PubMed Health⌕ Search

Biomedical subjects

Akbar Soltani

Publications and source records attributed to Akbar Soltani.

12 recordsLinked to original sources
PubMed2006

Preferred skeletal site for osteoporosis screening in high-risk populations.

OBJECTIVES: The current World Health Organization (WHO) definition of osteoporosis, which is based on densitometry of lumbar and femoral regions, is extensively used for decision-making in clinical practice. Discordance in diagnosis of osteoporosis using this definition is a known phenomenon. The aim of this study was to evaluate the impact of such discordance and to assess the diagnostic value of using one skeletal site for screening purposes as opposed to the two sites required in the WHO criteria. STUDY DESIGN: Data was collected from 4188 individuals (3848 female); mean age=53.4 years (standard deviation 11.8) referred to a community-based outpatient osteoporosis testing centre in Tehran, Iran. METHODS: Dual-energy X-ray absorptiometry (DXA) was performed on L1-L4 lumbar spine and total hip for all cases. The DXA results were categorized according to WHO criteria. Sensitivity for each site was calculated as number of cases with T-score < -2.5 at that site divided by the total number of cases with T-score < -2.5 at any site. RESULTS: Prevalence of osteoporosis diagnosis using lumbar DXA, femoral DXA, and WHO criteria (either of the sites) were 24.7%, 12.4%, and 27.8%, respectively. Sensitivity of lumbar DXA for diagnosis of osteoporosis (88.9%) was significantly higher than femoral DXA (44.6%, P<0.001); but this difference became non-significant for men > or = 60 and women > or = 70 (P=0.615 and P=0.077, respectively). Agreement of the procedures in different sites (kappa) was 0.40 (0.37 to 0.43). When proximal femur was considered as the reference, positive likelihood ratios of lumbar DXA to detect cases were 4.7 and 2.0 in younger and older groups, respectively. CONCLUSIONS: Concerning the high rate of discordance and low agreement between DXA results, the data obtained from each anatomical site cannot predict the condition of the other site. However, if use of a single assessment is intended for screening programs, public health authorities can develop different strategies for different age groups of their population. We propose lumbar DXA for the younger group (men < 60 and women < 70) and femoral densitometry for the older.

Absorptiometry, Photon↗
PubMed2006

Incidence and characteristics of falls leading to hip fracture in Iranian population.

An estimated one in three adults aged 65 years or older falls each year, making falls a major health concern. Hip fractures are the most serious consequences of falls in elderly people. Identifying the characteristics of falls leading to hip fracture may provide information about high risk individuals, environment, and activities useful for the development of intervention strategies. Little is known, however, about the incidence and characteristics of falls leading to hip fracture in Middle Eastern countries. Therefore, the authors presented data from the Iranian Multicenter Study on Accidental Injuries, a prospective population-based study conducted in 9 provinces of Iran in 2003. All the hospitals serving about 9.5 million people in the study area were prospectively surveyed for any incident injury resulting from accidental events. A total of 2,186 patients (1,372 male, 814 female) were admitted due to any injurious fall events, where 572 (26.2%) of them suffered a hip fracture. Annual incidence rates of injurious fall events and related hip fractures were 116.3 and 30.4 per 100,000 person-years, respectively. These figures were 237.1 and 93.6 per 100,000 person-years for people over the age of 50 years, respectively. 71% of fall injuries and 76% of hip fractures occurred indoors. Among 450 patients with hip fractures >or=50 years of age, 61.8% arose from a fall from standing height or less. Only 1 in these 450 hip fractures occurred at the time of recreational activity. In multivariate logistic regression analysis, no factor was an independent predictor of hip fractures comparing to other fall-related injuries among younger participants (>or=20 and <50 years). For older patients, falls from standing height or loss (odds ratio (OR) = 2.67), falls during walking (OR = 1.71), and falls on stairs (OR = 1.73) were detected as risk factors of hip fracture. Married persons and those falling from a ladder or other elevations were less likely to fracture their hip in this age group. Our data suggest that modification of the factors external to the homes is less likely to prevent more than a small proportion of fall-related hip fractures in Iran. Further studies on this topic have potential applications for developing preventive strategies.

Accidental Falls↗
PubMed2006

Primary hyperparathyroidism: a review of 177 cases.

BACKGROUND: We designed a comprehensive study to explore different aspects of primary hyperparathyroidism in a series of Iranian patients. Our study aimed to elucidate the demographic, pathologic, biochemical, and surgical findings of these patients. MATERIAL/METHODS: In a retrospective study from 1981 to 2003, we reviewed records of 177 patients operated on with the diagnosis of primary hyperparathyroidism in Shariati Hospital. Patients with secondary or tertiary hyperparathyroidism and those being re-operated were excluded. RESULTS: 88.1% of the lesions were adenoma, 9.6% hyperplasia, and 1 case proved to be carcinoma. In 1.7% of patients, no pathologic gland(s) were found. The majority of patients were female (female-to-male ratio: 5.5) and their mean age was 41.9+/-13.6 years. Most of the patients (77.6%) had mild hypercalcemia, and the mean calcium level was 11.2+/-0.8 mg/dl prior to surgery. Patients with hyperplasia had lower calcium levels than patients with adenoma 24 hours post-operation, with mean calcium levels of 8.1+/-1.2 mg/dl versus 9.03+/-1.2 mg/dl, respectively (p=0.02). Mean weight of adenomas was 4.1 gram (range 0.8-25 g). Adenomas were mostly (74%) located in lower parathyroid glands and 6.3% of them were ectopic. CONCLUSIONS: Primary hyperparathyroidism should be expected at younger ages in Iran. Parathyroid hyperplasia in a patient should alert the surgeon of the higher risk of postoperative hypocalcemia.

Adenoma↗
PubMed2006

The status of biochemical parameters in varying degrees of vitamin D deficiency.

Vitamin D (Vit D) is an essential element for the regulation of serum calcium, phosphate, and alkaline phosphatase (Alk Ph). Because the Vit D serum level is not usually measured directly, Vit D deficiency is diagnosed indirectly by changes in serum calcium, phosphate, and Alk Ph leves. The current study assessed the status of these biochemical parameters in subjects with different degrees of Vit D deficiency. We selected 1,210 subjects, between 20 and 69 years old, randomly from the Tehran population. Subjects with diseases or medications that modified bone metabolism were excluded from the study. Serum 25(OH) D, calcium, phosphate, Alk Ph, and parathyroid hormone (PTH) levels were measured and the status of these biochemical parameters was compared in subjects with different degrees of Vit D deficiency. Vit D deficiency was diagnosed in 79.6% of the subjects. Different degrees of Vit D deficiency were classified as follows: group 1, severe; group 2, moderate; and group 3, mild. Serum PTH levels in the Vit D-deficient groups were significantly higher than that in group 4 (normal Vit D). Serum calcium and phosphate levels in groups 1 and 2 were significantly lower than those in groups 3 and 4. No significant difference was seen in serum Alk Ph in the groups with different degrees of Vit D deficiency. The sensivity for at least one biochemical variable (calcium, phosphorus, or Alk Ph) for the detection of severe, moderate, and mild Vit D deficiency was 24.2%, 13.8%, and 6%, respectively. When the serum 25(OH) D level was reduced to less than 25 nmol/l (groups 1 and 2), the effects of Vit D deficiency on calcium and phosphate levels were obvious. Therefore, the usual biochemical parameters (calcium, phosphate, Alk Ph) alone do not have sufficient sensitivity to detect mild deficiency of Vit D.

Adult↗
PubMed2005

Normative data of bone Mineral Density in healthy population of Tehran, Iran: a cross sectional study.

BACKGROUND: Osteoporosis is a major problem and is a hidden epidemic disease in the world. Early diagnosis by measurement of Bone Mineral Density (BMD) and treatment can prevent and reduce disease complications, especially fractures. As there is no comprehensive study in Iran, this study designed to assess BMD discrepancy in 20-69 yr Tehran population as well as prevalence of osteoporosis and osteopenia. METHODS: 553 people (34% men, 66%women) from 50 Blocks in Tehran randomly selected. The assessment of BMD in spine and femur region performed through DXA method. All subjects clinically examined and their BMIs determined. RESULTS: The average spinal BMD score in men were more than in women. The peak bone mass of spine bone both in men and women occurred during 20-29 yr and reduction began from the age of 40. At the age of 60 to 69, loose of bone density was 19.6% in lumbar spine and 18.5% in femur of women and also 7.9% in lumbar spine and 14.6% in femur of men. Prevalence of osteoporosis in this age group in lumbar spine and femur was 32.4% and 5.9% in women and 9.4% and 3.1% in men respectively. CONCLUSION: In all age groups, peak bone mass was lower than European or American population, whereas the rate of bone loss was as much as the some population and actually this process justifies the prevalence of osteoporosis and osteopenia in Tehran population.

Adult↗
PubMed2005

Discordance in diagnosis of osteoporosis using spine and hip bone densitometry.

BACKGROUND: Diagnostic discordance for osteoporosis is the observation that the T-score of an individual patient varies from one key measurement site to another, falling into two different diagnostic categories identified by the World Health Organization (WHO) classification system. This study was conducted to evaluate the presence and risk factors for this phenomenon in a large sample of Iranian population. METHODS: Demographic data, anthropometric measurements, and risk factors for osteoporosis were derived from a database on 4229 patients referred to a community-based outpatient osteoporosis testing center from 2000 to 2003. Dual-energy X-ray absorptiometry (DXA) was performed on L1-L4 lumbar spine and total hip for all cases. Minor discordance was defined as present when the difference between two sites was no more than one WHO diagnostic class. Major discordance was present when one site is osteoporotic and the other is normal. Subjects with incomplete data were excluded. RESULTS: In 4188 participants (3848 female, mean age 53.4 +/- 11.8 years), major discordance, minor discordance, and concordance of T-scores were seen in 2.7%, 38.9% and 58.3%, respectively. In multivariate logistic regression analysis, older age, menopause, obesity, and belated menopause were recognized as risk factors and hormone replacement therapy as a protective factor against T-score discordance. CONCLUSION: The high prevalence of T-score discordance may lead to problems in interpretation of the densitometry results for some patients. This phenomenon should be regarded as a real and prevalent finding and physicians should develop a particular strategy approaching to these patients.

Journal Article↗
PubMed2005

What constitutes clinical evidence? A dynamic approach to clinical diagnosis.

The evidence-based diagnostic approach appreciates physicians' inability to eliminate uncertainties in clinical medicine. Likelihood ratios can be a dynamic tool for refining probability in clinical settings. Family physicians can use these parameters for better estimation of the strength of clinical evidence.

Diagnosis↗
PubMed2004

Vitamin D deficiency and causative factors in the population of Tehran.

BACKGROUND: There are multiple studies in different countries regarding the prevalence of vitamin D deficiency. These studies showed high prevalence of vitamin D deficiency in Asian countries. This study tries to elucidate the prevalence of vitamin D deficiency and its influencing factors in population of Tehran. METHODS: 1210 subjects 20-64 years old were randomly selected. 25 (OH) D serum levels were measured. Duration of exposure to sunlight, the type of clothing and level of calcium intake and BMI were quantified based on a questionnaire. RESULTS: A high percentage of vitamin D deficiency was defined in the study population. Prevalence of severe, moderate and mild Vitamin D deficiency was 9.5%, 57.6% and 14.2% respectively. Vitamin D serum levels had no significant statistical relation with the duration of exposure to sunlight, kind of clothing and BMI. Calcium intake in the normal vitamin D group was significantly higher than the other groups (714.67 +/- 330.8 mg/day vs 503.39 +/- 303.1, 577.93 +/- 304.9,595.84 +/- 313.6). Vitamin D serum levels in young and middle aged females were significantly lower than the older group. CONCLUSIONS: Vitamin D deficiency has a high prevalence in Tehran. In order to avoid complications of vitamin D deficiency, supplemental dietary intake seems essential.

Adult↗
PubMedDate not supplied

Bone mineral density is related to blood pressure in men.

The aim of this study was to determine the relationships between bone mineral density (BMD) and blood pressure in 214 men, age 20-76. BMD measurements were done by dual X-ray absorptiometry using a Lunar DPXMD densitometer at the lumbar spine (L2-L4) and different femoral regions. Systolic (SBP) and diastolic (DBP) blood pressure were measured using an MPC-350 sphygmomanometer. Physicians gathered demographic data and participants' dietary intake of calcium were determined by using food frequency questionnaires. After adjusting for age, body mass index, dietary calcium, and exercise history, multiple linear regression models showed that DBP was negatively related to femoral neck BMD (beta = -0.145, P = 0.032) and just shy of significant association with femoral neck BMC (beta = -0.114, P = 0.079). SBP was correlated with femoral neck (r = -0.171, P = 0.012) and Ward's (r = -0.186, P = 0.006) BMD but not after adjusting for possible confounders. Further studies are needed to determine whether elevated blood pressure is causally related to the development of low bone mass.

Absorptiometry, Photon↗
PubMedDate not supplied

Peak bone mass of Iranian population: the Iranian Multicenter Osteoporosis Study.

Osteoporosis is a major public health problem in the Western countries and is projected to have a similar impact in the Middle East. It has been suggested that peak bone mineral density (BMD), a major determinant of osteoporotic fractures later in life, may be lower in this part of the world compared with the Western world. The purpose of the Iranian Multicenter Osteoporosis Study was to determine peak bone mass in a randomly chosen sample of healthy Iranian subjects. A total of 5201 participants (2340 males, mean age 42.7+/-13.8) were recruited based on randomized clustered sampling from all regions of five major cities across the country. In women, peak lumbar BMD (1.182+/-0.127 g/cm2) occurred in the 29- to 33-yr age group, whereas peak total femur BMD (1.006+/-0.126 g/cm2) occurred in the 32- to 36-yr age group. In men, peak lumbar BMD (1.181+/-0.153 g/cm2) and femoral BMD (1.096+/-0.159 g/cm2) both occurred in the 20- to 24-yr age group. When standardized to mg/cm2 units using established formulas, Iranian peak bone mass values are comparable with that of Western countries and are generally higher than that of Eastern Asian and Middle Eastern countries.

Adult↗
PubMedDate not supplied

Towards evidence-based diagnosis in developing countries: the use of likelihood ratios for robust quick diagnosis.

Evidence-based medicine (EBM), a relatively new paradigm for clinical practice, stresses the use of research evidence in diagnostic evaluations and therapeutic interventions. Financial and instrumental scarcities in developing countries require cliniciansto visit patients under time constraints, especially in outpatient clinical settings. In this situation, clinicians need diagnostic approaches that reduce both diagnostic time and errors. This article discusses what EBM can do to help physicians in this regard. For quick history taking and physical examination, all physicians utilize certain "key pointers" (signs or symptoms or paraclinical tests that influence the pretest estimation of the disease prevalence). EBM emphasizes that these key pointers are nothing but signs or symptoms with significant likelihood ratios. Likelihood ratios are a practical means of interpreting clinical tests; physicians can derive likelihood ratios from critically appraised studies. The use of clinical tests with sizeable likelihood ratios and with likelihood ratios for key pointers from independent body systems may significantly decrease both diagnostic time and errors. EBM could be a significant aid to physicians in the developing world.

Ambulatory Care↗