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Objectives This study aimed to investigate the possible association of neck circumference with cardiometabolic risk factors, and to find out the possible cutoff points of neck circumference for the diagnosis of metabolic syndrome among the Iranian population. Method This is a cross-sectional study in 1619 participants who were selected through clustered random sampling, as a part of a health cohort in Amol, Iran. Diagnosis of metabolic syndrome (MetS) was based on the modified criteria of the National Cholesterol Educational Program Adult Treatment Panel (NCEP ATP III). Associations of neck circumference with Mets and its components were studied using logistic regression. The optimal cutoff point of neck circumference for MetS diagnosis was calculated based on the Youden index. Results Metabolic syndrome was diagnosed in 433 (26.7%) of patients. Neck circumference was shown to be significantly associated with central obesity, hypertension, hypertriglyceridemia, impaired fasting glucose, and low serum high-density lipoprotein (HDL) level, as well as MetS. The optimal cutoff points of neck circumference in the diagnosis of MetS are 36 cm and 42 cm for women and men, respectively. Sensitivity of the optimal cut-off point of NC for diagnosing patients with MetS was higher in women compared to men (70.6% compared to 55.9%). Conclusion A significant association was observed between neck circumference and the presence of MetS among the Iranian population and neck circumference can be offered as a new index in screening and diagnosis for MetS and assessing cardiometabolic risk factors.

Objective Pregnancy is associated with insulin resistance in tissues. Although this condition is resolved after termination of pregnancy, subtle metabolic changes can remain and prompt incidence of metabolic syndrome. However, lactation causes increased metabolic load and energy needs and it may confer with unfavorable effects of pregnancy in metabolic status. We conduct this study to evaluate impacts of lactation on development of metabolic syndrome (MetS) among women. Study design In this cross-sectional study, we enrolled 978 women aged between 40 and 70 years who had at least one previous live birth, referred to population research center of Amol, Iran in 2011. We surveyed medical registries of participants of Amol health cohort and filled the checklist we had designed for our study. The checklist included main variables like age, number of pregnancies, life-time lactation duration, waist size, systolic and diastolic blood pressures, blood triglyceride level, and blood glucose level. Results We included 978 women among which, the mean age of participants was 53.24±7.8 years. Calculated odds ratio (OR) for relationship of number of parities and metabolic syndrome (OR=1.14 [95% CI=1.02–1.28] p -value=0.017) was found to be statistically significant. However, calculated odds ratio for relationship of lactation duration and MetS (OR=0.99 [95% CI=0.99–1.00], p -value=0.322) was not statistically meaningful. Moreover, we calculated OR and Pearson correlation coefficient in different strata of number of parities, none of which were statistically significant and hence did not support protective roles of lactation in development of metabolic syndrome. Conclusions Our data did not support protective roles of lactation in development of metabolic syndrome, since in our study longer lactation durations as well as higher number of parities were seen among participants with metabolic syndrome.

BackgroundFrequency of insulin pen use, despite its higher costs, is increasing to substitute the traditional use of insulin vials. This study aims to report insulin pen use frequency and its associated factors among participants of the STEPS survey 2016 in Iran, which was conducted based on the World Health Organization (WHO) STEPS methodology.MethodsIn this cross-sectional study, 19,503 (mean age of 46.03±0.13) out of 30,541 participants of the Iran STEPS survey were included (Inclusion criteria: aged >25 years old and availability of their demographic, clinical, and laboratory results for serum glucose, HbA1c, and lipid profile). Clinical and demographic characteristics, a frequency of use of each diabetes mellitus treatment type, and the association of insulin pen use with health outcomes are reported using descriptive analysis and propensity score modeling.ResultsThere were 1,999(10.85%) individuals diagnosed with diabetes in the population, while 1,160(56.87%) cases were taking antihyperglycemic treatments. In this subset, 240(21.14%) individuals administered insulin with or without using oral agents at the same time. 52.28% of participants who were under insulin therapy used insulin pens. None of the socioeconomic determinants, including gender (p-value = 0.11), type of residential areas (p-value = 0.52), years of schooling (p-value = 0.27), wealth index (p-value = 0.19), marital status (p-value = 0.37), and insurance types (p-value = 0.72) were significantly different among groups using insulin pens and insulin vials. Moreover, in the propensity score modeling, pen usage was not associated with a lower heart attack and ischemic stroke histories, systolic blood pressure, serum lipid profile, blood glucose, or HbA1c levels.ConclusionResults showed that the use of the higher-costing insulin pens compared to traditional vials and syringes is not associated with improved glycemic control and better lipid profile in our sample. Future studies are needed to confirm these findings and to compare other aspects of insulin pen use, including adherence to treatment and cost-effectiveness.

Objective: Stress hyperglycemia is a transient increase in blood glucose during an acute physiological stress in the absence of diabetes. Stress hyperglycemia can be occurred in certain clinical conditions such as trauma, burns, sepsis and strokes in adults. In this study we aimed to evaluate the incidence of stress hyperglycemia among patients admitted to the Firouzgar hospital. Method: In this analytical cross sectional study, all patients who referred to emergency department of Firouzgar hospital due to one of the causes of trauma, myocardial infarction (MI), subarachnoid hemorrhage (SAH), head trauma, sepsis, CVA, and abdominal surgery and had stress hyperglycemia during 2012–2014 were evaluated. Blood glucose test including random blood sugar (BS) and glycosylated hemoglobin (HbA1C) was performed for patients at admission. Patients with BS>180 mgmg/dl and no previous history of diabetes were enrolled in this study. Patients were referred to endocrinology clinic after 3 months of the first test and were re-evaluated for diabetes mellitus. Fasting Blood Sugar (FBS), HbA1C and 2 h post glucose load test blood sugar were measured. Diabetes was confirmed if FBS was above 126 mg/dl or 2 h post glucose load BS was over 200 mg/dl. Result: A total of 98 (67 males & 31 women) patients enrolled in the study. No significant statistical relation found between mean of HBA1C at 3 months after admission and the background event (P=0.138). No statistical relation found between BMI and developing diabetes (P=0.352). 26 and 8 percent of the participants developed diabetes, and 25.8% were in pre-diabetic state. There was a statistical relation between gender and developing diabetes (P=0.027) and men developed diabetes more than women. Based on logistic regression the Odds Ratio (OR) was 1.017. Conclusion: Our study demonstrates a significant relationship between stress hyperglycemia and development of diabetes. Stress hyperglycemia could be a predicting factor of development of diabetes.

INTRODUCTION Patients with diabetes type2 should receive regular medical care. We aimed at investigating the association between the number of office visits and improvement of their cardiovascular-risk factors. METHODS Four hundred and ninety patients with type 2 diabetes mellitus who were followed in a tertiary center were enrolled in this longitudinal study. The minimum follow up period was 3 years. Patient data were extracted from manual or electronic records. RESULTS Sixty- four percent of cases were females, the mean age was 61 ± 12.45 years, and the mean disease duration was 6.5 ±7.9 years. The mean number of office visits was 2.69 ± 0.91 per year. Comparing the means of each of the cardio-vascular risk factors showed a significant decrease in all cardiovascular risk factors, while there was a significant weight gain over the same period. The association between changes in these parameters and the number of patients' office visits per year were not statistically significant. In patients with disease duration less than 5 years, each additional office visits by one visit per year was associated with a decrease in serum total cholesterol by 6.94 mg/dl. The mean number of office visits per year in patients older than 60 years old was more than younger patient (p = 0.001). CONCLUSION The decrease in the mean values of the investigated parameters was statistically significant between the first year of follow up and the following years. Yet, these changes were not related to the mean number of patients' office visits per year, which may reflect the poor compliance of patients to treatment regardless of the number of their office visits.

Normotensive hyperaldosteronism is a rare disorder. It is usually diagnosed with hypokalemia or an adrenal mass. Our patient was a 27-year-old female presented with weakness. She had normal blood pressure, hypokalemia, high plasma aldosterone level and suppressed plasma renin activity. After the saline load, test aldosterone didn't show suppression. Adrenal computed tomography revealed a left adrenal mass. The patient was treated with spironolactone and potassium supplement. Surgical adrenalectomy was done. Final pathologic diagnosis was benign adrenocortical adenoma without capsular invasion. In postoperative course serum, potassium was normal.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. These patients share common features like obesity with metabolic syndrome. C-reactive protein (CRP) is a low-grade chronic inflammation biomarker that independently predicts high-risk patients for cardiovascular diseases (CVD). Although many studies showed increased plasma CRP levels in patients with PCOS, there is still less evidence that can link obesity and CRP levels in patients with PCOS. The objective of this study was to investigate the relations between body mass index (BMI) and CRP plasma levels in patients with PCOS.Forty patients with PCOS and 30 controls matched by age and BMI were included. Blood sample was obtained from all individuals in early follicular phase of menstrual cycle. CRP, fasting blood sugar (FBS), triglyceride (TG), and total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), blood pressure, waist circumference (WC) and BMI was measured for all subjects.CRP and TG levels were higher in patients with PCOS (p 0.001 and p = 0.011, respectively). CRP level increased significantly only in patients with PCOS with BMI ≥ 25 kg/m(2) (p = 0.001) but was not significant in patients with PCOS with BMI 25 kg/m(2) (p = 0.067). In further analysis, BMI and WC affect CRP rising in patients with PCOS (p = 0.001).In patients with PCOS, serum CRP levels were higher than age and BMI-matched controls. Furthermore, BMI was strongly related to CRP only in overweight patients with PCOS.

Breast cancer is the most common cancer among females, worldwide, accounting for 22.9% of all cancers (excluding non-melanoma skin cancer) in females. Mammography is a sensitive (77-95%) and specific (94-97%) screening method for breast cancer. Previously, females between the 40-50 years old were recommended to have mammograms every one to two years. However, based on current evidence, in 2009, USPSTF recommended that the decision to start regular, biennial screening mammography for females younger than 50 years should be an individual decision and take patient context into account, including the patient’s values regarding specific benefits and harms. This decision was based on findings regarding radiation exposure, false-positive and false-negative rates, over-diagnosis, and pain and psychological responses. The goal of this paper is to focus on evidence for updating the U.S. Preventive Services Task Force (USPSTF) recommendation against routine mammography for females between 40-49 years of age.

Significant changes in thyroid function occur during pregnancy which can complicate the interpretation of thyroid function tests. Therefore, normative gestational related reference ranges for thyroid hormones tests are required. The aim of this study was to determine the reference ranges for free triiodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) in Iranian pregnant women.This study was a cross-sectional observational study conducted in the Obstetrics and Gynecology department, Akbarabadi University Hospital. A single blood sample from 584 pregnant women was analyzed for thyroid function. Serum levels of TSH, FT4, FT3, total T4 (TT4), T3 resin uptake (T3RU) and anti-thyroid peroxidase antibody (TPO Ab) were measured. Urinary iodine was determined in some cases. Reference intervals based on 2.5th and 97.5th percentiles were calculated.The composition of reference population comprising 584 women included 162 in first trimester and 422 in the third trimester. The 2.5th and 97.5th percentiles values were used to determine the reference ranges for FT3, FT4, TT4, T3RU and TSH. These values were T3 1.4 and 2.9 pmol/L, FT4 7.1 and 18 pmol/L, TT4 7.2 and 13.5 µg/dL and TSH 0.5 and 3.9 µg/L, respectively. The level of urinary iodine in 80.5% of the subjects was less than normal.Serum levels of thyroid hormones are different in Iranian population that could be due to racial differences or differences in iodine intake.