Evaluation of anterior pituitary function following traumatic brain injury

Neuroendocrine dysfunction following traumatic brain injury [TBI] is frequently missed due to the absence of major symptoms and very often, no appropriate management is prescribed, thus delaying the patient recovery. This study is aimed to determine the frequency and pattern of anterior pituitary dysfunction following TBI. From June to December 2009, over a period of seven months, a total of 156 cases were admitted to a trauma center following TBI. Of the seventy patients, [61 males and 9 females mean age 30 years] included in the study, 39 patients had moderate [GCS; 9 - 12] and 31 cases had severe [GCS < 8] TBI. Patients were tested 6 months after injury for possible secretory abnormalities of anterior pituitary hormones. Anterior pituitary secretary function was assessed by measurement of serum levels of FT4, TSH, basal GH, IGF-1, 8 am Cortisol, FSH, LH, total testosterone and prolactin. Dynamic tests of ACTH and glucagon stimulation were used to evaluate the pituitary-adrenal axis and GH secretory status. Forty-one patients [58.6%] were found to be suffering from at least one hormonal secretory abnormality, with patterns and frequencies of: Gonadotropins [LH, FSH], 12.9%, corticotrophin [ACTH], 12.9%, somatotropin [GH], 4.3%, and prolactin [PRL], 1.4%. There was no case with thyrotropin deficiency. Hyperprolactinemia was found to be present in 23 cases [31.5%]. The results of this study showed that anterior pituitary hormone deficiencies occur frequently, 6 months following traumatic brain injury. The two most commonly involved axes were the pituitary-gonadal and the pituitary-adrenal. Hypocortisolism may be particularly harmful for the patients' health

[Efficacy of oral angipars in chronic diabetes foot ulcer: a double blind placebo controlled study]

Diabetes mellitus is the most common human metabolic disease and chronic non healing diabetic foot ulcers are a critical complication for these patients. ANGIPARS is a new herbal extract which has been introduced to accelerate healing of these ulcers. The purpose of this study was to investigate the efficacy and safety of oral ANGIPARS in patients with chronic diabetic foot ulcers and also its effect on inflammatory blood markers. In a double-blind placebo-controlled trial, 40 patients with diabetic foot ulcers of at least 4 weeks duration, were randomized to receive either oral ANGIPARS, or placebo twice a day, until the ulcer was completely healed or for a maximum of 6 weeks and followed up to 12 weeks. Standard foot ulcer care was given to all patients. The healing process was assessed with measuring ulcer surface area and time needed to achieve complete wound healing. Drug safety was assessed by monitoring adverse events, using clinical and laboratory evaluations. In both groups, wound surface area decreased significantly [p<0.0005]. Mean improvement ratio was 95.8% in the ANGIPARS group and 79.2% in the placebo group, although mean percent of wound area reduction in the former group was higher than in the placebo group at weekly assessments, this difference was not statistically significant [p=0.25] except for at the 4[th] week. [84/2% vs. 56%, p=0.013] Ultimately, complete wound healing was achieved in 90% and 70% of ANGIPARS group and placebo group, respectively, after 12 weeks. Time to achieve complete wound healing, also, was not different significantly in either groups. [6.2 vs 7.4 weeks, p=0.3] Significant reduction in ESR was sent in the ANGIPARS group. [p=0.04] There was no significant changes in laboratory parameters. Two complications most likely attributable to ANGIPARS reported were worsening of proliferative diabetic retinopathy in one patient and acute renal failure and acute hepatitis in another patient with diabetic nephropathy. Although ANGIPARS enhanced wound healing at least within weeks 2 to 4 of treatment, we did not observe a significant effect in the outcome. Therefore, standard foot ulcer care seems to be the cornerstone of diabetic foot ulcer management and ANGIPARS should probably be reserved for treatment of the non-healing or difficult-to-heal ulcers that do not respond to standard treatments. Further studies are required to assess the efficacy of this new herbal extract

[Effects of total extract of urtica dioica on insulin and c-peptide secretion from rat [RIN5F] pancreatic beta cells and glucose utilization by human muscle cells]

The hypoglycemic effects of the Uritca Dioica [UD] extract, used for treatment of diabetes mellitus for many centuries, have been documented in several studies. The present study was designed to determine the possible mechanisms of hypoglycemic effects of UD on human muscle cells and RIN5F rat pancreatic beta cells. In the cell culture laboratory of the Drug Applied Research Center, pancreatic Beta cells and human muscle cells were prepared in multiple flasks containing culture media. Alcoholic extract of UD at concentrations of 50, 100 and 200 micro g/mL were added to muscle cell flasks. The same concentrations of extract plus insulin were added to other muscle cell flasks.Glucose levels were measured in the flasks before and after 60, 120, and 180 minutes after adding of extract. Also the same concentration of UD were added to flask containing RIN5F rat pancreatic beta cells, and insulin and C-peptide level were measured at 0, 60, 120 and 180 minutes. Mean glucose level in the muscle cell media with UD alone and UD plus insulin, at the concentrations and time intervals mentioned, did not change significantly. Insulin levels in pancreatic cells media, before and after applying of UD at different concentrations, and at different times was

Electrodiagnostic changes in patient with subclinical hypothyroidism

Electrodiagnostic changes typical of peripheral polyneuropathy have been reported in patients with over hypothyroidism. There are controversial reports regarding the effects of subclinical hypothyroidism on peripheral nervous system function. The aim of the present study is to investigate the possible effects of subclinical hypothyroidism of peripheral nervous system function by electrodiagnostic studies. A total of 28 patients [56 extremities] with subclinical hypothyroidism [defined as high serum TSH in the presence of normal free thyroxin by appropriate methods] including 25 adult females and 3 males [mean age of 46.07 +/- 6.87y] and 30 normal subjects as control group [60 extremities]. 27 females and 3 males [mean age 45 +/- 8.7y] had normal thyroid function tests enrolled in the study. Exclusion criteria were presence of diabetes mellitus, neuromuscular disorder, pregnancy, other disorders or drugs affecting neuromuscular function in all patients and control group. Electrodiagnostic studies including motor nerve conduction velocity [motor NCV], motor distal latency, CMAP Amplitude performed from tibial, median, peroneal and ulnar nerves bilaterally. Sensory function tests including sensory nerve conduction velocity, SNAP amplitude and sensory distal latency from median, ulnar and sural nerves bilaterally were studied by standard methods. Minimal f-response was studied from tibial, median and ulnar nerves bilaterally. Mean of sensory NCV, SNAP amplitude and sensory distal latency from median, ulnar and sural nerves and motor NCV, motor distal latency and CMAP amplitude from median, ulnar, personeal and tibial nerves and mean of minimal F-response of tibial, median and ulnar nerves were not significantly different in patients and control group. The results of this study shows that there is no functional impairment in peripheral nerves in subclinical hypothyroidism at the time of diagnosis

[Distribution of lipid disorders in the inhabitants of Tehran University of medical sciences]

Introduction: hyperlipidemia is a major cardiovascular risk factor. This survey has been performed to determine the prevalence of hyperlipidemia in the 17th zone of Tehran

Methods: 1573 individuals 25-64 aged were recruited from the inhabitants of the 17th zone of Tehran through one stage cluster sampling. Standard questionnaires were filled out for all of the participants. Lipid profile was categorized according to the NCEP:ATP III criteria

Results: 59% had ideal cholesterol levels, 27.1% borderline and 13.9% had high cholesterol levels. Hypercholesterolemia was more prevalent in women than men. 55% had ideal LDL-cholesterol level. Prevalence of hyper-LDL [>160mg/dl] was 2.3%. Hyper LDL was more prevalent in women than men [p<0.001]. Prevalence of hypo-HDL was 13.8% and it was more common in men than women [p<0.001]. 33.4% had high triglyceride levels

Conclusion: prevalence of dyslipidemia in this area of Tehran is not as high as that obtained from other urban studies. This fact should be considered in the future interventional programs which focus on noncommunicable disease management