Antithyroid drug induced a granulocytosis: what still we need to learn ?

Antithyroid drugs (ATDs) induced agranulocytosis is a rare but life threatening condition. We report a 29 years Filipino female diagnosed as having hyperthyroidism with normal base line blood counts, liver and renal profile. She was started on maximum 60mg (20mg TID) oral dose of carbimazole since one month by her treating physician. Exactly after one month of treatment she presented to emergency room (ER) with fever, sore throat and generalized weakness for several days.Pan African Medical Journal 2016; 2

Trajectory Analysis of Glycemic Control in Adolescents with Type 1 Diabetes Mellitus at Dammam Medical Complex, Saudi Arabia

Background. Saudi Arabia is reported to have the highest number of children and adolescents with T1DM. However, data concerning glycemic control during adolescence are lacking. Objectives. To determine glycemic control at transition stage from pediatric to adult clinics, determine HBA1c patterns during follow-up, and identify any clinical or demographic variables that may predict a distinctive glycemic pattern. Design. Observational retrospective study. Setting. Dammam Medical Complex, secondary care hospital. Patients and Method. Adolescents aged ≥12 years, with HbA1c recorded at least once a year over 4 years of follow-up, were eligible for inclusion. A trajectory analysis from 2008 to 2019 was conducted, using latent class growth modelling (LCGM), and two-sample t-tests and Fisher’s exact tests were conducted to determine whether there was a statistically significant difference in demographic and clinical variables. Sample Size. 44 patients. Results. 61.36% were referred from pediatric clinics, and 84% were on multiple insulin daily injections. For the trajectory prediction, two groups were identified. Group 1 comprised 71.7%, had high HbA1c values at age 13 (HbA1c, 11.28%), and had a significant and stable decrease in HbA1c values with age (−0.32, p<0.00). Group 2 comprised 28.2%, showed poor HbA1c values at age 13 (HbA1c, 13.28%), and showed increase in HbA1c values slightly by age 15, which then steadily decreased with age (−0.27). Results indicated that the initial HBA1c value was a significant predictor for group trajectory p=0.01, while the remaining variables did not have any significance. Conclusion. Our study identified two groups with poorly controlled diabetes; however, the first group performed relatively better than the second group. Both groups almost doubled their targets, with a trend towards HbA1c reduction by the age of 19 in both groups. Limitations. Retrospective study with convenient, small sample size

Prevalence of diabetes type-2 & pulmonary tuberculosis among Filipino and treatment outcomes: A surveillance study in the Eastern Saudi Arabia

Objective: To study prevalence of diabetes type-2 and pulmonary tuberculosis among Filipino patients and treatment out comes. Tuberculosis centre of Dammam medical complex (MOH) is a referral centre for the Eastern Saudi Arabia where patients from all government and private hospitals having open pulmonary tuberculosis are admitted for isolation till they are rendered noninfectious. All patients are treated for 6 months under DOTS strategy with 4 drugs (2HRZE) for 2 months as initial intensive phase and 2 drugs (HR) for 4 months as continuation phase. Methods and materials: We retrospectively reviewed clinical records of 1388 patients admitted with open pulmonary tuberculosis between Jan- 2003 and June-2010. Results: Among 1388 patients, 39% (n = 542) were Saudis and 61% (n = 846) were non-Saudis. Among these 12.39% (n = 172) were Filipinos,153 males and 19 females respectively. Out of 1388 patients, 114 (7.17%) were found to have diabetes type-2. Among these diabetics, majority n = 91 (79.82%) were Filipinos. Sputum conversion was late in diabetic patients resulting in relatively longer hospital stay compared to fellow patients having only tuberculosis. Conclusion: Our study has shown that one possible risk factor for tuberculosis is diabetes. Majority of TB patients having diabetes type-2, n = 91 (79.82%) were Filipinos. Their sputum conversion was relatively late and their hospital stay was longer than their fellow patients having only tuberculosis. Our findings are in agreement with the current literature on the correlation of diabetes and tuberculosis

Closing gaps in diabetes care: From evidence to practice

Background: Tracking progress in diabetes care may help in evaluating the quality of efforts and identifying gaps in the care. Objectives: To demonstrate that tracking important clinical indicators of diabetes mellitus can result in improved care as well as help identify and close gaps between evidence and practice in diabetes care. Subjects and Methods: The study is an observational, random audit of medical records of patients with diabetes who received care at the Diabetes Center, Dammam Medical Complex. Thirteen process and four outcome key performance indicators were studied using the quality improvement Plan–Do–Study–Act model, for the period between October 2012 and March 2016. Individual physician performance was also measured for the same duration. All data were benchmarked against peer organizations worldwide. Results: Urine examination for proteinuria, foot examination, annual influenza vaccination, aspirin prescription, structured education, personalized nutritional advice and self-monitoring of blood glucose significantly improved between baseline and the final observation of the study (P 9% decreased, and that of those who achieved the recommended levels of hemoglobin A1c (<7%), low-density lipoprotein cholesterol (<2.6 mmol/L) and blood pressure (<140/90 mmHg) significantly increased (P < 0.001). Benchmarking against peer organizations worldwide showed comparable results overall, and better results for certain indicators. Conclusion: Quality improvement strategies and key performance indicators can be utilized to improve the quality of diabetes care delivered, and thus reduce gaps and barriers that exist between recommended diabetes care and practice

Recommendations for Titration and Administration of Oral Semaglutide for the Treatment of Type 2 Diabetes during Ramadan

Background: Injectable glucagon-like peptide-1 receptor agonists (GLP-1RAs) are proven to be well tolerated and efficacious in people with type 2 diabetes mellitus (T2DM) fasting during Ramadan. The first oral GLP-1RA semaglutide, also indicated for the treatment of T2DM, has specific dosing instructions to optimize treatment exposure, which may need to be altered during Ramadan fasting to ensure optimal efficacy. Summary: Given the lack of current published evidence for the effect of oral semaglutide during Ramadan, a panel of experts formulated recommendations for the administration of oral semaglutide during Ramadan. Key Messages: This statement reports recommendations for oral semaglutide administration during Ramadan

Diagnosis and management of vitamin D deficiency in the Gulf Cooperative Council (GCC) countries: an expert consensus summary statement from the GCC vitamin D advisory board.

OBJECTIVE A summary of recommendations is given within the Gulf Cooperation Council (GCC) setting on the assessment and management of vitamin D deficiency in the region. METHODS An assembly of 11 regional experts gathered to formulate an all-inclusive approach to vitamin D deficiency within GCC. RESULTS AND CONCLUSION Several gaps were identified before regional guidelines could be developed. These include adequacy and standardization of vitamin D testing, frequency of repeated testing and reference ranges, distinguishing prevention from the treatment of vitamin D deficiency, quality assurance of vitamin D products sold within GCC including contents and origins of products, and cut-points for vitamin D levels in local populations. A platform is created that can be further developed for overall regional implementation

Recommendations for management of diabetes during Ramadan: update 2015

Since the first ADA working group report on the recommendations for management of diabetes during Ramadan in 2005 and our update in 2010, we received many inquiries asking for regular updates on information regarding education, nutritional habits and new oral and injectable agents that may be useful for the management of patients with diabetes during Ramadan. Patients can be stratified into their risk of hypoglycemia and/or complications prior to the start of the fasting period of Ramadan. Those at high risk of hypoglycemia and with multiple diabetic complications should be advised against prolonged fasting. Even in the lower hypoglycemia risk group, adverse effects may still occur. In order to minimize adverse side effects during fasting in patients with diabetes and improve or maintain glucose control, education and discussion of glucose monitoring and treatment regimens should occur several weeks prior to Ramadan. Agents such as metformin

Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus

Fasting the Holy month of Ramadan constitutes one of the five pillars of the Muslim faith. Although there is some evidence that intermittent fasting during Ramadan may be of benefit in losing weight and cardiometabolic risk factors, there is no strong evidence these benefits apply to people with diabetes. The American Diabetes Association/European Association for the Study of Diabetes consensus recommendations emphasize the importance of patient factors and comorbidities when choosing diabetes medications including the presence of comorbidities, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, hypoglycemia risk, weight issues and costs. Structured education and pre-Ramadan counseing are key components to successful management of patients with diabetes. These should cover important aspects like glycemic targets, self-monitoring of blood glucose, diet, physical activity including Taraweeh prayers, medication and dose adjustment, side effects and when to break the fast. The decision cycle adapted for the specific situation of Ramadan provides an aid for such an assessment. Children with type 1 diabetes should strongly be advised not to fast due to the high risk of acute complications such as hypoglycemia and probably diabetic ketoacidosis (DKA), although there is very little evidence that DKA is increased in Ramadan. Pregnant women with diabetes or gestational diabetes should be advised to avoid fasting because of possible negative maternal and fetal outcomes. Hypoglycemia is a common concern during Ramadan fasting. To prevent hypoglycemic and hyperglycemic events, we recommend the adoption of diabetes self-management education and support principles. The use of the emerging technology and continuous glucose monitoring during Ramadan could help to recognize hypoglycemic and hyperglycemic complications related to omission and/or medication adjustment during fasting; however, the cost represents a significant barrier