mohammad karim shahrzad

 Extended low serum thyrotropin (TSH) levels may increase the risk of cardiovascular events in patients with hyperthyroidism.

 This study aimed to compare the time spent with sustained normal TSH concentration following short- and long-term methimazole treatment.

 A total of 258 patients with Graves’ hyperthyroidism completed 18 - 24 months of methimazole therapy and were randomized to discontinue treatment (n = 128, short-term group) or continue an additional 36 - 102 months of methimazole therapy (n = 130, long-term group). Clinical and laboratory evaluations were performed every 6 months for 132 months after randomization.

 There was no difference in serum-free thyroxine, triiodothyronine, and TSH concentrations between the 2 groups at the time of randomization. Of 128 patients in the short-term group, 5 left in follow-up, 2 became hypothyroid, 67 (54%) had a relapse of hyperthyroidism, and only 54 (44%) were euthyroid at the end of the study. Among 130 patients on the long-term methimazole therapy, 4 were left in follow-up, 24 developed hyperthyroidism, 4 developed hypothyroidism, and 98 (78%) were euthyroid 132 months post-randomization. Total time spent on euthyroidism was 90.4% ± 8.1% of the study period in the short-term and 95.8% ± 7.0% in the long-term treatment groups (P < 0.001). The lowest time spent in euthyroidism (74.6% ± 6.4% of the study period) belonged to 29 (24%) patients in the short-term group under levothyroxine therapy because of fluctuation in serum TSH. Patients in both groups with hyperthyroidism relapse who chose methimazole therapy spent >90% of the study time in euthyroidism.

 In patients with Graves' hyperthyroidism, sustained normal serum TSH levels were more common in the long term as compared to the short-term methimazole treatment.

Despite the achievements of the national program for the prevention and control of diabetes (NPPCD) over the past two decades, the available evidence indicates a high prevalence of this disease in Iran. This qualitative study aims to investigate barriers to the NPPCD by pursuing the perspectives of relevant policy-makers, planners, and healthcare workers.

A grounded theory approach was used to analyze participants’ perceptions and experiences. Semistructured interviews (n=23) and eight focus groups (n=109) were conducted with relevant policy-makers, planners, and healthcare workers in charge of Iran’s national diabetes management program. Of the 132 participants, ages ranged from 25 to 56 years, and 53% were female. Constant comparative analysis of the data was conducted manually, and open, axial, and selective coding was applied to the data.

Two main themes emerged from data analysis: implementation barriers and inefficient policy-making/ planning. Insufficient financial resources, staff shortage and insufficient motivation, inadequate knowledge of some healthcare workers, and defects in the referral system were recognized as the NPPCD implementation barriers. Inappropriate program prioritizing, the lack of or poor intersectoral collaboration, and the lack of an effective evaluation system were the inefficient policy-making/planning problems.

Current results highlighted that inefficient policy-making and planning have led to several implementation problems. Moreover, the key strategies to promote this program are prioritizing the NPPCD, practical intersectoral collaboration, and utilizing a more efficient evaluation system to assess the program and staff performance.

Breast cancer is among the most common malignancies in women around the world. There is evidence of high prevalence of serum/blood Vitamin D deficiency in Iranian women. Considering the multitude of factors that may be involved in the prognosis and lifespan of breast cancer patients, this study investigated the level of Vitamin D in  ranian patients with nonmetastatic breast cancer.

  his cross?sectional study was carried out on 214 women diagnosed with breast cancer, who were referred to the radio?oncology department.  erum Vitamin D level of the patients was measured. Prognostic factors  ere determined based on demographic and pathological characteristics.  he results were analyzed using descriptive statistics tests, Chi?square,  ne?way analysis of variance, Kaplan–Meier, and Cox regression model in SPSS v22. For all cases, the significance level was considered to be P < 0.05.

The total mean of 25?hydroxyvitamin D serum level was  5.15 ± 17.68 ng/ml. There was no significant relationship between levels of Vitamin D with disease stage, tumor size, tumor grade, estrogen  eceptor, progesterone receptor, and Human epidermal growth factor  eceptor 2 (P > 0.05). The mean survival time was 5 years and 45 days.

No relationship was found between serum Vitamin D levels and the factors affecting the prognosis of nonmetastatic breast cancer. The Cox analysis showed that the survival time was not influenced by  itamin D as a prognosis factor.

The prevalence of diabetes mellitus (DM) and its morbidity and mortality are prominent all overthe world. Observational data suggest that vitamin D deficiency is associated with insulin resistance. In thisstudy, we aimed to assess this association.

This study was a clinical trial consisting of 42 patientswith type 2 DM who had vitamin D deficiency. The patients underwent vitamin D replacement with vitaminD pearls (50,000 iu) weekly for 10 weeks. The level of low-density lipoprotein (LDL), high-density lipoprotein(HDL), cholesterol (Chol), triglycerides (TG), hemoglobin A1c (HbA1C), 2 hour post prandial (2HPP), fastingblood sugar (FBS), body mass index (BMI), blood pressure (BP), and 25oHVitD3 were measured before and afterthe treatment in all patients. Data were analyzed with paired t test.

100% of patients reached acceptablevitamin D level (above 30 mg/dl). No toxicity was reported. Changes in FBS, 2Hpp, HbA1C, Chol, SBP weresignificant and there was no significant change in LDL, HDL, and DBP.

Screening for vitamin Ddeficiency and its replacement may have a beneficial effect on type 2 DM management and its associated riskfactors. More studies with larger sample size and use of placebo are recommended.

Recent studies suggest that the spleen has an important role as a source of multipotent stemcells and precursors of beta cells of pancreas islets. In addition, increased risk of developing hyperglycemiawas reported in patients who underwent splenectomy due to trauma in long-term follow up. Therefore, theremight be an association between splenectomy and an increased risk of type 2 diabetes mellitus. In this study,we evaluated the risk of type 2 diabetes and its risk factors including hyperglycemia, dyslipidemia, obesity andhypertension in trauma patients with splenectomy.

In this study, 221 patients whounderwent splenectomy surgery due to trauma in the surgical ward of Imam Hossein Hospital 5 to 10 yearsago were selected. Those with a history of diabetes, cancer, hyperthyroidism, Cushing’s syndrome, pancreatitis,renal failure, and cirrhosis were excluded from the study. Then fasting plasma glucose, hemoglobin A1c (HbA1c),triglyceride, cholesterol and high density lipoprotein (HDL), body mass index and blood pressure have beenevaluated in 90 patients who had had a history of splenectomy due to trauma from 2007, July 23 to 2012, July 22.

The results indicate that none of these patients has diabetes, 14.4 percent are in pre-diabetic stage, 56.6percent has dyslipidemia, 57.7 percent has obesity and 20 percent has hypertension.

The resultsof this study suggest that splenectomy does not increase the risk of type 2 diabetes. Prevalence of diabetes riskfactors was approximately the same with those of Tehran population.

Studying the treatment effect of subclinical hypothyroidism in decreasing metabolic syndromerisk factors and cardiovascular diseases is necessary and can be helpful to control future disorders. In spite ofvarious studies, the relationship between subclinical hypothyroidism and cardiovascular diseases remain con-troversial. Studies which consider the effects of subclinical hypothyroidism treatment on metabolic control andinsulin resistance have not been done in the Islamic Republic of Iran yet.

In this inter-ventional study, 153 patients with subclinical hypothyroidism (thyroid stimulation hormone (TSH) >5, normalT3 and T4 at least 2 times) were selected from Labbafinejad endocrine clinic. Laboratory tests were performedat 8 a.m. after 12-14 hours fasting. Patients were then treated with levothyroxine (25-50μg daily). To adjustthe dose, thyroid function tests (TFT) were checked every 2 months for 6 months. Collected data was usedfor analysis by spss18 software.

After 6 months treatment of subclinical hypothyroidism mean valuesimproved in factors such as insulin resistance profile (fasting blood sugar (FBS), 2 hours post prandial (2hPP),fasting insulin and homeostasis model assessment estimated insulin resistance (HOMA-IR index), lipid profile(total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL), decreased c-reactive pro-tein (CRP) and weight (all had P value<0.05). Treatment did not have significant effect on triglycerides (TG),waist circumference, body mass index (BMI), uric acid ad systolic/diastolic blood pressure (p values>0.05). Butthe number of cases with high systolic/diastolic blood pressure decreased significantly after 6 months treat-ment (P values=0.007 and 0.01).

Subclinical hypothyroidism treatment is suggested according tomentioned effects, especially in cases with insulin resistance, lipid profile disturbance, obesity, and high bloodpressure.

There is still controversy over the existence of a relation between hypothyroidism and fatty liverdisease. The scale by which hypothyroidism can affect fatty liver disease progression is also to be determined.Therefore, our study aims to contribute in the determination of this relation.

This ob-servational analytical-before and after study with 53 patients was conducted. The subjects were categorized ashaving either primary or subclinical hypothyroidism. The serum levels of thyroid stimulation hormone (TSH),free T3 (FT3), free T4 (FT4), alanine transaminase (ALT), aspartate aminotransferase (AST) and alkaline phos-phatase (ALP) were measured and liver ultrasound was done to screen nonalcoholic fatty liver disease (NAFLD).

The study consisted of 41 women and 12 men with the mean age of 48.3 years. The mean TSH levelsdecreased after hypothyroidism treatment in patients. The mean levels of FT4 did not have a significant increaseafter treatment, although in patients with subclinical hypothyroidism this increase was significant. T3 levels in-creased significantly after treatment. Statistical studies showed that there was a significant change in the degreeof fatty liver before and after hypothyroidism treatment.

There was an explicit relation betweenhypothyroidism and non-alcoholic fatty liver disease as Hypothyroidism treatment can prevent non-alcoholicfatty liver disease progression.

ntroduction: Proton pump inhibitors can influence glucose-insulin homeostasis by elevating plasma gastrin.Considering the few clinical trials and contradictory results of previous studies, we aimed to evaluate the effect ofomeprazole, a proton pump inhibitor, on glucose-insulin homeostasis in patients with type 2 diabetes mellitus(T2DM).

In this before-after clinical trial, 40 patients with T2DM received omeprazoletreatment for 12 weeks. Patients were asked to continue their diet, lifestyle, and physical activity throughoutthe study period. Glycosylated hemoglobin (HbA1c), fasting plasma sugar (FBS), insulin level, C-peptide and 2hours post prandial blood sugar (2hppBS) were measured at baseline and after 12 weeks. Homeostatic modelassessment of Insulin resistance (HOMA-IR) and homeostatic model assessment ofβ-cell dysfunction (HOMA-B) indices were also calculated at baseline and after 12 weeks of omeprazole administration.

After 12weeks of omeprazole administration, there was a clear decrease in the mean HbA1C before (8.11±0.96) and after(7.13±0.68) the treatment (P<0.001). Similarly, a decrease in mean FBS and 2HPPBS before and after treatmentwas observed, which was statistically significant for FBS (P=0.01) but not for 2HPPBS (P=0.1). There was a clearincrease in the level of Insulin (P=0.001) and C-peptide (P=0.003). The mean activity index of HOMA-B beforeand after receiving omeprazole was 54.41±27.06 and 79.24±45.32, respectively (P=0.007). Also, HOMA-IR indexwas 5 before, and 6 after receiving omeprazole (P=0.001).

Administration of omeprazole, increasesinsulin levels and decreases the levels of HbA1c, FBS, thus improving glycemic status and can be combined withother drugs used to manage DM, especially in patients with gastrointestinal problems; but more studies areneeded.

Thermal ablation therapies for benign thyroid nodules have been introduced in recent years to avoid the complications of traditional methods such as surgery. Despite the little complications and the reportedly acceptable efficacy of thermal ablation methods, quite few medical centers have sought the potential benefits of employing them. This paper provides an introduction to the literature, principles and advances of Percutaneous Laser Ablation therapy of thyroid benign nodules, as well as a discussion on its efficacy, complications and future. Several clinical research papers evaluating the thermal effect of laser on the alleviation of thyroid nodules have been reviewed to illuminate the important points. The results of this research can help researchers to advance the approach and medical centers to decide on investing in these novel therapies.

Transsphenoidal surgery (TSS) is the most effective treatment for acromegalic patients, and two major factors that have been suggested as useful predictors in assessing this therapy’s success are: tumor size and preoperative basal growth hormone (GH) levels. The aim of this study was to illustrate the relationship between some predictor factors and transsphenoidal surgery (TSS) outcomes and its remission rate.Patients and A total of 20 patients underwent TSS by 4 neurosurgeons in 4 university hospitals in Tehran and were followed up for 1 year. An oral glucose tolerance test was performed at 1 week after surgery and then 3, 6, and 12 months after surgery. Moreover, Insulin Growth Factor- 1 (IGF-1) was measured at 6 and 12 months after surgery. Initial remission was observed in 7 (35%) patients with a recurrence rate of 10%. The nonresponse rate was 55%. The analysis showed a significant relationship between IGF-1 and surgery outcome in the cured patients at 6 months after surgery (P = 0.005). No significant statistical relationship was found between tumor size and the TSS outcome (P = 0.696). Given the high failure and recurrence rates following TSS in Iran, it seems important to pay more attention to diagnosing the disease earlier and improving surgical methods.

There are more than 140 million people with diabetes in the world. Iran's share is estimated at 1.5 million people. The increasing prevalence of diabetes and the longer life expectancy of diabetic patients mean that an increasing number of patients with diabetes are undergoing surgery, and not just for diabetes and its complications, such as end-stage renal disease, retinopathy, peripheral vascular disease, and diabetic foot ulcers. The metabolic stress caused by general anaesthesia and the operation itself makes blood glucose control even more difficult. Stricter pre- and intra-operative glycaemic control reduces the risk of sepsis, cardiovascular events, disability and death, accelerates wound healing and decreases hospital stay. Improved outcome requires pre-operative ascertainment of the type of diabetes, quality of metabolic control, and detection of complications, as well as optimal metabolic and haemodynamic management during the operation. Local anaesthesia is the preferred option in this group of patients because it least interferes with metabolic control. The diet recommended to achieve normoglycaemia will depend on the type of diabetes, pre-operative glycaemic control, and the extent of the planned procedure. In all type 1 diabetic patients and type 2 diabetic patients on insulin or oral hypoglycaemic agents who are to undergo surgery under general anaesthesia, the glucose-insulin-potassium (GIK) regimen is the one recommended by most authors to achieve tight intra-operative blood glucose control, conditional upon blood glucose measurements being available every one or, at most, two hours. Intra-operative blood glucose levels in the 120-180mg/dl ranges are considered satisfactory. Failing this, it is recommended that 50% of the daily NPH requirement be given subcutaneously on the morning of the operation, together with an intravenous glucose infusion intra-operatively. Type 2 diabetic patients with unsatisfactory metabolic control, time permitting, should be admitted several days before the operation and switched to and stabilised on insulin.

There are more than 140 million people with diabetes in the world. Iran’s share is estimated at 1.5 million people. The increasing prevalence of diabetes and the longer life expectancy of diabetic patients mean that an increasing number of patients with diabetes are undergoing surgery, and not just for diabetes and its complications, such as end-stage renal disease, retinopathy, peripheral vascular disease, and diabetic foot ulcers. The metabolic stress caused by general anaesthesia and the operation itself makes blood glucose control even more difficult. Stricter pre- and intra-operative glycaemic control reduces the risk of sepsis, cardiovascular events, disability and death, accelerates wound healing and decreases hospital stay. Improved outcome requires pre-operative ascertainment of the type of diabetes, quality of metabolic control, and detection of complications, as well as optimal metabolic and haemodynamic management during the operation. Local anaesthesia is the preferred option in this group of patients because it least interferes with metabolic control. The diet recommended to achieve normoglycaemia will depend on the type of diabetes, pre-operative glycaemic control, and the extent of the planned procedure. In all type 1 diabetic patients and type 2 diabetic patients on insulin or oral hypoglycaemic agents who are to undergo surgery under general anaesthesia, the glucose-insulin-potassium (GIK) regimen is the one recommended by most authors to achieve tight intra-operative blood glucose control, conditional upon blood glucose measurements being available every one or, at most, two hours. Intra-operative blood glucose levels in the 120-180mg/dl ranges are considered satisfactory. Failing this, it is recommended that 50% of the daily NPH requirement be given subcutaneously on the morning of the operation, together with an intravenous glucose infusion intra-operatively. Type 2 diabetic patients with unsatisfactory metabolic control, time permitting, should be admitted several days before the operation and switched to and stabilised on insulin.