Type 1 Brugada pattern induced by DKA

A 25-year-old man with a past medical history of type 1 diabetes presented to the emergency department with 2 days of progressive abdominal pain, nausea, and vomiting after stopping insulin. His heart rate was 125 and the respiratory rate was 26. The glucose was 832 mg/dl, the potassium was 6.6 mmol/L, the beta-hydroxybutyrate was 111.8 mg/dl, and the pH was 6.95.

Common Problems Related to Podiatry

India is a developing country and lacks many things including Podiatry as subspecialty of Diabetes. There are no Podiatry Collegesnor provision for regular training of young physicians in podiatry. Missing job opportunity, kills interest of physicians in Podiatry. Most physicians have acquired some degree of skill by self-reading or doing observer ship abroad and by attending a few International conferences on Podiatry.

Surgery Management of Pancreatitis with Complication: A Review Article

Introduction: Acute pancreatitis is an inflammatory disease of the pancreas with clinical manifestations that vary from mild to severe manifestations to death. The incidence of pancreatitis varies in various countries in the world and depends on the cause such as alcohol, gallstones, and metabolic factors. The clinical picture and the main symptom in patients with acute pancreatitis is abdominal pain. Abdominal pain varies from mild to severe and excruciating. Abdominal pain that is felt is constant and dull, and is usually felt in the epigastrium and periumbilicus and often spreads to the back, chest, waist, and lower abdomen. Discussion: The onset of acute pancreatitis, the patient should be evaluated for hemodynamic status immediately and receive the necessary resuscitation measures. Patients with acute pancreatitis should receive aggressive intravenous rehydration (250 - 500 ml/hour with isotonic crystalloid fluid) as early as possible with close monitoring, unless contraindicated with cardiovascular and/or renal comorbidities. It is most effective within the first 12-24 hours, but after that the benefits may diminish. Debridement (necrosectomy) is the gold standard in infected acute necrotizing pancreatitis and peripancreatic necrosis. Indications for intervention either through radiological, endoscopic or surgical procedures in necrotizing pancreatitis are suspected or proven infected necrotizing pancreatitis with clinical deterioration, especially after the necrotic tissue has been encapsulated with thick walls (walled-off necrosis). Sterile necrotizing pancreatitis with persistent organ failure several weeks after the onset of acute pancreatitis, particularly after the necrotic tissue has been encapsulated with thick walls (walled-off necrosis). Conclusion: Surgical management is often used in pancreatitis associated with gallstones. Cholecystectomy within 48 hours of the complaint can increase healing time. In addition, cholecystectomy performed early may not increase the risk of complications secondary to surgery. Surgery is not performed in acute necrotizing pancreatitis until the inflammation is reduced and the fluid accumulation no longer increases in size.

Lifestyle Modification Therapy in Diabetes Disease: A Review Article

Introduction: Diabetes mellitus (DM) is a metabolic disease characterized by high blood glucose levels (hyperglycemia) resulting from disturbances in insulin secretion, insulin action or both. Insulin is a hormone produced by pancreatic beta cells, which is needed to utilize glucose from digested food. Comprehensive care is taken to treat patients with either prediabetes or diabetes. Diabetes management includes lifestyle interventions along with pharmacologic therapy and routine blood glucose monitoring. So that a decrease in blood glucose can occur and can be stable for a long time. Discussion:Lifestyle modification is an economical treatment that saves costs to prevent or delay the onset of diabetes. On the other hand, nutritional management provided by a dietitian is also recommended. Moderate weight loss goals are an important component of diabetes prevention and treatment, as large body weight can increase blood glucose levels, and can also have an increasing impact on blood pressure and cholesterol levels. Weight loss can be achieved through a balanced diet, with total control of calories and free carbohydrates. However, for diabetic patients following a low-carbohydrate diet, they should be informed about possible side effects such as hypoglycemia, headaches and constipation. Other studies have suggested the consumption of complex dietary fiber and whole grains to improve blood sugar control. Greater adherence to diet combined with light physical activity was associated with a lower likelihood of diabetes after adjusting for various factors. Conclusion:Lifestyle modification is a fairly cost-effective treatment to prevent or delay the onset of diabetes, with a risk reduction of about 58% in 3 years. It is strongly recommended by the ADA that patients with IGT, IFG or HbA1C levels of 5.7-6.4% be counseled on lifestyle changes such as diet and exercise. On the other hand, nutritional management provided by a dietitian is also recommended.

Covid-19 Pneumonia with Acute Pulmonary Embolism in a Morbidly Obese Patient; At Home Dramatic Reversal Management

Rationale: A novel COVID-19 with the severe acute respiratory syndrome had arisen in Wuhan, China in December 2019 Thromboembolism is a critical clinical entity commonly recognized sequel in COVID-19 patients. Interestingly, the presentation of COVID-19 infection with thromboembolism has a risk impact on both morbidity and mortality in COVID-19 patients. Morbid obesity may add over significant risk value in the presence of COVID-19 pneumonia with thromboembolism. Patient concerns: Middle-aged housewife female COVID-19 morbid obese patient presented to physician outpatient clinic with unilateral pneumonia suspected acute pulmonary embolism. Diagnosis: COVID-19 pneumonia with acute pulmonary embolism in morbid obesity. Interventions: CT pulmonary angiography, non- contrasted chest CT scan, electrocardiography, and oxygenation. Outcomes: Dramatic of both clinical and radiological improvement had happened. Lessons: The combination of morbid obesity, QTc prolongation with COVID-19 infection is an indicator of the over-risk of thromboembolism. It signifies the role of anticoagulants, antiplatelet, anti-infective drugs, and steroids in COVID-19 patients with unilateral pneumonia and acute pulmonary embolism in morbid obesity are effective therapies. An increasing the dose of both low-molecular heparin and oral anticoagulant with a morbidly obese patient was reasonable.

Pituitary Macroadenoma: A Rare Presentation of Hypothyroidism

Hypothyroidism is a common endocrine disease which occurs when the levels of Thyroid hormones produced by the Thyroid gland are decreased. Here we present a case of a 19-year-old female, who presented with symptoms of hyperprolactinemia, weight gain, unilateral blurring of eyes and headache. Examination findings of the patient were significant for presence of Acanthosis Nigricans and Hirsutism. Rest of the systemic examination was normal. Laboratory investigations revealed Hyperprolactinemia, Hypothyroid profile and dyslipidemia. MRI brain and pituitary done showed findings consistent with Pituitary macroadenoma. Patient was treated along the lines of hypothyroidism with Thyroxine. Follow-up after 3 months showed improvement of her symptoms and disappearance of lesion of MRI scan. This case was a rare presentation of Hypothyroidism. Such unusual and uncommon presentations should be reported and studied in detail to prevent misdiagnosis and provide the correct treatment to the patients.

The Psychosocial Impact of Diabetes and its Management in Women: A Review of Current Status

Diabetes mellitus (DM) is a chronic debilitating disease affecting 463 million people which accounts for 9.3% of the population globally as of 2019. Although diabetes affects men and women equally (prevalence in men: 9.6%, women: 9%), women are more severely impacted by its complications such as heart disease, retinopathy, and neuropathy. This gender difference in consequences of DM may be due to biological reasons, it is also a reality that globally women tend to receive less intensive care and treatment for diabetes compared to men. In low-income countries, women suffer unduly from economic, political, and social discrimination, and subsequently from poor health, lack of education, and employment.

Looking into a New Challenge, DKA and Covid-19 A Review on Pediatric DKA Cases during New Coronavirus Pandemic Who is to Blame, the Virus or Health System?

Since the first month of this new pandemic situation, all around the world healthcare system has been facing different challenges and difficulties; patients with chronic diseases such as cancer or diabetes with impaired immune system were at greater risk of infections and complications. It goes without saying that this issue was extremely important among pediatric clinicians dealing with diabetic pediatrics. Diabetes is the number one chronic illness among pediatric patients and the most dangerous and frightened complication of it is Diabetic Ketoacidosis (DKA). Studies have shown a strong association between pandemic and increase in new diabetes type 1 cases and its lethal complication called DKA. Here we are going to take a look at existing data and report about cases with this condition trying to find the missing piece of a big puzzle; what is the role of Covid-19 in causing Diabetes in previously healthy kids and what is the real association between SARS-COV2 virus infection and DKA? We are going to review different studies, possible mechanism, new t1dm cases and old cases, with or without covid infection, DKA cases and its severity.

Maternal 3,3’-Diiodothyronine Sulfate Formation from Guinea Pig Placenta Perfused with 3,3’,5-Triodothyronine

Objective: Serum 3, 3’,5-triiodothyronine (T3) remains low in near-term fetus to prevent the growing fetus from undue exposure to its active catabolic effect in mammals. The present study was undertaken to gain insight in the role of placenta in T3 metabolism, fetal to maternal transfer of T3, and its metabolites by in situ placenta perfusion with outer-ring labeled [125I]-T3 in pregnant guinea pig, a species showing increased sulfated 3, 3’-diiodothyronine (T2S) levels in maternal serum in late pregnancy (term = 65 days), similarly to humans in pregnancy. Materials and Methods: One-pass placenta perfusions performed on pregnant guinea pigs were studied between 58 - 65 days of gestation. In two separate experiments, the umbilical artery of the guinea pig placenta was perfused in situ at 37°C with outer-ring labeled [125I]-T3. Maternal sera and umbilical effluents were obtained for analysis at the end of a 60-minute perfusion, when the steady-state levels of radioactivity were reached in the placenta effluent after 30-minute. Results: Sulfated [125I]-T2S was readily detected in the maternal serum as the major metabolite of T3 following the perfusion of placenta with [125I]-T3, suggesting that placental inner-ring deiodinase and sulfotransferase may play an important role in fetal T3 homeostasis and in the fetal to maternal transfer of sulfated iodothyronine metabolites. Conclusions: The expression of type 3 deiodinase (D3) and thyroid hormone sulfotransferase activity in placenta may play an important role to protect developing organs against undue exposure to active thyroid hormone in late gestation in the fetus. The combined activities of D3 and sulfotransferase promoted a placental transfer of T2S into maternal circulation. The maternal circulation of T2S is fetal T3 in origin and its role as a fetal thyroid function biomarker deserves further evaluations and studies.

Effects of Insulin on Gestational Pima Indian Heritage Females

Diabetes and obesity reach epidemic proportions all over the world, while the effects of insulin resistance and its consequences are gaining prominence. The article derives the effects of insulin on gestational Pima Indian heritage females with minimum 21 years old. It is identified herein that mean insulin level for gestational women (GW) is positively linked with glucose level (P=0.0055), while it is negatively linked with age (P=0.0095). Mean insulin level for GW is independent of pregnancies (P=0.1866) and diabetes pedigree function (DPF) (P=0.5321), while it is partially positively linked with their joint interaction effect Pregnancies*DPF (P=0.0864). It is positively linked with blood pressure (BP) (P<0.0001) and triceps skin-fold thickness (TST) (P<0.0001), while it is negatively linked with the joint interaction effects BP*TST (P<0.0001) and DPF*TST (P<0.0001). In addition, mean insulin level is negatively linked with body mass index (BMI) (P=0.0001), while it is positively partially linked with the interaction effect BMI*DPF (P=0.1312). Variance of insulin level is positively linked with pregnancies (P=0.0184) and age (P=0.0027), while it is negatively linked with their joint interaction effect Pregnancies*Age (P=0.0418). Also variance of insulin level is partially negatively linked with BMI (P=0.0738) and glucose level (P=0.1439), while it is partially positively linked with their joint interaction effect BMI*Glucose (P=0.1472). Further, variance of insulin level is negatively linked with DPF (P=0.0309). It is concluded that for GW, insulin level increases with the increase of glucose level, BP, TST, and the interaction effects Pregnancies*DPF & BMI*DPF, and it decreases with the increase age, BMI, and the interaction effects BP*TST & DPF*TST. GW should be careful on her glucose level, BMI, BP & TST.