Developing a clinical diabetes guideline in diabetes research network in Iran

Development of evidence-based clinical guidelines to raising standards of medical care in diabetes is a core element of coping with the global diabetes epidemic. The purpose of this study was to develop a systematic clinical diabetes guideline from the latest scientific evidences and also to localize its recommendations according to regional and cultural needs of our society. Searches were conducted using NICE, SIGN, WDPCP, IDF, JDC, ADA, AACE, ICSI, CDA, AMDA, IDC, NyDoH guidelines which were examined and criticized and scored using Agree method. Guidelines which got higher score in some important areas of Agree scale including: rigor of development, clarity and comprehensiveness of the recommendations and applicability, especially in the climatic conditions of our country were selected. The existing recommendations were extracted by committee members and supporting evidences of each recommendation were determined based on the sources listed in the clinical guideline. Recommendations grading were classified from grade A to D based on the quality of their supporting evidences [BEL1-5]. This guideline covered all areas related to diabetes including screening and diagnosis, lifestyle modification and patient education, management, complications and hypoglycemia. Regarding capacities of this guideline and lack of comprehensive and updated guidelines in our country and region, it is suggested that designing a pilot study to implement this Learner-centered guideline and finding its weaknesses can lead to patient care improvement and also propel us towards our goal to design a comprehensive guideline in compliance with regional and national needs in Middle East

Effects of diabetes mellitus type I with or without neuropathy on vestibular evoked myogenic potentials

Diabetes mellitus type I is a metabolic disorder that affects multiple systems including the inner ear. Patients with diabetes mellitus commonly complain about dizziness, floating sensation, tinnitus and sweating. The aim of this study was to compare vestibular evoked myogenic potentials [VEMPs] between diabetic patients with or without neuropathy. Subjects included 14 patients with diabetes mellitus type I with polyneuropathy, 10 patients with diabetes mellitus type I without polyneuropathy and 24 healthy volunteers. Range of age in participants was 15-40 years old. The VEMPs were recorded with 500 Hz tone bursts with intensity at 95 dB. There was statistically significant difference between the groups in P13 and N23 latencies [P<0.05]. There was no statistically significant difference between groups in absolute and relative amplitudes. Prolonged latencies of the VEMP suggest lesions in the retrolabyrinthine, especially in the vestibulospinal tract

Stem cell therapy in treatment of different diseases

Stem cells are undifferentiated cells with the ability of proliferation, regeneration, conversion to differentiated cells and producing various tissues. Stem cells are divided into two categories of embryonic and adult. In another categorization stem cells are divided to Totipotent, Multipotent and Unipotent cells. So far usage of stem cells in treatment of various blood diseases has been studied [such as lymphoblastic leukemia, myeloid leukemia, thalassemia, multiple myeloma and cycle cell anemia]. In this paper the goal is evaluation of cell therapy in treatment of Parkinson's disease, Amyotrophic lateral sclerosis, Alzheimer, Stroke, Spinal Cord Injury, Multiple Sclerosis, Radiation Induced Intestinal Injury, Inflammatory Bowel Disease, Liver Disease, Duchenne Muscular Dystrophy, Diabetes, Heart Disease, Bone Disease, Renal Disease, Chronic Wounds, Graft-Versus-Host Disease, Sepsis and Respiratory diseases. It should be mentioned that some disease that are the target of cell therapy are discussed in this article

Low dose doxepin for treatment of pruritus in patients on hemodialysis

Pruritus is one of the frequent discomforting complications in patients with end-stage renal disease. We prospectively evaluated the effectiveness of doxepin, an H1-receptor antagonist of histamine, in patients with pruritus resistant to conventional treatment. A randomized controlled trial with a crossover design was performed on 24 patients in whom other etiologic factors of pruritus had been ruled out. They were assigned into 2 groups and received either placebo or oral doxepin, 10 mg, twice a day for 1 week. After a 1-week washout period, the 2 groups were treated conversely. Subjective outcome was determined by asking the patients described their pruritis as completely improved, relatively improved, or remained unchanged/worsened. Complete resolution of pruritus was reported in 14 patients [58.3%] with doxepin and 2 [8.3%] with placebo [P < .001]. Relative improvement was observed in 7 [29.2%] and 4 [16.7%], respectively. Overall, the improving effect of doxepin on pruritus was seen in 87.5% of the patients. Twelve patients [50.0%] complained of drowsiness that alleviated in all cases after 2 days in average. One patient refused to continue the treatment due to its sedative effect. We suggest that doxepin, a tricyclic antidepressant with anti-H1 receptor effect, can help improve pruritus resistant to antihistamines in end-stage renal disease patients who undergo hemodialysis. A low dose of doxepin is safe while effective and its main adverse effect, drowsiness, is temporary and can be easily tolerated by the patients