Tehran University Medical Journal

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Background: High-frequency electromagnetic field (EMF) is generated by differentsources such as radar installations, radio and television transmitters, medical microwave diathermy device and domestic use of microwave ovens. Radiation leakage of microwave oven may be harmful for users. Kids who are residing near their mothers may expose to electromagnetic field. This study was carried out to evaluate the effect of radiation leakage of microwave oven on body weight, cortisol, thyroid hormones and plasma lipid profile. Methods: Radiation leakage of microwave oven was measured by RF measuring instrument. For this study 20 immature (7±3 days old and 5±1 g weight) mice were selected and randomly divided in two groups, control and test group. Test groups were exposed to 2450 MHZ microwaves produced by microwave oven three times a day, 30 minute each time. After 60 days, body weights of both groups were determined and the blood samples were collected by heart puncture. Serum cortisol and thyroid hormones levels were evaluated using RIA method. Results: Radiation leakage from oven showed variations from 6.5 to 57.5 mW/cm2. Mean body weight in test group was 29.5% lower than control group. Serum cortisol, T3 and T4 level were significantly higher in test group compare to control group,(17.44±1.78 vs. 9.94±1.21 ng/ml), (1.39±0.15 vs. 0.86±0.09 nmol/L) and (77.80±7.67 vs.54.6±6.2 nmol/L) respectively. Compare to control group serum Triglyceride level increased while HDL decreased significantly in test group (p<0.05). Conclusion: Microwaves leaked from oven have deleterious effect on body weight, T4 and cortisol level by decreasing weight gain and increasing these hormones.

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Osteoporosis is a condition characterized with reduced bone density and destruction of the bone structure. The ideal treatment aims to reduce the risk of fracture while improving the density and structure of the bone. Parathormone (PTH) and its main analogue triparatide (rhPTH [1-34]) is a new class of anabolic medications which accelerates the healing process in the fractured bone through improving bone formation and therefore is used for treating severe osteoporosis. The present review article was designed to report the history, different types, anabolic and catabolic effects, complications, indications and contraindications of the hormone.

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Background: The effects of growth hormone (GH) on bone density in healthy adults is controversial. This study was performed to evaluate the effects of GH administration on bone density under controlled conditions in healthy adult rabbits.

Methods: Twenty healthy adult New Zealand white rabbits of both sexes were included in the study. The rabbits were divided into two groups. The experiment group received human GH and the controls placebo for three months. The density of femur and humerus were measured at proximal epiphysis, mid shaft and distal epiphysis by radiography, aluminum step-wedge and appropriate software. Measurements were performed in five stages, once before and four times after the administration of GH or placebo, with 3-week intervals.

Results: The mean concentration of serum insulin-like growth factor I (IGF-I) increased significantly after GH administration (P<0.05) in the experiment group. Bone density generally increased in all regions except the distal epiphysis of femur in the test group, but significant difference were only seen in the midshaft of femur in comparison to the controls (P<0.05). In the second stage, bone density decreased slightly in all regions except distal epiphysis of femur, but it increased in the next stages.

Conclusion: GH can increase bone density (mostly cortical bone) in adult rabbits. According to the similarities seen between growth hormone effects in rabbit and humans, this study suggests rabbits as a model for studying GH effects on bone density in acromegaly, growth hormone deficiency and even in healthy adult humans.

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Background: Body weight is regulated by both food intake and energy expenditure. Ghrelin, a hormone produced by the stomach and pancreas, enhances appetite. This study was undertaken to determine the effects of intermittent treadmill running on acylated ghrelin and appetite in individuals with obesity. Methods: Nine inactive male students, with a mean age of 20.56±0.48 yrs, a body mass index of 32.68±0.84 kg/m2 and a maximum oxygen uptake of 34.21±1.48 ml/kg/min, participated in the study in two trials (control and exercise) in a counterbalanced, randomized design. The protocol included intermittent running with a constant intensity at 65% of VO2 max on a treadmill. Blood samples were collected before, during, and 2h after cessation of the exercise. Results: Acylated ghrelin concentrations and hunger ratings decreased significantly in the second phase and remained lower than baseline (P=0.006 and P=0.002, respectively) at the end of the exercise. The total area under the curve values and hunger ratings (all P<0.0005) were significantly lower in the exercise trial compared with the control state. Similarly, growth hormone rose significantly at the second phase and remained higher than baseline (P=0.033) at the end of the exercise trial. Conclusion: These findings indicate that acylated ghrelin and appetite are reduced by running at 65% of VO2 max and remain lower than baseline even two hours afterwards in individuals with obesity. Growth hormone seems to be more responsible for this suppression. Further studies are required to investigate whether this protocol could elicit the same effects in short-term training programs.

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Background: Anti-Müllerian Hormone (AMH) is secreted from granulosa cells of growing follicles and is a useful marker of ovarian reserve. Fertility in women is determined by the quality and quantity of follicle pool and ovarian follicular reserve positively correlates with AMH. In this study we aimed to determine if AMH can predict ovarian response in IVF treatments.
Methods: In this retrospective observational study undertaken in Mehr Institute during 2010 to 2011, we studied the medical records of 101 patients and recorded the concentrations of AMH, day two or three FSH, LH, basal estradiol (E2), E2 on day of HCG administration and the number of metaphase II oocytes. Having undergone ovarian hyperstimulation, the women were divided into three groups: poor responders (retrieved oocytes ?3), normal responders (retrieved oocytes 4 to 15) and high responders (retrieved oocytes ?16).
Results: Overall, 20% of patients were defined as poor responders, 71% as average responders and 10% as high responders. There were significant differences in the concentration of AMH, E2 on day of HCG administration, FSH, the number of metaphase II oocytes and age between the three groups. MII oocyte count correlated positively with AMH (r=0.487), basal E2 (r=0.275) and LH (r=0.07) but it did negatively with FSH (r=-0.26) and age (r=-0.04). The areas under curve for AMH, FSH, LH, E2 and age were 0.799, 0.32, 0.429, 0.558 and 0.304, respectively. We determined the 0.85 ng/ml AMH concentration as the cut-off point with 71% specificity and 79% sensitivity for the prediction of poor responders. 
Conclusion: anti-müllerian hormone is an appropriate predicator of ovarian response following induction of ovulation.

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Background: It has been shown that coronary artery calcium scoring (CACS) can be used as a diagnostic method in coronary artery disease (CAD). The relationship between CACS and calcium metabolism in the body has been shown. The arterial calcification is an organized process similar to bone formation which is controled by parathormone (PTH). The relationship between PTH as an osteoregulatory factor and CACS has been also indicated. In this study, we tried to assess the value of serum PTH and CACS in patients planned to undergo coronary angiography (CAG) in order to find a simple, cost -benefit, noninvasive way, for ruling in/out obstructive CAD.
Methods: In a cross sectional study in Imam Khomeini hospital in 1390, CACS by using non-enhanced multi detector computed tomography (MDCT) and measurement of serum level of PTH, Calcium and Phosphate were done in 178 patients suspected to CAD which were scheduled to undergo coronary angiography serum PTH was measured by immuno-radiometric assay (IRMA) and serum Ca and Phosphate were measured by spectrophotometry methods.
Results: Of 178 Patients, 50 patients were females and 126 patients were male. Mean age of them was 56.2±11.6. The correlation coefficient between CACS and Gensini score (0.507, P<0.001), PTH (0.037, P=0.693), Ca (0.062, P=0.499) and Phosphate (0.061, P=0.506) were obtained. The level of serum PTH in the patients with and without coronary artery disease were 21.8±11.6 pg/dl, 23.2±11.5 pg/dl (P=0.427) respectively.
Conclusion: Our study showed association between CACS and CAD that was statistically significant while no relationship was found between PTH, CACS and CAD.

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Background: The prevalence of obesity has risen enormously over the past few decad-es. Both food intake (Appetite) and energy expenditure can influence body weight. Acylated ghrelin enhances appetite, and its plasma level is suppressed by growth horm-one. The present study, examines the effects of an intermittent exercise with progress-ive intensities on acylated ghrelin, appetite, and growth hormone in inactive male students with two levels of obesity.
Methods: Eleven inactive males were allocated into two groups on the basis of their body mass index (BMI). Six subjects in group one, BMI= 31.18±0.92 kg/m2, and five subjects in group two, BMI= 36.94±2.25 kg/m2, ran on the treadmill with progressive intensities of 50, 60, 70 and 80% of VO2max for 10, 10, 5, and 2 min respectively. Blood samples were collected before the exercise (as the resting values), after each workload (during the exercise), and at 30, 60, and 120 min (during recovery).
Results: Plasma acylated ghrelin concentrations and hunger ratings in two groups were decreased and remained significantly lower than resting values (P=0.008 and P=0.002 respectively) at the end of the trial and there was no significant differences between groups. Growth hormone levels in two groups were increased and remained significant-ly higher than resting values (groups one P=0.012, group two P=0.005) at the end of the trial and there was no significant differences between groups. In addition, there were no significant differences between area under the curves (AUC) values over total periods for acylated ghrelin, hunger ratings, and growth hormone in two groups.
Conclusion: These findings indicate that individuals with two levels of obesity have the same response to the different intensities of treadmill running and two hours thereafter during recovery period, which can be considered for designing a more effective weighting loss training program.

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Background: A variety of endocrine disorders can complicate pregnancy. Diabetes insipidus although uncommon, may have devastating effect on pregnancy outcome, if unrecognized and untreated. The etiology of diabetes insipidus is often unknown, many cases are likely autoimmune, with lymphocytic infiltration of the posterior pituitary gland. Massive polyuria, caused by failure of the renal tubular concentrating mechanism, and dilute urine, with a specific gravity 1.005, are characteristic of diabetes insipidus. The diagnosis of diabetes insipidus relies on the finding of continued polyuria and relative urinary hyposmolarity when water is restricted. Most women require increased doses Desmopressin Acetate during pregnancy because of an increased metabolic clearance rate stimulated by placental Vasopressinase. By this same mechanism, subclinical diabetes insipidus may become symptomatic during pregnancy. Transient diabetes insipidus is associated with acute fatty liver and HELLP syndrome as well as twin gestation. Increased placental Vasopressinase activity, along with insufficient liver degradation in HELLP syndrome and acute fatty liver, may unmask this condition. Diabetes insipidus in pregnancy is rare. The disease results from inadequate or absent antidiuretic hormone (vasopressin) production by the posterior pituitary gland. The increased glomerular filtration rate seen in pregnancy may increase the requirement for antidiuretic hormone. Case presentation: We present a 39 years old woman, gravida3 para3, was admitted to Akbarabadi Teaching Hospital in september 2013. She was admitted due to polyuria, malaise, thirst with slight fever, six days after normal vaginal delivery. The urine volume was 8 lit/day and the specific gravity (S.G.) of the urine was 1.010. The urine osmolarity was lower than the plasma osmolarity. Electrolyte serum examination showed hypernatremia. The patient received 5 µg/day of synthetic vasopressin, in the form of l- deamino-8-Darginine vasopressin (DDAVP). This drug was given as intranasal spray in doses 0.25 mg twice daily. Plasma electrolytes and fluid status monitored carefully with initiation of therapy. DDAVP was used because it was not degraded by vasopressinase. Treatment was continuing, when the symptoms of central diabetes insipidus resolve and urinary concentrating ability was preferred. Maximum urinary osmolality over the next 11 hours was assessed, 730 mosm/kg was considered normal. Conclusion: Close attention to electrolyte and fluid balance is important in the postpartum period. The symptoms of transient vasopressin-resistant diabetes insipidus resolve in few days to a few weeks after vaginal delivery or when hepatic function returns to normal.

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Background: Congenital hypothyroidism is a major but preventable cause of mental backwardness in infants. In case of hypothyroidism in fetuses, certain complications will occur in vital organs like the central nervous system and the skeleton. Before screening programs were introduced, congenital hypothyroidism was diagnosed with delay due to its few and non-specific symptoms during the first days of life. Given the difference in reference range for various races and populations, this study was aimed to determining a natural range for thyroid hormones used in the screening of infants.

Methods: In a descriptive cross-sectional study at Vali-asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, from March 2013 to 2014. The level of T4, FT4 and TSH hormones was measured in all natural childbirth, without any complications and with one-minute Apgar score above 7 while this study was underway.

Results: A group of 249 infants (male and female), including 35 (14.1%) aged between 0 and 4 days, 102 (41%) aged between 5 and 7 days and 112 (45%) aged between 7 and 30 days, were examined. The average TSH, T4 and FT4 amounts in infants, aged 0 to 30 days, were respectively 5.35 µU/ml, 10.77 µg/dl and 1.33 ng/dl. The interval was 4.76-6.01 µU/ml for TSH, 10.36-11.17 µg/dl for T4 and 1.29-1.37ng/dl for FT4. The difference between age groups with average TSH concentration is not meaningful (P=0.7) and the average T4 amount in different age groups was meaningfully different (P=0.05). The average FT4 in different age groups is meaningfully different (P=0.007). The thyroid hormone amounts calculated for males and females were not significantly different.

Conclusion: Given the difference in the reference range in race, population and geographical zones, it is necessary to determine a range for screening in Iran. According to the findings of the present study, lower cut-offs, compared with western countries, should be envisaged for TSH in congenital hypothyroidism screening programs that could speed up the diagnosis of minor cases of the disease and prevent complications.

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Background: Polycystic ovary syndrome (PCOS) is a common complex condition in women associated with reproductive and metabolic systems and also psychological disorders. There is considerable evidence to suggest that the sympathetic nervous system is involved in PCO and metabolic syndromes. Noradrenalin (NA), corticotrophin releasing hormone (CRH) and nerve growth factor (NGF) are the strong stimulants for two axes: hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-ovarian (HPO) axes which are regulators for the female reproductive system. Following previous studies on sympathetic nervous system over activity in PCOS, the main purpose of this study is to evaluate the role of CRH and NGF as two important findings from the perspective of the psycho-emotional.

Methods: This case-control study was conducted in Reproductive Health Research Center of Imam Khomeini Hospital, Tehran, Iran in the September of 2011. 170 women participated in this study. The diagnosis of PCOS was made according to the joint criteria of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine (ESHRE/ASRM). All women have 20-40 years of age and body mass index (BMI) of less than 28. Demographic questionnaire was used in this study and blood sample was obtained from all participants before 8AM. All analysis was done in SPSS software, version 19 (IBM SPSS, Armonk, NY, USA). P-value less than 0.05 considered as significant level.

Results: Serum levels of CRH and NGF in patients with polycystic ovary was significantly lower than the control group (P< 0.001). This reduction can disrupt two neural axes: the sympathetic nervous system (SAS) and hypothalamus-pituitary-adrenal (HPA). These axes have a fundamental role in psycho-emotional reactions in women with PCOS. Moreover, using demographic questionnaire quantitative and qualitative characteristics of the population studied, the results of which are reported in the regression model.

Conclusion: The results of this study confirmed previous studies. This reduction in serum levels of CRH and NGF shows the hyperactivity of sympathetic nervous system in polycystic ovary syndrome can be one of the causes of mental disorders in women with PCOS.

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Background: Hypertension is one of the major risk factors for cardiovascular disease. The studies show that factors such as vitamin D, parathyroid hormone, calcium and phosphorus are involved in the regulation of blood pressure. The purpose of this study was to investigate the relationship between blood pressure with vitamin D, parathyroid hormone, calcium, and phosphorus in sedentary postmenopausal women.

Methods: This investigation is in the form of a descriptive correlational study that was performed in September 2015. The statistical population was all healthy and sedentary postmenopausal women 50-70 years old in Urmia city, Iran. Fifty-four sedentary postmenopausal women were selected as subjects and voluntarily and bona fide participated in this study. General and anthropometric characteristics of height, weight, and body mass index (BMI) in subjects were measured by wall-meter with an accuracy of one millimeter, digital scale with precision of 100 g (Beurer, Germany), and dual emission X-ray absorptiometry (DXA) (Hologic, USA) machines, respectively. Diastolic and systolic blood pressure was measured by indicator machine. Serum levels of vitamin D, parathyroid hormone, calcium, and phosphorus were measured by ELISA and Auto-analyzer (BT 1500, Biotecnica, Italy machines, respectively. Results: The mean general, anthropometric, and physiological/laboratory variables of subjects were: age 54 yr, height 156 cm; weight 72 kg; BMI 29 kg/m2; systolic and diastolic blood pressure 76.20 and 110.70, respectively; vitamin D 25.22 ng/ml, parathyroid hormone 33.29 ng/ml, calcium 9.44 ng/ml, and phosphorus 3.26 ng/ml. Moreover, results showed that there was no significant relationship between systolic and diastolic blood pressure and vitamin D (P>0.581 and P>0.619, respectively). There was no significant relationship between systolic and diastolic blood pressure and parathyroid hormone (P>0.623 and P>0.341, respectively). There was no significant relationship between systolic and diastolic blood pressure and calcium (P>0.704 and P>0.141, respectively). There was no significant relationship between systolic and diastolic blood pressure and phosphorous (P>0.058 and P>0.357, respectively). Conclusion: The results suggest that there is no relationship between systolic and diastolic blood pressure with serum levels of vitamin D, parathyroid hormone, calcium, and phosphorous in sedentary postmenopausal women 50-70 years old.

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Background: Studies show that aerobic exercise prevents osteoporosis in menopause by stimulating osteoblastic cells. Therefore, the purpose of this study was to investigate the effect of 12 weeks of moderate-intensity aerobic exercise on alkaline phosphatase gene expression, serum levels of alkaline phosphatase, parathyroid hormone, and calcium in sedentary women.

Methods: This investigation is a semi-experimental study that was performed in September 2015 at Urmia University, Iran. The statistical population was all healthy and sedentary postmenopausal women 50 to 65 years old in Urmia city. Twenty sedentary postmenopausal women with an average age 60.12±2.12 yr, weight 72.35±10.50 kg, and body mass index 29.46±3.24 kg/m2 voluntarily and bona fide participated in this study, and then subjects were randomly divided to the Exercise/E (10 women) and Control/C (10 women) groups by random sampling method. E group performed of 12 weeks walking and jogging moderate-intensity aerobic exercise at 65-70% maximal heart rate of training, three sessions per week and per session 50-60 (min), but the C group participated in no intervention. Twenty-four hours before and after the 12-week training program were taken blood samples in order to measure of alkaline phosphatase gene expression and serum markers of bone in the E and C Groups. Evaluation of gene expression and serum markers of bone were measured by real-time reverse transcription PCR (RT-PCR) and Auto-analyzer (Biotechnica, Italy)/ ELISA reader (Awareness Inc., USA) machines, respectively. Data analysis included descriptive and inferential (ANCOVA test) statistics using SPSS version 23 (Chicago, IL, USA) and a significance level of P≥0.05 was considered. Results: The results showed that alkaline phosphatase gene expression and parathyroid hormone after 12 weeks of moderate-intensity aerobic exercise in between-groups were significantly increased (P=0.027 and P=0.006, respectively), while serum levels of calcium and alkaline phosphatase were not significantly different (P=0.941 and P=0.990, respectively).

Conclusion: The results suggest that 12 weeks of aerobic exercise of walking and jogging at 65-70% maximal heart rate of training increases alkaline phosphatase gene expression and parathyroid hormone in sedentary postmenopausal women.

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Background: Nowadays, chronic kidney disease (CKD) is known as an epidemic disease all around the world. Chronic kidney disease considered as a serious health problem with numerous side effects, including complications progressive in reducing glomerular filtration rate (GFR), imbalances in the homeostasis of the body and decreased quality of life and finally an increase in mortality due to cardiovascular problems. End-stage renal disease leads to hypocalcemia and hyperphosphatemia, that as a result of, parathyroid hormone (PTH) will increased that secondary hyperparathyroidism will occurred eventually. So it is essential to routine examination of electrolytes in these patients. The current study have been done to determine the electrolytes in saliva as a non-invasive sample in hemodialysis patients in order to the saliva to be presented as an appropriate samples for clinical laboratories. Methods: In the present case-control study that has been performed at Imam Ali Hospital, Bojnord, North Khorasan Province, Iran, in the summer of 2016, 44 hemodialysis patients and 44 aged, gender and body mass index (BMI) matched healthy controls were selected and then their cell count, Hb, HCT, iron, ferritin, total iron binding capacity (TIBC), glucose, CRP, triglycerides, cholesterol, urea, creatinine, calcium, phosphorus, potassium and PTH were measured. Results: Calcium and phosphorus were higher in hemodialysis patients in comparison to the control group. Furthermore, there are not any significant relationship between levels of calcium, phosphorus and potassium in both serum and saliva samples. In addition, we observed the positive relationship between PTH in serum as well as phosphorus and potassium in the saliva. Conclusion: The findings of current study have been shown that salivary levels of calcium and phosphorus in hemodialysis patients is higher than healthy people, therefor could be a non- invasive suitable marker for diagnosis. In addition, blood PTH levels in hemodialysis patients is associated with salivary levels of phosphorus and potassium, so, perhaps these parameters marked PTH's representative in the blood with further investigation of saliva’s electrolytes.

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Background: Hypocalcemia is one of the most prevalent complications following total thyroidectomy. Over recent years, in addition to hormone parathyroid hormone (PTH), vitamin D has been also studied as a factor causing post-total thyroidectomy hypocalcemia. This survey seeks to study the relationship between the serum level of vitamin D before surgery and during post-total thyroidectomy hypocalcemia. Methods: A group of 57 patients volunteering for total thyroidectomy were studied on Vali-e-Asr Hospital, Tehran, Iran, from March 2013 to March 2015. In all these patients, pre-surgery calcium, vitamin D and parathyroid hormone (PTH) as well as the level of calcium during the post-surgery first two days were measured. Based on objectives of this study, the relationship be-tween pre-surgery vitamin D level and post-surgery hypocalcemia was examined. Results: The average age of patients participating in the survey was 24.1±13.3. They included 19 women (33.3%) and 38 men, total of 40 patients (70.2%). Their average post-surgery calcium level was 9.2±0.77 milligrams per deciliters (mg/dl) and their average vitamin D content before the surgery was 42±12.1 nanomole per liter (nmol/l). The average calcium level before the surgery and the first post-surgery day were meaningfully different in terms of statistics (P<0.001). In terms of vitamin D, 37 patients (64.9%) had pre-surgery vitamin D deficiency and 20 patients (35.1%) had vitamin D insufficiency. Of 37 patients with pre-surgery vitamin D deficiency, 26 were diagnosed with post-surgery first-day hypocalcemia and of 20 patients with vitamin D insufficiency, 14 suffered post-surgery first-day hypocalcemia. This difference was not statistically meaningful (P>0.001). Of 37 patients with pre-surgery vitamin D deficiency, 31 suffered post-surgery second-day hypocalcemia and of 20 patients with vitamin D insufficiency, 18 suffered second-day hypocalcemia. This difference was not statistically meaningful either (P>0.001). Conclusion: The current study showed that the serum level of vitamin D before total thyroidectomy does not have any role in the occurrence of post-surgery hypocalcemia which is almost common after this type of surgery.

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Results: Height increase index (HSDS) was obtained with the use of growth hormone combined with one of the aromatase inhibitors (0.38-3.58=95%CI) (SMD=0.98), with the use of growth hormone (0.62-1.14=95%CI) (SMD=0.88), with the use of Letrozole (0.51-16.51=95%CI) (SMD=0.83), with the use of Oxandrolone (0.99-0.99=95%CI) (SMD=0.56), and with the use of Anastrozole (0.00-0.63=95%CI) (SMD=0.31), which shows that all these drugs have a significant effect on height increase. (P<0.05) Conclusion: Although the effect of growth hormone on height increase was greater than that of aromatase inhibitors, but according to our results, adding an aromatase inhibitor to growth hormone can increase the effectiveness of it.

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