Iranian Red Crescent Medical Journal
Year:2015 | Volume:17 | Issue:2|Papers Count:20

Background: Iran has the highest number of Umrah pilgrims among Islamic countries. Health care plays a major role in fulfilling the Umrah rites. Pilgrims' health situation depends on their health knowledge, attitude, and practice (KAP).Objectives: In this study, we aimed to determine the health KAP among Iranian Umrah pilgrims.Patients and Methods: In this cross-sectional study, 157 Iranian Umrah pilgrims were randomly selected in Mecca, Saudi Arabia in June 2011. Data were collected using a questionnaire. The questionnaire consisted of demographic information (sex, age, degree of education, and resource of health knowledge), health knowledge (5 questions), health attitude (5 questions) and health practice (10 questions).Results: Level of knowledge were very low in 12.1%, low in 25.2%, average in 38.1%, good in 20.4% and very good in 4.2% of respondents. Mean and standard deviation of attitude score was 18.58±2.20 out of 25 (ranged between 13.00 and 25.00). The pilgrims were given 74.2 % out of total score. The Mean and standard deviation of practice score was 8.19±1.32 out of 10 (ranged between 3 and 10). Although the old and low educated pilgrims had little knowledge of health tips, they had a good health attitude and practice.Conclusions: Educational strategy to improve knowledge regarding health-related problems and to develop health practices among pilgrims is needed.

Background: Many experts believe that the "health houses" of Iran have had major effects in increasing health status of Iranian rural community. One of the factors, which was critical to this success is the employment of young women and men from rural communities who serve as multipurpose health workers. They participate in a two-year task-oriented training course.Objectives: The purpose of this article was to describe the model of training behvarzes as the community health workers who deliver health services to the health houses of Iran. This description included the specific method of recruiting these CHWs, strategies and methods of their training which is different from general academic education.Materials and Methods: A descriptive study design was utilized for this analysis in six areas. These areas have been selected according to the expert opinions and experiences of the Center for Health Networks Management.Results: The results showed the specific method of student selection and clear objectives and standards of training related to the health needs of the community. Recruitment of native human resources, the relationship between training and performance are the characteristics, which have been made this system more efficient and responsive to the health system needs.Conclusions: Development of the job and task analysis to ensure providing the right training needs, applying more evidences through different studies for reforms, more decentralized equipped system with decision-making tools have been proposed for development.

Background: As a developing country, Iran has not had a substantial share in global science production activities; however, this country has recently been the forth country in the world regarding research output publications, and biomedical research has played a crucial role in achieving this honorable position.Objectives: In this paper, we aimed to introduce the strategies employed at Baqiyatallah University of Medical Sciences of Iran, to enhance scientific research output of this university.Patients and Methods: The present study used the qualitative content analysis technique. The Research deputies and the head of research centers of Baqiyatallah University of Medical Sciences were the research subjects. The main researcher conducted all the interviews.The participants were all authorities of the university. Sampling continued until data saturation. After speaking with 16 participants, the interviews yielded no new information, and no new categories or subcategories were added to the previous ones. Deep and semistructured interviews with open-ended questions were used to collect data.Results: Diplomacies employed to promote research, organizing educational classes, and foundation of infrastructural organizations for research and true surveillance of research programs were the main characteristics of Baqiyatallah University of Medical Sciences research strategies.Conclusions: Baqiyatallah University of Medical Sciences is a military university of limited resources that has won several awards in the recent years, and has been categorized as one of the leading first ranked medical universities in Iran; a position quite higher than several other larger universities of the country. We recommend more enhanced strategies for other universities.

Background: Since a long time skin incisions have routinely been made with scalpels. Now a day there is a shift in trend from this method to electrosurgical skin incisions. However, fear of bad scars and improper wound healing has prevented its wide spread use. This Study aimed to compare both methods of skin incisions for different variables.Objectives: The aim of this study was to examine incisional time, blood loss during incision and postoperative wound complications and pain with both methods of skin incision.Patients and Methods: A prospective, comparative and randomized study was conducted at different hospitals of Hyderabad and Nawabshah, Pakistan from 1st of December 2009 to 30th of November 2011. The study included patients of either sex above the age of five years with general surgical pathology who were to undergo surgery. these candidates were randomly put into two groups. In Group A patients incision was made with a scalpel and in group B with diathermy. Data was analyzed for age, sex, comorbid illness, incisional time, blood loss during incision making and postoperative pain and wound complications.Results: A total of 283 patients completed the follow-up and were included in the final analysis. Group A comprised of 143 (50.53%) patients; 83 (58%) males and 60 (42%) females with a mean age of 36.03 years. Amongst the 140 patients of group B, there were 85 (60.7%) males and 55 (39.3%) females with a mean age of 36.52 years. Twenty-five (17.48%) patients of group A and 27 (19.28%) of group B had comorbid illnesses. Mean incision time was 8.9025-sec/cm2 for group A and 7.3057 sec/cm2 for group B patients. Mean blood loss during incision making was 1.8262 mL/cm2 and 1.1346 mL/cm2 for group A and B patients, respectively. Pain was 5.2957 for group A patients on day one and 3.1181 for group B patients. Pain score was 2.1049 and 1.6206 on day two and 0.8191 and 0.7192 on day five, for group A and B patients, respectively. Postoperative wound complications were noticed in 26 (18.18%) patients of group A and 22 (15.71%) patients of group B.Conclusions: Diathermy incision is a safe and expedient technique. It takes less time than scalpel incision and loss of blood is also lower during incision. Diathermy is associated with lesser post-operative pain and complications than the scalpel incision. Diathermy should be method of choice in general elective surgery.

Background: In patients with thalassemia, chronic anemia causes bone marrow expansion and consequently skeletal manifestation in spine, skull, face and rib bones.Objectives: We aimed to compare chest radiographic findings and facial bone deformity in patients with thalassemia major (TM) and intermedia.Patients and Methods: In this cross sectional study, 86 consecutive thalassemia patients referring to the Thalassemia clinic in Shiraz, Southern Iran were evaluated during 2012. Patients were divided into three groups including TM and thalassemia intermedia (TI) with and without taking hydroxyurea (HU). Findings ofchest radiography (trabeculation, rib widening and paraspinal masses) as well as facial bone deformity were evaluated by an expert radiologist. Besides, laboratory findings were measured regarding hemoglobin, ferritin, NRBC and platelet count.Results: All radiologic findings were significantly higher in patients with TI compared to TM (P<0.05). In patients with TI, only trabeculation was observed with a higher frequency in patients with HU compared to those without HU (68% vs.27.3%, P=0.008). In the regression model, from all variables evaluated, only NRBC showed a significant correlation with trabeculation (Exp B=1.014, CI: 1.004-1.025, P=0.008) and age showed a significant correlation with paravertebral mass (Exp B=1.147, CI: 1.03-1.27, P=0.013).Conclusions: In patients with TM, bone widening, trabeculation, paraspinal masses and facial bone deformity were lower than patients with TI, whichcan be related to effectiveness of therapy with blood transfusion irrespective of its adverse effects in TM patients.

Introduction: Chronic renal dysfunction is a progressive and irreversible process in kidney function, which often resulted in chronic kidney disease (CKD) or chronic renal failure (CRF). Range of CKD is varying from proteinuria and renal failure to CRF.Case Presentation: A 78-year-old man presented with stage 4 CKD for 7 years; the glomerular filtration rate (GFR) and creatinine levels remained constant despite no change in his weight.Conclusions: Although our patient had CKD stage 4, but his condition has not deteriorated and remained constant and stable for several years only by control of blood pressure and usual treatment which prescribed for patients at this stage.

Background: Self-efficacy is an important predicator of coping with stress.Objectives: This study aimed to determine the psychometric characteristics of the coping self-efficacy (CSE) scale among HIV-infected Iranian patients.Patients and Methods: Psychometric properties of the CSE scale were examined by using a cross-sectional study design. One hundred and twenty HIV-infected Iranian patients that had been referred to the Counseling of Behavioral Diseases Center at Imam Khomeini Hospital in Tehran, Iran in 2014 were selected through simple random sampling method. To determine the Content Validity Index (CVI) and the content validity ratio (CVR), a panel of experts (n=20) reviewed items of CSE scale. Reliability was estimated through the internal consistency (n=30) and the conformity factor analysis was performed.Results: Iranian version of the CSE scale contained 16 items, including 7 items on the "use of problem-focused coping" method, 5 items on "stopping unpleasant emotions and thoughts", and 4 items on "getting support from friends and family". CVI and CVR scores were 0.79, 0.42 and more, respectively. Internal consistencies (range, 0.64 to 0.84) of 3 subscales were acceptable. Confirmatory factor analysis showed that comparative indices of the model, including CFI, IFI, GFI, RMSEA, and Chi-square (c2/df) were 0.96, 0.95, 0.84, 0.83, and 1.82, respectively, which indicated a good fit for the data.Conclusions: The Iranian version of the CSE scale is a valid instrument to measure the coping self-efficacy among people living with HIV in research and community settings in Iran.

Background: CPP-ACP (Phosphopeptide-Amorphous Calcium Phosphate) has an important role in caries prevention in pediatric patients. This study was done, because of the great use of CPP-ACP and the need for restoration for teeth treated with CPP-ACP as well as the importance of shear bond strength of adhesives in the success of restorations.Objectives: This study aimed to evaluate the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on shear bond strength of dental adhesives to enamel of primary teeth molars.Materials and Methods: This in vitro study was conducted on 180 extracted primary molars. They were randomly divided into 6 groups and each group was divided into 2 subgroups (treated with CPP-ACP and untreated). In subgroups with CPP-ACP, enamel was treated with CPP-ACP paste 1 h/d for 5 days. Types of adhesives that were evaluated in this study were Tetric N-Bond, AdheSE, AdheSE One F, single Bond 2, SE Bond, and Adper Prompt L-Pop. Shear bond strength was tested with a universal testing machine and mode of failure was evaluated under stereomicroscope. Data were analyzed by T test, 2-way analysis of variance (ANOVA), Tukey and Fisher exact test using SPSS18. P<0.05 was considered as significance level.Results: Shear bond strengths of different adhesive systems to enamel of primary teeth treated and untreated with CPP-ACP showed no significant difference (P>0.05). Mode of failure in all groups regardless of CPP-ACP administration was mainly adhesive type. Our results indicated that CPP-ACP did not affect shear bond strength of studied adhesives to primary teeth enamel.Conclusions: To have a successful and durable composite restoration, having a high strength bonding is essential. Considering the wide use of CPP-ACP in preventing tooth decay and the role of adhesive shear bond strength (SBS) in success of composite restoration, we conducted the present study to evaluate the effect of CPP-ACP on the SBS of adhesives to primary teeth enamel.

Background: Worldwide, suicide ranks among the three leading causes of death among those aged 15-44 years. An estimated 800000 people die by committing suicide annually.Objectives: To better understand the association between aggressive suicidal attempt and non-aggressive suicidal attempt in patients with suicide attempt in the emergency department.Patients and Methods: A cross-sectional observational study was conducted on suicide attempters of eastern region of Turkey between May 2008 and January 2012. Information of all adult suicide attempts was collected prospectively on a form. Suicide attempts were grouped as aggressive and non-aggressive attempts on a specially designed data-collection form. The aggressive suicide attempts contained violent suicide methods such as firearm, hanging, jumping, car exhaust or drowning.Results: A total of 533 patients were included. Sixty-four of these patients admitted to ED with aggressive suicide attempt (12%). Non-aggressive suicide attempts were consulted to psychiatry more compared to aggressive ones (%73.6, n=345 vs. %32.8, n=21, P<0.0001). Agitation in ED and being male increased aggressive suicide attempt risk by 3.5 (%95 CI: 1.6-7.6) and 3.2 times (%95 CI: 1.8-5.5), agitated patients in ED group and male group respectively. Patients with aggressive suicide attempt were statistically more frequent among these patients; patients with agitation, those hospitalized in intensive care or surgical services and those whose length of stay in the emergency department was less than one day (P<0.05 for all). Patients with non-aggressive suicide attempt were statistically more frequent in these patients; patients complained of nausea, vomiting, stomach pain, fatigue, those with confusion, those tending to sleep, those hospitalized in internal services or emergency ward and finally those whose length of stay in the emergency department was more than one day (P<0.05 for all).Conclusions: Patients with aggressive suicide attempt who have high risk of dying should be recognized and requested psychiatric consultation even if not in the emergency department.

Background: Interleukin (IL) -17-producing CD4+T helper (Th17) cells thatare known by producing IL-17 have recently been defined as a unique subset of proinflammatory helper cells. IL-17 is an inflammatory cytokine with robust effect on many cells and it can play important roles in pathogenesis of diverse groups of immune-mediated diseases.Objectives: The aim of this case-control study was to determine the gene expression of IL-6, IL-17, and transforming growth factor beta (TGF-b) in Iranian patients with bladder cancer.Patients and Methods: Blood samples were collected from 37 patients with bladder cancer and 37 healthy individuals with no history of malignancies or autoimmune disorders, based of simple sampling. The expression of IL-6, IL-17, and TGF-b were measured by quantitative real-time polymerase chain reaction (qRT-PCR).Results: The mean of IL-17 transcripts was significantly higher in patients with bladder cancer compared with healthy individuals (0.33±0.06 vs.0.42±0.14,) (P=0.04), but their TGF-b was lower (12.53±8.41 vs.54.94±17.95,) (P=0.04). However, the IL-6 transcripts level was similar in both groups (5.34±2.40 vs.8.07±3.28,) (P>0.05) and there was not any significant difference between the noted cytokines expressions among patients with different stages and grades.Conclusions: As most of the cases studied in this investigation were in stages I and II, IL-17 as a prominent proinflammatory cytokine may play an important role in recruiting and infiltrating of antitumor immune responses in early stages of bladder cancer. Furthermore, it can be used as predictor for the clinical stage and prognosis of cancers such as bladder carcinoma.

Background: Fatherhood, similarly to motherhood, is an important role and responsibility. For accepting this role, one needs to be well-prepared. Awareness of father’s experiences of pregnancy can help us to develop plans for the promotion of the role of fatherhood.Objectives: The purpose of this study was to explore how first time fathers describe their experiences of pregnancy.Patients and Methods: The data in this qualitative study were collected by individual open-ended interviews in five public health prenatal care clinics in Tehran, Iran, during 2010-2011. Participants were 26 Iranian and Moslem first-time fathers living in Tehran, whose partner was in the 32th to 40th week of her normal pregnancy. Qualitative content text analysis was used for analyzing interviews.Results: Through analysis of fathers’ experiences of their wives’ pregnancy, four categories, as well as associated subcategories, emerged. The categories include: "Emotional responses to pregnancy, Feeling of change, Accepting the reality and satisfaction, Developing identity as a father." These categories describe the phenomenon of "Transition to fatherhood".Conclusions: Transition to fatherhood extends beyond only moderate mental and social changes, and may be influenced by cultural background and beliefs. Therefore, caregivers should be aware of fathers' changes and needs during pregnancy, and support them while taking into consideration their culture and beliefs.

Background: Smoking is regarded as one of the main risk factors and additive to the global burden of diseases in the World.Objectives: This individual patient data (IPD) meta-analysis aimed to estimate the smoking prevalence in Mazandaran province of Iran.Materials and Methods: This study was an IPD meta-analysis. The study data were part of the STEPS Study in Mazandaran province (northern Iran), conducted annually from 2005 to 2009. Sample size was 7759 subjects. Sampling method was census. Data entry was in Epi6 software and the analyses were with stata 11 software.Results: Mean (standard error) age of starting to smoke was 20.21 (0.6) years and females had started smoking 4 years later (P=0.01). During the study, men smoked cigarettes more than women (total prevalence: 23.2%; 95% CI: 22.5-23.9 vs.0.9%; 95% CI: 0.7-1.1 respectively). The pooled prevalence of the current smoking was estimated about 12.08 % (95% CI: 11.40-12.81).Conclusions: Present study showed that the prevalence of Smoking in men is very high in this region of Iran. Therefore to prevent the problem it is necessary that educational and research centres and health providers make suitable policies and strategies.

Background: In modern countries today, herbal medicines are known to help in the treatment of various diseases, as rich sources of antioxidants and minerals.Objectives: To study the effect of Cinnamomum zeylanicum (C. zeylanicum) on spermatogenesis in rats.Materials and Methods: In this experimental study, Wistar male rats (n=20) were divided into two groups, a control group (n=10) and a Cinnamomum zeylanicum group (n=10). The subjects in the cinnamon group received 75 mg/kg/day cinnamon by gavage for 28 days, while the controls received an equal volume of distilled water daily. Animals were kept in standardized conditions. On day 28, a 5 mL blood sample from each rat was taken from tail area to measure testosterone, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), and malondialdehyde (MDA) levels. Testes were collected and were then prepared for sperm analysis by the WHO method.Results: Sperm quality parameters, total serum testosterone, SOD, CAT, and GPX levels were significantly increased in the cinnamon group in comparison to controls (P<0.05). Also, rats in the cinnamon group showed a significant decrease in the level of plasma MDA (P<0.05) in comparison to controls. There were no significant differences between the groups in testis weight (P>0.05).Conclusions: The administration of 75 mg/kg/day cinnamon significantly increased the sperm population, motility and viability, which supports the theory that in mammalians, cinnamon has a beneficial effect on spermatogenesis.

Background: A healthy lifestyle is a valuable source to reduce the prevalence of health problems, and promoteehealth.Objectives: The current study aimed to evaluate the lifestyle and obesity status of Hamadan public employees and their status based on the trans-theoretical model (TTM).Patients and Methods: This analytical cross-sectional study was performed in 2014 on 1200 public employees in Hamadan city, Iran selected through proportional stratified random sampling. Data collection was performed using a three-section questionnaire including demographic characteristics, The FANTASTIC lifestyle questionnaire, and the five-part algorithm. Data were analyzed by SPSS-20 using linear regression, Chi-square, Fisher exact test, and ANOVA.Results: The mean age of the employees was 38.12±8.04 years. Most of the employees (61.7%) had favorable lifestyle. About half of the employees were at the preparation stage of TTM. Most of the employees were in a poor condition regarding the physical activity and healthy eating habits. In most of the evaluated items, females got higher scores than males. The associations between lifestyle and age, gender, work experience, income satisfaction, and marital status were significant. Moreover, the associations between obesity and work experience, marital status, number of offspring, and gender were significant (P<0.05). Significant predicting variables of obesity were age and work experience; they explained 31.2% variance of obesity (adjusted R2=0.312, R2 change=0.01).Conclusions: Planning health education interventions for employees through effective approaches seems necessary.

Background: Social support has been identified as one of the key factors for enhancing the quality of life after stroke. However, a scientific tool that is valid for evaluating social support among stroke survivors in Nigeria has not been developed so far.Objectives: The objective of this study was to examine the psychometric properties of the Hausa translated versions of the Multidimensional Scale of Perceived Social Support (MSPSS) and to validate it for future use in clinical research in Nigeria.Patients and Methods: This cross-sectional study was conducted on a sample of 140 adult stroke survivors attending rehabilitation services at stroke referral centers in Kano, Nigeria. The psychometric analysis of the Hausa-MSPSS involved face, content, criterion and construct validity tests, as well as internal and test-retest reliability. Confirmatory factor analysis was performed to assess validity of the three-factor (Family, Friends and Significant others) model for the Hausa-MSPSS.Results: Based on expert panel, clinicians’ review and patients’ feedback, the 12 item Hausa-MSPSS had sufficient face, content and criterion validity. In reliability analysis, the Cronbach’s alpha was 0.781. In test-retest reliability analysis, the minimum kappa value was 0.673. In Confirmatory factor analysis, the three-factor model was not acceptable. An alternative two-factor model with Family and Friends, as the two domain was found to be acceptable (Chi-square/df<3, TLI, CFI>0.9, RMSEA<0.08). The average variances extracted for the two constructs were 0.5 and 0.7, respectively. The R-squared value between the two constructs was 0.397. Cross validity tested using 1000 bootstrap resamples gave satisfactory results (P=0.079).Conclusions: The 11 item Hausa-MSPSS index is valid for the assessment of perceived social support among stroke survivors in Nigeria.

Background: Recently, the deleterious effects of left bundle branch block (LBBB) on left ventricular systolic function have been taken into consideration.Objectives: The present study aimed to identify underlying factors that predict left ventricular ejection fraction (LVEF) deterioration in patients suffered from complete LBBB.Patients and Methods: In a retrospective case-control study, the data of 220 consecutive patients diagnosed with LBBB on their electrocardiograms were assessed. They were referred to Isfahan Heart Center in Isfahan Province, Iran in 2013. LVEF deterioration was defined as a decrease in LVEF at least 10% between the baseline and follow-up echocardiography study. Thus, achieving the LVEF values≤40% in patients with an initial EF of>50% was considered LVEF deterioration.Results: Among 220 patients, 40% of LBBB patients suffered LVEF deterioration within 3 months of initial assessment. The group with LVEF deterioration had higher male to female ratio, had higher NYHA score, and suffered more from systolic hypertension than another group. Those with coronary artery disease (CAD) had also significantly lower LVEF than non-CAD ones. Adverse associations were revealed between systolic blood pressure and LVEF measurement (r=-0.193, P=0.006) as well as between NYHA score and LVEF (r=-0.215, P=0.002). A multivariable logistic regression model showed that among baseline variables, male gender (OR=3.218, P<0.001), history of systolic hypertension (OR=2.012, P=0.029), higher NYHA score (OR=1.623, P=0.005), and the presence of coronary artery disease (OR=2.475, P=0.028) could effectively predict LVEF deterioration in patients with LBBB.Conclusions: Male gender, history of hypertension, high NYHA score, and the presence of CAD predict LVEF deterioration in patients with LBBB.

Background: Recently, global nursing experts have been aggressively encouraging nurses to pursue creativity and innovation in nursing to improve nursing outcomes. Nurses’ creativity plays a significant role in health and well-being. In most health systems across the world, nurses provide up to 80% of the primary health care; therefore, they are critically positioned to provide creative solutions for current and future global health challenges.Objectives: The purpose of this study was to explore Iranian nurses’ perceptions and experiences toward the expression of creativity in clinical settings and the outcomes of their creativity for health care organizations.Patients and Methods: A qualitative approach using content analysis was adopted. Data were collected through in-depth semi structured interviews with 14 nurses who were involved in the creative process in educational hospitals affiliated to Jahrom and Tehran Universities of Medical Sciences in Iran.Results: Four themes emerged from the data analysis, including a) Improvement in quality of patient care, b) Improvement in nurses’ quality of work, personal and social life, c) Promotion of organization, and d) Unpleasant outcomes.Conclusions: The findings indicated that nurses’ creativity in health care organizations can lead to major changes of nursing practice, improvement of care and organizational performance. Therefore, policymakers, nurse educators, nursing and hospital managers should provide a nurturing environment that is conducive to creative thinking, giving the nurses opportunity for flexibility, creativity, support for change, and risk taking.

Context: A tourniquet is a device that is used frequently in most orthopaedic surgeries but this routine device can lead to serious complications so we decided to review and declare it for safe instruction and use.Evidence Acquisition: We searched the word “tourniquet” in PubMed and Google and reviewed all full text English articles and abstracts of non-English articles. In addition, we read all the reference pages of articles to find the new references.Results: The use of tourniquet in orthopedic surgery can lead to serious but rare complications that can be prevented by its correct knowledge and use.Conclusions: At present, there is not enough evidence to discontinue the routine uses of tourniquets.

Background: Bipolar disorder (BPD) is a common and severe mood disorder. Although genetic factors have important rolesin the etiology of bipolar disorder, no specific gene has been identified in relation to this disorder. Monoamine oxidase gene is suggested to be associated with bipolar disorder in many studies.Objectives: This study aimed to investigatethe role of MAOA gene polymorphisms in the etiology of bipolar disorder in Iranian population.Patients and Methods: This study is a case-control study, with convenient sampling. Three common polymorphisms, a CA microsatellite, a VNTR, and a RFLP were typed in 156 bipolar patients and 173 healthy controls. Patients were chosen from Imam Hossein General Hospital, Psychiatry Ward (Tehran/Iran). Controlsamples for this study consisted of 173 healthy individuals recruitedby convenient sampling. Allelic distributions of these polymorphisms were analyzed in bipolar and control groups to investigate any association with MAOA gene.Results: Significant associations were observed regarding MAOA-CA (P=0.016) and MAOA-VNTR (P=0.004) polymorphisms in the bipolar females. There was no association between MAOA-RFLP and bipolar disorder.Conclusions: The obtained results confirm some previous studies regardinga gender specific association of MAOA gene with the bipolar disorder.

Background: Angiotensin-converting enzyme (ACE) insertion/deletion (I/D) and vascular endothelial growth factor (VEGF) polymorphisms have been shown to associate with diabetic nephropathy (DN).Objectives: We examined the hypothesis that ACE-D and VEGF-G alleles act synergistically in association with DN, in patients with type 2 diabetes mellitus (T2DM).Patients and Methods: The VEGF (rs2010963) and ACE (rs4646994) genotypes were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 490 T2DM patients. Diabetic patients were classified as T2DM patients with and without albuminuria (control). The PCR and RFLP were used to detect the VEGF and ACE alleles.Results: A total of 255 consecutive patients with T2DM and microalbuminuria (Group A) and 235 patients with T2DM and normoalbuminuria (Group B) were included in the study. In univariate analysis, the groups were statistically similar for all variables, except for glycated hemoglobin (HbA1c) (P=0.034), and the frequency of ACE (P=0.015) and VEGF (P=0.006) genotypes. Our study showed that the VEGF-G and ACE-D alleles are independently associated with the development of nephropathy. According to our data, the combination of these two risk factors had a significant synergistic effect on the risk of microalbuminuria development.Conclusions: Our study indicated that ACE-D and VEGF-G alleles can be an independent risk factor for microalbominuria in T2DM patients.