ResearchPad - endocrinology-diabetes-metabolism https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Doege-Potter Syndrome and Pierre-Marie-Bamberger Syndrome in a Patient With Pleural Solitary Fibrous Tumor: A Rare Case With Literature Review]]> https://www.researchpad.co/article/elastic_article_16507 Solitary fibrous tumors (SFT) represent a unique subset of mostly benign heterogeneous tumors with mesenchymal cell origins. These tumors have been reported in the past as being mostly indolent, with a slowly evolving clinical course and low potential for malignancy. Although found systemically, the incidence of SFT arising intrathoracically, from the pleura of the lung, is relatively poorly documented in the medical literature. SFT is a rare phenomenon, but in even rarer circumstances, these tumors are associated with distinctive paraneoplastic syndromes, such as Pierre-Marie-Bamberger syndrome (PMBS) and Doege-Potter syndrome (DPS). PMBS presents as digital clubbing and hypertrophic pulmonary osteoarthropathy. DPS has been characterized as a non-islet cell tumor hypoglycemia due to the ectopic secretion of insulin-like growth factor 2 (IGF-2), a pattern seen in fewer than 5% of cases of SFT. Treatment is typically through surgical resection. In our research of the medical literature, we found only very few cases in which the association with SFT and both paraneoplastic syndromes were described. Here, we report an uncommon case of a 68-year-old male patient found to have an incidental right hemithoracic tumor with digital clubbing and intermittent severe episodes of fasting hypoglycemia after initially presenting with a syncopal episode.

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<![CDATA[Prognostic Significance of Diastolic Dysfunction With Multiple Comorbidities in Heart Failure Patients]]> https://www.researchpad.co/article/elastic_article_14320 Background

Heart failure poses a significant burden on health care and economy. In recent years, diastolic dysfunction has been increasingly recognized as a significant predictor of readmission in heart failure patients.

Objectives

We aimed to identify factors predicting readmission in patients with clinical heart failure at 30 days and six months.

Methods

A retrospective chart review was performed at a single urban medical center, including 208 patients in our final analysis.

Results

A higher Charlson comorbidity index (CCI) and moderate anemia (hemoglobin [Hb] < 10 g/dL) were significant predictors of readmission at both 30 days and six months. In addition, advanced chronic kidney disease (CKD) stage (4 or 5) and follow-up in a cardiology clinic were significant predictors at six months. During multivariate analysis, worsening diastolic dysfunction (grade 3 or 4) (OR: 2.09; 95% CI: 1.03 to 4.23), higher CCI (OR: 1.18; 95% CI: 1.03-1.36), and Hb < 10 g/dL (OR: 3.42; 95% CI: 1.44-8.13) were independent predictors of readmission at 30 days. Higher CCI (OR: 1.37; 95% CI: 1.19-1.58) and CKD stage 4 or 5 (OR: 3.05; 95% CI: 1.40-6.62) were independent predictors of readmission at six months.

Conclusions

Worse diastolic dysfunction (grade 3 or 4) was a significant predictor of all-cause readmission at 30 days post-discharge in heart failure patients. Higher CCI precisely predicted readmission as an independent variable at 30 days and six months. Anemia (Hb < 10 g/dL) and CKD stage 4 or 5 were significant predictors of readmission at 30-days and six months, respectively.

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<![CDATA[Impact of Diabetes-related Self-management on Glycemic Control in Type II Diabetes Mellitus]]> https://www.researchpad.co/article/elastic_article_13985 Introduction: Self-care activities are behaviors adopted in order to enhance one’s health. Self-care behaviors and activities are studied in their role to enhance glycemic control, reduce diabetes-related complications, and contribute to enhancing overall quality of life in people with diabetes. The aim of this observational study was to evaluate the impact of diabetes self-care activities and behaviors on glycemic control in people with diabetes.

Methods: This observational, cross-sectional study was conducted at the outpatient department of a secondary care hospital in Karachi, Pakistan from 1st September 2019 till 30th November 2019. Patients with known type II diabetes of age ≥45 years visiting the hospital for routine follow-up visit were included. Diabetes Self-Management Questionnaire (DSMQ) in Urdu version was used to assess their status of self-management. For data entry and statistical analysis SPSS for Windows version 21.0 was used.

Results: There were 174 (54.9%) males and 152 (47.9%) were of age 45-60 years. Glycemic control was good (HbA1c <7%) in 125 (39.4%) and poor (HbA1c ≥7%) in 192 (60.6%) patients. Patients with good glycemic control scored significantly better on DSMQ overall (5.53 ± 0.35 vs. 4.32 ± 0.61; p<0.0001), and on three sub-scales - dietary control (4.24 ± 1.04 vs. 3.63 ± 0.98; p<0.0001), physical activity (4.16 ± 0.56 vs. 3.47 ± 1.17; p<0.0001), and healthcare use (4.22 ± 0.78 vs. 3.98 ± 0.65; p=0.003). 

Conclusions: The self-care activities that impact glycemic control in patients with diabetes include dietary control, physical activity, and healthcare use.

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<![CDATA[Prevalence of Vitamin D Deficiency in Children with Type 1 Diabetes Mellitus]]> https://www.researchpad.co/article/elastic_article_10713 Background

In the recent years, controversy has emerged regarding the relationship between vitamin D deficiency and the potential effects it could have on glycemic control in patients with type 1 diabetes mellitus (T1D). This study investigates the prevalence of vitamin D insufficiency/deficiency in pediatric patients with T1D from a single, large volume practice.

Methods

This was a retrospective chart review that collected clinical/demographic data as well as serum 25(OH) D levels from medical records of 395 children between the ages of 3 and 18 years with T1D followed at Nemours Children’s Hospital. This data was compared to the National Health and Nutrition Examination Survey (NHANES) database. A Pearson’s Chi-square test was used between group associations. All statistical tests were two-sided and p < 0.05 was used for statistical significance.

Results

Of the 395 children included in these analyses, 4% were vitamin D deficient and 60% were vitamin D insufficient. There were no significant associations of vitamin D deficiency based on sex and age. Vitamin D deficiency was more common among White children when compared to Hispanic children and African American children (42% vs 29%; p < 0.001). Of those that were vitamin D insufficient (n = 235), most were Hispanic (51%), 36% White and 13% African American. There was a significant association between vitamin D deficiency and body mass index (BMI) (p = 0.035). In the summer, children were less likely to be vitamin D deficient (3% vs 6% in winter) and less likely to be vitamin D insufficient (55% vs 71% in winter) (p = 0.007).

Conclusions

Vitamin D insufficiency is highly prevalent among pediatric type 1 diabetics of Central Florida and statistically significant correlation was found between vitamin D status and ethnicity, BMI as well as seasonal variation.

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<![CDATA[Idiopathic Carpal Spasm (Trousseau’s Sign) After Intraoperative Arm Tourniquet Inflation in an Intubated Patient]]> https://www.researchpad.co/article/Na7d605f6-b641-406b-b131-264643d519a8 We present a case of a 38-year-old male who sustained a laceration from a knife to the volar aspect of his left index and middle fingers. He had clinical injury to his flexor digitorum profundus tendons to both digits. He underwent operative exploration and repair of the tendons under general anaesthetic. An arm tourniquet was inflated to allow for haemostasis in the operative field. A few minutes after inflation, the patient’s hand went into carpal spasm. The tourniquet was deflated and the spasm resolved. Intraoperative serum calcium and carbon dioxide levels were normal. The operation proceeded with the tourniquet deflated. Postoperatively serum calcium and magnesium levels were within normal limits, as was serum vitamin D and parathyroid hormone levels. It has been reported that carpal spasm can occur with tourniquet use in the anxious patient due to hyperventilation and resultant metabolic alkalosis. This however is the first reported case of carpal spasm in the setting of tourniquet use and normal serum electrolytes and respiratory parameters in an intubated patient.

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<![CDATA[Coexistence of Two Different Thyroid Malignancies: A Collision Phenomenon]]> https://www.researchpad.co/article/N8a3f4b55-4f13-4a98-9c87-efa7ef7d789a The term “collision tumor” is described as the coexistence of two or more histologically distinct neoplastic morphologies separated by normal tissue in the same organ. Simultaneous papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) of the same thyroid lobe is a very rare pathology. Herein, we report a case of PTC and FTC of the same thyroid lobe. A 79-year-old man was evaluated at our hospital for the presence of left hip pain of two-month duration after sustaining a physical trauma to the left side of his body three days prior to admission. X-ray imaging of the left femur revealed a large lytic bony lesion at the proximal end of left femur. Biopsy of the bone lesion was suggestive of FTC. Computed tomography (CT) of the neck revealed an enlarged thyroid with a cystic lesion in the left lobe of the thyroid gland. Total thyroidectomy was performed. Histopathology revealed two separate primary malignancies of PTC and FTC. Genetic studies for RAS gene mutation were negative. He was initiated on suppressive doses of levothyroxine following thyroidectomy. Three months after surgery, thyrotropin alfa stimulated 204.5 mCi I-131 was administered. At seven months of follow-up, the thyroglobulin level was in the lower end of the normal range and anti-thyroglobulin antibody (anti Tg) remained negative (< 1.0 IU/mL). He was doing well and reported no symptoms.

For each type of well-differentiated thyroid cancers, several genes have been identified. However, thus far, no specific gene mutation responsible for the pathogenesis of the different tumor types has been described. Management of thyroid collision tumor is usually complex due to the presence of different pathology in the tumor tissues and given the fact that literature on this condition is limited. Typically, the treatment needs to be individualized. Our report brings up a concept that the occurrence is a rare phenomenon of simultaneous mutation of different genes that could give rise to different thyroidal neoplasms.

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<![CDATA[Benign Ectopic Thyroid Tissue in the Neck: A Case Report of a Rare Finding]]> https://www.researchpad.co/article/N71b25938-55e3-47db-8d76-a1974b39f807

Ectopic thyroid tissue (ETT), though an uncommon finding, is prone to be clustered along the midline in the neck and rarely it shows up as a lateral neck mass. Whenever the ETT is discovered in unusual places, the possibility of malignancy is higher, and rarely a benign variant. We present a 71-year-old female with a past history of hypertension, hypercholesteremia, and thyroid nodules presented to the physician’s office complaining of an unusual swelling in the right side of a neck. The physical examination revealed a rubbery, non-tender, mobile, dominant mass in the right upper neck at the jugulodiagastric region in the upper anterior cervical triangle. Ultrasonography (USG) and computed tomography (CT) of the neck strongly suggested the benign characteristics of the mass. The postoperative histological examination of the specimen was indicative of benign thyroid tissue with no metastatic potential and no lymphoid tissue confirming the diagnosis of ETT. To better understand the clinical, pathological, and radiological nature of this rare disease, we present a rare case of ETT in the lateral cervical area which was resected.

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<![CDATA[Relationship Between Oral Health and Clinical Osteoporosis Among Hospitalized Patients with and Without Diabetes]]> https://www.researchpad.co/article/N2593ae98-fadb-4317-970d-37dca78f8b9f

Objective

Diabetes mellitus (DM) is associated with poor oral health and osteoporosis (OP). The aim of this study was to assess the relationship between OP, periodontal disease (PD), and other dental and health outcomes in a cohort of hospitalized patients with and without DM.

Method

Using a cross-sectional study design, we enrolled consecutive hospitalized patients. We administered a questionnaire to gather demographic information, oral health history, smoking history, and history of OP. We inspected their dentition and reviewed their charts. Data were analyzed using t-tests, chi-square tests, and logistic regression models.

Result 

Out of 301 patients enrolled, 275 had PD, 102 had DM, and 30 had OP. In univariate analyses, factors associated with OP included older age (p<0.001), female gender (p=0.046), presence of DM (p=0.049), and having more discharge medications (p=0.01). There was no significant relationship between PD and OP. In logistic regression analyses, age remained significantly associated with having OP among all hospitalized patients and in the non-DM populations. In the DM population, female gender was the only significant predictor for having OP.

Conclusion

Although we found no significant relationship between having PD and OP in our population, we found that among patients with DM, female gender predicted OP, whereas in patients without DM, age was a stronger predictor. Earlier screening for OP in female patients with DM may be useful in identifying and treating OP sooner in this population.

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<![CDATA[Granulomatous Myositis Associated with Extremely Elevated Anti-striated Muscle Antibodies in the Absence of Myasthenia Gravis]]> https://www.researchpad.co/article/N5e386c26-20ef-4a7e-ba30-f996124067d9

Granulomatous myositis is a rare disease that predominantly results in proximal muscle weakness in the upper and/or lower extremities. As it can resemble other inflammatory myopathies, it is important to obtain a muscle biopsy to make the underlying diagnosis. We report the first case of granulomatous myositis associated with extremely elevated anti-striated muscle antibodies in a 69-year-old Caucasian woman. Granulomatous myositis has been associated with various autoimmune, infectious, rheumatologic, vasculitis, and oncologic disorders, and several antibodies have previously been reported to be associated with it. However, to the best of our knowledge, this is the first report where extremely elevated anti-striated muscle antibodies were found to be associated with granulomatous myositis in the absence of myasthenia gravis. The treatment of granulomatous myositis revolves around the use of corticosteroids, steroid-sparing immunosuppressive agents, and newer biologics.

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<![CDATA[Hypoglycemic Risk Factors Among Hospitalized Patients with Type 2 Diabetes Mellitus at King Abdulaziz Medical City, Jeddah]]> https://www.researchpad.co/article/Nb447db5d-0e3a-4305-8b9d-6d1b45872c7d

Background

Hypoglycemia is a pathological condition in which the serum glucose level measures less than 3.0 mmol/L. It is a well-known complication in patients with diabetes mellitus. Age, body weight, gender, insulin usage, nutritional therapy, body mass index (BMI), the presence of diabetes complications, intensive care unit admission, and infection were reported as possible risk factors that may increase the risk of hypoglycemia. Therefore, this study aimed to analyze predisposing factors for hypoglycemia among hospitalized patients with type 2 diabetes in King Abdulaziz Medical City.

Method

This is a retrospective, case-control study design. The study included 326 hospitalized patients with type 2 diabetes; 152 experienced hypoglycemia (blood glucose <3.9) at least once during hospitalization and have been compared to 174 in the non-hypoglycemic group (blood glucose ≥3.9). Data were extracted from their electronic medical records (EMRs).

Results

This study reported that patients with lower BMI (28.80 ± 7 versus 31.20 ± 12.93) experienced hypoglycemia (P-value 0.044). Those hospitalized with infections or had acquired infections or required intensive care unit (ICU) admission during hospitalization had a higher risk to develop hypoglycemia (P-value 0.005, 0.003, and <0.001, respectively). Moreover, the use of multiple doses of insulin therapy or basal-plus insulin therapy was associated with a higher risk of hypoglycemia (P-value 0.012 and 0.028, respectively). Those on supplemental insulin were less likely to develop hypoglycemia (P-value <0.001). Patients on oral feeding had a lower chance of having a hypoglycemic attack (P-value 0.002) while those on tube feeding had double the odds (OR=2.37).

Conclusions

Infection, intensive care unit admission, lower body mass index, insulin regimen and nutritional therapy (enteral feeding and nothing-per-mouth (NPO)) were correlated with an elevated risk of having hypoglycemia in hospitalized patients with type 2 diabetes mellitus.

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<![CDATA[Activities of Serum Magnesium and Thyroid Hormones in Pre-, Peri-, and Post-menopausal Women]]> https://www.researchpad.co/article/N7ae7a542-0d7e-4f85-b649-c47c7bd27548

Introduction: Females go through a complex hormonal variation once they reach menarche. The menstrual cycle repeats every month regularly and is dependent on the normal functioning of the hypothalamus, pituitary, and ovarian hormones. The overall wellness of the females during the menstrual cycle depends greatly on nutritional status. It is common that women develop menstrual cycle-related symptoms and are routinely prone to thyroid dysfunction. The present study is carried out to assess the activities of Mg and thyroid hormones in pre-, peri-, and post-menopausal women.

Methods: A total of 165 women were recruited in the study after satisfying the inclusion criteria. An equal number of age-matched subjects were included as controls. All the subjects included in the study were selected from the patients attending various out-patient departments of the Prathima Institute of Medical Sciences, Karimnagar, Telangana, India. Blood samples from each subject were collected and analyzed by a semi-automated analyzer for the activities of Mg, and thyroid hormones tetra-iodothyronine (T4), tri-iodothyronine (T3), and thyroid-stimulating hormone (TSH).

Results: There was a statistically significant relationship between the serum Mg activities and the thyroid hormones between the study subjects and the control group. The activities of the serum Mg (1.72±0.33) in relation to the TSH (5.09±7.54) in the cases were found statistically significant (p <0.001) when compared to the serum Mg (1.8±0.20) in relation to the TSH in the control group (2.41±2.05). The activities of Mg were noted to fall in women through the peri (1.70±0.43), and postmenopausal age (1.60±0.34). There was a significant increase in the activities of TSH in women of premenopause (4.27±5.76), perimenopause (5.65±8.53), and postmenopausal age (7.19±11.07). 

Conclusion: From the results of the present study, it can be concluded that the women reaching menopause could suffer from hypomagnesemia and inturn may develop thyroid and other hormonal disorders. 

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<![CDATA[Early Restenosis of Sirolimus-eluting Stent: An Unusual Case of a Hyperthyroid Patient]]> https://www.researchpad.co/article/N078eaaca-5d00-4e9b-bc96-fe59921e245f

The presentation of atherosclerosis with concomitant hyperthyroidism is not uncommon. Hyperthyroidism predisposes to worse cardiovascular pathologies like systolic hypertension, atrial fibrillation, and hypercoagulability. Drug-eluting stents, on the other hand, have emerged as a miracle treatment choice for patients having atherogenic conditions. They have the highest success rates when it comes to minimizing in-stent restenosis (ISR) during short-term follow-up. There is scarce literature that assesses the correlation of multinodular goiter (MNG) to ISR, especially in Pakistan, and thus any probable association between the two is left untouched. We report a case of a 57-year-old female who is a known hyperthyroid with a massive MNG, presenting with worsening chest pain. She had undergone sirolimus-eluting stent (SES) implantation in left anterior descending artery (LAD) six months back. Cardiac catheterization confirmed restenosis of the SES in the LAD, along with the occlusion of left circumflex and right coronary artery, accompanied by grade I diastolic dysfunction and mild aortic regurgitation on echocardiography.

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<![CDATA[Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery]]> https://www.researchpad.co/article/N68d33974-907c-4e70-9a16-0759a5447729

Background: Incidental parathyroidectomy with subsequent hypoparathyroidism and postoperative hypocalcemia is thought to be one of the common complications of thyroidectomy. Current literature reports wide discrepancy in incidence and risk factors.

Objectives: The aim of our study was to evaluate the incidence and risk factors of incidental parathyroidectomy in thyroid surgery.

Methods: A retrospective study included 270 patients who had thyroid surgery that was performed over two years from January 2017 to December 2018 in two tertiary care hospitals. Preoperative and postoperative records were assessed. Factors such as gender, diagnosis, type of surgery, and usage of surgical loupes during the procedure were evaluated and were compared to find the association with incidental parathyroidectomy in thyroid surgery.

Results: Incidental parathyroidectomy was noticed in 62 (23%) surgical specimens during histopathologic examination. There was no significant association between incidental parathyroidectomy and sex of patient, use of surgical loupes, pathology of thyroid disease, or neck dissection.

Conclusion: Although the risk of incidental parathyroidectomy is inevitable, careful dissection and meticulous intraoperative identification of parathyroid gland during thyroidectomy can reduce the incidence of incidental parathyroidectomy, thereby minimizing the risk of postoperative hypoparathyroidism and hypocalcemia.

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<![CDATA[Frequency of Hypogonadism in Type 2 Diabetes Mellitus Patients with and without Coronary Artery Disease]]> https://www.researchpad.co/article/Nb6bd0515-beef-4fb3-924e-416de4d4ef2e

Introduction

Hypogonadism is characterized by clinical and biochemical evidence of testosterone deficiency. Low testosterone levels have been reported in patients with type 2 diabetes mellitus (T2DM), which can predispose to coronary artery disease (CAD). It has been proposed that diabetic men with proven CAD have lower androgen levels than patients with normal coronary arteriograms. We conducted this study with the objective to determine the frequency of hypogonadism in patients with diabetes mellitus and its relationship with CAD.

Materials and Methods

It was a comparative cross-sectional study conducted at a tertiary care hospital. We recruited a total of 108 patients, divided into two groups, 54 patients in each arm of the study. Group A comprised patients with CAD, whereas group B consisted of diabetic patients without CAD. Hypogonadism was defined on the basis of erectile dysfunction clinically and total testosterone levels biochemically. CAD was diagnosed on the basis of findings of coronary angiography. Fasting blood samples were drawn and evaluated for fasting plasma glucose, HbA1c, fasting lipid profile, thyroid-stimulating hormone (TSH), serum prolactin, blood urea, serum creatinine, liver function tests (LFT), total testosterone, luteinizing hormone (LH), and follicle‑stimulating hormone (FSH) levels. Hypogonadism among two study groups was compared using chi-square and serum testosterone level was compared using independent t-test with p < 0.05 considered as statistically significant.

Results

There were 108 subjects in the study with the mean age of 54.4 ± 4.29 (range: 22 to 68) years. The mean duration of T2DM was 12.6 ± 8.2 years. The mean BMI of patients with and without CAD was 25.7 ± 2.37 and 26.9 ± 4.21 kg/m2, respectively. There was no significant difference in waist circumference and obesity between both the groups (p-value > 0.05). Fasting plasma glucose and HbA1c in both groups were not significantly different. Testosterone levels and erectile dysfunction score were found lower in T2DM with CAD compared to T2DM patients without CAD, although this difference was not statistically significant (p-value: 0.051). The majority of the subjects with hypogonadism in both groups had a hypogonadotrophic hypogonadism (39/42, 92.9% versus 16/20, 80.0%). No statistically significant difference was seen in serum levels of LH and FSH between the study groups. The frequency of hypogonadism was found higher in the group with CAD (72.2%, 39/54) as compared with T2DM patients without CAD (37.03%, 20/54; p-value = 0.000). 

Conclusion

Testosterone deficiency is a significant problem of males with T2DM. Patients with CAD have markedly low levels of testosterone as compared with patients without any CAD.

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<![CDATA[Adrenocorticotropic Hormone-producing Extrapulmonary Small Cell Carcinoma of the Breast]]> https://www.researchpad.co/article/N54406325-794b-4534-84de-dbe32e1c53c2

Extrapulmonary small cell carcinoma (EPSCC) of the breast is a very rare tumor. Adrenocorticotropic hormone (ACTH) production from these tumors is extremely rare and seldom reported resulting in significant diagnostic and therapeutic challenges and delays. We present a case of a 38-year-old female who presented with a breast lump and was diagnosed with primary EPSCC of the breast. Eighteen months later, she presented with refractory hypokalemia and metabolic alkalosis. Ectopic ACTH production was found to be the reason for her metabolic derangement. Extensive diagnostic evaluation, including a comprehensive metastatic workup, is necessary to differentiate this tumor from other primary malignancies such as lung and other breast cancers. We review the literature and discuss the diagnostic approach and suggested therapies.

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<![CDATA[Cholangiocarcinoma Presenting as Humoral Hypercalcemia of Malignancy: A Case Report and Literature Review]]> https://www.researchpad.co/article/Nc72f91cb-f9f3-46fb-b003-3a20cba961cb

Humoral hypercalcemia of malignancy (HHM) is most commonly encountered in squamous cell carcinoma (SCC) of different organs, and It is characterized by elevated parathyroid hormone-related peptide (PTHrP) levels. It may be seen as a manifestation of cholangiocarcinoma (CCC) at presentation and later in the course of the disease. However, HHM due to intrahepatic cholangiocarcinoma is a rare association and is associated with a poor prognosis.

We herein report a case of hypercalcemia presenting as the first manifestation of an underlying rare variant of intrahepatic cholangiocarcinoma. Our patient is a 57-year-old male who presented to the emergency room with severe symptoms of constipation and polyuria and was admitted to the hospital for symptomatic hypercalcemia. He was found to have a hypermetabolic 15 cm liver mass, abdominal lymph nodes on imaging, which was subsequently diagnosed as adenosquamous cholangiocarcinoma by liver biopsy. This necessitated an urgent inpatient treatment with gemcitabine/cisplatin combination chemotherapy to control the aggressive nature of the malignancy. However, he deteriorated and expired after three months of his diagnosis.

Adenosquamous cholangiocarcinoma is a very rare variant of a liver tumor. It develops due to squamous metaplasia of an underlying cholangiocarcinoma and usually has aggressive clinicopathological features. HMM is a life-threatening, yet unrecognized, phenomenon of cholangiocarcinoma, which represents a poor prognostic marker. Prompt recognition of this complication is important for preventing serious complications associated with hypercalcemia and to improve the quality of life of these patients.

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<![CDATA[Relationship of Serum Leptin and Reproductive Hormones in Unexplained Infertile and Fertile Females]]> https://www.researchpad.co/article/N96811140-723f-4785-8956-b23e474d4475

Objective: To investigate the relationship between serum leptin and reproductive hormones in females with unexplained infertility (UI).

Methodology: It was a case-control study conducted in the Gynecology and Obstetrics Department and Infertility Clinic, Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan. A total of 235 primary infertile females with an unidentified cause of infertility were selected from the Infertility Clinics. The patients were excluded if they were found to have polycystic ovary syndrome, endometriosis, tubal blockage, irregular menstrual cycles, hyperthyroidism, hypothyroidism, hyperprolactinemia, hyperandrogenemia, fasting blood sugar >110 mg/dl, and male factor infertility. A total of 205 healthy, fertile females were selected from the general population. The blood samples of both groups were collected on the 12th and 21st day of their menstrual cycle. Serum leptin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and E2 levels were measured. Statistical analysis was executed using the SPSS version 16 (SPSS Inc., Chicago, IL).

Results: No significant difference was observed in leptin values of fertile and UI females, 37.110±1.19 vs. 35.321±0.901. In the preovulatory phase (12th day) of the cycle, infertile subjects with body mass index (BMI) <20 and 20-24.9 had significantly higher values for leptin (p<0.05), whereas, with an increase in BMI, leptin levels were reduced in these females. Leptin was reduced further in the luteal phase of infertile females with BMI 25-30, with a significantly lower value for FSH (p<0.005), LH (p<0.005), and estradiol (p<0.005. In infertile subjects, it correlated with estradiol (r=0.501, p<0.005), BMI (r=0.903, p<0.001), and progesterone (r=0.146, p<0.05).

Conclusion: Low levels of leptin observed to have an increase in the BMI of UI females were associated with a reduced estradiol and progesterone production in the luteal phase of the cycle. 

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<![CDATA[Comparison Between the Treatment Modalities for Graves' Disease at King Abdulaziz Medical City, Jeddah]]> https://www.researchpad.co/article/N3acb0016-86a2-43db-907f-7f9a20ab1348

Background

Graves’ disease is the most common cause of thyrotoxicosis. It can be treated using three different modalities, which include anti-thyroid drugs (ATD), radioactive iodine (RAI), and near-total thyroidectomy. This cohort study aimed to assess the treatment modality preferred at King Abdulaziz Medical City (KAMC) and to compare the treatment options in relation to the prognosis of the disease.

Methods

A retrospective cohort study was conducted on a total of 100 patients with Graves’ disease who were treated and followed up in the endocrine clinics at KAMC between January 2013 and December 2018. Data on age at diagnosis, duration of illness, treatment modality, and response to treatment were extracted from paper and electronic medical files and analyzed.

Results

A total of 100 patients with Graves’ disease were included in this cohort study. The ratio of female:male was 2:1. The median age in years was 32 (16). They were treated with ATD (60%), RAI ablation (40%), and none were treated by surgery. The remission rate was 53.3% for patients treated with ATD and 95% for RAI ablation. Hypothyroidism occurred in 90% of the responders to RAI and in 12% that were treated with ATD. Most of the patients that relapsed underwent RAI as the second line of treatment. Their remission rate was 78.6%.

Conclusion

ATD was the treatment modality mostly used for Graves’ disease in our center. It resulted in a remission rate of 53%, which is higher than reported in national studies. Although the rate of remission post RAI ablation was as high as 95%, most patients developed hypothyroidism.

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<![CDATA[Acute Stroke in Diabetes Mellitus: A Prospective Observational Study Evaluating the Course and Short-Term Outcome in Basrah, Southern Iraq]]> https://www.researchpad.co/article/Nda692103-6190-4517-8cbf-49639e2d683c

Introduction

Stroke and diabetes mellitus (DM) are distinct conditions with many aspects in common. Both conditions are prevalent and associated with various vascular risk factors such as dyslipidemia and hypertension. This study was conducted to evaluate the association between stroke and DM regarding the course (i.e., type, recurrence, aspirin failure, and degree of disability) of stroke and short-term outcomes in patients with diabetes who suffer an acute stroke.

Patients and methods

We conducted a prospective observational study of 210 acute stroke patients admitted to the Neurology Unit of Al-Basrah Teaching Hospital in Basrah City in Southern Iraq from May 2014 to September 2015. Our study included 124 men (59%) and 86 (41%) women, and our study population had a mean age of 64 ± 11 years. The study participants were separated into two groups of 105 patients according to their diabetes status, and we evaluated each patient’s type of stroke, recurrence, aspirin failure, and degree of neurological disability according to the National Institutes of Health stroke scale. We assessed short-term outcomes (i.e., four weeks' mortality) following acute stroke.

Results

Ischemic stroke was the primary stroke experienced by patients with diabetes (94.3%), which is highly significant and associated with an increased risk of previous recurrent ischemic stroke (55.2%; P=0.003, <0.001, respectively). We noted a higher rate of loss of antiplatelet activity from aspirin in patients with DM rather than those without DM (p<0.001), and we noted more severe disability in outcomes in patients with DM. In the group of stroke patients with diabetes, 46 patients (59%) died, while 32 patients (41%) without diabetes died (p=0.046).

Conclusion

DM is associated with a heavier burden for acute stroke along with poorer outcomes than patients without DM. Our findings suggest acute stroke in patients with diabetes may be considered a distinct entity separate from acute stroke in patients without diabetes. The treatment of acute stroke in patients with diabetes warrants further investigation.

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<![CDATA[Light-intensity Activity-related Nausea: An Unusual Presentation of Pheochromocytoma]]> https://www.researchpad.co/article/Nf45b7b08-03bb-4832-8c26-ca252693ad7d

Pheochromocytomas are rare neuroendocrine tumors arising from chromaffin cells of the adrenal gland. Because of their highly variable clinical spectrum, these tumors often go undiagnosed and result in life-threatening complications. The typical presentations include episodic headache, palpitations and sweating accompanied with sustained or paroxysmal hypertension. However, less than half of pheochromocytoma patients have these classic symptoms. Many patients present with atypical symptoms, which could be overlooked. Our case represents an unusual presentation of pheochromocytoma, which is not well recognized as a possible manifestation. A 60-year-old woman presented with light-intensity-related nausea, which progressed to severe vomiting with hypovolemic shock. An unexpected adrenal mass was found during sonographic evaluation of the volume status. Pheochromocytoma was confirmed by 24-hour urine fractionated metanephrines and a computed tomography (CT) scan. In pheochromocytomas, the elevation of circulating catecholamines activates alpha-adrenergic receptors in the area postrema, which then initiates the emetic cascade. Light-intensity activity-related nausea and vomiting, especially when present with other symptoms of catecholamine excess, could be considered as a clinical presentation of pheochromocytomas.

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