Screening for asymptomatic cardiovascular disease in Arab patients with diabetes.

AIM: Diabetes mellitus is a major risk factor for atherosclerosis and accordingly increased morbidity and mortality. This study aimed at screening high risk diabetic patients for atherosclerosis in different arterial territories. METHODS: All high risk asymptomatic patients attending the diabetic clinic, King Fahd Hospital of the University, Saudi Arabia were invited to be screened for peripheral arterial disease (PAD), extra-cranial cerebrovascular disease (CVD) and coronary artery disease (CAD) over one year. All participants underwent measurement of ankle brachial pressure index, carotid Duplex scan and exercise electrocardiography (ECG). All patients underwent evaluation of conventional risk factors for atherosclerosis RESULTS: One hundred and sixty nine patients were invited to be screened. Of these 138 (82%) completed all the screening tests. The mean age was 53.5±7.18 years. Seventy-five (55%) had evidence of subclinical atherosclerosis. In the atherosclerotic group, 24 patients had PAD, 47 had CVD and 30 had CAD. There were significant differences between the atherosclerotic and non-atherosclerotic groups with regard to most risk factors. In age, sex adjusted, the risk of developing atherosclerosis was significantly increased with all risk factors. Dyslipidemia had the highest association (OR 9.7, 95% CI 8.1-10.2) CONCLUSION: Participation and diagnostic yield of screening for atherosclerosis had satisfactory validity and reliability. Routine screening in high-risk diabetic patients can serve as an effective tool for diagnosis of sub clinical cardiovascular disease and provide strategies to optimize risk reduction.

Prevalence of diabetes mellitus and impaired fasting glucose levels in the Eastern Province of Saudi Arabia: results of a screening campaign.

INTRODUCTION: This study aimed to estimate the prevalence of diagnosed and undiagnosed diabetes mellitus (DM) in the Eastern Province of Saudi Arabia, and to study its relationship with socioeconomic factors. METHODS: The study targeted all Saudi subjects aged 30 years and above who resided in the Eastern Province in 2004. DM screening was conducted by taking the capillary fasting blood glucose (CFBG) after eight hours or more of fasting, or the casual capillary blood glucose (CCBG). A positive screening test for hyperglycaemia was defined as CFBG more than or equal to 100 mg/dl (5.6 mmol/l), or CCBG more than or equal to 140 mg/dl (7.8 mmol/l). A positive result was confirmed on another day through the measurement of fasting plasma glucose (FPG) levels from a venous sample. A diagnosis of DM was considered if FPG was more than or equal to 126 mg/dl (7.0 mmol/l), or when there was a history of a previous diagnosis. RESULTS: Out of 197,681 participants, 35,929 (18.2 percent) had a positive history of DM or a positive screening test for hyperglycaemia. After confirmation by venous blood testing, the prevalence of DM dropped to 17.2 percent while the prevalence of newly diagnosed DM was 1.8 percent. The prevalence increased with age and was higher in women, widows, divorcees, those who had a low education level and the unemployed. CONCLUSION: The prevalence of DM in Saudi Arabia is one of the highest reported in the world, and its yield of screening is high.

Glucocorticoid-related osteoporotic fractures.

INTRODUCTION: This study was conducted to evaluate the prevalence of fractures secondary to steroid use. METHODS: A total of 165 patients (100 male and 65 female) who received glucocorticoid therapy at a dose of 7.5 mg or more, or its equivalent, for more than six months were identified from July 1, 2007 to December 30, 2007. Data extracted included age, gender, dose of glucocorticoid, concomitant diseases, the use of anti-resorptive therapy, calcium and vitamin D supplementation, and the results of bone mineral density (BMD) tests, if performed. Any fragility fractures, the site involved and the treatment administered were also recorded. The data was entered and analysed using the Statistical Package for the Social Sciences. RESULTS: 140 patients had no fractures while 25 (15.2 percent) sustained an osteoporotic fracture. The age (p-value less than 0.5), dose of steroids (p-value less than 0.001) and duration of glucocorticoid therapy (p-value less than 0.001) were significantly higher among patients who sustained fractures. Of these, 12 were male and 13 were female. None of the patients in both groups was started on antiresorptive therapy. The dosage of glucocorticoids was higher among women than men (11.5 versus 24.5 mg/day, p-value is 0.05). The commonest sites of osteoporotic fracture were the spine (44 percent) and proximal femur (24 percent). Eight out of 11 patients had more than one vertebra involved. CONCLUSION: Fractures due to steroid-induced osteoporosis could have been prevented if appropriate measures were taken.

Low bone mass due to sickle cell anemia: is it becoming a real issue?

BACKGROUND: The prevalence of sickle cell anemia in Saudi population was reported to be between 0-5.27%. OBJECTIVE: This cross-sectional study was conducted to assess the prevalence of osteoporosis and osteopenia in patients with sickle cell anemia and to correlate its severity with the hematological parameters. METHODS: A cross-sectional study which included consecutive adult patients with sickle cell anemia attending the outpatient clinics or were admitted with uncomplicated vaso-occlusive crisis to King Fahd University Hospital, Al Khobar, Saudi Arabia, between August 2006 and March 2007 was undertaken. After informed verbal consent to participate, patient's age and sex were documented and body mass index (BMI) calculated. Blood was drawn for heamatological and biochemical parameters. Bone mineral density (BMD) measurement was done using dual energy X-ray absorbtiometry (DEXA) at upper femur and lumbar spine. Osteopenia and osteoporosis were diagnosed as per the WHO criteria. RESULTS: A total of 87 patients were studied. There were 41 male and 46 female patients. The mean age of males was 29.59+/-6.1 years, and females was 32.1+/-7.6 years. Over 65% of the males and 65.2% of the females were either osteopenic or osteoporotic. The prevalence of osteoporosis in both groups was highest at lumbar spine. Other variables like BMI, percentage of sickle hemoglobin and degree of anemia did not affect the bone mass. CONCLUSIONS: This study supports the view that prevalence of osteopenia and osteoporosis among sickle cell anemia patients is high. Sickle cell anemia is becoming the most common cause of secondary osteoporosis and physician's awareness about this issue is essential for early diagnosis and appropriate management.

Sickle cell anaemia: is it a cause for secondary osteoporosis?

OBJECTIVE: The risk of osteoporosis and osteopenia i s patients with sickle cell anaemia is not well established. This prospective study was conducted to assess the prevalence of osteoporosis and osteopenia in sickle cell anaemia. METHODS: Consecutive adult sickle cell anaemia patients who were treated at the department of orthopaedic surgery of King Fahd University Hospital, AIKhobar, SaudiArabia, between April and July 2006, were the subjects of study. After a verbal consent to participate in the study, patients age and sex were documented and body mass index (BMI) was calculated. Blood was extracted for haematological and biochemistry which also included haemoglobin electrophoresis. Bone mineral density (BMD) measurement was done using dual energy x-rayabsorbtiometry (DEXA) at the lumbar spine and the upper femur. Osteopenia and osteoporosis was diagnosed as per the WHO criteria. RESULTS: The results of 36 patients were analyzed. There were 23 males and 13 females. The average age in males was 34.21+/-6.35 years, and females was 35.38+/-5.40 years. Eighty-two percent of males and 76% of the females were either osteopenic or osteoporotic. The prevalence of osteoporosis in males was highest at lumbar spine (P= 0.001). CONCLUSIONS: This study finds the prevalence of osteopenia and osteoporosis is quite high among Saudi adult SCA patients. Physicians should be aware of the risk of osteoporosis in sickle cell patients and every effort should be made to treat them adequately and prevent osteoporosis related fractures.

Physicians' knowledge, attitude and practice towards erectile dysfunction in Saudi Arabia

We aimed to test the knowledge, attitude and practice [KAP] of physicians towards erectile dysfunction in the Eastern province of Saudi Arabia. At a scientific meeting about erectile dysfunction, 159 physicians from both government and private sectors answered a 34-item questionnaire in private. The mean total KAP score for the group was below the expected st and ard of 60%. Male physicians scored significantly higher than females. Urologists scored the highest, followed by and rologists. Surprisingly, physicians with higher qualifications scored lower than those with intermediate qualifications and even less than general practitioners. Those who had practised for >/= 10 years scored better than those with < 10 years practice. The role of cardiologists in the diagnosis and management of erectile dysfunction is discussed