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author:("malenka, Ali")
1.  Metabolic syndrome and its components associated with chronic kidney disease 
There is limited information on the relationship between metabolic syndrome (MetS) and chronic kidney disease (CKD) in the Iranian population, a group that has a high prevalence of CKD and obesity. The aim of present study was to determine the relationship between MetS and CKD in West of Iran.
Materials and Methods:
A total of 800 subjects aged more than 35 years admitted from 2011 to 2013 were enrolled in the study. MetS was defined based on the Adult Treatment Panel III criteria, and CKD was defined from the Kidney Disease Outcomes Quality Initiative practice guidelines. Waist circumference and body mass index were calculated, as well, blood samples were taken and lipid profile, plasma glucose levels, and serum creatinine were measured. Data were analyzed with SPSS version 17 (SPSS Inc., Chicago, IL, USA).
CKD was seen in 14.8% patients with MetS and 8.3% individuals without MetS. MetS was associated with an increased odds ratio (OR) for a glomerular filtration rate <60 ml/min/1.73 m2 (OR: 1.91; 95% confidence interval [CI]: 1.22-2.99; P = 0.004). Individuals with 2, 3, 4, and 5 components of the MetS had an increased OR for CKD: 2.19 (95% CI: 0.95-3.62), 2.65 (95% CI: 1.03-4.71), 2.86 (95% CI: 1.08-5.53), and 5.03 (95% CI: 1.80-8.57), respectively, compared with individuals with none of the components.
We found a high prevalence of CKD in patients with MetS compared with the subject without MetS. Our observations raised major clinical and public health concerns in Iran, where both the MetS and kidney diseases are becoming common.
PMCID: PMC4590201  PMID: 26487875
Chronic kidney disease; end-stage renal disease; metabolic syndrome; serum creatinine
2.  Metabolic Syndrome and Inflammatory Biomarkers in Adults: A Population-Based Survey in Western Region of Iran 
There is evidence that inflammation may be involved in pathogenesis of MetS. Inflammatory biomarkers are moving to the forefront as the potent predictors of MetS.
The present study aimed to evaluate the association between MetS and some inflammatory biomarkers.
Patients and Methods:
This community-based cross-sectional study was conducted on 800 subjects aged above 35 years selected through random sampling in Borujerd (west of Iran) from 2011 to 2013. MetS was defined based on ATP III criteria and the subjects were divided into two groups (MetS and non-MetS groups). Waist circumference and Body Mass Index (BMI) were calculated. In addition, blood samples were taken and C-Reactive Protein (CRP), lipid profile, Fasting Blood Sugar (FBS), and Bleeding Time (BT) were measured. Then, the correlations between MetS and the above-mentioned variables were estimated. After all, the data were entered into the SPSS statistical software (v. 17) and analyzed using T-test, chi-square, median test, and spearman’s rank correlation.
In this study, 344 subjects (43%) met the ATP III criteria. The results showed a significant difference between MetS and non-MetS groups regarding BMI, white blood cell, total cholesterol, LDL, platelet, and high-sensitivity CPR (hs-CRP) (P < 0.0001, P = 0.040, P < 0.0001, P < 0.0001, and P = 0.045, respectively). Besides, waist circumference, Triglyceride (TG), FBS, and systolic and diastolic blood pressure were significantly higher, while HDL was significantly lower in the MetS group (P < 0.0001).
The incidence rate of MetS in our survey was higher compared to the previous reports. In addition, this incidence rate was higher in females in comparison to males. The results also showed a significant correlation between inflammatory biomarkers and MetS and that the higher levels of hs-CRP were associated with higher rate of MetS.
PMCID: PMC4302503  PMID: 25614859
Metabolic Syndrome; C-Reactive Protein; Body Mass Index; Waist Circumference
3.  Normal range of bleeding time in urban and rural areas of Borujerd, west of Iran 
ARYA Atherosclerosis  2014;10(4):199-202.
Bleeding time (BT) is the oldest and simplest test for assessing the platelets (Plts) function. BT can affect by several factors such as race and diet, which has a wide reference range. The aim of this project is to determine the normal range of BT in Borujerd, Iran. Determining the normal range of BT can help us to modify the definition of bleeding disorder and aspirin resistance.
This was cross-sectional study carried out in 2011-2012. Subjects with a history of coagulation disorders or a positive family history of coagulation disorders, consumption of anti-Plts, anti-histamines, and phenothiazine in the previous month and subject with Plt less than 150,000 were excluded. The samples were 505 volunteers who were referred from 16 urban and 9 rural clusters to research center. BT of the samples was determined according to Ivy simplate method considering national standard protocol in the selected persons. Normal range was calculated as mean ± 2 standard deviation.
Of 505 volunteers, 50.4% were female. The range of BT was 2.8-2.95 min with mean of 2.79 ± 0.78 min. Range and mean of BT in women was 2.83-3.06 min and 2.88 ± 0.87 min, and range and mean of BT in men was 2.7-2.9 min and 2.69 ± 0.67 min; this difference was significant (P = 0.012). BT in urban and rural participants was 2.78 ± 0.79 and 2.77 ± 0.73 min. There was no significant difference between BT in urban and rural participants.
The normal range of BT in Boroujerd was in the lower limit of the normal universal range. In this study, BT was significantly different in both genders, but its correlation with age, blood group, and place of residency was not significant.
PMCID: PMC4173314  PMID: 25258635
Bleeding Time; Blood Platelet; Iran
4.  Correlation Between Hypertension, C-Reactive Protein and Serum Uric Acid With Psychological Well-being 
Multiple population-based human studies have established a strong association between increasing levels of serum C-reactive protein, uric acid and subsequent development of hypertension.
We aimed to investigate the association between mental well-being with presence of hypertension, hyperuricemia and hs-CRP levels. ‬‬
Patients and Methods:
This was a cross sectional study of 801 individuals aged 35-85 years old in Broujerd, Iran, included by randomized cluster sampling. General Health Questionnaire (GHQ-12) for assessing mental health/distress level, MONICA standard questions for evaluating hypertension history, serum hs-CRP and Serum Uric Acid (SUA) were evaluated Data were analyzed by appropriate statistical test such as chi-square, T-test and correlation.
One hundred eighty five patients (23.1%) had high distress/minor psychiatric disorders. SUA had significant association with hypertension (r = 0.64, P = 0.034). No significant relation was observed between hs-CRP and hypertension. The correlation between GHQ and hs-CRP was not significant but a weak and negative correlation was found between GHQ and SUA SUA (P = 0.012, r = -0.089).
The weak and strong correlation among these parameters indicate that mental wellbeing relays on physical wellness and interact with each other; therefore, controlling hypertension along with uric acid control may effect mental health of any kind of patients.
PMCID: PMC4166100  PMID: 25237581
Mental Health; Hypertension; C - Reactive Protein; Uric Acid
5.  Fine Needle Aspiration: An Atraumatic Method to Diagnose Head and Neck Masses 
Trauma Monthly  2013;18(3):117-121.
Patients presenting with a mass require tissue biopsy for histological diagnosis and treatment. Fine needle aspiration (FNA) is offered as an atraumatic, well tolerated, and inexpensive method for obtaining a biopsy from these lesions.
In this study we evaluated the accuracy of FNA as an atraumatic method among patients with nonthyroidal masses for diagnosis of neoplastic masses compared to open surgery.
Patients and Methods
In a cross-sectional study, 65 patients with a head and neck masses (nonthyroidal) referred to us from 2004 to 2009. Those who had both FNA and open biopsy (the gold standard) were assessed for specificity, sensitivity, positive and negative predictive values of FNA in diagnoses.
Sixty-five cases with both definite diagnoses of open biopsy and FNA were assessed. The mean (± standard deviation) age of patients was 39.96 ± 19.69 years (range 10 to 82 years). Twenty-five (40.8%) subjects were categorized as malignant neoplasms, 16 (19.4%) as benign neoplasms, and 24 (39.8%) as non-neoplastic lesions. The sensitivity, specificity, positive and also negative predictive values of FNA in the diagnosis of neoplastic masses were 95%, 85%, 92.68%, and 91.66% respectively, and the diagnostic accuracy was 92.3%.
It seems that FNA is a useful atraumatic diagnostic technique with a high diagnostic accuracy which can provide a highly sensitive diagnosis with low false positive diagnoses in patients with nonthyroidal masses.
PMCID: PMC3864395  PMID: 24350168
Diagnosis; Biopsy, Fine-Needle; Sensitivity and Specificity; Predictive Value of Tests
6.  Large Scale Generation and Characterization of Anti-Human CD34 Monoclonal Antibody in Ascetic Fluid of Balb/c Mice 
Advanced Pharmaceutical Bulletin  2013;3(1):211-216.
Purpose: Monoclonal antibodies or specific antibodies are now an essential tool of biomedical research and are of great commercial and medical value. The purpose of this study was to produce large scale of monoclonal antibody against CD34 in order to diagnostic application in leukemia and purification of human hematopoietic stem/progenitor cells. Methods: For large scale production of monoclonal antibody, hybridoma cells that produce monoclonal antibody against human CD34 were injected into the peritoneum of the Balb/c mice which have previously been primed with 0.5 ml Pristane. 5 ml ascitic fluid was harvested from each mouse in two times. Evaluation of mAb titration was assessed by ELISA method. The ascitic fluid was examined for class and subclasses by ELISA mouse mAb isotyping Kit. mAb was purified from ascitic fluid by affinity chromatography on Protein A-Sepharose. Purity of monoclonal antibody was monitored by SDS -PAGE and the purified monoclonal antibody was conjugated with FITC. Results: Monoclonal antibodies with high specificity and sensitivity against human CD34 by hybridoma technology were prepared. The subclass of antibody was IgG1 and its light chain was kappa. Conclusion: The conjugated monoclonal antibody could be a useful tool for isolation, purification and characterization of human hematopoietic stem cells.
PMCID: PMC3846064  PMID: 24312838
Monoclonal antibody; Large Scale generation; Ascetic fluid; Human CD34
7.  Sézary syndrome, Kaposi sarcoma and generalized dermatophytosis 15 years after sulfur mustard gas exposure 
The relationship between compromised immune system and the development of malignancy, generalized dermatitis, and infection after sulfur mustard gas exposure has been established.
Main observation
We introduce a 58-year-old man with an abrupt, de novo and erythrodermic eruption in 2002 that was previously exposed to sulfur mustard during the Iran – Iraq war in 1987. Six weeks after the onset of diffuse eruption, he developed papules on the glans penis and generalized dermatophytosis. A biopsy of his eruption was consistent with cutaneous T-cell lymphoma/Sézary syndrome. A complete blood count demonstrated leukocytosis, eosinophilia and atypical lymphocytosis. Subsequently, Sézary syndrome was confirmed and T-cell count with increased CD4/CD8 in flow cytometry. The biopsy of his penile papules was consistent with Kaposi's sarcoma.
These findings suggest a causative relationship between sulfur mustard gas exposure, cutaneous T cell lymphoma and immune compromised state with opportunistic infections.
PMCID: PMC3470796  PMID: 23091586
cutaneous T-cell lymphoma; genotoxins; genital; Kaposi's sarcoma; Sezary syndrome; war
8.  Determination of normal range of bleeding time in rural and urban residents of Borujerd, Iran: A pilot study 
ARYA Atherosclerosis  2012;8(3):136-142.
Bleeding time test is used to assess the function of platelets in human body. The aim of this project was thus to estimate the sample size required to determine the normal range of bleeding time (BT) in Borujerd (a city in Iran). A pilot study was designed to determine the range of normal BT in a small group of normal people. The total sample size for the next study was then calculated according to the results.
In order to determine the sample size, a total of 33 volunteers participated in this study. The normal range of BT was determined by Ivy method. Written informed consents were obtained from all participants and their clinical history was recorded. The sampling was performed once for each participant. However, the results were interpreted by two observers. The study protocol was approved by the Ethics Committee of the research center at Lorestan University of Medical Sciences (Iran).
In this study, 33 normal participants (20 women and 13 men) were divided into four age groups of 35-44, 45-54, 55-64 and over 64 years old. Maximum and minimum BTs in men were 209 (in the age group of 35-44 years) and 150 seconds (in the age group of over 64 years), respectively. On the other hand, the corresponding values in women were 194 (in 55-64 year-old subjects) and 145 seconds (in women over 64 years of age). Considering the aforementioned results, the total sample size for the next study was determined to be 580 normal subjects by two-sample t-test power analysis at a power of 0.91816.
There was a significant difference between the normal range of BT in participants of Borujerd and previously recorded range in other studies. Moreover, normal BT in men decreased by aging. This study did not show any special order in increasing or decreasing BT in women.
PMCID: PMC3557001  PMID: 23358456
Platelet; Bleeding Time; Ivy Method; Gender
9.  Third-Degree Heart Block in Thalassemia major: A Case Report 
Iranian Journal of Pediatrics  2012;22(2):260-264.
First and second-degree heart blocks are partly common rhythm disorders in thalassemic patients but complete heart block is a very rare complication of iron overload cardiomyopathy.
Case Presentation
This 15-year-old boy, a known case of major β-thalassemia was admitted to our emergency unit with dyspnea and cough because of decompensated heart failure. The electrocardiogram showed complete heart block with junctional escape rhythm. Interestingly, his previous electrocardiogram taken 2 months earlier, had some PVC and second degree, Mobitz type 1 (Wenckebach) heart block. After improvement of dyspnea and control of blood pressure in normal range, the patient was referred to ER. A dual-chamber permanent pacemaker was implanted and his symptoms improved, but he died 24 days after discharge from hospital.
We present a rare case of complete heart block after a second-degree (Mobitz 1) heart block that was due to severe iron overload cardiomyopathy.
PMCID: PMC3446065  PMID: 23056897
β-Thalassemia; Arrhythmia; Iron overload; Cardiomyopathy
10.  Evaluation of fibrinolytic medical therapy for patients with acute myocardial infarction 
ARYA Atherosclerosis  2012;8(1):46-49.
Fibrinolytic therapy is the standard therapeutic method for patients with acute myocardial infarction (AMI). This study endeavored to assess the delay in arrival to the emergency department and door to needle time for thrombolytic therapy.
This study was conducted on 80 patients with AMI whom referred to our clinic from January 2009 to January 2010. We measured time of arrival, needle time and door to needle time for all patients. Moreover, the relations of these times to some variables such as age, gender and the referred shift of emergency department personnel were calculated.
A total of 80 patients, 62 (77.5%) male and 18 (22.5%) female were evaluated for thrombolytic therapy. The arrival time of overnight shifts was 14.59 ± 1.23 minutes shorter than other shifts. The median door to needle time was 46.56 minutes and the mean time of the onset of chest pain to arrival at the emergency department was 19.44 minutes. Seventy-two patients (90%) received fibrinolytic therapy within the first 30 minutes of arrival. The needle time was significantly longer in the night shift (P < 0.05) (between 8 to 14 minutes), while the time of receiving Streptokinase therapy in the other shifts was not meaningfully different. Finally there was a statistically significant difference between the referred shifts and needle time (P < 0.05).
Despite our good results for door to needle time, to improve and attain the gold standard’s limits in administering fibrinolytic therapy, improvement of policies like training the personnel to shorten this time is recommend.
PMCID: PMC3448456  PMID: 23056101
Fibrinolytic Therapy; Door to Needle Time; Acute Myocardial Infarction
11.  Nifedipine, Captopril or Sublingual Nitroglycerin, Which can Reduce Blood Pressure the Most? 
ARYA Atherosclerosis  2011;7(3):102-105.
Hypertension (HTN) is one of the most important problems in all parts of the world. Although the disease is usually asymptomatic, its diagnosis and treatment are easy. The aim of this study was to compare the effect of Nifedipine (Adalat®), Captopril and sublingual Nitroglycerin on reducing blood pressure (BP).
This study was a parallel group randomized controlled trial. From the patients referred to our heart clinic, 120 patients with severe HTN were enrolled in the study. The patients were randomly allocated into 3 groups A, B, and C. The patients were advised to use 5 drops of Adalat in group A, Captopril 25 mg sublingually in group B, and 1 sublingual Nitroglycerin pearl in group C. The BP was measured every 20 minutes during one hour.
Systolic BP was reduced significantly by Adalat and Captopril compared with sublingual Nitroglycerin in the 20th, 40th and 60th minutes (P = 0.001), but there was no significant difference between Adalat and captopril in reducing systolic BP. In addition, the result of reducing diastolic BP was not significantly different among the three groups.
We saw the same effect on reducing BP by Captopril, Adalat, and sublingual Nitroglycerin. Among these three drugs, the side effects of Captopril were the least frequent. Adalat caused headache and flushing. Thus, it seems Captopril can be used instead of Adalat in medical centers.
PMCID: PMC3347854  PMID: 22577455
Adalat; Captopril; Nitroglycerin; Severe Hypertension
12.  Prevalence and causes of visual impairment and blindness in Sistan‐va‐Baluchestan Province, Iran: Zahedan Eye Study 
To determine the prevalence and causes of visual impairment and blindness in the Sistan‐va‐Baluchestan Province of Iran.
A population‐based cross‐sectional study with a multistage cluster sampling technique was used to identify the study subjects. Visual acuity (VA) was defined for all participants aged ⩾10 years. Participants with a VA of <20/60 were examined by an ophthalmologist to determine the causes of low vision or blindness.
5446 (84.0%) of the invited people were examined. The prevalence of visual impairment (VA <20/60) was 6.81% (95% CI 5.91% to 7.71%) and of bilateral blindness (VA <3/60) was 0.79% (95% CI 0.50% to 1.08%). Visual impairment increased with age and illiteracy. Bilateral blindness doubled in women aged >40 years. The causes of visual impairment and blindness were cataract (37.7%), corneal opacity (15.0%), amblyopia (15.0%), glaucoma (5.7%) and hyperopia (5.0%). 39.5% of the visual impairment cases were potentially curable.
The estimated magnitude of visual impairment and blindness was much higher than our expectations. Further investigation of the pattern of vision loss in women and children, particularly as a result of trachoma and amblyopia, is warranted. Implementation of measures to treat curable cases of the study population can improve the situation in the region dramatically.
PMCID: PMC1954767  PMID: 17124245

Results 1-12 (12)