Background: Fasting the month of Ramadan should be achieved by every pubescent Muslim unless they have an excuse. Fasting involves complete abstinence of oral intake throughout daytime. Patients who have hypothyroidism usually require levothyroxine (L-thyroxine) replacement, which is typically given on an empty stomach away from meals. Taking L-thyroxine replacement without feeding is challenging during the nighttime of Ramadan, in addition to being prohibited during daytime.Objectives: This study aimed to determine the best time of L-thyroxine intake during Ramadan. Methods: Fifty patients who were taking L-thyroxine treatment for primary hypothyroidism were involved in this prospective study for three months including the fasting and pre-fasting months. The patients were divided into three groups with different times of L-thyroxine intake. In the group one (pre-iftar), the patients were asked to take L-thyroxine at the time of iftar (the sunset meal) but to delay any oral intake for at least 30 minutes. In the group two (post-iftar), the patients were asked to take L-thyroxine two hours after iftar. The patients in the last group (pre-suhoor) were asked not to eat in the last two hours before suhoor (the predawn meal) and to take L-thyroxine tablet one hour prior to suhoor.Results: When thyroid stimulating hormone (TSH) levels were compared before and after Ramadan, there were no significant differences neither within each group nor among all the study groups. Moreover, the frequencies of the TSH control after Ramadan showed no significant differences within each of the study groups (P = 0.18, 0.75, 1.0 for pre-suhoor, pre-iftar, and post-iftar respectively). Similarly, comparison among the groups of the study showed no significant differences regardless of whether the patients had controlled or uncontrolled TSH prior to Ramadan (P = 0.75 and 0.67, respectively). In the patients with controlled TSH before Ramadan, 8 out of 10 (pre-suhoor), 8 out of 12 (pre-iftar), and 4 out of 6 (post-iftar) maintained their control after Ramadan. While in the patients with uncontrolled TSH before Ramadan, 7 out of 10 (pre-suhoor), 6 out of 8 (pre-iftar), and 2 out of 4 (post-iftar) achieved controlled TSH after Ramadan.Conclusions: No significant differences in TSH control were observed in patients taking L-thyroxine at pre-iftar, post-iftar, or presuhoor time in Ramadan.

Background The relationship between diabetic retinopathy (DR) and nephropathy in type 1 diabetes mellitus (T1DM) is controversial. This study assessed the utility of the spot urinary albumin creatinine ratio (UACR) as a parameter for correlating diabetic nephropathy with DR in individuals with T1DM in Basrah. Methods The study was a cross-sectional observational study of 216 patients with T1DM (16–49 years old) with different DR types. We used demographic variables, different T1DM-related variables (onset and duration of T1DM, glycemic control, latency between T1DM and DR onset, age of onset of DR), and biochemical investigations, such as spot UACR, renal function tests, glycated hemoglobin (HbA1c), anti-glutamic acid decarboxylase-65 (anti-GAD-65) antibody, lipid profile, and thyrotropin. We used ordinal regression analysis to test for the possible primary covariates and adjusted the findings with an analysis of covariates (ANCOVA). Results The patient population showed a slight male preponderance, and uncontrolled T1DM with high HbA1c was found in 93% of the cohort. The mean UACR was 64.37 ± 8.99 mg/g. Normal UACR levels were seen in approximately 60% of the cohort (n=129). Sixty-five individuals were reported to have DR, with a median age of onset of 34 ± 8 years and a median latency period of 13 ± 7 years. UACR had no significant relationship with DR development at any association level, with or without adjustment for the composite regression factors. Conclusion There was no significant association between UACR at any level and DR development before and after adjustment for all of the possible covariates in this study.

No abstract

No abstract

Background: There is no single test can identify hypothalamic-pituitary-adrenal dysfunction (HPAD) perfectly. The study aimed to assess the performance of measuring serum cortisol, serum dehydroepiandrosterone sulfate (DHEA-S) and plasma corticotropin (ACTH) in comparison with standard-dose short cosyntropin (250 µg) testing for the diagnosis of HPAD.Methods: This is a cross-sectional study from Al-Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) in Basrah for the period of November 2014 to October 2015. For all patients with suspected HPAD; baseline serum cortisol, serum DHEA-S and plasma ACTH and were measured, followed by a formal short cosyntropin test as the gold standard test. Results:The total number of the study participant was 169 patients.Of them, 134 (79.3%) were women. Their age ranges from 5-80 years. The cut-off serum cortisol that predicts abnormal short cosyntropin test was less than 5.31 µg/dl with maximal sensitivity and specificity of 87.7% and 90.4% respectively. The cut-off serum DHEA-S that predict abnormal short cosyntropin test was less than 31.11 µg/dl with a sensitivity of 89.2%and specificity of 62.7%. The least reliable parameter to predict the abnormal short cosyntropin was the plasma ACTH level with a cut-off of less than 5.30 pg/ml and lowest sensitivity of 68.8% and specificity of 74.5%. Conclusion:To exclude HPAD, serum cortisol at 9-11 am having the highest predictive value, DHEA-S has the midway function and plasma