Daad H. Akbar

Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics.

Abstract Diabetes mellitus and thyroid disease are common endocrine disorders in the general population. To investigate the association between thyroid dysfunction, thyroid autoimmunity and Saudi type 2 diabetics, a random sample of 100 Saudi type 2 diabetics and 100 age- and sex-matched controls were studied. The mean age was 54 years for diabetics and 55 years for controls while the male:female ratios were 1:1.6 and 1:14 respectively. GAD65ab were found in 26% diabetics and 2% controls (p=0.001). Thyroid autoimmunity were detected in 10% diabetics vs. 5% controls (p=0.05), while thyroid dysfunction was found in 16% and 7% respectively (p=0.03). In GAD65ab-positive diabetics, thyroid autoimmunity was observed in 27% vs. 4% GAD65ab-negative diabetics (p=0.02) and thyroid dysfunction was reported in 42% and 7% respectively. We conclude that thyroid dysfunction and autoimmunity are common in Saudi type 2 diabetics. Further studies are needed on the cost effectiveness of thyroid screening in diabetics.

Effect of metformin and sulfonylurea on C-reactive protein level in well-controlled type 2 diabetics with metabolic syndrome.

The objective of this study was to examine the effect of the antihyperglycemic agents metformin (insulin sensitizer) and glibenclamide (insulin secretory agent) on the serum level of C-reactive protein (CRP) in well-controlled type 2 diabetics with metabolic syndrome. The participants were diabetic patients being followed in the medical outpatient clinic of King Abdulaziz University Hospital. The inclusion criteria were type 2 diabetics with the metabolic syndrome, well-controlled blood glucose on metformin alone or glibenclamide alone, and exclusion of major medical illness. Patients were divided into two groups according to the antihyperglycemic agent used. CRP level was measured 4-wk apart and the mean was calculated. The following data were collected from the study groups: age, sex, body mass index (BMI), duration of diabetes, smoking history, presence of hypertension, hyperlipidemia, and mean CRP level. A total of 110 patients were studied, 65 using metformin and 45 using glibenclamide. CRP level was significantly lower in patients using metformin for blood glucose control compared with those using glibenclamide, 5.56 and 8.3 mg/L, respectively (p=0.01). A significantly higher level was observed in hypertensive and hyperlipidemic patients compared with normotensive and normolipidemic, 5.3 vs 3.2 mg/L and 7.1 vs 4.3 mg/L, respectively (p=0.02, 0.01). There was a statistically significant correlation between CRP and BMI (r=0.37) and age (r=0.36) (all p=0.01). The data showed that metformin decreases the level of circulating CRP, a marker of inflammation, more than glibenclamide.

Bacterial pneumonia: comparison between diabetics and non-diabetics.

Abstract To determine the causative organisms, antimicrobial susceptibility, and outcome of community- and hospital-acquired pneumonia in diabetics and to compare this with non-diabetics, sputum cultures done at King Abdulaziz University Hospital in the period between January 1998 and December 1999 were reviewed. A total of 354 cases were studied, of which 125 (35%) were diabetics. Diabetic patients were older with a male predominance compared to non-diabetics. H. influenza was the commonest pathogen in community-acquired pneumonia (CAP) in both diabetics and non-diabetics, but there was a predominance of Staphylococcus aureus in diabetics compared to non-diabetics. Gram-negative bacilli were the commonest pathogens in hospital-acquired pneumonia (HAP) in both diabetics and non-diabetics. Ampicillin, co-amoxyclav, flouroquinolones, second-generation cephalosporins and erythromycin were used empirically in CAP while aminoglycosides, fluoroquinolones and imipenem were used in HAP in both diabetics and non-diabetics. No significant difference in mortality was found between diabetics and non-diabetics, for either CAP or HAP

Prevalence of Type-2 Diabetes in Patients with Hepatitis C and B Virus Infection in Jeddah, Saudi Arabia

Objectives: To determine the prevalence of type-2 diabetes mellitus (DM) in patients with hepatitis C virus (HCV) and B virus (HBV) infections. Materials and Methods: A cross-sectional study of HCV- and HBV-positive patients admitted to King Abdul Aziz University Hospital, Jeddah, Saudi Arabia, was conducted from January 1999 to September 2000. The following data were collected and analysed: demographic data, the presence and type of DM, details of the treatment, body mass index (BMI), family history of DM, serum transaminases, thrombocytopenia, and presence of liver cirrhosis on liver biopsy. A total of 399 patients were included in the study. Results: 165 (41%) were anti-HCV positive and 234 (59%) were HBsAg positive. Type-2 diabetes was present in 35 of 165 (21.2%) patients with HCV infection, and 33 of 234 (14.1%) with HBV infection. 94% of anti-HCV-positive type-2 diabetes were older than 40 years and 6% were younger, while for nondiabetics the corresponding percentages were 55 and 45%, respectively. 76% of HBsAg-positive type-2 diabetics were older than 40 and 24% were younger, while the corresponding percentages for nondiabetics were 27 and 73%, respectively. Anti-HCV-positive type-2 diabetics, when compared to nondiabetics, had a higher BMI, a frequent family history of DM, elevated serum transaminases, thrombocytopenia, and liver cirrhosis on biopsy. HBsAg-positive type-2 diabetics had only a more frequent family history of DM than did nondiabetics. Conclusion: Our findings indicate that type-2 diabetes is more common in patients with an HCV than with an HBV infection.

Candidemia at a University Hospital: epidemiology, risk factors and predictors of mortality.

BACKGROUND Blood stream infection due to candida species are becoming increasingly important causes of morbidity and mortality in hospitalized patients. The aim of this study was to obtain epidemiological data on candidemia in patients at King Abdulaziz University Hospital (KAUH), and to discuss the influence of several clinical variables on the development and outcome of candidemia. MATERIALS AND METHODS Demographic information, risk factors, therapy and outcome of all patients who had candidemia at KAUH between January 1998 and December 1999 were reviewed. RESULTS Thirty-one candidemic episodes were identified. All the candidemic episodes were hospital acquired. The most common risk factors to candidemia were central venous catheters (87%), stay in intensive care unit (ICU) (77%), and broad-spectrum antibiotics therapy (74%). Candida albicans was the most frequently isolated species (71%), followed by candida tropicalis and candida parapsilosis (13% each). Twenty-six patients (84%) were treated with amphotericin B, 4 (13%) with fluconazole, and one (3%) with ketoconazole. Antifungal susceptibility testing of the isolates in general revealed minimal levels of resistance to amphotericin B (3%) versus 39% resistance to fluconazole. Less than 5% of Candida albicans were resistant to amphotericin B, in comparison with >35% of these strains that were resistant to fluconazole. The overall mortality was 71%. Mortality was significantly associated with the presence of central venous catheters (P=0.001), stay in intensive care unit (P<0.001), and prolonged hospital stay before the onset of candidemia (P=0.05). CONCLUSION Despite antifungal treatment, the mortality of candidemia is still high. Rapid changes in the rate of infection, potential risk factors, and emerging species demand continued and close surveillance of this serious infection.

Comparison between the effect of glibenclamide and captopril on experimentally induced diabetic nephropathy in rats

Hypothesis: This study aimed to elucidate the role of glibenclamide in the prevention of diabetic nephropathy and to compare it with a reference drug captopril in rats. Materials and methods: There were two main groups of rats. Control group (I) was subdivided into four subgroups which received distilled water, vehicle of streptozotocin, glibenclamide or captopril. The streptozotocin-diabetic Group (II) was subdivided into three subgroups: untreated, glibenclamide or captopril treated. Measurement of arterial blood pressure, serum glucose and creatinine levels, 24 h urinary protein and albumin/creatinine ratio, kidney weight and its histological examination were done after 1, 2, 4, 8, 12 and 16 weeks of treatment. Results: In treated diabetic rats captopril reduced blood pressure significantly, while no significant change in the mean arterial blood pressure or blood glucose level was recorded with glibenclamide treatment. Glibenclamide and captopril-treated diabetic rats showed significant decrease in serum creatinine level, urine volume, urinary protein excretion, albumin:creatinine ratio and kidney:body weight ratio compared with the diabetic non-treated group. Histological examination of diabetic kidneys treated with either glibenclamide or captopril showed reduced glomerular hypertrophy, glomerulosclerosis, tubular degeneration and interstitial fibrosis compared with untreated diabetic rats. Conclusion: Glibenclamide attenuated some biochemical and histological changes produced by diabetic nephropathy, despite persistent hyperglycemia and hypertension.

Poor lipid control in type-2 diabetics with and without ischemic heart disease

To determine the frequency of type-2 diabetics who have target lipoprotein blood levels, to study these levels in patients with ischemic heart disease and cardiovascular disease risk factors, and to study the possible causes of poor control, we reviewed hyperlipdemic type-2 diabetics who were on regular follow up to the medical outpatient clinic of King Abdulaziz University Hospital from January 2000 to January 2001. A total of 202 patients were studied with mean age of 60 yr and equal male to female ratio. The mean duration of diabetes was 10 yr and it was 7 yr for hyperlipidemia. The mean level of LDL was 3.15 mmol/L and it was 1.0 mmol/L and 2.47 mmol/L for HDL and TG, respectively. Only 31% of patients had LDL < 2.6 mmol/L, 28% had HDL > 1.1 mmol/L, and 37% had TG < 1.7 mmol/L. No significant difference was found in the frequency of target level of LDL in patients with IHD and those without; 26% vs 34% (0.4). Similarly, no difference was found in those with hypertension, obesity, and patients with family history of IHD compared to those without these risk factors; 30%, 26%, 16% vs 34%, 36%, 33% (p=0.2, 0.1, 0.4, respectively). Males were found to have a higher frequency of target LDL level compared to females; 38% vs 25% (p=0.04). Poor diet restriction was found in 90% of patients’ with poor control, lack of patients’ knowledge in 62%, 70% have financial reasons, 86% of patients on multiple medications, and in 16% the treating physician took no proper action. In conclusion, a low frequency of type-2 diabetics have target levels of lipoproteins. Diabetics with IHD and CVD risk factors also have poor lipid control. Poor control was associated with poor diet compliance and use of multiple medications. Proper management and control of this disease is needed among elderly patients.

Estimation of insulin resistance in non-diabetic normotensive Saudi adults by QUICKI, HOMA-IR and modified QUICKI: a comparative study.

Background and Objectives :Identification of insulin resistance (IR) in the general population is important for developing strategies to reduce the prevalence of non-insulin-dependent diabetes mellitus (NIDDM). We used the original and a modified version of the Quantitative Insulin Sensitivity Check Index (QUICKI, M-QUICKI), and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) to divide non-diabetic normotensive adults into high- (HIR) and low-insulin-resistant (LIR) subgroups to investigate similarities and differences in their characteristics. Subjects and Methods : Three hundred fifty-seven healthy adults aged 18-50 years were recruited randomly from health centers in Jeddah in a cross-sectional study design. Anthropometric and demographic information was taken. Insulin, glucose, lipid profile and free fatty acid were determined in fasting blood samples. M-QUICKI, HOMA-IR and QUICKI were calculated. Reported cut-off points were used to identify HIR subjects, who were then matched for age and sex to others in the study population, resulting in 3 HIR and 3 LIR subgroups. Results : Two hundred nine subjects satisfied the selection criteria. M-QUICKI correlated significantly (P=.01) with HOMA-IR and QUICKI values. Increased adiposity was the common characteristic of the three HIR subgroups. HIR subgroups identified using M-QUICKI (97 subjects) and HOMA (25 subjects), but not QUICKI (135 subjects), had statistically different biochemical characteristics compared to corresponding LIR sub-groups. Conclusion : Adiposity, but not sex, is a risk factor for IR in the studied population. Further studies are needed to choose the most appropriate index for detecting IR in community-based surveys.

Diabetes mellitus and viral hepatitis: the unsolved mystery

Abstract. Diabetes mellitus is a common endocrine disorder that is becoming a major public health problem. Viral hepatitis infection is one of the most common causes of chronic liver disease. Several reports from different parts of the world found an association between these two common disorders. In this review we highlight some of the epidemiological aspects of these two disorders, discussed some of the possible mechanisms and questions to be answered to understand this link and be able to solve this mystery.

Bacterial Pneumonia at King Abdulaziz University Hospital: A Comparison between Hospital- and Community-Acquired

Objectives: To compare community- and hospital-acquired pneumonia (CAP, HAP) with respect to causative organisms, antimicrobial susceptibility, mortality and risk factors associated with high mortality. Methods: From March 1998 to December 1999, the medical charts of patients at King Abdulaziz University Hospital older than 14 years of age with a diagnosis of pneumonia were reviewed. The following data regarding the patient’s age, sex, type of pneumonia, admission to intensive care unit (ICU), type of organism isolated, antibiotic susceptibility, outcome, presence of hypotension, tachycardia, tachypnea, disturbed level of consciousness, and renal failure were recorded. Results: A total of 324 patients were studied (248 HAP, 76 CAP). Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae were the commonest isolates in CAP, while Pseudomonas spp. and Enterobacter spp. were more common in HAP. Pathogens isolated from CAP were more susceptible to ampicillin, co-amoxiclav, ciprofloxacin, cefuroxime, tetracycline and erythromycin, whereas isolates of HAP showed more sensitivity to aminoglycosides and imipenem. Mortality was higher in HAP compared to CAP: 50 versus 21%, respectively (p < 0.001). Risk factors associated with high mortality were a more advanced age, tachycardia, hypotension, a disturbed level of consciousness, renal failure and ICU admission. Conclusion: Older less expensive antibiotics can still be used in the treatment of both CAP and HAP, while the newer more expensive antibiotics should be kept in reserve to prevent the development of resistance.