Type 2 Diabetes Mellitus: A Review of Current Trends

Abdulfatai B. Olokoba,¹* Olusegun A. Obateru,² Lateefat B. Olokoba³

Abstract

Type 2 diabetes mellitus (DM) is a chronic metabolic disorder in which prevalence has been increasing steadily all over the world. As a result of this trend, it is fast becoming an epidemic in some countries of the world with the number of people affected expected to double in the next decade due to increase in ageing population, thereby adding to the already existing burden for healthcare providers, especially in poorly developed countries. This review is based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. Subject heading and key words used include type 2 diabetes mellitus, prevalence, current diagnosis, and current treatment. Only articles in English were included. Screening and diagnosis is still based on World Health Organization (WHO) and American Diabetes Association (ADA) criteria which include both clinical and laboratory parameters. No cure has yet been found for the disease; however, treatment modalities include lifestyle modifications, treatment of obesity, oral hypoglycemic agents, and insulin sensitizers like metformin, a biguanide that reduces insulin resistance, is still the recommended first line medication especially for obese patients. Other effective medications include non-sulfonylurea secretagogues, thiazolidinediones, alpha glucosidase inhibitors, and insulin. Recent research into the pathophysiology of type 2 DM has led to the introduction of new medications like glucagon-like peptide 1 analogoues: dipeptidyl peptidase-IV inhibitors, inhibitors of the sodium-glucose cotransporter 2 and 11ß-hydroxysteroid dehydrogenase 1, insulin-releasing glucokinase activators and pancreatic-G-protein-coupled fatty-acid-receptor agonists, glucagon-receptor antagonists, metabolic inhibitors of hepatic glucose output and quick-release bromocriptine. Inhaled insulin was licensed for use in 2006 but has been withdrawn from the market because of low patronage.

Hypercholesterolemia Among Apparently Healthy University Students

Said M. Shawar,^1* Neda A. Al-Bati,¹ Ali Al-Mahameed,² Das S. Nagalla,³ Mohammed Obeidat ⁴

Abstract

Background: Hypercholesterolemia (HC) is a major risk factor in the development of coronary heart disease (CHD). Serum cholesterol is directly related to complications and mortalities associated with heart diseases. There are a few studies that describe HC among youths in the Arab Gulf countries. We sought to evaluate HC among young healthy university students to assess their risk of developing CHD.

Methods: Lipid profile of 166 students between the ages of 16-30 years (Mean: 20.49±2.96) were examined and blood glucose, total protein, albumin, thyroid stimulating hormone (TSH) and the inflammation marker high sensitivity CRP (hsCRP) were determined. Each volunteer filled a questionnaire about her/his lifestyle and personal and family medical histories and height and weight were measured to determine body mass index (BMI). The data were analyzed using SPSS version 17. Chi-Square was used to determine the relation between categorical variables. A p-value <0.05 was considered statistically significant.

Results: According to the American Heart Association criteria, 44 (26.5%) students were identified with primary hypercholesterolemia (PHC) in the first testing round. After proper health counseling, the same tests were repeated after 2-3 weeks in all 44 hypercholesterolemic students. We found only 26 (15.6%) of them to be hypercholesterolemic. There was a significant relation between high total cholesterol (TC) and high TC/HDLC, as well as high or very high hsCRP and high TC/HDLC (both, p<0.001). Males tend to have higher TC/HDLC and hsCRP than females (both p0.002 and 0.005, respectively). Family history of CHD was found in 8 students and obesity was recorded in 5 volunteers.

Conclusion: The results necessitate further studies in determining the cause of PHC. We predict a genetic element contributing to the high percentage of PHC in the current study.

Keywords: Hypercholesterolemia; hsCRP; Coronary Heart Disease (CHD); University Students.

How Predictive are the Signs and Symptoms of Small Bowel Obstruction

Saleh Mohammad Al Salamah,¹* Fraz Fahim,² Abdul Majeed Abdul Hameed,³ Amal A. Abdulkarim,⁴ Ebtehal S. Al Mogbal,⁵Adel Al Shaer ⁶

Abstract

Objective: The present study aims to determine the diagnostic significance of signs and symptoms of Small Bowel Obstruction (SBO) and to ascertain if there was any delay in presentation of the patients to the hospital.

Methods: This retrospective case study spanning 3 years was conducted at Riyadh Medical Complex, Saudi Arabia. All adult patients admitted from the ER with a diagnosis of SBO were included in the study. The medical records of the patients with International Classification of Diseases (ICD) 9 codes 552.8, 560, 560.8, 560.81 and 560.9 were searched and retrieved.

Results: A total of 195 patients were included in the study out of which 174 patients had a definitive diagnosis of SBO. The study group was composed of 76.4% males and 71.8% were aged between 20 years to 60 years. The mean duration of symptoms was 4.8 days, ranging from 6 hours to 17 days. The cardinal signs and symptoms of obstruction had low sensitivity (Range: 56-75), and specificity (Range: 28-61), but relatively high positive predictive value (PPV) (Range: 86-93). The morbidity was 13.8% while mortality was 3.4%.

Conclusion: The cardinal features of SBO are neither specific nor sensitive, and though they may have an acceptable PPV, the predicted rate of false positive diagnosis is unacceptable. Therefore, the clinician may not rely on the clinical picture alone for the diagnosis of SBO. The presentation of the studied patients was delayed compared to the literature and it may be an important factor in increasing morbidity and mortality, but this aspect needs to be studied further.

Association of Cytokine Gene Polymorphisms in Patients with Chronic Obstructive Pulmonary Disease

Rajni Kant Shukla,¹ Surya Kant,¹ Sandeep Bhattacharya,¹ Balraj Mittal ^1*

Abstract

Objective: Chronic obstructive pulmonary disease (COPD) is a major health problem. The disease is driven by abnormal inflammatory reactions in response to inhaled particles and fumes. Therefore, inflammatory mediators are postulated to be of distinct importance. Keeping in view of the above facts; we investigate the role of polymorphisms of cytokine genes in the genetic predisposition of COPD.

Methods: In this present case-control study, the allele and genotype distributions of IL1B, IL1RN, TNF-α, and IL4 were studied in COPD patients (N=204) and healthy individuals (N=208). Genomic DNA was obtained by whole blood and genotyping was carried out by a polymerase chain reaction (PCR) based Restriction Fragment Length Polymorphism technique.

Results: Genotype IL1RN*2/IL1RN*2 was identified as protective for male COPD, its frequency being 8.7% in COPD patients and 14.6% in healthy subjects (p=0.017; OR=0.53), but IL1RN*1/IL1RN*2 turned out to be a risk factor for females COPD. No significant differences were found between the groups of COPD patients and healthy subjects concerning the genotype frequencies of the polymorphisms T (-511) C of IL1B and 70bp VNTR of IL-4. Genotype GA of the TNF-α polymorphism G (-308) A was more common in the COPD patients than in the controls (20.5% vs.14.4%; p=0.107), and allele A was significantly associated with COPD patients (p=0.023; OR=0.65).

Conclusion: IL-1RN *2 allele appears to be significantly associated with the COPD female patients and TNF-α-308A allele is a risk factor for the development of COPD.

Knowledge and Attitude of University Students Towards Premarital Screening Program

Rahma Al Kindi,¹* Salha Al Rujaibi,² Maya Al Kendi³

Abstract

Objectives: The aim of this study was to explore the knowledge and attitude of Sultan Qaboos University students towards premarital screening program.

Methods: A cross-sectional study conducted at the students’ clinic from January to April 2011. A self-administered questionnaire was distributed to 590 unmarried Omani students of both genders. The questionnaire consisted of 3 main parts; the first part was based on socio-demographic data, the second part dealt with the students’ knowledge about the premarital screening program while the third part explored their attitudes towards the screening program.

Results: Most of the participants (n=469; 79%) were aware about the availability of premarital screening program in Oman. The main sources of information were: school/college (n=212; 36%), media (n=209; 35%), family and friends (n=197; 33%), and/or health services (n=181, 31%). The vast majority of the participants (n=540; 92%) thought it is important to carry out premarital screening and agreed to do it. Around half of the participants (n=313; 53%) favored having premarital screening as an obligatory procedure before marriage and about one third (n=212; 36%) favored making laws and regulation to prevent marriage in case of positive results.

Conclusion: Even though the majority of the participants thought it is important to carry out premarital screening; only half favored making it obligatory before marriage and one third favored making laws and regulations to prevent marriage in case of positive results. This reflects the importance of health education as a keystone in improving knowledge and attitude towards premarital screening program.

Relationship Between Serum Ferritin Level and Amikacin Ototoxicity

Mohammad Shayaninasab,^1* Mohammadreza Fatololoomi,² Fatollah Behnood,³ Azam Alizamir⁴

Abstract

Objectives: Aminoglycosides are highly effective against bacteria but have serious side-effects including ototoxicity and nephrotoxicity. One of the theories in aminoglycosides ototoxicity is that Iron-aminoglycoside complex causes ototoxicity by creating free radicals. Based on this theory, the relationship between serum iron level and amikacin ototoxicity was studied to determine whether more iron results in more ototoxcity.

Methods: This prospective cohort study was conducted from August 2005 to October 2008. Patients with amikacin prescription and different serum-ferritin levels were examined. Burned patients with amikacin prescription were divided into Group1 (89 patients; serum-ferritin >150) and Group2 (92 patients, serum-ferritin <150). Their hearing thresholds and red-blood-cells indices were compared using t- and paired t-test.

Results: In comparing the two groups, thresholds of Group1 were higher than Group2 at all frequencies, and the difference was statistically significant (p<0.001). The maximum threshold shift in Group1 was greater than 20 dB and in Group2, it was less than 10 dB, at 8000Hz. Again, this result was statistically and clinically significant (p<0.001). Finally, the mean corpuscular volume (MCV)was higher in Group1 than Group2, and (p=0.001).

Conclusion: The results suggest that the level of iron is related to aminoglycoside ototoxicity. More iron can create more ototoxicity, and iron deficiency may inhibit aminoglycoside ototoxicity. An increase in MCV may be due to higher serum ferritin and an indication of more ototoxicity.

The Relationship Between Serum Lipid Profile and Selected Trace Elements for Adult Men in Mosul City

Osama M. Al-Sabaawy*

Abstract

Objectives: To evaluate the correlations of the serum concentrations of copper, zinc, and manganese with lipid profile parameters of adult men in Mosul City, Iraq.

Methods: The study included 51 apparently healthy adult men as a control group aged 34-62 years (group 1), and 31 hyperlipidemic patients aged 37-60 years (group 2). Trace elements copper, zinc and manganese were determined using atomic absorption spectrometry. Concentrations of total cholesterol, triglyceride and high density lipoprotein cholesterol were determined using enzymatic method. Indirect serum concentration of low-density lipoprotein cholesterol were calculated via the Friedewald formula. Data were evaluated as mean and standard deviation by analysis of variance (ANOVA) and t-test.

Results: The results indicated that there is a significant lower level of serum zinc in hyperlipidemic patients compared with the control group, while copper and manganese showed no significant differences between the two groups. A significant negative correlation was found between serum zinc and total cholesterol, low-density lipoprotein cholesterol, triglyceride and low/high-density lipoprotein cholesterol ratio; while a significant positive correlation was found between serum zinc and high density lipoprotein cholesterol. In addition, a significant positive correlation between copper and triglyceride existed in the patient group, while the control group showed no such correlation.

Conclusion: Hyperlipidemia may possibly be related to a decrease in the level of serum zinc in hyperlipidemic adult men. The data also supports the concept that zinc supplementation might be useful in improving metabolic complications in subjects with hyperlipidemia.

Characteristics of Hospitalized Patients Following Suicide Attempt in Hamadan District, Iran

Ali Ghaleiha,¹ Saeed Afzali,² Maryam Bazyar,³ Faeze Khorsand,³ Saadat Torabian^4*

Abstract

Objectives: Limited research has been undertaken on suicide in developing countries. This paper aims to investigate characteristics of suicide attempts in Hamadan district of Iran.

Methods: A prospective study was conducted in all university hospitals in the Hamadan district of Iran and patients admitted for attempted suicides were included. All cases were assessed by psychiatrists and visited by two trained interns of Medicine.

Results: The incidence rate per 100,000 persons of attempted suicides was 228.6 for males and 263.1 for females; moreover, 344.9 for rural areas and 222.7 for urban areas. The suicide attempt was the highest in the 15 to 24 age category for both sexes and regions.

Conclusions: Suicide is a complex, long-term outcome that requires multifaceted theoretical constructs for the appropriate study of its antecedents. Findings of this study along with other studies in Iran revealed that unemployed men, housewives, and rural women, high-school students, and those with a low level of education were at higher risk of suicidal behaviors.

Evaluation Children with Global Developmental Delay: A Prospective Study at Sultan Qaboos University Hospital, Oman

Roshan Koul,¹* Mohammed Al-Yahmedy,¹ Amna Al-Futaisi¹

Abstract

Objective: A prospective study was designed to analyze risk factors and clinical features in children with global developmental delay (GDD) at our hospital. No previous data is available on GDD from Oman.

Methods: This study was conducted at Sultan Qaboos University Hospital from January 2008 until June 2009. All the children aged 5 years or less, referred with suspected GDD were included in the study. Data was analyzed to determine the underlying etiology. The children with neurodegenerative disease and muscular dystrophy were excluded from the study.

Results: One hundred and ten children, 59 males (53.6%) and 51 females (46.4%) were included in the study. The mean age at initial evaluation was 13.29 months. An underlying etiology was determined in 79 (71.8%) children. Perinatal history was associated with significant difference in detection of etiology (p=0.039). Abnormal neurological examination was a significant factor in detection of the underlying etiology. Magnetic resonance imaging (MRI) in 105 children and metabolic screening in 93 children were the most frequently ordered investigations. Abnormal imaging, MRI (p=0.001), CT scan (p=0.036) and metabolic screening (p=0.034) were significantly associated with detection of etiology.

Conclusion: Etiology was detected in 71.8% of the children. MRI was the most significant investigation to detect the abnormality.

Giant Fibroadenoma of Breast in an Adolescent Girl

Nithya Thuruthiyath,^1* Purna Chandra Das,² K Shreedhara Avabratha,¹ Vanessa Mascarenhas,¹ Nisha Marla³

Abstract

A 12-year-old girl presented with a 15 × 15 cm, rapidly enlarging mass in left breast. Fine-needle aspiration cytology showed a benign proliferative breast lesion. Total excision of the mass was done preserving nipple and areola. Histopathology features were suggestive of giant fibroadenoma with benign phyllodes.

Keywords: Giant fibroadenoma; Adolescent girl; Breast tumor.

Extra-articular Tenosynovial Chondromatosis Mimicking a Neoplastic Disease in the First Web Space of the Hand

Oguz Cebesoy,^1* Mustafa Isik,¹ Mehmet Subasi,¹ Burcin Karsli,¹ Ugur Pamukcu¹

Abstract

Tenosynovial chondromatosis is a very rare disease. The most common symptom is a slowly enlarging soft tissue mass, which may be painful or cause limitation of joint motion. Plain radiograph may appear normal during early phases of the disease, but subsequent imaging may be necessary to exclude other pathologies. Nonoperative treatment may be elected for some patients, but a synovectomy and the removal of loose bodies are indicated for persistent symptoms. This report describe a case with a multinodular cartilaginous proliferation and rice body in the first web space of the hand, similar to synovial chondromatosis, but arising in the tenosynovial membranes.

Anomalous Systemic Artery to a Normal Lung: A Rare Cause of Hemoptysis in Adults

Ashu Seith Bhalla,^1* Pankaj Gupta,¹ Amar Mukund,¹ Arvind Kumar,² Mudit Gupta¹

Abstract

Bronchopulmonary sequestration represents a spectrum of abnormalities. One of these abnormalities is an aberrant systemic arterial supply to a normal lung with no bronchial sequestration. These lesions were originally classified by Pryce as type 1. Most of these patients are asymptomatic but with time, many patients develop localized pulmonary hypertension, hemoptysis, and eventually high output cardiac failure. Multidetector computed tomography (MDCT) plays an important role in the diagnosis and planning of definitive treatment by identifying the origin and course of the aberrant artery. Definitive treatment can be surgical (lobectomy or segmentectomy) or endovascular.

Anterior Abdominal Wall Leiomyoma Arising De Novo in a Perimenopausal Woman

Hamed A. Al-Wadaani*

Abstract

Extrauterine or extraintestinal leiomyomas are extremely uncommon especially in the pre-peritoneal area or within the anterior abdominal wall muscles. These tumors have been ascribed to intraoperative seeding during resection of a fibroid or a leiomyoma of gut, to exogenous hormone replacement therapy or a major derangement of glucose and/or lipid metabolism. So far, there is no published report of de novo origin of anterior abdominal wall pure leiomyoma in the literature. The author herein reports a case of perimenopausal multiparous woman without any listing of previous gynecological surgery or hormone therapy who presented with a large pre-peritoneal intramuscular leiomyoma of the anterior abdominal wall. The patient underwent complete primary resection with amelioration of her symptoms.

Dermatofibrosarcoma Protuberans of Male Breast: An Unusual Presentation

Kafil Akhtar,¹* Rana K. Sherwani,¹ Prasenjit Sen Ray¹

Abstract

Dermatofibrosarcoma protuberans (DFSP) is a rare tumor which usually presents during early or middle adult life, as erythematous indurated firm subcutaneous nodules. DFSP involving the breast is a rare phenomenon and even rarer in males. We describe a case of a male patient who presented with this tumor in his left breast.

Is Previous Tubal Ligation a Risk Factor for Hysterectomy because of Abnormal Uterine Bleeding?

Sanam Moradan,^1* Raheb Ghorbani²

Abstract

Objectives: Post tubal ligation syndrome (PTLS) is a term used to describe a variety of post tubal ligation side effects or symptoms. These include increased menstrual bleeding and hysterectomy. Whether or not post tubal syndrome is a real entity, it has been a subject of controversy in the medical literature for decades. Numerous studies have reported conflicting conclusions about these symptoms. In this study the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among non-sterilized female population of the same age.

Methods: This study was carried out on 160 women, 38-52 years, who underwent hysterectomy in Amir University Hospital, Semnan, Iran, from September 2008 to September 2011. After gathering of data from medical records, in this study, the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among nonsterilized female population for the same age.

Results: The mean age of the study group was 44/4±5/7 and the mean age of the control group was 45/2±5/3, (p=0.424).The mean parity of the study group was 3/8±1/8 and the mean parity of the control group was 3/5±1/4, (p=0.220). So, in regard to age and parity, two groups were matched. Hysterectomies were performed for 160 cases and abnormal uterine bleeding was the cause of hysterectomy in 67 cases. Among 67 cases, 19 cases (37.3%) had previous tubal sterilization + hysterectomy (study group) and 48 cases (44%) were not undergoing tubal sterilization but had hysterectomy for abnormal bleeding causes (control group). Statistical analyses showed that there were not significant differences between two groups, (RR=0.85; 95% CI: 0.56-1.28; p=0.418).

Conclusion: The result of this study showed that previous tubal sterilization is not a risk factor for undergoing hysterectomy because of abnormal uterine bleeding.

Prevalence of Hypoglycemia Among Patients Presenting with Cholestasis of Infancy in a Nigerian Teaching Hospital

Alphonsus N. Onyiriuka,^1* Kayode A. Adeniran,² Eucharia P.A. Onyiriuka³

Abstract

Objective: This study assesses the prevalence of hypoglycemia among patients presenting at the University of Benin Teaching Hospital, Benin City, Nigeria with cholestasis of infancy.

Methods: During a period of five years, forty patients aged between 15 days and 12 months who presented with cholestasis of infancy, were admitted and screened for hypoglycemia, using Accutrend glucometer. For patients with low blood glucose values, blood samples were further analyzed, using the standard glucose-oxidase method.

Results: Of the 2,835 patients admitted over a five-year period, 40 (1.4%) had cholestasis of infancy, giving an incidence of 14 cases per 1000 admissions, with a sex ratio of 2.1: 1 in favour of males. Nine (22.5%) of the 40 infants with cholestasis had at least one blood glucose concentration less than 2.6 mmol/L (hypoglycemia). Of the nine hypoglycemic infants, three (33.3%) had one blood glucose concentration less than 1.6 mmol/L (severe hypoglycemia). Seven (77.8%) of the nine hypoglycemic infants were diagnosed in the first 36 hours of admission. Lethargy and poor feeding were observed in three infants with severe hypoglycemia and three of them died. Six (66.7%) of the hypoglycemic infants were below 3 months of age.

Conclusions: Hypoglycemia was observed among patients with cholestasis of infancy and the prevalence was higher among infants below 3 months of age.