Introduction: The spectrum of kidney functional and structural alterations in sickle cell hemoglobinopathy (SCH) is broad. Also, morbidity and mortality from end organ dysfunction, especially cardiorenal dysfunction, are substantial. Consequently, screening an SCH population prospectively for surrogate markers of cardiorenal risk such as albuminuria and intima-media thickness (IMT) was the aim of this cross-sectional study. Patients and Methods: We screened 165 patients with SCH over 4 months at the Primary Care Department, King Abdulaziz Armed Forces Hospital, Saudi Arabia. The 133 who fulfilled the inclusion criteria have been referred for further investigations. Anthropometric evaluation of body mass index (BMI) and blood pressure (BP), determination of 24-hour urine albuminuria, fasting lipids, computed atherogenic risk ratio (ARR), estimated glomerular filtration rate (eGFR), common carotid artery (CCA) IMT measurements, and hemoglobin (Hb) electrophoresis were done. Results: Increased urinary albumin excretion (UAE) rate [380 (272.2–489.6) mg/day; mean and 95% confidence interval (95% CI) of mean] was detected in 24% of SCH patients (6 males and 26 females). Microalbuminuria (168.8 ± 59.7 mg/day) was noted in the majority (63.6%) while macroalbuminuria (752.7 ± 205.4 mg/day) was detected in a smaller percentage (36.4%). Patients with sickle cell disease (SCD) contributed about 66.6% of subjects with microalbuminuria and 100% of those with macroalbuminuria, while most individuals with sickle cell trait (89%) were normoalbuminuric (p < 0.0001). Preclinical atherosclerosis (increased CCA IMT and/or atheromatous plaques) was noticed in 68.8% of SCH individuals with increased UAE (ANOVA p = 0.003). The microalbuminuric and macroalbuminuric patients had comparable BMI, BP values and lipid profiles. However, the microalbuminuric sicklers were significantly younger (28.4 ± 6.7 vs. 34.0 ± 7.2 years, p = 0.04), less anemic (Hb: 9.13 ± 2 vs. 7.47 ± 0.8 g/dl, p = 0.015), with lesser atherosclerosis (IMT; 0.68 ± 0.1 vs. 0.78 ± 0.1 mm, p = 0.004) and higher eGFR (83.3 ± 17.2 vs. 61 ± 10.7 ml/min/1.73 m², p = 0.0004) compared to those with macroalbuminuria. UAE correlated positively with age (r = 0.591, p = 0.0001), systolic BP (r = 0.483, p = 0.005), IMT (r = 0.399, p = 0.024) and negatively with Hb (r = –0.409, p = 0.02), and eGFR (r = –0.620, p = 0.0001). By univariate analysis, the significant indicators of UAE in SCH patients were age (p = 0.05), BMI (p = 0.041), IMT (p = 0.018) and eGFR (p = 0.016). Also, increased risk (odds ratio) of albuminuria was noted with SCD, age, anemia, abnormal eGFR, obesity, and ARR. Conclusions: Markers of cardiorenal risk such as albuminuria and IMT are common findings in SCH patients of Arabic descent and could be useful screening tools to identify sicklers at risk for cardiovascular and renal events.

Diabetes mellitus is a metabolic disease characterised by elevated levels of blood glucose and is a leading cause of disability and mortality. Uncontrolled type 2 diabetes leads to complications such as retinopathy, nephropathy and neuropathy. Improved treatment of hyperglycaemia is likely to delay the onset and progression of microvascular and neuropathic complications.This article describes the efforts of 18 governmental hospitals in the Kingdom of Saudi Arabia that enrolled in a collaborative improvement project to improve the poor glycaemic control (HbA1c >9% to be less than 15%) of patients with diabetes by the end of 2021 among all the chronic illness clinics in the enrolled military hospitals. Enrolled hospitals were required to implement an evidence-based change package that included the implementation of diabetes clinical practice guidelines with standardised assessment and care planning tools. Furthermore, care delivery was standardised using a standard clinic scope of service that focused on multidisciplinary care teams. Finally, hospitals were required to implement diabetes registries that were used by case managers for poorly controlled patients.The project timetable was from October 2018 to December 2021. Diabetes poor control (HbA1c >9%) showed improved mean difference of 12.7% (34.9% baseline, 22.2% after) with a p value of 0.01. Diabetes optimal testing significantly improved from 41% at the start of the project in the fourth quarter of 2018, reaching 78% by the end of the fourth quarter of 2021. Variation between hospitals showed a significant reduction in the first quarter of 2021.The collaborative multilevel approach of standardising the care based on the best available evidence through policies, guidelines and protocols, patient-focused care and integrated care plan by a multidisciplinary team was associated with noticeable improvement in all key performance indicators of the project.

Background: Diabetes mortality is increased when accompanied with depression. Screening for depression is recommended by national and international authorities. Aims & Objective:To have an estimate of the diabetic patients at risk of depression and to identify the risk factors for depression in diabetic patients. Material and Methods:The study was designed as a cross-section design. Two hundred and three patients were selected by convenience sample. Diabetic patients of either sex, 18 years and older, new to the clinic or follow up were included. Mentally retarded patients or with psychiatric disease were excluded. An interview questionnaire was used for data collection. The two-item version of patients' health questionnaire (PHQ-2) was used as a screening tool. Results: Patients with PHQ-2 positive were constituted 45.8%. Depression was associated with female gender (p=0.049), long standing diabetes (p=0.035), insulin use (p=0.024), and with other medical comorbidities (p=0.006). Conclusion: Although all diabetic patients are at risk of having depression, female gender, long standing diabetes, insulin use and having medical comorbidities are at higher risk.

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