Sepehr Hamidi

Thyroid autoimmunity and recurrent spontaneous abortion in Iran: a case-control study.

OBJECTIVE To determine the association of thyroglobulin antibodies (TG-Ab) and thyroid peroxidase antibodies (TPO-Ab) with recurrent spontaneous abortion in a euthyroid, nonpregnant population of women in Iran. METHODS In this case-control study conducted between November 2003 and September 2006 in Tehran, Iran, nonpregnant women with a history of 3 or more consecutive pregnancy losses and age-matched, healthy parous women without a history of reproductive problems were assessed. Thyroid function tests were performed, which included assessment of thyroid-stimulating hormone, triiodothyronine, thyroxine, and the presence of TG-Ab and TPO-Ab. RESULTS A total of 641 patients and 269 controls were included. Mean age (+/- SD) was 30.6 +/- 6.4 years (range, 16-51 years) in the patient group and 30.05 +/- 6.6 years (range, 18-48 years) in the control group. Thyroid antibodies were present in 157 of 641 patients (24.5%) and in 34 of 269 controls (12.6%) (P<.001). The presence of thyroid antibodies was significantly associated with recurrent abortion independent of the impact of age with an odds ratio of 2.24 (95% confidence interval, 1.5-3.35). CONCLUSIONS In this population of women in Iran, TG-Ab and TPO-Ab were identified more frequently in women with recurrent abortions compared with controls, and thyroid autoimmunity was independently associated with a higher risk of recurrent abortion.

Insulin resistance is an independent correlate of increased urine albumin excretion: a cross‐sectional study in Iranian Type 2 diabetic patients

Aims  To assess the association of insulin resistance with increased urinary albumin excretion (UAE) in a cohort of Iranian Type 2 diabetic patients.

ARE BIOCHEMICAL VALUES PREDICTIVE OF ADENOMA’S WEIGHT IN PRIMARY HYPERPARATHYROIDISM?

Background:  Preoperative laboratory findings may carry some predictive value about the size of the abnormal parathyroid tissue that needs to be removed in primary hyperparathyroidism.

Short term effects of spironolactone on blood lipid profile: a 3-month study on a cohort of young women with hirsutism

AIMS To investigate the effects of spironolactone on serum lipids in women with hirsutism over a 3-month period. METHODS In a prospective setting, 27 hirsute women (20 with polycystic ovary syndrome and seven with idiopathic hirsutism) with a mean age of 23.0 +/- 5.1 years were studied at baseline and 3 months after receiving a daily dose of 100 mg of spironolactone. Patients did not receive any other medications and did not go through a specific diet during the study. Lipid profile, fasting blood glucose, testosterone, dehydroepiandrosterone sulphate (DHEAS) and prolactin (PRL) were measured at baseline and 3 months after therapy. RESULTS Mean body mass index of patients was 26.1 +/- 5.1 kg m(-2) before treatment and 25.9 +/- 5.7 kg m(-2) after treatment (NS). The therapy was associated with a significant decline of mean high-density lipoprotein (HDL), 39.5 mg dl(-1)[95% confidence interval (CI) 35.6, 43.4]vs. 32.2 mg dl(-1) (95% CI 29.2, 35.2), and a significant increase in mean low-density lipoprotein (LDL), 133.1 mg dl(-1) (95% CI 120.2, 146) vs. 150.8 mg dl(-1) (95% CI 139.1, 162.5), and cholesterol/HDL ratio, 5 (95% CI 4.4, 5.6) vs. 6.4 (95% CI 5.7, 7.1) (P < 0.05). No significant change was noted in total cholesterol, triglyceride or fasting blood glucose levels. Serum values of testosterone, DHEAS and PRL decreased significantly after 3 months of therapy (P < 0.05). CONCLUSIONS Spironolactone might have adverse effects on serum lipoprotein levels by increasing LDL and decreasing HDL over a short course of treatment. While treating hirsutism with spironolactone, special care should be given to women with metabolic disorders such as dyslipidaemia.

Albuminuria and its correlates in an Iranian type 2 diabetic population.

ObjectiveTo study the prevalence and correlates of increased urinary albumin excretion (UAE) in an Iranian type 2 diabetic population.MethodsOver a one year period since October 2002, 400 consecutive type 2 diabetic patients referred to an outpatient diabetes clinic, were enrolled in a cross sectional study. Subjects had no history of renal impairment or overt proteinuria. Data concerning demographic characteristics and cardiovascular risk factors were recorded and height, weight and blood pressure were measured. Glucose, cholesterol, HDL-C, LDL-C, triglyceride, apoprotein B, lipoprotein a, creatinine, and HbA1c were measured in fasting blood samples. Overnight twelve-hour UAE were assessed by immunoturbidometry method. Regression analyses were employed to determine the correlates of UAE.ResultsOut of 400 patients, 156 (40%) subjects had increased UAE (UAE ≥ 30 mg/24 hour). The UAE was higher in males compared to females (145.5 vs. 72.1 mg/day; p < 0.05); however, the age and HDL adjusted UAE levels were not significantly different between men and women (120.1 vs. and 87.9 mg/day; p = 0.37). Increased UAE was correlated with decreasing HDL-C and a longer duration of diabetes independent of other variables; increased UAE was correlated with HbA1c as well. Age, systolic and diastolic blood pressure, total cholesterol, LDL-C, triglyceride, apoprotein B, lipoprotein a, and GFR did not correlate with increased UAE.ConclusionIn this study, increased UAE was considerably frequent among type 2 diabetic patients without any significant history of renal dysfunction. Albuminuria was found to be associated with dyslipidemia (low HDL-C), long duration of diabetes, and uncontrolled glycemia revealed by higher HbA1c.

Changes in growth hormone and insulin-like growth factor-I levels in the acute stage after open heart surgery and at the time of discharge.

INTRODUCTION Stress conditions are known to disturb the axis of growth hormone (GH)/insulin-like growth factor-I (IGF-I), but there is little data on this topic after open heart surgery. This study aimed to investigate changes in GH/IGF-I axis in adults undergoing open heart surgery. METHODS A total of 162 adult patients admitted for elective major cardiac surgery were studied in a prospective setting. Serum concentrations of GH and IGF-I were measured at four time points: before operation as a baseline, 4 and 12 hours after operation in ICU, and at the time of discharge. Two to 4 venous blood samples were obtained from each patient. To study the changes of GH and IGF-I levels over time, general linear model for repeated measures was applied. RESULTS Mean age of patients was 51.2+/-14.3 years. Compared with preoperative values (median 0.8, range 0.05-19.4 ng/mL), GH levels rose significantly at four (median 3.3, range 0.1-55 ng/mL) and twelve hours after surgery (median 5.45, range 0.55-61.2 ng/mL), and continued to remain high at the time of discharge (median 2.1, range 0.02-22.7 ng/mL) (p<0.05). Conversely, compared with preoperative levels (173.5+/-89.9 ng/mL), IGF-I decreased at four (140.9+/-66.9 ng/mL) and twelve hours after operation (135.9+/-59.9 ng/mL) and reached its nadir on the day of discharge (114.8+/-43.8 ng/mL) (p<0.01). The patterns of changes in GH and IGF-I over time were significantly different (p<0.01). CONCLUSION Adult patients undergoing open heart surgery go through a state of GH resistance characterized by elevated GH and decreased IGF-I levels from the initial hours after operation.

Distribution of solitary parathyroid adenoma over the parathyroid glands and its surgical management.

OBJECTIVE To determine the distribution of solitary parathyroid adenoma over the parathyroid glands in a group of patients with primary hyperparathyroidism Design: A case-series. PLACE AND DURATION OF STUDY Departments of Surgery and Pathology at Shariati Hospital, Tehran, Iran, between the years 1981 and 2003. PATIENTS AND METHODS A retrospective review of surgery reports of 118 patients with primary hyperparathyroidism was performed. All of the patients had solitary parathyroid adenoma and the anatomical location of each adenoma was clearly defined during operation. Serum calcium, phosphorus and parathormone levels along with clinical characteristics were also included. RESULTS The distribution of adenomas over the superior and inferior parathyroid glands showed a significant higher incidence of adenoma in the lower parathyroids (p < 0.001). The right to left distribution of adenomas was not significant (p=0.4). CONCLUSION Surgical exploration for primary hyperparathyroidism should be initiated from the lower parathyroid glands provided that pre-operative localization scans are not helpful.

Correlations between Parathyroid Adenoma Weight and Biochemical Values

We read with interest the article by Özbey et al. in the March 2006 issue of the World Journal of Surgery. It is an enlightening article on the subject of primary hyperparathyroidism. However, we have a few comments and queries regarding the study. According to Table 1 of their study, mean weight of adenomas is 1231 – 930 mg. It can be worked out that 95% of adenomas have a weight within the range of 1–3091 mg. When we compare the heaviest (4400 mg) and the lightest (110 mg) adenomas of the study with the limits of the 95% interval, it seems that weights of the adenomas do not follow a normal distribution. The same thing appears to be the case with pre-operative PTH, 25hydroxyvitamin D (25-OHD) and alkaline phosphatase levels. Özbey et al. used the parametric Pearson correlation test to study associations between values such as adenoma weight and 25-OHD, or adenoma weight and PTH. In our own experience, while examining the correlations between biochemical parameters and adenoma weight, we noticed that adenomas did not have a normal distribution in respect to their weight. Therefore, to eliminate the impact of outliers on correlations, we used the non-parametric Spearman’s correlation test. We wish to know if Özbey et al. have observed any cases with outlying values in their sample. We are also interested to know whether the correlations’ details might change if they apply non-parametric tests wherever appropriate.