Evaluation of MRI-based MAGIC polymer gel dosimeter in small photon fields

Background: Accurate small radiation field dosimetry is essential in modern radiotherapy techniques such as stereotactic radiosurgery [SRS] and intensity modulated radiotherapy [IMRT]. Precise measurement of dosimetric parameters such as beam profile, percentage depth doses and output factor of these beams are complicated due to the electron disequilibrium and the steep dose gradients. In the present work the MAGIC polymer gel was used for dosimetry of small circular photon beams. The results of MAGIC were compared with EBT2 measurements and Monte Carlo [MC] calculations. Materials and Methods: Experimental measurements were made by mentioned dosimeters in four small field sizes 5, 10, 20 and 30 mm. The BEAMnrc code based on EGSnrc was used for simulation to calculate dosimetric parameters at these small fields. The phantoms were irradiated in a 6 MV photon beam Varian 2100C linear accelerator at SSD=100 cm. gel readout performed by 3 Tesla MRI scanner. Results: The results showed that the Percent depth dose [PDD] values measured and calculated by EBT2 film and MC had maximum local differences 4% and 5% with PDD values measured by MAGIC for field size of 5mm respectively. These differences decreased for larger field sizes. The measurements of output factor and penumbra [80%-20%] and [90%-10%] showed good agreement between the measurements and MC calculation. Conclusion: This study showed that the MAGIC polymer gel based on high resolution MRI images is useful detector for small field dosimetry but its agreement with MC is less than agreement of EBT2 film with MC

[Effects of silymarin on insulin resistance and blood lipid profile in first-degree relatives of type 2 diabetic patients]

Diabetes mellitus is a metabolic disorder that is characterized by hyperglycemia due to insulin deficiency or cellular resistance. Silymarin is an effective agent that reduces cell resistance to insulin and improves lipid profile. In this study the effects of silymarin on insulin resistance and blood lipid profile in first-degree relatives of type 2 diabetic patients were evaluated. This randomized clinical trial was performed on first-degree relatives of type 2 diabetic patients [n=60] with BMI above 25 kg/m[2]. After completing questionnaire and obtaining written consent, participants were randomly assigned to give placebo or silymarin group. The patients in silymarin group received two 140 mg capsules of silymarin daily and placebo group 140 mg placebo capsules similarly for 12 weeks. Fasting blood glucose, HbA1c, cholesterol, triglyceride, and LDL, HDL, insulin and 2hpp blood glucose level were determined before and after the study. In silymarin treated group, insulin resistance and serum insulin level were reduced significantly [p < 0.05] compared with beginning as well as compared with placebo group. The blood glucose level and lipid profile didn't change significantly after silymarin therapy compared with placebo group. According to our results silymarin positively influence insulin resistance and insulin level in first-degree relatives of type 2 diabetic patients but its effect on lipid profile need further studies

intermediary role of self-efficacy in relation with stress, glycosylated haemoglobin and health-related quality of life in patients with type2 diabetes

Stress is not always a direct result of stressful conditions, but rather the way they are perceived. Thus individual variables that may be associated with perceived stress should be examined in stress studies. This study investigates the intermediary role of self-efficacy in relation with stress, glycosylated haemoglobin and health-related quality of life in patients with type2 diabetes. All women with diabetes in Yazd Diabetes Research Centre, in 2012, were considered and 80 women were selected by random sampling. They completed Shirer's self-efficacy scale questionnaire, depression, anxiety and stress scale [DASS], and ADDQ0L19 questionnaire. Then they were introduced to the lab for blood test. Data were analysed by SPSS software and stepwise regression method. Pearson correlation test results showed that the hemoglobin A1c [r = 0.35] and Quality of Life [r = -0.22] are associated with stress [P <0.05]. As so hemoglobin A1c [r = 0.83] and Quality of Life [r = 0.37] with variable of self efficacy are associated positively and significantly [P <0.05]. Results of stepwise regression also showed that self efficacy and stress scales 0.697 of variance hemoglobin A1c and 0.140 of variance of Quality of life explaining to do. The impact of stress on blood sugar and patients' health-related quality of life can be influenced by their self-efficacy; therefore it is suggested that an educational intervention is done to increase patients' self-efficacy to better cope with stress in their life

Aloe vera leaf gel in treatment of advanced type 2 diabetes mellitus needing insulin therapy: a randomized double-blind placebo-controlled clinical trial

Advanced type 2 diabetes mellitus [T2DM] needing insulin therapy is a common disease. Previous studies indicate that aloe [Aloe vera L.] leaf gel may positively affect the blood glucose and lipid levels in patients with advanced T2DM needing insulin. Evaluation of the efficacy and safety of aloe leaf gel in the treatment of type 2 diabetic patients resistant to oral synthetic anti-hyperglycemic drugs needing insulin. In this randomized double - blind placebo-controlled clinical trial with the patients aged 40-60 years, the efficacy and safety of taking aloe leaf gel [one 300 mg capsule every 12 hours for 2 months] combined with oral synthetic anti-hyperglycemic drugs in treatment of 35 patients were evaluated and compared with the placebo group [n = 35]. The aloe leaf gel lowered the blood levels of fasting glucose and glycosylated hemoglobin significantly [p = 0.041 and p = 0.023 respectively] without any significant effects on the lipid profile and liver/kidney function tests [p > 0.05] compared with placebo at the endpoint. No adverse effects were reported. The results suggest that aloe leaf gel may safely improve glycemic control in patients with advanced T2DM needing insulin

[ role of health beliefs in preventive behaviors of individuals at high-risk of type 2 diabetes mellitus]

Diabetes mellitus is an important health problem that leads to severe complications, is the cause of early death, and is showing an increase in frequency. Development of positive health behaviors is extremely important for prevention of diabetes in at high-risk individuals. This study aims to identify the relationship between health beliefs and diabetes preventive behaviors in individuals at high-risk for developing type 2 diabetes mellitus in Taft city. A study using the Health Belief Model [HBM] framework was undertaken with 114 subjects of both genders aged 30 years and above from three urban health centers who were diagnosed as at high risk for type 2 diabetes during the screening program. Research tool was a 66-item questionnaire. Data was analyzed with descriptive statistics, Spearman correlation and Mann-Whitney U-test. Of the total, 29.8% of subjects were male and 70.2% were female. Regarding education, 68.4% of the subjects had not completed high school and 89.4% of them was married. Mean score of knowledge and preventive behaviors was 5.80 +/- 2.87 and 5.41 +/- 2.83, respectively such that subjects scored 30.05% of maximum obtainable score of preventive behaviors. There were significant correlations between preventive behaviors and perceived susceptibility, r=0.243[P<0.009], perceived severity, r=0.312 [P<0.001], perceived barrier, r=0.245 [P<0.006] and perceived self-efficacy, r=0.497 [P<0.001]. Preventive behaviors among the subjects at high-risk for developing type 2 diabetes despite the presence of risk factors was poor due to lack of susceptibility, severity, barriers and self-efficacy perception

[ effect of zinc supplemention on glycosylated hemoglobin in type II diabetic patients]

Diabetes mellitus is one of the most common metabolic disorders due to partial or complete deficiency of insulin or insulin resistance. The most common problems is uncontrolled diabetes are chronic complication including renal and cardiovascular failure. Zinc as an essential trace element, can affect some aspects of insulin synthesis, secretion and function. The aim of this study was to evaluate the effect of zinc supplementation in diabetes control status in a group of type-II diabetic patients. In this clinical trial, 60 fdiabetic patients [type-II] were divided in 2 groups, randomly. One of them consumed 25 mg/day zinc and the other had 50 mg daily for 2 months. Fasting blood glucose [FBS], 2 hour post prandial blood glucose [2hpp], glycosylated hemoglobin [HbA1c], and serum levels of zinc were evaluated in patients before and after zinc supplementation. Wilcoxon and Man-Whitney tests were used for statistical analysis. 22 patients in each group with the mean age of 48 years completed the study. Serum levels of zinc in the group with 25 mg/day supplementation didn't show significant change, but in the second group increased significantly after supplementation [160 +/- 30 micro g/dl vs 140 +/- 30, p=0.002]. HbA1c significantly reduced after supplementation [9.7 +/- 1.86 vs 8.9 +/- 1.5, p=0.02]. There were not significant changes in FBS and 2hpp before and after zinc supplementation. Our results indicate that elevation of zinc level in diabetic patients has favorable effect on HbA1c and diabetes control status. It is assumed that some of the diabetic patients suffer from a latent zinc deficiency and this may by unfavorably diabetes control status

[Effect of sour tea [Hibiscus sabdariffa] on blood glucose, lipid profile and lipoproteins in diabetics]

Hibiscus Sabdariffa is widely cultivated in tropical areas and its red persistent calyx is the major component possessing a sour taste that is used in beverages and food colorants. As a traditional medicine, it is claimed to be effective against kidney stones and urinary bladder stones, and is also used for its antibacterial, antifungal, hypocholesterolemic, antispasmodic and antihypertensive actions. We conducted this study to evaluate the effects of sour tea on blood sugar, lipids and lipoproteins. This sequential double-blind randomized controlled clinical trial was conducted on 60 diabetic patients in the Yazd Diabetic Research Center. Patients were assigned randomly into two groups, the sour tea [ST] and the ordinary tea [OT] group. Sachets containing one spoonful of sour or ordinary tea were given to the patients, based on random numbers. They were instructed to consume one glass of boiled water, boiled for 20-30 min, 2 times daily between their meals in the morning and afternoon, for 30 days. Fasting blood samples were taken at the beginning and at the end of the study for measuring blood glucose, hemoglobin A1C, total cholesterol, HDL-C, LDL-C, triglycerides, Apo AI, Apo B100 and Lp[a]. Data were analyzed using the SPSS statistical package. A total 60 patients were recruited, 53 of whom completed the study [27 in ST and 26 in OT]. Except for Lp[a] and Apo AI, means of all lipids and lipoproteins at the beginning, were significantly decreased or increased [HDL-C] compared with the related means at of the end of the study in the sourtea [ST] group however, only the mean for HDL-C was significantly increased [approximately 16.7%] at the end of intervention in in the ordinary tea [OT] group. The mean for fasting blood glucose at the end of study did not differ significantly with the initial mean in both groups. In contrast, the mean of hemoglobin A1C was significantly decreased in the ST group. The results showed that sour tea has significant effects on blood lipid profiles in diabetic patients however, it did not have significant effects on blood glucose or hemoglobin A1C. Drinking sour tea can be recommended for diabetic patients

Determination of association of macroprolactinemia with macroprolactinoma using poly ethylene glycol precipitation test

Prolactin in human serum exists in 3 different molecular forms, i. e, monomeric, big and at times big big [Macroprolactin]. Macroprolactin is a complex of prolactin and IgG and may account for a significant proportion of idiopathic hyperprolactinemia. Its biological activity is considered low or absent, usually idiopathic and poorly symptomatic. Since its association with a prolactin producing macroadenoma is poorly documented, we performed this study on the patients with Macroprolactinoma for the presence of macroprolactinaemia through its identification with Poly Ethylene Glycol. The study aims is to comparing the clinical [galactorrhea and oligomenorrhea] findings in patients with macroprolactinaemia and those without it. In this study 10 patients with Macroprolactinoma [macroadenoma in MRI of hypophysis, prolactin level more than l00gIL and clinical and radiological response of tumor to dopamionergic agents after treatment] were evaluated for the presence of Macroprolactinemia, using Poly Ethylene Glycol precipitation test. Doing so, one patient infected by Macroprolactinemia was detected. At the time of reception, the clinical findings in all 10 patients were classic and similar and in the follow ups, both clinical and radiological changes were the same. Our Results suggest that Macroprolactinoma may be associated with Macroprolactinemia

[Comparing the effects of Fluoxetine and Alprazolam on blood glucose in patients with type 2 diabetes]

Diabetes mellitus is the most common endocrine disorder causing micro- and macrovascular complications which could be prevented by good glycemic control. Considering many patients who become resistant to routine anti-diabetic drugs after few years, the administration of other drugs to reduce the level of glucose is an essential approach for a better glycemic control. The aim of this study was to compare the effects of fluoxetine and alprazolam added to regular anti-diabetic drugs on blood glucose in patients with type 2 diabetes. In this paralleled clinical trial, 66 uncontrolled type 2 diabetic patients referred to Yazd Diabetes Research Center were selected and received randomly either 20mg of fluoxetine or 0.5mg of alprazolam for 6 weeks. Mean FBS [fasting blood sugar], 2hpp [2 hours post-prandial glucose], HbA1c [Glycated Hemoglobin] and BMI [Body Mass Index] were measured before and after the study. Data were analyzed by t-test and paired t-test. The mean FBS, 2hpp, HbA1c and BMI were decreased after using fluoxetine by 27.5 +/- 7.5mg/dl, 47.5 +/- 10.5, 1.5 +/- 0.5% and 2.2 +/- 0.8kg/m2, respectively [P=0.001]. Also the mean FBS, 2hpp and HbA1c were decreased by 13.7 +/- 13.5mg/dl, 22.5 +/- 5.6mg/dl and 0.5 +/- 0.3% following the administration of alprazolam [P=0.001]. Similarly, the mean BMI was increased by 0.3 +/- 1.5 kg/m2 this difference was found to be statistically insignificant [P=0.35]. Both fluoxetine and alprazolam were useful for better control of blood glucose in diabetics who were free of diabetic complications nevertheless, it seems that fluoxetine is more effective than alprazolam

Comparative survey of problems in thalassemia major patients with regular and irregular follow ups of therapeutic principles

Thalassemia is one of the important chronic hereditary diseases. There are nearly 20000 thalassemia major patients in Iran. Multiple blood transfusion and aggregation of iron load cause numerous complications which can be reduced by regular treatments. This study was conducted to determine and compare the problems of thalassemia major clients in regular and irregular follow ups of therapeutic principles. This study was performed as a cross-sectional study. The sample consisted of all thalassemia major clients over 40 years of age having referred to the center of adult thalassemia in Tehran. 224 clients were divided into regular and irregular groups. A questionnaire was used for data collection. Based on difference between the averages of regular and irregular groups the average rate of psychological problems was 22.7%, sociological problems 18.7%, and economic problems 17.6%. Based on average differences between the two groups, important psychological problems include fatigue due to long periods of treatment [1.5], future hopelessness [1.4], and lack of self confidence [1.2]; sociological problems include community unawareness of the disease [1.3], difficult access to various specialists [1.1], and lack of ongoing training classes [1.0]; finally economic difficulties include access to necessary drugs and equipment [0.93], quality of free equipment [0.92], and family support [0.8]. These are the prominent problems addressed in irregular treatment follow ups. Results have revealed that psychological problems had a more distinct effect relative to social and economic problems on the therapeutic irregular follow ups

[Parental interaction patterns in children with ADHD and controls; a comparative study]

Communicational patterns of the parents can either positively or negatively influence children's personality. Parenting manner has long-term effects on behavior, function, expectations and eventually people's future personality. This study investigates parental interaction patterns in children with attention deficit- hyperactive disorder. In this study, 50 male children aged 7-12 years were selected in two groups including I] 25 students with ADHD referring to psychiatry clinics it3, Isfahan according to the diagnostic scale of DSM- IV and 2] 25 healthy boys selected by random cluster mukistage sampling from primary schools in five districts of Isfahan from Septamber 2005 until March 2005. Schaffer and Edgerton parental interaction questionnaire was filled for them. In "Communication" interaction pattern, the mean score of healthy children was 15.08, while the mean score of ADJID children was 13.42. In "admission" interactional pattern; the mean of the first group was 14.76, while the second group was 11.76. in "control" interactional pattern, mean of group one was 13.28 and the second group was 11.76. In "aggression control" interactional pattern, the mean of group one was 13 and the second group was 14.68. In "lack of aggressive attachment" interaetional pattern, mean of the first group was 13.36 and the second group was 16.67. The mean scores of parental interactional pattern in healthy children were all higher than ADHD children except for "aggression control" and "lack of aggressive attachment" interactional patterns. The more the parental "admission" interactional pattern score, the lower the signs of ADHD in children. The signs of severity are lower in cases with more positive parental "control" interactional patterns. If the scores of "lack of aggressive! attachment" and "aggressive/ control" interactional patterns are higher, ADHD signs are more severe

Developing a water quality management model for Karun and Dez rivers

The Karun and Dez rivers basin are the largest rivers basin in Iran which are situated in the south west of the country. Karun River originates from Zagros mountain ranges and passing through Khuzestan plain, reaches the Persian Gulf Several cities lie along its path of them the most important is Ahvaz, the center of Khuzestan province. To achieve water quality goals in Karun and Dez rivers, a water quality management model has been developed through the GIS approach and a mathematical water quality model. In Karun and Dez rivers, water quality has decreased due to heavy pollution loads from Khuzestan province cities and surrounding areas. In this survey, pollution sources, land use, geographic features and measured water quality data of the river basin were incorporated into the Arc-view geographic information system database. With the database, the model calculated management type and cost for each management project in the river basin. Until now, river management policy for polluted rivers in Iran has been first of all to get penalties from pollution sources and secondarily, to construct treatment plants for the pollution sources whose wastewater is released untreated and for which the wastewater quality goal of the Iranian Department of the Environment is not met. Different management projects with a time program were proposed and they were compared with the results of the river quality without any management approach. It became clear that the results based on the management approach were much better than those for the unmanaged condition from the viewpoint of the achievement of water quality goals and cost optimization

[ study of the severity of keratoconus in optometric clinic's patients of Mashhad University of medical sciences]

Keratoconus is characterized by thinning and steepening of the central cornea. This study was undertaken to determine the severity of this disease and its relation with age and gender. In a cross sectional study, the data are reviewed from 1485 keratoconic eyes examined at the optometric's clinic of Mashhad University of Medical sciences from 1991 to 2005. The criteria for diagnosis of keratoconus were: Irregular corneal astigmatism, scissors retinoscopy reflex, Vogt's striae, Fleischer's ring or central corneal power higher than 47.2 D. The disease severity based on the central keratometry reading classified into mild, moderate, advanced and severe. SPSS software was used for data analyzes. The patient's mean age in this study was 25.33 +/- 8.39 years. From 1485 eyes, 73.1, 20.7, 5.9 and 0.3 percent had mild, moderate, advanced and severe keratoconus respectively. The highest prevalence of this disease was in 20-29 years [49.02 percent] and the lowest was related to over 40 years of age [6.4 percent]. The prevalence of keratoconus in females was higher than males [P< 0.001]. The majority of patients in this study had mild keratoconus and were in 20-29 years and it's prevalence in females were higher than males

Study of four year incidence rate of diabetic retinopathy and its associated factors in type II diabetes patients

It seems that improvement in care and new treatment and screening methods along with better control of diabetes mellitus [DM] has led to a change in incidence of diabetic complications, especially diabetic retinopathy. This study was performed to assess the 4 years incidence rate of diabetic retinopathy in patients with type II diabetes and factors affecting its progression. In this prospective study on diabetic patients referring to Yazd diabetes center, 120 type II diabetic patients without diabetic retinopathy were selected. After complete ophthalmic examination, fasting blood sugar [FBS], post prandial blood sugar, triglyceride and cholesterol levels were measured, and height, weight and blood pressure [BP] were recorded. Then the patients were followed with yearly eye examinations for 4 years. Four year cumulative incidence of diabetic retinopathy was 47.5% [95% CI: 38.6 - 56.4]. The retinopathy was mild, non proliferative diabetic retinopathy [NPDR] in 43 [35.8%] where as 10[8.3%] patients had moderate NPDR and 3[2.5%] patients had severe NPDR. Only one patient had proliferative diabetic retinopathy. The incidence of diabetic retinopathy was 5.8% in first year, 20.3% in second year, 24.4% in third year and 7.4% in fourth year. Duration of diabetes, FBS and systolic BP had a statistically significant relationship with grades of diabetic retinopathy, but there was no significant association between age, sex, Body mass index [BMI], triglyceride and cholesterol levels, method of treatment, smoking and diastolic BP with grades of diabetic retinopathy. Duration of diabetes, blood glucose levels and systolic blood pressure are main risk factors of diabetic retinopathy

[Quality of life in diabetes type II patients in Yazd]

Diabetes is a chronic disease that affects and decrease the quality of life. The incidence of diabetes is increasing and the prevalence of non-insulin dependent diabetes mellitus in Iran is 4.5-6% and in population aged above 30 years is more than 14%. The prevalence of this disease in Yazd is 14.2%. The aim of the present study was to determine the quality of life of diabetes type II patients in Yazd and utilize the results for betterment of the quality of life of the patients. The object of this study was to assess diabetic patients' perceptions of their quality of life and its relation to certain socio-demographic variables. The data was collected by a questionnaire [SF=20] from 120 randomly selected patients at the Diabetes Research Center of Yazd. The data was analyzed with SPSS software and chi[2] test. The age of 40% of the samples was lower than 50 years while 60% was more than 50 years. Diabetes had affected quality of life of patients. The overall QOL, of patients was less than 50 percent.. There was no significant relationship between the level of education of patients and their QOL. There was a significant relationship between the job of patients and their QOL. About 87% of them had neuropathy and 78% had retinopathy. The QOL of patients with complications was lesser than those without complications. The findings of this study can help planners of diabetes management and education programs to identify persons at risk of decreased QOL at an early stage and tailor preventive interventional programs to bring about significant changes in patient's QOL

[Type 2 diabetes and its risk factors]

Type 2 diabetes is the most common form of diabetes and accounts for 90% of all cases. The number of diabetic patients in IR Iran is estimated to be about 1.5 million. Identification of diabetes risk factors and trying to remove them, can prevent or delay it. The relationship between type 2 diabetes and genetic factors is stronger than the relationship in type 1 diabetes. The concordance of type 2 diabetes in identical twins is 70-90%. Obesity particularly visceral is very common in type 2 diabetes. The risk of diabetes increases with increasing age. Prevalence rates of diabetes are strongly different among different ethnic groups. Women with a history of gestational diabetes have a 50% risk of eventually developing diabetes in the next 20 years of their lives. High blood pressure [=>140/90mm hg] could be an early sign of underlying insulin resistance, related to central adiposity. Risk of diabetes in persons with high blood pressure is twice the normal persons. Low birth weight is often followed by accelerated postnatal growth and this may be important for assessing the risk of diabetes. Impaired glucose tolerance [IGT] test is typically characterized by hyperglycemia and insulin resistance. Persons with IGT without changing their lifestyles develop type 2 diabetes in 10 years. Insulin resistance has been observed in women with polycystic ovary [PCO] syndrome. It is estimated that 35-50% of women with PCO have impaired glucose tolerance test. Stress stimulates the release of various hormones, which may cause elevated blood glucose levels. Smoking is not a well-documented risk factor for type 2 diabetes. In spite of this diabetes and CHD have many common causal factors. Large-scale prospective studies have shown that smoking is associated with the development of type 2 diabetes. However larger scale and long-term studies are needed to clarify the role of smoking as a risk factor of diabetes

[Study of blood leptin levels before and after treatment with metformin in diabetes type II patients]

Leptin is a fat tissue hormone that has 176 amino acids with a molecular weight of 16 KD. Leptin has effects on the hypothalamus and peripheral tissues resulting in decreased food absorption and increased energy consumption that finally reduces the body weight and BMI. The aim of this research was to investigate the blood levels of leptin before and after treatment with Metformin in type II diabetic patients. 25 type II diabetic patients without any previous drug treatment history were investigated. This study was a clinical trail before and after treatment with Metformin. There was no particular difference in BMI, average body weight, fat mass and free fat mass before and after treatment. Similarly, the difference in concentration levels of blood glucose, cholesterol, tri-glycerides and LDL-cholesterol before and after treatment was not statistically significant. Also, there was no difference in the average concentration of leptin and insulin before and after treatment. This result showed that although metformin decreased glucose and lipid levels during the treatment period, [1 month] it did not have an effect on leptin, Insulin and other related factors during treatment

[Study of the effect of garlic on serum lipids and blood glucose levels in type 2 diabetic patients]

Hyperlipidemia and diabetes are common risk factors for ischemic heart disease, which is themain cause of mortality in diabetic patients. Strict control of blood glucose and other risk factors in diabetics hasled to prevention of complications. Garlic has received particular attention for control of blood glucose anddecrease in blood lipid levels. At present, several studies have been carried out in order to prove advantages ofgarlic.In this study, effects of garsin [a derivative of garlic present in our country] on serum lipids and bloodglucose levels in diabetes mellitus type 2 patients was observed. Forty-five type 2 diabetics who hadhyperlipidemia were selected. These patients were kept on treatment with 3 tablets of Garsin / day for 4 weeks.Serum lipids and blood glucose levels were measured prior to and at the end of treatment.Relationship between sex and response to treatment in this study was meaningful, such that Gsarsin ledto decrease in LDL-C and increase in HDL in females.Therefore, Garsin can be used as an adjunct to treatment in diabetes type 2 patients withhyperlipidemia

Goiter prevalence, urinary iodine excretion and household salt iodine after 10 years of salt iodization in Yazd province in Iran

Iodine Deficiency Disorders[IDD] are the most important epidemic disorders in the world including Iran. For preventing IDD and its consequences, table salt has been iodized since 1989. At present, this programme has been 10 years old. Objective: To determine the total goiter rate[TGR] and urinary iodine in 6-11 years old students in Yazd province and related cities after 10 years of salt iodized programme. Subjects and Methods: A total 4755 primary school students[2948 boys and 1807 girls] aged 6-11 were selected by multistage cluster sampling method from the Yazd province. Thyroid examination and goiter classification were made according to World Health Organization[WHO] guidelines by two trained physicians. Urine sample and household salt was collected from 1/13th of total population. Urinary iodine was determined by a digestion method. Iodine of salt was determined by rapid test kit. Data was analyzed by SPSSWIN software. Results: TGR of Yazd province was 40.9%[Girls 41.8% and boys 40.3% not significant]. Prevalence of goiter grade 1 and grade 2 were 38.6% and 2.3%, respectively. These figures for girls were 39.1% and 2.7% and for boys were 38.3% and 2% respectively. TGR of Taft, Abarkuh, Khatam, Yazd, Bafgh, Sadugh, Mehriz, Mybod and Ardakan were 43.3%, 41.5% 32.4%, 40.2%, 38.5%, 53.8%, 41.8%, 37.8% and 31.5% respectively. TGR was significantly different among these cities[pv<0.0001]. Overall mean of the urinary iodine was 264 +/- 123 microg/l and the corresponding mean in girls and boys were 236 +/- 118 microg/l and 281 +/- 123 microg/l, respectively which were significantly different[pv=0.001]. Mean of urinary iodine in Taft, Abarkuh, Khatam, Yazd, Bafgh, Sadugh, Mehriz, Mybod and Ardakan were 224 +/- 146 microg/l, 229 +/- 130 microg/l, 332 +/- 114 microg/l, 266 +/- 122 microg/l, 264 +/- 84 microg/l, 291 +/- 116 microg/l, 208 +/- 125 microg/l, 235 +/- 103 microg/l and 279 +/- 118 microg/l, respectively [pv=0.02]. In general, 10.5% of study population had urinary iodine concentrations below 100 microg/l, 24.5% were in ideal range[100-200 microg/l] and 65% were higher than 200 microg/l. Approximately 94% of salt samples had iodine. The study shows that after ten years iodized salt program has decreased the prevalence of goiter and increased urinary iodine. This means that Yazd province is .IDD free. from 2002

[Outcome of reinitiation of combination anti diabetic oral therapy in insulin treated patients with Type 2 diabetes mellitus]

Before adding metformin to oral anti diabetic drugs, only sulfonylureas were available. When sulfonylureas failed, insulin therapy had to be initiated. For this reason utilization of insulin was more than now. The purpose of this study is evaluation of success in re-initiation of oral therapy in insulin treated patients with type 2 diabetes. This study is an outcome study, we attempted reinitiation of combination oral therapy with metformin and a sulfonylurea in 32 patients who had type 2 diabetes for less than 30 years and had received less than 40U insulin for less than 10 years. Of 32 patients, reinitiation of oral therapy was successful in 20 patients and unsuccessful in 12 [P=0.014]. In 13 of 16 patients with less than 10 years diabetes duration, and in 7 of 16 patients with more than 10 years diabetes duration, re-initiation of oral therapy was successful [P=0.028]. In patients who received 10-25 u/day,%76, and in patients who received 26- 40 U/day,%46.7, re-initiation of oral therapy was successful [P=0.05]. There was not association between reinitiation of oral therapy and age, duration of insulin therapy, dose of insulin and BMI. This study shows reinitiation of combination oral therapy in insulin treated patients with type 2 diabetes, is most likely to be successful with a shorter duration of diabetes and lower insulin requirements