Fatheya Alawadi

Comparison of Incidences, Hospital Stay and Precipitating Factors of Diabetic Ketoacidosis in Ramadan and the Following Month in Three Major Hospitals in United Arab Emirates. A Prospective Observational Study

1.7 billion Muslims worldwide obey religious commands of fasting for a month. This may increase morbidity in people with diabetes. Objective: Comparing the rate and duration of admissions with diabetic ketoacidosis and the leading precipitating factors during Ramadan and in the following month (Shawal) were our primary and secondary endpoints, respectively. Design and methods: This was a prospective study that included all Muslims who were admitted with DKA to three major hospitals in United Arab Emirates during Ramadan and Shawal. Demographics, clinical, and laboratory indices were collected and analyzed to assess primary and secondary end points. Results: 48 patients were admitted during the study duration, 20 were admitted during Ramadan and 28 in Shawal. All those admitted during Ramadan were people with type1 diabetes while 4 of those admitted during Shawal were people with type 2 diabetes. 75% of those admitted during Ramadan did not receive structured education program on diabetes management in Ramadan. Urinary tract infections represented the commonest cause for admission in both months. Hospital stay was longer during Ramadan compared to Shawal (p=0.04). The average HbA1c was lower in Ramadan group; moreover, frequency of DKA admissions in 6 months period before Ramadan was higher in Ramadan group (P= 0.05). Conclusion: Our study showed lower rate of DKA admissions, but longer hospital stay during Ramadan compared to the following month. The average HbA1c was lower in patients admitted during Ramadan; moreover, frequency of DKA admissions in 6 months period before Ramadan was higher in Ramadan group (P=0.05).

Novel approach to systematic random sampling in population surveys: lessons from the United Arab Emirates National Diabetes Study (UAEDIAB)

The prevalence of diabetes has risen rapidly in the Middle East, particularly in the Gulf Region. However, some prevalence estimates have not fully accounted for large migrant worker populations and have focused on minority indigenous populations. The objectives of the UAE National Diabetes and Lifestyle Study are to: (i) define the prevalence of, and risk factors for, T2DM; (ii) describe the distribution and determinants of T2DM risk factors; (iii) study health knowledge, attitudes, and (iv) identify gene–environment interactions; and (v) develop baseline data for evaluation of future intervention programs.

Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2-I) During the Month of Ramadan in Muslim Patients with Type 2 Diabetes

Objectives Sodium-glucose cotransporter 2 inhibitors (SGLT2-I) are a new class of antidiabetic drugs that might increase the risk of dehydration and hypoglycemia, particularly during the month of Ramadan in which Muslims abstain from eating and drinking for 14-16 hours daily. We aimed to provide real-life evidence about the safety of SGLT2-I during Ramadan. Methods All patients over the age of 18 years on SGLT2-I before Ramadan 2016 who would be fasting during Ramadan were included. Demographic data, detailed medical history including comorbidities and medication profile, and laboratory results were collected before and after Ramadan. We also conducted a phone interview to evaluate the frequency and severity of hypoglycemia and dehydration. Results Of the total of 417 patients, 113 (27.0%) experienced hypoglycemic events, and 93 of these (82.3%) checked their blood glucose using a glucometer. Confirmed hypoglycemia (< 70 mg/dL) was observed in 78 (83.8%). The hypoglycemic events were significantly more frequent in the SGLT2-I plus insulin-treated group than in those treated with SGLT2-I plus oral hypoglycemic agents group (p < 0.001). Confirmed hypoglycemic events were more frequent in those using SGLT2-I plus intensive insulin compared to those using SGLT2-I plus basal insulin (p = 0.020). Symptoms of dehydration were seen in 9.3% (n = 39) of the total population. We observed statistically significant reductions in glycated hemoglobin and weight by the end of Ramadan (p < 0.001). There were no significant changes in lipid profile and creatinine levels by the end of the study. Conclusions The use of insulin in combination with SGLT2-I increases the risk of hypoglycemia during Ramadan. Hypoglycemic events were mild and did not require hospital admission. However, careful monitoring during prolonged fasting is warranted. No significant harmful effects on renal function result from treatment with SGLT2-I during Ramadan.

Efficacy and Safety of SGLT2 Inhibitors in Reducing Glycated Hemoglobin and Weight in Emirati Patients With Type 2 Diabetes

Background SGLT2 inhibitors are a new class of drugs that act by inhibiting glucose reabsorption in the proximal renal tubules. Many trials have demonstrated their effectiveness in reducing glycated hemoglobin (HbA1c) and weight, but they have never been examined in Arab or Emirati populations. Methods We assessed the efficacy of SGLT2 inhibitors in reducing HbA1c and weight in our population and specifically in an Emirati cohort. We also assessed the effect on fasting blood glucose, blood pressure, lipid profile, serum creatinine, and side effects. Results The total number of patients was 307. The baseline HbA1c in the Emirati cohort was 8.9±1.7%, which dropped significantly to 8±1.5% at 6 months (P = 0.0001). At 1 year, the mean HbA1c was 8±1.4%, which was significantly different from baseline (P = 0.0001). However, the change in mean HbA1c from 6 months (8±1.5%) to 1 year (8±1.4%) was not statistically significant (P = 0.88). A similar highly significant change was observed when comparing weights at baseline and 6 months in the Emirati population (85.7 ± 17.8 kg vs. 84 ± 17.2 kg, P = 0.0001). Total cholesterol dropped significantly at 6 months (P = 0.008), as did low-density lipoprotein (LDL) (P = 0.005). Conclusions The use of SGLT2 inhibitors is associated with significant reductions in HbA1c and weight. Unlike all previous trials, the inhibitors significantly reduced total cholesterol and LDL. Larger trials are needed to reassess their effects on lipid parameters.

Late Presentation of a Disorder of Sexual Development Due to Rare46XX/47XX SRY-Positive 46XX/47XX Karyotype

Genital tract differentiation and development is a complex process beginning early in embryonic life. Mutation or translocation of the sex-determining region of the Y chromosome (SRY) may lead female genotype to become a male. The absence or genetic mutation of the SRY leads to a male phenotype individual but a female genotype individual (46xx), which is labeled as a Disorder of Sex Development (DSD). We are presenting an 18-year-old male who presented to the endocrine clinic with delayed puberty. There was no apparent predisposing factor upon review of his natal, childhood, and recent history. He had a no secondary sexual characteristics; stretched penile size was 5 cm, and the volume of both testes was around 4 ml. Biochemical assessment showed Hypergonadotrophic hypogonadism, while the peripheral blood Karyotyping showed SRY-positive 46XX/47XX DSD. This is the first reported case with SRY 46XX/47XX, although the somatic changes were not different from the rest of the genetic mutation. The spectrum of the DSD presentation is increasing in the population with time, which necessitates meticulous assessment in early infancy, and genetic screening whenever we suspect this condition. The threshold of suspicion of such diseases should be lower.

Diabesity in the Arabian Gulf: Challenges and Opportunities

Diabesity (diabetes associated with obesity) is a major global and local public health concern, which has almost reached an epidemic order of magnitude in the countries of the Arabian Gulf and worldwide. We sought to review the lifestyle trends in this region and to highlight the challenges and opportunities that health care professionals face and attempt to address and correct them. In this regard, we aimed to review the regional data and widely held expert opinions in the Arabian Gulf and provide a thematic review of the size of the problem of diabesity and its risk factors, challenges, and opportunities. We also wished to delineate the barriers to health promotion, disease prevention, and identify social customs contributing to these challenges. Lastly, we wished to address specific problems with particular relevance to the region such as minimal exercise and unhealthy nutrition, concerns during pregnancy, the subject of childhood obesity, the impact of Ramadan fasting, and the expanding role of bariatric surgery. Finally, general recommendations for prevention, evidence-based, and culturally competent management strategies are presented to be considered at the levels of the individual, community, and policymakers.

Survey of the knowledge and attitude of physicians toward the management of diabetes mellitus during Ramadan

Ramadan fasting has been a major concern among researchers considering the theoretically imposed risk on patients with diabetes mellitus due to prolonged fasting. Studies indicate that the knowledge and practices of physicians do not comply with the proposed recommendations in this regard in many cases. This study aimed to explore the viewpoints and attitudes of physicians toward the management of diabetes mellitus regarding to Ramadan fasting. In addition, we assessed the knowledge and compliance of physicians with available recommendations regarding the management of diabetes mellitus in Ramadan. According to the results, Ninety five present of the physicians (n=862) believed the type of diabetes to be “important” or “very important” in decision-making for Ramadan fasting. Control of diabetes before Ramadan was noted as “important” or “very important” by 95 of the physicians (n=848). Moreover, the majority of respondents emphasized on the pivotal role of self-monitoring of blood glucose in the management of patients receiving insulin or sulphonylureas (SUs), and to a lesser extend in cases treated with other oral hypoglycemic agents than SUs. Among the participants, 63.8 (n=397) confirmed the availability of Ramadan-focused educational programs for their patients, whereas thirty six present (n=225) mentioned the absence of such programs. According to the results of this study, it is crucial to raise the awareness of patients and physicians about the importance of Ramadan fasting through structured educational interventions in order to reduce the health risks associated with fasting in diabetic patients. Therefore, it is recommended that simplified guidelines and educational materials be dispensed for healthcare providers for related training programs before Ramadan.

An Unusual Dermatological Manifestation of Gravesâ Disease

Abstract Introduction Pityriasis Rubra Pilaris (PRP) is a chronic inflammatory dermatological disease, the cause of it is not yet clear. Researchers have linked it to autoimmune disease, infections like HIV and streptococcal diseases. There was an established link hypothyroidism. This was significant in the view of some researchers to recommend thyroid function test (TFT) as part of PRP assessment. Case presentation We are presenting a 24-year old lady with a full picture of thyrotoxicosis (Grave’s disease). At the time of she started appreciating the symptoms of the thyrotoxicosis; she started feeling extensive skin dryness, scaling and skin breaks at the joints and the extensor surfaces. She sought dermatological advice in many centres, with no response. With the thyrotoxicosis treatment the skin jeopardy started to improve while she was only on emollients. The skin findings completely vanished after the radioactive iodine (RAI). Conclusions This was the first report of PRP in association with Grave’s disease. This link needs to be confirmed with more case reports. Vanishing skin changes with the thyroid settlement could make it part of the treatment of the PRP. This might strengthen the recommendation of the previous papers of adopting TFT as part of the PRP workup.

Type II Pityriasis Rubra Pilaris Associated with Grave's Disease-Case Report

Introduction Pityriasis Rubra Pilaris (PRP) is a chronic inflammatory dermatological disease with no definite underlying cause to date, but many reports have linked it with autoimmune disorders, HIV infection, internal malignancies, streptococcal infections, hypothyroidism, and genetic mutation in a familial form. The relation to hypothyroidism is partially established. This link has been reported in medical literature; researchers suggested assessing the thyroid status as part of the PRP workup. We are reporting, for the first time, a case of PRP in association with Grave’s disease, which subsided after gaining control of the hyperthyroid status. Case presentation: A 24-year-old Syrian female presented with symptoms and signs of hyperthyroidism, as well as extensive skin dryness, hyperkeratosis, and skin breaks at the hands and feet associated with widespread squamous plaques over the extensor surfaces of the joints, which were not responding to any type of emollients. She was diagnosed with Grave’s disease and PRP and subsequently treated with anti-thyroid medications followed by radioactive iodine therapy, after which the PRP features improved remarkably. Conclusions: This is the first report of PRP in association with Grave’s disease. This link needs to be confirmed with more case reports. We agree with the previous suggestion of having thyroid function assessed cases of PRP refractory to traditional therapies. In those patients whose PRP is associated with thyroid dysfunction, in addition to topical agents, normalization of thyroid status should be attempted and might be beneficial.

Peri-portal lymphedema in association with an acute adrenal insufficiency: case report

IntroductionWe report the case of a patient with peri-portal lymphedema in association with severe adrenal insufficiency. To the best of our knowledge, this association was not previously reported in the literature. Peri-portal lymphedema is usually seen in cases such as blunt abdominal trauma, hepatic congestion and post–liver transplantation.Case presentationWe present the case of a 28-year-old Indian man who presented to our hospital with adrenal crisis and was treated accordingly. Computed tomography of his abdomen showed evidence of peri-portal lymphedema (edema) with some free fluid collection. We excluded other causes of this pathology and followed the patient’s condition after steroid replacement therapy. We found no other contributing factors to the patient’s peri-portal lymphedema apart from the adrenal crisis, which was more consolidated when we followed the patient after steroid replacement therapy, during which follow-up computed tomography showed complete resolution of the pathology.ConclusionsWe conclude following an extensive MEDLINE® search that this is the first case to be reported for the association between peri-portal lymphedema and adrenal insufficiency, after having excluded all other causes of peri-portal lymphedema. This signifies reporting of this case as the first one in the medical literature.