مجله دانشکده پزشکی اصفهان
پیاپی 584 (هفته چهارم شهریور 1399)

Progressive insulin resistance (IR) is a physiologic state during pregnancy which could be ended to gestational diabetes. Given the relationship between weight and insulin resistance (IR), the study of the association between nutrients intake and insulin resistance is particularly rational and predictive.

The current descriptive cross-sectional study was performed on 138 nulliparous women with healthy and single pregnancies. Individual characteristics were collected by a researcher-administered questionnaire. At 6th</sup>-10th</sup> weeks of pregnancy, physical activity scores and nutrients intake were determined using the Pregnancy Physical Activity Questionnaire and 24-hour recall for three consecutive days, respectively. At the same time, fasting serum glucose and insulin levels were also measured to calculate IR by the formula.

Square root transformation of IR index at the first trimester was significantly correlated with household income, occupational activity, pre-pregnancy body mass index (BMI), weight, and physical activity at 6th</sup>-10th</sup> weeks of gestation. However, after adjusting the effect of related variables, household income and maternal weight were significantly associated with IR, and occupational activity had a trend toward the significant association. Moreover, vitamin D, linolenic acid, beta-carotene, vitamin E, and carbohydrate intake were significantly correlated with IR index. However, after adjusting for the related variables, vitamin E had a direct significant relationship with IR, and glucose and maltose intakes were inversely associated with IR.</div>

Significant association between household income and maternal weight at the first trimester can be used to control IR, which is a key component for gestational diabetes. The association of vitamin E, glucose, and maltose intakes with IR may be a guide to get new results. We suggest further studies about the association between occupational activity and insulin resistance in pregnant women.

Diabetes mellitus is a chronic metabolic disorder with the main symptom of elevated blood sugar. Many drugs are now used to control diabetes. The aim of this study was to investigate the effect of Rosa damascena extract on blood glucose and insulin levels in diabetic rat models.

In this study, 100 male rats were divided into 10 equal groups of control, untreated diabetic, gavage stress, insulin treatment, and three healthy groups receiving different doses of extract (300, 600, and 900 mg/kg). Blood samples were taken at the day 0, 17, 31, and 45, and blood glucose, insulin, and malondialdehyde (MDA) levels were measured. Statistical analysis was performed using analysis of variance (ANOVA), and P < 0.050 was considered statistically significant.

There was no significant difference in mean fasting blood glucose and insulin level of different groups before beginning the interventions. Rose extract at the dose of 900 mg/kg significantly decreased blood glucose level (P = 0.007) and significantly increased blood insulin level (P = 0.009) in diabetic rats compared to diabetic control group. This dose of extract also reduced blood glucose and increased insulin levels in healthy non-diabetic rats.

Using rose extract can decrease blood sugar, and increase insulin levels. It seems that this extract could be of interest to researchers as a suitable therapeutic potential.

End of Life Care (EOL) and End-Stage Patients Care (ED) is usually presented in an environment full of a variety of emotional and moral challenges, the recognition of them can improve the quality of EOL services.

In this narrative review, ethical aspects of EOL sucs as diagnosing the time of death or the final stage of the disease, patient's autonomy, the use of life sustaining treatments, and assisted dying were reviewed in 8 databases and 45 sources.

Uncertainty is a principle in determining the proximity of the death or the final stage of a disease. In EOL, autonomy is limited, and some consider other moral principles, such as beneficence and justice, to be more important. Withholding of life sustaining treatments, especially in our country, is more moral and religious acceptance than withdrawing it. Approach different medically assisted dying varies in nations, and there are various moral justifications for accepting or denying it.

Ethical issues in EOL are complex in nature, and are intertwined with individual attitudes, religious beliefs, and social conditions. Proper communication between the patient, family members, and clinicians is the most important factor in preventing and resolving EOL challenges.