The impact of Ramadan fasting on Fetuin-A level in type 2 diabetes mellitus.

BACKGROUND/AIMS: Ramadan fasting creates changes in lifestyle, causing biochemical alterations that affect glucose metabolism and insulin sensitivity. This study aims to assess the impact of Ramadan fasting on glycemic control and Fetuin-A, a glycoprotein that affects insulin resistance, in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: This was a prospective study done among 37 patients with T2DM from Internal Medicine Polyclinic in a hospital in Jakarta, Indonesia. Anthropometric data as well as Hemoglobin A1c (HbA1c), Fasting Blood Glucose (FBG), and Fetuin-A levels of the subjects were measured in three time points: before, during, and after Ramadan fasting. A bivariate analysis was done to see the effect of Ramadan fasting on those parameters. RESULTS: Ramadan fasting reduced Fetuin-A levels [median (minimum-maximum), 5.35 (2.91-7.81) vs. 3.22 (2.35-5.60) mg/dl; p = 0.039] four weeks after the end of Ramadan compared to pre-Ramadan. After two weeks of Ramadan fasting, we found a significant reduction in body weight, BMI, FBG, and HbA1c levels which rebounded to baseline level after Ramadan. CONCLUSION: Ramadan fasting was associated with a significant decrease in Fetuin-A level post Ramadan.

Liposarcoma of the nasopharynx: a case report.

We present a case of liposarcoma of the nasopharynx in a 28-year-old woman. The tumor was incompletely resected through an intraoral approach and supplementary radiotherapy of 50 Gy in a restricted field was therefore administered. Eleven years of follow-up show the patient to be disease free.

Malignant nasopharyngeal tumors in children.

From 1964 to 1984, 25 children with malignant tumors of the nasopharynx were seen, and their progress was followed at The Hospital for Sick Children in Toronto. Two types of malignancies: rhabdomyosarcoma and lymphoepithelioma were most prevalent with eight cases apiece. The presenting signs and symptoms were related to local and/or regional manifestations of disease. No child presented with signs or symptoms related to distant metastatic disease. The diagnosis and treatment of this series of patients are described briefly. The advent of combined treatment modalities in the past decade has improved the prognosis for nasopharyngeal tumors, especially for the rhabdomyosarcomas; in general, however, survival rates are still poor, approximating 50%.

A study of cell membrane structure.

Neoplastic transformation has been associated with a variety of structural changes, among which are changes in membrane carbohydrates. Not much is known, though, e.g., how early in the tumourogenic event these changes take place and what effect these changes have on cell growth, invasion, and ability to metastasize. We were able to identify the B-D-Gal(1-3)DGal-NAc as a membrane carbohydrate component present in malignant laryngeal tissue, but not on adjacent normal mucous membrane. This carbohydrate structure was found to be present in metastatic as well as in nonmetastatic tumours. It was also found in well-differentiated as well as poorly differentiated carcinomas. We suggest that changes in carbohydrate components on the cell membrane of the laryngeal cancer cell are an early event in tumour progression and probably are not related to the degree of invasion or the ability to metastasize.

Obstructive sleep apnea in young infants.

Obstructive sleep apnea (OSA) was diagnosed in 14 infants less than 18 months of age. Snoring, apnea, failure to thrive, developmental delay and recurrent respiratory infections were the main presenting symptoms. The diagnosis was made by polysomnographic studies or overnight monitoring. Adenotonsillectomy resulted in the relief of symptoms and signs in 13 children. In one infant prolonged nasopharyngeal intubation was needed. An increased awareness of OSA in young infants may prevent the delay in diagnosis, will allow early treatment and thus prevent the development of sequela or complications associated with this syndrome.

Upper airway obstruction in Hunter syndrome.

Patients with Hunter syndrome may have symptoms of hoarseness, stridor and breathing difficulties as a result of laryngeal and tracheal involvement. In planning their evaluation, we must prefer non-invasive methods as X-ray or CT scan, and avoid doing endotracheal intubation or bronchoscopies. Review of adult cases in the literature and description of the only case of a child with Hunter syndrome having life-threatening complications of his upper airways is discussed in this report. In this case and in the literature we cannot exclude intubation or bronchoscopy as a serious aggravating factor, causing further narrowing of the larynx.

Detection of ABO(H) blood group antigens: a study in tissue culture.

The association between malignant transformation and the loss of ABO(H) blood group antigens was documented by several authors. Most of the work was done on paraffin sections, though a small portion was performed on fresh frozen tissues. We suggest that the specific red cell adherance (SRCA) test can be applied to tissues cultivated in tissue culture for determination of malignant transformation. This study supports this assumption.

Laryngeal foreign bodies in children.

Laryngeal foreign bodies (F.B.) in children are relative rare, especially in infants under one year of age, and the diagnosis and removal are difficult. The history, the clinical and radiologic findings can be misleading. Seventeen patients with laryngeal F.B. (10 of them under one year of age) are presented, and the diagnostic problems and treatment are discussed. Foreign bodies were either objects of a sharp and thin quality, e.g. an eggshell fragment, or large, e.g. a piece of meat, causing apnea and death.

Tumour of the nose as a presenting feature of leukaemia.

A skin nodule on the external nose, as a presenting feature of acute myeloid leukemia, is described. The child presented with a lesion on the tip of the nose together with the clinical and haematologic features of leukaemia. The histological finding of the nodule was found to be a characteristic leukaemia cutis with leukaemia cell infiltrate in the skin. Epistaxis and external ear infection were also additional features of E.N.T. system involvement, as we find in other leukaemic patients. Since starting chemotherapy the patient has been well, in complete remission, and the lesion on the nose has almost disappeared.

Anesthesia for laryngeal laser surgery in the infant and child.

Currently available anesthetic techniques for laryngoscopy and bronchoscopy are briefly evaluated. Recently reported complications from the literature are reviewed. Satisfactory anesthetic techniques are shown to be limited by the physical dimensions of the instruments as well as the extreme limitations of the flow capacity of the small airway itself. The technique used at the Hospital for Sick Children for the past ten years is described. It is based upon spontaneous respiration with inhalation anesthesia, supplemented by topical lidocaine (Xylocaine). Size and age of the patient are not limiting factors. The safety and effectiveness of this technique are supported by representative blood gas studies as well as the clinical records of over 400 cases.

Esophageal hiatal hernia in infants and children.

Although prior to 1950 esophageal hiatal hernia (EHH) in children was a seldom recognized entity, it has since then become well known. The symptoms in children are considerably different from those in adults. The cause of EHH is still somewhat in doubt. The term gastroesophageal reflux (GER) is often applied as a diagnosis where the diagnosis is uncertain. The authors have reviewed case histories of 56 patients admitted to the Hospital for Sick Children, Toronto, from 1972 to 1980. A comparison is made with 101 cases admitted between 1952 and 1960. It is our firm belief that all patients with symptoms of GER should be esophagoscoped for definitive diagnosis as well as for assessment of the esophagus. Because there is a high rate of respiratory complications in infants and children with GER, bronchoscopy should be carried out concurrently with the esophagoscopy. Infants with GER are at risk from the possibility of aspiration and it is possible that an unknown number of sudden infant death syndrome is due to this factor. The majority of patients with EHH can be managed by a medical regime. Those with esophageal strictures are treated by dilatation but many require surgical correction.