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Bazrafshan M, Nematollahi S, Kamali M, Farrokhian A, Moeinvaziri N, Bazrafshan H, Noormohammadi N, Keshtvarz Hesam Abadi M, Bazrafshan Drissi H. Bariatric surgery mitigated electrocardiographic abnormalities in patients with morbid obesity. Sci Rep 2024; 14:6710. [PMID: 38509211 PMCID: PMC10954646 DOI: 10.1038/s41598-024-57155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
Obesity can lead to cardiovascular dysfunctions and cause electrocardiographic disruptions. Bariatric surgery plays a significant role in weight loss. To assess its benefits, this study investigated electrocardiographic changes before and after bariatric surgery. The present article describes a retrospective cohort study with a 6-month follow-up period. Electrocardiograms were interpreted and compared before and six months after surgery. The relationships between weight loss, type of surgery, and electrocardiographic alterations were analyzed. A total of 200 patients participated in the study, with 34 (17%) men and 166 (83%) women. The mean age of the participants was 44.6 ± 8.6, and their mean body mass index was 43.8 ± 5.5 kg/m2. The mean of QTc decreased after the surgery, while the Sokolow-Lyon scores increased. The statistical analysis showed that QTc dispersion (> 40) (P < 0.001), right ventricular hypertrophy (P < 0.001), abnormal R wave progression (P < 0.001), QTc (P < 0.001) and Sokolow-Lyon criteria (P < 0.001) significantly changed postoperatively. In conclusion, bariatric surgery can reduce QTc, correct poor R wave progression, and resolve right ventricular hypertrophy (RVH) in patients with morbid obesity.
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Affiliation(s)
| | - Soroush Nematollahi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ariya Farrokhian
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Moeinvaziri
- Laparoscopy Research Center, Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hanieh Bazrafshan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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2
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Bahreini Z, Kamali M, Kheshty F, Bazrafshan Drissi H, Boogar SS, Bazrafshan M. Differentiating electrocardiographic indications of massive and submassive pulmonary embolism: A cross-sectional study in Southern Iran from 2015 to 2020. Clin Cardiol 2024; 47:e24252. [PMID: 38465696 PMCID: PMC10926280 DOI: 10.1002/clc.24252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Although using electrocardiogram (ECG) for pulmonary embolism (PE) risk stratification has shown mixed results, it is currently used as supplementary evidence in risk stratification. This cross-sectional study aimed to assess and compare ECG findings of massive and submassive PE versus segmental PE. METHODS This cross-sectional study included 250 hospitalized patients with a confirmed diagnosis of acute PE from 2015 to 2020 in Southern Iran. Demographic variables, clinical data, troponin levels, on-admission ECG findings, echocardiography findings, and ECG findings 24 h after receiving anticoagulants or thrombolytics were extracted. RESULTS Patients diagnosed with submassive or massive PE exhibited significantly higher rates of right axis deviation (p = .010), abnormal ST segment (p < .0001), S1Q3T3 pattern (p < .0001), inverted T wave in leads V1-V3 (p < .0001), inverted T wave in leads V4-V6 (p < .0001), and inverted T wave in leads V1-V6 (p < .0001). In a multivariable model, inverted T wave in leads V1-V3, inverted T wave in leads V4-V6, pulse rate, and positive troponin test were the statistically independent variables for predicting submassive or massive PE. Furthermore, inverted T wave in leads V1-V3 (sensitivity: 85%, specificity: 95%, accuracy: 93%, AUC: 0.902) and troponin levels (sensitivity: 72%, specificity: 86%, accuracy: 83%, AUC: 0.792) demonstrated the best diagnostic test performance for discriminating submassive or massive PE from segmental PE. CONCLUSION In addition to clinical rules, ECG can serve as an ancillary tool for assessing more invasive testing and earlier aggressive treatments among patients with PE, as it can provide valuable information for the diagnosis and risk stratification of submassive or massive PE.
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Affiliation(s)
- Zahra Bahreini
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
| | - Maliheh Kamali
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
| | - Fatemeh Kheshty
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
| | | | | | - Mehdi Bazrafshan
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
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3
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Kheshti F, Abdollahifard S, Hosseinpour A, Bazrafshan M, Attar A. Ablation versus medical therapy for patients with atrial fibrillation: An updated meta-analysis. Clin Cardiol 2024; 47:e24184. [PMID: 37937825 PMCID: PMC10826237 DOI: 10.1002/clc.24184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
To investigate the effect of ablation compared to medical therapy on clinical outcomes of patients with atrial fibrillation (AF). PubMed, Scopus, Embase, and Web of Science databases were searched using ablation, medical treatment, AF, and related words. The effect of ablation and medical therapy was sought to be gathered on stroke or transitional ischemic attack, mortality, hospitalization, recurrence of AF, progression of AF, and left ventricular ejection fraction. Analyses were performed using R software. 31 studies (the results of 27 randomized controlled trials), compromising an overall 6965 patients (Ablation, n = 3643; Medical treatment, n = 3322) were reviewed in our study, revealed that catheter ablation would result in substantial benefits for patients with AF without significant difference in serious adverse events compared to medical management (Risk Ratio: 0.92, [95% Confidence Interval (CI), 0.64-1.33]). Catheter ablation in patients with AF significantly resulted in a 29% reduction in all-cause mortality (RR: 0.71, [95% CI, 0.57-0.88]), a 57% reduction in hospitalization (RR: 0.43, [95% CI, 0.27-0.67]), a 53% reduction in AF recurrence (RR: 0.47, [95% CI, 0.36-0.61]), and a dramatic reduction, 89%, in progression of paroxysmal to persistent AF (RR: 0.11, [95% CI, 0.02-0.65]); also associated with a remarkable improvement in their left ventricular ejection fraction (LVEF) (Mean Difference, MD: 6.84%, [95% CI, 3.27-10.42]) compared to medical therapy. Our study showed that ablation may be superior to medical therapy in patients with AF regarding AF recurrence, mortality, LVEF improvement, hospitalization, and AF progression outcomes.
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Affiliation(s)
- Fatemeh Kheshti
- Department of Cardiovascular Medicine, School of MedicineShiraz University of Medical SciencesShirazIran
- Students' Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Saeed Abdollahifard
- Students' Research CommitteeShiraz University of Medical SciencesShirazIran
- Research Center for Neuromodulation and PainShirazIran
| | - Alireza Hosseinpour
- Department of Cardiovascular Medicine, School of MedicineShiraz University of Medical SciencesShirazIran
- Students' Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Mehdi Bazrafshan
- Students' Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Armin Attar
- Department of Cardiovascular Medicine, School of MedicineShiraz University of Medical SciencesShirazIran
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Abtahi F, Atashbarg M, Rahmanian M, Moeinvaziri N, Bazrafshan M, Bazrafshan H, Moammer F, Bazroodi H, Zolghadrasli A, Bazrafshan Drissi H. The evaluation of bariatric surgery effect on cardiac structure and function using transthoracic echocardiography: a cohort study. BMC Surg 2024; 24:37. [PMID: 38273285 PMCID: PMC10811858 DOI: 10.1186/s12893-024-02328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Obesity is a pathology and a leading cause of death worldwide. Obesity can harm multiple organs, including the heart. In this study, we aim to investigate the effect of bariatric surgery and following weight loss on cardiac structure and functions using echocardiography parameters in patients with morbid obesity. METHODS In this cohort study, 30 patients older than 18 with BMI > 40 or BMI > 35 and comorbidity between March 2020 to March 2021 were studied. The patients underwent transthoracic echocardiography before and after six months of the bariatric surgery. RESULTS In total, 30 patients (28 women, 93.3%) with a mean age of 38.70 ± 9.19 were studied. Nine (30%) were diabetic, and 9 (30%) had hypertension. After six months of bariatric surgery, all physical measurements, including weight, Body mass index, and Body surface area, decreased significantly (p < 0.001). After bariatric surgery, all parameters regarding left ventricular morphology, including left ventricular mass, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end-systolic diameter, and left ventricular end-diastolic diameter, improved significantly (p < 0.001). Also, LVEF rose post-bariatric surgery (p < 0.001). TAPSE parameter indicating right ventricular function also improved (p < 0.001). Right ventricular diameter, left atrium volume, and mitral inflow E/e' decreased significantly (p < 0.001). CONCLUSION Systolic and diastolic parameters refine significantly after bariatric surgery in patients with obesity. Bariatric surgery lead to significant cardiac structure and function improvement.
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Affiliation(s)
- Firoozeh Abtahi
- Department of Cardiology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Malek Atashbarg
- Department of Cardiology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Mahdi Rahmanian
- Cardiovascular research center, Shiraz university of medical science, Shiraz, Iran
| | - Nader Moeinvaziri
- Laparascopy research center, Surgery Department, Shiraz university of medical science, Shiraz, Iran
| | - Mehdi Bazrafshan
- Cardiovascular research center, Shiraz university of medical science, Shiraz, Iran
| | - Hanieh Bazrafshan
- Clinical Neurology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Farzaneh Moammer
- Student research committee, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Helia Bazroodi
- Student research committee, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | | | - Hamed Bazrafshan Drissi
- Cardiovascular research center, Shiraz university of medical science, Shiraz, Iran.
- Department of Cardiology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.
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Khodadadiyan A, Rahmanian M, Shekouh D, Golmohammadi M, Ghaedi A, Bazrgar A, Sayadi M, Bazrafshan M, Heydari A, Bazrafshan Drissi H. Evaluating the effect of vitamin D supplementation on serum levels of 25-hydroxy vitamin D, 1,25-dihydroxy vitamin D, parathyroid hormone and renin-angiotensin-aldosterone system: a systematic review and meta-analysis of clinical trials. BMC Nutr 2023; 9:132. [PMID: 37968749 PMCID: PMC10652523 DOI: 10.1186/s40795-023-00786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Vitamin D, one of the most essential micronutrients, is crucial in various health outcomes. However, previous studies showed conflicting results and uncertainty about vitamin D supplementation's optimal dosage and duration. In this study, we aimed to evaluate the vitamin D supplements efficiency on serum levels of 25-hydroxy vitamin D (25(OH)D), 1,25-dihdroxy vitamin D (1,25(OH)2D), parathyroid hormone (PTH) and renin-angiotensin-aldosterone system (RAAS) in adults. METHODS A systematic analysis of eligible and relevant randomized-controlled trials (RCT) published before April 2023 assessing the effect of vitamin D supplementations applied. The studies were identified by searching several databases, including Pubmed, Scopus, Web of Science, ProQuest, and Cochrane Register of controlled trials. RESULTS Five eligible RCTs with 346 participants in the intervention and 352 participants in the control group were assessed in our project. According to the results, there was a substantial change in 25(OH)D (SMD: 2.2, I2: 92.3, 95% Confidence Interval (CI): 1.38-3.02, P-value: 0.048) and 1,25(OH)2D (SMD:1.23, I2: 86.3, 95% CI: 0.01- 2.44, P-value < 0.010) affected by vitamin D intervention. Regarding Parathyroid hormone (PTH), however, vitamin D intervention showed a remarkable decrease (SMD: -0.75, I2: 82.4, 95% CI: (-1.3)-(-0.18), P-value < 0.010). Moreover, sensitivity analysis showed significant publication bias in terms of 25(OH)D. CONCLUSION Vitamin D supplements significantly increase the serum levels of 25(OH)D and 1,25(OH)2D and decrease PTH levels. While some studies reported decreasing effect of vitamin D supplements on RAAS activity, some reported no changes.
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Affiliation(s)
- Alireza Khodadadiyan
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Rahmanian
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Dorsa Shekouh
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Melika Golmohammadi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Bazrgar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Bazrafshan
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Aigin Heydari
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
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6
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Bazrafshan drissi H, Izadpanaha P, Bazrafshan M, Kasaei M, Arjangzade A, Amirghofran S, Keshavarz M, Safari A, Mohammadi M, Amanollahi F. A unique case of non-ST-elevation myocardial infarction with abnormal origin of left coronary system from the right coronary cusp. SAGE Open Med Case Rep 2023; 11:2050313X231200150. [PMID: 37745088 PMCID: PMC10515559 DOI: 10.1177/2050313x231200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
A unique case of non-ST-elevation myocardial infarctionis discussed, in which the left main coronary artery and anomalous coronary artery from the opposite sinus of Valsalva were absent. In this case, the left coronary cusp was blunted, and all three coronary arteries trifurcated from a single ostium in the right coronary cusp. The proximal part of the left anterior descending coronary artery had a trans-septal (intermuscular) course, while the left circumflex coronary artery had a retro-aortic course and severe thrombotic stenosis before the terminal portion. Due to the patient's refusal of coronary artery bypass graft, percutaneous coronary intervention was performed.
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Affiliation(s)
| | - Payman Izadpanaha
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Bazrafshan
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Kasaei
- Department of Cardiology, Al-Zahra Charity Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Arjangzade
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Amirghofran
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Keshavarz
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Safari
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mohammadi
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Foad Amanollahi
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
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7
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Khodadadiyan A, Jazi K, Bazrafshan Drissi H, Bazroodi H, Mashayekh M, Sadeghi E, Gholamabbas G, Bazrafshan M, Rahmanian M. Direct oral anticoagulants versus vitamin K antagonists: Which one is more effective in atrial fibrillation. Perfusion 2023:2676591231202383. [PMID: 37697799 DOI: 10.1177/02676591231202383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND The optimal approach for anticoagulation in patients with bioprosthetic valves and atrial fibrillation (AF) remains a subject of debate. A meta-analysis using updated evidence to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) in patients with AF and bioprosthetic valves to address this controversy. METHODS A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Web of Science, ProQuest, and the Cochrane Central Register of Controlled Trials, up until March 2023. The search aimed to identify relevant randomized controlled trials (RCTs) that examined the efficacy and safety outcomes of both direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with bioprosthetic valves and atrial fibrillation. The primary outcomes of interest were major bleeding and all-cause mortality. RESULTS Our study demonstrated that despite the difference was not significant, the hazard of all-cause mortality was 2.5% higher in the DOAC group (HR = 1.03, 95% CI = [0.88, 1.19], p-value = .75). Similarly, the hazard of stroke (HR = 1.03, 95% CI = [0.87, 1.32], p-value = .71) and major bleeding (HR = 1.11, 95% CI = [0.89, 1.38], p-value = .36) were found to be respectively 3.2 and 10.7% higher in the DOAC group, although the difference was not significant. However, the hazard of intracranial hemorrhage was found to be 28.8 lower in the DOAC treatment group (HR = 0.71, 95% CI = [0.39, 1.31], p-value = .27), which again was not statistically significant. CONCLUSIONS Our meta-analysis demonstrates that in patients undergoing bioprosthetic valve surgery and presenting with AF afterward, DOAC and VKA are similar regarding life-threatening and all-cause mortality outcomes, including major bleeding, stroke, and intracranial hemorrhage.
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Affiliation(s)
| | - Kimia Jazi
- Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
| | | | - Helia Bazroodi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mina Mashayekh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Erfan Sadeghi
- Research Consultation Center (RCC), Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ghazal Gholamabbas
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Bazrafshan
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Rahmanian
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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8
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Rahmanian M, Bazrafshan M, Kamali F, Zare M, Keshavarz M, Bazrafshan H, Izadpanah P, Mohammadi M, Zare M, Bazrafshan Drissi H. Predictive factors for type A aortic dissection mortality based on electrocardiogram parameters and clinical presentations. J Electrocardiol 2023; 80:58-62. [PMID: 37247497 DOI: 10.1016/j.jelectrocard.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/10/2023] [Accepted: 05/20/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Aortic dissection is a rare but potentially lethal disorder and may be associated with electrocardiogram (ECG) changes. In this study, we aim to investigate ECG-related parameters alongside clinical presentations of type A aortic dissection to come up with the predictive factors for the severity of the disease and its mortality rate. METHODS In this retrospective study, 201 patients with type A aortic dissection were studied between March 2015 and March 2020. Two expert cardiologists blinded to the diagnosis studied former and new patients' ECGs and recorded changes. RESULTS Two-hundred and one patients, including 143 (71.1%) men and 58 (28.9%) women, presented with acute dissection of the aorta, were studied. Forty-four (21.8%) and 84 (41.7%) patients had ST-segment elevation and depression in ECG, respectively. Bivariate analysis revealed that higher heart rate (p = 0.006), longer QTc (p = 0.044), and ST-segment elevation in aVR lead (p = 0.044) were associated with mortality in the patients. Multivariate regression showed higher heart rate (OR = 1.022, CI = 1.003-1.041, p = 0.012) and ST-segment elevation in aVR (OR = 4.854, CI = 2.255-10.477, p < 0.001) were independently associated with increased odds of mortality in aortic dissection patients. ROC curve analysis showed heart rate equal to or >60 per minute (AUC = 0.625, sensitivity = 86%, specificity = 10%, p = 0.019) and ST-segment elevation in aVR >0.5 mm (AUC = 0.854, sensitivity = 75%, specificity = 92%, p < 0.001) were associated with a higher mortality rate. CONCLUSION Heart rate equal or >60 and ST-segment elevation >0.5 mm in aVR lead can be used as predictive factors for mortality of patients with type A aortic dissection.
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Affiliation(s)
- Mahdi Rahmanian
- Cardiovascular research center, Shiraz University of medical science, Shiraz, Iran
| | - Mehdi Bazrafshan
- Cardiovascular research center, Shiraz University of medical science, Shiraz, Iran
| | - Farnaz Kamali
- Department of internal medicine, Shiraz University of medical science, Shiraz, Iran
| | - Maryam Zare
- Cardiovascular research center, Shiraz University of medical science, Shiraz, Iran
| | - Mohammad Keshavarz
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Hanieh Bazrafshan
- Clinical Neurology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Payman Izadpanah
- Department of Cardiology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Mohammad Mohammadi
- Department of Cardiology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Marjan Zare
- Student Research Committee, School of Medicine, Fasa University of Medical Science, Fasa, Iran
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9
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Bazrgar A, Rahmanian M, Ghaedi A, Heidari A, Bazrafshan M, Amini M, Bazrafshan H, Ahmadpour M, Bazrafshan Drissi H. Face-to-face, online, or blended: which method is more effective in teaching electrocardiogram to medical students. BMC Med Educ 2023; 23:566. [PMID: 37559020 PMCID: PMC10413712 DOI: 10.1186/s12909-023-04546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Electrocardiogram (ECG) remains an important medical diagnostic and screening tool. This study aimed to compare the effectiveness of online classes instead of traditional face-to-face or blended methods in medical students' ECG learning. METHODS Two hundred and fifteen medical students (including 105 (48.8%) males and 110 (51.2%) females) were studied from February 2021 to February 2022. Regardless of their grade, participants were divided into three groups: online, face-to-face, and blended. Then all participants sat for an ECG interpretation exam, and their results were compared. RESULTS Twenty-six (12.1%) participants were residents, and 189 (87.9%) were interns. Thirty-five (16.3%), 85 (39.5%), and 95 (44.2%) participants were taught ECG through face-to-face, online, and blended methods, respectively. Regarding participants' preferences on teaching methods, 118 (54.9%) preferred face-to-face learning, and the remaining 97 (45.1%) chose online learning (p < 0.001). The blended method seemed more promising in almost half of the exam questions regarding teaching method effectiveness. The mean total exam score was also significantly higher in participants who were taught blended than in the others (7.20 ± 1.89, p = 0.017). Face-to-face (5.97 ± 2.33) and online teaching methods (6.07 ± 2.07) had similar efficacy according to the mean total score (p = 0.819). CONCLUSION While most students preferred face-to-face learning to online learning, a blended method seemed more promising regarding students' skill enhancement to interpret ECG.
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Affiliation(s)
- Aida Bazrgar
- Student research committee, Shiraz University of medical science, Shiraz, Iran
| | - Mahdi Rahmanian
- Cardiovascular research center, Shiraz University of medical science, Shiraz, Iran
| | - Arshin Ghaedi
- Student research committee, School of Medicine, Shiraz University of medical science, Shiraz, Iran
| | - Ali Heidari
- Student research committee, School of Medicine, Shiraz University of medical science, Shiraz, Iran
| | - Mehdi Bazrafshan
- Cardiovascular research center, Shiraz University of medical science, Shiraz, Iran
| | - Mitra Amini
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hanieh Bazrafshan
- Clinical Neurology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Mahsa Ahmadpour
- Cardiovascular research center, Shiraz University of medical science, Shiraz, Iran
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10
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Jahangiri S, Abdiardekani A, Jamshidi S, Askarinejad A, Mosalamiaghili S, Bazrafshan M, Karimi M, Bazrafshan H, Bazrafshan drissi H. Electrocardiographic characteristics of cirrhotic patients and their association with Child-Pugh score. Clin Cardiol 2023; 46:967-972. [PMID: 37436825 PMCID: PMC10436787 DOI: 10.1002/clc.24089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Cardiac dysfunction is a serious complication of cirrhosis which is usually asymptomatic. We investigated the clinical and electrocardiographic (ECG)-related factors among patients with cirrhosis and our aim was to find any associations between ECG changes and the etiology of cirrhosis, as well as Child-Pugh score. HYPOTHESIS We hypothesized that some ECG-related factors, particularly prolonged QT interval, are more common in patients with cirrhosis. Also, these factors are associated with the severity of cirrhosis, measured by the Child-Pugh score. METHODS From April 2019 to December 2022, we reviewed admitted patients to Namazi and Abu-Ali Sina hospitals, Shiraz, Iran. Patients with confirmed diagnosis of cirrhosis and without concurrent disorders affecting the cardiovascular system were selected. Clinical and ECG-related data were then extracted for participants, and Child-Pugh score was calculated. RESULTS A total of 425 patients were included; the median age was 36 years, and 245 patients (57.6%) were men. Cryptogenic and primary sclerosing cholangitis were the most common etiologies. Prolonged QT followed by early transitional zone were the most common ECG changes (24.7% and 19.8%, respectively), which were significantly associated with the etiology of cirrhosis and Child-Pugh class. CONCLUSIONS Prolonged QT interval and presence of early transitional zone in patients with cirrhosis may indicate cardiac dysfunction, necessitating further evaluations.
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Affiliation(s)
- Soodeh Jahangiri
- Endocrine Research Center, Institute of Endocrinology and MetabolismIran University of Medical SciencesTehranIran
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
| | - Alireza Abdiardekani
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
- Department of Cardiology, Abu‐Ali Sina Charity HospitalShiraz University of Medical SciencesShirazIran
| | - Saideh Jamshidi
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
| | - Amir Askarinejad
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | | | - Mehdi Bazrafshan
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
| | - Mohamadreza Karimi
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
| | - Hanieh Bazrafshan
- Department of Neurology, Clinical Neurology Research CenterShiraz University of Medical SciencesShirazIran
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11
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Aslani A, Shahrzad S, Bazrafshan M, Rahmanian M, Fakhar R, Pirahesh K, Bazrafshan H, Bazrafshan H. Optimal method for ablation of atypical AVNRT. BMC Cardiovasc Disord 2023; 23:264. [PMID: 37208638 DOI: 10.1186/s12872-023-03305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Considering that ablation of atypical AVNRT may be unsuccessful after ablation at the right posterior septum, in this study, we aimed to present an optimal method for ablation of atypical AVNRT. Also, we evaluated the efficacy of this technique for preventing recurrences. METHODS This is a prospective, double-center study. It was conducted on 62 patients with atypical AVNRT referred for radiofrequency ablation. The patients were randomly divided into two groups before ablation: 1-Group A (n = 30): treated with conventional ablation at the anatomic area of the slow pathway; 2-Group B (n = 32): ablation was done 2 mm higher in the septum during fluoroscopy. RESULTS The mean age of patients in groups A and B were 54 ± 11.7 and 55 ± 12.2, respectively (P = 0.43). In group A, ablation was successful in 24 (80%) patients following right-sided slow pathway ablation, and the remaining patients required further treatment with either a left-side approach (N = 4, 13.3%) or ablation of additional regions (N = 2, 6.7%). In group B, ablation was successful in all patients. After a 48-month follow-up, recurrence of symptomatic atypical AVNRT was detected in 4 (13.3%) patients of group A and none of group B patients (p < 0.001). CONCLUSION In patients with atypical AVNRT, ablation 2 mm above the conventional area is more promising regarding success rate and recurrence of the arrhythmia.
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Affiliation(s)
- Amir Aslani
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehdi Bazrafshan
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Rahmanian
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Fakhar
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hanieh Bazrafshan
- Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran.
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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12
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Salimi A, Zolghadrasli A, Jahangiri S, Hatamnejad MR, Bazrafshan M, Izadpanah P, Dehghani F, Askarinejad A, Salimi M, Bazrafshan Drissi H. The potential of HEART score to detect the severity of coronary artery disease according to SYNTAX score. Sci Rep 2023; 13:7228. [PMID: 37142599 PMCID: PMC10160023 DOI: 10.1038/s41598-023-34213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
Clinical scoring systems such as the HEART score can predict major adverse cardiovascular events, but they cannot be used to demonstrate the degree and severity of coronary artery disease. We investigated the potential of HEART Score in detecting the existence and severity of coronary artery disease based on SYNTAX score. This multi-centric cross-sectional study investigated patients referred to the cardiac emergency departments of three hospitals between January 2018 and January 2020. Data including age, gender, risk factors, comorbidities, 12-lead ECG, blood pressure and echocardiogram were recorded for all the participants. Serum troponin I level was measured on admission and 6 h later. Coronary angiography was done via the femoral or radial route. HEART and SYNTAX scores were calculated for all patients and their association was assessed. 300 patients (65% female) with mean age of 58.42 ± 12.42 years were included. mean HEART Score was 5.76 ± 1.56 (min = 3, max = 9), and mean SYNTAX score was 14.82 ± 11.42 (min = 0, max = 44.5). Pearson correlation coefficient was 0.493 between HEART Score and SYNTAX score which was statistically significant (P < 0.001). We found that HEART Score of more than 6 is 52% sensitive and 74.7% specific to detect extensive coronary artery involvement (SNTAX score ≥ 23). The present study showed that the HEART score has a moderate and positive correlation with the SYNTAX score and HEART score with a cut-off value of 6 is a predictor for SYNTAX score of ≥ 23.
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Affiliation(s)
- Amirhossein Salimi
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Soodeh Jahangiri
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Hatamnejad
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Bazrafshan
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Izadpanah
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Dehghani
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Askarinejad
- Rajaie Cardiovascular Medical and Research Center, Iran university of medical sciences, Tehran, Iran
| | - Maryam Salimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Nematollahi MA, Jahangiri S, Asadollahi A, Salimi M, Dehghan A, Mashayekh M, Roshanzamir M, Gholamabbas G, Alizadehsani R, Bazrafshan M, Bazrafshan H, Bazrafshan Drissi H, Shariful Islam SM. Body composition predicts hypertension using machine learning methods: a cohort study. Sci Rep 2023; 13:6885. [PMID: 37105977 PMCID: PMC10140285 DOI: 10.1038/s41598-023-34127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/25/2023] [Indexed: 04/29/2023] Open
Abstract
We used machine learning methods to investigate if body composition indices predict hypertension. Data from a cohort study was used, and 4663 records were included (2156 were male, 1099 with hypertension, with the age range of 35-70 years old). Body composition analysis was done using bioelectrical impedance analysis (BIA); weight, basal metabolic rate, total and regional fat percentage (FATP), and total and regional fat-free mass (FFM) were measured. We used machine learning methods such as Support Vector Classifier, Decision Tree, Stochastic Gradient Descend Classifier, Logistic Regression, Gaussian Naïve Bayes, K-Nearest Neighbor, Multi-Layer Perceptron, Random Forest, Gradient Boosting, Histogram-based Gradient Boosting, Bagging, Extra Tree, Ada Boost, Voting, and Stacking to classify the investigated cases and find the most relevant features to hypertension. FATP, AFFM, BMR, FFM, TRFFM, AFATP, LFATP, and older age were the top features in hypertension prediction. Arm FFM, basal metabolic rate, total FFM, Trunk FFM, leg FFM, and male gender were inversely associated with hypertension, but total FATP, arm FATP, leg FATP, older age, trunk FATP, and female gender were directly associated with hypertension. AutoMLP, stacking and voting methods had the best performance for hypertension prediction achieving an accuracy rate of 90%, 84% and 83%, respectively. By using machine learning methods, we found that BIA-derived body composition indices predict hypertension with acceptable accuracy.
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Affiliation(s)
| | - Soodeh Jahangiri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arefeh Asadollahi
- Non Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Maryam Salimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Science, Shiraz, Iran
| | - Azizallah Dehghan
- Non Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mina Mashayekh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad Roshanzamir
- Department of Computer Engineering, Faculty of Engineering, Fasa University, Fasa, 74617-81189, Iran
| | - Ghazal Gholamabbas
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Geelong, Australia
| | | | - Hanieh Bazrafshan
- Department of Neurology, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan Drissi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, PO Box: 71348-14336, Shiraz, Iran.
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
- Cardiovascular Division, The George Institute for Global Health, Newtown, Australia
- Sydney Medical School, University of Sydney, Camperdown, Australia
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14
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Akbari-Khezrabadi A, Zibaeenezhad MJ, Shojaeefard E, Naseri A, Mousavi S, Sarejloo S, Karimi M, Hosseinpour M, Salimi M, Bazrafshan M, Salimi A, Parsa N, Sayadi M, Razeghian-Jahromi I, Zibaeenejad F, Mohammadi SS, Bazrafshan Drissi H. Can anthropometric indices predict the chance of hypertension? A multicentre cross-sectional study in Iran. BMJ Open 2022; 12:e062328. [PMID: 36418117 PMCID: PMC9685002 DOI: 10.1136/bmjopen-2022-062328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aims to assess the prevalence of hypertension (HTN), and determine the relationship between HTN and anthropometric indices including fat distribution, body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) in Shiraz Heart Study. SETTING In this cross-sectional study, subjects were enrolled in 25 clinics in Shiraz. I.R. Iran between 2019 and 2021. PARTICIPANTS A total number of 7225 individuals were selected, aged between 40 and 70 years of whom 52.3% were female. Among the people living in Shiraz, individuals living far from clinics, cases of mental or physical disabilitiy and documented cardiovascular diseases were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: The association of body composition, WHR, WHtR and BMI with HTN. SECONDARY OUTCOME The sensitivity and specificity of the WHtR for the prediction of HTN. RESULTS HTN prevalence was 19.3%. Obesity prevalence was estimated to be 28.5%. WHR and lean body mass showed a significant association with HTN (p<0.05). Receiver operating characteristic for WHtR yielded an area under the curve of 0.62 (95% CI 0.61 to 0.64) and 0.63 (95% CI 0.62 to 0.65) for males and females, respectively. The optimal threshold value yielded 0.54 in men and 0.61 in women. The sensitivity was 72.3% and 73.9% in women and men, with specificity of 48.4% and 44.3%, respectively. CONCLUSION HTN had a meaningful association with all the noted anthropometric indices. WHtR performed well as a predictor of HTN.
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Affiliation(s)
- Ali Akbari-Khezrabadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Mohammad Javad Zibaeenezhad
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Ehsan Shojaeefard
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Arzhang Naseri
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Shahrokh Mousavi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Shirin Sarejloo
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Mohammadreza Karimi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Morteza Hosseinpour
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Maryam Salimi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Mehdi Bazrafshan
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Amirhossein Salimi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Nader Parsa
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Mehrab Sayadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Iman Razeghian-Jahromi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Fatemeh Zibaeenejad
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Seyyed Saeed Mohammadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Hamed Bazrafshan Drissi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
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15
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Bazrafshan H, Masoudi MS, Bazrafshan M, Asadi-Pooya AA. Is Shunt Location a Risk Factor for the Development of De Novo Post-shunt Seizures? Iran J Med Sci 2022; 47:139-142. [PMID: 35291428 PMCID: PMC8919312 DOI: 10.30476/ijms.2021.88641.1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/19/2020] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
Background While ventriculo-extracranial shunting procedures have been the standard treatment option for hydrocephalus for a long time, their long-term morbidity, including the development of post-shunt de Novo seizures, should be taken into account. This study aimed to investigate the rate and risk factors of the occurrence of de Novo post-shunt seizures in patients with hydrocephalus. Methods In this retrospective longitudinal study, all patients with hydrocephalus who had ventriculo-peritoneal shunt insertion from 2014 to 2017 at Namazi Hospital, (Shiraz, Iran) were studied. Phone calls were made to all patients to obtain their postoperative seizure outcome and other data (e.g., sex, age at surgery, shunt insertion location, history of seizures before surgery, history of seizures after surgery, any other type of brain surgery, and the etiology of their hydrocephalus). The Pearson Chi Square was used for the analysis of binary variable (e.g., sex) differences, and the t test for the analysis of differences in the means of numerical variables (e.g., age). Bonferroni correction tests were also utilized. P values less than 0.05 were considered significant. Results A total of 114 patients were included in the study. Overall, 68 (60%) patients had a frontal location of shunt insertion and 46 (40%) had a parietal site. Twenty-four (21%) patients reported experiencing de Novo post-shunt seizures, 15 of which had a frontal location and nine a parietal location for shunt insertion (P=0.824). Conclusion De Novo post-shunt seizures are common occurrences. However, shunt location is not a significant risk factor for the development of de Novo post-shunt seizures.
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Affiliation(s)
- Hanieh Bazrafshan
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehdi Bazrafshan
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Akbar Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, PA, USA
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16
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Hatamnejad MR, Heydari AA, Salimi M, Jahangiri S, Bazrafshan M, Bazrafshan H. The utility of SYNTAX score predictability by electrocardiogram parameters in patients with unstable angina. BMC Cardiovasc Disord 2022; 22:8. [PMID: 35016624 PMCID: PMC8753933 DOI: 10.1186/s12872-022-02455-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background SYNTAX score is one of the risk assessment systems to predict cardiac events in acute coronary syndrome patients. Despite the large number of SYNTAX score benefits, invasive methods such as coronary angiography are necessary to perform the scoring. We hypothesized that ECG parameters could predict the SYNTAX score in unstable angina patients.
Methods During the retrospective cohort study, a total number of 876 patients were diagnosed with unstable angina. After applying the exclusion criteria, 600 patients were divided into tertiles based on the SYNTAX scores as low (0–22), intermediate (23–32), and high (≥ 33). The association between ECG parameters and SYNTAX score was investigated. Results The study included 65% men and 35% women with a mean age of 62.4 ± 9.97 years. The delayed transition zone of QRS complex, ST-depression in inferior-lateral territories or/and in all three territories, and T-wave inversion in lateral territory were significant (p < 0.05) independent predictors of intermediate SYNTAX score. High SYNTAX score was predicted by the presence of prolonged P wave duration, ST-depression in lateral territory or/and anterior-lateral territories, ST-elevation in aVR–III leads or/and aVR–III–V1 leads. Among those, all three territories ST-depression (AUC: 0.611, sensitivity: 75%, specificity: 51%) and aVR + III ST-elevation (AUC: 0.672, sensitivity: 50.12%, specificity: 80.50%) were the most accurate parameters to predict intermediate and high SYNTAX scores, respectively. Conclusion The present study demonstrates that accompanying the STE in the right side leads (aVR, III, V1) with ST-depression in other leads indicates the patients with high SYNTAX score; meanwhile, diffuse ST-depression without ST-elevation is a marker for intermediate SYNTAX score in unstable angina patients and can be applied for early risk stratification and intervention.
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Affiliation(s)
- Mohammad Reza Hatamnejad
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Cardiology Medicine, Al-Zahra Charity Hospital, Shiraz University of Medical Sciences, Zand St, PO Box: 71348-14336, Shiraz, Iran
| | | | - Maryam Salimi
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodeh Jahangiri
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Bazrafshan
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Cardiology Medicine, Al-Zahra Charity Hospital, Shiraz University of Medical Sciences, Zand St, PO Box: 71348-14336, Shiraz, Iran.
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17
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Hatamnejad MR, Bazrafshan H, Hosseinpour M, Izadpanah P, Kasravi MR, Bazrafshan M. Ventricular repolarization indicators in risk stratification of decompensated heart failure patients with ventricular systolic dysfunction. Caspian J Intern Med 2022; 13:533-545. [PMID: 35974927 PMCID: PMC9348206 DOI: 10.22088/cjim.13.3.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/04/2021] [Accepted: 02/26/2022] [Indexed: 11/10/2022]
Abstract
Background Ventricular repolarization measurement by QTc interval and QT dispersion can recognize high-risk patients. Previous research tended to evaluate the act of repolarization indicators alone but this study aimed to elucidate their prognostic utility before and after modifying confounding parameters in risk stratification of different aspects of prognosis in decompensated heart failure patients with systolic dysfunction. Methods Data of 98 variables were evaluated to determine their predictive value concerning arrhythmic events, in-hospital, and long-term mortality. Results From 858 cases that presented with acute heart failure, 19.2% (n=165) were enrolled in the study. During hospitalization, arrhythmic events and cardiac-related mortality occurred in 56(33.9%) and 11(7%) patients, respectively. QTc and QT dispersion were independent predictors of arrhythmia and in-hospital mortality after adjustment of the variables (arrhythmic events: QTc interval OR 1.085, P=0.007, QT dispersion OR 1.077, P=0.007, in-hospital mortality: QTc interval OR 1.116, P=0.009, QT dispersion OR 1.067, P=0.011). After being discharged, they were tracked for 181±56 days. Within the 16 deaths in follow-up time, 6 sudden cardiac deaths were documented. Cox regression, defined QTc as the predictor of all-cause and sudden death mortality (all-cause: HR 1.041, 95% CI 1.015-1.067, P=0.002; sudden death: HR 1.063, 95% CI 1.023-1.105, P=0.002); nevertheless, efforts to demonstrate QT dispersion as the predictor failed. Conclusion The predictive nature of QT parameters was significant after modification of the variables; therefore, they should be measured for risk stratification of ventricular repolarization arrhythmia and death in decompensated heart failure patients.
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Affiliation(s)
- Mohammad Reza Hatamnejad
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Al-Zahra Charity Hospital, Department of Cardiology Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran,Al-Zahra Charity Hospital, Department of Cardiology Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Hosseinpour
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Al-Zahra Charity Hospital, Department of Cardiology Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Izadpanah
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran,Al-Zahra Charity Hospital, Department of Cardiology Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehdi Bazrafshan
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Akrami M, Izadpanah P, Bazrafshan M, Hatamipour U, Nouraein N, Drissi HB, Manafi A. Effects of colchicine on major adverse cardiac events in next 6-month period after acute coronary syndrome occurrence; a randomized placebo-control trial. BMC Cardiovasc Disord 2021; 21:583. [PMID: 34876021 PMCID: PMC8650300 DOI: 10.1186/s12872-021-02393-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023] Open
Abstract
Background Cardiovascular disease in particular acute coronary syndrome (ACS) is remained one of the most cause of morbidity and mortality, annually. Considering inflammatory pathway of atherosclerosis, colchicine as an anti-inflammatory drug is introduced to be effective in pathogenesis, prognosis and mortality rate of these patients. So in order to find out the effects of this drug we conducted this trial to know whether it reduces major adverse cardiac events (MACE) in ACS patients or not. Methods In a prospective randomized double-blinded placebo-controlled trial, we enrolled ACS patients (40–70 years) with recent ST-segment elevation myocardial infarction (STEMI) or NSTE-ACS diagnosed by coronary angiography and managed with either medical therapy or percutaneous coronary intervention. Patients were assigned to two groups either receiving colchicine 0.5 mg daily or placebo for 6 months. Both groups simultaneously received standard medical therapy as accessible guidelines. MACE occurrence consists of decompensated heart failure, ACS, stroke and survival rate compared between two groups. Results A total of 249 patients were recruited between October 2019-March 2020 with mean age of 56.89 ± 7.54, 69.5% males; 120 assigned to the colchicine group and 129 assigned to the placebo group. Over the 6 months’ period, 36 MACE occurred that were 8 events in the colchicine group compared with 28 events in the placebo group experiencing the event (P = 0.001). All of four deaths in the colchicine group and two in the placebo group were due to cardiovascular events. Evaluating adverse effects, gastrointestinal symptom was the most with the rate of 15 (12.5%) in the colchicine group and 3 (2.5%) in the controls. (P = 0.002). Conclusion The addition of colchicine to standard medical therapy in ACS patients significantly reduces MACE occurrence and improves survival rate over the time.
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Affiliation(s)
- Mehdi Akrami
- Cardiovascular Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Izadpanah
- Cardiovascular Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Bazrafshan
- Cardiovascular Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Unes Hatamipour
- Cardiovascular Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Navid Nouraein
- Cardiovascular Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Manafi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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19
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Asadi-Pooya AA, Bazrafshan M, Farazdaghi M. Long-term medical and social outcomes of patients with Lennox-Gastaut syndrome. Epilepsy Res 2021; 178:106813. [PMID: 34798494 DOI: 10.1016/j.eplepsyres.2021.106813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 09/10/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the current study was to investigate the long-term outcome in a large cohort of patients with Lennox-Gastaut syndrome (LGS). METHODS This was a longitudinal study (a retrospective database review with a telephone follow-up interview). All patients 18 years of age and older, with a diagnosis of LGS were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. The inclusion criteria were: multiple seizure types, characteristic electroencephalographic patterns [either bursts of slow spike-waves or generalized paroxysmal fast activity], with or without intellectual disability. Being lost on follow-up was the only exclusion criterion. RESULTS 78 patients fulfilled the inclusion criteria. All the patients were followed for one to 12 years (9.3 ± 2.8 years). In the last follow-up (call), 14 patients (17.9%) were seizure-free for at least 12 months. Tonic seizure at diagnosis was associated with a poor seizure outcome (not seizure-free) (p = 0.045). Four patients (5.1%) reported having high school degree (diploma), four patients (5.1%) were married, and one person (1.3%) reported driving a motor vehicle; none of the patients were employed. CONCLUSION A minority of patients with LGS (almost one in six patients) may enjoy a seizure-free state in their adulthood. However, very few of them could enjoy a healthy social life. While intellectual dysfunction may not be evident at the onset of the disease, cognitive impairment usually becomes apparent over time, and almost all patients would suffer from poor social outcomes in their adulthood.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mehdi Bazrafshan
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Asadi-Pooya AA, Bazrafshan M, Farazdaghi M. Cluster analysis of a large dataset of patients with Lennox-Gastaut syndrome. Seizure 2021; 92:36-39. [PMID: 34416422 DOI: 10.1016/j.seizure.2021.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES We applied the Two-Step cluster analysis on a large cohort of patients with Lennox-Gastaut syndrome (LGS). We hypothesized that there are distinct clusters of patients with LGS based on their clinical characteristics. We also studied whether the seizure outcome differs between these patient clusters. METHODS This was a longitudinal study of a prospectively developed database. All patients with a diagnosis of LGS were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. The Two-Step cluster analysis (Schwarz's Bayesian Criterion: BIC) was applied to the whole dataset considering the demographic data, seizure types, and EEG data. In the next step, the seizure outcome was compared between the clusters of patients. RESULTS Two hundred and fifty-eight patients were studied. The Two-Step cluster analysis showed that there were three clusters of homogeneous subgroups of patients with LGS, with a fair silhouette measure of cohesion and separation. The seizure outcomes were significantly different between the clusters. In cluster 1, three out of 35 patients (8.6%) were seizure-free; in cluster 2, 13 out of 34 patients (38.2%) were seizure-free; and in cluster 3, nine out of 49 patients (18.4%) were seizure-free (p = 0.009; df: 2). CONCLUSION The Two-Step cluster analysis could identify three distinct clusters of patients with LGS; these data are helpful in providing appropriate prognosis and counselling for patients and their care-givers. Future studies should also investigate the effects of etiology in cluster analysis of patients with LGS.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mehdi Bazrafshan
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Asadi-Pooya AA, Bazrafshan M. Employment and disability status in patients with functional (psychogenic nonepileptic) seizures. Brain Behav 2021; 11:e02016. [PMID: 33372416 PMCID: PMC7994678 DOI: 10.1002/brb3.2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/16/2020] [Accepted: 12/11/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE We investigated the rate of employment in patients with functional seizures (FS) in a follow-up study. We also investigated the rate of receiving disability benefits in these patients. Finally, we investigated factors that are potentially associated with their employment status. METHODS In this long-term study, all patients with FS, who were diagnosed at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 to 2018, were investigated. In a phone call interview to the patients in February 2020, we tried to obtain the following information: seizure outcome, employment status, receiving disability benefits, and their current drug regimen, if any. The first call was made in the evening and after working hours. In case of no response, we made two more attempts in the following weeks to contact the patients during different time periods of the day. RESULTS Eighty- four patients participated. Thirty-one patients (37%) were employed, and 53 people (63%) were not; at the first visit, the rate of employment was 23%. Female sex (Odds Ratio [OR]: 12.18; 95% Confidence Interval [CI]: 3.51-42.18; p = .0001), taking psychiatric drugs (OR: 4.93; 95% CI: 1.17-20.73; p = .02), and being employed previously (OR: 0.19; 95% CI: 0.04-0.77; p = .02) were independently significantly associated with the current employment status. Three patients (4%) reported receiving disability social benefits, two women and one man. CONCLUSION This study highlights that unemployment is a serious issue in patients with FS and psychiatric comorbidities play a significant role in the employment status in these patients.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mehdi Bazrafshan
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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22
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Asadi‐Pooya AA, Farazdaghi M, Bazrafshan M. Impacts of the COVID-19 pandemic on Iranian patients with epilepsy. Acta Neurol Scand 2020; 142:392-395. [PMID: 32632917 PMCID: PMC7362008 DOI: 10.1111/ane.13310] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022]
Abstract
Objective To investigate the effects of COVID‐19 pandemic on patients' perceptions of hardship in obtaining their drugs and if this pandemic and the social restrictions in response to that has resulted in any changes in their seizure control status. We also investigated factors potentially associated with the perceptions of difficulty in obtaining their drugs (eg, polytherapy vs monotherapy, taking imported drugs, and seizure status worsening). Methods We surveyed a random sample of patients with epilepsy, who were registered in our database at Shiraz Epilepsy Center, Iran, on their perceptions on two issues: (a) What has been your experience on obtaining your antiseizure medications in the past 4 weeks (compared to before)? (b) Have you experienced any changes in your seizure control status in the past 4 weeks? Results We included 100 patients (53 male and 47 female patients). In response to the question “Have you had any difficulties in the past 4 weeks to obtain your drugs?,” 31 people (31%) expressed hardship obtaining their drugs. In response to the question “How has been your seizure control status compared with before?,” six people (6%) expressed worsening of their seizure control status in the past 4 weeks. None of the patients reported symptoms of coronavirus infection. Conclusion About one‐third of patients with epilepsy expressed significant hardship obtaining their drugs after the intensification of the COVID‐19 outbreak in Iran. The current COVID‐19 pandemic could be considered as a major shock to a nation that has already been under significant pressure (ie, Iran).
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Affiliation(s)
- Ali A. Asadi‐Pooya
- Epilepsy Research Center Shiraz University of Medical Sciences Shiraz Iran
- Department of Neurology Jefferson Comprehensive Epilepsy Center Thomas Jefferson University Philadelphia PA USA
| | - Mohsen Farazdaghi
- Epilepsy Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Mehdi Bazrafshan
- Epilepsy Research Center Shiraz University of Medical Sciences Shiraz Iran
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Asadi-Pooya AA, Bazrafshan M. Is patient acceptance of the diagnosis of functional (psychogenic nonepileptic) seizures linked to their clinical characteristics? J Psychosom Res 2020; 136:110193. [PMID: 32698079 DOI: 10.1016/j.jpsychores.2020.110193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE We investigated the rate of acceptance of functional seizures (FS) or psychogenic nonepileptic seizures (PNES) diagnosis in a cross-sectional study in a cohort from Iran. We hypothesized that the acceptance of FS diagnosis has association with clinical characteristics of the patients. METHODS In this cross-sectional study, all patients with FS, who were diagnosed at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2018, were investigated. In a phone call interview in February 2020, we obtained the following information: whether they have accepted the diagnosis that was delivered to them; what is their seizure outcome (seizure-free during the past 12 months or not). RESULTS 100 patients participated; at the time of the follow-up call, 74 (74%) patients expressed that they have accepted the diagnosis of FS. At the follow-up call, 48 patients (48%) were seizure-free and 52 patients (52%) were suffering from FS yet; 34 of seizure-free patients (71%) and 40 of those patients who still had seizures (77%) expressed that they have accepted the diagnosis of FS (p = .504; Fisher's exact test). Patients' characteristics and seizure semiology were not associated with the acceptance of the diagnosis of FS. CONCLUSION That the majority of patients with FS accept their diagnosis if it is delivered to them appropriately, and demographic and clinical characteristics of the patients do not have associations with this.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mehdi Bazrafshan
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Asadi-Pooya AA, Bazrafshan M. Driving rate and road traffic accidents in drivers with functional (psychogenic nonepileptic) seizures. Seizure 2020; 79:27-29. [DOI: 10.1016/j.seizure.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023] Open
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Bartkowiak M, Bazrafshan M, Fischer C, Fleischmann A, Enss C. Nuclear quadrupole moments as a microscopic probe to study the motion of atomic tunneling systems in amorphous solids. Phys Rev Lett 2013; 110:205502. [PMID: 25167425 DOI: 10.1103/physrevlett.110.205502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Indexed: 06/03/2023]
Abstract
The properties of amorphous solids below 1 K are dominated by atomic tunneling systems. A basic description is given by the standard tunneling model. Despite its success, the standard tunneling model still remains phenomenological and little is known about the microscopic nature of tunneling systems in amorphous solids. We present dielectric polarization echo experiments on partially deuterated amorphous glycerol. Nuclear quadrupoles, introduced by the deuteration, influence the echo amplitude in a characteristic way and allow us to draw for the first time detailed conclusions about the microscopic nature of the tunneling processes in amorphous glycerol.
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Affiliation(s)
- M Bartkowiak
- Kirchhoff-Institut für Physik, Universität Heidelberg, INF 227 D-69120 Heidelberg, Germany
| | - M Bazrafshan
- Kirchhoff-Institut für Physik, Universität Heidelberg, INF 227 D-69120 Heidelberg, Germany
| | - C Fischer
- Kirchhoff-Institut für Physik, Universität Heidelberg, INF 227 D-69120 Heidelberg, Germany
| | - A Fleischmann
- Kirchhoff-Institut für Physik, Universität Heidelberg, INF 227 D-69120 Heidelberg, Germany
| | - C Enss
- Kirchhoff-Institut für Physik, Universität Heidelberg, INF 227 D-69120 Heidelberg, Germany
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