Onset Of Type Research Articles

A comparative study on the incidence of type 1 diabetes mellitus between children of North African migrants and Italian children in Emilia-Romagna region, Italy.

Evaluate the incidence of type 1 diabetes in North African vs Italian children aged 0-14years from 1 January 2015, to 31st December 2018, in Emilia-Romagna region, Italy. Clinical and epidemiological data about childhood onset type 1 diabetes in Emilia Romagna region were retrospectively collected by the regional centers of pediatric diabetology and matched using 3 different data sources. 365 new cases were diagnosed. Total cumulative incidence was 15.4/100,000/year. North African cases showed a cumulative incidence of 53.8/100,000/year, statistically significant compared to cumulative incidence of the Italian cases alone 13.1/100,000/year (p value < 0.001). The annual incidence did not differ in the 4years for both groups. Conclusion: The incidence of type 1 diabetes in the pediatric age (0 14 years) was significantly higher in the North African population than in the Italian one, suggesting that a mix of genetic and environmental factors may have caused the increase in newly diagnosed cases. • The incidence of type 1 diabetes largely varies worldwide. • Study on immigrants helped to better understand the interplay role between genetics and environment. • This is the first study focused on the incidence of children and adolescents of North African migrants in Italy. • The incidence of children and adolescents of North African migrants in Emilia Romagna region, Italy, seems to be higher than that reported in the host countries, and, above all, than that reported in highest-incidence countries in Europe and in the world.

Risk factors to mortality and causes of death in frontotemporal dementia: An Australian perspective.

Frontotemporal dementia (FTD) is a common cause of dementia in younger people. There is less information known about risk factors to mortality such as the type of symptom onset and cause of death in this group. This was a retrospective file review of inpatients with FTD admitted to a tertiary neuropsychiatry unit located in Australia from 1992 to 2014. Mortality information including linkage of names and causes of death were obtained from the Australian Institute Health and Welfare National Death Index. One hundred inpatients were diagnosed with FTD, including behavioural-variant, language-variant FTDs and FTD-motor neuron disease (FTD-MND). Mean age was 52.8years (SD=10, range 31-76years). Sixty-seven of them had died at linkage. Median survival of the sample was 10.5years and FTD-MND had the shortest survival, 3.5years. Increasing age of onset and FTD-MND were found to be significant predictors of association for mortality. Compared to the general population, having a FTD had an 8× increased risk of death. Females had double the standardised mortality ratio compared to males. This study provides important prognostic information for people diagnosed with FTD living in Australia. It highlights the importance of obtaining a definitive diagnosis as early as possible for future planning. More investigation into the relationship of symptom onset type and sex differences in FTD is required.

Predictors of preoperative cognitive dysfunction in adults with Moyamoya disease: a preliminary research

ObjectiveTo explore potential risk factors of preoperative cognitive dysfunction in adult patients with moyamoya disease (MMD) and discuss significance of moyamoya vessels.MethodsThe author reviewed adult MMD patients harboring no parenchymal infarction or hemorrhage underwent a standardized neuropsychological assessment test battery from December 2018 to May 2019. The authors defined patients with cognitive dysfunction as cognitive impairment shown on 3 or more neuropsychological tests. According to the presence of cerebral angiography, arterial stenosis, moyamoya vessels, and compensatory arteries were conducted. Univariate and multivariate analyses were performed to identify predictors for cognitive dysfunction before surgery. Subgroup analyses by onset type and Suzuki stage were carried out to identify specific predictors for preoperative cognitive dysfunction.ResultsIn total, 29 of 92 (31.52%) patients had cognitive dysfunction. Multivariate analysis showed that moyamoya vessels generating from left hemisphere was recognized as independent predictor for cognitive dysfunction (P = 0.025, OR [95%CI], 0.085 [0.012–0.874]). For patients in left ICA-moyamoya subgroup, 19 of 45 (42.22%) cases with sparse moyamoya vessels had cognitive dysfunction (P = 0.031), while 22 (91.67%) of patients with dense moyamoya vessels had normal cognition (P = 0.004). Moyamoya vessels arising from ophthalmic artery had no significant association with cognitive dysfunction (P = 0.111). Multivariate analysis found that moyamoya vessels originating from left ICA was recognized as independent predictors for preoperative cognitive dysfunction (P = 0.048, OR [95%CI], 0.394 [0.132–0.926]).ConclusionsMoyamoya vessels arising from left hemisphere was a risk factor for the preoperative cognitive dysfunction in adult patients with MMD, with the denser moyamoya vessels, the less cognitive dysfunction. The current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.

A Case of Acute Onset Type 1 Diabetes Mellitus That Developed Three Months after Delivery With Depletion of Insulin Secretion from Just after the Onset

A Case of Acute Onset Type 1 Diabetes Mellitus That Developed Three Months after Delivery With Depletion of Insulin Secretion from Just after the Onset

Devastating Outcome of Late Onset Preeclampsia in a Multiparous Woman: A Case Report

Late onset preeclampsia may occur nascently in a multiparous woman. Although, early onset preeclampsia is associated with more adverse maternal and perinatal outcomes, late onset type in a multiparous woman can occur unexpectedly, and may progress rapidly to a life threatening situation. We report a case of late onset preeclampsia with HELLP syndrome and intracranial haemorrhage in a multiparous woman, who succumbed to death during the course of her treatment. We conclude that preeclampsia is a potential threat for dreadful outcomes, irrespective of its type, parity and duration of onset.

Characteristics of Patient with Status Epilepticus at the Emergency Department of Sanglah General Hospital

Introduction: Status epilepticus is a neurological condition caused by a failure of body mechanism to terminate the seizures or the onset of abnormal seizure activity resulting in prolonged seizure’s duration for more than five minutes. The available research data on status epilepticus in Indonesia is still limited. The purpose of this study was to determine the profile of patients with status epilepticus at Sanglah General Hospital from 2020 to 2021. Methods: This was a descriptive study with a retrospective approach. The study populations were patients with status epilepticus who were treated at Sanglah General Hospital in 2019-2020 who had no missing data in the medical records. Results: There were 117 patients with status epilepticus, 63 males (53.8%) and 54 females (46.2%). There are 41 patients&gt;60 years (35%), general onset in 63 patients (53.8%), and focal onset in 54 patients (46.2%). Etiology from cerebral was 68 patients (58.1%), followed by metabolic in 28 patients (23.9%). The most common OAE therapy was phenytoin (86.3%) and the longest length of stay status epilepticus patients was 8 days (55.6%). Patients with status epilepticus had leukocytosis (73.5%), increased NLR (66.7%), and decreased mean platelet volume (53.8%). Conclusion: The highest incidence of status epilepticus is in women, above 60 years, general onset type of seizure, and etiology from cerebral. Initial therapy in 117 patients was intravenous diazepam followed by phenytoin for maintenance. NLR increased in most of the patients showing signs of inflammation which further worsened the patient's outcome with a mortality rate of 47%. Keywords: Status epilepticus, seizure duration, anticonvulsant, neutrophil-lymphocyte ratio.

Identifying Changes in Peripheral Lymphocyte Subpopulations in Adult Onset Type 1 Diabetes.

T- and B-lymphocytes play an important role in the pathogenesis of type 1 diabetes (T1D), a chronic disease caused by the autoimmune destruction of the insulin-producing cells in the pancreatic islets. Flow cytometry allows their characterization in peripheral blood, letting to investigate changes in cellular subpopulations that can provide insights in T1D pathophysiology. With this purpose, CD4+ and CD8+ T cells (including naïve, central memory, effector memory and terminally differentiated effector (TEMRA), Th17 and Tregs) and B cells subsets (naïve, unswitched memory, switched memory and transitional B cells) were analysed in peripheral blood of adult T1D patients at disease onset and after ≥2 years using multiparametric flow cytometry. Here we report changes in the percentage of early and late effector memory CD4+ and CD8+ T cells as well as of naïve subsets, regulatory T cells and transitional B cells in peripheral blood of adult patients at onset of T1D when compared with HD. After 2 years follow-up these changes were maintained. Also, we found a decrease in percentage of Th17 and numbers of T cells with baseline. In order to identify potential biomarkers of disease, ROC curves were performed being late EM CD4 T cell subset the most promising candidate. In conclusion, the observed changes in the percentage and/or absolute number of lymphocyte subpopulations of adult T1D patients support the hypothesis that effector cells migrate to the pancreas and this autoimmune process perseveres along the disease. Moreover, multiparametric flow allows to identify those subsets with potential to be considered biomarkers of disease.

The Value of Telemedicine for the Follow-up of Patients with New Onset Type 1 Diabetes Mellitus During COVID-19 Pandemic in Turkey: A Report of Eight Cases

The current Coronavirus disease-2019 (COVID-19) pandemic has forced health care teams to look for alternative approaches to manage a great number of children with diabetes, not only in rural but also in urban locations. The aim was to assess the provision of information about follow-up of new-onset pediatric type 1 diabetes (T1D) patients, and to investigate the integration of telemedicine into routine clinical care in the long term. The changes in coefficient of variation (CV), standard deviation and percentages of time in range (TIR), time below range (TBR) and time above range were evaluated in eight children with new-onset T1D, diagnosed during the COVID-19 pandemic. The study period was two-months of follow-up using a telemedicine system. Median follow-up time was 51 (24-66) days. Two of the patients were using low glucose suspend system and six were on multiple daily injection therapy. Target TIR values were achieved in seven patients in the last televisit and, in line with recent guidelines, a TBR <70 mg/dL (<3.9 mmol/L) (level 1 hypoglycemia) of <4% and a TBR <54 mg/dL (<3.0 mmol/L) (level 2 hypoglycemia) of <1% were achieved in all patients. Seven patients achieved a CV of <36% at their last televisit. Telemedicine as an alternative follow-up tool during unusual circumstances such pandemics, even in countries where it is not routinely used, could be beneficial to achieve optimum glycemic control in patients with new-onset T1D.

Diurnal glycemic pattern on inclusion of sucrose in daily meals in type 2 diabetes: Reflection of antecedent glycemic control

Background: Inclusion of sucrose in diabetic diets is not recommended in subjects with diabetes since effects of such diets on glycemic indices are not established. Some studies have documented lapse in metabolic control on consumption of these diets type 2 diabetes. However, most studies examined plasma glucose only for a few hours after ingestion of a single meal containing sucrose after an overnight fast whereas others recommended increasing insulin dose prior to the meal. None of these studies examined influence of inclusion of sucrose in daily meals in subjects with new onset diabetes at diagnosis and again after achieving desirable glycemic control. Objective : Study was conducted to assess glycemic responses to ingestion of all meals containing sucrose constituting 50% of carbohydrate calories. Methods: 12 subjects with new onset type 2 diabetes participated. They were administered the following isocaloric diets for 4 days each prior to and after achieving desirable glycemic control; Diet 1- Diabetic diet recommended by American Diabetes Association (ADA), diet 2- test diet containing sucrose, diet 3- ADA diet. Glycemic control was assessed by diurnal glycemia (average of pre-prandial, postprandial and bedtime blood glucose), fasting plasma glucose, HbA1c and fructosamine on 4th day of each dietary period. Results: All glycemic indices deteriorated after consumption of sucrose containing meals prior to initiation of treatment and remained worsened on return to ingestion of ADA diet. Glycemic responses after all meals improved markedly on achieving desirable glycemic control. Moreover, glycemic indices remained unaltered on consumption of sucrose containing meals after attaining and maintaining desirable glycemic control. Conclusion: Diurnal glycemic responses deteriorate on ingestion of daily meals containing sucrose in subjects with new onset uncontrolled type 2 diabetes. In contrast, diurnal glycemic pattern is unaltered following consumption of daily meals containing sucrose after attaining and maintaining desirable glycemic control.

Exocrine pancreas function is impaired in adult relatives of patients with type 1 diabetes

AimsAlterations of the exocrine pancreas have been reported in type 1 diabetes, but their contribution to the pathogenesis of the disease is poorly understood. Here, we investigated markers of exocrine pancreas dysfunction in individuals at-risk of developing type 1 diabetes.MethodsSerum P-amylase and lipase levels were assessed in samples obtained from healthy controls, patients with new onset type 1 diabetes, relatives participating to the TrialNet Pathway to Prevention who were, at blood collection, autoantibody negative or positive for a single autoantibody (low-risk individuals), and positive for multiple autoantibodies (high-risk individuals). Linear mixed models were adopted to estimate variation of pancreatic enzymes among the groups and to evaluate the influence of high-risk HLA genotypes and residual beta cell function on exocrine pancreas function.ResultsIn adults, but not children, reduced levels of P-amylase and lipase were shown in at-risk individuals, including (for P-amylase levels only) those at low-risk, and in T1Dnew. Furthermore, while high-risk HLA genotypes negatively affected P-amylase levels in autoantibody negative adult individuals, fasting C-peptide levels did not correlate with pancreatic enzyme levels.ConclusionsExocrine pancreas dysfunction precedes the onset of type 1 diabetes in adult at-risk individuals and may be unrelated to fasting C-peptide levels.

P008 Lipid profile disorders in children and adolescents with Juvenile Idiopathic Arthritis

Abstract Background Dyslipidaemia is a well-recognized risk factor for cardiovascular diseases. Inflammation has been linked to alterations of the lipid profile and accelerated atherogenesis. Lipid profile disorders are one of the most studied problems in adult patients with rheumatoid arthritis. However, few studies addressed this problem in juvenile idiopathic arthritis patients. The objective is to describe the prevalence of dyslipidaemia in children and adolescents with Juvenile Idiopathic Arthritis. Methods One hundred patients diagnosed with JIA were included. Exclusion criteria were patients previously treated with lipid lowering drugs, history of familial dyslipidaemia, thyroid disease, and diabetes mellitus. Data obtained from the patients included age, gender, duration of disease and body mass index (BMI). Fasting lipid profiles included triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL) and high-density lipoprotein cholesterol (HDL). Fasting lipid profiles were measured after overnight fasting and consumption of normal diet for previous 2 days (without fat restriction). Normal values were considered according to reference values. Other laboratory tests included ESR, CRP, RF, and ANA. Disease activity was classified according to juvenile disease activity score (JADAS-27). Results The study included 100 JIA patients. Out of them, 78 patients were females, 51 patients had RF negative Polyarticular type, 20 patients had RF positive polyarticular type, 24 patients had systemic onset type and 5 patients had extended oligoarticular type. Mean age was 11.55 ± 4.02 years. Mean age at disease onset was 8.3 ± 1.5 years. Mean disease duration was 4.30 ± 1.7 years. Mean BMI was 22.3 ± 7.32 Kg/m2. Mean ESR was 31.24 ± 10.4 mm/h. Mean CRP level was 7.56 ± 4.61 mg/dl. About 20% of the patients had positive RF and about 8% had positive ANA. Twenty-six patients had active disease. Mean TC was 153.818 ± 29.8 mg/dl, mean HDL was 47.65 ± 16.8 mg/dl, mean LDL was 87.43 ± 28.1 and mean TG was 89.04 ± 26.1 mg/dl. The most common lipid abnormality was disturbed HDL, it was found in 40% patients followed by disturbed TG in 21% of patients. Abnormal TC was found in 15% of the patients and abnormal LDL was found in 12% of the patients. Active disease was significantly associated with abnormal TC, HDL, and TG levels (P = 0.03*), (P = 0.03*) and (P = 0.04*) respectively. No associations were found with ESR or CRP levels. Active disease is a significant risk factor for abnormal TG with increased risk of abnormal TG by 2.9 among cases with active disease than cases with inactive disease. The overall percent predicted was 73.8%. Conclusion Children and adolescents with JIA showed significant lipid profile abnormalities. Abnormal TC, HDL and TG are significantly associated with active disease. Active disease is a significant risk factor for abnormal TG. Therefore, we recommend monitoring lipid profile in JIA patients regularly to reduce the long-term risk of CVD.

A systematic review and meta-analysis of interventions to preserve insulin-secreting β-cell function in people newly diagnosed with type 1 diabetes: Results from intervention studies aimed at improving glucose control.

Type 1 diabetes is characterised by the destruction of pancreatic β-cells. Significant levels of β-cells remain at diagnosis. Preserving these cells improves glucose control and protects from long-term complications. We undertook a systematic review and meta-analyses of all randomised controlled trials (RCTs) of interventions to preserve β-cell function in people newly diagnosed with type 1 diabetes. This paper reports the results of interventions for improving glucose control to assess whether they preserve β-cell function. Searches for RCTs in MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov and WHO International Clinical Trials Registry. Eligible studies included newly diagnosed patients with type 1 diabetes, any intervention to improve glucose control and at least 1month of follow-up. Data were extracted using a pre-defined data-extraction sheet with 10% of extractions checked by a second reviewer. Twenty-eight studies with 1662 participants were grouped by intervention into six subgroups (alternative insulins, subcutaneous and intravenous insulin delivery, intensive therapy, glucose sensing, adjuncts). Only three studies demonstrated an improvement in glucose control as well as β-cell function. These interventions included intensive insulin therapy and use of an alternative insulin. This is the largest comprehensive review of RCTs in this area. It demonstrates a lack of robust evidence that interventions to improve glucose control preserve β-cell function in new onset type 1 diabetes, although analysis was hampered by low-quality evidence and inconsistent reporting of studies. Development of guidelines to support the design of trials in this field is a priority.

Altered DNA Methylation in Patients With Youth Onset Type 2 Diabetes in the iCARE Cohort

Type 2 diabetes (T2D) incidence in children is on the rise. Early environmental exposures are suspected risk factors for youth-onset T2D. However, the underlying mechanism by which these exposures confer risk have not been explained. We hypothesize that early exposures alter DNA methylation (DNAm) patterns that play a key role in youth-onset T2D. This study examined DNAm patterns and potential biological pathways implicated in youth-onset T2D. We examined whole blood DNAm from 306 youths (ages 9-26; diagnosed before 18) from the iCARE cohort using the Illumina EPIC methylation array. DNAm changes associated with T2D were identified by comparing the DNAm profiles of children with (n=224) and without (n=82) T2D, matched for BMI and ethnicity, using linear regression. We identified 2,982 differentially methylated CpGs (adjusted p-value <0.05, effect size ≥1%), a subset of which were previously associated with T2D in adults (TXNIP: effect size –11%; ABCG1: 3%; SREBF1: 3%). In addition, we identified CpGs with roles in mitochondrial metabolic regulation (VWA8: –7%) and insulin-induced vasodilation (MPRIP: 7%). Our findings build the basis for future studies to identify pathways involved in youth-onset T2D, assess the utility of these signatures as biomarkers for screening and early detection, and identify protective environmental exposures. We would like to acknowledge the important contributions and guidance of the iCARE Participant Advisory Group and Data Access Committee in this work’s interpretation.

Young adult onset type 2 diabetes versus type 1 diabetes: Progression to and survival on renal replacement therapy.

Young-onset type 2 diabetes is an aggressive disease characterized by development of diabetic complications, including nephropathy, early in the disease course. However, within the cohort of young-onset type 1 and type 2 diabetes there are limited comparative data regarding progression to ESKD requiring renal replacement therapy or renal-related death (RRT/RRD). Probabilistic linkage of data from the RPAH Diabetes Centre, National Death Index and Australian and New Zealand Dialysis and Transplant Registry was undertaken. Cumulative Incidence Competing Risk and Cox Proportional Hazards Modelling approaches were utilized to examine progression to ESKD in young-onset type 1 and type 2 diabetes (age of diagnosis 15-35years). Unadjusted incidence rates (95% CI) of RRT/RRD in young-onset type 1 and type 2 diabetes were 3.1 (2.3-4.0) and 4.6 (3.7-5.7) per 1000 person years respectively. After adjustment for gender, ethnicity and duration of diabetes, the HR (95% CI) of RRT/RRD in young-onset type 2 diabetes was 2.0 (1.4-2.9). The HR remained higher after further adjustment for first available cholesterol, HbA1c and systolic blood pressure but not BMI. For those who progressed to RRT, prognosis was similar irrespective of diabetes type; cumulative incidence of mortality was 40% in both young-onset type 1 and type 2 diabetes after 6years of dialysis. Progression to RRT/RRD is greater in young-onset type 2 diabetes than in young-onset type 1 diabetes. The increased progression is associated with increased BMI. However, once ESKD is reached, individuals with young-onset type 1 and type 2 diabetes do equally poorly.

Evaluation of associations between estimates of particulate matter exposure and new onset type 2 diabetes in the REGARDS cohort

BackgroundStudies of PM2.5 and type 2 diabetes employ differing methods for exposure assignment, which could explain inconsistencies in this growing literature. We hypothesized associations between PM2.5 and new onset type 2 diabetes would differ by PM2.5 exposure data source, duration, and community type.MethodsWe identified participants of the US-based REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort who were free of diabetes at baseline (2003–2007); were geocoded at their residence; and had follow-up diabetes information. We assigned PM2.5 exposure estimates to participants for periods of 1 year prior to baseline using three data sources, and 2 years prior to baseline for two of these data sources. We evaluated adjusted odds of new onset diabetes per 5 µg/m3 increases in PM2.5 using generalized estimating equations with a binomial distribution and logit link, stratified by community type.ResultsAmong 11,208 participants, 1,409 (12.6%) had diabetes at follow-up. We observed no associations between PM2.5 and diabetes in higher and lower density urban communities, but within suburban/small town and rural communities, increases of 5 µg/m3 PM2.5 for 2 years (Downscaler model) were associated with diabetes (OR [95% CI] = 1.65 [1.09, 2.51], 1.56 [1.03, 2.36], respectively). Associations were consistent in direction and magnitude for all three PM2.5 sources evaluated.Significance1- and 2-year durations of PM2.5 exposure estimates were associated with higher odds of incident diabetes in suburban/small town and rural communities, regardless of exposure data source. Associations within urban communities might be obfuscated by place-based confounding.

Immune response differs between intralymphatic or subcutaneous administration of GAD-alum in individuals with recent onset type 1 diabetes.

Immunomodulation with autoantigens potentially constitutes a specific and safe treatment for type 1 diabetes (T1D). Studies with GAD-alum administrated subcutaneously have shown to be safe, but its efficacy has been inconclusive. Administration of GAD-alum into the lymph nodes, aimed to optimise antigen presentation, has shown promising results in an open-label clinical trial. Herein, we compared the immune response of the individuals included in the trial with a group who received GAD-alum subcutaneously in a previous study. Samples from T1D individuals collected 15months after administration of either three doses 1month apart of 4μg GAD-alum into lymph nodes (LN, n=12) or two doses 1month apart of 20μg subcutaneously (SC, n=12) were studied. GADA, GADA subclasses, GAD65 -induced cytokines, peripheral blood mononuclear cell proliferation, and T cells markers were analysed. Low doses of GAD-alum into the lymph nodes induced higher GADA levels than higher doses administrated subcutaneously. Immune response in the LN group was characterised by changes in GADA subclasses, with a relative reduction of IgG1 and enhanced IgG2, IgG3, and IgG4 proportion, higher GAD65 -induced secretion of IL-5, IL-10, and TNF-α, and reduction of cell proliferation and CD8+ T cells. These changes were not observed after subcutaneous (SC) injections of GAD-alum. GAD-specific immune responses 15months after lymph node injections of GAD-alum differed from the ones induced by SC administration of the same autoantigen.

The epidemiology, clinical, biochemical, immunological and radiological features of youth onset type 2 diabetes mellitus in the state of Qatar.

To describe the epidemiology, clinical, biochemical, immunological and radiological aspects of youth with type 2 diabetes. Patients under 18year of age with type 2 diabetes were recruited from 2018 to 2020, clinical data collected, autoantibodies (GAD65, IAA, IA2 and ZnT8), insulin, ALT and c-peptide were measured. Hepatic ultrasound was performed for assessment of non-alcoholic fatty liver disease (NAFLD). 104 patients were identified. The incidence in 2020 and prevalence per 100,000 was 2.51 and 23.7, respectively. The age of onset was between 8.5 and 18years with 74% of the patients being of Qatari nationality. Males were more affected than females (1.5/1). Overweight/obesity was present in 98% of all the patients, a positive family history (either both parents or a single parent) in 71% and maternal gestational diabetes mellitus (GDM) in 60% of patients. More than 90% of the patients had acanthosis nigricans. 5 patients had 1 autoantibody positivity and hepatic ultrasound detected evidence of NAFLD in majority of patients. Obesity, maternal GDM and family history of diabetes were the key risk factors for the development of type 2 diabetes. Autoantibody positivity may be present in youth type 2 diabetes. As youth type 2 diabetes is associated with early onset microvascular and macrovascular complications, these findings have important social and health budget implications for Qatar. Tackling the burden of maternal GDM and childhood obesity and building programmes for early detection and intervention, are therefore, essential to reduce the risk of future complications.

VANISHING WHITE MATTER DISEASE WITH CENTRAL HYPOMYELINATION

Vanishing white matter disease (VWM) is the most prevalent inherited leucoencephalopathies in children with central hypomyelination. The classical phenotype is characterized by early onset of chronic neurological deterioration, dominated by cerebellar ataxia. The phenotypic variation is extremely wide from antenatal in onset type with early demise to adult in onset with slowly progressive disease. The basic defect is in one of the ve sub-units of eIF2Binitiation factor. Here we report a case of 80 days old male infant with decreased weight gain, stiffness of all four limbs, seizures following head trauma in whom MRI brain identied T2 hyperintensities in white matter of fronto-temporo-parieto-occipital regions and on DWI, it showed abnormal white matter with increased diffusivity reecting the rarefaction and cystic degenerations. Hence diagnosis of VWM disease was established.

Different Patterns of Juvenile Idiopathic Arthritis in Zagazig University Hospitals Mohamed Abd-Elkader Almalky, Ehab Mahmoud Rasheed,

Background: Pediatric rheumatic diseases can cause considerable disease burden to children and their families. They are associated with the potential for physical disability, diminished quality of life and significant direct and indirect costs. Objective: We aimed to describe the clinical spectrum and the frequencies and different patterns of Juvenile idiopathic arthritis (JIA) in children in Zagazig University Hospitals. Patients and methods: A cross-sectional study included 68 cases with Juvenile idiopathic arthritis < 16 years. The study was conducted over two years from December 2017 to December 2019. Investigations as complete blood count, C reactive protein, antinuclear antibody (ANA), rheumatoid factor (RF), complement C3 & C4, creatine phosphokinase, and EMG. Management and treatment plans were achieved and data about the results were collected. Results: Most of patients diagnosed with rheumatological diseases were females. Oligoarticular JIA was the commonestsubtype of JIA in our study followed by polyarticular then systemic onset type. NSAIDs was the commonest drug used by JIA patients followed by methotrexate then corticosteroids. Conclusion: Early diagnosis and effective management of these children is essential so that they can lead a normal or near normal life especially in patients with rheumatological diseases with chronic morbidity as JIA.

Cross-sectional study to identify the prevalence of and factors associated with laminitis in UK donkeys.

Laminitis causes lameness in donkeys, but its prevalence and factors associated with disease remain uncertain. To determine the prevalence of and identify factors associated with laminitis in donkeys. Retrospective cross-sectional study. All donkeys at the Donkey Sanctuary, UK, October 2015 to March 2019 were included. For animals that had laminitis during this period, age, sex, weight, body condition score, and the onset date and type of each episode (first or recurrent, acute or chronic) were recorded. Additionally, management data, foot lesion score, endocrine data, other medical conditions, occurrence of foot trimming, surgical procedures, diagnostic imaging, behavioural modification therapy or movement between farms within the month prior were noted. Controls were animals that did not experience laminitis during this period and similar data were recorded. Multivariable logistic regression modelling assessed the differences between the control group and laminitis outcome groups (first, all laminitis, acute and chronic episodes). Altogether, 707 animals were included; 364 were control animals; 343 had a first episode of laminitis during the study period, of which 200/343 had no further episodes and 143/343 had recurrent episodes resulting in a total of 512 laminitis episodes and the period prevalence was 48.5% over 42months. Overall, 180/512 (35%) laminitis episodes were acute and 332/512 (65%) were chronic. Compared with control animals, the laminitic outcome groups were significantly (P<.05) more likely to be younger (first episode), less likely to get extra feed (all four groups) or have an additional medical problem (first episode), and less likely to have undergone dental work, movement, imaging (all four groups) or surgery (first; all laminitis, chronic episodes) in the month preceding the episode. These results may not be applicable to the wider donkey population. Laminitis commonly affects donkeys, but factors associated with donkey laminitis differ from those reported in horses.