فهرست مطالب شیوا برزویی

Lack of sleep and insomnia are associated with an increase in the risk of diabetes. Sleep disorders in diabetic people are significantly higher than in healthy people. Moreover, sleep duration is related to blood sugar control in diabetes. This study was conducted with the purpose of investigating the level of sleepiness and obstructive sleep apnea in type 2 diabetic patients and its relationship with glycemic levels.

This cross-sectional study was conducted on 200 patients with type 2 diabetes referred to Shahid Beheshti Hospital in Hamadan in 2023 . Diabetes control status was evaluated by hemoglobin A1c, and the frequency of sleepiness and obstructive sleep apnea was assessed by the Epworth Sleepiness Scale and STOP-BANG questionnaires. Data analysis was done using SPSS 26 statistical software.

The mean age of the participants was 56.16 ± 9.77 years. A significant difference was observed between the frequency of daily sleepiness score with gender (P<0.001), smoking (P=0.003), and hypertension and dyslipidemia (P<0.001). There was a significant difference between the possibility of obstructive sleep apnea with smoking (P=0.002) and dyslipidemia (P=0.001). A significant difference was observed between hemoglobin A1c and smoking (P<0.001) and dyslipidemia (P=0.007). There was a positive and significant correlation between hemoglobin A1c and daily sleepiness score (P=0.036) and sleep apnea score (P=0.034).

In patients with type 2 diabetes, obstructive sleep apnea and daytime sleepiness are relatively common, and these disorders are related to poor glycemic control.

Considering the high prevalence of thyroid nodules and the increased incidence of malignancy of this gland, the present study aimed to assess the clinical characteristics and pathology results following surgery in patients with nodular goiter and referred to the endocrinology clinic in Hamadan, Iran.

This study was conducted as case series from 2011 to 2021. All patients diagnosed with thyroid nodules who underwent thyroidectomy according to the indication and whose pathology was benign or malignant were included in the study. The patients' information was collected by reviewing the files, which included demographic, clinical, and pathology results. The data was analyzed in SPSS software (version 26), and the significance level was considered less than 0.05.

Among the 507 patients studied, 88.2% were female, and 11.8% were male. The mean age of the patients was 41.93 years. Pathology result was malignant in 57% of cases and benign in 43% of subjects. Most patients with malignant pathology were under 35 years of age, and those with benign pathology were older (P<0.001). Most patients were in stage I of the disease; nonetheless, males compared to females were significantly in more advanced stages of the disease (P<0.001).

Thyroid nodules are very common, and their incidence is increasing. Considering the nature of malignancy, the good prognosis of these nodules, and effective treatment, early diagnosis of malignancy assumes critical importance.

The satisfaction of diabetic patients with the treatment and their cooperation in obtaining therapeutic results and increasing quality of life is very decisive. This study aimed to investigate the relationship between type II diabetes patients' satisfaction with medical services and their quality of life.

This cross-sectional study was conducted on 198 type II diabetic patients referred to Hamadan Diabetes Clinic in 2021. The convenience sampling method was used to select the samples. The data were collected using a checklist of demographic characteristics and the quality of care, patient behavior, and quality of life researcher-made questionnaire. The obtained data were then analyzed in SPSS software at a significant level of 0.05.

According to the results, the majority of the participants were female (70.71%), and the mean age of the respondents was obtained at 59.65 ± 9.26 years. In addition, the mean score of quality of life was estimated at 84.7±12.6. The quality of life score showed a significant relationship with education level, marital status, employment status, and body mass index. The mean score of satisfaction with services was 92.78±19.8. The high level of education and lack of health insurance revealed a correlation with lower satisfaction with services. Finally, there was a direct and significant relationship between quality of life and satisfaction with the received services.

A significant relationship was found between the quality of life and the level of satisfaction with the services received. Therefore, improving the quality of medical services for these patients in order to increase their satisfaction level with treatment can be effective in enhancing their quality of life.

Despite the existence of very effective drugs in controlling blood sugar in diabetic patients, unfortunately, a small proportion of patients follow their medication. Several factors may affect in drug adherence. In this study, the effect of drug-related beliefs on medication adherence in diabetes was investigated.

In a cross-sectional study using available sampling method, 248 patients with type 2 diabetes referred to the specialized diabetes clinic in Hamedan in 1400 were selected. Medication compliance was checked with MMSQ-8 and medication belief was checked with BMQ questionnaire. Data were analyzed using chi-square, ANOVA, Kruskal-Wallis and Spearman's correlation at significance level of 0.05.

The mean age was (16.9) 52.6 years. 51.6% were women, 61.3% were men. poor, moderate, and good medication adherence rate were 53.2%, 25.8% and 21%, respectively. In patients with poor, moderate and good drug treatment, the mean (SD) of the belief score for the Specific Necessity were 17.9 (5.8), 17.2 (3.7) and 17.7 (1.2), respectively. Belief of Specific concern 16.6(0.6), 17.6 (2.3) and 1/17(1.8), belief of General overuse 13.2 (2.2), 12.6 (2.6) and 12.2 (2.3), belief in General harm were 10.6 (2.9), 10.2 (3.5) and 8.5 (0.3) and the total score of belief in drug treatment were 58.3 (1.8), 57.6 (6.8) and 55.5 (4.7) and which only the belief of General harm was statistically significant (P<0.05).

More than half of patients do not follow appropriate medication adherence. Belief about harmful side effects of diabetes drugs were significantly associated with a decrease in medication adherence.

Today diabetes is one of the most common endocrine diseases today and a leading cause of death across the globe. There is evidence of thyroid dysfunction in people with type II diabetes, leading to a poorer prognosis in diabetics. The present study aimed to assess thyroid function in patients with type II diabetes.

This cross-sectional study was conducted on 800 patients with type 2 diabetes in Hamada, Iran, during 2018-1400. All patients under treatment with type II diabetes confirmed by the census method were included in the study. A checklist with two sections of demographic and clinical information was used to collect data. After data collection, they were analyzed in SPSS software (version 22) using descriptive and analytical methods.

The patients included 36.6% males and 63.4% females with a mean age of 58.09±10.95 years. The result of the thyroid examination was abnormal in 10.5% of diabetic patients. Thyroid disorder was detected in 31.4% of patients, including clinical hypothyroidism (17.8%), subclinical hypothyroidism (10.5%), and hyperthyroid (3.1%). The prevalence of thyroid disorder in patients with type 2 diabetes in females and those over 35 years of age was significantly higher than in males and those under 35 years of age (P<0.05).

About one-third of participants with diabetes had thyroid dysfunction. Both hypothyroidism and subclinical hypothyroidism were more common in type II diabetic patients. The findings of this study indicated that further research is needed in the future on measures to evaluate thyroid function in patients with type II diabetes.

Diabetes is the most common chronic metabolic disease in the world and one of its control principles is the patient's adherence to the physician's treatment recommendations. This study aimed to determine the adherence to medication treatment and related factors in type 2 diabetic patients referring to the Diabetes Clinic of Shahid Beheshti Hospital, Hamadan, Iran, in 2020.

The present cross-sectional study was conducted on 284 patients with type 2 diabetes referring to the Diabetes Clinic of Shahid Beheshti Hospital. The data collection tool was a researcher-made questionnaire whose validity and reliability were confirmed in a pilot study. Data were analyzed in Stata software (version 11) at the significance level of 0.05.

Most of the patients were women (64.08%) and urban dwellers (79.08%). The mean age of the patients was obtained at 54.78 years, and 47.89% of the patients had poor medication adherence. Patients' medication adherence showed a statistically significant relationship with gender, marital status, education, physician's respectful behavior, respect for patient privacy, physician skill, the satisfaction of the physician, a history of other diseases, and a history of hypertension (P<0.05).

It was revealed the medication adherence rate was not satisfactory in patients with type2 diabetes. In this study, the identified causes associated with poor medication adherence included factors related to the patient, care team and health system, treatment, and disease status.

The increased response of T helper (Th) 22cells might be involved in thepathogenesis ofType 2 Diabetes Mellitus (T2DM). The present study aimed to investigate the transcription factor of Th22 cells (aryl hydrocarbon receptor [AHR]) and interleukin 22 (IL-22) in CD4+ T cells as well as the impact of oral empagliflozin treatment. The correlation between the aforementioned factors and clinical parameters was also determined among the patients.

In this case-control study, 50 patients under the treatment of metformin and gliclazide were divided into two equal groups, including the patients receiving empagliflozin (EMPA+) and not receiving empagliflozin (EMPA, as the control group). The peripheral blood CD4+ T cells were isolated on the initiation day of the study and after 6 months of therapy, and the gene expression levels of AHR and IL-22 were evaluated by real-time polymerase chain reaction. In addition, the production of IL-22 after activation was measured using enzyme-linked immunosorbent assay.

The levels of fasting plasma glucose and hemoglobin A1c diminished in the EMPA+ group after empagliflozin therapy, compared to those reported at the baseline (initiation day; P<0.001 and P=0.04). The gene expression level of IL-22 and production of IL-22 significantly reduced after 6 months of empagliflozin therapy (P=0.011 and P=0.001). A significant positive correlation between IL-22 production and its gene expression with AHR as well as between fasting plasma glucose and hemoglobin A1c was observed in the EMPA+ patients after therapy (P˂0.05).

In addition to antidiabetic effects, empagliflozin has anti-inflammatory impacts on the immune system, especially on Th22 cell-related factors.

Type 2 diabetes mellitus (T2DM) is an inflammatory disease with alterations in immune system. Remarkably, cytokine imbalance plays an important role in pathogenesis of T2DM. The purpose of this study was to determine the serum levels of TNF-α, IL-1β and IL-10 and the effects of sitagliptin on the level of these cytokines in patients with T2DM.

Blood samples were collected from 60 T2DM patients and 30 healthy control subjects (HCs). T2DM patients were divided into two subgroups based on their treatment; with sitagliptin treatment (100 mg/day, n=30) for 8 months and without sitagliptin treatment (n=30). The serum levels of TNF-α, IL-1β and IL-10 cytokines were assessed using ELISA method. ANOVA with posthoc Bonferroni were applied to statistical analysis.

The serum level of TNF-α was significantly higher in T2DM patients without sitagliptin compared to HCs (p=0.002). Whereas, the serum level of TNF-α was significantly lower in patients with sitagliptin compared to patients without sitagliptin (p=0.01). The serum level of IL-10 showed a significant reduction in patients without sitagliptin compared to HCs (p=0.003). On the other hand, a significant elevation was observed in serum level of IL-10 between T2DM patients with and without sitagliptin (p=0.002). Considerably, no significant difference was observed in serum level of IL-1β between T2DM patients with and without sitagliptin and also in comparison to HCs.

Sitagliptin treatment significantly decreased the level of pro-inflammatory TNF-α and increased anti-inflammatory IL-10 in T2DM patients. It seems that sitagliptin had an anti-inflammatory effect on immune system of the patients.

Classification and prediction are two most important applications of statistical methods in the field of medicine. According to this note that the classical classification are provided due to the clinical symptom and  do not involve the use of specialized information and knowledge. Therefore, using a classifier that can combine all this information, is necessary. The aim of this study was to design a decision support system for classification of thyroid disorder using fuzzy if and then classifier.

The data consisted of 310 patients, including 105 healthy people, 150 hypothyroidisms and 55 hyperthyroidisms, who referred to Shahid Beheshti Hospital and Imam Khomeini Clinic of Hamadan (Iran) in order to investigate the status of their thyroid disease. In this fuzzy system variable including age and BMI, as well as laboratory tests such as TSH, T4, and T3, the score of hyperthyroid and hypothyroid symptoms used as input and the output variable includes individual health status. The max-min Mamdani inference system along with center of gravity deffizifier have been used in the fuzzy toolbox of MATLAB software.

The fuzzy rule-based classification model had a great performance for predicting thyroid disorder in the both test and train sets.

Fuzzy rules-based classifier by using overlapping sets, had a high potential for managing the uncertainty associated with medical diagnosis. Also, by enabling the use of linguistic variables in the decision making process and design, the interpretation of the results has improved for doctors who are not familiar with modeling concepts.

Thyroid nodules are among the most common clinical problems and the application of an inexpensive and accurate diagnostic method prevents performing inessential surgeries. In this regard, the aim of this study was to compare the cytologic report of fine-needle aspiration (FNA) of thyroid nodules with the results of thyroid surgery. In this cross-sectional study, all the patients who had referred to the clinic of Beheshti Hospital of Hamedan, Iran, due to thyroid nodule in 2017 underwent FNA. The samples were then sent to the pathology laboratory, and the cytology results were recorded in a checklist. Based on the cytology results, a portion of these cases was referred to undergo surgery. Following that, the sensitivity and specificity of cytology results of thyroid nodules were calculated in comparison to pathology results of the surgery sample. Out of 115 studied patients, 18 (15.65%) and 97 (84.35%) subjects were male and female, respectively. The mean age of the subjects was 40.14±12.34 years. Most cases were in the form of the right-side unilateral nodule (46.1%). The number of benign and malignant cases diagnosed by the pathologist was 73 (63.48%) and 42 (36.52%), respectively. The specificity, sensitivity, as well as positive and negative predictive values obtained from the FNA of thyroid nodules by the pathologist, were reported as 82.98%, 95.56%, 89.04, and 92.68%, respectively. It is necessary to mention that the diagnostics accuracy of the pathologist associated with the results of surgery pathology was 90.43%. Performing FNA enjoys a relatively high specificity and sensitivity as an inexpensive, low-risk, and simple method in the differentiation of benign and malignant cases if it is performed precisely from the site of the nodule with adequate biopsy and properly examined pathologically.

Different studies have demonstrated that maternal thyroid dysfunction during pregnancy is associated with adverse obstetrics and fetal outcomes. There is no international consensus regarding to use a guidelines for screening in high risk women. The aim of the present study was to determine prevalence of thyroid disorders in high and low risk pregnant women.
In a cross-sectional study during 2015-2016, from all pregnant women who had referred to Hamadan health center Lab for their first visit, a sample of 852 pregnant women were selected and assigned to low risk and high risk group. Thyroid tests and Anti TPO tests were carried out.
Of 852 pregnant women, 26.5% had Subclinical hypothyroidism, 1.2% had overt hypothyroidism, 0.5% had overt hyperthyroidism and 0.2% had subclinical hyperthyroidism. 25.6% were in the high risk group and 74.4% in the low risk group and 37.4% of high risk group and 25% of the low risk population had thyroid disorders (P<0/001). 89% were Anti TPO negative and 11% were Anti TPO positive.
Hypothyroidism is common in pregnant women, and if screening is performed only in high-risk groups, 25% of pregnant women with subclinical and overt hypothyroidism will not  be detected explicitly. In addition, to determine the exact frequency of thyroid disorders, we need to look for newer and more effective criteria.

Gestational diabetes is a health problem and is one of the most commonly occurring complications of pregnancy worldwide, which has many effects on the mother and the fetus. The present study was conducted to determine the prevalence of gestational diabetes and its risk factors in Hamadan city, Iran. In this cross-sectional study, the study population was 534 pregnant women who were referred to control pregnancy to Hamadan health center from April 2014 to December 2016. The study participants were 534 with the age range of 15-42 years old with an average age of 26.8 and a standard deviation of 5.56. The gestational age was 4 to 29 weeks with an average of 8.32 weeks with a standard deviation of 2.68. Of the 534 participants in this study, 211 (39.5%) had gestational diabetes and there was a significant relationship between factors such as macrosomia and history of impaired glucose tolerance with the prevalence of gestational diabetes. Gestational diabetes has a relatively high prevalence in Hamadan, further information is needed in this area as well as studies based on new guidelines in different parts of the country.

  Diabetes mellitus is one of the most commonly reported diseases that is associated with insulin resistance and increased blood glucose levels. The aim of this study was to determine the probable anti-inflammatory effects of sitagliptin and vitamin D3 (VitD3) on pro-inflammatory IL-6 and TNF-α in patients with type 2 diabetes mellitus (T2DM). In this case-control study, 20 blood samples of patients with T2DM and healthy controls (HCs) were collected (n=20). Peripheral blood mononuclear cells (PBMCs) were isolated using the Ficoll-Paque method and cultured with Phytohemagglutinin (PHA) in the presence or absence of sitagliptin and VitD3 for 4 days. The enzyme-linked immunosorbent assay was used to analyze the levels of IL-6 and TNF-α produced by PBMCs. After PHA stimulation, the production of IL-6 was increased significantly in T2DM patients compared to HCs (P=0.03) . Compared to PHA cultures, sitagliptin and VitD3 resulted in the reduction of IL-6 production in patients (P≤0.001, P≤0.001), and HCs (P=0.03, P=0.02), respectively. Moreover, with regard to the cultures with sitagliptin or VitD3, sitagliptin with VitD3 reduced the level of IL-6 in both groups of patients (P=0.02, P=0.002) and HCs (P=0.002, P=0.03). There was a significant reduction in the level of TNF-α by sitagliptin with VitD3 in patients (P=0.04, P=0.002) and HCs (P=0.04, P=0.03) , compared to cultures with sitagliptin or VitD3. According to the results, it can be concluded that the combined use of sitagliptin and VitD3 is more influential regarding the anti-inflammatory effects on patients. In addition, the reduction of sitagliptin dose may result in decreasing its possible side effects

During the recent years, vitamin D deficiency was determined as a risk factor for cardiovascular diseases. The purpose of this study was to evaluate the association of vitamin D with ischemic heart disease in the city of Hamadan.
A case control-study was performed with 72 patients with ischemic heart disease, which had been confirmed by angiography in the case group. Vitamin D levels were measured in 74 patients with no disease in the control group. The results were analyzed by the SPSS-21 software and statistical tests.
Overall, 31.9% of the patient group and 24.6% of the control group had deficiency of vitamin D (P = 0.04). After adjustment of all risk factors, the risk of ischemic heart disease in patients with deficiency was 2.047 times more than those with enough vitamin D (P = 0.05).
Vitamin D deficiency could be considered as a risk factor for ischemic heart disease, however more studies need to be done to confirm this relationship.

Metabolic syndrome (MetS) is one of the most common diseases and a public health problem in most populations and predisposes to many metabolic disorders such as type 2 diabetes. Inflammatory processes and oxidative stress are the important factors in pathogenesis of MetS. Also, the effect of sex, race, age, nutrition and life style is very important in incidence of this syndrome. This study was conducted to compare the activity of antioxidant enzymes and some other factors that are involved in oxidative stress in patients with metabolic syndrome.
In this study, 37 individuals with metabolic syndrome and 31 healthy controls participated. A blood sample was taken from all subjects and serum and red blood cells were isolated. Glucose, lipid profile, uric acid, malondialdehyde and thiol groups were determined in prepared samples. Antioxidant enzymes containing superoxide dismutase (SOD, gluthatione peroxidase (GPx), and catalase (Cat) were also measured in whole blood samples.
While triglycerides and blood glucose were significantly higher in subjects with metabolic syndrome as compared to control subjects, there was no significant difference for total cholesterol, HDL-Ch and LDL-Ch. A reduction in activities of SOD, GPx and Cat was observed in MetS group as compared to healthy individual (p=0.02, 0.01 and 0.03, respectively).
The reduction in antioxidant enzymes SOD, GPx and Cat indicate the weakness of antioxidative defense in MetS. These states can predispose for inflammation and other complication of MetS. Using antioxidants or consuming natural products can strength the antioxidant defense and prevent the MetS complications.

Introduction & Salivary antioxidants play important roles in the defensive mechanism of saliva against free radicals. Due to Prevalence of diabetes and numerous factors associated in its pathogenesis, understanding the defensive mechanism of salivary antioxidant against free radicals can provide helpful strategies in diagnosis and evaluation of diabetes. The aim of this study was evaluation of the paraoxonase (PON1) levels and total antioxidant capacity (TAC) of saliva in diabetic subjects. In this case -control study, 40 patients diagnosed with type II diabetes (20 males and 20 females) aged between 40 to 60 years and 40 healthy controls were selected. 5 mL unstimulated saliva samples using Spiting method were collected. PON-I and TAC levels were examined using FRAP (Ferric Reducing Ability of Plasma) methods. The data were ana-lyzed by t- test or its non parametric equivalent tests. Mean PON-I in the subjects and control group were 8.05±2.099 nmol /ml 9.98 ±2.957 nmol/ml, respectively and the difference was significant (P=0.001) TAC in saliva of the sub-jects and control group were 377.38 ±191.229 and 402.25±189.105 and no significant differ-ence was found (P=0.56). The level of salivary TAC, PON-1 of patients with type II diabetes was lower than healthy controls. Additionally, plasma low density lipoproteins level of the diabetic subjects was higher compared with the healthy ones.

Metabolic Syndrome (MetS) is a potential threatening factor for cardiovascular disorders and atherosclerosis which is accompanied by increase in plasma triglyceride, cholesterol, low density lipoproteins (LDL-c), fasting blood sugar (FBS) and low high density lipoproteins (HDL-c). Cholesteryl ester transfer protein (CETP) catalysis transfer of lipids and phospholipids between lipoproteins. CETP can have a significant role in balancing the quantity of plasma lipids and lipoproteins. The present survey attempted to show the association of Taq1B polymorphisms in CETP gene with metabolic syndrome parameters an Iranian population. In order to identify the association between the Taq1B polymorphisms of this gene and the lipid pattern of plasma and other parameters of MetS, the quantity of lipids in metabolic syndrome subjects (N=247) and healthy individuals (N=247) were measured. The abundance of alleles and genotypic distribution of the Taq1B polymorphisms were defined along with comparison between two control and patient groups. Blood samples were collected followed by routine biochemical analysis. DNA extraction was performed. Polymerase chain reaction-restriction fragment length polymorphism was applied to identify Taq1B polymorphism. Statistical analyses were applied using SPSS software. Lipid pattern of plasma and other parameters of MetS showed significant differences between the patient and control groups. Also the abundance of alleles and genotypic distribution of polymorphism showed a significant difference between two groups. Taq1B polymorphism was accompanied with MetS. The results confirm that in MetS patients, this genetic mutation in CEPT gene is accompanied with change in lipid profile and other MetS parameters. Our study suggests the promoting effect of Taq1B polymorphism in process of MetS disorder. We indicated this polymorphism can increase occurrence of metabolic syndrome. Our results showed Taq1B polymorphism is associated with some MetS associated variables in our population.

Previous studies have demonstrated that clinical features of 16TPolycystic ovary syndrome16T (PCOS) are associated with a lower degree of health, self, and sex satisfaction.

Our study aimed to investigate possible associations between depression and different clinicobiochemical markers of PCOS.

In a cross-sectional analytic study, 120 PCOS women aged 18-45 yr, were enrolled. Beck Depression Inventory was used to assess depression. Also, all participants underwent biochemical studies. Individuals with 15 points and more in Beck test were referred to a psychiatrist to participate in a complementary interview for the diagnosis of depression based on Diagnostic and Statistical Manual of Mental Disorders IV (DSMIV-TR) criteria.

Among the study participants, 82 women (68.3%) were non-depressed, and 38 patients (31.7%) had some degrees of depression. According to the psychiatric interview, 10 patients (8.3%) had major depression, 22 patients (18.3%) had minor depression and 6 patients (5%) had dysthymia. We failed to show any significant difference in body mass index, hirsutism, infertility, serum total testosterone, lipid profile, and the homeostasis model assessment of insulin resistance (HOMA-IR) between depressed and non-depressed subjects (p>0.05). Using Spearman correlation, we did not find a positive correlation between BDI scores and clinicobiochemical markers for all PCOS subjects (-0.139≤r≤+0.121, p>0.05).

In spite of high rate of depression in women with PCOS, there was no significant association between Clinicobiochemical Markers and depression.

Multiple endocrine neoplasia type IIa (MEN IIa) is an autosomal dominant syn-drome characterized bypheochromocytoma، medullary thyroid carcinoma and hyperparathy-roidism. Pheochromocytoma approximately occurs in 50% of patients with MEN IIa. This tumor has the capacity to produce ACTH ectopically and becomes manifest like Cushing syndrome،although it is very rare. Case Report: We report a 26-year-old woman patient with severe muscle weakness، skin le-sions in extremity، hypertension، new onset diabetes and in the laboratory data hypokalemia، metabolic alkalosis، high serum level of cortisol، metanephrine، normetanephrine، calcitonin and bilateral adrenal mass in computed tomography as the first clinical manifestations of an ACTH-secreting pheochromocytoma. In the patients with hypertension، new onset diabetes and hypokalemia Cushing syndrome and pheochromocytoma should always be ruled out.

Adrenocortical carcinoma is a rare and severe malignant tumor that in 60% of cases are functional and the most common clinical manifestation is Cushing''s syndrome with a progressive course. The only treatment is surgical removal of the entire tumor and effec-tiveness of medical treatments، including mitotane and chemotherapy for survival is still questionable. Case Report: A 36-year-old man with progressive muscle weakness، high blood pressure، and sudden heart failure is presented. In laboratory tests، hypokalemia، hyperglycemia، increased cortisol، increased serum estradiol and DHEAS were observed. There were an adrenal mass and multiple lung and liver metastases on imaging studies and CT-guided biopsy confirmed adrenal tumor. High serum concentrations of estradiol and cortisol appear to be effective on heart involvement and acute onset of diabetes، hypertension، and severe heart failure require more evaluations in young adults.

Insulin has an important and vital role in control of blood glucose for all diabetic patients. With increasing the prevalence of diabetes mellitus، insulin consumption will be increased too. Different types of insulin are available، i. e short، rapid، intermediate and long acting insulin and also mixed insulins. The side effects of insulin may lead to the lack of a desirable control of blood sugar or discontinuing insulin injection by the patients. On the other hand sometimes the side effects of insulin can be serious and fatal. Therefore، information about these complications and how to deal with them are very important. Hypoglycemia، weight gain، antibody-mediated insulin resistance، lipodystrophy (atrophy or hypertrophy)، edema، postural hypotension and Allergic reactions to insulin are major side effects of insulin therapy.

Introduction & Metabolic syndrome is one of the main health problems raised around the world and vitamin D deficiency is a possible new risk factor. The aim of this study was to understand this relationship in the Iranian population. This case-control study was done on 186 subjects over 20 years referred to endocrine clinic in the spring and summer of 2011. Clinical and laboratory data were col-lected using questionnaires. After determining the subjects with metabolic syndrome accord-ing to ATP III criteria and the control group, blood samples of all participants were taken to measure 25-hydroxyvitamin D levels and sent to the laboratory. The collected data were ana-lyzed with statistical software SPSS v.16.0 and Pearson's chi square test. Comparing vitamin D levels between the healthy individuals and the patients showed significant differences between the two groups (32.6± 16.5 in the control group vs.17.3± 10.7 in the case group). In the patients, those with vitamin D deficiency compared with those with normal levels of vitamin D, had higher levels of BMI and triglycerides and lower levels of HDL cholesterol. It seems that vitamin D-deficient individuals have a greater chance of having metabolic syndrome. However, prospective studies are needed to prove this relationship.

Papillary thyroid cancer (PTC) is the most common well-differentiated cancer of the thyroid. Only in few cases of PTC entity of renal cell carcinoma has been observed in patients affected with PTC. Case Report: In this study we report a case of sporadic PTC and renal cell carcinoma in a 63 year-old woman. After surgery the patient was hospitalized for 1 month in ICU section. 3 months after being discharged from the hospital, she was still in a good condition and is under the follow-up treatment.

The aim of the present study was to assess the diagnostic accuracy of the modified ATP III and IDF definitions of the metablic syndrome in identifying of insulin resistant individuals by HOMA_IR and to assess levels of agreement between these definitions and insulin resistance. The sample consisted of 347 nondiabetic subjects from the TLGS population (140 men and 207 women aged 27-87 years). The reference standard for insulin resistance was determined by HOMA-IR and insulin resistance was defined as HOMA-IR≥2.5. According to ATP III and IDF criteria 38.9%, 45% had metabolic syndrome respectively. The sensitivity and specificity of ATP III was 52.3% and 65% respectively, and this was 60% and 59% for IDF criteria respectively. Kappa agreement between modified ATP III and IDF with HOMA-IR was 0.14 and 0.15. Based on the area under the receiver operating characteristic curve constructed by counting metabolic syndrome components as recommended by modified ATP III and IDF diagnostic accuracy was fair. When each component of metabolic syndrome measures were considered as continous traits, waist circumference and fasting plasma glucose each separately had diagnostic accuracy equal or grater than at all the metabolic syndrome as a whole by ATP III and IDF criteria. ATP III and IDF definition, have low sensitivities for detecting insulin resistance and there is poor agreement between those criteria and insulin resistance. Measuring just waist circumference and fasting plasma glucose is simpler and may provide greater accuracy for identifying insulin resistance.