[Risk factors associated with depression in type 2 diabetics]

Depression is one of the most common psychological states in type 2 diabetes that contributes to adverse health outcomes. This study aimed to investigate the risk factors for the incidence of depression in type 2 diabetic patients. In this descriptive cross-sectional study, 254 type 2 diabetic patients were selected through convenience sampling among diabetes outpatient clinics of Tehran university of medical sciences and also Iranian diabetes society during 2010-11. Data were collected using demographic and disease characteristic questionnaire, patient health questionnaire, social support scale and diabetes self-management scale [DSMS] and then analyzed using Chi square, t-test and binary logistic regression. Increased pain and functional disability [OR=11.725], decreased social support [OR=3.086], decreased performance for diabetes self-care [OR=4.088], longer duration of diabetes [OR=1.328], diabetes complications [OR=2.324], the need for insulin therapy [OR=2.431], HbA1c>9% [OR=21.575], BMI>25kg/m2 [OR=2.251] and major life events [OR=14.043] were significantly different between the diabetic patients with and without depression [P=0.001]. There was no significant difference in age, sex and socio-economic status between the two groups. The regression model correctly was fitted in 95.3% of the cases. Pain and functional disability, poor social support, weaker diabetes self-care, longer duration of diabetes, diabetes complications, the need for insulin therapy, HbA1c>9%, BMI>25kg/m2 and the experience of major life events all together contribute to the incidence of depression in type 2 diabetic patients. The results of the study have implications for the prevention of depression in diabetic patients

Waist circumference, weight, and body mass index of Iranians based on national non-communicable disease risk factors surveillance

Obesity is an important and life-threatening disease, associated with different chronic conditions such as cardiovascular disease, diabetes, and dyslipidemia. We sought to address the paucity of information on the trends of anthropometric indices such as weight, waist circumference, and body mass index in the adult population of Iran. We drew upon data from the First Non-communicable Disease Survey in Iran in 2005. In total, 79,611 participants between 20 and 64 years old were selected via the random multistage cluster sampling. The Lambda Median Scale method was applied to construct normal curves for anthropometric indices. The mean of waist circumference in both genders increased with age and in all the age groups except those between 20 and 24 years old was higher in the women. The mean of body mass index was higher in all the age brackets in the women, but the means of weight and height were higher in the men. The association of theses indices with diabetes, hypertension, and dyslipidemia was stronger in men. The ranges of waist circumference and body mass index in Iranian population are different from those of other countries. The higher body mass index and waist circumference in females and the direct association between obesity and chronic diseases, is advisable that the effects of this phenomenon be fully investigated and due heed be paid to the importance of lifestyle modification

Analyses of some relevant predictors on self-management of type 2 diabetic patients

Diabetes is a life threatening illness in both developed and developing countries. Self-management in diabetes is a process which facilitates adoption of self-management behaviors. This process includes need assessment, goals setting and life experiences of diabetic patients. The aim of this study was to determine some relevant factors on self-management among type 2 diabetic patients in order to facilitate planning intervention programs in health promotion field. This study was a cross sectional analysis which assessed some related factors of self-management as a predictor among 140 diabetic patients affiliated to an ambulatory health center in Isfahan in 2011. The tool of data collection was a multidimensional questionnaire included socio demographic and health characteristics [12 items], diabetes distress [17 items], self-efficacy [8 items], and self-management [35 items].Collected data was analyzed by SPSS software version 11.5 with using statistical tests. Findings showed that some variables such as age [p=0.004], duration of disease [p<0.001], sex [p=0.003], co morbidity [p=0.004], BMI [p=0.02], level of education; higher than diploma [p=0.02], medication treatment [p<0.001], health status [p<0.001], diabetes distress, [p<0.001] and self-efficacy [p<0.001] had significant relation with self-management. Predictors [R[2] = 46%]. Multivariate regression dedicated some variables such as age [6=-0.155, P=0.02], health status [6= 0.238, P=0.009], diabetes distress [6= -0.243, P=0.001], self-efficacy [6- 0.372, p<0.001] and BMI [6- - 0.17, P=0.01]. Adopting of self-management behaviors has significant reverse in relation to age, duration of disease, BMI, and diabetes distress. Meanwhile there was significant direct relation with health status and self-efficacy. Therefore, the best proposed regression model is decreasing diabetes distress and enhancing self-efficacy in order to plan intervention programs among type 2 diabetes patients

Adrenal insufficiency in patients admitted to intensive care unit with moderate to severe traumatic brain injury

Traumatic brain injury is a cause of death in adult populations. Adrenal insufficiency has a great impact on the prognosis of patients with traumatic brain injury. However there is a lack of consensus regarding the diagnostic criteria of adrenal insufficiency. Our aim was to assess adrenal function in patients with moderate to severe traumatic brain injury. In a multicenter case-series study, 50 patients, aged 15 to 70 years, with moderate to severe traumatic brain injury were enrolled from 4 intensive care units in Tehran. Adrenal function was assessed using the 1 and 250 microg ACTH stimulation tests. The incidence of adrenal insufficiency in the first 10 days after traumatic brain injury varied from 34% to 82%, based on various definitions of adrenal insufficiency. More cases of adrenal insufficiency were detected by 1microg ACTH stimulation test compared to the basal cortisol and 250 microg ACTH tests. Since the gold standard insulin stimulation test is regarded as potentially dangerous in the acute phase of post traumatic brain injury, the sensitivity and specificity of the stimulation tests could not be assessed. Kappa test showed no agreement between the two tests [Kappa=0.17]. The incidence of hypotension and vasopressor requirement was higher in patients diagnosed by the 250 microg ACTH test. Baseline cortisol had linear correlation with the 60-minute cortisol of both the 1 and 250microg ACTH tests [P < 0.0001]. The prevalence and associated morbidity of adrenal insufficiency in patients with traumatic brain injury warrant early diagnosis of subclinical cases by dynamic stimulation tests and judicious corticosteroid therapy

Report pf bilateral inferior petrosal sinus sampling in Iran

The differential diagnosis of ACTH-dependent Cushing syndrome is a challenging issue for clinical endocrinologists. MRI is commonly used to diagnose Cushing disease and remains the obvious technique to identify pituitary microadenomas in a noninvasive manner but it has proved to be problematic in some cases

[Evaluation of diagnostic accuracy of intraoperative cytology [touch imprint] in malignancy of breast masses]

Due to absence of frozen section in the majority of hospitals, malignant breast masses are being operated in two admissions first for biopsy and second for mastectomy. With simple and rapid technique of touch imprint [intraoperative cytology] we can do both operations in one time, if it be accurate. During 2003 to 2006 reports of touch imprints of 70 patients with breast masses compared with reports of permanent section. We had tow pathology teams in separate hospitals for cytology and permanent section. In 70 patients, 39 cases had malignant and 31 cases had benign masses. In 39 patients with malignant masses, 36 patients had malignant and 3 patients had benign cytologic reports. In 31 patients with benign masses 2 patients had malignant reports in cytology. Therefore sensitivity, specificity and accuracy of touch imprint in diagnosis of malignant breast masses are 92.3%, 93.5% and 92.9% respectively. Because of high specificity of touch imprint it seems this test can be done in centers that do not have frozen section for intraoperative diagnosis of malignant breast masses

[Evaluation and prevention of diabetic neuropathy]

Diabetic neuropathy is an incapacitating disease that afflicts almost 50 percent of patients with diabetes. A late finding in type 1 diabetes, diabetic neuropathy can be an early finding in non insulin-dependent diabetes. Diabetic neuropathies are divided primarily into two groups, sensorimotor and autonomic. Patients may acquire only one type of diabetic neuropathy or may present with combinations of neuropathies, such as autonomic neuropathy or distal symmetric polyneuropathy, the latter of which the most common form. Motor deficits, orthostatic hypotension, silent cardiac ischemia, hyperhidrosis, vasomotor instability, gastroparesis, bladder dysfunction, and sexual dysfunction can also result from diabetic neuropathy. Strict control of blood sugar, combined with proper daily foot care, is essential to avoid the complications of this disorder. With the potential to afflict any part of the nervous system, diabetic neuropathy should be suspected in all patients with type 2 diabetes as well as patients who have had type 1 diabetes for over five years. Although some patients with diabetic neuropathy notice few symptoms, upon physical examination mild to moderately severe sensory loss may be noted by the physician. Idiopathic neuropathy has been known to precede the onset of type 2 diabetes