Assessment of risk factors in medical data using improved Binary Artificial Fish Swarm Algorithm with Classification upon Evaluation from F-Test

The objective of this research work is to effectively deploy improved Binary Artificial Fish Swarm optimization Algorithm (BAFSA) with the data classification techniques. The improvement has been made with accordance to the condition of visual scope and the movement of fish to update towards the central position and chasing behavior towards best point of movement has been modified among the given population. The experimental results show that feature selection by BAFSA and classification by Decision trees and Gaussian Naïve bayes algorithm provides an improved accuracy of about 89.6% for Pima Indian diabetic dataset, 91.1% for lenses dataset and 94.4% for heart disease dataset. Statistical analysis has also been made using Fisher’s F-Test for two sample variance and the selected risk factors such as glucose, insulin level, blood pressure for diabetics datasets, spectacle prescription, tear production rate for lenses dataset and trestbps, cholesterol level, thalach, chest pain type for heart disease dataset are found to be significant with R2<0.001 respectively.

Assessment of risk factors in medical data using improved Binary Artificial Fish Swarm Algorithm with Classification upon Evaluation from F-Test

The objective of this research work is to effectively deploy improved Binary Artificial Fish Swarm optimization Algorithm (BAFSA) with the data classification techniques. The improvement has been made with accordance to the condition of visual scope and the movement of fish to update towards the central position and chasing behavior towards best point of movement has been modified among the given population. The experimental results show that feature selection by BAFSA and classification by Decision trees and Gaussian Naïve bayes algorithm provides an improved accuracy of about 89.6% for Pima Indian diabetic dataset, 91.1% for lenses dataset and 94.4% for heart disease dataset. Statistical analysis has also been made using Fisher’s F-Test for two sample variance and the selected risk factors such as glucose, insulin level, blood pressure for diabetics datasets, spectacle prescription, tear production rate for lenses dataset and trestbps, cholesterol level, thalach, chest pain type for heart disease dataset are found to be significant with R2<0.001 respectively.

A case of spontaneous hypoglycemia

We describe a case of systemic lupus erythematosus with POEMS syndrome presenting as spontaneous hypoglycemia. A 58-year-old female suffered repeated episodes of hypoglycemia. During thesehypoglycemic episodes, her postprandial insulin level was inappropriately high. Further blood tests revealed the presence of antinuclear antibodies, anti-double-stranded DNA antibodies,low C4level.Altered albumin-globulin ratio,monoclonal gammopathy (IgG LAMBDA), polyneuropathy and organomegaly lead to suspicion of concurrent presence of POEMS syndrome.Bone marrow examination revealed plasma cell dyscrasia and plasmacytoma in trephine biopsy confirmed the diagnosis.Here, we emphasize on autoimmune cause of hypoglycemia. BIRDEM Med J 2022; 12(1): 70-73

The Research on Perioperative Blood Glucose and Insulin Levels of Patients with Single Insulinoma

Background The blood glucose level is an important biochemical parameter for evaluating the resection effectiveness of insulinomas. However, whether other biochemical parameters have better evaluating ability remains unclear. The current study aims to compare the evaluating capability of blood glucose and insulin levels at several aspects, such as the accuracy and response time. Methods Between September 2017 and July 2018, 21 insulinoma patients with single tumor who underwent surgical resection were enrolled. Peripheral venous blood samples were assayed for blood glucose and insulin levels on the day of surgery and at 30 minutes, 60 minutes, 1 day, and 7 days after surgery. The evaluating abilities of blood glucose and insulin levels for resection effectiveness were recorded and compared. Results The evaluating performance of the insulin level was better than that of the blood glucose level (100% for 21 patients vs 82.4% for 17 patients), as well as the response time ( p<0.0001). Furthermore, the insulin level was not effected by intravenous glucose infusion compared to the blood glucose level. Conclusions Comparing with blood glucose level, insulin level is a better parameter for evaluating resection effectiveness of insulinomas with faster response and regardless of perioperative intravenous glucose infusion.

Frequency of Insulin Resistance in People with Thyroid Dysfunction

Background: Thyroid dysfunction is an endocrine disorder with a recognized association with type 2 diabetes mellitus. Thyroid hormones have a remarkable effect on glucose metabolism and can cause insulin resistance (IR). This study was aimed at assessing the relationship between IR and thyroid dysfunction. Methods: This case–control study was conducted at the endocrinology outpatient clinics of Ibrahim Malik Hospital and Omdurman Military Hospital in Khartoum State, Sudan between May 2018 and January 2019. Fasting blood glucose (FBG), fasting insulin level, and thyroid function test (TFT) were measured for each candidate and IR was estimated using the HOMA-IR equation. Results: Thirty-one patients with thyroid dysfunction and fifty-seven control participants were enrolled. The highest mean FBG was found among cases (105.3 ± 15.7 mg/dl) compared to the controls (97 ± 12.1 mg/dl), but the difference was not statistically significant (P-value = 0.598). The mean fasting insulin level was 9.22 ± 4 IU/ml in the cases and 9.4 ± 4.2 IU/ml in controls, without a significant difference (P-value = 0.681). The highest HOMA-IR score was found among cases (2.4 ± 1.2). It was 2.4 ± 1.3 in hyperthyroidism, 2.3 ± 1.1 in hypothyroidism, and 2.4 ± 1.2 in controls, and the difference was insignificant (P-value = 0.859). IR was higher in the cases (58.1%) compared to the controls (52.6%) but again not statistically significant (P-value = 0.396). Among cases, IR was encountered in 61.9% and 50% of hyperthyroid and hypothyroid patients, respectively. Conclusion: Patients with thyroid dysfunction have some level of IR that was not statistically significant when compared with controls.

Adult-onset Focal Nesidioblastosis with Nodular Formation Mimicking Insulinoma

Nesidioblastosis is defined as the neoformation of the islets of Langerhans from the pancreatic ductal epithelium and is recognized as the most common cause of hyperinsulinemic hypoglycemia in infants. We herein report an extremely rare case of adult-onset focal nesidioblastosis with the unusual feature of hyperplastic nodular formation. A 55-year-old woman was admitted to our hospital for a tumor detected in the body of the pancreas by magnetic resonance imaging screening. Laboratory examinations showed a high insulin level in the blood. Contrast-enhanced computed tomography and the selective arterial calcium injection test suggested the presence of multiple insulinomas in the body and tail of the pancreas, and, thus, the patient underwent distal pancreatectomy. A histopathological examination of the tumor in the body of the pancreas showed the nodular hyperplasia of islet-like cell clusters. In addition, many small intralobular ductules and islet cells appeared to be budding from the proliferating ductal epithelium, forming “ductuloinsular complexes”. No other abnormal lesion was detected in the remainder of the pancreas. The histopathological diagnosis was focal nesidioblastosis. The patient has remained free of the recurrence of hypoglycemic episodes for more than 31 months. The present case of rare adult-onset focal nesidioblastosis with hyperplastic nodular formation was preoperatively identified as an apparent pancreatic tumor mimicking insulinoma. Nesidioblastosis and insulinoma need to be considered in cases of hyperinsulinemic hypoglycemia, even in adult patients.

Peptide receptor radionuclide therapy as a tool for the treatment of severe hypoglycemia in patients with primary inoperable insulinoma

Objectives Severe hypoglycemia in a course of inoperable insulinoma may be life-threating and often it is not well controlled, even by high doses of diazoxide requiring second line treatment. Among available methods PRRT is characterized by relatively low toxicity and is connected with favorable antitumor effect. The aim of the study was an evaluation of the PRRT effectiveness in control of hypoglycemia in patients with primary inoperable insulinoma. Methods Three patients (female with metastatic insulinoma, male with primary inoperable pancreatic tumor, female with MEN1 syndrome and hepatic metastases) were treated with PRRT due to severe hypoglycemia poorly controlled by diazoxide in course of primary inoperable insulinoma. Results Patient 1 baseline fasting glucose concentration increased from 2.4 mmol/L [3.30–5.60] to 5.9 mmol/L after PRRT. In patient 2 fasting glucose level 2.30 mmol/L increased after PRRT to 7.0 mmol/L, while baseline insulin level initially 31.15 uU/mL [2.6–24.9] decreased to 15.4 uU/mL. In patients 3, baseline fasting glucose level 2.5 mmol/L increased after PRRT to 7.9 mmol/L, and insulin decreased from 57.9 uU/mL to 6.3 uU/mL. In imaging there was partial response (PR) in patient 1 and 2 and stabilization of the tumor size in patient 3. In patient 2 reduction of tumor infiltration let for curative surgery performed 4 months after PPRT. Conclusions PRRT may be effective as a first or second line treatment in management of hypoglycemia for patients with hormonally active inoperable insulinoma.

A rare entity of malignant insulinoma diagnosed after 30 years of clinical manifestation of hypoglycemia: A case report and literature review

Malignant insulinomas, a rare life threatening pathology, exists in literature as an entity that constitutes 10% of all insulinomas and often present as multi-centric macro nodules with multiple lymph nodes or liver metastases before diagnosis. We report a rather rare case of a 68 year old male with a 30 years history of uninvestigated severe hypoglycemic attacks that improved on glucose intake. Blood tests showed a decreased value of glycemia (45 mg/dL) associated with increased insulin level (54 μU/ml) and an increased glycemia/ insulinemia ratio of 0.83 supporting the diagnosis of insulinoma. Abdominal CT showed a 4 cm mass localized in the head of the pancreas with atrophic body and tail, no signs of distant metastatic disease. A concomitant diagnosis of primary hyperparathyroidism raised, based on elevation of calcium associated and high level of PTH. The coexistence of the two endocrinopathies suggested the presence of type 1 multiple endocrine neoplasia (MEN I). Based on the workup suggesting a benign insulinoma with no signs of metastatic disease, co-existing with debilitating symptoms of hypoglycemia, pancreatectomy with lymph node dissection was performed. Histo-pathological examination returned surprisingly positive for malignant neuro-endocrine tumor with positive lymph nodes. In that domain, we summarized the literature discussion of neuroendocrine tumors, elaborating on malignant insulinoma diagnosis and management. Furthermore, what our article is trying to lay upon existing literature is a case of a long standing existent MEN 1 malignant insulinoma manifesting as a remarkably slow progressive disease of 30 years’ timeline versus a less likely chance of a transformation from benign insulinoma to malignant Keywords: neuroendocrine neoplasm; pancreatectomy; MENI; malignant insulinoma; chronic hypoglycemia.