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To evaluate a technique for contrast agent preparation as mixing the patients' blood with agitated saline and to compare it with agitated saline alone in diagnosis of cardiac right-to-left shunt in regard to their... more
To evaluate a technique for contrast agent preparation as mixing the patients' blood with agitated saline and to compare it with agitated saline alone in diagnosis of cardiac right-to-left shunt in regard to their sensitivity, time window, and distribution of artificially induced microembolic signals. Fifty-two patients with stroke who had Transesophageal echocardiography proven right-to-left shunt underwent contrast-transcranial Doppler sonography with injection of agitated (i) 9 ml saline with 1 ml air with Valsalva maneuver, (ii) 9 ml saline with 1 ml air without Valsalva maneuver, (iii) 8 ml saline, 1 ml of the patient's fresh blood and 1 ml air with Valsalva maneuver, and (iv) 8 ml saline, 1 ml of the patient's fresh blood and 1 ml air without Valsalva maneuver. The sensitivity of the bilateral middle cerebral artery monitoring in diagnosis of right-to-left shunt was 94.2%, 71.2%, 96.2% and 76.9% for agitated saline with Valsalva maneuver, agitated saline without Valsalva maneuver, agitated saline and blood with Valsalva maneuver, and agitated saline and blood without Valsalva maneuver methods, respectively. Severe right-to-left shunt was detected in 100% of patients when agitated saline and blood with Valsalva maneuver was used. Application of Valsalva maneuver resulted in detection of more right-to-left shunt (P = 0.002). Agitated saline mixed with blood with Valsalva maneuver is a sensitive method to detect right-to- left shunt, especially in the case of severe shunt. Mixing agitated saline with blood may increase the sensitivity of the test.
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Carotid angioplasty and stenting (CAS) is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after CAS. This is a prospective... more
Carotid angioplasty and stenting (CAS) is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after CAS. This is a prospective study that was conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing CAS were enrolled. Both standard- and high-risk patients for endarterectomy were enrolled. Demographic data, atherosclerotic risk factors, site of stenosis, degree of stenosis, and data regarding technical factors were recorded. Thirty-day stroke, myocardial infarction, and/or death were considered as the composite primary outcomes of the study. A total of 251 patients were recruited (mean age: 71.1 ± 9.6 years; male: 65.3%). Of these, 178 (70.9%) were symptomatic, 73 (29.1%) were diabetic, 129 (51.4%) were hyperlipidemic, 165 (65.7%) were hypertensive, and 62 (24.7%) patients were smokers. CAS was performed for left internal carotid artery (ICA) in 113 (45.4%) patients. Fourteen (5.6%) patients had sequential bilateral stenting. Mean stenosis of operated ICA was 80.2 ± 13.8%. An embolic protection device was used in 203 (96.2%) patients. Pre- and postdilation were performed in 39 (18.5%) and 182 (86.3%) patients, respectively. Composite outcomes were observed in 3.6% of patients (3.2% stroke, 0% myocardial infarction, and 1.2% death). Left-sided lesions and the presence of diabetes mellitus were significantly associated with poor short-term outcome (p = 0.025 and p = 0.020, respectively). There was a higher risk of short-term major complications in diabetic patients and for left carotid artery intervention.
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Secondary erythrocytosis in cyanotic congenital heart disease (CCHD) is a compensatory response to chronic hypoxia which should be managed with caution. CCHD patients, who have compensated erythrocytosis but do not manifest significant... more
Secondary erythrocytosis in cyanotic congenital heart disease (CCHD) is a compensatory response to chronic hypoxia which should be managed with caution. CCHD patients, who have compensated erythrocytosis but do not manifest significant neurologic symptoms, may experience secondary life-threatening complications such as stroke in case of inappropriate phlebotomy. This study reports a young man with CCHD who developed frequently repeated transient neurologic deficits with various presentations after one session of phlebotomy. The symptoms resolved a few days after the hematocrit (Hct) level returned to the prephlebotomy level.
Large artery disease (LAD) is a common cause of stroke, but a little is known regarding its role in Iranian stroke patients. The current study investigates the prevalence and risk factors for cervicocephalic arterial stenosis in the... more
Large artery disease (LAD) is a common cause of stroke, but a little is known regarding its role in Iranian stroke patients. The current study investigates the prevalence and risk factors for cervicocephalic arterial stenosis in the patients with ischemic stroke using digital subtraction angiography (DSA). This was a prospective cross-sectional study performed in hospitals affiliated to Shiraz University of Medical Sciences from March 2011 to March 2013. Patients with ischemic stroke underwent noninvasive vascular and cardiac investigations to find the etiology of the stroke. Patients suspected of having large artery stenosis underwent DSA. The severity of the stenosis was calculated according to the North American Symptomatic Carotid Endarterectomy (NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial criteria. The presence of cigarette smoking, hyperlipidemia, hypertension, and diabetes mellitus were documented for all subjects. A total of 3703 stroke patien...
The present study was carried out to evaluate cerebral perfusion in different types of cerebral palsy (CP) patients. For those patients who underwent hyperbaric oxygen therapy, brain perfusion before and after the therapy was compared. A... more
The present study was carried out to evaluate cerebral perfusion in different types of cerebral palsy (CP) patients. For those patients who underwent hyperbaric oxygen therapy, brain perfusion before and after the therapy was compared. A total of 11 CP patients were enrolled in this study, of which 4 patients underwent oxygen therapy. Before oxygen therapy and at the end of 40 sessions of oxygen treatment, 99mTc-ECD brain perfusion single photon emission computed tomography (SPECT) was performed , and the results were compared. A total of 11 CP patients, 7 females and 4 males with an age range of 5-27 years participated in the study. In brain SPECT studies, all the patients showed perfusion impairments. The region most significantly involved was the frontal lobe (54.54%), followed by the temporal lobe (27.27%), the occipital lobe (18.18%), the visual cortex (18.18%), the basal ganglia (9.09%), the parietal lobe (9.09%), and the cerebellum (9.09%). Frontal-lobe hypoperfusion was seen...
The purpose of this study is to propose an innovative method of knowledge transfer that aims to improve health literacy about pediatric infectious diseases prevention in families. Children have an appreciable role in this scheme. This... more
The purpose of this study is to propose an innovative method of knowledge transfer that aims to improve health literacy about pediatric infectious diseases prevention in families. Children have an appreciable role in this scheme. This study is a before and after trial that has been conducted in Hamedan in 2009. After changing seven infectious disease topics into childish poems, we selected five kindergartens randomly and taught these poetries to the children. Teaching process held after a pretest containing 24 questions that examined 103 of parents about mentioned topics. The same post-test was given after 4 months of teaching process. The mean of correct answers to the pretest was 59.22% comparable with 81.00% for post-test (P<0.00). Gender and knowledge degree could not change the results significantly. Assuming one's correct answers to the questions as his/her Knowledge Mark, the mean of this variable increased to 5.32 by this method. This cost-effective and joyful method ...
Water shortage problems have led to find either new water resources or improve wastewater treatment technologies in order to reuse. Due to less performance of previous units in microbial removal, disinfection has become a necessary step... more
Water shortage problems have led to find either new water resources or improve wastewater treatment technologies in order to reuse. Due to less performance of previous units in microbial removal, disinfection has become a necessary step in wastewater treatment plants. In the present study performance of hydrogen peroxide (HP) and modified Fenton&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s reagent (HP + Cu(++)) was considered for the disinfection of raw wastewater (RW) and activated sludge effluent (ASE). Plastic containers of 10-liter volume each were used for RW and ASE sampling. Microbiological analyses of the RW and ASE were performed in triplicate; before and after the disinfection process. Fecal coliforms were analyzed by the direct (without enrichment) multiple fermentation tube procedure. The results showed that using HP alone did not have any significant disinfection capability. In RW and ASE, the highest dose used in this study could reduce fecal coliforms (FC)s by only 1.54 and 1.16 log-inactivation, respectively. However, Maximum removal efficiency of modified Fenton in RW and ASE was 4.63 and 3.41 log-inactivation, respectively. The results suggested that Cu(++) ions used in combination with H2O2 produced very rigorous synergistic effect, and HP disinfection capacity increased significantly. Hydrogen peroxide, when applied alone, was not successful in disinfecting of either RW or ASE, and neither the WHO guideline nor the Iranian standard could be met. However, modified Fenton showed very significant disinfection potential and could reduce FCs under World Health Organization (WHO) guideline and Iranian national standard for agricultural irrigation.
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... A case of Degos disease with pleuropericardial fibrosis, jejunal perforation, hemiparesis, and widespread cutaneous lesions. Mostafa Mirshams Shahshahani MD,; Pantea Hashemi MD,;Reza Nemati MD,; Azita Nikoo MD,; Hamed Mazoochy MD,;... more
... A case of Degos disease with pleuropericardial fibrosis, jejunal perforation, hemiparesis, and widespread cutaneous lesions. Mostafa Mirshams Shahshahani MD,; Pantea Hashemi MD,;Reza Nemati MD,; Azita Nikoo MD,; Hamed Mazoochy MD,; Armin Rashidi MD. ...
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Research Interests: Multiple sclerosis, Risk, Cytokines, Vitamin D, Multidisciplinary, and 21 moreAdipose tissue, Lumbar spine, Prospective studies, Humans, Femur, Female, Male, Regression Analysis, Lectins, Bone Density, PLoS one, C reactive protein, Adult, Bone Mineral Density, Multiple regression analysis, Bone and Bones, Enzyme Linked Immunosorbent Assay, Total Hip, Gene Expression Regulation, Case Control Studies, and Matrix Metalloproteinase
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A reduced rate of neurogenesis occurs in the adult brain of patients with neurological diseases, with the rate of new neuron proliferation not sufficient to replace neuron loss. Neurogenesis can be induced by several factors, including... more
A reduced rate of neurogenesis occurs in the adult brain of patients with neurological diseases, with the rate of new neuron proliferation not sufficient to replace neuron loss. Neurogenesis can be induced by several factors, including basic fibroblast growth factor, epidermal growth factor, and brain-derived neurotrophic factor. Neurogenesis determination is a valuable parameter for determining disease progression and monitoring various treatments. Currently, neurogenesis detection is possible by invasive methods, such as bromodeoxyuridine (BrdU) cell labeling and immunohistological analysis of immature neuron markers. However, these are not compatible with alive model examination. Neurogenesis detection by noninvasive methods, such as radiolabeling of specific antibodies and scintigraphy imaging, could shed light on immature neuronal markers. We propose that brain scintigraphy after radiolabeling of a specific antibody of an immature neuronal marker is a useful new modality for neurogenesis detection and that it would aid the management of neurological diseases.
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Research Interests:
To evaluate the incidence, frequency, and contributing factors of microembolic signals (MESs) in patients with cryptogenic stroke with or without patent foramen ovale (PFO). Transcranial Doppler monitoring for MESs detection was performed... more
To evaluate the incidence, frequency, and contributing factors of microembolic signals (MESs) in patients with cryptogenic stroke with or without patent foramen ovale (PFO). Transcranial Doppler monitoring for MESs detection was performed for 62 patients with acute cryptogenic stroke with PFO (PFO(+)) and 34 patients with acute cryptogenic stroke without PFO (PFO(-)). The incidence of MESs was not significantly higher in PFO(+) patients (17/62, 27.4%) in comparison to PFO(-) patients (6/34, 17.6%; odds ratio 1.76, 95% confidence interval 0.62-5.00; P = .327). The frequency of MESs in PFO(+) patients was statistically higher than that of PFO(-) patients (0.70 ± 1.47 v 0.23 ± 0.55; P = .026). MESs was presented with higher incidence in a subgroup of patients suffering from both patent foramen ovale and atrial septal aneurysm (P = .044). The likelihood of PFO as a source of MESs is higher when associated with atrial septal aneurysm.
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The effects of antiepileptic drugs (AEDs) on bone mineral density (BMD) are well addressed, but data on children, especially concerning new antiepileptic medications, are scarce. This study aimed to reveal the impact of these drugs on the... more
The effects of antiepileptic drugs (AEDs) on bone mineral density (BMD) are well addressed, but data on children, especially concerning new antiepileptic medications, are scarce. This study aimed to reveal the impact of these drugs on the BMD of ambulatory patients with epilepsy. BMD and detailed clinical information were obtained on 108 patients and 38 controls using dual-energy x-ray absorptiometry. The patients were categorized into 2 groups: enzyme-inducing AEDs (EIAEDs) and non-EIAEDs. Also, the patients were classified as being in either a monotherapy or a polytherapy group. All patients completed a 63-item questionnaire. In this study, the raw value of BMD, T score, and z score of the spine, neck of femur, total hip, and forearm were analyzed. Patients receiving AEDs showed diminished lumbar BMD, compared with controls (P &amp;amp;amp;amp;amp;amp;lt; 0.05), regardless of the type of AED (EIAEDs or non-EIAEDs). In addition, there was a significant decrease in femoral neck BMD in patients receiving EIAEDs (0.922 ± 0.161, P &amp;amp;amp;amp;amp;amp;lt; 0.05) but not in those treated with non-EIAEDs. Patients undergoing carbamazepine monotherapy (33 patients) showed diminished lumbar and femoral neck BMD, whereas those receiving valproate (22 patients) or undergoing polytherapy showed a BMD similar to that of controls in all studied regions of interest. There was no notable change in BMD in the Ward triangle, trochanter, or total hip in either the EIAED or the non-EIAED group. AED therapy, especially in patients on new-generation medication, is associated with low bone density. It is hoped that the presented data stressing several clinical and diagnostic points will stimulate a high index of suspicion to facilitate early diagnosis and preventive care.
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Distinguishing epileptic generalized tonic-clonic seizures (GTCS) from either psychogenic nonepileptic seizures (PNES) or vasovagal syncope (VVS) is important. In this study, we investigated the use of postictal serum creatine... more
Distinguishing epileptic generalized tonic-clonic seizures (GTCS) from either psychogenic nonepileptic seizures (PNES) or vasovagal syncope (VVS) is important. In this study, we investigated the use of postictal serum creatine phosphokinase (CPK) concentrations in distinguishing between these events. Patients admitted to the Neurology Ward at Namazi Hospital in Shiraz, Iran, with an attack of transient loss of consciousness and abnormal movements witnessed by a neurologist were studied. We categorized the patients into three groups: 20 patients with GTCS, 22 with VVS, and 20 with PNES. A group of 20 normal healthy individuals were included in the study as the control group. Serum CPK concentration was measured 12-15 h after the attack in all patients and at one time in the control group. A P value less than 5% was considered significant. There were no significant differences between the four groups with respect to age and sex. Mean CPK concentrations statistically significantly differed between the four groups, with higher levels in patients with GTCS (P=0.0001). Serum CPK concentration had a sensitivity of 75% and specificity of 86% for the diagnosis of GTCS. CPK concentration was above 160 mg/dl in 75% of patients with GTCS, 15% of patients with PNES, 13.6% of patients with VVS, and 15% of the control group (P=0.0001). The PNES, VVS, and control groups did not statistically significantly differ with respect to CPK concentrations. In patients with a recent loss of consciousness and abnormal movements, serum CPK concentration is a useful, practical, and relatively accurate parameter to assist in the differentiation of epileptic seizures from either VVS or PNES.
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Research Interests:
ABSTRACT Many studies have been conducted to increase the efficiency of hydrogen peroxide (HP) in wastewater disinfection to make HP disinfection more cost-effective with respect to reduced concentration and detention time. In this study,... more
ABSTRACT Many studies have been conducted to increase the efficiency of hydrogen peroxide (HP) in wastewater disinfection to make HP disinfection more cost-effective with respect to reduced concentration and detention time. In this study, the effects of HP, copper ions (Cu 2+), and 1 atm. pressure-dissolved oxygen (termed O 2 in this study) applied either alone or in a binary or ternary combination to undisinfected secondary treated wastewater (STW) were assessed. Undisinfected STW in contact (1 h) with various doses of HP (alone), Cu 2+ (alone), HP/Cu 2+ (binary) and HP/Cu 2+ with O 2 (ternary) showed a variable fecal coliforms (FC) removal pattern, ranging from 0.03 to 3.8 logs inactivation. O 2 had the highest synergistic effect when combined with Cu 2+ and HP. The use of 200 mg L -1 HP + 5 mg L -1 Cu 2+ together with O 2 caused a 0.65 log inactivation of FC more than the binary combination (i.e., 200 mg L -1 HP + 5 mg L -1 Cu 2+).
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Research Interests:
We have recently defined the structures and biological activities of novel serine lipids of Porphyromonas gingivalis, and shown that these lipids are potent activators of both human and mouse Toll-like receptor 2 (TLR2). This lipid class... more
We have recently defined the structures and biological activities of novel serine lipids of Porphyromonas gingivalis, and shown that these lipids are potent activators of both human and mouse Toll-like receptor 2 (TLR2). This lipid class was previously identified in a limited number of Flavobacteria and was called Flavolipin. However, Flavolipin was reported to engage TLR4 rather than TLR2. Objective: The purpose of this investigation was to isolate the serine lipids of P. gingivalis in very high purity and verify their capacity to engage human TLR2. Method: Total lipids were extracted from lyophilized P. gingivalis (ATCC 33277) previously grown in broth culture. The lipids were fractionated by normal phase HPLC using a semi preparative column eluted with a neutral HPLC solvent (hexane:isopropanol:water, 6/8/0.75, v/v/v). The fractions were screened for serine lipids using liquid chromatography-mass spectrometry (LC-MS) and the fractions containing serine lipids were pooled and refr...
Landau-Kleffner syndrome (LKS) is a rare childhood disorder characterized by acquired aphasia and epilepsy. 99mTc-ECD SPECT imaging was performed in two right-handed children with LKS. A relative decrease in perfusion was found in the... more
Landau-Kleffner syndrome (LKS) is a rare childhood disorder characterized by acquired aphasia and epilepsy. 99mTc-ECD SPECT imaging was performed in two right-handed children with LKS. A relative decrease in perfusion was found in the left frontal-temporal cortices of both patients as well as in the left and right parietal cortices of one patient with aphasia, without clinical epilepsy. The degree of regional cerebral perfusion impairment did not correlate with the severity of the clinical and EEG abnormalities, but the area of hypoperfusion was compatible with the speech area of the brain. Overall, although asymmetrical temporoparietal perfusion appears as a common finding in LKS, SPECT findings in LKS alone cannot elucidate the pathogenic features of the disorder in the brain. Here, we present two cases of LKS in which we investigated SPECT perfusion scans.
Brain single photon emission computed tomography (SPECT) studies were conducted in three patients with A3243G mutation of the mitochondrial (mt) DNA tRNA. All were born to mothers suffering from chronic progressive external... more
Brain single photon emission computed tomography (SPECT) studies were conducted in three patients with A3243G mutation of the mitochondrial (mt) DNA tRNA. All were born to mothers suffering from chronic progressive external ophthalmoplegia (CPEO) with the same A3243G point mutation of the mtDNA tRNA. The first case manifested clinically with MELAS, the second case manifested with CPEO, and third case