There has been much effort recently to explore the role of adipocytokines in the interaction between adipose tissue, inflammation, and immunity. Tumor necrosis factor-alpha, interleukin-6, resistin, and many other adipocytokines are the soluble mediators derived mainly from adipocytes (fat cells). They are known to influence insulin sensitivity and glucose metabolism profoundly, thus providing a molecular link between increased adiposity and insulin resistance (IR). Resistin, an adipocytokine, is a member of a class of cysteine-rich proteins, collectively termed resistin-like molecules. They were initially discovered in rodents. It is present in gross visceral fat deposits and is released by adipocytes in humans. Owing to the regional variation in the expression of resistin mRNA and protein levels in humans, the highest levels have been noted in the abdominal depot. It is interesting to note that resistin also gets released from infiltrating white blood cells subsequent to subclinical chronic low-grade inflammatory response, accompanying obesity. This convergence of adipocyte and macrophage function in obese Type II diabetics has paved its role in molecular linkage of obesity, inflammation and metabolic syndrome (MetS) risk. Resistin, being a pro-inflammatory adiopokine, contributes to atherosclerosis. High serum resistin levels have been found, although with some inconsistencies, in cardiovascular patients, labeling it as a cardiovascular disease (CVD) marker, to predict incident cardiovascular events. Both IR and inflammation are the pathogenic factors contributing to increased risk of CVD, associated with diabetes, thus tagging resistin as a potential MetS marker. In conclusion, resistin is a fascinating new hormone awaiting further research in the obesity – IR – diabetes – MetS link.

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Autoimmune Polyglandular Syndrome (APS) is characterized by presence of immune dysfunction of two or more endocrine glands and other non-endocrine organs. Only few cases of APS III associated with different immunological or genetic disorders have been reported. We present a 17-year old boy presented with easy fatigability, recurrent abdominal pain, pallor and language impairment; evaluated to have Autoimmune Thyroiditis, Megaloblastic Anemia due to vitamin B12 deficiency and Type 1 Diabetes Mellitus; with final diagnosis as APS IIIB with Immune Thrombocytopenia, leucopenia and Beta Thalessemia trait. The child requires lifelong monitoring of glandular functions and hormone replacement therapy for established glandular failure or failures. APS IIIB is as yet known to occur in middle aged women. It should be suspected in younger ages and diagnosed early to prevent the complications associated with the chronic endocrine deficiencies.

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Hypothyroidism can present with a wide range of nonspecific symptoms, some of which are cutaneous. However, hypothyroidism presenting as isolated palmar hyperkeratosis is rarely described in the literature. Here, we describe a 30-year-old male who presented with hyperkeratosis and painful fissures of both palms for 1½ years' duration. He had minimal relief with keratolytic agents. On physical examination, he was found to have bradycardia and when investigated he was found to have severe hypothyroidism. A diagnosis of autoimmune hypothyroidism was made after further laboratory studies. He was treated with thyroxine, and a gradual improvement of hyperkeratosis was noted over a period of 3 months. Although extremely rare, clinicians should consider hypothyroidism as a cause of hyperkeratosis, especially when it is refractory to treatment and/or there are other possible symptoms of hypothyroidism.

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BAckground and Objectives: Thyroid cancer incidence is increasing globally. There is limited data regarding the epidemiology of thyroid cancer in the Middle East and North Africa region. This region has also experienced socioeconomic changes recently that have influenced the histopathological and epidemiological pattern of thyroid cancer. The aim of this study is to evaluate the histological, epidemiologic, and surgical factors of thyroid cancer patients who underwent thyroidectomy at Cleveland Clinic Abu Dhabi. Materials and Methods: A retrospective review of patients who underwent thyroidectomy and found to have thyroid cancer over a 2-year period from July 2015 - July 2017. The histopathological data were reviewed based on the College of American Pathologists Protocol for Carcinomas of Thyroid Gland (American Joint Committee on Cancer, 7^th edition, 2010). Results: One hundred patients underwent surgery for thyroid carcinoma in our patient population. In these cancer patients, the female to male ratio was 5.25:1 and 71 patients (71%) were below 45 years of age. The most common surgery performed was total thyroidectomy at 75.7%. Papillary thyroid carcinoma (PTC) was the most common pathology in 89%, followed by follicular thyroid carcinoma (FTC) in 9%, one case of mixed papillary follicular carcinoma, and one case of Hurthle cell carcinoma. Hypocalcemia was the most common postoperative complication (20.6%). Conclusion: PTC, traditionally seen in iodine sufficient regions, is the most common histologic subtype of thyroid cancer and its rates are increasing in the United Arab Emirates (UAE). Female gender and age <45 were associated with thyroid carcinoma in our UAE patient cohort.

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Background: Preclinical and clinical studies have shown the importance of calorie restriction diet in weight reduction and cardiovascular risk factors. In this study, our objective is to compare the naturopathic-based short-term fasting therapy with low-calorie diet (LCD) on anthropometric and lipid profile among obese and overweight persons. A total number of subjects (n = 100) with body mass index (BMI) ≥25 were randomly allocated into either fasting therapy intervention (n = 48) or a LCD (n = 52). Materials and Methods: Participants underwent very LCD (288–904 kcal) in fasting therapy and a LCD (1234 kcal) in the other group respectively for 10 days. Individuals in both the groups were assessed with anthropometric parameters such as BMI, weight, waist circumference, hip circumference and waist-hip ratio, serum lipid profile, and serum leptin levels at the baseline and after 10 days. Results: The anthropometric measurements were decreased significantly in the fasting group when compared with the LCD group (P < 0.05). The decrease in mean serum total cholesterol (TC) (−27.43%), triglycerides (TGs) (−13.05%), and low-density lipoprotein (LDL) (−20.9%) in the treated group were statistically significant (P < 0.001), whereas serum high density lipoprotein (2.32%) was increased but insignificantly (P > 0.001) when compared with the nontreated group. Conclusions: Our findings support that short-term fasting therapy is beneficial in anthropometric measures and reducing leptin level among obese or overweight person compared to LCD. However, long-term adherence of weight loss with these interventions should be tested in future studies with bigger sample size.

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Background and Objective: Chronic hepatitis C infection can affect glycemic control in patients with diabetes mellitus (DM). This study was done to assess the influence of hepatitis C viral infection compared to hepatitis B viral infection and noninfected cases on the occurrence of secondary oral anti-hyperglycemic drugs (OADs) failure in type 2 diabetes mellitus (T2DM) patients. Patients and Methods: This prospective study was conducted on 1293 T2DM patients who had their hepatitis B and C status checked by the enzyme-linked immunosorbent assay method. Glycemic management was done according to the standard guidelines, and glycemic control was reviewed after 6 months of enrollment. Patients who had hemoglobin HbA1c >7.5% in spite of taking >75% of the maximum dosage of three OADs, that is, metformin, sulfonylurea, and thiazolidinediones were selected. Those who were already taking insulin therapy regardless of HbA1c were also considered as secondary OADs failure. The status of secondary OADs failure was analyzed in three groups: hepatitis C virus (HCV) positive, hepatitis B virus (HBV) positive, or noninfected patients. Results: Of selected 1293 cohorts, DM with HCV positive was 152 (11.7%), and DM with HBV positive was 111 (8.5%). Among 152 HCV-positive patients, secondary OADs failure was detected in 64 (42.1%), and in those with 111 HBV-positive patients, it was detected in 30 patients (27.02%), whereas it was 177 of 1030 noninfected patients (17.1%). Conclusion: Hepatitis C infection is more common than hepatitis B infection among diabetes patients. Secondary OADs failure is significantly associated with HCV-infected diabetes patients compared to other groups, and timely consideration of insulin initiation is important in these cases.

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The aim of this study was to determine, using meta-analysis, the prevalence of diabetes mellitus (DM) and to explore the influence of method of diagnosis, DM types, and study year on the prevalence of DM with the view to evaluating the trend and the burden of DM in KSA. Prevalence estimates were derived using a random effect model on carefully selected population-based studies in KSA. The derived estimates were applied to the total populations in the country to give an estimated burden of DM. Twenty-one studies, with 376,998 participants out of whom 54,837 had DM, were selected. The prevalence of DM was 20.9%, 0.9%, and 12.6% for T2DM, T1DM, and combined T1/T2DM, respectively. Subgroup analysis using the method of DM diagnosis showed that the prevalence of DM was 14.2% (95% confidence interval [CI]: 9.3% to 19.0%) in the fasting plasma glucose group, 6.8% (95% CI: 2.6% to 11%) in oral glucose tolerance group, and 12.5% (6.2%–18.9%) in glycated hemoglobin group. Meta-regression revealed 4.6 × 10⁻³ increase in prevalence per year. The prevalence of DM in Saudi Arabia is high. There is a rising trend in the prevalence of DM in KSA and it is accompanied by a proportionate increase in the burden of DM.

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Context: Diabetic foot ulcer (DFU) is one of the most dreaded complication of diabetes which often affects the morbidity and mortality of a diabetic. Biomarkers are required for follow-up of these patients to prevent further complications to the affected limb. Aim: The aim of this study is to evaluate ischemia-modified albumin (IMA), fibrinogen in relation with high sensitive-C-reactive protein (hs-CRP) in patients with DFUs. Methods: a hospital-based cross-sectional study was carried out among 30 patients with DFU admitted in the surgery department of tertiary care teaching hospital. The duration of the study was 2 months. Serum IMA, hs-CRP, and plasma fibrinogen levels were measured. Results: The present study has demonstrated that IMA levels (P < 0.05) and fibrinogen levels (P < 0.05) are statistically significantly elevated in patients with DFU and had significant correlation with albumin and hs-CRP (P < 0.05). Conclusions: The use of IMA, hs-CRP, and fibrinogen may be incorporated during the follow-up of type 2 diabetes mellitus patients and may probably prevent the development of DFU and also possibly prevent lower limb amputation. Further studies with a larger number of patients with DFU are necessary to reach a definitive judgment.

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Triple-A syndrome, also known as Allgrove syndrome, is an uncommon disorder which is inherited as an autosomal recessive disorder. About 100 cases have been described in literature. The three AAA comprises adrenal insufficiency secondary to adrenocorticotropic hormone (ACTH) resistance, achalasia cardia, and alacramia. We are reporting a case of a 10-year-old boy diagnosed as triple-A syndrome with ACTHresistant adrenal insufficiency, achalasia cardia, and alacrimia. He has alacramia since birth, and at the age of 7 years, he was diagnosed to have achalasia cardia. He developed the symptoms of adrenal insufficiency at the age of 9 years. Allgrove syndrome might be underreported in literature as the diagnosis requires high index of suspicion. In our patient, there was a delay of 3 years after the initial diagnosis of achalasia cardia. The diagnosis of Allgrove syndrrome should be considered in every child presenting with alacremia or achalasia cardia.

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Background and Objectives: Thyroid disorders are very common in the general population, and it is second only to diabetes as the most common condition to affect the endocrine system. In this study, we try to observe the prevalence of the type of thyroid dysfunction in patients with type 2 diabetes mellitus (T2DM). and its effect on glycemic parameters and the prevalence of autoimmune thyroid disorder in patients with T2DM. Settings and Design: This study included adults having T2DM. Patients were explained about the nature of the study and consent was obtained. Materials and Methods: Clearance was taken from the ethics committee. All participants who met the inclusion criteria were subjected to detailed clinical examination and relevant investigation. Statistical Analysis: Chi-square test was used for the analysis. Results: Two hundred and thirty-four patients (112 males and 122 females) were included in the study. The mean body mass index was high (26.21 ± 3.13 kg/m²). The mean hemoglobin (Hb) A1c was 8.81% ± 1.96%, whereas mean HbA1c in patients with both T2DM and thyroid dysfunction was 9.68% ± 1.35%. Thyroid dysfunction was found in 84 cases (35.8%), out of which the most common thyroid abnormality was overt hypothyroidism (61.9%) followed by subclinical hypothyroidism (27.3%). Out of 84 cases with thyroid dysfunction anti-thyroid peroxidase (TPO) was found positive in 45 cases (53.5%), and the most common thyroid dysfunction associated with positive anti-TPO was subclinical hypothyroidism (44%). Conclusions: The study shows a high prevalence of thyroid dysfunction among patients with T2DM and its association with poor glycemic control. The study also shows the prevalence of anti-TPO among patients and its significant correlation with thyroid dysfunction.

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Uncommon scenario of spontaneous hypoglycemia after starting carbimazole due to insulin autoimmune syndrome, characterized by high levels of insulinemia and circulating autoantibodies to insulin without prior insulin administration. So far, in Western countries, <70 cases have been published. In addition, more than 380 cases of this syndrome have been reported.

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Objectives: Our aim was to assess the clinical profiles and determine the precipitating factors for diabetic ketoacidosis (DKA) in adult patients admitted to a tertiary care center in United Arab Emirates (UAE). Materials and Methods: We conducted a retrospective analysis of all patients admitted with DKA at a tertiary care hospital in UAE during June 2014–December 2017. Variables recorded included gender, type of diabetes, and HbA1c on presentation and identified precipitating factors. Results: Data from a total of 255 patients with DKA were analyzed. One hundred and fifty-seven of these patients had type 1 diabetes (61.6%) whereas 69 patients were diagnosed with type 2 diabetes mellitus (T2DM) (27.1%), and 22 patients could not be classified as type 1 or type 2. A small number of patients (2.7%) were found to have secondary diabetes as their DKA was precipitated by acute pancreatitis. Around 12% of cases occurred in the setting of newly diagnosed diabetes. The most common precipitating factor for DKA was noncompliance to treatment (31.4%), followed by infections (22.7%). Pancreatitis was another important precipitating factor which accounted for 6.3% of the cases. Conclusions: DKA is not limited to patients with T1DM, and there seems to be a steady increase in its occurrence in patients with T2DM. Noncompliance to therapy is a major precipitating factor which needs to be addressed by offering better education programs to prevent hospitalization of these cases.

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Aims: The aim of this study is to retrospectively assess the effect of ongoing diabetes self-management education (DSME) on glycemic control among patients who received diabetes care at the Dubai Diabetes Center in Dubai, United Arab Emirates. Materials and Methods: The electronic medical records of all patients who attended the Dubai Diabetes Center for an initial visit between January and December 2015 were reviewed. Results: Patients who attended frequent follow-up visits (≥4 visits) within 1 year were found to have significantly lower HbA1c levels at the end of the 12-month study period as compared to those who attended less frequent follow-up visits (< visits). The mean difference in HbA1c from the initial visit was significantly greater in the group that attended frequent follow-up visits as compared to those who did not. The logistic regression analysis revealed the frequency of follow-ups to be a significant predictor of glycemic control, whereby patients who attended more frequent follow-ups had better glycemic control. Conclusions: Our research revealed the significance of frequent diabetes patient education on glycemic control in the United Arab Emirates. Our results can aid in shedding light that frequent and continued DSME can have a positive impact on disease outcomes in patients with diabetes.

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Involvement of adrenal glands in lymphoma is rare; the patient may have variable presentations. We report a case of a 62-year-old Saudi female who presented to our center with a few-week history of fatigue, weight loss, subjective fever, and a recent change in skin color. On examination, she looked dehydrated and had a drop in blood pressure with postural change and hyperpigmentation of the skin of the face and hands. Morning cortisol levels were low, and adrenocorticotropic hormone levels were high, which indicated primary adrenal insufficiency (PAI). An adrenal computed tomography (CT) scan revealed bilateral adrenal enlargement. After excluding pheochromocytoma, a CT scan-guided trucut biopsy of the adrenals confirmed non-Hodgkin lymphoma. The patient was started on steroid replacement therapy, and after stabilization, a plan was made to initiate chemotherapy for the treatment of lymphoma; unfortunately, the patient died shortly after diagnosis because of rapid progression of the disease. Adrenal lymphoma can present with PAI and should be considered in the presence of bilateral adrenal enlargement; it is an aggressive tumor and carries poor prognosis if the treatment is delayed.

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Context: Acupoint injection therapy with Vitamin B₁is very effective in the management of diabetic peripheral neuropathy (DPN), and there are few adverse side effects. Aims: The overall purposes of our study are to determine the specific methods of acupoint injection therapy with Vitamin B₁for patients with DPN and to demonstrate the effectiveness of this therapy for DPN patients. Settings and Design: The enrolled patients were divided into two groups – the experimental group (75 patients) and the control group (51 patients). Subjects and Methods: We used four main acupoints in our study – EX-B3, ST36, GB39, and GB34. We compared the changes of DPN symptoms, days of pain loss, changes of tendon reflexes, and electromyographic (EMG) parameters between two groups after 15 days of treatment. Statistical Analysis Used: T-test was used to compare the characteristics between different treatments. Results: The best acupoint set for performing the acupoint injection therapy with 5% Vitamin B₁, includes EX-B3, ST36, GB34, and GB39. The mean efficiency rate in terms of changes of DPN symptoms was 84.5% that is significantly lower compared with 61.9% of control group. Furthermore, the day of the pain loss of experimental group was significant lower than that of control group and the efficiency rates in terms of patellar reflex and Achilles tendon reflex were 90.0% and 89.1%, respectively (P < 0.05). In the experimental group, EMG parameters were improved significantly. Conclusions: Our study suggests that the acupoint injection therapy with Vitamin B₁is preferable, easier, and cost-effective approach in terms of DPN treatment.

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The literature on health aspects of Ramadan fasting (RF) is widely spread in many journals, making it not readily accessible to those interested in the subject. We aimed to provide a narrative overview of the global literature production in 1 year (2020) on diabetes and RF. This was a narrative, nonsystematic review of the international literature from a single major medical online database (i.e., PubMed) during the year 2020. The search term “Ramadan fasting AND Diabetes” was used, and the relevant literature was narrated in a concise thematic account. The publications spanned a vast array of topics related to RF, including assessments of safety and efficacy profiles of older and newer diabetes therapies, modes of insulin delivery, evaluating the role of utilizing advanced technology for the treatment, and monitoring of blood glucose during RF. Increased interest was evident in capturing patients' perspectives and healthcare professionals' perceptions, attitudes, and practices during Ramadan. Fasting by high-risk groups was studied. Not surprisingly, some reports covered COVID-19 and Ramadan and the role of telemedicine in ramadan. The current literature review presents this year's research data on the safety of fasting practices, care models, and patients' experiences and perspectives. It emphasizes the need for more comprehensive interventions for high-risk patients, promoting newer antidiabetic medicines, and advanced technology for safer fasting practices.

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Background: Thyroid nodules are a common presentation in clinical practice. Fine-needle aspiration cytology (FNAC) is a useful method of triaging patients between benign, suspicious, and malignant categories. Materials and Methods: This is a retrospective review of the electronic medical record of all surgical thyroid patients presenting to our institution between July 2015 and June 2017. The cytological and histological data were reviewed and correlated based on the Bethesda system for reporting thyroid cytopathology. Results: Two hundred and seven patients underwent thyroidectomies during that period of which 164 had preoperative FNAC. The female-male ratio of 4.9:1. On histology, 52% of nodules were benign and 48% of nodules were malignant. When comparing with cytologic diagnosis, FNAC showed a sensitivity of 52%, specificity of 95%, positive predictive value of 92%, negative predictive value of 64%, false positive rate 5%, and false negative rate 48%. Total accuracy was found to be 72%. Conclusion: FNAC is a useful tool in deciding management options for patients, but has limitations, particularly when evaluating follicular lesions. This leads to discrepancy in the calculation of statistical values in literature.

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Background: There are varying reports on the association of high-density lipoprotein cholesterol (HDL-C) phenotypes and glycemia in type 2 diabetes mellitus (T2D) patients. Such information is lacking in Nigerian data. Aim: The aim of this study was to determine the relationship between HDL-C phenotypes and glycemic control in T2D patients. Materials and Methods: Clinical and laboratory data were collected from consenting T2D patients. Information was managed and analyzed with appropriate software. Results: Four hundred T2D patients consisting of 235 and 165 persons with and without poor glycemic control, respectively, were recruited for this study. There was a significant negative correlation between glycosylated hemoglobin (HbA1c) and the HDL₂-C phenotype (r_s = −0.12, P = 0.01). The correlation between HbA1c and the HDL₃-C phenotype was not statistically significant (r_s = −0.06, P = 0.21). Conclusion: The HDL₂ phenotype has a stronger correlation with glycemic status than the HDL₃ phenotype in T2D patients.

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Background: Patients with diabetes are targeted with diabetes education 8–10 weeks before Ramadan to have a safe fasting experience. In 2020, this timing coincided with COVID-19 lockdown when virtual clinics were implemented to secure patient care continuity. Objectives: We evaluated hypoglycemia episodes among patients with diabetes fasting in Ramadan 2020 during COVID-19 lockdown. Patients and Methods: A cross-sectional study was conducted after the month of Ramadan 2020, using a self-administered online questionnaire and convenient sampling methods. Patients with diabetes aged 14 years and older who practiced fasting in Ramadan were included in the study. Hypoglycemia rate in total and diabetes treatment among observers of Ramadan 2019 and Ramadan 2020 were compared. Predictors of hypoglycemia during fasting Ramadan 2020 were estimated. Results: Out of 367 patients with diabetes aged 14 years and older, 326 (88.8%) participants had the ability to fast Ramadan and were included in the study. Comparing patients' experience in Ramadan 2019 and Ramadan 2020, participants reported lower hypoglycemia episodes during Ramadan 2020 than Ramadan 2019, P = 0.017. In subgroup analysis based on the type of treatment, patients on noninsulin treatment had statistically significant lower hypoglycemia episodes during Ramadan 2020 than Ramadan 2019 (P = 0.006). Patients on insulin treatment had fewer hypoglycemia episodes during Ramadan 2020 than Ramadan 2019, but the difference was not statistically significant (P = 0.405). The probability of hypoglycemia during fasting Ramadan 2020 was higher among younger age groups 14–30 years (odds ratio [OR] 7.24, 95% confidence interval [CI] 1.72–30.39), patients aged 31–45 years (OR 7.18, 95% CI 1.97–26.19), patients with longer duration of diabetes (more than 10 years) (OR 2.30, 95% CI 1.01–5.26), and patients on insulin (OR 14.14, 95% CI 1.72–30.39). Conclusions: COVID-19 pandemic and lockdown did not affect the diabetes-related experience among participants' fasting Ramadan. The hypoglycemia episodes of patients with diabetes in Saudi Arabia were improved during the pandemic era. This could be related to telemedicine services. More studies are required to support its role in improving health conditions beyond our population's pandemic era.

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