Publications by authors named "Sahra Emamzadeh-Fard"

10 Publications

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Penile Skin Involvement as the First Presentation of Henoch-Schonlein Purpura Report of Nine Cases and Review of Literature.

Iran J Pediatr 2015 Aug 24;25(4):e2177. Epub 2015 Aug 24.

Pediatric Urology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran.

Introduction: Involvement of penis is a rare presentation in henoch-schonlein purpura (HSP). The presentations are mainly due to the deposition of immunoglobulin A (IgA) into the vessel walls. In this report, we present the clinical history of nine HSP cases that presented with penile skin involvement.

Case Presentation: All patients were referred in the acute phase of HSP. Penile skin involvement was evident as erythema, edema, ecchymosis, or induration of prepuce and/or penile shaft, that appeared simultaneously with skin rash in seven patients. Gastrointestinal involvement was positive in six patients. Patients were treated with steroids and follow up visits were normal except for one patient that developed crescentic glomerulonephritis.

Conclusions: We present nine cases of HSP with penile involvement in order to indicate another rare aspect of HSP and its possible complications as well as its appropriate treatment.
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http://dx.doi.org/10.5812/ijp.2177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575794PMC
August 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

CA 19-9 is associated with poor glycemic control in diabetic patients: role of insulin resistance.

Clin Lab 2014 ;60(3):441-7

Background: CA19-9 is considered a tumor marker. Reports have suggested higher CA19-9 levels in diabetic patients even with no malignancy. Our aim was to reveal the relation of CA19-9 with glycemic control in diabetic and non-diabetic subjects. For the first time we considered diabetes as an outcome based on a cut-off where the association of CA19-9 with diabetes is considerable.

Methods: The study was carried out at an outpatient metabolism clinic. A total of 422 consecutive participants were enrolled. Subjects with prior diagnosis of any cancer, renal, endocrine, or hepatic problems were not included. Age, gender, and medications as well as weight, height, and BMI were recorded. Creatinine, fasting plasma glucose (FPG), post-prandial plasma glucose (PPPG), fasting plasma insulin, HbA1c, C-peptide, HOMA-IR, and CA 19-9 were measured.

Results: In all, 266 (63.03%) subjects had recently been diagnosed with diabetes. CA19-9 was significantly higher in the diabetic group (16.73 +/- 13.83 vs. 11.93 +/- 11.42, p < 0.001). BMI, waist circumference, FPG, and HbA1c were higher in quartiles with greater CA19-9 levels. Number of diabetic subjects in each quartile had a stepwise increase (48%, 56%, 72%, and 77%, p < 0.01). FPG, PPPG, HbA1c, and HOMA-IR were directly correlated with CA19-9 levels independent of age, gender, and BMI. We presume the 10.83 U/mL value for CA19-9 to be the optimal cut-off in indicating diabetes status (sensitivity: 0.63, specificity: 0.55).

Conclusions: Otherwise normal diabetic subjects have greater CA19-9 values. CA19-9 should be interpreted with regard to diabetes status. We suggest that CA19-9 levels above 10.83 U/mL in the absence of other pathologies are in favor of glycemic impairments. CA19-9 values greater than 34.30 U/mL may accompany an 84% frequency of diabetic subjects especially in settings such as referral metabolism clinics. CA19-9 values of less than 6.46 U/mL are likely to rule out the presence of diabetes, especially while testing in general population.
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http://dx.doi.org/10.7754/clin.lab.2013.121243DOI Listing
April 2014

Combination of probiotics and antibiotics in the prevention of recurrent urinary tract infection in children.

Iran J Pediatr 2013 Aug;23(4):430-8

Pediatric Urology Research Center, Pediatric Center of excellence, Tehran University of Medical Sciences, Tehran, Iran.

Objective: We examined the preventive effect of probiotic and antibiotics versus antibiotics alone, in children with recurrent urinary tract infections (RUTI) in a preliminary randomized clinical trial.

Methods: Between March 2007 and April 2011, children with the history of RUTI and unilateral vesicoureteral reflux (VUR) were randomly assigned to receive concomitant probiotic and antibiotics (Lactobacillus acidophilus and bifidobacterium lactis, 10(7)/ml, as 0.25 ml/kg three times a day regimen in addition to Nitrofurantoin, 1mg/kg daily (group I). In group II, all children received conventional prophylactic antibiotics alone (Nitrofurantoin, 1 mg/kg daily). Randomization was performed via using the random numerals table in a 1:1 manner with stratification by sex, age and grade of reflux. The urine examinations were done monthly and the incidence of UTI was evaluated in these two groups.

Findings: Forty-one children (age: 8.3±3.1 years) in group I and 44 children (age: 8.0±3.0 years) in group II were compared. During the course of three years, 39% in group I and 50% of participants in group II experienced RUTIs (P=0.4). Incidences of UTI - febrile and afebrile - reduced in both groups without any significant differences after two years of prophylaxis. Also, incidence of afebrile UTIs did not significantly differ (0.51±1.30 and 0.81±1.41 respectively, P =0.3); however, the incidence of febrile UTIs in particular were lower in group I (0.00±0.00 versus 0.13±0.40, P =0.03) in the last year.

Conclusion: The consumption of probiotic and antibiotics in children with RUTI is safe and more effective in reducing the incidence of febrile UTI in comparison to prophylactic antibiotics alone.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883373PMC
August 2013

Prevalence of HIV infection and the correlates among homeless in Tehran, Iran.

Asian Pac J Trop Biomed 2014 Jan;4(1):65-8

Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Objective: To determine the prevalence of HIV infection among homeless men and women and the related risk behaviors in Tehran, Iran.

Methods: In 2007-2008, Tehran municipality stacked up 10672 homeless men and women for assessment of HIV and began collaboration with Iranian Research Center for HIV/AIDS (IRCHA) departments to conduct HIV infection prevalence surveys in homeless populations. The results were analyzed for associations with demographic information, family support, status of drug abuse and relation with family and friends.

Results: Overall HIV prevalence was 1.7% (95% confidence interval 1.4-1.9). Factors independently associated with HIV infection included history of using drugs [AOR 8.15 (4.86-13.67)], older age [AOR 1.80 (1.08-2.99) for 40-55 yr], occupation [AOR 1.64 (1.19-2.24) for unemployed], and no relation with family [AOR 1.82 (1.30-2.54)].

Conclusions: This study supports the idea that injection drug use is contributing to the increased spread of HIV among Iranian homeless. Harm reduction programs should be expanded, particularly among homeless injection drug users.
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http://dx.doi.org/10.1016/S2221-1691(14)60210-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819498PMC
January 2014

The emergence of drug resistant HIV variants and novel anti-retroviral therapy.

Asian Pac J Trop Biomed 2013 Jul;3(7):515-22

Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran.

After its identification in 1980s, HIV has infected more than 30 million people worldwide. In the era of highly active anti-retroviral therapy, anti-retroviral drug resistance results from insufficient anti-retroviral pressure, which may lead to treatment failure. Preliminary studies support the idea that anti-retroviral drug resistance has evolved largely as a result of low-adherence of patients to therapy and extensive use of anti-retroviral drugs in the developed world; however, a highly heterogeneous horde of viral quasi-species are currently circulating in developing nations. Thus, the prioritizing of strategies adopted in such two worlds should be quite different considering the varying anti-retroviral drug resistance prevalence. In this article, we explore differences in anti-retroviral drug resistance patterns between developed and developing countries, as they represent two distinct ecological niches of HIV from an evolutionary standpoint.
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http://dx.doi.org/10.1016/S2221-1691(13)60106-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3695575PMC
July 2013

Prevalence survey of infection with Treponema pallidum among HIV-positive patients in Tehran.

Asian Pac J Trop Biomed 2013 Apr;3(4):334-6

Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran.

Objective: To identify the frequency of syphilis among Iranian HIV-positive patients.

Methods: A cross-sectional study on the prevalence of syphilis and HIV co-infection among 450 patients diagnosed with HIV infection was conducted between 2004 and 2008 at Imam Khomeini hospital, Tehran, Iran. The lab tests including CD4 cell count, cerebrospinal fluid, veneral disease research laboratory (VDRL), fluorescent treponema antibody-absorption (FTA-Abs) and viral load were performed for all the patients. Data regarding medical history and their demographics were also collected.

Results: Of all 450 HIV-positive patients, 24 (5.3%) had a positive VDRL test and only two men had a FTA-Abs positive test which means 0.45% of them had a definite co-infection of syphilis. 65.3% of the HIV-positive patients were injection drug users that the co-infection prevalence of them was 0.7%. We did not find any patient with neurosyphilis.

Conclusions: Considering the increasing prevalence of HIV and also extensive use of highly active antiretroviral therapy in developing nations, the diagnosis of syphilis should be timely established using screening tests among such patients.
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http://dx.doi.org/10.1016/S2221-1691(13)60074-XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3634935PMC
April 2013

Adherence to anti-retroviral therapy and its determinants in HIV/AIDS patients: a review.

Infect Disord Drug Targets 2012 Oct;12(5):346-56

Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran.

Although Highly Active Anti-Retroviral Therapy (HAART) significantly reduced HIV/AIDS mortality, appropriate adherence level is recommended for viral suppression and therapeutic response in People Living with HIV/AIDS (PLWHA). In the most studies, adherence is defined as taking ≥95% of prescribed medications. Poor or non-adherence may lead to treatment failure and drug resistance. There is no golden standard for evaluation of adherence to medication and many measurement methods are used to assess adherence rate. Moreover, several determinants have been contemplated for adherence in different studies; however, the exact roles of some determinants are not well established. The goals of this review are to describe the adherence rates, to discuss the advantages and disadvantages of common adherence measurement methods, to examine significant correlations related to adherence and to recommend strategies for improving adherence in clinical care.
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http://dx.doi.org/10.2174/187152612804142251DOI Listing
October 2012

Anticonvulsive effect of atorvastatin on pentylenetetrazole-induced seizures in mice: the role of nitric oxide pathway.

Fundam Clin Pharmacol 2013 Aug 19;27(4):387-92. Epub 2012 Mar 19.

Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Atorvastatin has shown to possess neuroprotective, antiexcitotoxic, and antiepileptic effects besides its cholesterol-lowering properties. Nitric oxide (NO) may be responsible for a group of these effects. In the present study, a model of clonic seizure induced by pentylenetetrazole (PTZ) in male NMRI mice was used to investigate the anticonvulsive effects of atorvastatin through NO-dependent pathways. Atorvastatin (5 mg/kg) significantly increased the seizure threshold (P < 0.001). Moreover, L-arginine (a precursor of NO) significantly (P < 0.01) potentiated the anticonvulsive effects of subeffective doses of atorvastatin (1 mg/kg). Finally, L-NAME [L-arginine methyl ester dihydrochloride], a nonspecific NO synthase inhibitor, completely abolished the anticonvulsive properties of atorvastatin. Our findings demonstrated the role of atorvastatin as an anticonvulsive agent and showed the effects to be mediated through NO-related pathways.
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http://dx.doi.org/10.1111/j.1472-8206.2012.01038.xDOI Listing
August 2013

Safety and efficacy of Setarud (IMOD TM ) among people living with HIV/AIDS: a review.

Recent Pat Antiinfect Drug Discov 2012 Apr;7(1):66-72

Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran.

The broad use of highly active anti-retroviral therapy (HAART), especially in developing world, has been associated with several problems such as lactic acidosis, lipodistrophy, pancreatitis, hyperlipidemia, insulin resistance and hepatotoxicity. Extensive use of HAART has also resulted in emergence of resistant HIV variants. Thereby, a pressing need for development of novel and cost-effective agents arises from these limitations. Setarud (IMOD™) is a safe, naturally- derived immunomodulator that was introduced for treatment of HIV patients in Iran. It is prepared as a mixture of herbal extracts including Tanacetum vulgare (tansy), Rosa canina and Urtica dioica (nettle) in addition to selenium, flavonoids and carotenes. Tanacetum vulgare may relieve anti-inflammatory symptoms and Rosa canina defers blood glucose and cholesterol elevation. Extracts from Urtica dioica may prevent maturation of myeloid dendritic cells and reduce T cell responses. A significant rise of CD4 count was observed in HIV patients treated by IMOD™ in clinical trial phases, which could be explained by its immunomodulatory effects. Anti-oxidative activity of compounds in IMOD™ might play a role in the clinical outcomes of patients treated with this drug. Moreover, IMOD™ may show improving activity upon lipid profile and liver metabolism. According to studies on IMOD™, it seems that IMOD™ has minor side effects. IMOD™ with international publication number WO 2007/087825 A1 is an herbal extract which includes Rosa canina, Urtica dioica, Tanacetum vulgare, and selenium comprising a treatment by pulsed electromagnetic field of high frequency and is useful in treatment of HIV infection and AIDS.
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http://dx.doi.org/10.2174/157489112799829756DOI Listing
April 2012