Psychological, social and structural determinants of diabetes self-management

Self-management of diabetes, an important aspect of diabetes treatment, is strongly affected by psychological and sociostructural factors. The aim of this research was to investigate the psychological, social and structural determinants of diabetes self-management in patients with type 2 diabetes. In cross-sectional design study, 500 out patients [245 men and 255 women] with type II diabetes were selected by convenience sampling. Data collected by demographic questionnaires on the Scales of diabetes self-management, diabetes self- efficacy, belief to treatment effectiveness, belief to illness certainty, treatment motivation, patient- provider therapeutic communication, diabetic knowledge, satisfaction for therapeutic services, access to therapeutic services, familial social support, and on collaborative decision-making, were analyzed by correlation and stepwise multiple regressions. Diabetes self-management mean [standard deviation] was 45.77 [21.81]. Self-efficacy, belief of treatment effectiveness, social support, >HbA1c%7 and Insulin therapy significantly predicted diabetes self-management variance [P<0.001]. The variables explained 91% of diabetes self-management [R2 = 0.91]. Self-efficacy has highest weight in prediction of diabetes self-management [beta = 0.338, P<0.001]. Self-efficacy, belief of treatment effectiveness, social support, mild HbA1c and treatment type are important factors for diabetes self-management and these variables explained the high rate of the diabetes self-management variance, emphasizing the importance of improvement of self-management behaviors in these patients

[Wild lettuce toxicity: case - series]

Wild lettuce [Lactuca virosa] is a famous herb in the world but is unknown in Iran. It has many dangers when used randomized or over dosage. Wild lettuce grows in the North of Iran and some natives consume it unaware of its adverse side effects. Here, we presented 8 patients with manifestations of wild lettuce toxicity, admitted to a general hospital affiliated to Golestan University of Medical Sciences. All patients recovered [except for an ICU admission] and no chronic complications were reported. Toxicity happened because wild lettuce was fresh and out of the time of harvest. Clinical suspicious to toxicity and history taking are the basis of diagnosis. It should be suggested to avoid using any suspicious substance like herbal materials, except when aware of its complications and effects

[Evaluation of diagnostic value of PH in differentiation of pleural effusion]

The PH of pleural fluid is one of the most important criteria in determination of type of pleural effusion. It is important in decision making for chest tube insertion. Pleural PH is a sensitive index for predicting the pleurisies out come too. Pleural fluid PH is decreased in parapneomonic effusion, cancers, tuberculosis and collagen vascular diseases. This study was designed to determine the sensitivity, specificity, positive and negative predictive values for better management of patients with pleural effusion. This descriptive study was conducted on 350 patients affected with pleural effusion referring to the Shahid-Beheshti University hospitals. Pleural fluid [20-30 ml] was taken from the patients and the amounts of blood sugar, proteins, WBC and HDL were measured. From the total number of the pleural effusion patients [350 patients] 266 patients had exudative pleural fluid and 84 patients had transudative pleural fluid. The sensitivity, specificity, positive predictive value, negative predictive value and efficacy of the pleural effusion PH were 75%, 22%, 72%, 26% and 61%, respectively. Measuring the pleural PH can be useful for differentiation of exudative from transudative pleural effusion. It seems that PH measurement has lesser mistakes compared to the previous measurements

[Patients with leukocytosis hospitalized in Labafinejad and Loghman-Hakim hospital, 2003-2004]

Complete blood count [CBC] is one of the frequently required tests in clinics and leukocytosis is the most frequent finding. Few modem studies have enumerated the conditions associated with leukocytosis. In this descriptive study, we evaluated its etiologies in 2 teaching infectious wards from 1382until 1383. 100 inpatients with WBC [white blood cells] count of >/= 10000 cells/mm3 presenting at the Loghman Hakim and Labafinejad Medical center of Shaheed Beheshti Medical University were evaluated. Data were recorded on data sheets and analyzed. We documented infection in 75 patients [75%]. Of these 75 patients, 29 [38.7%] had pneumonia, 19[25.3%] had urinary tract infections, 14[18.7%] had skin and soft tissue infections, 4[5.3%] had bone and joint infections, 3[%4] had CNS infections, 2[2.7%] had cardiovascular infections, 2 [2.7%] had pharyngitis, 1[1.3%] had Gastroenteritis and 1[1.3%%] had intra-abdominal abscess. Non- infection causes of leukocytosis in the 100 patients included physiological stress [11%], medication and drug [5%], hematologic and malignant disorder [2%], and necrosis-inflammation [4%]. 3 patients died without any diagnosis. The mean leukocyte count was 15386 +/- 4747. Infection, especially respiratory tract infection, is a prominent cause of leukocytosis [75%] but non-infectious conditions should also be considered. Despite few malignant cases in this study, malignancy should be ruled out in patients with a very high leukocyte count

[Determining the prevalence of cryptosporidium and measuring of micro nutrients in cryptosporidiosis among children under 5 years in Shahrekord]

Cryptosporidium is a worldwide protozoa and one of the most important causes of diarrhea among under 5 years children and immunocompromized patients. The majority of studies conducted about the parasite is in developed countries and mainly focused on immunocompromized subjects. Also diarrhea and malnutrition are common in young children in developing countries and a reciprocal relationship has been postulated with diarrhea leading to malnutrition and malnutrition predisposing to diarrhea. Therefore this study was carried out in order to find the prevalence of Cryptosporidium infection and to assess micronutrient deficiencies in children hospitalized due to diarrhea and to compare micronutrient status in children with or without Cryptosporidium. In this survey 504 stool samples were collected from hospitalized and outpatient children with acute diarrhea [259 and 245, respectively]. Mean while, 114 stool samples were collected from children hospitalized for elective surgery who did not have diarrhea during the past 2 weeks before consultation [control group]. All stools were screened by ELISA method for detection of Surface Cryptosporidium Antigen. In addition serum samples were collected from hospitalized children with diarrhea to assess vitamin A level by HPLC and Zn and Se by ICP-MS technique. Of 504 samples, 12[2%] were infected with cryptosporidium. None of the controls were positive for cryptosporidium antigen. According to gender, there was no difference between girls and boys. Seven cases [58%] of infected children were seen in during spring. The mean of vitamin A and Zn in children with cryptosporidium were lower than other hospitalized children with diarrhea [p<0.05], however, the mean of selenium was higher in infected children although their difference did not reach a statistically significant level. Results revealed that the prevalence of infection with cryptosporidium in this survey was similar to the majority of studies performed in other parts of Iran. It seems that there is a need of laboratory tests to diagnose cryptosporidium infection in watery stools in Iran