Comparing MRI volume measurement techniques for pituitary macroadenoma: Investigating volume reduction and its relationship with biochemical control.

Pituitary adenomas are one of the most common types of primary intracranial tumors. Measuring pituitary adenoma volume is fundamental for effective management. This study aimed to assess the reliability of the ellipsoid method in comparison with the perimeter method for measuring pituitary macroadenoma volume. In addition, we investigated the correlation between adenoma size reduction and biochemical control in functioning adenomas. This was a retrospective cross-sectional cohort study including 113 patients with pituitary macroadenomas. MRI was obtained for volume measurement by ellipsoid and perimeter methods using two types of DICOM viewer software. Both ellipsoid and perimeter methods exhibit positive, strong, and significant correlations in pituitary macroadenomas in pre-treatment and post-treatment volume (Spearman correlation coefficient 0.95, p-value <0.0001). There was no significant difference in the mean post-treatment pituitary adenoma volume measurements utilizing the ellipsoid and the perimeter methods in different treatment modalities. There were significant differences in the pre-treatment volume measurements between the two methods, both in NFPA and prolactinoma. No correlation was found between volume variability measured by ellipsoid and perimeter methods and the degree of hormonal control in functioning pituitary adenomas. Both the ellipsoid and perimetric methods can be utilized for pituitary adenoma volume measurements as they demonstrate a strong and positive correlation. However, it is important to note that the ellipsoid method tends to result in overestimated tumor volume. There was no correlation between the adenoma size reduction and the degree of biochemical response in functioning adenomas.

Gluten-Free Diet in Co-Existent Celiac Disease and Type 1 Diabetes Mellitus: Is It Detrimental or Beneficial to Glycemic Control, Vascular Complications, and Quality of Life?

Celiac disease (CeD) is associated with type 1 diabetes mellitus (T1DM), and both have the same genetic background. Most patients with T1DM who develop CeD are either asymptomatic or have mild CeD-related gastrointestinal symptoms. Therefore, children affected by T1DM should undergo screening for asymptomatic CeD. The aim of this review is to highlight the influence of a gluten-free diet (GFD) on glycemic control, growth rate, microvascular complications, and quality of life in patients with T1DM and CeD. PubMed, Google Scholar, Web of Science, and Cochrane Central databases were searched. Reports reviewed were those published from 1969 to 2022 that focused on the interplay of T1DM and CeD and examined the effect of diet on glycemic control, growth rate, and quality of life. The most challenging aspect for a child with T1DM and CeD is that most GFD foods have a high glycemic index, while low glycemic index foods are recommended for T1DM. Interestingly, dietary therapy for CeD could improve the elevated HbA1c levels. Avoiding gluten added to a diabetic dietary regimen in T1DM patients might impose practical limitations and lead to important restrictions in the lifestyle of a young patient. Consequently, non-adherence to GFD in patients with T1DM and CeD is common. GFD in patients with T1DM and CeD seems to lower the incidence of micro- and macrovascular complications, but this requires further investigation. It seems that adherence to GFD in young patients with T1DM and CeD leads to regular growth and a stable body mass index without any negative effect on HbA1c or insulin requirements. Furthermore, the lipid profile and quality of life seem to have improved with the introduction of GFD.

Clinical and Radiological Findings in Mayer-Rokitansky-Küster-Hauser Syndrome Type 2: Case report.

Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) or Müllerian agenesis represents uterovaginal aplasia or hypoplasia of unknown aetiology in young women with usual 46,XX karyotype and normal secondary sexual characteristics. We report a 15-year-old female patient who presented to a specialised diabetes endocrine and metabolism centre in Basrah, Iraq, in 2019 with primary amenorrhoea and normal pubertal secondary sexual characteristics, hormonal workup and clinical examination. Abdominopelvic magnetic resonance imaging (MRI) revealed cervical and uterine agenesis with the absence of the proximal thirds of the vagina. Both kidneys were fused in the right iliac fossa with oval lobulated appearance and crossed fused ectopia. The ovaries were normal and located bilaterally. The diagnosis of MRKHS type 2 was confirmed based on clinical, biochemical and radiological findings. The correct clinical and radiological diagnosis of MRKHS by MRI is crucial for long-term management.

Association between biochemical hyperandrogenism parameters and modified Ferriman-Gallwey score in patients with hirsutism in Basrah (Southern Iraq).

INTRODUCTION: Hyperandrogenemia is the most frequent endocrine disorder in women causing a variety of adverse metabolic disturbances. Establishing the diagnosis of androgen overproduction has significant implications for the follow-up and treatment of patients. AIM: To investigate the severity of hirsutism and its correlation with serum androgen in women with hirsutism from Basrah (Southern Iraq). MATERIAL AND METHODS: This was a cross-sectional study of 300 hirsute women, mean age: 26.6 ±7.1 years with a modified Ferriman and Gallwey (mFG) score of 8 or higher. Assessment of hirsutism severity was performed and hormonal markers including total testosterone (TT), calculated free testosterone (FT) and dehydroepiandrosterone sulfate (DHEA-S), were measured. RESULTS: There was a significant correlation between the severity of hirsutism using mFG score and FT, TT levels (p < 0.001 and p < 0.047, respectively), while no association was seen between mFG score and DHEA-S. CONCLUSIONS: Our data suggest that FT and, to a less extent, TT were important biochemical hyperandrogenism markers that correlate with severity of hirsutism. DHEA-S was not found to be beneficial.

Effectiveness of simplified diabetes nutrition education on glycemic control and other diabetes-related outcomes in patients with type 2 diabetes mellitus.

BACKGROUND & AIMS: The study aimed to evaluate the effectiveness of the Simplified Diabetes Nutrition Education (SDNE) on glycemic control and other diabetes-related outcomes in patients with type 2 diabetes mellitus (T2DM). METHODS: This a randomized controlled trial (RCT) randomized 208 patients with T2DM [mean age = 48.8 ± 11.8 years, Glycated Hemoglobin (HbA1c) = 9.5 ± 2.4%, and Body Mass Index = 28.0 ± 5.6 kg/m2] to intervention group (n = 104) or control group (n = 104). Participants in the intervention group received a weekly diabetes nutrition module based on the health belief model for 12 weeks in addition to the usual care whereas the control participants were given the usual care. We evaluated HbA1c and diabetes-related outcomes (metabolic parameters, dietary intake, and physical activity level) at baseline, 12 weeks, and 22 weeks. Health beliefs, diabetes knowledge, and health literacy were also evaluated. RESULTS: After 22 weeks, HbA1c improved significantly in the intervention group (-1.7%) from the baseline value, compared to the control group (+0.01%) (p < 0.001). Furthermore, the intervention group also showed better improvement in metabolic parameters than the control group (p < 0.05). Besides, dietary intake and physical activity levels improved significantly among the intervention group compared to the control group (p < 0.05). Likewise, health beliefs, diabetes knowledge, and health literacy also improved significantly in the intervention group compared to the control group (p < 0.05). CONCLUSION: SDNE improves glycemic control and other diabetes-related outcomes among the intervention group compared to the control group. TRIAL REGISTRATION: ClinicalTrials.gov with ID: NCT04433598. Registered on 16 June 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04433598.

Association of Health Literacy and Nutritional Status Assessment with Glycemic Control in Adults with Type 2 Diabetes Mellitus.

While the role of medical and nutrition factors on glycemic control among adults with type 2 diabetes mellitus (T2DM) has been well-established, the association between health literacy (H.L.) and glycemic control is inconsistent. This study aims to determine the association of H.L. and nutritional status assessments with glycemic control in adults with type 2 diabetes mellitus. A total of 280 T2DM respondents (mean (SD) age = 49.7 (10.3) years, Glycated hemoglobin (HbA1c) = 9.9 (2.6) %, and Body Mass Index = 32.7 (15.1) kg/m2) were included in this study. A short-form Test of Functional Health Literacy in Adults (S-TOFHLA) assessed the H.L. levels. Nutritional status assessments included client history, glycemic control, anthropometric, and biochemical data. The mean (S.D.) H.L. score was 45.7 (24.6), with 56% of the respondents had inadequate H.L. Inadequate H.L. was more common among those females; housewives, low education, received oral antidiabetic therapy, and shorter diabetes duration. Respondents with inadequate H.L. were significantly older and had higher HbA1c than those with marginal and adequate H.L. Meanwhile, respondents with inadequate and marginal H.L. levels had significantly higher total cholesterol, LDL-cholesterol, and systolic blood pressure than the respondents with adequate H.L. Low H.L. scores, self-employment status, received dual antidiabetic therapy (insulin with oral agents), received insulin alone, and had higher fasting blood glucose explained about 21% of the total variation in HbA1c (adjusted R2 = 0.21; p < 0.001). Respondents with inadequate H.L. had poor glycemic control. The H.L. scores, together with nutritional status assessments, were the factors that predicted poor glycemic control among adults with T2DM.

Effect of exogenous glucocorticoids on male hypogonadism.

The aim of the present study was to investigate the effects of exogenous glucocorticoids (GCs), a potent cause of male hypogonadism, on the function of the hypothalamic-pituitary-gonadal axis, and to determine their secondary effects in male patients. The present study was a case-controlled study conducted in Basrah, Iraq. Of the 152 participants who met the inclusion criteria, 100 patients used different types of GCs. Of these 100 patients, 57 patients (57%) were current GC users, and 43 patients (43%) were not currently using GCs (had not used GCs in the past 30 days). The control group was comprised of 52 men (34.21%), considered as healthy participants, although 7 men (13.65%) were biochemically diagnosed with hypogonadism. Current GC exposure significantly decreased the total and free testosterone levels, whereas previous GC exposure increased estradiol (E2) levels, with the 31 patients on oral dexamethasone (cumulative dose, 18.9 mg) exhibiting a 7.5-fold increased risk of being diagnosed with hypogonadism. For previous GC users, a significant increase in the E2 level was observed, whereas all other gonadal hormonal levels were within normal reference ranges, including the total and free testosterone levels. The total cumulative dose of equivalent GCs was 240 mg, which resulted in a decrease in total testosterone levels, and subsequent hypogonadism. Oral dexamethasone at a lower total cumulative dose resulted in hypogonadism.

Best Time for Levothyroxine Intake in Ramadan (THYRAM): Basrah Experience.

BACKGROUND: Fasting the month of Ramadan should be achieved by every pubescent Muslim unless they have an excuse. Fasting involves complete abstinence of oral intake throughout daytime. Patients who have hypothyroidism usually require levothyroxine (L-thyroxine) replacement, which is typically given on an empty stomach away from meals. Taking L-thyroxine replacement without feeding is challenging during the nighttime of Ramadan, in addition to being prohibited during daytime. OBJECTIVES: This study aimed to determine the best time of L-thyroxine intake during Ramadan. METHODS: Fifty patients who were taking L-thyroxine treatment for primary hypothyroidism were involved in this prospective study for three months including the fasting and pre-fasting months. The patients were divided into three groups with different times of L-thyroxine intake. In the group one (pre-iftar), the patients were asked to take L-thyroxine at the time of iftar (the sunset meal) but to delay any oral intake for at least 30 minutes. In the group two (post-iftar), the patients were asked to take L-thyroxine two hours after iftar. The patients in the last group (pre-suhoor) were asked not to eat in the last two hours before suhoor (the predawn meal) and to take L-thyroxine tablet one hour prior to suhoor. RESULTS: When thyroid stimulating hormone (TSH) levels were compared before and after Ramadan, there were no significant differences neither within each group nor among all the study groups. Moreover, the frequencies of the TSH control after Ramadan showed no significant differences within each of the study groups (P = 0.18, 0.75, 1.0 for pre-suhoor, pre-iftar, and post-iftar respectively). Similarly, comparison among the groups of the study showed no significant differences regardless of whether the patients had controlled or uncontrolled TSH prior to Ramadan (P = 0.75 and 0.67, respectively). In the patients with controlled TSH before Ramadan, 8 out of 10 (pre-suhoor), 8 out of 12 (pre-iftar), and 4 out of 6 (post-iftar) maintained their control after Ramadan. While in the patients with uncontrolled TSH before Ramadan, 7 out of 10 (pre-suhoor), 6 out of 8 (pre-iftar), and 2 out of 4 (post-iftar) achieved controlled TSH after Ramadan. CONCLUSIONS: No significant differences in TSH control were observed in patients taking L-thyroxine at pre-iftar, post-iftar, or pre-suhoor time in Ramadan.

Reliability of adrenal computed tomography in predicting the functionality of adrenal incidentaloma.

BACKGROUND: Adrenal incidentaloma (AI) is an adrenal mass discovered accidentally during abdominal or chest imaging techniques not aimed to adrenal gland assessment. Guidelines suggested confirming the benignity of AI radiologically and excluding hormonal dysfunctions. This study evaluated the reliability of computed tomography (CT) scan radiological parameters in predicting the functionality of AI. PATIENTS AND METHODS: A cross-sectional study performed in Faiha Specialized Diabetes, Endocrine and Metabolism Centre from July 2017 to July 2018, involving 38 patients (23 females [60.5%]) harbouring 43 AI referred for evaluation. For all patients, we assessed history, physical examination, radiological parameters of AI by CT scan (native Hounsfield unit [HU]), maximum diameter and absolute percentage washout [APW] and blood investigations (glycated haemoglobin, adrenocorticotropic hormone, aldosterone, renin, aldosterone/renin ratio, normetanephrine, metanephrine, dehydroepiandrosterone sulphate, cortisol and 1 mg overnight dexamethasone suppression test). RESULTS: Native CT adrenal HU ≥18.5 was statistically significant seen in most functional AI (FAI) (P = 0.006), especially in patients with mild autonomous cortisol excess (MACE) and pheochromocytoma (PCC) with P = 0.02 in both. Maximum diameter was significantly high (≥40 mm) in PCC and congenital adrenal hyperplasia (CAH) (P = 0.018 and 0.008, respectively). APW was significantly < 60% only in PCC (P = 0.02). CONCLUSIONS: Native HU was the most significant radiological parameter in predicting the functionality of FAI, MACE and PCC, but not in CAH and aldosterone-producing adenoma. The maximum diameter was significant in predicting the PCC and CAH, whereas the APW was significant in predicting PCC only.

Prevalence and correlation of glycemic control achievement in patients with type 2 diabetes in Iraq: A retrospective analysis of a tertiary care database over a 9-year period.

BACKGROUND: This study was designed to assess the achievement of a glycated hemoglobin (HbA1c) target in Iraqi type 2 diabetes mellitus (T2DM) patients via retrospective analysis of a tertiary care database over a 9-year period. METHODS: A total of 12,869 patients with T2DM with mean (SEM) age: 51.4(0.1) years, and 54.4% were females registered into Faiha Specialized Diabetes, Endocrine and Metabolism Center(FDEMC) database between August 2008 and July 2017 were included in this retrospective study. Data were recorded for each patient during routine follow-up visits performed at the center every 3-12 months. RESULTS: Patients were under oral antidiabetic drugs (OAD; 45.8%) or insulin+ OAD (54.2%) therapy. Hypertension was evident in 42.0% of patients, while dyslipidemia was noted in 70.5%. Glycemic control (HbA1c <7%) was achieved by 13.8% of patients. Multivariate analysis revealed <55 years of age, female gender, >3 years duration of diabetes, HbA1c >10% at the first visit, presence of dyslipidemia, and insulin treatment as significant determinants of an increased risk of poor glycemic control. BMI <25 kg/m2 and presence of hypertension were associated with a decreased risk of poor glycemic control. CONCLUSION: Using data from the largest cohort of T2DM patients from Iraq to date, this tertiary care database analysis over a 9-year period indicated poor glycemic control. Younger patient age, female gender, longer disease duration, initially high HbA1c levels, dyslipidemia, insulin treatment, overweight and obesity, and lack of hypertension were associated with an increased risk of poor glycemic control in Iraqi T2DM patients.

Patterns of pituitary dysfunction three months or more after traumatic brain injury.

PURPOSE: Chronic posttraumatic brain injury (TBI) pituitary dysfunction is not a newly discovered subject, it has been reported more frequently, probably due to increasing chances of exposure to its causes, mainly the road traffic accidents, sport-related injuries, falls, and injuries during wars. This study aims to estimate the frequency of pituitary dysfunction 3 months or more after head trauma and the patterns of hormonal deficiencies. METHODS: A cross-sectional study was conducted between January 2016 and August 2017. Participants were patients having a history of moderate-to-severe TBI at least 3 months before enrolment. Pituitary function test was done for all patients to determine the frequency of pituitary dysfunction, the number of axes deficiencies, and which hormone is mostly affected. Statistical Package for the Social Sciences (SPSS) version 23.0 was used for univariate analysis, P < 0.05 was considered statistically significant. RESULTS: Out of the 28 patients involved in this study, 17 (61%) had pituitary dysfunction, while 11 (39%) had not. Single hormonal defect was the most prevalent abnormality in 12 (43%), and the most affected hormone was the growth hormone (GH) in 14 patients (50%), followed by gonadal axis, thyroid stimulating hormone, and finally adrenocorticotropic hormone (ACTH), 6 (21%), 3 (11%), and 1 (4%), respectively. CONCLUSION: TBI pituitary dysfunction is more prevalent than was predicted in the population studied, single hormonal defect was found to be the most prevalent abnormality, being the GH is the most affected axis, and the ACTH seems to be the least.

Spectrum of Pituitary disorders: A retrospective study from Basrah, Iraq.

Background: Sellar and parasellar region lesions spectrum includes a wide variety of diseases. This study aimed at providing a comprehensive overview of such lesions in patients from  Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah (Southern Iraq). Methods: Retrospective data analysis from FDEMC for the period January 2012 through June 2017. We included all patients with sellar and parasellar region lesions who received a MRI scan on their pituitary region Results: The total enrolled patients were 232 (84 men and 148 women),with age range 15-75 years.Pituitary disease and adenoma were more common among women. Those with macroadenoma were older than those with microadenoma, with nearly equal gender prevalence of macroadenoma. Pituitary adenoma constituted the bulk of pituitary disease in this setting (67.2%). Growth hormone secreting adenoma were the most common adenoma seen in 41.0%, followed by clinically non-functioning pituitary adenoma (NFPA) in 31.4% and prolactinoma in 26.9%. About 64.8% of pituitary adenoma was macroadenoma. Macroadenoma was seen in 73.4% of growth hormone secreting adenoma (acromegaly), 61.2% in NFPA and 62.0% of prolactinom a(of them six were giant prolactinoma). Conclusion: Pituitary adenoma constituted the bulk of sellar and parasellar region lesions, growth hormone secreting adenoma is the the most common adenoma followed by NFPA and prolactinoma due to referral bias. A change  in  practice of adenoma treatment is needed.

The Contribution of New Areas to the Total Hirsutism Scores in Basrah Hirsute Women.

BACKGROUND: Hirsutism is the presence of excessive growth of terminal hair in a female in the male-like pattern. It is the most common indicator of hyperandrogenism. The primary objective of this study was to evaluate the clinical impact of new androgens sensitive skin area to total body hirsutism score. METHODS: This was cross-sectional study. Most of the patients in this study group (n = 300) were women of reproductive age group (20-39 years) with a mean age of 26.6 ± 7.1 years. They were recruited in Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) during the period from August 2016 to the end of August 2017. All complained from hirsutism and were assessed by using modified Ferriman-Gallwey (m-FG) score system by a single examiner. Each patient underwent detailed clinical assessment in addition to transabdominal or transvaginal ultrasonography of the pelvis with endocrinological investigations. RESULTS: Comparison of the mean score at different body areas revealed that new androgens sensitive skin areas (sideburn, lower jaw/neck, buttocks/perineum) were comparable to others area of original m-FG score system or higher than at least three area used in the score. The sideburn area was observed to have the highest score among the new androgens sensitive skin areas. CONCLUSION: Evaluating the terminal hair growth in the new three androgen-sensitive skin areas (sideburn, lower jaw/neck, and buttocks/perineum) were clinically useful in assessing hirsutism score with high impact on total score.

Predictors of hypoglycemia in insulin-treated patients with type 2 diabetes mellitus in Basrah.

AIM: To measure the incidence and determinants (predictors) of hypoglycemia among patients with type 2 diabetes mellitus (T2DM) who were on insulin treatment for at least one year. METHODS: The present study is an out-patients based inquiry about the risk and predictors of hypoglycemia among patients with T2DM seeking care at the Al-Faiha Specialized Diabetes, Endocrine, and Metabolism Center, in Basrah over a period of 7 mo (from 15th of April, 2013 to 15th of October, 2013). The data used in the study were based on all detailed interview and selected laboratory investigations. A total of 336 patients could be included in the study. RESULTS: The incidence of overall hypoglycemia among the studied patients was 75.3% within the last 3 mo preceding the interview. The incidence of hypoglycemia subtypes were 10.2% for severe hypoglycemia requiring medical assistance in the hospital, 44.36% for severe hypoglycemia treated at home by family; this includes both confirmed severe hypoglycemia with an incidence rate of 14.6% and unconfirmed severe hypoglycemia for which incidence rate was 29.76%. Regarding mild self-treated hypoglycemia, the incidence of confirmed mild hypoglycemia was 21.42%, for unconfirmed mild hypoglycemia the incidence rate was 50.0% and for total mild hypoglycemia, the incidence rate was 71.42%. The most important predictors of hypoglycemia were a peripheral residence, increasing knowledge of hypoglycemia symptoms, in availability and increasing frequency of self-monitoring blood glucose, the presence of peripheral neuropathy, higher diastolic blood pressure, and lower Hemoglobin A1c. CONCLUSION: Hypoglycemia is very common among insulin-treated patients with T2DM in Basrah. It was possible to identify some important predictors of hypoglycemia.

Trimester-Specific Reference Intervals of Thyroid Function Testing in Pregnant Women from Basrah, Iraq Using Electrochemiluminescent Immunoassay.

BACKGROUND: Thyroid function test results of healthy pregnant women differ from those of healthy non-pregnant women. This study aimed to determine trimester-specific reference ranges for total tetraiodothyronin (T4), free T4, total triiodothyronin (T3) and thyroid stimulation hormone (TSH) using electrochemiluminescence techniques from apparently healthy pregnant women in Basrah. MATERIAL AND METHODS: A cross sectional study was conducted between January 2014 and June 2015. The total enrolled pregnant women were 893. Clinical examination, estimation of free T4, total T4, total T3, TSH, and anti-thyroid peroxidase (anti-TPO) using electrochemiluminescence technique done for each. RESULTS: Trimester specific normal range of TSH in µIU/mL was 0.04-3.77, 0.30-3.21 and 0.60-4.50 µIU/mL respectively, for each trimester. For FreeT4, the trimester specific reference range was 0.8-1.53, 0.7-1.20 and 0.7-1.20 ng/dL for each trimester, respectively. The reference range for total T4 for the first, second and third trimester was 7.31-15.00, 8.92-17.38, and 7.98-17.70 µg/dL, respectively. Furthermore, last trimester specific reference range for total T3 was 0.90-2.51, 1.99-2.87 and 1.20-2.70 ng/mL, respectively. CONCLUSION: Using this thyroid function study, we established for first time trimester-specific reference ranges for each thyroid function test and thyroid antibody status for the first time in Iraq. The reference ranges are different from all previous studies outside Iraq and the reference kit range from the method we used.

Prevalence of diagnosed and undiagnosed diabetes mellitus in adults aged 19 years and older in Basrah, Iraq.

BACKGROUND: Six of the top ten countries in the world with the highest prevalence of diabetes mellitus are in the Middle East. The objective of this investigation was to evaluate the prevalence of diabetes in Basrah, Southern Iraq. METHODS: A population-based, cross-sectional, simple random study screened 5,445 persons aged 19-94 years in Basrah, with glycated hemoglobin measured in 88.3% of the population and fasting plasma glucose in 18.7%. Body mass index and other demographic parameters were also measured. RESULTS: Of the 5,445 persons screened, 8.7% had already been diagnosed with diabetes and 11% were found by screening to have undiscovered diabetes, giving an age-adjusted prevalence of diabetes of 19.7%, with 55.7% of those with diabetes being previously undiagnosed. In addition, 29.1% of the screened population had prediabetes, giving a prevalence of dysglycemia of 48.8%, with only 51.2% of the persons screened being normoglycemic. The prevalence of diabetes in both sexes peaked at age 46-60 years. Diabetes was slightly more prevalent in females than in males, and about 70.3% of diabetic individuals had a body mass index ≥25 kg/m(2). CONCLUSION: The prevalence of diabetes in Basrah, Iraq, is very high, affecting one in five adults. The epidemic of diabetes will result in strain on the financial resources of health care systems.

Atherosclerotic cardiovascular disease among patients with type 2 diabetes in Basrah.

AIM: To determine the frequency of atherosclerotic cardiovascular disease and its risk factors among patients with type 2 diabetes in Basrah, Iraq. METHODS: Participants in this cross-sectional study were patients who had type 2 diabetes for at least 1 year, presenting at the Al-Faiha Diabetes Endocrine and Metabolism Center in Basrah (Southern Iraq) over the period from January to December 2008. RESULTS: The series included 1079 patients (58.8% men), of whom 25.0% were smokers. The prevalence of symptomatic cardiovascular disease and hypertension was 16.0%, and 44.3% respectively. Those who were overweight or obese constituted 70.5%. Insulin was used in only 26.9% despite 56.1% having had diabetes for 6 years and more. The mean glycated hemoglobin (HbA1c) was 9.46% ± 2.0% and only 5.5% achieved the target of HbA1c of < 7%. We had 68.7% of patients with total cholesterol of ≥ 200 mg/dL, 21.5% with high density lipoprotein cholesterol of < 40 mg/dL, 84.1% with low density lipoprotein cholesterol of ≥ 100 mg/dL and 71.6% with triglyceride of ≥ 150 mg/dL. CONCLUSION: Among adults with type 2 diabetes mellitus, there was increased frequency of cardiovascular disease and its modifiable risk factors. This finding necessitated urgent work to modify these risk factors in a population based setting.

Prevalence and control of hypertension in iraqi diabetic patients: a prospective cohort study.

OBJECTIVES: Diabetes and hypertension are major risk factors for cardiovascular disease, a leading cause of death in humans. The aim of our study was to determine the prevalence of hypertension, and hypertension control among adults with diabetes in Basrah (Southern Iraq). METHODS: A prospective cohort study was conducted at Al-Faiha Diabetes and Endocrine Center in Basrah. It was started in August 2008 to April 2011. The total number of recruited patients with diabetes was 5578. RESULTS: Hypertensive diabetic patients constituted 89.6% of this study cohort, with 45.3% of them newly discovered in the center. From hypertensive patients, 48.2% achieved the target blood pressure of less than 130/80 mmHg. The results of the multivariate analyses showed that the factors independently associated with the hypertension were aged > 50 years (odds ratio, 0.4; 95% CI, 0.3 to 0.5; p < 0.001), body mass index equal or more than 25 (odds ratio, 0.5; 95% CI, 0.4 to 0.6; p < 0.001), insulin use (odds ratio, 0.6; 95% CI, 0.5 to 0.8; p < 0.001) and duration of diabetes > 5 years (odds ratio, 0.6; 95% CI, 0.5 to 0.7; p < 0.001) . CONCLUSION: This study confirmed that hypertension was seen in ~90% of diabetic patients in Iraq, and approximately half of them were achieving target blood pressure level.

Acute Phase Hyperglycemia among Patients Hospitalized with Acute Coronary Syndrome: Prevalence and Prognostic Significance.

OBJECTIVES: Regardless of diabetes status, hyperglycemia on arrival for patients presenting with acute coronary syndrome, has been associated with adverse outcomes including death. The aim of this study is to look at the frequency and prognostic significance of acute phase hyperglycemia among patients attending the coronary care unit with acute coronary syndrome over the in-hospital admission days. METHODS: The study included 287 consecutive patients in the Al-Faiha Hospital in Basrah (Southern Iraq) during a one year period from December 2007 to November 2008. Patients were divided into two groups with respect to admission plasma glucose level regardless of their diabetes status (those with admission plasma glucose of <140 mg/dl (7.8 mmol/L) and those equal to or more than that). Acute phase hyperglycemia was defined as a non-fasting glucose level equal to or above 140 mg/dl (7.8 mmol/L) regardless of past history of diabetes. RESULTS: Sixty one point seven percent (177) of patients were admitted with plasma glucose of ³140 mg/dl (7.8 mmol/L). There were no differences were found between both groups regarding the mean age, qualification, and smoking status, but males were predominant in both groups. A family history of diabetes, and hypertension, were more frequent in patients with plasma glucose of ³140 mg/dl (7.8 mmol/L). There were no differences between the two groups regarding past history of ischemic heart disease, stroke, lipid profile, troponin-I levels or type of acute coronary syndrome. Again heart failure was more common in the admission acute phase hyperglycemia group, but there was no difference regarding arrhythmia, stroke, or death. Using logistic regression with heart failure as the dependent variable we found that only the admission acute phase hyperglycemia (OR=2.1344, 95% CI=1.0282-4.4307; p=0.0419) was independently associated with heart failure. While male gender, family history of diabetes mellitus, hypertension and diabetes were not independently associated with heart failure. CONCLUSION: Admission acute phase hyperglycemia of ³140 mg/dl (7.8 mmol/L) was associated with heart failure in this study.

Coeliac disease in Iraqi type 1 diabetic patients.

BACKGROUND AND STUDY AIMS: High prevalence rates of coeliac disease (CD) in patients with type 1 diabetes mellitus (T1DM) have been reported. The aim of this study was to evaluate the frequency of silent CD in a sample of Iraqi patients with T1DM. PATIENTS AND METHODS: This is a cross-sectional study done in Baghdad Teaching Hospital, Baghdad Medical City, Baghdad, Iraq, on 62 patients with T1DM. For all patients, immunoglobulin A (IgA) anti-tissue transglutaminase antibodies (IgA tTG), IgG anti-tissue transglutaminase antibodies (IgG tTG), IgA endomysial antibody (IgA EMA), IgA antigliadin antibodies (IgA AGA) and IgG antigliadin antibodies (IgG AGA) tests were done, with duodenoscopy, and at least four biopsies were taken from the second part of the duodenum. RESULTS: A total of 27 patients (43.5%) had normal small-intestinal histopathology (Marsh 0), one of them had a positive result for all serological markers used in the study, and another patient was positive for IgA tTG only. Ten patients (16.1%) had Marsh grade I, one of them was positive for IgA tTG, IgG tTG and IgA EMA, another patient was IgA deficient and had positive IgG tTG only and another patient with Marsh I had positive IgA tTG and IgG tTG only. Two patients (3.2%) had Marsh IIIA; three patients (4.8%) had Marsh IIIB histopathology, two of them were positive for all tests and one had positive IgA tTG and IgA EMA only. Two patients (3.2%) had Marsh IIIC histopathological features; they were positive for all serological tests, hence, the frequency of CD was 11.2%. CONCLUSION: The frequency of silent CD in Iraqi patients with T1DM is not rare, reaching up to 11.2%. Both EMA and tTG antibodies are useful as screening tests.