Peripheral neuropathy is a commonly reported chronic adverse event among diabetes mellitus (DM) patients secondary to poor glycemic control. It might also result secondary to deficiency of vitamin B12, reportedly common among diabetic patients. Deficiency of vitamin B12 might result from prolonged metformin administration in patients with type II DM (T2DM). It might also result from reduced absorption and impaired metabolism-related events in type I DM (T1DM) patients. This occurs secondary to the presence of associated autoimmune disorders. Vitamin B12 deficiency is a commonly encountered condition among diabetic patients, both T1DM and T2DM, with variable etiologies. Our current study discussed the epidemiology and importance of screening of vitamin B12 in these patients. However, our findings show that screening is not commonly practiced in different settings. Therefore, awareness is low about the benefits and complications of this practice. Therefore, further research is encouraged to alleviate the quality of care in diabetic patients. Screening for vitamin B12 deficiency might intervene against any potential complications, including irreversible, painful, and potentially disabling nerve injury. Accordingly, it is recommended that screening should be initiated since the start of metformin administration and every year or when relevant clinical manifestations were reported.

Background: Irritable Bowel Syndrome (IBS) is a very common gastrointestinal dysfunction. Notwithstanding strong evidence of high prevalence of depression and anxiety in IBS there is very limited research on this topic in KSA. Materials and Methods: Cases of irritable bowel syndrome and controls with non-ulcerative dyspepsia were employed between March 2016 to May 2017 from the gastroenterology department in King Abdulaziz hospital, KSA. Presence of anxiety disorder and depression were evaluated by utilizing the Hamilton Anxiety rating scale and Hamilton Depression rating scale respectively. Occurrence rates of anxiety and depression were established and Odds Ratio (OR) was calculated to determine the association of depression and anxiety disorders with IBS. Results: In IBS cases, the prevalence of depression and anxiety disorder was 37.2% and 31.5% respectively. In patients with irritable bowel syndrome the OR for depression was 6.1 (95% CI 1.7-23.6, P=0.008) and the OR for anxiety disorder was 7.3 (95% CI 1.5-36.2, P=0.011). Conclusion: The occurrence of depression and anxiety disorder in IBS is very high. As a result, screening of IBS patients for anxiety and depression would facilitate better interventions and consequently better outcomes and medical treatment.

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Results from published studies on the association between non-alcoholic fatty liver disease and hypothyroidism are still controversial. Thyroid dysfunction is closely related with components of metabolic syndrome. We conducted this meta-analysis using a comprehensive search of EMBASE, MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials till 31 January 2018 for prospective observational studies that evaluated the relationship of non-alcoholic fatty liver disease and thyroid function in adult patients. Thirteen studies were included in the present meta-analysis. Meta-analysis of the 13 studies found a high correlation between hypothyroidism and NAFLD (OR=1.48, 95% CI 1.22–1.91, p<0.001). In the meta-regression analyses, we found that study design was a possible source of heterogeneity (p=0.17), but other covariates were not. The present meta-analysis provides strong epidemiological evidence for the relationship between hypothyroidism and NAFLD. Both individuals with subclinical and overt hypothyroidism are at higher risk for NAFLD than euthyroid subjects.