فهرست مطالب رخساره عقیلی

The aim of this study was to determine the frequency of distal symmetric polyneuropathy (DSP) and the role of physical examination for neuropathy diagnosis in subjects with type 2 diabetes mellitus.

A cross-sectional study was carried out from 2009 to 2010. A total of 107 patients with type 2 diabetes were evaluated using the Michigan Neuropathy Screening Instrument (MNSI). MNSI consists of two parts: History and physical assessment. History was focused on positive (burning, tingling) and negative (numbness) sensory symptoms, cramps and muscle weakness, foots ulcers or cracks, and prior diagnoses of diabetic neuropathy by a physician. Physical assessment was determined from foot appearance, ulceration, ankle reflexes, vibratory perception and monofilament testing.

A total of 72 women and 35 men were participated in this study. The frequency of neuropathy diagnosed based on physical assessment was 78.5%. The mean age was 57.6 (± 10.2) and the mean duration of diabetes was 10.2 (± 7.3) years. Ankle reflexes were not observed in both both foot in 67% of patients. Vibration perception was absent in 25% of patients. Monofilament testing was normal in 86% of patients in both feet.

The results showed a key role of physical examination in diagnosis of DSP in diabetic patients. The high frequency of DSP among diabetic patients demonstrated the importance of annual screening, further evaluations, planning and management of patients in diabetic foot clinics. However, considering the results of this study, the sensitivity of monofilament test in screening of DSP is questionable.

Several investigations have been conducted on the effects of Islamic Ramadan fasting on blood glucose levels and lipid profile of type two diabetic subjects. However، this matter remained to be controversial. This study was designed to investigate the effect of Ramadan fasting and structured SMBG on blood glucose control in this group of subjects. Forty type two diabetic subjects on oral agent were selected. These subjects were randomly divided into two equal groups and matched based on their age and sex. Group A monitored their blood glucose level using structured SMBG method and group B monitored their blood glucose level in a traditional way. Fructosamine level، total cholesterol، LDL، HDL and TG were measured in all subjects before and after Ramadan. Fructosamine level raised from 363 (±53. 55) to 400. 29 (±73. 25) (P < 0. 003) in group A and from 388. 52 (±61. 89) to 411. 10 (±68. 37) (P < 0. 04) in group B. Total chol، LDL and TG levels were increased and HDL level was decreased in both groups; however، these changes were not statistically significant. Poor metabolic control despite structured SMBG method is observed in this study. This might be due to have high caloric diet and less physical activity during Ramadan in order to prevent hypoglycemic attacks.

Verbal memory and executive function might be disturbed in subclinical hypothyroidism. The aim of this study was to explore the effect of levothyroxine treatment on the memory quotient of Anti-TPO-Ab positive subjects with subclinical hypothyroidism. Sixty Anti-Tpo-Ab positive subjects (51 female, 9 male) with subclinical hypothyroidism with a mean age of 34 were enrolled in this randomized double blind placebo controlled trial. Subjects were randomized into two groups, i.e. the case (26 females- 4 males) and the controls (25 females, 5 males) groups. Using the Weschler memory test, memory quotient was assessed at the beginning and three months after initiation of levothyroxine treatment. The mean age of subjects was 34.22±10.75 y and the mean TSH level was 8.25±3.64 mIU/l. There was no difference between two groups in relation to the memory quotient at the beginning of the study (10.5.70±11.66 vs 105.87±11.49, P=0.83). Following treatment the mean for the memory quotient rose by 9.9±8.01 in the cases and 3.23±7.63 in the controls (P=0.002). In this study we observed an increase in the memory quotient after treatment with levothyroxine in individuals with subclinical hypothyroidism, demonstrating that levothyroxine treatment could be recommended to improve verbal memory and executive function in this group of subjects.