New evidence suggests that low serum Vitamin D may cause nonalcoholic fatty liver disease (NAFLD). Hypovitaminosis D is associated with the severity and incidence of NAFLD. The objective of this study was to conduct a systematic review on randomized controlled trials (RCTs) assessing the effect of Vitamin D on serum metabolic profile among NAFLD patients. Databases including PubMed, Institute for Scientific Information Web of Science, Scopus, and Google Scholar were searched up to November 2016. RCTs which studied Vitamin D effect on metabolic profiles and liver function, and conducted among adults were included. Six articles were eligible to be considered in this systematic review. According to the result, Vitamin D supplementation might improve lipid profile and inflammatory mediators when compared with placebo. No article indicated significant effect of Vitamin D on liver enzymes except one article which revealed that Vitamin D together with calcium carbonate can reduce liver enzymes. Vitamin D supplementation may not improve anthropometric measures and glycemic index variables among patients with NAFLD. Vitamin D supplement might improve NAFLD symptoms, especially inflammatory mediators. More RCTs in different parts of world with different forms and doses of Vitamin D are necessary.

Background: Reforming the health care system to improve suitable health care model for diabetic patients is essential. This study aimed to implement, identify, and overcome the challenges of implementing the Chronic Care Model in diabetes management in a clinic. Methods: This study is a qualitative technical action research with the Kemmis and McTaggart model including planning, action, reflection, observation, and revision plan which was conducted in the specialized polyclinic from 2015 to 2017 in Isfahan city – Iran. Data were gathered through qualitative and quantitative methods. Diabetes team and 17 patients with type 2 diabetes participated in semi-structured interviews that were purposively chosen. Qualitative data were analyzed using content analysis and then quantitative data collected. Results: The qualitative findings of this research are in five main categories: System design upgrade, self-management upgrade, decision support, health care organization, and clinical information system upgrade. Results of quantitative data showed that most metabolic indicators like HbA1c have statistical meaningful changes (P value < 0.05). Conclusions: Implementing the Chronic Care Model became feasible despite serious challenges and two groups of ready and active team and active patients were developed. The study showed that one important lost link of diabetes management is underestimating the nurses' capabilities in the management of this disease. Inevitably, serious investment on maximum use of nurses' knowledge and skills in improving diabetes management will help diabetes care upgrade significantly.

Background: The aim of the study was to determine the effects of coenzyme Q10 (CoQ10) supplementation on biomarkers of inflammation and oxidative stress among diabetic hemodialysis (HD) patients. Methods: Sixty diabetic HD patients participated in the randomized, double blind, placebo-controlled clinical trial. They were randomly assigned into two groups to intake either 60 mg CoQ10 supplements (n = 30) or placebo (n = 30) twice a day for 12 weeks. Results: After 12 weeks of intervention, CoQ10 supplementation significantly increased total antioxidant (TAC) (54.921 ± 26.437 vs. −126.781 ± 26.437, P < 0.001) and nitric oxide (NO) levels (4.121 ± 1.314 vs. −1.427 ± 1.314, P = 0.006) and decreased C-reactive protein (CRP) (−1.302 ± 0.583 vs. 0.345 ± 0.583, 0.042) levels compared with the placebo. We did not observe any significant effect of CoQ10 supplementation on malondialdehyde (MDA) and glutathione (GSH) levels compared with the placebo. Conclusions: Overall, our study showed that CoQ10 supplementation to diabetic HD patients for 12 weeks was associated with increased levels of TAC and NO levels and decreased level of high-sensitivity CRP (hs-CRP) levels, but did not have any beneficial effects on MDA and GSH.

Background: Diabetes has a genetic predisposition and is generally not diagnosed for many years because hyperglycemia develops gradually, without presenting the classic symptoms of diabetes. The aim of this study is to verify whether, in a potentially genetically predisposed population, men and women under the age of 50 years, at the time of the study, not suffering from diabetes can be detected using parameters derived from initial metabolic alteration indices of the possible evolution of pathology. Methods: In the hereditary and healthy group, salivary concentration of malondialdehyde, total mucins, and pH were determined. All participants in the two groups had fasting glucose level below 110 mg/dL. The results were statistically analyzed using Pearson correlation test, Mann–Whitney test, and –Student's t-test. Results: Salivary concentration of malondialdehyde statistically increased in the hereditary group vs the healthy group (P = 0.0368) as the mucins (P ≤ 0.005). The salivary pH decreased but, the values were not statistically significant (P = 0.085). Some alteration processes occur without increase in glucose levels, produced by changes in metabolic redox processes along with an increase in the salivary malondialdehyde index of oxidative stress in the body. The modification of the salivary buffer system lowers the pH, whereas increase in salivary mucins alters the value of spinnbarkeit, which measures the capacity of the mucous layer to adhere to the epithelium, causing alterations of the oral mucosa. Conclusions: This study shows that it is possible to predict in hereditary predisposition conditions the development of diabetes, and the related dangerous consequences by monitoring two salivary parameters – mucins and malondialdehyde.

Background: Inflammatory bowel disease (IBD) as a chronic and debilitating disease is affected by sleep disturbance which increases the risk of malignancy. Sleep disturbance is more common in irritable bowel syndrome (IBS) and few reported studies have assessed its role in IBD. We evaluated the effect of IBS on sleep quality and quality of life (QOL) of IBD patients in clinical remission. Methods: In a cross-sectional study, 115 IBD patients in clinical remission aged from 14 to 70 years referred to gastroenterology outpatient departments and private gastroenterology offices from 2007 to 2016. Patients considered in four groups (with/without IBS). The Revised “Rome III criteria” used for diagnosing IBS. Pittsburgh Sleep Quality Index questionnaire and the health-related QOL questionnaire used for evaluating sleep quality and QOL. Results: About 85 (73.9%) cases had ulcerative colitis (UC) and 30 (26.1%) cases had Crohn's disease (CD). Forty (34.8%) cases had IBD + IBS. Poor sleep quality in UC + IBS (OR: 0.018, P = 0.003) and UC (OR: 0.016, P = 0.002) was less than CD. Diseases extent in left side colitis (OR: 0.064, P = 0.016) were less than with pancolitis. Sleep quality affected by quality of life (IBDQ) (P = 0.048). Mean quality of life (IBDQ) in patients who had poor sleep was 11% less than those with good sleep. Conclusions: The syndrome of IBS affects the sleep quality of IBD in clinical remission, especially in CD. Its additive effect with IBD may worsen symptoms that correlated with sleep disturbance, such as pain, psychological and physical condition, and QOL.

Background: The HIV control and prevention program is one of the Public Health programs that confronts with many ethical challenges. This study aimed to explore ethical considerations from the viewpoint of headquarters experts on HIV and AIDS prevention and control strategic plan. Methods: In this qualitative study with content analysis design, focus group discussion method was utilized. After purposeful introduction of the experts and previous coordination about subject and time, two discussion sessions were held with the participation of six ministry and university headquarters experts of HIV control program. After frequent reviews of the data and using deductive content analysis, main themes and subthemes were categorized. In order to transformability of the findings to similar situations, the data were checked by three external reviewers. Results: The participants agreed that HIV/AIDS control requires focusing on prevention, treatment, and support services, and considering the general population and all vulnerable groups. In this study, five main themes were emerged: informing and empowering to make autonomous decisions, observing confidentiality, prohibiting stigma and discrimination, and being accountable. Conclusions: The viewpoint of participants indicates on the more need to pay attention the mentioned ethical considerations when compiling and finalizing the program. Moreover, in addition to instructing moral norms in PH programs with a special look to HIV/AIDS and how to apply them in the formulation and implementation of program, systematic evaluation of the program by an ethical framework is recommended to ensure the achievement to the goals of program.

Background: Insulin-like growth factor-1 (IGF-1) and interleukin-2 (IL-2) play an essential role in pathophysiology of several chronic diseases. As a stressor, fasting in Ramadan may increase inflammatory markers such as IGF-1 and IL-2 in Muslims. The aim of this before–after study was to investigate the effects of fasting in Ramadan on IGF-1 and IL-2 levels in individuals. Methods: In all, 34 men age 16–64 years were selected out of the overall number of individuals who were ready for fasting entirely throughout Ramadan. A sample of blood was drawn from the contributors before and after Ramadan, and plasma IGF-1, IL-2, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were determined. To identify differences between the initial and final values of test results of the study for plasma IGF-1, IL-2, and lipid parameters, we used paired sample T-test. Results: Paired sample T-test illustrated a significant decrease in IGF-1 and IL-2 levels after Ramadan fasting compared to before Ramadan. The concentration of TG, cholesterol, and LDL-C levels underwent significant decreases over the period of the study. HDL-C levels did not change significantly during the study. A significant decrease in weight, waist circumferences, calorie, carbohydrate, and fat intake were observed in participants during Ramadan fasting. Conclusions: It is concluded that fasting in Ramadan independent of anthropometric measures attenuates inflammation and is beneficiary to health.

Introduction: Abu Bakr Mohammad Ibn Zakariya Al-Razi (865–925 CE), who was known as “Rhazes” in the west, was a famous scientist of medieval ages. He has more than 200 books and treatises. His masterpiece on medicine “Kitab Al-Hawi Fi Al-Tibb” contains around 900 case reports. Some of the diseases which seem to be recently reported have been stated previously, but not well described. Considering symptoms of the patient described at that time, differential diagnosis will be discussed. Case presentation: Rhazes described a patient with bilious fever. He had developed bloody urine and stool on the fourth day and fatigue. Subsequently, the patient's urine and stool color turned into dark and black, respectively, and died the following day. According to Rhazes attitude, it was malignant measles. Meyerhof in his book has referred to post-measles acute glomerulonephritis, but more appropriate differential diagnoses are compatible with this patient. Discussion: One of the best diagnoses for this case can be Weil's syndrome. Presence of fever, icterus, hemorrhage and renal injury, all suggest Weil's syndrome without pulmonary involvement. The other probable diagnosis is thrombotic thrombocytopenic purpura (TTP). Meningococcal sepsis is the other possible diagnosis. Conclusion: To sum up, as three compatible diseases with the case; have been described more than a thousand years after Rhazes (Weil's syndrome 1886, TTP 1925 and meningococcemia 1805); if the case is either Weil's or TTP or meningococcal sepsis, it is the first report of the disease in the world by Rhazes.

Background: Cyclophosphamide (CP), as a chemotherapy drug, causes severe damage in testicular tissue through producing free radicals. Cerium oxide nanoparticles (NC) exhibit antioxidant and anti-inflammatory properties. The purpose of this study was to investigate the protective effect of NC on CP-induced testicular damage in mice. Methods: In this experimental study, thirty-two male mice were divided into four groups (eight mice in each group). The control group was received intraperitoneally (IP) normal saline, NC group was received NC for three consecutive days (100 μg/kg, IP), CP group was received CP (200 mg/kg, IP), and the CP + NC group received NC, three consecutive days before receiving CP. After 2 days, testicles were assessed for biochemical, histomorphometrical, histopathological, and immunohistochemical analyses. Results: CP administration caused statistically significant increases in sperm abnormality, malondialdehyde, protein carbonyl levels, reactive oxygen species, level and apoptosis, and decreases in sperm count, sperm viability, testosterone, glutathione activity, the mean thickness of the germinal epithelium, diameter of seminiferous tubules in mice. Degeneration, necrosis, arrest of spermatogenesis, congestion, and atrophy in testicular tissue confirmed the low Johnsen's Testicular score in CP group. Administration of NC significantly ameliorated the CP-induced adverse effects on testis compared with the CP group. In addition, pretreatment mice with NC significantly reduced caspase-3 immunoreactivity induced by CP in testis. Conclusions: This study showed that NC with scavenging free radicals and antiapoptotic properties enable to reduce the side effects of CP in the testicular tissue.

Background: This study was conducted to assess the effects of folate supplementation on carotid intima-media thickness (CIMT), biomarkers of inflammation, and oxidative stress in carbamazepine-treated epileptic children. Methods: This randomized, double-blind, placebo-controlled trial was carried out in 54 epileptic children aged 2–12 years old receiving carbamazepine monotherapy. Participants were randomly allocated into two groups to receive either 5 mg folate supplements or placebo (n = 27 in each group) for 12 weeks. Results: After the 12-week intervention, compared with the placebo, folate supplementation resulted in a significant reduction in plasma homocysteine (Hcy) (changes from baseline − 2.1 ± 2.5 vs. +0.1 ± 0.4 μmol/L, P < 0.001), serum high-sensitivity C-reactive protein (hs-CRP) (changes from baseline − 1.5 ± 3.5 vs. +0.4 ± 1.4 mg/L, P = 0.01), a significant increase in plasma nitric oxide (NO) (changes from baseline + 1.9 ± 5.8 vs. −2.0 ± 6.4 μmol/L, P = 0.02), and total antioxidant capacity (TAC) concentrations (changes from baseline + 88.6 ± 116.0 vs. +1.8 ± 77.4 mmol/L, P = 0.002). We did not observe any significant effects in mean levels of left and right CIMT, maximum levels of left and right CIMT, and total glutathione (GSH) and malondialdehyde (MDA) levels following the supplementation of folate compared with the placebo. Conclusions: Overall, folate supplementation at a dosage of 5 mg/day for 12 weeks among epileptic children receiving carbamazepine had beneficial effects on Hcy, hs-CRP, NO, and TAC levels, but did not affect CIMT, and GSH and MDA levels.

Background: Due to high content of fructose, honey has been introduced as a suitable natural sweetener for patients with type 2 diabetes. We investigated the effect of honey consumption on glycemic control and anthropometric measures of patients with type 2 diabetes. Methods: This randomized controlled crossover clinical trial was conducted on 53 patients with type 2 diabetes. The participants were randomly divided into groups of control (weight maintenance diet) or treatment (weight maintenance diet +50 g/day honey) for 8 weeks. After a 4-week washout, the second phase began, in which the role of the groups was interchanged. Blood glycated hemoglobin (HbA1c), glucose, insulin, and anthropometric characteristics were measured. Statistical analysis was performed with SPSS. Repeated measures of ANOVA were used to test differences within- and between the two conditions. Results: Forty-two patients completed the study. HbA1c significantly decreased in control (−0.22%, P = 0.03) and nonsignificantly increased in honey condition (+0.17%, P = 0.22). There was a significant difference between the two conditions (P = 0.02). Fasting glucose did not significantly change in either honey or control condition but insulin concentrations (−0.85 μU/ml, P = 0.01) and insulin secretion (−10.7%, P = 0.01) decreased significantly in the control condition. There was no significant difference in any of these parameters between the two conditions. Waist circumference decreased by honey treatment with a significant difference between the two conditions (P = 0.02). Conclusions: Eight weeks consumption of 50 g/day honey increased HbA1c and decreased waist circumference of patients with type 2 diabetes.

Metabolic syndrome (MetS), a series of symptoms, including abdominal obesity, impaired glucose tolerance and insulin metabolism, hypertension, and dyslipidemia, is considered as the risk of developing cardiovascular disease and diabetes that can predispose a pregnant women to serious health problem, women in the developed as well as the developing countries. This study was aimed to investigate the effects of appropriate interventions on pregnant women with indicators of MetS to further improve the outcome of pregnancy. This systematic review was performed to extract articles of randomized controlled trials (RCT) on pregnant women with indicators of ( MetS) and focusing on physical activity, dietary or lifestyle interventions on maternal health or perinatal outcomes, with searching in the Web of Science, PubMed, CDSR, Scopus, and Google Scholar were investigated. Two researchers independently evaluated the quality of the studies, being presented in all the articles and ranked the studies as high/low quality; the level of evidence was based on the number of high-quality studies and the coordination of the obtained results. Then, 17 articles, which met the inclusion criteria, were selected; among these, 7 articles studied the physical activity, 3 articles reviewed diets, 6 probed the lifestyle interventions, and 1 article was on counseling. In general, evidence suggested how the physical activity and proper diet impacts on proper weight gain during pregnancy, prevents maternal complications, and improves the outcome of pregnancy. According to the results of this systematic review, proper interventions during pregnancy can have a positive effect on maternal weight gain and the general health condition of pregnant women with indicators of MetS.

Background: To examine the associations among nutritional label use, medically diagnosed hypertension, and sociodemographic factors among teachers. Methods: A cross-sectional study of elementary and secondary school teachers in Londrina, Paraná, Brazil, was conducted. Data regarding sociodemographic variables, hypertension diagnosis, and the reading of nutritional information on food/beverage labels were collected in 2012–2013. Associations were analyzed using Chi-square test or Fisher's exact test, and multivariate binary logistic regression models were used to adjust for possible confounders; odds ratios (ORs), 95% confidence intervals (CIs), and adjusted P values were calculated. Results: Of the 978 teachers interviewed, 15% were diagnosed with hypertension, and 62.5% read nutritional information in the 12 months prior to the survey (41% frequently or always). No differences were found between teachers with and without hypertension with regard to frequent reading (frequently/always) of nutritional labels. The frequent use of nutritional labels was significantly associated with female sex (OR = 1.39; 95% CI = 1.04–1.85) and the highest monthly family income level (OR = 1.82; 95% CI = 1.07–3.11). Teachers with hypertension reported checking for sodium more frequently than those without (adjusted P value = 0.040). Medical advice (adjusted P value <0.001) and choosing healthier foods (adjusted P value = 0.002) were the major reasons for reading labels provided by teachers with and without hypertension, respectively. Conclusions: Checking for sodium values on nutritional labels was significantly higher among teachers with hypertension, which most likely results from medical advice, and was the major reported reason for reading these labels.