Graves' disease with pancytopenia: A rare case report.

Key Clinical Message: In this case report we describe a patient with Grave's disease (GD) who was first diagnosed with pancytopenia and did not have any typical symptoms of GD. His hematologic abnormalities were alleviated after treatment with an anti-thyroid drug. Hence, in patients with pancytopenia, GD should also be considered. Abstract: A variety of hematologic abnormalities can be seen in Graves' disease (GD), however; here, we describe a patient with GD and a very rare complication; pancytopenia. His hematologic abnormalities and clinical status were alleviated after treatment with an anti-thyroid drug. Hence, in patients with pancytopenia and normal bone marrow examination, GD should also be considered.

Pheochromocytoma triggered by coronavirus disease 2019: a case report.

BACKGROUND: Coronavirus disease 2019 is an infectious disease with many presentations, and many of its effects on the human body are still unknown. Pheochromocytoma is a neuroendocrine tumor that may occur sporadically or be a manifestation of a hereditary disease line multiple endocrine neoplasia type 2. CASE PRESENTATION: In this study, we report a case of an Iranian patient infected with coronavirus disease 2019, causing unusual presentations of pheochromocytoma, including myocarditis and cerebrovascular involvement. CONCLUSIONS: We discovered a case of pheochromocytoma as an unusual presentation of COVID-19. In further investigations we also discovered thyroid medullary carcinoma and at the end MEN 2 syndrome was diagnosed. After proper treatment many symptoms were eliminated.

High levels of FBS and HbA1c and their association with diabetic retinopathy: a study in the north of Iran.

Background: Diabetic retinopathy, which is a common complication of diabetes, is one of the most common reasons of blindness in adults. There are several potential risk factors for diabetic retinopathy such as hypertension (HTN), hyperlipidemia (HLP), high fasting blood sugar (FBS), and high Hemoglobin A1c (HbA1c). Yet, ethnicity is another factor which may contribute to diabetic retinopathy regardless of the potential risk factors mentioned. The aim of this study, therefore, is to find the risk factors associated with diabetic retinopathy in the north of Iran. Methods: This was a retrospective cohort study including a total of 1,125 patients divided into three groups as follows: (i) patients with no diabetic retinopathy (NDR group; n = 398); (ii) patients with non-proliferative diabetic retinopathy (non-PDR group; n = 408); (iii) patients with proliferative diabetic retinopathy (PDR group; n = 319). The laboratory data were collected from patients for analysis. Results: Diabetic patients with retinopathy had significantly higher levels of FBS compared with those without retinopathy (p = 0.001). Patients with PDR or non-PDR had higher levels of HbA1c compared with patients without retinopathy (p = 0.001). In contrast, no association was observed between HTN or HLP and diabetic retinopathy. On the other hand, duration of diabetes was another important factor affecting diabetic retinopathy. Conclusions: Higher levels of FBS and HbA1c were observed in patients with diabetic retinopathy. Monitoring and controlling of FBS and HbA1c of diabetic patients could prevent the occurrence of diabetic retinopathy.

A path causal model in the association between self-efficacy and self-care with quality of life in patients with type 2 diabetes: An application of the structural equation model.

Background and Aims: The simultaneous role of self-care and self-efficacy in improving the quality of life (QoL) of diabetic patients has been less considered in previous studies. This study was aimed to investigate the path association between self-care and self-efficacy with QoL using the structural equation model (SEM). Methods: This cross-sectional study was conducted with 496 individuals of type 2 diabetic patients aged 35-75 years that were selected consequently from outpatients' clinic, in Babol, the north of Iran. The data collection instruments were demographic, self-care, self-efficacy, and QoL scales. The conceptual hypothesized model was designed based on previous evidence and tested by confirmatory factor analysis using SEM and path coefficients were estimated by the maximum likelihood method. Results: Self-care had a significant relationship with employment status, level of education, and body mass index. QoL was significantly associated with economic status and place of residence. Self-efficacy beliefs had a positive and a direct effect on both self-care and QoL. But self-care and self-efficacy tended to have a nonsignificant positive relationship with QoL. The postulated conceptual path model was acceptable through the SEM goodness of fit criteria. Conclusion: The findings show the fitness of the framework hypothesized structural model in the QoL of diabetic patients and this SEM makes this study unique from others. The results showed that the role of self-efficacy and self-care could be considered on the QoL. Therefore, nonpharmacological and supportive methods, such as strengthening self-efficacy and self-care, could be recommended as an effective method to enhance the QoL of diabetic patients.

Decreased serum testosterone level was not significantly correlated with lipid indices in elderly men.

BACKGROUND: Aging in men causes a gradual decline in endogenous testosterone levels, which may have detrimental effects on their health status. Testosterone deficiency is thought to promote atherosclerosis by modulating lipid metabolism. Therefore, this study was conducted to evaluate the serum testosterone level and its correlation with lipid profile in men aged ≥60 years old. METHODS: All elderly men aged ≥60, residing in Amirkola and participating in a phase of the comprehensive project on "investigating the health status of the elderly in Amirkola" were entered into this descriptive cross-sectional study. After fasting over 12 hours, the venous blood samples were taken. Serum concentration of testosterone was determined using ELISA method. Moreover, HDL-LDL, total cholesterol, triglyceride and fasting blood glucose were measured. RESULTS: The prevalence of hypogonadism was 91.28% among the 792 participants of this study with a cut-off point of 9.72 nmol/L (95% confidence interval, 93.25-89.31) and the prevalence of severe hypogonadism with a cut-off point of 5.2 nmol/L was reported 71.59% (95% confidence interval, 74.73-68.44%). Based on the results, there was no significant statistical correlation between the serum level of testosterone and triglyceride (r=0.03, P=0.34). Furthermore, there was a negative correlation between testosterone and HDL, which was not statistically significant(r=-0.05, P=0.13). No significant statistical correlation was found between testosterone and LDL (P=0.98). There was a negative correlation between testosterone and cholesterol, which was not statistically significant (r=-0.02, P=0.49). CONCLUSION: According to the study results, 91% of men aged ≥60 years old had hypogonadism, no correlation was found between testosterone and lipid indices.

Prevalence of diabetes-associated autoantibodies among patients presenting with type 2 diabetes and related metabolic differences.

BACKGROUND: To explores the prevalence of autoantibodies (zinc transporter 8 autoantibodies (ZnT8A), antibodies to insulin (IAAs), glutamic acid decarboxylase autoantibody (GAD65)), the relation of the type of positive autoantibody and the number of positive autoantibodies with the glycemic and lipid profile of the patients with LADA (Latent Autoimmune Diabetes in Adults) and compares it to the metabolic profile of patients presenting with type 2 diabetes (T2DM). METHODS: 263 patients with T2DM were recruited for this cross-sectional study in Tehran, Iran. Data from patients included complete medical history, GAD65, ZnT8A, IAA and routine metabolic laboratory workup. Assay for autoantibodies were conducted using ELISA kits. The association between autoantibodies and glycemic and lipid profile of patients with diabetes was assessed using univariate and multivariate regression analysis. RESULTS: Our study revealed that among 263 patients with T2DM, 29 (11%) cases were positive for IAAs, 9 (3.4%) for ZnT8A, and 12 (4.6%) for GAD65. Six (2.3%) of the patients had triple positive antibodies. Patients with positive results were younger, had lower body mass index (BMI), c-peptide, triglyceride, low-density lipoprotein (LDL), and higher high-density lipoprotein (HDL), HbA1c and fasting blood glucose (FBG) levels. Triple antibody positivity was significantly associated with lower levels of C-Peptide, Triglycerides, FBG, and HbA1c compared to triple negative antibodies. CONCLUSION: Patients with LADA positive for either of the autoantibodies (GAD65, ZnT8 and IAA) presented with worse glycemic control. Measurement of these autoantibodies can assist in discrimination of these patients and help with earlier control of glycemic profile.

The efficacy of a Persian herbal formulation on functional bloating: A double-blind randomized controlled trial.

BACKGROUND: Bloating is a common gastrointestinal complaint which is difficult to treat. OBJECTIVE: This study investigated the efficacy and compliance of a formulation called KAASER comprised of Trachyspermum ammi (L.) Sprague seed, Zingiber officinale Roscoe. rhizome and Piper nigrum L. berry in the treatment of functional bloating. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: A total of 106 patients with functional bloating, between 20 and 50 years of age, participated in this double-blind randomized controlled trial. Patients were divided into 3 parallel groups that received 500 mg of placebo, dimethicone or KAASER, three times a day for 2 weeks. MAIN OUTCOME MEASURES: The frequency and severity of bloating were primary outcomes, while the frequencies of eructation, defecation, borborygmus and early satiation were secondary outcomes. All parameters were evaluated at the beginning (week 0), and also weeks 2, 4 and 10 of the study, through self-report checklists with a scoring system. RESULTS: Among the 84 patients who completed the study, the frequency and severity of bloating (P < 0.001), the frequencies of eructation, defecation and borborygmus (P = 0.03) were significantly improved in the group receiving KAASER (36 patients) compared with the dimethicone (35 patients) and placebo (35 patients) groups, during the 3 phases of follow-up. These significant differences persisted through the 2 and 8 weeks of follow-ups after cessation of medication (week 4 and 10). In early satiation, no significant differences were observed among the 3 groups. CONCLUSION: The results showed that KAASER can be effectively used to treat patients suffering from bloating. Bloating, eructation, defecation and borborygmus in the KAASER group remained significantly improved after 2 and 8 weeks of cessation of medication, making this mechanism an interesting area for further investigation. TRIAL REGISTRATION: Registration trial IRCT2015100324327N on Iranian Registry of Clinical Trials.

Pulse pressure and diabetes treatments: Blood pressure and pulse pressure difference among glucose lowering modality groups in type 2 diabetes.

Type 2 diabetes is associated with higher pulse pressure. In this study, we assessed and compared effects of classic diabetes treatments on pulse pressure (PP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in patients with type 2 diabetes.In a retrospective cohort study, 718 non-hypertensive patients with type 2 diabetes were selected and divided into 4 groups including metformin, insulin, glibenclamide+metformin, and metformin+insulin. They were followed for 4 consecutive visits lasting about 45.5 months. Effects of drug regimens on pulse and blood pressure over time were assessed separately and compared in regression models with generalized estimating equation method and were adjusted for age, duration of diabetes, sex, smoking, and body mass index (BMI).Studied groups had no significant change in PP, SBP, and DBP over time. No significant difference in PP and DBP among studied groups was observed (PP:P = 0.090; DBP:P = 0.063). Pairwise comparisons of PP, SBP, and DBP showed no statistically significant contrast between any 2 studied groups. Interactions of time and treatment were not different among groups.Our results demonstrate patients using metformin got higher PP and SBP over time. Averagely, pulse and blood pressure among groups were not different. Trends of variation in pulse and blood pressure were not different among studied diabetes treatments.

Relationship between Helicobacter pylori infection (HP) and bone mineral density (BMD) in elderly people.

BACKGROUND: Low bone mass is a frequent complication of chronic inflammatory disease. The pathogenesis of osteoporosis in chronic inflammatory disease may be secondary to releases of cytokines such as TNF- and IL6. Chronic gastritis due to helicobacter pylori (HP) infection may lead to decreased bone mineral density (BMD) and predispose patients to osteoporosis. The objective of this study was to determine the BMD status in HP positive patients with gastritis versus HP negative cases. METHODS: In this cross-sectional study, we enrolled 967 participants aged 60 years old and more from Amirkola Health Study Ageing Project. Seven-hundred and fifty eight HP positive and 209 HP negative patients were analyzed. BMD was measured by dual-energy x-ray absorptiometry (DXA) method in the spine and femoral neck in all participants. RESULTS: The mean age in HP+ and HP- negative patients was 68.3±6.8 and 69.3±7.4 years, respectively. BMD g/cm2 in the spine and femoral neck did not differ between the two groups (P=0.19 and 0.22 respectively). The prevalence of osteoporosis did not also differ across the two groups as well. There was no relationship between the level of antibodies against HP and BMD. CONCLUSION: According to the findings of this study, H. pylori infection is not associated with BMD changes in the elderly population.