[Evaluation of peripheral neuropathy in patients with type 1 diabetes mellitus by bedside scoring procedure]

Foot ulceration and lower limb amputation are still common complications of Diabetes mellitus [DM]. Diabetic foot problems account for more hospitalization days than any other diabetic problem. The main etiologic factors are diabetic neuropathy and peripheral vascular disease. An easy, simple to use and low cost method for screening of diabetic peripheral neuropathy will be very useful. From May 2003 to May 2004, all diabetic patients [type 1] referred to endocrine clinic of Namazi Hospital were evaluated for diabetic peripheral neuropathy [DPN], using the bedside scoring procedure. A score of 3-5 indicated mild, 6-8 moderate, and 9- 10 severe DPN. The perception of vibration, temperature, pinprick and ankle reflex was examined. Tuning fork [128 Hz], neuropen, cold and warm water and reflex hammer were used for evaluation. In this study we evaluated 80 patients [34 male and 46 female] with type 1 DM, with the age range of 6-31 years [Mean +/- SD 18.16 +/- 5.22 yr]. The overall prevalence of DPN was 13.75%: mild in 7.5%, moderate in 5% and severe in 1.25% of the patients. The most common physical finding was the absence of ankle reflex. Patients were divided into 2 groups based on the presence of DPN. The prevalence of DPN was significantly associated with age, duration of DM and BMI [P< 0.05]. There was no significant correlation with sex, HbAlc, puberty, parental consanguinity and family history of DM. Bedside scoring procedure is a simple, low cost and easy method for screening of DPN in patients with type 1 DM in outpatient clinic. Examination of ankle reflex is very important. It is concluded that the diabetic patients need better follow-up and more education

[Evaluation of malnutrition, as a possible cause of persistence of goiter despite iodine supplementation]

Iodine deficiency is the most common cause of endemic goiter. Frequency of goiter has remained >5% despite iodide supplementation and sufficient iodide intake. Other causes have to be investigated. This study was conducted to assess influences of malnutrition on persistence of goiter frequency while iodine intake is sufficient. 1504 school age children [8-10 year] were selected randomly and examined in south of Iran - Firoozabad. 102 cases with goiter grade 2 and 3 were found. 100 completely normal children regarding thyroid examination were also selected randomly as control. Growth parameters [Weight for age, Height for age and Body Mass Index] and urinary iodine as an indicator of iodine intake were assessed in both groups. Median of urinary iodine was 21 micro g/dL in patients. [>10 micro g/dL indicates sufficiency of iodine intake.] Regarding growth indicators there was not statistically significant difference between the two groups, which rules out malnutrition as a cause of persistence of goiter. On the other hand our study may show that malnutrition [several nutritional deficiencies] could be as a cause of goiter just in the presence of iodine deficiency. Larger studies in iodine sufficient but with more severe malnutrition or comparison of frequency of goiter before and after nutritional improvement in a population with malnutrition and iodine sufficiency may be more helpful. Malnutrition per se could not be considered as a cause of goiter when iodine intake is sufficient

longitudinal growth study from birth to maturity for weight, height and head circumference of normal Iranian children compared with western norms: a standard for growth of Iranian children

At the present there is no growth reference for Iranian children, and cross-sectional studies indicate that Iranian children grow at a lower percentile curve than Western children. Aim: The present longitudinal study was undertaken: 1. To establish a growth standard for Iranian children and, 2. To compare their growth with Western norms. Weight, length, height, and head circumference were measured from birth to maturity in 180 boys and 180 girls living in Shiraz in socioeconomic conditions similar to high income groups in Western Europe and USA. Raw data and smoothed distance curves are reported here. The 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles of the measurements were not significantly different from London and NCHS standards. 1. These data can be used as standard for the growth of Iranian children. 2. The growth potential for Iranian children is similar to that of West European and US children. 3. Data from crosssectional studies performed in developing countries should not ideally be used as standards

Prevalence of phototherapy-induced hypocalcemia

Hyperbilirubinemia is the single most common abnormal physical finding in the first week of life and is commonly managed by phototherapy with its inherent complications. A lesser known complication of the phototherapy is hypocalcemia. To study the prevalence of phototherapy-induced hypocalcemia and to compare it between premature and full-term babies. This study was performed on 153 jaundiced neonates [62 premature, 91 full-term] that were managed with phototherapy. These neonates were completely normal on physical examination. Serum calcium was checked on arrival, 48 hours after starting phototherapy and 24 hours after discontinuation of the treatment. The first samples were considered as controls. A comparative study was made between these groups to determine the prevalence of hypocalcemia. Twenty- two neonates [14.4%] developed hypocalcemia. There were significant differences between the prevalence of hypocalcemia in premature [22.6%] and full-term neonates [8.7%] [p= 0.018]. None of the hypocalcemic neonates was symptomatic clinically. Serum levels of calcium returned to normal 24 hours after discontinuation of phototherapy in almost all hypocalcemic neonates. The study shows that neonates under phototherapy are at high risk of hypocalcemia. This risk is greater in premature neonates

Thyroxine and thyrotropin levels in cord blood sera from south Iran

Birth is associated with significant changes in the hypothalamic-pituitary-thyroid axis and these changes complicate the proper assessment of thyroid function in neonates. Normal values forT[4] [thyroxine] and TSH [thyroid stimulating hormone] in cord blood are not well established. The present study was carried out on 4000 specimens of cord sera of both sexes in order to establish reliable reference values for these hormones. Our data imply that the level of T[4] in cord sera [mean +/- 1 SD: 10.99:1:2.46 micro g/dL] is less than that of the neonatal period but is comparable to that of older infants. The concentration of TSH [mean +/- 1 SD:7.09+4.54 micro/mL] is comparable to the level expected in the first week of life but is higher than that of older infants. The values of T[4] and TSH obtained from cord blood of boys and girls did not show any statistically significant differences. It is suggested that these values can be used as normal reference values for T[4] and TSH in cord blood

Experience with 115 patients with congenital adrenal hyperplasma and evaluation of growth patterns in 24 patients with the salt-losing type

In this study the data on 115 cases of congenital adrenal hyperplasia [CAH] who were followed in the Pediatric Endocrine Clinic at Nemazee Hospital, Shiraz will be reported Among these cases 51 were male and 64 female. The most common type of CAH in these patients was the salt-losing type of 21-hydroxylase deficiency [85.2%]. 11-hydroxylase deficiency was present 13.04% of patients. There was only one case with 20,22-desmolase deficiency and one also with 3-beta-hydroxysteroid dehydrogenase deficiency. Presenting complaints were ambiguous genitalia, vomiting, failure to thrive, precocious puberty and hypertension. The analysis of data on 24patients with the salt-losing type of 21-hydroxylase deficiency who were followed for at least 2 years showed that these patients suffered from abnormal growth patterns. Growth failure was maximal during the first year of life

Congenital permanent diabetes mellitus with hypoplasia of the pancreas: report of 2 cases and review of the literature

Two siblings [a girl and a boy] with intrauterine growth retardation and early onset insulin dependent diabetes mellitus, who had a clinical syndrome consistent with congenital pancreatic hypoplasia will be reported

Type I diabetes [iddm]; an epidemiological study from southern Iran

This epidemiological study was carried out to determine the prevalence of IDDM in the age group of 0-18 years in southern Iran. To ensure completeness of the data, two different sources were used: School Health Services and patient records from hospitals and diabetic clinics where all diabetic cases are referred for management. To evaluate the effect of environmental factors in the pathogenesis of the disease, for each diabetic child two of his or her classmates were selected as controls. The prevalence of diabetes in the age group zero to 18 years was 40.83 per 100,000 children. The annual incidence of diabetes in this age group was 4/100,000 with a higher frequency in females. A seasonal variation was noted in the onset of symptoms; highest during October and lowest during August [p<0.001]. Analysis of breast feeding practices did not reveal any significant difference between the diabetic and the control groups [median duration 4.47 months]. Positive history of insulin- requiring diabetes in the first degree family members of 184 cases of IDDM and 462 control subjects was 15.2 and 1.3% respectively [p<0.001]. Both patients and controls, reported a similarly low frequency of NIDDM in their first degree relatives [6.5% in patients and 4.8% in the control group]. Determination of major blood groups and Rh in diabetics and control population showed a lack of association between IDDM and blood group and Rh [p=0.15]. The majority of the patients presented initially with the classical signs and symptoms of diabetes and 15% presented with diabetic ketoacidosis

Congenital lipoid adrenal hyperplasia in a two-year old phenotypic female: report of a case and literature review

Congenital lipoid adrenal hyperplasia is a genetically transmitted, fatal disorder manifested by severe adrenal insufficiency and lack of differentiation of the external genitalia in males. In this report, a two-year old phenotypically female patient with this disorder is presented. The diagnosis was based on manifestation of salt loss during the first week of life. A buccal smear was negative for nuclear chromatin and a karyotyping study revealed a 46-XY genotype

Immunosuppression with azathioprine and prednisolone in recent-onset insulin-dependent diabetes mellitus

Fifteen patients [mean age 8.5 years range 4 to 12] with newly diagnosed insulin-dependent diabetes mellitus were randomly selected for this study. The patients were admitted within eight weeks of the beginning of their symptoms. The therapy consisted of daily oral corticosteroids [2mg/kg] for 10 weeks and daily oral azathioprine [2mg/kg] for one year

Neonatal primary hyperparathyroidism: report of two clinical cases without bone lesions and literature review

Primary hyperparathyroidism is reported in two neonates from unrelated parents. Clinical signs became apparent during the first weeks of life and included severe respiratory distress, muscular hypotonia, failure to thrive and polyuria. Both patients had marked hypercalcemia, hypophosphatemia, increased plasma immunoreactive parathyroid hormone and increased fractional clearance of inorganic phosphate in the urine. Radiography revealed normal bone density without sign of hyperparathyroidism. Since they did not respond to medical therapy, a near total parathyroidectomy was performed at 2 months of age for the first case and at 1 month of age for the second. The characteristic pathologic changes of the glands were those of chief cell hyperplasia. Post-parathyroidectomy, both patients developed hypocalcemia which was controlled with vitamin D and calcium therapy

Thiamin responsive anemia, report of 3 cases and review of the literature

Three cases of megaloblastic anemia in children with concurrent hyperglycemia and sensorineural deafness are described. Therapy with folic acid and vitamin B[12] had little effect. The anemia responded to thiamine administration [100 mg/day] within 14 days. The hyperglycemia of the youngest patient <3 yrs old resolved but not that of the oldest [6 yrs old]. It is believed that hyperglycemia and sensorineural deafness can be corrected in cases of thiamine-responsive megaloblastic anemia if therapy can be started at a younger age. In all three cases the parents were related