Background and Objectives: The complications of type 2 diabetes mellitus (T2DM) can occur in some organs, such as the heart, blood vessels, eyes, kidneys, and nerves. Stroke, one of such complications, is increasing every year. This study aims to investigate the prevalence of and risk factors for stroke among T2DM patients in Qatar. Methods: This was a secondary post hoc analysis of collected data from our previous study titled “Association of Vitamin D deficiency with dyslipidemia, glycemic control, and microalbuminuria in patients with T2DM in Qatar.” Results: The prevalence of stroke among our patients was 3.8%. A comparison between stroke and no-stroke groups showed a significant association between stroke and other diseases, namely, chronic kidney diseases (CKD) (p=0.007), coronary artery disease (CAD) (p=0.010), peripheral vascular disease (PVD) (p<0.001), retinopathy (p=0.044), prolonged duration of diabetes mellitus (DM) (p=0.041), glycated hemoglobin (HbA1c) (p=0.006), and a high serum creatinine level (p=0.003). In the multivariate analysis, we identified the following variables as independent risk factors for stroke in patients with T2DM: male gender, CKD, CAD, PVD, high HbA1c, a high creatinine level, and prolonged duration of DM. Conclusion: The prevalence of stroke among T2DM patients in Qatar was around 3.8%. The main risk factors were male gender, CKD, CAD, PVD, high HbA1c, prolonged duration of DM, and a high level of creatinine.
The coexistence of Moyamoya syndrome (MMS) and Graves’ disease (GD) is uncommon. Here, we report a case of a 41-year-old Filipino female, who presented with thyrotoxicosis and acute ischemic stroke. Based on her clinical presentation, cerebral computed tomography angiography, and thyroid function tests, she was diagnosed with MMS and GD. Her Burch-Wartofsky point scale score was 30, suggesting an impending thyroid storm. Antithyroid therapy was started with her neurological status deterioration initially, but after controlling the thyroid storm, the patient’s neurological status stabilized. She remained stable till she travelled to her country. We hypothesized that MMS in a patient with GD is mediated through anti-dsDNA antibodies, by altering key biological mechanisms, that is, inflammation, neutrophil extracellular traps, and apoptosis that drive a distinctive and coordinated immune and vascular activation. To the best of our knowledge, this is the first case of MMS associated with GD reported in Qatar.
Patients who are on regular hemodialysis and who have advanced renal failure but have not yet started on renal replacement therapy have a high risk of tendon rupture, although this is a rare situation. We reported a case of 55-year-old male patient who had been on regular hemodialysis for the past 10 years. He presented with a sudden onset of pain and swelling in the left posterior ankle while climbing stairs. Ultrasonography revealed a complete disruption of the Achilles tendon, which was surgically repaired. His medical history was remarkable for the right Achilles tendon rupture a year ago. Investigations revealed tertiary hyperparathyroidism with chronic metabolic acidosis and high β-2 macroglobulin. With surgical repair, physiotherapy, and parathyroidectomy, the patient regained full active mobility. This case emphasized the importance of high parathyroid hormone level, metabolic acidosis, and high β-2 macroglobulin in the pathogenesis of tendons ruptures.