ObjectiveTo explore the evaluation, treatment and impact of hyperprolactinaemia on male infertility and testicular function, as hyperprolactinaemia is commonly detected during the evaluation of infertile men.MethodsA literature search was performed using MEDLINE/PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all studies exploring hyperprolactinaemia in male infertility.ResultsElevated levels of serum prolactin have a detrimental effect on male reproduction through inhibition of the pulsatile release of gonadotrophins from the anterior pituitary gland, and a direct effect on spermatogenesis. Treatment of confirmed hyperprolactinaemia with dopamine agonists leads to significant improvements in both semen parameters and hormone levels.ConclusionHyperprolactinaemia, both directly and indirectly, has a negative effect on sperm production, and its detection and management in men seeking fertility is mandatory.

BackgroundPremature ejaculation (PE) is a highly prevalent sexual dysfunction among patients with diabetes mellitus (DM). Despite this, the underlying mechanism of this association is poorly understood. In this study, we aimed to investigate the prevalence of PE in a group of patients with DM and explore possible associations linking both conditions together.MethodsThis was a prospective study of subjects recruited with advertisement pamphlets and whose sexual function was assessed using the international index of erectile function-5 (IIEF-5) and the Arabic index of premature ejaculation (AIPE) questionnaires together with stopwatch measured intravaginal ejaculatory latency time (ELT). Participants were divided into two groups; group A subjects had DM and group B were healthy adult males.ResultsA total of 488 subjects were recruited. Group A included 199 (40.8%) subjects, while group B included 289 (59.2%). The prevalence of PE and ED was significantly higher in group A subjects (P<0.001). Mean ELT ± standard deviation (SD) was 3.6±2.7 in group A versus 4.3±2.8 in group B (P<0.014). Diabetic patients with erectile dysfunction (ED) showed a significantly higher incidence of PE with significantly shorter ELT.ConclusionsPE is more prevalent in diabetic patients. DM is a multi-systemic disorder with complications that could help explain the pathophysiology of PE.

BackgroundMetformin may lead to B12 deficiency and neuropathy. There are no published data on the prevalence of Metformin-related B12 deficiency and neuropathy in the Arabian Gulf.AimsDetermine whether Metformin intake is associated with B12 deficiency and whether B12 deficiency is associated with diabetic peripheral neuropathy (DPN) and painful diabetic neuropathy.MethodsPatients with type 2 diabetes mellitus (T2DM) (n = 362) attending outpatient clinics at HMC underwent assessment of B12 levels, the DN4 questionnaire, and vibration perception threshold (VPT).ResultsComparing Metformin to non-Metformin users there were no differences in B12 levels, VPT, or DN4. The prevalence of B12 deficiency (B12 <133 pmol/l) was lower (P < 0.01) in Metformin (8%) compared to non-Metformin (19%) users. Patients with B12 deficiency had a comparable prevalence and severity of sensory neuropathy and painful neuropathy to patients without B12 deficiency.ConclusionSerum B12 levels were comparable between Metformin and non-Metformin users with T2DM in Qatar. T2DM patients on Metformin had a lower prevalence of B12 deficiency. Furthermore, the prevalence and severity of neuropathy and painful diabetic neuropathy were comparable between patients with and without B12 deficiency.

Aims/IntroductionPainful diabetic peripheral neuropathy (PDPN) has a significant impact on the patient's quality of life. The prevalence of PDPN in the Middle East and North Africa region has been reported to be almost double that of populations in the UK. We sought to determine the prevalence of PDPN and its associated factors in type 2 diabetes mellitus patients attending secondary care in Qatar.Materials and MethodsThis was a cross‐sectional study of 1,095 participants with type 2 diabetes mellitus attending Qatar's two national diabetes centers. PDPN and impaired vibration perception on the pulp of the large toes were assessed using the Douleur Neuropathique en 4 questionnaire with a cut‐off ≥4 and the neurothesiometer with a cut‐off ≥15 V, respectively.ResultsThe prevalence of PDPN was 34.5% (95% confidence interval [CI] 31.7–37.3), but 80% of these patients had not previously been diagnosed or treated for this condition. Arabs had a higher prevalence of PDPN compared with South Asians (P < 0.05). PDPN was associated with impaired vibration perception adjusted odds ratio (AOR) 4.42 (95% CI 2.92–6.70), smoking AOR 2.43 (95% CI 1.43–4.15), obesity AOR 1.74 (95% CI 1.13–2.66), being female AOR 1.65 (95% CI: 1.03–2.64) and duration of diabetes AOR 1.08 (95% CI 1.05–1.11). Age, poor glycemic control, hypertension, physical activity and proteinuria showed no association with PDPN.ConclusionsPDPN occurs in one‐third of type 2 diabetes mellitus patients attending secondary care in Qatar, but the majority have not been diagnosed. Arabs are at higher risk for PDPN. Impaired vibration perception, obesity and smoking are associated with PDPN in Qatar.

Background. Muslims all over the world fast during the month of Ramadan from dawn until dusk. There is little data regarding the best timing of levothyroxine intake during the month of Ramadan where taking it on an empty stomach represents a challenge to most patients. Our study aims to compare two-time points of levothyroxine intake during Ramadan in terms of change in thyroid stimulating hormone (TSH), compliance, and convenience. Study Design and Methods. This was an open-label, randomized, prospective trial. Adult patients known to have primary hypothyroidism with stable TSH for the last 6 months who intended to fast during the month of Ramadan were invited to participate in this prospective study. The study took place during Ramadan of H1438 (May-June 2017). All patients were randomly assigned to two groups. In group A (n= 50) patients took levothyroxine 30 minutes before breaking the fast at sunset (iftar), and in group B (n= 46) patients took it 30 minutes before an early morning meal before sunrise (suhour). Results. TSH levels increased in both group A (from 1.99 to 3.28 mIU/L) and group B (from 1.54 to 3.28 mIU/L) after Ramadan fasting. There was no difference between the two groups. Compliance with intake instructions, all of the time, was reported in 41.6% of group A and 35.7% of group B patients. In both the groups, 95% of patients said it was convenient for them to take the medication at the assigned time. Conclusion. Choosing an optimal time for levothyroxine intake during the month of Ramadan remains a challenge. The current study did not provide any evidence on ideal time and dose of levothyroxine administration during fasting to manage hypothyroidism. Studies with a larger number of patients need to be done to further explore this issue.

Aims/Introduction: This study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN) and painful DPN (pDPN) in patients with type 2 diabetes in primary healthcare (PHC) and secondary healthcare (SHC) in Qatar. Materials and Methods: This was a cross-sectional multicenter study. Adults with type 2 diabetes were randomly enrolled from four PHC centers and two diabetes centers in SHC in Qatar. Participants underwent assessment of clinical and metabolic parameters, DPN and pDPN. Results: A total of 1,386 individuals with type 2 diabetes (297 from PHC and 1,089 from SHC) were recruited. The prevalence of DPN (14.8% vs 23.9%, P = 0.001) and pDPN (18.1% vs 37.5%, P < 0.0001) was significantly lower in PHC compared with SHC, whereas those with DPN at high risk for diabetic foot ulceration (31.8% vs 40.0%, P = 0.3) was comparable. The prevalence of undiagnosed DPN (79.5% vs 82.3%, P = 0.66) was comparably high, but undiagnosed pDPN (24.1% vs 71.5%, P < 0.0001) was lower in PHC compared with SHC. The odds of DPN and pDPN increased with age and diabetes duration, and DPN increased with poor glycemic control, hyperlipidemia and hypertension, whereas pDPN increased with obesity and reduced physical activity. Conclusions: The prevalence of DPN and pDPN in type 2 diabetes is lower in PHC compared with SHC, and is attributed to overall better control of risk factors and referral bias due to patients with poorly managed complications being referred to SHC. However, approximately 80% of patients had not been previously diagnosed with DPN in PHC and SHC. Furthermore, we identified a number of modifiable risk factors for PDN and pDPN.

Aims: Diabetic neuropathy (DN) is a "Cinderella" complication, particularly in the Middle East. A high prevalence of undiagnosed DN and those at risk of diabetic foot ulceration (DFU) is a major concern. We have determined the prevalence of DN and its risk factors, DFU, and those at risk of DFU in patients with type 2 diabetes mellitus (T2DM) in secondary care in Qatar.Materials and methods: Adults with T2DM were randomly selected from the two National Diabetes Centers in Qatar. DN was defined by the presence of neuropathic symptoms and a vibration perception threshold (VPT) ≥ 15 V. Participants with a VPT ≥ 25 V were categorized as high risk for DFU. Painful DN was defined by a DN4 score ≥4. Logistic regression analysis was used to identify predictors of DN.Results: In 1082 adults with T2DM (age 54 ± 11 years, duration of diabetes 10.0 ± 7.7 years, 60.6% males), the prevalence of DN was 23.0% (95% CI, 20.5%-25.5%) of whom 33.7% (95% CI, 27.9%-39.6%) were at high risk of DFU, and 6.3% had DFU; 82.0% of the patients with DN were previously undiagnosed. The prevalence of DN increased with age and duration of diabetes and was associated with poor glycaemic control (HbA 1c ≥ 9%) AOR = 2.1 (95% CI, 1.3-3.2), hyperlipidaemia AOR = 2.7 (95% CI, 1.5-5.0), and hypertension AOR = 2.0 (95% CI, 1.2-3.4). Conclusions:Despite DN affecting 23% of adults with T2DM, 82% had not been previously diagnosed with one-third at high risk for DFU. This argues for annual screening and identification of patients with DN. Furthermore, we identify hyperglycaemia, hyperlipidaemia, and hypertension as predictors of DN. K E Y W O R D S diabetic neuropathy, painful diabetic neuropathy, diabetic foot ulceration, type 2 diabetes mellitus

Klinefelter's syndrome (KS) is the most common chromosomal abnormality in men with infertility and hypogonadism. Although its influence on fertility has been extensively investigated, very few studies assessed the sexual function of patients with KS. Our aim was to assess the prevalence of sexual dysfunction in patients with KS and investigate possible aetiological factors for reported findings. Medical records of 53 patients with KS were retrospectively reviewed and compared to 75 age-matched control subjects who were prospectively recruited. Sexual history was evaluated through utilisation of international index of erectile function-5 and Arabic index for premature ejaculation questionnaires. Sexual desire was reported subjectively by patients or controls. The incidence of erectile dysfunction and premature ejaculation in patients with KS was 18.9% and 22.6% respectively. Compared to age-matched controls, patients with KS had significantly lower incidence of PE. However, there was no statistically significant difference between both groups regarding erectile function. Libido was significantly lower in patients with KS than normal controls (54.7% vs. 17.3%, p = 0.001). Klinefelter's syndrome is a condition that has a variable presentation. Despite having a higher likelihood of reduced sexual desire, patients may have normal erectile function comparable to age-matched individuals. They tend to have a lower incidence of premature ejaculation.