Central diabetes insipidus secondary to COVID-19 infection: a case report.

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) mainly affects the lungs, but can involve several other organs. The diagnosis of acute and chronic sequelae is one of the challenges of COVID-19. The current literature proposes that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may involve the hypothalamic-pituitary axis. In this case report, we present a unique case of new-onset central diabetes insipidus secondary to the COVID-19 disease in a 54-year-old woman. CASE PRESENTATION: A 54-year-old woman presented with the history of excessive thirst, polyuria, and polydipsia, six weeks after being infected by COVID-19. Laboratory tests revealed low urine osmolarity and increased serum osmolarity, and the patient was diagnosed with central diabetes insipidus. After administration of nasal desmopressin, urinary osmolarity increased, and the patient's symptoms improved. However, to stabilize her condition, desmopressin treatment was required. CONCLUSIONS: We reported a unique case of diabetes insipidus in a COVID-19 patient. Central diabetes insipidus may be included in clinical manifestations of the COVID-19, in case of new-onset polyuria and polydipsia following COVID-19 disease. Nevertheless, a causal relationship has not been established between the symptoms of the patient and the SARS-CoV-2 infection.

Radiofrequency ablation of parathyroid adenomas causing primary hyperparathyroidism: A report of 27 patients.

PURPOSE: To study treatment outcome of parathyroid adenomas using ultrasound-guided radiofrequency ablation. METHODS: Twenty-seven patients with a single adenoma of the parathyroid gland were included in the study. Using color Doppler ultrasonography, the lesion and its characteristics were determined, and dextrose was injected to dissect the gland from the surrounding structures. The ablation process was done with 6-12 watts of power. RESULTS: No complications were seen in any of the subjects. A significant reduction was seen in serum parathyroid hormone (PTH) and calcium levels after treatment. PTH levels showed a median decrease of 13.8%, and a median decrease of 8.2% was seen in serum calcium levels (p < 0.001). Phosphorus levels did not change significantly after treatment. In 1-month follow-up of patients, the lesion size had decreased considerably. In long-term follow-up, 11 of 20 patients having subsequent imaging had indistinguishable lesions. CONCLUSION: Our results showed that RFA of parathyroid adenomas caused a significant reduction in biomedical indicators of disease and resulted in a significant reduction or disappearance of the lesion in the majority of the patients while having no considerable complications.

The roles of dipeptidyl peptidase-4 inhibitors in prognosis of COVID-19 infection in patients with type 2 diabetes mellitus.

Background: COVID-19 is responsible for the latest pandemic. Dipeptidyl peptidase-4 (DPP-4) is one of the cellular receptors of interest for coronavirus. The aim of this study was to assess the roles of DPP-4 inhibitors in prognosis of COVID-19 infection in patients with type 2 diabetes mellitus. Materials and Methods: retrospective cohort study was performed in 2020 in military medical centers affiliated to AJA University of Medical Sciences in Tehran on 220 patients with type 2 diabetes mellitus who were admitted in medical centers with COVID-19 infection. We collected demographic data of patients including age, gender, drug history, usage of DPP-4 inhibitors, clinical presentations at the time of the first visit, and the disease outcome including hospitalization duration and need for respiratory assist. Results: The study population consisted of 133 males (60.5%) and 87 females (39.5%), with a mean age of 66.13 ± 12.3 years. Forty-four patients (20%) consumed DPP-4 inhibitors (sitagliptin and linagliptin). Patients who were treated with DPP-4 inhibitors required less oxygen (O2) therapies compared to other cases (76.7% vs. 88.6%, P = 0.04). Patients who were treated with DPP-4 inhibitors had significantly lower hospitalization duration compared to other cases (6.57 ± 2.3 days vs. 8.03 ± 4.4 days, respectively, P = 0.01). There were no significant differences between the two groups of patients regarding survival rates (P = 0.55). Age was a predictive factor for survival (odds ratio, 1.13; 95% confidence interval, 1.04-1.23; P = 0.004). Conclusion: DPP-4 inhibitors could significantly decrease hospitalization days in patients with type 2 diabetes mellitus who were hospitalized for COVID-19. However, DPP-4 inhibitor usage showed no statistically significant impact on survival. Age was the important prognostic factor.

The Effect of Vitamin D Deficiency on Immune-Related Hub Genes: A Network Analysis Associated With Type 1 Diabetes.

Background Type 1 diabetes (T1D) is an autoimmune disorder that results in the destruction of pancreatic beta cells, causing a shortage of insulin secretion. The development of T1D is influenced by both genetic predisposition and environmental factors, such as vitamin D. This vitamin is known for its ability to regulate the immune system and has been associated with a decreased risk of T1D. However, the specific ways in which vitamin D affects immune regulation and the preservation of beta cells in T1D are not yet fully understood. Gaining a better understanding of these interactions is essential for identifying potential targets for preventing and treating T1D. Methods The analysis focused on two Gene Expression Omnibus (GEO) datasets, namely, GSE55098 and GSE50012, to detect differentially expressed genes (DEGs). Enrichr (Ma'ayan Laboratory, New York, NY) was used to perform enrichment analysis for the Gene Ontology (GO) biological process and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. The Search Tool for the Retrieval of Interacting Genes 12.0 (STRING) database was used to generate a protein-protein interaction (PPI) network. The Cytoscape 3.10.1 (Cytoscape Team, San Diego, CA) was used to analyze the PPI network and discover the hub genes. Results The DEGs in both datasets were identified using the GEO2R tool, with a particular focus on genes exhibiting contrasting regulations. Enrichment analysis unveiled the participation of these oppositely regulated DEGs in processes relevant to the immune system. Cytoscape analysis of the PPI network revealed five hub genes, MNDA, LILRB2, FPR2, HCK, and FCGR2A, suggesting their potential role in the pathogenesis of T1D and the response to vitamin D. Conclusion The study elucidates the complex interaction between vitamin D metabolism and immune regulation in T1D. The identified hub genes provide important knowledge on the molecular pathways that underlie T1D and have the potential to be targeted for therapeutic intervention. This research underscores the importance of vitamin D in the immune system's modulation and its impact on T1D development.

Ultrasound-Guided Radiofrequency Ablation of Locally Recurrent Thyroid Carcinoma.

INTRODUCTION: We aimed to evaluate the effectiveness and safety of radiofrequency ablation (RFA) for non-surgical treatment of locally recurrent thyroid cancers, in both well-differentiated and medullary thyroid carcinomas (DTC and MTC) that are not amenable to traditional treatments. METHODS: We conducted a retrospective review of 48 patients with 103 recurrent tumors (81 DTC, 22 MTC) who underwent ultrasound-guided RFA. Patients were followed for 12-37 months to observe the outcomes and complications. RESULTS: 64 tumors (62.1%) completely disappeared at the last follow-up visit with 61 (59.2%) being resolved within 12 months. Technical success (volume reduction ratio (VRR) > 50%) was 96% (n = 99) in all tumors. The mean largest diameter of treated tumors decreased from 11.2 ± 5.3 to 2.4 ± 3.4 mm (p value < 0.001), and the mean volume decreased from 501.0 ± 807.0 to 41.6 ± 97.1 mm3 at the last follow-up (mean VRR = 91%). Our patients had a 77.1% recurrence-free survival rate (11 recurrences, 7 DTC, 4 MTC), with an overall mean recurrence-free survival time of 34.6 months (95% confidence interval, 30.0-39.1). We observed 3 cases with complications (voice changes in DTC patients) that completely resolved during follow-ups. CONCLUSION: RFA is a safe and effective alternative to repetitive surgeries in recurrent loco-regional DTCs as well as MTCs. LEVEL OF EVIDENCE: Level 3, Non-randomized controlled cohort/follow-up study.