bijan iraj

Diabetic retinopathy (DR) is one of the complications of diabetes. This study was conducted to investigate the effect of curcumin?piperine on laboratory factors and macular vascular in DR.

The present study was a randomized, placebo?controlled, double?blind, parallel?arm clinical trial that was conducted on 60 patients with DR aged 30–65 years. Patients were randomized into two groups to receive (i) 1010 mg/day of curcumin?piperine (two tablets per day, each tablet containing 500 mg curcuminoids and 5 mg piperine) (n = 30) or (ii) the matched placebo (n = 30) for 12 weeks. The investigated factors included optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), oxidative stress factors, C?reactive protein (CRP), fasting blood glucose (FBG), triglycerides (TGs), blood urea nitrogen (BUN), and creatinine.

The trial was completed by 27 patients in the intervention group and 29 patients in the placebo group. Curcumin?piperine significantly increased total antioxidant capacity (0.86 ± 0.66 vs. 0.45 ± 0.89; P = 0.022) and superoxide dismutases (0.77 ± 2.11 vs. ?0.45 ± 3.08; P = 0.031), while it decreased and malondialdehyde (MDA) (?1.06 ± 5.80 vs. 1.89 ± 6.12; P = 0.043) and creatinine (?0.04 ± 0.16 vs. 0.03 ± 0.05; P = 0.042) compared with placebo. However, this supplement had no significant effect on CRP, FBG, TG, BUN, OCT, and OCTA.There were no adverse reactions.

Curcumin?piperine is effective in improving oxidative stress and reducing creatinine in DR. Further trials are necessary to confirm these promising findings.

The current study aims to assess cardiovascular risk factors (CVRFs) among diabetic versus nondiabetic nonalcoholic fatty liver disease (NAFLD) patients. NAFLD is the most common hepatic disorder worldwide which is directly associated with diverse CVRFs such as type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS).

The current cross?sectional population?based study has been conducted on 1031 NAFLD patients. After excluding 340 prediabetes patients, the NAFLD patients were divided into T2DM and normal blood glucose (NBG). Then, CVRFs were compared between the two groups.

Out of 691 NAFLD cases included in the study, 337 (48.8%) patients had T2DM. In the T2DM and NBG groups, the body mass index (BMI) was 31.2 ± 4.6 and 29.9 ± 4.3 kg/m2, respectively (P = 0.001). The waist circumference was 102.2 ± 10.2 and 97.6 ± 10.6 cm, respectively (P < 0.001). The systolic blood pressure was 123.3 ± 15.6 and 119.6 ± 13.6 mmHg, respectively (P = 0.043).The triglyceride levels were 191.9 ± 104.7 and 176.5 ± 89.6 mg/dL, respectively (P = 0.042). Generally, these factors were significantly higher among the diabetic patients. Besides, cardiovascular disease (CVD), hypertension, and MS were statistically more prevalent in NAFLD patients with T2DM (P < 0.001) than nondiabetic NAFLD patients. In multiple logistic regression models, the odds ratioof CVD, hypertension, and MS was 2.18, 2.12, and 6.63 for patients with T2DM compared with NBG, respectively. Adjustment was made for age, sex, BMI, smoking, and physical activity.

CVRFs were higher in NAFLD patients with T2DM than NAFLD patients with NBG.

To determine the average cutoff values of serum?free and total testosterone (FT, TT) and dehydroepiandrosterone sulfate (DHEAS) among healthy premenopausal women.

Participants were women aged 18–55 years without signs and symptoms of hyperandrogenism (n = 489). Participants if Ferriman–Gallwey (FG) scores between 6 and 8 were considered a group located in the upper spectrum related to the normal hirsutism score (n = 30). DHEAS, TT, and FT levels were compared between different populations. Upper limits of 97.5 and 95 and lower limits of 5 and 2.5 percentiles were calculated to provide the reference intervals for DHEA, TT, and FT in the total sample and in the population with FG 6–8.

In the total population, the mean ± standard deviation (SD) serum FT, TT, and DHEAS levels were 1.40 ± 0.63 pg/mL, 0.42 ± 0.17 ng/mL, and 1.5 ± 0.97 ?g/ml, respectively. The cutoff values of FT at 1.35 and TT at 0.49 were obtained for differentiating the patients with FG 6–8 scores from the normal population, with the corresponding specificity of 0.60, the sensitivity of 0.67, and area under the ROC curve (AUC) (confidence interval 95%) of 0.63 (0.52–0.73), P = 0.01 and 0.68 (0.58–0.78) P = 0.001, respectively.

In our study, the mean ± SD serum FT level was 1.40 ± 0.63 pg/mL, the TT level was 0.42 ± 0.17 ng/mL, and the DHEAS level was 1.5 ± 0.97 ?g/ml, in premenopausal women between 18 and 49 years of age. Furthermore, in a population with FG 6–8 score, a cutoff value of FT at 1.35 and TT at 0.49 was obtained. Although the irregular menstrual cycle did not change the reference range when compared with the normal group.

Increasing incidence rates of diabetes related to air pollution have been reported in high‑income countries. However, few studies evaluated air pollution effect on plasma glucose indices, in addition to diabetes and prediabetes incidence in developing countries. This study investigated the association between exposure to common air pollutants and the changes plasma glucose indices over time. The incidence of type 2 diabetes (T2D) and prediabetes in future were also examined in association with exposure to air pollution.

A total of 3828 first‑degree relatives of patients with T2D who were prediabetes or had normal glucose tolerance (NGT) were enrolled in this study. Cox regression was used to assess the relationships between particulate matter (PM2.5 and PM10), nitrogen monoxide (NO), nitrogen dioxide, nitric oxides, sulfur dioxide (SO2), and ozone exposure and the incidence of T2D and prediabetes. We also applied a linear mixed model to assess the association between exposure to these air pollutants and changes in plasma glucose indices over time.

Air pollutants showed a significant positive association with changes in fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), and 2 h oral glucose tolerance (OGTT) in participants with NGT and prediabetes. The maximum increase in plasma glucose indices was associated with NO concentration. Our study also showed exposure to all air pollutants except SO2 was significantly associated with an increased risk of developing T2D and prediabetes (Hazard ratio > 1, P < 0.001).

According to our results, exposure to air pollution increases the risk of T2D and prediabetes incidence in our population. The exposure to air pollutants was also associated with increasing trend in FPG, HbA1c, and OGTT levels in both groups of NGT and prediabetic participants.

Angiotensin II receptor blockers (ARBs) and angiotensin‑converting enzyme inhibitors (ACEinhs) may deteriorate or improve the clinical manifestations in severe acute respiratory syndrome coronavirus 2 infection. A comparative, cross‑sectional study was conducted to evaluate the association of ARBs/ACEinhs and hydroxy‑3‑methyl‑glutaryl‑CoA reductase inhibitors (HMGRis) with clinical outcomes in coronavirus disease 2019 (COVID‑19).

From April 4 to June 2, 2020, 659 patients were categorized according to whether they were taking ARB, ACEinh, or HMGRi drugs or none of them. Demographic variables, clinical and laboratory tests, chest computed tomography findings, and intensive care unit‑related data were analyzed and compared between the groups.

The ARB, ACEinh, and HMGRi groups significantly had lower heart rate (P < 0.05). Furthermore, a lower percent of O2 saturation (89.34 ± 7.17% vs. 84.25 ± 7.00%; P = 0.04) was observed in the ACEis group than non‑ACEinhs. Mortality rate and the number of intubated patients were lower in patients taking ARBs, ACEinhs, and HMGRis, although these differences failed to reach statistical significance.

Our findings present clinical data on the association between ARBs, ACEinhs, and HMGRis and outcomes in hospitalized, hypertensive COVID‑19 patients, implying that ARBs/ACEinhs are not associated with the severity or mortality of COVID‑19 in such patients.

Curcumin is a safe phytochemical with antioxidant, anti-inflammatory, antidiabetic, and lipid-lowering effects. This study aims to investigate the efficacy of curcumin-piperine in non-proliferative diabetic retinopathy. In this double-blind randomized trial, 60 diabetic retinopathy patients after meeting the inclusion criteria will be randomly assigned to two groups of curcumin-piperine supplementation (1000 mg per day for 12 weeks) or receiving placebo. The density of small blood vessels in the retina by optical coherence tomography angiography (OCTA), fasting blood glucose, triglyceride, renal indices (blood urea nitrogen and creatinine), high-sensitivity C-reactive protein, total antioxidant capacity, total oxidant status, body mass index, waist circumference, and weight will be measured. If the beneficial effects of curcumin on diabetic retinopathy are observed, this safe, this natural and inexpensive herbal supplement can be considered a therapeutic solution in these patients.

Medicinal plants with fewer side effects and low cost than synthetic medicines are increasingly advised to treat diseases. The present study aimed to identify Eryngium billardieri compounds and evaluate the plant’s effects on hyperglycemic and hyperlipidemia indices, and liver, and kidney function. Following identification of Eryngium billardieri using GC/MS method, 72 participants were randomly divided into two groups (n=36 per group), receiving oral hypoglycemic medication (metformin) with or without 50 ml hydrosol  twice a day for three months as intervention and placebo control, respectively. Body mass index (BMI), systolic and diastolic blood pressure, fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride, HDL-C, and LDL-C levels were measured at the beginning and end of the experiment. Also, aspartate transaminase, alanine transaminase, blood urea nitrogen, and creatinine levels were measured to assess adverse effects on liver and kidney functions. The main components were terpenes with 46.69% of the total ingredients of E. billardieri essential oil. Other prominent compounds identified included octanoic acid (12.14 %) and isoxazole (6.72 %).  Intergroup changes in blood parameters showed that E. billardieri hydrosol for three months could significantly reduce HbA1C and blood cholesterol levels but did not affect other measured parameters. Also, there were no adverse effects on kidney or liver function. The present findings showed that the consumption of 50 ml of E. billardieri hydrosol as a complementary treatment in diabetic patients reduced HbA1C and cholesterol levels without adverse effects on the liver or kidneys functions.

Role of multimedia training materials on Mini-CEX scores of internal medicine residents. We aimed to assess the effect of multi multimedia training materials on Mini-CEX scores of internal medicine residents of Isfahan University of Medical Sciences. SETTINGS AND DESIGN: A quasi-experimental action research study on 1st, 2nd, and 3rd-year internal medicine residents were implemented.

The Mini-CEX test measures students’ performance in six core skills necessary for medical practice. Mini-CEX scores of 135 internal medicine residents in 2017–2018 were compared before and after the training with prepared multimedia materials. We used repeated measured ANOVA and Mann–Whitney U test to compare the distribution of Mini-CEX scores across corresponding groups. Analysis was done using the SPSS software version 23 (IBM SPSS Statistics for Windows. Armonk, NY, USA: IBM Corp).

The median Mini-CEX score (IQR) of students in preintervention and postintervention groups were 16.14 (5.19) and 19.62 (3.13), respectively. Findings of this study showed a significant increase in mini-CEX scores of the groups who used the multimedia learning material compared to those who did not use it (P < 0.001).

Multimedia learning resources demonstrated a promising influence on internal residents’ mini‑CEX scores in this study. They demonstrate significantly greater performance after using multimedia learning materials compared to their same‑year residents who did not benefit from it. This demonstrates the favorable effect of multimedia on the acquisition of practical skills such as obtaining a history or performing a physical examination.

 Type 2 diabetes is a metabolic abnormality that results in increased plasma glucose, glycosylated hemoglobin and decreased quality of life due to decreased insulin secretion. Considering the side effects of chemical drugs, researchers are looking for alternative and complementary methods such as herbal treatments. The aim of this study was to determine the effect of the tea of pistaciakhinjuk plant on the indicators of metabolic control and the quality of life of type 2 diabetes patients.

 72 patients with type 2 diabetes were randomly divided into 2 intervention and control groups. The intervention group consumed 240 cc of pistaciakhinjuk leaf tea daily after breakfast and dinner for one month. The control group continued their treatment process. Data collection was done with Jacobsen's questionnaire measuring the quality of life of diabetes patients and data analysis was done using descriptive and inferential statistics methods.

 The independent t-test and also the analysis of variance test with repeated observations showed that the average score of metabolic indicators and quality of life one month and three months after the intervention in the test group was significantly lower than the control group (P≺0.05). .

 The results showed that there was a statistically significant difference in the experimental group before and after the intervention. This means that pistaciakhinjuk leaves billardieri has been able to affect fasting sugar, glycosylated hemoglobin and quality of life in patients with type 2 diabetes.

Diabetes as a chronic disease requires a change in the paradigm of treatment and health care system based on acute illnesses to chronic conditions. Chronic Care Model has been designed to address this need. This study aimed to explore the lived experiences of the diabetes team and diabetic patients regarding the health care system after redesigning delivery system and supporting self-management based on the Chronic Care Model in Iran.

Research was conducted with a qualitative descriptive approach in one of the Isfahan city clinics in 2018. The participants were diabetes team (composed of diabetes physician, nurse, assistant nurse and dean of the clinic) and 17 type- 2 diabetic patients who were selected through purposive sampling. Data collection was performed through semi-structured interviews and then were analyzed using content analysis with an inductive approach.

The findings of this study were composed of the following two main categories: (1) educational function change, including the sub-categories of evidence-based nurse education and patients’ demand to ongoing participation in the training classes; and (2) treatment and care method upgrade, including the sub-categories of nurse’s role change in a team approach, continuity in cares and upgrading patients’ self-care behaviors.

Delivery system redesign and diabetes self-management support based on Chronic Care Model changed organizational structure and performance of the diabetes care system. It also reformed the structure of treatment providers from a vertical and hierarchical form to a team arrangement. Nurse’s educational function became evidence-based and patients’ self-care behaviors upgraded.

Acute kidney injury (AKI) is one of the most prevalent and extreme physio-pathological disorders in hospitalized patients, 20-40% of whom are hospitalized in the intensive Care Unit (ICU). Sepsis is the most commonplace reason for AKI in intensive care patients, accounting for 50% of ICU cases This was a descriptive cross-sectional study conducted at Isfahan University of Medical Sciences from 22 October 2016 to 22 October 2017. Two hundred and thirty-two selected patients at Al-Zahra Hospital in Esfahan were enrolled in the study. Patients were followed for 10 days to determine the short-term mortality rate. Data were analyzed using t-test and Chi-squared test using SPSS software (ver. 16). In this study, 232 patients with sepsis were evaluated. Their mean age (± standard deviation) was 69.9 (18.4) years. The mean age of patients with acute kidney Injury (72.7 years) was significantly higher than the mean age of non-patients (non-AkI) (66.6 years) (p-value= 0.012). However, the significant difference was not between the age groups, but the p-value was near the significant border. The mortality rate of patients (53.6%) was significantly higher than the non-patients (non-AKI) (29.6%) (p-value<0.0001). This study showed that the prevalence of AKI was 57.3%, which was similar to the prevalence rate in other countries. A relationship was also demonstrated between AKI and mortality rate and showed that AKI increases the mortality rate.

Previous studies have suggested that linagliptin may represent renoprotective effects besides its anti-hyperglycemic properties in patients with type 2 diabetes. However, there is a lack of decisive evidence to support this assumption. This study aimed to address the effect of linagliptin in type 2 diabetic patients with severely increased albuminuria.

In this randomized double-blind, placebo-controlled clinical trial, type 2 diabetic patients with severely increased albuminuria (albuminuria ≥ 300 mg/24 h) were enrolled. Patients were randomized to linagliptin (5 mg/d) and placebo based on a computer-generated list of random numbers. Biochemical (fasting blood sugar (FBS) (mg/dL), hemoglobin A1c (HbA1c) (%), proteinuria (mg/24h), blood urea nitrogen (BUN) (mg/dL), serum creatinine (mg/dL)) and clinical variables (weight (kg), systolic, and diastolic blood pressure (mmHg)) were measured at baseline and 3 and 6 months post intervention.

At baseline, no statistically significant difference was detected in demographic characteristics between the two groups (P > .05). A significant decrease was observed in proteinuria, FBS, weight, SBP, and DBP in the intervention group after 6 months (Ptime < .05), however; none of the clinical and biochemical variables showed a significant difference between groups after 6 months (Pgroup > .05).

Linagliptin may serve as a renoprotective therapeutic option in diabetic patients with severely increased albuminuria due to its role in proteinuria reduction. Results of this study can be used for future large-scale, long-term studies investigating the renoprotective effects of linagliptin in patients with diabetic nephropathy.

Education in vulnerable communities can be a health affordable strategy to promote patient empowerment. Recognition and understanding the problems of diabetes education are of significance to overcome the barriers and advance the educational and care services to control diabetes and promotion of society health. The aim of this study was to explore participants’ perspectives, experiences, and preferences, regarding diabetes education problems.

This descriptive, qualitative study was conducted from March 2016 to September 2017. The participants were 23 people including nine patients with diabetes and their family members and 14 members of diabetes healthcare team (physicians, nurses, and nutritionists). The data were collected through individual semi‑structured interviews and analyzed through conventional content analysis approach proposed by Graneheim and Lundman. Some main categories and subcategories emerged.

Three main categories showed the most prominent problems of diabetes education, namely, inadequate infrastructure for diabetes education, insufficient defined and de facto position for the role of diabetes nurse educator, and the failure in patient‑oriented team approach in diabetes education.

This article addresses the most important problems of diabetes education. The fundamental strategy to overcome these problems seems to be the planning and management of diabetes education as a high priority in the noncommunicable disease management policies of the Ministry of Health and Medical Education.

The new coronavirus outbreak quickly filled hospital beds and stunned the world. Intensive care is required for 5% of patients, and the mortality rate for critically ill patients is 49%. The “cytokine storm” is considered as the main cause of pathogenesis for coronavirus disease‑19 (COVID-19)‑related respiratory failure, hemoperfusion may be a modality for treatment of disease.

Thirty-seven an patients with positive real‑time polymerase chain reaction for SARStions2 in an upper respiratory tract sample or typical chest computed tomography lesion were eligible for this case–control study. Patients meeting the criteria for hemoperfusion including clinical and laboratory indices, were evaluated for outcomes such as hospitalization length and mortality. Patients were divided into three groups, i.e., patients who received hemoperfusion without a need for mechanical ventilation (MV), patients who received hemoperfusion before MV, and patients who received hemoperfusion after MV.

Among 37 patients with COVID-19 respiratory failure, 32% were female with a mean age of 55.54 (standard deviation 14.1) years. There was no statistically significant difference between the three groups in terms of length of hospital stay and intensive care unit (ICU) stay (P-tayns: 0.593 and 0.243, respectively, confidence interval [CI]: 95%). Heart rate, respiratory rate, PaO2 /FIO2 , high‑sensitivity C‑reactive protein, and ferritin significantly improved after the application of hemoperfusion in all groups (P < 0.05, CI: 95%).

It seems that applying hemoperfusion in the inflammatory phase of the disease, especially before the intubation, reduce the need for MV. However, hemoperfusion does not have any impacts on the duration of hospital and ICU stay.

During the past decade, the benefits of using portfolios, especially electronic portfolios, were recognized. Due to the lack of using portfolios and especially electronic portfolio in the clinical evaluations of internship training in medical schools of Iran, this study has designed, implemented, and evaluated a comprehensive system for monitoring and evaluating the activities of interns.

This study was a software development study in the three phases of design, implementation, and evaluation. All stages of the project were carried out in the Isfahan University of Medical Sciences during 2019–2020. The software design phase was performed using the Rapid Application Development Methodology (RAD model). In the implementation phase, it was used as a pilot study in the internal department of the medical school. System evaluation was performed using a combination of quantitative and qualitative methods. Data were analyzed using the content analysis for qualitative data and descriptive statistical analysis using the SPSS software for quantitative data.

In the educational standards survey, in 10 items, the percentage of choosing “perfectly fit” and “fit” was above 90% (high quality). In the technical standards questionnaire, out of 35 items related to software technical quality, eight items were of acceptable quality and 27 of them were partially acceptable. In the Student Satisfaction Questionnaire, in 9 items, interns’ satisfaction with the system was high or very high, and in either case, there was little or no dissatisfaction or satisfaction.

Positive educational effects can be used in all clinical settings if modification and improvement of the software continues, with slight modifications.

A key step for improving the effectiveness of diabetes self‑management education (DSME) is to identify its restrictors.

The aim of this study was to explore the restrictors of the effectiveness of DSME.

This descriptive qualitative study was conducted in March 2016–2017. Participants were 16 DSME providers (viz., physicians, nurses, nutritionists, and psychologists) and nine DSME receivers (viz., patients and their family members) – 25 in total. Semi‑structured interviews were held for data collection. Interviews were transcribed word by word and analyzed through conventional content analysis approach proposed by Graneheim and Lundman.

The restrictors of the effectiveness of DSME were categorized into three main categories and 11 subcategories, namely patients’ limited welcoming of DSME classes (allocating limited time for participation in DSME classes, inadequate knowledge about diabetes mellitus [DM] importance, inappropriate educational environment, and financial problems), unfavorable adherence to treatments: serious challenge (inattention to educations, poor motivation for adherence to medical recommendations, and inattention to the psychological aspects of DM), and the difficulty of adult education (the difficulty of changing health‑related attitudes and behaviors, mere information delivery during education, adults’ physical and perceptual limitations, and diabetes educators’ limited competence in adult education).

The findings of the present study provide an in‑depth understanding about the restrictors of the effectiveness of DSME. DM management authorities and policymakers can use these findings to develop strategies for improving the effectiveness of DSME

Maturity‑onset diabetes of the young (MODY) is a clinically and genetically heterogeneous group of diabetes characterized by noninsulin‑dependent, autosomal‑dominant disorder with strong familial history, early age of onset, and pancreatic beta‑cell dysfunction. Mutations in at least 14 different genes are responsible for various MODY subtypes. Heterozygous mutations in the hepatocyte nuclear factor 1 alpha (HNF1A) gene are responsible for the MODY3 subtype, which is a common subtype of MODY in different studied populations. To date, more than 450 different variants of this gene have been reported as disease causing for MODY3. This study was carried out to evaluate HNF1A mutations in Iranian diabetic families fulfilling MODY criteria.

Polymerase chain reaction and Sanger sequencing were performed. All the ten exons of the HNF1A gene were sequenced in ten families, followed by cosegregation analysis and in silico evaluation. Computational protein modeling was accomplished for the identified mutation.

MODY3 was confirmed in two large families by detecting a mutation (p.G253E) in coding regions of HNF1A. Compound heterozygous state for two common variants in HNF1A (p.I27 L and p.S487N) was detected in affected members of 5 families, and in one family, a rare benign variant in the coding sequence for Kozak sequence was detected. Two new nonpathogenic variants were found in noncoding regions of HNF1A.

It seems that HNF1A mutations are a common cause of MODY in Iranian diabetic patients. Identified common variants in heterozygous state can cause diabetes Type II in earlier ages. The role of rare variant rs3455720 is unknown, and more investigation is needed to uncover the function of this variant.

Diabetic nephropathy (DN) is a common cause of end‑stage renal disease (ESRD). The benefits and effects of renin–angiotensin system blocker drugs are obvious in decreasing albuminuria, but there is a need to find other drugs that can decrease albuminuria. The aim of our study is to evaluate the effect of short‑term administration of curcumin on overt albuminuria in patients with type 2 diabetes mellitus (T2DM).

A randomized, double‑blind clinical trial was performed on 46 patients with T2DM, overt albuminuria ≥300 mg/24 h, and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2. After the random allocation of the patients, they were divided into two groups. In the curcumin group, the patients received 500 mg (one capsule) of curcumin with each meal (three times/day after meal) for 16 weeks. Other variables including blood urea nitrogen (BUN), creatinine (Cr), fasting blood sugar (FBS), 2‑h postprandial blood sugar (2‑h pp BS), lipid profile, 24‑h urine analysis for albuminuria, serum albumin, and hemoglobin A1C (HbA1C) were checked at baseline and bimonthly too.

two groups at baseline were comparable in terms of basic characteristics (P > 0.05). Albuminuria decreased significantly from 900.42 ± 621.91 at the baseline to 539.68 ± 375.16 at the end of the study in the curcumin group (PTime = 0.002); however, no statistically significant changes were observed in the placebo group (519.94 ± 214.33 at the baseline vs. 444.00 ± 219.10 at the end of the trial; PTime = 0.43), and the decrease was significantly higher in the curcumin group than that of the placebo group (PIntervention = 0.01). No significant differences were observed between the placebo and curcumin in terms of changes in serum BUN, Cr, FBS, 2‑h pp BS, HbA1C, lipid profile, and albumin.

Our study showed that curcumin as an active turmeric metabolite was an effective adjuvant therapy for ameliorating macroscopic proteinuria in type 2 diabetic patients. Its effect may appear after 2 months of therapy and even in patients with a mild decrease in GFR. Further studies with larger sample size and longer duration are recommended.

Increasing rate of type 2 diabetes (T2D) prevalence during the recent years has caused concern about significant risks for the public health. Dietary patterns have recently attracted great attention in the evaluation of the relationship between diet and health. In the present study, we investigated the relationship between the major identified dietary patterns and T2D.

In this matched case–control study, 315 individuals (125 newly diagnosed cases and 190 controls); 18–60 years of age were selected. A valid semiquantitative food frequency questionnaire was used to collect dietary intakes of individuals. Anthropometric characteristics and blood pressure were measured with standard instructions and body mass index and waist to hip ratio were calculated. Factor analysis was used to identify major dietary patterns. The relationship between major food patterns and T2D was assessed by logistic regression analysis.

Two dietary patterns were identified: healthy and Western dietary patterns. The second tertile of the healthy dietary pattern had significantly association with decreased risk of T2D in the crude model (Odds ratios [OR]: 0.51, 95% Confidence interval [CI]: 0.29–0.9; P for trend = 0.018), Model II (OR: 0.5, 95% CI: 0.27–0.9; P for trend = 0.019), and Model III (OR: 0.56, 95% CI: 0.23–1.4 P for trend = 0.048). The inverse association of the second tertile of Western dietary pattern score with the T2D was significant in crude (OR: 9.25, 95% CI: 4.95– 17.4; P for trend <0.001) and multivariable‑adjusted model (OR: 16.65, 95% CI: 2.99–92.84; P for trend <0001).

Our study found an inverse relationship between adherence of healthy pattern and direct association with Western dietary pattern and the risk of T2D.

Considering the physiologic roles of vitamin D on insulin regulation, the effects of vitamin D treatment on insulin sensitivity and resistance indexes and beta cell function in pre‑diabetic vitamin D deficient patients were investigated.

In a randomized open clinical trial, 61 pre‑diabetic vitamin D deficient patients who were the first degree relatives of type 2 diabetic patients, were enrolled and randomized into three groups (A, B and C). GroupA (n = 21) were treated with intramuscular injection of 300,000 units of vitamin D at the beginning of the study and one month later. In group B (n = 20), injection of vitamin D plus 500 mg/d calcium and in group C (n = 20), just calcium was administered for two months. At baseline and two months later, oral glucose tolerance test was done. Homeostasis Model of Assessment-Insulin Resistance (HOMAIR), insulin resistance index, Homeostasis Model of Assessment-B (HOMA-B) which is a beta cell function index, and Matsuda index, an insulin sensitivity index, were calculated and compared before and after intervention and between three groups.

In vitamin D treated groups (A + B), the mean (SD) of HOMA‑IR increased from 2.46 (1.36) to 3.1 (2.3) (P = 0.02), and Matsuda index decreased from 11 (3) to 9.0 (2.3) (P = 0.001).

Injection of vitamin D increased insulin resistance and decreased insulin sensitivity indexes.

The complications in thyroid surgery have been reported variable in literature. The aim of this study was to evaluate the early and late (3 months after surgery) complication rates of thyroidectomy in a cohort of patients undergoing thyroid surgery at two hospitals of Isfahan University of Medical Science, Iran.

This study included 204 patients who candidates for thyroidectomy presenting at Medical Educational Centers of Al-Zahra and Kashani hospitals in Isfahan between March 2016 and March 2017. Clinical data are collected for all patients by continuous enrollment. The patients examined before and after thyroid surgery and the findings were recorded.

The highest prevalence of thyroidectomy was in women (81.9%). The most frequent thyroid surgery was total thyroidectomy and the most common indication for thyroid surgery was suspicious fine-needle aspiration for thyroid malignancy. Hypocalcemia was the most common complication with a frequency of 54.4%. The odds ratios for early complications were 2.375 and 2.542 for intermediate- and low-volume surgeons, respectively, compared to high-volume surgeons.

According to the results of this study, the high level of surgeon's skill is effective to reduce the likelihood of late and early complications; furthermore, the chance of late complications increases with age.

  This study aimed to investigate whether pre-operative dexamethasone could ameliorate transient hypoparathyroidism outcome through total thyroidectomy.

This randomized clinical trial study was conducted on 128 patients underwent total thyroidectomy from March 2014 to April 2015. Patients were randomly assigned to two groups of experimental receiving 8 mg IV of intravenous dexamethasone (n=45) 45 min before skin incision treatment and control (n=83). After the surgery, all patients were evaluated for clinical and laboratory hypocalcaemia.

Post-operative transient biochemical hypoparathyroidism and hypocalcaemia did not occur more often in the control group, compared to the dexamethasone group while controlling for the baseline variables. However, there was a significant difference in phosphorus level between the dexamethasone and control groups (P=0.028). A total of 50 (39.1%) patients developed hypocalcaemia after surgery. Moreover, post-operative symptomatic hypocalcemia occurred more frequently in the control group (68%) compared to the dexamethasone group (32%); however, this difference was not statistically significant (P=0.54).

The pre-operative administration of dexamethasone reduced post-operative hypocalcemia rate. It is essential to conduct future studies with validated means for better results.

Reforming the health care system to improve suitable health care model for diabetic patients is essential. This study aimed to implement, identify, and overcome the challenges of implementing the Chronic Care Model in diabetes management in a clinic. This study is a qualitative technical action research with the Kemmis and McTaggart model including planning, action, reflection, observation, and revision plan which was conducted in the specialized polyclinic from 2015 to 2017 in Isfahan city – Iran. Data were gathered through qualitative and quantitative methods. Diabetes team and 17 patients with type 2 diabetes participated in semi-structured interviews that were purposively chosen. Qualitative data were analyzed using content analysis and then quantitative data collected. The qualitative fndings of this research are in fve main categories: System design upgrade, self-management upgrade, decision support, health care organization, and clinical information system upgrade. Results of quantitative data showed that most metabolic indicators like HbA1c have statistical meaningful changes (P value < 0.05). Implementing the Chronic Care Model became feasible despite serious challenges and two groups of ready and active team and active patients were developed. The study showed that one important lost link of diabetes management is underestimating the nurses’ capabilities in the management of this disease. Inevitably, serious investment on maximum use of nurses’ knowledge and skills in improving diabetes management will help diabetes care upgrade signifcantly.

Body image, as an important factor in quality of life (QOL) satisfaction, in amputee patients is strongly affected by amputation, which can put the patient at risk of psychological disorders such as depression. Hence, this study was conducted to investigate the effect of spiritual care on body image in patients with type 2 diabetes‑related amputation.
In this study, an experimental pretest‑posttest design with two groups was used. A total of 54 participants (Males = 41, Females = 13) aged between 40 and 72 who had diabetes‑related amputation participated in the study. The participants were randomly assigned to the meditation and control group. For the experimental group, three sessions of meditation, and for control group, three sessions regarding prevention of diabetic foot ulcer were conducted. The participants in the experimental group were asked to perform meditation exercises for a month. The data was collected via Amputee Body Image Scale before and 4 weeks after the intervention.
There were no significant differences between groups on demographic variables. After intervention, the meditation group showed lower levels of body image disturbance compared with the control group, which was significant (t=3.41, p = 0.001).
It can be concluded that meditation can improve body image in patients with diabetes‑related amputation. In addition, because of no side effects and high acceptance of spiritual care, this method can be used as a way to improve the condition of patients.

Diabetes mellitus (DM) is the most common metabolic disease. In Iran, family medicine program has been started since the year 2005 with the goal of increasing in service quality and quantity. This study aimed to evaluate current health care services for patients with type 2 diabetes mellitus in rural areas of Iran.
This cross-sectional descriptive-analytic study was done in the year 2014 in 20 health houses under control of 7 secondary level health centers in Jarghoyeh region in southern part of Isfahan City, Iran. The data were collected randomly from 383 households with diabetes mellitus files using special checklists. These checklists were designed in accordance with health ministries for patients with diabetes mellitus. The collected data were analyzed via SPSS software using ANOVA, chi-square, and logistic regression tests.
Findings: None of the patients received advice care based on national protocols. Less than 6% of patients received 6-8 regular cares in the recent year. The mean values of hemoglobin A1C (HBA1C), systolic blood pressure, total cholesterol, low-density lipoprotein (LDL), triglycerides (TG), and body mass index (BMI) showed higher level in women than men. From all advised and key cares, blood pressure measurement in 81.6% and weight control in 80.5% were more favorable care services. There was significant relationship between foot examination, smoking status, and gender (P Health care services needed for patients with type 2 diabetes mellitus are less than national comprehensive prevention and diabetes control protocol in quality and quantity of cares in most of the cases.