Context: Diabetic septic foot (DSF) is a serious outcome complication of diabetes mellitus. Patients having DSF are at a high risk of amputations and surgical hazards. Aim: The aim of this study was to identify the self-care of foot and factors associated with DSF among diabetic patients attending the DSF unit in the Military Hospital. Materials and Methods: A case-control study was conducted among diabetic patients attending the diabetic clinic in the Military Hospital during May-June 2012. Thirty DSF cases and 30 controls were interviewed using a structured questionnaire and DSF was observed and graded by Wagner's classification. Statistical Analysis: Descriptive statistics of the cases was presented and Fisher's exact test was used to test the risk factors associated with DSF. Results: The mean age for the study groups was 55.60 ΁ 11.9 years. Based on the Wagner classification, 83.3% of septic feet were classified as grades 3, 4 and 5. Considering the delay in presentation with DSF to the hospital, 86.7% presented after 1 week up to more than 2 months from the start of the lesion. Low socioeconomic status, lack of self-care of foot, peripheral neuropathy and foot ischemia and deformity were associated with developing DSF (P-value < 0.05). Conclusion: Most patients with DSF seek care late and present with advance grade lesions. Lack of self-care of foot, peripheral neuropathy and foot ischemia and deformity are the risk factors of DSF.

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Lipohypertrophy has been a recognized complication of insulin therapy. Despite improvements in insulin purity and the introduction of recombinant human insulin, its prevalence has remained high particularly in those with a poor glycemic control. Injection of insulin into a site of lipohypertrophy, although painless, may lead to erratic absorption of insulin, with the potential for poor glycemic control and unpredictable hypoglycemia. Rotation of injection sites can reduce the frequency of the problem but does not abolish it. The importance of this complication is not only cosmetic but also in its impact on insulin absorption, and hence glycemic control. Lipohypertrophy is characterized by a benign "tumor-like" swelling of fatty tissue secondary to subcutaneous insulin injections. A strong association of lipoatrophy and lipohypertrophy with insulin antibodies might suggest that autoimmune phenomena with insulin play a role in the development of both. Presented here is a young type 1 diabetic on human insulin with poor glycemic control who developed lipohypertrophy at the injection sites around the umbilicus.

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This is a comparative study of cutaneous leishmaniasis (CL) in the Eastern Province of the Kingdom of Saudi Arabia and Sudan. The disease in both countries is caused by Leishmania major of different syndromes and the vector is Phlebotomus papatasi. The animal reservoir host in Saudi Arabia is Psammomys obesus and the Nile rat in Sudan. The clinical manifestations are similar, but some forms encountered in Sudan were not seen in Saudi Arabia. The pathology, immunology, diagnosis and treatment of CL are discussed.

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Gastroesophageal reflux (GER) refers to the passage of gastric contents (acid, pepsin, etc) in the esophagus. It is a worldwide physiologic condition most common in infants. This physiologic condition (GER) should be differentiated from the pathologic reflux called gastroesophageal reflux disease (GERD). The distinction between GER and GERD is based on severity of the reflux episodes. ^[1],[2] The most common mechanism of reflux is transient lower esophageal sphincter relaxation (TLESR) and less commonly low resting LES pressure. ^[3] GER presents with regurgitation and occasional vomiting only without effects on growth and development whereas GERD usually has additional presentations. The objective of this review is to provide update on recent developments in the diagnosis and management of this condition.

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Although appendiceal endometriosis is rare, appendix is the second most common site of intestinal endometriosis. Clinical diagnosis is difficult and histopathology is the only way to establish the diagnosis. We present a case of chronic pelvic pain secondary to appendiceal endometriosis and a review of the literature. There are no pathognomonic criteria to establish an accurate preoperative diagnosis. There is no specific radiologic test for diagnose. Laparoscopy provides detailed evaluation of the appendix but gross inspection of appendix alone is not enough to rule out the problem. The appendix may harbor endometriosis and could be a cause of chronic pelvic pain. When performing surgeries in a patient with chronic pelvic pain, surgeons should be aware of the possible contribution of the problem pelvic pain in patients with endometriosis. The appendix should be examined thoroughly during endometriosis-related operations. Appendectomy should be performed if the appendix looks abnormal.

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Background: Blood transfusion-dependent beta Thalassemia Major (BTM) patients are at risk of hemosiderosis. Hemosiderosis of pancreas results in impaired glucose homeostasis tolerance and diabetes mellitus (DM). Since glycosylated hemoglobin has limited role in patients with hemoglobinopathies, this study was conducted as a first attempt worldwide to understand glucose homeostasis and evaluate efficacy of Continuous Glucose Monitoring (CGM) system as a diagnostic tool of abnormal glucose homeostasis in these patients. Materials and Methods: A case series study of six non-diabetic, transfusion-dependent beta-thalassemia patients aged 9-13-year-old. Clinical and laboratory data were collected on admission for their monthly transfusion. Patients were connected to CGM systems for one day. Findings: Using CGM and based on American Diabetes Association guidelines, three patients were found to have abnormal glucose levels of diabetic range. The other three showed impaired glucose tolerance. Among all patients, glycosylated hemoglobin (HbA1C) readings have an inverse relationship to CGM and calibration readings. Conclusion: CGM could be a promising tool for evaluating BTM patients. Larger studies are recommended.

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Childhood asthma is a common chronic respiratory disease; it may be associated with other co-morbidities which may influence its severity. Among these is chronic rhino sinusitis, conjunctivitis, or gastroesophageal reflux disease. However, nasal polyps are rare in asthmatic children, being more common in those more than 20 years. Its exact cause is not completely understood and it has been associated with sensitivity to non-steroidal anti-inflammatory drugs. In this communication we report a case of a 11-year-old boy with multiple nasal polyps and difficult to manage asthma.

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Indeterminate cell tumor (ICT; histiocytosis) is a rare disorder characterized by accumulation of histiocytes that do not fulfill the phenotypic criteria designated for Langerhans cells (LC). The cells classified as "indeterminate" exhibit overlapping features between dendritic cells and histiocytic cells by showing variable reactivity for CD1a and positivity for S-100 protein and CD68. Ultrastructurally, absence of Birbeck granules, a feature consistent with LC, epitomizes the lesional cells. Herein, we report a case of ICT in a new born emphasizing its histogenesis and clinical, morphologic, immunohistochemical, and ultrastructural features.

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Introduction: End-stage renal disease patients undergoing peritoneal dialysis usually have significant hyperlipidemia. The peritoneal membrane permeability and residual renal function (RRF) may affect lipid profile in these patients. Objective: To study the correlation of lipid profile with peritoneal membrane transport characteristic and RRF as well as cancer antigen (CA)-125 in patients on automated peritoneal dialysis (APD). Materials and Methods: The present study is a retrospective analysis of forty end-stage renal disease patients on APD. Lipid profile (total cholesterol, serum triglyceride, low-density lipoprotein and high-density lipoprotein), serum albumin and CA-125 were correlated with various peritoneal membrane transporters, assessed by peritoneal equilibration test (PET). Lipid profile was also correlated with residual renal function and KT/V. Results: The study included 21 female and 19 male patients on APD. The duration of peritoneal dialysis was 18-70 months. There was no significant difference in lipid profile at baseline and at one year in patients with different peritoneal transporter status. There was no correlation between lipid profile and residual renal function as well as CA-125. Conclusion: The findings suggest that there is no relation of lipid profile with peritoneal membrane transporter status and residual renal function in patients maintained on automated peritoneal dialysis.

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Background: Congenital diaphragmatic hernia (CDH) is a major birth defect, which continues to be associated with significant rate of morbidity and mortality. CDH-local studies are limited. The objective of this article is to determine the epidemiology and demographics of CDH; and if the introduction of nitric oxide has influenced the outcome. Materials and Methods: A retrospective 10-year medical records review of neonates with CDH admitted to the neonatal intensive care unit (NICU) of a tertiary care hospital. Results: A total of 29 infants had been admitted to the NICU with CDH between January 2001 and December 2010. The mean gestational age was 38.58 ΁ 2.6 weeks and the mean birth weight was 2821 ΁ 682 g. The incidence of CDH among the inborn infants was 1/250 live births (P < 0.05) and the overall male to female ratio was 0.7. Of the 12 infants (41%) were inborn and 17 (59%) were referred from other centers. Out of the 29 infants, 23 (79%) were Saudis; the same figure was true for the vaginal deliveries and those born at term. Only 10 infants (34%) were diagnosed antenatally. The mean Apgar scores were 5 and 7 at the 1 ^st and 5 ^th min respectively. Two infants (7%) had right-sided defect against 27 (93%) who had it left-sided. Moreover, 18 infants had survived and were discharged home, with an overall mortality rate of 38% (compared with 45% before introducing inhaled nitric oxide [iNO]), P > 0.05. Conclusion: The incidence of CDH was found much higher than the reported cases in literature; and although the mortality rate has improved after the introduction of iNO, the difference was not statistically significant. Both interesting findings necessitate further studies.

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