Diabetes Mellitus-Not Just Type 1 or Type 2 Anymore.

INTRODUCTION: Diabetes mellitus traditionally has been categorized as type 1 (insulin deficiency due to autoimmune destruction of islet cells) or type 2 (insulin resistance with the development of relative insulin deficiency). However, other pathophysiologic etiologies for diabetes must be considered in the evaluation of patients with new-onset diabetes. CASE PRESENTATION: We report the case of a 50-year-old man with a diagnosis of type 2 diabetes mellitus who-despite appropriate pharmacotherapy-developed worsening hyperglycemia. Further investigation revealed the presence of metastatic pancreatic cancer. DISCUSSION: Although an association between pancreatic cancer and diabetes has been noted widely in the gastroenterology, oncology, and endocrine literature, a paucity of primary care literature on the topic exists. Features of predominant insulin deficiency and new onset of diabetes in a patient without family history of type 2 diabetes should raise suspicion for undetected/early-stage pancreatic cancer. CONCLUSIONS: This case highlights the importance of considering all possible pathophysiologic etiologies when a patient has a new diagnosis of diabetes. Clinicians should consider the possibility of pancreatic cancer in patients with new-onset diabetes mellitus, especially when features not characteristic of type 2 diabetes are present. Understanding the relationship between diabetes and pancreatic cancer has the potential to improve early detection of pancreatic cancer and can provide an opportunity for early treatment and improved survival.

Assessment and mapping of total suspended particulate and soil quality around brick kilns and occupational health issues among brick kilns workers in Pakistan.

Brick kilns constitute one of the major sources of environmental degradation in Pakistan. The present study was conducted to determine the soil quality and total suspended particulates (TSPs) around the brick kilns and assess the health effects on brick kiln workers. Four brick kilns were selected, two each at Sheikhupura and Pattoki city. The soil quality was assessed by analyzing pH, electrical conductivity, moisture content, nitrogen, phosphorus, potassium content, and heavy metal concentration while TSPs were measured by hand-held Microdust Pro Real time monitor. Average TSP concentration around brick kilns at Sheikhupura and Pattoki ranged between 1100 and 1200 µg/m3 and between 550 and 600 µg/m3 respectively which exceeded the Punjab Ambient Air Standards. The soil was slightly acidic (Sheikhupura: average pH = 6.41; Pattoki: average pH = 6.6) while all other analyzed parameters, except heavy metals, were lower than the required FAO Standards for good quality agriculture soil. Heavy metal accumulation in soil samples followed the general order zinc (Zn) > chromium (Cr) > nickel (Ni) > manganese (Mn) > cadmium (Cd) > copper (Cu). For assessment of occupational health and safety issues, all 440 brick kiln workers from the study areas were interviewed. Mostly, brick kiln workers suffered from chronic back pain (84%), skin issues (80.5%), dry cough (72.9%), common cold (46.1%), and shortness of breath (17.1%). The vulnerability risk varied with the nature of the work as workers engaged in brick baking were more vulnerable to respiratory issues than were those in molding task. The study concludes that brick kilns are a source of increased TSP, deteriorated surrounding soil quality, and impaired worker health. It is necessary to regulate these activities and implement requisite health and safety measures.

Transcatheter Aortic Valve Replacement Incidentalomas: A Multimodality Imaging Case of Giant Right Coronary Aneurysm.

Giant coronary artery aneurysms (CAAs) are defined as having a diameter of greater than 2 cm. We report a case of an 82-year-old male with severe aortic stenosis incidentally diagnosed with giant right coronary artery aneurysm (gRCAA) while undergoing evaluation for transcather aortic valve replacement (TAVR). It was causing a mass effect on the right cardiac chambers but was otherwise asymptomatic. Our patient was successfully treated with surgical excision of aneurysm with concomitant coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR). The patient remained stable at discharge and on serial follow-ups for two years. In conclusion, due to the associated complication and increased risk of mortality with giant coronary aneurysms, we recommend surgical approach instead of medical management alone. We also call for evidence-based recommendations and guidelines for management of TAVR incidentalomas.