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Mortazavi A, Hashemi A, Jamali A, Hashemi H, Aghamirsalim M, Khabazkhoob M. Prevalence of retinal pathologies in people over 60 years: the Tehran Geriatrics Eye Study. Int J Ophthalmol 2024; 17:721-728. [PMID: 38638250 PMCID: PMC10988065 DOI: 10.18240/ijo.2024.04.17] [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: 04/14/2023] [Accepted: 11/20/2023] [Indexed: 04/20/2024] Open
Abstract
AIM To determine the prevalence of some retinal pathologies in people over 60y and their association with demographic and ocular factors. METHODS A cross-sectional study was conducted in Tehran using multistage cluster sampling. After selecting subjects aged 60 and over, optometric, and ophthalmic examinations were done. For retinal examination, a 90 D lens was used and indirect ophthalmoscopy was performed after instilling tropicamide drops. Biometry was done using the IOL Master for all participants. RESULTS Of 3791 people that were invited through cluster sampling, 3310 participated in the study (response rate=82%). The prevalence of retinal pigmented epithelium (RPE) change, drusen, geographic atrophy (GA), hypertensive retinopathy (HTR), nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), choroidal neovascularization (CNV), central retinal artery occlusion (CRAO), myopic retinopathy (MR), branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO) was 27.42%, 11.08%, 4.52%, 3.03%, 4.05%, 0.54%, 0.82%, 0.39%, 0.20%, 0.49%, and 0.19%, respectively. After removing the effect of age, the odds of NPDR were 1.68 times higher in women compared to men (P=0.014). After removing the effect of sex, the odds of drusen, RPE change, GA, CNV, BRVO, and CRVO increased with age. CONCLUSION There is a higher prevalence of RPE change, drusen, GA, CNV and a lower prevalence of MR and CRAO in the elderly population of Tehran aged over 60y compared to global average values. Considering the correlation of most of the diseases with age and their effects on vision, attention should be paid to these diseases and the related screening programs to prevent vision impairment.
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Affiliation(s)
- Abolghasem Mortazavi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Alireza Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran 1983963113, Iran
| | - Alirerza Jamali
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran 1545913487, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran 1983963113, Iran
| | - Mohammadreza Aghamirsalim
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran 1157715354, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 1968653111, Iran
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Hashemi A, Nabovati P, Mortazavi A, Hashemi H, Khabazkhoob M. Subfoveal choroidal thickness in a general elderly population; Tehran geriatric eye study. BMC Ophthalmol 2024; 24:136. [PMID: 38532398 DOI: 10.1186/s12886-024-03401-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE To determine the distribution of subfoveal choroidal thickness (SFCT) and its associated demographic, ocular, and systemic factors in an elderly population. METHODS This report is part of the Tehran Geriatric Eye Study (TGES); a population-based cross-sectional study that was conducted on the urban elderly population of Tehran, aged 60 years and above using multi-stage stratified random cluster sampling. Choroidal imaging was performed using Spectralis SD-OCT with enhanced depth imaging mode. RESULTS The average SFCT was 265.3 ± 25.9 μm (95% CI: 262.8-267.7) in the whole sample. According to the multiple generalized estimating equation (GEE) model, pseudophakia had a statistically significant direct relationship with SFCT (coefficient = 5.69), and history of cerebrovascular accident (CVA) was significantly inversely related to SFCT (coefficient=-4.77). Moreover, there was a significant interaction between age and sex in the average SFCT so that with increasing age, the SFCT increased in men and decreased in women. CONCLUSION The normal values of SFCT in the present study can be used as a reference database for clinical and research purposes. Age-sex interaction, pseudophakia, and history of CVA were significantly associated with SFCT in the elderly population. It is recommended that these factors be taken into account when interpreting SFCT data.
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Affiliation(s)
- Alireza Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Payam Nabovati
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Mortazavi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran.
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hashemi A, Khabazkhoob M, Narooei F, Mortazavi A, Hashemi H. Corneal topographic indices of scheimpflug camera in type 2 diabetic and non-diabetic elderly populations. BMC Ophthalmol 2023; 23:427. [PMID: 37872473 PMCID: PMC10594925 DOI: 10.1186/s12886-023-03169-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE The present study was conducted to determine the corneal topographic indices of Scheimpflug camera in type 2 diabetes patients without diabetic retinopathy (DR), DR and non-diabetic elderly populations. METHODS A total of 1105 participants were selected using random cluster sampling from Tehran, Iran and categorized into three groups including type 2 diabetes patients without diabetic retinopathy (DR), DR and non-diabetic. The diabetic group had HbA1c levels ≥ 6.4% with no other systemic problems. The non-diabetic participants had normal eye findings and no systemic diseases. The pachymetric progression index (PPI) values were measured using the Pentacam AXL. RESULTS A total of 1105 participants including 429 diabetes patients (38.46% male) and 676 non-diabetic (38.76% male) subjects entered the study. Only PPIavg and PPImax were higher in the diabetics versus non-diabetics (P = 0.019 and 0.010, respectively). There was a significant difference in PPImax between the three groups (P = 0.036). There were significant differences only in index of vertical asymmetry (IVA), central keratoconus index (CKI), PPI average, and PPI max between different stages of diabetic retinopathy (DR) (P = 0.045, 0.005, 0.002, and 0.004, respectively). There was a significant difference in index of Surface Variance (ISV), index of vertical asymmetry (IVA), PPIavg, and PPImax between diabetes patients with and without DR (P = 0.016, 0.022, < 0.001, and < 0.001, respectively). CONCLUSION According to the results, diabetes and DR change several topographic indices. In addition, the HbA1c level may affect pachymetric progression index max. Therefore, special attention should be paid to these patients for different treatment strategies.
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Affiliation(s)
- Alireza Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Narooei
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Abolghasem Mortazavi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran.
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Hashemi H, Shahidi A, Hashemi A, Jamali A, Mortazavi A, Khabazkhoob M. The prevalence of red-green color vision deficiency and its related factors in an elderly population above 60 years of age. Int J Ophthalmol 2023; 16:1535-1541. [PMID: 37724279 PMCID: PMC10475627 DOI: 10.18240/ijo.2023.09.22] [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: 04/07/2023] [Accepted: 06/12/2023] [Indexed: 09/20/2023] Open
Abstract
AIM To determine the prevalence of red-green (RG) color vision deficiency (CVD) in an elderly population and its related factors. METHODS This report is a part of the Tehran Geriatric Eye Study: a cross-sectional population-based study that was conducted on the elderly population (≥60y) of Tehran, Iran using multi-stage stratified random cluster sampling. All study participants underwent complete ocular examination, including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, and slit-lamp biomicroscopy. The color vision was tested using Ishihara plates with the near optical correction in place. RESULTS Of the 3791 invitees, 3310 participated in the study. The data of 2164 individuals were analyzed after applying the exclusion criteria. The prevalence of R-G CVD was 3.73% (95%CI: 2.37%-5.09%) in the whole sample; the prevalence of protanomaly, protanopia, and deuteranopia was 1.51%, 1.76%, and 0.45%, respectively. The prevalence of R-G CVD was significantly higher in males than in females. The prevalence of RG CVD increased with advancing age from 2.91% in the age group 60-64y to 5.8% in the age group ≥80y (P=0.070). According to the multiple logistic regression model, male sex, and glaucoma were significantly related to RG CVD. Older age and hypertension also had a marginally significant relationship with RG CVD. CONCLUSION Changes in color vision occur in the elderly due to the aging process and some physiological and pathological factors. Since the change in visual perception may affect the person's performance, this aspect of the visual system's function should also be taken into consideration in the examinations of the elderly.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran 1983963113, Iran
| | - Aida Shahidi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran 1983963113, Iran
| | - Alireza Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran 1983963113, Iran
| | - Alireza Jamali
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran 1545913487, Iran
| | - Abolghasem Mortazavi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 1968653111, Iran
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Hashemi H, Asharlous A, Jamali A, Mortazavi A, Hashemi A, Khabazkhoob M. Auto-refraction versus subjective refraction in different phakic and pseudophakic conditions: the Tehran Geriatric Eye Study (TGES). Int J Ophthalmol 2023; 16:1309-1316. [PMID: 37602339 PMCID: PMC10398526 DOI: 10.18240/ijo.2023.08.18] [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: 10/21/2022] [Accepted: 06/16/2023] [Indexed: 08/22/2023] Open
Abstract
AIM To compare the subjective refraction data with non-cycloplegic auto-refraction findings in the geriatric population above 60 years of age according to the different crystalline lens conditions. METHODS This report is a part of the Tehran Geriatric Eye Study (TGES) that was conducted from January 2019 to January 2020 on elderly population 60 years of age and above in Tehran. The samples were selected by multi-stage stratified random cluster sampling. Of 3791 individual invitees, 3310 (response rate: 87.3%) participated in this study. All study participants underwent non-cycloplegic auto-refraction (auto-refractometer/keratometer Nidek ARK-510) and subjective refraction. RESULTS Regarding the sphere, eyes with mixed cataract had the worst limits of agreement (LoA: -1.24 to 0.87) and the best agreement was related to the pseudophakic eyes (LoA: -0.83 to 0.54). The highest (0.27±0.31 D) and lowest (0.21±0.27 D) differences between the two methods regarding the cylinder power were observed in eyes with cortical cataract and normal eyes, respectively. The worst LoA between the two methods in measuring the cylinder power was related to the eyes with mixed cataract (LoA: -0.44 to 0.96). Regarding the J0 (horizontal/vertical components of astigmatism), the mean values of J0 obtained by auto-refraction were tended more toward against the rule direction in all crystalline lens conditions, and the two methods had the greatest difference in cortical cataract cases (0.05±0.17 D). Regarding the J45 (oblique components of astigmatism), the lowest (0±0.11 D) and highest (-0.01±0.12 D) differences were observed in normal eyes and eyes with cortical cataract, respectively. CONCLUSION The auto-refractometer/keratometer Nidek ARK-510 results in the elderly with different phakic and pseudophakic conditions do not correspond well with subjective refraction findings. This discrepancy in spherical findings is more pronounced in individuals with mixed cataract than in other cases.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran 1968653111, Iran
| | - Amir Asharlous
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran 1661635198, Iran
| | - Alireza Jamali
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Abolghasem Mortazavi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Alireza Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran 1661635198, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 1968653111, Iran
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Hashemi A, Khabazkhoob M, Mehri A, Yekta A, Mortazavi A, Hashemi H. Epidemiology of Ocular Trauma in the Elderly: A Population-Based Study. J Curr Ophthalmol 2023; 35:79-85. [PMID: 37680290 PMCID: PMC10481976 DOI: 10.4103/joco.joco_53_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose To determine the prevalence of different types of ocular trauma and their relationship with some factors in the elderly population. Methods The present population-based cross-sectional study was conducted on the elderly population aged 60 years and above in Tehran, Iran, using multi-stage stratified random cluster sampling in 2019. After selecting the samples and their participation in the study, demographic information and history of ocular trauma were obtained through an interview. Psychological evaluation was performed using the Goldberg's 28-question General Health Questionnaire. All study participants underwent optometric and ophthalmological examinations. Results Three thousand three hundred and ten people participated in the study (response rate: 87.3%). Of these, 1912 individuals (57.8%) were female and the mean age of individuals was 68.25 ± 6.55 (from 60 to 97) years. 7.46% (95% confidence interval [CI]: 6.51-8.41) of the study participants reported a history of ocular trauma. Blunt and chemical traumas were the most and the least common types of ocular trauma, respectively (5.72% and 0.16%). 3.93% of cases visited an ophthalmologist for ocular trauma, 1.67% reported a history of hospitalization, and 1.47% underwent surgery. The prevalence of visual impairment in individuals with a history of ocular trauma was 12.53%. Visual impairment was more prevalent in people with a history of ocular trauma than those without a history of ocular trauma (P < 0.05). History of ocular trauma was only significantly related to low education level (odds ratio = 0.63, 95% CI = 0.40-0.99). Participants with a history of ocular trauma had more anxiety and higher mean psychological distress score than those without a history of ocular trauma (P = 0.035). Conclusions The development of preventive programs against the occurrence of ocular trauma can play an important role in reducing the psychological damage of affected patients while reducing visual disorders. These interventions should be especially considered in groups with a lower education level.
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Affiliation(s)
- Alireza Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Mehri
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbasali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolghasem Mortazavi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
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Yarandi KK, Pour-Rashidi A, Mortazavi A, Shirani M, Mohammadi E, Karimiyarandi H, Amirjamshidi A. Pitfalls in diagnosis of cord tethering in scoliosis: Lessons learned from a series in a single centre. Interdisciplinary Neurosurgery 2022. [DOI: 10.1016/j.inat.2022.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Dmytriw AA, Ghozy S, Sweid A, Piotin M, Bekelis K, Sourour N, Raz E, Vela-Duarte D, Linfante I, Dabus G, Kole M, Martínez-Galdámez M, Nimjee SM, Lopes DK, Hassan AE, Kan P, Ghorbani M, Levitt MR, Escalard S, Missios S, Shapiro M, Clarençon F, Elhorany M, Tahir RA, Youssef PP, Pandey AS, Starke RM, El Naamani K, Abbas R, Mansour OY, Galvan J, Billingsley JT, Mortazavi A, Walker M, Dibas M, Settecase F, Heran MKS, Kuhn AL, Puri AS, Menon BK, Sivakumar S, Mowla A, D'Amato S, Zha AM, Cooke D, Vranic JE, Regenhardt RW, Rabinov JD, Stapleton CJ, Goyal M, Wu H, Cohen J, Turkel-Parella D, Xavier A, Waqas M, Tutino V, Siddiqui A, Gupta G, Nanda A, Khandelwal P, Tiu C, Portela PC, Perez de la Ossa N, Urra X, de Lera M, Arenillas JF, Ribo M, Requena M, Piano M, Pero G, De Sousa K, Al-Mufti F, Hashim Z, Nayak S, Renieri L, Du R, Aziz-Sultan MA, Liebeskind D, Nogueira RG, Abdalkader M, Nguyen TN, Vigilante N, Siegler JE, Grossberg JA, Saad H, Gooch MR, Herial NA, Rosenwasser RH, Tjoumakaris S, Patel AB, Tiwari A, Jabbour P. International Controlled Study of Revascularization and Outcomes Following COVID-Positive Mechanical Thrombectomy. Eur J Neurol 2022; 29:3273-3287. [PMID: 35818781 PMCID: PMC9349405 DOI: 10.1111/ene.15493] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/25/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
Background and purpose Previous studies suggest that mechanisms and outcomes in patients with COVID‐19‐associated stroke differ from those in patients with non‐COVID‐19‐associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID‐19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors. Methods A cross‐sectional, international multicenter retrospective study was conducted in consecutively admitted COVID‐19 patients with concomitant acute LVO, compared to a control group without COVID‐19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable‐adjusted analysis was conducted. Results In this cohort of 697 patients with acute LVO, 302 had COVID‐19 while 395 patients did not. There was a significant difference (p < 0.001) in the mean age (in years) and gender of patients, with younger patients and more males in the COVID‐19 group. In terms of favorable revascularization (modified Thrombolysis in Cerebral Infarction [mTICI] grade 3), COVID‐19 was associated with lower odds of complete revascularization (odds ratio 0.33, 95% confidence interval [CI] 0.23–0.48; p < 0.001), which persisted on multivariable modeling with adjustment for other predictors (adjusted odds ratio 0.30, 95% CI 0.12–0.77; p = 0.012). Moreover, endovascular complications, in‐hospital mortality, and length of hospital stay were significantly higher among COVID‐19 patients (p < 0.001). Conclusion COVID‐19 was an independent predictor of incomplete revascularization and poor functional outcome in patients with stroke due to LVO. Furthermore, COVID‐19 patients with LVO were more often younger and had higher morbidity/mortality rates.
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Affiliation(s)
- Adam A Dmytriw
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA.,Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sherief Ghozy
- Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Kimon Bekelis
- Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Nader Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eytan Raz
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Daniel Vela-Duarte
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Florida, USA
| | - Italo Linfante
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Florida, USA
| | - Guilherme Dabus
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Florida, USA
| | - Max Kole
- Department of Neurosurgery, Henry Ford Hospital, Michigan, USA
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Spain
| | - Shahid M Nimjee
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Demetrius K Lopes
- Department of Neurosurgery, Advocate Aurora Health, Chicago, Illinois, USA
| | - Ameer E Hassan
- Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, UTMB, Houston, Texas, USA
| | | | - Michael R Levitt
- Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Simon Escalard
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Symeon Missios
- Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Maksim Shapiro
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Fréderic Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Mahmoud Elhorany
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Rizwan A Tahir
- Department of Neurosurgery, Henry Ford Hospital, Michigan, USA
| | - Patrick P Youssef
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert M Starke
- Department of Neurosurgery & Neuroradiology, University of Miami & Jackson Memorial Hospital, Miami, Florida, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Jorge Galvan
- Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Spain
| | | | - Abolghasem Mortazavi
- Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Melanie Walker
- Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Mahmoud Dibas
- Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fabio Settecase
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manraj K S Heran
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna L Kuhn
- Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Bijoy K Menon
- Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sanjeev Sivakumar
- Department of Medicine (Neurology), Prisma Health Upstate, USC, Greenville, South Carolina, USA
| | - Ashkan Mowla
- Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA
| | - Salvatore D'Amato
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - Alicia M Zha
- Department of Neurology, UT Health Science Center, Houston, Texas, USA
| | - Daniel Cooke
- Department of Neurointerventional Radiology, San Francisco General Hospital, San Francisco, California, USA
| | - Justin E Vranic
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - James D Rabinov
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - Mayank Goyal
- Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Hannah Wu
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.,Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.,Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - Jake Cohen
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.,Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.,Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - David Turkel-Parella
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.,Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.,Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - Andrew Xavier
- Department of Neurology, Sinai Grace Hospital, Detroit, Michigan, USA.,Department of Neurology, St. Joseph Mercy Health, Ann Arbor, Michigan, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Vincent Tutino
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Gaurav Gupta
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Anil Nanda
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Priyank Khandelwal
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Cristina Tiu
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Pere C Portela
- Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, Spain
| | - Natalia Perez de la Ossa
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xabier Urra
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Mercedes de Lera
- Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Juan F Arenillas
- Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain; Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain; Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Mariangela Piano
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Guglielmo Pero
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Keith De Sousa
- Department of Neurology, Eastern Region, Northwell Health, Long Island, New York, New York, USA
| | - Fawaz Al-Mufti
- Department of Neurology, Radiology, and Neurosurgery, Westchester Medical Center at NY Medical College, Valhalla, New York, USA
| | - Zafar Hashim
- Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Sanjeev Nayak
- Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Leonardo Renieri
- Department of Radiology, Neurovascular Unit, Careggi University Hospital, Florence, Italy
| | - Rose Du
- Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohamed A Aziz-Sultan
- Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Liebeskind
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, USA
| | - Raul G Nogueira
- Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohamad Abdalkader
- Departments of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, Massachusetts, USA
| | - Thanh N Nguyen
- Departments of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, Massachusetts, USA
| | - Nicholas Vigilante
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | | | - Hassan Saad
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Michael R Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Aman B Patel
- Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA
| | - Ambooj Tiwari
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.,Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.,Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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9
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Jabbour P, Dmytriw AA, Sweid A, Piotin M, Bekelis K, Sourour N, Raz E, Linfante I, Dabus G, Kole M, Martínez-Galdámez M, Nimjee SM, Lopes DK, Hassan AE, Kan P, Ghorbani M, Levitt MR, Escalard S, Missios S, Shapiro M, Clarençon F, Elhorany M, Vela-Duarte D, Tahir RA, Youssef PP, Pandey AS, Starke RM, El Naamani K, Abbas R, Hammoud B, Mansour OY, Galvan J, Billingsley JT, Mortazavi A, Walker M, Dibas M, Settecase F, Heran MKS, Kuhn AL, Puri AS, Menon BK, Sivakumar S, Mowla A, D'Amato S, Zha AM, Cooke D, Goyal M, Wu H, Cohen J, Turkel-Parrella D, Xavier A, Waqas M, Tutino VM, Siddiqui A, Gupta G, Nanda A, Khandelwal P, Tiu C, Portela PC, Perez de la Ossa N, Urra X, de Lera M, Arenillas JF, Ribo M, Requena M, Piano M, Pero G, De Sousa K, Al-Mufti F, Hashim Z, Nayak S, Renieri L, Aziz-Sultan MA, Nguyen TN, Feineigle P, Patel AB, Siegler JE, Badih K, Grossberg JA, Saad H, Gooch MR, Herial NA, Rosenwasser RH, Tjoumakaris S, Tiwari A. Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study. Neurosurgery 2022; 90:725-733. [PMID: 35238817 PMCID: PMC9514728 DOI: 10.1227/neu.0000000000001902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke. OBJECTIVE To describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. METHODS We conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020. RESULTS The total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002). CONCLUSION COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.
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Affiliation(s)
- Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Adam A. Dmytriw
- Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France;
| | - Kimon Bekelis
- Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Nader Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eytan Raz
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Italo Linfante
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA
| | - Guilherme Dabus
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA
| | - Max Kole
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA;
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain;
| | - Shahid M. Nimjee
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;
| | - Demetrius K. Lopes
- Department of Neurosurgery, Advocate Aurora Health, Chicago, Illinois, USA
| | - Ameer E. Hassan
- Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Michael R. Levitt
- Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA;
| | - Simon Escalard
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France;
| | - Symeon Missios
- Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Maksim Shapiro
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Mahmoud Elhorany
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Daniel Vela-Duarte
- Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA
| | - Rizwan A. Tahir
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA;
| | - Patrick P. Youssef
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;
| | - Aditya S. Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert M. Starke
- Department of Neurosurgery & Neuroradiology, University of Miami & Jackson Memorial Hospital, Miami, Florida, USA;
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Bassel Hammoud
- Department of Biomedical Engineering, American University of Beirut, Beirut, Lebanon;
| | - Ossama Y. Mansour
- Department of Neurology and Neuroradiology, Alexandria University Hospital, Al Attarin, Egypt;
| | - Jorge Galvan
- Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain;
| | | | - Abolghasem Mortazavi
- Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Melanie Walker
- Departments of Neurological Surgery and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA;
| | - Mahmoud Dibas
- Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA
| | - Fabio Settecase
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, USA
| | - Manraj K. S. Heran
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, USA
| | - Anna L. Kuhn
- Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Ajit S. Puri
- Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Bijoy K. Menon
- Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sanjeev Sivakumar
- Department of Neurosurgery & Neuroradiology, University of Miami & Jackson Memorial Hospital, Miami, Florida, USA;
| | - Ashkan Mowla
- Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA
| | - Salvatore D'Amato
- Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA
| | - Alicia M. Zha
- Department of Neurology, UT Health Science Center, Houston, Texas, USA
| | - Daniel Cooke
- Department of Neurointerventional Radiology, San Francisco General Hospital, San Francisco, California, USA
| | - Mayank Goyal
- Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Hannah Wu
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA
- Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA
- Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - Jake Cohen
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA
- Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA
- Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - David Turkel-Parrella
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA
- Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA
- Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
| | - Andrew Xavier
- Department of Neurology, Sinai Grace Hospital, Detroit, Michigan, USA
- Department of Neurology, St. Joseph Mercy Health, Ann Arbor, Michigan, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Vincent M. Tutino
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA
| | - Gaurav Gupta
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Anil Nanda
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Priyank Khandelwal
- Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Cristina Tiu
- Department of Physics, University of Toronto, Toronto, Ontario, Canada;
| | - Pere C. Portela
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Natalia Perez de la Ossa
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain;
| | - Xabier Urra
- Department of Neurology, Hospital Clínic, Barcelona, Spain;
| | - Mercedes de Lera
- Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain;
| | - Juan F. Arenillas
- Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain;
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain;
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA;
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain;
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA;
| | - Mariangela Piano
- Department of Physics, University of Toronto, Toronto, Ontario, Canada;
| | - Guglielmo Pero
- Department of Physics, University of Toronto, Toronto, Ontario, Canada;
| | - Keith De Sousa
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Fawaz Al-Mufti
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain;
| | - Zafar Hashim
- Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - Sanjeev Nayak
- Department of Neurology, Hospital Clínic, Barcelona, Spain;
| | - Leonardo Renieri
- Department of Radiology, Neurovascular Unit, Careggi University Hospital, Florence, Italy
| | - Mohamed A. Aziz-Sultan
- Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA
| | - Thanh N. Nguyen
- Departments of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA;
| | - Patricia Feineigle
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA;
| | - Aman B. Patel
- Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA
| | - James E. Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA;
| | - Khodr Badih
- Department of Physics, University of Toronto, Toronto, Ontario, Canada;
| | | | - Hassan Saad
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - M. Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Nabeel A. Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Robert H. Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
| | - Ambooj Tiwari
- Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA
- Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA
- Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA
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10
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Asharlous A, Doostdar A, Ghaemi V, Farzi M, Yekta A, Mortazavi A, Ostadimoghaddam H, Khabazkhoob M. Binocular Function in Different Gaze Positions. J Ophthalmic Vis Res 2022; 17:209-216. [PMID: 35765624 PMCID: PMC9185207 DOI: 10.18502/jovr.v17i2.10792] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate varied aspects of binocular function in multiple gaze positions. Methods In 2018, this cross-sectional study was conducted on 21 participants (male = 11) with an age range of 19–25 years. Having emmetropia and 10/10 visual acuity in both eyes were conditions of the inclusion criteria for the cross-sectional study. The following aspects of binocular function including amplitude of accommodation (AA), near point of convergence, near phoria, and monocular accommodative facility were evaluated in five gazes (primary, upward, downward, left, and right) for all subjects. Results Near point of convergence values showed significant differences in all gaze positions (P< 0.001). The lowest near point of convergence value was seen in the primary gaze (2.69 cm) and the downward gaze (3.47 cm) and the highest near point of convergence value was seen in the left gaze (7.5 cm). There was also a significant difference in the amplitude of accommodation among the upward, downward, and the primary gaze (P< 0.001) positions but no difference was observed among the temporal, nasal, and the primary gaze positions. There was a significant difference in near phoria between the upward gaze and the primary gaze (P = 0.008) while no significant differences were observed among the other gazes. There was no significant variance in the monocular accommodative facility among the different gaze positions (P = 0.175). Conclusion The results of this study indicated variations that exist in the convergence and accommodation reflex functions in multiple gaze positions, which proved to be more prominent in the convergence system. Although the accommodative sufficiency evaluation was inconsistent among the multiple gaze positions, the accommodative facility evaluation was consistent in all gazes.
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Affiliation(s)
- Amir Asharlous
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Asgar Doostdar
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Ghaemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mina Farzi
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolghasem Mortazavi
- Sina Hospital, Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Ghorbani M, Mortazavi A, Lafta G, Kadkhodazadeh Asl M, Bahrami R, Rahbarian F. Bilateral Internal Carotid Artery Dissection as a Possible Complication in a patient with Covid-19 infections and coughing. Caspian J Intern Med 2022; 13:281-283. [PMID: 35872686 PMCID: PMC9272953 DOI: 10.22088/cjim.13.0.281] [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: 10/08/2021] [Revised: 11/23/2021] [Accepted: 12/29/2021] [Indexed: 11/08/2022]
Abstract
Background Cervical carotid dissection is one of the causes of ischemic stroke in young people. Most of the patients with carotid dissection do not have connective tissue diseases (Marfan syndrome, Ehlers-Danlos syndrome). It seems that dissection may occur without an obvious cause or may follow environmental injuries like vigorous neck movements, chiropractic manipulation, emesis, severe coughs, and some infections. We present a case of bilateral carotid dissection in a patient following coronavirus infection and severe coughs. Case Presentation A 38-year-old right-handed man presented with recurrent episodes of transient right hemiparesis and aphasia. He had a history of coronavirus infection and severe persistent, nonproductive cough 7 days before the onset of his symptoms. Carotid angiography showed tapered flame-like appearance in proximal segment of left ICA starting about 2 cm distal to the carotid bulb caused complete occlusion of left ICA and in right CCA angiography there is pseudo aneurysm in right cervical ICA just before the Petrous segment. In 3 months in follow up DSA there is evidence of complete occlusion of right pseudo aneurysm and recanalization of left ICA without stenosis. Conclusion COVID-19 may have role in the processes that eventually led to CAD.
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Affiliation(s)
- Mohammad Ghorbani
- Division of vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Mortazavi
- Division of vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ghazwan Lafta
- Department of Surgery, University of Al-Ameed, Karbala, Iraq
| | - Mahdi Kadkhodazadeh Asl
- Division of vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Bahrami
- Division of vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Rahbarian
- Division of vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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12
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Ebrahimi H, Digaleh H, Pour-Rashidi A, Kazemi V, Hadadi A, Nasseri S, Mirzaii F, Mortazavi A, Amirjamshidi A. Spontaneous Intraparenchymal Hemorrhage in Patients with COVID-19: A Prospective Study and Literature Review. Indian Journal of Neurosurgery 2021. [DOI: 10.1055/s-0041-1735352] [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] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Coronavirus disease 2019 (COVID-19) is a devastating pandemic that may also affect the nervous system. One of its neurological manifestations is intracerebral hemorrhage (ICH). Data about pure spontaneous intraparenchymal hemorrhage related to COVID-19 is scarce. In this study, we present some patients with COVID-19 disease who also had spontaneous intraparenchymal hemorrhage along with a review of the literature.
Methods This single-center prospective study was done among 2,862 patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) between March 1 and November 1, 2020. Out of 2,862 patients with SARS-CoV-2, 14 patients with neurological manifestations were assessed with a noncontrast brain computed tomography scan. Seven patients with spontaneous intraparenchymal hemorrhage were enrolled.
Results All seven patients were male, with a mean age of 60.8 years old. Six patients (85.7%) only had minimal symptoms of COVID-19 without significant respiratory distress. The level of consciousness in two patients (28.5%) was less than eight, according to the Glasgow Coma Scale (GCS). Hypertension (71.4%) was the most common risk factor in their past medical history. The mean volume of hematoma was 41cc. Four patients died during hospitalization, and the others were discharged with a mean hospital stay of 42.6 days. All patients with GCS less than 11 died.
Conclusion It concluded that ICH patients with COVID-19 are related to higher blood volume, cortical and subcortical location of hemorrhage, higher fatality rate, and younger age that is different to spontaneous ICH in general population. We recommend more specific neuroimaging in patients with COVID 19 such as brain magnetic resonance imaging concomitant with vascular studies in future. The impact of COVID-19 on mortality rate is not clear because of limited epidemiologic studies, but identifying the causal relationship between COVID-19 and ICH requires further clinical and laboratory studies.
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Affiliation(s)
- Hannan Ebrahimi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hadi Digaleh
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ahmad Pour-Rashidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Vahid Kazemi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Azar Hadadi
- Department of Infectious Disease, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Shahin Nasseri
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farshid Mirzaii
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abolghasem Mortazavi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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13
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Ghorbani M, Griessenauer CJ, Wipplinger C, Jabbour P, Asl MK, Rahbarian F, Mortazavi A. Adenosine-induced transient circulatory arrest in transvenous embolization of cerebral arteriovenous malformations. Neuroradiol J 2021; 34:509-516. [PMID: 33657933 DOI: 10.1177/1971400921998972] [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: 11/15/2022] Open
Abstract
Due to advances in interventional techniques, the transvenous approach may present an effective treatment option for embolization of brain arteriovenous malformations (AVMs). Contrary to the transarterial method, the transvenous approach can only be utilized in a specific subset of patients and is not suitable as a standard procedure for all AVM lesions. While this technique can be helpful in certain patients, careful patient selection to ensure patient safety and favorable clinical outcomes is important. However, especially in high-flow AVMs, targeted deposition of embolic materials through a transvenous access can be challenging. Therefore, a temporary flow arrest may prove helpful. Transient cardiac arrest by use of adenosine has been applied in cerebrovascular surgery but is not common for endovascular embolization. Adenosine-induced arrest and systemic hypotension may be a feasible, safe method to reduce flow and help endovascular transvenous embolization of certain AVMs. Our study evaluated the efficiency and safety of adenosine-induced circulatory arrest for transvenous embolization of cerebral AVMs.
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Iran
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Health System, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | | | - Pascal Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University Hospital, USA
| | - Mahdi Kadkhodazadeh Asl
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Iran
| | - Farhad Rahbarian
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Iran
| | - Abolghasem Mortazavi
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Iran
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Ghorbani M, Lafta G, Rahbarian F, Mortazavi A. Treatment of post-traumatic direct carotid-cavernous fistulas using flow diverting stents: Is it alone satisfactory? J Clin Neurosci 2021; 86:230-234. [PMID: 33775333 DOI: 10.1016/j.jocn.2021.01.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/11/2020] [Revised: 01/08/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Direct carotid cavernous fistula (CCF) occurs between the internal carotid artery (ICA) and the cavernous sinus. Carotid cavernous fistulas (CCFs) frequently present with chemosis, pulsatile proptosis, ocular bruit, vision loss, and occasionally intracerebral hemorrhage or seizure. In this article, we share our experience in endovascular treatment of six patients having this pathology with intracranial flow diverting stents with review of literatures. CASE DESCRIPTION All six patients had posttraumatic direct CCF, most of their signs and symptoms were visual disturbance, chemosis, orbital bruit, headache, paralysis of extraocular muscles. They were treated with flow diversion stents with or without coils or liquid embolizing material; transvenous and transarterial routes were used. Most of them underwent multiple sessions, and their conditions were improved dramatically. CONCLUSION The best and most effective method is to start the procedure by coiling to convert the high-flow fistula to an aneurysmal pouch with the smallest possible size in the cavernous sinus, and then close the defect site with one or two flow diversion devices (FDDs).
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ghazwan Lafta
- Department of Surgery, Faculty of Medicine, University of Al-Ameed, Karbala, Iraq
| | - Farhad Rahbarian
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Mortazavi
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Pourlak T, Pourlak T, Ghodrati M, Mortazavi A, Dolati S, Yousefi M. Usage of stem cells in oral and maxillofacial region. J Stomatol Oral Maxillofac Surg 2020; 122:441-452. [PMID: 33099018 DOI: 10.1016/j.jormas.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/07/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022]
Abstract
Malformations of the maxillofacial region has disturbing psychosocial effects and causes enormous socioeconomic concerns. The management of maxillofacial defects caused by congenital anomalies, trauma, osteoporotic fractures, periodontitis, or cancer treatment is challenging for oral and maxillofacial surgeons. Numerous approaches have been recommended for the managing of these deficiencies. The traditional treatment for maxillofacial defects or their repair is an intricate process by autologous bone grafts from the scapula, ribs, fibula, or iliac crest origins. Regenerative medicine is well thought-out as a perfect substitute approach for autologous bone grafts to renovate bone deficiencies. The use of stem cells has improved results and offered a technique to reconstruct craniofacial bone defects. The field of tissue engineering for the regeneration of maxillofacial needs integration of biochemical and biomaterial engineering aspects with cell transplantation to generate better-quality biomimetic scaffolds, prevascularize three-dimensional (3D) tissue structures, and engineer the composite interface of diverse facial tissues. In this review, we have discussed the application of different adult stem cells to repair oral and maxillofacial defects in animal models and clinical trials.
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Affiliation(s)
- T Pourlak
- Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - T Pourlak
- Department of Pathology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Ghodrati
- Department of Endodontics, Dental and Periodental Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A Mortazavi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - S Dolati
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - M Yousefi
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Li M, Li Z, Kalinski P, Verschraegen C, Clinton S, Yang Y, Mortazavi A, Monk P, Folefac E, Yin M, Parikh A, Yang Y. 156P High TLR3 expression predicts improved survival in patients with clear cell renal cell carcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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17
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Ghorbani M, Asaadi S, Nouri M, Asl MK, Lafta GA, Bahrami R, Mortazavi A. The effect of adenosine in inducing cardiac arrest for endovascular treatment of paediatric high-flow brain and spinal vascular malformation. Neuroradiol J 2020; 33:328-333. [PMID: 32314649 PMCID: PMC7416345 DOI: 10.1177/1971400920920827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Endovascular treatment of high-flow vascular lesions with onyx may be very dangerous due to premature occlusion of the vein resulting from high flow-induced migration of this embolic substance without occlusion of the feeding vessels and the nidus. It is also dangerous because of the risk of occlusion of the normal vessels around the lesion. Inducing temporary cardiac arrest using adenosine may be helpful in limiting and minimizing these risks. However anaesthetic management of this procedure in children suffering from high-flow vascular lesions is difficult and challenging. METHODS We report three paediatric patients with high-flow cerebrospinal vascular lesions that underwent endovascular treatment under general anaesthesia and temporary cardiac arrest with adenosine. Adenosine was administered in escalating doses to induce a few seconds of cardiac standstill and the onyx injection was synchronized with the onset of adenosine-induced cardiac standstill, the fistula being occluded by onyx. RESULTS There were no complications in peri-procedural treatment in all three cases. Post-embolization angiography revealed complete obliteration of the lesion, and the patients' neurological status progressively improved at follow-up. CONCLUSION Adenosine-induced temporary cardiac standstill was successfully used to facilitate safe and controlled endovascular onyx embolization of high-flow central nervous system vascular lesions.
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Iran University of
Medical Sciences, Iran
| | - Sina Asaadi
- Division of Vascular and Endovascular Neurosurgery, Iran University of
Medical Sciences, Iran
| | - Mohsen Nouri
- Department of Neurosurgery, North Shore University Hospital, USA
| | - Mahdi Kadkhodazadeh Asl
- Division of Vascular and Endovascular Neurosurgery, Iran University of
Medical Sciences, Iran
| | - Ghazwan Alwan Lafta
- Division of Vascular and Endovascular Neurosurgery, Iran University of
Medical Sciences, Iran
| | - Reza Bahrami
- Division of Vascular and Endovascular Neurosurgery, Iran University of
Medical Sciences, Iran
| | - Abolghasem Mortazavi
- Division of Vascular and Endovascular Neurosurgery, Iran University of
Medical Sciences, Iran
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Mortazavi A, Jelodar S, Edraki K, Narimani S, Ghorbani M, Karimi-Yarandi K, Asaadi S. Dual antiplatelet therapy in a patient with simultaneous aneurysmal subarachnoid hemorrhage and myocardial infarction. Surg Neurol Int 2020; 11:49. [PMID: 32257575 PMCID: PMC7110275 DOI: 10.25259/sni_472_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/31/2019] [Accepted: 02/05/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Electrocardiography (ECG) changes after subarachnoid hemorrhage (SAH) are well described. However, concurrent myocardial infarction (MI) and SAH are rarely reported, and its management remains a dilemma. We report a patient with traumatic SAH concurrent with acute MI that managed successfully by endovascular intervention and dual antiplatelet therapy. Case Description: A 47-year-old man was admitted to the emergency department with a complaint of severe headache. Diffuse SAH, with a Hunt and Hess score of 5, was noticed. ECG showed ST elevation in anterior leads, and cardiac troponin became positive. On brain computed tomography angiogram, a 6 mm anterior communicating artery aneurysm was seen. Considering the possibility of MI and SAH simultaneously, endovascular obliteration of the aneurysm was done, and then, the patient received dual antiplatelet medications until coronary angiography was done. Coronary angiography revealed normal epicardial coronary arteries. The patient was discharged with a Glasgow Coma Scale score of 15 and was visited 2 months after discharge without any new episodes of intracranial hemorrhage with a modified Rankin scale score of 2. Conclusion: Cerebral aneurysm coiling could be considered as the first choice of treatment in the case of acute MI with hemodynamic stability, before carrying out cardiac endovascular intervention or antiplatelet medication to reduce the risk of rebleeding from a brain aneurysm.
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Affiliation(s)
| | - Sina Jelodar
- Department of Neurosurgery, Sina Hospital, Tehran, Iran
| | - Keyvan Edraki
- Department of Neurosurgery, Sina Hospital, Tehran, Iran
| | - Sima Narimani
- Tehran Heart Center, Department of Interventional Cardiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghorbani
- Department of Neurosurgery, Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Sina Asaadi
- Department of Neurosurgery, Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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Ghorbani M, Griessenauer CJ, Wipplinger C, Abdolhoseinpour H, Bahrami R, Asaadi S, Mortazavi A. Combined Endovascular and Endoscopic Approach for Treatment of Concomitant Sphenoid Sinus Giant Traumatic Aneurysm and Direct Carotid Cavernous Fistulas. World Neurosurg 2019; 134:211-214. [PMID: 31678447 DOI: 10.1016/j.wneu.2019.10.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/14/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Direct carotid cavernous fistulas (CCFs) and sphenoid sinus traumatic aneurysms are well-known pathologies that can present concomitantly in rare cases. Patients with both lesions are usually symptomatic from both the CCF and the traumatic aneurysm. Symptoms include proptosis, chemosis, bruit, epistaxis, visual field defects, and loss of vision. Surgical treatment can be challenging, and for most cases an endovascular approach is the treatment of choice. CASE DESCRIPTION We present an unusual case of a direct CCF with an associated large traumatic aneurysm in the sphenoid sinus due to a history of trauma presenting with unusual symptoms that was treated by a combined endoscopic and endovascular approach. CONCLUSIONS Concurrent occurrence of a traumatic CCF and traumatic aneurysm of the cavernous segment is extremely rare. Early diagnosis and treatment of these lesions are important considering their high mortality rate. Complete occlusion of the fistula and aneurysm while preserving the patency of the carotid artery via an endovascular approach is the treatment of choice for these lesions.
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Affiliation(s)
- Mohammad Ghorbani
- Divisions of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran, University of Medical Sciences, Tehran, Iran
| | | | | | - Hesam Abdolhoseinpour
- Department of Neurosurgery, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Reza Bahrami
- Divisions of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran, University of Medical Sciences, Tehran, Iran
| | - Sina Asaadi
- Divisions of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran, University of Medical Sciences, Tehran, Iran
| | - Abolghasem Mortazavi
- Divisions of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran, University of Medical Sciences, Tehran, Iran.
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Campbell M, Xie W, Shah A, Habra M, Jimenez C, Venkatesan A, Bubley G, McKay R, Choueiri T, McGregor B, Killbridge K, Mortazavi A, Bilen M. Initial results of a phase II study of nivolumab and ipilimumab in metastatic adrenal tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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21
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Sadeghi S, Groshen S, Parikh R, Mortazavi A, Dorff T, Hoimes C, Doyle L, Quinn D, Newman E, Lara P. Phase II California cancer consortium trial of gemcitabine-eribulin combination (ge) in cisplatin ineligible patients (pts) with metastatic urothelial carcinoma (mUC): Efficacy report (NCI-9653; 1UM1CA186717, NO1-CM-2011-00038). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Nadal R, Mortazavi A, Stein M, Pal S, Davarpanah N, Parnes H, Ning Y, Cordes L, Lin J, Bagheri M, Linderberg L, Berniger M, Steinberg S, Moore T, Lancaster T, Aviles M, Costello R, Bottaro D, Dahut W, Apolo A. Final results of a phase I study of cabozantinib (cabo) plus nivolumab (nivo) and cabonivo plus ipilimumab (Ipi) in patients (pts) with metastatic urothelial carcinoma (mUC) and other genitourinary (GU) malignancies. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Zhang T, Harrison M, O'Donnell P, Alva A, Hahn N, Appleman L, Cetnar J, Burke J, Fleming M, Milowsky M, Mortazavi A, Shore N, Schmidt E, Kresja C, Chen T, Bitman B, Izumi R, Hamdy A, George D. Phase 2 study of pembrolizumab alone or combined with acalabrutinib in platinum-refractory metastatic urothelial carcinoma (mUC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Sadeghi S, Groshen S, Parikh R, Mortazavi A, Dorff T, Hoimes C, Pal S, Levine E, Doyle L, Quinn D, Newman E, Lara P. Phase II California Cancer Consortium trial of gemcitabine–eribulin combination (GE) in cisplatin ineligible patients (pts) with metastatic urothelial carcinoma (mUC): tolerability and toxicity report (NCI-9653; 1UM1CA186717-01, NO1-CM-2011-00038). Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30706-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Aftari RV, Rezaei K, Bandani A, Mortazavi A. Antioxidant activity optimisation of Spirulina platensis C-phycocyanin obtained by freeze-thaw, microwave-assisted and ultrasound-assisted extraction methods. Quality Assurance and Safety of Crops & Foods 2017. [DOI: 10.3920/qas2015.0708] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- R. Vali Aftari
- Department of Food Science and Technology, Faculty of Agriculture, Ferdowsi University of Mashhad, P.O. Box 91775-1163, Mashhad, Iran
| | - K. Rezaei
- Department of Food Science, Engineering and Technology, University of Tehran, 31587-77871 Karaj, Iran
- Center of Excellence for Application of Modern Technologies for Producing Functional Foods and Drinks, University of Tehran, 31587-77871 Karaj, Iran
| | - A.R. Bandani
- Department of Plant Protection, University College of Agriculture and Natural Resources, University of Tehran, 31587-77871 Karaj, Iran
| | - A. Mortazavi
- Department of Food Science and Technology, Faculty of Agriculture, Ferdowsi University of Mashhad, P.O. Box 91775-1163, Mashhad, Iran
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Baharvand M, Hamian M, Moosavizadeh MA, Mortazavi A, Ameri A. Phenytoin mouthwash to treat cancer therapy-induced oral mucositis: A pilot studyPrimary neuroendocrine carcinoma of breast: A rare tumor. Indian J Cancer 2016; 52:81-5. [PMID: 26837983 DOI: 10.4103/0019-509x.175597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Oral mucositis is one of the most common side effects of cancer therapy with no definite treatment. Phenytoin has positive effects on healing of mucosal and dermal wounds. In this study efficacy of 1% phenytoin mouthwash on severity of mucositis (on the basis of WHO scale), pain relief (based on Visual Analogue Scale), and improvement of patients' quality of life (on the basis of EORTC-QLQ-H and N35 questionnaire) was evaluated. MATERIALS AND METHODS In a pilot -double-blind randomized clinical trial, eight patients in study group were given 1% phenytoin mouthwash while eight patients in control group used normal saline. Data analysis was performed by Mann-Whitney and Repeated Measured ANOVA tests. RESULTS Reduction of mucositis severity was observed, but the difference was not significant. On the other hand, patients on phenytoin therapy had better pain relief (VAS# 6.75 ± 1.58 at the beginning of the study reached to # 3.75 ± 1.16 after 3 weeks in phenytoin group) and improvement in quality of life (score of QOL was 70.63 ± 5.5 that reached to 63.61 ± 6.39 in phenytoin group) than normal saline group significantly (P < 0.05). CONCLUSION One percent phenytoin mouthwash caused pain relief and improvement of life quality significantly in patients with mucositis due to cancer therapy, but it did not reduce the severity of mucositis in a statistically significant scale.
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Affiliation(s)
| | - M Hamian
- Department of Oral and Maxillofacial Medicine, Qom University of Medical Sciences, Qom, Iran
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Apolo A, Mortazavi A, Stein M, Pal S, Davarpanah N, Parnes H, Ning Y, Francis D, Cordes L, Berniger M, Steinberg S, Monk P, Lancaster T, Mayer T, Costello R, Bottaro D, Dahut W. A phase I study of cabozantinib plus nivolumab (CaboNivo) in patients (pts) refractory metastatic urothelial carcinoma (mUC) and other genitourinary (GU) tumors. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Saeedinia S, Nouri M, Azarhomayoun A, Hanif H, Mortazavi A, Bahramian P, Yarandi KK, Amirjamshidi A. The incidence and risk factors for surgical site infection after clean spinal operations: A prospective cohort study and review of the literature. Surg Neurol Int 2015; 6:154. [PMID: 26500800 PMCID: PMC4596055 DOI: 10.4103/2152-7806.166194] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 03/05/2015] [Accepted: 06/26/2015] [Indexed: 01/20/2023] Open
Abstract
Background: Postoperative infection is one of the most common complications after spine surgeries. In our study, surgical site infection (SSI) is described as; superficial (i.e., skin and subcutaneous tissues) and deep (i.e., fascia and muscles) infections occurring in the short term (i.e., 1-month) after spine surgeries (Centers for Disease Control and Prevention definition 81.00–81.08). To detect the risk factors for the occurrence of such a complication, studies require a large number of patients, a high quality of data and adequate analysis. In this study, we prospectively enrolled 987 patients undergoing spinal surgery over a 3 years period. Methods: From November 2010 to November 2013, 987 patients had a variety of spinal operations that included; disc herniation, spinal stenosis, spondylolisthesis, fracture-dislocations, spine and spinal cord tumors, and syringomyelia. Patients under the age of 10, those with a recent history of infection and antibiotherapy, and patients with immunodeficiency disorders were excluded. Results: Of the 987 spine procedures performed, 27 (2.73%) developed postoperative infections. Multi-variant data analysis indicated that multiple factors correlated with an increased risk of SSI in descending order; trauma, a past history of diabetes, smoking, being confined to bed, in the perioperative period, mean blood sugar levels above 120 mg/dl, longer lengths of incisions, and longer hospital stay. Conclusion: Considering the preventable nature of most of the factors contributing to SSI, it should be possible to reduce these complications.
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Affiliation(s)
- Saeed Saeedinia
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Nouri
- Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Azarhomayoun
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Hanif
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Mortazavi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Bahramian
- Department of Neurosurgery, Razi Hospital, Zahedan University of Medical Sciences, Saravan, Iran
| | - Kourosh Karimi Yarandi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Mirrahimi B, Mortazavi A, Nouri M, Ketabchi E, Amirjamshidi A, Ashouri A, Khajavi M, Mojtahedzadeh M. Effect of magnesium on functional outcome and paraclinical parameters of patients undergoing supratentorial craniotomy for brain tumors: a randomized controlled trial. Acta Neurochir (Wien) 2015; 157:985-91; discussion 991. [PMID: 25824556 DOI: 10.1007/s00701-015-2376-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies have demonstrated that magnesium (Mg) plays an important role in the prevention and treatment of central nervous system (CNS) insults. In this study, we tested the effect of intravenous magnesium sulfate (MgSO4) on the outcome of patients with brain tumors who underwent craniotomy. The outcome was defined clinically as the Barthel index score and paraclinically as blood levels of NSE (neuron-specific enloase) and S100Β protein. METHODS Sixty patients were randomly divided into two groups of 30 patients: the treatment and control groups. In the treatment group, 5 g of MgSO4 in normal saline was infused in 6 h 2 days before surgery, and the same dosage was repeated the day before and during surgery. The control group received placebo. Serum S100Β and NSE concentrations were measured at baseline before administration of magnesium, before surgery, and on the 2nd postoperative day. The Barthel index score was evaluated and registered before surgery, 3, and 6 months after the operation. RESULTS The study results showed a significant change in S100Β protein levels before and after surgery (p < 0.05), but we could not find similar results for NSE protein and the Barthel index score. There was a correlation between NSE protein and the Barthel index. CONCLUSIONS The results of this study revealed that administration of intravenous MgSO4 before and during surgery is safe and effective in reducing S100B protein levels in patients undergoing supratentorial craniotomy for brain tumors. Further studies to elucidate the pathophysiology of brain injuries and role of magnesium are warranted.
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Affiliation(s)
- Bahador Mirrahimi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar Ave., Enghelab Sq., P.O. Box. 14155-6451, Tehran, Iran
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Mortazavi A, Khamseh AA, Naderi B. A novel chaotic imperialist competitive algorithm for production and air transportation scheduling problems. Neural Comput Appl 2015. [DOI: 10.1007/s00521-015-1828-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Lipomyelomeningocele, a congenital spine defect, is presented as skin-covered lipomatous tissue that attaches to the cord in different ways according to its subtypes. Unlike other types of neural tube defects, the exact cause of this birth defect has not been confirmed yet, but it is proposed to be a multifactorial disease with involvement of both genetic and environmental factors. The authors describe identical twins with lipomyelomeningocele of the same subtype and location without any familial history of similar abnormality. Therefore, the same genetic and/or environmental risk factors could have played a part in their condition.
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Affiliation(s)
- Sara Hanaei
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences
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Abstract
BACKGROUND Until now, several formulations of topical phenytoin have been used to promote wound healing. AIM This study was aimed at re-evaluating the effects of a newly formulated phenytoin mucoadhesive paste on wound healing after oral biopsy. SUBJECTS AND METHODS In a double-blind clinical trial, 35 consecutive patients with oral lichenoid or lichen planus lesions were randomized into two groups. After incisional biopsy, patients applied simple, or 1% phenytoin paste at least three times a day (after each meal), for 4 days. They were evaluated every other day for size of wound closure, severity of pain, and diameter of the inflammatory halo. This study was approved by Medical Ethics committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Statistical analysis was performed using Mann-Whitney U test and Ordinal Logistic Regression. RESULTS Of 35 patients, 17 (10 [10/17, 59%]) men, 7 (7/17, 41%) women, mean age: 40 (4.11) were in phenytoin group, and 18 (9 [9/9, 50%]) men, 9 (9/9, 50%) women, mean age: 43.1 (5.15) were in placebo group. There were no significant differences between both study groups in terms of age and sex (male/female ratio) (P = 0.76, P = 0.88). As all biopsies were done by means of punch number 8, the incisions were of 10 mm length. After second and third appointments, it was observed that patients in the treatment group showed quicker wound closure and less pain compared to control group significantly (P < 0.05). Although not significant, patients treated with phenytoin paste had smaller inflammatory halo than controls. CONCLUSION Applying 1% phenytoin mucoadhesive paste on oral biopsy incisions resulted in accelerated wound healing and decrease in pain.
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Affiliation(s)
- M Baharvand
- Department of Oral and Maxillofacial Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Mortazavi
- Department of Pharmaeutics, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Mortazavi
- Department of Oral and Maxillofacial Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Yaseri
- Department of Biostatistics and Epidemiology, Tehran University of Medical Sciences, Tehran, Iran
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Lautenschlaeger T, Efstathiou J, Shipley W, Meng W, McElroy J, Paly J, Ibrahim A, Nguyen P, Volinia S, Saylor P, Clayman R, Clinton S, Mortazavi A, Wu C, Chakravarti A. Novel Predictive MicroRNA Signature in the Setting of Selective Trimodality Bladder Preservation Therapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yavarmanesh M, Abbaszadegan M, Alum A, Mortazavi A, Habibi Najafi MB, Bassami MR, Nassiri MR. Impact of milk components on recovery of viral RNA from MS2 bacteriophage. Food Environ Virol 2013; 5:103-109. [PMID: 23430411 DOI: 10.1007/s12560-013-9107-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 02/12/2013] [Indexed: 06/01/2023]
Abstract
Noroviruses are responsible for approximately 44 % of outbreaks involving dairy products for which causative agents are reported. Recovery of viruses from milk and dairy products is a difficult task. The role of different components of milk in the recovery of viral RNA was evaluated in this study. Four model milk formulations (A-D) were prepared by mixing different combinations of lactose, whey protein, casein, and fat in water. Each model formulation was spiked with five concentrations of bacteriophage MS2. The phenol-guanidine thiocyanate-chloroform protocol was used for extracting viral RNA from the model milk formulations and then extracted RNA was measured by a nanodrop spectrophotometer in ng/μl. The results showed that casein and whey protein had the highest negative impact on RNA yield, especially when the number of MS2 was less than 1.3 pfu/ml. The highest RNA recovery was obtained from the model milk formulation containing all four components; lactose, whey protein, casein, and fat. The amount of extracted RNA was closely correlated with the dry matter content of each formulation and the spiked concentration of coliphage using response surface modeling (R²:0.93). It was determined that milk fat is the most effective component in facilitating RNA extraction and the highest RNA yield can be achieved via elimination of whey protein and casein from milk by centrifugation at 40,000×g for 60 min. To achieve the highest viral RNA recovery efficiency by the proposed method, milk fat must be recombined with the supernatant of the centrifuged sample and then homogenized before performing the extraction protocol.
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Affiliation(s)
- M Yavarmanesh
- Department of Food Science and Technology, Faculty of Agriculture, Ferdowsi University of Mashhad, Mashhad, Iran.
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Ghodsi M, Mortazavi A, Shahjouei S, Hanaei S, Esmaeili A, Nejat F, El Khashab M. Exophytic glioma of the medulla: presentation, management and outcome. Pediatr Neurosurg 2013; 49:195-201. [PMID: 24861884 DOI: 10.1159/000362621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/29/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Exophytic gliomas of the medulla are rare childhood tumors that mostly are pilocytic astrocytomas. Here we report our experience in 11 -children with this rare tumor. METHODS A retrospective study was performed using the records of children with exophytic gliomas of the medulla at Children's Hospital Medical Center in Tehran, Iran, from 2002 through 2013. The general, clinical, and radiological data and follow-up of all patients were reviewed. RESULTS The patients mostly were male aged from 11 months to 7 years. Swallowing problems, failure to thrive and nausea and vomiting were the most common symptoms. The time span between the onset of symptoms and the diagnosis was 2-24 months. Gross total resection of tumor was possible in 8 patients. Most tumors were pilocytic astrocytomas. Patients were followed for 2 months to 11 years (mean = 3.6 years). There was no intraoperative mortality. Recurrence occurred in 1 child with fibrillary astrocytoma. CONCLUSION Gross total resection of symptomatic dorsal exophytic medullary glioma is recommended. Most tumors are pilocytic astrocytomas. The attachment of these tumors to important brainstem structures usually inhibits total resection. Electrophysiological monitoring of sensorimotor pathways and cranial nerves can be helpful to preserve surrounding neural tissue during tumor resection and to minimize complications. Regular follow-up of patients with clinical examination and brain MRI is mandatory. Repeated surgery, radiation therapy and chemotherapy are suggested in cases with tumor recurrence or progression.
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Affiliation(s)
- Mohammad Ghodsi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
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Krajcer Z, Strickman N, Mortazavi A, Dougherty K. Single-center experience of percutaneous abdominal aortic aneurysm repair with local anesthesia and conscious sedation: technique and results. J Cardiovasc Surg (Torino) 2012; 53:695-706. [PMID: 23138600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Totally percutaneous endovascular abdominal aortic aneurysm repair (PEVAR) by using the "Preclose" technique has been previously described. We retrospectively analyzed data, collected prospectively at our institution, regarding PEVAR via femoral artery access with local anesthesia and conscious sedation. METHODS Between January 2001 and May 2009, 1150 patients underwent PEVAR in the endovascular suite of the cardiac catheterization laboratory at our institution. Of those procedures, 915 (79%) were performed with local anesthesia and conscious sedation. RESULTS The majority of patients were male (87%). Their mean age was 72±10 years, and 98% had a risk status of American Society of Anesthesiologists class III or IV. The PEVAR involved bilateral percutaneous femoral access with 12F to 24F sheaths (depending on the stent-graft system). The mean total procedure time was 149 minutes. Percutaneous closure of the arterial access sites with the Prostar XL was successful in 1727 (94.3%) of the 1830 femoral arteries in which PEVAR was attempted, whereas 103 femoral arteries (5.6%) required surgical repair because adequate hemostasis was not attained at the access site. There were no procedural deaths, but 6 patients (0.6%) died within 30 days of the procedure: 3 died of intestinal ischemia, 1 of stroke, 1 of refractory ventricular arrhythmia, and 1 of worsening renal failure. Mean length of hospital stay was 1.3±2 days. CONCLUSION PEVAR with local anesthesia and intravenous sedation is safe and feasible and should be considered for patients for whom general anesthesia poses a high risk.
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Affiliation(s)
- Z Krajcer
- Division of Cardiology, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA.
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Haidari M, Zhang W, Chen Z, Mortazavi A, Dixon R. P5-02-04: Disruption of Endothelial Cells Barrier Integrity by Invasive Breast Cancer Cells. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-02-04] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Despite its critical role in cancer metastasis the molecular mechanisms regulating breast cancer cells transendothelial migration are poorly understood, but clearly depend on the invasive capacity of tumor cells and their ability to breach the endothelial cell barrier. Vascular endothelial-cadherin (VE-cadherin) is found specifically in the endothelial cell adherens junction and has been implicated in playing a fundamental role in controlling the transport across the endothelial barrier. Tyrosine phosphorylation of VE-cadherin has been implicated in the disruption of endothelial cells adherens junctions and diapedesis of metastatic cancer cells. We tested this hypothesis that interaction of breast cancer cells with endothelial cells initiates the signal transductions that disrupt the endothelium barrier integrity. Our studies demonstrated that the attachment of MDA-MB-231 human breast cancer cells to Human Umbilical Vein Endothelial Cells (HUVECs) leads to tyrosine phosphorylation of VE-cadherin and the formation of gaps between endothelial cells. These were accompanied by activation of two tyrosine kinases, Src and proline rich tyrosine kinase (Pyk-2). In addition, immunoprecipitation studies indicated that the endothelial cells adherens junction structure was disrupted through MDA-MB-231-induced dissociation of VE-cadherin and β-catenin complex. Activation of RhoA and HRas by over expression of constitutively active forms of the genes leads to tyrosine phosphorylation of VE-cadherin and Pyk-2 in HUVECs. Over expression of dominant negative forms of RhoA, HRas, Raf and ERK2 but not Rac1 and Cdc42 attenuated breast cancer cell-induced tyrosine phosphorylation of VE-cadherin and Pyk-2 in HUVECs. Indicating that breast cancer cell-induced VE-cadherin tyrosine phosphorylation and disruption of adherens junction in endothelial cells is mediated by RhoA and HRas\Raf\MEK\ERK signaling cascade. Understanding the precise molecular mechanisms that facilitate breast cancer cells transendothelial migration could develop novel therapeutic strategies targeting cancer cell metastasis by improving the protective role of endothelial cells.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-02-04.
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Affiliation(s)
- M Haidari
- 1Texas Heart Institute, Houston, TX; The University of Texas Health Science Center at Houston, Houston, TX
| | - W Zhang
- 1Texas Heart Institute, Houston, TX; The University of Texas Health Science Center at Houston, Houston, TX
| | - Z Chen
- 1Texas Heart Institute, Houston, TX; The University of Texas Health Science Center at Houston, Houston, TX
| | - A Mortazavi
- 1Texas Heart Institute, Houston, TX; The University of Texas Health Science Center at Houston, Houston, TX
| | - R Dixon
- 1Texas Heart Institute, Houston, TX; The University of Texas Health Science Center at Houston, Houston, TX
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Mitra N, Monk JP, Pohar KS, Shabsigh A, Sharp DS, Abaza R, Box GN, Zynger DL, Vandlik SL, Bhinder AS, Olencki T, Bahnson RR, Clinton SK, Mortazavi A. Early outcomes with neoadjuvant high-dose intensity methotrexate, vinblastine, doxorubicin, and cisplatin (HD-MVAC) or gemcitabine and cisplatin (GC) in muscle-invasive urothelial carcinoma of the bladder: A single-institution experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bhinder AS, Varma V, Abbaoui B, Thomas-Ahner JM, Kulp SK, Chen C, Clinton SK, Mortazavi A. Antitumor effects of AR-42, a novel histone deacetylase inhibitor, in embryonal carcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
232 Background: Histone deacetylase inhibitors (HDACIs) modulate gene expression and induce cellular differentiation, growth inhibition and apoptotic cell death by chromatin hyperacetylation. Developmental arrest of germ cell differentiation earlier in the life is responsible for the pathogenesis of germ cell tumors (GCT). With current treatment nearly 95% of patients with GCT can be cured. Yet, effective agents with less toxicity are desired. In addition, those with relapsed/refractory disease have a dismal prognosis, indicating a clear need for new, more effective agents. Here we assess the antitumor effects of AR-42, a novel HDACI in in vitro and in vivo models of embryonal carcinoma. Methods: In vitro effects of AR-42 and suberoylanilide hydroxamic acid (SAHA) were evaluated in NTERA-2, an embryonal carcinoma (EC) cell line derived from a human testicular cancer. Cell viability (MTS assay), apoptosis (caspase 3/7 activity and PARP cleavage), cell cycle analysis (flow cytometry) and HDAC inhibition (immunoblotting) were assessed. The in vivo efficacy of AR-42 was assessed in a NTERA-2 xenograft tumor model in male athymic nude mice. Mice were fed control diet and diet containing AR-42 at an average dose of 25 mg/kg/day. Tumor volumes and weights were used as in vivo endpoints. Results: Treatment of NTERA-2 cells with both agents at 0.1-10 μM concentrations showed a time- and dose-dependent reduction in cell viability. Both agents significantly induced apoptosis, cell cycle inhibition and hyperacetylation of histones H-3 and H-4 in a dose-dependent manner. In vitro studies showed that AR-42 was more potent than SAHA. In our rodent model, AR-42-containing diet resulted in a significant reduction in tumor volumes and weights (50% and 56%, respectively). The results for intratumoral changes of proliferation and apoptosis are pending. There were no significant toxicities associated with AR-42, except for testicular atrophy, known to be reversible. Conclusions: AR-42 appears to be a potent inhibitor of EC through different mechanisms, orally bioavailable and well tolerated in our rodent model. Our data indicates that AR- 42 may have clinical value in the treatment of GCT and requires further investigation in clinical trials. No significant financial relationships to disclose.
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Affiliation(s)
- A. S. Bhinder
- Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - V. Varma
- Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - B. Abbaoui
- Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - J. M. Thomas-Ahner
- Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - S. K. Kulp
- Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - C. Chen
- Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - S. K. Clinton
- Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - A. Mortazavi
- Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
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Mehnert JM, Mortazavi A, Stein MN, Donadio AC, Zelterman D, McDonough JA, Rowen E, Hoimes CJ, Gibney G, Kelly WK. A phase II trial of gemcitabine (G), carboplatin (C), and sorafenib (S) in patients (pts) with transitional cell carcinoma (TCC): Preliminary safety and outcome. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.278] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
278 Background: Sorafenib is an oral tyrosine kinase inhibitor with anti-angiogenic properties that may enhance the antitumor activity of GC and when administered as maintenance therapy after GC may delay disease recurrence. This study investigated the safety and clinical outcome of adding S to GC for pts with advanced TCC and the role of S maintenance after GC. Methods: Metastatic/unresectable chemotherapy naive TCC pts ECOG PS 0-1 received G 1,000 mg/m2 d1, 8 and C AUC = 5 d1 with S 400 mg bid d2-19 q21 d for 6 cycles. Pts with stable disease or PR/CR continued on 400 mg bid of S. The primary endpoint was proportion of pts free of progression at 5 months with secondary endpoint of proportion of pts with PR/CR. A Simon two-stage design would enroll 30 pts; if 8 of the initial 17 followed for 5 months or more post treatment showed disease progression, the trial would terminate. Results: 17 pts enrolled, 14 male, 3 female; median age 64 (47-86); ECOG 0 (7)/1 (10). The median number of cycles of GC + S given was 4.4 with multiple dose reductions in 71%. 7 pts (47%) experienced grade (gr) 3/4 neutropenia and 4 (24%) gr 3/4 anemia during GC + S; no neutropenic fever was seen. Gr 3/4 thrombocytopenia occurred in 59% with 2 events of hematuria, 1 epistaxis, and 1 bleeding colitis. Gr 3 nonhematologic toxicities: hypophosphotemia (29%), diarrhea (6%), fatigue (24%), anorexia (6%), dehydration (6%), hand foot syndrome (6%), rash (12%), hypertension (6%). Responses: 1 CR (6%), 4 PR (24 %), 8 SD (47%); 3 pts with evaluable disease showed tumor shrinkage, including 1 with resolution of bone metastases. 9 (53 %) were progression free at 5 months; 7 (41%) came off trial due to > 3 dose reductions (1 prior to first restaging) and 1 withdrew consent. 7 (41%) that achieved CR, PR or SD after a minimum of 4 cycles GC + S received maintenance S for a median of 8 cycles. Conclusions: GC + S showed clinical activity in advanced TCC similar to GC alone but prolonged progression-free intervals were observed in patients treated with S maintenance. GC + S was associated with increased hematologic toxicity although S maintenance was well tolerated. Further studies exploring the role of S maintenance after chemotherapy are warranted. [Table: see text]
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Affiliation(s)
- J. M. Mehnert
- Cancer Institute of New Jersey, New Brunswick, NJ; The Ohio State University, Columbus, OH; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; St. Francis Regional Cancer Center, Hartford, CT; Epidemiology/Public Health, Yale University, New Haven, CT; Yale Cancer Center, New Haven, CT; Thomas Jefferson University, Philadelphia, PA
| | - A. Mortazavi
- Cancer Institute of New Jersey, New Brunswick, NJ; The Ohio State University, Columbus, OH; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; St. Francis Regional Cancer Center, Hartford, CT; Epidemiology/Public Health, Yale University, New Haven, CT; Yale Cancer Center, New Haven, CT; Thomas Jefferson University, Philadelphia, PA
| | - M. N. Stein
- Cancer Institute of New Jersey, New Brunswick, NJ; The Ohio State University, Columbus, OH; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; St. Francis Regional Cancer Center, Hartford, CT; Epidemiology/Public Health, Yale University, New Haven, CT; Yale Cancer Center, New Haven, CT; Thomas Jefferson University, Philadelphia, PA
| | - A. C. Donadio
- Cancer Institute of New Jersey, New Brunswick, NJ; The Ohio State University, Columbus, OH; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; St. Francis Regional Cancer Center, Hartford, CT; Epidemiology/Public Health, Yale University, New Haven, CT; Yale Cancer Center, New Haven, CT; Thomas Jefferson University, Philadelphia, PA
| | - D. Zelterman
- Cancer Institute of New Jersey, New Brunswick, NJ; The Ohio State University, Columbus, OH; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; St. Francis Regional Cancer Center, Hartford, CT; Epidemiology/Public Health, Yale University, New Haven, CT; Yale Cancer Center, New Haven, CT; Thomas Jefferson University, Philadelphia, PA
| | - J. A. McDonough
- Cancer Institute of New Jersey, New Brunswick, NJ; The Ohio State University, Columbus, OH; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; St. Francis Regional Cancer Center, Hartford, CT; Epidemiology/Public Health, Yale University, New Haven, CT; Yale Cancer Center, New Haven, CT; Thomas Jefferson University, Philadelphia, PA
| | - E. Rowen
- Cancer Institute of New Jersey, New Brunswick, NJ; The Ohio State University, Columbus, OH; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; St. Francis Regional Cancer Center, Hartford, CT; Epidemiology/Public Health, Yale University, New Haven, CT; Yale Cancer Center, New Haven, CT; Thomas Jefferson University, Philadelphia, PA
| | - C. J. Hoimes
- Cancer Institute of New Jersey, New Brunswick, NJ; The Ohio State University, Columbus, OH; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; St. Francis Regional Cancer Center, Hartford, CT; Epidemiology/Public Health, Yale University, New Haven, CT; Yale Cancer Center, New Haven, CT; Thomas Jefferson University, Philadelphia, PA
| | - G. Gibney
- Cancer Institute of New Jersey, New Brunswick, NJ; The Ohio State University, Columbus, OH; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; St. Francis Regional Cancer Center, Hartford, CT; Epidemiology/Public Health, Yale University, New Haven, CT; Yale Cancer Center, New Haven, CT; Thomas Jefferson University, Philadelphia, PA
| | - W. K. Kelly
- Cancer Institute of New Jersey, New Brunswick, NJ; The Ohio State University, Columbus, OH; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; St. Francis Regional Cancer Center, Hartford, CT; Epidemiology/Public Health, Yale University, New Haven, CT; Yale Cancer Center, New Haven, CT; Thomas Jefferson University, Philadelphia, PA
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Lam ET, Lesinski G, Mortazavi A, Kendra KL, Carson WE, Tahiri S, Liersemann R, Clinton SK, Olencki T, Monk JP. Phase I study of high-dose interleukin (HD-IL2) and sorafenib in patients with metastatic clear cell renal cell carcinoma (RCC) and melanoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
337 Background: HD-IL2 has demonstrated activity for immune therapy of RCC and melanoma. Sorafenib is a multitargeted kinase inhibitor with antiangiogenic activity and may also modulate antitumor immunity. This ongoing phase I study assesses the safety, tolerability, dose-limiting toxicity (DLT), and maximum tolerated dose of the combination of HD-IL2 and sorafenib in patients with unresectable or metastatic clear cell RCC and melanoma. Methods: Eligible patients with ECOG PS 0-1, adequate organ function, and favorable or intermediate Motzer status (RCC patients) received up to two series of therapy. Each 82-day series consisted of two cycles of bolus HD-IL2 and 8 weeks of sorafenib. HD-IL2 (600,000 IU/kg IV q8h x 8-12 doses) was given on days 1-5 (cycle 1) and 15-20 (cycle 2). Sorafenib was given on days 29-82 and discontinued 48-72 hours prior to the next series. Dosing levels for sorafenib were (1) 200mg daily, (2) 200mg BID, (3) 200mg qAM and 400mg qPM, and (4) 400mg BID. Patients who achieved stable disease (SD), partial response (PR), or complete response (CR) after Series 1 proceeded to Series 2. Results: Fourteen patients (8 RCC, 6 melanoma) have been treated. Nine patients completed Series 1 (5 patients came off study due to poor tolerance of HD-IL2, prior to receiving sorafenib). Six patients had SD or better (3 PR, 3 SD) after Series 1. Of these, five have completed Series 2 and one patient progressed during sorafenib treatment in the second series. No DLTs were observed at the first 3 dose levels. All observed grade 3 and 4 AEs were transient and attributable to the known toxicities of HD-IL2 or sorafenib, and were not considered DLT. Adverse events occurring more frequently in Series 2 (HD-IL2 after sorafenib) included proteinuria and dry skin. One death occurred in a patient with melanoma who received only the first cycle of HD- IL2 (never received sorafenib) and one week later experienced sudden death at home, an event reported as possibly related to the HD-IL2. Conclusions: No DLT was seen in this study of HD-IL2 and sorafenib and the toxicity was predictable and manageable. Both RCC and melanoma patients experienced PR and SD, but not CR. Enrollment to cohort 4 is ongoing. [Table: see text]
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Affiliation(s)
- E. T. Lam
- The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University Medical Center, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - G. Lesinski
- The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University Medical Center, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - A. Mortazavi
- The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University Medical Center, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - K. L. Kendra
- The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University Medical Center, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - W. E. Carson
- The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University Medical Center, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - S. Tahiri
- The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University Medical Center, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - R. Liersemann
- The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University Medical Center, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - S. K. Clinton
- The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University Medical Center, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - T. Olencki
- The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University Medical Center, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - J. P. Monk
- The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH; The Ohio State University Medical Center, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH
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Mitra N, Monk JP, Pohar KS, Shabsigh A, Sharp DS, Abaza R, Box GN, Zynger DL, Clinton SK, Mortazavi A. Early outcomes with neoadjuvant high-dose intensity methotrexate, vinblastine, doxorubicin, and cisplatin (HD-MVAC) or gemcitabine and cisplatin (GC) in muscle-invasive urothelial carcinoma of the bladder: A single-institution experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.280] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
280 Background: Compared to MVAC, HD-MVAC achieves significantly higher complete response rates in patients (pts) with metastatic bladder cancer. Based on current literature, 7%-38% of pts with muscle-invasive bladder cancer achieve pathological down-staging (pT0) with neoadjuvant chemotherapy (NC), which correlates with improved disease-free and overall survival. The role of HD-MVAC has not been evaluated in the neoadjuvant setting. In this retrospective study, we present our data in pts who received NC with HD-MVAC or GC followed by radical cystectomy (RC). Methods: From July 2008 to August 2010, 38 (pts) received 4 cycles of NC with either HD-MVAC or GC for at least T2 bladder cancer followed by RC. The endpoints of interest of this study were the complete pathologic response (pT0) or down-staging to < pT2 (pT0, pTis, and pT1) at RC; and median interval to RC from the time of diagnosis of muscle-invasive bladder cancer and start of NC. Results: Median age at the time of diagnosis was 66 years (35-80 years). Fifteen pts received neoadjuvant HD-MVAC, and 23 received neoadjuvant GC. Clinical T stage at the time of diagnosis was T2 in 29 (76%), T3 in 3 (8%), and T4 in 6 (16%) pts. Down-staging to < pT2 was achieved in 8 (53%) of HD-MVAC pts and 10 (43%) of GC pts. pT0 was achieved in 5 (33%) of HD-MVAC pts and 9 (39%) of GC pts. The median interval from time of diagnosis to RC was 129 days (range 84-154) for the HD-MVAC pts, and 145 days (range 108-252) for the GC pts. The median interval from initiation of NC to RC was 85 days (range 53-122) for the HD-MVAC pts and 107 days (range 60-126) for the GC pts. Overall, NC was well tolerated with 80% of HD-MVAC pts and 78% of GC pts completing the planned chemotherapy. To this date, none of the pT0 pts had recurrence. Conclusions: Both neoadjuvant HD-MVAC and GC appear to be well tolerated, with very promising rate of pathological down-staging. Longer follow-up is needed for the survival outcomes of these patients. A shorter interval from diagnosis and initiation of NC to RC might be responsible for our better outcomes comparing to some historical data. No significant financial relationships to disclose.
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Affiliation(s)
- N. Mitra
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - J. P. Monk
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - K. S. Pohar
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - A. Shabsigh
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - D. S. Sharp
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - R. Abaza
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - G. N. Box
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - D. L. Zynger
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - S. K. Clinton
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
| | - A. Mortazavi
- The Ohio State University James Cancer Hospital, Columbus, OH; The Ohio State University, Columbus, OH; Division of Medical Oncology, The Ohio State University, Columbus, OH; Arthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH
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Khorrami MH, Javid A, Moshtaghi D, Nourimahdavi K, Mortazavi A, Zia HR. Sildenafil efficacy in erectile dysfunction secondary to spinal cord injury depends on the level of cord injuries. ACTA ACUST UNITED AC 2011; 33:861-4. [PMID: 20050938 DOI: 10.1111/j.1365-2605.2009.01033.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To evaluate the efficacy of sildenafil in the treatment of neurogenic erectile dysfunction (ED) secondary to upper motor neuron (UMN) and lower motor neuron (LMN) spinal cord injury (SCI). After taking consents 105 patients suffering from ED were enrolled in this prospective study. Seventy-two patients had signs and symptoms of UMN and 33 patients had signs and symptoms of LMN or mixed (UMN and LMN) spinal cord injuries. The patients took 50-100 mg sildenafil or placebo tablet at least 45 min before sexual intercourse. Based on a IIEF questionnaire, success in achieving erection adequate for sexual intercourse was compared between sildenafil and placebo groups in UMN and non-UMN spinal cord injuries. In patients with UMN disease, sildenafil was effective in 82% of patients and its efficacy was statistically higher than placebo (82 vs. 25%, p < 0.05). Twenty-eight per cent of patients with non-UMN disease had a favourable response to sildenafil that was not statistically different from placebo. Sildenafil seems more effective in the treatment of neurogenic ED secondary to UMN spinal cord injury compared with that secondary to LMN injury. Actually, its efficacy on LMN injuries does not seem different from placebo and administration of this treatment may not be effective in spinal cord injury which has caused LMN symptoms.
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Affiliation(s)
- M H Khorrami
- Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran
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Mortazavi A, Deam D, Ling Y, Harper EJ, Phelps MA, Espinoza-Delgado IJ, Monk JP, Otterson GA, Grever MR, Bekaii-Saab T. A phase I study of prolonged infusion of triapine in combination with a fixed-dose rate of gemcitabine in patients with advanced solid tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ahmed B, Mortazavi A, Kim S, Li X, Liersemann R, Ghany AM, Villalona-Calero MA, Bekaii-Saab TS. Biomodulation of capecitabine by carboplatin and weekly paclitaxel (CCP) in patients with adenocarcinoma of unknown primary (ACUP). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
INTRODUCTION Premature ejaculation (PE) is regarded as the most common male sexual disorder. To date, there is no accurate and objective diagnostic test for PE. AIM To determine the diagnostic value of serum leptin level for PE. METHODS In a case-control design, the serum leptin level of 46 PE patients referred to our outpatient clinic were determined and compared with 44 control patients referred to the same clinic with the complaint of nephrolithiasis. PE was defined based on the Diagnostic and Statistical Manual of Mental Disorders IV criteria and an intravaginal ejaculatory latency time of less than a minute. MAIN OUTCOME MEASURES Serum leptin level and presence of PE. RESULTS The PE patients had significantly higher serum leptin levels (8.3+/-3 ng/mL) than the controls (3.3+/-1 ng/mL) (P<0.001). Sensitivity and specificity for the test as a predictive diagnostic tool for PE were 80.4% and 97.7%, respectively, at the cutoff value of 6.3 ng/mL. CONCLUSIONS According to our results, leptin level in patients with PE was significantly higher than in the control subjects. More studies are necessary to determine the value of serum leptin as a diagnostic tool for PE.
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Van de Geest J, Simon B, Mortazavi A. A computational parametric study on the permeability of intra-luminal thrombus and aortic wall within abdominal aortic aneurysms. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)84050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Shaukat A, Mortazavi A, Demmy T, Nava H, Wilkinson N, Yang G, Kepner J, Javle M. Should preoperative, post-chemoradiotherapy endoscopy be routine for esophageal cancer patients? Dis Esophagus 2004; 17:129-35. [PMID: 15230725 DOI: 10.1111/j.1442-2050.2004.00389.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chemoradiation therapy is used widely for locoregional esophageal cancer. Patients with persistent disease may benefit from surgery. Preoperative esophagoscopy can identify persistent tumor but its accuracy is uncertain. The primary objective of this study is to assess the extent of agreement between esophagoscopy and surgical pathology in patients treated with neoadjuvant chemoradiation. A retrospective chart review of patients who underwent chemoradiation, preoperative endoscopy and surgery from January 1996 to December 2002 was performed. Cohen's kappa statistic was used to measure the degree of agreement between findings at endoscopic biopsy and surgical pathology. Thirty cases were identified. All patients received chemoradiation followed by surgical resection. There was insufficient agreement between tumor size (kappa 0.25, standard error 0.17, P = 0.07) and appearance (kappa 0.19, standard error 0.18, P = 0.14). Preoperative endoscopy revealed atypia/inflammation in 15 cases and dysplasia in eight. Of these 23 cases, 11 were adenocarcinomas at surgery. Only nine patients had concurrence between surgical pathology and endoscopy. The positive and negative predictive values of esophagoscopy for identifying residual tumor were 100% and 11%, respectively. Our data suggests that after chemoradiation, esophagoscopy is unreliable for excluding residual disease. The roles of other modalities need to be explored.
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Affiliation(s)
- A Shaukat
- Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York, NY, USA
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