Predictive risk factors for fear of hypoglycemia and anxiety-related emotional disorders among adolescents with type 1 diabetes

To explore the fear of hypoglycemia [FOH] and anxiety-related emotional disorders and their risk factors among adolescents with type 1 diabetes mellitus [T1DM].Subjects and A cross-sectional study was conducted among 187 adolescents [aged 13-18 years; 92 males, 95 females] with T1DM at the Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia, from June 2013 to February 2014. The participants were interviewed using FOH and Screen for Child Anxiety-Related Disorders [SCARED] scales. Females had significantly higher scores on all FOH and SCARED subscales compared to males. The mean scores for many subscales of FOH and SCARED were higher in the older age group [16-18 years], in those under multiple-dose injection [MDI] treatment [compared with the insulin pump treatment], and in those with a longer duration of T1DM. Similarly, significant differences were observed in those with high frequencies of hypoglycemia, passing out, hypoglycemia while asleep and awake, and hypoglycemia in front of friends and at school. Regression analysis revealed that higher age, female gender, MDI treatment, longer duration of T1DM, higher frequencies of hypoglycemia, passing out, hypoglycemia while asleep and awake, and hypoglycemia in front of friends and at school were the risk factors associated with the majority of the FOH and SCARED subscales. The behavior of the FOH subscale correlated with all the subscales of SCARED except the subscale of generalized anxiety disorder. Similarly, the FOH subscale of worry significantly correlated with all the subscales of SCARED. The strongest determinants of higher risk for the majority of the FOH and SCARED subscales were higher age, female gender, MDI treatment, longer duration of T1DM, higher frequency of hypoglycemia, passing out due to hypoglycemia, hypoglycemia while asleep and awake, and hypoglycemia in front of friends and at school

Screening for autoimmune diseases in type 1 diabetes: low incidence of adrenal insufficiency

Primary Adrenocortical insufficiency [Addison's disease] is a potentially fatal condition that often develops incidentally and can be easily overlooked. Although rare in the general population, it is more common in patients with type 1 diabetes mellitus [T1D]. In this study, we reviewed our experience with the occurrence of associated adrenal insufficiency [AI] in children with T1D over 15 year's period at King Khalid University Hospital [KKUH], Riyadh, Saudi Arabia. This is a retrospective hospital based study, included children and adolescents with T1D at KKUH in the period January 1995-December 2012. All patients were serologically screened for Celiac and thyroid diseases. Adrenal function was assessed at the time of diagnosis, and annually thereafter by measuring serum cortisol and adrenal corticotrophic hormone [ACTH] using the available commercial kit. Adrenal cortex antibodies [AAA] test was done by Bioscientia laboratory, Germany, in one patient. In a cohort of 305 children and adolescents with T1D at KKUH, only one patient was found to have AI as a part of autoimmune polyendocrine syndrome type 1. Thyroid functions were abnormal in 65 [21.3%] patients. Of these, 26 [8.5%] patients have evidence of overt hypothyroidism and 39 [12.8%] patients had subclinical hypothyroidism. In twenty-six patients [8.5%], the intestinal biopsy results were positive for CD. There is no international consensus on the issue of screening for AI in children with T1D. In our experience, we do not favour screening for AI in children with T1D unless there is a clear risk factor

prevalence and risk factors for psychiatric disorders among youths in a borstal institution in Nigeria

To document psychiatric disorders and the risks among youths in a Borstal in Nigeria in order to direct the focus of policy makers to their mental health needs. 2-staged cross-sectional study. This study was conducted in a borstal institution in llorin, Nigeria in October, 2008. All the inmates were recruited and administered with socio-demographic and GHQ-12 questionnaires; and a MINI KID interview. Data was analyzed with SPSS for Windows, version 11, using 2-tailed tests at a 5% level of significance. Of the 53 inmates, 58.5% stayed >24weeks, 35.8% were in middle position within family, the parents were responsible for inmates' admission in 81.1%, and 64.2% had their parents living together. While 62.3% had psychiatric problems in the past months, 50.9% had MINI lifetime diagnoses, and 45.3% had 'current' diagnoses. When diagnoses were collapsed, 98.1% had 'any psychiatric disorder', 67.9% had 'any distruptive behaviour disorder' [DBD], 58.5% had 'any substance use disorder', and 54.7% had 'any mood disorder'. The mean psychiatric diagnosis in the cohort was 4.26 +/- 2.5. Significant associations were observed between Christianity and 'any DBD' [[x[2]= 6.34,df=1, p = 0.01],[r = -0.35,OR=1.8,CI = 1.0-2.9, p=0.01]]; parents who were living together and 'any mood disorder' [[x[2]=6.4, df=i p=0.01],[r=-0.35,OR=2.1lCI = 1.1 -4.3, p=0.01]], and 'any current disorder' [[x[2]=4.3,df=1, p=0.04], [r=-0.28, OR=2.1,CI=0.9-4.7, p=0.04]]; and between ages >18years and 'any psychiatric disorder' [[x[2]=9.8,df=3, p=0.02],[r=0.33, p=0.02]]. Findings were indicative of the prevalence of mental disorders, and the need to refocus attention on this cohort

Acute pancreatitis in pregnancy and postpartum period-case reports and review

Case reports of two patients with acute pancreatitis in late pregnancy are presented with a discussion of their management. These cases are reported because this condition often presents a diagnostic challenge, and any delay in diagnosis is associated with increased maternal and fetal morbidity and mortality. The first one was treated in the Obstetrics and Gynecology department. The second, was treated jointly with the surgical department

Caregivers' knowledge of etiology of mental illness in a tertiary health institution in Nigeria

Erroneous beliefs about causation and lack of adequate knowledge have been found to sustain deep seated negative attitudes about mental illness. Conversely, better knowledge results in improved attitudes towards people with mental illness and a belief that mental illnesses are treatable can encourage early treatment seeking and promote better outcomes. The aim of this study was to assess the awareness of the etiology of mental illness among the caregivers and to determine their knowledge on the treatment possibilities. A cross sectional study of all consenting consecutive caregivers of mentally ill patients attending the in-, and out-patients psychiatric facilities of University Teaching Hospital, Ilorin, Nigeria was done, using a questionnaire method. Three hundred and ninety-four respondents were recruited for the study. The mean age of the respondents was 38.84 +/- 14.64. Majority [244 or 61.9%] of the respondents believed drug and alcohol misuse could cause mental illness, while the belief that it could be due to 'curse' were reported by only 75 [19.0%] respondents. Male gender was associated with belief that alcohol and drug misuse, stress, genetic inheritance, physical illness, and poverty were causes of mental illnesses[p<0.05]. Higher educational status was also associated with alcohol and drug, traumatic events, stress, genetic inheritance, and physical abuse [p<0.05] as causes of mental illness. There is a better knowledge of mental illness among caregivers than the predominant supernatural causes earlier attributed to mental illness by Nigerian communities. In order to sustain this, there is need for psycho-education

Antenatal diagnosis and management of fetal mid-gut volvulus

Fetal volvulus is an uncommon cause of bowel obstruction, which is rarely detected by an antenatal ultrasound scan. We report a case which presented with fetal stomach and small bowels dilatation at 33 weeks of gestation detected by ultrasonography. She was referred to our unit for safe delivery at 34th week of gestation following a spontaneous rupture of membranes and signs of fetal distress. Delivery was accomplished by Cesarean section. Postnatally, the infant was surgically explored with resection of ileum and end to end anastomosis because of bowel gangrene and volvulus. Ultrasound diagnosis during pregnancy with fetal bowels dilatation is an important tool and may lead to early diagnosis and optimal management of intestinal obstruction

Interstitial pregnancy

This report describes a case of interstitial pregnancy which was diagnosed at six weeks of gestation and treated surgically by excision. Initially, the signs and symptom were rather confusing, but the diagnosis was eventually made using ultrasound scanning. The patient was treated by excising the site of the interstitial pregnancy. The patient made a good recovery and was discharged home. Because of the question of future reproduction in such cases we have discussed alternative, minimal invasive techniques such as laparoscopic removal with or without arterial embolization, medical treatment with methotrexate or local injection with potassium hydroxide. This case was reported because it is rare, difficult to diagnose, and because modern treatment has less adverse effects on future fertility

Human papillomavirus infection among women attending health facilities in the Kingdom of Bahrain

To investigate the occurrence of human papillomavirus [HPV] infection and the associated risk factors in Bahrain's female population. This study was carried out between March to December 2004, which includes cervical scrapings for Pap smear and HPV-DNA testing using polymerase chain reaction[PCR] and restriction fragment length polymorphism [RFLP] analysis, obtained from 100 women attending the Gynecology Clinic at Salmaniya Medical Center and Sheikh Sabah Health Center in the Kingdom of Bahrain. We distributed questionnaires that include the sociodemographic data as well as information on risk factors such as smoking, parity, and the contraceptive used. Eleven women [11%] with normal cytology were HPV-positive. The RFLP analysis detected HPV-types 16, 18, 45, 62 and 53. Positive women were significantly older [43.3 +/- 10.1 years] than negatives [36.5 +/- 9.9 years; P=0.04], however, there was no difference in age of first sexual contact [positive: 18.1 +/- 5.7 years versus negative: 20.6 +/- 4.4 years]. Polygamy, smoking and hormonal contraception was not identified as risk factors, but positive women showed higher parity. In this study on HPV infection in Bahrain, the 11% positivity with high risk HPV types, in the presence of normal cytology suggests that in addition to the cervical cancer screening program, offer of HPV testing deserves consideration

Congenital adrenal hyperplasia in the Palestinian

Between 1985-1999, congenital adrenal hyperplasia [CAH] was diagnosed in 37 children in Gaza Strip, 19 [58%] were diagnosed in the last 5 years, the estimated incidence is 1.02/1000. This figure may be higher as there are 20 children died with suggestive evidence of CAH. Classic CAH were diagnosed in 33 [89%] and 4 [11%] as 11 hydroxylase deficiency. Girls were 20 [61%] and boys 13 [39%]. Salt losers, were 19 [85%], 11 girls and 8 boys. Females were diagnosed earlier than males. Mean age of diagnosis for females is 40 weeks and for males 54 weeks. Salt losers were diagnosed earlier than non salt losers. Mean age of diagnosis for salt losers is 7.5 weeks while non-losers 98 weeks. Salt losers girls were diagnosed earlier than boys

diagnostic accuracy of fine needle aspiration cytology versus core needle biopsy for palpable breast lump

Breast lump is one of the most common surgical problems in females. Surgical biopsy of palpable breast lump was considered the gold standard for the diagnosis of breast lump[s]. Emphasis has been placed on improving method for establishing a definitive diagnosis of breast mass prior to surgery. Our aim was to compare the diagnostic accuracy of fine needle aspiration cytology [FNAC] and core needle biopsy [CNB] in patients with palpable breast masses. Prospective randomized controlled clinical trial included 296 Female patients with breast lumps, presented to Al-Thawra Teaching Hospital, Sanaa, Yemen between May 1998 - May 2002. All the patients submitted either to FNAC or CNB equally. The results were then compared with the final diagnosis by histopathology. The patient age ranged from 15-74 years with a mean of 33.77 +/- 11.91 years. Married patients were 69.3% and the most common presentation was breast lump[s] [88.5%]. The mean size of the tumor was 3.47 +/- 1.43 cm in diameter. The FNAC sensitivity was 66.66%, 81.8% specificity, 75.7% accuracy, positive predictive value [PPV] 100% and negative predictive value [NPV] 90%, while in core needle breast biopsy sensitivity was 92.3%, 94.8% specificity, 93.4% accuracy, PPV 100% and NPV 100%. The diagnostic accuracy of CNB was higher than the FNAC, which was statistically significant [p<0.05]. Both procedures are simple, easy, safe, cheap and reliable, but CNB is more accurate than the FNAC

Effect of interferon: a on experimental schistosoma mansoni infection in mice

To investigate the immunomodulatory effect of the Th1 mediated cytokine IFN-alpha on schistosomiasis, this cytokine was weekly injected into mice experimentally infected with S. mansoni, beginning from day 0 [group II], week 3 [group III], week 6 [group IV] and week 10 [group V] post-infection. TGF beta 1 serum levels were estimated on a weekly basis and beginning one week after initiation of IFN-alpha therapy, while all animals were sacrified on week 14 to be used for egg counts in liver and small intestine, oogram study for determination of the maturity of deposited eggs, and histopathological examination of stained liver sections. IFN-alpha treated groups were characterized by a more intense oviposition in the intestine [liver/intestine ratio less than 1], with higher egg numbers the earlier IFN-alpha was administered. Oograms of the intestine indicated the level of immature eggs to be statistically significantly higher in group II, III and IV than in the control group I [p < 0.05]. In IFN-alpha medicated mice, the mean numbers and diameters of hepatic granulomas were less than in GI, in addition to a lower representation of fibrocellular and fibrous granulomas among them [all parameters p < 0.05], especially in Gs IV and V. The inflammatory cell population in the form of eosinophils, histiocytes and giant cells was more pronounced in Gs III, IV and V. TGF-beta 1 serum levels showed a progressive rise, however more pronounced in the untreated control. A statistically positive significant was established between TGF-beta 1 levels and number, size and percentage of fibrotic hepatic granulomas in all groups

case report and review of the literature: Pelvic congestion syndrome

Pelvic congestion syndrome [PCS] is a well described, but frequently overlooked cause of chronic pelvic pain. It is manifested by pelvic pain of variable intensity that is aggravated by prolonged standing, fatigue, menstruation or intercourse.Although the condition has been described since the middle of the nineteenth century, the exact cause of the condition is not fully understood. Recent advances in imaging and laparoscopy have helped in achieving an accurate diagnosis. Surgical procedures are not always helpful in managing cases of pelvic varices. The most recent breakthrough has been the management of gonadal varicosities by an embolization technique. This case was first suspected following a pelvic ultrasound study. The diagnosis was confirmed by venography and embolization was performed in the Radiology Depar tment. This treatment modality is the first ever in the Kingdom of Bahrain. It shows specialized skills can satisfactorily cure a hither to difficult disease with simple minimally invasive techniques

Invasive malignant thymoma in early pregnancy

Thymomas are an uncommon tumor of the mediastinum. When they are malignant it is even rarer for a young or pregnant woman to be affected. The condition has a bad prognosis unless surgery is followed by radiation therapy and chemotherapy, which must be instituted. The urgency of treatment makes medical termination of pregnancy an important procedure, particularly if the tumor is discovered in early pregnancy. We present here the first case reported in Bahrain of an invasive malignant thymoma in early pregnancy. The epidemiology, pathology and management of such cases are discussed

Cryptogenic fibrosing alveolitis necessitating therapeutic termination of a first trimester pregnancy

Twenty-seven years old Bahraini lady, known to be suffering with fibrosing alveolitis for some eight years, presented to the accident and emergency department of Salmaniya Medical Complex. Recently her respiratory function had deteriorated and she had become house-bound on home oxygen therapy and nebulizers. She was taking Prednisolone tablets and Immuran. She was admitted to the Intensive Care Unit [ICU] in extreme respiratory distress for the past two days. While she was in the hospital, she complained of breast tenderness and supra pubic pain, her period being twenty days overdue. BIICG pregnancy test proved to be positive. Management and outcome of her case is herewith discussed

Screening for gestational diabetes by measuring fasting plasma glucose levels

To test the sensitivity and specificity of measuring fasting plasma glucose levels [FPG] as a screening test for gestational diabetes mellitus [GDM]. [b] To compare predicting levels of FPG levels with the one-hour, oral 50g non-fasting glucose challenge test [GCT] for predicting GDM. One thousand and six hundred pregnant women from the Health Centres, antenatal clinics and Salmaniya Medical Complex were screened by the GCT after 50g of oral glucose during 26-32 weeks gestation, giving a 13.5% incidence of GDM [using the Third International Workshop cutoff values of 7.8 mmol/l]. All patients also had an FPG estimation followed by the three-hour oral glucose tolerance test [oGTT]. Seventy eight percent of the patients were Bahraini, 19% Asian and 3% other nationalities. Their mean age was 27.2+0.2 years. Receiver-operating curves [ROC] were used to test the ability of the FPG and the oGTT to differentiate patients with GDM and identify the cut off values for predicting a diagnosis of GDM. FPG levels of 5.6 mmol/l and 5.4 mmol/l yielded sensitivities and specificities of 94% and 93% respectively. Measuring FPG as a screening test required a diagnostic oGTT in 32% compared with 13% when the GCT was used. Using FPG levels at a cutoff value of >/= 5.5 mmol/l is an easier, more acceptable test for patients compared to the GCT. Using the FPG levels is also more cost effective and allows nearly 70% of women to avoid the oGTT

HELLP Syndrome [hemolyisis, elevated liver enzymes and low platelets]: a review of the pathophysiology, diagnosis, management and anaesthetic considerations

HELLP syndrome [hemolysis, elevated liver enzymes, low platelets] is associated with poor maternal and fetal outcomes. Maternal mortality has been estimated as high as 24%. These patients are also at greater risks from pulmonary edema, adult respiratory distress syndrome [ARDS], abruption placentae, disseminated intravascular coagulopathy [DIC], ruptured liver hematomas, and acute renal failure [ARF]. Perinatal mortality is equally high ranging from 79 to 367 per 1000 live births, and neonatal complications correlate with the severity of maternal disease. Many clinicians view HELLP syndrome as an entity of preeclampsia, and with the varied symptomatology, the initial diagnosis may be obscured. Prodromal signs include: 1] right upper quadrant and/or epigastric pain, 2] nausea and vomiting, 3] headache, 4] visual changes, 5] increased tendency to bleed from minor trauma, 6] jaundice, 7] diarrhea and 8] shoulder or neck pain. Prior to delivery, aggressive obstetric management is directed toward stabilization of the affected organ systems and timely interruption of the pregnancy in the early phase of accelerated disease progression. Definitive therapy is delivery. Parturients with HELLP syndrome are often critically ill; their infants are frequently premature and compromised. Management criteria should include a multidisciplinary approach in a tertiary care centre. The obstetric anesthesia personnel should petform a thorough preanaesthetic evaluation and have considerable knowledge of the pathophysiology of this syndrome. Unless significant coagulopathy is diagnosed, epidural anesthesia is preferred over general anesthesia, and spinal anesthesia is perhaps contraindicated

Antiphospholipids [Hughes] syndrome pregnancy: a report of three cases and review of the literature

Since the discovery of the antiphospholipids syndrome in the early eighties, many clinical conditions have been described in patients with antiphospholipid antibodies. Complications include infertility, recurrent miscarriage and increased perinatal mortality. A more serious complication, however, are episodes of arterial thrombosis during pregnancy and puerperium. We have had six such cases in the last three years, of which, the three with major complications are reported here. The first patient had a combination of sickle cell disease, J3-thalassaemia and antiphospholipid antibodies during pregnancy. Put on heparin prophylaxis, she was delivered at 38 weeks by Caesarean section, but died postnatally of a massive pulmonary embolism. The second patient reported at eight weeks of gestation with evidence of a cerebro-vascular accident. Her condition improved and her pregnancy was terminated. The third, a young woman with a history of infertility, was treated with assisted reproductive technology and became pregnant but had a mid-trimester abortion. Eventually she had a normal gestation with heparin prophylaxis and delivered a live baby. Antiphospholipids syndrome is not uncommon in Bahraini pregnancies. Considering the impact of this disease on reproduction and the range of complications involved, screening of pregnant women with a bad obstetric history or recurrent miscarriage is essential

Fertility after myomectomy

This study aimed to assess pregnancy rates in women after treatment of uterine fibroids with myomectomy. A retrospective analysis in Jordan University Hospital was carried out. This study included 70 women over a 10-year period. The results revealed that 55% of women were infertile at the time of surgery. The most common indication for the myomectomy was a combination of infertility and menorrhagia. Successful pregnancies in those women who attempted pregnancy after operation was 53.8%. It was concluded in the absence of other causes for infertility, myomectomy is an appropriate operation for improving the fertility