Demographic and clinical characteristics of type 1 diabetes mellitus in omani children - single center experience

OBJECTIVES

To describe the demographic characteristics and clinical presentation of Omani children with type 1 diabetes mellitus at Sultan Qaboos University Hospital, Muscat, Oman.

METHODS

A retrospective analysis of all children with type 1 diabetes mellitus attending the Pediatric Endocrine Unit at Sultan Qaboos University Hospital, Oman from June 2006 to May 2013.

RESULTS

One hundred and forty-four patients were included in the study. The mean±SD of age at diagnosis was 6.7 ± 3.7 years. The median duration of symptoms was 10 days (IQR; 5-14). The most commonly reported presenting symptoms were polyuria (94%), polydipsia (82%), and weight loss (59%). Diabetic ketoacidosis at initial presentation was diagnosed in 31% of the patients. Different insulin regimens were prescribed: multiple daily injections in 109 (76%) patients, twice daily insulin regimen in 23 (16%) patients, and insulin pump therapy in 12 (8%) patients. Family history of type 1 diabetes mellitus was present in 31 (22%) patients. There were no significant differences in presenting complaints (polyuria, p=0.182; polydipsia, p=0.848), duration of symptoms (p=0.331), reported weight loss (p=0.753), or diabetic ketoacidosis at presentation (p=0.608) between patients with and without family history of type 1 diabetes mellitus.

CONCLUSION

Polyuria, polydipsia and weight loss are the most common presenting symptoms. Family history of type 1 diabetes mellitus is highly prevalent among the studied patients. Diabetic ketoacidosis was found to be less common in Oman compared to other diabetes centers in the Middle East.

Neuroprotective effect of osmotin against ethanol-induced apoptotic neurodegeneration in the developing rat brain

Fetal alcohol syndrome is a neurological and developmental disorder caused by exposure of developing brain to ethanol. Administration of osmotin to rat pups reduced ethanol-induced apoptosis in cortical and hippocampal neurons. Osmotin, a plant protein, mitigated the ethanol-induced increases in cytochrome c, cleaved caspase-3, and PARP-1. Osmotin and ethanol reduced ethanol neurotoxicity both in vivo and in vitro by reducing the protein levels of cleaved caspase-3, intracellular [Ca²⁺]_cyt, and mitochondrial transmembrane potential collapse, and also upregulated antiapoptotic Bcl-2 protein. Osmotin is a homolog of adiponectin, and it controls energy metabolism via phosphorylation. Adiponectin can protect hippocampal neurons against ethanol-induced apoptosis. Abrogation of signaling via receptors AdipoR1 or AdipoR2, by transfection with siRNAs, reduced the ability of osmotin and adiponectin to protect neurons against ethanol-induced neurodegeneration. Metformin, an activator of AMPK (adenosine monophosphate-activated protein kinase), increased whereas Compound C, an inhibitor of AMPK pathway, reduced the ability of osmotin and adiponectin to protect against ethanol-induced apoptosis. Osmotin exerted its neuroprotection via Bcl-2 family proteins and activation of AMPK signaling pathway. Modulation of AMPK pathways by osmotin, adiponectin, and metformin hold promise as a preventive therapy for fetal alcohol syndrome.

Self assembled homodinuclear dithiocarbamates: one pot synthesis and spectral characterization

Several self assembled homodinuclear complexes of the type [M2(Ldtc)2·4H2O] derived from quadridentate ligand (Ldtc), where Ldtc = 2-aminobenzoylhydrazidebis(dithiocarbamate) and M = Mn(II), Fe(II), Co(II), Ni(II), Cu(II) and Zn(II) have been reported. The in situ procedure gives high yield with the formation of single product as evident by TLC and various other physicochemical techniques. Elemental analysis, TGA, (1)H NMR, (13)C NMR, ESI mass spectrometry, EPR, UV-vis. and IR spectroscopy were used to characterize the homodinuclear complexes. The spectroscopic evidences and room temperature magnetic moment values suggest that all the complexes have octahedral geometry around the transition metal atom. A symmetrical bidentate coordination of the dithiocarbamato moiety has been observed in all the complexes. The energy-minimized structure of the molecule also showed that each metal atom acquires a distorted octahedral geometry. The complexes exhibit a three-step thermolytic pattern and are non-electrolyte in nature.

A national house-staff audit of medical prophylaxis in medical patients for the PREVENTion of Venous ThromboEmbolism (PREVENT-VTE)

We established a national audit to assess the thromboprophylaxis rate for venous thromoembolism (VTE) in at risk medical patients in acute hospitals in the Republic of Ireland and to determine whether the use of stickers to alert physicians regarding thromboprophylaxis would double the rate prophylaxis in a follow-up audit. 651 acute medical admission patients in the first audit and 524 in the second re-audit were recruited. The mean age was 66.5 yrs with similar numbers of male and female patients and 265 (22.6%) patients were active smokers. The first and second audits identified 549 (84%) and 487 (93%) of patients at-risk for VTE respectively. Of the at-risk patients, 163 (29.7%) and 132 (27.1%) received LMWH in the first and second audit respectively. Mechanical thromboprophylaxis was instigated in 75 (13.6%) patients in the first and 86 (17.7%) patients in the second audit. The placement of stickers in patient charts didn't produce a significant increase in the number of at risk patients treated in the second audit. There is unacceptably low adherence to the ACCP guidelines in Ireland and more complex intervention than chart reminders are required to improve compliance.

Change in heritability estimates due to half-sib family selection in the maize variety Pahari

This research was carried out at the Agriculture Research Farm, Khyber Pakhtunkhwa Agricultural University, Peshawar, and the Cereal Crops Research Institute, Pirsabak, Nowshera, during 2009 and 2010. Half-sib families (HS) derived from the maize variety Pahari in spring crop seasons 2009 and 2010 were developed at the Cereal Crops Research Institute. All HS families were detasseled well before pollen shedding. At maturity, each family was harvested and shelled separately. During the summer crop of seasons 2009 and 2010, these HS families were evaluated in 12 x 12 and 11 x 11 partially balanced lattice square arrangements at the Khyber Pakhtunkhwa Agricultural University, Peshawar, for various flowering and yield traits, respectively. The data on days to mid-silking, anthesis, anthesis-silking interval, 100-grain weight, and grain yield were recorded. The results revealed significant differences among families for all traits in both cycles. High heritability (0.88) was observed for days to mid-silking in cycle 0 (C₀), while moderate heritability (0.42) was recorded for 100-grain weight in C₁. The selection differential was quite reasonable and varied according to the traits of interest. The observed response for grain yield in C₀ (815.74 kg/ha) was greater than the expected response (681.76 kg/ha).

Mycobacterium chelonae hand infection following ferret bite

We present a case of hand infection caused by Mycobacterium chelonae. The patient was a 58-year-old woman with Type II diabetes mellitus and stage 4 chronic kidney disease. The infection occurred following a ferret bite and had not responded to oral antibiotics in the primary care setting. She developed signs of pyogenic flexor tenosynovitis of the index and middle fingers of her left hand. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Ultrasound imaging confirmed the clinical diagnosis. Plain radiographs showed no osseous involvement. The infection was treated with surgical debridement and broad spectrum parenteral antibiotics. The intra-operative tissue specimens were initially negative on aerobic and anaerobic cultures. Following transient improvement of her inflammatory parameters and clinical signs, she developed a recurrence with added features of osteomyelitis of the index and middle finger metacarpal heads on repeat radiographs. A revision surgical debridement of the flexor tenosynovitis and osteomyelitis with specific long-term antibiotic cover has led to resolution of the infection. Extended cultures of the tissue specimens at the regional laboratory confirmed the causative organism to be M. chelonae. To our knowledge, this is the first reported case of M. chelonae infection resulting from a ferret bite. This case reminds us of the need for a high index of suspicion for infection with uncommon pathogens following animal bites, especially in patients with altered immune status.

Detection of bacterial blight resistance genes in basmati rice landraces

Aromatic basmati rice is vulnerable to bacterial blight disease. Genes conferring resistance to bacterial blight have been identified in coarse rice; however, their incorporation into basmati varieties compromises the prized basmati aroma. We identified bacterial blight resistance genes Xa4, xa5, Xa7, and xa13 in 52 basmati landraces and five basmati cultivars using PCR markers. The Xa7 gene was found to be the most prevalent among the cultivars and landraces. The cultivars Basmati-385 and Basmati-2000 also contained the Xa4 gene; however, xa5 and xa13 were confined to landraces only. Ten landraces were found to have multiple resistance genes. Landraces Basmati-106, Basmati-189 and Basmati-208 contained Xa4 and Xa7 genes. Whereas, landraces Basmati-122, Basmati-427, Basmati-433 were observed to have xa5 and Xa7 genes. Landraces Basmati-48, Basmati-51A, Basmati-334, and Basmati-370A possessed Xa7 and xa13 genes. The use of landraces containing recessive genes xa5 and xa13 as donor parents in hybridization with cultivars Basmati-385 and Basmati-2000, which contain the genes Xa4 and Xa7, will expedite efforts to develop bacterial blight-resistant basmati rice cultivars through marker assisted selection, based on a pyramiding approach, without compromising aroma and grain quality.

Genetic diversity analysis of Bt cotton genotypes in Pakistan using simple sequence repeat markers

The popularity of genetically modified insect resistant (Bt) cotton has promoted large scale monocultures, which is thought to worsen the problem of crop genetic homogeneity. Information on genetic diversity among Bt cotton varieties is lacking. We evaluated genetic divergence among 19 Bt cotton genotypes using simple sequence repeat (SSR) markers. Thirty-seven of 104 surveyed primers were found informative. Fifty-two primers selected on the basis of reported intra-hirsutum polymorphism in a cotton marker database showed a high degree of polymorphism, 56% compared to 13% for randomly selected primers. A total of 177 loci were amplified, with an average of 1.57 loci per primer, generating 38 markers. The amplicons ranged in size from 98 to 256 bp. The genetic similarities among the 19 genotypes ranged from 0.902 to 0.982, with an average of 0.947, revealing a lack of diversity. Similarities among genotypes from public sector organizations were higher than genotypes developed by private companies. Hybrids were found to be more distant compared to commercial cultivars and advanced breeding lines. Cluster analysis grouped the 19 Bt cotton genotypes into three major clusters and two independent entries. Cultivars IR-3701, Ali Akbar-802 and advanced breeding line VH-259 grouped in subcluster B2, with very narrow genetic distances despite dissimilar parentage. We found a very high level of similarity among Pakistani-bred Bt cotton varieties, which means that genetically diverse recurrent parents should be included to enhance genetic diversity. The intra-hirsutum polymorphic SSRs were found to be highly informative for molecular genetic diversity studies in these cotton varieties.

Vitamin C protects against ethanol and PTZ-induced apoptotic neurodegeneration in prenatal rat hippocampal neurons

Exposure to alcohol during brain development may cause a neurological syndrome called fetal alcohol syndrome, characterized by pre- and postnatal growth deficiencies, craniofacial anomalies, and evidence of CNS dysfunction. The objective of this study was to evaluate pentylenetetrazol (PTZ) and ethanol effects on Bax, Bcl-2 expression, which further induced activation of caspase-3, release of cytochrome-c from mitochondria, and to observe the protective effects of vitamin C (vit-C) against PTZ and ethanol-induced apoptotic neurodegeneration in primary-cultured neuronal cells at gestational day 17.5. Apoptotic neurodegeneration and neuroprotective effect of vit-C were measured by using 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide assay, Western blot analysis, which further conformed by the measurement of mitochondrial membrane potential using JC-1 detection kit and immunofluorescence analysis. The results showed that PTZ and ethanol produced extensive Bax-dependent caspase-9 and caspase-3 activation and caused neuronal apoptosis. Furthermore, the cotreatment of vit-C along with ethanol and PTZ showed significantly decreased expression of Bax, caspase-9, caspase-3, cytochrome-c, and significantly increased expression of antiapoptotic Bcl-2 protein when compared with control group. Our findings indicate that PTZ and ethanol activate an intrinsic apoptotic death program in neurons that is likely to contribute to the neuropathologic effects in fetal alcohol exposure, and vit-C can prevent some of the deleterious effects of PTZ and ethanol on the developing brain. The available experimental evidence and the safety of vit-C in pregnancy suggest the experimental use of ascorbic acid as a new and effective protective agent ethanol and PTZ-induced apoptotic neurodegeneration.

Ethanol and PTZ effects on siRNA-mediated GABAB1 receptor: down regulation of intracellular signaling pathway in prenatal rat cortical and hippocampal neurons

GABA(B) receptors (R) are widely expressed and distributed in the nervous system, and have been implicated in variety of neurodegenerative and pathophysiological disorders. However, the exact molecular mechanism regarding responsibility of GABA(B1)R in downstream signaling pathway is not well understood. The present study was undertaken to explore the downstream signaling and role of GABA(B1)R upon acute ethanol and pentylenetetrazol (PTZ) exposure for (20 min) in cortical and hippocampal neuronal cell cultures by using GABA(B1)R RNA interference (i) (30 nM, 48 h) at gestational days 17.5. The results showed that GABA(B1)R and protein kinase A-alpha (PKA) showed decreased expression upon ethanol and PTZ exposure in cortical and hippocampal neurons during transfected and nontransfected conditions, whereas these effects could lead to significant changes in phosphorylation of cAMP-response element binding protein (p-CREB) expression where GABA(B1)R was knocked down. Furthermore, intracellular Ca(+2) concentrations were also reduced in some groups after transfection with GABA(B1)R RNAi. These results showed a critical role of GABA(B1)R upon ethanol and PTZ exposure by modulating downstream signaling pathway. Finally, these findings suggested that inhibition of GABA(B1)R results in the modulation of PKA, p-CREB pathway may play a role in long-term changes in the nervous system, and may be an underlying cause of ethanol's effects.

The BCG scar size in asthmatic and non-asthmatic children

OBJECTIVE

To compare the BCG size in asthmatic and nonasthmatic children.

METHODS

The size of BCG scar of two groups of children (the asthmatic group with a family history of some allergic disorder like asthma, atopic dermatitis, allergic rhinitis or allergic conjunctivitis in the first degree blood relatives and the control non asthmatic group with no history of any allergic disorder in the child or in the first degree blood relatives) of age 18 to 60 months having weight at or above 5th centile and BCG scar on right arm with a history of BCG vaccination in the first month of life, coming to a paediatric Clinic at Liaqatpur on every Friday and Sunday from October 2007 to July 2008, was measured and compared.

RESULTS

Total 284 children were included for the study, 142 children in each group. The diameter of BCG scar was measured. 45.77% asthmatics compared to 31.69% nonasthmatics had BCG scar mark < or = 5 mm. The asthmatic patients demonstrated a 1.82 times greater risk of presenting a BCG scar diameter of < or = 5 mm when compared to the nonasthmatic group (odd ratio: 1.82; P = 0.0204). The mean (95% CI) diameter of BCG scar was 6.4mm (CI: 6.026082 to 6.775918 ) in the nonasthmatic group and 5.8mm ( 95% CI: 5.459303 to 6.146297) in asthmatic group. The difference was significant ( t test, P = 0.0204).

CONCLUSION

Asthmatic children have smaller BCG scar as compared to nonasthmatic children.

Genetic variation for stomatal conductance in upland cotton as influenced by heat-stressed and non-stressed growing regimes

Stomatal conductance is an important heat avoidance mechanism and its association with higher yield and heat resistance has been established in Pima cotton. Experiments were carried out on upland cotton under heat-stressed and non-stressed greenhouse and field regimes, to understand the impact of heat-stressed and non-stressed environments on the genetic and combining ability variations for stomatal conductance. The experimental material comprised 8 upland cotton cultivars and their 15 F 1 cross combinations obtained in a line × tester mating arrangement. The results showed high genetic variability for stomatal conductance in a single environment, but low genetic variability across environments, due to the higher magnitude of the environmental interaction, especially that caused by temperature regimes. The interaction effect of temperature regimes also substantially modified general and specific combining ability variations for stomatal conductance. The relative contributions of general and specific combining abilities to total phenotypic variation for stomatal conductance also underwent a great change across field temperature regimes. The non-stressed regime favoured the expression of genes causing the additive type of genetic variability. The heat-stressed field regime, however, favoured the expression of both additive and non-additive types of genetic variation for stomatal conductance in upland cotton. Recurrent selection for the accumulation of favourable genes for general combining ability under non-stressed conditions was suggested for improving stomatal conductance in applied cotton breeding programmes.

Isolated hypoglossal nerve palsy: a harbinger of malignancy

The hypoglossal nerve is an underrated nerve usually consigned to a few words in anatomical text books, under the last four cranial nerves. However, paralysis of this nerve may be the first indication of a serious underlying disorder. Excluding previous surgery, radiotherapy and trauma, 50 per cent of cases of isolated hypoglossal nerve palsy are idiopathic. A further 20 per cent are malignant, 20 per cent are vascular and 10 per cent are due to miscellaneous causes. Presentation of an isolated hypoglossal nerve palsy is therefore an ominous sign. There is confusion over both cause and investigation, and management protocols for isolated hypoglossal nerve palsy are ill-defined. We present a case of isolated hypoglossal palsy which was due to a metastatic skull base deposit. This case illustrates the fact that magnetic resonance imaging is the investigation of choice in assessing the entire course of the hypoglossal nerve.

Do citation classics in rhinology reflect utility rather than quality?

Citation rates have been suggested to be more of an indicator of utility than quality. The aim of this study was to apply measures of utility and quality to articles identified as citation classics in rhinology/anterior skull base surgery. There were 14 articles analysed in the study. The assessment of quality was performed by combining factors from previous publications on quality assessment and the various elements were categorised into four groups; quality of written article and publication, quality of research, quality of evidence-based methodology and quality of outcome. This study revealed that citation classics in rhinology/anterior skull base surgery were well-written and satisfied peer review in reputable journals in the specialty. Quality is satisfied by clarity of exposition and patient numbers. The research was generally asking an important question and the methodology overall was adequate and appropriate for the type of study performed. A good quality of research and outcome was demonstrated with a definite historical importance, and reports that stimulated further research and enquiry. Quality is not satisfied by the lack of randomised controlled trials, appropriate statistical analysis or patient criteria. In conclusion citation rates when considered as an individual measure, reflect utility rather than quality.

Nutritional evaluation of desi and kabuli chickpeas and their products commonly consumed in Pakistan

Physicochemical and nutritional quality of five improved cultivars of desi and kabuli chickpeas and their products were studied. The kabuli chickpea had larger seed (26 g/100 seeds) than desi type (21 g/100 seeds). The hydration capacity per seed of desi (0.16 g) was lower than kabuli type (0.26 g). A positive correlation (r = 0.87) between seed weight and hydration capacity was observed. The mean cooking time of dry desi vs kabuli seed (124.5 vs 113.8 min) was reduced to 37.5 vs 32.8 min and to 28.8 vs 22.5 min when soaked overnight in water and in 0.5% solution of sodium bicarbonate respectively. The mean value of protein (25.4 vs 24.4%), fat (3.7 vs 5.1%), carbohydrate (47.4 vs 55%), crude fibre (11.2 vs 3.9%), ash (3.2 vs 2.8%) and caloric value (327 vs 365 kcal/100 g) were for desi vs kabuli chickpeas respectively. There was no difference in the essential amino acid contents and in chemical scores of desi (65) and kabuli (67) chickpeas. The order of limiting amino acid was methionine+cystine, threonine and valine in both types. The chickpeas products contained 8.9-21.1% protein (N x 6.25), 3.1-21.8% fat, 53.4-75.9% carbohydrate, 1.6-11.1% crude fibre, 1.2-5.9% ash, 226-360mg Ca, 126-315 mg P, 3.8-8.2 mg Fe, 1.8-5.4 mg Zn, 1.5-5.4 mg Mn, 0.6-1.1 mg Cu and 370-490 kcal per 100 g. All chickpea products provided 7-23%, 7-40% and 52-78% of the total calories from protein, fat and carbohydrates respectively.(ABSTRACT TRUNCATED AT 250 WORDS)