IRANIAN JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2006 | Volume:8 | Issue:1 (SN 29)|Papers Count:13

Introduction: Iodine deficiency was endemic in Fars province since several years. Mandatory production of iodinized salt for household use was started from 1994. The aim of this study was to evaluate the prevalence of goiter, urinary iodine excretion in school children ten years after starting the program. Material & Method: A cross sectional study in which 1188 school children, aged of 8 -13 years, from Marvdasht city were chosen by random cluster sampling for evaluation of goiter prevalence according to WHO classification. Of these this 1188 school children, 500 persons were selected for evaluation of urinary iodine excretion (UIE) by digestion method, difference in UIE was assessed among different age groups, goitrous and non goitrous school children. Result: Following the assessment, goiter was found to be still endemic in school children (39.6%) but majority of them had grade1 goiter. Median urinary iodine (95% CI) excretion levels in boys and girls and total number of school children were 17 mg/dl (13.1-20.9), 22.4 mg/dl (20.4-24.1) and 18.8 mg/dl (16.1-21.5) respectively. Differences in UIE between two sexes were significant (P<0.001) but differences among age groups were not significant. The UIE levels in goitrous and non goitrous school children were 18 mg/dl (16.4-19.9) and 20 mg/dl (17.1-22.9) respectively, with no statistically significant difference. Prevalence's of school children with urinary excretion in normal, above normal and below normal ranges was 29.5%, 47.5%, 23% respectively, meanwhile less than 13% had urinary iodine excretion < 5 mg/dl.Conclusion: We conclude that the iodine intake is sufficient but persistent, albeit, reduced prevalence of goiter in spite of adequate iodine supplementation suggests the existence of additional causes in goiterogenesis. It is necessary to consider the role of other factors in persistence of goiter.

Introduction: The province of Charmahal & Bakhtiari was one of the first regions with endemic goiter in Iran. Following initiation of the program of control of iodine deficiency in 1989, production, distribution and consumption of iodized salt were begun. Goal This survey was conducted within the framework of the 2001 national monitoring survey to find the prevalence of goiter and urinary iodine level in order and to evaluate the iodine status of school aged children in Charmahal & Bakhtiari. Methods 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Charmahal & Bakhtiari, and the grade of goiter, in 600 boys and 600 girls, was determined according to WHO classification. Urinary iodine content was estimated using the digestion method in one tenth of the schoolchildren. Results: Total goiter rate was 18.4%, 15.4% in girls and 21.4% in boys. Median urinary iodine was 17 mg/dl. Urinary iodine was above 10 g/dl in 80.9% and less than 5 mg/dl in 2.5%, no one had urinary iodine below 2 mg/dl. Conclusion: It is concluded that the rate of goiter in Charmahal & Bakhtiari has decreased significantly since 1996 and urinary iodine levels in schoolchildren are indicative of adequate iodine intake. The charmahal & Bakhtiari province therefore can hence be considered a "iodine deficiency free" zone.

Introduction: Several researchers believe that thyroid autoimmunity is more prevalent in patients with hepatitis C than in the general population, however this is still a controversial issue. The aim of the current study was to determine 1) the frequency of thyroid autoantibodies, 2) the frequency of thyroid dysfunction, 3) correlation of thyroid autoantibodies and dysfunction with demographic and clinical variables, in patients with chronic hepatitis C. Materials and Methods: This cross-sectional study was conducted on 250 patients with chronic hepatitis C; patients were selected by simple non sampling from patients referring to the Tehran Hepatitis Center in 2003 and 2004. Demographic data (age, sex, educational level, job) and clinical variables (including risk factors, liver enzymes, liver histopathology, HCV RNAviral load), were obtained. Anti Thyronin (TPO Ab, 124), Anti thyroglobulin (TG Ab, n=117), TSH (n=239), T3 (n=242), T4 (n=245), T3RU (n=134) was tested. Results: TPO Ab and TGAb were seen in 4% and 3.4% respectively. 1.2% had the history of thyroid diorders. 4 subjects had thyrotoxicosis, 1 subject had Hashimoto thyroiditis, 3 subjects had subclinical hyperthyroidisem, and 5 patients had subclinical hypothyroidisem. Positive TPO Ab had a statistical correlation that was marginally significant correlation with cirrhosis, physical symptoms and history of traditional phlebotomy (0.05<p<0.1). Positive TG Ab had statistical correlation that was marginally significant correlation with diabetes and blood transfusion (0.05<p<0.1). Positive TPO Ab or TG Ab was not significantly correlated with thyroid dysfunction. Conclusion: This study reported the relative frequency of thyroid autoantibodies in hepatitis C patients of our country to be 7%, which is in agreement with some previous studies.While this study did report some correlation with antithyroid antibodies and clinical variables in chronic hepatitis C, further studies in this field with a larger sample size is recommended.

Introduction: Medullary Thyroid Carcinoma (MTC) occurs in either sporadic or hereditary forms.The susceptibility gene for hereditary MTC is the RET proto-oncogene. The aim of this study was to evaluate the prevalence of common germline RET mutations in exons 10 and 11 among Iranian MTC patients. Materials and Methods: 57 non-related MTC patients were examined in this survey (F: M=1.2:1.0, 40.0±11.5 years). Genomic DNA was extracted from their peripheral blood samples and exons 10 and 11 of the RET proto-oncogene were amplified using polymerase chain reaction (PCR). The PCR products were then digested by specific restriction enzymes and the Restriction Fragment Length Polymorphism (RFLP) patterns were analyzed for common RET mutations in exons 10 and 11. Results: Only the MEN2Apatient displayed a C634W mutation in exon 11. Three of the six first-degree relatives of the MEN2 Aevaluated patient had the same mutation. Among apparently sporadic MTC patients (53 cases), one patient showed a C620R mutation in exon 10 and two other patients displayed C634Ymutations in exon 11 of the RET proto-oncogene. Neither were the only MEN2 Bpatient nor the two FMTC patients found to carry germline mutations in exons 10 and 11 of the RET proto-oncogene. It seems that the prevalence of germline RET mutations in exons 10 or 11 is prominent (5.7%) among Iranian, apparently sporadic, MTC patients. Conclusion: We conclude that a routine germline mutation analysis of the RET proto-oncogene should be advised for apparently sporadic MTC patients. Hereditary forms of MTC require a more extended investigation for RET mutations.

Introduction: Patients with type 2 diabetes are at high risk for coronary heart disease and have a worse prognosis than patients who do not have diabetes. The high prevalence of cardiovascular disease in those patients is related to risk factors. In this study, we investigated the prevalence of cardiovascular risk factors in newly diagnosed type 2 diabetes patients. Methods: In this Cross sectional study, conducted between 2001-2003, 710 newly diagnosed type 2 diabetic patients, referring to the Isfahan endocrine and metabolism research center, were studied. Patients were evaluated for age, height, weight, smoking, hypertension, Fasting blood glucose, HbA1c, urea, creatinin, plasma lipid and lipoproteins and albuminuria. Results: Mean age was 48.8±9.8 years at presentation, and BMI 28.6±4.5kg/m2. Prevalences of obesity, hypertension, hypertriglyceridemia and hypercholesterolemia were 34.6%, 28.6%, 77.2% and 71.6% respectively. 78.6% of patients had high LDL-C (higher than 100 mg/dl), and 52.9% low HDL-C (lower than 40 mg/dl). 74.2% of patients had more than two cardiovascular risk factors (64.3% of men and 80.9% of women) and 48.1% over three (32.8% of men and 58.5% of women). Conclusion: The prevalence of cardiovascular risk factors is common in newly diagnosed type 2 diabetic patients, demonstrating the importance of early interventions for proper diagnosis and treatment of these factors in such patients.

Introduction: HBV and HCV infections play a vital role in the pathogenesis of DM in patients with hepatitis Band C. The aim of this study is to determine insulin resistance and p cells function in such patients suffering from chronic hepatitis Band C with impaired glucose resistance during a period of 3 years. Materials and Methods: In 560 glucose intolerant patients divided in to three groups (hepatitis B, C and seronegative), participants of the Tehran Lipid and Glucose Study, FBS, HOMA-IR, b cell function were evaluated at initiation and after 3 years of follow up. The results were compared usually the t and paired t test, X2, McNemar and ANOVA, Spearman and Pearson correlation coefficient tests. Results: Participants were 64.9% female and 35.1% male; average age was 50.8±12.7 years at the initial evaluation. Two were HCV positive and eight were HBV positive in the first phase. There were no meaningful differences between the FBS, HOMA-IR and p cell function groups. After three years, six of them had HCV positive serology results and six others had become HBV positive; there was no meaningful difference between their FBS, HOMA-IR and p cell function. Evaluations there were positive in the first assessment, such as Blood glucose changes and p cell function in persons, HCV, HBV had no meaningful statistical change after three years, whereas insulin resistance index showed a meaningful reduction as compared to those from the beginning of study (4±2 to 3.1±2.2 mIU/L, p<0.05). In general, persons that were negative for HBV&HCV in both stages of the study, demonstrated meaningful changes in different degrees of insulin resistance after three years (22.5% of persons sensitive to insulin became resistant and-49.6% became sensitive, P<0.0001). These changes were not observed in seropositive patients.Conclusion: Seronegative patients showed significant reduction in insulin resistance index and p cell function, after 3 years, whereas serapositive ones did not.

Introduction: Nowadays diabetes mellitus is one of the most common chronic diseases, with an increasing incidence and prevalence in Iran and worldwide. Improvement quality of life and health status are important factors for self management behaviors of diabetic patients. These behavior play an important role in prevention of acute and chronic complications of diabetes. This study has been conducted to evaluate correlation between quality of life and disease and demographic variables of diabetic patients. Materials and Methods: In this cross-sectional study participants were selected from diabetes clinics of four general hospitals of medical sciences universities in Tehran using convenience sampling. The demographic and disease characteristics questionnaire and also the short form health survey (SF-36) scale were used for data collection. The data were analyzed using descriptive and inferential statistic tests with SPSS software, windows version.Results: 131 diabetic patients were participated in this study, 60.3% of subjects were female, 39.7% male with an average age of 47.3±12.7 years. The range of mean of quality of life scores in different domains varied from 46.2±13 for general health perceptions to 64.1±26.6 for physical functioning. There was a significant difference between age and physical functioning and role limitations due to emotional problem dimensions. There were significant differences between quality of life different, dimensions scores and variables of sex, educational level, type of diabetes and type of treatment. The statistical tests did not reveal significant correlations between other variables and quality of life different dimensions scores. Conclusion: The findings of this study showed that diabetes decreases the quality of life in diabetic patients. Difference between the results of this study- in comparison with other studies- indicates inversions cultural aspects of these diabetic patients. Cultural factors in the management of diabetes for improvement quality of life of such diabetic patients need to be considered.

Introduction: Hypoglycemia is a medical emergency with severe side effects and also nonspecific symptoms. This survey aims at determining the causes and symptoms of hypoglycemia in patients with low blood glucose admitted to the emergency ward, approaches for prevention in hypoglycemia and decrease of further side effects are proposes. Materials and Methods: All patients with symptoms of hypoglycemia and blood glucose less than 45 mg/dl admitted to the emergency ward, between 2002 and 2003, were included in this survey. Initially a questionnaire on demographic information, coexisting disorders and drug history was completed, physical exam was done and 10 ml venous samples were obtained for CBC, liver and renal function tests. Hormonal assay and 72 hour fasting assessment was done. Results: 89 patients with a mean age of 66.73±14.91 were included; 53% females and 47% males (P= NS). 86.5% were diabetic and 13.5% nondiabetic (P< 0.001). Common causes were: drugs (36.3%), renal failure (23%), sepsis (14.3%) and medical mismanagement (11%). The most common symptoms in diabetic and nondiabetic patients were adrenergic + norglycopenic 50.6% and 58.3%, norglycopenic 46.8% and 41.7%, and adrenergic 2.6% and 0% respectively (P=NS).Conclusion: Drugs were the most common cause of hypoglycemia, although medical mismanagement was also observed in 11% of patients. Education not only for patients but also for medical groups is the basis of prevention. High percentage of patients had norglycopenic symptoms due to long durations of diabetes and old age as an independent risk factor, drugs should hence be used contiously in older patients; also training physicians especially for geriatric groups is recommended.

Introduction: In present study the effect of vitamin E on diabetes induced nephropathy, plasma antioxidant capacity and lipid peroxidation was investigated. Materials and Methods: 24 male wistar rats with average body weight of 250±20 gr were chosen. 16 rats, diabetized by STZ (60 mg/kg B.W, i.p) were divided into 3 groups (n=8) of non-diabetic, diabetic non-treated and diabetic treated with Vit.E (300 mg daily). After 8 weeks all rats were anaesthetized by hydrate chloral. After blood sampling, kidneys were removed and kept in 10% formalin buffer. Plasma and red blood cells of blood samples were separated. Plasma antioxidant capacity by FRAP method, and malondialdehyde (MDA) as lipid peroxidation indicator were measured. Also renal samples were studied for focal cell proliferation and glomerule and tubule structural changes. Results: MDA in non-diabetic, diabetic and diabetic treated with Vit.E rats was 126.14±6.6, 245.2±17 and 170.8±9 nmol/grHb respectively. Significant attenuation of MDA in diabetic treated with Vit. E rats showed decrease of lipid peroxidation in comparison to the diabetic non treated group (P<0.01). Antioxidant capacity in the three groups mentioned was 582.7±23.33, 586.2±23.79 and 808.7±30.82 mmol/lit respectively. Plasma antioxidant capacity in Vit.E treated rats showed significant augmentation comparing to the first two groups (P<0.05). In the non-treated rats, glomerule diffused proliferation, cell diffused inflammation and hyaline changes were seen; arteries walls also shows thickening. These changes were significantly reduction in rats treated with Vit. E. Conclusion: This study showed that Vit. E causes decrease the oxidative effects stress and improve diabetes induced nephropathy.

Introduction: Patients with chronic liver disease (CLD) have an increased prevalence of osteoporosis but it is unclear which patients are at high risk for developing bone disease. The goal of this study was to evaluate the bone mineral density (BMD) among Iranian CLD patients and to compare it with healthy controls. We have also established a mathematical method, which can be used to determine high-risk patients based on clinical findings. Methods: A total of 65 patients (36 male, 29 female; mean age 51.1years) with chronic liver disease were recruited over a 1-year period. BMD measurements were done using dual energy X-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN). Osteoporosis and osteopenia were defined by WHO criteria and BMD of patients was compared with the BMD of 65 ages and sex matched normal individuals as controls. Finally we constructed a mathematical function to identify CLD patients who are at high risk for decreased BMD. Results: The overall prevalences of osteopenia and osteoporosis in both sites were 47/7% and 23/1% respectively. BMDs at LS and FN were significantly lower in CLD patients than BMD in controls (p<0.005 and p<0.05, respectively). BMD at LS and FN among women and BMD at LS among men was significantly lower in patients compared to controls (p<0.005 for all). Increasing age was inversely correlated to BMD of females at LS and BMD of males at FN when the effect of BMI was controlled (r=-0.43 and rs=-0.5, respectively). BMI was also correlated to BMD of females at LS and FN and BMD of males at FN when the effect of age was controlled (r=0.37,r=0.44 and rs=0.4, respectively). At FN, BMD in Women with autoimmune, idiopathic and cholestatic liver disease was lower than BMD in viral hepatitis. Osteoporosis was more frequent in women with ascites and decreased (p<0.05). Longer duration of CLD was correlated with lower BMD in women (p<0.05).Women with Child C liver disease had higher abnormal BMD frequency compared to Child A (p<0.05); in men, no statistically significant correlation was found. Two functions were built based on sex, age, BMI and presence or absence of ascites, which could predict the abnormal BMD with sensitivity and positive predictive values of 85% and 87% respectively, which is significantly better than purely by guessing (p<0.05). Conclusion: Osteoporosis is fairly common in CLD. We could screen high-risk patients by clinical indices as sex, age, BMI and presence of ascites so diagnostic and preventive measures could be instituted earlier in the course of the disease.

Introduction: It seems that the risk of cardiovascular diseases increases adults of the Middle- Eastern region within the normal limits of BMI and WC, as defined for universal application by the WHO. This study was conducted to determine a point of BMI and WC above which the chances of having cardiovascular risk factors increased. Materials and Methods: In this population-based cross-sectional study, a representative sample of 3447 subjects (1781 males and 1666 females) with normal body mass index (BMI = 19-<25 kg/m2 for both genders) and normal waist circumference (WC) «102 cm for men and <88 cm for women) were included. Demographic data was collected; anthropometric indices and blood pressure were measured according to standard protocol. Hypertension was defined based on Joint National Committee VI (JNC VI). Biochemical analysis was conducted on fasting blood samples. Diabetes was defined as fasting plasma glucose (FPG) ³26 mg/dl or 2-hour plasma glucose (2hPG) ³200 mg/dl. Dyslipidemia was considered based on Adult Treatment Panel III (ATPIII).The presence of "at least one risk factor" and "at least two risk factors" of the three major risk factors for cardiovascular disease (hypertension, dyslipidemia, diabetes) were also evaluated. Results: Men had higher WC than women (79.6±6.5vs. 74.7±6.2cm, P<0.001), while their BMls was not statistically different (22.4±1.6vs.22.4±1.6, P=0.224). The prevalence of all metabolic risk factors increased with BMI and WC in both genders; such that those in the highest category of BMI and WC had the highest prevalence of all metabolic abnormalities. Individuals in the highest category of BMI (24 -< 25 kg/m2) had significantly higher odds for being at risk for metabolic risk factors (odds ratios ranging from 1.3 to 1.6 for men and 1.36 to 2.0 for women for different risk factors) compared to those of the first category (19 -< 20 kg/m2). Also, individuals in the highest category of waist circumference (95 -< 102 cm for men and 85-88cm for women) had significantly higher chances for having metabolic abnormalities (odds ratios ranging from 2.6 to 4.5 for men and 2.1 to 2.6 for women for different risk factors) compared to those in the first category (62-<70 cm for men and 60 -< 65 cm for women) in both genders.Conclusion: It is concluded that the cut-points of BMI and WC suggested by WHO are inappropriate for the Tehranian urban population and that the appropriate cut-points of BMI and WC should be lower in this population.

Introduction: There is some evidence about the role of estrogen in the nervous system such, as increasing plasticity in different areas of brain and interference phenomena like reproduction, pain and memory. Results of some investigation indicate the neuromodulatory effect of estrogen. In this study, the effect of estradiol benzoate in morphine dependency was investigated. Material and Methods: Albino mice weighing 25±3 grams, were divided to in to control (sham operation), ovariectomized, ovariectomized receiving sesame oil and acute and chronically administrered estradiol benzoate groups. Addiction was induced in all animals by morphine injections 3 times per day, for four days. On the fourth day, half an hour before induction of withdrawal syndrome naloxone, stradiol benzoate was acutely injected (0.1 mg/kg, SC) and jumping of animals as a sign of withdrawal syndrome was assessed. Chronic treatment of estradiol benzoate was coadministered with morphine on four the day. Results: The results showed that ovarectomy decreased jumping activity of withdrawal syndrome or intensity of morphine-dependency and estradiol benzoate treatment partially increased this sign of the withdrawal syndrome although but it was less than the control groups. Conclusion: The results suggest that the other sex related factors probably influence the intensity of morphine dependency.