مجله غدد درون ریز و متابولیسم ایران
سال یازدهم شماره 5 (پیاپی 47، دی 1388)

The metabolism of Zine (Zn), an essential nutrient, changes in diabetes. It has been shown that there is a relationship between Zn and both, type 1 or insulin-dependent diabetes mellitus (IDDM) and type 2 or non-insulin-dependent diabetes mellitus (NIDDM). Increased lipid peroxidation in diabetic patients leads to MDA production. This study aimed to investigate relationships between serum Zn concentration and insulin, insulin resistance and oxidative stress in postmenopausal diabetic women.

We studied 45 diabetic women and 45 healthy ones (controls) with BMI 25-30 kg/m2 and age 45-60 y. Fasting blood sugar (FBS), serum zinc, insulin, insulin resistance and MDA were determined in both groups.

There were non significant correlations between Zn, insulin (r= -0.06) and insulin resistance (r = -0.027) and MDA (r = -0.09) as well in diabetic group.

There were no significant relationships between serum zinc and insulin, insulin resistance and MDA in postmenopausal diabetic women.

The purpose of this study was to determine the effect of an educational program, based on Health Belief Model (HBM), on control sugar in women with type 2 diabetes.

This perspective, quasi-experimental intervention study was carried out on 88 women with type 2 diabetes. Data was collected using a questionnaire based on the health belief model, a checklist related to patient practices and recording patient HbA1c and FBS levels. All group completed the questionnaire and checklist. Results were documented before and three months after intervention. The patients of the experimental group participated in 4 educational classes during the one month of intervention and again two months after, with 2 sessions as the follow up of the intervention. Data were collected and analyzed.

Our findings indicated that mean scores of HBM Model variables, i.e susceptibility, severity, benefit and barriers perceived, were significantly increased in the experimental group compared to controls after intervention. Also, behavioral walking, rates of HbA1c (before intervention - 9.59%, after three months - 8.63%) and FBS levels (before intervention 184.63, after three months 151.29) improved significantly among the experimental group, compared to controls (p<0/001).

Applying the HBM Model proved is very effective in developing an educational program for diabetics, to control their blood sugar and enhance walking. Besides such programs, follow up education for controlling and monitoring are highly recommended.

Precise control of diabetes mellitus, one of the most prevalent endocrine diseases, is important for prevention of serious vascular complications. Helicobacter pylori (H. pylori) is one of the most common chronic bacterial infections in the world and data reveals that diabetic patients with concomitant H. pylori infection require higher doses of insulin, despite which they have higher levels of HbA1c than their uninfected counterparts. Our study was hence designed to assess the effect of H. pylori eradocatopmon hyperglycemia control in diabetic patients.

Between January and June 2005, patients with type 2 diabetes mellitus and positive urea breath tests, were randomly allocated into two groups, the first treated for H. pylori infection (cases) and the second served as controls. HbA1c and FBS were measured in all patients at initiation of study and three months later.

The study included 19 cases and 22 controls. Mean decrease of HbA1c and FBS in the two groups showed no significant differences.

Study results indicate that treating H. pylori in patients with type 2 diabetes mellitus has no role in short-term control of the disease. In most studies numbers and types of evaluated cases have limitations, and results differ. More extensive studies, using long term randomized clinical trials-term are recommendated.

Vitamin D deficiency is prevalent worldwide. Low 25 hydroxyvitamin D3 concentration is inversely associated with type 2 diabetes, metabolic syndrome, insulin resistance, and probably cardiovascular disease. The objective of this study was to evaluate of association between vitamin D deficiency and cardiovascular risk factors among diabetic patients.

This cross-sectional study, which investigated 119 type 2 diabetes patients, was conducted in Mashhad between December 2007 and March 2008. Coronary, cerebrovascular and peripheral vascular diseases in the subjects were confirmed, and blood biochemical parameters, including laboratory risk markers of cardiovascular disease were determined. Serum 25 (OH) D was measured during winter to determine the correlation between vitamin D deficiency and cardiovascular prevalent and the laboratory variables.

Mean patient age was 55.3±11.2 years. Mean 25 (OH) D concentration was 32.4±21.6 ng/ml. Prevalence of vitamin D level / deficiency D was 26.1% among diabetic patients, difference with control group not being significant (P=0.12). Overall, 36 (30.3%) patients were positive for coronary vascular disease (CVD). The correlation between hypovitaminosis D and CVD was not significant (p=0.11). Patients with vitamin D deficiency had significant differences in body mass index (P=0.003), metabolic syndrome (P=0.05), high sensitive CRP (P=0.009), microalbuminuria (P=0.04), and glumerolar filtration rate (P=0.02) compared with patients with sufficient vitamin D FBS, HbA1c, lipid profiles, homocysteine, uric acid and insulin resistance were not related to vitamin D deficiency.

Results showed an association between hypovitaminous D and coronary risk markers indicating the importance of this vitamin in cardiovascular health.

Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) are the most abundant steroids in human plasma. The aim of this study was to evaluate the relationship between DHEA and DHEA-S and anthropometric indices in women with different grades of obesity.

This cross- sectional study investigated 170 women 35 normal weight (BMI= 18.9-24.9), 33 overweight, (BMI = 25-29.9) as 36 women (BMI= 30-34.9) as obese grade I, 33 (BMI = 35-39.9) as obese grade II and 33 (BMI≥40) as obese grade III. Body mass index was defined as weight in kilograms divided by the square of the height in meters. Serum levels of ehydroepiandrosterone, dehydroepiandrosterone sulfate and glucose were measured by commercially available enzyme immunoassay kits and the glucose oxidase method, respectively.

There was a negative and significant correlation between DHEA and age in the normal (r=-0.457, P=0.006) overweight (r=-0.414, P=0.017) obese I(r=-0.402, P=0.015) obese II(r=-0.391, P=0.024) and obese III (r=-0.354, P=0.043) groups, respectively. Also a negative and significant correlation was found between DHEA-S and age in overweight (r=-0.394, P=0.019), obese grade I (r=-0.455, P=0.005) and obese grade II (r=-0.390, P=0.023) groups respectively. We found a positive and significant correlation between DHEA and frame size in individuals of the Obese I, Obese II and Obese III groups, and also a positive and significant correlation between DHEA-S and frame sizes in individuals of these three groups.

Results showed that serum levels of DHEA decrease with increasing grades of obesity, whereas serum levels of DHEA-S increase with increasing obesity.

Existing data show a rising prevalence of overweight and obesity among Iranian adolescents. Considering the lack of related studies from Iran, the current study investigates personal barriers to life style Modification among overweight/obese adolescents.

This is a qualitative study, conducted according to the grounded theory approach. Participants were 35 school children (19 girls and 16 boys), aged 15-17 years, who were either overweight or obese. To collect data, 5 semi-structured focus group discussions and 10 in-depth interviews were conducted. To obtain views across a range of socioeconomic backgrounds, two demographically diverse areas in Tehran were selected, and in each area, participants were recruited from schools. All interviews and focus group discussions were audio recorded and transcribed verbatim. Data collection and analysis were done simultaneously according to the Strauss and Corbin analysis method.

Based on data analysis, positive perception of conditions, priority of studying, lack of willingness, negative experiences, low self-esteem, and perceived lack of control were the major personal barriers to adolescents’ healthy lifestyles.

Study results demonstrated the main personal barriers for a healthy life style as perceived by adolescents, barriers that any effective interventions require to address for tackling overweight and obesity in adolescents.

This study amis at determining which components of the metabolic syndrome are the best predictors of its development.

In this cohort study, from the participants of the cross sectional phase of the Tehran Lipid and Glucose Study(TLGS), 2279 subjects (aged 20-87) who did not have the metabolic syndrome, based on modified ATP III criteria, and 2310 subjects (aged 20-87) without the metabolic syndrome according to IDF criteria were followed.

After a mean interval of 6.5 years, 462 and 602 new cases of the metabolic syndrome were diagnosed on basis of the modified ATP III and IDF criteria, respectively. The adjusted odds ratio for development of the metabolic syndrome by ATP III criteria was highest for central obesity in men, 2.8 (2.2-3.7) and for triglycerides in women, 2.8 (2.0-4.1). The adjusted odds ratio for development of the metabolic syndrome by IDF criteria was highest for triglycerides in both men and women, OR being: 2.8 (2.2-3.7) and 2.9 (1.9-4.3) respectively. The area under the ROC curves for waist circumference, triglycerides and HDL were the highest. A model that included waist circumference and triglycerides or waist circumference and HDL predicted the metabolic syndrome as well as a model that included all five metabolic syndrome components.

High risk subjects should undergo periodic screening, including measurement of waist circumference, triglycerides and plasma HDL, for timely prediction of development of metabolic syndrome.

Congenital hypothyroidism (CH), the most common congenital endocrine disorder in childhood and one of the causes of mental retardation, may be caused by defects in the enzymatic cascade of thyroid hormone synthesis, called thyroid dyshormonogenesis, of which thyroid peroxidase gene (TPO) mutations are one of the most common causes. The aim of this study was to assess frequency of TPO gene defects in patients with thyroid dyshormonogenesis in Isfahan province.

This was a cross sectional study conducted on 40 patients with permanent congenital hypothyroidism, due to thyroid dyshormonogenesis. Genomic DNA was extracted from the peripheral blood of these patients, using the salting out method. The 17 exonic region of the TPO gene was amplified and mutation screening was performed by single-strand conformational analysis (SSCP) and sequencing.

Results demonstrated one missense mutation in the (G2669A) location of exon 15 in one patient and seven different single nucleotide polymorphisms (SNPs) in exons 1, 7, 8, 11 and 15 of the TPO gene.

Frequency of TPO gene mutation in this study was lower in comparison to other similar studies. It remains possible that in these patients, the disorder was caused by a TPO gene defect in regulatory or intronic regions. In addition, methods besides SSCP analysis and detection of other gene defects in thyroid dyshormonogenesis need to be further investigated in this field.

The purpose of this study was to investigate the effect of active recovery (AR) vs passive recovery (PR) on serum levels of interleukin 6 (IL)-6, IL-8, IL-10 and Creatine Kinase (CK) after eccentric strenuous exercise.

Twenty-eight female students of physical education participated in this study, age (23.8±1.99) years, height 164.03±5.61 cm, weight 58.21 (8.23) kg and fat percent 27.18 (4.86)]. The subjects were randomly divided into two groups and completed a set of strenuous workouts, including a 30 min of treadmill downhill running (-5% grade) at 80-85% of Maximal Heart Rate (MHR), followed by AR for 15 min at 50-60% of MHR, or complete rest in the seated position (PR). Blood samples were collected pre- and post exercise, and after recovery in order to measure the levels of IL-6, IL-8, IL-10 and CK.

Both the AR & PR groups showed increase in the levels of serum cytokines after exercise and recovery, except IL-10 that decreased after exercise. IL-6 levels after recovery were higher in AR. Also, there were significant differences between the two groups after recovery in IL-8 and IL-10.

The results show no significant differences in the levels of IL-6 in either group. It also seems that the post exercise increase in the levels of circulating cytokines is not due to the muscle damage, in spite of the increase in CK indicating that the increase of cytokines after AR is probably because of their anti-inflammatory effects.

The relationship between dyslipidemia and hearing is controversial, especially in children as data are scarce and limited to case reports. We sought to determine whether dyslipidemia is associated with sensorineural hearing loss (SNHL) in a group of 5-18 year old children and adolescents.

Records of all 5 to 18 year old children who attended the pediatric endocrinology clinic of Loghman Hospital in Tehran, Iran, between April 2007 and April 2009, were reviewed. Records with a lipid profile were obtaimed and following confirmation of their lipid profiles, they were enrolled if the results were the same as before (normal or dyslipidemic). Pure tone thresholds, speech discrimination score and lipid profiles were analyzed. Results. When controlled for age and sex, no associations between dyslipidemia and SNHL were found. There was also no statistically significant relationship between dyslipidemia and SNHL in different age groups. Conclusion. No association was found between dyslipidemia and SNHL in children and adolescents aged 5 to 18 years.

The Reverse Cholesterol Transport (RCT) process consists of removing excess cholesterol and phospholipids from peripheral cells to liver to exert as bile. This process consists of removing excess cholesterol by ABCA1 transporter to the Apolipoprotein A-I to form PreBeta HDL, which is then converted to spherical HDL by the action of LCAT enzyme. Previously we have shown that six weeks of endurance training has positive effects on expression of ABCA1. In the present study, we investigate the effect of short term endurance training on ABCA1 expression and other factors in RCT such as Apolipoprotein A-I, Prebeta HDL, LCAT activity and HDL-C concentration.

Twenty-eight male wistar rats were subjected to endurance training treadmill running for 3 weeks, 5 days a week, 90 min with 26 m/min during each training session.

Expression of hepatic ABCA1 was clearly evident following the 3 weeks of endurance training. The concentration of Apo A-I did not change because of endurance training but the results showed significant increases in PreBeta HDL (P=0/01), LCAT activity (P=0/04) and HDL-C concentration (P=0/004).

The results of this study clearly show that 3 weeks of endurance training with moderate intensity can improve the RCT process and has a positive effect in prevention of arteriosclerosis.

Recent data shows that retinoic acid (RA) signaling is required for early pancreatic development in animals, whereas the effects of exogenous All-trans Retinoic Acid (ATRA) on gestation day (GD) 10 in later development have not been well documented.

In this experimental interventional study, female rats, were randomly divided into two groups (experimental and control, n=5 each). Animals in the experimental group received single dose (100 mg /kg) of ATRA orally on GD 10 and fetuses were observed on GD 18.The fetus pancreas (from both the experimental and control groups each n=24) were processed for staining and followed by measuring the accumulation of pancreatic acinus and pancreatic ductile associated with the islets of langerhans. In addition, the mean diameter of pancreatic acinus, acinar cells and related nucleus were measured. Statistical analysis was done by student t-test, P value<0.05 being considered significant.

In the experimental embryos on GD 18, the mean accumulation of pancreatic acinus (23.5%), and pancreatic ductile, associated with the islets of langerhans (76%) per field were increased. There was a significant difference in accumulation of pancreatic acinus (P< 0.0001) and pancreatic ductile, associated with the islets of langerhans (P< 0.0001), between the groups in this regard. The mean diameter of pancreatic acinus and the related nucleus were compared in the two groups, and results showed significant (P< 0.0001) decrease of this parameter in the experimental group.

Results suggest that ATRA may have positive effects on proliferation, differentiation and maturation of pancreatic acinus and pancreatic ductile associated with the islets of langerhans.

Hyperalgesia is recongnized as one of the marked signs of diabetic neuropathy. Considering the hypoglycemic and antioxidant effects of silymarin, this study was designed to investigate the analgesic effect of silymarin in an experimental model of diabetic neuropathy in male rats.

In warm tail immersion test, rats were divided into control, silymarin-treated control, diabetic, silymarin-treated diabetic groups. For the formalin test, sodium salicylate (SS)-treated control and diabetic groups were addded to the previous four groups. For induction of diabetes, streptozotocin (60 mg/Kg, i.p., STZ) was administered as a single dose. The treatment groups(in diabetic group, before induction of diabetes), first received a single dose (200mg/kg i.p) and then a daily dose(100mg/kgi.p) of silymarin for eight weeks.

Results showed that diabetic rats exhibited a higher score of pain during both phases of the formalin test(P=0.03-0.006) and significant decrease in tail flick latency (P<0.02) after eight weeks of diabetic induction in the warm tail immersion test. Treatment with silymarin for eight weeks caused significant decrease in pain scores at both phases of the formalin test(P=0.06-0.0006) and increase in tail flick latency (P=0.03). On the other hand, silymarin caused no significant decrease in pain scores of control rats.

It seems that eight weeks i.p. administration of silymarin could attenuate nociception in an experimental model of diabetic neuropathy, which may be considered as a treatment for painful diabetic neuropathy.

Hypothyroidism is a relatively common disease, and patients are often treated with levothyroxin however when high doses of levothyroxin are needed for its treatment of hypothyroidism, we should carefully consider the reasons. Case report: A 43 year old woman, suffering from uncontrolled hypothyroidism, referred to an endocrine clinic, was treated with 1000 microgram levothyroxin and 150 microgram liothyronin tablets. She admitted to hospital with a likely diagnosis of levothyroxin false malabsorbtion to take the levothyroxin loading test.

Serum T4 was measured at 0, 30, 60,120 and 240 minutes after levothyroxin consumption and showed increases in serum T4 level was 0.9, 1.2, 1.4, 2.3, 2.6 μg/dL respectively. Absorption of T4 was normal in the small bowel, due to false levothyroxin malabsorbtion that had occurred because of irregular drug consumption.

Levothyroxin loading test can differentiate between true and false malabsorbtion. Considering the high prevalence of psychological symptoms, depression in particular, in hypothyroid patients who do not responsd to treatment despite increased the doses of levothyroxin, levothyroxin malabsorbtion needs to be researched, especially the false type and following a definite diagnosis, appropriate treatment can be prescribed.