Relation between third trimester urinary iodine concentrations and newborn thyrotrophic hormone

Background: the aim of the study was to evaluate the third trimester urinary iodine excretion and to assess its relation with newborns thyroid function

Materials and Methods: a total of 208 healthy third trimester pregnant women without previous history of thyroid disease were included in the study. Urinary iodine levels of mothers were measured and neonatal TSH levels were screened on the 3- 5th day following birth

Results: the median urinary iodine level in the mothers was 50microg/L. According to WHO criteria for iodine status: 14.9%, 34.1% and 49.6% had severe, moderate and mild iodine deficiency, respectively, and only 1.4%, had the adequate iodine intake. In 6 neonate [2.8%] who their TSH level were between 5- 10 IU/ml, nobody had criteria for congenital hypothyroidism at recall visit [15th day]. Our results showed the reverse relation between mean Neonatal TSH levels and mother's third trimester iodine level [r= -0.19, p=0.006]

Conclusion: although all of mothers included in this study stated that they were using iodized salt, iodine deficiency was frequent. There was also a significant relation between mean neonatal TSH levels and mother's third trimester iodine urinary level

Impact of glibenclamide versus Insulin on neurological and functional outcomes of hemorrhagic stroke in diabetic patients

Background & Objective: Stroke is one of the common leading causes of morbidity and mortality worldwide. Diabetes is one of the modifi able risk factors of stroke which is related to a higher mortality and a poorer outcome. We aimed to evaluate the protective effect of Insulin versus glibenclamide on the improvement of neurological and functional outcomes of hemorrhagic stroke. Methods: The present single blind clinical trial was conducted on 100 patients with stroke and diabetes who had referred to Neurology Emergency Department of Vali-e-Asr hospital, Arak, Iran. The patients were categorized into two groups according to the glucose control treatment before stroke. Without any randomization, glibenclamide was used in 45 patients, while others (55 ones) received insulin. National Institute of Health Stroke Scale (NIHSS) and modifi ed Rankin scale (MRS) systems were used for evaluating the neurological and functional outcomes. Results: Hemiparesis was the most common sign of the patients. The mean of changes in NIHSS and MRS scores of the two groups were -29.69±21.4 and -17.24±21, respectively. Although Insulin group had a higher decrease in NIHSS and MRS scores, no signifi cant difference was found between the two groups. Both treatment methods had a signifi cant decreasing effect on NIHSS and MRS scores (p<0.001). Conclusion: Patients treated with both glibenclamide and insulin had similar decrease in their one week NIHSS and MRS scores with no signifi cant difference in the two treatment groups.

Hyperglycemia and mortality in critically ill patients

To analyze the relation between serum glucose concentration and hospital outcome across the critically ill patients. A single-centre, retrospective study was performed at surgical and medical intensive care unit. Admission glucose, mean morning glucose, mean glucose, maximal glucose and time-averaged glucose levels were calculated for each patient. The time-averaged hyperglycemia was defined as the area under the curve above the upper limit of normal, divided by the total length of stay. Of 300 patients with a median stay of 16 days, the mortality rate was 32%. Mean fasting glucose was 121 mg/dl in survivors versus 160 mg/dl in non survivors [P=0.001]. Mean admission glucose was 127 mg/dl in survivors versus 142 mg/dl in non survivors [0.03]. Median time-averaged hyperglycemia was 4 mg/dl in survivors versus 17.5 mg/dl in nonsurvivors [P < 0.006]. The area under the receiver operator characteristic [ROC] curve was 0.59 for time-averaged glucose and 0.73 for mean fasting glucose. Whereas time-averaged hyperglycema is a useful assessment for glucose control in critically ill patients, it has no priority to admission glucose and mean fasting glucose for outcome prediction

Acute renal failure in a patient with Sheehan syndrome and rhabdomyolysis

We report a case of acute renal failure related to rhabdomyolysis in a patient with Sheehan syndrome, while other diseases that could cause rhabdomyolysis were excluded. The patient's kidney function completely recovered with 3 sessions of intermittent hemodialysis. After thyroxine replacement therapy, musculoskeletal symptoms disappeared and creatine kinase concentrations decreased. Steroid replacement therapy was also administered. The present case suggests that rhabdomyolysis could occur in a patient with Sheehan syndrome without other precipitating factors

Panhypopituitarism presentation with acute renal failure associated with rhabdomyolysis

A 30-year woman developed rhabdomyolysis and acute renal failure. She had history of amenorrhea after her last delivery. On admission, she was pale, afebrile and ill, had slight tenderness of the muscles. Her muscle enzyme was high and her renal function decreased rapidly, suggesting rhabdomyolysis. Her laboratory investigation was compatible with panhypopituitarism. Treatment was started with levothyroxine and Hydrocortisone. Her renal function recovered completely with conservative treatment without need of dialysis. The present case suggests that rhabdomyolysis could occur in patient with central hypothyroidism