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Gangliosidosis GM1, is a lipid storage disorder due to deficiency of the lysosomal enzyme &beta-galactosidase. This deficiency leads to lysosomal accumulation of gangliosidosis GM1 to be, which contributes to swelling, cell damage and dysfunction of the organs. Gangliosidosis GM1a rare neurodegenerative disorder. Mongolian spots are significant clinical sign in some of the metabolic diseases, such as gangliosidosis GM1, but limited information is available. Hepatomegaly, hypotonia, edema, seizures, and skeletal malformations and Cherry red spot in the macula of the eye are of other symptoms of the disease. In this paper, we present a 10-month-old child with gangliosidosis GM1 type 1 with extensive mongolian spots who was referred the Hajar Medical Educational Therapeutic Center Shahrekord.

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Background: A unique subset of Individuals with normal body mass index (BMI= 18.5-24.9 kg/m2) and high body fat percentage (above 30% in women and 23% in men) that are termed as normal weight obese, are at increased risk for development of the metabolic syndrome and chronic diseases because the adipose mass and the excess of fat mass are an important source of proinflammatory cytokines. The aim of the present study was based on this hypothesis that women with high body fat percentage and normal body mass index are at increased risk for the metabolic syndrome in compared to healthy non obese women. Methods: This was as case-control study in which 40 obese women with normal weight (BMI= 18.5-24.9 kg/m2) and body fat percentage above 30% (FM> 30%) and 30 non-normal weight obese women (BMI= 18.5-24.9 kg/m2) and fat percentage less than 25% (FM <25%) who were matched for age (mean age = 28 years) recruited for this study. The components of metabolic syndrome including Anthropometric variables, blood pressure and fasting plasma concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glucose and insulin were measured. Results: The anthropometric measurements including waist and hip circumferences in NWO was higher than non-NWO (respectively 74.78±4.81 vs. 70.76±2.91 and 99.12±4.32 versus 93.16±2/91, Pvalue<0.001), while the waist-to-hip ratio did not differ between the two groups (p=0.448).Also no significant differences were observed in concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, fasting plasma glucose, systolic and diastolic pressure between groups. Fasting serum insulin and insulin resistance was higher in NOW compared to non NWO (Pvalue<0.05) and insulin sensitivity in NWO was lower than non NWO (0.357 versus 0.374, pvalue = 0.043). Conclusion: Because of the higher serum insulin concentration and the lower insulin sensitivity, obese women with normal body mass index but high body fat percentage can be associated with a higher risk for metabolic dysregulation and metabolic syndrome compared to healthy women with the same body mass index and normal body fat percentage

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Background: Diabetic foot ulcers are one of the most common complications of diabetes that affect more than 15 percent of diabetic people. In the other hand, due to problems in the immune system of diabetic patients, these ulcers are often slow to take hold and this dramatically increase the risk of gangrene, amputation and even death. Conventional methods to identify vulnerable areas to ulcers that are based on the examination and palpation of the skin, this usually can’t reveal changes of integrity of the skin at the right time to prevent the ulcers. Therefore in recent years, thermal imaging from the body as a new method to early diagnosis has been considered to be as a ulcers area. This method is based on comparing the left and right feet‘s temperature to identify areas of inflammation occurs.

Methods: In this study from 25 participants feet’s thermal images were taken in the Image Processing Laboratory, University of Hakim Sabzevari at standard conditions and Then The algorithm is fully automatic order to compare the thermal image accurately and extraction of passionate area from the temperature matrix for correspondent comparison of left and right feet‘s temperature Is designed to identify areas of hidden inflammation.

Results: The proposed system is designed based on image processing and computer vision techniques, Able to find two cases of inflammation were among the participants in the study. The accuracy, sensitivity and specificity of the algorithm, respectively equal of 90%, 100% and % 88 achieved.

 Conclusion: Unlike past researches that is more for the quality of their action on the thermal images, we managed to design quite a smart system that quantitatively comparing peer to peer parts of the left and right people’ planetary, in order to identify the inflammation area. While the researchers said that when a patient does not feel the monofilament testing and couldn’t noticed the temperature of his/her soles of his/her feet, In fact, the only method to prediction and prevention of creating ulcers in a foot without sense, is detecting the temperature difference, that designed algorithm in this research well and accurately, makes meet The authenticity and acceptability of this demands.

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Background: Cardiomyopathy is a side effect caused by diabetes. Prolonged hyperglycemia gives rise to an increase in the expression of the receiver gene RAGE subsequently triggering pathogenesis cardiac signaling pathways in the heart of rats with type II diabetes. The present paper aims to examine how a 12 week Resistance training on gene expressions RAGE, ICAM, VCAM in the heart of diabetic rats with STZ.
Methods: 16 male Wistar rats with weight mean ranging from 200 ± 20 g were randomly assigned to two groups of Resistance diabetes (n = 8) and control diabetes (n = 8) and were kept under lab circumstances. A 12 week Resistance training was administered with the experimental group and 48 hours after the end of the last training session the rats were made unconscious and examined. Their hearts were, afterwards, cut out and the extent of gene expressions RAGE, ICAM, VCAM in the left ventricular heart was measured using Real time-PCR method.
Results: The results indicated there was a significant difference between left ventricular heart of the Resistance diabetes and that of control diabetes in terms of gene expression RAGE, yet no significant difference was detected between the two groups in terms of gene expressions ICAM, VCAM.
Conclusion: According to the results, in seems that Resistance trainings effectively reduce gene expressions RAGE and reduction pattern but non-significant in the Gene ICAM, VCAM in left ventricular heart of diabetic rats and therefore can be considered an effective way in reducing pathogenesis cardiac signaling pathways in the heart of rats with type II diabetes.

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Background: Increasing number of elder people accompanied with an increasing number of subjects with chronic diseases among them. The aim of this study was to compare the results of physical condition of elder people in Grogan city, Golestan, Iran, in 2009 with the results in 2004.
Methods: Through a cross-sectional study using a standard questionnaire data on 884 elder people who were resident in 4^th and 5^th health station covered by Gorgan health center at 2009 were collected by trained persons as self-report. Participants entered in the study through a census method are asked about their physical condition. Using Qui-Square method, collected data has been analyzed. The results were compared with the outcomes of pervious study (unpublished) at 2004 which has been carried out among 315 elder people in the same study area. SAS 9.2 software has been used for data analyzing.
Results: Mean age of elders at 2009 was 67.20±6.67 years and at 2004 was 67.59±6.72 years. Frequency of Hypertension, hyperlipidemia, asthma, diabetes showed a statistically significant (p<0.05) increase in 2009 compared with 2004. On the other hand, the frequency of epilepsy, losing of teeth, inguinal hernia and heart burn decreased during these years, statistically significant again (p<0.05).
Conclusion: The results of the current study indicated that cardiovascular disease significantly increased in second phase of the study rather than first one. It is necessity to interventions to the control of these problems.

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Background: Older people are vulnerable in terms of health status. The elderly`s Khuzestan due to the very warm weather of this region are more at risk for health problems. This study is a report on the health status of the elderly in Khuzestan province in 2012.
Methods: This is a Cross-sectional study, with multi-level proportional cluster Random sampling among people aged ≤ 60 years of Khuzestan province. Nutritional status was assessed by Mini Nutritional Assessment (MNA), depressed mood screening was conducted with Geriatric Depression Scale-15 questionnaire, activities of daily living was evaluated using KATZ ADL and Lawton Instrumental ADL tools.
Results: In this study, 387 people participated. The prevalence of hypertension, diabetes mellitus, depressed mood, and anxiety in the participants, were 38.8%, 28.6%, 34.9 and 38.7, respectively. Hearing loss reported in 33.9% and vision impairment was in 62.2% of the participants. Memory impaired founded in 14.9% of the participants.  4.3% of the elderly suffered from malnutrition and 48.3% were at risk of malnutrition. Dysfunction in ADL were existed in 13.9% and 30.3% of the participants had some degrees of dysfunction in IADL.
Poly pharmacy (consumed more than 3 medications) was observed in 36.5% of older adults in this province. The most common health services need was medical services at home and then transport services.
Conclusion: Although the health status of the elderly in Khuzestan province  generally was not worse than the average of Iran, it needs that a special pay attention in some areas, such as hypertension, diabetes, nutritional status and lack of independence in activities of daily living in this age group.
 

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Background: Improved in health condition, reduced fertility rates, and increased life expectancy has increased number and proportion of elderly population. This study was reported the health status of older population in North Khorasan province.
Methods: This is a cross-sectional study that enrolled 99 subjects (40 men and 59 women) ≥ 60 years by a multi-levels proportionate cluster random sampling method.
Required information was gathered by means of a demographic questionnaire. Mini Nutritional Assessment (MNA), Geriatric Depression Scale-15 (GDS-15), Katz's basic activity of daily living, and Lawton's instrumental activity of daily living were administered. Measurements of anthropometric and blood pressure were performed based on standard methods
Results: The prevalence of diabetes and hypertension in elderly, were 17.7% and 57.6%, respectively. Depressed mood was observed in 36.4% of the participants 36.4% of the participants and 18.2 percent of them reported that their health condition was bad. In addition, 73.5% of the elderly had complained about any bodily pain. As well as, 22.6% of the participants used opium at least once during the last year.
Conclusion: It seems that the health status of the elderly in North Khorasan province is not suitable in many indicators, such as hypertension, malnutrition, drug abuse and complaints of pain and their health status was worse than the national average of Iran. A special attention requires to the health status of elderly in this province .

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Background: Although several tools for evaluating and screening of cognitive status have been introduced, most of them are not applicable in Iranian elderly population because of cultural differences and high illiteracy rate. This study is report of "Brief Cognitive Assessment Tool"(BCAT) was developed as a cognitive status-evaluating test and reported psychometric characteristics.
Methods: the BCAT tool includes memory assessment using three words recall test with a rating similar to Mini-Cog and the functional status including "ability to dress", "ability to use the phone," " ability to manage own medications", among both two sexes and financial management capabilities in men and ability to prepare food in women. Functional rating is different in educated and non-educated people. Diagnosis of dementia is considered, when memory impairment is accompanied by the dysfunction. Eighty-six residents of a nursing home (41 men and 45 women) among who had inclusion and no had exclusion criteria also consent to participate were randomly enrolled. Concurrent validity was shown as correlation coefficient between the BCAT categorization and score of mini meAntal state examination (MMSE). Criterion validity, sensitivity and specificity of BCAT were evaluated based on global deterioration scale (GDS). Reliability of two raters results within two weeks was indicated by Kappa coefficient.
Results: The sensitivity and specificity and accuracy rate of the BCAT based the GDS was 88.6%, 82.6%, and 84.9%, respectively. The correlation between the MMSE score and results of the BCAT classifying was significant. The Kappa coefficient between the results of two raters was 81.1%.
Conclusion: It seems that the BCAT has good psychometric properties to recognize cognitive impairment among Iranian older adults.

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Background: Osteoarthritis (OA) is the most common joint disorder and the most prevalent cause of joint pain across the spectrum of middle age to elderly. The purpose of this study was to determine the role of subjective norms and perceived behavioral control on self-care among elderly patients with osteoarthritis who are suffering from OA in Yazd city, Iran.
Methods: A cross-sectional study was conducted and 87 elderly who attained to health centers subjects through simple sampling methods. The data collection instrument was a questionnaire designed for the study which the first includes demographic variables, of subjective norms and perceived behavioral control Part II, and self-care behaviors categories of items Part III. The questionnaires completed by interview and data were analyzed by SPSS18 software using T-Test, ANOVA, correlation coefficient tests.
Results: The mean score of the subjective norms, perceived behavioral control and self-care were 81.85±11.40 (The top 110 scores), 90.19±6.19 (The top 120 scores) and 44.93±5.84 (The top 60 scores), respectively. The results showed that between subjective norms and perceived behavioral control and self-care with demographic variables except education and perceived behavioral control (P =0.001), the history of disease of self-care (P =0.001) and perceived behavioral control and economic status (P =0.002) were not a significant relationship, Also The results Pearson’s correlation test revealed that there was a significant correlation between self-care behaviors and perceived behavioral control (P =0.008, r=0.297).
Conclusion: As for strong association between behavioral control and self-care that we found in our study and high influence and extension of mass media, it recommends to emphasis on using these methods as educational assistance devices in interventional programs in these medias.

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Background: The aging of the population is a great challenge of the public health in this century. The health promotion of the elderly people requires a comprehensive and accurate understanding of their health status.
Methods: This cross-sectional study has assessed the health status of 191 old people ≥ 60 in Sistan and Balouchestan province that selected by a multi-level cluster random sampling. General health data was collected using SF-36 questionnaire, nutrition status was assessed using Mini Nutritional Assessment (MNA), depression status was detected by the geriatric depression scale-15 (GDS-15), functional status was assessed using the activity daily living (ADL) and instrumental activity daily living (IADL) questionnaires, as well as, the information about demographic, history of diseases, vaccination, participation in social activities, and the utilization of elderly care services were evaluated by an approved questionnaire. History of hypertension was asked from the participants. Moreover the blood pressures of them were twice measured.
Results: The mean age of the participants was 69.81 (8.32) years. The health status was reported excellent and bad by 4.2% and 9.4% of the participants, respectively. The prevalence of fall in recent year, memory disorder, hearing and visual impairment, and malnutrition were 35.3%, 15.6%, 30.3%, 56.6%, and 8.9%, respectively. The prevalence of dependency in "activity of daily living" and "instrumental activity of daily living" were 25.8% and 58.2%, respectively.
Conclusion: It seems that the prevalence of malnutrition, impaired ADL and IADL, and memory impairment in the older population of Sistan and Baluchestan are above the national and global averages.
 

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Background: Alborz Province is one of the provinces that accepted immigrants. Immigration has a profound effect on physical and mental health in elderly. This study was performed to assess the health status of Alborz province older population.
Methods: In this cross-sectional study, 235 subjects were enrolled (113 men and 122 women) aged ≥ 60 years using multi-level proportionated cluster random sampling that selected from 19 cities of this province. Data was collected by a demographic questionnaire, measuring anthropometric characteristics, and blood pressure and using "Mini Nutritional Assessment", ”Geriatric Depression Scale-15 ", “Katz’s Activity of daily living”, and "Lawton’s Instrumental activities of daily living”. Data was analyzed with spss21.
Results: The mean age of the participants was 68(6.00) years.  The prevalence of anxiety and depression among the participants was as 51.5% and 34%, respectively. At risk or malnutrition was observed in 27% of the participants and 54.5% had suffered dental problems and 49.8% also had problem in walking.
Conclusion: Overall, the health status of elderly people in the Alborz, perhaps slightly better than the national average, but the high prevalence of metabolic disorders also the high prevalence of depression and anxiety require serious intervention by policy makers to promote the health in elderly.

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Background: Diabetes is a common disease and one of the biggest health problems in the country. These patients, in addition to physical problems, also suffered from mental problems which the disorder of body image is one of the most prominent problems. This study compared mental image of patients with type 2 diabetes treated with oral medication and those with insulin.
Methods: This study was conducted in a descriptive-analytic way in 1394. The study population included patients with type II diabetes are treated in diabetes center of Aran and Bidgol in 1394. A sample of 168 people was randomly chosen. Needed data was collected by demographic and multi-dimensional questionnaire using a person's attitude about their body image (MBSRQ) Dry reliable 0.73 and were analyzed with SPSS 22 software by using independent t tests, chi-square and Mann-Whitney and Fisher
Results: Base on the duration of disease, the most common was among patients with oral treatment (82.1 percent) and treated with insulin (58.3 per cent) of less than 10 years. Average rating of orientation to fit oral treatment was for patients with 41.79 and 40.15 for insulin therapy, in health assessment section for patients with 17.58 oral treatment and 16.71 for insulin. State of disease trends was in 63/1 percent of patients with moderate oral treatment and 46.4 percent with severe insulin treatment. Independent t test results showed a significant difference between the scores of two patients in the above sections (P<0.05) but significant differences in other aspects of mental image between the two groups was observed.
Conclusion: Generally, average mental image in patients treated with oral medication was not more than patients treated with insulin. Because one of the negative effects of diabetes on patients is psychiatric disorder, therefore, to improve the mental state of these patients and improve health and to control disease in these patients, research findings is expected to be the use.
 
 

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Background: Insulin is first choice for gestational diabetes control, but its needed to frequent injections; one thing that is difficult for pregnant women, so interest to metformin consumption is increased. Metformin easily crosses the placenta and its fetal blood levels is equivalent to the level of the mother's blood. Metformin also easily cross the brain barrier and enter the brain. Possible side effects of metformin compared to insulin on fetus brain development was concerned to design of present study.  

Methods: In this cross-sectional prospective trial, gestational diabetes women were recruited randomly to insulin (64 patients) and metformin (64 patients) groups and compared for pregnancy and neonatal outcome and also six-month-old infancy developmental indexes. The results considered significant if P value was ≤ 0.05.
Results: Six-month body mass index of insulin group women was significantly more than metformin group(P=0.05), but there was not any significant difference in cesarean section, preterm labor, dystocia, preeclampsia and still birth rate between two groups. Also neonatal characteristics, need to admission and six-month-old infancy developmental indexes according to Ages stages questionnaire were no different between two groups.
Conclusion: Metformin consumption in compare to insulin was not associated with maternal, neonatal and six-month-old infancy developmental indexes side effects.

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Background: Effect of mobile text message on blood glucose (HbA1c) control in providing type 2 diabetes care (diabetes mellitus non insulin dependent).

Methods: The present study is a systematic review with meta-analysis. A search of the most important electronic medical databases of medical resources from December 1992 to January 2017 in a systematic manner, including: CRD, Ovid Medline, PubMed, Cochrane Library, and moreover, by referring to the resources found in the articles and manual search on the site. Related to this technology and, if necessary, contacting experts. All randomized clinical trials and cohort studies were reviewed.
Results: Participants included nine studies (818), all randomized clinical trials, and quality assessment. The average decrease in Mobile SMS Services users compared to the control group (SMD-0.324, 95% CI, -0.526 to -0.121; I2 = 51.0). The analysis of subgroups showed that young patients are more likely to use diabetes programs, and the size of the effect increases with short intervals of interventions and the size of large samples.
Conclusion: Mobile SMS services may be considered as an effective component for helping control glycosylated hemoglobin and as a side intervention for the care of patients with type 2 diabetes.

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Background: Due to the progress of diabetes and the use of alternative herbal medicines, In this study, the effects of oral administration of the mucilage extracted from pods of Abelmoschus esculentus (Ae) fruits on serum levels of glucose, lipids and morphology of Langerhans islets in diabetic rats was investigated.
Methods: In this experimental study, 24 female wistar rats were randomly allocated into four groups (n=6): normal control (NC), diabetic control (DC) and 2 diabetic groups that received (oral) 300 and 500 mg/kg/body weight of Abelmoschus esculentus. After preparing and confirming the type of, mucilage extraction from the fruit’s green okra was done by evaporation device in vacuum. Diabetes mellitus was induced by single dose intraperitoneal injection of streptozotocin 60mg/kg/body weight in diabetic groups. After 4 weeks, the serum levels of glucose and lipid profile of all groups were analyzed. Also morphology of Langerhans islets in the 4 groups was evaluated using H&E staining method. The data analyzed by SPSS software using ANOVA and Tukey tests.
Results: The results indicate a significant increase (P<0/05) in glucose, cholesterol, triglyceride, LDL and significant decrease (P<0.05) in HDL in diabetic rats compared to normal control. The use of the mucilage extracted from A. esculentus caused a significant decrease in serum levels of glucose, cholesterol, triglyceride, LDL and significant increase in serum level of HDL comparison with diabetic group.
Conclusion: according to the results of this study, the mucilage extracted from A. esculentus could be effective on control hyperlipidemia and hyperglycemia caused by diabetes mellitus.

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Background: Nowadays, thinness is generally considered as a standard of women's beauty, and high BMI is associated with negative physical and psychological consequences among women, including negative body image and eating disorders. Therefore, identifying the effective factors in reducing these outcomes seems necessary. The purpose of this study was to determine the moderating role of self-compassion in the relationship between body mass index, body image and symptoms of eating disorders.
Methods: The research method was correlation and the statistical population was all female students of Tehran in 2018 that Among them, 345 students were selected by convenient sampling. Measurement tools included Eating Disorders Diagnostic Scale (EDDS), Self-compassion Measurement Scale (SCS) and Body Appreciation Scale (BAS-2). Data were analyzed using Pearson correlation coefficient and multiple regression analysis (hierarchical method).
Results: The results showed that there was a significant positive correlation between body mass index and eating disorder (P<0.01), and a significant negative correlation with body appreciation and self-compassion (P <0.01). On the other hand, the results of hierarchical regression analysis showed that self-compassion moderates the relationship between body mass index and symptoms of eating disorders (P<0.01), but it did not moderate the relationship between body mass index and body appreciation (P>0.05).
Conclusion: These findings showed that self-compassion may protect women against negative consequences of a high body mass index. As a result, self-compassion can be beneficial in improving mental health and preventing disorders.

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Background: Neuroinflammation and oxidative stress play a pivotal role in the diabetic neuropathic pain. The aim of this study was to evaluate the effect of aerobic exercise with melatonin on RAGE gene expression and some indicators of oxidative stress in rats with diabetic neuropathic pain
Methods: Forty 8-week-old male Wistar rats (weight range 204 ± 11.3 g) were randomly divided into five of 8 groups including: diabetic neuropathy (50 mg / kg streptozotocin intraperitoneal injection), diabetic melatonin neuropathy (mg / kg 10 melatonin daily for 6 weeks), diabetic neuropathy exercise (30 minutes of aerobic exercise at 15 meters per minute, 5 days a week for 6 weeks), diabetes melatonin neuropathy and healthy exercise and control. After confirmation of diabetic neuropathy by behavioral tests, exercise protocol and supplementation were performed. RAGE gene expression was measured by real-time technique and oxidative stress indices in spinal cord tissue by spectrophotometer. One-way analysis of variance and Tukey's post hoc test were used for statistical analysis.
Results: Exercise and melatonin reduced the sensitivity of the nervous system to thermal hyperalgesia and mechanical allodynia. Aerobic exercise with melatonin significantly reduced RAGE gene expression and MAD concentration and increased the activity of SOD and CAT enzymes compared to the diabetic neuropathy group (P <0.05).
Conclusion: Aerobic exercise with melatonin modulates the expression of RAGE gene and oxidative stress indices and improves the sensitivity of nociceptors to pain factors. It is recommended to use aerobic exercise with melatonin for diabetics to reduce neuropathic pain.

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Background: The role of the immune system and inflammation in controlling metabolic diseases such as insulin resistance, type 2 diabetes, obesity and overweight is well established. Also, physical activity controls and prevents the occurrence of metabolic diseases, which has anti-inflammatory and anti-oxidative effects. The aim of the present study was to study the effect of eight weeks of 10, 20, 30 seconds exercise training on the levels of antimicrobial factors in the saliva of obese adolescent boys.
Methods: 32 male students voluntarily participated in the present study and were randomly assigned to four groups: 1) obese aerobic exercise, 2) normal weight aerobic exercise, 3) obese control without exercise, and 4) normal weight control without exercise. The criteria for the obese group was a BMI above 25. Anthropometric indices of height, weight and body mass index were measured exactly. Before and after eight weeks of practice, Shatell-Run standard test was performed. Salivary samples of lysozyme, lactoferrin, lactate and C-reactive protein concentrations were taken after eight weeks of training with a frequency of three sessions per week with an intensity of 30 to 90% of maximum aerobic power. Using analysis of covariance, variables with a significance level of less than (P≤0.05) were included in the analysis.
Results: The results showed a significant increase in salivary levels of lactoferrin (P=0.001), lysozyme (P=0.003), lactate (P=0.001), and C-reactive protein (P=0.006). There are more obese students than people of normal weight (Youth body mass index criterion)
Conclusion: The increased response of some antibacterial and inflammatory salivary proteins after eight weeks of 10-20-30 sports training following exhaustive activity may be due to the acute response of the immune system.

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Background: Fatty liver disease and its relationship with cardiovascular diseases is one of the concerns of today's society, therefore the present study was conducted to investigate the effect of eight weeks of endurance training and growth hormone injections on Cardiac mitochondrial PGC1α content and some oxidative stress indices in mice with hepatic damage.
Methods: In this experimental study, 21 male mice were, randomly, divided into three groups (n=7): control (C), Exercise (E), Exercise + Growth Hormone (EGH) group. The Medium intensity endurance training program was performed for eight weeks and 5 sessions with an intensity of 50% VO2max of per week. The somatropin injection protocols were 1 mg/ kilogram/body weight, respectively. Statistical analysis of the data was performed using the software SPSS, using One-Way ANOVA and post hoc Tukey tests.
Results: PGC1a levels increased in both groups compared to the control group. SOD and MDA levels increased and decreased in both groups compared to the control group, respectively. The reduction of HOMA levels was significant only in E group compared to the control group. Also, the difference between E and E-GH group was significant. ALT/AST ratio decreased in both groups compared to the control group. The reduction of LDL/HDL ratio was significant only in group E compared to the control group.
Conclusion: Endurance training has produced a more effective response in improving NAFLD markers than GH peptides. Growth hormone injection can have negative consequences on some indicators of this abnormality.

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Background: The health assistant and treatment assistant in the Ministry of Health and Medicine are in charge of educating people with diabetes and empowering them to achieve self-management of diabetes. The present study was conducted with the aim of determining the status of education and support for diabetes self-management in comprehensive health service centers and diabetes clinics in Isfahan province.
Methods: The diabetes education units of 20 comprehensive health service centers and 11 diabetes clinics in Isfahan province formed the sample size. The data collection tool was a checklist with 107 items, which was completed by observing and reviewing 170 paper/electronic files of patients with diabetes.
Results: In more than two-thirds of the files of diabetes centers/clinics, initial assessment were neither performed nor recorded. Educational needs assessment was recorded in 5% of the files and educational planning was not recorded in nearly 100% of them. In more than a third of the files (36.5%), diet education was recorded once when the case was filed. In 3.4% of files, educational effectiveness evaluation was recorded and in three quarters of files (75.78%), continuous support for self-management was not recorded.
Conclusion: There is a significant gap between the status of education and support for diabetes self-management and the process and outcome standards of DSMES in the educational units covered by the provincial health and treatment department. This gap seriously and negatively affects the results of this approach.