Endocrine Problems Research Articles

Thyroid Disorders in Pregnancy: Role of Routine Antenatal Thyroid Screening

Background & objective:Thyroid disorders are among the common endocrine problems during pregnancy with well-known adverse effects on both mother and fetus. Many of these adverse effects could be prevented or ameliorated by early detection and appropriate treatment of conditions, provided routine antenatal thyroid screening is done. Considering this view, the present study was aimed to find the prevalence of thyroid disorders and their spectrum in pregnancy in order to justify the necessity of routine antenatal thyroid screening.
 Methods: This cross-sectional study was conducted in the Department of Obstetrics & Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period 1 year from July 2012 to June 2013 on pregnant women to screen for the thyroid disorders in pregnancy. Based on predefined eligibility criteria, a total of 246 pregnant women up to 36 weeks of gestation were consecutively included in the study. A short history with brief physical examination was done followed by collection of blood samples. Thyroid function was assessed by measuring serum levels of thyroid stimulating hormone (TSH). Serum free thyroxin (FT4) level was estimated in 71 cases, where TSH value was deranged. Trimester specific reference range of serum TSH was used to define hypothyroid, euthyroid and hyperthyroid cases. The suspected risk factors were then compared between abnormal and euthyroid groups to find their association with thyroid disorders.
 Result: The results of the study showed that the overall prevalence of abnormal thyroid function status was 30.9% (hypothyroidism 29.7% and hyperthyroidism 1.2%) based on normal range of serum TSH in different trimesters of pregnancy. Pregnant women with thyroid disorders were generally older than their euthyroid counterparts (p = 0.039). Hypothyroid state was fairly common with advancing gestation (21.3%, 30.3% and 34% in the 1st, 2nd, and 3rd, trimesters respectively). Pregnant women with personal or family history of thyroid disease in the past exhibited a higher prevalence of abnormal thyroid function than those who did not have such history (p = 0.041 and p = 0.044 respectively). Past menstrual irregularity, past history of subfertility or abortion were significantly associated with thyroid disorders (p = 0.042, p = 0.004 and p < 0.001 respectively). Presence of goitre (21.1%) in current pregnancy also showed significant association with thyroid dysfunction (p = 0.001). The risk of developing abnormal thyroid function was observed to be 3.6(95% CI = 1.9 – 6.4) times higher in those who had at least one risk factor than those who did not have any risk factors (p < 0.001). However, a sizable portion (27.6%) of pregnant women without any risk factors developed abnormal thyroid function.
 Conclusion: The study concluded that one in every three women may have thyroid disorder during pregnancy, primarily hypothyroidism. Adopting risk factor-based screening for thyroid disorders in pregnancy, there is every chance that a substantial number of cases with thyroid dysfunction may be missed. Therefore, routine antenatal thyroid screening is recommended.
 Ibrahim Card Med J 2020; 10 (1&2): 74-83

Vitamin D Deficiency in Patients with Attention Deficit Hyperactivity Disorder

Objective: This study aimed to investigate the connection between childhood Attention Deficit Hyperactivity Disorder (ADHD) and the level of Vitamin D in the blood.
 Materials and Methods: The study was undertaken in 2018 on children in the age group of 4-13 years. Twenty two children diagnosed with ADHD were selected, along with a control group comprising twenty two healthy children showing no symptoms of ADHD or any other neurological disorder or liver or kidney disease or any endocrine problem. Anyone using Vitamin D supplements was excluded from the study. Venous blood samples were acquired from the subjects and serum Vitamin D level was measured.
 Results: The mean average level of Vitamin D in the research subjects exhibiting ADHD (18.60±6.33 ng/ml) was found to be lower than the control group (34.34±8.19) (P-value < 0.0005).
 Conclusions: This study has shed some light on the role played by Vitamin D in maintaining the antioxidant status of the brain. The study has shown that the Vitamin D is much lower in children diagnosed with ADHD. Vitamin D increases the expression of the enzyme, Gamma-Glutamyl Transferase (GGT). This enzyme is involved in the metabolism of Glutathione, which is considered an important antioxidant in the brain.

The Effectiveness of a Structured Teaching Programme on Knowledge Regarding Polycystic Ovarian Syndrome (PCOS) among Adolescent Girls at a Selected School of Raipur

Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders. PCOS is acomplex, heterogeneous disorder of uncertain etiology. PCOS produces symptoms in approximately 5%to 10% of women of reproductive age (12–45 years old). It is thought to be one of the leading causes offemale infertility and the most frequent endocrine problem in women of reproductive age. Adolescents agedbetween 10-19 years account for more than one fifth of the world’s population. In India, this age groupforms 21.4 percent of the total population. Menstrual abnormalities are one of the common problemsof adolescents. Polycystic ovary syndrome (PCOS) is the commonest cause of an-ovulatory infertility.This study was carried out to evaluate the effectiveness of a structured teaching programme on knowledgeregarding polycystic ovarian syndrome (PCOS) among adolescent girls at a selected school of Raipur.Quantitative research approach with pre-experimental design (one group pretest- posttest design) wasadopted for this study. The study was conducted in a selected school at Raipur i.e. Maharshi Vidya Mandir.The sample size was 100. Adolescent girls between the age of 13-17 years were selected. Non probabilityconvenient sampling was used. The Structured Teaching Programme was effective for adolescent girlsaccording to the level of knowledge before and after the intervention. The obtained t- value (24.92) wasstatistically highly significant at 0.05 levels.

Reference values and the effect of clinical parameters on thyroid hormone levels during early pregnancy.

Objective: Thyroid dysfunction is a common endocrine problem during pregnancy; correct diagnosis and appropriate treatments are essential to avoid adverse pregnancy outcomes. Besides, it is vital to identify and quantify the major risk factors for gestational thyroid dysfunction, including thyroid autoimmunity, human chorionic gonadotropin (HCG) concentration, body mass index (BMI) and parity. The study objective was to establish reference ranges during early pregnancy and to explore the relationship between risk factors and thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyroxine (FT3).Design, patients and measurements: To establish the reference ranges of thyroid hormone during early pregnancy in China and to identify the risk factors for thyroid dysfunction, woman in the first trimester of pregnancy (4–12 weeks gestation) were recruited. After excluding thyroid peroxidase antibody (TPO-Ab) positive and/or thyroglobulin antibody (TG-Ab) positive women, previous thyroid disease, a lack of iodine intake, reference values were calculated by 2.5th to 97.5th percentiles.Results: After exclusion of TPO-Ab and/or TG-Ab positive women, reference values were as follows: TSH, 0.11–3.67 mIU/l; FT3, 3.19–5.91 pmol/l; FT4 10.95–16.79 pmol/l. Higher BMI was associated with lower FT4 concentrations (P=0.005). In multiple regression analysis, TSH was significantly and positively associated with TG (P=0.03). Maternal parity and maternal age may be risk factors for the abnormal thyroidal response to hCG concentrations.Conclusions: Our study defined first trimester-specific reference ranges for serum TSH, FT4, FT3 in a Chinese population, and demonstrated that BMI ≥23kg/m2, maternal parity ≥3 and maternal age ≥30 years may increase the risk of thyroid dysfunction.

Patterns of Pediatric and Adolescent Gynecological Problems in China: A Hospital-Based Retrospective Study of 97,252 Patients and a Systematic Review

Background: Gynecological and reproductive problems that arise during childhood and adolescence can have a significant impact on individuals, families and society, and they are increasingly recognized as a public health priority. Methods: We conducted a retrospective study based on the electronic medical records of 207,287 gynecological visits over a period of 13 years (January 2006 to December 2018) at the Department of Pediatric and Adolescent Gynecology of The Children’s Hospital, Zhejiang University Medical School. The final analyses included 97,252 patients with gynecological problems. Additionally, we conducted a systematic review focused on previous studies examining PAG problems in China. Findings: The number of first-visit PAG patients increased from 4,582 to 11,876 during 2006-2018. Overall, genital inflammation was the most common presentation (57·0%), followed by early puberty (18·2%) and consultation of growth and development (10·2%). The proportion of other problems such as gynecological examination, menstrual disorder, other endocrine problems, genital trauma, masturbation syndrome, anomalies of the genital tract, and genital tumor, ranged from 0·5% to 5·6%. The disease pattern varied across age groups: among the 0-6 age group, over 78·0% had genital inflammation; for the 7-9 age group, genital inflammation and early puberty accounted for 43·4% and 39·6% of the cases, respectively; for ages 10-18, the most common problems were consultation of growth and development (34·9%), genital inflammation (21·4%), and menstrual disorder (20·7%). Twenty-two studies analyzing patterns of PAG issues in outpatient settings in China were included in the systematic review, showing an average weighted percentage of 48·8% for genital inflammation and 25·2% for menstrual disorder. Interpretation: Genital inflammation was the most common issue for pediatric and adolescent patients with gynecological problems. Other common issues included early puberty for children and teenagers, and consultation of growth and development and menstrual disorder for adolescents. Funding: The National Nature Science Foundation of Zhejiang (LQ18H040001, LY20H040011) Medical Scientific Projects from Health department of Zhejiang Province(2017KY101). Declaration of interests: The authors report no conflict of interests. Ethical Approval: The study was approved by the Human Subjects Committees of the Children’s Hospital, Zhejiang University School of Medicine.

Prevalence of overweight/obesity and associated factors among basic education teachers in a city in the north of Minas Gerais, Brazil

ABSTRACT Objective To estimate the prevalence of overweight/obesity and its associated factors among basic education teachers. Methods This is a cross-sectional study with probabilistic sampling by clustering. A questionnaire with socio-demographic, occupational, and psychosocial variables, as well as lifestyle, and health profiles was used. Results 707 teachers participated in the study. Associations with overweight / obesity were found for the variables: the male gender, age >40 years, three or more children, workload, contracted/designated employment relationship, fat intake through meat, abusive consumption of alcoholic beverages, presence of depressive episodes, endocrine problems, arterial hypertension, and negative self-perception of health with the prevalence ratio ranging from 1.16 to 1.52 in the associated variables. Conclusion Overweight / obesity affected approximately half of those surveyed. There is a relationship between sociodemographic, occupational, and psychosocial variables and lifestyles, on the one hand, and health factors and the presence of overweight / obesity in teachers, on the other. Measures must be implemented on modifiable factors, aiming to promote their quality of life.

The Oxidative Stress and Chronic Inflammatory Process in Chagas Disease: Role of Exosomes and Contributing Genetic Factors

Chagas disease is a neglected tropical disease caused by the flagellated protozoa Trypanosoma cruzi that affects several million people mainly in Latin American countries. Chagas disease has two phases, which are acute and chronic, both separated by an indeterminate time period in which the infected individual is relatively asymptomatic. The acute phase extends for 40-60 days with atypical and mild symptoms; however, about 30% of the infected patients will develop a symptomatic chronic phase, which is characterized by either cardiac, digestive, neurological, or endocrine problems. Cardiomyopathy is the most important and severe result of Chagas disease, which leads to left ventricular systolic dysfunction, heart failure, and sudden cardiac death. Most deaths are due to heart failure (70%) and sudden death (30%) resulting from cardiomyopathy. During the chronic phase, T. cruzi-infected macrophages respond with the production of proinflammatory cytokines and production of superoxide and nitric oxide by the NADPH oxidase 2 (NOX2) and inducible nitric oxide synthase (iNOS) enzymes, respectively. During the chronic phase, myocardial changes are produced as a result of chronic inflammation, oxidative stress, fibrosis, and cell death. The cellular inflammatory response is mainly the result of activation of the NF-κB-dependent pathway, which activates gene expression of inflammatory cytokines, leading to progressive tissue damage. The persisting production of reactive oxygen species (ROS) is the result of mitochondrial dysfunction in the cardiomyocytes. In this review, we will discuss inflammation and oxidative damage which is produced in the heart during the chronic phase of Chagas disease and recent evidence on the role of macrophages and the production of proinflammatory cytokines during the acute phase and the origin of macrophages/monocytes during the chronic phase of Chagas disease. We will also discuss the contributing factors and mechanisms leading to the chronic inflammation of the cardiac tissue during the chronic phase of the disease as well as the innate and adaptive host immune response. The contribution of genetic factors to the progression of the chronic inflammatory cardiomyopathy of chronic Chagas disease is also discussed. The secreted extracellular vesicles (exosomes) produced for both T. cruzi and infected host cells can play key roles in the host immune response, and those roles are described. Lastly, we describe potential treatments to attenuate the chronic inflammation of the cardiac tissue, designed to improve heart function in chagasic patients.

Establishing paediatric endocrinology services in a limited resource country: experience from Sudan.

Non-communicable diseases including paediatric endocrine disorders are becoming another health burden in the developing countries. No published data on the magnitude of the problem and pattern of cases is available from Sudan as there was no organised paediatrics endocrinology service before 2005.The objective of this study was to see the number and pattern of cases which were seen over the first 10 years in our unit which was established from scratch in 2006. Before starting the unit, a situational analysis was made, and proposal showing the objectives and needs was written. Staff was trained, equipment, investigative facilities and medication were secured gradually, management guidelines and protocols were written taking into consideration the available facilities. A unit registry was created. The unit registry and medical records of patients seen between 2006 and 2015 were reviewed. During this period a total of 7,306 cases were seen, 4,735 endocrine and 3,131 diabetics. A separate unit solely devoted to paediatric endocrinology was established, and multidisciplinary staff including 13 paediatric endocrinologists, were trained. Nationwide diabetes program was established. Research work is being done. Currently, we have started a local paediatric endocrinology fellowship program. Pediatric endocrine problems are common in Sudan. We plan to make services available, accessible and affordable in all of the states of Sudan. This needs collaboration between the government and local and international societies.

Drug Utilization Evaluation On Antidiabetic, Thyroid And Antithyroid Drugs

Aim: To evaluate the drug utilization of antidiabetic, thyroid and antithyroid drugs at an endocrinology speciality hospital among the ambulatory patients. Method: This was a prospective observational study conducted for a period of 6 months. Patients who were diagnosed with either diabetes mellitus (both type-I & type-II) or thyroid disorders and receiving their respective pharmacological therapy irrespective of age and gender were included in this study. Pregnant, lactating women and patients with endocrine problems other than diabetes mellitus and thyroid disorders were excluded from this study. Results: The total number of cases collected and analyzed during a period of 6 months was 246 in which 139 (56.5%) were diabetes mellitus and 107 (43.5%) were thyroid disorders. Among the parenteral hypoglycaemic agents, long acting-insulin glargine and intermediate acting + short acting- NPH + regular insulin were prescribed in almost similar frequency. In case of mono therapy, teneligliptin was the most commonly prescribed medication and this was the unique finding in this study which signified that the trend in prescribing pattern is changing and updating from time to time. In dual combination therapy Glimepiride + Metformin and in triple combination Glimepiride + Metformin + Voglibose combinations were the most commonly prescribed medication. In hypothyroidism, supplementation with levothyroxine was the only treatment alternative as it is related to the underactive thyroid, secreting insufficient amount of hormone. Irrespective of many classes of drugs available in treating hyperthyroidism carbimazole was the most frequently prescribed drug in this study. Conclusion: It was observed that some changes in the prescribing pattern of antidiabetic drugs that signified the trend in drug utilization pattern. Clinical pharmacists should play a key role in observing and identifying the trends in prescribing patterns by performing the drug utilization evaluation studies thereby providing a better pharmaceutical care in collaboration with the other health care professionals.

EXPERIMENTAL MODELS OF FETOPLACEENTAL INSUFFICIENCY IN ANIMALS (LITERATURE REVIEW AND OWN OBSERVATIONS)

This literature review is devoted to experimental models of placental disorders in animals. Today, our knowledge of the structure and function of the placenta during pregnancy is remaining limited. The use of new technologies and imaging methods in animals that can provide safe monitoring of the growth and function of the placenta in vivo requires preclinical studies and trials in appropriately developed animal models that can be easily translated into a clinical setting. All this, of course, requires the use of test animals for modelling placental pathologies. The review considers the positive and negative aspects of various animals and methods of modelling the pathological conditions during pregnancy. In the experiment, models of fetoplacental insufficiency are very often used, arising from oxidative stress and activation of free radical oxidation. To simulate the experimental fetoplacental insufficiency caused by histotoxic hypoxia, the xenobiotic tetrachloromethane is used. Women of very young and mature reproductive age have a high risk of fetoplacental insufficiency. It is not known exactly how placental insufficiency in mothers will affect the sexual development of pubertal offspring. That is why we conducted a comprehensive experimental study on this issue at the base of V. Danilevsky Institute of Endocrine Pathology Problems, NAMS of Ukraine. To solve this problem, our institute has developed and proposed a new pharmaceutical composition that should not only contribute to the correction of placental insufficiency, but also has a certain prophylactic value for maintaining reproductive potential in adulthood. The study was carried out on Wistar rats of two age groups. We modelled experimental fetoplacental insufficiency and then corrected it with this pharmaceutical composition. Our study made it possible to establish that fetoplacental insufficiency has a different effect on the formation of the reproductive system in male and female rats in puberty. Prophylactic adding of the composition to the food for pregnant female rats with modelled placental insufficiency leads to the decrease in reproductive diseases of their offspring in puberty. Research on animal models provides important insight into the molecular and functional mechanisms underlying fetoplacental insufficiency and intrauterine growth retardation, as it enables to carry out studies, which are not possible in pregnant women.

Rehabilitation Care of Women with PCOS: A Case Study

Background: The most widely recognized endocrine problem is Polycystic Ovary Syndrome (PCOS) that shows during puberty with menstrual irregularities, acne and hirsutism. The fundamental imperfections in PCOS are still unclear, so insulin resistance and metabolic syndrome are most common in both healthy weight and as well as in obese patients. Numerous treatments are offered for women related to PCOS including weight loss, gonadotropins, metformin, DASH diet, letrozole and laparoscopic ovarian diathermy. Case presentation: This case report 35-years-old female presented for evaluation of obesity, menstrual irregularity and amenorrhea, and had no received any kind of hormonal treatment. Luteinizing hormone and serum testosterone level were elevated, while follicle stimulating hormone and estradiol level was normal. Conclusion and Outcome: Metformin and DASH diet was best treatment choice for PCOS patient that requires further examination before to being suggested on a long term basis and successful treatment outcome.

Thyroid profile in patients of thalassemia with multiple blood transfusions and high serum ferritin: a cross-sectional study

Introduction: Beta-thalassemia major patients undergo regular blood transfusion resulting ingrowth faltering and various endocrine problems including thyroid dysfunction due to iron overloadin the body. This study was conducted to determine the frequency of thyroid dysfunction in childrenpresenting with Beta-thalassemia major on regular blood transfusions. Materials and methods:Sixty children were included with proven beta-thalassemia major who reported to the Department ofPediatrics, VIMS, and RC, Bangalore. Inclusion criteria: 1.Children 4 to 18 years age group .2.Thechild received transfusions for more than 2 years. 3.Children with serum ferritin level >700.Results: In this study, four patients(6.8%) had overt hypothyroidism, eight patients(13.6%) hadsubclinical hypothyroidism and 47 patients(79.7%) had euthyroid status. There was a positivecorrelation between Ferritin and T4, TSH levels. i.e., with an increase in Ferritin level, there was anincrease in T4, TSH levels, and vice versa. However, the correlation was significant with TSH. Therewas a significant negative correlation between Ferritin and T3 levels. i.e with an increase in Ferritinlevel, there was a decrease in T3 levels and vice versa. Conclusion: Thyroid dysfunction can exist inthalassemia patients on multiple transfusions and chelation therapy with high serum ferritin levels.Detection of hypothyroidism is important as inexpensive oral replacement therapy is readilyavailable. Hence regular screening of beta-thalassemia major patients for Serum T3, Serum T4,Serum TSH for early detection and timely treatment could improve the life expectancy and quality oflife of these patients.

Клініко-морфологічний аналіз патології надниркових залоз у Харківському регіоні (за даними архівного матеріалу у період 2015-2019 рр.)

The adrenal glands play an important role in the functioning of the human body. There are more opportunities for early tumors detection of these endocrine glands thanks to modern diagnostic procedures, but the problem is very relevant. Morphological investigation is the basis for differentiating adrenocortical adenoma from carcinoma. Material and methods. The article presents the clinical and morphological features of the adrenal glands pathology in Kharkiv region in the period 2015-2019 by analyzing the archival histological material of 77 patients who were operated in hospitals of the State Institution "Institute of General and Emergency Surgery named after V. T. Zaitsev of National Academy of Medical Sciences of Ukraine" and "V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine". Results and discussion. The study established that in 2015 there were 18 cases (including 8 malignant tumors), in 2016 – 16 cases (2 cases with bilateral damage, 1 malignant tumor), in 2017 – 12 cases, in 2018 – 20 cases, in 2019 – 11 cases. All tumors were benign in the last 3 years of the study. We calculated that 48.6 years was the average age of patients with this localization tumor processes (20-75 years). Women suffered more often than men (61.03% and 38.97%, respectively). Both adrenal glands had pathological changes in 2 people. The left gland is most often affected. The vast majority of the formations in 2015-2019 were benign (88.61%). Adrenocortical adenomas (45 cases, mostly clear cell variant, leftward, in women) and mature pheochromocytomas (13 cases, uncomplexed variant, leftward, in men), adrenal cysts (6 cases, more often on the right, in men, with a dense fibrous capsule), hyperplasia of the cortical, cerebral or both layers (4 cases), ganglioneuroma of the adrenal medulla (1 case) and a combination of pheochromocytoma with two adrenocorticosteromas (1 case) were among them. Conclusion. Malignant tumors were represented by malignant corticosteromas (5 cases out of 9, leftward, various sizes, with secondary changes in tumor tissue), malignant pheochromocytomas (3 cases out of 9, right, different size) and malignant paraganglioma (1 case). The larger size of the tumor did not always correlate with the nature of the process

Women’s exposure to pesticides in a cohort of Brazilian smallholder family farmers

Women living in rural areas are at higher risk of pesticide exposure, especially when involved in agricultural tasks. Objective: To discuss women’s exposure to pesticides among a cohort of Brazilian farmers. Methods: A cross-sectional study investigated pesticide exposure and health effects of family farmers from Rio de Janeiro State, providing relevant data to discuss women’s potential exposure. Results: The assessed female farmers (n=37) had a mean age of 45y, and 57% were at bearing age (18-45y), which is an important risk for reproductive, gestational, and endocrine problems. They were mother of 21 children aged <10y and 22 from 11-18y, who are often taken to planting areas from very early ages. Female farmers were exposed to mixtures of multiple pesticides (31 classes including organophosphates, carbamates and pyrethroids) for 23y on average, and none of them had ever received occupational training. While men were mostly involved in pesticide manipulation and spraying, women daily performed other tasks without recommended personal protection. Most women lived close to cultivation sites with pesticide use (85% <1km), reported residential exposure (95%), storage of chemicals at home or nearby, and cleaning work-contaminated clothes and equipment, and that are additional sources of exposure for them. As a consequence, a high prevalence of poisoning (e.g. headache, tingling, cramps, dyspnea and cough) and mental health (e.g. depression and anxiety) symptoms were reported. Conclusion: The female farmers investigated are at higher risk of being exposed to pesticides throughout multiple pathways, which may have harmful impacts on their health and offspring. Technical support must be improved to smallholder family farmers in Brazil and risk mitigation strategies adopted to minimize women’s exposure to pesticides in order to protect their health and families.

Osteoporosis risk prediction in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease

The aim of the study is to optimize the method of osteoporosis (OP) risk prediction in patients with type 2 diabetes mellitus (DM) and non-alcoholic fatty liver disease (NAFLD) by using specific and sensitive diagnostic criteria.Materials and methods. The design of the risk prediction method of the OP development in patients with type 2 DM and NAFLD was conducted by using the most significant diagnostic indicators. The calculation method of the OP risk probability in patients with type 2 DM and NAFLD was developed by using statistical methods of multivariate factor analysis and logistic regression. The method was evaluated in the Clinic of the State Institution “V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine” in 51 patients, whose average age was 63.2 ± 0.99 years with the average duration of type 2 DM 7.84 ± 0.68 years.Results. In order to establish the diagnostic accuracy of the proposed method of the OP development risk prediction in patients with type 2 DM and NAFLD, the data on all examined patients were analyzed and the following diagnostic characteristics were obtained: the sensitivity of the developed method is 88.23 %, the probability of a negative result with a negative prognosis, or the specificity of the developed method, is 70.58 %; the accuracy (the proportion of true-positive results and true-negative results) is 82.35 %, the odds ratio is 18.37.Conclusions. The proposed OP risk prediction method in patients with type 2 DM and NAFLD allows obtaining reliable predictions with sufficient accuracy for practical use. The application of this method will serve beyond assessing the risk of OP development, but also to provide timely treatment with drugs aimed to prevent the OP progression and to avoid complications, thereby reducing disability and influencing the quality of life.

Prenatal smoke exposure is associated with increased anogenital distance in female infants: a prospective case-control study.

To investigate the effects of maternal smoking during pregnancy on newborn infants' anogenital distance (AGD). Fifty-six female and sixty-four male newborn infants from mothers who smoked during pregnancy were included in this study. A control group for each sex was selected from infants whose mothers had no active or passive (in either the household or the workplace) smoke exposure before or during pregnancy. Questionnaire data on maternal demographic characteristics and information about cigarette use were collected. We assessed genital anthropometry which included AGD for both male and female neonates, and stretched penile length (SPL), penile girth for males within the first 48h after birth. AGD measurements were also normalized according to birth weight (AGD/weight in grams), length (AGD/height in millimeters), and ponderal index [AGD/(weight in grams/height in cubic centimeters)]. Anogenital index (AGI) was calculated by dividing the AGD by cube root of birth weight. In female infants, prenatal smoke exposure was associated with significantly increased weight-adjusted AGD (p=0.03). There was also a significant correlation between mothers' daily smoking rates and weight-adjusted AGD (r=0.27/p=0.03). In male infants, fetal smoke exposure was not associated with any AGD measurements, SPL and penile girth. A significant increase in weight-adjusted AGD in female infants exposed to maternal smoking may be an indicator of antenatal androgen exposure and may pose a risk for short and long-term endocrine, metabolic and behavioral problems.

Assessment of Thyroid Function and Oxidative Stress State in Foundry Workers Exposed to Lead.

Background.Exposure to lead (Pb) has been associated with endocrine, hematological, gastrointestinal, renal and neurological problems in humans. However, effects on the thyroid gland are controversial.Objectives.The aim of the present study was to assess thyroid function in foundry workers occupationally exposed to Pb and the mechanism of oxidative-antioxidant imbalance.Methods.Thyroid function parameters and markers of oxidative stress were examined in 59 adult males who had been occupationally exposed to Pb. The results were then compared to those of 28 male subjects who had no history of Pb exposure or thyroid abnormalities and served as a control group.Results.Mean blood lead levels (16.5±1.74 μg/dl) were significantly higher among the exposed workers compared to those of the control group (12.8±1.16 μg/dl, (p <0.001)). The exposed group had significantly increased free triiodothyronine (FT3), free thyroxine (FT4) and significantly decreased thyroid stimulating hormone (TSH) (1.77±0.44 μIU/ml), whereas the control group had a TSH level of 2.61±0.94 μIU/ml (p< 0.0001). A state of oxidative stress was indicated by the significant increase in mean levels of malondialdehyde (MDA) and significant decrease in glutathione (GSH) (p < 0.0001). There was a significant positive correlation (r=0.358, p <0.05) between blood lead levels (BLL) and duration of employment, while BLL showed a significant negative correlation with TSH (r =−0.486, p <0.001), and GSH (r =−0.336, p <0.05). Of the occupationally exposed workers, 32.76% had elevated thyroid hormones. The results showed a significant positive relationship between GSH and TSH (β coefficient=0.274, p < 0.05), MDA with FT3 (β coefficient=0.355, p < 0.05) and FT4 (β coefficient = 0.491, p < 0.0001) among exposed workers.Conclusions.Workers exposed to Pb dust proved to be at risk for hyperthyroidism, which was found to have a significant role in oxidative–antioxidant imbalance present among workers with increasing duration of exposure.Participant Consent.ObtainedEthics Approval.This study was approved by the Ethical Committee of the National Research Centre in Egypt (NRC) under the registration number 15225.Competing Interests.The authors declare no competing financial interests.

Neurodevelopmental risk evaluation of premature closure of the anterior fontanelle.

To evaluate neurological development of completely healthy children with anterior fontanelle premature closure via Denver Developmental Screening Test II and to compare the results with control group. The records of 140 patients applied to Mersin University Pediatric Neurology Outpatient Clinic between 2011 and 2019 with the complaint of premature closure of the anterior fontanelle were retrospectively reviewed. Patients with microcephaly, craniosynostosis, infection, sequelae of hypoxia-ischemia, metabolic disorders, intracranial hemorrhage, epilepsy, endocrine problems, and dysmorphic features were excluded from the study. Sixty-six completely healthy children with anterior fontanelle premature closure were included in the study. Denver Developmental Screening Test II was performed by the same developmental specialist to the children with premature closure of the anterior fontanelle as well as to the healthy control group. For each child included in the case and the control group, 90% of the values for each development area were calculated and recorded. Then, the results were compared. Denver II Developmental Screening Test (p < 0.001) and gross motor subtest (p < 0.001) results showed statistically significant retardation in the case group compared with the control group. The study was the first study in the literature on the gross motor development of children with premature closure of anterior fontanelle, and it has been found significantly undeveloped compared with the control group, and it has been concluded that similar patients should be evaluated from this view point in pediatric neurology department.

Are Heavy Metal Exposure and Trace Element Levels Related to Metabolic and Endocrine Problems in Polycystic Ovary Syndrome?

This study aimed to determine the relationship between the metabolic and endocrinological pathologies in polycystic ovary syndrome (PCOS) and the levels of arsenic, chromium, cadmium, lead, mercury, antimony, zinc, and copper to evaluate the relationship of these toxic metals with inflammatory/oxidative parameters. This study included a total of 154 patients (84 with PCOS, 70 healthy volunteers). Metabolic and endocrine parameters and arsenic, chromium, cadmium, lead, mercury, antimony, zinc, and copper serum levels of the patients were compared between the groups. Considering the action mechanism of toxic metals, serum malondialdehyde (MDA), superoxide dismutase (SOD), serum total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), tumor necrosis factor-alpha (TNFα), and high-sensitivity C-reactive protein (HsCRP) levels were determined. Serum TAS (p = 0.002), OSI (p = 0.006), SOD (p = 0.006), zinc (p = 0.010), and copper (p = 0.030) values were statistically lower whereas TOS (p = 0.008), MDA (p < 0.001), HsCRP (p < 0.001), TNFα (p < 0.001), antimony (p < 0.001), cadmium (p < 0.001), lead (p < 0.001), and mercury (p < 0.001) levels were significantly higher in the PCOS group than those determined in the control group. Antimony was positively correlated with fasting glucose (FG) and HOMA-IR while cadmium, in addition to FG and HOMA-IR, positively correlated with insulin and lead had a positive correlation only with FG (p < 0.05). Also, these three heavy metals correlated positively with some oxidative system and inflammatory parameters and negatively with the antioxidant system parameters (p < 0.05). In conclusion, heavy metal exposures in PCOS may be related to insulin resistance and hirsutism through oxidative and inflammatory mechanisms. This approach can be used to identify the risky patient group and to develop new treatment modalities.

Gastrointestinal, nutritional, endocrine, and microbiota conditions in autism spectrum disorder.

Gastrointestinal, nutritional, metabolic, endocrine, and microbiota medical problems in pediatric patients diagnosed with autism spectrum disorder (ASD) are some of the coexisting medical conditions in ASD diagnosis. Their prevalence reaches more than 91 % for gastrointestinal problems, up to 89 % for nutritional and metabolic disorders, more than 50 % for thyroid dysfunction, and up to 100 % for microbiota-related conditions. There is an urgency for medical practice to be updated and to include the assessment, testing, diagnosis, and treatment of these coexisting medical conditions in ASD diagnosis in the pediatric, adolescent, and adult population. A strict management of such conditions results in positive changes in the quality of life and symptoms based on which ASD is diagnosed many times. It should be based on high-quality scientific evidence with an adequate medical care and control.