Design and implementation of a national quality registry of thyroid cancer in Iran: study protocol.

Purpose: Thyroid cancer is recognized as the predominant form of endocrine cancer. The likelihood of cancer recurrence and the development of distant metastases varies depending on the cancer's pathology and stage. Iran currently lacks country-specific data on thyroid cancer, which can potentially result in clinicians deviating from the optimal treatment. The primary objectives of establishing such a registry are to determine the incidence, identify risk factors, and evaluate treatment outcomes for thyroid cancer within the Iranian population. Ultimately, the overarching goal of this protocol study is to reduce mortality and morbidity rates among thyroid cancer patients by implementing appropriate interventions based on the findings derived from this registration system. Methods: The study will enroll all individuals aged 18 years and older who have received a diagnosis of primary thyroid carcinoma based on pathology criteria. Data will be collected from various thyroid clinic centers. The participating centers include the Endocrinology Clinic at Shariati Hospital, the Thyroid Clinic in the Nuclear Medicine Center at Shariati Hospital, as well as pathology and nuclear medicine centers in Kerman and Bushehr. Patient records comprise information on outpatient visits to the clinic. Conclusion: The registry aims to enhance treatment approaches and follow-up protocols while serving as a foundation for conducting clinical, epidemiological, and basic science studies based on robust evidence-based data.

General and abdominal obesity trends in the Iranian adult population from 2004 to 2021.

Purpose: The prevalence of overweight/obesity and abdominal obesity is increasing worldwide, accompanied by an increase in the incidence of non-communicable diseases. This study aims to determine the trends of Body Mass Index (BMI) and prevalence of overweight/obesity and abdominal obesity changes in Iranian adult population from 2004 to 2021. Methods: We conducted this study based on the eight national surveys of noncommunicable disease risk factor surveillance (STEPS) from 2004 to 2021 in Iran. We estimated the crude and standardized mean of BMI and prevalence of general and abdominal obesity in these eight STEPS surveys data. Data weighted using post-stratification method and the trends depicted based on the standardized estimates. Results: Between 2004 and 2021, and based on the standardized estimates, the mean of BMI increased from 25.19 kg/m2 in 2004 to 26.63 kg/m2 in 2021 (P-value for trend = 0.03). The standardized mean of WC increased from 86.38 cm in 2004 to 91.65 cm in 2021 (P-value for trend = 0.38). The standardized prevalence of obesity (class I and II) increased from 14.54% in 2004 to 20.17% in 2021 (P-value for trend = 0.01). The standardized prevalence of obesity class III increased from 0.82% in 2004 to 1.35% in 2021 (P-value for trend = 0.03). The standardized prevalence of abdominal obesity based on the national and international cut-points increased, but the trend was not statistically significant [(National cut-point: 27.53% in 2004 to 40.43% in 2021 (P-value for trend = 0.71)) (International cut-point: 27.58% in 2004 to 41.81% in 2021 (P-value for trend = 0.06))]. Conclusion: The standardized mean of BMI and prevalence of overweight/obesity and abdominal obesity increased among Iranian adults between 2004 and 2021. Because of the negative public and clinical health implications of obesity, health policymakers should develop comprehensive programs to control this increasing trend of weight gain.

Diabetes Management during the COVID-19 Pandemic: An Iranian Expert Opinion Statement.

The coronavirus infection is an evolving pandemic with high morbidity and mortality, especially in people with comorbidities. The case fatality rate (CFR) is 9.2% in the presence of diabetes, while it is 1.4% in those without any comorbidity. Diabetes is a prevalent disease globally; hence, healthcare professionals are highly concerned about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic progression. Current evidence does not support higher incidence of coronavirus disease 2019 (COVID-19) in people with diabetes (PWD). However, people with diabetes are considered high risk for developing complications. Optimal metabolic control is a challenging concept, especially in the presence of an acute and severe respiratory viral infection. In this consensus, we considered the challenging issues in management of patients with diabetes during the COVID-19 pandemic. The consensus covers various aspects of outpatient as well as inpatient care based on the current evidence.

Is there any link between tumor-induced osteomalacia and psoriasis? A case report.

BACKGROUND: Tumor-induced osteomalacia is an uncommon paraneoplastic syndrome caused by Fibroblast growth factor-23-secreting tumors. It is characterized by phosphaturia, hypophosphatemia, and a high plasma level of alkaline phosphatase. CASE PRESENTATION: We report a young patient with psoriasis who had suffered from bone pain and muscle weakness for more than 6.5 years. He was finally diagnosed with tumor-induced osteomalacia. However, mistakenly attributing the patient's signs and symptoms to psoriatic arthritis for a long time had resulted in multiple complications for the patient. Finally, the tumor was localized and surgically resected. This resulted in clinical improvements and the resolution of all biochemical abnormalities. CONCLUSION: To our knowledge, this is the second case of tumor-induced osteomalacia accompanied by psoriasis. There is growing evidence to suggest that Fibroblast growth factor-23 has a role in regulating immune function while an increased level of it may play a role in the pathogenesis of psoriasis. As a result, tumor-induced osteomalacia may affect the psoriasis clinical course by secreting a high amount of Fibroblast growth factor-23. On the other hand, several studies have showed an increased risk of malignancy among patients with psoriasis. Consequently, long-term psoriasis may predispose patients to Fibroblast growth factor-23-secreting tumors. Finally, as psoriasis is a common disease, this presentation may simply be a coincidence.

Liquid base cytology in evaluation of thyroid nodules.

BACKGROUND: Palpable thyroid nodules are present in 4-7% of general population and Fine Needle Aspiration (FNA) is now accepted by endocrinologists and thyroid surgeons as a safe, simple and cost effective procedure for evaluating a thyroid nodule. The obtained sample can be spread directly on slides, processed as cell block preparations or prepared as liquid base smears. Liquid base method has been recently accepted due to its shorter preparation time and better preservation of nuclear details. The aim of this study is to compare the diagnostic results of two commonly used methods: Liquid Base Preparation and Cell Block Preparation in evaluation of thyroid nodules. METHODS: The samples were taken from 100 patients with a solitary nodule or a prominent nodule on a multinodular goiter background (excluding hot nodules). The obtained samples were used to prepare conventional smears (CS), Cell Block Preparations (CBP) and Liquid Base Preparations (LBP). The slides were studied by two pathologists, considering the following parameters: Cellularity, Colloid, Lymphocytes/Plasma cells and Macrophages. RESULTS: 87% of cases revealed informative results in LBP method while in the same group of patients only 69% of samples were informative after processing by CBP method. Sensitivity and specificity of both methods compared with the conventional smears and with each other and it is concluded that LBP is a reliable method for evaluating of a thyroid nodule. Other studies also show the same results. CONCLUSION: The liquid base method should be trusted due to its easier procedure, cleaner slide background, its higher specificity and higher diagnostic yields. It can be used instead of CBP and in association with CS to increase the accuracy of evaluation of thyroid nodules.

Establishing a cGMP pancreatic islet processing facility: the first experience in Iran.

It has been predicted that one of the greatest increase in prevalence of diabetes will happen in the Middle East bear in the next decades. The aim of standard therapeutic strategies for diabetes is better control of complications. In contrast, some new strategies like cell and gene therapy have aimed to cure the disease. In recent years, significant progress has occurred in beta-cell replacement therapies with a progressive improvement of short-term and long term outcomes. In year 2005, considering the impact of the disease in Iran and the promising results of the Edmonton protocol, the funding for establishing a current Good Manufacturing Practice (cGMP) islet processing facility by Endocrinology and Metabolism Research Center was approved by Tehran University of Medical Sciences. Several islet isolations were performed following establishment of cGMP facility and recruitment of all required equipments for process validation and experimental purpose. Finally the first successful clinical islet isolation and transplantation was performed in September 2010. In spite of a high cost of the procedure it is considered beneficial and may prevent long term complications and the costs associated with secondary cares. In this article we will briefly describe our experience in setting up a cGMP islet processing facility which can provide valuable information for regional countries interested to establish similar facilities.

Comparison of MRI findings with traditional criteria in diagnosis of Pendred syndrome.

Pendred syndrome, defined as the constellation of goiter, sensori-neural hearing loss, and positive perchlorate discharge test, is the most frequent cause of congenital deafness. Newly introduced diagnostic approaches to the disease are rather expensive and complicated, therefore we evaluated the value of MRI as the sole, or adjunctive diagnostic approach, and compared it with the traditional ones. Presuming the classic triad as the gold standard, we compared MRI findings in six such defined patients with six cases having goiter, hearing loss, and normal perchlorate discharge test. Our results indicated that MRI was 83.6% sensitive and 66.7% specific in patients fulfilling all three criteria (complete), while in the 'partial' group the sensitivity and specificity were 66.7% and 100% respectively. In conclusion, MRI, although impressive as an adjunctive diagnostic tool, may not replace the holistic approach, and the latter may be more convenient, cheaper, and still more accurate. However in 'partial' cases with equivocal findings, and in relatives of the patients, MRI may be a valuable diagnostic adjunct.