مجله غدد درون ریز و متابولیسم ایران
سال دوم شماره 1 (پیاپی 5، بهار 1379)

This study was performed to compare the clinical value of fructosamine and glycosylated hemoglobin for the evaluation of NIDDM. In this study, 100 cases of NIDDM (50 males, 50 females) and 100 control subjects (60 male, 40 female) were selected. Venous blood samples were collected at fasting status to measure fasting blood glucose (FBG), glycosylated hemoglobin, albumin and fructosamine. Significant correlation between FBS with serum levels of glycosylated hemoglobin (r=0.64, P<0.001) and fructosamine (r=0.34, P<0.001) was observed in patients versus control group (r=0.3, P<0.001, and r=0.5, P<0.001, respectively). There was also significant correlation between serum levels of glycosylated hemoglobin and fructosamine (r=0.99, P<0.001). The results of this study demonstrated that fructosamine measurement is an appropriate parameter for evaluation of NIDDM control.

Breast carcinomas with steroidal receptors and good response to hormonal therapy have better prognosis than those without steroid receptors. This study was to evaluate the association between estrogen and progesterone receptors and the age of patients with the type and severity of malignancy in 140 cases with breast carcinoma between 1997 to 1999 in Shiraz University of Medical Sciences affiliated hospitals. Immunocytochemical method on paraffin fixed sections was used for the evaluation in this study. The prevalence of positive esterogen and progestin receptors in cases aged under 50ys (95 subjects) and over 50ys (45 subjects) were (%46, %41) and (%44, %48), respectively. The highest and lowest positivity of receptors were due to lobular carcinoma (%66.7) and medullary carcinoma (%21.4), respectively. The prevalence of streroid receptors had inverse association with higher grades of differentiated ductal carcinoma (114 cases). However, immunocytochemical estrogen and progestin assay in breast cancer is a reliable method to estimate the prognosis and to make decision for hormonal therapy.

To compare the effects of two brands of Simvastatin, Simvastatin (Shahre Daroo) and Zocor (Merck Sharp & Dohme), 20 hyperlipidemic patients (14 women, 6 men) with a mean age of 53.9±9.4 years, being candidates for drug therapy based on National Cholesterol Education Program guidelines and having no contraindications for using “statin”, were randomly assigned to treatment with Simvastatin (11 patients) or Zocor (9 patients), 20 mg to be taken before the evening meal. The mean basal total cholesterol and LDL cholesterol of patients were 326±38 mg/dl and 245±47 mg/dl, respectively. The patients were visited 4 and 8 weeks after treatment to repeat clinical and laboratory exams. There were no significant differences between the treatment groups in the male to female ratio, mean age, mean basal lipid levels and attending follow up. Four weeks after treatment, Simvastatin reduced total cholesterol by 24.9% ± 4.8 (83 ± 54 mg/dl, P<0.001) and Zocor reduced it by 24.9% ± 3.8 (81 ± 38 mg/dl, P<0.001). Almost all of the difference in total cholesterol at 4 weeks was due to the reduction in LDL cholesterol, 34.2% ± 5.5 (85 ± 47 mg/dl, P<0.001) and 32% ± 4.8 (79 ± 39 mg/dl, P<0.001) in the Simvastatin and Zocor groups respectively. Eight weeks after treatment, Simvastatin reduced total cholesterol by 26.8% ± 4.3 (87 ± 39 mg/dl, P<0.01) and Zocor reduced it by 24.4% ± 3.3 (77 ± 28 mg/dl, P<0.01). Almost all of the difference in total cholesterol at 8 weeks was due to the reduction in LDL cholesterol, 34.6% ± 4.3 (82 ± 29 mg/dl, P<0.001) and 27.8% ± 6.5 (65 ± 42 mg/dl, P<0.05) in the Simvastatin and Zocor groups respectively. Changes in HDL cholesterol and triglycerides were not significant after 4 and 8 weeks of treatment in any group. There were no significant differences between the treatment groups in the changes of any lipid levels. This study shows that Simvastatin (Shahre Daroo) produces similar reductions in total cholesterol and LDL cholesterol as Zocor.

To determine the association of serum apolipoprotein (apo) A-I and apo B concentrations, and paraoxonase (PON) high-density lipoprotein (HDL) associated enzyme activity with angiographically determined coronary artery disease (CAD) in Iranian diabetic and nondiabetic CAD patients and nondiabetic control subjects, 251 subjects aged 30-70 years, who underwent their first coronary angiography were matched and randomly assigned into three groups: CAD+DM+, CAD+DM-, and CAD-DM- (control). Stenosis of >= 50% in 1 or more coronary arteries was classified as CAD+. CAD- was defined as a maximum stenosis of 10% in any coronary artery. Fasting serum concentrations of cholesterol (TC), triglycerides (TGs), LDL-C, HDL-C, apo A-I, apo B, and PON activity were determined. Apolipoprotein concentrations were measured in a fasting serum sample by immunoturbidometric assay and paraoxonase/arylesterase activities by spectrophotometric assay of p-nitrophenol/phenol production following addition of paraoxon/phenylacetate. Information concerning nonlipid risk factors were collected by questionnaires. No significant difference was observed in HDL-C, LDL-C, apo A-I, and PON/arylesterase activity between the study groups. The values of TC (213 ± 38 vs 196 ± 45, p<0.05), TGs (209 ± 187 vs 151 ± 113, p<0.005), apo B (99 ± 22 vs 96 ± 24, p<0.0001), TC/HDL-C (4.8 ± 1.5 vs 4.0 ± 1.3, p<0.001), and LDL-C/HDL-C (2.9 ± 1.1 vs 2.4±1.1, p<0.05) were higher and apo A-I / apo B (1.7 ± 0.4 vs 2.0 ± 0.6, p<0.01) was lower in CAD+DM+ patients than in control subjects. In CAD+DM- group, only the level of apo B (96 ± 24 vs 85 ± 18, p<0.01), and the ratio of apo A-I/apo B (1.8 ± 0.4 vs 2.0 ± 0.6, p<0.01), were significantly higher than those of control group. On multiple logistic regression analysis, the best markers for discrimination between CAD+ groups and CAD- control subjects were the ratio of apo A-I/apo B in diabetic and apo B in nondiabetic patients. The results suggest that in Iranian diabetic and nondiabetic patients with CAD the concentration of apolipoproteins are better markers than traditional lipid parameters in discriminating between CAD+ and CAD- subjects. Lack of significant difference in PON activity between CAD+ patients and CAD- controls supports the concept of interethnic variability in PON polymorphism and unimodal distribution of its activity in non-Europid populations observed in other studies.

In the 1995 Natinal Survery for Monitoring IDD Prevention Program in Iran, the levels of urine iodine in Ilam province were the highest among 26 provinces. This study was designed to evaluate the reproducibility and camparison between the rural and urban regions of Ilam in 2000. In a cross sectional study 75 and 61 households aged more than 2yr from rural and urban regions of Ilam were selected by cluster sampling (352 subjects in city, 292 in villages). Urine iodine, sodium and potassium were measured in a random sampling. The salt intake of each household member was calculated. A nonfasting blood sample was drawn to perform thyroid function test. The Food Frequency Questionnaire (FFQ) was filled out for some salted foods in each household. The mean age of study population in the urban and rural regions, were 27.3±19 and 26±19.6 (P>0.05), respectively. Urine iodine and sodium levels in city and villages were 19.1±8.6 vs. 20.6±9 μg/dl (P<0.05) 157±49 vs. 166±47 meq/L (P<0.05), respectively. Mean daily intake of iodized salt (without considering salted foods) was 9±4.3 g in city and 11.6±4.3 in villages. Mean T3 in city and villages were 141±26 vs. 129±25 ng/dl (P<0.001). There was no significant difference between other thyroid function tests in the rural and urban regions. These findings reveal decreased urinary iodine levels in Ilam province in comparison with the results of the study in 1995, however within normal limits. Mean urinary iodine in rural regions was significantly higher than that in urban regions due to higher salt intake in rural regions. There was no significant difference between rural and urban regions except for T3.

To evaluate the role of a single progesterone measurement in prediction of the outcome of pregnancy in women with vaginal bleeding at early gestational period, this prospective, case–control study was performed on 100 pregnant women with vaginal bleeding under 18th gestational week who were referred to Mirza Khoochak Khan Hospital. Serum progesterone was measured in cases and compared with control subjects (53 pregnant women under 18th gestational week who were visited for prenatal care in the same hospital). The study group was divided into 2 groups prospectively including 65 subjects with terminated pregnancy due to abortion (group 1) and 35 subjects with viable gestation. Cases and controls were adjusted for age, the number of deliveries and gestation and the history of abortion. Serum progesterone level in group 1 was significantly lower than that in group 2 (27±9 ng/ml) and control group (34±12 ng/ml) (P<0.05). Cutoff point of 10ng/ml for progesterone level was considered to differ between viable and aborted pregnancy. The sensitivity of %77 and specificity and positive predictive value (PVP) of %100 were calculated for this cutoff point. Therefore, a single progesterone measurement can be applied for women with vaginal bleeding at early pregnancy in order to predict the viability of pregnancy.

Finding a simple clinical method for early and cost-effective diagnosis of osteomyelitis in diabetic patients is of great importance due to high prevalence of diabetic foot infection and the devastating outcome of osteomyelitis. Bone involvement in diabetic foot infection is due to local spread not hematogenous spread. Therefore, bone exposure predisposes bone to osteomyelitis. In this study, diabetic foot ulcers were examined by sterile probe (D/E) to detect exposed bone in the depth of the ulcer and the results were compared with the results of other clinical and paraclinical methods. This study was performed on 35 cases admitted in Imam Khomeini Hospital with a total of 37 pedal ulcers in 1998. Among 37 evaluated ulcers, 17 were positive on probing and 20 were negative on probing. Among 17 positive ulcers, 13 had osteomyelitis. Among 20 ulcers with negative probing, only 5 ulcers had osteomyelitis. The sensitivity, specificity and positive predictive value of bone touch by probing were %78.9, %76.4 and %75, respectively. So, there is strong association between bone touch by probing in the depth of diabetic foot ulcers with the presence of osteomyelitis.