Dietary Intake of Children with Type 1 Diabetes in Bahrain: A Case-Control Study

Background & Objectives: Bahrain is reported to rank amongst the top 10 countries for diabetes prevalence worldwide. In particular, growing numbers of children are being diagnosed with Type 1 diabetes mellitus (T1DM). The objective of this study was to describe the dietary intake of Bahraini children with T1DM as compared to a sample of healthy counterparts and to determine whether the nutrient intakes of Bahraini children with T1DM meet the current recommendations.Design & Setting: This was a case-control study. Dietary intake, estimated using a24-hour dietary recall, for the cases was gathered from the Pediatric Endocrine and Diabetes Unit at the Salmaniya Medical Complex and compared to the 24-hour recalls of children without diabetes recruited from Local Health Centers.Patients & Methods: 50 children aged 6-12 years receiving a confirmed diagnosis of T1DM in the years 2009 and 2010 compared with 55 healthy comparators.Results: Children with T1DM consumed significantly more calories than controls (p<0.001) and significantly more protein relative to their RDA (p<0.029). Both groups failed to meet the RDA values for dietary fiber and for Vitamin D. Sodium intakes were in excess of RDA values although no significant difference was observed between groups (p=0.403).Conclusion: The diets of both children with and without T1DM were found to contain excess protein and sodium and inadequate fiber, vitamin D and calcium. Children with T1DM also appeared to consume excess energy and fat. There is a need to endorse existing dietary guidelines for children with T1DM

Conceptualising and Challenging Child Neglect in Humanitarian Action:Protecting Displaced Children in Jordan and Palestine

Background: Humanitarian organisations commonly identify neglect as a specific form of harm from which children should be protected. However, lack of debate about the aetiology of child neglect has left intact a tendency to assume that it is due to a failure of caregivers. Obscured by this assumption are the role of the humanitarian system in supporting or, indeed, undermining the efforts of primary caregivers. Objective: To bring together insights from the literature on child neglect in humanitarian settings with findings from empirical research in the Middle East. Participants and setting: Fieldwork involved 38 ‘peer researchers’ from five refugee communities: Sudanese, Somali, Iraqi, Syrian (in Jordan) and Palestinian (in Gaza). These researchers undertook enquiry with a total of around 300 people across their respective communities. Methods: • 100 interviews. 70 follow-up interviews. • Theatre-based workshops and focus group discussions with 30 children. • Research workshops with 35 children. • Focus group discussions with 40 parents. • Creative writing project with 60 children. Results: Fieldwork revealed neglect in three distinct areas: educational participation, access to healthcare, and physical safety. This neglect can be related to the humanitarian system, (including humanitarian agencies, host government, donors, etc.), that is both directly neglectful and undermining of caregivers' efforts. Conclusion: Caregivers in our study illustrated the impossibility of exercising constant vigilance over children within conditions of extreme social and economic marginalisation. Thoroughgoing debate about child neglect is needed to address this situation and ensure that caregivers receive adequate support to meet their children's needs. Such support should be offered in a manner that upholds the dignity of displaced people - adults and children alike.</p

Hydrogen Sulfide in the RVLM and PVN has No Effect on Cardiovascular Regulation

Hydrogen sulfide (H2S) is now recognized as an important signaling molecule and has been shown to have vasodilator and cardio-protectant effects. More recently it has been suggested that H2S may also act within the brain to reduce blood pressure (BP). In the present study we have demonstrated the presence of the H2S-producing enzyme, cystathionine-β-synthase (CBS) in the rostral ventrolateral medulla (RVLM), and the hypothalamic paraventricular nucleus (PVN), brain regions with key cardiovascular regulatory functions. The cardiovascular role of H2S was investigated by determining the BP, heart rate (HR), and lumbar sympathetic nerve activity (LSNA) responses elicited by a H2S donor sodium hydrogen sulfide (NaHS) or inhibitors of CBS, microinjected into the RVLM and PVN. In anesthetized Wistar Kyoto rats bilateral microinjections of NaHS (0.2–2000 pmol/side) into the RVLM did not significantly affect BP, HR, or LSNA, compared to vehicle. Similarly, when the CBS inhibitors, amino-oxyacetate (AOA; 0.1–1.0 nmol/side) or hydroxylamine (HA; 0.2–2.0 nmol/side), were administered into the RVLM, there were no significant effects on the cardiovascular variables compared to vehicle. Microinjections into the PVN of NaHS, HA, and AOA had no consistent significant effects on BP, HR, or LSNA compared to vehicle. We also investigated the cardiovascular responses to NaHS microinjected into the RVLM and PVN in spontaneously hypertensive rats. Again, there were no significant effects on BP, HR, and LSNA. Together, these results suggest that H2S in the RVLM and PVN does not have a major role in cardiovascular regulation

Student Behavior Ratings and Response to Tier 1 Reading Intervention: Which Students Do Not Benefit?

Core reading instruction and interventions have differential effects based on student characteristics such as cognitive ability and pre-intervention skill level. Evidence for differential effect based on affective characteristics is scant and ambiguous; however, students with problem behavior are more often non-responsive to core reading instruction and intensive reading interventions. In this study, we estimated the range of students\u27 behavior ratings in which a core reading instruction intervention was effective using a data set including 3,024 students in K-3. Data came from seven independent studies evaluating the individualized Student Instruction (ISI) Tier 1 reading intervention and were pooled using integrative data analysis. We estimated Johnson-Neyman intervals of student behavior ratings that showed a treatment effect both at the within and between classroom level. ISI was effective in improving reading scores (b = 0.51, p = .020, d = 0.08). However, students with very low or very high behavior ratings did not benefit from the approaches (range of behavior rating factor scores: -0.95-2.87). At the classroom level, students in classrooms with a higher average of problem behaviors did not benefit from ISI (average classroom behavior rating factor score: 0.05-4.25). Results suggest differentiating instruction alone is not enough for students with behavior problems to grow in reading ability

Prospective study of immunological factors in non-inflammatory bowel disease enterocutaneous fistulas

© 2011 The Authors. Published by BMC, part of Springer Nature. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1186/1471-2482-11-12Background: Enterocutaneous fistulas (ECF) are debilitating and usually result following complex abdominal surgery. While there is an association with inflammatory bowel disease (IBD), a large number of fistulas occur after surgery not related to IBD. The consequences of ECF include short bowel syndrome and the need for long term parenteral nutrition. ECF can heal spontaneously and in the case of IBD can be cured by medical therapy in some instances. Those that do not resolve spontaneously have to be cured by surgery which is complex and associated with a high morbidity. It is not considered traditional treatment to use the same medical therapy as in IBD to cure ECF caused by other conditions. A small case series has reported three patients with persistent ECF not related to IBD to have healed following use of Infliximab which is the treatment commonly used for ECF caused by IBD. Infliximab acts by inhibiting the activity of the inflammatory cytokine TNF- alpha. It is not known if this cytokine is present in ECF tissue in the absence of IBD. The aim of this study is to demonstrate the presence of inflammatory markers in tissue surrounding non-IBD ECF and in particular to quantify the presence of the cytokine TNF- alpha. We hypothesise that TNF - alpha levels are raised in non-IBD ECF. Methods/Design. Tissue and serum from ECF of IBD and non-IBD patients will be prospectively collected at St. Mark's Hospital Intestinal Failure Unit. The control group will consist of patients undergoing colonoscopy for bowel cancer screening, with normal findings. Biopsies of the terminal ileum will be obtained from this group during colonoscopy. The fistula tract and serum cytokine profiles of interleukins (IL)-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, TNF- alpha, IFN-y, MCP-1, EGF and VEGF will be assessed. Discussion. This study aims to assess the presence or absence of TNF- alpha expression in the ECF tissue in non-IBD origin. If our hypothesis is correct we would then be able to study the use of the TNF- alpha inhibitor Infliximab as a therapeutic option in the treatment of non-IBD ECF. Secondary aims include assessing the spectrum of inflammatory cytokines and markers present in tissue and serum of non-IBD ECF when compared with IBD ECF and normal controls. © 2011 Rahbour et al; licensee BioMed Central Ltd.The study has secured funding from Bowel Disease Research Foundation (BDRF).Published versio

Periprosthetic acetabular fractures as a complication of total hip arthroplasty

Periprosthetic acetabular fractures are rare but potentially devastating complications of total hip arthroplasty. As the number of total hip arthroplasties performed annually increases, so has the incidence of periprosthetic fractures, with the topic being spotlighted more frequently in the orthopaedic community. There is a particular sparsity of literature regarding periprosthetic acetabular fractures, with periprosthetic femoral fractures after total hip arthroplasty being traditionally far more commonly reported. This article aims to provide an up-to-date review of the epidemiology, risk factors, diagnostic challenges, classifications, and management strategies for periprosthetic acetabular fractures after total hip arthroplasty

Lost therapeutic potential of monocyte-derived dendritic cells through lost tissue homing: Stable restoration of gut specificity with retinoic acid

© 2013 The Authors. Published by Wiley. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1111/cei.12118Summary: Human monocyte-derived dendritic cells (DC) (MoDC) are utilized for immunotherapy. However, in-vitro immunological effects are often not mirrored in vivo. We studied the tissue-homing potential of MoDC. Circulating monocytes and DC expressed different tissue-homing markers and, during in-vitro development of MoDC, homing marker expression was lost resulting in a 'homeless' phenotype. Retinoic acid (RA) induced gut-homing markers (β7 and CCR9) and a regulatory phenotype and function [decreased human leucocyte antigen D-related (HLA-DR) and increased ILT3 and fluorescein isothiocyanate (FITC-dextran uptake) in MoDC]. RA-MoDC were less stimulatory and primed conditioned T cells with a gut-homing profile (β7+CLA-). Unlike the normal intestinal microenvironment, that from inflamed colon of ulcerative colitis (UC) patients did not induce regulatory properties in MoDC. However, RA-MoDC maintained their regulatory gut-specific properties even in the presence of UC microenvironment. Therefore, MoDC may be ineffectual for immunotherapy because they lack tissue-homing and tissue-imprinting specificity. However, MoDC rehabilitation with gut-homing potential by RA could be useful in promoting immunotherapy in pathologies such as UC. © 2013 The Authors. Clinical and Experimental Immunology published by John Wiley & Sons Ltd on behalf of British. Society for Immunology.This work was supported by Marie Curie Intra European Fellowship (FP7‐people‐IEF‐2008‐235993), St Mark's Hospital Foundation the Brigid Balfour Fund and the BBSRC (WMNI P33458).Published versio