Obesity, overweight and underweight among adults in an urban community in Yemen.

High body mass index (BMI) is an important risk factor for morbidity and mortality, while low BMI is an indicator of undernutrition; both may be concerns in low-income countries. This cross-sectional, primary-care based study aimed to measure the sex and age-specific mean BMI and estimate the prevalence of obesity, overweight and underweight among adults in an urban community in Sana'a, Yemen. A total of 2500 subjects (919 males and 1581 females) were recruited in 2006. The crude mean BMI for all ages was significantly higher in females [23.9 (SD 5.1) kg/m2] than males [21.8 (SD 8.9) kg/m2]. The mean BMI trend was associated with age, with a peak in the age group 35-44 years. Calculated prevalence showed 18.0% of males and 14.6% of females were overweight (BMI > or = 25 kg/m2) and 2.5% of males and 12.4% of females were obese (BMI > or = 30 kg/m2). In contrast a substantial number of subjects were underweight (BMI <18.5 kg/m2): 20.1% of males and 14.6% of females.

Obesity, overweight and underweight among adults in an urban community in Yemen

High body mass index [BMI] is an important risk factor for morbidity and mortality, while low BMI is an indicator of undernutrition; both may be concerns in low-income countries. This cross-sectional, primary-care based study aimed to measure the sex and age-specific mean BMI and estimate the prevalence of obesity, overweight and underweight among adults in an urban community in Sana'a, Yemen. A total of 2500 subjects [919 males and 1581 females] were recruited in 2006. The crude mean BMI for all ages was significantly higher in females [23.9 [SD 5.1] kg/m2] than males [21.8 [SD 8.9] kg/m2]. The mean BMI trend was associated with age, with a peak in the age group 35-44 years. Calculated prevalence showed 18.0% of males and 14.6% of females were overweight (BMI >/=25 kg/m2] and 2.5% of males and 12.4% of females were obese [BMI >/=0 kg/m2]. In contrast a substantial number of subjects were underweight [BMI < 18.5 kg/m2]: 20.1% of males and 14.6% of females

Causes of visual impairment and blindness among Yemenis with diabetes: a hospital-based study.

We assessed the causes of visual impairment and blindness in 694 diabetic patients attending our eye centre in Sana'a, Yemen from 2001 to 2005 by review of their medical records. The mean age of the patients was 53.9 (SD 11.52) years, range 13-95 years, and 382 (55%) were males. According to the World Health Organization definitions, 273 (39.3%) patients had visual impairment and 109 (15.7%) were blind. Cataract, proliferative diabetic retinopathy (PDR) and diabetic maculopathy were the main causes of visual impairment and blindness. Patients with PDR and maculopathy were significantly more likely to have visual impairment compared to patients without retinopathy (RR = 1.99, 95% CI: 1.74-2.28 and RR = 1.84, (95% CI: 1.60-2.13 respectively) and be blind (RR = 4.69, 95% CI: 3.70-5.95 and RR = 2.53, 95% CI: 1.92-3.34 respectively). Diabetic retinopathy is a public health problem in Yemen and national screening and educational programmes are highly needed to reduce the risk of visual impairment and blindness among diabetics.

Causes of visual impairment and blindness among Yemenis with diabetes: a hospital-based study

We assessed the causes of visual impairment and blindness in 694 diabetic patients attending our eye centre in Sana'a, Yemen from 2001 to 2005 by review of their medical records. The mean age of the patients was 53.9 [SD 11.52] years, range 13-95 years, and 382 [55%] were males. According to the World Health Organization definitions, 273 [39.3%] patients had visual impairment and 109 [15.7%] were blind. Cataract, proliferative diabetic retinopathy [PDR] and diabetic maculopathy were the main causes of visual impairment and blindness. Patients with PDR and maculopathy were significantly more likely to have visual impairment compared to patients without retinopathy [RR = 1.99, 95% CI: 1.74-2.28 and RR - 1.84, [95% Cl: 1.60-2.13 respectively] and be blind [RR - 4.69, 95% Cl: 3.70-5.95% and RR= 2.53, 95% CI: 1.92-3.34 respectively]. Diabetic retinopathy is a public health problem in Yemen and national screening and educational programmes are highly needed to reduce the risk of visual impairment and blindness among diabetics

Prevalence of type 2 diabetes and other cardiovascular risk factors in a semirural area in Yemen.

The study determined the prevalence of type 2 diabetes, abnormal glucose tolerance and other cardiovascular risk factors in a sample of 250 adults aged > or = 35 years in a semirural area near Sana'a, the capital of Yemen,. The overall crude prevalence of diabetes was 10.4% (95% CI: 6.6%-14.2%) and the age-standardized rate was 6.3% (95% CI: 5.4%-7.2%). The age-standardized rate of having either impaired fasting glucose or impaired glucose tolerance was 9.0% (95% CI: 6.0%-12.0%) and the age-standardized prevalence of hypertension was 14.2% (95% CI: 13.0%-16.0%). Age and waist circumference were independently related to total glucose intolerance. The observed high frequency of central obesity suggests a dietary origin for these adverse health conditions.

Prevalence of type 2 diabetes and other cardiovascular risk factors in a semirural area in Yemen

The study determined the prevalence of type 2 diabetes, abnormal glucose tolerance and other cardiovascular risk factors in a sample of 250 adults aged >/= 35 years in a semirural area near Sana'a, the capital of Yemen. The overall crude prevalence of diabetes was 10.4% [95% CI: 6.6%-14.2%] and the age-standardized rate was 6.3% [95% CI: 5.4%-7.2%]. The age-standardized rate of having either impaired fasting glucose or impaired glucose tolerance was 9.0% [95% CI: 6.0%-12.0%] and the age-standardized prevalence of hypertension was 14.2% [95% CI: 13.0%-16.0%]. Age and waist circumference were independently related to total glucose intolerance. The observed high frequency of central obesity suggests a dietary origin for these adverse health conditions

Khat (Catha edulis): health aspects of khat chewing.

Catha edulis Forsk leaves (khat) are chewed daily by a high proportion of the adult population in Yemen for the mild stimulant effect. Cathinone is believed to be the main active ingredient in fresh khat leaves and is structurally related and pharmacologically similar to amphetamine. The habit of khat chewing is widespread with a deep-rooted sociocultural tradition in Yemen and as such poses a public health problem. The objective of this literature review was to examine studies on khat, particularly human studies, with special reference to its effect on the central nervous system, cardiovascular, digestive and genitourinary systems, oral-dental tissues, diabetes mellitus and cancer.

Khat [Catha edulis]: health aspects of khat chewing

Catha edulis Forsk leaves [khat] are chewed daily by a high proportion of the adult population in Yemen for the mild stimulant effect. Cathinone is believed to be the main active ingredient in fresh khat leaves and is structurally related and pharmacologically similar to amphetamine. The habit of khat chewing is widespread with a deep-rooted sociocultural tradition in Yemen and as such poses a public health problem. The objective of this literature review was to examine studies on khat, particularly human studies, with special reference to its effect on the central nervous system, cardiovascular, digestive and genitourinary systems, oral-dental tissues, diabetes mellitus and cancer

Prevalence of known diabetes and hypertension in the Republic of Yemen.

The present study was undertaken to determine the prevalence of known cases of diabetes and hypertension among adults in Sana'a city. Thus 1080 persons aged 20-85 years were selected for interview using a multistage random sampling technique. The crude prevalence of known diabetes was 6.57% (95% CI: 5.2-8.2) and of known hypertension 13.5% (95% CI: 11.5-15.6). The age-standardized prevalence for the age range 30-64 years was 9.75% (95% CI: 7.55-11.95) for diabetes and 17.1% (95% CI: 15.0-19.2) for hypertension. These results provide an estimate of the prevalence of known diabetes, hypertension and related vascular events in a well-defined urban community.

Prevalence of known diabetes and hypertension in the Republic of Yemen

The present study was undertaken to determine the prevalence of known cases of diabetes and hypertension among adults in Sana'a city. Thus 1080 persons aged 20-85 years were selected for interview using a multistage random sampling technique. The crude prevalence of known diabetes was 6.57% [95% CI: 5.2-8.2] and of known hypertension 13.5% [95% CI: 11.5-15.6]. The age-standardized prevalence for the age range 30-64 years was 9.75% [95% CI: 7.55-11.95] for diabetes and 17.1% [95% CI: 15.0-19.2] for hypertension. These results provide an estimate of the prevalence of known diabetes, hypertension and related vascular events in a well-defined urban community

Etiologies of the urinary tract infections in a Yemeni City.

OBJECTIVE: To determine the causative agents of urinary tract infection in Yemeni patients in Sana'a city, and to determine the antibiotic susceptibilities of these agents in vitro. METHODS: Consecutive mid-stream urine specimens were submitted to our laboratory by 4029 patients in Sana'a city from 1990 to the end of 1999. The specimens were cultured and the isolates were identified using standard microbiological techniques. The antibiotic susceptibilities of the isolates were also determined (in vitro). RESULTS: The number of patients with urinary tract infection who yielded positive cultures from their mid stream urine specimens was 685 out of 4029 patients (17%). The ratio of female-to-male patients was 462:223 (2.07:1). The causative agents were mainly members of the family Enterobacteriaceae, 579 out of the 685 isolates (84.5%). Escherichia coli was the main pathogen, 357 isolates out of all the isolates (52%) followed by Klebsiella pneumoniae, 143 isolates (21%) and Proteus species, 56 isolates (8%). The other pathogens (Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter aerogenes, Staphylococcus saprophyticus, Corynebacterium urealyticum and Enterococcus faecalis) constituted 129 out of the 685 isolates (19%). There was a shift in the types of the causative agents of urinary tract infection between the first and 2nd halves of the study period. The isolation of Escherichia coli decreased from 60% in the first half to 42% in the 2nd. Whereas Klebsiella pneumoniae increased from 16% in the first half to 27% in the 2nd, Proteus species from 8% to 9%, Staphylococcus aureus from 5% to 7%, Pseudomonas aeruginosa from 3% to 7%, Enterobacter aerogenes from 3% to 3.5%, Staphylococcus saprophyticus from 2% to 3% and Corynebacterium urealyticum from 1% to 2%. Ninety percent of all the urinary pathogens were sensitive to ciprofloxacin, 75% to nitrofurantoin, 57% to gentamicin, 46% to cefaclor, 46% to nalidixic acid, 39% to doxycycline, 37% to co-trimoxazole and 20% to ampiclox. CONCLUSION: The types of urinary tract pathogens and their antibiotic susceptibilities in addition to the rate of isolation from male and female patients are reported. It is recommended that ciprofloxacin and nitrofurantoin or both are used in the blind treatment of urinary tract infection while awaiting the culture and sensitivity results. It is also recommended to continuously monitor the pattern of urinary pathogens from the community to guide the blind treatment of patients in the future.

The effect of Qat chewing on blood pressure and heart rate in healthy volunteers.

The leaves of the Qat plant (Catha edulis Forsk., Celastraceae) which contain amphetamine like compounds are widely chewed in Yemen and East Africa for their pleasurable stimulant properties. There are also a number of unwanted side-effects and this paper studies the effect on heart rate and blood pressure in 80 healthy volunteers. During a 3-h period of chewing fresh Qat leaves there was a significant and progressive rise in systolic and diastolic blood pressure and heart rate, and levels had not returned to baseline 1 h after chewing had ceased. Further studies are needed on possible cardiovascular morbidity associated with regular Qat chewing.

Familial clustering of type II diabetes mellitus (DM) diagnosed under the age of 40 years in Yemen: Is it early-onset type II DM or maturity-onset diabetes of the young?

BACKGROUND: Clinical presentation of type II diabetes mellitus (DM) has frequently been observed at an early age in developing countries, probably as a result of genetic, epidemiological and demographic factors. This study aimed to investigate the pattern of familial clustering of type II DM in patients who developed clinical diabetes before the age of 40 years. PATIENTS AND METHOD: The study involved family pedigrees, clinical assessments and laboratory investigations of 191 patients with type II DM, and 260 age-matched randomly selected non-diabetic controls. RESULTS: The prevalence of type II DM was found to be statistically higher among parents (P<0.0001), fullsiblings (P<0.0001), half-siblings (P<0.001), uncles (P<0.01) and aunts (P<0.001) of the index patients, as compared to the corresponding relatives of nondiabetic controls. The odds ratio of the family history index (FHI), in association with type II DM in probands who had no family history of diabetes (FHI=0.0), was significantly negative (OR=0.34; 95% CI 0.23, 0.52; P<0.0001). At an FHI level of 0.5-1.0, there was a slight nonsignificant increase in odds ratio for diabetes (OR=1.53; 95% CI 0.95, 2.45; P=0.08). A higher level of FHI (A(3)1.5) was associated with a significant increase in odds ratio for diabetes (OR=3.75; 95% CI 2.13, 6.64; P<0.0001). The age-corrected relative risk of type II DM for the offspring of diabetic parents was found to be progressively increasing from a nonconsanguineous diabetic father (22%) or mother (26.5%), to nonconsanguineous conjugal diabetic parents (27%) and to the offspring of consanguineous single or conjugal diabetic parents (37.5%). On the contrary, the age-corrected relative risk for the offspring of nonconsanguineous and consanguineous nondiabetic parents was characteristically lower (14% for each). Maturityonset diabetes of the young (MODY) was suspected in 10 probands (5%), and early-onset type II DM in the offspring of conjugal diabetic parents in 16 probands (9%). The remaining 165 probands (86%) were unclassified due to lack of specific classification criteria. CONCLUSION: The considerable familial clustering of type II DM diagnosed under the age of 40 years in this study population reflects the presence of a strong genetic component in its etiology. In addition, the development of early-onset type II DM was more likely associated with a consanguineous and/or conjugal diabetic parents and probably MODY subtype among a substantial number of patients. Epidemiological and demographic factors might have been implicated, especially in those with negative parental diabetic history.

Chewing Qat leaves slows the whole gut transit time.

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Demographic and clinical features of diabetes mellitus in 1095 Yemeni patients.

The ever-increasing incidence of diabetes mellitus is a cause for growing public health concern in both developed and developing countries. In this study, we aim to explore the special demographic and clinical features of diabetes, as seen in a large sample of Yemeni patients, and to compare these features with those reported in other countries. All patients referred to our diabetic clinic over a five-year period were investigated according to a standardized protocol. Data was collected and fed into a personal computer with a software statistical package for analysis. The relative frequencies of clinical classes of diabetes were 10.5% for IDD, 58.6% for non-obese NIDDM; 26.2% for obese NIDDM, and 4.7% for IGT. In the IDDM class, the age-specific relative frequency rate showed a higher and earlier onset peak frequency in females than in males. Among NIDDM class, about 31% of patients were diagnosed under the age of 45 years, and only 12% were first diagnosed after the age of 65 years. Most NIDDM patients came from social classes I and II (professionals and intermediate professionals) and most IDDM patients came from social class IIIM (skilled manual). A positive family history of diabetes among first-degree relatives of index patients was observed in 33.7% of IDDM patients, in 30% of non-obese NIDDM patients, in 39.2% of obese NIDDM patients and 32% of IGT patients. Female NIDDM patients had a significantly higher mean body mass index (BMI) than males (P<0.0001). Hypertension was recognized in 24.2% of the diabetic population aged 20 to A(3) 65 years. Large vessel disease (LVD) was observed in 28% of patients, small vessel disease (SVD) in 45%, and peripheral neuropathy in 40.7%. Inadequate glycemic control was noticed during follow-up in the majority of patients. Diabetes mellitus in Yemen, especially NIDDM, is characterized by an earlier age at onset, and predominance of males and non-obese NIDM subclass. Other characteristics include moderate genetic susceptibility, inadequate glycemic control and high prevalence of chronic complications.

Acute sporadic hepatitis in the Republic of Yemen.

The causes of acute icteric viral hepatitis were determined in 78 adult Yemeni patients. Acute hepatitis B (IgM anti-HBc positive) was the most common type (26.9%). Acute hepatitis E (IgM anti-HEV positive) occurred in 14% and was not associated with travel outside Yemen. Sixty percent of all 78 patients were positive for IgG anti-HEV as were 40% of a series of 48 healthy male blood donors and pregnant females, indicating that HEV is prevalent in Yemen. Acute hepatitis A (IgM anti-HAV positive) and hepatitis C and D were responsible for 5.1%, 6.4%, and 2.6% cases, respectively. This totals to 106%, as an infection with two viruses occurred in 6.4% cases. In 51.3% of all cases, no virological markers of acute hepatitis were detected, suggesting an as yet undiscovered agent.

Oesophageal and gastric carcinoma in the Republic of Yemen.

We conducted a preliminary survey on 3064 patients who underwent upper gastrointestinal endoscopy at the Al-Thawra Hospital in Sana'a, Republic of Yemen, between January and December 1991. The age/sex distribution, demographic features and social habits with respect to cigarette and water-pipe smoking and Qat chewing were compared for patients with oesophageal and gastric cancers (n = 183). A preponderance of women with carcinoma of the mid-oesophageal was noted, previously only recorded in areas of high prevalence. Unlike Western populations, smoking and alcohol consumption were not significant risk factors. A high frequency of Qat chewing and water-pipe smoking was found for both men and women and for a group with tumours of the gastro-oesophageal junction or cardia (chi 2 = 2.646, P > 0.05). Numbers were insufficient to identify independent effects of each factor individually. Dietary habits alone were insufficient to account for the excess of affected females. A case-control study is now underway to investigate further the role of dietary factors, social habits, demographic features and Helicobacter pylori infection on the development of upper gastrointestinal cancer in the Yemen.

Prevalence of hepatitis B, C, and D virus markers in Yemeni patients with chronic liver disease.

A serological survey for hepatitis B, C, and D markers was carried out in the Yemen Republic. Serum samples from 243 pregnant females, 294 male blood donors, and 108 patients with chronic liver disease were examined. Hepatitis B surface antigen (HBsAg) was found in 18.5% healthy individuals and 24.1% patients with chronic liver disease (P = 0.03). Evidence of any marker for hepatitis B virus (HBV) infection was found in 59.8% healthy individuals and 75.9% of patients with chronic liver disease (P = 0.0016). HBeAg was detected in 32.1% of the HBsAg-positive pregnant females, indicating that vertical transmission probably plays a part in forming the pool of HBV carriers. Vaccination against HBV as part of the extended programme of immunisation (EPI) is recommended. Antibodies to hepatitis D were found in only 2 of 100 HBsAg-positive sera. Antibodies to hepatitis C (anti-HCV) were found in 2.1% healthy individuals and 21.5% patients with chronic liver disease (P = 0.0001). These results indicate that hepatitis B is hyperendemic in the Yemen Republic but that hepatitis D is very uncommon. The prevalence of anti-HCV is higher than in Europe and similar to neighbouring Arab countries. Infection with both HBV and HCV are important causes of chronic liver disease in the Yemen Republic.

Effect of khat on the metabolism of erythrocytes.

The plant khat "Catha Edulis Forsk" is widely distributed among most East African countries, Yemen and many other areas of the world. Administration of khat extract by the intragastric route in rabbits affected the metabolism of erythrocytes. There is a significant decrease in pyruvate kinase and the level of reduced glutathione (P less than 0.001), and a highly significant increase in both glucose-6-phosphate dehydrogenase and glutathione reductase activities (P less than 0.001) in khat-fed rabbits as compared to controls. On the other hand the activity of uridyl transferase as well as the concentration of 2,3-diphosphoglycerate were not significantly changed in experimental khat-fed rabbits (P greater than 0.5).