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Hossein Bahrami

Publications and source records attributed to Hossein Bahrami.

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

Obesity and hypertension in an Iranian cohort study; Iranian women experience higher rates of obesity and hypertension than American women.

BACKGROUND: Once considered as the main public health problem in developed countries, obesity has become a major problem throughout the world and developing countries, like Iran, are joining the global obesity pandemic. We determined the prevalence of overweight, obesity, and hypertension in a large cohort of Iranians and compared age-adjusted rates with the rates in the US. METHODS: Golestan Cohort Study is a population-based study of 8,998 men and women, aged 35-81 years, from urban and rural areas. Anthropometric parameters were measured by interviewers. Prevalence rates were directly adjusted to the 2000 United States standard population. RESULTS: The age-adjusted prevalence rates of overweight (BMI > or = 25 kg/m2) and obesity (BMI > or = 30 kg/m2) in this Iranian population were 62.2% and 28.0%, respectively. Both overweight and obesity were more common in women than men. Age-adjusted prevalence of overweight was significantly higher in Iranian women compared to the American women (68.6% vs. 61.6%), while the age-adjusted prevalence of obesity is closer in these two populations (34.9% vs. 33.2%). Iranian men-compared to American men-had significantly lower age-adjusted prevalence of overweight (53.7% vs. 68.8%) and obesity (16.2% vs. 27.5%). Age-adjusted prevalence of hypertension was higher in Iranian women than American women (35.7% vs. 30.5%). Diabetes mellitus was reported in 6.2% of participants. Mean waist-to-hip ratio (WHR) among women was 0.96. Smoking rates in men and women were 33.2% and 2.2%, respectively. CONCLUSION: The prevalence of obesity, overweight, and hypertension in Iran is as high as the US. However, Iranian women are more obese than American women and Iranian men are less obese than their American counterparts. This discrepancy might be due to the low rate of smoking among Iranian women. Iranian women have higher mean WHR than what WHO has defined in 19 other populations.

Adult↗
PubMed2006

Lutein supplementation in retinitis pigmentosa: PC-based vision assessment in a randomized double-masked placebo-controlled clinical trial [NCT00029289].

BACKGROUND: There is no generally accepted medical or surgical treatment to stop the progressive course of retinitis pigmentosa. Previous studies have suggested lutein as a potential treatment with positive effects on macular pigment density. The objective of this study was to examine the effect of lutein supplementation on preservation of visual function in patients with retinitis pigmentosa (RP) METHODS: In a double-masked randomized placebo-controlled phase I/II clinical trial with a cross-over design, 34 adult patients with RP were randomized to two groups. One group, consisted of 16 participants, received lutein supplementation (10 mg/d for 12 wks followed by 30 mg/d) for the first 24 weeks and then placebo for the following 24 weeks, while the other group included 18 participants for whom placebo (24 weeks) was administered prior to lutein. Visual acuity, contrast sensitivity, and central visual field were measured at different illumination levels at baseline and every week using a PC-based test at home. RESULTS: For visual acuity (VA) at normal illumination level, treatment with lutein reduced logMAR, i.e. improved VA, but this effect was not statistically significant. The changes in normal (100%), low (4%), and very low (0.1%) illumination log CS were not statistically significant (p-values: 0.34, 0.23, and 0.32, respectively). Lutein had a statistically significant effect on visual field (p-value: 0.038) and this effect increased in the model assuming a 6-week delay in effect of lutein. Comparing the development of vision measures against the natural loss expected to occur over the course of 48 weeks, most measures showed reduced decline, and these reductions were significant for normal illumination VA and CS. CONCLUSION: These results suggest that lutein supplementation improves visual field and also might improve visual acuity slightly, although these results should be interpreted cautiously. As a combined phase I and II clinical trial, this study demonstrated the efficacy and safety of lutein supplementation.

Contrast Sensitivity↗
PubMed2006

Causal inference in primary open angle glaucoma: specific discussion on intraocular pressure.

OBJECTIVES: As the first part of a comprehensive review of the concept of causal inference in epidemiology, this article explains how causal inference is established in epidemiology and applies these methods to evaluate the evidence in favor or against the causal association between intraocular pressure (IOP) and primary open angle glaucoma (POAG) as an example. METHODS: After an introduction to causal inference in epidemiology and general guidelines for assessment of the causal relationship, the association between IOP and POAG will be evaluated in the context of these guidelines and the categories suggested by the Surgeon General's report. RESULTS: The literature indicates a consistent strong association between IOP and POAG and there is no strong evidence against temporal precedence. The association is biologically plausible, coherent with scientific principles, and has noticeable biological gradient. However, it seems that IOP is not specific for POAG and vice versa. CONCLUSION: Despite the absence of specificity, we conclude that the evidence is sufficient to infer a causal relationship between IOP and POAG. In sum, based on the literature and our current knowledge of glaucoma, currently most competing causes are not strong enough to confront the causal role of IOP.

Causality↗
PubMed2006

Causal models in primary open angle glaucoma.

OBJECTIVES: To apply three of the most common epidemiologic causal models for glaucoma and explain the issues pertaining to the use of them. METHODS: Three causal models will be explained: (1) counterfactual model, (2) graphical model, and (3) sufficient-component causal model. Using literature search and experts' opinions these models will be applied in glaucoma. RESULTS: Introducing the counterfactual model, as one of the most important quantitative causal models and formalizes the concepts of cause and effect, this article emphasizes the limitations with the use of this model for glaucoma. Explaining causal diagram, as a useful qualitative tool that provides a lucid depiction of the assumptions concerning a causal pathway, this article provides a working causal diagram for glaucoma based on the evidence in the literature and experts' comments. In addition, the limitations in developing appropriate causal diagrams for glaucoma are discussed. Finally, the sufficient-component causal models and their importance in portraying the mechanics of causal interactions will be discussed. CONCLUSION: Paucity of evidence is the main issue with the use of causal models for glaucoma. This article calls for convergent review of different theories and different pieces of evidence that can enable us to apply different causal models for glaucoma.

Causality↗
PubMed2005

Clinical course of ulcerative colitis in patients with and without primary sclerosing cholangitis.

BACKGROUND AND AIM: We noticed in our practice that patients with ulcerative colitis (UC) who have developed primary sclerosing cholangitis (PSC) experience a milder course of colonic disease. Our objective in this study was to define whether or not there is any difference between UC activity and its course in patients with and without PSC. METHODS: Nineteen patients with UC and PSC (eight male, mean age 25 years) were enrolled. To every patient with UC and PSC, three patients with UC alone (total of 57 patients, 28 male, mean age 24 years) matched for age at onset, duration of the disease and extension of colonic disease were selected as the control group. We used number of hospitalizations due to activity of UC and number of short corticosteroid administrations in various years of follow-up as variables indicating course and severity of the colonic disease in this period. For comparing trends of UC activity between two groups, we used repeated measures two-way analysis of variances. RESULTS: Mean duration of follow up in case and control groups was 12.2 +/- 5.7 and 11.4 +/- 4.9 years, respectively. Two groups had no significant difference in use of sulfasalzine or aminosalicylates. Number of hospitalizations and courses of steroid therapy because of UC activity decreased significantly over time (P < 0.000) in both groups, and it was significantly higher in controls than in cases (P = 0.045 and 0.032, respectively). CONCLUSIONS: Development of PSC in patients with UC might have a positive effect on colonic disease. Further investigations to evaluate the basis of this improvement are warranted.

Adolescent↗
PubMed2005

Effects of indomethacin on viral replication markers in asymptomatic carriers of hepatitis B: a randomized, placebo-controlled trial.

OBJECTIVES: Previous studies have suggested some benefits of nonsteroidal antiinflammatory drugs (NSAIDs) use in patients with chronic viral hepatitis. We evaluated potential effects of indomethacin in asymptomatic carriers of hepatitis B surface antigen (HBsAg). DESIGN: Randomized, placebo-controlled, double-masked clinical trial. METHODS: One hundred and twelve patients who were confirmed to be HBsAg carriers for at least 6 months and had normal liver function tests, normal abdominal sonography, and no sign of cirrhosis were randomly assigned into two groups. One group (56 participants, mean age (+/-SD) 31.7 (+/-9.6) yr, 29 male, mean serum alanine aminotransferase (ALT) (+/-SD) 24.9 (+/-9.2)) received indomethacin capsules (25 mg) three times daily and the other group (56 participants, mean age (+/-SD) 33.8 (+/-10.2) yr, 33 male, mean serum ALT (+/-SD) 24.5 (+/-8.7)) took placebo capsules with identical package and appearance. All participants were under treatment for 6 months and were followed 3 months thereafter. Statistical analyses were performed both by intention-to-treat and on-treatment methods. RESULTS: Nine participants in the indomethacin group (16%) and 8 in the placebo group (14%) did not complete the trial. HBsAg seroconversion did not differ by treatment group (2 subjects in each group became seronegative). Hepatitis B virus DNA (HBV-DNA) became negative in sera of 7 participants in the indomethacin group but only in 1 in the placebo group (intention-to-treat p= 0.06; on-treatment p= 0.03). Seroconversion of HBeAg to anti-HBe occurred only in 5 participants in the indomethacin group (intention-to-treat p= 0.06; on-treatment p= 0.03). Adverse events included one case of hepatotoxicity and two cases of gastritis in the indomethacin group and one suspected gastritis in the placebo group. CONCLUSIONS: We suggest use of indomethacin only in the subgroup of asymptomatic HBsAg carriers who have detectable HBV-DNA or HBeAg in their sera.

Adolescent↗
PubMed2004

Simple method for rapid diagnosis of tuberculosis pleuritis: a statistical approach.

Among the extrapulmonary presentations of tuberculosis, pleural tuberculosis is the second most frequent. Failure to diagnose and treat pleural tuberculosis can result in progressive disease with involvement of other organs in as many as 65% of patients. Conventional methods such as direct examination of pleural fluid, pleural fluid culture and pleural biopsy have proven to be insufficient for diagnoses of pleural tuberculosis. In this study, we examined a statistical method by combining the diagnostic efficiency of adenosine deaminase activity, pleural fluid protein, lactate dehydrogenase and cellular components in patients with tuberculous pleural effusions. Eighty eight patients over 12 years of age presenting with pleural effusions were included. A positive result by either three of the methods was considered to be indicative of a positive diagnosis of pleural tuberculosis. The determination of adenosine deaminase activity, lactate dehydrogenase levels, and lymphocyte to neutrophil ratio in the pleural fluid yielded a sensitivity of 100% for pleural tuberculosis. A patient was considered positive if any of the three tests was positive, with a specificity of 100%. A positive diagnosis was made when all three tests were positive. Similarly, these different approaches to the combination of pleural adenosine deaminase and lactate dehydrogenase result in sensitivity and specificity of 91.4% and 100% respectively.

Adenosine Deaminase↗
PubMed2003

Clinical and histological features of nonalcoholic steatohepatitis in Iranian patients.

BACKGROUND: Although several studies have been performed on risk factors and natural course of NASH, it seems that NASH tends to be more than a disease confined to strict boundaries. The objective of this study was to assess the clinical and paraclinical features and risk factors for non-alcoholic steatohepatitis (NASH) patients in an Iranian population METHODS: Patients with histologically confirmed NASH who had elevated liver aminotransaminases, negative serologic markers of viral or autoimmune hepatitis and no findings in favor of metabolic liver disease were enrolled. A careful history was taken regarding alcohol intake. RESULTS: 53 patients consisting of 32 male and 21 female entered the study. The mean age was 37.8 +/- 11.3 years. Twenty-six patients (55.3%) were overweight, 15 (31.9%) obese, 40 (75.5%) dyslipidemic, and three patients (5.7%) were diabetic. Liver biopsy showed mild steatosis in 35.7%, moderate steatosis in 53.6%, and severe forms in 10.7%. In 80.2% of patients, portal inflammation was present, and 9.4% had cirrhosis. The amount of increase in liver enzymes bore no relationship with fibrosis, portal inflammation, and degree of steatosis. CONCLUSIONS: The patients in our study showed a male predominancy and were somewhat younger than other studies.

Adolescent↗
PubMed2003

The efficacy of furazolidone-based quadruple therapy for eradication of Helicobacter pylori infection in Iranian patients resistant to metronidazole-based quadruple therapy.

BACKGROUND: Furazolidone has recently shown promising efficacy in H. pylori eradication and has replaced metronidazole in different eradication regimens especially in countries, like Iran, with high prevalence of metronidazole resistance and where clarithromycin is expensive and hardly available. This study tries to determine the efficacy of a quadruple therapy based on furazolidone as a second line treatment. MATERIAL/METHODS: 90 consecutive patients with a prior history of H. pylori infection who had failed to respond to a 14 day course of metronidazole-based quadruple therapy were included to take a two week quadruple therapy consisting of furazolidone, bismuth subcitrate, amoxicillin and omeprazole. Eradication was described as negative 14C-urea breath test, 4 to 6 weeks after end of the treatment. RESULTS: 89 of 90 patients completed the treatment course. The total eradication rate was 70/89 (78.7%). 35/49 (71.4%) of male patients and 35/40 (87.5%) of female patients had successful eradication. Eradication rate did not have any significant relationship with patient's sex (p>0.05). All patients had at least one upper GI endoscopy before the treatment by which they were categorised into three groups: duodenal ulcer (DU, 78.9%), gastric ulcer(GU, 11.1%) and non-ulcer dyspepsia (NUD, 10%). Eradication rates was different in these groups, but not significantly (p>0.05). Eradication rate was significantly lower in smokers (p<0.05, OR=3.12). CONCLUSIONS: Furazolidone can replace metronidazole successfully in those patients who have failed to respond to metronidazole-based quadruple therapy and it is well tolerated. We recommend it, especially in countries where clarithromycin is expensive or not available.

Adult↗