Empty sella in somatotropic pituitary adenomas; a series of 23 cases.

Purpose: We aimed to investigate empty sella syndrome in somatotrophic pituitary adenoma for possible etiology, complications, and treatment options. Method: Among over 2,000 skull base masses that have been managed in our center since 2013, we searched for growth hormone-producing adenomas. Clinical, surgical, and imaging data were retrospectively collected from hospital records to check for sella that lacked pituitary tissue on routine imaging. Result: In 220 somatotrophic adenomas, 23 patients had an empty sella with surgical and follow-up data. The mean age of the sample was 46 years with the same male-to-female ratio. Five cases had partial empty sella and the rest were complete empty sellas. The most common simultaneous hormonal disturbance was high prolactin levels. Six had adenoma invasion into the clivus or sphenoid sinus and 10 had cavernous sinus intrusion. Peri-operative low-flow and high-flow cerebrospinal fluid (CSF) leaks were encountered in one and two patients, respectively, which were successfully sealed by abdominal fat. The majority of cases required growth hormone replacement therapy while it was controlled without any replacement therapy in nine patients. No pituitary hormonal disturbance occurred after transsphenoidal surgery except for hypothyroidism in one patient. Conclusion: An empty sella filled with fluid can be detected frequently in pituitary adenomas, especially in the setting of acromegaly. The pituitary gland may be pushed to the roof of the sella and might be visible as a narrow rim on imaging or may be detected in unusual places out of the sella. The pathophysiology behind such finding originates from soft and hard tissue changes and CSF pressure alternations during abundant growth hormone production.

Methadone-induced hypoglycemia: A case report.

Hypoglycemia is rare in patients without diabetes mellitus. Methadone is a synthetic µ-opioid receptor agonist used for cancer or non-cancer pain and the treatment of opioid dependence. Here, we report a case of a 31-year-old man who presented with recurrent hypoglycemic events that resolved on discontinuation of methadone. Thus, if hypoglycemia occurs while a patient takes methadone, the amount should be reduced or replaced with another opioid before a full investigation for inappropriate hyperinsulinism is initiated.

The potential beneficial effects of education and familiarity with cesarean section procedure and the operating room environment on promotion of anxiety and pain intensity: A randomized controlled clinical trial.

BACKGROUND: Anxiety before and pain intensity after cesarean section is among the factors that should be taken into consideration among the candidates for cesarean section. The present study aimed to investigate the effect of familiarity with cesarean section and the operating room environment on anxiety and pain intensity among the mothers undergoing cesarean section. METHODS: This clinical trial was conducted on 80 women referred to the hospitals affiliated to Shiraz University of Medical Sciences for cesarean section in 2018. The participants were randomly divided into a control (n = 40) and an intervention group (n = 40). The intervention group took part in four educational sessions, while the control group received the hospital's routine care. The Beck Anxiety Inventory was completed by the two groups before and after the intervention. The McGill Pain Questionnaire was also filled out by the two groups in the ward after the cesarean section. After all, the data were entered into the SPSS software, version 21, and were analyzed using independent t-test and ANCOVA. RESULTS: The results showed no significant difference between the two groups regarding the mean score of anxiety prior to the intervention. After the intervention, the mean score of anxiety was 7.98 ± 3.77 in the intervention group and 19.70 ± 6.45 in the control group, and the difference was statistically significant (P < 0.0001). Indeed, the mean intensity of pain was 43.98 ± 7.63 in the intervention group and 57.75 ± 10.69 in the control group after the intervention, and the difference was statistically significant (P < 0.017). CONCLUSION: The patients' familiarity with cesarean section and the operating room environment caused a decline in the anxiety level prior to cesarean section as well as a decrease in the score of pain after the operation. Hence, midwives and nurses have to play effective roles in decreasing pregnant women's anxiety and pain through identification of strategies for empowering them and managing their worries.

Stereological assessment of the effects of vitamin D deficiency on the rat testis.

BACKGROUND: Accumulating evidence suggests that low vitamin D status may affect male gonadal structure. This study was undertaken to reveal whether vitamin D-deficient rats have demonstrable changes in the quantitative histomorphometric properties of the testis. METHODS: In the present investigation, adult male Sprague-Dawley rats were divided into four groups and received: group 1) conventional diet; group 2) vitamin D-deficient diet; group 3) vitamin D-deficient diet and paricalcitol and group 4) conventional diet plus paricalcitol. After 3 months, serum levels of vitamin D metabolites, Ca, P, LH, FSH, testosterone, and epididymal sperm quality were evaluated. Moreover, the morphometric characteristics of testis were assessed via stereological methods. RESULTS: Rats fed a vitamin D-deficient diet (groups 2 and 3) were normocalcemic and had 25-hydroxyvitamin D3 level below 10 ng/mL. A significant reduction in serum testosterone and comparable gonadotropin levels were seen in vitamin D-deficient groups compared to controls. The concentration, morphology, and motility of sperm cells were profoundly disturbed in animals raised on the vitamin D-deficient diet. There was a significant decline in the population of different germ cells, the volume of interstitial tissue and germinal epithelium in group 2 and 3 rats, which were placed on the vitamin D-deficient diet. No appreciable difference in the estimates of the Leydig or Sertoli cell numbers were observed between groups. CONCLUSIONS: The depletion of vitamin D stores and induction of moderate grades of vitamin D deficiency by dietary measures led to remarkable impairment of spermatogenesis and microscopic architecture of rat testis. These findings can be attributed, at least in part, to decreased androgen production.

The Correlation Between Serum Adipokines and Liver Cell Damage in Non-Alcoholic Fatty Liver Disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic hepatitis, which can lead to cirrhosis and hepatocellular carcinoma. OBJECTIVES: The aim of the study was to evaluate the correlation between serum adipocytokines and the histologic findings of the liver in patients with non-alcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS: This case-control study was performed on those with persistent elevated liver enzymes and with evidence of fatty liver in ultrasonography. After exclusion of patients with other etiologies causing abnormal liver function tests, the resulting patients underwent liver biopsies. NAFLD was diagnosed based on liver histology according to the Brunt scoring system. RESULTS: Waist circumferences and levels of blood glucose (after fasting), insulin, triglycerides, alanine aminotransferases (ALT), and aspartate aminotransferases (AST) were higher in patients with NAFLD than in those in the control group. ALT, AST, and gamma glutamine transferase (GGT) levels were lower in patients with liver steatosis of a grade of less than 33% than those with higher degrees of steatosis. Serum low-density lipoprotein (LDL), cholesterol, and hepcidin levels were significantly higher in those with lobular inflammation of grade 0 - 1 than in those with inflammation of grade 2 - 3 (Brunt score). Meanwhile, AST was significantly lower in those with lobular inflammation of grade 1 than in those with grade 2-3. Hepcidin and resistin levels were significantly higher in patients with moderate to severe fibrosis than in those with mild fibrosis. CONCLUSIONS: It seems that surrogate liver function tests and adipocytokine levels were correlated with the histologic findings of the liver.

Monotheistic and spiritual style literature in traditional medicine's resources.

The basis for success of Iranian Gnostics, poets and scientists were moral teaching, attention to origin and searching for specific goals in creation of human and creatures as well as finding some of his essence in studying all phenomena regarding the creation of universe by divine attitude. There is no surprise that such relationship was bilateral and according to his promise to those who truly follow him such that he will show the right path of learning to human in order to obtain the secrets of life. This relationship has resulted in growth of famous Iranian scientists such as Rhazes, Ahvazi, Avicenna, Ferdousi and… at the beginning of the second millennium. Thus, goal of this research is to study the style of writing in original resources of traditional medicine. In order to increase the accuracy of this study, an electronic database version of traditional medicine resources has been prepared. Writing style of Alhavi book (by Rhazes), Kamel-al-Sanaah (by Ahvazi), Canon of Medicine (by Avicenna) and Zakhireye Khwarazmshahi (by Jorjani) was considered. This task was accomplished by searching using related key words such as God, creator, magnificent, omnipotent, transcendent, omniscient and many other similar words and then encoding them. Finally, content analysis of these words was performed. Hundreds of monotheistic words and many small and great texts related to monotheistic literature have been encountered in the literature, and some are mentioned in the following. Rhazes has started some parts of Alhavi by remembering the name of merciful God and saluting his prophets and has mentioned "God" for more than 570 times and the word "God willing" for more than 215 times. Ahvazi has written his book called Kamel-al-Sanaah by using monotheistic literature, so that both volumes of book are started by remembering the name of God and saluting his prophets. In the introduction of first volume of his book, he has acknowledged God due to conferring logic and wisdom to human and has used the word "God" more than 230 times in his book. He has also referred to a famous testimony of Hippocrates and added some more issues in relation to medical ethics. Avicenna has started the Canon of Medicine in five volumes by remembering God and saluting his prophets. When referring to points related to having specific goal in structure of body organs, he immediately has praised God. Jorjani also has followed up the same attitude of three mentioned writers. We have found out that any of the Iranian poets, Gnostics and scientists who have studied nature have reached to the same conclusion from their own point of view, meaning, they all have observed permanent emergence of God in all phenomena of universe. Poets considered the beauties of nature, Gnostics studied mental issues and scientists of natural sciences explored the physiology and anatomy of human body; however, all of them referred to beauty, magnificent, discipline and having goal in creation of universe and all of its phenomena in their books. They have written their valuable books by benefiting monotheistic literature and have published their research results by inference of seeking God and paved the way for next generations. They experienced the usefulness of cumulative effects of spirituality, religion and health on performance and thereby emphasizing the need to incorporate spirituality and religion in teachings curriculums.

The religious and social principles of patients' rights in holy books (Avesta, Torah, Bible, and Quran) and in traditional medicine.

Health protection and promotion in healthy people and restoring patients' health have been the most important themes in medicine and health throughout our history. Therefore, discussion of different aspects of patients' rights includes implementation of these objectives by the medical community, including physicians, nurses, pharmacists, etc., and the people in charge of health affairs. The principal objective of our research is the study of medical ideology and the approaches of our ancestors in relation to different aspects of patients' rights. To study the different ideologies of traditional medicine in relation to patients' rights, appropriate data were extracted from the original resources of traditional medicine and from religious books. By means of library research we studied these resources in addition to electronic versions of the Alhavi book (by Rhazes), the Kamel-al-Sanaah (by Ahvazi), the Canon of Medicine (by Avicenna), the Zakhireye Khawrazmshahi (by Jorjani), the Avesta, the Torah, the Bible, the Quran, and many other resources, and, finally, after searching, gathering, and encoding the findings, analyzed them qualitatively for thematic content. The holy Avesta book clearly insists on the competence of physicians and setting the appointment fee in accordance with peoples' income. The Old Testament (holy Torah) warned government officials who did not observe patients' rights. In the four gospels (holy Bible) the importance of treatment and taking care of the patient is stressed. After the emergence of Islam, medical students, before beginning the principal courses, had to study Islamic jurisprudence, ethics, logic sciences, natural sciences, geometry, astrology, calculus, and similar courses so that after purifying their soul they could enter the saintly profession of physicians. The holy Quran refers to saving the life of a human irrespective of social class, race, and religion, and insists on exemption of patients from physical activity, including the physical aspects of prayer. In these resources, some warnings are offered in relation to fake drugs, the lack of awareness of some physicians, the need for complete preparedness of medical society, and the need to manufacture appropriate drugs and offer a suitable medical service. This information is to familiarize medical and health authorities and persons receiving health services. According to the evidence available about traditional medicine, there was no specific difference between public and professional ethics, public and professional rights, or rights and ethics-ethics were no different from rights nor rights from ethics. So ethics are similar to the soul in the body of rights, and rights are similar to the litter of ethics, and they have developed in parallel with each other. Traditional medicine is community-based and preservation of the health of healthy people is given priority over the treatment of patients; there is insistence that "health rights" has wider scope than "patients' rights". It can be stated that health rights in Iran both before and after the emergence of Islam have been based on guidance from divine religions, observation of humanist ethics, passing suitable courses in the basic sciences, and an introduction to the practical piety of our ancestors, in addition to the syllabus of medical and health education.

The socio-political situation of Avicenna's time and his spiritual messages: on the occasion of 1031 st birth anniversary of Avicenna (23 August 980).

In the fourth century A.H. (tenth century AD) many thinkers, philosophers, jurisprudents, poets, and authors were present in different scientific, literary and health fields in ancient Iran and Islamic world that by their hard attempts the sciences and literature were safe from incidents and resulted in growth, development and innovation of Islamic sciences. Meanwhile, Avicenna was superior to all others and the most famous scientist. He was a great human that by attempting hard, perseverance, stability, patience, and believing in God could complete supreme scientific ranks and compiled encyclopedia of Canon of Medicine and besides gathering many written important issues that most of them were confiscated at libraries of kings. He added medical experiences of ancient Iran and especially Jondishapour University and also his personal experiences and finally Canon of Medicine by benefiting from monotheistic style and science based on faith was written. He has written a book that is regarded as root and basics of modern medicine and by completing it some infrastructure health viewpoints and common medicine were created. It is a kind of book that in spite of scientific advances and production of modern research tools many of its contents are replaced with modern methods of medicine and health, but still many of its health basic messages, research orientation and monotheism with great dynamic mode is considerable at world's medical references. The aim of this study is evaluate the political situation of Avicenna's time and a review of his Godly writings. This is a library study by using electronic version of Canon of Medicine and other related resources. Findings, include writing style of monotheistic literature, and freeing from nihilism and affiliating diseases to Satan, jinn and such issues. It is necessary that our students within course of Iranian and Islamic culture and civilization to be more familiar with monotheistic thoughts and activities of scientists like Avicenna.

Mindfulness-based Cognitive Therapy (MBCT) Reduces Depression and Anxiety Induced by Real Stressful Setting in Non-clinical Population

A randomized, controlled study was conducted in a non-clinical population to investigate the impact of mindfulness-based cognitive therapy (MBCT) on depression, anxiety, automatic thoughts, and dysfunctional attitudes, normally induced by exam as a real stressful setting. The participants were randomly assigned either to receive 8 weekly 2.5- hour MBCT or remain in a waiting list control group. A series of two-way ANOVA with repeated measures were performed to detect if the application of MBCT would result in a systematic reduction in the dependent variables over five assessment points: pre-test, session 4, session 8, first follow-up (1 month) and second follow-up (6 months). The results indicated that MBCT was effective at helping participants to deal with their anxiety and depressive feelings before, during and after stressful circumstances. In addition, the reductions in negative automatic thoughts and dysfunctional attitudes in those who received MBCT were significant. The findings provide further evidence that MBCT might be a useful intervention for enhancing well-being in non-clinical populations who are susceptible to experience anxiety and depression in real life situations (AU)

Se realizó un estudio aleatorio controlado en una población no-clínica para analizar el impacto de la terapia cognitiva basada en mindfulness (TCBPC) sobre la depresión, la ansiedad, los pensamientos automáticos y las actitudes disfuncionales, inducidas por situa- ciones de examen en contextos universitarios. Los participantes fueron asignados al azar para recibir 8 sesiones semanales de 2.5 horas de TCBPC o permanecer en lista de espera como grupo control. Se utilizó un análisis de varianza de medidas repetidas para ver si la aplicación de la TCBPC causa la reducción sistemática de las variables dependientes a lo largo de cinco mediciones: pre-test, sesión 4, sesión 8, primer seguimiento (1 mes) y segundo seguimiento (6 meses). Los resultados indicaron que la TCBPC resultó efectiva para manejar la ansiedad y los sentimientos depresivos antes, durante y después de las situaciones estresantes. Además, la reducción en los pensamientos automáticos y las actitudes disfuncionales fueron significativas entre los participantes que recibieron TCBPC. Los resultados aportan evidencia adicional en el sentido de que la TCBPC puede ser una intervención útil para mejorar el bienestar en poblaciones no-clínicas susceptibles de experimentar ansiedad y depresión en situaciones de la vida real (AU)