مجله غدد درون ریز و متابولیسم ایران
سال بیست و چهارم شماره 6 (پیاپی 126، بهمن و اسفند 1401)

Hajj is one of the main pillars of Islam, and it is obligatory for all adult Muslims who can afford to travel and are in acceptable health. In this religious event, every year, about 2 to 3 million Muslim pilgrims of different nationalities gather in the city of Mecca, Kingdom of Saudi Arabia, and a large part of this population consists of older adults (25% over 65 years old) who are exposed to various chronic diseases such as diabetes. At least 5% of pilgrims have diabetes, and 13.8% have underlying diabetic neuropathy. Diabetic foot ulcer, a preventable complication of diabetes, is one of the most common reasons for visiting a doctor during Hajj, and if not treated, it leads to amputation and disability. It has profound consequences on the health system and society.On the other hand, many conditions affect pilgrims. Crowding, hot desert weather, physical activity in the open environment, neglecting self-management, changes in diet, and the existence of restrictions such as the prohibition of placing oneself in the shade can be examples of new conditions that increase the risk of diabetic foot ulcers. This article provides recommendations for preventing diabetic foot ulcers for patients with diabetes and their medical teams before and during this valuable spiritual pilgrimage.

Hypothyroidism is a common, important endocrine disorder. In this study, we aimed to evaluate family physicians' knowledge about hypothyroidism. 

 Thi s an alytical cross-sectional study assessed the knowledge knowledge of hypothyroidismin 180 family physicians working in two Shiraz urban health centers in 2021. A researcher-made questionnaire containing four areas, including screening, diagnosis, treatment, and referral, was used. The total score of the questionnaire was 22. Initially, the validity and reliability of the questionnaire were confirmed in a pilot study. 

150 out of 180 participants completed the questionnaire. The average score was 15.7±2 of the total 22 scores. The mean scores on screening, diagnosis, treatment, and referral subscales were 0.8±3.2, 0.8±2.3, 1.4±6.6, and 0.6±3.5, respe ctively. Less than 50% of the doctors answered five out of 22 questions correctly. The doctor's age had a significant negative relationship with the questionnaire score. 

Although family physicians' knowledge was acceptable in screening, diagnosis, and referral areas, their knowledge of treatment was not sufficient. Using evidence-based national clinical guidelines and updating them at specific intervals, focusing on the performance of family physicians, can be an effective way to improve the knowledge and performance of these doctors. Planning for targeted retraining is suggested as another way to improve performance.

Diabetic cardiomyopathy is an important factor in increasing the risk of heart failure and mortality in people with diabetes. Cathepsin D has been shown to play a crucial role in maintaining multiple physiological functions, including the degradation of intracellular proteins and enzyme precursors. This research aimed to investigate the combined effects of vitamin D3 supplementation and aerobic exercise on cardiac cathepsins and insulin resistance in diabetic rats induced by the combination of high-fat diet and streptozotocin (HFD-STZ).

In 40 male Wistar rats, type 2 diabetes was induced by a high-fat diet fed+ streptozotocin, and they were divided into 5 groups: 1) Normal control (NC), 2) Diabetic control (DC), 3) Diabetes+Aerobic training (DAT), 4) Diabetes+Vitamin D3 (DVD), and 5) Diabetes+Aerobic training and Vitamin D3 (DVDAT). After eight weeks of aerobic training and vitamin D3 supplementation, cathepsin D protein content of heart tissue and serum levels of insulin, glucose, vitamin D3, and insulin resistance index were measured.

One-way ANOVA showed that cathepsin D content increased by 335% in the DC group compared to the NC group (P<0.0001). In contrast, there were significant decreases in the DAT, DVD, and DVDAT groups (44.37%, 50.80%, and 62.76%, respectively) compared to the DC group (P<0.0001). The HOMA-IR index also decreased in the DAT, DVD, and DVDAT groups by 52.95%, 39.27%, and 63.68%, respectively (P<0.0001).

Eight weeks of aerobic training with vitamin D3 supplementation improves glucose metabolism in diabetic rats induced by HFD-STZ, probably via reducing cardiac tissue level of cathepsin D and insulin resistance index.

Collagen 6 is one of the important components of the adipose tissue extracellular matrix, and its deposition is associated with metabolic disorders. This study aimed to investigate the effect of High-intensity Interval Training (HIIT) simultaneously with a high-fat diet on the expression of collagen 6 chain 3 alpha gene (Col6A3) and the amount of its protein product (COL6α3) in subcutaneous adipose tissue, as well as insulin resistance in rats.

Twenty-four adult male rats were randomly divided into four groups: normal diet (ND), high-fat diet (HFD), HIIT+ND, and HIIT+HFD. The HIIT consisted of eight periods of intense activity at 90% of Maximum Running Capacity (MRC) for 2.5 minutes, with periods of active rest at 50% MRC for 2.5 minutes. Blood samples were collected from the heart 48 hours after the last training session, and the subcutaneous adipose tissue was removed. Serum glucose and insulin levels were measured, and insulin resistance (HOMA-IR) was calculated. The RT-PCR and ELISA methods were used to measure gene expression and COL6α3 tissue protein levels, respectively. Two-way ANOVA and correlation coefficient were used to analyze the data (P≤0.05).

The combination of HIIT and a high-fat diet caused a significant decrease in COL6α3 gene expression and tissue protein levels (P<0.001) and a 21% decrease in HOMA-IR (P<0.001). A significant positive correlation was observed between gene expression and COL6α3 protein level and HOMA-IR (P<0.001) (r=0.794, r=0.870).  

HIIT, simultaneously with consuming a high-fat diet, prevents the increase of COL6α3 in subcutaneous fat tissue and can have a preventive effect on insulin resistance.

Thyroid cancer is the most common endocrine malignancy. Molecular analysis of thyroid tumors has shown that the cause of its development, as with other cancers, is the accumulation of genetic and epigenetic changes along with progressive disorders. This study aimed to provide a comprehensive overview of the genetic alterations related to the pathogenesis of thyroid cancer. For this purpose, PubMed and Science Direct databases were searched from the beginning of 2018 to January 5, 2022, to investigate the relationship between genetic alterations and the pathogenesis of thyroid cancers. The keywords used included a combination of “Thyroid cancer/carcinoma/neoplasm” AND “pathogenesis” AND “genetic alterations”. The results showed that the most frequently reported genetic modifications included independent mutations, especially in the BRAF, RAS, TERT, and TP53 genes, gene rearrangements, especially in the RET, TRK, BRAF, and PAX8/PPARγ genes, numerical changes, and common co-mutations. The connection between these changes and numerous secondary molecular changes leads to the strengthening and synergy of their effects on the molecular pathogenesis of cancer. In addition, genes involved in DNA repair, signal transmission, and cell cycle control are affected more by genetic alterations, and mutations in the mitogen-activated protein kinase (MAPK) pathway and somatic mutations in the genes involved in the PI3K-AKT pathway lead to tumorigenesis and its progression in most cases. Therefore, secondary molecular disorders and simultaneous genetic alterations lead to synergism and genetic enhancement in thyroid tumorigenesis. A better understanding of the molecular pathogenesis and the discovery and recognition of markers can provide prognosis and realize potential clinical solutions for managing and treating thyroid cancer.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age worldwide. Most of the affected women with PCOS have clinical and biochemical symptoms of metabolic disorders. In recent years, researchers have shown the association between the gut dysbiosis with many types of endocrine diseases. Evidence showed that an imbalance of gut microbiota, immune disorder and environmental changes can contribute to various diseases including polycystic ovary syndrome. This study aims to summarize the role of gut microbiota in the development of common metabolic disorders in PCOS.

A comprehensive search was conducted on PubMed, Scopus, and Google Scholar databases for articles published from the beginning to 2022. Only articles with English abstracts were reviewed.

The composition of gut microbiota and related secretions influence the biochemical pathways involved in ovarian metabolism and the increase of androgens. This make individuals with PCOS more susceptible to or worsen metabolic disorders such as obesity, dyslipidemia, liver dysfunction, diabetes and heart disease. Furthermore, studies have shown that interventions targeting the gut microbiota can lead to improvements in metabolic indices. This study provides a comprehensive roadmap for identifying factors that contribute to the progression of PCOS and potential treatment methods.

Reversing gut dysbiosis by affecting metabolic pathways may be effective in the prevention and treatment of PCOS.