Endocrinology Center Research Articles

Serological characterization of Coxsackievirus B in type 1 diabetes mellitus (T1DM) patients in Basrah city- Iraq

Background: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune illness that causes severe insulin shortage and hyperglycemia. Pancreatic cells may be destroyed by enteroviral (EV) infection either directly or by inducing an inflammatory response in the pancreatic islets that brings autoreactive T lymphocytes to the site of inflammation. Aim of study: investigate whether coxsackievirus group B (CVB) strains are associated with the onset of islet autoimmunity and T1DM. Objective: Serum samples were collected from newly diagnosed patients of type 1 diabetes mellitus who were attending the endocrinology centers at Al-Mawani general hospital and Al-Fayhaa teaching hospital from October 2022 to May 2023. A total of 168 children of both sexes, comprising 86 (51.1%) patients as a patient group. Results and discussion: Showed that there were no significant differences (p≤ 0.871) between patients and control according to age range however, the results showed elevated IgM titers in patients (15.14±2.43) in comparison with the control (8.66±1.56) with highly significant differences (p< 0.000). The age group (11-17) had the highest percentage (57.58%) of positive CVB-IgM patients which was 19 children of the total 33 infected children, while other age groups had 7 patients each (21.21%). Conclusion: Females were significantly more susceptible to T1DM than males. The age group (11-17) significantly more susceptible to T1DM than other age groups. Serological methods were more favorable than molecular methods in diagnosing the Coxsackievirus B. Elevated titers of IgG or IgM in patients in comparison with the control.

Multiparametric ultrasound-based assessment of overt hyperthyroid diffuse thyroid disease.

Hyperthyroidismis a prevalent condition affecting global populations, with an overall prevalence of 1.2%. Our research aimed to establish a systematic diagnostic approach using multiparametric ultrasound (MPUS) to diagnose hyperthyroid diffuse thyroid disease (DTD). We conducted a retrospective study from June 2021 to June 2023 at a specialized endocrinology center in Timisoara, Romania, enrolling subjects presenting with clinical hyperthyroidism. Using the Mach 30 Aixplorer ultrasound equipment, evaluations were performed initially in B-mode US, followed by Color Doppler and Spectral Doppler measurements, and finally, 2D Shear wave elastography (SWE). From the 218 patients analyzed, the diagnosis of DTD with hyperthyroidism was confirmed through biochemical assessment, subgrouping various pathologies such as subacute thyroiditis, Graves' disease, painless thyroiditis, Hashimoto's thyroiditis, iatrogenic, as well as healthy controls. In the first step, B-mode hypoechogenicity had an AUC of 0.951 for DTD detection. In the second step, the peak systolic velocity differentiated Graves' disease with a median of 42.4 cm/s and an AUC of 1. Lastly, the third step consisted of SWE evaluation, revealing a mean elasticity index in the SAT subgroup significantly higher from other subgroups (p<0.001) with an AUC of 1. Our study offers a step-by-step evaluation algorithm for DTD diagnosis, with a very good overall diagnostic performance (AUC of 0.946).

Association of Genetic polymorphisms of EDN1 gene and Endothelin-1 level in patients with type 2 diabetes mellitus in the Jordanian population

Endothelin-1 (ET-1) is one of the most potent vasoconstrictors, encoded by the endothelin-1 (EDN1) gene. It has been shown to play an important role in different diseases including Diabetes Mellitus (DM). Various single nucleotide polymorphisms (SNPs) in the EDN1 gene are related to microvascular complications of type 2 diabetes mellitus (T2DM) such as retinopathy, neuropathy and nephropathy. This study aims to determine the association between two selected EDN1 gene polymorphisms (rs2071942 G > A, rs5370 G > T) and T2DM in the Jordanian population, also to measure the level of ET-1 in T2DM. The samples were collected from the National Center of Diabetes, Endocrinology, and Genetics- Amman, Jordan, including 97 patients with T2DM and 80 healthy individuals. PCR-RFLP was used for SNPs genotyping. ET-1 level was determined using IQELISA kits. The univariate analysis for both SNPs didn't show statistically significant differences in the genotype or allele frequencies among T2DM cases as well as in controls. The same results were obtained regarding ET-1 concentration. The subgroup analysis by sex showed that the genotype and allelic frequencies of rs5370, rs2071942 G/A polymorphisms were not significantly different in males and females. Multivariate Analysis adjusted for various confounders didn't express statistical significance difference for occurrences of both SNPs. However, height and gender showed to be significant risk factors for occurrences of heterozygote alleles in both SNPs. On the other hand, the duration of diabetes has appeared to be related to the recessive allele in rs5370.

Myo-inositol versus metformin effects on clinical features, endocrine and metabolic profiles in infertile women with polycystic ovary syndrome: A randomized controlled trial

Objective: To compare the effectiveness of inositol and metformin on the clinical characteristics, and endocrine and metabolic profiles of infertile polycystic ovarian syndrome (PCOS) women from Vietnam. Methods: From June 2018 to August 2022, a randomized trial was undertaken at the Hue Center for Endocrinology and Reproduction on infertile women aged 18 to 40 years with polycystic ovarian syndrome. The clinical, endocrine, and metabolic features of these individuals were assessed before and after 3 months of treatment with 2 g of inositol or 1700 mg of metformin per day. Natural pregnancy rates, adverse effects, and tolerance of inositol were recorded. Results: The study included 171 infertile PCOS women who were eligible to participate and took part in the baseline assessment, of whom 132 women participated in data analysis after 3 months. After metformin treatment, 42.1% of women with oligomenorrhea experienced regular menstruation. Metformin significantly lowered body mass index (BMI), waist circumference and testosterone levels, but had no effect on other clinical characteristics, endocrine profiles, or metabolic profiles. 29.2% Of women reported experiencing side effects. 21% Of them attained pregnancy, which resulted in 17.1% of live births. In the inositol group, the rate of regular cycle increased by 18.2% and the total testosterone concentration significantly decreased. In overweight/obese women with PCOS, inositol significantly decreased weight, BMI, waist and hip circumferences (P&lt;0.05). 100% Of women tolerated inositol and continued treatment. 18.9% Of them became pregnant, leading to 17% of live births. Conclusions: Metformin and inositol can improve weight and waist circumference in overweight/obese infertile women with PCOS. Metformin is associated with a higher rate of regular menstruation, whereas inositol is associated with a lower rate of adverse effects. The spontaneous conception, clinical pregnancy, and live birth rates between two groups are comparable.

Quantifying the variability in the assessment of reproductive hormone levels

To quantify how representative a single measure of reproductive hormone level is of the daily hormonal profile using data from detailed hormonal sampling in the saline placebo-treated arm conducted over several hours. Retrospective analysis of data from previous interventional research studies evaluating reproductive hormones. Clinical Research Facility at a tertiary reproductive endocrinology centre at Imperial College Hospital NHS Foundation Trust. Overall, 266 individuals, including healthy men and women (n = 142) and those with reproductive disorders and states (n = 124 [11 with functional hypothalamic amenorrhoea, 6 with polycystic ovary syndrome, 62 women and 32 men with hypoactive sexual desire disorder, and 13 postmenopausal women]), were included in the analysis. Data from 266 individuals who had undergone detailed hormonal sampling in the saline placebo-treated arms of previous research studies was used to quantify the variability in reproductive hormones because of pulsatile secretion, diurnal variation, and feeding using coefficient of variation (CV) and entropy. The ability of a single measure of reproductive hormone level to quantify the variability in reproductive hormone levels because of pulsatile secretion, diurnal variation, and nutrient intake. The initial morning value of reproductive hormone levels was typically higher than the mean value throughout the day (percentage decrease from initial morning measure to daily mean: luteinizing hormone level 18.4%, follicle-stimulating hormone level 9.7%, testosterone level 9.2%, and estradiol level 2.1%). Luteinizing hormone level was the most variable (CV 28%), followed by sex-steroid hormone levels (testosterone level 12% and estradiol level 13%), whereas follicle-stimulating hormone level was the least variable reproductive hormone (CV 8%). In healthy men, testosterone levels fell between 9:00 am and 5:00 pm by 14.9% (95% confidence interval 4.2, 25.5%), although morning levels correlated with (and could be predicted from) late afternoon levels in the same individual (r2 = 0.53, P<.0001). Testosterone levels were reduced more after a mixed meal (by 34.3%) than during ad libitum feeding (9.5%), after an oral glucose load (6.0%), or an intravenous glucose load (7.4%). Quantification of the variability of a single measure of reproductive hormone levels informs the reliability of reproductive hormone assessment.

Factors associated with Adherence to Insulin Self-Administration among Children and Adolescents with Type 1 DM in Iraq

Abstract Adolescents and children with type 1 diabetes have been reported to have challenges regarding adherence to treatment regimens compared with other age groups with diabetes. The study aimed to determine the level of commitment and investigate the effects of different factors on insulin adherence in type 1 diabetes patients in Iraq. This cross-sectional study included face-to-face interview questionnaires with caregivers of children and adolescents. Interviews were conducted in the Specialized Center of Endocrinology and Diabetes in Nasiriyah City, Iraq, from October 4, 2022, to March 30, 2023. The adherence questionnaire consisted of two sections; each consisted of five questions, including insulin and blood glucose recommendations. Blood samples were obtained from the patient to determine fasting blood glucose (FBG) and glycated hemoglobin (HBA1c)—results: 180 patients (86 males and 94 females) with type 1 DM. The mean age, weight, and disease duration were 10.75 (4.36) years, 36.30 (16.41) kg, and 6.24 (3.70) years, respectively. They had uncontrolled blood glucose (208.42 95.0 mg/dl) and HBA1c (9.90 2.85%). The patients (52.2%) were girls with primary school qualifications (43.3%). Most of the caregivers (parents and guardians) were either illiterate (30.6%) or had completed primary school (33.9%). In addition, the patient's families (43.9%) had low income (0.5 million ID cards). Therefore, most patients (60%) did not visit a doctor regularly or check their blood glucose. Adherence in the studied population could be higher. Focusing on raising their patients' awareness is pivotal to enhancing their medication adherence to reduce their short- and long-term diabetic complications, improve blood glucose control, and improve clinical outcomes. Keywords: Diabetes, Adherence, Insulin self-medication, Iraqi patients.

Fulminant hypercorticism due to ACTG producing pheochromocytoma

Endogenous hypercorticism (EH) is a severe symptom complex caused by hypercortisolemia; according to the etiology, ACTH-dependent and ACTH-independent variants are distinguished, which, according to the literature, occur in 70-80% and 20-30% of cases, respectively. A rare cause of ACTH-dependent endogenous hypercorticism is ACTH-ectopic syndrome (ACTH-ES) (about 15-20% of cases). ACTH-ES is a syndrome of adrenocorticotropic hormone (ACTH) hyperproduction by neuroendocrine tumors of extrahypophyseal origin. Various tumors can secrete ACTH: bronchopulmonary carcinoid, small cell lung cancer, less frequently, thymus carcinoid, islet cell tumors and pancreatic carcinoid, medullary thyroid cancer, carcinoid tumors of the intestine, ovaries, as well as pheochromocytoma (PCC).This publication presents a clinical case of rarely detected paraneoplastic ACTH production by pheochromocytoma. Thepatient had clinical manifestations of hypercorticism, therefore, she applied to the Russian National Research Center of Endocrinology of the Ministry of Health of Russia. During the examination Cushing's syndrome (CS) was confirmed, multispiral computed tomography (MSCT) of the abdominal cavity revealed a voluminous formation of the left adrenal gland. Additional examination recorded a multiple increase in urinary catecholamine levels. Subsequently, the patient underwent left-sided adrenalectomy. The diagnosis of pheochromocytoma was confirmed morphologically, immunohistochemical study demonstrated intensive expression of chromogranin A and ACTH by tumor cells.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome - two cases presenting to a large UK Paediatric Endocrinology Centre

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome - two cases presenting to a large UK Paediatric Endocrinology Centre

Increasing Social Determinants of Health Screening Rates Among Six Endocrinology Centers Across the United States: Results From the T1D Exchange Quality Improvement Collaborative.

Social determinants of health (SDOH) are strongly associated with outcomes for people with type 1 diabetes. Six centers in the T1D Exchange Quality Improvement Collaborative applied quality improvement principles to design iterative Plan-Do-Study-Act cycles to develop and expand interventions to improve SDOH screening rates. The interventions tested include staff training, a social risk index, an electronic health record patient-facing portal, partnerships with community organizations, and referrals to community resources. All centers were successful in improving SDOH screening rates, with individual site improvements ranging from 41 to 70% and overall screening across the six centers increasing from a baseline of 1% to 70% in 27 months.

Проявления синдрома сухого глаза у детей с сахарным диабетом 1-го типа в зависимости от уровня гликированного гемоглобина

Introduction. Diabetes mellitus is one of the serious diseases that leads not only to restrictions on physical activity, but also changes the social and psychological spheres of life of patients. The purpose of the studyis to evaluate the results of functional methods for studying tear production function in children with type 1 diabetes mellitus. Materials and methods of research. The study included 240 children registered at the Children's City Endocrinology Center in Almaty. There were 133 boys (55.42 %), 107 girls (44.58 %). The examined children were divided into 6 groups depending on the level of glycated hemoglobin (HbA1c). The control group consisted of 52 people. All patients were assessed for the severity of blockage of the breast ducts, the state of total tear production (Schirmer test 1), the state of the tear meniscus (biometry of the tear meniscus), the time of tear film rupture, and the state of the conjunctiva. Patients with dry eye syndrome were prescribed softdrops and the dynamics of the process were monitored. Research results. In patients with type 1 diabetes mellitus, in 69.6 % of cases there were manifestations of breast dysfunction of varying severity. From 17 % to 39.8 % of patients in the main groups had manifestations of hyperemia and 28 % mild conjunctival edema, which is clinically a sign of the presence of an irritating factor, possibly due to an increase in tear hyperosmolarity. The Schirmer test showed a decrease in tear secretion function, a decrease in tear film rupture and a decrease in the level of menisci in comparison with the control. The use of softdrops eye drops helps to stabilize the tear film, increase tear secretion and tear production functions in children with signs of dry eye syndrome due to type 1 diabetes mellitus. These studies should be taken into account when prescribing pathogenetic therapy for the correction of dry eye syndrome in these groups of patients. Keywords: diabetes mellitus, ophthalmological manifestations of diabetes mellitus, dry eye syndrome, dry eye disease

Increasing Continuous Glucose Monitoring Use for Non-Hispanic Black and Hispanic People With Type 1 Diabetes: Results From the T1D Exchange Quality Improvement Collaborative Equity Study.

Despite the benefits of continuous glucose monitoring (CGM), there is lower use of this technology among non-Hispanic Black and Hispanic people with type 1 diabetes compared with their non-Hispanic White counterparts. The T1D Exchange Quality Improvement Collaborative recruited five endocrinology centers to pilot an equity-focused quality improvement (QI) study to reduce racial inequities in CGM use. The centers used rapid QI cycles to test and expand interventions such as provider bias training, translation of CGM materials, provision of CGM education in multiple languages, screening for social determinants of health, and shared decision-making. After implementation of these interventions, median CGM use increased by 7% in non-Hispanic White, 12% in non-Hispanic Black, and 15% in Hispanic people with type 1 diabetes. The gap between non-Hispanic White and non-Hispanic Black patients decreased by 5%, and the gap between non-Hispanic White and Hispanic patients decreased by 8%.

Multivariable Model to Predict an ACTH Stimulation Test to Diagnose Adrenal Insufficiency Using Previous Test Results.

The adrenocorticotropin hormone stimulation test (AST) is used to diagnose adrenal insufficiency, and is often repeated in patients when monitoring recovery of the hypothalamo-pituitary-adrenal axis. To develop and validate a prediction model that uses previous AST results with new baseline cortisol to predict the result of a new AST. This was a retrospective, longitudinal cohort study in patients who had undergone at least 2 ASTs, using polynomial regression with backwards variable selection, at a Tertiary UK adult endocrinology center. Model was developed from 258 paired ASTs over 5 years in 175 adults (mean age 52.4 years, SD 16.4), then validated on data from 111 patients over 1 year (51.8, 17.5) from the same center, data collected after model development. Candidate prediction variables included previous test baseline adrenocorticotropin hormone (ACTH), previous test baseline and 30-minute cortisol, days between tests, and new baseline ACTH and cortisol used with calculated cortisol/ACTH ratios to assess 8 candidate predictors. The main outcome measure was a new test cortisol measured 30 minutes after Synacthen administration. Using 258 sequential ASTs from 175 patients for model development and 111 patient tests for model validation, previous baseline cortisol, previous 30-minute cortisol and new baseline cortisol were superior at predicting new 30-minute cortisol (R2 = 0.71 [0.49-0.93], area under the curve [AUC] = 0.97 [0.94-1.0]) than new baseline cortisol alone (R2 = 0.53 [0.22-0.84], AUC = 0.88 [0.81-0.95]). Results of a previous AST can be objectively combined with new early-morning cortisol to predict the results of a new AST better than new early-morning cortisol alone. An online calculator is available at https://endocrinology.shinyapps.io/sheffield_sst_calculator/ for external validation.

AN EPIDEMIOLOGICAL STUDY TO DETERMINE THE PREVALENCE OF E.GINGIVALIS IN ORAL OF DIABETIC MELLITUS PATIENTS IN CITY OF KERBALA

Background: Many people suffer from infection with Entamoeba gingivalis which mainly causes for periodontitis and other dental diseases specially in patient suffering from Diabetic mellitus. Aim of study: To determine the prevalence of the Entamoeba gingivalis among diabetes mellitus patients in Kerbala city. Methodology: oral swap samples were collected from 300 of respondents ( patients were diagnosed clinically by physician suffering from DM) attended to Imam Hassan Center for Endocrinology and Diabetes and some of outpatients clinics in Kerbala Province of Iraq from May to August 2023. Oral swap specimens were collected and immediately introduced for microscopic examination for diagnosis of Entamoeba gingivalis parasites.

SAT328 Severe Exogenous Cushing Syndrome Caused By A Potent Steroid Concealed In Arthritis Supplement

Abstract Disclosure: S. Maraqa: None. L. Bushnaq: None. R. Singh, PhD: None. N. Genere: None. Cushing syndrome (CS) is a rare disorder caused by excessive systemic glucocorticoids and associated with increased mortality and worsening quality of life. CS most commonly occurs from exogenous glucocorticoid use, while Cushing disease causes most of endogenous cases. Here, we present a case of a 64-year-old woman with rapidly progressive CS due to an over-the-counter (OTC) arthritis supplement with unlisted dexamethasone. A 64-year-old woman with reported CS who was evaluated in our Endocrinology center after she moved to the United States. She was previously diagnosed with pituitary CS in Mexico following a 6 months history of rapid 50-pound weight gain, profound proximal muscle weakness requiring assistive device, and unprovoked vertebral fractures; laboratory evaluation found elevated 24-hour urinary cortisol 272 mcg/24h, 1mg dexamethasone suppression test total cortisol 5.6 mcg/dl (&amp;lt; 1.8), and adrenocorticotropic hormone (ACTH) 16 pg/mL. Pituitary MRI was unremarkable. Past medical history included primary hypothyroidism and hypertension. Physical exam was notable for blood pressure 160/108 mmHg, heart rate 96, BMI 33 kg/m², moon face, supraclavicular fat pads, central obesity, skin bruises, and proximal muscle weakness. Unexpectedly, re-evaluation showed undetectable serum ACTH and cortisol. A thorough review of medications identified no recent exposure to glucocorticoids. However, a synthetic glucocorticoid screen showed markedly elevated serum dexamethasone concentration. Follow-up discussion revealed that she had started an arthritis supplement “Artri-King” 6 months prior to these symptoms. We collaborated with Mayo Clinic Labs to evaluate dexamethasone contents in this drug; each tablet was found to contain 0.9 mg of dexamethasone, which was unreported in the ingredient list. This supplement was stopped, and the patient was started on physiologic hydrocortisone. Two months later, AM cortisol was 5.6 mcg/dL and ACTH 23 pg/ml. Eight months later, she continues to have adrenal insufficiency but has had a substantial clinical improvement.Exogenous CS is readily diagnosed in patients taking prescribed glucocorticoids; however, diagnosis can be more challenging in cases where the presence of glucocorticoids is concealed. The US Food and Drug Administration follows more limited regulatory guidelines for dietary supplements compared to prescribed drugs. A study by Tucker.et.al. reported that 20% of dietary supplements have unapproved ingredients.1 This is especially concerning, considering that over half of the US population admits to taking dietary supplements.2 On April 2022, the FDA published a public notice for “Artri-King”, declaring the presence of unlisted dexamethasone.3 Should such agents prove to be the culprit of CS, they must be tapered off gradually or in the presence of physiologic hydrocortisone to avoid the risk of adrenal crisis. Presentation: Saturday, June 17, 2023

THU203 Self-puberty Staging In Endocrine Encounters During The COVID Pandemic

Abstract Disclosure: C. Ebo: None. J. McCray: None. K. Bowers: None. S.R. Rose: None. N. Yayah Jones: None. Background and Objective: Telemedicine became increasingly necessary during the COVID 19 pandemic. It presents challenges for evaluating pubertal staging, essential for endocrine care. Studies testing validity of pubertal self-staging compared with clinical examination have had conflicting results and have not focused on telemedicine encounters. The aim of this study was to determine validity and reliability of patients’ self-staging pubertal assessments for potential use at home during telemedicine visits. Methods: Study included patients [referred to Cincinnati Children Hospital Medical Center pediatric endocrinology center for specialty care], age 7-22y, who required pubertal staging as part of their comprehensive evaluation. Upon clinic check-in, patients received a packet with description of study procedure and rationale; an option to “opt in” or “opt out” of the study; written sex-specific instructions on how to do self-pubertal staging; and gender-appropriate illustration sheet(s) depicting Tanner (T) stages. Boys’ packets included drawings and descriptions for pubic hair (PH) stages T1-T5; girls’ packets included drawings and descriptions for PH and also for breast development (BR) stages T1-T5. Patients who “opted in” were given &amp;lt;10 minutes alone in their clinic room to choose the image(s) that most resembled their bodies. Their selection went in a sealed envelope. Patients then underwent their clinic visit with physical examination by a board-certified pediatric endocrinologist including BR staging for girls, assessment of testicular size in boys, and PH staging in both sexes. Results: We received 243 self-assessments (51.4% girls), of which 80% were complete with self- and endocrinologist staging (48.0% girls). Mean age of participants was 12.8y. Mean BMI was 22.2 kg/m2 (boys), 23.7 (girls). Hypothyroidism was the most common endocrine diagnosis among participants. We calculated a Tanner stage kappa statistic for agreement with the endocrinologist with 95%CI for BR/PH by sex. Kappa &amp;gt;0.60 was considered strong agreement; 0.40-0.60 moderate agreement; 0.20-0.40 fair agreement. Agreement for girls was highest in T1 (BR 0.65, 95%CI 0.44-0.86; PH 0.57, 95%CI 0.35-0.79) and T5 (BR 0.57, 95%CI 0.37-0.77; PH 0.65, 95%CI 0.47-0.83). Agreement for boys PH was highest in T1 (0.73, 95%CI 0.59-0.87) and T2 (0.58, 95%CI 0.59-0.87). A greater level of agreement was found when female (F) and male (M) T stages were grouped by pre-puberty (T1; BR 0.65, FPH 0.57, MPH 0.73), early-mid puberty (T2-3; BR 0.60, FPH 0.52, MPH 0.59), and late puberty (T4-5; BR 0.76, FPH 0.74, MPH 0.79). Conclusion: Using self-staging of puberty, children and adolescents can distinguish between "puberty" and "no puberty", although differentiating between later pubertal stages is less reliable. These results contribute to defining utility and limitations of self-staging during telemedicine visits. Presentation: Thursday, June 15, 2023

THU086 Pituitary Post-Surgical Outcomes According To Neurosurgical Expertise: A Retrospective Study From A Tertiary Endocrinological Centre

Abstract Disclosure: S. De Vincentis: None. S. Pederzoli: None. M. Monzani: None. N. Bacchi: None. B. Madeo: None. C. Diazzi: None. V. Rochira: None. BACKGROUND: Neurosurgeons’ expertise is a key element to achieve better pituitary outcomes. At present the impact of expertise has been investigated mainly on disease control in functioning pituitary adenomas. AIM: To explore from a real-life database the impact of neurosurgical centre expertise on post-surgical outcomes in patients with pituitary masses attending a tertiary academic medical centre. METHODOLOGY: A retrospective, observational, single-centre study was carried out including all patients attending the Endocrinology Unit of Modena (Italy) that underwent pituitary surgery from January 1995 to February 2022. Pre- and post-surgical data (i.e. tumor diameter, surgery-related complications and pituitary function) were collected from record charts. Patients were divided in two groups according to neurosurgical centre expertise: Low-Volume Centres (LVC) (less than 50 pituitary surgeries per year) and High-Volume Centres (HVC) (50 or more pituitary surgeries per year). RESULTS: A total of 125 enrolled patients (59 females; 66 males; median age 52) were grouped in LVC (67 patients, 54%) and HVC (58 patients, 46 %) groups according to neurosurgical centre expertise. At histology 106 patients (84.8%) had a pituitary adenoma, 10(8.0%) a craniopharyngioma, and 9 (7.2%) other rarer diagnoses. A pre-surgical endocrinological evaluation was performed more frequently in patients with adenoma (50%) than craniopharyngioma (11.3%) (p &amp;lt;0.001). Pre-surgical endocrinological evaluation was significantly more frequently available in LVC (25.4%) than HVC (1.7%) (p &amp;lt;0.001). Surgical approach was trans-sphenoidal in 90.4% of cases, with only few craniotomy (9.6%). No patients were approached with craniotomy in HVC group, compared to 17.9% of LVC group (p&amp;lt;0.001). A post-surgical remnant was present in 72 patients (57.6%) and it was significantly more frequent in patients of LVC than HVC group (74.6% vs 37.9%, p&amp;lt;0.001). At the binary logistic regression analysis, we found that patients of LVC group had an almost five-fold increased likelihood to have a postoperative residual lesion compared to HVC (OR 4.8; 95% CI: 2.2-10.3). Median percentage decrease from baseline was 76% [-8.2; 100] and it was significantly higher in patients of HVC than LVC group (p&amp;lt;0.001). LVC patients had four-fold increased likelihood to have hypopituitarism (OR: 3.7; 95% CI: 1.7-7.8), while no difference was found for other post-surgical complications. CONCLUSIONS: This study demonstrates that post-surgical outcomes are better in neurosurgical centres with superior expertise. The lack of pre-operative endocrinological evaluation is significantly associated to surgery performed in a not-experienced centre. A close multidisciplinary cooperation between experienced endocrinologists and neurosurgeons is required both before and after surgical procedures. Presentation: Thursday, June 15, 2023

Assessment of Vitamin D3 Level Among a Sample of Type 2 Diabetic Patients Attending Diabetes and Endocrinology Center in Al-Hilla City

Vitamin D is found in foods in two primary forms: cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2), with vitamin D3 being a fat-soluble vitamin. that is necessary for calcium homeostasis and the maintenance of proper function in a variety of tissues. Humans get vitamin D from their diets or from being exposed to ultraviolet B radiation from the sun. Aside from its well-known effects on bone health, vitamin D has been hypothesized to play a role in various disease states and health situations, such as cardiovascular disease and type 2 diabetes. To assess vitamin D3 concentration in patients with type 2 diabetes, using the Vitamin D Total III kit on the Cobas E 411 device. A total of 300 people were recruited, with 150 people suffering from type 2 diabetes serving as cases and 150 healthy volunteers of the same gender and age being used as the control group. Both genders were represented, with an age group between 30 – 79 years. The collection of data lasts for five months, beginning Started in November 2022 to April 2023. The data was analyzed with the readily available statistical package SPSS-28, and Chi-square tests were used to evaluate the relationship among vitamin D, T2DM, and control. Data were provided in simple frequency, percentage, mean, standard deviation, and range measures. Type 2 diabetes patients' mean ± SD ages were 55.4 ± 10.1, while controls had a mean ± SD of age of 55.3 ± 10.0. the sociodemographic features of T2DM and participant control. Shows A statistically significant association was found in the variables of age groups, school level (P = 0.0001), and marital status (P = 0.008). The BMI: mean ± SD (29.69 ± 5.14) of T2DM was higher than the BMI: mean ± SD (24.41 ± 1.95) of controls, as well as the waist-to-height ratio, which showed that the mean ± SD (0.527 ± 0.046) of T2DM was greater than the control mean ± SD (0.483 ± 0.019) at level (P = 0.0001); T2DM patients had deficient and insufficient vitamin D3 levels (38.7% and 33.3%, respectively), whereas controls had deficient and insufficient vitamin D3 levels (28.7% and 30.0%, respectively). It was found that there is a significant difference between low vitamin D3 levels and individuals with type 2 diabetes, and A lack of vitamin D3 is related to an increased risk of developing T2DM.

Assessment of Serum Levels of Advanced Oxidation Protein Products in Type 2 Diabetic Patients with and without Retinopathy Taking Different Antidiabetic Treatments

The goal of this study was to investigate the protein peroxidation role by measuring serum levels of advanced oxidation protein products (AOPP) in type 2 diabetic patients with or without retinopathy and comparing them to controls to see if circulating AOPP levels can be used as a detection biomarker for DR. And see which of the two widely used antidiabetic treatment groups had the most impact on this oxidative stress marker. The groups were divided into two subgroups: 1) 70 type 2 diabetic patients (36 male, 34 female), 35 with diabetic retinopathy (DR) and 35 with no evidence of DR, and 2) non-diabetic controls (11 male, 9 female) were chosen from Ibn AL-Haitham Hospital for Ophthalmology and a Specialized Center for Endocrinology and Diabetes. AOPP levels were significantly higher in diabetic patients with (12.5±5.6 ng/ml) or without DR (5.1±4 ng/ml) when compared to those of controls (1.45 0.8 ng/ml) (p&lt;0.05). AOPP levels were higher in the late stage of DR compared to the early stage(14 3.15 ng/ml ) and ( 10 2.13 ng/ml) respectively so. Furthermore, Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) cause a better reduction in AOPP levels compared to Sulfonylureas (SUs) in the NDR group. Increased protein oxidation may involve in the pathogenesis and severity of DR and the serum AOPP levels have the prospect to become a marker for the diagnosis of DR. DPP-4 inhibitors were better in slowing the progression of the disease compared to SUs.

Modern diagnosis and treatment of papillary thyroid cancer

thyroid cancer is the most common malignant tumor of the endocrine glands, accounting for 1% of all cases of malignant neoplasms. According to the National Cancer Registry, 24,626 patients with thyroid cancer were identified in Ukraine for the period from 2014 to 2021, of which 4,556 were men (18.5%) and 20,070 were women (81.5%). Treatment of papillary thyroid cancer combines three methods: surgery, the use of radioiodine therapy, and hormone replacement therapy with levothyroxine drugs. The aim of this work, based on the example of a clinical case, was to analyze the patient's route, methods of diagnosis, and treatment of a thyroid neoplasm in accordance with current guidelines and recommendations. This clinical case highlights the importance of early diagnosis of TG diseases, namely papillary thyroid cancer. The patient turned to the clinic of the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of MoH of Ukraine with complaints of an increase in the front surface of the neck and deterioration of the general condition for a long time. After analyzing the complaints, the patient was sent for a comprehensive examination, where an ultrasound of the TG revealed a mass, cytological examination confirmed a thyroid papillary cancer, grade 6. After undergoing preparation, the patient was referred for surgical intervention, namely extrafascial thyroidectomy. Combined treatment was carried out (operative intervention and treatment with the drug I131), and a suppressive dose of levothyroxine was prescribed, followed by dose correction and dynamic supervision by an endocrinologist. The described clinical case testifies to the high quality of diagnosis and treatment of a patient with thyroid papillary cancer in the conditions of a highly specialized endocrinological center. This approach fully meets the international requirements for the treatment of thyroid cancer. Despite the difficult epidemiological situation in Ukraine and the state of war, the patient was promptly referred to the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues, where she received the necessary assistance in full.

Quality of Life in Thyroid Cancer Patients.

Thyroid cancer ranks as the ninth most common cancer worldwide and third in Saudi Arabia. Given thyroid cancer's high incidence, thyroid cancer patients' quality of life (QoL) has been a concern for many years. However, no study has been dedicated to assessing thyroid cancer patients' QoL in Saudi Arabia. Thus, we aimed to fill this gap by assessing thyroid cancer patients' QoL in Saudi Arabia. This cross-sectional study was conducted among thyroid cancer patients attending outpatient clinics at the Diabetes and Endocrinology Centre, King Fahad Specialist Hospital, Qassim region, Saudi Arabia, from 2017 to 2023. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) assessed the patients' QoL through an individual interviewer-administered technique. We used RStudio to perform statistical analysis. Statistical differences between groups based on QoL scores were assessed using the Wilcoxon and Kruskal-Wallis rank-sum tests. Our results showed that for QoL scores of functional domains, the lowest was in social functioning, and the highest was in cognitive functioning. Regarding the subscales of symptoms, the highest scores were fatigue and insomnia. In conclusion, numerous factors affect thyroid cancer patients' QoL. Recognition and appropriate management of these factors will improve the overall QoL; there is a need to understand what is driving these factors in further clinical studies.