Comparison between the effect of glibenclamide and captopril on experimentally induced diabetic nephropathy in rats.

HYPOTHESIS: This study aimed to elucidate the role of glibenclamide in the prevention of diabetic nephropathy and to compare it with a reference drug captopril in rats. MATERIALS AND METHODS: There were two main groups of rats. Control group (I) was subdivided into four subgroups which received distilled water, vehicle of streptozotocin, glibenclamide or captopril. The streptozotocin-diabetic Group (II) was subdivided into three subgroups: untreated, glibenclamide or captopril treated. Measurement of arterial blood pressure, serum glucose and creatinine levels, 24 h urinary protein and albumin/creatinine ratio, kidney weight and its histological examination were done after 1, 2, 4, 8, 12 and 16 weeks of treatment. RESULTS: In treated diabetic rats captopril reduced blood pressure significantly, while no significant change in the mean arterial blood pressure or blood glucose level was recorded with glibenclamide treatment. Glibenclamide and captopril-treated diabetic rats showed significant decrease in serum creatinine level, urine volume, urinary protein excretion, albumin:creatinine ratio and kidney:body weight ratio compared with the diabetic non-treated group. Histological examination of diabetic kidneys treated with either glibenclamide or captopril showed reduced glomerular hypertrophy, glomerulosclerosis, tubular degeneration and interstitial fibrosis compared with untreated diabetic rats. CONCLUSION: Glibenclamide attenuated some biochemical and histological changes produced by diabetic nephropathy, despite persistent hyperglycemia and hypertension.

Autoimmune thrombocytopenia. Is it a different disease or different aspects of a single disease?

OBJECTIVE: To evaluate the association between autoimmune thrombocytopenia with other autoimmune disorders, to show if they are different autoimmune diseases or one disease with different presentations at the same time, and to study the effect of treatment on platelet count in different thyroid condition. METHODS: In this retrospective study, we included 141 patients with thrombocytopenic purpura. The result of thyroid function test, thyroid autoantibodies, Coombs' reactivity, anti-nuclear antibody, and double-stranded DNA were analyzed. This study was conducted in the Clinical Hematology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia between June 2003 and August 2010. RESULTS: There were 51 (36.2%) patients with laboratory evidence of autoimmune disease, 13 (9.2%) with hypothyroidism, and 6 (4.3%) with hyperthyroidism. In addition, 5 (3.5%) patients showed laboratory evidence of Evan syndrome and 3 (2.1%) patients had isolated positive thyroid antibodies. There was non-significant difference (p=0.61) in platelets count after one month of treatment of patients with different thyroid condition. CONCLUSION: Immune thrombocytopenia is associated with evidence of different autoimmune disease or a combination of them, which may appear at presentation or during the course of disease giving evidence that they are different manifestations of a single disease. Screening patients for antithyroid antibodies would identify a patient at risk of developing overt thyroid disease. These patients may be further screened with a thyroid-stimulating hormone assay to detect subclinical thyroid disease.

Estimation of insulin resistance in non-diabetic normotensive Saudi adults by QUICKI, HOMA-IR and modified QUICKI: a comparative study.

BACKGROUND AND OBJECTIVES: Identification of insulin resistance (IR) in the general population is important for developing strategies to reduce the prevalence of non-insulin-dependent diabetes mellitus (NIDDM). We used the original and a modified version of the Quantitative Insulin Sensitivity Check Index (QUICKI, M-QUICKI), and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) to divide non-diabetic normotensive adults into high- (HIR) and low-insulin-resistant (LIR) subgroups to investigate similarities and differences in their characteristics. SUBJECTS AND METHODS: Three hundred fifty-seven healthy adults aged 18-50 years were recruited randomly from health centers in Jeddah in a cross-sectional study design. Anthropometric and demographic information was taken. Insulin, glucose, lipid profile and free fatty acid were determined in fasting blood samples. M-QUICKI, HOMA-IR and QUICKI were calculated. Reported cut-off points were used to identify HIR subjects, who were then matched for age and sex to others in the study population, resulting in 3 HIR and 3 LIR subgroups. RESULTS: Two hundred nine subjects satisfied the selection criteria. M-QUICKI correlated significantly (P=.01) with HOMA-IR and QUICKI values. Increased adiposity was the common characteristic of the three HIR subgroups. HIR subgroups identified using M-QUICKI (97 subjects) and HOMA (25 subjects), but not QUICKI (135 subjects), had statistically different biochemical characteristics compared to corresponding LIR sub-groups. CONCLUSION: Adiposity, but not sex, is a risk factor for IR in the studied population. Further studies are needed to choose the most appropriate index for detecting IR in community-based surveys.

Non-alcoholic fatty liver disease and metabolic syndrome: what we know and what we don't know.

NAFLD is a very common asymptomatic liver condition that may progress to cirrhosis and hepatocellular carcinoma, and a relation to the different components of the metabolic syndrome has been found. In this review we highlight some of the epidemiological aspects of the two disorders and discuss some of the possible mechanisms and questions to be answered concerning the risk factors for the progression of this condition, as well as the need for more studies to focus on possible modalities of treatment.

Helicobacter pylori infection at a university hospital in Saudi Arabia: prevalence, comparison of diagnostic modalities and endoscopic findings.

The presence of Helicobacter pylori (H. pylori) was examined in 491 sequential patients, complaining mainly of epigastric pain, by three biopsy-based methods (rapid urease, histology, and culture), and by a serological test, enzyme immunosorbent assay, (ELISA). H. pylori was detected in 341 (70%) of 491 patients examined by histology, 287 (59%) by rapid urease test, whereas 385 (78%) were seropositive for H. pylori immunoglobulins by ELISA. None of the test methods used was independently sufficient to make an etiologic diagnosis of H. pylori infection. The endoscopic findings revealed that 315 (69%) of 456 patients with non-ulcer dyspepsia, 17 (74%) of 23 patients with duodenal ulcer, 7 (78%) of 9 patients with gastric ulcer, and 2 (67%) of 3 patients with gastric cancer were H. pylori positive. No statistically significant correlation was found between the endoscopic and the histopathological findings. A significant correlation was found between H. pylori infection and the histopathological gradings of gastritis (P < 0.001).

Subclinical hypothyroidism in elderly women attending an outpatient clinic.

BACKGROUND: The object was to determine the frequency of subclinical hypothyroidism (SH) in elderly women and study its relation to serum lipids, hypertension, diabetes, and ischemic heart disease. MATERIAL/METHODS: A sample of 257 patients was randomly selected among women above the age of 50 visiting the King Abdulaziz University outpatient clinic. All were examined for thyroid function. Positive cases of SH were further tested for thyroid antibodies, hypothyroid symptoms, and goiter. Data were collected from the cases and a control group regarding age, presence of hypertension, diabetes, and ischemic heart disease, and lipoprotein levels and body mass index (BMI) values. Comparative analysis was performed between the cases and controls regarding dyslipidemia, BMI, hypertension, diabetes, and ischemic heart disease after age adjustment with logistic regression. RESULTS: Ninety patients out of 257 (35%) had SH. Positive thyroid antibodies were present in 55 (61%), goiter in 8 (9%), and hypothyroid symptoms in 22 (24%). In multiple regression analysis, SH cases were found to have lower risk for hypertension, ischemic heart disease, and diabetes than the controls after adjustment for age: OR 1.5 (95% CI: 0.8-2.83), 2.17 (0.75-6.28), 2.67 (1.50-4.76), respectively; the p-values were found to be significant for diabetes (0.19, 0.14, <0.001). However, there were no significant differences between cases and controls regarding measurements of LDL and cholesterol: 3.3+/-1.1 mmol/l and 5.5+/-1.2 mmol/l vs. 3.4+/-0.9 mmol/l and 5.4+/-1.1 mmol/l, respectively. CONCLUSIONS: There is a high prevalence of SH among our sample, with no increased risk of hypertension, hyperlipidemia, ischemic heart disease, or diabetes.

Sub-optimal postprandial blood glucose level in diabetics attending the outpatient clinic of a University Hospital.

OBJECTIVE: To determine the frequency of diabetic patients who attained the optimal postprandial blood glucose level. METHODS: Cross-sectional study of type-2 diabetic patients being followed at the medical outpatient clinic of King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from January 1999 to December 2001. Patients were classified according to postprandial blood glucose level into 3-categories; group-1 (<9 mmol/l), group-2 (9.1-10 mmol/l), group-3 (>10 mmol/l). Other data such as age, sex, duration of diabetes, presence of hypertension, hyperlipidemia, smoking, obesity, ischemic heart disease was recorded as well as mortality. RESULTS: A total of 443 patients were studied with mean age of 55 years and equal male to female ratio. The mean 2-hour postprandial blood glucose level was 14 mmol/l. The majority of patients were in group-3 (71%), while group-1 was 22% and group-2 was 7%. Patients with high 2-hour postprandial blood glucose (group-3) have a higher prevalence of hypertension [120/315 (38%) versus 31/97 (32%) p=0.01], hyperlipidemia [72/315 (23%) versus 13/97 (13%) p=0.02], obesity [79/315 (25%) versus 18/97 (19%) p=0.04], ischemic heart disease [72/315 (23%) versus 16/97 (17%) p=0.04] and mortality [35/315 (11%) versus 8/97 (8%) p=0.06] compared to those with controlled level (group-1). CONCLUSION: A low frequency of diabetics attained the optimal 2-hour postprandial blood glucose level. Action should be taken on this crucial issue for the optimal management of diabetes.

Poor lipid control in type-2 diabetics with and without ischemic heart disease.

To determine the frequency of type-2 diabetics who have target lipoprotein blood levels, to study these levels in patients with ischemic heart disease and cardiovascular disease risk factors, and to study the possible causes of poor control, we reviewed hyperlipdemic type-2 diabetics who were on regular follow up to the medical outpatient clinic of King Abdulaziz University Hospital from January 2000 to January 2001. A total of 202 patients were studied with mean age of 60 yr and equal male to female ratio. The mean duration of diabetes was 10 yr and it was 7 yr for hyperlipidemia. The mean level of LDL was 3.15 mmol/L and it was 1.0 mmol/L and 2.47 mmol/L for HDL and TG, respectively. Only 31% of patients had LDL < 2.6 mmol/L, 28% had HDL > 1.1 mmol/L, and 37% had TG < 1.7 mmol/L. No significant difference was found in the frequency of target level of LDL in patients with IHD and those without; 26% vs 34% (0.4). Similarly, no difference was found in those with hypertension, obesity, and patients with family history of IHD compared to those without these risk factors; 30%, 26%, 16% vs 34%, 36%, 33% (p = 0.2, 0.1, 0.4, respectively). Males were found to have a higher frequency of target LDL level compared to females; 38% vs 25% (p = 0.04). Poor diet restriction was found in 90% of patients' with poor control, lack of patients' knowledge in 62%, 70% have financial reasons, 86% of patients on multiple medications, and in 16% the treating physician took no proper action. In conclusion, a low frequency of type-2 diabetics have target levels of lipoproteins. Diabetics with IHD and CVD risk factors also have poor lipid control. Poor control was associated with poor diet compliance and use of multiple medications. Proper management and control of this disease is needed among elderly patients.

Is hypertension well controlled in hypertensive diabetics.

OBJECTIVE: To determine the degree of blood pressure (BP) control in hypertensive diabetics and to study the types of antihypertensive agents used for BP control. METHODS: A cross-sectional study was carried out on hypertensive diabetics followed in the outpatient clinic of King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia from January 2000 to February 2001. Patient's age, sex, duration of diabetes and its control, duration of hypertension and the type of antihypertensive agents used, were noted. Patients were classified according to the degree of systolic and diastolic BP control into 4 groups: systolic group-I (< or = 120 mmHg), group-II (121-130 mmHg), group-III (131-140 mmHg), group-IV (>140 mmHg); diastolic group-I (< or = 80 mmHg), group-II (81-85 mmHg), group-III (86-90 mmHg), group-IV (>90 mmHg). RESULTS: A total of 230 patients were included with a mean age of 61 years and an equal male to female ratio. Mean duration of diabetes was 14 years and 9 years for hypertension. Five of 230 (2.2%) were in systolic group-I, 28/230 (12%) in group-II, 94/230 (41%) in group-III, 103/230 (44.8%) in group-IV; while 7/230 (3%) were in diastolic group-I, 30/230 (13%) in group-II, 92/230 (40%) in group-III, and 101/230 (43.9%) in group-IV. Angiotensin converting enzyme-inhibitors were used in 163/230 (70.9%) followed by diuretics in 99/230 (43%), Calcium channel-blockers in 62/230 (27%), and B-blockers in 25/230 (10.9%). CONCLUSION: Only a small percentage of hypertensive diabetics met the recommended BP for diabetics. Efforts should be made by both patients and physician to achieve better BP control.

Effect of metformin and sulfonylurea on C-reactive protein level in well-controlled type 2 diabetics with metabolic syndrome.

The objective of this study was to examine the effect of the antihyperglycemic agents metformin (insulin sensitizer) and glibenclamide (insulin secretory agent) on the serum level of C-reactive protein (CRP) in well-controlled type 2 diabetics with metabolic syndrome. The participants were diabetic patients being followed in the medical outpatient clinic of King Abdulaziz University Hospital. The inclusion criteria were type 2 diabetics with the metabolic syndrome, well-controlled blood glucose on metformin alone or glibenclamide alone, and exclusion of major medical illness. Patients were divided into two groups according to the antihyperglycemic agent used. CRP level was measured 4-wk apart and the mean was calculated. The following data were collected from the study groups: age, sex, body mass index (BMI), duration of diabetes, smoking history, presence of hypertension, hyperlipidemia, and mean CRP level. A total of 110 patients were studied, 65 using metformin and 45 using glibenclamide. CRP level was significantly lower in patients using metformin for blood glucose control compared with those using glibenclamide, 5.56 and 8.3 mg/L, respectively (p = 0.01). A significantly higher level was observed in hypertensive and hyperlipidemic patients compared with normotensive and normolipidemic, 5.3 vs 3.2 mg/L and 7.1 vs 4.3 mg/L, respectively (p = 0.02, 0.01). There was a statistically significant correlation between CRP and BMI (r = 0.37) and age (r = 0.36) (all p = 0.01). The data showed that metformin decreases the level of circulating CRP, a marker of inflammation, more than glibenclamide.

A case of rifampicin induced pseudomembraneous colitis.

We report a case pf pseudomembranous colitis that developed in a patient with tuberculous abdominal lymphadenopathy during treatment with rifampicin. The patient had delayed presentation (3 months) after the start of rifampicin. She had one relapse after 2 months that was successfully treated, and she finished her antituberculosis therapy without any further relapses. Awareness of this serious complication of rifampicin therapy should be encountered.

The insulin resistance syndrome among type II diabetics.

OBJECTIVE: The aim of this study is to determine the prevalence of insulin resistance syndrome among type-II Saudi diabetics. METHODS: The study involved type-II Saudi diabetics followed at the Out-patient Clinic of King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from January 1997 to December 1998. Their age, sex and body mass index was recorded. Serum samples were analyzed for glucose. Insulin C-peptide level and insulin glucose index was calculated. Serum cholesterol, high density lipoproteins, low density lipoproteins, triglyceride, and uric acid were measured. RESULTS: A total of 109 patients were studied, (67 females and 42 males) with an age range from 28 to 105 years. Median body mass index was 27 in males and 30.2 in females. Percentage of male and female patients with the following abnormalities were as follows: Total cholesterol >5.3 mmol/L (47.6% males, 40.9% females), high density lipoproteins-cholesterol <1.2 mmol/L (71.4% males, 40.9% females), low density lipoproteins-cholesterol >3.4 mmol/L (42.8% males, 37.9% females), triglyceride >2.3 mmol/L (40.5% males, 31.8% females), insulin >24 mIU/l (23.8% males, 29.7% females), C-peptide >1324 pmol/L (21.2% males, 13% females) and hypertension (33.3% males, 43.8% females). Uric acid >420 umol/L was found in 35.5% males and >390 umol/L in 25.6% females. Body mass index >27.8 was found in males (35.7%) and >27.3 in females (67.7%). Insulin resistance as defined by insulin glucose index >5.4 was found in 19.8% of the study group (23.8% males, 15.9% females). Insulin resistance syndrome was found in 16.5% (17.1% males, 15.9% females). CONCLUSION: Insulin resistance syndrome is common among type-II Saudi diabetics.

Prevalence of Type-2 diabetes in patients with hepatitis C and B virus infection in Jeddah, Saudi Arabia.

OBJECTIVES: To determine the prevalence of type-2 diabetes mellitus (DM) in patients with hepatitis C virus (HCV) and B virus (HBV) infections. MATERIALS AND METHODS: A cross-sectional study of HCV- and HBV-positive patients admitted to King Abdul Aziz University Hospital, Jeddah, Saudi Arabia, was conducted from January 1999 to September 2000. The following data were collected and analysed: demographic data, the presence and type of DM, details of the treatment, body mass index (BMI), family history of DM, serum transaminases, thrombocytopenia, and presence of liver cirrhosis on liver biopsy. A total of 399 patients were included in the study. RESULTS: 165 (41%) were anti-HCV positive and 234 (59%) were HBsAg positive. Type-2 diabetes was present in 35 of 165 (21.2%) patients with HCV infection, and 33 of 234 (14.1%) with HBV infection. 94% of anti-HCV-positive type-2 diabetes were older than 40 years and 6% were younger, while for nondiabetics the corresponding percentages were 55 and 45%, respectively. 76% of HBsAg-positive type-2 diabetics were older than 40 and 24% were younger, while the corresponding percentages for nondiabetics were 27 and 73%, respectively. Anti-HCV-positive type-2 diabetics, when compared to nondiabetics, had a higher BMI, a frequent family history of DM, elevated serum transminases, thrombocytopenia, and liver cirrhosis on biopsy. HBsAg-positive type-2 diabetics had only a more frequent family history of DM than did nondiabetics. CONCLUSION: Our findings indicate that type-2 diabetes is more common in patients with an HCV than with an HBV infection.

Low aspirin use in diabetics.

OBJECTIVE: To determine the percentage of adult diabetics with cardiovascular disease, or risk factors for cardiovascular disease who are using aspirin, and to report on any differences between males and females, or Saudis and non-Saudis. METHODS: Medical records of diabetics seen at King Abdulaziz University Hospital during the period January 1998 through to December 2000 were analyzed. The following data were collected: patients age, sex, nationality, body mass index, duration of diabetes, history of cardiovascular disease, risk factors for cardiovascular disease (hypertension, hyperlipidemia, obesity, smoking, family history of ischemic heart disease) and aspirin use. RESULTS: A total of 550 patients were studied with a mean age of 53 years and male: female ratio 1.1:1. Saudis constitute 260/550 (47%) of the study group. In patients with cardiovascular disease 110/174 (63%) were using aspirin versus 64/174 (37%) (p 0.001). In patients with one or more risk factors for cardiovascular disease but no cardiovascular disease, aspirin was used in 27/223 (12%) versus 195/223 (88%) (p 0.0001). Aspirin was used by 85/291 (29%) male versus 56/259 (22%) females (p 0.2). Sixty-three of 260 (24%) Saudis used aspirin versus 77/290 (27%) non-Saudis (p 0.7). CONCLUSION: Aspirin use is low in diabetics with cardiovascular disease and one or more risk factor of cardiovascular disease, with no significant difference between males and females, or Saudis and non-Saudis. Physicians should be encouraged to use aspirin more in diabetics for both primary and secondary prevention of cardiovascular disease.

Clinical profile of stroke:: The experience at King Abdulaziz University Hospital.

OBJECTIVES: To determine the pattern and risk factors of stroke in Saudi nationals and non-Saudis, at King Abdulaziz University Hospital (KAUH), in the western province of Saudi Arabia. METHOD: All cases of stroke admitted to KAUH in the period between January 1995 and December 1999 were studied. Demographic data of the patients, stroke types, risk factors and mortality were reported. RESULTS: Of the 103 patients studied, 56% were Saudis and 44 % non-Saudis with male predominance and mean ages of 66 and 62 years respectively. In Saudis, the stroke types were 74% ischemic, 10% hemorrhagic and 16% unspecified, whereas in non-Saudis, the figures were respectively 62%, 29% and 9%. The frequency of stroke increased steadily with age in Saudis but dropped after the sixth decade in non-Saudis. There was no significant difference between the Saudis and the non-Saudis in the occurrence of risk factors for stroke or in mortality. CONCLUSION: The pattern and risk factors of cases of stroke treated at KAUH are similar to those reported from other regions of Saudi Arabia and other parts of the world.