BACKGROUND: Squamous cell carcinoma (SCC) of the thyroid is a rare condition comprising less than 1% of all thyroid malignancies. Thyroid SCC is a variant of undifferentiated thyroid carcinoma and is also associated with the tall-cell variant of papillary thyroid carcinoma (PTC) and spindle cell carcinoma. Given its aggressive clinical course, early recognition of the disease is essential to management. CASE: We report a rare case of a 67-year-old, Filipino male initially presenting with an anterior neck mass over a period of 11 months. This was accompanied by compressive symptoms, anorexia, and easy fatigability. He underwent total thyroidectomy with histopathology consistent with diffuse sclerosing variant of PTC with squamous differentiation. The patient had rapid tumor growth, tumor recurrence, nodal metastasis, and invasion of local structures within a year after his initial presentation. He underwent completion thyroidectomy and selective neck dissection and concurrent chemo-radiotherapy with a course of radiation (60 Gy in 33 fractions) and chemotherapy with Carboplatin and Paclitaxel. After 13 months of initial presentation, the patient eventually succumbed to cardiac arrest. CONCLUSION This transformation of the thyroid is an aggressive malignancy with increased mortality; hence it should be considered in cases presenting with progressive clinical behavior. Due to his aggressive disease, the patient’s nutritional status, airway protection, and immunity were compromised. A combined modality with surgery, radiotherapy, and chemotherapy to prevent disease progression may be needed due to its aggressive clinical course.

Objective: To determine the association between serum 25-hydroxyvitamin D (25(OH)D) and measures of glycemic control, hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG), in adult patients with diabetes mellitus. Methodology: This is an analytical cross-sectional study of 270 patients with diabetes admitted to a tertiary hospital. Serum 25(OH)D levels were categorized as follows: sufficient (>30 ng/mL), insufficient (20 to 30 ng/mL), and deficient (<20 ng/mL). The correlation of HbA1c and FPG with serum 25(OH)D and other variables was determined using Spearman’s rho (ρ) coefficient. The risk factors associated with HbA1c ≥7% and FPG ≥126 mg/dL were determined using logistic regression analysis to generate crude and adjusted odds ratios. The null hypothesis was rejected at 0.05 α-level of significance. Results: The median serum 25(OH)D was 18.92 (range 3.56–56.3) ng/mL. Ninety percent (245 patients) had vitamin D levels below 30 ng/mL. This study showed that vitamin D level is significantly but weakly correlated with patient’s age (ρ=0.339) and duration of diabetes (ρ=0.147), whereas it had inverse correlations with BMI (ρ=-0.134), HbA1c (ρ=-0.261), and FPG (ρ=-0.198). Conclusion In this study, we found a possible association between vitamin D levels and measures of glycemic control among this group of adult Filipino patients with diabetes mellitus, but further investigations in other cohorts of individuals with diabetes are needed.
Vitamin D ; diabetes mellitus ; glycemic control

Background: Although elevated glucose levels are associated with adverse outcomes in the critically ill, HbA1c-based adjusted glycemic variables have not been extensively utilized as a tool to evaluate patients in the acute critical condition. Objective: This study aims to determine whether glycemic gap can predict adverse outcomes in patients with type 2 diabetes diagnosed with COVID-19. Methodology: A single center and retrospective study of adult patients with type 2 diabetes diagnosed with COVID- 19. Glycemic gap was calculated as the difference between the admission blood glucose and A1c‐derived average glucose. Logistic regression was used to determine association of glycemic gap and several adverse clinical outcomes. A decision curve analysis was used to determine the clinical utility of a clinical decision model based on this cut-off. Results: A total of 150 diabetic patients with COVID-19 were analyzed. Median baseline HbA1c was 7.5% (range 4.79–18.42), while median admitting blood glucose was 196 (range 71–506) mg/dL. From these, computed glycemic gaps ranged from -180.5 to 312.8 mg/dL, with a median of 13.75 mg/dL. On univariate analysis, for every unit increase in glycemic gap, odds of developing ARDS increased five times (cOR 4.798, 95% CI 2.08 to 11.09); odds of developing shock increased four times (cOR 4.48, 95% CI 1.48 to 13.44). No single cut-off value for glycemic gap was able to discriminate patients with favorable outcome from those with adverse outcome. The decision curve analysis graphically shows that glycemic gap has a positive net benefit for threshold risk of 50% or higher. Conclusion Higher glycemic gaps were significantly associated with increased risk for poor outcomes in diabetic patients with COVID-19. Glycemic gap should be correlated with clinical status and other laboratory parameters to make it a more powerful discriminant among COVID-19 infected patients.
Diabetes Mellitus, Type 2 ; COVID-19