Prevalence of pre-diabetes and associated risk factors in an adult Omani population

The Sultanate of Oman has experienced an epidemiological transition over the last 4 decades with rising tide of non-communicable disease such as type-2 diabetes. This study aims to estimate the prevalence of pre-diabetes and explore the associated demographic, clinical and biochemical risk factors among a semi-urban Omani population. A semi-urban satellite town, Bidbid, located about 30 km west of the capital, Muscat, was selected as the study setting. The targeted participants were Omani adults (18 to 60 years old) who had resided in Bidbid municipality for at least 6 months prior to enrollment in the study. Using multistage random sampling, 1,600 Bidbid residents were invited to participate in the study. The study protocol gathered data on the socio-demographic and clinical backgrounds of the participants. Participants’ impaired glucose tolerance (IGT) impaired fasting glucose (IFG) and cholesterol and triglyceride levels were then measured. The study surveyed 1,313 individuals (490 men and 823 women) out of 1,600 who had been invited to participate. The participation rate was higher among women than men (91.5% compared to 54.3%). A total of 459 individuals (35% of participants) were diagnosed as pre-diabetic by either the IGT or IFG test; 121 (9%) were pre-diabetic by virtue of both measurements. Male gender, advanced age and obesity were each independently associated with higher prevalence of pre-diabetes. Increased prevalence of pre-diabetes also correlated with the indices of hypercholesterolemia and dyslipidaemia. Pre-diabetes is a substantial health problem in Oman that may present a significant challenge to the national healthcare system in the near future. Customized interventions targeting groups with high risk of pre-diabetes, especially men, the elderly and the obese, are urgently needed.     

Interleukin-1 receptor antagonist and interleukin-1β-511 gene polymorphisms among Egyptian children with febrile seizures

Febrile seizures (FSs) are the most common form of childhood seizures. The higher levels of pro-inflammatory cytokines in children may induce seizures, and alternatively, higher levels of anti-inflammatory cytokines may act as a defense mechanism against seizures. We aimed to investigate whether interleukin (IL)-1β-511 C/T (pro-inflammatory cytokine) (rs16944) and IL-1 receptor antagonist (IL-1Ra) (an anti-inflammatory cytokine) gene polymorphisms could be used as markers for prediction of susceptibility to FSs. The current study included 22 patients with FSs and 22 normal control subjects. All patients were subjected to thorough history taking, full neurological examination, electroencephalography, and peripheral blood sampling for genotype analyses. Detection of IL-1Ra gene polymorphisms was done using polymerase chain reaction (PCR), while a restriction fragment length polymorphism analysis of the PCR products was used for the detection of IL-1β-511 C/T gene polymorphisms. The mean age of onset of first febrile seizures was 15.7 months. Eighteen (81.8 %) cases had the criteria of complex FSs. Frequencies of alleles C and T for IL-1β-511 were 26/44 and 18/44, respectively, in FS patients and 22/44 for both in the control subjects. The CC genotype was significantly more common in the FS patients than in the control group. The IL-1Ra-I homozygote was more frequent in patients with FSs than in healthy controls. The IL-1Ra homozygous I/I and IL-1β-511 CC gene polymorphisms are associated with a higher susceptibility to febrile seizures, which may be useful markers for predicting the development of febrile seizures.     

Primary Stroke in a Woman With Sickle Cell Anemia Responsive to Hydroxyurea Therapy

The most common cause of stroke in children with sickle cell anemia is infarction due to ischemia. In adults, however, stroke is most commonly hemorrhagic in nature. Other causes of stroke in patients with sickle cell disease are very rare. In this short communication, we describe a woman with sickle cell anemia responsive to hydroxyurea (HU) therapy who had primary stroke due to paradoxical embolization caused by a large atrial septal defect. Successful management of the stroke included surgical closure of the defect with trans-esophageal echocardiographic guidance. To the best of our knowledge, this is the first patient with sickle cell anemia and stroke due to congenital heart disease who did not require open heart surgery for successful management.     

Dental age estimation on Bosnian–Herzegovinian children aged 6–14 years: Evaluation of Chaillet's international maturity standards

BackgroundDental age estimation in children plays an important role in forensic dentistry. The most commonly used method for age estimation was developed by Demirjian in 1973 on a French–Canadian sample. It generally overestimates dental age in many populations. International maturity standards were formed to obtain a predicted age with more confidence when ethnic origin was not available.ObjectivesThe aim of this study was to evaluate the applicability of Chaillet's international scores in the dental age assessment on Bosnian Herzegovinian (BH) children.MethodsOrthopantomograms of 1772 children, 980 girls and 792 boys aged 6.04–14.90 years, were assessed using Chaillet's international maturity tables and curves. The dental ages for both genders were compared to the chronological ages through a paired t-test.ResultsMean overestimation using Chaillet's international maturity standards were 0.09 ± 0.83 for girls and 0.28 ± 0.90 for boys. The absolute accuracy of residuals between the dental and chronological age were 0.65 ± 0.52 years for girls (Median: 0.52 years) and 0.73 ± 0.60 years for boys (Median: 0.57 years).ConclusionThe Polynomial compound formula was recommended to predict dental age with more accuracy for results of international maturity standards on BH children.     

Hyperuricemia,Hypertension, and Chronic Kidney Disease: an Emerging Association

Uric acid is a product of purine metabolism and has been linked to gout and kidney calculi. Chronic kidney disease (CKD) and hypertension (HTN) are two major public health problems, and both are associated with increased risk of cardiovascular events. Emerging evidence suggests a pathogenic role of hyperuricemia in the development of HTN and CKD, in addition to progression of CKD, by inducing renal inflammation, endothelial dysfunction, and activation of the renin-angiotensin system. In addition, several epidemiological studies have linked hyperuricemia with an increased risk of HTN and CKD. A few clinical trials have assessed the use of uric acid-lowering therapies such as allopurinol and febuxostat in the management of HTN and delaying progression of CKD. To date, most of these trials are short-term with a small sample size; however, their results are encouraging and provide a rationale for larger randomized controlled trials to establish the role of uric acid-lowering therapies in the management of HTN, in addition to prevention of CKD progression and cardiovascular events.     

Topical Corticosteroids and Hospital Length of Stay in Children with Eczema Herpeticum

Abstract: There is concern that the use of topical corticosteroids in patients with eczema herpeticum may facilitate dissemination of herpes simplex virus and worsen disease. Our primary aim therefore was to determine whether topical corticosteroid use in children hospitalized with eczema herpeticum is associated with longer hospital length of stay (LOS). We performed a multicenter retrospective cohort study of 1,331 children ages 2 months to 17 years admitted with a diagnosis of eczema herpeticum between January 1, 2001, and March 31, 2010, to 42 tertiary care children’s hospitals in the Pediatric Health Information System database. Multivariable linear regression models determined the association between receipt of topical corticosteroid therapy on the first day of hospitalization and the main outcome measure: LOS. Receipt of topical corticosteroid therapy on day 1 of hospitalization was not associated with a longer LOS on unadjusted or multivariable analysis (p = 0.75). Receipt of topical calcineurin inhibitors during the hospitalization was also not associated with a longer LOS (p = 0.12). Receipt of systemic corticosteroids was associated with an 18% adjusted longer LOS (95% confidence interval 2%–36%; p = 0.03). Further study is needed to identify which children with eczema herpeticum may benefit from topical corticosteroids, but their use during active infection is not associated with poorer outcomes, although the use of systemic corticosteroids was associated with a longer LOS and should be avoided in patients with eczema herpeticum pending future prospective study.