Mixed gynecomastia.

Gynecomastia is an enlargement of male breast resulting from a proliferation of its glandular component, and it is usually due to an altered estrogen-androgen balance. It should be differentiated from pseudogynecomastia, which is characterized by fat deposition without glandular proliferation and from breast carcinoma. Gynecomastia could be physiological in neonates and pubertal or pathological due to drug intake, chronic liver, or renal disease, hyperthyroidism, testicular or adrenal neoplasms, and hypogonadism whether primary, or secondary. Properly organized work-up is needed to reach the cause of gynecomastia. Here, we reported a case of a young Omani man with gynecomastia with the aim of creating awareness of the occurrence of Klinefelter's syndrome (KS) in patients with gynecomastia, to observe any differences in clinical presentation of KS from those reported in the literature, and highlight the needed diagnostic work-up and treatment.

Assessment of glomerular filtration rates by cockcroft-gault and modification of diet in renal disease equations in a cohort of omani patients.

OBJECTIVES: Glomerular filtration rate (GFR) is the best index of renal function and is frequently assessed by corrected creatinine clearance (CCLcr). The limitations of CCLcr have inspired researchers to derive easy formulas to estimate GFR, with Cockcroft-Gault (C-G) and the modification of diet in renal disease (MDRD) being the most widely used. This study aimed to evaluate the validity of these equations by finding the relation between CCLcr and estimated GFR (eGFR) by C-G, modified C-G and MDRD equations. METHODS: From 2007 to 2011, 158 subjects were analysed for serum creatinine and CCLcr at Bowsher Polyclinic, Muscat, Oman. The C-G equation was used to obtain eGFRC-G which was adjusted to body surface area (BSA) to obtain eGFRmC-G, and the MDRD equation was used to obtain eGFRMDRD. The eGFRMDRD, eGFRmC-G and eGFRC-G were then compared to CCLcr. RESULTS: The eGFRMDRD, eGFRmC-G and eGFRC-G significantly correlated with CCLcr, with a slightly stronger correlation with eGFRMDRD (r = 0.701, 0.658 and 0.605, respectively). A receiver operating characteristic curve analysis showed that the diagnostic accuracy of eGFRMDRD for diagnosing chronic kidney disease (CKD) was higher than that of eGFRmC-G, which in turn was higher than that of eGFRC-G (area under the curve was 0.846, 0.831, and 0.791; cut-off limits were 61.9, 58.3 and 59.5, respectively). CONCLUSION: C-G and MDRD equations can be an alternative to the CCLcr test for assessing GFR, thus avoiding the need for the cumbersome and expensive GFR test. The MDRD formula had greater validity than the C-G equation and the C-G equation validity was improved by an adjustment to BSA.

Hypomagnesemia in type 2 diabetic Omani patients.

OBJECTIVE: To study serum total magnesium (Mg) levels in type 2 diabetic Omani patients, and to find the relation between Mg levels and glycosylated hemoglobin (HbA1c), body mass index (BMI), and age of the patient. METHODS: This work was carried out at the Bousher Polyclinic, Muscat, Oman from January to October 2008. We compared 34 type 2 diabetic patients with non-diabetic subjects as regards serum total Mg. We assessed diabetic patients in terms of age, gender, HbA1c, BMI, and their medications. Subjects at risk for apparent causes of hypomagnesemia or hypermagnesemia were excluded. RESULTS: The mean serum total Mg level was 0.92 mmol/L (SD 0.06) in the control subjects, and 0.81 mmol/L (SD 0.08) in the diabetic group, and although almost all our diabetic patients have no hypomagnesemia, their levels of serum total Mg were significantly reduced compared with control subjects. T-test shows that our diabetics have significantly lower total Mg levels with a difference of 0.12 mmol/L (p=0.000) irrespective of age and gender. The Mg levels are positively correlated with age, but no correlation with HbA1c and BMI. CONCLUSION: Although ionized and intracellular Mg levels are more reliable than total serum Mg in assessing Mg deficiency, low total serum levels of Mg are frequently seen in individuals with type 2 diabetes. Further studies on the role of Mg supplementation in the prevention of type 2 diabetes mellitus and its complications and similar studies in type 1 diabetes mellitus are recommended.