Publications by authors named "Alireza Sadeghi"

41 Publications

Evaluation of treatment plan by three-period pulses of high-dose dexamethasone among patients with primary immune thrombocytopenia on platelet count response and adverse events: A randomized Clinical trial.

J Res Med Sci 2020 30;25:88. Epub 2020 Sep 30.

Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Primary immune thrombocytopenia (ITP) decreases platelet count as well as increases the risk of bleeding due to platelet destruction in an autoimmune disorder. For many years, prednisone (PDN) has been the standard first-line treatment in ITP practical guidelines. The current randomized clinical trial compared the efficacy of treatments between three-pulse high-dose dexamethasone (HD-DXM) and the traditional PDN regimen among untreated patients with ITP in accordance with platelet count responses and adverse events.

Materials And Methods: We randomly assigned eligible patients with ITP to receive PDN or a three-pulse regimen of HD-DXM. In the HD-DXM group, 40 mg of DXM was administered intravenously for 4 consecutive days and was repeated in 14-day intervals for three pulses of treatment. Patients in the PDN group received 1.0 mg/kg of PDN orally per day for 4 consecutive weeks. The Mann-Whitney test was used for comparing the median of platelet count between the two groups, and logistic regression was used to evaluate odds ratio (OR) in the response rate of platelet count between the two groups. Blindness was not applied for both patients and physicians.

Results: The initial response rate of platelet count in the HD-DXM group was significantly higher than the PDN group (P < 0.05). According to the results of logistic regression, the initial and sustained response (SR) rate of platelet count in the HD-DXM group was significantly higher than the PDN group (OR: 5.68 and 4.17, respectively, P < 0.05). In fact, in the HD-DXM group, more patients reached SR after the 8-month follow-up (88.9% vs. 66.6%, P < 0.05).

Conclusion: In patients with ITP disease who have not received any kind of treatment, HD-DXM was more effective than conventional PDN therapy.
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http://dx.doi.org/10.4103/jrms.JRMS_257_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698390PMC
September 2020

Fatal Invasive Pulmonary Aspergillosis in COVID-19 Patient with Acute Myeloid Leukemia in Iran.

Mycopathologia 2020 Dec 3;185(6):1077-1084. Epub 2020 Oct 3.

Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Although patients with severe immunodeficiency and hematological malignancies has been considered at highest risk for invasive fungal infection, patients with severe pneumonia due to influenza, and severe acute respiratory syndrome coronavirus (SARS-CoV) are also at a higher risk of developing invasive pulmonary aspergillosis (IPA). Recently, reports of IPA have also emerged among SARS-CoV-2 infected patients admitted to intensive care units (ICUs). Here, we report a fatal case of probable IPA in an acute myeloid leukemia patient co-infected with SARS-CoV-2 and complicated by acute respiratory distress syndrome (ARDS). Probable IPA is supported by multiple pulmonary nodules with ground glass opacities which indicate halo sign and positive serum galactomannan results. Screening studies are needed to evaluate the prevalence of IPA in immunocompromised patients infected with SARS-CoV-2. Consequently, testing for the presence of Aspergillus in lower respiratory secretions and galactomannan in consecutive serum samples of COVID-19 patients with timely and targeted antifungal therapy based on early clinical suspicion of IPA are highly recommended.
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http://dx.doi.org/10.1007/s11046-020-00493-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532731PMC
December 2020

Postbiotic and Anti-aflatoxigenic Capabilities of Lactobacillus kunkeei as the Potential Probiotic LAB Isolated from the Natural Honey.

Probiotics Antimicrob Proteins 2021 Apr;13(2):343-355

Department of Food Science and Technology, Gorgan University of Agricultural Sciences and Natural Resources, Gorgan, Iran.

The use of probiotic, postbiotic, and anti-aflatoxigenic capabilities of the lactic acid bacteria (LAB) isolated from stressful niches is a major strategy to prepare functional cultures and bio-preservatives for food industries. In the present study, abundant LAB strains isolated from natural honey were screened based on their tolerance to continuous pH and bile salt treatments. Then, the pro-functional properties of the selected LAB were investigated. In accordance with the screening data, a bacilli isolate was selected for further characterization. Sequencing results led to the identification of Lactobacillus kunkeei as the selected LAB isolate. In vitro antibacterial and antifungal activities of the LAB and in situ antifungal activity of the isolate cell-free supernatant (CFS) were verified against food-borne indicators. Accordingly, in vitro antibacterial and antifungal effects of Lact. kunkeei ENH01 on respective Escherichia coli and Aspergillus niger were significantly (P < 0.05) higher than the other indicators. Furthermore, in situ inhibitory effect of Lact. kunkeei CFS on Candida albicans (as the highest in situ effect) was equal to 76.36%. The presence of three antibacterial peptides was also verified in the Lact. kunkeei CFS according to the results of liquid chromatography mass spectrometry (LC/MS) assay. Antibiotic susceptibility profile and auto-aggregation ability of the isolate were noticeable. Anti-mycotoxigenic capabilities of Lact. kunkeei ENH01 as viable and heat-killed cells were also revealed against total aflatoxins according to the HPLC-based analysis. In vivo safety of the isolate was also attested through the evaluation of blood biochemistry and hematological parameters in the Lact. kunkeei ENH01 fed-mice compared with the control. Based on the findings, probiotic properties of Lact. kunkeei ENH01 and postbiotic capabilities of the isolate CFS and its heat-killed cells were approved.
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http://dx.doi.org/10.1007/s12602-020-09697-wDOI Listing
April 2021

The association between nutrient patterns and metabolic syndrome among Iranian adults: cross-sectional analysis of Shahedieh cohort study.

Public Health Nutr 2020 Jul 9:1-10. Epub 2020 Jul 9.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Objective: To assess the association between patterns of nutrient intake and metabolic syndrome (MetS) in a large sample of Iranian adults.

Design: Baseline data from the Shahedieh cohort study were used in the current cross-sectional study. Dietary intakes were assessed through the use of a validated semi-quantitative FFQ. Nutrient patterns (NP) were derived using factor analysis. The MetS was defined according to criteria introduced from the National Cholesterol Education Program Adult Treatment Panel III, modified for Iranian adults.

Setting: Yazd, Iran.

Participants: A total of 7325 Iranian adults aged between 30 and 75 years.

Results: Three NP were identified. A significant positive association was found between adherence to semi-plant NP (characterised by the high intakes of P; vitamins B1, B3, B6 and B5; Se; Mg; Fe; protein; Cr; Cu; fibre; biotin; Mn; Zn and Na) and odds of MetS (OR 1·68, 95 % CI 1·43, 1·98). However, after adjusting for potential confounders, this association became non-significant. In addition, after taking potential confounders into account, individuals in the highest quintile of the semi-animal NP, rich in Ca; K; vitamins B2, B12, A, D, K and C; SFA; dietary cholesterol and trans-fatty acid, were 26 % more likely to have MetS compared with those in the lowest quintile (OR 1·26, 95 % CI 1·05, 1·51). No significant association was seen between adherence to the high-carbohydrate/low-fat NP and odds of MetS.

Conclusions: We found that adherence to a semi-animal NP was associated with increased odds of MetS.
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http://dx.doi.org/10.1017/S1368980020001639DOI Listing
July 2020

Efficacy and Safety of Proposed Bevacizumab Biosimilar BE1040V in Patients With Metastatic Colorectal Cancer: A Phase III, Randomized, Double-blind, Noninferiority Clinical Trial.

Clin Ther 2020 05 22;42(5):848-859. Epub 2020 Apr 22.

Department of Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: The purpose of this study was to compare the efficacy and safety of a proposed bevacizumab biosimilar to those of the reference product in patients with metastatic colorectal cancer (mCRC).

Methods: This Phase III, multicenter, randomized, double-blind (patient- and assessor-blind), active-controlled, 2-armed, parallel-group, noninferiority trial was conducted in patients with histologically verified colorectal cancer with evidence of at least 1 metastasis. Patients with mCRC were randomized 2:1 to receive 5 mg/kg IV of either study drug plus FOLFIRI-3 (with repeated irinotecan 100 mg/m 60-min infusion on day 3) or the reference drug plus FOLFIRI-3 every 2 weeks for 1 year. Progression-free survival (PFS) was the primary end point, and overall survival, objective response rate, and time to treatment failure as well as safety and immunogenicity were secondary end points. The population assessable for PFS was per protocol, and the intention-to-treat population was used for sensitivity analysis. Safety was assessed based on reports of adverse events, laboratory test results, and vital sign measurements.

Findings: A total of 126 patients were enrolled; PFS values in the biosimilar and reference arms were 232 days (7.7 months) and 210 days (7 months), respectively (P = 0.47). The hazard ratio of the biosimilar arm versus the reference arm was 0.79 in the per-protocol population (90% CI, 0.46-1.35; P = 0.47). The upper limit for the 2-sided 90% CI was lower than the margin of 1.44, indicating that the biosimilar drug was noninferior to the reference drug. The hazard ratio for overall survival in the intent-to-treat population was 0.99 (95% CI, 0.55-1.80; P = 0.99). The difference between other efficacy end points among the groups was not statistically significant. No significant difference was observed in the comparison of the two arms for safety. The antidrug antibody was positive in 1 patient in each arm.

Implications: The proposed biosimilar BE1040V was noninferior to the reference product in terms of efficacy in the treatment of mCRC, and tolerability was comparable between the 2 drugs. ClinicalTrials.gov identifier: NCT03288987.
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http://dx.doi.org/10.1016/j.clinthera.2020.03.009DOI Listing
May 2020

Metformin Therapy Reduces Obesity Indices in Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Child Obes 2020 04 18;16(3):174-191. Epub 2020 Feb 18.

Students' Scientific Research Center, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Few studies have summarized findings for the effect of metformin on obesity indices. Therefore, we aimed to conduct a systematic review and meta-analysis on the effect of metformin on obesity indices among children and adolescents. Relevant articles published up to September 2018 were searched in SCOPUS, Medline, and Google Scholar using appropriate keywords. All clinical trials that examined the effect of metformin on obesity indices in children and adolescents were included. Overall, 38 studies, including 2199 participants (39.75% male and 60.25% female), were included. The pooled results indicated that metformin significantly reduced BMI [weighted mean difference (WMD): -1.07 kg/m; 95% confidence interval (CI): -1.43 to -0.72]. Same findings were found for waist circumference (WC) (WMD: -1.93 cm; 95% CI: -2.69 to -1.16). Metformin also reduced body weight in all participants (WMD: -2.51 kg; 95% CI: -3.14 to -1.89). Moreover, it reduced body fat mass in patients with overweight or obesity (WMD: -1.90%; 95% CI: -3.25 to -0.56) and chronic diseases (WMD: -1.41%; 95% CI: -2.23 to -0.58), but not among those with growth problems. Metformin therapy did not affect lean body mass (LBM) in patients with overweight or obesity and growth problems; however, it reduced LBM in patients with chronic diseases (WMD: -1.49 kg; 95% CI: -2.69 to -0.30). We found a significant reduction in BMI, body weight, WC, and fat mass following administration with metformin. However, the effect of metformin on LBM was not significant. Further studies are required to confirm these findings.
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http://dx.doi.org/10.1089/chi.2019.0040DOI Listing
April 2020

Influence of Statins on Circulating Inflammatory Cytokines in Patients With Abnormal Glucose Homeostasis: A Meta-analysis of Data From Randomized Controlled Trials.

Clin Ther 2020 02 17;42(2):e13-e31. Epub 2020 Jan 17.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address:

Purpose: Chronic inflammation increases the risks for cardiovascular disease, type 2 diabetes, and cancer. Recently, the antiinflammatory effects of statins, as cholesterol-lowering medications, have been considered. This study systematically reviewed and summarized earlier findings from randomized clinical trials about the effects of statins on serum concentrations of C-reactive protein (CRP) and interleukin (IL)-6 in patients with abnormal glucose homeostasis.

Methods: Relevant articles published through October 2019 were searched using suitable key words on the PubMed/MEDLINE, SCOPUS, EMBASE, and Google Scholar databases. RCTs were included if they compared the effects of statins on serum concentrations of CRP and IL-6 in adults with abnormal glucose homeostasis. The effect sizes were represented as weighted mean differences (WMDs) and 95% CI s using a random-effects model. Subgroup analysis was performed to find possible sources of heterogeneity.

Findings: Overall, 17 publications with 21 effect sizes and which enrolled 3766 subjects (1895 participants in intervention and 1871 in control groups) were included. Combining 13 effect sizes from 10 studies, a significant reduction in serum CRP concentration following the administration of atorvastatin was found (WMD, -0.35; 95% CI, -0.54 to -0.17; I = 90.6%). Based on 5 effect sizes from 4 studies, we found a statistically significant reduction in serum IL-6 concentration after atorvastatin therapy (WMD, -0.44; 95% CI, -0.65 to -0.22; I = 93.9%). Pooling 6 effect sizes from 5 studies revealed a significantly reduced serum concentration of CRP after simvastatin therapy (WMD, -0.66; 95% CI, -0.79 to -0.54; I = 97.6%).

Implications: The administration of atorvastatin or simvastatin in patients with abnormal glucose hemostasis was associated with a reduced serum CRP concentration. Atorvastatin therapy might also help to decrease serum IL-6 concentration in these patients.
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http://dx.doi.org/10.1016/j.clinthera.2019.12.009DOI Listing
February 2020

Adherence to the dietary approaches to stop hypertension-style diet is inversely associated with chronic kidney disease: a systematic review and meta-analysis of prospective cohort studies.

Nutr Res 2019 12 24;72:46-56. Epub 2019 Oct 24.

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia. Electronic address:

No conclusive information is available about the association between the Dietary Approaches to Stop Hypertension (DASH)-style diet and chronic kidney disease (CKD). Hence, we aimed to summarize the findings of prospective cohort studies on the relationship between adherence to the DASH-style diet and risk of CKD. A systematic search was done using relevant keywords in the online databases for relevant publications up through July 2018. In total, we included 6 studies in the current systematic review and meta-analysis, with a total sample size of 568 156 individuals and 9249 cases of CKD. Combining 6 effect sizes from 6 studies revealed a significant inverse association between adherence to the DASH diet and risk of CKD (Combined effect size: 0.72, 95% CI: 0.61-0.85, P < .001). In addition, adherence to a DASH-style diet was inversely associated with a risk of rapid decline in estimated glomerular filtration rate (eGFR) (Combined effect size: 0.74, 95% CI: 0.54-0.99, P = .04) and microalbuminuria (Combined effect size: 0.61, 95% CI: 0.43-0.88, P = .009), but not with low eGFR. Adherence to the DASH-style diet, as a healthy dietary pattern, might be beneficial for the prevention of CKD.
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http://dx.doi.org/10.1016/j.nutres.2019.10.007DOI Listing
December 2019

Response surface methodology for investigating the effects of sourdough fermentation conditions on Iranian cup bread properties.

Heliyon 2019 Oct 10;5(10):e02608. Epub 2019 Oct 10.

Department of Food Science and Technology, Gorgan University of Agricultural Sciences and Natural Resources, Gorgan, Iran.

In this study, the dominant lactic acid bacteria present in whole wheat sourdough was isolated and identified as by molecular methods, before being utilized as the starter culture in the processing of sourdough cup breads. Subsequently, the effects of sourdough fermentation time, ash content, and sugar content on bread quality attributes were investigated by response surface methodology. In terms of the independent variables, the best polynomial models were fitted for bread hardness, chewiness, specific volume, total color difference (TCD), porosity and overall acceptability (OAA). Based on statistical analysis (P < 0.05), the effect of fermentation time on hardness and TCD was significant; ash content influenced specific volume and TCD significantly. In comparison with other functions, the interaction between fermentation time and sugar content had a significant (P < 0.05) influence on bread OAA. Furthermore, a strong positive correlation was ascertained between sourdough total titratable acidity and most of the quality attributes of cup bread (especially hardness, specific volume and OAA). Accordingly, the control of sourdough fermentation conditions is influential on microbial activity and metabolites, which affect bread quality characteristics.
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http://dx.doi.org/10.1016/j.heliyon.2019.e02608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812221PMC
October 2019

Carbohydrate quantity and quality affect the risk of endometrial cancer: A systematic review and dose-response meta-analysis.

Clin Nutr 2020 Jun 19;39(6):1681-1691. Epub 2019 Aug 19.

Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Data on the association of dietary intake of total carbohydrates as well as dietary glycemic index (GI) and glycemic load (GL) with risk of endometrial cancer are contradictory. Therefore, we conducted a systematic review and dose-response meta-analysis of observational studies to summarize available findings in this field.

Methods: The online databases were searched for relevant publications to May 2018 using relevant keywords.

Results: Overall, eight prospective cohort and five case-control studies with a total sample size of 734,765 individuals, aged ≥18 years, and 8466 cases of endometrial cancer were included. Although the overall association between dietary intake of total carbohydrates and risk of endometrial cancer was non-significant, we found a significant positive association in some subgroups of cohort studies including those with ≥10 years' duration of follow-up (combined effect size: 1.29, 95% CI: 1.09-1.53, P = 0.003) and studies with sample size of ≥50,000 participants (combined effect size: 1.24, 95% CI: 1.08-1.43, P = 0.002). In addition, a non-linear dose-response relationship was found in this regard after considering the estimates from cohort studies (P = 0.002). Combining effect sizes from case-control studies showed a significant positive association between dietary GI and risk of endometrial cancer; such that a-10 unit increase in GI was associated with a 4% greater risk of endometrial cancer (combined effect size: 1.04, 95% CI: 1.02-1.05, P < 0.001). There was also a significant positive association between dietary GL and risk of endometrial cancer in some subgroups of cohort studies and also in non-linear dose-response analysis.

Conclusions: Although the overall associations of dietary total carbohydrate intake, GI, and GL with risk of endometrial cancer were not significant, there were significant positive associations in some subgroups of the included studies, particularly those with high quality. There was also a dose-response association between dietary total carbohydrate intake, GI and GL, and risk of endometrial cancer.
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http://dx.doi.org/10.1016/j.clnu.2019.08.001DOI Listing
June 2020

A Rare Presentation of Multiple Myeloma: A Case Report of Hepatic Amyloidosis.

Iran J Med Sci 2019 Jul;44(4):342-346

Department of Clinical Pharmacy, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran.

The clinically reported case of liver involvement with multiple myeloma (MM) is rare. Amyloidosis, defined as a tissue deposition of clonal light-chain fibrils, has been reported in 10-15% of the MM patients. We described a rare MM patient with the primal presentation of fulminant hepatic failure and biliary system involvement due to amyloidosis. Our patient had the primal symptoms of hyperbilirubinemia, ascites, hepatosplenomegaly, and anemia. Chemotherapy with a standard regimen containing bortezomib, thalidomide, and dexamethasone was implemented and led to a dramatic response. Liver involvement due to light chain amyloidosis can be the first drastic presentation of MM. It is important to consider infiltrative disorders, like MM and amyloidosis, when patients present non-specific symptoms and impaired liver function tests. Proper and timely diagnosis can directly affect the prognosis of patients. The optimal approach in the standard management of similar cases is still a matter of debate.
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http://dx.doi.org/10.30476/IJMS.2019.44953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661521PMC
July 2019

The Effect of Zinc Supplementation on Serum Leptin Levels: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Horm Metab Res 2019 Aug 13;51(8):503-510. Epub 2019 Aug 13.

Department of Community Nutrition, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Recently, obesity has become a common worldwide concern. Leptin, as an adipocytokine, plays a major role in the etiology of obesity. Prior studies have demonstrated that zinc potentially affects serum leptin levels. However, clinical trials carried out in this regard are not consistent. Therefore, current meta-analysis was conducted to ascertain the actual effect of zinc supplementation on serum leptin levels in adults. Databases of PubMed, SCOPUS, and Google Scholar were methodically searched to identify relevant articles up to April 2018. Clinical trials that examined the effect of zinc supplementation on serum leptin concentrations as outcome variables in human adults were included. The mean difference (SD) of leptin changes in the intervention and placebo groups were used to calculate the overall effect size. Totally, 663 articles were identified, of which 6 studies were eligible randomized controlled trials (RCTs) with 7 treatment arms. The analysis suggested that zinc supplementation exerts no significant effect on overall serum leptin (WMD: 0.74 ng/ml; 95% CI: -1.39 to 2.87, p=0.49). Nevertheless, sex and duration of intervention seemed to impact the extent of zinc's influence. In trials with female subjects, zinc consumption led to a significant decrease in serum leptin level (WMD: -1.93 ng/ml; 95% CI: -3.72 to -0.14, p=0.03) as well as trials that lasted for more than 6 weeks (WMD: -1.71 ng/ml; 95% CI: -3.07 to -0.35, p=0.01), in comparison to the control group. Zinc supplementation did not significantly improve leptin concentrations, but it may result in a decreased circulating leptin level in studies with a duration of more than 6 weeks especially among females.
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http://dx.doi.org/10.1055/a-0955-6662DOI Listing
August 2019

Multiple Myeloma with Intracytoplasmic Azurophilic Granules.

Int J Hematol Oncol Stem Cell Res 2019 Apr;13(2):58-60

Department of Medical Oncology and Hematology, Isfahan University of Medical Sciences, Isfahan, Iran.

Bone marrow examination plays an important role in the diagnosis of multiple myeloma. In some cases with multiple myeloma, marrow plasma cells with cytoplasmic inclusions are seen. In this study, a 46-year- old man was evaluated for multiple myeloma. In bone marrow aspiration, large intracytoplasmic azurophilic granules, resembling intracellular microorganisms were seen. IHC study demonstrated that these cells are CD138 positive. This is a rare histologic finding that usually results from the deposition of excess immunoglobulin.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660474PMC
April 2019

Corrigendum to "Dietary acid load and risk of hypertension: A systematic review and dose-response meta-analysis of observational studies" [Nutr Metabol Cardiovasc Dis 29 (7) (July 2019) 665-675].

Nutr Metab Cardiovasc Dis 2019 Sep 25;29(9):999. Epub 2019 Jul 25.

Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.numecd.2019.06.013DOI Listing
September 2019

Dietary Glycemic Index and Glycemic Load and the Risk of Prostate Cancer: An Updated Systematic Review and Dose-Response Meta-Analysis.

Nutr Cancer 2020 11;72(1):5-14. Epub 2019 Jun 11.

Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

A meta-analysis in 2015 revealed no significant association between glycemic index (GI), glycemic load (GL), and prostate cancer. Moreover, until now, no study has examined the dose-response association of GI, GL, and prostate cancer yet. The online databases were searched by two independent researchers for relevant publications up to Jan. 2019, using relevant keywords. Nine studies including five prospective and four case-control studies were included in the current systematic review and meta-analysis. These studies have included 290,911 individuals. We found a significant positive dose-response association between dietary GI and prostate cancer ( = 0.03). Comparing individuals in the highest category of GI with those in the lowest category, no significant association was found between GI and prostate cancer (combined effect size: 1.08, 95% CI: 0.97-1.19,  0.17). Furthermore, no significant association was seen between dietary GL and prostate cancer in both dose-response analysis and when comparing the highest versus lowest categories of GL (combined effect size: 1.03, 95% CI: 0.91-1.16,  0.65). In conclusion, we found a significant positive dose-response association between dietary GI and prostate cancer. However, significant association was not seen for dietary GL.
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http://dx.doi.org/10.1080/01635581.2019.1621356DOI Listing
September 2020

Dietary acid load and risk of hypertension: A systematic review and dose-response meta-analysis of observational studies.

Nutr Metab Cardiovasc Dis 2019 07 23;29(7):665-675. Epub 2019 Mar 23.

Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background And Aim: Previous studies have assessed diet-induced mild metabolic acidosis in relation to blood pressure, however, data are conflicting. Current systematic review and dose-response meta-analysis aimed to summarize earlier findings from observational studies on the association between dietary acid load and hypertension.

Methods And Results: We searched the online databases for relevant publications up to Feb 2019, using relevant keywords. Overall, 14 studies (3 prospective and 11 cross-sectional studies) that included 306,183 individuals and 62,264 cases of hypertension were included in the current meta-analysis. Combining effect sizes from both prospective and cross-sectional studies revealed no significant non-linear association between dietary acid load (based on net endogenous acid production (NEAP) method) and hypertension. However, stratified analysis based on study design showed a significant non-linear association between dietary acid load and hypertension in prospective studies (P = 0.006), but not cross-sectional ones. According to linear dose-response analysis, no significant association was found between dietary acid load (based on NEAP) and hypertension (combined effect size: 1.01, 95% CI: 0.97-1.06, P = 0.51). In terms of dietary acid load based on potential renal acid load (PRAL) method, no significant non-linear association was seen with hypertension (P = 0.52). However, in linear dose-response analysis, a-20 unit increase in PRAL values was associated with 3% increased risk of hypertension (combined effect size: 1.03, 95% CI: 1.00-1.06, P = 0.03).

Conclusion: We found a significant positive association between dietary acid load and hypertension. Further studies, particularly those with prospective nature, are needed to confirm our findings.
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http://dx.doi.org/10.1016/j.numecd.2019.03.009DOI Listing
July 2019

Dietary total antioxidant capacity and risk of cancer: a systematic review and meta-analysis on observational studies.

Crit Rev Oncol Hematol 2019 Jun 4;138:70-86. Epub 2019 Apr 4.

Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Recent studies have shown that dietary total antioxidant capacity (D-TAC) may affect risk of cancer; however, findings are conflicting. Hence, we aimed to summarize the current evidence on the association between D-TAC and risk of cancer.

Methods: We searched the online databases of PubMed, ISI Web of Science, Scopus, ProQuest, Science Direct and Embase until October 2018 using relevant keywords. To pool data, fixed- or random-effects models were used where appropriate.

Results: In total, 19 studies including 8 prospective and 11 case-control studies with 721429 individuals and 16159 cases of cancer were included in the current systematic review and meta-analysis. Combining 15 effect sizes from 6 prospective and 8 case-control studies revealed a significant inverse association between D-TAC (obtained from ferric reducing antioxidant power (FRAP)) and risk of cancer (combined effect size: 0.86, 95% CI: 0.81-0.92, P < 0.001). Such inverse association was also seen for D-TAC obtained from other methods including trolox equivalence antioxidant capacity (TEAC) (combined effect size: 0.80, 95% CI: 0.70-0.90, P < 0.001), total radical trapping antioxidant parameter (TRAP) (combined effect size: 0.69, 95% CI: 0.62-0.78, P < 0.001) and oxygen radical absorbance capacity (ORAC) (combined effect size: 0.72, 95% CI: 0.52-1.00, P = 0.04). In addition, a significant non-linear association was found between D-TAC (based on FRAP and TRAP) and cancer risk (P-nonlinearity<0.001). Based on linear dose-response meta-analysis, a-10 mmol/day increase in FRAP and a-5 mmol/day increase in TRAP and TEAC were associated with 9%, 17% and 14% reduction in risk of cancer, respectively. Furthermore, D-TAC was inversely associated with risk of colorectal (combined effect size: 0.82, 95% CI: 0.75-0.89, P < 0.001), gastric (combined effect size: 0.63, 95% CI: 0.53-0.73, P < 0.001), and endometrial cancer (combined effect size: 0.78, 95% CI: 0.69-0.89, P < 0.001).

Conclusions: Diet with high antioxidant capacity might have protective effects against cancer.
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http://dx.doi.org/10.1016/j.critrevonc.2019.04.003DOI Listing
June 2019

Dietary Fat Intake and Risk of Ovarian Cancer: A Systematic Review and Dose-Response Meta-Analysis of Observational Studies.

Nutr Cancer 2019 6;71(6):939-953. Epub 2019 May 6.

d Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics , Tehran University of Medical Sciences (TUMS) , Tehran , Iran.

Observational studies have reported controversial evidence of the association between dietary fat intake and ovarian cancer. This dose-response meta-analysis aimed to clarify quantitatively the association between dietary fat intake and ovarian cancer. The linear and non-linear relationships between fat intake and risk of ovarian cancer were investigated. Heterogeneity, sensitivity analysis, and publication bias were also assessed. Overall, 21 studies involved approximately 900,000 subjects were included. A significant nonlinear association was found between total fat intake with the risk of ovarian cancer, with a relatively steep slope at total fat intake higher than 30 g/day ( non-linearity <.01). Moreover, the risk of ovarian cancer was increased in non-linear form for both saturated and monounsaturated fat from 25 g/day ( non-linearity <.05). According to the findings from the linear meta-analysis, we observed a 2, 2, 1, and 1% greater risk of ovarian cancer per 10, 0.5, 2.5 g/day and 50 mg/day increase in total, trans and monounsaturated fat intake as well as cholesterol, respectively. However, this association for monounsaturated fat was marginally significant (=.052). The findings of this meta-analysis suggest that dietary total, trans, saturated and partially monounsaturated fat as well as cholesterol intake are positively associated with increased risk of ovarian cancer.
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http://dx.doi.org/10.1080/01635581.2019.1595049DOI Listing
June 2020

Effects of Coffee, Black Tea and Green Tea Consumption on the Risk of Non-Hodgkin's Lymphoma: A Systematic Review and Dose-Response Meta-Analysis of Observational Studies.

Nutr Cancer 2019 2;71(6):887-897. Epub 2019 May 2.

a Students' Scientific Research Center, Tehran University of Medical Sciences (TUMS) , Tehran , Iran.

Several studies have evaluated the association between coffee, black and green tea consumption and non-Hodgkin's lymphoma (NHL) risk, while the results were inconsistent. We conducted a dose-response meta-analysis of available observational studies to assess the association among coffee, black and green tea intake and the risk of NHL in the general population. Studies published up to August 2018 were identified on the basis of a literature search in PubMed, ISI Web of Science, Scopus and Cochrane databases using Mesh and non-Mesh relevant keywords. Relative risks (RRs) with 95% confidence intervals (CIs) and the dose-response relationships were calculated using random-effects models. In the meta-analysis of 19 effect sizes (315,972 participants with 4,914 cases of NHL), we found that higher green tea intake was associated with a 39% reduced risk of NHL (pooled RR = 0.61; 95% CIs = 0.38-0.99, =60.4%, =0.080) in high- versus low-intake meta-analysis. No association was observed between coffee intake (pooled RR = 1.21; 95% CIs = 0.97-1.50, =52.6%,   <  0.05), black tea intake (pooled RR = 1.01; 95% CI = 0.82-1.24, =0%, =0.875) and risk of NHL in high- versus low-intake meta-analysis. Findings from this dose-response meta-analysis suggest that green tea intake may be associated with reduced risk of NHL.
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http://dx.doi.org/10.1080/01635581.2019.1595055DOI Listing
June 2020

WITHDRAWN: Treatment with 3 cycle pulses of high‐dose dexamethasone (HD -DXM) in adults with Primary Immune thrombocytopenia : a prospective randomized clinical trial

Turk J Haematol 2019 03 12. Epub 2019 Mar 12.

Corresponding author, Internal Medicine Department , Isfahan University of Medical Sciences, Isfahan, Iran

Ahead of Print article withdrawn by publisher.
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http://dx.doi.org/10.4274/tjh.galenos.2019.2018.0346DOI Listing
March 2019

The effect of probiotics on inflammatory biomarkers: a meta-analysis of randomized clinical trials.

Eur J Nutr 2020 Mar 11;59(2):633-649. Epub 2019 Mar 11.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155-6117, Tehran, Iran.

Purpose: No study has summarized earlier findings on the effect of probiotic supplementation on inflammatory biomarkers. This systematic review and meta-analysis was conducted to systematically review the available placebo-controlled clinical trials about the effect of probiotic supplementation on several inflammatory biomarkers in adults.

Methods: Relevant papers published up to March 2018 were searched up through PubMed, MEDLINE, SCOPUS, EMBASE, and Google Scholar, using following suitable keywords. Clinical trials that examined the effect of probiotic supplementation on inflammation in adults were included.

Results: Overall, 42 randomized clinical trials (1138 participants in intervention and 1120 participants in control groups) were included. Combining findings from included studies, we found a significant reduction in serum hs-CRP [standardized mean difference (SMD) - 0.46; 95% CI - 0.73, - 0.19], TNF-a (- 0.21; - 0.34, - 0.08), IL-6 (- 0.37; - 0.51, - 0.24), IL-12 (- 0.47; - 0.67, - 0.27), and IL-4 concentrations (- 0.48; - 0.76, - 0.20) after probiotic supplementation. Pooling effect sizes from 11 studies with 12 effect sizes, a significant increase in IL-10 concentrations was seen (0.21; 0.04, 0.38). We failed to find a significant effect of probiotic supplementation on serum IL-1B (- 0.17; - 0.37, 0.02), IL-8 (- 0.01; - 0.30, 0.28), and IFN-g (- 0.08; - 0.31, 0.15) and IL-17 concentrations (0.06; - 0.34, 0.46).

Conclusions: Probiotic supplementation significantly reduced serum concentrations of pro-inflammatory cytokines including, hs-CRP, TNF-a, IL-6, IL-12, and IL-4, but it did not influence IL-1B, IL-8, IFN-g, and IL-17 concentrations. A significant increase in serum concentrations of IL-10, as a anti-inflammatory cytokine was also documented after probiotic supplementation.
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http://dx.doi.org/10.1007/s00394-019-01931-8DOI Listing
March 2020

Aetiology of livestock fetal mortality in Mazandaran province, Iran.

PeerJ 2019 18;6:e5920. Epub 2019 Jan 18.

Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.

In the farming industry, the productivity of livestock herds depends on the fertility efficiency of animals. The accurate diagnosis of a broad range of aetiological agents causing fetal death is often difficult. Our aim was to assess the prevalence rates of , , and spp. infections in ruminant abortion using bacteriological culture and molecular techniques in Mazandaran Province, northern Iran. Samples were collected from 70 aborted sheep, goat, and cattle fetuses between September 2014 and December 2015. Necropsy was performed on all the received samples, and brain tissue and abomasal content were obtained from the aborted fetuses. Protozoan infections were detected by specific polymerase chain reaction (PCR) and bacterial agents using bacteriological examinations and PCR assay. Infectious pathogens were detected in 22 out of 70 (31.4%) examined fetuses. Moreover, , , and were verified in 13 (18.6%), four (5.7%), and two (2.85%) samples, respectively. Our results showed that infection with the mentioned pathogenic agents may lead to fetal mortality, which can be a major cause of economic loss. The listed pathogens could be considered important etiological agents of fetal loss in Mazandaran Province, for which appropriate control measures such as vaccination and biosecurity can be implemented to prevent infection and reduce reproductive loss in livestock farms.
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http://dx.doi.org/10.7717/peerj.5920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340351PMC
January 2019

Potential Drug-drug Interactions at a Referral Pediatric Oncology Ward in Iran: A Cross-sectional Study.

J Pediatr Hematol Oncol 2019 04;41(3):e146-e151

Clinical Pharmacy, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran.

Incidence of drug-drug interactions (DDIs) has been widely reported; however, such reports in pediatric oncology patients still remain scarce. We studied frequency and demographic correlates of moderate and major DDIs at a pediatric oncology ward in Isfahan, Iran. All pediatric oncology patients admitted to the Omid hospital during a 6-month period (2017) who received at least 2 anticancer or non-anticancer drugs concomitantly were included in our study. Potential DDIs between anticancer and non-anticancer drugs during hospitalization was identified using Lexi-Interact on-line software. We detected 194 DDIs with moderate or major severity for our included 115 patients. Mechanistically, most of DDIs (56.4%) were pharmacodynamic. Systematic use of corticosteroids (82.0%), antimetabolites (77.0%), and antiemetic drugs (69.5%) were the most frequent medication classes responsible for detected DDIs. The interaction between aminoglycosides and the third generation cephalosporins was the most common (13.9%) non-anticancer DDI. The only identified interaction between 2 anticancer drugs was doxorubicin with cyclophosphamide. Age, sex, and the number of administered medications were associated with DDIs. Potential moderate or major DDIs occur frequently among pediatric cancer patients. More studies are needed to assess clinical and economic implications of DDIs in pediatric oncology patients.
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http://dx.doi.org/10.1097/MPH.0000000000001346DOI Listing
April 2019

A z-gradient array for simultaneous multi-slice excitation with a single-band RF pulse.

Magn Reson Med 2018 07 4;80(1):400-412. Epub 2017 Dec 4.

National Magnetic Resonance Research Center (UMRAM), Bilkent University, Bilkent, Ankara, Turkey.

Purpose: Multi-slice radiofrequency (RF) pulses have higher specific absorption rates, more peak RF power, and longer pulse durations than single-slice RF pulses. Gradient field design techniques using a z-gradient array are investigated for exciting multiple slices with a single-band RF pulse.

Theory And Methods: Two different field design methods are formulated to solve for the required current values of the gradient array elements for the given slice locations. The method requirements are specified, optimization problems are formulated for the minimum current norm and an analytical solution is provided. A 9-channel z-gradient coil array driven by independent, custom-designed gradient amplifiers is used to validate the theory.

Results: Performance measures such as normalized slice thickness error, gradient strength per unit norm current, power dissipation, and maximum amplitude of the magnetic field are provided for various slice locations and numbers of slices. Two and 3 slices are excited by a single-band RF pulse in simulations and phantom experiments.

Conclusion: The possibility of multi-slice excitation with a single-band RF pulse using a z-gradient array is validated in simulations and phantom experiments. Magn Reson Med 80:400-412, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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http://dx.doi.org/10.1002/mrm.27031DOI Listing
July 2018

Effect of weight losing on the clinical status improvement of patients with knee osteoarthritis.

Reumatol Clin 2019 Mar - Apr;15(2):73-76. Epub 2017 Nov 2.

Zanjan University of Medical Science, Medical School, Zanjan, Iran.

Objective: Osteoarthritis causes severe pain and disability in joints, one of the most prevalent involved joints is the knee joint. There are several therapeutics ways to control pain and disability, but almost none of them are definite treatment. In this article, we tried to reveal the effect of weight loss on improving symptoms of knee osteoarthritis as an effective and permanent therapeutic approach.

Methods: We chose 62 patients with grade 1-2 (mild to moderate) knee osteoarthritis and divided them equally into case and control groups. Patients should not had used NSAIDs at least for 6 months before study initiation. Symptoms severity was measured by WOMAC and VAS questionnaires before and after 3 months follow up. Weight and BMI were recorded too. Case group was suggested to have weight loss diet of less fat and carbohydrates and control group did not have any limitation.

Results: Comparison of variables' average of case and control groups was not logistically meaningful at the initiation and after the end of the study. But there was a meaningful correlation between variables' changes and lifestyle change in both groups, especially in WOMAC and VAS scores. All variables in case group had statistically meaningful differences between their amounts at the beginning and after the end of the study, on the contrary of the control group.

Conclusion: In the comparison of our study with similar studies in the world. We deduced that weight loss can improve symptoms of knee osteoarthritis even in short time weight loss diet (3 months).

Trial Registration Number: ZUMS.REC.1394.94.
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http://dx.doi.org/10.1016/j.reuma.2017.06.016DOI Listing
July 2019

Evaluation of serum levels of C3 and C4 complement factors in patients with beta thalassemia major in Khuzestan Province, Southwest Iran.

J Immunoassay Immunochem 2017 27;38(6):629-638. Epub 2017 Nov 27.

d Department of Pharmacology & Toxicology, Faculty of Medicine, Baqiyatallah University of Medical Sciences , Tehran , Iran.

Background And Objectives: Thalassemia syndrome is the most common genetic disorder in the world and infection is the second cause of death in these patients. Measurement of serum C3 and C4 complement factors in serum was done in 60 patients with beta thalassemia major in comparison with 30 healthy subjects as control group.

Materials And Methods: The serum level of C3 and C4 complement factors in 60 patients with beta thalassemia major who were randomly selected from among the patients referred to Shafa Hospital of Ahvaz was evaluated and compared with 30 samples from healthy individuals with no history of recent infectious or autoimmune diseases. It should be noted that single-radial-immunodiffusion assay was used in this study.

Results: This study has shown a significant reduction in serum levels of C3 and C4 in patients compared to controls (P value < 0.05).

Discussion: Decreased synthesis or increased consumption of complement factors in patients receiving multiple blood transfusions might lead to continuous contact between the immune system and various antigens, causing nonstop use of complement factors, recurrent infections, changes in parameters of the immune system due to iron overload as well as exposure to infectious factors such as HBV, HCV, HIV, and HTLV through blood transfusion.
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http://dx.doi.org/10.1080/15321819.2017.1384388DOI Listing
February 2018

Serum Profiles of Cytokines in Behcet's Disease.

J Clin Med 2017 May 2;6(5). Epub 2017 May 2.

Zanjan Applied Pharmacology Research Center, Zanjan University of Medical Sciences, Zanjan 4513956184, Iran.

Behcet's disease (BD) is a chronic systemic autoinflammatory vasculitis which is handled by the variety of proteins like cytokines. Therefore, cytokines are considered as one of the prototypic factors during inflammatory responses of BD. Consequently, the present study was designed for evaluation of cytokine profiles in Iranian BD cases, including those with and without uveitis. All cases were divided into three groups based on ophthalmologic exam results: BD with uveitis, BD without uveitis, and recovered uveitis BD. Cases with a history of BD recovery were placed in the group of recovered uveitis. The patients with infectious uveitis as well as other collagen vascular diseases and patients who have used biologics to treat ocular immune-mediated diseases were excluded. Finally, after venous blood sampling, levels of cytokines were quantified and statistical approaches were performed for measurements. Enrolled cases were divided to 26 patients with active uveitis, 25 patients with recovered uveitis and 24 patients without uveitis and interestingly, just IL-2 was the only cytokine that showed statistical difference in patients with BD uveitis in comparison with other groups ( = 0.02). The pair wise comparison showed a significant difference between the patients with and without uveitis groups ( = 0.004) as well as patients with uveitis and recovered uveitis groups ( = 0.002). Significant elevation of IL-2 in patients with uveitis (in comparison with recovered or without uveitis cases) demonstrates that it may be one of the main proteins that enroll in the pathophysiology of BD uveitis and may be considered as a new target for refractory disease therapies. Studies with larger samples can help to obtain more accurate conclusions.
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http://dx.doi.org/10.3390/jcm6050049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447940PMC
May 2017

Elevated Levels of T-helper 17-associated Cytokines in Diabetes Type I Patients: Indicators for Following the Course of Disease.

Immunol Invest 2016 Oct 9;45(7):641-51. Epub 2016 Sep 9.

d Department of Student Research Committee, School of Medicine , Jahrom University of Medical Sciences , Jahrom , Iran.

Background: Type 1 diabetes (T1D) is thought to involve chronic inflammation, which is manifested by the activation and expression of different inflammatory mediators. Th1- and Th17-associated cytokines are factors that have been shown to exert profound pro-inflammatory activities and have been implicated in the pathogenesis of T1D in mice and humans.

Objectives: Therefore, the aim of this case control study was to determine the serum level of IL-17, IL-21, IL-27, transforming growth factor beta (TGF-β), and IFN-γ and their reciprocal relationship in Iranian T1D patients.

Patients And Methods: Blood samples were collected from 48 T1D patients and 49 healthy individuals with no history of malignancies or autoimmune disorders based on simple sampling. The serum levels of IL-17, IL-21, IL-27, TGF-β, and IFN-γ were measured by the enzyme linked immunosorbent assay (ELISA).

Results: The serum levels of IL-17 and IL-21 were significantly higher in T1D patients compared to the healthy individuals (p = 0.005 and 0.01, respectively), but interestingly, the opposite was the case for IL-27 (p < 0.0001). However, there were no significant differences in TGF-β and IFN-γ between both groups. In addition, IL-17/IFN-γ and IL-17/IL-27 ratios were higher in patients compared to the control group.

Conclusions: Our results indicated dominant Th17-associated IL-17, suggesting a shift from the Treg and Th1 phenotypes toward the Th17 phenotype. Therefore, it can promote inflammation in β cells in T1D. In addition, it suggests the role of Th17 and Th17/Th1 ratios as a potential contributor to β cells destruction and the Th17/Th1 response ratio may provide a novel biomarker for rapid T1D diagnosis before the destruction of β cells and progression of the disease to the clinical end stages.
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http://dx.doi.org/10.1080/08820139.2016.1197243DOI Listing
October 2016

Bioimpacts of dialyzer variety on phosphorus level in Iranian hemodialysis patients.

J Renal Inj Prev 2016 30;5(2):94-7. Epub 2016 May 30.

Zanjan Applied Pharmacology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran ; Department of Pharmacotherapy, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran.

Introduction: Cardiovascular events are the major cause of death in patients with chronic renal failure. About half of dialysis patients because of reduced phosphorus clearance have hyperphosphatemia. Hyperphosphatemia and following secondary hyperparathyroidism lead to some cardiovascular changes. Hemodialysis (HD) partly removes phosphorus during each dialysis session.

Objectives: Presented study was designed to evaluate dialyzer variation effect on phosphorus level as a prognostic factor after dialysis using.

Materials And Methods: Six kinds of dialyzer were used for dialysis; low flux (LF) dialyzer (F7 and F8), high flux (HF) dialyzer (F70 and F80) and finally hollow-fiber dialyzers including polyethersulfone (PES) 130 HF and polysulfone (PS) 13 LF. Fifty-seven patients were divided into 6 matched groups included three groups of 10 people and 3 groups of 9 persons in groups: A (F70), B (F80), C (F7), D (F8), E (PES 130 HF) and F (PS 13 LF). Patients were treated for one month with these dialyzers. At the end of the month, blood samples were taken again for phosphorus level before dialysis handling.

Results: The mean pre-dialysis serum phosphorus was 5.03, 5.4, 5.2, 4.6, 4.95 and 5.1 mg/dl and the mean phosphorus was 5.43, 5.01, 4.9, 4.18, 4.17 and 5.3 mg/dl after one month of dialysis, respectively in groups A to F without any statistically differences between pre- and after one month dialysis values respectively.

Discussion: The findings indicate dialyzer type in the control of serum phosphorus has not been effective in the short-term HD. We suggest a study with more duration time.
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http://dx.doi.org/10.15171/jrip.2016.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962677PMC
July 2016

Using the Retrograde Internal Mammary System for Stacked Perforator Flap Breast Reconstruction: 71 Breast Reconstructions in 53 Consecutive Patients.

Plast Reconstr Surg 2016 Feb;137(2):265e-277e

New Orleans, La.; and New York, N.Y. From the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center; and the Institute of Reconstructive Plastic Surgery, New York University School of Medicine.

Background: Abdominal tissue is the preferred donor source for autologous breast reconstruction, but in select patients with inadequate tissue, additional volume must be recruited to achieve optimal outcomes. Stacked flaps are an effective approach in these cases, but can be limited by the need for adequate recipient vessels. This article reports outcomes for the use of the retrograde internal mammary system for stacked flap breast reconstruction in a large number of consecutive patients.

Methods: Fifty-three patients underwent stacked autologous tissue breast reconstruction with a total of 142 free flaps. Thirty patients underwent unilateral stacked deep inferior epigastric perforator (DIEP) flap reconstruction, five had unilateral stacked profunda artery perforator flap reconstruction, one had bilateral stacked DIEP/superior gluteal artery perforator flap reconstruction, and 17 underwent bilateral stacked DIEP/profunda artery perforator flap reconstruction. In all cases, the antegrade and retrograde internal mammary vessels were used for anastomoses. In situ manometry studies were also conducted comparing the retrograde internal mammary arteries in 10 patients to the corresponding systemic pressures.

Results: There were three total flap losses (97.9 percent flap survival rate), two partial flap losses, four reexplorations for venous congestion, and three patients with operable fat necrosis. The mean weight of the stacked flaps for each reconstructed breast was 622.8 g. The retrograde internal mammary mean arterial pressures were on average 76.6 percent of the systemic mean arterial pressures.

Conclusions: The results demonstrate that the retrograde internal mammary system is capable of independently supporting free tissue transfer. These vessels provide for convenient dissection and improved efficiency of these cases, with successful postsurgical outcomes.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/01.prs.0000475743.08559.b6DOI Listing
February 2016