Obesity in COVID-19 era, implications for mechanisms, comorbidities, and prognosis: a review and meta-analysis.

BACKGROUND: Recent studies have shown that obesity is associated with the severity of coronavirus disease (COVID-19). We reviewed clinical studies to clarify the obesity relationship with COVID-19 severity, comorbidities, and discussing possible mechanisms. MATERIALS AND METHODS: The electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar, were searched and all studies conducted on COVID-19 and obesity were reviewed. All studies were independently screened by reviewers based on their titles and abstracts. RESULTS: Forty relevant articles were selected, and their full texts were reviewed. Obesity affects the respiratory and immune systems through various mechanisms. Cytokine and adipokine secretion from adipose tissue leads to a pro-inflammatory state in obese patients, predisposing them to thrombosis, incoordination of innate and adaptive immune responses, inadequate antibody response, and cytokine storm. Obese patients had a longer virus shedding. Obesity is associated with other comorbidities such as hypertension, cardiovascular diseases, diabetes mellitus, and vitamin D deficiency. Hospitalization, intensive care unit admission, mechanical ventilation, and even mortality in obese patients were higher than normal-weight patients. Obesity could alter the direction of severe COVID-19 symptoms to younger individuals. Reduced physical activity, unhealthy eating habits and, more stress and fear experienced during the COVID-19 pandemic may result in more weight gain and obesity. CONCLUSIONS: Obesity should be considered as an independent risk factor for the severity of COVID-19. Paying more attention to preventing weight gain in obese patients with COVID-19 infection in early levels of disease is crucial during this pandemic.

Comparison of adrenalectomy with conservative treatment on mild autonomous cortisol secretion: a systematic review and meta-analysis.

Objective: This systematic review and meta-analysis was conducted to compare the benefits of adrenalectomy and conservative treatment for comorbidities associated with mild autonomous cortisol secretion (MACS) in patients diagnosed with MACS. Background: MACS is the most common benign hormone-secreting functional adrenal incidentaloma. Overproduction of cortisol is observed in MACS patients, resulting in a variety of long-term health issues, including arterial hypertension (HTN), diabetes mellitus (DM), dyslipidemia, obesity, and osteoporosis; however, the classic clinical manifestations of Cushing's syndrome (CS) are not present. Methods: A systematic search was conducted using MEDLINE, Embase, Web of Sciences, and Scopus databases on December, 2023. Two reviewers independently extracted data and assessed the quality of the included articles. A meta-analysis was performed to compare the beneficial effects of adrenalectomy versus conservative management for MACS-related comorbidities. Results: Fifteen articles were included in this study, which evaluated 933 MACS patients (384 Adrenalectomy and 501 Conservative treatment, and 48 excluded due to incomplete follow-up duration). MACS diagnosis criteria were different among the included articles. All studies, however, stated that there must be no overt CS symptoms. Meta-analysis demonstrates the overall advantage of adrenalectomy over conservative treatment for MACS-related comorbidities (Cohen's d = -0.49, 95% CI [-0.64, -0.34], p = 0.00). Subgroup analysis indicated that the systolic blood pressure (pooled effect size = -0.81, 95% CI [-1.19, -0.42], p = 0.03), diastolic blood pressure (pooled effect size = -0.63, 95% CI [-1.05, -0.21], p = 0.01), and BMD (pooled effect size = -0.40, 95% CI [-0.73, -0.07], p = 0.02) were significantly in favor of adrenalectomy group rather than conservative treatment but no significant differences between the two treatment groups in other MACS-related comorbidities were reported. Conclusion: Despite the limited and diverse data, this study demonstrates the advantage of adrenalectomy over conservative treatment for MACS-related comorbidities.

Hypoglycemia in non-diabetic in-patients at a teaching referral hospital in Iran.

Purpose: This study aims to investigate comorbidities, clinical features, laboratory values, and diagnoses in non-diabetic patients experiencing hypoglycemic episodes. Methods: A retrospective observational study was conducted at Shariati Hospital in Iran from 2016 to 2023. Seventy-four non-diabetic patients admitted with a diagnosis of hypoglycemia were included, while patients with diabetes were excluded. Demographic data, symptoms, and biochemical assessments were obtained from the hospital information system. Hypoglycemic episodes were identified based on low measured blood glucose, recorded medications for hypoglycemia treatment, or recorded codes indicating hypoglycemia. Hypoglycemia was defined as blood glucose below 70 mg/dL (3.9 mmol/L) along with two other criteria of the Whipple triad. Statistical analysis was performed using SPSS software (version 26). Results: Among the enrolled patients, 63.5% were female, and 13.5% were elderly (≥ 65 years). The most common comorbidities observed were cardiovascular disease (20.3%), psychological disorders (20.3%), hypothyroidism (14.9%), and hypertension (8.1%). The prevalent symptoms included weakness, loss of consciousness, sweating, palpitations, dizziness, and tremors. Non-diabetic hypoglycemia was caused by factitious disorders, insulinoma, organ failure, and infection, respectively. Conclusion: Due to the diverse range of clinical symptoms, hypoglycemia in non-diabetic patients may be diagnosed late, leading to misdiagnoses such as psychological disorders or seizures. It is crucial to consider the possibility of hypoglycemia in non-diabetic patients and determine its underlying cause. Given the poor prognosis associated with hypoglycemia, timely interventions are essential.

Evaluating the effectiveness of melatonin in reducing the risk of foot ulcers in diabetic patients.

Objectives: Diabetes and its complications, as a major health concern, are associated with morbidity and mortality around the world. One of these complications is diabetic foot ulcer. Factors such as hyperglycemia, neuropathy, vascular damage and impaired immune system can cause foot ulcers. The present review aims to study the potential effects of melatonin, the main product of pineal glands, on diabetic foot ulcers. Methods: A narrative review was performed using present literature in an attempt to identify the different aspects of melatonin's impact on diabetic foot ulcers by searching related keywords in electronic databases without any restriction. Results: This review shows that, melatonin has anti-diabetic effects. It is effective in reducing the risk of hyperglycemia, neuropathy, vascular damage and immune system impairment in diabetic patients. By reducing these complications with melatonin, correspondingly, the incidence of diabetic foot ulcers may also decrease in these patients. Conclusions: The results of this study indicate promising properties of melatonin while dealing with diabetic foot ulcers and their common underlying conditions, but still, it needs to be investigated more in future studies.

Pituitary tumor registry: a multidisciplinary program protocol.

Purpose: This registry aims to collect information to create an appropriate platform for the development of a basis for clinical research and basic sciences to carefully study pituitary adenomas. Methods: Demographic data, diagnosis, treatment, and outcome information of the patients with a confirmed diagnosis of pituitary adenomas will be collected by investigators of the registry. Analysis of registry data generates aggregate reports summarizing pituitary tumor epidemiology, treatment, and outcome. These reports include annual public data reports. In the future, the registry program may provide a wider network in Iran and ultimately support the expansion of international studies. Conclusion: For a long time, patients with pituitary adenomas should be observed. Implementing a registration system would greatly reduce the challenges of patients' follow-up so that their monitoring can be improved.

Do patients with diabetic foot ulcer need booster dose of tetanus vaccine?

Purpose: Diabetic foot ulcer is a public health concern around the world. These wounds are prone to a variety of infections including Clostridium Tetani that may lead to tetanus. The aim of this study was to evaluate the immunity status as a result of tetanus vaccination and other preventive measures in these patients. Methods: We conducted a narrative review of previous studies which were related to the risk of tetanus infection in diabetic foot patients by searching electronic databases. Results: It was found that usually tetanus antibody titers in diabetic patients are below the protective level and they are not appropriately vaccinated. Therefore, diabetes and lack of immunity, put diabetic foot ulcer patients more at risk of tetanus. But this problem is not given serious attention in diabetes care. Conclusions: Thus, it is recommended to provide specific guidelines for tetanus vaccination and prophylaxis in diabetic patients. These recommendations can play a vital role in the prevention of diabetic foot ulcers complication.