Ahmadreza Zarifian | University Hospital Lewisham (original) (raw)

Papers by Ahmadreza Zarifian

Aggression is a behavior that might be accompanied by violence and agonistic behavior. Aggression... more Aggression is a behavior that might be accompanied by violence and agonistic behavior. Aggression and violence have numerous social adverse effects such as family conflict, crime, murder, rape and theft. International issues of war and terrorism are correlated as well (1). WHO categorizes violence among the top 20 causes of disability adjusted life years worldwide and this figure projected to increase by 2030s (2). Anger and violence has been associated with numerous adverse outcomes both individual and social. The relation of coronary heart diseases (CHD) with anger has been proven repeatedly. Fear and stress arousal because of aggression can lead to tachycardia, hypertension and atherosclerosis (3). Studies linked the unhealthy anger management behaviors to social and individual adverse effects. A somewhat smaller literature has focused on health-promoting ways of managing anger (controlling anger and releasing it through discussion with a confidant), showing that these anger mana...

DOAJ (DOAJ: Directory of Open Access Journals), Feb 1, 2015

Introduction: Staphylococcus aureus is a prominent human pathogen. One of the drugs used in the t... more Introduction: Staphylococcus aureus is a prominent human pathogen. One of the drugs used in the treatment of staphylococcal infections (particularly infections of skin and soft tissue), is clindamycin. Resistance to clindamycin includes two types: inducible and constitutive. Routine laboratory methods of antibiotic susceptibility testing cannot detect the inducible type and Dtest is required for its detection. The purpose of this systematic review was to determine the relative prevalence of this type of resistance in Iran. Methods: Search terms "inducible clindamycin resistant", "D-test", "Staphylococcus aureus" and "Iran" were used to find relevant articles in PubMed, Google Scholar and two Persian search engines. Also, the abstracts of the recent national microbiology congresses were checked. All studies used D-test to find iMLSB (inducible macrolide, lincosamide and streptograminB resistance) phenotype among clinical isolates (not nasal swabs) of S. aureus, were included. In order to perform meta-analysis, we used "comprehensive meta-analysis" software (ver. 2). Results: In total, 9 articles and 8 abstracts related to the topic of the study were found. Random effects meta-analyses showed a pooled estimate for percentage of iMLSB phenotype among 2683 samples of S. aureus was about 10% (95% confidence interval: 0.07-0.12). Using the fixed effect model, the odds of positive iMLSB in methicillin-resistant S. aureus was about 5 times more likely to occur in comparison with methicillin-susceptible S. aureus (95% CI: 3.49 to 7.76). Conclusion: Fortunately, the relative frequency of inducible resistance to clindamycin in our country is relatively low. However, we believe that D-test should be performed for all erythromicin-resistant isolates in order to identify inducible resistance to clindamycin. Moreover, reevaluation of inducible resistance to clindamycin in forthcoming years is highly recommended.

The American Journal of Emergency Medicine, 2022

Background: We aimed to determine the characteristics, risk factors, and outcomes associated with... more Background: We aimed to determine the characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients. Methods: PubMed, Embase, Web of Science, and Scopus databases were searched to retrieve articles on readmitted COVID-19 patients, available up to September 25, 2021. All studies comparing characteristics of readmitted and non-readmitted COVID-19 patients were included. We also included articles reporting the reasons for readmission in COVID-19 patients. Data were pooled and meta-analyzed using random or fixed-effect models, as appropriate. Subgroup analyses were conducted based on the place and duration of readmission. Results: Our meta-analysis included 4823 readmitted and 63,413 non-readmitted COVID-19 patients. The rehospitalization rate was calculated at 9.3% with 95% Confidence Interval (CI) [5.5%-15.4%], mostly associated with respiratory or cardiac complications (48% and 14%, respectively). Comorbidities including cerebrovascular disease (Odds Ratio (OR) = 1.812; 95% CI [1.547-2.121]), cardiovascular (2.173 [1.545-3.057]), hypertension (1.608 [1.319-1.960]), ischemic heart disease (1.998 [1.495-2.670]), heart failure (2.556 [1.980-3.300]), diabetes (1.588 [1.443-1.747]), cancer (1.817 [1.526-2.162]), kidney disease (2.083 [1.498-2.897]), chronic pulmonary disease (1.601 [1.438-1.783]), as well as older age (1.525 [1.175-1.978]), male sex (1.155 [1.041-1.282]), and white race (1.263 [1.044-1.528]) were significantly associated with higher readmission rates (P < 0.05 for all instances). The mortality rate was significantly lower in readmitted patients (OR = 0.530 [0.329-0.855], P = 0.009). Conclusions: Male sex, white race, comorbidities, and older age were associated with a higher risk of readmission among previously admitted COVID-19 patients. These factors can help clinicians and policy-makers predict, and conceivably reduce the risk of readmission in COVID-19 patients.

journal of cardio-thoracic medicine, 2016

Introduction: Psoriasis is a chronic inflammatory skin disease characterized by plaques covered w... more Introduction: Psoriasis is a chronic inflammatory skin disease characterized by plaques covered with silvery scales. Psoriasis is highly prevalent in different countries in the world, including Iran. Several studies have reported a significant association between psoriasis and cardiovascular diseases. This study aimed to evaluate the relationship between psoriasis and cardiac disease using echocardiography.Materials and Methods: This cross-sectional study was conducted in Imam Reza Hospital of Mashhad, Iran during 2013-2014 on patients with clinical diagnosis of psoriasis confirmed via biopsy. In addition, healthy volunteers homogenous in terms of age and gender were selected as the control group. Echocardiography was performed on patients and control subjects. Size of the left and right ventricles, left ventricle ejection fraction, diastolic function, and pulmonary artery pressure were recorded. In addition, patients were assessed in terms of the presence of valve regurgitation and...

Introduction: Anger and aggression are associated to many personal and social outcomes and physic... more Introduction: Anger and aggression are associated to many personal and social outcomes and physical adverse effects. The aggressive behaviors also affected academic and job achievements. This study aimed to assess aggressive behaviors and their predictors in general population of Mashhad, Iran, 2014. Materials and Methods: In this descriptive cross-sectional study, a total number of 656 people in Mashhad city (the second biggest city of Iran) were assessed. The survey was done using the Buss-Perry Aggression Questionnaire in the public spaces across the city. Data were analyzed using descriptive statistics, t-test, Mann-Whitney U test, and linear regression by SPSS 11.5 software Results: The mean ages in women and men were 27.68±10.54 years and 29.83±12.72 years respectively. Mean scores were 23.37 and 22.17 for physical, 12.3 and 13.15 for verbal, 17.31 and 15.99 for anger, and 19.57 and 18.06 for hostility domains among men and women respectively. There was a significant differ...

journal of cardio-thoracic medicine, 2016

Introduction: Although coronary endarterectomy is not an ideal procedure, it is the only availabl... more Introduction: Although coronary endarterectomy is not an ideal procedure, it is the only available option for cardiac surgeons in some patients with diffuse coronary artery disease. Based on the majority of conducted studies, the results of coronary endarterectomy (including survival, graft patency, and recurrence of the symptoms of myocardial ischemia) are less prevalent than standard coronary artery bypass grafting. Generally, the left anterior descending artery (LAD) is the most commonly involved artery in coronary endarterectomy. The aim of this study was evaluate clinical and early results of Endarterectomy of LAD artery. Materials & Methods: In total, 30 cases of coronary endarterectomy of the LAD were studied from January 2015 until January 2016.this is a retrospective study that Endarterectomy procedure was performed in Imamreza hospital of Mashhad university of medical sciences. Results: The mean age of the subjects was 63±4.5 years (range: 45-78 years). As the findings ...

future of medical education journal, 2018

Background Concept maps are considered not only as a powerful method of meaningful learning, but ... more Background Concept maps are considered not only as a powerful method of meaningful learning, but also as an instrument for evaluating the efficiency of learning. Different inquiries suggest that concept maps by promoting critical thinking and clinical reasoning may play a significant role in increasing adherence to infection prevention methods and therefore reduce healthcare-associated infections. Methods In January 2015, Mashhad Medical Microbiology Student Research Group (MMMSRG) invited all academics from all over Iran to design concept maps trying to answer this focus question: “How can we reduce the Healthcare-associated Infections?” We received about 40 concept maps, from which 29 met our inclusion criteria. All the C-maps were judged based on the designed rubrics, adapted from Novak and Cronin’s scoring criteria with some modifications. Results Among the accepted concept maps, four, which had achieved the most scores and proposed some new ideas in infection prevention and con...

International Journal of Pediatrics, 2016

Background Pulmonary artery banding (PAB) is a technique of palliative surgical therapy used by c... more Background Pulmonary artery banding (PAB) is a technique of palliative surgical therapy used by congenital heart surgeons as a staged approach to operative correction of congenital heart defects. Materials and Methods We report 5- year experiences from January 2011 to January 2016 of Imam Reza Hospital center (a tertiary referral hospital in Mashhad city, North East of Iran) that consist of 50 patients with congenital heart disease with left to right shunt that pulmonary artery banding procedure was performed for them were studied. Results Age of patients (n=50) was 1to 9 months (mean=4.6 + 1.3). In this study, the most common disease that need to PAB procedure was Ventricular septal defect (VSD) with twenty-eight patients (56%). Mean of extubation time (hour) was 10.4 + 0.8 and mean of hospital stay (day) was 13.3 + 2.4 respectively. Conclusion Although the number of pulmonary artery banding palliation surgery was decreased, but in selected group of congenital heart disease, this p...

Introduction: Birth weight, as one of the main indices of growth, is among the determining factor... more Introduction: Birth weight, as one of the main indices of growth, is among the determining factors of survival. Given the absence of documented studies and lack of information regarding the influence of mothers’ body mass index (BMI) on newborns’ birth weight, this study was carried out with the aim to determine the relation between the mother’s BMI at the beginning of pregnancy and the infant’s weight at birth. Methods: In the current cross-sectional study, 800 pregnant women, who were referred to medical and healthcare centers of Mashhad during 2011 (with a gestational age less than 12 weeks), were selected using stratified random multi-level cluster sampling. In the first prenatal checkup, a questionnaire, containing questions about personal information, was completed and mothers’ BMIs were calculated. At birth, the infants’ weight and other variables were surveyed. Analysis of data was done using SPSS version 11.5 and descriptive and analytical tests. Results:Among 800 mothers, ...

Background Radial head fractures commonly occur during elbow traumas. Among those, treatment of M... more Background Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type III fractures is still under controversy. Common treatment methods for these fractures include open reduction and internal fixation (ORIF) as well as radial head excision. In this study, we compared long-term outcomes of both methods in treatment of patients with Mason type III fractures of radial head. Methods Fifteen men and five women with Mason type III radial head fractures were evaluated retrospectively. Ten patients had undergone excision whereas the other ten patients had been treated with ORIF. Outcomes were assessed based on stability and range of motion of the elbow joint, grip strength, and pain. Data were gathered using Mayo elbow performance index (MEPI), Oxford elbow score, and disability of arm-shoulder-hand (DASH), along with the short form (SF)-36 questionnaire. Results The mean age of the subjects was 36.25±9.22 years and the mean follow-up time was 25.05±11....

Background Radial head fractures commonly occur during elbow traumas. Among those, treatment of M... more Background Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type III fractures is still under controversy. Common treatment methods for these fractures include open reduction and internal fixation (ORIF) as well as radial head excision. In this study, we compared long-term outcomes of both methods in treatment of patients with Mason type III fractures of radial head. Methods Fifteen men and five women with Mason type III radial head fractures were evaluated retrospectively. Ten patients had undergone excision whereas the other ten patients had been treated with ORIF. Outcomes were assessed based on stability and range of motion of the elbow joint, grip strength, and pain. Data were gathered using Mayo elbow performance index (MEPI), Oxford elbow score, and disability of arm-shoulder-hand (DASH), along with the short form (SF)-36 questionnaire. Results The mean age of the subjects was 36.25±9.22 years and the mean follow-up time was 25.05±11....

Introduction: Unwanted pregnancy is one of the most important problems, facing married couples. T... more Introduction: Unwanted pregnancy is one of the most important problems, facing married couples. This type of pregnancy has a negative impact on maternal, fetal, and neonatal outcomes. In this study, we aimed to evaluate the relationship between unwanted pregnancy (based on the couples’ opinions) and infants’ nutrition in patients admitted to medical centers of Mashhad in years 2009-2010. Methods: In this cross-sectional study, 300 women with infants under the age of 1 year, who were referred to medical centers of Mashhad, were asked whether or not their pregnancy was planned. Then, they were questioned about their infants’ nutritional status (at the age of 4 months). Data were collected using questionnaires and interviews. Validity and reliability of the methods were confirmed using content analysis and test-retest. Data were analyzed using SPSS version 11.5 and statistical tests. In statistical tests, P-value of 0.05 was considered statistically significant. Results: The findings o...

A 54-year-old female patient was presented with upper extremity ischemia. Further investigation r... more A 54-year-old female patient was presented with upper extremity ischemia. Further investigation revealed ulcerated atherosclerosis plaque in aorta with intramural hematoma and clot formation. The subject underwent a successful surgical resection of mass with the assistance of cardiopulmonary bypass and total circulatory arrest.

Introduction: Coronary endarterectomy is not a perfect procedure. However, it is sometimes the on... more Introduction: Coronary endarterectomy is not a perfect procedure. However, it is sometimes the only available alternative for cardiac surgeons in patients suffering from diffuse coronary artery disease. According to a large volume of studies, coronary endarterectomy results (such as survival, recurrence of the symptoms of myocardial ischemia, and graft patency) are not as satisfactory as standard coronary artery bypass grafting (CABG). While the left anterior descending artery (LAD) is the artery most commonly involved in coronary endarterectomy, RCA can be treated with coronary endarterectomy. This study aimed to evaluate clinical evidence and early results of right coronary artery

Journal of Education and Health Promotion, 2018

BACKGROUND: The development of public transportation (PT) is a crucial issue in the modern societ... more BACKGROUND: The development of public transportation (PT) is a crucial issue in the modern societies. The aim of this study was to assess the status of PT usage among the population residing in Mashhad. MATERIALS AND METHODS: In a cross-sectional design, 464 citizens of Mashhad filled a checklist about PT-use (i.e., bus, taxi, and metro) to find their supporting and opposing factors in 2014. Chi-square, Mann–Whitney, Student's t-test, and logistic regressions were used for inferential analysis in SPSS 11.5. RESULTS: Mean age was 30.02 ± 11.24 years and 57% (263) were female. Bus (169, 50%) was the most popular PT means, followed by metro (98, 29%) and taxi (74, 21%). Most transportations were happened at morning (248, 35%) and evening (221, 31%). Increasing age (odds ratio [OR] =1.04, confidence interval [CI] 95% = 1.008–1.07), higher education (OR = 2.91, CI 95% = 1.14–7.38), being homemaker (OR = 2.97, CI 95% = 1.19–7.36), or student (OR = 2.91, CI 95% = 1.14–7.38) were predictors of PT-use. CONCLUSION: Individual preference between PT and driving is associated with social, economic, and cultural aspects of a population. Recognizing the influencing factors can help to design population-oriented services.

Clinical Rheumatology, 2019

Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis leading to joint dama... more Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis leading to joint damage and physical disability. Cardiovascular diseases (CVDs) are considered a common comorbidity in patients with RA. However, the mechanism underlying its pathogenesis is not definitively explained. Endothelial dysfunction caused by impaired nitric oxide synthesis is an early indicator of cardiovascular disease. Asymmetric and symmetric dimethylarginine (ADMA and SDMA, respectively) the inhibitors of endothelial nitric oxide synthase (NOS) have emerged as novel CVD risk factor determiners. Concerning the unmet need to identify a salutary biomarker for CVD prediction, the purpose of this meta-analysis was to assess the serum/plasma ADMA and SDMA levels in RA patients compared with the healthy controls. A thorough literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar to identify all studies reporting ADMA and/or SDMA levels in RA patients compared with healthy controls. The quality of studies was evaluated using the Newcastle-Ottawa scale (NOS). Pooled standard mean difference (SMD) with 95% confidence interval (CI) was used as the effect size in this study. We also conducted stratified analysis based on assay methods and median age of the participants. Fourteen articles were included. The pooled serum/plasma levels of ADMA were higher in RA patients compared with those of healthy controls (SMD = 1.02, 95% CI = 0.49 to 1.55); However, no statistical differences between RA patients and healthy controls in serum/plasma SDMA levels was seen (SMD = 0.57, 95% CI = −0.21 to 1.36). Subgroup analyses suggested that participants aged > 50 years had higher levels of ADMA rather than controls and the measurement method was a source of heterogeneity for ADMA. According to the results of this metaanalysis, ADMA measurement but not SDMA, can be useful for assessment of endothelial dysfunction as a predictor of CVD risk in RA patients. Prospero registration number: CRD42019121126.

Journal of Pharmaceutical Research International, 2019

Aims: This study aimed to assess possible alterations in adiposity and dietary intake during holi... more Aims: This study aimed to assess possible alterations in adiposity and dietary intake during holiday periods in healthy subjects. Study Design: 452 students of medicine faculty of Mashhad University of Medical Sciences were participated in this study and announced via internet and campus announcement in Feb 2014. Methodology: Anthropometric parameters and body composition were measured using standard protocols. Individual nutritional intakes were assessed using the Dietplan6 software. SPSS software version 11.5 was used for statistical analysis. Results: Of the 452 students who attended the pre-holiday visit, 433 returned for the post-holiday appointments. Of these participants, 82 (18.1%) were men. The mean age was 24.4 years for men and 23.8 years for women (p=0.171). All the adiposity and body composition variables significantly changed over the follow-up except for fat free mass (p=0.074) and truck fat free mass (p=0.935). Mean weight of participants increased from 63.5 kg to 6...

International Urogynecology Journal, 2018

Introduction and hypothesis Genitourinary syndrome of menopause is a major health concern in post... more Introduction and hypothesis Genitourinary syndrome of menopause is a major health concern in postmenopausal women. This study was aimed at comparing the effect of a vitamin E vaginal suppository with that of conjugated estrogen vaginal cream on sexual function in postmenopausal women with genitourinary syndrome of menopause. Methods This survey was carried out on 52 postmenopausal women aged 40-65 years who had been referred to gynecology clinics in Mashhad city, during 2013-2014. Keeping β = 0.1, the power was calculated to be 90%. The patients were randomly divided into two groups: vitamin E vaginal suppository and conjugated estrogen vaginal cream. Participants used the medications for 12 weeks. They were visited at the 4th, 8th, and 12th weeks. Validated Abbreviated Sexual Function Questionnaire (ASFQ), as the primary outcome measure, and a demographic information questionnaire, were used to collect data at each visit. Data were analyzed using SPSS and p < 0.05 was considered statistically significant. Results Mean overall scores of the ASFQ were increased significantly in both groups during the course of the study, compared with baseline (p < 0.001). However, the mean ASFQ scores of the two treatments did not differ significantly. Conclusion Improved scores of ASFQ after the 12th week showed that the treatment was successful in both groups. Therefore, a vitamin E vaginal suppository may be an alternative to vaginal estrogen in relieving the symptoms of vaginal atrophy in postmenopausal women, especially those not able to use hormone therapy or have low compliance.

Infectious Diseases, 2019

Brucellosis, caused by the intracellular pathogens Brucella, is one of the major zoonotic infecti... more Brucellosis, caused by the intracellular pathogens Brucella, is one of the major zoonotic infections. Considering the economic burden, its prevalence has been a health concern especially in endemic regions. Brucella is able to survive and replicate within host cells by expressing different virulence factors and using various strategies to avoid the host's immune response. This leads to progression of the disease from an acute phase to chronic brucellosis. Exploration of genetic variations has confirmed the expected influence of gene polymorphisms on susceptibility and resistance to brucellosis of humans. Since there is no approved human vaccine and treatment is uncertain with risk of relapse, it is important to increase knowledge about pathogenesis, diagnosis and treatment of brucellosis in order to manage and control this infection, especially in endemic regions.

Indian journal of endocrinology and metabolism

Obesity is associated with several complications like metabolic syndrome. Many professional athle... more Obesity is associated with several complications like metabolic syndrome. Many professional athletes adopt a sedentary lifestyle after retirement. This study was aimed at assessing the risk of developing obesity, insulin resistance (IR), and metabolic syndrome among former power-sports athletes, compared with age-matched active athletes and nonathletes. The study was conducted in Mashhad during 2012-2014. The individuals were recruited through announcements and were divided into three groups of active athletes ( = 34), ex-athletes ( = 30), and nonathletes ( = 30). Demographic and anthropometric data were collected and biochemical factors including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol, triglycerides (TG), fasting plasma glucose, insulin, and high-sensitive C-reactive protein were measured. Ex-athletes had significantly higher mean values of weight, body mass index, diastolic blood pressure, LDL-C, insulin, homeos...

Aggression is a behavior that might be accompanied by violence and agonistic behavior. Aggression... more Aggression is a behavior that might be accompanied by violence and agonistic behavior. Aggression and violence have numerous social adverse effects such as family conflict, crime, murder, rape and theft. International issues of war and terrorism are correlated as well (1). WHO categorizes violence among the top 20 causes of disability adjusted life years worldwide and this figure projected to increase by 2030s (2). Anger and violence has been associated with numerous adverse outcomes both individual and social. The relation of coronary heart diseases (CHD) with anger has been proven repeatedly. Fear and stress arousal because of aggression can lead to tachycardia, hypertension and atherosclerosis (3). Studies linked the unhealthy anger management behaviors to social and individual adverse effects. A somewhat smaller literature has focused on health-promoting ways of managing anger (controlling anger and releasing it through discussion with a confidant), showing that these anger mana...

DOAJ (DOAJ: Directory of Open Access Journals), Feb 1, 2015

Introduction: Staphylococcus aureus is a prominent human pathogen. One of the drugs used in the t... more Introduction: Staphylococcus aureus is a prominent human pathogen. One of the drugs used in the treatment of staphylococcal infections (particularly infections of skin and soft tissue), is clindamycin. Resistance to clindamycin includes two types: inducible and constitutive. Routine laboratory methods of antibiotic susceptibility testing cannot detect the inducible type and Dtest is required for its detection. The purpose of this systematic review was to determine the relative prevalence of this type of resistance in Iran. Methods: Search terms "inducible clindamycin resistant", "D-test", "Staphylococcus aureus" and "Iran" were used to find relevant articles in PubMed, Google Scholar and two Persian search engines. Also, the abstracts of the recent national microbiology congresses were checked. All studies used D-test to find iMLSB (inducible macrolide, lincosamide and streptograminB resistance) phenotype among clinical isolates (not nasal swabs) of S. aureus, were included. In order to perform meta-analysis, we used "comprehensive meta-analysis" software (ver. 2). Results: In total, 9 articles and 8 abstracts related to the topic of the study were found. Random effects meta-analyses showed a pooled estimate for percentage of iMLSB phenotype among 2683 samples of S. aureus was about 10% (95% confidence interval: 0.07-0.12). Using the fixed effect model, the odds of positive iMLSB in methicillin-resistant S. aureus was about 5 times more likely to occur in comparison with methicillin-susceptible S. aureus (95% CI: 3.49 to 7.76). Conclusion: Fortunately, the relative frequency of inducible resistance to clindamycin in our country is relatively low. However, we believe that D-test should be performed for all erythromicin-resistant isolates in order to identify inducible resistance to clindamycin. Moreover, reevaluation of inducible resistance to clindamycin in forthcoming years is highly recommended.

The American Journal of Emergency Medicine, 2022

Background: We aimed to determine the characteristics, risk factors, and outcomes associated with... more Background: We aimed to determine the characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients. Methods: PubMed, Embase, Web of Science, and Scopus databases were searched to retrieve articles on readmitted COVID-19 patients, available up to September 25, 2021. All studies comparing characteristics of readmitted and non-readmitted COVID-19 patients were included. We also included articles reporting the reasons for readmission in COVID-19 patients. Data were pooled and meta-analyzed using random or fixed-effect models, as appropriate. Subgroup analyses were conducted based on the place and duration of readmission. Results: Our meta-analysis included 4823 readmitted and 63,413 non-readmitted COVID-19 patients. The rehospitalization rate was calculated at 9.3% with 95% Confidence Interval (CI) [5.5%-15.4%], mostly associated with respiratory or cardiac complications (48% and 14%, respectively). Comorbidities including cerebrovascular disease (Odds Ratio (OR) = 1.812; 95% CI [1.547-2.121]), cardiovascular (2.173 [1.545-3.057]), hypertension (1.608 [1.319-1.960]), ischemic heart disease (1.998 [1.495-2.670]), heart failure (2.556 [1.980-3.300]), diabetes (1.588 [1.443-1.747]), cancer (1.817 [1.526-2.162]), kidney disease (2.083 [1.498-2.897]), chronic pulmonary disease (1.601 [1.438-1.783]), as well as older age (1.525 [1.175-1.978]), male sex (1.155 [1.041-1.282]), and white race (1.263 [1.044-1.528]) were significantly associated with higher readmission rates (P < 0.05 for all instances). The mortality rate was significantly lower in readmitted patients (OR = 0.530 [0.329-0.855], P = 0.009). Conclusions: Male sex, white race, comorbidities, and older age were associated with a higher risk of readmission among previously admitted COVID-19 patients. These factors can help clinicians and policy-makers predict, and conceivably reduce the risk of readmission in COVID-19 patients.

journal of cardio-thoracic medicine, 2016

Introduction: Psoriasis is a chronic inflammatory skin disease characterized by plaques covered w... more Introduction: Psoriasis is a chronic inflammatory skin disease characterized by plaques covered with silvery scales. Psoriasis is highly prevalent in different countries in the world, including Iran. Several studies have reported a significant association between psoriasis and cardiovascular diseases. This study aimed to evaluate the relationship between psoriasis and cardiac disease using echocardiography.Materials and Methods: This cross-sectional study was conducted in Imam Reza Hospital of Mashhad, Iran during 2013-2014 on patients with clinical diagnosis of psoriasis confirmed via biopsy. In addition, healthy volunteers homogenous in terms of age and gender were selected as the control group. Echocardiography was performed on patients and control subjects. Size of the left and right ventricles, left ventricle ejection fraction, diastolic function, and pulmonary artery pressure were recorded. In addition, patients were assessed in terms of the presence of valve regurgitation and...

Introduction: Anger and aggression are associated to many personal and social outcomes and physic... more Introduction: Anger and aggression are associated to many personal and social outcomes and physical adverse effects. The aggressive behaviors also affected academic and job achievements. This study aimed to assess aggressive behaviors and their predictors in general population of Mashhad, Iran, 2014. Materials and Methods: In this descriptive cross-sectional study, a total number of 656 people in Mashhad city (the second biggest city of Iran) were assessed. The survey was done using the Buss-Perry Aggression Questionnaire in the public spaces across the city. Data were analyzed using descriptive statistics, t-test, Mann-Whitney U test, and linear regression by SPSS 11.5 software Results: The mean ages in women and men were 27.68±10.54 years and 29.83±12.72 years respectively. Mean scores were 23.37 and 22.17 for physical, 12.3 and 13.15 for verbal, 17.31 and 15.99 for anger, and 19.57 and 18.06 for hostility domains among men and women respectively. There was a significant differ...

journal of cardio-thoracic medicine, 2016

Introduction: Although coronary endarterectomy is not an ideal procedure, it is the only availabl... more Introduction: Although coronary endarterectomy is not an ideal procedure, it is the only available option for cardiac surgeons in some patients with diffuse coronary artery disease. Based on the majority of conducted studies, the results of coronary endarterectomy (including survival, graft patency, and recurrence of the symptoms of myocardial ischemia) are less prevalent than standard coronary artery bypass grafting. Generally, the left anterior descending artery (LAD) is the most commonly involved artery in coronary endarterectomy. The aim of this study was evaluate clinical and early results of Endarterectomy of LAD artery. Materials & Methods: In total, 30 cases of coronary endarterectomy of the LAD were studied from January 2015 until January 2016.this is a retrospective study that Endarterectomy procedure was performed in Imamreza hospital of Mashhad university of medical sciences. Results: The mean age of the subjects was 63±4.5 years (range: 45-78 years). As the findings ...

future of medical education journal, 2018

Background Concept maps are considered not only as a powerful method of meaningful learning, but ... more Background Concept maps are considered not only as a powerful method of meaningful learning, but also as an instrument for evaluating the efficiency of learning. Different inquiries suggest that concept maps by promoting critical thinking and clinical reasoning may play a significant role in increasing adherence to infection prevention methods and therefore reduce healthcare-associated infections. Methods In January 2015, Mashhad Medical Microbiology Student Research Group (MMMSRG) invited all academics from all over Iran to design concept maps trying to answer this focus question: “How can we reduce the Healthcare-associated Infections?” We received about 40 concept maps, from which 29 met our inclusion criteria. All the C-maps were judged based on the designed rubrics, adapted from Novak and Cronin’s scoring criteria with some modifications. Results Among the accepted concept maps, four, which had achieved the most scores and proposed some new ideas in infection prevention and con...

International Journal of Pediatrics, 2016

Background Pulmonary artery banding (PAB) is a technique of palliative surgical therapy used by c... more Background Pulmonary artery banding (PAB) is a technique of palliative surgical therapy used by congenital heart surgeons as a staged approach to operative correction of congenital heart defects. Materials and Methods We report 5- year experiences from January 2011 to January 2016 of Imam Reza Hospital center (a tertiary referral hospital in Mashhad city, North East of Iran) that consist of 50 patients with congenital heart disease with left to right shunt that pulmonary artery banding procedure was performed for them were studied. Results Age of patients (n=50) was 1to 9 months (mean=4.6 + 1.3). In this study, the most common disease that need to PAB procedure was Ventricular septal defect (VSD) with twenty-eight patients (56%). Mean of extubation time (hour) was 10.4 + 0.8 and mean of hospital stay (day) was 13.3 + 2.4 respectively. Conclusion Although the number of pulmonary artery banding palliation surgery was decreased, but in selected group of congenital heart disease, this p...

Introduction: Birth weight, as one of the main indices of growth, is among the determining factor... more Introduction: Birth weight, as one of the main indices of growth, is among the determining factors of survival. Given the absence of documented studies and lack of information regarding the influence of mothers’ body mass index (BMI) on newborns’ birth weight, this study was carried out with the aim to determine the relation between the mother’s BMI at the beginning of pregnancy and the infant’s weight at birth. Methods: In the current cross-sectional study, 800 pregnant women, who were referred to medical and healthcare centers of Mashhad during 2011 (with a gestational age less than 12 weeks), were selected using stratified random multi-level cluster sampling. In the first prenatal checkup, a questionnaire, containing questions about personal information, was completed and mothers’ BMIs were calculated. At birth, the infants’ weight and other variables were surveyed. Analysis of data was done using SPSS version 11.5 and descriptive and analytical tests. Results:Among 800 mothers, ...

Background Radial head fractures commonly occur during elbow traumas. Among those, treatment of M... more Background Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type III fractures is still under controversy. Common treatment methods for these fractures include open reduction and internal fixation (ORIF) as well as radial head excision. In this study, we compared long-term outcomes of both methods in treatment of patients with Mason type III fractures of radial head. Methods Fifteen men and five women with Mason type III radial head fractures were evaluated retrospectively. Ten patients had undergone excision whereas the other ten patients had been treated with ORIF. Outcomes were assessed based on stability and range of motion of the elbow joint, grip strength, and pain. Data were gathered using Mayo elbow performance index (MEPI), Oxford elbow score, and disability of arm-shoulder-hand (DASH), along with the short form (SF)-36 questionnaire. Results The mean age of the subjects was 36.25±9.22 years and the mean follow-up time was 25.05±11....

Background Radial head fractures commonly occur during elbow traumas. Among those, treatment of M... more Background Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type III fractures is still under controversy. Common treatment methods for these fractures include open reduction and internal fixation (ORIF) as well as radial head excision. In this study, we compared long-term outcomes of both methods in treatment of patients with Mason type III fractures of radial head. Methods Fifteen men and five women with Mason type III radial head fractures were evaluated retrospectively. Ten patients had undergone excision whereas the other ten patients had been treated with ORIF. Outcomes were assessed based on stability and range of motion of the elbow joint, grip strength, and pain. Data were gathered using Mayo elbow performance index (MEPI), Oxford elbow score, and disability of arm-shoulder-hand (DASH), along with the short form (SF)-36 questionnaire. Results The mean age of the subjects was 36.25±9.22 years and the mean follow-up time was 25.05±11....

Introduction: Unwanted pregnancy is one of the most important problems, facing married couples. T... more Introduction: Unwanted pregnancy is one of the most important problems, facing married couples. This type of pregnancy has a negative impact on maternal, fetal, and neonatal outcomes. In this study, we aimed to evaluate the relationship between unwanted pregnancy (based on the couples’ opinions) and infants’ nutrition in patients admitted to medical centers of Mashhad in years 2009-2010. Methods: In this cross-sectional study, 300 women with infants under the age of 1 year, who were referred to medical centers of Mashhad, were asked whether or not their pregnancy was planned. Then, they were questioned about their infants’ nutritional status (at the age of 4 months). Data were collected using questionnaires and interviews. Validity and reliability of the methods were confirmed using content analysis and test-retest. Data were analyzed using SPSS version 11.5 and statistical tests. In statistical tests, P-value of 0.05 was considered statistically significant. Results: The findings o...

A 54-year-old female patient was presented with upper extremity ischemia. Further investigation r... more A 54-year-old female patient was presented with upper extremity ischemia. Further investigation revealed ulcerated atherosclerosis plaque in aorta with intramural hematoma and clot formation. The subject underwent a successful surgical resection of mass with the assistance of cardiopulmonary bypass and total circulatory arrest.

Introduction: Coronary endarterectomy is not a perfect procedure. However, it is sometimes the on... more Introduction: Coronary endarterectomy is not a perfect procedure. However, it is sometimes the only available alternative for cardiac surgeons in patients suffering from diffuse coronary artery disease. According to a large volume of studies, coronary endarterectomy results (such as survival, recurrence of the symptoms of myocardial ischemia, and graft patency) are not as satisfactory as standard coronary artery bypass grafting (CABG). While the left anterior descending artery (LAD) is the artery most commonly involved in coronary endarterectomy, RCA can be treated with coronary endarterectomy. This study aimed to evaluate clinical evidence and early results of right coronary artery

Journal of Education and Health Promotion, 2018

BACKGROUND: The development of public transportation (PT) is a crucial issue in the modern societ... more BACKGROUND: The development of public transportation (PT) is a crucial issue in the modern societies. The aim of this study was to assess the status of PT usage among the population residing in Mashhad. MATERIALS AND METHODS: In a cross-sectional design, 464 citizens of Mashhad filled a checklist about PT-use (i.e., bus, taxi, and metro) to find their supporting and opposing factors in 2014. Chi-square, Mann–Whitney, Student's t-test, and logistic regressions were used for inferential analysis in SPSS 11.5. RESULTS: Mean age was 30.02 ± 11.24 years and 57% (263) were female. Bus (169, 50%) was the most popular PT means, followed by metro (98, 29%) and taxi (74, 21%). Most transportations were happened at morning (248, 35%) and evening (221, 31%). Increasing age (odds ratio [OR] =1.04, confidence interval [CI] 95% = 1.008–1.07), higher education (OR = 2.91, CI 95% = 1.14–7.38), being homemaker (OR = 2.97, CI 95% = 1.19–7.36), or student (OR = 2.91, CI 95% = 1.14–7.38) were predictors of PT-use. CONCLUSION: Individual preference between PT and driving is associated with social, economic, and cultural aspects of a population. Recognizing the influencing factors can help to design population-oriented services.

Clinical Rheumatology, 2019

Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis leading to joint dama... more Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis leading to joint damage and physical disability. Cardiovascular diseases (CVDs) are considered a common comorbidity in patients with RA. However, the mechanism underlying its pathogenesis is not definitively explained. Endothelial dysfunction caused by impaired nitric oxide synthesis is an early indicator of cardiovascular disease. Asymmetric and symmetric dimethylarginine (ADMA and SDMA, respectively) the inhibitors of endothelial nitric oxide synthase (NOS) have emerged as novel CVD risk factor determiners. Concerning the unmet need to identify a salutary biomarker for CVD prediction, the purpose of this meta-analysis was to assess the serum/plasma ADMA and SDMA levels in RA patients compared with the healthy controls. A thorough literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar to identify all studies reporting ADMA and/or SDMA levels in RA patients compared with healthy controls. The quality of studies was evaluated using the Newcastle-Ottawa scale (NOS). Pooled standard mean difference (SMD) with 95% confidence interval (CI) was used as the effect size in this study. We also conducted stratified analysis based on assay methods and median age of the participants. Fourteen articles were included. The pooled serum/plasma levels of ADMA were higher in RA patients compared with those of healthy controls (SMD = 1.02, 95% CI = 0.49 to 1.55); However, no statistical differences between RA patients and healthy controls in serum/plasma SDMA levels was seen (SMD = 0.57, 95% CI = −0.21 to 1.36). Subgroup analyses suggested that participants aged > 50 years had higher levels of ADMA rather than controls and the measurement method was a source of heterogeneity for ADMA. According to the results of this metaanalysis, ADMA measurement but not SDMA, can be useful for assessment of endothelial dysfunction as a predictor of CVD risk in RA patients. Prospero registration number: CRD42019121126.

Journal of Pharmaceutical Research International, 2019

Aims: This study aimed to assess possible alterations in adiposity and dietary intake during holi... more Aims: This study aimed to assess possible alterations in adiposity and dietary intake during holiday periods in healthy subjects. Study Design: 452 students of medicine faculty of Mashhad University of Medical Sciences were participated in this study and announced via internet and campus announcement in Feb 2014. Methodology: Anthropometric parameters and body composition were measured using standard protocols. Individual nutritional intakes were assessed using the Dietplan6 software. SPSS software version 11.5 was used for statistical analysis. Results: Of the 452 students who attended the pre-holiday visit, 433 returned for the post-holiday appointments. Of these participants, 82 (18.1%) were men. The mean age was 24.4 years for men and 23.8 years for women (p=0.171). All the adiposity and body composition variables significantly changed over the follow-up except for fat free mass (p=0.074) and truck fat free mass (p=0.935). Mean weight of participants increased from 63.5 kg to 6...

International Urogynecology Journal, 2018

Introduction and hypothesis Genitourinary syndrome of menopause is a major health concern in post... more Introduction and hypothesis Genitourinary syndrome of menopause is a major health concern in postmenopausal women. This study was aimed at comparing the effect of a vitamin E vaginal suppository with that of conjugated estrogen vaginal cream on sexual function in postmenopausal women with genitourinary syndrome of menopause. Methods This survey was carried out on 52 postmenopausal women aged 40-65 years who had been referred to gynecology clinics in Mashhad city, during 2013-2014. Keeping β = 0.1, the power was calculated to be 90%. The patients were randomly divided into two groups: vitamin E vaginal suppository and conjugated estrogen vaginal cream. Participants used the medications for 12 weeks. They were visited at the 4th, 8th, and 12th weeks. Validated Abbreviated Sexual Function Questionnaire (ASFQ), as the primary outcome measure, and a demographic information questionnaire, were used to collect data at each visit. Data were analyzed using SPSS and p < 0.05 was considered statistically significant. Results Mean overall scores of the ASFQ were increased significantly in both groups during the course of the study, compared with baseline (p < 0.001). However, the mean ASFQ scores of the two treatments did not differ significantly. Conclusion Improved scores of ASFQ after the 12th week showed that the treatment was successful in both groups. Therefore, a vitamin E vaginal suppository may be an alternative to vaginal estrogen in relieving the symptoms of vaginal atrophy in postmenopausal women, especially those not able to use hormone therapy or have low compliance.

Infectious Diseases, 2019

Brucellosis, caused by the intracellular pathogens Brucella, is one of the major zoonotic infecti... more Brucellosis, caused by the intracellular pathogens Brucella, is one of the major zoonotic infections. Considering the economic burden, its prevalence has been a health concern especially in endemic regions. Brucella is able to survive and replicate within host cells by expressing different virulence factors and using various strategies to avoid the host's immune response. This leads to progression of the disease from an acute phase to chronic brucellosis. Exploration of genetic variations has confirmed the expected influence of gene polymorphisms on susceptibility and resistance to brucellosis of humans. Since there is no approved human vaccine and treatment is uncertain with risk of relapse, it is important to increase knowledge about pathogenesis, diagnosis and treatment of brucellosis in order to manage and control this infection, especially in endemic regions.

Indian journal of endocrinology and metabolism

Obesity is associated with several complications like metabolic syndrome. Many professional athle... more Obesity is associated with several complications like metabolic syndrome. Many professional athletes adopt a sedentary lifestyle after retirement. This study was aimed at assessing the risk of developing obesity, insulin resistance (IR), and metabolic syndrome among former power-sports athletes, compared with age-matched active athletes and nonathletes. The study was conducted in Mashhad during 2012-2014. The individuals were recruited through announcements and were divided into three groups of active athletes ( = 34), ex-athletes ( = 30), and nonathletes ( = 30). Demographic and anthropometric data were collected and biochemical factors including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol, triglycerides (TG), fasting plasma glucose, insulin, and high-sensitive C-reactive protein were measured. Ex-athletes had significantly higher mean values of weight, body mass index, diastolic blood pressure, LDL-C, insulin, homeos...

Journal of Medical Virology, 2020

Background and aim Although not common, gastrointestinal and liver symptoms have reportedly been ... more Background and aim
Although not common, gastrointestinal and liver symptoms have reportedly been the initial presentation of COVID‐19 in a large group of patients. Therefore, knowing the frequency and characteristics of these manifestations of COVID‐19 is important for both clinicians and health policymakers. A systematic review and meta‐analysis of the available data on the gastrointestinal and liver manifestations of COVID‐19 patients was performed.

Methods
PubMed and Scopus databases and Google Scholar search engine were searched for published and unpublished preprint articles up to April 10, 2020. Original studies providing information on clinical digestive symptoms or biomarkers of liver function in patients with polymerase chain reaction confirmed diagnosis of COVID‐19 were included. After quality appraisal, data were extracted. Prevalence data from individual studies were pooled using a random‐effects model.

Results
Overall, 67 studies were included in this systematic review and meta‐analysis, comprising a pooled population of 13,251 patients with confirmed COVID‐19. The most common gastrointestinal symptoms were anorexia (10.2%, 95%CI=6.2‐16.4%), diarrhea (8.4%, 95%CI=6.2‐11.2%), and nausea (5.7%, 95%CI=3.7‐8.6%), respectively. Decreased albumin levels (39.8%, 95%CI=15.3‐70.8%), increased aspartate aminotransferase (22.8%, 95%CI=18.1‐28.4%) and alanine aminotransferase (20.6%, 95%CI=16.7‐25.1%) were common hepatic findings. After adjusting for pre‐existing gastrointestinal (5.9%) and liver diseases (4.2%), the most common gastrointestinal findings were diarrhea (8.7%, 95%CI=5.4‐13.9%), anorexia (8.0%, 95%CI=3.0‐19.8%), and nausea (5.1%, 95%CI=2.2‐14.3%).

Conclusions
Gastrointestinal and liver manifestations are not rare in patients with COVID‐19, but their prevalence might be affected by pre‐existing diseases. Diarrhea and mild liver abnormalities seem to be relatively common in COVID‐19, regardless of comorbidities.

Archives of Bone and Joint Surgery, 2018

Background:Radial head fractures commonly occur during elbow traumas. Among those, treatment of M... more Background:Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type III fractures is still under controversy. Common treatment methods for these fractures include open reduction and internal fixation (ORIF) as well as radial head excision. In this study, we compared long-term outcomes of both methods in treatment of patients with Mason type III fractures of radial head. Methods:Fifteen men and five women with Mason type III radial head fractures were evaluated retrospectively. Ten patients had undergone excision whereas the other ten patients had been treated with ORIF. Outcomes were assessed based on stability and range of motion of the elbow joint, grip strength, and pain. Data were gathered using Mayo elbow performance index (MEPI), Oxford elbow score, and disability of arm-shoulder-hand (DASH), along with the short form (SF)-36 questionnaire. Results:The mean age of the subjects was 36.25±9.22 years and the mean follow-up time was 25.05±11.43 months. The ranges of extension and supination, and frequency of pain reporting was significantly different between the groups. The average grip strength in the operated side was significantly higher in the ORIF group, compared with the excision (P= 0.03). Ten (100%) patients of ORIF group and 5 (50%) patients of excision group had elbow joint stability (P=0.01). Mean MEPI and DASH scores were significantly higher in ORIF group (P<0.001 and =0.04, respectively). Conclusion:The results are in favor of ORIF method. Therefore, this method is recommended and preferred over excision in treating radial heads with Mason type III fracture.