Takotsubo (stress) cardiomyopathy induced by acute asthma exacerbation in elderly woman.

A 73-year-old patient who was admitted secondary to acute asthma exacerbation that required frequent salbutamol and adrenaline nebulization. Takotsubo cardiomyopathy (TTC) was diagnosed after the new onset of chest pain with modest troponin elevation and normal coronary angiogram. Low ejection fraction and apical akinesia were completely resolved after her symptoms got improved.

The role of vitamin D, obesity and physical exercise in regulation of glycemia in Type 2 Diabetes Mellitus patients.

AIM: The aims of this study were to determine the role of vitamin D, obesity and physical exercise in the regulation of glycemia in Type 2 Diabetes Mellitus patients in a highly consanguineous population. DESIGN: Case and control study. SETTING: The survey was carried out at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar. SUBJECTS: The study was conducted from November 2012 to June 2014 among subjects above 30 years of age. Of the 2224 registered with diagnosed diabetes and free diseases attending Hamad General Hospital and PHC centers agreed and gave their consent to study. METHODS: Questionnaire included socio-demographic variables, body mass index (BMI), consanguinity, lifestyle habits, family history of diabetes, blood pressure and development of diabetes complications such as retinopathy, nephropathy, and neuropathy were collected at regular intervals throughout the follow-up. Univariate and multivariate statistical analysis were performed. RESULTS: There were statistically significant difference between patients with diabetic and control in terms of ethnicity (p=0.012), level of education (p=0.002), occupation (p<0.001), monthly income (p<0.001), BMI(p=0.024), sport activity (p=0.018), cigarette smoking (p<0.001), consanguinity (p=0.029) and family history of Diabetes Mellitus (p<0.001) and co-morbidity hypertension (p=0.041). Further, the biochemistry values in the studied subjects with T2DM compared to healthy controls and the study revealed that serum Vitamin D, BMI, fasting glucose level, calcium, HbA1c, total cholesterol HDL, LDL, bilirubin, triglycerides, uric acid and blood pressure systolic and diastolic were higher in T2DM compared to their counterparts. Multivariate logistic regression showed that vitamin D deficiency ng/mL, Family History of T2DM, BMI (kg/m2) hypertension, consanguinity, income, mother occupation, ethnicity, educational level and Lack of physical exercise variables were significant predictors of diabetes. In the group of Diabetes Mellitus Type 2 patients, 39.3% as opposed to 51.2% in the control group had vitamin D deficiency, 25(OH) D3 levels≤10ng/ml (p<0.001). In the group of Diabetes Mellitus Type 2 patients, 34.6% as opposed to 37.9% in the control group had vitamin D insufficiency, 25(OH)D3 levels <20ng/ml (p < 0.001). In the group of Diabetes Mellitus Type 2 patients, 22.8% as opposed to 14.2% in the control group had vitamin D sufficiency, 25(OH)D3 levels >30 10ng/ml (p < 0.001). CONCLUSION: Vitamin D, family history of diabetes, consanguinity marriages' and hereditary gene-environment interactions and physical exercise may also contribute to the current diabetes epidemic in Qatari's Arab populations.

A study of diabetes complications in an endogamous population: an emerging public health burden.

AIM: The aims of this study were to determine the prevalence of diabetic complications namely neuropathy, nephropathy, and retinopathy among Qatari's DM patients; and to find associations between these complications and socio-demographic and clinical characteristics in a highly consanguineous population. DESIGN: It is an observational cohort study. SETTING: The survey was carried out at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar. SUBJECTS: The study was conducted from May 2011 to January 2013 among Qatari nationals above 20 years of age. Of the 2346 registered with diagnosed diabetes attending Hamad General Hospital and PHC centers, 1633 (69.3%) agreed and gave their consent to take part in this study. METHODS: Questionnaire included socio-demographic variables, body mass index (BMI), consanguinity, lifestyle habits, family history of diabetes, blood pressure and development of diabetes complications such as retinopathy, nephropathy, and neuropathy were collected at regular intervals throughout the follow-up. Univariate and multivariate statistical analysis were performed. RESULTS: Out of 1633 diabetic patients, 842 (51.6%) were males. The prevalence of diabetic nephropathy 12.4% and retinopathy was 12.5% followed by neuropathy 9.5% among diabetic population. The proportion of diabetic neuropathy and nephropathy were significantly higher among diabetic patients with age 60 years and above as compared to younger age groups (p=0.010). Nephropathy was significantly higher among male diabetic (p=0.014) and smokers (p<0.001) while diabetic neuropathy was more common among diabetic hypertensive patients (p=0.028). Multivariate logistic regression showed that Age (p=0.025), being male (p=0.045), and having high blood pressure (p=0.006) were significant predictors of diabetic neuropathy. For diabetic retinopathy, family history of DM (p<0.001), consanguinity (p=0.010), having high blood pressure (p=0.042) and physical activity (p<0.001) were significant predictors of diabetic retinopathy. Meanwhile, for diabetic nephropathy, age (p<0.001), smoking (p=0.045), physical activity (p<0.001) hypertension (p<0.001) and gender (p=0.012) were the significant predictors. CONCLUSION: Diabetes exerts a significant burden in Qatar, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high morbidity and mortality and prevalence of complications observed. The significant interactions between diabetes and associated complications highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.

Gender and age-related differences in patients with the metabolic syndrome in a highly endogamous population.

The objective of the study was to examine the differences in gender and age prevalences of metabolic syndrome (MetS) among adult Qatari population according to the revised criteria of NCEP ATP III and IDF, assess which component contributed to the higher prevalence of the MetS and identify the characteristics of the subjects with MetS. The study was designed as a cross-sectional study. The survey was carried out in urban and semi-urban primary health care centers. The survey was conducted in the period from January 2007 to July 2008 among Qatari nationals above 20 years of age. Of the 1536 subjects who were approached to participate in the study, 1222 (79.6%) gave their consent. Face to face interviews were conducted using a structured questionnaire followed by laboratory tests. MetS was defined using the National Cholesterol Education Program - Third Adult Treatment Panel (ATP III) as well as the International Diabetes Federation (IDF). The overall prevalence of MetS in studied subjects was 26.7% and 33.9% according to ATPIII and IDF (p<0.001) criteria respectively. The prevalence of MetS by both definitions peaked in the 30-39 years age group among males, and the 40-49 years age group among females. The greatest number of males with MetS were university educated; while the greatest number of females with MetS were either illiterate or had a primary school education. The prevalence of MetS was higher among females. Among the components of MetS, the prevalence of central obesity was significantly higher in studied subjects. The overall prevalence of MetS and its components according to IDF criteria was higher in studied subjects than the estimates given by the ATPIII criteria. Overall, the prevalence of the metabolic syndrome in the State of Qatar is about 10-15% higher than in most developed countries, with generally higher prevalence rates for women. Preventive strategies will require identifying socio-demographic factors and addressing modifiable risk behaviours, including lack of physical activity, and dietary intake.