BackgroundSickle cell disease (SCD) is highly prevalent in the Al-Hasa area of eastern Saudi Arabia. We analyzed our patient data to try and find an explanation for the unexpected observation that more males than females with SCD were transferred to the hospital after a stay in the stabilization unit.Patients and MethodsWe compared differences between males and females in demographics, pattern of response to treatment for pain, and discharge records for SCD patients admitted to the stabilization unit during the years 2000 to 2002.ResultsApproximately 20% of patients were transferred to the hospital and the remainder were discharged home. Males were admitted more often to the stabilization unit for pain control. Males were also over-represented among those whose pain persisted for over 47 hours and needed hospitalization. Female patients were distributed more evenly over the age groups; there were fewer males in the older age groups.ConclusionThese preliminary observations point to the need for further studies into gender differences in pain crisis in patients with SCD.
A pilot Diabetic Support Service (DSS) based on a computer register was devised for diabetic patients identified within three group practices in an inner city district of London. Of 159 eligible diabetics, 142 were followed over 2 years. Glycosylated haemoglobin (GHb) monitoring and adequacy of clinic reviews were audited. Care achieved by the DSS was compared with conventional Diabetic Clinic (DC) management of a sample of 200 diabetics from the same district. Serial GHb measurements were made on 66.2% of DSS and 44.5% of DC patients: GHb fell significantly only in DSS patients (13.1% to 11.4%). Proportional falls in GHb were comparable in each DSS treatment group (diet alone, oral hypoglycaemic agents, and insulin) and for hospital attenders and non-attenders equally. The planned clinical reviews were achieved in 40.1% of DSS patients entered (29% GP only, 54% of clinic attenders) and in 15% of DC patients (plus 75% fundal and blood pressure examination). The study led to provision of a formal diabetic clinic annual review system, diabetic mini-clinics in two of the three group practices, and the appointment of two Diabetic Liaison Sisters. With administrative simplification the system is to be made available to all diabetics in the District through their GPs during 1986-8.
BACKGROUNDSickle cell pain crisis continues to challenge patients and health professionals in places like Saudi Arabia, where the disease is common, and use of narcotic analgesics is strictly controlled. We sought to find the most effective and appropriate pain control regime for adult sickle cell pain crisis in Saudi Arabian patients.PATIENTS AND METHODSAdult sickle cell disease patients in crisis, treated initially in the emergency room of a private health center, usually undergo further treatment with different pain control regimes in an observation ward. We compared the adequacy of pain conrol during the three recent years (2000–2002) with those of the preceding three (1995–1997).RESULTSTreatment with regular opiates supplemented with oral analgesics during the second three-year period produced better results than “on demand” regimes. The former regimen enabled about 83% of patients from the second three-year period to be discharged home within two days compared with 71% during the first three-year period (P<0.05). A minority of patients needed more time for pain resolution. Patient response to oral analgesics was variable and females appeared to fare better than males.DISCUSSIONGreater empathy and individualized treatment are required for sickle cell pain crisis patients because of their variable clinical presentation, response to medications, and the regularity of pain in their lives. The observed gender differences in pain response require further study.
The increasing incidence of diabetes mellitus worldwide makes traditional approaches to its management inadequate. The involvement of young people in this diabetic “epidemic” provides an opportunity to apply a multidisciplinary approach to its management, to help reduce the huge burden of the disease and its complications. In 1998, we established a diabetic clinic for young adults, located within a privately owned company health center, because they were not receiving adequate attention in the adult clinic. Our purpose was to optimize diabetes control by teaching about diet, exercise, medications, and other practical diabetic management issues. In this special communication, we describe the organization of the clinic and present our experience with 105 patients in the first 4 years. Diabetic control as measured by serial glycosylated haemoglobin levels (HbA1c) and the occurrence and severity of diabetic ketoacidosis improved in our patients over those 4 years. Studies in the West have shown that small reductions in HbA1c have translated into dramatic decreases in microvascular complications. Application of this model to a larger population group is needed. Further study may help determine whether to adopt this pattern of care more widely, with its obvious benefits in reduction of diabetic morbidity, mortality and health care cost. We also identified three groups that may require special attention: females, young adults who develop the disease as children, and adolescents who have no regular adult supervision.
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