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edicine Middle East Journal of Internal Medicine
ISSN 1837 9052
Chief Editor: Ahmad Husari Ethics Editor and Publisher: Ms Lesley Pocock medi+WORLD International 11 Colston Avenue Sherbrooke, Vic Australia 3789 Phone: +61 (3) 9005 9847 Fax: +61 (3) 9012 5857 Email:
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May 2012
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Editorial
Ahmad Husari
Original Contribution / Clinical Investigation 3 8
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- Volume 5, Issue 3
Mortality Rate in Burn Unit: A Six Years Study at the Burn Unit in the King Hussein Medical Center, Royal Medical Services, Jordan Khalid A. El Maaytah, Maher Al Khateeb, Ra’fat Al Abdallat, Lamees Arabiyat’ Manar El-Maaytah, Katreen Obeidat Basal Insulin versus premixed human insulin in insulin naive patients with type 2 diabetes mellitus. A randomised trial from Basrah Abbas Ali Mansour
13 The Role of B-scan ultrasonography in the pre-operative assessment of the posterior eye segment in patients with dense cataract Rafiq I. Haddad, Ahmed E. Khatatbeh, Fakhry S. Athamneh, Mohamad Shaker Khasawneh Review Article 17
Significance of waist circumference in diabetes mellitus Almoutaz Alkhier Ahmed, Emad Alsharif, Ali Alsharif, Mohammed A Garout, Shahid Abdin
Research Article 20
Impacts and effects of different kinds of Analgesics on duration of labour: A Retrospective Quantitative Outcome data Ebtisam Elghblawi
Community Care 29
The Cost Analysis of Different Types of Cancer Treatments and its Effect on Household Expenditure Ferdous Ara Islam, Housne Ara Begum
Models and Methods and Clinical Research 39
Seed oil composition of red raspberry (Rubus ideaus) fruit in Sulaimani city Dalia A. Abdul, Srwa N. Majeed, Nazk M. Aziz
FROM THE EDITOR
From the Editor A
paper from the UK looked at the effects of different kinds of analgesics on duration of labour. The author stressed that Labour pain is a main distress to many patients. Pain involves many aspects, for instance, culture, ethnicity, and psychosocial factors. The study involved 4,509 patients undergoing labour at Birmingham Women’s Hospital (BWH). The study design was non-experimental; a retrospective cohort collected through tracing the patients’ record from the archives of Birmingham Women’s Hospital, for women who had delivered vaginally. The author noted that Entonox was associated with the shortest duration of labour stage-1 (6 hours), and stage-2 (25 minutes), compared to the Epidural analgesia, which was associated with longer labour, p or = 80% TBSA burns (> or = 70% full-thickness). Ann Surg. 1997 May;225(5):554-65; discussion 565-9. 7. Sheridan RL, Ryan CM, Yin LM, Hurley J, Tompkins RG. Death in the burn unit: sterile multiple organ failure. Burns. 1998 Jun;24(4):307-11. 8. Koller R, Zöch G, Bayer GS, Agstner I, Andel H, Frey M, Meissl G. The influence of different therapeutic approaches on the survival of elderly burn patients. Chirurg. 1999 Aug;70(8):915-22; discussion 921-2. 9. Guttormsen AB, Onarheim H, Thorsen J, Jensen SA, Rosenberg BE. Treatment of serious burns. Treatment of serious burns [Treatment of serious burns]. 10. Herruzo R, Banegas JR, de la Cruz JJ, Muñoz-Ratero S, Garcia-Torres V. Impact of infection on mortality in burn patients. Multivariate study in 1,773 intensive care unit patients. Enferm Infecc Microbiol Clin. 2009 Dec;27(10):5804. Epub 2009 May 5. 11. Bloemsma GC, Dokter J, Boxma H, Oen IM. Mortality and causes of death in a burn centre. Burns. 2008 Dec;34(8):1103-7. Epub 2008 Jun 6. 12. Khaldoon H, Adel H. profile of pediatric scald burns in Jordan. Journal of Royal medical services 1999; 6; 1. 13. Al-Shlash S, Warnasuriya ND, al Shareef Z. Eight years experience of a regional burns unit in Saudi Arabia: clinical and epidemiological aspects. Burns 1996;22:376-80 14. Ho WS, Ying SY. An epidemiological study of 1063 hospitalized burn patients in a tertiary burns centre in Hong Kong. Burns 2001;27:119-23.
Low threshold for immediate intubation in DFB with more than 40% TBSA regardless of signs of inhalational injury should be considered.
MIDDLE 3E 3 M I D D LEAST E E A SJOURNAL T J O U R N AOF L OINTERNAL F I N T E R N A MEDICINE L M E D I C I N EVOLUME • VO LU 5, M EISSUE 2 , I SSU
O R I G I N A L CO N T R I B U T I O N A N D C L I N I C A L I N V E S T I G AT I O N
Basal Insulin versus premixed human insulin in insulin naive patients with type 2 diabetes mellitus. A randomised trial from Basrah Abbas Ali Mansour
ABSTRACT Background: Type 2 diabetic patients failing oral antidiabetes (OADs) medications need insulin. The aim of this study is to see if there was any difference in glycemic control if we started insulin naive patients with type 2 diabetes mellitus, on NPH or premixed insulin. Patients and methods: This was an open-label, prospective study. Throughout July 2009, we enrolled insulin naïve patients with type 2 diabetes mellitus in the Al-Faiha Diabetes and Endocrine Center in Basrah. In the first month we enrolled 1500 patients with suboptimal glycemic control (HbA1c > 7%) despite increasingly aggressive therapy with OADs in addition to lifestyle changes, but only 791 (52.7%) patients continued the study for 12 months. Both NPH or Premixed insulin was used for alternating patients, and started twice daily in a dose of 0.2 unit /kg/d. Secretogogus was stopped on commencing insulin, but metformin was continued. Results: Premixed insulin was used in 66.8 % and NPH in 33.2 %. Target HbA1c was achieved in 12.4 % of patients at the end of one year. The NPH group significantly had a higher age, 55.7±10.4 vs. 52.5±11.6 (OR, 2.805; 95% CI, 1.636-4.966; p 7% ) despite increasingly aggressive therapy with OADs in addition to lifestyle changes, but only 791 (52.7%) patients continued the study to 12 months. Data analysis was done at the beginning of July 2010. This high dropout and low enrolment numbers were because we excluded before and during the study, the following: those on insulin, pregnant women, defaulters for more than 3 months, type 1 diabetes, those with recent diabetic foot, acute coronary syndrome with admission to CCU, stroke or acute medical illness which needed hospitalisation for intensive control using a basalbolus regimen of insulin. HbA1c was measured at enrolment and after 12 months. Life style changes and metformin were used for all unless there was a contraindication. Both NPH and Premixed insulin was started twice daily in a dose of 0.2 unit /kg/d. Insulin doses were titrated every month for the first 3months, according to fasting and prandial plasma glucose and then each 3 months according to HbA1c. The dose changed monthly according to fasting and prandial glucose levels and every 3 months by HbA1c level.
Baseline characteristics of the diabetes population were compared using a t-test for continuous variables and a Chi-squared test for dichotomous variables respectively. Means and standard deviations were reported for continuous variables, proportions for dichotomous variables.
Results
Table 1 (next page) shows the characteristics of patients. Of 791 patients enrolled, 303 (38.3%) were men, with mean age of 53.6±11.1 years and BMI of 5.8± 5.0. Premixed insulin was used in 66.8 % and NPH in 33.2 %. The insulin was started 8.6±6.9 years after diagnosis with a median of 7 years. At the time of enrollment and before the use of insulin the mean HbA1c was 10.4±1.7 percent with median HbA1c 10.4 % and after one year of insulin therapy it was 8.6 ±1.4 percent with a median HbA1c 8.4 %. Target HbA1c was achieved by 12.4 % of patients at the end of one year. Table 2 shows the demography, onset of insulin use and HbA1c according to the type of insulin. There were no differences between both study groups regarding the gender, or BMI but the NPH group had a significantly higher age at 55.7±10.4 vs. 52.5±11.6 (OR, 2.805; 95% CI, 1.636-4.966; p
