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   Table of Contents - Current issue
July-September 2021
Volume 4 | Issue 3
Page Nos. 87-147

Online since Wednesday, September 22, 2021

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COVID-19 endocrinology, adrenals, diabetes and obesity p. 87
Salem A Beshyah
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COVID-19 and the pituitary gland p. 88
Kanchana Ngaosuwan, Desmond G Johnston
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Management of adrenal insufficiency p. 90
Shazia Hussain, Sufyan Hussain, Nazim Ghouri, Karim Meeran
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The pituitary gland in the COVID-19 pandemic: A narrative review of the literature p. 93
Mussa H Almalki, Khaled M Aldahmani, Moeber M Mahzari, Zaina Rohani, Mohamed Asha, Salem A Beshyah
The COVID-19 pandemic has had implications in the central nervous system. COVID-19 infection is characterized by coagulation activation and endothelial dysfunction, causing the endocrine system's ischemic and hemorrhagic vascular syndromes. We aimed to provide an overview of the global literature on the impact of COVID-19 on pituitary function and structure. A narrative, nonsystematic review of the literature retrieved from a significant medical online database (PubMed) between February 1, 2020 and June 30, 2021. The relevant literature was narrated in a concise thematic account. Most specific recommendations for managing endocrine disorders during COVID-19 rely on the same principles of epidemiological safety measures, delaying nonemergency admissions and transforming the routine follow-up to telemedicine clinics. Ongoing medications should be continued. Special attention is required to both primary and secondary adrenal disorders. Corticosteroids are a mainstay of treatment in COVID-19 infection. Therefore, it is essential to consider all aspects of high doses, including adverse metabolic reactions, especially in people with diabetes and prediabetes. Surgery is postponed for nonemergency situations, restricting most planned surgeries, and if required in an emergency, plans should include an additional risk. Sick-day rules should be adhered to strictly. Regular contact with endocrinology teams can be maintained through teleconsultations and virtual clinics. In conclusion, special attention is needed to the interaction between COVID-19 infection and pituitary conditions in a bidirectional manner. The direct impact of COVID-19 on pituitary structure and function is possible and should be recognized timely and treated effectively. Furthermore, appropriate organizational adjustments are needed to maintain a coordinated response within the conventional multidisciplinary management to optimize the care of patients with pituitary conditions among the ongoing COVID-19 pandemic.
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Diabetic kidney disease update: Pathogenesis and treatment overview for clinicians p. 107
Elmukhtar Habas, Abdel-Naser Y Elzouki
Diabetes mellitus is a common cause of chronic kidney disease that progresses to end-stage renal disease (ESRD). Albuminuria (proteinuria) is an early manifestation of diabetic kidney disease (DKD). Although the hemodynamic alterations that occur in diabetics seem the underlying mechanism, others such as metabolic, inflammatory, and hypoxia have a role in DKD pathophysiology. Despite the proven beneficial effects of angiotensin-converting enzyme inhibitors and renin–angiotensin II–aldosterone receptor blockades in proteinuria improvement, their effect to prevent the DKD and to modify its progression to ESRD is not clear enough. New agents such as SLGT2 and autophagy inhibitors and anti-inflammatory are promising agents that may improve proteinuria and inhibit DKD progression. Pathophysiology and new strategies in DKD therapy updates will be reviewed.
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A proposal for the cutoff points of waist circumference values predictive of increased risk of Type 2 diabetes and hypertension in Arab adults p. 115
Naji J Aljohani, Mohamad Maswood Ahmad, Ashwaq Alfaqeeh, Ahmed Bahnassi, Nasser Alhamdan
Introduction: Central obesity is an established risk factor for diabetes mellitus (DM) and hypertension. We aimed to identify people at the highest risk by ethnically adjusted waist circumference (WC) cutoff points. Subjects and Methods: Data were collected from a cross-sectional study of 4350 Saudi adults aged 15–64 years using a stratified, multistage, cluster random sampling. DM was based on known history or fasting blood glucose higher than 7.0 mmol/L, and hypertension was determined by having a systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg. WC was measured midway between the lower costal margin and iliac crest during the end-expiratory phase. Results: The mean age for all the study population was 36.6 + 13.0 years (35.6 ± 12.0 years for females; 37.5 ± 13.9 years for males). The mean WC was 95.2 + 14.01 cm for males and 89.9 + 12.6 cm for females (P < 0.001). The prevalence of diabetes was 23.8% for all subjects. The prevalence of hypertension for all subjects was 25.5%. Receiver operator characteristics curves revealed that WC cutoff points for diabetes risk are 91 cm and 97 cm for women and men, respectively, and for hypertension are 90 cm and 97 cm for women and men, respectively. Conclusions: The present study proposes the obtained cutoffs to identify those at high risk for diabetes and hypertension in the Saudi population who can be considered candidates for preventive interventions.
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Knowledge, beliefs, and practices of people with Type 2 diabetes toward self-management and diabetic foot p. 120
Hani Naguib, Shiju Raman, Avinash Pinto, Aisha Al Mehrezi, Aziza Al Hinaii
Introduction: Diabetic foot syndrome is one of the most common and devastating preventable complications of diabetes mellitus. Knowledge and awareness about the disease can have a positive influence on attitude and practices of patients. Objectives: We aimed to evaluate the knowledge, beliefs, and practices (KBPs) regarding diabetes and diabetic foot syndrome among Omani type 2 diabetic patients. Patients and Methods: We studied 150 participants from the diabetes clinic, Bausher Polyclinic, Muscat. A questionnaire was used to determine KBPs around diabetic foot care. Results: There were 90 females and 60 males, 67.9% were older than 50 years, 42.7% were illiterate, and 72% of them were not working or retired. Only 38% checked their feet regularly; 5.6% had diabetic foot syndrome. Over half of the respondents (55.3%) did not know the causes of diabetic foot syndrome and half of the respondents did not know symptoms of the same. Just over one-third (37.3%) thought that their doctor alone was responsible for foot examination. Only 32.7% thought that they should examine their own feet. The majority believed that walking barefoot and diabetic foot syndrome are “big” problems (84% and 80%, respectively). More than three-quarters (78%) reported checking water temperature before use, 38.7% use warm water for washing feet, and 39.3% reported drying their feet after washing. Only 38% check their feet regularly. Finally, only one-third confirmed checking their blood sugar regularly. Conclusions: The KBP triad must be interconnected in order to achieve successful preventive foot care.
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Management of adrenal insufficiency: A survey of perceptions and practices of physicians from the Middle East and North Africa p. 125
Salem A Beshyah, Khawla F Ali
Introduction: Treatment of adrenal insufficiency (AI) requires correct lifelong use of glucocorticoids (GCs) with early dose adjustments to cover the increased demand in stress to avoid life-threatening emergencies. Objectives: We determine the current specific knowledge of physicians in a convenience sample on the pathophysiological and clinical aspects of AI in the two regions of North Africa and the Middle East. Materials and Methods: Participants (n = 96) were invited to complete an electronic questionnaire with various possible answers on the subject of multiple-choice questions covering physiology, pharmacology, and clinical management and define respondents' professional profiles. Results: The present study suggests that in the investigated settings, physicians' knowledge of physiology and pharmacology GCs, medical replacement strategies in AI, and prevention of adrenal crisis may be insufficient. Great knowledge gaps were demonstrated. Conclusions: There is a need for continuous structured education and training on AI in both general medical and endocrine forums.
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Reduction of cardiometabolic risk factors with lifestyle intervention: Randomized controlled trial for efficacy among corporate workers p. 131
Abiodun Bamidele Adelowo
Background: Cardiovascular diseases and Type 2 diabetes mellitus are two leading noncommunicable diseases globally. Mitigating their overlapping cardiometabolic risk factors have been identified as vital to the global effort to prevent and control these chronic diseases. Objective: The purpose of the study was to examine the efficacy of lifestyle education intervention on cardiometabolic risk factors. Subjects and Methods: A prospective, placebo-controlled, parallel-group, randomized trial was used to conduct a 12-week lifestyle educational intervention on 184 corporate workers. The collected data were analyzed with analysis of covariance at 0.05 alpha level. Results: The treatment significantly improved the mean difference (all P < 0.05) of the intervention groups' fruits and vegetable consumption (0.64, 95% confidence interval [CI]: 1.03–1.81), physical activity (0.38, 95% CI: 1.22–1.80), and attitude toward healthy living (22.3, 95% CI: 35.56–59.37). It also significantly reduced the mean difference of the participants' salt intake (0.39, 95% CI: 1.44–1.99), daily tobacco use (0.12, 95% CI: 1.70–1.96), alcohol consumption (0.31, 95% CI: 0.37–0.99), resting heart rate (−4.81 bpm, 95% CI: 77.89–84.65), systolic blood pressure (−5.52 mmHg, 95% CI: 117.9–127.61), diastolic blood pressure (−4.41 mmHg, 95% CI: 75.10–81.47), body mass index (−1.78, 95% CI: 24.58–27.65), waist circumference (−0.90 cm, 95% CI: 87.70–91.53), fasting blood glucose (−0.36 mmol/l, 95% CI: 4.84–5.48), total blood cholesterol (0.41 mmol/l, 95% CI: 4.41–5.19), and type 2 diabetes risk scores (−1.76, 95% CI: 5.25–8.86). Conclusion: Lifestyle education is an effective intervention program in reducing the prevalence of cardio-metabolic risk factors among corporate workers.
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Thyroid lymphoma: Correlation of clinical, radiological, and pathological features p. 139
Yumn Hashem Shilli, Shaza Ahmed Samargandy, Abdulrahman H Shilli, Salwa I A. Bakhsh, Razan Daghistani, Shady Alkayyat, Hani Marzouki
Primary thyroid lymphoma (PTL) comprises 5% of all thyroid malignancies. In this case series, we aim to review its clinical presentation, diagnosis, and treatment. We included five PTL patients. All were females (mean age of 59.8 years). All patients presented with a rapidly growing neck swelling, and only two had obstructive symptoms. All patients had solitary masses, aside from one patient who had two lesions. All were causing mass effect and two with invasion of the surrounding tissue. All were diagnosed with diffuse large B-cell lymphoma. Cytology examination for PTL demonstrates atypical lymphoid cells. Four patients in our series had chemotherapy and currently in remission. The fifth died early after the clinical presentation. Two had thyroid surgeries.
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Conference highlights: The 81st Annual (Virtual) conference of the American diabetes association: June 25–29, 2021 p. 143
Mohamed Suliman, Nagi Hashim Mohammed
The American Diabetes Association (ADA) annual conference is the most notable annual event in diabetes. Like many conferences in 2020 and 2021, it was held virtually due to the COVID-19 pandemic. In this highlights summary, we selected the sections that we felt are particularly relevant to practicing clinicians. The results of several long-awaited studies were released. These include the GRADE study, SURPASS, and STEP studies. The first ADA-European Association for the Study of Diabetes consensus on the management of type 1 diabetes was also aired during the conference. Besides, the AMPLITUDE-O study with new data on the cardiovascular and renal effects of Efpeglenatide was published. The role of Teplizumab for the prevention of type 1 diabetes and Volagidemab in patients with type 1 diabetes were discussed. Furthermore, the PROMISE study on the safety and accuracy of next-generation 180 days implantable continuous glucose monitoring systems was published. New news included advancing the role of glucagon in treating and preventing severe hypoglycemia. Furthermore, the Effects on heart failure with preserved ejection fraction from a pooled analysis of SOLOIST and SCORED studies were presented. Finally, data on Dapagliflozin in COVID-19 (DARE-19) and the STRENGTH versus REDUCE-IT studies were compared and contrasted. We hope to present a concise summary of the conference highlights for those who missed the live event.
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