Foot ulcers among diabetic patients visiting surgery department in a university teaching hospital in Ajman, UAE

Diabetes is a very common lifestyle-related metabolic disease in UAE. UAE has the second highest prevalence of diabetes worldwide. Foot problems are one of the commonest reasons for hospital admission among diabetics. The major risk factors for foot disease are peripheral neuropathy, peripheral vascular disease, poor vision and foot deformities. Development of foot ulceration is preventable. To assess the frequency of foot ulcers among diabetic patients visiting the surgery department in a university teaching hospital in Ajman, UAE especially in relation to gender, nationality and age. This hospital-based retrospective record analysis was conducted for patients with diabetes mellitus visiting department of surgery for a period of 8 years from 2002 to 2010. Among the diabetic patients recruited for this study, 75% were males and 25% were females. Among these diabetic patients, 76.3% of male patients were diagnosed with foot ulcers as opposed to 23.8% of female patients. It was witnessed that majority of diabetic patients were from Asia [53.1%] and Middle East [33.8%] whereas African [12.3%] and European [0.8%] patients made up a minority. Diabetic foot ulcers were reported more in Asian patients [57%] compared to patients from Middle East [29.1%]. The age of majority of the diabetic patients in this study was the range of 30 to 70 years and diabetic foot ulcers were most prevalent in the age group 50 to 59 years [42.5%] and least prevalent in the age group 20 to 29 years [5%]. Asian middle-aged male diabetics are most likely to have foot complications. It is important to educate all diabetic patients about the importance of self-examination of both feet, and physicians should routinely examine the feet of all diabetic patients, which would go a long way in preventing development of foot ulcers

Age and gender-based utilization pattern of anti-diabetic drugs in Ajman, UAE

Diabetes is a chronic multi-system metabolic disease associated with morbidity and mortality and cost to the society. Pharmacotherapy is an integral part of the management of diabetes. Factors like age, gender, Body Mass Index [BMI] and coexisting illnesses determine the prescription. The objective of the study was to evaluate the drug usage pattern of anti-diabetic drugs in different age groups and gender. A cross sectional epidemiological survey of all prescriptions of patients with diabetes attending the Outpatient department of Internal Medicine of Gulf Medical College Hospital and Research Centre, Ajman was conducted for a duration of 3 months. The socio-demographic and drug information was obtained by researchers with the help of a questionnaire. 54.8% patients were males and 45.2% were females. The mean age of patients with diabetes was 54.09 +/- 10.24 years. 128 patients were type 2 diabetes. Metformin combinations were the commonly prescribed anti-diabetic drug. Insulin prescription was noted in 14 patients, the commonest being Human Insulin. Metformin combinations were commonly prescribed in both genders. For patients below 45 years and those between 45-60 years of age metformin combinations were the commonest prescribed, while among patients above 60 years of age sulfonylureas were the most commonly prescribed. The utilization pattern of anti diabetic drugs varied among different age groups and gender. Metformin combination with newer antidiabetic medications were commonly utilized

Patients' adherence to anti-diabetic medications and factors associated with adherence

Anti-diabetic drug therapy plays a pivotal role in the glycemic control patients with diabetes. Patient with chronic diseases such as diabetes often discontinue their medications for various reasons which could lead to ineffective control of blood glucose levels. The objective of the study was to assess the patient adherence of anti-diabetic drug therapy and explore the reasons for non-adherence. This was a cross sectional survey of patients with diabetes attending the Outpatient department of Internal Medicine of Gulf Medical College Hospital and Research Centre, Ajman carried out over a period of three months. Data on patient adherence, knowledge of anti-diabetic drugs and patient-provider relationship were collected with the help of a researcher-administered questionnaire. A total of 132 patients were included [63 males and 69 females]. The mean age of the subjects was 54.09 +/- 10.24 years. Patient adherence rate to anti-diabetic drugs was 84%. Adherence was similar among male and female patients. Based on the educational status, patients with schooling showed non-adherence. The most common reason for non-adherence was forgetfulness. Only 2.3% of the patients took self-medication and alternative therapies in addition to the medications prescribed. The majority of the patients had good patient-physician relationship. The patients had good knowledge of diabetes and anti-diabetic medications, received from their doctor or as self-learned. It is crucial that health providers assess adherence of patients to drug therapy in the event of poor glucose control and presumed failure of the prescribed therapeutic regimen. Additionally, the health care providers should practice patient counseling on medication adherence for effective management of diabetes

Lipid profile of patients with and without diabetic foot ulcers

To compare the lipid profile of patients with and without diabetic foot ulcers visiting surgery department in a university teaching hospital in Ajman, UAE. This hospital-based retrospective record analysis was conducted for patients with diabetes mellitus with or without foot ulcers visiting department of surgery during a period of eight years, from 2002 to 2010. Lipid parameters included were total cholesterol, HDL, LDL, VLDL. Among the diabetic patients recruited for this study, 75% were males and 25% were females. The mean HDL value for diabetic patients with foot ulcers was 37.3 +/- 8.3 whereas that for the non-foot ulcer patients was 31.3 +/- 7.9. The difference observed was statistically significant [p<0.05]. The mean value for the total cholesterol level was in the safe range for both non-foot ulcer and foot ulcer patients as they were both under 200. The mean total cholesterol was higher for diabetic patients with foot ulcer. Similar patterns can be seen for the LDL and VLDL with mean values for non-foot ulcer group being 102.1 and 35.5 and for foot ulcer group being 103.3 and 48.2 respectively, revealing that the mean is higher for diabetic patients with foot ulcer. The mean values for triglycerides were 207.4 and 186.1 for non-foot ulcers and foot ulcer patients respectively, which does not follow the pattern like the other values but this may be due to diet control. The mean values of all lipids except triglycerides were higher for the diabetic patients with foot ulcer group than those without but the only value which was statistically significant was HDL levels. This could be attributed to inability to adhere to an exercise regime due to the presence of foot ulcers. The differences observed in levels of total cholesterol, LDL, VLDL and triglycerides between the two groups were not significant

overview of changing trends in systemic fungal infections

Invasive mycoses are a significant and growing public health problem. The increasing use of invasive monitoring and aggressive therapeutic technologies in intensive care units has resulted in improved survival of individuals with life-threatening illnesses, but has also contributed to an increase in number of persons at risk for fungal infections. Today, invasive fungal infections pose the chief infectious challenge in hematology, oncology and intensive care practice. This review discusses the changing patterns in the risk factors, epidemiology, the impact of changes in medical practice on the incidence of systemic fungal infection and the emergence of antifungal resistance. Relevant English-language articles were identified through search of four databases [PubMed, ProQuest, Medline and Embase [all, 2005-2011]] conducted in June 2011 using Keywords "systemic fungal infection", "aspergillosis", "candidosis" and "antifungal". Original research and review articles related to patients with systemic fungal infection were considered for the review. Despite marked reduction in the rates of invasive fungal infections in developed countries, the burden is increasing largely in developing countries. Infections with Candida albicans may be decreasing in frequency, yet the number of persons at risk for them continues to grow. Prolonged and deep neutropenia and treatments neutralizing macrophage inflammatory cytokines have increased the likelihood of opportunistic infections. Extensive use of fluconazole in neutropenic patients has resulted in marked decrease in the incidence of invasive candidosis but it has also resulted in a shift from highly susceptible to less susceptible Candida spp.: Candida glabrata. Along with Aspergillus app., Fusarium spp., Scedosporium spp., Penicillium spp. and Zygomycetes are gaining importance. Although there is improvement in the survival rates of patients with invasive fungal infection in recent years, continued research is required to meet the challenges associated with changes in epidemiology and resistance development

Diabetes Mellitus and Ramadan - review

Objective of the review is to find out the management of Diabetes Mellitus in the month of Ramadan. For this review the published literatures on diabetes management during the month of Ramadan in Middle-East are studied with the aim of getting a global picture of the condition at a time when diabetes is having an adverse effect on health care delivery. I hope the review will be a useful and comprehensive source on the subject [Diabetes Mellitus] for researchers, academics and clinicians who care for the increasing number of patients and help health care providers curb the tide of the diabetes epidemic. I have searched available articles published in PubMed and Medline primarily by using the key words "Diabetes Mellitus", "Ramadan" and "fasting". I have covered epidemiology, clinical, management and complication profile. Few studies show that Ramadan fasting did not alter clinical, body composition and biochemical parameters. However other studies have shown that there is either an increase or a decrease in clinical and biochemical parameters during Ramadan. The EPIDIAR study was the largest study where 50% of the whole sample changed their treatment and hypoglycemia was the only observed event. There are also few studies which evaluated specific management modalities. It follows from this review that Ramadan fasting is acceptable for well balanced type 2 Diabetes patients conscious of their disease and compliant with their diet and drug intake. Islamic rules allow patients not to fast. However, it patients with diabetes wish to fast, it is necessary to advise them to undertake glycaemia control several times a day to prevent hypoglycemia risks during daytime fasting or hyperglycemia during the night. Patients with type 1 Diabetes who will fast during Ramada may be better managed with fast absorption insulin