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   Table of Contents - Current issue
January-March 2021
Volume 4 | Issue 1
Page Nos. 1-42

Online since Tuesday, April 13, 2021

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Journal of diabetes and endocrine practice 2021 and beyond: New affiliation; Same mission Highly accessed article p. 1
Salem A Beshyah
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Identifying and treating hypoglycemia in insulin-treated diabetes p. 2
Brian M Frier
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Thyroid nodules in the gulf: Renewed interest and ongoing debate p. 4
Aly B Khalil, Basel Altrabulsi, Roberto Dina
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Serum and salivary glucose levels in diabetes mellitus: A review on the quest for diagnostics p. 6
Abhishek Singh Nayyar
The salivary fluid has an old history of study, but its physiological importance has only been recognized recently. In the past 50 years, the pace of salivary research has accelerated with the advent of new techniques that illuminated the biochemical and physicochemical properties of saliva. The recent introduction of molecular biology opens up, once again, new vistas and a new search of the role of salivary fluid as a potential diagnostic tool which has an added advantage of being noninvasive. The role of saliva in the diagnosis as well as monitoring of glycemic control has also been attracting the attention of clinical researchers in recent times although results have been conflicting. The present review presents such insight into the possible use of salivary fluid for the monitoring of serum glucose levels and in the detection of glycemic control in diabetic patients with the evidence of its reliability based on the existing literature.
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Nasal glucagon: A new hope for severe hypoglycemia in type 1 diabetes p. 13
Salva Fatima Heba, Uzma Parveen, Sara Sana Ayesha Khanum, Maaria Gulnaaz, Maimuna Tabassum, Syeda Batool Safiyya
Until now, injectable glucagon was the only available treatment used in the management of severe hypoglycemia wherein glucagon had to be prepared in several steps before administration. This method of delivery of injectable glucagon being cumbersome and unappealing for wide majority of the patients had led to a search for an alternative route of drug delivery. nasal glucagon (NG) now serves an efficient, safe, easy-to-administer, and a favorable substitute to glucagon injections. This ready to use device stand in clear contrast to overcome the limitations associated with the currently available glucagon preparations has emerged a key advancement in the management of severe hypoglycemia in adolescents and children with type 1 diabetes. NG is now being developed and studied in other countries as well to meet the unmet need for an easy and convenient glucagon administration. This review covers the basic information of nasal glucagon, trials on nasal glucagon in children and adults and its potential uses, limitations, and future scope in practice.
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Accuracy of fine-needle aspiration cytology for detecting cancer in resected thyroid nodules at a referral hospital p. 19
Reem Alawadhi, Ahmad Matalkah, Naveed Ahmed, Ahmad Alduaij, Alain Sabri, Samer El-Kaissi, Yasir Akmal
Background: Thyroid nodules are a common presentation in clinical practice. Fine-needle aspiration cytology (FNAC) is a useful method of triaging patients between benign, suspicious, and malignant categories. Materials and Methods: This is a retrospective review of the electronic medical record of all surgical thyroid patients presenting to our institution between July 2015 and June 2017. The cytological and histological data were reviewed and correlated based on the Bethesda system for reporting thyroid cytopathology. Results: Two hundred and seven patients underwent thyroidectomies during that period of which 164 had preoperative FNAC. The female-male ratio of 4.9:1. On histology, 52% of nodules were benign and 48% of nodules were malignant. When comparing with cytologic diagnosis, FNAC showed a sensitivity of 52%, specificity of 95%, positive predictive value of 92%, negative predictive value of 64%, false positive rate 5%, and false negative rate 48%. Total accuracy was found to be 72%. Conclusion: FNAC is a useful tool in deciding management options for patients, but has limitations, particularly when evaluating follicular lesions. This leads to discrepancy in the calculation of statistical values in literature.
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Admission hyperglycemia and adverse clinical outcomes in critically ill patients: A prospective, observational study p. 23
Vishakha Jain, Sunil Bade, OP Gupta
Background: Admission hyperglycemia is known to cause increase in in-hospital mortality, increased length of intensive care unit (ICU) stay, increased morbidity across critically ill patients. In patients with vascular disease (myocardial infarction, stroke, etc.), this has been extensively studied. We planned to study the prevalence of admission hyperglycemia and its association with adverse outcomes in all critically ill patients. Methods: In an observational, prospective study, 200 critically ill inpatients admitted to the medicine ICU were included. The patients were stratified into known diabetes, newly detected diabetes, and stress hyperglycemia. Baseline clinical and laboratory parameters were collected, and Acute Physiology and Chronic Health Evaluation (APACHE)-II, Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiology (SAP II) scores were calculated. Data regarding clinical outcomes (discharge or in-hospital death) were also collected. Results:   The prevalence of admission hyperglycemia and of stress hyperglycemia was found to be 11.99% and 1.51%, respectively. The newly detected diabetes had higher admission hyperglycemia and glycosylated hemoglobin. The prognostic scores – APACHE-II, SAP II, and SOFA scores – were worse among patients who died in the newly detected diabetes and the stress hyperglycemia group but not in the known diabetes group.   The odds of death increased by 3.5 times with 1-day increase in the ICU. Conclusion: Our study concluded that the patients with newly detected diabetes and stress hyperglycemia had more severe illness as compared to the known diabetics.
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The effect of treatment duration on metabolic parameters in patients with prolactinoma: A prospective longitudinal study p. 30
Mehrnaz Imani, Rowshanak Abbasi, Fatemeh Golgiri, Alireza Khajavi, Hamideh Akbari
Background: Hyperprolactinemia is associated with changes in body composition and metabolic abnormalities. Normalization of prolactin (PRL) has been suggested to reverse these abnormalities. The present study was designed to determine the effect of treatment duration on metabolism as well as metabolic alterations after treatment in comparison with baseline in patients with prolactinoma in Iranian individuals. Methods: In a prospective and longitudinal study, 27 consecutive patients with prolactinoma were assessed during 6 months. Anthropometric data and metabolic variables were studied at baseline and at 3 and 6 months after normalization of PRL. Results: In the present study, there was a statistically significant decrease of metabolic syndrome (Met.S) after 3 months (P = 0.01), with a further decline after 6 months (P < 0.001) of cabergoline therapy. Moreover, a statistically significant decline was seen in total cholesterol (P = 0.007 and P = 0.01 after 3 and 6 months, respectively) and uric acid (P = 0.05 and P = 0.03 after 3 and 6 months, respectively) after normalization of the serum PRL. Conclusions: We found a significant reduction in Met.S after normalization of PRL level in patients with prolactinoma. We suggest that it is important to consider the metabolic profile of patients with prolactinoma. Then, patients may benefit even at 3 months after treatment.
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Lack of knowledge about hypoglycemia among adult patients with diabetes in Saudi Arabia: A cross-sectional study p. 35
Abdullah M Al Zahrani, Sarah Al-Zaidi, Adnan Al Shaikh, Abdulrahman Alghamdi, Fayssal Farahat
Background: Hypoglycemia has a significant impact on an individual's quality of life. This study aimed to assess knowledge of adult patients with diabetes on hypoglycemia and its management. Methods: A cross-sectional study using a newly developed self-administered questionnaire was conducted from April to May 2017, at National Guard Primary Health Care Centers, Jeddah, Saudi Arabia. Simple descriptive statistics were used. Inferential statistics was performed in the form of Student's t-test and one-way ANOVA. Regarding knowledge questions, a score of (1) was given to the right answer, and summation of scores was computed (the total score was 42). Knowledge scores were categorized into good, moderate, and poor based on the mean score. Results: A total of 361 adult patients with diabetes were involved (208 (57.6%) women; 153 (42.4%)). The majority (341; 94.5%) were Type 2 diabetes patients. Mean knowledge score was 32.0 (±8.2), and a score of ≥31.5 represented good knowledge, while a score between 21 and 31.5 represented a moderate level of knowledge, and a score below 21 represented poor knowledge. The majority (92.2%) had poor level of knowledge. Factors associated with better knowledge were male sex, younger age, being a student, or holding a bachelor degree, being single, receiving high monthly income, Type 1 diabetes, and having previous hypoglycemia experience. Regarding hypoglycemia management, 66.8% identified the right management, which was “eating 15 g of fast-acting carbohydrate.” Conclusion: Most participants showed poor knowledge regarding hypoglycemia. More efforts and time should be made during regular visits to provide the necessary health education about hypoglycemia signs for all patients with diabetes.
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The gulf association of endocrinology and diabetes is born: History in the making p. 41
Nasreen A AlSayed, Yousef Al Saleh, Nasser Rajallah Aljuhani
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