Iranian Journal of Public Health
Volume:43 Issue: 3, Mar 2014

Advancements in different field of medicine have given rise to complex ethical dilemmas in clinical practice. The more the clinicians are sensitized to ethical problems and familiar with ethical decision-making, the more they can value professionalism in their practice. The current paper is designed to emphasize physicians to think ethically in the field of internal medicine and endocrinology. Being aware of the ethical issues and being sensitive to them are the first steps for ethical conduct. So, some important ethical issues will be described in brief, and an overview of professionalism and the principles of ethical decision making will be provided. Three ethical cases are included in order to make the discussion more practical.

Because of superficial location and not being covered by boney structure, thyroid is the ideal organ for 2-dimensional gray scale ultrasonography. Availability of relatively low cost equipment and ever increasing number of endocrinologists with expertise in thyroid ultrasound has made it an integral part of thyroid practice in the office of endocrinologists. In particular, the current recommendation for fine needle biopsy of thyroid nodules is ultrasound guided biopsy. Follow up of thyroid nodules for change in size can also be better documented by ultrasound than palpation. Although cytology obtained by fine needle biopsy is the gold standard for detection of malignancy, yet ultrasound features of the nodules direct the clinician to select for biopsy the higher risk nodules in a multinodular gland. For detection of parathyroid adenoma isotopic parathyroid scan is preferable but ultrasound is occasionally is needed for confirmation, in particular for cases when parathyroid isotopic scan is ambiguous. The present article is an overview of ultrasonography of thyroid and parathyroid intended for endocrinologists.

Evidence-based medicine is becoming an important s of human life span, which crucial developmental processes occur. Since peers play a critical role in the psychosocial development of most adolescents, peer education is currently considered as a health promotion strategy in adolescents. Peer education is defined as a system of delivering knowledge that improves social learning and provides psychosocial support. As identifying the outcomes of different educational approaches will be beneficial in choosing the most effective programs for training adolescents. The present article reviewed the impact of the peer education approach on adolescents. In this review, databases such as PubMed, EMBASE, ISI, and Iranian databases, from 1999 to 2013, were searched using a number of keywords. Peer education is an effective tool for promoting healthy behaviors among adolescents. The development of this social process depends on the settings, context, and the values and expectations of the participants. Designing such programs requires proper preparation, training, supervision, and evaluation.

Noncommunicable diseases pose a real threat to and their incidence is forecast to increase in both developed and developing countries; and, diabetes, obesity, and related complications are predicted to pose a great burden on health care systems all across the world. However, current used conventional medications and surgical interventions fall short of effectively controlling the rampant spread of obesity and diabetes. Moreover, as the world population grows older, increases the need for more effectively controlling old-age diseases such as obesity and diabetes. It is clear that many traditional plants are used for treatment of diseases in Iran and throughout the world as adjuncts to conventional therapy. This work aimed to present current science on the efficacy and safety of medicinal plants useful in diabetes mellitus, obesity, hyperlipidemia, hyper prolacrinemia and antioxidant effects by reviewing all human and some animal studies. Amongst reviewed studies, some natural products were found effective in the treatment of these metabolic disorders that deserve further works to isolate and characterization of their constituents to reach novel therapeutic agents. The findings of the current study demonstrated that some medicinal plants are effective in the treatment of different metabolic and endocrine disorders. For example Citrulluscolocynthis, Silybummarianum, Psyllium, Teucriumpolium, pomegranate, ginseng, Aloe vera and fenugreek decreased blood glucose significantly. Moreover, a variety of herbal supplements were found to be effective in the management of obesity such as ephedra, cissusquadrangularis, ginseng, bitter melon (Momordicacharantia), and zingiber.

Because of the ability of proliferation, regeneration, conversion to differentiated cells and tissue producing, stem cell therapy has important clinical implications for treatment of different diseases. In this chapter we discuss different kinds of stem cells that have been used in treatment of neurologic diseases, gastrointestinal diseases, heart diseases, bone disease, kidney disease, chronic wounds, graft versus heart disease, sepsis and respiratory diseases. Then we will discuss stem cell therapy in treatment of diabetes which is one of the most important diseases of Endocrinology and after that we will provide a brief summary of ethical challenges of stem cell transplantation.

The field of endocrine pharmacology is very wide but most of studies in the recent years from the world and Iran have focused on diabetes, osteoporosis, and lipid disorders. In the present review, we tried to evaluate the improvements and publications in that field briefly. Interestingly, many of studies have focused on agents that have traditional and natural origin. Although few basic studies have gone on the direct line to complete preclinical and some clinical trial studies, there are many non-clinical studies that have proved efficacy of many compounds in endocrine diseases but these studies were not continued at clinical stages to reach a drug. However, it is appreciable that, some researchers have given novel ideas that deserve investment by grant bodies to reach out valuable works. We believe that science of endocrine pharmacology is still young and more quality studies are still needed to introduce effective medications for diseases like diabetes and osteoporosis or even obesity and lipid disorders.

The aim of the clinical laboratory in endocrine disease diagnosis and management is detecting either the hormones or their downstream reaction metabolites or some other related substances. In the case of hormone measurement almost all the routine methods are based on immunoassay with different labels (radioimmunoassay, enzyme linked immunosorbant assay, chemiluminescence assays …) and different sensitivity and specificity. But their related metabolites can be measured with different methods from simple biochemical to highly sophisticated methods. These tests are used either for diagnosis or monitoring. With respect to diabetes the tests are categorized to biochemical, immunological and genetic. In this paper we will describe the most common tests, but the genetic tests that are not used in routine investigations are out of the scope of this paper.

Obesity is currently considered as a serious global health problem which is influenced by environmental and genetic factors. Association of genetic variants with obesity is widely scrutinized in recent years. The aim of this study was to evaluate present data on genetics of obesity in Iranian population in a systematic review study. To obtain all related studies, Google Scholar, PubMed, and Persian web databases; IranMedex and Magiran were searched up to January 2013. The search terms were; “gene”, “polymorphism, “obesity”, “waist circumference”, “BMI” affiliated to Iran. Non-population cross sectional studies, experimental studies, in vitro studies, case reports, review articles, letters to editor, short communications and dissertations were excluded. Finally 11 articles that investigated association of different gene variants with obesity were included. Due to the heterogeneity of data, it was impossible to perform a Meta-analysis. Our study showed that males with TT genotype for +45T>G variant of adiponectin gene, GG genotype for -11391G>A polymorphism of adiponectin, GC+GG genotype for Pro12Ala PPARγ2 gene variant, 1484insG carriers of PTP1B and AA genotype of 4223A>C ADA gene variant had significant positive association with obesity in Iranian population. However gene variants of glucokinase, TNF-α, UCP2, MTHFR, β3-adrenoreceptor and apolipoprotein E were not significantly associated with obesity. There are discrepancies in association between obesity and genetic variants in Iranian population compared to other populations. Therefore we suggest large scale genome wide association studies on defined populations with distinct clinical features are necessary in future to further investigate underlying genetic variants associated with obesity in Iranian population.

Modeling and simulation techniques are now widely used alongside with their experimental counterparts in order to complement them, or sometimes to bring first insights into the possible outcome of experiments. “Modeling” is a general word that could encompass a wide range of methods that could be applied to a variety of subjects and problems. Here, the use of selected molecular modeling methods has been described in the field of endocrinology, throughout of some concrete examples.

Biosensors are classes of sensors in which at least a biological process is used in sensing procedure. They are generally composed of three parts: a sensing element, a transducer, and a signal processor (or detector). They can be categorized by type of sensing materials or by detection techniques. From their invention time up to now, various biological species have been analyzed using variety of biosensors. They have been widely used for environmental, industrial, pharmaceutical and clinical applications in many research papers. Perhaps the number of biosensors which had a chance to commercialize and enter to the market is limited, but by recent developments in science and technology, day-by-day, the number of commercial biosensors are growing. Their importance in clinical medicine can be found in determination of biomarkers for early diagnosis of disease or for control and manage of them in point-of-care devices. Diagnosis and control of many endocrine diseases and metabolic disorders depend strongly on determination of chemicals, hormones and antibodies. A large number of biosensors research studies have focused on determination of these biomolecules. One of the famous commercial biosensor is widely used in management of diabetes is glucometer. They are portable commercial biosensors which measure the amount of glucose in a blood drop. The main challenges in designing biosensors are decrease the limit of detection, increasing the sensitivity and accuracy in an analysis, increasing lifetime and miniaturization. Even scientists are now trying to develop biosensors for non-invasive measurements of biomarkers in saliva or tears.

Energy expenditure is determined by basal metabolic rate, physical activity, and Thermic Effect of Foods (TEF). Some endocrine hormones have role in basal metabolism and hence in human energy expenditure. And some foods pose more thermic effects on the total body energy expenditure and therefore can influence body weight. This review was performed to discuss factors which may affect body metabolism and body weight. Latest medical databases and nutrition and metabolism books were reviewed. We used the following keywords in online databases: "Weight Management" and "Hormones"; "Energy Metabolism" and "dietary factors"; "Weight Management" and "dietary factors"; "Endocrine Hormones" and "energy expenditure"; "Basal Energy Expenditure" and "dietary factors"; " Thermic Effect of Foods" and "dietary factors". The best designed articles were used to perform this review. The results are presented bellow. Spicy foods, Caffeine, and alcohol are some dietary factors and Body Size, Body Composition, Age and Gender are the non-dietary factors which may affect the metabolism. Diet composition can also slightly influence the metabolism. This effect depends on how efficient a dietary component is metabolized in the body. Regular dietary pattern also can slightly increase TEF comparing with irregular dietary pattern. Thyroid hormones, Ghrelin, Epinephrine, Cortisol, Steroid hormones, Leptin, Growth hormone, and insulin are among the most important hormones which may influence on metabolism and body weight. Energy expenditure is the basis for measuring human energy requirement and is crucial for weight management. Various hormonal, dietary and non-dietary factors are engaged in total body energy expenditure and are important for weight management.

Recently, a number of procedures for interventional radiology diagnosis and treatment have been developed by the radiologists. The ‘Interventional Radiology’ refers to the therapeutic procedures performed under imaging guidance. The emergence of this specialty has been made possible by a lot of advances in the technology, imaging systems, and radiologists experience. Interventional radiologists are physicians who are experienced in minimally invasive procedures and targeted treatments which have less risk, less pain and less recovery time in comparison with the surgery. Minimizing the patient discomfort, avoid of general anesthesia, lower incidence of morbidity and mortality, and decreases the length and cost of hospitalization are some advantages of interventional radiology procedures. Similar to all medical fields, interventional procedures have been introduced and developed for the diagnosis and treatment of endocrinology procedures. In this article we aim to review and report our experience about the role of interventional radiology in venous sampling for endocrine diseases (such as parathyroid venous sampling, inferior petrosal sinus sampling, adrenal venous sampling, and venous sampling for islet cell tumors). In addition, interventional treatments of neuroendocrine cancer metastases to the liver, percutaneous ethanol injection therapy for secondary hyperparathyroidism, treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection, radiofrequency ablation of the adrenal gland neoplasms, and also establishing a cGMP pancreatic islet processing facility have been discussed in this article.