sima hashemipour

self-care is one of the best and most cost-effective measures to deal with diabetes, which has attracted a lot of attention today. The aim of the current study was psychometric self-care tools for diabetic patients in Qazvin medical centers in Iran.

The present study was of methodological type. The statistical population was all the patients in the medical centers of Qazvin city. The sample size was determined to be 256 people. After collecting the data, it was subjected to exploratory factor analysis with the principal component analysis (PCA) method. SPSS software was used for data analysis. Also, Kaiser-Meier and Bartlett's test was used to measure the adequacy of the sample and the significance of the results.

The average age of the participants in the study was 59.12±11.14 and the average years of diabetes was 10.76±7.55. The results of exploratory factor analysis showed that self-care of diabetic people was observed in four factors. The first factor was healthy eating, the second factor was physical activity, the third factor was blood sugar monitoring, and the fourth factor was checking the health of the feet. The results showed that four explanatory factors of self-care can explain 95.22% of the variance of self-care in diabetic patients.

The psychometric analysis of the diabetes self-care Scale in the Iranian population showed that the self-care Scale (DSCS-I) had very good validity and reliability. Therefore, it is necessary to use this Scale to check the self-care status of diabetic patients.

Hypothyroidism has been associated with complications such as increased inflammation, and oxidative stress.

This pilot study was created to assess the impact of Illicium verum (I. verum) on serum levels of thyroid hormones as well as depression, anxiety, and stress in hypothyroidism patients given the detrimental effects of oxidative stress on thyroid function and considering the antioxidant properties of I. verum.

In this double-blind clinical research with a placebo group, which was performed as a pilot, 20 hypothyroid individuals were recruited. Participants were randomly allocated to a capsule containing 1.5 g of I. verum (per day) (n=10) or a placebo (n=10) for 8 weeks. Thyroid hormones, including free triiodothyronine (FT3), free thyroxine (FT4), triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were measured at the beginning and end of the study. Furthermore, depression and stress were assessed using the Depression Anxiety Stress Scales-21 (DASS-21) survey. Quantitative analysis was performed using SPSS software, version 20.

No discernible difference was observed between the blood thyroid hormone levels at the baseline. TSH levels in the intervention group decreased significantly at the end of the study, while FT3, FT4, T3, and T4 levels increased significantly (P<0.05). Compared to the study’s initial findings, the intervention group experienced considerably lower mean changes in terms of depression, anxiety, and stress scores. (P<0.05). 

The I. verum supplement can be helpful as a dietary supplement with antioxidant properties in patients with hypothyroidism. This herbal supplement can increase the effectiveness of medication in patients with hypothyroidism.

Adverse effects of high parathormone hormone (PTH) in critical illness have been described in some studies. 

The relationship between high PTH levels with mortality in hospitalized patients with COVID-19 was evaluated in the present study.

A total of 123 patients were included in the study. The patients were evaluated in phase 1 (on admission) and phase 2 (days 4-6 of hospitalization). The patients were categorized into four groups based on the PTH status in both phases: normal PTH1/normal PTH2 (group 1), high PTH1/normal PTH2 (group 2), high PTH1/high PTH2 (group 3), and normal PTH1/high PTH2 (group 4). The multiple logistic regression analysis was performed to examine the independent association of late hyperparathyroidism with mortality. After excluding ineligible participants, 115 patients in phase 1 and 96 patients in phase 2 (days 4-6 of hospitalization) were evaluated.

The level of phase 2 PTH in non-survivors was significantly higher than in survivors (57.5±40.9 pg/mL vs. 27.6±16.2 pg/mL, P=0.001). The mortality rate was significantly higher in high-PTH groups in phase 2 compared to normal-PTH groups in this phase (50% and 42.9% in groups 3 and 4 vs. 6.6% and 18.2% in PTH groups 1 and 2, respectively, P=0.007). Late hyperparathyroidism was associated with 11.4 times higher mortality risk (95% CI: 2.3-56.1, P=0.003).

Late hyperparathyroidism remained a significant predictor of mortality after adjusting for the main PTH secretion modulators and disease severity. Late hyperparathyroidism is an independent and strong risk factor for mortality in COVID-19. Further studies are necessary to clarify the mechanisms involved.

Preterm birth (PB) is a worldwide gestational problem. Poor sleep quality and short duration have been reported as possible predisposing factors of PB in some studies.

This study was conducted to investigate the roles of sleep quality/duration in the occurrence of PB.

This longitudinal study was performed on pregnant women with gestational age ≤14 weeks. The sleep quality was evaluated using the Pittsburgh sleep quality index (PSQI) at the first visit and women were followed until delivery. A total of 76 women with preterm and 441 women with term delivery were compared regarding the sleep quality components, sleep duration, and long or short sleep duration. The multivariate logistic regression was performed to examine the independent association of sleep quality/duration with PB.

Data from 517 participants were analyzed. PB occurred in 14.7% of participants. No significant difference of 7 items of sleep quality was observed between preterm and non-preterm groups (P>0.05 for each comparison). The total PSQI score in the preterm group was significantly higher (poorer quality) compared to the non-preterm group (5.6±2.1 vs 5.3±2.4, P=0.076). In multivariate logistic regression, each unit of worsening PSQI was independently associated with a 20% higher risk of PB occurrence. Sleep duration was not associated with PB either in unadjusted or adjusted models.

No relationship was observed between poor sleep quality (defined as PSQI>5) and PB; however, based on our results, poorer sleep quality (as a continuous variable) can be an independent risk factor for PB.

Electrolyte disorders, particularly hyponatremia, have been reported in a considerable number of patients with Coronavirus Disease 2019 (COVID-19).

The current study aims to evaluate the risk factors, symptoms, and prognosis of hyponatremia in hospitalized patients with COVID-19.

In this retrospective cohort study, 467 patients with COVID-19 were divided into 4 groups based on the sodium level at the time of admission: normal, mild hyponatremia, moderate hyponatremia, and severe hyponatremia. Symptoms, laboratory findings, and prognosis were compared among these groups. The risk factors for the occurrence of moderate/severe hyponatremia and the association of hyponatremia with in-hospital mortality were investigated using logistic regression analysis.

Hyponatremia was diagnosed in 60% of the patients. The prevalence of mild, moderate, and severe hyponatremia was 80.7%, 15.1%, and 4.2%, respectively. The severity of the clinical symptoms and level of hypoxia showed no significant difference between the groups. White blood cells count was significantly higher and lymphocyte percentage was significantly lower in hyponatremia groups compared to the normal group. The history of chronic kidney disease was an independent risk factor for the moderate/severe hyponatremia (Adjusted OR=5.11, 95%CI: 1.72-15.2, P=0.003). After adjustment of different risk factors, moderate/severe hyponatremia remained a significant independent risk factor for in-hospital mortality (OR=2.58, 95%CI: 1.13-5.88, P=0.024).

Hyponatremia is prevalent in COVID-19 patients. However, it is not definitely associated with severity of COVID-19 at the time of admission. Moderate/severe hyponatremia is associated with higher in-hospital mortality rate despite the similarity of disease severity between the sodium groups.

Free-living amoebae (FLA) such as Acanthamoeba spp., are considered as opportunistic and pathogenic protozoans.  Acanthamoeba granulomatous encephalitis (AGE) is a serious threat for immunodeficient patients and Acanthamoeba keratitis (AK) for contact lens users. We aimed to identify the presence of free living amoebae in nasal swabs of patients and contact lens users in Qazvin, Iran.

During 2019, 251 nasal and oral swabs (including the pharynx and mouth) were collected from patients with diabetes, AIDS and those under periodic dialysis in Qazvin, Iran. In addition, 27 soft contact lenses were collected from the participants. Following DNA extraction, PCR and sequencing were conducted to identify the genotypes of the amoeba. Phylogenetic analysis of the identified sequences was performed using MEGA 7 software.

A strain of Acanthamoeba belonging to the T3 genotype was isolated from hemodialysis patients. Two specimens of Acanthamoeba with T3 genotype were isolated from keratitis patients.

The clinicians should pay attention to the possible complication of this organism because this amoeba is potentially pathogenic for immunocompromised patients. Since the amoeba is present in environmental resources, the use of contact lenses should be accompanied by considering proper hygiene.

There are inconsistent data about the association of smoking with the prognosis of hospitalized patients with COVID-19. This inconsistency is so huge that some investigators have suggested some protective roles for smoking against COVID-19 disease. 

This study was designed to investigate the association of smoking with mortality in hospitalized patients with COVID-19.

This cross-sectional study was conducted on 493 adult patients with COVID-19 disease. Other underlying diseases, clinical and laboratory findings, and mortality rates were compared between smoking and non-smoking patients using univariate and multivariate analyses.

 The prevalence of current smoking among hospitalized patients was 6.1%. Clinical complaints and disease severity at admission were similar between smokers and non-smokers. Leukocyte count and blood sugar were higher in smokers compared to non-smokers (P=0.003, P=0.018, respectively). The rate of ICU admission and days of hospitalization were comparable between smokers and non-smokers. However, smokers had a significantly higher mortality rate than non-smokers (36.7% vs 13.8%, respectively, P=0.001). After adjusting for significantly different variables in univariate analysis, smoking was associated with a 3.78 times higher mortality rate (OR=3.78, 95% CI: 1.48-9.67, P=0.005).

Smoking is an independent predictor of mortality in hospitalized patients with COVID-19.

Hypocalcemia is highly prevalent in Coronavirus disease 2019 (COVID-19). There is limited evidence about the course and roles of different parameters in the occurrence of new or worsening hypocalcemia.

This prospective longitudinal study was conducted on hospitalized COVID-19 patients in Qazvin, Iran, in 2021.

Serum levels of calcium, albumin, parathormone (PTH), 25(OH)D (vitamin D), magnesium, and phosphate were assessed on the first day (time one), as well as fourth to sixth days (time two) of hospitalization. Paired t-test, McNemar’s test, and multivariate logistic regression test were used to compare data at two times and evaluating the independent roles of different variables in the occurrence or worsening of hypocalcemia.

Out of a total of 123 participants, 102 patients completed the study. The mean serum calcium level significantly decreased from 8.32 ± 0.52 mg/dL to 8.02 ± 0.55 mg/dL at time two compared to time one (P < 0.001). Also, we witnessed new or worsening hypocalcemia at time two in 44 (55%) patients with normal serum calcium or mild hypocalcemia at time one (P < 0.001). The PTH level decreased from 42.17 ± 27.20 pg/mL to 31.28 ± 23.42 pg/mL (P < 0.001). The decrease in albumin and PTH levels was an independent significant factor in the occurrence or worsening of hypocalcemia at time two (OR = 1.27; 95% CI: 1.10 - 1.46; P = 0.001 for each 1 g/L decrement albumin and OR = 1.29; 95% CI: 1.03 - 1.62; P = 0.026 for each 10 pg/mL decrement PTH). Vitamin D deficiency or changes during hospitalization did not have a significant role in new or worsening hypocalcemia.

Decreased PTH secretion and hypoalbuminemia have significant roles in the occurrence of new or worsening hypocalcemia during hospitalization due to COVID-19.

Changes in thyroid function test (TFT) in COVID-19 patients have been reported in several studies. However, some features such as thyrotoxicosis are inconsistent in these studies. In addition, some drugs such as heparin interfere with the free T4 assay.

This study was designed to examine TFT abnormalities in COVID-19, utilizing direct and indirect methods of free T4 assay.

This prospective cross-sectional study was conducted on 131 hospitalized COVID-19 patients. Serum levels of total T3, TSH, T3RU, and total T4 were measured. The free T4 assay was performed using direct (free T4) and indirect (free thyroxin index or FT4I) methods. The patients were categorized into different TFT groups. The clinical characteristics, laboratory findings, and outcomes were compared between the groups.

The frequencies of Nonthyroidal Illness (NTI), subclinical/overt hypothyroidism and subclinical/overt thyrotoxicosis were 51.7, 6.9, and 6.9%, respectively. Besides, 6 and 8.1% of the patients had isolated high free T4 and isolated high FT4I without any other TFT abnormality, respectively. The lymphocyte percent was lower in the subclinical/overt group than in other TFT groups (P = 0.002). Atrial Fibrillation (AF) was found in 37.5% of subclinical/overt thyrotoxicosis patients versus 1.7% in the NTI and nil in the other three groups (P < 0.001).

In addition to the reported TFT abnormalities in COVID-19 in previous studies, some new features like isolated hyperthyroxinemia were found in our study. We found a strong association between subclinical/overt thyrotoxicosis and AF. Regarding the high prevalence of AF in hospitalized COVID-19 patients, the thyroid function test is rational in COVID-19 patients with this arrhythmia.

Pathophysiological changes in the mouth of patients with diabetes mellitus (DM) predispose to overgrowth of Candida albicans. Various virulence factors such as proteinase and phospholipase production are involved in the process of degradation of the host cell membrane. These enzymes are involved in binding Candida species, especially in the hyphae stage, to the target tissue. In this study, the proteinase and phospholipase activity of 51 C. albicans strains was evaluated. Overall, the rates of proteolytic and phospholipase activities in controlled and uncontrolled diabetic patients were 90.2% and 72.5%, respectively. No significant difference was observed between proteinase and phospholipase activities in both groups of patients (P>0.05), while there was a significant difference between the activity of hydrolytic enzymes with HbA1C and dentures in the uncontrolled diabetic group (P<0.05). According to the importance of hydrolytic enzymes activity of C. albicans species in diabetic patients, oral health of diabetic patients to control and prevent disease progression in these patients is essential.

The beneficial effects of polyphenols to improve glycemic status in patients with type 2 diabetes have been reported in scientific studies. The aim of this study was to investigate the effect of oral ellagic acid (EA) supplement on glycemic index and insulin resistance in type 2 diabetic patients.

In this double blind randomized clinical trial, 44 diabetic patients were selected, and were randomly assigned to the intervention group (22 subjects) and placebo (22 subjects) and received a capsule containing 180 mg of EA per day or placebo for 8 weeks, respectively. At the beginning and end of the study, demographic information, anthropometric indices, food intake and physical activity, biochemical factors of fasting and two-hour blood sugar, plasma insulin level, glycosylated hemoglobin percentage (HbA1c) and insulin resistance (IR) were measured.

At the beginning and end of the study, there was no significant difference between the two groups in terms of anthropometric indices, food intake and physical activity (P>0.05). At the end of the study, receiving EA in the intervention group significantly reduced fasting and two-hour blood sugar means, plasma insulin levels, HbA1c percentage, and IR levels compared with placebo group (P<0.05).

EA supplementation can be helpful as a dietary antioxidant supplement in patients with type 2 diabetes by improving chronic side effects. This may be due to the antioxidant power of this polyphenol.

 Despite the widespread obesity epidemic in the world, not all obese people are equally susceptible to the complications of obesity. Inflammatory factors play an important role in the complications of obesity.

 This study aims to evaluate the association of White Blood Cell (WBC) count with metabolic syndrome in overweight/obese men and women.

 This cross-sectional study is a part of the Qazvin Metabolic Disease Study (QMDS) conducted in 2010 in Qazvin, Iran. Participants were 622 obese people with a body mass index (BMI) ≥25 kg/m2, recruited from the QMDS. Metabolic syndrome was defined according to the Adult Treatment Panel III criteria. Data were analyzed using chi-square test, t-test, and logistic regression analysis (to evaluate the relationship between WBC count quartiles and metabolic syndrome).

 Prevalence of metabolic syndrome was not significantly different between men and women. In men, prevalence of metabolic syndrome and its components were not different between WBC quartiles. In women, 2.23% and 5.06% had metabolic syndrome in the first and fourth quartiles of WBC count, respectively (P<0.001). Moreover, the prevalence of insulin resistance was higher in fourth quartile compared to the first quartile (7.74% vs. 6.52%, P<0.001). After controlling the effects of age and BMI factors, the risk of metabolic syndrome in the fourth quartile of WBC count remained significant in women (OR=2.56, P<0.01).

 Association of WBC count with metabolic syndrome is significant in obese women compared to obese men.

Evening chronotype is usually associated with insomnia and short sleep duration.

To investigate the independent association of chronotype with diabetes control.

In this cross-sectional study, 140 patients with type 2 diabetes were studied. The insomnia score was examined by a 7-item questionnaire. Also, chronotype was assessed by a 19-item questionnaire, and using the questionnaire, the patients were divided into three groups of morning, intermediate, and evening. This questionnaire has been developed for evaluating the preference for performing mental and physical activities at a special time of day. The Multivariate hierarchical analysis was applied for investigating the independent association of chronotype and glycated hemoglobin (HbA1c).

The fasting blood glucose and HbA1c levels were significantly different across all the three chronotype groups such that it had the highest value in the evening group and the lowest value in the morning group (FBS = 164.5 ± 34.1 mg/dL and HbA1c = 8.7% ± 1.7, in the evening group, and FBS = 132.7 ± 23.1 mg/dL and HbA1c = 6.9% ± 0.4 in the morning group, P < 0.001). The morning group had longer sleep duration and less insomnia than other groups. Results of the hierarchical regression analysis showed that the chronotype explained 28.4% of the variance of HbA1c. Results of the final model demonstrated that the chronotype had a relationship with HbA1c, independent of body mass index (BMI), time of going to bed, and insomnia score.

Evening chronotype is associated with poorer control of diabetes, independent of BMI and sleep variables.

Hyperglycemia in diabetic people resulted in oxidative conditions. Propolis is the third most important component of bee products which has various functional properties such as anti-oxidant due to its components. The aim of this study was to evaluate the propolis effect on fructosamine level, the catalase activity, and the level of oxidized LDL changes in type 2 diabetic patients. In this double-blind, randomized controlled trial study, 62 type 2 diabetic patients, attending Endocrine clinic in Velayat Hospital (Qazvin, Iran) in 2017, were randomly assigned to one of intervention and placebo (n=31) groups. Participants in intervention group took propolis capsule (500 mg) 3 times a day and those in placebo group took placebo capsules for 8-week. Fructosamine level, catalase activity and the level of oxidized-LDL were measured at the baseline and at the end of the study. Statistical analysis was performed using SPSS software. At the end of the study, significant differences were seen within groups and in-between groups. In Propolis group compared to the placebo, fructosamine (p<0.05), and the level of oxidized LDL (p<0.05) decreased, and catalase activity (p<0.05) improved. However, there were no significant changes in the placebo group at the end of trial. Eight weeks intake of propolis as a supplement in type II diabetic patients could improve anti-oxidant defense and decline production of hyperglycemia induced products such as fructosamine.

Hypocalcemia is a common condition in pregnancy. Approximately 20-30 g maternal calcium is actively transferred to the fetus during pregnancy for fetal skeletal mineralization. The aim of this study was to determine the association of pregnancy hypocalcemia with neonatal growth indices.
This cohort study was conducted on 112 pregnant women with the gestational age of 22-26 weeks in 2016. Calcium, albumin, 25(OH)D, and urinary calcium/creatinine ratio were measured for all participants. Hypocalcemia was defined as corrected serum calcium level of Out of the 112 subjects, 35 (31.2%) cases had hypocalcemia. The mean 25(OH)D, calcium/creatinine ratio, and neonatal growth indices were not significantly different between the normocalcemic and hypocalcemic groups (P>0.05). Furthermore, neonatal growth indices were not significantly different in the maternal calcium quartiles. The two groups showed no significant difference in terms of the adjusted mean of neonatal growth indices (P>0.05).
According to the findings of the present study, hypocalcemia was a prevalent condition in pregnancy; however, this condition exerted no adverse effects on neonatal growth indices.

Propolis is one of the hive products which has a wide clinical usage due to variety of bioactive components. This clinical trial was conducted to evaluate the effects of propolis supplementation on glucose metabolism and inflammation.

In the 8-week randomized, double-blinded, placebo-controlled clinical trial, registered patients with type 2 diabetes were randomly assigned to propolis group (n = 30) and placebo group (n = 30). The first group received a propolis capsule (500 mg) 3 times a day. The second group received the same therapy but a placebo capsule. Fasting blood samples were obtained .The liver enzymes, inflammatory indices and glucose-related indicators were measured at the beginning and end of the study.

Compared with the control group, the propolis group showed remarkable changes in fasting plasma glucose (propolis -19.8±29.16; placebo 0.7±27.8; P = 0.01), two-hour postprandial glucose (propolis -27.42±44.5; placebo -0.95±42.7; P = 0.001), Hemoglobin A1c (propolis -1.07±1.6; placebo 0.03±1.5; P= 0.041), insulin (propolis -1.65±4.3; placebo 0.04±4.02; P 0.03), HOMA-IR (propolis -1.08±0.7,placebo 0.03±0.42, p=0.044), TNF-α(propolis -2.67±4.1,placebo 0.12±4,p=0.025) and C-reactive protein (propolis -2.5±3.01,placebo -0.67±2.84,p=0.031), . Furthermore propolis reduced the mean of AST (propolis -1.62±10.4, placebo 0.13±11.07, p=0.12) and ALT level (propolis -0.61±6.47, placebo 0.12±7.01, p= 0.54), but it was not significant.

Propolis treatment in type II diabetic patients has a beneficial effect on improving the glycemic profile and inflammatory status. However, there was no significant change in the level of AST and ALT enzymes that more studies need to be done on this.

Vitamin D deficiency is associated with physiologic changes that are similar to pathogenesis of preeclampsia. Although association of vitamin D and preeclampsia has been studied previously, their results are not consistent. The aim of this study was to investigate the relationship of serum vitamin D and calcium with preeclampsia severity.
This case- control study was conducted in 75 healthy pregnant women and 74 pregnant women with preeclampsia (46 mild preeclampsia and 28 severe preeclampsia) in Qazvin, Iran in 2015. Serum vitamin D, calcium, and albumin were measured; corrected calcium was also calculated. Hypocalcemia and vitamin D deficiency were compared between the groups. Logistic regression analysis was used to study the independent association of hypocalcemia and hypovitaminosis D with preeclampsia.
Mean serum vitamin D level was 27.7±15.3, 22.9±15.9, and 27.6±16.6 in normal, mild preeclampsia, and severe preeclampsia groups (P> 0.05); also vitamin D deficiency was not different between the groups. Hypocalcemia in severe preeclampsia group was more frequent than normal group (25.9% vs. 6.6%, P: 0.017). Hypocalcemia was associated with severe preeclampsia after adjustment for age, parity, and calcium supplement consumption (OR: 6.7, 95% CI: 1.45-30.79; P: 0.015).
There was not any association between vitamin D deficiency and preeclampsia in the present study, however low corrected serum calcium was associated with about six times increased risk of sever preeclampsia. More studies are needed to determine the role of hypocalcemia and vitamin D in preeclampsia.

There are contradictory results of different studies about the effect of periodontal treatment on metabolic control of diabetes. Due to the importance of management of the patients, the purpose of this study was to examine the effect of periodontal therapy [scaling and root planning (SRP)] with doxycycline on glycemic control in patients with type 2 diabetes mellitus. In this double-blind randomized controlled clinical trial, 40 patients with type 2 diabetes mellitus who had moderate periodontitis were treated with scaling and root planning + placebo (SRP; n = 20) or with scaling and root planning + doxycycline 100 mg/day, for 21 days (SRP + Doxy; n=20). Periodontal parameters including bleeding on probing (BOP), clinical attachment loss (CAL), plaque index (PI), and probing depth (PD), also metabolic parameter (HbA1c) were recorded at baseline and 3 months after the treatment. After 3 month, all periodontal parameters and HbA1c showed significant improvement in both groups (P < 0.001). The reduction of all periodontal parameters and HbA1c was not significantly different between the groups in this study (P for BOP = 0.799; P for CAL = 0.667; P for PI = 0.253; P for PD = 0.989; and P for HbA1c = 0.301). Periodontal treatment with the adjunctive systemic doxycycline may influence the systemic conditions of patients with type 2 diabetes mellitus, but no statistical differences was observed between the control and treatment groups. Therefore, confirmatory studies with controlled diabetes are necessary.

Changes of serum minerals and vitamin D have been reported in anticonvulsant drugs user patients. The present study aimed at comparing the changes of serum minerals and vitamin D among two groups of enzyme-inducing and non enzyme-inducing anticonvulsant drug users.

In this study 22 patients treated with enzyme-inducing drugs (carbamazepin، phenytoin، phenobarbital) were compared to 25 patients of matched sex، age، and BMI treated with non enzyme-inducing drugs (sodium evaporate، lamotrigine). Serum calcium، phosphate، parathormone، and 25-hydroxy vitamin D were calculated in both groups. Calcium was measured by Calorimetery method. Parathormone and vitamin D were measured using ELISA method.

The mean serum vitamin D level was lower in enzyme-inducing than non enzyme-inducing drugs users (15. 9±8. 3 and 24. 2±14. 8، P=0. 02). Frequency of vitamin D deficiency was higher in enzyme-inducing compared to non enzyme-inducing drugs users، 84% and 48%، respectively (P=0. 016). The mean serum calcium level was significantly lower in enzyme-inducing drugs users. (8. 7±0. 2 vs. 9. 0± 0. 7، p= 0. 05). Four percent in enzyme-inducing group compared to twenty four percent of non enzyme-inducing group had secondary hyperparathyroidism (P=0. 016).

While vitamin D deficiency is more frequent in enzyme-inducing drug users، secondary hyperparathyroidism is less frequent.

Heart disease، particularly coronary heart disease is a major cause of mortality among patients with diabetes mellitus. High level of hs-CRP is considered as a risk factor for heart diseases. Treatment with pioglitazone in patients with or without type II diabetes decreases serum concentrations of hs-CRP. The purpose of this study was to compare the effects of pioglitazone and metformin on hs-CRP level. A randomized clinical trial was performed on 40 patients with type 2 diabetes and defined inclusion criteria. Patients were divided into two groups receiving metformin and pioglitazone. Blood levels of cholesterol، triglycerides، fasting blood glucose، Alanine transaminase، Aspartat aminotransferase، HbA1C and hs-CRP were measured in all subjects before and after 3 month drug therapy. The average change in each group before and after drug therapy were analyzed by paired T-test، the mean change between groups were compared by T-test. In both groups، hs-CRP level was significantly decreased after drug therapy. The mean change of hs-CRP، HbA1C، cholesterol was significantly higher in metformin treated group. Since the average reduction in the level of hs-CRP، cholesterol and HbA1C in diabetic patients treated with metformin is significantly higher than patients treated with pioglitazone; treatment with metformin is recommended to reduce risk of heart disease

Early diagnosis of albuminuria and the prevention of its progression to macroalbuminuria and diabetic nephropathy are crucial. Angiotensin converting enzyme inhibitors (ACEIs) and antagonists of angiotensin II receptors type I (ARBs) are currently used as first-line treatment for albuminuria in these patients. The present study was conducted to assess the efficacy of addition of spironolactone to ACEIs or ARB in the prevention of diabetic nephropathy. Sixty patients were selected from the patients who referred to a Diabetes Clinic in this randomized clinical trial study. The control group received enalapril and the case group took additive therapy with spironolactone for 12 weeks. Blood pressure, concentrations of creatinine and albumin in the serum and urine, urinary albumin/creatinine ratio, serum potassium were determined for each patient in the beginning of and every 4-6 weeks until the end of the study. This clinical trial was registered in the Iranian Registry of Clinical Trials (www.irct.ir) with registration number ID: IRCT201105084849N2. There was statistically significant difference in albumin/creatinine ratio between the two groups (p<0.001). Albuminuria reduced more significantly in case group compared to control group. It was measured 66.6±26.8 mg/mmol and 45.7±19 mg/mmol in control and case groups, respectively. The patients did not develop any significant adverse effect including reduction in GFR, hyperkalemia, and hypotension. Low to moderate doses of spironolactone can augment the effect of ACEIs in the prevention of diabetic nephropathy.

This Study was performed to determine appropriate cut off point in 24 hours urine total protein to diagnose micro- and macroalbuminuria in patients with diabetes mellitus.Patients and In this study, 204 patients with diabetes mellitus type I and II were selected. In collected 24 hours urine from patients, protein and albumin were measured by using Pyrogallol and Immunoturbidimetry methods, respectively. Normoalbuminuri (albumin < 30 mg/24hrs urine), microalbuminuri (albumin = 30-300 mg/24hrs urine), and macroalbuminuri (, albumin > 300 mg/24hrs urine) were detected in 130, 51, and 23 patients, respectively. In 24hrs urine collections, amounts of protein and albumin were compared to calculate cut off point of exerted protein for nephropathy diagnosis. cut off point of 73mg/day for urinary total protein had appropriate sensitivity (94.5 %, CI = 91.4 % -97.6 %) and specificity (77.9 %, CI = 72.8 % -82.9 %) for microalbuminuria, while cut off point of 514 mg/day (sensitivity 95.7 %; specificity 98.9 %) was detected for diagnosis macroalbuminuria. Urine protein exertion of 150 mg/day that is currently considered as a normal value in most laboratory kits had a sensitivity of 73.1 % by which 30 % of microalbuminuric cases remained undiagnosed. Urinary total protein cut-off points of 73mg/day and 514 mg/day were diagnostic for micro- and macroalbuminuria, respectively.