Gulf implantable cardioverter-defibrillator registry: rationale, methodology, and implementation

Background: The implantable cardioverter-defibrillator [ICD] is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region

Methods: Gulf ICD is a prospective, multi-center, multinational, and observational study. All adult patients 18 years or older, receiving a de novo ICD implant and willing to sign a consent form will be eligible. Data on baseline characteristics, ICD indication, procedure and programing, in-hospital, and 1-year outcomes will be collected. Target enrollment is 1500 patients, which will provide adequate precision across a wide range of expected event rates

Results: Fifteen centers in six countries are enrolling patients [Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar]. Two-thirds of the centers have dedicated electrophysiology laboratories, and in almost all centers ICDs are implanted exclusively by electrophysiologists. Nearly three-quarters of the centers reported annual ICD implant volumes of

Conclusions: Gulf ICD is the first prospective, observational, multi-center, and multinational study of the characteristics and, the outcomes of patients receiving ICDs in the Arab Gulf region. The study will provide valuable insights into the utilization of and outcomes related to ICD therapy in the Gulf region

Minimally invasive use of coloured composite resin in aesthetic restoration of periodontially involved teeth: case report

Gingival recession causes not only aesthetic problems, but problems with oral hygiene, plaque accumulation, speech, and tooth sensitivity. Replacing the missing gingival tissue with composite resin, when indicated, can be a time- and cost-effective solution. Here we report the case of a 25-year-old female who presented with generalized gingival recession. Black triangles were present between the maxillary and mandibular anterior teeth due to loss of interdental tissues, caused by recent periodontal surgery. She also had slightly malposed maxillary anterior teeth. The patient elected to replace gingival tissue with pink composite resin and to alter the midline with composite resin veneers. The first treatment phase involved placement of pink gingival composite to restore the appearance of interdental papilla to her upper [16, 15, 14, 13, 12, 11, 21, 22, 23, and 24] and lower [34, 33, 32, 31, 41, 42, 43, and 44] teeth. Phase two was to place direct composite resin bonded veneers on her upper [16, 15, 14, 13, 12, 11, 21, 22, 23, and 24] teeth to alter the midline and achieve desired colour. The third treatment phase was to level the lower incisal edge shape by enameloplasty [31, 32, 41, and 42] to produce a more youthful and attractive smile. This case report and brief review attempt to describe the clinical obstacles and the current treatment options along with a suggested protocol. Use of contemporary materials such as gingival coloured composite to restore lost gingival tissue and improve aesthetics can be a simple and cost-effective way to manage patients affected by generalized aggressive periodontitis [AgP]

Adrenal hemangioma in a 19-year-old female

Adrenal masses are being detected with increasing frequency due to the widespread use of computed tomography, magnetic resonance imaging and even ultrasonography for the evaluation of diseases with abdominal involvement. It is estimated that adrenal masses are an accidental finding in 1% to 5% of all abdominal CT scans performed. Adrenal hemangiomas are rare and nonfunctioning benign tumors and their differential diagnosis preoperatively is rather challenging. Adrenal hemangiomas are most usually cavernous, unilateral lesions of the adrenal glands; bilateral involvement has been reported twice, which appears between the ages 50 and 70 years, with a 2:1 female-to-male ratio. Approximately 60 surgical cases have been reported in the literature. In general, this tumor is large, and all cases reported were treated with open surgery or retroperitoneoscopic procedure. We report a case of a 19-year-old female patient with adrenal hemangioma that was removed by laparoscopic adrenalectomy

Glycogen hepatopathy in a 13-year-old male with type 1 diabetes

Glycogenic hepatopathy [GH] is a rare cause of serum transaminase elevations in type 1 diabetes mellitus. We describe a 13-year-old male with a history of poorly controlled type 1 diabetes mellitus who presented with hepatomegaly and severe transaminase flares. Liver histology confirmed GH. Treatment consists of improving glycemic control. Hepatomegaly due to excess glycogen storage in poorly controlled type 1 diabetics has been associated with younger patients with poor glycemic control, occurring about 2-4 weeks after starting insulin treatment, and resolving upon glucose stabilization. We conclude that glycogenic hepatopathy can cause hepatomegaly and significant transaminase elevations in individuals with type I diabetes mellitus, The recovery of severe transaminase elevations in this patient illustrates the more benign course of GH, which is a condition with a far better prognosis. Clinician awareness of GH should prevent diagnostic delay and will provide better insight into the prevalence of GH

Prevalence of diabetes mellitus in a Saudi community

Quantifying the prevalence of diabetes mellitus is important to allow for rational planning and allocation of resources. Therefore, we designed this study to determine the prevalence of diabetes among Saudi nationals. A cross-sectional study among patients attending a primary care clinic in June 2009. Patients were interviewed with structured questionnaires to determine the presence of diabetes by questioning for history of the disease, and charts were reviewed to document any diabetic therapies that the patients may have undergone in the past or were undergoing at that time. Of 6024 subjects, diabetes mellitus was present in 1792 [30%] patients. The mean [SD] age of the patients was 55.3 [13.2] years. The prevalence of diabetes was 34.1% in males and 27.6% in females [P<.0001]. The mean [SD] age for onset of diabetes in males and females was 57.5 [13.1] and 53.4 [13.1] years, respectively [P<.0001]. Females <50 years old had a higher prevalence than males in the corresponding age range-34.1% and 25.1%, respectively [P<.0001]. The prevalence of diabetes decreased in patients older than 70 years. The prevalence of body mass index of >/= 25 was 72.5%. Among patients with diabetes, the prevalence of body mass index of >/= 25 was 85.7% [P<.0001]. There was a higher prevalence of obesity [body mass index >/= 25] in females [87.7%] as compared to males [83.1%] [P=.008]. The prevalence of diabetes is high among the Saudi population and represents a major clinical and public health problem. A national prevention program to prevent diabetes and address the modifiable risk factors at the community level, targeting high-risk groups, should be implemented soon

Glycemic changes after vitamin D supplementation in patients with type 1 diabetes mellitus and vitamin D deficiency

A prospective, nonblinded and nonrandomized controlled trial was conducted to test the hypothesis that vitamin D supplementation would improve glycemic control in patients with type 1 diabetes mellitus who have vitamin D deficiency. Eight patients with type 1 diabetes mellitus who had 25-hydroxyvitamin D levels less than 50 nmol/L were assigned to receive 4000 IU of vitamin D3. Calcium supplements were provided to ensure a total calcium intake of 1200 mg/d. Glycosylated hemoglobin and 25-hydroxyvitamin D levels were measured at baseline and at 12 weeks. There was a significant difference in mean [SD] glycosylated hemoglobin level [%] between the groups that achieved 25-hydroxyvitamin D levels of <35.4 nmol/L, 35.4-51 nmol/L and >51 nmol/L at 12 weeks [P=.02]. There was a significant difference in glycosylated hemoglobin change from baseline between the groups that achieved 25-hydroxvitamin D levels of<35.4 nmol/L, 35.4-51 nmol/L and >51 nmol/L at 12 weeks [P=0.4]. There was a significant difference in25-hydroxyvitamin D level between the groups that achieved glycosylated hemoglobin levels of <7.8, 7.8-9.9 and >9.9 at 12 weeks [P=.001]. Patients were more likely to achieve lower glycosylated hemoglobin levels at 12 weeks if they had higher 25-hydroxyvitamin D levels at 12 weeks [r=-0.4, p=0.01]. There was an observed effect of vitamin D supplementation on glycemic control in vitamin D-replete, type 1 diabetes mellitus patients. Further studies are needed to determine if these findings are applicable

Thyrotoxic periodic paralysis in a Saudi patient complicated by life threatening arrhythmia

Thyrotoxic periodic paralysis [TPP] is rare in non-Orientals, and sporadic case reports were reported world-wide. Eight cases were reported in Arabs, including 3 Saudis. We present an additional case of TPP in a 38-year-old Saudi man, and review the literature on TPP in Arabs. Our patient presented with complete flaccid quadriplegia, 5 weeks after he was diagnosed with Graves' disease that was treated with carbimazole and propranolol. He was hyperthyroid, and his potassium was extremely low [1.5 mmol/L]. During initial evaluation in the emergency room, he developed transient asystole manifested by syncope. He was resuscitated and his hypokalemia was corrected, and he had a full recovery. This case emphasizes the notion that TPP can occur in patients of any ethnic background. The development of serious cardiac complications in our patient underscores the importance of early and correct diagnosis of this potentially life-threatening complication of hyperthyroidism

Migrainous infarct: an update

Migraine and stroke have been linked in a complex bi-directional association, though there are quite a few pathophysiological pieces to be found to complete the puzzle. International Classification of Headache Disorders-11 [ICHD-II] has defined a specific term 'migrainous infarct' that can be the crucial link between the two disorders. The authors review the latest developments related to migrainous infarct and present a compilation of case reports from 1988 to 2006

Spinal tuberculosis easy to diagnose; difficult to manage

The author reviewed 60 cases of spinal tuberculosis treated from Jan 1993 to Jan 1995 at Lahore General Hospital, Clinical findings included back pain in 47[79%] paraparesis in 40[66%] and Kyphosis in 31[52%] patients, less common features included fever, sensory disturbance and sphincter dysfunctions. Predominant vertebral body involvement was present in 26 [43%] and marked bone collapse in 11 [18%] patients. Intraspinal granulomatous tissue causing neurological dysfunction in the absence of bone destruction was seen in 33[55%] cases. All 60 patients received antituberculous medications. Laminectomy and debridement of extra granulomatous tissue or abscess drainage was done in 43 [71%] patients, laminectomy and bracing in 8.3%, biopsy followed by bracing in 11.6% and bracing only in 3.3%. We didn't perform internal stabilization in any of our patients. An average follow-up time of 6 months course of antituberculous therapy [ATT] shorter than six months were invariably associated with disease recurrence. It is suggested that any young female from poor social background with backache and positive family history of tuberculosis should be examined and investigated fully for tuberculous spine and managed with appropriately selected treatment modality and compliance of the patient. Satisfactory outcome can be obtained in majority of patients

Management of post-traumatic cerebrospinal fluid rhinorrhea

Out of 2760 patients with head injury seen from January 1990 to June 1994 at Nishtar Hospital, Multan 64 [2.31%] had cerebrospinal fluid [CSF] leakage. Rhinorrhoea was found in 48 [1.74%] of these which stopped in 36 patients on conservative treatment. However, surgical repair was required in 12 patients, 2 of whom had involvement of the frontal sinus and 10 had the fracture extending into the cribriform plate. Five underwent bifrontal craniotomy, exploration and repair. In 7, precise localization of the defect through C.T. cisternography enabled the repair to be carried out through a unilateral frontal approach, thus reducing recovery time, morbidity and mortality

Diacetone alcohol, natural occurrence, toxic effects, other health hazards and diversified uses

Diacetone alcohol, a beta-hydroxy ketone, is prepared on an industrial scale by aldolization of acetone in the presence of basic catalysts. It undergoes dealdolization and dehydration in various amines and dehydrating agents respectively. It occurs as a component of flavour and aroma of different plants, fruits and their products. It is found in a few animal bodies and in some insect secretions, where it functions as a sex-attractant alarm pheromone. It is toxic to man, some fishes, bacteria and even plants. Diacetone-urea adduct finds uses in animal feed, where it acts as growth stimulant. Its use has also been reported in clinically important formulations. It has wide applications in the surface coating, cleaning and corrosion inhibition. It acts as a good frothing and foaming agent in various ores. It finds limited applications in the analytical chemistry

Gur as nutritive food and medicine

A brief history of the solidified cane juice [gur] and its traditional and present methods for its manufacturing have been described. Improvements made in its technique have been suggested, which eliminate the use of hazardous chemicals. Expert opinion about its nutritional and medicinal uses have been susbstantiated with its components, determined with modern techniques. It has suggested that the use of this cheap and useful material in the big cities be encouraged to control lead poisoning caused by gasoline emission