Publications by authors named "Behnam Heidari"

33 Publications

Acute Promyelocytic Leukemia Presenting as Bilateral Acute Limb Ischemia and ST Elevation Myocardial Infarction: A Case Report.

Cureus 2020 Jun 7;12(6):e8495. Epub 2020 Jun 7.

Internal Medicine, Houston Methodist Hospital, Houston, USA.

Acute myelogenous leukemia (AML) is one of the most common hematologic malignancies. Among them, acute promyelocytic leukemia (APL) is well known for its coagulopathies. Bleeding secondary to disseminated intravascular coagulation, is a common initial presentation and carries a high risk for mortality if left untreated. Thrombotic complications are uncommon and can be related to treatment with chemotherapeutic agents. Large artery thrombosis is very rare, and standardized management remains elusive given the classic revascularization techniques carry a significant risk of re-thrombosis, as well as high risk for mortality given the multiple surgical and percutaneous interventions that are attempted. A multidisciplinary approach is necessary in these cases to carefully weigh the risk and benefits as the classical approach to revascularization and acute arterial thrombosis could potentially cause harm.
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http://dx.doi.org/10.7759/cureus.8495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343312PMC
June 2020

Effect of Metformin on Microvascular Endothelial Function in Polycystic Ovary Syndrome.

Mayo Clin Proc 2019 12;94(12):2455-2466

Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN. Electronic address:

Objective: To investigate the factors that are associated with the effect of metformin on endothelial dysfunction in polycystic ovary syndrome (PCOS).

Patients And Methods: From March 24, 2014, to November 18, 2016, 48 women with PCOS were randomly assigned to 1500 mg/d of metformin (N=29) or no treatment (N=13) for 3 months; 42 patients (29 in the initial treatment group and 13 in the no treatment group) completed the study. Study variables were measured at baseline and after 3 months. Participants who did not receive metformin initially were then treated with metformin for another 3 months, and study variables were measured again. Endothelial function was measured as reactive hyperemia-peripheral arterial tonometry (RH-PAT) from the index finger.

Results: The age and baseline endothelial function (mean ± SD) of the participants were 32.7±6.9 years and 1.8±0.5, respectively. No notable change was observed in endothelial function after 3 months with metformin compared with no treatment. However, after stratifying participants who received metformin based on baseline endothelial function, there was a significant improvement following metformin treatment in participants with abnormal baseline endothelial function (1.3±0.3 vs 1.7±0.3; P<.001) but not in those with normal baseline endothelial function (2.1±0.4 vs 2.0±0.5; P=.11).

Conclusion: Metformin improves endothelial function in women with PCOS and endothelial dysfunction independent of changes in glucose metabolism, dyslipidemia, or presence of prediabetes. Metformin has a direct effect on endothelial function in PCOS, and measurement of endothelial function can stratify and follow response to metformin treatment in PCOS.

Trial Registration: clinicaltrials.gov Identifier: NCT02086526.
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http://dx.doi.org/10.1016/j.mayocp.2019.06.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050832PMC
December 2019

Transcatheter aortic valve replacement outcomes in mixed aortic valve disease compared to predominant aortic stenosis.

Int J Cardiol 2020 01 1;299:209-214. Epub 2019 Aug 1.

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address:

Background: MAVD, defined as severe aortic stenosis with moderate or severe aortic regurgitation, is frequently encountered in clinical practice. However, the data regarding TAVR outcomes in MAVD are sparse. We compared Transcatheter Aortic Valve Replacement (TAVR) outcomes between Mixed Aortic Valve Disease (MAVD) and Predominant Aortic Stenosis (PAS) patients.

Methods: Patients who underwent TAVR at Mayo Clinic from February 7, 2012 to December 16, 2016 were enrolled. The primary end point was all-cause mortality. Secondary end points were central or paravalvular regurgitation, device success, and Valve Academic Research Consortium (VARC)-2 defined post TAVR complications (access site complications, bleedings, myocardial infarction, stroke, and cardiac arrest).

Results: A total of 622 patients were enrolled. Mean age was 81 ± 8.9 years, and 263 (42.3%) were female. Median follow-up duration was 1.5 years. One hundred and sixteen patients (18.6%) had MAVD. Central or paravalvular leak was higher in MAVD patients post-TAVR (15.5% vs 6.7%, P = 0.004). Device success and VARC-2 in-hospital complications were similar between the two groups. The cumulative probability of survival at 3 years was 71.3% in MAVD patients vs. 62.6% in PAS patients (Log-Rank P = 0.024). In a multi-variant logistic regression analysis, MAVD was an independent negative predictor of all-cause mortality (HR = 0.53, 95% CI 0.3-0.89, P = 0.015).

Conclusions: A significant number of patients referred for TAVR have MAVD disease. Despite higher rates of paravalvular regurgitation, all-cause mortality at mid-term was lower in patients with MAVD compared with those with PAS. Our results show the safety and efficacy of TAVR in MAVD patients.
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http://dx.doi.org/10.1016/j.ijcard.2019.07.099DOI Listing
January 2020

Metabolic syndrome is associated with peripheral endothelial dysfunction amongst men.

Diabetes Metab Syndr Obes 2019 5;12:1035-1045. Epub 2019 Jul 5.

Division of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.

Metabolic syndrome (MetS) and peripheral endothelial dysfunction (PED) are both independently associated with an increased risk of cardiovascular disease (CVD). PED provides prognostic information beyond that provided by conventional risk factors. However, the association between MetS and PED remains uncertain. We evaluated the association between MetS and PED. We performed a retrospective analysis of patients who were referred to Mayo Clinic between 2006 and 2014 for evaluation of chest pain and/or an assessment of CVD risk that included an assessment of PED measured with reactive hyperemia peripheral arterial tonometry. MetS was defined as the presence of at least 3 of the following: body mass index25 kg/m, impaired fasting glucose or diabetes, high blood pressure or hypertension, hypertriglyceridemia, or low high-density lipoprotein cholesterol. Six hundred seventy-eight patients were included (mean age 51.9±13.5 years, 418 (61.6%) women), of which 293 (43.2%) had PED, and 249 (36.7%) had MetS. In multivariable analyses adjusted for age, sex, CVD, smoking status, and elevated low-density lipoprotein, MetS was significantly associated with PED (Odds Ratio (OR) 2.06; =0.0090). Of the individual MetS components, only being overweight and MetS range high-density lipoprotein had a similar association. After stratifying by sex, the association between MetS and PED persisted only in men (OR 3.16, =0.0094). MetS is associated with PED in men undergoing an assessment of chest pain and/or CVD risk. Identifying PED in individuals with MetS could provide an abridged assessment of risk, potentially allowing for earlier and more intensive management of risk factors.
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http://dx.doi.org/10.2147/DMSO.S204666DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615711PMC
July 2019

Transcatheter aortic valve replacement outcomes in patients with sarcopaenia.

EuroIntervention 2019 Oct;15(8):671-677

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.

Aims: Sarcopaenia is a prevalent disease of ageing, associated with adverse clinical outcomes. We aimed to compare in-hospital adverse outcomes and overall mortality in sarcopaenic and non-sarcopaenic patients undergoing transcatheter aortic valve replacement (TAVR).

Methods And Results: This was a retrospective cohort study including 602 patients who underwent TAVR. Sarcopaenia was defined as skeletal muscle mass index <55.4 cm2/m2 in males and <38.9 cm2/m2 in females obtained through pre-TAVR CT scan. Mortality, length of hospital stay, ICU admission, and Valve Academic Research Consortium (VARC)-2-defined post-TAVR complications were defined as outcomes. Study participants (mean age 80.9±8.9 years and 56.8% male) were followed for a median of 1.5 years. Two thirds of the TAVR population was sarcopaenic. In-hospital outcomes were similar in both groups; however, overall survival was worse in sarcopaenic patients (HR for mortality=1.46 [1.06-2.14], p=0.02). In a multivariable model, sarcopaenia, porcelain aorta, pre-TAVR atrial fibrillation/flutter, severe chronic kidney disease, chronic pulmonary disease, VARC-2 bleeding, acute renal failure following TAVR, and post-TAVR cardiac arrest were predictors of mortality.

Conclusions: Sarcopaenic patients had similar in-hospital clinical outcomes to non-sarcopaenic patients following TAVR which reveals TAVR safety in sarcopaenic patients. However, sarcopaenia was an independent risk factor for midterm mortality indicating its potential value in systematic evaluation of this highly comorbid population in order to decide the best treatment approaches.
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http://dx.doi.org/10.4244/EIJ-D-19-00110DOI Listing
October 2019

Association of non-alcoholic fatty liver disease with microvascular complications of type 2 diabetes.

Prim Care Diabetes 2019 12 1;13(6):505-514. Epub 2019 May 1.

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Introduction: Non-alcoholic fatty liver disease (NAFLD) affects risks of type 2 diabetes (T2D), diabetes-related complications, and cardiovascular disease in a complex manner. This study is designed to clarify associations of sonographically-detected NAFLD and serum liver enzymes with diabetes-related microvascular complications.

Methods: A matched case-contorl study was designed for 440 patients with T2D and at least one of the chronic diabetes-related microvascular complications and 495 age- and gender-matched control patients with T2D.

Results: Considering pre-existing and newly developed chronic microvascular complications, diabetic peripheral neuropathy was found in 347 out of 935 (37.1%) study patients, diabetic retinopathy in 141/935 (15.1%), and diabetic nephropathy in 103/935 (11.0%). Diagnosis of diabetic retinopathy and diabetic nephropathy were inversely associated with the presence of NAFLD in the crude logistic regressions (OR [95% CI] = 0.18 [0.05-0.63], p value = 0.007; OR [95% CI] = 0.17 [0.04-0.59], p value = 0.011, respectively). The subgroup of NAFLD with elevated liver enzymes had lower odds of having diabetic peripheral neuropathy in the fully adjusted model (OR [95% CI] = 0.34 [0.12-0.98], p value = 0.048).

Conclusion: Diagnosis of NAFLD with or without elevated serum liver enzymes was inversely correlated with certain chronic diabetes microvascular complications. Possible explanations for this counter-intuitive and unexpected finding are discussed and center on reverse-causality, wherein sicker patients may develop beneficial compensatory physiological and behavioral adaptations. Diversity of studied patients, in particular with regards to the ethnic and racial differences among the Western and Asian populations may also partly account for contrasting findings of the relationship between NAFLD and microvascular complications of diabetes.
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http://dx.doi.org/10.1016/j.pcd.2019.03.009DOI Listing
December 2019

Associations of Serum S100B and S100P With the Presence and Classification of Diabetic Peripheral Neuropathy in Adults With Type 2 Diabetes: A Case-Cohort Study.

Can J Diabetes 2019 Jul 11;43(5):336-344.e2. Epub 2019 Jan 11.

Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objectives: Novel biomarkers of diabetic peripheral neuropathy provide potentially useful information for early identification and treatment of diabetic neuropathy, ultimately serving to reduce the burden of disease. This study was designed to investigate the potential associations of serum S100B and S100P (calcium-modulated proteins) with the presence and classification of diabetic peripheral neuropathy in adults with type 2 diabetes.

Methods: In a case-cohort setting, the data of 44 participants diagnosed with diabetic peripheral neuropathy, 44 control participants with type 2 diabetes but free of peripheral neuropathy and 87 healthy control individuals were collected and analyzed.

Results: Serum S100P concentrations were elevated in participants with diabetic peripheral neuropathy compared with their controls with type 2 diabetes (median [IQR]: 2,235 pg/mL [1,497.5 to 2,680] vs. 1,200 pg/mL [975 to 1,350)], respectively; p<0.001). Conversely, serum S100B values were comparable in these 2 groups (p=0.570). Those with the typical diabetic peripheral neuropathy had significantly higher serum S100P levels compared to their counterparts with the atypical group of diabetic peripheral neuropathies (p=0.048). The independent significant association between serum S100P and diabetic peripheral neuropathy persisted into the multivariable adjusted logistic regression model (OR for S100P: 1.004 [95% CI 1.002 to 1.006]; p<0.001).

Conclusions: The present study's findings demonstrated that serum S100P is a more significant indicator of peripheral neuropathy in type 2 diabetes than is serum S100B. Prospective longitudinal studies are required to confirm the prognostic value of baseline serum S100P to predict incident peripheral neuropathy in people with diabetes.
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http://dx.doi.org/10.1016/j.jcjd.2019.01.003DOI Listing
July 2019

The use of steel slags in the heterogeneous Fenton process for decreasing the chemical oxygen demand of oil refinery wastewater.

Water Sci Technol 2018 Oct;78(5-6):1159-1167

Department of Natural Resources, Isfahan University of Technology, Isfahan, 841568311, Iran E-mail:

The Fenton process is a useful and inexpensive type of advanced oxidation process for industrial wastewater treatment. This study was performed with the aim of using the steel slag as a catalyst in the heterogeneous Fenton process in order to reduce the chemical oxygen demand (COD) of oil refinery wastewater. The effects of various parameters including the reaction time (0.5, 1.0, 2.0, 3.0 and 4.0 h), pH (2.0, 3.0, 4.0, 5.0, 6.0 and 7.0), the concentration of steel slag (12.5, 25.0 and 37.5 g/L), and HO concentration (100, 250, 400 and 500 mg/L) on the Fenton process were investigated. Furthermore, the effect of microwave irradiation on the process efficiency was studied by considering the optimum conditions of the mentioned parameters. The results showed that using 25.0 g/L of steel slag and 250 mg/L HO, at pH = 3.0, could reduce COD by up to 64% after 2.0 h. Also, microwave irradiation decreased the time of the process from 120 min to 25 min in the optimum conditions, but it consumed a high amount of energy. It could be concluded that steel slags had a high potential in the treatment of oil refinery wastewater through the Fenton process.
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http://dx.doi.org/10.2166/wst.2018.347DOI Listing
October 2018

Beneficial Effects of Pentoxifylline Plus Losartan Dual Therapy in Type 2 Diabetes with Nephropathy.

Am J Med Sci 2018 05 1;355(5):442-448. Epub 2018 Feb 1.

Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: This study was designed to comparatively assess the effects of add-on pentoxifylline to losartan versus increasing the dose of losartan on serum N-terminal pro-brain natriuretic peptide (NT-proBNP), serum highly sensitive C-reactive protein (hsCRP) and the urinary albumin excretion (UAE) rate in patients with type 2 diabetes and nephropathy.

Methods: In an open-label, single-center, parallel-group, randomized clinical trial (NCT03006952), 30 patients received b.i.d. dose of pentoxifylline 400mg plus daily dose of losartan 50mg (pentoxifylline arm) and 29 patients received b.i.d. dose of losartan 50mg (losartan arm) during a 12-week follow-up period.

Results: Serum NT-proBNP, serum hsCRP and UAE levels all significantly decreased from baseline in both trial arms. The pentoxifylline and losartan trial arms were equally effective in reducing serum NT-proBNP levels during the course of trial (multivariable adjusted model P value = 0.864, effect size = 0.2%). There was a greater decrease in UAE and serum hsCRP levels in the pentoxifylline arm (P = 0.034, effect size = 7.8%; P = 0.009, effect size = 11.7%, respectively). Conversely, patients in the losartan arm achieved better systolic and diastolic blood pressure control (P < 0.001, effect size = 25.4%; P = 0.010, effect size = 11.3%, respectively).

Conclusions: Circulating NT-proBNP levels equally and significantly reduced from baseline in the pentoxifylline and losartan treatment arms, in parallel with comparatively superior decreases of UAE and serum hsCRP in the pentoxifylline arm, and larger decreases of systolic and diastolic blood pressures in the losartan arm.
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http://dx.doi.org/10.1016/j.amjms.2017.12.015DOI Listing
May 2018

National Prevalence of Self-Reported Coronary Heart Disease and Chronic Stable Angina Pectoris: Factor Analysis of the Underlying Cardiometabolic Risk Factors in the SuRFNCD-2011.

Glob Heart 2018 06 9;13(2):73-82.e1. Epub 2018 Feb 9.

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Coronary heart disease (CHD) is one of the most common causes of mortality worldwide. The national prevalence remains unclear in most of the developing countries.

Objective: This study sought to estimate national prevalence of self-reported CHD and chronic stable angina pectoris in the general adult population of Iran using data from the fourth round of the Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2011) survey.

Methods: The analysis comprised data of 11,867 civilian, nonhospitalized and noninstitutionalized residents ages 6 to 70 years of age. The calculated prevalence of self-reported CHD and chronic stable angina pectoris were extrapolated to the Iranian adult population who were >20 years old using the complex sample analysis. The factor analysis was performed for clustering of the associated cardiometabolic risk factors among people ages >40 years of age.

Results: The estimated national prevalence of self-reported CHD and chronic stable angina pectoris were 5.3% (95% confidence interval: 4.6 to 5.9) and 7.7% (95% confidence interval: 4.6 to 8.7), respectively. Higher prevalence of these conditions were observed among the older people, urban residents, and women. Factor analysis generated 4 distinct factors that were mainly indicators of dyslipidemia, hypertension, central obesity, hyperglycemia, and tobacco smoking. The factor incorporating hypertension was a significant correlate of self-reported CHD.

Conclusions: We report concerning prevalence of self-reported CHD and chronic stable angina pectoris in the adult population of Iran. The constellation of raised systolic and diastolic blood pressures was significantly predictive of the presence of self-reported CHD.
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http://dx.doi.org/10.1016/j.gheart.2018.01.001DOI Listing
June 2018

Diabetes in Iran: Prospective Analysis from First Nationwide Diabetes Report of National Program for Prevention and Control of Diabetes (NPPCD-2016).

Sci Rep 2017 10 18;7(1):13461. Epub 2017 Oct 18.

Department of Medicine, Biochemistry, Physiology and Biophysics, Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, Ohio, United States.

We estimated proportions of different types of diabetes, comorbidities, treatment (the use of oral glucose-lowering agents and insulin), control (hyperglycemia, dyslipidemia and hypertension) and chronic microvascular and macrovascular complications among people with diabetes presenting to the tertiary-care academic diabetes outpatient clinics in Iran. This study is the prospective analysis of data (n = 30,202) from the registry of university-affiliated adult outpatient diabetes clinics in the country during 2015-2016. The proportions of type 1 diabetes, types 2 diabetes, and other types of diabetes were 11.4%, 85.5%, and 1.3%, respectively. The frequencies of drug-naivety, use of oral agents, insulin monotherapy and insulin combination therapy were 2.9%, 60.5%, 11.5%, and 25.1%, respectively. Around 13.2%, 11.9% and 43.3% of patients with diabetes had controlled hyperglycemia, hyperlipidemia and hypertension, respectively. The proportions of retinopathy, nephropathy, peripheral neuropathy, diabetic foot, and ischemic heart disease were 21.9%, 17.6%, 28.0%, 6.2%, and 23.9%, respectively. Despite the wide availability of medications and insulin coverage in Iran, the estimated national control of hyperglycemia, hyperlipidemia and hypertension (especially for young men and old women) remains subpar. The present study further suggests that the frequencies of chronic vascular complications among patients with diabetes are relatively high in Iran.
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http://dx.doi.org/10.1038/s41598-017-13379-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647418PMC
October 2017

All-Cause and Cardiovascular Mortality following Treatment with Metformin or Glyburide in Patients with Type 2 Diabetes Mellitus.

Arch Iran Med 2017 Mar;20(3):141-146

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background: Both metformin and sulfonylurea (SU) drugs are among the most widely-used anti-hyperglycemic medications in patients with type 2 diabetes mellitus (T2DM). Previous studies have shown that treatment with SUs might be associated with decreased survival compared with metformin. This study aimed to evaluate all-cause and cardiovascular mortality rates between glyburide and metformin in patients diagnosed with T2DM.

Methods: This was a cohort study on 717 patients with T2DM (271 undergoing monotherapy with glyburide and 446 with metformin). Data were gathered from 2001 to 2014. All-cause and cardiovascular mortality were end-points.

Results: During the follow-up, 24 deaths were identified, of which 13 were cardiovascular in nature. The group with glyburide monotherapy had greater all-cause mortality (17 (6.3%) in glyburide vs. 7 (1.6%) in metformin, P = 0.001) and cardiovascular mortality (11 (4.1%) in glyburide vs. 2 (0.4%) in metformin; P = 0.001). Metformin was more protective than glyburide for both all-cause (HR: 0.27 [0.10 - 0.73] P-value = 0.01) and cardiovascular mortality (HR: 0.12 [0.20 - 0.66], P-value = 0.01) after multiple adjustments for cardiovascular risk factors. Among adverse cardiovascular events, non-fatal MI was higher in glyburide compared to metformin monotherapy group (3.2% vs. 0.8%; P-value = 0.03), but not coronary artery bypass grafting (P-value = 0.85), stenting (P-value = 0.69), need for angiography (P-value = 0.24), CCU admission (P-value = 0.34) or cerebrovascular accident (P-value = 0.10).

Conclusion: Treatment with glyburide is associated with increased all-cause and cardiovascular mortality in patients with T2DM.
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http://dx.doi.org/0172003/AIM.005DOI Listing
March 2017

Oxidized Low-Density Lipoprotein (ox-LDL) to LDL Ratio (ox-LDL/LDL) and ox-LDL to High-Density Lipoprotein Ratio (ox-LDL/HDL).

Clin Lab 2016 Sep;62(9):1609-1617

Background: Oxidized low-density lipoprotein (ox-LDL) plays a principal role in diabetes complications, though ox-LDL concentrations and its functions are dependents of other oxidative and anti-oxidative particles. The oxLDL to low-density lipoprotein ratio (ox-LDL/LDL) and ox-LDL to high-density lipoprotein ratio (ox-LDL/HDL) as new lipid biomarkers may serve as a good estimation of oxidation and anti-oxidation in type 2 diabetes mellitus. The aim of this study was first to examine ox-LDL/LDL and ox-LDL/HDL levels in patients with type 2 diabetes mellitus compared to a control group and evaluate their diagnostic accuracies, and, second, to investigate the correlation of these two ratios with triglyceride and HDL levels.

Methods: This study was included 144 patients admitted to the diabetes clinic of a University general hospital and 41 healthy individuals as controls. Levels of LDL, HDL, triglyceride (TG) ox-LDL, and malondialdehyde (MDA) were measured for all patients. Levels of ox-LDL/LDL and ox-LDL/HDL were calculated. Diagnostic accuracies were determined by receiver-operating characteristic curve analysis by measuring the area under the curve.

Results: Ox-LDL, ox-LDL/LDL, and ox-LDL/HDL were significantly higher in patients compared to the control group after adjustment for age, gender, and BMI (p = 0.000). The area under the curve for diagnosing diabetes was 0.946 for ox-LDL/HDL, 0.918 for ox-LDL/LDL, and 0.832 for ox-LDL. Ox-LDL/HDL was positively correlated with MDA (r = 0.210, p = 0.011). Ox-LDL/LDL was negatively correlated with HDL (r = -0.2 p = 0.016) and positively correlated with TG (r = 0.45 p = 0.000). Ox-LDL/HDL and TG had significant positive correlation (r = 0.173 p = 0.037). The ox-LDL/LDL level was significantly higher in patients with coronary heart disease (CHD) or hypertension (HTN) compared to those without (p = 0.042).

Conclusions: Our findings revealed that ox-LDL/LDL and ox-LDL/HDL are potent biomarkers of type 2 diabetes, which apparently reflect the association between lipids in the state of oxidative stress.
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http://dx.doi.org/10.7754/Clin.Lab.2016.150412DOI Listing
September 2016

Absence of a positive correlation between CRP and leptin in rheumatoid arthritis.

Heliyon 2016 Dec 5;2(12):e00205. Epub 2016 Dec 5.

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Aims: Rheumatoid Arthritis (RA) is a model of chronic inflammatory disease. In this study we evaluated the correlation of leptin and CRP in patients with RA and normal controls.

Main Methods: A total of 75 patients with RA and 40 healthy adults were recruited in this case-control study. RA patients were categorized into high (DAS-28 > 3.2) and low activity (DAS ≤ 3.2) group according to their DAS-28 score.

Key Findings: Leptin level was significantly correlated with CRP in healthy controls (r = 0.365; p < 0.05), but this correlation was lost in RA patients (r = 0.095, p = 0.41). Patients with RA had higher serum leptin levels compared to healthy controls (P < 0.01). No difference in serum leptin level was observed between patients with high and low activity disease. Also leptin was correlated with BMI in healthy controls (r = 0.326, p = 0.037). This correlation was not present in RA patients (r = 0.039, p = 0.756).

Significance: We observed that the physiologic correlation between leptin and CRP and BMI and CRP was not present RA patients. This is a new study reporting the lost correlation between leptin and CRP in RA patients.
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http://dx.doi.org/10.1016/j.heliyon.2016.e00205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5148782PMC
December 2016

Diabetes Care in Iran: Where We Stand and Where We Are Headed.

Ann Glob Health 2015 Nov-Dec;81(6):839-50

Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: The prevalence of diabetes has steadily increased in Iran from the time of the first published nationally representative survey in 1999 and despite efforts and strategies to reduce disease burden.

Objectives: The aim of the present review was to describe the current status of diabetes care in Iran.

Methods: A selective review of the relevant literature, focusing on properly conducted studies, describing past and present diabetes care strategies, policies, and outcomes in Iran was performed.

Findings: The quality of diabetes care has gradually improved as suggested by a reduction in the proportion of undiagnosed patients and an increase in affordability of diabetes medications. The National Program for Prevention and Control of Diabetes has proven successful at identifying high-risk individuals, particularly in rural and remote-access areas. Unfortunately, the rising tide of diabetes is outpacing these efforts by a considerable margin.

Conclusions: Substantial opportunities and challenges in the areas of prevention, diagnosis, and management of diabetes exist in Iran that need to be addressed to further improve the quality of care and clinical outcomes.
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http://dx.doi.org/10.1016/j.aogh.2015.10.003DOI Listing
January 2018

Nonlinear relation between pulse pressure and coronary heart disease in patients with type 2 diabetes or hypertension.

J Hypertens 2016 May;34(5):974-80

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Wide pulse pressure (PP) is an independent predictor of coronary heart disease (CHD). However, the linearity of the relation between PP and CHD was not examined before. We aimed to examine this relation in patients with type 2 diabetes and/or hypertension.

Methods: A total of 3120 patients (including 2607 with diabetes and 1586 with hypertension) were followed for 7.8 years. Physician-adjudicated first hard CHD event was the primary outcome. Cox regression analysis was used to investigate the association between PP and incident CHD. Restricted cubic splines were used to investigate nonlinear relations.

Results: Four spline covariates were defined between 30, 40, 50, 60, and 70 mmHg. The null-hypothesis of the linearity of the relation between PP and CHD was rejected (P value = 0.004). The second, third, and fourth spline covariates were significant (P value = 0.02, P value = 0.02 and P value = 0.01, respectively), supporting a nonlinear relation in corresponding PP intervals. Patients with PP less than 45 mmHg and PP more than 55 mmHg had increased risk of future CHD event, compared with those with PP between 45 and 55 mmHg [hazard ratio (HR) = 1.33 (1.00-1.77) and HR = 1.67 (1.23-2.27), respectively]. This remained significant after controlling for systolic, diastolic, or mean arterial pressures in wide PP group. However, adjustment for traditional cardiovascular risk factors (especially age) attenuated the relation in those with wide PP.

Conclusion: The relation between PP and CHD is nonlinear in patients with type 2 diabetes and hypertension. Both narrow and wide PPs increase risk of future hard CHD events. The association between wide PP and CHD is independent from SBP, DBP, or mean arterial pressure.
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http://dx.doi.org/10.1097/HJH.0000000000000866DOI Listing
May 2016

Abdominal obesity and gestational diabetes: the interactive role of magnesium.

Magnes Res 2015 Dec;28(4):116-25

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Aims: Magnesium is a cofactor for numerous metabolic enzymatic reactions. It is required for glucose utilization and insulin signaling. We compared plasma magnesium concentrations in pregnant women with and without abdominal obesity, and investigated the interactive roles of magnesium and obesity in the development of gestational diabetes mellitus (GDM).

Methods: Pregnant women with and without abdominal obesity (n = 40 in each group) were followed during gestation. Oral glucose tolerance tests (OGTT) were performed at 24-28 weeks of pregnancy to diagnose GDM. Plasma glucose, insulin, triglycerides, high-sensitive C-reactive protein (hs-CRP), and malondialdehyde (MDA) were measured. The obesity-GDM relationship was investigated prospectively, and the magnesium-GDM relationship was analyzed on a cross-sectional basis.

Results: Sixteen patients in the obese group and one in the control developed GDM. There were no differences in plasma magnesium levels between obese and control groups (p-value = 0.14), but significant differences between diabetic and non-diabetic patients (p-value = 0.05). Fourteen out of 17 diabetic patients had magnesium concentrations below the median. Increases in insulin, homeostatic model for insulin resistance, triglycerides, hs-CRP, MDA and second-hour blood glucose were more pronounced in those with both abdominal obesity and low-normal magnesium concentrations. In the Poisson regression model, obesity (relative risk = 20.6, p-value = 0.002), low-normal magnesium level (relative risk = 4.2, p-value = 0.009), and their interaction (p-value<0.001) were significant.

Conclusion: Abdominally obese patients with lower plasma magnesium are more likely to show abnormal OGTT results. Insulin resistance, inflammatory response and oxidative stress are exaggerated in these patients.
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http://dx.doi.org/10.1684/mrh.2015.0392DOI Listing
December 2015

Contribution of vitamin D deficiency to the risk of coronary heart disease in subjects with essential hypertension.

Atherosclerosis 2016 Jan 23;244:165-71. Epub 2015 Nov 23.

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Vitamin D deficiency is proposed as a risk factor for coronary heart disease (CHD). An inverse relation was observed between serum 25-Hydroxy-Vitamin-D level and incidence of hypertension. This study aimed to evaluate the predictive value of serum 25-Hydroxy-Vitamin-D in improvement of CHD risk-stratification in patients with hypertension.

Methods: In this cohort, we followed 1586 patients with essential hypertension (1078 diabetic and 508 non-diabetic) for 8.5 years. Physician-adjudicated first hard CHD event was the primary outcome. Cox regression analysis was used to investigate the association between 25-Hydroxy-Vitamin-D quartiles and incident CHD. 25-Hydroxy-Vitamin-D was also added to the Framingham Risk Score (FRS) and Net-Reclassification-Improvement (NRI) and Integrated-Discriminant-Improvement (IDI) were used to examine improved reclassification.

Results: During follow-up, 176 events were recorded. Patients in the lowest quartile of 25-Hydroxy-Vitamin-D experienced the most number of hard CHD events. A significant linear trend was observed in hazard ratios (HR) of incident hard CHD events in 25-Hydroxy-Vitamin-D quartiles which remained significant after multiple adjustments for conventional CHD risk-factors (HRs in full-adjusted model: 2.87 [1.76-4.70] for 1st quartile, 2.31 [1.39-3.83] for 2nd quartile and 1.87 [1.15-3.03] for 3rd quartile, compared with the highest quartile; p-for-trend<0.001). Addition of 25-Hydroxy-Vitamin-D to FRS could improve CHD risk-estimation (relative-IDI = 15%, p-value<0.001). Addition of 25-Hydroxy-Vitamin-D to FRS successfully reclassified 33% [18-49] of patients with hypertension among CHD risk groups (p-value<0.001).

Conclusion: We observed that serum 25-Hydroxy-Vitamin-D is independently associated with future hard CHD events and improves its prediction in patients with essential hypertension. Addition of serum 25-Hydroxy-Vitamin-D to CHD risk-estimation models may have additive values.
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http://dx.doi.org/10.1016/j.atherosclerosis.2015.11.020DOI Listing
January 2016

Non-linear contribution of serum vitamin D to symptomatic diabetic neuropathy: A case-control study.

Diabetes Res Clin Pract 2016 Jan 21;111:44-50. Epub 2015 Oct 21.

Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran. Electronic address:

Aims: Vitamin D deficiency has recently been speculated to be associated with increased risk of diabetes neuropathy (DN). The aim of this study was to evaluate the odds of symptomatic DN across serum vitamin D levels.

Methods: All patients with DM were assessed using diabetic neuropathy symptoms and diabetic neuropathy examination score. Overall, 150 cases with DN and 600 controls were included. Serum 25-hydroxyvitamin D (25-OH-D) was measured to determine vitamin D status.

Results: A non-linear association between 25-OH-D and suffering from symptomatic DN was observed which was extracted after stratifying the ORs across different serum 25-OH-D levels. When compared to individuals with 25-OH-D of 30-40 ng/mL, patients with deficient (<20 ng/mL) vitamin D levels had higher odds of having symptomatic DN (OR: 2.04, 95%CI: 0.99-4.02, P=0.054). Participants with vitamin D values of greater than 40 ng/mL were also more likely to exhibit symptomatic DN (fully adjusted OR: 4.29, 95%CI: 1.59-11.55).

Conclusions: We hypothesize a non-linear contribution of serum vitamin D to symptomatic DN occurrence, which emphasizes that administration of vitamin D should be monitored and evaluated more carefully, especially in patients with diabetes.
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http://dx.doi.org/10.1016/j.diabres.2015.10.018DOI Listing
January 2016

Changes in leukocyte subpopulations with decline in glomerular filtration rate in patients with type 2 diabetes.

Acta Med Iran 2015 Jul;53(7):425-31

Department of Endocrinology, Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences, Tehran, Iran.

Recent studies suggested the role of white blood cells (WBCs) in the pathogenesis and complications of type 2 diabetes. Increased WBC counts predict mortality in patients with chronic kidney disease (CKD). In this study alterations in WBC subpopulations in diabetic patients with non-dialysis dependent CKD are investigated. This was a cross-sectional study  on 376 participants, including   272 diabetic  patients  and  104  healthy  controls.  Total  and  differential  WBC  counts  were  compared  among diabetics with CKD, diabetics without CKD and controls. Among patients with type 2 diabetes, there was no significant difference in total WBC count between those with and without CKD. Diabetic patients with CKD had higher neutrophil, monocyte and eosinophil and lower lymphocyte count compared with both diabetic patients without CKD and healthy controls. Except for monocytes, a significant association was observed between GFR and differential WBC counts, which persisted after adjustment for conventional diabetes riskfactors (R2=0.272, P < 0.001 for regression model). Neutrophil/lymphocyte ratio was the best predictor ofGFR in total study population (beta= -1.995 ± 0.45, P<0.001). Changes in WBC subpopulations are present even before significant alterations in total WBC count. Immune system dysfunction needs special consideration in diabetic patients with CKD.
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July 2015

Elevated serum levels of pregnancy-associated plasma protein-A in type 2 diabetics compared to healthy controls: associations with subclinical atherosclerosis parameters.

Acta Med Iran 2015 Jul;53(7):395-402

Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Type 2 diabetes mellitus is associated with increased inflammation and accelerated atherosclerosis. The association of the pro-inflammatory and potentially pro-atherosclerotic molecule, pregnancy associated plasma protein-A (PAPP-A) with diabetes and vascular diseases remains to be further established. A total of 107 patients with type 2 diabetes and 101 healthy controls participated in this study. Serum levels of PAPP-A was measured by Enzyme-linked Immunosorbent Assay (ELISA). We also evaluated the lipid profile, aortic augmentation index, coronary calcium score, ankle brachial index, flow mediated dilation, and carotid intima media thickness. Serum level of PAPP-A was significantly higher in patients with diabetes compared to controls (P<0.001). In the multivariable regression analysis, PAPP-A was positively correlated with diabetes (P<0.001), aortic augmentation index (P=0.021) and was negatively associated with coronary calcification (P=0.050). In conclusion, serum levels of PAPP-A were significantly higher in diabetics compared to healthy controls and correlated with aortic augmentation index and coronary calcification. Our study results suggest that PAPP-A can be a marker of subclinical atherosclerosis in patients with diabetes.
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July 2015

Assessment of serum 25-hydroxy vitamin D improves coronary heart disease risk stratification in patients with type 2 diabetes.

Am Heart J 2015 Sep 27;170(3):573-9.e5. Epub 2015 Jun 27.

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: A growing body of evidence suggests an association between lower serum 25-hydroxy vitamin D (25(OH)VitD) levels and adverse cardiovascular events. Patients with type 2 diabetes mellitus (T2DM) are at increased risk for developing coronary heart disease (CHD). 25-Hydroxy vitamin D deficiency is highly prevalent, especially among patients with T2DM. This study aimed to evaluate the predictive value of serum 25(OH)VitD in improvement of CHD risk stratification in patients with T2DM.

Methods: In an open cohort, community-dwelling T2DM patients were followed up for first CHD event. Patients were divided into 4 categories, based on 25(OH)VitD quartiles. Cox regression analysis was used to obtain hazard ratios.

Results: A total number of 2,607 T2DM patients were followed up for median time of 8.5 years. During follow-up, 299 patients experienced CHD events. Patients in the lowest quartile experienced more CHD events. Adjusted hazard ratios (95% CI) for developing CHD events were 0.77 (0.55-1.07) for second quartile, 0.52 (0.38-0.73) for third quartile, and 0.43 (0.31-0.60) for fourth quartile, compared with the first quartile. The incidence rate decreased as serum 25(OH)VitD increased, which remained significant after stepwise adjustments (P value for trend ≤.001). Addition of 25(OH)VitD to traditional risk factors in Framingham Risk Score successfully reclassified 29% of study population.

Conclusions: Serum 25(OH)VitD is an independent predictor of future adverse CHD events in patients with T2DM. Addition of 25(OH)VitD status to Framingham Risk Score improves CHD risk prediction in patients with T2DM.
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http://dx.doi.org/10.1016/j.ahj.2015.06.017DOI Listing
September 2015

HAV Immunity in Iranian Medical Students.

Hepat Mon 2015 Mar 31;15(3):e26219. Epub 2015 Mar 31.

Infectious Diseases Research Center, AJA University of Medical Sciences, Tehran, IR Iran.

Background: Hepatitis A, a fecal-oral transmitted disease, which has been considered endemic in developing countries, seems to change its pattern in developing countries because of their improved socioeconomic status.

Objectives: In the present study, we aimed to determine the need of vaccination in 270 students at AJA University of Medical Sciences.

Materials And Methods: The serum level of anti-HAV antibody was checked in 270 students of AJA University of medical students, and effect of different factors, including age, gender, pre-university entrance exam region, familial education, familial income, clean water availability, and previous history of jaundice were tested.

Results: Of total 270 students, 30 were female. Their age ranged between 18 and 30 years old with the mean age of 20.58 years and just 34% of students had positive level of anti-HAV antibody. Age and sex had no role in positive serum level of anti-HAV antibody. According to analyzed data, lack of clean water availability, pre-university entrance exam region, lower family education, and poor health status estimation increased statistically the risk of HAV infection.

Conclusions: Because 66% of students were anti-HAV antibody negative and they will work as health care workers in future, our study suggest vaccinating all students accepted at AJA University of Medical Sciences.
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http://dx.doi.org/10.5812/hepatmon.26219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359362PMC
March 2015

Dual-energy X-ray absorptiometry diagnostic discordance between Z-scores and T-scores in a young Iranian population.

Med J Islam Repub Iran 2014 22;28:151. Epub 2014 Dec 22.

6. MD, Professor,Endocrinology & Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Dual-energy X-ray Absorptiometry (DXA) is considered the gold standard for non-invasive measurement of bone mass. T-scores and Z-scores are used to present the results of bone mass. The present study was designed to evaluate the discordance between T-scores and Z-scores calculated at a same level and its relation with age, gender and body mass index (BMI) in a representative sample of normal population.

Methods: This cross-sectional study was conducted as a part of a comprehensive survey, Iranian Multicenter Osteoporosis Study (IMOS), designed to assess bone health among healthy adults. Each individual underwent both L1-L4 antero-posterior lumbar spine and hip DXA scan. The difference between the T- and Z-scores measured at each of the four skeletal sites was then calculated.

Results: A -1.21 to 1.21 point difference was noted in the Z- and T- scores measured at each site. While the difference between the T-and Z-scores was less than 0.5 SD in most of the cases, the difference was higher than 1 SD in about 5% of the subjects.

Conclusion: Standardization of Z-score definition and calculation techniques as well as developing an ethnicity-matched reference population is needed to improve the reliability of DXA-generated Z-scores.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322344PMC
February 2015

Pulse pressure does not predict the response of diabetic nephropathy to glucose-lowering therapy.

Diab Vasc Dis Res 2015 Mar 18;12(2):150-1. Epub 2014 Dec 18.

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

We aimed to study whether pulse pressure (PP) predicts the response of diabetic nephropathy to glucose-lowering treatment. Patients with uncontrolled type 2 diabetes were followed for decrease in albuminuria after insulin/oral-hypoglycemic treatment. A total of 143 patients were followed for a median time of 10.5 months in a cohort study. Fasting blood sugar and HbA1C significantly decreased, while systolic, diastolic and pulse pressures remained constant during intervention. Median albuminuria decreased from 18.4 mg/day [10-40] to 16.4 mg/day [9-28] at the end of study (p-value < 0.005). The number of patients with normo/micro/macro-albuminuria changed from 98/36/9 to 108/31/4 (p-value < 0.001). No significant difference in baseline PP (47.5 ± 1.61 vs. 45.9 ± 1.81 mmHg; p-value = 0.51) or final PP (47.0 ± 2.41 vs. 49.4 ± 2.38 mmHg; p-value = 0.47) existed between those with decreased and increased albuminuria. PP was not a significant predictor of albuminuria changes in receiver operating characteristic curve (p-value = 0.77) and regression (p-value = 0.98) analyses. Benefits of glycemic control in diabetic nephropathy are independent of PP.
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http://dx.doi.org/10.1177/1479164114559208DOI Listing
March 2015

Risk of coronary heart disease associated with metabolic syndrome and its individual components in Iranian subjects: a matched cohort study.

J Clin Lipidol 2014 May-Jun;8(3):279-86. Epub 2014 Feb 15.

Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, PO Box 13145-784, Tehran, Iran.

Background And Objectives: To evaluate the risk of coronary heart disease (CHD) associated with metabolic syndrome (MetS) and its individual components in a representative sample of diabetic and nondiabetic Iranians. Moreover, we aimed to define the most hazardous MetS components.

Methods: Two cohorts consisting of 1737 nondiabetic and 2385 diabetic participants were followed for the first CHD event during 8.5 years (until December 2013).

Results: MetS is defined as having 3 individual components associated with increased risk of CHD (hazard ratio [HR] for MetS: in the unadjusted were 2.85 [2.27-3.57] and in the fully adjusted model 1.80 [1.42-2.28]). MetS was associated with lower hazard of CHD in subjects older than 65 (HR: 1.50 vs. 3.47; P for interaction < .05) and in men (HR: 1.68 vs. 4.87; P for interaction < .05). Presence of 4 of 5 individual MetS components increased the risk of CHD associated with MetS as a constellation. The value of MetS is augmented in the presence of low high-density lipoprotein-cholesterol (HR: 5.74 [2.52-13.08]) versus its absence (HR 1.91 [1.33-2.75]), high triglycerides (HR: 3.39 [1.38-8.34] vs. 1.99 [1.40-2.82] in its absence) and elevated blood pressure (HR: 2.61 [1.43-4.76] vs. 1.80 [1.26-2.58] in its absence).

Conclusions: We address the value of MetS components in the prediction of CHD and in the absence of traditional risk factors. This study provides evidence for the synergistic effect of MetS components on the incidence of CHD.
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http://dx.doi.org/10.1016/j.jacl.2014.02.002DOI Listing
April 2015

Mechanisms of anti-retroviral drug resistance: implications for novel drug discovery and development.

Infect Disord Drug Targets 2013 Oct;13(5):330-6

Iranian Research Center for HIV/AIDS (IRCHA), Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran.

Anti-retroviral drug resistance evolves as an inevitable consequence of expanded combination Anti-retroviral Therapy (cART). According to each drug class, resistance mutations may occur due to the infidel nature of HIV reverse transcriptase (RT) and inadequate drug pressures. Correspondingly, resistance to Nucleoside Reverse Transcriptase Inhibitors (NRTIs) occurs due to incorporation impairment of the agent or its removal from the elongating viral DNA chain. With regard to Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), resistance mutations may alter residues of the RT hydrophobic pocket and demonstrate high level of cross resistance. However, resistance to Protease Inhibitors requires complex accumulation of primary and secondary mutations that substitute amino acids in proximity to the viral protease active site. Resistance to novel entry inhibitors may also evolve as a result of mutations that affect the interactions between viral glycoprotein and CD4 or the chemokine receptors. According to the current studies, future drug initiative programs should consider agents that possess higher genetic barrier toward resistance for ascertaining adequate drug efficacy among patients who have failed first-line regimens.
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http://dx.doi.org/10.2174/1871526514666140321104049DOI Listing
October 2013

Comparing the Predictive Ability of Prognostic Models in Ischemic Stroke; Derivation, Validation, and Discrimination Beyond the ROC Curve.

Front Neurol 2014 27;5. Epub 2014 Jan 27.

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences , Tehran , Iran.

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http://dx.doi.org/10.3389/fneur.2014.00009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3902471PMC
June 2014

Concentrations of Cd, Cu, Pb and Zn in soft tissue of oyster (Saccostrea cucullata) collected from the Lengeh Port coast, Persian Gulf, Iran: a comparison with the permissible limits for public health.

Food Chem 2013 Dec 10;141(3):3014-9. Epub 2013 Jun 10.

Department of Environmental Pollution, Science and Research Branch, Islamic Azad University, Khouzestan, Iran.

This study examines concentrations of Cd, Cu, Pb and Zn in the soft tissue of Saccostrea cucullata in the intertidal zones of Lengeh Port, Persian Gulf, Iran, to survey whether heavy metals are within the acceptable limits for public health? The results revealed that the average metal concentrations (μg/g dry weight) ranged from 10.28 to 12.03 for Cd, 294.10 to 345.80 for Cu, 20.64 to 58.23 for Pb and 735.60 to 760.40 for Zn in the soft tissue of oysters. From the human public health point of view, comparison between the mean concentrations of the metals in the soft tissue of oyster and global guidelines clearly indicates that nearly in all cases concentrations are higher than the permissible amounts for human consumption. In addition, levels of Zn, Pb and Cu were well below their recommended oral maximum residue level (MRLs), whereas levels of Cd were observed two times higher.
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http://dx.doi.org/10.1016/j.foodchem.2013.06.002DOI Listing
December 2013