Dr. Ardalan  Enkeshafi  Md image

Dr. Ardalan Enkeshafi Md

900 Seton Dr
Cumberland MD 21502
301 234-4000
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: D0068455
NPI: 1003000126
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Does the prevalence of psychiatric distress and violence behaviors of children and adolescents differ according to the socioeconomic status of the living region? The CASPIAN- IV study. - Minerva pediatrica
This nationwide study aims to investigate the prevalence of psychiatric distress and violent behaviors in a nationally-representative sample of Iranian children and adolescents according to the socioeconomic status (SES) of their living region.In this study, 14880 school students, aged 6-18 years, were selected from 30 provinces in Iran. The World Health Organization Global School-based Health Survey questionnaire was used. Data were compared at national and subnational levels according to the SES of the living region.Overall, 13486 students (49.2% girls) with mean (SD) age of 12.47(3.36) years completed the study. At national level, the prevalence of psychiatric distress ranged between 9 to 38%; the most and least prevalent psychiatric distresses were angriness (37.73%, 95%CI: 36.5, 38.99) and confusion (8.65%, 95%CI: 8.04, 9.29), respectively. Students living in regions with highest SES experienced angriness (41.24%, 95%CI: 38.94, 43.59) more than in those from the regions with lowest SES (31.18%, 95%CI: 26.71, 36.02). The prevalence of bully, victim and physical fight was 17.56% (95% CI: 16.73, 18.42), 27.36% (95% CI: 26.34, 28.42), and 39.94% (95% CI: 38.69, 41.20), respectively. The prevalence of violent behavior did not differ significantly in various regions of Iran.The relatively high prevalence of psychiatric distress in Iranian children and adolescents necessitates paying more attention to mental health of this vulnerable age group. Differences in the prevalence of such disorders according to the SES of the living area should be considered in planning evidence-based preventive programs and in international comparisons.
Study of C-MYC amplification and expression in Iranian gastric cancer samples using CISH and IHC methods. - Advanced biomedical research
Gastric cancer is the fourth most frequent malignancy and the second cause of cancer-related mortality worldwide. It has been suggested that in gastric carcinogenesis, the C-MYC gene has an important function. The objective of this study is to establish the preference of Chromogenic in situ hybridization (CISH) and Immunohistochemistry (IHC) in the diagnosis and prognosis of gastric cancer.Samples comprised of 50 randomly selected patients of whom 40 were male and 10 female. To evaluate the MYC copy number and its protein expression, CISH and IHC analyses were performed for 50 gastric adenocarcinomas, in Iran.The location of the tumor in 64% of the patients was the fundus, and in 72% of patients, the tumors were of a diffuse type; 22 samples showed no amplification, and 28 samples were with amplification. MYC immunoreactivity was observed in 13 samples. Twelve samples showed both MYC amplification and MYC immunoreactivity. In addition, among the 28 CISH+ samples, 12 samples had positive signals for IHC and 16 samples had negative signals for IHC. A majority of the IHC-negative patients had no amplification, but only one patient with IHC positive had no amplification.Our conclusion was that for the management and treatment of gastric cancer, and for special attention of clinicians, for prognosis and tumor progression, the CISH was a better and more feasible test than IHC, in regard to the sensitivity and specificity.
Is the association of continuous metabolic syndrome risk score with body mass index independent of physical activity? The CASPIAN-III study. - Nutrition research and practice
Although the association of body mass index (BMI) with metabolic syndrome (MetS) is well documented, there is little knowledge on the independent and joint associations of BMI and physical activity with MetS risk based on a continuous scoring system. This study was designed to explore the effect of physical activity on interactions between excess body weight and continuous metabolic syndrome (cMetS) in a nationwide survey of Iranian children and adolescents.Data on 5,625 school students between 10 and 18 years of age were analyzed. BMI percentiles, screen time activity (STA), leisure time physical activity (LTPA) levels, and components of cMetS risk score were extracted. Standardized residuals (z-scores) were calculated for MetS components. Linear regression models were used to study the interactions between different combinations of cMetS, LTPA, and BMI percentiles.Overall, 984 (17.5%) subjects were underweight, whereas 501 (8.9%) and 451 (8%) participants were overweight and obese, respectively. All standardized values for cMetS components, except fasting blood glucose level, were directly correlated with BMI percentiles in all models (P-trend < 0.001); these associations were independent of STA and LTPA levels. Linear associations were also observed among LTPA and standardized residuals for blood pressure, high-density lipoprotein, and waist circumference (P-trend < 0.01).Our findings suggest that BMI percentiles are associated with cMetS risk score independent of LTPA and STA levels.
Virtual Disaster Simulation: Lesson Learned from an International Collaboration That Can Be Leveraged for Disaster Education in Iran. - PLoS currents
Disaster education needs innovative educational methods to be more effective compared to traditional approaches. This can be done by using virtual simulation method. This article presents an experience about using virtual simulation methods to teach health professional on disaster medicine in Iran. The workshop on the "Application of New Technologies in Disaster Management Simulation" was held in Tehran in January 2015. It was co-organized by the Disaster and Emergency Health Academy of Tehran University of Medical Sciences and Emergency and the Research Center in Disaster Medicine and Computer Science applied to Medicine (CRIMEDIM), Università del Piemonte Orientale. Different simulators were used by the participants, who were from the health system and other relevant fields, both inside and outside Iran. As a result of the workshop, all the concerned stakeholders are called on to support this new initiative of incorporating virtual training and exercise simulation in the field of disaster medicine, so that its professionals are endowed with field-based and practical skills in Iran and elsewhere. Virtual simulation technology is recommended to be used in education of disaster management. This requires capacity building of instructors, and provision of technologies. International collaboration can facilitate this process.
Diabetes Research in Iran: a Scientometric Analysis of Publications Output. - Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : časopis Društva za medicinsku informatiku BiH
In the developing countries, diabetes mellitus as a chronic diseases, have replaced infectious diseases as the main causes of morbidity and mortality. International Diabetes Federation (IDF) recently estimates 382 million people have diabetes globally and more than 34.6 million people in the Middle East Region and this number will increase to 67.9 million by 2035. The aim of this study was to analyze Iran's research performance on diabetes in national and international context.This Scientometric analysis is based on the Iranian publication data in diabetes research retrieved from the Scopus citation database till the end of 2014. The string used to retrieve the data was developed using "diabetes" keyword in title, abstract and keywords, and finally Iran in the affiliation field was our main string.Iran's cumulative publication output in diabetes research consisted of 4425 papers from 1968 to 2014, with an average number of 96.2 papers per year and an annual average growth rate of 25.5%. Iran ranked 25th place with 4425 papers among top 25 countries with a global share of 0.72 %. Average of Iran's publication output was 6.19 citations per paper. The average citation per paper for Iranian publications in diabetes research increased from 1.63 during 1968-1999 to 10.42 for 2014.Although diabetic population of Iran is increasing, number of diabetes research is not remarkable. International Diabetes Federation suggested increased funding for research in diabetes in Iran for cost-effective diabetes prevention and treatment. In addition to universal and comprehensive services for diabetes care and treatment provided by Iranian health care system, Iranian policy makers should invest more on diabetes research.
The association of vitamin D deficiency with psychiatric distress and violence behaviors in Iranian adolescents: the CASPIAN-III study. - Journal of diabetes and metabolic disorders
Subtle effects of vitamin D deficiency on behavior have been suggested. We investigated the association of vitamin D status with mental health and violence behaviors in a sample of Iranian adolescents.This nationwide study was conducted in 2009-2010 in 1095 Iranian school students with mean age 14.7 ± 2.6 years. Items were adapted from the Global School-based Student Health Survey (GSHS). Psychiatric distress was considered as the self-reported anger, anxiety, poor quality sleep, confusion, sadness/depression, worry, and violence-related behaviors (physical fight, having bully, or getting bullied).Forty percent had serum 25(OH)D values below 10 ng/mL (vitamin D deficient), and 39 % had levels 10-30 ng/mL (vitamin D insufficient). The prevalence of self-reported anger, anxiety, poor quality sleep, sadness/depression, and worry was significantly lower (P < 0.05) in vitamin D sufficient participants compared with their other counterparts. The odds of reporting anger, anxiety, poor quality sleep, and worry, increased approximately 1.5 to 1.8 times in vitamin D insufficient compared with normal children and adolescents (P < 0.05). Risk estimates indicated that vitamin D insufficient and deficient subjects had higher odds of reporting worry compared to normal vitamin D group [OR = 2.417 (95 % CI: 1.483-3.940) for vitamin D insufficient students, and OR = 2.209 (95 % CI: 1.351-3.611) for vitamin D deficient students] (P-trend = 0.001). Violence behaviors did not show any association with vitamin D status (P > 0.05).Some psychiatric distress such as anger, anxiety, poor quality sleep, depression, and worry are associated with hypovitaminosis D in adolescents. The clinical significance of the current findings should be determined in future longitudinal studies.
Application of Behavioral Theories to Disaster and Emergency Health Preparedness: A Systematic Review. - PLoS currents
Preparedness for disasters and emergencies at individual, community and organizational levels could be more effective tools in mitigating (the growing incidence) of disaster risk and ameliorating their impacts. That is, to play more significant roles in disaster risk reduction (DRR). Preparedness efforts focus on changing human behaviors in ways that reduce people's risk and increase their ability to cope with hazard consequences. While preparedness initiatives have used behavioral theories to facilitate DRR, many theories have been used and little is known about which behavioral theories are more commonly used, where they have been used, and why they have been preferred over alternative behavioral theories. Given that theories differ with respect to the variables used and the relationship between them, a systematic analysis is an essential first step to answering questions about the relative utility of theories and providing a more robust evidence base for preparedness components of DRR strategies. The goal of this systematic review was to search and summarize evidence by assessing the application of behavioral theories to disaster and emergency health preparedness across the world.The protocol was prepared in which the study objectives, questions, inclusion and exclusion criteria, and sensitive search strategies were developed and pilot-tested at the beginning of the study. Using selected keywords, articles were searched mainly in PubMed, Scopus, Mosby's Index (Nursing Index) and Safetylit databases. Articles were assessed based on their titles, abstracts, and their full texts. The data were extracted from selected articles and results were presented using qualitative and quantitative methods.In total, 2040 titles, 450 abstracts and 62 full texts of articles were assessed for eligibility criteria, whilst five articles were archived from other sources, and then finally, 33 articles were selected. The Health Belief Model (HBM), Extended Parallel Process Model (EPPM), Theory of Planned Behavior (TPB) and Social Cognitive Theories were most commonly applied to influenza (H1N1 and H5N1), floods, and earthquake hazards. Studies were predominantly conducted in USA (13 studies). In Asia, where the annual number of disasters and victims exceeds those in other continents, only three studies were identified. Overall, the main constructs of HBM (perceived susceptibility, severity, benefits, and barriers), EPPM (higher threat and higher efficacy), TPB (attitude and subjective norm), and the majority of the constructs utilized in Social Cognitive Theories were associated with preparedness for diverse hazards. However, while all the theories described above describe the relationships between constituent variables, with the exception of research on Social Cognitive Theories, few studies of other theories and models used path analysis to identify the interdependence relationships between the constructs described in the respective theories/models. Similarly, few identified how other mediating  variables could influence disaster and emergency preparedness. The existing evidence on the application of behavioral theories and models to disaster and emergency preparedness is chiefly from developed countries. This raises issues regarding their utility in countries, particularly in Asisa and the Middle East, where cultural characteristics are very different to those prevailing in the Western countries in which theories have been developed and tested. The theories and models discussed here have been applied predominantly to disease outbreaks and natural hazards, and information on their utility as guides to preparedness for man-made hazards is lacking. Hence, future studies related to behavioral theories and models addressing preparedness need to target developing countries where disaster risk  and the consequent need for preparedness is high. A need for additional work on demonstrating the relationships of variables and constructs, including more clearly articulating roles for mediating effects was also identified in this analysis.
Prevalence of General and Abdominal Obesity in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study. - Iranian journal of pediatrics
Pediatric obesity is one of the predisposing risk factors for many non-communicable diseases.The purpose of this study was to estimate the national prevalence of general and abdominal obesity among Iranian children and adolescents.This cross-sectional nation-wide study was performed in 30 provinces in Iran among 14880 school students aged 6 - 18 years, selected by multistage random cluster sampling. The World Health Organization growth curve was used to categorize Body Mass Index (BMI). Obesity was defined as BMI equal to or higher than the age- and gender-specific 95(th) percentile; abdominal obesity was considered as waist-to-height ratio of more than 0.5.Data of 13486 out of 14880 invited students were complete (response rate of 90.6%). They consisted of 6543 girls and 75.6% urban residents, and had a mean age of 12.45 (95% CI: 12.40 - 12.51) years. The prevalence rate of general and abdominal obesity was 11.89% (13.58% of boys vs. 10.15% of girls) and 19.12% (20.41% of boys vs. 17.79% of girls), respectively. The highest frequency of obesity was found in the middle school students (13.87% general and 20.84% abdominal obesity). The highest prevalence of general obesity was found in Boushehr (19%) followed by Guilan and Mazandaran (18.3%, 18.3%), while the lowest prevalence was observed in Hormozgan (2.6%). The highest frequency of abdominal obesity was found in Mazandaran (30.2%), Ardabil (29.2%) and Tehran (27.9%). Provinces such as Sistan-Baloochestan (8.4%), Hormozagan (7.4%), and Kerman (11.4%) had the lowest prevalence of abdominal obesity. The Southern and South Eastern provinces had the lowest prevalence of general obesity (2.6% and 5.6%) and abdominal obesity (7.4% and 8.8%). Moreover, the highest prevalence of obesity was found in North and North West Iran by maximum frequency of 18.3% general obesity and 30.2% of abdominal obesity.The results showed a high prevalence of general and abdominal obesity among boys living in the Northern provinces of Iran. The present study provides insights that policy makers should consider action-oriented interventions for prevention and control of childhood obesity at national and sub-national level.
Regional Disparities in Sedentary Behaviors and Meal Frequency in Iranian Adolescents: The CASPIAN-III Study. - Iranian journal of pediatrics
The prevalence of obesity is increasing among Iranian youngsters like other developing countries.This study was conducted to assess regional disparities in sedentary behaviors and meal frequency in Iranian adolescents.In this national survey, 5682 students aged 10 - 18 years from urban and rural districts of 27 provinces of Iran were selected via stratified multi-stage sampling method. The country was classified into four sub-national regions, based on criteria of the combination of geography and socioeconomic status (SES). Mean of meal frequency and physical activity levels as well as prevalence of omitting meals and sedentary behavior were compared across regions with different SES after stratifying with sex and age group.Meal frequency in lower socio-economic regions was significantly higher than two other regions in 10 - 13 and 10 - 18 years old groups (P trend < 0.001). However, the mean of working hours with computer was linearly increased with increasing the SES in studied regions (P trend < 0.001), whereas the corresponding figure was not significant for the mean of watching TV (P trend > 0.05). Frequency of adolescents omitting their meals was higher in higher SES regions especially in West Iran (P < 0.001) in 10 - 13 years old age group. Having personal computer and working with it more than two hours per day mainly was observed in central Iran which ranked as the highest SES group.Efforts to ensure Iranian youth meet healthy food habits and screen time guidelines include limiting access to screen technologies and encouraging parents to monitor their own screen time is required.
6q16.3q23.3 duplication associated with Prader-Willi-like syndrome. - Molecular cytogenetics
Prader-Willi syndrome (PWS) is characterized by hypotonia, delayed neuropsychomotor development, overeating, obesity and mental deficiency. This phenotype is encountered in other conditions, defining Prader-Willi-like syndrome (PWLS).We report a 14-year-old boy with a complex small supernumerary marker chromosome (sSMC) associated with PWLS. The propositus presents clinical features commonly found in patients with PWLS, including growth hormone deficit. Banding karyotype analysis and fluorescence in situ hybridization (FISH) revealed a marker derived from chromosome 6 and a neocentromere as suspected, but array-CGH enabled us to characterize this marker as a der(10)t(6;10)(6qter → 6q23.3::10p11.1 → 10p11.21)dn. As far as we know, this is the first diagnosed case of PWLS associated with a complex sSMC, involving a 30.9 Mb gain in the 6q16.3q23.3 region and a 3.5 Mb gain in the 10p11.21p11.1 region. Several genes have been mapped to the 6q region including the TCBA1 gene, which is associated with developmental delay and recurrent infections, the ENPP1 gene, associated with insulin resistance and susceptibility to obesity and the BMIQ3 gene, associated with body mass index (BMI). No OMIM gene was found in the smallest 10p11.21p11.1 region.We suggest that the duplicated chromosome segment 6q16.3q23.3 may be responsible for the phenotype of our case and may also be a candidate locus of PWLS.

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