masoud mohebbi

Hypocalcemia is a common complication of total thyroidectomy (TT). This study was designed to investigate the effect of preoperative vitamin.D (Vit.D) status on the occurrence of post-total thyroidectomy hypocalcemia.

Patients who underwent TT without parathyroidectomy were divided into three groups based on their preoperative Serum Vit.D levels (<20 ng/ml, 20-30 ng/ml, and ≥30 ng/ml were considered deficient, insufficient, and normal Vit.D levels, respectively). Serum levels of calcium and phosphorus were measured before and 24 hours after surgery in all patients. The patients were examined for clinical symptoms and signs of hypocalcemia postoperatively. In cases with positive clinical symptoms and signs of hypocalcemia and/or calcium levels <8 mg/dl, PTH level was measured before starting calcium infusion, while serum calcium and phosphorus levels were also measured 24 hours later.

Among 100 patients enrolled in this study, 81% were females. The mean age was 36.60±8.32 years. Before surgery, the mean Vit.D level was 26.9±16.89 ng/ml, while 47% of cases had normal Vit.D level, 32% had insufficient vitamin levels, and 21% had Vit.D deficiency. Twenty-four hours after surgery, the calcium (P=0.356) and phosphorus (P=0.743) levels were not significantly different between the three Vit.D groups. A comparison of postoperative PTH levels between the three Vit.D groups showed no significant difference (P=0.596).

Based on our findings, preoperative serum Vit.D levels did not affect postoperative serum calcium levels.

Various studies have assessed the link between the thyroid and kidney and concluded that dysfunction in one organ can disrupt the other. Thyroid dysfunction is more prevalent in individuals with end-stage renal disease (ESRD) compared to the general population. Hypothyroid ESRD patients have higher mortality than euthyroid patients. In this study, we evaluated the prevalence of hypothyroidism in dialysis-dependent ESRD patients and assessed the association of possible prognostic factors with mortality.

Patients who were undergoing dialysis in centers affiliated with the Mashhad University of Medical Sciences were enrolled and followed for a year to obtain survival rates. Lab parameters including thyroid stimulating hormone (TSH), parathyroid hormone (PTH), and magnesium (Mg) were recorded at baseline, and the relationship between these values and mortality was assessed.

The prevalence of hypothyroidism was 23% and 32.5% in hemodialysis and peritoneal dialysis patients, respectively. Blood urea was meaningfully higher in hemodialysis patients, while hypocalcemia and hyponatremia were more common in peritoneal dialysis patients. Higher ages (P=0.006), lower baseline Mg (P=0.044) and PTH (P=0.01), and diabetes (P=0.037) were all linked to a higher risk of mortality.

Hypothyroidism was notably prevalent in our study population. As hypothyroidism is associated with higher mortality, proper screening and intervention in this group are essential. We recommend the prescription of supplementary Mg in dialysis patients as baseline Mg and PTH levels are associated with better outcomes in this group. Diabetes was also associated with higher mortality. Maintaining glycated hemoglobin between 6%-8% is therefore suggested to increase the survival of diabetic patients.

Diabetes mellitus (DM) is a leading cause of morbidity and death worldwide. DM will affect 570.9 million people worldwide by 2025. The usefulness of vitamin C in improving diabetes control has been a point of contention.

This clinical-trial double-blind study with control groups was conducted on 164 patients with type 2 diabetes mellitus (T2DM). The intervention group received 1000 mg of oral vitamin C daily, and a placebo was administered to the controls. To analyze the obtained data, one-way ANOVA was used in SPSS software (version 20). A P< 0.05 was considered statistically significant.

Fasting blood sugar (FBS), hemoglobin A1c (HbA1C), triglyceride (TG), and high-density lipoprotein (HDL) were improved significantly in the intervention group (P< 0.05), while the low-density lipoprotein (LDL) and cholesterol were unaffected (P> 0.05). HbA1C and LDL levels in the control group increased significantly (P< 0.05). Meanwhile, this group's HDL levels decreased considerably.

Our findings support the consumption of vitamin C to complement the primary treatment for DM. According to our results, vitamin C provides a clear benefit over a placebo in the treatment of diabetic patients' serum parameters.

Nowadays, seed treatment with growth regulators or nutrients is widely used in the seed industry due to its significant effect on growth and yield, as well as resistance to diseases and pests. Therefore, in the present research, the effects of seed treatments with salicylic acid, humic acid, and zinc on two durum wheat cultivars were investigated under rainfed conditions.

This research was conducted as a factorial experiment based on a randomized complete blocks design (RCBD) with three replications in the research farm of the Campus of Agriculture and Natural Resources, Razi University, Kermanshah, Iran, in 2019-2020. Factors included two cultivars of durum wheat (Saji and Zahab) and seed treatments (salicylic acid, humic acid, zinc, salicylic acid + humic acid, salicylic acid + zinc, humic acid + zinc, salicylic acid + humic acid + zinc, and control). Seed treatments were applied before sowing with a concentration of one millimolar (mM) salicylic acid solution, zinc solution (2%), and humic acid powder (95%) at the ratio of one kg or lit to 100, 100, and 300 kg of seeds, respectively. The investigated traits included the content of photosynthetic pigments and flag leaf area in the boot stage (code 45 on the Zadoks growth scale) and yield and yield components and seed protein percentage at the ripening stage.

The results of the analysis of variance showed that the effect of cultivars, seed treatments, and interactions between them was significant on the studied traits (except the number of spikes per square meter). The grain yield in durum wheat cv. Zahab was significantly higher than Saji. The grain yield of two cultivars in all seed treatments was higher than the control. Grain yield in Zahab was almost the same in all of the seed treatments, but in Saji, the highest grain yield was obtained in seed treatment with zinc usage (5033 kg. ha-1), and other seed treatments had the same effects. There was no significant difference between the two cultivars in terms of seed protein percentage, but the highest and lowest amount of seed protein was observed in salicylic acid + humic acid and control seed treatments with 13.14 and 12.11%, respectively. At the boot stage, the effects of cultivar and seed treatment on flag leaf area and the content of photosynthetic pigments (except carotenoids) were significant. Zahab cv. was superior to Saji in terms of flag leaf area and photosynthetic pigment content.

Based on the results of this research, durum wheat cv. Zahab had a better performance than Saji. The effect of seed treatments with salicylic acid, humic acid, zinc, and the combination of these treatments had positive and significant effects on the grain yield compared to the control.

The Covid-19 disease pandemic has affected various aspects of life including medical education. Therefore, it has been inevitable to shift medical education programs towards "combined virtual and face-to-face learning and hybrid learning". In this regard, we activated a   virtual education system along with face-to-face training to improve the education of learners in the internal medicine department.

 A present quasi-experimental study without control group was performed on residents of the internal medicine department of Mashhad University of Medical Sciences residing in both Imam Reza and Ghaem hospitals from March 2020 to December 2021 by census. Virtual training started alongside face-to-face training. Student satisfaction was assessed using the Distance education learning environments survey (DELES) questionnaire, the validity and reliability of which have been assessed in previous studies. All learners who did not answer more than one of the 30 questions in the questionnaire and final year students were excluded from the study. Data analysis was performed using SPSS software (22).

 A total of 26 learners were participated in the survey, including 10 men (38.5%) and 12 women (46.5%) and 4 individuals with undisclosed gender. In this survey, the level of satisfaction with the new implemented integrated education program in the internal group was %66.66. The greatest scores given by the learners to the system belonged to the ability to share information and the opportunity to cooperate with other students.

The results of this survey showed that learners were very satisfied with the combined learning system as a part of their educational program. Improving learners' outcomes and feedback after moving to combined method of virtual and face-to-face training, despite all the constraints imposed during the Covid-19 Pandemic era, promises a brighter future in training programs of the internal medicine department.

Studies examining the effect of Empagliflozin in patients with type 2 diabetes have reported different results regarding the effect of this drug on electrolytes and lipid profiles. This study aimed to evaluate the effect of Empagliflozin on electrolytes and lipid profiles in patients with type 2 diabetes.

In this systematic meta-analysis, clinical trials published in the Web of Science, Scopus, PubMed, and Cochrane Library databases up to April 2022 were reviewed. Information on the mean and standard deviations of electrolytes, including phosphate, calcium, sodium, potassium, magnesium, and lipid parameters, including total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides, before receiving Empagliflozin was extracted from the selected studies and analyzed.

A total of seven clinical trials with 398 patients were analyzed. The sodium, potassium, phosphate, and magnesium levels remained unchanged or slightly changed after receiving different doses of Empagliflozin. Estimation of the standardized mean difference of calcium after receiving 10 mg of Empagliflozin was insignificant. The standardized mean difference in levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides was insignificant after receiving different doses of Empa gliflozin.

Administration of Empagliflozin in patients with type 2 diabetes does not affect phosphate, calcium, sodium, potassium, magnesium, total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. However, further research is needed due to the small number of studies and conflicting results on the issue.

The present randomized clinical trial assessed the antihyperglycemic and hypolipidemic effects of hydro-ethanolic extract of Ribes khorassanicum. Eighty type 2 diabetic patients were randomly allocated to placebo or intervention groups and respectively received placebo or extract capsules (700 mg, bid) beside their conventional medication for 3 months. Patients' blood pressure and blood levels of fasting blood glucose (FBS), glycosylated hemoglobin (HbA1c), 2 hr postprandial glucose (2hPPG), triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured at the beginning of the study and after 3 months of treatment. For determination of plant safety, liver enzymes (SGOT and SGPT) and kidney function (in terms of urea, creatinine, and microalbumin levels) were assessed and patients were asked to report adverse effects. The R. khorasanicum hydro-ethanolic extract supplementation significantly decreased the levels of FBS, total cholesterol, triglyceride, and LDL-C in the extract group compared to the placebo group (p<0.05-p<0.01). However, 2hPPG, HbA1c, HDL-C, SGOT, SGPT, urea, creatinine, and urine microalbumin values were not significantly different between the placebo and the extract groups. No adverse effects were reported by the patients. Co-supplementation of diabetic patients with R. khorasanicum extract ameliorated hyperglycemia and hyperlipidemia without causing any adverse effects; therefore, the plant extract may be recommended as a complementary therapy to improve diabetes-induced metabolic disturbances.

The recent technological advancement has regrettably resulted in the preference of para clinical services over physical examination by physicians. This study is carried out to evaluate a new (remote learning) method for better instruction of physical examination skills to the first-year internal medicine residents as a sample of medical population and using available equipment.Materials &

 This Quasi-Experiment study was carried out on 11 first-year internal medicine residents in 2019. Residents initially were assessed in an Objective Structured Clinical Examination (OSCE) based on a standard checklist. Then, online learning resources in the form of videos from 7 common headlines of internal diseases were provided for one month. Residents were re-evaluated in the next OSCE.

 Comparison of the scores of all stations before and after the intervention showed that intervention has increased the average of total score of residents significantly. It should be noted that in all stations the difference was significant in all station (P<0/001) except the station of chronic bronchitis (P=0.243).

this study showed that using virtual learning resources can be a proper method for enhancing the level of competency in clinical examination of residents.

 Diabetic nephropathy occurs in 20 - 30% of diabetic cases globally, and microalbuminuria (MA) is the first symptom of this disorder. Some studies have suggested that there is an association between the serum magnesium (Mg) level and MA.

 Therefore, we investigated the association between the serum Mg level and MA in type 2 diabetes mellitus (T2DM) patients.

 We conducted a cross-sectional study on 122 subjects with T2DM. We categorized them into two groups of microalbuminuria (MA) and non-microalbuminuria (NMA) according to their urine albumin-creatinine ratio (UACR). MA was considered as a UACR of 30 to 300 mg/g. Participants were excluded if they had the following conditions: The age of under 16 years, cardiac, renal, or hepatic disorders, using corticosteroids, diuretics, Mg /calcium (Ca) supplements, and antiepileptic drugs, heavy physical activity within 24 hours before the test, pregnant and breastfeeding women, febrile patients, and patients who were unwilling to participate in the study. The analysis was performed using SPSS version 15. A P-value < 0.05 was considered significant.

 Among the patients, 50.81% were male. Also, the mean body mass index (BMI) of the NMA group was greater than the MA group (29.84 ± 5.64 vs. 27.31 ± 3.14, P-value = 0.003). Mg levels of the MA and NMA groups showed no significant differences (2.13 ± 0.42 and 2.10 ± 0.43, respectively; P-value = 0.67). Overall, data analysis provided no significant difference between Mg level and the urine albumin concentration between the MA and NMA groups (P-value = 0.21 and 0.81, respectively.).

 Serum Mg level and MA have no significant relationship. Further prospective studies are needed to assay this issue.

Thyroid malignancies are found in 7% to 15% of all thyroid nodules. Immunohistochemical markers, including CK19, HBME-1and TROP2, have shown an effective role in identifying these malignancies. Hence, due to the lack of appropriate diagnostic tests for the identification of thyroid neoplasms, in this study, we aimed to determine the diagnostic value of these biomarkers in the identification of different types of follicular thyroid neoplasms. In this cross-sectional study, paraffin-embedded tissue blocks from the surgical resection of patients with thyroid nodules, referring to Imam Reza and Razavi Hospitals of Mashhad in 2017, were studied. Sensitivity, specificity, and positive and negative predictive values of these biomarkers for the identification of different types of follicular thyroid neoplasms were also studied. 129 patients with a mean age of 44.65±12.59 years participated in this study, of whom 101 (78.29%) were women. The most common type of follicular thyroid neoplasm was papillary carcinoma (60.47%). The highest sensitivity (94.87%) and positive predictive value (68.51%) in the detection of follicular neoplasms was observed by CK19 in papillary carcinoma. The sensitivity and positive predictive value of TROP2 in the detection of papillary neoplasms was 93.58% and 75.25%, respectively. In addition, HBME-1 had the highest specificity (72.54 %) and positive predictive value (81.57%) in identifying this neoplasm. The results of this study showed that CK19, HBME-1, and TROP2 had high diagnostic value in the detection of papillary thyroid neoplasms. Although these biomarkers had low diagnostic value in identifying follicular adenoma and carcinoma, given the high negative predictive value, they can be considered as powerful markers in identifying negative cases.

According to some studies, Ramadan fasting causes minimal changes in the levels of thyroid hormones. The present study aimed to evaluate the impact of Ramadan fasting on the levels of thyroid hormones in fasting women with hypothyroidism and levothyroxine intake. 

Serum levels of free thyroxine (T4) and thyroid-stimulating hormone (TSH) were measured in 36 women with hypothyroidism aged 12-56 years, who fasted during Ramadan. Three blood samples were collected three days before Ramadan, on day 27 of Ramadan, and two months after Ramadan. In addition, the levels of hemoglobin and hematocrit (HCT) were measured during and after Ramadan. 

The serum level of free T4 significantly decreased during Ramadan compared to before Ramadan (P<0.05). However, no significant difference was observed in the serum free T4 level before and after Ramadan. On the other hand, the TSH was higher during Ramadan compared to before Ramadan although the difference was not considered significant (normal range). TSH level reduced after Ramadan compared to during Ramadan, while no significant difference was denoted in the TSH level at the three measurement times. In addition, hemoglobin and HCT decreased significantly after Ramadan compared to during Ramadan. 

According to the results, Ramadan fasting could reduce the serum levels of free T4 in the women with hypothyroidism. However, only a slight increase was observed in the TSH levels, which was not considered significant. Further investigation is required regarding the changes caused by Ramadan fasting in the levels of hemoglobin and HCT.

Ectopic increase of adrenocorticotropic hormone (ACTH) or ectopic Cushing syndrome is a rare initial presentation of small cell carcinoma and carcinoid tumor of the lung. Here, we reported a 36-year-old male with atypical symptoms of Cushing syndrome managed by Etomidate that had a central pulmonary nodule, and pathologic evaluation of pulmonary lobectomy revealed the diagnosis of well-differentiated, low-grade typical carcinoids of lung.

Intercity high speed trains are amongst the most suitable options for passenger travel. Iran has planned for these transportation systems, especially Tehran-Qom-Isfahan high speed rail project, which is a national megaproject. Therefore, due to the importance of this project in terms of its first experience and travel safety issues, it is discussed in this article. In the present article, by modeling the geometry of rail track embankment and high speed train of this project and simulating the worst weather conditions in the region, based on meteorological data, it is attempted to understand the behavior of high speed train on the proposed track, and to increase the transportation safety factor, the effect of installing of windshield walls is surveyed. Results proved that the presence of windbreak wall reduces the drag force. The outcome of this research can be very effective in raising the safety of travel along the tracks of this high speed rail corridor.

According to the available data, vitamin D deficency is prevalent in iran and consumption of this agent, both oral and intravenous is increasing remarkably. It seems that the prevalence of vitamin D toxicity is very low and is a rare cause of hypercalcemia .Although most prescriptions are prescribed by physitions but over the counter use without medical cosult or evaluation may result in vitamin D intoxication ,which nowadays occure more in clinical practice.
In this paper, a 23-year-old Man who was athlete and referred to the hospital with loss of appetite, nausea , frequent vomiting and vitamin D intoxication due to self-medication, is introduced. The patient was treated with intravenous fluids ,diuretic and calcitonin and was discharged with improvement of symptoms and laboratory results.
The aim of this report, was to nottice about potentially adverse outcomes of excessive vitamin D consumption ,having no clinical supervision.