Aim: This study evaluated the effect of sitagliptin versus glibenclamide on arterial stiffness, blood pressure, lipid profile, oxidative stress, and high-sensitivity C-reactive protein (hsCRP) in type 2 diabetes mellitus patients. Subjects and Methods: Forty diabetes patients, inadequately controlled on metformin, were randomly assigned to either sitagliptin (100 mg/day) or glibenclamide (5 mg/day) for 3 months. Following a 1-month washout period, a crossover switch from glibenclamide to sitagliptin and vice versa was performed for an additional 3 months. Arterial stiffness, 24-h ambulatory blood pressure monitoring, lipids, hsCRP, glycated hemoglobin, fasting glucose, STAT-8-isoprostane (a measure of oxidative stress), body mass index (BMI), and waist circumference were measured at baseline and at 3 months with each of the study drugs. Results: Thirty-four patients completed the study. Glibenclamide had a better glucose-lowering effect than sitagliptin, but this was associated with more hypoglycemic events. BMI increased following glibenclamide treatment, whereas sitagliptin proved weight-neutral. Mean BMI gain was +0.5±1.0 kg/m ² for glibenclamide versus −0.01±0.9 kg/m ² for sitagliptin ( P <0.001). Triglyceride levels significantly dropped following sitagliptin, although they remained unaltered after glibenclamide treatment. Mean triglyceride decrease was −18.4±45 mg/mL after sitagliptin but −0.2±57 mg/dL following glibenclamide treatment ( P =0.018). There was no change in low-density lipoprotein, high-density lipoprotein, arterial stiffness, blood pressure monitoring, hsCRP, or STAT-8-isoprostane with each of the study drugs. Conclusions: Sitagliptin, but not glibenclamide, demonstrated a significant beneficial effect on BMI and triglyceride levels. However, arterial stiffness, blood pressure, oxidative stress, and inflammatory status were not significantly affected by adding sitagliptin or glibenclamide to metformin-treated type 2 diabetes patients.

Background: The extent of surgery for differentiated thyroid cancer (DTC) remains a controversial issue. Since a less aggressive approach is becoming more predominant, we aim here to study the short- and long-term outcomes of DTC patients after hemithyroidectomy. Methods: From a total of 1252 consecutive papillary thyroid cancer (PTC) patients, 109 treated with hemithyroidectomy and 50 with total thyroidectomy but no I¹³¹ were included. Persistent or recurrent disease was defined based on histopathology, imaging studies, and thyroglobulin levels. Results: Our hemithyroidectomy cohort included females (84.4%), microcarcinomas (81.9%), TNM stage I (95.4%), and a low American Thyroid Association (ATA) recurrence risk (94.5%). At one-year post-treatment, 3.7% had persistent disease (all female, median age 55 years, tumor size 7.5 mm). Recurrent disease was detected in 7.5% of those with excellent response at 1-year. With a follow-up of 8.6 years (1–48), all 109 patients were disease free at last visit, including the 11 patients (10.1%) who received additional treatment. Also, when comparing the hemi- and total thyroidectomy groups no significant differences were found in the rate of persistent and recurrent disease, overall mortality, and disease status at last visit. Conclusions: For properly selected low-risk PTC patients, hemithyroidectomy is a safe treatment option with a favorable long-term outcome.

Background: The management of relapsing Graves’ disease is controversial. Previous surveys from different regions in the world demonstrated variations in the clinical practices of patients with Graves’ disease relapse. Methods: To determine management pattern among endocrinologists in Israel an electronic questionnaire was e-mailed to all members of the Israeli Endocrine Society. Questionnaires included demographic data and clinical scenarios with questions regarding the treatment and follow up of patients with relapsing Graves’ disease. Results: We received 98 responses from Israeli endocrinologists. 42 (43%) males and 56 (57%) females. 41.8% had board certificate for more than 10 years. 72.4% responders work in hospital environment and 26.5% work in community clinics. 61.2% see more than 10 thyroid patients in clinic per week. When managing Graves’ relapse following ATD treatment in a young male, 68% would restart ATD (98% mercaptizol) and 32% would refer to RAI treatment. Interestingly, endocrinologist who treat more thyroid patients (more than 10/week) tend to choose ATD over RAI (P=0.04). In case of recurrent Graves’ and ophtalmopaty 50% would continue ATD, 22.4% would recommend RAI treatment and 27.6% surgery. Most endocrinologists (56%) would continue ATD for 12–24 months. 75% would monitor CBC and liver function (39% for the first month and 36% for 6 months). 44% would recommend routine neck US, and 19.3% would recommend routine DEXA. In a case of thyrotoxicosis due to 3 cm toxic nodule tirads 4a most endocrinologists (70%) would refer to RAI ablation, 46.4% without FNA and 23.7% with FNA. No significant difference was found in correlation with gender, years of board certificate, or work environment.

Aim: The aim of this study was to compare maternal and neonatal outcomes between Israeli Arab and Jewish women with GDM not controlled with lifestyle modification. Methods: We conducted a retrospective cohort study of women with GDM who were not controlled with lifestyle modification and were followed and gave birth in a university affiliated medical center between 2005 and 2015. Results: The study included 343 women, 45 (11.8%) of them Arabs. There were no differences in the baseline characteristics between the two ethnic groups including age, gravidity, parity or pre-pregnancy body mass index. There were 41.85% Jewish women with good glycemic control compared to 31.4% of the Arab women (P=0.197). A similar fraction gave birth by caesarian section or assisted labor (%17.8 of the Arab versus 15.1% of the Jewish women, P=0.669). There were no differences in composite outcome comprised of pre-eclampsia, caesarian section due to diabetes, macrosomia and neonatal hypoglycemia (68.9% for the Arabs vs. 62.4% for the Jewish women P=0.42). Conclusions: Our study did not find differences in maternal and neonatal outcomes of Arab and Jewish population of women with GDM controlled with glucose lowering agents. These results are not consistent with previous published data. It is possible that the Arab population in our study shares comparable socioeconomic elements with the Jewish one and has access to similar medical care. Other possible explanation is a small sample size of this study.

Introduction: GEP-NETs incidence increased markedly over the past decades probably due to increased imaging. GEP-NETs are generally indolent but often have unpredictable biological behavior and aggressive clinical course. Aims: To collect information regarding demographics, presentation, pathology characteristics, treatment and outcome of GEP-NETs. Methods: Following approval of our institutional ethical board, pathology and clinical records of all GEP-NETs patients diagnosed and treated at our institution during 2005–2015 were reviewed. Results: We identified 110 patients with GEP-NETs distributed by site as pancreatic 32 (F=45.1%, age 61.2±6.8), gastric 19 (F=50%, age 66.2±11), duodenum 9 (F=33.3%, age 66.3±12), small bowel 13 (F=25%, age 60±12), appendix 34 (F=55.8%, age 36±19) and colorectal 3. The pNETs presented with abdominal pain (45.1%) incidentally (25.8%) or syndromatic (21.8%); including two insulinomas, one gastrinoma and four MEN1 patients. Mean size was 31±23 mm and grading was G1 39.2, G2 42.8, G3 17.8%. Distant metastases (DM) were seen in five patients (M1=3). Surgery was performed in 61.3%, additional treatment given to 32.2% (re-op, somatostatin analogue, TKI, chemotherapy). The gNETs presented mostly during work-up for anemia or GI bleeding (70.6%). Mean size was 15 mm and the majority (82.3%) were GCT1 and there were no DM. The dNETs presented with anemia (43%), abdominal pain (43%) or incidentally. None was syndromatic. Mean size was 11.2 mm, 50% were G1, and 2 had DM at presentation. Surgery was performed in 33.3% patients. The sbNETs presented with bowel obstruction (27%), abdominal pain (36%) or incidentally. None were syndromatic. Only 15% were G1, 6 had DM (M1=5), and 77% had surgery. Excluding aNETs, the overall mortality at last visit was 23.7% (7.9% disease related) at mean follow-up of 34.5 months. Conclusion: GEP-NETs are associated with significant morbidity and mortality. The primary site of the tumor has clinical implication for disease management.