فهرست مطالب mojgan sanjari

Treatment adherence is one of the behaviors associated with type 2 diabetes that predicts whether it will be successfully treated or develop complications and become uncontrolled. This study aimed to determine factors affecting nonadherence to treatment among diabetic patients with limited health literacy from the perspectives of patients, their families, and healthcare providers.

This qualitative study with a content analysis approach was conducted on 84 eligible type 2 diabetes patients with limited health literacy and poor adherence to treatment, as well as their families and healthcare providers using a purposive sampling method, in Kerman city in 2021. Interviews were conducted using a semistructured interview guide with a broad, open‑ended question to provide a general history of the disease separately. The interviewer asked participants to identify the perceived barriers to treatment nonadherence. Each interview lasted 45–60 min. MAXQDA version 20 and inductive content analysis were used to code and analyze extracted data.

Four major themes emerged from the patients’ perspectives as “financial problems,” “individual factors,” “problems related to medication availability,” and “healthcare providers’ poor practices.” Two major themes were classified from the perspective of patients’ families as “financial problems” and “Individual factors,” and four major themes were identified from the viewpoint of healthcare providers including “financial problems,” “individual factors,” “scarcity and medication availability,” and “poor practice of the healthcare provider.” These mentioned barriers were confirmed regarding treatment nonadherence among study participants.

Study findings revealed different factors of treatment nonadherence among diabetic patients with limited health literacy. Therefore, these factors should be considered in tailoring promotive educational and supportive interventions. Considering the importance of adherence to treatment patients, planning empowerment family‑based interventions focusing on health literacy improvement seems necessary

Noninvasive risk prediction models have been widely used in various settings to identify individuals with undiagnosed diabetes.

We aimed to evaluate the discrimination, calibration, and clinical usefulness of the Finnish Diabetes Risk Score (FINDRISC) and Australian Diabetes Risk Assessment (AUSDRISK) to screen undiagnosed diabetes in Kerman, Iran.

We analyzed data from 2014 to 2018 in the second round of the Kerman Coronary Artery Disease Risk Factors Study (KERCADRS), Iran. Participants aged 35 - 65 with no history of confirmed diabetes were eligible. The area under the receiver operating characteristic curve (AUROC) and decision curve analysis were applied to evaluate the discrimination power and clinical usefulness of the models, respectively. The calibration was assessed by the Hosmer-Lemeshow test and the calibration plots.

Out of 3262 participants, 145 (4.44%) had undiagnosed diabetes. The estimated AUROCs were 0.67 and 0.62 for the AUSDRISK and FINDRISC models, respectively (P < 0.001). The chi-square test results for FINDRISC and AUSDRISC were 7.90 and 16.47 for the original model and 3.69 and 14.61 for the recalibrated model, respectively. Based on the decision curves, useful threshold ranges for the original models of FINDRIS and AUSDRISK were 4% to 10% and 3% to 13%, respectively. Useful thresholds for the recalibrated models of FINDRISC and AUSDRISK were 4% to 8% and 4% to 9%, respectively.

The original AUSDRISK model performs better than FINDRISC in identifying patients with undiagnosed diabetes and could be used as a simple and noninvasive tool where access to laboratory facilities is costly or limited.

Adverse effects related to treatment negatively affect the quality of life of patients with thyroid cancer. The current study aimed to evaluate the psychometric properties of the Persian version of the thyroid‑cancer‑specific health‑related quality of life (TC‑specific HRQoL) questionnaire among patients with thyroid cancer in Kerman province, Iran.

This research was a cross‑sectional study conducted on 240 patients with thyroid cancer in Kerman province from 2000 to 2015. The patients were selected through the census method and were asked to complete the thyroid‑cancer‑specific quality of life questionnaire. Data were analyzed by SPSS version 19.0 and LISREL version 8.80. The reliability of the Persian version was determined by Cronbach’s a coefficient and the intraclass correlation coefficient (ICC). Exploratory and confirmatory factor analysis (CFA) was also conducted.

The Cronbach’s a and ICCs were determined as 0.92 and 0.88, respectively. Five factors were extracted in the exploratory factor analysis with a total of 55.76% explained variance. Acceptable goodness of fit indices were found in CFA.

The Persian version of the TC‑specific HRQoL has sufficient psychometric properties and can be used to assess HRQoL among patients with thyroid cancer.

Dendritic cells (DCs) play key roles in regulating the immune response using the specialized function of processing and presenting antigens. Prolactin (PRL), a hormone produced by the pituitary gland, participates in DC maturation and function. The present study was aimed to determine the frequencies of peripheral blood DC subpopulations of myeloid DC (MDC) and plasmacytoid DC (PDC) in hyperprolactinemic (HPRL) women compared to normal healthy volunteers. This study was conducted on 70 women, including 35 HPRL patients and 35 matched healthy controls, whose PRL serum levels were in the normal range (lower than 25 ng/mL). Serum thyroid-stimulating hormone (TSH) levels were measured in both groups as an indicator of normal thyroid function. The electrochemiluminescence immunoassay method was applied to measure the serum levels of TSH and PRL. The frequencies of MDC and PDC in the peripheral blood samples of both groups were determined by flow cytometry. The mean serum PRL levels in the HPRL patients and healthy individuals were 46.41±21.96 and 13.75±11.19, respectively (p<0.0001); however TSH levels in both groups were similar and within the normal range (0.4–4.5 mIU/mL) (p=0.2). The frequencies of both MDC and PDC subpopulations in the peripheral blood of HPRL patients were significantly lower than they were in the healthy controls. However, the ratio of MDCs/PDCs in HPRL patients was not significantly different between the two groups (p=0.8). Our study revealed that an increased level of serum PRL may lead to a reduction in the number of MDC and PDC subpopulations. These results could help clarify the complex relationship between the immune system and the neuroendocrine axis and may be of potential use in understanding the pathogenesis of endocrine and immune disorders.

Clinical reasoning as a critical and high level of clinical competency should be acquired during medical education, and medical educators should attempt to assess this ability in medical students. Nowadays, there are several ways to evaluate medical students’ clinical reasoning ability in different countries worldwide. There are some well-known clinical reasoning tests such as Key Feature (KF), Clinical Reasoning Problem (CRP), Script Concordance Test (SCT), and Comprehensive Integrative Puzzle (CIP). Each of these tests has its advantages and disadvantages. In this study, we evaluated the reliability of combination of clinical reasoning tests SCT, KF, CIP, and CRP in one national exam and the correlation between the subtest scores of these tests together with the total score of the exam.

A total of 339 high ranked medical students from 60 medical schools in Iran participated in a national exam named “Medical Olympiad”. The ninth Medical Olympiad was held in Shahid Beheshti University of Medical Sciences, Tehran, Iran, under the direct supervision of the Ministry of Health and Medical Education in summer 2017. The expert group designed a combination of four types of clinical reasoning tests to assess both analytical and non-analytical clinical reasoning. Mean scores of SCT, CRP, KF, and CIP were measured using descriptive statistics. Reliability was calculated for each test and the combination of tests using Cronbach’s alpha. Spearman’s correlation coefficient was used to evaluate the correlation between the score of each subtest and the total score. SPSS version 21 was used for data analysis and the level of significance was considered <0.05.

The reliability of the combination of tests was 0.815. The reliability of KF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. The mean total score was 169.921±41.54 from 240. All correlations between each clinical reasoning test and total score were significant (P<0.001). The highest correlation (0.887) was seen between CIP score and total score.

The study showed that combining different clinical reasoning tests can be a reliable way of measuring this ability.

Diabetes is a global health problem that its prevalence is increasing rapidly. Rosa damascena extract has shown to have an intensive non-competitive inhibitory effect on α-glucosidase in an animal study. The aim of this study was to assess the safety and efficacy of Rosa damascena (RD) Mill in diabetic patients and healthy subjects.
In a triple-blind, placebo and Acarbose-controlled randomized trial in Kerman in the south-east of Iran, we randomly allocated diabetic patients (n=32) and healthy volunteers (n=28) to 100mg Acarbose, 200 mg RD-methanolic extract, 400mg RD-methanolic extract and placebo groups. Over 15 days, the participants were followed up to monitor the changes in blood biochemical parameters and apparent symptoms. Analyses were carried out by intention to treat.
RD extract decreased postprandial blood glucose levels comparable to the effects of Acarbose, demonstrating its α-glucosidase inhibitory activity. Besides, fasting plasma glucose levels significantly decreased in patients treated with 400 mg/day RD-methanolic extract compared to the 200 mg RD-methanolic extract (127.6±26.8vs. 165.5±27.1, p=0.041), suggesting that Rosa damascena Mill is effective in a dose dependent manner. No major or minor hypoglycemic event was observed. NO adverse event was observed in the RD treatment groups in comparison with Acarbose or placebo groups. Serum levels of biochemical parameters did not fluctuate significantly in RD treatment groups compared to Acarbose and placebo controls.
Rosa damascena not only decreases blood glucose levels, but also is safe to be used for the purpose of controlling blood glucose levels in drug naïve patients with type II diabetes.

papillary thyroid cancer is the most common cancer of thyroid accounting for 75%-85% of all thyroid malignancies. Recently, β-catenin has been determined to play a role in clinical course of human epithelial cancers. This study was designed to reveal the association of β-catenin marker and papillary thyroid carcinoma behavior.
63 paraffin blocks of papillary thyroid carcinoma were stained with ready to use monoclonal β-catenin antibody according to manufacturer’s instructions. Memberanous, cytoplasmic and nuclear staining was scored according to intensity of immunoreactivity. β-catenin immunostaining association with clinical parameters like number of recurrences and cumulative dose of radioiodine therapy were analyzed using SPSS version 15. Histopathologic parameters like tumor stage, grade, capsular invasion, lymphovascular invasion, lymph node involvement, distant metastasis and other variables were also evaluated for association with β-catenin immunoreactivity
77.8% of papillay thyroid carcinoma were well differentiated and the remaining were poorly differentiated. Loss of β-catenin membrane immunostaining depicted correlation with number of recurrences (p=0.023% , Pearson correlation= -0.285). Its loss of memberanous staining correlated similarly with cumulative dose of radioiodine (p= 0.046, Pearson correlation = -0.253). Loss of membranous β-catenin was significantly associated with some histopathologic findings like nodal involvement (p Loss of β-catenin membranous staining and its cytoplasmic accumulation were associated with aggressive clinicopathologic behavior. The exact effect of radioiodine exposure on β-catenin pathway remained to be determined in future.

To study the effect of humic acid and drought stress on some physiological characteristics of roselle (Hibiscus sabdariffa) an experiment was conducted in the research field of Agricultural Education Centre of Jiroft in 2013. Field experiment was carried out as split plot design with three replications. Water deficit stress as main factor with three levels (A1 = Irrigation after 50، A2 = 100 and A3 = 150 mm evaporation from pan class A) and humic acid was sub plots in four methods of application (B1 = non humic acid، B2 = with irrigation، B3 = with irrigation + once spraying، B4 = with irrigation + twice spraying). Humic acid was used with irrigation at 10kg/ha and for spraying at 250ml/100l. Drought stress had significant effect on chlorophyll a، chlorophyll b، carotenoids، relative humidity content and proline of roselle leaves. Interaction effect of humic acid and drought stress was only significant for total chlorophyll and soluble carbohydrate. Drought stress decreased chlorophyll a (48. 22 percent)، chlorophyll b (32. 77 percent)، carotenoid content (79. 64 percent) and relative humidity (12. 59 percent)، while increased proline content (12. 59 percent). Humic acid increased chlorophyll a، chlorophyll b and carotenoids but reduced proline content (15. 04 percent).

Oral manifestations in diabetic patients can have different causes. Possibly, one of these causes is salivary glucose. The aim of this study was to evaluate salivary glucose concentrations in patients with Type II diabetes mellitus (DM) and their association with oral and dental manifestations and compare them with normal adults. In this analytical study, 128 patients with Type II DM and 132 non-diabetic healthy individuals were selected. The subjects’ blood and unstimulated salivary samples were collected. Salivary glucose concentrations were measured by glucose oxidase method. Then, the oral cavity and teeth were examined for oral manifestations such as ulcers, white and red plaques, lichenoid reaction, candidiasis and decayed missing filled teeth (DMFT) and periodontal disease index (PDI) indices. Data were analyzed by independent t-test and Pearson’s correlation test. The results of the present study showed that, in general, individuals with higher concentrations of salivary glucose had significantly higher DMFT and PDI, irrespective of belonging to the diabetic or the control group (P < 0.050). However, there was no significant correlation between salivary glucose concentrations and oral manifestations. Meanwhile, there was a significant correlation between salivary glucose concentration and glycated hemoglobin in diabetic patients compared with the control group (P < 0.001). The present study showed that the salivary glucose concentration had a positive association with DMFT and PDI in diabetic and non-diabetic patients. In this study, we found an association between salivary and blood glucose in diabetic patients.

High prevalence of obesity and the importance of this issue as a risk factor for chronic diseases such as severe cardiovascular diseases, diabetes, and cancer necessitate the need for treatment. The aim of this study was the evaluation of acarbose effect on the weight loss in non-diabetic overweight or obese patients in Kerman. A double-blind randomized controlled clinical trial was performed on 66 patients with the body mass index (BMI) between 25 and 35 kg/m2. Patients were divided in treatment and control groups using the randomization. Th e treatment group took 100 mg acarbose 3 times a day for 20 weeks in combination with the low-calorie diet and exercise. Control group was given placebo, low-calorie diet, and exercise. BMI was measured after 20 weeks. The analyses were carried out using t-test and repeated measured ANOVA. Patients in acarbose and placebo group had a non-significant difference in BMI at baseline. Reducing in weight was considered in every month in both groups, but this reduction was higher in the treatment group. At the 5th month, the difference of BMI in the treatment group was significantly lower than the placebo group (2.31 } 0.6 vs. 0.76 } 0.6 kg/m2, P < 0.001). Acarbose, especially in combination with the low-calorie diet and exercise, seems to lose weight effectively in obese and overweight patients in communities that have a high carbohydrate intake (like Persian diet).

An inverse association between serum adiponectin level and metabolic syndrome was seen in few studies. The aim of this study was to assess the association between serum adiponectin levels and metabolic syndrome in a sample of Iranian women from Kerman. In a cross-sectional study 946 subjects were studied to determine the prevalence of metabolic syndrome and in a case control study (170 subjects for each group) the association between serum adiponectin levels and metabolic syndrome were investigated. Metabolic syndrome was defined using International Diabetes Federation (IDF) criteria. Socio-demographics factors and measures of waist circumference, blood pressure and lipid profiles were collected. Serum adiponectin level was measured by ELISA method. The prevalence of the metabolic syndrome was 36.7%. Mean of serum adiponectin level in individuals with metabolic syndrome was lower than individuals without it (10.5 ± 4.1 and 13.45 ± 5.6 µg/ml, respectively, p < 0.001). Low level of adiponectin was a good predictor for metabolic syndrome (a range of β coefficients out of -2.03 to -2.85 according to five models). Systolic blood pressure, body mass index (BMI) and diastolic blood pressure were independent predictors of serum adiponectin (p values were 0.001, 0.009 and 0.034, respectively). We found that adiponectin is negatively associated with metabolic syndrome. Systolic and diastolic blood pressure and BMI were identified as independent predictors.

Resistin and ghrelin are hormones that have roles in the glucose and lipid homeostasis and weight regulation. Human studies regarding resistin and ghrelin in diabetic patients are scarce, especially in the cases of normotensive and non-obese patients. This study was designed to illuminate some of the missing points.
Eighty diabetic patients and eighty healthy individuals participated in this study; according to the inclusion criteria [age, gender, body mass index (BMI), blood pressure (BP) and diabetes type]. Fasting and postprandial glucose, hemoglobin A1c (HbA1c), insulin, acylated-ghrelin and resistin were evaluated for all the participants while HOMA and QUICKI were calculated.
Fasting and postprandial glucose, HbA1c, insulin and calculated HOMA increased, while QVICKI decreased among the diabetic patients (p<0.001). All patients also had reduced acylated-ghrelin that was more predominant among type I cases (p<0.001), while resistin was significantly reduced among the female patients (p<0.001). Furthermore, a significant negative correlation between circulating insulin and resistin of older healthy subjects [female (R=-0.72, p<0.001) and male (R=-0.59, p<0.01)] was detected which was absent for the patient groups.
None of the diabetes indicators correlated with the circulating ghrelin or resistin that may indicate reductions in the results of protective phenomena due to excess glucose, increase insulin, or high circulating lipids usually observed among the diabetic patients. On the other hand, a strong negative correlation between the insulin and resistin among the older (38-55 years) healthy individuals that indicate the rise of resistin can be a sign of initiation of type II diabetes.

Backgrounds & Ramadan fasting is a unique cycle in which man should avoid eating and drinking. In many conditions such as plasma LDL and IGF-1 concentration, effects of prolonged & Ramadan fasting are different. This study was conducted to determine the effect of Ramadan fasting on LDL & IGF-1 and their correlations. 132 healthy adult volunteers (60 women, 72 men) took part in this quasi-experimental study. All participants fasted for at least 25 days in the lunar month of Ramadan.The amount of serum IGF-1 was measured by radioimmunoassay 1 week before and on the 14th and 28th days of Ramadan. Statistical analysis with ANOVA, the Student's paired t-test, and Pearson's regression analysis were all carried out in this respect. No significant change in the serum concentration of IGF-1 was found in men, women or the group during this study, but serum level of LDL was decreased significantly. Ramadan fasting has no effect on plasma IGF-1, but it decreases plasma LDL significantly

There is as yet no consensus as to the effect of Ramadan fasting on fasting blood glucose. We carried out a study to help clarify the situation.
This was a semi-experimental (pre- and post-) study of 115 healthy volunteers (67 men and 48 women), who fasted for at least 25 days during Ramadan. Blood samples were taken 7 days before Ramadan (at 7am after a 8-hour overnight fast), and on the 14th and 28th days of Ramadan (1 hour before sundown). The mean duration of daily fasting was 11.5±0.5 hours. Plasma glucose was measured by an enzymatic assay. Statistical analysis was by the paired-t and ANOVA functions on SPSS10.0 software.
Fasting plasma glucose in the group as a whole decreased from 88.4±9.0mg/dl pre-Ramadan to 75.4±15.3mg/dl on day 14 and 62.9±7.7mg/dl on day 28 (p Fasting plasma glucose decreases with Ramadan fasting and is associated with a reduction in calorie intake. The decrease in plasma glucose does not seem to be accompanied by any serious adverse effects in healthy volunteers, however.