International Journal of Endocrinology and Metabolism

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The aim of the International Journal of Endocrinology and Metabolism (IJEM) is to increase knowledge, stimulate research in the field of endocrinology, and promote better management of patients with endocrinological disorders. To achieve this goal, the journal publishes original research papers on human, animal and cell culture studies relevant to endocrinology.

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Positive Interference in Triiodothyronine (T3) Assay Using a Radioimmunoassay Kit
(Brieflands, 2007-10-31) N Rezaei-Ghaleh; M Hedayati; A Ordookhani; F Azizi
Determination of thyrotropin (TSH), total and free thyroxine (T4) and triiodothyronine (T3) are widely used for thyroid function evaluation. There have been numerous reports of interfer-ence in thyroid hormone immunoassays. Herein, the possible occurrence of interference is inves-tigated for a radioimmunoassay kit of total T3. Materials and Methods: A total of 3471 patients were examined through the serum level meas-urement of TSH, total T4 and T3. T3 analysis was made through a competitive solid-phase radio labeled (125I) immunoassay by T3 Izotop kit (Izotop Co. Budapest, Hungary). The presence of T3 assay interference was considered probable if the endocrine profile was inconsistent with the clinical picture and/or the obtained value for T3 showed extreme deviaton from normal levels, i.e. above 780 ng/dL. For such patients, the exis-tence of interference was verified by re-measuring T3 level by another RIA kit (Immu-notech kit, Marseille, France). Results: Among 3471 patients studied, 40 cases (1.2 %) had spuriously high T3 serum levels with T3-Izotop kit while normal T3 levels (132.1±31.0 ng/dL) were observed with T3-Immunotech kit; the positive interference was more prevalent among women (1.4% vs. 0.5% in men), especially post-menopausal women. Mean serum levels of total T4 and TSH in the positive interference group were 9.0±2.0 μg/dL and 1.79±1.47 μU/mL, respectively. Conclusion: In accordance with numerous re-ports of interferences in thyroid hormone im-munoassays, the results of our study indicates that both laboratory professionals and clinicians must be vigilant to the possibility of antibody interference in thyroid function assays.
Thyroid, Parathyroid and Gonadal Function, and Glucose Tolerance After Bone Marrow Transplantation and Chemotherapy
(Brieflands, 2003-01-31) M Khoshnyat; B Larijani; A Ghavamzadeh; b Bahar; O Tabatabaei
: Following bone marrow transplantation (BMT), life expectancy of many patients increases, necessitating medical follow up, especially function of the endocrine gland. Previous studies have shown that endocrine dysfunctions are caused not only by total body irradiation, but also by cytotoxic conditioning regimens.Materials and Methods: 46 patients (12 F, 34 M), aged 1.5-49 years were evaluated for thyroid (T3, T4, TSH, T3RU, FTI, Anti Tg-Ab, Anti TPO-Ab), parathyroid (Ca, Alkp, PTH), gonad function (LH, FSH, E2, progesterone in females and semen analysis in males) and function of β-cells of pancreas by O.G.T.T (in 12 major thalassemic patients) before and 3, 6, 12, 24 months after BMT, by the “Little” Busulfan-Cyclophosphamide conditioning regimen.Results: There are no differences between results of clinical examinations and laboratory tests of pre and post BMT function of thyroid or parathyroid and calcium metabolism. The function of leydig cells was normal in 11 adult men (G5P5) before and 3, 6, 12 months after BMT, but injury of germinal cells (oligo- or azospermia) before and 12 months after BMT was seen. There is no relation between FSH and injury of germinal cells. Development of puberty was normal in 5 boys (G2P2 or G3P3) before and one year after BMT Primary hypogonadism was induced in 4 females (B5P5) after BMT In one 14 year-old female, regular menstruation continued 2 years after BMT In one girl (P1B1 before BMT) ovarian failure developed 12 months after BMT. Function of β- cells in thalassemic patients (Ferritin>1000 before BMT) before and after BMT was normal.Conclusion: One year after B.M.T, the chemotherapy-conditioning regimen per se did not affect function of thyroid or parathyroid gland, but ovarian failure and germinal cells injuries developed (without effect on leydig cells). BMT had no effect on the function of β- cells of the pancreas.
Remission Rate of Graves' Disease and the Trend of Changes in Serum TSH Receptor Antibodies in Prolonged Antithyroid Drug Treatment
(Brieflands, 2020-06-30) Danilo Villagelin; Roberto Bernardo Santos; João Hamilton Romaldini
Context: Graves’ disease is an autoimmune disease caused by thyrotropin receptor antibodies (TRAb). These antibodies can be measured and used for the diagnosis, prediction of remission, and risk of Graves’ orbitopathy development. There are three treatments for Graves’ disease that have remained unchanged for the last 75 years: Antithyroid drugs, radioiodine, and surgery. Antithyroid drugs are the first treatment option worldwide and are usually used for 12 - 18 months. Recent reports suggest the use of antithyroid drugs for more than 18 months with better outcomes. This review focuses on two aspects of treatment with antithyroid drugs: The impact of using antithyroid drugs for more than 12 - 18 months on remission rates and the trend of TRAb during prolonged antithyroid drug treatment. Evidence Acquisition: A review was performed in Medline on the published work regarding the duration of ATD treatment and remission of Graves' disease and also ATD treatment and TRAb status during the 1990 - 2019 period. Results: Remission rates are variable (30% - 80%), and many clinical and genetic factors serve as predictors. The long-term use of antithyroid drugs appears to increase remission rates. TRAb values usually decline during ATD treatment, but the trend could occur in two ways: Becoming negative or showing a fluctuating pattern. However, approximately 10% of the patients will remain TRAb-positive after five years of treatment with antithyroid drugs. Conclusions: Antithyroid drugs can be used for long periods with an increase in remission rates, and a gradual decrease in TRAb levels, with the disappearance of TRAb in 90% of the patients after 60 months.
Physical Development at School Entry in Children with Congenital Hypothyroidism Diagnosed by the National Program of Newborn Screening in Iran
(Brieflands, 2023-01-31) Shahin Yarahmadi; Bahram Nikkhoo; Hesam Parvizi; Rozhin Motaghi; Khaled Rahmani
Background: The newborn screening program for diagnosing and treating children with congenital hypothyroidism (CH) in Iran was established in 2004. Objectives: This study aimed to evaluate the national program’s success in maintaining the physical development and anthropometric indexes of children with CH. Methods: This historical cohort study was carried out in five provinces located in five different geographical regions of Iran. The anthropometric indexes, including weight, height, and head circumference of 240 children diagnosed with transient congenital hypothyroidism (TCH) (n = 131) and permanent congenital hypothyroidism (PCH) (n = 109) were measured and compared with those of 240 healthy children aged six. Results: Mean ± standard deviation (SD) of weight, height, and head circumference of children with CH aged six were 20304.8 ± 4457.9 g, 115.6 ± 5.9 cm, and 50.8 ± 1.7 cm, respectively. Mean ± SD of height (116.7 ± 6.1 cm) and head circumference (51.1 ± 1.7 cm) in the control (healthy) group were significantly higher than those of the CH children group (P < 0.05). Mean ± SD weight in the control group (20741.2 ± 4337.3 g) was higher than that in the CH group (20304.8 ± 4457.9 g). However, the difference was not statistically significant (P = 0.3). No significant difference was observed between TCH and PCH children in the subgroup analysis (P > 0.05). Conclusions: Although the mean of anthropometric indexes in CH patients was slightly lower than that in healthy children aged six, the difference between the two groups was insignificant. The physical development of children with CH was evaluated as good. Our results suggested that the newborn screening program for identifying and treating children with CH in Iran may have improved the growth outcomes.
External Validation of Finnish Diabetes Risk Score and Australian Diabetes Risk Assessment Tool Prediction Models to Identify People with Undiagnosed Type 2 Diabetes: A Cross-sectional Study in Iran
(Brieflands, 2022-10-31) Saeedeh Mahmoodzadeh; Younes Jahani; Hamid Najafipour; Mojgan Sanjari; Mitra Shadkam-Farokhi; Armita Shahesmaeili
Background: Noninvasive risk prediction models have been widely used in various settings to identify individuals with undiagnosed diabetes. Objectives: We aimed to evaluate the discrimination, calibration, and clinical usefulness of the Finnish Diabetes Risk Score (FINDRISC) and Australian Diabetes Risk Assessment (AUSDRISK) to screen undiagnosed diabetes in Kerman, Iran. Methods: We analyzed data from 2014 to 2018 in the second round of the Kerman Coronary Artery Disease Risk Factors Study (KERCADRS), Iran. Participants aged 35 - 65 with no history of confirmed diabetes were eligible. The area under the receiver operating characteristic curve (AUROC) and decision curve analysis were applied to evaluate the discrimination power and clinical usefulness of the models, respectively. The calibration was assessed by the Hosmer-Lemeshow test and the calibration plots. Results: Out of 3262 participants, 145 (4.44%) had undiagnosed diabetes. The estimated AUROCs were 0.67 and 0.62 for the AUSDRISK and FINDRISC models, respectively (P < 0.001). The chi-square test results for FINDRISC and AUSDRISC were 7.90 and 16.47 for the original model and 3.69 and 14.61 for the recalibrated model, respectively. Based on the decision curves, useful threshold ranges for the original models of FINDRIS and AUSDRISK were 4% to 10% and 3% to 13%, respectively. Useful thresholds for the recalibrated models of FINDRISC and AUSDRISK were 4% to 8% and 4% to 9%, respectively. Conclusions: The original AUSDRISK model performs better than FINDRISC in identifying patients with undiagnosed diabetes and could be used as a simple and noninvasive tool where access to laboratory facilities is costly or limited.
Assessing the Effectiveness of Type 2 Diabetes Screening in the Republic of Uzbekistan
(Brieflands, 2022-10-31) Anna Alieva; Anvar Alimov; Feruza Khaidarova; Saidiganikhoja Ismailov; Gulnara Rakhimova; Dilorom Nazhmutdinova; Barno Shagazatova; Victoria Tsareva
Background: Type 2 diabetes (T2D) screening should be performed continuously at the primary care level in order to prevent disabling complications. Due to the high prevalence of undiagnosed T2D in the Republic of Uzbekistan, a decision was made to implement a nationwide screening program for T2D. Objectives: The current study, taking into account the limited resources of Uzbekistan's health care system, aimed to offer the most effective, simple, and economical option required for the actual implementation of regular T2D screening in the country’s primary care. Methods: The screening was conducted from December 2018 to March 2019. There were four different scenarios, which differed in terms of eligibility criteria and the methodology adopted for detecting dysglycemia. Results: A total of 2,430 patients were examined in four months. The T2D diagnosis was established by an endocrinologist in 9.3% of the cases with one eligibility criterion and 15.9% of the cases with three eligibility criteria. The diagnosis of T2D was established by an endocrinologist in 11.7% of the cases with HbA1c screening and 13.5% of the cases with glucose screening. Conclusions: The screening was feasible in Uzbekistan only in limited conditions. The reasonable strategy was found to be the screening for incidental glycemia in all patients with at least one T2D risk factor. It was recommended that patients with incidental glycemia ≥ 7.8 mmol/L should be tested for fasting glycemia.
Improved Physical and Mental Health After a Combined Lifestyle Intervention with Cognitive Behavioural Therapy for Obesity
(Brieflands, 2023-01-31) Mostafa Mohseni; Susanne Kuckuck; Renate E. H. Meeusen; Geranne Jiskoot; Robin Lengton; Mesut Savas; Kirsten A. C. Berk; Eline S. Van der Valk; Bibian Van der Voorn; Sjoerd A. A. Van den Berg; Anand M. Iyer; Johannes B. J. Bussmann; Pieter J. M. Leenen; Willem A. Dik; Cornelis J. de Groot; Erica L. T. Van den Akker; Elisabeth F. C. Van Rossum
Background: Obesity is a multifactorial, chronic, progressive disease associated with decreased health-related quality of life, comorbidities, and increased mortality risk. Lifestyle interventions, focusing on dietetics, physical exercise, and behavioral therapy, are a cornerstone of therapy. Despite this very multidisciplinary treatment approach, the definition of treatment success is often based only on a weight loss of ≥ 5%. However, the heterogeneous nature of obesity may necessitate a more comprehensive approach to assessing treatment effects. Objectives: Here, we describe changes in physiological, psychological, and behavioral health after a multidisciplinary combined lifestyle intervention (CLI). Additionally, we investigated whether these changes were related to weight loss. Methods: This prospective observational longitudinal study comprised 96 adults with obesity (73 women, 81 Caucasian) participating in a CLI at the Obesity Center CGG, Erasmus University Medical Center, Rotterdam, the Netherlands. The 1.5-year intervention comprised multidisciplinary professional guidance towards a healthy diet, increased physical activity, and included cognitive behavioral therapy. Physiological health outcomes, psychological well-being, eating behavior, and physical activity were assessed after ten weeks and 1.5 years and compared to baseline. Results: An average of 5.2% weight loss (-6.0 kg) was accompanied by a mean 9.8% decrease in fat mass (-5.9 kg; both P < 0.001) and significant improvements in metabolism, hormonal status, and immune parameters (all P < 0.05). Moreover, we observed decreased psychopathology, increased quality of life, and decreased disordered eating (all P < 0.05). Weight loss correlated with most metabolic changes (all P < 0.05) but not with most psychological/behavioral changes. Conclusions: Combined lifestyle intervention in patients with obesity was accompanied by significant improvements in body weight and body composition along with cardiometabolic, endocrine, immunological, psychological, and behavioral improvements. Interestingly, most changes in psychological and behavioral health occurred independently of weight loss. Obesity treatment success should be evaluated based on a combination of physical and patient-reported outcomes rather than weight loss alone.
Investigation of Association Between Insulin Injection Technique and Blood Glucose Control in Patients with Type 2 Diabetes
(Brieflands, 2022-10-31) Akram Mehrabbeik; Nasim Namiranian; Reyhaneh Azizi; Mohammadreza Aghaee Meybody; Mahbobeh Shariati; Hassan Ali Mahmoudi Kohani
Background: The appropriate insulin injection skill is essential for optimal blood sugar control in patients with diabetes. However, the art of insulin injection is still not well understood in numerous medical centers. Objectives: This study was designed to determine the association between appropriate insulin injection and blood glucose control in patients with type 2 diabetes in Yazd, Iran. Methods: This cross-sectional study was conducted on 301 patients with type 2 diabetes who referred to Diabetes Research Center in Yazd within August 2020 to February 2021. Based on simple random sampling, the subjects with inclusion criteria, such as age >18 years, using an insulin pen for at least 3 months, and self-injection, were selected. The insulin injection technique was evaluated by a 13-item researcher-made questionnaire. The total score of this questionnaire was 26, and its validity and reliability were confirmed. The data were analyzed using SPSS software (version 20). Results: The mean age of the participants was 59.83 ± 10.26 years, and 60.1% had primary school or less education. Most participants (87%) used a needle more than five times, and almost half of them (53.5%) did not rotate the injection sites properly. The patients who reported pain during injection had statically lower injection scores than others (17.90 vs. 19.38, P = 0.001). There was a significant negative correlation between insulin injection score with fasting blood sugar (β = -0.232, P < 0.001), two-hour postprandial glucose (β = -0.164, P = 0.005), and hemoglobin A1c (HbA1c) level (β = -0.263, P < 0.001). Conclusions: None of the patients in this study fully followed the principles of a proper injection, which can lead to pain during injection, lipohypertrophy, hyperglycemia, and increased HbA1c levels.
Potential Methods to Improve Self-management in Those with Type 2 Diabetes: A Narrative Review
(Brieflands, 2023-01-31) Tintin Sukartini; Nursalam Nursalam; Rifky Octavia Pradipta; Masunatul Ubudiyah
Context: The ability of self-manage was important for type 2 diabetes mellitus (T2DM) patients and it was supported and depend on the method used. We aimed to summarize the potential method of self-management to improve self-empowerment. Evidence Acquisition: To obtain the related data, 5 databases, including Scopus, Science Direct, ProQuest, CINAHL, and SAGE, were comprehensively searched. The search was done in advance using the Boolean operator. The full texts of articles presenting data on self-management methods were screened and retrieved. Results: A total of 22 studies were included in this review. Various self-management techniques were covered with primary and secondary outcomes. Primary outcomes included blood pressure, fasting blood glucose (FBG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Secondary outcomes included knowledge, self-efficacy, lifestyle habits, physical activity, diet, smoking, medical treatment, support, and health behavior. A goal-setting-oriented approach was effective in setting targets and gaining support from family members. A family-centered approach was effective in taking care of and taking good care of patients with T2DM. Strength training exercises provide patients with a choice of physical activity that can help them manage their blood sugar and blood pressure. Acceptance and commitment therapy (ACT) is a stress-reduction technique. The patient’s acceptance of the disease and treatment for diabetes is aided by education. Conclusions: A successful self-management method was one which balances and adapts to the patient's condition. Regardless of the age of the patients, the overall findings from the review suggest that self-management methods can help patients become healthier and improve their quality of life by controlling their hemoglobin A1c (HbA1c) level.
Risk Reassessment of Differentiated Thyroid Cancer in Ahvaz, Iran: A Cross-sectional Retrospective Study
(Brieflands, 2023-01-31) Alireza Jahanshahi; Atefeh Asoodeh Sarshoori; Homeira Rashidi; Ferdos Zaman; Leila Moradi
Background: Accurate evaluation of response to treatment in differentiated thyroid cancer (DTC) is the sine qua non of preventing over-treatment in low-risk patients and implementing appropriate interventions in high-risk individuals. Objectives: This study aimed to assess the response to therapy in DTC patients based on dynamic stratification method. Methods: In this cross-sectional study, 154 medical records of subjects with DTC (with at least 6 months after total thyroidectomy) and referred to endocrinology clinics in Ahvaz, Iran, from April 2020 to May 2021 were examined. Patients were stratified according to a dynamic risk stratification system (informed by their specific clinical, histopathological, and ultrasonography findings, and other diagnostic imagines) into four groups: Excellent response (ER), indeterminate response (IR), biochemical incomplete response (BIR), and structural incomplete response (SIR). Results: For a mean follow-up period of 28.59 months, excellent response to treatment was observed in 92 patients (59.7%), indeterminate response to treatment was found in 32 patients (20.8%), biochemical incomplete response was detected in 2 patients (1.3%), and structural incomplete response was seen in 28 patients (18.2%). In the group with low risk of recurrence, ER and IR were observed in 79.2% and 15.6% of the patients, respectively (P < 0.0001). In the group with an intermediate risk of recurrence, ER was found in 32% of the patients, while IR and SIR + BIR were seen in 34% and 34% of the patients, respectively (P < 0.0001). No cases of ER or IR were observed in the group with high risk (P = 0.001). Conclusions: In sum, response to treatment significantly varied based on dynamic risk stratification, with ER being highest in the low-risk group, less likely in moderate risk group, and undetected in the high-risk group.
Self-reported Male Infertility and Metabolic Disturbance: A Cross-Sectional Study
(Brieflands, 2023-04-30) Mahbanoo Farhadi-Azar; Marzieh Saei Ghare Naz; Mehrdad Ghahremani; Maryam Mousavi; Fereidoun Azizi; Fahimeh Ramezani Tehrani
Background: Male infertility is a growing health problem. It is proposed that infertility is associated with some metabolic abnormalities. Objectives: This study aimed to examine the prevalence of self-reported male infertility and related metabolic disturbances. Methods: This is a cross-sectional analysis of the Tehran Lipid and Glucose Study (TLGS). A total of 1526 males participated in the study. Logistic regression was used to examine metabolic factors associated with self-reported male infertility. Results: The total prevalence of self-reported male infertility was 6.42%. The mean (SD) body mass index (BMI) of participants among fertile and infertile males was 26.80 (3.93) and 26.92 (4.36), respectively. The majority of participants in both groups were in the age group of 40-50 years old. In the fully adjusted model, the odds of infertility were significantly increased by each unit increase in total cholesterol [TC; odds ratio (OR), 1.01; 95% CI, 1.01 - 1.01; P = 0.03] and hip circumference (HC; OR, 1.06; 95% CI, 1.00 - 1.12; P = 0.02), respectively. Conclusions: The prevalence of self-reported male infertility was 6.42%. Male infertility was positively associated with TC and HC, indicating that knowledge about these risks might assist health care professionals and governments in developing and executing measures to change the status quo.
Diabetic Ketoacidosis in Children Before and During COVID-19 Pandemic: A Cross-sectional Study
(Brieflands, 2023-04-30) Mahtab Ordooei; Mehran Karimi; Elahe Akbarian; Zahra Rasoulizadeh
Background: Coronavirus disease 2019 (COVID-19) has spread quickly. Comorbidities, such as diabetes, have been determined as critical risk factors for COVID-19. Objectives: This study aimed to determine the frequency and severity of diabetic ketoacidosis (DKA) in children before and during the COVID-19 pandemic. Methods: This retrospective study examined children aged less than 18 years diagnosed with DKA hospitalized in Yazd Shahid Sadoughi Hospital from February 20, 2020, to November 21, 2021. The collected information was compared to those obtained during the same period in 2019 (pre-pandemic). According to the inclusion criteria, only children with suspected symptoms of COVID-19 or an infected family member underwent PCR. Results: The study included 70 children with confirmed DKA during the COVID-19 pandemic and 33 children hospitalized during the pre-pandemic period. The findings showed that the rate of DKA was higher during the pandemic than in the pre-pandemic period. In the DKA subgroups (during the COVID-19 pandemic vs. pre-pandemic), 35.7% vs. 21.2% were severe, 37.1% vs. 36.4% were moderate, and 27.1% vs. 42.4% were mild. Of 70 children, 30 underwent PCR tests for COVID-19, showing six positive cases. Among positive cases, five had mild symptoms, while one was hospitalized with signs of respiratory distress, polyuria, and polydipsia. All physical examinations of this patient were normal, except for the chest exam. Conclusions: A remarkable increase was observed in the frequency and severity of DKA in children during the pandemic.
Scientific Publishing in Biomedicine: A Brief History of Scientific Journals
(Brieflands, 2023-01-31) Asghar Ghasemi; Parvin Mirmiran; Khosrow Kashfi; Zahra Bahadoran
Scientific publishing, with about 350-year historical background, has played a central role in advancing science by disseminating new findings, generalizing accepted theories, and sharing novel ideas. The number of scientific journals has exponentially grown from 10 at the end of the 17th century to 100,000 at the end of the 20th century. The publishing landscape has dramatically changed over time from printed journals to online publishing. Although scientific publishing was initially non-commercial, it has become a profitable industry with a significant global financial turnover, reaching $28 billion in annual revenue before the COVID-19 pandemic. However, scientific publishing has encountered several challenges and is suffering from unethical practices and some negative phenomena, like publish-or-perish, driven by the need to survive or get a promotion in academia. Developing a global landscape with collaborative non-commercial journals and platforms is a primary proposed model for the future of scientific publishing. Here, we provide a brief history of the foundation and development of scientific journals and their evolution over time. Furthermore, current challenges and future perspectives of scientific publishing are discussed.
Recurrent Pericardial Effusion Due to Panhypopituitarism: A Rare Case Report
(Brieflands, 2023-01-31) Sher Singh Dariya; Deepak Agrawal
Introduction: A female patient, 48 years of age, with a complaint of recurrent episodes of diffuse chest pain, vertigo, and shortness of breath in the last five years, presented needing immediate medical attention. Case Presentation: The patient was evaluated and suspected of severe hypotension, cold hands, and feet with distended neck veins and muffled heart sounds. ECG revealed low voltage complexes and large pericardial effusion with a collapse in the diastole of the right auricle and ventricle. The provisional diagnosis was kept as pericardial effusion with hemodynamic compromise. Detailed history disclosed that she had suffered similar events five years before, during which a pericardial tap was performed, and the patient was on anti-tuberculosis treatment for nine months. The symptoms continued despite the treatments. She had a history of severe postpartum hemorrhage, failure of lactation, and early menopause with a history of hysterectomy dated ten years back. The biochemical study indicated decreased LH, FSH, TSH, ACTH, and serum cortisol levels. MRI brain revealed empty sella. The hormonal replacement was started with clinical improvement. Conclusions: Although hypothyroidism is an extremely rare cause of pericardial effusion, detailed history and further investigations are imperative to form a definitive diagnosis.
Diabetes Ketoacidosis and COVID-19: An Insight into the Pathophysiology
(Brieflands, 2023-04-30) Seyed Amirabbas Ahadiat; Zeinab Hosseinian
This article does not have an abstract.
Association Between Poor Sleep Quality and Glycemic Control in Adult Patients with Diabetes Referred to Endocrinology Clinic of Guilan: A Cross-sectional Study
(Brieflands, 2022-01-31) Mojtaba Mehrdad; Mehrnaz Azarian; Amir Sharafkhaneh; Ali Alavi; Roghayeh Zare; Afagh Hassanzadeh Rad; Setila Dalili
Background: Diabetes is a prevalent chronic medical comorbid condition worldwide. Diabetes mellitus is associated with various sleep disorders. Objectives: We aimed to determine the prevalence of poor sleep and the main factors of sleep interruptions in patients with diabetes mellitus. We further evaluated the association of sleep interruptions with glycemic control in this cohort. Methods: We conducted a cross-sectional study on 266 patients with type 1 and type 2 diabetes recruited from a university outpatient endocrinology clinic. Patients completed a checklist including demographic and disease-related characteristics in addition to the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. Using the PSQI cutoff score of 5, we created two subgroups of good sleepers (GS) and poor sleepers (PS). Results: Our results showed that good sleeper and poor sleeper patients with diabetes were significantly different regarding sex, employment status, BMI, presence of diabetes-related complications, HbA1c, and 2-hour postprandial blood sugar (2HPPBS) (all significant at P < 0.05). The most prevalent factors of sleep interruptions were “waking up to use a bathroom”, “feeling hot”, “pain”, “having coughs or snores”, and “bad dreams”. Among the subjective factors of sleep interruption, problems with sleep initiation, maintenance, or early morning awakenings in addition to having pain or respiratory problems such as coughing or snoring had the most significant associations with HbA1c. Conclusions: Our study showed significant subjective sleep disturbances (both quality and quantity) in patients with diabetes mellitus (both type I and II) and its association with diabetes control. We further identified the main factors that led to sleep interruptions in this cohort.
Effects of Vitamin D on Left Ventricular Ejection Fraction in Patients with Systolic Heart Failure: A Double-Blind Randomized Clinical Trial
(Brieflands, 2020-07-31) Reza Hassanzadeh-Makoui; Maziar Jamei; Masoud Hassanzadeh-Makoui; Hamid Khederlou
Background: Heart failure is a pathophysiologic state in which the cardiac output is not able to supply the body with enough oxygen and nutrients. The prevalence of heart failure has increased dramatically over the last decades. Vitamin D levels in patients with chronic heart failure are lower than healthy controls, and vitamin D deficiency has a direct relationship with mortality. Objectives: This study aimed to evaluate the effect of vitamin D on the improvement of left ventricular ejection fraction in patients with systolic heart failure. Methods: In this case-control clinical trial, 142 patients with chronic systolic heart failure were identified. Based on the inclusion and exclusion criteria, 114 patients were enrolled in the study and randomly divided into two groups. One group (n = 58) received 50,000 units of vitamin D capsules weekly for eight weeks, and the patients in the other group (n = 56) received a placebo. After excluding 15 patients from the placebo group and 17 patients from the intervention group during the study, according to the exclusion criteria, 41 patients were evaluated in both groups for ejection fraction changes after two months. Results: According to the results of this research, there were no statistically significant differences in the baseline parameters between the two studied groups. The intervention group consisted of 18 female and 23 male patients with a mean age of 61.68 ± 19.8 years. Moreover, the placebo group included 21 female and 20 male patients with a mean age of 62.12 ± 18.2 years. After a 2-month follow-up, the intervention group showed statistically significant changes in ejection fraction, end-diastolic volume, and heart failure class compared to the placebo group. Also, the serum level of albumin and vitamin D in the intervention group was significantly higher than the placebo group. Conclusions: The results of this study show that vitamin D treatment can improve the ejection fraction and functional ability of patients with vitamin D deficiency. If more comprehensive studies support this hypothesis, vitamin D deficiency assessment and correction in patients with chronic heart failure may be recommended.
Wide Spectrum of Thyroid Function Tests in COVID-19: From Nonthyroidal Illness to Isolated Hyperthyroxinemia
(Brieflands, 2022-01-31) Sima Hashemipour; Pouria Shahsavari; Somaieh Kiani; Milad Badri; Arefeh Ghobadi; Seyyed Mohammad Reza Hadizadeh Khairkhahan; Alireza Tariverdi
Background: Changes in thyroid function test (TFT) in COVID-19 patients have been reported in several studies. However, some features such as thyrotoxicosis are inconsistent in these studies. In addition, some drugs such as heparin interfere with the free T4 assay. Objectives: This study was designed to examine TFT abnormalities in COVID-19, utilizing direct and indirect methods of free T4 assay. Methods: This prospective cross-sectional study was conducted on 131 hospitalized COVID-19 patients. Serum levels of total T3, TSH, T3RU, and total T4 were measured. The free T4 assay was performed using direct (free T4) and indirect (free thyroxin index or FT4I) methods. The patients were categorized into different TFT groups. The clinical characteristics, laboratory findings, and outcomes were compared between the groups. Results: The frequencies of nonthyroidal illness (NTI), subclinical/overt hypothyroidism and subclinical/overt thyrotoxicosis were 51.7, 6.9, and 6.9%, respectively. Besides, 6 and 8.1% of the patients had isolated high free T4 and isolated high FT4I without any other TFT abnormality, respectively. The lymphocyte percent was lower in the subclinical/overt group than in other TFT groups (P = 0.002). Atrial Fibrillation (AF) was found in 37.5% of subclinical/overt thyrotoxicosis patients versus 1.7% in the NTI and nil in the other three groups (P < 0.001). Conclusions: In addition to the reported TFT abnormalities in COVID-19 in previous studies, some new features like isolated hyperthyroxinemia were found in our study. We found a strong association between subclinical/overt thyrotoxicosis and AF. Regarding the high prevalence of AF in hospitalized COVID-19 patients, request for thyroid function test is rational in COVID-19 patients with this arrhythmia.
The Action Plan and Strategy Development for the Community Readiness Improvement for Tackling Childhood Obesity (CRITCO) Study
(Brieflands, 2021-10-31) Mahdieh Niknam; Nasrin Omidvar; Parisa Amiri; Hassan Eini-Zinab; Naser Kalantari
Background: Community Readiness Improvement for Tackling Childhood Obesity (CRITCO) study has been developed based on the community readiness model (CRM) to improve the readiness of targeted local communities from two diverse socioeconomic districts of Tehran for tackling childhood obesity (CO) of late primary school children (10 - 12 years of age). Objectives: This study aimed to describe the rationale and process of developing the fourth phase of CRITCO study by developing an intervention package. Methods: The readiness level data was used to analyze strengths, weaknesses, opportunities, and threats (SWOT) of four intervention sites to guide proper strategies in partnership with key community members. Then, the action plan was developed as a living document to guide a 6-month quasi-experimental community-based intervention around the six dimensions of CRM. Finally, the community engagement process, outcome, and evaluation process were explained. Results: The current report described the action plan and strategy development of the CRITCO study. Expectedly, this study can provide valuable information to guide the public health policymakers in planning and executing relevant interventions.
Clinical Response to Treatment with Teriparatide in an Adolescent with Osteoporosis-Pseudoglioma Syndrome (OPPG): A Case Report
(Brieflands, 2022-04-30) Ali Homaei; Victoria Chegini; Fatemeh Saffari
Introduction: Osteoporosis-pseudoglioma syndrome (OPPG) is a rare autosomal recessive disorder characterized by severe osteoporosis and eye abnormalities that leads to vision loss. In this study, we report the outcome of a short period of treatment with teriparatide in one patient with OPPG. Case Presentation: The patient was a 17-year-old girl who suffered a bone fracture at the age of two and was diagnosed with OPPG at the age of three. Genetic testing was performed for the patient, and a novel homozygous nonsense mutation (c.351G>A) in exon 2 of the LRP5 gene was reported. She was treated with pamidronate, but the bone fracture increased, and the disability progressed. Therefore, at the age of 11 years and nine months, teriparatide was administered subcutaneously at a dose of 20 micrograms per day for four consecutive months. After the treatment with teriparatide, physical activity was achieved, and no further fractures were observed besides the gradual rise in bone mineral density (BMD) (from 0.532 to 0.711 gr/cm2 in lumbar spine and 0.372 to 0.635 gr/cm2 in femur neck). Conclusions: In children and adolescents diagnosed with OPPG who do not respond to other conventional therapies, short courses of teriparatide therapy may be helpful.

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