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Articles by Shekoufeh Nikfar
Total Records ( 10 ) for Shekoufeh Nikfar
  Mojdeh Mohammadi , Shokoufeh Atashpour , Nazila Pourkhalili , Amir Nili-Ahmadabadi , Maryam Baeeri , Azadeh Mohammadirad , Shokoufeh Hassani , Shekoufeh Nikfar and Mohammad Abdollahi
  Increased oxidative stress plays a role in the pathogenesis of cellular death and β-cell failure. The aim of this study was to evaluate the action of different types of phosphodiesterase (PDE) inhibitors including milrinone (PDE-3), rolipram (PDE-4) and sildenafil (PDE-5) on viability, production of Reactive Oxygen Species (ROS) and secretion of insulin from isolated rat pancreatic islets. Pancreatic islets were carefully isolated and incubated in RPMI 1640 for 24 h. After overnight incubation, islets were picked up and divided into ten in each groups. Then, milrinone, rolipram and sildenafil at doses of 0.1, 1, 10 and 100 FM were added to islet groups and incubated for further 24 h. Then static insulin secretion at 2.8 and 16.7 mM concentrations of glucose, was tested. Then the viability of cells, level of ROS and insulin were examined. The results of static experiments showed that secretion of insulin increased significantly in response to glucose at both basic (2.8 mM) and stimulation (16.7 mM) levels by the lower doses of tested PDE inhibitors. The level of ROS at the lower doses of milrinone decreased. The viability of islets at the lower doses of all of PDE inhibitors were increased; however, viability at the higher doses of sildenafil and rolipram reduced significantly. Milrinone was the most effective PDE inhibitors on the function of isolated pancreatic islets. PDE inhibitors show the most significant anti-oxidative effects at lower doses. Concerning improvement of isolated islets function, PDE-3 inhibitor is the best among tested compounds. PDE inhibitors may help management of diabetes and facilitate conditions of islet transplantation.
  Shekoufeh Nikfar , Mohsen Khatibi , Akbar Abdollahi-Asl and Mohammad Abdollahi
  Epidemiological data show that the most inpatient disease resulting in hospitalization in Iran is poisoning where drug poisoning is the second cause of mortality in hospitalized patients. There is no report on the use, availability and cost expenditure of antidotes in the country. Regarding the importance of this kind of information in health policy, we aimed to review accessibility and affordability of antidotes in Iran as a sample model. Demographic and epidemiologic data about antidotes and their impacts in economic situation of the country during 2004-2008 were extracted from Iranian drug affair's, drug selection committee, pharmaceuticals statistics, direct interview with stockholders and key opinion leaders in toxicology and World Health Organization (WHO) reports. Data were extracted and analyzed for demographic, economic and health information, availability and accessibility of antidotes and five-year cost-utilization trends of antidotes. As a developing country, Gross National Production (GNP) per capita in Iran is about 7000 $US. Gross national income per capita in Iran is 9,800 USA dollar (USD). Total expenditure on health per capita is 731 USD that is 7.8% of Gross Domestic Production (GDP) and total drug expenditure is 24000 billion Rials (10000 Rials≈1 USD). Iranian drug list (IDL) include most of antidotes, while 73% of them are registered and available in the market. Entire IDL includes 2230 medicines that 27 of them are antidote (1.1%). The volume of utilization of existing antidotes during 5 years indicate that 25% of them are almost expensive (more than 40000 Rials or 10 dollars) that is 1% of expenditure basket of Iran. All antidotes are under umbrella of insurance. Because of multi-purpose use of these drugs and high price of some of them, a real estimation of demand for good management of poisoning and pharmaceutical regulation and supply management is necessary for having a strategic depot. More feasible and reliable procurements, appropriate information and effective integration of health care services would have a good impact on poisoning management and policy making to better afford health cares in all countries like Iran. Effective impact of poisoning in economical and social concerns of the life necessitates implementation of stronger policies in clinical toxicology matters.
  Shekoufeh Nikfar , Solmaz Ehteshami-Afshar and Mohammad Abdollahi
  The proinflammatory cytokine tumor necrosis factor alpha (TNF-α) plays a major role in severity of Ulcerative Colitis (UC) and thus inhibition of TNF-α is used to control severe cases of UC. The present meta-analysis was performed to collect and review all the clinical trials that investigated the efficacy and tolerability of infliximab in order to determine whether infliximab is more effective than placebo or corticosteroids in inducing response and remission in UC. All bibliographic databases such as PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials were searched for studies investigated the efficacy of infliximab for the management of UC. Data were collected from 1966 to September 2010. Three trials represented 57 patients with UC who were randomized to receive infliximab or corticosteroids and 5 trials represented 827 patients with UC who were randomized to receive infliximab or placebo were included in the analysis. The summary Relative Risk (RR) for clinical remission in comparison of infliximab with placebo was 1.93 with a 95% Confidence Interval (CI) of 1.62-2.3 and a significant RR (p<0.0001). Summary RR for adverse events of infliximab comparing to placebo was 1.07 with a 95% CI of 0.99-1.14, a non-significant RR (p = 0.0725). The summary RR for serious adverse events of infliximab comparing to placebo was 0.83 with a 95% CI of 0.44-1.54 as a non-significant RR (p = 0.5472). The summary RR for clinical remission of infliximab comparing to corticosteroids was 1.07 with a 95% CI of 0.87-1.31 as a non-significant RR (p = 0.5353). Patients receiving infliximab were 1.93 and 1.07 times more likely to go to the remission as compared to those receiving placebo and corticosteroids, respectively. Meanwhile, the risk of adverse events in the patients receiving infliximab was 1.07 times more than placebo group. The risk of opportunistic infection was high in patients who have failed steroids and cyclosporine and were using infliximab. Although infliximab is more effective than corticosteroids in inducing clinical remission, we believe further trials are still needed to judge stronger in this respect.
  Pooneh Salari , Shekoufeh Nikfar and Mohammad Abdollahi
  Recently, exenatide as an incretin mimetic was approved by FDA as an adjunct to diet and exercise in treating type 2 diabetes. Therefore comparing every new medication with insulin can provide more clues about the real benefit of paying extra budget for new drugs. In this meta-analysis we compared the efficacy and tolerability of exenatide to insulin. The literature search provided 1016 articles while only 5 articles were eligible to be included in the meta-analysis with a total of 1404 patients enrolled in the study. The results show that there is no superiority for exenatide over insulin even in its weight reduction advantage. However, the high risk of gastrointestinal side effects including nausea and vomiting is of major concern. Current evidence does not support the advantage of exenatide over insulin but more clinical trials are needed to reach a convincing conclusion.
  Amir Hashemi Meshkini , Khosro Keshavarz , Zahra Gharibnaseri , Shekoufeh Nikfar and Mohammad Abdollahi
  The Diabetic Peripheral Neuropathy (DPN) is the most common complication in diabetic patients which is accompanied with substantial economic burden regarding the productivity loss and medical therapy. In this study, we analyzed the cost efficacy of pregabalin for treatment of diabetic neuropathic pain in Iran. To evaluate the efficacy of pregabalin, we conducted a systematic review of published articles by searching on PubMed, Scopus and Google scholar. The keywords were: “pregabalin”, “neuropathic pain”, “diabetic peripheral neuropathy”. The “mean pain score” and also “percentage of patients with more than 50% pain reduction” were the outcome of interest for evaluation of efficacy of drug in peripheral neuropathic pain. For calculation of cost, only direct medical costs were evaluated. The Incremental Cost Effectiveness Ratio (ICER) was compared with one and three times of Gross Domestic Product (GDP) per capita as threshold to evaluate if the treatment is “highly cost effective”, “cost effective” and “not cost effective”. Out of 8476 evaluated papers, finally five articles were included in the study which met our inclusion criteria. All of these reports were Randomized Controlled Trial (RCT) of the comparison of pregabalin with placebo. Considering the efficacy extracted from the reports, pregabalin 75 and 150 mg day-1 did not have any significant efficacy in comparison with placebo. In pregabalin 300 mg day-1, the ICER range for generic and brand pregabalin were 6-200 and 63-2059, respectively. Accordingly, for generic and brand pregabalin (600 mg day-1), they were 11-755 and 78-5333 US Dollars (USD) per one more score reduction in mean pain score compared with placebo that could be seen as highly cost effective treatment. Our analysis indicated that pregabalin (300 mg day-1 or 600 mg day-1) is highly cost effective treatments in both generic and brand forms. Considering the same efficacy of generic and brand pregabalin, it seems more rational to include generic pregabalin in positive list of reimbursement, although both of them are cost effective.
  Amir Farshchi , Shekoufeh Nikfar and Mohammad Abdollahi
  Not Available
  Hadi Mirfazaelian , Shekoufeh Nikfar , Saeed Derakhshani and Mohammad Abdollahi
  Anal fistula is an abnormal connection between the anal or rectal lumen and perianal skin that reduce quality of life. There are various surgical options for treatment with variable success rate. A novel treatment is to seal the fistula tract using biomaterials (fibrin glue and fibrin plug). Objective of this study was to evaluate the healing efficacy and incontinence rate of biomaterials (fibrin glue and fibrin plug) in comparison to surgical interventions in the treatment of cryptoglandular perianal fistula using meta-analysis of randomized controlled trials. PubMed, Scopus, Google Scholar and Web of Science were searched for clinical trial studies investigated the effects of biomaterials in the treatment of fistula-in-ano. Studies on patient with anal fistulae underwent fibrin glue, fibrin plug or other biomaterials application and surgical management for healing of fistula were included. Clinical response and incontinence were the key outcomes of interest. Six randomized placebo-controlled clinical trials consisting 315 patients in various arms met our criteria (comparing biomaterial with surgical interventions) and were included in the analysis. Pooling of data showed that effectiveness of biomaterials in comparison to surgical interventions was non-significant with relative risk (RR) of 0.73 (95% CI of 0.31-0.89, p = 0.096). The incontinence rate RR in biomaterials and intervention was also non significant with RR of 0.35 (95% CI = 0.05-2.28, p = 0.27). The included clinical trials had different follow-up durations, causes of fistula and method of intervention in treated patients. This meta-analysis demonstrates that the effectiveness and incontinence rate of biomaterials and conservative treatment is not significantly different.
  Roja Rahimi , Shekoufeh Nikfar and Mohammad Abdollahi
  The use of herbal medicine for the management of Inflammatory Bowel Disease (IBD) is increasing. The aim of the present study is to compare the efficacy and tolerability of herbal medicines with 5-aminosalicylates (5-ASAs) in IBD by conducting a meta-analysis. For this purpose, electronic databases were searched for studies comparing efficacy and/or tolerability of herbal medicines with 5-ASAs in different types of IBD. The search terms were: “herb” or “plant” or “herbal” and “inflammatory bowel disease”. Data were collected from 1966-2013 (up to Feb). The “clinical response”, “clinical remission”, “endoscopic response”, “endoscopic remission”, “histological response”, “histological remission”, “relapse”, “any adverse events” and “serious adverse events” were the key outcomes of interest. Eight placebo controlled clinical trials met criteria and were included. Comparison of herbal medicine with 5-ASAs yielded the following results: a significant Relative Risk (RR) of 1.28 (95% Confidence Interval (CI): 1.07-1.54, p = 0.008) for clinical remission; a significant RR of 1.19 (95% CI = 1.01-1.39, p = 0.04) for clinical response; a non-significant RR of 0.85 (95% CI: 0.34-2.12, p = 0.73) for endoscopic remission; a non-significant RR of 1.14 (95% CI: 0.99-1.3, p = 0.07) for endoscopic response; a non-significant RR of 0.8 (95% CI: 0.05-13.72) for histological remission; a non-significant RR of 1.32 (95% CI: 0.64-2.9) for histological response; a non-significant RR of 1.05 (95% CI: 0.6-1.83, p = 0.87) for relapse; a non-significant RR of 1.31 (95% CI: 0.8-2.14, p = 0.28) for any adverse events; and a non-significant RR of 1.8 (95% CI: 0.13-24.5, p = 0.66) for serious adverse events. Overall, the efficacy and tolerability of herbal medicines in IBD is comparable to 5-ASAs, but the evidence is too limited to make any confident conclusion. Further high quality, large controlled trials are still needed.
  Hadi Mirfazaelian , Shekoufeh Nikfar , Mohammad-Amin Rezvanfar and Mohammad Abdollahi
  The present study is a meta-analysis of clinical studies evaluating the efficacy of Fresh Frozen Plasma (FFP) in the treatment of organophosphorus (OP) poisoning. PubMed, Scopus, Google Scholar and were searched for studies investigating the effects of FFP in the treatment of OP poisoning. Mortality, intermediate syndrome (IMS) and hospital stay duration were the key outcomes of interest. Data were searched in the time period of 1966 through April 2014. Three studies that met our inclusion criteria were included in the analysis. Pooling of data showed that the Relative Risk (RR) of mortality in OP poisoning for three included trials comparing FFP to placebo was 0.77 (95% CI = 0.28 to 2.07 (P = 0.6)). The summary of RR for IMS in 2 studies was 0.74 with 95% CI = 0.05 to 10.99 (P = 0.83). The summary of a standard effect for the hospital stay duration in OP poisoning for two trials comparing FFP with placebo was -0.37 with 95% CI = -4.68 to 3.94. According to these data, FFP effect on OP poisoning in mortality, hospital stay duration and IMS incidence was not significant.
  Hadi Mirfazaelian , Shekoufeh Nikfar , Amir-Ahmad Salarian and Mohammad Abdollahi
  The present study is a meta-analysis on clinical trials evaluating the efficacy of oximes on organophosphorus (OP) intoxication treatment. PubMed, Scopus, Google Scholar and were searched for studies investigating the effects of oximes in the treatment of OP poisoning. Mortality, intermediate syndrome, Intensive Care Unit (ICU) admission rate, hospital stay duration and intubation rate were the key outcomes of interest. Data were searched in the time period of 1966 through April 2014. Thirteen studies (eleven clinical trials and two historical cohorts) that met our criteria were included in the analysis. Pooling of data showed that Relative Risk (RR) of need for intubation in OP poisoning for ten included trials comparing oximes with placebo was 1.18 with 95% CI = 0.76 to 1.84 (p = 0.27). RR of the single observational study was 1.57 (95% CI = 0.79 to 3.2, p>0.05). The summary of RR for mortality rate in 11 studies was 1.4 (95% CI = 0.77 to 2.54, p = 0.41) and for two observational studies was 1.19 (95% CI = 0.5 to 2.85, p>0.05). The RR for ICU admission rate in OP poisoning for three trials comparing oximes to placebo was 2.12 with 95% CI = 0.89 to 5.03 (p = 0.09). For the single observational study, RR was 0.81 (95% CI = 0.49 to 1.25, p>0.05). For intermediate syndrome while the RR of only trial comparing oximes with placebo was 1.89 (95% CI = 1.27 to 2.91, p<0.05), for the single observational study, it was 1.43 (95% CI = 0.7 to 2.96, p>0.05). For hospital stay duration (difference), the RR of four studies was 0.75 with 95% CI = -0.51 to 1.99. According to these data, oximes beneficence in OP poisoning is unclear and there is a potential increase in the incidence of intermediate syndrome.
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