The Effect of Uric Acid as a Predisposing Factor on Polyneuropathy in Patients with Type 2 Diabetes Mellitus

Background: Since serum uric acid is a controllable and modifiable factor in diabetic patients, identifying the risk factors and accelerating the incidence of neuropathy in these patients plays an important role, and can reduce its level, and the patient's disability, as well as additional therapeutic costs for the patient and the health system in the country. Method: In this retrospective cohort study conducted at the Golestan Hospital in 2015-2017, the study population was 100 type 2 diabetic patients based on NCS of 54 patients with polyneuropathy. First, the demographic data on clinical examinations, lab tests, and uric acid levels in these patients were recorded on a checklist. Then, in 2017, patients were reassessed for clinical investigations and lab tests, and all data entered on the previous checklist. Finally, all the data were analyzed using the SPSS v23. Results: The mean age of patients with polyneuropathy was 51.77 years, and there was a significant relationship between age, BMI and duration of diabetes with neuropathy, but there was no significant difference in gender, smoking and hypertension. The mean serum level of uric acid in the two years ago was 3.85 mg/dl, and at the time of the study, it was 4.18 ±1.55 mg/dl. There was no significant difference in serum levels of this substance after two years of follow up in patients with polyneuropathy (P=0.139). The incidence of polyneuropathy was reported by NCS findings of 54%. In other words, 54% of diabetic patients developed diabetic polyneuropathy for two years. Conclusion: Polyneuropathy is a common complication in diabetic patients, and the serum levels of uric acid over time cannot have a significant effect on the incidence of this disorder

Empathy Level and its Related Factors in the Different Specialties of Medical Residents

Introduction: Given the importance of empathy in the process of caring for patients, this study investigated the level of empathy and its associated factors among medical residents at Ahvaz Jundishapur University of Medical Sciences (AJUMS). Method: This cross-sectional study was conducted at AJUMS in 2022. All 473 medical residents who were studying at AJUMS were included in the study using census method. Participants completed the Jefferson Scale of Physician Empathy. This scale has 20 items that are scored based on a 7-point Likert scale. Data were analyzed using independent t-test, ANOVA, and Pearson's correlation coefficient. Results: The number of medical residents who completed the questionnaires was 290 (response rate 61.3%). These medical residents' mean score of empathy was 102.81±12.75 (out of a total of 140 points). Empathy scores had no statistically significant relationship with sex, marital status, and entry year (p˃ 0.05). Pearson's correlation coefficient showed that there is a significant relationship between the level of empathy and age (r=0.223, p=0.001). Also, there was a significant difference between the empathy scores of medical residents of different specialties (p=0.0001, F=5.249), with the psychiatry residents having the highest mean empathy score (118.31±6.1) and the ophthalmology residents having the lowest (92.85±14.2). Conclusion: The findings showed that the empathy score of the residents is at a moderate level, and given the significant difference between the empathy scores of residents of different specialties, it can be argued that empathy changes under the influence of the clinical education environment and is a teachable skill

The Association between Cardio-metabolic and hepatic indices and anthropometric measures with metabolically obesity phenotypes: a cross-sectional study from the Hoveyzeh Cohort Study

Abstract Background This study aimed to compare the cardio-metabolic, anthropometric, and liver function indices among metabolic obesity phenotypes. Methods In this cross-sectional study, which was carried out in Hoveyzeh, Khuzestan Province, Iran, a total of 7,464 individuals (male: 2859, female: 4605), were recruited and classified into four groups, based on Body Mass Index (obese, BMI ≥ 30 kg/m2; non-obese, BMI = 18.5–29.9 kg/m2) and the National Cholesterol Education Program and Adult Treatment Panel (NCEP ATP) III criteria (Healthy group, ≤ 1 of the criteria; Unhealthy group, ≥ 2 of the criteria), as follows: Metabolically Healthy Non-Obese (MHNO, 28.14%), Metabolically Unhealthy Non-Obese (MUNO, 33.06%), Metabolically Healthy Obese (MHO, 6.54%), and Metabolically Unhealthy Obese (MUO, 32.26%). Anthropometric indices (Waist/Hip Ratio (WHR), Waist/Height Ratio (WHtR), Body Adiposity Index (BAI), Visceral Adiposity Index (VAI), and Weight adjusted Waist Index (WWI)), cardio-metabolic indices (Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP), Cardio-Metabolic Index (CMI), Lipoprotein Combine Index (LCI), Triglyceride-Glucose (TyG), TyG-BMI, TyG-WC, and Thrombolysis In Myocardial Infarction (TIMI) risk index), and hepatic indices (Hepatic Steatosis Index (HSI) and ALD/NAFLD index (ANI)) were calculated and compared between the groups. Results WHR,VAI, AIP, LAP, CMI, LCI, TyG, and TIMI risk index values were significantly higher in the MUNO phenotype compared to the MHO phenotype (WHR: 0.97 vs. 0.95; VAI: 3.16 vs. 1.33; AIP: 0.58 vs. 0.25; LAP: 78.87 vs. 55.79; CMI: 2.69 vs. 1.25; LCI: 27.91 vs. 12.11; TyG: 9.21 vs. 8.41; TIMI: 18.66 vs. 15.63; p < 0.001). The highest and lowest HSI and ANI values were detected in the MUO phenotype. After adjustment for age, sex, physical activity, and years of education, VAI showed the highest Odds Ratio for MUNO (OR: 5.65; 95% CI: 5.12, 6.24) and MUO (OR: 5.40; 95% CI: 5.89, 5.95) compared to the MHNO phenotypes (p < 0.001). The ANI indices was associated with a reduced risk of MUO (OR: 0.76; 95% CI: 0.75–0.78), MUNO (OR: 0.88; 95% CI: 0.87–0.90), and MHO (OR: 0.79; 95% CI: 0.77–0.81) phenotypes (p < 0.001). Conclusion MUNO phenotype was exposed to a higher risk of cardiovascular disease compared to the MHO phenotype. VAI was found to be the optimal index for cardiovascular risk assessment

Association between Serum Vitamin D Level and Glycemic and Inflammatory Markers in Non-obese Patients with Type 2 Diabetes

Background: Low serum 25-hydroxy vitamin D (25(OH)D) has been shown to correlate with an increased risk of type 2 diabetes mellitus (T2DM). The objective of this study was to investigate the association between serum 25(OH)D and glycemic and inflammatory markers in non-obese patients with T2DM. Methods: Eighty-four non-obese patients with T2DM were recruited in this cross-sectional study. Demographic, anthropometric, and dietary information was obtained from all the participants. The serum concentrations of glucose, HbA1C, insulin, 25(OH)D, and inflammatory markers including tumor necrosis factor-alpha (TNF-α) and high sensitive C-reactive protein (hs-CRP) were measured. A homeostatic model of insulin resistance (HOMA-IR) was also evaluated. Results: The mean serum concentration of 25(OH)D was 11.01±5.55 ng/mL. Severe deficiency, deficiency, and insufficiency of vitamin D were detected in 60.71%, 35.72%, and 3.57% of the participants, respectively. The results showed that those in the lowest group of serum 25(OH)D had significantly higher TNF-α than did those in the highest group (P=0.026). Although the association between serum 25(OH)D and fasting blood sugar and TNF-α was statistically significant (P=0.049 and P=0.044, respectively), the other glycemic markers and hs-CRP did not have any significant relationships with 25(OH)D. Conclusion: According to the high prevalence of vitamin D deficiency in the diabetic patients and the inverse relationship between serum 25(OH)D and fasting blood sugar and TNF-α in this study, vitamin D status may be a determining factor of systemic inflammation in patients with T2DM. Further studies with larger sample sizes are suggested in this regard

Correlation matrix between burnout and empathy and between their dimensions.

Correlation matrix between burnout and empathy and between their dimensions.</p

Predicting burnout through empathy dimensions in residents.

Predicting burnout through empathy dimensions in residents.</p

Mean scores of burnout and empathy along with their dimensions among medical residents.

Mean scores of burnout and empathy along with their dimensions among medical residents.</p

Effect of COVID‐19 infection on sex hormone levels in hospitalized patients: A prospective longitudinal study in Iran

Abstract Introduction This study aimed to evaluate the levels of sex hormones in patients with COVID‐19 in Ahvaz, Iran. Methods A prospective longitudinal study was conducted at Razi hospital, Ahvaz, Iran, from July 2020 to Febuary 2021. The levels of sex hormones including estradiol, progesterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), and total and free testosterone were measured in 162 patients with COVID‐19 infection during hospitalization and 1 month after discharge. A demographic questionnaire and a checklist were used to collect the data. Mann−Whitney U test, χ2 test, Fisher's exact test, Wilcoxon test, and logistic regression were used to analyze the data. Results Sex hormones were assessed in 162 patients at baseline; however, a month after discharge, only 69 patients provided consent for assessment, and 9 had passed away. The estradiol level was 407.70 ± 623.37 and 213.78 ± 407.17 pg/ml in female patients with severe and moderate diseases at baseline, respectively which reduced to 195.33 ± 380.04 and 58.20 ± 39.45 pg/ml after discharge (p = 0.011 and p = 0.001). The alteration in the levels of progesterone, LH, and FSH were not significant. The level of LH in both groups of male patients with severe (6.64 ± 2.91 IU) and moderate disease (6.42 ± 4.44 IU) was high, which reduced after discharge (4.16 ± 2.44 and 3.93 ± 3.15 IU, respectively), but this decrease was significant only in the patients with severe disease (p < 0.0001). The alteration of FSH and free testosterone were not significant. The level of testosterone was 1.19 ± 0.73 and 1.46 ± 1.22 ng/ml at baseline in patients with severe and moderate diseases which increased to 2.64 ± 1.25 ng/ml, p < 0.0001, and 2.54 ± 0.93 ng/ml, p = 0.001, respectively after discharge. Conclusion Our findings showed that the level of estradiol in female patients increased significantly while the level of testosterone in male patients decreased during the active phase of infection. Due to the attrition of patients in the follow‐up period, more studies are needed to confirm these results

Association of rs7903146 polymorphism in the TCF7L2 gene with diabetic nephropathy and decreased estimated GFR in an Arab population in southwest Iran

Background: Transcription factor 7-like 2 (TCF7L2) acts as a downstream effector in the Wnt signaling pathway. It plays important roles in the proliferation and differentiation of islet betacell, insulin secretion and kidney development. Objectives: This study aimed to demonstrate whether rs7903146 variant is associated with diabetic nephropathy (DN) and measures of kidney function in a diabetic and healthy Arab population in southwest of Iran. Patients and Methods: This study is comprised of 132 diabetic subjects (T2DM) and 66 healthy participants. The diabetic subgroups were composed of patients with DN (n=56) and early onset of diabetes (n=71). The rs7903146 polymorphism was genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in all the participants. Blood glucose, HbA1c, blood urea nitrogen (BUN), creatinine and urinary albumin were evaluated by a biochemistry analyzer and enzyme-linked immunosorbent assay (ELISA) was employed for cystatin C measurement. Results: The frequency of genotypes was significantly different between all the diabetic cases and control subjects (P<0.05). The TT variant odds ratio (OR) versus CT/CC genotypes for diabetes was 2.47 (95% CI 1.11-5.48). An association was observed between TT homozygous and DN (OR for TT 2.78, 1.13-6.84). Early onset diabetic patients showed stronger association (OR: 4.64, 1.64-13.14, P=0.003). The TT genotype was also found to be a risk variant for decreased estimated glomerular filtration rate (eGFR)(Cys-Cr) below 60 mL/min/1.73 m2 (OR: 3.36, 1.4-8.1, P=0.005). Conclusions: The results confirmed that the TCF7L2 gene rs7903146 variants are significantly associated with T2DM in Arab population of Iran. The TT genotype of this SNP is also predisposed to the risk of developing DN especially in subjects with early onset diabetes. Patients with TT genotype were also at risk of decreased GFR

Comparing the Efficacy of Duloxetine with High Tone Power Therapy in Diabetic Peripheral Neuropathic Pain: A Double-Blind Randomized Phase III Clinical Trial

&lt;p&gt;&lt;strong&gt;Abstract:&lt;/strong&gt; &nbsp;&nbsp;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background and Objective:&nbsp;&lt;/strong&gt;Diabetic neuropathy pain is a common pain condition that has a major negative impact on health-related quality of life. However, despite many studies, it remains difficult to treat neuropathic pain. This study aimed to&lt;strong&gt; &lt;/strong&gt;compare the efficacy of duloxetine with high tone power therapy (HTPT) in diabetic peripheral neuropathic pain.&lt;br&gt;&lt;strong&gt;Materials and Methods:&nbsp;&lt;/strong&gt;The study is a single-centre, phase III clinical trial comparing the effect of HTPT versus treatment with duloxetine in diagnosed diabetic neuropathy patients between October 2019 to December 2020. In the case group, the HTPT was used with a four-second duration for 30 minutes daily. This treatment was continued twice a week for 10 sessions. The control group received duloxetine (30 mg/m2 once a day). The treatment response was assessed based on the VAS score.&lt;br&gt;&lt;strong&gt;Results:&lt;/strong&gt;&nbsp;The results showed that in both groups, there was a significant reduction in pain severity. In HTPT group, the average pain decreased from 7.36 to 4.6 and in duloxetine group from 7.7 to 4.8. During 8 measurements after the intervention; decrease in VAS score was higher in HTPT group (5.6) than in duloxetine group (6.5) in the first and fourth times after the intervention (P-Value=0.01). Further analysis demonstrated a positive correlation between pain severity and age so that, the pain also increases with &nbsp;advancing age.&lt;br&gt;&lt;strong&gt;Conclusion:&nbsp;&lt;/strong&gt;The results of the present study showed that both duloxetine and high tone therapies are safe and effective methods for neuropathic pain relief.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Keywords: &lt;/strong&gt;&lt;a href="https://zums.ac.ir/journal/search.php?sid=1&amp;slc_lang=en&amp;srchterm=Diabetic+Neuropathy"&gt;Diabetic Neuropathy&lt;/a&gt;, &lt;a href="https://zums.ac.ir/journal/search.php?sid=1&amp;slc_lang=en&amp;srchterm=Duloxetine"&gt;Duloxetine&lt;/a&gt;, &lt;a href="https://zums.ac.ir/journal/search.php?sid=1&amp;slc_lang=en&amp;srchterm=TENS"&gt;TENS&lt;/a&gt;&lt;/p&gt