حسن رضوانیان

Chronic diseases, including diabetes mellitus, have become increasingly prevalent, posing significant physical, psychological, and economic challenges. Type 2 diabetes, accounting for approximately 90% of diabetes cases, is characterized by insulin resistance and impaired insulin production. In Iran, over 1.5 million individuals are affected by diabetes, a condition associated with a doubled risk of mood disorders. To comprehensively address this complex issue, a biopsychosocial model has been adopted to explain the disease and its contributing factors. Adherence to diabetes treatment (The degree to which a patient follows a prescribed healthcare plan, including taking medications as directed, attending follow-up appointments, and making lifestyle changes) is crucial, yet it varies widely among patients, ranging from 23% to 93%.    Non-adherence is associated with increased health risks and hospitalizations. Furthermore, diabetic patients often experience elevated cholesterol levels, emphasizing the importance of effective management. Psychological interventions, such as Compassion-Focused Therapy (CFT is a therapeutic approach that combines elements of mindfulness, cognitive-behavioral therapy, and evolutionary psychology to foster compassion, helps individuals develop a more balanced and compassionate relationship with themselves and others by addressing underlying fears and insecurities) have demonstrated potential in improving treatment adherence and overall well-being in diabetic patients. Self-compassion, encompassing self-kindness, shared humanity, and mindfulness, is central to CFT and can enhance resilience and self-care. Research has consistently shown that CFT positively impacts treatment adherence, quality of life, and stress reduction.  This research was semi-experimental using pretest, posttest and quarterly follow-up with control group. The statistical population consisted of patients with type 2 diabetes referred to Isfahan Endocrine and Metabolism Research Center in the autumn of 2021 that 46 of them were selected via purposive sampling and randomly allocated to experimental and control group (23 people in each group). The members of the experimental group underwent eight sessions of compassion-focused therapy (two 90-minute sessions per week) and the control group was waiting for intervention. Modanloo Adherence to Treatment Questionnaire (2013) and evaluation of blood lipids by specialist  doctor was done in pre-test, post-test and three-month follow-up stages in both experimental and control groups.  Data were analysed by using Mixed Model ANOVA with SPSS software version 24. The findings indicated an improvement in adherence to treatment (F=36.132, P=0.001) and the balancing of blood lipids (triglycerides, cholesterol, LDL and HDL) in the experimental group compared to the control group, as well as the stability of the results in the follow-up phase (F=70.306, P=0.001). These results align with both domestic and international research, supporting the role of self-compassion in improving self-care and treatment adherence. By cultivating mindfulness and self-compassion, CFT empowers patients to reduce negative emotions, increase motivation to follow medical advice, and develop effective coping mechanisms. Self-compassion plays a crucial role in enhancing treatment adherence among individuals with diabetes. When individuals cultivate kindness and understanding towards themselves, they are more likely to engage in healthy behaviors and make choices that support their long-term well-being. By practicing self-compassion, individuals with diabetes can reduce feelings of self-blame and guilt associated with treatment failures, which can be a significant barrier to adherence. Furthermore, self-compassion can help individuals develop a more positive outlook on life, which can increase motivation and empower them to take an active role in managing their condition. Despite limitations such as the COVID-19 pandemic and reliance on self-report measures, this study highlights the value of CFT as a complementary approach to diabetes care. By addressing the psychological dimensions of the disease, CFT enhances treatment adherence, Healthcare providers are encouraged to incorporate CFT into their treatment plans to optimize the physical and psychological well-being of diabetic patients. Continued research is warranted to further explore the long-term effects of CFT and its applicability to diverse populations.

Milk thistle has antioxidative effects and may improve renal performance. Our study investigated whether Milk thistle improve renal performance in patients with type II diabetes mellitus nephropathy. In this clinical trial study, after ethics committee approval, 65 Patients with type II diabetes mellitus were enrolled into a randomized simple sampling, prospective, double-blinded study. In the case group, was gave Milk thistle and control group was given placebo. We measured urine albumin/cratinine (A/C) ratio and eGFR before and after intervention. The gathered data were analyzed by t and paired-t tests. P < 0.05 was regarded as significant level. The groups were well matched for age, sex, and duration of diabetes. The mean age was 55.9 ± 6.5 and 57.7 ± 7.7 years in case and control groups, respectively. There was not any significant difference between A/C ratio in case and control groups after intervention (P > 0.05); but in case group, after intervention A/C ratio was worse than before it (P < 0.05). The results suggest that Milk thistle did not improve the renal performance in patients with type II diabetes mellitus.

Several studies showed that obesity and fat deposition in the tissues along with inflammatory response may induce insulin resistance and finally type II diabetes. Salsalate can inhibit IKK and NF-KB inflammatory pathway. The aim of this study was to determine the efficacy of salsalate as an anti-inflammatory drug in blood glucose decrement of diabetics. This was a double blind case-control trial. Sixty newly diagnosed diabetic patients were randomized in the drug and the placebo groups. The drug group used were received 3g Salsalate per day (two 750 mg tablets every 12 hours orally) for one month. At baseline there was no significant differences between drug group mean fasting plasma glucose level (124 mg/dl) and placebo group (127 mg/dl) (P = 0.628). Twenty eight patients in drug group and 23 ones in placebo group finished the study. Salsalate had reduced significantly the fasting glucose in the drug group (20 mg/dl) in comparison to placebo group (P < 0.05). This study showed that using 3 grams of Salsalate for one month reduces 15.5% of baseline blood glucose level of diabetic cases. These acceptable results may open a new approach in the treatment of diabetes.

Thyroid nodules are common and surgery is the usual treatment. One of the common complications after thyroid surgery is keloid formation in front of the neck which is an important cosmetic problem. Nodular goiter is a common disorder of thyroid and its common treatment is surgery. Considering the fact that with clinical evaluation and FNA, the risk of malignancy in these cases is low a non aggressive approach to this complication is necessary. This study aims to evaluate of the effectiveness of percutaneous laser photocoagulation (PLP) in reducing the volume of benign thyroid nodules. In this case-controlled clinical trial, 39 female euthyroid patients with solitary solid benign thyroid nodules were enrolled 18 patients were treated with ultrasound guided percutaneous laser photocoagulation, and 21 patients were included in the control group. PLP was performed by diode surgical laser with 1-3 watt output for 123-1019 seconds. All patients were followed up for 3 months. After PLP, mean nodule volume decreased from a baseline value of 26.3 ± 23 mL to 15.1 ± 13 at 3 months. Mean nodule volume reduction in comparison with baseline was 42.72%. Compressive symptoms showed relative decrease. No serious complication was seen, nor was any keloid or scar observed in the front of the neck. PLP can be a minimally invasive effective alternative treatment for symptomatic benign solitary solid thyroid nodules in patients not suitable for surgery.

Polyneuropathy is one of the most common complications of type 2 diabetes mellitus. Clinical examination and electrophysiological findings (i.e., nerve conduction velocity) will not only provide an accurate diagnosis of neuropathy but will also help the physician in preventing and treating the disorder. The aim of the current study was to determine the prevalence of neuropathy as well as the validity of the clinical scoring system in detecting the presence and severity of diabetic peripheral sensorimotor polyneuropathy-as confirmed by nerve conduction velocity. In this cross-sectional study conducted at the diabetic center affiliated to Isfahan University of Medical Sciences, 446 Patients were evaluated by two neurologists and two residents. Through neurologic examination all patients were classified into four categories namely patients with no neuropathy, mild neuropathic ones, those with moderate neuropathy, and cases suffering from severe neuropathy. A number of patients with moderate and severe neuropathy were tested for nerve conduction velocity. All of the obtained data was analyzed by SPSS using Chi-square statistical test at the significant level of P0.0.5. Sensorimotor polyneuropathy was clinically diagnosed in 77.4% of the cases, mild polyneuropathy in 47.98%, moderate neuropathy in 25.78%, and severe polyneuropathy in 3.59%. 22.65% of the subjects were not affected by neuropathy. Nerve conduction velocity was assessed in 62 patients with moderate and severe neuropathy the results showed high correlation with the neurological scoring system (P<0.05). The prevalence of sensorimotor neuropathy is relatively high in our catchment area (Isfahan). Moreover, the clinical scoring system is a valid tool in early diagnosis of neuropathy in which the primary caregiver would be able to realize diabetic complications such as pain in the limbs, foot ulcer, and syncopal attack.

In spite of iodine fortification programs, goiter is still hyperendemic in Semirom, a mountainous region in the central part of Iran. This study was conducted to assess whether iron deficiency could be responsible for the high prevalence of goiter in this region. A total of 1828 schoolchildren, aged 7-13 years, were evaluated for presence of goiter, and 220 cases were randomly selected. Urine and serum samples were collected from these children and assayed for urinary iodine concentraton (UIC) and serum ferritin, iron, thyroxine (T4) and thyroid stimulating hormone (TSH) concentrations. In the 1828 children evaluated, 670 cases (36.7%) were goitrous, with goiters of grade 1 or 2. The mean UIC in children was 19.3±9.1 µg/dl. Mild (UIC <10 µg/dl) and moderate (UIC <5 µg/dl) iodine deficiency was detected in 6.4% and 3.2% of cases, respectively. Only 1.8% of children were severly iodine deficient (UIC <2 µg/dl). The median serum ferritin concentration was 26.6 ng/ml (95% CI: 24.2-28.9), and 11 cases (5%) had serum ferritin concentrations less than 20 ng/ml. Goiter rate was 48.3% and 50.3% in children with low and normal serum ferritin levels, respectively (P=NS). It seems that factors other than iodine and iron deficiency may, at least partly, be responsible for the high prevalence of goiter in the area studied. Further investigations for evaluating other micronutrient deficiencies and autoimmunity in goitrous children would contribute to the planning more effective goiter control programs.

Background and With respect to the high prevalence of goiter in Semirom before the initiation of National Program for Elimination of Iodine Deficiency Disorders (NPEIDD), the impact of the program on the prevalence of goiter in 8-12 years old students of Semirom was investigated in this study, after 15 years of sucessful execution of NPEIDD. After excluding students with any clinical evidence of hyper- or hypo-thyroidism, 1817 students aged 8-12 years were recruited based on a cluster sampling method. The participants were examined for the presence of goiter by experiencd endocrinologists. Urinary iodine was measured in 182 examined students, too. Chi- Square statistical method was used to analyze the data. Goiter was detected in 36.7% of the students (grade 1: 30.4%, grade 2: 6.3%). The median urinary iodine was 18.5 and mean was 19.37 ± 9.22 μg/dl in collected specimens. The adequacy of urinary iodine in students of Semirom confirms the success of NPEIDD, however, the higher than expected prevalence of goiter in the region suggests the probable role of other goitrogenous or autoimmune factors. Further studies should be performed to investigate the possible causes.

Elevated level of serum homocysteine, as an independent risk factor for cardiovascular diseases, has been reported in hypothyroid patients. Considering the effect of levothyroxine on lowering homocysteine levels in these patients, and the fundamental role of folate in the metabolic cycle of homocysteine, this study was performed to compare the level of homocysteine in patients with hypothyroidism following treatment either with levothyroxine alone or in combination with folic acid. In this double-blind clinical trial study, 60 hypothyroid patients were randomly divided into two groups (n=30 each), and both were treated with 50-100 ‌µg of levothyroxine, with conjunction of an additional 1 mg folic acid (cases) or placebo (controls). The level of fasting homocysteine, folic acid, and vitamin B12 was measured and compared in all participants at the beginning of the study and after TSH levels were normalized. The level of homocysteine in the case group was decreased from 15.77±6.33 µmol/L to 10.8±3.54 µmol/L (p<0.001), and was also decreased in the control group from 15.69±6.4 µmol/L to 13.9±6 µmol/L (p=0.03). The difference in the mean serum homocysteine level between 2 groups was statistically significant at the end of the study (p=0.0165). Although the level of homocysteine was decreased in both groups, it was lowered to a greater extent in the group who received levothyroxine and folic acid. It seems that using folic acid in conjunction with levothyroxine can lower the potential harmful effects of homocysteine, which may even be exerted over a short-time period more efficiently.

Hyperhomocysteinemia is associated with an increased risk of cardiovascular disease in diabetic patients. The aim of this study was to determine plasma homocysteine levels in diabetics and compare with control persons and also evaluation of correlation between plasma homocysteine concentration and diabetic related variables.

This study was done on 39 type II diabetic patients, 27 subjects with impaired glucose tolerance and 23 normal persons referring to Endocrine and Metabolism Research Center of Medical university of Isfahan. Physical characteristics were recorded. After an overnight fast, a blood sample was drawn for determination of FPG, HbA1c – homocysteine, Cr. Cholesterol – Triglyceride and HDL- Cholesterol. Mean plasma homocysteine levels in the groups were compared by one way ANOVA. The Correlation of different parameters was tested by Pearson’s correlation.

There was no statistically significant difference in the plasma homocysteine levels of all the groups.(P=0.71). Correlation between homocysteine levels and HbA1c was not significant (P=0.42) in diabetic patients.

The findings suggest that diabetes does not influence plasma homocysteine levels. Also, there is no correlation between plasma homocysteine levels and HbA1c in diabetic patients

Hyperhomocysteinemia may increase blood pressure by inducing endothelial cells dysfunction. The aim of this study was determining the relationship between plasma Homocysteine (Hcy) levels and blood pressure in new cases of type 2 diabetes mellitus. As a cross sectional study, 46 new cases of type 2 diabetes mellitus referred to Isfahan Endocrine and Metabolism Research Center were selected by convenient sampling. Basal characteristics of patients were recorded. Systolic and diastolic blood pressure was measured two times with 30 minutes interval on two consequent days. After ten hours of overnight fasting, blood samples were taken to measure fasting plasma glucose, HbA1c, triglyceride, Total cholesterol, HDL-C and creatinine. All data were expressed as mean (SD). Relationship between plasma Homocysteine levels and both systolic and diastolic blood pressure was assessed by Pearson's correlation coefficient. Patients were divided into three groups according to their plasma Homocysteine levels, (Hcy<10mol/L, 10Hcy<15 mol/L and Hcy15mol/L).. Then mean of systolic and diastolic blood pressure between groups were compared by one – way ANOVA and Tuckey-HSD tests. Mean (SD) of plasma Homocysteine levels was 12.2 (6.8) mol/L and of systolic and diastolic blood pressure was 128.8 (18.1) and 82.3(9) mm/Hg, respectively. There was a significant correlation between plasma Homocysteine levels, and both systolic (r=0.39, P<0.01) and diastolic (r=0.46, P<0.01) blood pressures. Mean (SD) of systolic and diastolic blood pressure in patients with plasma Homocysteine level of 15mol/L was 152.5 (17.7) and 91.8 (7.3) mm/Hg, respectively, so blood pressure in those group with hyperhomocysteinemia was higher than other two groups (P<0.001). There was no correlation between Homocysteine levels and FPG, HbA1c and lipid profile. There is a significant correlation between plasma Homocysteine levels and both systolic and diastolic blood pressure in newly diagnosed type 2 diabetics. Patients with hyperhomocyteinemia have higher blood pressure.

Diabetic patients need to detect blood glucose level (BGL) foe diagnosis, treatment and flow up. Typically a blood sample for analysis is obtained via intravenous or a finger stick or other such invasive procedures. Often, this procedure cause physical and mental stress to the patient. Thus, it is desirable to use other biologic liquid such as saliva to detect the blood glucose level. The present study attempts to determine the correlation coefficient between blood glucose level and saliva glucose level (SGL) in healthy men. It was a cross sectional study. 130 blood and 130 saliva samples were gathered from 10 healthy men in 13 times during a five-day period. Each day samples were taken 3 times, fasting, post parricidal and evening. Samples were analyzed with glucose oxidase method. Mean of fasting blood glucose level was 84.9±3.43 mg/dl (58-118 mg/dl). Mean of saliva glucose level was 1.22±0.81 mg/dl (0.32-4.94 mg/dl). Correlation coefficient between BGC and SGL from the 5 days of measurement was 0.23. Correlation coefficient for each day was 0.38 (First day), 0.29 (Second day), 0.01 (Third day) and 0.37 (Fourth day). Unfortunately with this correlation coefficient and limited range of SGL we can not use saliva to detect BGL.

Diabetic nephropathy is the most common cause of ESRD. Proteinuria has an important role in rapid progression to ESRD. Pentoxifylline (PTX) is a drug with TNF-α suppression effect and hence reduction of proteinuria and slowing of progression of diabetic nephropathy. To evaluate this hypothesis of PTX effect in comparison with captopril, we studied 40 type 2 diabetics with macroproteinuria (> 300 mg/day), who had no contraindication for PTX and didn’t take PTX or ACEI for the past year. We didn’t change the profile of diabetes or HTN drugs of our patients. We planned a cross over study in two 2-month periods of PTX or captoril therapy spaced with a one-month washout period. At beginning and the end of each treatment period we measured blood pressure, FBS, creatinine and 24-hour urine collection for volume, creatinine and protein. PTX reduced proteinuria by 0.44±0.63g/day in comparison with 0.1±0.22g/day with captoprial (P = 0.008). In conclusion PTX is superior than captopril in reducing proteinuria in type 2 diabetic patients.

Diabetic patients need to monitor blood glucose level (BGL) for diagnosis, treatment and follow up of their disease. Typically a blood sample for analysis is obtained via intravenous or a finger stick or other such invasive procedures. Often, this blood collecting causes physical and mental stress to the patient. For this reason, it is desirable to use other biologic liquids such as saliva to detect the blood glucose level. This article studies correlation coefficient between blood glucose level and salive glucose level (SGL) in healthy men. This is a descriptive, cross sectional study. 130 Blood and 130 saliva samples were obtained from 10 healthy men in 13 times in 5 days. Each day samples were taken in 3 times, fasting, postprandial and evening. Samples were analyzed with glucose oxidase method. Value of blood glucose level ranged from 58mg/dl to 118 mg/dl. Mean of fasting blood glucose level was 84.9±3.13mg/dl. Value of salive glucose level ranged from 0.322mg/dl to 4.941 mg/dl. Mean of saliva glucose level was 1.22±0.81mg/dl. Correlation coefficient between BGC and SGL from the 5 days of measurement was 0.23. Correlation coefficient for each day was 0.38 (first day), 0.21 (second day), 0.01 (third day) 0.37 (fourth day). Correlation coefficient for each person was 0.31 (case A). (case B), 0.07 (case C), 0.07 (case D), 0.45 (case E), 0.10 (case F), -0.05 (case E), 0.32 (case H), 0.87 (case I), 0.87 (case J). Unfortunately considering the values of correlation coefficients and the limited range of SGL we cannot use saliva for detecting BGL.

Iodine deficiency disorders (IDD) have been a major health problem in Iran. In order to train primary health workers (Behvarz) the diagnosis of visible goiter, two methods were compared. I: With head and neck in normal position; II: With extended neck. Behvarzes in 29 rural health centers in Ghazvin were trained method I an d30 were trained method II. 1541 school children in Ghazvin and 1532 in Abjar, aged 8 to lo years were examined by Behvarz and 2 weeks later by an endocrinologist. The results showed sensitivity of 69.3 and 42.0 positive predictive value of 76.3 and 51.8% and efficiency of 610 and 58.7% with methods I and II, respectively. It is concluded that Bchvarzes do better diagnosis with method II and they should be trained with extended meck for epidemiological detection of goiter.