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  Bidirectional Relationship between COVID-19 and Diabetes Abstract In December 2019, novel coronavirus 2019 has appeared in china, eventually spread to other countries. Many studies on COVID-19 have reported its strong relationship with Diabetes Mellitus (DM). It is discovered that not only diabetes is a key risk factor for developing severe COVID-19, but also the virus might trigger DM in some cases. The aim of this review to show the bidirectional relationship between COVID-19 and DM. Keywords:  COVID-19, Bidirectional relationship, Diabetes, Diabetes Mellitus, Single-stranded RNA viruses, Ketoacidosis, Hyperosmolarity, Glucose homeostasis, Renin Angiotensin System, Pathophysiological Introduction Coronaviruses are enveloped, positive single-stranded RNA viruses widely distributed in humans and animals worldwide [1]. The outbreak of a new coronavirus, termed officially by the World Health Organization (WHO) coronavirus disease-2019 (COVID-19) and the international committee on taxon

Malignant Duodenal Obstruction Caused by Urothelial Carcinoma Abstract A 79-year-old male presented with several weeks of abdominal pain associated with nausea and vomiting. He was found to have an obstruction of the duodenum and hepatobiliary system that was highly suggestive of malignancy. A thorough evaluation revealed no indication of metastatic disease. The patient elected to undergo a palliative, if not potentially curative, Whipple procedure. After a successful operation, the final report from pathology was highly unexcepted. The patient’s duodenal obstruction had been caused by metastatic urothelial carcinoma within the pancreas. Metastatic disease to the pancreas is an exceptionally rare occurrence, more so when considering occult primary tumors of urogenital origin. This is the first description of a patient presenting with duodenal obstruction caused by urothelial carcinoma metastasizing to the pancreas. The following case highlights the aggressive nature of this disease whi

  K-Ras Plasma Membrane Interactions: A Tractable Therapeutic Target Annotation Ras proteins are small GTPases that function like a molecular switch regulating cell proliferation, survival and differentiation at the plasma membrane (PM). Of the three major Ras isoforms, constitutively active mutations in K-Ras are frequently found in human cancers. Despite its critical role in tumorigenesis, no anti-K-Ras therapies are currently available in clinic. One strategy for blocking oncogenic K-Ras activity is to disrupt K-Ras interaction with the PM since K-Ras must primarily interact with the PM for its biological activity. This review will provide insights into recently reported molecular mechanisms that regulate K-Ras from the PM, which can be targeted to disrupt oncogenic K-Ras signaling. Ras small GTPases are central regulators of cell proliferation, differentiation, survival and apoptosis. Consistent with this key regulatory role, constitutively active mutations of Ras are present in ~1

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  Encephalopathy Due to Urea Cycle Disorder Post Gastric Bypass Surgery Introduction Obesity is implicated in multiple health care problems including cardiovascular diseases, diabetes and increased frequency of some cancer types such as colon cancer [1-3]. Obesity is on the high rise in developed societies due to lifestyle modifications and diet shifts from healthy diet to junk food and from active life to sedentary living style [4]. In the late 20th century and due to the exponential increase in the burden of obesity on the health care system, bariatric surgeries gained popularity as a solution for such a problem [5]. Gastric bypass surgery (GBS) is considered the benchmark for any weight loss surgery, as it accounted for almost 50% of all weight loss surgeries performed in 2018 [5,6]. It is prescribed as a management solution for people with morbid obesity having a BMI>40Kg/m2 or >35Kg/ m2 with any other comorbid disease such as diabetes, hypertension and sleep apnea [6]. As an

  Thyrotoxic Periodic Paralysis Presenting with Hypokalemia: A Case Report Abstract Background:  Thyrotoxic periodic paralysis (TPP), a serious complication of hyperthyroidism, is a common etiology of secondary hypokalemic periodic paralysis (HPP). In this study, we present a case report of a patient who presented to our ED with weakness and hypokalemia and was found to have severe hyperthyroidism. Case presentation:  A 29-year-old Chinese man presented to our Emergency Department complaining of feeling very weak and tired for 8 hours. The weakness was limited to his four limbs. On physical examination, he was conscious and oriented to place, persons, and time. Upper and lower limb exams showed a power of 4/5 with normal sensation and an absence of Babinski signs. The initial blood work was normal, except for mild hypokalemia; therefore, the initial plan was to start him on one liter of IV normal saline mixed with 40 mEq KCl over 4 hours before repeating the laboratory investigations.