33 research outputs found
Diabetes mellitus: The epidemic of the century
The epidemic nature of diabetes mellitus in different
regions is reviewed. The Middle East and North Africa region has the highest prevalence of diabetes in
adults (10.9%) whereas, the Western Pacific region
has the highest number of adults diagnosed with
diabetes and has countries with the highest prevalence
of diabetes (37.5%). Different classes of diabetes
mellitus, type 1, type 2, gestational diabetes and other
types of diabetes mellitus are compared in terms of
diagnostic criteria, etiology and genetics. The molecular
genetics of diabetes received extensive attention in
recent years by many prominent investigators and
research groups in the biomedical field. A large array
of mutations and single nucleotide polymorphisms
in genes that play a role in the various steps and
pathways involved in glucose metabolism and the
development, control and function of pancreatic cells
at various levels are reviewed. The major advances in
the molecular understanding of diabetes in relation to
the different types of diabetes in comparison to the
previous understanding in this field are briefly reviewed
here. Despite the accumulation of extensive data at
the molecular and cellular levels, the mechanism of
diabetes development and complications are still not
fully understood. Definitely, more extensive research
is needed in this field that will eventually reflect on
the ultimate objective to improve diagnoses, therapy
and minimize the chance of chronic complications
development
Diabetes mellitus: The epidemic of the century
The epidemic nature of diabetes mellitus in different
regions is reviewed. The Middle East and North Africa region has the highest prevalence of diabetes in
adults (10.9%) whereas, the Western Pacific region
has the highest number of adults diagnosed with
diabetes and has countries with the highest prevalence
of diabetes (37.5%). Different classes of diabetes
mellitus, type 1, type 2, gestational diabetes and other
types of diabetes mellitus are compared in terms of
diagnostic criteria, etiology and genetics. The molecular
genetics of diabetes received extensive attention in
recent years by many prominent investigators and
research groups in the biomedical field. A large array
of mutations and single nucleotide polymorphisms
in genes that play a role in the various steps and
pathways involved in glucose metabolism and the
development, control and function of pancreatic cells
at various levels are reviewed. The major advances in
the molecular understanding of diabetes in relation to
the different types of diabetes in comparison to the
previous understanding in this field are briefly reviewed
here. Despite the accumulation of extensive data at
the molecular and cellular levels, the mechanism of
diabetes development and complications are still not
fully understood. Definitely, more extensive research
is needed in this field that will eventually reflect on
the ultimate objective to improve diagnoses, therapy
and minimize the chance of chronic complications
development
Prevalence and awareness of osteoporosis among postmenopausal Palestinian women
Summary The prevalence and awareness of postmenopausal
osteoporosis was assessed among 569 postmenopausal
women randomly selected from the population. Osteoporosis
was assessed based on bone mineral density (BMD)
values at three indicative sites. The results indicate a
significant prevalence of the disease among this fraction
of the population with a poor knowledge of its risk factors.
Introduction Postmenopausal osteoporosis is a major health
problem at the individual and population levels. Assessment
of its prevalence and awareness of risk factors provide
the basis for health plans to control the disease. No
previous studies have been done in our population. A
cross-sectional study including 569 postmenopausal women
showed a significant prevalence of osteoporosis with a poor
awareness of risk factors.
Methods Included in the study were 569 randomly selected
postmenopausal women (≥49 years of age). BMD was
measured in 505 subjects at the lumbar spine, femoral neck
and total hip using dual energy x-ray absorptiometry.
Awareness was evaluated using a special questionnaire.
Results Osteoporosis affected the lumbar spine, femoral
neck and total hip in 24%, 14% and 29.7% of subjects,
respectively. There was a significant negative correlation (p<0.001) between age and number of years since menopause
and BMD at all the sites evaluated. Conversely,
BMD increased at the three sites as weight, height and BMI
increased. There was a significant positive correlation
between BMD at the three sites and the physical characteristics
of the subjects (weight, height and BMI) (p<0.001 at the
hip and femoral neck, and p=0.05 at the lumbar spine). BMD
was higher at the lumbar spine and femoral neck among
subjects aware of the disease (0.893 and 0.746 g/cm2,
respectively) than among subjects unaware of the disease
(0.835 and 0.712 g/cm2, respectively). This investigation is
the first among Palestinian women in this region. It indicates
the urgent need for a comprehensive national programme to
reduce the incidence of osteoporosis.
Conclusion Postmenopausal osteoporosis is significant
among the Palestinian population and there is a poor
awareness of the risk factors.The authors would like to thank PCBS for their
valuable assistance and the Bethlehem Arab Society for Rehabilitation
in Beit Jala for their significant assistance in bone scanning. This
study was partially funded by a generous grant from the Union of
Health Work Committees in Palestine
Evaluation of Glycated Hemoglobin (HbA1c) for Diagnosing Type 2 Diabetes and Prediabetes among Palestinian Arab Population
The purpose of the study is to compare the potential of HbA1c to diagnose diabetes among Palestinian Arabs compared to
fasting plasma glucose (FPG). A cross-sectional sample of 1370 Palestinian men (468) and women (902) without known
diabetes and above the age of 30 years were recruited. Whole blood was used to estimate HbA1c and plasma for FPG and
total lipid profile. Fasting plasma glucose was used as a reference to diagnose diabetes ( 6.3%
(45 mmol/mol). The sensitivity, specificity and the discriminant ability were 65.6% (53.1–76.3%), 94.5% (93.1–95.6%), 80.0%
(72.8–87.3%), respectively. However, using cut-off value of 6.5% (48 mmol/mol) by itself diagnosed 5.3% and 48.3% as having diabetes and prediabetes compared to 4.5%
and 24.2% using FPG, respectively. Mean HbA1c and FPG increase significantly with increasing body mass index. In
conclusion, the ROC curves showed HbA1c could be used for diagnosing diabetes when compared to FPG but not for
prediabetes in Palestinians Arabs even though only about 50% of the diabetic subjects were identified by the both HbA1c
and FPG.This project was partially supported by United Nation Relief and Working Agency (UNRWA. No additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Evaluation of Glycated Hemoglobin (HbA1c) for Diagnosing Type 2 Diabetes and Prediabetes among Palestinian Arab Population
The purpose of the study is to compare the potential of HbA1c to diagnose diabetes among Palestinian Arabs compared to
fasting plasma glucose (FPG). A cross-sectional sample of 1370 Palestinian men (468) and women (902) without known
diabetes and above the age of 30 years were recruited. Whole blood was used to estimate HbA1c and plasma for FPG and
total lipid profile. Fasting plasma glucose was used as a reference to diagnose diabetes ( 6.3%
(45 mmol/mol). The sensitivity, specificity and the discriminant ability were 65.6% (53.1–76.3%), 94.5% (93.1–95.6%), 80.0%
(72.8–87.3%), respectively. However, using cut-off value of 6.5% (48 mmol/mol) by itself diagnosed 5.3% and 48.3% as having diabetes and prediabetes compared to 4.5%
and 24.2% using FPG, respectively. Mean HbA1c and FPG increase significantly with increasing body mass index. In
conclusion, the ROC curves showed HbA1c could be used for diagnosing diabetes when compared to FPG but not for
prediabetes in Palestinians Arabs even though only about 50% of the diabetic subjects were identified by the both HbA1c
and FPG.This project was partially supported by United Nation Relief and Working Agency (UNRWA. No additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The authors thank Fida Zeidan from UNRWA for organizing the teams at
different UNRWA clinics. Also, the authors thank the staff of UNRWA
clinics for their cooperation in the study. Thanks to Dr. Khaldoun Bader
from Al-Quds University for his assistance in statistical analysis.Guarantor:
Akram T. Kharroubi
Strategy for DNA extraction and detection frominsect pests in stored home grain samples
Stored grains are subjected to infestations with more than 60 species of insects, that responsible for millions of dollars loss and cause several health problems including allergies and gastrointestinal disorders. Traditional detection techniques are laborious, expensive and not sensitive to detect insect contamination at the egg and larvae stages. Therefore, alternative methods are needed for rapid and sensitive detection. One obvious approach is to develop a molecular approach utilizing genetic information of the potential insect species that infest grains for amplification of specific target gene fragment utilizing polymerase chain reaction [PCR]. In the present study, a number of known infested grain samples were used in standardizing a method to isolate larvae and adult insects that were based on centrifugation washing method and a filtration washing method. The isolated insects were subjected to DNA extraction and PCR amplification of defined regions of cytochrome oxidase I (COI) gene followed by sequencing to identify the different pest species. For PCR amplification new primers were designed and for this purpose the obtained COI sequences from different insects were aligned to design two sets of primers (named: COI-PCR4 and COI-PCR5) specific for the indicated insect mitochondrial COI gene. The designed primers were tested for their specificity and sensitivity. The suitability of PCR primers and DNA extraction methods were evaluated on eleven samples of commercial grains utilizing each primer set with the two extraction methods
Efficacy of vaccine from whole killed Vibrio alginolyticus cells on the immune response of white shrimp (Litopenaeus vannamei)
Vibrio alginolyticus causes high mortality in white shrimp, leading to significant worldwide losses to the aquaculture industries. Vaccine development has become a priority to prevent the spread of disease by activating the immune responses of aquatic organisms. This study aims to compare the efficacy of two types of whole killed Vibrio alginolyticus cells vaccines; formalin killed cells (FKC) and heat-killed cells (HKC), on the immune responses of white shrimp (Litopenaeus vannamei) via oral administration. The shrimp immunization for seven days, the vaccine provided with food twice per day. All shrimps challenged by injection with 0.1 mL of culture contain 1.5×106 CFU mL-1; of V. alginolyticus and monitored for ten days. Total haemocytes count (THC) and the relative percent of survival (RPS) recorded. The shrimp immunized with HKC showed a significant increase in THC than shrimp immunized with FKC and the shrimp in control groups. In addition, the RPS values show significantly higher survival rates, 82.14% and 60.71%, in the immunized groups with HKC and FKC, respectively, compared to the control group 6.68%. This study found that the HKC vaccine offered a good immunity in shrimp against the infection of virulent V. alginolyticus
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030
Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17
Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20
[1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030