مجله غدد درون ریز و متابولیسم ایران
سال هشتم شماره 4 (پیاپی 32، زمستان 1385)

The importance of screening for diabetes mellitus is a contruversial issue worldwide, its vitality is obvious when it leads to effective treatment for those identified at screening. This study was performed in Isfahan city to evaluate quality of care and treatment one year after diagnosis, in diabetic patients, newly diagnosed by screening. In this prospective study, 1640 adults were screened for diabetes in the Isfahan endocrine and metabolism research center, 2003-2004. Height, weight, blood pressure, plasma glucose, lipids, and HbA1c of diabetic patients who identified at screening, were measured twice, once, at time of diagnosis and then again one year later. The results of the two measurments were compared. Furthermore quality of care and treatment of patients were evaluated. Eighty-three (5.06%) of 1640 adults, were diagnosed as having diabetes. The prevalences of dyslipidemia and hypertension among diabetic patients were 78.3% and 45% respectively. One year after diagnosis 77.1% of diabetic patients were treated for hyperglycemia, whereas 49.2% of dyslipidemic and 45% of hypertensive patients were treated for dyslipidemia and hypertension respectively. After one year, patients had significant improvements in BMI, plasma glucose, lipids and HbA1c but no improvements were seen in systolic and diastolic blood pressure. Diabetes screening is effective for detection of undiagnosed diabetes and improvement of glucose and control of other cardiovascular risk factors. It seems that quality of care and treatment, especially hypertension management, needs to be improved.

Individuals with IGT are at an increased risk of developing DM type, II and IGT is a known risk-factor for non-communicable diseases also the risk of cardiovascular disease in these patients is increased. The aim of this study was to determine the features of patients with IGT in Tehran and the correlation of IGT with other variables and risk factors of non-communicable disease. This was a descriptive analytical and cross-sectional study. Out of 9204 participants in the first phase of Tehran lipid and glucose study 960 had IGT. At least 8 weeks later, a second OGTT was done and 331 had IGT. DM and IGT diagnosis were based on WHO criteria. In this group, anthropometric indices, BP, serum glucose, and lipid levels were obtained after 12 hours of fasting. Obesity was defined as BMI >30 kg/m2, over weight BMI 25 to 29. 9 Kg/m2. WHR more than 0. 8 in females and 0. 95 in males were defined as truncal obesity, Hypertension was defined as SBp>_140 or DBp>_90mmHg or taking of anti hypertensive drugs. Statistical analyses were performed using the independent T-test, and ANOVA. Totally 331 patients were studied with IGT, 232 of whom (70%) were female and 99(30%) were male. In 43% of cases BMI was ≥ 30. WHR was abnormal in 83. 7%. Total cholesterol level in 32% was ≥ 240 mg/dl and LDL-C in 28.1% was ≥ 130 mg/dl and in 24.8% was ≥ 160 g/dl. HDL-C in 32. 9% of cases was ≤ 35mg/dl. In 43.2% of cases TG was ≥ 200 mg/dl. Assessment of parameters according to BMI showed that means of cholesterol and triglyceride level in obese patients were higher than the rest (p<0. 42, p<0. 001) and mean of HDL-C in obese patients was lower (p<0. 014). ETT performed in 199 patients (14%) was positive. According to the results of the study, patients with IGT have high risk of cardiovascular events because of multiple risk factors such as obesity, hypertension, smoking, hyper lipidemia

Subclinical hyperthyroidism is defined by the suppressed level of TSH and normal values of T4 and T3. The effect of this status on lipid metabolism is not well recognized this study was done to address this issue. Methods and Materials: In this case-control study, 41 patients with subclinical hyperthyroidism and 36 euthyroid subjects were recruited. Subclinical hyperthyroidism was difined as TSH<0. 3 and normal T3 and T4 values, and confirmed with the TRH test. Questionnaires for clinical data and drug history were completed for all patients and blood samples were obtained for laboratory tests. In this study the markers of lipid oxidation, antioxidants, paraoxonase enzyme activity, serum lipid levels, vit A, E and B-carotene were measured and the parameters were analysed using the appropriate statistical methods. There were no significant changes between the two groups regarding age (46±13 vs 47±13, years old), sex (30/11 vs 14/12 male/female), weight (79±14 vs 77±13 kg), body mass index and hypertension. Significantly lower serum TSH (0.16±0.1 vs 1.1±1.0, mIU/L p<0. 001) was found in the subclinically hyperthyroid group. Significantly lower level of paraoxonase enzyme activity, vit A, B caroten, oxidized LDL-C, TAC, total cholesterol, triglyceride, LDL-C and Pon/LDL ratio were found in patients with subclincal hyperthyroidsim as compared with the control group. Significant differences in lipid levels and lipid oxidation and antioxidants seen in these patients show a change in the basal methobolism of this group.

Postprandial lipaemia refers to the acute period of dietary lipid absorption, transport and distiribution, which has been associated with the process of atherosclerosis. There is some evidence that apple cider vinegar and acetic acid could reduce serum lipids in rat and mice, but the effect of vinegar on blood lipids in humans has not been investigated. This study, using a randomized crossover design, was carried out to investigate the effect of apple cider vinegar on postprandial plasma lipids in sixteen healthy adults. On two separate occasions, subjects randomly consumed the fat-rich meal containing 0. 5g fat/Kg body weight, with 15cc diluted apple cider vinegar or water (as control), each time 3 venous blood samples, fasting, 4 and 8 hours after test meal ingestion were taken. Samples were analyzed for plasma triglyceride, cholesterol and HDL-C concentrations and LDL-C was calculated. Area under the curve (AUC) of TG was calculated using the trapezoid rule. Statistical analysis was carried out using repeated measures ANOVA and paired t-test (SPSS version 11). The concentrations of TG was significantly (p<0. 05) increased after both meals but there was no difference between meals for postprandial responses and TG AUC after both meals were similar (820. 75±326. 66 mg/dl. 8h versus 850. 88±385. 66 mg/dl. 8h). Also, vinegar had no effect on the postprandial responses of TC, LDL-C and HDL-C. The present study showed that consumption of a single dose of apple cider vinegar with a fatty meal had no effect on the postprandial lipid response in healthy adults. However, to investigate the chronic effects of vinegar on blood lipids of human subjects, further work is recommended.

Decision making in pathology is changing toward quantitative criteria. Quantitative measurements obviously can demonstrate minimal differences, not readily identifiable to human vision. Morphometry is the quantitative description of geometric characteristics of objects. This study aims at testing the feasibility of this new technique using available instruments and software and selecting useful parameters and their thresholds for discrimination of benign versus malignant lesions of thyroid. The cases were selected based on surgical pathology reports of fine needle aspiration thyroid specimens from the pathology department of Dr. Shariati hospital between October 2003 to March 2004. Patients whose surgical pathologic reports were unavaible were excluded. At least 100 cells, selected by a zone guided manner, were measured for each patient. Totally 67 patients were enrolled for the study, 36 with benign pathology diagnosis and 31 with malignant lesions. In a pilot study to test reproducibility of measurements, a single cell was selected and measured 20 times. Coefficient of variation remained below 2% for all measurements, except for nuclear diameter which has been excluded from analysis. Benign cells were different from malignant ones in mean nuclear perimeter (Peri), mean nuclear area (Area), nuclear area to perimeter ratio (A/P), cluster diameter, mean gray level (in 256 gray levels) and standard deviations of Peri, Area and A/P (P-values < 0. 05) but not in CV of nuclear area, intercellular standard deviation of gray levels, intracellular CV of gray levels and its standard deviation. The receiver Operator Characteristic curve analysis was performed for parameters with significant difference and sensitivities and specificities calculated for different cut-off values. The highest sensitivity was reached for nuclear perimeter, nuclear area, cluster diameter and nuclear area to perimeter ratio equal to 93%.55 and for cluster diameter equal to 89%.55%. The results are comparable to classic cytology practice, and this technique is recommended screening of thyroid FNA specimens.

Intrathoracic goiter (ITG) or substernal goiter (SSG) includes any thyroid enlargement in which over 50% portion of the thyroid permanently located under the thoracic inlet and lower pole of thyroid is not palpable with the neck in hyperextended position. Between Jan 1993 and July 2002, 334 patients underwent thyroidectomy for goiters in Rasht (North of Iran). In this investiagation, initial presentations, surgical managements and complications of 32 patients with substernal goiter have been evaluated retrospectively. There were 20 women and 12 men, with a mean age of 40 years (range 45-67 yrs). Twenty-two patients presented with respiratory symptoms, two had dysphagia, four complained of hoarseness, and five patients were detected incidentally by CXR. Chest X-ray was the first step in diagnosis, and C. T Scan was the best imaging examination for diagnosis. Isotope scanning was helpful only in five patients. Twenty-one patients were operated with the collar incision, seven with collar incision, and in some along with partially sternotomyfour and four patients were operated by median sternotomy. Localization: In 17 patients the goiters were in the right anterior mediastinum and in 14, in the left anterior mediastinum, in one patient goiter was seen in the hilum of the right lung. Pathologic reports were as follows: multinodular goiter in 22 patients papillary cell carcinoma in seven patients anaplastic carcinoma in one patient and lymphoma in one patient. Medullary cell carcinoma in one patient. There was no hospital mortality. Postoperative complications occured in five patients. This study recommends that intrathoracic goiter should be operated early under suitable conditions because of malignant transformation and other hemorrhagic or serious complications.

Hyperhomocysteinemia is a rare autosomal recessive inherited metabolic disorder. The main clinical manifestations of hyperhomocysteinemia include mental retardation, psychological disturbance, thromboembolic events and skeletal abnormalities. The case reported here is of a 28 year-old man admitted in hospital with recurrent seizures. In the brain MRI, areas of venous infarction were seen and MRA revealed thrombosis in brain venous sinuses. Lab investigation showed increases in serum level of homocystein and protein C deficiency. The patient had no family history of genetic disease or cerebrovascular attack. As sinus thrombosis is a multifactorial disease, Protein C deficiency can be one of aggravating causes of thromboembolic events in patients with hyperhomocysteinemia.

In spite of iodine fortification programs, goiter is still hyperendemic in Semirom, a mountainous region in the central part of Iran. This study was conducted to assess whether iron deficiency could be responsible for the high prevalence of goiter in this region. A total of 1828 schoolchildren, aged 7-13 years, were evaluated for presence of goiter, and 220 cases were randomly selected. Urine and serum samples were collected from these children and assayed for urinary iodine concentraton (UIC) and serum ferritin, iron, thyroxine (T4) and thyroid stimulating hormone (TSH) concentrations. In the 1828 children evaluated, 670 cases (36.7%) were goitrous, with goiters of grade 1 or 2. The mean UIC in children was 19.3±9.1 µg/dl. Mild (UIC <10 µg/dl) and moderate (UIC <5 µg/dl) iodine deficiency was detected in 6.4% and 3.2% of cases, respectively. Only 1.8% of children were severly iodine deficient (UIC <2 µg/dl). The median serum ferritin concentration was 26.6 ng/ml (95% CI: 24.2-28.9), and 11 cases (5%) had serum ferritin concentrations less than 20 ng/ml. Goiter rate was 48.3% and 50.3% in children with low and normal serum ferritin levels, respectively (P=NS). It seems that factors other than iodine and iron deficiency may, at least partly, be responsible for the high prevalence of goiter in the area studied. Further investigations for evaluating other micronutrient deficiencies and autoimmunity in goitrous children would contribute to the planning more effective goiter control programs.

Main shortcomings in existing methods for iodine determination in milk samples are non safe alkaline solution, harsh thermal conditions, and their being time consuming. In this study, for determination of total iodine content in milk, a simple and rapid kinetic catalytic colorimetric, acid digestion and rapid microplate reading format method, was investigated. Sample digestion was done on 50L milk in metavanadate/perchloric acid, at 230◦C for 10 min. After digestion, iodine determination was based on famous Sandell – Kolthoff reaction. The reaction results were read in 96 wells microplate by ELISA reader. Work range of the assay was between 2-40µg/dl. The within-run coefficient of variation percent ranged from 6. 7 to 9. 3 and between-run coefficients of variation ranged from 8.6 to 12.3%. The results obtained (n=70) by the optimized method had good correlation with the results of alkaline incineration as the reference method (p<0.000, n=70 r2=0.907 y=0. 952x-0.084). Recovery tests for accuracy assessment were between 91.3 to 113%. This method enabled us to achieve 0.1 µg/dl sensitivity. This study showed that, fast acid digestion, mild thermal, fast results reading and low sample volume, were the main advantages of the acid digestion and microplate reading format investigated.

Many hypo and hyperthyroid patients are anemic. Changes in concentration of thyroid hormones can affect Na+- K+ ATPase number and activity and also phospholipid composition of the cell membranes leading to changes in the surface to volume ratio and strength of membrane. In this study, the osmotic fragility of the red blood cells from non-treated hypo and hyperthyroid patients diagnosed on the basis of clinical examinations and paraclinical data were compared to that of control subjects. Written consent was obtained from all subjects. After washing three times with normal saline, red blood cells were placed in varying sodium chloride (NaCl) concentrations (0-0.9gr%), following which, fragility was assessed with routine colorimetry methods. To do this, after the incubation period, tubes were centrifuged and the optical densities of the tubes was measured. Hemolysis percent in tubes was calculated on the basis of 100% hemolysis in the tubes containing 0 gr% of NaCl. The results indicate that the osmotic fragility of the cells from hyperthyroid patients in 0. 45gr% NaCl (74.6%±30.2) was significantly (p<0.01) lower than control subjects (93.8%±9.1). Osmotic fragility of red blood cells in 0. 5 g percent concentration of sodium chloride in hyperthyroid patients (27.8%±26.0) was significantly less (p<0.001) compared to the controls (63.5%±27.5). It appears that this change cannot be explained by changes observed in red blood cell indices (micrococytosis hypochromia). According to the results of this study one can conclude that anemia reported in hypo- or hyperthyroid patients is not due to high osmotic fragility of the red blood cells and other causes need to be investigated.

The earliest sign of renal involvement is an elevated rate of urinary albumin excretion. One of the strongest predictors of microalbuminuria is the duration of diabetes. However, population-based studies reported albuminuria in newly diagnosed type 2 diabetic patients. The aim of this study was to determine the prevalence and risk factors of albuminuria in type 2 diabetic patients at diagnosis.

In this cross-sectional study,235 (32. 3% male and 67.7% female) newly diagnosed type 2 diabetic patients, from the Isfahan endocrine and metabolism research center were enrolled. The patients were evaluated for age, height, weight, cigarette smoking, blood pressure, glycated hemoglobin, fasting plasma glucose, serum lipid and lipoprotein, triglyceride and albuminuria. Urinary albumin excretion was determined from timed 24-h. Albuminuria were defined as urinary albumin excretion above > 30 mg/24 h. Mean age was 49.2±9.2 year and BMI 28/8±4/9 Kg/m2. The prevalence of albuminuria was 16.6% and more prevalent in males than females. (27.6% being more 11.6% respectively). In albuminuric patients mean of age, BMI, diastolic and systolic blood pressure were higher than in the normoalbuminric individuals, whereas no differences were seen in cholesterol, triglycerides, lipid profiles or smoking between the groups. In a logistic regression analysis, male sex, hypertension and retinopathy, are independent risk factors for albuminuria.

These data suggest that an appreciable percentage of individuals have abnormal albumin excretion within the first year after the onset of type 2 diabetes. These findings suggest that urinary tests for albuminuia at diagnosis and control of risk factors in Type 2 diabetic patients can decrease progression of diabetic neohropathy.

Precise prediction of menarcheal age enables and prepares girls to face the changes they may experience in this period the future. In Iran, there are no available data in this regard yet. This cross-sectional descriptive study was done on 629 girls from 24 provinces of Iran. Relative questionnaires to collect data were filled out with the help of the participant herself and one other family member as well. The stage of maturity regarding telarche and pubarche, percent of body fat were entered based on history taken and physical examinations. For predicting menarche age in cases, the linear regression model was used. In the 454 cases studied, menarche age, mean of age at menarche was 13.18±0.06 years old (158.2± 0.7 months). The means of menarche age in grandmothers and mothers of these 454 cases were 12.9±0.25 and 13.6±0.14 years respectively. Earlier menarche was observed in girls of lower height (p<0.001), girls of lower age at the beginning of study exercise (P=0.019), girls with lesser number of sisters (P=0.007), or those with lesser number of brothers (P=0.003), higher percent of body fat (P=0.037), those with higher body mass index (P=0.002), and those residing in mountainous regions (P=0.001). The regression model showed that the menarcheal age was predictable based on following variables: current height of individual (p<0.001) height of place of residence from sea level (p<0.001) number of brothers (P=0.006) number of sisters (P=0. 008) [P=0. 001, R-square = 0. 99]. Lower height, number of family members and residing in mountainous areas in that order are the most useful predictors of age at menarche. In recent decades, apparently there has been a significant decrease in menarcheal age due to improvement in the quality of nutrition the increasing trend seen today could be due to both weak dietary habits and more sedentary life styles or as a response to increased physical and psychosocial stresses.