Fatemeh Bandarian

Potential risk factors for diabetic neuropathy: a case control study

BackgroundDiabetes mellitus type II afflicts at least 2 million people in Iran. Neuropathy is one of the most common complications of diabetes and lowers the patients quality of life. Since neuropathy often leads to ulceration and amputation, we have tried to elucidate the factors that can affect its progression.MethodsIn this case-control study, 110 diabetic patients were selected from the Shariati Hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS) was used to differentiate cases from controls. The diagnosis of neuropathy was confirmed by nerve conduction studies (nerve conduction velocity and electromyography). The multiple factors compared between the two groups included consumption of angiotensin converting enzyme inhibitors (ACEI), blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality.ResultsStatistically significant relationships were found between neuropathy and age, gender, quality of diabetes control and duration of disease (P values in the order: 0.04, 0.04, < 0.001 and 0.005). No correlation was found with any atherosclerosis risk factor (high BP, hyperlipidemia, cigarette smoking).ConclusionIn this study, hyperglycemia was the only modifiable risk factor for diabetic neuropathy. Glycemic control reduces the incidence of neuropathy, slows its progression and improves the diabetic patients quality of life. More attention must be paid to elderly male diabetic patients with poor diabetes control with regard to regular foot examinations and more practical education.

Total plasma homocysteine, folate, and vitamin b12 status in healthy Iranian adults: the Tehran homocysteine survey (2003–2004)/a cross – sectional population based study

BackgroundElevated plasma total homocysteine is an independent risk factor for cardiovascular disease and a sensitive marker of the inadequate vitamin B12 and folate insufficiency. Folate and vitamin B12 have a protective effect on cardiovascular disease. This population based study was conducted to evaluate the plasma total homocysteine, folate, and vitamin B12 in healthy Iranian individuals.MethodsThis study was a part of the Cardiovascular Risk Factors Survey in the Population Lab Region of Tehran University has been designed and conducted based on the methodology of MONICA/WHO Project. A total of 1214 people aged 25–64 years, were recruited and assessed regarding demographic characteristics, homocysteine, folate, and vitamin B12 levels with interview, questionnaires, examination and blood sampling. Blood samples were gathered and analyzed according to standard methods.ResultsThe variables were assessed in 1214 participants including 428 men (35.3%) and 786 women (64.7%). Age-adjusted prevalence of hyperhomocysteinemia (Hcy≥15 μmol/L) was 73.1% in men and 41.07% in women (P < 0.0001). Geometric mean of plasma homocysteine was 19.02 ± 1.46 μmol/l in men and 14.05 ± 1.45 μmol/l in women (P < 0.004) which increased by ageing. Age-adjusted prevalence of low serum folate level was 98.67% in men and 97.92% in women. Age-adjusted prevalence of low serum vitamin B12 level was 26.32% in men and 27.2% in women. Correlation coefficients (Pearsons r) between log tHcy and serum folate, and vitamin B12 indicated an inverse correlation (r = -0.27, r = -0.19, P < 0.0001, respectively).ConclusionThese results revealed that the prevalence of hyperhomocysteinemia, low folate and vitamin B12 levels are considerably higher than other communities. Implementation of preventive interventions such as food fortification with folic acid is necessary.

Craniopharyngioma: a clinicopathological study of 141 cases.

Craniopharyngioma is a tumor of the suprasellar region that histologically has two distinct variants with some differences in clinical behavior. The papillary type is almost always seen in adults and has a more indolent course compared with the adamantinomatous type, which is more common in childhood. In the present study, surgical specimens of craniopharyngiomas from 141 patients were reviewed. Their histomorphologic types were determined and the clinical features and prognosis of each group were assessed. The sizes of papillary type tumors were smaller and during the follow-up period there was no recurrence in the squamous papillary group. Aside from surgical resection (total vs subtotal), the recurrence rate for papillary type craniopharyngioma was lower than for adamantinomatous type. Histologic typing of craniopharyngioma especially in adults is useful for decision making with regard to treatment and follow-up.

SERUM URIC ACID LEVELS AND RISK OF METABOLIC SYNDROME IN HEALTHY ADULTS

OBJECTIVE To investigate the relationship between hyperuricemia and metabolic syndrome in a population of healthy subjects. METHODS We studied 1,573 healthy adults (25 to 64 years old) in the population laboratory of the Tehran University of Medical Sciences. The study was designed according to the World Health Organization MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) project with use of the National Cholesterol Education Program Adult Treatment Panel III criteria for metabolic syndrome. RESULTS The crude prevalence of the metabolic syndrome was 29.9% (age-adjusted, 27.5%). The rate of metabolic syndrome significantly increased in higher quartiles of serum uric acid in both sexes but especially in women (P<.0001 versus P = .026). The bivariate correlation was significant between uric acid levels and age, total serum cholesterol, high-density lipoprotein cholesterol, triglycerides, body mass index, waist and hip circumferences, waist-to-hip ratio, and systolic and diastolic blood pressures; however, there was not a significant correlation between serum uric acid concentrations and fasting plasma glucose. CONCLUSION These data indicate that an independent relationship exists between hyperuricemia and the metabolic syndrome. Moreover, hyperuricemia is significantly correlated with hypertriglyceridemia, hypertension, and visceral obesity. Early detection of hyperuricemia seems to be essential for prevention of the metabolic syndrome.

Primary Thyroid Malignancies in Tehran, Iran

Objective: The aim of this study was to present a descriptive epidemiology of primary thyroid cancer in Tehran, Iran, using cancer registry data. Subjects and Methods: All cases of thyroid cancer registered from 1998 to 2001 in Tehran Metropolitan Area Population-Based Cancer Registry were used for this study. The incidence of thyroid cancer was estimated for the area covered by the cancer registry. Survival of patients was ascertained by telephone call to the patients or the patient’s family and/or linkage of registry data to mortality data from the Bureau of Vital Statistics. Patient’s survival was based on sex, age and morphological type of tumour. Results: Four hundred and twenty-nine cases of primary thyroid cancer were registered in the Tehran Metropolitan Area Cancer Registry. The incidence of thyroid cancer was 3.5 and 1.0 per 100,000 population per year for females and males, respectively. Seventy percent of tumours were papillary, 11% follicular, 6.2% medullary, and the rest were other subtypes. The papillary and follicular variants occurred in younger age: 43 ± 16 and 46 ± 13 years, respectively; the medullary and anaplastic variants occurred in older age: over 50 years. A 5-year survival rate was 82.2%, with median survival of 66 months and 95% confidence interval of 63 and 69 months. Men and women had a similar survival experience.Conclusions: While the incidence of thyroid cancer was slightly high, the descriptive epidemiology of thyroid cancer in Tehran did not manifest a unique feature. Tehran patients experienced a high rate of survival, and the survival time for males and females was similar.

Association between serum adropin levels and gestational diabetes mellitus; a case–control study

Abstract Gestational diabetes mellitus (GDM) is increasing worldwide. The aim of this study was to investigate the association between serum adropin concentration and GDM. In a case–control study, conducted in 2013, 40 pregnant women with GDM and 40 healthy pregnant women (controls) were evaluated. Fasting serum adropin and lipid concentration were measured during 24th–28th weeks of gestation for both groups. These factors were compared between the two groups using independent sample t-test. There was a significant difference in adropin levels between the two groups and mean adropin levels were lower in GDM group (p: 0.016). There was no significant correlation between serum adropin levels and body mass index as well as fasting blood glucose (FBS) or serum lipid profile including high-density lipoprotein, low-density lipoprotein, cholesterol and triglyceride concentration (p > 0.05). There was a significant association between adropin concentration and GDM even after using regression model for removing confounding factors (odds ratio = 0.681). Low serum adropin concentration is associated with GDM in Iranian pregnant women.

The effect of vitamin D on primary dysmenorrhea with vitamin D deficiency: a randomized double-blind controlled clinical trial

Abstract Dysmenorrhea is common among women of reproductive age. This study aim was to investigate the effect of vitamin D (vit D) supplementation in treatment of primary dysmenorrhea with vit D deficiency. A randomized double-blind placebo-controlled clinical trial was conducted on 60 women with primary dysmenorrhea and vit D deficiency referred to our clinic at Arash Women’s Hospital from September 2013 to December 2014. Eligible women were randomly assigned into treatment and control groups (30 in each group). Individuals in the treatment group received 50 000 IU oral vit D and the control group received placebo weekly for eight weeks. After two months of treatment, there was a significant difference in serum vit D concentration between the two groups (p < 0.001). Pain severity decreased significantly in treatment group after eight weeks of treatment. There was a significant difference in pain intensity between the two groups after eight weeks of treatment and one month after the end of treatment (p < 0.001 for both). A weekly high dose (50 000 IU) oral vit D supplementation for eight weeks in patients with primary dysmenorrhea and vit D deficiency could improve pain intensity.

Household cardiovascular screening of high-risk families: a school-based study.

Background A parental history of cardiovascular disease has a strong relationship with risk factor clusters in the offspring. This study was performed to identify major cardiovascular risk factors in middle school-aged children and their parents in both high and low-risk families. Design A school-based, cross-sectional study. Methods The middle schools of the 6th district of Tehran were divided randomly into two groups. A total of 169 high-risk children with their families were recruited from the first group and 105 low-risk children with their families were recruited from the second group of schools. Anthropometric and metabolic measurements were performed. Results The means of the waist circumference and waist-to-hip ratio were significantly higher in high-risk fathers. The means of total and low-density lipoprotein (LDL) cholesterol were significantly higher in both parents and children of the high-risk group. The means of the fasting plasma glucose were significantly higher in fathers and offspring of high-risk families. More fathers in high-risk families were smokers. The prevalence of increased total cholesterol, LDL-cholesterol and hyperglycemia (≥100mg/dl) were higher in high-risk parents and children. The prevalence of increased body mass index (≥25 kg/m2 for parents and 85th percentile for children) was higher in fathers and children of high-risk families. Conclusions Cardiovascular risk factors are more prevalent and clustered in high-risk families. The screening of high-risk families is essential to prevent the progression of atherosclerosis from childhood and reduce the burden of cardiovascular disease in adulthood.

Diagnostic value of frozen section examination in thyroid nodule-surgery at the shariati hospital (1997–2000)

INTRODUCTION There is controversy regarding the use and accuracy of frozen section (FS) in managing thyroid nodules. We compared the diagnostic value of FS with that of permanent histopathology examination and fine needle aspiration (FNA). MATERIALS AND METHODS Permanent, FS, and FNA sample reports were compared in 214 patients between 1997 and 2000. FS, FNA, and permanent pathology (gold standard) results were compared using McNemars test. RESULTS 160 women and 54 men (mean age: 42.3 +/- 5.4 yr) took part in the study; 163 patients (76%) had benign and 51 (24%) malignant lesions; 76% of our thyroid cancer cases were papillary, 13.5% follicular, 6% medullary carcinoma, 4% Hürthle cell carcinoma, and 0.5% anaplastic carcinoma. FNA yielded definite results in 150 patients (sensitivity 72%, specificity 96%, and precision 90%). In 64 patients with equivocal FNA, FS was performed (sensitivity 36%, specificity 73%, and precision 85%). The observed difference between FNA and FS was not statistically significant. DISCUSSION When FNA results are inconclusive, FS does not provide any further information. In suspected cases of papillary, undifferentiated, or medullary carcinomas, FS can confirm FNA findings and guide surgical therapy.

Iran Diabetes Research Roadmap (IDRR): the study protocol

BackgroundDiabetes mellitus is a common metabolic disorder which is increasing worldwide. This study aimed to undertake a survey of the diabetes research in Iran to identify gaps and highlight strengths in order to develop a roadmap for diabetes research in Iran for the next years.MethodsTo develop a roadmap and to identify major areas of diabetes research, we carried out a systematic assessment of Iranian diabetes research publications. All obtained studies were categorized to 11 groups and each group was classified according to the “study design”, “subject area”, “World Health Organization (WHO) classification”, and “Australian Standard Research Classifications”. The number of publications per each year was calculated. Research trends in publications in each area were assessed and compared.ConclusionBy this study, we will provide the highlighted priorities, the gaps of research and strategic mapping of each area of diabetes research that could serve as a precious guideline for national research initiatives in the field of diabetes. By a strategic map, we can achieve many advances in the all aspects of diabetes research that finally impact on the health, quality of life and well-being of diabetic patients.