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Assaad Khalil SH, Abdelaziz SI, Al Shammary A, Al Zahrani A, Amir A, Elkafrawy N, Hassoun AA, Hostalek U, Jahed A, Jarrah N, Mrabeti S, Paruk I, Zilov AV. Prediabetes management in the Middle East, Africa and Russia: Current status and call for action. Diab Vasc Dis Res 2019; 16:213-226. [PMID: 30606039 DOI: 10.1177/1479164118819665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Most data on the burden of diabetes and prediabetes are from countries where local infrastructure can support reliable estimates of the burden of non-communicable diseases. Countries in the Middle East and Africa, together with Russia, have a total population of almost 2 billion, but have been relatively overlooked by authors in this field. We reviewed the prevalence and drivers of prediabetes and diabetes across this large region. A large, and variable, burden of dysglycaemia exists, especially in Middle Eastern and North African countries, associated with high levels of obesity and sedentariness, with a generally lower prevalence in most other parts of Africa. The design and size of studies are highly variable, and more research to quantify the scale of the problem is needed. Local barriers to care relating to issues concerned with gender, consanguinity, lack of understanding of diabetes, lack of understanding of obesity as a health issue, and limited resource at a national level for tracking and intervention for diabetes and other non-communicable diseases. Lifestyle interventions with proven local cost-effectiveness, enhanced access to pharmacologic intervention, and societal interventions to promote better diet and more activity will be an important element in strategies to combat these adverse trends.
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Affiliation(s)
- Samir Helmy Assaad Khalil
- 1 Unit of Diabetology, Lipidology & Metabolism, Department of Internal Medicine, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sulaf Ibrahim Abdelaziz
- 2 Department of Internal Medicine and Endocrinology, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Affaf Al Shammary
- 3 International Health Department, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ali Al Zahrani
- 4 Medicine and Molecular Endocrinology Section, Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ashraf Amir
- 5 Department of Family Medicine, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Nabil Elkafrawy
- 6 Egyptian National Committee of Diabetes, Department of Internal Medicine and Diabetology, Menoufia University, Al Menoufia, Egypt
| | | | | | - Adel Jahed
- 9 Diabetes Education Advisory Committee, Gabric Diabetes Education Association, Tehran, Iran
- 10 Tehran General Hospital, Tehran, Iran
| | - Nadim Jarrah
- 11 Internal Medicine Department, The Specialty Hospital, Amman, Jordan
| | | | - Imran Paruk
- 13 University of KwaZulu-Natal, Durban, South Africa
| | - Alexey V Zilov
- 14 Department of Endocrinology, Sechenov's First Moscow Medical University, Moscow, Russia
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Khalil AB, Beshyah SA, Abdella N, Afandi B, Al-Arouj MM, Al-Awadi F, Benbarka M, Ben Nakhi A, Fiad TM, Al Futaisi A, Hassoun AA, Hussein W, Kaddaha G, Ksseiry I, Al Lamki M, Madani AA, Saber FA, Abdel Aal Z, Morcos B, Saadi H. Diabesity in the Arabian Gulf: Challenges and Opportunities. Oman Med J 2018; 33:273-282. [PMID: 30038726 DOI: 10.5001/omj.2018.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Aly Bernard Khalil
- Department of Endocrinology, Imperial College London Diabetes Center, Abu Dhabi, UAE
| | - Salem A Beshyah
- Center for Diabetes and Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Nabila Abdella
- Department of Medicine, Faculty of Medicine, University of Kuwait City, Kuwait City, Kuwait
| | - Bachar Afandi
- Department of Endocrinology, Tawam Hospital, Al-Ain, UAE
| | | | | | | | | | - Tarek M Fiad
- Center for Diabetes and Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Abdullah Al Futaisi
- Department of Endocrinology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Wiam Hussein
- Department of Endocrinology, Dr. Wiam Clinic for Diabetes and Endocrine Disorders, Riffa, Bahrain
| | - Ghaida Kaddaha
- Department of Diabetes and Endocrinology, Suliman Al Habib Hospital, Dubai Medical City, Dubai, UAE
| | - Iyad Ksseiry
- Department of Diabetes and Endocrinology, Mediclinic Hospital, Dubai, UAE
| | - Mohamed Al Lamki
- Department of Diabetes and Endocrinology, Royal Hospital, Muscat, Oman
| | | | - Feryal A Saber
- Department of Diabetes and Endocrinology, Bahrain Defense Force Hospital, Riffa, Bahrain
| | | | - Bassem Morcos
- Medical Affairs, Merck Sharp and Dohme Corp., Dubai, UAE
| | - Hussein Saadi
- Medical Subspecialties Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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Hassoun AA, Coomer RW, Mendez-Vigo L. Intraperitoneal daptomycin used to successfully treat vancomycin-resistant enterococcus peritonitis. Perit Dial Int 2009; 29:671-673. [PMID: 19910570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Matsumoto S, Kandaswamy R, Sutherland DE, Hassoun AA, Hiraoka K, Sageshima J, Shibata S, Tanioka Y, Kuroda Y. Clinical application of the two-layer (University of Wisconsin solution/perfluorochemical plus O2) method of pancreas preservation before transplantation. Transplantation 2000; 70:771-4. [PMID: 11003355 DOI: 10.1097/00007890-200009150-00010] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The two-layer method [University of Wisconson solution (UW)/perfluorochemical plus O2] for pancreas preservation has been demonstrated to be superior to simple UW storage alone in the canine model. For the first time, we applied the two-layer method to clinical whole-pancreas transplantation. METHODS Pancreases were placed in the two-layer method in 10 cases and UW alone in 44 cases before transplant. The mean cold ischemic time was 16.5 hr in the two-layer group versus 18.1 hr in the UW group (P=NS). We compared the condition of graft at the time of reperfusion, and then 3 months posttransplant graft function and complications. RESULTS At the time of reperfusion, no grafts in the two-layer group were edematous, compared with 10(23.3%) of 43 in the UW group (P=0.18). Seven (70%) of 10 grafts in the two-layer group obtained the best overall quality score, compared with 24(57.1%) of 42 in the UW group (P=0.72). Nine (90%) of 10 recipients in the two-layer group became insulin-independent during hospitalization, compared with 31(70.5%) of 44 in the UW group (P=0.26). Time to insulin independence was no different between the two groups. No pancreas grafts preserved by the two-layer method suffered acute rejection. Conclusions. The two-layer preservation method is feasible in human clinical transplantation. It was at least equivalent and may be superior to UW alone in both morphologic and functional assessment of the transplanted pancreas.
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Affiliation(s)
- S Matsumoto
- Department of Surgery, University of Minnesota, Minneapolis 55455, USA
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Abstract
OBJECTIVE To determine whether preoperative levels of glycated hemoglobin (GHb) are lower in patients with functioning insulinoma and, if so, whether a distinct separation of GHb values from those in control subjects might serve for diagnosis. METHODS We examined preoperative GHb in consecutive patients (who had this measurement done) with surgically confirmed insulinoma for the period 1983 (when the current method became available for routine use) through 1996. Hemoglobin A(1) (HbA(1)) was measured by the Isolab Glyc-Affin Test System (normal range, 4 to 7%). We studied 64 patients with insulinoma (40 women and 24 men; median age, 47.5 years; age range, 21 to 79) and 38 control subjects (25 women and 13 men; median age, 42.5 years; age range, 20 to 83) considered not to have a hypoglycemic disorder on the basis of normal results of a supervised 72-hour fast. RESULTS HbA(1) was significantly lower in patients with insulinoma (median, 4.7%; range, 2.7 to 6.9%) than in control subjects (median, 5.3%; range, 4.1 to 6.4%) (P<0.001, two-tailed rank sum test). Among 15 patients with insulinoma treated with diazoxide preoperatively, HbA(1) was higher (median, 4.8%; range, 4.2 to 6.9%) than in patients not treated with diazoxide (median, 4.6%; range, 2.7 to 5.7%), although the difference was not statistically significant (P = 0.08). CONCLUSION Because of considerable overlap in HbA(1) values, no GHb value was diagnostic for insulinoma; however, 16 of 64 patients (25%) with insulinoma had HbA(1) values below the lowest value (4.1%) in control subjects. Thus, HbA(1) values less than 4.1% in patients with possible insulinoma are strongly indicative of that disorder.
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Affiliation(s)
- A A Hassoun
- Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Khosla S, Hassoun AA, Baker BK, Liu F, Zein NN, Whyte MP, Reasner CA, Nippoldt TB, Tiegs RD, Hintz RL, Conover CA. Insulin-like growth factor system abnormalities in hepatitis C-associated osteosclerosis. Potential insights into increasing bone mass in adults. J Clin Invest 1998; 101:2165-73. [PMID: 9593772 PMCID: PMC508804 DOI: 10.1172/jci1111] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Hepatitis C-associated osteosclerosis (HCAO) is a rare disorder characterized by a marked increase in bone mass during adult life. Despite the rarity of HCAO, understanding the mediator(s) of the skeletal disease is of great interest. The IGFs-I and -II have potent anabolic effects on bone, and alterations in the IGFs and/or IGF-binding proteins (IGFBPs) could be responsible for the increase in bone formation in this disorder. Thus, we assayed sera from seven cases of HCAO for IGF-I, IGF-II, IGF-IIE (an IGF-II precursor), and IGFBPs. The distribution of the serum IGFs and IGFBPs between their ternary ( approximately 150 kD) and binary (approximately 50 kD) complexes was also determined to assess IGF bioavailability. HCAO patients had normal serum levels of IGF-I and -II, but had markedly elevated levels of IGF-IIE. Of the IGFBPs, an increase in IGFBP-2 was unique to these patients and was not found in control hepatitis C or hepatitis B patients. IGF-I and -II in sera from patients with HCAO were carried, as in the case of sera from control subjects, bound to IGFBP-3 in the approximately 150-kD complex, which is retained in the circulation. However, IGF-IIE was predominantly in the approximately 50-kD complex in association with IGFBP-2; this complex can cross the capillary barrier and access target tissues. In vitro, we found that IGF-II enhanced by over threefold IGFBP-2 binding to extracellular matrix produced by human osteoblasts and that in an extracellular matrix-rich environment, the IGF-II/IGFBP-2 complex was as effective as IGF-II alone in stimulating human osteoblast proliferation. Thus, IGFBP-2 may facilitate the targeting of IGFs, and in particular IGF-IIE, to skeletal tissue in HCAO patients, with a subsequent stimulation by IGFs of osteoblast function. Our findings in HCAO suggest a possible means to increase bone mass in patients with osteoporosis.
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Affiliation(s)
- S Khosla
- Endocrine Research Unit, Division of Endocrinology and Metabolism, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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Affiliation(s)
- A A Hassoun
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
BACKGROUND Insular thyroid carcinoma is intermediate in aggressiveness between well differentiated and anaplastic thyroid carcinomas. METHODS The authors describe two children with insular thyroid carcinoma who had markedly different outcomes. In the first case, a girl age 15 years, 2 months presented with a large pulsatile mass in the right thyroid lobe. In the second case, a girl age 16 years, 3 months presented after total thyroidectomy was performed elsewhere for confirmed pTNM Stage I insular thyroid carcinoma. RESULTS In Case 1, total thyroidectomy was performed, and histologic examination revealed insular thyroid carcinoma with lymph node involvement. Six weeks postoperatively, neck masses reappeared. There was significant radioactive iodine uptake in the thyroid bed and in a palpable right supraclavicular lymph node; this was associated with an increased serum thyroglobulin level. Ultrasound-guided biopsy of the lymph node confirmed recurrent insular carcinoma, and neck dissection was performed. Six weeks later, there was 0.35% iodine uptake in the neck, and the patient was treated with 300 mCi of (131)I. She had no signs of recurrence when last seen 22 months postoperatively. In Case 2, the patient was given 29.9 mCi of (131)I for remnant ablation. Four months postoperatively, fine-needle aspiration biopsy of a high jugular lymph node demonstrated recurrence. The patient was given 200 mCi of (131)I but had no significant response. Right modified neck dissection was performed, followed by external beam radiation. Despite aggressive treatment with a further 500 mCi of (131)I, progressive lung and mediastinal metastases developed, followed by brain metastasis. The patient died 31 months after the initial diagnosis. CONCLUSIONS Insular thyroid carcinoma may occur and behave aggressively in children. Vigorous initial surgical and radioactive iodine treatments are warranted.
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Affiliation(s)
- A A Hassoun
- Division of Endocrinology/Metabolism and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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