Prevalence of Goitre in Isfahan, Iran, Fifteen Years After Initiation of Universal Salt Iodization

This cross-sectional study investigated the prevalence of goitre in Isfahan, a centrally-located city in Iran, 15 years after the initiation of universal salt iodization. In total, 2,523 Isfahani adults (1,275 males, 1,248 females) aged >20 years were selected by multi-stage cluster-sampling method. Goitre rate, serum thyroid-stimulating hormone (TSH), thyroxine (T4), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), and urinary iodine concentration (UIC) were measured and compared between the goitrous (n=478) and the non-goitrous (n=2,045) participants. The total goitre rate was 19% (n=478) of the 2,523 adults. The rate of Grade I and II goitre was 12.4% (n=312) and 6.6% (n=166) respectively. The total goitre rate, Grade I and II goitre were more prevalent among women than among men. Hypothyroidism was observed in 6.4% (130/2,045) and 18.6% (89/478) of the non-goitrous and goitrous participants respectively [odds ratio (OR)=3.6, 95% confidence interval (CI) 2.7-4.9, p=0.001]. Hyperthyroidism was present in 0.8% (17/2,045) and 5.2% (29/478) of the non-goitrous and goitrous adults respectively (OR=9.0, 95% CI 4.9-16.6, p=0.001). Hypothyroidism was more prevalent in Grade II than in Grade I goitre and among those without goitre (31.3%, 14.1%, and 6.4% respectively) (p=0.001). Positive TPOAb was observed in 24% (n=50) of the non-goitrous and 33.5% (n=84) of the goitrous subjects (p=0.03). Positive TPOAb was observed in 24.6% (35 of 142) of the Grade I and 45% (49 of 109) of the Grade II goitrous adults (p=0.001). Positive TgAb was observed in 21.6% (n=45) of the non-goitrous and 35.9% (n=90) of the goitrous adults (p=0.001). Positive TgAb was observed in 30.3% (43 of 142) of the Grade I and 43.1% (47 of 109) of the Grade II goitrous adults (p=0.04). The median UIC was 18 μg/dL (range 1-80 μg/dL). It was 17.9 μg/dL and 19 μg/dL in the non-goitrous and goitrous adults respectively. After 15 years of successful universal salt iodization in Isfahan, goitre is still endemic, which may be due to thyroid autoimmunity. However, other environmental or genetic factors may have a role

Hypertension in Non-Type 2 Diabetes in Isfahan, Iran: Incidence and Risk Factors

Objective. To estimate the incidence of and risk factors for the development of hypertension (HTN) in people with T1D using routinely collected data. Method. The mean 16-year incidence of HTN was measured among 1,167 (557 men and 610 women) nonhypertensive patients with T1D from Isfahan Endocrine and Metabolism Research Center outpatient clinics, Iran. HTN was defined as a systolic blood pressure (BP) of 140 mm Hg or higher and/or a diastolic BP 90 mm Hg or higher and/or use of antihypertensive medications. The mean (standard deviation [SD]) age of participants was 20.6 years (10.5 years) with a mean (SD) duration of diabetes of 3.6 years (4.8 years) at registration. Results. The prevalence of HTN at baseline was 9.7% (95% CI: 8.2, 11.5). Among the 1,167 patients free of HTN at registration who attended the clinic at least twice in the period 1992–2016, the incidence of HTN was 9.6 (8.0 women and 11.3 men) per 1000 person-years based on 18,870 person-years of follow-up. Multivariate analyses showed that male gender, older age, higher triglyceride, and higher systolic BP were significantly and independently associated with the development of HTN in this population. Conclusion. These findings will help the identification of those patients with T1D at particular risk of HTN and strongly support the case for vigorous control of BP in patients with T1D

Cross-sectional and longitudinal assessments of risk factors associated with hypertension and moderately increased albuminuria comorbidity in patients with type 2 diabetes: a 9-year open cohort study.

Background: Moderately increased albuminuria (MIA) is strongly associated with hypertension (HTN) in patients with type 2 diabetic mellitus (T2DM). However, the association between risk factors and coexisting HTN and MIA remains unassessed. Objectives: This study aimed to determine both cross-sectional and longitudinal associations of risk factors with HTN and MIA comorbidity in patients with T2DM. Methods: A total of 1,600 patients with T2DM were examined at baseline and longitudinal data were obtained from 1,337 T2DM patients with at least 2 follow-up visits to assess the presence of HTN alone (yes/no), MIA alone (yes/no) and the coexistence of both (yes/no) in a 9-year open cohort study between 2004 and 2013. Bivariate mixed-effects logistic regression with a Bayesian approach was employed to evaluate associations of risk factors with HTN and MIA‎ comorbidity in the longitudinal assessment. Results: After adjustment for age and BMI, patients with uncontrolled plasma glucose, as a combined index of the glucose profile, were more likely to have HTN [odds ratio (OR): 1.73 with 95% Bayesian credible intervals (BCI) 1.29-2.20] and MIA [OR: 1.34 (‎95% BCI 1.13-1.62)]. The risks of having HTN and MIA were increased by a one-year raise in diabetes duration [with 0.89 (95% BCI 0.84-0.96) and 0.81 (95% BCI 0.73-0.92) ORs, respectively] and a one-unit increase in non-high-density lipoprotein-cholesterol (Non-HDL-C) [with 1.30 (95% BCI 1.23-1.34) and 1.24 (95% BCI 1.14-1.33) ORs, respectively]. Conclusions: T2DM patients with HTN,‎ MIA, and the coexistence of both had uncontrolled plasma glucose, significantly higher Non-HDL-C, and shorter diabetes duration than the other T2DM patients. Duration of diabetes and uncontrolled plasma glucose index showed the stronger effects on HTN and MIA comorbidity than on each condition separately

Prevalence of goitre in Isfahan, Iran, fifteen years after initiation of universal salt iodization

This cross-sectional study investigated the prevalence of goitre in Isfahan, a centrally-located city in Iran, 15 years after the initiation of universal salt iodization. In total, 2,523 Isfahani adults (1,275 males, 1,248 females) aged >20 years were selected by multi-stage cluster-sampling method. Goitre rate, serum thyroid-stimulating hormone (TSH), thyroxine (T4), thyroid peroxidase antibody (TPOAb), thyroglobulin anti-body (TgAb), and urinary iodine concentration (UIC) were measured and compared between the goitrous (n=478) and the non-goitrous (n=2,045) participants. The total goitre rate was 19% (n=478) of the 2,523 adults. The rate of Grade I and II goitre was 12.4% (n=312) and 6.6% (n=166) respectively. The total goitre rate, Grade I and II goitre were more prevalent among women than among men. Hypothyroidism was observed in 6.4% (130/2,045) and 18.6% (89/478) of the non-goitrous and goitrous participants respec-tively [odds ratio (OR)=3.6, 95% confidence interval (CI) 2.7-4.9, p=0.001]. Hyperthyroidism was present in 0.8% (17/2,045) and 5.2% (29/478) of the non-goitrous and goitrous adults respectively (OR=9.0, 95% CI 4.9-16.6, p=0.001). Hypothyroidism was more prevalent in Grade II than in Grade I goitre and among those without goitre (31.3%, 14.1%, and 6.4% respectively) (p=0.001). Positive TPOAb was observed in 24% (n=50) of the non-goitrous and 33.5% (n=84) of the goitrous subjects (p=0.03). Positive TPOAb was observed in 24.6% (35 of 142) of the Grade I and 45% (49 of 109) of the Grade II goitrous adults (p=0.001). Positive TgAb was observed in 21.6% (n=45) of the non-goitrous and 35.9% (n=90) of the goitrous adults (p=0.001). Positive TgAb was observed in 30.3% (43 of 142) of the Grade I and 43.1% (47 of 109) of the Grade II goitrous adults (p=0.04). The median UIC was 18 \u3bcg/dL (range 1-80 \u3bcg/dL). It was 17.9 \u3bcg/dL and 19 \u3bcg/dL in the non-goitrous and goitrous adults respectively. After 15 years of successful universal salt iodization in Isfahan, goitre is still endemic, which may be due to thyroid autoimmunity. However, other environmental or genetic factors may have a role

Wpływ witaminy D na insulinooporność u pensjonariuszy domu opieki: kliniczne badanie eksperymentalne

Introduction: Insulin resistance is defined as reduction of insulin-stimulated glucose uptake in skeletal muscles and inadequate suppression of the production of endogenous glucose. The aim of this study was to assess the effect of vitamin D intake on insulin resistance in aged patients. Materials and methods: This interventional study was carried out on residents of Sadeghieh Nursing Home in Iran. The participants were healthy adults aged &ge; 65. For eight weeks, the participants took pills containing 50,000 IU vitamin D3 per week. Insulin resistance was defined as homeostasis model assessment of insulin resistance (HOMA-IR) > 2.5. We used McNemar&#8217;s test, Wilcoxon test, chi-square, and Pearson correlation coefficient and SPSS software (v. 12) to analyse the collected data. Results: The average age of the 76 participants was 78.7 &#177; 8 years and 52 of the participants were female. Before and after the study, 37 and four participants had vitamin D deficiency, respectively (p < 0.001). Impaired fasting plasma glucose (FPG) and insulin resistance was not more prevalent in the participants with vitamin D deficiency. In this study, vitamin D intake had no significant effect on FPG level (p = 0.9), but it increased the prevalence of insulin resistance significantly (p < 0.001). Conclusions: In our study, before and after the intervention, vitamin D deficiency had no relationship with FPG level and insulin resistance. Vitamin D intake had no significant effect on FPG level, but it increased the prevalence of insulin resistance significantly. We believe that performing more studies, with a longer timespan and larger sample size, as double-blind clinical trials, is necessary.Wstęp: Insulinooporność określa się jako zmniejszony insulinozależny wychwyt glukozy w mięśniach szkieletowych i niedostateczną supresję endogennej produkcji glukozy. Celem niniejszego badania była ocena wpływu stosowania witaminy D na insulinooporność u osób w podeszłym wieku. Materiał i metody: To kliniczne badanie eksperymentalne przeprowadzono u osób przebywających w placówce opiekuńczo-leczniczej Sadeghieh Nursing Home w Iranie. Uczestnicy byli zdrowymi osobami dorosłymi w wieku &ge; 65 lat. Przez 8 tygodni podawano im witaminę D3 w kapsułkach w dawce 50 000 jm./tydzień. Insulinooporność definiowano jako wskaźnik HOMA-IR > 2,5. W ramach analizy statystycznej danych przeprowadzono testy McNemara, Wilcoxona, &chi;2 i określono współczynnik korelacji Pearsona, używając programu SPSS (wersja 12). Wyniki: Średni wiek 76 uczestników badania (52 kobiety) wynosił 78,7 &#177; 8 lat. Niedobór witaminy D przed badaniem stwierdzono u 37 osób, a w trakcie badania &#8212; u 4 osób (p < 0,001). Nieprawidłowa glikemia na czczo (FPG, fasting plasma glucose) i insulinooporność nie występowały częściej u uczestników badania z niedoborem witaminy D. W niniejszym badaniu przyjmowanie witaminy D nie wpływało istotnie na FPG (p = 0,9), jednak powodowało istotne zwiększenie częstości insulinooporności (p < 0,001). Wnioski: W niniejszym badaniu nie wykazano zależności między niedoborem witaminy D przed i w trakcie badania a FPG i insulinoopornością. Suplementacja witaminy D nie wpłynęła istotnie na wartości FPG, jednak spowodowała zwiększenie częstości insulinooporności. Zdaniem autorów konieczne jest przeprowadzenie kolejnych badań metodą podwójnie ślepej próby, o dłuższym okresie obserwacji i o większej liczebności próby

Prevalence of Vitamin D Deficiency among Adult Population of Isfahan City, Iran

Determination of vitamin D status in different age-groups in a community and in different climates of a country is necessary and has important implications for general health. The study was conducted to determine the prevalence of vitamin D deficiency among the adult population of Isfahan, a centrally-located city in Iran. In this cross-sectional study, 1,111 healthy people—243 men and 868 women—aged 41.4 (mean 14 and range 20-80) years, who attended a single-consultation outpatient clinic, were selected. Serum 25-hydroxy vitamin D (25-OHD), parathyroid hormone (PTH), calcium and phosphorus concentrations were measured. Mild, moderate and severe vitamin D deficiencies were defined as 25-OHD values of 20-30 ng/mL, 10-20 ng/mL, and <10 ng/mL respectively. The median (range) concentrations of 25-OHD were 21 (4.0-105.0) ng/mL in males and 18 (1.5-117) ng/mL in females (p=0.05). The prevalence of mild, moderate and severe vitamin D deficiencies among the adult population was 19.6%, 23.9%, and 26.9% respectively. Vitamin D deficiency was more prevalent among women (p=0.001) and younger age-group (p=0.001). Medians of 25-OHD in spring-summer and autumn-winter were 21 ng/mL and 18 ng/mL respectively (p=0.005). The prevalence of severe vitamin D deficiency was higher in autumn-winter than in spring-summer (odds ratio=1.6, 95% confidence interval 1.2-2.2, p=0.001). The prevalence of vitamin D deficiency was high in a sunny city—Isfahan— especially among women and younger population. The high prevalence of vitamin D deficiency in this city emphasizes the necessity of vitamin D supplementation as more exposure to sun is limited due to the type of clothing required by current law

Cardiovascular risk factors in relatives of type 2 diabetics with normal glucose tolerance test and elevated one-hour plasma glucose

Introduction: To investigate the effect of elevated one hour post-load plasma glucose on cardiovascular risk factors, in normal glucose tolerance (NGT) people, who are first degree relatives of type 2 diabetics. Material and methods: A cross-sectional study on 1475 NGT subjects (Arian ethnicity), who had one hour post-load plasma glucose was carried out. We compared the mean of age, sex, body mass index, waist circumference, blood pressure, lipid profile, and area under the curve of glucose (AUC-G) of 1190 out of 1475 NGT subjects with one hour plasma glucose (1hpG) &#8805; 155 mg/dL, and 285 NGT subjects with 1hpG < 155 mg/dL. Results: The mean age, body mass index, waist circumference, blood pressure, lipid profile (but not low HDL-cholesterol), and area under the curve of glucose (AUC-G) was significantly higher in NGT subjects with 1hpG &#8805; 155 mg/dL (P < 0.05). Normal glucose tolerance people (first degree relatives of type 2 diabetic patients) with 1hpG &#8805; 155 mg/dL were older and heavier than those with 1hpG < 155 mg/dL. Cardiovascular risk factors (but not low HDL and hypertension) were more prevalent in those with elevated one hour post-load group (P < 0.05). Conclusions: NGT subjects with elevated one hour post-load plasma glucose (1hpG &#8805; 155 mg/dL) had higher prevalence of most cardiovascular risk factors in comparison with those with 1hpG < 155 mg/dL. (Pol J Endocrinol 2010; 61 (4): 359-363)Wstęp: Celem badania była ocena wpływu podwyższonej glikemii w pierwszej godzinie po obciążeniu glukozą na czynniki ryzyka sercowo- naczyniowego u osób z prawidłową tolerancją glukozy (NGT, normal glucose tolerance) będących krewnymi pierwszego stopnia chorych na cukrzycę typu 2. Materiał i metody: Badanie wieloośrodkowe objęło 1475 osób z prawidłową tolerancją glikemii (etniczni Arianie), u których oznaczono stężenie glukozy w osoczu w godzinę po doustnym obciążeniu glukozą. Wszystkich chorych podzielono na dwie grupy w zależności od wartości glikemii: 1190, u których glikemia 1 godzinę po obciążeniu glukozą wynosiła &#8805; 155 mg/dl i 285 osób < 155 mg/dl. W obu grupach porównano średnie wartości następujących parametrów: wieku, płci, wskaźnika masy ciała, obwodu talii, ciśnienia tętniczego, profilu lipidowego i pola pod krzywą stężenia glukozy. Wyniki: U osób z prawidłową tolerancją glikemii (będących krewnymi pierwszego stopnia chorych na cukrzycę typu 2), u których glikemia na czczo w godzinę po doustnym obciążeniu glukozą wynosiła &#8805; 155 mg/dl (p < 0,05) stwierdzono istotnie wyższe wartości następujących parametrów: średni wiek, wskaźnik masy ciała, obwód talii, ciśnienie tętnicze, stężenia lipidów (z wyjątkiem cholesterolu frakcji HDL) i pola pod krzywą stężenia glukozy. Osoby, u których glikemia w godzinę po obciążeniu glukozą wynosiła &#8805; 155 mg/dl były starsze i cięższe niż osoby z niższym poposiłkowym stężeniem glukozy (< 155 mg/dl). Czynniki ryzyka sercowo-naczyniowego (z wyjątkiem niskiego stężenia cholesterolu frakcji HDL i nadciśnienia tętniczego) występowały częściej u osób z wyższymi wartościami glikemii w godzinę po obciążeniu glukozą (p < 0,05). Wnioski: U osób z prawidłową tolerancją glukozy i wyższymi wartościami glikemii w godzinę po obciążeniu glukozą (&#8805; 155 mg/dl) stwierdzono częstsze występowanie czynników ryzyka chorób sercowo-naczyniowego niż u osób, u których glikemia w godzinę po obciążeniu glukozą wynosiła < 155 mg/dl. (Endokrynol Pol 2010; 61 (4): 359-363

Left Ventricular Pseudoaneurysm as a Complication of Myocardial Infarction; A Case Series and Review of the Literature

Introduction: Pseudoaneurysm may occur as a rare complication of myocardial infarction (MI) when a hemorrhagic process is covered by adherence of the visceral or parietal pericardium or of both, preventing the formation of cardiac tamponade. Pseudoaneurysm is prone to rupture because they are not easy to diagnose.&nbsp;Case presentation: Here, we report three cases of left ventricular pseudo-aneurysm (LVP) that all were related to MI. Two patients were managed conservatively, one of them was lost to follow-up, and the other one expired one month later. One patient underwent surgery, but he expired during post-operation period.&nbsp;Conclusions: High mortality rate of LVP emphasizes the importance of looking for it in cardiac evaluation of patients with history of MI. Due to available non-invasive modalities, the ability to differentiate LVP from other cardiac pathologies is improving. Still, the most recommended management of LVP is early surgery

Alendronate improves fasting plasma glucose and insulin sensitivity and decreases insulin resistance in prediabetic osteopenic postmenopausal women: a randomized triple-blind clinical trial

Aims Postmenopausal women receive bisphosphonates for osteoporosis treatment. The effect of these medications on developing diabetes mellitus (DM) in prediabetic patients is yet to be investigated. We aimed to determine the effect of alendronate on plasma glucose, insulin indices of postmenopausal women with prediabetes and osteopenia. Methods This triple‐blind randomized controlled clinical trial included 60 postmenopausal women, aged 45–60 years. All patients were vitamin D sufficient. They were randomly enrolled in intervention (70 mg/week alendronate for 12 week) and control (placebo tablet per week for 12 weeks) groups. The morning 8 hour fasting blood samples were collected at the baseline and follow–up visits to measure the fasting plasma glucose (FPG) (mg/dl), insulin and hemoglobin A1c (HbA1c). Plasma glucose and insulin concentration were measured 30, 60, and 120 minutes after glucose tolerance test. Matsuda index, homeostasis model assessment of insulin resistance (HOMA–IR), homeostasis model assessment of beta–cell function (HOMA–B) and the area under the curves (AUC) of glucose and insulin were calculated. Results Mean (SD) FPG (102.43 (1.46) mg/dl vs. 94.23)1.17) mg/dl, P=0.001), 120‐minutes insulin concentration (101.86)15.70) mU/l vs. 72.60 (11.36), P=0.026), HbA1c (5.60 (0.06) % vs. 5.40 (0.05)%, P=0.001), HOMA‐IR (3.57 (0.45) vs. 2.62 (0.24), P=0.021) and Matsuda index (7.7 (0.41) vs. 9.2 (0.4), P=0.001) significantly improved in the alendronate‐treated group. There was statistically significant more reductions in FPG (‐8.2 (8.63) mg/dl vs. ‐2.5 (14.26) mg/dl, P=0.002) and HbA1c (‐0.2 (0.23) % vs. ‐0.09 (0.26) %, P=0.015) were observed in alendronate‐treated group than placebo group during the study course, respectively. Conclusions Administration of 70 mg/week alendronate improves fasting plasma glucose, HbA1c and insulin indices in postmenopausal women

Sonographic and functional characteristics of thyroid nodules in a population of adult people in Isfahan

Wstęp: Celem badania była ocena cech sonograficznych zmian ogniskowych tarczycy u mieszkańców Isfahanu, obszaru w cenralnym Iranie, który wcześniej charakteryzował się niedoborem jodu. Materiał i metody: W przekrojowym badaniu przeprowadzonym w 2006 roku wybrano próbę liczącą 2523 dorosłych osób (wiek > 20 lat) metodą wielostopniowego losowania grupowego. Spośród tej grupy, 263 ochotników poddano badaniom sonograficznym. Badanie tarczycy przeprowadzili doświadczeni specjaliści w zakresie ultrasonografii. Ponadto oznaczono stężenia T3, T4, T3RU, TSH, TPO Ab i Tg Ab w surowicy oraz wydalanie jodu z moczem. Wyniki: Kobiety stanowiły 46% grupy poddanej badaniom sonograficznym (n = 263). Średnia wieku wynosiła 35,5 lat (zakres 20-64 lat). Mediana stężenia jodu w moczu wynosiła 19.4 &#956;g/dl. Obecność zmian ogniskowych tarczycy wykazano w badaniu sonograficznym u 22,4% osób z badanej grupy; u 30% kobiet i 16,3% mężczyzn (OR = 2,2; p = 0,01). Częstość występowania zmian ogniskowych tarczycy zwiększała się z wiekiem (p = 0,006). Zmiany ogniskowe tarczycy występowały częściej u osób z niedoczynnością tarczycy niż w grupie z eutyreozą (35,1% v. 20,5%, OR = 2,1; p = 0,04). Nie stwierdzono korelacji między stężeniem jodu w moczu ani stężeniem autoprzeciwciał a występowaniem zmian ogniskowych tarczycy w badaniu sonograficznym. Wnioski: Częstość występowania zmian ogniskowych tarczycy oceniana na podstawie wyników badania sonograficznego jest nadal duża w badanej populacji, mimo prawidłowego stężenia jodu w moczu. (Endokrynol Pol 2010; 61 (2): 188-191)Introduction: The aim of this study was to investigate the current status of sonographic characteristics of thyroid nodules in Isfahan, a previously iodine deficient area in central Iran. Material and methods: In a cross-sectional study conducted in 2006, 2523 adult people (age > 20 years) were selected by a multistage clustering sampling method. Of these people, 263 volunteered persons were underwent sonographic evaluation. Thyroid examination was done by two expert sonographers. Serum T3, T3, T3RU, TSH, TPO Ab and Tg Ab, and urinary iodine were measured. Results: Forty-six per cent of the 263 people were women. Their mean age was 35.5 years with a range of 20-64 years. Median urinary iodine was 19.4 &#956;g/dL. The prevalence of thyroid nodules on sonography was 22.4% in the whole group; 30% in women and 16.3% in men (OR = 2.2, P = 0.01). The prevalence of thyroid nodules increased with age (P = 0.006). The prevalence of thyroid nodules was higher in hypothyroid people than in euthyroid people (35.1% v. 20.5%, OR = 2.1, P = 0.04). Neither urinary iodine nor autoantibody concentrations correlated with the prevalence of thyroid nodules in sonography. Conclusions: The prevalence of thyroid nodule by sonography is still high despite relatively normal urinary iodine in this population. (Pol J Endocrinol 2010; 61 (2): 188-191