The thyroid gland is naturally resistant to infectious processes, which explains the rarity of thyroid abscess. It represent about 0.1% of the surgical thyroid pathology. We report in this article a case of thyroid gland abscess in a 61 year-old man who was followed for diabetes and hypothyroidism with poor adherence, who consulted in emergency department for acute neck swelling. CT scan showed a fluid collection of the left thyroid lobe. The patient was operated, and histopathological examination concluded of laryngeal carcinoma associated to thyroid papillary carcinoma.

Diabetic retinopathy (DR) is a common complication amongst patients that have diabetes. It is a leading cause of blindness in middle age people. A large proportion of patients who have diabetes develop retinopathy. There are several immunological reasons associated with the pathophysiology of this disease. Role of several mediators that increase the oxidative stress and have a pro-inflammatory effect which leads to capillary occlusion and neovascularization (NV). Increased vasopermeability due to disruption of the blood-retinal barrier (BRB) leading to diabetic macular edema (DME). Immunotherapies utilise different compounds and target various inflammatory molecules like TNF-a and pathways such as PPAR? for treatment of this progressive disease. Inflammatory and pro-inflammatory pathways are found to have an essential role in promoting DR; therefore, targeting them provides a useful technique for curing DR.

Aim/background: Obesity is a chronic disease contributing to many metabolic illnesses, in particular type 2 diabetes. The Relative Fat Mass (RFM) is a tool recently introduced for obesity which better predicts the level of visceral fat than the Body Mass Index (BMI). The aim of this study is to determine whether RFM is a better predictor of the cardiometabolic risk factors and the complications of type 2 diabetes than BMI. Materials and methods: This is a cross sectional study. A list of information was collected from endocrinologists treating type 2 diabetic patients in a primary healthcare clinic and a tertiary hospital in Beirut. This list allowed us to evaluate the micro and macro vascular complications of type 2 diabetic patients, to assess their risk factors and to calculate their RFM and BMI. Results: We analyzed the data of 359 patients. Higher RFM was associated with higher systolic blood pressure (p < 0.05), and both RFM and BMI were significantly correlated to higher CRP, triglyceride levels and liver enzymes. However, the BMI was better associated with other cardiometabolic risk factors such as the total cholesterol (p = 0,003), LDL cholesterol (p = 0,002) and HbA1c (p = 0,01) than RFM. Both RFM and BMI were correlated with higher microalbuminuria (p < 0.001) but unlike BMI, higher RFM was associated with higher creatinine level (p = 0.317 versus 0.047 respectively) and therefore better linked to diabetic nephropathy than BMI. More importantly, we observed an unprecedented result, associating RFM to diabetic neuropathy: a normal RFM excludes diabetic neuropathy with a high probability of 82.5%. Furthermore, a RFM cutoff value of 30.76 in men and 43.31 in women showed an increased risk of developing diabetic neuropathy by 2.464. No association was observed between RFM and diabetic retinopathy. Conclusion: The RFM better predicts microvascular complications of diabetes than BMI except for retinopathy. It is also associated with a worse profile of metabolic syndrome. This study is unique in its discovery of the potential role of RFM as a tool that could rule out neuropathy in diabetic patients.

Background: The effects of metformin therapy on the prognosis of patients with coronavirus disease 2019 (COVID-19) are unclear. Objective: To review effects of metformin on clinical outcomes, particularly mortality, in patients with type 2 diabetes and COVID-19. Methods: Review of English literature by PUBMED search until April 20, 2021. Search terms included diabetes, COVID-19, metformin, Retrospective studies, meta-analyses, pertinent reviews, and consensus guidelines are reviewed. Results: All available studies in this area are retrospective. Two population-based studies did not find significant association between metformin use and susceptibility to COVID-19. Most, but not all studies, suggest that metformin use prior to hospital admission might be associated with significant decrease in mortality in patients with type 2 diabetes and COVID-19. Continuing metformin use after hospital admission did not have significant impact on COVID-19 related death but may decrease risk of acute respiratory distress syndrome (ARDS). Meanwhile, in-hospital metformin administration may be associated with approximately 4.6 times increase risk of lactic acidosis in patients with severe symptoms of COVID-19, patients taking =2 gm/d of metformin, and patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 kg/m2. Conclusions: Although most retrospective studies suggest that metformin administration may be associated with decreased risk of COVID-19 mortality, these data should be confirmed by randomized trials. In patients with type 2 diabetes and COVID-19 admitted to the hospital, metformin use should be avoided in presence of severe symptoms of COVID-19, kidney dysfunction (eGFR < 60 ml/min/1.73m2), and in daily doses of = 2 gm due to increased risk of lactic acidosis.

Introduction: Usually, onset of thelarche heralds puberty. Delayed puberty is worrisome and needs medical attention. Our patient in her late adolescence presented with primary amenorrhea, whose evaluation left us surprised. Case report: An eighteen-year-old scholastically backward girl, presented with complaints of not attaining menarche. Physical examination included a height of 156 cm(10th-25thcentile),weight 51 kg(50th centile), wide carrying angle, multiple nevi and a broad chest, however no other Turner stigmata was noted. Her sexual maturity rating (SMR) was A2P2B1 Laboratory investigations revealed increased gonadotropins (FSH:77mIU/ml; LH:25.4mIU/ml), low estradiol (14 pg/ml) and vitamin-D deficiency (21ng/ml). Ultrasonography of abdomen-pelvis showed small infantile uterus with streak ovaries. Karyotype (50 metaphases) demonstrated mosaicism [47,XXX (29)/45,X(19)/46,XX(2)]. Hormone replacement therapy and vitamin D replacement was initiated. Conclusion: 30-40% of the Turner syndrome are mosaics, the most common being 45,X/46,XX. Mosaicism is the presence of 2 or more cell lines with different chromosomal constitutions. The cell lines are derived due mostly to postzygotic mitotic nondisjunction. X/XX/XXX can present with or without classical turner stigmata. Trisomy X has a spectrum of presentation from normal menses and fertility to recurrent abortions and primary/secondary amenorrhea (primary ovarian insufficiency). Varied clinical phenotype due to three cell lines in a Turner mosaic makes this case unique.