Fasting of Ramadan in peoples with diabetes in Benghazi, Libya: an exploratory study

Background: The epidemiology of diabetes and Ramadan fasting was reported from many Muslim countries, but not from Libya. Methodology: We interviewed 493 consecutive diabetic patients at Benghazi Diabetes and Endocrine Center for the potential complications of fasting during Ramadan. Results: We found 70% of diabetic patients completed the 30 days of Ramadan fasting. Hypo- and hyperglycemia was the most commonly reported complications especially during the first two weeks of Ramadan month. Conclusion: It seems majority of diabetic patients in Libya manage to fast during Ramadan month. Patient education and early planned adjustment of diabetic medication is needed to decrease the frequency of diabetic complication during Ramadan month

Skeletal Muscle Phenotypically Converts and Selectively Inhibits Metastatic Cells in Mice

Skeletal muscle is rarely a site of malignant metastasis; the molecular and cellular basis for this rarity is not understood. We report that myogenic cells exert pronounced effects upon co-culture with metastatic melanoma (B16-F10) or carcinoma (LLC1) cells including conversion to the myogenic lineage in vitro and in vivo, as well as inhibition of melanin production in melanoma cells coupled with cytotoxic and cytostatic effects. No effect is seen with non-tumorigenic cells. Tumor suppression assays reveal that the muscle-mediated tumor suppressor effects do not generate resistant clones but function through the down-regulation of the transcription factor MiTF, a master regulator of melanocyte development and a melanoma oncogene. Our findings point to skeletal muscle as a source of therapeutic agents in the treatment of metastatic cancers

Tyrosine Kinase Inhibitors Induced Thyroid Dysfunction: A Review of Its Incidence, Pathophysiology, Clinical Relevance, and Treatment

Tyrosine kinase inhibitors (TKI) belong to a new class of molecular multitargeted anticancer therapy which targets different growth factor receptors and hence attenuates cancer cell survival and growth. Since their introduction as adjunct treatment for renal cell carcinoma and gastrointestinal stromal tumors (GIST), a number of reports have demonstrated that TKI can induce thyroid dysfunction which was especially more common with sunitinib maleate. Many mechanisms with respect to this adverse effect of tyrosine kinase inhibitors have been proposed including their induction of thyroiditis, capillary regression in the thyroid gland, antithyroid peroxidase antibody production, and their ability to decrease iodine uptake by the thyroid gland. Of interest is the observation that TKI-induced thyroid dysfunction may actually be protective as it was shown to improve overall survival, and it was suggested that it may have a prognostic value. Followup on thyroid function tests while patients are maintained on tyrosine kinase inhibitor is strongly recommended. When thyroid dysfunction occurs, appropriate treatment should be individualized depending on patients symptoms and thyroid stimulating hormone level

Primary hyperparathyroidism and non-medullary thyroid cancer- A review

Background: The association of thyroid disease and primary hyperparathyroidism is well described, with thyroid carcinoma being reported in 2-15% of cases. The most commonly associated carcinoma is non-medullary thyroid cancer. While the association of PHPT and medullary thyroid cancer (MCT) is well known, that of NMTC, despite its increasing incidence, is still not established. Our study is a review of incidence and underlying mechanisms of non-medullary thyroid cancer associated with PHPT. Also, best imaging tools for concomitant diagnosis is reviewed to ensure an adequate plan of care. Methods & findings: A search was done using two databases: Medline & Embase. The search conducted from the period of 2008 until April 2018 yielded a total of 142 studies. After an adequate screening, 26 studies were reviewed.  Incidence of DTC in association with PHPT in the literature ranged between 0.91% and 17.6%. The main histological thyroid malignancy found is micropapillary carcinoma. Despite its less aggressive presentation, these microcarcinomas may grow or develop nodal metastases on follow up. Although bilateral neck exploration with hemi/total thyroidectomy carries the risk of temporary recurrent laryngeal nerve injury or hypoparathyroidism, permanent complications are rare especially when compared to re-do neck surgery. Recently, parathyroid surgeries are going towards minimal invasive procedures, requiring an adequate imaging tool to ensure diagnosis of both diseases. Multiple risk factors for concomitant diseases were hypothesized, the more robust are the common embryologic origin and activation of angiogenic growth factors. Conclusion: NMTC is frequently associated with PHPT especially in endemic goiter areas. With the high prevalence of micropapillary carcinoma and its risks, a partial/total thyroidectomy in addition to parathyroidectomy may be warranted. With the recent need of adequate diagnostic tools, combining both Technetium Sestamibi scintigraphy and thyroid ultrasound improved sensitivities and accuracy of diagnosis, but dual-isotope scintigraphy (I-123 sodium iodide/ 99mTc-sestamibi) seems an attractive modality in hyperparathyroid patients with concomitant suspicious thyroid nodules. However, further studies for validation may be needed

Prevalence and determinants of albuminuria in a cohort of diabetic patients in Lebanon

<b>Background and Objectives: </b> Few data are available on the extent of albuminuria in diabetic populations in the Middle East generally and in Lebanon specifically. We conducted this study to determine the prevalence of albuminuria and its major risk factors in a cohort of diabetic patients in Lebanon. <b> Patients and Methods: </b> Diabetic patients followed in the outpatient department at the American University of Beirut Medical Center (AUBMC) were included in a prospective observational study. AUBMC is a tertiary referral center and the outpatient department typically handles patients of low socioeconomic status with ad-vanced disease. Patients were classified according to their urinary albumin-to-creatinine ratio (ACR) as having normoalbuminuria (ACR&#60; 30 mg/g creatinine), microalbuminuria (ACR=30 to &#60; 300 mg/g creatinine), or macro--albuminuria (ACR 2300 mg/g creatinine). The three groups were compared to analyze the association between albuminuria and its risk factors. In addition, independent predictors of albuminuria were determined using multivariate logistic regression and presented as an odds ratio.<b> Results: </b> Microalbuminuria<b> </b> and macroalbuminuria were present in 33.3&#x0025; and 12.7&#x0025; of 222 patients (mean age 56.4 years, mean deviation of diabetes 8.6 years, 58.7&#x0025; women, 43.8&#x0025; obese), respectively. Factors significantly associated with microalbuminuria included glycemic control, insulin use, and total and LDL cholesterol.Those associated with macroalbuminuria included in addition to glycemic control and insulin use, duration of diabetes, hypertension, elevated mean arterial pressure (MAP), and presence of neuropathy, retinopathy and peripheral vascular disease by bivariate analysis. Only glycemic control was an independent risk factor for both in addition to MAP and retinopathy for macroalbuminuria by multivariate analysis. <b> Conclusion:</b> Albuminuria is highly prevalent<b> </b> among this cohort of diabetic patients in Lebanon. Both glyce--mic control and blood pressure need to be better targeted in its management