فهرست مطالب مژگان افخمی زاده

helicobacter pylori infection is a common infection worldwide. One of the side effects that are suggested for this infection is Diabetes and insulin resistance (IR). The aim of this study is evaluation of HP eradication on insulin resistance is NAFLD. 51 patients with NAFLD and HP infection and dyspepsia were selected for this study. Patients were divided into two groups (control group and intervention group). Control group received only the life style changes and intervention group, on the other hand, received HP eradication therapy in addition to the life style changes. FBS, Chol, TG, LDL, HDL, insulin, BMI, HOMA-IR were checked before and after HP eradication in both groups. In both groups, no significance difference were observed between the parameters which were evaluated. it seems that HP eradication per se might not effect on FBS, lipid profile and insulin resistance. Although further studies are needed on this subject.

There is strong clinical and experimental data that testosterone stimulates erythropoiesis. Inflammation، on the other hand، significantly impacts on haemopoiesis، partly through its suppression of erythropoietin and partly through its direct action on erythropoiesis. Therefore، in this study we evaluated correlation of serum testosterone levels with hemoglobin (Hb) and high sensitive CRP (hs-CRP) in patients with Chronic Kidney Disease (CKD (in third and fourth stages and hemodialysis patients. A total of 29 patients with CKD in third and fourth stages (group1) and 29 hemodialysis patients (group 2) were included in this study. Serum hs-CRP، Hb، total and free testosterone، LH، FSH and erythropoietin levels were measured. Pearson`s correlation analysis was used for determining correlation between variables. The mean of serum hs-CRP level was significantly lower in group1 than group 2، while serum FSH was significantly higher in group1. Pearson`s correlation analysis showed a significant positive correlation between hs-CRP and LH in total patients in two groups and patients in group 2. In comparison among 4 groups including group 1 and 2 with (Hgb The significant inverse correlation between hs-CRP and total testosterone in hemodialysis patients with Hb lower than 11gr/dl suggested that this association may also partly contribute to anemia in hemodialysis patients compared with CKD patients in third and fourth stages.

Communication skills assessment requires the use of valid instruments. The present study has done to investigate concurrent validity of the simulated patient meaning relationship between test results by the simulated or real patient and possibility to generalize the results by simulated patient and in simulated environment for real patient and in bedside. In this correlation study, 32 medical externships were enrolled by purposive sampling method. The students were divided randomly into two equal and homogeneous groups. Using crossover design, first group were assessed by real patient initially and then, simulated patient and second group, were measured conversely. Communication skills assessment was done using a checklist retrieved from Calgary-Cambridge interview skills checklist. The data were analyzed using descriptive and analytical statistics. In first assessment, comparing scores by simulated and real patient in first group, second group and total students showed significant differences. In second assessment between two groups, the statistics results was not significant with very minor differences (P = 0.064). There were positive correlation between scores of total students by simulated and real patient (r = 0.63). According to the results, communication skills of each student in simulated position cannot be generalized to real situation and cannot be claimed that simulated patient can be used instead of real patient.

The prevalence of obesity is increasing worldwide as a warning. There are some evidences that show a relationship between thyroid hormones and weight changes. The aim of this study was to determine the relationship between thyrotropin and body mass index، in euthyroid people with different weights. This study was conducted on healthy women who were referred to the endocrine clinic. After taking a thorough history، doing a complete physical examination، checking for signs and symptoms of hypothyroidism or hyperthyroidism and measuring their height and weight، thyroid function tests were done. Overall 283 women participated. The mean age and BMI were 35. 88±12. 75 years and 26. 18±6. 25 Kg/m2، respectively، 11% of them were underweight، 35. 5% were normal and 29. 3% were overweight and 24% were suffering from obesity. The mean serum TSH level was 2. 29±0. 07. The lowest serum TSH levels was in people with normal BMI، but there was no significant relationship between TSH serum levels in different BMI groups. There wasn’t significant relation between BMI and TSH (r=0. 108، P=0. 071). Based on the results of this study، there was no relationship between BMI and TSH serum levels in euthyroid women.

Peripheral neuropathy has been known as the main cause of diabetic foot ulcer and limb amputation. Early diagnosis of this complication can prevent more severe morbidity as well as enormous economic costs.

Based on the duration of the disease, 110 diabetic patients were divided in two groups of less than 10 and more than 10-year history. After taking complete history about the symptoms of neuropathy, the patients were examined neurologically. Then, electrodiagnostic studies were performed on the patients.

96 patients (87/2%) had diabetic neuropathy. The prevalence of neuropathy had a significant relationship with the duration of the disease (P value= 0.004). 61 patients (55/4%) complained of neuropathic symptoms. The results of the neurological exams were abnormal in 65 patients (59.09%). The most common symptom was paresthesia (50% of patients) and the most frequent sign was abnormal Achille's reflex. 77 patients (70%) had abnormal indices in nerve conduction studies the most common of which was decrease amplitude of peroneal and sural nerves. 16 patients (14/5%) showed alterations in NCS in the absence of clinical signs or symptoms and 19 patients (17/2%) had normal NCS indices despite the presence of signs or symptoms of neuropathy.

High sensitivity of taking history and a careful neurological examination in the diagnosis of diabetic neuropathy necessitates physicians to pay more attention to clinical examinations and patient complaints, and avoid costly electrodiagnostic investigations. Thus, early diagnosis of sub-clinical neuropathy in these patients and providing them with necessary recommendations, irreversible complications such as amputation can be prevented.

Vitamin D deficiency is prevalent worldwide. Low 25 hydroxyvitamin D3 concentrations inversely associated with type 2 diabetes, metabolic syndrome and insulin resistance. The aim of this study was the evaluation of effects of oral 1, 25 (OH) 2D3(calcitriol) treatments on glycemic control and lipid profiles in patients with type 2 diabetes. Methods and Materials: This was an interventional study, conducted in Ghaem Hospital, Mashhad, Iran on 58 type 2 diabetic patients. Patients underwent calcitriol treatment with 0.5 microgram per day for 8 weeks. In all cases, clinical parameters including weight, systolic and diastolic blood pressure and laboratory parameters including levels of fasting blood glucose, insulin, lipid profile, calcium, phosphorous, HbA1C and insulin resistance (HOMA-IR) were measured, before and after the treatment period. The two sets of results were then compared with one another. Following treatment with calcitriol, FBS, HbA1C, Cholesterol, triglycerides and insulin resistance decreased but the changes were not significant (p>0.05). LDL and diastolic blood pressure decreased significantly after treatment with calcitriol. (p=0.02 and 0.04 respectively). Supplementation with active form of vitamin D did not have a significant effect on glycemic control but may be effective in control of hyperlipidemia and blood pressure in type 2 diabetic patients, findings which need to be confirmed in large randomized trials

Thalassemia major, as hemolytic disorder leads to increased iron load in patients and despite current treatment with deferouxamine the precipitation of iron in different endocrine systems results in disturbances in theses endocrine systems. In this study we evaluated endocrine disorders in patients with thalassemia major.

Subjects were patients with thalassemia major who referred to the endocrinology clinic. All of them underwent thyroid function tests and biochemistry assays. Growth hormone stimulation with levodopa, was done if indicated. FSH and LH, stradiol and testosterone were requested for adolescents.

44 patients 8.5 to 25 years old, underwent all tests. 40.9% of them were female. 11.3% of them had diabetes, and 88% of adolescents had hypogonadotropic hypogonadism. 15.9% had hypocalcemia and hyperphosphatemia. None of them had thyroid disorders. Height of 90.9% of patients was under the fifth percentile. Only 22.2% had abnormal response to stimulation test with levodopa. 22.7% of patients, had normal results for endocrine tests.

Our result showed that despite deferoxamine treatment in our patients, thalassemia major endocrine disorders were common. Hence, more effective treatment with deferoxamine appropriate dose and time of initiation is recommended.