Online Ann Intern Med editorial

Elective use of early insulin therapy in newborn babies who weigh <1.5 kg does not improve survival, and is associated with an increased risk of hypoglycemia in those <1 kg in weight.

Improved glycemic control after bariatric surgery might have a beneficial effect on the response to oxidative stress in morbidly obese patients with diabetes mellitus.

Transdermal exogenous testosterone improves libido in postmenopausal women receiving estrogen therapy. Davis et al. have now demonstrated that 300 microg of testosterone a day, administered via skin patches, results in a modest but clinically important increase in sexual function in postmenopausal women with hypoactive sexual desire disorder who are not receiving estrogen.

Daily consumption of chamomile tea with meals could help to prevent the development or worsening of hyperglycemia and diabetic complications.

The authors conclude that patients with hypoparathyroidism have reduced bone turnover and increased bone volume. The atypical bone quality observed in these patients is most probably a result of parathyroid hormone deficiency.

Scientists are trying to help women find answers. MaryFran Sowers and her colleagues from the University of Michigan in Ann Arbor are using a range of variables, including age and hormone levels, to predict the time window in which a woman is likely to hit menopause.

Inhaled insulin was a rare occasion in clinical practice when the response of patients and health-care providers to a new technology was in line with the unfavorable aspects of the product, and in opposition to the perceived need and aggressive marketing by the manufacturer. Perhaps we, the consumers, have learned our lesson after all.

Background: Non-thyroidal illness syndrome (NTIS) is a characteristic functional constellation of thyrotropic feedback control that frequently occurs in critically ill patients. Although this condition is associated with significantly increased morbidity and mortality, there is still controversy on whether NTIS is caused by artefacts, is a form of beneficial adaptation, or is a disorder requiring treatment. Trials investigating substitution therapy of NTIS revealed contradictory results. The comparison of heterogeneous patient cohorts may be the cause for those inconsistencies. Objectives: Primary objective of this study is the identification and differentiation of different functional states of thyrotropic feedback control in order to define relevant evaluation criteria for the prognosis of affected patients. Furthermore, we intend to assess the significance of an innovative physiological index approach (SPINA) in differential diagnosis between NTIS and latent (so-called "sub-clinical") thyrotoxicosis. Secondary objective is observation of variables that quantify distinct components of NTIS in the context of independent predictors of evolution, survival or pathophysiological condition and influencing or disturbing factors like medication. Design: The approach to a quantitative follow-up of non-thyroidal illness syndrome (AQUA FONTIS study) is designed as both a cross-sectional and prospective longitudinal observation trial in critically ill patients. Patients are observed in at least two evaluation points with consecutive assessments of thyroid status, physiological and clinical data in additional weekly observations up to discharge. A second part of the study investigates the neuropsychological impact of NTIS and medium-term outcomes. The study design incorporates a two-module structure that covers a reduced protocol in form of an observation trial before patients give informed consent. Additional investigations are performed if and after patients agree in participation. Trial Registration: ClinicalTrials.gov NCT00591032