NEW PROPOSED FORMULA OF TI-RADS CLASSIFICATION BASED ON ULTRASOUND FINDINGS.

INTRODUCTION: The present study aimed to introduce a new formula for classification of nodules in TI-RADS and describe ultrasonography features of benign and malignant thyroid nodules. METHODS: This study was conducted on thyroid mass in 1033 patients. The incidence of malignancy for thyroid nodules was determined by selecting malignancy coefficients. Then the patients were first classified using conventional TI-RADS classification criteria and once again according to a new proposed formula. RESULTS: Among ultrasonography features of thyroid nodules, the irregular shape (46.7%), unclear margin (47.3%), extension to the capsule (irregular and infiltrative margin) (85%), the marked hypo-echoic nodules (63.8%), micro-calcification (49%), and to have vertical axis (74.0%) were associated with high incidence of malignancy. CONCLUSION: According to the proposed new formula for TI-RADS, there are four coefficients of 7, 3, 1 and 0 for incidence of malignancy of each one of ultrasound findings that help to standardization and unifying of TI-RADS classification. The incidence of malignancy in TI-RADS classification according to the new proposed formula was achieved as follows: group 2: 0.0%, group 3: 0.7%, groups 4a, 4b, 4c: 16.7%, 43.4%, 68.5%, and group 5: 95.2%, respectively.

INCREASED SERUM LEVEL OF FGF21 IN GESTATIONAL DIABETES MELLITUS.

OBJECTIVE: Gestational diabetes mellitus (GDM) is a common endocrine complication in pregnancy. There are few risk factors that clearly correlate with GDM. Fibroblast growth factor 21 (FGF21) is a metabolic hormone that can regulate glucose metabolism. It has been recognized that serum levels of FGF21 are significantly increased in diabetes and insulin resistance states. The objective of this study was to determine the serum FGF21 levels in women with GDM compared with non-GDM women and its correlation with insulin resistance. METHODS: Thirty GDM patients and 60 healthy pregnant controls that matched for maternal and gestational age were selected. Women with previous history of GDM, hypertension, polycystic ovary syndrome, renal or liver failure and drug consumption with effects on glucose or insulin levels were excluded. FGF21 was determined and correlated with biochemical parameters of glucose metabolism and insulin resistance. RESULTS: FGF21 concentration was significantly higher in GDM (264.5±196.2 ng/L) as compared with control groups (59.1±36.5ng/L). Correlation of FGF21 with insulin resistance was not significant. A cut-off 82.07 ng/L of FGF21 had sensitivity of 100% and specificity of 85% for prediction of GDM. CONCLUSION: FGF21 is increased in GDM and it is independent of insulin resistance. We suggest that FGF21 resistance could be directly involved in pathophysiology of GDM.

SERUM LEVELS OF FIBROBLAST GROWTH FACTOR 21 IN TYPE 2 DIABETIC PATIENTS.

BACKGROUND AND PURPOSE: Fibroblast growth factor 21 (FGF21) has recently been identified as a metabolic regulator, but its physiological role is still not completely known. The aim of this study was to evaluate serum FGF21 levels in an Iranian population with type 2 diabetes. MATERIALS AND METHODS: This cross-sectional study was conducted in patients with type 2 diabetes. All patients were evaluated for fasting serum levels of glucose, glycated hemoglobin (HbA1c), lipids, urea and creatinine. Participants were divided into two groups with poorly-controlled and well-controlled diabetes based on their HbA1c levels. Healthy non-diabetic subjects (matched with patients in terms of age, sex and body mass index [BMI]) were also recruited as control group. Serum FGF21 concentrations were determined in all subjects using ELISA. RESULTS: Of the evaluated 141 subjects, 49 (34.8%) were categorized as having well-controlled diabetes, 66 (46.8%) had poorly-controlled diabetes, and there were 26 subjects in the normal control group. Mean serum FGF-21 concentration was 337.89±283.67 ng/L in the diabetic group and 237.25±43.22 ng/mL in the non-diabetic group (p<0.001). Mean serum FGF21 level was 237.25 ± 43.22 ng/mL in the control group, 309.81 ± 301.68 ng/mL in the well-controlled diabetic group, and 358.73 ± 269.98 ng/mL in the poorly controlled diabetic group. Serum FGF21 level in the poorly controlled diabetic group was significantly higher than that in the well-controlled diabetic and the healthy control groups (p=0.02) but there was no significant difference between the well-controlled and healthy groups. There was no significant association between serum FGF21 levels with lipid levels, presence of diabetic complications and BMI (p > 0.05). CONCLUSIONS: The present results suggested an association between elevated serum levels of FGF21 and poor control of diabetes. Future studies are warranted to elucidate the prognostic role of these elevated levels of FGF21 in diabetic subjects.

Vitamin D receptor gene polymorphisms in type 1 diabetes mellitus: a new pattern from Khorasan Province, Islamic Republic of Iran.

Reported associations between vitamin D receptor (VDR) polymorphism and type 1 diabetes mellitus vary across ethnic groups. We studied the association between type 1 diabetes and 4 VDR gene polymorphisms (Bb, Ff Aa and Tt) in an Iranian population. A group of 69 patients with type 1 diabetes mellitus and 45 unrelated healthy subjects were recruited. The prevalence of VDR polymorphisms in 4 restriction fragment length polymorphism sites including Bsml, Fokl, Apal and Taql were analysed in patients and controls. The frequencies of 3 genotypes (Aa, FF and Bb) were significantly higher in the patient group. The relationship between VDR gene polymorphisms and onset pattern of diabetes was not significant. There were no significant difference between the genotype frequencies and chronic complications of diabetes, but the relationship between the Ffgenotype and ketoacidosis was significant. Our results differ from previous polymorphism studies in other regions.

Vitamin D receptor gene polymorphisms in type 1 diabetes mellitus: a new pattern from Khorasan province, Islamic Republic of Iran

Reported associations between vitamin D receptor [VDR] polymorphism and type 1 diabetes mellitus vary across ethnic groups. We studied the association between type 1 diabetes and 4 VDR gene polymorphisms [Bb, Ff, Aa and Tt] in an Iranian population. A group of 69 patients with type 1 diabetes mellitus and 45 unrelated healthy subjects were recruited. The prevalence of VDR polymorphisms in 4 restriction fragment length polymorphism sites including BsmI, FokI, ApaI and TaqI were analysed in patients and controls. The frequencies of 3 genotypes [Aa, FF and Bb] were significantly higher in the patient group. The relationship between VDR gene polymorphisms and onset pattern of diabetes was not significant. There were no significant difference between the genotype frequencies and chronic complications of diabetes, but the relationship between the Ff genotype and ketoacidosis was significant. Our results differ from previous polymorphism studies in other regions

Protective effect of low serum thyroid hormone concentration on occurrence of functional delayed kidney allograft function early after transplantation.

BACKGROUND: Thyroid hormones affect the functioning of a number of organs and may alter kidney function. In contrast, the thyroid gland may be influenced by renal dysfunction. The present study evaluated triiodothyronine (T3), thyroxine, and thyroid-stimulating hormone concentrations before and early after transplantation relative to the occurrence of delayed graft function. PATIENTS AND METHODS: Eighty-seven consecutive patients (52 male and 37 female patients) undergoing kidney transplantation were entered in this cross-sectional study, and T3, thyroxine, and thyroid-stimulating hormone concentrations were measured on the day before transplantation and on days 1, 3, and 7 after engraftment. RESULTS: The mean (SD) serum T3 concentration was significantly greater before transplantation in patients with delayed graft function compared with those with normally functioning kidney allografts (129±31.44 ng/dL versus 102±36.77 ng/dL; P-value=.048). Lower T3 concentration values were predictive of delayed graft function. It was hypothesized that early after transplantation, in patients with uremia, a low T3 concentration confers a protective effect against ischemia-reperfusion injury, mitigating a hypercatabolic state. CONCLUSION: Low serum T3 concentration in patients with uremia before transplantation may have protective effects against the hypercatabolic uremic state and ischemia-reperfusion injury early after engraftment.

Cardiovascular disease and risk factors in patients with type 2 diabetes mellitus in Mashhad, Islamic Republic of Iran.

The aim of this study in 2006-08 was to determine the prevalence and risk factors of CVD in an Iranian population of patients with type 2 diabetes mellitus. History and physical examinations were recorded and laboratory tests were performed in 752 patients attending the Mashhad Endocrine and Metabolism Research Center. The prevalence of CVD was 20.1%. CVD was significantly associated with age, duration of diabetes, hypertension, diabetic retinopathy, metabolic syndrome, renal insufficiency, triglycerides, high-density lipoprotein (HDL) cholesterol, uric acid and triglycerides/HDL ratio. Using a logistic regression model, age, metabolic syndrome and HDL cholesterol were significant independent predictors of CVD. The high prevalence of CVD in Iranian patients with type 2 diabetes underscores the importance of better detection and treatment of metabolic risk factors of CVD in these patients.

The effects of fasting during Ramadan on glycemic excursions detected by continuous glucose monitoring system (CGMS) in patients with type 2 diabetes.

OBJECTIVE: Safety of fasting in Ramadan for diabetic patients is not clearly known. The aim of this study was to determine the effects of fasting on glycemic excursions by continuous glucose monitoring system (CGMS). MATERIALS AND METHODS: This pilot, observational study conducted in the Endocrine Research Center, Mashhad University of Medical Sciences, Mashhad, IRAN, in Ramadan 2008. Seventeen well controlled patients with diabetes type 2 who were taking oral agents underwent 72 hour monitoring of glycemic excursions by CGMS one month before Ramadan and during Ramadan. The extent and duration of hyperglycemic and hypoglycemic events were evaluated and compared. RESULTS: A significant reduction in hyperglycemic events was observed during Ramadan. The extent and duration of hypoglycemic events was not significantly different between two states (Ramadan and before). A significant increase in number of hypoglycemic events in Ramadan was found in patients who take sulfonylurea compared with those who take only metformin. CONCLUSION: Fasting in Ramadan can be safe for well controlled patients with type 2 diabetes.

Cardiovascular disease and risk factors in patients with type 2 diabetes mellitus in Mashhad, Islamic Republic of Iran

The aim of this study in 2006-08 was to determine the prevalence and risk factors of CVD in an Iranian population of patients with type 2 diabetes mellitus. History and physical examinations were recorded and laboratory tests were performed in 752 patients attending the Mashhad Endocrine and Metabolism Research Center. The prevalence of CVD was 20.1%. CVD was significantly associated with age, duration of diabetes, hypertension, diabetic retinopathy, metabolic syndrome, renal insufficiency, triglycerides, high-density lipoprotein [HDL] cholesterol, uric acid and triglycerides/HDL ratio. Using a logistic regression model, age, metabolic syndrome and HDL cholesterol were significant independent predictors of CVD. The high prevalence of CVD in Iranian patients with type 2 diabetes underscores the importance of better detection and treatment of metabolic risk factors of CVD in these patients