Early Insulin Glargine Initiation in Iranian People With Uncontrolled Type 2 Diabetes: Glycemic Control, and Adverse Events

To explore glycemic control, and adverse events of Iranian people with uncontrolled type 2 diabetes after initiation of long-acting basal insulin, glargine. People with uncontrolled type 2 diabetes that was on at least two oral anti-diabetic drugs (OAD) were enrolled in this observational prospective study. Insulin glargine was prescribed by physicians in the course of routine clinical practice. Patients were followed for 24 weeks. Insulin doses were titrated to reach fasting blood sugar (FBS) target between 90 mg/dl and 130 mg/dl. HbA1c and adverse events were recorded at baseline, week 12, and week 24. Form a total of 292 participants, 243 patients completed the study. HbA1c, FBS, postprandial glucose, total cholesterol, triglycerides, and low-density lipoprotein cholesterol, but not body mass index decreased during the study. The proportion of poorly controlled patients (HbA1C>9%) decreased from 172 (58.9%) to 39(13.4%), and 21(7.2%) during follow up. Controlled glycemia (HbA1C<7%) was detected in 7(2.4%), 48 (16.4%) and 56 (19.2%) of patients at baseline, week 12 and week 24. Hypoglycemia was reported in 5.1% and 3.4% of the participants in the week at 12 and 24, respectively. Patients felt more satisfied with their blood glucose control, timing and choices of meals, and hypo/hyperglycemic experiences. Insulin glargine initiation in people with uncontrolled type 2 diabetes on 2 OADs is associated with significant improvement in metabolic control.  Insulin glargine has good safety profile and well tolerated by the patients

Neuroendocrine tumors treatment with I-131 Metaiodobenzylguanidine (MIBG)

Background: I-131 Metaiodobenzylguanidine (MIBG) is a radiopharmaceutical which is proved effective in treatment of tumors with neuroendocrine origin, especially the neuroectodermal (sympathoadrenal) type, including pheochromocytoma, paraganglioma and neuroblastoma. It is also of some value in other neuroendocrine tumors (mainly carcinoid and medullary carcinoma of thyroid). Methods: The method employed in this research was a systematic bibliographic review, in which only valid studies or the clinically detailed enough open-labeled studies using validated scales were used. Results: I-131 MIBG is the best nonsurgical method for treatment of pheochromocytoma. It not only increases survival, but also significantly improves patients&rsquo; symptoms (75-90%). Although the efficacy of this method for refractory or relapsing neuroblastoma has been 30%, adding other treatment modalities increases the impact of this treatment. For other neuroendocrine tumors including carcinoid tumor and medullary carcinoma of thyroid, MIBG therapy has been effective in reducing patients&rsquo; symptoms. The most important complication of this method is myelosuppression which needs follow-up and if necessary relevant treatment. Conclusion: I-131 MIBG has an important role in treatment of chromafin tumors. For pheochromocytoma and neuroblastoma it is the best nonsurgical treatment. It is effective in neuroblastoma especially if it is used in conjunction with other treatment modalities. I-131 MIBG can also diminish symptoms of carcinoid tumor and medullary thyroid carcinoma efficiently

Decompressive Craniectomy in Traumatic Brain Injury:Factors Influencing Prognosis and Outcome

Background and Aim: Decompressive craniectomy can be life-saving for patients with severe traumatic brain injury, but many questions about its ideal application, indications, timing, technique, and even the definition of success of decompressive craniectomy remains unclear. The aim of this study was to assess the factors associated with prognosis and outcome of patients with traumatic brain injury who had undergone a rapid decompressive craniectomy. Methods and Materials/Patients: We investigated 61 patients, who had undergone rapid decompressive craniectomy. The effect of variables including demographic features of patients, primary level of consciousness, pupil size and reactivity, and midline shift in patients' brain CT scan on outcome of patients were assessed. Results: 61 patients (36 males and 25 females) underwent rapid surgical decompressive craniectomy within 4.5±2 hours after trauma. Mean age of patients was 36.09±15.89 years old (range: 16 to 68 years). Of 61 patients, 33 (54.1%) had favorable and 28 (45.9%) had unfavorable outcome. Patients with following conditions had significantly worse outcome; age older than 60 years, bilateral non-reactive mydriasis, critical head injury (GCS<5), midline shift more than 10 millimeters in their brain CT scan. GCS and age could predict the outcome of surgery more significantly than other variables, so that higher age predicted unfavorable outcome with 1.13 times, and in GCS<5 the probability of unfavorable outcome is about 192 times. Patients with midline shift more than 10 mm are 6.15 times more likely to have risk of unfavorable outcome than those with midline shift less than 10 mm. Conclusion: In this study, we found that age more than 60 years and GCS less than five were associated with poor outcome. Patients with these conditions could not benefit much from early decompressive craniectomy

Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy

Objective(s): Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer. Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring) were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT) to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions) over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol) was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed) and 36 patients with right-sided cancer (controls)] were enrolled. Dose-volume histogram (DVH) [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46). In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03) and anterolateral (17.1% versus 2.8%, P=0.049) walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS) of>3 was observed in twelve cases (34.3%), while in five of the controls (13.9%),(Odds ratio=1.3). There was no significant difference between the groups regarding left ventricular ejection fraction. Conclusion: The risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the left hemi thorax is not low. It is reasonable to minimize the volume of the heart being in the field of radiation employing didactic radiation planning techniques. Also it is advisable to screen these patients with MPI-SPECT, even if they are clinically asymptomatic, as early diagnosis and treatment of silent ischemia may change the outcome

Changes in salivary gland function following radioiodine therapy of thyroid diseases: A comparison of high-dose therapy for thyroid cancer and low-dose therapy for benign thyroid disease

ABSTRACT Introduction: High-dose radioactive iodine therapy in differentiated thyroid cancer (DTC) may adversely affect the salivary gland function. This study is aimed to evaluate the effect of radioactive iodine (RAI) with dose of 100 mCi in DTC patients compared to lower doses of less than 30 mCi in hyperthyroid cases. Methods: Fifty four patients (13 men and 41 women) age: 42.3±14.3 (21-71) years were enrolled in the study. Twenty seven hyperthyroid cases received less than 30 mCi of I-131 for the treatment, and 27 DTC patients were treated with 100 mCi of I-131. All patients underwent Tc-99m pertechnetate scintigraphy before and three months after radioiodine therapy. Salivary gland excretion fractions (EF) were compared between groups. A decrease of more than 5% in EF was considered significant. Results: The total frequency of salivary dysfunction was 41.7%. In patients received a dosage of 100 mCi of I-131, this frequency was 49.1%, while with less than 30 mCi, it was 34.3% (p&lt;0.01). The right parotid gland was affected more than the left following 100 mCi treatment. Risk ratio of salivary gland involvement in high-dose versus low-dose group was significant (risk ratio=1.04-1.98, CI (95%); p=0.019). However, there was no significant difference in symptom presentation, i.e. xerostomia between two groups. Conclusion: RAI therapy may cause salivary gland dysfunction and this effect is more frequent in DTC patients with higher dose of 100 mCi compared to hyperthyroid cases with lower doses of less than 30 mCi