Report of A Case of Papillary Thyroid Carcinoma Following Intracranial Germinoma

Introduction The occurrence of second primary thyroid malignancy should be noticed in survivors of brain germinoma treated by irradiation. Case Report A patient with a history of intracranial germinoma who underwent chemoradiotherapy was referred to our endocrine clinic due to impotency and infertility. The patient received replacement therapy due to hypopituitarism. He returned to us 11 years after brain radiation with enlargement of the thyroid gland. Thyroid ultrasonography showed enlargement with a dominant 62*37 mm solid hypoechoic nodule in the right thyroid lobe. Several lymph nodes at both sides of the neck were seen. Total thyroidectomy revealed PTC with regional metastasis. Conclusion Endocrine disruption must be considered in adult cancer survivors and the importance of long-term follow-up should be emphasized in these patients.

Tirzepatide: A Useful Addition for Treatment of Type 2 Diabetes and Obesity

Background: Tirzepatide is a dual receptor agonist of the 2 incretin hormones: glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) which is currently under development. Objective: To clarify the potential role of tirzepatide for treatment of type 2 diabetes and obesity. Methods: Pubmed search until August 2nd, 2021. Search terms were GLP-1, GIP, incretins, tirzepatide, efficacy, safety. Clinical trials and pertinent reviews were included. Results: In one phase 3 clinical trial, mean reduction of glycated hemoglobin (HbA1c) with tirzepatide (5-15 mg/week) was -1.87% to -2.07% versus + 0.04% with placebo after 40 weeks. In another phase 3 randomized trial, tirzepatide decreased HbA1c levels by -2.01% to -2.3% versus -1.86% with semaglutide (1.0 mg/week) (P<0.0001). In the previous 2 studies, tirzepatide use was associated with dose-related mean weight loss at 40 weeks of -7.0 kg to -9.5 kg vs -0.7 kg with placebo (P<0.0001) and -7.6 kg to -11.2 kg vs -5.7 kg with semaglutide ((P<0.001). Tirzepatide had generally favorable effects on lipid profile, particularly on lowering serum triglyceride levels: -19% to -24.8% mean reduction compared with -11.5% with semaglutide. Gastrointestinal (GI) adverse effects were the commonest reported symptoms associated with tirzepatide use and occurred more frequently than with placebo and semaglutide. Hypoglycemia was reported more coomonly with high-dose terzipatide (1.7%) compared with semaglutide (0.4%). Drug discontinuation rates due to adverse effects were 6-8.5 % with tirzepatide vs 4.1% with semaglutide. Conclusions: Available data from 2 short-term randomized trials suggest that tirzepatide may be more effective than placebo and the GLP-1 agonist semaglutide in reducing HbA1c levels and body weight. Pattern of safety profile of tirzepatide is similar to that of GLP-1 agonists, but frequency of GI adverse effects and hypoglycemia is more common with tirzepatide.

Value of a Detailed Clinical Examination

The role of a physician in modern medicine has changed in recent times. The advances in technology, easy access to modern diagnostic investigations, workload and time constraints seems to a deterrent to the physical examination skills of modern doctors [1]. There are many recent studies suggesting the failure of modern doctors to correctly identifying physical signs [2]. The restrictions on face-to-face consultations imposed by the COVID-19 pandemic adds to the challenge in examining patients. This at times induces a huge threat to patients’ safety, leading to missing vital diagnoses, unnecessary investigations, and prolonged treatments with drugs causing harmful adverse effects [4]. Here, we present a case of post-herpetic neuralgia which was misdiagnosed initially as Giant Cell Arteritis due to insufficient history and physical examination.

Prevalence of Hypertension and Associated Factors Among Residents in Cyprus

Background: Hypertension is a major health problem that physicians have to face globally. It is known as the most important risk factor for cardiovascular disease. Objectives: This study searched for the prevalence of hypertension among the residents of Cyprus. Methods: The study involved 195 patients with or without treatment for arterial hypertension with age ranged among 34-93 years, patients examined and followed for 2 years at the medical office. Hypertension was defined as Systolic blood pressure (SBP) ≥ 140 and/or Diastolic blood pressure (DBP) ≥ 90mm Hg. Data were analysed using statistics. Results: The overall prevalence of hypertension was 38.1% (male 42.7% and female 33.4%). The mean age of the respondents was 66.6 ± 12.4 years. 26.8% of the patients who enrolled in the study were obese. Alcohol and tobacco use were found in 33.2% and 42.2% of the population studied. Hypertension was significantly associated in age groups 45-85 years, and also being overweight or obese. Conclusion: The above data show a high prevalence of hypertension, even in patients under anti-hypertensive treatment. Policy makers should study the need for further awareness at the primary sector preventively and implement interventions for early detection and care of hypertension, in early stage.

Case Series: Reversal of Diabetic Neuropathy Utilizing Physiologic Insulin Resensitization

Diabetes is a growing global problem that is currently on the rise. Type 2 diabetes (T2D) is a chronic condition that results from aberrant B-cell function coupled with progressive insulin resistance. The majority of Type 2 diabetic patients develop diabetic neuropathy, which can lead to devastating complications (i.e., infection, ulceration, osteomyelitis, & amputation). The proinflammatory state of diabetes, along with prolonged hyperglycemia damages peripheral nerves (most common in the lower extremities). Additionally, compromised wound healing exacerbates the risk when skin breakdown occurs in this patient population. To overcome these risks for T2D, physiologic insulin resensitization (PIR) has been used as a novel protocol to treat patients with severe neuropathy symptoms. In our case study, we present two patients who initially experienced a loss of sensation in their extremities and decreased wound healing. Using PIR treatment, we demonstrate that both patients experienced neuropathy reversal and improved wound healing.

The Impact of Autophagy on The Differentiation of Immune Cells

Autophagy, as a conservative lysosomal degradation pathway, has been well studied for its multiple functions in the immune system. Autophagy has been gradually explored for the regulation of immune cell differentiation. In order to explore the specific mechanism, it is necessary to summarize the role of autophagy in the proliferation and differentiation of immune cells. It is summarized the effects of autophagy in some researches on the function and differentiation of immune cells by introducing the function of autophagy selective degradation. In this review, we discuss the effect of autophagy in the differentiation of immune cells.

The Impacts of Body Mass Index on Gestational Diabetes Pima Indian Heritage Women

Body mass index (BMI) acts as a casual factor for developing many diseases such as cardiovascular, breast cancer, heart, diabetes etc. The article presents the impacts of BMI on gestational diabetes Pima Indian heritage women with at least 21 years old. It is established here that mean BMI is larger for gestational diabetes mellitus (GDM) women (P=0.0007) than normal. Mean BMI is directly linked with triceps skin fold thickness (TSFT) (P<0.0001), and it is not related with age (P=0.5185), while it is inversely linked with their joint interaction effect TSFT*Age (P=0.0023). In addition, mean BMI is partially inversely linked with insulin (P=0.1813), and it is partially directly linked with diabetes pedigree function (PDF) (P=0.1601). Variance of BMI is larger for normal women (P<0.0001) than GDM women. It is inversely linked with glucose (P<0.0001), and it is not associated with the number of pregnancies (NOP) (P=0.5494), while it is directly linked with their joint interaction effect Glucose*NOP (P=0.0434). Mean and variance of BMI show many complex impacts on GDM women. Gestational women must care on BMI along with TSFT and glucose levels.

What Is the Relationship between Diabetic Patients and Greater Propensity to COVID-19?

Patients with diabetes are more likely to have COVID-19 as demonstrated in the article written by Abdi et al. (2020) entitled Diabetes and COVID-19: A systematic review on the current evidence [1]. But what is the real reason why diabetic patients being more likely to have COVID-19 than the hyperglycemia they present? In the article written by the author (2019) Why Are Diabetic Patients Still Having Hyperglycemia despite Diet Regulation, Antiglycemic Medication and Insulin? the author demonstrates through a case report, that diabetic patients have chakras’ energy deficiency, that is leading to alteration in the energy level, leading to Yin deficiency and Heat retention, that are two energy imbalances that is producing hyperglycemia according to traditional Chinese Medicine, in the root level of the tree [1, 2].

Diabetes Complications (DC) Review – A Tale of Two Paradigms

Introduction: The paradigm that diabetes complications (DC) are caused by hyperglycaemia is put in juxtaposition with the new paradigm by Bempah that polyuria is the cause of DC. Method: The theories evolved from the two paradigms have been examined; the treatment methods used for treating manifestations of DC in the different organs have been evaluated; efficacy and end-point of treatment are assessed and conclusions drawn. The Glycation Theory that evolved from the glucose paradigm, does not offer any effective treatment so, physicians and health workers are left with their own improvisations. The result is that for each afflicted organ, there are numerous treatment methods; some of them invasive, none effective in curing or reversing the affliction. Literature-sourced information has led to the insight that polyuria is the cause of DC. The polyuria paradigm has led to a therapy that has proven efficacious in curing and reversing symptoms of DC afflicting all organs with microcirculation. These organs are deemed to be the centres of glucose-fuelled energy production in the body. Conclusion: The vitamin deficiency theory is, possibly, the most significant development in diabetes research since Hunting and Best discovered Insulin in 1921. The therapy is promising and deserves to be tested more rigorously for use as standard treatment for DC.

SGLT2 Inhibitors: The “Metabolic Molecule” Or “Disease Modifying Anti Metabolic Drugs- DMAMDs”?

The major health hazard of the modern world, “Metabolic Syndrome” or “Syndrome X”, defined by WHO, as pathologic condition characterised by abdominal obesity, insulin resistance, hypertension and dyslipidemia [1]. The criteria for diagnosis are listed in Figure 1 [2]. It is being accepted almost a decade ago that we are in the phase of epidemic for this Non Communicable Condition. Though it was started in western world, spread of western lifestyle across the globe, truly it has now become the major global issue. Until recently the condition was far more prevalent in urban population than rural but in today’s time, especially in Country like India, the incidence showed trends towards becoming almost equal [3]. Though recognised all over the world, the condition is rather dealt as managing different component(s) of the syndrome rather than taking the syndrome per say as diagnosis. We rather tend to care much of those patients who actually show prominently one or more components of metabolic syndrome, and this approach is leading us to neglect rather major bulk of patients who, in spite qualifying for criteria of diagnosis of metabolic syndrome, where not only patients are in early asymptomatic phase, but also the physicians caring for them do not reinforce the importance of the needed care at this very moment to prevent or delay the progression of the condition. Healthcare all over world, particularly in India has shown enormous growth, in terms of not only infrastructure but also skill development [4]. Today we do have much better level of expertise in all the subspecialty with regards to high end care of all such conditions arise from one or more components of metabolic syndrome like Heart Failure, Chronic liver disease, chronic kidney disease and Diabetes (related complication). In developing country like India, somewhere 3 to 4 decades ago to subject a patient for liver or kidney transplant used to be mere dream of treating consultants but today we are not only doing the transplants smoothly but also survival rate is getting better and better [5]. But its quiet unfortunate that in spite of all these progresses, the actual numbers of such patients needing high end care is steadily on rise, thanks to increase in life expectancy in general and relatively better exposure to needed healthcare [5]. But author do strongly believe that still whatever we are seeing is more at treatment cum cure level but nothing much at prevention level is going on. In decades to come, we have large population at risk, at this very moment, for all such advanced staged chronic metabolic conditions. We are in genuine need of a molecule which can be offered to all such early or intermediate metabolic syndrome patient, expecting the improvement in almost all the aspect on the syndrome. Author do believe, the group of drugs known as “SGLT2 Inhibitors”, an originally used for Hyperglycemia management, has now expanded its preventive effects on various metabolic conditions, showing promising results in all the trials and early real world evidences, is the real nomination for the “Metabolic Molecule” or “Disease modifying anti metabolic drugs- DMAMDs” of today.