The influence of the HLA-DRB, HLA-DQB and polymorphic positions of the HLA-DRß1 and HLA-DQß1 molecules on risk of Iranian type 1 diabetes mellitus patients.

Type 1 Diabetes mellitus (T1D) is an autoimmune and multifactorial disease. HLA-DRB1 and DQB1 loci have the strongest association with T1D. This study aimed at investigating (i) susceptibility or protection of alleles, genotypes and haplotypes of HLA-DRB1 and DQB1 loci; and (ii) highly polymorphic amino acid residues of HLA-DRß1 and DQß1 in 105 Iranian T1D patients and 100 controls. The results indicated that DRB1*04:01, 03:01, DQB1*03:02, 02:01 alleles, DRB1*03:01/04:01, 03:01/13:03, DQB1*02:01/03:02 genotypes, DRB1*04:01-DQB1*03:02, DRB1*03:01-DQB1*02:01, DRB1*07:01-DQB1*03:03 haplotypes had positive association with T1D. In contrast, HLA-DRB1*15:01, 13:01, DQB1*03:01, 06:01 alleles, DRB1*11:01/15:01, DQB1*03:01/06:01, 03:01/05:01 genotypes and DRB1*15:01-DQB1*06:01, DRB1*11:01-DQB1*03:01 haplotypes had negative association with T1D. Analysis of amino acid sequence of HLA-DRß1 and DQß1 revealed that DRß1(Lys71+) and DQß1(Asp57-) were significantly more frequent in patients than in controls and had a positive effect in the development of T1D. Haplotype analysis demonstrated that HLA-DRB1(Lys71+) allele provided major susceptibility for T1D, and DQß1(Asp57-) had an additive effect. We designed an allele-specific primer to develop an easy, quick and cost-benefit method to detect the DRß1(Lys71+) . This method can identify all 114 DRB1 alleles encoding DRß1(Lys71+) by three PCR reactions. The PcPPV and PcNPV were also calculated to determine the impact of HLA genotype testing at amino acid positions. It showed that the DRß1(Lys71+/+) genotype carrier had 1% absolute risk of developing T1D.

Chloramphenicol residues in chicken liver, kidney and muscle: a comparison among the antibacterial residues monitoring methods of Four Plate Test, ELISA and HPLC.

There are many concerns about safety of food contaminated with antibacterial residues. This study was designed to investigate the occurrence of chloramphenicol (CAP) residue in broiler chickens tissues, namely liver, kidney and muscle. One hundred and sixty broiler chickens carcasses were collected from three provinces of Iran. Four Plate Test (FTP), ELISA and HPLC were used to qualify and quantify the contamination of the samples with CAP. The results of FPT revealed that up to 17.5% of the samples were contaminated with the antibiotic. The ELISA assay showed that out of 28 positive samples in FPT, 22 liver, 21 kidney and 14 muscle samples were positive for CAP. ELISA analyses demonstrated that the minimum and maximum levels of 0.54 and 155.2 ng/g were detected in the kidney and liver, respectively. HPLC analyses confirmed the ELISA findings although the level of contamination was lower than that of ELISA. These data showed that despite the prohibition of CAP application in food animals including poultry, the CAP residue was detectable indicating an illegal use of this antibiotic. Our findings also demonstrated the application of sensitive and more specific analytical assays in screening and quantitation of CAP residues in food products.

Assessment of bone structure in renal transplant recipients: comparison of phalangeal qualitative ultrasound and dual x-ray absorptiometry.

According to the WHO criteria many renal transplant patients display osteopenia or osteoporosis. Dual-energy X-ray absorptiometry (DXA), the standard method to assess bone mineral density (BMD), is not always available. Quantitative ultrasound (QUS) of the phalanx is an inexpensive, mobile, and radiation-free diagnostic alternative. Few data address the correlation of this method with DXA in renal transplant patients. This study assessed the value of QUS compared with DXA to detect changes in bone structure among renal transplant recipients. This cross-sectional study of 42 patients (22 women), of mean age 40.2 +/- 11.9 years, mean time since transplantation of 2.8 +/- 2.9 years, and mean dialysis time of 8.55 +/- 10.26 months, included. DXA for bone mineral densitometry of the hip (neck and total femur) and spine as well as QUS to measure the amplitude-dependent speed of sound (Ad-SOS) in the phalanx. Using DXA, osteoporosis was observed in 19% of all patients: 9.5% in femoral neck, 9.5% in total region of the femur, and 9.5% in the spinal region. The sensitivity of Ad-SOS for osteoporosis diagnosis in the above regions were 100%, 75%, and 25%, respectively; its specificity was 45%, 43%, and 37%, respectively. There was no significant relation between the two methods for diagnosis of osteoporosis in any region. QUS of phalanx can be recommended for osteoporosis screening in renal transplant patients. Those suspected of osteoporosis should be examined by additional DXA measurements in order to establish the diagnosis.

Presentation and outcome of 93 cases of craniopharyngioma.

We studied a series of 93 patients diagnosed with craniopharyngioma during a 15-year period with respect to presenting symptom, clinical course and management. The majority (62%) of patients were men, and had presented with neurological symptoms (75%), with headaches (82%) being the most common presenting symptom. The incidence of certain endocrine and ophthalmic symptoms varied little from that in the literature, on the other hand, the incidence of certain other symptoms did differ markedly from the literature. For example, loss of libido and amenorrhoea were seen at a much lower frequency than that stated in the literature. Hypertension, sensorimotor symptoms and urinary incontinence were not seen at all in our patients. In most cases diagnosis was made by a cranial CT scan, which is more sensitive than plain radiography for detection of enlarged sella turcica (69% vs. 24%; P < 0.001). In over 90% of cases, therapy consisted of removal of a variable portion of the tumour, with or without radiotherapy. Post-operative mortality was substantially reduced in cases treated by radiotherapy (P < 0.05). The most common post-operative complications in all cases were recurrence of disease, panhypopituitarism and diabetes insipidus.

Effects of levothyroxine suppressive therapy on bone mineral density in premenopausal women.

BACKGROUND: Levothyroxine (L-T4) is widely prescribed for treating thyroid disorders, but its effect on bone mineral density (BMD), is being debated. OBJECTIVES: We studied the effect of supraphysiologic doses of L-T4 on BMD in a group of premenopausal women. PATIENTS AND METHODS: We included 50 women (mean age=36.8 +/- 7.6 years) receiving L-T4 for at least 1 year for treating their benign cold thyroid nodules. Serum T3, T4, thyroid-stimulating hormone (TSH), parathyroid hormone (PTH), calcium, and phosphate and urine calcium and sodium levels of all patients were measured. Bone density at femoral neck and lumbar (L1-L4) regions was measured, using dual energy X-ray absorptiometry (DXA). RESULTS: No significant decrease was detected in the bone density of the subjects treated with L-T4 compared with the control group. CONCLUSION: L-T4 treatment for 1 year is not associated with increased risk of osteoporosis in premenopausal women but other potential adverse effects still need to be monitored in women receiving L-T4 especially long-term.

Metabolic and clinical effects of Ramadan fasting in patients with type II diabetes.

OBJECTIVE: To evaluate the effects of fasting on anthropometric indices and carbohydrate and lipid metabolism in patients with type II diabetes. DESIGN: Observational non-interventional study. PLACE AND DURATION OF STUDY: : Diabetes clinic, Shariati Hospital, Tehran, Iran during Ramadan 1419 (winter 1998-99). PATIENTS AND METHODS: Fifty-seven volunteers with type II diabetes underwent anthropometric and biochemical evaluation before and on the 14th and 28th days of Ramadan. Biochemical markers were measured by standard laboratory methods and anthropometric indices by WHO criteria. Statistical analysis was done by ANOVA for repeated measurements and Friedman's two-way ANOVA using SPSSv6 software. RESULTS: Daily cholesterol intake increased in all subjects (p<0.03). Body mass index increased in women (p<0.03), but BMI and waist-hip ratio both decreased in men (p<0.01). Blood pressure, fasting blood glucose and serum fructosamine did not change during the study. Plasma insulin (p<0.05), C-peptide (p<0.01) and insulin resistance (p<0.01) decreased only in men. Total and LDL cholesterol increased significantly in all subjects during the study. CONCLUSION: Ramadan fasting does not alter carbohydrate metabolism or tissue insulin sensitivity in patients with type II diabetes given appropriate dietary education and rescheduling of oral hypoglycaemic medication. Lipid profile is unfavourably altered due to changes in both diet and biochemical response to starvation.

Sustainable control of iodinedeficiency in Iran: beneficial results of the implementation of the mandatory law on salt iodization.

Iodine deficiency disorders (IDD) were prevalent in the Islamic Republic (IR) of IRAN before 1989, when the national salt iodization program with 40 mg l/k of salt was initiated. Despite a comprehensive IDD control program, less than 50% of the households in rural areas consumed iodized salt by 1994. A law for the mandatory production of iodized salt for households was passed in 1994. The purpose of this study was to evaluate goiter status and urinary iodine excretion 2 yr after this law was implemented. In each of 26 provinces, 30 groups of 40 schoolchildren, total 36,178, were examined for goiter and classified according to World Health Organization (WHO) classification. Urinary iodine excretion was measured in 2,917 children by digestion method. Goiter was endemic in all provinces, but the majority were small (grade 1) goiter. Median urinary iodine was 20.5 microg/dl 85.1% had urinary iodine > or =10 microg/dl. Median urinary iodine was above 13 microg/dl in all 26 provinces. In all provinces the percentage of schoolchildren with urinary iodine <5 microg/dl was less than 16%. In nine provinces the median urinary iodine was between 13 to 20 microg/dl; urinary iodine of their schoolchildren was <5 microg/dl in 10.8% and <2 microg/dl in 6-9%. No significant difference was observed between boys and girls or children of rural and urban regions in urinary iodine excretion. We conclude that 7 yr after the beginning of salt iodization and 2 yr following mandatory iodized salt consumption, urinary iodine excretion is adequate in schoolchildren; considering the data of the percent of households consuming iodized salt and programmatic setting of the IDD program, The IR of Iran has reached a sustainable control program for iodine deficiency.

Evaluation of suppressive therapy for cold thyroid nodules with levothyroxine: double-blind placebo-controlled clinical trial.

OBJECTIVE: To study the efficacy of levothyroxine suppressive therapy in the management of benign thyroid nodules. METHODS: We performed a double-blind clinical trial comparing levothyroxine treatment (1.5 to 2.0 mg/kg of body weight daily) (N = 32) with placebo (N = 30) for a 1-year period in patients with a benign, cold thyroid nodule confirmed by biopsy and 99mTc-pertechnetate scanning, who were randomly assigned to the treatment or control group. High-resolution sonography was used to measure the size of the nodules before and after the treatment. Suppression of thyrotropin was evaluated by the administration of thyrotropin-releasing hormone to 10 patients randomly in each group. RESULTS: The mean volume of the thyroid nodules decreased significantly after 6 months in both the levothyroxine group (from 12.8 +/- 11.9 mL to 9.4 +/- 9.8 mL; P = 0.003) and the placebo group (from 13.2 +/- 10.2 mL to 11.5 +/- 8.0 mL; P = 0.003). After 12 months, however, the volume of the nodules had increased. Thus, no significant decrease was found in the mean nodule volume in either study group at 1 year in comparison with the mean volume at baseline (final mean volume: 12.4 +/- 16.7 mL in the levothyroxine group and 11.7 +/- 13.6 mL in the placebo group). CONCLUSION: Suppressive therapy with levothyroxine for a period of 12 months proved to be ineffective in significantly reducing the size of the thyroid nodules in our patients despite effective suppression of the thyrotropin level.

Dermopathy of Graves disease (pretibial myxedema). Review of 150 cases.

Pretibial myxedema is an uncommon manifestation of Graves disease, and little information is available regarding its natural course and its relation to other manifestations of Graves disease. We reviewed 150 consecutive cases with the diagnosis of pretibial myxedema over a 20-year period in a referral center. Only 1 patient in this group did not have ophthalmopathy, whereas 88% had significant proptosis and 30% required orbital decompression surgery. Dermopathy was a late manifestation of Graves disease, and its onset usually followed the diagnosis of hyperthyroidism and ophthalmopathy. In a few patients, dermopathy preceded diagnosis of hyperthyroidism or onset of ophthalmopathy. Fourteen patients were never clinically hyperthyroid; spontaneous hypothyroidism had developed in 11 in this group. All cases involved the lower extremities, with only 1 patient having combined upper and lower extremity involvement. The most common form of thyroid dermopathy was nonpitting edema, followed by nodular and plaque forms, which occurred with equal frequency. The polypoid form occurred in 1 patient and the elephantiasic form in another; 7.3% had thyroid acropachy. Follow-up was available for 120 patients (range, 3 mo to 19 yr; mean, 3.2 yr), and complete remission was observed in only 12 patients. Topically applied corticosteroid therapy was used in 76 patients, and in this group 38% had sustained long-term partial remission, as opposed to 18% in the group receiving no corticosteroid therapy.