Fatigue, Nonrestorative Sleep and Associated Factors Among Sudanese Patients with Type 2 Diabetes: A Case-Control Study

Background: Fatigue, nonrestorative sleep, and other sleep disorders could be pointers to serious medical problems like obstructive sleep apnea; when present in patients with diabetes, they exacerbate each other deleterious consequences. The present study aimed to assess fatigue, nonrestorative sleep, sleep duration, and daytime sleepiness among patients with type 2 diabetes. Methods: This cross-sectional descriptive study was conducted among 103 consecutive patients with type 2 diabetes and 121 healthy controls attending an outpatient clinic in Omdurman, Sudan during the period from December 2015 to June 2016. All participants signed a written informed consent and were interviewed using a questionnaire based on Epworth Sleepiness Scale to assess subjective nonrestorative sleep, sleep duration, and snoring. A blood sample was taken for the HbA1c. The local ethical committee approved the research, and chi-square test and t-test were used for data analysis. Results: Highly significant statistical differences were observed between the diabetic patients and the control subjects regarding fatigue, nonrestorative sleep, sleep duration, snoring, and excessive daytime sleepiness (P-value < 0.001). Patients with fatigue had higher nonrestorative sleep than those without, no significant differences were found between patients with the symptoms of fatigue and those without regarding excessive daytime sleepiness, snoring, sleep duration, and the HbA1c (P-value > 0.05). Conclusions: Fatigue, nonrestorative sleep, sleep duration, excessive daytime sleepiness, and snoring were common among patients with type 2 diabetes than their healthy counterparts, diabetic patients with fatigue had more nonrestorative sleep than those without. The reliance on a self-administered questionnaire is a limitation of the study.  Keywords: fatigue, nonrestorative sleep, excessive daytime sleepiness, diabetes mellitus, Suda

A Case Report of Duodenal Psammomatous Somatostatinoma

Somatostatinoma is a neuroendocrine tumor; its incidence in the duodenum around the ampulla of Vater is rare, and it is often not associated with secretory manifestation. We report a case of a female with an ampullary (Vater) tumor displaying neuroendocrine nuclear features, psammoma bodies, and the positivity for immunohistochemical panel of neuroendocrine tumors. Our patient presented with some features compatible with somatostatin secretion associated syndrome; albeit with normal serum levels of the hormone. Initial attempt of complete resection failed, and the involved margins were revised with a subsequent surgery, and the patient showed an uneventful course on follow-up for 2 years

Lobectomy versus total thyroidectomy in differentiated thyroid carcinoma: A review

BackgroundThyroid cancer is on the rise globally, there is increasing adoption of lobectomy for low-risk differentiated thyroid cancer.AimsThe current review aimed to assess lobectomy versus total thyroidectomy in low-risk differentiated thyroid carcinoma.Methods A systematic electronic search was conducted in the Pub Med and Google Scholar with no limitation of the period, 85 articles published in English were retrieved, two researchers screened the abstract for removal of duplications. Twenty-one articles fulfilled the inclusion and exclusion criteria.Results Among the twenty-one articles included (more than two-thirds were retrospective), eleven were from the USA, two from Europe, six from Asia, one from Canada and one from Australia. The results were mixed, some preferred lobectomy, others were on the side of total thyroidectomy, while some advised to weigh the risks and benefits.ConclusionThe results were mixed regarding the mode of surgery in low-risk differentiated thyroid cancer. Further, well-designed studies are needed to solve the current controversy

Pattern and temporal profile of thyroid carcinoma in the Kingdom of Saudi Arabia: A review and meta-analysis

BackgroundThere is an increasing rate of thyroid carcinoma in the developed world attributed mainly to over-diagnosis due to healthcare improvement. Saudi Arabia has made health a top priority, an increasing rate of over diagnosis is expected.AimsThe current review assessed the trends, spatial distribution, and epidemiology of thyroid carcinoma in the Kingdom of Saudi Arabia.Methods A systematic electronic search was conducted in PubMed and Google Scholar for relevant articles. All human studies published during the period 2009-December 2019 including Epub and ahead of print were eligible. The keywords thyroid carcinoma, thyroid lesion, Saudi Arabia, prevalence, and incidence were used in different combinations, among the three hundred fifty-four articles identified, twenty-three full text were assessed and only seventeen studies were included. Then the author's names, year and region of publication, the study type, period of study, and the result were recorded. The Statistical Package for Social Sciences (SPSS, IBM, version 20, New York was used for data analysis.Results Seventeen articles were included (9754 patient, age 44.53±5.42 years), women outmoded men and showed younger age (36.59 years), papillary carcinoma was the commonest sub-variant of carcinoma (75.62±17.53, age 52.3 years) followed by follicular (6.52±2.92).  An increasing trend was observed all over the Kingdom, but not consistent in all-region.ConclusionAn increasing rate of thyroid carcinoma was evident in the Kingdom of Saudi Arabia, the commonest being papillary carcinoma. Females were more commonly affected at a younger age group. Further National studies assessing whether the increased rate is due to over-diagnosis or other risk factors are highly recommended

The current state of knowledge regarding thyroid-stimulating hormone lowering/suppressive therapy and its cardiovascular risks in differentiated thyroid carcinoma

BackgroundThyroid-stimulating hormone acts as a growth factor for thyroid follicular cells, so some patients with differentiated thyroid carcinoma (DTC) are placed on thyroid hormone suppressive therapy. However, (TSH) suppression is not without risks.AimsWe thought to assess the potential benefits and cardiovascular risks among patients on TSH suppressive therapy following thyroid surgery for DTC.Methods A systematic electronic search was conducted in PubMed, MEDLINE, and Google Scholar for relevant articles. All human and cell lines studies published during the period 2009-October 2019 were eligible. The keywords TSH suppression, differentiated thyroid carcinoma, TSH level, cardiovascular risk, cardiovascular morbidity, cardiovascular mortality, atrial fibrillation, and left ventricular volume were used One hundred and eighty-five articles were retrieved and only eighteen met the inclusion and exclusion criteria.Results Out of 185 articles, eighteen studies were included, more than half (55.6 per cent)were published in Europe, 22.2 per cent were from Asia,11.1 per cent from Latin America and one study was from the USA, the majority (72.2 per cent were observational studies),. Patients on TSH suppression were at a high risk of cardiovascular morbidity and mortality that increases at lower TSH levels. Levels < .1mU/L are beneficial in patients with micro or macroscopic disease. However it may induce tumour growth among patients with aggressive recurrent disease, no benefit was observed in low-intermediate DTC.ConclusionPhysicians may need to suppress TSH in patients with micro or macroscopic DTC. However, caution is needed in aggressive recurrent disease. The available level of evidence showed no benefit of TSH lowering therapy in low-intermediate disease

The relationship between dyslipidemia and lupus nephritis in systemic lupus erythematosus patients attending a Saudi Rheumatic Center, Tabuk

Background: There is an increasing awareness of the role of dyslipidemia in lupus nephritis patients, no researchers have studied dyslipidemia in systemic lupus erythematosus (SLE) in Tabuk. In this study, we aimed to investigate the association between dyslipidemia and lupus nephritis in Tabuk, Saudi Arabia. Methods: This cross-sectional comparative longitudinal hospital-based study was conducted at a rheumatic clinic in the North West Armed Force Hospital (NWAFH) during the period April 2014–June 2015. Seventy-three patients diagnosed with SLE were invited to participate in the study. All participants were required to sign a written informed consent, following which they were interviewed using a structured questionnaire. Data collected include demographic data, clinical characteristics, fasting lipid profile, renal function tests, urine analysis, antinuclear antibody, anti-double-stranded antibodies, complement levels, serum albumin, anticardiolipin, ant bodies, and antiphospholipid antibodies. Lupus nephritis was ascertained by renal biopsy. The research was approved by the ethical committees of both the University of Tabuk and the NWAFH and data were analyzed using the Statistical Package for Social Sciences (SPSS). Results: Out of 73 patients with SLE, 86.3% were females with a mean age of&nbsp; 34 ± 6.4 years. Lupus nephritis was evident in 26% of the patients, proteinuria in 44.1%, high total cholesterol in 17.8%, high low-density lipoprotein in 15.1%, high triglycerides in 27.3%, and low high-density lipoproteins in 52.1%. Patients with lupus nephritis had high total cholesterol, high LDL, high TG, and low HDL than those without lupus nephritis P-value &lt; 0.05. Conclusion: Dyslipidemia was more common among patients with SLE nephritis, and an aggressive treatment is recommended to reduce this serious complication. The relatively small size of the study group and the fact that the study was conducted at a single tertiary center are the limitations of this study. Keywords: dyslipidemia, lupus nephritis, Saudi Arabi

The Outcome of Assisted Reproductive Techniques among Couples with Male Factors at Prince Khalid Bin Sultan Fertility Centre, Kingdom of Saudi Arabia

BACKGROUND: Thirty-three percent of infertility due to paternal factors, there are an increasing proportion of couples who decide to conceive by assisted reproductive techniques (ART). The outcome prediction is pivotal for decision making.AIM: We aimed to study the pregnancy outcomes of different ART with male factors infertility.METHODS: This retrospective cross-sectional study conducted at Tabuk, Kingdom of Saudi Arabia. One hundred fifteen patients' records reviewed using a structured checklist to collect demographic data, sperm (concentration, motility, and morphology). Female with significant infertility factor were excluded. Chi-square was used for the outcome of various ART.RESULTS: Out of 115 couples with male factors; treated by Intracytoplasmic Sperm Injection (ICSI), In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI); the mean age was 35.2 ± 6.3 years for men and 29.7 ± 5.1 for females. IVF had the highest success rate overall and had a high pregnancy rate with oligospermia and asthenospermia. ICSI has a good outcome for those with azoospermia, severe oligospermia, and teratozoospermia. IUI must be tried as a first line treatment when semen concentration is more than 10 million sperm/ml. all are not significant (P &gt; 0.05).CONCLUSION: No significant differences were reported in the pregnancy outcome between various assisted reproductive techniques, smoking, type of infertility and medication

Effects of Hibiscus sabdariffa on high blood pressure, lipid profile and C- reactive protein among adult hypertensive patients

BackgroundHypertension is a leading cause of mortality and morbidity worldwide. Hibiscus is a cheap readily available preparation.AimsWe aimed to assess the effect of Hibiscus sabdariffa on blood pressure, lipid profile, plasma sugar, and h-sensitive C-reactive protein.MethodsThis is a prospective cohort study conducted among 19 College staff members at the University of Tabuk, Saudi Arabia during January 2020. The participants signed written informed consent, then responded to a questionnaire to report their demographic data. At baseline,  the blood pressure was measured, anthropometric measures collected, and, and a blood sample was taken to measure fasting plasma sugar, serum cholesterol, triglycerides, high-density lipoproteins, and high-sensitive C-reactive protein. Participants thereafter took Hibiscus sabdariffa for four weeks, then the above measurements were repeated. The compliance of the participants was also assessed.Results No significant effects of Hibiscus sabdariffa consumption were observed on systolic and diastolic blood pressure, fasting plasma glucose, lipid profile, and high-sensitive C-reactive protein, P-value< 0.05.ConclusionNo significant effects were observed among Hibiscus sabdariffa users on blood pressure, plasma sugar, lipid profile, and C-reactive protein. Further larger multicenter studies are recommended

The site of insulin storage inside domestic refrigerators is associated with ketoacidosis and hypoglycemic episodes among patient with diabetes mellitus

BackgroundInsulin storage is vital for use in type 1 diabetes and most patients with type 2 diabetes mellitus. No researchers have investigated the site of insulin storage inside the fridge, the proper rotation of insulin injection sites, and the worsening glucose profile in Tabuk, Saudi Arabia.AimsThe study aimed to assess the association between storing insulin in different sites of the fridge, rotating insulin injection sites, hypoglycemia, and ketoacidosis.Methods This is a cross-sectional study conducted in King Fahd Specialist Hospital, Tabuk, Saudi Arabia during the period from May 2019 to November 2019, 394 participants were approached to collect demographic data, site of insulin storage in domestic refrigerators, number of ketoacidosis and hypoglycaemic attack during the last year, number of insulin injection sites and rotation of injections, and if the patients were regularly checking their glycated haemoglobin.Results Of the 349 patients (98 per cent had type 2 diabetes), 98.3 per cent had a hypoglycaemic episode during the last year, and 11.2 per cent were admitted for ketoacidosis, this is mirrored by not properly storing insulin inside the fridge (39.2 per cent), and inappropriately rotating insulin injection sites (87.4 per cent). Patients who were storing their insulin inappropriately had higher rates of both ketoacidosis and hypoglycaemia than their comparators (0.26±0.65 vs. 0.11±0.39, and 19.51±19.46 vs. 7.07±9.54 respectively, P < 0.05.ConclusionHypoglycaemia and ketoacidosis were common among patients who inappropriately store insulin inside the fridge and wrongly rotate insulin injection sites. Further larger multi-center studies investigating the patient's behaviour to high and low blood sugar and the rates of lipohypertrophy are recommended

Epidemiology of congenital heart disease among pediatric patients in Northwest, Saudi Arabia

BackgroundCongenital heart defect (CHD) is considered one of the commonest major birth defects, causing children’s morbidity and mortality.AimsTo define the frequency and epidemiology of congenital heart disease among children in Tabuk, Saudi Arabia.Methods This was a retrospective observational study based on the medical hearts. The study population consisted of pediatric patients with confirmed CHD, who were referred to the pediatric cardiology clinic at the King Salman Armed Forces Hospital, Tabuk, Saudi Arabia between January 2015 and June 2019. Of patients with CHD, those with patent ducts arteriosus (PDA) and persistent foramen oval spontaneously resolved during the first four weeks of life were excluded.Results A total of 1,647 pediatric patients were referred to the pediatric cardiology clinic. Of these, 851 were confirmed to have CHD. The diagnosis was made most frequently during the neonatal period. The following three were most frequently observed (in the order of): Ventricular septal defect (VSD: 42 per cent), atrial septal defect (ASD: 32.6 per cent), PDA (16.2 per cent). Down syndrome (DS) was the most frequent underlying condition. Approximately two-thirds of cases were managed conservatively.ConclusionWe demonstrated the characteristics of children’s CHD in this referral center. The data may be important to further make health-policy-making in this area