Background:Cabergoline is a long-acting agonist of dopamine, which has a high affinity to dopamine receptors (type 2). Treatment using a dopaminergic agonist reduces hypothalamic stimulation that increases during liver gluconeogenesis, lipids synthesis, and insulin resistance. Our aim was to evaluate the effects of cabergoline on blood glucose levels in patients with type 2 diabetes mellitus (DM).Methods:This study was a double-blind, controlled clinical trial in patients with type 2 DM. The patients received treatments of a placebo (control group; n = 20) or cabergoline 0.5 mg (cabergoline group; n = 20) using the sequential method, once per week for 3 months, while using previously prescribed glucose-lowering drugs. All tests, such as levels of fasting blood glucose, 2-hour post-prandial glucose, complete lipid profile, prolactin, alanine amino transferase, aspartate amino transferase, creatinine, blood urea nitrogen, and serum insulin, and homeostasis model assessment insulin resistance were measured at baseline and at 3-month follow-up.Results:The fasting blood sugar levels were significantly different between placebo and cabergoline groups after 3 months of treatment (P = 0.004). The prolactin levels were significantly different from beginning of the treatment to 6 months later (P = 0.001). In the cabergoline group, there was a significant decrease in glycosylated hemoglobin (HbA1C) levels after 3 months (P = 0.003). Overall, 65%and 45% patients in the cabergoline and control groups, respectively, responded to treatment (HbA1C<7%).Conclusion:Cabergoline may be useful as a long-acting antidiabetic agent in patients with type 2 diabetes mellitus.

BackgroundWe aimed to evaluate the effects of a hydroalcoholic extract of Juglans regia L. leaves on blood glucose level and cardiovascular risk factors in type 2 diabetic patients.MethodsIn this randomized, double-blind, placebo-controlled, parallel-group (2 arms) clinical trial, 50 diabetic patients were divided into two groups: treatment group (receive the capsules containing 100 mg J. regia leaf extract) and control group (receive the capsules containing placebo, microcrystallin cellulose). Baseline participant data were matched between the two arms of the study. We administered the prepared capsules to the patients twice daily for 8 weeks. Blood glucose level, glycosylated hemoglobin (HbA1c) level, body weight, body mass index, blood pressure, lipid profile, serum insulin, and insulin resistance were compared between the two groups before and after the intervention. P < 0.05 was considered significant.ResultsAfter excluding eleven patients, 20 received J. regia leaf extract and 20 patients received placebo. The J. regia leaf extract did not significantly change the blood glucose and insulin resistance condition. However, in this group, body weight, body mass index, and systolic blood pressure significantly decreased compared with the baseline measurements (P = 0.028, P = 0.030, and P = 0.005, respectively). The lipid profile did not change significantly compared with the baseline measurements. In the control group, postprandial glucose and HbA1c levels significantly decreased after the intervention (P = 0.030 and P = 0.028, respectively). The other variables were not significantly different in this group. At the end of the study, the variables were not significantly different between the two groups.ConclusionIn this double-blind study, 200 mg/d of J. regia leaf extract had no significant effect on blood glucose level and HOMA-IR score in patients with type 2 diabetes. However, the J. regia leaf extract was effective in reducing body weight and blood pressure. An accidental finding of our study was that microcrystalline cellulose, a widely used placebo in clinical trials, led to a reduction in blood glucose level.Trial registrationIranian Registry of Clinical Trials (IRCT: 138901203180 N2, 2010/6/6); retrospectively registered.

Background: Nursing is a critical job in the health care system. However, nurses suffering from poor job conditions suffer from job dissatisfaction, eventually causing burnout. This is a very important concern for the health care system because the turnover of nurses leads to a waste of money and time of this system. Therefore, nurse managers need to find a way to measure and reduce the burnout. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) is a famous inventory to measure the job burnout in human services. This study aimed to measure the validity and reliability of the Persian version of MBI-HSS. Materials and Methods: This study was conducted in two hospitals of Fasa University of Medical Sciences, Fars Province, Iran, in July 2017. Nurses participated with their own discretion in this study and filled the MBI-HSS themselves. The questionnaire consisted of 22 items comprising three dimensions. Exploratory factor analysis and Cronbach’s  alpha were performed in this study using Stata software, version 12. Results: Overall, 200 nurses were included in this study, with a mean age of 29.48 ± 6 years. The result of the exploratory factor analysis showed that the weight of each item in its own dimension was greater than 0.4 or another dimension. Also, the Cronbach’s alpha for 3 dimensions was greater than 0.7. Conclusions:  Our study showed that the Persian version of MBI-HSS has sufficient validity and reliability, similar to that of the original version, for the measurement of burnout in Persian speakers of human services workers.[GMJ.2018;7:e995]

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BackgroundImpaired fasting glucose (IFG), and impaired glucose tolerance (IGT) are two prediabetes conditions which have some correlation with macrovascular disorders. The risk of microvascular complications in these groups is not clear.ObjectivesThe prevalence of albuminuria in subjects with IFG and IGT was evaluated in the present study.Patients and MethodsIn this study three groups of subjects were entered (45 subjects in each group): IFG, IGT, and normal glucose tolerance as control. The urine albumin-creatinine ratio was studied in morning spot urine samples to detect microalbuminuria. The subjects were followed up for two years, and blood sugar and urine albumin and glycosylated hemoglobin (HbA1C) were measured every 6 months.ResultsThe prevalence rate of microalbuminuria was 15.5% in the prediabetic groups, while no one had microalbuminuria in the control group (P = 0.005). The prevalence of microalbuminuria in patients with IFG or IGT was not significantly different (17.8% vs. 13.3%) (P = 0.4). Fourteen subjects (4 in IFG group and 10 in IGT group) developed diabetes mellitus within a 2-year follow-up period (P = 0.1). Thirty six percent of subjects with albuminuria, and twelve percent of subjects without albuminuria progressed to diabetes mellitus during a 2-year follow-up (P = 0.02, odd ratio = 4.1; CI95%, 1.13-15.1).ConclusionsThe risk of microalbuminuria in prediabetic subjects is high, and probably prediabetic subjects are at higher risk of progression to diabetes mellitus. We suggest periodically evaluation of albuminuria in prediabetic patients after the diagnosis.

A major predicament in certain users of metformin, which is one of the most commonly used antihyperglycemic agents for type 2 diabetes (T2DM) treatment, is the lack of appropriate response to the drug. We evaluated the role of metformin response and OCT1 (organic cation transporter1) Met420del polymorphism in a monotherapy study (metformin therapy for 12 weeks) on patients newly diagnosed with T2DM. Based on the response to metformin, patients (n = 108) were divided into two groups: responders (n = 49) and non-responders (n = 59). HbA1c levels were determined by affinity technique. The OCT1-Met420del polymorphism was genotyped by PCR-based restriction fragment length polymorphism. There was a significant association between the variable response with HbA1c and fasting blood sugar (FBS) (Wilks' λ = 0.905, p = 0.01). Responders had significantly lower HbA1c and FBS levels compared with non-responders (η (2) = 0.087, p = 0.004 for HbA1c and η (2) = 0.055, p = 0.022 for FBS). The interaction treatment-response increased the effect sizes from 32 to 58 % for HbA1c. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) values were significantly lower in the responder group than in the non-responders (η (2) = 0.067, p = 0.01 for ALT and η (2) = 0.052, p = 0.025 for AST). This observational study showed that the variant OCT1-Met420del may be more effective on plasma glucose than HbA1c. The variable response could account for a significant proportion of the variance in HbA1c levels observed following treatment with metformin. Metformin shows a significantly greater effect on ALT and AST in responders than in non-responders.

Here we report a single-center cohort of 6 patients (4 kidney-only, and 2 simultaneous liver/kidney transplants) diagnosed with COVID-19 at a median of 1.9 years (range=0.2-9.3 years) post-transplant. Five (of 6) patients required inpatient admission, two patients (mortality=33%) died. Among those with mortality, an increased concentration of inflammatory biomarkers [interleukin-6 (IL6) and C-reactive protein] was noted with a lack of response to IL-6 blockade, remdesivir and/or convalescent plasma. None of the kidney-only transplants (4/6; 67%) had elevation in plasma donor-derived cell-free DNA above the previously published cut-off of 1% suggesting absence of significant allo-immune injury. Four (of 5) admitted patients had detectable SARS-CoV-2 (severe acute respiratory syndrome–coronavirus 2) in blood on samples obtained at/during hospitalization. Of the 4 discharged patients, two patients with undetectable virus on repeat nasopharyngeal swabs had seroconversion with positive SARS-CoV-2 IgG formation at 30-48 days post-infection. One patient had prolonged shedding of virus on nasopharyngeal swab at 28 days post-discharge despite lack of symptoms. In this preliminary report, we find that immunocompromised transplant patients had higher rates of RNAemia (67%) than reported in the general population (15%), seeming absence of allo-immune injury despite systemic inflammation and formation of IgG overtime after recovery from infection.

BackgroundIn this study, we investigated whether response to metformin, the most frequently drug for diabetes treatment, influences the therapeutic effects of antilipidemic medication in newly diagnosed patients with type 2 diabetes mellitus (T2DM).MethodsA total of 150 patients with T2DM were classified into two groups following 3 months of metformin therapy (1000 mg twice daily): responders (patients showing ≥1% reduction in HbA1c from baseline) and nonresponders (patients showing <1% reduction in HbA1c from baseline). The patients received atorvastatin 20 mg, gemfibrozil 300 mg, or atorvastatin 20 mg and gemfibrozil 300 mg daily.Principal FindingsHbA1c and fasting glucose levels were significantly different between baseline and 3 months among responders receiving atorvastatin; however, these differences were not statistically significant in nonresponders. Atherogenic ratios of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C; p = 0.002), total cholesterol to HDL-C (TC/HDL-C; p<0.001) and AIP (the atherogenic index of plasma; p = 0.004) decreased significantly in responders receiving atorvastatin than in nonresponders. Moreover, responders receiving atorvastatin showed a significant increase in HDL-C levels but nonresponders receiving atorvastatin did not (p = 0.007). The multivariate model identified a significant association between metformin response (as the independent variable) and TG, TC, HDL-C and LDL-C (dependent variables; Wilk's λ = 0.927, p = 0.036).ConclusionsMetformin response affects therapeutic outcomes of atorvastatin on atherogenic lipid markers in patients newly diagnosed with T2DM. Metformin has a greater impact on BMI in responders of metformin compared to nonresponders. Adoption of better therapeutic strategies for reducing atherogenic lipid markers may be necessary for metformin nonresponders.