Masked Hypertension in Adolescents with Type 1 Diabetes Mellitus: An Exploratory Study

Introduction: Masked hypertension (MHTN) is the finding of elevated out-of-office blood pressure (BP) measurement. This is a pilot study to evaluate the prevalence of MHTN in adolescents with type 1 diabetes mellitus (T1DM). Patients and Methods: Normotensive, adolescents with T1DM were recruited from Tawam Adolescents Diabetes Clinic at Tawam hospital, Al Ain, UAE. They consented to wear the ambulatory BP monitoring (ABPM) device. The heart rate and ambulatory BP were recorded at 15-min intervals for 24 h. Abnormal systolic BP (SBP) and diastolic BP (DBP) were defined as readings above 135 and 85 mm Hg; respectively. Results: Thirteen patients (10 females) were recruited from “Tawam Adolescents Diabetes Clinic.” The median age was 17 (15–19) years, median BMI 21.4 (14.8–29), and median diabetes duration 9 (3–12) years. All patients had normal retinal examination within the past 12 months. Family history of hypertension (HTN) was present in 6/13 (46%) patients. Office BP measurements revealed a mean DBP ± SD of 72 ± 6.9 mm Hg and mean SBP ± SD116 ± 5.5 mm Hg. The median HbA1c was 8.4% (5.6–13.7) and median GFR 125 mL/min/m2 (87–134). Two patients had microalbuminuria. Twenty-four hour ABPM revealed elevated SBP and DBP in 12.2 and 5.8% of the values; respectively. Further analysis confirmed MHTN in 4 (30%) patients, nondipping pattern of BP in 5 (38%) patients, and elevated pulse pressure in 8 (61.5%) patients. Only 4 (30%) patients had normal studies. Conclusions: ABPM uncovered a very high prevalence of MHTN in our patients. Whenever available, ABPM provides an excellent tool for diagnosis and hence early evaluation and management of HTN in adolescents with T1DM. Well-designed large-scale studies are needed to examine the magnitude of MHTN among adolescents with T1DM

Secure and Privacy-Preserving Automated Machine Learning Operations into End-to-End Integrated IoT-Edge-Artificial Intelligence-Blockchain Monitoring System for Diabetes Mellitus Prediction

Diabetes Mellitus, one of the leading causes of death worldwide, has no cure to date and can lead to severe health complications, such as retinopathy, limb amputation, cardiovascular diseases, and neuronal disease, if left untreated. Consequently, it becomes crucial to take precautionary measures to avoid/predict the occurrence of diabetes. Machine learning approaches have been proposed and evaluated in the literature for diabetes prediction. This paper proposes an IoT-edge-Artificial Intelligence (AI)-blockchain system for diabetes prediction based on risk factors. The proposed system is underpinned by the blockchain to obtain a cohesive view of the risk factors data from patients across different hospitals and to ensure security and privacy of the user's data. Furthermore, we provide a comparative analysis of different medical sensors, devices, and methods to measure and collect the risk factors values in the system. Numerical experiments and comparative analysis were carried out between our proposed system, using the most accurate random forest (RF) model, and the two most used state-of-the-art machine learning approaches, Logistic Regression (LR) and Support Vector Machine (SVM), using three real-life diabetes datasets. The results show that the proposed system using RF predicts diabetes with 4.57% more accuracy on average compared to LR and SVM, with 2.87 times more execution time. Data balancing without feature selection does not show significant improvement. The performance is improved by 1.14% and 0.02% after feature selection for PIMA Indian and Sylhet datasets respectively, while it reduces by 0.89% for MIMIC III

Terbufos sulfon pogoršava srčane lezije u štakora koji boluju od dijabetesa: studija subakutne toksičnosti

Organophosphorus compounds (OPCs) have a wide range of applications, from agriculture to warfare. Exposure to these brings forward a varied kind of health issues globally. Terbufos is one of the leading OPCs used worldwide. The present study investigates the cardiac effect of no observable dose of a metabolite of terbufos, terbufos-sulfone (TS), under nondiabetic and streptozotocin-induced diabetic condition. 100 nmol per rat (1/20 of LD50) was administered intraperitoneally to adult male Wister rats daily for fifteen days. The left ventricle was collected for ultrastructural changes by transmission electron microscopy. The blood samples were collected for biochemical tests including RBC acetylcholinesterase, creatinine kinase (CK), lactate dehydrogenase (LDH), cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides, ALT, AST, and GGT. The study revealed about 10 % inhibition of RBC-AChE in two weeks of TS treatment in non-diabetic rats whereas RBC-AChE activity was significantly decreased in diabetic TS treated rats. CK, LDH, and triglycerides were significantly higher in diabetic TS treated rats. Electron microscopy of the heart showed derangement and lesions of the mitochondria of cardiomyocytes in the TS treated groups. The present study concludes that a non-lethal dose of TS causes cardiac lesions which exacerbate under diabetic condition. Biochemical tests confirmed the ultrastructural changes. It is concluded that a non-lethal dose of TS may be a risk factor for a cardiovascular disease, which may be fatal under diabetic condition.Organofosforni spojevi (eng. Organophosphorous Compounds - OPCs) imaju široku primjenu, od one u poljoprivredi do one u vojne svrhe. Izlaganje takvim spojevima izaziva niz različitih zdravstvenih problema od globalnog značaja. Terbufos je jedan od vodećih OPC-a koji se koriste diljem svijeta. U ovom je istraživanju na modelu štakora bez dijabetesa sa streptozotocinom izazvanim dijabetesom ispitivan metabolit terbufos-sulfon (TS) u najvišoj dozi koja ne izaziva učinak te njezin utjecaj na srce. Odrasli mužjaci štakora soja Wistar dobivali su petnaest dana dnevnu dozu od 100 nmol štakor-1 (1/20 LD50) intraperitonealno. Transmisijskim elektronskim mikroskopom istražene su ultrastrukturne promjene lijeve klijetke. Na krvnim uzorcima provedeni su biokemijski testovi, uključujući aktivnost acetilkolinesteraze u crvenim krvnim stanicama, razinu kreatinin kinaze (CK), laktat dehidrogenaze (LDH), kolesterola, lipoproteina visoke gustoće (HDL), lipoproteina niske gustoće (LDL), triglicerida, ALT, AST i GGT. Istraživanjem je otkriveno oko 10 % inhibicije AChE-a u crvenim krvnim stanicama nakon dva tjedna izlaganja štakora bez dijabetesa TS-u, dok je u štakora s dijabetesom aktivnost AChE-a bila značajno smanjena. Razine CK, LDH i triglicerida bile su značajno više u TS tretiranim štakorima s dijabetesom. Elektronsko-mikroskopska analiza srca upućuje na narušenu strukturu i lezije u mitohondrijima u kardiomiocitima skupina štakora koji su tretirani TS-om. Zaključuje se da nesmrtonosna doza TS-a uzrokuje srčane lezije koje se pogoršavaju u prisutnosti dijabetesa. Biokemijski testovi potvrdili su ultrastrukturne promjene. Navedena doza TS-a može biti rizični čimbenik za kardiovaskularne bolesti, koje se mogu pokazati smrtonosnima uz istovremeno postojanje dijabetesa

Knowledge, Attitude and Practices of Diabetic Patients in the United Arab Emirates

Diabetes self-management education is a cornerstone of diabetes care. However, many diabetics in the United Arab Emirates (UAE) lack sufficient knowledge about their disease due to illiteracy. Thus, before considering any possible intervention it was imperative to assess present knowledge, attitudes, and practices of patients towards the management of diabetes

Management of the terrorist threat. The French System of prevention and repression

Cette thèse porte sur la gestion du risque terroriste en France.En tant que droit fondamental, la sécurité publique est prise en charge par l’État qui a le devoir d’assurer la défense et la protection des personnes et des biens publiques. Afin de protéger le pays contre tout risque et toute menace terroriste, la France, un des pays du monde les plus ciblés par les terroristes, a dû s’adapter aux nouvelles formes de terrorisme qui sévissent. Pour ce faire, elle a mis en place un important dispositif d’outils et de moyens de prévention et de répression pour lutter contre le terrorisme, tels que les fichiers de police informatisés. Des outils dérogatoires de prévention du terrorisme ont ainsi été créés, d’autres ont été perfectionnés. Dans ce contexte de lutte contre le terrorisme, de nombreux acteurs interviennent, au niveau local, national, mais aussi européen et international, au sein des institutions.De leur côté, les législateurs, devant les diverses formes de terrorisme, mais également face à la fréquence de tels actes et à leur violence toujours plus grande, ont dû créer de nouvelles lois relatives à la répression et à la prévention des actions terroristes.Ils se sont aussi attachés à la répression du financement du terrorisme en incriminant les personnes qui seraient, directement ou indirectement liées à des réseaux criminels. Enfin, grâce à une collaboration efficace des acteurs sur les plans international, européen et national, ainsi qu’à des outils opérationnels et des moyens de plus en plus performants, la sécurité des personnes et des biens publics est assurée.This thesis focuses on terrorist risk management in France.As a fundamental right, public safety is supported by the State, it has the duty to defend and protect people and public property. To protect the country against all risks and terrorist threat, France, one of the most targeted countries of the world by the terrorists, had to adapt to new forms of terrorism. To do this, it has established an important tool device and means of prevention and enforcement to fight against terrorism, such as computerized police files. Derogatory tools to prevent terrorism have also been created, others have been improved. In this context of fight against terrorism, many actors involved, at local, national as well as European and international, within the institutions.For their part, legislators, facing the frequency of such acts and their ever-increasing violence, had to create new laws for the repression and prevention of terrorism.They also committed to the suppression of terrorist financing by criminalizing those who would be directly or indirectly linked to criminal networks. Finally, through effective collaboration of actors on the international, European and national, as well as operational tools and means of increasingly effective, the safety of persons and public goods is assured

DEVELOPMENT OF A COMPOSITE SUSTAINABILITY INDEX FOR ROADWAY INTERSECTTION DESIGN ALTERNATIVES IN THE UAE

Many studies had been carried out to evaluate the sustainability of transportation systems, but little attention was given in these studies to the design of roadway intersections. The objective of this study was to define a framework to assess intersection sustainability from a road-user perspective and to develop a visual tool that helps decision-makers to support a more sustainable design of roadway intersections. Suitable sustainability indicators that would serve as elements in the built framework at the strategic and early planning level were extracted from the literature. The extracted indicators were utilized with relative weights to develop basic dimensional indices that would be further combined into a Composite Sustainability Index (CSI) tool. The application of the CSI tool was demonstrated in four case studies of existing intersections in Al Ain City, UAE. For each case study, the sustainability of fifteen design alternatives was evaluated for different scenarios of traffic volume and operational speed. Indices representing the individual dimensions of sustainability (economic, environmental, and social) and the overall CSI were determined for each alternative using the Multi-Criteria Decision Making (MCDM) method and Technique of Order Preference by Similarity to Ideal Solution (TOPSIS) technique. For each scenario, the most sustainable design alternative and its dimensional tradeoffs were determined. A sensitivity analysis was carried out to study the impact of weight assignment that reflects stakeholders’ interests and priorities on the sustainability assessment of the proposed intersection designs. Results indicated that traffic volume had a significant impact on sustainability ranking between single intersection design alternatives, while the effect of operational speed was insignificant. Moreover, sensitivity analysis proved that weight assignment had an effect on determining the most sustainable design alternative. Whereas, alternatives that rank highest in the dimension of the major weight, would result in being the most sustainable. However, if an alternative performs exceedingly well in another dimension, other than the one with the heaviest weight, it may still have the highest contribution to the overall CSI. The developed methodology would assist decision-makers in other cities to assess and implement sustainable roadway intersection projects that correspond to their regional visions and goals

Physical Activity and Reported Barriers to Activity Among Type 2 Diabetic Patients in the United Arab Emirates

OBJECTIVES: This study was designed to assess the physical activity practice among type 2 diabetic patients in the United Arab Emirates (UAE). METHODS: This is a cross-sectional study of type 2 diabetic patients who participated in the outpatient clinics in Al-Ain District, during 2006. The patients completed an interviewer-administered questionnaire, and measurements of blood pressure, body mass index, body fat, abdominal circumference, glycemic control (HbA1c), and fasting lipid profile. RESULTS: Of the 390 patients recruited, only 25% reported an increase in their physical activity levels following the diagnosis of diabetes, and only 3% reported physical activity levels that meet the recommended guidelines. More than half of the study subjects had uncontrolled hypertension (53%) and unacceptable lipid profiles; 71% had a high low-density lipoprotein (LDL), 73% had low high-density lipoprotein (HDL), and 59% had hypertriglyceridemia. Forty-four percent were obese and a further 34% were overweight. Abdominal obesity was also common (59%). Only 32% had an acceptable glycemic control. CONCLUSIONS: The physical activity practice of type 2 diabetic patients in the UAE is largely inadequate to meet the recommended level necessary to prevent or ameliorate diabetic complications. Interventions aiming at overcoming the barriers to physical activity are urgently needed

Assessment of Dietary Practice Among Diabetic Patients in the United Arab Emirates

OBJECTIVES: The aim of this study was to assess dietary practices and risk profile (hypertension, obesity, lipid profile and glycemic control) among people with diabetes in Al-Ain District, United Arab Emirates (UAE). METHODS: During 2006, we performed a cross-sectional study of diabetic patients attending diabetic outpatient clinics at Tawam Hospital and primary health care centers in Al-Ain District. Subjects completed an interviewer-administered questionnaire, blood pressure, body mass index, percentage body fat and abdominal circumference were measured and recorded and the most recent HbA1c levels and fasting lipid profile were identified. RESULTS: A sample of 409 diabetic patients was recruited, 50% of whom were illiterate. Only 24% read food labeling. 76% reported being unable to distinguish clearly between low and high carbohydrate index food items and no one reported counting calorie intake. 46% reported that they had never been seen by dietician since their diagnosis. Their overall risk profile, notably body weight, lipid profile and blood pressure, was very unfavorable; more than half of the study sample had uncontrolled hypertension and uncontrolled lipid profile and the majority was overweight (36%) or obese (45%). Abdominal obesity was particularly common (59%). Only 31% had an HbA1c of less than 7%. CONCLUSIONS: The dietary practices of diabetic patients in the UAE are inadequate and need improvement