مژگان کاویانی

Tuberculosis is the leading cause of death from infectious diseases worldwide. Diabetes has been suggested as an important risk factor for tuberculosis. To date, few studies have examined the association between diabetes and tuberculosis. In this study, the prevalence of latent tuberculosis in diabetic patients was investigated.

In this study, 195 patients with type 2 diabetes were studied in a cross-sectional study to diagnose latent tuberculosis infection with a tuberculin skin test. Individuals with symptoms of active tuberculosis were excluded from the study, and individuals with a positive tuberculin test were evaluated for active tuberculosis by chest x-ray. For analyzing the data, SPSS software version 16 was run, a t-test was used to analyze quantitative variables, and for qualitative variables, Chi-square was applied.  The significance level of 0.05 was considered for all the results.

Out of 195 diabetic patients, 115 patients were referred for tuberculin test results. 43 out of 115 patients (37.39%) had an induration diameter greater than or equal to 5 mm, 29 patients (25.21%) had an induration diameter greater than or equal to 8 mm, and 3 patients (2.61%) had an induration diameter greater than or equal to 10 mm (Positive tuberculin test) (p>0.05).

False tuberculin skin test results can hide the true prevalence of latent tuberculosis infection. The sensitivity of the tuberculin test decreases in immunocompromised patients and leads to limitations in assessing the prevalence of latent tuberculosis infection. Although not enough information was available in this study to establish a significant association between diabetes and latent tuberculosis infection, further studies will help to investigate this association.

Diabetic ketoacidosis is an acute complication of diabetes, and a medical emergency that is usually seen in type I diabetic patients. No manifestation of type I diabetes is sometimes diagnosed, particularly in children, and the disorder is accompanied by insulin deficiency, reduced size, and altered mental status. This descriptive epidemiological study included all the diabetic patients with diabetic ketoacidosis who had been hospitalized in Shohada hospital from June 2009 to June 2013. The records of the patients were studied and the necessary data were extracted considering the specified criteria. The data were then recorded in a questionnaire. Thirty-eight cases with diabetic ketoacidosis were found in the hospital records. Most of the infected cases were female, and the complications was more prevalent in the age groups of 9-10 and 20-29 years. Discontinuation of insulin was the single most frequent predisposing factor. Most of the cases were severe, mostly in the females. The patients and their familie's unawareness of the acute symptoms of the disease, and refusal of treatment, which led to the discontinuation of insulin use, were the probable causes of the severity of the disease in our study population.

In addition to adequate nutrition and balance of nutrients in the pregnant mother's diet, maternal weight gain during pregnancy has a major impact on maternal health and fetal well-being. The purpose of this study was to compare pre-gestational BMI and gestational weight gain on GDM according to the new definition of GDM. This descriptive cross-sectional study was carried out on 18 to 35 years old pregnant women with no underlying disease using convenience sampling method In the first months of pregnancy, women's height, weight and blood pressure as well as FBS were measured.The second assessment was done in the 24th-28th weeks of gestation using repeated measurements of weight, blood pressure, and gestational diabetes screening test (GCT). The third evaluation was conducted at the end of pregnancy to measure mother and infant weight.The data was analyzed by SPSS, version 16, t-test and Mann-Whitney test. In this study, 600pregnant women were evaluated.Mean BMI befor pregnancy in the women with GDM was significantly higher than in the women without the above-mentioned problems(P=0.0001). The mean weight gained during pregnancy in the women with these symptoms was significantly higher than that in the women without the above –mentioned problems(P=0.039)(P=0.0001). Compared to pre-pregnancy BMI, weight gain during pregnancy had a higher with GDM(0.278 vs 0.077). Pre-pregnancy BMI in comparison with weight gain during pregnancy, had a higher correlation with GDM and macrosomia

Although the relationship between foods and nutrients with metabolic syndrome is known to some extent، the study of dietary patterns and their relationship with metabolic syndrome have more benefits than the relationship is exclusively one or more micronutrients. This study aimed to determine the relation between western dietary patterns with metabolic syndrome in Khorramabad city. In this study، 973 patients (237 males and 736 females) Khorramabad''s residence with multistage cluster and randomized systematic sampling selected. Food intake assessment، weight and height were measured and BMI was calculated. Venous blood samples were collected for measurement of metabolic variables and blood pressure were measured. Metabolic syndrome was defined based on AHA (American Heart Association) criteria. This study showed that participants in the highest quintile of western dietary pattern in compare to the participants in the lowest quintile of western dietary pattern had more risk of metabolic syndrome (OR=2. 21، CI 95%: 1. 42-3. 44). Discussion & Findings of this study showed that healthy dietary pattern (poultry، low and high fat dairy، cruciferous vegetables، green and yellow vegetables، other vegetables، legumes، whole grains، fish، olives، fruits) decreases the risk of metabolic syndrome.

Gestational diabetes is defined as a glucose intolerance of varying severity، with onset or first recognition during pregnancy. The aims of the present study were assessing the serum levels of leptin and adiponectin and the relationship between adiponectin/leptin ratio and insulin resistance (HOMA-IR) in gestational diabetes. This cross-sectional study was conducted on 30 pregnant women with gestational diabetes and 30 healthy pregnant women referred to Asalian hospital of Khramabad، Iran in 2012. Serum levels of Insulin، leptin and adiponectin were assessed using enzyme-linked immunosorbent assay method (ELISA). Data were analyzed using SPSS software version 11. 5، Mann-Whitney and Spearman correlation tests. P value less than 0. 05 was considered significant. Serum level of leptin was not significantly different between groups (p=0. 20) but adiponectin level was significantly decreased in gestational diabetes group (p=0. 01). Serum level of insulin was not significantly different between groups (p=0. 42)، but HOMA-IR was significantly increased in gestational diabetes groups (p=0. 04). The adiponectin/leptin ratio was decreased significantly in pregnant women with gestational diabetes compared to healthy pregnant women (p=0. 01). The adiponectin/leptin ratio might be used as a potential biomarker for diagnosis or early recognition of insulin resistance in gestational diabetes.

Diabetes is a chronic and worldwide common disease. This disease has many physical chronic complications. The aim of this study was to evaluate chronic complications of type 2 diabetes in the patients hospitalized in Shohada Ashayer hospital because of lack of control of plasma glucose with oral drugs. This retrospective cross sectional study was carried out on the patients hospitalized because of lack of control of plasma glucose by oral drugs in 2009-2010. The required data were gathered using a questionnaire. The collected data were analyzed by SPSS software and chi-square and Fisher''s exact test. P value <0. 05 was statistically regarded significant. Studied subjects were 299 patients، of them 177 were female. The mean age of the patients was 58. 6±14. 7 years. Cardiovascular diseases (41. 5%) and retinopathy (37. 4%) were the most frequent complications. There was a significant relation between retinopathy and nephropathy، and the duration of the disease. Considering the high prevalence of cardiovascular complications in the patients and the lack of a routine method for evaluation of these complications in the diabetic patients، designing a plan for periodic evaluation of these patients is suggested.

Self-care is considered as an important process in to control diabetes. The aim of this study was to investigate the self care and its influencing factors in diabetic patients in Khorramabad city.

In this cross-sectional study 80 patients with type 2 diabetes، a dmitted to hospitals diabetes clinic and urban health care centers and an endocrinologist''s office in Khorramabad، were selected using convenience sampling method. Data ghathering tool in this study was self-care scale Tubert – Glasgow which assessed the self care of their patients in different domains during the past seven days. Data were analysed by independent t- tests and one way ANOVA.

Self-care average scores in patients were (32. 7±12. 76) and the utility level was moderate. Low self-care behaviors were seen in daily check of blood glucose (3. 4±3. 8)، physical activity (4. 7±4. 2) and general care of the feet (4. 9±4. 9). The self care average scores based on litrecy، resident place، type of treatment and the patients'' life net was significantly different.

In order for health promotion and optimal control of disease in diabetic patients، training programs to empower patients in their self care should be considered.

Gastrointestinal Cancers are one of the most important causes of mortality of patients in the world as well as in our country. The North of Iran is in Asian belt of esophagus cancer in addition, in other areas of our country gastric cancer is the most common GI Cancer. Because GI Cancers are common in Lorestan, we decided to study them in patients undergo endoscopy and colonoscopy in Shahid Rahimi hospital. This descriptive, cross-sectional research was carried out on patients from the city of Khorram Abad and its suburbs who underwent endoscopy and colonoscopy at Rahimi hospital since Sep 1996 to Sep 1999. Biopsy samples were taken from all patients and analyzed pathologically. The distributions of cancers were determined according to age, sex, type and site of cancer. Totally, 408 patients out of 3088 patients had GI cancer. The most common site of GI cancer was esophagus (52.93%). Gastric cancer had a lower frequency (37.3%) and colorectal cancer had the lowest frequency (9.57%). The frequency of all GI cancers in men was higher than women. Squamous cell carcinoma (SCC) was the most common esophageal cancer and adenocarcinoma was the most common type of cancer of stomach and colon. Cancers of esophagus, stomach and colon are the most frequent type of GI cancers in studied patients, respectively. Esophagus cancer had the highest frequency and colon cancer had the lowest frequency.

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.