IRANIAN JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2000 | Volume:2 | Issue:4 (SN 8)|Papers Count:10

There are many studies about the metabolic effect of vanadium salts on STZ- induced diabetic rats. These studies confirmed the effects of this ultra trace element as a insulin-mimetic agent. Vanadyl sulfate had a positive effect on glycemic control and lipid profile in STZ-diabetic rats, according to McNeill et al & other centers studies. This agent had no adverse effect in any organs. After studies about vanadium salts in human diabetes in Joslin Clinic which declared positive results, we organized our study in NIDDM patients. 45 consecutive series of NIDDM patients groupted into monotherapy (n=35) and combination therapy (n=10) the results showed a significant reduction in BMI only in monotherapy group (27.7±3.6 vs 26.3±3.3), P<0.05 Glycemic control demonstrated 17% decrease in FBS, 2hppG after 6 weeks (P< 0.01). After 3 to 4 months, 27 percent reduction in blood glucose occurred in both groups. Fasting blood glucose (260.9±14.8 mg/dl vs 190.6±13.73) and 2hppG (366.5±21.2 vs 267.3±16.1) decreased (P<0.01). The improvement of HbA1c (1.34%) established long term efficacy of vanadyl sulfate in NIDDM control and potential risk reduction properties (P<0.05). In conclusion, three to four months’ treatment with vanadyl sulfate improves short and long term control of diabetes mellitus.

Diabetic patients need to monitor blood glucose level (BGL) for diagnosis, treatment and follow up of their disease. Typically a blood sample for analysis is obtained via intravenous or a finger stick or other such invasive procedures. Often, this blood collecting causes physical and mental stress to the patient. For this reason, it is desirable to use other biologic liquids such as saliva to detect the blood glucose level. This article studies correlation coefficient between blood glucose level and saliva glucose level (SGL) in healthy men. This is a descriptive, cross sectional study. 130 Blood and 130 saliva samples were obtained from 10 healthy men in 13 times in 5 days. Each day samples were taken in 3 times, fasting, postprandial and evening. Samples were analyzed with glucose oxidase method. Value of blood glucose level ranged from 58mg/dl to 118 mg/dl. Mean of fasting blood glucose level was 84.9±3.13mg/dl. Value of saliva glucose level ranged from 0.322mg/dl to 4.941 mg/dl. Mean of saliva glucose level was 1.22±0.81mg/dl. Correlation coefficient between BGC and SGL from the 5 days of measurement was 0.23. Correlation coefficient for each day was 0.38 (first day), 0.21 (second day), 0.01 (third day) 0.37 (fourth day). Correlation coefficient for each person was 0.31 (case A). (case B), 0.07 (case C), 0.07 (case D), 0.45 (case E), 0.10 (case F), -0.05 (case E), 0.32 (case H), 0.87 (case I), 0.87 (case J). Unfortunately considering the values of correlation coefficients and the limited range of SGL we cannot use saliva for detecting BGL.

Glycated hemoglobin (HbA1C) is known as an indicator of diabetes metabolic control and glycation of proteins. There are some evidences about the role of vitamin C on inhibition of hemoglobin glycation. So, in this study, we evaluated the effect of vitamin C on glycated hemoglobin (HbA1C) level in type 2 diabetic patients. A clinical trial study was conducted on 18 type 2 diabetic patients (14 women, 4 men). We used 1000 mg supplement of vitamin C (4 250 mg) per day for 6 weeks. BMI, 3-day food records, fasting plasma glucose and glycated hemoglobin were measured before and after using vitamin C supplements. The results were analyzed by paired t-test and P<0.05 was considered significant. Glycated hemoglobin was significantly decreased at the end of the study (P<0.015). Fasting plasma sugar increased slightly but it was not statistically significant. Our results show that vitamin C, which has structural similarities with glucose, can reduce the glycosylation of hemoglobin in type 2 diabetic patients through competition with glucose. This effect can be used to control the pathogenic mechanism of protein glycation in diabetes, after more detailed studies.

Thyroid dysfunction during the first year after delivery (postpartum thyroid disease: PPTD) is an immunologic reaction which has been of interest to researchers for many years. This disease includes Graves’ disease, hypothyroidism, and postpartum thyroiditis. Ultrasonographic manifestations have been reported as diffuse or multifocal hypoechogenicity of the thyroid tissue. The purpose of this study was to compare thyroid volume and sonographic manifestations in a group of PPTD patients with controls in Tehran. From 120 mothers with PPTD, 65 agreed to undergo ultrasonography. Ninety-seven healthy mothers were selected after delivery as the control group. Thyroid examination and ultrasongraphy were done monthly from delivery to recovery. Thyroid size and echogenicity were studied. Visible goiter was present in 6.7% of controls and 21.8% of cases (P<0.001). 98.5% of patients had distinct hypoechogenicity, while the figure was only 7% in the control group (P<0.001). Nodules were seen in 8% of patients, but in 1% of the controls. These changes were present in monthly follow-up ultrasonographies until recovery, and their degree was related to the intensity of the disease. Mean thyroid volume of patients at the onset of the disease was 77% more than that of the control group (P<0.005). As the patients recovered, thyroid volume decreased by 25% compared with the onset, but it was still a little more than that of the control group. This study shows the importance of ultrasonography, along with laboratory tests and antibody levels, in confirming thyroid inflammation, course of the disease, and subsequent recurrences.

To evaluate sex hormones profile and sperm quality in hemodialysed and live-related renal transplant patients the plasma levels of sex hormones (FSH, LH, Testoserone, Prolactin) and spermogram in 30 men [mean 38 years (24-52)] who were under hemodialysis for at least 6 months were studies. The same sex hormones and spermogram were determined at six months interval. Control group were 30 healthy men with mean age of 37 years (22-52). Mean prolactin was 16.6ng/ml (3.5-40) (P=0.001), mean FSH 9.6mIU/ml (2.5-20) (P=0.001), mean LH 8.6mIU/ml (2.2-16.5) (P=0.004) in hemodialized patients, while mean testosterone level mean 3.92 (95% CI= 1-9) (P=0.02) was lower in hemodialized patients. In hemodialized group the sperm normal morphology was observed in 55.31% (95% CI= 30-80) (P= 0.002), mean sperm motility was 50.62% (95% CI = 32-70) (P= 0.001) and sperm count was 60.62 mil/ml (95% CI= 40-75) (P= 0.05). The mean prolactin 10.52 ng/ml (95% CI= 2-25) (P= 0.001), mean FSH 7.04nlU/ml (95% CI= 2-12) (P= 0.01) and mean LH 8.75 nlU/ml (95% CI= 1.5-16.5) (P= 0.001) decreased and mean testosterone level 4.5ng/ml (95% CI= 1.7-8.5) (P= 0.005) increased significantly 6 months after transplantation. Sperm motility mean (56.56%) (95% CI= 50-75) (P= 0.006) was significantly improved while other patterns showed moderate improvement. Sex hormone disturbance and spermogram abnormality are common consequences of chronic renal failure. Renal transplantation restores most of these hormone abnormalities, sperm quality and sexual dysfunction.

Obesity, hypertension and hyperlipidemia are risk factors of atherosclerosis, a major cause of mortality. There haven’t been enough epidemiologic studies on these risk factors, especially in rural populations. 2705 residents of Tehran Province villages, including 1296 (48%) men and 1409 (52%) women, all aged more than 30, were selected by multistage random sampling. Cholesterol, triglyceride and HDL were measured in a fasting blood sample and blood pressure, height and weight were determined. Waist to hip ratio (WHR) was used as an index of abdominal obesity. Women had a higher mean BMI (28.2±5.1) compared with men (25.4±3.9) (P<0.001). 24.3% of studied individuals had moderate to severe obesity. Mean diastolic and systolic blood pressures were 72±12 and 122±12mmHg, respectively and were higher in women. Altogether, 11.1% and 22.2% of individuals had diastolic and systolic hypertension, respectively. Mean triglyceride level was 191±151 with no difference between the sexes. Hypertriglyceridemia was present in 32.7% and hypercholesterolemia in 15.4% of individuals. Mean LDL level was higher in women (129±38.6 mg/dl in women vs. 118±35 mg/dl in men, P<0.001). There was no difference in the prevalence of obesity, LDL to HDL and cholesterol to HDL ratios between men and women. All variables except HDL increase with age. This increased continued to the age of 50 in the case of BMI and WHR, and to the 6th decade for lipids. Lipid and blood pressure levels increased with weight. 12.8% of obese individuals and 8.3% of non-obese individuals had diastolic hypertension. The figures for systolic hypertension in these two groups were 23.5% and 20%, respectively. Hypertriglyceridemia and hypercholesterolemia were seen more commonly in obese (42.5% and 16.5%, respectively) than in non-obese individuals (16.5% and 8.6%, respectively). Considering the remarkable increase in triglyceride, cholesterol, weight and blood pressure in studied individuals, it seems that more extensive studies on environmental factors, especially diet and exercise, and finding suitable solutions to prevent risk factors are necessary.

Preliminary studies denote that screening for congenital hypothyroidism (CH) is feasible in Iran due to elimination of iodine deficiency and resulting decreased hyperthyrotropinemia and recall rate. In this article the incidence rate of neonatal hypothyroidism, managerial processing and operational feasibility are discussed. Six general hospitals of Tehran, and one hospital and a delivery center under the coverage of PHC in Damavand district health network were set for cord blood specimen collection on filter paper. Specimen collection and transportation to Endocrine Research Center central lab were performed according to NCCLS and Wisconsin newborn screening program guidelines. TSH values ?20 mU/L were recalled, venous TSH and T4, maternal and neonatal urinary iodine concentration were measured between 7-14 days of life. Hypothyroidism was confirmed by venous TSH more than 10 mU/L and T4 less than 6.5 µg/dl. Hypothyroid newborns underwent thyroid scanning, using 99mTc pertechnetate and radiographic imaging for detection of probable delayed bone age. Thereafter, L-T4 replacement therapy began promptly. 16124 neonates were screened from Feb 20, 1998 to Mar 20, 2001(37 months). 90% of total births were covered. 0.2% of all specimens were unsatisfactory for TSH testing. Recall rate was 1.4%. 17 cases were hypothyroid (Incidence rate was 1: 950 births). Mean and SD for the interval between birth to starting L-T4 treatment was 11± 5 days. Median maternal and neonatal iodine excretion were 18.3 (8-40) and 38.9 (7.8-45) µg/dl, respectively. Among CH newborns, 12, 2, 0, and 3 cases had cord blood TSH values >100, 50-100, 40-50, and 20-40 (mU/L), respectively. There were consanguineous marriages between parents of 11 hypothyroid cases. The screening program for CH is feasible and highly effective in both PHC and non-PHC systems in Tehran and Damavand because of high coverage of total births, minimal rate of unsatisfactory cord blood samples, short interval between birth to starting treatment, and low recall rate. High incidence of neonatal hypothyroidism, which may be due to consanguineous marriages necessitates a national screening program.

Due to high prevalence of bone manifestations in hyperthyroidism and in order to evaluate the contributing role of vitamin D stores in the pathogenesis of the disorder, serum 25-hydroxyvitamin D3 (25-OH-D) and parathormone (PTH) levels were evaluated in 33 hyperthyroid, 17 hypothyroid and 186 normal subjects from Tehran. Mean 25-OH-D levels in hyperthyroid patients (18.3±8.1 ng/ml) were not significantly different from normal subjects (20.±11.4). Mean levels of PTH in hyperthyroid group was not significantly different from normal subjects. In hypothyroid group mean PTH (45±17.9) was significantly higher than hyperthyroid patients (31.6±14) and normal controls (31.3±12.7) (P<0.003). There were no significant correlations between thyroid hormone levels and duration of the disorder with 25-OH-D and PTH levels. It seems that bone manifestations of hyperthyroidism are not solely attributed to vitamin D levels even in areas with moderate to severe vitamin D deficiency.