Lipids and related parameters in Saudi type II diabetes mellitus patients.

BACKGROUND: Non-insulin dependent diabetes mellitus (type II DM) is frequently associated with abnormal levels of lipids, particularly in patients with poor diabetic control. This study was designed to investigate the influence of type II DM on levels of plasma lipids and other related parameters in Saudi patients. Saudi Arabia has a high prevalence of diabetes mellitus in the adult population. Since the Saudi population presents a unique group with different dietary habits, lifestyle and genetic make-up, we investigated the lipids, lipoprotein and apolipoprotein pattern in Saudi type II DM patients. MATERIALS AND METHODS: This study was conducted on 2835 diabetic patients (1361 males, 1474 females) and 200 age-matched healthy adults from the same areas with no history of diabetes mellitus. Data collected included height, weight, body mass index (BMI), blood pressure and other relevant parameters. Lipids, lipoproteins and apolipoproteins were estimated, and correlation studies were carried out between these parameters. Lipids, lipoproteins and apolipoproteins were also correlated with the fasting blood glucose. RESULTS: Our results showed significant elevation in cholesterol and triglyceride, apo A and apo B levels in the diabetic males and females compared to the controls. Approximately 37% of the total DM patients fell in the borderline risk group, while 28.4% fell in the high-risk group for development of cardiovascular disease. Lipoproteins did not differ significantly. Cholesterol, triglyceride, VLDL, LDL and Hb A1c correlated positively with glucose (P<0.05), while triglyceride, VLDL, HDL, LDL, apo A and apo B showed significant correlation with cholesterol, where all parameters increased with cholesterol except HDL, which decreased as cholesterol increased. CONCLUSION: The findings point toward high prevalence of dyslipidemia in type II DM Saudi patients.

Clinical presentation of spontaneous primary hypothyroidism in adults.

In a retrospective study of 309 cases of hypothyroidism seen at King Fahd Hospital of the University (KFHU), Al-Khobar, 124 (90 Saudis and 34 non-Saudis) adult patients with spontaneous primary hypothyroidism satisfied the inclusion criteria for detailed analysis. Their male:female ratios for Saudis and non-Saudis were 1:4.6 and 1:3.9 respectively. The majority were diagnosed in their third and fourth decades. The prevalence of previously undiagnosed spontaneous and biochemically overt primary hypothyroidism in Saudis was 5.2/1000 females and 0.94/1000 males. FT4I was normal in 43 (35%) and low in 81 (65%). FT4I correlated with cold intolerance, constipation, dry skin, hoarseness, delayed reflex relaxation, and coarse and cold skin. In rank order, presenting symptoms in those with low FT4I were tiredness (56%), cold intolerance (38%), constipation, weight gain, menstrual disturbance - especially amenorrhea - (36% each), dry skin (35%), hoarseness (31%); signs were coarse skin (53%), delayed reflex relaxation (32%), cold skin and goiter (24% each). The above clinical findings may help physicians in the early detection of primary hypothyroidism. Population-based studies are necessary to provide more data on this disease in this country.

Body mass index of Saudi children ages six to 16 years from the eastern province.

Body mass index (BMI) is generally accepted as a useful index of various clinical situations related to obesity. However, there are no reference BMI charts for Saudi children; this paper is an attempt to establish these. A total of 21,638 Saudi schoolchildren between ages six to 16 years (49.6% males) were studied. Curves for BMI, seven percentiles - 5th, 10th, 25th, 50th, 75th, 90th and 95th - were constructed. As a reference material, BMI data for American children were modified into Hegira years. It was found that, in agreement with others, the BMI for the Saudi children studied was age- and gender-dependent. Comparison between Saudi data and international reference showed the expected genetic influence. These results remain to be compared with those from other regions in the Kingdom.

Pediatric liver disease in the eastern province of Saudi Arabia: A clinicopathological study.

This prospective study analyzes the clinical features and histopathological findings in liver biopsies of pediatric patients presenting to the hospital with liver disease during a 10 year period. Only those patients in whom liver biopsy was performed for a tissue diagnosis were included. Fifty patients were investigated, all below the age of 12 years, of whom 36 were male and 14 female. Thirty-two were of neonatal-infantile group, 11 had a diagnosis of neonatal giant cell he hepatitis of infections origin and an intact biliary tree. Two had septic shock and one had leishmaniasis. The remaining 18 patients of the neonatal-infantile group constituted five case of glycogen storage disease, six of infantile obstructive cholangiopathy (biliary atreasia), four of fatty change and one each of congenital hepatic fibrosis, neuroblastoma and nonspecific reactive hepatitis. The eighteen older children had the following diagnoses: thalassemia in five, sickle cell disease in four, two each of Reye syndrome and hepatoblastoma. The remaining were one each of glycogen storage disease, Rotor syndrome, cirrhosis, fatty change and non-Hodgkin lymphoma (NHL). These findings are presented and discussed.

Weight and height of Saudi children six to 16 years from the eastern province.

Measurements of weight and height of 21,638 Saudi boys and girls ages six to 16 years from the Eastern Province were taken. It was observed that the occurrence age of children could only be made out in Hegira years, as age is recorded by parents and at schools by the Hegira calendar. Age is a crucial factor in studies such as this and for valid comparison with any international reference standard, the latter must be adapted to the Hegira calendar year. Curves for weight and height percentiles for age have been constructed and compared with the Hegira adaptation of the NCHS growth standard.

Acute thrombocytopenic purpura in an infant with Cushing's syndrome: a case report.

This paper describes the case of a female child who presented with severe thrombocytopenia and Cushing's syndrome. The underlying cause was found to be an adrenal cortical adenoma, removal of which was followed by complete recovery of both conditions. The pathogenesis of both presenting features in relation to the adrenal tumor is discussed.

Hegira adaptation of the NCHS weight and height charts.

The ages of Saudi children are recorded and based on the Hegira calendar. When charted on the National Center for Health Statistics (NCHS) weight and height charts, children will be at disadvantage since the Hegira year is shorter than the Gregorian year. In this paper, centiles for the NCHS reference population are estimated for age in Hegira years from 2-18 for height and weight for both sexes using mathematical interpolation. Charts are prepared for use in hospitals and health centers for children whose ages have been reported based on the Hegira calendar.

Why do cardiology out-patient appointments fail in Saudi Arabia?

In a retrospective study, 534 appointments for a cardiology clinic were analysed to determine the frequency of no-show and to identify contributory factors. The overall rate of no-show was 30.1%, which is higher than the 18% and 20% reported from other teaching hospitals. Variables with the strongest univariate association with no-show were nationality (Saudi 35%, non-Saudi 22%; p = 0.0015), gender (males 34%, females 25%; p = 0.03), heart failure (present 44%, absent 27.9%; p = 0.005) and valvular heart disease (present 23.4%, absent 32.6%; p = 0.04). Turning to a stepwise logistic regression to predict no-show behaviour, we found that nationality, gender and heart failure were significant, while valvular heart disease was not. We conclude by recommending that physicians and mass media should share in the responsibility of stressing the importance of keeping out-patient department (OPD) appointments to all patients especially those who are more prone to no-show behaviour, namely male nationals. Telephone and mailed reminders have been used successfully to improve attendance at the OPD, and can be evaluated in our community.

Prevalence of dental caries in school children in Al-Khobar, Saudi Arabia.

The author collected base-line data on the prevalence of dental caries in Al-Khobar. He submits that examination of children's teeth should be part of clinical examinations by pediatricians.

The use and misuse of the CT scan of the brain.

Analysis of the results of 897 computerized tomographic (CT) scan examinations of the brain, performed on a wide range of patients over a one-year period was carried out to evaluate the use and possible misuse of the CT scan. During the one-year period, over one-half of the brain scans performed were normal and only 32.7% of CT scans demonstrated a reportable abnormality. The results show a general tendency to request CT scans demonstrated a reportable abnormality. The results show a general tendency to request CT scans on patients with little indication for this expensive investigation. This, in return, calls for steps to justify the use of the CT scan facility by means of a medical audit in order to reach optimum efficiency and significant cost effective savings for health institutions in the Kingdom.

The low birth-weight infants of Saudi adolescents: maternal implications.

Maternal factors and perinatal outcome of low birth-weight (less than or equal to 2,500 g) infants of 46 adolescent mothers was studied and compared with 160 adolescents who delivered infants weighing greater than 2,500 g. The significant factors found in the low birth-weight group were anaemia, small maternal physique and preterm delivery. Expectedly, the perinatal mortality rate was significantly increased in low birth-weight infants.

PIP: From 1981-1985, researchers studies pregnancy outcomes of 206 female adolescents (= or 17 years old at the time of 1st hospital visit) at King Fahd Hospital in Al-Khobar, Saudi Arabia. 23% of all infants born to adolescents were classified as low birth weight (= or 2500g). 17.4% of these mothers were 15 years old or younger, 39.1% were 16, and 43.5% were 17. For mothers who delivered an infant 2500g, 17.5% were 15, 26.9% were 16, and 55.6% were 17. Mothers who had low birth weight infants (mean weight 53.48k) tended to weigh less at time of delivery than those who had infants 2500g (61.89kg; p.005). Further, the stature of 31.1% of those in the low birth weight group was 150cm whereas only 13.5% of the remaining mothers were 150cm. 64% of mothers who had low birth weight infants delivered before 37 weeks gestation (p.005). Anemia (Hb10.6g/dl) was the most significant complication contributing to low birth weight (38.6%; p.005). This suggests that many adolescent mothers did not take iron and vitamin supplements and that they did not take iron and vitamin supplements and that they did not eat adequately during pregnancy. Even though toxemia also contributed significantly to low birth weight (9%; p.05), its overall prevalence was markedly low (1.9% in 2500g group). The mode of delivery did not affect birth weight. Perinatal mortality for low birth weight infants stood at 14.6%. None of the .2500g infants died. All adolescent mothers should receive early prenatal care. In addition, more health education of health professionals and adolescents is needed to stress the importance of regular prenatal care, liberal hospitalization, intensive antepartum and intrapartum fetal monitoring.

Oral cancer in Saudi Arabia: the role of alqat and alshammah.

The purpose of this retrospective clinical study is to look into the etiological role of alshammah and alqat consumption in the causation of squamous cell carcinoma of the head and neck (SCHN) in Arabia. Alshammah and alqat are traditional forms of chewable tobacco very commonly used in southern Saudi Arabia and Yemem. In a 2 year period 64 patients with histologically proven SCHN were found. Most of them were originally from southern Saudi Arabia and Yemen. Of these 64 patients 52 (81%) admitted alshammah consumption. Of these 52 patients 22 admitted alqat consumption in addition. Thirty-eight (59%) had oral cancer, while the rest had pharyngeal and laryngeal cancer. All the 38 patients with oral cancer either used alshammah alone (16 patients) or used both alshammah and alqat (22 patients). The median duration of alshammah consumption was 15 years and that of alqat was 12 years. Alcohol was not consumed among the group and only few were cigarette smokers. Most patients presented in the late stage of the disease. The evidence implicating alshammah and alqat in the causation of SCHN is only clinically based. Further controlled prospective clinical and experimental studies are needed to confirm the theory.