Effect of selenium on anti-Tg antibody in patients with autoimmune hypothyroidism: A randomized controlled trial.

Background: The current study intends to assess the impact of oral selenium intake on anti-Tg antibody in individuals with autoimmune hypothyroidism. Methods: In this double-blinded randomized controlled trial, two groups of 72 autoimmune hypothyroid patients were randomly assigned; one group received levothyroxine (LT4) and oral selenium and the other group was given placebo with LT4. Anti-Tg antibody, free T4, anti-TPO antibody, and TSH were identified in both groups before the treatment and also 3 months after treatment and analysis of data was done by SPSS software. Results: After the intervention, the average amount of anti-Tg antibody decreased in both of the groups, and this decrease was noticeably greater in the intervention group (P = 0.03). In the intervention group, the TSH level decreased after the intervention (p < 0.05), and the free T4 level increased after the intervention (p < 0.05); the changes in these two variables were statistically significant. Conclusion: Consumption of selenium, compared to placebo, in patients with autoimmune hypothyroidism drastically reduces the level of anti-Tg antibody, and it significantly increases the free T4 level. Also, there is a greater decrease in the level of TSH compared to the control group.

High-dose Vitamin D Supplementation and Improvement in Cognitive Abilities, Insomnia, and Daytime Sleepiness in Adolescent Girls.

INTRODUCTION: Vitamin D may affect the modulation of signaling pathways in the central nervous system. We aimed to evaluate the effect of high-dose vitamin D supplementation on neuropsychological functions in female adolescents. METHODS: We studied the effects of 9 weeks of vitamin D supplementation (50000 IU vitamin D3 [cholecalciferol]/week) on cognitive abilities and sleep disorders in 940 adolescent girls. RESULTS: Oral vitamin D supplementation improved cognitive abilities, including memory, inhibitory control, selective attention, decision making, planning, sustained attention, and cognitive flexibility in healthy adolescent girls (P<0.001). The prevalence of subjects with insomnia after intervention fell from 15.0% to 11.3%. Similar results were also found for the prevalence of sleepiness (15.6% reduced to 14.7%), or cases with both insomnia and sleepiness (8.0% reduced to 6.1%; P<0.05). CONCLUSION: High dose of vitamin D can improve cognitive abilities and alleviate insomnia and daytime sleepiness in adolescent girls. Further investigations are required on different population groups (age and gender) to determine the sustainability of these effects. The value of vitamin D therapy in other neurological disorders would also be of research interest.

Effect of high-dose vitamin D supplementation on antibody titers to heat shock protein 27 in adolescent girls.

Background Although vitamin D deficiency is associated with several inflammatory conditions, there have been few studies on the effects of vitamin D supplementation on markers of oxidative stress (OS) and inflammation. The aim of the current study was to evaluate the effects of high-dose vitamin D supplementation on heat shock protein 27 antibody (anti-Hsp27) titers in adolescent girls. Methods Five hundred and fifty adolescent girls received vitamin D3 at a dose of 50,000 IU/week for 9 weeks. Demographic, clinical and biochemical markers including serum fasting blood glucose (FBG), lipid profile and anti-Hsp27 titers as well as hematological parameters including white blood cell (WBC) count and red blood cell (RBC) distribution width (RDW) were determined in all the subjects at baseline and at the end of the study. Results Serum vitamin D significantly increased from 6.4 (4.2-9.6) ng/mL to 35.6 (25.8-47.5) ng/mL (p < 0.001) following the intervention. Furthermore, serum anti-Hsp27 titers were significantly lower after the 9-week vitamin D administration period (0.22 [0.12-0.33] optical density [OD] vs. 0.19 [0.11-0.31] OD; p = 0.002). A significant correlation was found between serum anti-Hsp27 and RDW (r = 0.13, p = 0.037). The reduction in RDW values after intervention was particularly evident in subjects with the greatest increase in serum vitamin D levels. Conclusions High-dose vitamin D supplementation was found to reduce antibody titers to Hsp27. Further randomized placebo-controlled trials are warranted to determine the long-term effect of vitamin D administration on the inflammatory process especially that associated with chronic disease.

Effect of Different 131I Dose Strategies for Treatment of Hyperthyroidism on Graves' Ophthalmopathy.

PURPOSE: The study aims to define the effect of different dose strategies on ophthalmic complications in patients with Graves' disease (GD). METHODS: All the patients with GD and no or inactive ophthalmopathy (clinical activity score; CAS < 3) underwent Snellen chart examination, measurement of proptosis, thyroid volume, and radioactive iodine uptake, and randomized into 1 of 3 groups. In group 1, all the patients received fixed low dose (FLD) of 259 MBq of I, whereas in group 2, all the patients received fixed high dose (FHD) of 555 MBq, and in group 3, calculated dose (CD) was administered to deliver 5.55 MBq/g (thyroid weight) of I. All examinations were repeated 6 months after treatment. The measurement of thyroid function tests and clinical examination were repeated after 12 months. RESULTS: We studied 92 patients (58 female and 34 male) with mean age of 38.2 ± 12.0 years. Overall, 29, 32, and 31 patients were studied in FLD, FHD, and CD groups, respectively. The patients in CD received a mean activity of 240.5 MBq. The 3 groups were not significantly different regarding age, sex ratio, radioactive iodine uptake, smoking, visual acuity, and proptosis. The response rate 12 months after radioactive iodine therapy was 66.7%, 94.4%, and 92.9% in FLD, FHD, and CD groups, respectively (P = 0.05). Overall, CAS was increased significantly after treatment. Delta proptosis and delta CAS were increased significantly in FHD group compared with other groups (P < 0.05). The highest increment in proptosis was seen in FHD group. CONCLUSIONS: The administration of 5.55 MBq/g of I has fewer ophthalmic complications compared with high fixed dose model and is more effective than low fixed dose strategy.

Menstrual disorders and premenstrual symptoms in adolescents: prevalence and relationship to serum calcium and vitamin D concentrations.

There have been several studies evaluating the association between vitamin and mineral status and menstrual disturbance. In the present study, we aimed to assess the relationship between the menstrual bleeding pattern and premenstrual syndrome (PMS) symptoms with serum 25-hydroxyvitamin D, and calcium levels in adolescent girls. A cross-sectional study was carried out in 897 high school girls from northeastern Iran. The prevalence of hypocalcaemia, normal serum calcium and hypercalcaemia was 27.1, 59.8 and 13.1%, respectively. The menstrual flow of participants differed significantly between the calcium status groups (p = .005). There was no significant association between the symptoms of PMS, as assessed by the questionnaire and serum vitamin D status, or serum calcium concentrations, apart from the irritability. There appears to be an association between serum calcium, menstrual blood loss and irritability in adolescent girls. Impact statement What is already known on this subject? Several studies have evaluated the association of vitamin and mineral status with menstrual disturbance, although these relationships are not consistent, specifically among calcium and vitamin D levels with a menstrual bleeding pattern. What do the results of this study add? In the present study, we investigated the correlation of menstrual bleeding patterns and PMS with calcium and vitamin D levels in a large population in adolescent girls. We found that the level of calcium was associated with the level of menstrual blood loss and irritability. However, no significant association was observed between the menstrual bleeding pattern or the PMS symptoms with a vitamin D status. What are the implications of these findings for future clinical practise/research? Further studies are required to assess the value of a calcium adequate intake or a calcium supplementation for the amelioration of PMS and a better understanding the role of calcium in PMS.

Design, Implementation, and Evaluation of Self-Describing Diabetes Medical Records: A Pilot Study.

BACKGROUND: Each patient's medical record consists of data specific to that patient and is therefore an appropriate source to adapt educational information content. OBJECTIVES: This study aimed to design and implement an information provision system based on the medical records of diabetic patients and to investigate the attitudes of users toward using this product. METHODS: The study was organized into three phases: need analysis, design and implementation, and final evaluation. The aim of the need analysis phase was to investigate the questioning behavior of the patient in the real-world context. The design and implementation phase consisted of four stages: determining the minimum dataset for diabetes medical records, collecting and validating content, designing and implementing a diabetes electronic medical record system, and data entry. Evaluating the final system was done based on the constructs of the technology acceptance model in the two dimensions of perceived usefulness and perceived ease of use. A semistructured interview was used for this purpose. RESULTS: Three main categories were extracted for the patient's perceived usefulness of the system: raising the self-awareness and knowledge of patients, improving their self-care, and improving doctor-patient interaction. Both patients and physicians perceived the personalized sense of information as a unique feature of the application and believed that this feature could have a positive effect on the patient's motivation for learning and using information in practice. Specialists believed that providing personal feedback on the patient's lab test results along with general explanations encourages the patients to read the content more precisely. Moreover, accessing medical records and helpful notes was a new and useful experience for the patients. CONCLUSIONS: One of the key perceived benefits of providing tailored information in the context of medical records was raising patient awareness and knowledge. The results obtained from field observations and interviews have shown that patients were ready to accept the system and had a positive attitude when it was put into practice. The findings related to user attitude can be used as a guideline to design the next phase of the research (ie, investigation of system effectiveness on patient outcomes).

Determination of the most important risk factors of gestational diabetes in Iran by group analytical hierarchy process.

BACKGROUND: The outbreak of gestational diabetes has a significant increase during recent years. This disease has complications for mother and her baby. Screening is an opportunity for preventing of gestational diabetes complications. OBJECTIVE: The aim of this research was to determine the most important risk factors for Gestational Diabetes Mellitus (GDM) in Iran according to the expert's views by Group Analytical Hierarchy Process. MATERIALS AND METHODS: In this cross-sectional study, papers related to the prevalence and risk factors of GDM in Iran from 1992-2015 were reviewed. By studying texts and Up to Date databases, 10 risk factors for gestational diabetes were collected. Among these 10 items, the risk factors that have become significant based on studying literature in Iran were selected for analysis. Group Analytical Hierarchy Process (GAHP) questionnaire distributed among all experts. RESULTS: 8 risk factors of gestational diabetes were significant in Iran. The analysis of experts' views showed that "History of GDM or disorder in glucose tolerance in pregnancy" is the most important risk factor for developing GDM (40.7%). The second and third most important risk factors were "History of macrosomia (infant birth weight > 4.1 Kg)" (20.2%) and" History of diabetes in first degree relatives" (10.7%). CONCLUSION: Suggesting screening based on the determined order of these risk factors can reduce the cost and stress in pregnant women. Also, it makes patient identifying faster. The healthcare sector can consider these priorities determined in experts' views to prevent gestational diabetes.

Diabetic Personal Health Record: A Systematic Review Article.

BACKGROUND: Diabetes disease is one of the 4 main types of non-communicable diseases. No research has been conducted in order to identify data items for Diabetic Personal Health Record (DPHR), in Iran. This study, with the aim of systematically developing the DPHR was done to supply ultimately the country with a national model through Delphi method. METHODS: We conducted a systematic review of the literature using the following electronic databases: PubMed, Web of sciences, Scopus, Science Direct, and ACM digital library. The year of the study included the obtained articles was 2013. We used a 3-step method to identify studies related to DPHR. Study selection processes were performed by two reviewers independently. The eligible studies were included in this review. Quality of studies was assessed using a mixed approach scoring system. Reviewers used 2-step method for the validation of the final DPHR model. RESULTS: Initially, 2011 papers were returned from online databases and 186 studies from gray literature search. After removing duplicates, study screening, and applying inclusion and exclusion criteria, 129 studies were eligible for further full-text review. Considering the full-text review, 34 studies were identified for final review. Given the content of selected studies, we determined seven main classes of DPHR. The highest score belongs to home monitoring data class by mean of 19.83, and the lowest was general data class by mean of 3.89. CONCLUSION: Together with representative sample of endocrinologist in Iran achieved consensus on a DPHR model to improve self-care for diabetic patients and to facilitate physician decision making.

Evaluating the Effect of Web-Based Iranian Diabetic Personal Health Record App on Self-Care Status and Clinical Indicators: Randomized Controlled Trial.

BACKGROUND: There are 4 main types of chronic or noncommunicable diseases. Of these, diabetes is one of the major therapeutic concerns globally. Moreover, Iran is among the countries with the highest incidence of diabetic patients. Furthermore, library-based studies by researchers have shown that thus far no study has been carried out to evaluate the relationship between Web-based diabetic personal health records (DPHR) and self-care indicators in Iran. OBJECTIVE: The objective of this study is to examine the effect of Web-based DPHR on self-care status of diabetic patients in an intervention group as compared with a control group. METHODS: The effect of DPHR on self-care was assessed by using a randomized controlled trial (RCT) protocol for a 2-arm parallel group with a 1:1 allocation ratio. During a 4-month trial period, the control group benefited from the routine care; the intervention group additionally had access to the Web-based DPHR app besides routine care. During the trial, 2 time points at baseline and postintervention were used to evaluate the impact of the DPHR app. A sample size of 72 people was randomly and equally assigned to both the control and intervention groups. The primary outcome measure was the self-care status of the participants. RESULTS: Test results showed that the self-care status in the intervention group in comparison with the control group had a significant difference. In addition, the dimensions of self-care, including normal values, changes trend, the last measured value, and the last time measured values had a significant difference while other dimensions had no significant difference. Furthermore, we found no correlation between Web-based DPHR system and covariates, including scores of weight, glycated hemoglobin (HbA1c), serum creatinine, high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and planned visit adherence, as well as the change trend of mean for blood glucose and blood pressure. CONCLUSIONS: We found that as a result of the Web-based DPHR app, the self-care scores in the intervention group were significantly higher than those of the control group. In total, we found no correlation between the Web-based DPHR app and covariates, including planned visit adherence, HbA1c, serum creatinine, HDL, LDL, total cholesterol, weight, and the change trend of mean for blood glucose and blood pressure. CLINICALTRIAL: Iranian Registry of Clinical Trials (IRCT): 2013082914522N1; http://www.irct.ir/searchresult.php?id= 14522&number=1 (Archived by WebCite at http://www.webcitation.org/6cC4PCcau).

Development, Validation, and Evaluation of Web-Based Iranian Diabetic Personal Health Record: Rationale for and Protocol of a Randomized Controlled Trial.

BACKGROUND: Diabetes is one of the four main types of noncommunicable or chronic diseases. Iran is among the countries with the highest incidence of diabetic patients. A study demonstrated that the collection of diabetic data is neither organized nor standardized. There is currently no instance of electronic personal health records particularly used for diabetic patients in Iran, hence the need for one, which will be useful for self-care of diabetic patients. OBJECTIVE: The objective of the study is to examine the impact of a Web-based diabetic personal health record (DPHR) on the self-care status of diabetic patients as compared with the control group. METHODS: This study is a randomized control trial, which involves a systematic review of literature of the preferred data elements regarding a DPHR, and reevaluating the results with the opinions of local endocrinologists. Inclusion criteria were as follows: type 2 diabetic patients between 20-70 of age who live in the Mashhad City and having the disease for at least one year. The sample size is 72 people that were randomly assigned to the control and intervention groups. The participants in the intervention group were allowed access to the Web-based DPHR system, while those in the control group will continue to receive the usual care for 4 months. The study primary outcome measures include self-care status of participants and planned visit adherence. RESULTS: At the moment, there is an ongoing recruitment of participants, and preliminary results will be published in early 2016. CONCLUSIONS: We expect the final DPHR model, developed and tested during this study, to help diabetic patients to actively participate in their care management process, and also to empower the physician in providing more quality informed decisions regarding their patients. TRIAL REGISTRATION: irct.ir IRCT2013082914522N1; http://www.irct.ir/searchresult.php?id=14522&number=1 (Archived by WebCite at http://www.webcitation.org/6cC4PCcau).