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Search Results: 1 - 10 of 119154 matches for " Sami T. Azar "
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The Role of Vitamin D Deficiency in the Incidence, Progression, and Complications of Type 1 Diabetes Mellitus
Marlene Chakhtoura,Sami T. Azar
International Journal of Endocrinology , 2013, DOI: 10.1155/2013/148673
Controversies in the Management and Followup of Differentiated Thyroid Cancer: Beyond the Guidelines
Hala Ahmadieh,Sami T. Azar
Journal of Thyroid Research , 2012, DOI: 10.1155/2012/512401
Controversies in the Management and Followup of Differentiated Thyroid Cancer: Beyond the Guidelines
Hala Ahmadieh,Sami T. Azar
Journal of Thyroid Research , 2012, DOI: 10.1155/2012/512401
Abstract: Thyroid cancer is among the most common endocrine malignancies. Genetic and environmental factors play an important role in the pathogenesis of differentiated thyroid cancer. Both have good prognosis but with frequent recurrences. Cancer staging is an essential prognostic part of cancer management. There are multiple controversies in the management and followup of differentiated thyroid cancer. Debate still exists with regard to the optimal surgical approach but trends toward a more conservative approach, such as lobectomy, are being more favored, especially in papillary thyroid cancer, of tumor sizes less than 4 cm, in the absence of other high-risk suggestive features. Survival of patients with well-differentiated thyroid cancer was adversely affected by lymph node metastases. Prophylactic central LN dissection did improve accuracy in staging and decrease postop TG level, but it had no effect on small-sized tumors. Conservative approach was more applied with regard to the need and dose of radioiodine given postoperatively. There have been several advancements in the management of radioiodine resistant advanced differentiated thyroid cancers. Appropriate followup is required based on risk stratification of patients postoperatively. Many studies are still ongoing in order to reach the optimal management and followup of differentiated thyroid cancer. 1. Incidence and Prevalence of Thyroid Cancer Thyroid cancer is one of the most common endocrine malignancies currently present. The estimated new thyroid cancer cases in the United States in 2012 are 56,460 and there are around 1780 deaths from thyroid cancer [1]. Incidence of thyroid cancer has been increasing. This could be related to the earlier detection of thyroid cancer with the current use of imaging and the use of FNA of all suspicious thyroid nodules. It is important to note that the overall 10-year mortality for DTC is low at about 7% but the recurrence rate occurrence is higher, causing considerable anxiety among patients and treating physicians. The current paper focuses on the controversies in the initial management and subsequent followup of well-differentiated thyroid cancer. 2. Pathogenesis of Differentiated Thyroid Cancer Papillary and follicular thyroid carcinomas are the two histological subtypes of differentiated thyroid cancer. Both are indolent and have good prognosis overall. The biological behavior of these two carcinomas differ significantly, where papillary thyroid carcinoma is known to frequently metastasize to regional lymph nodes, whereas follicular thyroid carcinoma more
Type 2 Diabetes Mellitus, Oral Diabetic Medications, Insulin Therapy, and Overall Breast Cancer Risk
Hala Ahmadieh,Sami T. Azar
ISRN Endocrinology , 2013, DOI: 10.1155/2013/181240
Abstract: Breast cancer is among the most common cancers worldwide. Diabetes is an important chronic health problem associated with insulin resistance, increased insulin level, changes in growth hormones and factors, and activation of mitogen-activating protein kinase (MAPK) pathways, leading to an increased breast cancer risk. This paper looked at the epidemiologic studies of the association between type 2 diabetes and risk of breast cancer and its effect on overall cancer-specific survival. The combined evidence overall supported a modest association between type 2 diabetes and the risk of breast cancer, which was found to be more prevalent among postmenopausal women. Effect of oral diabetics and insulin therapy on breast cancer risk was also evaluated. It was found that metformin and thiazolidinones tended to have a protective role. Metformin therapy trials for its use as an adjuvant for breast cancer treatment are still ongoing. Sulfonylurea and insulin therapy were found to be mildly associated with increased overall cancers. No evidence or studies evaluated the association of DPPIV inhibitors and GLP 1 agonists with breast cancer risk because of their recent introduction into the management of diabetes. 1. Introduction Breast cancer is among the most common cancers worldwide and is the second leading cause of cancer death for women in the United States, after lung cancer, with an estimated incidence of 226,870 cases and estimated deaths of 39,510 cases in the year of 2012. The National Cancer Institute also estimated that 1 in 8 women in the United States has the chance of developing invasive breast cancer throughout her lifetime [1, 2]. Diabetes is also a very common chronic health problem where it is currently estimated that 10% of women in the United States over the age of 20 have type 2 diabetes. Prevalence of diabetes has steadily increased since 1990. The 2010 CDC study projected that by 2050, as many as one of three US adults could have diabetes if the current trend continues [3, 4]. Association between diabetes and breast cancer has been noted where 16% of older breast cancer patients were found to suffer from diabetes, and this might have important public health implications. 2. Pathogenesis Different mechanisms contribute to the association between diabetes and breast cancer. Diabetes induces several changes in different hormonal systems including insulin, insulin-like growth factors, estrogen, and other growth factors, all of which may affect the risk for breast cancer development. As shown in Figure 1, type 2 diabetes mellitus is associated with
The Link between Thyroid Function and Depression
Mirella P. Hage,Sami T. Azar
Journal of Thyroid Research , 2012, DOI: 10.1155/2012/590648
Abstract: The relation between thyroid function and depression has long been recognized. Patients with thyroid disorders are more prone to develop depressive symptoms and conversely depression may be accompanied by various subtle thyroid abnormalities. Traditionally, the most commonly documented abnormalities are elevated T4 levels, low T3, elevated rT3, a blunted TSH response to TRH, positive antithyroid antibodies, and elevated CSF TRH concentrations. In addition, thyroid hormone supplements appear to accelerate and enhance the clinical response to antidepressant drugs. However, the mechanisms underlying the interaction between thyroid function and depression remain to be further clarified. Recently, advances in biochemical, genetic, and neuroimaging fields have provided new insights into the thyroid-depression relationship. 1. Introduction The association between thyroid function and psychiatric disorders particularly mood disorders has long been recognized. Historically, this association has been described more than 200 years ago. Parry in 1825 reported an increased incidence of “nervous affectations” in thyroid disorders. Gull in 1873 showed the relation between myxedema and psychosis that was confirmed in 1888 by the Committee of the Clinical Society. Later, Asher in 1949 coined the term “myxedema madness” to describe the mental state of subjects with hypothyroidism [1]. Today, it is well recognized that disturbances in thyroid function may significantly affect mental status including emotion and cognition. Both excess and insufficient thyroid hormones can cause mood abnormalities including depression that is generally reversible with adequate thyroid treatment. On the other hand, depression can be accompanied by subtle thyroid dysfunction. Overt thyroid disease is rare in depression. One to 4% of patients with affective disorders are found to have overt hypothyroidism while subclinical hypothyroidism occurs in 4% to 40% of these patients [2]. Furthermore, thyroid hormones are reported by many authors to be an effective adjunct treatment for depression. In this paper, we will present an overview of thyroid hormone metabolism in the brain, reexamine the different observations and clinical studies assessing the relationship between thyroid and depression, and shed light on the advances in neuroimaging approaches in this field. Understanding the link between both disorders will guide clinicians to appropriately interpret thyroid function tests in depression, better understand the pathophysiology of both diseases, and try to identify the subjects who will
Osteoporosis in Men with Diabetes Mellitus
Claire Issa,Mira S. Zantout,Sami T. Azar
Journal of Osteoporosis , 2011, DOI: 10.4061/2011/651867
Abstract: Osteoporosis is more common in women than in men. The prevalence in men is not defined yet; however it is becoming much more recognized as its prevalence and impact have become explicable. It is estimated that around 1% of bone mineral density is lost in men every year. Studies show that secondary osteoporosis is the major cause thus, making it important to define the disorders associated with male osteoporosis. Diabetes is a risk factor for bone fractures. In male patients with diabetes measures should be undertaken such as encouraging exercise, assuring adequate calcium and vitamin D intake, and treating diabetic complications.
Thyroid Disorders and Diabetes Mellitus
Mirella Hage,Mira S. Zantout,Sami T. Azar
Journal of Thyroid Research , 2011, DOI: 10.4061/2011/439463
Abstract: Studies have found that diabetes and thyroid disorders tend to coexist in patients. Both conditions involve a dysfunction of the endocrine system. Thyroid disorders can have a major impact on glucose control, and untreated thyroid disorders affect the management of diabetes in patients. Consequently, a systematic approach to thyroid testing in patients with diabetes is recommended. 1. Introduction Thyroid diseases and diabetes mellitus are the two most common endocrine disorders encountered in clinical practice. Diabetes and thyroid disorders have been shown to mutually influence each other and associations between both conditions have long been reported [1, 2]. On one hand, thyroid hormones contribute to the regulation of carbohydrate metabolism and pancreatic function, and on the other hand, diabetes affects thyroid function tests to variable extents. This paper demonstrates the importance of recognition of this interdependent relationship between thyroid disease and diabetes which in turn will help guide clinicians on the optimal screening and management of these conditions. 2. Frequency of Thyroid Disorders in the General Population and in Patients with Diabetes Thyroid disorders are widely common with variable prevalence among the different populations. Data from the Whickham survey conducted in the late 1970s in the north of England revealed a prevalence of 6.6% of thyroid dysfunction in the adult general population [3]. In the Colorado Thyroid Disease Prevalence study involving 25,862 participants attending a state health fair, 9.5% of the studied population were found to have an elevated TSH, while 2.2% had a low TSH [4]. In the NHANES III study, a survey of 17,353 subjects representing the US population, hypothyroidism was found in 4.6% and hyperthyroidism in 1.3% of subjects [5]. The latter further observed an increased frequency of thyroid dysfunction with advancing age and a higher prevalence of thyroid disease in women compared to men and in diabetic subjects compared to nondiabetic. Several reports documented a higher than normal prevalence of thyroid dysfunction in the diabetic population. Particularly, Perros et al. demonstrated an overall prevalence of 13.4% of thyroid diseases in diabetics with the highest prevalence in type 1 female diabetics (31.4%) and lowest prevalence in type 2 male diabetics (6.9%) [6]. Recently, a prevalence of 12.3% was reported among Greek diabetic patients [7] and 16% of Saudi patients with type 2 diabetes were found to have thyroid dysfunction [8]. In Jordan, a study reported that thyroid dysfunction was
Connecting the Lines between Hypogonadism and Atherosclerosis
Akl C. Fahed,Joanna M. Gholmieh,Sami T. Azar
International Journal of Endocrinology , 2012, DOI: 10.1155/2012/793953
Abstract: Epidemiological studies show that atherosclerotic cardiovascular disease is a leading cause of morbidity and mortality worldwide and point to gender differences with ageing males being at highest risk. Atherosclerosis is a complex process that has several risk factors and mediators. Hypogonadism is a commonly undiagnosed disease that has been associated with many of the events, and risk factors leading to atherosclerosis. The mechanistic relations between testosterone levels, atherosclerotic events, and risk factors are poorly understood in many instances, but the links are clear. In this paper, we summarize the research journey that explains the link between hypogonadism, each of the atherosclerotic events, and risk factors. We look into the different areas from which lessons could be learned, including epidemiological studies, animal and laboratory experiments, studies on androgen deprivation therapy patients, and studies on testosterone-treated patients. We finish by providing recommendations for the clinician and needs for future research.
Gemfibrozil Improves Postprandial Hypertriglyceridemia in Patients with Isolated Low HDL
Hania S. Kassem, Mira S. Zantout and Sami T. Azar
Lipid Insights , 2012, DOI: 10.4137/LPI.S5722
Abstract: Aim: To assess the response of postprandial (PP) hypertriglyceridemia to genfibrozil in healthy male subjects with isolated low HDL-Cholesterol but without the metabolic syndrome (MS). Patients and methods: 14 male subjects with isolated low HDL (HDL-C ≤ 33), normal fasting triglycerides and LDL-C levels and without any feature of the MS, were studied. 13 male subjects with HDL-C > 38 mg/dl served as controls. They also had normal fasting triglycerides and LDL-C levels and without any feature of the MS. The 2 groups were statistically similar with respect to age, blood pressure, BMI, body fat composition, waist circumference, waist to hip ratio, fasting insulin, fasting and PP blood sugar, baseline fasting TG level and baseline LDL-C. Postprandial TG levels were measured at 2, 4, and 6 hours following a morning meal. Ten of the patients with PP hypertriglyceridemia were treated with gemfibrozil 600 mg PO twice/day for one month. Results: Patients had markedly higher levels of the peak PP TG at 4 hours compared to controls (296.0 ± 37.7 vs. 206.7 ± 29.9 mg/dl; P < 0.05) the other two postprandial levels were also higher in patients but the difference was not significant. Treatment with gemfibrozil significantly decreased the levels of fasting and postprandial TG and increased HDL-C by around 3.6 mg/dl (11.7%) without affecting LDL-C. Conclusion: Postprandial increase in serum TG may be present in patients with isolated HDL-C without the MS. Treatment of patients with PP hypertriglyceridemia with gemfibrozil improves the low HDL-C and postprandial rise in TG.
Gemfibrozil Improves Postprandial Hypertriglyceridemia in Patients with Isolated Low HDL
Hania S. Kassem,Mira S. Zantout,Sami T. Azar
Lipid Insights , 2011,
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