A late-diagnosed dermoid cyst complicated with a fistula in the left scapular region: a case report.

Dermoid cysts are a rare case of developmental abnormality that results in benign tumors, which are classified into three categories based on their cause and appearance. Dermoid cysts tend to present within the first year after birth and are most commonly diagnosed by the age of 5. A 15-year-old girl presented with a complaint of localized, paroxysmal pain and malodorous fluid oozing from the left shoulder for the last 2 weeks. A fistulogram showed an extension of the fistula behind the clavicle and above the scapula with a cystic formation measuring ~2 cm on the upper part of the fistula tract, which called for appropriate surgical intervention. Our case is the first reported dermoid cyst in the left shoulder area associated with a fistula at birth, which is a rare complication since the complications of dermoid cysts differ depending on their location and size.

Brain insulin resistance as a mechanistic mediator links peripheral metabolic disorders with declining cognition.

BACKGROUND AND AIMS: Studies continue to investigate the underlying mechanism of the association between the increased risk of different types of cognitive decline and metabolic dysregulation. Brain insulin resistance (BIR) has been suggested to explain this association. The vital role of insulin in the body has been examined intensively and extensively; however, its role in the brain requires further investigation. Herein, we confined our focus to summarize the role of brain insulin signaling and the negative effect of dysmetabolism on insulin functioning in the brain. METHODS: Published scientific manuscripts between 1998 and 2020 that discussed the effect of selected metabolic disorder conditions such as obesity, type 2 diabetes mellitus (T2DM), and high-fat diet (HFD) on brain functions were reviewed. The main keywords used were insulin resistance, brain insulin resistance, obesity, T2DM, and cognition. RESULTS: Various metabolic disorders were linked to the increased risk of BIR, and was suggested to increase the probability of cognition impairment occurrence. Several proposed mechanisms explain this association among which insulin resistance and hyperinsulinemia were primary factors attributed to an increased risk of BIR among various metabolic disorders. CONCLUSIONS: Understanding the trajectory of the association between metabolic disorders and alternation in cognition status could expand our vision of those overlapping conditions and pave the road to both treatment and preventative strategies for cognitive disorders.

Case report: actinomycosis of the abdominal wall.

Primary abdominal wall actinomycosis is rare, but even rarer when it comes to intestinal infiltration; it is usually misdiagnosed as a neoplasm in computed tomography till proved otherwise with pathological examination. We report a 59-year-old diabetic male presented with a year-old abdominal wall mass, diagnosed by pathology after surgical excisional biopsy, and treated with penicillin for 6 months. We recommend consideration of actinomycosis in cases of abdominal wall mass, especially in immunocompromised patients, as a differential diagnosis of neoplastic lesions.

A Neglected Case of Multifocal Liposarcoma Presented in Five Different Sites in a Syrian Woman: A case report.

INTRODUCTION: Multifocal soft tissue sarcoma is a rare clinical entity occurring in 1 % of patients with extremity soft tissue sarcoma and in 4.5 % of patients with liposarcoma. Multifocal disease may arise either synchronously or metachronously and has been associated with poor prognosis. CASE PRESENTATION: Herein, we report a rare case of a Syrian woman patient with six different foci of liposarcoma in five sites at the time of diagnosis. DISCUSSION: Liposarcomas are currently classified into four different subtypes based on histologic or genetic analysis according to the World Health Organization (WHO), including cell-differentiated, dedifferentiated, myxoid, and pleomorphic. In the present work, we report a neglected patient with a multicentric round cell liposarcoma in five different sites. CONCLUSION: Medicine cannot provide much care for these advanced cases of multicentric liposarcoma so far. Therefore, more research should be conducted to improve the ability to manage these entities and to identify potential novel therapies.

A rare cause of small bowel diaphragm disease presenting with palpated abdominal mass.

Small bowel diaphragm disease is a rare complication related to non-steroidal anti-inflammatory drug (NSAID) use. It presents with non-specific symptoms such as vomiting, abdominal pain, subacute bowel obstruction and occasionally as an acute abdominal condition. We report a case of diaphragm disease in a 33-year-old female who presented with vomiting, constipation and abdominal pain started 5 days earlier. Physical examination revealed palpated abdominal mass. The patient's past medical history was remarkable for NSAID use. The patient was managed by surgical resection of involved intestine and diagnosis was confirmed by histological examination. Although there are few published cases of diaphragm disease in the medical literature, we recommend that this disease should be considered as one of the differential diagnoses when assessing patients presenting with non-specific abdominal symptoms with remarkable past medical history of NSAID use.

Thinking about brain insulin resistance.

INTRODUCTION: Dementia and type 2 diabetes mellitus (T2DM) are two of the epidemics of our time; in which insulin resistance (IR) is playing the central role. Epidemiological studies found that different types of dementia development may be promoted by the presence of T2DM. OBJECTIVES: We aimed in this review to highlight the role of insulin and the IR in the brain as a pathophysiological factor of dementia development and also to expand our understanding of T2DM as a mediator of IR in the brain and to review the possible mechanisms of action that may explain the association. METHODOLOGY: A critical review of the relevant published English articles up to 2018, using PubMed, Google Scholar, Science Direct, ADI, and WHO database was carried out. Keywords were included insulin resistance, T3DM, T2DM, dementia, brain insulin resistance were used. CONCLUSION: The rapidly increased prevalence of dementia concurrently with T2DM and obesity need urgent action to illustrate guidelines for prevention, modifying, and treatment based on mechanistic studies.

Association between complement component C3 and body composition: a possible obesity inflammatory biomarker for insulin resistance.

BACKGROUND AND OBJECTIVES: The C3 complement component (C3) is increasingly recognized as a cardiometabolic risk factor. We aimed to examine the role of C3 in insulin resistance (IR) and its association with adiposity. METHODS AND STUDY DESIGN: Sixty-seven obese (18-35 years) participants were matched with normal weight participants from the University of Jordan. BMI, waist-hip ratio (WHpR), and waist-height ratio (WHtR) were calculated. Body percent fat mass (%FM) was determined using the bioelectrical impedance analysis. C3, insulin, and glucose serum concentrations were measured. IR was assessed by the homeostasis model assessment of IR (HOMA-IR). RESULTS: Serum concentrations of C3 and IR were significantly higher in the obese group than that in the normal body weight, regardless of gender (women: 1.2±0.08 and men: 1.2±0.08 vs women: 0.88±0.07 and men: 0.94±0.05, p<0.01; women: 3.6±0.34 and men: 3.9±0.43 vs women: 1.7±0.12 and men: 2.0±0.24, respectively; p<0.001). After adjustment for the potential confounders, BMI, waist circumference, WHtR and %FM were correlated positively with C3 (r=0.44; 0.42; 0.47; 0.43, respectively; p<0.001), and with IR (r=0.67; 0.61; 0.59; 0.59, respectively; p<0.001). C3 was correlated with IR (r=0.35, p<0.001). In linear regression analysis, C3 was not associated with IR independent of BMI (p>0.05). CONCLUSIONS: C3 may be a marker of chronic inflammatory process independently underlying IR obese individuals regardless of gender, which may have a role in the progression of IR during obesity.

Vitamin D Insufficiency Predicts Elevated Levels of Complement 3 Independent of Insulin Resistance and BMI.

This study was to determine serum 25-hydroxyvitamin D (25(OH)D), the complement 3 (C3), and C-reactive protein (CRP) levels, and their association with the risk of insulin resistance (IR). A case-control study was carried out among 134 participants with body mass index (BMI) ≥30 kg/m2 and BMI=18.5-24.99 kg/m2. Anthropometric and body composition indicators were measured. Serum levels of C3, CRP, 25(OH)D, insulin, and glucose were also measured. IR was assessed by the homeostasis model assessment (HOMA-IR). C3, CRP, insulin, and HOMA-IR levels were higher in participants with obesity than that of controls (p<0.001). After adjustment for the potential confounders, anthropometric and body composition indicators were correlated positively with C3 (p<0.001), and negatively with 25(OH)D (p<0.05). C3, and 25(OH)D were correlated with HOMA-IR (r=0.350; r=-0.212; p<0.05). In logistic regression analyses, C3 and CRP were significantly related to increased odds of IR among participants with obesity as compared to controls after progressively adjusting for the potential confounders (p<0.001), whereas 25(OH)D was negatively, but insignificantly, related to decreased odds of IR among participants with obesity (p>0.05). C3 was associated positively with 25(OH)D insufficiency/deficiency independent of HOMA-IR and/or BMI (ß=0.183, p<0.05). Obesity is associated with elevated levels of proinflammatory biomarkers and IR. 25(OH)D insufficiency/deficiency was associated with C3 regardless of HOMA-IR or BMI, which could in turn, have a role in the augmentation of IR during obesity.

Complement 3 serum levels as a pro-inflammatory biomarker for insulin resistance in obesity.

INTRODUCTION: Obesity is frequently characterized by chronic inflammation and insulin resistance (IR). Obesity-associated inflammation is responsible for the complement system activation of which the third component (C3) plays the central role. OBJECTIVE: to discuss several aspects of the central component of the complement system in relation to obesity and obesity-associated IR. METHODS: A critical review of the relevant published English articles from 2003- 2014 was carried out using several search engines including PubMed, Google Scholar, and ScienceDirect. Keywords were used, including complement system, C3, obesity-induced inflammation, IR, ASP, and adipose tissue. CONCLUSION: The defect in the adipose tissue secretory function during obesity may result in different metabolic disorders including IR. The C3 role during obesity-associated inflammation in IR is emerging. More longitudinal studies are warranted to evaluate the role of C3 among other pro-inflammatory biomarkers for IR.

Determinants of self-reported physical activity among Jordanian adults.

PURPOSE: To assess health-promoting behaviors among adult Jordanians and examine relationships among individual characteristics (age, gender, income, and education), perceptual factors (perceived self-efficacy, perceived benefits, and perceived barriers), competing demands, and self-reported physical activity. DESIGN: A cross-sectional, correlational design with self-administered questionnaires was conducted in three major cities in Jordan. METHODS: Descriptive statistics and path analysis were used to examine the direct and indirect effects of independent variables on adults' physical activity. FINDINGS: Men scored higher than did women on physical activity, and women scored higher than did men on health responsibility. Total variance in self-reported physical activity accounted for by independent variables was 30%. Self-efficacy had the strongest direct effects, followed by perceived benefits, perceived barriers, and competing demands on physical activity. Age had the strongest indirect effect on physical activity participation via perceptual factors. CONCLUSIONS: Counseling these adults for physical activity should include application of behavior change strategies suitable to age and focused on increasing self-efficacy, decreasing barriers, increasing perception of benefits, and decreasing sedentary activities.