International Journal of Endocrinology and Metabolism
Volume:14 Issue: 3, Jul 2016

Context: Appropriate management of neonates, tested positive for congenital hypothyroidism (CH), in particular, the initial dosage of levothyroxine and the time of initiation of treatment is a critical issue. The aim of this study was to assess all current evidence available on the subject to ascertain the optimal initial dose and optimal initiation time of treatment for children with CH.
Evidence Acquisition: In this study, all published research related to the initiation treatment dose and the onset time of treatment in congenital hypothyroidism were reviewed. The searched electronic databases included Medline, Science direct, Scopus EMBASE, PsycINFO, Cochrane, BIOSIS and ISI Web of Knowledge. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major thyroid and pediatrics journals published within the past 35 years. Studies were included if they were written in English and investigated levothyroxine dose or timing of treatment or both, used for the treatment of children with congenital hypothyroidism.
Two thousand three hundred and seventy-four articles (excluding duplicates) were retrieved from the primary search. After reviewing the titles, abstracts and full-texts of studies, eventually, 22 studies were found that met our inclusion criteria. Amongst these, 17 and 12 evaluated outcomes of different treatment doses and treatment timing, respectively. Overall, the majority of these studies emphasized the initial high dose of levothyroxine and early treatment of newborns with hypothyroidism. There were, however, some studies that disagreed with increasing levothyroxine dose at initiation of treatment.
Considering the results of this review, apparently there is no difference in opinion regarding the early initiation of treatment, whereas determining the optimal dose of levothyroxine for start of treatment in CH patients still remains a controversial issue, demonstrating the need for further studies, despite the fact that use of high doses can lead to rapid normalization of biochemical indices, although this may cause complications..

Context: Hypoxia reduces osteoblast growth resulting in bone thinning and osteoporosis. Although obstructive sleep apnea (OSA) with recurrent hypoxia might be a contributing factor for osteoporosis development, whether OSA is a risk or protective factor for osteoporosis has not been demonstrated..
This systematic review and meta-analysis evaluated the association between OSA and osteoporosis using published observational studies..
Data Sources: PubMed/MEDLINE and EMBASE databases.
Study Selection: We completed a systematic review and meta-analysis of published observational studies that evaluated incidence or prevalence of osteoporosis or bone mineral density in obstructive sleep apnea compared with controls. Severity of OSA was characterized using the apnea-hypopnea index (AHI)..
Data Extraction: Primary outcomes were incidence, prevalence, or odds ratio of having osteoporosis, defined as bone mineral density T-score Of 353 articles, 344 articles were excluded, 9 underwent full-length review and data were extracted from 7 studies consisting of 113,558 patients. Finally, 3 extracted studies were included in the meta-analysis of osteoporosis. Among cohort studies, the pooled odds ratio of osteoporosis in patients with OSA was 1.92 (95% confidence interval [CI]: 1.24 - 2.97) compared with controls. Among cross-sectional studies, odds of osteoporosis was higher in controls compared with patients with OSA (OR = 0.60, 95% CI: 0.42 - 0.87). In subgroup analysis by gender and study design, in both sexes, only cohort studies had higher odds of osteoporosis compared with controls..
There was significant association between OSA and osteoporosis in studies with cohort design. Further prospective studies with large numbers of patients adjusted for the effects of age, sex, or BMI are required to comprehensively determine whether OSA is a risk factor for osteoporosis..

Diabetic foot ulcer is a worldwide health care concern affecting tens of thousands of patients. If these ulcers left untreated, they can create severe complications.
This study was designed to examine the effect of infrared radiation on the healing of diabetic foot ulcer.
Patients and This clinical trial was performed on 50 patients referred to Dr. Ganjavian hospital in Dezful city, Iran, with diabetic foot ulcer degree 1 and 2 (based on Wegener Scale). Sample size was determined based on relevant studies of the recent decade. Patients were classified into the intervention and control groups (n = 25 in each group) in terms of age, gender, degree of ulcer, ulcer site and body mass index. In this study, work progress was evaluated according to the checklist of diabetic foot ulcer healing evaluation.
The results of the current study showed that there was a statistically significant difference in healing ulcers (P Using the infrared plus routine dressing is more effective than using merely routine dressing.

Prevalence of diabetes mellitus type 2 (DM) is increasing globally. Considering the potential role of poly-unsaturated fatty acids in prevention of DM type 2 and lipid profiles improvement, some studies have been carried out on walnut. However, there are no studies on control of blood sugar in DM type 2 patients using walnut.
The current study aimed to evaluate the effect of walnut oil on blood sugar in DM type 2 patients.
This randomized control clinical trial was performed on 100 patients with DM type 2. For the experiment group (n = 50), walnut oil (15 g/day for three months) was added to their diet, while the control group (n = 50) did not undergo any interventions. Before initiation of the experiment and after the experiment, the systolic and diastolic blood pressure (SBP and DBP) levels, fasting blood sugar (FBS) and HbA1c were measured.
The two groups were not significantly different for SBP, DBP, body weight, and Body Mass Index. HbA1c level decreased significantly in the experiment group by 7.86% ± 21.97 (P = 0.005) from 7.00 ± 1.08 before the intervention to 6.37 ± 1.29 after the intervention. Also, FBS level decreased significantly by 8.24% ± 16.77 (P = 0.001); from 158.37 ± 48.16 before the intervention to 137.91 ± 23.24 after the intervention in the experimental group. These changes in the control group were not significant.
Consumption of walnut oil (15 g/day for three months) was shown to improve blood glucose level but, no changes were noted for bodyweight and blood pressure in type two diabetic patients.

Gestational diabetes mellitus is one of the most common complications of pregnancy. Physical activity is associated with a lower risk of type 2 diabetes mellitus. A recent meta-analysis study suggested that more research is needed to investigate the type, duration and intensity of physical activity that can help to reduce the risk of gestational diabetes mellitus.
The present study aimed to understand the association between physical activity and gestational diabetes mellitus through comparing the type and intensity of physical activity performed by pregnant females with gestational diabetes and healthy pregnant females in the first 20 weeks of their pregnancy.
Patients and In the current case-control study, 100 pregnant females with gestational diabetes mellitus as the case group and 100 pregnant females as the non-diabetic control group were recruited. The age range of the participants was 18 - 40 years with the gestation of 20 - 28 weeks. To diagnose gestational diabetes mellitus using the criteria introduced by carpenter and coustan females with abnormal glucose challenge test (> 140 mg/dL) were asked to perform the three-hour 100 g oral glucose tolerance test. The details of physical activity were collected by a modified version of the pregnancy physical activity questionnaire. Anthropometric and relevant data were recorded for all of the participants. Data were analyzed by SPSS version 21. Risk estimates were obtained by logistic regression and adjusted for confounders.
Females who had low total physical activity according to the pregnancy physical activity questionnaire during early pregnancy were at a significantly higher risk of developing gestational diabetes mellitus (OR = 4.12, 95% CI (2.28 - 7.43), P = 0.001) compared to the ones who reported higher levels of physical activity. Moreover, after adjusting for age, body mass index (BMI), gravidity and a family history of diabetes, females with low physical activity in the domain of transportation activity during 20 weeks of pregnancy were at a significantly higher risk of developing gestational diabetes mellitus. The statistical findings indicate that females with the low intensity of sedentary, light and moderate physical activity are at a higher risk of developing gestational diabetes mellitus (OR 2.32; 95% CI 1.21-4.43, P = 0.010, OR 6.26; 95% CI 2.95 - 13.30, P = 0.001 and OR 6.73; 95% CI 3.15 - 14.38, P = 0.001) compared to females with a higher intensity of sedentary, light and moderate physical activity.
The amount and intensity of physical activity during pregnancy is associated with a lower risk of gestational diabetes mellitus. As a result, the pregnant Iranian females have to be encouraged to do regular daily physical activity during pregnancy, if there is no specific contraindication to it.

Emerging evidences indicate that patients diagnosed with Adrenal Incidentaloma (AI) may present cardiovascular complications. Epicardial fat thickness (EFT) has recently been described as a new risk factor and an active player in metabolic syndrome and cardiovascular disease.
We aimed to evaluate the relationship between EFT and left ventricular hypertrophy and carotid intima-media thickness, which are both strong predictors of cardiovascular morbity and mortality, in patients with nonfunctioning AI.
Patients and We evaluated 51 patients (36 females and 15 males) diagnosed with AI and 35 (29 females, 6 males) age, gender and body mass index (BMI) matched healthy controls in terms of cardiovascular risk parameters. Epicardial fat was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium.
Epicardial fat thickness was significantly higher in patients with AI when compared to the control group (0.89 ± 0.32 cm vs. 0.74 ± 0.26 cm; P = 0.023). left ventricular (LV) mass index and median carotid intima-media thickness (CIMT) were also higher in subjects with AI than in controls (99.8 g/m2 vs. 86.9 g/m2; P = 0.024 and 7.5 mm (5.5 - 11.5) vs. 6.5 mm (4.5 - 9.5); P = 0.017). There was a positive correlation between EFT, LV mass index, EFT and CIMT (r = 0.315, P = 0.004; r = 0.363, P In this study we showed that EFT, measured by echocardiography is higher in subjects with AI when compared to healthy controls. epicardial fat thickness had the best independent correlation with AI in multiple logistic regression analysis. Incidentaloma is also associated with increased left ventricular mass index and CIMT. Adrenal incidentaloma patients may show early cardiac changes, such as increased left ventricular mass and increased CIMT.

Muscles and bones are interconnected. Recent studies suggest that undercarboxylated osteocalcin from bone may affect muscle mass and strength. There are, however, no prospective human data on this relationship.
We previously treated patients with hypoparathyroidism with intact Parathyroid Hormone (PTH) or placebo in a six-month randomized, placebo-controlled trial and demonstrated a marked increase in undercarboxylated osteocalcin (ucOC) in the PTH-treated group. We therefore investigated if this increase correlated with changes in muscle mass, strength or function. Primarily, the muscle mass using Dual energy X-ray Absorptiometry (DXA) was measured and the maximal voluntary isometric muscle strength at the upper and lower extremities, using dynamometry, was assessed. Furthermore, repeated chair stands test, Timed Up and Go test were performed and postural stability using a stadiometer was assessed. Finally, the relationship between change in ucOC or the ratio of the changes in ucOC and total OC (ucOC%/OC%) and different measures of muscle function were analyzed, using regression analyses.
The findings indicated that ucOC%/OC% was positively and significantly associated with percentage change in max force production during elbow extension (β = 0.28, P = 0.034), however, all other associations were non-significant.
Given the number of statistical tests that were carried out, our one significant finding may represent a false positive. Thus the results do not support the role of ucOC in muscle function in humans with hypoparathyroidism. Our results are inconsistent with previous data from a human cross-sectional study; however, cross-sectional studies, do not allow for inference of causality. The analyses should be repeated in larger, randomized trials including healthy individuals.