The relation of TSH and depression in hypothyroid patients

Background and aims: Many of hypothyroid patients that are under treatment with levothyroxine. In spite of normal blood level of thyroid hormones, are suffering from depression symptoms that show it is necessary the normal level of TSH should be detected specificially related to depression. Methods: A cross-sectional study was conducted on 174 hypothyroid patients under treatment with levothyroxine who referred to endocrinology clinic with TSH levels of 0.5-5 MIU/L for more than one year. Laboratory tests including TSH, T4 and T3 were performed. Beck depression questionnaire was completed for all patients by trained experts. Based on Beck depression test, scoreless and more than 10 was considered healthy and depressed, respectively. Then, TSH cut-off values based on depression was determined by Roc Curve analysis. Results: 174 hypothyroid patients (Female: 116, Male: 58) with mean age 45.5±11.7 years old were entered to the study. According to Roc Curve analysis, the optimal cut-off value of TSH based on depression was estimated 2.5 MIU/L with 89.66% sensitivity. Conclusion: The present study suggested that a TSH cut-off value for treatment of depression in hypothyroid patients should be based on depression, not just based on population studies. Based on the assessment of depression, our study concludes that a TSH cut-off value of 2.5 MIU/L is optimal. This cut point can provide the greatest effect in terms of depression improvement and quality of life for these patients

Idiopathic Hirsutism and Insulin Resistance

Background and Objectives. Polycystic ovary syndrome (PCOS) and idiopathic hirsutism (HI) are the two most common causes of hirsutism. Insulin resistance plays a key role in PCOS, but there are not enough data showing that patients with HI also have insulin resistance. This study was designed to evaluate the presence of insulin resistance in women with HI. Methods. Based on a cross-sectional study, two groups of age-BMI matched, hirsute women were compared to age-BMI matched, nonhirsute women. Sixty nonobese women with PCOS, thirty nonobese women with HI, and sixty nonobese control women were included in the study. Samples of hormones including androgens were measured. Insulin resistance based on homeostasis model assessment of insulin resistance (HOMA-IR) was compared between three groups by the Kruskal-Wallis test. Results. Patients with PCOS had significantly higher basal insulin level (16.04±1.4 versus 7.32±6.85 μIu/mL) and HOMA-IR score (3.7±3.36 versus 1.75±1.67) than patients with HI (P  0.001). Patients with HI also had significantly higher basal insulin level and HOMA-IR score than control group (P  0.001). Conclusion. Our data suggest that both PCOS and HI are associated with insulin resistance and these patients are more insulin resistant than healthy control people

Comparison of quality and type of sleep disorders in good control and uncontroled diabetic type2 patients

Background and aims: Evidence from laboratory and epidemiologic studies has showed that sleep duration and its quality relate with diabetes and may increase diabetes risk. Sleep disorders in Chronic diseases are prevalent. This study was aimed to compare sleep quality and disorders among patients with controled and uncontroled diabetes mellitus and relationship between metabolic controls of glucose and sleep. Methods: In this case control study160 Type 2 diabetic mellitus patients referred to the Qom and Arak diabete center were selected and according to Glycemic control was assessed by hemoglobin A1c (HbA1c) level divided in to groups with good control (n=65) and uncontroled control (n=95). Data were collected using Pittsburgh sleep quality index (PSQI) and DSM-IV-TR schedule and analyzed using chi-square, logestic regression and t-test. Results: In the currentr study, sleep duration and quality were in significant linear corolation with HbA1c level, a key marker of glycemic control and in general, major sleeping disorders in uncontroled diabetes were dissomnia. Conclusion: According to the importance rule of good glycemic control in type 2 diabetic mellitus patients, adjustment of related factors is important. Life style is one of the most important effective factor for care of diabetic patients. Sleep and rest are the most important components of human life, and for glysemic control. So, optimizing sleep duration and quality and identifying and treatment of sleep disorders should be considered as an intervention to improve glucose control in patients with type 2 diabetes. In the other hand, patients with good glycemic control have beter sleep and beter sleep quality

Exploration of Arak Medical Students’ Experiences on Effective Factors in Active Learning: A Qualitative Research

Introduction:: Medical students should use active learning to improve their daily duties and medical services. The goal of this study is exploring medical students’ experiences on effective factors in active learning. Methods: This qualitative study was conducted through content Analysis method in Arak University of Medical Sciences. Data were collected via interviews. The study started with purposeful sampling and continued by theoretical sampling. Totally 20 medical students were interviewed within 2 months. Data were analyzed via constant comparative analyzing method. Results: Three main themes were identified: individual differences, educational and environmental conditions emerged. Proper educational planning, teaching quality, emotional and psychological stimuli, beliefs, individual abilities, learning skills, relatives’ support, financial support and appropriate environment were considered as effective factors or subthemes in active learning experience of participants. Conclusion: The findings of this study showed that active learning does depend not only on individual abilities, but also dependents on educational and environmental conditions

Prevalence of skin lesions in diabetic patients, Arak:1392

Background: Diabetes mellitus (DM) is the most common of the endocrine disorders characterized by hyperglycemia. Diabetes mellitus affects every organ of the body including the skin. Skin lesions have negative impact on quality of life of diabetic patients and it is also very frustrating for both patients and their physicians. The pathophysiologic mechanisms of skin lesions are mainly unknown.The aim of this study was to evaluate the frequency of skin manifestations in this patients. Materials & Methods: A cross sectional study was performed on 700 patients attending to the diabetes clinic. The Institute ethical clearance was obtained before the start of the study.A complete cutaneous examination was done in all cases. A detailed dermatological examination was carried out by a consultant dermatologist and cutaneous findings were recorded. Relevant microbiologic and histopathological investigations were done whenever they were necessary to diagnose the cutaneous disorders.Statistical analysis was carried out by using t- test and Chi-square test.   Results:Seven hundred patients(73% women and 27% men )were enrolled in the study.Diabetic skin manifestations were detected in 94.5% of diabetic patients.The most common skin lesions were cherry angioma (37%),skin tag (32%) and eczema (32.8%).Our study showed a significant difference between the involvement by skin lesions and duration of diabetes (P=0.05) and age of patients (P=0.03) but it didn,t show any  significant difference between the involvement of skin lesions and HbA1C Conclusion: Our study showed that the skin lesions are common in DM patients and the duration of diabetes and age are positively correlated with skin lesions. For these reasons, education and special attention to medical staff and patients and searching approach to early diagnosis and treatment of skin lesions seem to be necessary

Correlation between metabolic syndrome and serum concentration of vitamin 25(OH)D

Background: The simultaneous occurrence of risk factors for both type II diabetes and coronary artery disease show the existence of "metabolic syndrome".The studies have been shown that vitamin D deficiency has an inverse correlation with the components of metabolic syndrome such as BMI,systolic blood pressure,waist,fatsing blood glucose,LDL cholesterol and insulin resistance. So, this sudy evaluated the association between metabolic syndrome and vitamin D deficiency. Materials and Methods: In this cross – sectional study among overweight patients referred to private and public clinics,70 patients with metabolic syndrome based on ATPIII criteria and 70 overweight healthy participants were selected and mean of 25 hydroxyvitamin D level in the two groups were compared. Laboratory tests for lipid profile and fasting blood glucose and vitamin D level and also examinations for waist, weight,height were done. Mann-Whitney-U and Student-t-test were used to evaluate the relationship of vitamin D level and metabolic syndrome. Results: Participants in this study were 63% female.The prevalence of vitamin D deficiency was 71.4% and 26.2% in metabolic and control groups, respectively (P 0.001). Mean of vitamin D was 20±22 and 27±17 ng / ml in metabolic and control groups respectively (P 0.01). Conclusion: The findings showed a significant correlation between vitamin D deficiency and metabolic syndrome and vitamin D deficiency has a role in establishment of metabolic syndrome through different mechanisms

The effects of Vitamin D supplementation on thyroid function in hypothyroid patients: A randomized, double-blind, placebo-controlled trial

Background: Data on the effects of vitamin D supplementation on thyroid function in hypothyroid patients are scarce. Objective: This study was done to evaluate the effects of vitamin D supplementation on thyroid function in hypothyroid patients. Material and Methods: This randomized double-blind, placebo-controlled trial was conducted on 201 hypothyroid patients aged 20–60 years old. Subjects were randomly assigned into two groups to intake either 50,000 IU vitamin D supplements (n = 102) or placebo (n = 99) weekly for 12 weeks. Markers of related with thyroid function were assessed at first and 12 weeks after the intervention. Results: After 12 weeks of intervention, compared to the placebo, vitamin D supplementation resulted in significant increases in serum 25-hydroxyvitamin D (+26.5 ± 11.6 vs. 0.0 ± 0.0 ng/mL, P < 0.001) and calcium (+0.4 ± 0.7 vs. 0.1 ± 0.6 mg/dL, P = 0.002), and a significant decrease in serum thyroid-stimulating hormone (TSH) levels (−0.4 ± 0.6 vs. +0.1 ± 2.0 μIU/mL, P = 0.02). A trend towards a greater decrease in serum parathyroid hormone (PTH) levels was observed in vitamin D group compared to placebo group (−3.8 vs. +1.9, P = 0.07). We did not observe any significant changes in serum T3, T4, alkaline phosphatase (ALP) and albumin levels following supplementation of vitamin D compared with the placebo. Conclusion: Overall, the current study demonstrated that vitamin D supplementation among hypothyroid patients for 12 weeks improved serum TSH and calcium concentrations compared with the placebo, but it did not alter serum T3, T4, ALP, PTH, and albumin levels

The Effect of Atorvastatin on Inflammatory Markers in Patients with Type Two Diabetes

Background and Aim: Regarding to paradoxical results of the studies about the effects of atorvastatin on inflammatory markers and metabolism, we aimed to evaluate the effects of atorvastatin on inflammatory markers in diabetic patients. Materials and Methods: Through a double blind randomized clinical trial, placebo control, 88 type two diabetic patients (T2DP), were treated with anti-diabetes oral agents, were randomly classified into two 44 cases groups. The intervention group took atorvastatin 40 mg daily and control group took placebo for three months and adiponectin, hsCRP, leptin, TNF-α, lipid profile and fasting blood glucose (FBS) were measured and compared at the beginning and the end of the study. The data were analyzed using student t test and paired t test. Findings: After three months, adiponectin was significantly increased in intervention group in comparison to control group, but leptin had not a significant change in two groups. Total cholesterol, hsCRP and LDL cholesterol (Low density Lipoprotein) were decreased significantly in the intervention group than control group, while FBS was non-significantly decreased. Conclusion: It seems atorvastatin is effective to decrease inflammatopry markers in diabetic patients

The effect of vitamin D on insulin resistance in patients with type 2 diabetes

Abstract Introduction Over the past decade, numerous non-skeletal diseases have been reported to be associated with vitamin D deficiency including type2 diabetes mellitus (T2DM). Different studies provide evidence that vitamin D may play a functional role in glucose tolerance through its effects on insulin secretion and insulin sensitivity. This study evaluates the effects of vitamin D supplementation on insulin resistance in T2DM. Method Through a before-after study, 100 patients with T2DM, 30–70 years old, were recruited from an Arak diabetes clinic as consecutive attenders. Participants were assessed for clinical and biochemistry. Serum insulin and, 25(OH)D concentration, and HOMA-IR was calculated. All measurements were performed at the beginning and the end of the study. Patients received 50,000 unit of vitamin D3 orally per week for eight weeks, Statistical analysis was made using SPSS17. The results were analyzed by descriptive tests, and a comparison between variables were made using paired T-tests or Wilcoxon tests, as appropriate. Results 100 participants including 70 women (70%) and 30 men (30%) took part in the study. All results were presented as Mean±SD, or medians of non-normally distributed. 24% of the participants were Vitamin D deficient {serum 25(OH)D ≤ 20 ng/ml(50 nmol/l)}. Mean serum 25 (OH) D concentration was 43.03± 19.28 ng/ml (107.5±48.2 nmol/l). The results at baseline and at the end, for FPG were 138.48±36.74 and 131.02±39 mg/dl (P=0.05), for insulin, 10.76±9.46 and 8.6±8.25 μIu/ml (P=0.028) and for HOMA-IR, 3.57±3.18 and 2.89±3.28 (P=0.008) respectively. Conclusion Our data showed significant improvements in serum FPG, insulin and in HOMA-IR after treatment with vitamin D, suggested that vitamin D supplementation could reduce insulin resistance in T2DM.</p

The Study the Effect of Vitamin D on Hypothyroidism

Background: Vitamin D deficiency or insufficiency is a common worldwide problem. The association between hypothyroidism and vitamin D deficiency is controversial. We aimed to study the effect of vitamin D on thyroid function in hypothyroid patients. Material and Methods: In this case-control randomized clinical trial study, 201 hypothyroid patients reffered to endocrinology clinics in Arak, were randomly classified into two groups.&nbsp; All patients were taking levothyroxine. Case group received vitamin D 50000 unit weekly and control group received placebo in addition to levothyroxine. After three months, thyroid function tests were repeated and compared with the results of the beginning of the study both intra groups and inter groups by student t test and paired t test analysis. Results: Male/Female ratio in both case and control groups were 0.24 and 0.15 respectively (P=0.1). The prevalence of vitamin D deficiency and insufficiency were 68.7 % (138) and 93.5% (188) and after vitamin D taking were 70% (34.8) and 51.2% (103) respectively.Student t test showed that TSH level in people who received vitamin D had a significant decrease in comparison to the people who received placebo (P<0.05). There were a significant change of TSH level between two groups at vitamin D level 10-30 ng/ml. Conclusion: Most of hypothyroid patients had vitamin D deficiency and vitamin D taking improved thyroid function by TSH suppression in these patients. We recommend the screening for vitamin D deficiency in hypothyroid patients. Although, more researches are needed to clarify molecular explanations of this hypothesis