Background/AimsNon-alcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases in recent years. The aim of this study was to evaluate the effects of sitagliptin with and without a synbiotic supplement in the treatment of patients with NAFLD.MethodsIn total, 138 NAFLD patients aged 18-60 years were enrolled in the study. Patients were randomized to one of the following treatments for 16 weeks: Group I (n=68), sitagliptin 50 mg daily plus placebo (one capsule per day) or group II (n=70) sitagliptin 50 mg daily plus synbiotic (one capsule per day). Changes in fasting blood glucose (FBS), liver enzymes, lipid profile, and body mass index were compared between the groups.ResultsThe mean change in FBS with sitagliptin-placebo from baseline was -10.47±5.77 mg/dL, and that with sitagliptin-synbiotic was -13.52±4.16 mg/dL. There was a significant difference between the groups (P<0.001). The mean change in cholesterol (Chol) was -8.34±28.83 mg/dL with sitagliptin-placebo and -21.25±15.50 mg/dL with sitagliptinsynbiotic. There was a significant difference between the two groups (P=0.029). The administration of sitagliptin-placebo induced an increase of 6.13±27.04 mg/dL in low density lipoprotein (LDL), whereas sitagliptin-synbiotic induced a decrease of 14.92±15.85 mg/dL in LDL. A significant difference was observed between the two groups (P<0.001). On the other hand, in the sitagliptin-synbiotic group, there was significant improvement in aspartate aminotransferase (AST) level compared to the sitagliptin-placebo group (P=0.018).ConclusionsSitagliptin-synbiotic produced greater improvement in FBS, AST, Chol, and LDL compared to sitagliptin alone in patients with NAFLD.

Purpose Hypothyroidism is a clinical syndrome that can lead to elevated levels of serum creatinine and uric acid by causing impaired renal function. Although many studies have been carried out on the relationship between overt hypothyroidism and renal function, few studies have been conducted on subclinical hypothyroidism and renal function, especially in pediatric patients. For this reason, we studied this issue in children, so as to provide a background for more useful research and future education.Methods This case-control study was performed on 107 children aged 2–14 years, 56 children with subclinical hypothyroidism in the case group, and 51 healthy children in the control group presenting to Ayatollah Mousavi Hospital in Zanjan and private clinics of Zanjan city. Thyroid stimulating hormone, triiodothyronine, thyroxine, creatinine, and uric acid were measured in both groups of children after obtaining the necessary criteria for entering the study.Results Compared to the control group, subjects with subclinical hypothyroidism had higher levels of creatinine (P=0.003), while serum uric acid levels in subclinical hypothyroid children was not significantly different from those in the control group (P=0.200).Conclusions In subclinical hypothyroidism in children, creatinine was higher than in euthyroid patients, but uric acid was not different.

BACKGROUND:Diabetes mellitus is a progressive disorder that often requires combination therapy.AIM:This study aimed to compare and study of add-on sitagliptin versus pioglitazone in patients with type 2 diabetes inadequately controlled with metformin.METHODS:This 12-week, randomised, open-label and single centre study compared sitagliptin (100 mg daily, n = 80) and pioglitazone (30 mg daily, n = 80) in type 2 diabetic patients whose disease was not adequately controlled with metformin.RESULTS:The mean change in HbA1c from baseline was -1.001 ± 0.83 with sitagliptin and -0.75 ± 1.20 with pioglitazone, and there were no significant difference between groups (P = 0.132). The mean change in fasting blood sugar (FBS) was -18.48 ± 33.32 mg/dl with sitagliptin and -20.53 ± 53.97 mg/dl with pioglitazone, and there were no significant difference between groups (P = 0.773). Sitagliptin caused 1.08 ± 2.39 kg decrease in weight, whereas pioglitazone caused 0.27 ± 2.42 kg increase in weight, with a between-group difference of 0.81 kg (P < 0.001). On the other hand, in sitagliptin group, there was greater improvement in lipid profile than pioglitazone group.CONCLUSION:Sitagliptin and Pioglitazone demonstrated similar improvements in glycemic control in type 2 diabetes mellitus patients whose diabetes had been inadequately controlled with metformin. Nevertheless, sitagliptin was more effective than pioglitazone regarding lipid and body weight change.

Background: Testicular choriocarcinoma is a rare type of non-seminomatous germ cell tumour, and it often occurs in young males. It is the most aggressive form of germ cell tumour and tends to spread hematogenously, especially to the lungs. Pneumothorax is rarely the first manifestation of lung metastasis. Case summary: This case report describes a 33-year-old male with testicular choriocarcinoma and pulmonary metastasis, who presented with pneumothorax as the first critical manifestation. To the best of our knowledge, this is the second report of its kind in the literature. Conclusion: Spontaneous pneumothorax should be considered as the first serious clinical manifestation in patients with germ cell tumours.