Navid Saadat - Academia.edu (original) (raw)
Papers by Navid Saadat
any studies have been performed to compare WHO and ADA criteria for detection of diabetic patient... more any studies have been performed to compare WHO and ADA criteria for detection of diabetic patients. This study aims to compare these two criteria in a community-based epidemiological survey in an urban population of Tehran, Iran. Materials and Methods: Subjects were chosen from among 15005 urban individuals, 3 years old and over, selected by cluster random sampling in the cross-sectional phase of a longitudinal study conducted in the east of Tehran; there were 3870 men and 5359 women aged 20 years and over. Those with known diabetes were excluded. Blood samples were taken after 12-14 hours overnight fast and 2 hours post 75gr glucose taken orally. Prevalence of glucose tolerance categories and the level of agreement (ĸ statistic) were obtained using WHO and ADA criteria. Results: Based on WHO criteria 6.0% (0.95 CI, 5.5-6.5) had type-2 diabetes and 13.0% (12.3-13.7) had IGT (Impaired glucose tolerance). Using ADA, 3.3% (2.9-3.7) had type-2 diabetes and 4.8% (4.4-5.2) had IFG (Impair...
Archives of Iranian Medicine
Background: A rise in the global prevalence of severe obesity (body mass index; BMI of ≥35 kg/m2 ... more Background: A rise in the global prevalence of severe obesity (body mass index; BMI of ≥35 kg/m2 ) has been reported. In this study, we investigated the trends in the prevalence of severe obesity among Tehranian adults over the past two decades. Methods: A representative sample of 10,045 Tehranians aged ≥19 years were followed from 1999 to 2017. The trends in the prevalence of severe obesity were investigated over six cross-sectional phases with 3.6-year intervals using generalized estimating equations. Results: In this cohort, the overall prevalence of severe obesity increased from 4.6% (1.8% in males and 6.7% in females) in 1999 to 10.1% (4.7% in males and 14.3% in females) in 2017. The persisted rising in prevalence in the youngest age-group in both genders, with the most rapid increase among females aged 19–29 years, plateaued in the older ages and remained unchanged among males aged over 50 years. After age-sex standardized analysis by using Tehranian urban population data, the...
American Journal of Gastroenterology
Journal of Diabetes & Metabolic Disorders
Purpose Diabetic peripheral neuropathic pain (DPNP) is one of the most sufferings, disabling, and... more Purpose Diabetic peripheral neuropathic pain (DPNP) is one of the most sufferings, disabling, and dominant complications of diabetes. Duloxetine (DLX) and Pregabalin (PGB) are among first-line therapy and the most prescribed drugs for DPNP relief. The effectiveness-risk profile of drugs may differ from region to region due to variations in genetic and health situation of populations. This study aims to evaluate the efficacy and safety of DLX and PGB in a sample of Iranian population with DPNP. Methods A double-blind, randomized clinical trial was conducted on 180 type-2 diabetic patients with DPNP≥40 mm according to Visual Analogue Scale (VAS), with other eligibility criteria throughout twelve weeks. We divided the patients randomly into two equal groups: DLX and PGB. Each patient received ten days placebo as a washout period, then blind capsules of DLX (group 1) or PGB (group 2). We assessed the efficacy and safety of drugs by VAS and recorded the Adverse Drug Reactions (ADRs) during the study. Results In the DLX group, sixty-six and the PGB group, seventy-eight patients completed the study. The intensity of patients' pain was improved by both drugs significantly (p˂0.001), but there was no significant difference between the two groups. Average daily doses of DLX and PGB were 42.5 and 235.5 mg, respectively. In the DLX group, 74% of patients and the PGB group, 37% reported ADRs. The discontinuation rates due to ADRs were 19% and 7% correspondingly. Conclusion We found that in Iranian patients, the mean effective doses of these drugs are different in comparison with several other studies. Surprisingly intolerance and discontinuation of DLX in our patients were attributed to mild and severe Serotonin Syndrome, which had not much occurred in other studies. Accordingly, despite the same efficacy, PGB was better tolerated than DLX in our patients. Thus we would recommend PGB for DPNP treatment in Iranian patients. Keywords Adverse drug reactions (ADRs). Diabetes. Diabetic peripheral neuropathic pain (DPNP). Duloxetine (DLX). Pregabalin (PGB) The original version of this article was revised due to a retrospective Open Access order.
International journal of clinical pharmacy, 2018
Background Pharmacists' interventions to improve outcomes of diabetes management have been pr... more Background Pharmacists' interventions to improve outcomes of diabetes management have been promising. However, evidence on using telephone-based interventions in pharmacy practice are limited, particularly in developing countries. Objective To evaluate the efficacy of a telephone-based intervention to improve care and clinical outcomes in type-2 diabetes. Setting A referral community pharmacy and drug information center. Method We conducted a two-armed randomized controlled trial on 100 patients with type-2 diabetes. The intervention consisted of 16 telephone calls in 3 month by a trained pharmacist working in an academic drug information center, while the control group received usual care. Before random allocation, patients attended a live education session delivered by pharmacists to learn the basics of diabetes care and to confirm the eligibility criteria. Assessments were performed at baseline, month-3 (after intervention), and month-9 (follow-up). Main outcome measure Hemog...
Medical journal of the Islamic Republic of Iran, 2015
Increase in prevalence of obesity and type 2 diabetes which are of the main risk factors of metab... more Increase in prevalence of obesity and type 2 diabetes which are of the main risk factors of metabolic syndrome, is not only the result of changes in genetic, diet or physical activity, but also an imbalance of micro flora may play an important role. Therefore, alteration of micro flora using pre/probiotic is considered as a new strategy for treatment of metabolic disorders. The current study is a triple blind randomized controlled trial. 46 patients from both sexes, who fulfilled inclusion criteria, randomly categorized into intervention or placebo group. The intervention and placebo groups consumed 2 probiotic capsules or 2 placebo capsules during 3 months, respectively. Both groups received a weight loss diet, according to their adjusted ideal body weight. Anthropometric, body composition, blood pressure and nutritional measurements were done in the beginning, at 6th week, and at the end of the study. T-test and paired-t test were used for statistical analysis. 40 patients complet...
International Journal of Endocrinology and Metabolism, 2015
Background: Maternal thyroid disease in pregnancy is associated with adverse impact on both mothe... more Background: Maternal thyroid disease in pregnancy is associated with adverse impact on both mother and fetus. Both the American thyroid association and the endocrine society have recently published guidelines for the management of thyroid disease in pregnancy. Objectives: The objective of this survey was to assess and compare the current practices of various East-Asian physicians in the screening and management of thyroid disease in pregnancy. Materials and Methods: Completed survey questionnaires were collected from 112 physicians of six East-Asian countries. The survey was based on clinical case scenarios, asking questions about the clinical practices related to diagnosis and management of thyroid disease during pregnancy. Reponses from 76 endocrinologists and 33 internists and general practitioners (generalists) were analyzed. Results: There were minor differences in treatment preferences for Graves' disease in pregnancy and tests to monitor antithyroid drugs between endocrinologists and generalists; the major difference being targeted free thyroxin, and also thyroxin, depicted in the upper end of normal range, by the majority of endocrinologist and within the normal range, by generalists. Compared to generalists, endocrinologists perform more targeted screening and are more familiar with its risk factors. Predominantly, endocrinologists increase levothyroxine dose in hypothyroid women, upon confirmation of pregnancy and also indicate full dose in a pregnant woman, diagnosed with overt hypothyroidism, and treat thyroid peroxidase antibody positive or negative pregnant women with thyroid stimulating hormone (2.5-5 mU/L), as compared to generalists. Conclusions: There is wide variation in the clinical practices of screening and management of thyroid disorders during pregnancy in East-Asia, with many clinicians, in particular general practitioners, not adhering to clinical practice guidelines, unfortunately.
Annals of Saudi medicine
To improve cardiovascular (CV) health of American population, the American Heart Association (AHA... more To improve cardiovascular (CV) health of American population, the American Heart Association (AHA) developed definitions of ideal, intermediate, and poor CV health based on 7 accessible health metrics. The applicability of this construct and the distribution of its components in the community-based populations in the Middle East region have not been reported. A prospective population-based cohort study conducted from 1999 to 2011. We used data from phase 4 of Tehran Lipid and Glucose Study (2009-2011) (2861 women and 2004 men, aged >= 20 years) to estimate the frequency of CV health levels (ideal, intermediate, and poor) in adults of both genders, and the frequency of each metric at each level of CV health. The median or mean of each CV health metric was also estimated in the whole spectrum of CV health in all subgroups. Only 1 adult participant met all 7 ideal CV health metrics; 25.01% of women and 26% of men had intermediate CV health; 74.8% of women and 74% of men exhibited po...
Background: The healthy properties of conjugated linoleic acid (CLA) such as weight loss, reducin... more Background: The healthy properties of conjugated linoleic acid (CLA) such as weight loss, reducing cardiovascular risk factors and inflammation have been reported. The trans-10, cis-12 CLA isomer is related to increasing insulin resistance, but the effects of cis-9, trans-11 isomer is not clear. The aim of this study was to investigate the effects of CLA with and without Vitamin E on body weight, body composition, glycemic index, inflammatory and coagulation factors, lipid profile, serum leptin and adiponectin, malondialdehyde (MDA), and blood pressure in type2 diabetes. Methods: 56 patients with type2 diabetes were included in 8 week double-blind control trial that used metformin. They randomly divided into three groups: CLA + VitE, CLA + VitE placebo, CLA placebo + VitE placebo. All variables, anthropometric measurements, and body composition were evaluated at the beginning and the end of study. Statistical analysis and analysis of dietary data were performed using SPSS and nutritionist IV software, respectively. Results: There were not any significant differences in variable changes among three groups. However, there was a trend to increase in MDA and decrease in apoB100 among CLA consumers. Conclusion: The results of this study showed that administration of CLA supplementation for 8 weeks does not affect any indicators of metabolic control in overweight type2 diabetic patients.
Trials, 2009
Background: The Tehran Lipid and Glucose Study (TLGS) is a long term integrated community-based p... more Background: The Tehran Lipid and Glucose Study (TLGS) is a long term integrated community-based program for prevention of non-communicable disorders (NCD) by development of a healthy lifestyle and reduction of NCD risk factors. The study begun in 1999, is ongoing, to be continued for at least 20 years. A primary survey was done to collect baseline data in 15005 individuals, over 3 years of age, selected from cohorts of three medical heath centers. A questionnaire for past medical history and data was completed during interviews; blood pressure, pulse rate, and anthropometrical measurements and a limited physical examination were performed and lipid profiles, fasting blood sugar and 2-hours-postload-glucose challenge were measured. A DNA bank was also collected. For those subjects aged over 30 years, Rose questionnaire was completed and an electrocardiogram was taken. Data collected were directly stored in computers as database software-computer assisted system. The aim of this study is to evaluate the feasibility and effectiveness of lifestyle modification in preventing or postponing the development of NCD risk factors and outcomes in the TLGS population. Design and methods: In phase II of the TLGS, lifestyle interventions were implemented in 5630 people and 9375 individuals served as controls. Primary, secondary and tertiary interventions were designed based on specific target groups including schoolchildren, housewives, and high-risk persons. Officials of various sectors such as health, education, municipality, police, media, traders and community leaders were actively engaged as decision makers and collaborators. Interventional strategies were based on lifestyle modifications in diet, smoking and physical activity through face-to-face education, leaflets & brochures, school program alterations, training volunteers as health team and treating patients with NCD risk factors. Collection of demographic, clinical and laboratory data will be repeated every 3 years to assess the effects of different interventions in the intervention group as compared to control group. Conclusion: This controlled community intervention will test the possibility of preventing or delaying the onset of non-communicable risk factors and disorders in a population in nutrition transition.
The Journal of Clinical Endocrinology & Metabolism, 2013
Objective: Our objective was to examine whether wrist circumference is associated with incident t... more Objective: Our objective was to examine whether wrist circumference is associated with incident type 2 diabetes mellitus, independently of general (body mass index [BMI]) or central (waist circumference [WC]) adiposity measures in a cohort of an Iranian adult population. Research Design and Methods: A total of 9330 subjects Ն20 years of age were included in the cross-sectional study. For prospective analysis, subjects with prevalent diabetes were excluded, leaving 6393 subjects (2716 males and 3677 females). The standard 2-hour postchallenge plasma glucose test was performed at baseline and during follow-up. Cox regression analysis was used to estimate the hazard ratio of diabetes for wrist circumference. Results: During a mean follow-up of 8.8 years, 649 new cases of diabetes occurred. At baseline, using linear regression models, we showed significant linear associations between wrist circumference and diabetes risk factors in both genders, and this association remained significant after controlling for BMI or WC among females. In prospective evaluation, wrist circumference was significantly associated with incident diabetes (multivariable-adjusted hazard ratio ϭ 1.17 [1.03-1.32] and 1.31 [1.18-1.45] for males and females, respectively). After controlling for the subjects' BMI or WC, wrist circumference was an independent predictor of diabetes only among females. Wrist circumference was an independent predictor of metabolic syndrome only among women even after adjustment for BMI, WC, or both. Conclusions: Wrist circumference is a significant predictor of diabetes in both genders of adult population. However, its predictability is independent of BMI or WC only among females. Because of its simple and easy-to-detect nature, wrist circumference could be considered as a new anthropometric assessment for prediction of type 2 diabetes and metabolic syndrome.
International Journal of Surgical Pathology, 2012
Insular carcinoma represents a rather rare form of thyroid cancer. Total encapsulation and histor... more Insular carcinoma represents a rather rare form of thyroid cancer. Total encapsulation and history of hyperthyroidism are even extremely rarer events with only a few cases reported in the literature. This article reports an insular carcinoma of the thyroid in a 51-year-old woman, displaying these features and pulmonary metastasis with no cervical lymph node involvement.
Arquivos Brasileiros de Cardiologia, 2011
Abstract Introduction: Some cell culture and animal studies have reported that Conjugated Linolei... more Abstract Introduction: Some cell culture and animal studies have reported that Conjugated Linoleic Acids (CLAs) have several health related benefits. CLAs have been shown to have antiadipogenic, antiatherogenic, antidiabetogenic and anti-inflammatory properties. While ...
Journal of Ovarian Research
Background: Reduction of the body iron stores can improve hyperandrogenemia and insulin resistanc... more Background: Reduction of the body iron stores can improve hyperandrogenemia and insulin resistance. This study aimed to compare clinical and para-clinical responses to the treatment of phlebotomy using oral contraceptive pills (OCs) containing cyproterone acetate in women with PCOS. Methods: In this randomized clinical trial, 64 patients with PCOS were randomly assigned to the phlebotomy and OCs groups (n = 32 in each group). The intervention group, using a single treatment procedure, underwent venesection of 450 mL of whole blood at the early follicular phase of the spontaneous or progesterone-induced menstrual cycle. The control group received OCs pills for 3 months from the 1th day of spontaneous or progesterone-induced menstrual cycle onwards for 3 weeks, followed by a pill-free interval of 7 days. The women were evaluated after the 3-month intervention. The primary outcome measure was a change in the HOMA-IR and free androgen index (FAI). Secondary outcomes were changes in the Ferriman-Gallwey (FG) score and other clinical, biochemical and hormonal changes from the baseline (pre-treatment) to week 12. Results: In the phlebotomy group, 27 (84.3%) and in the OCs group 30 (93.7%) of the women completed the 3-month follow-up. The median HOMA-IR significantly decreased from 3.5 to 2.7 in the phlebotomy, and from 3.1 to 2.8 in the OCs group, and the changes were comparable between the groups. Median changes in the FAI significantly decreased in both groups, but the differences were not statistically significant between the groups (P = 0.061). With regard to secondary outcomes, mean FG scores in both groups significantly decreased [from 16.8 (6) to 13.3 (7.4), P < 0.028] in the phlebotomy group and [from 14.3 (7) to 9.8 (7.6) in the OCs group, P = 0.001] after 3 months of treatment, but such changes had no statistically significant differences between the groups. During treatment, menstrual cycles became regular in all women in the OCs group and in 12.27 (44.4%) of the women in the phlebotomy group, and the difference was statistically significant (P = 0.001). Despite no statistically significant differences in lipid profiles between the groups at the baseline, triglycerides were significantly higher in the OCs group compared to the phlebotomy at end of follow up (p = 0.019).
Endocrine, 2013
Acromegaly secondary to extra-pituitary tumors secreting growth hormone releasing hormone (GHRH) ... more Acromegaly secondary to extra-pituitary tumors secreting growth hormone releasing hormone (GHRH) is rarely encountered. We review the literature on ectopic acromegaly and present the index report of ectopic acromegaly secondary to GHRH secretion from a mediastinal paraganglioma. Clinical and pathological manifestations and therapeutic management of 99 patients with ectopic acromegaly are reviewed. Acromegaly secondary to ectopic GHRH secretion is usually caused by a neuroendocrine tumor in the lung and pancreas. We report an additional cause of ectopic acromegaly from a mediastinal paraganglioma. Diagnostic criteria of ectopic GHRH syndrome include biochemical and pathologic tumoral confirmation of GHRH secretion and expression. Management of ectopic acromegaly consists of surgical resection of the primary tumor and biochemical normalization, with possible adjuvant use of somatostatin analogs. The review demonstrates that there are several tumor types, including paragangliomas which may secrete GHRH, leading to acromegaly. Clinical and laboratory manifestations of the syndrome and challenges in diagnosis and management of these rarely encountered patients require early diagnosis and appropriate treatment to prevent long-term morbidity and mortality with ectopic acromegaly.
The Diabetes educator, 2015
The purpose of the study was to investigate the efficacy of a community pharmacist-delivered diab... more The purpose of the study was to investigate the efficacy of a community pharmacist-delivered diabetes support program for patients receiving specialty medical care in a middle-income country (Iran). A randomized controlled trial was conducted on 101 patients who received diabetes care from an endocrinologist. A qualified community pharmacist educated patients about medications, clinical goals, self-care activities, and self-monitoring of blood glucose. The pharmacist trained patients in the intervention group for 5 months (5 follow-up visits and 5 phone calls) and recommended physician visits when necessary. The primary outcome was A1C, and the secondary outcomes included self-care activities, medication adherence, blood pressure, and body mass index. Satisfaction and willingness to pay was assessed in the intervention group. Eighty-five patients completed the study, and baseline A1C was similar between groups (intervention: 7.6 ± 1.6 [59 mmol/mol] vs control: 7.5 ± 1.9 [58 mmol/mol...
Iranian journal of pharmaceutical research : IJPR, 2015
Dopaminergic signaling is one of the regulatory pathways being investigated for its implication i... more Dopaminergic signaling is one of the regulatory pathways being investigated for its implication in glucose metabolism. The aim of this study was to determine the effect of cabergoline on biochemical and anthropometric parameters in prediabetes stage (impaired fasting glucose and impaired glucose tolerance). In this double blind, placebo-controlled, pilot study, 27 prediabetic adults were randomized to receive 0.25-mg cabergoline twice weekly for two weeks, followed by 0.5 mg twice weekly for next 14 weeks (n = 13) or placebo (n = 14). All subjects were advised to follow a 500 kcal-deficit energy diet. Fasting plasma glucose (FPG), oral glucose tolerance, glycated hemoglobin (A1c), fasting, and 2-h insulin were measured at baseline and at 16-week follow-up. Homeostasis model assessment (HOMA) 2 was calculated to estimate steady-state beta-cell function, insulin sensitivity, and insulin resistance. Our results showed significant reductions in fasting (P = 0.004) and 2-h plasma glucose...
Iranian biomedical journal, Jul 1, 2009
Patients with diabetes mellitus type II suffer from hyperglycemia because they are not able to us... more Patients with diabetes mellitus type II suffer from hyperglycemia because they are not able to use the insulin that they produce, often due to inadequate function of insulin receptors. There are some evidences that this deficiency is inherited in a dominant autosomal manner and leads to the malfunction of the pancreatic beta cells resulting in insulin excretion disorders. In this study, we sought to identify mutations in the insulin receptor (INSR) gene, which can cause insulin resistance in type II diabetic patients. DNA was extracted from peripheral blood cells of the patients (n = 128) diagnosed with type II diabetes. All 22 exons of the INSR gene of the patients were analyzed for mutations running PCR, conformation-sensitive gel electrophoresis and DNA sequencing, consecutively. Approximately 26% of the patients had genetic mutations; however, most of them were not reported. These mutations include exon 2 (His171Asn, Ile172Ser, Cys196Ser and Ser210Arg), exon 3 (Gly227Asp and Gly...
Pakistan Journal of Biological Sciences, 2007
The aim of this study was to determine whether iron supplementation in iron-deficient adolescent ... more The aim of this study was to determine whether iron supplementation in iron-deficient adolescent girls would improve thyroid function. A double-blind clinical trial was performed in a region in southern I.R. Iran. A total of 103 iron deficient participants were chosen. In all, 94 participants successfully completed this study. Participants were randomly assigned to one of two groups and treated with a 300 mg ferrous sulfate 5 times/week (n = 47) and placebo 5 times/week (n = 47) for 12 weeks. Blood samples were collected and assayed for hemoglobin, hematocrit, serum ferritin, iron, total iron binding capacity (TIBC), Thyroid stimulating hormone (TSH), total thyroxine (TT4), total triiodothyronine (TT3), free thyroid hormones (FT4 and FT3), triiodothyronine resin uptake (T3RU), reverse triiodothyronine (rT3), selenium and albumin concentrations. Statistical analysis was performed with parametric and non-parametric methods as appropriate. Data analysis revealed a significant increase in TT4, TT3, T3RU and a significant decrease in rT3 concentration in comparison to initial values in iron treated group (12%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; 3.5%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; 16%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 and 47%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001, respectively). At 12 week there were significant differences between control and placebo in TT4, TT3, T3RU and rT3 concentrations (9.9 vs 8.4 microg dL(-1), 145.2 vs 130.4 microg dL(-1), 32.5 vs 28.4% and 23 vs 41 microg dL(-1), respectively, all p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Alterations in FT3 and TSH concentration were not significant, but concentration of FT4 revealed a significant difference between the beginning and the end of the study in iron treated group (10.3 vs 11.4, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Iron supplementation improves some indices of thyroid function in iron-deficient adolescent girls.
any studies have been performed to compare WHO and ADA criteria for detection of diabetic patient... more any studies have been performed to compare WHO and ADA criteria for detection of diabetic patients. This study aims to compare these two criteria in a community-based epidemiological survey in an urban population of Tehran, Iran. Materials and Methods: Subjects were chosen from among 15005 urban individuals, 3 years old and over, selected by cluster random sampling in the cross-sectional phase of a longitudinal study conducted in the east of Tehran; there were 3870 men and 5359 women aged 20 years and over. Those with known diabetes were excluded. Blood samples were taken after 12-14 hours overnight fast and 2 hours post 75gr glucose taken orally. Prevalence of glucose tolerance categories and the level of agreement (ĸ statistic) were obtained using WHO and ADA criteria. Results: Based on WHO criteria 6.0% (0.95 CI, 5.5-6.5) had type-2 diabetes and 13.0% (12.3-13.7) had IGT (Impaired glucose tolerance). Using ADA, 3.3% (2.9-3.7) had type-2 diabetes and 4.8% (4.4-5.2) had IFG (Impair...
Archives of Iranian Medicine
Background: A rise in the global prevalence of severe obesity (body mass index; BMI of ≥35 kg/m2 ... more Background: A rise in the global prevalence of severe obesity (body mass index; BMI of ≥35 kg/m2 ) has been reported. In this study, we investigated the trends in the prevalence of severe obesity among Tehranian adults over the past two decades. Methods: A representative sample of 10,045 Tehranians aged ≥19 years were followed from 1999 to 2017. The trends in the prevalence of severe obesity were investigated over six cross-sectional phases with 3.6-year intervals using generalized estimating equations. Results: In this cohort, the overall prevalence of severe obesity increased from 4.6% (1.8% in males and 6.7% in females) in 1999 to 10.1% (4.7% in males and 14.3% in females) in 2017. The persisted rising in prevalence in the youngest age-group in both genders, with the most rapid increase among females aged 19–29 years, plateaued in the older ages and remained unchanged among males aged over 50 years. After age-sex standardized analysis by using Tehranian urban population data, the...
American Journal of Gastroenterology
Journal of Diabetes & Metabolic Disorders
Purpose Diabetic peripheral neuropathic pain (DPNP) is one of the most sufferings, disabling, and... more Purpose Diabetic peripheral neuropathic pain (DPNP) is one of the most sufferings, disabling, and dominant complications of diabetes. Duloxetine (DLX) and Pregabalin (PGB) are among first-line therapy and the most prescribed drugs for DPNP relief. The effectiveness-risk profile of drugs may differ from region to region due to variations in genetic and health situation of populations. This study aims to evaluate the efficacy and safety of DLX and PGB in a sample of Iranian population with DPNP. Methods A double-blind, randomized clinical trial was conducted on 180 type-2 diabetic patients with DPNP≥40 mm according to Visual Analogue Scale (VAS), with other eligibility criteria throughout twelve weeks. We divided the patients randomly into two equal groups: DLX and PGB. Each patient received ten days placebo as a washout period, then blind capsules of DLX (group 1) or PGB (group 2). We assessed the efficacy and safety of drugs by VAS and recorded the Adverse Drug Reactions (ADRs) during the study. Results In the DLX group, sixty-six and the PGB group, seventy-eight patients completed the study. The intensity of patients' pain was improved by both drugs significantly (p˂0.001), but there was no significant difference between the two groups. Average daily doses of DLX and PGB were 42.5 and 235.5 mg, respectively. In the DLX group, 74% of patients and the PGB group, 37% reported ADRs. The discontinuation rates due to ADRs were 19% and 7% correspondingly. Conclusion We found that in Iranian patients, the mean effective doses of these drugs are different in comparison with several other studies. Surprisingly intolerance and discontinuation of DLX in our patients were attributed to mild and severe Serotonin Syndrome, which had not much occurred in other studies. Accordingly, despite the same efficacy, PGB was better tolerated than DLX in our patients. Thus we would recommend PGB for DPNP treatment in Iranian patients. Keywords Adverse drug reactions (ADRs). Diabetes. Diabetic peripheral neuropathic pain (DPNP). Duloxetine (DLX). Pregabalin (PGB) The original version of this article was revised due to a retrospective Open Access order.
International journal of clinical pharmacy, 2018
Background Pharmacists' interventions to improve outcomes of diabetes management have been pr... more Background Pharmacists' interventions to improve outcomes of diabetes management have been promising. However, evidence on using telephone-based interventions in pharmacy practice are limited, particularly in developing countries. Objective To evaluate the efficacy of a telephone-based intervention to improve care and clinical outcomes in type-2 diabetes. Setting A referral community pharmacy and drug information center. Method We conducted a two-armed randomized controlled trial on 100 patients with type-2 diabetes. The intervention consisted of 16 telephone calls in 3 month by a trained pharmacist working in an academic drug information center, while the control group received usual care. Before random allocation, patients attended a live education session delivered by pharmacists to learn the basics of diabetes care and to confirm the eligibility criteria. Assessments were performed at baseline, month-3 (after intervention), and month-9 (follow-up). Main outcome measure Hemog...
Medical journal of the Islamic Republic of Iran, 2015
Increase in prevalence of obesity and type 2 diabetes which are of the main risk factors of metab... more Increase in prevalence of obesity and type 2 diabetes which are of the main risk factors of metabolic syndrome, is not only the result of changes in genetic, diet or physical activity, but also an imbalance of micro flora may play an important role. Therefore, alteration of micro flora using pre/probiotic is considered as a new strategy for treatment of metabolic disorders. The current study is a triple blind randomized controlled trial. 46 patients from both sexes, who fulfilled inclusion criteria, randomly categorized into intervention or placebo group. The intervention and placebo groups consumed 2 probiotic capsules or 2 placebo capsules during 3 months, respectively. Both groups received a weight loss diet, according to their adjusted ideal body weight. Anthropometric, body composition, blood pressure and nutritional measurements were done in the beginning, at 6th week, and at the end of the study. T-test and paired-t test were used for statistical analysis. 40 patients complet...
International Journal of Endocrinology and Metabolism, 2015
Background: Maternal thyroid disease in pregnancy is associated with adverse impact on both mothe... more Background: Maternal thyroid disease in pregnancy is associated with adverse impact on both mother and fetus. Both the American thyroid association and the endocrine society have recently published guidelines for the management of thyroid disease in pregnancy. Objectives: The objective of this survey was to assess and compare the current practices of various East-Asian physicians in the screening and management of thyroid disease in pregnancy. Materials and Methods: Completed survey questionnaires were collected from 112 physicians of six East-Asian countries. The survey was based on clinical case scenarios, asking questions about the clinical practices related to diagnosis and management of thyroid disease during pregnancy. Reponses from 76 endocrinologists and 33 internists and general practitioners (generalists) were analyzed. Results: There were minor differences in treatment preferences for Graves' disease in pregnancy and tests to monitor antithyroid drugs between endocrinologists and generalists; the major difference being targeted free thyroxin, and also thyroxin, depicted in the upper end of normal range, by the majority of endocrinologist and within the normal range, by generalists. Compared to generalists, endocrinologists perform more targeted screening and are more familiar with its risk factors. Predominantly, endocrinologists increase levothyroxine dose in hypothyroid women, upon confirmation of pregnancy and also indicate full dose in a pregnant woman, diagnosed with overt hypothyroidism, and treat thyroid peroxidase antibody positive or negative pregnant women with thyroid stimulating hormone (2.5-5 mU/L), as compared to generalists. Conclusions: There is wide variation in the clinical practices of screening and management of thyroid disorders during pregnancy in East-Asia, with many clinicians, in particular general practitioners, not adhering to clinical practice guidelines, unfortunately.
Annals of Saudi medicine
To improve cardiovascular (CV) health of American population, the American Heart Association (AHA... more To improve cardiovascular (CV) health of American population, the American Heart Association (AHA) developed definitions of ideal, intermediate, and poor CV health based on 7 accessible health metrics. The applicability of this construct and the distribution of its components in the community-based populations in the Middle East region have not been reported. A prospective population-based cohort study conducted from 1999 to 2011. We used data from phase 4 of Tehran Lipid and Glucose Study (2009-2011) (2861 women and 2004 men, aged >= 20 years) to estimate the frequency of CV health levels (ideal, intermediate, and poor) in adults of both genders, and the frequency of each metric at each level of CV health. The median or mean of each CV health metric was also estimated in the whole spectrum of CV health in all subgroups. Only 1 adult participant met all 7 ideal CV health metrics; 25.01% of women and 26% of men had intermediate CV health; 74.8% of women and 74% of men exhibited po...
Background: The healthy properties of conjugated linoleic acid (CLA) such as weight loss, reducin... more Background: The healthy properties of conjugated linoleic acid (CLA) such as weight loss, reducing cardiovascular risk factors and inflammation have been reported. The trans-10, cis-12 CLA isomer is related to increasing insulin resistance, but the effects of cis-9, trans-11 isomer is not clear. The aim of this study was to investigate the effects of CLA with and without Vitamin E on body weight, body composition, glycemic index, inflammatory and coagulation factors, lipid profile, serum leptin and adiponectin, malondialdehyde (MDA), and blood pressure in type2 diabetes. Methods: 56 patients with type2 diabetes were included in 8 week double-blind control trial that used metformin. They randomly divided into three groups: CLA + VitE, CLA + VitE placebo, CLA placebo + VitE placebo. All variables, anthropometric measurements, and body composition were evaluated at the beginning and the end of study. Statistical analysis and analysis of dietary data were performed using SPSS and nutritionist IV software, respectively. Results: There were not any significant differences in variable changes among three groups. However, there was a trend to increase in MDA and decrease in apoB100 among CLA consumers. Conclusion: The results of this study showed that administration of CLA supplementation for 8 weeks does not affect any indicators of metabolic control in overweight type2 diabetic patients.
Trials, 2009
Background: The Tehran Lipid and Glucose Study (TLGS) is a long term integrated community-based p... more Background: The Tehran Lipid and Glucose Study (TLGS) is a long term integrated community-based program for prevention of non-communicable disorders (NCD) by development of a healthy lifestyle and reduction of NCD risk factors. The study begun in 1999, is ongoing, to be continued for at least 20 years. A primary survey was done to collect baseline data in 15005 individuals, over 3 years of age, selected from cohorts of three medical heath centers. A questionnaire for past medical history and data was completed during interviews; blood pressure, pulse rate, and anthropometrical measurements and a limited physical examination were performed and lipid profiles, fasting blood sugar and 2-hours-postload-glucose challenge were measured. A DNA bank was also collected. For those subjects aged over 30 years, Rose questionnaire was completed and an electrocardiogram was taken. Data collected were directly stored in computers as database software-computer assisted system. The aim of this study is to evaluate the feasibility and effectiveness of lifestyle modification in preventing or postponing the development of NCD risk factors and outcomes in the TLGS population. Design and methods: In phase II of the TLGS, lifestyle interventions were implemented in 5630 people and 9375 individuals served as controls. Primary, secondary and tertiary interventions were designed based on specific target groups including schoolchildren, housewives, and high-risk persons. Officials of various sectors such as health, education, municipality, police, media, traders and community leaders were actively engaged as decision makers and collaborators. Interventional strategies were based on lifestyle modifications in diet, smoking and physical activity through face-to-face education, leaflets & brochures, school program alterations, training volunteers as health team and treating patients with NCD risk factors. Collection of demographic, clinical and laboratory data will be repeated every 3 years to assess the effects of different interventions in the intervention group as compared to control group. Conclusion: This controlled community intervention will test the possibility of preventing or delaying the onset of non-communicable risk factors and disorders in a population in nutrition transition.
The Journal of Clinical Endocrinology & Metabolism, 2013
Objective: Our objective was to examine whether wrist circumference is associated with incident t... more Objective: Our objective was to examine whether wrist circumference is associated with incident type 2 diabetes mellitus, independently of general (body mass index [BMI]) or central (waist circumference [WC]) adiposity measures in a cohort of an Iranian adult population. Research Design and Methods: A total of 9330 subjects Ն20 years of age were included in the cross-sectional study. For prospective analysis, subjects with prevalent diabetes were excluded, leaving 6393 subjects (2716 males and 3677 females). The standard 2-hour postchallenge plasma glucose test was performed at baseline and during follow-up. Cox regression analysis was used to estimate the hazard ratio of diabetes for wrist circumference. Results: During a mean follow-up of 8.8 years, 649 new cases of diabetes occurred. At baseline, using linear regression models, we showed significant linear associations between wrist circumference and diabetes risk factors in both genders, and this association remained significant after controlling for BMI or WC among females. In prospective evaluation, wrist circumference was significantly associated with incident diabetes (multivariable-adjusted hazard ratio ϭ 1.17 [1.03-1.32] and 1.31 [1.18-1.45] for males and females, respectively). After controlling for the subjects' BMI or WC, wrist circumference was an independent predictor of diabetes only among females. Wrist circumference was an independent predictor of metabolic syndrome only among women even after adjustment for BMI, WC, or both. Conclusions: Wrist circumference is a significant predictor of diabetes in both genders of adult population. However, its predictability is independent of BMI or WC only among females. Because of its simple and easy-to-detect nature, wrist circumference could be considered as a new anthropometric assessment for prediction of type 2 diabetes and metabolic syndrome.
International Journal of Surgical Pathology, 2012
Insular carcinoma represents a rather rare form of thyroid cancer. Total encapsulation and histor... more Insular carcinoma represents a rather rare form of thyroid cancer. Total encapsulation and history of hyperthyroidism are even extremely rarer events with only a few cases reported in the literature. This article reports an insular carcinoma of the thyroid in a 51-year-old woman, displaying these features and pulmonary metastasis with no cervical lymph node involvement.
Arquivos Brasileiros de Cardiologia, 2011
Abstract Introduction: Some cell culture and animal studies have reported that Conjugated Linolei... more Abstract Introduction: Some cell culture and animal studies have reported that Conjugated Linoleic Acids (CLAs) have several health related benefits. CLAs have been shown to have antiadipogenic, antiatherogenic, antidiabetogenic and anti-inflammatory properties. While ...
Journal of Ovarian Research
Background: Reduction of the body iron stores can improve hyperandrogenemia and insulin resistanc... more Background: Reduction of the body iron stores can improve hyperandrogenemia and insulin resistance. This study aimed to compare clinical and para-clinical responses to the treatment of phlebotomy using oral contraceptive pills (OCs) containing cyproterone acetate in women with PCOS. Methods: In this randomized clinical trial, 64 patients with PCOS were randomly assigned to the phlebotomy and OCs groups (n = 32 in each group). The intervention group, using a single treatment procedure, underwent venesection of 450 mL of whole blood at the early follicular phase of the spontaneous or progesterone-induced menstrual cycle. The control group received OCs pills for 3 months from the 1th day of spontaneous or progesterone-induced menstrual cycle onwards for 3 weeks, followed by a pill-free interval of 7 days. The women were evaluated after the 3-month intervention. The primary outcome measure was a change in the HOMA-IR and free androgen index (FAI). Secondary outcomes were changes in the Ferriman-Gallwey (FG) score and other clinical, biochemical and hormonal changes from the baseline (pre-treatment) to week 12. Results: In the phlebotomy group, 27 (84.3%) and in the OCs group 30 (93.7%) of the women completed the 3-month follow-up. The median HOMA-IR significantly decreased from 3.5 to 2.7 in the phlebotomy, and from 3.1 to 2.8 in the OCs group, and the changes were comparable between the groups. Median changes in the FAI significantly decreased in both groups, but the differences were not statistically significant between the groups (P = 0.061). With regard to secondary outcomes, mean FG scores in both groups significantly decreased [from 16.8 (6) to 13.3 (7.4), P < 0.028] in the phlebotomy group and [from 14.3 (7) to 9.8 (7.6) in the OCs group, P = 0.001] after 3 months of treatment, but such changes had no statistically significant differences between the groups. During treatment, menstrual cycles became regular in all women in the OCs group and in 12.27 (44.4%) of the women in the phlebotomy group, and the difference was statistically significant (P = 0.001). Despite no statistically significant differences in lipid profiles between the groups at the baseline, triglycerides were significantly higher in the OCs group compared to the phlebotomy at end of follow up (p = 0.019).
Endocrine, 2013
Acromegaly secondary to extra-pituitary tumors secreting growth hormone releasing hormone (GHRH) ... more Acromegaly secondary to extra-pituitary tumors secreting growth hormone releasing hormone (GHRH) is rarely encountered. We review the literature on ectopic acromegaly and present the index report of ectopic acromegaly secondary to GHRH secretion from a mediastinal paraganglioma. Clinical and pathological manifestations and therapeutic management of 99 patients with ectopic acromegaly are reviewed. Acromegaly secondary to ectopic GHRH secretion is usually caused by a neuroendocrine tumor in the lung and pancreas. We report an additional cause of ectopic acromegaly from a mediastinal paraganglioma. Diagnostic criteria of ectopic GHRH syndrome include biochemical and pathologic tumoral confirmation of GHRH secretion and expression. Management of ectopic acromegaly consists of surgical resection of the primary tumor and biochemical normalization, with possible adjuvant use of somatostatin analogs. The review demonstrates that there are several tumor types, including paragangliomas which may secrete GHRH, leading to acromegaly. Clinical and laboratory manifestations of the syndrome and challenges in diagnosis and management of these rarely encountered patients require early diagnosis and appropriate treatment to prevent long-term morbidity and mortality with ectopic acromegaly.
The Diabetes educator, 2015
The purpose of the study was to investigate the efficacy of a community pharmacist-delivered diab... more The purpose of the study was to investigate the efficacy of a community pharmacist-delivered diabetes support program for patients receiving specialty medical care in a middle-income country (Iran). A randomized controlled trial was conducted on 101 patients who received diabetes care from an endocrinologist. A qualified community pharmacist educated patients about medications, clinical goals, self-care activities, and self-monitoring of blood glucose. The pharmacist trained patients in the intervention group for 5 months (5 follow-up visits and 5 phone calls) and recommended physician visits when necessary. The primary outcome was A1C, and the secondary outcomes included self-care activities, medication adherence, blood pressure, and body mass index. Satisfaction and willingness to pay was assessed in the intervention group. Eighty-five patients completed the study, and baseline A1C was similar between groups (intervention: 7.6 ± 1.6 [59 mmol/mol] vs control: 7.5 ± 1.9 [58 mmol/mol...
Iranian journal of pharmaceutical research : IJPR, 2015
Dopaminergic signaling is one of the regulatory pathways being investigated for its implication i... more Dopaminergic signaling is one of the regulatory pathways being investigated for its implication in glucose metabolism. The aim of this study was to determine the effect of cabergoline on biochemical and anthropometric parameters in prediabetes stage (impaired fasting glucose and impaired glucose tolerance). In this double blind, placebo-controlled, pilot study, 27 prediabetic adults were randomized to receive 0.25-mg cabergoline twice weekly for two weeks, followed by 0.5 mg twice weekly for next 14 weeks (n = 13) or placebo (n = 14). All subjects were advised to follow a 500 kcal-deficit energy diet. Fasting plasma glucose (FPG), oral glucose tolerance, glycated hemoglobin (A1c), fasting, and 2-h insulin were measured at baseline and at 16-week follow-up. Homeostasis model assessment (HOMA) 2 was calculated to estimate steady-state beta-cell function, insulin sensitivity, and insulin resistance. Our results showed significant reductions in fasting (P = 0.004) and 2-h plasma glucose...
Iranian biomedical journal, Jul 1, 2009
Patients with diabetes mellitus type II suffer from hyperglycemia because they are not able to us... more Patients with diabetes mellitus type II suffer from hyperglycemia because they are not able to use the insulin that they produce, often due to inadequate function of insulin receptors. There are some evidences that this deficiency is inherited in a dominant autosomal manner and leads to the malfunction of the pancreatic beta cells resulting in insulin excretion disorders. In this study, we sought to identify mutations in the insulin receptor (INSR) gene, which can cause insulin resistance in type II diabetic patients. DNA was extracted from peripheral blood cells of the patients (n = 128) diagnosed with type II diabetes. All 22 exons of the INSR gene of the patients were analyzed for mutations running PCR, conformation-sensitive gel electrophoresis and DNA sequencing, consecutively. Approximately 26% of the patients had genetic mutations; however, most of them were not reported. These mutations include exon 2 (His171Asn, Ile172Ser, Cys196Ser and Ser210Arg), exon 3 (Gly227Asp and Gly...
Pakistan Journal of Biological Sciences, 2007
The aim of this study was to determine whether iron supplementation in iron-deficient adolescent ... more The aim of this study was to determine whether iron supplementation in iron-deficient adolescent girls would improve thyroid function. A double-blind clinical trial was performed in a region in southern I.R. Iran. A total of 103 iron deficient participants were chosen. In all, 94 participants successfully completed this study. Participants were randomly assigned to one of two groups and treated with a 300 mg ferrous sulfate 5 times/week (n = 47) and placebo 5 times/week (n = 47) for 12 weeks. Blood samples were collected and assayed for hemoglobin, hematocrit, serum ferritin, iron, total iron binding capacity (TIBC), Thyroid stimulating hormone (TSH), total thyroxine (TT4), total triiodothyronine (TT3), free thyroid hormones (FT4 and FT3), triiodothyronine resin uptake (T3RU), reverse triiodothyronine (rT3), selenium and albumin concentrations. Statistical analysis was performed with parametric and non-parametric methods as appropriate. Data analysis revealed a significant increase in TT4, TT3, T3RU and a significant decrease in rT3 concentration in comparison to initial values in iron treated group (12%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; 3.5%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; 16%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 and 47%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001, respectively). At 12 week there were significant differences between control and placebo in TT4, TT3, T3RU and rT3 concentrations (9.9 vs 8.4 microg dL(-1), 145.2 vs 130.4 microg dL(-1), 32.5 vs 28.4% and 23 vs 41 microg dL(-1), respectively, all p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Alterations in FT3 and TSH concentration were not significant, but concentration of FT4 revealed a significant difference between the beginning and the end of the study in iron treated group (10.3 vs 11.4, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Iron supplementation improves some indices of thyroid function in iron-deficient adolescent girls.