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Osteoprotegerin and VEGF are independently increased in normoalbuminuric type 1 diabetic patients

Category: Articles » Diabetes and Nephropathy

Comparison of osteoprotegerin and vascular endothelial growth factor in normoalbuminuric Type 1 diabetic and control subjects

Comparison of osteoprotegerin and vascular endothelial growth factor in normoalbuminuric Type 1 diabetic and control subjects
Alireza Esteghamati, M.D. 1,*, Alireza Arefzadeh, M.D. 1, Ali Zandieh, M.D., M.P.H. 1,
Mohammad Salehi Sadaghiani, M.D., M.P.H. 1, Sina Noshad, M.D., M.P.H. 1, Manouchehr
Nakhjavani, M.D. 1
1 Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of
Medicine, Tehran University of Medical Sciences, Tehran, Iran.
* Address correspondence to Alireza Esteghamati, Endocrinology and Metabolism
Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical
Sciences, Tehran, Iran.

 



Abstract:
Background: The aim of the current study was to evaluate the association of osteoprotegerin
and vascular endothelial growth factor (VEGF) with glycaemic indices and diabetes status.
Methods: A total of 44 normoalbuminuric type-1 diabetic patients and 44 healthy control
subjects, matched for age, body mass index, sex ratio and lipid measures were enrolled.
Univariate and multivariate logistic regression analyses were used to determine the association of
osteoprotegerin and VEGF with diabetes status. Further, linear regression analysis was
performed to investigate the roles of osteoprotegerin and VEGF as determinants of hemoglobin
A1c (HbA1c).
Results: Osteoprotegerin and VEGF were significantly elevated in diabetic subjects
(2.76±0.85 vs. 2.26±0.75 pmol/l and 187.1±92.7 vs. 125.9±52.3 pg/ml, respectively, P <0.01)
and were positively correlated with glycaemic indices (i.e. fasting plasma glucose and HbA1c, P
<0.001). After controlling for possible confounding factors odds ratios (confidence interval) of
osteoprotegerin and VEGF for diabetes were 2.113 (1.043-4.280) and 1.014 (1.002-1.026),
respectively (P <0.05). Further, linear regression analysis revealed that the association of
osteoprotegerin with HbA1c is independent of VEGF and vice versa (P <0.001).
Conclusion: Osteoprotegerin and VEGF are elevated in normoalbuminuric type 1 diabetic
subjects and are independently associated with glycaemic indices and diabetes status.

Tags for this article: Dr. alireza arefzadeh, alireza arefzadeh, arefzadeh, alireza, doctor alireza arefzadeh, tehran, iran, doctor arefzadeh alireza, arefzadeh alireza, Dr. Alireza Arefzadeh, Dr. Arefzadeh, dr, . arefzadeh alireza, dr. arefzadeh alireza

Information of news

The Cost of Hemodialysis In Iran

Category: Articles » Hemodialysis In Iran

 


The Cost of Hemodialysis in Iran
Alireza Arefzadeh, Mahboub Lessanpezeshki, Sepideh Seifi
Department of Nephrology, Imam Khomeini Hospital, Tehran University of Medical Sciences,
Tehran, Iran
ABSTRACT. The use of dialysis in patients with end-stage renal disease (ESRD) remains one of
the most resource-intensive and hence, expensive therapeutic interventions. The purpose of this
study was to assess the cost of hemodialysis (HD) in Iran. This study was conducted in the
Department of Nephrology at the Imam Khomeini Hospital of Tehran University of Medical
Sciences, Iran, between April 2006 and June 2007. Patients with ESRD on chronic HD were
involved in the study. Relevant data were collected using interview and questionnaire. Analyzed
costs included: transportation plus absence from work, treatment instruments, drugs and other
medical procedures, diet, staff salary, equipment and building support services, non-medical
supplies, depreciation of installations and equipments, depreciation of reverse osmosis (RO) and
building rent. Sixty-three patients of whom 47.7% were males and 52.3% were females, with
mean age of 47 ± 12 years were studied. The estimated cost of each HD session was about 74 US
dollars by which an annual cost of $11549 could be estimated for each patient. Transportation and
work leaves (28.9%), staff costs and salaries (21.5%), and treatment instruments (21.1%) were
among the greatest expenses. We conclude that the annual cost of dialysis in Iran is similar to
other developing countries, but significantly less than the cost in developed countries.
Keywords: Cost, End-stage renal disease, Hemodialysis, Iran
Introduction
End-stage renal disease (ESRD) is a serious
illness with significant health consequences
and high-cost treatment options.1 As seen
worldwide, the prevalence of ESRD has significantly
increased in developing countries.2 In
Iran, the prevalence/incidence of renal replacement
therapy (RRT) and ESRD have increased
from 238 and 49.9 per million population (pmp)
in 2000,3 to 357 and 63.8 pmp, respectively in
2006.4 Currently, 50% of these patients are on
hemodialysis (HD).4
The use of dialysis in patients with ESRD
remains one of the most resource-intensive and
hence, expensive therapeutic interventions.5-7
Additionally, the growing number of ESRD
patients will devour a greater proportion of
Correspondence to:
Dr. Alireza Arefzadeh
Department of Nephrology
Imam Khomeini Hospital
Tehran University of Medical Sciences
P.O. Box13185-1678, Tehran, Iran
Email: alireza.arefzadeh@gmail .com
health-care budget. Consequently, the worldwide
demand for, and cost of renal replacement
therapy (RRT) is rapidly becoming a
major burden for health-care systems. For this
reason, chronic kidney disease (CKD) and
ESRD are considered as emerging public health
problems in developing countries necessitating
changes in health-care policies.8,9 An accurate
estimate of the cost of caring for patients with
ESRD and a better understanding of the scope
and magnitude of the total economic burden of
ESRD would help in making policy decisions
and to enable ESRD programs to develop
strategies for more cost-efficient care.10 As
there are no studies on estimation of the cost
of HD in Iran, this study was performed.
Materials and Methods
Following the approval of the Institutional
Review Board, 63 patients with ESRD on
chronic HD at the Imam Khomeini Hospital of
Tehran University of Medical Sciences, Iran
between April 2006 and June 2007, were
recruited into the study. All patients were treated
with in-center HD. Patients who survived
less than three months after commencement of
HD were excluded. The frequency as well as
duration of HD was determined by the physician
based on available resources and medical
necessity.
To assess the overall cost of treating all the
patients as well as the unit cost per each dialysis
session, we collected cost data associated with
dialysis by a customized version of the method
utilized by Adomakoh et al.11 The method was
used to determine both direct (those directly
attributed to dialysis treatment) and indirect
costs (the proportion of overhead costs incurred
by hospital in providing the dialysis
service). Relevant data were collected using
interview and questionnaire. Cost analysis was
performed from ten different viewpoints as
follows:
a) Transportation cost of patients plus his/her
attendant to the dialysis center, the cost of
elapsed time, and the expenses related to
absence from work.
b) The cost of treatment instruments (e.g.
dialysis supplies like Shaldon catheter, injection
filters, and non-dialysis supplies like
printing material).
c) The cost of drugs such as erythropoietin,
all the solutions and other drugs which
were utilized during the dialysis session or
were prescribed after that, and other medical
procedures (e.g. blood transfusion,
laboratory investigations, X-rays, etc.).
d) Dietary costs.
e) Costs related to staff salaries (e.g. nursing
staff, physicians, and dietitians).
f) Non-medical supply costs (e.g. office supplies,
cleaning).
g) All equipment and building support services
including engineering (fixing and
maintenance services), and housekeeping.
h) Depreciation of installations and equipments
(e.g. dialysis machines).
i) Depreciation of reverse osmosis (RO)
machine.
Table 1. The breakdown of hemodialysis maintenance costs for each session in Iran
Cost Amount
(US$)
Proportion of
total cost
Transportation plus absence from work 21.4 28.9%
Treatment instruments 15.6 21.1%
Drugs and other medical procedures 8.7 11.7%
Dietary 1.6 2.2%
Staffs 15.9 21.5%
Equipment and building support services 3.9 5.2%
Non-medical supplies 0.1 0.1%
Depreciation of installations and equipments 2.1 2.8%
Depreciation of RO (Reverse osmosis) machine 0.3 0.3%
Building rent 4.5 6.1%
Total 74.0 100%
308 Arefzadeh A, Lessanpezeshki M, Seifi S
[Downloaded free from http://www.sjkdt.org on Saturday, March 14, 2009]
Table 2. Comparison of total hemodialysis cost per patient in some countries
Country (Reference) Total RRT expenses ($US)
Mexico (13) $ 9,631
Brazil (14) $ 10,065
Barbados (12) $ 17,029
Turkey (26) $ 22,759
New Zealand (19) $ 35,270
USA (21) $ 46,000
Japan (25) $ 46,000
Canada (16) $ 76,023
Australia’s Northern Territory (18) $ 78,600
France (24) $ 78,947
j) Building rental costs.
Data were expressed as mean ± SD for quantitative
variables and percentages for categorical
variables.
Results
The mean age of the study patients was 47 ±
12 years. Among the 63 patients studied,
47.7% were males and 52.3% were females.
All study patients received three sessions of
HD weekly with duration per session varying
between two and four hours.
The breakdown of HD maintenance costs are
shown in Table 1. The cost of each session of
HD was about US $ 74 through which an
annual cost of US $ 11,549 could be estimated
for each patient. Transportation and work leaves
(28.9%), staff costs and salaries (21.5%), and
treatment instruments (21.1%) were among the
principal contributors to the expenses.
Discussion
The results of this study revealed that the
annual cost of dialysis in Iran is higher than
that in Mexico,12 about the same as in Brazil,13
but lower than the cost in countries such as
Canada,14-16 Australia’s Northern Territory,17
New Zealand,18 Greece,19 United States,20 Italy,
5,21 Spain,22 France,10,23 Japan,24 and Turkey25
(Table 2).
The differences noted in the reported cost in
different studies are very high and cannot be
explained only in terms of their annual per
capita income. True differences in cost obviously
ensue as a result of various factors including
different management protocols, inpatient
care, an older population of patients
with more co-morbid illnesses (especially in
the United States), different local labor costs,
import duties and shipping charges, tariffs,
etc.11 For instance, while drugs constituted 53%
of overall expenses of dialysis in Greece,19 we
found that they constituted only 11.7% of the
cost. The availability of full medical insurance
coverage for these patients, makes treatment
modalities available for every patient, regardless
of the socioeconomic status. In Iran, all
patients with ESRD are eligible for government-
provided medical insurance. The ESRD
management program is mainly sponsored by
The Ministry of Health (MOH) which acts
through the Management Center for Transplantation
and Special Diseases (MCTSD).5
Thus, different modalities of RRT are provided
at no charge and are accessible to all
nationals in Iran. A fixed reimbursement rate
is paid for dialysis in both public and private
hospitals.4
There are several approaches to reduce the
annual cost of RRT. Obviously, in the longterm,
the most important factor to reduce the
overall yearly cost of RRT is to reduce the
number of patients with ESRD. This goal can
be achieved by preventing the progression of
renal disease.25 In Iran, the most frequent
causes of ESRD are diabetes mellitus, hypertension,
obstructive uropathy, cystic and congenital
disorders, glomerulonephritis, urinary tract
infections, vasculitis, tubulo-interstitial nephritis
and pregnancy related.26 Early detection of
these diseases is as important as their optimal
treatment and we should place initial focus on
The cost of hemodialysis in Iran 309

strategies and treatments that slow disease
progression, to postpone the need for RRT. 4
Furthermore, considering the fact that HD is
the most common RRT modality, accounting
for 53.7% of prevalent RRT patients in Iran,3 it
is highly recommended that we try to increase
the use of peritoneal dialysis as well as live or
cadaveric donor kidney transplantation.4 Kidney
transplantation is the most cost-effective
treatment for ESRD,27-29 and offers considerable
savings and a drastic improvement in quality
of life in these patients. It has been revealed
that compared with other countries, the
cost of kidney transplantation is low in Iran.30
Since transport expenses, which are paid directly
by the patients, and work leaves constitute
the main expenditure section in Iran, as
in Spain,22 we suggest greater use of such
modalities as home dialysis or autonomous incenter
HD, which are already well developed,
and could generate significant savings. 31,32 In
addition, there is room for the use of satellite
HD units, a dialysis mode that may prove costeffective
apart from offering psychological
benefits to the patients.19,21,32,33
Several factors limit interpreting the results
of this study. Firstly, we did not consider costs
which ESRD imposes on society in terms of
production losses due to treatment requirements,
morbidity, mortality, and time spent to
care for patients. On the other hand, if compensating
mechanisms are taken into account,
the estimated productivity losses are significantly
lower but still considerable. Additionally,
differences in funding of health-care
systems, in dialysis modality utilization, and
other cost estimation techniques limit the accuracy
of comparison of our results with other
countries.
Conclusions
In summary, in our single-center study from
Iran, we found that the annual cost of dialysis
is similar to other developing countries but
significantly less than the cost in developed
countries. In future studies, further in-depth
comparison between the cost of other modalities
of treatment of ESRD like continuous
ambulatory peritoneal dialysis and cadaver/living
donor transplantation should be taken into consideration.
Acknowledgement
The authors would like to thank Farzan Institute
for Research and Technology for technical
assistance.
References
1. Zelmer JL. The economic burden of end-stage
renal disease in Canada. Kidney Int 2007;
72(9):1122-9.
2. Prodjosudjadi W. Incidence, prevalence, treatment
and cost of end-stage renal disease in
Indonesia. Ethn Dis 2006;16(2 Suppl 2):S2-14-6.
3. Haghighi AN, Broumand B, D'Amico M,
Locatelli F, et al. The epidemiology of endstage
renal disease in Iran in an international
perspective. Nephrol Dial Transplant. 2002;17
(1):28-32.
4. Mahdavi-Mazdeh M, Zamyadi M, Nafar M.
Assessment of management and treatment
responses in haemodialysis patients from
Tehran province, Iran. Nephrol Dial Transplant
2008;23:288-93
5. Tediosi F, Bertolini G, Parazzini F, et al. Cost
analysis of dialysis modalities in Italy. Health
Serv Manage Res 2001;14(1):9-17.
6. Sennfalt K, Magnusson M, Carlsson P. Comparison
of hemodialysis and peritoneal dialysisa
cost-utility analysis. Perit Dial Int 2002;2
1):39-47.
7. Lysaght MJ. Maintenance dialysis population
dynamics: current trends and long-term impliations.
J Am Soc Nephrol 2002;13 Suppl 1:
37-40.
8. Grassmann A, Gioberge S, Moeller S, Brown
G. ESRD patients in 2004: Global overview of
patient numbers, treatment modalities and
associated trends. Nephrol Dial Transplant
2005;20(12):2587-93.
9. Modi GK, Jha V. The incidence of end-stage
renal disease in India: a population-based
study. Kidney Int 2006;70(12):2131-3.
10. Lee H, Manns B, Taub K, et al. Cost analysis
of ongoing care of patients with end-stage
renal disease: The impact of dialysis modality
and dialysis access. Am J Kidney Dis 2002;
40(3):611-22.
11. Adomakoh SA, Adi CN, Fraser HS, Nicholson
310 Arefzadeh A, Lessanpezeshki M, Seifi S
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GD. Dialysis in Barbados: The cost of hemoialysis
provision at the Queen Elizabeth
Hospital. Rev Panam Salud Publica 2004;16
5):350-5.
12. Arredondo A, Rangel R, de Icaza E. Costeffectiveness
of interventions for end-stage
renal disease. Rev Saude Publica 1998;32(6):
56-65.
13. Sesso R, Eisenberg JM, Stabile C, et al. Costeffectiveness
analysis of the treatment of endstage
renal disease in Brazil. Int J Technol
Assess Health Care 1990;6(1):107-14.
14. Goeree R, Manalich J, Grootendorst P, et al.
Cost analysis of dialysis treatments for endstage
renal disease (ESRD). Clin Invest Med
1995;18(6):455-64.
15. Coyte PC, Young LG, Tipper BL, et al. An
economic evaluation of hospital-based hemoialysis
and home-based peritoneal dialysis for
pediatric patients. Am J Kidney Dis 1996;27
4):557-65.
16. Prichard SS. The costs of dialysis in Canada.
Nephrol Dial Transplant. 1997;12(Suppl 1):22-
4.
17. You J, Hoy W, Zhao Y, et al. End-stage renal
disease in the Northern Territory: Current and
future treatment costs. Med J Aust 2002;176
10):461-5.
18. Croxson BE, Ashton T. A cost effectiveness
analysis of the treatment of end stage renal
failure. N Z Med J 1990;103(888):171-4.
19. Kaitelidou D, Ziroyanis PN, Maniadakis N,
Liaropoulos LL. Economic evaluation of
hemodialysis: Implications for technology
assessment in Greece. Int J Technol Assess
Health Care 2005;21(1):40-6.
20. Garella S. The costs of dialysis in the USA.
Nephrol Dial Transplant 1997;12(Suppl 1):10-
21.
21. Piccoli G, Formica M, Mangiarotti G, et al.
The costs of dialysis in Italy. Nephrol Dial
Transplant 1997;12(Suppl 1):33-44.
22. Rodriguez-Carmona A, Perez Fontan M,
Bouza P, et al. The economic cost of dialysis: a
comparison between peritoneal dialysis and incenter
hemodialysis in a Spanish unit. Adv
Perit Dial 1996;12:93-6.
23. Jacobs C. The costs of dialysis treatments for
patients with end-stage renal disease in France.
Nephrol Dial Transplant 1997;12(Suppl 1):29-
32.
24. Nakajima I, Akamatsu M, Tojimbara T, et al.
Economic study of renal transplantation: A
single-center analysis in Japan. Transplant
Proc 2001;33(1-2):1891-2.
25. Erek E, Sever MS, Akoglu E, et al. Cost of renal
replacement therapy in Turkey. Nephrology
(Carlton) 2004;9(1):33-8.
26. Afshar R, Sanavi S, Salimi J. Epidemiology of
chronic renal failure in Iran: a four year singlecenter
experience. Saudi J Kidney Dis Transpl
2007;18(2):191-4.
27. Karlberg I, Nyberg G. Cost-effectiveness
studies of renal transplantation. Int J Technol
Assess Health Care 1995;11(3):611-22.
28. Karlberg I. Cost analysis of alternative treatments
in end-stage renal disease. Transplant Proc
1992;24(1):335.
29. Roberts SD, Maxwell DR, Gross TL. Costeffective
care of end-stage renal disease: A
billion dollar question. Ann Intern Med
1980;92(2.1):243-8.
30. Nourbala MH, Einollahi B, Kardavani B, et al.
The cost of kidney transplantation in Iran.
Transplant Proc 2007;39(4):927-9.
31. Benain JP, Faller B, Briat C, et al. Cost of dialysis
in France. Nephrol Ther 2007;3(3):96-106.
32. Soroka SD, Kiberd BA, Jacobs P. The
marginal cost of satellite versus in-center
hemodialysis. Hemodial Int 2005;9(2):196-
201.
33. Gonzalez-Perez JG, Vale L, Stearns SC,
Wordsworth S. Hemodialysis for end-stage
renal disease: A cost-effectiveness analysis of
treatment-options. Int J Technol Assess Health
Care 2005;21(1):32-9.

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Adress in Abroad

Category: Address » Address in Abroad

  Address :Nørrebrogade, Copenhagen N, 2200. Denmark, Phone :0045731837 
E-mail :info@drarefzadeh.com

 

 

Address: Unit:16,4th Floor, NO:29, Sina Building, Shovari Alley, Near (Mina) Shariati Gas Stition,In Front of Shariati Metro Station, Shariati St, Tehran,IRAN.

 

 

Contact Tell Numbers:

  

 

  For Appointment inside Iran:

00989198673034

 

00982122898836

 

Iran For Answer to Questions:

00989373622621

 

 

USA & Canada:

0016612623255

 

North Europe & Scandinavian:

 

0037253141799

 

Europe, Asia & Middle East:

 

00447700309990

 

آدرس:

 

تهران، خیابان شریعتی، بالاتر از میرداماد، روبروی مترو شریعتی

 

 

جنب پمپ بنزین شریعتی(مینا)، کوچه شواری، پلاک 29

 

                                         

ساختمان پزشکان سینا، طبقه4، واحد 16

 

ساعات فعالیت مطب:

 

روزهای زوج  از ساعت ۵ بعد از ظهر الی 7 شب

 

 

 

  تلفن تماس:

09198673034-02122898836

 

 

 

تلفن نوبت دهی:09198673034

 

 

تلفن پاسخ گویی به سوالات:09373622621

 

 

 

Information of news

Short Statue

Category: Patient Education » Short Stature

  Short Stature is one of the most important problems in children. 

 

The European Society for Pediatric Endocrinology (ESPE) classifies the main causes of

  • Primary growth disorders, where the condition is intrinsic to the growth plate.
  • Secondary growth disorders, where the growth plates change as a consequence of the condition.
  • Idiopathic, where there is no identifiable cause of short stature.

 

Primary growth disorders

  • Clinically defined genetic syndromes, such as:
    • Down's syndrome
    • Prader-Willi syndrome
    • Silver- Russell syndrome
    • Noonan's syndrome
    • Turner syndrome
  • Intrauterine growth restriction with failure to catch up:
    • Fetomaternal factors
    • Prematurity
    • Placental dysfunction
  • Congenital bone disorders such as:
    • Achondroplasia
    • Hypochondroplasia
    • Osteogenesis imperfecta

Secondary growth disorders

  • Endocrine:
    • Hypothyroidism.
    • Panhypopituitarism.
    • Hypothalamic or pituitary lesions (eg, trauma or tumour).
    • Laron's syndrome (growth hormone insensitivity).
    • Cushing syndrome.
    • Growth hormone deficiency or insufficiency.
    • Precocious puberty.
    • Disorders of the growth hormone insulin-like growth factor I axis.
  • Metabolic:
    • Mucopolysaccharidoses.
    • Glycogen storage diseases.
  • Diabetes mellitus (poor control).
  • Chronic disease:
    • Cardiovascular disease.
    • Respiratory disease (eg, cystic fibrosis).
    • Haemoglobinopathies.
    • Renal disorders disease.
    • Malignancy.
    • Neurological (eg, hydrocephalus).
    • Juvenile arthritis.
  • Malnutrition:
    • Poverty or neglect.
    • Inflammatory bowel disease.
    • Coeliac disease.
    • Bowel obstruction.
    • Enzyme deficiencies.
    • Chronic bowel infection.
    • Short bowel syndrome.
    • Anorexia nervosa.
    • Rickets.
  • Psychosocial deprivation, including hyperphagic short stature syndrome.
  • Medication: steroid therapy.

 

 

Although many etiologies have roles in short stature, however, malnutrition is  important factor in short stature.

 

Malnutrition is the most common cause of growth failure and is usually related to poverty or anarchy. Nutritional deficiencies in developed countries are more often the result of self-restricted diets. Poor weight gain is often more noticeable than short stature.

 

Nutrition is most important factor specially before puberty.

 

Parents should check their children and refer to doctor continuously to assess children's stature.

 

Notice:

 

After puberty and fusion of the growth plates, doctor can not help to increase height, therefore patients should refer before this time.

 

Tags for this article: SHORT, STATURE, Alireza, arefzadeh, puberty, growth, development, doctor

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Address

Category: Address » Address in Iran

Address :Nørrebrogade, Copenhagen N, 2200 Denmark  
Phone :004591731837  

E-mail :info@drarefzadeh.com

 

 

Address: Unit:16,4th Floor, NO:29, Sina Building, Shovari Alley, Near (Mina) Shariati Gas Stition,In Front of Shariati Metro Station, Shariati St, Tehran,IRAN.

 

 

:Tell Numbers

  

 

 Iran For Appointment:

00989198673034

 

00982122898836

 

Iran For Answer to Questions:

00989373622621

 

 

USA & Canada:

0016612623255

 

North Europe & Scandinavian:

 

0037253141799

 

Europe, Asia & Middle East:

 

00447700309990

 

آدرس:

 

تهران، خیابان شریعتی، بالاتر از میرداماد، روبروی مترو شریعتی

 

 

جنب پمپ بنزین شریعتی(مینا)، کوچه شواری، پلاک 29

 

                                         

ساختمان پزشکان سینا، طبقه4، واحد 16

 

ساعات فعالیت مطب:

 

روزهای زوج  از ساعت ۵ بعد از ظهر الی 7 شب

 

 

 

  تلفن تماس:

09198673034-02122898836

 

 

 

تلفن نوبت دهی:09198673034

 

 

تلفن پاسخ گویی به سوالات:09373622621

 

 

 

 

 

 


 

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Hirsutism

Category: Patient Education » Hirsutism

What Is hirsutism?

Hirsutism is excessive hair growth in unusual areas of a woman’s face and body, such as the mustache and beard areal like male. .

Hirsutism in women means that hair follicles are being over-stimulated by testosterone or other androgen hormones. Androgens are the dominant sex hormones in men. Women normally have low levels of androgens. Hirsutism can be caused by abnormally high levels of androgens or abnormal stimulation of hair follicles even when androgen levels are normal.

 

Causes:

 

Hirsutism can be caused by:

Polycystic ovary syndrome.
Cushing's syndrome.
Congenital adrenal hyperplasia.

Obesity.

Acromegaly.

Hypothyroidism.

Hyperprolactin.

Stress and Anxiety.
Medications.

 

 

Symptoms

 significant growth of hair  on the upper lip, chin, sideburn area, around the nipples or lower abdomen.


Diagnosis

Your doctor will ask you about your medical history with special attention to your menstrual cycles. He or she also will examine you. If you have a normal cyclic pattern of menstrual periods, the hirsutism is most likely genetic (inherited).

 


Expected Duration

Many women will have a satisfactory response to medical treatment if they continue the therapy for several months or longer. A few causes of hirsutism (such as tumors that produce androgen hormones or tumors in the pituitary gland) can be cured with surgical treatment, radiation or both.

Cosmetic treatments can remove unwanted hair temporarily, and may limit hair regrowth in treated areas.


Treatment

If a specific cause of hirsutism is diagnosed, your doctor may suggest appropriate treatment for that cause. For women who are overweight, losing weight may reduce androgen levels and improve hirsutism.

 

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Diabetes Mellitus

Category: Patient Education » Diabetes Mellitus

Diabetes mellitus is very common in Iran.

It is a complex disease and patients need to control four important factors :

1) Reduce stress and sudden emotional behaviour

 

2)Control of Diet 

 

3) Excersie 

 

4) Self monitoring blood glucose 

 

 

 

Tags for this article: alireza, arefzadeh, Dr. Arefzadeh, Dr. Alireza Arefzadeh, Diabetes, Mellitus, Diabetes mellitus, Thyroid, Address, Endocrinology, Tehran, Iran, Assistant, Prof, Of, Endocrinologist, Education, Sugar

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About Us :

Dr. Alireza Arefzadeh
Assistant Prof of Endocrinology & Metabolism
Faculty Member of Medical University
Internal Medicine Specialist
Endocrinology and Metabolism SubSpecialist
Clinician and Researcher
Member of American Diabetes Association(ADA).
Member of European Society of Endocrinology(ESE)and European Research Association(CORDIS).

Contact Us :

Address :Norrebrogade, Copenhagen N, 2200 Denmark.
Phone :004591731837
E-mail :info@drarefzadeh.com
Contact TEL Number for patients outside Iran: 0016612623255-0037253141799-00447700309990
Contact TEL Number for patients inside Iran: 02122898836-09198673034-09373622621
آدرس: تهران، خیابان شریعتی، بالاتر از میرداماد، روبروی مترو شریعتی، جنب پمپ بنزین شریعتی(مینا)، کوچه شواری، پلاک 29، ساختمان پزشکان سینا، طبقه4، واحد 16. روزهای زوج از ساعت 5بعداز ظهر تا 7 شب تلفن تماس:09198673034-02122898836 تلفن پاسخ گویی به سوالات09373622621
 

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