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Thyroid nodules are common in clinical practice and are routinely evaluated with neck ultrasound. Multiple guidelines rely on sonographic features to assist physicians when deciding if nodules require observation or fine-needle aspiration (FNA). Existing classification systems for risk stratification of thyroid nodules are different but equally accurate. The purpose of this article is to review the significance of thyroid nodule location as an important factor in assessing the risk of malignancy. Several topical issues are addressed. (1) Thyroid nodule location and risk of differentiated thyroid cancer, (2) Thyroid nodule location and risk of nodal metastasis, (3) Thyroid nodule location and surgical approach, (4) Thyroid nodule location and stratifications systems (5) Conclusions and future direction. In conclusion, it is advisable not to reply solely on ultrasound-derived risk levels when evaluating thyroid nodules to determine optimal management including nodule FNA, follow-up or no additional intervention. This is likely because other clinically important features might not be accounted for when using those risk stratification algorithms. There are now reasonable data to suggest thyroid nodule location may be an additional prognostic predictor. In the lack of clear radiologic guidance, clinical judgment remains the main driving factor.

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Critical limb ischemia (CLI) is considered the end-stage of peripheral arterial disease, with a prevalence between 2% and 4% in the general population and more than 15% in older adults. One-year major amputation rate can reach 30%, and diabetic patients are five times more likely to develop CLI than nondiabetics. The vascular damage and the complexity in the anatomical extension of the lesions are also worse in people with diabetes with poorer outcomes after vascularization attempts. Following the classifications suggested by international guidelines, we can define the presence of CLI and have a precise evaluation of the amputation risk and the best revascularization procedure for the patient. Nowadays, new endovascular techniques and devices make it possible to treat tibial vessels and even arteries below the ankle with promising initial results. Nevertheless, the re-occlusions rate and the need to re-do treatments at 1 year remain between 30% and 50%. The disease progression and hyperplasia can because it. However, the damage at the microcirculatory level can also lead to a decrease in tissue runoff and an increase in peripheral resistance, which determine the revascularization failure. In the last 20 years, several trials have been designed to avoid amputation in patients with no surgical options. The aim is to find a valid cellular base therapy to create a new vessel web in the ischemic tissue based on the angiogenetic power that stem cells have already demonstrated in vitro and animal studies. Different types of cells have been tested with different concentrations and administration routes with promising results. CD34⁺ Mononuclear cells, Mesenchymal stem cells, growth factors have demonstrated their contribution to the neo-angiogenesis in ischemic areas. At Abu Dhabi Stem Cells Center, we created a cellular cocktail as an adjunct treatment to surgical revascularization. We think that acting at the microcirculatory and immunological level. We may reduce postsurgery hyperplasia and increase tissue perfusion, ultimately prolonging the patency of revascularization procedures.

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Objective: We sought to scope the practices in managing thyroid nodules in the Middle East and Africa (MEA). Materials and Methods: Survey of a convenience sample of physicians concerned with the management of thyroid disease. Results: Two hundred and twelve responses are included. Fine needle aspiration (FNA) is performed chiefly using ultrasound guidance (74.9%), generally by radiologists (47.1%). Respondents have a lower threshold for FNA than recommended. Management depends on the FNA cytology, with the follicular lesion of undetermined significance/atypia of undetermined significance resulting in repeat FNA for cytology (40.7%), immediate referral for thyroid surgery (32.9%), or molecular testing (13.2%). Follicular neoplasms are referred for lobectomy or total thyroidectomy by 81.6% of respondents. Nodules suspicious for malignancy are referred for thyroid surgery by 76.6% and for molecular testing by 20.1%. Respondents are less likely to perform FNA in an octogenarian than a younger patient with a comparable nodule. For a multinodular goiter, 29.9%, 25.9%, or 17.8% of respondents would, respectively, sample the largest 2–3 nodules, single largest nodule, or all nodules >1 cm in size. During pregnancy, respondents would perform FNA with nodular growth (27.1%) in the absence of nodular growth (25.6%), but more respondents (35.2%) would defer FNA until after pregnancy. Conclusions: The physicians' survey revealed a practice pattern in managing thyroid nodules in the MEA region, including both agreements and deviations from current guidelines. Focused quality assurance exercises, education, and research are needed.

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Introduction: Dyslipidemia is often associated with type 2 diabetes (T2D), with both having an additive effect on cardiovascular risk. The objective of the meta-analysis was to determine the prevalence of dyslipidemia in individuals living with T2D mellitus in Nigerian and to examine the pattern of their dyslipidemia. Methods: The study followed the preferred reporting items for systematic reviews and meta-analyses guidelines. Medical databases such as PubMed, Google Scholar, African Journals Online, and SCOPUS as well as the gray literature were systematically searched. MetaXL was used for statistical analysis adopting the random effect model. Heterogeneity was determined using the I² statistic, while publication bias was assessed with the funnel plot. Results: Twenty-two studies met the eligibility criteria for the meta-analysis. The total sample size was 3575. The prevalence of dyslipidemia among Nigerians living with diabetes ranges from 25% to 97.1%. The pooled prevalence of dyslipidemia among Nigerians living with T2D was 63% (95% confidence interval [CI]: 52%–72%). I² statistic was 97%. The funnel plot implied minimal publication bias. The pooled prevalence of elevated low-density lipoprotein cholesterol was 33% (95% CI: 18%–49%). The pooled prevalence of elevated hypertriglyceridemia was 88% (95% CI: 84%–91%). The pooled prevalence of low high-density lipoprotein cholesterol (HDL-C) was 47% (95% CI: 32%–62%). The pooled prevalence of elevated hypercholesterolemia was 33% (95% CI: 23%–43%). Conclusions: The prevalence of dyslipidemia among Nigerians with T2D mellitus is very high. The most common abnormalities are hypertriglyceridemia and low HDL-C.

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Purpose: The purpose of this study is to identify the rates of diabetes distress and depression in patients with Type 2 diabetes and to explore the relationship between glycemic control, depression, and diabetes distress. Patients and Methods: One hundred and fifteen adults with Type 2 diabetes were recruited for this cross-sectional study from the Dubai Diabetes Center in Dubai, United Arab Emirates. The Arabic version of the Diabetes Distress Scale was used to assess diabetes distress, and the Arabic version of the Beck Depression Inventory-II scale was used to assess depression symptoms. Results: Our study population consisted of 63 males (54.8%) and 52 females (45.2%). We found that, out of this study population, 54.3% had uncontrolled diabetes with glycosylated hemoglobin (HbA1c) >7% (53 mmol/mol), 54.8% exhibited diabetes distress, and 29.6% showed depression. Using a combined oral and insulin treatment was found to be significant independent predictors of poor glycemic control as defined by an HbA1c >7% (53 mmol/mol). Conclusion: This study has identified psychosocial issues as a significant health problem among adult patients with type 2 diabetes and offers data confirming the relevance of diabetes distress and depression among them. This finding can help clinicians have a better understanding of the extent to which psychosocial issues influence diabetes management so as to develop effective and appropriate treatment approaches.

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Background: COVID19 infection is associated with worse outcomes in patients admitted with diabetic ketoacidosis (DKA). The indirect impact of the pandemic on DKA admissions to COVID19 free hospitals has not been evaluated. In this study, we evaluate the characteristics and outcomes of DKA admissions before and during the pandemic. Materials and Methods: This retrospective study included 146 episodes of DKA for patients aged 16 years and above admitted to Tawam Hospital, A COVID-19-free hospital, between April and October from 2017 to 2020. Sociodemographic, clinical, and laboratory data were retrieved from the electronic records. Data from the (2017–2019) period were compared to those during the COVID19 pandemic in 2020. Results: We evaluated 79 pre-COVID19 and 67 during the COVID19 admissions. During the pandemic, patients were older (30 vs. 23 years, P 0.2) with higher proportions of male sex (66% vs. 25%) and non-Emirati nationals (Arabs 17.9% vs. 12.7% and South Asian 20.9% vs. 3.8%). In addition, only 64.2% of patients had medical coverage compared to 92.4% in pre-COVID19 time. More patients with newly diagnosed diabetes (25.4% vs. 7.6%) and type 2 diabetes mellitus (32.8% vs. 17.7%) were encountered during the pandemic. Overall, there was no significant difference in severity, time to resolution, and mortality. Length of stay was longer for DKA admissions during the pandemic (4 vs. 3 days). Conclusion: In our COVID19-free hospital, the pandemic has led to an increased rate of DKA admissions and significant change in the sociodemographic characteristics of patients with DKA. Clinical care, patients' management, and outcomes were not adversely affected. Assessing the indirect impact of the pandemic is essential for future service planning.

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Introduction: The coronavirus disease-2019 (COVID-19) pandemic was associated with international obligations that modified lifestyles and clinical practice. These changes are worrisome for patients with diabetes, as disruption from a routine can have devastating effects on glucose control. This retrospective study aims to assess the impact of lockdown and the efficacy of the instituted changes in patient management on blood sugar control. Methods: Patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) who received management through telemedicine at the National Diabetes Center over a lockdown period of 3 months were included. The blood investigations that were done for them as part of standard care were reviewed. Results: A total of 509 patients were included. HbA1c slightly decreased in 49.5% of the patients after the lockdown (P = 0.42). Patients who were not hypertensive experienced a significant reduction in HbA1c (adjusted odds ratios [ORa]: 0.59, 95% confidence interval [CI]: 0.39–0.91, P = 0.018) during the lockdown. A significant association between body mass index (BMI) and lower HbA1c level postlockdown was also determined (ORa: 0.95, (95% CI: 0.92–0.98, P = 0.001). A significant HbA1c reduction was only noted in the BMI group of normal weight (mean: 0.46 ± 0.3, P = 0.03). Conclusion: The imposed lockdown due to COVID-19 did not adversely impact the HbA1c level and glycemic control in T1DM and T2DM patients. Inversely, HbA1c improvements were determined in patients with normal weight and blood pressure after the lockdown period.

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Background: Despite the increasing demand for continuous subcutaneous insulin infusion (CSII) or insulin pump therapy in preschool children with Type 1 diabetes (T1D), reports on its advantages over conventional methods, particularly multiple dose injection (MDI) therapy, are scant. Objectives: We aimed to investigate the effectiveness, safety, and parental satisfaction of using CSII compared to MDI in preschool children with T1D. This study also seeks to establish criteria to help clinicians choose patients most suitable for CSII. Methods: Relevant terms based on the study outcomes were used to search electronic databases and manual search for the literature. Selected articles were then thoroughly reviewed and evaluated. Results: The effect in the meta-analysis showed a small, nonsignificant positive effect on HbA1c of the CSII compared to the MDI insulin intervention method (mean Cohen's d effect size = 0.25, Standard Error = 0.18, P = 0.16 (n = 127)) and a small, nonsignificant negative effect on safety of the CSII compared to the MDI insulin intervention method (mean Cohen's d effect size = −0.26, SE = 0.36, P = 0.47 [n = 70]). For parental satisfaction, data were small and therefore inappropriate for meta-analysis. Conclusion: For preschool children, the effectiveness and safety of insulin pump therapy compared with MDI therapy was considered statistically nonsignificant. All preschool children with T1D can be considered potentially eligible candidates for insulin pump therapy. Suggested selection criteria to apply when considering preschool children for insulin pump therapy were presented.

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An increase in the incidence of subacute thyroiditis (SAT) following the COVID-19 vaccine. The aim of this report is to shed the light on different presentations of SAT postCOVID-19 vaccine while reviewing the link between the vaccine and subsequent thyroid inflammation. We present the case of a middle-aged man who presented symptoms of SAT 1-week postvaccine. He achieved euthyroidism 6 weeks later. We also present the case of a middle-aged woman with less severe symptoms of SAT 4 weeks after the vaccine. She is in the hypothyroid phase 11 weeks later. A 37-year-old male developed severe symptoms 2 weeks after the first dose and is still hyperthyroid 5 weeks later. A 36-year-old woman presented with silent SAT 3 weeks after the first dose. Cases of SAT following SARS-Cov-2 are now reported increasingly. COVID-19 can cause thyroiditis via direct cell, or alternatively though immune destruction of the thyroid in genetically susceptible individuals. Similarly, the vaccine can promote inflammation through the same mechanisms. Indeed, there is a postulated cross-reactivity between the spike protein and thyroid antigens. More-so, there is the studied vaccine adjuvant effect on the endocrine system, namely the thyroid in this case. Cases of SAT postCOVID-19 vaccines are increasingly reported. Theories are similar to COVID19-induced thyroiditis but also other mechanisms are uniquely mediated by vaccines. A low threshold should be set to diagnose SAT in patients with one or more hyperthyroid symptoms presenting 1–8 weeks postCOVID-19 vaccine.

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Multiple factors control the growth of a child, including genetics, nutrition, and socioeconomic factors. Referral of tallboys who are otherwise well is very rare. However, sometimes, extraordinary tall stature for the age can be a cause of great concern to the parents. We report a case of an Omani child with a de novo mutation of NSD1 that led to his overgrowth and diagnosis of Sotos syndrome (SoS). This syndrome is a rare genetic disorder. Only two cases of genetically proven diagnosis were reported from the Middle East and North Africa region. Therefore, we describe a case and highlight the comorbidities associated with this condition, encouraging colleagues from the region to report their cases to understand better the phenotype–genotype and the natural history of this disorder in this part of the world.

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