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: Dyslipidemia accounts as a major risk factor for cardiovascular diseases. The aim of this survey was to determine the prevalence of dyslipidemia among relatives of patients with premature coronary artery disease (PCAD).
Methods: As a cross-sectional study 232 first degree relatives of patients with PCAD were recruited. A questionnaire was filled out by all of the participants all of them undergone physical examination and blood sampling. Lipid profile was categorized according to the NCEP: ATPIII criteria.
Results: Total Cholesterol>200 in 29.7%, LDL>160 in 10.3%, HDL<40 in 12.9%, TG>200 in 32.8%, ApoB100>130 in 14.2%, Apo A1<90 in 1.7% and LP(a)>30 in 47% of participants were seen. Serum levels of TG were significantly higher in men than women levels of HDL and ApoA1 were lower in men than women. The Prevalence of dyslipidemia among relatives was 59.6%.
Conclusion: In view of high prevalence of Dyslipidemia among relatives of PACD patients, active interventions in order to primary prevention of cardiovascular diseases via exact screening is recommended.

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Background: Insulin dependent diabetes is an autoimmune disease characterized as a T cell-mediated destruction of insulin-producing β cells. Dendritic cells (DCs) can either induce stimulating or regulatory functions of T cells depending on cytokines microenvironments.
Methods: In this study DCs were generated from mouse bone marrow progenitors through culturing in the presence of granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin-4 (IL-4) for 7 days followed by two other day treatments with IL-10 or LPS. The DCs were then pulsed with insulin peptide B9-23 and their maturation markers and their ability to induce T cell responses and cytokine profiles were studied.
Results: IL-10 treated DCs had an immature phenotype compared to LPS-treated DCs and expression of MHC-II in LPS-matured DCs was significantly higher than whom were treated with IL-10 (93% and 72% respectively, P<0.04). Although IL-10 like LPS-treated DCs were able to stimulate T cell proliferation, but the IFN-γ production was lower in IL-10 treated DCs (P<0.02).
Conclusion: Using IL-10 treated DCs seems to be useful in prevention and treatment of autoimmune diabetes. However to clarify this hypothesis it needs to study these effects in animal models of insulin dependent diabetes.

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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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Background: Gestational diabetes mellitus is a common metabolic disorder in pregnancy. Low levels of sex hormone–binding globulin level (SHBG) is associated with increased insulin resistance and hyperinsulinemia. The aim of this study was comparison of SHBG levels between gestational diabetic pregnant women and normal ones.
Methods: Serum SHBG concentration were measured in 38 women with gestational diabetes and in 143 women with normal pregnancy. The levels of Insulin, C-peptide and testosterone were measured and Insulin resistance was estimated via HOMA Index. Insulin sensitivity was estimated via QUIKE Index.
Results: Serum SHBG concentrations was significantly lower in the diabetic group (P=0.015). In a logistic regression model after adjustment of age, body mass index (BMI) and number of gravid, lower than 25 percentile of SHBG was independently effective in prediction of gestational diabetes mellitus.
Conclusion: SHBG concentrations are lower in gestational diabetic pregnant women and low levels account as a predictor of gestational diabetes mellitus.

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Background: Diabetes mellitus is an insidious disease which can affect different organs. One of the problems is resistant vaginitis, which is related to factors such as high blood glucose levels, allergy and atopia. One of the most common pathogens associated with this condition is Candida Albicans. Thus most physicians begin anti-fungal therapy in first visit even without documented evidence of fungal origin.
Methods: This descriptive analytical cross-sectional study was performed on 160 non-pregnant diabetic women in diabetes clinic of Shariati Hospital during a period of three years (2002-2005). Fasting and 2 hours postprandial blood glucose levels and HbA1C were measured and culture of vaginal discharge was performed. Fisher's exact test was used for statistical analysis.
Results: 71% of women had clinical vaginitis (fungal or bacterial) and 12.5% were diagnosed with Candida vaginitis. Microscopic findings were positive in 1.3 % of patients who had Candida vaginitis (16.7% of all patients). Culture of vaginal discharge revealed that the Candida was responsible of 4.4% of Candida vaginitis. Overlay, the prevalence of Candida vaginitis based on positive culture was 8.8 % in this study. There was significant statistical relationship between mean FBS and infectious vaginal culture. However, the difference was not significant between positive culture of Candida and age, controlled blood glucose, history of allergy, genital hygiene, occupation, level of education, kind of treatment , and type or duration of diabetes.
Conclusion: We suggest in the patients with positive signs of vaginitis, especially Candida vaginitis (even with positive smear) culture of vaginal discharge be carried out.

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Background: The risk of cardiovascular diseases increase in diabetic patients. So, it is important for patients to achieve the optimal lipid levels. Nutrition including consumption of anthocyanins plays a primary role in reducing the risk of heart disease and hypertension. In this study, we assessed the effect of concentrated sour cherry juice (SCJ) consumption as a rich source of anthocyanins on lipid profile and blood pressure of type II diabetic patients.
Methods: In this quasi-experimental study 16 type II diabetic women with fasting blood sugar ≥110 mg/dl and LDL-C ≥100 mg/dl were recruited and consumed 40 g/day of SCJ for 6 weeks. Measurements of weight, lipid profile and blood pressure were done in baseline and after completion of the study. A 2-day food records was completed by patients so. The Wilcoxon test was used for statistical analysis. Results: Mean (± SD) age, weight, total cholesterol, LDL-C, systolic and diastolic blood pressure were 53.6±8.8 years, 72.8±14.9 kg, 213.9±27/0 mg/dl, 118.4±14.7 mg/dl, 129.1±15.7 mmHg and 81.7±8.1 mmHg respectively in the beginning of the study. After consumption of SCJ, a significant decrease (P<0.05) in weight, total cholesterol, LDL-C, systolic and diastolic blood pressure was seen. Changes in serum triglyceride and HDL-C concentrations were not significant statistically.
Conclusion: It is concluded that SCJ consumption may modify cardiovascular disease risk factors in diabetic type 2 patients.

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Background: Assessing the trend of ischemic heart diseases and the process of acute coronary care is one of the most important tools in monitoring the programs dedicated to control of ischemic diseases. The current project was developed to assess the feasibility of using routine data registered in clinical records for coronary event registration according to the standards of WHO/MONICA project.
Methods: Hospital records of 320 cases with primary diagnosis of acute coronary syndrome (80 cases from each quarter, July 2003-4) were evaluated according to sufficiency of data. Data were evaluated according to “internal consistency”, “change in the proportion of missing data in the time periods” and “the proportion of insufficient data”.
Results: Available data of hospital records were not sufficient to determine the diagnosis in 0.7% of cases In addition, they were resulted in a probable diagnosis in 11.2% of coronary events. Median percents of missing data regarding the prescribed drugs before event was more than 10% in both fatal and non-fatal coronary events (score 1 of 4). Median percents of missing data regarding the ECGs, cardiac enzymes and cardiac resuscitation was lower than 5% in non-fatal coronary events and lower than 2% in fatal cases (scores 2 and 3 of 4 relatively).
Conclusion: The quality of available registered data in the evaluated clinical records was comparable with many reporting units of MONICA project. Using the available clinical records seems to be effective and feasible for systematic registration of cardiac events.

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Suppurative hidradenitis is a recurrent disease involving apocrine gland of skin with a predilection for intertriginous areas, including genital skin. It has a highly variable clinical course. Mild cases may present as recurrent isolated nodules, while severe instances of the disease with chronic inflammation may lead to abscesses , scarring, and rarely, squamous cell carcinoma. While genetic factors, hormones and infection play a role in disease expression, a comprehensive understanding of the pathogenesis remains to be elicited. Additionally, effective treatment is largely unknown. The mainstay of therapy had been surgery, and topical or systemic antimicrobial agents. We report a 65 years old diabetic man who had a long history of untreated suppurative hidradenitis with extensive gluteal area involvement. We search in pubmed and find 7 cases of suppurative hidradenitis with diabetes.

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Background: Peroxisome Proliferators- Activated Receptor-Gamma2 (PPAR- γ2) is a nuclear receptor that regulates adipocyte differentiation, lipid metabolism and insulin sensitivity. The aim of this study was to evaluate the association of the Pro12Ala polymorphism at the PPAR- γ2 gene in Iranian population with obesity.
Methods: The genomic DNAs of the 156 subjects including obese and healthy isolated from EDTA whole blood. Pro12Ala polymorphism detected by Polymerase Chain Reaction – Restriction Fragment Length polymorphism (PCR-RFLP).
Results: In the obese group , one sample (1.3%) was as homozygote Ala/Ala genotype , 24 samples (30.8%) were Pro/Ala heterozygote and 53 samples (67.9%)as Pro/Pro genotype were identified . in the control group , one sample (1.3%) was as Ala/Ala genotype , 12 samples (15.4%) were Pro/Ala genotype and 65 samples (83.3%) were Pro/Pro genotype. allele frequencies of Ala in obese subjects (qAla=%16.7)were significantly different from those in control subjects (qAla=%8.9).
Conclusion: Our results revealed that Pro12Ala polymorphism in PPAR- γ2 gene associated with obesity in the Iranian population and presence Ala allele cause to significantly higher BMI and lower fasting blood sugar.

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Background: Sulfonylurea agents such as Glibenclamide (Glyburide) have been widely prescribe in treatment of type 2 diabetic patients for decades, but controversy remains about their precise mechanism of action. On the other hand, glucokinase serves as a glucose sensor in pancreatic β-cells and plays a key role in the regulation of insulin secretion and glucose homeostasis. The aim of the present study was to evaluate the effect of Glibenclamide on insulin secretion and glucokinase activity in the rat isolated pancreatic islets of Langerhans.
Methods: The islets from normal and type 2 diabetic rats were isolated by collagenase digestion method. Glucokinase activity was measured via determination the rate of glucose-6-phosphate formation in the fluorometric assay. Insulin secretion from hand-picked islets was evaluated by static incubation technique. Insulin concentration was measured by rat insulin ELISA kit.
Results: Our findings obtained from incubation of Glybenclamide with pancreatic islets revealed that this agent increases basal insulin secretion (at 2.8 mM glucose) in both normal and diabetic rats as compared it with control islet (without drug). However, the increase of insulin secretion in response to 16.7 mM glucose was not significant. On the other hand, Glybenclamide had no activating and/or inhibiting effect on pancreatic glucokinase activity in both diabetic and normal Rats. But reduced activity of this enzyme in diabetic rats was significant in comparison with normal.
Conclusion: These data show that increasing effect of Glybenclamide on insulin secretion is through a mechanism other than affecting Glucose Mediated Insulin Release. Moreover, the regulation of pancreatic glucokinase does not depend on glybenclamid.

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Background: Overweight is one of the most worldwide health problems particularly in industrial and developed communities. Obese subjects are at high risk for developing various disorders such as diabetes and especially cardiovascular diseases. It has been well established that life style modification plays an important role in reducing these complications, particularly weight reduction and caloric restriction (CR) as a non- pharmacological approach. In the present study the possible effects of caloric restriction on Nitric Oxide production and blood pressures in rat were investigated.
Methods: Four groups of rats were selected as control(C), caloric restriction (CR), diabetic (D), and caloric restriction diabetic (CRD). Control animals fed freely with standard pellet but caloric restricted animals fed an every other day diet for 4 weeks. The systolic blood pressure (SBP) was measured in all groups using the tail-cuff method under the light general anesthesia induced by ether. Nitric oxide (NO x) concentrations were determined in serum using a colorimetric non- enzymatic NO assay kit .
Results: In CR experimental groups (CR&CRD) SBP was significantly decreased as compared to control: (P<0.001) and diabetic (P<0.01) rats , while the serum NO x was significantly increased (P<0.01) in both groups as compared to control and diabetic rats.
Conclusion: On the basis of obtained results, it could be concluded that caloric restriction may reduce blood pressure and increase nitric oxide in diabetic and non-diabetic rats. Increase nitric oxide is the likely mechanism for decreasing blood pressure .

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Background: Detecting mothers with gestational diabetes mellitus (GDM) is not only important in prevention of prenatal morbidities but also has significant effect on neonatal and maternal long term outcomes. Today, there are screening tests for GDM but they are time-consuming and expensive, therefore it seems necessary to perform testes that are uses expensive but with higher sensitivity and specificity. The aim of this study was to determine a cut - off point of fasting plasma glucose (FPG) for screening of GDM.
Methods: 200 pregnant women referring to the perinatal clinic of Imam Khomeini hospital, (Sari – Iran) were studied. All cases with age ≥25 years old, history of recurrent abortion, GDM, preeclampsia, macrosomia, still birth, diabetes mellitus(DM) in first degree family or pre gestational body mass index ≥25kg/m2 were selected. Those with pre gestational diabetes mellitus were excluded. All of participants underwent a 50 g glucose challenge test (GCT) between the 24th and 28th gestational week. If 1- hour plasma glucose was more than 130 mg/dl, a 3- hour 100g oral glucose tolerance test (OGTT) was performed. The diagnosis of GDM was made by ADA 2006 recommendation (Carpenter and Coustan diagnostic criteria). Referring to the Receiver Operative Characteristic Curve, level of FPG having highest sensitivity and specificity in diagnosis of GDM was determined.
Results: From 200 participants, 65 women had positive GCT, of them 58 (response rate 89%) referred for 100g OGTT and 20(10%) were diagnosed GDM. Using ROC curve and under curve area of 0.853 the FBG level of 91.5 mg/dl, showed the highest sensitivity and specificity, 80% and 92% respectively in diagnosis of GDM.
Conclusion: FBG ≥ 91.5 mg/dl has good sensitivity and specificity in screening of GDM. Since this is simpler and cheaper than 50g GCT, is recommended as a screening method in diagnosis of GDM.

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Background: Pregnancy is a condition that favors oxidative stress mostly because of the mitochondria-rich placenta. Transitional metals, especially Iron, which is particularly abundant in the placenta, are important in the production of free radicals. Also studies showed that free radicals has a role in GDM. This study was performed to compare Iron status between gestational diabetes mellitus (GDM) patients and control groups.
Methods: As a case- control study 34 women with GDM were compared with 34 Healthy women matched for referred center, age, parity and BMI. Iron status measurements including ferritin, serum iron, total iron binding capacity (TIBC), hemoglobin, MCV and MCH at 24-28 weeks of pregnancy were assessed and compared between two groups.
Results: In this study, concentration of serum ferritin, Iron, transferin saturation and hemoglobin, MCV and MCH were significantly higher in GDM group and TIBC was significantly lower in this group as compared with controls (P<0.05). No significant association was observed in other variables including familial history of diabetes and GDM
Conclusion: Our findings indicate an association between increased Iron status and GDM. The role of excess Iron from Iron supplementation in the pathogenesis of GDM needs to be examined.

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Background: Combination of physical activity and pharmacotherapy in diabetes may augment the effects of the drug and may allow lower doses of medication that can minimize the side effects. The goal of the study was to determine the effectiveness of aerobic training and Glibenclamide combination in type 2 diabetes.
Methods: A total of 28 men with type 2 diabetes were divided to 3 groups randomly: Glibenclamide (5 mg daily) only, Glibenclamide (5 mg daily) plus aerobic training, Glibenclamide (2.5 mg daily) plus aerobic training. Aerobic training protocol was performed for 12 week, 3 days (session) a week, 45 minutes in a session (ergo cycle program at 60-70 % heart rate reserve). Fasting glucose, HbA1c, fasting insulin, c-peptide, and insulin resistance were measured at pre, mid and post treatment periods. Analysis of Variance test (ANOVA) were used to evaluate data.
Results: HbA1c significantly decreased and c-peptide significantly increased in three groups (P<0.05).There were also no between-group differences for c-peptide and HbA1c (P>0.05). Fasting insulin concentration did not alter in three groups, however, insulin resistance decreased ( no significant ) after 12 weeks.
Conclusion: In type 2 diabetic patients, Glibenclamide treatment alone or combination of aerobic training and Glibenclamide treatment, was effective in improving glycemic control in patients with type 2 diabetes .As a result, in patients with type 2 diabetes, the addition of aerobic training to Glibencelamide treatment allow lower doses of Glibenclamide to be used without impairment in glycemic control.

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Background: Cardiovascular Diseases are becoming increasingly prevalent due to urbanization and industrialization of our country. Therefore Screening of the Cardiovascular Risk Factors is one of the most important health system priorities. The aim of this study was to evaluate a screening method implementing family history for cardiovascular risk factors.
Methods: We chose 10 Junior-high schools in the 6th district of Tehran using simple random sampling. Then a questionnaire asking about family history of cardiovascular disease in the first degree relatives (including grand parents) was distributed between them and was completed – with contribution of parents. Then high-risk and low-risk families were invited separately to Dr Shariati Hospital for further evaluation. SPSS software version 10 using student T-test, Chi-Square and descriptive tests were applied for data analysis
Results: Approximately 40% of families had positive family history (high risk). From this group, 72% participated for follow-up. From the low-risk group, only 34% participated. Total cholesterol and LDL-C levels were significantly higher in high risk (HR) group. FBS was also significantly higher in fathers and children of the HR group (P<0.05). High TC, LDL-C and FBS levels were more prevalent among the HR families (P<0.05). No significant differences were observed in age, BMI, BP, TG and HDL-C between the 2 groups.
Conclusion: Families with a history of cardiovascular disease participated in greater numbers in the screening process and the prevalence of risk factors in this group was significantly higher. The findings confirm the usability of family history in screening programs.

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Background: Pancreatic islet transplantation has been reported as an appropriate method for treatment of type I diabetes patients, however there are strong indications that cytokine and chemokines secreted from transplanted islets play an important role in islet graft rejection in different stage post-transplantation. The NF-kB signaling pathway is activated in response to the stress resulted from isolation and purification process of pancreatic islets. Secretion and release of inflammatory mediators, including MCP-1, result from activation of this pathway which plays important part in activation of inflammatory processes accelerating graft rejection.
Methods: This study was performed to examine the effect of curcumin on secretion of inflammatory mediators and function of pancreatic islets.
Results: We observed that curcumin significantly decreased MCP-1 release from mouse islets compared to the control group and had no effect on function of pancreatic islets. Conclusion: Investigating the stimulatory signals leading to production and secretion of inflammatory mediators from pancreatic islets and discovering their underlying mechanisms will be useful in finding new therapeutic interventions for blocking inflammatory pathways and improvement in outcome of islet cell transplantation.

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Background: Aloe vera is a herbal plant being used as an anti-inflammatory agent, burning recovery as well as immune system boosting agent. The aim of this study was to evaluate the effects of Aloe vera on blood glucose , lipids and lipoproteins in streptozotocin-induced diabetic male rats.
Methods: This study was carried out on 56 male rats, weighing 150-200 gr. Animals are divided into 7 groups (one control and six test groups). Diabetes were induced in test groups via streptozocin (65mg/ kg-IP). After a week, blood samples analyses for FBS. All diabetic groups, except the control one, were taken 100,200,300,400 mg/kg Aloe vera extract and 5mg/kg glibenclamid by gavages for a period of 4 weeks, respectively. After this period fasting blood samples were collected from all groups.
Results:The results showed that the FBS decreased in groups that received 400mg/kg and glibenclamid (respectively,162/62±23.12and193.37±26.51). In addition, 3-6 groups showed decrease TG and Cholesterol level in comparison with those of control groups. In all groups which received Aloe vera and glibenclamid, LDL level were significantly decreased in comparison with control groups but HDL level had no change.
Conclusion: The results of this research indicate that Aloe vera aqueous extract lead to decreased Blood glucose, Cholesterol, LDL and TG levels. Further studies is suggested for exact mechanism of Aloe vera in diabetic rats.

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Background: Fetal hyperinsulinemia correlated with large birth weight and impaired glucose tolerance test and obesity in second decades of life. In this study we compared the correlation between fetal insulin production (as estimated by amniotic fluid (AF) C-peptide concentration) and AF insulin with macrosomia (as estimated by neonatal birth weight 4000 gr).
Methods: Thirty eight neonates were studied. Ten infants were macrosom and 28 were normal (birth weight < 4000 gr). Amniontic fluid C-peptide and insulin concentration and mother and fetal blood C-peptide and insulin were measured during delivery with radioimmunoassay and mother and fetal glucose were measured at the same time and correlated with neonatal macrosomia within first hour of birth.
Results: There was a significant correlation between infant serum C-peptide level and macrosomia. Amniotic fluid insulin level was higher in the macrosom infants but this correlation was not significant. AF C-peptide was higher in the macrosom group. Also there was a significant correlation between maternal serum C-peptide and macrosomia. Infant and mother serum insulin was higher in the macrosom group.
Conclusion: Our results suggest that fetal insulin (as estimated by AF C- peptide) and mother insulin and C- peptide production, can influence fetal weight and induce fetal macrosomia.

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Background: Diabetes mellitus can have variable and sometimes profound effects upon the oral tissues. It has been shown that uncontrolled or poorly controlled diabetics have particularly a greater incidence of severe recurrent bacterial or fungal infections and periodontal diseases. The purpose of this study was to determine thee relationship between oral manifestations in diabetic patients and duration of disease, and glycemic control.
Methods: We studied 116 diabetic outpatients referred to Diabetes Clinic of Shahid Bahonar Hospital of Kerman Province. We evaluated the following parameters: dental caries, periodontal status, xerostomia, burning sensation and mucosal alterations. We also recorded information about history of diabetes and glycemic control. Data were subjected to SPSS and X, t- test.
Results: The most frequent alterations in this study were gingivitis (96.3%), periodontitis (90.2%), and xerostomia (97.24%). Burning sensation and periodontal diseases were significantly correlated to duration of diabetes (P=0.002, P=0.012 respectively).The results of the present study showed that periodontal diseases occur more frequently in moderately and poorly controlled diabetic patients than in those with good glucose control, but this difference was not statistically significant.
Conclusion: In this study, dry mouth and periodontal diseases are common complaints among diabetic patients. Therefore management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function and periodontal status.