Background and Aim: There are numerous studies published regarding the association between air pollutants and diabetes mellitus but limited studies on the overall trend and association of Particulate Matter 2.5 and HbA1c among lower-middle-income and high-income countries. So, this secondary data analysis is aimed to investigate the trend of Particulate Matter 2.5 and Haemoglobin A1c and evaluate the association between them in these countries.

Materials and Methods: This is secondary data analysis. The values of Particulate Matter 2.5 (years 2010-17), fasting plasma glucose (years 2010-14), and Gross Domestic Product per capita (years 2010-18) for Lower middle income and High Income countries were obtained from relevant sources. Haemoglobin A1c values were calculated. Countries with missing data were excluded. The Independent-Student T-test and Pearson correlation were applied to analyse the data using the SPSS-23-Trial version.

Results:  The Gross Domestic Product per capita in High-income countries increased significantly in the past10 years while minimal changes were seen in Lower middle-income countries. The particulate Matter 2.5 value has decreased, and there is a slight increase in Haemoglobin A1c in both groups. There is a substantially higher Gross Domestic Product per capita in High income countries, significantly higher Particulate Matter 2.5 in Lower middle-income countries, and similar HaemoglobinA1c in both income groups. There is a weak negative correlation between particulate Matter 2.5 and Haemoglobin A1c in Lower middle-income countries, while a significant positive correlation was seen in High-income countries.

Conclusion: The higher Particulate matter 2.5 in Lower middle-income countries is a concern because various studies have related the increased Particulate Matter 2.5 to increased Diabetes Mellitus prevalence. This demands the appropriate interventions in Lower middle-income group countries to reduce ambient air pollution and health planning to reduce the prevalence of Diabetes mellitus in the future. 

Background: Vitamin D insufficiency is a common disorder worldwide and children are involved in this disorder. In this study, we aimed to evaluate the effectiveness of vitamin D insufficiency treatment with vitamin D 50,000 IU in children who had vitamin D insufficiency.

Methods: Children’s vitamin D levels were evaluated and if they had vitamin D insufficiency, one pearl of vitamin D 50,000 IU was prescribed weekly for 6 weeks, and after 6 weeks, vitamin D levels were checked again. Then all data were analyzed by SPSS software version 20.

Results: In this study, 97 children were evaluated and 61.9% were boys. The average age of children was 101.01 ± 19.27 months. The average BMI of these children was 15.46 ± 2.52 kg/m2. The initial vitamin D level was 18.21 ± 6.42 ng / mL with a range of 4.2 to 29.8. After treatment, this level reached 41.08 ± 14.61ng / mL (12.2 - 98.4 ng / mL) and this increase was statistically significant (P-value< 0.005). There was no correlation between age, gender, height, and BMI with the increased efficacy of vitamin D level with one pearl of vitamin D 50000 unit.

Conclusion: Using one pearl of vitamin D 50000 IU weekly for 6 weeks is a good method for vitamin D insufficiency treatment in children.

Abstract

Background and aim:

Oral candidiasis is an opportunistic and common infection in the oral cavity. It is caused by the overgrowth of Candida albicans species. The prevalence of this infection varies according to gender and other predisposing factors. Ozone therapy is one of the modern and new non-pharmacological treatments and so far, many antimicrobial and antifungal effects of ozonated water have been reported.

Materials and Methods

An ozone gas generator was used to prepare ozonated water. After turning on the generator, its connector hose was placed in a graduated cylinder containing yeast suspension (at 0.5 McFarland turbidity). Then the generator was turned on for 15 minutes and at 0 seconds, 15 seconds, 30 seconds, 3 minutes, 5 minutes, 10 minutes and 15 minutes the graduated cylinder was sampled and cultured in Sabouraud agar medium. Samples incubated for 48 hours. After incubation the colonies were counted and the effect of ozonated water was examined.

Results

 Ozonized water completely destroyed all Candida colonies in a short time (15 seconds).

Conclusion

The antifungal activity of ozonated water seems to depend on the duration of its exposure to Candida yeast and ozonated water can destroy Candida colonies in a short time.

Background and aim: varicose veins are common and can make some complaints, such as cosmetic problems and pain. This disorder has risk factors such as long-time standing, high body mass index, and pregnancy. In this study, we aimed to investigate the relationship between clinical presentations of varicose veins and the patient's risk factors and the relationship with sonographic findings.

Methods: in this cross-sectional study, all patients who came to Shohada-e –Tajrish hospital (Tehran-Iran) with varicose vein presentation were evaluated. Age, sex, standing time, smoking, multi-gravidity, and symptoms were recorded. A color Doppler sonography was taken from the veins of the involved legs among the patients.

Results: a total of 158 patients were evaluated and based on CEAP classification, 15.2% of patients had grade C0, 20.9% had grade C1, 24.1% had grade C2, 19.6% had grade C3, 7% had grade C4, 8.2% had grade C5, and 5.1% had grade C6. There was no relationship between symptoms of varicose veins and varicose veins severity. There was a relationship between the severity of varicose veins with age, sex, smoking, obesity, multi-gravidity, and standing time. Also, there was a relationship between sonographic findings of venous valves insufficiencies and the severity of varicose veins.

Conclusion: symptoms of varicose veins have no relationship with varicose vein severity but venous valve insufficiency, age, sex, smoking, obesity, multi-gravidity, and standing time have an association with varicose vein severity.

A 16-year- old girl with history of hypertension was referred to the surgery department due to multiple hypertrophied lesions in both lips and on the lateral sides of the tongue. The lesions have been appeared gradually within the last year and only issued as a cosmetic concern.

Which one could not be considered as the differential diagnosis of the patient?

1. neurofibroma
2. neurilemoma
3. Leukoplakia
4. Neuroma

Correct answer:

• This figure demonstrates enlarged lip and hypertrophied tongue lesions which can be seen in neurofibroma, traumatic neuroma, neurilemoma, granular cell tumor, and neuroma; the net diagnosis is made by microscopic examination of a tissue biopsy. Leucoplakia as it is understood by its name is a white plaque with wide range of differential diagnosis; trauma, lichen planus, systemic lupus erythematous (SLE), leukoedema, and malignancy.

On retrograde history taking, the patient had a total thyroidectomy due to medullary thyroid carcinoma (MTC) two years ago and right adrenalectomy due to pheochromocytoma last year.

What would be the most probable diagnosis?

1. Neurofibromatosis type 1
2. MEN 2A syndrome
3. MEN 2B syndrome
4. MEN 1 syndrome

Correct answer:

• The classic combination of the mucosal neuroma, MTC, and pheochromocytoma together define the multiple endocrine neoplasia type 2B (MEN 2B). Patients with MEN 2B syndrome also might have marfanoid features. In Neurofibromatosis type 1, neurofibromas, multiple café- au- lait spots, iris hamartomas, skeletal abnormalities, glioma, and cognitive disorders are expected. MEN 2A is identical with MEN 2B but instead of marfanoid features and neuromas, parathyroid hyperplasia is seen. MEN 1 syndrome is characterized by pituitary adenoma, parathyroid hyperplasia, and pancreatic tumor.

Due to the high fatality of MTC, early detection of MEN 2B cases and prophylactic thyroidectomy is of great importance and clinical suspicion to MEN 2B by non- endocrinologic features is critical in patients [1]. Currently, growing evidence is affecting our mindset about the clinical picture of MEN 2B syndrome. While MEN 2B patients are classically considered to be tall with marfanoid features, current studies report pediatric patients with proportionate short stature. It is also highlightable that intestinal ganglioneuromatosis associated with MEN 2B, should be considered in the differential diagnosis of Hirschsprung’s disease in children with constipation during early infancy.