Protein-energy malnutrition in goitrous schoolchildren of Isfahan, Iran

Some studies have shown the possible role of protein-energy malnutrition [PEM] in persistence of endemic goiter in iodine replenished areas. The present study was conducted to assess the association between PEM and goiter in schoolchildren of Isfahan, Iran. In a cross-sectional study using multistage cluster random-sampling, 2331 schoolchildren with age ranged from 6-13 years old with a female to male ratio of 1.60 were enrolled. Thyroid size was examined by two endocrinologists for goiter detection. Children were considered goitrous if they had palpable or visible goiters according to World Health Organization [WHO]/United Nations children's Fund/International Council for the Control of Iodine Deficiency criteria. Weight and standing height were measured using the standard tools and anthropometric indices were calculated using the WHO AnthroPlus software developed by the World Health Organization. Height-for-age Z-scores [HAZ], weight-for-age Z-scores [WAZ] and body mass index [BMI] for age were calculated for each child. Children with a HAZ, WAZ or BMI-for-age of Z-score < -2.0 were classified as stunted, underweight or thin, respectively. Blood samples were drowned to measure serum thyroid hormones. Overall, 32.9% of subjects were classified as goitrous. Weight, height, BMI, WAZ and BMI-for-age Z-score were significantly lower in children with goiter than in children who did not have goiter [P < 0.05]. The prevalence of goiter in thin children was higher than that in non-thin ones [48.4 vs. 31.6%, odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.52-2.69, P < 0.001]. Although 33.4% of non-stunted children were goitrous, 31% of stunted ones had goiter [P = 0.5]. According to the logistic regression model taking sex and age as covariates, the only significant parameter affecting palpable goiter detection was thinness [OR = 2.13, 95% CI: 1.22-3.69, P < 0.001]. In the present study, we found a high prevalence of goiter in children who were malnourished. It seems that PEM may play a role in the still high prevalence of goiter in this region

Absence of association between -1131T>C polymorphism in the apolipoprotein apoa5 gene and pediatric metabolic syndrome

In the present study, we evaluated the association of rs662799 variant of the APOA5gene with Metabolic syndrome [MetS] in a sample of children and adolescents from Isfahan. This case control study comprised 50 cases of MetS and 50 controls. Mismatched polymerase chain reaction-restriction fragment length polymorphism [mPCR-RFLP] was used to genotype -1131T>C polymorphism. No significant association was documented for APOA 5 genotypes with the measured laboratory parameters for CC, CT, and TT genotypes in the two groups studied. By logistic regression using a dominant model, the odds ratio [95% confidence interval 10 for the MetS was 0.38 [0.139-1.0350 and 0.29 [0.08-1.071 for the unadjusted and adjusted models, respectively. This study suggests that among studied children and adolescents, -1131T>C polymorphism in the APOA5gene may not be a major contributor to the MetS risk

G395R mutation of the sodium/iodide symporter [NIS] gene in patients with dyshormonogenetic congenital hypothyroidism

Considering the high prevalence of congenital hypothyroidism [CH] in Isfahan and its different etiologies in comparison with other countries, the high rate of parental consanguinity, and the role of NIS gene in permanent CH due to dyshormonogenesis, the aim of this study was to investigate the G395R mutation of the NIS gene in patients with permanent CH due to dyshormonogenesis. In this case-control study, patients diagnosed with permanent CH due to dyshormonogenesis during CH screening program were selected. Venous blood sample was obtained to determine the G395R mutations of NIS gene using polymerase chain reaction [PCR] sequencing method. In this study, 35 CH patients with permanent CH due to dyshormonogenesis and 35 neonates with normal screening results as a control group were studied. We did not find any changes of the mentioned mutation of NIS gene in the patients' group. Considering the findings of the current study, it seems that further studies with larger sample size and with consideration of other gene mutations such as pendrin and thyroglobulin are needed for more accurate conclusion

Prevalence of permanent congenital hypothyroidism in Isfahan-Iran

Considering the importance to determine the reasons for the higher occurrence of congenital hypothyroidism [CH] in Iran, in this study we report the prevalence of permanent CH [PCH] in Isfahan province 7 years after initiation of CH screening program in Isfahan. In this cross sectional study, children with a primary diagnosis of CH studied. They clinically examined and their medical files were reviewed by a pediatric endocrinologist. Considering screening and follow-up lab data, radiologic findings and the decision of pediatric endocrinologists the final diagnosis of PCH was determined. A total of 464,648 neonates screened in Isfahan province. The coverage percent of the CH screening and recall rate was 98.9% and 2.1%, respectively. A total of 1990 neonates were diagnosed with primary CH. PCH was diagnosed in 410 neonates. The prevalence of PCH and transient CH [TCH] was 1 in 1133 and 1 in 294 live births. The most common etiology of CH was thyroid dyshormonogenesis. Though the prevalence of PCH is high, but the higher prevalence of CH in Isfahan is commonly due to cases with TCH. Hence, the necessity of determining new strategies for earlier diagnosis of patients with TCH is recommended

The effect of low glycemic index diet on body weight status and blood pressure in overweight adolescent girls: a randomized clinical trial

Although several studies have assessed the influence of the glycemic index on body weight and blood pressure among adults, limited evidence exists for the pediatric age population. In the current study, we compared the effects of low glycemic index (LGI) diet to the healthy nutritional recommendation (HNR)-based diet on obesity and blood pressure among adolescent girls in pubertal ages. This 10-week parallel randomized clinical trial comprised of 50 overweight or obese and sexually mature girls less than 18 years of age years, who were randomly assigned to LGI or HNR-based diet. Macronutrient distribution was equivalently prescribed in both groups. Blood pressure, weight and waist circumference were measured at baseline and after intervention. Of the 50 participants, 41 subjects (include 82%) completed the study. The GI of the diet in the LGI group was 42.67 +/- 0.067. A within-group analysis illustrated that in comparison to the baseline values, the body weight and body mass index (not waist circumference and blood pressure) decreased significantly after the intervention in both groups (P = 0.0001). The percent changes of the body weight status, waist circumference and blood pressure were compared between the two groups and the findings did not show any difference between the LGI diet consumers and those in the HNR group. In comparison to the HNR, LGI diet could not change the weight and blood pressure following a 10-week intervention. Further longitudinal studies with a long-term follow up should be conducted in this regard.

Hearing impairment in congenitally hypothyroid patients

Thyroid hormone is necessary for normal development of the auditory system. The aim of this study was to investigate the rate of hearing impairment in congenitally hypothyroid [CH] patients, and its relation with factors such as CH severity and age at starting treatment, during CH screening program in Isfahan. Hearing acuity was assessed in two groups of children with [94 patients aged 4 months - 3 years] and without CH [450], between 2000-2006. Otoacostic emission [OAE] was performed by a two step method. After two tests without OAE signals bilaterally, they were referred for auditory brainstem response [ABR] test. Subjects with both OAE and ABR abnormal test results were considered to have hearing problem. Obtained data was compared in case and control group and also CH patients with and without hearing impairment. Three [3.2%] of patients and 1 of control group [0.2%] were diagnosed with sensorineural hearing loss. The rate of hearing loss was not different significantly in two studied groups [P>0.05]. There was no difference between age of starting treatment and first T4 and TSH level in CH patients with and without hearing loss [P>0.05]. CH neonates with hearing impairment had thyroid dyshormonogenesis according to the follow up results. The rate of hearing loss was low among our studied CH patients. It may be due to proper management of CH patients. In view of the fact that all CH neonates were dyshormonogentic and considering the relation between certain gene mutations and hearing impairment in CH patients, further studies with larger sample size, with regard to different etiologies of CH should be investigated to indicate the possible gene mutations related to hearing loss in CH

case of congenital lipoid adrenal hyperplasia

Lipoid congenital adrenal hyperplasia [lipoid CAH], a rare disorder of steroid biosynthesis, is the most severe form of CAH. In this disorder the synthesis of glucocorticoids, mineralocorticoids and sex steroids is impaired which result in adrenal failure, severe salt wasting crisis and hyperpigmentation in phenotypical female infants irrespective of genetic sex. In this report, we presented a 28-day-old phenotypic female infant, which referred with lethargy, failure to thrive and electrolyte abnormalities. Considering the clinical and biochemical findings, lipoid CAH was diagnosed and replacement therapy with standard doses of glucocorticoid and mineralocorticoid and sodium chloride was initiated. During follow-up, she had good clinical condition, but at 6 years of age, she refers with hypertension and adrenal insufficiency because of arbitrary drug discontinuation by mother. In ultrasonography an abdominal mass [the testicles] was reported. Chromosome study showed 46XY pattern. Orchiectomy was performed. We recommended that in cases with clinical presentation of adrenal insufficiency if there is not the facility to determine the karyotype, repeated ultrasonography perform during follow-up. In addition, investigating the genetic bases of the disorder would help us to determine the pathogenesis of lipoid CAH in our community. It would be helpful in prenatal diagnosis and treatment of the disorder to prevent its related comorbidities

role of maternal thyroid stimulating hormone receptor blocking antibodies in the etiology of congenital hypothyroidism in Isfahan, Iran

Considering the role of maternal thyroid stimulating hormone [TSH] receptor blocking antibody [TRAb] in the etiology of congenital hypothyroidism [CH], this study aimed to determine TRAb among patients with CH in Isfahan, Iran. In this case-control study, patients with CH and their mothers were compared with a group of healthy neonates and their mothers. Venous blood samples were obtained for measurement of TRAb using enzyme-linked immunosorbent assay [ELISA] method among mothers and their neonates. TSH of mothers was also determined. The case group consisted of 65 patients with CH and their mothers; controls were 148 healthy neonates and their mothers. The prevalence of positive TRAb in patients with CH and their mothers was higher than in the control group [81.5% vs. 1.3% in mothers and 80% vs. 0% in neonates, respectively, P<0.05]. The relationship between the TRAb and occurrence of CH was significant [P<0.05], whereas the corresponding figure was not significant for TRAb and the level of maternal and neonatal TSH in case and control groups [P>0.05]. It seems that autoimmunity has an important role in the etiology of CH. Further studies are necessary to determine other autoantibodies in CH patients

Thyroid disorders in children and adolescents with type 1 diabetes mettitus in Isfahan, Iran

Studies in different populations have shown great variation in the prevalence of thyroid diseases in patients with type 1 diabetes mellitus [TIDM]. Our aim was to study the prevalence of thyroid disorders such as autoimmunity of thyroid [AIT], thyroid dysfunction, and goiter in children and adolescents with TIDM, compared with age- and sex-matched healthy controls in Isfahan. One hundred patients with TIDM who were referred to Isfahan Endocrine and Metabolism Research Center and 184 healthy schoolchildren matched for age and sex were included. They were examined for goiter by two endocrinologists. Thyroid function test and serum thyroid antibodies [anti-TPO Ab and anti-Tg AbJ were measured. The prevalence of subclinical hypothyroidism was high in both groups [18%]. TIDM patients had lower frequency of goiter [21% vs. 38%, P=0.001], and higher prevalence of positive AIT [22% vs. 8%, P=0.001], anti-TPO Ab positivity [19.3% vs. 5.3%, P=0.000], and anti-Tg Ab [11.1% vs. 6.4%, P=0.1] in comparison with the control group. Being positive for AIT in diabetic patients meant an odds ratio of 5 [Cl 95%: 1.5-15.6] for thyroid dysfunction. There was no association between age, sex, duration of diabetes and HbAic with serum anti-TPO Ab and anti-Tg Ab concentrations in this group. Our results demonstrated the high prevalence of AIT and thyroid dysfunction in patients with TIDM. We suggest regular thyroid function and antibody testing in these patients

case of atypical mccune-albright syndrome with vaginal bleeding

McCune-Albright syndrome [MAS] is a rare non-inherited disorder characterized by the clinical triad of precocious puberty, cafe-au-lait skin lesions, and fibrous dysplasia of bone. We report a girl with MAS, presenting initially with vaginal bleeding at the age of 17 months. Ultrasonography revealed unilateral ovarian cysts and ureteral and ovarian enlargement. Considering the clinical and paraclinical findings, the patient diagnosed as a case of gonadotropin-independent precocious puberty was treated with medroxy-progestrone acetate [MPA] for three months. During the follow up, recurrent episodes of bleeding, ovarian activation and cyst formation, as well as breast size development were reported. At the age of 5.5 years, fibrous dysplasia was detected, which in coexistence with precocious puberty confirmed the diagnosis of MAS. The patient had no cafe-au-lait skin macles during follow up. Considering that clinical manifestations of MAS appear later in the course of recurrent periods of ovarian activation and cyst formation, a careful clinical observation and follow up of patients is necessary and the diagnosis of MAS must be kept in mind in cases with gonadotropin-independent precocious puberty

[Otologic problems in turner syndrome]

Turner syndrome is the most common sex chromosome abnormality in females, affecting an estimated 3% of all conceiving females. Otologic disease is a common problem in Turner syndrome patients that is due to a combination of small dysfunction Eustachian tube, palatal dysfunction and cochlear malformation. This study assessed the otologic and audiologic characteristics of a group of Turner syndrome patients. We studied 40 Turner patients aged 10 to 20 years [mean age: 15.84 years, SD= 2.67]. Pure tone audiometry was carried out for all of them. Forty percent of the patients reported a history of middle ear disease. Analysis of audiometric data in 40 patients tested reveals normal hearing in 47.5%, pure sensorineural hearing loss in 32.5%, pure conductive hearing loss in 17.5% and mixed hearing loss in 2.5% of patients. Careful follow up during early childhood of children with turner syndrome is necessary to detect middle ear disease and prevent the probable sequel. However, long term periodic follow up is mandatory even after resolution of middle ear disease to detect sensorineural hearing loss

Association of cell blood counts and cardiometabolic risk factors among young obese children

To determine the association of cell blood count with obesity and cardiometabolic risk factors in children. This cross-sectional study was conducted from 1 st November 2007 to 1 st October 2008 in the Obesity and Metabolic Syndrome Research Clinic of the Preventive Pediatric Cardiology Department, Isfahan Cardiovascular Research Center, Isfahan, Iran. It comprised 326 [172 girls and 154 boys] obese children aged 6-12 years. The mean age of participants was 8.8 +/- 2.7 years. A significant increasing trend in the mean body mass index [BMI], waist circumference [WC], triglycerides [TG], total- and low density lipoprotein [LDL]- cholesterol were documented across the quartiles of the white blood cell [WBC]count, and for waist-to-hip ratio and total cholesterol across platelet quartiles. A similar increasing trend was documented for BMI, waist and hip circumference, diastolic blood pressure, LDL-C, and for TG from the second to the fourth quartile of the red blood cells. By the increase in the number of components of metabolic syndrome, the mean BMI, WBC, and TG increased significantly. The highest correlation was documented between WBC count and TG. The WBC count increased the risk of increased BMI [odds ratio [OR]=1.45, confidence interval [CI] 95%; 1.11-1.65, p=0.001], increased WC [OR; 1.47, CI 95%; 1.15-1.74, p=0.001], and high TG [CI 95%; 1.241.06-1.44,p=0.005]. We found significant associations between CBC components and cardiometabolic risk factors in young obese children. The findings are confirmatory evidence of the pro-inflammatory state of obese individuals, even in young children

Comparison of dietary intake in children with type I diabetes mellitus and controls

The purpose of nutritional recommendations for children with type I diabetes mellitus [1DDM] is the control of blood sugar to decrease the long term complications of diabetes such as cardiovascular disease that should be prevented from the early childhood Still there are no precise data on compliance with these recommendations in diabetic children. To compare the dietary intake of children with IDDM and Controls and with current recommendations for children with IDDM. In this case-control study, 143 IDDM children and adolescents aged 4-18 years who visited at least three times a year in our research center were selected by continuous convenient sampling. Their nutrient intake was compared with 147 healthy controls matched for age, sex and area of residence. The nutrient content were analyzed by using the Nutritionist III software package and data were analyzed through SPSS software package [version 6]. P value <0.05 was considered significant. The data are presented as mean [ +/- SD] and frequencies. In the 4-6 years age group, the intake of total calories and fiber, in the 7-10 years age group intake of fiber, fat, protein, carbohydrate, sugar and saturated fatty acid [SFA], also the percentage of calorie intake from, fat, protein, carbohydrate, sugar and SFA, in the 10-14 year age group intake of sugar and fiber, also the energy intake from poly unsaturated fatty acid [PUFA] and sugar and in the 15-18 year age group the intake of fiber, total calorie, protein, carbohydrate and sugar in diabetic children were higher than the control group. In all age groups the energy intake of carbohydrates and fats were in the standard allowance limits, while percentage of energy consumed from protein in all age groups was slightly higher than standard allowances, bringing about the risk of nephropathy in diabetic children. The intake of fiber decreased by age and SFA intake increased by age, so, dietary educational measures on a national basis are needed to change unhealthy eating pattern in our community

[Relationship between pancreas echogenisity and insulin sensitivity during the course of OGTT in children with beta-thalassemia major aged 10-20 years]

Background: increased echogenicity of pancreas, due to hemosiderosis, is a frequent finding in beta thalassemic paitents. Hemosiderosis also leads to beta - cell dysfunction. So diabetes and glucose intolerance are common consequences of hemosiderosis. The aim of this study was to investigate the association of increased pancreas. echogenicity [IPE] with insulin sensitivity in beta - thalassemic children aged 10-20 years

Methods: after exclusion of thalassemic paitents with diabetes or familial history of diabetes, pancreas ultrasonography was performed in 42 beta-thalassemic children and they were divided into 2 groups with normal [21] and increased [21] pancreas echogenicity. Serum ferritin was measured, as well as serum insulin and glucose values, during an OGTT, at 0, 30, 60 and 120 minutes. A control group was selected randomly [n= 23]. Insulin Sensitivity Index and Fasting Glucose/Insulin Ratio were calculated and the data were analysed using t-test and ANOVA statistical methods

Results: serum feritin differed significantly between 2 groups of thalassemic paitents [P<0.005], but the insulin and glucose values were not significantly different among studied population [P>0.05]. Serum feritin was inversely correllated with ISI in patients IPE and 28.6% of them had IFG, as compared to patients with normal echogenicity [P<0.05]

Conclusion: regarding the detection of all IFG cases among thalassemic paitents with IPE and the relation of feritin with IS1 in this group, pancreas ultrasonography may be used to investigate the early stages of diabetes in these patients. however after conducting further studies with larger sample size and on older paitents are recommended