مجله غدد درون ریز و متابولیسم ایران
سال نهم شماره 2 (پیاپی 34، تابستان 1386)

Type 2 Diabetes is fast increasing in adolescents various populations there is a lack of related data in Iranian population. The aim of this study is to determine the prevalence of diabetes, its risk factors (such as family history, obesity, sedentary life, high caloric diet, birth weight, history of GDM in their mothers), associated disease (hypertension, dyslipidemia, obesity) and related complications (proteinuria and retinopathy). This is a cross sectional study of 4480, 3 – 19 year old children from eastern Tehran selected by multiple stratified cluster random sampling this study was done in 3 steps. In the first step, the children were screened by detecting FBS. Then 210 persons with FBS> 100 were selected and GTT (1.75 mg/kg glucose) was done for all of them and in the third step, we measured Anti GAD, ICA, serum insulin levels and C peptide in patients with Impaired Fasting Glucose. Questionnaires for history, physical examination and nutritional status and the results of tests were completed for each one, all the patients were evaluated for retinopathy and nephropathy. Overall, we detected one case of IFG, 6 cases of IGT and 5 cases of DM. Finally, the results were compared with those of 20 age sex matched controls. The prevalence of IFG was 22 in 105 for IGT it was 133 in 105 and 110 in 105 for DM. The prevalence of type 2 diabetes was 45 in 105 in adolescents in this population. Obesity and strong family history of diabetes mellitus was observed in most of them. None of them had complications of DM. In spite of the few cases of type 2 diabetes identified in Iranian adolescents, prevalence of this disease in our population is low. The probability of this disease should be considered in obese children with strong family history of DM. In order to prevent type 2 DM in adolescents appropriate dietary and physical activity interventions are is recommended for the general population.

Stroke is one of the most common causes of mortality and morbidity worldwide. In addition to the effects of some risk factors like old age, hypertension, hyperlipidemia and smoking, the prevalence of this disorder is twice as high in diabetic as compared to nondiabetic patients. The purpose of this survey to detect asymptomatic intracranial stenosis and to determine its risk factors in hypertensive diabetic patients aged over 50 years using Transcranial Doppler Sonography(TCD). Diabetic patients aged over 50 years with hypertension and no previous history of cerebrovascular problems were invited, and initially a questionnaire on demographic information, smoking, history of hyperlipidemia, duration of diabetes and hypertension and physical exams was completed. Then evaluation of peak systolic flow velocity (PSV) in middle cerebral (MCA) internal carotid (ICA) and vertebral arteries (VA) was done by TCD, PSV ≥ 120 cm/sec for MCA and ICA and PSV ≥ 100 cm/sec for VA over 50% stenosis of arterial wall diameter was classified (defined) as significant stenosis,. Student t test, analyze of variance and non parametric tests were used for data analysis. Overall 108 patients with mean age 62.51±7.90 years were studied, of which 22 (20.3%) patients (11male, 11 female) had stenosis and 34 (31.4%) stenotic arteries were also detected 7 out of 22 patients (32%) had multiple stenosis. Mean durations of hypertension in these two groups were 5.36±1/7and 3.07±0.39 years respectively (P = NS), and mean durations of diabetes were 14.09±1/8 and 8.15±0/72 years respectively (P< 0.01). Of 22 (41%), 9 had hyperlipidemia, with 6 of them having multiple involvement, whereas only 1 out of 13 patients without hyperlipidemia had multiple stenosis. (P<0/003). More than 20% of our patients had significant but asymptomatic cerebral artery stenosis 30% of patients had multiple artery Involvement. There was no relation between occurence of stenosis and age, sex or duration of hypertension, but there was a significant relation between prevalence and multiplicity of stenoses and the duration of diabetes and also the presence of hyperlipidemia. Periodic evaluation of cranial vessels hence, in aged diabetic patients with risk factors of atherosclerosis using TCD is recommended.

Vanadyl sulfate (vanadium) has insulin like activity and trophic effects on the pancreatic beta cells of experimental-induced partial diabetic mellitus rats. In this study we investigated the trophic and regenerative effects of vanadium on pancreatic beta cells in conjunction with its insulin like actions in moderate diabetic rats. Moderate diabetic hyperglycemia was induced by IV injection of 40 mg/kg streptozotocin (STZ). Diabetic animals with blood glucose levels (BG) of 500-600 mg/dl were randomly divided into three groups and treated as follows: group I (n=9), remained untreated (diabetic) whereas normoglycemia was induced in group II by daily IP injection of NPH insulin (n=11) and group III (n=10) used fluid containing 1mg/ml vanadium. Blood samples were taken at specified times during the two months of treatment by nicking the tip of the tail to measure BG. Finally the rats were deeply anesthetized and sacrificed for histological evaluation of their pancreas. BG remained high in group I (552±7mg/dl), whereas group II were euglycemic and in group III, vanadium reduced BG level to 320±33mg/dl. Comparison of histological slides obtained from the pancreases of the three groups, with the exception of group III, revealed small and scarce islets of the pancreas, whereas, in group III, vanadium increased the size and the number of these islets looking like of normal rats. Amelioration of hyperglycemia in conjunction with increases in the size and the number of beta cells of group III seems to indicate that vanadium has regenerative and trophic effects on degenerated beta cells of moderate diabetic rats, and therefore, seems to cure diabetes by improving the activity beta cells of diabetic rats when degeneration of beta cells was not complete.

Thyroid nodules are a common clinical problem and Fine Needle Aspiration (FNA) is the principal method used for preoperative diagnosis. This study was designed to evaluate the diagnostic accuracy of FNA for detection of malignancy in thyroid nodules. In this retrospective study, 1016 patients with thyroid nodule were evaluated over a six year period (1999-2005). FNA was done for all of these patients by two expert pathologists. Thyroidectomy was performed on 104 patients and the cytologic and pathologic diagnoses were compared. For evaluation of diagnostic value of FNA, malignant and suspicious diagnoses of FNA were considered as positive cytologic results and the final malignant cases (excluding microscopic carcinoma) as positive pathologic results. In addition, risk of malignancy in thyroid nodules was calcuated based on the cytologic results documented in our patients. There were 884 females and 132 males (f/m: 7:1), with an age range of 9-81 years. The cytological results of 1016 specimens were as follows: 85% benign, 7% suspicious, 0.9% malignant and 7% inadequate. One hundred and four patients underwent surgery, (85 females and 19 males, f/m: 4.5:1), with an age range of 13-56 years. Preoperative cytologic results in this group were as follows: 62.5% benign, 35.5% suspicious and 2% malignant. Final pathologic results were 83.6% benign and 16.3% malignant. FNA sensitivity was 93.8%, specificity 72.7%, diagnostic accuracy 75.9%, positive predictive value 38.4% and negative predictive value 98.4%. False positive rate was 27%, and false negative rate 6%. Among patients with a suspicious cytology who were operated, malignancy in pathologic results was 35% (13 cases of 37 cases). While the incidence of malignancy in thyroid nodules was 3.8% in all patients, this rate was 6% in solitary thyroid nodules and 2% in multinodular goiters. Because of its high sensitivity and low false negative results, FNA seems a reliable method for the diagnosis of cancer in thyroid nodules, a method however that is useful only as an adjunct to clinical judgment and not as a replacement.

Iodine deficiency has been identified as a significant public health problem in Iran. The main strategy for control of iodine deficiency was country wide salt iodination. 10 years after starting this program, goiter is still endemic in some school children. The most important differential diagnosis is autoimmune thyroiditis. The aim of the present study was to evaluate prevalence of autoimmune thyroiditis in school children with normalized iodine intake. 1188 school children, aged 8-13 years, were selected by cluster random sampling to evaluate prevalence of goiter. From a total of 1188, 500 school children were chosen to assess urinary iodine excretion, free T4, free T3, TPO anti body (TPOAb) and TSH. Goiter was endemic in 39.6 %(95% CI 36/3%-41/7%) but majority of them had grade I thyromegaly. Median urinary iodine excretion (18/8 µg/ dl) indicated normal iodine intake. Mean (95%CI) free T4, free T3 and TSH concentration were 13.1(12.8-13.3) pg/ml, 3.7(3.6-3.8)pg/ml and 2.5 (2.2-2.8) IU/ml respectively. TPOAb was positive in 3.7% of children with a higher prevalence in girls(P< 0.001). The prevalence of hypothyroidism and hyperthyroidism was 9% and 0.2% respectively but only 0.8% of school children had TSH>10. There was a significant relationship between detection of positive TPOAb, prevalence of goiter and hypothyroidism however no relation was seen between urinary iodine excretion status and detection of positive TPOAb, hypothyroidism and prevalence of goiter. Despite median urinary iodine excretion being normal, persistence of goiter suggested presence of goiterous factors alhought the autoimmune mechanisms of thyroid may to some extent autoimmune of thyroid explain some part of the goiter prevalence it is however necessary to evaluate other factors.

The province of Kermanshah was one of the regions with endemic goiter in Iran, where following initiation of the program of control of iodine deficiency in 1989, production, distribution and consumption of iodized salt were begun. This survey was conducted within the framework of national monitoring survey in 2001 to ascertain the urinary iodine levels and the prevalence of goiter and in order to evaluate the iodine status of school aged children in Kermanshah. 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Kermanshah, 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. Total goiter rate was 122.9, 22.8% in girls and 123.0% in boys. Median urinary iodine was 18.0 µg/dl. Urinary iodine was above 10 µg/dl in 90.2% and less than 5 µg/dl in 2.2% no one had urinary iodine below 2 µg/dl. UIC levels and goiter prevalence were not statistically different between boys and girls and also between urban and rural areas. It is concluded that the rate of goiter in Kermanshah has decreased significantly since 1996 and urinary iodine levels in schoolchildren are indicative of adequate iodine intake. Kermanshah province therefore, can be considered an “iodine deficiency free” zone.

The main aim of this study was to evaluate the utility of C-reactive protein (CRP) in risk prediction of cardiovascular outcomes. In a nested case-control study, 207 cardiovascular events among participants over 30 years of the Tehran Lipid and Glucose Study (TLGS) were documented during 3 years of follow up. Cases that were free of cardiovascular disease at baseline (126 subjects) were matched to 259 normal controls for age and sex. High sensitivity CRP and traditional cardiovascular risk factors were measured at baseline. Modest correlation was found between CRP and body mass index (r=0.34), waist-to-hip ratio (r=0.22), total cholesterol (r=0.24) and calculated 10-year Framingham coronary risk score (FRS) (r=0.27) (all P values <0.001). The age and sex adjusted relative risk of cardiovascular events for subjects in the highest quartile of the population distribution of CRP when compared with the lowest quartile was 2.6 (95% CI=1.4-5.1, P=0.006). After additional adjustment for traditional cardiovascular risk factors the odds ratio decreased to non-significant levels (0.8,95% CI=0.3-1.9). Addition of CRP did not improve the area under receiver operating characteristic curve of risk functions that was based on traditional cardiovascular risk factors or FRS. It is concluded that for short-term prediction of cardiovascular outcomes in the Iranian population, when traditional cardiovascular risk factors are known measurement of CRP has no additional value.

Studies show that the plaus a role hormone oxytocin in the control of pain, sexual behavior, anxiety and love. The mechanism of this neuropeptide is not completely understood in the CNS. This study aimed at researching the effect of oxytoxin administered in the locus coeruleus (LC) nucleus on pain and its interaction with opioid system, because LC influences the nociception and also contains oxytocin and opioid receptors. Male wistar rats weighing 270±20 grams were used. Animals divided to the in control group, receiving only oxytocin (3nmol/2µl) and the group receiving oxytocin (3nmol/2µl) with naloxone as an opioid receptor antagonist (3nmol/1µl) in LC nucleus. Hot plate and tail flick tests were used for pain response evaluations. Oxytocin injection in locus coeruleus nucleus induced analgesic effect significantly in two analgesiometer tests (p<0.001). Naloxone prevented the analgesic effect of oxytocin significantly (Hot plate p<0.001, Tail flick p<0.05). Oxytocin exerts part of its antinociception effect via LC nucleus and probably by excitation of the opioid system because of the inhibiting effect of naloxone.

Diabetes mellitus is one of the most common metabolic disorders, which is accompanied by debilitating complications in the long term. Considering the therapeutic significance of medicinal plants, this study was conducted to evaluate the effects of i.p. intraperitonead administration of Apium graveolens on the serum glucose, triglyceride, total cholesterol, and HDL- and LDL-cholesterol levels of diabetic rats. Twenty-eight, female Wistar rats were divided into 4 groups, i.e. the control, AG-treated control, the diabetic, and AG-treated diabetic groups. The treatment groups received 200 mg/kg i.p. of the aqueous extract of the plant on alternate days for 4 weeks. Serum glucose, triglyceride, total cholesterol, LDL- and HDL- cholesterol levels were determined before the study, and two and four weeks after the study. Serum glucose levels in diabetic group increased 2 and 4 weeks after the experiment as compared to data obtained one week before the study (P<0.001) AG treatment of diabetic rats did not have any significant effect. In addition, triglyceride levels in the diabetic group increased 4 weeks after the experiment in comparison to related data of one week before the study (P<0.05) and there was a significant lower level of triglyceride in AG-treated diabetic rats (p<0.01). Furthermore, a similar significant reduction was obtained for the treated-diabetic group as compared to the diabetic group regarding serum cholesterol levels (p<0.05). On the other hand, HDL- and LDL- cholesterol levels were significantly higher (p<0.05) and lower (p<0.01) in the AG-treated diabetic group as compared to the untreated diabetic group respectively. Although intraperitoneal administration of the aqueous extract of Apium graveolens has no significant hypoglycemic effect, it could possibly lead to appropriate changes in blood lipid profiles.

Recent evidence indicated that when a stabilized memory is recalled or reactivated, it again becomes labile and initiates a time-dependent process referred to “reconsolidation”. Considering the documented role of stress hormones on emotional memory, the purpose of this study was to compare the effects of glucocorticoids on consolidation and reconsolidation of a fear conditioning memory. Adult male Wistar rats were trained in fear conditioning system. In experiment 1, rats were placed into context and after 180 s were given two 2 s, 0.4 mA shocks with an interval of 120 s. Twenty seconds after the final shock, rats removed from the context box and were injected with different doses of corticosterone or vehicle. In reconsolidation experiments, rats received 2 s, 0.4 mA shocks with an interval of 120 s (moderate memory) or given eight 2 s, 1.5 mA shocks with an interval of 62 s (strong memory). Thirty seconds after the final shock, rats removed from the context box. For reactivation, 24 h later rats were returned to the chamber for 90s. Immediately after reactivation, rats were injected with different doses of corticosterone or vehicle. Twenty-four hours after training or memory reactivation, rats were returned to the context box for 5 min. Seconds of freezing (defined as the absence of all visible movement oxcept respiration) during the retrieval testing were scored for each rat. The findings indicated that injections of corticosterone after training enhanced memory consolidation at dose of 3 mg/kg. Injections of the drug after memory reactivation did not change recall of moderate memory, but impaired recall of strong memory at dose of 3 mg/kg. The data indicate that glucocorticoids have opposite effects on consolidation and reconsolidation of contextual fear conditioning memory. Further studies are needed to determine the underlying mechanisms.

Recent studies have shown that dairy consumption is inversely associated with the metabolic syndrome. Calcium and vitamin D, two major components of dairy products, have been postulated as being primarily responsible for the beneficial effect of dairy consumption. The objective was to examine whether and to what extent intakes of calcium and vitamin D are related to the metabolic syndrome in adults. In this population-based cross sectional study, a representative sample of 808 subjects (male and female) aged 18-74 y were randomly selected. Subjects were categorized based on quartile cut-points of dietary intakes of calcium and vitamin D. Multivariate logistic regression was used in 4 models to compare different dietary intake levels of calcium and vitamin D adjusted for lifestyle and nutritional confounders. Each model was additionally adjusted for more variables than the previous one. After adjusting for age, calories, smoking status, exercise, BMI and parental history of myocardial infarction before age 60 years, dietary calcium levels were significantly and inversely associated with the prevalence of metabolic syndrome, and the ORs of having the metabolic syndrome for increasing quartiles of dietary calcium intake were 1.00 (reference), 0.90 (95% CI 0.61–1.04), 0.85 (0.78–0.99) and 0.74 (0.62–0.95) P for trend <0.02, and was not appreciably altered by additional adjustment for dietary vitamin D intake. Dietary vitamin D was inversely associated with the prevalence of metabolic syndrome but was not independent of total calcium intake. Similar strong relations between intakes of dairy products and metabolic syndrome were also observed and the multivariable OR comparing highest with lowest intake quartiles was 0.81(0.64-0.98), P for trend <0.03. It is concluded that intakes of calcium and dairy products may be associated with a lower prevalence of the metabolic syndrome in adults.

This research aimed determining the levels of cortisol, immunoglobulins and major serum cytokines, following Ramadan fasting, as immune response indexes. For this before and after Ramadan fasting study, twenty-five students residing at the dormitory of the Tehran University of Medical Sciences were selected. All cytokines levels (IL-1α, TGF-β, TNF-α, IFN-α, IFN-γ) were determined by the ELISA method, Immoglobulines were determined by the Radial Immunodiffusion (SRID) technique and cortisol levels were measured by EIA too. While IFN-γ a showed a considerable increase after Ramadan fasting (P<0.01), IFN-α and TNF-α had decreased (P³ 0.5 and <0.02 respectively). Serum level of TGF-β increased but not significantly (P>0.3) cortisol also increased after one month of fasting (P<0.05). Serum IL-1α had a non-significant decrease (P ³ 0.5). Although IgG & IgM levels showed no significant increase, IgA levels showed significant decrease [P<0.5]. Our data revealed that Ramadan fasting increased IFN-y, while decreasing TNF-a and IgA levels ramadan fasting can probably increase T-Cell function, lower the inflammatory appreance rate and affect immunoglubulin production.

In order to assess variations of urinary iodine concentration (UIC) during a 4-week period among pregnant and non-pregnant women in an iodine-replete area. Pregnant and non-pregnant women referred to two maternity hospitals in Tehran were consecutively recruited from September 2005 to March 2006 urine samples (5–10 mL) were collected on an every-other-day basis for 4 weeks (i.e., 12 samples for each individual). UIC was determined using modified Sandell-Kolthoff method. Thirty-six pregnant and 32 non-pregnant women completed the study. Mean±SD age of pregnant women was 27.4±6.4 and that of non-pregnant women was 27.6±4.5 years (p=0.897). Mean±SD gestational age was 11.0±3.3 weeks in pregnant participants. Median UIC of <100, 100-149, 150-249, and ≥250 µg/L was present in 19.4, 25.0, 30.6, and 25.0% of pregnant, 15.6, 37.5, 34.4, and 12.5% of non-pregnant, and 17.6, 30.9, 32.4, and 19.1% of total individuals, respectively. Median UIC values of sample, numbers 1 to 12 were not significantly different either in pregnant (p=0.591) or in non-pregnant subjects (p=0.745), except for sample number 11, median UIC was not significantly different between pregnant versus non-pregnant women (P values > 0.05). Mean SD value for UIC in samples number 1 to 12 in pregnant women was 138.4 (24.1–404), whereas in non-pregnant women this value was118.0 (29.5-272.4) µg/L (p=0.286). There was a wide intrapersonal variation in UIC values among pregnant and non-pregnant women residing in an iodine-replete area, supporting the notion that casual UIC would not reflect iodine status of the individual.