Coeliac disease in Iraqi type 1 diabetic patients

High prevalence rates of coeliac disease [CD] in patients with type 1 diabetes mellitus [T1DM] have been reported. The aim of this study was to evaluate the frequency of silent CD in a sample of Iraqi patients with T1DM. This is a cross-sectional study done in Baghdad Teaching Hospital, Baghdad Medical City, Baghdad, Iraq, on 62 patients with T1DM. For all patients, immunoglobulin A [IgA] anti-tissue trans-glutaminase antibodies [IgA tTG], IgG anti-tissue transglutaminase antibodies [IgG tTG], IgA endomysial antibody [IgA EMA], IgA antigliadin antibodies [IgA AGA] and IgG antigliadin antibodies [IgG AGA] tests were done, with duodenoscopy, and at least four biopsies were taken from the second part of the duodenum. A total of 27 patients [43.5%] had normal small-intestinal histopathology [Marsh 0], one of them had a positive result for all serological markers used in the study, and another patient was positive for IgA tTG only. Ten patients [16.1%] had Marsh grade I, one of them was positive for IgA tTG, IgG tTG and IgA EMA, another patient was IgA deficient and had positive IgG tTG only and another patient with Marsh I had positive IgA tTG and IgG tTG only. Two patients [3.2%] had Marsh IIIA; three patients [4.8%] had Marsh IIIB histopathology two of them were positive for all tests and one had positive IgA tTG and IgA EMA only. Two patients [3.2%] had Marsh IIIC histopathological features; they were positive for all serological tests, hence, the frequency of CD was 11.2%. The frequency of silent CD in Iraqi patients with T1DM is not rare, reaching up to 11.2%. Both EMA and tTG antibodies are useful as screening tests

Acute phase hyperglycemia among patients hospitalized with acute coronary syndrome: prevalence and prognostic significance

Regardless of diabetes status, hyperglycemia on arrival for patients presenting with acute coronary syndrome, has been associated with adverse outcomes including death. The aim of this study is to look at the frequency and prognostic significance of acute phase hyperglycemia among patients attending the coronary care unit with acute coronary syndrome over the in-hospital admission days. The study included 287 consecutive patients in the Al-Faiha Hospital in Basrah [Southern Iraq] during a one year period from December 2007 to November 2008. Patients were divided into two groups with respect to admission plasma glucose level regardless of their diabetes status [those with admission plasma glucose of <14- mg/dl [7.8 mmol/L] and those equal to or more than that]. Acute phase hyperglycemia was defined as a non-fasting glucose level equal to or above 140 mg/dl [7.8 mmol/L] regardless of past history of diabetes. Sixty one point seven percent [177] of patients were admitted with plasma glucose of >/= 140 mg/dl [7.8 mmol/L]. There were no differences were found between both groups regarding the mean age, qualification, and smoking status, but males were predominant in both groups. A family history of diabetes, and hypertension, were more frequent in patients with plasma glucose of >/= 140 mg/dl [7.8 mmol/L]. There were no differences between the two groups regarding past history of ischemic heart disease, stroke, lipid profile, troponin-I levels or type of acute coronary syndrome. Again heart failure was more common in the admission acute phase hyperglycemia group, but there was no difference regarding arrhythmia, stroke, or death. Using logistic regression with heart failure as the dependent variable we found that only the admission acute phase hyperglycemia [OR=2.1344, 95% CI= 1.0282-2.2307; p=0.0419] was independently associated with heart failure. While male gender, family history of diabetes mellitus, hypertension and diabetes were not independently associated with heart failure. Admission acute phase hyperglycemia of >/= 140 mg/dl [7.8 mmol/L] was associated with heart failure in this study

association of diabetes and hyperthyroidism in Basrah

The aim of this study was to determine the effect of hyperthyroidism on diabetes in a single center in Basrah. During the period from November 2006 to September 2009, 44 patients with concomitant diabetes and hyperthyroidism were observed at Al-Faiha Diabetes and Endocrine Center in Basrah [Southern Iraq]. The diabetes diagnosis was made before the onset of hyperthyroidism in 27 [61.4%], after in 15 [34.1%] and at same time in 2 [4-5%]. The mean HbA1c before the control of hyperthyroidism was 9.48 +/- 2.07 percent and it was 7.49 +/- 0.9 percent after control of hyperthyroidism or induction of remission. Of those with diabetes before the onset of hyperthyroidism, the suspicion of hyperthyroidism was based on symptoms and deterioration in the control of diabetes and in 7 patients the symptoms of hyperthyroidism was subtle and realized mainly on biochemical diagnosis. A deleterious effects of hyperthyroidism on diabetes control was observed. In areas of limited resources where thyroid function is not readily available, screening for hyperthyroidism in uncontrolled diabetes seems to be justifiable

Corticosteroid nonprescription use: a cross-sectional hospital-based study in Basrah

To study the prevalence and attitude of using nonprescription corticosteroids [oral or parenteral formulation of glucocorticosteroids] in Basrah, Iraq. A face-to-face model structured interview was used to collect information from 682 patients between January 2006 and December 2008. The following information was obtained: age, gender, marital status, smoking, drinking of alcohol, occupation, educational level, social class and place of residence. Of the 682 [2.6%] subjects using nonprescription corticosteroids most were females: 471 [69%]; married: 567 [83%]; of low social class: 430 [63.1%]; lived in the city center: 475 [69.6%]. The majority [569, 83.5%] thought that corticosteroid use was safe and 463 [68.0%] did not feel guilty for using such medications. About half of them [377, 55.3%] were still using drugs at the time of presentation. Three hundred and fifty-seven [52.4%] reported that physicians advised them for the first time to use corticosteroids and the remaining 325 [42.2%] used it to become beautiful or marry. Three hundred and sixty-four [53.4%] patients obtained the drug from the pharmacy and 252 [36.9%] from street vendors. Weight gain was the main indication for use in 342 [50.1%] patients. Almost all had some features of corticosteroid side effects. This study showed high use of nonprescription corticosteroid in Basrah, Iraqi. We therefore recommend educational programs to alert the population of the untoward side effects of corticosteroids

prevalence of comorbid depression among adults with diabetes in southern Iraq

symptoms of depression severe enough to warrant treatment are encountered in one of every four patients with diabetes. The goal of this study was to determine the prevalence of comorbid depression among sample of patients with type 2 diabetes mellitus [DM] using Center for Epidemiologic Studies Depression Scale [CES-D] in Basrah [Southern Iraq]. This was a cross sectional case control study. It's conducted on patients with type 2 DM being monitored at the endocrinology unit of the Al-Faiha Hospital in Basrah. Diabetics patients depression score 44.5 +/- 11 while that of the control was 34.4 +/- 6. Both the diabetics and control score more than 16, which is the lower threshold for diagnosis of depression according to the CES-D. If these figures applied, than almost all of our population will have depression according to CES-D. Diabetic were having higher score for depression than the control, but both group scored >16, which mean that all of our population were depressed

Foot abnormalities in diabetics: prevalence and predictors in Basrah, Iraq

The diabetic foot abnormalities is clearly one of the most important complications of diabetes mellitus [DM] and is the leading cause of hospitalization with substantial morbidity, impairment of quality of life and engender high treatment costs. The aim of this study was to estimate the prevalence of diabetic foot abnormalities among patients with type 2 DM and the predictors of these abnormalities in Basrah, Iraq. This was cross sectional study of patients attending the out patient clinic of two hospitals in Basrah [the General and the Teaching] for the period from January to the end of December 2005.All patients were having type 2 DM. The total number of patients was 182 [80 males and 102 females. Diabetic foot abnormalities were reported in 46.7% of patients. Most of patients were having more than one abnormality. Structural foot abnormalities reported in diabetic patients were prominent metatarsal heads in 36.2%, wasting in 11.5% hammer toes in 10.9%, pes cavus in 5.4%, claw toes in 3.8%, and amputees in 2.1%. While skin changes includes dryness if the skin in 17%, fissures in the skin in 14.7%, callosities in 14.2%, Tinea pedis in 13.7%, foot ulcer in 13.7%, and nails changes in 7.1%. Peripheral neuropathy and dermopathy were seen in 21.9% and 6% respectively. Variables that predict foot abnormalities were higher age, male sex, less school achievement, longer duration of DM, higher BMI, smoking history, low social class, insulin use, hypertesnion, heart failure and proteinuria

Foot abnormalities in diabetics: prevalence and predictors in Basrah

Diabetic foot abnormalities are clearly one of the most important complications of diabetes mellitus [DM] and the leading cause of hospitalization with substantial morbidity, impairment of quality of life, and engender high treatment costs. The aim of this study was to estimate the prevalence of diabetic foot abnormalities among patients with type 2 DM and the predictors of these abnormalities in Basrah. This was a cross sectional study of patients attending the out patient clinic of two hospitals in Basrah [the General and the Teaching] for the period from January to the end of December 2005. All patients had type 2 DM. The total number of patients was 182 [80 males and 102 females]. Diabetic foot abnormalities were reported in 46.7% of patients. Most patients had more than one abnormality. Structural foot abnormalities reported in diabetic patients were prominent metatarsal heads in 36.2%, wasting in 11.5% hammer toes in 10.9%, pes cavus in 5.4%, claw toes in 3.8%, and amputees in 2.1%. While skin changes included dryness of the skin in 17%, fissures in the skin in 14.7%, callosities in 14.2%, Tinea pedis in 13.7%, foot ulcer in 13.7% and nail changes in 7.1%. Peripheral neuropathy and dermopathy were seen in 21.9% and 6% respectively. Variables predicting foot abnormalities were higher age, male sex, less school achievement, longer duration of DM, higher BMI, smoking history, low social class, insulin use, hypertension, heart failure and proteinuria

Pattern of small intestinal mucosal changes in patients with type 1 diabetes mellitus

The coexistence of type 1 diabetes mellitus [DM] and Celiac disease [CD] is well recognized with a prevalence of CD in type 1 DM reported to be between 0% and 10.4%. The aim of this study was to find the pattern of small intestinal mucosal changes in patients with type 1 DM. A cross sectional study done in Al-Faiha hospital in Basrah,Iraq,on patients with type 1 DM. Duodenoscopy was done and at least four biopsies were taken from the second part of the duodenum. Four patients had normal biopsy, 16 patients had duodenitis, and 10 patients had Marsh type I. Marsh type IILA were seen in 4 patients. Marsh IIIB were seen in two patients, and Marsh IIIC in 4 patients. Marsh IIIB and C histology were regarded compatible with CD, so the incidence of CD was 15%. All patients with type 1 DM should be screened for CD-Duodenal biopsy is a relevant tool for screening CD in patients with type I DM

Overweight and obesity among adults attending a medical department

In Iraq the data on obesity and overweight are scarce. The aim of this study was to establish data about the occurrence of overweight and obesity in Basrah. This was a cross sectional study with follow up of patients attending the out-patient and in-patient medical clinics of Al-Faiha Hospital in Basrah over the period from May 2003 to April 2004. The total number of patient was 4580, of whom 2556 [55.8%] were men and 2024[44.1%] were women. The study was restricted to people aged 18 years and above with mean age of 44.8 +/- 15.6. Overweight was prevalent among 31.1% with similar patient in males and females, and obesity was seen in 25.4% and was consistently higher among female regardless of grade. The over weight and obese were more likely to be hypertensive, diabetic, having evidence of Q wave myocardial infarction, with visceral obesity, and more likely to develop cancer. The majority [56.6%] of our patients were overweight and obese. Obesity was more frequently found in women. Community based cross sectional studies are needed give a better idea about the prevalence of overweight and obesity in adults in Basrah

relation between hemoglobin level hemoglobin F percentage and pain rate of sick in Basrah

the increase in total hemoglobin [Hb] and low fetal hemoglobin [Hb F] levels were found to be deleterious in patients with sickle cell disease [SCD], and were associated with high rates of pain. Aim of this study is to explore the relation between Hb level, Hb F% and pain rate in patients with SCD in basrah. cross sectional observational study was conducted in the out patient clinic of basrah military hospital. The pain rate was estimated for the preceding 3 years and the average rate as taken. total number of patients were 150.7 were females and the others were males. The diagnosis was SCA in 79, sickle beta + thalassemia in 69 and sickle beta 0 thalassemia in 2.mean age 20.5 +/- 4.5 year. There were no difference in the pain rate between those with high or low Hb and those with high and low Hb Felevels. no clear relation noticed between pain rate in patients with SCD and the Hb and Hb F levels. Further larger prospective study might give more clear answer for the relation