Evaluation of the correlation between non-alcoholic fatty liver disease and insulin resistance

Non-alcoholic fatty liver disease [NAFLD] is one of the most prevalent liver diseases, being associated with type II diabetes mellitus, obesity and dyslipidemia. It seems that insulin resistance observed in those with type II diabetes or in obese persons plays an important role in the pathogenesis of NAFLD. The aim of this study was to evaluate the relationship between NAFLD and insulin resistance, disregarding obesity and diabetes. This case-control study was performed on those patients with NAFLD referring to Sari Imam Khomeini Hospital in 2007 after obtaining informed consent from patients. After repeated sonography and proved fatty liver, 80 patients were enrolled [34 cases and 46 controls] matched for age, gender and body mass index [BMI]. NAFLD was documented in the case group, using ultrasonographic indices. Those in the control group were healthy. ALT and AST were normal in both groups. Fasting plasma glucose, fasting insulin, 2-hour oral glucose tolerance test [OGTT] and insulin-resistance were compared between the two groups. Insulin resistance was calculated using HOMA-IR formula. There were 20 men [58.8%] and 14 women [41.2%] in the case group with the mean age of 38.0 +/- 9.4 years. Those in the control group were 27 men [58.7%] and 19 women [41.3%] with the mean age of 39.4 +/- 10.5 years. There was no significant difference between the two groups concerning their age, gender or BMI. The mean level of FPG was 91.8 +/- 8.4 mg/dl in the case and 92.5 +/- 10.1 mg/dl in the control group. The mean level of OGTT was 110.9 +/- 18.8 mg/dl in the case group and 103.1 +/- 25.8 mg/dl in the control group and the difference was not significant. The mean levels of fasting insulin were 16.1 +/- 4.2 mg/dl and 10.3 +/- 4.8 mg/dl in the case and control groups, respectively [p<0.001]. Insulin resistance was 3.6 +/- 0.8 micro u/l.mmol/l in the case and 2.3 +/- 1.2 micro u/l.mmol/l in the control group. Since the intervening factors were identical in both groups, we can conclude that the role of insulinresistance in the pathogenesis of NAFLD is not dependent on age, gender and BMI

[Diabetic ketoacidosis in a patient with acromegaly, a case report]

Although impaired glucose tolerance affects 36% and overt diabetes mellitus can be seen in 30% of cases with acromegaly, diabetic ketoacidosis is rarely reported in patients with this disease. We present an unusual complication of acromegaly: a 22 year old woman with amenorrhea [6 month age] and blurred vision of left eye [4 month ago] referred to Ghaem neurology clinic in Mashhad. With a growth hormone [GH] level of = 100 ng/ml, Insulin like growth Factor-1 [IGF-1] =1560 ng/ ml and pituitary macro adenoma in magnetic resonance imaging [MRI], she was candidated for surgery. A few hours before surgery she had dyspnea, loss of consciousness, fever and with blood sugar [BS] =500 mg/ml, Hco3 = 2.4, PH=7.06 and keton in urine. Diabetic ketoacidosis was diagnosed. The patient was treated with high dose of insulin [500 IU/day] and hydration. After octerotide administration the need for insulin decreased and after pituitary adenectomy, there was no need for insulin therapy and the patient was discharged on metformin [one tablet per day]

[Comparison of the adequacy of specimens provided by fine needle aspiration, fine needle non - aspiration sampling and combined technique in thyroid nodules]

Thyroid dysfunctions are one of the most important diseases in endocrinology. Fine needle aspiration [FNA] is currently the first line diagnostic tool for the evaluation of thyroid nodules. The adequacy of specimens provided by this method is also very important. FNA puncture in thyroid causes intra- parenchyma hemorrhage, which may distribute the quality of tissue specimens. Fine needle non-aspiration [FNNA], may provide better specimens without this problem. The aim of this study was to evaluate the adequacy of thyroid nodules specimens provided by fine needle aspiration and fine needle non - aspiration sampling in Imam Hospital. This descriptive study was performed on 200 patients with thyroid nodules in Imam Hospital, Sari, Iran. After a detailed clinical history, systemic examination and thyroid sonography, FNA and FNNA sampling were performed in all patients. The adequacy of specimens was evaluated by Mair scoring system in both techniques. All data, including demographic data and sonographic results and background blood, amount of cellular material, degree of cellular degeneration, degree of cellular trauma and retention of appropriate architecture were recorded. Results were analyzed by means of SPSS [11] software and Wilcoxon Signed Rank Test. The P.value less than 0.05 were considered to be significant statistically. 200 patients, 189 [94.5%] females and 11 [5.5%] males, with mean age of 43.36 +/- 12.3 years were studied. Cytological findings showed that in FNA technique, 26[13%] of specimens were unsuitable for diagnosis, 97[48.5%] were diagnostic/adequate, while 77[38.5%] were diagnostic/superior for diagnosis. In FNNA technique, 32[16%] of specimens were unsuitable, 96 [48%] were diagnostic/ adequate, while 72 [36%] were diagnostic/superior for diagnosis. In the combined application of FNA and FNNA, 9 [4.5%] of specimens were not diagnostible and 191 [95.5%] were diagnostic. Mean of total score in FNA was 5.82 +/- 2.3, while in FNNA was 5.70 +/- 2.4, with the difference was not statistically significant. Furthermore, there was no statistically significant difference between other parameters. Our study demonstrates that there is no difference between FNA and FNNA sampling, however, applying the combination of these two techniques, may improve the diagnostic quality

[Prevalence of lipodystrophy associated with human recombinant insulin]

Lipodystrophy is potentially a clinical adverse effect, associated with insulin therapy and is believed that usage of human recombinant insulin's is associated with decreasing prevalence of Lipodystrophy. The objective of this study was to determine the prevalence of insulin induced Lipodystrophy, among diabetic out-patients referred to Imam Khomeini Hospital, in Sari during 2007. In this cross sectional descriptive study, 220 diabetic patients referred to the Diabetes Center at Imam Khomeini Hospital, in Sari, who under treatment by insulin at least three months prior to referral was evaluated. First, the demographic and clinical characteristics of the patients were recorded in a questionnaire; then all patients were examined clinically to evaluate lipodystrophy. In all subjects, glycated hemoglobin [HbA1C] was measured to assess the range of blood glucose level control. Recorded data were analyzed by statistical methods, such as descriptive T-test and X[2].Of 220 diabetic patients studied, thirty-five [15.9%] showed clinical evidences of insulin induced Lipodystrophy; 32 out of 35 cases of Lipodystrophic patients [14.5%] had Lipohypertrophy, while 3 cases [1.4%] had Lipoatrophy. The factors included Age, Sex, Education, BMI [Body mass index], type of Diabetes, The duration of insulin consumption and injection site had statistically significant effects on development of insulin induced Lipodystrophy [P<0.05]. The results of this study demonstrated that despite using human recombinant insulin's, the prevalence of insulin induced lipodystrophy, especially Lipohypertrophy, has remained high up to present. Therefore, regular examination of patients for this side effect is necessary, especially in subjects without good control of blood glucose level