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

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

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 &gt;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

Changes in miR146b Following Different Exercise Interventions in Adolescents with Overweight and Obesity

Introduction: Serum microRNAs are associated with numerous metabolic diseases, including obesity, hyperlipidemia, and type 2 diabetes. This study aimed to identify the miR146b changes following different exercise training interventions in adolescents with overweight and obesity.Methods: In this quasi-experimental study, 30 obese and overweight male adolescents aged 13-15 years were selected through the convenience sampling method based on body mass index (BMI) and assigned to two high-intensity interval training (HIIT) (Mean BMI: 26.15±2.25 kg/m2) and  school-based (SBE) (Mean BMI: 26.02±2.26 kg/m2) groups. Exercises in each group were performed for 12 weeks/ three weekly sessions after 10-15 minutes of initial warm-up. Moreover, at the end of each training session, 5-10 minutes were considered for cooling down. The circulating miR146b was extracted using a Real-Time PCR system. The subjects’ lipid profile was  measured by enzymatic methods, using certified commercial kits.Results: The expression of miR146b in both training groups, HIIT and SBE, dropped around 46.88% vs. 62.05%, respectively, but there was no significant difference between groups (p=0.836). Lipid profile levels also improved in both HIIT and SBE groups, but there were no significant differences in the Cholesterol (p=0.677), Triglyceride (p=0.977), LDL (p=0.247), and HDL levels between the two groups (p=0.977).Conclusion: The results showed that both school-based and high-intensity interval training can be used to modify lipid Profile and miR146b levels as an indicator of the pathological status of obesity in children and reduce the risk of disease in adulthood

Effects of Positioning on Complications of Preterm Infants with Respiratory Distress Syndrome Treated with Nasal Continuous Positive Airway Pressure: A Randomized Clinical Trial

Background: Nasal Continuous Positive Airway Pressure (N-CPAP) is the standard method of respiratory support in neonatal intensive care units, and this method is used for almost all infants with respiratory distress syndrome (RDS) for respiratory support. The position of infants under N-CPAP (prone and supine) affects the amount of blood supply. This study aimed to compare the prone \\and supine positions, followed by the investigation of their effects on various respiratory parameters and prematurity complications in premature infants with RDS treated with N-CPAP.Methods: This randomized clinical trial was conducted on 127 premature infants under N-CPAP treatment in the neonatal intensive care units of Al-Zahra and Shahid Beheshti hospitals, Isfahan, Iran. Babies were placed in two groups of 68 and 59 cases with supine and prone positions, respectively. The duration of N-CPAP, the number of prescribed doses of surfactant, the need for mechanical ventilation, time to full feed, and positive end-expiratory pressure (PEEP) were investigated in this study. The obtained data were then analyzed using SPSS software (version 22).Results: The mean±SD values of gestational age and birth weight of the neonates were 31.88±1.30 weeks and 1672.40±443.67 g, respectively. The frequency of using different modes of mechanical ventilation was significantly lower in the prone position group, compared to the supine position group ([17% vs. 32.4%], X2[3, N=127]=7.95, P<0.05). There was a significant correlation between position and using mechanical ventilation during the first 72 hours (P=0.04, Correlation Coefficient=0.182). Multivariate analysis indicated a significant correlation between position and mean time of PEEP (P<0.001, F=13.67), mean of surfactant use (P=0.013, F=6.38), and time to full feed (P=0.002, F=10.29).Conclusion: The results of this study showed that placing preterm infants with RDS who are treated with N-CPAP in the prone position reduces complications related to being preterm or using N-CPAP

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 centrallylocated city in Iran. In this cross-sectional study, 1,111 healthy people\u2014243 men and 868 women\u2014aged 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 &lt;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\u2014Isfahan\u2014 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

Urine and milk iodine concentrations in healthy and congenitally hypothyroid neonates and their mothers

Wstęp: Częste występowanie wrodzonej niedoczynności tarczycy (CH, congenital hypothyroidism) w Iranie skłoniło autorów do oceny roli jodu w etiologii CH, opierając się na porównaniu jego stężenia w moczu zdrowych noworodków i noworodków z wrodzoną niedoczynnością tarczycy oraz w mleku i moczu ich matek. Materiał i metody: W tym przekrojowym badaniu zmierzono stężenie jodu w moczu (UIC, urinary iodine concentration) noworodków z CH oraz UIC i stężenie jodu w mleku (MIC, milk iodine concentration) ich matek, a następnie porównano je z wynikami otrzymanymi w grupie kontrolnej. Wartości UIC zmierzone u noworodków i karmiących matek podzielono na 3 kategorie: niskie UIC < 150 mg/l, średnie - 150-230 mg/l i wysokie > 230 mg/l. Analogiczne kategorie przyjęto dla MIC: niskie 180 mg/l. Wyniki: Mediana UIC u noworodków z CH (n = 68) i u zdrowych noworodków (n = 179) wynosiła odpowiednio 300,5 i 290,5 mg/dl, (P > 0,05). Mediana UIC w grupach badanej i kontrolnej wynosiła odpowiednio 150 i 130 mg/l (P > 0,05). Mediana MIC w grupie badanej była większa niż w grupie kontrolnej (210 mg/l v. 170 mg/l, P < 0,05). Stwierdzono dodatnią korelację między UIC u noworodków i MIC u ich matek. Nie wykazano wyraźnej zależności między UIC i stężeniem TSH w surowicy u noworodków oraz UIC I MIC u matek. Wnioski: Spożycie sodu w badanej populacji było prawidłowe. Nadmierna podaż sodu może być czynnikiem ryzyka CH, jednak w badaniu wykazano brak korelacji między MIC I UIC u matek i podobne wartości mediany UIC u noworodków w obu grupach, dlatego do sformułowania jednoznacznych wniosków potrzebne są dalsze badania. (Endokrynol Pol 2010; 61 (4): 371-376)Introduction: In view of the high prevalence of Congenital Hypothyroidism (CH) in Iran, in this study we evaluated the role of iodine in the aetiology of CH by comparing urine and milk iodine concentrations in healthy and congenitally hypothyroid neonates and their mothers. Material and methods: In a cross-sectional study, urinary iodine concentrations (UIC) in newborns with CH, as well as UIC and the milk iodine concentrations (MIC) of their mothers, were measured and compared with a control group. The lower, mid, and upper range of UIC for neonates and lactating mothers was considered to be 230 mg/L, and lower, mid, and upper range of MIC was considered to be 180 mg/L, respectively. Results: The median UICs in subjects with CH (n = 68) and healthy subjects (n = 179) were 300.5 and 290.5 mg/L, respectively (P > 0.05). The median UICs in the case and control groups were 150 and 130 mg/L, respectively (P > 0.05). The median MIC in the case group was higher than in the control group (210 mg/L v. 170 mg/L, P < 0.05).There was a positive correlation between newborn UIC and MIC. There was no significant correlation between newborn UIC and serum TSH, maternal UIC and maternal MIC, or newborn UIC and serum TSH. Conclusions: There is no inadequacy in iodine intake in the studied population. Iodine excess could be a possible risk factor for CH, but there were findings, such as lack of correlation between maternal MIC and UIC, and the median neonatal UIC, which was similar in the two groups, so, drawing conclusions should be done with some caution and requires further studies. (Pol J Endocrinol 2010; 61 (4): 371-376

Thyroid Peroxidase Gene Mutation in Patients with Congenital Hypothyroidism in Isfahan, Iran

Background. Thyroid peroxidase gene (TPO) mutations are one of the most common causes of thyroid dyshormonogenesis in patients with congenital hypothyroidism (CH). In this study, the prevalence of TPO gene mutations in patients with thyroid dyshormonogenesis in Isfahan was investigated. Methods. In this cross-sectional study, genomic DNA of 41 patients with permanent CH due to thyroid dyshormonogenesis was extracted using the salting out method. The 17 exonic regions of the TPO gene were amplified. SSCP technique was performed for scanning of the exonic regions of the TPO gene, except exon 8. DNA sequencing was performed for those with different migration patterns in SSCP by chain termination method. Exon 8 was sequenced directly in all patients. In 4 patients, all fragments were also sequenced. Results. One missense mutation c.2669G>A (NM_000547.5) at exon 15 (14th coding exon) in one patient in homozygous form and seven different single nucleotide polymorphisms (SNPs) in exons 1, 7, 8, 11, and 15 of TPO gene. Conclusion. The TPO gene mutations among CH patients with dyshormonogenesis in Isfahan were less frequent in comparison with other similar studies. It may be due to the presence of other unknown gene mutations which could not be detected by SSCP and sequencing methods

Marjolin ulcer: the importance of early diagnosis and excision

Introduction: Marjolin’s ulcer is a rare disease characterized by the malignancy of chronic wounds that present healing disorders, often due to chronic irritation and repetitive trauma in this area. The diagnosis is made mainly through clinical history and histopathological examination. The differential diagnoses of other diseases that course with ulcers must always be researched and ruled out. Method: The present work presents a bibliographic review to elucidate the subject’s relevance for medical students, physicians and nurses, to assist in early diagnosis. Results: Nine observational studies were selected to compose the discussion. Conclusion: The most effective treatment for this condition is surgery, and lymph node dissection is suggested in some cases. Chemotherapy has not shown satisfactory results, while radiotherapy is used in selected cases. Given the rapid evolution, tissue damage, and worse prognosis, diagnosis, and excision should be performed early for a better clinical outcome

ANESTESIA PERIDURAL PARA CIRURGIA ORTOPÉDICA DE QUADRIL EM IDOSOS

Epidural anesthesia is a technique that involves administering local anesthetic close to the spinal cord to block the sensation of pain in a specific region of the body. In orthopedic hip surgeries in the elderly, it is often chosen due to its effective analgesic effect and lower overall impact on the body compared to general anesthesia. However, the decision on the type of anesthesia should be made based on individual medical assessment. Epidural anesthesia works by temporarily blocking pain signals transmitted by nerves in the spinal cord region. A local anesthetic is injected into the epidural space, which is located outside the membrane surrounding the spinal cord. This impedes the conduction of nerve impulses, resulting in numbness and reduced pain sensation in the specific area of ​​the body where the anesthesia is administered. It is a common option for surgeries and procedures involving lower areas of the body, such as orthopedic hip surgery. The objective of this study is to understand the action of epidural anesthesia in this type of procedure. The results of epidural anesthesia generally include the absence of pain in the affected region during the surgical procedure. Furthermore, as epidural anesthesia allows for greater preservation of respiratory function and other autonomic reflexes compared to general anesthesia, it may contribute to faster postoperative recovery.A anestesia peridural é uma técnica que envolve a administração de anestésico local próximo à medula espinhal para bloquear a sensação de dor em uma determinada região do corpo. Em cirurgias ortopédicas de quadril em idosos, ela é frequentemente escolhida devido ao seu efeito analgésico eficaz e menor impacto geral no organismo em comparação com a anestesia geral. No entanto, a decisão sobre o tipo de anestesia deve ser feita com base na avaliação médica individual.A anestesia peridural age bloqueando temporariamente os sinais de dor transmitidos pelos nervos na região da medula espinhal. Um anestésico local é injetado no espaço peridural, que está localizado fora da membrana que envolve a medula espinhal. Isso impede a condução dos impulsos nervosos, resultando em dormência e redução da sensação de dor na área específica do corpo onde a anestesia é administrada. É uma opção comum para cirurgias e procedimentos que envolvem áreas inferiores do corpo, como cirurgias ortopédicas de quadril. O objetivo deste estudo é compreender a ação da anestesia peridural nesse tipo de procedimento. Os resultados da anestesia peridural geralmente incluem a ausência de dor na região afetada durante o procedimento cirúrgico. Além disso, como a anestesia peridural permite maior preservação da função respiratória e outros reflexos autonômicos em comparação com a anestesia geral, pode contribuir para uma recuperação mais rápida pós-operatória