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Background Thyroid nodules were widely encountered in the population, and the selection of thyroid nodules for fine needle aspiration cytology (FNAC) remains confusing. It is essential to investigate the risk factors associated with thyroid nodules. Aim of work This study aimed to evaluate the accuracy of the American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) scoring system in distinguishing malignant thyroid nodules from benign ones and its association with cytological examination of the FNAC of the thyroid nodules. Additionally, we seek to investigate any potential association between thyroid nodules and some metabolic derangements. Patients and methods The study included 111 Egyptian patients with euthyroid nodules whom were subjected to history taking, clinical examination, and laboratory investigations including thyroid profile, fasting blood sugar (FBS), glycosylated hemoglobin A1c (HbA1c), and lipid profile. Thyroid ultrasound and FNAC were done for all patients. Categorization of each nodule was done according to the TIRADS. Cytopathological diagnosis was done by Bethesda system cytology classification. Results There were 19 malignant and 92 benign nodules. There was a statistically significant difference between benign and malignant nodules regarding TIRADS classification, taller-than-wide shape, solidity, border, presence of peripheral calcifications, or punctuate echogenic foci ( p < 0.05). Taller-than-wide shape had the highest specificity followed by irregular margin (94.6% and 92.6%, respectively). Sensitivity, specificity, PPV, and NPV for ACR-TIRADS versus cytopathology were 73.7%, 57.6%, 26.4%, and 91.4% respectively with overall accuracy of 60.4%. The high sensitivity and NPV of the US-based TIRADS classification system have excellent utility for correctly classifying nodules as positive for malignant disease. As regards risks for thyroid nodules, results showed that most of the study population were obese [Body Mass Index (BMI) = 31.6 ± 6.3, Waist circumference (WC) = 107.4 ± 13.9]. TSH and hypercholesterolemia did not show a significant association with thyroid malignancy. Conclusion ACR-TIRADS classification is of high significant value in classifying nodules as positive for malignant disease and for predicting the absence of malignant disease, reducing unnecessary nodule FNAC. Hypercholesterolemia and TSH value were not significantly associated with malignant thyroid nodules.

Background: Thyrotoxicosis may be caused by Graves' disease or destructive thyroiditis. Differentiation between causes of thyrotoxicosis is crucial as management will differ. \"\"Technetium (Tc)-pertechnetate thyroid scintigraphy is currently the gold standard for this purpose, however, is expensive and uses ionizing radiation. Objective: To evaluate the role of color flow Doppler Ultrasound (CDU) of the superior thyroid (STA) and inferior thyroid arteries (ITA) as an inexpensive, non-invasive tool that can aid in differentiating between Graves' disease and thyroiditis and compare it with thyroid scintigraphy. Methods: Sixty-nine patients with newly-diagnosed thyrotoxicosis and 30 controls were enrolled. Thyroid functions, thyroid scintigraphy, and CDU of STA and ITA with measurements of peak systolic velocity (PSV) and end diastolic velocity (EDV), were performed. According to thyroid scintigraphy results, patients were divided into two groups: 42 patients with Graves' disease and 27 patients with thyroiditis. Results: PSVand EDV of both STA and ITA were significantly higher in patients with Graves' disease than thyroiditis (p-values <0.001). The STA-PSV had an equal sensitivity and specificity of 66.7%; cut-off value 76.57 cm/s, while those of STA-EDV were 73.8%, and 77.8% respectively; cut-off value 28.22 cm/s. ITA-PSV had a sensitivity and specificity of 76.2% and 77.8%, respectively; cut-off value 62.12 cm/s), while those of ITA-EDV were 78.6% and 77.8%, respectively; cut-off value 5.22 cm/s. Conclusion: CDU parameters of the STA and ITA could be used as an alternative to thyroid scintigraphy for discriminating between Graves' disease and thyroiditis. Keywords: Color Doppler Flow Ultrasound, peak systolic velocity, end-diastolic velocity, Graves' disease, thyroiditis

Background Hepatocellular carcinoma is considered one of the most common cancers occurring in human population all over the world. It became an increasingly threatening malignancy due to both morbidity and mortality. Chronic viral hepatitis B and hepatitis C are two risk factors, which account for 80–90% of all HCC cases worldwide. Alfa Feto protien is used as a tumor marker for HCC diagnosis and prognosis prediction; however, its false negative rate when used alone is as high as 40% for patients with early-stage HCC. AFP levels remain normal in 15–30% of all the patients, even patients with advanced HCC. It has been demonstrated that miRNAs (MicroRNAs) are an important class of non-coding RNAs. They act as tumor oncogenes or suppressors and are involved in the HCC development. MiRNAs are endogenous nucleotides that can be found in intra- and extracellular spaces, such as the blood, urine, and saliva. The study evaluated the miRNA 21 as a novel biomarker in patients with HCV related hepatocellular carcinoma. Results The study was conducted on three groups. Group (1) included 25 patients with liver cirrhosis due to hepatitis C virus infection. Group (2) included 25 patients with hepatocellular carcinoma (HCC) on top of liver cirrhosis due to hepatitis C virus infection. Group (3) included 10 normal control subjects. There was a significant difference in the mean level of miRNA between the three groups with p value < 0.001 with the highest value in group 2 ( 8.28 ± 2.55), then in group1 (5.04 ± 2.11) and the lowest in group 3 (control) (1.02 ± 0.07). MiRNA 21 has a sensitivity of 68% and a specificity of 96%, to differentiate between the liver cirrhosis group and HCC group. Conclusion miRNA 21 can be a promising marker for detection of patients with HCV-related hepatocellular carcinoma, with higher specificity compared to α feto protein; however, its cost is higher.

Introduction Nonalcoholic fatty liver disease (NAFLD) is a common cause of impaired liver functions. It is associated with hepatic and adipose tissue insulin resistance (IR) as well as decreased whole-body insulin sensitivity. Thyroid hormones are important for the intrahepatic metabolism of lipids. Thyroid disorders have been associated with IR owing to various mechanisms such as altered insulin secretion and lipid levels. Aim The aim of our study was to assess thyroid functions, thyroid autoimmunity, and IR in nondiabetic patients with NAFLD. Materials and methods The study was conducted on 90 nondiabetic participants (60 patients with NAFLD and 30 participants with normal liver). Both groups were sex matched. Ultrasonography was used to categorize the study participants into NAFLD and normal liver groups. Thyroid functions and thyroid peroxidase antibody were assessed in all participants. Homeostatic model assessment (HOMA IR) was used to assess IR in the study population. Results Our results showed a significantly higher HOMA IR in the NAFLD compared with the normal liver group ( P <0.001). Moreover, significantly higher percentage of patients with NAFLD have IR (HOMA IR) compared with the normal liver group (56.7 vs. 6.7%, respectively; P <0.001). Our results also showed higher percentage of thyroid dysfunction in patients with NAFLD compared with individuals without NAFLD ( P <0.02). Overall, 22 (36.7%) 60 patients in the NAFLD group versus three (10%) of 30 patients in the non-NAFLD group had subclinical hypothyroidism. Thyroid functions did not show any statistically significant correlations with IR, but thyroid peroxidase antibody showed significant positive correlation with IR ( P <0.02) within the total study population. Conclusion There is an increased prevalence of subclinical hypothyroidism in nondiabetic patients with NAFLD who also have higher IR. The role of thyroid autoimmunity in this relationship needs further assessment.

Background Ischemia-modified albumin (IMA) is a novel marker of tissue ischemia and oxidative stress. Aim We assessed the level of IMA concentration in type 2 diabetes mellitus (T2DM) patients with diabetic nephropathy and its correlation with glycemia level, duration of diabetes, dyslipidemia, serum creatinine, and urinary albumin/creatinine ratio. Patients and methods This study included 91 patients who were divided into three groups: group A (33) included T2DM patients without nephropathy; group B (29) included T2DM patients with nephropathy; and group C (29) included healthy as control. Blood samples were analyzed manually for plasma IMA by spectrophotometric cobalt (II)-albuminbinding assay. Results Serum levels of IMA were significantly higher in group B in comparison to group A with a P value less than 0.001 and group C with a P value less than 0.0001. IMA positively correlated with blood pressure, duration of diabetes, fasting blood glucose, postprandial blood glucose, glycated hemoglobin, cholesterol, low-density lipoprotein, triglycerides, serum creatinine, and albumin/creatinine ratio, all with a P value less than 0.0001 and also with BMI ( P <0.003). IMA was a significant discriminator for diabetic nephropathy ( P <0.001) with 100% specificity and 100% sensitivity. Conclusion IMA could serve as an indicator of glycemic control and a sensitive marker of diabetic nephropathy.

Despite the availability and benefits of the Human papillomavirus (HPV) vaccine, parental acceptance remains low in the eastern mediterranean region (EMR). Therefore, this meta-analysis aimed to estimate the pooled proportion of parental uptake and willingness to vaccinate their children with the HPV vaccine and their determinants in the EMR. We searched PubMed Central, PubMed Medline, Scopus, Web of Science, ProQuest, Google Scholar, and medRxiv according to PRISMA guidelines until the 5th of April 2024. We included all papers discussing parental uptake and willingness to vaccinate their children with the HPV vaccine in EMR without time or language limitations. The study risk of bias was assessed using the Newcastle–Ottawa Scale quality assessment tool. We pooled data using the random effect model. Leave one sensitivity analysis, subgroup analysis, and meta-regression were used to address heterogeneity. Out of 1551 screened studies, thirty-three studies of 18,455 parents from 12 countries fully met the inclusion criteria and were eligible for meta-analysis. The pooled proportion of parental willingness for future HPV vaccination, based on 32 studies involving 17,815 parents was 61 % (95 % CI: 54–68 %, I2 = 99 %). Using meta-regression, the proportion of working parents, study quality, and geographical region explained approximately 52.46% of the observed heterogeneity. In contrast, based on 9 studies involving 5029 parents, the pooled proportion of parental uptake was 7 % (95 % CI: 5–10 %, I2 = 91 %). Using meta-regression, study quality and geographical region explained 71.42% of the observed heterogeneity. Despite the high parental willingness for HPV vaccination, the uptake of the vaccine in EMR remains critically suboptimal and far behind the goal of the World Health Organization's cervical cancer elimination strategy. Urgent interventions are needed, including adding the vaccine to the national vaccination programs (NVPs) and tailoring parents–targeted awareness campaigns to improve knowledge and address barriers to vaccine uptake.