BackgroundAlthough depression is associated with changes in the hypothalamic-pituitary-thyroid axis, its relationship with subclinical hypothyroidism (SCH) is controversial. To date, there is a lack of data on the improvement of depressive symptoms with levothyroxine therapy among individuals with coexistent SCH.MethodsWe conducted a meta-analysis to evaluate the association between SCH and depression including 1) the prevalence of depression in SCH (with a sub-analysis of the geriatric cohort), 2) thyroid stimulating hormone (TSH) level among patients with depression and 3) the effect of levothyroxine therapy among patients with SCH and coexistent depression.ResultsIn a pooled analysis of 12,315 individuals, those with SCH had higher risk of depression than euthyroid controls (relative risk 2.35, 95% confidence intervals [CI], 1.84 to 3.02; p < 0.001). Geriatric cohort with SCH had a 1.7-fold higher risk of depression compared with healthy controls (odds ratio 1.72, CI, 1.10 to 2.70; p = 0.020). There was no difference in the mean TSH level between individuals with depression and healthy controls (2.30 ± 1.18 vs. 2.13 ± 0.72 mIU/L, p = 0.513). In individuals with SCH and coexistent depression, levothyroxine therapy was neither associated with improvement in the Beck Depression Inventory scoring (pooled d + = − 1.05, CI -2.72 to 0.61; p = 0.215) nor Hamilton Depression Rating Scale (pooled d + = − 2.38, CI -4.86 to 0.10; p = 0.060).ConclusionSCH has a negative impact on depression. Early and routine screening of depression is essential to prevent morbidity and mortality. However, the use of levothyroxine among patients with SCH and coexistent depression needs to be individualized.

Aims/IntroductionAlthough patients with type 1 diabetes are medically exempt, many insist on fasting during Ramadan. Multiple daily insulin injections (MDI), premixed insulin and continuous subcutaneous insulin infusion (CSII) are commonly used. To date, little is known about the safety of Ramadan fasting in these patients.Materials and MethodsWe pooled data from 17 observational studies involving 1,699 patients treated with either CSII or non‐CSII (including premixed and MDI) regimen. The study outcomes were the frequencies of hypoglycemia, hyperglycemia and/or ketosis. Given the lack of patient‐level data, separate analyses for premixed and MDI regimen were not carried out.ResultsThe CSII‐treated group (n = 203) was older (22.9 ± 6.9 vs 17.8 ± 4.0 years), and had longer diabetes duration (116.7 ± 66.5 vs 74.8 ± 59.2 months) and lower glycated hemoglobin (7.8 ± 1.1% vs 9.1 ± 2.0%) at baseline than the non‐CSII‐treated group (n = 1,496). The non‐CSII‐treated group had less non‐severe hypoglycemia than the CSII‐treated group (22%, 95% CI 13–34 vs 35%, 95% CI 17–55). Of the non‐CSII‐treated group, 7.1% (95% CI 5.8–8.5) developed severe hypoglycemia, but none from the CSII‐treated group did. The non‐CSII‐treated group was more likely to develop hyperglycemia (12%, 95% CI 3–25 vs 8.8%, 95% CI 0–31) and ketosis (2.5%, 95% CI 1.0–4.6 vs 1.6%, 95% CI 0.1–4.7), and discontinue fasting (55%, 95% CI 34–76 vs 31%, 95% CI 9–60) than the CSII‐treated group.Conclusions The CSII regimen had lower rates of severe hypoglycemia and hyperglycemia/ketosis, but a higher rate of non‐severe hyperglycemia than premixed/MDI regimens. These suggest that appropriate patient selection with regular, supervised fine‐tuning of the basal insulin rate with intensive glucose monitoring might mitigate the residual hypoglycemia risk during Ramadan.

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Aims We aimed to examine if bariatric surgery was associated with a reduction in the prevalence of depressive and anxiety symptoms among people with obesity. Materials and Methods We pooled data from 49 studies involving 11,255 people with obesity who underwent bariatric surgery. The study outcomes were the prevalence of depressive and anxiety symptoms among these patients pre‐ and post‐surgery. Results There was a significant reduction in body mass index (BMI) post‐operatively (pooled d+: −13.3 kg/m2 [95% confidence interval [CI] 15.19, −11.47], p < 0.001). The pooled proportion of patients with anxiety symptoms reduced from 24.5% pre‐operatively to 16.9% post‐operatively, with an odds ratio (OR) of 0.58 (95% CI 0.51, 0.67, p < 0.001). The reduction remained significant in women aged ≥40 years and irrespective of post‐operative BMI. There were significant reductions in Hospital Anxiety and Depression Score (HADS) (anxiety component) by 0.64 (pooled d+: −0.64 [95% CI −1.06, −0.22], p = 0.003) and Generalized Anxiety Disorder Assessment‐7 score by 0.54 (pooled d+: −0.54 [95% CI −0.64, −0.44], p < 0.001). The pooled proportion of depressive symptoms reduced from 34.7% pre‐operatively to 20.4% post‐operatively, with an OR of 0.49 (95% CI 0.37, 0.65, p < 0.001). The reduction remained significant irrespective of patient's age and post‐operative BMI. There were also significant reductions in HADS score (depressive component) (pooled d+: −1.34 [95% CI −1.93, −0.76], p < 0.001), Beck’s Depression Inventory score (pooled d+: −1.04 [95% CI −1.46, −0.63], p < 0.001) and Patient Health Questionnaire‐9 score (pooled d+: −1.11 [95% CI −1.21, −1.01], p < 0.001). Conclusion Bariatric surgery was associated with significant reduction in the prevalence and severity of depressive and anxiety symptoms among people with obesity.

Background Polycystic ovarian syndrome is a common disorder characterized by clinical or biochemical hyperandrogenism and ovulary dysfunction. Female sexual dysfunction can have adverse effects on quality of life and interpersonal relationship. Methods We conducted a meta-analysis to evaluate the prevalence and severity of sexual dysfunction in women with PCOS. Results Compared to women without PCOS, those with PCOS were younger (28.90±3.11 versus 31.42±3.37 years; p<0.0001) and had higher body mass index (27.76±3.79 versus 24.95±3.71 kg/m2; p=0.002), Ferriman-Gallwey score (9.90±3.37 versus 4.11±2.17; p<0.0001) and serum total testosterone level (2.26±0.59 versus 1.51±0.49 nmol/L; p<0.0001). There was no significant difference in mean total FSFI score (25.72±2.33 versus 26.62±3.38; p=0.608) in women with and without PCOS. For the FSFI subscales, women with PCOS had a lower score for the pain subscale than women without PCOS (4.60±0.71 versus 5.24±0.39; p<0.001). Other subscales were not significantly different between the two groups. Women with PCOS had a 1.39 higher odds (95% CI 1.13, 1.72; p=0.002, I2 11.9%) of having FSD than women without PCOS. Conclusion FSD is a prevalent and disabling condition in young women with PCOS. Sensitive probing into the intimate aspects of their sex lives is needed to further understand the struggles that afflict women with PCOS. Parallel efforts should be undertaken to investigate the impact of new treatment strategies.

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Primary aldosteronism (PA), the most common cause of secondary hypertension, is a well-recognized condition that can lead to cardiovascular and renal complications. PA is frequently left undiagnosed and untreated, leading to aldosterone-specific morbidity and mortality. In this review we highlight the evidence linking PA with other conditions such as (i) diabetes mellitus, (ii) obstructive sleep apnea, and (iii) bone health, along with clinical implications and proposed underlying mechanisms.

BackgroundMethadone is an effective therapy for opiate dependence. However, one of the commonest side effects is sexual dysfunction among male patients. Buprenorphine is an alternative to methadone. This study aimed to compare sexual desire among opiate-dependent male patients on buprenorphine (BMT) and methadone maintenance therapy (MMT).MethodsThis cross-sectional study involved 126 male opiate-dependent patient who were tested for total testosterone (TT) and prolactin levels, and were interviewed and completed the Sexual Desire Inventory-2 (SDI-2), Malay language of International Index of Erectile Function (Mal-IIEF-15) and the Malay version of the self-rated Montgomery-Asberg Depression Rating Scale (MADRS-BM) questionnaires.ResultsThere were 95 (75.4%) patients on MMT and 31 (24.6%) on BMT. Patients on MMT scored significantly lower in the sexual desire domain (Mal-IIEF-15 scores) (p < 0.01), dyadic sexual desire (p = 0.04) and TT plasma level (p < 0.01) when compared to BMT group after controlling all the confounders.ConclusionsPatients on MMT are associated with lower sexual desire when compared with patients on BMT. Smoking may further lower testosterone and, hence, sexual desire in those already on methadone.