Iranian Journal of

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Background: In many studies, Serum lipoprotein(a) [Lp(a)] levels considered as an independent risk factor for atherosclerosis. The aim of this study was to assess the association between Lp(a) and cervical carotid artery stenosis in one sample the Iranian population.
Methods: As a cross sectional study, between June 2004 and January 2005, at Tehran Heart Center, 1189 candidates for any kind of open heart surgery, were recruited into this study. Carotid Dopplers ultrasonography was performed for all participants. Serum levels of Lp(a), total cholesterol, triglyceride and blood sugar and quantitative CRP were measured in fasting state and their correlations with carotid atherosclerosis were assessed.
Results: Among 1189 participants, 837 (70.5%) were male and 352 (29.4%) were female. Their mean age was 60±9.3 years (range between 35 to 88). There was not significant relation between Lp(a) serum levels and carotid artery stenosis (P=0.46). The relationship between Lp(a) levels and carotid artery stenosis in both ≤55 years and >55 years patients was not significant too (P=0.25). Also gender has no relationship in this regard (P=0.15). Significant relationship was found between Lp(a) level & hypoecho plaques (vulnerable lesions) (P=0.001).
Conclusion: In our study, we found no significant correlation between serum Lp(a) and carotid stenosis. Lp(a) was found to have positive relationship with hypoecho plaques (vulnerable lesions) which predispose patients for CVA. Further investigations suggest for better evaluations.

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Background: The relationship between diabetes and periodontal diseases has already been proved, but the effect of non-surgical periodontal therapy on the control of diabetes is controversial. The aim of this study was to determine the effect of this type of treatment on the control of diabetes.
Methods: In this randomized clinical trial 30 type 2 diabetic patients with moderate to severe periodontitis who were referred to the diabetes clinic of Imam Khomeini hospital during 2004-2005 were studied. The treatment procedure was explained for control group and an informed consent was taken. Scaling and root planning was randomly done for 15 patients, while control group were not treated for periodontal disease. The glycated hemoglobin (HbA1C) and clinical attachment loss was measured for all of the patients before and 2 months after treatment.
Results: At the baseline the clinical attachment loss (CAL) was significantly different between two groups. There was no significant difference between baseline HbA1C in the control and the experimental group. After 2 months the HbA1C was reduced in the treated group which was not statistically significant.
Conclusion: In this study non-surgical periodontal therapy had not effect on the control of type 2 diabetes.

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Diabetes among Eastern Mediterranean (EM) population above age of 20 years is around 10.5% and is ranked among the leading causes of blindness, renal failure and lower limb amputation. While 50% of EM people with diabetes will die of cardiovascular diseases. This means that in our region, there are pandemic trends in prevalence of diabetes and associated complications. Globally, people with diabetes are 25 times more likely to have a leg amputated than those without the condition, and up to 70% of all leg amputations happen to people with diabetes. Somewhere in the world, a leg is lost to diabetes every 30 seconds. Foot ulcer is the most common single precursor to lower extremity amputations among diabetics. Hyperglycemia, impaired immunologic responses, neuropathy, and peripheral arterial disease are the major predisposing factors leading to limb-threatening diabetic foot infections. Diabetic foot represents a health problem and economic burden among majority of EM Countries. Infection in a diabetic foot is limb-threatening and must be treated empirically and aggressively. Treatment of infected foot wounds is the most common reason for diabetes- related hospitalization. The good news is that up to 85 percent of diabetic amputations can be prevented. As to above challenge, the best approach for EMR is education, community awareness and prevention of diabetic foot. The public approach and education that emphasize on proper footwear and foot care are best preventive and cost-effective modalities that can be easily implemented among EM Countries. EM Countries need to strengthen national health services that promote the concept of prevention and tight control of diabetes in order to prevention diabetes complications. This also necessitates building/strengthening diabetes registry and complications.

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Background: Use of medicinal plants for attenuation of hyperglycemia and restoration of lipids to normal levels is very important. The effect of oral administration of Vaccinium myrtillus (VM) on serum glucose and lipids in diabetic rats was investigated.
Methods: Female Wistar rats were divided into 4 groups: control, VM-treated control, diabetic, and VM-treated diabetic groups. The treatment groups received oral administration of plant-mixed food (6.25%) for 4 weeks. Serum glucose, triglyceride, total cholesterol, LDL- and HDL- cholesterol levels were determined before the study, and at 2nd and 4th weeks after the study.
Results: Serum glucose level in diabetic group increased 2 and 4 weeks after the experiment as compared to data one week before the study (P<0.001) and VM treatment of diabetic rats did have a significant hypoglycemic effect (P<0.01). In addition, triglyceride level in diabetic group increased 4 weeks after the experiment in comparison with related data one week before the study (P<0.05) and there was a significant lower level of triglyceride in VM-treated diabetic rats (P<0.05). Furthermore, there was no significant changes regarding serum total cholesterol, HDL- and LDL- cholesterol levels in treated diabetic group as compared to untreated diabetic group.
Conclusion: Oral administration of VM has a significant hypoglycemic effects and leads to an appropriate changes only in triglyceride level.

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Background: Type 2 diabetes mellitus is the most common type of diabetes which is triggered by various factors such as obesity, hyperlipidemia, hypertension, dietary habits and inheritance. With respect to geographic variation of diabetes prevalence, it is important to know the risk factors regionally.

Methods: As a case-control study, we looked for important risk factors of diabetes in our region. This study consisted of 400 individuals in case group and 400 individuals in control group. All these anthropometric measurements were calculated by standard methods. Blood samples taken from two groups were studied for TG, FBS, Cholesterol and HbA1c. Data are reported as the Mean±SD. P<0.05 was considered as statistically significant.

Results: There was no significant difference between two groups about mean age and sex ratio. Statistically significant difference were found for central obesity, hyperlipidemia, hypertension, polycystic ovarian syndrome (PCOS) and positive family history of diabetes in both groups (P<0.05).

Conclusion: The results showed that central obesity, hyperlipidemia, hypertension, PCOS and positive family history of diabetes are important risk factors of diabetes mellitus in Shiraz. In concordance with the results of this study, screening programme for that risk factor of diabetes in this region is suggested.

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Background: The relationship between diabetes and serum insulin and Zinc (Zn) levels is complex with no clear cause and effect relationships. Since Zn plays a clear role in the synthesis, storage and secretion of insulin as well as conformational integrity of insulin in the hexametric form, the decreased Zn, which affects the ability of the islet cell to produce and secrete insulin, might then compound the problem, particularly in type 2 diabetes. The aim of this study was to determine the changes of plasma Zn in patients with type 2 diabetes mellitus and healthy control in Shiraz city.
Methods: As a case-control study, we determined the serum Zn levels by atomic absorption spectrophotometer, blood HbA1c levels with columnar chromatographic method and Glucose, by enzymatic colorimetric method in auto analyzer. Data are reported as the Mean±SD and P<0.05 was considered as statistically significant Results: Results of this study revealed that levels of Zn in serum of diabetic patients is lower than in the healthy control in Shiraz city (P<0.05).
Conclusion: With respect to the result of this study, dietary educations about consuming enriched Zn foods such as sea foods and corn in diabetic patients is necessitated.

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Background: Food insecurity refers to the inability to afford enough food for an active, healthy life. The metabolic syndrome, otherwise known as syndrome X or the insulin resistance syndrome, is a collection of cardiovascular risk factors including hypertriglyceridemia, lowered HDL-cholesterol, glucose intolerance, abdominal obesity and hypertension. Recent studies indicate widespread prevalence of food insecurity and metabolic syndrome in various regions of Iran. No studies have been conducted so far to investigate the relationship between food insecurity and the metabolic syndrome in Iran. This study was conducted to investigate the relationship between food insecurity and metabolic syndrome in women. Methods: In this study, 130 women 30 to 60 years old with metabolic syndrome as cases and 130 women without metabolic syndrome as controls referred to clinics affiliated to Shiraz University of Medical Sciences were selected. The USDA household food security questionnaire was used to assess food insecurity status. The metabolic syndrome was defined according to the criteria of the Adult Treatment Pane l II (ATP III). Results: The prevalence of food insecurity was 69.2% in cases and 45.4% in controls (P< 0.001). After multiple logistic regression and removal of potential confounders, food insecurity was significantly associated with metabolic syndrome (OR3.2&CI 95%: 1.9-5.6)(P<0.05). Conclusion: Given that food insecurity is an important risk factors for metabolic syndrome, Planners should reduce food insecurity in society, especially women through measures to improve the economic situation and dietary patterns of households.

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Background: There are no available reports indicating the effects of Dietary Approaches to Stop Hypertension (DASH) eating plan on insulin resistance, inflammation and oxidative stress among pregnant women with gestational diabetes mellitus (GDM) We aimed to investigate the effects of DASH diet on insulin resistance, serum hs-CRP and biomarkers of oxidative stress among pregnant women with GDM. Methods: This randomized controlled clinical trial was performed among 32 pregnant women diagnosed with GDM at 24-28 weeks' gestation. Subjects were randomly assigned to consume either the control (n=16) or DASH diet (n=16) for 4 weeks. The DASH diet was rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, total fats, cholesterol, refined grains, and sweets, with a total of 2400 mg/d sodium. The control diet contained 40-55% of its energy as carbohydrates, 10-20% as proteins and 25-30% as total fats. Fasting blood samples were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose (FPG), serum insulin and hs-CRP, HOMA-IR, plasma total antioxidant capacity (TAC) and total glutathione levels (GSH). Results: Consumption of DASH diet, compared to the control diet, resulted in decreased FPG (-7.62 vs. 3.68 mg/dL P=0.02), serum insulin levels (-2.62 vs. 4.32 µIU/ml, P=0.03) and HOMA-IR score (-0.8 vs. 1.1 P=0.03). Increased concentrations of plasma TAC (45.2 vs. -159.2 mmol/L P<0.0001) and GSH (108.1 vs. -150.9 µmol/L P<0.0001) were also seen in the DASH group compared with control group. We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets. Within-group comparisons revealed a significant reduction in plasma TAC and GSH levels in the control diet, while a significant rise in these biomarkers in the DASH diet. Conclusion: In summary, consumption of DASH diet in pregnant women with GDM had beneficial effects on FPG, serum insulin levels, HOMA-IR score, plasma TAC and total GSH levels. The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies.

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Background: Diabetes is a chronic disease that is increasing in the world that has a different outbreak in different societies. 90% to 95% of all types of diabetes include type 2 diabetes. This disease is spreading due to the Industrial life and urbanization .The Nationwide Program for Prevention and Control of Diabetes is already under way for controlling the disease and its side-effects. This study is intended to probe into the effects of the program in the country.
Methods: This study used a cross-sectional pre- and post-test design involving 100 elderly patients newly introduced to be suffering from diabetes who were selected by convenience sampling in Isfahan. The data collection methods were a questionnaire on demography and health, and another one on patients’ levels of fasting blood sugar (FBS) and hemoglobin glycosides (HbA1c(The data was gathered before and three months after the patients’ entrance into the program.
Results: The mean and standard deviation of the fasting blood sugar before the program were 172.73 and 71.68 and after the program 143.02 and 51.19, respectively (P<.001; t=5.30). And finally, glycated hemoglobin mean and standard deviation before the program were 8.24 and 1.9 and after the program 7.44 and 1.66, respectively (P<.001; t=4.79).
Conclusion: The results indicate the importance of the program for the prevention and control of the elderly patients’ diabetes by controlling their fasting blood sugar and glycated hemoglobin.It is recommended that this program be implemented in all health centers of the country.

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Background: Prevalence of obesity and overweight in women increases the possibility of metabolic syndrome and diabetes. Based on the variety of the effects of different type of exercise and the differences in the upper and lower body muscle volume involved in the exercise, the effects of high intensity interval exercise with arm and leg ergometer on metabolism and insulin resistance might be different. The aim of this study was to compare the effect of upper and lower body interval exercise on carbohydrate metabolism and insulin resistance in obese women.
Methods: Twelve obese and overweight women (body mass index, 31.1±5.5 kg/m²) performed two interval exercise trials of 30-min on arm and leg ergometer with one week intervening. Interval exercise included 5 sets of 6 min in which 2- min activity at 85% VO_2max and 4 min active rest at 45% VO_2max was performed. Two blood samples were taken before and immediately after exercise for measuring glucose and insulin. VO₂ and VCO_2m were collected during exercise and used to calculate the amount of carbohydrate oxidation.
Result: Although interval exercise reduced the insulin concentration, responses of insulin to upper and lower body exercises were not significantly different (P>0.05). Glucose level reduced following interval exercise, and this reduction was significantly (P<0.05) higher following lower body interval exercise than upper body exercise. Similarly the reductions in HOMA-IR were significantly (P<0.05) higher following lower body interval exercise than upper body exercise. Interval exercise resulted in increases in oxidation of carbohydrate, though; responses to upper and lower exercises were not significantly different.
Conclusion: It could be concluded that interval exercise in obese women leads to changes in carbohydrate metabolism and insulin resistance, and that the changes in insulin resistance are related to type of exercise (upper and lower body), though carbohydrate oxidation is not.
 

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consumption of medicinal plants, especially when conventional treatments are not able to control diabetes, and the patient needs insulin administration, is remarkable. The aim of this paper is the attitude and social behaviors of Bandar Abbas 's people to consume of herbal medicine in treatment of DM.

Methods: This descriptive cross-sectional study was conducted in 2017. In this study, 300 individuals aged 20 to 65 years were selected randomly from 10 locations in Bandar Abbas. The research instrument was a two-part questionnaire that evaluated demographic information and attitude. Data were analyzed by SPSS-24 software using descriptive statistics (mean, standard deviation and frequency), ANOVA, T-test Independent and Chi-Square tests.
Results: The mean and standard deviation of people's attitude toward using herbal drugs in the treatment of diabetes was 47.15±3.23. The mean score of attitude with gender variables (P = 0.002), age (P = 0.04) and education (P = 0.02) was statistically significant. The majority of people had their information on herbal medicines through their parents and relatives, and this difference was statistically significant in distributing the frequency of information sources in individuals. (P = 0.001)

Conclusion: According to the results of this research, people's attitude towards the use of herbal medicines in the treatment of diabetes was at a relatively good level, which can play a constructive role in the scientific and executive planning of the health and medical professions.

 

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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: Although a positive association between type 2 diabetes and breast cancer has been reported, an association with gestational diabetes mellitus (GDM) is less clear. This study aimed to assess the relationship between the history of GDM and the incidence of BC a long term population based study.
Methods: To conduct this research, 4076 women aged 20-50 years who participated in the first phase of Tehran-Lipid-and-Glucose-Study, who had at-least one pregnancy were included. Each participants were asked about the history of GDM every 3 years. They was evaluated about the occurrence of breast cancer (BC). Cox-survival analysis was used to measure the Hazard-ratio (HR) for both groups with and without history of GDM
Results: The study population included 886 women with prior GDM and 3,909 women without history of GDM. The median duration of follow-up among women with and without the history of GDM were 12.12 and 11.62 years, respectively. The incidence of BC was 0.64 per 1,000 year-olds with confidence=interval of 95% (0.44-0.91). Among them, 4 cases were reported in women with GDM and 26 cases in women without GDM. (Incidence of 0.36 per 1000 person-years with confidence=interval 95% (0.11-0.99) in women with prior GDM and 0.73 per 1,000 person-years with confidence=interval 95% (0.49-1.1) in women without a history of GDM.
Conclusion: Our study showed that the history of GDM is not an independent risk factor for breast cancer.

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Background: Diabetes is the most common glandular disease in the world. The aim of this study was to compare the effect of three types of endurance, resistance and combination training on inflammation and insulin resistance in visceral adipose tissue of type 2 diabetic rats. 

Methods: For this purpose, among eight-week-old male Wistar rats, 48 ​​rats were selected and randomly divided into 6 groups (diabetic endurance training, diabetic resistance training, diabetic combination training, healthy combined training, healthy control and diabetic control). The rats became diabetic by injecting 95 mg of nicotinamide and after 15 minutes of STZ injection at the rate of 55 mg/kg body weight. 4 days after injection, rats with serum glucose above 300 mg/dL were considered diabetic. Then, the endurance training group trained for 6 weeks, 3 sessions per week with moderate intensity (50-60% of maximum oxygen consumption). The initial load to start resistance training was 50% of the rat's body weight. Each session added 15% of body weight to the weights. The combined exercise group also performed resistance and endurance exercises in a row. 48 hours after the last session, the rats were anesthetized and visceral adipose tissue was removed to examine the variables. 

Results: The results showed that there was a significant difference between the effect of six weeks of endurance, resistance and combined exercise on inflammation and insulin resistance in the visceral adipose tissue of male diabetic mice. 

Conclusion: The results confirm the effect of three training methods on the mechanisms involved in diabetes.

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Background: The prevalence of overweight, obesity and related complications is increasing rapidly in the world. Also, treating this disease in the presence or absence of co-morbidities has become a challenge. In this article, based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, a comprehensive clinical guide has been written for the stages of treating obese patients and its individualization, and it has been tried to be adjusted as much as possible based on the conditions in Iran.
Methods: with a specific search strategy, a complete search was performed in PubMed, Scopus, ISI Web of Science, EMBASE and Google Scholar Cochrane databases. Then, the best clinical guidelines suitable for the Iranian society were selected and using the opinions of specialists and clinical experts, a clinical guideline was prepared for the treatment of obesity in Iranian adults.
Results: In this article, in continuation of the previous article, we answered the questions number 4 to 6 regarding the stages of obesity treatment and its individualization in adults of Iranian society, and presented a total of 60 recommendations in this regard.
Conclusion: In this part of the clinical guide for obesity in Iranian adults, we tried to have a special view on the treatment of these patients and by providing evidence-based recommendations and statements, the treatment process was personalized as much as possible for patients with special conditions so that decision-making in this regard is facilitated for the relevant colleagues in this field.

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Background: Aging and consuming a high-fat diet lead to increased oxidative damage to various tissues, oxidative stress is a critical factor in the aging process that can cause direct damage to cellular structure. This study aimed to investigate the Effects of 8 Weeks of HIIT Training on the Nrf2 Gene Expression, lipid peroxidation and Insulin resistance in the pancreas tissue of Aged rats fed a high-fat diet.
Methods: In this experimental study, 20 aged male Wistar rats (age: 18 months and mean weight: 500±100 gr) were randomly divided into four groups including normal food control G1 (n=5), normal food + training G2 (n=5), high-fat food G3 (n=5) and high-fat food +training G4 (n=5). The high intensity interval training program was performed on a treadmill, three days a week for eight weeks. Nrf2 gene expression was performed using real-time PCR and malondialdehyde levels, glucose and insulin were measured using a kit and ELISA method. Data were analyzed by MANOVA test at the P<0.05.
Results: The results of the MANOVA statistical test on the interactive effect of training and diet indicated a significant difference in the insulin resistance index (P = 0.017 and F = 7.17). However, no significant effect was observed for the insulin factor (P = 0.30 and F = 1.13), glucose (P = 0.116 and F = 2.75), MDA (P = 0.87 and F = 0.028), and Nrf2 (P = 0.816 and F = 0.056).
Conclusion: In general, it can be stated that HIIT training in this research can improve insulin resistance by affecting the expression of the Nrf2 transcription factor gene by reducing the oxidant activity in aged rats.

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Background: With the increasing prevalence of diabetes in children and the resulting mental pressures, attention to these patients has become a health priority in the world. Psychological distress is one of the problems of these patients that affects different aspects of their lives. It seems that enduring psychological distress can affect the psychological problems of these patients. Therefore, the present study was conducted with the aim of determining the relationship between psychological distress and tolerance of psychological distress in children with diabetes in Zahedan city.
Methods: This was a cross-sectional study. The samples included 200 children with pediatric diabetes referred to the diabetes clinic of Ali Ibn Abi Talib (AS) hospital in Zahedan and met the inclusion criteria. The data collection tool included the demographic information form and Kessler's psychological distress and Gaher's distress tolerance questionnaires, which were completed by interviewing the child. Descriptive and analytical data analysis was done using spss27 software.
Results: 52.6% of all subjects studied were girls and the average duration of infection was 22.6 months. A significant relationship was found between psychological distress and tolerance of psychological distress (r = -0.65 p < 0.001).
Conclusion: The findings showed that there is a significant and inverse correlation between psychological distress and distress tolerance. In other words, the higher the psychological distress tolerance, the less distress a person experiences. Therefore, it seems that in order to enjoy higher mental health in these patients, attention should be paid to improving their distress tolerance.

 

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Background: Diabetes is a chronic condition that can significantly impairs quality of life and requires long-term care due to its complications. Effective self-care education plays a key role in blood glucose control and in the prevention of diabetes-related complications. Telenursing is considered a promising approach to enhance self-care education in patients with type 2 diabetes.
Methods: This study was a systematic review conducted using a three-stage search strategy. Using Persian and English keywords including "telenursing," "self-care," and "diabetes," as well as their MeSH equivalents, relevant literature was searched in Persian databases (Magiran, SID) and international databases (PubMed, Scopus, Google Scholar) within the time frame of 2000 to 2023. After applying inclusion criteria, 17 out of 1,092 retrieved articles were selected for final review and analysis.
Results: A total of 1,092 articles were initially retrieved. After removing duplicates and applying the inclusion criteria, 17 relevant articles were included in the review. These studies evaluated the use of telenursing—either via telephone or in combination with other technologies—for effectively improving self-care behaviors in diabetic patients. 
Conclusion: The findings indicated that telephone calls can serve as a potential method of remote nursing care for educating patients on diabetes self-management. Nurses can utilize telenursing as an effective and efficient educational tool to enhance blood glucose control in diabetic patients. This approach not only improves the quality of healthcare services but also empowers patients to manage their disease more consciously and prevent its complications.
 

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Background: Biobanks are biological repositories that collect, process, store, and distribute human biological samples. Among them, tumor banks play a central role in biomedical research. The overall goal of a tumor bank is to collect cancerous and normal samples under standardized conditions for basic, clinical, or applied research.
Methods: Tumor samples from patients with endocrine neoplasms were collected from excess tissue samples not required for diagnostic purposes after surgery in the surgical department of Dr. Shariati Hospital, Tehran, Iran. In addition, relevant biological samples such as serum, plasma and DNA were collected in parallel. Prior to sampling, informed consent was obtained from the patients and a questionnaire was completed. After rapid freezing with isopentane, tissue samples were stored in a liquid nitrogen tank, while other biological materials, such as serum, were stored in a -80°C freezer.
Results: Tissue, plasma, serum, and DNA samples collected from patients with endocrine neoplasms were stored in separate barcoded storage boxes in the biobank and were made available to researchers.
Conclusion: The use of bioproducts in domestic research and international networks has strengthened research collaborations through supporting the collection and distribution of tissues, especially cancer tissues. This trend plays an important role in facilitating basic and applied research in various fields of cancer, including molecular biology, immunology, genetics and pharmacology, and will pave the way for scientific advances and therapeutic innovations.