A Case of Acute Pancreatitis: An Unusual Manifestation of Acute Q Fever / 가정의학회지

Acute pancreatitis is a sudden inflammation affecting the exocrine region of the pancreatic parenchyma. Infectious etiologies are rare. Here we report an exceptional case of a 44-year-old woman from a rural area who was referred to our hospital with fever and abdominal pain. A physical examination revealed pale skin and epigastric tenderness. Thoracoabdominal computed tomography revealed a Balthazar score of D. Serum laboratory findings revealed hemolytic anemia, hepatic cytolysis, and high C-reactive protein level. Calcium and lipase levels were normal. There was no history of recent trauma, alcohol consumption, or drug intoxication. The diagnosis of “query” pancreatitis was confirmed by serological Coxiella burnetii positivity. Oral doxycycline 200 mg daily was initiated. The clinical evolution was favorable. To our knowledge, no association between acute pancreatitis and hemolytic anemia caused by C. burnetii was reported previously. Q fever must be considered in cases of acute pancreatitis, especially when the patient is from a rural area or has a high-risk profession.

A Case of Painful Diplopia after COVID-19 Vaccination: Could It Be Tolosa-Hunt Syndrome? / 가정의학회지

Herein, we report a rare case of Tolosa-Hunt syndrome (THS) following coronavirus disease 2019 (COVID-19) vaccine administration. A 64-year-old patient presented with recurrent horizontal diplopia and ipsilateral orbital pain, 2 weeks after being administered the COVID-19 vaccination. A diagnosis of THS was based on the relevant criteria after ruling out the differential diagnoses. The clinical presentation improved with corticosteroid administration. THS must be recognized as a complication of COVID-19 vaccination. This association can be explained by an autoimmune response.

[Anthropometric profile of children and adolescents from diabetic pregnancies]

Background: Exposure in utero to maternal diabetes is a risk factor for obesity and type 2 diabetes. It may contribute to the current epidemic outbreak of these diseases

Aim: To evaluate the impact of the exposure to maternal diabetes on the anthropometric profile of the offspring. Methods: This cross-sectional study was conducted in the department "A" of the National Institute of Nutrition. It involved 120 children and adolescents who were from 5 to 19 years old and recruited between October 2008 and November 2009. They were divided into two groups: o A first group of 80 children from diabetic mothers ; o A second control group of 40 children from non-diabetic pregnancies. They have had a clinical examination. Data about diabetic pregnancies were collected from the mothers'medical records

Results: body mass index and waist circumference of children from both groups were comparable. In both groups, two thirds of children had a normal weight [62.5% in the first group versus 65% in the control group]. Obesity is more common in children exposed to maternal hyperglycemia [31.3% versus 25% in the control group], but the difference is not statistically significant. The majority of obese children [88%] are those from diabetic mothers with type 2 or gestational diabetes

Conclusion: our results underline the need for early screening for gestational diabetes and an optimal management of diabetic pregnancy to reduce the metabolic risk in the offspring

Efficacy and safety statins in the treatment of diabetic dyslipidemia

The Adult Treatment Panel III recommends 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors or statins as first-line-lipid-altering therapy for all adult patients with diabetes mellitus. This is based on the well-characterized efficacy and safety profiles of this class of agents as well as several clinical trials demonstrating that statin treatment reduces the risk of cardiovascular events. The objective of our study was to investigate the efficacy and safety of statin therapy in patients with diabetes type 2. We analyzed data from 120 individuals with diabetes type 2. For all patients, the mean baseline LDL-cholesterol level was 4, 26 +/- 0, 82 mmol per liter, the total cholesterol level was 6, 52 +/- 0, 75 mmol/l, HDL-cholesterol level was 1, 15 +/- 0, 31 mmol/l and triglyceride level was 1, 77 +/- 0, 67 mmol/l. There was a significant reduction in total cholesterol [P=2.10-3] and LDL-cholesterol [P=5.10-4] with statins; the mean LDL-cholesterol level was reduced from 4, 26 +/- 0, 82 mmol/l at baseline to 2, 8 +/- 0, 59 mmol/l at 12 months. The percentage variation of LDL-cholesterol was between 24 and 35%; in addition, the percentage reduction of total cholesterol was between 22 and 28%, the mean reduction in TG levels was between 11 and l6%.There was a no significant increasing in HDL cholesterol. Among these 120 patients, 5, 1%had a moderate CK elevation. Moreover 2%had a significant elevation of transaminase levels. Statins have also been associated with muscle-related adverse events; so milder complaints [myalgia] are reported by approximately 3, 6%of patients who take statins. Statins as highly efficacious agents for the lowering of low-density lipoprotein-cholesterol [LDL-C] revolutionized treatment of hypercholesterolemia, a long established risk factor for premature coronary heart disease and they are not only exhibit a remarkely high benefit to risk ration, but are equally characterized by a safety profile with excellent tolerance

[Is the respiratory function altereted during the diabetes mellitus?]

Because of its wealth in blood capillaries and conjunctive fabric the lung is a potential body targets of microvascular diabetic complications. The purpose of this work is to evaluate the respiratory function among 23 diabetics patients, while being helped of measurements of volumes and respiratory flows as well as pulmonary broadcasting capacity of CO. The measured parameters were the total pulmonary capacity [CPT], the vital capacity [CV], the functional residual capacity [CRF], residual volume [VR], maximum expiratory volume in 1 second [VEMS], the coefficient of Tiffeneau [VEMS/CV] and the expiratory flow of point [EPD]. The pulmonary broadcasting capacity of carbon monoxide [DLCO] was measured. Residual volume [VR] was on average of 76, 53 +/- 19, 76% of the theoretical values, it was decreased among 12 patients. The functional residual capacity [CRF] on average of 86, 11 +/- 19, 47% of the theoretical values, found was decreased among 10 patients. The pulmonary diffusion [DLCO/VA], which varies approximately 10% with the change of position at the healthy subject, was normal in sitting position among studied patients [114, 93 +/- 24, 18%] and decreased only by 3, 64 +/- 9, 63% in position upright. Moreover, this variation was all the more weak as the rate of albuminuria was high. Thus, the repercussions of the diabetes over the respiratory function exist, but remain often infraclinic because of the broad ventilatory reserve available to the human being. In addition, the absence of variation of DLCO/VA according to the position could constitute an invaluable index precociously to detect the lesions of the pulmonary capillary bed among patients presenting a nephropathy diabetic

[Breast feeding: can protect against childhood obesity?]

Obesity is a multifactorial disease resulting from complex interaction between genes and environment. Early infant nutrition constitutes one of the environmental determinants of infantile obesity. The effect of breast-feeding on the development of obesity in the child was the subject of many studies the results of which are still controversial. We realized this case-control study to search for an association between breastfeeding and obesity in childhood. Our study included 92 children [46 obese and 46 with normal weight]. Age, sex, socio-economic level and birth weight were comparable in the two groups. Our results show a significant relationship between obesity and breastfeeding [Odds Ratio=0.23, p=0,01]. This protective effect of breastfeeding persists after adjustment for the family history of obesity [OR=0.18, P<0,01]. Although this association is not an evidence for a link of causality, the promotion of breastfeeding is recommended for the prevention of childhood obesity