From the Editor

This is the third issue this year with papers from the region and strong collaborative papers across the region.

Alzahrani AS et al; explored the effect of using SMBG on glycemic control among type 2 diabetic patients attending the primary health care centers in Abha city in the Kingdom of Saudi Arabia by comparing those who are monitoring themselves and others who are not. The study design was analytical cross-sectional and conducted through an interviewing questionnaire. The age of participants was 30-82 years old, with a mean age distribution of 57.4 years old. The percentages of groups doing and not doing SMBG were 43% and 57% respectively. The relationship between glycemic control and compliances according to SMBG shows there is a statistically significant relationship with appointment compliance among the group doing SMBG, and with drug compliance among the other group. The authors concluded that there is no sufficient evidence to show that the self-monitoring of blood glucose is associated with an improvement in glycemic control among type2 diabetics and it is shown that glycemic control for both groups that are using and not using SMBG is above the target .It is recommended that more well conducted randomized controlled trials should be undertaken to evaluate the relationship between SMBG and glycemic control in type 2 diabetes ,at the same time the current guidelines for the use of SMBG among patients with well controlled non-insulin treated type 2 diabetes need to be reviewed.

Helvaci MR et al, tried to understand significance of white coat hypertension (WCH), clinically. Consecutive patients with underweight were taken in the first phase, and age-matched consecutive patients with normal weight, overweight, and obesity were taken in the second phase into the study. Although we were able to detect 50 cases in the underweight group with a mean age of 24.7 years, we were only able to detect nine age-matched cases in the obesity group, thus the obesity group was not taken for comparison. There were gradual and statistically significant increases in the prevalence of WCH beside the gradual and significant decreases in the sustained normotension (NT) from the underweight towards the normal weight and overweight groups. Eventually, only 31.8% of the overweight cases have sustained NT although the very young mean age of them. The authors concluded that due to the gradually increased prevalence of WCH from the underweight towards the normal weight and overweight groups and the very low prevalence of sustained NT in the overweight group although the very young mean age of them and the already known increased prevalence of hypertension, impaired fasting glucose, impaired glucose tolerance, type 2 diabetes mellitus, hypertriglyceridemia, hyperbetalipoproteinemia, dyslipidemia, coronary artery disease, chronic obstructive pulmonary disease, cirrhosis, chronic renal disease, and stroke and an increased all-cause mortality rate in the same direction, WCH may actually be an acute phase reactant mainly alarming overweight and obesity and many associated health problems in future.

Alqahtani Y.M et al, report an Unusual Persistent Mullerian Duct Syndrome in a child in Abha city: A Case Report. The authors stressed that Persistent Mullerian duct syndrome (PMDS) is a rare condition that is characterized by the presence of the Mullerian duct structures among phenotypically and genotypically male. It could result from insufficiency of Mullerian inhibiting factor (MIF) or its receptors. A 9 months-old Syrian boy was admitted to Abha Maternity and Children Hospital with a previous history of huge left inguinal swelling since 8 hours, vomiting 4 times, yellowish discharge. Routine examinations and investigations were done and the boy was diagnosed with left unilateral inguinal hernia with obstruction and during surgery left ovotestes with fallopian tubes and rudimentary uterus were detected. The histopathology showed no signs of malignancy. After two weeks from left inguinal hernia repair, the boy was presented with right incarcerated hernia. The boy undergone right inguinal herniotomy and right gonadopexy. During the operation, right ovotestis, with vas and fallopian tube were detected. The tube was resected and the sac was dissected, vas and vessels were secured. The boy had no sexual dysfunction and chromosomal investigation showed normal male karyotype. The testosterone level was less than the normal range (0.087 nmol/l).

The authors concluded that The PMDS is a rare condition and during early stages can't be detected but the only diagnostic procedure is when the children are tested for other diseases as hernia or cryptorchidism. The correct and early diagnosis depend on genetic investigation and endocrinology. Surgery is the treatment of choice.

A paper from Yemen looked at the Prevalence of abdominal obesity and its associated comorbid condition in adult Yemeni people of Sana'a City. A sample of 118 adult Yemeni people aged equal or over 18 years was randomly chosen to represent the population living in Sana'a City during a period of two years from April 2016 to April 2018. All the study group undergo full clinical history and examination includes measurement of BP and waist circumference and the following laboratory investigation ( FBS , serum TG , HDL , and LDL ). the prevalence of abdominal obesity in this study was 24.5% (7.9% male and 44.2% female) .central obesity in this study was significantly correlated with age, sex , The highest prevalent comorbidity in patients with abdominal obesity was high BP (41.3%), followed by high serum TG (40 %), higher prevalence of MS (40%) , low serum HDL (37.8%) high LDL ( 20.1% ) raised fasting blood glucose (22.1%) than those without abdominal obesity ( 5.5%, 31.3%, 16.6%, 8.5%, 12.5% and increased FBS 10% respectively . The authors concluded that hypertension, diabetes, dyslipidemia and MS are strongly correlated with abdominal obesity

A paper from Turkey, Lebanon and Australia looked at the possibility of Smoking causing irritable bowel syndrome. The study included 647 patients with the IBS and 340 control cases. Mean age of the IBS patients was 41.4 years. Interestingly, 64.2% of the IBS patients were female. Prevalence of smoking was higher in the IBS cases (36.4% versus 20.5%, p<0.001). Similarly, prevalence of antidepressants use was higher in the IBS patients (48.0% versus 15.5%, p<0.001). Additionally, prevalence of urolithiasis was also higher in the IBS group (23.3% versus 9.4%, p<0.001). Mean body mass index values were similar in the IBS and control groups (27.5 versus 27.7 kg/m2, p>0.05, respectively). Prevalence of white coat hypertension were also similar in them (29.3% versus 31.4%, p>0.05, respectively). Although prevalence of hypertension and diabetes mellitus and mean values of total cholesterol, triglycerides, low density lipoproteins, and high density lipoproteins were all similar in them, mean value of fasting plasma glucose (FPG) was significantly higher in the IBS group (110.1 versus 105.6 mg/dL, p= 0.013). The authors concluded that IBS may be a low-grade inflammatory process being initiated with infection, inflammation, psychological disturbances-like stresses, and eventually terminated with dysfunctions of gastrointestinal and genitourinary tracts and other systems of the body. Although there may be several possible causes of IBS, smoking induced chronic vascular endothelial inflammation may even cause IBS. The higher FPG in the IBS patients should be researched with further studies.

A paper from Scotland takes a comprhnsive look at Early Onset Dementia. The author finds
there is increasing recognition that EOD (Early Onset Dementia) represents an important social problem affecting economic and social impacts (Campbell et al., 2008; Johannessen et al., 2018). Recent research calls for greater efforts to be made in consulting with the PwD (people with dementia) directly (Allen 2001; Bamford & Bruce 2000). The condition is understood to occur between the ages of 45-65 (Mercy, 2008). This makes EOD a sub-group of dementia with numerous differences when compared to later onset dementia. These include the likelihood of still being in work and having a family to raise. Being responsible for an income and for dependent others is particularly difficult for those affected. Additionally, the social and psychological context for younger people is different (Beattie, 2004). PwEOD (people with Early Onset Dementia) are more likely to be physically fitter than those with later onset dementia which may impact on their physical care needs.

Chief Editor:
A. Abyad
MD, MPH, AGSF, AFCHSE
Email: aabyad@cyberia.net.lb

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