Khaled A. Alswat

Association between type 1, type 2 cytokines, diabetic autoantibodies and 25-hydroxyvitamin D in children with type 1 diabetes

AbstractPurpose Vitamin D may play a role in the pathogenesis of type 1 diabetes (T1D). The aim of the current study was to determine the possible association between 25-hydroxyvitamin D [25(OH)D] levels and circulating levels of type 1 and type 2 cytokines, as well as the pathophysiology of T1D in children.MethodsA total of 250 T1D patients and 250 sex- and age-matched T1D-free controls were screened for 25(OH)D, hemoglobin A1c (HbA1c), type 1 and type 2 cytokines, C-reactive protein (CRP) and bone mineral metabolism, as well as antibodies against insulin, glutamic acid decarboxylase (anti-GAD 65) and islet cells.ResultsOur data showed that the plasma level of 25(OH)D was significantly lower in T1D patients and that there was a significant negative correlation between 25(OH)D levels and HbA1c values. There was a significant association between deficient levels of 25(OH)D and higher levels of cytokines (IFN-γ, TNF-α, IL-6, IL-1β, IL-4 and IL-10) and CRP. Total blood hemoglobin, the hematocrit percentage, body mass index SDS values, phosphate and magnesium levels were significantly lower in T1D patients than in T1D-free subjects. The levels of parathyroid hormone and alkaline phosphatase were significantly higher in T1D patients. Higher levels of cytokines were significantly associated with deficient levels of 25(OH)D. Moreover, in T1D patients, higher levels of islet antibodies, anti-GAD antibodies and anti-insulin antibodies were significantly associated with deficient levels of 25(OH)D.ConclusionsIn type 1 diabetic children, deficient levels of 25(OH)D are associated with high levels of HbA1c, circulatory cytokines and antibody markers.

The Association Between Body Mass Index and Dental Caries: Cross-Sectional Study.

Background Obesity is a growing health-related problem worldwide. Both obesity and dental caries are important health issues with multifactorial aspects. Some studies have shown an association between body mass index (BMI) and caries in childhood/adolescence but limited data about such an association are available in adults. The primary goal of this study was to assess the prevalence of dental caries and its relationship to BMI. Methods We conducted a cross-sectional study at Taif University Outpatient Clinic, for adults who had a visit to the dental clinic. Baseline characteristics were obtained by the participating physician. The decayed, missing, and filled teeth (DMFT) index was used to determine the prevalence of dental caries. Information about healthy eating, smoking, exercise, sleep patterns, media consumption, and brushing habits were collected. Results A total of 385 patients were enrolled with a mean age of 28.39 years, 72.8% were male, mean DMFT index score was 6.55, and 85.5% reported brushing their teeth at least once daily. Of the participants, 55.3% were either overweight or obese, and 42.2% demonstrated a high prevalence of dental caries with no significant difference in BMI when compared to the low dental caries group. Conclusions A high prevalence of overweight/obesity and dental caries was observed among the participants. After controlling for potential confounders like smoking and brushing habits, significant positive correlation between BMI and DMFT was observed.

Role of Cholestyramine in Refractory Hyperthyroidism: A Case Report and Literature Review.

Patient: Female, 52 Final Diagnosis: Refractory iodine induced hyperthyroidism Symptoms: Neck swelling • shortness of breath Medication: Cholestyramine Clinical Procedure: Total thyroidectomy Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Hyperthyroidism is a common disease that usually responds to the conventional therapy of anti-thyroidal medications (methimazole or PTU) and beta-blocker. Refractory hyperthyroidism is a rare condition in which hyperthyroidism fails to respond to the above therapy. Cholestyramine has been shown to decrease thyroid hormone level when added to the ongoing anti-thyroidal medications. Case Report: A 52-year-old woman with past medical history of enlarging goiter presented with obstructive symptoms of worsening shortness of breath and snoring. Admission thyroid function test showed mild hyperthyroidism (suppressed TSH, slightly high FT4, and high normal FT3) that worsened after she received a CT scan with contrast and failed to respond to a 3-week course of high-dose dexamethasone, high-dose carbimazole, and up-titrated propranolol. Five days after cholestyramine was added, her FT4 decreased by 30% and normalized after 12 days. The patient underwent total thyroidectomy as definitive treatment for the hyperthyroidism and for the obstructive symptoms. Conclusions: Cholestyramine is an effective additional treatment for hyperthyroidism and may be an effective treatment for refractory iodine-induced hyperthyroidism. The possibility of self-remission (natural course) is less likely given the dramatic and rapid response to cholestyramine.

The association between body mass index and academic performance

Objectives: To examine the relation between body mass index (BMI) and the academic performance of students from Taif city, Kingdom of Saudi Arabia (KSA) using the grade point average (GPA). Method: A cross-sectional study that includes students from intermediate and high schools located in Taif city, KSA between April 2014 and June 2015. Height and weight were measured and BMI calculated. Related risk factors including dietary habits, activity, parent’s education, sleeping pattern, and smoking were recorded. Result: A total of 14 schools included 424 students. 24.5% were either overweight or obese. The mean age was 15.44 year, 74.8% of the students were male, 53.8% were high school students, and 83.7% attended public schools. The mean overall GPA was 82.44% and the mean GPA for science subjects was 70.91%. No statically significant difference in the BMI was found between those who achieved >90% of the overall grade compared with those who achieved <90%. Post hoc 1-way-analysis of variance showed that obese students were performing worse in physics than normal weight peers (p=0.049). Students who achieved >90% overall grade are more likely to attend private school (p<0.05), live with their parents (p=0.013), having educated parents (p=0.037), getting optimal sleep (p<0.05), and they rarely eat their food outside their home (p<0.05). Conclusion: There was no correlation between the BMI and school performance, except in physics results where obese students perform worse than normal-weight students.

Diabetics Retinopathy Knowledge and Awareness Assessment among the Type 2 Diabetics

INTRODUCTION: Diabetic retinopathy (DR) is a leading cause of blindness worldwide. In Saudi Arabia and other Arab countries, several studies estimated the prevalence of DR ranging from 30 - 40%. AIM: To assess the DR knowledge and its association with diabetes control among Type 2 diabetic patients. METHODS: A cross-sectional study of patients with Type II diabetes (T2D) who had a routine visit to the endocrine clinic to assess the DR knowledge and its relation to the glycemic control. We used a questionnaire that was used in previously published studies, and the reliability was assessed using the alpha Cronbach coefficient. Patients who answered correctly > 60% were considered to have good knowledge about DR. RESULTS: Total of 253 patients participated, 43.4% has diabetes > 10 years and 30.7% have it for 5 - 10 years, 36.4% did college degree or higher, 40.8% considered having low income. 37.7% of participants were not screened for the DR in the past year. 28.4% of participants think that seeing optometrist is enough for DR diagnosis. Diabetics with good knowledge who have T2D > 10 years were 46.3% compared to 38.6% (p = 0.04). Diabetics with good knowledge have mean A1c of 8.55 vs. 8.59 (p = 0.32), mean BMI 30.4 vs. 30.2 (p = 0.46), mean diastolic pressure was 77.12% vs. 79.48% (p = 0.03). CONCLUSION: Almost two-thirds of screened T2D were considered to have good knowledge about DR. The good knowledge group tends to have a longer duration of T2D, more likely to have a college degree, and tend to have non -significantly better A1c control.

Gestational Diabetes Mellitus Knowledge Assessment among Saudi Women

BACKGROUND: IDF estimates that 16.2% of women giving live births in 2015 had some form of hyperglycemia during pregnancy. In Saudi, a study estimated that the prevalence of gestational diabetes mellitus (GDM) is 39.4%. AIM: We aimed to assess Saudi women’s GDM knowledge and awareness. METHODS: A cross-sectional study was conducted between August and December 2016 in Saudi Arabia using a validated questionnaire that included 12 questions focused on awareness and knowledge about GDM. Their responses were scored, and participants were divided poor knowledge (≤ 4/12) fair/good knowledge (≥ 5/12). RESULTS: A total of 9002 adult female participated. Mean age was 27.8 ± 7.9, and they were mainly married urban residents with bachelor’s degrees or higher. The mean overall score was 5.5 ± 2.5 with most of them in the fair GDM knowledge category. Participants were mostly aware of the GDM risk factors (54%) while they were least aware of the GDM diagnosis (15.9%). Multigravida and a prior history of GDM were the two risk factors about which participants were most aware (67.7%). Compared to those with poor knowledge, those with fair/good knowledge were more likely to live in urban areas, live in the central region of Saudi Arabia, work in medical fields, and be married, educated, and have personal and/or family histories of chronic diseases (all P values < 0.001). CONCLUSION: Our study showed a high prevalence of poor awareness and knowledge, mainly in those areas relating to GDM diagnosis.

The Potential Role of PTPN-22 C1858T Gene Polymorphism in the Pathogenesis of Type 1 Diabetes in Saudi Population

ABSTRACT Background: Recent investigations have reported an association between protein tyrosine phosphatase non-receptor type-22 (PTPN-22) gene polymorphism and susceptibility to the development of type 1 diabetes (T1D) in some populations and not in others. In this study, we aimed to investigate the association of PTPN-22 C1858T polymorphism with T1D in Saudi children. Methods: A cohort of 372 type 1 diabetic children and 372 diabetes-free subjects was enrolled in the current investigation. The PTPN-22 C1858T polymorphism was identified using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: Our data showed that the frequency of CT and TT genotypes of PTPN-22 C1858T was higher in T1D children (17.7% and 4.3%, respectively) compared to healthy controls (4.8% and 1.6%, respectively), and both genotypes were statistically associated with T1D patients (OR = 4.4, 95% CI: 2.55–7.58, p < 0.001; and OR = 3.2, 95% CI: 1.23–8.28, p = 0.017, respectively). Moreover, the 1858T allele was significantly associated with T1D patients compared to the C allele (OR = 3.2, 95% CI: 1.59–6.88, p < 0.001). In addition, the T allele was significantly associated with elevated levels of HbA1c, anti-GAD, and anti-insulin antibodies (p < 0.001) and a lower concentration of C-peptide (p < 0.001) in T1D children. Conclusion: The data presented here suggests that the T allele of PTPN-22 C1858T polymorphism might be a risk factor for T1D development in Saudi children.

Benefits of Using the i-Port System on Insulin-Treated Patients

Background. Insulin-treated patients demonstrate low adherence to insulin injections, which results in poor glycemic control. The i-Port Advance is a new advanced injection method. Our aim was to evaluate patient satisfaction, glycemic control, and adherence with this device. Methodology. This prospective study examined i-Port use in 55 insulin-treated patients. Baseline characteristics and Diabetes Treatment Satisfaction Questionnaire status (DTSQs) scores were collected at baseline and at the end of the follow-up period. All patients were trained to use the i-Port. Patients were divided into two groups: regular users of the i-Port, who used it for ≥3 months, and irregular users, who used it for <3 months. Local complications during use of the i-Port were recorded. Results. Of the 55 patients, 92.7% had type 1 diabetes, the mean age was 14.96 ± 8.95 years, and 92.7% used an insulin pen. The patients were divided into 27 regular users and 28 irregular users. Irregular users had a longer duration of diabetes (P = 0.901) at baseline compared to regular users, were less likely to report noncompliance with insulin usage (P = 0.338), were more likely to self-inject insulin (P = 0.038), and had a lower A1C (P = 0.056). There were no statistical differences between groups in mean DTSQs treatment satisfaction scores or mean glycemic control scores. At the end of the follow-up period, regular i-Port usage improved compliance with insulin usage (P = 0.028), reduced diabetes-related hospitalizations (P <0.001), and reduced the frequency of hypoglycemia (P = 0.184). Scarring at the i-Port site was the most common complication. Conclusion. Regular i-Port usage improved compliance and decreased hospitalizations and hypoglycemic episodes, with a nonsignificant 0.73% reduction in A1C.

The benefits of using the i-Port system on insulin-dependent patients

Aim: To investigate whether adding metformin, a potent agent reducing insulin resistance (IR), improves treatment efficacy of chronic hepatitis C (genotype 1) naïve patients. Methods: 133 patients were analyzed: 70 patients with IR and 63 patients without it. 28 of 70 patients with IR received metformin. Metformin was added to conventional Peg-IFNα-2b/ribavirin therapy, or 3-6 months before the starting of antiviral treatment and continue throughout the course of therapy. Patients in the second (control) group with IR did not receive metformin (n=42). Patients receiving and not receiving metformin did not differ significantly by gender, the average of viral load and the degree of liver fibrosis (measured with using FibroScan®502). Results: Among the patients with HCV-1 without IR, SVR rate was 46% (n=29/63), and in patients with HCV-1 with IR (not receiving metformin), SVR was achieved in 42% of patients (n=18/42), p=0,33. In patients with HCV-1 and IR, receiving metformin, the SVR rate was 64% (n=18/28), p=0,001. Conclusion: Correction of IR with using of metformin has led to an increase of SVR in HCV-1 patients by 1.5 times. Significant reduction of glucose levels in patients with IR receiving metformin, wasn’t noted. Thus, metformin is safe for use in patients with chronic hepatitis C and IR as a medication reducing IR. ISSN 2639-9326 Research Article Citation: Olga Khafisova, Natalia Mazurchik, Olga Tarasova, et al. Interferon-Based Antiviral Treatment of Chronic Hepatitis C in Combination with Metformin in Patients with HCV-1 Genotype and Insulin Resistance. Diabetes Complications. 2017; 1(4): 1-3.

Association of IL-37 gene polymorphisms with susceptibility to tuberculosis in Saudi population

Tuberculosis (TB) is one of the most common infectious diseases worldwide. IL‐37, a novel member of the IL‐1 family, has anti‐inflammatory activity. Various cytokine genes polymorphisms are reportedly associated with susceptibility to TB infection. However, an association between genetic variations in the IL‐37 gene and susceptibility to TB infection has not been investigated. The aim of this case‐control study was therefore to identify such an association in Saudi subjects, in which five single‐nucleotide polymorphisms (SNPs) in the IL‐37 gene were assessed. Serum concentrations of IL‐37 were evaluated using ELISA, and genetic variants genotyped by multiplex PCR and ligase detection reaction. It was found that the C/C genotype of rs2723176 (–6962 A/C) occurs significantly more frequently in patients with active TB and that the C allele of this SNP is associated with TB. In addition, the C allele of rs2723176 SNP was associated with high circulating concentrations of IL‐37. However, the genotype and allele frequency of the other four SNPs (rs3811046, rs3811047, rs2723186 and rs2723187) were not significantly associated with TB infection. In conclusion, the present data suggest that rs2723176 SNP of IL‐37 is involved in the development of TB infection. Furthermore, high circulating concentrations of IL‐37 may have a negative effect on protective immunity against TB infection.