Association between platelet, white blood cell count, platelet to white blood cell ratio and sarcopenia in community-dwelling older adults: focus on Bushehr Elderly Health (BEH) program.

BACKGROUND: Sarcopenia is a progressive age-related skeletal muscle disorder associated with harmful impacts on health. The present study aimed to investigate the relation between sarcopenia, platelet (PLT), white blood cell (WBC), and PLT to WBC ratio (PWR) due to the importance of early sarcopenia diagnosis. METHODS: This cross-sectional study was conducted based on the second stage of the Bushehr Elderly Health (BEH) Program. Sarcopenia was defined based on the revised edition of the European Working Group on Sarcopenia in Older People (EWGSOP2) in accordance with the Iranian cut-off point. Univariate and adjusted multivariate logistic regression and linear regression were used to evaluate the associations. RESULTS: The prevalence of sarcopenia among participants was 35.73%. PLT count and PWR were statistically higher in severe sarcopenic participants, while no differences were seen in WBC. In crude analysis, sarcopenia was not associated with quartiles of PLT, WBC, and PWR, while after adjusting for age, marital status, and sex, the association was seen in the fourth quartile of PLT and PWR [OR (95%CI) = 1.40 (1.08 to 1.81), p-value = 0.009 for PLT; OR (95%CI) =1.55 (1.20 to 2.00), p-value =0.001 for PWR]. This association remained significant in the fully adjusted model [OR (95%CI) =1.82 (1.20 to 2.78), p-value =0.005 for PLT; OR (95%CI) =1.57 (1.03 to 2.40), p-value =0.035 for PWR]. Among sarcopenia parameters, PLT count was more likely to be associated with handgrip strength and muscle mass. After stratifying the participants by gender, sarcopenia parameters were no longer statistically significant in men. CONCLUSION: This study showed that PLT and PWR were associated with sarcopenia after considering confounding factors, while this association was not seen in WBC. Moreover, results showed that gender had an important impact on sarcopenia parameters.

Prevalence of vitamin D deficiency and its associated risk factors among rural population of the northern part of the Persian Gulf.

BACKGROUND: Accumulating evidence indicates that vitamin D deficiency has been increased globally over the last two decades. However, the majority of these studies are concerned with cities and there is scant information regarding the prevalence of vitamin D in rural areas. The main aim of this study was to investigate the prevalence of vitamin D deficiency and its associated risk factors among the rural population in Bushehr province which shares the longest border with the Persian Gulf. METHODS: The rural inhabitants of more than 25 years old from three mountainous, plain, and seashore areas of Bushehr province were selected through a stratified multi-cluster random sampling method. After obtaining the participants' demographic and anthropometric data and their past medical history, serum 25-hydroxyvitamin D [25(OH)D] was measured using ELISA. RESULTS: A total of 1806 (means ±SD, 46± 14years old) rural subjects (35 % males and 65 % females) participated in this study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 28 %, 50 %, and 22 %, respectively. The deficiency of vitamin D in women was higher than in men (OR=1.27, 95 % CI: 1.05 to 1.54, P=0.04). There was a positive significant correlation between age and serum vitamin D levels. Men with vitamin D deficiency had higher BMI (P=0.008); this association was not observed among women (P=0.7). There was no significant difference between the food item's consumption frequencies, and vitamin D status (P>0.05). The mountainous, and plain areas had the highest and lowest vitamin D levels, respectively. CONCLUSIONS: Although, Bushehr province is located in a sunny part of Iran, the prevalence of vitamin D deficiency was high among its rural population. The shift of their lifestyle patterns and rapid industrialization in these rural areas may be responsible. Therefore, the enrichment of dietary sources with vitamin D and the use of vitamin D supplements are recommended to tackle the high prevalence of vitamin D deficiency in the rural population of the northern part of the Persian Gulf.

Integrated neural network and evolutionary algorithm approach for liver fibrosis staging: Can artificial intelligence reduce patient costs?

Background and Aim: Staging liver fibrosis is important, and liver biopsy is the gold standard diagnostic tool. We aim to design and evaluate an artificial neural network (ANN) method by taking advantage of the Teaching Learning-Based Optimization (TLBO) algorithm for the prediction of liver fibrosis stage in blood donors and hepatitis C patients. Methods: We propose a method based on a selection of machine learning classification methods including multilayer perceptron (MLP) neural network, Naive Bayesian (NB), decision tree, and deep learning. Initially, the synthetic minority oversampling technique (SMOTE) is performed to address the imbalance in the dataset. Afterward, the integration of MLP and TLBO is implemented. Results: We propose a novel algorithm that reduces the number of required patient features to seven inputs. The accuracy of MLP using 12 features is 0.903, while that of the proposed MLP with TLBO is 0.891. Besides, the diagnostic accuracy of all methods, except the model designed with the Bayesian network, increases when the SMOTE balancer is applied. Conclusion: The decision tree-based deep learning methods show the highest levels of accuracy with 12 features. Interestingly, with the use of TLBO and seven features, MLP reached an accuracy rate of 0.891, which is quite satisfactory when compared with those of similar studies. The proposed model provides high diagnostic accuracy, while reducing the required number of properties from the samples. The results of our study show that the recruited algorithm of our study is more straightforward, with a smaller number of required properties and similar accuracy.

A Review of Hyperglycemia in COVID-19.

Diabetes mellitus (DM) is one of the most common chronic metabolic disorders worldwide, which increases the risk of common and opportunistic infections. Following the coronavirus disease 2019 (COVID-19) pandemic, a higher incidence rate, more severe forms of the disease, and exacerbation of hyperglycemia and its complications have been observed in patients with DM. Moreover, stress-induced hyperglycemia has been observed in many hospitalized nondiabetic patients after contracting COVID-19. Hyperglycemia worsens prognosis in both diabetic and nondiabetic patients. In this study, the mechanism of new-onset or exacerbation of hyperglycemia, the effect of the treatments used for COVID-19 on hyperglycemia, the importance and appropriate method of blood glucose (blood sugar (BS)) control during the disease, and the possible fate of new-onset hyperglycemia after recovery from COVID-19 to some extent is expressed.

Feasibility and therapeutic potential of the 68Ga/177Lu-DOTATATE theranostic pair in patients with metastatic medullary thyroid carcinoma.

BACKGROUND: This study assessed: 1) the clinical efficacy of imaging with 68Ga-DOTATATE PET/CT (SSTR (somatostatin receptor)-PET) to detect medullary thyroid carcinoma (MTC); and 2) the therapeutic efficacy of peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE in MTC patients. MATERIALS AND METHODS: Patients with histologically proven MTC and suspected recurrence following thyroidectomy, based on raised serum calcitonin levels, underwent SSTR-PET. In addition, to evaluate the clinical efficacy and safety of PRRT, the patients with intense uptake on SSTR-PET or 99mTc-octreotide scintigraphy underwent PRRT. The Common Terminology Criteria for Adverse Events (version 4.03) was used to grade adverse events after PRRT. Treatment response was classified as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). RESULTS: Twenty MTC patients (10 male, 10 female) with a median age of 48.5 years underwent SSTR-PET. SSTR-PET was positive in 17/20 patients (85%). Four of the 17 patients with positive SSTR-PET were scheduled for PRRT. In addition, 2 patients had positive 99mTc-octreotide scintigraphy results (Krenning score ≥ 2) and were scheduled for PRRT. Two of the 6 patients who underwent PRRT showed PR, 2 SD and 2 PD. Two patients died during the follow-up period. Median overall survival was 19 months (95% CI: 5.52-29.48). There were no cases of significant toxicity. CONCLUSION: Radiolabeled somatostatin analogs are contributive for the management of recurrent MTC. 68Ga-DOTATAE PET-CT showed a relatively high detection rate in recurrent MTC. In addition, PRRT with 177Lu-DOTATATE was found to be a safe alternative therapeutic option for MTC.

Relationship Between Neck Circumference and Risk Factors of Metabolic Syndrome in a Bushehr Elderly Health Study.

Metabolic syndrome includes a set of metabolic disorders such as obesity, high blood pressure, hypertriglyceridemia, lipid disorders, and glucose intolerance. In this cross-sectional (descriptive-analytical) study, 2,426 people were selected from the 60 years old and above population of Bushehr for a second-phase investigation of the relationship between neck circumference (NC) and cardiometabolic risk factors in the elderly people. The data (mean and standard deviation) were analyzed using STATA MP Version 15 software. The results of the study showed that the average age of all elderly participants in the study was 69.34 ± 6.39 years. The mean and standard deviation of the NC index in men, women, and all participants were 39.31 ± 2.89, 34.86 ± 2.84, and 37.00 ± 3.62, respectively. The mean and standard deviation of most laboratory indicators (triglyceride [TG], total cholesterol [TC], low-density lipoprotein [LDL], high-density lipoprotein [HDL]) were significantly higher in women, and there was no significant difference in fasting blood glucose (FBG) between men and women. NC index in the total population was significantly associated with all risk factors of metabolic syndrome (body mass index, systolic blood pressure, diastolic blood pressure) and laboratory indicators (FBG, TG, TC, LDLC, and HDL). The present study shows that the NC index can be a good predictor for the diagnosis of metabolic syndrome and visceral adipose tissue in the elderly.

Microplastics and phthalate esters release from teabags into tea drink: occurrence, human exposure, and health risks.

Tea, the most common infusion worldwide, is usually sold in teabags due to the ease of usage. The increase in the use of plastic materials in the food packaging industry has led to an increase in released contaminants, such as microplastics (MPs) and phthalates (PAEs), in various food products including teabags. In this research, the abundance and features of MPs as well as PAEs concentration were investigated in 45 teabag samples of different Persian and German brands. The abundance of MPs in the Persian and German teabag samples was averagely 412.32 and 147.28 items/single teabag, respectively. Also, average PAEs levels in the Persian and German teabag samples were 2.87 and 2.37 mg/g, respectively. The predominant size category of MPs was related to 100-250 µm. Fibers and transparent were the dominant shape and color of detected MPs in teabags, respectively. Polyethylene (PE) and nylon were the most common MP polymer types. The most prominent PAEs congeners in teabag samples were diethylhexyl phthalate (DEHP) and diisobutyl phthalate (DiBP). Furthermore, MP exposure hazard through tea ingestion was analyzed for children and adults. DEHP showed the cancer risk (CR) for children and adults. The findings of this research indicated that high MPs and PAEs levels are released from teabags into tea drinks. Considering a daily drinking of a volume of 150 and 250 mL tea by children and adults, 486 and 810 MPs may enter their bodies, respectively. Thus, tea prepared with teabag-packed herbs may pose a significant health risk for consumers.

Reduced serum osteocalcin concentrations are associated with type 2 diabetes mellitus and the metabolic syndrome components in postmenopausal women: the crosstalk between bone and energy metabolism.

Although it has been shown that osteocalcin functions as a hormone in the regulation of glucose metabolism and fat mass, no population-based study to date has addressed serum osteocalcin levels in relation to energy metabolism concurrent with bone metabolism in postmenopausal women. In a population-based study, cardiovascular risk factors, high-sensitivity C-reactive protein (hs-CRP), osteoprotegerin, receptor activator of nuclear factor-κB ligand, osteocalcin, CrossLaps, alkaline phosphatase, and bone mineral density (BMD) at the lumbar spine (L2-L4) and the proximal femur were measured in 382 Iranian postmenopausal women. In multiple logistic regression analysis, lower osteocalcin and CrossLaps levels were associated with a higher odds ratio (OR) of having type 2 diabetes mellitus when adjustments were made for age, hs-CRP, cardiovascular risk factors, BMD, and markers of bone metabolism [OR 5.17, CI (2.66-10.04), p < 0.0001 and OR 2.51, CI (1.37-4.61), p = 0.003, respectively]. However, lower alkaline phosphatase levels were associated with a lower OR of having type 2 diabetes mellitus [OR 0.28, CI (0.15-0.52), p < 0.0001] in regression analysis. No significant difference was found between serum osteocalcin levels of those with and without metabolic syndrome. Among the metabolic syndrome components, low osteocalcin levels had significant associations with elevated blood glucose [OR 1.89, CI (1.16-3.07), p = 0.010] and elevated waist circumference [OR 2.53, CI (1.13-5.67), p = 0.024] in multivariate analyses. In conclusion, serum osteocalcin was independently associated with glucose intolerance and abdominal obesity as the components of metabolic syndrome and type 2 diabetes mellitus in postmenopausal women. Since CrossLaps and alkaline phosphatase levels were independently associated with the presence of type 2 diabetes mellitus, the unique contribution of osteocalcin in glucose metabolism could not be concluded.

Evaluation of HIV-Related Cardiomyopathy in HIV-Positive Patients in Bushehr, Iran.

Objectives In 2020, according to the UNAIDS (Joint United Nations Programme on HIV/AIDS), more than 37 million people lived with human immunodeficiency virus (HIV) infection worldwide. The disease is known to affect several organs, and one of the most affected organs is the heart. Cardiac diseases are highly prevalent among HIV-infected individuals, and recent findings suggest that this could be due to the damage caused by the virus. HIV patients are subject to advanced immunosuppression, which may lead to cardiac muscle damage and, in turn, cardiomyopathy. We aimed to study the incidence of HIV-related cardiomyopathy. Methods A pilot cross-sectional study was conducted to assess cardiomyopathy among 200 HIV patients who presented to the Heart Center, Bushehr, Iran. Patients' files were used to determine the demographic data including age, gender, education, marital status, history of illicit drug use, unsafe/unprotected sexual contact, and whether the patient was a prisoner. Several laboratory data were also collected from these files. Physical examination of the cardiovascular system and echocardiography were also included as part of the evaluation. Results Although at least four out of five patients presented with some kind of cardiac damage, including valvular damage and pericardial effusion, none was diagnosed with cardiomyopathy. Valvular dysfunction was detected in 88.5% of the patients. Diastolic dysfunction was found in 7.7% of them. The mean ejection fraction was found to be 58%. In addition to cardiomyopathy, none of the patients developed systolic dysfunction, wall motion abnormality, intra-cardiac mass, or vegetation. Conclusions Cardiovascular complications are common among HIV-infected patients. Cardiomyopathy was not detected in our patients. In addition, the most common manifestations that were detected among our patients were valvular heart diseases and pericardial effusion.

Peptide Receptor Radionuclide Therapy Using 177 Lu-DOTATATE in Advanced Neuroendocrine Tumors (NETs) in a Limited-Resource Environment.

Background This study was conducted to evaluate the clinical efficacy and safety of peptide receptor radionuclide therapy (PRRT) using 177 Lu-DOTA0-Tyr3-octreotate (DOTATATE) in patients with neuroendocrine tumors (NETs). Methods Sixteen patients with pathologically verified NETs including eight females and eight males were enrolled in this study. Before PRRT, the patients underwent 68 Ga-DOTATATE positron emission tomography/computed tomography or 99m Tc-octreotide scintigraphy for evaluation of somatostatin receptor expression. Response to treatment was assessed according to the Response Evaluation Criteria In Solid Tumors (RECIST) classified as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). In addition, for evaluation of toxicity, monthly blood analysis was performed including hematology, renal function (creatinine) test, and liver function test. The Eastern Cooperative Oncology Group (ECOG) status performance was applied to estimate the patients' general condition in a scale of 0 (fully active) to 5 (dead). In addition, overall survival (OS) was calculated as the time interval from the start of PRRT to death from any reason. Results Sixteen patients including eight females and eight males with a median age of 60.5 years (range: 24-74) were enrolled in this study. The patients underwent PRRT with a median cycle of 3.5 (range: 1-7) and a median dose of 20.35 (range: 7.4-49.95 GBq). At the end of data collection, PR, CR, SD, and PD were seen in 11, 2, 1, and 2 patients according to the RECIST, respectively. Three patients expired during or after the PRRT period. The median ECOG and Karnofsky Performance Scale was 1.5 and 75 before PRRT, which improved significantly to 1 and 80 after PRRT, respectively ( p < 0.05). According to the Kaplan-Meier test, the median OS was 23 months (95% confidence interval: 7.90-38.09). According to the National Cancer Institute's Common Terminology Criteria for Adverse Events, three patients showed grade I and three patients showed grade II leucopenia. Furthermore, three and seven patients had grade II and grade I anemia, respectively. Conclusion Since PRRT using 177 Lu-DOTATATE has a favorable response rate and few adverse effects and improves the quality of life in NETs, it can be used as an effective therapeutic option, especially in nonoperative, metastatic, and progressive NETs.

Oncogenic osteomalacia secondary to glomus tumor.

SUMMARY: Oncogenic osteomalacia secondary to glomus tumor is extremely rare. Localization of causative tumors is critical as surgical resection can lead to a complete biochemical and clinical cure. We present a case of oncogenic osteomalacia treated with resection of glomus tumor. A 39-year-old woman with a history of chronic sinusitis presented with chronic body ache and muscle weakness. Biochemical evaluation revealed elevated alkaline phosphatase hypophosphatemia, increased urinary phosphate excretion, low calcitriol, and FGF23 was unsuppressed suggestive of oncogenic osteomalacia. Diagnostic studies showed increase uptake in multiple bones. Localization with MRI of paranasal sinuses revealed a sinonasal mass with concurrent uptake in the same area on the octreotide scan. Surgical resection of the sinonasal mass was consistent with the glomus tumor. The patient improved both clinically and biochemically postoperatively. Along with the case of oncogenic osteomalacia secondary to a glomus tumor, we have also discussed in detail the recent development in the diagnosis and management of oncogenic osteomalacia. LEARNING POINTS: Tumor-induced osteomalacia is a rare cause of osteomalacia caused by the secretion of FGF23 from mesenchymal tumors. Mesenchymal tumors causing TIO are often difficult to localize and treat. Resection of the tumor can result in complete resolution of biochemical and clinical manifestations in a very short span of time. Glomus tumor can lead to tumor induced osteomalacia and should be surgically treated.

Efficacy and Safety of Resveratrol in Type 1 Diabetes Patients: A Two-Month Preliminary Exploratory Trial.

Resveratrol has been reported to be beneficial against diabetes complications. The objective of this study was to evaluate the efficacy of resveratrol in decreasing hyperglycemia in patients with type 1 diabetes (T1D) by a preliminary investigation designed as an exploratory clinical trial. Thirteen patients with T1D from both the sexes participated in this trial. All patients received resveratrol in 500 mg capsules, twice daily for 60 days. Bodyweight, fasting blood sugar (FBS), hemoglobin A1c (HbA1c), insulin, homeostasis model of assessment for insulin resistance (HOMA-IR), homeostasis model of assessment for ß-cell function (HOMA-ß), and markers of liver and kidney damage, inflammation, and oxidative stress were measured before the intervention, at 30 days and at 60 days. Resveratrol supplementation for 60 days significantly decreased FBS and HbA1c in comparison with the baseline values. Resveratrol treatment also resulted in a decrease in the level of a marker for oxidative stress, malondialdehyde, and an increase in total antioxidant capacity in T1D patients. Insulin, HOMA-IR, HOMA-ß, and markers of liver and kidney function and inflammation were not significantly affected by resveratrol treatment. Overall, the results showed that 60 days of resveratrol supplementation exerted strong antidiabetic and antioxidant effects in patients with T1D.

RAGE is a Potential Cause of Onset and Progression of Nonalcoholic Fatty Liver Disease.

OBJECTIVE: Fatty liver is a rising global health concern, significantly increasing the burden of health care cost. Nonalcoholic fatty liver disease (NAFLD) has a correlation with metabolic syndrome and its complications. METHOD: We reviewed the literature regarding the mechanisms of developing NAFLD through AGE-RAGE signaling. RESULTS: NAFLD, metabolic syndrome, and production of advanced glycation end-products (AGEs) share many common risk factors and appear to be connected. AGE induces production of the receptor for AGE (RAGE). AGE-RAGE interaction contributes to fat accumulation in the liver leading to inflammation, fibrosis, insulin resistance, and other complications of the fatty liver disease. The immune system, especially macrophages, has an important defense mechanism against RAGE pathway activities. CONCLUSION: Soluble form of RAGE (sRAGE) has the capability to reduce inflammation by blocking the interaction of AGE with RAGE. However, sRAGE has some limitations, and the best method of usage is probably autotransplantation of transfected stem cells or monocytes, as a precursor of macrophages and Kupffer cells, with a virus that carries sRAGE to alleviate the harmful effects of AGE-RAGE signaling in the settings of fatty liver disease.

Significance of Microalbuminuria in Predicting Silent Myocardial Ischemia in Patients with Type 2 Diabetes Using Myocardial Perfusion Imaging

Objectives: In light of increased risk of cardiovascular events and the poor prognosis of coronary artery disease (CAD) in diabetic versus non-diabetic patients and also with respect to the importance of early diagnosis of CAD in this status, the study was aimed to assess the importance of microalbuminuria in predicting silent myocardial ischemia (SMI) in patients with type 2 diabetes using myocardial perfusion imaging (MPI). Methods: This study included 120 patients with diabetes type 2, but without previously known CAD or any cardiac symptoms that were stratified into two groups based on presence/absence of microalbuminuria. All participants underwent CAD evaluation using gated myocardial perfusion single-photon emission computed tomography (MPS) imaging. Other clinical and laboratory indices were also recorded Results: Studied population consisted of 84 males (70%) and 36 females (30%), totally 120 patients with mean age of 58.61±9.90). In total, asymptomatic ischemia was detected in 78 (65%) of the included diabetic patients. Stress induced ischemia was found in 56 patients (87.5%) of albumin+ (Alb) group and in 22 patients (39.3%) of Alb- group. The frequency of stress induced ischemia was 10.81 times higher in the patients with microalbuminuria compared to Alb- ones [p<0.001, Odds ratio: 10.81, 95% confidence interval: 4.33-26.99]. On the other hand, no relationship was found between the presence of stress induced ischemia and therapy type, diabetes duration, history of evident retinopathy, history of hypertension and also serum levels of hemoglobin A1c (p>0.05). Conclusion: The current study showed that abnormal MPI findings are significantly more common in diabetic patients with microalbuminuria. With respect to low cost and availability of urine Alb detection tests, it might be as a biomarker for prediction of SMI in daibetic population.

Quantum dot-based diabetic foot mapping for diagnosing osteomyelitis and Charcot neuroarthropathy.

The location of osteomyelitis is very important in Charcot neuroarthropathy (CN), especially when a physician is considering amputation of the affected extremity. In diabetic CN, the presence of osteomyelitis is likely. Thus, to identify the infected tissue that needs to be removed, the specific area of infection must be correctly identified. Both CN and osteomyelitis have high mortality rates, but osteomyelitis is more life threatening and needs aggressive treatment. We propose a QD-based method for distinguishing CN with sterile inflammation from osteomyelitis that does not require multiple and frequent imaging modalities. The method utilizes two different colored QDs (i.e., red and green). The red QD is attached to a UBI, an antimicrobial peptide, which attaches to bacteria, enabling their detection. The green QD is attached to MDP, which accumulates in areas of inflammation. When these QDs are injected intravenously at the same time, the red QD-UBI accumulates in infected areas and attaches to bacteria, and the green QD-MDP accumulates both in areas with sterile inflammation and infected areas. The accumulation of only green QDs in the suspect extremity signifies a sterile inflammation process (CN). However, the accumulation of both the red and green QDs signify infectious and inflammation processes (i.e., osteomyelitis or a soft tissue infection, depending on the location). In the latter case, the treatment needs to be more intensive, with even amputation considered.

The diagnostic value of ultrasound compared with nerve conduction velocity in carpal tunnel syndrome.

OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common form of peripheral entrapment neuropathy. The use of sonography for investigation and diagnosis of musculoskeletal conditions has been rapidly increasing over the past few decades. The purpose of this study was to determine whether sonography can be an alternative method to nerve conduction study (NCS) in the diagnosis of CTS. METHODS: Individuals with electrodiagnostically proven CTS and healthy control subjects were enrolled prospectively. Median nerve cross-sectional area (CSA) and flattening ratio (FR) at three different levels, proximal to tunnel inlet, at tunnel inlet and tunnel outlet, and flexor retinaculum thickness, were measured. Then, comparisons between ultrasonography and NCS were made. RESULTS: We assessed 180 wrists, of which 120 were electrophysiologically confirmed as CTS diseased hands and 60 nondiseased hands in 90 patients (83 women and seven men). The mean median nerve CSA at the tunnel inlet was 13.31 ± 3.23 mm(2) in CTS diseased hands and 8.57 ± 0.82 mm(2) in nondiseased hands. Post hoc comparisons between the diseased and nondiseased hands demonstrated that the CSA at various levels of the median nerve were significantly greater in the CTS diseased hands than the nondiseased hands (P = 0.001). CSA at the tunnel inlet with a threshold of 9.15 mm(2) gave the best diagnostic accuracy with a sensitivity and specificity of 99.2% and 88.3%, respectively. The difference in cross-sectional area of the median nerve in mild, moderate and severe CTS was statistically significant. CONCLUSION: Ultrasonographic measurement of the CSA of the median nerve at the carpal tunnel inlet is useful in diagnosing and grading CTS.

Comparison of thyroid blood flow and uptake indices using technetium-99m pertechnetate in patients with graves' disease and euthyroid subjects.

OBJECTIVE: The aim of the present study was to evaluate parameters of early blood flow (EBF) including duration of EBF, perfusion index (PI), uptake indexes 1 and 2 (UI1 and UI2) derived from dynamic thyroid scintigraphy in patients with Graves' disease (GD), and euthyroid (EI). Maximum instant uptake and maximum uptake of the thyroid gland were also assessed. METHODS: A total of 50 patients with GD and EI were included in this study. Each patient underwent two dynamic scans of 1-minute (20 images at 3 seconds) and 20-minute (20 images at 1 minute) with 99mTcO4. The time-activity curve of a 1-minute scan was employed to derive EBF parameters; likewise, the time-activity curve of a 20-minute scan was used to determine maximum instant uptake, and the gradient of the curve from the 10th to 20th minute was used to assess maximum uptake. RESULTS: Values of EBF duration, PI, UI1, UI2, and maximum instant uptake were significantly lower in patients with GD than in those with EI (p<0.05). The calculated gradient of the second half of the curves for all of the patients ranged from 0 to 0.88 and was significantly higher in patients with GD than in those with EI. CONCLUSION: Lower values of PI, UI1, UI2 and durations of EBF, along with faster maximum instant uptake in patients with GD in comparison to EI are indicators of a heightened desire for hyper-functioning thyroid glands of patients with GD to absorb 99mTcO4. Additionally, because of the uprising gradient at the end of the 20-minute time-activity curve, a maximum thyroid uptake of 99mTcO4 was achieved at more than 20 minutes after the radiopharmaceutical injection.

Technetium-99m methoxyisobutylisonitrile scintigraphy in the assessment of cold thyroid nodules: is it time to change the approach to the management of cold thyroid nodules?

BACKGROUND: Scanning with technetium-99m methoxyisobutylisonitrile (Tc-MIBI) is recommended for evaluating thyroid nodule metabolism. In addition, it may help differentiate between benign and malignant nodules; however, the efficacy of this technique has not been fully elucidated. Therefore, it is not currently performed for routine clinical application. This prospective study was conducted to investigate the clinical significance of Tc-MIBI scintigraphy in the assessment of patients with cold thyroid nodules. PATIENTS AND METHODS: This prospective study was conducted on 104 patients with cold thyroid nodules greater than 1 cm in diameter as detected on Tc-pertechnetate scintigraphy. Uptake of MIBI in thyroid nodules was compared with that in the surrounding normal thyroid tissue for both early and delayed images, and a score of 0-3 was assigned to each nodule as follows: 0, cold; 1, decreased; 2, equal; 3, increased. The thyroid scan was performed 20 and 40 min after intravenous injection of 555 MBq of Tc-MIBI. The patients underwent fine-needle aspiration cytology (FNAC). Detailed statistical parameters were determined on a per-nodule basis for each qualitative and quantitative scan analysis, as defined by histology. RESULTS: A total of 104 patients (93 women and 11 men; mean age 40.76±11.40 years, range 20-73) with a total number of 167 cold nodules were included in this study. When Tc-MIBI uptake was regarded as the criterion of malignancy in Tc-MIBI scintigraphy, the accuracy was between 69.46 and 92.21% on using seven different methods. In addition, FNAC findings indicated a sensitivity of 66.66%, a specificity of 100%, a negative predictive value of 95.72%, a positive predictive value of 100%, and an accuracy of 96.06%. Six malignant cold nodules were detected on a positive Tc-MIBI scan, which were determined as benign nodules on FNAC examinations. CONCLUSION: The study demonstrated that Tc-MIBI scanning can be complementary to other diagnostic techniques in patients with cold thyroid nodules. In addition, because of its availability, rather low cost, simple protocol, and objective semiquantitative information, Tc-MIBI scanning seems to hold promise in routine imaging of cold thyroid nodules.