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   2012| November-December  | Volume 4 | Issue 6  
    Online since July 17, 2017

 
 
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ARTICLES
Role of absolute eosinopenia as marker of enteric fever: Experience from a Tertiary Care Hospital in the United Arab Emirates
Aliasgar Lokhandwala, Syed Athar, Nicolas P Turrin
November-December 2012, 4(6):249-253
DOI:10.4103/1947-489X.210782  
Background: Involvement of bone marrow is common in salmonella infections. Enteric fever is a cause of morbidity and mortality world wide. Materials and Methods: We conducted a retrospective study of 51 blood cultures or widal positive salmonella patients who were admitted to a tertiary care hospital. Medical records and laboratory information system were used to collect the data. Results: The result established that significant eosinopenia was present in all enteric fever patients and eosinophil count of zero was almost diagnostic of enteric fever in the right clinical setting. Conclusion: Absolute eosinopenia is an important finding that should help timely diagnosis and early treatment initiation of enteric fever.
[ABSTRACT]   Full text not available  [PDF]
  1,692 240 -
“Targeted diabetes education” and glycemic control during ramadan fasting: An exploratory study
Huda Ezzeddin Mustafa, Tarek Hashim, Salem A Beshyah, Ruqaya Amin, Raja Eissa, Mary Tommy, Salouha Al Fayyadi, Batoul Nizar
November-December 2012, 4(6):242-248
DOI:10.4103/1947-489X.210781  
Background: Management of diabetes during Ramadan fasting may be taken as a classical example of culturallysensitive care in some parts of the world. Several medical problems face diabetic patients who choose to fast. Objectives: To evaluate the effect of a locally-designed “targeted diabetes education” initiative on glycemic control of patients who intended to fast during Ramadan. Patients and Methods: This is a prospective cohort, controlled, non-randomized study. Seventy-one patients were recruited (46 women, 25 men); 10 had type 1 diabetes and 61 had type 2 diabetes. Of these, 51 patients were allocated to the intervention group, 13 were controls; 7 dropped out of the study. The “Targeted Diabetes Education” program included 2-3 educational visits to diabetes educators and 2-3 dietary counseling sessions before, during, and after Ramadan, in addition to telephone counseling and support. Home glucose monitoring was recommended to be performed in both the preprandial and 2 hour post prandial states at least 3-6 times per week plus recording of all hypoglycemic events. There was no deliberate intensification of medication for any patient. Outcome Measures: Risk stratification of patients was conducted according to the 2005 American Diabetes Association (ADA) guidelines. Preprandial and postprandial blood glucose levels, serum fructosamine, and hypoglycaemic episodes were measured during and after Ramadan. HbA1c, body weight changes and lipid profiles were also measured before and after Ramadan fasting. Results: More than 60% of the diabetic patients who fasted during Ramadan were in the higher risk groups (very high risk category 33.8%, high risk category 29.6%). Mean fasting blood glucose was reduced by 57 mg/ dL (95% CI, 21 - 94; p=0.005) in the intervention group. Mean HbA1c was lower in the intervention group by 1.5% (95% CI, 0.5 - 2.6; p=0.007) compared with the controls. Although serum fructosamine was reduced by 0.1 mmol/L (95% CI, -0.9 - 0.8; p=0.84) in the intervention group, this was not statistically significant. Mean difference in total Background: Management of diabetes during Ramadan fasting may be taken as a classical example of culturallysensitive care in some parts of the world. Several medical problems face diabetic patients who choose to fast. Objectives: To evaluate the effect of a locally-designed “targeted diabetes education” initiative on glycemic control of patients who intended to fast during Ramadan. Patients and Methods: This is a prospective cohort, controlled, non-randomized study. Seventy-one patients were recruited (46 women, 25 men); 10 had type 1 diabetes and 61 had type 2 diabetes. Of these, 51 patients were allocated to the intervention group, 13 were controls; 7 dropped out of the study. The “Targeted Diabetes Education” program included 2-3 educational visits to diabetes educators and 2-3 dietary counseling sessions before, during, and after Ramadan, in addition to telephone counseling and support. Home glucose monitoring was recommended to be performed in both the preprandial and 2 hour post prandial states at least 3-6 times per week plus recording of all hypoglycemic events. There was no deliberate intensification of medication for any patient. Outcome Measures: Risk stratification of patients was conducted according to the 2005 American Diabetes Association (ADA) guidelines. Preprandial and postprandial blood glucose levels, serum fructosamine, and hypoglycaemic episodes were measured during and after Ramadan. HbA1c, body weight changes and lipid profiles were also measured before and after Ramadan fasting. Results: More than 60% of the diabetic patients who fasted during Ramadan were in the higher risk groups (very high risk category 33.8%, high risk category 29.6%). Mean fasting blood glucose was reduced by 57 mg/ dL (95% CI, 21 - 94; p=0.005) in the intervention group. Mean HbA1c was lower in the intervention group by 1.5% (95% CI, 0.5 - 2.6; p=0.007) compared with the controls. Although serum fructosamine was reduced by 0.1 mmol/L (95% CI, -0.9 - 0.8; p=0.84) in the intervention group, this was not statistically significant. Mean difference in total cholesterol was 9.6 mg/dL (95% CI, -37.5 - 18.3; p=0.5) and in triglycerides 19.6 mg/dL (95% CI, -5 – 12; p=0.23) for the intervention group. Number of hypoglycemic events was significantly lower in the intervention group; 94% had no events compared to 73% in the control group. Mean difference in body weight was 0.4 kg (95% CI, -3.0 - 3.8: p=0.81). Conclusion: Targeted diabetes education is effective in achieving better glycemic control and reducing the risk of hypoglycemia in diabetic patients who fast during Ramadan. Therefore, more Muslim patients with diabetes who wish to fast during Ramadan can do this safely.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  915 149 13
ABSTRACTS BOOK
Excellence in diabetes and endocrinology 2012; September 6-8, 2012, Rocco Forte Hotel, Abu Dhabi, UAE
Salem A Beshyah, Asma Deeb
November-December 2012, 4(6):258-277
DOI:10.4103/1947-489X.210784  
This conference is the second of the series of “Excellence in Diabetes and Endocrinology” organized jointly by the adult and pediatric departments of endocrinology at Sheikh Khalifa Medical City and Mafraq Hospitals in Abu Dhai, United Arab Emirates. The organizers are building on the great success of the first meeting held in 2010. The importance of adult and pediatric endocrine physicians is particularly relevant in this part of the world where the transfer of care from pediatrics to adults clinic may occur as early 13 years of age. Practicing adult physicians may find themselves faced by situations they may not have met during their formal training. Several international, regional and national speakers participated in the conference to address most topical issues in diabetes and endocrinology covering global and regional epidemiology, diagnostic strategies, and the latest good clinical care guidelines. The abstracts are grouped under the sub-headings of their respective sessions. We hope by publishing these abstracts we extend the education cause of the conference.
[ABSTRACT]   Full text not available  [PDF]
  773 109 -
VIEW POINT
Guidelines for management of type 2 diabetes 2012: Common sense prevails!
Salem A Beshyah, Ahmed A. K Hassoun, Ali B Khalil, Hussein F Saadi
November-December 2012, 4(6):216-221
DOI:10.4103/1947-489X.210778  
Recently, guidelines on the management of hyperglycemia in type 2 diabetes were released by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) as their formally adopted position statement. These guidelines are different from the previously published documents. They introduced a nonalgorithmic patient-centered approach that stressed the principles of individualization of care based on several important patients' attributes. They affirmed the role of lifestyle modification as a basic requirement, metformin as the first line pharmacological therapy and individuallytailored basis for the choice of the second and third line drugs. In this paper, the authors reflect on these guidelines from the world-wide practicing physicians' view point.
[ABSTRACT]   Full text not available  [PDF]
  774 79 -
REVIEW
Role of Renin-Angiotensin-Aldosterone System (RAAS) inhibition in the renal continuum
Alaaeldin M Bashier, Amna Al Hadari
November-December 2012, 4(6):222-230
DOI:10.4103/1947-489X.210779  
Renal involvement in patients with type 2 diabetes carries a risk of increased cardiovascular mortality. This is particularly true in the presence of microalbuminuria being an early marker of endothelial dysfunction. The use of Renin Angiotensin Aldosterone System (RAAS) blockers has been found beneficial in improving endothelial dysfunction as well as preventing development of microalbuminuria and its progression to macroalbuminuria. This class of drugs has been proved effective in delaying the development of end stage renal disease. However; in patients with established end stage renal disease, it becomes controversial whether using these drugs may still be beneficial. Indeed, some studies have shown that they may even be harmful if used in late stages of chronic kidney disease. In this article, we will review firstly, the renovascular changes in health and disease and secondly appraise the different trial data pertaining to the assessment of the use of various RAAS inhibitors at different stages of the renal continuum. We hope the review will help put together a physiologicallybased fundamental knowledge and a trial-derived evidence base for to help inform day to day decision-making in clinical practice.
[ABSTRACT]   Full text not available  [PDF]
  710 93 -
CASE REPORT
Multilocular cystic renal cell carcinoma in an HIV patient: A diagnostic dilemma
Laila Elbarghati, Lubna Azzouz
November-December 2012, 4(6):254-257
DOI:10.4103/1947-489X.210783  
A radical nephrectomy specimen was referred for pathological examination. The history, course and the pathological findings proved very interesting. The specimen belonged to a forty four year old HIV positive man who was admitted with pain and tenderness in the right hypochondriac region. Sonography demonstrated fatty liver and incidental multilocular enhancing cystic lesion in the left kidney. A left radical nephrectomy was performed and pathological examination of the specimen showed a multilocular cystic renal cell carcinoma (MCRCC). The clinical presentation, management and outcome of this new entity are discussed.
[ABSTRACT]   Full text not available  [PDF]
  702 74 -
ARTICLES
Effect of triiodothyronine (T3) supplementation on the cerebral neurotransmitters in offspring of hypothyroid rats
Hayam Gaber Sayyed
November-December 2012, 4(6):231-241
DOI:10.4103/1947-489X.210780  
Introduction: Nervous system growth and differentiation are intimately interrelated with the presence of thyroid hormones (THs) in early development stages. Hypothyroidism during the fetal and postnatal life results in an irreversible mental retardation syndrome. Aim of the study: Assessment of the effect of 3,5,3’-triiodo-L-thyronine (T3) on changes in the cerebral neurotransmitters level in hypothyroid rats male offspring and the possible role of Na+, K+-ATPase activity. Materials and methods: Hypothyroidism during pregnancy and lactation in one group (hypothyroid group) was induced by the antithyroid drug, methimazole (MMI) that was added to drinking water at a concentration of 0.02%. In the second group (T3-treated hypothyroid group), MMI was stopped and animal's offsprings were given T3 (20 μg/100 g body weight in 0.01 N NaOH, i.p.) for one week. The third group is the control group; neither the mother nor the offspring received any drug. The hypothyroid state in mothers during pregnancy was confirmed by measuring total thyroxine (TT4) and total triiodothyronine (TT3) at gestational day 10. At the end of experiment, the offsptings were sacrificed and free thyroxine (FT4) and free triiodothyronine (FT3) in sera and neurotransmitters (dopamine, norepinephrine and serotonin) and Na+, K+-ATPase activity were measured in the cerebral homogenate. Results: Maternal hypothyroidism induced a significant decrease in the cerebral level of dopamine, norepinephrine, serotonin and Na+, K+-ATPase activity when compared with euthyroid group. Treatment with T3 significantly increased the cerebral level of neurotransmitters and Na+, K+-ATPase activity when compared with the hypothyroid group. Conclusion: T3 supplementation during the postnatal period through its effect on the cerebral Na+, K+-ATPase effectively reversed the effect of maternal methimazole-induced hypothyroidism on the cerebral level of dopamine, norepinephrine and serotonin.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  676 96 1
LETTER FROM THE EDITORS
A vote of thanks and an appeal for further support
Elmahdi A Elkhammas, Salem A Beshyah
November-December 2012, 4(6):278-279
DOI:10.4103/1947-489X.210785  
Full text not available  [PDF]
  490 94 -