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BACKGROUND: Hearing loss is an underestimated comorbid condition in type 2 diabetes. OBJECTIVES: Investigate hearing loss as a comorbidity associated with type 2 diabetes mellitus and evaluate the factors associated with hearing loss. DESIGN: Cross-sectional. SETTING: Tertiary care center, diabetes clinic. PATIENTS AND METHODS: Patients with type 2 diabetes, aged 30 to 60 years, were randomly selected to participate. All patients underwent clinical ear examinations and were referred for full audiological evaluation. Otoacoustic emission was used to assess inner function, tympanometry to assess middle-ear function, and pure tone air/bone audiometry to assess hearing sensitivity. Risk factors for hearing loss were assessed by multivariate logistic regression. MAIN OUTCOME MEASURE: Frequency, severity and risk factors for hearing loss. SAMPLE SIZE: 157 RESULTS: Of the 157 patients, 77 had hearing loss in both ears (49.0%), 13 in the right ear only (8.3%), 14 in the left ear only (8.9%), and 53 (33.8%) had normal hearing. In the 181 ears with sensorineural hearing loss, 90 had mild loss (49.7%), 69 moderate loss (38.2%), 16 severe loss (8.8%) and 6 had profound loss (3.3%). Disabling hearing loss was observed in 46 (29%) patients. A higher frequency of hearing loss was present in patients with glycated hemoglobin levels ≥8%. In the multivariate logistic regression analysis, the most important factors associated with hearing loss were longer diabetes duration, poor glycemic control and the presence of hypertension. CONCLUSIONS: Hearing loss is an underestimated comorbid condition in type 2 diabetes that warrants frequent hearing assessments and management. Strict glycemic and hypertension control is essential for the minimization of the effects of diabetes on hearing sensitivity. LIMITATIONS: Small sample size, limited age window (30-60 years), which was chosen to eliminate the natural aging effect on hearing. Cross-sectional nature was not ideal for the assessment of causality. CONFLICT OF INTEREST: None.

A new, eco-friendly, and rapid micelle-mediated preconcentration technique was described for trace mercury in water, food and hair samples perior to its spectrophotometric determination. The developed method depended on cloud point extraction supported with ionic liquid (IL-CPE) for extraction of mercury utilizing a nonionic surfactant (Triton X-114) and 1-hexadecyl-3-methylimidazolium chloride (C16MeImCl) ionic liquid, as an extracting phase in the presence of 5-benzyl-4-[4-methoxybenzylideneamino)-4H-1,2,4-triazole-3-thiol (BMBATT) as a new chelating agent at pH 7.0. The influence of varous analytical variables on improving the extraction performance was tested. In the range of 2.0-600 µg L−1, the calibration curve was linear with correlation coefficient of 0.9997. The detection limit and preconcentration factor were 0.4 µg L−1 and 100, respectively. The reliability and precision of the developed IL-CPE system as the relative standard deviation (RSD %) of 100 and 400 µg L−1 mercury were in the range 1.0 and 2.4%, respectively (n=10). The validity of the developed IL-CPE approach was confirmed by the analysis of certified reference materials (NIST-1641d mercury in natural water and NCS ZC81002B human hair). The applicability of proposed IL-CPE technique was demonstrated successfully by estimation of trace mercury in real water, food and hair samples.

Objective: An eco-friendly, simple and sensitive vortex-assisted ionic liquid-based dispersive liquid-liquid microextraction method (VA-IL-DLLµE) has been proposed to enrich and determine trace levels of cadmium (Cd2+ ) and lead (Pb2+ ) ions in water, vegetables and tobacco samples, prior to its FAAS determination. Methods: The proposed method based on utilization of ionic liquid (IL) (1-hexyl-3-methylimidazolium tris(pentafluoroethyl)trifluorophosphate [HMIM][FAP]) as an extraction solvent for both ions after the complexation with 4,5-dihydroxy-3-phenylazo-2,7-naphthalenedisulfonic acid, disodium salt (Chromotrope 2R) at pH 6.5. The impact of different analytical parameters on microextraction efficiency was optimized. Results: In the ranges of 1.0–300 and 2.0-400 μg/ml, the calibration graphs were linear. The limits of detection were 0.3 and 0.6 μg/ml for Cd2+ and Pb2+ ions, respectively. The preconcentration factor was 100. The relative standard deviation (RSD %)

Objectives: The DISCOVER study is a global, prospective, three- year- observational (non-interventional) study that was conducted in 37 countries throughout the world including Saudi Arabia and aimed to assess variations in treatment patterns and therapeutic outcomes in type 2 diabetic patients. The current manuscript is reporting data of DISCOVER study across different health sectors of various provinces in the Kingdom of Saudi Arabia. Methods: In this study, 519 Saudi type 2 diabetics, non-insulin users, aged 18 years or older, initiating second line therapy, were selected from nine health institutes, in four out of five provinces in Saudi Arabia. Data was collected at baseline (initiation of 2nd line therapy) by the treating physician using an electronic case report form (eCRF) via a web-based data capture system. Each selected subject was asked to complete four self-administered questionnaires. Results: The mean age of the studied population was 52.4 ± 11 years. Among the subjects selected from the nine medical centers, 55% were men, with almost 65% between the ages of 46 and 65 years. The oral agent used as 1st line in the majority of patients was metformin, prescribed in 89.2% of the study cohort. In the second line, sitagliptin was the most frequently used, at 61.8%. followed by gliclazide, glibenclamide, and glimepiride at 35.6%, 13.1%, and 12.7%, respectively. Conclusion: Metformin, with or without sulfonylureas, is the most commonly prescribed first-line treatment for patients with type 2 diabetes, managed either in governmental institutions, or in the private sector. The most common second line drugs were DPP4 inhibitors, mainly sitagliptin, followed by the third and second generation of sulfonylureas. Drug affordability was not an issue, since the vast majority of the patients received medication free of charge. Keywords: Discover Type 2 diabetes, First line management, Second line management

An environmentally friendly, sensitive, easy and fast ultrasound-assisted ionic liquid-based dispersive liquid-liquid microextraction technique (UA-IL-DLLME) was developed to preconcentrate trace q...

Patients with type 2 diabetes nowadays have a wide range of new antidiabetic medications with better efficacy and safety. Physicians’ attitude toward selecting antidiabetic medications to reach targeted glycemic control and better quality of life (QOL) has not been studied prospectively. The global DISCOVER study aims to comprehensively provide a real-world assessment of the treatment pattern changes for patients with type 2 diabetes, in addition to QOL assessment. The Kingdom of Saudi Arabia was one of the countries participating in the DISCOVER study program. This study is a part of the prospective, longitudinal multinational DISCOVER study conducted in 38 countries including Saudi Arabia, a country facing an epidemic of type 2 diabetes, recruited 519 adult patients with type 2 diabetes with a mean age of 52.4 ± 11 years, where, they were followed up for three years period, where 477 patients completed the follow-up period. The clinical, biochemical, and patient lifestyle data were assessed periodically during the study period. DISCOVER study is registered with ClinicalTrials.gov identifiers: NCT02322762. The most frequently used antidiabetic medications (ADMs) initially and during the follow-up were biguanides (metformin) and sulfonylureas (gliclazide, glibenclamide, glimepiride, glipizide, and glyclopyramide). Insulin (premix Insulin, basal insulin, and basal/bolus insulin) and dipeptidyl peptidase-4 (DPP-4) inhibitors (sitagliptin, vildagliptin, saxagliptin, and linagliptin) were the most frequent second and alternative of therapy. Other medications namely thiazolidinediones (TZds) (pioglitazone and rosiglitazone), incretins (exenatide and liraglutide), and Sodium-glucose co-transporter-2 (SGLT-2) inhibitors (canagliflozin) were used at a lesser rate. Drug availability, efficacy, and safety were the main determinants for choosing antidiabetic medications. The physical component score of the QOL had shown a significant decrease, while the mental component score has demonstrated an increase in QOL using SF36v2 Survey. There is an increasing trend of using of newly available ADMs, mainly DPP-4 inhibitors. The major limitation of ADMs use is related to efficacy, availability, and safety. This warrant taking all the measures to overcome these limitations through adopting a multidisciplinary team approach for close monitoring of the patients and any unfavorable side effects. Additionally, global insurance coverage for all patients with type 2 diabetes could be a solution for the drug availability factor.

Background COVID-19 is diagnosed using RT-PCR assays of samples from nasal and oropharyngeal swabs. People with negative RT-PCR often presented with clinical manifestations of COVID-19. The data on such patients are lacking. The present study aims to characterize the patients who were suspected COVID-19 cases and tested negative in RT-PCR compared to patients who had been tested RT-PCR positive. Methods This is a retrospective, observational study of adult suspected and confirmed patients of COVID-19 admitted to King Saud University Medical City, Riyadh, Saudi Arabia, from 1st March 2020 until 30th November 2020. Laboratory confirmation is done through nasal/pharyngeal swab specimens, tested positive in RT-PCR assay. Patients with initial negative RT-PCR test results were assessed again within 48−72 h to avoid false-negative results. Patient data were extracted from the electronic medical files of each included patient using a predesigned case report form. Results The study included 488 (80.93%) patients with RT-PCR swab results positive, and 115 (19.07%) patients who were negative. Respiratory rate and diastolic blood pressure were higher among the swab-positive cases. More number of swab-negative patients had comorbidities such as coronary heart disease, chronic kidney disease, and carcinoma. Fever, cough, and shortness of breath were reported higher among the swab-positive cases. ALT and AST, and LDH levels were found higher among RT-PCR-positive patients. Serum creatinine, blood urea nitrogen and troponin were more elevated in RT-PCR-negative patients. Antibiotics, anticoagulants, and corticosteroids were used more by swab-positive patients. Significantly higher number of RT-PCR-positive patients required proning, high-flow nasal cannula, non-invasive mechanical ventilation, and invasive mechanical ventilation. Acute cardiac ischemia and death were found to be similar among the patients. However, deaths occurred significantly earlier among the swab-positive cases when compared to the swab-negative group. Conclusion Distinctive symptoms and markers of COVID-19 are more frequent among patients who had RT-PCR-positive results.

Background: Premenstrual dysphoric disorder (PMDD) is a female psychiatric disorder affecting the behaviour, cognitive abilities, mental health status and academic performance of female students. It includes: mood symptoms, behaviour symptoms and physical symptoms. Aim: To assess phenomenology, measure the prevalence of PMDD among university students and assess the relationship between PMDD and socio-demographic and personality characteristics. Setting: This study was conducted at Zagazig University, Sharqia Governorate, Egypt. Methods: A cross-sectional study was conducted from September 2020 to December 2020. It included 755 university students. They filled several questionnaires covering Diagnostic and Statistical Manual of Disorders (DSM-5) criteria to diagnose PMDD, socio-demographic, menstrual factors, physical activity and personality traits. Results: Premenstrual dysphoric disorder was found in 159 out of 755 students (21.1%). Overall, the most frequently reported premenstrual symptoms were overeating/food cravings (84.2%), fatigue/lack of energy (83.6%), depressed mood/hopelessness (82.0%) and hypersomnia (78.9%). Binary logistic regression model revealed that significantly related PMDD risk factors include: being a medical student, having a duration of menstrual bleeding ≥ 7 days, the average length of one cycle ˂ 28 days, high menstrual blood loss, presence of dysmenorrhea and positive family history of premenstrual syndrome (sister/mother). Regarding personality traits, low extroversion and agreeableness, and high neuroticism were also significant PMDD risk factors. Conclusion: Prevalence of PMDD was high among university students, especially medical students, and it can have a detrimental effect on both academic life and educational accomplishments, quality of life and daily living activities.

Background: Childhood trauma is an environmental and risk modifying factor for schizophrenia. Aim of the work: The objective of the present work is to evaluate the incidence of childhood trauma among schizophrenic patients and how this impacts the clinical features of the disorder. Subjects and Methods: It is a crosssectional study conducted from January 2019 to June 2019 at the Psychiatry Department, Zagazig University hospitals where the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Arabic version was used to verify the diagnosis of randomly chosen 104 schizophrenic patients meeting the inclusion criteria. Positive and Negative Syndrome Scale (PANSS) for the assessment of positive, negative and general psychopathology connected with schizophrenia. Adverse Childhood Experiences International Questionnaire (ACE-IQ) Arabic version to assess adverse childhood experience. The study was approved by the medical ethics committee of Zagazig University Hospitals and a written informed consent is obtained from all patients. Results: The prevalence of childhood trauma in schizophrenic patients is (85.6 %), (42.3%) of them had ≥3 types of trauma. Childhood trauma was associated with low education level and rural residence. There was a statistically significant positive correlation between childhood trauma and positive symptoms of schizophrenia in which (ACE total score ≥ 3 traumas) were associated with severe positive symptoms. Conclusion: Childhood trauma is prevalent in patients with schizophrenia. Childhood trauma patients are associated with more severe positive symptoms, especially in patients with 3 or more traumas. Patients with childhood trauma were associated with early schizophrenia onset.

BACKGROUND: Diabetic retinopathy (DR) is considered the fifth leading cause of visual impairment worldwide and is associated with a huge social and economic burden. OBJECTIVE: Describe the practicality of non-mydriatic funduscopic screening photography for the detection of DR among patients with type 1 and type 2 diabetes. DESIGN: Cross-sectional hospital-based study. SETTING: Diabetes center, Riyadh. PATIENTS AND METHODS: Between July and December 2017, patients with diabetes and aged ≥18 years were selected by systematic random sampling from the University Diabetes Center. Fundoscopic eye examination was performed using the TRC-NW8 non-mydriatic camera, which performs ocular coherence tomography (OCT) to detect macular edema. Using telemedicine, pictures were graded by a retinal-specialized ophthalmologist using the international clinical DR disease severity scale. Patients were classified according to the type and severity of DR. MAIN OUTCOME MEASURES: Detection and classification of DR. SAMPLE SIZE: 978 Saudi patients with diabetes. RESULTS: Of 426 (43.5%) patients with DR, 370 had nonproliferative DR and 55 had proliferative DR. Nineteen (1.9%) had macular edema. The most important risk factors for DR were longer diabetes duration and poor glycemic control. Both older age and insulin use contributed to the higher prevalence of DR and macular edema. DR was more common among type 1 patients at 55.4% compared with 49% among type 2 patients. In addition, more females had macular edema (57.1% versus 42.9% among males). Nine patients with macular edema (47.3%) had hypertension while 154 of 426 patients with DR (36.2%) had hypertension. CONCLUSION: Non-mydriatic funduscopic screening photography was practical and useful for the detection of DR in patients with type 1 and type 2 diabetes. LIMITATIONS: Conducted in a single center. CONFLICT OF INTEREST: None.

Background Although, the relation between inflammation and major depressive disorder (MDD) looks like firm, it may not exist in all patients with depression. Therefore, the main aim of this study was to compare serum C-reactive protein (CRP) level among clinical subtypes of MDD and its relation with suicidality. Results According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for MDD, 98 patients included and categorized into five clinical subtypes groups: atypical, anxious, melancholic, psychotic, and unspecified depression with percent (11.2%, 31.6%, 19.4%, 15.3%, and 22.4%) respectively. Twenty-four (24.5%) of all patients had suicidal thoughts using Beck Scale for Suicidal Ideation (BSS) with statistically significant increase (P < 0.05*) in suicidality among atypical group. On assessing CRP level, there was highly statistical significant increase (P < 0.001**) among cases with atypical type and also cases with suicidal ideation. Also, logistic regression analysis found that the significant predictors for high CRP among the studied cases were smoking, suicidality, atypical depression, and suicide depression. Conclusions Higher level of CRP was found among patients with atypical MDD, and there was significant relationship between CRP and suicidality.

Background Executive function (EF) domain deficits which most reported include in particular set shifting and inhibition, which are considered main deficits in obsessive-compulsive disorder (OCD). So, this research aimed to assess EF in patients with a primary diagnosis of OCD in comparison to a healthy control group; in order to understand the impaction of this disorder on the patient’s neuropsychological status. Results There was no significant difference between OCD patients and controls regarding demographic characteristics. Average duration of illness in OCD group was 3.97 ± 5.08 years. Forty patients (60.6%) had OCD medication prior to the study. Depression was the most prevalent comorbidity among OCD group (36.4%) then anxiety (12.1%) and social anxiety (3%). Regarding WCST indices, a significant difference (P < 0.05) was found between both groups in total number of correct answers, total number of errors, mean of errors, total number of perseverative errors, mean of perseverative errors, total number of non-perseverative errors, mean of non-perseverative errors, and conceptual level responses without significant difference (P ≥ 0.05) in the remaining indices. In ToL indices, there was highly significant difference (P < 0.001) between both groups regarding total time, but not regarding total moves (P ≥ 0.05). The defect in EF was positively correlated to the severity of symptoms of OCD. There was no significant difference between patients who had been receiving medical treatment and those who had not, also between patients who had comorbidities accompanying OCD and those who had not regarding EF as evident by both WCST measured parameters and TOL parameters. Conclusions OCD patients appear to have EF deficits in the fields of set-shifting, inhibitory control, working memory, and planning ability.

Background Charcot's arthropathy (CA) is a destructive rare complication of diabetes, and its diagnosis remains challenging for foot specialists and surgeons. We aimed to assess the clinical presentation and characteristics of CA and the frequencies of its various types. Methods This cross-sectional study was conducted from January 1, 2007, to December 31, 2016, and included 149 adults with diabetes diagnosed as having CA. Cases of CA were classified based on the Brodsky anatomical classification into five types according to location and involved joints. Results The mean ± SD age of the studied cohort was 56.7 ± 11 years, with a mean ± SD diabetes duration of 21.2 ± 7.0 years. The CA cohort had poorly controlled diabetes and a high rate of neuropathy and retinopathy. The most frequent type of CA was type 4, with multiple regions involved at a rate of 56.4%, followed by type 1, with midfoot involvement at 34.5%. A total of 47.7% of the patients had bilateral CA. Complications affected 220 limbs, of which 67.7% had foot ulceration. With respect to foot deformity, hammertoe affected all of the patients; hallux valgus, 59.5%; and flatfoot, 21.8%. Conclusions There is a high rate of bilateral CA, mainly type 4, which could be attributed to cultural habits in Saudi Arabia, including footwear. This finding warrants increasing awareness of the importance of maintaining proper footwear to avoid such complications. Implementation of preventive measures for CA is urgently needed.

Albuminuria is widely used to indicate early phases of diabetic nephropathy although it is limited by the fact that structural damage might precede albumin excretion. This necessitates identifying better biomarkers that diagnose or predict diabetic nephropathy. This is a cross-sectional hospital based study recruiting type 2 diabetic patients cohort aged 35–75 years with diabetes duration of ≥10 years. Out of total eligible 467 patients, 200 patients were with normal albumin excretion, 184 patients with microalbuminuria and 83 patients with macroalbuminuria. All the patients were tested for the 22 selected biomarkers including serum, plasma and urinary markers. Sensitivity, specificity, and area under the curve (AUC) were calculated as measures of diagnostic accuracy. Out of the tested biomarkers, urinary transferrin, urinary Retinol binding protein (RBP) and serum osteopontin had the best diagnostic value for diabetic nephropathy presence based on the AUC value. The rest of the biomarkers had comparatively less or even no discriminative power. The urinary transferrin and RBP and serum osteopontin, had the best diagnostic value in type 2 diabetic patients at different stages of diabetic nephropathy. Further longitudinal prospective studies are needed to evaluate the predictive power of those markers for detecting diabetic nephropathy before any structural damage occurs.

Background: Bipolar disorders (BD) have been accompanied with disturbances in neuroplasticity. Brain-de‌rived neurotrophic factor (BDNF) plays important role in neuroplasticity. It plays a vital role in the neurobiology of such disorders.Objectives: This study aimed to check BDNF serum levels in euthymic BD type I patients and correlate them with the clinical manifestations.Methods: Forty-eight Egyptian individuals were included in this study. They were arranged in three groups: The first one ‘G-A’ included twelve patients diagnosed with bipolar I disorder in manic episode; while the second ‘G-B’ consisted of twelve patients diagnosed with bipolar I disorder in full remission, and the third group ‘G-C’ consisted of 24 healthy persons as control subjects. The cases were diagnosed according to DSM-5 and psychometric analysis. The BDNF levels were assessed using the technique of quantitative sandwich enzyme immunoassay.Results: There was no statistical significant difference between the studied groups as regard demographic characteristics. Serum BDNF levels were lower in bipolar I patients in manic episode compared with those in euthymic state and also control subjects.Conclusion: patients with manic episode of bipolar I disorder have lower serum BDNF levels compared with those with euthymic state and control group.

Aim: To investigate the pathophysiological role of different biomarkers in diabetic kidney disease (DKD) among normoalbuminuric patients with a low-estimated glomerular filtration rate (eGFR). Methods: In this cross-sectional study of 200 normoalbuminuric Type 2 diabetes patients, 28 patients (14%) had a low eGFR. Results: The IL-18, VCAM-1 and P-selectin levels were significantly higher at a low eGFR. On analyzing the area under the receiver operating characteristic curve, these biomarkers had significant diagnostic value and have important pathophysiological role in the progression of DKD. Conclusion: Among normoalbuminuric Type 2 diabetes patients, IL-18, VCAM-1 and P-selectin may play a significant role in the prediction of early DKD. Further prospective studies need to be conducted to confirm this observation.

Objectives: To assess health care services provided to type 1 and type 2 diabetic patients and diabetes health care expenditure in the Kingdom of Saudi Arabia (KSA). Methods: This study was part of a nationwide, household, population based cross-sectional survey conducted at the University Diabetes Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia between January 2007 and December 2009 covering 13 administrative regions of the Kingdom. Using patients’ interview questionnaires, health care services data were collected by trained staff. Results: A total of 5,983 diabetic patients were chosen to assess health care services and expenditure. Approximately 92.2% of health services were governmental and the remaining 7.8% were in private services. The mean annual number of visits to physicians was 6.5±3.9 and laboratories was 5.1±3.9. Diabetic patients required one admission every 3 years with a mean admission duration of 13.3±28.3 days. General practitioners managed 85.9% of diabetic cases alone, or shared with internists and/or endocrinologists. Health care expenditure was governmental in 90% of cases, while it was personal in 7.7% or based on insurance payment in 2.3%. Conclusion: Health services and its expenditure provided to diabetic citizens in Saudi Arabia are mainly governmental. Empowerment of the role of both the private sector and health insurance system is badly needed, aside from implementing proper management guidelines to deliver good services at different levels. Saudi Med J 2015; Vol. 36 (10): 1216-1225 doi: 10.15537/smj.2015.10.12596

Background Saudi Arabia is a community thrilled by sudden social and economical changes, leading to a sharp increase in the prevalence of abnormal glucose metabolism. Age-specific diabetes and impaired fasting glucose prevalence is the focus of this study with the expected risk factors. Methods A nationwide, household, randomized, population based cohort of 18 034 participants aged ≥30 years was selected to test for abnormal glucose metabolism using fasting plasma glucose (FPG) according to American Diabetes Association (ADA) criteria. Results The prevalence of diabetes was 25.4% with 40.3% being unaware of their disease, while impaired fasting glucose (IFG) affected 25.5% of the total sample. IFG to diabetes ratio was one in this study, decreasing with age and increasing with body weight. Age ≥45 years, hypertension, history of gestational diabetes mellitus (GDM), and high triglycerides are the strongest risk factors in diabetic patients, while history of GDM, dyslipidemia, obesity, and high triglycerides are the most significant risk factors in IFG participants. Conclusions Abnormal glucose metabolism has reached an epidemic level in this society, where half of adults and older are affected. Risk factors are behind this epidemic and the quick shift from IFG to diabetes in this society. 摘要 背景： 沙特阿拉伯是一个正处于社会与经济快速变化时期的国家，这导致糖代谢异常的患病率急剧上升。这项研究的焦点是特定年龄段的糖尿病与空腹血糖受损的患病率以及预期的危险因素。 方法： 这是一项全国性、以家庭为单位、基于人群的随机队列研究，挑选了18034名年龄 ≥30岁的参与者，根据美国糖尿病协会的标准使用空腹血糖（FPG）检测他们的糖代谢是否异常。 结果： 糖尿病患病率为25.4%，并且40.3%的人不知道他们有糖尿病，在全部的样本人群中空腹血糖受损的患病率为25.5%。在这项研究中空腹血糖受损与糖尿病的比值为1，这个比值随着年龄增加而减少，随着体重增加而增加。在糖尿病患者中年龄 ≥45岁、高血压、妊娠糖尿病病史以及高甘油三酯血症是最强的危险因素，而GDM病史、血脂异常、肥胖以及高甘油三酯血症是空腹血糖受损最显著的危险因素。 结论： 在这个社会中糖代谢异常已经达到了一个流行病的水平，并且已经累及到了一半的成年人与老年人。在这个社会中空腹血糖受损向糖尿病的转变非常迅速，而危险因素却隐藏在这个流行病的背后。

Background The evaluation of metabolic syndrome in a society predisposed to the diabetes mellitus epidemic opens a new avenue to understanding this rapidly growing global metabolic problem. Although Saudi Arabia reports one of the highest prevalence levels of obesity and diabetes, a very limited number of epidemiological studies have examined the prevalence of metabolic syndrome. Therefore, the main aim of the current study was to estimate the prevalence of metabolic syndrome and its risk factors among the adult Saudi population in comparison to other countries. Methods A total of 12,126 Saudi subjects were randomly recruited from the 13 administrative regions, and evaluated for metabolic syndrome and its risk factors. This exercise was carried out by trained physicians, through clinical evaluations and overnight fasting blood glucose and lipid profile measurements. Both the International Diabetes Federation (IDF) and modified National Cholesterol Education Program and Adult Treatment Panel III (NCEP ATP III) Criteria were employed, and subjects with metabolic syndrome were identified using country-specific waist circumference cutoff values. Results The prevalence of metabolic syndrome in Saudi Arabia was found to be 39.8% (34.4% in men and 29.2% in women) and 31.6% (45.0% in men and 35.4% in women), according to the NCEP ATP III and IDF criteria, respectively. Metabolic syndrome was also observed to be more prevalent among men and older subjects. The most frequently observed component of metabolic syndrome was found to be low levels of high-density lipoprotein (HDL), followed by abdominal obesity. The most significant risk factors in the studied cohort included age ≥ 45, smoking history, low educational level, and living in urban areas. Conclusions This study shows a high prevalence of metabolic syndrome in Saudi Arabia, and thereby warrants urgent implementation of preventive health care strategies to reduce both morbidity and mortality related to this medical problem.

BACKGROUND: The prevalence of metabolic syndrome varies widely by ethnicity and by the criteria used in its definition. OBJECTIVE: To identify the optimal cutoff values for waist circumference (WC), waist-to-hip ratio (WHR) and body mass index (BMI) for identifying metabolic syndrome among the Saudi population. DESIGN: Nationwide household cross-sectional population-based survey. SETTING: Thirteen health sectors in Saudi Arabia. SUBJECTS AND METHODS: We used data for subjects in the Saudi Abnormal Glucose Metabolism and Diabetes Impact Study (SAUDI-DM), which was conducted from 2007 to 2009. Using International Diabetes Federation (IDF) criteria, metabolic syndrome and its different components were assessed using anthropometric measurements, blood pressure, fasting plasma glucose, triglycerides and HDL cholesterol. Receiver operating characteristic (ROC) curves were generated to assess sensitivity and specificity for different cutoff values of WC, WHR, and BMI. The Youden index was used to calculate the optimal cutoff value for each anthropometric measurement. MAIN OUTCOME MEASURE(S): Optimal cutoff value for WC, WHR, and BMI for identifying the risk of metabolic syndrome. RESULTS: The prevalence of two or more risk factors for metabolic syndrome was observed in 43.42% of the total cohort of 12 126 study participants ≥18 years of age. The presence of two or more risk factors were significantly higher among men (46.81%) than women (40.53%) (P

Background Although Diabetes mellitus is a major public health problem in the Middle East and North Africa (MENA) region with high rates of diabetic foot complications, there are only limited data concerning mortality among such a high risk group. Therefore, the main aim of the current study was to assess all-cause mortality and its related predictors among diabetic patients with and without diabetic foot complications. Methods Using data from the Saudi National Diabetes Registry (SNDR), a total of 840 patients with type 1 or type 2 diabetes aged ≥25 years with current or past history of diabetic foot ulcer (DFU) or diabetes related lower extremity amputation (LEA) were recruited in 2007 from active patients’ files and followed up to 2013. These patients were compared with an equal number of age and gender matched diabetic patients without foot complication recruited at the same period. All patients were subjected to living status verification at 31st December 2013. Results The all-cause mortality rate among patients with DFU was 42.54 per 1000 person-years and among LEA patients was 86.80 per 1000 person-years among LEA patients for a total of 2280 and 1129 person-years of follow up respectively. The standardized mortality ratio (SMR) (95% CI) was 4.39 (3.55–5.23) and 7.21 (5.70–8.72) for cases with foot ulcer and LEA respectively. The percentage of deceased patients increased by almost twofold (18.5%) among patients with diabetic foot ulcer and more than threefold (32.2%) among patients with LEA compared with patients without diabetic foot complications (10.7%). The worst survival was among patients with LEA at 0.679 and the presence of diabetic nephropathy was the only significant independent risk factor for all-cause mortality among patients with diabetic foot complications. On the other hand, obese patients have demonstrated significantly reduced all-cause mortality rate. Conclusions Diabetic patients with diabetic foot complications have an excess mortality rate when compared with diabetic counterparts without foot complications and the general population. Early interventions to prevent foot ulceration and consequent LEA as well as all the measurements for reducing the prevalence of microvascular and macrovascular complications should be considered.

BACKGROUND AND OBJECTIVES: Saudi Arabia underwent opulence-driven socio-cultural and lifestyle changes leading to soaring rates of diabetes mellitus. This study exposes the epidemiology of abnormal glucose metabolism namely: diabetes and impaired fasting glucose (IFG) in 13 administrative regions of Saudi Arabia. DESIGN AND SETTINGS: This is a nationwide, household, population-based cross-sectional study that was conducted through primary health care centers during the period 2007–2009. PATIENTS AND METHODS: A nationwide, household, population-based cohort of 53 370 participants aged 0–100 years adjusted to be compatible with population census was interviewed and anthropometric measures were collected. Fasting blood sample was used to screen for IFG and diabetes. RESULTS: The overall prevalence of abnormal glucose metabolism was 34.5%, which included 22.6% patients with IFG, 11.9% patients with diabetes, and 6.2% patients who unaware of their disease. Diabetes prevalence was 40.2% for subjects aged ≥45 years and 25.4% for those aged ≥30 years that decreased to 11.9% when the full age spectrum was considered. Type 1 diabetes prevalence was 0. 8%, contributing only to 6.6% of the total population of patients with diabetes. The top 5 regions with the highest abnormal glucose metabolism prevalence were Makkah (43.4%), Aljouf (41.7%), Eastern region (37.16%), Madinah (35.4%), and Qassim (33.7%). Urbanization, age, and obesity were behind the wide variations in diabetes and IFG prevalence in the 13 regions. CONCLUSION: Abnormal glucose metabolism has reached an epidemic state in Saudi Arabia, where one-third of the population is affected and half of diabetic cases were unaware of their disease. This observation warrants an urgent strategy for launching diabetes primary prevention and screening programs.

Multiple risk factors contribute to cognitive impairment in children with β-thalassemia major. For a more refined understanding of this issue, we attempted to evaluate cognitive function in β-thalassemia major patients and identify the relationship between possible cognitive dysfunction and the following: demography, transfusion and chelation characteristics, iron overload, and disease complications. We studied 100 β-thalassemia major children and 100 healthy controls who matched well in terms of age, sex, and socioeconomic status. All participants underwent psychometric assessment using Wechsler Intelligence Scale for Children–Third Edition, Arabic version. The mean Full-Scale IQ and Performance IQ of patients were significantly lower than those of controls, whereas no significant difference was found for Verbal IQ. No significant relationship existed between IQ and any of the assessed parameters. We concluded that Performance IQ, not Verbal IQ, was significantly affected in β-thalassemia major patients, but there was no clear association between IQ and any of the parameters.

SummaryThis study aimed to assess knowledge, attitude and practice related to consanguinity among multiethnic health care providers in the Kingdom of Saudi Arabia. Using a cross-sectional study design, a validated, self-administered close-ended questionnaire was randomly distributed to health care providers in different health institutions in the country between 1st August 2012 and 31st July 2013. A total of 1235 health care providers completed the study questionnaire. Of the 892 married participants (72.23% of total), 11.43% were married to a first cousin, and were predominantly Arabs, younger than 40 years and male. Only 17.80% of the patients seen by the health care providers requested consanguinity related counselling. A knowledge barrier was expressed by 27.49% of the participants, and 85.67% indicated their willingness to have more training in basic genetic counselling. A language barrier was expressed as a limiting factor to counselling for consanguinity among non-Arabs. The health care providers had a major dearth of knowledge that was reflected in their attitude and practice towards consanguinity counselling. This finding indicates the need for more undergraduate and postgraduate medical and nursing education and training in the counselling of consanguineous couples. It is recommended that consanguinity counselling is included in the current premarital screening and counselling programmes in the Kingdom.

Background There are limited data on the epidemiology and risk factors of ophthalmoplegia among diabetic patients. This study aims to determine the prevalence and important risk factors related to ophthalmoplegia among diabetic patients. Methods This is an observational registry-based study using the Saudi National Diabetes Registry (SNDR) database to select diabetic patients regardless of their diabetes type. A total of 64,351 Saudi diabetic patients aged more than 18 years and registered in SNDR between January 2000 and December 2010 were analyzed to identify ophthalmoplegic cases. Demographic, clinical, and biochemical parameters were studied and STROBE guidelines were used to design and report the results of this study. Results The overall prevalence of ophthalmoplegia cases was 0.32 %, further distributed into: 53.11 %, 36.36 %, and 2.8 % for cranial nerves VI, III, IV palsies respectively. Ophthalmoplegic cases were predominantly type 2 diabetic males with older age and longer diabetes duration. The most important and significant risk factors were age ≥ 45 years, diabetes duration ≥ 10 years, male gender and presence of retinopathy and nephropathy. Conclusions Ophthalmoplegia is a rare entity associated mainly with type 2 diabetes. Clinicians have to consider its risk factors when screening or planning for prevention of this condition.

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Saudi Arabia is a community thrilled by sudden social and economical changes, leading to a sharp increase in the prevalence of abnormal glucose metabolism. Age-specific diabetes and impaired fasting glucose prevalence is the focus of this study with the expected risk factors.A nationwide, household, randomized, population based cohort of 18 034 participants aged ≥30 years was selected to test for abnormal glucose metabolism using fasting plasma glucose (FPG) according to American Diabetes Association (ADA) criteria.The prevalence of diabetes was 25.4% with 40.3% being unaware of their disease, while impaired fasting glucose (IFG) affected 25.5% of the total sample. IFG to diabetes ratio was one in this study, decreasing with age and increasing with body weight. Age ≥45 years, hypertension, history of gestational diabetes mellitus (GDM), and high triglycerides are the strongest risk factors in diabetic patients, while history of GDM, dyslipidemia, obesity, and high triglycerides are the most significant risk factors in IFG participants.Abnormal glucose metabolism has reached an epidemic level in this society, where half of adults and older are affected. Risk factors are behind this epidemic and the quick shift from IFG to diabetes in this society.

AimsThe prevalence of diabetic nephropathy and its risk factors have not been studied in a society known to have diabetes epidemic like Saudi Arabia. Using a large data base registry will provide a better understanding and accurate assessment of this chronic complication and its related risk factors.MethodologyA total of 54,670 patients with type 2 diabetes aged ≥ 25 years were selected from the Saudi National Diabetes Registry (SNDR) and analyzed for the presence of diabetic nephropathy. The American Diabetes Association (ADA) criterion was used to identify cases with microalbuminuria, macroalbuminuria and end stage renal disease (ESRD) for prevalence estimation and risk factor assessment.ResultsThe overall prevalence of diabetic nephropathy was 10.8%, divided into 1.2% microalbuminuria, 8.1%macroalbuninuria and 1.5% ESRD. Age and diabetes duration as important risk factors have a strong impact on the prevalence of diabetic nephropathy, ranging from 3.7% in patients aged 25-44 years and a duration of >5 years, to 21.8% in patients ≥ 65 years with a diabetes duration of ≥ 15 years. Diabetes duration, retinopathy, neuropathy, hypertension, age >45 years, hyperlipidemia, male gender, smoking, and chronologically, poor glycemic control has a significantly high risk for diabetic nephropathy.ConclusionThe prevalence of diabetic nephropathy is underestimated as a result of a shortage of screening programs. Risk factors related to diabetic nephropathy in this society are similar to other societies. There is thus an urgent need for screening and prevention programs for diabetic nephropathy among the Saudi population.

Purpose To assess diabetic retinopathy prevalence and its risk factors in a society with type 2 diabetes epidemic using the Saudi National Diabetes Registry (SNDR). Method This is a cross-sectional study using patient's clinical data found in SNDR data base. A cohort of 50 464 Saudi patients with type 2 diabetes aged ≥25 years were selected to assess for the prevalence and risk factors for diabetic retinopathy. Results The overall prevalence of diabetic retinopathy is 19.7%, where 9.1% have non-proliferative diabetic retinopathy (NPDR), 10.6% have proliferative diabetic retinopathy (PDR) and 5.7% have macular oedema (ME). Duration of diabetes and age are the most significant risk factors for diabetic retinopathy with odds ratio (OR) and 95% confidence interval (95% CI) 8.88 (8.30–9.50) and 5.76 (5.10–6.55), respectively. Nephropathy, neuropathy, insulin use, poor glycemic control, hypertension and male gender significantly increased the risk for diabetic retinopathy. Smoking, hyperlipidemia and obesity significantly reduced the risk for diabetic retinopathy among type 2 Saudi diabetic cohort. Conclusion vThe low prevalence of diabetic retinopathy in our registry may be a result of the shortage or absence of well-structured screening programmes. Therefore, many patients with NPDR might have been missed. A prevention programme is needed to reduce the effect of diabetic retinopathy risk factors in this society.

Diabetes and thyroid dysfunction found to exist simultaneously. In this regard, the present study looked into the prevalence of different forms of thyroid dysfunction and their risk factors among Type 2 diabetic Saudi patients.Methodology. A cross-sectional retrospective randomized hospital-based study of 411 Type 2 diabetic Saudi patients of >25 years of age was conducted to test the prevalence of different types of thyroid dysfunction and their risk factors.Results. The prevalence of different types of thyroid dysfunction is 28.5%, of which 25.3% had hypothyroidism, where 15.3%, 9.5%, and 0.5% are clinical, subclinical, and overt hypothyroidism, respectively. The prevalence of hyperthyroidism is 3.2%, of which subclinical cases accounted for 2.7% and overt hyperthyroidism accounted for 0.5%. Risk factors for thyroid dysfunction among Saudi Type 2 diabetic patients are family history of thyroid disease, female gender, and duration of diabetes of >10 years, while the risk was not significant in patients with history of goiter and patients aged >60 years. Smoking and parity show a nonsignificant reduced risk.Conclusion. Thyroid dysfunction is highly prevalent among Saudi Type 2 diabetic patients, and the most significant risk factors are family history of thyroid disease, female gender, and >10 years duration of diabetes.