Background The use of mobile health technologies has been necessary to deliver patient education to patients with diabetes during the COVID-19 pandemic. Objective This open-label randomized controlled trial evaluated the effects of a diabetes educational platform—Taipei Medical University–LINE Oriented Video Education—delivered through a social media app. Methods Patients with type 2 diabetes were recruited from a clinic through physician referral. The social media–based program included 51 videos: 10 about understanding diabetes, 10 about daily care, 6 about nutrition care, 21 about diabetes drugs, and 4 containing quizzes. The intervention group received two or three videos every week and care messages every 2 weeks through the social media platform for 3 months, in addition to usual care. The control group only received usual care. Outcomes were measured at clinical visits through self-reported face-to-face questionnaires at baseline and at 3 months after the intervention, including the Simplified Diabetes Knowledge Scale (true/false version), the Diabetes Care Profile–Attitudes Toward Diabetes Scales, the Summary of Diabetes Self-Care Activities, and glycated hemoglobin (HbA1c) levels. Health literacy was measured at baseline using the Newest Vital Sign tool. Differences in HbA1c levels and questionnaire scores before and after the intervention were compared between groups. The associations of knowledge, attitudes, and self-care activities with health literacy were assessed. Results Patients with type 2 diabetes completed the 3-month study, with 91 out of 181 (50.3%) patients in the intervention group and 90 (49.7%) in the control group. The change in HbA1c did not significantly differ between groups (intervention group: mean 6.9%, SD 0.8% to mean 7.0%, SD 0.9%, P=.34; control group: mean 6.7%, SD 0.6% to mean 6.7%, SD 0.7%, P=.91). Both groups showed increased mean knowledge scores at 12 weeks, increasing from 68.3% (SD 16.4%) to 76.7% (SD 11.7%; P<.001) in the intervention group and from 64.8% (SD 18.2%) to 73.2% (SD 12.6%; P<.001) in the control group. Positive improvements in attitudes and self-care activities were only observed in the intervention group (attitudes: mean difference 0.2, SD 0.5, P=.001; self-care activities: mean difference 0.3, SD 1.2, P=.03). A 100% utility rate was achieved for 8 out of 21 (38%) medication-related videos. Low health literacy was a significant risk factor for baseline knowledge scores in the intervention group, with an odds ratio of 2.80 (95% CI 1.28-6.12; P=.01); this became insignificant after 3 months. Conclusions The social media–based program was effective at enhancing the knowledge, attitudes, and self-care activities of patients with diabetes. This intervention was also helpful for patients with low health literacy in diabetes knowledge. The program represents a potentially useful tool for delivering diabetes education to patients through social media, especially during the COVID-19 pandemic. Trial Registration ClinicalTrials.gov NCT04876274; https://clinicaltrials.gov/ct2/show/results/NCT04876274

Background Papillary thyroid carcinoma (PTC) is the most common type of malignant thyroid neoplasm. However, the incidence of PTC with autoimmune thyroid disease (AITD) varies between studies. This study aims to investigate whether patients with AITD have increased incidence of PTC. We also analyzed the relationship of serum thyroid-stimulating hormone (TSH) levels and PTC in relation to AITD based on histopathological data. Methods A total of 533 participants who underwent thyroidectomy were enrolled in this retrospective study based on clinicohistopathological data and known thyroid autoantibodies. Patients were divided into PTC and benign groups according to histopathologic diagnosis. Age, gender, body mass index, and serum TSH level before thyroidectomy were recorded. Results Of the 533 enrolled patients, 159 (29.8%) were diagnosed with PTC, of which 38 (35.5%) had Hashimoto's thyroiditis (HT). More patients with HT were female, and patients with HT, Graves' disease, and thyroid nodules with higher TSH level had a higher incidence of PTC. Conclusions A high proportion of the patients with PTC had HT. There was a trend that a higher serum TSH level was associated with a greater risk of thyroid cancer.

A 68-year-old woman was sent to the emergency department (ED) because of alterations in her level of consciousness. The patient had polydipsia and experienced a weight loss of about 6 kg, which was associated with progressive general weakness over a period of several months. Intermittent diaphoresis and palpitation with occasional headache were also noted. She had no known underlying systemic disease, such as hypertension or cardiac dysrhythmia. She denied taking any medication. She smoked 0.2 packs per day for 3 years, but denied taking either alcohol or illicit drugs. She denied a family history of diabetes mellitus (DM) or any familial diseases.At the ED, the patient's body mass index was underweight at 17.6 kg/m 2 . Her body temperature was 38.0°C, with a blood pressure of 199/118 mmHg, pulse rate 129 beats per minute, and respiratory rate 18 breaths per minute. The oxygen saturation was 93 % while she was breathing in ambient air. The laboratory data showed a newly-diagnosed DM complicated with a hyperosmolar hyperglycemic state (serum glucose at 1836 mg/dl, serum sodium 124 mmol/l, hemoglobin A1 C 14.4 %, and effective osmolality 350 mOsm/kg). After adequate hydration, insulin therapy and appropriate antibiotics for suspected aspiration pneumonia, the patient's blood sugar improved and the fever subsided. During hospitalization, blood pressures were 100-120/60-70 mmHg without any sign of hypertension or signs suggestive of orthostatic changes.However, on the 20th hospital day, the patient had a second bout of fever with sepsis-like presentation (high fever 39.3°C, tachycardia 110 beats per minute, tachypnea, but without leukocytosis) that was refractory to antibiotic therapy. Abdominal sonography was performed to search for the infection focus, which revealed an intraabdominal tumor near the liver and kidney. A subsequent computed tomography confirmed a 4-cm solid heterogeneous mass lesion in the right adrenal gland (Fig. 1a). Based on the patient's clinical presentations (markedly elevated blood pressure at ED, history of intermittent palpitation, and unusual fever), a pheochromocytoma was highly likely. Collection of 24-h urine for catecholamine and vanillylmandelic acid (VMA) levels showed the isolated elevation of epinephrine levels. Repeated collection of urinary examination for catecholamines and VMA levels were performed after the patient was free from her acute illness showed similar results (Table 1). Pre-operative treatment with a-and b-blockade treatment were given to the patient, and she underwent uneventful laparoscopic right adrenalectomy. The pathological examination confirmed our diagnosis of pheochromocytoma (Fig. 1b). The patient remained symptom-free with normal urinary catecholamines excretion after 6 months of post-operative follow-up. Her DM is presently under good glycemic control (hemoglobin A1 C 6.1 %) using an oral antidiabetic agent (metformin 250 mg daily). Moreover, she gradually gained weight to a body mass index of 23.4 kg/m 2 . Pheochromocytoma is a rare catecholamine-produc...

Vitamin D deficiency is associated with hyperlipidemia, but it remains unclear whether vitamin D supplementation reduces serum lipid levels. The aims of this study were to investigate the associations between increased serum 25-hydroxyvitamin D (25(OH)D) concentrations and lipid levels, and identify the characteristics of people with or without lipid reduction associated with increased 25(OH)D levels. The medical records of 118 individuals (53 men; mean age, 54.4 ± 10.6 years) whose serum 25(OH)D levels increased between two consecutive measurements were retrospectively reviewed. People with increased 25(OH)D levels (from 22.7 (17.6–29.2) to 32.1 (25.6–36.8) mg/dL; P < 0.01) had a significant reduction in serum levels of triglycerides (TG) (from 111.0 (80–164) to 104.5 (73–142) mg/dL; P < 0.01) and total cholesterol (TC) (from 187.5 (155–213) to 181.0 (150–210) mg/dL; P < 0.05). The individuals who responded to vitamin D (≥10% reduction in TG or TC levels) exhibited significantly higher baseline TG and TC levels than did those who did not. Only patients with hyperlipidemia (not those without hyperlipidemia) at baseline exhibited significantly reduced TG and TC levels at follow-up. However, increasing serum 25(OH)D concentrations were significantly correlated with decreasing lipid levels in individuals with baseline 25(OH)D levels less than 30 ng/mL, and in individuals aged 50–65 years (not in patients younger than 50 years or older than 65 years). In conclusion, increasing serum 25(OH)D concentrations may be potentially helpful for the treatment of hyperlipidemia in people with vitamin D deficiency.