Risk Reassessment of Differentiated Thyroid Cancer in Ahvaz, Iran: A Cross-sectional Retrospective Study.

Background: Accurate evaluation of response to treatment in differentiated thyroid cancer (DTC) is the sine qua non of preventing over-treatment in low-risk patients and implementing appropriate interventions in high-risk individuals. Objectives: This study aimed to assess the response to therapy in DTC patients based on dynamic stratification method. Methods: In this cross-sectional study, 154 medical records of subjects with DTC (with at least 6 months after total thyroidectomy) and referred to endocrinology clinics in Ahvaz, Iran, from April 2020 to May 2021 were examined. Patients were stratified according to a dynamic risk stratification system (informed by their specific clinical, histopathological, and ultrasonography findings, and other diagnostic imagines) into four groups: Excellent response (ER), indeterminate response (IR), biochemical incomplete response (BIR), and structural incomplete response (SIR). Results: For a mean follow-up period of 28.59 months, excellent response to treatment was observed in 92 patients (59.7%), indeterminate response to treatment was found in 32 patients (20.8%), biochemical incomplete response was detected in 2 patients (1.3%), and structural incomplete response was seen in 28 patients (18.2%). In the group with low risk of recurrence, ER and IR were observed in 79.2% and 15.6% of the patients, respectively (P < 0.0001). In the group with an intermediate risk of recurrence, ER was found in 32% of the patients, while IR and SIR + BIR were seen in 34% and 34% of the patients, respectively (P < 0.0001). No cases of ER or IR were observed in the group with high risk (P = 0.001). Conclusions: In sum, response to treatment significantly varied based on dynamic risk stratification, with ER being highest in the low-risk group, less likely in moderate risk group, and undetected in the high-risk group.

Effect of Sitagliptin Versus Glibenclamide on Glycemic Markers, Lipid Profile Inflammatory and Oxidative Stress Factors in Type 2 Diabetes Patients: a Double-Blinded Randomized Controlled Trial.

Objectives:Diabetes mellitus is leading to chronic complications, including cardiovascular diseases. The aim of this study was to compare the effect of Sitagliptin and Glibenclamide on glycemic markers, lipid profile inflammatory, and oxidative stress factors in type 2 diabetes patients. Methods: This double-blinded randomized controlled trial was performed on patients with type 2 diabetes mellitus (n=54). The treatment group (27 patients) received 100 mg of Sitagliptin once daily + 500 mg Metformin twice daily, orally, for 12 weeks, and the control group (27 patients) was given 5 mg of Glibenclamide once daily + 500 mg Metformin twice daily, also orally, for 12 weeks. Serum levels of tumor necrosis factor alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), lipid profile [cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride (TG)], fasting blood sugar (FBS) and hemoglobin A1C (HbA1c), body weight, and body mass index (BMI) were measured before and after the study. Results:In both groups, the FBS level was significantly reduced from baseline (P=0.03 in the Sitagliptin group and P=0.02 in the Glibenclamide one). The percent of HbA1c was also significantly reduced from baseline in both the Sitagliptin group (P=0.01) and the Glibenclamide one (P=0.008). However, comparing the groups, these changes were not different. In the Sitagliptin group, IL-6 was significantly reduced from baseline (P=0.01) as well as in comparison with the Glibenclamide group (P=0.001). The TG level was significantly lower than the baseline in the Sitagliptin group (P=0.03), so changes between groups were significant (P=0.04). Weight and BMI were significantly increased from baseline in the Glibenclamide group (P=0.02 and P=0.03, respectively), and their changes between the two groups were also significant (P=0.001). Conclusion:These finding support the favorable effects of Sitagliptin on cardiovascular risks beyond its advantages on insulin-glucose hemostasis in patients with type 2 diabetes.

Recurrent cardiac and skin myxomas along with acromegaly: A case report of carney complex.

BACKGROUND: Carney complex (CNC) is an uncommon multisystem endocrine disorder with significant variability of clinical manifestations including mucocutaneous involvement (pigmented lesions, myxomas, blue nevi, etc.), endocrine tumors (adrenal, pituitary, thyroid glands, or testicles), and non-endocrine tumors [cardiac myxomas, psammomatous melanotic schwannomas (PMS), breast myxomas as well as ductal adenomas, and osteochondromyxomas]. To our knowledge, this is the second report of CNC in Iran, presenting with typical manifestations. CASE REPORT: A 29-year-old man was referred to our clinic to evaluate the likelihood of CNC because of recurrent cardiac myxomas. He sometimes suffered from self-limited episodes of non-exertional palpitation, dyspnea, weakness, and pallor. He had some features of acromegaly (such as increase in acral size and frontal bossing). The laboratory tests revealed a high insulin-like growth factor 1 (IGF1) level, with no growth hormone (GH) suppression after oral glucose tolerance test (OGTT). Pituitary magnetic resonance imaging (MRI) showed a microadenoma (5.79 × 2.80 mm) of the pituitary gland; then, he was diagnosed with CNC, having the following major criteria: recurrent cardiac myxomas, skin myxomas, and acromegaly due to GH pituitary microadenoma, as well as minor criteria: multiple cafe´-au-lait (CAL) spots, several skin tags and moles, and thyroid nodules. In this patient, laboratory tests for Cushing's syndrome were equivocal, whereas pheochromocytoma was proven biochemically but unexpectedly pathology did not confirm it. Rather, the pathology of the right adrenocortical specimen revealed nodular hyperplasia. CONCLUSION: For patients with recurrent cardiac myxoma, especially with skin myxoma, the diagnosis of CNC should be considered and the search for other associations should be done even in an asymptomatic patient.

The effects of ginger supplementation on inflammatory, antioxidant, and periodontal parameters in type 2 diabetes mellitus patients with chronic periodontitis under non-surgical periodontal therapy. A double-blind, placebo-controlled trial.

BACKGROUND: The aim of this study was to evaluate the effects of ginger supplementation on inflammatory, antioxidant, and periodontal parameters in type 2 diabetes mellitus (T2DM) patients with chronic periodontitis (CP) under non-surgical periodontal therapy (NSPT). MATERIAL AND METHODS: In this double-blind clinical trial study, 46 T2DM patients with CP were randomly allocated to intervention and control groups and received either 4 tablets 500 mg (2 g) ginger or placebo twice a day for 8 weeks. All patients were treated with NSPT during the intervention period. Serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), hs-C-reactive protein (hs-CRP), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), periodontal indices including clinical attachment loss (CAL), bleeding on probing (BOP), pocket depth (PD), and plaque index were evaluated in all subjects pre- and post-intervention. RESULTS: Following 8 weeks of ginger treatment with NSPT, significant reductions were observed in the mean levels of IL-6 (p=0.001), hs-CRP (p=0.03), TNF-α (p=0.007), CAL, and PD (p<0.001) in the intervention group. The mean serum levels of SOD and GPx were significantly increased in the intervention group after the intervention (p=0.001 and 0.002, respectively). At the end of the study, the mean changes of GPx were significantly higher in the intervention group compared with the control group (p=0.04). Also, after the administration of the ginger with NSPT, significant decrease occurred in the mean change of IL-6 (p=0.009), hs-CRP (p=0.049), TNF-α (p=0.049), CAL (p=0.003), and PD (p=0.04) compared with the control group. CONCLUSION: It is recommended that ginger supplementation along with NSPT may be effective in the improvement of inflammation, oxidative, and periodontal status in T2DM with CP.

The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community based study in Southwest of Iran.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common endocrinopathy, associated with metabolic abnormalities. Metabolic features of various phenotypes of this syndrome are still debatable. The aim of present study hence was to evaluate the metabolic and hormonal features of PCOS phenotypes in comparison to a group of healthy control. METHODS: A total of 646 reproductive-aged women were randomly selected using the stratified, multistage probability cluster sampling method. The subjects were divided into five phenotypes: A (oligo/anovulation + hyperandrogenism + polycystic ovaries), B (oligo/anovulation + hyperandrogenism), C (hyperandrogenism + polycystic ovaries) and D (oligo/anovulation + polycystic ovaries). Hormonal and metabolic profiles and the prevalence of metabolic syndrome among these groups were compared using ANCOVA adjusted for age and body mass index. RESULTS: Among women with PCOS (n = 85), those of groups A and C had higher serum levels of insulin and homeostatic model assessment for insulin resistance (HOMA-IR), compared to PCOS women of group D. Serum concentrations of cholesterol, low density lipoprotein, triglycerides and glucose in group A were higher than in other phenotypes, whereas the metabolic syndrome was more prevalent among group B. CONCLUSIONS: Women who had all three components of the syndrome showed the highest level of metabolic disturbances indicating that metabolic screening of the severest phenotype of PCOS may be necessary.

To what extent does the use of the Rotterdam criteria affect the prevalence of polycystic ovary syndrome? A community-based study from the Southwest of Iran.

OBJECTIVES: There are limited data on the prevalence of polycystic ovary syndrome at the community level: heterogeneity in diagnostic criteria and lack of universal agreement on definitions of each criterion for population-based studies complicate comparability of the existing literature. This study aimed to assess the impact of using three principal definitions for polycystic ovary syndrome on its reported prevalence in a large community-based study conducted in the Southwest of Iran. STUDY DESIGN: A total of 646 reproductive-age women were randomly selected using the stratified, multistage probability cluster sampling method. The prevalence of polycystic ovary syndrome was estimated according to the National Institutes of Health, the Androgen Excess Society and the Rotterdam criteria, using universal assessment of ultrasonographic parameters, hormonal profiles and clinical histories. RESULTS: The mean age of participants was 33.2 years and 36.9% of them were overweight. The estimated prevalence of polycystic ovary syndrome in this population based study was 14.1% using the Rotterdam criteria, 12% by the Androgen Excess Society criteria, and 4.8% according to the National Institutes of Health recommendation. CONCLUSIONS: Using the Rotterdam versus the National Institutes of Health criteria increased the prevalence of polycystic ovary syndrome 2.9-fold. This indicates the need for more studies on the long-term consequences of the additional cases diagnosed using the Rotterdam criteria.

The prevalence of idiopathic hirsutism and polycystic ovary syndrome in the Tehran Lipid and Glucose Study.

BACKGROUND: There is no clear and contemporaneous method for screening of idiopathic hirsutism (IH) and polycystic ovary syndrome (PCOS) at the community level and current estimates regarding their prevalence are limited. We aimed to ascertain the prevalence of IH and PCOS in a randomly selected sample of reproductive aged female participants of the Tehran Lipid and Glucose Study (TLGS). METHODS: One thousand and two women, aged 18-45 years, were randomly selected from among reproductive aged women who participated in the TLGS. Those women with either hirsutism or menstrual dysfunction were assessed for biochemical hyperandrogenemia; whereas those participants with hirsutism per se were further assessed for subclinical menstrual dysfunction. PCOS were diagnosed using the National Institute of Health (NIH) criteria. IH was defined as hirsutism without clinical or sub clinical menstrual dysfunction or biochemical hyperandrogenemia (BH). RESULTS: The mean±SD of age of study population was 29.2±8.7 years. Estimated prevalences of idiopathic hirsutism and pure menstrual dysfunction were 13.0% (95% CI: 10.9%-15.1%) and 1.5%(95% CI: 1.1%-1.9%), respectively. The prevalence of PCOS was 8.5% (95% CI: 6.8%-10.2%); more than one third of these cases would possibly have remained undiagnosed or misdiagnosed, had we not assessed them for subclinical menstrual dysfunction or biochemical hyperandrogenemia. CONCLUSIONS: These data from a large representative and non selected population of women confirm the concept that IH and PCOS are the two most common gynecological endocrinopathies among reproductive aged women. The estimated prevalence of these conditions is highly influenced by their screening methods at the community level.