Publications by authors named "Mansour Siavash"

40 Publications

Reply to "Methodological notes, should be considered in research on Mizaj".

J Res Med Sci 2021 28;26. Epub 2021 Jan 28.

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

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http://dx.doi.org/10.4103/jrms.JRMS_905_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103963PMC
January 2021

Bacterial Profile and Antimicrobial Resistance Patterns of Infected Diabetic Foot Ulcers in Iran: A Systematic Review and Meta-Analysis of Cross-Sectional Studies.

Int J Low Extrem Wounds 2021 Apr 28:15347346211002715. Epub 2021 Apr 28.

Isfahan Endocrine and Metabolism Research Center, 48455Isfahan University of Medical Sciences, Isfahan, Iran.

Since infectious foot ulcers represent one of the major causes of lower-limb amputation, it calls for an appropriate action for early detection and sufficient treatment of diabetic foot infection (DFI). The present study aimed at investigating the bacterial epidemiology and antimicrobial resistance (AMR) patterns of DFIs in Iran. We have conducted a systematic search in PubMed, Embase, Web of Science, Scopus, Google Scholar, and Scientific Information Database to identify all articles reporting the proportion of different kinds of bacteria isolated from Iranian DFI samples. Quality was assessed using Joanna Briggs Institute tool. A pooled estimate of proportion with a corresponding 95% confidence interval (95% CI) was calculated using the random effect method. Fifteen studies were eligible, of which 1970 bacterial isolates were obtained from 1316 patients. The most predominant isolates recovered from DFIs was with a pooled proportion of 24.29% (95% CI: 20.25%, 28.57%) from which 55% (95% CI: 38%, 72%) were methicillin-resistant (MRSA). Among Gram-negative strains, had the highest proportion (17.19%; 95% CI: 13.96%, 20.68%) followed by , 7.54% (95% CI: 4.56%, 11.14%). The highest pooled estimates of resistance against cotrimoxazole and ciprofloxacin were found in 66% (95% CI: 48%, 82%) and isolates 68% (95% CI: 51%, 84%), respectively. Our study revealed that AMR is at a high level in Iran and clinicians should be aware of bacterial resistance patterns to prescribe appropriate antibiotic regimens.
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http://dx.doi.org/10.1177/15347346211002715DOI Listing
April 2021

Ultrasound-guided ethanol injection for the treatment of parathyroid adenoma: A prospective self-controlled study.

J Res Med Sci 2020 28;25:93. Epub 2020 Oct 28.

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

Background: Parathyroidectomy, the standard treatment of primary hyperparathyroidism (PHP) due to parathyroid adenoma, is not suitable for all patients. We evaluated the efficacy of ultrasound-guided ethanol ablation of parathyroid adenoma in a group of patients with PHP.

Materials And Methods: In a prospective self-controlled trial, 39 patients with parathyroid adenoma, who were not candidates for surgery, were enrolled. Ethanol injections were performed by two experienced interventional radiologists under the guidance of real-time ultrasonography. Adenoma size changes were assessed at about 1 month later. Serum levels of parathyroid hormone, calcium, phosphate, 25-OH Vitamin D, and alkaline phosphatase were evaluated at the baseline, 1, 3, 6, and 12 months after the injections. The treatment effects on outcome variables were assessed by repeated measures analysis.

Results: Volume of the adenomas decreased during the study period from 1.87±6.45 cm to 0.38± 0.48cm ( < 0.001). Corrected serum calcium levels decreased from 10.40 ± 0.96 mg/dl to 8.82 ± 0.58 mg/dl ( < 0.001), and remained stable during one year follow-up. Serum levels of parathyroid hormone decreased gradually from 129.85 ± 63.37 to 72.58 ± 53.86 pg/mL after 3 months and to 44.78 ± 28.04 pg/mL after 1 year ( < 0.001). Overall, 46% of the patients improved after 1 month of ethanol ablation therapy which increased to 84.5% during 1-year follow-up. No major complications were observed.

Conclusion: The current study showed the efficacy of ultrasound-guided ethanol injection in PHP and may be considered as a suitable alternative treatment in patients who are not candidates for the surgery. It has also a good safety profile without major complications if performed by experienced hands.
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http://dx.doi.org/10.4103/jrms.JRMS_553_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698383PMC
October 2020

Efficacy of Maggot Debridement Therapy on Refractory Atypical Diabetic Foot Ulcers: An Open-Label Study.

Int J Low Extrem Wounds 2020 May 5:1534734620920403. Epub 2020 May 5.

Islamic Azad University of Shahreza, Isfahan, Iran.

Atypical or refractory diabetic foot ulcers (DFUs) are still a major health problem. Maggot debridement therapy (MDT) by larva of is an ancient and a modern option for wound healing. It works by debridement, stimulation of wound healing, and disinfection. In this study, we aimed to evaluate the efficacy of MDT for healing atypical and refractory DFUs. Patients with atypical DFUs were selected and further evaluated for some predefined differential diagnoses like atypical fungal, parasitic, or bacterial infections, malignancy, trauma, and so on. Multiple MDT sessions were carried out. Ulcer size was measured before every MDT session. Complete wound healing, time to heal, and adverse effects were recorded as well. Forty-two DFU patients (26 men, 16 women) with 42 nonhealing atypical ulcers participated in this study. Complete wound healing was achieved in 35 patients (83.3%) by MDT. Complete debridement and then healing of the wounds happened in less than 1.79 ± 0.8 months. Four ulcers persisted, and 3 (7.1%) were eventually amputated. MDT may be considered as an effective treatment for atypical DFUs, which are unresponsive to conventional therapies.
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http://dx.doi.org/10.1177/1534734620920403DOI Listing
May 2020

Development and Primary Evaluation of a Smartphone Application for Blood Glucose Control in Hospitalized Patients.

Adv Biomed Res 2019 25;8:45. Epub 2019 Jul 25.

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

Background: Diabetes is one of the major causes of morbidity and mortality. Diabetes and hyperglycemia are leading causes for cardiovascular diseases, chronic infections, and other serious problems. The use of smartphone is dramatically increasing, and as such, it is sensible to use an application for management of hospitalized patients with diabetes or hyperglycemia. We designed a software for physicians by use of which they educate to take appropriate decisions in management of patients with diabetes and evaluated the quality of the application using a questionnaire.

Materials And Methods: Application is designed in a cascade framework to help in management of patients with diabetes and hyperglycemia. The treatment protocols presented in the program were extracted from diabetes management guidelines and valid review articles. Furthermore, we developed a questionnaire to assess the quality of the program. Physicians ( = 36) used this program for 1 week after which they completed the questionnaire.

Results: The physicians described the application to be useful and understandable.

Conclusion: A high percentage of physicians and health providers are aware of the problems when it comes to hospitalized patients with diabetes and our application was designed to resolve the associated difficulties.
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http://dx.doi.org/10.4103/abr.abr_188_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683406PMC
July 2019

Comparing Mizaj (temperament) in type 1 diabetes mellitus and healthy controls: A case-control study.

J Res Med Sci 2019 24;24:58. Epub 2019 Jul 24.

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

Background: Diabetes mellitus (DM), named in Persian medicine (PM), was categorized as hot or cold according to the Mizaj of patients. This study aimed to compare the Mizaj of patients with newly diagnosed type 1 DM (T1DM) with chronic cases and healthy children.

Materials And Methods: In a case-control study, three groups including chronic T1DM patients ( = 31), newly diagnosed T1DM patients ( = 37), and healthy children as the control group ( = 80) were recruited. Mojahedi Mizaj Questionnaire was used to measure two subscales, hot/cold and wet/dry, of Mizaj for participants. The mean scores of the Mizaj subscales were compared between the groups. Cutoff values were determined using receiver operating characteristic analysis, and the corresponding odds ratio (OR) for each subscale was identified.

Results: Overall 148 participants, with a mean age of 10.0 ± 6.2 years, were enrolled in the study. Analysis showed that the mean total heat and total dryness scores were significantly higher in new T1DM than that of chronic patients and healthy children (19.59 ± 1.7 vs. 16.6 ± 2.1 and 18.17 ± 1.9, < 0.001 for hot/cold and 4.70 ± 1.0 vs. 4.09 ± 0.9 and 4.31±0.8, = 0.02 for wet/dry). "Extra heat" based on the cutoff value of >18.5 was found to be a risk factor for T1DM (OR = 3.62, 95% confidence interval = 1.52-8.63).

Conclusion: New T1DM patients have higher frequency of hot and dry Mizaj, which is consistent with the concept of hot in PM. Most importantly, we found that "extra heat" in children can be considered as a risk factor for T1DM.
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http://dx.doi.org/10.4103/jrms.JRMS_980_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6670284PMC
July 2019

The effects of conventional drugs in the treatment of rheumatoid arthritis on the serum lipids.

J Res Med Sci 2018 28;23:105. Epub 2018 Dec 28.

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

Background: Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that leads to damage of human joints. There are various treatment approaches in which different drugs are prescribed which have several alterations in serum lipids. This research aimed to study the effect of RA treatments on the serum lipids.

Materials And Methods: Two hundred randomly selected patients with RA were randomly assigned to three different groups. The first group of patients was treated with a combination of prednisolone (PRD) and hydroxychloroquine (HCQ). The second group was treated with three drugs including PRD, HCQ, and methotrexate (MTX). The third group was treated with four medications including PRD, HCQ, MTX, and sulfasalazine. Within each group, the lipid factors such as triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), erythrocyte sedimentation rate, and visual analog scale were measured at the beginning of the experiment and 6 months after exposing the treatments. For each group, we also calculated the Disease Activity Score-28 (DAS-28). The analysis of variance revealed that the overall DAS-28 was significantly different among the three groups.

Results: In the first group, the level of TG and TC significantly decreased ( = 0.015 and ≤ 0.001, respectively). In the second group, the level of TG and LDL significantly decreased ( = 0.009). In the third group, the LDL level increased considerably ( < 0.001). The HDL level significantly increased in all three groups ( = 0.012, = 0.014, and = 0.028, respectively).

Conclusion: The treatment PRD + HCQ + MTX was more effective in reducing the LDL level and increasing the HDL level. To reduce the risk of cardiovascular diseases in patients with RA, it is important to prescribe the combination of drugs which leads and normalizes the lipid profile levels.
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http://dx.doi.org/10.4103/jrms.JRMS_869_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327686PMC
December 2018

Production and Clinical Application of the First Iranian Ultrasonic Desktop Nebulizer.

Adv Biomed Res 2018 20;7:114. Epub 2018 Jul 20.

Research and Development Center of Pishgaman Fonoon Tebe Behnood, Isfahan, Iran.

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http://dx.doi.org/10.4103/abr.abr_56_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071447PMC
July 2018

Effects of nanozeolite/starch thermoplastic hydrogels on wound healing.

J Res Med Sci 2017 26;22:110. Epub 2017 Sep 26.

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

Background: Wound healing is a complex biological process. Some injuries lead to chronic nonhealing ulcers, and healing process is a challenge to both the patient and the medical team. We still look forward an appropriate wound dressing.

Materials And Methods: In this study, starch-based nanocomposite hydrogel scaffolds reinforced by zeolite nanoparticles (nZ) were prepared for wound dressing. In addition, a herbal drug (chamomile extract) was added into the matrix to accelerate healing process. To estimate the cytocompatibility of hydrogel dressings, fibroblast mouse cells (L929) were cultured on scaffolds. Then, 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium-bromide assay test and interaction of cells and scaffolds were evaluated. For evaluating healing process, 48 male rats were randomly divided into four groups of four animals each (16 rats at each step). The ulcers of the first group were treated with the same size of pure hydrogels. The second group received a bandage with the same size of hydrogel/extract/4 wt% nZ (hydrogel NZE). The third group was treated with chamomile extract, and the fourth group was considered as control without taking any medicament. Finally, the dressings were applied on the chronic refractory ulcers of five patients.

Results: After successful surface morphology and cytocompatibility tests, the animal study was carried out. There was a significant difference between starch/extract/4 wt% nZ and other groups on wound size decrement after day 7 ( < 0.05). At the clinical pilot study step, the refractory ulcers of all five patients were healed without any hypersensitivity reaction.

Conclusion: Starch-based hydrogel/zeolite dressings may be safe and effective for chronic refractory ulcers.
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http://dx.doi.org/10.4103/jrms.JRMS_1037_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629837PMC
September 2017

Extended honeymoon period in a type 1 diabetic child by Iranian Traditional Medicine treatments, a case report.

Prim Care Diabetes 2017 12 29;11(6):583-585. Epub 2017 Sep 29.

Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran. Electronic address:

We present a 4-year-old newly diagnosed T1DM boy who presented with sever polyuria and polydipsia and HbA1C of 9.3%. Coincident with onset of ITM program insulin doses were tapered and the baby got free from insulin soon. Only three months after traditional anti-diabetic medications, his HbA1C improved to 5.8%.
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http://dx.doi.org/10.1016/j.pcd.2017.08.001DOI Listing
December 2017

Frequency of Cutaneous Fungal Infections and Azole Resistance of the Isolates in Patients with Diabetes Mellitus.

Adv Biomed Res 2017 6;6:71. Epub 2017 Jun 6.

Department of Mycology and Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Diabetic patients are more susceptible to cutaneous fungal infections. The higher blood sugar levels cause increasing the cutaneous fungal infections in these patients. The main objective of this study was to find the frequency of fungal infections among cutaneous lesions of diabetic patients and to investigate azole antifungal agent susceptibility of the isolates.

Materials And Methods: In this study, type 1diabetes ( = 78) and type 2 diabetes ( = 44) comprised 47 cases (38.5%) with diabetic foot ulcers and 75 cases (61.5%) with skin and nail lesions were studied. Fungal infection was confirmed by direct examination and culture methods. Antifungal susceptibility testing by broth microdilution method was performed according to the CLSI M27-A and M38-A references.

Results: Out of 122 diabetic patients, thirty (24.5%) were affected with fungal infections. Frequency of fungal infection was 19.1% in patients with diabetic foot ulcer and 28% of patients with skin and nail lesions. and were the most common species isolated from thirty patients with fungal infection, respectively. Susceptibility testing carried out on 18 representative isolates (13 , five ) revealed that 12 isolates (10 and two isolates) (66.6%) were resistant (minimum inhibitory concentration [MIC] ≥64 mg/ml) to fluconazole (FCZ). Likewise, eight isolates (80%) of spp. were resistant (MIC ≥4 mg/ml), to itraconazole.

Conclusion: Our finding expands current knowledge about the frequency of fungal infections in diabetic patients. We noted the high prevalence of FCZ-resistant spp., particularly in diabetic foot ulcers. More attention is important in diabetic centers about this neglected issue.
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http://dx.doi.org/10.4103/2277-9175.191003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468785PMC
June 2017

Comparing the Effects of Zinc Sulfate, Calcium Pantothenate, Their Combination and Minoxidil Solution Regimens on Controlling Hair Loss in Women: A Randomized Controlled Trial.

J Res Pharm Pract 2017 Apr-Jun;6(2):89-93

Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Science, Isfahan, Iran.

Objective: This study was conducted to evaluate the combination of oral supplements with 2% minoxidil solution in four groups of women with hair loss.

Methods: A prospective, randomized controlled trial was conducted from July to December 2016 in dermatology clinics affiliated to Isfahan University of Medical Sciences. A total of 73, 15-45-year-old, women with hair loss participated in this 4-month study. Simple randomization using Random Allocation Software was done to put the participants in four groups to receive coadministration of zinc sulfate and calcium pantothenate, zinc sulfate, calcium pantothenate, and 2% minoxidil solution. The primary endpoint was the change in hair density and diameter measured by dermatoscope. Secondary endpoints included the researcher's evaluation, dermatologist's opinion - which was blinded to the study - from comparing the participants' photographs before and after treatment and finally, overall changes in hair density measured by participants' self-assessment.

Findings: Seventy-three women participated in this study. Primary hair count and thickness were 118.5 ± 10 hairs/cm and 58.8 ± 5.8 μ that changed to 124 ± 11 hairs/cm and 62.3 ± 4.3 μ respectively ( < 0.001) which in the zinc plus pantothenate group these changes were from 118.6 ± 9.9 hairs/cm to 121.9 ± 11.1 hairs/cm ( = 0.042) and from 62.2 ± 6.6 μ to 64.0 ± 5.0 μ ( = 0.126), respectively. Hair density increments were more obvious in the minoxidil group, and hair thickness increments were more obvious in pantothenate group. Participants' satisfaction was 85% in the combination therapy which was more than other groups. Participants' satisfaction, author's and blind dermatologist's opinion showed a significant correlation ( = 0.0001).

Conclusion: Based on the participants' satisfaction, the combination of zinc sulfate and calcium pantothenate when administered in a pulse therapy way could be a good choice for hair loss controlling in initial stages.
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http://dx.doi.org/10.4103/jrpp.JRPP_17_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463555PMC
June 2017

Severity of Gastrointestinal Side Effects of Metformin Tablet Compared to Metformin Capsule in Type 2 Diabetes Mellitus Patients.

J Res Pharm Pract 2017 Apr-Jun;6(2):73-76

Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: This study was designed to compare the severity of gastrointestinal (GI) side effects in Type 2 diabetes mellitus (DM) patients receiving tablet or capsule forms of metformin.

Methods: In this prospective interventional study, patients were evaluated from June to November 2016 at DM clinics affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Adult patients with Type 2 DM who were eligible for inclusion criteria switched from metformin tablet to metformin capsule. Hemoglobin A1c (HbA1c), GI side effects, and patient satisfaction based on visual analog scale (VAS) were assessed during a 6-week follow-up of receiving metformin capsule.

Findings: One hundred and three patients were evaluated, and 75 patients participated in this study. At the baseline, 40 patients (53.3%) had GI side effects due to metformin tablet which was reduced to 16 patients (21.3%) after switching to metformin capsule ( = 0.001). There was also an improvement in HbA1c (from 7 to 6.8, < 0.0001). The results of patients' satisfaction based on VAS and numeric rating scale indicated that in 59 patients (78.67%), GI side effects were reduced after switching to metformin capsule (mean score: 7.2 with the range of 6-9) while 16 patients stated no treatment preference.

Conclusion: Switching to metformin capsule may result in less GI side effects, with no further side effect complications.
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http://dx.doi.org/10.4103/jrpp.JRPP_17_2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463552PMC
June 2017

ointment can reduce abdominal fat thickness and abdominal circumference of overweight women: A randomized controlled study.

J Res Med Sci 2016 1;21:63. Epub 2016 Aug 1.

Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Obesity is a worldwide health problem which is associated with a lot of complications. One of these comorbidities is the metabolic syndrome that is in correlation with abdominal fat thickness and waist circumference. Various methods were used to reduce abdominal fat thickness such as liposuction. A noninvasive method is the topical agent. In this study, we investigated the effectiveness of (AE) ointment on the abdominal fat thickness.

Materials And Methods: This study was a double-blind clinical trial which was done at the endocrinology clinic in Khorshid Hospital, Isfahan, Iran, in 2014. After explaining the procedure and obtaining informed consent, the candidates were randomly divided into the case and control groups. The participants of the case and control groups applied AE ointment or placebo for 6 weeks on their abdominal area. Body mass index, waist and buttock circumference, and abdominal fat thickness were measured in both case and control groups at their first visit and then at the next 2, 4, and 6 weeks. We used -test for comparing parametric variables between groups, paired -test for changes from baseline to final, and repeated measure ANOVA for changes at different steps.

Results: Sixty female candidates participated in this study (thirty in each group). Ten patients left the study and fifty participants finished the trial. At the end of the study, participants had a significant weight loss (2.96 ± 1.6 kg, < 0.001) that was slightly more in the case group (3.15 ± 1.5 kg vs. 2.75 ± 1.7, = 0.375). Abdominal circumference also decreased significantly in the participants (11.3 ± 6.7 cm, < 0.001), but the changes were more significant in the case group (13.9 vs. 6.5 cm, = 0.004). Similarly, abdominal fat thickness decreased significantly in the participants (2.3 ± 1.1 cm, < 0.001), although changes were not significantly different between two groups (2.53 vs. 2.04 cm, = 0.139).

Conclusion: Topical AE ointment can reduce the abdominal fat thickness as well as the waist circumference without causing any side effect.
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http://dx.doi.org/10.4103/1735-1995.187347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122106PMC
August 2016

Efficacy of bolus insulin calculation by a mobile-based bolus advisor: An open label clinical trial.

J Res Med Sci 2015 Nov;20(11):1064-9

Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: We investigated the efficacy of a mobile-based bolus advisor app in comparison with the usual multiple daily injections (MDIs) in diabetic patients.

Materials And Methods: In a nonrandomized, controlled clinical trial, 62 diabetic patients were selected to receive a 12-week intensive glycemic control by either a mobile-based bolus advisor (app) or MDI in the usual manner. We compared mean blood glucose (BG) and HbA1c before and just after the treatment program. The data were analyzed using paired sample t-test and analysis of variance (ANOVA).

Results: Fifty-six patients (30 cases and 26 controls) completed the study. The mean [standard deviation (SD)] of BG was 220.57 (43.7) and 231.5 (55) in the app group and control group, respectively. Mean BG decreased 38 mg/dL in the app and 16 mg/dL in the control group (P = 0.001 and 0.049 respectively). Changes of mean BG were different between the two groups significantly (P = 0.039). HbA1c decreased from 8.4% to 7.6% in the case and from 8.4% to 8% in the control group (P = 0.001 and 0.06, respectively). Changes of HbA1c were not different between the two groups (P = 0.141). The mean episodes of hypoglycemia were not different between the groups significantly (P = 0.108).

Conclusion: In conclusion, this study revealed that mobile-based bolus advisors can reduce mean BG better in patients who are planned to have a tight glycemic control as a feasible and available method and may improve HbA1c in the long term.
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http://dx.doi.org/10.4103/1735-1995.172817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755093PMC
November 2015

Autologous fibroblast suspension for the treatment of refractory diabetic foot ulcer.

Indian J Dermatol Venereol Leprol 2016 Jan-Feb;82(1):105-6

Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran.

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http://dx.doi.org/10.4103/0378-6323.172905DOI Listing
October 2016

Evaluation of the Effects of Cornus mas L. Fruit Extract on Glycemic Control and Insulin Level in Type 2 Diabetic Adult Patients: A Randomized Double-Blind Placebo-Controlled Clinical Trial.

Evid Based Complement Alternat Med 2015 5;2015:740954. Epub 2015 Oct 5.

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

Background. The plant Cornus mas L. (cornelian cherry) is traditionally used as an antidiabetic supplement; however, there is no related clinical trial. In this study, we evaluated the effects of the fruit extract of this plant on biomarkers of glycemic control in adult patients with type 2 diabetes. Methods. Sixty patients with type 2 diabetes were randomly assigned to two groups to receive either the extract or placebo capsules (2 capsules twice daily) for 6 weeks. Each drug capsule contained 150 mg of anthocyanins. Fasting plasma levels of glucose, insulin, HgbA1C, and triglyceride as well as 2-hour postprandial glucose level (2Hpp) were measured before and after the intervention and finally the mean values were compared between groups. Results. After 6 weeks of intervention, significant increase in insulin level (1.13 ± 1.90 versus -0.643 ± 1.82, P < 0.05) as well as decrease in HgbA1C (-0.24 ± 0.429 versus 0.023 ± 0.225, P < 0.05) and TG (-23.66 ± 55.40 versus 2.83 ± 15.71, P < 0.05) levels was observed in drug group compared to placebo. Conclusion. Daily consumption of the fruit extract of Cornus mas L. improves glycemic control by increasing insulin level and reduces TG serum level in type 2 diabetic adult patients.
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http://dx.doi.org/10.1155/2015/740954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609821PMC
October 2015

Effect of flaxseed on blood lipid level in hyperlipidemic patients.

Rev Recent Clin Trials 2015 ;10(1):61-7

Food Security Research Center, Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, P.O Box 81745-151, Isfahan, Iran.

Introduction: Hyperlipidemia is one of the most important risk factors of ischemic heart disease. Previous studies showed that flaxseed has the potential to improve lipid profiles. In this study we investigated the effects of flaxseed powder intake on lipid profiles of patients with hyperlipidemia.

Materials And Methods: This study was a randomized controlled clinical trial. Seventy patients with hyperlipidemia participated in the research. After detailed diet and lifestyle education, blood samples were collected from the participants. Patients with hyperlipidemia were randomly divided in to two intervention and control groups. The intervention group received 30 g of raw flaxseed powder every day for 40 days. Serum lipids were measured again in two groups after that time. Activity and food intakes of two groups were recorded.

Results: In the intervention group, weight and body mass index were considerably reduced. Total cholesterol was reduced in the intervention group and increased in the control group, both of which were significant. Low density lipoprotein significantly increased in the control group and reduced in intervention group; also, triglyceride was increased in the control group and reduced in the intervention group, which were significant Table 1.

Conclusion: Based on the findings obtained in this research, flaxseed powder intake desirably reduced serum lipids. The differences between two groups on the basis of analysis of covariance test were significant. In all cases except for the HDL-c, this is an effective intervention. Therefore, flaxseed may be regarded as a useful therapeutic food for reducing hyperlipidemia.
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http://dx.doi.org/10.2174/1574887110666150121154334DOI Listing
March 2016

Vitamin C may have similar beneficial effects to Gemfibrozil on serum high-density lipoprotein-cholesterol in type 2 diabetic patients.

J Res Pharm Pract 2014 Jul;3(3):77-82

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

Objective: Type 2 diabetes mellitus (DM-T2) is commonly associated with increased triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein cholesterol (HDL-C) levels. Fibrates like gemfibrozil are frequently used in diabetic patients to decrease TG and increase HDL-C levels. We compared the efficacy of Vitamin C, an antioxidant vitamin, with gemfibrozil on serum HDL-C in diabetic patients.

Methods: Type 2 diabetic patients, referred to our out-patient clinic were randomly divided into three groups. After 1 month of lifestyle and diet modifications, groups A, B, and C were prescribed 1000 mg Vitamin C, 600 mg gemfibrozil and combination of both, respectively. Before the study initiation and after 6(th) week of drug prescription, the blood samples were taken and analyzed for total cholesterol (Total-C), HDL-C, TG, fasting blood sugar (FBS), and hemoglobin A1c (HbA1c) levels.

Findings: Sixty-seven patients entered, and 50 patients (18 male, 32 female) finished the study. Overall, serum HDL-C increased significantly from 39.8 to 45.2 mg/dL in the participants (P = 0.001). HDL-C increased 6.3, 4.4 and 5.0 mg/dL in groups A, B and C, respectively (related significances were 0.017, 0.022 and 0.033, respectively). Significant decrease of serum TG and Total-C occurred in gemfibrozil and combination groups, but not in Vitamin C group. Changes in serum HDL-C between three groups were not significant (P = 0.963). We found a significant decrease in TG and Total-C in the groups B and C (P < 0.05), but no significant changes of TG, Total-C, LDL-C, FBS and HbA1c in group A (P > 0.05).

Conclusion: The results demonstrated that Vitamin C may have beneficial effects on HDL-C in diabetic patients without significant effects on plasma glucose or other lipid parameters; however, its role for the treatment of low HDL-C patients should be evaluated in larger studies.
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http://dx.doi.org/10.4103/2279-042X.141075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199195PMC
July 2014

Use of conventional regional DXA scans for estimating whole body composition.

Arch Iran Med 2014 Oct;17(10):674-8

Department of Medical Physics and Medical Engineering, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Using soft-tissue composition in conventional regional dual-energy X-ray absorptiometry (DXA) scans of the spine and hip to predict whole body composition (whole-body fat mass, whole-body lean mass and trunk-fat mass) instead of a whole body DXA scan.

Methods: We identified 143 adult patients who underwent DXA evaluation of the whole body. Anthropometric indices were also measured. Datasets were split randomly into two parts; the derivation set including a sample of 100 subjects, and the validation set including a sample of 43 subjects. Multiple regression analysis with the backward stepwise elimination procedure was used for the derivation set and the estimates were then compared with the actual measurements from the whole-body scans for the validation set. The Ra2 (adjusted coefficient of multiple determination) and SSE (error sum of squares) criteria were applied to compare regression models.

Results: Using multiple linear regression analyses, the best equation for predicting whole-body fat mass (Ra2= 0. 945) included gender, height, weight, waist circumference (WC), spine fat fraction and hip fat fraction; the best equation for predicting whole-body lean mass (Ra2 = 0. 970) included gender, weight, WC, spine fat fraction and hip fat fraction; and the best equation for predicting trunk-fat mass (Ra2 = 0. 944) included gender, weight, spine fat fraction and hip fat fraction.

Conclusion: The results of this study show that regional DXA scans of the spine and hip can be used to accurately predict body composition.
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http://dx.doi.org/0141710/AIM.007DOI Listing
October 2014

Recommendations for patients with diabetes mellitus during hajj pilgrimage.

J Res Med Sci 2012 Oct;17(10):988-9

Department of Endocrinology, Isfahan Endocrine and Metabolism Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698663PMC
October 2012

How does the impact of a community trial on cardio-metabolic risk factors differ in terms of gender and living area? Findings from the Isfahan healthy heart program.

J Res Med Sci 2012 Aug;17(8):732-40

Cardiovascular Research Center, Isfahan Cardiovascular Research Institute,Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: To assess the impact of gender and living area on cardiovascular risk factors in the context of a comprehensive lifestyle intervention program.

Design: Data from independent sample surveys before (2000--2001) and after (2007) a community trial, entitled the Isfahan Healthy Heart Program (IHHP) were used to compare differences in the intervention area (IA) and reference area (RA) by gender and living area.

Setting: The interventions targeted the population living in Isfahan and Najaf-Abad counties as IA and Arak as RA.

Participants: Overall, 12 514 individuals who were more than 19 years of age were studied at baseline, and 9570 were studied in postintervention phase.

Interventions: Multiple activities were conducted in connection with each of the four main strategies of healthy nutrition, increasing physical activity, tobacco control, and coping with stress.

Main Outcomes: Comparing serum lipids levels, blood pressure, blood glucose and obesity indices changes between IA and RA based on sex and living areas during the study.

Results: In IA, while the prevalence of hypertension declined in urban and rural females (P < 0.05). In IA, the prevalence of hypercholesterolemia and hypertriglyceridemia decreased in both females and males of urban and rural areas except for hypercholesterolemia in rural males (P < 0.01). In RA, the significant changes include both decrease in the hypercholesterolemia among rural males (P < 0.001) and hypertriglyceridemia in urban females (P < 0.01), while hypertriglyceridemia was significantly increased in rural females (P < 0.01).

Conclusions: This comprehensive community trial was effective in controlling many risk factors in both sexes in urban and rural areas. These findings also reflect the transitional status of rural population in adopting urban lifestyle behaviors.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687879PMC
August 2012

The efficacy of topical royal jelly on healing of diabetic foot ulcers: a double-blind placebo-controlled clinical trial.

Int Wound J 2015 Apr 8;12(2):137-42. Epub 2013 Apr 8.

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

Foot ulcers are major sources of morbidity in individuals with diabetes mellitus. As royal jelly (RJ, a worker honey bee product) contains enzymatic, antibacterial and vasodilative properties, it can potentially help in healing of diabetic foot ulcers (DFUs). This study aimed to evaluate the efficacy of topical RJ on healing of DFUs. Diabetic patients with foot ulcers who were referred to us at Khorshid Hospital, Isfahan, Iran, were managed by offloading, infection control, vascular improvement and debridement (if required). Then, all ulcers were randomly selected to receive either 5% sterile topical RJ or placebo on their total surface area. Patients were followed for 3 months or until complete healing. Twenty-five patients (6 females and 19 males) and a total of 64 ulcers were included and randomly allocated to case or control group (32 per group). Four ulcers were excluded and 60 ulcers included in the final analysis. Healing parameters including depth, length and width reduction rate, duration of complete healing and incidence of complete healing did not show any significant difference (P = 0·69, 0·95, 0·7, 0·74 and 0·6, respectively) between groups. We did not observe any side effect of topical RJ application. This study could not confirm any significant superiority of 5% topical RJ over placebo for the treatment of DFUs.
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http://dx.doi.org/10.1111/iwj.12063DOI Listing
April 2015

Autoimmune encephalitis associated with Graves' disease: a case report.

Acta Neurol Belg 2013 Jun 11;113(2):185-7. Epub 2012 Jul 11.

Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Almost all patients who developed autoimmune thyroid disease associated with encephalopathy were diagnosed to have Hashimoto's thyroiditis, but a few patients with Graves' disease who developed encephalopathy have been reported. A 36-year-old female with a 10-year history of Graves' disease had experienced three episodes of tonic-clonic seizure. At admission, the patient's status was confused, and she also developed tactile and visual hallucinations. The cranial MRI confirmed white-matter lesion and showed subcortical high signal lesions on T2-weighted images. In EEG record, diffuse slow activity was noticed in both sides. T3 and TSH were decreased, T4 remained normal and thyroid peroxidase antibody (TPO) was evaluated to be more than 2,000 (T4 = 8.4, T3 = 12/9, TSH = 0/14, TPO >2,000). The diagnosis of autoimmune thyroid disease is probable in all patients with signs of encephalopathy with unknown origin, while they have a previous history of thyroid disease.
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http://dx.doi.org/10.1007/s13760-012-0107-0DOI Listing
June 2013

The efficacy of topical Royal Jelly on diabetic foot ulcers healing: A case series.

J Res Med Sci 2011 Jul;16(7):904-9

Associate professor of endocrinology, Isfahan University of medical sciences, Isfahan, Iran.

Background: Foot ulcers and infections are the major sources of morbidity in individuals with diabetes mellitus. This study aimed to evaluate the efficacy of topical Royal Jelly (a worker honey bee product) on healing diabetic foot ulcers.

Methods: Diabetic patients with foot ulcers that were referred to our clinic at Khorshid Hospital, Isfahan, Iran; were evaluated three times a week and treated according to standard treatments consisted of offloading, infection control, vascular improvement and debridement if required. In addition, all ulcers were measured and then topical sterile 5% Royal Jelly was applied on the total surface area of the wounds. Eventually, they were covered with sterile dressings. Each patient was followed for a period of three months or until the complete healing.

Results: A total of eight patients were enrolled in this study. Of these, two had two ulcers and, therefore, ten ulcers were evaluated. Two ulcers were excluded. Seven of the remained eight ulcers healed. Mean duration of complete healing was 41 days. One ulcer did not completely heal but improved to 40% smaller in length, 32% in width and 28% in depth. The mean length, width and depth reduction rates were 0.35 mm/day, 0.28 mm/day and 0.11 mm/day, respectively.

Conclusions: Royal Jelly dressing may be an effective method for treating diabetic foot ulcers besides standard treatments.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263103PMC
July 2011

Correlation between microalbuminuria and urinary copper in type two diabetic patients.

Indian J Endocrinol Metab 2011 Oct;15(4):316-9

Department of Endocrinology, Arak University of Medical Sciences, Arak, Iran.

Introduction: Diabetes mellitus and its chronic complications may be associated with alterations in the plasma, tissue, and urinary levels of some trace elements like copper.

Materials And Methods: This cross-sectional study evaluates the 24 hour urinary copper levels in type 2 diabetic patients with microalbuminuria in comparison with patients without albuminuria.

Results: Forty-two patients with microalbuminuria (case) and 40 patients without microalbuminuria (control) participated in the study. Mean (CI 95%) urinary copper levels were 36.14 (14.54-57.74) and 14.77μcg /L (10.17-19.37) in the case and control groups respectively (P = 0.003). There was no significant effect of diabetes duration or HbA1c on urinary copper.

Conclusion: The present study shows diabetic patients with microalbuminuria have increased urinary copper excretion, however does not exclude the potential toxic effects of this high copper excretion on the progression of diabetic nephropathy.
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http://dx.doi.org/10.4103/2230-8210.85586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193781PMC
October 2011

The effect of dehydroepiandrosterone on insulin resistance in patients with impaired glucose tolerance.

Hormones (Athens) 2010 Oct-Dec;9(4):326-31

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

Objective: Dehydroepiandrosterone (DHEA) and Dehydroepiandrosterone-sulfate (DHEA-S) are the most abundant steroid hormones in the body. Recently, DHEA-S has gained interest as an antidepressant substance, with positive effects on autoimmune disease such as lupus and ulcerative colitis, as well as obesity, cancer, cardiovascular disease and diabetes. Its effect on insulin resistance is also assumed to be positive, but has not as yet been confirmed. The present cross-over clinical trial was conducted to evaluate the efficacy of DHEA and placebo on insulin resistance.

Design: Participants were selected among relatives of diabetic patients who were referred to the Isfahan Endocrine Research Center because of Impaired Glucose Tolerance (IGT) test. Thirty IGT patients were treated randomly with DHEA (50 mg/day) or placebo by cross-over clinical trial for six months and insulin resistance between the beginning and the end of each three months treatment period was assessed.

Results: At the end of the first three months, the mean changes from baseline of the various parameters in the drug group were: DHEA-S, 2.5 µmol/l (p=0.008); Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), 0.6 (p=0.6); insulin, 7.1 pmol/l (p=0.3) and FPG, 0.5 mmol/l (p=0.1). The changes in the placebo group were: DHEA-S, 0.08 µmol/l (p=0.6); HOMA-IR, 0.9 (p=0.03); FPG, 0.8 mmol/l (p=0.1); insulin, 25.1 pmol/l (p=0.05). In the second three months, the mean changes in the drug group were: DHEA-S, 4.5 µmol/l (p=0.003); Fasting Plasma Glucose (FPG), 0.1 mmol/l (p = 0.4); insulin, 4.3 pmol/l (p=0.2); HOMA-IR, 0.3 (p=0.1) and the changes in placebo group were: DHEA-S, 0.7 µmol/l (p=0.5); FPG, 0.3 mmol/l (p=0.3); insulin, 10.7 pmol/l (p=0.1); HOMA-IR, 0.6 (p=0.03).

Conclusion: DHEA did not reduce insulin resistance, although there was a tendency to improvement. The data indicate a possible but not clearly favorable effect of DHEA on insulin resistance.
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http://dx.doi.org/10.14310/horm.2002.1284DOI Listing
March 2011

Thiocyanate status does not play a role in the etiology of residual goiter in school children of Isfahan, Iran.

World J Pediatr 2010 Nov 16;6(4):357-60. Epub 2010 Nov 16.

Medical Students Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Despite long standing iodine supplementation in Iran the prevalence of goiter remains high in some areas. In the present study we investigated the possible role of thiocyanate as a goitrogen in the etiology of goiter in Isfahan, Iran.

Methods: A total of 2331 (6-13 year old) school children were selected by multistage random sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC) and urinary thiocyanate (USCN) were measured.

Results: Overall, 32.9% of the 2331 students had goiter. The median UIC was 195.5 μg/L. The mean ± SD of USCN in goitrous and nongoitrous subjects was 0.42 ± 0.28 mg/dL and 0.41 ± 0.32 mg/dL, respectively (P=0.86). USCN level in goitrous and nongoitrous boys was 0.41 ± 0.32 mg/dL and 0.43 ± 0.37 mg/dL, respectively (P=0.67). USCN level in goitrous and nongoitrous girls was 0.43 ± 0.26 mg/dL and 0.40 ± 0.28 mg/dL, respectively (P=0.43).

Conclusions: Thiocyanate overload does not play a role in high prevalence of goiter in the studied population. We suggest the role of other goitrogenic factors should be investigated in this region.
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http://dx.doi.org/10.1007/s12519-010-0236-6DOI Listing
November 2010

High prevalence of goiter in schoolchildren in Isfahan; zinc deficiency does not play a role.

Endokrynol Pol 2010 May-Jun;61(3):287-90

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

Introduction: There are controversial data about the role of zinc deficiency in the aetiology of endemic goiter. The aim of the present study was to determine the association between zinc status and goiter in schoolchildren of Isfahan.

Material And Methods: This study was performed in 2005. Two thousand three hundred and thirty-one schoolchildren were enrolled, and thyroid size was determined by inspection and palpation. Urinary iodine concentration (UIC) and serum zinc level were measured in a group of those children.

Results: The prevalence of goiter was 32.9%. The median UIC was 195.5 microg/L. Serum zinc was measured in 94 goitrous and 326 nongoitrous children. The mean + or - standard deviation of serum zinc in goitrous and non-goitrous children was 100.81 + or - 22.33 and 96.00 + or - 25.79 microg/dL, respectively (P = 0.08). The prevalence of zinc deficiency (serum zinc < or = 65 microg/dL) in goitrous and non-goitrous children did not differ significantly (6.4 % v. 8.0%, P = 0.61).

Conclusions: The prevalence of goiter is still high in Isfahan schoolchildren. It seems that zinc status is not involved in the high prevalence of goiter in this region. The role of other possible goitrogens should be investigated in Isfahan.
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November 2010

Association between serum ferritin and goitre in Iranian school children.

J Health Popul Nutr 2010 Apr;28(2):137-42

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

Despite long-standing supplementation of iodine in Iran, the prevalence of goitre among general people remains high in some regions. The study investigated the role of iron status in the aetiology of goitre in school children in Isfahan, Iran. Two thousand three hundred and thirty-one school children were selected by multi-stage random sampling. Thyroid size was estimated by inspection and palpation. Urinary iodine concentration (UIC) and serum ferritin (SF) were measured. Overall, 32.9% of the children had goitre. The median UIC was 195.5 microg/L. The mean +/- SD of SF in the goitrous and non-goitrous children was 47.65 +/- 42.51 and 44.55 +/- 37.07 microg/L respectively (p=0.52). The prevalence of iron deficiency in goitrous and non-goitrous children was 9.6% and 3.1% respectively (p=0.007). Goitre is still prevalent in school children of Isfahan. However, their median UIC was well in the accepted range. Iron deficiency is associated with goitre in a small group of goitrous children. The role of goitrogens should also be investigated in this region.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2980875PMC
http://dx.doi.org/10.3329/jhpn.v28i2.4883DOI Listing
April 2010