Prevalence and prognosis of fulminant type 1 diabetes mellitus in The Middle East: a comparative analysis in a 5-year nationwide cohort.

PURPOSE: To analyze the prevalence and progression of fulminant type 1 diabetes (FT1D) in Qatar. METHODS: This retrospective study analyzed consecutive index- diabetic ketoacidosis (DKA) admissions (2015-2020) among patients with new-onset T1D (NT1D) in Qatar. RESULTS: Of the 242 patients, 2.5% fulfilled the FT1D diagnostic criteria. FT1D patients were younger (median-age 4-years vs.15-years in classic-T1D). Gender distribution in FT1D was equal, whereas the classic-T1D group showed a female predominance at 57.6% (n = 136). FT1D patients had a mean C-peptide of 0.11 ± 0.09 ng/ml, compared to 0.53 ± 0.45 ng/ml in classic-T1D. FT1D patients had a median length of stay (LOS) of 1 day (1-2.2) and a DKA duration of 11.25 h (11-15). The median (length of stay) LOS and DKA duration in classic-T1D patients were 2.5 days (1-3.9) and 15.4 h (11-23), respectively. The FT1D subset primarily consisted of moderate (83.3%) and severe 916.7%) DKA, whereas classic T1D had 25.4% mild, 60.6% moderate, and 14% severe DKA cases. FT1D was associated with a higher median white cell count (22.3 × 103/uL) at admission compared to classic T1D (10.6 × 103/uL). ICU admission was needed for 66.6% of FT1D patients, compared to 38.1% of classic-T1D patients. None of the patients in the FT1D group had mortality, while two died in the classic-T1D group. CONCLUSION: This is the first study establishing the existence of FT1D in ME, which presented distinctively from classic-T1D, exhibiting earlier age onset and higher critical care requirements. However, the clinical outcomes in patients with FT1D seem similar to classic T1D.

Corrigendum: Association of Complement-Related Proteins in Subjects With and Without Second Trimester Gestational Diabetes.

[This corrects the article DOI: 10.3389/fendo.2021.641361.].

Association of Complement-Related Proteins in Subjects With and Without Second Trimester Gestational Diabetes.

Introduction: Gestational Diabetes Mellitus (GDM) development is related to underlying metabolic syndrome that is associated with elevated complement C3 and C4. Elevated C3 levels have been associated with preeclampsia and the development of macrosomia. Methods: This case-control study included 34 pregnant women with GDM and 16 non-diabetic (ND) women in their second trimester. Complement-related proteins were measured and correlated with demographic, biochemical, and pregnancy outcome data. Results: GDM women were older with a higher BMI (p<0.001); complement C3, C4 and Factor-H were significantly elevated (p=0.001, p=0.05, p=0.01, respectively). When adjusted for age and BMI, Complement C3 (p=0.04) and Factor-H (p=0.04) remained significant. Partial correlation showed significant correlation between C4 with serum alanine aminotransferase (ALT) (p<0.05) and 2nd term diastolic blood pressure (p<0.05); Factor-H and C-reactive protein (CRP; p<0.05). Pearson bivariate analysis revealed significant correlations between C3, C4, and Factor-H and CRP; p<0.05; C3 and gestational age at delivery (GA; p<0.05); C4 and ALT and second-trimester systolic blood pressure (STBP) (p=0.008 and p<0.05, respectively); Factor-H and glycated hemoglobin (HbA1c) (p<0.05). Regression analysis showed that the elevation of C3 could be accounted for by age, BMI, GA and CRP, with CRP being the most important predictor (p=0.02). C4 elevation could be accounted for by ALT, CRP and STBP. CRP predicted Factor-H elevation. Conclusion: The increased C3, C4 and Factor-H during the second trimester of pregnancy in GDM are not independently associated with GDM; inflammation and high BMI may be responsible for their elevation. The elevation of second trimester C3 in GDM is associated with earlier delivery and further work is needed to determine if this is predictive.

The prevalence of metabolic syndrome in patients receiving antipsychotics in Qatar: a cross sectional comparative study.

BACKGROUND: Metabolic abnormalities are common in patients maintained on antipsychotics. These abnormalities increase the risk of cardiovascular diseases and mortality in this population. The aim of this study is to assess the prevalence of metabolic syndrome (MetS) in subjects maintained on antipsychotics relative to controls in Qatar, and to assess the factors contributing to the development of MetS. METHODS: A cross sectional design was used to collect data and fasting blood samples from subjects maintained on antipsychotics for at least six months (n = 112) and from a control group (n = 114). The groups were compared in regard to prevalence of MetS, and multiple regression analysis was used to determine the risk factors in each group. RESULTS: The two groups (antipsychotics vs. control) were similar in regard to age (35.73 ± 10.28 vs. 35.73 ± 8.16 years) and gender ratio. The MetS was higher among the subjects on antipsychotics, but this difference did not reach statistical significance. Blood pressure (BP) was significantly higher in the antipsychotics group and BMI was the major risk factor to develop MetS in this group. CONCLUSIONS: The prevalence of MetS in both groups is high and mostly attributed to obesity and high BP. Public health interventions are needed to address this major health problem overall. Larger studies are needed to further assess the impact of antipsychotics and mental illness on the development of MetS.

Antibiotic screening of urine culture as a useful quality audit.

INTRODUCTION: The diagnosis of urinary tract infections includes microbiologic culture of urine to determine the etiology of the infection. However, interpretation of the results can be confounded by various factors including the accuracy of a patient's history of current antibiotic usage.  METHODOLOGY: In this report, we tested urine specimens for the presence of antibiotics and compared our results to the accuracy of antibiotic data entry on the accompanying request forms. In addition, the consequences of culturing urine specimens with incomplete antibiotic history received in the laboratory were investigated. RESULTS: During the study period, 14,680 urines were obtained and tested with a modified urine antibacterial substance assay (UABA). There were (97.32%) true-negative, 6 (0.04%) false-negative, 222 (1.51%) true-positive and 166 (1.13%) false-positive results. The sensitivity and specificity of this test was 97.37% and 98.85% respectively. CONCLUSION: This internal audit practice demonstrates the importance of accurately completed request forms and how this information impacts the clinical interpretation of urine culture results. 

Real-time validation and presentation of the cumulative antibiogram and implications of presenting a standard format using a novel in-house software: ABSOFT.

BACKGROUND: Antibiograms must use a standard format to present microbiologic data. OBJECTIVE: When antibacterials are selected for the treatment of infections, knowledge of the locally most likely causative organisms and the prevalence of resistant pathogens to antibacterial agents are essential. This involves generating a cumulative antibiogram. We designed an in-house novel software to prepare our antibiogram, validate data, and analyze results and assessed the performance of this technology. It should be noted that analysis of specific antibiotic resistance patterns were not a focus of this study. SETTING: The study was conducted at Al Khor Hospital, Hamad Medical Corporation, a 110-bed acute care hospital that serves patients in the northern area of Qatar. Positive microbiology cultures excluding surveillance samples, isolated in the microbiology laboratory from January 2008 to December 2008, were entered into an in-house software, ABSOFT, designed by one of the authors. RESULTS: The software produced the antibiogram in a fixed format. Epidemiologic data and comparison of our data to the National Nosocomial Infection Surveillance benchmark for multidrug-resistant organism distribution were also presented real time. Automatic color-coded results in tabular format were printed instantaneously without errors, thus eliminating the need to be reviewed. CONCLUSION: The paper highlights real-time validation and presentation of the cumulative antibiogram, additionally suggesting the format for reporting using a novel in-house software ABSOFT. This technology provided us an accurate, simple, cost-effective solution to present validated data real-time in a transparent and consistent manner. To our knowledge to date, no uniform format has been recommended for the presentation of cumulative antibiograms.

Enhancing self-management in children with sickle cell disease through playing a CD-ROM educational game: a pilot study.

PURPOSE: To determine whether playing a simple CD-ROM educational game (developed specifically for children with sickle cell disease), improved children's knowledge and confidence in selected symptom management and practice. METHOD: Twenty-two eligible children completed a pretest to determine knowledge and confidence levels, played the Sickle Cell Slime-O-Rama Game, then completed an identical posttest. FINDINGS: Significant increases in knowledge (t = 2.828, p =.010) and confidence (t = 3.759, p =.001) levels between pre- and posttests were identified. CONCLUSIONS: It is promising that a simple, interacting CD-ROM game allowed children with sickle cell disease to quickly acquire knowledge about the disease and symptom management, and increased their confidence to apply this new knowledge. Results suggest the high utility of this tailored game to foster active self-management behaviors in this population.

Lipid peroxidation of fish oils.

Fish and fish oils are the richest sources of ω-3 fatty acids. However, they are susceptible to lipid peroxidation due to their high degree of unsaturation. In the present study, the level of thiobarbituric acid reactive material in various fish oils available in the market with and without added Vitamin E was determined. The peroxide levels in fish oil heated to food frying temperature of 180°C and the effect of addition of vitamin E has also been studied. The results indicate that the peroxide levels in almost all the products available in the market were abnormally high irrespective of their Vitamin E content. This might be due to the inefficient methods used for processing and storage of fish oils. Addition of vitamin E was found to have a significant effect in lowering the rate of peroxidation of fish oil during thermal stress, showing that association of antioxidants with ω-3 fatty acids lowers the rate of lipid peroxidation.