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Background The literature on the prevalence of glycaemia dysregulation among Lebanese adults is inconclusive. Methods The PREDICT study was a national cross-sectional study that aimed to report the prevalence of incidental hyperglycaemia, prediabetes or type-2 diabetes mellitus (DM) in Lebanese adults. Glycaemia was measured by blood glucose finger prick test and data on demographic, medical history and lifestyle were collected. Results Out of 10,448 subjects included in the analysis, 2785 belonged to the prediabetes group (Group P), with 93 subjects (0.9%) reporting a prior diagnosis of prediabetes and 2692 (25.8%) with study-determined glycaemia in the prediabetes range. Additionally, 1135 subjects (10.9%) reported a prior diagnosis of type-2 DM and 640 (6.1%) had study-determined glycaemia in the type-2 DM range, making up 1775 subjects in the type-2 DM group (Group D). Hyperglycaemia significantly increased with age, and was detected in elderly (58.5%), older adults (46.3%) and younger adults (33.0%), p  < 0.0001. Subjects with normal glycaemia were 43.7 ± 15.2 years old; while age in group P was 46.4 ± 15.6 years and in group D it was 57.6 ± 14.6 years ( p  < 0.001). Group P subjects had a body mass index (BMI) of 26.7 ± 4.6 kg/m 2 and Group D subjects had a BMI of 27.9 ± 5.1 kg/m 2 , significantly higher than BMI in the normal glycaemia group (26.2 ± 4.4 kg/m 2 , p  < 0.001). Among subjects in Group P ( n  = 2785) or in Group D ( n  = 1775), respectively 1648 (59.2%) and 297 (16.7%) had reported no known risk factors for glycaemia disorders, equivalent to 15.8% and 2.8% of study population. Conclusions In this study, 10% of subjects had a prior diagnosis of type-2 DM. Alarmingly, 6% and 26% of subjects had incidentally-detected hyperglycaemia in the type-2 DM and prediabetes range, respectively. The prevalence of hyperglycaemia and of prediabetes that might progress to type-2 DM poses a serious threat to the Lebanese population and healthcare system; especially among younger and seemingly healthy adults. Hence, this study shed the light on potentially undiagnosed cases of glycaemia disorders, urging the need for early detection and timely management to curb the medical, social and health burden of type-2 DM.

Parathyroid cancer (PC) is one of the rarest causes of primary hyperparathyroidism (PHPT), typically exhibiting an indolent course but presenting with more severe symptoms compared to its benign counterparts. The diagnosis is most often made postoperatively through histopathological examination; however, certain clinical and biochemical features may raise suspicion preoperatively. These include markedly elevated serum calcium and parathyroid hormone (PTH) levels, a large parathyroid lesion with suspicious ultrasonographic features, and evidence of renal or skeletal complications. Although the exact etiology remains unclear, somatic mutations in the CDC73 gene have been identified in patients with PC. Complete surgical resection via en bloc excision remains the first‐line and most effective therapeutic approach to maximize the chance of cure, although recurrence is common during follow‐up. Other treatment modalities, including radiotherapy, chemotherapy, and immunotherapy, have limited evidence supporting their efficacy. Here, we report the case of a 53‐year‐old male who presented with lower limb weakness, confusion, and significant weight loss over the preceding month. His past medical history included prediabetes and dyslipidemia. Initially evaluated by a neurologist for depressive symptoms, he subsequently developed rapidly progressive neurocognitive decline, impaired mobility, and continued unexplained weight loss. Upon hospital admission, he was somnolent and confused, though hemodynamically stable. Laboratory investigations revealed severe hypercalcemia at 18 mg/dL (reference range: 8.5–10.5), acute kidney injury with a creatinine of 4.2 mg/dL (0.7–1.3), and a markedly elevated PTH level of 1095 pg/mL (10–65). Initial management included aggressive intravenous hydration and administration of denosumab to control the symptomatic hypercalcemia, which resulted in improved calcium levels and renal function. Further evaluation with imaging, including parathyroid ultrasound and Technetium‐99m (Tc‐99m) sestamibi scintigraphy, was consistent with a right parathyroid adenoma. The patient subsequently underwent parathyroidectomy, and histological analysis confirmed the diagnosis of parathyroid carcinoma.

Type 2 diabetes (T2D) is a global health problem accompanied by an elevated risk of complications, the most common being cardiac and renal diseases. In Lebanon, the prevalence of T2D is estimated at 8–13%. Local medical practice generally suffers from clinical inertia, with gaps in the yearly assessment of clinical manifestations and suboptimal screening for major complications. The joint statement presented here, endorsed by five Lebanese scientific medical societies, aims at providing physicians in Lebanon with a tool for early, effective, and comprehensive care of patients with T2D. Findings from major randomized clinical trials of antidiabetic medications with cardio-renal benefits are presented, together with recommendations from international medical societies. Optimal care should be multidisciplinary and should include a multifactorial risk assessment, lifestyle modifications, and a regular evaluation of risks, including the risks for cardiovascular (CV) and renal complications. With international guidelines supporting a shift in T2D management from glucose-lowering agents to disease-modifying drugs, the present statement recommends treatment initiation with metformin, followed by the addition of sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists due to their CV and renal protection properties, whenever possible. In addition to the selection of the most appropriate pharmacological therapy, efforts should be made to provide continuous education to patients about their disease, with the aim to achieve a patient-centered approach and to foster self-management and adherence to the medical plan. Increasing the level of patient engagement is expected to be associated with favorable health outcomes. Finally, this statement recommends setting an achievable individualized management plan and conducting regular follow-ups to monitor the patients’ glycemic status and assess their risks every 3–6 months.

Pneumococcal disease affects people across all ages but is more prevalent in young children and the elderly. Despite the availability of the pneumococcal vaccine for adults, the disease burden and mortality associated with it remains a challenge. A few studies conducted in Lebanon have reported epidemiology of pneumococcal disease, concurring the high burden among adults and older adults in the region. The pneumococcal vaccine is a part of the routine immunization schedule for children, but there are no recommendations for adult vaccination. A medical advisory board was hence conducted in September 2020 to discuss the burden of pneumococcal disease (PD) among adults in Lebanon. The participants were experts from the fields of internal medicine, family medicine, hematology, cardiology, oncology, endocrinology, pulmonology, and infectious diseases. The experts reached a consensus that there is a need to take steps to increase the rate of adult vaccination uptake and create awareness among physicians, pharmacists, caregivers, and patients. The physicians should be trained on adult immunization and should actively discuss the importance of the pneumococcal vaccine, especially with high-risk adult patients. Implementing adult vaccination as a routine practice and involving various stakeholders to address the gaps can help in reducing the burden of pneumococcal disease in adults.

Subacute thyroiditis (SAT) is a transient inflammatory thyroid disorder, typically following an upper respiratory tract viral infection, and can rarely present as fever of unknown origin (FUO). Considering endocrine diseases in the differential diagnosis of fever is essential to prevent delayed diagnosis and unnecessary investigations. We report a case of a 65-year-old male who presented with a prolonged fever of two to three weeks, unresponsive to antibiotics, starting with mild upper respiratory symptoms. Extensive infectious and other workups were negative. Thyroid function tests revealed suppressed thyroid-stimulating hormone (TSH) and elevated free thyroxine (T4) and triiodothyronine (T3) levels. Thyroid ultrasound findings were consistent with thyroiditis. The patient was diagnosed with SAT and treated with corticosteroids, leading to rapid symptom resolution. SAT can be overlooked in the evaluation of FUO, particularly in the absence of classic symptoms. Thyroid function testing can be considered in the routine workup of FUO. Treatment should be based on symptoms, with an appropriate corticosteroid regimen if needed, and proper follow-up is essential to monitor thyroid recovery and potential progression.

Objective: To evaluate the effectiveness and safety of insulin detemir treatment as add-on therapy in a real-world setting of Lebanese insulin naïve persons, with type 2 diabetes poorly controlled on oral antidia­betic drugs (OADs). Methods: Our study was a prospective, ob­servational study representing the Lebanese arm of the multinational prospective and observational study involving 2,155 persons across Near East countries, Lebanon, Pakistan, Israel and Jordan. Effectiveness endpoints were changes in HbA1c, fasting and post-prandial glucose (FPG, PPG) after 24 weeks of treatment with insulin detemir in eligible persons. Safety endpoints were number of hypoglycemic events, incidence of adverse drug reactions (ADRs), serious ADRs, adverse events, and body weight change between baseline and end of treat­ment. Results: 868 persons were included (mean age: 59.5 ± 10.4 years, men: 55.3%). Glycemic control improved with significant reduction in mean HbA1c from 9.7 ± 1.6% to 7.2 ± 1% (P<.0001). The percent­age of persons who achieved the target of HbA1c<7% increased from .7% at baseline to 39% at week 24. Mean FPG decreased significantly from 213.7 ± 60.1 mg/dL to 120.3 ± 25.7 mg/dL (P<.001), and mean PPG from 271 ± 65.3 mg/dL to 158.1 ± 36.4 mg/dL (P<.0001). The rate of major hypoglycemic episodes decreased from .1498 at baseline to .0448 at week 24. Three adverse events but no ADR or serious ADR were reported. Body weight decreased from 80.4±13.2 Kg to 79.9±12.5 Kg (P<.0001). Conclusions: Initiating insulin detemir in a clinical health care setting among Lebanese with type 2 diabetes mellitus on OADs improves glycemic control with no increase in hypoglycemia, adverse events or weight compared with baseline. Ethn Dis.2017;27(1):45-54; doi:10.18865/ed.27.1.45.