عذرا اخی

Diabetes Mellitus is a group of complex, multi-system metabolic disorders that alter many functions of the immune system and are associated with delayed recovery and a reduced immune response. Apical periodontitis is the inflammation and destruction of the periodontium in the apical region of the root, originating from the pulp, and as a result, an inflammatory response creates a radiolucent area at the root apex. In this study, we aimed to investigate the relationship between the presence of pulp and periapical lesions and controlled type 2 diabetes in the radiographic images of patients.

In this cross-sectional study, 45 patients were included in the case group (patients with controlled diabetes) and 45 in the control group (healthy individuals). Periapical and endodontic status was evaluated based on examinations using panoramic and periapical images. In the dental examinations (excluding third molars), the following were recorded for each patient: the number of teeth in the mouth, the number and location of teeth without root canal treatment with a periapical lesion, the number and location of teeth with root canal treatment, and the number and location of teeth with root canal treatment with a periapical lesion. The periodontal condition was assessed using the periapical index (PAI), with scores greater than 3 considered indicative of periapical pathology. For inferential analysis, chi-square tests and independent t-tests were used.

Among the 90 participants, 53 were women and 37 were men. The average age of the participants was 43.6 years, and the average age was higher in the diabetic group. In total, 52.2% of patients had periapical lesions and 63.3% had pulpal lesions, with these two lesions being significantly more common in diabetic individuals(P<0.05). Among all patients, there was a significant relationship between gender and periapical lesions (P=0.022), with women having a higher prevalence of these lesions. In non-diabetic individuals, unlike diabetic individuals, the relationship between gender and periapical lesions was significant, with women having more lesions(P=0.03). Across all patients, there was a significant relationship between age and periapical lesions (P=0.001), with the average age being higher in patients with periapical lesions. In diabetic individuals, unlike non-diabetic individuals, no significant relationship was observed between these two variables (P=0.828).

The study results demonstrated a significant relationship between the prevalence of pulp and periapical lesions and factors such as sex, age, and type 2 diabetes. The findings revealed that the prevalence of pulp and periapical lesions is higher in patients with type 2 diabetes compared to those without diabetes. The likelihood of developing these lesions increases with age and is generally higher in women. Additionally, no correlation was found between the prevalence of pulp and periapical lesions in men without type 2 diabetes and increasing age in individuals with type 2 diabetes.

Previous reports on the symptoms and quality of life of patients with pituitary adenomas have paid little attention to physical activity. However, numerous studies have shown that physical activity can significantly influence prolactin secretion. Prolactin secretion levels, in turn, can affect various clinical outcomes, including tumor size, sleep quality, and fatigue levels in patients with pituitary adenomas. Given the intricate relationship between these factors, it is crucial to investigate how they interact to impact the overall health and quality of life of these patients. This study aims to bridge this gap by exploring the relationship between tumor size and fatigue levels, sleep quality, and physical activity in patients with pituitary adenomas. Understanding these relationships can provide insights into potential therapeutic strategies to improve patient outcomes.

A total of 116 patients diagnosed with pituitary adenomas from the Neurosurgery and Internal Medicine departments of Imam Khomeini Hospital in Sari were included in the study via census sampling. The inclusion criteria ensured that all participants had a confirmed diagnosis of pituitary adenoma. Demographic characteristics, tumor size (from patients' imaging records), prolactin levels (from patient records), physical activity levels (using the International Physical Activity Questionnaire), sleep quality (using the Pittsburgh Sleep Quality Index), and fatigue levels (using the Multidimensional Fatigue Inventory 20) were measured using checklists and validated questionnaires.

In the present study, 68 participants (58.6%) were female, and 48 (41.4%) were male. A total of 108 participants (93.1%) were aged 55 years or younger, and 8 participants (6.9%) were older than 55, with a mean age of 43.72±7.70 years. Of the participants, 71(61.2%) had prolactinomas, and 39(33.6%) had non-functional tumors. Tumor sizes ranged from 2.1 to 42.9 mm, with a mean size of 16.16±8.71 mm. The mean prolactin level was 561.52±413 ng/mL, with a minimum level of 8 ng/mL and a maximum of 1578 ng/mL. The results showed significant differences in the mean scores of sleep quality (5.81±1.91 vs. 6.73±2.14), fatigue (55.86±8.79 vs. 60.32±8.39), and physical activity (1203.95±258.65 vs. 1085.20±310.99) between patients with microadenomas and macroadenomas (P=0.048, P=0.008, P=0.038). Furthermore, correlation coefficients for age (r=0.415), fatigue (r=0.336), sleep quality (r=0.253), physical activity (r=-0.230), and prolactin (r=0.496) with tumor size were significant. The findings indicated that with increasing age, fatigue scores, sleep quality scores, and prolactin levels, tumor size also increases, while higher physical activity levels are associated with smaller tumor sizes. Additionally, as tumor size increases, prolactin levels, fatigue scores, and sleep quality scores increase, whereas physical activity scores decrease.

The study concludes that with increasing age, fatigue and sleep quality scores worsen, but physical activity levels decrease. Moreover, as tumor size increases, prolactin levels, fatigue scores, and sleep quality scores increase, while physical activity scores decrease. An increase in prolactin levels is also associated with increased fatigue.

This descriptive study included all hyperthyroid patients. All therapeutic results were recorded and analyzed.

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 <0.05). Patients with toxic adenomas and patients who did not respond to ATD or those who experienced relapse of hyperthyroidism received radioactive iodine or underwent surgery. Hypothyroidism occurred in 13.1% of patients with ATD alone, in 66.7% of those with surgery, and in 79.4% of the patients who received radioactive iodine (P= 0.0001).

A significant proportion of hyperthyroid patients experience drug failure. Age, BMI, thyroid weight, and basal levels of thyroid hormones are associated with drug treatment failure. Prevalence of hypothyroidism after treatment with radioactive iodine is higher than the drug treatment alone or surgery groups.

Correction to: Frequency of Psychiatric and Psychological Disorders in Patients with Type II Diabetes
Mollod Eskandari Khanghahi1,
Seyyed Hamzeh Hosseini2,
Ozra Akha3,
Mahdie Nasiri4
1 General Practitioner, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran
2 Professor, Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
3 Associate Professor, Department of Endocrinology, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
4 MA in Clinical Psychology, Faculty of Educational Sciences and Psychology, Alzahra University, Tehran, Iran 
* Corresponding Author: Ozra Akha - Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
(E-mail: zr_akha@yahoo.com)


In the article published in volume 27, issue 155, 2017, the email address for corresponding author was published incorrectly, which is now corrected.

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. 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. 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 <0.5, 4.9-0.5, and ≥5 using person correlation. This study showed no significant difference between the three groups (P= 0.3). TSH alone is not a suitable marker for predicting thyroid malignancy.

Background and Urinary tract infections (UTI) are one of the most common complications of diabetes. Asymptomatic bacteriuria or frequent symptomatic urinary tract infection are common in diabetic patients. Study of bacterial factors of UTI in these patients and the antibiotic resistance pattern and resistant strains are necessary.
In this descriptive cross-sectional study, 302 urine samples of diabetic patients attending Sari diabetes clinic (in 2015) were used. The specimens were cultured in Blood agar and McConkey and incubated at 37° C for 24 hours. Biochemical tests were done to identify the pathogenic bacteria and antibiotic susceptibility test was carried out by Kirby-Bauer disk diffusion.
Among the samples, 22.5% were positive for urinary tract infections including 76.4% of the females’ samples and 32.6% of males’ samples. The most prevalent bacteria isolated were group B Streptococcus (25%). According to antibiogram testing, the most sensitive antibiotic was chloramphenicol (70%) while cefotaxime, ceftazidime, and ciprofloxacin were found to be highly resistant.
The study showed that the third generations of cephalosporins commonly used in treatment of UTI are not appropriate in diabetic patients. So, Chloramphenicol is recommended for treatment of these patients.

Background and 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.
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%.
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 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.

Background and Today, cognitive-behavioral group therapy is empirically supported in treatment of emotional disorders and in some ​​chronic diseases such as diabetes. The aim of the present research was to study the effect of cognitive-behavioral group therapy on glycosylated hemoglobin (HbA1c), self-efficacy, depression, illness perception, and quality of life in patients with type II diabetes.
In this clinical trial, 43 patients were found eligible, of whom 30 were selected using simple random sampling and were divided into two groups: experimental and control. HbA1c was measured in all participants and they completed the Beck Depression Inventory (BDI), Self-efficacy in diabetic patients (DMSES), Illness Perception Questionnaire (IPQ), and Diabetes D-39. The experimental group attended 10 training sessions based on cognitive-behavioral therapy (Beck approach), for 1.5 hours, twice a week. The scales were completed again, after the intervention and a month later. The HbA1c was also measured again.
The mean age of participants was 46.5±7.21 years. At first, both groups were heterogeneous in dependent variables. Cognitive behavioral group therapy decraesed depression (P=0.049) and increased illness perception (P=0.005) in patients with type II diabetes, but HbA1c, self efficacy, and quality of life did not change significantly.
In this study, cognitive-behavioral group therapy was found to have positive effects on reducing depression and increasing the illness perception in diabetic patients. Hence, it is suggested along with current treatments in type II diabetes.

Diabetes mellitus is a common chronic metabolic disease which have numerous physical effects for patients.
The aim of this study was to determine the prevalence of subjective xerostomia and burning mouth of patients with type 2 diabetes mellitus in cities of Sari and Qaemshahr.
In this descriptive-analytic study, totally 1455 patients with type 2 diabetes mellitus with complain of xerostomia and/or burning mouth which had referred to diabetes clinic in Sari and Qaemshahr were examined in 2016. For every patient asked about chronic xerostomia and burning mouth and if the answer was positive, the oral examination was done to ensure the absence of mucosal lesions and find signs of xerostomia. Then, xerostomia questionnaire was completed by patients suffering from dry mouth. Finally, the information was statistically analyzed by T test and chi square test.
Findings: Prevalence of burning mouth was found 111 (7.6%) in diabetic patients that in the women were significantly higher than in men (P Possibility of burning mouth, and xerostomia will increase in the diabetic patients with low metabolic control which can cause more severe side effects related to oral health.

Background and Evidence shows many kinds of psychological disorders and problems in interpersonal and social communications associated with diabetes. Such problems reduce the quality of life of people involved. The aim of this study was to investigate the prevalence of psychiatric disorders in patients with type II diabetes.
This cross-sectional study was conducted in 202 type II diabetic patients with at least one year experience of the disease attending endocrine clinic in Sari, Iran 2015. Data collection was carried out using a demographic questionnaire, the SCID-I and General Health Questionnaire (GHQ-28). Data was analyzed in SPSSV20.
The mean duration of diabetes was 9.67±6.6 years. Among the patients 25.4% had major depressive disorder, 34% had obsessive-compulsive disorder, and 4.6% were found with generalized anxiety disorder. According to SCID-I, 9.57% had at least one psychiatric disorder and based on GHQ-28, 37% had mental health problems.
High prevalence of mental disorders was found in patients with type II diabetes. These disorders have negative impacts on the control and treatment of diabetes, therefore, psychiatric consultations on a regular basis are necessary to avoid further problems.

Gordon syndrome is a familial autosomal dominant syndrome with hyperkalemia, increased extracellular volume, hypertension, normal kidney function, and metabolic acidosis. It is also called type II Pseudohypoaldosteronism due to usually normal aldosterone and low renin levels. In this report a 35 years old woman is presented with 2-year history of hypertension, eclampsia, and fetal death. Laboratory tests showed hyperkalemia and metabolic acidosis. After evaluation, thiazide was administrated according to Gordon syndrome diagnosis. Interestingly, after reciving low dose of hydrochlorothiazide the patient had a successful full term pregnancy and a healthy baby. In patients with high blood pressure and hyperkalemia and Gordon syndrome can control blood pressure and hyperkalemia well with low dose thiazide and have healthy pregnancy without materno - fetal complication.

Background and Vitamin D is a steroid hormone. It plays an important role in bone metabolism and neuromuscular function. It is mainly synthesis from converting 7-dehydrocholesterol to cholecalciferol on skin with exposure to sunlight. This study aimed at comparing the serum levels of 25-hydroxyvitamin D after taking parenteral and oral vitamin D in patients with vitamin D insufficiency.
This historical cohort study was done in 400 patients with vitamin D insufficiency attending Rheumatology and Endocrinology clinics in Sari, 2013-2014. The patients were treated either by vitamin D3 (cholecalciferol) orally (control group) or injection (case group).
The patients were 333 females (83%) and 67 males (16.8%). Two hundred forty four patients received intramuscular (IM) and 158 received oral vitamin D3. The mean serum levels of 25 (OH) D before and after the intervention in oral group were 17.16 ± 0.39 and 43.02 ± 0.48 ng/ml, respectively (P Administration of oral or injectable vitamin D led to increase in 25 (OH) D levels, but there were no difference in terms of the effects or compilations. According to the requirements and wishes of the patients either the oral or injectable form could be administered for prevention or treatment.

Background and Ischemic Heart Disease (IHD) is one of the most important complications of diabetes mellitus (DM). This study was designed to investigate the prevalence of IHD and related factors in patients with type II DM in north of Iran. A cross sectional study was conducted in 1021 patients with diabetes type II attending endocrine clinics affiliated with Mazandaran University of Medical Sciences, Iran, 2010 to 2012. Age, gender, history of myocardial infarction, hypertension, hyperlipidemia, smoking and other recognized complications of DM were recorded. All patients were referred to cardiologist and the exercise test was used and if needed the thallium perfusion scan and coronary angiography were done for patients without history of myocardial infarction,coronary artery bypass surgery or stent placement. There were 1021 patients and 907 were female (88.8%). Mean age and duration of diabetes were 54.4 (95% CI: 53.8- 55.1) and 8.8 (95% CI: 8.4 - 9.2) years, respectively. Almost 87% (95% CI: 85-89) and 53% (95% CI: 50-56) had dyslipidemia and hypertension, respectively. Among the patients, 274 patients (37% males and 25% females, 26.8%; 95% CI: 24.1-29.5) were suffering from IHD (P =0.006). According to regression logistic analysis duration of diabetes, older age, hypertension, and low left ventricular ejection fraction were independent predictor factors for IHD. Approximately one-third of diabetic patients are suffering from IHD. This disorder can be asymptomatic in individuals with diabetes, therefore, it may not be diagnosed in almost half of patients. Most important associated factors are older age, duration of diabetes, hypertension and low left ventricular ejection fraction.

Background and In recent years the prevalence of diabetes mellitus has been increasing worldwide. Many researchers investigated the probable effect of vitamin D on pathophysiology of diabetes mellitus but there are contradictory results. This study was designed to survey the effect of vitamin D improvement on blood glycemic control in patients with type II diabetes. In a controlled clinical trial, 102 patients with type II diabetes were participated whose vitamin D levels were under 15 ng/ml. They were classified into two groups; moderate deficiency (10-15 ng/ml, n=48) and severe deficiency (under 10 ng/ml, n=54). Two intramuscular (IM) injections of vitamin D (300,000 IU) were administered at a one-week interval. We measured vitamin D levels, FBS, HbA1c, and used Homeostasis model assessment of Insulin Resistance (Homa-IR) before the treatment and after 12 weeks. Paired t-test was used to analyze the pre and post intervention results and independent t-test was applied to compare the data between the two groups. In both groups there were differences in vitamin D levels before and after the treatment (P=0.0001). But no significant difference was found before and after the intervention in HbA1c, FBS and Homa-IR. According to before intervention Homa-IR, significant dicreasion in HbA1c was observed only in insulin sensitive group (P=0.01). Also Patients with atleast 0.5% decreasion in HbA1c after the treatment had higher first HbA1c than no response group (P= 0.014). Treatment of vitamin D deficiency with intermuscular vitamin D dose not significant effect on blood glocuse though patients with higher HbA1c and also insulin sensitive show better respons to treatment.

Background and Diabetic foot ulcers are one of the major causes of morbidity and mortality in diabetic patients. For centuries Aleo vera has been used in treatment of diabetic foot ulcers. In this study, a mixture of honey and Aloe vera was used for diabetic foot ulcer healing. In a double-blind clinical trial, patients with nonischemic, noninfected diabetic foot ulcers (attending Imam Khomeini Hospital Diabetes Center, Sari, Iran) were divided into two groups, a treatment group (n= 24) and a placebo group (n=15). To compare the effect of the mixture t-test and qui square were applied. A total of 39 patients (19 males and 20 females) with diabetic foot ulcers were enrolled. Mean age of the patients, mean body mass index, and mean duration of diabetes were 56.3 ±10.2, 31.2 ± 4.2, 16.2 ± 6.6, respectively which were not significantly different between the two groups. Wound size was determined using a ruler that showed no significant difference between the two groups (P=0.36). Debridement, offloading and washing were done for all participants. Combined gel of Aleo vera and honey was used for treatment group. Wound healing was seen in 21 (95.5%) patients in treatment group and in 11 (78.6%) patients in placebo group. In small, non-infected, non-ischemic ulcers the effect of honey and Aloe vera gel was the same as that of the placebo. Offloading, debridement and washing with normal saline have similar effect to the mixture in healing diabetic foot ulcers.

Background and Urinary tract infection (UTI) is one of the most common and the most important clinical problems in patients with diabetes mellitus. In asymptomatic form it could cause symptomatic UTI and sepsis. There is controversy over the prevalence and risk factors of asymptomatic UTI. This study was conducted to determine the prevalence of asymptomatic UTI in diabetic patients attending Imam Khomeini Hospital in Sari. This cross sectional study included 349 diabetic patients referring Diabetes Clinic in Imam Khomeini Hospital without symptoms of UTI. Urine analysis and urine culture were performed and data was collected including demographic characteristics, duration of disease, FBS, 2hrpp, and number of WBC bacteria in urine. The patients were 92 male (26.36%) and 257 (73.63%) female and asymptomatic UTI was observed in 16.9% (n= 59 patients). Its prevalence was 13.04% in male and 18.28% in female. According to the results prevalence of asymptomatic UTI was high in patients with long duration of disease, poor control of diabetes, high number of WBC and bacteria in urine.

One of the most common clinical problems among individuals is thyroid nodule diseases which are characterized by one or more nodules in the thyroid and are usually benign. It can be said that thyroid cancer is the most common endocrine cancer worldwide. This study aimed to determine the risk factors for cancer in patients with thyroid nodule in Mazandaran province،Iran، using parametric survival analysis. In the present historical cohort study، 26،730 patients with thyroid nodules who were referred to health care centers from July 2002 to March 2008 were identified. Parametric log-normal and log-logistic models were compared with and without taking frailty into account. The criterion for comparing models was Akaike''s criterion. All calculations were performed with the SPSS software and the significance level was considered 0. 05. The mean time of the conversion of thyroid nodules to cancer in patients was found to be 29. 32 months. Using Kaplan-Meier method، survival rates of one year، five years and ten years of nodule conversion to cancer was calculated 94. 6، 88. 6 and respectively. According to the log rank test age (p=0. 03)، hypothyroidism (p=0. 01)، bilateral nodules (p <0. 001)، a multi-nodular goiter (p <0. 001)، TSH hormone (p <0. 001)، T4 hormones (p = 0. 005)، cholesterol (p = 0. 03)، creatinin levels (p = 0. 001) a significant relationship was seen. Based on the Akaike''s criterion، the lognormal model which takes frailty into account best fits to the data. Based on the log-normal model with frailty، It can be concluded that the thyroid nodule patients with abnormal TSH hormone are 6. 55 times more likely to develop risk of thyroid cancer than patients who had normal TSH hormone overall. This model also indicated that patients who had heart palpitations are 5. 52 times more likely to develop risk of cancer than patients who did not have heart palpitations.

Dialectical Behavior Therapy (DBT) is one of the cognitivebehavioral therapeutic methods based on skill training, which have drawn so much attention in recent years. This study aimed to determine the effectiveness of an intervention based on DBT in reducing trait and state anxiety level of patients with type II diabetes. The population study was all the patients with type II diabetes who attended private clinic in Sari among them 20 were permitted. An experimental pretest-posttest design control group was used. Participants of the experimental group received 12 therapeutic sections in 6 weeks. Each section lasted 2 hours where skills based on DBT were taught based on therapeutic manual (mindfulness, emotion regulation, tolerance and interpersonal efficacy). Spielberger State-Trait Anxiety Inventory (STAI-Y) was used to measure anxiety in pretest and posttest. Data were analyzed using analysis of covariance. Results showed that modifying the preset effect, there was a a statistically significant difference between two groups in the posttest Consequently, the intervention based on DBT is effective in the reduction of statetrait anxiety in patients with type II diabetes.

Diabetes is a major risk factor of chronic diseases such as cardiovascular disease with high mortality. Prevalence of diabetes type 2 is increasing in Middle Eastand Iran. In the current study, relationship between major food patterns and diabetes type 2 were assessed. In this case control study, 332 subjects (110 newly diagnosed cases and 222 controls); 43-77 years of age were selected with simple sampling method. A valid semi- quantitative food frequency questionnaire was used to collect dietary intakes of subjects. Anthropometric characteristics and blood pressure were measured with standard instructions and body mass index (BMI) and waist to hip ratio (W/H) were calculated. Blood sample was gathered in order to metabolic variables assessment. Factor analysis was used to identify major food patterns. Relationship between major food patterns and diabetes type 2 was assessed by logistic regression analysis. Three major food patterns were identified in our study subjects: the healthy food pattern (rich in vegetables, vegetable oils, fish, fruits and nuts), the mixed food pattern (high consumption of salt, organ meats, dried fruits, poultry, tea, low- fat dairy products and other vegetables) and the traditional food pattern (high consumption of garlic, dough, high- fat dairy products, dried fruits, red meats, grains and animal fat). After controlling for confounding variables, subjects in the highest quartile of mixed and traditional food patterns had 117% (odds ratio: 2.17 and 95% CI: 1.0-4.50) and 113% (odds ratio: 2.13 and 95% CI: 1.03-4.41) higher odds of diabetes type 2, respectively, compared to those in the lowest quartile. Even before and after controlling for confounders, no overall significant relationship was observed between healthy food pattern and diabetes type 2. this study suggests that mixed and traditional food patterns are associated with an increased odd for type 2 diabetes.

Background and Diabetes mellitus due to impaired insulin secretion, leads to short term and long term complications. Some of these complications are diabetic nephropathy and renal failure. The prevalence of diabetic nephropathy is 20-30% in Iran and 20% of type II diabetes and 75% of type I diabetes are affected in 20 years. Microalbuminuria has utmost importance as a marker of renal dysfunction in predicting the course and treatment of disease. The aim of this study was to evaluate microalbuminuria and diabetic nephropathy and their related risk factors in type II diabetic patients referred to endocrine clinics in Sari. In this study, 914 patients with type II diabetes mellitus who referred to endocrine clinics in Sari from 2003 to 2009 were investigated on the 24-hour urine samples, fasting blood glucose, glucose 2 hours after a meal, glucose 4 pm and HbA1c. Data were entered into SPSS17 statistical software and statistical analysis was performed. Data were extracted from patient records. The prevalence of microalbuminuria was 45% in this study. There was a significant correlation statistically between microalbuminuria and variables; body mass index (P= 0.02), systolic blood pressure (P= 0.05), total cholesterol (P= 0.05), metformin (P= 0.033). Thus, the body mass index, systolic blood pressure and total cholesterol were higher in patients with microalbuminria. And the consumption of Metformin was lower in them. Microalbuminuria is a major problem in our patients and according to study findings, attention to control of blood pressure, reducing of serum cholesterol and weight in these patients is essential.

Previous studies have reported a relatively high incidence of total and subtotal thyroidectomy complications in Iran. Fear of this complication has led some internists and patients to avoid thyroid surgery. The aim of study was to determine the recent decade frequency of total and subtotal thyroidectomy complications in Sari, Iran.

In this cross-sectional study, the patients underwent total or subtotal thyroidectomy during 2001-2011 at two referral hospitals in sari (Imam Khomeini as academic and Shafa as private hospital) were enrolled. The questionnaire included demographic information, diagnosis and pathology of the disease, type of thyroid surgery, serum calcium level after the surgery, recurrent laryngeal nerve injury, and hematoma data. Frequencies, Odds ratio and their 95%CI were reported.

Among the 382 subjects (66 men and 316 women), 86 cases (22.5%) underwent total and 296 cases (77.5%) underwent subtotal thyroidectomy. The final pathology was malignant in 25.1%. Hypocalcaemia occurred in 40.3% of patients (CI95%: 35.5-45.3) that 4.2% (CI95%: 2.3-6.6) were permanent. Recurrent laryngeal nerve injury was reported in 0.8% (CI95%: 0.3-2.3) [0.3% permanent (CI95%: 0.05-1.5)] and two cases (0.5%) complicated by cervical hematoma (CI95%: 0.1-1.9). Total thyroidectomy was associated with more complications than subtotal. [OR: 6.4 (CI95%: 2.6-16.1), P = 0.0001].

The findings of this study show that total and subtotal thyroidectomy complications has significantly decreased that can be due to improved surgical techniques and increased proficiency of surgeons.

Insulin has an important and vital role in control of blood glucose for all diabetic patients. With increasing the prevalence of diabetes mellitus، insulin consumption will be increased too. Different types of insulin are available، i. e short، rapid، intermediate and long acting insulin and also mixed insulins. The side effects of insulin may lead to the lack of a desirable control of blood sugar or discontinuing insulin injection by the patients. On the other hand sometimes the side effects of insulin can be serious and fatal. Therefore، information about these complications and how to deal with them are very important. Hypoglycemia، weight gain، antibody-mediated insulin resistance، lipodystrophy (atrophy or hypertrophy)، edema، postural hypotension and Allergic reactions to insulin are major side effects of insulin therapy.

Background and The prevalence of malignancy in thyroid nodules have been reported 1-10%. Epidemiological studies suggest that thyroid cancer incidence is rising over the last 20 years. The aim of this study was to evaluate the results of fine needle aspiration of thyroid nodules in patients referred to Imam Khomeini hospital in recent decades (2003-2011) in Sari. This is a cross sectional, retrospective study. The results of cytology were recorded and compared with pathology results. The sensitivity, specificity, positive and negative predictive value of fine needle aspiration for prediction of malignancy were assessed. The study population included 2002 patients with thyroid nodules, 210 cases were male (10.5%) and 1792 women (89.5%). Cytology results in 1598 cases (79.8%) were benign, 205(10.2 %) unsatisfactory, 53(2.6 %) suspicious and 146 (7.3 %) malignant. 217 reports of pathology results of patients with thyroidectomy were available, 153(70.5%) specimens were benign and 64 (29.5%) malignant. The sensitivity of fine needle biopsy was 81.2% and specificity, 75.1%. positive predictive value(PPV) and negative predictive value(NPV) were 63.4% and 93.5 percent respectively. According to the results of this study, thyroid fine needle aspiration is still a good way to predict thyroid malignancy and the incidence of thyroid malignancy in our patients has not increased in recent decades.

Background and Âlthough congenital hypothyroidism is a preventable cause of mental disabilities, less than 10% of newborns are diagnosed based on clinical symptoms in the first month. Ând if the diagnosis is not made based on screening programs, it would be delayed and irreparable cerebral and auditory complications will result. The purpose of this study was to determine the prevalence of congenital hypothyroidism in the Mazandaran province. The study is a descriptive (screening) survey. From infants born from January 2007 to January 2008 in Mazandaran province heel blood samples on filter paper were obtained. TSH values were measured by ËLÏSÂ method and TSH> 5 mlu/L was considered as the recall criterion. Diagnosis of neonatal hypothyroidism was made based on TSH>10 and T4<6.5. Treatment was performed based on the results of second tests. Ëxcept in cases where the initial TSH was greater or equal to 20 -where the treatment was started from the beginning- if the second test results were reported normal, treatment was discontinued and the case was considered as a transient hypothyroidism. Ôut of 45218 infants studied, 49% were female and 51% were male. 4.6% of newborns (2109) were recalled, among whom 1885 had 5< TSH< 10 mlu/L and 185 had 10< TSH< 20 mlu/L and 39 had TSH ³ 20.73 infants were diagnosed with hypothyroidism. Thus, the prevalence of neonatal hypothyroidism was 1.6/1000 in live births in Mazandaran province. Âlso prevalence of transient neonatal hypothyroidism was 1 in every 2500 live births.Çonclusion: Given the high prevalence of hypothyroidism in the province, more screening program is essential.

Background and

Based on the high prevalence of diabetes mellitus and hypothyroidism and different disorders from their coincidence, the present study was designed to determine the correlation between type 2 diabetes mellitus and hypothyroidism.

Ïn this case-control study, 103 type 2 diabetic patients were compared with 103 healthy subjects. Âge, gender and family history of thyroid disease were matched between the two groups. For all patients, anti-thyroid peroxidase antibody (Ânti-TPÔ), FBS, Triglyceride, Çholesterol, HDL and LDL were measured. Descriptive analysis, T-test and X2 were used for data analysis.

Ïn each group, 14 (%13.59) cases were men and 89 (%86.4) cases were women. The prevalence of hypothyroidism in the case group and the control group were %17.5 and %26.2, respectively, which was not statistically significant (P>0.05). Twenty eight percent of hypothyroid patients in diabetic group and 55% in the control group had autoimmune hypothyroidism (P<0.05).Çonclusion: The results of this study showed that the prevalence of hypothyroidism in type 2 diabetic patients is as high as normal population. Because of the interaction between diabetic mellitus and hypothyroidism, screening of hypothyroidism and suitable treatment in diabetic patients is recommended.