Thyroid Dysfunction in Type 2 Diabetic Patients and the Effect of Diabetes Duration and Anti-glycemic Medications on Mean TSH and A1c levels: A Retrospective study

Background: The association between type 2 diabetes mellitus and thyroid disorder is a well-recognized one, necessitating checking diabetic patient for the presence of thyroid abnormality. Objective: To check the presence of hypo or hyperthyroidism in a sample of type 2 diabetic patients and to see whether anti-glycemic medications have any effect on mean TSH and A1c levels. Methods: This is a retrospective study on records of 1341 type 2 diabetic patients in the Specialized Center for Endocrinology and Diabetes, Baghdad for a period of 3 months in 2019, data were taken from patient records software and analyzed the presence of hypo or hyperthyroidism. Results: Out of 1341 type 2 diabetic patients 108 have thyroid dysfunction (8%), 7% for hypothyroidism and 1% for hyperthyroidism. Mean TSH levels were significantly lower with diabetes duration>5 years in hypothyroid patients (p=0.032) and lower when metformin was included in the treatment of hypothyroidism (p=0.036). No such an effect was present in hyperthyroid patients. Conclusion: Thyroid disorders among type 2 diabetic patients are under-estimated in our country, mean TSH levels are lower in hypothyroid patients when their treatment included metformin and lower with diabetes duration more than 5 years.

Idiopathic non-traumatic facial nerve palsy [Bell's palsy] in neonates; an atypical age and management dilemma

Idiopathic [Bell's] palsy is the commonest cause of unilateral facial paralysis in children. Although being idiopathic by definition, possible infectious, inflammatory, and ischemic triggers have been suggested. Bell's palsy is thought to be responsible for up to three-fourths of cases of acute unilateral facial paralysis worldwide. The diagnosis has to be reached after other causes of acute peripheral palsy have been excluded. However, it is rarely described in neonates and young infants. Steroids may have some role in treatment, but antiviral therapies have doubtful evidence of benefit. Prognosis is good, though residual dysfunction is occasionally encountered. We report the case of a two-week-old neonate with no prior illnesses who presented with acute left facial palsy. Clinical findings and normal brain imaging were consistent with the diagnosis of Bell's palsy. The patient had a good response to oral steroids

Disseminated strongyloidiasis in an immunocompromised host: A case report

Infections caused by Strongyloides stercoralis (S. stercoralis) in human are generally asymptomatic, however in immunocompromised individual, hyperinfection may develop with dissemination of larvae to extra-intestinal organs. The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself, which may lead to low index of suspicion as a consequence. In this report, a case of a Malaysian male with underlying diabetes mellitus, hypertension, cerebrovascular accident, bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented. However, he developed septicemic shock later, and S. stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli. Regardless of aggressive resuscitation, the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome. It was revealed that the current case has alarmed us via incidental finding of S. stercoralis larvae in the tracheal aspirate, indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.

Leukemia during pregnancy: long term follow up of 32 cases from a single institution

Background and objectives: There is limited information regarding the outcome of patients treated for leukemiaduring pregnancy. This study was performed on all cases of leukemia during pregnancy identified in our institution leukemia database

Patients and Methods: It is a retrospective study from our existing database. Thirty two cases were identified among the cohort of patients treated for acute and chronic leukemia between January 1991 and July 2003

Results: Among the acute leukemia patients [n = 21], 10 patients [47.6%] received chemotherapy during pregnancy, seven had live birth and three had spontaneous abortion. No teratogenicity or congenital malformations or postnatal complication were reported. The remaining 11 [52.4%] were not given chemotherapy while pregnant; three patients presented after 34 weeks of gestation ending in normal live births and then received chemotherapy and eight patients had abortion before starting chemotherapy. Among the chronic myeloid leukemia [CML] patients [n = 11], nine patients received hydroxyurea, one patient received alfa-interferon and one patient was treated with leukapheresis. Eight patients had normal live births and three patients had abortion. Out of the 32 patients, 18 patients [56.2%] subsequently underwent HLA matched sibling allogeneic stem cell transplantation, seven for acute myeloid leukemia [AML], two for acute lymphocytic leukemia [ALL] and nine for CML. After a median follow up of 16 years, five patients [15.6%] are alive in remission [one from chemotherapy group and four from SCT group]

Conclusions: Our report lends credence to the safety and feasibility of administering anti-leukemic therapy in acute and chronic leukemias during pregnancy although acute leukemia patients had possibly a poor long term outcome compared to non-pregnant patients

Successful treatment of steroid-refractory autoimmune thrombocytopenia associated with Castleman disease with anti-CD-20 antibody [rituximab]

Multicentric Castleman disease [MCD] is a lymphoproliferative disorder of incompletely understood etiology and with various clinical presentations. The best therapeutic option for this disease is not well established. MCD is known to be associated with autoimmune phenomena. A 70-year-old female patient of MCD with progressive nodal disease associated with autoimmune thrombocytopenia failed steroid treatment and showed a transient response to intravenous immunoglobulin. The patient achieved complete recovery of her platelet count and a very good response in nodal disease after 3 weekly doses of anti-CD-20 antibody [rituximab]. Anti-CD20 antibody treatment could be a good therapeutic option for MCD, mainly when associated with immune-related disorders

Occurrence of bacteriuria and bacteraemia after urodynamic study

Urodynamic studies [UDS] are multi-channel pressure flow techniques which are accepted as standard diagnostic tool in the evaluation of lower urinary tract dysfunctions. But UDS are invasive procedures that involve urethral catheterization. Further more, water or radio opaque dye are infused or pumped into the urinary bladder during UDS for pressure volume studies. This study was conducted to assess the incidence of the female urinary tract infections and bacteraemia after UDS. One hundred seventy women complaining of lower urinary dysfunction elected for UDS were enrolled in this work. Bacteriuria was detected in 13 out of 170 cases. E.coli was detected in 9 cases while coagulase negative Staphylococci was detected in 4 cases. We also found no positive blood culture after UDS without use of routine prophylactic antibiotics. There is no need to use prophylactic antibiotics before UDS as the risk of developing complication is infrequent

Hypolipidemic effect of silymarin in dyslipidaemia of different etiologies

Many drug and non drug approaches are utilized for the treatment of dyslipidemia; flavonoids, the major constituents of silymarin, have been proved to positively modify lipoproteins in experimentally - induced dyslipidemia. This study was designed to evaluate the effect of silymarin, when used alone or in combination with other hypolipidemic agents, on the lipid profile in dyslipidemic patients. Fifty seven patients with dyslipidaemia of various etiologies are involved in this clinical trial. They are randomized into three groups treated with either 400mg / day silymarin [gr. A] or 20 mg / day lovastatin [gr. B] or a combination of 200 mg/day silymarin and 10 mg/day lovastatin [gr. C] for 2 months, only 45 patients complete the study. Serum lipid profile [total cholesterol, triglycerides, LDL-C, VLDL-C and HDL-C] and liver functions indices [SGOT, SGPT, total bilirubin] were evaluated each month during the follow up period. Treatment with silymarin results in a significant decrease in TC, TG, LDL-C and VLDL-C levels, with a significant elevation in HDL-C levels, without any significant changes in liver function. Meanwhile, adjunct use of silymarin with lovastatin widens the scope of lovastatin-hypolipidemic effect, without increasing in the score of adverse effects, and ameliorating the hepatic damage emerged due to its use. The results presented in this study indicated that silymarin can be used alone in clinical practice for the treatment of dyslipidemia, and when combined with other hypolipidemic agents like lovastatin, improves therapeutic profile and ameliorate some of its adverse effects

Effect of melatonin and zinc on the lipid profile in typel diabetic patients poorly controlled with insulin

Many in vitro and experimental animal studies indicated that melatonin has an important role in regulation of blood glucose level. No clinical data on the pharmacological use of this supplement in the management of diabetic complications, like dyslipidemia, were available to support its therapeutic role in diabetes mellitus. This study was designed to evaluate the effect of adjuvant use of melatonin and zinc acetate to improve the impaired lipid profile in type 1 diabetes mellitus patients poorly controlled with exogenous insulin. This study was carried on 50 type 1 diabetes mellitus patients with mild response to insulin treatment, and randomized into 3 groups. Group A treated with a combination of lOmg melatonin and 50mg zinc acetate; group B treated with 50mg zinc acetate only and group C treated with placebo. All treatment formulas were administered orally for 90 days. Plasma levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol [LDL-C] and high-density lipoprotein cholesterol [HDL-C] were evaluated before starting treatment and after each 30 days for 3 months. Treatment of DM patients with melatonin and zinc decreases the elevated levels of total cholesterol, triglycerides and LDL-C after 30 days, while HDL-C levels were significantly elevated after 90 days of treatment. Adjuvant use of a combination of melatonin and zinc improves the impaired lipid profile in type 1 diabetic patients poorly controlled with insulin treatment

influemce of different plasticizers on some physical and mechanical properties of hydroxypropyl methylcellulose free films

Coating has been widely used in pharmaceutical manufacture either as non-functional or a functional entity. The objectives of the present study were to investigate the effect of plasticizers such as PEG400, PEG1000 and triacetin on mechanical properties, glass transition temperature and water vapor transmission of free films prepared from HPMC and/or HPMC:PVA blends, to develop suitable coating system for tablets, and to determine the release profiles of the coated tablets. The tensile strength of plasticized HPMC films was generally lower than that of control HPMC film and could be attributed to increased crystallinity and segmental chain mobility of HPMC. This effect increased as the concentration of plasticizer increased. Generally the addition of both grades of polyethylene glycol [PEG400 and PEG1000] increased the moisture permeability of HPMC films but the films containing triacetin provided a more rigid barrier to moisture compared to unplasticized HPMC films. The dissolution profiles of paracetamol tablets coated with 7% w/v HPMC coating-solutions containing PEG400, PEG1000 and triacetin, and those containing PEG400 and PVA together showed that HPMC had weak water resistance. The presence of PEG400 and 1000 in HPMC films further weakened its resistance to solubility while the presence of triacetin caused a little increase in HPMC water resistance. From the results it was concluded that HPMC at 7%w/w concentration was suitable for film-coating intended for non-functional coating. Presence of the PEG 400, PEG1000 and triacetin as well as the presence of PVA and PEG400 together improved the coating properties of HPMC films and made it more suitable as a non-functional coating material