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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 deepseated 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.

Background and purpose: Obesity is a common risk factor for lipid disorders, diabetes, and prediabetes, all of which are associated with adverse health outcomes and premature mortality. Considering the serious complications of hyperlipidemia and the lack of sufficient studies examining hyperlipidemia in prediabetic patients, timely identification of underlying factors, along with prevention and education, is critical in reducing the incidence of these conditions. The aim of this study was to investigate the relationship between obesity and lipid disorders in prediabetic individuals, as well as to evaluate the independent effect of prediabetes on lipid levels and the combined effect of obesity and prediabetes. Materials and methods: The present study is descriptive and analytical in nature. The statistical population consists of individuals over 30 years of age who visited health centers in Amol city. The centers were selected through simple random sampling, and the sample size was calculated to be 530 individuals. By reviewing health records, prediabetic individuals who were obese or had normal BMI were included in the study until the required sample size was reached. A person is considered obese if their BMI is equal to or higher than 30 kg/m². Information on blood sugar and lipid levels was extracted from patient files and recorded. The weight, height, and waist circumference of the subjects were measured, and BMI was calculated. Blood pressure was measured using a mercury sphygmomanometer. After data collection, data entry and analysis were performed using SPSS-23 software. The significance level was set at 0.05. Due to the normal distribution of the data, the Student’s t-test and ANOVA were used to compare quantitative variables, while multiple regression analysis was employed to evaluate the dependent variable against other independent variables. Pearson’s correlation coefficient was used to assess relationships between quantitative variables. Results: In total, 515 individuals met the inclusion and exclusion criteria, with 396 women and 119 men participating. The results indicated a significant relationship between abnormal waist circumference and dyslipidemia (P= 0.001), BMI and dyslipidemia (P= 0.001), and family history of obesity, family history of hyperlipidemia, and dyslipidemia (P= 0.001). However, no significant relationship was found between family history of diabetes and dyslipidemia (P= 0.05) or between dyslipidemia and age, occupation, sex, and smoking. The findings showed that for every increase in LDL, the likelihood of dyslipidemia increases by 1.5 times; for every increase in fasting blood sugar (FBS), it increases by 1.2 times; and for every increase in triglyceride levels, it increases by 1.1 times. The chance of dyslipidemia increases by 14.6 times in people with a family history of diabetes and by 0.02 times in those with a family history of hyperlipidemia. A significant relationship between BMI and dyslipidemia was observed (P= 0.001). With increasing BMI, the chance of dyslipidemia increases by 0.68 times. Additionally, a significant relationship was found between LDL and BMI (P= 0.000), and a significant inverse relationship was observed between HDL and BMI (P= 0.003). A significant relationship was also found between cholesterol (COL) and BMI (P= 0.000), triglycerides and BMI (P= 0.000), and waist circumference and BMI (P= 0.000). Conclusion: This study demonstrates that BMI has a positive correlation with HDL, LDL, triglycerides, and cholesterol. As obesity increases, the likelihood of dyslipidemia rises as well. Moreover, increases in LDL, FBS, and triglycerides, along with a family history of diabetes and hyperlipidemia, are associated with an elevated risk of dyslipidemia.

Background: Several studies have investigated the effects of acupressure in patients with known diabetes. However, no studies have investigated the effects of acupressure on women with prediabetes.Objectives: The present study aimed to investigate the effects of self-administered acupressure on fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), and anxiety levels in prediabetic women.Methods: This randomized controlled trial was carried out on 50 women with prediabetes who referred to the Diabetes Clinic of Mazandaran University of Medical Sciences, Sari, Iran, from September 4, 2021, to February 20, 2023. Participants were randomly assigned to two groups of 25 to receive either metformin and self-administered acupressure or metformin and sham point pressure. FBS, HbA1c, and anxiety levels were measured in both groups before and 12 weeks after the intervention. All patients also received routine training. Data were analyzed using chi-square test and Fisher's exact test, independent samples t-test and analysis of covariance (ANCOVA).Results: The two groups did not differ significantly in their mean baseline FBS and HbA1c values. However, the mean baseline anxiety was significantly higher in the control group (P=0.009). After the intervention, the mean FBS, HbA1c, and anxiety were significantly lower in the intervention group (P

Background and purpose: Many patients fail to reach the expected results, even with the very considerable strides forward in the treatment of hypertension (HTN). They undergo serious complications after this condition remains uncontrolled. Patients' perceptions regarding the importance of Islamic self-care may be the occasion for managing chronic diseases. The present study aimed to investigate the effectiveness of the Islamic self-care model on blood pressure (BP) and medication adherence (MA) among older adults living with HTN. Materials and methods: Utilizing a randomized controlled trial in 2019 in Amol City of Iran, 60 elderly patients suffering from high blood pressure were assigned to two intervention and control groups in the form of random block allocation. Then, their BP and MA were measured using a dial sphygmomanometer and Morisky questionnaire, respectively. Designed for four weeks, the intervention group participated in an HTN-management education program, putting much emphasis on proper nutrition within the framework of the Islamic self-care model and gaining divine satisfaction. Simultaneously, the control group received a similar scientific HTN management and medication adherence education program. Following the re-measurement of BP and MA in both groups, the data were analyzed using descriptive statistical tests, Chi-square, Fisher, independent-samples t-test, and analysis of covariance. Results: In the pre-intervention phase, there was no significant difference between the two groups in the mean BP indices and MA. At the post-intervention, results revealed a significant reduction in the average systolic blood pressure (133.125±8.95) and diastolic (78.33±61.4) of the Islamic self-care group compared to systolic blood pressure (141.33±10.16) and diastolic (82.0±4.27) in the control group (P>0.001). Also, there was a significant improvement in the MA score in the Islamic self-care group (1.07±1.01) compared to the control group (2.43±1.38) (P

Background and purpose: Fibromyalgia is a syndrome characterized by chronic musculoskeletal pain, tenderness, and other physical symptoms. We determined the frequency of Fibromyalgia in hypothyroid patients and the relationship between FM symptoms and hypothyroid status. Materials and methods: The current study is a cross-sectional descriptive study investigating the prevalence and demographic characteristics of fibromyalgia in hypothyroid patients referred to University clinic in Sari in 1401-1402. Ninety-one hypothyroid patients were included in the study. The sampling method was convenience sampling. The sociodemographic features and the clinical features of hypothyroid patients were recorded. Thyroid tests included T4, TSH, and Anti Tpo Ab. Patients were examined for Fibromyalgia using American College Rheumatology (ACR) criteria for FM 2010 and 1990. For the patients who were classified as FM, the FIQR questionnaire was completed. To analyze the data, descriptive statistics indicators such as central and dispersion indicators and calculation of ratios were used, and to check the relationship between qualitative variables, chi-square test and quantitative variable comparison in different groups were used by t-tests and ANOVA in SPSS-25 software was used. Results: The mean age and duration of hypothyroidism were 48.35 ± 13.8 and 9.84± 6.6 years respectively. The frequency of fibromyalgia in hypothyroid patients was 7(8%) patients based on ACR 2010 criteria. In patients with hypothyroidism and fibromyalgia, 6 patients (85.7%) were positive for Anti Tpo Ab, while in patients with hypothyroidism without fibromyalgia, 29 patients (34.5%) had this antibody (P=0.007). Conclusion: It seems that Anti Tpo Ab is more important than thyroid dysfunction, and it is suggested to check this antibody in fibromyalgia patients in addition to thyroid function tests.

Background and purpose: Stress hyperglycemia is a neuroendocrine physiological response to medical stress, hyperglycemic stress increases the risk of mortality and morbidity in ill patients. This study aimed to investigate the frequency of hyperglycemic stress and its related factors, as well as the relationship between hyperglycemia and the severity and clinical outcomes of hospitalized patients with COVID-19. Materials and methods: This cross-sectional study was conducted in Imam Khomeini Hospital in Sari in 2019. The patients were diagnosed based on clinical symptoms, CBC, CRP, ESR tests, RT-PCR test, and CT scan of the lungs and were hospitalized in the Covid ward. Data analysis was performed using SPSS Software. Results: 312 COVID-19 patients were investigated, and 22 (7.1%) suffered from hyperglycemic stress. Hyperglycemic stress patients had more mortality, hospitalization in ICU, respiratory ventilation, and length of hospital stay compared to the normoglycemic subjects, but only in terms of mortality, there was a statistically significant difference between the two groups (P=0.46) Conclusion: Considering the effect of hyperglycemia on the outcome of the disease and the death rate in ill and hospitalized patients compared to patients with normal blood sugar, it shows the importance of timely diagnosis and proper control of blood sugar in these patients.

Background and purpose: Currently, there is a significant emphasis on utilizing empowering models to improve the health status and quality of life of patients. This study was conducted with the aim of investigating the effect of the empowerment program on the quality of life of the elderly with type 2 diabetes. Materials and methods: This randomized clinical trial study was conducted in 2021 on elderly patients with type 2 diabetes referred to the diabetes clinic of Vali Asr Ghaemshahr Hospital and Mostafavian Diabetes Clinic in Sari. 90 elderly patients participated in this study. The participants were randomly divided into two groups, including the intervention group (45 patients) and the control group (45 patients). The intervention group participated in eight empowerment sessions for 45 minutes, including 6-8 patients in each session. On the other hand, the control group received the conventional treatment. The demographic characteristics questionnaire and quality of life assessment for diabetic patients was completed by both groups before the intervention and two months after the intervention. Results: The mean score of overall quality of life in the intervention group was 29.95±3.94, which significantly increased to 33.86±3.70 after the intervention (P=0.001). In the control group, the average quality of life score before the intervention was 39.00±5.01, which decreased to 37.06±4.87 after the intervention, which was a significant difference (P=0.001). The result of the covariance test showed that the empowerment program had a significant impact on the quality of life of the elderly with diabetes (P=0.001). Conclusion: The empowerment program based on education about diabetes and its complications, healthy lifestyle and self-care in diabetes can be an effective approach to improve the quality of life of elderly patients with type 2 diabetes. Therefore, the implementation of such programs can strengthen the sense of independence and control among elderly patients and be a valuable help in the routine treatment of these patients. (Clinical Trials Registry Number: IRCT20180609040020N2)

Background and purpose: The present study investigated the association of Metformin use with disease severity, inflammatory markers, and the outcome of COVID-19 in hospitalized diabetic COVID-19 patients at Imam Khomeini Hospital, Sari, in 2021. Materials and methods: The current descriptive study was performed after obtaining the code of ethics and permission from the hospital director for the medical records evaluation. The relevant data of diabetic COVID-19 patients admitted at Imam Khomeini Medical Education Center were determined and analyzed using SPSS software. Results: In this study, 324 patients were included in the study; So that 168 people (51.85%) were men and 156 people (48.15%) were women. The difference in the number of people with and without metformin use in the need to be admitted to the special care unit was statistically significant (P

Background and purpose: Given the inevitable use of metformin in treatment, the management and possible elevation of cobalamin levels by metformin use should be addressed. However, the reduction in vitamin B12 levels caused by metformin has been mentioned in many studies and books, but there is no suggestion for the concomitant use of vitamin B12 with metformin. This study was conducted with the aim of assessing the association between metformin use and vitamin B12 depletion in type 2 patients Materials and methods: In this descriptive cross-sectional study, 96 people were randomly selected. Two clinic patients referred to Tankab Hospitals and Imam Sajjad (AS) Ramsar Hospital internal clinic with normal CBC from the beginningwere included in this study. Information was recorded in patient records through paraclinics and interviews. 5 ml of venous blood samples was drawn these patients who had been taking metformin for at least 6 months to determine hemoglobin levels, red blood cell indices including MCV, and vitamin B12 levels. CBC and B12 plasma level were taken.t-tests and analysis of variance, Mann-Whitney and Kruskal-Wallis tests, chi-square tests and logistic regression were used. The software used in this study is IBM-SPSS V.20, and the significance level of the tests is considered to be less than 5%. Results: In this study, 96 patients were examined. The differences in vitamin B12 levels in diabetic patients taking metformin were borderline significant depending on age (P=0.063). The vitamin B12 level was significantly higher in men than in female patients (P=0.023). There were no statistically significant differences in vitamin B12 levels depending on BMI, Hb level, underlying disease and use of other hypoglycaemic medication (P>0.05). The frequency of vitamin B12 level was significantly lower in diabetic patients taking metformin with normal MCV than in patients with MCV (P=0.012). The frequency of vitamin B12 level was highestin diabetic patients taking 2000 mg metformin per day (13.3%) and lowest in patients taking 500 mg per day, and this difference was statistically significant (P=0.013). Conclusion: The results show that metformin causes a decrease in vitamin B12 levels in diabetics who take it. Due to the high prevalence of vitamin B12 deficiency caused by metformin and its relationship with dose and duration of use, patients ' serum levels of vitamin B12 should be monitored regularly and, in case of deficiency or symptoms of deficiency, patients should take vitamin B12 supplements to improve the quality of treatment and prevent complications caused by diabetes and metformin.

Background and purpose: Hypothyroidism is one of the most common endocrine diseases that affects the basic metabolism and has a great impact on the quality of life of patients. Despite the treatment, some of the patients are still symptomatic. Persian medicine pays attention to mizaj as one of the important principles of effective treatment. Therefore, the purpose of this study was to determine the frequency of mizaj types in hypothyroid patients. Materials and methods: This descriptive cross-sectional study was conducted on under treatment hypothyroid patients, aged 20 to 60 years, who referred to Sari Touba Clinic from January to June 2023. The mizaj of the patients was determined using a standard questionnaire. Results: Out of 300 eligible female hypothyroid patients, a total of 194 participated in the study. In terms of simple temperament, more than half of the patients were cold and 72.2% of the patients were wet. In terms of mixed temperament, 41% of patients were cold and wet. Also, there was a statistically significant relationship between BMI and dry or wet temperament. Conclusion: This study showed that the predominant temperament of hypothyroid disease is cold and wet; therefore, in order to achieve complementary treatment for the disease and choose best medicinal interventions based on the principles of Persian medicine, hypothyroid patients should avoid all measures that increase coldness and wetness. In other words, measures that increase coldness and wetness should be avoided in hypothyroid patients as much as possible.

Background and purpose: Diabetes is one of the most common diseases in the world, and blood sugar control and periodontal diseases are mutually related. The aim of this study was to investigate the periodontal status of people with type 2 diabetes referred to Imam Khomeini and Touba Medical Centers in Sari during 2018-2019. Materials and methods: This descriptive cross-sectional study included 107 randomly selected patients who were diagnosed with type 2 diabetes (controlled and uncontrolled). HbA1C values were evaluated to check the diabetes status of the patients, and Community Periodontal Index (CPI) was evaluated to check the periodontal status. Statistical analysis was performed using SPSS V24. Results: All the 107 patients were females, with an average age of 49.7±11.2. Diabetes was controlled in 46.7% of the patients, while 37.4% of the patients had uncontrolled diabetes. In the examination of periodontal condition, 40.2% were healthy, 30.8% had gingivitis, and 29% had periodontitis. The value of CPI was 1.8 ± 0.5, and code 3 (envelope 4-5 mm) was the most frequent index. Conclusion: Since the highest frequency of Community Periodontal Index of Treatment Needs (CPITN) was related to code 3 (4-5 mm packet depth), it is recommended that diabetic patients fulfill their oral hygiene and make regular visits to the dentist for follow up examinations.

Background and purpose: Obesity is a growing public health concern worldwide. This study examined the prevalence of obesity/overweight and its relation with cumulative socioeconomic risk in women of reproductive age in Mazandaran province, Iran. Materials and methods: In this descriptive correlational study using a multi-stage cluster sampling method, 540 married women aged 15-45 referred to primary health centers in Mazandaran province were recruited (2020). Body mass index was categorized into three levels: obese (≥30), overweight (25-29.9), and normal (18.5-24.9). Socio-economic status was classified using generalized Oaxaca-Blinder decomposition method. Each of the socio-economic variables (8 indicators) was given a score of zero or one, and then the scores were added up. The scores of ≥5, 3-5, and ≤2 were considered good, average, and poor, respectively. The relationship between socio-economic variables and different levels of body mass index was assessed once separately and once cumulatively in binary regression. Results: The prevalence of obesity and overweight was 23.3% and 48.5%, respectively. The socio-economic status of 26.2% of the participants was classified as good, 64.3% as average, and 9.5% as poor. There was a significant positive and negative relationship between obesity in women with their number of children (OR: 2.72, 95% CI: 1.50-5.17) and obesity in their parents (OR: 0.43, 95% CI: 0.19-0.94) respectively. Statistical tests did not show significant relationship between women's obesity and their cumulative socio-economic status (P>0.05). Conclusion: The prevalence of obesity and overweight among women of reproductive age, regardless of their socio-economic status, has reached epidemic proportions. Extensive studies are suggested to better understand the factors that contribute to obesity and to provide a more accurate explanation for the rapid increase in obesity among various socio-economic groups.

Background and purpose: The prevalence of type 2 diabetes mellitus has increased along with the global epidemic of obesity. One of the most important advances in metabolic surgery is its impact on type 2 diabetes. In this review, the effect of metabolic surgeries, and their physiological and molecular effects have been investigated on weight loss, improvement of diabetes, and metabolic disorders. Materials and methods: Metabolic surgeries have been introduced as an effective treatment modality for type 2 diabetes. This review discusses various types of metabolic surgeries along with their benefits and drawbacks. It also explores the different physiological and molecular mechanisms that contribute to the improvement or remission of diabetes. Results: In general, anatomical, physiological, and molecular changes in the gastrointestinal tract, independent of weight loss, can effectively improve blood glucose levels and regulate insulin secretion over a long period. The most important effects of metabolic surgery include enhanced insulin sensitivity, improved functionality and enhanced quantity of β cells in the pancreas, increased insulin release by affecting incretin hormones, alterations in the configuration and circulation of bile acids and intestinal microbiota, and improvement in intestinal glucose metabolism. Conclusion: Considering the significant effects of metabolic surgery on improving type 2 diabetes independent of weight loss, it would be valuable to explore the different mechanisms that contribute to glucose reduction after surgery.

Background and purpose: Thyroid gland disorders are the second most common disorders of the endocrine system which can affect oral health and patients' health-related quality of life. The aim of this study was to evaluate the oral health-related quality of life (OHRQOL) in patients with thyroid disorders. Materials and methods: In this case-control study, 43 patients and 43 healthy people were asked questions about demographic information, systemic conflicts, alcohol consumption, oral dryness, OHRQOL, years of illness, and medication (in case group). Then, patients were clinically evaluated and oral health indicators such as gingival index, plaque index, bleeding from gingival salicylate, and DMFT were assessed on Ramford teeth. Unstimulated salivary samples were taken in both groups and weight measurement was performed. Data analysis was performed in SPSS V24 applying independent T-test and Mann-Whitney U test. Results: Significant differences were found between the two groups in quality of life related to oral health ADD-OHIP-14 (P=0.015) and unstimulated saliva flow rate, GI, SBI, and DMFT (P

Background and purpose: Stress and socio-economic and psychological consequences of COVID-19 pandemic have affected family and marital relationships. The present study investigated the frequency of marital conflicts and related factors in Mazandaran province, north of Iran during this pandemic. Materials and methods: In this cross-sectional study, 357 married people were selected by convenience sampling via social networks in 2020. Data were electronically collected using demoghraphic and medical checklist and the Marital Conflict Questionnaire- revised form (MCQ-R). Data were analyzed in SPSS V25. Results: The average age of participants was 38.2±9.9 years. The average duration of marriage was 14.9±10.7 years. The total mean score for marital conflicts was 103.8±28.3 indicating a moderate level of conflict. The respondents reported mild (n=188, 57.7), moderate (n=132, 40.5), and severe (n=6, 1.8) levels of marital conflicts. Significant direct relationships were found between marital conflicts and age, gender, educational level, remarriage, nuclear family or extended family, history of marital conflict before the pandemic, individual or family history of COVID-19, and number of children (P

Abstract 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.

The application of nanocarriers in medicine and pharmaceuticals suggests a new procedure in nanotechnology terminology, nanomedicine. DNA has been significantly highlighted due to its amazing functionality and nature as a nanomaterial in biomedicine. Given that DNA is biocompatible, its use as a nanomaterial in medicine provides an excellent prospect for the rational engineering of DNA nanostructures. According to new approaches in disease treatment at gene levels, gene therapy, DNA as a nanomedicine plays an essential role in the medical sciences. In this field, researchers have published enormous documents regarding the applications of DNA and DNA-based nanostructures as drug or gene nanocarriers, DNA-based diagnostics, and DNA nano vaccines. In this review, the novelty of DNA-based nanomedicine has been considered.

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), a new strain of RNA viruses causes coronavirus disease in human. Though some studies suggested different blood group types as risk factors for Coronavirus Disease 2019 (COVID-19) infection, the association between blood groups and the COVID-19 infection may not be the same in various societies with different genetic statuses. Also, no studies so far have investigated the relationship between COVID-19 severity and ABO blood groups in Iran and developing countries according to the World Health Organisation (WHO) criteria. Aim: To evaluate the association between blood types and the severity of COVID-19 infection. Materials and Methods: This cross-sectional study enrolled 171 patients infected with SARS-CoV-2 {49 severe (severe or critical) and 122 non severe (mild to moderate)}, who were admitted to hospitals of Mazandaran University of Medical Sciences, Sari, Iran from April 2020 to June 2020. To evaluate the distribution of the blood group, 171 COVID-19 patients were compared with the reported data of Iranian population blood groups. The severity of COVID-19 infection was determined based on WHO criteria including clinical symptoms, radiological findings, and signs of organ dysfunction. The associations between ABO blood groups and the severity of COVID-19, were evaluated using Pearson’s Chi-square. Results: The distribution of the blood group in 171 patients with COVID-19 was not different compared to the reported general Iranian population blood group (p-value=0.344). Evaluation of the association between ABO blood groups and the severity of COVID-19 showed that patients with blood group type B developed severe COVID-19 infection compared to other blood types who showed mild or moderate conditions (p-value=0.048). Mortality due to COVID-19 was not statistically different between the ABO blood group and Rh (p-value=0.96, p-value=0.27 respectively), but the frequency of patients with Rh-negative that needed intubation and mechanical ventilation was higher compared to Rh-positive patients (p-value=0.003). Conclusion: A positive correlation was found between blood type B and COVID-19 severity. Also, mechanical ventilation was significantly more in Rh-negative patients.

Background and purpose: Sexual self-efficacy as one of the major issues of sexual health is influenced by various individual and interpersonal factors in different socio-cultural contexts. The aim of this study was to investigate sexual self-efficacy and related factors in reproductive-aged diabetic women. Materials and methods: This cross-sectional study was conducted in 410 diabetic women attending endocrinology centers affiliated to Mazandaran University of Medical Sciences, 2019-2020. The participants were selected by simple random sampling. Data were collected using Vaziri sexual self-efficacy questionnaire, the Female Sexual Function Index (FSFI), ENRICH Marital Satisfaction Scale, and Goldberg Big Five personality traits. Data were analyzed applying Independent t-test, ANOA, Pearson correlation coefficient, and Backward Stepwise Regression. Results: The mean score for sexual self-efficacy was 15.93±5.70 (95% CI: 15.37-16.48). Multiple linear regression showed that spouse's education (β= 1.27, P= 0.026), spouse's age (β= -0.09, P= 0.013), conscientiousness (β= 0.09, P= 0.014), occupation (β= -2.26, P= 0.022), satisfaction from socioeconomic class (β= 0.93, P= 0.024), sexual function (β= 0.23, P< 0.0001), marital satisfaction (β= 0.06, P< 0.0001), and taking antidepressants (β= -1.13, P= 0.051) explained 59% of the variance of sexual self-efficacy score. Conclusion: Various sociodemographic and socioeconomic factors affect the sexual self-efficacy of diabetic women in reproductive age, so, it is necessary to use a multi-disciplinary approach in providing sexual health care services for these women.

Background: Although a nodular thyroid disease is higher in patients with pituitary adenoma, concurrent thyroid cancer with pituitary tumor is uncommon. Case Presentation: We report a young woman with discovered papillary thyroid carcinoma after 1-year transsphenoidal surgery for Cushing’s disease. Thyroidectomy was done and patient is well after three years follow-up. Conclusion: We suggest the patient with functional pituitary adenoma be evaluated for thyroid tumor.

Background and purpose: High prevalence of Type 2 Diabetes Mellitus (T2DM) and its demand for regular care have resulted in a massive amount of electronic health records (EHRs). Hemoglobin A1c (HbA1c) and Fasting Blood Sugar (FBS) levels are two widely-used diagnostic measures for evaluation of diabetes care. This study aimed at assessing Family Medicine Plan (FMP) and exploring the trend of changes in FBS and HbA1c levels in patients attending a referral lab affiliated with Mazandaran University of Medical Sciences. Materials and methods: This cross-sectional survey was carried out in 12761 EHRs of a registry database containing the results of blood sugar tests and demographic features selected from over 250 thousand EHRs from 2012-2018. The records were categorized according to normal and abnormal levels of HbA1c (cut-off at 7%). The bivariate logistic regression model was performed by R v.3.6.1 and ggplot2 for data visulazation. Results: Abnormal HbA1c levels were seen in 37.1% of women, 36.7% of men, and 36.7% of the general population. There were significant associations between HbA1c level and age, type of insurance, FMP, kind of care plan, and the year of testing (P0.05). Conclusion: Despite the increasing prevalence of T2DM in Iran, the trend of blood sugar changes during these years showed that changes in HbA1c level was lower than 7% in studied citizens. Considerable attention to self-management in recent years indicates improvements in diagnosis and care of citizens at-risk of diabetes.

Abstract Aim Regular physical activity can reduce the chance of developing type 2 diabetes in women with a history of gestational diabetes. The present study investigated the relationship between the constructs of the health action process approach and regular physical activity in women with a history of gestational diabetes. Design This was a cross‐sectional study. Methods A total of 150 women who had given birth 6–24 months prior to the study and had experienced gestational diabetes in their recent pregnancy were selected using multistage cluster sampling. Data were collected from December 2018 to May 2019 using a researcher‐made questionnaire including constructs of health action process approach. Results The common fit indices revealed that health action process approach had an acceptable fit to the observations (root mean square error of approximation = 0.054, Tucker–Lewis index = 0.95, comparative fit index = 0.955). The model's constructs predicted 48% of intention variance and 35% of physical activity variance. Action self‐efficacy and coping planning were the most important predictors of intention and behaviour, respectively.

Background: Hashimotochr('39')s thyroiditis can be present with a localized palpable nodule though presentation as a hyperfunction "nodule" is extremely rare. The first case of Hashimotochr('39')s thyroiditis and hot nodule was reported in 1971 by warner. Case Presentation: We reported a 26-year-old hypothyroid woman in Hashimotochr('39')s thyroiditis background with a hyperactive thyroid nodule in both 99mTc and I131scintigraphy. The nodule disappeared after eight months sufficient thyroid hormone replacement therapy. Conclusion: Toxic adenoma in hypothyroid patients can be resolved after the thyroxin replacement therapy.

Abstract Background Socioeconomic inequality in mental health in Iran is poorly understood. This study aimed to assess socioeconomic inequality in poor mental health among Iranian adults. Methods The study used the baseline data of PERSIAN cohort study including 131,813 participants from 17 geographically distinct areas of Iran. The Erreygers Concentration index (E) was used to quantify the socioeconomic inequalities in poor mental health. Moreover, we decomposed the E to identify factors contributing to the observed socioeconomic inequality in poor mental health in Iran. Results The estimated E for poor mental health was − 0.012 (95% CI: − 0.0144, − 0.0089), indicating slightly higher concentration of mental health problem among socioeconomically disadvantaged adults in Iran. Socioeconomic inequality in poor mental health was mainly explained by gender (19.93%) and age (12.70%). Region, SES itself, and physical activity were other important factors that contributed to the concentration of poor mental health among adults with low socioeconomic status. Conclusion There exists nearly equitable distribution in poor mental health among Iranian adults, but with important variations by gender, SES, and geography. These results suggested that interventional programs in Iran should focus on should focus more on socioeconomically disadvantaged people as a whole, with particular attention to the needs of women and those living in more socially disadvantaged regions.

Background: Persistent thyroglossal duct leads to a fibrous cyst formation named thyroglossal cyst which is the most common form of congenital cyst and usually located in the midline neck below the hyoid bone. Rarely the thyroglossal cyst is associated with thyroid cancer. Although the Sistrunk procedure is often considered adequate, currently there is no clear consensus on the optimal management of thyroglossal duct cyst especially duct cyst carcinoma. In addition, there is no consensus about concurrent thyroidectomy in patients with thyroglossal cyst duct carcinoma. Case presentation: In this article, we present four patients with thyroglossal duct cyst and papillary thyroid cancer. Papillary thyroid cancer was located into the thyroglossal duct cyst (thyroglossal duct carcinoma) in two patients and two patients had thyroglossal duct cyst with thyroid carcinoma in thyroid tissue. Cervical lymph nodes were involved in one of the three patients. Sistrunk procedure and total thyroidectomy were performed for all. The thyroid lobes were not involved in patients with thyroid duct cyst carcinoma. Tumor or thyroglossal duct cyst recurrence did not occur in any of the patients in follow-up. Conclusion: The correlation between thyroglossal cyst and papillary thyroid carcinoma is high. In subjects with thyroglossal duct cyst, in addition to cyst assessment, thyroid gland and neck lymph nodes should be evaluated for malignancy.

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

Abstract 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.

Introduction: Inflammatory state is considered as the pathogenesis of Gestational Diabetes Mellitus (GDM). Cytokines can cause insulin resistance and maybe the molecular basis of inflammation in Diabetes Mellitus (DM). Aim: To assess the level of Interleukin-10 (IL-10) in addition to a new anti-inflammatory cytokine marker Interleukin-35 (IL-35) in pregnant women with and without GDM. Materials and Methods: Participants in the study included 29 pregnant women with GDM (case group) and 29 healthy pregnant women (control group). Blood levels of IL-10, IL-35, Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) were measured in all participants. Independent t-test and Chi-square test were used for data analysis. Quantitative data between three gestational subgroups (32 weeks) in each GDM and control group were compared by ANOVA test. The p-value 32 weeks) (p=0.04), but this was not true in the control group. There was no significant difference between the mean level of IL-35 at different gestational ages in both GDM and control groups. Conclusion: The present study showed the decreased level of anti-inflammatory marker IL-10 in the late stage of pregnancy in diabetic women especially during the last weeks of gestation. New inflammatory marker IL-35 was not statistically significant in GDM subjects.

Materials and methods: This descriptive study included all hyperthyroid patients. All therapeutic results were recorded and analyzed. Results: In this study, 329 records were studied and 104 patients met the study inclusion criteria. Graves' disease (GD) and toxic adenoma were reported in 94% and 6%, respectively. Among the patients with GD, 30.5% (21.7-40.3%) did not respond to initial ATD treatment and 20% had recurrent GD despite appropriate initial response. Overall, antithyroid drugs failure occurred in 50.5% (40.45-60.55%) of the patients. Lower age, lower body mass index (BMI), high thyroid weight, and higher baseline thyroid hormone levels were associated with ATD failure (P

Objectives Different factors are responsible for the silent epidemic of diabetes mellitus in developing and developed countries. This study aimed to determine the role of demographic factors, lipid profile, family history (the estimation of genetic association) and anthropometric factors on diabetes onset. Methods Data from the enrolment phase of the Tabari Cohort study was applied for this study and included 10,255 participants aged between 35–70 years. Anthropometric variables were measured by trained staff using standard tools. Blood specimens were collected for lipid profile and blood glucose measurements. Data analyses were performed using SPSS version 24, with univariate and multivariate logistic regression. Results The prevalence of diabetes mellitus was estimated to be 17.2% in the cohort population, 15.6% in men, and 18.3% in women. The adjusted odds ratios (95% confidence intervals) for age groups 40–49, 50–59 and over 60 were 2.58 (2.20–3.69), 5.80 (4.51–7.48) and 8.72 (6.67–11.39), respectively. In addition, the odds ratios (95% confidence intervals) for 2 (or more), and 1 affected family member were 4.12 (3.55–4.90) and 2.34 (2.07–2.65), respectively. Triglyceride concentrations more than 500, and abnormal high-density lipoprotein levels increased the odds of diabetes mellitus by 3.29- and 1.18-fold, respectively. Conclusion The current study showed that old age and a family history were strong predictors for diabetes mellitus.

Background and purpose: The aim of this study was to identify the factors affecting the progression of retinopathy in patients with type 2 diabetes. Materials and methods: In this historical prospective cohort study, 728 patients with type 2 diabetes, attending Sari Tooba Clinic, were followed up for retinopathy. Data analysis was performed using accelerated failure time Weibull regression model in Stata V12. Results: The mean and median times until retinopathy progression was 17.24 and 15 years, respectively. A total of 304 (41.8%) patients developed retinopathy and 424 (58.2%) were considered as right censoring observations. The incidence of retinopathy was 40.5 per 1000 in person per year, and 5-year incidence rate from 5 to 25-year follow up were 7%, 15%, 24%, 41%, and 49%, respectively. The accelerated failure time Weibull regression showed age at the time of diagnosis of diabetes (P< 0.001) and at first referral (P< 0.001), nephropathy (P= 0.122), hypertension (P< 0.001), and hemoglobin A1c level (P= 0.034) as the factors affecting the progression of retinopathy. Conclusion: Early diagnosis of diabetes and controlling hypertension and blood glucose as well as periodic examinations for early detection of nephropathy can delay the progression of retinopathy.

Background and purpose: Thyroid nodules are quite common witch are found in clinical or ultrasound examinations. They are detected in 4-8% of clinical examinations and 7-15% are malignant. TSH is one of the growth factors for nodule growth. Controversial reports are published on the effect of TSH on thyroid nodule malignancy. This study aimed at investigating the effect of TSH in predicting malignancy in thyroid nodules. Materials and methods: In this cross sectional research, 500 patients were studied. Serum TSH level was measured prior to fine needle aspiration (FNA). Data analysis was done applying inferential statistics. Results: The patients were 457 (91.4%) females and 43 (8.6%) males and the mean age was 43.43±13.9 years. Among the patients 240 had single nodule and 260 had multiple thyroid nodules (P=0.08). The mean size of nodules in benign and malignant nodules were 26.1±12.2 and 27.3±9.8 mm, respectively (P=0.6). Malignant and benign nodules were observed in 31 (6.2%) and 469 (93.8%) patients. Mean TSH level was 3.3±6.9 and 2.4±2 in patients with benign and malignant nodules, respectively (P= 0.47). To investigate the association between TSH and FNA cytology, TSH levels were divided into

Abstract Background We aimed to evaluate the effects of a hydroalcoholic extract of Juglans regia L. leaves on blood glucose level and cardiovascular risk factors in type 2 diabetic patients. Methods In this randomized, double-blind, placebo-controlled, parallel-group (2 arms) clinical trial, 50 diabetic patients were divided into two groups: treatment group (receive the capsules containing 100 mg J. regia leaf extract) and control group (receive the capsules containing placebo, microcrystallin cellulose). Baseline participant data were matched between the two arms of the study. We administered the prepared capsules to the patients twice daily for 8 weeks. Blood glucose level, glycosylated hemoglobin (HbA1c) level, body weight, body mass index, blood pressure, lipid profile, serum insulin, and insulin resistance were compared between the two groups before and after the intervention. P

Background and purpose: All pregnant women should be screened for diabetes mellitus. In this regard, two strategies are proposed that superiority of these two is still not clear. The aim of this study was to investigate the prevalence of gestational diabetes mellitus (GDM) according to these recommended strategies, (one-step and two-step glucose tolerance tests) in pregnant women attending health centers in rural areas of Sari, Iran during 2012-2014. Materials and methods: In this cross-sectional study, the medical records of pregnant women were randomly selected using cluster sampling. In Sari rural areas, the gestational diabetes mellitus screening had been done by two-step (50-g and 100-g) and one- step (75-g) tests in 2012 and 2014, respectively. Demographic data and the results of the glucose tolerance tests were extracted from the records and the frequency and odds ratios were calculated with a confidence interval of 95%. Results: Totally, 627 subjects (one-step n= 317 and two-step n=310 patients) were investigated. The mean ages in those screened by one-step and two-step tests were 26.6±4.1 and 26.5±4 years, respectively (P= 0.843). The mean values for BMI, history of pervious gestational diabetes and macrosomal baby delivery and diabetes familial history were not significantly different between the two groups. According to one-step screening, the prevalence of GDM was 38.5% (CI95%:33.1-44.1) while, the two-step test showed a prevalence rate of 4.2% (CI95%:2.3-7.1) (P< 0.0001) OR=14.3 (CI95%: 7.8-26.0). Conclusion: Prevalence of gestational diabetes mellitus is estimated to be much higher in one-step compared with that of the two-step screening. But, maternal and fetal benefits of this method should be assessed more accurately.

It is widely assumed that Gitelman syndrome is a rare genetic disorder with such electrolyte imbalance as hypokalemia and hypomagnesaemia. The impact of hypothyroidism on Gitelman syndrome and its management is not clear. In this case study, a hypothyroid young woman referred to our endocrine clinic for muscle cramp after the hypothyroidism management. Based on Laboratory and clinical findings, the woman was diagnosed to have been suffering from Gitelman syndrome and the treatment with magnesium, potassium and oral Spironolactone began immediately. After two years of treatment, the woman experienced a successful planned pregnancy.

Purpose: The present study aimed to investigate the role of librarians, information services and information literacy skills of graduate students of Ferdowsi University of Mashhad (FUM) in decreasing their information seeking anxiety. Methodology: This was an applied study conducted through survey method. The statistical population included 12260 graduate students consisting of 8100 master’s students and 4160 doctoral students. Of these, 236 students were selected by non-proportional stratified random sampling method. Data were gathered using questionnaires and were analyzed through descriptive and inferential statistics using SPSS software. Results: The students’ information seeking anxiety level was moderate. In addition, students' information literacy status was lower than average. On the other hand, students' use of information services was moderate. There was a significant relationship between their information seeking anxiety and information literacy. The findings showed that the role of librarians in decreasing the information seeking anxiety of graduate students was at moderate level. Also, participation in related workshops did not have any effect on students’ information seeking anxiety. There was also a significant positive correlation between the students' score on librarians’ communication skills and their level of information anxiety. There was a significant positive correlation between the use of information services and the information seeking anxiety of graduate students. The findings also showed that there was no significant difference between the mean scores of students' information seeking anxiety and their gender and academic field, but their educational level. In addition, there was no significant difference between the mean scores of the students’ information literacy skills and their gender, academic field and educational level. Conclusion: Awareness of the various factors that can affect the process of people’s informing seeking to the point where they are anxious is necessary. The results of this study, with emphasis on the role of librarians, the students’ use of information services and information literacy skills can be addressed by librarians and university authorities in order to recognize the effective factors and to take the needed steps for removing them.

Background and purpose: Diabetes mellitus is one of the most common metabolic diseases and neuropathy is one of the main complications of diabetes. Modification of eating habit is the most effective and most economical way in prevention of diabetic complications. This research aimed at studying the relationship between food habits and diabetic neuropathy. Materials and methods: This cross-sectional study was performed in 176 patients with diabetic neuropathy attending Sari Imam Khomeini Hospital, 2016. They were selected via convenience sampling. Data was collected using food habits questionnaire, neuropathy complication checklist, and demographic questionnaire. Data was then analyzed using Chi-square, K-S, Mann–Whitney, Spearman correlation and Linear Regression in SPSS V18. Results: The results showed that 78 (44.3%) and 98 (55.7%) patients had undesirable and somewhat favorable food habits, respectively. About sensory neuropathy complications, the highest and lowest prevalence was associated with limbs tingling (93.3%) and soft tissue atrophy in foots (7.4%). While digestive disorders (57.4%) and syncope (8%) were the most and least common autonomic complications, respectively. A negative significant correlation was found between food habits and prevalence of diabetic neuropathy complications (P=0.03, r= -0.21). Conclusion: According to the results, modification of food habits is necessary. The prevalence of some complications (autonomic and sensory) was found to be high in current study. So, any intervention to prevent diabetic complications and their progress should focus on modification of food habits and lifestyle, and lowering blood glucose level.

Background & Aim: Tuberculosis is the major cause of morbidity and mortality among HIV patients. Thus, early diagnosis of Tuberculosis among these patients is important. The purpose of the present study was to determine the Sensitivity, Specificity, PPV and NPV for tools of diagnosing TB among HIV patients referred to behavioral disorder counseling center of Shiraz city. Methods & Materials: In this cross sectional study, 250 HIV+ patients in Shiraz were evaluated. For each patient, three sputum smears and a Chest X-ray and PPD was taken. Sensitivity, specificity, and positive and negative predictive values were determined based on the results of sputum cultures as a gold standard. Results: Among 250 HIV+ individuals who entered the study, 8 (3.2 %) were diagnosed with tuberculosis. The sensitivity, specificity, PPV and NPV for chest x-ray were 62.5%, 96%, 38% and 98.7%, respectively. Also they were 62.5%, 98.7%, 62.5% and 98.7% for AFB 1, and 25%, 99.5%, 66% and 97.5% for AFB 2. Finally, these factors were 99.5%, 99.5%, 66% and 97.5% for AFB 3. Conclusion: The prevalence of TB among HIV+ patients referring to the behavioral disease counseling center in Shiraz was lower than in other endemic areas of developing countries. The screening tools for diagnosis of tuberculosis included the chest x-ray and Acid Fast Bacilli and PPD test in order to find out the important role of detecting TB disease among HIV-infected people.

Introduction: Diabetes Mellitus (DM) is a chronic multisystem disease characterised by persistent hyperglycaemia that lead to a wide range of complications, including Musculoskeletal Disorders (MSD). Quality Of Life (QOL) in chronic diseases such as DM has an important role in mental, physical and social performance of patients and plays an important role in health care. Aim: To study the impact of upper limbs MSD on QOL in diabetic patients. Materials and Methods: A cross-sectional study was conducted at Department of Internal Medicine in Imam Khomeini Hospital, Sari, North of Iran from March 2013 to April 2016, on 50 patients with type 2 DM suffering from upper limb MSD and 50 age and sex matched diabetic patients with no upper limb problems. QOL was evaluated using the Mental and Physical Components Scores (MCS and PCS) of the Short Form-36 and Diabetes Quality of Life (DQOL). In patients with MSD, Arthritis Impact Measurement Scales 2-Short Form (AIMS2-SF) was completed. Comparisons between groups were undertaken using Chisquare test for categorical data and t-tests for continuous data. Statistical significance was taken at p≤0.05. Results: Patients with MSD showed significantly lower mean of PCS (36.05±6.8 vs. 41.52±10.4, p=0.003), and higher DQOL (2.76±0.41 vs. 2.45±0.6, p=0.006), but MCS scores were not significantly different. Conclusion: Upper limb MSDs could reduce quality of life in diabetic patients. Physicians are required to be aware of these complications and manage them effectively.

Background: Levothyroxine is commonly used in the treatment of patients with hypothyroidism. Levothyroxine is often administered in the morning, on an empty stomach, to increase its absorption. However, many patients have trouble for taking levothyroxine in the morning. The aim of this study was to evaluate the effect of changing administration time of levothyroxine from before breakfast to before dinner on serum levels of TSH and T4. Methods: Fifty hypothyroidism patients aged 18-75 years old were included in the study and randomly divided into two groups. Each group received two tablets per day blindly (one levothyroxine tablet and one placebo tablet) before breakfast and before dinner. After two months, the administration time for the tablets was changed for each group, and the new schedule was continued for a further two-month period. The serum TSH and T4 levels were measured before and after treatment in each group. Results: Changing the levothyroxine administration time, resulted in 1.47±0.51 µIU/mL increase in TSH level (P=0.001) and 0.35±1.05µg/dL decrease in T4 level (P=0.3). Conclusion: Changing the levothyroxine administration time from before breakfast to before dinner minimally reduced the therapeutic efficacy of levothyroxine.

Background: Sexual dysfunction (SD) is one of the important problems in diabetic patients. The present study aimed to determine the prevalence of sexual problems in Iranian women with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted among type 2 diabetic women who visited two outpatient endocrine clinics, namely Imam Hospital and Tuba clinic (Sari, Iran) in 2012. Patients were asked to complete two validated questionnaires: Female Sexual Function Index (FSFI) and The Hospital Anxiety and Depression Scale (HADS) as well as a demographic questionnaire. Analysis was performed using descriptive and analytical tests. P

Background: Hypocalcemia is a well-recognized complication after total thyroidectomy. Hypovitaminosis D may have additional effect in the development of hypocalcemia. This study aimed to determine the effect of total thyroidectomy on postoperative serum calcium in patients with and without hypovitaminosis D. Methods: This prospective study was performed on patients who underwent total thyroidectomy from 2011 to 2014 in Imam Khomeini General Hospital of Mazandaran University of Medical Sciences. Serum calcium and vitamin D values were recorded before and after surgery. The patients were classified according to serum vitamin D concentrations as less 10 ng/ml (vitamin D deficiency) or higher (control group). The mean values of postoperative calcium level for each class of serum vitamin D were determined and compared. Hypocalcemia was defined as a postoperative calcium level 0.05). Conclusion: The findings of this study indicated that vitamin D deficiency had no significant effect on post-thyroidectomy serum calcium level.

BACKGROUND:In this study, we investigated whether response to metformin, the most frequently drug for diabetes treatment, influences the therapeutic effects of antilipidemic medication in newly diagnosed patients with type 2 diabetes mellitus (T2DM). METHODS:A total of 150 patients with T2DM were classified into two groups following 3 months of metformin therapy (1000 mg twice daily): responders (patients showing ≥1% reduction in HbA1c from baseline) and nonresponders (patients showing

(Received 23 Jul, 2008 ; Accepted 12 Nov, 2008)AbstractBackground and purpose: Pruritus is one of the common problems in hemodialysis patients with end stage renal disease. Approximately, 60% of these patients suffer from this condition. There are several causes for pruritus, thus, various treatments are applied in order to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in hemodialysis patients.Materials and methods: This randomized double blind cross over clinical trial study, was performed on 34 hemodialysis patients with uremic pruritus in 1386. All patients were divided in two groups. One group received Caspian 0.03%, while the other, placebo for four weeks. Treatment was stopped for two weeks and continued as cross over technique. Pruritus scores were analyzed with Paired t-test and Repeated measurement ANOVA.Results: In this study, the difference between Mean of pruritus score before capsian treatment and in weeks following 1 to 4 was statistically significant (P=0.0001). In placebo group, the difference between pruritus score before treatment and in weeks 1 to 4 was statistically significant (P=0.0001). There was no significant difference before treatment in two groups, however, after each week, the difference was significant (P=0.0001). Repeated measurement test showed that reduction in pruritus severity in capsian group was more than placebo group, during treatment period (P=0.0001).Conclusion: Although our study indicated the appropriate effects of Capsian in pruritus, the placebo also has a good effect in controlling hemodialysis related pruritus. Our placebo had emollient property; therefore, we can apply it to control the pruritus in these patients.J Mazand Univ Med Sci 2009; 19(69): 7-13 (Persian)

(Received 19 May, 2008; Accepted 14 Jan, 2008) Abstract Background and purpose: Measurement of height and weight of children and adolescents are important sources of information and the best index for evaluation of their growth and nutritional and health status of society. This study performed to evaluate weight, height and pubertal stage of girls in sari. Materials and methods: This cross – sectional study was performed on 1320 6-18 years old school girls in elementary guidance and high school of Sari. Their height, weight and pubertal stage were evaluated and recorded by educated personas . Also Body Mass Index was calculated and recorded. Then Z score (SDS) of weight, height and the Body Mass Index studied people was compared by using calculated standard curve and findings in NCHS curve and findings of 1997 in Sari.For analyzing data, descriptive statistics, Mean±SD, Frequency and percent were used.Results: By using NCHS curve 1256 persons ( 95. 2 % ) from total persons that were studied , had normal height ( 5 – 95 percentile ) and the weight of 1254 persons ( 95 % ) were in 5 - 95 percentile . 2/5 centemers increasing in height and 2.5 Kg increasing in weight were seen in comparison to 1997 study .BMI of persons in all age groups ( expect 17 year old with ± 0.05 SD )were over than 50 percentile and mean age of beginning of menarche was 11.4 ± 1.1 .Conclusion: Our study in Sari shows the improvement in growth index in comparison to 1997 study which become near to standard curve in developed country.

(Received 18 May,2008 ; Accepted 10 Sep, 2008) Abstract Leptospirosis is a Zoonotic disease that rarely manifests in a severe manner, (Weil's syndrome). Regarding epidemiology of this disease, in some rural areas of Mazandaran Province we encountered a rare case of acute pancreatitis during progression of severe Leptosprosis is presented herein. Patient is a 50 year old male farmer who was admitted to the hospital due to experiencing 10 days of fever, myalgia, vomiting, jaundice and abdominal pain. He underwent haemo-dialysis due to acute renal failure only once. Direct bilirubin was 31.7 mg/dl with serum amylase, while lipase was three times more than normal levels. The CT-Scan demonstrated diffuse pancreatic enlargement. The IgM titer fourfold which was more than normal level against leptospirosis (ELISA) confirmed the diagnosis. Patient was cured completely through supportive care and antibiotic therapy, thus, this case was reported in drawing attention to Leptospira infections, which should be considered in the differential diagnosis of patients with jaundice and pancreatitis. J Mazand Univ Med Sci 2008; 18(66):92-97(Persian)

(Received 14 Jul, 2008; Accepted 12 Nov, 2008) Abstract Background and purpose: Hypothyroidism is one of the most common diseases in endocrinology Thyroid hormone deficiency effects on nerve and muscle fibers, pulmonary system and alveolar ventilation. The aim of this study was to evaluate the effect of Levothyroxine therapy on pulmonary function in hypothyroidism patients in Imam Hospital.Materials and methods: This study was performed on 50 patients with hypothyroidism in Imam Hospital, Sari, Iran, 2006-2007. After a detailed clinical history and systemic examination, level of TSH, T4 and ABG test, chest radiography and spirometery was performed in all patients. The spirometery indexes including FVC, FEV1, FEV1/FVC, FEF 25-75, PEF were recorded. All patients treated with Levothyroxine 1.6μg/kg. After that all systemic and clinical examination, and chest radiography and spirometery performed again. Results analyzed by means of SPSS (11) software and paired t test. The p value less than 0.05 was considered to be significant statisticallyResults: 50 female patients, with mean age of 34.98±13.4 years were studied. The mean of TSH, T4 before treatment were 51.44±25.3 mIu/l and 2.8± 0.9 μg/dl and after treatment were 3.64±2.4 mIu/l and 9.80±4.9 μg/dl respectively (P= 0.0001). The ABG parameters were in normal range and there was no statistically significant difference between before and after treatment. Statistical analysis demonstrated significant differences between mean of FVC, FEV1, FEV1/FVC, FEF 25-75, and PEF before and after treatment.Conclusion: Our study demonstrates that treatment of hypothyroidism with Levothyroxine can improves the pulmonary function according to spirometery findings.

It is widely assumed that Gitelman syndrome is a rare genetic disorder with such electrolyte imbalance as hypokalemia and hypomagnesaemia. The impact of hypothyroidism on Gitelman syndrome and its management is not clear. In this case study, a hypothyroid young woman referred to our endocrine clinic for muscle cramp after the hypothyroidism management. Based on Laboratory and clinical findings, the woman was diagnosed to have been suffering from Gitelman syndrome and the treatment with magnesium, potassium and oral Spironolactone began immediately. After two years of treatment, the woman experienced a successful planned pregnancy.

Riedel's thyroiditis is a rare inflammatory disease of the thyroid gland and has been reported in 0.05% of thyroid surgeries. Herein we report two cases of Riedel's thyroiditis with variable clinical presentations. One of these cases was a 51-year-old man who was presented with hypothyroidism and the other a 17-year-old young male with thyrotoxicosis. In these cases, age may be a determining factor in presenting symptoms and signs, disease process, and response to treatment.