The Prevalence of Polycystic Ovary Syndrome, Its Phenotypes and Cardio-Metabolic Features in a Community Sample of Iranian Population: Tehran Lipid and Glucose Study.

Objectives: The aim of the present study was to evaluate the prevalence of polycystic ovary syndrome (PCOS), its phenotypical and cardio-metabolic features in a community sample of the Iranian population in comparison to healthy eumenorrheic, non-hirsute women without polycystic ovaries. The second aim was to assess the cardio-metabolic characteristics of women who suffered from one criteria of PCOS compared to those healthy eumenorrheic, non-hirsute women. Methods: In this cross-sectional population-based study, a total of 1,960 eligible women, aged (18-45 years) were recruited from the Tehran-Lipid and Glucose-Study participants and were classified as the three groups of (i) women with PCOS by the Rotterdam criteria, (ii) non-PCOS women with one criteria of PCOS and (iii) healthy eumenorrheic, non-hirsute women without polycystic ovaries morphology (PCOM) as the control group. Further PCOS women were extended to four phenotypes of hyperandrogenism, oligo-anovulation, polycystic ovaries (phenotype A), hyperandrogenism, oligo/anovulation (phenotype B), hyperandrogenism, polycystic ovaries (phenotype C) and oligo-anovulation, polycystic ovaries (phenotype D). Cardio-metabolic profiles and the prevalence of comorbidities of metabolic syndrome (MetS) and lipid abnormalities were compared among these groups linear, and the median regression models adjusted for age and body mass index. Results: The prevalence of PCOS according to the diagnostic criteria of the NIH, Rotterdam and AE-PCOS Society were 13.6, 19.4, and 17.8, respectively. Among those who met the Rotterdam criteria, 23.9, 46.3, 21.6, and 8.2% had phenotypes A, B, C, and D, respectively. Among the remaining 1,580 women who did not fulfil the PCOS criteria, 108 (6.8%) suffered from only oligo/anovulation, 332 (21%) only hyperandrogenism/hyperandrogenemia, 159 (16.2%) only PCOM in ultrasound and 981 (62%) were healthy eumenorrheic, non-hirsute women without PCOM. The study revealed that some adiposity indices and lipid abnormalities in PCOS phenotypes with hyperandrogenism (A, B, and C) were worse than in healthy women. By contrast, women with phenotype D did not differ from the healthy ones in terms of adiposity and lipid abnormalities. However, the respective values for other cardio-metabolic profiles and MetS rates in different phenotypes of PCOS were similar to the healthy women. Only the prevalence of MetS in phenotype A was significantly higher than in the healthy women. There were no statistically significant differences between participants with one criteria of PCOS and healthy counterparts in terms of most adiposity indexes, cardio-metabolic factors, and comorbidity of MetS and its components. However, women with hyperandrogenism had a significantly higher level of the waist to height ratio (WHtR) and hypertriglyceridemia than their healthy counterparts. Conclusion: PCOS, mainly classical phenotypes A and B, are common among Iranian women of reproductive age. Women with PCOS who had androgen excess exhibited the worst lipid profile, and those who had full three criteria of the syndrome exhibited the higher rate of MetS. However, women with only ovulatory dysfunction and only PCOM had similar cardio-metabolic characteristics, compared to healthy subjects. These data suggest that routine screening for metabolic disturbances may be needed in the prevention of cardio-metabolic disorders in patients with more serious phenotypes of PCOS.

Non-stationary response of rain-fed spring wheat yield to future climate change in northern latitudes.

The non-stationary response of crop growth to changes in hydro-climatic variables makes yield projection uncertain and the design and implementation of adaptation strategies debatable. This study simulated the time-varying behavior of the underlying cause-and-effect mechanisms affecting spring wheat yield (SWY) under various climate change and nitrogen (N) application scenarios in the Red Deer River basin in agricultural lands of the western Canadian Prairies. A calibrated and validated Soil and Water Assessment Tool and Analysis of Variance decomposition methods were utilized to assess the contribution of crop growth parameters, Global Climate Models, Representative Concentration Pathways, and downscaling techniques to the total SWY variance for the 2040-2064 period. The results showed that the cause-and-effect mechanisms, driving crop yield, shifted from water stress (W-stress) dominated (27 days of W-stress days) during the historical period to nitrogen stress (N-stress) dominated (27 to 35 N-stress days) in the future period. It was shown that while higher precipitation, warmer weather, and early snowmelts, along with elevated CO2 may favor SWY in cold regions in the future (up to 50% more yields in some sub-basins), the yield potentials may be limited by N-stress (only up to 0.7% yield increase in some sub-basins). The N-stress might be partially related to the N deficiency in the soil, which can be compensated by N fertilizer application. However, inadequate N uptake due to limited evapotranspiration under elevated atmospheric CO2 might pose restrictions to SWY potentials even in the least N deficient regions. This study uncovers important information on the understanding of spatiotemporal variability of hydrogeochemical processes driving crop yields and the non-stationary response of yields to changing climate. The results also underscore spatiotemporal variability of N-stress due to N deficiency in the soil or N uptake by crops, both of which may restrain SWY by changes in atmospheric CO2 concentrations in the future.

Congenital external carotid-external jugular arteriovenous fistula: diagnosis with contrast-enhanced computed tomography.

Arteriovenous fistula (AVF) between the external carotid artery and external jugular vein is extremely rare, with only few cases reported in the literature so far. Most of these AVFs have been either iatrogenic or secondary to previous trauma. Herein, we report a 42-year-old woman with congenital AVF between the external carotid artery and external jugular vein, presenting with palpitation and dyspnea. The patient was suffering from mitral and tricuspid regurgitation. On physical examination, a thrill on the left side of the neck and an audible bruit over the left mandibular angle were detected. The possibility of abnormal AVF was considered and it was confirmed on contrast-enhanced computed tomography (CT), inferring that this modality is not only fast and non-invasive, but also accurate in detecting vascular abnormalities.