55.9%) had been treated every month. In patients receiving treatment with the once-yearly dose of zoledronic acid, significant increases were observed in the lumbar spine BMD z-score, from-2.45 ± 0.69 to-1.97 ± 0.82 (P=0.02). When comparing BMD across the two treatment regimens, the mean lumbar spine BMD was 0.82 greater (95% CI 0.31, 1.33, P=0.003) and the mean femoral neck BMD 0.37 greater (95% CI-0.15, 0.87, P=0.1) in the group receiving annual zoledronic acid treatment. Conclusions: In patients with thalassemia-associated osteopenia, annual treatment with zoledronic acid increases lumbar spine bone density while being more effective, less expensive, and associated with fewer adverse events than dosing every 3 months.
Medical archives (Sarajevo, Bosnia and Herzegovina), 2018
Right ventricular infarction (RVI) develops in 30-50% of patients with inferior wall infarction (... more Right ventricular infarction (RVI) develops in 30-50% of patients with inferior wall infarction (IWI). The rates of mortality, morbidity, and complications in these patients are greater than in the patients without RVI. We compared the tissue Doppler imaging (TDI) indices between a group of patients with IWI and RVI, with a similar group of patients who had IWI alone to investigate the application of TDI indices in the evaluation and detection of right ventricular function. We studied 49 patients with first acute IWI in two groups. Group 1 (N=24) were patients with IWI and RVI while group 2 consisted of patients with IWI alone (N=25), based on standard electrocardiogram criteria. The peak systolic (Sm), peak early (Em) and late (Am) diastolic velocities, and Em/Am ratio were obtained from the apical four chamber view, at the lateral side of the tricuspid annulus. We measured trans-tricuspid early (ET) and peak (AT) filling velocity, ET/AT ratio, right ventricular end diastolic diame...
This study aimed to determine the potential iron-chelating effects of silymarin in patients with ... more This study aimed to determine the potential iron-chelating effects of silymarin in patients with β-thalassemia major receiving standard iron-chelation therapy. We evaluated whether addition of silymarin to standard iron-chelation therapy could improve iron burden markers and liver and cardiac function in these patients, via a placebo-controlled, crossover clinical study. Silymarin (140 mg) or placebo were administered thrice daily to all patients (n = 82) for 12 weeks, and after a 2-week washout period, patients were crossed over to the other groups. Silymarin efficacy was assessed by measuring serum iron level, ferritin level, total iron-binding capacity and liver and cardiac function on magnetic resonance imaging. Silymarin treatment resulted in a negative change in the serum iron and ferritin levels and a positive change in the total iron-binding capacity levels (treatment effect, p < .001, p = .06, and p = .05, respectively). Silymarin treatment led to positive changes in car...
Highlight; 1. Iron overload is the main cause of oxidative stress in patients with thalassemia 2.... more Highlight; 1. Iron overload is the main cause of oxidative stress in patients with thalassemia 2. Silymarin may modify nuclear expression through enhancing the synthesis of ribosomal RNA by stimulating DNA polymerase I. 3. Silymarin has the potential to be used as adjuvant therapy to restore antioxidant defenses and decrease complications of iron overload status.
Brief Communication IntRoductIon Ventilator-associated pneumonia (VAP) is an important complicati... more Brief Communication IntRoductIon Ventilator-associated pneumonia (VAP) is an important complication in patients who need mechanical ventilation (MV). [1] VAP is the most common infection among patients undergoing MV and has been associated with increased mortality (approaching 50%), morbidity, duration of MV, and length of Intensive Care Unit (ICU) stay. Despite advances in preventive strategies, such as the implementation of VAP bundle and Centers for Disease Control and Prevention recommendations in critical care, the mortality and morbidity rate still requires substantial improvement. [1,2] It is believed that critical illness stress-induced immune suppression plays an important role in the development of hospital infections. [3] Insufficient zinc levels have been suggested to play a role in stress-induced lymphopenia, and consequent immune suppression. Zinc is a crucial mineral for many biological functions in humans. [3,4] A number of studies have been performed in children and elderly, clearly demonstrated the beneficial impact of zinc supplementation on immune function and the prevention of pulmonary infections; [5-7] however, the association between zinc supplementation Background: Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the Intensive Care Unit (ICU). The aim of this analysis is to determine potential association between zinc supplementation with the occurrence of VAP in adult mechanically ventilated trauma patients. Subjects and Methods: This secondary analysis of a prospective observational study was carried out over a period of 1 year in ICUs of one teaching hospital in Iran. A total of 186 adults mechanically ventilated trauma patients, who required at least 48 h of MV and received zinc sulfate supplement (n = 82) or not (n = 104) during their ICU stay, were monitored for the occurrence of VAP until their discharge from the ICU or death. Results: Forty-one of 186 patients developed VAP, 29.09 days after admission (95% confidence interval [CI]: 26.27-31.9). The overall incidence of VAP was 18.82 cases per 1000 days of intubation (95% CI: 13.86-25.57). Patients who received zinc sulfate supplement have smaller hazard of progression to VAP than others (hazard ratio: 0.318 [95% CI: 0.138-0.732]; P < 0.0001). Conclusion: The findings show that zinc supplementation may be associated with a significant reduction in the occurrence of VAP in adult mechanically ventilated trauma patients. Further well-designed randomized clinical trials to confirm the efficacy of this potential preventive modality are warranted.
Globally, b-thalassemia major (b-TM) is one of the most common hereditary disorders. Multiple blo... more Globally, b-thalassemia major (b-TM) is one of the most common hereditary disorders. Multiple blood transfusions, that are a life-saving therapy in patients with b-TM, is a major source of iron overload. Iron overload can lead to significant morbidity and mortality. Research evidence indicates that oxidative stress induced by iron overload, is one of the major precipitating causes of vitamin C deficiency in b-TM patients. It has previously been shown that patients with b-TM have significantly lower levels of vitamin C as compared to healthy individuals. It is believed that vitamin C can reduce both ferric (Fe 3+) and ferrous (Fe 2+) ions, and also facilitate the accessibility of iron to chelators through increase of iron release from the reticuloendothelial system. Despite the potential benefits of vitamin C in patients with b-TM, several areas of concern exist that should be addressed by high quality research designs. Some recommendations have been provided through this study.
Background: Ventilator-associated pneumonia is the most frequent infection occurring in mechanica... more Background: Ventilator-associated pneumonia is the most frequent infection occurring in mechanically ventilated patients in the intensive care unit. Ventilator-associated pneumonia is a serious issue and remains a significant clinical problem for critically ill patients. The aim of this review article is to evaluate studies to conclude the best existing evidence for providing oral hygiene to intensive care unit patients receiving mechanical ventilation, determine the clinical evidence considering chlorhexidine, and to document a research to improve care interventions used for oral care in the critical patients. Materials and Methods: Searching was performed in the databases: Sciencedirect, SID, CINAHL, Google Scholar, Cochrane Library, Springer and PubMed for accessibility to the studies carried out regarding with chlorhexidine mouthwash and ventilator-associated pneumonia between 1991 to 2014 years by using keywords: chlorhexidine mouthwash and ventilator-associated pneumonia. Results: Although oral care with chlorhexidine cause a reduce the incidence of ventilatorassociated pneumonia, but no evidence exists on decrease of mortality in patients undergoing mechanical ventilation admitted in the intensive care unit following its using. Conclusion: Base on this current review article can be said that protective effect of chlorhexidine mouthwash has proved in oral health and prevention of ventilator-associated pneumonia in the critical patients, but unfortunately no evidence exists to the appropriate protocol for using of chlorhexidine mouthwash in these patients.
Oropharyngeal colonization of bacteria is one of the most important risk factors for ventilator a... more Oropharyngeal colonization of bacteria is one of the most important risk factors for ventilator associated pneumonia. One of the ways to prevent accumulation of bacteria in the throat is to use mouthwash. Among the oral rinse, chlorhexidine has been introduced as the gold standard but has a variety of side effects. The aim of this study is to determine and compare the antibacterial effects of persica® mouthwash 10% (miswak extract) and chlorhexidine gluconate 0.2% in mechanically ventilated patients in intensive care unit (ICU). In this double blind randomized clinical trial, 60 patients who were admitted in a surgical ICU and met the inclusion criteria were enrolled and were randomly divided in two equal intervention and one control groups. In the first intervention group, chlorhexidine gluconate mouthwash 0.2% was used, in the second one, the researchers used persica® herbal mouthwash 10% and finally in the control group, normal saline was used. In order to culture Staphylococcus aureus and Streptococcus pneumoniae, immediately before and after 6 minutes of mouth washing, saliva samples were taken without any stimulation. Data were analyzed using Chi-square and ANOVA tests in SPSS 17 software. Decrease of bacterial counts was significant in all three groups after intervention (p<0.001). Unlike normal saline, chlorhexidine and persica® mouthwashes had significant antibacterial effects on Staphylococcus aureus (respectively p <0.001 and P = 0.008) and Streptococcus pneumoniae (p <0.001 and p <0.001). The findings of this study indicated that herbal persica® mouthwash can be considered as an alternative for chlorhexidine in ICU patients due to high resistance of the bacteria to synthetic mouthwashes and side effects of these drugs.
Some studies have indicated that the use of luspatercept may be a novel and efficient treatment f... more Some studies have indicated that the use of luspatercept may be a novel and efficient treatment for β-thalassemia patients. In this article, we aimed to review the current evidence related to luspatercept prescription and its clinical effectiveness in patients with β-thalassemia. PubMed, Web of Science, Scopus, Trip and CENTRAL were searched up to June 2020. The inclusion criteria were English-language articles that studied the effects of luspatercept on improving anemia severity in patients with β-thalassemia in a clinical setting. The search strategy yielded 273 potentially relevant articles. After searching the databases, scanning of titles, abstracts and full texts for relevancy was performed to identify suitable articles. A total of 77 articles were confirmed for full text analysis. The estimated number of patients needed to treat (NNT) for luspatercept treatment, using data derived from conducted clinical trials, according to a reduction in transfusion need of ≥ 33% or ≥ 50 from baseline, during week 13–24/week 37–48/any 12- and 24-week intervals as outcomes, was 3–5 in patients with β-thalassemia. Based on the conducted studies, the effectiveness of luspatercept on transfusion burden and hemoglobin levels was outstanding in β-thalassemia patients. Further large and well-designed clinical studies are needed to identify any unforeseen complications subsequent to use of luspatercept, particularly when used with other treatments with potentially serious adverse effects such as anti-osteoporotic and iron chelator agents.
Background: Major thalassemia prevention project in Iran began in 1997. Mazandaran Province in no... more Background: Major thalassemia prevention project in Iran began in 1997. Mazandaran Province in northern Iran took effective steps in preventing the birth of patients with thalassemia major in the country. We report on the demographic status of patients with thalassemia major registered in the electronic system of Mazandaran Province in Iran.Methods: The web-based application of the Mazandaran Thalassemia Registry (THRegistry) was designed based on the Net Framework platform in VB.Net and the 2014Sql Server database. The information source included clinical records in 14 thalassemic wards of the Mazandaran province hospitals. Epidemiological data of patients and date of transfusion, blood group, educational status, employment, marital status and having children were recorded.Results: The study population was 1,725 patients including 889 (51.5%) women and 836 (48.5%) men with a mean age of 30±9.6 years. A total of 188 patients born have been identified after the launch of the country&...
Background: Ventilator-associated pneumonia (VAP) is one of the most important causes of mortalit... more Background: Ventilator-associated pneumonia (VAP) is one of the most important causes of mortality in intubated traumatic patients admitted in ICU. The aim of current study was to determine correlation between blood products transfusion with incidence of VAP in traumatic patients under mechanical ventilation in ICU. Materials and Methods: This study was a prospective descriptive-analytical study. Current study was carried out on traumatic patients under mechanical ventilation admitted to Imam Khomeini hospital ICU wards of Sari city, from September 2015 to September 2016. In addition to demographic data, patients' clinical information were daily recorded. Results: Of total of 2304 patients admitted to ICU, 186 traumatic patients under mechanical ventilation longer than 48 hours were reviewed and analyzed. Among patients infected with VAP, 36 persons(87.8%) had transfusion of blood products before VAP incidence. Blood products transfusion (before and / or after 48 hours) had the ...
Introduction: Thalassemia is a hereditary hemolytic disease spread throughout India, Arabian Peni... more Introduction: Thalassemia is a hereditary hemolytic disease spread throughout India, Arabian Peninsula, Iran, Turkey, and Southeast Asia. Diabetes mellitus (DM) is a common complication of patients with β-thalassemia major (β-TM) due to iron sediment in the pancreas. The purpose of this study was to survey the prevalence of DM in patients with β-TM. Material and Methods: Demographic, clinical information, and some biological tests in conjunction with the proportion of T2DM were retrieved from the Mazandaran Thalassemia Registry (MTR) affiliated to the Mazandaran University of Medical Science. The data belong to December 2017 until December 2019. Results: The results are as follows: Use of iron chelators like deferiprone should be with caution and with respect to the patients' metabolic state to avoid complications like diabetes. 2024 ꞵ-TM patients have registered in MTR (Mazandaran Thalassemia Registration). Data were completed for 597 cases including 72 patients (12.1%)...
Numerous problematic disorders such as vitamin D (Vit-D) deficiency subsequent to large iron load... more Numerous problematic disorders such as vitamin D (Vit-D) deficiency subsequent to large iron loading can be developed in patients with β-thalassemia. The study aimed to estimate Vit-D insufficiency and its risk factors in patients with β-thalassemia. In this multicenter and observational study, all β-thalassemia patients, who referred to 14 hospital-based thalassemia divisions or clinics in Mazandaran province, Iran were included in the study. The data belong to December 2015 until December 2019. The study population was made of transfusion dependent thalassemia (TDT) and non-transfusion-dependent thalassemia (NTDT) patients. Serum levels of 25-OHD3 have been measured by high performance liquid chromatography (HPLC) method as ng/mL. Demographic and clinical information along with some biological tests, as well as the results of T2*-weighted magnetic resonance imaging were analyzed. Of 1959 registered patients, 487 (24.9%) patients had Vit-D-related data. The prevalence of Vit-D insu...
Background: In β-thalassemia major (β-TM) patients, iron overload is one of the main causes of in... more Background: In β-thalassemia major (β-TM) patients, iron overload is one of the main causes of inflammation. This study investigated whether use of silymarin could improve inflammatory status in patients with β-TM and iron overload, through a placebo-controlled, crossover study. Methods: Silymarin (140 mg, 3 times a day) or placebo were prescribed to all patients (n = 82) for 12 weeks, and after a 2-week washout period, patients were crossed over to the other group. The efficacy of silymarin was assessed by measuring serum C-reactive protein (CRP) (mg/dL), interleukin (IL)-6 (pg/mL), and IL-10 (pg/mL). Results: Sixty-nine patients completed the study. Data analysis showed that compared to the placebo, silymarin could decrease CRP, IL-6, and raise IL-10 significantly (the p values for all variables were <0.001). Cohen’s d for CRP adjusted according to the baseline CRP value was –1.72, the 95% confidence interval (CI) –2.12 to –1.33. The adjusted Cohen’s d equal to –1.12, 95% CI –1....
Background: Electronic registry system of beta-thalassemia patients was run by Thalassemia Resear... more Background: Electronic registry system of beta-thalassemia patients was run by Thalassemia Research Center (TRC) in 2017. The aim of the current study was presentation of therapeutic status in these patients at Mazandaran Province, Iran. Methods: Therapeutic status variables including: Name of cities and hospitals, age and sex of patients, dependent and non-transfusion-dependent, starting age of the blood transfusion and iron-chelating agents, blood group and Rh, washed blood transfusion, abnormal antibody, transfusion reactions, mean hemoglobin during the last 3 months, type of iron chelators, iron chelators dosage, serum ferritin, and the use of hydroxyurea. Results: Overall, 1831 patients were registered [891 male (48.7%)]. Mean age of patients was 30±9.7 yr. Average of hemoglobin levels for female and male were 9.1±5.1 and 9.4±6.3 gr/dl, respectively. Seventy-six percent of transfusion-dependent patients (1385) have received iso-group PRBC (packed red blood cells), after crossma...
Abstract Diabetes mellitus (DM) is one of the potential complications in patients with transfusio... more Abstract Diabetes mellitus (DM) is one of the potential complications in patients with transfusion-dependent β-thalassemia major (β-TM). In this case-controlled study, we examined the pancreatic iron levels in outpatients with β-TM. In this study, cases of patients with β-TM and DM were gender- and age-matched with control subjects, who were non-diabetic and had normal blood glucose on standard oral glucose tolerance (OGTT) tests. One of four diagnoses [normal, pre-diabetes, impaired glucose tolerance (IGT), DM] was made according to the American Diabetes Association (ADA) criteria. The T2*-weighted magnetic resonance imaging (T2*-weighted MRI) of the heart, liver, and pancreas was performed using a 1.5 Tesla scanner. The study enrolled 26 diabetic cases, 17 non-diabetic cases, and eight cases of IGT or pre-diabetes cases. The severity of pancreatic and cardiac iron siderosis was significantly different between the groups. We found a statistically significant difference at 5.6 ms in the T2*-weighted MRI values for the pancreas between patients with normal vs. abnormal glucose metabolism [p < 0.009; odds ratio (OR): 11.2; 95% confidence interval (95% CI): 1.32-94.4)]. The receiver operating characteristic (ROC) curve for the 5.6 ms cutoff led to an area under the curve (AUC) of 0.69 (95% CI: 55.0-84.0; p < 0.02), with sensitivity and specificity of 94.0 and 42.0%, respectively. There was a moderate positive correlation between pancreatic and cardiac T2*-weighted MRI (r = 0.4; p < 0.001), and a weak correlation between the pancreas and the liver (r = 0.38; p < 0.005). To conclude, we have introduced a cutoff of 5.6 ms on T2*-weighted MRI of the pancreas for prediction of abnormal glucose metabolism in β-TM patients.
Cognitive impairment and dementia are major neurocognitive disorders that cause a noticeable decl... more Cognitive impairment and dementia are major neurocognitive disorders that cause a noticeable decline in cognitive abilities, including memory and thinking skills. The effectiveness of using folic acid as an adjuvant for management of neurocognitive disorders is not well-known. This paper explains the role of folic acid, including its usefulness, effectiveness, adverse side effects, and active mechanisms on cognitive functions of the elderly. In the current study, we reviewed clinical and experimental studies investigating the use of folic acid prior to November 2017, using PubMed, ISI Web of Knowledge, Science Direct, Scopus, Ovid, and Cochrane Library databases. A total of 142 articles were retrieved by electronic search. Based on the preset inclusion and exclusion criteria, a total of 36 articles were retrieved for full text analysis. According to data obtained from the review, it seems that folic acid supplementation may improve cognitive function by decreasing homocysteine (Hcy), vascular care, attenuating inflammatory status, modification of cerebral folic acid deficiency, and antioxidant responses. Specifically, people with high levels of Hcy have a better response to folic acid supplementation, which may arise from low serum folate concentration.
Introduction: Pulmonary arterial hypertension (PAH) is relatively prevalent in patients with thal... more Introduction: Pulmonary arterial hypertension (PAH) is relatively prevalent in patients with thalassemia. PAH treatment is necessary as the prevalence of Doppler-estimated PAH and the resultant mortality is high in such patients. Materials and methods: This study aimed at evaluating the effect of bosentan therapy on patients with thalassemia suspected of PAH. Based on pulsed Doppler echocardiography, all the cases were suspected of severe PAH. Consequently, bosentan was initiated at a dose of 62.5 mg twice a day for 4 weeks, which was increased to 62.5-125 mg twice a day, if no adverse side effects were observed. Results: The results of this study showed that pulmonary artery pressure (PAP) decreased after the administration of bosentan in three cases, from 160 to 120, 110 to 65, and 60 to 25 mmHg; in other words, the PAP reduced in the mentioned cases by 25%, 36.4%, and 58.4%, respectively. Conclusion: In this study, PAP improved after bosentan therapy in patients with β-thalassemia suspected of PAH; however, further studies are required to confirm the findings.
Background: Despite advances in pain management, several patients continue to experience severe a... more Background: Despite advances in pain management, several patients continue to experience severe acute pain after lumbar spine surgery. The aim of this study was to assess the safety and effectiveness of single ultra-low-dose intrathecal (IT) naloxone in combination with IT morphine for reducing pain intensity, pruritus, nausea, and vomiting in patients undergoing lumbar laminectomy with spinal fusion. Materials and Methods: In this double-blind trial, patients scheduled for lumbar laminectomy with spinal fusion were randomly assigned to receive single ultra-low-dose IT naloxone (20 μg) and IT morphine (0.2 mg) (group M+N) or IT morphine (0.2 mg) alone (group M). The severity of postoperative pain, pruritus and nausea, and frequency of vomiting were assessed at recovery from anesthesia and, subsequently, at 1, 3, 6, 12, and 24 hours postoperatively using an 11-point (0-10) visual analogue scale. Results: A total of 77 patients completed the study, and there were significant differences in postoperative pain, pruritus, and nausea visual analogue scale between the groups (P < 0.05). After adjusting for body mass index and surgery duration, IT naloxone administration reduced the pain score (coefficient = 1.84; 95% confidence interval [CI], 1.05-2.63; P < 0.001), and the scores of pruritus and nausea (coefficient = 0.9; 95% CI, 0.44-1.37; P < 0.001 and coefficient = 0.71; 95% CI, 0.12-1.31; P = 0.02, respectively) compared with IT morphine alone. No serious adverse effects were observed. Conclusions: The addition of ultra-low-dose IT naloxone to IT morphine provides excellent postoperative pain management and effectively controls pruritus and nausea in patients undergoing laminectomy with spinal fusion.
Introduction: The benefit of annual administration of zoledronic acid in the management of thalas... more Introduction: The benefit of annual administration of zoledronic acid in the management of thalassemia-associated osteoporosis is unknown. Aim: The aims of this study were to evaluate the efficacy of treatment with two different dosing regimens of IV zoledronic acid (annually versus every 3 months) for increasing low bone mineral density (BMD) in patients with osteoporosis associated with β-thalassemia as annually and 3-monthly on bone density in patients. Materials and Methods: This retrospective, single-center study analyzed patients' clinical records and bone density measurements. Those enrolled in the study were 14 to 53 years of age, had documented β-thalassemia, and were treated with IV zoledronic acid on either an annual or every 3 months dosing regimen. Dual-energy X-ray absorptiometry was used to obtain the z-score for BMD in the lumbar spine and femoral neck. Results: Thirty-four patients were enrolled in the study; 15 (44.1%) had been treated annually, and 19 (55.9%) had been treated every month. In patients receiving treatment with the once-yearly dose of zoledronic acid, significant increases were observed in the lumbar spine BMD z-score, from-2.45 ± 0.69 to-1.97 ± 0.82 (P=0.02). When comparing BMD across the two treatment regimens, the mean lumbar spine BMD was 0.82 greater (95% CI 0.31, 1.33, P=0.003) and the mean femoral neck BMD 0.37 greater (95% CI-0.15, 0.87, P=0.1) in the group receiving annual zoledronic acid treatment. Conclusions: In patients with thalassemia-associated osteopenia, annual treatment with zoledronic acid increases lumbar spine bone density while being more effective, less expensive, and associated with fewer adverse events than dosing every 3 months.
Medical archives (Sarajevo, Bosnia and Herzegovina), 2018
Right ventricular infarction (RVI) develops in 30-50% of patients with inferior wall infarction (... more Right ventricular infarction (RVI) develops in 30-50% of patients with inferior wall infarction (IWI). The rates of mortality, morbidity, and complications in these patients are greater than in the patients without RVI. We compared the tissue Doppler imaging (TDI) indices between a group of patients with IWI and RVI, with a similar group of patients who had IWI alone to investigate the application of TDI indices in the evaluation and detection of right ventricular function. We studied 49 patients with first acute IWI in two groups. Group 1 (N=24) were patients with IWI and RVI while group 2 consisted of patients with IWI alone (N=25), based on standard electrocardiogram criteria. The peak systolic (Sm), peak early (Em) and late (Am) diastolic velocities, and Em/Am ratio were obtained from the apical four chamber view, at the lateral side of the tricuspid annulus. We measured trans-tricuspid early (ET) and peak (AT) filling velocity, ET/AT ratio, right ventricular end diastolic diame...
This study aimed to determine the potential iron-chelating effects of silymarin in patients with ... more This study aimed to determine the potential iron-chelating effects of silymarin in patients with β-thalassemia major receiving standard iron-chelation therapy. We evaluated whether addition of silymarin to standard iron-chelation therapy could improve iron burden markers and liver and cardiac function in these patients, via a placebo-controlled, crossover clinical study. Silymarin (140 mg) or placebo were administered thrice daily to all patients (n = 82) for 12 weeks, and after a 2-week washout period, patients were crossed over to the other groups. Silymarin efficacy was assessed by measuring serum iron level, ferritin level, total iron-binding capacity and liver and cardiac function on magnetic resonance imaging. Silymarin treatment resulted in a negative change in the serum iron and ferritin levels and a positive change in the total iron-binding capacity levels (treatment effect, p < .001, p = .06, and p = .05, respectively). Silymarin treatment led to positive changes in car...
Highlight; 1. Iron overload is the main cause of oxidative stress in patients with thalassemia 2.... more Highlight; 1. Iron overload is the main cause of oxidative stress in patients with thalassemia 2. Silymarin may modify nuclear expression through enhancing the synthesis of ribosomal RNA by stimulating DNA polymerase I. 3. Silymarin has the potential to be used as adjuvant therapy to restore antioxidant defenses and decrease complications of iron overload status.
Brief Communication IntRoductIon Ventilator-associated pneumonia (VAP) is an important complicati... more Brief Communication IntRoductIon Ventilator-associated pneumonia (VAP) is an important complication in patients who need mechanical ventilation (MV). [1] VAP is the most common infection among patients undergoing MV and has been associated with increased mortality (approaching 50%), morbidity, duration of MV, and length of Intensive Care Unit (ICU) stay. Despite advances in preventive strategies, such as the implementation of VAP bundle and Centers for Disease Control and Prevention recommendations in critical care, the mortality and morbidity rate still requires substantial improvement. [1,2] It is believed that critical illness stress-induced immune suppression plays an important role in the development of hospital infections. [3] Insufficient zinc levels have been suggested to play a role in stress-induced lymphopenia, and consequent immune suppression. Zinc is a crucial mineral for many biological functions in humans. [3,4] A number of studies have been performed in children and elderly, clearly demonstrated the beneficial impact of zinc supplementation on immune function and the prevention of pulmonary infections; [5-7] however, the association between zinc supplementation Background: Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the Intensive Care Unit (ICU). The aim of this analysis is to determine potential association between zinc supplementation with the occurrence of VAP in adult mechanically ventilated trauma patients. Subjects and Methods: This secondary analysis of a prospective observational study was carried out over a period of 1 year in ICUs of one teaching hospital in Iran. A total of 186 adults mechanically ventilated trauma patients, who required at least 48 h of MV and received zinc sulfate supplement (n = 82) or not (n = 104) during their ICU stay, were monitored for the occurrence of VAP until their discharge from the ICU or death. Results: Forty-one of 186 patients developed VAP, 29.09 days after admission (95% confidence interval [CI]: 26.27-31.9). The overall incidence of VAP was 18.82 cases per 1000 days of intubation (95% CI: 13.86-25.57). Patients who received zinc sulfate supplement have smaller hazard of progression to VAP than others (hazard ratio: 0.318 [95% CI: 0.138-0.732]; P < 0.0001). Conclusion: The findings show that zinc supplementation may be associated with a significant reduction in the occurrence of VAP in adult mechanically ventilated trauma patients. Further well-designed randomized clinical trials to confirm the efficacy of this potential preventive modality are warranted.
Globally, b-thalassemia major (b-TM) is one of the most common hereditary disorders. Multiple blo... more Globally, b-thalassemia major (b-TM) is one of the most common hereditary disorders. Multiple blood transfusions, that are a life-saving therapy in patients with b-TM, is a major source of iron overload. Iron overload can lead to significant morbidity and mortality. Research evidence indicates that oxidative stress induced by iron overload, is one of the major precipitating causes of vitamin C deficiency in b-TM patients. It has previously been shown that patients with b-TM have significantly lower levels of vitamin C as compared to healthy individuals. It is believed that vitamin C can reduce both ferric (Fe 3+) and ferrous (Fe 2+) ions, and also facilitate the accessibility of iron to chelators through increase of iron release from the reticuloendothelial system. Despite the potential benefits of vitamin C in patients with b-TM, several areas of concern exist that should be addressed by high quality research designs. Some recommendations have been provided through this study.
Background: Ventilator-associated pneumonia is the most frequent infection occurring in mechanica... more Background: Ventilator-associated pneumonia is the most frequent infection occurring in mechanically ventilated patients in the intensive care unit. Ventilator-associated pneumonia is a serious issue and remains a significant clinical problem for critically ill patients. The aim of this review article is to evaluate studies to conclude the best existing evidence for providing oral hygiene to intensive care unit patients receiving mechanical ventilation, determine the clinical evidence considering chlorhexidine, and to document a research to improve care interventions used for oral care in the critical patients. Materials and Methods: Searching was performed in the databases: Sciencedirect, SID, CINAHL, Google Scholar, Cochrane Library, Springer and PubMed for accessibility to the studies carried out regarding with chlorhexidine mouthwash and ventilator-associated pneumonia between 1991 to 2014 years by using keywords: chlorhexidine mouthwash and ventilator-associated pneumonia. Results: Although oral care with chlorhexidine cause a reduce the incidence of ventilatorassociated pneumonia, but no evidence exists on decrease of mortality in patients undergoing mechanical ventilation admitted in the intensive care unit following its using. Conclusion: Base on this current review article can be said that protective effect of chlorhexidine mouthwash has proved in oral health and prevention of ventilator-associated pneumonia in the critical patients, but unfortunately no evidence exists to the appropriate protocol for using of chlorhexidine mouthwash in these patients.
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Papers by Hadi Darvishi Khezri