Seyyed Mojtaba Nekooghadam

Shahid Beheshti University of Medical Sciences

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Mehdi Pishgahi

Shahid Beheshti University of Medical Sciences

Erfan Ghadirzadeh

Mazandaran University of Medical Sciences

Elham Paraandavaji

Shahid Beheshti University of Medical Sciences

Behzad Hajimoradi

Shahid Beheshti University of Medical Sciences

Rita Rezaee

Shiraz University of Medical Sciences

Sasan Shafiei

Shahid Beheshti University of Medical Sciences

Elham Charkazi

Semnan University of Medical Sciences

Milad Ahmadi Marzaleh

Shiraz University of Medical Sciences

Parastoo Ghorbani

Mazandaran University of Medical Sciences

Mahmoudreza Peyravi

Shiraz University of Medical Sciences

Cooperative Institutions

Shahid Beheshti University of Medical Sciences

Tehran University of Medical Sciences

Shahid Beheshti University

Shiraz University of Medical Sciences

Iran University of Medical Sciences

Roozbeh Hospital

Kermanshah University of Medical Sciences

Guilan University of Medical Sciences

Emory University

Imam Hossein Hospital

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Several foreign bodies thoughout the torso following a shotgut injury

Zhale Nahavandi AmirHossein Aghdaee Seyyed Mojtaba Nekooghadam

A 50 year old man with a history of posterior bullet shot with a shotgun was presented to the hospital 18 hours after the accident complaining of abdominal and gluteal pain. He had stable vital signs, no respiratory distress, and no active bleeding. Physical examination revealed abdominal tenderness and generalized abdominal guarding.After a primary survey, a complete abdominopelvic ultrasonography and whole body computed tomography (CT) scan were performed (Figure 1) and revealing several bullet fragments (confirmed with Hounsfield scale) in paraspinal and abdominal wall, mesenteric fossa, pererectal and prenephric area, intestinal surroundings and illiac fossa (Figure 2 and 3).One of the bullet fragments was observed in left inferior renal calyx (Figure 4). Moreover another fragment was touching aortic arch (Figure 5).Afterwards, the patient underwent explorative laparatomy. About two liters of blood clot was observed in pelvic fossa. Also evidences of spleen injury and pancreas head and rectum hematoma with no active bleeding was observed. All four quadrants were packed, drainage was applied for pancreas. Since there was no fragment in aortic intima, no intervention was needed.After post-operative antibiotic therapy and other follow-ups such as urologic assessments, the patient was discharged. After two weeks, the patient was again referred to the hospital with pain in the site of drainage tubes. In laboratory tests amylase levels was 162 (U/L) and lipase levels was 83 (U/L). Plural effusion and atelectasis were observed in left lung CT scan (Figure 6) which did not need invasive intervention. Accumulation of spleen subcapsular fluid was observed in abdominopelvic CT scan. Loculated fluid collection was observed in pancreaticosplenic and paracolic areas (Figure 7) which led to diagnosis of pancreas drainage infection. The patient was treated with wide spectrum antibiotics and the symptoms were resolved. Also, there was the possibility for lead poisoning with lead bullet fragments, therefore serum levels of lead were examined after two months. The results showed a high level of lead concentration in serum (29 µg/dL). The patient was treated with antioxidant and vitamin C and asked to refer to the hospital every 2 months to check the lead level and have it under control. Administrating chelating agents such as dimercaptosuccinic acid and calcium disodium EDTA should be considered if the serum lead level is increased in the follow-up. Moreover, with the possibility for secondary adverse effects due to retained fragments, such as fistula formation, visceral adhesion, recurrent infection, et Cetra, the patient was advised to do frequent imaging checkups. According to similar cases and new studies, the presence of the lead in the bullet fragments won’t be causing any contraindications for magnetic resonance imaging but may cause some artifacts thus the alternative imaging tests such as CT or X-ray graphy are suggested. There’s also no evidence for the pellets movements and visceral organs injury after MRI in shotgun injury cases.

10.22037/smsj.v3i2.36009

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Waldenström's macroglobulinemia with necrotic extremities: A case with challenging diagnosis

Clinical Case Reports (2023)

Seyyed Mojtaba Nekooghadam Erfan Ghadirzadeh Mahsa Mohammadi Lapevandani Parastoo Ghorbani Yeganeh Ghalichehbaf Yazdi

Waldenström's macroglobulinemia may begin with constitutional symptoms that are common in primary care settings and it is crucial for physicians to be aware of the potential complications of hyperviscosity syndrome and to employ the appropriate diagnostic methods in order to achieve better outcomes.

Hyperviscosity syndrome

Cytopenia

Lymphoplasmacytic Lymphoma

Macroglobulinemia

Hepatosplenomegaly

Hyperviscosity

Constitutional symptoms

10.1002/ccr3.7809

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Heparin induced thrombocytopenia in pregnancy: A therapeutic challenge case report and literature review

Clinical Case Reports (2023)

Seyyed Mojtaba Nekooghadam Sepehr Ebrahimi‐Dehkordi Elham Paraandavaji Mehdi Pishgahi Erfan Ghadirzadeh

The anticoagulants of choice for the prevention and treatment of venous thromboembolic disease during pregnancy are unfractionated heparin and low-molecular-weight heparin. Heparin-induced thrombocytopenia (HIT) is introduced as a rare but critical side effect of heparin products raising the thromboembolic event paradoxically. Here, we present a case of HIT in pregnancy with challenging management due to coincidence of lupus anticoagulant (LA) and limited anticoagulant options in the pharmaceutical market of our country of residence. We describe a 6-week pregnant patient with deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE), which developed HIT during antenatal care. Therapeutic anticoagulation was initiated with argatroban, then switched to apixaban due to limited access to argatroban. Another therapeutic challenge was the concurrent incidence of LA. The interdisciplinary care team decided on adding up warfarin and scheduled termination at 12 weeks regarding the hazardous condition of the patient. We also reviewed related case literature to convey a new insight into managing pregnancy-related HIT. HIT is a pro-coagulatory and lethal complication associated with heparin therapy that can be diagnosed by clinical suspicion, the 4T score system, and confirmatory laboratory analyses. Alternative anticoagulation is the cornerstone of the treatment and an interdisciplinary plan will be worthwhile to make the best clinical decision regarding the critical situation and least the thromboembolic events mortality during pregnancy.

Heparin-Induced Thrombocytopenia

Lepirudin

10.1002/ccr3.7839

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Predictors of Mortality Among COVID-19 Patients With or Without Comorbid Diabetes Mellitus

ACTA MEDICA IRANICA (2021)

Seyedreza Mirsoleymani Erfan Taherifard Ehsan Taherifard Mohammad Hossein Taghrir Milad Ahmadi Marzaleh

Late in 2019, the first case of COVID-19 was detected in China, and the disease caused a pandemic state worldwide. Up to now, many studies have investigated the impact of comorbid diseases, especially diabetes mellitus, on COVID-19 outcomes. In this study, we aimed to assess the para-clinic characteristics of COVID-19 patients with or without diabetes mellitus to identify factors indicative of poor prognoses. In this prospective study, 153 in-patients with COVID-19 were followed up from 1 March to 19 April. Paraclinical information of these patients was gathered from their medical records. Afterward, the association between these factors among both diabetic and non-diabetic patients was assessed in the correlation analyses. Discharge and expiration of 77.1% and 22.9% of the study participants resulted in a 1063 person-day follow-up for patients who were discharged healthily and 384 person-day follow-ups for expired patients. 41.8% of the participants had diabetes mellitus. Lymphocytopenia and Neutrolhilia prevalences increased during hospitalization; comparing with their initial prevalences. Thirty-seven patients got acute respiratory distress syndrome; of those, 35 died. The mean of the initial C reactive protein level was 42.49, and serum creatinine of 1.39. The study showed that higher initial neutrophil count, increasing neutrophil count more than 15000 and decreasing lymphocyte count below 1000 during hospitalization; development of acute respiratory distress syndrome and being intubated; initial C reactive protein and serum creatinine level were associated with higher mortality rates in COVID-19 victims.

Lymphocytopenia

10.18502/acta.v59i7.7018

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Novel coronavirus disease 2019: predicting prognosis by using a computed tomography severity score and clinicolaboratory data

Polskie Archiwum Medycyny Wewnętrznej (2020)

Ali Sabri Amir H. Davarpanah Arash Mahdavi Alireza Abrishami Mehdi Khazaei

Risk stratification in COVID -19 629 the COVID -19 mortality risk to be 3.4%.2 The median time from symptom onset to radiological confirmation of this viral pneumonia is 5 days, whereas the median time from symptom onset to ICU admission is approximately 9.5 days. 3To identify predictors of clinical outcomes in patients with COVID -19 is essential in helping healthcare facilities in pandemic planning and INTROduCTION Coronavirus disease 2019 (COVID -19), caused by the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS -CoV -2), has recently been announced a global pandemic by the World Health Organization. 1 This infection can lead to severe respiratory distress requiring intensive care unit (ICU) admission.The World Health Organization estimated

Oxygen Saturation

10.20452/pamw.15422

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Systemic Fibrinolytic Therapy in the Presence of Absolute Contraindication; a Case Series.

DOAJ (DOAJ: Directory of Open Access Journals) (2018)

Mahdi Pishgahi Toktam Alirezaei Behzad Hajimoradi Seyyed Mojtaba Nekooghadam Shima Shahi

In massive pulmonary embolism (PE), fibrinolytic therapy is a potential lifesaving treatment; therefore, if other treatments are not available, the physicians encounter this question: can we accept the risk of complications from fibrinolytic therapy, especially intracranial hemorrhage, in the presence of absolute contraindication, in order to save the patient's life? Here, we describe three cases of massive PE with absolute contraindication for fibrinolytic therapy who presented to emergency department following dyspnea. Since, surgical or catheter embolectomy were not available and patients were very high risk for transferring to another hospital, systemic fibrinolytic was administered. The patients improved clinically and were discharged from hospital. It seems that, if no other acceptable treatments are available, physicians could consider fibrinolytic therapy, even at the presence of contraindication, to save the patient's life.

Contraindication

Fibrinolytic therapy

Fibrinolytic agent

Embolectomy

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A Case of Acute Leukemia Following Remission of COVID-19 Infection; an Urge to Search for a Probable Association

DOAJ (DOAJ: Directory of Open Access Journals) (2021)

Seyyed Mojtaba Nekooghadam Afshin Moradi Kimia Karimi Toudeshki Mehdi Pishgahi

Many aspects of Covid-19 infection, especially its complications and long-term health consequences are still unknown. Several reports concerning concomitant covid-19 infection and hematological disorders have been published recently. We aim to present a unique case of acute myeloid leukemia in a 61-year-old man with a previous history of covid-19 infection 40 days ago, with near complete resolution of signs and symptoms attributable to covid-19 infection. After 3 weeks, the patient presented again with progressive weakness, nausea, vomiting, and epigastric pain. No evidence of active covid-19 infection was observed. Instead, remarkable drop of hemoglobin and platelets relative to the values recorded in the discharge notes of the patient was observed. Further workup of the patient revealed evidence of acute leukemia and severe bone marrow involvement. We decided to present the current case as a concerning probable association.

2019-20 coronavirus outbreak

Association (psychology)

10.22037/aaem.v9i1.1338

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Citations (8)

Successful systemic thrombolytic therapy for massive pulmonary embolism in a patient with breast cancer, brain metastasis, and thrombocytopenia: A case report

Clinical Case Reports (2018)

Toktam Alirezaei Behzad Hajimoradi Mehdi Pishgahi Seyyed Mojtaba Nekooghadam Mohamad Golmohamadi

A female with massive PTE and absolute contraindication for thrombolytic did not meet guidelines due to unavailability of catheter or surgical embolectomy and giving thrombolytic as a last resort to save a life. In such cases, physicians should consider to act outside of the guidelines to save a life.

Systemic therapy

10.1002/ccr3.1629

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Assessment of Risk Factors for Severe Coronavirus Disease 2019 among Iranian Patients

Iranian Red Crescent Medical Journal (2020)

Seyedreza Mirsoleymani Seyyed Mojtaba Nekooghadam Milad Ahmadi Marzaleh Mahmoudreza Peyravi Ahmad Soltani

Background: The outbreak of Coronavirus Disease 2019 (COVID-19) has led to a major concern for those who are more vulnerable to infections. Objectives: This study aimed to evaluate the most important risk factors for severe COVID-19 pneumonia. Methods: This retrospective study included information on clinical and epidemiological features of 105 patients with severe COVID-19 pneumonia hospitalized in Tajrish Hospital, Tehran, Iran. Initially, the medical records of the patients were investigated, and an interview was conducted based on a pre-prepared checklist to seek information about symptoms, past medical history, medication history, and behavior before hospitalization. Results: Out of 105 participants, 76 (72.5%) cases were male, and 54 (51.4%) patients were older than 54 years old. The majority of the patients (n=18; 17.1%) had both hypertension and diabetes (n=12; 11.4%). Metformin (n=36; 34.3%) was the most used medication amongst the studied patient. In addition, 24 (22.9%) patients were recreational hookah smokers, and the majority (75%) of them were under the age of 46 years old. Eventually, 19 patients were excluded from the study, of whom 11 individuals had diabetes, and 10 cases were using metformin. Conclusion: Apparently, hookah smoking played a critical role in the spread of COVID-19 in Iran and has made younger people more susceptible. In addition to older age, the immunosuppressive effects of Metformin seem to make diabetic patients with an impaired immune system more vulnerable to severe COVID-19 pneumonia. More studies on the immune system of vulnerable individuals by identifying their differences can help to protect them.

Medical record

Medical History

10.32592/ircmj.2020.22.9.72

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Citations (5)

Paraneoplastic acute eosinophilic pneumonia due to carotid angiosarcoma: A rare case

Clinical Case Reports (2023)

Elham Paraandavaji Homa Hadidi Mahtab Norouzi Maryam Azaddehghan Mohadeseh Khodaparasti

Key Clinical Message This case report emphasizes that we should analyze a patient's signs and symptoms as a whole rather than relying exclusively on a common pattern to diagnose the condition and indicates that thorough histological investigation and sample collection are needed to accurately diagnose this malignancy. Abstract Angiosarcoma is a rare, fatal, and poorly understood malignant tumor of vascular endothelial cells which is a challenging disease to diagnose in the clinical settings and requires early diagnosis to achieve a favorable prognosis. Paraneoplastic syndromes associated with angiosarcoma can include hypercoagulability, thrombocytopenia, anemia, fever, weight loss, and night sweats. In some cases, the paraneoplastic syndrome can be the first sign of the underlying malignancy. Here, we present a 47‐year‐old individual with angiosarcoma over the right scapula accompanied by hemoptysis and other pulmonary complaints whom at first was thought to be metastatic polmunary involvement. However, the patient's dramatic response to corticosteroids, in addition to further imaging and paraclinical studies, led us to an acute eosinophilic pneumonia (AEP) diagnosis which is an eosinophilic infiltrations of alveolar spaces. The patient received chemotherapy for angiosarcoma and radiation, since the brachial nerve network was disrupted, leaving the tumor unresectable. After 3 years of continuous follow‐up, the patient is now completely cured.

Hemangiosarcoma

10.1002/ccr3.7348

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