فهرست مطالب

  • Volume:18 Issue: 2, 2020
  • تاریخ انتشار: 1399/02/20
  • تعداد عناوین: 7
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  • Shahin Yarahmadi, Nasrin Azhang, Bahram Nikkhoo, Khaled Rahmani * Page 1

    Context: 

    Today, newborn screening for congenital hypothyroidism (CH) as one of the significant achievements in preventive medicine is integrated into the health systems of many countries worldwide. The national newborn screening for early identification of CH disorder in Iran was established in 2004. The purpose of this study was to review the national newborn screening for CH and its achievements in Iran. Evidence 

    Acquisition:

    In this study, we reviewed the structures, processes, main indicators, and achievements during the 15 years of implementing the national neonatal screening program for the diagnosis and treatment of CH in Iran.

    Results

    Primary TSH measurement with backup thyroxine (T4) determination in infants with high TSH levels was used as the screening strategy in Iran. The coverage of this screening program was higher than 98%. By the end of 2017, 1,501,624 neonates were screened, among which 40,773 were diagnosed with CH and treated based on the national guidelines. The average incidence rate of CH during these years was approximately 2.6:1,000 live births.

    Conclusions

    The performance of the newborn screening program for congenital hypothyroidism in Iran is favorable, with over a 95% coverage rate. Due to the high recall rate and incidence rate of CH, it is essential to monitor the screening program in the country and also to conduct further studies to determine the main risk factors for the high recall rate and incidence of this congenital error.

    Keywords: Iran, Congenital Hypothyroidism, Neonates, Screening
  • Fereidoun Azizi, Atieh Amouzegar *, Ladan Mehran, Hengameh Abdi Page 2

    Context: 

    Levothyroxine (LT4) is recommended as replacement therapy for thyroid hormone deficiency. However, some hypothyroid patients receiving LT4 therapy do not feel as well as healthy subjects. This article aimed to review current knowledge regarding LT4 monotherapy versus LT4+LT3 combination therapy and propose future directions regarding LT4+slow release T3 combination treatment for hypothyroidism.

     Evidence Acquisition:

    We searched PubMed and Scopus using related keywords.

    Results

    The LT4 monotherapy causes higher serum free T4 (fT4), subnormal serum free T3 (fT3), and fT3/fT4 ratio in one-fourth of patients. The LT4+LT3 combination therapy increases serum T3 and fT3 concentrations and may normalize the fT3/fT4 ratio. However, the primary outcomes, including thyroid hormone deficiency, anxiety, depression, and quality of life, may not be better in LT4+LT3 combination therapy than in LT4 monotherapy. Recent surveys show that combination therapy is on the rise, in particular, due to patient demand. The LT4 plus slow-release LT3 preparation has shown promising results in improving serum thyroid hormone concentrations.

    Conclusions

    The beneficial effect of LT4+LT3 combination therapy is not clear, and the safety of long-term therapy is yet under question. More scientific well-designed research projects are required in this field.

    Keywords: Treatment, Hypothyroidism, T3+T4 Combination
  • Zahra Bahadoran, Parvin Mirmiran, Khosrow Kashfi, Asghar Ghasemi * Page 3

    Citation, the act of properly referring to others’ ideas, thoughts, or concepts, is a common and critical practice in scientific writing. Citations are used to give credit to own work, to support an argument, to acknowledge others’ work, to distinguish other authors’ ideas from one’s work, and to direct readers to sources of information. A good citation adds to the scientific prestige of the paper and makes it more valuable to the reader. The citation has three basic elements: quoting from others, an in-text reference to the source, and bibliographic details of the source. Beyond technical skills, the citation needs an in-depth knowledge of the field and should follow basic rules, including the selection of relevant and valid sources, stating information/facts from others’ work, and referring to others’ work accurately and ethically. Several systems and styles are used to cite scientific sources; however, the most commonly used systems in medical sciences are ‘author-date’ systems (e.g., Harvard system) and numerical systems (e.g., Vancouver system). Here, we discuss how to make an accurate, complete, and ethical citation, and provide simple and practical guides to organize references in a scientific medical paper.

    Keywords: Citation, Medical Scientific Journals, Scientific Writing, Reference
  • Sandhya Nair_Hetal Bhadricha_Sonam Hatkar_Seema S Kadam_Anushree Patil_Suchitra Surve_Beena Joshi_M. Ikram Khatkhatay_Meena Desai * Page 4
    Background

     Vitamin D deficiency is prevalent among Indian women. Subclinical vitamin D deficiency is a significant risk factor for osteopenia and fractures. However, its effect on bone metabolism and bone mineral density (BMD) is still debatable.

    Objectives

     This study aimed to determine the relationship between the vitamin D status with bone turnover markers, carboxy-terminal telopeptide of type-I collagen (CTX), N-terminal propeptide of type I procollagen (PINP), and BMD in healthy Indian women.

    Methods

     In this cross-sectional study, we determined serum levels of 25-hydroxy vitamin D (25(OH)D), parathyroid hormone, serum CTX, and PINP using commercial ELISA kits in 310 healthy Indian women aged 25 - 65 years who underwent BMD measurements with DXA scan.

    Results

     The prevalence of vitamin D deficiency was 53.87% and vitamin D insufficiency 31.29%. A direct correlation of BMD with vitamin D levels was not observed. PINP negatively correlated with vitamin D in both premenopausal (Spearman’s r = -0.169, P < 0.05) and postmenopausal (Spearman’s r = -0.241, P < 0.05) women. However, CTX positively correlated with vitamin D in both premenopausal (Spearman’s r = 0.228, P < 0.01) and postmenopausal (Spearman’s r = 0.244, P < 0.05) women.

    Conclusions

     Vitamin D deficiency is more prevalent in premenopausal women than in postmenopausal ones. Although vitamin D does not show any association with BMD, it affects bone remodeling, which is reflected by the change in the bone formation marker PINP and the bone resorption marker CTX.

    Keywords: Osteoporosis_Vitamin D Deficiency_Bone Turnover Markers
  • Ibrahim Abbood Zaboon, Haider Ayad Alidrisi, Ibrahim Hani Hussein, Majid Alabbood, Nassar Taha Yaseen Alibrahim, Ammar Mohammed Saeed Almomin *, Dheyaa Kadhim Al Waeli, Ali Hussein Ali Alhamza, Adel Gassab Mohammed, HusseinAli Nwayyir, Ahmed Jaafer Hindi Al Ali, AbbasAli Mansour Page 5
    Background

     Fasting the month of Ramadan should be achieved by every pubescent Muslim unless they have an excuse. Fasting involves complete abstinence of oral intake throughout daytime. Patients who have hypothyroidism usually require levothyroxine (L-thyroxine) replacement, which is typically given on an empty stomach away from meals. Taking L-thyroxine replacement without feeding is challenging during the nighttime of Ramadan, in addition to being prohibited during daytime.

    Objectives

     This study aimed to determine the best time of L-thyroxine intake during Ramadan.

    Methods

     Fifty patients who were taking L-thyroxine treatment for primary hypothyroidism were involved in this prospective study for three months including the fasting and pre-fasting months. The patients were divided into three groups with different times of L-thyroxine intake. In the group one (pre-iftar), the patients were asked to take L-thyroxine at the time of iftar (the sunset meal) but to delay any oral intake for at least 30 minutes. In the group two (post-iftar), the patients were asked to take L-thyroxine two hours after iftar. The patients in the last group (pre-suhoor) were asked not to eat in the last two hours before suhoor (the predawn meal) and to take L-thyroxine tablet one hour prior to suhoor.

    Results

     When thyroid stimulating hormone (TSH) levels were compared before and after Ramadan, there were no significant differences neither within each group nor among all the study groups. Moreover, the frequencies of the TSH control after Ramadan showed no significant differences within each of the study groups (P = 0.18, 0.75, 1.0 for pre-suhoor, pre-iftar, and post-iftar respectively). Similarly, comparison among the groups of the study showed no significant differences regardless of whether the patients had controlled or uncontrolled TSH prior to Ramadan (P = 0.75 and 0.67, respectively). In the patients with controlled TSH before Ramadan, 8 out of 10 (pre-suhoor), 8 out of 12 (pre-iftar), and 4 out of 6 (post-iftar) maintained their control after Ramadan. While in the patients with uncontrolled TSH before Ramadan, 7 out of 10 (pre-suhoor), 6 out of 8 (pre-iftar), and 2 out of 4 (post-iftar) achieved controlled TSH after Ramadan.

    Conclusions

     No significant differences in TSH control were observed in patients taking L-thyroxine at pre-iftar, post-iftar, or pre-suhoor time in Ramadan.

    Keywords: Hypothyroidism, Fasting, Thyroxine, Ramadan
  • Mounes Asadi Shavaki, Tayebeh Fasihi Harandy *, Mitra Rahimzadeh, Ata Pourabbasi Page 6
    Background

     Having a child with diabetes creates a great deal of stress for mothers. The transactional model of stress and coping is one of the best conceptual frameworks for stressors.

    Objectives

     This study aimed to investigate factors related to health promoting behaviors based on transactional model in mothers of children with type 1 diabetes.

    Methods

     This study was conducted on 180 mothers of children with type 1 diabetes. The data was collected using a multi-sectional questionnaire including demographic characteristics and questions about the model constructs. Data were analyzed by SPSS software (version 19) and using statistical tests.

    Results

     The highest mean score was related to interpersonal relationships (13.8 ± 4.5) and the lowest was related to stress management (10.8 ± 4.2). Linear regression model showed that mother’s education, information seeking, and social support had a positive effect, and primary appraisal and emotion-focused coping had a negative effect on the mother’s health promotion behaviors. In the regression model R-square accounts for 53.7% of the variance.

    Conclusions

     The transactional model was an appropriate framework for explaining the coping outcomes in mothers of children with type 1 diabetes. By mothers’ attempts to improve attitude about diabetes and reduce their vulnerability, training to use coping strategies, increasing information and inter-sectoral interventions for attracting sufficient support from patients’ families can be hopeful in improving mothers’ behavioral Functioning.

    Keywords: Type 1 Diabetes_Mothers_Coping Behaviors_Transactional Model of Stress Coping
  • Adlyne Reena Asirvatham *, Karthik Balachandran, Shriraam Mahadevan, Satish Kumar Balasubramaniam Page 7
    Background

     The recovery of hypothalamic-pituitary-adrenal (HPA) axis suppression following pharmacological doses of various steroids has been studied previously. However, no study has been conducted using the more commonly used 1-mg dexamethasone in the overnight dexamethasone suppression test (ODST). Hence, we aimed at evaluating HPA axis recovery after the 1-mg ODST.

    Objectives

     This study aimed at investigating the pattern and time of recovery of the HPA axis following the 1-mg ODST in healthy subjects.

    Methods

     Ten healthy volunteers aged 18 - 40 years, BMI < 30 kg/m2, with neither exposure to steroids nor interfering drugs were included. The 1-mg ODST was performed, and the adrenocorticotropic hormone (ACTH) and cortisol samples were withdrawn at regular intervals. The serum cortisol of < 1.8 µg/dL was considered as HPA axis suppression, whereas the cortisol value equal to or more than baseline was deemed as recovery.

    Results

     Cortisol and ACTH levels were suppressed in all subjects 9 hours following the 1-mg ODST. Although ACTH showed an early increase after 8 hours, the upsurge was noticed following 24 hours (mean ± SD, 34.42 ± 18 pg/mL). Later, cortisol accompanied ACTH, and both reached their baseline after 72 hours (mean ± SD, ACTH, 37.48 ± 12.44 pg/mL; cortisol, 8.45 ± 3.32 μg/dL). A small dip in ACTH and cortisol (mean ACTH, 23.84 pg/mL; mean cortisol, 2.3 μg/dL) was observed after 24 - 36 hours indicating the return of the diurnal rhythm before complete recovery.

    Conclusions

     The complete recovery of the HPA axis occurs only 72 hours following the 1-mg ODST. ACTH begins to recover as early as 8 hours after the maximal suppression and diurnal rhythm of ACTH and cortisol resume 24 to 36 hours later.
     

    Keywords: Cortisol, Dexamethasone, Hypothalamic-Pituitary-Adrenal Axis, 1-mg Dexamethasone Suppression Test, Hypothalamic-Pituitary-Adrenal Axis Recovery