Iranian Journal of

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There are controversies on the effects of diabetes and lifestyle of affected patients on their bone mineral densities (BMDs). This study has investigated the effects of lifestyle of type 2 diabetics on BMD at the lumbar spine and proximal femur in pre and postmenopausal women.
Methods: In a historical cohort study, 20 pre-menopausal type 2 diabetics and 57 non-diabetics and 126 type 2 Diabetics and 315 non-diabetics postmenopausal women, were recruited. BMD measurements were also made to the spine and proximal femur (Neck, Wards, and Shaft) by dual energy X-ray absorptiometry (DXA) technique. Exclusion criteria were endocrine, rheumatologic or chronic diseases. Type 2 diabetic cases and non-diabetics were matched for age and body mass index (BMI) in both pre menopausal or postmenopausal groups.
Results: A total of 146 type 2 Diabetic patients without any other endocrine disorder and 372 non-diabetic women, aged 40-81 years were enrolled. No significant differences were found between diabetics and healthy controls in terms of BMD values of spine and femur regions in the pre‌menopausal women. Postmenopausal diabetics, however, had higher BMD at the lumbar spine compared with the healthy postmenopausal controls. An age-related decrease in BMD values (lumbar and femur) was observable in all groups and a significant correlation between BMI and BMD was found. Adjusting for age and BMI, the effect of lifestyle on BMD at all sites was investigated. Occupation was associated with BMD in postmenopausal, but not in premenopausal women. Among the investigated dietary items, milk, yogurt and cheese were all associated with increased BMD in at least one region in diabetic patients. Smoking was not associated with BMD.
Conclusion: Type 2 Diabetes does not seem to be complicated by bone loss and osteoporosis. Physical activity and milk consumption in postmenopausal diabetic women can be a protective factor against bone loss.

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Diabetes mellitus (DM) is the commonest cause of renal failure, blindness and non traumatic amputation. According to ADA, prevention of DM complications is possible through monitoring and control of blood glucose levels.
Methods: The Betachek strip, produced in Australia, is able to determine biood glucose level with no need for electronic glucometer devices.
Results: In this study, we compared venous and capillary blood glucose levels as determined by lest strips with measurements of enzymatic method (the standard laboratory kit). The mean capillary and venous blood glucose measured by the strip test was 21.85 mg/dl (P< 0.0001) and 17.9 mg/dl (P< 0.002) respectively that was 11.13% more than the standard method.
Conclusion: In this study, standard method had higher correlation with venous samples glucose level, than capillary samples (as measured by Betachek) (0.84 vs. 0.824). This difference was statistically significant (P< 0.0001).
Good correlation between the Betachek strip and the standard enzymatic method of blood glucose measurements, advocate its usage in home setting.

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At least 2 million people are affected by type II diabetes mellitus in Iran. Neuropathy is one of the commonest complications of diabetes affecting the quality of life of patients and can result in foot ulcer and amputation. The current study aimed to examine possible factors that could alter development of diabetic neuropathy.
Methods: In this case-control study, 110 diabetic patients were selected from Shariati hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS) was used to distinguish cases from controls. The neuropathic status of patients was confirmed with EMG-NCV. Multiple factors were compared between the two groups including ACE-I consumption, blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality.
Results: Statistically significant relations were found between neuropathy and age, gender, quality of glycemic control and duration of diabetes (P values: 0.04, 0.04, 0.000 and 0.005, respectively). No correlation existed between atherosclerotic risk factors (high BP, hyperlipidemia, cigarette smoking) and diabetic neuropathy.
Conclusion: In this study, hyperglycemia was the only modifiable risk factor for diabetic neuropathy. Glycemic control can decrease the incidence of neuropathy and delay its progression leading to improvement in the quality of life in diabetics. Aged and male diabetic patients and those with poor diabetes control are groups in most need of regular foot exam and more practical educations.

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 Alterations in carbohydrate metabolism are frequently observed in cirrhosis. We conducted this study to define the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in patients with chronic liver disease (CLD), and explore the factors that may be potentially associated with the development of DM in these patients.
Methods: From October 2002 to March 2003, 185 consecutive patients with CLD, who referred to "Tehran Hepatitis Center", were enrolled into the study. Fasting plasma glucose and two-hour plasma glucose were measured in patients' sera. DM and IGT were diagnosed according to latest American Diabetes Association criteria.
Results: The subjects included 42 inactive HBV carriers, 102 patients with HBV or HCV chronic hepatitis, and 41 cirrhotic patients. Mean age was 43.8±12.0 years ranging between 22 to 84 years. DM and IGT were diagnosed in 40 (21.6%) and 21(11.4%) patients, respectively. Univariate analysis showed that age (P=0.000), CLD status (P=0.000), history of hypertension (P=0.007), family history of DM (P=0.000), and body mass index (BMI) (P=0.009) were associated with DM. Using Multivariate analysis, age (P=0.01), family history of DM (P=0.0001), chronic hepatitis (0.0004), and cirrhosis (P=0.0004) remained as the factors independently associated with DM. When patients with cirrhosis and chronic hepatitis were analyzed separately, higher Child-Pugh's score in cirrhosis (P=0.04) and older age (P=0.04), higher fibrosis score (P=0.04), and higher BMI (P=0.003) in patients with chronic hepatitis were found to be associated with higher prevalence of DM. Conclusion: Our findings indicated that patients with cirrhosis and chronic hepatitis are at risk of developing DM. Older age, sever liver disease, and obesity were associated with development of DM.

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Depression is one of the most prevalent mental disorders in diabetics, which affects treatment course and disease prognosis. This study focuses on the association between diabetes and depression as well as depression and glycemic control.
Methods: 375 diabetic patients (type I and II) of diabetes clinic of Doctor Shariati Hospital and diabetes association of Iran participated in this cross-sectional study.Patients were screened for depression with Beck Depression Inventory. Then depressed subjects were
evaluated with DSM IV criteria for determination of the depressive disorders category.
Results: Depression was diagnosed with Beck Depression Inventory in 41.9% of patients. Of these patients major depressive disorder was defined in 23.7%, dysthymic disorder in 9.3% and association of two disorders in 0.8% of patients. Major depressive disorder was more prevalent in 31-59 year old group and dysthymic disorder in more than 60 year age group. Also depression was more prevalent in
women, diabetics with uncontrolled blood glucose and patients with diabetes complications.
Conclusion: Depression is a prevalent psychiatric disorder in diabetics, which is associated with female gender, poor glycemic control and diabetes complications. Therefore, glycemic control and prevention and treatment of diabetes complications can prevent depressive disorders in diabetics.

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Hyperlipidemia is a major risk factor for cardiovascular diseases (CVDs). A hundred and sixty six people die each day due to cardiovascular diseases in Iran which accounts for 12500 annual deaths. Several studies have revealed that changes in lifestyle are keys to the prevention of CVDs. This urges the role of continuous and comprehensive educational programs, which should be designed and performed by medical staff specially education nurses.In this study the effect of patient education thorough group discussion or an educational booklet is
compared on knowledge and practice of patients with hyerlipidemia.
Methods: This was an interventional study. Participants were randomly assigned to the "interactive discussion" group or "booklet" group. Knowledge and practice of participants in both groups were assessed before and after intervention using a standardized questionnaire. A total number of 304 patients with hyperlipidemia were studied which were equally divided into "booklet" or "Interactive
discussion" groups.
Results: "Interactive discussion" group showed %27 rise in knowledge and practice. This figure was %26 in the "booklet" group and no significant difference was observable.
Conclusion: It was concluded that interventional sessions and educational booklets had comparable efficacies. We suggest that these sessions be held on regular Intervals so as to achieve better results.

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Background: Type 1A Diabetes Mellitus (T1DM) is a chronic and progressive auto- immune disorder resulting from immune mediated destruction of Langerhans islet beta cells. The etiology of T1DM like the other autoimmune diseases is unknown and many factors are involved, Both humoral and cell-mediated immunity have a critical role in T1DM pathogenesis. The cytokines, the immunomodulatory peptides, are responsible for the immune cell recruitment and producing auto-antibodies by the immune effector cells. To evaluate the role of cytokines in sensitivity or resistance to T1DM, we have employed IFN gamma to determine their gene polymorphisms and their association with T1DM.
Methods: 30 patient suffering from T1DM and 40 normal control were studied simultaneously .PCR technique was used to characterize the polymorphisms of cytokine. Salting out method was performed for DNA isolation .The polymorphosime of IFN gamma gene was determined on position UTR+5664`5.The PCR products were evaluated by Gel Electerophoresis Technique.
Results: There was a significant difference between patient and control group in TT allele IFN gamma gene: p<0.05, RR: 0.39(0.22

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Background: Diabetic Neuropathy is the most common and troublesome complication of Diabetes Mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care. Early diagnosis of distal symmetric sensorimotor polyneuropathy, a common complication of diabetes, may decrease morbidity by allowing potential therapeutic interventions.
Methods: In 68 diabetic patients after neuropathy screening by U.K and Michigan scores, Bilateral sural nerve conduction parameters as nerve conduction velocity, latency and amplitude were determined and analysed.
Results: 54.4% of patients had Rt sural abnormal response, 50% had abnormality in left side and 39.7% had bilateral abnormality. There was significant statistical correlation between Michigan physical score and electrophysiologic finding (P-value < 0.003) but no correlation with U.K score (P-value > 0.3). The most prevalent abnormal electrophysiologic finding was amplitude decrement of sural response. Conclusion: Sural nerve response is one of the simplest and most sensitive peripheral sensory nerves for electrophysiologic study of diabetic neuropathy and its evaluation is recommended in all diabetic patients in spite of normal physical examination and history for detection of subclinical neuropathic cases. For increment of sensitivity, amplitude measurement of sensory response is highly recommended.

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Background:Obesity is a serious public health problem in developing countries due to its association with the cardiovascular risk factors. Childhood obesity is responsible for a number of different complications both during childhood and adulthood. The aim of the present study was to determine the cardiovascular risk factors in overweight and obese Iranian children.
Methods: We screened 13086 children aged 7-12 years by measuring waist circumference. Those with a waist circumference ≥61 cm were selected for further evaluation. Anthropometric measurements were done and blood samples were taken from 563 enrolled overweight/obese children (284 boys and 279 girls). We determined cardiovascular risk factors (including fasting total cholesterol, LDL-C, HDL-C, triglycerides, blood pressure). In addition we measured the fasting blood sugar, insulin, apo-A , apo-B and leptin levels.
Results: Only 2.7% of overweight or obese children had no risk factors. While, 20.6% had one and 70.85% had two or more risk factors. The prevalence of high total Cholestrol levels was 42.6%. HDL-C showed an acceptable level in 92.4%of children .There were strong correlations between BMI and serum apoB and leptin levels (p<0.005).
Conclusion: The high prevalence of cardiovascular risk factors in overweight and obese Iranian children emphasizes the need for prevention and control of childhood obesity from early childhood in our country.

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Background: Diabetes Mellitus is a common chronic disease with severe of complications. Proper glycaemic control can prevent these complications considerably. Evaluation of effectiveness of community based and patient centered interventions on glycaemic control, quality of life, patient satisfaction, patient knowledge and reported symptoms were the main aims of this research.
Methods: In a clinical trial, patients referring to Iranian Diabetes Association, who were more than 18 years old, divided to intervention and control group randomly. After three months of general interventions in both groups, including diabetes education and specific interventions including telephone calls, continuous corresponding and sending educational issues in intervention group, changes in variables were studied. Results: Among 52 patients in each group, 17 were male and 42 had type 2 diabetes. The average age was 49 in intervention and 51 in control group. Two groups had no significant difference in age, sex, type of diabetes, treatment method and duration of diabetes, other diseases and education. Both groups showed significant improvement in glycaemic control. The mean reduction in HbA1c was 1.45 in intervention and 0.86 percent in control group the difference is statistically significant (P= 0.02). Patient satisfaction increased in both groups. The satisfaction is significantly higher in intervention group (P=0.000). Knowledge has increased significantly in both groups the difference in groups is not significant. The improvement in Quality of Life was just significant in intervention group. The reported sign and symptoms have not changed in both groups.
Conclusion: Community based and patient centered interventions with emphasis on continuous education and support can improve glycemic control, quality of life, patient satisfaction and patient knowledge in diabetes mellitus.

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Background: The precise mechanisms of vascular diseases in insulin dependent diabetes mellitus (IDDM) are not clearly understood. There are evidences of alteration in mechanisms involved in regulating vascular tone including increased ACE activity in some tissues. To investigate the effect of insulin treatment on these changes this study was performed.
Methods: Three groups of 8 male Sprauge Dawely rats including control (C) and two diabetic groups (D, IT) were used in this study. Diabetes was induced by injection of 60 mg/kg STZ ip. After induction of diabetes IT group were treated with insulin (10 units/kg/day s.c.) for four weeks. The control group and the untreated diabetic group were treated with the same amount of Saline and for the same time. ACE activity was determined by HPLC method.
Results: 4 weeks after induction of diabetes, SBP and ACE activity in serum, lung, heart and aorta increased in D group compared to control rats. Insulin treatment reversed these changes to normal values in IT group.
Conclusion: It is concluded that increased ACE activity could contribute to the development of diabetic vasculopathy and ACE reducing activity of insulin may be partially involved in decrease of cardiovascular complications in diabetes.

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Background: Previous clinical and experimental studies suggest the valuable effect of antioxidants on lipids status. The present study was designed to investigate the efficacy of silymarin treatment as an antioxidants on lipids profile in type II diabetic hyperlipidemic patients. Methods: A 4-month randomized double blind clinical trial was conducted in 54 non-insulin dependent diabetic hyperlipidemic patients in a two well – matched groups. First group (n=29) received 200mg silymarin tablet 3 times a day plus standard therapy, while the control group (n=25) received placebo tablet 3 times a day plus standard therapy. The patients were visited monthly and fasting blood glucose, total cholesterol, LDL, HDL cholesterol, triglyceride, SGOT and SGPT were determined at the beginning and at the end of the study after four months.
Results: Results revealed that in silymarin treated patients, fasting blood glucose, LDL and total cholesterol, triglycerid, SGOT, SGPT and glucose level at the end of the study were significantly decreased as compared to beginning of the study. In placebo treated patients fasting blood glucose level at the end of the study were significantly increased as compared to beginning of the study.
Conclusion: In conclusion, the silymarin as an herbal antioxidant have beneficial effects on reducing glucose and lipids profile in type II diabetic patients

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

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

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

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Background: In the recent years, new medical technologies and their probable misusing have emerged public concerns about medical ethics. Medical ethics is a practical discipline that provides a structured approach for identifying, analyzing, and resolving ethical issues in clinical medicine.
Methods: In this study we reviewed some new methods of teaching medical ethics in other countries by searching in internet and literature books.
Results: Two key features related to the teaching of medical ethics are actively involving students in the learning process instead of merely lecturing about ethical principles and assessing how students apply their knowledge of ethical principles in simulated and actual situations. In many countries such as Iran medical schools attempted to address medical ethics issues in formal ethics classes.
Conclusion: It is clear that the traditional method is no longer sufficient to meet the needs of practitioners and societies and new methods particularly those emphasizing active learning, individual participation, group interactions, and a process-based approach, should be developed and implemented. In addition, a concerted effort to improve education in medical ethics will benefit the medical profession and the patients served there by. Therefore, we recommended policy makers of medical ethics education to change the traditional method with regard to modern methods witch is used now in the world.

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

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

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

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