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Background: A possible relationship between thyroid hormones and glucose metabolism in diabetes has already been established. Objectives: We aimed to evaluate the thyroid function markers and their relationship with inflammation, which is considered as a pathogenic condition of diabetes. Methods: This cross-sectional study included 276 patients with type 2 diabetes. Serum levels of thyroid (TSH, FT4, and FT3) and inflammatory markers (CRP, IL-6, and TNF-α) were measured. Results: The mean age of the subjects was 55.2 years and mean diabetes duration of 16.8 years. The inflammatory markers showed significant differences with the tertiles of TSH and thyroid hormones. TSH was significantly correlated with inflammatory markers, IL-6 (r = 0.13, P = 0.020) and TNF-α (r = 0.17, P = 0.003), while FT4 had a correlation only with TNF-α (r = 0.25, P = Conclusion: Abnormalities in the thyroid hormone metabolism are related to the increased inflammatory activity as well as insulin resistance, and are associated with the disorders of glucose metabolism.

Background/aim In recent years, the diagnostic utility of urinary protein levels has been demonstrated for the early detection and progression of kidney disease. This study aimed to evaluate the associations of the non-albumin protein (NAP) with different urinary marker for tubular and glomerular damage in patients with type 2 diabetes (T2D). Methods In this observational cross-sectional study, 424 patients with T2D duration > 10 years were classified into two groups according to estimated glomerular filtration rate (eGFR). The ratios of different urinary markers (albumin, NAP, total protein, transferrin, retinol-binding protein (RBP), and neutrophil gelatinase-associated lipocalin (NGAL) to creatinine were analyzed. Results The levels of urinary biomarkers increased significantly with decrease in eGFR levels. In the group with moderately decreased eGFR, the albumin to-creatinine ratio (ACR), non-albumin protein-to-creatinine ratio (NAPCR), and total protein-to-creatinine ratio (PCR) were independently associated with all urinary markers after being adjusted for risk factors. The area under the receiver operating characteristics (ROC) curve for ACR and PCR had a better diagnostic value than other urinary biomarkers. Comparing ROC curve of NAPCR with other urinary biomarkers, it was significantly better than NGAL/Cr (p = 0.033). Conclusions The findings of the present study confirm that ACR and PCR are diagnostic biomarkers in T2D patients with decreased eGFR. NAPCR in these patients diagnostically only outperformed NGAL/Cr.

Background Primary Empty Sella (PES) syndrome is an increasingly common disorder, mostly diagnosed as an incidental finding during brain imaging scans. We intended to review the clinical management and hormonal profile of patients with PES. Methods The study included ten-year retrospective analysis of registry containing PES cases in the period 2007 to 2017, from a single tertiary care center. The keyword ‘primary empty sella’ was used to retrieve patient details from the radiology unit. The clinical and biochemical profile of PES patients was analyzed. Case management of PES patients and their rate of referral to endocrinologists was explored. Results The registry had 765 cases with a male: female ratio of 1:3.8 suggesting female predominance by almost four times. Although not significant, the onset of disease was earlier for males [Mean ± standard deviation (SD) (46.7 years ±17.3 vs 48.8 years±14.1), p = 0.110]. Almost 79% of the cases were found as an incidental finding during Magnetic Resonance Imaging. Of the total PES cases, only 20% were referred to the endocrinologists and the rest were handled by general physicians. Only 1–2.5% of the cases were evaluated for gonadal, growth and adrenal hormones by the general physicians. The hormonal evaluation by the endocrinologists was also found to be sub-optimal. Headache and visual disturbances were the most common presenting complaints followed by menstrual abnormalities. Endocrine abnormalities like thyroid dysfunction, hyperprolactinemia, hypogonadism and hypocortisolism were highly prevalent among those assessed. Conclusion There is a gross under-evaluation of hormonal assessment and minimal case-referral to Endocrinologists. PES is associated with varying degrees of hormonal dysfunction, and hence early assessment and management is needed. Establishing a standard protocol for diagnosis and case management is essential with the involvement of a multidisciplinary team consisting of endocrinologists, neurologists, primary care phys icians and ophthalmologists.

Background Diabetes-related complications can be prevented by maintaining good glycemic control. Despite huge efforts to obtain acceptable glycemic control among diabetics, this has not yet been achieved. Thus, there is a need to discover all factors that might affect glycemic control. Here, our main aim was to assess the association between self-awareness of Hemoglobin A1c (HbA1c) among Saudi patients with type 2 diabetes and glycemic control, thereby identifying those factors that might affect the glycemic control. Methods The data for this study was collected using questionnaires through interviews among 600 patients with type 2 diabetes. The study was conducted in outpatient diabetes clinics in tertiary hospitals in Riyadh, Qassim and Jeddah, Saudi Arabia. The data collection was done during the period from March and April 2018. The subject’s self-awareness about the HbA1c test was assessed based on the combined score of four questions. The latest HbA1c result before the time of data collection was obtained from medical records. Frequencies and percentages were calculated for all categorical variables used in the analysis. Means and standard deviations were calculated for continuous variables. A p-value of less than 0.05 was considered statistically significant for all analyses. Results The mean age of the respondents was 54.7 years, and the mean duration of diabetes was 11.9 years. The prevalence of HbA1c self-awareness was approximately 40%. Overall, 63.9% accurately reported their Hemoglobin A1C Self-Knowledge (HbA1csk). The prevalence of good glycemic control (defined as HbA1c less than 7.0%) was 21.0%. Five of the participants’ characteristics were associated with better glycemic control: good HbA1c self-awareness (OR = 3.25, 95%CI: 1.15–9.24), duration of diabetes (negatively associated with glycemic control) (OR = 0.91, 95%CI: 0.87–0.95), discussed HbA1c target with the health care provider (OR = 2.42, 95%CI: 1.22–4.79), monthly income between 10,001 and 15,000 SR (OR = 2.28, 95%CI: 1.13–4.60), and number of follow up visit (OR = 0.77, 95%CI: 0.63–0.94). Conclusions We conclude that there is a positive association between HbA1c self-awareness and glycemic control. Glycemic control was good among those who were educated about the meaning of the test, their levels, and their target goal. Awareness among health care providers regarding the role of the patient’s education about their condition might help in providing the patient with optimal care. Further studies with different experimental designs are needed to study this association, which will contribute to the development of a structured educational program.

Background The Bethesda System for Reporting Thyroid Cytolopathology (TBSRTC) is the standardized category-based reporting system for thyroid nodule (TN) aspirations; however, atypia of undetermined significance/follicular lesion of undetermined significance (Bethesda category III, AUS/FLUS) is the most controversial category. The aim of this study was to identify the degree of malignancy risk and the related risk factors in the surgical pathology of the Bethesda Category III thyroid nodules. Methods A total of 4074 patients (15-90 years, 81.5% of females) were subjected to retrospective analysis, and a total of 463 nodules were classified as Bethesda Class III and included in the analysis. Once all the thyroid cytopathological slides and ultrasound (US) reports were reviewed, they were classified according to the Bethesda System for Reporting Thyroid Cytology, the American College of Radiology (ACR) and the Thyroid Imaging Reporting and Data System (TI-RADS). Results Among the 463 Bethesda class III nodules, 167 nodules were surgically excised, showing an overall malignancy of 27.6% (n = 46/167). Patients having thyroid-stimulating hormone (TSH) levels of >4.5 mIU/L (35%), TN

Background: High prevalence of undiagnosed cases of diabetes mellitus (DM) has increased over the last two decades, most patients with DM only become aware of their condition once they develop a complication. Limited data are available regarding the knowledge and awareness about DM and the associated risk factors, complications and management in Saudi society. Aim: This study aimed to assess knowledge of DM in general Saudi society and among Saudi healthcare workers. Results: Only 37.3% of the participants were aware of the current DM prevalence. Obesity was the most frequently identified risk factor for DM. Most comparisons indicated better awareness among health workers. Conclusion: A significant lack of knowledge about DM in Saudi society was identified. Social media and educational curriculum can improve knowledge and awareness of DM.

Summary Central diabetes insipidus (CDI) and several endocrine disorders previously classified as idiopathic are now considered to be of an autoimmune etiology. Dermatomyositis (DM), a rare autoimmune condition characterized by inflammatory myopathy and skin rashes, is also known to affect the gastrointestinal, pulmonary, and rarely the cardiac systems and the joints. The association of CDI and DM is extremely rare. After an extensive literature search and to the best of our knowledge this is the first reported case in literature, we report the case of a 36-year-old male with a history of CDI, who presented to the hospital’s endocrine outpatient clinic for evaluation of a 3-week history of progressive facial rash accompanied by weakness and aching of the muscles. Learning points: Accurate biochemical diagnosis should always be followed by etiological investigation. This clinical entity usually constitutes a therapeutic challenge, often requiring a multidisciplinary approach for optimal outcome. Dermatomyositis is an important differential diagnosis in patients presenting with proximal muscle weakness. Associated autoimmune conditions should be considered while evaluating patients with dermatomyositis. Dermatomyositis can relapse at any stage, even following a very long period of remission. Maintenance immunosuppressive therapy should be carefully considered in these patients.

Background and objectiveThis study aimed to determine the validity of using a single-question self-report of erectile dysfunction (ED) as a screening tool among Saudi men with type 2 diabetes mellitus (T2DM). Materials and methodsA cross-sectional study was conducted using a single-question self-report questionnaire to determine the association between the risk of ED and poor glycemic control among men with T2DM. The study was conducted in a hospital-based diabetes clinic in Riyadh, Saudi Arabia. Married adults (aged >18 years) suffering from T2DM for at least 1 year were included in the study. All statistical analy-ses were performed using SAS version 9.2 and R software (Foundation for Statistical Computing, Vienna, Austria). ResultsWith 86% response rate, 293 participants were included in this study. Over half (53.9%) of the partic-ipants were below 60 years of age. More than half (55.3%) were suffering from uncontrolled diabetes (i.e., HbA1c > 7%). There was significant correlation between the International Index of Erectile Function (IIEF) and self-reported question in terms of duration of T2DM (p < 0.001), type of treatment (p = 0.004), income of the participants (p = 0.005), age (p < 0.001), education level (p = 0.032), and occupation (p < 0.001). However, there was no significant correlation between IIEF and self-reported question in terms of body mass index (p = 743) and smoking. Regarding overall diagnostic accuracy of IIEF score to predict self-reported ED, receiver operating characteristic curve showed area under curve as 89.4%, which is sta-tistically significant. ConclusionSingle-question self-report of ED is a valid and reliable tool to screen diabetic patients suffering from sexual problems. Such tool may help to identify ED in diabetic patients and warrant early management.

Type-2 diabetes (T2D) is associated in observational studies with both higher bone mineral density (BMD) and higher fracture risk for given BMD. These relationships may however be confounded by factors such as body mass index (BMI). Here we used Mendelian randomization (MR) to obtain non-confounded estimates of the effect of T2D and glycemic traits on BMD. We identified genetic variants strongly associated with T2D risk (34,840 T2D cases and 114,981 controls) and fasting glucose (133,010 nondiabetic individuals), but not associated with BMI, and determined the effects of these variants on BMD (up to 83,894 individuals). Using these variants as instrumental variables, we found that a genetically-increased risk of T2D increased femoral neck BMD (+0.034 SD in BMD per unit increase in log-odds of T2D [95% CI, 0.001 to 0.067; p = 0.044]). Genetically-increased fasting glucose also increased femoral neck BMD (+0.13 SD in BMD per mmol/L increase in fasting glucose [95% CI, 0.01 to 0.25; p = 0.034]). Similar nonsignificant trends were observed for the effects of T2D and fasting glucose on lumbar spine BMD. Our results indicate that both genetically-increased T2D risk and genetically-increased fasting glucose have weak positive effects on BMD. © 2016 American Society for Bone and Mineral Research.

The current recommended cutoff value for low vitamin D may result in overestimation of hypovitaminosis D. Vitamin D levels at 30.0 nmol/L can diagnose the hyperparathyroid cases leading to bone loss, with moderate accuracy, in the Saudi population. The new cutoff may help in identifying true cases that need clinical treatment and can reduce the burden on healthcare system. Different regions of the world have reported varying cutoff points as optimal values for vitamin D status to maintain bone health. A cross-sectional study comprising of interviews, anthropometrics, and blood samples was conducted in primary healthcare centers in Riyadh, Saudi Arabia. Standardized serum 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) were measured using electrochemiluminescence immunoassays. Independent sample and paired sample t test were conducted to compare the true means. Pearson correlation co-efficient was calculated to measure the association between original and standardized 25(OH)D. Software program, MedCalc, was utilized to measure the receiver operating curve (ROC) for determining the optimal threshold value for vitamin D. The mean standardized 25(OH)D levels for 846 males and 1285 females were (32.0 ± 14.4 nmol/L vs 31.6 ± 16.7 nmol/L) respectively. Using the gold standard PTH cutoff > 6.9 pmol/L, the ROC had an optimal criterion value for males and females at 30.0 and 24.0 nmol/L, respectively. In the males, the sensitivity and specificity were 72% and 51%, whereas in females, it was 58.2% and 66.7%, respectively. The area under the curve (AUC) was at 0.62 and 0.65 (p

The coronavirus disease of 2019 (COVID-19) pandemic significantly affected different life aspects, including healthcare communities and academic institutes. We aimed to assess the level of stress and risk factors among medical students and interns during the COVID-19 pandemic in the setting of the middle east respiratory syndrome -CoV endemic area.A questionnaire-based cross-sectional study was conducted on a randomly selected sample of medical students and interns. The questionnaire was anonymously self-administered to indicate perceive hygienic practice change, importance of viral prevention domestic hygiene, perceive adequacy of received information, perceived agreement to facilitators to alleviate covid stress, self-reported stress level, and generalized anxiety disorder score.A total of 322 returned the questionnaire (69.7% response rate). Participants had good knowledge regarding severe acute respiratory syndrome -CoV2 in multiple aspects, with an average score of 13.8 out of 14. Two-thirds (62.4%) of the students experienced mild anxiety, (23.9%) had moderate anxiety, (6.8%) had clinically high anxiety level, and another (6.8%) had a clinically very high anxiety level. The stress level, as reported by the respondents (on a 1-10 scale), showed a correlation with the Generalized Anxiety Disorder scale. We observed an increased level of social avoidance and hygienic practice facilitated by availability of hand sanitizers. Majority of the students receive information regarding COVID-19 from reliable and official resourcesMost students reported mild to moderate levels of anxiety, and was associated with enhancement of their universal precaution measures. The availability of alcohol-based hand sanitizers and the off-campus study were great relievers. The importance of reliable pandemic resources in educating students during pandemics is emphasized. Furthermore, this study indicate the importance of students' support services to address mental health and students' wellbeing in the era of pandemics.

Background: The study considered the long-term outcome of patients with papillary thyroid carcinoma treated with 30 mCi radioiodine. Objective: The aims of this study were to define and compare the remission rates of papillary thyroid carcinoma ablated with 30 mCi 131I prepared by either thyroid hormone withdrawal (THW) or recombinant human thyrotropin (rhTSH; Thyrogen®), and to identify variables predictive of a favorable prognosis. Method: An observational study was conducted at an academic medical center and a comparative summary of six studies is presented. Three hundred and seventy patients (THW group, n = 203; rhTSH group, n = 167) were recruited from a prospectively managed registry. The mean follow-up was 9.3 years (range 5.1–15.8 years) in the THW group and 7.1 years (range 5.0–9.7 years) in the rhTSH group. The primary endpoint was the long-term remission rates (no evidence of disease) in the THW group compared with the rhTH group. Results: The response at 12–18 months after 30 mCi remnant ablat...

In observational studies, type-2 diabetes (T2D) is associated with an increased risk of coronary heart disease (CHD), yet interventional trials have shown no clear effect of glucose-lowering on CHD. Confounding may have therefore influenced these observational estimates. Here we use Mendelian randomization to obtain unconfounded estimates of the influence of T2D and fasting glucose (FG) on CHD risk. Using multiple genetic variants associated with T2D and FG, we find that risk of T2D increases CHD risk (odds ratio (OR)=1.11 (1.05–1.17), per unit increase in odds of T2D, P=8.8 × 10−5; using data from 34,840/114,981 T2D cases/controls and 63,746/130,681 CHD cases/controls). FG in non-diabetic individuals tends to increase CHD risk (OR=1.15 (1.00–1.32), per mmol·per l, P=0.05; 133,010 non-diabetic individuals and 63,746/130,681 CHD cases/controls). These findings provide evidence supporting a causal relationship between T2D and CHD and suggest that long-term trials may be required to discern the effects of T2D therapies on CHD risk., In order to effectively design interventions, it is useful to understand the complex interplay between multiple syndromes. Here, Ahmad et al. use genome-wide association study data and Mendelian randomisation to examine the influence of Type 2 diabetes and fasting glucose levels on coronary heart disease.

Introduction: The term collision tumor refers to the coexistence of two histologically distinct neoplastic tumors within the same mass. Collision tumor of the thyroid (also referred to as tumor-to-tumor metastasis) with metastatic colorectal carcinoma to a preexisting thyroid adenomatoid nodule is rare. Preoperative diagnosis of this disorder is exceedingly difficult. This report highlights the rare occurrence of a tumor-to-tumor metastasis of colorectal cancer to a preexisting thyroid adenomatoid nodule unveiled in real time by serial positron emission tomography CT scans (PET/CT). Since cytological diagnosis of these lesions is often insufficient, we present a stepwise diagnostic approach with a combination of investigations in the preoperative setting. The patient management is reviewed together with a rationalized use of targeted therapy based on the genetic status of the tumor. Methods: Ultrasound (US)-guided fine needle aspiration (FNA) biopsies of the collision tumor of thyroid were performed and analyzed for cytologic, immunologic, and molecular tumor phenotyping. KRAS gene analysis of the metastatic lesion was also performed. Results: The samples revealed adenocarcinoma of the colon (Tg-negative, TTF-1-negative, HBME-1-negative, galectin-3 negative, CEA-positive, CK-20 positive) intense glucose transporter-1(GLUT-1) expression and KRAS positivity. The patient was then brought to surgery for a left hemithyroidectomy and ipsilateral central compartment node dissection. Final histology revealed metastatic colonic carcinoma, invading the benign adenomatoid nodule. His recovery was uneventful and the post-op chemotherapeutic regimen was guided by the KRAS analysis of the tumor. Conclusion: Once a collision tumor of the thyroid gland is suspected on PET/CT, the lesion should be corroborated by sonography of the thyroid gland. FNA with combined cytological, immunocytochemical and when necessary KRAS gene analysis can lead to a timely diagnosis and a treatment plan. In the context of limited systemic malignant disease and good performance status, palliative thyroidectomy with or without combined chemotherapy may control local disease and prevent tracheal invasion.

AIM To determine the clinical and biological characteristics of double diabetes (DD) among young people in Saudi Arabia. METHODS This was a retrospective descriptive chart review study including 312 young newly diagnosed diabetic patients (aged 12-20 years), whom were admitted over a five year period (January 2009 to December 2013). Family history of diabetes mellitus (DM) (first degree), physical body mass index (BMI), acanthosis nigricans, history of auto-immune disease and laboratory information for glycosylated hemoglobin, basal C peptide level and diabetes autoantibody response (anti-GAD, anti-IA2 and anti-ICA) were collected from medical report. A mean follow-up of 3 years for these patients was performed. RESULTS Patients were categorized into 4 groups, based on the autoantibody response (Ab+ or Ab-) and C-peptide secretion (β+ for fasting level 0.4-2.1 ng/mL and β- if < 0.4 ng/mL). Group1 (type 1a): Ab+ β- (21%), group 2 (type 1b): Ab- β- (9%), group 3 (DD): Ab+ β+ (31%) and group 4 (classic type 2 DM): Ab- β+ (39%). The mean age of the DD patients in our study was 15.1 ± 6.4 years. A total of 41% of the study population presented with diabetic ketoacidosis and 61% of the study population presented with positive family history of DM. The mean BMI was 26.8 kg/m2 with 64% of overweight or obese patients. Ninety two percent of the patients were started on insulin at the time of diagnosis. During a mean follow-up of 3 years, only 32% of the patients with DD required insulin and 78% were on metformin alone or with insulin. CONCLUSION Our findings enable us to arrive at the conclusion that almost one-third of the young Saudi diabetic patients reveal atypical forms of DM (double diabetes) expressing features resulting from both T1D and T2D.