Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics.

Diabetes mellitus and thyroid disease are common endocrine disorders in the general population. To investigate the association between thyroid dysfunction, thyroid autoimmunity and Saudi type 2 diabetics, a random sample of 100 Saudi type 2 diabetics and 100 age- and sex-matched controls were studied. The mean age was 54 years for diabetics and 55 years for controls while the male:female ratios were 1:1.6 and 1:14 respectively. GAD65ab were found in 26% diabetics and 2% controls (p=0.001). Thyroid autoimmunity were detected in 10% diabetics vs. 5% controls (p=0.05), while thyroid dysfunction was found in 16% and 7% respectively (p=0.03). In GAD65ab-positive diabetics, thyroid autoimmunity was observed in 27% vs. 4% GAD65ab-negative diabetics (p=0.02) and thyroid dysfunction was reported in 42% and 7% respectively. We conclude that thyroid dysfunction and autoimmunity are common in Saudi type 2 diabetics. Further studies are needed on the cost effectiveness of thyroid screening in diabetics.

Diabetes mellitus and viral hepatitis: the unsolved mystery.

Diabetes mellitus is a common endocrine disorder that is becoming a major public health problem. Viral hepatitis infection is one of the most common causes of chronic liver disease. Several reports from different parts of the world found an association between these two common disorders. In this review we highlight some of the epidemiological aspects of these two disorders, discussed some of the possible mechanisms and questions to be answered to understand this link and be able to solve this mystery.

Cardiovascular risk factors in Saudi Arabian and non-Saudi Arabian diabetic patients in Saudi Arabia.

To determine frequency of cardiovascular risk factors in Saudi and non-Saudi diabetics, we studied patients attending King Abdulaziz University Hospital for follow-up in the period January 1997 to December 2001. Cardiovascular risk factors, including hypertension, hyperlipidaemia, obesity and smoking, were studied as well as degree of blood glucose control. Of 1122 patients in the study, 48% were Saudis and 52% non-Saudis. No statistically significant difference was found for prevalence of cardiovascular risk factors between the two groups. Correlation of each of the risk factors to patient's age showed significant correlation to hypertension and smoking.

Cardiovascular risk factors in Saudi Arabian and non-Saudi Arabian diabetic patients in Saudi Arabia

To determine frequency of cardiovascular risk factors in Saudi and non-Saudi diabetics, we studied patients attending King Abdulaziz University Hospital for follow-up in the period January 1997 to December 2001. Cardiovascular risk factors, including hypertension, hyperlipidaemia, obesity and smoking, were studied as well as degree of blood glucose control. Of 1122 patients in the study, 48% were Saudis and 52% non-Saudis. No statistically significant difference was found for prevalence of cardiovascular risk factors between the two groups. Correlation of each of the risk factors to patient's age showed significant correlation to hypertension and smoking

Urinary tract infection. Diabetics and non-diabetic patients.

OBJECTIVE: To determine the clinical characteristics, risk factors, causative organisms and antimicrobial susceptibility in diabetics and non-diabetics admitted to King Abdulaziz University Hospital Medical Unit to decide on the use of empiric antimicrobial therapy. METHODS: Significant bacteriuria from the Medical Unit of King Abdulaziz University Hospital from January 1999 to August 1999 were included in the study. Medical records were reviewed and the patients were divided into 2 groups according to the presence or absence of diabetes. The following information was recorded, patients' age, sex, type of infection (community or hospital acquired), presence of dysuria, urinary catheter, intensive care unit admission, duration of hospital stay, type of organism isolated and their antimicrobial susceptibility. RESULTS: A total of 182 specimens were studied, 58 (32%) were diabetics. Mean age of diabetics was 64 years versus 54 years in non-diabetics and the male:female ratio was 1:1.6 versus 1:1.1 (p0.001, 0.03). Urinary catheters were present in 12/58 (20%) diabetics and 31/124 (25%) non-diabetics, intensive care unit admission was in 23/58 (40%) versus 38/124 (31%), and duration of hospital stay was 43 days versus 38 days (p0.6, 0.1, 0.4). Escherichia coli was isolated in 9/50 (18%) hospital acquired infections and 4/8 (50%) community acquired infections in diabetics versus 26/106 (25%) and 8/18 (47%) in non diabetics. Pseudomonas species were isolated in 16/50 (32%) and 1/8 (13%) in diabetics and 22/106 (21%) and 0/18 in non-diabetics. Escherichia coli and pseudomonas in both groups showed resistance to ampicillin and sensitivity to aminoglycoside and ciprofloxacin. CONCLUSION: Diabetics were older with high female ratio compared to non-diabetics. Escherichia coli is the most common isolate in community and hospital acquired infections in non-diabetics, while Escherichia coli was common in community acquired infection and pseudomonas was the predominant isolate in hospital acquired infection in diabetics. Aminoglycoside and ciprofloxacin can be used empirically to treat both types of infection in diabetics and non-diabetics.

Is hypertension common in hospitalized type 2 diabetic patients?

OBJECTIVE: To report on the prevalence and implications of hypertension in hospitalized type 2 diabetic patients at King Abdulaziz University Hospital. METHODS: Relevant data was retrieved from the medical charts of type 2 diabetic patients admitted to the medical unit of King Abdulaziz University Hospital in the period between January 1998 and September 1999. Patients' age, sex, body mass index, presence of hypertension and hyperlipidemia, degree of glycemic control, reason for admission, duration of hospital stay and mortality were recorded. RESULTS: A total of 427 patients were studied, 46% of whom were hypertensive. Hypertensive diabetics tend to be older, more likely to have a higher body mass index and hyperlipidemia, to develop cardiovascular complications and renal failure, to stay longer in hospital and to have higher mortality compared to normotensive diabetics. CONCLUSION: Hypertension is common in diabetics, early treatment of which is important to prevent cardiovascular complications, to minimize the progression of microvascular complications and to decrease mortality.

Low rates of diabetic patients reaching good control targets.

A cross-sectional study was conducted of 404 diabetic patients attending King Abdulaziz University Hospital medical clinic from June 1998 to January 2000 in order to determine their rates of reaching target levels for blood glucose, blood pressure, serum lipids and body mass index. Greatest difficulty was found in reaching target levels for low-density lipoprotein and glycated haemoglobin. Target levels for blood pressure were harder to achieve for Saudis than non-Saudis. Significantly fewer females reached target levels for blood glucose, body mass index, low-density lipoprotein or all targets than males (both Saudi and non-Saudi). Efforts are needed to improve compliance to diet and drug regimens and to identify and treat risk factors in each patient.

Candidemia at a University Hospital: epidemiology, risk factors and predictors of mortality.

BACKGROUND: Blood stream infection due to candida species are becoming increasingly important causes of morbidity and mortality in hospitalized patients. The aim of this study was to obtain epidemiological data on candidemia in patients at King Abdulaziz University Hospital (KAUH), and to discuss the influence of several clinical variables on the development and outcome of candidemia. MATERIALS AND METHODS: Demographic information, risk factors, therapy and outcome of all patients who had candidemia at KAUH between January 1998 and December 1999 were reviewed. RESULTS: Thirty-one candidemic episodes were identified. All the candidemic episodes were hospital acquired. The most common risk factors to candidemia were central venous catheters (87%), stay in intensive care unit (ICU) (77%), and broad-spectrum antibiotics therapy (74%). Candida albicans was the most frequently isolated species (71%), followed by candida tropicalis and candida parapsilosis (13% each). Twenty-six patients (84%) were treated with amphotericin B, 4 (13%) with fluconazole, and one (3%) with ketoconazole. Antifungal susceptibility testing of the isolates in general revealed minimal levels of resistance to amphotericin B (3%) versus 39% resistance to fluconazole. Less than 5% of Candida albicans were resistant to amphotericin B, in comparison with >35% of these strains that were resistant to fluconazole. The overall mortality was 71%. Mortality was significantly associated with the presence of central venous catheters (P=0.001), stay in intensive care unit (P<0.001), and prolonged hospital stay before the onset of candidemia (P=0.05). CONCLUSION: Despite antifungal treatment, the mortality of candidemia is still high. Rapid changes in the rate of infection, potential risk factors, and emerging species demand continued and close surveillance of this serious infection.

Bacterial pneumonia: comparison between diabetics and non-diabetics.

To determine the causative organisms, antimicrobial susceptibility, and outcome of community- and hospital-acquired pneumonia in diabetics and to compare this with non-diabetics, sputum cultures done at King Abdulaziz University Hospital in the period between January 1998 and December 1999 were reviewed. A total of 354 cases were studied, of which 125 (35%) were diabetics. Diabetic patients were older with a male predominance compared to non-diabetics. H. influenza was the commonest pathogen in community-acquired pneumonia (CAP) in both diabetics and non-diabetics, but there was a predominance of Staphylococcus aureus in diabetics compared to non-diabetics. Gram-negative bacilli were the commonest pathogens in hospital-acquired pneumonia (HAP) in both diabetics and non-diabetics. Ampicillin, co-amoxyclav, flouroquinolones, second-generation cephalosporins and erythromycin were used empirically in CAP while aminoglycosides, fluoroquinolones and imipenem were used in HAP in both diabetics and non-diabetics. No significant difference in mortality was found between diabetics and non-diabetics, for either CAP or HAP.

Low rates of diabetic patients reaching good control targets

A cross-sectional study was conducted of 404 diabetic patients attending King Abdulaziz University Hospital medical clinic from June 1998 to January 2000 in order to determine their rates of reaching target levels for blood glucose, blood pressure, serum lipids and body mass index. Greatest difficulty was found in reaching target levels for low-density lipoprotein and glycated haemoglobin. Target levels for blood pressure were harder to achieve for Saudis than non-Saudis. Significantly fewer females reached target levels for blood glucose, body mass index, low-density lipoprotein or all targets than males [both Saudi and non-Saudi]. Efforts are needed to improve compliance to diet and drug regimens and to identify and treat risk factors in each patient

Adult bacteremia. Comparative study between diabetic and non-diabetic patients.

OBJECTIVES: To compare type of infection, microbiology, source, complications and outcome of bacteremia in diabetic and non-diabetic patients in our teaching hospital. To study the risk factors associated with diabetic bacteremia's mortality and to compare our findings with those reported in the literatures. METHODS: Retrospective study of all adult cases of bacteremia admitted to King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from January 1998 to January 1999. RESULTS: Rate of bacteremia per 1000 admission was 23. We compared 71 episodes in 48 diabetics with 100 episodes in 77 non-diabetics. Diabetic patients were older than non-diabetics (mean age 61.08 versus 49.89 years, p <0.001). No statistically significant difference was found between the 2 groups in the type and source of infection. Klebsiella of urinary source was isolated from 37% episodes in diabetics versus 11% non-diabetics (p 0.03). Acute renal failure and septic shock were the 2 complications significantly developed in non-diabetics compared to diabetics (19% versus 7% and 13% versus 4%, p=0.02 and 0.05). Mortality due to bacteremia was 24% in diabetics and 44% in non-diabetics (p 0.007). Hospital acquired infections, presence of underlying malignancy, use of ventilators, development of septic shock and acute renal failure, were factors associated with high mortality in diabetic bacteremia. CONCLUSION: Our results are comparable with those reported in the literatures. The better outcome observed in our diabetic bacteremia could be due to adequate glycemic control during bacteremic episode and appropriate choice of empiric antibiotics.

Staphylococcus aureus bacteremia.

OBJECTIVES: To study the episodes of Staph.aureus bacteremia diagnosed at King Abdulaziz University Hospital, to determine the source of infection, risk factors, the outcome of treatment and to compare our results with those reported in the literature. METHODS: A retrospective study in which the episodes of Staph.aureus bacteremia diagnosed at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia in the period from June 1996 to December 1998 were analyzed. RESULTS: A total of 103 episodes of Staph.aureus bacteremia were diagnosed in 95 patients with a mean age of 33.61 years (range 2 months to 90 years) and male:female ratio of 1.9:1. More than 50% of patients were Saudi nationals. Hospital-acquired infection was detected in 74% of the episodes versus 25% community-acquired. Methicillin resistant Staph.aureus was found in 29% of the episodes. Intravenous catheters and wounds were the main sources of bacteremic episodes (29% and 21%). The overall mortality was 32% with significant association with old age, diabetes mellitus and hemodialysis for renal failure. Risk factors such as surgical wounds, diabetes mellitus and malignancy, were more frequently associated with hospital-acquired than community-acquired bacteremia. Infective endocarditis was higher in patients with community-acquired bacteremia who had unknown source of infection. CONCLUSIONS: As discussed in the text, our results are comparable with those reported in the literature. Insertion of intravenous catheters under aseptic precaution, better care and judicious limitation of patients length of exposure to central line, in addition to proper wound dressings could reduce the frequency of blood stream infections.

Etiology and outcome of thyrotoxicosis at a university hospital.

OBJECTIVE: To determine the causes, clinical manifestations, mode of treatment, and outcome of hyperthyroidism at King Abdulaziz University Hospital. METHODS: A retrospective study of all cases of thyrotoxicosis diagnosed at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, in the period between January 1997 to January 1999, that received a minimum of one year treatment. RESULTS: A total of 203 patients were seen with female: male ratio of 3.8:1 and mean age of 35.49+/-10.86 years. Graves' disease was the underlying cause in 69% of cases, toxic multi nodular goiter in 29%, and toxic adenoma and sub acute thyroiditis in 1% each. Palpitations, tremor, weight loss and nervousness were the commonest presenting manifestations. Forty-five (45%) of patients were treated with antithyroid drugs, 36% with radioactive iodine and 18% underwent subtotal thyroidectomy. Post radiotherapy hypothyroidism developed in 37% of patients. CONCLUSION: Causes and clinical manifestations of thyrotoxicosis in our patients were comparable with those reported in the literature. There is under use of radioactive iodine therapy, and physicians should be encouraged to use this mode of therapy as its efficacy, safety and low cost made it the preferred definitive treatment in most patients with hyperthyroidism.

Bronchiolitis obliterans organizing pneumonia associated with pseudomonas aeruginosa infection.

Bronchiolitis obliterans organizing pneumonia is a rare disease characterized by the presence of granulation tissue within alveolar ducts and alveoli. Most cases are idiopathic, but it may also be seen during resolution of viral or bacterial pneumonia (mycoplasma, legionella and chlamydia). It may present as a community acquired pneumonia which does not respond to antibiotics, which make the diagnosis very difficult. We described a 53-year old patient who presented with Bronchiolitis obliterans organizing pneumonia during the resolution of pseudomonas aeruginosa pneumonia. Initially there was slight improvement on antibiotics but later he became severely hypoxic and placed on mechanical ventilator. Diagnosis of Bronchiolitis obliterans organizing pneumonia was obtained with bronchoscopic lung biopsy. He showed an excellent response to steroid treatment. To our knowledge this is the first case of Bronchiolitis obliterans organizing pneumonia secondary to Pseudomonas aeruginosa pneumonia.

Deep vein thrombosis at King Abdul Aziz University Hospital.

OBJECTIVE: To study the incidence of deep vein thrombosis and pulmonary embolism at King Abdul Aziz University Hospital. To determine the risk factors, use of different diagnostic modalities, treatment given and to compare our findings with those reported in the literature. METHODS: Retrospective study which included all cases of deep vein thrombosis and pulmonary embolism admitted to the medical ward of King Abdul Aziz University Hospital during the period between January 1994 till March 1999 were analyzed. RESULTS: Total of 75 patients were diagnosed to have deep vein thrombosis with mean age of 44.16 +/- 14.5 years and male:female ratio of 1:2. Doppler ultrasound was used for the diagnosis in 56 of 75 patients (75%). Pulmonary embolism as a complication of deep vein thrombosis developed in 24 of 75 patients (32%). Prolonged immobilization was found to be the most common risk factor 17 of 75 (23%). All the patients were treated with conventional heparin followed by warfarin. CONCLUSION: As discussed, our results are comparable with those reported in the literature. Post operative patients who are anticipated to have prolonged immobilization should receive prophylactic anti coagulation with subcutaneous heparin. Thrombophillia screening should be reserved for those with recurrent deep vein thrombosis or patients with positive family history.

Subclinical diabetic neuropathy: a common complication in Saudi diabetics.

OBJECTIVE: To determine the prevalence of sub clinical diabetic neuropathy in Saudi diabetics and the risk factors associated with symptomatic diabetic neuropathy. METHODS: A prospective study of Saudi diabetics attending King Abdulaziz University Hospital out patient clinic from January 1998 until April 1999. Detailed information of each patients' age, sex, body mass index, type and duration of diabetes mellitus, mode of treatment, degree of blood glucose control, presence of hypertension, hyperlipidemia, smoking, family history of diabetes mellitus and hypertension were recorded. Patients were assessed for diabetic neuropathy using the Michigan Neuropathy Program. Patients who were asymptomatic and scored less than 2 on simple clinical examination were referred to a neurologist for a complete neurological examination and nerve conduction studies. RESULTS: A total of 237 patients were studied with a mean age of 54.19 years and mean duration of diabetes 10.6 years. Symptomatic diabetic neuropathy was present in 132 (56%) patients while subclinical neuropathy was present in 58 (57%) of asymptomatic patients. Old age, type II diabetes with long duration, poor control and smoking were risk factors associated with symptomatic diabetic neuropathy (p<0.001, p=0.09, p<0.001, p=0.04, p=0.08). CONCLUSION: Subclinical diabetic neuropathy is common. Early diagnosis is important for possible prevention of late neuropathic complications (foot ulcers and infections). Prolonged poorly controlled diabetes mellitus, old age and smoking are risk factors for symptomatic diabetic neuropathy. Meticulous blood glucose control is important for nerve function protection. Researches are urgently needed for satisfactory therapy.

Common causes of admission in diabetics.

OBJECTIVE: To report on the causes of admissions of diabetic patients to the medical unit of King Abdulaziz University Hospital, mortality and risk factors, associated with high mortality, and to find out possible ways to reduce admissions, cost and mortality. METHODS: Retrospective analysis of diabetic admissions to the medical unit of King Abdulaziz University Hospital between January 1996 to September 1999. Patients age, sex, body mass index, type and duration of diabetes mellitus, mode of treatment, degree of blood glucose control, presence of hypertension, hyperlipidemia, and smoking were recorded as well as the causes of admissions and mortality. RESULTS: A total of 5917 patients were admitted, 17% of them were diabetics. Admissions for blood glucose control and for macrovascular complications were found in 21% and 38%. Mortality rate was 13%. Hypertension, hyperlipidemia, smoking, obesity, infection, poor glycemic control, long duration of diabetes mellitus and long hospital stay were risk factors associated with high mortality. CONCLUSION: Macrovascular complications and uncontrolled blood glucose were the most common causes of admissions. Control of hypertension, hyperlipidemia, cessation of smoking and weight reduction will not only decrease the risk of macrovascular complications, but also in addition to patient's education for tight blood glucose control, will decrease the rate, cost and mortality of diabetic admissions.

Subclinical diabetic neuropathy. A common complication in Saudi diabetics.

OBJECTIVE: To determine the prevalence of sub clinical diabetic neuropathy in Saudi diabetics and the risk factors associated with symptomatic diabetic neuropathy. METHODS: A prospective study of Saudi diabetics attending King Abdulaziz University Hospital out patient clinic from January 1998 until April 1999. Detailed information of each patients` age, sex, body mass index, type and duration of diabetes mellitus, mode of treatment, degree of blood glucose control, presence of hypertension, hyperlipidemia, smoking, family history of diabetes mellitus and hypertension were recorded. Patients were assessed for diabetic neuropathy using the Michigan Neuropathy Program. Patients who were asymptomatic and scored less than 2 on simple clinical examination were referred to a neurologist for a complete neurological examination and nerve conduction studies. RESULTS: A total of 237 patients were studied with a mean age of 54.19 years and mean duration of diabetes 10.6 years. Symptomatic diabetic neuropathy was present in 132 (56%) patients while subclinical neuropathy was present in 58 (57%) of asymptomatic patients. Old age, type II diabetes with long duration, poor control and smoking were risk factors associated with symptomatic diabetic neuropathy (p<0.001, p=0.09, p<0.001, p=0.04, p=0.08). CONCLUSION: Subclinical diabetic neuropathy is common. Early diagnosis is important for possible prevention of late neuropathic complications (foot ulcers and infections). Prolonged poorly controlled diabetes mellitus, old age and smoking are risk factors for symptomatic diabetic neuropathy. Meticulous blood glucose control is important for nerve function protection. Researches are urgently needed for satisfactory therapy.