International Journal of Endocrinology and Metabolism
Volume:16 Issue: 2, Apr 2018

Context: Metabolic syndrome (MetS) is documented to increase the risk of mortality in the general population. However, there are reports of lower mortality in end stage renal disease (ESRD) patients with obesity. Since obesity is a major component of MetS, this meta-analysis was conducted to determine the risk of all-cause mortality, cardiovascular disease (CVD) mortality, and cardiovascular disease events (CVE) associated with MetS in ESRD subjects.
Evidence Acquisition: Eligible studies from inception to March 2017 assessing the clinical outcome of MetS in ESRD subjects were comprehensively searched in MEDLINE, EMBASE, and CENTRAL. ESRD participants treated with hemodialysis (HD) or peritoneal dialysis (PD) were included, but renal transplant subjects were excluded. Two authors independently assessed article quality and extracted the data. The primary outcome was all-cause mortality and, secondary outcomes were CVD death and CVE.
Fifty full-text articles were reviewed and eight studies were included in the meta-analysis, based on the random effects model. ESRD subjects with MetS, as compared with the non-MetS, had significant increased risk of all-cause mortality (pooled RR = 1.92; 95% confidence interval [CI] 1.15 - 3.21; P = 0.01) and CVE (pooled RR = 6.42; 95% CI 2.00 - 20.58). Age, type of dialysis, triglycerides, and HDL-C were significant predictors of risk of mortality, based on univariate meta-regression analyses.
Metabolic syndrome is associated with an increased risk of all-cause mortality in ESRD patients.

Context: Insulin can be prescribed as a monotherapy or a combined therapy with other anti-diabetic medications. In this narrative review, the authors aimed to gather data related to comparison of insulin monotherapy versus combination of insulin and other anti-diabetic treatments with regards to different outcome measures in type 2 diabetes.
Evidence Acquisition: This study searched and focused on the most recently published systematic reviews and their references investigating issues related to the primary aim.
The current data available on this topic is heterogeneous and suffers from low quality with respect to most combination treatments. Considering the efficacy and safety of combination therapy of insulin with older hypoglycemic agents, in general metformin and pioglitazone have the best and worst profiles, respectively. Compared to insulin monotherapy, combination of insulin and metformin is associated with better glycemic control, reduced daily insulin dose, less hypoglycemia, and weight gain; combination of insulin and pioglitazone results in greater hypoglycemia and weight gain and is associated with increased risk of edema and heart failure. Regarding sulphonylurea, there is some concern regarding hypoglycemia and weight gain. Addition of dipeptidyl peptidase-4 inhibitors to insulin seems to be beneficial with respect to glycemic control without any significant adverse effects. New drugs, including glucagon-like peptide-1 agonists and sodium glucose co-transporter 2 inhibitors, have acceptable profiles with significant benefits regarding weight reduction when added on insulin therapy.
Considering the quality and longevity of evidence, compared to insulin monotherapy, insulin combined with metformin and pioglitazone has the best and worst profiles, respectively. New anti-diabetic medications have acceptable profiles yet are expensive. It is important for clinicians to meticulously weigh the advantages of combination therapy against the possible adverse effects with each drug class in every patient, individually.

The health related quality-of-life (HRQoL) among females with polycystic ovary syndrome (PCOS) is reduced due to emotional, psychosocial, infertility, marital, and hirsutism problems.
The current study aimed at analyzing exploratory and confirmatory factor structures of HRQoL questionnaire for polycystic ovary syndrome (PCOSQ-50) in females with PCOS in order to verify the validity of the developed instrument.
The current cross validation study was conducted on females with PCOS using the PCOSQ-50. The PCOSQ-50 was developed based on a qualitative study. The exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) were conducted to examine the factor structure of PCOSQ-50. After the CFA, the reliability of the new instrument was also evaluated using Cronbach’s alpha coefficient.
Totally, 350 females with PCOS were entered into the study. The mean age of the subjects was 26.9 ± 5.1 years. Based on the results of CFA, data were fit to the 43-item model: the comparative fit index (CFI) = 0.91; the normal fit index (NFI) = 0.90; the goodness of fit index (GFI) = 0.60; incremental fit index (IFI) = 0.91; the root mean square error of approximation (RMSEA) = 0.09; standardized root mean square residual (SRMR) = 0.09 and the relative chi-square (x2/df) = 2.20, P The 43-item PCOSQ showed appropriate validity and reliability and its psychometric quality was superior to that of the original version. However, further longitudinal studies should be conducted to evaluate its predictive efficacy.

Functional limitation is one of the most important health - related concerns of diabetic patients. This study aimed to identify the factors associated with functional limitation among diabetic patients using generalized additive model (GAM) as a flexible technique to reveal the non - linear and non - monotonic association between the response and a set of independent variables.
The source data belonged to two cross - sectional studies conducted in 2014. A total of 694 people with type 2 diabetes in the age range of 31 - 70 years were selected via convenience sampling from diabetes clinics in Ardabil and Tabriz. The data were collected by interviewers using structured questionnaires and checklists. The functional capacity was measured using the physical functioning subscale of the Medical Outcomes Study Short Form 36 - Item Health Survey (SF36). Participants with a total functional capacity of less than 90 were considered to have “moderate or high level of functional limitation.” To identify the factors associated with functional limitation and reveal the shape of associations, the GAM procedure with “logit” link function was applied to the dataset of 378 diabetic patients without any missing data by smoothening of the effect of underlying factors. The Akaike information criterion (AIC) as the relative quality of the model’s criterion was computed for GAM and compared with AIC of the simple logistic regression.
Sex (P = 0.029), age (P In our sample, GAM could identify some linear and nonlinear associations between underlying factors and functional limitation in diabetic patients. These complex associations could relatively increase the fit quality of the GAM when compared to logistic regression.

Hypothyroidism (HT) and hypoparathyroidism (HPT) are common endocrine complications in thalassemia major (TM) patients.
In the present study, we assessed the frequency of HT and HPT in a population of TM patients in Southeast of Iran.
This cross sectional study was performed on 194 TM patients in Zabol, Sistan and Baluchestan Province, Iran, during February - July 2016. The demographic, clinical, and laboratory data were collected via interviews and history - taking. For hormone measurements, specific ELISA kits were used. Statistical analysis was performed in SPSS version 16.
A total of 103 (53.1%) and 91 (46.9%) females and males were recruited in this study, respectively. The mean age of the patients was 15 ± 7.5 years. HT and HPT showed overall frequencies of 8.2% (18/194) and 18% (35/194), respectively. Subclinical and overt HT were observed in 13 (6.7%) and 5 (2.6%) patients, respectively. There was no significant association between HT and age, while patients with HPT were significantly older than those without HPT (20.1 ± 5.8 vs. 13.9 ± 6.2 years; P In patients with TM, HT was a complication with a relatively low frequency, while HPT was more common. Based on the findings, HPT was more frequent in older patients receiving regular blood transfusions, thereby necessitating close monitoring of these patients.

The aim of this study was to explore the underlying latent factors that can explain the observed variation of components of metabolic syndrome (MetS) in Iranian non-diabetic adult population.
The researchers performed an exploratory factor analysis (EFA) of metabolic syndrome components, including body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic blood pressure (DBP), triglyceride (TG), high density lipoprotein (HDL), and Fasting blood sugar (FBS). These observed variables were measured from a representative sample of 841 non-diabetic participants in a cross-sectional population-based study of adults aged 20 to 70 years in the North of Iran.
Three factors were extracted by EFA in both genders. In males, the 3 generated factors were, 1) blood pressure factor underlying systolic and diastolic blood pressure, 2) obesity factor manifested by BMI and WC, 3) lipid/glucose factor underlying TG, HDL and FBS that explained 23.9%, 23.0% and 18.4% of variance in the observed data, respectively, in males. However, in females, BMI and WC were revealed as obesity factors, and systolic and diastolic blood pressure were characterized as hypertension factor, and TG, HDL and FBS appeared to be loaded on lipid/glucose factor, similar to males, and designated 25.6%, 25.4%, and 15.8% of the variance, respectively. Triglyceride and FBS were positively loaded, whereas HDL was loaded negatively with similar loading pattern in both genders. Overall, these 3 underlying latent factors explained 65.3% of the variance of observed clinical data sets in males and 66.8% in females. When TG and HDL were replaced by TG to HDL ratio and also SBP and DBP by mean arterial pressure (MAP), the two-factor model was generated in both genders.
The 2-and 3-factor models were characterized indicating a single pathogenesis that could not explain the unified clustering of MetS in non-diabetic adults.

Papillary thyroid cancer (PTC) is the most common endocrine malignancy. The aim of this study was to investigate the association of tissue inhibitor metalloproteinase-3 (TIMP3) mRNA and protein levels in thyroid tissues, based on BRAF V600E status with the clinicopathologic characteristics of PTC.
A total of 60 fresh frozen tissue samples of PTC patients (15 male and 45 female) were collected during thyroidectomy. All clinicopathological information was obtained and samples were reviewed as well as confirmed by a pathologist; exon 15 of the BRAF gene was genotyped by sequencing, TIMP3 mRNA level was assessed using SYBR-Green Real-Time PCR, and TIMP3 protein level was measured using ELISA.
Of 60 cases, BRAF mutation was found in 24 (40%). Larger tumor size and higher lymph node metastasis frequency were observed, significant in BRAF (), compared to the BRAF (-) PTC group (P = 0.039 and P = 0.03, respectively). No significant difference was seen in the tumoral tissues of the TIMP3 mRNA level in BRAF (), compared to BRAF (-) PTC samples. However, the mean TIMP3 protein level was significantly lower in tumoral tissues, compared to matched non-tumoral tissues in BRAF () PTC (P=0.003); TIMP3 protein level was significantly lower in tumoral tissues compared to matched non-tumoral tissues in BRAF (), in subjects who had no lymph node metastasis and also in subjects with lymph node metastasis in both BRAF positive and negative PTC cases.
Our results showed that BRAF mutation was associated with a larger tumor size, higher frequency of lymph node metastasis, and lower TIMP3 protein levels. Lower TIMP3 protein level was associated with the lymph node metastasis in PTC patients.

The study aimed to investigate whether diet-induced inflammation assessed by Empirical Dietary Inflammatory Pattern (EDIP) is associated with odds of unhealthy metabolic phenotype and components of metabolic syndrome (MetS).
This cross-sectional study included 403 overweight/obese individuals recruited from employees of two pharmaceutical companies in Iran. The weighted intake of 15 food groups was summed to construct EDIP and metabolic phenotypes were defined based on MetS criteria.
After adjusting for age, sex, BMI, and marital status, the odds of unhealthy phenotype increased significantly from quartile 1 to quartile 4 (P-trend = 0.013). However, the association became non-significant after adjusting for energy intake. Compared to those in the lowest quartile, individuals with higher EDIP scores had higher odds of high fasting blood sugar (FBS) (P-trend = 0.031) and low HDL-C (P-trend = 0.036) after adjusting for all covariates. By adding energy intake into the model, an inverse association was observed between EDIP, waist circumference (WC), and odds of high WC.
A higher pro-inflammatory diet was associated with higher odds of unhealthy phenotype, high FBS, and low-HDL-C in overweight/obese individuals. However, the association with unhealthy phenotype seems to be dependent on the energy intake.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women during the reproductive age. Considering disorders reported in women with PCOS, e.g. infertility, pregnancy complications (premature delivery, caesarean section and spontaneous miscarriages), and hormonal disorders, we hypothesized that uterine contractions in PCOS rats may be different from controls. We aimed to compare uterine contractions in PCOS rats with controls.
Rats in the experimental group were subcutaneously injected with 5 mg of free testosterone on gestational day 20, while controls received solvent. The contractions of isolated uterus in offspring of both groups were recorded by the power lab system, after exposure to carbachol and oxytocin. Two-way analysis of variance was used to compare results between 2 groups.
PCOS rats showed more irregular uterine contractions compared to controls. After exposure to carbachol, frequency, and resting tone in the PCOS rats were significantly increased compared to controls (P = 0.004, P = 0.02, respectively). After exposure to oxytocin, the frequency, resting tone and amplitude of rhythmic contractions did not differ between the 2 groups.
Our study indicates irregular uterine contractions and different mechanical responses of isolated uterus in PCOS rats compared to controls.