We continuously underestimate the eating process: food and cooking methods play a pivotal role in our health. According to the Dietary Guidelines for Americans (DGA), more than 117 million American adults have one or more preventable chronic diseases, many of which are related to poor quality eating patterns and physical inactivity. Despite the usual belief about fat in the diet, it has shown that fat has a uniquely positive effect on blood lipid concentrations and cardiovascular risk factors. A low-carb/high-fat/fried-food (LCHFFF) diet has shown to be one of the best natural treatments in lipid profile and glycemia in a patient with metabolic syndrome.

Objective: Evaluation of patients' preferences (PP) impact on decision-making for solitary thyroid nodule management. Study Design: A retrospective review of prospectively collected data in patients with clinical solitary nodules admitted for thyroid surgery. PP survey in various management strategies included determinants of surgery, fine-needle aspiration cytology (FNAC), frozen section (FS), and PP for total thyroidectomy (TT) or total lobectomy (TL) compared to guidelines concordance. Results: Thyroid surgery was performed for 558 patients, 75.8% were females and 43.7% were international. FNAC was done in 79.8% and refused by 20.2% due to the misperception that it spreads cancer. The risk of malignancy was the reason for choosing surgery in 35.1%. FS was preferred by 87% of the patients for decision-making (TT vs TL) in our setting with available pathology resources and low FS cost. FS based decisions were more guideline-concordant (79%) with TT performed in 41% patients compared to 74.4% in PP based decisions alone (P < 0.001). 57.9% of the patients preferred surgeon authorization for decision-making when FS was unavailable. Papillary thyroid carcinoma (PTC) occurred in 85.3%. FS diagnosed PTC in 79% of the patients with malignant nodules in inconclusive FNACs (Bethesda I, III, IV, and V). Conclusion: Decisions (TT vs TL) based on PP and beliefs compared to FS based decisions were less guideline-concordant (21% vs 79%) with more TT performed (74.4% vs 41%) (P < 0.001). Advancing patients’ knowledge on their disease, guidelines, and equipoise awareness is needed for better-shared decision-making.

Aim and Objective: To find the association between polypharmacy and health consequences in type 2 diabetes mellitus (T2DM). Materials and Methods: 50 patients with multiple drugs (two or more) and morbidity, glycemic control, macrovascular complications, hospitalization, gastrointestinal disorders, cost of medicine were studied. History, physical examination, relevant investigation, and consequences of drugs were also studied. Results: Male to female: 32:18; average age: 44 years. Findings were: hyperglycemia is seen in 34 patients, hypoglycemia in 2, retinopathy in 10, coronary artery disease (CAD) by electrocardiogram (ECG) and 2D echo in 12, old myocardial infarction in 3, renal function test abnormality in 6, stroke in 2, hypertension in 15, dyslipidemia in 13, hypothyroidism in 3, and hospitalization due to any of the above in 5. Conclusion: Diabetes, a metabolic disorder, due to chronicity leads to macrovascular and microvascular complications which in turn are compelled to increase the number of medications due to uncontrolled hyperglycemia. More than two-third of patients in our study showed uncontrolled hyperglycemia. Diabetes has multiple sites and mechanisms of altered physiological and pathological processes. It is practical to have the requirement of more than two drugs when blood sugar in diabetes is not controlled. Also, it is obvious that the simultaneous use of more than one drug-having different mechanism of action appears to have an impact on treatments to control hyperglycemia. Sometimes, multiple drugs/therapy may give rise to undesirable side effects and it may be due to drug-drug or disease drug interaction. Furthermore, the activity of multiple targets by multiple drugs requires additional study. Multiple drugs in diabetes were seen more in males with geriatric age groups. Main reasons being comorbidities, which may be the main cause of morbidity and mortality, especially CAD, heart failure and diabetic cardiomyopathy. There is an indirect relationship between the glycemic control and the development and progression of clinical manifestations of comorbidities. Various comorbid diseases in diabetes require concomitant medications, that increases pill burden. Tailoring medical therapies to the patient’s biological characteristics may help to optimize disease treatment, thereby improving overall prognosis and decreasing comorbidities’ risk. Appropriate exercise and diet may reduce hyperglycemia with reduction in pill burden.

In the current COVID-19 pandemic, co-morbid metabolic syndromes are identified as important risk factors. The presence of metabolic syndrome not only increases mortality rate and probability of hospitalization but is also predicted to have a long-term impact on cognition. A decline in cognitive functioning and functional abilities can be seen in the COVID-19 survivors and it became accelerated by metabolic syndromes that include hypertension, diabetes mellitus, low HDL cholesterol, abdominal obesity, etc. In the present study, it was aimed to explore the cognitive status in COVID-19 survivors with and without metabolic syndrome. For this purpose, total 36 COVID-19 survivors participated who were divided into two groups, one with existing metabolic syndrome and the other without any significant co-morbidities. Mini-Mental State Examination (MMSE) and Brief Cognitive Rating Scale (BCRS) were administered to assess the cognitive status of the participants. Results suggest a significant difference between the groups in the domains of concentration and memory along with functioning and self-care.