المؤلفون: Fotros, Danial, Sohouli, Mohammadhassan, Yari, Zahra, Sakhdari, Hanie, Shafiekhani, Mojtaba, Nikoupour, Hamed, Jafarzadeh, Mohammad Amin, Jafari, Keynoosh, Afiatjoo, Seyedeh Sara, Fatemi, Seyed Amirreza, Amiri, Mahmoud, Eghlimi, Hesameddin, Rabbani, Amirhassan, Broumandnia, Nasrin, Mazdeh, Ghazaleh Mahdavi, Jafarian, Ali, Hekmatdoost, Azita

المصدر: Scientific Reports ; volume 13, issue 1 ; ISSN 2045-2322

مصطلحات موضوعية: Multidisciplinary

الوصف: It is well known that vitamin D plays a pivotal role in immune system modulation; however, its role in liver transplantation (LT) has not yet been well elucidated. This study aimed to assess the association between vitamin D status and LT outcomes. This retrospective cohort study was conducted on 335 registered cirrhotic patients with end-stage liver disease (ESLD) who underwent LT during 2019–2021 and had measurement of serum vitamin D before LT. The association of vitamin D levels before LT with the odds of acute cellular rejection (ACR) and risk mortality was assessed by applying logistic and cox regression, respectively. The mean MELD-Na and serum level of vitamin D were 20.39 ± 9.36 and 21.52 ± 15.28 ng/ml, respectively. In the final adjusted model, there was a significant association between vitamin D deficiency in the pre-transplant period and odds of ACR (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.50–4.68). Although in the crude model, vitamin D deficiency in the pre-transplant period was significantly associated with an increased risk of mortality after two years of follow-up (Hazard ratio (HR) = 2.64, 95% CI 1.42–4.33), after adjustment for potential confounders, the association of vitamin D status and mortality became non-significant (HR = 1.46, 95% CI 0.71–3.00). The present study provides evidence that pre-transplant serum vitamin D levels may be a predictor for ACR in patients with cirrhosis undergoing LT.

الإتاحة: https://doi.org/10.1038/s41598-023-48496-5Test
https://www.nature.com/articles/s41598-023-48496-5.pdfTest
https://www.nature.com/articles/s41598-023-48496-5Test

المؤلفون: Karar, Hassan, Shafiekhani, Mojtaba, Mahmoudi, Mohamad Mahdi, Azadeh, Nazanin, Shamsaeefar, Alireza, Nazari, Sahar Sohrabi, Jafari, Mehran, Ashrafzadeh, Kiarash, Esmaeili, Maryam, Nikeghbalian, Saman, Nikoupour, Hamed

المصدر: BMC Research Notes ; volume 16, issue 1 ; ISSN 1756-0500

مصطلحات موضوعية: General Biochemistry, Genetics and Molecular Biology, General Medicine

الوصف: Introduction Simultaneous pancreas kidney (SPK) transplantation is an invaluable procedure to enhance the quality of life of insulin-dependent patients with advanced renal disease. The creation of vascular anastomoses of the donor’s pancreas vessels to the recipient’s, is of utmost importance to predict the graft outcome and surgical complications. In the study we introduce a novel technique for arterial reconstruction during SPK transplantation. Methods Conventionally, during the SPK transplantation, a so-called Y-graft is anastomosed between donor’s superior mesenteric and splenic artery to the recipient’s right iliac artery. In the study we adopted a new technique by preparing an extra extension using the donor’s carotid artery, to be anastomosed to the Y-graft and the iliac artery. In this non-blinded randomized clinical trial we compared the surgical complications and early outcomes between the 2 groups of patients with the traditional and new arterial reconstruction techniques during 3 months after transplantation. Results Thirty adult patients were included in the study. The incidence of pancreatitis, vascular thrombosis and surgical site infection was lower in the new Y-graft and extension technique, which was not statistically significant. However, the calculated Cohen’s d index showed the medium effect of new Y-graft and extension technique on complication after SPK transplantations. Conclusion The post-operative complications tend to be lower in the novel arterial reconstruction technique, however a study on a larger patient group is encouraged to confirm our primary results. Trial registration The study was registered at the Iranian Registry of Clinical Trials on 12/05/2022; IRCT 20210625051701N2; ( http://www.irct.irTest/ ).

الإتاحة: https://doi.org/10.1186/s13104-023-06568-9Test

المؤلفون: Shafiekhani, Mojtaba, Shabani-Borujeni, Mojtaba, Karimian, Ava, MomeniTabar, Mohammad Javad, Zare, Zahra, Arabsheybani, Sara, Vazin, Afsaneh

المصدر: BMC Surgery ; volume 23, issue 1 ; ISSN 1471-2482

مصطلحات موضوعية: General Medicine, Surgery

الوصف: Background Using Antimicrobial stewardship programs (ASP) to monitor the use of antibiotics can lead to improved antibiotic use and reduced costs. Methods This retrospective cohort study was done at Shiraz Organ Transplant Center, the largest transplant center in Asia. Antimicrobial use, cost, clinical outcomes, and antibiotic resistance pattern were evaluated before and after ASP. Results This study included 2791 patients, 1154 of whom were related to the time before ASP and 1637 to the time after ASP. During the period of the research, a total of 4051 interventions were done. The use of all classes of antibiotics was significantly reduced by ASP, with 329 DDD/100PD before the intervention compared to 201 DDD/100PD after it ( p = 0.04). In addition, the overall cost of antibiotics purchased was much lower after the ASP measures were implemented ($43.10 per PD) than before implementation of the ASP measures ($60.60 per PD) ( p = 0.03). After the implementation of ASP, the number of MDR isolates was significantly reduced. Conclusion The results of our study showed that the implementation of ASP significantly reduced the number and costs of antibiotics and also the number of resistant pathogens, but did not affect the patients’ length of stay.

الإتاحة: https://doi.org/10.1186/s12893-023-01991-yTest

المؤلفون: Shafiekhani, Mojtaba, Niknam, Tahmoores, Tara, Seyed Ahmad, Mardani, Parviz, Mirzad Jahromi, Khatereh, Jafarian, Sedigheh, Arabsheybani, Sara, Negahban, Halimeh, Hamzehnejadi, Majid, Zare, Zahra, Ghaedi Ghalini, Khadijeh, Ghasemnezhad, Ali, Akbari, Mahmoud, Shahriarirad, Reza, MalekHosseini, Seyed Ali

المصدر: Cost Effectiveness and Resource Allocation ; volume 21, issue 1 ; ISSN 1478-7547

مصطلحات موضوعية: Health Policy

الوصف: Background Since Shiraz Transplant Center is one of the major transplant centers in Iran and the Middle East, this study was conducted to evaluate outcomes of the applied policies on COVID-19 detection and management. Methods During 4 months from March to June 2020, patient's data diagnosed with the impression of COVID-19 were extracted and evaluated based on demographic and clinical features, along with the length of hospital stay and expenses. Results Our data demonstrated that a total of 190 individuals, with a median age of 58, were diagnosed with COVID-19 during the mentioned period. Among these, 21 patients had a positive PCR test and 56 patients had clinical symptoms in favor of COVID-19. Also, 113 (59%) patients were classified as mild based on clinical evidence and were treated on an outpatient basis. Furthermore, 81 out of 450 cases (18%) of the healthcare workers at our center had either PCR of clinical features in favor of COVID-19. The mortality rate of our study was 11% and diabetes mellitus, hypertension were considered risk factors for obtaining COVID-19 infection. The direct cost of treatment and management of patients with COVID-19 amounted to 2,067,730,919 IRR, which considering the 77 patients admitted to Gary Zone per capita direct cost of treatment each patient was 26,853,648 IRR. Conclusion We demonstrated that the COVID-19 pandemic had a noticeable influence on our transplant center in aspects of delaying surgery and increased hospital costs and burden. However, by implanting proper protocols, we were able to was able to provide early detection for COVID-19 and apply necessary treatment and prevention protocols to safeguard the patients under its coverage, especially immunocompromised patients.

الإتاحة: https://doi.org/10.1186/s12962-023-00427-xTest

المؤلفون: Shafiekhani, Mojtaba, Shahabinezhad, Farbod, Tavakoli, Zahra, Tarakmeh, Tahereh, Haem, Elham, Sari, Negar, Nasirabadi, Shohreh, Dehghani, Masoud

المساهمون: Shiraz Transplant Research Center, Shiraz University of Medical Sciences

المصدر: Frontiers in Pharmacology ; volume 14 ; ISSN 1663-9812

مصطلحات موضوعية: Pharmacology (medical), Pharmacology

الوصف: Purpose: Transplanted organ survival after solid organ transplantation highly correlates with the adherence levels of the patients to their immunosuppressive drugs. On the other hand, one of the main goals of liver transplantation is to increase the overall quality of life (QOL) for the patient. This study is aimed to analyze the relationship between adherence and QOL in adult liver transplant recipients of the biggest liver transplant center in Asia. Methods: All of the included patients were older than 18 years and at least 6 months had passed from their liver transplantation. The adherence level was measured with BAASIS method and the QOL was assessed by SF-36 questionnaire in real-time interviews. The relationship between adherence and different aspects of QOL in addition to qualitative and quantitative influential factors on these two outcomes was calculated with statistical analysis. Results: Among the 122 included patients, 41% of the were categorized in the non-adherent group. The most important reasons for non-adherence in these patients included forgetfulness (62%), lack of medication (12%), financial problems for drug supply (9%), and side effects (2%). According to the results of the multivariate linear regression model, rejection was the only influential factor in the occurrence of non-adherence among patients (OR = 8.226 CI (1.404-48.196)). The overall mean QOL score of patients was reported 51.09 ± 21.86. The lowest is given to social functioning, while mental health has achieved the highest score. The mean QOL scores in different dimensions in patients with adherence were higher than non-adherents, which was only significant in mental health ( p -value = 0.01). Additionally, in total scores related to Physical Composite Score (PSC) and Mental Composite Score (MCS), the mean MSC scores in adherent patients were significantly higher than non-adherent patients ( p -value: 0.02). Although adherent patients have an overall greater QOL, the only meaningful effect on QOL total score was from income ...

الإتاحة: https://doi.org/10.3389/fphar.2023.1051350Test

المؤلفون: Shafiekhani, Mojtaba, Shekari, Zahra, Boorboor, Arash, Zare, Zahra, Arabsheybani, Sara, Azadeh, Nazanin

المصدر: Virology Journal ; volume 19, issue 1 ; ISSN 1743-422X

مصطلحات موضوعية: Infectious Diseases, Virology

الوصف: Background SARS-CoV-2, a novel corona virus, has caused clusters of fatal pneumonia worldwide. Immune compromised patients are among the high risk groups with poor prognosis of the disease. The presence of bacterial or fungal co-infections with SARS-CoV-2 is associated with increased mortality. Methods The electronic data of the liver and kidney recipients, hospitalized in COVID-19 intensive care unit in an 8-month period in 2020 were retrospectively assessed. The documented bacterial or fungal infections alongside with outcome and risk factors were recorded and analyzed by binary logistic regression model and multivariate analyses. Results Sixty-Six liver and kidney recipients with positive RT-PCR for SARS-CoV-2 were included this study. Twenty one percent of the patients had at least one episode of co-infection during their COVID-19 course. Bacterial and fungal co-infections contributed to a significantly higher mortality. Urine and sputum were the most common sites of pathogen isolation (45.45% and 36.36%; respectively). The majority of infections were caused by vancomycin- resistant Enterococci (30%). Escherichia coli stood in the next position with 23.3%. Prior hospitalization and high doses of corticosteroids were associated with co-infections (p < 0.001 and p = 0.02; respectively.) Conclusions Bacterial and fungal co-infections with COVID-19 are more prevalent in solid organ recipients compared to the general population. Prior hospitalizations and use of broad-spectrum antimicrobial agents lead to emergence of multi-drug resistant pathogens in this susceptible patient population. Early detection and treatment of co-infections as well as antibiotic stewardship is recommended in solid organ recipients.

الإتاحة: https://doi.org/10.1186/s12985-022-01763-9Test

المؤلفون: Motamedi, Marjan, Golmohammadi, Zahra, Yazdanpanah, Somayeh, Saneian, S. Mojtaba, Shafiekhani, Mojtaba

المصدر: Scientific Reports ; volume 12, issue 1 ; ISSN 2045-2322

مصطلحات موضوعية: Multidisciplinary

الوصف: Mucormycosis is an invasive fungal infection with high morbidity and mortality rate despite the early diagnosis and proper therapeutic interventions. Given the importance of epidemiological data in reviewing the attitude toward infectious diseases in developing countries, the current retrospective case study aimed to compare the epidemiological aspects, risk factors, clinical characteristics, therapeutic interventions, and outcomes of mucormycosis between adults and children during eight years (2013–2021) in the main infectious disease referral centers in the southwest of Iran. The median age of 164 patients included in this study was 47 years (IQR 22–59). The median length of hospitalization was 33 days.The annual incidence of mucormycosis-related hospitalizations was estimated 1.76 per 10,000 admissions during the study period. Moreover, the incidence of infection was 2.4 times higher in males than females in children. Diabetes mellitus was the most frequent predisposing factor in adults (46.0%). The main risk factor in children was hematologic malignancy (52.6%), but a considerable proportion of them (28.9%) were immunocompetent.The most frequent antifungal agent used was liposomal amphotericin B (82.3%) as monotherapy. The combination therapy was used more in adults (15.8%) than children (7.9%). In addition, surgical intervention with antifungal therapy was considered the most effective therapeutic approach. The in-hospital mortality rate was 14.6% for adults, whereas it was zero for children. Our findings provide a recent epidemiologic analysis of mucormycosis among hospitalized patients in both children and adults. Mucormycosis mainly affects individuals with diabetes mellitus or hematological malignancies and presents as rhino-orbito-cerebral form. Proven diagnosis of mucormycosis according to clinical manifestations and histopathology observations accompanied by proper antifungal treatments may improve survival rates.

الإتاحة: https://doi.org/10.1038/s41598-022-21611-8Test
https://www.nature.com/articles/s41598-022-21611-8.pdfTest
https://www.nature.com/articles/s41598-022-21611-8Test

المؤلفون: Shafiekhani, Mojtaba, Azadeh, Nazanin, Ashrafzadeh, Kiarash, Esmaeili, Maryam, Nikoupour, Hamed

المصدر: BMC Surgery ; volume 21, issue 1 ; ISSN 1471-2482

مصطلحات موضوعية: General Medicine, Surgery

الوصف: Background Various abdominal pathologies end up with surgical resection of small intestine. When the small intestine remnant is too short for adequate fluid and micronutrients absorption, short bowel syndrome is diagnosed. The disabling condition needs a multidisciplinary approach to design parenteral nutrition, care for thrombotic, hepatic and infectious complications and gradually wean the patient from parenteral nutrition. Various surgical techniques have been introduced to increase absorptive mucosa and enhance the intestinal adaptation process. Serial transverse enteroplasty and nipple valve reconstruction are among the procedures, which will be discussed in the current article. Case presentation Herein, we presented 5 cases of short bowel syndrome as a consequence of abdominal laparotomies, patients were referred to our center to receive parenteral nutrition and to be prepared for the final autologous gastrointestinal reconstruction or intestinal transplantation, if indicated. Conclusion Patient’s age, performance status and bowel remnant length determines the appropriate technique for autologous gastrointestinal reconstruction. Serial transverse enteroplasty is designed to increase bowel’s length by creating zigzag patterns through dilated bowel loops. Presence of ileocecal valve is crucial to delay intestinal transit time and to prevent colonic bacterial transfer to ileum. Patient’s with ileocecal valve loss benefit from creating an artificial valve, namely, nipple valve.

الإتاحة: https://doi.org/10.1186/s12893-021-01454-2Test

المؤلفون: Shafiekhani, Mojtaba, Shahabinezhad, Farbod, Niknam, Tahmoores, Tara, Seyed Ahmad, Haem, Elham, Mardani, Parviz, Zare, Zahra, Jafarian, Sedigheh, Mirzad Jahromi, Khatereh, Arabsheybani, Sara, Moeini, Yalda Sadat, Alavi, Jalile, Jalali, Seyed Soroush, Salimi, Maryam, Shahriarirad, Reza, Malekhosseini, Seyed Ali

المصدر: Virology Journal ; volume 18, issue 1 ; ISSN 1743-422X

مصطلحات موضوعية: Infectious Diseases, Virology

الوصف: Background The management of COVID-19 in organ transplant recipients is among the most imperative, yet less discussed, issues based on their immunocompromised status along with their vast post-transplant medication regimens. No conclusive study has been published to evaluate proper anti-viral and immunomodulator medications effect in treating COVID-19 patients to this date. Method This retrospective study was conducted in Shiraz Transplant Hospital, Iran from March 2020 to May 2021 and included COVID-19 diagnosed patients based on SARS-CoV-2 RT-PCR positive test who had been hospitalized for at least 48 h before enrolling in the study. Clinical and demographic information of patients, along with their treatment course and the medication used were evaluated and analyzed using multiple regression analysis. Results A total of 245 patients with a mean age of 49.59 years were included with a mortality rate of 8.16%. The administration of Remdesivir as an anti-viral drug ( P value < 0.001) and Tocilizumab as an immunomodulator drug ( P value < 0.001) could reduce the hospitalization period in the hospital and the intensive care unit, as well as the mortality rates significantly. Meanwhile, the patients treated with Lopinavir/Ritonavir experienced a lower chance of survival (OR < 1, P value = 0.04). No significant difference was observed between various therapeutic regimens in clinical complications such as bacterial coinfections, cardiovascular and gastrointestinal adverse reactions, and liver or kidney dysfunctions. Conclusion The administration of Remdesivir as an anti-viral and Tocilizumab as an immunomodulatory drug in solid-organ transplant recipients could be promising treatments of choice to manage COVID-19.

الإتاحة: https://doi.org/10.1186/s12985-021-01700-2Test

المؤلفون: Shafiekhani, Mojtaba, Kazemi, Kourosh, Bahador, Ali, Imanieh, Mohammad Hadi, Karimzadeh, Parisa

المصدر: BMC Surgery ; volume 21, issue 1 ; ISSN 1471-2482

مصطلحات موضوعية: General Medicine, Surgery

الوصف: Background We aimed to evaluate the impact of COVID-19 pandemic on pediatric transplant outcomes and determine whether to continue pediatric transplant activity or not, and how policies intended our center has been effective in preventing COVID-19 among organ transplant recipients. Methods We conducted a single-center, retrospective, cohort study of hospitalized pediatrics after organ transplantation at Shiraz transplant center since March to August 2020. All liver and kidney transplanted children were included the study and their laboratory and clinical related COVID-19 characteristics were followed up till 3 months after transplantation during hospitalization period and then weekly by the transplant committee. Results Fifty-one patients underwent transplantation including 11 kidney and 40 liver recipients. The mean age of the pediatric cases was 6.72 ± 5.47 years. A total of 11 patients died due to post-transplant complications, while none of the patients presented any sign or symptoms in favor of COVID-19 in the hospital course after transplantation. Six transplants including 2 kidney and 4 liver were canceled when positive PCR tests were detected in their donors before the surgery. In the 3 months of follow up, two patients presented with symptoms including high grade fever, malaise, rhinorrhea, and GI symptoms. Both patients had two negative PCR, and no radiologic or laboratory results regarding COVID-19 were also detected. One had positive influenza PCR, while the second one had a positive serologic test for EBV; CT, computed tomography Conclusion Transplant programs could continue their activities during the COVID-19 pandemic with specific case selection, accurate screening methods and following protective protocols.

الإتاحة: https://doi.org/10.1186/s12893-021-01226-yTest