Combined occurrence of diabetes mellitus and retinitis pigmentosa

The combined occurrence of diabetes mellitus [DM] and retinitis pigmentosa [RP] is rare. It has been reported in the form of four different syndromes that are inherited in an autosomal recessive fashion. We describe two cases of DM and RP occurring together. The first case was a 35-year-old male who presented with insulin-treated diabetes, obesity, hypertension, polydactyly, normal cognitive functions, an ataxic gait, blindness secondary to RP, dyslipidemia, impaired renal function, and multiple renal cysts. He was diagnosed clinically as having Bardet-Biedl syndrome. The second case was a 34-year-old male who presented with insulin-resistant diabetes, hypertension, blindness secondary to RP, deafness, normal cognitive functions, primary infertility, renal, and liver impairment. He was diagnosed clinically as having Alstrom syndrome. Because of overlapping clinical manifestations and the cost and time involved in genetic studies, clinical criteria can be used for diagnosis and as a guide for genetic mapping in these patients

Evaluation of the impact of the Kuwait diabetes care program on the quality of diabetes care

To evaluate the impact of the Kuwait Diabetes Care Program on the quality of care provided for diabetic patients in the Primary Health Care setting. The Kuwait Diabetes Care Program developed, published and disseminated clinical practice guidelines, conducted training courses, standards for diabetes care, and introduced a monitoring and evaluation system. Four audits [September 1999, October 2001, 2002 and 2003] were carried out at five diabetic clinics. September 1999 referred to in this study as first [baseline] audit was prior to the introduction of the clinical practice guidelines. The three other audits were performed to assess adherence with the guidelines in the administrative management of patients' records and implementation of the standards. Two hundred and fifty patients were involved in the study. The proportion of patients with organized, structured files increased significantly from 60.0 to 100.0% [p < 0.001], and recording of patients' demographic data increased from 38.6 to 95.6% [p < 0.001]. Use of structured visit sheets, proper fixation of the laboratory and prescription sheets had also improved significantly. The prevalence of smoking assessment, fundus examination, and foot examination increased significantly from 2.8 to 27.2% [p < 0.001]; 2.4 to 31.6% [p < 0.001]; 0.4 to 40.4% [p < 0.001], respectively. The prevalence of measuring urinary microalbumin, serum creatinine and HbAlc increased significantly from 4.4 to 26.4% [p < 0.001]; 16.0 to 78.4% [p < 0.001], and 10.4 to 60.8% [p < 0.001], respectively. The prevalence of measuring serum total cholesterol, triglycerides, HDL-C, and LDL-C levels increased significantly from 16.4 to 80.0% [p < 0.001]; 14.4 to 80.0% [p < 0.001]; 2.4 to 32.8% [p < 0.001], and 2.4 to 24.0% [p < 0.001], respectively. This audit shows that a national diabetes program was associated with improved processes of diabetes care. Further, support from health authorities, provision of manpower resources, a continuing monitoring and evaluation system, and conduction of structured education programs may lead to further improvements in the quality of diabetes care

Autoimmune thyroid disease in a patient with Usher's syndrome: case report

Usher's syndrome [US] is a rare genetic disorder characterized by congenital sensorineural deafness arid retinitis pigmentosa. Here, we describe the association of US and hypothyroidism due to autoimmune thyroid disease [AITD] in a 50-year-old Kuwaiti woman diagnosed clinically to have US. As far as we are aware, this is the first case report of US in Kuwait arid to our knowledge the association with AITD has not been previously reported

Retroperitoneal liposarcoma: an unusual cause of abdominal enlargement encountered in the medical outpatients'dept

A large retroperitoneal tumor [10kg] was excised from a 50 year old lady who presented to the Medical Outpatients' Department with abdominal enlargement. Retroperitoneal liposarcoma is a rare soft-tissue sarcoma which commonly presents as a painless abdominal mass. Diagnosis is usually by computerised tomography and histological examination. It has a poor prognosis and a high recurrence rate. Wide local surgical excision is the optimal therapy