Publications by authors named "Bijan Iraj"

74 Publications

Rhabdomyolysis plus Hypocalcemia and Diabetic Ketoacidosis as Concurrent Rare COVID-19 Manifestations.

Case Rep Med 2021 8;2021:6625086. Epub 2021 Mar 8.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Common manifestations of coronavirus disease 2019 (COVID-19) from its initial official introduction are mostly related to the respiratory system. However, other rarer presentations are reported nowadays. . We reported three cases of COVID-19-infected patients with rhabdomyolysis as well as two other rarer simultaneous signs, including hypocalcemia (Case 1) and diabetic ketoacidosis (DKA) (Case 2).

Conclusion: Despite the fact that rhabdomyolysis is an infrequent manifestation of COVID-19, high clinical suspicion is required for proper diagnosis and management of this disease as well as other concurrent rarer presentations, including hypocalcemia and DKA for the prevention of further complications.
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http://dx.doi.org/10.1155/2021/6625086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7945673PMC
March 2021

Restrictors of the effectiveness of diabetes self-management education: A qualitative content analysis.

J Educ Health Promot 2021 28;10:18. Epub 2021 Jan 28.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: A key step for improving the effectiveness of diabetes self-management education (DSME) is to identify its restrictors.

Objectives: The aim of this study was to explore the restrictors of the effectiveness of DSME.

Methods: This descriptive qualitative study was conducted in March 2016-2017. Participants were 16 DSME providers (viz., physicians, nurses, nutritionists, and psychologists) and nine DSME receivers (viz., patients and their family members) - 25 in total. Semi-structured interviews were held for data collection. Interviews were transcribed word by word and analyzed through conventional content analysis approach proposed by Graneheim and Lundman.

Results: The restrictors of the effectiveness of DSME were categorized into three main categories and 11 subcategories, namely patients' limited welcoming of DSME classes (allocating limited time for participation in DSME classes, inadequate knowledge about diabetes mellitus [DM] importance, inappropriate educational environment, and financial problems), unfavorable adherence to treatments: serious challenge (inattention to educations, poor motivation for adherence to medical recommendations, and inattention to the psychological aspects of DM), and the difficulty of adult education (the difficulty of changing health-related attitudes and behaviors, mere information delivery during education, adults' physical and perceptual limitations, and diabetes educators' limited competence in adult education).

Conclusion: The findings of the present study provide an in-depth understanding about the restrictors of the effectiveness of DSME. DM management authorities and policymakers can use these findings to develop strategies for improving the effectiveness of DSME.
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http://dx.doi.org/10.4103/jehp.jehp_914_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933700PMC
January 2021

Effects of curcumin-piperine co-supplementation on clinical signs, duration, severity, and inflammatory factors in patients with COVID-19: a structured summary of a study protocol for a randomised controlled trial.

Trials 2020 Dec 17;21(1):1027. Epub 2020 Dec 17.

Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objectives: This study aims to investigate the efficacy of curcumin-piperine co-supplementation on disease duration, severity and clinical symptoms, and inflammatory mediators in patients with coronavirus (COVID-19).

Trial Design: This is a randomized, placebo-controlled, double-blind, parallel arm clinical trial.

Participants: All patients aged 20-75 years with the diagnosis of Covid-19 based on the PCR test. The exclusion criteria will include an age less than 20 and more than 75 years, current use of warfarin or other anticoagulant drugs, and the presence of sensitivity to herbal products such as turmeric and pepper. This study will be conducted in academic hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran.

Intervention And Comparator: Fifty outpatients will be randomly allocated in a ratio of 1:1 to receive a capsule of curcumin-piperine containing 500 mg curcumin plus 5 mg piperine or matching placebo containing 505 mg maltodextrin twice a daily, after lunch and dinner, over a period of 2 weeks. Similarly, 50 inpatients who are admitted to hospital wards excluding intensive care unit (ICU) will be randomly assigned in a ratio of 1:1 to receive a capsule curcumin-piperine or matching placebo (provided by the Sami Labs company) twice a daily, after lunch and dinner, over a period of 2 weeks.

Main Outcomes: The main outcomes of this study are the efficacy of curcumin-piperine on coronavirus disease's clinical symptoms, duration, severity, and inflammatory mediators after 2 weeks of curcumin-piperine co-supplementation.

Randomisation: Randomization sequences will be generated with the use of a random-number table with a permuted block design (block size of 4) and stratification according to the gender variable (male vs. female). These sequences will be prepared by an independent statistician and will be kept in opaque, sealed, numbered envelopes which will be opened only at the time of enrollment. The allocation ratio in intervention and control groups is 1:1. Researchers and all patients will be unaware of the study-group assignment until the completion of data analyses.

Blinding (masking): This study is a double-blind clinical trial (participant, researcher). The curcumin-piperine and placebo supplements are packaged in similar numbered drug containers, and the researcher and all patients will be unaware of the study assignment until the end of the study.

Numbers To Be Randomised (sample Size): The calculated total sample size is 100 patients, with 25 patients in each group.

Trial Status: The protocol is Version 2.0, May 24, 2020. Recruitment began May 4, 2020, and is anticipated to be completed by April 19, 2021.

Trial Registration: This trial has been registered by the title of "Effect of curcumin-piperine co-supplementation on disease duration, severity and clinical signs, and inflammatory factors in patients with coronavirus (COVID-19): A randomized, double-blind, placebo-controlled clinical trial study" in the Iranian Registry of Clinical Trials (IRCT) with code "IRCT20121216011763N46", https://www.irct.ir/trial/47529 . The registration date is May 4, 2020.

Full Protocol: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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http://dx.doi.org/10.1186/s13063-020-04924-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745196PMC
December 2020

A one-year hospital-based prospective COVID-19 open-cohort in the Eastern Mediterranean region: The Khorshid COVID Cohort (KCC) study.

PLoS One 2020 5;15(11):e0241537. Epub 2020 Nov 5.

Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

The COVID-19 is rapidly scattering worldwide, and the number of cases in the Eastern Mediterranean Region is rising. Thus, there is a need for immediate targeted actions. We designed a longitudinal study in a hot outbreak zone to analyze the serial findings between infected patients for detecting temporal changes from February 2020. In a hospital-based open-cohort study, patients are followed from admission until one year from their discharge (the 1st, 4th, 12th weeks, and the first year). The patient recruitment phase finished at the end of August 2020, and the follow-up continues by the end of August 2021. The measurements included demographic, socio-economics, symptoms, health service diagnosis and treatment, contact history, and psychological variables. The signs improvement, death, length of stay in hospital were considered primary, and impaired pulmonary function and psychotic disorders were considered main secondary outcomes. Moreover, clinical symptoms and respiratory functions are being determined in such follow-ups. Among the first 600 COVID-19 cases, 490 patients with complete information (39% female; the average age of 57±15 years) were analyzed. Seven percent of these patients died. The three main leading causes of admission were: fever (77%), dry cough (73%), and fatigue (69%). The most prevalent comorbidities between COVID-19 patients were hypertension (35%), diabetes (28%), and ischemic heart disease (14%). The percentage of primary composite endpoints (PCEP), defined as death, the use of mechanical ventilation, or admission to an intensive care unit was 18%. The Cox Proportional-Hazards Model for PCEP indicated the following significant risk factors: Oxygen saturation < 80% (HR = 6.3; [CI 95%: 2.5,15.5]), lymphopenia (HR = 3.5; [CI 95%: 2.2,5.5]), Oxygen saturation 80%-90% (HR = 2.5; [CI 95%: 1.1,5.8]), and thrombocytopenia (HR = 1.6; [CI 95%: 1.1,2.5]). This long-term prospective Cohort may support healthcare professionals in the management of resources following this pandemic.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241537PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644058PMC
November 2020

Genetic Study of Hepatocyte Nuclear Factor 1 Alpha Variants in Development of Early-Onset Diabetes Type 2 and Maturity-Onset Diabetes of the Young 3 in Iran.

Adv Biomed Res 2019 23;8:55. Epub 2019 Sep 23.

Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Maturity-onset diabetes of the young (MODY) is a clinically and genetically heterogeneous group of diabetes characterized by noninsulin-dependent, autosomal-dominant disorder with strong familial history, early age of onset, and pancreatic beta-cell dysfunction. Mutations in at least 14 different genes are responsible for various MODY subtypes. Heterozygous mutations in the hepatocyte nuclear factor 1 alpha () gene are responsible for the MODY3 subtype, which is a common subtype of MODY in different studied populations. To date, more than 450 different variants of this gene have been reported as disease causing for MODY3. This study was carried out to evaluate mutations in Iranian diabetic families fulfilling MODY criteria.

Materials And Methods: Polymerase chain reaction and Sanger sequencing were performed. All the ten exons of the gene were sequenced in ten families, followed by cosegregation analysis and evaluation. Computational protein modeling was accomplished for the identified mutation.

Results: MODY3 was confirmed in two large families by detecting a mutation (p.G253E) in coding regions of . Compound heterozygous state for two common variants in (p.I27 L and p.S487N) was detected in affected members of 5 families, and in one family, a rare benign variant in the coding sequence for Kozak sequence was detected. Two new nonpathogenic variants were found in noncoding regions of .

Conclusion: It seems that mutations are a common cause of MODY in Iranian diabetic patients. Identified common variants in heterozygous state can cause diabetes Type II in earlier ages. The role of rare variant rs3455720 is unknown, and more investigation is needed to uncover the function of this variant.
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http://dx.doi.org/10.4103/abr.abr_54_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777141PMC
September 2019

Curcumin as a major active component of turmeric attenuates proteinuria in patients with overt diabetic nephropathy.

J Res Med Sci 2019 28;24:77. Epub 2019 Aug 28.

Shahid Asghare Shaabani Diabetic Clinic, Isfahan, Iran.

Background: Diabetic nephropathy (DN) is a common cause of end-stage renal disease (ESRD). The benefits and effects of renin-angiotensin system blocker drugs are obvious in decreasing albuminuria, but there is a need to find other drugs that can decrease albuminuria. The aim of our study is to evaluate the effect of short-term administration of curcumin on overt albuminuria in patients with type 2 diabetes mellitus (T2DM).

Materials And Methods: A randomized, double-blind clinical trial was performed on 46 patients with T2DM, overt albuminuria ≥300 mg/24 h, and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m. After the random allocation of the patients, they were divided into two groups. In the curcumin group, the patients received 500 mg (one capsule) of curcumin with each meal (three times/day after meal) for 16 weeks. Other variables including blood urea nitrogen (BUN), creatinine (Cr), fasting blood sugar (FBS), 2-h postprandial blood sugar (2-h pp BS), lipid profile, 24-h urine analysis for albuminuria, serum albumin, and hemoglobin A1C (HbA1C) were checked at baseline and bimonthly too.

Results: two groups at baseline were comparable in terms of basic characteristics ( > 0.05). Albuminuria decreased significantly from 900.42 ± 621.91 at the baseline to 539.68 ± 375.16 at the end of the study in the curcumin group ( = 0.002); however, no statistically significant changes were observed in the placebo group (519.94 ± 214.33 at the baseline vs. 444.00 ± 219.10 at the end of the trial; = 0.43), and the decrease was significantly higher in the curcumin group than that of the placebo group ( = 0.01). No significant differences were observed between the placebo and curcumin in terms of changes in serum BUN, Cr, FBS, 2-h pp BS, HbA1C, lipid profile, and albumin.

Conclusion: Our study showed that curcumin as an active turmeric metabolite was an effective adjuvant therapy for ameliorating macroscopic proteinuria in type 2 diabetic patients. Its effect may appear after 2 months of therapy and even in patients with a mild decrease in GFR. Further studies with larger sample size and longer duration are recommended.
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http://dx.doi.org/10.4103/jrms.JRMS_1055_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734668PMC
August 2019

Relationship between Dietary Patterns and Incidence of Type 2 Diabetes.

Int J Prev Med 2019 5;10:122. Epub 2019 Jul 5.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Introduction: Increasing rate of type 2 diabetes (T2D) prevalence during the recent years has caused concern about significant risks for the public health. Dietary patterns have recently attracted great attention in the evaluation of the relationship between diet and health. In the present study, we investigated the relationship between the major identified dietary patterns and T2D.

Methods: In this matched case-control study, 315 individuals (125 newly diagnosed cases and 190 controls); 18-60 years of age were selected. A valid semiquantitative food frequency questionnaire was used to collect dietary intakes of individuals. Anthropometric characteristics and blood pressure were measured with standard instructions and body mass index and waist to hip ratio were calculated. Factor analysis was used to identify major dietary patterns. The relationship between major food patterns and T2D was assessed by logistic regression analysis.

Results: Two dietary patterns were identified: healthy and Western dietary patterns. The second tertile of the healthy dietary pattern had significantly association with decreased risk of T2D in the crude model (Odds ratios [OR]: 0.51, 95% Confidence interval [CI]: 0.29-0.9; for trend = 0.018), Model II (OR: 0.5, 95% CI: 0.27-0.9; for trend = 0.019), and Model III (OR: 0.56, 95% CI: 0.23-1.4 for trend = 0.048). The inverse association of the second tertile of Western dietary pattern score with the T2D was significant in crude (OR: 9.25, 95% CI: 4.95-17.4; for trend <0.001) and multivariable-adjusted model (OR: 16.65, 95% CI: 2.99-92.84; for trend <0001).

Conclusions: Our study found an inverse relationship between adherence of healthy pattern and direct association with Western dietary pattern and the risk of T2D.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_206_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639850PMC
July 2019

Assessment of the Early and Late Complication after Thyroidectomy.

Adv Biomed Res 2019 27;8:14. Epub 2019 Feb 27.

General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The complications in thyroid surgery have been reported variable in literature. The aim of this study was to evaluate the early and late (3 months after surgery) complication rates of thyroidectomy in a cohort of patients undergoing thyroid surgery at two hospitals of Isfahan University of Medical Science, Iran.

Materials And Methods: This study included 204 patients who candidates for thyroidectomy presenting at Medical Educational Centers of Al-Zahra and Kashani hospitals in Isfahan between March 2016 and March 2017. Clinical data are collected for all patients by continuous enrollment. The patients examined before and after thyroid surgery and the findings were recorded.

Results: The highest prevalence of thyroidectomy was in women (81.9%). The most frequent thyroid surgery was total thyroidectomy and the most common indication for thyroid surgery was suspicious fine-needle aspiration for thyroid malignancy. Hypocalcemia was the most common complication with a frequency of 54.4%. The odds ratios for early complications were 2.375 and 2.542 for intermediate- and low-volume surgeons, respectively, compared to high-volume surgeons.

Conclusions: According to the results of this study, the high level of surgeon's skill is effective to reduce the likelihood of late and early complications; furthermore, the chance of late complications increases with age.
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http://dx.doi.org/10.4103/abr.abr_3_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425745PMC
February 2019

Preventive Effect of Dexamethasone Therapy on the Transient Hypoparathyroidism through Total Thyroidectomy.

Iran J Otorhinolaryngol 2019 Mar;31(103):73-80

Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Introduction: This study aimed to investigate whether pre-operative dexamethasone could ameliorate transient hypoparathyroidism outcome through total thyroidectomy.

Materials And Methods: This randomized clinical trial study was conducted on 128 patients underwent total thyroidectomy from March 2014 to April 2015. Patients were randomly assigned to two groups of experimental receiving 8 mg IV of intravenous dexamethasone (n=45) 45 min before skin incision treatment and control (n=83). After the surgery, all patients were evaluated for clinical and laboratory hypocalcaemia.

Results: Post-operative transient biochemical hypoparathyroidism and hypocalcaemia did not occur more often in the control group, compared to the dexamethasone group while controlling for the baseline variables. However, there was a significant difference in phosphorus level between the dexamethasone and control groups (P=0.028). A total of 50 (39.1%) patients developed hypocalcaemia after surgery. Moreover, post-operative symptomatic hypocalcemia occurred more frequently in the control group (68%) compared to the dexamethasone group (32%); however, this difference was not statistically significant (P=0.54).

Conclusion: The pre-operative administration of dexamethasone reduced post-operative hypocalcemia rate. It is essential to conduct future studies with validated means for better results.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6449529PMC
March 2019

Diabetes management challenges in Iran: A qualitative content analysis.

J Nurs Manag 2019 Sep 14;27(6):1091-1097. Epub 2019 May 14.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Aim: To explore and analyse diabetes management challenges in the patients visiting a diabetes unit in Iran.

Background: Managing a chronic disease like diabetes needs the patients' follow-up and coherent care delivery system. In fact, it requires a systematic and organised care delivery system with skilful and specialist team.

Methods: This qualitative research was conducted at a specialized poly-clinic of Isfahan insurance organisation in 2016. The research participants were the members of clinic diabetes unit (physician, nurse, secretary, clinic director) and 21 type 2 diabetic patients of the clinic who were selected using purposeful sampling method. Data were collected by semi-structured interviews and analysed using content analysis.

Results: The qualitative findings of this research were obtained in two main categories including the following: (a) weak care delivery system and (b) defective diabetes self-care.

Conclusions: The results of this research have demonstrated that there are system-centred and patient-centred challenges in diabetes management, and they can affect the patients' health outcomes.

Implications For Nursing Management: Since diabetes is one of the health system priorities, the findings of this study can be a warning for managers and policy makers to plan seriously to reform diabetes management system infrastructures.
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http://dx.doi.org/10.1111/jonm.12777DOI Listing
September 2019

Overcoming Challenges of Implementing Chronic Care Model in Diabetes Management: An Action Research Approach.

Int J Prev Med 2019 15;10:13. Epub 2019 Jan 15.

Diabetologist of Diabetes Unit, Shahid Malakooti Polyclinic of Social Welfare Organization of Isfahan, Diabetes Clinic, IR, Iran.

Background: Reforming the health care system to improve suitable health care model for diabetic patients is essential. This study aimed to implement, identify, and overcome the challenges of implementing the Chronic Care Model in diabetes management in a clinic.

Methods: This study is a qualitative technical action research with the Kemmis and McTaggart model including planning, action, reflection, observation, and revision plan which was conducted in the specialized polyclinic from 2015 to 2017 in Isfahan city - Iran. Data were gathered through qualitative and quantitative methods. Diabetes team and 17 patients with type 2 diabetes participated in semi-structured interviews that were purposively chosen. Qualitative data were analyzed using content analysis and then quantitative data collected.

Results: The qualitative findings of this research are in five main categories: System design upgrade, self-management upgrade, decision support, health care organization, and clinical information system upgrade. Results of quantitative data showed that most metabolic indicators like HbA1c have statistical meaningful changes ( value < 0.05).

Conclusions: Implementing the Chronic Care Model became feasible despite serious challenges and two groups of ready and active team and active patients were developed. The study showed that one important lost link of diabetes management is underestimating the nurses' capabilities in the management of this disease. Inevitably, serious investment on maximum use of nurses' knowledge and skills in improving diabetes management will help diabetes care upgrade significantly.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_485_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360841PMC
January 2019

The Effect of Spiritual Care on the Body Image of Patients Undergoing Amputation due to Type 2 Diabetes: A Randomized Clinical Trial.

Iran J Nurs Midwifery Res 2018 Jul-Aug;23(4):322-326

Endocrine and Metabolism Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Body image, as an important factor in quality of life (QOL) satisfaction, in amputee patients is strongly affected by amputation, which can put the patient at risk of psychological disorders such as depression. Hence, this study was conducted to investigate the effect of spiritual care on body image in patients with type 2 diabetes-related amputation.

Materials And Methods: In this study, an experimental pretest-posttest design with two groups was used. A total of 54 participants (Males = 41, Females = 13) aged between 40 and 72 who had diabetes-related amputation participated in the study. The participants were randomly assigned to the meditation and control group. For the experimental group, three sessions of meditation, and for control group, three sessions regarding prevention of diabetic foot ulcer were conducted. The participants in the experimental group were asked to perform meditation exercises for a month. The data was collected via Amputee Body Image Scale before and 4 weeks after the intervention.

Results: There were no significant differences between groups on demographic variables. After intervention, the meditation group showed lower levels of body image disturbance compared with the control group, which was significant (t=3.41, = 0.001).

Conclusions: It can be concluded that meditation can improve body image in patients with diabetes-related amputation. In addition, because of no side effects and high acceptance of spiritual care, this method can be used as a way to improve the condition of patients.
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http://dx.doi.org/10.4103/ijnmr.IJNMR_113_15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034524PMC
July 2018

Effect of Vitamin D deficiency treatment on thyroid function and autoimmunity markers in Hashimoto's thyroiditis: A double-blind randomized placebo-controlled clinical trial.

J Res Med Sci 2017 26;22:103. Epub 2017 Sep 26.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The link between autoimmune thyroid diseases and Vitamin D deficiency has been reported. However, there are controversies in this regard. We conducted a double-blind randomized placebo-controlled clinical trial to investigate the effect of Vitamin D deficiency treatment on thyroid function and autoimmunity marker (thyroid peroxidase antibody [TPO-Ab]) in patients with Hashimoto's thyroiditis.

Materials And Methods: Fifty-six patients with Hashimoto's thyroiditis and Vitamin D deficiency (25-hydroxyvitamin D level ≤20 ng/mL) were randomly allocated into two groups to receive Vitamin D (50000 IU/week, orally) or placebo for 12 weeks, as Vitamin D-treated ( = 30) and control ( = 26) groups, respectively. TPO-Ab, thyroid-stimulating hormone (TSH), parathormone, calcium, albumin, and creatinine concentrations were compared before and after trial between and within groups. The data were presented as mean (standard error [SE]) and analyzed by appropriate tests.

Results: Mean (SE) of Vitamin D was increased in Vitamin D-treated group (45.5 [1.8] ng/mL vs. 12.7 [0.7] ng/mL, = 0.01). Mean (SE) of TPO-Ab did not significantly change in both groups (734 [102.93] IU/mL vs. 820.25 [98.92] IU/mL, = 0.14 in Vitamin D-treated and 750.03 [108.7] [IU/mL] vs. 838.07 [99.4] [IU/mL] in placebo-treated group, = 0.15). Mean (SE) of TSH was not changed in both groups after trial, = 0.4 and = 0.15 for Vitamin D-treated and control groups, respectively. No significant difference was observed between two study groups in none studied variables ( > 0.05).

Conclusion: Vitamin D treatment in Vitamin D deficient patients with Hashimoto's thyroiditis could not have significant effect on thyroid function and autoimmunity.
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http://dx.doi.org/10.4103/jrms.JRMS_1048_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629831PMC
September 2017

Pseudohypercalcemia in Multiple Myeloma: A Case Report.

Int J Hematol Oncol Stem Cell Res 2017 Jul;11(3):246-249

Internist, Isfahan University of Medical Sciences, Isfahan, Iran.

Hypercalcemia is a common finding in patients with multiple myeloma. Clinical manifestations of hypercalcemia correlate with the level of serum calcium. Ionized serum calcium (Ca (I)) will be increased in true hypercalcemia. In pseudohypercalcemia the Ionized Ca is normal, although binding of calcium to abnormal immunoglobulin causes increased serum calcium level. In the asymptomatic multiple myeloma patients with moderate to severe hypercalcemia, measurement of ionized calcium is critical to exclude pseudohypercalcemia. Here, we describe an asymptomatic 44-year-old man with multiple myeloma who had severe hypercalcemia, but normal serum Ionized Ca level.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625476PMC
July 2017

Evaluation of Bone Density, Serum Total and Ionized Calcium, Alkaline Phosphatase and 25-hydroxy Vitamin D in Papillary Thyroid Carcinoma, and their Relationship with TSH Suppression by Levothyroxine.

Adv Biomed Res 2017 28;6:94. Epub 2017 Jul 28.

Department of Biostatistics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: This study aimed to evaluate the situation of Bone Mineral Density (BMD), Z score, T score, serum level of corrected and ionized calcium, alkaline phosphatase and 25-hydroxy vitamin D in percutaneous transhepatic cholangiography (PTC) patients and correlation of these variants with thyroid stimulating hormone (TSH) suppression level by levothyroxine.

Materials And Methods: Among the patients referred to Esfahan's endocrinology research center, 34 PTC patients (aged 20-50 years) with a history of thyroidectomy and conceived radioactive iodine and suppressive dose of levothyroxine were evaluated in this case-control study, and 38 healthy persons participated as the control group (matched by age and sex, body mass index). Bone density was evaluated with the DEXA method in four areas: Lumbar spine, femoral neck, and trochanter and distal of forearm. A reference laboratory assessed TSH, corrected and ionized calcium, Alkaline phosphatase (ALP) and 25OH vitamin D levels using fasting plasma and evaluated correlation of TSH level with variants by multivariate variance analysis.

Results: There was no significant difference in bone density and laboratory data (unless TSH) between the groups. In the PTC group, there was no significant correlation between TSH and difference values of BMD, Z score or T score, corrected calcium ( value = 0.12), ionized calcium ( = 0.54), ALP ( = 0.22) and 25 OH vitamin D ( = 0.38). There was no significant correlation in the TSH subgroups with BMD. The TSH suppression level has no relation with the elevated prevalence of low BMD, hypocalcemia and vitamin D deficiency. Difference in odds ratio was not significant for osteopenia and osteoporosis between the TSH subgroups (TSH < 0.02, >0.02 and <0.1 and >0.1 mu/L).

Conclusion: Suppressive therapy with levothyroxine cannot decrease BMD, Z score and T score in PTC patients.
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http://dx.doi.org/10.4103/2277-9175.211799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549548PMC
July 2017

Area under the curve during OGTT in first-degree relatives of diabetic patients as an efficient indicator of future risk of type 2 diabetes and prediabetes.

Clin Endocrinol (Oxf) 2017 Dec 20;87(6):696-705. Epub 2017 Sep 20.

Isfahan Endocrine & metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: To establish whether the area under the curve of an OGTT has a predictive role in identifying prediabetic and diabetic subjects among first-degree relatives (FDR) of patients with diabetes mellitus type 2 (DM).

Design, Patients And Measurements: In a population-based cohort study, 766 FDR of diabetic patients with a normal glucose tolerance test (NGT) completed a 2-hour OGTT. They were followed up for 7 years and classified according to the American Diabetes Association criteria into: NGT, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and DM. Relative risk (RR) and 95% confidence intervals (95%CI) were calculated based on logistic regression. Receiver operator characteristic (ROC) analysis along with AUC at different intervals and at time points during the OGTT was used to evaluate the risk of prediabetes and diabetes.

Results: Twenty-three subjects (3%) developed type 2 DM, 118 (29.3%) IFG, 81 (11.5%) IGT and 544 (71%) subjects remained NGT. AUC and mean difference of glucose in all high-risk groups demonstrated significant differences in both intervals and time points when compared to the NGT group. The cut-off values during OGTT to predict prediabetes and diabetes was determined as blood glucose more than 7.2 and 7.8 mmol/L at 30 and 60 minutes, respectively. The time point 60 has the highest predictive role for the development of diabetes, alone, and improved the performance of a prediction model containing multiple important clinical risk factors.

Conclusion: The data suggest that the glycaemic response to an OGTT may predict the risk of development of diabetes in first-degree relatives of DM patients.
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http://dx.doi.org/10.1111/cen.13443DOI Listing
December 2017

Are body mass index and waist circumference significant predictors of diabetes and prediabetes risk: Results from a population based cohort study.

World J Diabetes 2017 Jul;8(7):365-373

Fahimeh Haghighatdoost, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran.

Aim: To determine the predictive role of body mass index (BMI) and waist circumference (WC) for diabetes and prediabetes risk in future in total sample as well as in men and women separately.

Methods: In a population based cohort study, 1765 with mean ± SD age: 42.32 ± 6.18 healthy participants were followed up from 2003 till 2013 ( = 960). Anthropometric and biochemical measures of participants were evaluated regularly during the follow up period. BMI and WC measures at baseline and diabetes and prediabetes status of participants at 2013 were determined. Multivariable logistic regression analysis was used for determining the risk of diabetes and prediabetes considering important potential confounding variables. Receiver operating characteristic curve analysis was conducted to determine the best cut of values of BMI and WC for diabetes and prediabetes.

Results: At 2013, among participants who had complete data, 45 and 307 people were diabetic and prediabetic, respectively. In final fully adjusted model, BMI value was a significant predictor of diabetes (RR = 1.39, 95%CI: 1.06-1.82 and AUC = 0.68, 95%CI: 0.59-0.75; < 0.001) however not a significant risk factor for prediabetes. Also, WC was a significant predictor for diabetes (RR = 1.2, 95%CI: 1.05-1.38 and AUC = 0.67, 95%CI: 0.6-0.75) but not significant risk factor for prediabetes. Similar results were observed in both genders.

Conclusion: General and abdominal obesity are significant risk factors for diabetes in future.
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http://dx.doi.org/10.4239/wjd.v8.i7.365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507834PMC
July 2017

Novel Effects of Traditional Wooden Toothbrush on Bowel Motility Symptoms in Spinal Cord Injury Patients; Findings from a Pilot Quasi-experimental Study.

Int J Prev Med 2017 23;8:46. Epub 2017 Jun 23.

Fellow of Gastroenterology, Department of Internal Medicine, Isfahan University of Medical sciences, Isfahan, Iran.

Background: The aim of this study was to investigate the therapeutic effect of traditional wooden toothbrush usage on most severe constipation, which usually occurs in spinal cord injury (SCI) patients.

Methods: In a quasi-experimental study, 61 SCI patients were selected who had injuries in different spinal levels (cervical, thoracic, and lumbar), and severe constipation from one defection in a few days to 3 weeks. They were recommended to use traditional wooden toothbrush for 5 min twice a day, after breakfast and dinner, over a 6 weeks period. Two proper standard scales, called neurogenic bowel dysfunction (NBD), and "Constipation Assessment Scale (CAS)," were used for evaluating the changes in patients' gastrointestinal (GI) habits during the period of using the wooden toothbrush. Through these scales (NBD and CAS), the therapeutic effects of traditional wooden toothbrush usage on the severity of constipation before and after intervention were measured.

Results: The mean of NBD and CAS scores were reduced significantly, from 8.95 ± 0.78 and 3.34 ± 0.28; respectively, to 3.03 ± 0.57 and 1.74 ± 0.25, after 6 weeks using traditional wooden toothbrush ( < 0.0001). There was a significant difference in terms of NBD scores in patients with different levels of injury ( < 0.01), particularly in patients with thoracic injury, before (10.52 ± 0.88) and after (3.13 ± 0.78) treatment, respectively ( < 0.0001). Eventually, all symptoms of bowel problems improved significantly after the intervention ( < 0.05).

Conclusions: The use of traditional wooden toothbrush lead to the improvement of bowel and defecation problems in SCI patients. Yet more studies, particularly randomized control clinical trials are needed to investigate the effect of using wooden toothbrush on other GI reflexes. In addition, if some clinical trials are devised to study the effects of wooden toothbrush on both conscious and unconscious patients in ICU, best results are expected to be found on keeping their mouth and teeth hygiene, as well as, getting rid of their constipations.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_174_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499390PMC
June 2017

Effects of Vitamin D deficiency treatment on metabolic markers in Hashimoto thyroiditis patients.

J Res Med Sci 2017 27;22. Epub 2017 Jan 27.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The aim of the current trial was to investigate the effect of Vitamin D treatment on metabolic markers in people with Vitamin D deficiency and thyroid autoimmunity.

Materials And Methods: In this double-blind, randomized, placebo-controlled clinical trial, 65 Vitamin D deficient euthyroid or hypothyroid patients with positive TPO-Ab were enrolled. They randomly allocated into two groups to receive oral Vitamin D50000 IU weekly) and placebo for 12 weeks. Serum concentration of calcium, phosphorus, albumin, C-reactive protein, blood urea nitrogen, creatinine, glycated hemoglobin (HbA1c), insulin, fasting plasma glucose (FPG), triglyceride (TG), total cholesterol, and high-density lipoprotein were measured in both groups before and after the trial. Homeostasis model assessment estimates of beta cell function (HOMA-B) and HOMA-insulin resistance (HOMA-IR) were calculated before and after trial in both groups.

Results: Thirty-three and thirty-two participants were allocated to Vitamin D-treated and placebo-treated groups, respectively. Mean (standard error) level of Vitamin D increased significantly in Vitamin D-treated group (45.53 [1.84] ng/mL vs. 12.76 [0.74] ng/mL, = 0.001). The mean of HbA1c and insulin was increased significantly both in Vitamin D-treated and placebo-treated groups ( < 0.05). Other variables did not meet a significant change after trial ( = NS). In between-group comparison, there was not any significant difference between Vitamin D-treated and placebo-treated groups regarding measures of HOMA-B, HOMA-IR, FPG, HbA1c, and TG ( = NS).

Conclusion: Our findings showed that weekly 50000 IU oral Vitamin D3 for 12 weeks did not improve metabolic markers, IR, or insulin secretion in Vitamin D deficient patients with Hashimoto thyroiditis.
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http://dx.doi.org/10.4103/1735-1995.199090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5361437PMC
January 2017

The Effect of a Lifestyle Modification Education on Adiposity Measures in Overweight and Obese Nonalcoholic Fatty Liver Disease Patients.

Int J Prev Med 2017 23;8:10. Epub 2017 Feb 23.

Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Obesity is increasingly associated with nonalcoholic fatty liver disease (NAFLD) and weight loss through a combination of dietary modifications and increased physical activity is a primary goal of therapy in this disease. Therefore, this study was conducted to evaluate the effects of a lifestyle modification education on adiposity measures, physical activity, and total calorie intake in overweight and obese NAFLD patients.

Methods: During 8 weeks, 82 obese patients were randomly assigned into either an intervention group ( = 41) receiving a lifestyle modification education or to a control group ( = 41) receiving usual care. Total calorie intake, physical activity, and body composition indices were measured before and after the intervention.

Results: Thirty-six patients in intervention group and 33 in control group completed the study. The analysis of body composition variables did not show any significant reduction for percent of body fat, abdominal circumference, waist to hip ratio, visceral fat area, age matched of body, and soft lean mass (SLM) of the trunk ( > 0.05). On the other hand, a significant reduction in weight, body mass index, mass of body fat (MBF), SLM, and MBF of the trunk was observed after 2 months of intervention compared to the controls ( < 0.05). A significant reduction was observed in total calorie intake of intervention group as compared to the control group. Physical activity status did not show any significant improvements after 2 months of intervention.

Conclusions: Our lifestyle modification education and its guidelines could be used in obese patients with NAFLD to improve their body composition measurements and to lose weight. This could result in significant long-term benefits in NAFLD patients.
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http://dx.doi.org/10.4103/2008-7802.200854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343609PMC
February 2017

Effects of Pomegranate Seed Oil on Metabolic State of Patients with Type 2 Diabetes Mellitus.

Int J Prev Med 2016 29;7:124. Epub 2016 Nov 29.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Rapid increasing prevalence of diabetes mellitus is a serious health concern in the world. New data determined that the pathogenesis of diabetes mellitus is chronic low-grade inflammation, resulting insulin resistance. Pomegranate seed oil (PSO) has anti-inflammatory effects; though it may reduce insulin resistance and improve glycemia in diabetes mellitus. The present study has been designed to investigate the effects of PSO as a natural dietary component on metabolic state of patients with Type 2 diabetes mellitus.

Methods: In a randomized double-blind clinical trial study, 80 patients (28 men) with Type 2 diabetes were randomly allocated to the intervention and control groups. The intervention group consumed PSO capsules, containing 1000 mg PSO twice daily (2000 mg PSO), whereas controls take placebo for 8 weeks. The participants followed their previous dietary patterns and medication use. Dietary factors and metabolic factors including lipid profile, fasting plasma sugar, and insulin and were assayed at the baseline and after 8 weeks.

Results: Participants in two intervention and control group were similar regarding anthropometric and the dietary factors at baseline and after trial ( > 0.05). Mean level of total cholesterol, triglyceride, low-density lipoprotein-cholesterol, and high-density lipoprotein was not different significantly between groups after trial ( > 0.05). Consumption of PSO did not significantly affect the levels of parameters such as fasting blood sugar (FBS), insulin, HbA1c, alanine transferase, and homeostasis model assessment-insulin resistance.

Conclusions: Consumption of 2000mg PSO per day for 8 weeks had no effect on FBS, insulin resistance and lipid profile in diabetic patients.
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http://dx.doi.org/10.4103/2008-7802.194883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139452PMC
November 2016

The characteristics of pre-diabetic patients associated with body composition and cardiovascular disease risk factors in the Iranian population.

J Res Med Sci 2016 8;21:20. Epub 2016 Apr 8.

Department of Community Nutrition, Food Security Research Center, School of Nutrition and Food Sciences, Isfahan, Iran.

Background: Different populations have shown various patterns of association between impaired fasting glucose (IFG) and body composition parameters and risk factors of cardiovascular disease (CVD). The current study aimed at investigating the differences between persons with prediabetes and healthy people in terms of CVD risk factors including body composition parameters, blood pressure, and lipid profile in a sample of the Iranian population.

Materials And Methods: In a case-control setting, a sample containing 386 (193 prediabetic subjects and 193 normal subjects) of the first-degree relatives of diabetic patients aged 35-55 years were investigated. Samples were assessed using glucose tolerance categories. Prediabetes was defined according to the American Diabetes Association (ADA) criteria. Body composition parameters, blood pressure, glucose parameters, and lipid profile were measured and compared between the two groups.

Results: Prediabetic patients had higher body mass index (BMI), waist circumference (WC), and body fat (BF) in comparison to the control group ( < 0.05). In addition, prediabetic subject had a higher intake of energy, carbohydrate, protein, fat, and cholesterol and it seems that these patients had an unhealthy dietary intake ( < 0.05). Fasting blood glucose (FBG) ( < 0.001), total cholesterol ( = 0.007), low-density lipoprotein cholesterol (LDL-C), and triglyceride ( = 0.021) were higher in prediabetic patients ( < 0.05) than in the controls.

Conclusion: Both the risk factors of CVD and body composition parameters were different between the prediabetic and normal groups; total cholesterol (TC), triglyceride (TG), and FBS were predictors of the risk of prediabetes.
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http://dx.doi.org/10.4103/1735-1995.179888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122248PMC
April 2016

Effect of eradication on insulin resistance among prediabetic patients: A pilot study and single-blind randomized controlled clinical trial.

J Res Med Sci 2016 23;21. Epub 2016 Feb 23.

Department of Endocrinology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Type II diabetes mellitus (T2DM) is the prevalent type of diabetes in the world. Prediabetic patients are the most probable group to get diabetes. Several studies have mentioned the role of inflammation in the incidence of diabetes. The origin of inflammation can be infection such as (HP) infection. This study was designed to explore the effect of eradication on insulin resistance.

Materials And Methods: This single-blind randomized controlled clinical trial was conducted in 2014-2015. The sample size consisted of 49 individuals who were in prediabetes stage with HP infection. Patients with positive stool antigen were allocated randomly into two groups. The treatment group took medication to eradicate HP infection by the routine method of four-drug eradication. However, placebo capsules and tablets were given to the patients in the placebo group. Then fasting plasma glucose (FPG), fasting plasma insulin (FPI), and quantitative C-reactive protein (CRP) levels were measured and homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of beta-cell function (HOMA-B), Matsuda index, insulinogenic index, and disposition index were calculated.

Results: Results of this study showed that FPI and HOMA-IR increased significantly ( value of FPI = 0.023 and value of HOMA-IR = 0.019) after HP eradication in the treatment group. On the other hand, comparison of differences at the baseline and after 6 weeks in FPG ( value = 0.045), FPI ( value = 0.013), and HOMA-B ( value = 0.038) revealed significant differences between the placebo group and treatment group.

Conclusion: Results showed that HP eradication by a 2-week antibiotic medication did not decrease insulin resistance and even increased FPI and insulin resistance indices. So HP eradication among prediabetic patients is not recommended for the decrease of insulin resistance and postponement of the development of diabetes mellitus.
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http://dx.doi.org/10.4103/1735-1995.177355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121998PMC
February 2016

Comparative Study on the Effect of and Seeds on Anthropometric Measures in Nonalcoholic Fatty Liver Patients.

Int J Prev Med 2016 10;7:114. Epub 2016 Oct 10.

Department of Community Nutrition, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Due to the attribution of fatty liver with some chronic diseases such as obesity, finding a way to control obesity can be useful for the management of fatty liver. This study was performed to assess the effects of (PP) and (OB) on anthropometric measurements in people with hepatic steatosis.

Methods: All patients with nonalcoholic fatty liver disease (NAFLD) were enrolled in this four-arm parallel, randomized, and single blind trial. They randomly assigned into four groups receiving (1) OB 10 g/day; (2) PP 10 g/day; (3) mix of OB and PP 10 g/day; and (4) control group without placebo for 12 weeks. Anthropometric measurements were assessed during study baseline and after 12 weeks intervention. The data were analyzed using paired sample -test for within group and analysis of covariance for between groups.

Results: In within group analysis, weight and body mass index show a significant reduction after 12 weeks intervention. In addition, soft lean mass and lean body mass were decreased in PP and mixed of PP and OB groups significantly; another group (OB) shows the same result for mass body fat. Although in intervention groups, we see considerable reduction, between group changes did not demonstrate the same consequences.

Conclusions: The results of this study showed that administration of OB, PP, or mix of them for 12 weeks does not affect any of the anthropometric measures in NAFLD.
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http://dx.doi.org/10.4103/2008-7802.191865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070040PMC
October 2016

Relationship between non-alcoholic fatty liver disease and inflammation in patients with non-alcoholic fatty liver.

Adv Biomed Res 2016 15;5:28. Epub 2016 Feb 15.

Department of Clinical Nutrition, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Non-alcoholic fatty liver is the most chronic liver disease that eventually can become cirrhosis. One of the underlying assumptions for the fatty liver created by inflammation of the hepatocytes. We aimed to assess the association between non-alcoholic fatty liver disease (NAFLD) and sub-clinical inflammation.

Materials And Methods: This is a cross-sectional study which was conducted on 55 patients over 30 years, with NAFLD. Fatty liver grade was assessed using liver ultrasound. Liver enzymes (alanine aminotransferase, aspartate aminotransferase), anthropometric characteristics and inflammatory marker C-reactive protein (CRP) were measured. Qualitative variables (sex and fatty liver grade) and quantitative variables such as were compared with independent t-test and Chi-square test. Relationship between fatty liver grade and inflammatory index was assessed with SPSS software (version 20; SPSS, Inc. Chicago, IL, USA).

Results: Non-alcoholic fatty liver grades were associated with CRP level and this relationship remains in statistically significant level even after adjusting the effects of confounding variables such as age, sex and body mass index of participants (P = 0.016).

Conclusion: In this cross-sectional study, presentation of NAFLD showed a significant correlation with sub-clinical systemic inflammation and CRP level.
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http://dx.doi.org/10.4103/2277-9175.176368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785782PMC
March 2016

Effect of garlic powder consumption on body composition in patients with nonalcoholic fatty liver disease: A randomized, double-blind, placebo-controlled trial.

Adv Biomed Res 2016 27;5. Epub 2016 Jan 27.

Department of Epidemiology and Biostatistics, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease that is becoming a public health problem in recent decades. Obesity and overweight play a key role in NAFLD pathogenesis. Thus, weight loss (especially body fat mass) is one component of therapeutic strategies in NAFLD. Results from experimental studies have shown that garlic (Allium sativum L.) can reduce body weight and body fat mass. However, the effect of garlic on body fat mass and weight in the human population, which is addressed in this study, is still obscure.

Materials And Methods: In this clinical trial, 110 subjects with NAFLD were randomly assigned to the intervention or the control group. The intervention group received two garlic tablets (containing 400 mg of garlic powder) daily while the control group received placebo tablets. Dietary intake and physical activity of participants were obtained by a validated questionnaire. Body composition was measured by bioelectrical impedance analysis. Data were analyzed using SPSS software version 16.

Results: In the intervention group, significant reductions were observed in body weight and body fat mass (P < 0.05). We also observed a significant reduction in body weight in the control group, but there were no significant changes in total body water and lean body mass in both groups (P > 0.05). In the intervention group, the percentage change in body weight was significantly greater than the control group (-2.6 vs. -0.7, P = 0.02). No serious side effects associated with the intervention were reported.

Conclusion: Our trial suggests that garlic supplemfrom experimental studies have shown thatentation can reduce body weight and fat mass among subjects with NAFLD.
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http://dx.doi.org/10.4103/2277-9175.174962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763563PMC
March 2016

Effect of Cucurbita ficifolia and Probiotic Yogurt Consumption on Blood Glucose, Lipid Profile, and Inflammatory Marker in Type 2 Diabetes.

Int J Prev Med 2016 2;7:30. Epub 2016 Feb 2.

Department of Community Nutrition, School of Nutrition and Food Sciences, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Control of blood sugar, hypertension, and dyslipidemia are key factors in diabetes management. Cucurbita ficifolia (pumpkin) is a vegetable which has been used traditionally as a remedy for diabetes in Iran. In addition, consumption of probiotics may have beneficial effects on people with Type 2 diabetes. The aim of this study was an investigation of the effects of C. ficifolia and probiotic yogurt consumption alone or at the same time on blood glucose and serum lipids in diabetic patients.

Methods: Eighty eligible participants randomly were assigned to four groups: 1 - green C. ficifolia (100 g); 2 - probiotic yogurt (150 g); 3 - C. ficifolia plus probiotic yogurt (100 g C. ficifolia plus 150 g yogurt); and 4 -control (dietary advice) for 8 weeks. Blood pressure, glycemic response, lipid profile, and high-sensitive C-reactive protein (hsCRP) were measured before and after the intervention.

Results: Total cholesterol (TC) decreased significantly in yogurt and yogurt plus C. ficifolia groups (within groups P = 0.010, and P < 0.001, respectively). C. ficifolia plus yogurt consumption resulted in a decrease in triglyceride (TG) and an increase in high-density lipoprotein cholesterol (HDL-C) (within groups P < 0.001 and P = 0.001, respectively). All interventions led to a significant decrease in blood sugar, hemoglobin A1c (HbA1c), hsCRP, and low-density lipoprotein cholesterol (LDL-C) level within groups. Blood pressure decreased significantly in Cucurbita group and yogurt group (within groups P < 0.001, and P = 0.001 for systolic blood pressure [SBP] and P < 0.001, and P = 0.004 for diastolic blood pressure [DBP], respectively). All variables changed between groups significantly except LDL-C level.

Conclusions: Variables including TG, HDL-C, TC, fasting blood sugar, HbA1c, SBP, DBP, and hsCRP changed beneficially between groups. It seems that consumption of C. ficifolia and probiotic yogurt may help treatment of diabetic patients.
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http://dx.doi.org/10.4103/2008-7802.175455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763470PMC
March 2016

Case series of rhinocerebral mucormycosis occurring in diabetic patients.

Caspian J Intern Med 2015 ;6(4):243-6

Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Rhinocerebral mucormycosis is a fatal infection typically affecting diabetic or immunosuppressed patients. In most cases, infection is caused by inhalation of fungal spores. Mortality rate of patients is very high (40-85%).

Case Presentation: In this study, three diabetic patients with rhinocerebral mucormycosis were presented. The etiologic agents of mucormycosis in two patients were isolated and identified by sequence analysis and data were registered in Gene bank database.

Conclusion: In patients with mucoreosis, early detection, surgical excision and appropriate debridement, suitable antifungal therapy, and control of risk factors like diabetes mellitus are the main parameters of successful management of this lethal infection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649276PMC
December 2015

Risk of diabetes in combined metabolic abnormalities and body mass index categories.

Diabetes Metab Syndr 2016 Jan-Mar;10(1 Suppl 1):S71-8. Epub 2015 Oct 9.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Aim: The present study was designed to estimate the progression rates from combination of normal weight, overweight, obesity, and number of metabolic abnormalities (MA) to type 2 diabetes (T2D) in a non-diabetic high risk population in Isfahan, Iran.

Methods: A total of 1869 non-diabetic first-degree relatives (FDR) of patients with T2D 30-70 years old were examined and followed for a mean (SD) of 7.3 (2.2) years for T2D incidence. At baseline and through follow-up, participants underwent a standard 75-g 2-h oral glucose tolerance test.

Results: The metabolically healthy overweight and obese at baseline were associated with incidence of T2D, independently of age and gender. Any one MA increased the risk of developing T2D among normal weight, overweight and obese individuals. Those with normal weight and ≥3 MA were over 20 times (odds ratios (OR) 20.21; 95% confidence intervals (CI) 2.4, 170.4) and those with overweight and ≥3 MA 22.5 times (OR 22.5; 95% CI 3.0, 167.0) and obese with ≥3 MA were 25.4 times (OR 25.4; 95% CI 3.4, 187) more likely to develop T2D than those with normal weight and without MA. Compared with participants without MA, obese individuals with concomitant MA were not significantly more likely to progress to T2D.

Conclusion: Our data provide further evidence that normal weight, overweight and obese individuals with MA had a higher risk of incident T2D than normal weight individuals without MA.
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http://dx.doi.org/10.1016/j.dsx.2015.09.020DOI Listing
January 2017

Effect of Playing Interactive Computer Game on Distress of Insulin Injection Among Type 1 Diabetic Children.

Iran J Pediatr 2015 Jun 27;25(3):e427. Epub 2015 Jun 27.

Department of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, IR Iran.

Background: Diabetic children and their families experience high level stress because of daily insulin injection.

Objectives: This study was conducted to investigate the impact of an interactive computer game on behavioral distress due to insulin injection among diabetic children.

Patients And Methods: In this clinical trial, thirty children (3-12 years) with type 1 diabetes who needed daily insulin injection were recruited and allocated randomly into two groups. Children in intervention groups received an interactive computer game and asked to play at home for a week. No special intervention was done for control group. The behavioral distress of groups was assessed before, during and after the intervention by Observational Scale of Behavioral Distress-Revised (OSBD-R).

Results: Repeated measure ANOVA test showed no significantly difference of OSBD-R over time for control group (P = 0.08), but this changes is signification in the study group (P = 0.001). Comparison mean score of distress were significantly different between two groups (P = 0.03).

Conclusions: According to the findings, playing interactive computer game can decrease behavioral distress induced by insulin injection in type 1 diabetic children. It seems this game can be beneficial to be used alongside other interventions.
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http://dx.doi.org/10.5812/ijp.25(3)2015.427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4505990PMC
June 2015