Mark Ghamsary

Background: Diabetic peripheral neuropathy (DPN) is a prevalent complication of type 2 diabetes (T2D), associated with microvascular dysfunction and significant morbidity. Exercise is a cornerstone of diabetes care and has demonstrated benefits for neuropathic pain, whereas Intraneural Facilitation^TM (INF^®) therapy is a manual technique designed to enhance intraneural perfusion. This study compared the effects of INF^® therapy and exercise on neuropathic pain qualities in adults with DPN. Methods: In this single-blinded randomized controlled trial, 38 adults with T2D and moderate to severe DPN were randomized to INF^® therapy (n = 20) or standardized exercise (n = 18). Participants completed nine 60-min sessions over a period of six weeks. Neuropathic pain qualities were assessed using the Pain Quality Assessment Scale (PQAS) at baseline and post-treatment. Paired t tests, independent t tests, and linear mixed models adjusted for age and body-mass index (BMI) evaluated within- and between-group changes. Results: Both treatment groups demonstrated significant reductions in total PQAS scores (p = 0.001). INF^® therapy produced improvements across paroxysmal, superficial, and deep pain domains, with reductions in descriptors such as shooting, sharp, electrical, numb, and unpleasant pain. Exercise led to selective improvements, including sharp, electrical, numb, sensitive, and unpleasant sensations associated with pain. Between-group analyses and mixed-effects models revealed no significant differences after adjusting for confounding factors. Conclusions: Both INF^® therapy and exercise improved neuropathic pain qualities in adults with DPN. INF^® therapy demonstrated broader within-group effects, suggesting its potential as a passive adjunct or alternative for patients unable to tolerate active exercise.

This study employed a passive dust sampling method using flat glass traps at 44 locations across Tehran, which allowed for detailed analysis of V, Pb, Cu, Zn, Cd, Ni, and Cr concentrations. It offers an essential understanding of the spatial distribution and seasonal variation of urban dust pollution, along with its associated environmental and human health risks. The results indicate that Zn, Pb, Cu, and Cd are key factors influencing the dust pollution burden in Tehran. The findings highlight the pollution and ecological impacts of dust, showing that most of the dust throughout Tehran has "moderate to high pollution levels" and "considerable ecological risk". In addition, these studies show that Cd and Pb need special attention. Multivariate statistical analyses demonstrated that Cu, Zn, Pb, and Cd were predominantly affected by human activities, while Ni and Cr were affected to a lesser degree, and V appeared to be more influenced by geological sources. The assessment of health risks showed that these levels were within the safe limits (non-carcinogenic < 1 and carcinogenic < 1 ✕ 10^–6), and the possible health risks in children were more than in adults. The most unsafe route of exposure in children was ingestion, followed by dermal contact and inhalation. The findings of this research showed that cold seasons can be most problematic with the negative effects of pollution and ecological risks, and may also have health risks in the long term. The findings pointed to reasons such as increased consumption of fossil fuels, increased traffic, temperature inversion, and atmospheric stability.

Background: The aim was to establish a 10-year dyslipidemia incidence model, investigating novel anthropometric indices using exploratory regression and data mining. Methods: This data mining study was conducted on people who were diagnosed with dyslipidemia in phase 2 (n = 1097) of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study, who were compared with healthy people in this phase (n = 679). The association of dyslipidemia with several novel anthropometric indices including Conicity Index (C-Index), Body Roundness Index (BRI), Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), Abdominal Volume Index (AVI), Weight-Adjusted-Waist Index (WWI), A Body Shape Index (ABSI), Body Mass Index (BMI), Body Adiposity Index (BAI) and Body Surface Area (BSA) was evaluated. Logistic Regression (LR) and Decision Tree (DT) analysis were utilized to evaluate the association. The accuracy, sensitivity, and specificity of DT were assessed through the performance of a Receiver Operating Characteristic (ROC) curve using R software. Results: A total of 1776 subjects without dyslipidemia during phase 1 were followed up in phase 2 and enrolled into the current study. The AUC of models A and B were 0.69 and 0.63 among subjects with dyslipidemia, respectively. VAI has been identified as a significant predictor of dyslipidemias (OR: 2.81, (95% CI: 2.07, 3.81)) in all models. Moreover, the DT showed that VAI followed by BMI and LAP were the most critical variables in predicting dyslipidemia incidence. Conclusions: Based on the results, model A had an acceptable performance for predicting 10 years of dyslipidemia incidence. Furthermore, the VAI, BMI, and LAP were the principal anthropometric factors for predicting dyslipidemia incidence by LR and DT models.

Background Due to the controversial effect of dietary fat intake on cardiovascular diseases (CVDs) risk, this study aimed to, adopt a new dynamic model that was tested and evaluated to estimate the effect of dietary fatty acids on the incidence of cardiovascular disease in the MASHAD cohort. Methods Total subjects of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study, 9704 subjects (of whom 233 developed CVD after 6 years with CVD) were recruited using a randomized clustering approach. Lipids profiles were taken after a 14 hours of overnight fast. 24-h recall questionnaire was used to measure the dietary intakes. A four-dimensional mathematical model based on the susceptible-exposed-infectious-recovered (SEIR) model in the dynamics of food intake was formulated for cardiovascular patients. Results Dietary saturated fatty acid (SFA), polyunsaturated fatty acid (PUFA) and monounsaturated fatty acid (MUFA) had an effect on the HDL in women and dietary trans fatty acid (TFA) and cholesterol had an effect on serum LDL, had the greatest effect on the CVDs. In addition, among other dietary fatty acids, cholesterol and TFA had the most and least effect on the incidence of CVDs in dyslipidemia patients, respectively. Regardless of the effect of fatty acids intake on lipid profile, which is more evident in females, CVDs were more in males. Conclusion Our models showed that higher intake of MUFA, PUFA as well as lower intake of SFA had a significant effect on serum HDL in women and among other dietary factors, had the most effect on the occurrence of CVDs.

Adenocarcinoma (AC) is the most common lung cancer among non-smokers, but few studies have assessed the effect of PM2.5 on AC among never smokers. The purpose of this study was to assess the association between ambient PM2.5 and incident lung AC in the Adventist Health and Smog Study-2 (AHSMOG-2), a cohort of 80,044 non-smokers (81% never smokers) followed for 7.5 years (597,177 person-years) (2002–2011). Incident lung AC was identified through linkage with U.S. state cancer registries. Ambient PM2.5 levels at subjects’ residences were estimated for the years 2000 and 2001, immediately prior to study start. A total of 164 incident lung AC occurred during follow-up. Each 10 μg/m3 increment in PM2.5 was associated with an increase in the hazard rate of lung AC [HR = 1.31 (95% confidence interval (CI) 0.87–1.97)] in the single-pollutant model. Excluding those with prevalent non-melanoma skin cancer (NMSC) strengthened the association with lung AC (HR = 1.62 (95% CI, 1.11–2.36) for each 10 μg/m3 PM2.5 increment. Also, limiting the analyses to subjects who spent more than 1 h/day outdoors, increased the estimate (HR = 1.55, 95% CI: 1.05, 2.30). Increased risk of AC was observed for each 10 μg/m3 increment in ambient PM2.5 concentrations. The risk was higher among those without prevalent NMSC and those who spent more than 1 h/day outdoors.

Despite increasing numbers of Iranian-American physicians practicing in the United States, little is known about the barriers that may impact them as providers of sexual health care. This is an important topic as discussions of sexual topics are generally considered a taboo among Iranians. We aimed to identify barriers experienced by Iranian-American physicians that inhibit their willingness to engage in discussions of sexual health care with patients. In 2013, a self-administrated questionnaire was sent to 1,550 Iranian-American physicians in California. Questions included demographics of the physicians as well as their perception of challenges in discussing various sexual health topics with their patients. Factor analysis: Principal components approach with a Varimax rotation was used to detect latent factors within the data that may help explain possible barriers to discussion of sexual health among physicians. The analysis was performed on 11 items, specifically focused on possible barriers, to detect a possible relationship between correlated variables within the data to produce a set of uncorrelated variables (factors). The overall response rate was 23 %. Data revealed specific barriers regarding sexual history taking, discussing STIs and sexual dysfunctions with patients based on their gender, and age. Three factors were identified as internally consistent (Cronbach’s alpha = 0.82 to 0.91): (i) embarrassment, (ii) cultural and religious, (iii) lack of time and financial constraint. Significant associations were found between these 3 factors and some variables such as: country of medical graduation, religious affiliation, birthplace, age, and gender. Our findings are the first to identify possible barriers among Iranian-American physicians in delivering effective sexual health care to patients. Additional studies from Iranian-American physicians as well as from other foreign-born/subpopulation of US physicians populations and mainstream US physicians are needed to assess the extent of such barriers, and changes over time. Effective strategies to better engage such physicians in these studies are needed. If confirmed from other studies, our findings could have implications for the training of US medical graduates.