mohammad ebrahim khamseh

Considering the high prevalence of benign thyroid disorders, the availability of an instrument measuring health-related quality of life (HRQoL) in this population is very important.

The current study aims to translate and validate the Persian version of the ThyPRO-39.

In accordance with standard methodology, a double forward, reconciliation, and backward translation of the questionnaire was conducted. A field consultant identified discrepancies between the original questionnaire and the back translation. Discrepancies were addressed, revised, and retested before submitting it for developer review. Finally, five cognitive interviews were conducted among patients with benign thyroid problems to ensure alignment between their understanding of the Persian items and their original English counterparts.

Translation and linguistic validations of the Persian version of the ThyPRO-39 Questionnaire were developed according to the established rules. Two translators did the forward translation with no significant disagreement. Considering backward translation, the field consultant changed eight items, and the developer provided seven additional comments. After interviewing five patients, nine revisions were performed by the field consultant. Finally, an external consultant reviewed all changes and approved the questionnaire.

We translated and linguistically validated the Persian version of the ThyPRO-39. Now, the ThyPRO-IR is ready for assessment of thyroid-specific QoL in Iranian patients with benign thyroid disorders.

The aim of this study was to assess the performance of the Framingham, UK Prospective Diabetes Study (UKPDS)[1], and the Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE)[2] risk equations in prediction of 4-year cardiovascular events in an Iranian people with type 2 diabetes.

The 4-year risks of cardiovascular disease (CVD)[3] were estimated using the three equations in a community of 557 patients with type 2 diabetes and free of CVD at baseline. A trained physician evaluated all of the participants regarding occurrence of CVD event during follow up. CVD was defined as major events including fatal/ non-fatal myocardial infarction as well as fatal/non-fatal stroke, minor events including treated coronary heart disease (CHD)[4], and established peripheral arterial disease (PAD)[5].

During 4 years of follow-up, 64 CVD events were observed (66% minor CVD events). Despite having a good calibration (estimated to observed ratio ranging from 91.37 to 98.2 percent, Hosmer–Lemeshow χ2 (HLχ2)[6] values <15), both general (Framingham) and diabetes specific (UKPDS and ADVANCE) equations did not have adequate discriminative ability (AUC[7] ranging from 0.48 to 0.56).

Framingham, UKPDS, and ADVANCE risk equations, regardless of being general or diabetes specific, could not precisely predict 4-year risk of CVD in Iranian individuals with type 2 diabetes.

Gestational diabetes mellitus (GDM) is a major pregnancy endocrine problem that has several confirmed risk factors and is associated with adverse pregnancy-related outcomes (PRO).

To evaluate the relationship between GDM diagnosis and the associated risk factors of PRO (maternal, intrapartum, perinatal, and neonatal) in accordance with International Association of Diabetes and Pregnancy Study Groups criteria.

This prospective cohort study was performed with 531 singleton parturient (265 GDM and 266 non-GDM). They were selected consecutively from referral hospitals, and the maternal, intrapartum, perinatal, and neonatal outcomes were assessed.

The major risk factors influencing the GDM diagnosis were maternal age, obesity, family history of diabetes, previous history of GDM, and previous history of macrosomia. In the comparison of PRO between the groups, significant associations were detected for emergency cesarean delivery, preeclampsia, polyhydramnios, premature rupture of membrane, preterm delivery, and neonatal hyperbilirubinemia in the GDM group. In the multivariate logistic regression analysis, a previous history of stillbirth was significantly associated with maternal and perinatal outcomes. The odds ratios (CI 95%) of the PRO in the women with a GDM diagnosis were: maternal = 2.43 (1.51-3.90), intrapartum = 2.05 (1.35-3.11), perinatal = 2.00 (1.29-3.10), and neonatal = 1.68 (1.08-2.62). The PRO was significantly correlated with GDM diagnosis, but not with the risk factors.

The adverse pregnancy outcomes were significantly correlated with GDM diagnosis, and the outcomes were not directly affected by the risk factors. Given the related adverse outcomes for mothers and offspring, early screening and management of GDM is necessary especially in Asians and in low-/middle-income countries.

Type 2 diabetes (T2D) is a progressive disease that should be managed with insulin in case of oral glucose lowering drugs (OGLDs) failure. If basal insulin is not sufficient, rapid acting insulin will be added before the largest meal. We assessed the impact of adding one prandial insulin to a basal based regimen and insulin glargine in patients with type 2 diabetes to measure the percentage of subjects achieving the HbA1c target by the end of 24 weeks of treatment in routine clinical practice.

This study was a 24-week observational study of patients with T2D not adequately controlled with OGLDs and basal insulin, for whom the physician had decided to initiate prandial insulin. The study endpoint was assessed at visit 1 (baseline), visit 2 at week 12 (±1 week) and visit 3 at week 24 (±1 week). The percentage of patients who achieved HbA1c targets was assessed at week 24. Statistical analyses were performed using IBM SPSS for Windows v 19 (IBM, Armonk, New York, USA). Logistic regression analysis was used to detect predicting factors of achieving the HbA1c target by week 24. P<0.05 was considered as significant level.

Four hundred and eighteen patients with a mean±SD age of 56.24±9.85 years and a mean±SD duration of diabetes of 12.50±7.16 years were included. The median total daily dose of basal insulin was 24 units, while prandial insulin was started with 6 (4, 10) U/day, titrating up to 10 (8, 18) U/day at week 24. The daily dose of prandial insulin was the only factor that could significantly predict achieving targeted HbA1c by week 24 [OR: 1.04; 95% CI: 1.007,1.079; p-value: 0.019]. At week 24, 96 (22.9%) subjects achieved the HbA1c target with one prandial insulin.

The results of our study suggest that “basal plus therapy” can lead to good glycemic control with a low risk of hypoglycemia and weight gain in patients with type 2 diabetes.

Scientometric studies are highly important, as they provide information about scientific products worldwide and empower scientists to compare research activities in different regions. The present study was conducted to map scientific research in diabetes mellitus using scientometric analysis in Middle Eastern countries during 2003- 2007. This was an analytical study with a scientometric approach. The study population was formed by the indexed scientific results of diabetes mellitus in the Web of Science database during 2007-2013. Data were analyzed using Excel, and HistCite to map the scientific texts. A total of 6532 records were retrieved from 3926 institutions. These records belonged to 19 323 authors and were published in 1420 journals.
The Journal of Diabetes Care, with 3928 citations, had the most global citation score (GCS). The Journal of Diabetes Research and Clinical Practice, with 185 citations, achieved the first degree of local citation score (LCS). Most of the scientific documents produced in the Middle East belonged to Turkey (31.91%) and Iran (21.7%). Seven scientific clusters based on LCS, and 5 based on GCS existed in the scientific mapping. Topical clusters based on global and local indices showed that the prevalence of diabetes, hyperglycemia, and pregnancy outcomes, diabetic risk factors, diabetic complications and their new treatments, and glucose monitoring in Type 1 diabetes were the fields being addressed in the main articles of the clusters. Scientific production and local and global citations in diabetes research in Iran (21.7% of diabetes research in the Middle East) have elevated the country to a prominent position. Top ranking countries in diabetic research were Turkey, Iran, and Israel, respectively. Moreover, this paper quantified the studies that were done on different aspects of diabetes. The results of this study can be used by health care providers to employ the best multidisciplinary approach for managing diabetes and its complications. Also, the results can help the policy-makers and governments to determine the priorities for budget allocation based on the burden of diseases. Establishing a regional diabetes network in the Middle East can be beneficial and lead to scientific collaboration and an increase in scientific production in this field.

This study was designed to determine the level of fear of hypoglycemia (FoH), pediatric parenting stress and self-efficacy in parents of children with type 1 diabetes (T1D). In this cross-sectional study, 61 families of children with T1D who had been diagnosed for at least 6 months recruited from "Gabric Diabetes Education Association" in Tehran. Sixty mothers and 41 fathers of 61 children (26 girls, age: 6.0-12.7 years) were assessed using the Hypoglycemia Fear Survey-Parent (HFS-P), Pediatric Inventory for Parents (PIP) and Self-Efficacy for Diabetes Scale-Parent (SED-P) questionnaires. Pearson correlation analysis was used to compute the correlation between HFS-P, PIP and SED-P scores separately for mother and fathers. Only 8.3% of children had controlled diabetes. Internal reliability of the Persian version of all questionnaires was good. FoH were higher for mothers. Mothers whose children had diabetes for less than two years had significantly lower mean HFS-Behavior subscale (HFS-B) scores than mothers whose children had diabetes for more than two years. There was a positive correlation between fathers’ mean HFS-B score and children’s total insulin dose per day. Parents' FoH score was positively correlated with increased pediatric parenting stress. Findings also showed considerable emotional distress in 51% of mothers and 29.7% of fathers. Frequency of self-monitoring blood glucose tests (SMBG) correlated negatively with HbA1c. We concluded that parents with high levels of FoH and stress may benefit from diabetes education. Important implications for education are considering psychological adjustment, recognizing diabetes-related fear and stress in parents, encouraging fathers to become actively involved in the child’s diabetes management and emphasizing the importance of SMBG.

explore glycemic control, and adverse events of Iranian people with uncontrolled type 2 diabetes after initiation of long-acting basal insulin, glargine. People with uncontrolled type 2 diabetes that was on at least two oral anti-diabetic drugs (OAD) were enrolled in this observational prospective study. Insulin glargine was prescribed by physicians in the course of routine clinical practice. Patients were followed for 24 weeks. Insulin doses were titrated to reach fasting blood sugar (FBS) target between 90 mg/dl and 130 mg/dl. HbA1c and adverse events were recorded at baseline, week 12, and week 24. Form a total of 292 participants, 243 patients completed the study. HbA1c, FBS, postprandial glucose, total cholesterol, triglycerides, and low-density lipoprotein cholesterol, but not body mass index decreased during the study. The proportion of poorly controlled patients (HbA1C>9%) decreased from 172 (58.9%) to 39(13.4%), and 21(7.2%) during follow up. Controlled glycemia (HbA1C

This study was designed to present initial results on clinical presentation, therapeutic modalities, and outcome information of patients with pituitary tumors registered in Iran Pituitary Tumor Registry (IPTR).
We collected data from a web-based electronic medical records of patients with various pituitary tumors referred to four tertiary care centers in the country. Retrospective analysis was performed on demographic, clinical, and therapeutic information of 298 patients including 51 clinically nonfunctioning adenoma (CNFA), 85 acromegaly, 135 prolactinoma, and 27 Cushing’s disease (CD).
From October 2014 to July 2016, 298 people with the diagnosis of pituitary tumor were registered. Prolactinoma was the most prevalent tumor (45.3%), followed by Acromegaly (28.6%), CNFPA (17.1%), and CD (9%). Female dominance was seen among patients with prolactinoma and CD, while the majority of patients with CNFPA were male and acromegaly was equally distributed between men and women. Hypogonadal symptoms were almost always seen in all types of pituitary groups. Surgery alone was the most common therapeutic modality used in cases of acromegaly, CNFPA, and CD. However, medical therapy alone was frequently applied for cases of prolactinoma. Finally, biochemical cure was achieved in most cases of prolactinoma and CD, but only in 36.5% of acromegalics. Moreover, 80% of patients suffering from CNFPA showed no residual tumor in their imaging.
In conclusion, this comprehensive tumor registry enables early identification, selection of best therapeutic approaches, and evaluation of long-term treatment outcomes. Furthermore, this registry can be used to improve surveillance protocols.

Latent autoimmune diabetes of adults (LADA) is a slowly progressive form of diabetes managed with diet and oral hypoglycemic agents before becoming insulin requiring. Islet autoantibodies are used for differential diagnosis between LADA and Type 2 diabetes mellitus. The aims of this study were to investigate the frequency of LADA using islet autontibodies in population with T2DM and characterize clinical and biochemical characteristics of them.
In this cross-sectional study, 86 T2DM patients aged between 28-67 years were tested for the presence of autoantibodies by ELISA technique. The Glutamic acid decarboxylase antibody, Islet Cell Antibody and Insulinoma Antigen2 Antibody were evaluated for diagnosis of LADA patients.
Of 86 T2DM, 35 (40.70%) were antibody positive and 51 (59.30%) persons were negative for any antibody. A significant difference was found between groups in age at study, insulin therapy, C- peptide levels and family history of autoimmune diseases. On the other hand, no significant difference was found between the two groups in other risk factors.
Among our T2DM subjects, the number of LADA patients were not high. Also, multiple autoantibodies were more frequent than single autoantibodies in LADA patients

Latent autoimmune diabetes of adults (LADA) is a form of autoimmune diabetes initially managed with oral hypoglycemic agents before becoming insulin requiring. One of the LADA risk factors is family history of diabetes (FHD) that less well understood. Our aim was investigate the influence of FHD on the incidence of LADA compared with those for type 1.
In this cross sectional study, 126 patients participated. Of these, 86 patients had type 2 diabetes and 40 persons were diagnosed with type 1 diabetes. The two groups compared for biochemical, anthropometric and clinical characteristics. The GADA, ICA and IA2A assessed by ELISA technique used for diagnosis of LADA patients. Then, LADA and T1DM patients compared regarding diabetes mellitus family history.
According to the findings this study, 26 (74.28%) patients with LADA and 17 (42.50%) patients with type 1 diabetes had a family history of diabetes. Also, a significant association was observed between family history of diabetes and LADA. Mean concentrations of C-peptide in LADA patients with a family history of diabetes was 0.62±0.22 and in those without a family history of diabetes was 1.05±0.43 ng/mL, showed significant differences (p= 0.001).
Our study indicates that family history of diabetes could be a risk factor for LADA and that the effect of family history may be mediated through a heritable reduction of insulin secretion.

This sub-analysis of the Iran-AFECT study was to determine the baseline characteristics are predicting the likelihood of attainment of HbA1c goal and changing in HbA1c after initiation of basal insulin glargine in insulin naïve people with type 2 diabetes not adequately controlled with oral glucose-lowering drugs. Iran-AFECT was a 24-week, prospective, multicenter, observational study of people with type 2 diabetes initiated or switched to insulin glargine. In this sub-analysis, we included all insulin naïve people. Glycemic response was defined as HbA1c≤7.0% and/or change in HbA1c at week 24. Data on 433 participants were included. The mean HbA1c was 8.9%±0.9% at baseline which decreased to 7.6%±1.2% (P

Both genetic and environmental factors are important in pathogenesis of diabetes. Non HLA (Human Leukocyte Antigen) genes such as INS-VNTR and CTLA-4 in addition of HLA genes have influence on genetic susceptibility for diabetes mellitus. In this study the association of A/G CTLA-4 and -23 A/T INS-VNTR polymorphisms with diabetes and their association with islet autoantibodies were investigated.
Thirty four autoantibody positive adult persons with diabetes mellitus and 39 persons with Type 1diabetes mellitus (T1DM), 40 autoantibody negative Type 2 diabetes mellitus (T2DM) patients and 40 healthy controls were studied using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) technique.
The frequencies of -23 A/T INS-VNTR genotypes were not significantly different among study groups. It was shown that the distribution of the  CTLA-4 allele and genotype frequencies did not differ between T1DM patients, autoantibody positive adult patients and controls. With increasing CTLA-4 G allele and GG/AG genotypes, the frequency of Glutamic Acid Decarboxylase Autoantibody (GADA), Islet Cell Autoantibody (ICA) and Islet Antigen 2 Antibody (IA2A) positive patients were increased.
Our results suggest that susceptibility allele A of -23A/T INS-VNTR does not have any role in the pathogenesis of diabetes in our patients and susceptibility allele G of A/G CTLA-4 if not, has a small role in pathogenesis of diabetes in T1DM and autoantibody positive adult patients and in spite of significant increase in autoantibody negative T2DM group it does not have any role in disease pathogenesis.

Social capital is an important interpersonal organizational resource that may affect health behaviors and seems to be an important factor in chronic diseases. Considering the lack of evidence on this topic, in the present study, we aimed at investigating the association between components of social capital, socioeconomic condition, and controlling Type 2 diabetes mellitus in Iran.
This study was conducted on 300 patients with Type 2 diabetes in Tehran, Iran. In this study, simple random sampling method was used for data collection. Path analysis model was used to examine the potential association between social capital components and to determine the factors that control Type 2 diabetes.
In the present study, most of the participants were female (70.7%) and married (78.7%). Path coefficients were calculated by a series of multiple regression analyses based on the conceptual model. The final model had a proper fit with Chi-square = 2.08 (DF = 1, P = 0.049), GFI = 0.542, AGFI = 0.915, NFI = 0.228, RFI = 0.284, IFI = 0.299, TLI = 0.292, CFI = 0.219, and RMSEA = 0.033. The Groups and networks (network) (β = 0.051, p = 0.036) and trust and solidarity (β = -0.018, p = 0.028) had a direct positive and negative effect on HbA1C, respectively. The results also revealed that education levels had a direct positive effect on groups and networks (network) (β = 0.118, p = 0.036), trust and solidarity (β = 0.082, p = 0.007), information and communication (β = 0.037, p = 0.027), and contribution in team works and public activities (β = 0.064, p = 0.003). In addition, education levels had an indirect positive effect on HbA1C through their effect on groups and networks (network), trust and solidarity, and information and communication.
Social capital has a significant relationship with diabetes. Although it was not specified clearly which components of social capital were associated with diabetes, trust and solidarity showed a negative direct effect on HbA1C, respectively. Therefore, developing and implementing local and collective programs to build trust and increase the standards of social trust in patients with diabetes can be effective in controlling HbA1C.

Low health literacy (HL) of patients has obtained more attention as a risk factor for poor adherence to treatment and adverse outcomes in chronic disease’s management particular in diabetes care. Diabetes Numeracy Test‑15 (DNT‑15) has been developed specifically for this purpose. The objective of the current study is to evaluate psychometric properties of Iranian (Persian) version of the DNT‑15.
The shortened version of the DNT (15‑items) was completed by 120 patients with diabetes. The Kuder–Richardson Formula 20 for internal consistency was conducted. Content validity, criterion‑related validity, and construct validity were also evaluated.
The average score on the DNT was 72% and took an average of 25 minutes to complete. The DNT‑15 had a very good internal reliability (KR‑20 = 0.90) and also content validity (content validity ratio: 089 and content validity index: 0.86).
The DNT‑15 (Persian version) is a reliable and valid measure of diabetes‑related numeracy skills for Iranian patients with diabetes; however, additional studies are needed to further explore the association between diabetes‑specific numeracy and acculturation and their impact on diabetes‑related outcomes in Iranian population.

Hypoglycemia is associated with adverse health outcomes and can result in vascular events in diabetic patients. The impact of hypoglycemia on cardiovascular outcomes in non-critically ill people with diabetes is not well-determined. So, we examined short-term cardiovascular outcomes of hypoglycemic events in people with type 2 diabetes treated with insulin during routine clinical care.
This study was conducted in Tehran, Iran from January 2012 to January 2013. One hundred and twenty non-critically ill people with type 2 diabetes on oral glucose lowering drugs were enrolled. Insulin therapy was initiated for uncontrolled diabetes. The patients were educated to perform self-monitoring of blood glucose on a daily basis. Furthermore, they were asked to record the results if they experienced any symptom indicative of hypoglycemia during the 24 weeks of the study. The occurrence of any major cardiovascular event including unstable angina, fatal or non-fatal myocardial infarction, fatal and non-fatal stroke, or death from cardiovascular cause was also evaluated based on the patients’ hospital records.
There were 210 hypoglycemic episodes and 31 major cardiovascular events. Forty four percent of patients with documented hypoglycemic episodes developed cardiovascular events compared to 15.6% of those who did not experience any hypoglycemia (P = 0.001). The odds ratio for occurrence of major cardiovascular events related to hypoglycemia was 7.41 (CI = 2.15–25.47) with a risk ratio of 2.66.
Hypoglycemia is a major risk factor for occurrence of the first major cardiovascular event in non-critically ill people with type 2 diabetes initiating insulin therapy.

To obtain information related to the knowledge and clinical practice of general practitioners (GPs) in management of people with type 2 diabetes, and to explore the impact of formal continuous medical education (CME) programs. A total of 1104 GPs participated in a cross sectional survey related to diabetes management considering ADA/EASD consensus 2011 focused on demographic and background characteristics, diabetes related knowledge, and patient care. Fisher’s Exact and Chi-square tests were used in the analysis of contingency tables. The majority of the participants (83.9%) worked in large cities and 39.8% had taken part in CME programs in diabetes management. Overall, 52% of the GPs knew the treatment goal for HbA1c. The rate was slightly higher for those taken part in CME (P = 0.003). Considering patient care, slightly more than half of the participants answered correctly to the questions on duration and distribution of physical activity, with no difference by taking part in CME programs. On average, 41.5% of the physicians selected metformin as the first OGLD for treatment of type 2 diabetes, and only 27.9% stated that they add basal insulin to OGLD if treatment failed. The results of this study provide the evidence that the knowledge and clinical practice of Iranian GPs in management of type 2 diabetes were not satisfactory. Furthermore, traditional CME programs in diabetes management were not effective in changing the GPs’ clinical practice. Consequently, designing and implementing more effective strategies are necessary for improving patient health related outcomes.

This study was to estimate the frequency of prehypertension and to characterize patient awareness and associated cardiovascular risk factors in an urban population in Iran. During a hypertensive awareness program, a cross-sectional study was conducted on 2036 people. All participants completed a questionnaire about their demographic and anthropometric indices and were asked about symptoms, risk factors and preventive measures of hypertension. Data were compared between prehypertensive and non-hypertensive groups. Prehypertension was detected in 30% (n=611) of the subjects. Previous CHD, diabetes, and hyperlipidemia were more prevalent in low prehypertension group compared to high normal blood pressure. The male sex, increasing age and body weight were positively associated with the rate of prehypertension. Only 8% of participants with prehypertension were aware about the symptoms of hypertension, 12% correctly mentioned at least three risk factors of hypertension, and 48% explained appropriate preventive measures. Prehypertension was prevalent in this population. Age, body weight, male sex, and previous CHD were the major determinants. Furthermore, hypertension awareness was alarmingly poor. Therefore, hypertension prevention programs focused on increasing public awareness are essential.

The aim of this study was to assess the safety and efficacy of treatment with insulin analog Novomix30 in Iranian patients with type 2 diabetes using the results of the A1chieve study. The A1chieve study was a 24 week، open-label، multicenter، observational study of people with type 2 diabetes. The study was conducted in 28 countries across four continents on 66،726 people with type 2 diabetes، both insulin users and non-insulin users، to assess the safety and efficacy of Novomix30. This article reports the results of 919 Iranian patients with type 2 diabetes treated with insulin Novomix30. After 24 weeks treatment with Novomix30، HbA1c reduced significantly (P<0. 001). Despite a significant reduction in fasting blood sugar and postprandial sugars، the incidence of severe and nocturnal hypoglycemia was significantly decreased in prior insulin users. The mean arterial blood pressure decreased significantly and the quality of life improved in all patients. Insulin Novomix30 was well tolerated despite good glycemic control and the incidence of hypoglycemia was not increased in Iranian patients with type 2 diabetes.

Some results exist on fetuin-A as marker for vascular disease in type diabetes. We examined the relationship between serum fetuin-A with some factors, in patients with type 2 diabetes mellitus (T2DM). From October 2012 to June 2013, a total of 131 T2DM patients were recruited and evaluated for various parameters including HOMA-IR, Apo-A1, Apo-B100, body fat percentage and waist circumference. Serum fetuin-A levels were measured by enzyme-linkedimmunosorbent assay (ELISA), and Serum glucose with a Cobas MIRA analyzer by enzymatic method. Apo-B100 and apo-A1 were measured by immunoturbidimetry with a Cobas MIRA analyzer. HOMA-IR was calculated by the following formula: [fasting insulin (uIU/mL) × fasting blood glucose (mmol/L)]/22.5. The mean levels of HOMA-IR were significantly increased progressively across fetuin-A tertiles (p for trend=0.04) in women but not men. Fetuin-A had just a significant positive correlation with Apo- A1(r=0.22, p=0.02). This present study showed that levels of serum fetuin-A are significantly associated with insulin resistance in women with T2DM.

This study aims at investigating the possible effects of different daily doses of green tea (GT) intake for eight weeks on certain anthropometric, metabolic, and oxidative stress biomarkers of diabetic patients. This randomized clinical trial included 63 patients with type 2 diabetes (30 males and 33 females). After a two-week run-in period without green tea, they were randomly assigned into one of the three groups, with a different daily intake of green tea; four cups of green tea per day (n = 24),two cups of green tea per day (n = 25), and the control group (n = 14) with no green tea intake for two months. At baseline and after the intervention, blood tests, dietary, and anthropometric variables were assessed. The patients were instructed to maintain their usual dietary intake and normal physical activity. Consumption of four cups of GT per day caused a significant decrease in body weight (73.2 to 71.9) (P < 0.001), body mass index (27.4 to 26.9) (P < 0.001), waist circumference (95.8 to 91.5) (P < 0.001), and systolic blood pressure (126.2 to 118.6) (P < 0.05) in this group. No significant change was seen in the other groups and between group comparisons. The metabolic and oxidative stress parameters did not show any significant differences within and between groups. Drinking four cups of green tea led to a significant reduction in weight and systolic blood pressure.

Autoimmune thyroid diseases (ATD) are multifactorial conditions that result from genetic predisposition in combination with environmental risk factors. Helicobacter pylori infection as an environmental risk factor has been proposed to imitate the antigenic components of the thyroid cell membrane and may play a leading role in the onset of the autoimmune diseases, such as Hashimoto thyroiditis. The aim of this study was to investigate the association between Helicobacter pylori (HP) infection and Hashimoto''s thyroiditis (HT). The participants in this case-control study included 43 patients affected by Hashimoto''s thyroiditis, and 40 healthy individuals without history of autoimmune disease as the control group. Anti HP IgG and anti-TPO antibodies were determined using ELISA method. Results were considered positive when the IgG anti-HP value was higher than 30 IU/ml and the anti-TPO autoantibody value was higher than 75 IU/ml. The mean TSH level was 18.3±16.8 IU/ml for patients and 2.8±1.2 IU/ml for the control group (P<0.001). 46.5% of the patient group and 10.8% of the control group were infected with HP. The association between HP and Hashimoto''s thyroiditis was statistically significant (Odds Ratio=7.2, 95%, Confidence Interval: 2.0- 28.8, P<0.001). The findings show that, there is an association between HP and Hashimoto''s thyroiditis. To establish a definite correlation between them, more detailed studies with a more specialized examination and precise consideration regarding species of HP, genetic polymorphism of the host and investigation of environmental factors are needed.

Patients with diabetes experience some level of emotional distress varying from disease-specific distress to general symptoms of anxiety and depression. Since empirical data about symptom distress in relation to diabetes are sparse in Iran, this study was designed to assess the diabetes-specific distress in Iranian population. Persian version of Diabetes Distress Scale (DDS) questionnaire was completed by volunteer outpatients on a consecutive basis between February 2009 and July 2010, in Endocrine Research Center (Firouzgar Hospital). Then, scheduled appointments were made with a psychiatrist in the same week following completion of the questionnaire. The psychiatrist was not aware about the results of this questionnaire and patients were interviewed based on DSM-IV criteria. One hundred and eighty-five patients completed the questionnaire and were interviewed by a psychiatrist. Fifty-two percent of the patients were females. The mean age was 56.06 (SD=9.5) years and the mean of duration of diabetes was 9.7 (SD=7.3) years. Sixty-five (35%) had distress. Among the patients with distress, 55% were females and 64% had lower grade of education. Eighty patients were diagnosed as having Major Depressive Disorder. There was a relation between Emotional Burden subscale and age (P=0.004), employment status (P=0.03), and also diabetes duration (P=0.02). The physician-related distress subscale was also related to the type of medication (P=0.009) and marital status (P=0.01). It has been shown that the regimen-related distress subscale was also related to age (P=0.003) and duration of diabetes (P=0.005). High prevalence rate of distress in the study highlights the significance of the need for identifying distress and also other mental health conditions in patients with diabetes in order to take collaborative care approaches.

Several investigations have been conducted on the effects of Islamic Ramadan fasting on blood glucose levels and lipid profile of type two diabetic subjects. However، this matter remained to be controversial. This study was designed to investigate the effect of Ramadan fasting and structured SMBG on blood glucose control in this group of subjects. Forty type two diabetic subjects on oral agent were selected. These subjects were randomly divided into two equal groups and matched based on their age and sex. Group A monitored their blood glucose level using structured SMBG method and group B monitored their blood glucose level in a traditional way. Fructosamine level، total cholesterol، LDL، HDL and TG were measured in all subjects before and after Ramadan. Fructosamine level raised from 363 (±53. 55) to 400. 29 (±73. 25) (P < 0. 003) in group A and from 388. 52 (±61. 89) to 411. 10 (±68. 37) (P < 0. 04) in group B. Total chol، LDL and TG levels were increased and HDL level was decreased in both groups; however، these changes were not statistically significant. Poor metabolic control despite structured SMBG method is observed in this study. This might be due to have high caloric diet and less physical activity during Ramadan in order to prevent hypoglycemic attacks.

Metabolic syndrome is a collection of metabolic disorders that increase the risk of cardiovascular diseases (CVD) and diabetes. Metabolic syndrome is characterized by abdominal obesity, hypertriglyceridemia, low HDL level, hyperglycemia and HTN. With regard to the development of CVD disease in recent years, the present study was completed to determine the degree of metabolic syndrome prevalence in the adult population of Semnan province.

This epidemiological cross-sectional study was carried out in the province of Semnan (Iran) on 3799 individuals between 30 and 70 years of age. In the study, multi-stage individuals were randomly selected from urban and rural environments and the prevalence of metabolic syndrome was determined according to ATPIII and IDF criteria.

The prevalence of metabolic syndrome according to ATPIII and IDF was 28.5% and 35.8% respectively, and increased with age in both sexes. The highest degree of prevalence was seen in the above-60-years age group. The Prevalence of metabolic syndrome was significantly higher in women on basis of both definitions; it was higher among non-smokers on basis of the IDF definition (P<0.05). Decrease in the prevalence of the syndrome had significant relation to literacy. There was no significant difference of metabolic syndrome prevalence between urban and rural settings. Among the risk factors of metabolic syndrome according to ATPIII and IDF, high triglycerides (40.8%) and abdominal obesity (70.8%) had the highest prevalence respectively.

The findings show the high prevalence of metabolic syndrome in the 30 to 70 year-old population. Therefore, the identification of the risk factors should be attempted to prevent syndrome acquisition.