Have we forgotten the non-COVID-19 diabetic patients? Impact of lockdown on daily life, sleep and mental health: cross-sectional study in Moroccan diabetic patients.

The main objective of this work is to describe the impact of lockdown on daily life, sleep and the mental health of Moroccan diabetics patients. The secondary objective is to study the factors affecting compliance with lockdown and deterioration of sleep in diabetic patients while lockdown. It´s a cross-sectional study including diabetic patients followed up at the Endocrinology department of Casablanca. Patients answered a questionnaire about Socio-demographic characteristics, Sleep-related characteristics and predominant activities during the lockdown. The psychological impact was assessed by the score of Anxiety and Depression Assessment Scale (HDAS). Statistical analysis was carried out using SPSS 20 software. Bedtime was shifted by 53 minutes during the lockdown. Waking time was also 1 hour 18 minutes later, while sleep duration increased from 8 hours 20 minutes before lockdown to 8 hours 30 minutes during it (p=0.24) with a deterioration in sleep quality reported by 53 patients. Sleep deterioration was not correlated with anxiety or duration of screen exposure, but was more related to age between 50 and 65 years old. HAD score showed anxiety in 29 patients which were correlated to the female gender. The study included 100 patients with an average age of 48 years. 38 patients had a professional activity before lockdown, 5 of them kept working face-to-face, 3 teleworked and 30 were unemployed. Only 59 % of them respected lockdown. This respect was correlated with female gender, educational level and the number of members under the same roof when it is more than 6. Deterioration in sleep, a change in bedtime and waking time and an increase in anxiety was observed in diabetic patients during the lockdown. Therefore, the psychiatric care system needs to adapt to provide psychological support not only to infected persons but also to other vulnerable communities including diabetic patients.

Adrenocorticotropic hormone (ACTH) independent Cushing's syndrome due to unilateral adrenocortical hyperplasia: two case reports.

Adrenal unilateral macronodular hyperplasia is a rare cause of Cushing's syndrome. We discuss the case of two patients who present Cushing syndrome due to unilateral adrenal hyperplasia. They presented the signs of clinical hypercorticism as well as metabolic, cardiovascular and osteoporotic complications. Both patients presented clinical and laboratory signs of adrenocorticotropic hormone (ACTH)-independent Cushing syndrome with elevated urinary free cortisol (UFC) levels, adrenal computed tomography (CT) scan revealed the appearance of unilateral adrenal adenoma and normal contralateral adrenal gland. Adrenalectomy was performed under laparoscopic surgery; the resected mass was pathologically diagnosed as unilateral nodular adrenal hyperplasia. Unilateral adrenal hyperplasia is a very rare etiology of ACTH-independent Cushing syndrome, often mistaken for adenoma on CT and only pathological examination can confirm the diagnosis.

Impact of pregnancy on papillary thyroid carcinoma prognosis.

INTRODUCTION: thyroid carcinoma is more frequent in women of reproductive age. It can affect both fertility and the course of pregnancy. The aim of the study was to investigate the influence of pregnancy as a factor of recurrence or progression, on the prognosis of thyroid carcinoma. METHODS: we conducted a retrospective cohort study of 117 young female patients followed up for papillary thyroid carcinoma (PTC) at the Department of Endocrinology, Diabetology and Metabolic Diseases of Ibn Rochd University Hospital of Casablanca, from January 2010 to December 2018, divided into 2 groups: group 1 composed of pregnant patients (n=42) and group 2 being the control group (n=75). Statistical analysis was made using SPSS software version 22.0.0. RESULTS: average age of pregnant patients was 35 ± 6.5 years old. Mean duration between first pregnancy and treatment completion was 4.4 ± 3.1 years. Over an average treatment duration of 14.4 months in postpartum, 30 patients were in remission (thyroglobulin (Tg) <1µg/l, negative thyroglobulin antibody and no morphological abnormality), while 12 had persistent symptoms (detectable Tg/thyroglobulin antibody and/or morphological abnormality). Thyroid stimulating hormone (TSH) during pregnancy was on average 0.83 mIU/l. Cancer progression was correlated with persistence of thyroid cancer to treatment before pregnancy (p = 0.01), pre-existing distant or locoregional metastases (p = 0.02) and delayed administration of radio-iodine therapy (p = 0.01). Interval between diagnosis and pregnancy, TSH level during pregnancy or the pre-conception thyroglobulin level did not have a statistically significant impact. Pregnancy was not associated with progression or recurrence of thyroid cancer (adjusted risk ratio 1.04, 95% confidence interval 0.91-1.32). CONCLUSION: this study shows that pregnancy has no impact on recurrence or progression of thyroid cancer in patients declared in remission prior to conception.

COVID-19: Patient care after discharge from the Intensive Care Unit.

INTRODUCTION: The Ibn Rochd CHU is a tertiary care structure that provides care for the most severe cases of COVID-19 requiring hospitalisation in intensive care. The objective of study is to describe the complementary medical and psychological care of patients with COVID-19 in the endocrinology department after a stay in intensive care. PATIENTS AND METHODS: This is a descriptive observational study of patients transferred from the intensive care unit to the endocrinology service following a COVID-19 infection during the period from 17 April 2020 to May 26, 2020. Clinical characteristics of the patients and complications related to COVID-19 infection were studied; a nutritional assessment using the MNA nutritional status assessment questionnaire; psychological assessment using quality-of-life questionnaires (Hamilton depression and anxiety, HAD, SF36, PCLS); a treatment satisfaction questionnaire (TQCMII) and an assessment of patient autonomy by the ADL score. RESULT: Our study included 41 patients with an average age of 55 years (19-85 years), a sex ratio M/F of 1.05, 43.9% were diabetic, 34.1% hypertensive, 4.9% asthmatic and 5% obese, and 51.2% were severe and critical cases. The average ICU stay is 8.42 days, requiring intubation in 12.2% of cases. All patients were treated with the Hydroxychloroquine, Azithromycin, vitamin C, zinc and corticosteroid protocol, 14.6% had undernutrition and 65.9% had a risk of undernutrition. The average BMI was 25.34 kg/m2 (17-42), 61% had experienced weight loss, which was greater than 8 kg in 26.1% of cases, 12.2% of patients were not autonomous, 12.2% had moderate depression, 2.4% severe depression, 14.6% mild to moderate anxiety, 12.2% severe anxiety and 29.3% suffered acute post-traumatic stress disorder. CONCLUSION: Patients with COVID-19 are, in addition to the complications from coronavirus infection, vulnerable to undernutrition, psychological and motor complications. Additional care before discharge is essential for better integration of patients into their families.

Nutritional status assessment in patients with Covid-19 after discharge from the intensive care unit.

INTRODUCTION: The nutritional diagnosis and early nutritional management of COVID-19 patients must be integrated into the overall therapeutic strategy. The aim of our study is to assess the nutritional status of patients with COVID-19 after a stay in intensive care, to describe the prevalence of undernutrition, to determine the factors influencing undernutrition and to describe the nutritional management. TOOLS AND METHODS: This is a descriptive observational study of adult patients admitted to the endocrinology service for additional care after a stay in intensive care during the period from April 17, 2020 to May 26, 2020. The assessment tool used was the Mini Nutritional Assessment (MNA). RESULTS: Our study included 41 patients; the average age of the patients was 55 years, 51.2% had a severe or critical form of COVID-19, 75.6% stayed in intensive care, 12.2% had a loss of autonomy. The average BMI was 25.2 kg/m2 (17-42 kg/m2), 42.5% were overweight, 61% had weight loss, 26.2% had weight loss greater than 10%, 14.6% of our patients were undernourished, 65.9% were at risk of undernutrition, 19.5% had hypoalbuminemia, 17.1% had hypoprotidemia, 19.5% hypocalcemia, 34.1% anemia, 12.2% hypomagnesemia and 51.2% had a deficiency in vitamin D. A positive correlation was found between poor nutritional status and a longer stay in intensive care (>5 days) (p = 0.011) and lymphopenia (p = 0,02). CONCLUSION: Despite a personalized diet, 14.6% of patients presented undernutrition. Particular attention should be paid to patients with a long stay in intensive care.

[Anxiety and depression in patients treated for differentiated thyroid microcarcinoma]. / L'anxiété et la dépression chez les patients suivis pour microcarcinome différencié de la thyroïde.

INTRODUCTION: Thyroid microcarcinoma is a cancer associated with good prognosis but it may affect patients' quality of life. The purpose of this study is to assess depression and anxiety in patients treated for differentiated thyroid microcarcinoma and to compare them to patients with other cancer stages. METHODS: We conducted a cross-sectional observational study between October 2013 and February 2015. The study included adult patients treated for differentiated thyroid cancer. Depression and anxiety were assessed using two quality of life scales, whose translation was validated in Arabic: Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale. Patients were divided into two groups: thyroid microcarcinoma group and non-microcarcinoma group. Data analysis was performed using SPSS software 16. RESULTS: The study involved 37 patients treated for differentiated thyroid microcarcinoma and a comparison group of 87 patients treated for other stages of differentiated thyroid cancer. Patients? quality of life in the thyroid microcarcinoma group was better than that of patients with other stages of differentiated thyroid cancer. Thyroid microcarcinoma was significantly associated with lack of anxiety (p=0.042), Hamilton Depression Rating Scale revealed a positive trend (p value was not significant). CONCLUSION: Patients' quality of life in thyroid microcarcinoma group was better than that of patients to with other stages of differentiated thyroid cancer. This can be explained by a non-aggressive treatment (absence of radioactive iodine treatment and lower TSH level).

Interest of hepatic steatosis index (HSI) in screening for metabolic steatopathy in patients with type 2 diabetes.

INTRODUCTION: metabolic steatopathy or non-alcoholic fatty liver disease (NAFLD) is frequently associated with type 2 diabetes mellitus (T2DM) with an increased risk of progression to advanced fibrosis. The purpose of our study was to determine the interest of hepatic steatosis index (HSI) in the detection of hepatic steatosis in patients with type 2 diabetes in order to establish an appropriate screening program of this disease in our population. METHODS: cross-sectional study involving 281 type 2 diabetics hospitalized in the Department of Endocrinology in collaboration with the Hepato-gastroenterology Department at the University Hospital Ibn Rochd Casablanca between January 2018 and June 2018. Anthropometric variables studied were, biological, hepatic steatosis index (HSI) and liver ultrasound. The HSI score of> 36 predicted the presence of fatty liver. The HSI score (fatty liver index) was calculated for all patients using the following formula: 8 × (ALT / AST) + BMI + 2 (if type 2 diabetes) + 2 (if female). Statistical analysis was performed with SPSS Version 19 software. The sensitivity and the specificity of the HSI score were calculated by 2x2 contingency table. The area under the receiver operating characteristic curve (AUROC) was also analyzed. RESULTS: average age of patients was 54.15 ± 13.14 years with a female predominance (76.9% of cases), and a sex ratio of 3.32. Mean duration of diabetes of 10.5 ± 8.03 years with an average glycated hemoglobin of 10.23 ± 1.96%. BMI was 29.53 ± 4.55 kg/m2, the average waist circumference was 99.51 ± 10.98 cm. 39.1% of patients were hypertensive, 58% were dyslipidemic. Abnormalities in transaminases were found in 6% of patients. Prevalence of NAFLD was 45.2% based on the HSI score > 36. This prevalence is consistent with the findings made by the liver ultrasound (47.7% of cases). Hepatic steatosis was significantly correlated with dyslipidemia (P=0.006), overweight (P=0.00015), obesity (P=0.001) and hypertriglyceridemia (P=0.0003). The sensitivity of HSI was 89.55%, negative predictive value (NPV) was 90.91%, specificity was 95.24%, and positive predictive value (PPV) was 94.49%. AUROC for HSI was at 0.979 (95% CI, 0.962-0.997). CONCLUSION: hepatic steatosis is common among our patients; it is correlated with dyslipidemia, obesity and hypertriglyceridemia.

Evaluation of the quality of life in patients followed for differentiated cancer of the thyroid.

Thyroid cancer often has good prognosis but can impact quality of life. The objective of this study is to evaluate quality of life in patients treated for differentiated thyroid carcinoma and look for associated factors. An observational cross-sectional study with comparison group was conducted in the Endocrinology Department of the Ibn Rochd University Hospital between October 2013 and February 2015. The patient group included 124 adult patients followed for differentiated thyroid carcinoma; the control group comprised 124 healthy subjects of the same age. Quality of life was evaluated by 3 questionnaires validated in Arabic: SF36, Hamilton anxiety and Hamilton depression. Patients' quality of life was significantly impaired compared to controls on the two Hamilton and all SF36 scores. Factors influencing quality of life were TNM stage, radioiodine therapy and dose, and the presence of metastases. The psychological management of patients with thyroid cancer is an essential point always to be considered, especially in the presence of risk factors for impaired quality of life.

[Association of hyperthyroidism with differentiated thyroid cancer]. / Association hyperthyroïdie et cancers différenciés de la thyroïde.

The presence of hyperthyroidism is no longer an insurance against the occurrence of thyroid cancer. The combination of the two is common. This is a retrospective study of 355 files of patients followed for differentiated thyroid cancer in the endocrinology department at CHU IBN ROCHD from 1986 to 2014. 12 of those patients were followed for hyperthyroidism, and a fortuitous association with differentiated thyroid cancer was found during the anatomopathological exam, giving us a 3.38% prevalence. The average age of discovery is 44.8 years, with a marked female predominance (8/12). Eight patients had a toxic nodule, 3 had Basedow's goiters, and one had Graves' disease. All underwent total thyroidectomy. In all patients, the cancer was a papillary carcinoma. Microcarcinoma was the most predominant (6 patients). An insular carcinoma was found in a patient with spinal and retro-orbital metastases. Treatment with radioactive iodine was prescribed to five patients. The diagnosis of hyperthyroidism does not eliminate the possibility of an associated thyroid cancer. Malignancy should always be kept in mind and therefore lead to a diagnostic approach comparable to that for any thyroid nodule.