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A 51-year-old female with a history of multinodular goitre presented with vomiting, abdominal discomfort, and generalized tiredness. Investigations revealed hypercalcemia (ionized calcium 1.41 mmol/L), hypokalaemia, suppressed parathyroid hormone, and significantly elevated free thyroxine (> 7.77 ng/dL) with a suppressed thyroid-stimulating hormone level consistent with hyperthyroidism. Further, the workup confirmed Graves’ disease as the underlying aetiology. Hyperthyroidism is occasionally associated with mild to moderate hypercalcemia, but severe hypercalcemia or hypercalcaemic crisis is an extremely rare complication. Prompt recognition and treatment are crucial to prevent life-threatening complications. The patient was treated with intravenous fluids, a low-calcium diet, zoledronic acid, carbimazole, and a beta-blocker, leading to improvement in her condition. This case highlights a rare occurrence of hypercalcaemic crisis in a patient with thyrotoxicosis due to Graves’ disease. Hyperthyroidism-induced hypercalcemia requires prompt recognition and multidisciplinary management involving endocrinologists, internists, and critical care specialists to prevent potentially life-threatening complications. Healthcare providers should consider the hypercalcaemic crisis in the differential diagnosis of hypercalcemia in the context of hyperthyroidism.

Zinc induced pediatric preventing respiratory 2019-nCoV is required that supplementation with zinc gluconate 20 mg in Zn deficient children resulted in a nearly twofold reduction of acute lower respiratory infections as well as the time to recovery. Zinc supplementation in children is associated with a reduction in the incidence and prevalence of pneumonia. Preventing 2019-nCoV pneumonia is required that zinc supplementation alone (10 to 20 mg) for more than 3 months significantly reduces in the rate of pneumonia. zinc pediatric intake may be required to be effective range 10～20 mg/d for 2019-CoV prevention, 10～30 mg/d for reduction of COVID-19 bronchitis, and 20～30 mg/d for recovery from COVID-19 pneumonia, in which Zn2+ could bind with viral surface proteins by Zn2+ions-centered tetrahedrally coordination pattern. On the other hand, for aults, the zinc-homeostatic immune concentration may provide a protective role against the COVID-19 pandemic, likely by improving the host’s resistance against viral infection. 50 mg of zinc per day might provide an additional shield against the COVID-19 pandemic, possibly by increasing the host resistance to viral infection to minimize the burden of the disease. In order to prevent that an outbreak of respiratory sickness caused by a novel coronavirus (COVID-19) has become a serious public threat and disrupted many lives,assessing the efficacy of FDA-approved Zn-ejector drugs such as disulfiram combined with interferon to treat COVID-19 infected patients has been proposed. The key strategies for preventing lung damages include avoiding direct lung infection, altering host-virus interactions, promoting immune responses, diluting virus concentrations in lung tissues by promoting viral migration to the rest of the body, maintaining waste removal balance, protecting heart function and renal function, avoiding other infections, reducing allergic reactions and anti-inflammatory. The interactions had been found on the binding specificity by Zn2+ ions-centered tetrahedral geometric coordination of the inhibitors against 3C and 3C-like proteases. In addition, transient zinc chelation TPEN and EPDTC have been noted as preventing virus replication. Zinc-induced ROS production in COVID-19 respiratory ailment and pneumonia occurs both in children and adults. In children. ROS production in zinc (Ⅱ)-immune pediatric patient with COVID-19 bronchitis and pneumonia cannot be elucidated yet. In adults, zinc induced ROS generation in pulmonary COVID-19 infected cells is that alterations of ROS-producing and scavenging pathways that are caused by respiratory viral infections are implicated in inflammation, lung epithelial disruption, and tissue damage, and, in some cases, even pulmonary fibrosis. The involvement of oxidative stress in cell deaths caused during RNA virus infection and ROS production is correlated with host cell death.

Introduction: Childhood obesity is one of the current themes of medical research, being considered not so much a multidimensional condition but primarily a real problem of worldwide interest.The aim of our randomized study was to evaluate and compare the effects of physical exercise associated with an educational program on clinical-functional status in overweight and obese children.Material and method: Participants were children hospitalized, through the emergency service, in the Pediatric Department, Craiova Municipal Clinical Hospital, between June and November 2023. 93 overweight and obese children, aged between 2 and 16 years, were evaluated (clinical, paraclinical and functional) by a multidisciplinary team and randomized into the control group (group C – 63 children) and the study group (group S – 30 children). After the resolution of the acute digestive or respiratory disease, the children in group S underwent a program to restore their functional status, based on educational measures (following the 5-2-1-0 rule) and physical exercises, for 12 weeks. Anthropometric data were measured (height, weight, body mass index); physical performance wasevaluated by gait analysis (we used the BTS G – WALK / BTS G – SENSOR 2 system, BTS Bioengineering Corp, Italy) with the determination of four parameters – the Timed Up-and-Go (TUG) test, the symmetry index, the walking test six minutes (6 MWT) and walking cadence or average cadence (steps/min) in both groups of children.The results were obtained by analyzing the differences in values obtained in the two moments T1 (initial) and T2 (after three months). The proportion of girls and boys was approximately equal within obesity class in each study group. Although we did not obtain statistically significant differences between the monitored parameters, between the two groups, for the two evaluation moments, the children in Group S had a clearly favorable evolution for physical performance parameters, whose average value was improved in T2. Anthropometric data did not change.Conclusion: The present study confirms the effectiveness of the multimodal (educational-kinetic) program for the physical performance of overweight/obese children. The sustained running of the program at home, with the involvement of the family and the school environment, is essential for the well-being of these children, with a favorable impact on the quality of life later.

Objectives: To examine the effect of dietary supplements on diabetic risk progression, blood glucose level, and lipid profiles.Methods: A randomized, double-blind, placebo-controlled study was conducted at Rajavithi hospital, Thailand. Participants with prediabetes were randomly allocated to three arms of dietary supplements: placebo (PL) or curcumin plus fish oil and vitamin D (CFD), or curcumin plus fish oil (CF) for 24 weeks. Primary outcomes were the progression of glycemic status and the progression to overt diabetes at 24-week and 36-week follow-ups. Secondary outcomes were changes in glycemic profiles (fasting plasma glucose, 75 g OGTT 2-h plasma glucose or HbA1C), body weight, BMI and lipid profiles.Results: A total of forty-seven participants (PL, n = 16; CFD, n = 15; CF, n = 16) were included in the study. At the 24-week follow-up, the participants with worsening glycemic status in the intervention groups were lower, CFD, CF and Placebo, 14.29%, 13.33% and 31.25%, respectively. However, the primary outcome, progression of glycemic status, was statistically different, with p - value = 0.046 (p < 0.05) when excluding previous diabetes in the study. As well as the incidence of type 2 diabetes at 24-week follow-up was not statistically different between the three groups, 14.29%, 13.33%, and 12.5%, p - value = 0.699 (p < 0.05) in CFD, CF, PL group, respectively. The secondary outcomes also failed to demonstrate the effect of dietary supplements on blood glucose, lipid profiles, weight, BMI and blood chemistry.Conclusion: The combined dietary supplements which contained curcumin-fish oil-vitamin D,could lower the glycemic status progression in prediabetes at six months follow-up and were well-tolerated among the participants.

Background: Myxedema is an extreme manifestation seen in patients with untreated hypothyroidism. It is a lethal endocrine emergency, which arises when a precipitating cause overwhelms the compensatory mechanisms of the hypothyroid state.Objectives: This case report aims to present a case of myxedema coma secondary to cretinism. It also aims to discuss how hypothyroidism leads to hypoventilation and eventually respiratory failure, as well as to discuss the epidemiology, pathophysiology, clinical manifestation, diagnosis, and management of a child with myxedema coma.Case presentation: This is a case of a 7-year-old female, diagnosed with congenital hypothyroidism at 5 months of age, but eventually was lost to follow-up. She came back after 7 years presenting with difficulty of breathing. She was seen hypothermic, obtunded, and in severe respiratory distress. She was severely stunted and underweight with coarse facial features. Initial laboratory work-up showed elevated Thyroid Stimulating Hormone (TSH) as well as decreased tri-iodothyronine (FT3) and thyroxine (FT4). She was immediately started on levothyroxine, with noted resolution of the edema and improvement in sensorium. There was also noted improvement in the patient’s ventilation and was sent home on Continuous Positive Airway Pressure (CPAP) while asleep.Conclusion: This case highlights the importance of having a high index of suspicion of its clinical manifestations, which could lead to earlier intervention thereby preventing further complications. A multidimensional approach is essential in managing this case, as various organ systems are involved in this condition.

Background: Human Immunodeficiency Virus (HIV) and thyroid function have been described. Prevalence pattern and atherogenic status significantly differ from HIV-negative control in several studies. Unfortunately, few studies have determined the prevalence of thyroid function and lipids among Nigerians living with HIV. Objective: This study is to evaluate thyroid hormones and lipid profiles in HIV-positive subjects attending a faith-based health facility in Anambra State Nigeria.Materials and methods: The serum concentration of Thyroid Stimulating Hormone (TSH), free Triiodothyronine (fT3), triiodothyronine (T3), free Thyroxine (fT4), Thyroxine (T4), Total Cholesterol [TC], Triglyceride [TG], High-Density Lipoprotein [HDL], Low-Density Lipoprotein [LDL] and Very Low-Density Lipoprotein [VLDL] was determined in 95 HIV positive subjects which include 48 patients who were on HAART- group 1 and 47 not on HAART- group 2; and compared to 30 HIV negative controls – group 3. Results: The level of TSH and fT3 was significantly (p < 0.05) higher in group 1 participants than in group 2 and the group 3 participants. The level of T4 was significantly higher in group 2 than in group 1 and group 3 participants. The level of T3 was significantly lower in Control participants in comparison to both HAART and non-HAART participants. The prevalence of fT4 dysfunction across the groups was significantly different from each other. The total mean of Cholesterol (163.5 ± 22.7), Triglyceride (163.5 ± 22.7), and Very Low-Density Lipoprotein (14.2 ± 2.4) of the HIV-positive participants were significantly (p < 0.05) lower than that of the HIV negative participants.Conclusion: The results obtained from this study indicate that serum levels of thyroid hormones may be used as baseline periodic markers during antiretroviral therapy and many people living with HIV may benefit from supplementation if appropriate.

Central Diabetes Insipidus (CDI) results from the inability to secrete ADH secreted by the neurohypophysis system to control water-electrolyte metabolism. In the etiology of CDI in childhood, many congenital and acquired central nervous system (CNS) tumors (germinoma, pinealoma, craniopharyngioma, optic glioma, acute myeloid leukemia), infiltrative diseases (Langerhans cell histiocytosis, sarcoidosis), infections (meningitis, tuberculosis, encephalitis), autoimmune events, head trauma, idiopathic) can be responsible [1]. Hibernomas, which are very rare in childhood, may also rarely involve the central nervous system.

Diseases - diabetes mellitus (especially type 1) and autoimmune diseases are incurable diseases. In type 1 diabetes, the beta cells of the tail of the pancreas die. It is in the beta cells of the tail of the pancreas that insulin is located, a hormone that maintains normal blood sugar levels in patients with type 1 diabetes. Until now, no methods have been known to restore dead pancreatic beta cells. Methods for restoring the lymphoid system in patients with autoimmune diseases were not known. With these diseases, the normal properties of the lymphoid system are lost. This review aims to present materials on the effective treatment (cure) of these diseases. For the treatment, the resonance therapy method was used, which has been known for at least 25 years and which has been modified in our work since 2016. The essence of our modification was that the author began to use 1. Not only low (previously known) but also high potencies of resonant drugs. 2. We have created a direction in resonance therapy, which is called “resonance of creation.” So far, only the direction is known as “resonance of destruction” is known, with the help of which oncological tissues, infectious processes, cysts, stones, etc. are treated - destroyed. With the help of the resonance of creation, various biological structures that have undergone degeneration and death are restored - the myelin sheath of the nerves in multiple sclerosis, nerve cells in Parkinson’s disease and Alzheimer’s disease, etc. With the help of the resonance of creation, the beta cells of the tail of the pancreas are restored in type 1 diabetes and restoration of the lymphoid system in autoimmune diseases. So, in patients with autoimmune diseases, organ preparations were tested: “lymph nodes”, “lymphocytes”. It turned out that in all patients with various autoimmune diseases, lymph nodes, and lymphocytes were tested as being in a degenerative state. There was not a single patient whose lymph nodes and lymphocytes were tested as normal. The task was to normalize the functional state of the lymph nodes and lymphocytes in our patients and thereby take an important step towards curing their autoimmune disease. To this end, it was necessary to increase the potency of the lymph nodes and lymphocytes in the same way as we did it in relation to the beta cells of the pancreas in patients with diabetes mellitus, in relation to the substantia nigra of the midbrain in patients with Parkinson’s disease and in relation to the myelin sheath. Nerves in multiple sclerosis. After testing organ preparations: “lymph nodes”, and “lymphocytes” in patients with autoimmune diseases, the potency was selected, which led to the fact that lymph nodes and lymphocytes were no longer tested as degenerated formations. It was this potency of lymph nodes and lymphocytes that was the basis for the treatment of patients. Thus, as a result of the treatment of diabetes mellitus (especially type 1) and autoimmune diseases by resonance therapy, these diseases become curable.

Over the last few years, the prevalence of thyroid nodules has increased. There are multiple reasons: true increase in incidence and increase in investigations with better technology. Finding a nodule in the thyroid does lead to a flurry of investigations. 

NAFLD is characterized by accumulation of fat in the liver that can lead to health complications. Previous studies have found the obesity phenotype and its components to be risk factors for the development of NAFLD. This study aims to examine the relationship between the obesity phenotype and NAFLD among each racial-ethnic group. We analyzed data from the NHANES III survey (1988-1994). The obesity phenotype was defined based on BMI and metabolic syndrome. NAFLD was defined by abdominal ultrasounds among non-alcoholics with no infection or taking drugs affecting the liver. A higher prevalence of NAFLD was found among the metabolically unhealthy obese group (43.1%) and the metabolically unhealthy overweight (29.4%) than the metabolically unhealthy normal weight (11.8%). Mexicans-Americans had higher odds of NAFLD relative to whites (adjusted odds ratio (AOR) = 1.3, 95% confidence interval (CI) = 1.01-1.9, p = 0.04). The metabolically healthy obese phenotype was associated with NAFLD (p > 0.05) in the overall sample and in Whites. The metabolically healthy overweight was associated with NAFLD only among Mexican-American (p < 0.05). Metabolically unhealthy overweight or obese had higher odds of NAFLD relative to the metabolically healthy normal weight and this relation is consistent in all the racial/ethnic groups (p < 0.05). Metabolically healthy overweight and obese individuals had a high chance of NAFLD and it varied by race/ethnicity. Healthcare providers should pay more attention to care for those who are part of the metabolically healthy overweight or obese group especially among the Mexican-American population.