Enrolment Phase Results of the Tabari Cohort Study: Comparing Family History, Lipids and Anthropometric Profiles Among Diabetic Patients

OBJECTIVES: Different factors are responsible for the silent epidemic of diabetes mellitus in developing and developed countries. This study aimed to determine the role of demographic factors, lipid profile, family history (the estimation of genetic association) and anthropometric factors on diabetes onset. METHODS: Data from the enrolment phase of the Tabari Cohort study was applied for this study and included 10,255 participants aged between 35–70 years. Anthropometric variables were measured by trained staff using standard tools. Blood specimens were collected for lipid profile and blood glucose measurements. Data analyses were performed using SPSS version 24, with univariate and multivariate logistic regression. RESULTS: The prevalence of diabetes mellitus was estimated to be 17.2% in the cohort population, 15.6% in men, and 18.3% in women. The adjusted odds ratios (95% confidence intervals) for age groups 40–49, 50–59 and over 60 were 2.58 (2.20–3.69), 5.80 (4.51–7.48) and 8.72 (6.67–11.39), respectively. In addition, the odds ratios (95% confidence intervals) for 2 (or more), and 1 affected family member were 4.12 (3.55–4.90) and 2.34 (2.07–2.65), respectively. Triglyceride concentrations more than 500, and abnormal high-density lipoprotein levels increased the odds of diabetes mellitus by 3.29- and 1.18-fold, respectively. CONCLUSION: The current study showed that old age and a family history were strong predictors for diabetes mellitus.

Insulin therapy: Side effects and their management

Insulin has an important and vital role in control of blood glucose for all diabetic patients. With increasing the prevalence of diabetes mellitus, insulin consumption will be increased too. Different types of insulin are available, i.e. short, rapid, intermediate and long acting insulin and also mixed insulins. The side effects of insulin may lead to the lack of a desirable control of blood sugar or discontinuing insulin injection by the patients. On the other hand sometimes the side effects of insulin can be serious and fatal. Therefore, information about these complications and how to deal with them are very important. Hypoglycemia, weight gain, antibody-mediated insulin resistance, lipodystrophy [atrophy or hypertrophy], edema, postural hypotension and allergic reactions to insulin are major side effects of insulin therapy

Thyroid disorders in rheumatoid arthritis and osteoarthritis

Auto immune disorders such as rheumatoid arthritis [RA] and thyroid disorders are caused by a reaction of the immune system against self antigens and there is a tendency for more than one syndrome in a patient. Our objective was to determine the prevalence of thyroid disorders in patients with RA and compare it with that in osteoarthritis [OA] patients, as well as determination of characteristics of RA patients with thyroid disorders. Subjects were 80 patients with RA and 80 age and sex matched patients with osteoarthritis. All participants were examined for thyroid disorders by physical examination and thyroid function tests. Criteria of disease activity in RA patients were recorded. Clinical hypothyroidism was observed in 13 [16.3%] of RA patients, which was not significantly different from controls [p=0.3]. Existence of antithyroid peroxidase antibody [Anti TPO Ab] was lower in RA patients [20% vs. 36.3%] [p=0.02] and thyroid nodules were more prevalent in RA patients [17.5% vs. 7.5%] [p=0.1]. There were two RA patients with subclinical hyperthyroidism. No significant difference was found in patients' age, seropositivity and disease activity in RA patients with or without thyroid disorders [p < 0.05]. Patients with RA and OA did not have any significant difference in thyroid dysfunction. RA patients did not have any particular characteristic pointing to a requirement for assessment of thyroid disorders, too. Because of its importance in cardiovascular disorders, monitoring of thyroid function in all patients with RA is recommended

Relationship between serum parathyroid hormone and hypertension in hemodialysis patients

Prevalence of hypertension is high in hemodialysis patients. Increase of intracellular calcium due to hyperparathyroidism is one of probable factors for hypertension in hemodialysis patients. In this study, the relationship between serum parathyroid hormone [PTH] level and severity of hypertension in hemodialysis patients was investigated. In a case-control study, 50 hemodialysis patients with hypertension were compared with 50 hemodialysis patients without hypertension. The two groups were comparable in age, sex, body mass index, hemodialysis duration, KT/V, serum calcium, hemoglobin, and erythropoietin dose. Serum PTH level was measured in the two groups. The mean age was 57.0 +/- 7.7 years in the hypertensive group and 56.4 +/- 6.0 years in the control group [P = .61]. The mean hemodialysis duration was 15.28 +/- 5.74 months in the hypertensive group and 14.98 +/- 6.35 months in the control group. The mean serum PTH was 487.18 +/- 408.85 pg/mL in hypertensives [445.12 +/- 447.92 pg/mL in stage 1 of hypertension and 561.94 +/- 326.67 pg/mL in stage 2 of hypertension, P = .003] and 170.64 +/- 122.09 pg/mL in the case group [P = .001]. According to this study, there is a positive relationship between serum PTH and severity of hypertension in hemodialysis patients. We conclude that control of secondary hyperparathyroidism might be helpful in controlling hypertension in hemodialysis patients

25-hydroxyvitamin D deficiency in kidney transplant recipients

After kidney transplantation, patients appear to have vitamin D deficiency due to the use of immunosuppressive treatment and prevention of sunlight. This study was designed to determine vitamin D serum levels in kidney transplant patients in comparison with healthy individuals. Forty-six kidney transplant patients with a creatinine clearance greater than 60 mL/min and 46 healthy individuals with normal kidney function were tested for serum levels of calcium, phosphorus, 25-hydroxyvitamin D, and parathyroid hormone at the end of the summer. Thirty-one participants were men and 15 were women in each group. The mean age was 41.0 +/- 14.2 years in kidney transplant recipients and 41.4 +/- 13.7 years in the control group. Inadequate serum 25-hydroxyvitamin D was seen in 93.5% of the transplant patients and in 89.1% of the controls. There was a 58.7% vitamin D insufficiency [20 ng/mL to 30 ng/mL] and a 34.8% deficiency [lower than 20 ng/mL] in the patients, and these rates were 58.7% and 26.0% in the control group, respectively. There was no significant difference between the two groups. Vitamin D deficiency is prevalent in kidney transplant patients. Lack of a significant difference between our two groups may be attributable to the high prevalence of vitamin D deficiency in general population and the use of vitamin D supplementation in transplant patients. Indeed, adequate doses of vitamin D in these patients are undetermined. They may need higher doses for normalization of serum vitamin D and metabolic requirements

48-year-old woman with left subclavian artery occlusion and intrathoracic lymphadenopathy

Sarcoidosis is a systemic disorder characterized by noncaseating granulomas, involving multiple organs including thyroid and great vessels. We present a 48 year-old women with sarcoidosis, left subclavian artery occlusion and sarcoidal thyroid gland involvement. The patient presented with a 1 week history of progressive left upper limb pain with coldness of left hand and fingers. On examination, radial, ulnar, and brachial artery pulses were not palpable. She had also enlarged thyroid gland with firm consistency. CT angiography of aortic arc demonstrated occlusion of left subclavian artery. Because of progressive ischemic necrosis of left hand and fingers, amputation above elbow was performed. Fine needle aspiration [FNA] was suspicious for thyroid neoplasm and total thyroidectomy was performed. Thoracic CT scan showed mediastinal and bilateral hilar lymphadenopathy. Fiberoptic bronchoscopy with transbronchial needle aspiration [TBNA] from right hilar lymph nodes and endobronchial biopsy showed multiple granulomas with negative acid-fast stain. Pathologic examination of thyroid also revealed fibrosis and granulomatous inflammation. On follow up, the ACE level was 104 u/l

Correlation between amputation of diabetic foot and nephropathy

A diabetic foot lesion remains a major cause of morbidity in diabetic patients with chronic kidney disease. We studied the relation between kidney function and the risk of amputation in patients with diabetic foot. We reviewed retrospectively the charts of 244 patients admitted to Imam Khomeini Hospital of Sari, Iran, for diabetic foot from 1996 to 2005. Their clinical characteristics and kidney function indicators, including urine protein excretion and serum creatinine were analyzed and compared between amputees and nonamputees. There were 244 patients with diabetic foot who were admitted to our center during the studied period. The duration of being affected by DM was between 3 months and 34 years [mean, 11.80 +/- 6.81 years]. Sixty-six patients [27.0%] underwent amputation. The amputees were older than the nonamputees [61.1 +/- 11.5 years versus 55.6 +/- 12.5 years, P < .001]. There were 20 patients [30.3%] in the amputee group and 44 [24.7%] in the nonamputee group who had proteinuria [P = .38]. The mean creatinine level was significantly higher in the amputees compared to the nonamputees [1.78 +/- 1.36 mg/dL versus 1.28 +/- 1.23 mg/dL, P - .03]. Lower extremity amputations in our patients with diabetic foot were strongly associated with elevated serum creatinine levels. The presence of this complication necessitates intensifying actions in order to prevent amputations

[Evaluation of therapeutic effect of capsaicin pomade [Caspian 0.03%] in hemodialysis related pruritus]

Pruritus is one of the common problems in hemodialysis patients with end stage renal disease. Approximately, 60% of these patients suffer from this condition. There are several causes for pruritus, thus, various treatments are applied in order to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in hemodialysis patients. This randomized double blind cross over clinical trial study, was performed on 34 hemodialysis patients with uremic pruritus in 1386. All patients were divided in two groups. One group received Caspian 0.03%, while the other, placebo for four weeks. Treatment was stopped for two weeks and continued as cross over technique. Pruritus scores were analyzed with Paired t-test and Repeated measurement ANOVA. In this study, the difference between Mean of pruritus score before capsian treatment and in weeks following 1 to 4 was statistically significant [P=0.0001]. In placebo group, the difference between pruritus score before treatment and in weeks 1 to 4 was statistically significant [P=0.0001]. There was no significant difference before treatment in two groups, however, after each week, the difference was significant [P=0.0001]. Repeated measurement test showed that reduction in pruritus severity in capsian group was more than placebo group, during treatment period [P=0.0001]. Although our study indicated the appropriate effects of Capsian in pruritus, the placebo also has a good effect in controlling hemodialysis related pruritus. Our placebo had emollient property; therefore, we can apply it to control the pruritus in these patients

[Acute pancreatitis in severe leptospirosis infection]

Leptospirosis is a Zoonotic disease that rarely manifests in a severe manner, [Weil's syndrome]. Regarding epidemiology of this disease, in some rural areas of Mazandaran Province we encountered a rare case of acute pancreatitis during progression of severe Leptosprosis is presented herein. Patient is a 50 year old male farmer who was admitted to the hospital due to experiencing 10 days of fever, myalgia, vomiting, jaundice and abdominal pain. He underwent haemo-dialysis due to acute renal failure only once. Direct bilirubin was 31.7 mg/dl with serum amylase, while lipase was three times more than normal levels. The CT-Scan demonstrated diffuse pancreatic enlargement. The IgM titer fourfold which was more than normal level against leptospirosis [ELISA] confirmed the diagnosis. Patient was cured completely through supportive care and antibiotic therapy, thus, this case was reported in drawing attention to Leptospira infections, which should be considered in the differential diagnosis of patients with jaundice and pancreatitis

[Evaluation of levothyroxine effect on pulmonary function in hypothyroidism]

Hypothyroidism is one of the most common diseases in endocrinology Thyroid hormone deficiency effects on nerve and muscle fibers, pulmonary system and alveolar ventilation. The aim of this study was to evaluate the effect of Levothyroxine therapy on pulmonary function in hypothyroidism patients in Imam Hospital. This study was performed on 50 patients with hypothyroidism in Imam Hospital, Sari, Iran, 2006-2007. After a detailed clinical history and systemic examination, level of TSH, T4 and ABG test, chest radiography and spirometery was performed in all patients. The spirometery indexes including FVC, FEV1, FEV1/FVC, FEF 25-75, PEF were recorded. All patients treated with Levothyroxine 1.6 microg/kg. After that all systemic and clinical examination, and chest radiography and spirometery performed again. Results analyzed by means of SPSS [11] software and paired t test. The p value less than 0.05 was considered to be significant statistically. 50 female patients, with mean age of 34.98 +/- 13.4 years were studied. The mean of TSH, T4 before treatment were 51.44 +/- 25.3 mIu/l and 2.8 +/- 0.9 microg/dl and after treatment were 3.64 +/- 2.4 mIu/l and 9.80 +/- 4.9 microg/dl respectively [P= 0.0001]. The ABG parameters were in normal range and there was no statistically significant difference between before and after treatment. Statistical analysis demonstrated significant differences between mean of FVC, FEV1, FEV1/FVC, FEF 25-75, and PEF before and after treatment. Our study demonstrates that treatment of hypothyroidism with Levothyroxine can improves the pulmonary function according to spirometery findings

[ study on 6-18 years-old girl students about weight and height in Sari]

Measurement of height and weight of children and adolescents are important sources of information and the best index for evaluation of their growth and nutritional and health status of society. This study performed to evaluate weight, height and pubertal stage of girls in sari. This cross - sectional study was performed on 1320 6-18 years old school girls in elementary guidance and high school of Sari. Their height, weight and pubertal stage were evaluated and recorded by educated personas. Also Body Mass Index was calculated and recorded. Then Z score [SDS] of weight, height and the Body Mass Index studied people was compared by using calculated standard curve and findings in NCHS curve and findings of 1997 in Sari. For analyzing data, descriptive statistics, Mean +/- SD, Frequency and percent were used. By using NCHS curve 1256 persons [95.2%] from total persons that were studied, had normal height [5 - 95 percentile] and the weight of 1254 persons [95%] were in 5 - 95 percentile. 2/5 centemers increasing in height and 2.5 Kg increasing in weight were seen in comparison to 1997 study. BMI of persons in all age groups [expect 17 year old with +/- 0.05 SD] were over than 50 percentile and mean age of beginning of menarche was 11.4 +/- 1.1. Our study in Sari shows the improvement in growth index in comparison to 1997 study which become near to standard curve in developed country