Autoimmune thrombocytopenia. Is it a different disease or different aspects of a single disease?

To evaluate the association between autoimmune thrombocytopenia with other autoimmune disorders, to show if they are different autoimmune diseases or one disease with different presentations at the same time, and to study the effect of treatment on platelet count in different thyroid condition. In this retrospective study, we included 141 patients with thrombocytopenic purpura. The result of thyroid function test, thyroid autoantibodies, Coombs' reactivity, anti-nuclear antibody, and double-stranded DNA were analyzed. This study was conducted in the Clinical Hematology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia between June 2003 and August 2010. There were 51 [36.2%] patients with laboratory evidence of autoimmune disease, 13 [9.2%] with hypothyroidism, and 6 [4.3%] with hyperthyroidism. In addition, 5 [3.5%] patients showed laboratory evidence of Evan syndrome and 3 [2.1%] patients had isolated positive thyroid antibodies. There was non-significant difference [p=0.61] in platelets count after one month of treatment of patients with different thyroid condition. Immune thrombocytopenia is associated with evidence of different autoimmune disease or a combination of them, which may appear at presentation or during the course of disease giving evidence that they are different manifestations of a single disease. Screening patients for antithyroid antibodies would identify a patient at risk of developing overt thyroid disease. These patients may be further screened with a thyroid-stimulating hormone assay to detect subclinical thyroid disease

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

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. 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. 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. 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

Sub-optimal postpr and ial blood glucose level in diabetics attending the outpatient clinic of a University Hospital

To determine the frequency of diabetic patients who attained the optimal postpr and ial blood glucose level. Cross-sectional study of type-2 diabetic patients being followed at the medical outpatient clinic of King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from January 1999 to December 2001. Patients were classified according to postpr and ial blood glucose level into 3-categories; group-1 [<9mmol/l], group-2 [9.1-10 mmol/1], group-3 [>10 mmol/1]. Other data such as age, sex, duration of diabetes, presence of hypertension, hyperlipidemia, smoking, obesity, ischemic heart disease was recorded as well as mortality. Results; A total of 443 patients were studied with mean age of 55 years and equal male to female ratio. The mean 2-hour Postpr and ial blood glucose level was 14 mmol/1. The majority of patients were in group-3 [71%], while group-1 was 22% and group-2 was 7%. Patients with high 2-hour postpr and ial blood glucose [group-3] have a higher prevalence of hypertension [120/315 [38%] versus 31/97 [32%] p=0.01], hyperlipidemia [72/315 [23%] versus 13/97 [13%] p=0.02], obesity [79/315 [25%] versus 18/97 [19%] p=0.04], ischemic heart disease [72/315 [23%] versus 16/97 [17%] p=0.04] and mortality [35/315 [11%] versus 8/97 [8%] p=0.06] compared to those with controlled level [group-1]. A low frequency of diabetics attained the optimal 2-hour postpr and ial blood glucose level. Action should be taken on this crucial issue for the optimal management of diabetes

case of Rifampicin induced pseudomembraneous colitis

We report a case pf pseudomembranous colitis that developed in a patient with tuberculous abdominal lymphadenopathy during treatment with rifampicin. The patient had delayed presentation [3 months] after the start of rifampicin. She had one relapse after 2 months that was successfully treated, and she finished her antituberculosis therapy without any further relapses. Awareness of this serious complication of rifampicin therapy should be encountered

Dyslipidemia and type-2 diabetics

To determine the frequency of type-2 diabetics who have target lipoprotein blood levels and to study these levels in patients with ischemic heart disease and cardiovascular disease risk factors. Retrospective analytical study of hyperlipidemic type-2 diabetics between January 2000 and January 2001 was undertaken. King AbdulAziz University Hospital. We studied 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. The mean lipoprotein levels, duration of hyperlipidemia and it's treatment, duration of diabetes, it's treatment and degree of blood glucose control, presence of hypertension, ischemic heart disease, and smoking were recorded. A total of 202 patients were studied with mean age of 60 years and equal male to female ratio. The mean duration of diabetes was 10 years and it was 7 years 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 LDL and TG respectively. Only 31% of patients had LDL<2.6 mmol/l, 28% had IIDL >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% versus 34% [0.4]. Similarly, no difference was found in those with hypertension, obesity, and patients with family history of hID compared to those without these risk factors; 30%, 26%, 16% versus 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% versus 25% [p 0.04]. A low frequency of type-2 diabetics has target levels of lipoproteins and this was also evident in diabetics with IHD and CVD risk factors

Is hypertension common in hosptalized type 2 diabetic patients?

To report on the prevalence and implications of hypertension in hospitalized type 2 diabetic patients at King Abdulaziz University Hospital. Relevant data was retrieved from the medical charts of type 2 diabetic patients admitted to the medical unit of King Abdulaziz University Hospital in the period between January 1998 and September 1999. Patients' age, sex, body mass index, presence of hypertension and hyperlipidemia, degree of glycemic control, reason for admission, duration of hospital stay and mortality were recorded. A total of 427 patients were studied, 46% of whom were hypertensive. Hypertensive diabetics tend to be older, more likely to have a higher body mass index and hyperlipidemia, to develop cardiovascular complications and renal failure, to stay longer in hospital and to have higher mortality compared to normotensive diabetics. Hypertension is common in diabetics, early treatment of which is important to prevent cardiovascular complications, to minimize the progression of microvascular complications and to decrease mortality

Urinary tract infection

To determine the clinical characteristics, risk factors, causative organisms and antimicrobial susceptibility in diabetics and non-diabetics admitted to King Abdulaziz University Hospital Medical Unit to decide on the use of empiric antimicrobial therapy. Significant bacteriuria from the Medical Unit of King Abdulaziz University Hospital from January 1999 to August 1999 were included in the study. Medical records were reviewed and the patients were divided into 2 groups according to the presence or absence of diabetes. The following information was recorded, patients' age, sex, type of infection [community or hospital acquired], presence of dysuria, urinary catheter, intensive care unit admission, duration of hospital stay, type of organism isolated and their antimicrobial susceptibility. A total of 182 specimens were studied, 58 [32%] were diabetics. Mean age of diabetics was 64 years versus 54 years in non-diabetics and the male:female ratio was 1:1.6 versus 1:1.1 [p0.001, 0.03]. Urinary catheters were present in 12/58 [20%] diabetics and 31/124 [25%] non-diabetics, intensive care unit admission was in 23/58 [40%] versus 38/124 [31%], and duration of hospital stay was 43 days versus 38 days [p0.6, 0.1, 0.4]. Escherichia coli was isolated in 9/50 [18%] hospital acquired infections and 4/8 [50%] community acquired infections in diabetics versus 26/106 [25%] and 8/18 [47%] in non diabetics. Pseudomonas species were isolated in 16/50 [32%] and 1/8 [13%] in diabetics and 22/106 [21%] and 0/18 in non-diabetics. Escherichia coli and pseudomonas in both groups showed resistance to ampicillin and sensitivity to aminoglycoside and ciprofloxacin. Diabetics were older with high female ratio compared to non-diabetics. Escherichia coli is the most common isolate in community and hospital acquired infections in non-diabetics, while Escherichia coli was common in community acquired infection and pseudomonas was the predominant isolate in hospital acquired infection in diabetics. Aminoglycoside and ciprofloxacin can be used empirically to treat both types of infection in diabetics and non-diabetics

Clinical profile of stroke: the experience at King Abdulaziz University Hospital

To determine the pattern and risk factors of stroke in Saudi nationals and non-Saudis, at King Abdulaziz University Hospital [KAUH], in the western province of Saudi Arabia. All cases of stroke admitted to KAUH in the period between January 1995 and December 1999 were studied. Demographic data of the patients, stroke types, risk factors and mortality were reported. Of the 103 patients studied, 56% were Saudis and 44% non-Saudis with male predominance and mean ages of 66 and 62 years respectively. In Saudis, the stroke types were 74% ischemic, 10% hemorrhagic and 16% unspecifi ed, whereas in non-Saudis, the fi gures were respectively 62%, 29% and 9%. The frequency of stroke increased steadily with age in Saudis but dropped after the sixth decade in non-Saudis. There was no signifi cant difference between the Saudis and the non-Saudis in the occurrence of risk factors for stroke or in mortality. The pattern and risk factors of cases of stroke treated at KAUH are similar to those reported from other regions of Saudi Arabia and other parts of the world

Secondary prevention measures after acute myocardial infraction: Comparison between diabetics and non-diabetics at a Saudi teaching hospital

To compare between the use of secondary prevention measures after acute myocardial infarction in diabetic and non-diabetic patients who were admitted to the King Abdulaziz University Hospital. Method: All patients admitted with a definitive diagnosis of acute myocardial infarction between January 1995 and December 1999 were studied. Patients' age, sex, body mass index, development of heart failure, peak serum creatinine phosphokinase, duration of hospital stay, use of aspirin, beta-blockers or angiotensin-converting enzyme [ACE] inhibitors on discharge and outcome were reported. A total of 184 patients were studied, 53% were diabetics and 47% non-diabetics. The mean age for diabetics was 56 years with a male:female ratio of 3.9:1, while for non-diabetics it was 53 years with a male:female ratio of 7.7:1 [p = 0.05, p = 0.09, respectively]. Diabetic patients had a higher incidence of heart failure compared to non-diabetics, 57 versus 43% [p = 0.05], and had a longer hospital stay, 12 versus 10 days [p = 0.03]. Aspirin was used by 97% of the diabetics and 94% of the non-diabetics [p = 0.4], while beta-blockers were used by 43 and 44% [p = 0.9] and ACE inhibitors by 67 and 51% [p = 0.03], respectively. There is no difference in the use of aspirin and beta-blockers between diabetic and non-diabetic patients. ACE inhibitors were used more by diabetics. There is underutilization of beta-blockers by diabetics and non-diabetics. Physicians should be encouraged to use beta-blockers as secondary prevention measures after acute myocardial infarction as they have substantial benefits and are of generally low treatment cost

Subclinical diabetic neuropathy a common complication in Saudi Diabetics

To determine the prevalence of sub clinical diabetic neuropathy in Saudi diabetics and the risk factors associated with symptomatic diabetic neuropathy. A prospective study of Saudi diabetics attending King Abdulaziz University Hospital out patient clinic from January 1998 until April 1999. Detailed information of each patients' age, sex, body mass index, type and duration of diabetes mellitus, mode of treatment, degree of blood glucose control, presence of hypertension, hyperlipidemia, smoking, family history of diabetes mellitus and hypertension were recorded. Patients were assessed for diabetic neuropathy using the Michigan Neuropathy Program. Patients who were asymptomatic and scored less than 2 on simple clinical examination were referred to a neurologist for a complete neurological examination and nerve conduction studies. A total of 237 patients were studied with a mean age of 54.19 years and mean duration of diabetes 10.6 years. Symptomatic diabetic neuropathy was present in 132 [56%] patients while subclinical neuropathy was present in 58 [57%] of asymptomatic patients. Old age, type II diabetes with long duration, poor control and smoking were risk factors associated with symptomatic diabetic neuropathy [p<0.001, p=0.09, p<0.001, p=0.04, p=0.08]. Subclinical diabetic neuropathy is common. Early diagnosis is important for possible prevention of late neuropathic complications [foot ulcers and infections]. Prolonged poorly controlled diabetes mellitus, old age and smoking are risk factors for symptomatic diabetic neuropathy. Meticulous blood glucose control is important for nerve function protection. Researches are urgently needed for satisfactory therapy

Adult bacteremia comparative study between diabetic and non-diabetic patients

To compare type of infection, microbiology, source, complications and outcome of bactermia in diabetic and non-diabetic patients in our teaching hospital. To study the risk factors associated with diabetic bacteremia's mortality and to compare our findings with those reported in the literatures. Retrospective study of all adult cases of bactermia admitted to King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from January 1998 to January 1999. Rate of bacteremia per 1000 admission was 23. We compared 71 episodes in 48 diabetics with 100 episodes in 77 non-diabetics. Diabetic patients were older than non-diabetics [mean age 61.08 versus 49.89 years, p <0.001]. No statistically significant difference was found between the 2 groups in the type and source of infection. Klebsiella of urinary source was isolated from 37% episodes in diabetics versus 11% non-diabetics [p 0.03]. Acute renal failure and septic shock were the 2 complications significantly developed in non-diabetics compared to diabetics [19% versus 7% and 13% versus 4%, p=0.02 and 0.05]. Mortality due to bacteremia was 24% in diabetics and 44% in non-diabetics [p 0.007]. Hospital acquired infections, presence of underlying malignancy, use of ventilators, development of septic shock and acute renal failure, were factors associated with high mortality in diabetic bacteremia. Our results are comparable with those reported in the literatures. The better outcome observed in our diabetic bactermia could be due to adequate glycemic control during bacteremic episode and appropriate choice of empiric antibiotics