Circadian rhythm of granulocyte-macrophage colony-stimulating factor in normal subjects and neutropenic hospitalised patients.

BACKGROUND: Granulocyte-macrophage colony-stimulating factor (GM-CSF), one of the haemopoietic growth factors, has rarely been detected in human serum. It has, therefore, been suggested that a paracrine model can explain its behaviour where the substance is produced and acts locally. An alternative explanation might be due to blood sampling time with GM-CSF concentrations undetectable at the nadir of secretion. HYPOTHESIS: We hypothesised that endogenous production of GM-CSF in humans is subject to diurnal rhythm. METHODS: Blood samples were obtained from 17 healthy individuals and 17 neutropenic hospitalised patients with haematological malignancies on myelosuppressive therapy at 6, 12, 18 and 24 hours. In the neutropenic patients, samples were collected at the nadir of the neutrophil count (ANC < 0.2 x 109/L). Serum was assayed for GM-CSF levels using an enzyme-linked immunosorbent assay method. RESULTS: There were significant differences in the mean levels of GM-CSF within the two groups (P < 0.001). In normal subjects, peak GM-CSF levels were reached at six hours (mean = 10.1 pg/ml). Peak levels were reached in hospitalised neutropenic patients at 18 hours (mean = 13.7 pg/ml). The difference between the peak GM-CSF levels in the two groups was not significant (P = 0.11). On factorial design analysis, there was a significant interaction between the time of blood collection and the subject groups (P < 0.001). CONCLUSIONS: Our data are consistent with a diurnal secretion pattern for GM-CSF in both normal and neutropenic patients. As this finding might have practical implications, including timing of administration of GM-CSF in neutropenic patients, further studies are suggested.

Subclinical diabetic neuropathy. A common complication in Saudi diabetics.

OBJECTIVE: To determine the prevalence of sub clinical diabetic neuropathy in Saudi diabetics and the risk factors associated with symptomatic diabetic neuropathy. METHODS: A prospective study of Saudi diabetics attending King Abdulaziz University Hospital out patient clinic from January 1998 until April 1999. Detailed information of each patients` age, sex, body mass index, type and duration of diabetes mellitus, mode of treatment, degree of blood glucose control, presence of hypertension, hyperlipidemia, smoking, family history of diabetes mellitus and hypertension were recorded. Patients were assessed for diabetic neuropathy using the Michigan Neuropathy Program. Patients who were asymptomatic and scored less than 2 on simple clinical examination were referred to a neurologist for a complete neurological examination and nerve conduction studies. RESULTS: A total of 237 patients were studied with a mean age of 54.19 years and mean duration of diabetes 10.6 years. Symptomatic diabetic neuropathy was present in 132 (56%) patients while subclinical neuropathy was present in 58 (57%) of asymptomatic patients. Old age, type II diabetes with long duration, poor control and smoking were risk factors associated with symptomatic diabetic neuropathy (p<0.001, p=0.09, p<0.001, p=0.04, p=0.08). CONCLUSION: Subclinical diabetic neuropathy is common. Early diagnosis is important for possible prevention of late neuropathic complications (foot ulcers and infections). Prolonged poorly controlled diabetes mellitus, old age and smoking are risk factors for symptomatic diabetic neuropathy. Meticulous blood glucose control is important for nerve function protection. Researches are urgently needed for satisfactory therapy.

Subclinical diabetic neuropathy: a common complication in Saudi diabetics.

OBJECTIVE: To determine the prevalence of sub clinical diabetic neuropathy in Saudi diabetics and the risk factors associated with symptomatic diabetic neuropathy. METHODS: A prospective study of Saudi diabetics attending King Abdulaziz University Hospital out patient clinic from January 1998 until April 1999. Detailed information of each patients' age, sex, body mass index, type and duration of diabetes mellitus, mode of treatment, degree of blood glucose control, presence of hypertension, hyperlipidemia, smoking, family history of diabetes mellitus and hypertension were recorded. Patients were assessed for diabetic neuropathy using the Michigan Neuropathy Program. Patients who were asymptomatic and scored less than 2 on simple clinical examination were referred to a neurologist for a complete neurological examination and nerve conduction studies. RESULTS: A total of 237 patients were studied with a mean age of 54.19 years and mean duration of diabetes 10.6 years. Symptomatic diabetic neuropathy was present in 132 (56%) patients while subclinical neuropathy was present in 58 (57%) of asymptomatic patients. Old age, type II diabetes with long duration, poor control and smoking were risk factors associated with symptomatic diabetic neuropathy (p<0.001, p=0.09, p<0.001, p=0.04, p=0.08). CONCLUSION: Subclinical diabetic neuropathy is common. Early diagnosis is important for possible prevention of late neuropathic complications (foot ulcers and infections). Prolonged poorly controlled diabetes mellitus, old age and smoking are risk factors for symptomatic diabetic neuropathy. Meticulous blood glucose control is important for nerve function protection. Researches are urgently needed for satisfactory therapy.

Wet vs. dry chemical analysis of renal stones.

Analysis of renal stones may help in elucidating the pathogenesis of nephro-lithiasis. This study compared the use of 2 methods for the analysis of renal stones. One method is qualitative dry 'spot tests' whereas the other is quantitative 'wet chemistry.' In the wet chemistry method, dissolved stone material were analysed using automated chemistry analysers, whereas, the dry method involved spot colour end-point detection. Stones (n = 64) were analysed by both methods. The majority of stones were calcium oxalate as determined by wet chemistry (57.4 per cent) and spot tests (50.0 per cent). Fewer mixed stones were obtained by the wet chemistry method (16.8 per cent) compared with the spot tests method (39.0 per cent), whereas, more uric acid stones were obtained by the wet chemistry method (5.6 per cent) compared with the spot tests method (1.9 per cent). 'Pure' calcium phosphate stones (3.0 per cent) were only obtained by the wet chemistry method. In the wet chemistry method, dissolved stone material did not show significant deterioration on storage for up to 9 days.

Epidemiology of hepatitis E virus in male blood donors in Jeddah, Saudi Arabia.

To our knowledge, only a few epidemiological reports on the prevalence of hepatitis E antibodies in Saudi blood donors have been published. Men of several nationalities, donating blood at King Khalid National Guard Hospital (Jeddah, Saudi Arabia) were selected (n = 593) for this study examining the seroprevalence of hepatitis E virus (HEV) in the local male donor population and testing the relationship of the antibody to HEV (anti-HEV) to donor characteristics using Odds Ratio (OR) and Chi-square statistic. The prevalence of anti-HEV in the group examined was 16.9 per cent (100/593). The seroprevalence for Saudi donors was 14.8 per cent compared with 33.3 per cent for non-Saudis of Middle Eastern origin. Donors who were 40 yr and over had significantly higher seroprevalence than those donors who were 30 yr or younger (OR = 2.5, p = 0.006). There was a significant association between anti-HEV and anti-HCV with donors who were positive to anti-HCV having about 5 times the risk of HEV than those who were anti-HCV negative (p = 0.02). These findings demonstrate the high seroprevalence rate of anti-HEV among male blood donors in Saudi Arabia.

The effects of therapy with rifampicin and isoniazid on basic investigations for Cushing's syndrome.

Rifampicin(R) is a potent enzyme inducer which is now widely used to treat many conditions. We have investigated its effect on adrenal function tests in 18 adults with tuberculosis on rifampicin (R) and isoniazid (INH) as in-patients. Midnight cortisol was above 250 nmol/l in 11 patients with a mean +/- (SD) of 340 +/- 193 nmol/l. The morning serum cortisol following 1 and 4 mg dexamethasone overnight was abnormal in 88.9 per cent and 83.3 per cent respectively. The respective mean values +/- (SD) were 350 +/- 179 and 336 +/- 279 nmol/l. The mean 24-hour urinary free cortisol +/- SD was 513 +/- 375 nmol and was above normal in 6 (33.3 per cent) patients. These results show that midnight cortisol, dexamethasone suppression tests and 24-hour urinary free cortisol are misleading in patients with tuberculosis on (R) and should not be employed for investigating such patients for Cushing's syndrome.

Friedreich's ataxia, with retained lower limb tendon reflexes, in a Saudi Arabian family.

Friedreich's ataxia (FA) was studied in a large inbred Arab family living near Jeddah, Saudi Arabia, in which DNA linkage studies localised the disease gene to 9q13-q21.1. Five siblings (aged 19-35 years), and their 27 year old cousin, had the typical features of FA, however in two patients, tendon reflexes were retained and were indeed brisk in the lower limbs, 13 and 19 years respectively after onset of symptoms: retention of lower limb tendon reflexes is exceptional in FA. Another 6 deceased individuals from two related families are presumed to have had FA.

The prevalence of hepatitis C virus antibodies among hemodialysis patients in jeddah area, saudi arabia.

The prevalence of antibody to hepatitis C virus (HCV) in hemodialysis (HD) patients is high and variable. One hundred and thirty nine patients undergoing maintenance HD at three different renal units in Jeddah, Kingdom of Saudi Arabia, were studied for prevalence of anti-HCV antibody. The overall prevalence in the group examined was 52.5% (73/139). There was a significant correlation between prevalence of anti-HCV and duration of HD; 53/ 74 (71.6%) in patients on HD for > 3 years as against 20/65 (30.8%) for patients on HD for < 3 years (P< 0.05). We were unable to demonstrate a correlation of anti-HCV positivity with history of blood transfusions, previous exposure to hepatitis-B virus, sex, age, or ethnic group. The very high prevalence of anti-HCV found in patients on maintenance HD and the positive correlation between anti-HCV reactivity and duration on dialysis suggest that factors within the dialysis unit might contribute to the spread of the virus.

The value of serum interleukin-6 measurement in the investigation of patients suspected of myocardial infarction.

Interleukin-6 (IL-6) is one of the cytokine mediators of the acute phase response. The value of IL-6 determination in the investigation of patients suspected of acute myocardial infarction and unstable angina is not fully established. In 26 patients being investigated for AMI and UA, IL-6, Creatine Kinase (CK) and Troponin T (TnT) were elevated with peak values at 12 hours (for IL-6 and CK) and at 0 and 24 hours (for TnT) following admission. CK values in AMI were significantly different from UA patients at 0, 6, 12, and 25 hours following admission, whereas, IL-6 values showed significant difference only at 24 hours. TnT showed a significant difference between the groups at 0 and 24 hours following admission. There was poor negative correlation between IL-6 and CK levels and percentage left ventricular ejection fraction. This study showed that, although IL-6 was elevated in AMI and UA patients, the spread of the data indicated that its measurement is of limited value in the diagnosis of AMI.

Seckel syndrome in a Yemeni family in Saudi Arabia.

We studied a 28-year-old Yemeni woman with typical Seckel syndrome. Two deceased sibs, a twin sister and a brother, had also been affected. The father of these individuals was married to his cousin's daughter: the pedigree suggests autosomal recessive inheritance. Classical Seckel syndrome has not been reported previously in Arabs, and this appears to be the first report from the Middle East.

Pericardial effusion in normal pregnant women.

Fifty-two normally pregnant women underwent echocardiography to examine their pericardium in the first, second and third trimester. Pericardial effusion was noted in 15.3% of the women (n = 8) in the first trimester, 19.2% (n = 10) in the second trimester and 44.2% (n = 23) in the third trimester of pregnancy. Pericardial effusion during pregnancy was found to be completely resolved in all patients who underwent an echocardiogram 6 weeks post delivery (n = 11). There was no statistically significant difference in age, hemoglobin, total protein, albumin/globulin ratio or mean blood pressure during pregnancy between those who developed pericardial effusion and those who did not. The frequency of occurrence of pericardial effusion in primigravidas at 69.2% (9/13) was higher than that in multigravidas, with a ratio of 35.9% (14/39), the difference being statistically significant (p less than 0.025). The frequency of occurrence of pericardial effusion in patients who gained more than 12 kg during pregnancy at 67.7% (11/17) was higher than in patients who gained less than 12 kg, with a ratio of 34.3% (12/35), the difference being statistically significant (p less than 0.025).

Level of serum fructosamine in Saudi diabetic patients.

Fructosamine, a compound used to measure serum glycosylated proteins was assayed in 105 Saudi diabetic subjects and 54 healthy non-diabetic Saudi subjects. Fructosamine concentrations in diabetics were significantly higher than in healthy controls (p less than 0.0005). Fructosamine concentrations correlated significantly with fasting blood glucose and HbA1 in diabetics (r = 0.677, p less than 0.0005, and r = 0.598, p less than 0.0005, respectively). The correlation between fructosamine and HbA1 was significant in the oral hypoglycemic-treated diabetics and poor in the insulin-treated diabetic group (r = 0.568, p less than 0.0005, and r = 0.526, p = 0.01). Fructosamine concentrations correlated poorly with the duration of diabetes (r = 0.221, p less than 0.05).

Altered cortisol levels in relation to Ramadan.

During the month of Muslim fasting (Ramadan) many people alter their sleeping habits and stay awake most of the night. We investigated the effect of this alteration on morning and midnight cortisol levels in 10 healthy adults in their homes. Four of the subjects showed alteration of the cortisol rhythm during the last 2 weeks of fasting with reversal of the morning/midnight ratio in some values. One lady was admitted for 24-h cortisol profile on Day 15 of Ramadan when the acrophase and nadir showed a forward shift by about 5-6 h, consistent with the shift of the subject's sleep. The morning cortisol returned to normal in all subjects 4 weeks after Ramadan. However, the midnight value was above 250 nmol/l in three of the subjects who exhibited the alteration during Ramadan. These findings suggest that single-point cortisol values can be misleading in many Muslin countries during or shortly after Ramadan.