Objectives. To compare the level of insulin resistance and β-cell function between lean and overweight/obese Filipino patients with newly diagnosed type 2 diabetes mellitus (T2DM).Methodology. This was a cross-sectional analytical study including newly diagnosed T2DM Filipino patients from St. Luke's Medical Center -Quezon City. The patients were classified as either lean or overweight/obese. Age, sex, smoking history, anthropometric measures and blood pressure were obtained. Insulin resistance and β-cell function were determined using the homeostasis model assessment (HOMA). The original model ( HOMA1) and the updated model (HOMA2) were used.Results. A total of 80 subjects were included. There were 40 subjects in each group. The overweight/obese subjects had significantly higher mean insulin resistance (HOMA1-IR 9.8±11.7, HOMA2-IR 3.0±2.0) compared to the lean group (HOMA1-IR 2.9±1.5, HOMA2-IR 1.3±0.5). This was consistent in both HOMA1 and HOMA2 (p-values=0.001 and <0.001, respectively). The mean β-cell function of the overweight/obese patients was significantly higher than the lean subjects when using HOMA1 (lean=57.8±35.5, overweight/obese=93.6±66.4, p-value=0.003), but not in HOMA2 (lean=57.6±30.5, overweight/obese=74.8±45.7, p-value=0.051). Overweight/obesity increased HOMA1-IR by 4.0 and HOMA1-B by 46.1 (p-values= 0.002 and <0.001, respectively). Through the use of HOMA2, overweight/ obesity increased HOMA2-IR by 1.4 and HOMA2-B by 29.1 (p-values<0.001). Being overweight/obese was also associated with significantly higher odds for developing greater insulin resistance (HOMA1-IR adjOR = 5.

Background : Tuberculosis (TB) of the thyroid gland is a rare occurrence even in regions where TB is endemic. This affects about 0.1% of the population with TB and remains to be underdiagnosed due to the rarity of the condition. Case : We report three cases of TB of the thyroid. The first patient is a 60 year old female who presented with anterior neck mass with no obstructive symptoms, neck pain or fever. There were no signs nor symptoms of hyperthyroidism or hypothyroidism. She also has no history of tuberculosis. Ultrasound showed multiple thyroid nodules. Ultrasound guided FNABof the left nodule was done revealing chronic granulomatous inflammation with necrosis. The second case is a 60 year old male presenting with a history of painful, marble-sized right neck mass for 1 month accompanied by occasional low grade fever, weakness and weight loss. An ultrasound guided FNAB was performed revealing polymorphic lymphoid cells with occasional giant cells consistent with granulomatous thyroiditis. The third case is a 37 year old female presenting with an enlarging anterior neck mass with concomitant abscess. She complained of neck pain and dysphagia. Incision and drainage of the abscess was done. Microbiological studies revealed negative AFB with chronic granulomatous lymphadenitis and caseation necrosis. Mycobacterium culture and polymerase chain reaction were negative as well. Ultrasound of the thyroid gland revealed a left thyroid mass measuring 2.1 x 3.5 x 4.1 cm. Result: The first case was referred to an infectious disease specialist but was lost to follow up. The second casecompleted treatment for 6 months with anti Koch’s medications and on repeat ultrasound, there was decrease in the size and number of the nodules. The third case underwent thyroid lobectomy with histopathologic criteria for TB hence a diagnosis of thyroid TB was made. The patient was given anti-Kochs treatment. Conclusion: Though rare, tuberculosis of the thyroid should be one of the differential diagnoses of patients presenting with neck masses in communities where the prevalence of TB is high even in patients with no history of TB.

Background: VIPoma is a rare neuroendocrine neoplasm that autonomously secretes vasoactive intestinal peptide. It is a syndrome of watery diarrhea, hypokalemia and achlorydia. Majority of VIPOmas have metastasized at the time of diagnosis. 1 Case: We report a case of a 36 year-old male initially presenting with non-pruritic, maculopapular rashes over the facial area. Upon consult with a primary care physician, he was prescribed with doxycycline. Few days after the intake of medication, he developed non-bloody, non-mucoid loose watery stools with increasing frequency during the subsequent days. Diarrhea was initially attributed to doxycycline. Hence, it was discontinued. However, despite its discontinuation, the previously noted watery diarrhea persisted for the next three months. This was accompanied by persistent hypokalemia despite sufficient electrolyte correction. On work up, thyroid function test and 5HIAA level were unremarkable. VIP level was elevated at 320 pg/mL (normal < 75 pg/mL). CT scan of the whole abdomen revealed a heterogeneously enhancing pancreatic tail mass measuring 4.0 x 6.6 x 4.1cm. Distal pancreatectomy with peripancreatic lymph node dissection and splenectomy were subsequently done. Frozen section revealed well-differentiated pancreatic neuroendocrine tumor. Immunohistochemical stains were positive for chromogranin and synaptophysin with 1% ki-67. Final staging for the VIPoma were as follows: WHO and ENETS histological classification low grade, G1; AJCC staging for PNET stage 1B; ENETS Classification Stage IIB. The patient’s aforementioned symptoms completely resolved post-operatively. Conclusion: The diagnosis of VIPoma is usually delayed due to its nonspecific manifestations. If it is left untreated, it may lead to renal failure and death. Hence, there should be a high index of suspicion for VIPoma in patients with chronic watery diarrhea and persistent hypokalemia. Reference: 1. Abu-Zaid, A., Azzam, A., Abudan, Z., Algouhi, A., Almana, H., Amin, T. Sporadic pancreatic vasoactive intestinal peptide-producing tumor (VIPoma) in a 47-year-old male. Hematol Oncol Stem Cell Ther. 2014; 7(3): 109-115.