Introduction: Treatment of type 2 diabetes (T2DM) in patients with obesity can be challenging. Metabolic and bariatric surgery (MBS) has shown promising results in improving glycemic control and even achieving remission in T2DM patients with obesity. However, the durability of glycemic improvements in T2DM patients following MBS remains insufficiently studied. Aim: Determine the incidence of durable remission and relapse of T2DM rates 10 years after MBS, characterize the glycemic profile after surgery, and identify factors predicting persistent remission of T2DM. Methods: Retrospective observational study of T2DM patients undergoing MBS between 2010 and 2013. Clinical and analytical assessments were performed preoperatively, at 2- and at 10-years postoperatively. Paired t-tests, Wilcoxon-signed-rank and McNemar tests were used to assess the differences in the metabolic status during the follow-up. Logistic regression models were used to identify predictors of T2DM remission. Results: Ninety-five patients were included (mean age 48.8 ± 9.1 years, mean HbA1c 7.0 ± 1.5%). Ten years after surgery, the rate of complete T2DM remission was 31%, partial remission was 15%, and late recurrence after initial remission was 24%. Patients with lower HbA1c (OR = 0.50; p = 0.05) and taking fewer antidiabetic drugs (OR = 0.31; p = 0.01) preoperatively were more likely to maintain long-term remission. Ten years post-MBS, patients maintained lower fasting plasma glucose (p < 0.001), HbA1c (p < 0.001), number of antidiabetic drugs (p < 0.001), and insulin use (p < 0.001). Conclusion: MBS can induce a significant improvement and sustainable remission of T2DM. Early intervention, while patients still have a good glycemic control with a lower number of anti-diabetic drugs, is crucial to achieve long-lasting benefits and a potential "surgical cure" for T2DM.

Non-alcoholic fatty liver disease (NAFLD) is associated with several other metabolic disorders, which are typically pro-inflammatory states. Body fat content is an important marker of metabolic health and abdominal fat is associated with harmful cardiometabolic outcomes. We aimed to evaluate the association between the risk of NAFLD (through Fatty Liver Index (FLI), and BMI, AST/ALT ratio, and presence of diabetes (BARD)), and anthropometric parameters, predictors of metabolic status, in patients with morbid obesity, and to evaluate the association of FLI and BARD scores with pro-inflammatory markers. We have retrospectively studied patients with morbid obesity followed in our center. In total, 2184 participants were included, with an average age of 42.8 ± 10.6 years, 84.5% being females. We report a positive association of FLI with waist circumference (β = 0.10 [0.09 to 0.11], p < 0.01) and waist-to-hip ratio (β = 8.68 [6.85 to 10.52, p < 0.01]), even after adjusting for age, sex, body mass index, diabetes, and dyslipidemia (p < 0.01 for both adjusted models). The associations of BARD with anthropometric measures were significant only in the non-adjusted model. There was a positive association between both FLI and BARD and C-reactive protein. Our results point towards a positive association between waist-to-hip ratio and the risk of hepatic steatosis, and between pro-inflammatory markers and both hepatic steatosis and fibrosis.

Introduction: The COVID-19 pandemic has led to a worldwide lockdown, which affected physical exercise habits, as well as having a detrimental effect on psychological health and follow-up visits of patients submitted to bariatric surgery. The aim of this study was to evaluate the impact of COVID-19 lockdown on the 2-year weight loss of patients submitted to bariatric surgery in our center. Methods: This was an observational study comparing the weight loss of patients who underwent bariatric surgery from January to March 2020 with a control group submitted to surgery between January and March 2017. Percentage of total weight loss (% TWL) and excess weight loss (% EWL) were assessed 6, 12, and 24 months after surgery. Results: A total number of 203 patients were included in this study, 102 had bariatric surgery during the selected period in 2020 and 101 underwent surgery during the same period in 2017. There was no statistically significant difference in weight loss between the 2017 and 2020 groups which was reported as % TWL (mean 27.08 ± 7.530 vs. 28.03 ± 7.074, 33.87 ± 8.507 vs. 34.07 ± 8.979 and 34.13 ± 9.340 vs. 33.98 ± 9.993; p = 0.371) and % EWL (mean 66.83 ± 23.004 vs. 69.71 ± 17.021, 83.37 ± 24.059 vs. 84.51 ± 21.640 and 83.47 ± 24.130 vs. 84.27 ± 23.651; p = 0.506) at 6, 12, and 24 months post-surgery. Conclusion: Despite social limitations imposed by the COVID-19 lockdown, we found no significant difference between weight loss at 2 years postoperatively in the 2020 group when compared with a control group who underwent bariatric surgery in 2017. These results show that the outcomes of bariatric surgery during the COVID-19 lockdown were comparable with those recorded before the pandemic, supporting the efficacy of bariatric procedures’ metabolic effects during the first 2 years after surgery, regardless of lifestyle habits.

Summary: X-linked hypophosphatemic (XLH) is the most common inherited form of rickets, caused by inactivating mutations in the PHEX gene. Resultant overproduction of fibroblast growth factor 23 (FGF23) leads to renal phosphate wasting, reduced 1,25-dihydroxyvitamin D (1,25(OH)₂D) levels, and impaired bone mineralization. We describe 26-year-old male monozygotic twins with lifelong skeletal deformities, short stature, and chronic bone pain. Despite hallmark features of rickets, both were misdiagnosed for decades and developed progressive functional impairment. Biochemical investigations revealed persistent hypophosphatemia, elevated alkaline phosphatase, reduced tubular maximum reabsorption of phosphate per glomerular filtration rate (TmP/GFR), normal calcium and parathyroid hormone, and inappropriately normal 1,25(OH)₂D. Radiographs showed pseudofractures, consistent with osteomalacia. The twins were born from a triplet pregnancy; their dizygotic female sibling remained asymptomatic and biochemically normal. Genetic analysis revealed a novel de novo hemizygous deletion in exon 22 of PHEX, confirming the diagnosis of XLH. Both patients initiated conventional therapy with oral phosphate and calcitriol, resulting in notable clinical improvement, including restored ambulation and reduced pain. To our knowledge, this is the first documented case of phenotypically concordant XLH in monozygotic twins caused by a previously unreported PHEX mutation. The presentation underscores the risk of diagnostic delays in XLH, particularly in sporadic cases without family history, and highlights the value of early molecular testing in complex skeletal disorders. Timely recognition and treatment of XLH are essential to prevent irreversible complications and improve long-term outcomes, even when initiated in adulthood. Learning points: XLH should be considered in patients with skeletal deformities, short stature, and recurrent dental abscesses. Diagnosis is frequently delayed due to variable phenotype and misdiagnosis as nutritional rickets or isolated orthopedic conditions. Biochemical findings of isolated hypophosphatemia with inappropriately normal 1,25(OH)₂D levels should prompt evaluation for FGF23-mediated phosphate-wasting conditions. In cases without family history, genetic testing remains essential to confirm XLH and may reveal de novo mutations with clinical and research relevance. Conventional therapy with phosphate and calcitriol may lead to meaningful clinical improvement, including restored mobility, even in adults with long-standing disease. This case contributes to the understanding of genotype–phenotype relationships in XLH, highlighting the potential value of twin studies in elucidating the genetic and non-genetic modifiers of disease expression.

Ovotesticular disorder of sex development (OT-DSD) is a rare condition characterized by the presence of both ovarian and testicular tissue in the gonads. Management and sex designation of these patients depend on several factors, and an underlying potential for gender dysphoria should be acknowledged. We present a case of a patient diagnosed with 46,XX OT-DSD at 12 months old who was attributed a female sex designation but started manifesting gender dysphoria during adolescence. Gender identity is an important factor to consider on long-term follow-up of OT-DSD patients.