[Effective risk factors for foot skin in diabetic patients]

Introduction: foot ulceration is one of the most serious and disabling complications of Diabetes Mellitus and identification of risk factors affecting foot ulcer can prevent it from causing irreparable consequences

Objective: therefore the aim of this study was to comparing the situation of the foot skin in diabetic patients with and without foot ulcers

Methods: in this cross - sectional study of 355 diabetic patients referred to Razi Hospital in 2013 were randomly selected based on a questionnaire consisted of four parts: demographic profiles, clinical characteristics, skin situations and diabetic foot, by a trained nurse were studied. History of the disease based on Charlson Co morbidity Index and foot ulcers by Wagner ulcer classification system were evaluated. Patients were divided into two groups of foot ulcer and non-ulcer and each of the variables were compared between these two groups. We used Chi square test and logistic regression analysis to compare some variables. P-value less than 0.05 was considered significant

Results: based on these findings, 16.1% had foot ulcers. Dry skin with no sweating, pallor, fisher, edema, impaired growing toe nails in the group with ulcer was [89.47%, 42.1%, 26.31%, 21.05%, and 64.91%] and in the group without ulcer was [73.48%, 35.9%, 11.74%, 12.08%, and 48.65%]. There is significant correlation between foot ulcers and dry skin [p=0.01], fissure [p=0.004] and impaired growth toenail [p=0.02].Risk of foot ulcers in people with dry skin 3.07 times, the people of Fisher 2.68 times in people with impaired growth and toenails 1.95 times higher

Conclusion: since skin problems affecting the foot ulcer, nurses by identifying risk factors played a role in the prevention and treatment of foot ulcers

[Survey the changes of thyroid functional tests in patients with liver cirrhosis due to hepatitis B and C and correlation of thyroid hormone levels with severity of liver dysfunction]

The liver played an important role in the metabolism of thyroid hormones and was involved in their conjugation, excretion and peripheral deiodination in synthesizing Thyroid Binding Globulin [TBG]. Thus liver dysfunction can be influenced thyroid function. Determine the changes of thyroid functional tests in patients with liver cirrhosis due to hepatitis B and C and correlation of thyroid hormone levels with severity of liver dysfunction. Sixty Four Cirrhotic patients due to hepatitis B and C referring to Razi hospital were studied during 2007-2009 years. Data were collected by prepared questionnaire. Thyroid hormone levels were measured in a unit laboratory. Liver dysfunction was scored by MELD and child pugh scoring systems. Mann-Whitney U, chi square and kruskal wallis test were used for measuring severity of liver dysfunction. Among 64 patients, [42 patients were male and 22 patients were female]. Mean age of patients was 55.03 +/- 12.05. Level of TT3 TT4 and FT3 had decreased in the majority of patients, TT3, TT4 and FT3 levels. There was a correlation between level of TT3 and severity of liver dysfunction base on Child score [p=0.0001] and MELD [p=0.02].There was a reciprocal correlation between TT3 level and probability of the history of digestive systems bleedings, Ascites and encephalopathy [P=0.01, P=0.011, P=0.009] .It means that when TT3 level was low probability of this complication was high. This study showed that liver disease is accompanied by changes in thyroid hormone levels specially decrease the level of TT3, TT4, FT3 and it is indicated that TT3 level can be used as liver function index in cirrhotic patients due to hepatitis B and C

Anaplastic thyroid carcinoma, a report on 10 cases

Anaplastic thyroid carcinomas are undifferentiated and highly aggressive tumors of the thyroid follicular epithelium, with a disease-specific mortality approaching 100 percent. This study reports ten cases with advanced anaplastic thyroid carcinoma with ineffective surgical interventions. Between 2001-2006, we treated 10 patients with anaplastic carcinoma of the thyroid. All patients presented with advanced phase and were documented by pathological study. The surgical intervention was thyroidectomy in 3 cases, debunking surgery in other three, just tracheostomy in three cases, and only biopsy in one patient. All of our patients died in 4 days to 8 months after surgery. Surgical intervention had no benefit in treatment of advanced anaplastic carcinoma of the thyroid and the suitable surgical intervention was to maintain an open airway. Early recognition of the disease is essential to allow prompt initiation of therapy. There is no cure for advanced situations, and surgery, radiotherapy, and chemotherapy play no important role in the treatment

[Prevalence of metabolic syndrome among 3-9 years old children inTehran lipid and glucose study]

The metabolic syndrome is a constellation of risk factors that increase the incidence of cardiovascular disease and type 2 diabetes mellitus in adults. Some studies in recent years have found evidence of initiation of this disease in childhood and of the association of childhood obesity with adult cardiovascular disease and diabetes. The present study was carried out to determine the prevalence of risk factors for metabolic syndrome in children, in order to prevent, or at-least decrease the occurrence of fatal cardiovascular and diabetic complications. In a cross-sectional study within the framework of the Tehran Lipid and Glucose Study [TLGS], 1067 children, 3-9 years of age, including 506 boys and 561 girls were investigated. Weight and height was measured and BMI calculated. Fasting blood samples for the measurements of glucose and lipid concentrations were drawn. A qualified physician measured blood pressure three times in a seated position using a standard mercury sphygmomanometer and the mean of three measurements was considered as the participant's blood pressure. After gathering the results of basic measurements, all results, except blood pressure were matched with Iranian tables of percentiles of BMI and lipids for age and sex. For blood pressure we used the world wide accepted NCHS tables. 'At risk of overweight' was defined as >/=85th to <95th percentile of BMI for age and sex. Subjects with three or more characteristics of the following components of metabolic syndrome were categorized as having the syndrome [1] BMI>/=95th percentile for age and sex [2] TG>/=95th percentile for age and sex [3] HDL cholesterol <5th percentile for age and sex [4] Impaired fasting glucose [FBS between 100-125 mg/dl] [5] systolic/ diastolic blood pressure>95th percentile for age, sex, and height. Prevalence of metabolic syndrome was 0.9 percent, [95%CI:0.3-1.5] overall, 8.9 percent in overweight youngsters, 0.3 percent in at risk of overweight and only 0.1 percent in the normal weight group. Prevalence increased with increases of body-weight with a significant difference between overweight children and other BMI groups. Overall, 12 percent of children were at risk of overweight, 8.4 percent were overweight, with no significant difference between two sex groups. Most prevalent components of metabolic syndrome in overweight children were hypertension and high TGL, [14.4%] low HDL and impaired fasting glucose were next in order of frequency. In comparison with subjects with normal weights, the difference in hypertension was significant in overweight children, [P<0.01].TGL was significantly different from normal weight group [P<0.01] and also with at risk of overweight [P<0.05]. This study showed a low prevalence of metabolic syndrome among Iranian children but the prevalence of this syndrome in overweight youngsters was significantly higher than other BMI groups. The prevalence of at risk of overweight of 12 percent on one hand, and the high rate of transition of overweight children into obese adults in subsequent years of life on the other hand, is alarming. Special attention to weight control through nutritional counseling and increased physical activity during childhood and adolescence is recommended

[Giant parathyroid adenoma presenting with bone pain]

Primary hyperparathyroidism is a quite frequent disorder however, giant parathyroid adenoma is a rare entity. We described a 39-year old woman presenting with lower extremities bone pain within the recent 3 years. She had been receiving levothyroxin during the past 10 years due to hypothyroidism, meanwhile, she had a bulge right thyroid lobe. Laboratory examinations revealed she was euthyroid, however, scanning showed parathyroid adenoma. During surgery, an adenoma measured 2x3x6cm, weighted 22gr was resected. Giant parathyroid adenoma present with non-characteristic symptoms, thus, routine laboratory measurements including serum calcium and phosphorous should be proposed for suspected individuals