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Introduction: Diabetic  ketoacidosis  is  an  acute  complication  of  insulin  dependent  diabetes  mellitus  with  high  mortality  rate. The  aim  of  present  study  was  evaluation  of  clinical  signs, laboratory  findings  and  predisposing  factors  of  DKA  in  Arak  Vali-asr  hospital.
Materials  and  Methods: This  investigation  is  a  descriptive, cross-sectional  study  during  2  years  on  30  patients  with  DKA  with  passion  sampling  method.
Results:  Twenty  percent  of  patients  were  male  and  eighty  percent  were  female. Majority  of  patients  were  on  insulin (83.3%)  but  DKA  was  first  presenting  sign  of  diabetes  in 16.6%  of  patients. Most  common  signs  were  fatigue  and  weakness (100%) and  then  gastrointestinal  and  pulmonary  signs  (96.6%)  and  decreased  level  of  consciousness  in  60%.  Hyperkalemia  was  seen  in  20%  and  hypokalemia  only  in  30.3%.
Conclusion: Trying  for  patient  education  and  giving  a  wareness  about  primary  and  common  sign  of  DKA  will  have  an  important  role  in  decreasing  mortality. Nobody  had  hypernatremia  and  only  one  patient  had  hyponatremia  and  only  on  one  patient  had  hyponatremia.

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Introduction: Depression is one of the most common affective disorders, and in addition to different neurotransmitters and life events, various internal stressors such as blood glucose, cholesterol, triglyceride and other factors are responsible for it. Considering hyperglycemia as a possible risk factor of this disorder and inconsistency in results of previous studies, we decided to assess the relationship between different levels of HbA1C and major depression. Materials and Methods: This is a cross-sectional analythical study that is carried out on 134 samples. They were chosen randomly among patients with type2 diabetes reffering to Vali-e-Asr hospital. The patients were divided into 2 groups on the basis of their HbA1C test results patients with HbA1C less than 7% (group A), consisting 55 persons and patients with HbA1C more than 7% and equal to it (group B), including 79 persons. Participants were assessed by Hamilton scale of depression. The relation between HbA1C levels and major depression in these 2 groups was assessed using Chi square and Mann Whitney U tests. Results: We found that 40% of depressed patients had HbA1C level lower than 7% and 60% of them had HbA1C level higher than 7%. No significant correlation was found between HbA1C and major depression. But the duration of disease, using Insulin and being hypertensive simultaneously was correlated to major depression in this study. Conclusion: This study indicates that uncontrolled diabetes and high level of blood glucose is cosidered of less importance as an undelying mechanism of depression in patients with type 2 diabetes.

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Introduction: Paints are composed of extensive variety of hazardous substances, such as organic solvents and heavy metals. Occupational exposure to paint increases oxidative stress, hematological disorders, and DNA injury. This study was performed to explore the beneficial effects of Selvit on the paint workers by measuring total antioxidant capacity, lipid peroxidation, and blood parameters as main oxidative stress biomarkers.

Materials and Methods: This clinical trial study was conducted on 25 male workers who worked in the paint factory. Serum markers such as total antioxidant capacity (TAC), lipid peroxidation (LPO) and also hematological parameters were measured before and after using Selvit (14 days). SPSS software was used for data analyses and paired t-test and Pearson correlation analysis were applied.

Results: Results showed that after using the Selvit, an increase in TAC and a decrease in LPO were observed but they were not significant. Also, aspartate transaninase significantly decreased after using Selvit and high density lipoprotein significantly increased.

Conclusion: Selvit have beneficial effect on hematological parameters due to its antioxidant capacity.

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Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with first dignosis during pregnancy. There is some evidence indicating that chemerin play a role in the development of GDM. In this study, for the first time, a possible association of rs17173608 polymorphism in the chemerin gene with the risk of GDM in Arak population was investigated.

Materials and Methods: In this case-control study, 120 GDM and 150 pregnant women with normal glucose tolerance were selected. GDM was confirmed by oral glucose tolerance according to the new IADPSG criteria. Genomic DNA was extracted from EDTA treated whole blood. The polymorphism of chemerin gene was determined using tetra-amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR).

Results: The genotype frequencies of  TT, GT and GG at rs17173608 were respectively 81.7%, 17.5% and 0.8% in the GDM group and 73.3%, 25.3% and 1.3% in the control group. There were no statistical differences in genotype frequencies between case group and the control group. Also, allele frequencies in the GDM group  (T 90.4% , G 9.6%), did not differ significantly from the control group ( T 96% ,G 14%). No association was found between genotype frequencies and FBS, 1h, 2 h and BMI.

Conclusion: The present study show that the rs17173608 polymorphism in the chemerin gene is not associated with the development of glucose intolerance and GDM in the studied population.

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Background: Diabetes is one of the most common disease resulted from metabolism disorders. Thus, Studying medication adherence in patients to explain educational interventions to improve the health of these patients is necessary. Therefore, the present study aimed to assess the factors affecting medication adherence in diabetics patients based on health belief model in Arak 2014.

Materials and Methods: In this analytical study, 366 diabetic patients in Arak in 2014 were selected and data were collected through a researcher made questionnaire about patients behavior in the field of medication adherence and its influencing factors based on the health belief model. Linear regression model was used to determine the predictive power of structures.

Results: The mean knowledge score and the medication adherence was 31.34 and 84.34, respectively. In this study, perceived susceptibility, perceived barriers and internal action guide were as the strongest predictors of medication adherence behavior in patients and predicted their behavior variance 0.36. Between function and susceptibility and severity and perceived benefits and self- efficacy of manual internal and external action guides in the field of medication adherence with diabetes, there was a direct correlation that the highest correlation was related to the perceived susceptibility structure (r=0.42 , p<0.001).

Conclusion: The results showed that the educational interventions with an emphasis on building the perceived sensitivity of patients with diabetes for medication adherence and emphasis on internal incentives as motivators and incentives for patients to achieve better results in the field of medication adherence should be at the heart of educational interventions.

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Background: The renin-angiotensin system(RAS) has a major role in development of diabetic nephropathy and blocking of RAS by inhibitors and blocking of angiotesin receptors is standard treatment for preventing kidney disease and proteinuria. It is reported that VIT-D analogues are able to suppress renin exertion and improve proteinuria. The aim of this study is to evaluate the effect of VitD analogue (calitriol) on reducing proteinuria in patients with diabetic nephropathy.

Materials and Methods: In this clinical trial study, 132 eligible patients that had diabetic nephropathy and hadn’t vit D deficiency were selected. The patients were divided into two equal groups. First group received the combination of losartan 25mg twice daily and calcitriol 0.25mg and second group received losartan 25 mg twice daly alone for 3 months. The FBS, lipid profile, ESR-CRP BUN, Cr, HbA1c, Ca, P, and 24 hours urine protein were evaluated in all patients at beginning and end of study and the results were statistcally compared.

Results: The 24-hour urine protein in losartan and calitriol group was improved compared to losartan. This difference was statistically significant (p=0.003). As well as, in kidney function (BUN, Cr) in the losartan and calcitriol group compared to losartan alone was significantly improved(p<0.05).

Conclusion: Combination of calcitriol with angiotesin receptor blockers(ARBs) is more effective than ARBs alone in improvement of proteinuria and real function.

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Introduction: Fetuin-A is a secreted protein from the liver, which plays a role in microvascular disorders of diabetes through insulin resistance and inflammation. The aim of this study is to investigate the amount of fetuin-A in diabetic patients without and with microvascular disorders.
Methods: 90 people in 4 groups, diabetic control, nephropathy, retinopathy and retinopathy-nephropathy participated in this research. Data were analyzed using Kruskal-Wallis and Pearson correlation tests. Measurement of parameters including VEGF, interleukin 8 (IL-8), insulin, interleukin 6 (IL- 6) and Fatuin-A was done by ELISA method. The concentration of C-reactive protein (CRP) was measured by nephrometric method.
Ethical considerations: This study was conducted after the approval of the protocol in the research ethics committee and receiving the ethical code number IR.ARAKMU.REC.1400.250 and according to the Declaration of Helsinki.
Results: The obtained results showed that the correlation between fetuin-A and VEGF in the control group was not significant (p=0.234), in the nephropathy group it was significant (p<0.01), in the retinopathy group it was significant (p<0.01) and in the retinopathy group - Nephropathy was significant (p=0.032). Also, the correlation between fetuin-A and interleukin-6 in the nephropathy group is not significant (p=0.285), in the retinopathy group is not significant (p<.075), in the retinopathy group is not significant (p<0.059) and in the retinopathy-nephropathy group. It was insignificant (p=0.113). The correlation between fetuin-A interleukin 8 in the control group is not significant (p=0.592), in the nephropathy group (p=0.592), in the retinopathy group (p=0.314) and in the retinopathy-nephropathy group (p= 0.362). The correlation between Fetuin-A and the homeostatic model of insulin resistance was significant in all groups (p<0.01). Fetuin-A and VEGF levels in the three groups of nephropathy and retinopathy increased significantly compared to the control group. The amount of interleukin 6, interleukin 8 and homeostatic model of insulin resistance in nephropathy, retinopathy and retinopathy-nephropathy groups has increased significantly compared to the control group.
Conclusions: Because fetuin-A is directly related to insulin resistance and VEGF production, its control can have an effect in preventing and controlling the development of microvascular disorders, especially in the early stages of diabetes. Although the results showed that fetuin-A level has no significant relationship with inflammatory factors such as interleukin 6 and interleukin 8, especially in the retinopathy-nephropathy group, but a significant increase of interleukin 6, interleukin 8 and CRP in patients with microvascular disorders to the diabetic control group, it shows the importance of inflammation in the development and progression of microvascular disorders and the importance of its control in diabetic patients.