mohammad reza rezvanfar

The present study aimed to compare the levels of the inflammatory biomarkers of fibrinogen and highsensitivity C-reactive protein (hs-CRP) among type 2 diabetic patients treated with empagliflozin and other hypoglycemic drugs.

This cross-sectional study was performed on 90 patients with type 2 diabetes ( ≥ 30 years) receiving empagliflozin, metformin, and sulfonylurea who were referred to the diabetes clinics affiliated with Arak University of Medical Sciences. After obtaining consent to participate in the study, the patients were categorized into the treatment groups of metformin, metformin + empagliflozin, or metformin + sulfonylurea, and their characteristics and hypoglycemic drugs were recorded in the information checklist. The data were analyzed in SPSS 16 statistical software.

The fibrinogen level was minimized in the metformin + empagliflozin group, although the three groups were not significantly different in this regard (P = 0.382). Based on the results, the parameter was higher in the individuals with ischemic heart disease, while a lower level was found among those treated with a lipid-lowering agent. In terms of hs-CRP level, no statistically significant difference was observed among the three groups, although the metformin group had a lower level (P = 0.522).

The minimum fibrinogen and hs-CRP levels were related to the metformin + empagliflozin and metformin groups, respectively. Further, several factors such as comorbidities and other consumed drugs could affect the concentration of inflammatory factors. Thus, it is suggested that clinical trials should be conducted in this respect.

Increased levels of reactive oxygen species is a key factor involved in the pathogenesis of type 2 diabetes mellitus (T2DM). Coenzyme Q10 (CoQ10) is a nonenzymatic antioxidant that restores other antioxidants. Tis randomized, double-blind placebo-controlled trial study has been designed to evaluate the e?ects of CoQ10 supplementation on serum values of amylase, adenosine deaminase, catalase (CAT), total antioxidant capacity (TAC) and the quantitative insulin sensitivity check index (QUICKI) in women with T2DM. Serum levels of CoQ10 were measured too. Sixty-eight women with T2DM were enrolled in this study and randomly divided into two groups. One group received 100 mg/day of CoQ10 supplement for 12 weeks (n = 34), and the other group was given placebo for the same time duration and dosage (n = 34). After the intervention, serum CAT activity (P < 0.001), TAC (P = 0.006), CoQ10 (P = 0.001), and QUICKI (P = 0.005) increased and fasting blood sugar (FBS) (P = 0.05) decreased signifcantly in CoQ10 group. Tis study showed that daily supplementation with 100 mg of CoQ10 could increase TAC and CAT activity as, CoQ10 and QUICKI and could reduce oxidative stress and FBS in women with T2DM.

Insulin is first choice for gestational diabetes control, but its needed to frequent injections; one thing that is difficult for pregnant women, so interest to metformin consumption is increased. Metformin easily crosses the placenta and its fetal blood levels is equivalent to the level of the mother's blood. Metformin also easily cross the brain barrier and enter the brain. Possible side effects of metformin compared to insulin on fetus brain development was concerned to design of present study.
In this cross-sectional prospective trial, gestational diabetes women were recruited randomly to insulin (64 patients) and metformin (64 patients) groups and compared for pregnancy and neonatal outcome and also six-month-old infancy developmental indexes. The results considered significant if P value was ≤ 0.05.
Six-month body mass index of insulin group women was significantly more than metformin group(P=0.05), but there was not any significant difference in cesarean section, preterm labor, dystocia, preeclampsia and still birth rate between two groups. Also neonatal characteristics, need to admission and six-month-old infancy developmental indexes according to Ages stages questionnaire were no different between two groups.
Metformin consumption in compare to insulin was not associated with maternal, neonatal and six-month-old infancy developmental indexes side effects.

It has been suggested that inflammation might be implicated in the gestational diabetes mellitus (GDM) complications, including insulin resistance. The aims of the current study were to explore maternal circulating values of TNF-α, adiponectin and the adiponectin/TNF-α ratio in women with GDM compared with normal pregnancy and their relationships with metabolic syndrome biomarkers.
Forty women with GDM and 40 normal pregnant women were included in the study. Commercially available enzyme-linked immunosorbent assay methods were used to measure serum levels of TNF-α and total adiponectin.
Women with GDM had higher values of TNF-α (225.08±27.35 vs 115.68±12.64 pg/ml, p In summary, the adiponectin/TNF-α ratio decreased significantly in GDM compared with normal pregnancy. The ratio might be an informative biomarker for assessment of pregnant women at high risk of insulin resistance and dyslipidemia and for diagnosis and therapeutic monitoring aims in GDM

Hypothyroidism and hyperthyroidism have been known as the most important reasons for DUB (dysfunctional uterine bleeding) that presents as menstrual irregularities. Regarding to the effects of thyroid hormones on mense, levothyroxine intake may be effective on DUB in euthyroid women.
Material and In this interventional randomized, double-blind, placebo-controlled clinical trial on 120 women aged 35-55 years old with DUB that they had no organic reasons and had normal thyroid function and they were taking oral contraceptive pill (OCP), were divided in two groups that each group included 60 women. The intervention group took one tablet of levothyroxine 0.1 mg daily and control group took placebo for three months and after 3 months, comparison between two groups were performed by using SPSS software 16 and in order to data analyzing paired t test and student t test and covariance analysis was used.
Our study showed the overall recovery rate of all kinds of mense irregularities was 48(80%) and 51(85%) in intervention and control groups respectively that shows there was no difference in comparison to pretreatment (P=0/47). The comparison of recovery rate based on different kinds of mense irregularities in two groups showed that recovery rate in metrorrhagia was significantly more in intervention group (100%) than control group. Based on covariance analysis, a meaningful recovery rate in duration and interval bleeding, and the number of used pads was seen in intervention group in comparison to control group (F=4.352, P=0.006).

Vitamin C is one of the life necessary soluble vitamins of body composition that its role has been shown in collagen synthesis, immunity, cancer prevention and a lots of enzyme activity. Thyroid function effects of vitamin C supplementation has proposed in some human and experimental studies. The aim of present study was to evaluate the effect of simultaneous consumption of vitamin C and levothyroxine on thyroid function of patients with primary hypothyroidism.
Subjects and In this before-after clinical trial, 73 patients with primary hypothyroidism of both sexes were treated with one brand of levothyroxine sodium (OSVEH Company). Fasting serum levels of T3, T4, and TSH were measured before and 8 weeks after treatment. Then, vitamin C tablet 500mg was added to levothyroxine treatment of the same patients for another 8 weeks. Again, thyroid function was measured at the end of this period. The results considered significant if P value was ≤ 0.05.
With vitamin C, the mean levothyroxine need reduced in 83.6 percent of patients. (P=0.001). The results of present study showed significant difference between mean TSH levels, before and after adding vitamin C. (P=0.001).
Consumption of Vitamin C with levothyroxine, improves primary hypothyroidism control.

The renin-angiotensin system(RAS) has a major role in development of diabetic nephropathy and blocking of RAS by inhibitors and blocking of angiotesin receptors is standard treatment for preventing kidney disease and proteinuria. It is reported that VIT-D analogues are able to suppress renin exertion and improve proteinuria. The aim of this study is to evaluate the effect of VitD analogue (calitriol) on reducing proteinuria in patients with diabetic nephropathy.
In this clinical trial study, 132 eligible patients that had diabetic nephropathy and hadn’t vit D deficiency were selected. The patients were divided into two equal groups. First group received the combination of losartan 25mg twice daily and calcitriol 0.25mg and second group received losartan 25 mg twice daly alone for 3 months. The FBS, lipid profile, ESR-CRP BUN, Cr, HbA1c, Ca, P, and 24 hours urine protein were evaluated in all patients at beginning and end of study and the results were statistcally compared.
The 24-hour urine protein in losartan and calitriol group was improved compared to losartan. This difference was statistically significant (p=0.003). As well as, in kidney function (BUN, Cr) in the losartan and calcitriol group compared to losartan alone was significantly improved(p Combination of calcitriol with angiotesin receptor blockers(ARBs) is more effective than ARBs alone in improvement of proteinuria and real function.

Noticing to high prevalence and complications rates of Diabetes Mellitus and its effect on quality of life, and also considering low quality of life, can cause low self-care and increase complications among these patients. The goal of this study is comparing the effect of multimedia education with live successful experiments on quality of life in type 2 diabetic patients.
This is a semi experimental study. First 160 type 2 diabetic patients were selected First 160 type 2 diabetic patients were selected and then randomly allocated into two tests and one control groups. Research tools were self-statement demographic and WHO-QOL Brief questionnaires which were completed before interventions. For first test group educational classes with multimedia method (group discussion, educational film and slides) were hold in 5 sessions each in 45 minutes. For second test group education was based on narrating of live successful experiments by the patients who controlled their diabetes and answer to questions of the patients. After 3 month WHO-QOL Brief questionnaires which were completed again. All data were analyzed with SPSS version 20 software.
There was no significant difference in means of quality of life among three groups before interventions (p= 0.194). There was significant difference in means of quality of life among three groups after interventions (p= 0.04). There were significant differences between the means of quality of life in first test group (P≤0.001) and second test group (P≤0.001) before and after interventions.
Qualities Of Life in first and second test group were increased more than control one.

Diabetes is one of the most common disease resulted from metabolism disorders. Thus, Studying medication adherence in patients to explain educational interventions to improve the health of these patients is necessary. Therefore, the present study aimed to assess the factors affecting medication adherence in diabetics patients based on health belief model in Arak 2014.
In this analytical study, 366 diabetic patients in Arak in 2014 were selected and data were collected through a researcher made questionnaire about patients behavior in the field of medication adherence and its influencing factors based on the health belief model. Linear regression model was used to determine the predictive power of structures.
The mean knowledge score and the medication adherence was 31.34 and 84.34, respectively. In this study, perceived susceptibility, perceived barriers and internal action guide were as the strongest predictors of medication adherence behavior in patients and predicted their behavior variance 0.36. Between function and susceptibility and severity and perceived benefits and self- efficacy of manual internal and external action guides in the field of medication adherence with diabetes, there was a direct correlation that the highest correlation was related to the perceived susceptibility structure (r=0.42 , p The results showed that the educational interventions with an emphasis on building the perceived sensitivity of patients with diabetes for medication adherence and emphasis on internal incentives as motivators and incentives for patients to achieve better results in the field of medication adherence should be at the heart of educational interventions.

The aim of the study was to evaluate the third trimester urinary iodine excretion and to assess its relation with newborns thyroid function.
A total of 208 healthy third trimester pregnant women without previous history of thyroid disease were included in the study. Urinary iodine levels of mothers were measured and neonatal TSH levels were screened on the 3- 5th day following birth.
The median urinary iodine level in the mothers was 50μg/L. According to WHO criteria for iodine status:14.9%, 34.1% and 49.6% had severe, moderate and mild iodine deficiency, respectively, and only 1.4%, had the adequate iodine intake . In 6 neonate (2.8%) who their TSH level were between 5- 10 IU/ml, nobody had criteria for congenital hypothyroidism at recall visit (15th day). Our results showed the reverse relation between mean Neonatal TSH levels and mother’s third trimester iodine level (r= -0.19, p=0.006).
Although all of mothers included in this study stated that they were using iodized salt, iodine deficiency was frequent . There was also a significant relation between mean neonatal TSH levels and mother’s third trimester iodine urinary level.

Gestational diabetes mellitus (GDM) is defined as glucose intolerance with first dignosis during pregnancy. There is some evidence indicating that chemerin play a role in the development of GDM. In this study, for the first time, a possible association of rs17173608 polymorphism in the chemerin gene with the risk of GDM in Arak population was investigated. In this case-control study, 120 GDM and 150 pregnant women with normal glucose tolerance were selected. GDM was confirmed by oral glucose tolerance according to the new IADPSG criteria. Genomic DNA was extracted from EDTA treated whole blood. The polymorphism of chemerin gene was determined using tetra-amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR). The genotype frequencies of TT, GT and GG at rs17173608 were respectively 81.7%, 17.5% and 0.8% in the GDM group and 73.3%, 25.3% and 1.3% in the control group. There were no statistical differences in genotype frequencies between case group and the control group. Also, allel frequencies in the GDM group (T,90.4%, G 9.6%), did not differ significantly from the control group (T 96%, G 14%). No association was found between genotype frequencies and FBS, 1h, 2 h and BMI. The present study show that the rs17173608 polymorphism in the chemerin gene is not associated with the development of glucose intolerance and GDM in the studied population.

Diabetes Mellitus (DM) is a major health care problem. The relationship between DM and zinc has frequently been reported in various research. The present study aims to investigate serum zinc level in patients with type 1 (IDDM) and type 2 (NIDDM). Association between glyaceted hemoglobin and level of zinc is also evaluted. This cross-sectional study was conducted on 60 subjects with DM (Type l: N=30; Type 2: N=30) who met inclusion criteria of the study. Patients’ serum zinc level and HbA1c were measured. Data were analyzed using t-test and Mann-Withney U test. Seventy five percent of the subjects were female. The average age of the IDDM was 15.36±5.28 years and that of NIDDM was 48.70±11.45 years. The average HbA1c of subjects was 8.06±1.64%. The average serum level of zinc in IDDM group was 95.82±14.51 mg/dl and that of NIDDM was 97.47±32.36 mg/dl, no significant difference was found between the two groups. Serum zinc difficiency was detected in 20% of the patients with NIDDM and 16.6% of the patients with IDDM. However, no significant correlation between HbA1c and serum level of zinc was detected in this study. Zinc deficiency was detected among a significant percentage of IDDM and NIDDM patients, but no significant correlation between serum zinc level and HbA1c was detected.

During recent years, opium consumption has increased among Iranian diabetic men. The belief that opium consumption can control or even eradicate DM is increasing. This study was conducted to compare the blood sugar, HbA1c, lipid profile and the frequency of diabetes complications in male type II diabetic patient with and without opium consumption. Two hundred thirty two type 2 diabetic men were included in a case- control study between September 2009 and June 2010. They were divided into two groups: with (n= 88), and without (n=144) current opium consumption. Serum glucose was measured by two hexokinase (automized and manual) and orthotolidine method, and Hb A1C was measured by chromatographic ion exchange. The opium consumption was evaluated by thin-layer chromatography (TLC) of urine. Analyses were performed using SPSS and P≤0.05 was considered significant. There was not a significant age difference between two groups. The mean duration of opium use was 36±6 months. The difference between mean serum fasting glucose levels in different methods of measurement was not significant between case and control groups. The results of this study showed a significant lower level of serum HbA1C (p=0.006) and triglyceride (p=0.005) in diabetic patients with opium abuse, but the frequency of peripheral neuropathy and ophthalmic photocoagulation was not different between two groups. Although the HbA1c was lower in males with opium consumption, the frequency of chronic complications of diabetes was not significantly different between two groups. We didnt evaluate other complications of opium consumption, especially mental and physical dependence. In summary, despite observed effects on some of glucose indices, opium is not a harmless treatment for diabetes.

To investigate fasting glucose, glucose tolerance, insulin resistance and insulin–like growth factor 1 in patients with or without colorectal polyps. In this cross-sectional study, we evaluated fasting glucose, insulin, insulin–like growth factor 1 (IGF-1), lipid profile and glucose tolerance test in 103 patients undergoing colonoscopy (52 normal and 53 with Adenomatous polyps). We also estimated homeostasis model assessment insulin resistance index (HOMA-IR) in two groups. Statistical analyses were performed using the Student T-test and Chi-square test. For all tests a P value ≤ 0.05 was considered to be statistically significant.The mean of waist circumference (P < 0.01), waist to hip ratio (P < 0.01), fasting serum glucose (P < 0.05), total cholesterol (P < 0.05), and LDL (P < 0.05) were significantly higher in patients with adenomatous polyps. The mean of HDL was significantly lower in patients with adenomatous polyps (P < 0.01). There was no relation between fasting serum insulin, IGF-1 and glucose tolerance test with adenomatous polyps. Hence HOMA-IR was higher in patients with adenomatous polyps (2.9 ± 2.6 vs. 2.82 ± 2.1), this difference was not significant statistically.Fasting hyperglycemia could be a risk factor to adenomatous polyps’ development. Although this study did not show any relation between insulin resistance index and adenomatous polyps, further studies are needed for more evaluation.

: To evaluate the relation between major depressions and glucose control index in type 2 diabetes mellitus.
MATERIALS AND METHODS: One- hundred thirty four patients with type 2 diabetes were enrolled in this study. Hamilton Rating Scale for Depression (HAM-D) and HbA1c were measured in patients. Linear mixed-model analysis was applied to determine the relation between HbA1c levels and depressive symptoms.
Groups of patients with and without depression were similar in age and BMI. Correlation analysis revealed no significant relationship between HAM-D scores and HbA1c level. Depressive scores were significantly higher in diabetic patients with hypertension (P = 0.0001) and on insulin treatment (P = 0.005). There was a significant positive relationship between HAM-D scores and disease duration. (P < 0.01).
The findings of this study showed that there was no significant association between the level of depressive symptoms and HbA1c in patients with type 2 diabetes.

We report a case of acute renal failure related to rhabdomyolysis in a patient with Sheehan syndrome, while other diseases that could cause rhabdomyolysis were excluded. The patient’s kidney function completely recovered with 3 sessions of intermittent hemodialysis. After thyroxine replacement therapy, musculoskeletal symptoms disappeared and creatine kinase concentrations decreased. Steroid replacement therapy was also administered. The present case suggests that rhabdomyolysis could occur in a patient with Sheehan syndrome without other precipitating factors