Incidence trends of childhood type 1 diabetes in eastern Saudi Arabia

To assess the epidemiology and incidence rate of type 1 diabetes in children <15 years of age in a subpopulation in the eastern province of the Kingdom of Saudi Arabia[KSA]. This is a subpopulation-based observational incidence study. Admission dates, diagnosis, age, and gender were collected for all Saudi children <15 years of age with new onset type 1 diabetes that received medical care at the Saudi Aramco Medical Services Organization, Dhahran Health Center, Dhahran, KSA during the period 1990-2007. The case ascertainment rate was estimated to be 100%. There were 438 patients diagnosed during the study period. The average incidence rate was 27.52/100, 000/year [95% CI: 26.72-28.32], increasing from 18.05/100,000/year in the first 9 years of the study period to 36.99/100,000/year in the last 9 years. Twenty-one percent of patients were <5 years of age, with no significant difference in the rate of increase in the incidence rate of this age group compared to the older age groups. Of the total patients, 55% were females, and 40% presented with diabetic ketoacidosis. The incidence rate of childhood type 1 diabetes increased alarmingly over the past 18 years in our study population. A Kingdom-wide diabetes registry is essential to study the epidemiology of this disease in the whole country

Unusual occurrence of cystic fibrosis and alobar holoprosencephaly

Holoprosencephaly [HPE] is a defect of embryonic forebrain resulting from failure of growth and segmentation of the anterior end of the neural tube. It has been classified into 4 types based on the severity of associated brain and facial malformations. The most severe variety called alobar HPE is generally associated with major cranio-facial anomalies such as cyclopia, ethmocephaly, cebocephaly, or cleft-lip/palate. Significant etiological heterogeneity exists in HPE and includes both genetic and environmental causes. Maternal diabetes is a well-established environmental factor with a significant increased risk for HPE. We report on a Saudi Arab girl born to a diabetic mother, with the alobar type of holoprosencephaly, associated with very minimal cranio-facial defects. However, she displayed several other congenital malformations. In addition, she was diagnosed with cystic fibrosis. Simultaneous occurrence of cystic fibrosis and congenital anomalies has been rare

Endoscopic removal of chicken bone that caused gastric perforation and liver abscess.

A 40-yr-old gentleman presented with abdominal pain, nausea and vomiting since 3 weeks. CT scan of the abdomen showed a liver abscess but also a bone penetrating the left lobe of the liver. A 5-cm-long chicken bone was removed endoscopically. He was discharged on day 8 and was asymptomatic 12 months later. Endoscopic retrieval of an extraluminal foreign body causing liver abscess has not been reported previously.

Reference intervals for important serum sex steroid hormones, prostate specific antigen, insulin like growth factor 1 and IGF binding protein 3 concentration in a normal Kuwaiti adult male population

The purpose of this study was to determine the age-specific reference ranges for some important male sex steroid hormones, prostate-specific antigen [PSA], insulin-like growth factor-1 [IGF-1], and IGF binding protein-3 [IGFBP-3], for the Kuwaiti population. Blood samples were taken from 398 consenting, fasting, healthy Kuwaiti males aged 15-80 years between 8.00 a.m. and 12.00 noon. The serum concentrations of total testosterone [TT], dehydro-epiandrosterone sulfate [DHEAS], androstenedione [ADT], sex hormone binding globulin, luteinizing hormone [LH], follicle-stimulating hormone [FSH], prolactin, PSA, IGF-1 and IGFBP-3 were determined. A distribution curve was plotted and age-specific reference levels were determined for each analyte. The reference interval for parameters with a normal distribution [Gaussian] was mean +/- 2 SD, while for the non-normal distribution [non-Gaussian], it was 2.5-97.5 percentile. The reference intervals for the analytes obtained from this study were compared with those suggested by the kit manufacturers and currently used by the Ministry of Health, Kuwait Laboratories [MOHKL]. Serum IGFBP-3 and ADT had normal distribution while other analytes had non-normal distribution. The reference intervals from this study, manufacturers kit and MOHKL were as follows: TT 3-31, 9-60, 8-35 nmol/l; DHEAS 0.9-11, 1.0-7.3, 2.2- 15.2 micro mol/l; ADT 0.5-4.3, 0.8-2.8, 2.0-9.2 nmol/l; LH 1-11, 0.8-7.6, 0.4-5.7 mIU/l; FSH 0.5-11, 0.7-11.1, 1.1-13.5 mIU/l; prolactin 42-397, 53-360, 80-230 nmol/l; IGF-1 41-542, 78-956, 71-261 ng/ml; IGFBP-3 88- 2,090, 900-4,000, 900-4,000 ng/ml, and PSA 0-3.1, 0-4, 0-4 ng/ml, respectively. These data indicate that for Kuwaitis lower reference ranges must be used for serum TT, DHEAS, ADT, IGFBP-3 and PSA. There is no need to change the currently used reference interval for FSH whereas higher values must be used for LH, prolactin, and IGF-1

Dengue haemorrhagic fever outbreak in October-November 1996 in Ludhiana, Punjab, India.

An epidemic of haemorrhagic fever broke out in Ludhiana in October and November 1996. Persons of all age groups were affected with preponderance of young adults. Haemorrhagic manifestations like rashes, epistaxis, bleeding from the gums and haematemesis were observed. The cause of fever was investigated. Serum samples collected at random from 71 patients were tested by ELISA for dengue types 1-4 IgM antibodies. These were positive in 96.7 per cent of cases. Immunoblot testing for IgM and IgG for all serotypes of dengue virus were positive in 90.2 and 73.2 per cent of the serum samples respectively. The haemorrhagic fever was serologically proven to be due to dengue virus.

Detection & elimination of preanalytical errors in the determination of zinc in biological samples.

Exogenous contamination poses a major problem to accurate determination of trace metals in biological samples. Analysis of these elements in biological material entails adoption of special precautionary measures. In this study we have assessed the various procedural steps of sampling and analysis of zinc in order to identify and minimize extraneous contamination in the laboratory. In addition we have established reference limits (2 SD) for zinc in human plasma, erythrocytes and hair.

Assessment of left ventricular diastolic function in young diabetics--a two dimensional echo Doppler study.

Left ventricular diastolic function was assessed in 21 young diabetic subjects (less than 35 years) by Doppler transmitral flow velocity examination and compared with an equal number of matched controls. Diabetic subjects had higher heart rates (89 +/- 2 vs 79 +/- 4 beats/minute, p less than 0.015), peak late diastolic (A) velocity and a velocity time integral (56.6 +/- 13.4 vs 45.3 +/- 11.4 cm/sec. p less than 0.005 and 7.3 +/- 5.2 vs 6.5 +/- 2.5 cm p less than 0.03 respectively) and total transmitral flow velocity integral (25.8 +/- 5 vs 22 +/- 3.2 cm, p less than 0.05). Peak E velocities, E velocity time integrals, E/A ratio, and peak filling rates were similar in two groups (p = not significant). These data suggests that young patients with diabetes mellitus have normal left ventricular diastolic function. The minor transmitral flow abnormalities are possibly due to autonomic dysfunction, e.g. increased sympathetic activity resulting in increased heart rate and cardiac output.

Hypoglycaemic effects of onion, Allium cepa Linn. on diabetes mellitus - a preliminary report.

Hypoglycaemic fractions of A. cepa Linn (onion) have been separated. After 7 days treatment, the more active hypoglycaemic fraction was about half as active as Phenformin in lowering the fasting blood sugar of alloxan-diabetic rabbits. Oral administration of the hypoglycaemic fraction to alloxan-diabetic rabbits improved their glucose tolerance also. Juice expressed residue of onion, when fed to diabetic patients along with their food, controlled the hyperglycaemia effectively.