Tehran University of Medical Sciences Journal, 2023
Background: Systemic Sclerosis (SSc) is an autoimmune disease with multi-organ involvement mostly... more Background: Systemic Sclerosis (SSc) is an autoimmune disease with multi-organ involvement mostly due to fibrosis and ectopic or excessive collagen fibers production in organs. Myocardial fibrosis is the main finding of cardiac involvement in patients with systemic sclerosis. In recent studies, the presence of Fragmented QRS complexes (FQRS) has been shown in the surface electrocardiogram in relation to fibrosis. Methods: The present study is a case-control study during March 2019 to February 2020 that was conducted in 148 patients with scleroderma referred to the Rheumatology clinic in Shariati Hospital and 101 non-ischemic individuals in the control group matched by age and sex with the patient group. All the medical records were reviewed and those who were low risk according to 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment were selected as case groups. Data of ECG were evaluated for availability of FQRS or conductive abnormalities and calculating PR, QRS, QT, QTc and Tp-e intervals. Results: Of the 141 patients with systemic sclerosis, 127(85.81%) were female and 21(14.19%) were male. In the control group, 81 women (80.2%) were present. 61(41.2%) of patients with scleroderma and 8(7.9%) of the control group in this study had FQRS changes in their electrocardiogram. In this study, QRS, QTc and Tp-e intervals were significantly higher in patients with systemic sclerosis compared to those in the control group. The frequency of FQRS, LAHB and LPHB in patients with systemic sclerosis was significantly more than control group. The relationship between PR, QRS, QTc, Tp-e intervals with age, length of disease onset and the severity of skin involvement was assessed. There was a significant correlation between PR-interval and age. Furthermore, there were a correlation between QRS interval and Rodnan skin score, Pulmonary Artery Pressure and Finger to Palm. It is also a meaningful correlation between QTc interval and Rodnan score. Conclusion: The FQRS finding in electrocardiogram in patients with systemic sclerosis, which has no obvious cardiac symptoms, may indicate myocardial fibrosis and predict future cardiac disorders.
Background: Pneumatic Balloon Dilation (PBD) as an achalasia treatment is painful procedure becau... more Background: Pneumatic Balloon Dilation (PBD) as an achalasia treatment is painful procedure because of tearing the lower esophageal sphincter (LES) muscle fibres. Recently, two sedation methods including the moderate sedation and deep sedation are used for increasing the convenience of the patients and gastroenterologist. Methods: To compare the efficacy of moderate and deep sedation in PBD in treatment of Idiopathic Achalasia (IA). Results: We prospectively assessed 200 IA patients. The first 100 patients (group A) underwent PBD by the moderate sedation using diazepam or midazolam and meperidine injections. The patients in the group B (100 patients) received midazolam, fentanyl and propofol as a deep sedation. The pulse rate (PR), systolic and diastolic blood pressure (SBP, DBP), respiratory rate (RR), and oxygen saturation were monitored before, during and after PBD and achalasia symptom scores (ASS) were collected before and 1.5 months after treatment. The mean PR during and aft...
Problem Endometriosis is an immune‐related chronic inflammatory disease with a polygenic predisp... more Problem Endometriosis is an immune‐related chronic inflammatory disease with a polygenic predisposition. The aim of this study was to investigate whether polymorphisms in killer cell immunoglobulin‐like receptors (KIRs) is responsible, in part, for genetic susceptibility to endometriosis.Method of study The KIRs genotype was determined in 186 patients with endometriosis and 165 control women using polymerase chain reaction with sequence‐specific primers.Results The frequency of KIR3DS1 was significantly decreased in patients compared with controls (32%versus 44%, P = 0.028). KIR data were analyzed using a model comprised of three large groups, in which a gradient of activation/inhibitory potential derived from the combination of KIR and human leukocyte antigen (HLA) ligand genes was taken into account. The frequency of inhibitory KIRs/HLA‐class I combination genotypes was significantly higher in patients than in controls (χ2 = 6.010, 2 df, P = 0.0496).Conclusion Our results sugg...
Background Systemic sclerosis is a multiorgan autoimmune disease that can overlap with other rheu... more Background Systemic sclerosis is a multiorgan autoimmune disease that can overlap with other rheumatologic disorders; however, co-occurrence with antineutrophil cytoplasmic antibody-associated vasculitis is rare. Case presentation A 39-year-old Persian female patient with systemic sclerosis according to American College of Rheumatology/European League Against Rheumatism 2013 criteria with a disease duration of 6 years was admitted to the hospital due to a rise in creatinine level in July 2021. She had complaints of nasal speech and feeling of nasal perforation. The first symptoms of antineutrophil cytoplasmic antibody-associated vasculitis had started 5 years earlier with palpable purpura in the lower limbs, hemoptysis, and positive perinuclear (p)-antibody-associated vasculitis level (> 300 AU/mL). Still, the diagnosis was not achieved due to the patient's reluctance to undergo a biopsy. She was treated with azathioprine (150 mg/day) and prednisolone (10 mg/day) during the 5...
Objectives In the current study, we aimed to investigate the effect of smoking on inadequate resp... more Objectives In the current study, we aimed to investigate the effect of smoking on inadequate response to methotrexate (MTX-IR) in rheumatoid arthritis (RA) patients. Methods We searched PubMed, Embase, and Web of Science until 6 June 2022. Observational or interventional studies investigating MTX-IR in RA patients based on smoking status were included. Two independent reviewers assessed the risk of bias and the certainty of the evidence using the Risk of Bias in Nonrandomized Studies–of Interventions and Grades of Recommendation, Assessment, Development, and Evaluation tools, respectively. Results We included 23 studies in the systematic review and 13 in the meta-analysis. Of the 13 included studies, 6 had a moderate risk, 3 had a serious risk, and 4 had a critical risk of bias. The overall random-effect meta-analysis suggested that smokers were 58% more likely to be MTX-IR when compared with nonsmokers [odds ratio (OR) 1.58, 95% confidence interval 1.21–2.06; P = .001; I2 = 69.3%]....
BACKGROUND: The rate of hospital readmission is seen as a measure of quality and accountability. ... more BACKGROUND: The rate of hospital readmission is seen as a measure of quality and accountability. Knowing the risk factors that can be changed could reduce the cost burden on patients with inflammatory bowel disease (IBD) and the health system. METHODS: Retrospective analysis was performed on the data extracted from hospital records during a 4-year period. The study setting encompassed three referral hospitals in Tehran and the south of Iran. The primary outcome was hospital readmission of patients with IBD. The factors associated with binary and categorical dependent variables were analyzed using robust logistic regression and multinomial logistic regression, respectively. The significance level was set at P=0.05. RESULTS: 187 patients were admitted during the 4-year study period for an IBD-related reason, among whom 131 patients (70.1%) had ulcerative colitis (UC), and 56 patients (29.9%) had Crohn’s disease (CD). Moreover, 29% (55) of the participants had been readmitted at least ...
A new approach to fire engineering opens possibilities of designing buildings in which the struct... more A new approach to fire engineering opens possibilities of designing buildings in which the structural skeleton is part of the architectural statement. Fire and corrosion requirements used to make it difficult to use exposed steel in buildings. Various methods over the years have been used, such as flame shielding and intumescent coatings, but these methods also obscure the steel. Since the work about 15 years ago by Margaret Law in the 1980's, and full-scale testing in the U.S. and the U.K., more analytical methods have developed. The current state-of-the-art procedure has four steps. Designers determine the fire load based on the combustible material present or on a code-prescribed magnitude. Then they characterize the fire and flame profile, and the duration of the fire. They consider the compartment and window openings and ventilation. They use empirical fire engineering equations to do this. The process is described in detail. The authors give three examples of buildings for...
Systemic sclerosis (SSc) is a collagen-vascular disorder characterized by fibrosis and vasculopat... more Systemic sclerosis (SSc) is a collagen-vascular disorder characterized by fibrosis and vasculopathy. Delta finger to palm distance (delta FTP) is an index measuring the distance between the tip of the third finger to the distal palmar crease in the flexed and extended position. The present study aimed to evaluate the clinical value of delta FTP and to assess the correlation of delta FTP with modified Rodnan skin score (mRSS) and forced vital capacity (FVC) over the 12-month follow-up. This prospective longitudinal study began with 50 participants who were followed for twelve months. Lowess smoothing and linear regression were applied to detect and assess the relationship between delta FTP and mRSS. p-values were adjusted by the Benjamini-Hochberg method (BHM) as a control for false discovery rate. Delta FTP was lower among patients with higher disease duration (p-valueadj: 0.008), diffuse cutaneous SSc (p-valueadj: 0.006), digital ulcers (p-valueadj: 0.003), telangiectasia (p-valuea...
The recent pandemic of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to wo... more The recent pandemic of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to worldwide uncertainty about the potential risks to those with autoimmune diseases [1]. Long-term immunosuppression in patients with rheumatic diseases is a major concern. As already known, microbial infections have a more severe and complicated course in immunocompromised patients [2]. However, the clinical course of Coronavirus Disease 2019 (COVID-19) in this high-risk population is still unknown [1]. Systemic Sclerosis (SSc) is a systemic autoimmune disease with multi-organ manifestations secondary to fibrosis and vasculopathy. Cardiopulmonary involvement is a major problem and the main cause of mortality in these patients [3]. Theoretically, the synergistic effect of long-term immunosuppression and underlying pulmonary involvement renders these patients susceptible to a more severe form of COVID-19 [1]. In this letter, we reported clinical data on COVID-19 in 150 patients with SSc. To the best of our knowledge, this is the first report focusing exclusively on the clinical features of COVID-19 in SSc patients. We studied 150 patients with SSc from February 20 to August 20, 2020, and all patients were on treatment with immunosuppressants. During in-person or virtual visits, the patients were asked to complete a questionnaire about their clinical manifestations of COVID-19 and their medications. All patients gave informed consent to have their data used for research purposes.
Tehran University of Medical Sciences Journal, 2023
Background: Systemic Sclerosis (SSc) is an autoimmune disease with multi-organ involvement mostly... more Background: Systemic Sclerosis (SSc) is an autoimmune disease with multi-organ involvement mostly due to fibrosis and ectopic or excessive collagen fibers production in organs. Myocardial fibrosis is the main finding of cardiac involvement in patients with systemic sclerosis. In recent studies, the presence of Fragmented QRS complexes (FQRS) has been shown in the surface electrocardiogram in relation to fibrosis. Methods: The present study is a case-control study during March 2019 to February 2020 that was conducted in 148 patients with scleroderma referred to the Rheumatology clinic in Shariati Hospital and 101 non-ischemic individuals in the control group matched by age and sex with the patient group. All the medical records were reviewed and those who were low risk according to 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment were selected as case groups. Data of ECG were evaluated for availability of FQRS or conductive abnormalities and calculating PR, QRS, QT, QTc and Tp-e intervals. Results: Of the 141 patients with systemic sclerosis, 127(85.81%) were female and 21(14.19%) were male. In the control group, 81 women (80.2%) were present. 61(41.2%) of patients with scleroderma and 8(7.9%) of the control group in this study had FQRS changes in their electrocardiogram. In this study, QRS, QTc and Tp-e intervals were significantly higher in patients with systemic sclerosis compared to those in the control group. The frequency of FQRS, LAHB and LPHB in patients with systemic sclerosis was significantly more than control group. The relationship between PR, QRS, QTc, Tp-e intervals with age, length of disease onset and the severity of skin involvement was assessed. There was a significant correlation between PR-interval and age. Furthermore, there were a correlation between QRS interval and Rodnan skin score, Pulmonary Artery Pressure and Finger to Palm. It is also a meaningful correlation between QTc interval and Rodnan score. Conclusion: The FQRS finding in electrocardiogram in patients with systemic sclerosis, which has no obvious cardiac symptoms, may indicate myocardial fibrosis and predict future cardiac disorders.
Background: Pneumatic Balloon Dilation (PBD) as an achalasia treatment is painful procedure becau... more Background: Pneumatic Balloon Dilation (PBD) as an achalasia treatment is painful procedure because of tearing the lower esophageal sphincter (LES) muscle fibres. Recently, two sedation methods including the moderate sedation and deep sedation are used for increasing the convenience of the patients and gastroenterologist. Methods: To compare the efficacy of moderate and deep sedation in PBD in treatment of Idiopathic Achalasia (IA). Results: We prospectively assessed 200 IA patients. The first 100 patients (group A) underwent PBD by the moderate sedation using diazepam or midazolam and meperidine injections. The patients in the group B (100 patients) received midazolam, fentanyl and propofol as a deep sedation. The pulse rate (PR), systolic and diastolic blood pressure (SBP, DBP), respiratory rate (RR), and oxygen saturation were monitored before, during and after PBD and achalasia symptom scores (ASS) were collected before and 1.5 months after treatment. The mean PR during and aft...
Problem Endometriosis is an immune‐related chronic inflammatory disease with a polygenic predisp... more Problem Endometriosis is an immune‐related chronic inflammatory disease with a polygenic predisposition. The aim of this study was to investigate whether polymorphisms in killer cell immunoglobulin‐like receptors (KIRs) is responsible, in part, for genetic susceptibility to endometriosis.Method of study The KIRs genotype was determined in 186 patients with endometriosis and 165 control women using polymerase chain reaction with sequence‐specific primers.Results The frequency of KIR3DS1 was significantly decreased in patients compared with controls (32%versus 44%, P = 0.028). KIR data were analyzed using a model comprised of three large groups, in which a gradient of activation/inhibitory potential derived from the combination of KIR and human leukocyte antigen (HLA) ligand genes was taken into account. The frequency of inhibitory KIRs/HLA‐class I combination genotypes was significantly higher in patients than in controls (χ2 = 6.010, 2 df, P = 0.0496).Conclusion Our results sugg...
Background Systemic sclerosis is a multiorgan autoimmune disease that can overlap with other rheu... more Background Systemic sclerosis is a multiorgan autoimmune disease that can overlap with other rheumatologic disorders; however, co-occurrence with antineutrophil cytoplasmic antibody-associated vasculitis is rare. Case presentation A 39-year-old Persian female patient with systemic sclerosis according to American College of Rheumatology/European League Against Rheumatism 2013 criteria with a disease duration of 6 years was admitted to the hospital due to a rise in creatinine level in July 2021. She had complaints of nasal speech and feeling of nasal perforation. The first symptoms of antineutrophil cytoplasmic antibody-associated vasculitis had started 5 years earlier with palpable purpura in the lower limbs, hemoptysis, and positive perinuclear (p)-antibody-associated vasculitis level (> 300 AU/mL). Still, the diagnosis was not achieved due to the patient's reluctance to undergo a biopsy. She was treated with azathioprine (150 mg/day) and prednisolone (10 mg/day) during the 5...
Objectives In the current study, we aimed to investigate the effect of smoking on inadequate resp... more Objectives In the current study, we aimed to investigate the effect of smoking on inadequate response to methotrexate (MTX-IR) in rheumatoid arthritis (RA) patients. Methods We searched PubMed, Embase, and Web of Science until 6 June 2022. Observational or interventional studies investigating MTX-IR in RA patients based on smoking status were included. Two independent reviewers assessed the risk of bias and the certainty of the evidence using the Risk of Bias in Nonrandomized Studies–of Interventions and Grades of Recommendation, Assessment, Development, and Evaluation tools, respectively. Results We included 23 studies in the systematic review and 13 in the meta-analysis. Of the 13 included studies, 6 had a moderate risk, 3 had a serious risk, and 4 had a critical risk of bias. The overall random-effect meta-analysis suggested that smokers were 58% more likely to be MTX-IR when compared with nonsmokers [odds ratio (OR) 1.58, 95% confidence interval 1.21–2.06; P = .001; I2 = 69.3%]....
BACKGROUND: The rate of hospital readmission is seen as a measure of quality and accountability. ... more BACKGROUND: The rate of hospital readmission is seen as a measure of quality and accountability. Knowing the risk factors that can be changed could reduce the cost burden on patients with inflammatory bowel disease (IBD) and the health system. METHODS: Retrospective analysis was performed on the data extracted from hospital records during a 4-year period. The study setting encompassed three referral hospitals in Tehran and the south of Iran. The primary outcome was hospital readmission of patients with IBD. The factors associated with binary and categorical dependent variables were analyzed using robust logistic regression and multinomial logistic regression, respectively. The significance level was set at P=0.05. RESULTS: 187 patients were admitted during the 4-year study period for an IBD-related reason, among whom 131 patients (70.1%) had ulcerative colitis (UC), and 56 patients (29.9%) had Crohn’s disease (CD). Moreover, 29% (55) of the participants had been readmitted at least ...
A new approach to fire engineering opens possibilities of designing buildings in which the struct... more A new approach to fire engineering opens possibilities of designing buildings in which the structural skeleton is part of the architectural statement. Fire and corrosion requirements used to make it difficult to use exposed steel in buildings. Various methods over the years have been used, such as flame shielding and intumescent coatings, but these methods also obscure the steel. Since the work about 15 years ago by Margaret Law in the 1980's, and full-scale testing in the U.S. and the U.K., more analytical methods have developed. The current state-of-the-art procedure has four steps. Designers determine the fire load based on the combustible material present or on a code-prescribed magnitude. Then they characterize the fire and flame profile, and the duration of the fire. They consider the compartment and window openings and ventilation. They use empirical fire engineering equations to do this. The process is described in detail. The authors give three examples of buildings for...
Systemic sclerosis (SSc) is a collagen-vascular disorder characterized by fibrosis and vasculopat... more Systemic sclerosis (SSc) is a collagen-vascular disorder characterized by fibrosis and vasculopathy. Delta finger to palm distance (delta FTP) is an index measuring the distance between the tip of the third finger to the distal palmar crease in the flexed and extended position. The present study aimed to evaluate the clinical value of delta FTP and to assess the correlation of delta FTP with modified Rodnan skin score (mRSS) and forced vital capacity (FVC) over the 12-month follow-up. This prospective longitudinal study began with 50 participants who were followed for twelve months. Lowess smoothing and linear regression were applied to detect and assess the relationship between delta FTP and mRSS. p-values were adjusted by the Benjamini-Hochberg method (BHM) as a control for false discovery rate. Delta FTP was lower among patients with higher disease duration (p-valueadj: 0.008), diffuse cutaneous SSc (p-valueadj: 0.006), digital ulcers (p-valueadj: 0.003), telangiectasia (p-valuea...
The recent pandemic of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to wo... more The recent pandemic of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to worldwide uncertainty about the potential risks to those with autoimmune diseases [1]. Long-term immunosuppression in patients with rheumatic diseases is a major concern. As already known, microbial infections have a more severe and complicated course in immunocompromised patients [2]. However, the clinical course of Coronavirus Disease 2019 (COVID-19) in this high-risk population is still unknown [1]. Systemic Sclerosis (SSc) is a systemic autoimmune disease with multi-organ manifestations secondary to fibrosis and vasculopathy. Cardiopulmonary involvement is a major problem and the main cause of mortality in these patients [3]. Theoretically, the synergistic effect of long-term immunosuppression and underlying pulmonary involvement renders these patients susceptible to a more severe form of COVID-19 [1]. In this letter, we reported clinical data on COVID-19 in 150 patients with SSc. To the best of our knowledge, this is the first report focusing exclusively on the clinical features of COVID-19 in SSc patients. We studied 150 patients with SSc from February 20 to August 20, 2020, and all patients were on treatment with immunosuppressants. During in-person or virtual visits, the patients were asked to complete a questionnaire about their clinical manifestations of COVID-19 and their medications. All patients gave informed consent to have their data used for research purposes.
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Papers by Zahra Tamartash
Methods: The present study is a case-control study during March 2019 to February 2020 that was conducted in 148 patients with scleroderma referred to the Rheumatology clinic in Shariati Hospital and 101 non-ischemic individuals in the control group matched by age and sex with the patient group. All the medical records were reviewed and those who were low risk according to 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment were selected as case groups. Data of ECG were evaluated for availability of FQRS or conductive abnormalities and calculating PR, QRS, QT, QTc and Tp-e intervals.
Results: Of the 141 patients with systemic sclerosis, 127(85.81%) were female and 21(14.19%) were male. In the control group, 81 women (80.2%) were present. 61(41.2%) of patients with scleroderma and 8(7.9%) of the control group in this study had FQRS changes in their electrocardiogram. In this study, QRS, QTc and Tp-e intervals were significantly higher in patients with systemic sclerosis compared to those in the control group. The frequency of FQRS, LAHB and LPHB in patients with systemic sclerosis was significantly more than control group. The relationship between PR, QRS, QTc, Tp-e intervals with age, length of disease onset and the severity of skin involvement was assessed. There was a significant correlation between PR-interval and age. Furthermore, there were a correlation between QRS interval and Rodnan skin score, Pulmonary Artery Pressure and Finger to Palm. It is also a meaningful correlation between QTc interval and Rodnan score.
Conclusion: The FQRS finding in electrocardiogram in patients with systemic sclerosis, which has no obvious cardiac symptoms, may indicate myocardial fibrosis and predict future cardiac disorders.
Methods: The present study is a case-control study during March 2019 to February 2020 that was conducted in 148 patients with scleroderma referred to the Rheumatology clinic in Shariati Hospital and 101 non-ischemic individuals in the control group matched by age and sex with the patient group. All the medical records were reviewed and those who were low risk according to 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment were selected as case groups. Data of ECG were evaluated for availability of FQRS or conductive abnormalities and calculating PR, QRS, QT, QTc and Tp-e intervals.
Results: Of the 141 patients with systemic sclerosis, 127(85.81%) were female and 21(14.19%) were male. In the control group, 81 women (80.2%) were present. 61(41.2%) of patients with scleroderma and 8(7.9%) of the control group in this study had FQRS changes in their electrocardiogram. In this study, QRS, QTc and Tp-e intervals were significantly higher in patients with systemic sclerosis compared to those in the control group. The frequency of FQRS, LAHB and LPHB in patients with systemic sclerosis was significantly more than control group. The relationship between PR, QRS, QTc, Tp-e intervals with age, length of disease onset and the severity of skin involvement was assessed. There was a significant correlation between PR-interval and age. Furthermore, there were a correlation between QRS interval and Rodnan skin score, Pulmonary Artery Pressure and Finger to Palm. It is also a meaningful correlation between QTc interval and Rodnan score.
Conclusion: The FQRS finding in electrocardiogram in patients with systemic sclerosis, which has no obvious cardiac symptoms, may indicate myocardial fibrosis and predict future cardiac disorders.