Background: Diabetic peripheral neuropathy (DPN) is common among people with diabetes and can result in foot ulceration and amputation. Objective: The objective of the study is to estimate the prevalence and risk factors of DPN among patients with Type 2 diabetes mellitus (T2DM) at a diabetes clinic in Benghazi Medical Center (BMC), Benghazi, Libya. Patients and Methods: Three hundred and sixty-seven patients with T2DM (127 [34.6%] males and 240 [65.4%] females) were included in this cross-sectional study. The patients aged ≥18 years, and they attended the outpatient diabetes clinics at BMC from May 2015 to October 2016, for routine follow-up. Patients with T1DM, gestational diabetes, and latent autoimmune diabetes in adults were excluded. Data including gender, age, type of DM, duration of DM, history of smoking, history of hypertension, weight, height, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, creatinine, and urea were obtained by a prepared pro forma. Peripheral neuropathy was diagnosed in the presence of numbness, paresthesia, 10-g monofilament examination, and loss of vibration and joint position sensations. The relationship between DPN and its risk factors, in addition to independent predictors of DPN, was explored using multiple forward stepwise logistic regression and presented as an odds ratio (OR) and 95% confidence interval (CI). Results: The prevalence of DPN was 30.5% in the studied group. A statistical significant association found between DPN and age (P = 0.014), duration of DM (P < 0.001), macrovascular complications of DM (P < 0.001), diabetic retinopathy (P = 0.001), diabetic nephropathy (P < 0.001), poor glycemic control (high HbA1c) (P < 0.001), hypertension (P = 0.011), uncontrolled blood pressure (≥140/90 mmHg) (P = 0.007), and insulin treatment (P < 0.001). Multiple forward stepwise logistic regression analyses revealed two independent risk factors influencing DPN: diabetic nephropathy (OR = 1.976, 95% CI: 1.289–3.027) (P = 0.009) and insulin treatment (OR = 3.430, 95% CI: 2.021–5.821), (P < 0.001). Conclusions: The overall prevalence rate of DPN in this study was 30.5% among patients with T2DM. It increases with the presence of diabetic nephropathy and insulin treatment.

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Certain bacteria and antibiotic combinations can result in unusual morphologic transformations such as the creation of septate filamentous bacterial rods, where division is preserved, but separation is inhibited. This is often seen when subinhibitory concentrations of antibiotics are administered. Herein, we describe this phenomenon in the case of a teenage boy with an infected ventriculoperitoneal shunt, whose culture-proven Pseudomonas aeruginosa took on a filamentous appearance following antibiotic treatment. This transformation is important to recognize, so it is not misconstrued as fungal hyphae, committing the patient to unnecessary treatment.

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The term fat evokes a multitude of ideas, images, and prejudices. It encompasses the different types of adipose tissue (AT) and cellular components as well as the myriad of lipid molecules. The AT and lipid molecules throughout the body carry out scores of vital functions ranging from thermal insulation to energy homeostasis to signal transduction. A fact that is not generally appreciated is that in addition to its roles in energy balance and thermoregulation, the AT is also an integral part of both the endocrine and immune systems. Fatty acids (FAs) are the primary building blocks of most lipids. They serve as fuel, structural components, and regulatory molecules (mediators). Most of the free FAs in the body are either obtained from the diet or released by the AT (lipolysis). However, most of the short-chain FAs such as propionate and butyrate are generated in the colon by the fermentation of dietary fiber by the gut microbiota. In addition to providing fuel for the colon enterocytes, these molecules act on specific G protein-coupled receptors in the gut cells stimulating the release of glucagon-like peptide-1 and peptide YY simultaneously improving insulin sensitivity and curbing appetite. The essential FAs linoleic and α-linolenic give rise to two distinct classes of omega FAs, n-6 and n-3, respectively, and hence to more complex lipid derivatives (eicosanoids) which are involved in virtually all aspects of cellular function including immunomodulation and inflammation. These include prostacyclins, thromboxanes, leukotrienes, and epoxyeicosatrienoic acids.

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Ileocolic and colocolic intussusception with an inflamed appendix is a rare clinical entity in adults, particularly when caused by lipoma. A 48-year-old female nurse presented with recurrent, intermittent, central, colicky abdominal pain for 2 months. It became constant the night before admission and was associated with abdominal distension and large palpable mass at the right lower quadrant. An exploratory laparotomy was carried out and. The operative findings were ileocolic and colocolic intussusceptions with large cecal mass (lipoma) about 5 cm × 5 cm as a lead point just close to the ileocecal valve with an inflamed appendix, ileocolic resection was performed. Assessment of the resected specimen confirmed the diagnosis. Cecal lipoma should be considered in the differential diagnosis of cecal mass causing ileocecal intussusception.

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Sodium-glucose co-transporter 2 (SGLT2) inhibitors are the newest class of oral antidiabetic agents. In addition to glucose lowering, they have other advantageous effects on blood pressure and body weight. The use of those agents has increased exponentially after the emerging evidence of cardiovascular protection following the publication of the EMPA-REG OUTCOME study. Although they are relatively safe and effective, they are not without side effects. Perhaps, the most serious complication is euglycemic diabetic ketoacidosis (DKA). Several cases were reported in the literature. We describe a case of severe DKA in association with the use of an SGLT2 inhibitor (empagliflozin) in a 69-year-old male with type 2 diabetes who is not absolutely insulin deficient following knee replacement. The case highlights the increased risk of DKA and the importance of discontinuation of SGLT2 inhibitors before major surgery.

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Introduction: Light amplification by stimulated emission of radiation (LASER) toys are widely available in the market with no clear information about their wavelength and hazardous effects. To be safe to the eyes, LASER should be classified <3b (according to international safety classification). Case History: We here report an illustrative case of macular injury post LASER toy direct exposure. A 12-year-old boy, previously known hypermetrope with left-eye (LE) amblyopia, presented complaining of drop of vision in the right eye (RE) after his colleague pointed a LASER toy directly over his RE. His corrected visual acuity (VA) was 5/60 (amblyopic) in the LE and 6/18 in the RE. The anterior segment was normal in both eyes. Fundus examination showed the LE to be normal, and the RE had a macular yellowish, oval-shaped lesion. Optical coherence tomography and fundus picture revealed central macular burn. Local and systemic corticosteroids were prescribed tapering over 9 days. After 1-week, the patient noticed some improvement in VA in RE to 6/9. Conclusion: LASER toys available in several markets are reported to be vision threatening and cause macular burn which responds partially to corticosteroids. More education and strict regulation of distribution and use of LASER toys and instruments is urgently needed.

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Background: Radioiodine (RI) is a commonly used treatment modality for primary hyperthyroidism. A single dose of RI has been reported to cure hyperthyroidism in the range of 50%–90% of the treated cases. The efficacy of RI treatment has not yet been investigated in the local population. Objectives: To assess the efficacy of RI therapy in patients with primary hyperthyroidism treated at Tawam Hospital, Al Ain, UAE. Patients and Methods: The electronic medical records of hyperthyroid patients who received RI treatment at Tawam Hospital between January 2009 and March 2017 were reviewed. The diagnosis was verified by reviewing clinical, laboratory, and imaging data. Following RI therapy, a cure was defined as the development of hypothyroidism or euthyroid status without the aid of antithyroid drugs (ATDs) within 6 months post-RI therapy. Multivariate analysis was used to assess predictors of RI response. Results: A total of 125 patients (68.8% women) met the study criteria. The mean age ± standard deviation (SD) at RI therapy was 40 ± 15.1 years. The etiology of hyperthyroidism was available for 121 patients; Graves' disease (GD) (n = 83, 68.6%), toxic multinodular goiter (TMNG) (n = 31, 25.6%), and toxic adenoma (TA) (n = 7, 5.8%). The majority of patients (109, 87.2%) were pretreated with ATDs; 70.3% of those were treated for a period exceeding 18 months. Almost quarter of the patients were referred to RI due to other compelling medical reasons including ATDs intolerance, neutropenia, and hepatotoxicity. The mean ± SD administered RI activity was 14.6 ± 3.7 mCi (range: 8–25). Treatment response evaluation was possible in 97 cases. Post a single dose of RI treatment, 91.8% of patients achieved either euthyroid or hypothyroid status. Patients with GD developed hypothyroidism more frequently than TMNG or TA (80.6% vs. 65.2% vs. 33.3%, respectively). The time to cure was within 3 months in 21% and 3–6 months in 79% of the patients. The given dosage of I¹³¹ was the only predictor of cure rate. No major adverse effects were reported. Conclusion: We found that there is a delay in referring potential patients with hyperthyroidism for RI treatment and the cure rate of a single dose of I¹³¹ is 91.8% within 6 months of posttreatment; patients with TA may require higher doses of I¹³¹ therapy. Further studies are needed to explore the patient–physician barriers in utilizing RI as a timely mode of treatment for appropriately selected patients.

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Introduction: Sleep disorders (SD) are common in patients with renal failure, particularly in those on dialysis. This can impair their daily quality of life and worsen their cardiovascular prognosis. Objective: Our work aimed to describe the prevalence and risk factors of SDs among chronic hemodialysis patients in the Nephrology and Dialysis Department of the Rabat Military Hospital, Morocco. Patients and Methods: The trial was designed as a prospective single-center study and included all hemodialysis patients in the nephrology department of the Rabat Military Hospital. For each patient, we assessed four SDs: insomnia, sleep apnea, restless legs syndrome, and excessive daytime sleepiness. Results: We included 52 patients; the mean age of the patients was 50 ± 17 year (range 24–76); male:female ratio was 1.1. SDs were found in 40 patients with a predominance of insomnia and sleep apnea syndrome (SAS), and multivariate logistic regression was used to identify factors associated with different SD Insomnia was correlated with anemia, excessive daytime sleepiness, and inflammation; SAS was correlated with age ≥50 years, obesity and excessive daytime sleepiness. Restless legs syndrome was associated with advanced age, excessive daytime sleepiness and presence of a biological inflammatory syndrome. Conclusions: Sleep disorders have a considerable impact on the quality of life of patients on dialysis, so it is essential to look for them and especially to determine the associated factors to control them.

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