Thyroid incidentaloma in Isfahan, Iran - a population-based study

Introduction: Thyroid nodules not detected in palpation but diagnosed following a radiological procedure or during surgery are called thyroid incidentalomas. We designed this study to investigate the prevalence of sonographic thyroid incidentaloma in Isfahan, Iran, for the first time. Material and methods: By a multistage cluster sampling method, 2523 adults were selected randomly. From this group, 2045 had normal thyroid examination. 234 out of the 2045 were selected randomly for thyroid sonography. Thyroid stimulating hormone (TSH), urinary iodine concentrations (UIC) and antithyroid antibodies were measured. Results: The prevalence of thyroid incidentaloma was 13.2% [Confidence interval (CI) 95% = 8-18]. The average age of subjects with and without incidentaloma was 46.1 (12.4) and 38.4 (12.1), respectively (P = 0.002). It was more prevalent in females than in males (19% vs. 10%) [Odds ratio (OR) = 2.59, CI 95% = 1.17-5.76, P value (P) = 0.01]. Median UIC in the incidentaloma group (14 mug/dl) was significantly lower than in the group of subjects without nodules (20 mug/dl) (OR = 0.9, CI 95% = 0.91-0.99, P = 0.02). There was no difference in the levels of TSH and antithyroid antibodies between the two groups (P > 0.05). Mean diameter of nodules was 8.14 (3.43) mm. Conclusions: The prevalence of thyroid incidentaloma was 13.2% in Isfahan. It was higher in females than males and increased with age.     

Low Goiter Rate Associated with Small Average Thyroid Volume in Schoolchildren after the Elimination of Iodine Deficiency Disorders

Background

After the implementation of the universal salt iodization (USI) program in 1996, seven cross-sectional school-based surveys have been conducted to monitor iodine deficiency disorders (IDD) among children in eastern China.

Objectives

This study aimed to examine the correlation of total goiter rate (TGR) with average thyroid volume (Tvol) and urinary iodine concentration (UIC) in Jiangsu province after IDD elimination.

Design

Probability-proportional-to-size sampling was applied to select 1,200 children aged 8–10 years old in 30 clusters for each survey in 1995, 1997, 1999, 2001, 2002, 2005, 2009 and 2011. We measured Tvol using ultrasonography in 8,314 children and measured UIC (4,767 subjects) and salt iodine (10,184 samples) using methods recommended by the World Health Organization. Tvol was used to calculate TGR based on the reference criteria specified for sex and body surface area (BSA).

Results

TGR decreased from 55.2% in 1997 to 1.0% in 2009, and geometric means of Tvol decreased from 3.63 mL to 1.33 mL, along with the UIC increasing from 83 μg/L in 1995 to 407 μg/L in 1999, then decreasing to 243 μg/L in 2005, and then increasing to 345 μg/L in 2011. In the low goiter population (TGR < 3.9%), TGR was positively associated with average Tvol (r = 0.99); UIC showed a non-linear association with average Tvol, and UIC > 300 μg/L was associated with a smaller average Tvol in children.

Conclusions

After IDD elimination in Jiangsu province in 2001, lower TGR was associated with smaller average Tvol. Average Tvol was more sensitive than TGR in detecting the fluctuation of UIC. A UIC of 300 μg/L may be defined as a critical value for population level iodine status monitoring.     

Prevalence of Cryptosporidium infection in cattle in Isfahan, Iran

Cryptosporidium are commonly identified as intestinal pathogens in humans and animals. Fecal samples from 480 cattle randomly selected from 30 regions in Isfahan, Iran, were examined to investigate the prevalence of Cryptosporidium infection. Cryptosporidium oocysts were identified by using sheather's concentration and the Ziehl-Neelsen modified staining technique in 30 of 480 cattle ranging from less than 6 mo of age to older than 1 yr of age. Infected animals were found in 86.6% (26/30) of regions investigated. Overall prevalence of infection was 6.25%, but higher in cattle less than 6 mo of age (10.8%) and this was statistically significant (P<0.05). Both sexes of cattle were infected with Cryptosporidium parasites, but prevalences were higher in diarrheic (56.7%) than in non-diarrheic (39%) cattle. Cryptosporidium appears to be prevalent in cattle in Isfahan.     

Prevalence of congenital hypothyroidism in Isfahan, Iran: results of a survey on 20,000 neonates

AIMS: To evaluate the prevalence of congenital hypothyroidism (CH) in a screening program performed for the first time in Isfahan, Iran. METHODS: From May 2002 to December 2002, T4 and TSH serum concentrations of 20,000 3- to 7-day-old newborns, born in all 17 hospitals of the city, were measured by radioimmunoassay and immunoradiometric assay, respectively. The newborns with abnormal screening results (TSH >20 mIU/l, T4 <6.5 microg/dl and based on the weight) were re-examined. RESULTS: Of 531 recalled subjects (recall rate 2.6%), 54 were confirmed to be hypothyroid, showing a prevalence of 1:370 for CH. CONCLUSION: Considering the high frequency of CH, the necessity of implementing a routine screening program in the healthcare system of Isfahan Province is emphasized.     

Calcium and Vitamin D Status in Heart Failure Patients in Isfahan, Iran

Both calcium and vitamin D play important roles in cardiac muscle contraction and performance. In this cross-sectional study, we evaluated the status of serum calcium, PTH and 25(OH)D₃ and their correlation with left ventricular Function and NYHA Functional class in 95 heart failure patients referred to Shahid Chamran Hospital, Isfahan, Iran, by colorimetric, immunoradiometric, and Immunochemiluminescent assays, echocardiography and interview respectively. The study was performed between Oct 2007 and Feb 2008. Twenty eight women and 67 men of functional classes 1, 2, or 3 participated in the study. Mean (SD) of age of the participants was 62(11)?years. Mean (SD) serum calcium and 25(OH)D₃ were 2.41(0.16)?mmol/L and 56.78(51.33)?nmol/L, respectively. The overall prevalence of low vitamin D status was 84.2%. There was no correlation between serum calcium and 25(OH)D₃ with LVEF. Interestingly, patients with hyperparathyroidism (serum PTH>65 ng/L) had lower LVEF (27% versus 32.5% p?=?0.03). NYHA functional class was worse in patients with hyperparathyroidism (p?=?0.08). Hypovitaminosis D is very prevalent in heart failure patients. Hyperparathyroidism in these patients may adversely affect cardiac function. Vitamin D3 might serve as an adjunctive treatment for heart failure patients.     

Isolation of opportunistic fungi from bronchoalveolar lavage of compromised hosts in Isfahan,Iran

In this study, bronchoalveolar lavage (BAL) specimens from 247 immunocompromised patients were investigated for the incidence of opportunistic fungi. In the direct examination and culture of the specimens, 5 (2.02%) of filamentous fungi and 55 (22.26%) yeasts were isolated and identified as follows: Aspergillus fumigatus (2), A. terreus (1), A. nidulans (1), Mucorsp. (1), Candida albicans (29), C. glabrata (3), C. Parapsilosis (1), Trichosporon beigelii (1), Candida sp. (13) and unknown yeasts (8). In addition, one strain of Nocardia asteroides and two strains of Streptomyces sp. were isolated.     

Health Risk Assessment of Fluoride Exposure in Soil,Plants, and Water at Isfahan,Iran

Fluoride is a potentially toxic element, with a narrow range of tolerable amounts taken up via food or drinking water. To evaluate F content in surface soils, 255 topsoil samples (0–20 cm) in an area of 6800 km² in Isfahan province of central Iran were collected. Crop plants and randomly sampled water samples from wells were evaluated during the spring and summer seasons. Total F concentration in 96% of soil samples was lower than the global suggested average of 200 mg kg^?1. The mean F concentration of water samples in the study area was 0.05 and 0.3 mg L^?1 in summer and spring, respectively. Fluoride concentrations in different plant species were in the range of normal values. The total hazard quotient (HQ) for both population groups via consumption of cereals, vegetables, and water; incidental ingestion of soil; inhalation of soil particulates; and dermal contact with water and soil was less than 1.0, resembling no obvious risk. It is suggested that neither age group in Isfahan province will experience a significant potential health risk through their dietary intake of cereals, vegetables, and water; ingestion of soil; inhalation of particulates; and dermal contact.     

Evidence of Endemic Goiter and Iodine Deficiency in a Mountainous Area of Haiti

ObjectiveTo investigate reports of iodine-deficiency disorder in a specific area of Haiti.MethodsIn March 2008, this cross-sectional study was performed in an area 15 miles northeast of Jacmel, Haiti, within the Chaîne de la Selle Mountains. Before arrival of the study team, an announcement was made throughout local villages soliciting volunteers to meet at a central location. Of those who arrived, participants were selected in an attempt to sample individuals from all age groups, regardless of goiter status. After providing verbal informed consent, each participant was photographed and assigned a number to be used to protect privacy. An examiner performed palpation of the thyroid gland on each participant in accordance with World Health Organization criteria. Results of palpation were classified into 3 grades: grade 0, the thyroid gland was not palpable; grade 1, the thyroid gland was palpable but not visible; and grade 2, the thyroid gland was palpable and visible while the patient was in a normal position. Casual urine samples were collected from each participant and analyzed spectrophotometrically for urinary iodine concentration.ResultsEighty-eight individuals aged 2 to 72 years participated in the study. Median urinary iodine concentration was 39 μg/L. Of the 88 participants, 82 (93%) were iodine deficient (18 [20%] were severely deficient), and 45 (51%) had goiter on physical examination, including 27 with grade 1 goiters and 18 with grade 2 goiters.ConclusionsWe have documented iodine deficiency with associated endemic goiter in this previously uninvestigated Haitian population, for which world health agencies currently lack definitive data. These data have potential implications for both the local area and the country as a whole where further evaluation and treatment are needed for persons at high risk for iodine-deficiency disorder. (Endocr Pract. 2009;15:298-301)     

Prevalence of polycystic ovary syndrome in girls aged 14-18 years in Isfahan, Iran

OBJECTIVE: To determine the prevalence of clinical polycystic ovary syndrome (PCOS) in 14- to 18-year-old high school girls in Isfahan, Iran. METHODS: In this cross-sectional study, 1,000 high school girls (14-18 years old) were selected by multi-stage random sampling from different high schools in Isfahan. Following physical examination, a single physician recorded the presence of hirsutism, severe acne, androgenic alopecia, menstrual dysfunction and obesity using a validated questionnaire. Clinical PCOS was diagnosed if menstrual dysfunction and clinical hyperandrogenism were detected. RESULTS: Clinical PCOS was present in 30 (3%), hirsutism in 60 (6%), menstrual dysfunction in 74 (7.4%) and severe acne in 47 (4.7%) of the population studied. CONCLUSION: The prevalence of clinical PCOS in our study population was similar to those of other studies; however, the prevalence could have been higher with hormonal assessment.     

Health Risks from Heavy Metals via Consumption of Cereals and Vegetables in Isfahan Province,Iran

The present study was conducted to assess the risks to human health from exposure to arsenic, lead, nickel, zinc, and copper through consumption of wheat, rice, and some vegetables in Isfahan Province, central Iran, using the total non-carcinogenic hazard quotient and cancer risk assessment estimates. Risk contribution from Ni is minimal compared with other metals and it was less than the U.S. Environmental Protection Agency guidelines. The results showed that total non-carcinogenic hazard of As and Pb, were greater than 1, and total cancer risk of As slightly greater than 1 × 10^?4 for all age groups. Therefore, the inhabitants who reside in Isfahan Province may experience the adverse health risks via consumption of cereals and vegetables.     

Seasonal variation of Leishmania major infection rates in sandflies from rodent burrows in Isfahan province, Iran

Abstract. In preparation for field trials of killed Leishmania major vaccine, natural infections with Leishmania promastigotes were monitored in Phlebotomine sandfly vectors from villages of Borkhar rural district, northeast of Isfahan in central Iran, where Lmajor zymodeme MON-26 (=LON-l) has been identified as causing zoonotic cutaneous leishmaniasis (ZCL). Sandflies were collected and dissected weekly, from burrows of rodent colonies, during the 'sandfly season', June-October 1991. Leptomonad infection rates were 12% of 26 Phlebotomus ansarii , 8% of 280 P.caucasicus , 11 % of 1042 P.papatasi and none of 126 Sergentomyia sintoni , being greatest during late August through September, coinciding with peak activity of the sandflies, 2–3 months before the highest incidence of ZCL human cases in November-December.     

Selenium and Vitamin E Deficiency in Pigs

The effect of selenium (Se) and vitamin E (Vit. E) on reproductive performance, growth and health was studied in pigs. Two levels of Se were used, 0.03 and 0.06 nag per kg feed. The major component of the experimental diets was barley originating from soil which had formerly produced crops with a very low content of Se. Prior to seeding, the area was divided into 2 plots, 1 of which was treated with Se in the form of sodium selenite, 100 g Se per ha. The use of Se enriched fertilizer was an effective way of increasing the Se concentration of the grain. Thus the concentration of Se in the barley produced on the treated area was 5 times higher than in barley from the untreated one. Vit. E was added at a level of 30 i.u. per kg feed, and the concentrations were approx. 15 and 45 i.u. in the basal and experimental diets, respectively. The higher level of Se or Vit. E was not significantly associated with milk yield of the sow, litter size, birth weight or haemoglobin levels. However, there was a tendency to an increase in milk yield of the sows following additions of Se plus Vit. E, and litter size was slightly higher from sows which had received an addition of Vit. E. The concentration of Se and Vit. E was much higher in colostrum than in sow milk, and additions of dietary Se and Vit. E were associated with marked increases in the concentrations of these compounds in both colostrum and sow milk. There was a moderately improving effect of a high Se concentration in feed on growth rate and feed utilization. Low dietary levels of Se and Vit. E were followed by increased mortality rate in piglets; iron toxicity in connection with iron treatment was observed in piglets on low dietary Vit. E. Symptoms characteristic of PSE were not observed in the Se and Vit. E deficient pigs.     

Selenium Deficiency Induces Autophagy in Immune Organs of Chickens

The aim of the present study was to investigate the effects of selenium (Se) deficiency on autophagy-related genes and on ultrastructural changes in the spleen, bursa of Fabricius, and thymus of chickens. The Se deficiency group was fed a basal diet containing Se at 0.033 mg/kg and the control group was fed the same basal diet containing Se at 0.15 mg/kg. The messenger RNA (mRNA) levels of the autophagy genes microtubule-associated protein 1 light chain 3 (LC3)-I, LC3-II, Beclin 1, dynein, autophagy associated gene 5 (ATG5), and target of rapamycin complex 1 (TORC1) were assessed using real-time qPCR. The protein levels of LC3-II, Beclin 1, and dynein were investigated using western blot analysis. Furthermore, the ultrastructure was observed using an electron microscope. The results indicated that spleen mRNA levels of LC3-I, LC3-II, Beclin 1, dynein, ATG5, and TORC1 and the protein levels of LC3-II, Beclin 1, and dynein were increased in the Se deficiency group compared with the control group. In the bursa of Fabricius, the mRNA levels of LC3-I, LC3-II, Beclin 1, dynein, ATG5, and TORC1 and the protein levels of Beclin 1 and dynein were increased; furthermore, the protein level of LC3-II was decreased in the Se deficiency group compared to the control group. In the thymus, the mRNA levels of LC3-I, Beclin 1, and ATG5 increased; the levels of LC3-II, dynein, and TORC1 were decreased; the protein level of Beclin 1 increased; and the levels of LC3-II and dynein decreased in the Se deficiency group compared to those in the control group. Further cellular morphological changes, such as autophagy vacuoles, autolysosomes, and lysosomal degradation, were observed in the spleen, bursa of Fabricius, and thymus of the Se-deficiency group. In summary, Se deficiency caused changes in autophagy-related genes, which increased the autophagic process and also caused structural damages to the immune organs of chickens.     

Clinical and Pathologic Features of a Suspected Selenium Deficiency in Captive Plains Zebras

Previous studies have shown that selenium (Se) deficiency is associated with nutritional myopathy, known as white muscle disease (WMD), in horses. However, correlations between Se deficiency and clinical findings, such as hematologic biochemical values and pathological features, have not been evaluated in captive plains zebras. The purpose of the present study was to investigate the clinical and pathologic features that may be caused by a Se deficiency in the captive plains zebra. Clinical findings, feed analyses, hematologic biochemical analyses, response to treatment, and pathologic examination were assessed in six affected plains zebras. The dietary concentration of Se in feed was also tested. Sudden death occurred in two cases during the first day of the onset of symptoms. Two zebras died at 4 days and two zebras survived after treatment. The clinical signs in affected animals were characterized by general weakness, astasia, and abnormal postural positions. The Se concentration in hay from the breeding stable was low, based on the reference value. Glutathione peroxidase (GSH-Px) activity was lower compared with the equine reference value. Multiple areas of subcutaneous steatitis and pale skeletal muscle and myocardium were revealed at gross necropsy. Degeneration and necrosis of myocardial and skeletal muscles, as well as congestion of the liver, lung, and kidney were found via histopathological examination. No suspected bacterial infections were found. Feed analyses, response to treatment, serum GSH-Px activity, and pathological features suggest that Se deficiency may have caused the disease in the six affected captive plains zebra.     

Long-term Selenium Deficiency Increases the Pathogenicity of a Citrobacter rodentium Infection in Mice

Citrobacter rodentium is a mouse pathogen that causes infectious colitis and shares characteristics with human enteropathogenic (EPEC) and enterohemorrhagic (EHEC) Escherichia coli, including the ability to cause attaching and effacing lesions in the colon and serves as a useful model to study the pathogenicity of these bacteria. In this study, mice were fed a selenium-deficient diet for 5 or 20?weeks and then infected with C. rodentium. Colonization of the colon by C. rodentium was similar in mice fed adequate or selenium-deficient diets, but total bacterial colonization of the spleen was elevated in mice fed selenium-deficient diet for 20?weeks. Infection-induced changes to the colon included inflammatory cell infiltration, gross changes in crypt architecture, and ulceration and denuding of the epithelial layer that were greatest in mice fed a selenium-deficient diet for 20?weeks. Expression of pro-inflammatory genes was significantly higher 12-days post-infection in mice fed the selenium-deficient diet for 20?weeks compared to mice fed a selenium-adequate diet or selenium-deficient diet for 5?weeks. Diarrhea was prevalent in mice fed the selenium-deficient diet for 20?weeks but not 5?weeks, and this was associated with decreased expression of solute carrier family 26a3 and carbonic anhydrase IV, genes involved in ion transport. These results indicated that selenium played an important role in resistance to the pathological effects of a C. rodentium infection, and therefore, selenium status may be important in the expression of human disease caused by common food-borne bacteria.