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Background and objective: Dyslipidemia is a major modifiable factor in elderly people. The study objective was to assess the prevalence and associated risk factors of dyslipidemia among the Iranian population aged over 50. Methods: This population-based cross-sectional study is part of the Iranian Longitudinal Study on Ageing conducted in Ardakan, Iran. In total, 5,197 participants aged over 50 years old were included through a stratified random sampling method. Dyslipidemia was defined in compliance with the Adult Treatment Panel III criteria. The Chi-square and independent sample t-test were used to compare categorical and quantitative variables, respectively. A logistic regression analysis was applied to determine associated factors of dyslipidemia. Results: The mean age of the participants was 62.24±7.52. The prevalence of dyslipidemia was 68.85%. High levels of total cholesterol, triglyceride, low-density lipoprotein, and low level of high-density lipoprotein were seen among 9.74%, 24.66%, 5.54%, 19.20% of the participants, respectively. In addition, 66.05% of the study participants were under the treatment of lipid-lowering medications. Among the possible investigated risk factors of dyslipidemia, male gender (odds ratio (OR) = 0.56, 95% confidence interval (CI): 0.47, 0.68), waist circumference (OR = 1.03, 95%CI: 1.02, 1.04), diabetes mellitus (OR = 2.28, 95%CI: 1.96, 2.66), and hypertension (OR = 1.59, 95%CI: 1.38, 1.83) showed a statistically significant association (p<0.05). Conclusion: Dyslipidemia is highly prevalent in Ardakanˈs older population. So, lipid management interventions are necessary for this population. [ABSTRACT FROM AUTHOR]

Background: Cushing's syndrome (CS) poses diagnostic challenges, particularly in distinguishing pituitary-dependent Cushing's syndrome, Cushing's disease (CD), from the ectopic ACTH syndrome (EAS). This study evaluated the diagnostic value of the desmopressin stimulation test (DST) in patients with ACTH-dependent CS in helping this discrimination. Methods: Twenty-three ACTH-dependent CS patients underwent sequential DST, bilateral inferior petrosal sinus sampling (BIPSS), and transsphenoidal surgery (TSS). Two definitions of a positive DST results were applied. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios. To avoid bias from predetermined criteria, we generated univariate receiver-operating characteristic (ROC) curves, plotting sensitivity against 1-specificity at various percentage cortisol and ACTH response levels. Results: Against BIPSS, DST demonstrated robust sensitivity (Definition 1: 90.0%, Definition 2: 76.2%) and overall accuracy (Definition 1: 87.0%, Definition 2: 73.9%). PPV was high (Definition 1: 95.0%, Definition 2: 94.1%), but NPV indicated potential false negatives. Compared to TSS, DST showed good sensitivity (Definition 1: 90.9–77.3%) and PPV (100.0%) but limited NPV (16.7%). The likelihood ratios emphasized the diagnostic value of the test. Notably, against TSS, DST showed perfect discriminatory power (AUC 1.000 for percent ACTH, 0.983 for percent cortisol). Conclusion: The desmopressin test shows promise in accurately identifying the underlying cause of ACTH-dependent CS, potentially reducing the reliance on invasive procedures and providing a practical solution for managing complex cases. Further research with larger cohorts is required to validate the utility of the DST in routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: Dynamic contrast-enhanced magnetic resonance imaging (MRI) is the modality of choice for the diagnosis of pituitary microadenomas; however, it may be associated with a relatively high false-negative rate, especially in small lesions. Purpose: To evaluate the usefulness of subtraction images for enhancing the visual detection of pituitary microadenomas. Material and Methods: In total, 50 patients with clinically established diagnosis hyperprolactinemia, acromegaly, and Cushing's disease were enrolled. Ten patients referred for brain MRI for reasons other than pituitary abnormality were selected as control group. Routine dynamic MRI of the pituitary gland and obtained subtraction MRI scans were scrutinized separately on different sessions by an experienced radiologist blinded to the study design and patient's data. The investigator's opinion on the presence or absence of a lesion and lesion size were collected. Results: In patients with pituitary microadenoma, dynamic MRI images were reported positive in 42 (84%) patients and negative in 8 (16%). Subtraction images were described as positive in all patients (100%)—including all patients with negative dynamic MRI—and the difference was statistically significant (P =0.016). Undetected lesions on dynamic MRI had a mean size of 2.84 ± 1.79 mm (median= 2.20 mm, interquartile range=1.62–4.62 mm) and a significant inverse correlation was noted between lesion size and negative report of dynamic MRI (P =0.018). Brain MRI scans in the control group were reported negative for pituitary microadenoma in both dynamic contrast-enhanced and subtraction images. Conclusion: Subtraction images can successfully identify all lesions detectable with conventional dynamic MRI as well as improving visualization of lesions undetected on dynamic MRI, especially in small lesions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the association between glycemic control status and serum levels of vitamin D3 in Iranian patients with type 2 diabetes (T2D). Materials and methods: This was a cross-sectional study on 452 patients with T2D in Tehran, Iran, performed between September 2019 and September 2020. We assessed the diabetes laboratory test and vitamin D3 level in all participants using the Enzymatic Glucose Oxidase method. Data were analyzed using SPSS version 24. Results: a total of 452 patients were enrolled in this study (mean age: 59.4 ± 11.4 years, 63.5% females). Vitamin D deficiency was reported in half of the participants. Deficient vitamin D was significantly associated with higher mean level of hemoglobin A1c, fasting plasma glucose, total cholesterol, and low-density lipoprotein-cholesterol (p < 0.05). Multiple regression showed that the level of vitamin D3 could be a good predictor of hemoglobin A1c after adjusting for confounding variables affecting the hemoglobin A1c (regression coefficient: 0.442, 95% CI, 0.072-0.811, p = 0.063). Conclusions: With the alarming rates of vitamin D deficiency in patients with T2D, there was a significant direct association between vitamin D3 and hemoglobin A1c levels before and after adjusting for the associated factors. [ABSTRACT FROM AUTHOR]

BACKGROUND: War veterans are at risk for obesity, metabolic syndrome and diabetes mellitus because of specific mental and physical status, and underlying disorders. Also, due to lower exposure to sunlight they are at risk of vitamin D deficiency. OBJECTIVE: We aimed to investigate the relationship between vitamin D levels and obesity and metabolic syndrome in veterans in order to identify nutritional deficits, improve metabolic status and reduce the risk of related diseases. METHODS: Demographic information, anthropometric parameters and blood tests (FBS, HbA1C, TG, HDL, vitamin D3) of veterans referring to the weight disorder clinic during 2017 to 2018 were collected. RESULTS: 339 veterans were included. The mean BMI was 30.4±6.7 kg/m2. 80.5% of this population had vitamin D deficiency and it was associated with weight, TG, LDL, FBS, HbA1C, metabolic syndrome, dyslipidemia and Diabetes. In multivariate analysis, there was a significant relationship between obesity and hypovitaminosis D (P < 0.05). CONCLUSIONS: The prevalence of vitamin D deficiency, metabolic syndrome and obesity is high among veterans. Despite non-significant relationships, risk of metabolic syndrome is higher in patients with hypovitaminosis D. Hence, prevention, diagnosis and treatment of vitamin D deficiency in veterans seems to be necessary. [ABSTRACT FROM AUTHOR]

Background: A number of studies investigated the general practitioners' and family physicians' knowledge, attitude, and practice (KAP) on diabetes. However, studies on internists' KAP on diabetes management are limited. This study aimed to investigate the Iranian internists' KAP on diabetes mellitus and its management. Methods: A cross-sectional study was conducted on a random sample of internists who participated in the 26th annual congress of internists in Tehran, Iran. The level of KAP and affecting factor was evaluated by a validated instrument. Results: One-hundred internists with the mean age of 41.98±9.26 years were evaluated. Totally, the physicians possessed 66.29%±19.5%, 50.44%±19.39%, and 64.5%±15.3% of the scores in KAP, respectively. The time since graduation in general medicine had significant negative correlation with their knowledge and practice, that was along with the subjects' age (P<0.05). The KAP level had not significant difference between subjects participated in a continuing medical education (CME) program during the last year compared to subjects did not participated (P>0.05). Attitude, and practice scores were significantly higher in physicians who were working at diabetes clinic (P<0.05), and attitude was more in physicians working at teaching hospitals compared to those who were not working (57.82 vs. 47.72, P=0.020). Conclusion: According to our results, subjects' age and time since graduation in general medicine and specialty were inversely correlated by knowledge and practice. So internists with older age seems to be in priority for educational programs. And holding CME programs in current forms seems to be not suitable to increase the KAP regarding diabetes. [ABSTRACT FROM AUTHOR]

Background: The results of the studies on the effects of sodium on bone metabolism have been inconsistent. There is no definitive answer to the question of whether sodium restriction can be associated with a lower incidence of osteoporosis. What reinforces the necessity of designing this study is the lack of findings with the approach of examining the effects of sodium on bone in our country. Methods: This was a cross-sectional study conducted on 185 retired female teachers aged 45 to 70. Sodium intake was evaluated using two methods: A 24-hour recall and a 12-hour urine sample. To assess bone health, ORAI index was calculated for each individual. Urinary calcium, phosphorus, potassium and serum vitamin D and PTH were measured as laboratory variables. To compare the general characteristics of the participants across tertiles of urinary sodium, the analysis of variance (ANOVA) was used for quantitative variables and the Chi-square test for categorical variables. Results: Phosphorous, calcium and potassium urinary excretion rate increased with the increase in urinary sodium (p<0.05). However, the changes in serum vitamin D, and PTH levels across tertiles of urinary sodium were not significant. Changes in urinary sodium levels were not significant (p=0.933) in ORAI groups (sorted by rating). The relationship between urinary calcium and sodium was apparent in low calcium intake (r=0.415, p<0.001), but not in higher calcium intake (r=0.144, p=0.177). Conclusion: Although urinary calcium and potassium increased with the increase in sodium intake, no relationship was found between sodium and ORAI. [ABSTRACT FROM AUTHOR]

Summary Aim Recent studies highlight barriers of diabetes educational programs in Iran and also present some successful experiences carried out for improving the knowledge, attitude, and practice (KAP) of type-2 diabetic patients. Hence, evaluation of patients’ KAP seems to be needed. We designed a multicenter study evaluating level of KAP in type-2 diabetic patients in the capital city of Tehran and identifying variables that affect this KAP level. Methods This multicenter analytical cross-sectional study was approved by Shahid Beheshti University of Medical Sciences Ethics Committee. Questionnaires were designed for evaluation of diabetes-related KAP in patients. After validating the questionnaires by endocrinologists, test–retest method was used for questionnaire reliability by checking in 15 diabetic patients. Two hundred type-2 diabetic patients admitted to 4 hospitals of Tehran filled out the questionnaires. Using SPSS software, the level of KAP and its confounders were evaluated in patients. Results Two hundred type-2 diabetic patients with the mean age of 60.17 years were evaluated (106 male and 94 female). The mean diabetes duration was 13.06 years. The levels of patients’ good knowledge, attitude, and practice were 61.41%, 50.44% and 52.23%, respectively. Age, treatment methods, DM duration, and existence of diabetic retinopathy had significant correlations with KAP level. Conclusions The results of this study showed that recent educational programs in Iran improved KAP level. Patients’ KAP increases as their condition worsens/progresses. Hence education should be considered as a priority for newly diagnosed patients and those with lower KAP levels before occurrence of diabetes complications. [ABSTRACT FROM AUTHOR]

Introduction: Osteomyelitis is one of the complications of diabetic foot infection. The present study aimed to evaluate the diagnostic value of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) in detection of osteomyelitis in patients with diabetic foot., Methods: In this cross-sectional study, serum levels of ESR and CRP were measured for patients with diabetic foot referring to emergency department or endocrinology clinic and the screening performance characteristics of these markers in detection of osteomyelitis were calculated. The diagnosis of osteomyelitis was based on clinical examination and positive probe-to-bone test, which was confirmed by plain x-rays or MRI., Results: 142 diabetic patients with an average age of 61.2 ± 11.8 years were evaluated (66.2 % male). The area under the ROC curve of ESR in detection of osteomyelitis in diabetic foot cases was 0.70 (95% CI: 0.62-0.79). The best ESR cut-off point in this regard was 49 mm/hour. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ESR in 49 mm/Hour cut-point were 74.6% (95% CI: 62.9-83.9), 57.7% (95% CI: 45.5-69.2), 63.9% (95% CI: 52.5-73.9), 69.5 % (95% CI: 56.0-80.0), 1.8 (95% CI: 1.3-2.4) and 0.4 (95% CI: 0.3-0.7), respectively. The area under the ROC curve of CRP in detection of osteomyelitis was 0.67 (95% CI: 0.58-0.76). The best cut-off point for CRP in this regard was 35 mg/liter with sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of 76% (95% CI: 64.2-85), 54.9% (95% CI: 42.7-66.6), 62.8% (95% CI: 51.6-72.8), 69.6% (95% CI: 51.7-80.8), 1.7 (95% CI, 1.3-2.2), and 0.4 (95% CI: 0.3-0.7), respectively., Conclusion: Based on the findings of ROC curve analysis, ESR and CRP had fair and poor accuracy, respectively, in detecting the diabetic foot cases with osteomyelitis.

Objectives: Thalassemia major (TM) is one of the most common blood disorders with a high mortality rate due to cardiovascular disease. Vitamin D deficiency has been suggested to implicate in cardiac abnormalities. In this prospective study, we aimed to investigate the relationship between serum levels of vitamin D and tissue Doppler (TD) echocardiographic indices in thalassemia major patients., Methods: A total of 81 TM patients, including 56 females and 25 males, with a mean age of 27.5± 6.8 years, were enrolled consecutively. Serum levels of vitamin D and other biomedical parameters were measured. Then, all patients were subjected to TD echocardiography. Correlations between the serum parameters and systolic and diastolic indices were examined., Results: The serum level of vitamin D was correlated with systolic and diastolic indices such as the EF (r= 0.33, P= 0.003) and TD Imaging (TDI)-lateral (r= 0.31, P= 0.005). However, no correlations were observed between vitamin D deficiency and the LV septal and posterior wall thickness, TDIseptal, tricuspid regurgitation peak gradient (TRPG), pulmonary artery systolic pressure (PASP), deceleration time (DT), and propagation velocity (PVcm/s) indices. The results revealed also no linear correlations between serum vitamin D and albumin (r= -0.17, P= 0.06), ALP (r= -0.12, P= 0.14), T4 (r= -0.11, P= 0.16), as well as TSH (r= -0.10, P= 0.19)., Conclusion: It seems that vitamin D deficiency in patients with TM is associated with systolic but not diastolic dysfunctions, possibly as consequences of related biochemical abnormalities., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objectives: This study aimed to assess the prevalence of gestational diabetes mellitus (GDM) based on two sets of criteria, namely the old criteria suggested in 2009 by the American Diabetes Association and new criteria of the International Association of Diabetes in Pregnancy Study Group. We also evaluated the predictive power of the risk factors of GDM., Methods: Pregnant women from three outpatient clinics in Tehran, Iran, participated in this cross-sectional observational study. During the first perinatal visit, demographic data, medical histories, weight, and height of mothers were recorded. The mother's fasting glucose and glycosylated hemoglobin were measured. An oral glucose tolerance test was also performed. The prevalence of GDM, based on the two criteria, was estimated and its predictive factors were investigated., Results: Of 1,117 pregnant women, 156 (15.6%) and 71 (7.1%) patients had GDM based on the new and old criteria, respectively. Multivariate analysis showed that older age at pregnancy (OR = 1.05; 95% CI: 1.006 - 1.107; P = 0.03), higher body mass index (OR = 1.2; 95% CI: 1.15 - 1.3; P < 0.001), family history of diabetes (OR = 1.97; 95% CI: 1.11 - 3.5; P = 0.02), and history of macrosomia (OR = 7.8; 95% CI: 1.96 - 30.9; P = 0.004) were independent predictive factors for GDM., Conclusions: Using the new criteria, the prevalence of GDM increases by 2.2 folds compared to the old criteria. Several factors can independently predict the occurrence of GDM., Competing Interests: Conflict of Interests:The authors have no conflict of interest., (Copyright © 2019, International Journal of Endocrinology and Metabolism.)

Melatonin is widely available as over the counter product. Despite promising effects of melatonin supplementation on glycemic control, there is a significant heterogeneity between studies. The current study aimed at determining the effect of melatonin on fasting blood glucose (FBG), insulin resistance/sensitivity indices, glycosylated hemoglobin A1c (HbA1c), and high sensitivity C-reactive protein (hs-CRP) among type 2 diabetes mellitus (T2D) population during 8 weeks in a randomized, triple-blind, placebo-controlled trial. Thirty four subjects with the mean age ± standard deviation of 57.74 ± 8.57 years and 36 subjects with the mean age of 57.61 ± 9.11 years were allocated to 6 mg nightly melatonin and placebo groups, respectively. Melatonin and placebo groups were matched by age, gender, body mass index, and duration of diabetes. Also, there was no significant difference in laboratory findings except for HbA1c, which was lower in the placebo group (7.00 ± 0.89% vs 7.60 ± 1.47%, P =0.042). After trial completion, the increase of serum levels of melatonin was greater in the intervention than the placebo group (3.38 ± 1.33 vs 0.94 ± 1.28 ng/L, P =0.192). Moreover, compared to placebo group, among melatonin users, homeostasis model assessment of insulin resistance (HOMA1-IR) tended to be unfavorable at the end of follow-up [-0.51 (-1.76-0.81) vs. 0.28 (-1.24-1.74), P =0.20]; the similar trend was also shown for insulin sensitivity index (HOMA1-S) [2.33 (-3.59-12.46) vs. -2.33 (-10.61-9.16), P =0.148]. No differences were observed in FBG, HbA1C, and hs-CRP changes between the trial groups. The current study did not support the improving effect of melatonin on glucose homeostasis.