study of effectiveness of blended learning approach for medical training courses

Blended learning as a method of learning that includes face to face learning, pure E-learning and didactic learning. This study aims to investigate the efficacy of medical education by this approach. This interventional study was performed in 130 students at different clinical levels participating in class sessions on [congenital adrenal hyperplasia and ambiguous genitalia]. Sampling was done gradually during 6 months and all of them filled a pretest questionnaire and received an educational compact disk. One week later, a presence class session was held in a question and answer and problem solving method. Two to four weeks later, they filled a posttest questionnaire. There was a significant correlation between pretest and posttest scores and the posttest scores were significantly more than the pretest ones. Sub-specialized residents had the most and the students had the least attitude towards blended learning approach. There was a significant correlation between the research samples' accessibility to computer and their attitude and satisfaction to blended learning approach. Findings generally showed that the blended learning was an effective approach in making a profound learning of academic subjects

Serum zinc levels in children and adolescents with type-1 diabetes mellitus

There have been very few studies, with contradictory results, on the zinc status of children and adolescents with type-1 diabetes mellitus. The objective of this cross-sectional study was to determine zinc status based on the serum zinc concentration in type-1 diabetic children and adolescents and compare it with that of healthy controls. Thirty children and adolescents with type-1 diabetes mellitus, aged 6 to 18 years, and 30 age- and sex-matched healthy controls participated in the study. Serum zinc, fasting blood sugar, hemoglobin A[1c] and serum albumin were measured by flame atomic absorption spectrophotometry, enzymatic colorimetry, ion-exchange chromatography and colorimetry using bromocresol green methods, respectively. No statistically significant difference was found in the mean serum zinc concentration between diabetic patients and healthy controls [111.0 +/- 3.1 and 107.1 +/- 3.8 mg/dl respectively, P= 0.4]. No correlations were found between the serum zinc levels and fasting blood sugar, hemoglobin A[1c], or the duration of the disease in the patients. The zinc levels of diabetic children and adolescents are not noticeably different compared to those of healthy controls and are independent of glycemic control and the duration of the disease

[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

[ effect of long-acting LHRH agonists on linear growth of girls with constitutional precocious puberty]

Background: Central precocious puberty [CPP] is characterized by premature activation of the Hypothalamic-pituitary-gonadal axis, resulting In accelerated growth and bone maturation with clinical signs of puberty before the age of 8 years in girls. The most common type of CPP in girls is the constitutional type. Short adult stature is one of the most important outcomes of CPP that is due to early closure of epiphyses. The aim of this study was to determine the effect of a LHRH agonist on the final height of girls with precocious puberty

Materials and Methods: In this prospective study, 15 girls with a definite diagnosis of precocious puberty were selected and treated with decapeptyl, a longacting LHRH agonist, 60microg per kilogram of body weight as i.m. injections every 28 days

Results: The age and bone age ranges of the patients were 8-9.5 and 8-11.5 years, respectively. The predicted adult height increased from 151.34±3.6 cm at the beginning of treatment to 158.7±4.08 cm on the iast examination after 5 years of treatment [p<0.001]

Conclusion: The present data indicates that treatment with long-acting LHRH-agonists markedly affects final height in epp without any significant complications

Hypercalciuria, hyperphosphaturia and growth retardation in children with diabetes mellitus

Previous studies have demonstrated that patients with insulin-dependent diabetes mellitus [IDDM] have a high prevalence of osteopenia. Hypercalciuria has also been well documented in human diabetes and many children with insulin- dependent diabetes mellitus have short stature. To investigate the relationship of hypercalciuria and hyperphosphaturia with growth retardation in patients with IDDM. Forty patients with IDDM aged between 6 and 12 years whose mean heights were less than their 32 non-diabetic siblings of similar age group were enrolled in this study. Urinary and plasma calcium, phosphorus and creatinine levels were measured in both groups. Meanwhile, the height and body weight were determined. Both, the mean height and weight percentiles of subjects with IDDM were significantly less than those of nondiabetic siblings [p<0.001]. The height percentile of children with IDDM had negative correlation [r=-0.75, p<0.001] with the disease duration. The mean urinary calcium to creatinine [Ca/Cr] and phosphorus to creatinine [P/Cr] ratios were significantly higher in IDDM patients compared to their normal siblings [p<0.001]. The growth in the group of diabetic children correlated inversely and significantly [p<0.001] with hypercalciuria and hyperphosphaturia, duration of diabetes and HbA1C level. It is concluded that hypercalciuria and hyperphosphaturia may play a role in growth retardation of diabetic children

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

Anterior hypopituitarism associated with sickle cell trait in a 13-year-old boy

We are reporting a 13-year-old boy with hypopituitarism associated with sickle cell trait. The patient was referred with growth arrest since 10-year of age, and had evidence of growth hormone deficiency, hypoadrenalism and secondary hypothyroidism. A magnetic resonance imaging study revealed an empty sella with no evidence of tumor. Review of the literature showed three patients with sickle cell trait and hypopituitarism, all being in the third decade or later of life. To our knowledge, this patient is the first case of sickle cell trait with anterior hypopituitarism in childhood. This case supports a causal relationship between sickle cell trait and hypopituitarism

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 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

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 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

Pure gonadal dysgenesis, report of a case and review of the literature

We report a 16 year old phenotypic female who presented with delayed puberty. The patient had a eunuchoid habitus, no breast development and little pubic hair. External genitalia were normal. Serum gonadotropin levels were elevated but the plasma testosterone level was normal for a prepubertal woman. Karyotype of the peripheral blood showed a 46XY pattern- At laparotomy the patient was found to have an infantile uterus, normal fallopian tubes and bilateral streak gonads. Histological examination revealed bilateral small streak gonads with fibrofatty tissue

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

Incidence of congenital hypothyroidism in Fars province, Iran

The incidence of congenital hypothyroidism is high in Fars province, Iran, in comparison with the available data from other countries. In a pilot study of 4300 neonates an incidence of 1/1433 thyroid abnormalities was found. This finding suggests the necessity of screening all neonates delivered in this region for early diagnosis and treatment of congenital hypothyroidism