mohammad e. khamseh

The health-related quality of life and management of patients with thalassemia has significantly improved in recent years due to standard treatments and safe blood transfusions with effective chelation therapy to reduce iron overload. Transfusion-dependent thalassemia is associated with numerous skeletal abnormalities, including osteoporosis, which is a significant cause of morbidity in these patients. Osteoporosis is characterized by low bone mass and an increased risk of fractures, particularly in the lumbar spine and in patients with extramedullary hematopoiesis. It remains a significant problem in adult transfusion-dependent thalassemia, particularly in patients under chelation therapy. A fracture history is significantly associated with lower Dual-Energy X-ray Absorptiometry (DEXA) T/Z scores, which decrease with age. Improved management and modern treatments for transfusion-dependent thalassemia patients with osteoporosis should be prioritized to prevent bone fractures and improve quality of life in older age.

Introduction: 

Thalassemia, particularly α and β types, are characterized by mutations causing varied clinical manifestations such as anemia, skeletal deformities, and iron accumulation. Patients with transfusion-dependent thalassemia (TDTs) often face growth and puberty complications, which are influenced by the disease’s type and severity. These disruptions not only result from chronic anemia, iron chelation therapy, and endocrinopathies but also significantly impact the patient’s quality of life.

A comprehensive guideline was formulated through a systematic literature review and stakeholder engagements. The protocol emphasizes diagnosing and managing growth and puberty disorders in TDT patients, integrating consistent monitoring, documentation, and patient-specific assessments.

The guideline proposes a detailed monitoring schedule from birth to adulthood, focusing on growth velocity norms and referral criteria to pediatric endocrinologists. It outlines protocols for hormone treatments in cases of delayed or arrested puberty, with distinctions for boys and girls. The treatment approach is multidisciplinary, combining growth monitoring, hormone therapy, and potential surgical interventions. The complexities demand continuous management, with treatment plans tailored to individual patient needs.

The research provides a pivotal national protocol for addressing growth and puberty anomalies in TDT patients, aiming to enhance their well-being and standardize care. The emphasis on proactive, individualized strategies will bolster healthcare outcomes and reduce associated costs.

Mortality has been indicated to be high in patients with underlying diseases. This study aimed to examine the comorbidities is associated with a higher risk of death during the hospital course.   

We retrospectively evaluated the risk of in-hospital death in 1368 patients with COVID-19 admitted to 5 academic hospitals in Tehran between February 20 and June 13, 2020.  We also assessed the composite end-point of intensive care unit admission, invasive ventilation, and death. The Cox proportional survival model determined the potential comorbidities associated with deaths and serious outcomes.   

The retrospective follow-up of patients with COVID-19 over 5 months indicated 280 in-hospital deaths. Patients with diabetes (risk ratio (RR), 1.47 (95% CI, 1.10-1.95); P = 0.008) and chronic kidney disease (RR, 1.72 (95% CI, 1.16-2.56); P = 0.007) showed higher in-hospital mortality. Upon stratifying data by age, patients aged ˂65 years showed a greater risk of in-hospital death in the presence of 2 (hazard ratio (HR), 2.68 (95% CI, 1.46-4.95); P = 0.002) or more (HR, 3.47 (95% CI, 1.69-7.12); P = 0.001) comorbidities, compared with those aged ≥ 65 years.   

Having ≥ 2 comorbidities in nonelderly patients is associated with a greater risk of death during hospitalization. To reduce the mortality of COVID-19 infection, younger patients with underlying diseases should be the focus of attention for prevention strategies.

Papillary thyroid carcinoma is the most frequent type of thyroid cancer. The BRAFV600E mutation is associated with tumor progression. We explored the utility of the BRAF molecular testing on fine needle aspiration fixed specimens of patients with confirmed diagnoses of papillary thyroid carcinoma.  

Fixed thyroid cytology slide specimens of 19 patients with Bethesda II to VI reports were used to detect BRAFV600E mutation by pyrosequencing of extracted DNA.   

BRAFV600E mutation was detected in 25% of the specimens with Bethesda category III and IV nodules and in 73% of the nodules with Bethesda category V and VI.   

BRAF mutation analysis can be performed on fixed fine needle aspiration cytology specimens. Although the frequency of the mutation is higher in specimens with higher Bethesda category scores, it could support clinical decision-making in thyroid nodules with intermediate Bethesda category scores.

Obesity is a serious chronic disease that adversely affects health and quality of life. However, a significant percentage of people do not participate in or adhere to weight loss programs. Therefore, a multidisciplinary approach is needed to identify critical barriers to effective obesity management and to examine health practitioners’ attitudes and behaviors towards effective obesity treatment.

This systematic review was conducted in accordance with PRISMA 2020. Eligible studies were identified through a systematic review of the literature using Medline, Scopus, Cochrane, Google Scholar, Web of Science, and Embase databases from January 1, 2011 to March 2, 2021.

A total of 57 articles were included. Data on 12 663 physicians were extracted from a total of 35 quantitative articles. Some of the most commonly perceived attitude issues included “obesity has a huge impact on overall health”, “obesity is a disease” and “HCPs are to blame”. Health professionals were more inclined to believe in “using BMI to assess obesity,” “advice to increase physical activity,” and “diet/calorie reduction advice.” The major obstacles to optimal treatment of obesity were “lack of motivation”, “lack of time” and “lack of success”.

Although the majority of health care professionals consider obesity as a serious disease which has a large impact on overall health, counseling for lifestyle modification, pharmacologic or surgical intervention occur in almost half of the visits. Increasing the length of physician visits as well as tailoring appropriate training programs could improve health care for obesity.

Thalassemia major hemoglobinopathy requires regular blood transfusions, often leading to iron overload due to repeated transfusions and increased intestinal iron absorption. The association between thalassemia major and metabolic complications, including diabetes and metabolic syndrome, has been recognized due to iron overload, insulin secretion impairment, insulin resistance, hepatic dysfunction, and other endocrine complications. These hormonal imbalances can also influence glucose metabolism and contribute to the development of metabolic syndrome. It's essential for individuals with thalassemia major to undergo regular monitoring of their glucose metabolism, including periodic assessments of fasting blood glucose, oral glucose tolerance tests, and measurement of Fructosamine. Early detection and management of diabetes and metabolic syndrome in thalassemia major patients are crucial to minimize complications and optimize overall health. Medical management may involve a combination of regular blood transfusions, iron chelation therapy to reduce iron overload, lifestyle modifications such as a healthy diet and physical activity, and, if needed, pharmacological interventions for glycemic control. Close collaboration between hematologists and endocrinologists is often necessary to provide comprehensive care for individuals with thalassemia major and metabolic complications.

 The aim of this study was to compare moderate- versus high-intensity statin therapy in patients with type 2 diabetes and low-density lipoprotein (LDL) cholesterol less than 130 mg/dL.

 This was a randomized, open-label, parallel design trial comprised of 79 patients randomly allocated into two groups receiving high-intensity [atorvastatin 40 mg (A40) or rosuvastatin 20 mg (R20) daily] or moderate-intensity [atorvastatin 20 mg (A20) or rosuvastatin 10 (R10) mg daily] statins for eight weeks. The variables investigated were lipid profile, high sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6).

 The percentage of decrease in LDL levels (±SD) for the high-intensity group (-35.5±25.5) was significantly greater than the moderate-intensity group (-24.6±23.5) (P=0.04). While 38.1% (n:8) of patients receiving A20 and 55% (n:11) of those being on R10 achieved the targets of≥30% reduction in the LDL level, these figures were 63.2% (n=12) and 73.8% (n=14) for A40 and R20 subgroups, respectively. Subsequently, the likelihood of achieving LDL reduction≥30%, was significantly greater with high-intensity statin therapy (OR: 3.1, 95% CI: 1.09, 8.90, P=0.03). Logistic regression analysis also showed that for every 1 mg/dL increase in the baseline LDL level, the odds of achieving the LDL reduction≥30% increased by 1.04 times [95% CI: (1.01, 1.07), P=0.003].

 Despite the general conception, moderate-intensity statins are not adequate for the majority of patients with T2DM and mild hyperlipidemia and greater numbers of patients could reach the LDL cholesterol target with high-intensity statin therapy.

Iron overload can adversely affect thyroid and parathyroid function in patients with transfusion-dependent thalassemia. Iron deposition in both glands or the pituitary gland, which controls thyroid function, can lead to their destruction and dysfunction. Hypothyroidism can cause symptoms such as fatigue, weight gain, and depression, while hypoparathyroidism can cause symptoms such as numbness and tingling in the hands and feet, muscle cramps, and seizures. Regular thyroid and parathyroid function monitoring is essential in thalassemia patients to detect any dysfunction early and provide appropriate treatment. Treatment may include medications to replace thyroid hormone or calcium and vitamin D supplements to manage hypoparathyroidism. A comprehensive approach to managing endocrine complications in thalassemia patients can improve outcomes and quality of life for these individuals. To provide professional healthcare members with clear and concise recommendations for diagnosing and treating hypothyroidism and hypoparathyroidism in transfusion dependent thalassemia patients, a practical national guideline should be developed.

Detection of cancer in patients with thyroid nodules requires sensitive and specific diagnostic modalities that are accurate and inexpensive. This study aimed to identify a potential microRNA(miRNA) panel to detect papillary thyroid carcinoma (PTC).

Following a comprehensive literature review as well as miRNA target predictor databases, Real-time PCR was used to quantify the expression of candidate miRNAs in 59 tissue specimens from 30 patients with PTC and 29 patients with benign nodules. A receiver operating characteristic (ROC) curve analysis was used to assess the accuracy of miRNA expression levels compared to the pathology report as the gold standard. Based on prediction results, four miRNAs, including miR-9, miR-20b, miR-221, and miR-222, were selected to evaluate their expression level in Iranian thyroid samples.

A significant difference between the tissue expression level of miR-20b, miR-9, miR-222, and miR-221 was detected in the PTC group compared with non-PTC (P < 0.05). The area under the curves for the included miRs were 1, 0.98, 0.99, 0.98, and 1, respectively.

Our results confirmed deregulations of miR-20b as well as miR-222, miR-221, and miR-9 in PTC and, therefore, could be used as a helpful miRNA panel to differentiate PTC from benign nodules, which results in the more efficient clinical management of PTC patients.

Social network analysis (SNA) evaluates the connections and behavior of individuals in social groups. The scientific collaboration network is a kind of SNAs. A social network could be defined as a collection of nodes (social existence) and links (connections) associated with the nodes. The aim of this study was to evaluate the scientific outputs and collaboration networks of the countries and authors using indicators of SNA in the field of pituitary disorders between 2000 and 2020.

This is a practical study performed by applying a scientometric approach and SNA. We retrieved 31257 papers in the field of pituitary disorders between 2000 and 2020. Data were analyzed using scientific software, namely, VOSviewer, UciNet, and Netdarw.

Based on degree centrality, Colao and Pivonello in the world, Shimon and Kadioghlu in the Middle-East (ME), and Khamseh, Ghorbani in Iran achieved the top ranking. Based on the betweenness centrality, Pivonello, Colao, and Chanson in the world, Laws, and Kadioghlu in the Middle-East, and Larijani, Mohseni, and Khamseh in Iran were known as the top authors. According to closeness centrality, Pivonello, Colao, and Chanson in the world, Kadioghlu and Kelestimur in the Middle-East, and Mohseni, Khamseh, and Larijani in Iran were the top authors. The map of the authors’ collaboration in the field of pituitary disorders consists of 92 nodes. A total number of 77313 authors had global collaboration. The global collaboration network was comprised of 129 nodes (country) and 2694 links (country’s collaboration). The Middle-East collaboration network revealed 69 nodes and 1708 links. The collaboration network of the Middle-East countries consists of 13 nodes and 50 links.

Authors with a higher degree, betweenness and closeness centrality have greater efficiency (the number of articles) and effectiveness (the number of received citations). Moreover, the authors and countries that published more scientific products received more citations. In addition, in the Middle-East countries, the interdisciplinary scientific collaboration between the researchers in the fields of endocrinology, neurosurgery, pathology, and radiology has a significant impact on improving scientific outputs.

Non-alcoholic fatty liver disease (NAFLD) is common in people with type 2 diabetes mellitus (T2DM). We aimed to explore predictive factors of NAFLD in T2DM and identify high risk subgroups.

This was a cross-sectional study including 100 individuals with T2DM and 100 without diabetes matched for age, sex, and body mass index (BMI). Hepatic steatosis grades (calculated by controlled attenuation parameters-CAP score-3), and liver fibrosis stages (F0-F4) were determined using transient elastography.

The frequency of NAFLD was comparable between the two study groups. However, CAP scores were significantly higher in individuals with diabetes (294.90 ± 53.12 vs. 269.78 ± 45.05 dB/m; P < 0.001). Fifty percent of individuals with diabetes had severe steatosis (S3), while this figure was 31.6% in those without diabetes (P < 0.05). Significant fibrosis (F2-F4) was more frequent in individuals with T2DM (13% vs. 4.1%, P = 0.02). Individuals with T2DM and advanced fibrosis had significantly higher BMI, waist circumference (WC), waist-hip ratio (WHR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and CAP score compared to those without fibrosis (P < 0.05). In the regression analysis, a model including BMI, WHR, AST and female gender explained 50% of the variation in CAP score in patients with diabetes (all P < 0.05, adjusted R2 : 0.508). CAP scores were also the major determinant of liver fibrosis in this group (OR: 1.04; CI: 1.017–1.063; P = 0.001).

Individuals with diabetes are more likely to have severe fibrosis. Obesity (especially central obesity), the female gender, elevated liver enzymes, and higher degree of insulin resistance are associated with more advanced liver disease in individuals with T2DM.

The coronavirus infection is an evolving pandemic with high morbidity and mortality, especially in people with comorbidities. The case fatality rate (CFR) is 9.2% in the presence of diabetes, while it is 1.4% in those without any comorbidity. Diabetes is a prevalent disease globally; hence, healthcare professionals are highly concerned about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic progression. Current evidence does not support higher incidence of coronavirus disease 2019 (COVID-19) in people with diabetes (PWD). However, people with diabetes are considered high risk for developing complications. Optimal metabolic control is a challenging concept, especially in the presence of an acute and severe respiratory viral infection. In this consensus, we considered the challenging issues in management of patients with diabetes during the COVID-19 pandemic. The consensus covers various aspects of outpatient as well as inpatient care based on the current evidence.

Chronic diseases such as diabetes have an adverse effect on the quality of life (QOL) of patients. It has been shown physical activity can improve the quality of life.

The aim of current study was to determine the effectiveness of Physical activity package (PAP) on the quality of life (QOL) of individuals with type 2 diabetes.

Using a randomized controlled trial, 100 individuals with type 2 diabetes were studied. The patients were selected from endocrine clinic of a teaching hospital of Iran University of Medical Sciences. Subjects were randomly assigned to intervention (PAP and routine care), and control (just education and routine care) groups. The WHO Quality of Life‑ brief (WHOQOL ‑ BREF) Questionnaire was completed by all patients at the beginning and after three months. The IPAQ (long form) physical activity questionnaire was completed at the beginning, 1.5 and 3 months follow‑up for all subjects. The Mann‑Whitney U, Chi‑square and repeated measure of analysis of variance (ANOVA) tests were used to analysis of data. The significant level was considered as 0.05.

Average of age was 46.22 ± 6.10 years. The scores of physical, psychological and environmental domains of WHOQOL ‑ BREF were 27.42 ± 3.34, 21.44 ± 3.24 and 27.02 ± 4.68 in intervention group versus 22.58 ± 3.71, 17.29 ± 3.46, and 24.41 ± 3.92, in control group respectively. These differences were statistically significant (P < 0.0001). There was not any significant difference for social relations domain across two groups.

Physical activity package had a significant effect on all aspects of QOL just social relations of individuals with type 2 diabetes. It seems social relations activities needs more time to change

The Corona Virus Disease 2019 (COVID-19) outbreak is becoming pandemic with the highest mortality in patients with associated comorbidities. These RNA viruses containing 4 structural proteins usually use spike protein to enter the host cell. Angiotensin-converting enzyme 2 (ACE2) acts as a host receptor for the virus. Therefore, medications acting on renin-angiotensin-aldosterone system can lead to serious complications, especially in patients with diabetes and hypertension. To avoid this, other potential treatment modalities should be used in COVID-19 patients with associated comorbidities.

The aim of this study was to determine the frequency of distal symmetric polyneuropathy (DSP) and the role of physical examination for neuropathy diagnosis in subjects with type 2 diabetes mellitus.

A cross-sectional study was carried out from 2009 to 2010. A total of 107 patients with type 2 diabetes were evaluated using the Michigan Neuropathy Screening Instrument (MNSI). MNSI consists of two parts: History and physical assessment. History was focused on positive (burning, tingling) and negative (numbness) sensory symptoms, cramps and muscle weakness, foots ulcers or cracks, and prior diagnoses of diabetic neuropathy by a physician. Physical assessment was determined from foot appearance, ulceration, ankle reflexes, vibratory perception and monofilament testing.

A total of 72 women and 35 men were participated in this study. The frequency of neuropathy diagnosed based on physical assessment was 78.5%. The mean age was 57.6 (± 10.2) and the mean duration of diabetes was 10.2 (± 7.3) years. Ankle reflexes were not observed in both both foot in 67% of patients. Vibration perception was absent in 25% of patients. Monofilament testing was normal in 86% of patients in both feet.

The results showed a key role of physical examination in diagnosis of DSP in diabetic patients. The high frequency of DSP among diabetic patients demonstrated the importance of annual screening, further evaluations, planning and management of patients in diabetic foot clinics. However, considering the results of this study, the sensitivity of monofilament test in screening of DSP is questionable.