The association between subclinical hypothyroidism and diabetic retinopathy in the patient with type 2 diabetic

The present study aimed to determine the relationship between subclinical hypothyroidism and diabetic retinopathy in patients with type 2 diabetes mellitus. In this cross-sectional analytical study, 150 patients with type 2 diabetes mellitus were assessed. The eye fundus examination was performed using fundoscopy to confirm or rule out retinopathy. Thyroid hormones were also measured by special kits to diagnose subclinical hypothyroidism. The criteria for diagnosis of this disorder include the high serum thyrotropin concentration (� 4mIU/L) plus normal serum free thyroxin levels. Statistical analyses were done using IBM-SPSS. In the study, 34.66 suffered retinopathy. A total of 24.0 suffered subclinical hypothyroidism with higher prevalence rate in those with retinopathy as compared with the group without retinopathy (p = 0.001). Those with diabetic retinopathy also experienced longer duration of diabetes than those without this event. (p = 0.006). Analysis show a significant role for type 2 diabetes mellitus (OR = 1.121, P = 0.003), and high TSH level (OR = 1.342, P = 0.006) to predict diabetic retinopathy.This study showed an association between hypothyroidism, diabetes and increased TSH with retinopathy. Retinopathy is significantly predicable with the presence of subclinical hypothyroidism and longer duration of diabetes. © 2021, Institute of Medico-Legal Publications. All rights reserved

Vitamin K-dependent coagulation in the first six weeks of life The effects of surgery and surgical complications

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Association between vitamin b12 serum level and staging of colorectal cancer in semnan city

Introduction: The prevalence of colorectal cancer is on the rise, with a high prevalence of vitamin B12 levels. Some studies have reported vitamin B12 deficiency as a risk factor for colorectal cancer. We aimed to determine the relationship between serum vitamin B12 levels and the stage of disease in colorectal cancer patients. Materials and Methods: This cross-sectional study was performed on 43 colorectal cancer patients referring to the Oncology Clinic of Semnan in 2016-2018. Patients received blood tests for serum vitamin B12 levels measurement. Data on age, gender, stage of disease, tumor penetration depth, regional lymph node involvement, remote metastasis, and tumor location were extracted from medical records and pathologic reports. Finally, the relationship between serum vitamin B12 levels and these variables was investigated. Results: The mean level of vitamin B12 among women was significantly higher than that of men (P = 0.015). On average, 62.5 of patients with the stages 2 and 3 as well as 41.8 of patients with the stage4 showed abnormal serum levels of vitamin B12 (deficiency and partial deficiency), while no significant difference was seen (P=0.613). Vitamin levels in patients with lymph node involvement were higher than those without lymph node involvement, but there was no significant difference between them (P = 0.236). Also, levels of vitamin B12 in patients with distant metastases were higher than those without such metastases, but there was insignificant difference between them (P= 0.290). Conclusion: More extensive studies with a larger sample size are recommended to evaluate the relationship between serum vitamin B12 levels and the disease stage in predicting the prognosis of colorectal cancer patients with vitamin B12 deficiency. © 2020, Advanced Scientific Research. All rights reserved

Robotic versus Non-Robotic Instruments in Spatially Constrained Operative Workspaces - A Pre-Clinical Randomised Crossover Study

Objective To compare the effectiveness of robotic and non‐robotic laparoscopic instruments in spatially constrained workspaces. Materials and Methods Surgeons performed intracorporeal sutures with various instruments within three different cylindrical workspace sizes. Three pairs of instruments were compared: 3‐mm non‐robotic mini‐laparoscopy instruments; 5‐mm robotic instruments; and 8‐mm robotic instruments. Workspace diameters were 4, 6 and 8 cm, with volumes of 50, 113 and 201 cm3 respectively. Primary outcomes were validated objective task performance scores and instrument workspace breach counts. Results A total of 23 participants performed 276 suture task repetitions. The overall median task performance scores for the 3‐, 5‐ and 8‐mm instruments were 421, 398 and 402, respectively (P = 0.12). Task scores were highest (best) for the 3‐mm non‐robotic instruments in all workspace sizes. Scores were significantly lower when spatial constraints were imposed, with median task scores for the 4‐, 6‐ and 8‐cm diameter workspaces being 388, 415 and 420, respectively (P = 0.026). Significant indirect relationships were seen between boundary breaches and workspace size (P < 0.001). Higher breach counts occurred with the robotic instruments. Conclusions Smaller workspaces limit the performance of both robotic and non‐robotic instruments. In operating workspaces <200 cm3, 3‐mm non‐robotic instruments are better suited for advanced bimanual operative tasks such as suturing. Future robotic instruments need further optimization if this technology is to be uniquely advantageous for clinical roles that involve endoscopic access to workspace‐restricted anatomical areas

Non-functioning pituitary macroadenoma: surgical outcomes, tumor regrowth, and alterations in pituitary function�3-year experience from the Iranian Pituitary Tumor Registry

Purpose: The aim of this study was to assess clinical features and therapeutic outcomes in patients with clinically non-functioning pituitary macroadenomas (NFPMAs). Method: This is a retrospective cohort study of NFPMA patients treated surgically and followed periodically between 2015 and 2017 in a tertiary care center in Iran. Descriptive analysis was performed applying appropriate tests. Binary logistic regression models were used to determine the predictive factors for subtotal tumor resection (STR) and hormonal recovery. Data were analyzed by Stata software. Result: A total of 71 patients with a mean age of 50.6 ± 1.4 years were studied. The mean diameter of the adenoma was 26.8 ± 1.1 mm. The most frequent symptoms were headache (85.75), visual field defect (VFD) (78.3), and hypogonadal symptoms (40.3). Gross total resection (GTR) was achieved in 45.1. Preoperative hypopituitarism was observed in 50.7 of patients. Recovery of at least one axis occurred in 36.1 of the patients suffering from hypopituitarism preoperatively, while new-onset postoperative hormonal deficiency appeared in 14.3 of patients. Multivariate analyses showing preoperative tumor size (OR = 38.2; P = 0.008) and cavernous sinus extension (OR = 13.4; P = 0.020) were predictors of STR. Moreover, hormonal recovery was observed not to be related to age, gender, tumor size, or the extent of tumor resection. Conclusions: Tumor size and cavernous sinus extension are the main predictors for STR. Notably, recovery of the gonadal axis in a large proportion of patients supports the surgical resection of NFPAM in patients suffering from gonadal deficiency, even in the absence of VFD. © 2019, Hellenic Endocrine Society