Type 1 diabetes mellitus (T1DM) is an autoimmune disorder that leads to beta cell destruction and lowered insulin production. In recent years, stem cell therapies have opened up new horizons to treatment of diabetes mellitus. Among all kinds of stem cells, mesenchymal stem cells (MSCs) have been shown to be an interesting therapeutic option based on their immunomodulatory properties and differentiation potentials confirmed in various experimental and clinical trial studies. In this review, we discuss MSCs differential potentials in differentiation into insulin-producing cells (IPCs) from various sources and also have an overview on currently understood mechanisms through which MSCs exhibit their immunomodulatory effects. Other important issues that are provided in this review, due to their importance in the field of cell therapy, are genetic manipulations (as a new biotechnological method), routes of transplantation, combination of MSCs with other cell types, frequency of transplantation, and special considerations regarding diabetic patients' autologous MSCs transplantation. At the end, utilization of biomaterials either as encapsulation tools or as scaffolds to prevent immune rejection, preparation of tridimensional vascularized microenvironment, and completed or ongoing clinical trials using MSCs are discussed. Despite all unresolved concerns about clinical applications of MSCs, this group of stem cells still remains a promising therapeutic modality for treatment of diabetes.
BackgroundsDiabetes is one of the most common metabolic disorders worldwide. This study aim was to provide detail analysis of diabetes research output and its trend in Iran as well as in the world and compare them.MethodsData was retrieved from PubMed database using a suitable search strategy and application of proper operator “AND”, “OR” and “NOT”. All English documents published from 2008 to 2012 were included. Meeting abstract, letter to the editor, guidelines, consensus and reviews were excluded. Obtained documents for Iran and world were categorized in eleven groups including diabetes management, education, paediatrics, nutrition, epidemiology, diabetes complications, stem cells, gestational diabetes mellitus (GDM), psychiatrics, genetics and prevention and were compared.ResultsTotal number of DM publications was 59513 for world and 648 for Iran. Trend of DM publications was increasing during the 5 years with a growth rate of 22.5% for world and 23.4% for Iran. Contribution of Iran in the world diabetes output reached 1.08 in 2012. The most and the least number of DM documents were related to complications and preventions, respectively both in Iran and the world. Three leading countries with highest proportion of RCTs (randomized clinical trial) to their total DM publications were Italy, Germany and Iran.ConclusionThe most number of diabetes research was in the field of diabetes complication, management and genetics in the world as well as in Iran. During the 5-year period, despite of the world sanctions against Iran, diabetes research trend was increasing in Iran relatively parallel to the world research and sanction had no significant effect on Iran.
Background: Some ethical challenges have emerged along with advances within the field of pediatrics. Meanwhile, the residents of pediatrics face particular ethical challenges, since they have different roles in their professional career as educators, students, advocators, and clinicians. Objectives: The aim of the present study was to identify ethical challenges in the field of pediatrics from the viewpoints of Iranian pediatric residents Methods: This cross-sectional study was conducted during 9 months. The studied population consisted of 90 residents of pediatrics studying at Tehran University of Medical Sciences in Tehran, capital of Iran. Sampling was conducted in the form of census counts of a 32-item instrument that evaluated ethical challenges in the field of pediatrics. Validity and reliability of this questionnaire were evaluated by experts in the field of medical ethics and pediatrics. Data were analyzed using the SPSS software using descriptiveanalytic statistic methods. Results: The most serious ethical challenges in the field of pediatrics were providing enough information to obtain informed consent (4.74 ± 0.22), dealing effectively with the conflicts of decision-making by the sick children and their families (4.68 ± 0.14), giving bad news to the sick children or their parents as appropriately as possible (4.64 ± 0.18), and taking necessary actions in dealing with cases of child maltreatment (4.62 ± 0.16), respectively. In addition, based on linear regression analysis, there was a significant correlation (P = 0.03, r = 0.059) between the residents' gender and their views towards ethical conflicts; female residents paid more attention to these challenges than male residents. Conclusions: Paying attention to ethical challenges in the field of pediatrics helps the authorities provide favorable conditions in clinical settings. Therefore, resulting in less ethical challenges in similar situations.
Background: To normally grow and develop, children with congenital heart diseases (CHD) in the hypermetabolic state need 50% more energy than healthy ones. Objectives: This study aimed to investigate the prevalence of malnutrition and its association with other factors among the nonsyndromic acyanotic patients with CHD undergoing palliative or corrective surgery. Methods: A retrospective study of medical records of 812 children with acyanotic congenital heart disease undergoing palliative or corrective surgery was performed from March 2011 to March 2017. Collected data consisted of the age at the time of the surgery, gender, weight at the time of the surgery, height at the time of the surgery, birth weight, length of ICU stay, and 1-year mortality. The WAZ, WLZ, LAZ, and BMI Z-scores were calculated based on World Health Organization (WHO) standards. We classified the Z-scores into 4 groups, including normal (Z-scores >-1), mild (-2 to >-1), moderate (-3 to >-2), and severe (<-3) malnutrition groups. Results: Total amount of 812 patients, 375 (46.2%) were female and 437 (53.8%) male, participated in this study. The average age, weight, and height at the time of the surgery were 23.52 + 29.38 months, 9.086 + 6.71 kilograms, and 76.93 + 23.37 centimeters, respectively. Moreover, 68.7% and 66.4% of the patients suffered from mild to severe forms of malnutrition based on WAZ and WLZ, respectively (P value < 0.0001, 0.025). There was no significant difference between males and females in WAZ, WLZ, LAZ and, BMIZ (P value: 0.154, 0.265, 0.965, and 0.667, respectively). Generally, in acyanotic defects, we found that more severe malnutrition causes an increment in length of ICU stay (P value = 0.001) and lesser birth weight has a significant relationship with the severity of growth failure in infancy or childhood (P value < 0.0001). Conclusions: In our study, the high prevalence of the malnutrition and related complications during and after surgical repair shows the importance of nutritional support and interventions in patients with CHD.
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