IRANIAN JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2009 | Volume:10 | Issue:6 (SN 42)|Papers Count:17

Introduction: Geometric indices of the femoral neck and bone mineral density (BMD) have been proposed to play a major role in prediction of hip fracture risk, with some studies showing a racial variation in such indices. However, no data study in Iran has estimated these parameters for Iranian patients, nor has the relationship between these indices and BMD parameters in different sub-regions of hip been investigated. Materials and Methods: Postmenopausal women referred to the bone densitometry center of the Shariati Hospital comprised the study population. Patients with apparent risk factors of osteoporosis were excluded. Bone mass was determined using dualenergy X-ray absorptiometry on Lunar DPX bone densitometers. For calculation of femoral neck geometric indices, the printout of the hip densitometry with magnification of ½ was used. Hip axis length (HAL) and neck-shaft angle (NSA) were the main outcomes of the study. We used Pearson correlation analysis for determination of relationship between geometric indices and other variables and multivariate linear regression analysis for adjustment of other independent variables in prediction of femoral BMD. Results: Among 103 postmenopausal women studied, mean HAL was 99.8±4.3 millimeters and mean NSA was 120.3±4.3 degrees. Pearson correlation analysis revealed no correlation between HAL and NSA with BMD results of different sub-regions of hip, but there was a significant positive correlation between HAL and height and weight neither did multivariate regression analysis reveal any significant relationship between HAL and NSA with BMD of total femur and femoral neck. Conclusion: According to our results, it is unlikely that geometric indices play a major role in determination of hip BMD parameters making their routine use in bone densitometry centers not essential supported. Mean HAL of Iranian women is lower than that of Western countries and higher than that of East Asian countries. This is in line with observation of rates of hip fracture in Iran lower that Western rates and higher than Eastern rates.

Introduction: Nontraumatic hip fracture due to osteoporotic is one of the most serious complications of this significant worldwide health problem. Osteoporotic hip fracture constitutes almost 20% of orthopedic ward admissions in most countries, with significant health related budgets being spent for care of these patients. Considering the lack of precise statistical data of osteoporotic hip fracture rates in our country, and any previous investigations regarding the problem in Tabriz (a large city in northwestern part of Iran), we investigated the frequency of this epidemic in residents aged over 50 years of Tabriz. Materials and Methods: In a retrospective - descriptive study, we reviewed medical records of all patients over 50 year’s inhabitants of Tabriz, admitted with hip fracture in city hospitals, during 24 months, from March 2005 to February 2007. Data regarding age, sex, type of trauma, type of fracture, and in-hospital morbidity and mortality were extracted, and analysis was performed using SPSS14 software. Results: During the study period there were 878 admissions for hip fracture in subjects aged over 50 years; there were 779 patients with nontraumatic hip fracture (398 males and 381 females) mean age 75.1±9.1. It is estimated that the rate of nontraumatic hip fracture in these citizens of Tabriz is 175 per 100000 population, 174 for females and 176 for males, with a female to male ratio of 0.96. Conclusion: The frequency of nontraumatic osteoporotic hip fracture among individuals aged over 50 years of Tabriz, is high, although these rates are lower than those reported from Sweden and the Netherlands, and similar to France and Portugal. The age related surge of osteoporotic hip fracture occurs 10 years earlier in our country, and female to male ratio is lower than those of other countries.

Introduction: The extract of the seeds of Nigella sativa (Ns) has been used therapeutically for centuries as a safe herbal medicine, and has been reported to have beneficial effects in the treatment of diabetic osteopenia and bone healing in animal models. In the present study, we examined the effect of Ns seed oil extract on biochemical bone markers in osteopenic postmenopausal women. Materials and Methods: In a placebo controlled clinical trial, 30 osteopenic postmenopausal women, aged 49-72 years, were randomized to either 3-month Ns (oil) treatment (3cc, 0.05 cc/kg/day p.o.) or placebo groups. In all subjects, calcium-D supplements (1 tab per day) were administered during the 3 month study period. At baseline and after 3 months CBC diff, liver and kidney function tests, and serum levels of calcium and phosphate and plasma levels of bone markers (including CTX, Osteocalcin and Bone-ALP) were measured. Results: Twenty-two participants completed the 3 month study period (9 in the Ns group and 13 in the placebo group). Women in the placebo group had relatively higher BMI in comparison with those in the Ns group. Other characteristics and bone markers levels were similar between two groups at the baseline. Plasma levels of bone markers including CTX, Osteocalcin and Bone ALP did not differ significantly between the Ns and placebo groups at the end of the 3 months; neither did changes in bone markers over the course of study show statistically significant differences between the two groups. Conclusion: Although Ns oil was safe, no reports of adverse reactions were observed in this study, we found no beneficial effect of Ns treatment on bone turnover markers. Based on our results, we do not recommend it for the prevention or treatment of bone loss. However this needs to be further investigated in the long-term clinical trials and with larger sample sizes.

Introduction: It has been recognized that adoption of self treatment or self management skills by diabetics is beneficial in treatment/management of their disorder. Self-treatment or self-management is the behavior that a patient follows to relieve his/her health related problems without professional supervision. Materials and Methods: In a qualitative and phenomenology study, adult patients with diabetes mellitus type 2, who were referred to the diabetes clinic in Kashan in 1386, were interviewed with and questioned about their experiences in self treatment; all interviews were recorded and data was analyzed using the Colizzi method. Results: Twenty patients (14 females and 6 males) participated in the study, average age 51 years. The 80 themes extracted from the interviews were clustered in 7 categories. Concealing the disease, such as denial; factors facilitating self treatment, such as treatment costs; factors related to disease such as type and severity of the disease; factors related to the physician, such as trust and availability; and hopeless of consulting the doctor; the restricting inhibitor factors like education, or unsupervised self treatment, such as self medication; self treatment related consequences like delayed recovery or complications. Conclusion: Self treatment is a complex behavior with different presentations that is influenced by so many interrelated factors. Self treatment in diabetes mellitus can have severe consequences, viz. delay in treatment. Patient education and facilitating easier access to treatment can improve the use of such treatments.

Introduction: Hibiscus Sabdariffa is widely cultivated in tropical areas and its red persistent calyx is the major component possessing a sour taste that is used in beverages and food colorants. As a traditional medicine, it is claimed to be effective against kidney stones and urinary bladder stones, and is also used for its antibacterial, antifungal, hypocholesterolemic, antispasmodic and antihypertensive actions. We conducted this study to evaluate the effects of sour tea on blood sugar, lipids and lipoproteins. Materials and Methods: This sequential double-blind randomized controlled clinical trial was conducted on 60 diabetic patients in the Yazd Diabetic Research Center. Patients were assigned randomly into two groups, the sour tea (ST) and the ordinary tea (OT) group. Sachets containing one spoonful of sour or ordinary tea were given to the patients, based on random numbers. They were instructed to consume one glass of boiled water, boiled for 20-30 min, 2 times daily between their meals in the morning and afternoon, for 30 days. Fasting blood samples were taken at the beginning and at the end of the study for measuring blood glucose, hemoglobin A1C, total cholesterol, HDL-C, LDL-C, triglycerides, Apo AI, Apo B100 and Lp(a). Data were analyzed using the SPSS statistical package. Results: A total 60 patients were recruited, 53 of whom completed the study (27 in ST and 26 in OT). Except for Lp(a) and Apo AI, means of all lipids and lipoproteins at the beginning, were significantly decreased or increased (HDL-C) compared with the related means at of the end of the study in the sourtea (ST) group; however, only the mean for HDL-C was significantly increased (approximately 16.7%) at the end of intervention in the ordinary tea (OT) group. The mean for fasting blood glucose at the end of study did not differ significantly with the initial mean in both groups. In contrast, the mean of hemoglobin A1C was significantly decreased in the ST group. Conclusion: The results showed that sour tea has significant effects on blood lipid profiles in diabetic patients; however, it did not have significant effects on blood glucose or hemoglobin A1C. Drinking sour tea can be recommended for diabetic patients.

Introduction: Polycystic ovarian syndrome (PCOS) is the most common cause of an ovulation and hyperandrogenism, and obesity and insulin resistance are usually associated with this disease. Body iron stores are positively associated with glucose intolerance, type 2 diabetes mellitus, gestational diabetes and metabolic syndrome. It is reported that serum ferritin levels increase in obese women with PCOS. The aim of this study was to evaluate this relationship in women, neither overweight nor obese, but suffering from PCOS. Materials and Methods: Fifty women with PCOS, without overweight, were selected based on the Rotterdam workshop criteria. After 12 hours fasting, serum ferritin, fasting blood sugar, cholesterol, triglycerides, HDL and insulin were measured and insulin resistance was calculated by HOMA-IR; data was compared with that of 38 asymptomatic control subjects, matched for BMI and age. Results: In the patient group, mean age was 27±5.78 years and mean BMI was 21.11±3.82 Kg/m2; mean serum ferritin in patients was 60.45±32.39, being 47.48±23.65 ng/mL in controls. Insulin resistance in patients was 2.61±0.91 and 1.74±0.72 in controls. Increases in serum ferritin, insulin and insulin resistance in patients were not statistically significant. There was no correlation between body iron stores and serum insulin level, insulin resistance and serum lipoproteins. Conclusion: Results showed that in nonoverweight women with PCOS there is no significant increment of body iron stores.

Introduction: Overweight and obesity is a rapidly growing health problem in every society. Although different reports on increasing obesity in Iran have been published, no accurate estimate has been reported on the prevalence of obesity among young men. The aim of this study, conducted in a sample population of young Tehranian men, was to determine the frequency of overweight and obesity in this group. Materials and Methods: This cross-sectional study was carried out between the 1st and 20th of Shahrivar 1386. Subjects were 680 young men, randomly selected from among those referring to the health centers for the Pre-Military Service Vaccination Program. Of these, 37 who were sportsmen, were, excluded from the study population. Anthropometric measurements for height, weight, waist and hip circumference of the remaining 643 male subjects, aged 18-25 years old, were obtained their body mass index (BMI) and waist-tohip ratios were also estimated. Following data collection, the frequencies of obesity and overweight for each age group were determined. Results: Mean age was 20.7±1.9, and mean body mass index was 24.1±6.5. The frequency of abnormal body mass index (equal to or more than 25Kg/m2) among the sample population was 32.7% (CI 95%: 29-36.3) of which 23.2% (CI 95%: 19.9- 26.5) were overweight and 9.5% ( CI 95%: 7.2-11.8) were obese; the frequency of central obesity, was 7.2%, based on criteria ³0.9 for waist- to- hip ratio, and 7.5%, based on criteria ³94 cm for waist circumference. Results showed that 70.8% of obese subjects and 29.2% of overweight ones had abdominal obesity (P<0.001). The highest frequency (18.4%) for obese persons was seen around the age of 25 years and that for overweight (41.5%) was seen around the age of 24y. Conclusion: This study reveals that a remarkable percentage of young men in the city of Tehran are either obese or overweight.

Introduction: Congenital hypothyroidism (CH) is the most prevalent preventable cause of mental retardation. Since it is impossible to determine the etiology of CH by biochemical tests per se, imaging modalities of thyroid gland are used to evaluate the morphology and function of this gland and among them radionuclide scanning is currently the gold standard. Considering the limitations of time and accessibility of radioisotope scanning and benefits and faults of ultrasonography in determination of etiology of CH, the aim of this study was to determine the usefulness of sonography as compared to the gold standard imaging method of scintigraphy, in the diagnosis of etiology of primary congenital hypothyroidism in the screening program of Isfahan. Materials and Methods: This study was conducted from May 2002-February 2007. In order to compare ultrasonography to thyroid scintigraphy for etiologic diagnosis of CH, 102 CH newborns examined by both thyroid scintigraphy and ultrasonography were included in this study. The ultrasonographic findings were compared with the standard-of-reference scintigraphic findings and the sensitivity, specificity of the ultrasonography was determined. Results: According to results of the ultrasonography 63, 27, 3 and 9 infants had normal thyroid glands, agenesia, ectopia and hypoplasia respectively and based on scintigraphic results 57, 36 and 9 of them had normal thyroid gland, agenesia and ectopia respectively. Ultrasound detected sensitivity, specificity, positive predictive value, negative predictive value, LR+ and LR- were 86%, 86%, 90%, 90%, 6.1 and 0.16 respectively. The sensitivity and specificity of ultrasonography compared with thyroid scintigraphy in diagnosis of thyroid gland ectopia was 33% and 100% respectively.Conclusion: Although calculated sensitivity and specificity of this method was not equal to those of thyroid radioisotope scanning but had an acceptable range, thyroid ultrasonography is a relatively appropriate imaging tool for diagnosing thyroid dysgenesia. Hence ultrasonography can be used as the first imaging tool for diagnosing CH, especially when the family prefers not to have the infant scanned.

Introduction: Caffeine is a naturally occurring substance that is widely consumed in a variety of forms. The aim of this study was to assess the effect of caffeine on blood pressure in overweight men during exercise and at rest. Materials and Methods: In double-blind randomly designed study, six men (BMI 29.55±1.22 kg/m2, age 22.50±0.83 yr, height 174±9.12cm, weight 89.31±8.85kg, body fat percent 26.38±3.62) with sedentary lifestyles, performed 30 minutes running on treadmill at similar exercise intensities (60% VO2max), 1 hour after taking caffeine (5 mg/kg body weight) or placebo. Heart rate was recorded during exercise, and blood pressure (BP) was measured before and 1 hour after taking caffeine and immediately after exercise, and data analysis was conducted using student' t-test. Result: Results indicated that systolic and diastolic BP and mean arterial pressure significantly elevated following caffeine intake at rest, but no significant differences were observed after exercise; no significant differences were observed between caffeine and placebo in heart rate during exercise. Conclusion: The findings indicate that caffeine at this dosage level alters cardiovascular dynamics by augmenting arterial blood pressure in moderately obese men at rest. However, it seems that taking caffeine before exercise does not cause abnormal elvations in blood pressure in moderately obese men.

Introduction: Many studies have shown uncontrolled brain edema to be the cause of disabilities and deaths following head trauma. Current data also suggests that a single administration of estrogen or progesterone can have neuroprotective effects on brain injury. In this study we investigated the combined effect of estrogen and progesterone on brain edema and neurological outcomes following traumatic brain injury (TBI) in female rats. Materials and Methods: This interventional- experimental study was performed on 8 groups of female rats as follows: 1- control, 2-Sham, 3-Ovarectomized trauma (TBI+OVX); 4-Vehicle; 5-Physiologic dose of estrogen + physiologic dose of progesterone (E1+P1), 6- physiologic dose of estrogen+pharmacologic dose of progesterone (E1+P2); 7-Pharmacologic dose of estrogen+physiologic dose of progesterone (E2+P1); and 8-Pharmacologic dose of estrogen+pharmacologic dose of progesterone (E2+P2). Hormones were injected i.p, half an hour after diffuse traumatic brain injury through marmarou model to 2 week old ovarectomized rats. Brain edema (via brain water content), blood-brain barrier permeability (via extravascular evans blue dye) and neurological outcome (via veterinary coma scale) were measured in this animals. Results: The results showed significance decreases of 2.68% and 2.88% in water content in group 8 compared to the vehicle group and group 6 respectively and a significant decrease of 2.29% in water content in group 5 compared to group 6. Evans blue level showed significant decreases of 14.7% and 21.1% in groups 6 and 7 compared to the vehicle group. Neurological scores showed significant increases of 2.5 and 2 in group 5 compared to the vehicle group and group 3, 1 hour after TBI respectively; a significant increase was seen in all groups compared to group 3 at 4 and 24 hours after TBI. Scores showed a significant increase of 1.2 in groups 7 and 8 compared to the vehicle group at 24 hours following the TBI. Conclusion: Based on these results, it can be concluded that combined administration of estrogen and progesterone have benefical effects on both the reduction of brain edema and the neurological outcomes, the improvement depending on what dose of estrogen is administered with progesterone.

Introduction: It has been reported that apical glycocalyx expression of uterine affects embryo implantation. The aim of this study was to determine endometrial glycocalyx and endometrial thickness after estrogen and progesterone injection in hyperstimulated mice at luteal phase.Materials & Methods: Adult male and female mice were used for induction of pesudopregnancy. The mice were divided into two groups; experimental and control groups. Female mice in the experimental group were superovulated and were then mated with vasectomised mice to induce psudopregnancy; Experimental group based on hormone injection was subdivided into five groups; 1) Estrogen, 2) Progesterone, 3) Estrogen + Progesterone, 4) Antiprogesterone + Estrogen, 5) Sham. Pesudopregnancy in the control group was achieved without any hyperstimulation. The uterines of all groups were collected after 4.5 days of pregnancy and prepared for the assessment of endometrial thickness and endometrial glycocalyx expression. Results: The results showed that estrogen and progesterone injection increased the intensity of PAS reaction, whereas progesterone decreased this. Also our results showed that the endometrial thickness in the sham group was the highest and in the progesterone group was the lowest. Conclusion: Our results showed that addition of estrogen to progesterone, compared to P supplementation alone, provided appropriate endometrial conditions to embryo implantation. Hence combination of estrogen and progesterone injection as luteal support hormones can be used in IVF protocols.

Introduction: Considerable attention is focused on the effects of the electromagnetic field (EMF) due to its wide-ranging use in everyday life. Appliances and various equipments are sources of electromagnetic fields with a wide-range of technical characteristics. In this study we investigated the effect of EMF (50 Hz, 0.5 mT) on fertility and mouse gonads in preimplantation. Materials and Methods: Eighty female mice were divided in to 2 groups; the control group was not exposed to EMF, while the case group was exposed to 4 hours per day, to 50 Hz & 0.5 mT EMF 6 days a week, for 2 weeks. On the 8th day of exposure, female mice in both groups were superovoulated and mated overnight. Next morning females with a vaginal plug were identified as pregnant mice; at the time of implantation, the pregnant mice were sacrificed and blastocysts were subsequently obtained from these mice by flushing the uterus horns. The samples of ovaries in all groups were taken and were processed for light microscopic studies, and the data was compared using t-test (SPSS, considering, and P<0.05), significant. Results: The mean number of pregnant mice decreased in the EMF group (50%) as compared to the control group (67.5%), difference not significant. The mean number of fetuses per pregnancy was 9±4.8 in the control group and 5.5±5.7 in the experimental group, with significant decrease between the means of the 2 groups (P<0.03). The analysis of the size of monolayer primary follicle in the EMF exposed groups did not show significant decrease compared to the control group (12.33±1.53, 12.17±1.79 and P>0.810). Although the total number of follicles, number of monolayer primary follicles and corpus luteum, increased in comparison to control group following there was no significant differences between them. Conclusion: The findings indicated that the EMF, following short periods of exposure, has negative effects on female mice fertility, whereas histological studies showed no changes in ovaries.