Iranian Journal of

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Diabetes mellitus is a common disease and its incidence and prevalence are increasing in most populations. The trend is particularly worrying in developing countries. The number of diabetic patients in Iran is estimated at 1.5 million. The distribution of diabetes in Iran has been the subject of several surveys. Disease prevalence rates, for all forms of diabetes, of 7–17% have been variously reported in several adult urban populations. Geographical prevalence is not uniform, however, and the prevalence of type 2 diabetes mellitus has been reported at 3-5% in rural communities. A screening program conducted at different locations of Iran revealed that nearly 50% of people with type 2 diabetes were unaware of their condition. Not surprisingly, therefore, that the incidence of complications for diabetes is high in Iran. A battle is being waged on all fronts at present to control the socio-economic scourge that is diabetes mellitus. A national program has been designed for the primary, secondary, and tertiary prevention of diabetes. The major strategies that it puts forwards are screening, the identification of high-risk groups, public education, and the training of specialist care providers. This article reviews the epidemiological features of diabetes in Iran.

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Background: Studies of the metabolic effects of Ramadan fasting on patients with type 2 diabetes mellitus are inconclusive.
Methods: Fifty-seven volunteers with type 2 diabetes underwent anthropometric and biochemical evaluation before and on the 14th and 28th days of Ramadan. Biochemical markers were measured by standard laboratory methods. Anthropometric measurements followed WHO criteria. Statistical analysis was by ANOVA for repeated measurements and Friedman’s two-way ANOVA, using SPSSv6 software.
Results: Daily cholesterol intake increased in all subjects (p<0.03). Body mass index increased (p<0.03) in women, but body mass index (BMI) and waist-to-hip ratio both decreased (p<0.01) in men. Blood pressure, fasting blood glucose and serum fructosamine did not change during the study. Plasma insulin (p<0.05), C-peptide (p<0.01) and insulin resistance (p<0.01) decreased only in men. Total and LDL cholesterol increased significantly in all subjects during the study.
Conclusion: Ramadan fasting does not alter carbohydrate metabolism or tissue insulin sensitivity in type 2 diabetes patients, given appropriate dietary education and rescheduling of oral hypoglycaemic medication. Lipid profile is unfavourably altered due to changes in both diet and biochemical response to starvation. Anthropometric indices improve in men but not women, possibly because of reduced physical activity in the latter.

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Background: The American Heart Association used the findings of the Framingham Heart Study to design an equation that quantifies the risk of coronary heart disease (CHD).
Methods: The variables in this equation are age, total cholesterol, HDL-cholesterol, systolic blood pressure, cigarette smoking, diabetes mellitus and evidence of left ventricular hypertrophy on electrocardiography. We calculated the CHD risk of 139 patients, with type 2 diabetes mellitus, who attended our diabetes clinic. We also assessed risk factors not taken into account by the Framingham equation, such as obesity (body mass index (BMI) or waist-hip ratio (WHR)), plasma triglyceride, LDL-cholesterol (LDL-C), and diastolic blood pressure (DBP). We used the linear regression and one-way ANOVA functions on the SPSS.v6 software to analyze our data.
Results: Ninety-one women and 48 men enrolled in the study. Men had a higher five- and ten-year CHD risk than women. 36.4% of our subjects had plasma HDL-C <35mg/dl. The TC:HDL-C ratio was 6.18±1.76 in men and 5.97±2.21 in women. We found no significant correlation between two- and five-year CHD risk and WHR, BMI or triglyceride levels. There was a significant correlation between two- and five-year CHD risk and DBP (p=0.0006 and p=0.0001) and LDL-C (p=0.005 and p=0.001).
Conclusion: Patients with diabetes mellitus have a higher, but smaller than expected, risk of CHD. The value of the Framingham equation in diabetic patients is equivocal, given the absence of correlation between obesity markers and CHD risk. Larger, prospective, studies are needed to clarify the matter.

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The incidence and prevalence of type2 diabetes mellitus is increasing worldwide. Many believe that type 2 diabetes mellitus is a disease that can be prevented by appropriate interventions in individuals at high risk for the disease. A number of studies have therefore looked at primary prevention during the past decade. Iran’s diabetic population of approximately 2 million people and the warning by the World Health Organisation that diabetes is on the rise in developing countries make the primary prevention of diabetes mellitus in Iran doubly important. Researchers have been increasingly focusing on identifying the risk factors for type 2 diabetes and, through these, appropriate strategies to prevent the rapidly growing incidence of this disease in the population at risk. Genetic predisposition (a positive family history), insulin resistance, obesity, impaired glucose tolerance, a history of gestational diabetes mellitus, physical inactivity and an unsuitable diet are among the most important recognised risk factors for type 2 diabetes other factors have also been found to contribute. Most of the available research has evaluated the effect of behavioural or lifestyle modification, in the form usually of dietary education and increased physical activity, in the primary prevention of type 2 diabetes. The second most common approach has been pharmacological manipulation. The information available indicates that type 2 diabetes will come to be considered as a preventable disease within the next decade. The weight of research behind this problem will undoubtedly discover even more effective methods of preventing type 2 diabetes in the near future than behavioural/lifestyle modification.

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Introduction: There is as yet no consensus as to the effect of Ramadan fasting on fasting blood glucose. We carried out a study to help clarify the situation.
Methods: This was a semi-experimental (pre- and post-) study of 115 healthy volunteers (67 men and 48 women), who fasted for at least 25 days during Ramadan. Blood samples were taken 7 days before Ramadan (at 7am after a 8-hour overnight fast), and on the 14th and 28th days of Ramadan (1 hour before sundown). The mean duration of daily fasting was 11.5±0.5 hours. Plasma glucose was measured by an enzymatic assay. Statistical analysis was by the paired-t and ANOVA functions on SPSS10.0 software.
Results: Fasting plasma glucose in the group as a whole decreased from 88.4±9.0mg/dl pre-Ramadan to 75.4±15.3mg/dl on day 14 and 62.9±7.7mg/dl on day 28 (p<0.001). Both men [87.5±8.8mgdl (pre-Ramadan)  60.8±6.4mg/dl (day 28)] and women [89.7±9.3mgdl (pre-Ramadan)  65.7±8.4mg/dl (day 28)] experienced a significant decrease in fasting plasma glucose levels (p<0.001 in both). There was a reduction in calorie intake during Ramadan in every volunteer (p<0.001), and there was a direct correlation between reduction in calorie intake and fasting plasma glucose (p<0.01).
Conclusion: Fasting plasma glucose decreases with Ramadan fasting and is associated with a reduction in calorie intake. The decrease in plasma glucose does not seem to be accompanied by any serious adverse effects in healthy volunteers, however.

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Background: In modern biomedicine, there is an increasing speed of development of new ideas and technologies and, consequently, increasing speed of new applicable knowledge. The rapid advances in medicine and biotechnology during recent decades, is accompanied with important discussions about new questions and dilemmas in the field of professional ethics. The increased recognition of ethical problems has contributed to the emergence of medical ethics as a new, cooperative and collaborative discipline in the world.
Methods: This article provides an introduction to main issues in modern medical ethics. It is a review of a great deal of books and articles which are published in the recent years.
Results: Some of the issues discussed include: physician-patient relationship, consent and informed decision-making, issues before birth, and end of life issues. Ethical issues in organ transplantation, biotechnology, assisted reproduction, medical research, clinical ethics education, and resource allocation are also reviewed briefly.
Conclusion: This intensive review of the basic issues in contemporary medical ethics is aimed at providing health care professionals a basic knowledge about ethical issues within their clinical practice.

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Background: The increased recognition of ethical problems has contributed to the resurgence of ethics in relation to health care, and to the emergence of medical ethics as a new collaborative discipline in the world. The growing trends in biomedical technologies have been associated with increasing discussions about ethical aspects of the new knowledge in different societies. Advances in genetics, stem cell research, and organ transplantation are some of the medical issues that have raised important ethical and social issues in different countries. Given the special attention that has been paid toward moral ethics in Islam, an emphasis on ethics has been also voiced by medical and religious professions in Iran. In the recent decade, great strides have been made in biomedical ethics, especially in the field of education, research, and legislation.
Methods: In this article, a brief history, and some of the activities in the field of medical ethics that are carried out have been reviewed.
Results & Conclusion: Establishment of the National Committee for Medical Research and Regional Committee of Ethics for Medical Research, and compiling the National codes of ethics in biomedical research are the main early activities carried out during 1990s. A comprehensive strategic plan for medical ethics in the national level has been introduced in 2002. After implementation of this plan, considerable activities are being carried out that most important related activities will be also reviewed in this paper.

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Background: In recent decades, traditional medical ethics which is confined to certain commands and prohibitions, is substituted by modern medical ethics which deals with problems such as euthanasia, abortion, organ transplantation, etc. and tries to find proper ethical solutions. These solutions wittingly or unwittingly are rooted in certain philosophical foundations.
Methods: The philosophy of medical ethics constitutes the basic part of medical ethics which tries to clarify the right and wrong in practice in various subjects of medicine and health care. Philosophy of ethics, on the one hand, makes an analysis of the principals of ethical theories and on the other hand, it offers some criterions for ethical actions as to what is good or bad.
Results: Four principles have been proposed in the West as clues to make decision about medical ethics which are as follows: autonomy, beneficence, nonmaleficence, and justice. However, some questions or interpretations may arise concerning these principles in various cultures and schools of thought. Evidently there is a different between the philosophical foundations of the Western thought with that of Islamic one concerning ethical decision-making in medicine.
Conclusion: Thus it is necessary to explain the philosophical position of medical ethics in Islam which can be realized only through the exchange of views between philosophers and physicians. The authors of this article try to explain the effect of different outlooks in philosophy on ethical decision-makings of physicians with special reference to the necessity of formulating the comprehensive principals of Islam in this field.

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Background: While the results of genetic research have increased our medical knowledge, promoted health and treatment of illness, some unique ethical problems arise about this type of research. Genetic information is often considered "special", or different from other kinds of medical information because of its close association with individual identity, which is due in part to the common assumption that genes are determinative of human health and characteristics. Thus there is potentially risk of harmful events genetic research participants including stigmatization or discrimination by employers and insurers. In addition, the fact that genetic information about an individual reveals information about relatives, creates new and complex ethical issues, particularly regarding privacy and confidentiality.
Methods: Given the importance of this subject, we searched PubMed, Medline and Ovid for some keywords such as "genetic research" and "ethics" during the recent decade. We compiled the article by reference to valid searched articles and some books.
Results & Conclusion: Informed consent, confidentiality, ownership of genetic information, family/cultural considerations, storage and future use of genetic samples, counseling and supervision contrivances are some respect important general ethical concerns which this paper discuss about briefly

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Background: In recent years, many progresses have been confirmed in the field of medicine. Transplantation is one of the instances which have had rapid improvements. Human and nonhuman organs and tissues, embryo, fetus and even the human stem cells have been used for transplantation. The researches in this field have lead to the more functional and new methods. Regarding the ethical problems would prevent the future dangers of human being and society. The researchers’ duty is to respect all of the ethical points associated with the transplantation. In this article, the researches on corps, samples of human tissues and especially in embryo and fetus have been discussed.
Methods: For compilation of the article, we searched articles by means of PubMed, Medline, and Ovid and so we concerned some books.
Results & Conclusion: In transplantation researches on corps, the patient’s consent in advance (before death) or the relatives consent is important. In Islam respect to the dead Muslim is highly insisted. In human tissue researches the reason of tissue collection, kind and amount of it, research use and non-beneficence use of the research results have to be significantly considered. In recent years, the researches on embryo and fetus have been attenuated. This kind of research despite of its advantages has brought many ethical questions in consent acquisition, viability or non-viability of the embryo and fetus and the permission of research confirmation. In this review article it has been tried to regard all of the current ethical problems in this field, wishing this article to be a guide for more extensive researches.

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Background: Human embryonic stem (hES) cells have the unrivaled ability to differentiate into any specialized cell type. Significant attention is currently directed to the biological and therapeutic capabilities of these cells for developing novel treatments for acute and chronic diseases including heart disease, diabetes, Parkinson's disease, Alzheimer's disease, multiple sclerosis, spinal injuries and cancer. However, these technologies have posed profound ethical issues. Ethical challenges are largely based on concerns for safety, efficacy, resource allocation, and methods of harvesting stem cells. Fundamental points in the issues are the human dignity and human rights, the concept of the moral status of human embryos, concerns about commercialization of stem cells and oocyte donors, and slippery slopes towards reproductive cloning. The use of hES cells for research is currently high on the ethical and political agenda in many countries and international organizations such as UN, UNESCO, and WHO. Many countries allow strictly regulated research on human embryos. The purpose of this paper is to describe the scientific background to the current ethical and legislative debates about the generation and use of human stem cells, and to give an overview of the ethical issues underlying these debates. The successes and limitations of mammalian reproductive cloning are itemized.
Methods: For compilation the article, we searched particulary in Pubmed and Ovid for keywords of " cloning", "stem cell research", "ethics", etc. Considered articles which were published during recent ten years.
Results and Conclusion: This review hopes to bring the reader closer to the science and the ethics of this new technology, and what the implications are for the medical practitioner. This review also discusses the legal status of ES cell research in the world with special attention paid to the Islamic perspectives.

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Background: Medical students at all levels of experience, encounter learning opportunities in a wide variety of clinical settings. There are some ethical dilemmas a student may face and possibly carry the burden throughout his file. Most of formal medical ethics teaching focuses on dilemmas that students may face in their future practice, rather than the ethical problems they encounter as medical students. Several studies suggest that students’ clinical experiences constitute an informal or hidden ethics curriculum, which can undermine their developing professionalism. Methods: In this article, we discuss some ethical dilemmas of medical education and also some solutions for them.
Results & Conclusion: In order to promote a setting that is satisfying to the student, to the faculty, and most importantly, to the patients, we have proposed ethical notes for medical students about informed consent, protecting patient confidentiality and managing ethical concerns.

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Background: Cardiovascular disease is one of the major leading cause of death in Iran. There is a strong association between parental history of cardiovascular disease clustering of risk factors in the offspring. Detection and treatment of cardiovascular risk factors since childhood is essential to reduce the incidence of disease in adulthood. This study was performed to identify major cardiovascular risk factors in middle school-aged children and their parents in high risk compared to control families.
Methods: The middle schools of the 6th of Tehran were divided randomly into two groups. A total of 169 high-risk children with their families were recruited from the first group while 105 control children with their families were recruited from the second group of schools. Coronary risk factor survey was performed in the participants.
Results: Prevalence of increased total- and LDL-cholesterol and high FBS were higher in high-risk parents and children. Prevalence of increased BMI was higher in fathers and children of high-risk families. More fathers in high-risk families were smoker. The means of waist circumference and WHR were significantly higher in high-risk fathers. The means of total- and LDL- cholesterol were significantly higher both in parents and children of high-risk group. The means of FBS were significantly higher in fathers and offspring of high-risk families. Conclusion: Cardiovascular risk factors are more prevalent and clustered in high-risk families. Screening of these families is essential to prevent progression of cardiovascular disease since childhood and reduce its burden in adulthood.

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Medicine and ethics have increasingly more links caused by considerable progresses in biotechnology in different fields of medical diagnosis, treatment and prevention. The issue of research ethics is one of the most important subjects which have been emphasized by international and regional organizations, policy-makers, medical and religious professions, scientists and researchers in different countries in recent decade. It is widely understood that research ethics committees typically play an important role in evaluating the ethical aspects of medical research. A ‘Research Ethics Committee’ (REC) is defined as a multidisciplinary, independent, body charged with reviewing research involving human participants to ensure that their dignity, rights and welfare are protected. Research ethics committees protect the welfare and rights of participants involved in research through reviewing research proposals, monitoring the conduct of research and dealing with complaints that arise from research. This manuscript will introduce you to the concepts underlying research ethics committees worldwide and in Iran. This paper will begin with a brief history of research ethics, continues with a concise overview of ethics committee situation and responsibilities, and ends with an outline of the national activities. We hope the manuscript could enhance awareness of biomedical researchers about status and duties of research ethics committees and consequently strengthen the RECs in our country.

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Background: Regarding the adverse effect of stress on glycemic control in type 2 diabetic patients, the present study investigates the function of Glibenclamide on insulin release from β cells of rat pancreatic islets, subsequent to chronic psychological stress exposure.
Methods: In this study 30 male Wistar rats were divided into equal groups of control and experiment (5 groups). Four different restraint stressors with random sequence were used 1h twice daily for 15 and 30 days. 24 hours after the last stress session, static insulin secretion from isolated pancreatic islets of each animal were evaluated in the presence of 5.6, 8.3 and 16.7 mM glucose. Also insulin release in response to 5.6 mM glucose in the presence of 10 μM Glibenclamide was evaluated.
Results: The insulin release from isolated islets of the stress experienced animals was significantly increased only on the 30th day as compared to the control animals. In the experiment group, insulin release from the islets in the presence of 5.6 mM glucose alone was significantly increased on the 15th and 30th days as compared to the first day. However, in the control group there was no significant increase in insulin release at the similar conditions. In contrast to the control group, insulin release in response to 5.6 mM glucose in the presence of 10 μM Glibenclamide revealed no significant difference in the experiment group on the 1st 15th and 30th days as compared to the insulin release in the presence of 5.6 mM glucose alone. Insulin release from the isolated islets exposed to 5.6 mM glucose in the presence of 10 μM Glibenclamide, on different experimental days was not significantly different between the control and experiment groups.
Conclusion: According to the results of this study, it appears that chronic psychological stress decreases the responsiveness of pancreatic β cells to Glibenclamide, subsequently could prevent the augmentation of insulin release induced by the drug. This finding is worthy to consider in metabolic control of diabetic patients whom consume the agent.

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In the field of health care and medical practice, gain sharing plans should be carefully examined to be sure they reflect the codes of ethics. Ethical principles involved in gain sharing include informed consent and conflict of interest. Physicians must discharge their responsibilities to patients with loyalty, honesty and good faith, all the while avoiding conflict of interest. Conflict of interest rules usually focus on financial gain. This may raise some important issues, including kickbacks, fee-splitting and self-referral. These practices can potentially distort professional judgment. Some countries have rules of professional conduct governing these issues. In this article, we intend to describe importance of the issues of kickbacks, fee-splitting and self-referral in the field of clinical medicine and discuss some ethical issues that should be considered by physicians.

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Medical ethics has a long history worldwide, and the move towards a trans-cultural ethics must be based on an appreciation of the civilizations’ history. It is often thought that medical ethics history has begun by Hippocrates, however it is much older. It is clear that various cultures such as Babylonia, ancient Egypt, Greece, and the Persians have attempted to regulate medicine and to protect patients' rights in the known ancient world. One of the earliest written provisions in this field, which comes back to about 1750 BC, is the code of Hammurabi written by Babylonian. In this paper we aimed to explore the roots of medical ethics in Persian history, particularly, after adherence of Iranians to Islam. In this article, we used related books of great Iranian and non-Iranian historians, and examined some authentic articles collected through searches of databases such as Medline and Ovid and search engines such as Google Scholar. History of medicine in Iran has begun about fourth century BCE. Great Iranian physicians had paid special attention to ethics in their practices, teachings and manuscripts. There was a gap between the ancient civilizations and the Renaissance era in Europe, commonly called the dark ages (Medieval). The immense strides have been made by the Persians in that long interval which is briefly reviewed.

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Background: The scavenger receptor class B type I (SR-BI), as the high density lipoprotein cholesterol (HDL-C) receptor, is a key component in the reverse cholesterol transportation. The objective of this study was to assess the association between exon1 (G→A) polymorphism of SR-BI gene and lipid profiles among the Tehran Lipid and Glucose Study (TLGS) population.

Methods: This cross-sectional study included 774 adults (322 males and 452 females) aged 20–70 years, who were randomly selected from among TLGS population. Anthropometrical and biochemical variables for participants were measured. Selected SR-BI gene polymorphism was determined with restriction fragment length polymorphism (RFLP) using the Alu restriction enzyme.

Results: according to the results of current study, in the Tehran population, the allele frequency of SR-BI (G→A) polymorphism was 0.159 for an allele (minor allele) and 0.841 for G allele. Allele frequencies were in conformity with Hardy–Weinberg equilibrium. The result of this study showed that Subjects with the less common allele (allele A), after adjusting for age, have lower HDL-CandHDL3concentrations (p=0.046, p=0.041 respectively).

Conclusion: lipid disorders are caused by the interaction of environmental and genetic factors; therefore, exon1 (G→A) polymorphism of SR-BI gene could not be the only cause for the abnormality in the HDL-C levels. In future, this polymorphism may be use as a molecular marker for diagnosis.

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Background: Recently the role of apelin in inflammation has been known. However, the effect of exercise training-induced cytokine apelin in diabetes status hasn’t been investigated. The purpose of this study was to determine the atni-inflammation effect of 8-week aerobic training on apelin plasma concentration in diabetic male rats.
Methods: Twenty eight diabetic male Wistar rats were randomly divided into 3 groups: Non-diabetic (n=9), control diabetic (n=9) and trained diabetic (n=10). Type 2 diabetes was induced by intraperitoneal injection of nicotinamide (95 mg/kg body weight) and streptozotocin (60 mg/kg body weight). The training group ran 8-week on treadmill progressively for 45 min at a speed of 24 m/min and a 5% grade. After the training, plasma concentrations of glucose, insulin, TNF-α and apelin were measured and HOMA-IR was calculated. One-way analysis of variance (ANOVA) and Pearson’s correlation was used for analyzing data. P<0.05 was considered to be statistically significant.
Results: Results showed a significant decrease in plasma concentrations of glucose, insulin and  TNF-α  and HOMA-IR in trained diabetic vs control diabetic group, a significant increase in plasma concentration of apelin in trained diabetic group vs non-diabetic and control diabetic group and a significant negative correlation between plasma concentrations of apelin and TNF-α in trained diabetic group.
Conclusion: It appears that 8-week aerobic training by improvement of insulin sensitivity and decrease of inflammation can increase plasma concentration of apelin in diabetic male rats.
 

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Background: Hemodialysis is the most common treatment in patients with end stage of renal disease (ESRD). Patients undergoing hemodialysis due to multiple drug treatments, special food programs and being able to cope with their illness need to self-care activities. Due to lack of information about the role of health literacy in effectiveness of self-care in these patients, this research aimed to determine the correlation between self-care and health literacy in patients undergoing hemodialysis in Valiasr Hospital of Arak in 2015.
Methods:  In this descriptive correlational study, 93 undergoing hemodialysis patients selected by objective sampling method. Data collecting instruments were "demographic questionnaire", "self-care questionnaire " and "Health Literacy for Iranian Adults questionnaire". The content and face validity of questionnaires was assessed. Reliability assessed through internal consistency (Cronbach's alpha) and Intra- Class Correlation Coefficient. Data were analyzed by SPSS, version 21, using, Kolmogorov–Smirnov test, Descriptive Statistics and Kolmogorov–Smirnov test. 
Results: The results showed that 79/6% of patients were male and 20/4% were female with an average age of 54/18 ± 13/9 year. The mean score of self-care and health literacy were 146/90± 45/46, 88/14± 36/42 and were at a moderate level. The lowest score of self-care and health education related to the field of fluid intake and decision-making and behavior. There was a significant positive correlation between self-care and health literacy (p<0/0001, r= 0/6).
Conclusion: The existence of a significant positive correlation between self-care and health literacy showed that the hospital managers and the nurses must pay more attention to what patients undergoing hemodialysis need. Considering the importance of health literacy in the care of patients undergoing hemodialysis, it seems necessary to nursing administrators and Politicians use educational programs tailored to the patient's health literacy level in order to promote their health and quality of life.