nature and prognosis of thyroid disorders and the heart

This is an attempt to review the current major thyroid disorders that may affect the heart directly and/ or indirectly and their prognostic pattern. It is accepted that cardiac disability can occur in thyroid dysfunction in the absence of any other underlying cardiac abnormality. This "Thyrocardiac disease" occurs more commonly within creasing age and in the elderly and may reflect occult thyroid function impairment. The advent of non-invasive cardiology particularly cross-sectional echocardiography has demonstrated ability to assess ventricular internal dimensions and function and to detect various cardiac disorders in the so called thyroid heart disease. Nevertheless great awareness has been reached in the age long controversy regarding the magnitude of cardiac abnormality in thyroid disorders

Clinical and electrophysiologic study of polyneuropathy among diabetic patients in Saudi Arabia

Seventy diabetic patients [44 males, 26 females] were evaluated for peripheral neuropathy clinically and by nerve conduction studies [NCS]. These included conduction velocity, distal latency, peak-to-peak amplitude and area in two motor [median and common perineal] and two sensory nerves [median and sural] Sixty-three patients had type II diabetes and seven had type I. Their median age was 47 years and median duration of diabetes six years. NCS results were scored using values previously obtained in healthy controls. Thirty-three patients [47.1%] had clinical neuropathy [22 definite, 11 probable] and 37 [52.8%] were normal. Clinical neuropathy showed significant association with type of treatment [x2 = 8.38, p = 0.038], but not with control of diabetes or its duration presumably because of the relatively small number of patients studied. NCS were normal in 14 patients [20%] and abnormal in 56 [80%] with the following pattern of abnormalities: mild sensorimotor neuropathy 13 [18%], moderate sensorimotor 11 [16%], severe sensorimotor 10 [14%], predominant sensory 17 [24%] predominant motor 5 [7%]. The NCS status showed no statistically significant association with type of treatment, diabetes control or duration. In multiple regression analysis, only clinical neuropathy contributed significantly to NCS status [p = 0.01]. The prevalence of clinical neuropathy in Saudi diabetic patients is similar to that in other populations and the greater sensitivity of NCS has been confirmed

effect of bacterial infection on oxidative burst activity in leukocytes from diabetic patients

Respiratory burst activity in phagocytes was assessed by measuring luminal dependent chemiluminescence [CL] in whole blood and isolated polymorphonucleocytes [PMNs] from four groups of subjects in the basal state and after stimulation with phorbol myristate acetate [PMA]. The groups were: healthy controls [group I]; diabetics with bacterial infection [group II]; diabetics without infection [group III]; and non-diabetics with bacterial infection [group IV]. In the basal state with whole blood, there was a statistically significant difference in resting CL response only between groups I and II, [p<0.05, by ANOVA and t-test with Bonferoni's adjustment]. With isolated PMNs, there was no statistically significant difference between any of the groups. After stimulation with PMA, in whole blood there was a statistically significant difference, p<0.05 when group II was compared with groups I and III. With isolated PMNs, the only significant observation was between groups II and III, p<0.05. In the presence of bacterial infection, PMNs from diabetic patients demonstrated higher CL responses than controls and non-diabetic patients with infection. The findings suggest that PMNs from diabetic patients with bacterial infection can be functionally and metabolically activated. The susceptibility to infection in diabetic patients may not be due to impairment of the respiratory burst activity in PMNs

comparison of acute glycaemic and insulin response to dates [phoenix dactylifera] and oral dextrose in diabetic and non-diabetic subjects

An oral glucose tolerance test [OGTT] with 75 g dextrose and an oral dates tolerance test [ODTT] using an isocaloric [300 kcal] amount of dates [110 g] were performed in 16 well-controlled non-insulin dependent diabetic patients and 10 healthy subjects, using semi-dried Sukkari dates [AI-Qassim] in the ripe [tamer] stage. In the patients, the glucose values were significantly higher after dextrose, p<0.05, from 60 to 120 min and the incremental area under curve [IAUC] for glucose [mmol/litre 2h,mean +/- SE] following dextrose -76.1 +/- 5.2, was significantly larger than for dates - 51.4 +/- 3.1, p<0.05. Among the non-diabetic controls, there was no significant difference in the glucose levels following dextrose and dates throughout the tests and the IAUC for dextrose -21.6 +/- 2.2 and dates - 11.9 +/- 2.1 were not significantly different, p>0.05. The glycaemic index [Gl] for dates in patients -67 +/- 6 was not significantly different from the value in controls -56 +/- 8.5, p>0.2. The IAUC [micro U/ml 2 h, mean +/- SE] for insulin in patients were: dextrose -147.9 +/- 25.7, dates -129.4 +/- 17.0, p>0.5. In controls, the values were dextrose: 164.6 +/- 22.7, dates: 61.0 +/- 14.7, p<0.025, reflecting a significantly blunted response to dates. The glycaemic potential of the variety of dates used in this study was two-thirds that of pure dextrose in well-controlled diabetic patients but just over half in healthy volunteers. Dates stimulated less insulin secretion than dextrose in healthy subjects. Further studies are necessary to determine whether dates will adversely affect the control of diabetes significantly

Pattern of diabetic foot lesions in Saudi Arabia: experience from King Khalid University Hospital, Riyadh

A retrospective study was carried out to estimate the magnitude and pattern of foot lesions seen in diabetics living in Saudi Arabia. A review of the records of 1010 diabetic patients seen at King Khalid University Hospital, Riyadh, revealed an overall prevalence of 10.4% for diabetic foot lesions. Of these, 88 patients were further characterized; 55 [62 .5%] were males and 33 [37.5%] were females. Seventy-five patients [85.2%] were Saudis and 13 [14.8%] were non-Saudis. The average age was 58 years. Eighty-five patients had type 2 diabetes and three had type 1. The spectrum of foot lesions included: 10 cases of cellulitis, 33 cases of ulcers, 29 cases of gangrene, and 16 cases of abscess. Evidence of peripheral vascular disease was present in 48 patients [54.5%] while peripheral neuropathy was found in 43 [48.8%]. Surgical debridement with prolonged dressing was done in 58 patients [66%] while amputation was performed in 30 [34.1%]. The average hospitalization was 6.8 weeks. Diabetic foot lesions constitute a major complication of this disease in Saudi Arabia. The high amputation rate is a source of concern and improved techniques are urgently needed to reduce this serious outcome