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Backgroud and Objective: Lipodystrophy is a potential clinical complication induced by insulin therapy, and it is believed that its frequency has been reduced by using recombinant human insulin. Aim of this study was to determine the frequency of recombinant human insulin induced lipodystrophy in diabetic patients. Materials and Methods: This cross sectional study was done on 220 diabetics referring to Imam Educational Hospital of Sari Township in 2007-2008 who had been under treatment with recombinant human insulin at least three months before. First, the anthropologic and clinical features of the patients were recorded in questionnaire, then all of the patients were examined clinically for lipodystrophy. In all patients, glycosylated hemoglobin (HbAlC) was measured for control of the blood glucose. The obtained data were analyzed by the descriptive statistical methods, t-test and 2 test. Results: From the total 220 diabetics under study, 35 (15.9%) had insulin induced lipodystrophy, of them 32 (14.5%) had lipohypertrophy and 3 (1.4%) with lipoatrophy. Factors such as age, sex, level of education, body mass index (BMI), type of diabetes, period of using insulin and injection site had significant influence in development of insulin induced lipodystrophy (p<0.05). Conclusions: Findings of this study revealed that despite using a recombinant human insulin, the frequency of the lipodystrophy particularly of lipohypertrophy still remained high level. Therefore, a regular examination of the diabetic patients for this complication is necessary, specially in the individuals who have a defective control on their blood glucose level. [ABSTRACT FROM AUTHOR]

INTRODUCTION. A diabetic foot lesion remains a major cause of morbidity in diabetic patients with chronic kidney disease. We studied the relation between kidney function and the risk of amputation in patients with diabetic foot. MATERIALS AND METHODS. We reviewed retrospectively the charts of 244 patients admitted to Imam Khomeini Hospital of Sari, Iran, for diabetic foot from 1996 to 2005. Their clinical characteristics and kidney function indicators, including urine protein excretion and serum creatinine were analyzed and compared between amputees and nonamputees. RESULTS. There were 244 patients with diabetic foot who were admitted to our center during the studied period. The duration of being affected by DM was between 3 months and 34 years (mean, 11.80 +/- 6.81 years). Sixty-six patients (27.0%) underwent amputation. The amputees were older than the nonamputees (61.1 +/- 11.5 years versus 55.6 +/- 12.5 years, P < .001). There were 20 patients (30.3%) in the amputee group and 44 (24.7%) in the nonamputee group who had proteinuria (P = .38). The mean creatinine level was significantly higher in the amputees compared to the nonamputees (1.78 +/- 1.36 mg/dL versus 1.28 +/- 1.23 mg/dL, P = .03). CONCLUSIONS. Lower extremity amputations in our patients with diabetic foot were strongly associated with elevated serum creatinine levels. The presence of this complication necessitates intensifying actions in order to prevent amputations. [ABSTRACT FROM AUTHOR]

We report the novel HLA-Cw allele HLA-Cw*0751. The allele was identified during routine sequence-based typing in our laboratory. The novel allele is identical to Cw*07020101 except for a single nucleotide change in codon 90.2 in position 268. HLA-Cw*0751 allele possesses an adenine at position 268 in exon 2, while HLA-Cw*07020101 has a cytosine at this position. Although this substitution does not change serologic reactivity of HLA-Cw7 molecule, it changes the amino acid at codon 90 from an aspartic acid to an alanine. Aspartic acid is polar and acidic, while alanine is non-polar and neutral. [ABSTRACT FROM AUTHOR]

Background and Purpose: Hypotension during Hemoadialysis is one of the risk factors of mortality and morbidity in patients. This study was preformed at Imam Khomeini and Fatemeh Zahra Hospitals, in Sari during 2007. Materials and Methods: 100 Hemoadialysis patients were evaluated. Serum calcium and serum albumin levels were measured prior to Hemoadialysis. Patient's blood pressure was measured before, during and after Hemoadialysis and data was analyzed using descriptive statistics, X2 test. Results: Hypotension, during Hemoadialysis was seen in 28% of patients. Of the total patients, 25% had hypocalcaemia. Of 25 patients with hypocalcaemia, 39.3% had hypotension, while 19.4% had normal blood pressure, thus, showing a significant difference between the two groups. Conclusion: It is suggested to revise the calcium concentration of dialysate. [ABSTRACT FROM AUTHOR]

Background and Purpose: Lipodystrophy is potentially a clinical adverse effect, associated with insulin therapy and is believed that usage of human recombinant insulin's is associated with decreasing prevalence of Lipodystrophy. The objective of this study was to determine the prevalence of insulin induced Lipodystrophy, among diabetic out-patients referred to Imam Khomeini Hospital, in Sari during 2007. Materials and Methods: In this cross sectional descriptive study, 220 diabetic patients referred to the Diabetes Center at Imam Khomeini Hospital, in Sari, who under treatment by insulin at least three months prior to referral was evaluated. First, the demographic and clinical characteristics of the patients were recorded in a questionnaire; then all patients were examined clinically to evaluate lipodystrophy. In all subjects, glycated hemoglobin (HbA 1 C) was measured to assess the range of blood glucose level control. Recorded data were analyzed by statistical methods, such as descriptive T-test and X2. Results: Of 220 diabetic patients studied, thirty-five (15.9%) showed clinical evidences of insulin induced Lipodystrophy; 32 out of 35 cases of Lipodystrophic patients (14.5%) had Lipohypertrophy, while 3 cases (1.4%) had Lipoatrophy. The factors included Age, Sex, Education, BMI (Body mass index), type of Diabetes, The duration of insulin consumption and injection site had statistically significant effects on development of insulin induced Lipodystrophy (P<0.05). Conclusion: The results of this study demonstrated that despite using human recombinant insulin's, the prevalence of insulin induced lipodystrophy, especially Lipohypertrophy, has remained high up to present. Therefore, regular examination of patients for this side effect is necessary, especially in subjects without good control of blood glucose level. [ABSTRACT FROM AUTHOR]

Background and Purpose: Thyroid dysfunctions are one of the most important diseases in endocrinology. Fine needle aspiration (FNA) is currently the first line diagnostic tool for the evaluation of thyroid nodules. The adequacy of specimens provided by this method is also very important. FNA puncture in thyroid causes intra-parenchyma hemorrhage, which may distribute the quality of tissue specimens. Fine needle non-aspiration (FNNA), may provide better specimens without this problem. The aim of this study was to evaluate the adequacy of thyroid nodules specimens provided by fine needle aspiration and fine needle non - aspiration sampling in Imam Hospital. Materials and Methods: This descriptive study was performed on 200 patients with thyroid nodules in Imam Hospital, Sari, Iran. After a detailed clinical history, systemic examination and thyroid sonography, FNA and FNNA sampling were performed in all patients. The adequacy of specimens was evaluated by Mair scoring system in both techniques. All data, including demographic data and sonographic results and background blood, amount of cellular material, degree of cellular degeneration, degree of cellular trauma and retention of appropriate architecture were recorded. Results were analyzed by means of SPSS (11) software and Wilcoxon Signed Rank Test. The P.value less than 0.05 were considered to be significant statistically. Results: 200 patients, 189 (94.5%) females and 11(5.5%) males, with mean age of 43.36±12.3 years were studied. Cytological findings showed that in FNA technique, 26(13%) of specimens were unsui.table for diagnosis, 97(48.5%) were diagnostic/adequate, while 77(38.5%) were diagnostic/superior for diagnosis. In FNNA technique, 32(16%) of specimens were unsuitable, 96 (48%) were diagnostic! adequate, while 72 (36%) were diagnostic/superior for diagnosis. In the combined application of FNA and FNNA, 9 (4.5%) of specimens were not diagnostible and 191 (95.5%) were diagnostic. Mean of total score in FNA was 5.82±2.3, while in FNNA was 5.70±2.4, with the difference was not statistically significant. Furthermore, there was no statistically significant difference between other parameters. Conclusion: Our study demonstrates that there is no difference between FNA and FNNA sampling, however, applying the combination of these two techniques, may improve the diagnostic quality. [ABSTRACT FROM AUTHOR]

Introduction. Prevalence of hypertension is high in hemodialysis patients. Increase of intracellular calcium due to hyperparathyroidism is one of probable factors for hypertension in hemodialysis patients. In this study, the relationship between serum parathyroid hormone (PTH) level and severity of hypertension in hemodialysis patients was investigated. Materials and Methods. In a case-control study, 50 hemodialysis patients with hypertension were compared with 50 hemodialysis patients without hypertension. The two groups were comparable in age, sex, body mass index, hemodialysis duration, KT/V, serum calcium, hemoglobin, and erythropoietin dose. Serum PTH level was measured in the two groups. Results. The mean age was 57.0 ± 7.7 years in the hypertensive group and 56.4 ± 6.0 years in the control group (P = .61). The mean hemodialysis duration was 15.28 ± 5.74 months in the hypertensive group and 14.98 ± 6.35 months in the control group. The mean serum PTH was 487.18 ± 408.85 pg/mL in hypertensives (445.12 ± 447.92 pg/mL in stage 1 of hypertension and 561.94 ± 326.67 pg/mL in stage 2 of hypertension, P = .003) and 170.64 ± 122.09 pg/mL in the case group (P = .001). Conclusions. According to this study, there is a positive relationship between serum PTH and severity of hypertension in hemodialysis patients. We conclude that control of secondary hyperparathyroidism might be helpful in controlling hypertension in hemodialysis patients. [ABSTRACT FROM AUTHOR]

Introduction. After kidney transplantation, patients appear to have vitamin D deficiency due to the use of immunosuppressive treatment and prevention of sunlight. This study was designed to determine vitamin D serum levels in kidney transplant patients in comparison with healthy individuals. Materials and Methods. Forty-six kidney transplant patients with a creatinine clearance greater than 60 mL/min and 46 healthy individuals with normal kidney function were tested for serum levels of calcium, phosphorus, 25-hydroxyvitamin D, and parathyroid hormone at the end of the summer. Results. Thirty-one participants were men and 15 were women in each group. The mean age was 41.0 ± 14.2 years in kidney transplant recipients and 41.4 ±13.7 years in the control group. Inadequate serum 25-hydroxyvitamin D was seen in 93.5% of the transplant patients and in 89.1% of the controls. There was a 58.7% vitamin D insufficiency (20 ng/mL to 30 ng/mL) and a 34.8% deficiency (lower than 20 ng/mL) in the patients, and these rates were 58.7% and 26.0% in the control group, respectively. There was no significant difference between the two groups. Conclusions. Vitamin D deficiency is prevalent in kidney transplant patients. Lack of a significant difference between our two groups may be attributable to the high prevalence of vitamin D deficiency in general population and the use of vitamin D supplementation in transplant patients. Indeed, adequate doses of vitamin D in these patients are undetermined. They may need higher doses for normalization of serum vitamin D and metabolic requirements. [ABSTRACT FROM AUTHOR]

Background and Purpose: In diabetic foot ulcers, if fungal agents, such as Candida species penetrate the cutaneous or depth of the ulcer, it can increase the wound severity and make it more difficult to heal., Materials and Methods: A cross-sectional study was performed on 100 diabetic patients with a foot ulcer from December 2019 to November 2020 in northern Iran. Patient data and wound grades were recorded in a questionnaire. Candida infection was confirmed by direct microscopic examination and culture. To identify the causative agent, polymerase chain reaction-restriction fragment length polymorphism using MspI enzyme and the partial amplification of hyphal wall proteins ( HWP1 ) gene were performed., Results: Mean age of the participants was 62.1 ± 10.8 years old, and 95% of them had type 2 diabetes. Moreover, more than 83% of them had diabetes for a duration of 10 years. In addition, 59% of the patients were male, and 66% > of them had poor education levels. Besides, 99% of them were married, and 52% were rural. Furthermore, 95% of the participants had neuropathic symptoms and 88% used antibiotics. The HbA1C level was > 9% in 69% of them, and the mean ulcer grade of the patients was 2.6±1.05. Candida infection was detected in 13% of the deep tissue and 7% of the tissue surrounding the wound. The predominant Candida isolate was C. parapsilosis (71.5%) and C. albicans (14.3%). Infections caused by filamentous fungi were not detected. There was a statistically significant relationship between Candida infection and gender, rural lifestyle, HbA1C, and ulcer grade., Conclusion: Mycological evaluations of diabetic foot ulcers are often ignored. The present study revealed that C. parapsilosis is the most common causative agent of deep-seated foot ulcer infection in these patients and may require specific treatment. Therefore, more attention of physicians to Candida infections, early diagnosis, and prompt treatment can help accelerate wound healing and prevent amputation., Competing Interests: The authors declare no conflicts of interest., (Copyright: © 2021, Published by Mazandaran University of Medical Sciences on behalf of Iranian Society of Medical Mycology and Invasive Fungi Research Center.)

Purpose: Genetic factors play important role in the severity of the COVID-19 infection since SARS-CoV-2 binds to the ACE2 receptor on the surface of host cells. ACE2 polymorphisms that may influence the expression of ACE2 can alter patients' susceptibility to COVID-19 infection or increase the severity of the disease. This study aimed to investigate the association between ACE2 rs2106809 polymorphism and the severity of the COVID-19 infection., Methods: In this cross-sectional study, ACE2 rs2106809 polymorphism was assessed in 142 COVID-19 patients. The disease was confirmed according to clinical symptoms, imaging, and laboratory findings. The severity of the disease was graded as severe versus non-severe based on the CDC. Genomic DNA was extracted from the whole blood and PCR- RFLP was performed to genotype the ACE2-rs2106809 with specific primers and Taq1 restriction enzyme., Results: G/G genotype was significantly associated with COVID-19 severity (44.4% in severe vs. 17.5% in non-severe, OR: 4.1; 95%CI: 1.8-9.5, p = 0.0007). Patients with the G/G genotype need more mechanical ventilation (p = 0.021). ACE2 expression in patients carrying the A/G genotype was higher in the severe compared to the non-severe form of the disease (2.99 ± 0.99 vs. 2.21 ± 1.1), but it was not statistically significant (p = 0.9)., Conclusion: The G allele and G/G genotype of ACE2 rs2106809 is associated with more severe COVID-19 and adverse disease outcomes., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Background and Aims: Novel biomarkers are required to improve cardiovascular disease prediction in patients with type 2 diabetes (T2D) as a high-risk population. This study was conducted to examine whether coronary artery disease (CAD) risk assessment can be improved by substituting high-density lipoprotein (HDL)-bound paraoxonase 1 (PON1) activity for HDL cholesterol (HDL-C) concentration in patients with T2D., Methods and Results: In this study, we studied 139 patients with T2D (mean age 64.12 ± 8.17 years) who underwent coronary angiographic examination. The initial rate of substrate hydrolysis was spectrophotometrically assayed in kinetic mode for measuring PON1 activity. Receiver operating characteristic (ROC) graphs are created by plotting true positivity versus false positivity. In patients with HbA 1c  ≥ 7%, PON1 (AUC = 0.7, p = 0.029) and nonHDL-C/PON1 (AUC = 0.75, p = 0.013) were significantly more capable of differentiating patients with CAD from those without CAD compared to HDL-C and nonHDL-C/HDL-C. Also, the predictive power of PON1 (AUC = 0.64, p = 0.029) and nonHDL-C/PON1 (AUC = 0.71, p = 0.004) were significantly higher in comparison with HDL-C and nonHDL-C/HDL-C for CAD characterization in patients aged ≥50 years. Moreover, PON1 and nonHDL-C/PON1 are associated with the incidence of CAD with an AUC of 0.7 (p = 0.026) and AUC of 0.64 (p = 0.087), respectively, among subjects with low HDL-C., Conclusion: PON1 and the ratio of nonHDL-C/PON1 significantly improve the prediction of severe CAD in T2D patients and in patients with HbA 1c  ≥ 7%, age ≥50 years, or low HDL-C. PON1 activity and lipid ratios using this enzyme may be valuable as substitutes of HDL-C for increasing clinical efficacies in cardiovascular risk assessment., Competing Interests: Declaration of competing interest All authors state that they have no conflicts of interest., (Copyright © 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

The seeds of Descurainia sophia (L.) Webb ex Prantl contain goitrogenic glucosinolates, such as gluconapin (3-butenyl glucosinolate). Because of the important role of iodine in the synthesis of thyroid hormones and the inhibitory activity of D. sophia on iodine uptake by the thyroid gland, this study aimed to determine the effects of D. sophia syrup on clinical and biochemical variables of thyrotoxicosis in hyperthyroid patients. In this randomized, double-blind trial, 10 newly diagnosed hyperthyroid female patients were randomly assigned to treatment with (1) methimazole (MMI) plus D. sophia capsules (350 mg/d) or (2) MMI plus placebo capsules. The primary outcomes were clinical and biochemical manifestations of hyperthyroidism after 60 days. Serum levels of FT3 and FT4 significantly decreased (5.9 ± 2.5 vs. 9.4 ± 5.9 and 29.1 ± 3.1 vs. 31.77 ± 3.7, respectively) and the serum thyroid-stimulating hormone (TSH) concentration significantly increased in the D. sophia group contrasted to the placebo group (4.7 ± 0.1 vs. 0.05 ± 0.02). Significant improvement in the thyrotoxicosis clinical symptoms was reported in the D. sophia group contrasted to the placebo group ( p  < .05). D. sophia can suppress plasma levels of FT3 and FT4 and may be useful as adjunctive therapy for hyperthyroidism., Competing Interests: The authors declare that they do not have any conflict of interest., (© 2023 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: A further understanding of the mechanisms linking inflammation to T2D and related complications can help prevent or control this silent but dangerous disease. This study was conducted to determine the association between paraoxonase 1 (PON1) activity and interleukin-6 (IL-6) in type 2 diabetes (T2D). Furthermore, we have evaluated the role of age and gender in the relationship between the PON1 activity and IL-6., Methods: A total of 105 people with T2D were enrolled in this study. IL-6 levels were determined using ELISA. For the PON1 activity assay, the hydrolysis rate of the substrate phenylacetate was spectrophotometrically assayed in serum at 270 nm. The determined velocities were the initial velocities of substrate hydrolysis., Results: PON1 activity was negatively correlated with IL-6 in total data ( r = -0.34, P = 0.001). In both groups with age ≥50 and <50 years, PON1 activity was negatively correlated with IL-6, but the correlation was significant in patients aged 50 years and above ( r = -0.358, P = 0.005) compared with patients with age <50 years. In both women and men, PON1 activity was negatively correlated with IL-6, but the correlation was significant in women ( r = -0.318, P = 0.006) in comparison with men., Conclusions: Inverse association between PON1 activity and IL-6 in T2D may represent the oxidative-inflammatory interaction in this disease. Our findings highlight that at older ages and in women, the associations between lower PON1 activity and higher IL-6 concentrations are more evident, and this should be considered in patients with T2D., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 International Journal of Preventive Medicine.)

Background: The association between liver enzymes and metabolic syndrome (MetS) has been evaluated in several studies with different results. The purpose of this study is to determine the association between the serum levels of these liver enzymes and MetS in Tabari cohort population., Method: In this case-control study, data collected from the enrolment phase of the Tabari cohort population have been used. MetS was defined based on IDF (international diabetes federation) standards. Then, 476 patients with MetS (case group) and 476 age-sex matched controls were selected randomly., Results: Mean aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were higher in case group than control group (20.59 vs. 19.99 respectively, p = 0.339 and 24.64 vs. 20.16 respectively, p < 0.001). The chance of having MetS, high triglyceride, and fasting blood glucose (FBG) was significantly higher in people with ALT ≥ 40 (1.63, 2.35, and 2.02, respectively). The chance of having MetS in people with AST ≥ 40 was 1.45 times higher than that among those with normal AST level (p > 0.05)., Conclusion: This study showed that there is an association between liver enzymes and MetS as well as some of its components. Liver enzymes, especially ALT, can be used as an early indicator of MetS in the at risk population., (© 2021. Royal Academy of Medicine in Ireland.)

Background: Appropriate service delivery, access to high quality of cares and optimal management of type 2 diabetes mellitus (T2DM) can decrease the risk of micro and macro vascular complications and mortality. Therefore, monitoring the quality of diabetes care, including keeping glycemic levels at an optimal level, is crucial. The aim of this study was to evaluate processes and outcome-related quality of care indicators, in T2DM using retrospective patient-level data from 2013 to 2017 in 15 Tertiary Diabetes Care Centers in Iran., Method: A retrospective observational study was conducted among 1985 T2DM patients at public, semipublic and private diabetes centers. Annual tests for HbA1c, serum lipid (LDL), and screening for nephropathy were used to evaluate process-related indicators; and intermediate biomedical markers including HbA1c, blood pressure (BP), and LDL cholesterol, were used to assess outcome-related indicators., Results: Data were extracted from 15 diabetes centers in five provinces in Iran. 62.7% of the patients were female, and the mean duration of diabetes in the patients was 14.7 years. Evaluation of process-related indicators showed that only 9% of patients took the HbA1c test. The percentage of the patients without annual low-density lipoprotein (LDL) test decreased from 13% in 2013 to 7% in 2017. The results of achieving to all indicators concurrently (ABC care) showed that less than 2% of the patients met the criteria of optimal process-related quality indicators. The mean percentage of the patients with HbA1c under 7%, blood pressure (BP) less than 130/80 mmHg, and LDL less than 100 mg /dl in the selected provinces were 32.4, 55, and 71 respectively. However, the average of total achievement in ABC goals was 14.2%., Conclusion: Our findings showed that the management of T2DM in all selected provinces was far from the optimal control in both processes and outcome-related indicators and therefore needs serious consideration and improvement., (© 2022. The Author(s).)

Introduction: Although the relationship between personality traits and sexual self-efficacy has received theoretical and empirical support, there is little information on how personality affects the sexual self-efficacy of diabetic women. This study aimed to investigate the mediating role of marital satisfaction and sexual function in the relationship between personality traits and sexual self-efficacy in diabetic women., Methods: Using a two-stage sampling method, 410 reproductive-aged Iranian women with type 2 diabetes were recruited in this descriptive-analytical study. The participants completed self-administered questionnaires, including the Vaziri Sexual Self-Efficacy Questionnaire, the Female Sexual Function Index, ENRICH Marital Satisfaction Scale, and the Goldberg's Big Five Questionnaire. To analyze the data, structural equation modeling was employed in Amos software version 24., Results: Results indicated an acceptable fit of the model to the data. Personality trait of openness to experience was associated with sexual self-efficacy directly (β = .02, p = .030) and indirectly through the mediators of marital satisfaction (β = .06, p = .009) and sexual function (β = .18, p = .014). Furthermore, sexual function was associated with sexual self-efficacy directly (β = .50, p = .025) and indirectly through the mediator of marital satisfaction (β = .36, p = .012)., Conclusion: Due to the mediating role of marital satisfaction and sexual function, this study has some practical implications for improving the sexual self-efficacy of diabetic women with different personality traits., (© 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Here we report a single-center cohort of 6 patients (4 kidney only, and 2 simultaneous liver/kidney transplants) diagnosed with COVID-19 at a median of 1.9 years (range = 0.2-9.3 years) post transplant. Five (of 6) patients required inpatient admission, 2 patients (mortality = 33%) died. Among those with mortality, an increased concentration of inflammatory biomarkers (interleukin-6 and C-reactive protein) was noted with a lack of response to interleukin-6 blockade, remdesivir, and/or convalescent plasma. None of the kidney-only transplants (4/6; 67%) had elevation in plasma donor-derived cell-free DNA above the previously published cut-off of 1%, suggesting absence of significant allo-immune injury. Four (of 5) admitted patients had detectable SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) in blood on samples obtained at/during hospitalization. Of the 4 discharged patients, 2 patients with undetectable virus on repeat nasopharyngeal swabs had seroconversion with positive SARS-CoV-2 IgG formation at 30 to 48 days post infection. One patient had prolonged shedding of virus on nasopharyngeal swab at 28 days post discharge despite lack of symptoms. In this preliminary report, we find that immunocompromised transplant patients had higher rates of RNAemia (67%) than reported in the general population (15%), seeming absence of allo-immune injury despite systemic inflammation, and formation of IgG overtime after recovery from infection., (Copyright © 2020. Published by Elsevier Inc.)