How Does The Fasting of Ramadan Affect Breast Milk Constituents?

Background: Breast-feeding of infants is associated with their better biological, psychological and intellectual development. However, many factors affect the volume and composition of human milk such as stage of lactation and maternal diet. Many breast-feeding Muslim mothers fast the lunar month of Ramadan. The effects of fasting on milk constituents have not been previously studied in Sudan. Therefore, we aimed to investigate the variations between milk constituents during fasting and non-fasting periods among a group of Sudanese women.Materials and Methods: Twenty four healthy breast-feeding mothers volunteered to participate in this cross-sectional study. Each mother provided 100 ml of breast milk during fasting and again 2 weeks after end of the fasting month of Ramadan. Milk was properly stored and analyzed for the various constituents, using the appropriate laboratory methods. The main constituents analyzed were: ash, protein, lactose, iron and electrolytes.Results: The age range of lactating women was between 18 and 38 years, mean (+SD) 28.8 (± 5.15 years). Most mothers 17 (70.8%) were house-wives. Analysis of breast milk during fasting and non-fasting periods showed that: lactose, protein, sodium, potassium, calcium and phosphate were significantly decreased in the fasting breast milk compared with the non-fasting milk (p=0.01), while total soluble solid, moisture, ash and iron constituents had not significantly changed during fasting.Conclusion: Fasting of Ramdan significantly affects proteins, carbohydrates and electrolytes in breast milk.Keywords: breast-feeding, milk constituents, Ramadan, fasting

Dépression et niveau de fardeau chez les aidants familiaux des sujets déments en Tunisie

Introduction: La démence peut retentir lourdement sur les aidants familiaux du patient. Les objectifs de notre étude étaient de déterminer le niveau de fardeau et de la dépression chez les aidants familiaux de sujets déments, et d’identifier les facteurs associés à un niveau de fardeau élevé. Méthodes: Il s’agissait d’une enquête auprès de 65 aidants tunisiens. Les niveaux de fardeau et de la dépression ont été évalués par, respectivement, l’inventaire de Zarit et l’échelle de Beck. Résultats: Le taux des aidants qui avaient un niveau de fardeau élevé était de 52,3 %. Une dépression modérée ou sévère a été relevée chez 46,2 %. Un niveau de fardeau élevé était corrélé, du côté de l’aidant, avec le niveau socioéconomique moyen à élevé, la cohabitation avec le patient, le fait d’être son conjoint, la réduction des activités quotidiennes et la sévérité de la dépression, et, du côté du dément, avec l’agressivité. Conclusion: Les facteurs corrélés à un niveau de fardeau élevé orientent vers les cibles d’intervention et sont susceptibles d’être améliorés par la prise en charge, ce qui contribuerait à alléger la détresse des aidants

Demographic and Clinical Aspects of Congenital Hypothyroidism (Dyshormonogenesis) in Sudan

Introduction: Congenital hypothyroidism is the most common congenital endocrine disorder worldwide. Approximately 80 to 85% of cases are caused by defects in thyroid development (dysgenesis), the remaining 15 to 20% are due to errors of thyroid hormone biosynthesis (dyshormonogenesis). Congenital hypothyroidism is also the most common preventable cause of mental retardation. Its neurological defects can only be reversible if diagnosed and treated early. Its incidence rate is 1 out of 3000/4000 live births worldwide However, this incidence rate is higher in developing countries such as Sudan (1 of 1400/2200 newborn infants) in which its population is characterized by consanguinity (25-70%). The present study aimed to assess the demographic and clinical pattern of congenital hypothyroidism (dyshormonogenesis) in Sudan.Material and Methods: A total of 54 patients referred to Gaffar Ibn Auf Children Hospital presented with clinical features suggesting congenital hypothyroidism (dyshormonogenesis) were enrolled in this study. Demographic and clinical data was obtained by a predesigned questionnare. Data were analyzed using SPSS 13 software. Descriptive statistics (frequencies and percentages) were obtained for categorical variables.Results: Most patients enrolled in this study (85.7%) are descendants of consanguineous marriages. There were 11 reported families, comprising 74.3% of cases, with more than one affected member, of those family members, 68.6 % were in fact siblings. Patients from consanguineous marriage had a 96.6% positive family history. The majority of patients (97.1%) developed complications. According to the tribal origin, the vast majority of patients (65.7%) were from Afro-Asiatic tribes, whereas 34.3% were from Nilo-Saharan tribes. There was a large variation in the geographical distribution of patients. Biochemical analysis and ultrasound findings were concordant with the clinical presentation of patients.Conclusion: 1) Early diagnosis and treatment are crucial to prevent both cognitive and motor detrimental effects of the disease. 2) Consanguineous marriages are a major risk factor in patients with congenital hypothyroidism. 3)There is a wide range of tribal variation of both Afro-Asian (65.7%) and Nilo-Saharan (34.3%) tribes. 4) Poor education and unawareness of the disease were major factors in late diagnosis, treatment and further complications.Keywords: Congenital Hypothyroidism, Dyshormonogenesis, Sudan

Measurement of serum interleukin 17 level in patients with genital warts before and after intralesional tuberculin injection

Introduction and aim: Genital wart infection is a distressing sexually transmitted infection that causes marked fear and stress to both males and females. Tuberculin Purified protein derivative (PPD) injection is an upcoming safe and effective modality for the treatment of genital warts. Interleukin 17 (IL-17) was found to be lower in wart patients than controls. This study aimed at measurement of serum level of IL-17 in genital warts patients before and after PPD injection. Patients and methods: The study was carried out as case-control interventional study on 63 patients (37 males and 26 females) with genital warts attending Dermatology and Andrology Clinics, faculty of medicine, Suez Canal University hospitals. 50 controls were enrolled in the study. All patients have injected 10 tuberculin units of PPD intradermally in the mother or largest warts every 2 weeks till 6 sessions. Serum level of IL-17 was measured by Sandwich ELISA technique to all patients before and after PPD injection and to all control subjects. Results: The mean age of patients was 30.8 years, the mean duration of warts was 4.73 months, the mean number of warts was 9.76 warts and 14.3% of patients experienced side effects to PPD. (58.7%) of patients were completely recovered from warts. Mean serum IL-17 was 81.1 ± 64.2 pg/mL versus 118.9 ± 93.8 pg/mL in genital wart patients versus controls respectively (P < 0.05) and 81.1 ± 64.2 pg/mL versus 107.1 ± 66.8 pg/mL before and after PPD injection respectively (P < 0.05). Conclusion: IL-17 serum level was significantly lower in genital wart patients than normal controls. IL-17 serum level had been increased significantly after PPD intralesional injection than pretreatment levels and significantly related to clinical response to PPD. IL-17 suggested having a role in the clinical efficacy of PPD in the treatment of genital warts

What doesn't kill you makes you stranger: Dipeptidyl peptidase-4 (CD26) proteolysis differentially modulates the activity of many peptide hormones and cytokines generating novel cryptic bioactive ligands

Dipeptidyl peptidase 4 (DPP4) is an exopeptidase found either on cell surfaces where it is highly regulated in terms of its expression and surface availability (CD26) or in a free/circulating soluble constitutively available and intrinsically active form. It is responsible for proteolytic cleavage of many peptide substrates. In this review we discuss the idea that DPP4-cleaved peptides are not necessarily inactivated, but rather can possess either a modified receptor selectivity, modified bioactivity, new antagonistic activity, or even a novel activity relative to the intact parent ligand. We examine in detail five different major DPP4 substrates: glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), peptide tyrosine-tyrosine (PYY), and neuropeptide Y (NPY), and stromal derived factor 1 (SDF-1 aka CXCL12). We note that discussion of the cleaved forms of these five peptides are underrepresented in the research literature, and are both poorly investigated and poorly understood, representing a serious research literature gap. We believe they are understudied and misinterpreted as inactive due to several factors. This includes lack of accurate and specific quantification methods, sample collection techniques that are inherently inaccurate and inappropriate, and a general perception that DPP4 cleavage inactivates its ligand substrates. Increasing evidence points towards many DPP4-cleaved ligands having their own bioactivity. For example, GLP-1 can work through a different receptor than GLP-1R, DPP4-cleaved GIP can function as a GIP receptor antagonist at high doses, and DPP4-cleaved PYY, NPY, and CXCL12 can have different receptor selectivity, or can bind novel, previously unrecognized receptors to their intact ligands, resulting in altered signaling and functionality. We believe that more rigorous research in this area could lead to a better understanding of DPP4’s role and the biological importance of the generation of novel cryptic ligands. This will also significantly impact our understanding of the clinical effects and side effects of DPP4-inhibitors as a class of anti-diabetic drugs that potentially have an expanding clinical relevance. This will be specifically relevant in targeting DPP4 substrate ligands involved in a variety of other major clinical acute and chronic injury/disease areas including inflammation, immunology, cardiology, stroke, musculoskeletal disease and injury, as well as cancer biology and tissue maintenance in aging

Mild Cognitive Impairment among Type II Diabetes Mellitus Patients Attending University Teaching Hospital

BACKGROUND: Type II diabetes mellitus (TIIDM) has been associated with structural and functional changes in the brain. TIIDM is commonly associated with obesity, insulin resistance, hypertension, and dyslipidemia, all of which can have negative impact on brain. AIM: The aim of the study was to study the risk of mild cognitive impairment (MCI) among both diabetics and non-diabetics and to identify risk factors to MCI among both groups. METHODS: Two comparative cross-sectional studies were carried out enrolling 100 diabetics and 100 age, sex, and education matching non-diabetics. Cognitive function was assessed using Montreal Cognitive Assessment (MoCA) test and risk factors for MCI were assessed. RESULTS: The subjective complaint of memory impairment among diabetics was significantly higher (34%) compared to non-diabetics (13.0%), p &lt; 0.05. The mean of objective MoCA score was significantly lower among diabetics (25.9 ± 2.5) compared to non-diabetics (27.4 ± 2.4), p &lt; 0.001. The rate of MCI was significantly higher among TIIDM patients (22%) compared to non-diabetics (9%), p &lt; 0.01 and odds ratio (OR) 2.8 (95% confidence interval 1.2–6.5). Among the two studied groups, the rate of MCI was significantly higher among those aged over 50 years compared to younger age as well as among hypertensive compared to non-hypertensive persons, (p &lt; 0.05). Among diabetics, the MCI was significantly higher among those with secondary education, having heart diseases, longer duration of DM, or repeated hypoglycemia attack, p &lt; 0.05. A healthy diet, brain training, and social activities were found to be significantly associated with normal cognition. Logistic analysis revealed that diabetics aged above 50 was the only significant predicting factor for MCI with an OR 2.9 (95% CI: 3.8–123.3), p &lt; 0.001. CONCLUSION: TIIDM is significantly associated with 3-times increasing risk of having MCI compared to non-diabetics. The age, hypertension, cardiovascular diseases, duration of diabetes, and frequency of hypoglycemic episodes are risk factors for cognitive impairment. A healthy diet, brain training, and social activities were associated with better cognitive function

Patient-specific air puff-induced loading using machine learning

Introduction: The air puff test is a contactless tonometry test used to measure the intraocular pressure and the cornea’s biomechanical properties. Limitations that most challenge the accuracy of the estimation of the corneal material and the intraocular pressure are the strong intercorrelation between the intraocular pressure and the corneal parameters, either the material properties that can change from one person to another because of age or the geometry parameters like central corneal thickness. This influence produces inaccuracies in the corneal deformation parameters while extracting the IOP parametric equation, which can be reduced through the consideration of the patient-specific air puff pressure distribution taking into account the changes in corneal parameters. This air puff pressure loading distribution can be determined precisely from the fluid-structure interaction (FSI) coupling between the air puff and the eye model. However, the computational fluid dynamics simulation of the air puff in the coupling algorithm is a time-consuming model that is impractical to use in clinical practice and large parametric studies. Methods: By using a supervised machine learning algorithm, we predict the time-dependent air puff pressure distribution for different corneal parameters via a parametric study of the corneal deformations and the gradient boosting algorithm. Results: The results confirmed that the algorithm gives the time-dependent air puff pressure distribution with an MAE of 0.0258, an RMSE of 0.0673, and an execution time of 93 s, which is then applied to the finite element model of the eye generating the corresponding corneal deformations taking into account the FSI influence. Using corneal deformations, the response parameters can be extracted and used to produce more accurate algorithms of the intraocular pressure and corneal material stress-strain index (SSI). Discussion: Estimating the distribution of air pressure on the cornea is essential to increase the accuracy of intraocular pressure (IOP) measurements, which serve as valuable indicator of corneal disease. We find that the air puff pressure loading is largely influenced by complex changes in corneal parameters unique to each patient case. With our innovative algorithm, we can preserve the same accuracy developed by the CFD-based FSI model, while reducing the computational time from approximately 101000 s (28 h) to 720 s (12 min), which is about 99.2% reduction in time. This huge improvement in computational cost will lead to significant improvement in the parametric equations for IOP and the Stress-Strain Index (SSI)

Correlation of Circulating ANGPTL5 Levels With Obesity, High Sensitivity C-Reactive Protein and Oxidized Low Density Lipoprotein in Adolescents

Angiopoietin-like proteins (ANGPTL) is a family of eight members known to play an important role in metabolic diseases. Of these, ANGPTL5 is suggested to regulate triglyceride metabolism and is increased in obesity and diabetes. However, its role in metabolic diseases in adolescents is not well-studied. In this study, we tested the hypothesis of a positive association between plasma ANGPTL5, and obesity, high sensitivity C-reactive protein (HsCRP) and oxidized low-density lipoprotein (Ox-LDL) in adolescents. Adolescents (N = 431; age 11–14 years) were randomly selected from middle schools in Kuwait. Obesity was classified by the BMI-for-age based on the WHO growth charts. Plasma ANGPTL5, HsCRP, and Ox-LDL were measured using ELISA. The prevalence of overweight and obesity was 20.65% and 33.18%, respectively. Mean (SD) plasma ANGPTL5 levels were significantly higher in obese, compared with overweight and normal-weight adolescents (23.05 (8.79) vs 18.39 (7.08) ng/mL, and 18.26 (6.95) ng/ml, respectively). ANGPTL5 was positively associated with both HsCRP (ρ=0.27, p \u3c 0.001) and Ox-LDL (ρ = 0.24, p \u3c 0.001). In Conclusion, ANGPTL5 levels are elevated in obese adolescents and are associated with cardiovascular disease risk factors, HsCRP and Ox-LDL. The use of ANGPTL5 as a powerful diagnostic and prognostic tool in obesity and metabolic diseases needs to be further evaluated

Safety performance of school buses in the State of Qatar

School buses and minibuses are one of the major modes of traveling for students in the state of Qatar. Many studies pointed to the fact that school buses travelling are safer for students than walking or car riding (Bolte, et al., 2000; Hinch, et al., 2002). For that reason, safety measures and performance of school buses in the State of Qatar should be studied and evaluated carefully and wisely. The project aims were done through merged qualitative and quantitative methods. Initially a safety checklist was constructed for school buses and a comprehensive schools map to evaluate of the current safety measures in school buses and to understand the conditions around the surrounding areas like the location of the bus stops and the availability of signage. Then, the second step focuses on conducting a survey for school bus drivers, school bus guides, students, and parents. Finally, the third steps compares between the school bus safety strategies followed in the State of Qatar and the strategies followed in other high income countries. The results of the field visits revealed many very important statistics for all surveys on the safety of school bus and the surrounding areas as well as the behavior of students and drivers. The results revealed that most of the parents are not happy with the safety while loading and unloading and with the safety procedures. In addition, 43% of school bus users didn't attend any training or workshops about the safety procedures in school bus. References: [1] Bolte, K. et al., 2000. Simulations of Large School Bus Crashes. [Online] Available at: http://papers.sae.org/2000-01-0469/ [Accessed 10 october 2014]. [2] Hinch, J. et al., 2002. School Bus Safety: Crashworthiness Research, Washington: National Highway Traffic Safety Administration.Qscienc