Onset Of Type Research Articles

Dimensions of Child Maltreatment in Australians With a History of Out-of-Home Care.

Research suggests that the dimensions of childhood maltreatment (type, age of onset, duration, frequency and perpetrator) play an important role in determining health and wellbeing outcomes, though little information is available on these dimensions for any care experienced cohorts. This study aimed to determine if any variation in maltreatment dimensions were experienced between two subsets of the nationally representative Australian Child Maltreatment Study, both of which reported childhood maltreatment histories: care-experienced (n = 358) and non-care-experienced (n = 4922). Using a series of independent t-tests and chi-square tests, we compared the two groups on seven dimensions (number of maltreatment types, range of maltreatment items, age of onset, duration, frequency, perpetrator number, and perpetrator type) for the five child maltreatment types (physical, emotional, sexual abuse, neglect, and exposure to domestic violence). Results showed that the care-experienced group reported a higher intensity of maltreatment, being younger when maltreatment first started, experiencing greater variety of maltreatment types, for longer periods, more times and by more perpetrators than maltreated people with no care experience. We conclude that children and young people in out-of-home care experience maltreatment at a higher intensity than the rest of the population, which has implications for effective treatment.

Is alcohol use disorder associated with higher rates of depression and anxiety among people with new onset type 2 diabetes? A cohort study using linked primary care data in England

IntroductionDepression and alcohol use disorder (AUD) in people living with Type 2 diabetes mellitus (T2DM) are associated with worse health outcomes. AUD is strongly associated with depression and anxiety, but it is not known how these conditions cluster in people with T2DM. We investigated rates of new episodes of depression and anxiety following T2DM diagnosis in people with and without prior AUD among an English primary care population.MethodsThe study population was people diagnosed with T2DM between 2004 and 2019. We used the Clinical Practice Research Datalink (CPRD) Aurum database and linked Hospital Episode Statistics Admitted Patient Care (HES APC) and Office for National Statistics (ONS) mortality data. We examined incidence of new episodes of anxiety or depression in people with T2DM with and without AUD. AUD was defined as any of i) clinical diagnosis; ii) alcohol withdrawal; or iii) chronic alcohol-related harm (physical or mental) using SNOMED-CT or ICD-10 codes. People were excluded if they had codes for depression/anxiety 12 months prior to T2DM diagnosis. Poisson regression models were fitted adjusting sequentially for a) age, gender, calendar time; b) region, Index of Multiple Deprivation, ethnicity, body mass index, smoking status, Charlson co-morbidity index; and c) history of a mental health condition.ResultsOur study population was 479,447 people of whom 10,983 (2.3%) had an AUD code prior to T2DM diagnosis.After adjusting for all measured confounders except history of a mental health condition, IRR for depression was 2.00 (95% CI 1.93, 2.06) for people with AUD compared to without AUD. This reduced to 1.45 (95% CI 1.41, 1.50) after further adjustment for history of a mental health condition.Findings for anxiety were substantially similar to those for depression (adjusted for all measured confounders except history of a mental health condition, IRR 2.08 95% CI 1.99, 2.18 fully adjusted IRR 1.48 95% CI 1.41, 1.55).ConclusionsPeople with AUD have over double the rates of depression and anxiety following T2DM diagnosis than those without AUD. This was only partially explained by pre-existing diagnoses of mental health conditions. A holistic approach incorporating mental health support is needed to improve health outcomes for people with AUD who develop T2DM.Trial registrationNot applicable.

Late eating is associated with poor glucose tolerance, independent of body weight, fat mass, energy intake and diet composition in prediabetes or early onset type 2 diabetes

This study investigates the impact of habitual late calorie intake on glucose metabolism in adults with overweight or obesity and diet or metformin-controlled prediabetes or type 2 diabetes independently of body weight, fat mass, energy intake or diet composition. Participants (n = 26) were classified as Later Eaters (LE) if ≥45% daily calories were consumed after 5 pm and Early Eaters (EE) if not, based on daily caloric intake assessed over 2-wk. EE and LE did not differ in anthropometrics or daily energy intake, but LE consumed more carbohydrates (p = 0.038) and fats (p = 0.039) after 5 pm. Fasting glucose, insulin, and C-peptide did not differ between groups but LE exhibited higher glucose concentrations after an oral glucose tolerance test (p = 0.001), even after adjusting for body weight, fat mass, energy intake and diet composition (p < 0.05). Glucose results remained when participants with T2D were excluded (p = 0.031). After diabetes status adjustment, differences in glucose concentrations were higher in LE for time 30 (p = 0.028) and 60 min (p = 0.036). LE, compared to EE, had poorer glucose tolerance, independent of body weight, fat mass, daily energy intake and diet composition. ClinicalTrials.gov: NCT04465721.

Association of polymorphism of NLRP3, ICAM-1, PTPN22, INS genes in childhood onset type 1 diabetes in a Pakistani population.

Type 1 diabetes (T1D) is an organ-specific autoimmune disorder characterized by the destruction of pancreatic β cells, leading to absolute insulin deficiency. The genes NLRP3, ICAM-1, PTPN22, and INS are reportedly associated with T1D in other populations. However, the genetic pattern of T1D in the Pakistani population is not clear. This study aimed to find the association of polymorphisms in the PTPN22, INS, NLRP3, and ICAM-1 genes with T1D susceptibility in the Pakistani population. This case-control study includes 100 T1D patients (3-14 years), recruited randomly from the pediatric endocrinology department of Fatima Memorial Hospital, Lahore, Pakistan and 100 age-matched healthy controls were selected from different localities of the same population. The polymorphisms in PTPN22 (rs601, rs33996649, rs2488457), INS (rs80356664), NLRP3 (rs10754558, rs35829419), and ICAM-1 (rs1799969, rs5498) genes were genotyped by Sanger sequencing. The genotypic and allelic frequencies, haplotypes, and linkage disequilibrium were computed using the genetic toolset PLINK to investigate their relationship to T1D. The results indicate that the occurrence of the GT genotype of the rs33996649 variant is significantly higher in children with T1D compared to a control group of healthy individuals (P = 0.001, OR: 2.0, 95% CI = 0.15-0.45). Furthermore, the CT genotype of rs2488457 was notably associated with T1D patients (P = 0.007, OR: 2.8, 95% CI = 0.56-0.67). The CG genotype of rs80356664 showed a slight association with T1D (P = 0.03, OR: 1.9, 95% CI = 0.35-0.59). The prevalence of the AT genotype of rs10754558 showed a strong association with T1D (P = 0.005, OR: 3.4, 95% CI = 0.45-0.69). The TG genotype of rs5498 was also strongly associated with T1D (P = 0.009, OR: 2.8, 95% CI = 0.75-0.89). The present study provides evidence that SNPs in the PTPN22, INS, NLRP3, and ICAM-1 genes are associated with the development of T1D. Further research is needed to explore their potential use in genetic screening and personalized medication.

NMNAT1 Is Essential for Human iPS Cell Differentiation to the Retinal Lineage.

The gene encoding nicotinamide mononucleotide adenylyltransferase 1 (NMNAT1), a nicotinamide adenine dinucleotide synthetase localized in the cell nucleus, is a causative factor in Leber's congenital amaurosis, which is the earliest onset type of inherited retinal degeneration. We sought to investigate the roles of NMNAT1 in early retinal development. We used human induced pluripotent stem cells (hiPSCs) and established NMNAT1-knockout (KO) hiPSCs using CRISPR/cas9 technology to reveal the roles of NMNAT1 in human retinal development. NMNAT1 was not essential for the survival and proliferation of immature hiPSCs; therefore, we subjected NMNAT1-KO hiPSCs to retinal organoid (RO) differentiation culture. The expression levels of immature hiPSC-specific genes decreased in a similar manner after organoid culture initiation up to 2 weeks in the control and NMNAT1-KO. Neuroectoderm-specific genes were induced in the control and NMNAT1-KO organoids within a few days after starting the organoid culture; PAX6 and TUBB3 were higher in NMNAT1-KO organoids up to 7days than in the control organoids. However, the induction of genes involving retinal early development, such as RAX, which was induced at around day 10 in this culture, was considerably reduced in NMNAT1-KO organoids. Morphological examination also showed failure of retinal primordial structure formation, which became visible at around 2 weeks of the control culture, in the NMNAT1-KO organoids. Decreased intracellular NAD levels and poly(ADP-ribosyl)ation were observed in NMNAT1-KO organoids at 7 to 10days of the culture. Mass spectrometry analysis of inhibited proteins in the poly(ADP-ribosyl)ation pathway identified poly(ADP-ribosyl)ation of poly(ADP-ribose) polymerase 1 (PARP1) as a major protein. These results indicate that NMNAT1 was dispensable for neural lineage differentiation but essential for the commitment of retinal fate differentiation in hiPSCs. The NMNAT1-NAD-PARP1 axis may play a critical role in the appropriate development of human retinal lineage differentiation.

Management Strategies for Young-Onset Type 2 Diabetes Mellitus: An Integrated Approach

The prevalence of young-onset type 2 diabetes is increasing rapidly worldwide along with the incidence of obesity, including in Korea. Compared with later onset type 2 diabetes, patients with young-onset type 2 diabetes have a higher risk of microvascular complication, macrovascular complication, and disease-related mortality. Thus, integrated attention and management of associated pathobiological, socioeconomic, and mental health factors are needed. Based on the very few evidence-based studies in management, in this review, we describe strategies for the integrated management for young-onset type 2 diabetes.

Unlocking the Secrets: Predictive Risk Factors for Long-term Olfactory Dysfunction in COVID-19 Patients

&lt;b&gt;Introduction:&lt;/b&gt; COVID-19 is a multisystem disease that can severely impact overall health. It causes non-lethal complications that may significantly affect the quality of life, such as smell dysfunction, which has been identified as an essential and early indicator of infection. A substantial proportion suffer from prolonged or even permanent loss of smell.&lt;b&gt;Aim:&lt;/b&gt; The study aims to identify key clinical and demographic risk factors that significantly predict the prognosis of such an olfactory loss in patients with COVID-19.&lt;b&gt;Materials and method:&lt;/b&gt; A prospective, cross-sectional, descriptive study. Qualified patients were aged ≥ 18 years with a past COVID-19 infection confirmed by PCR. They all underwent thorough clinical assessments and nasoendoscopy to exclude other nasal pathologies. The Alcohol Threshold Test (ATT) was used to assess olfactory function and only patients with severe hyposmia and anosmia were included in the study. The Arabic version of the Kessler Psychological Distress Scale (K10) was used to assess the emotional impact on the patient.&lt;b&gt;Results:&lt;/b&gt; The study included 100 patients suffering from severe smell loss. Sixty-two patients (62%) were ≥39 years and 38 (38%) were ≤ 40 years old. The mean age of the patients was 37.5 10.8 years. There were 62 females (62%). The mean duration of olfactory loss was 4.4 2.8 months. Sudden onset was reported in 98 patients. Only 2 patients (2%) had rhinorrhea. Eighty-one patients (81%) suffered from mild symptoms of COVID infection. There were 21 smokers (21%). Eighteen patients (18%) had comorbidities. Twenty-seven patients (27%) belonged to the low socioeconomic status. Severe hyposmia (TS of ATT = 4–5) was reported in 96 patients (96%) and anosmia (TS of ATT = 6) in 4 patients (4%). Kessler’s test indicated that 63 patients (63%) experienced moderate to severe distress.&lt;b&gt;Conclusions:&lt;/b&gt; The following risk factors showed significant differences in the prognosis of olfactory loss: older age, long duration of loss, smoking, presence of comorbidities, low socioeconomic status, and increased severity of COVID-19. These factors may be important predictors of the persistence of olfactory loss. Factors like sex, onset type, nasal symptoms, severity of olfactory loss, and Kessler’s test score did not show significant differences.

Mortality in type 1 diabetes mellitus: A single centre experience from the ICMR – Youth onset diabetes registry in India

IntroductionThe prevalence of youth onset diabetes is rising globally along with a greater burden of complications and mortality in them. The current study was undertaken to examine the mortality and causes of death in patients with youth onset diabetesregistered in a tertiary care hospital in North India. MethodsWe analyzed mortality and causes of death in 1088 patients with youth onset diabetes registered from 2006 to 2019 at University College of Medical Sciences, Delhi. Information of death was obtained telephonically or by home visit or from hospital records wherever available. Verbal autopsy according to ICMR questionnaire was performed and cause of death determined as per WHO ICD-10/11. ResultsAmong 898 youth onset type 1 diabetes mellitus (T1D) patients who had a mean follow up of 6.4 years, 105 deaths (11.6 %) occurred. Forty three percent of deaths had diabetes onset at 15 years or below, and 75.6 % had HbA1C > 10 %. Deaths occurred in 24.2 % within 2 years and in 53.6 % within 3 years of diagnosis. Chronic Kidney disease, infections and ketoacidosis were the commonest causes. ConclusionWe found poor glycaemic control and high mortality in people with youth onset T1D being treated at a tertiary care hospital in north India.

Impacts of Local Circulations on Ozone Pollution in the New York Metropolitan Area: Evidence From Three Summers of Observations

AbstractElevated surface ozone levels are often detected in the New York metropolitan area during summertime. Moreover, surface ozone in this region exhibits sharp spatial gradients and distinctive diurnal cycles under the influence of complex boundary layer circulations induced by the intricate coastal geometry. This study examines how surface ozone is impacted by local circulations spatially and temporally under different temperature scenarios (all summer days, hot summer days, and extreme heat days) with the help of cluster‐based meteorological conditions during the summertime of 2017–2019. The most polluted days are found to be highly associated with hot sea breeze days with weak background flow. When sea breeze development in the New York Bight is delayed and its penetration north is intercepted by the dominant westerlies during hot summer days, daily maximum 8‐hr average ozone (DMA8) in some ozone hot spots of New York City (NYC) and the south shore of Connecticut (CT) typically drops 9–10 ppb under comparable temperature levels. The average regional decrease of DMA8 for NYC and coastal CT is 6.7 and 8.3 ppb, respectively. Furthermore, we conclude that a change in early morning meridional wind direction is the most critical meteorological characteristic in controlling sea breeze onset type and helping modulate ozone exceedances in the region during extreme hot days when ozone exceedances are expected to be very common. The conclusion is further demonstrated with two case studies during the Long Island Sound Tropospheric Ozone Study 2018 field campaign.

Long-term TNF-alpha therapy for preserving beta cell function in new onset type 1 diabetes: a case report

BackgroundType 1 diabetes mellitus (T1D) is an autoimmune disease caused by destruction of pancreatic islet beta-cells. There is significant residual beta-cell function, measured through circulating C-peptide, present at the time of T1D diagnosis but this subsequently decreases with time. Higher residual beta-cell function at diagnosis associates with better glycaemic control and less glucose variability, and later in the disease course with less hypoglycaemia, lower glucose variability and fewer microvascular complications. There is therefore value in preserving residual beta cell function in new onset T1D Immunotherapeutic agents can protect residual beta-cell function in type 1 diabetes. However, clinical trials of such agents, whilst demonstrating C-peptide preservation in short term studies, have yet to be taken forward into routine clinical care due to concerns around safety and long-term efficacy. Here we report the case of a gentleman with newly diagnosed T1D whose glycaemic control and insulin requirement improved whilst on a five year infusion programme of infliximab, a monoclonal antibody against TNF-alpha, for colitis.Case presentationA 52-year-old White Caucasian man was diagnosed with T1D in August 2018. Glucose was 25.6 mmol/L, HbA1c was 98mmol/mol and GAD antibodies were strongly positive. HbA1c marginally improved to 91mmol/mol following initiation of insulin detemir 5 units at night and 1:10 g of insulin aspart (November 2018). In June 2019, he developed rectal bleeding and abdominal pain. Following colonoscopy, he was diagnosed with “indeterminate colitis” and commenced on 6-weekly infusions of 400-450 mg infliximab. Thus far, he has received 32 doses and achieved colitis remission. Following infliximab initiation there was increased frequency of mild-moderate hypoglycaemia and he was gradually weaned off and discontinued detemir in June 2020. Since then, HbA1c improved from 57mmol/mol in August 2019 to 52mmol/mol in April 2022, remaining stable at 51mmol/mol. His most recent HbA1c is 54mmol/mol in February 2024. His c-peptide was 550pmol/L in October 2022 and 442pmol/L in February 2024, suggesting well-preserved beta-cell function almost 6 years post-diagnosis.ConclusionsOur patient’s improvement in glycaemic control can be explained by immunomodulation and C peptide preservation from infliximab. With the growing focus on type 1 diabetes disease modulation and working towards an ‘insulin free T1D’, our findings strengthen the evidence base for the repurposing of and long-term treatment with anti-TNF-α agents to preserve beta-cell function in new onset T1D.

Intravenous lacosamide for acute repetitive seizures and convulsive status epilepticus in critically ill children.

Acute repetitive seizures and convulsive status epilepticus are common neurological emergencies in critically ill children. The aim of the study was to evaluate the effectiveness and safety of intravenous lacosamide in critically ill children with acute repetitive seizures and convulsive status epilepticus. This retrospective study included children who received intravenous lacosamide for acute repetitive seizures or convulsive status epilepticus from October 2017 to September 2022 and were admitted to the pediatric intensive care unit at a tertiary medical center. Children who were newly started on intravenous lacosamide were included and divided into two groups: (a) previously healthy, and (b) history of epilepsy and receiving antiseizure medications. Efficacy was defined as the cessation of seizures within 72 h of administering lacosamide. Adverse effects were defined using predefined criteria, and most were evaluated during the first 7 days. Sixty-seven children were enrolled, including 25 (37.3%) girls and 42 (62.7%) boys with a mean age of 7.20 ± 5.66 years. Among them, 30 (44.8%) had acute repetitive seizures, and 37 (55.2%) had convulsive status epilepticus. The seizure types were focal onset (n = 34, 50.7%), generalized onset (n = 27, 40.3%), and mixed type (n = 6, 9.0%). In the previously healthy group, 9 patients had acute repetitive seizures and 23 had convulsive status epilepticus, and the rates of seizure cessation when lacosamide was used as the first to fourth choice of antiseizure medication were 100.0%, 85.7%, 40.0%, and 50.0%, respectively, compared to 73.7%, 54.5%, 100.0%, and 0.0% in the patients with epilepsy (21 had acute repetitive seizures and 14 had convulsive status epilepticus). Sixteen (23.9%) patients developed bradycardia and 1 (1.5%) patient developed a rash. The early use of intravenous lacosamide was effective with acceptable side effects in treating acute repetitive seizures and convulsive status epilepticus in critically ill children, including young infants and children less than 4 years old and those with different etiologies. Acute repetitive seizures and convulsive status epilepticus are common neurological emergencies in pediatric intensive care units (PICUs), traditional intravenous antiseizure medications (ASMs) include phenytoin, valproic acid, levetiracetam, and phenobarbital. In this study, we categorized patients based on their epilepsy history and different etiologies. We observed that early use of lacosamide, even in young infants, demonstrated good efficacy and safety.

All-cause and cause-specific mortality risk and loss in life expectancy associated with incident type 2 diabetes onset age and duration.

Evidence on type 2 diabetes onset age and duration on mortality risk has been limited by short follow-up, inadequate control for confounding, missing repeated measurements, and inability to cover the full range of onset age, duration, and major causes of death. Moreover, scarce data dissect how type 2 diabetes onset age and duration shape life expectancy. We evaluate prospectively these topics based on 270,075 eligible participants in the Nurses' Health Studies and Health Professionals Follow-up Study, leveraging repeated measurements throughout up to 40 years of follow-up. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). In fully adjusted analyses, incident early onset type 2 diabetes (diagnosed <40 years of age) was associated with significantly higher mortality from all-causes (HR, 95% CI was 3.16, 2.64-3.79; vs. individuals without type 2 diabetes), cardiovascular disease (6.56, 4.27-10.1), respiratory disease (3.43, 1.38-8.51), neurodegenerative disease (5.13, 2.09-12.6), and kidney disease (8.55, 1.98-36.9). The relative risk elevations declined dramatically with each higher decade of age at diagnosis for deaths from most of these causes, though the absolute risk difference increased continuously. A substantially higher cumulative incidence of mortality and a greater loss in life expectancy were associated with younger age at type 2 diabetes diagnosis. Longer disease duration was associated with generally higher relative and absolute risk of mortality. Early onset of type 2 diabetes and longer disease duration are associated with substantially increased risk of all-cause and cause-specific mortality and greater loss in life expectancy.

Aboriginal young people's experiences of type 2 diabetes diagnosis, management and support: A qualitative study in the Kimberley region of Western Australia.

In Australia, Aboriginal and Torres Strait Islander young people in remote settings are most-affected by young onset type 2 diabetes (T2D). It is necessary to understand young people's experiences, including factors impacting on self-management, to improve models of care. A phenomenological methodology underpinned this qualitative study in Western Australia's Kimberley region. Two Aboriginal Community Controlled Health Services supported recruitment of seven Aboriginal young people aged 12-24 with T2D, who participated in interviews. A carer and health professional of one young person in each site were also interviewed and relevant medical record data reviewed to assist with triangulation of data. De-identified transcripts were inductively coded and a coding structure developed with oversight by a Kimberley Aboriginal researcher. Young people reported varied experiences and emotions relating to a T2D diagnosis. Most recounted this was upsetting and some reported current negative impact on emotional wellbeing. Challenges with understanding and managing diabetes were highlighted, particularly regarding healthy eating, physical activity and medication. Family are a prominent source of self-management support, with the intergenerational impact of diabetes being evident for each participant. Positive relationships with health professionals, entailing continuity of care, were valued. There are significant emotional and medical challenges for young people with T2D and their families. Recommendations from this work will contribute to the development of local resources and initiatives to improve diabetes-related support. SO WHAT?: Alongside broader efforts to support good health at the societal level, enhanced health education and family-oriented support structures including Aboriginal clinical staff for young people with T2D are needed.

Increased prevalence of younger onset type 2 diabetes: why and what could be done?

Increased prevalence of younger onset type 2 diabetes: why and what could be done?

Incidence of new onset type 2 diabetes in adults living with obesity treated with tirzepatide or semaglutide: real world evidence from an international retrospective cohort study

Tirzepatide, a novel dual agonist of glucagon-like-peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), has demonstrated greater magnitude of weight loss compared to semaglutide in a phase 3 clinical trial. However, the effect of tirzepatide on incidence of type 2 diabetes (T2D) in individuals with overweight and obesity, and the effect on major adverse cardiovascular outcomes in individuals with pre-existing T2D, remains unknown. We performed a retrospective cohort study of anonymised electronic medical records using the TriNetX network (TriNetX LLC, Cambridge, MA, USA) a global federated database. The data used in this study was collected on 5th June 2024. Two cohorts of individuals were generated: 1) without pre-existing T2D and, 2) with T2D. We adopted an active comparator new user design on new initiations of either tirzepatide or semaglutide therapy. Analysis began from the index event which was defined as individuals on respective therapy for 6 months only. Analysis of outcomes was conducted off-drug, in individuals without a pre-existing history of the disease of interest. Individuals were followed up for 12 months post the index event. Primary outcome for cohort 1 was incidence of T2D, and for cohort 2 was composite: all-cause mortality, cerebral infarction, acute coronary syndrome, and heart failure. Secondary outcomes for cohort 1 were change in HbA1c and body weight and for cohort 2: incidence of micro- and macrovascular complications, suicidal ideation and/or attempt, and all-cause mortality. We propensity score matched (1:1) for potential confounders: baseline demographics, socioeconomic circumstances, HbA1c, weight, relevant co-morbidities, and anti-obesity, hypoglycaemic and cardioprotective agents. The study population without T2D consisted of 13,846 individuals, equally split between tirzepatide and semaglutide users. Tirzepatide was associated with both lower risk for incident T2D (HR 0.73, 95% CI 0.58-0.92, p<0.001) and greater weight loss (-7.7kg, [95% CI-6.8,-8.5kg], p<0.001), compared to semaglutide (-4.8kg, [95% CI-3.9,-5.6kg], p<0.001). In individuals with pre-existing T2D (n=8446), tirzepatide was associated with lower risk of the composite outcome (HR 0.54, 95% CI 0.38-0.76, p<0.001), cerebral infarction (HR 0.45, 95% CI 0.24-0.84, p=0.010) and all-cause mortality (HR 0.33, 95% CI 0.15-0.73, p=0.004) compared to semaglutide. Tirzepatide is associated with significantly reduced risk of developing T2D and major adverse cardiovascular events in individuals living with obesity and T2D respectively. Randomised controlled trials investigating the utility of dual incretin agonists in the primary prevention of T2D and cardiovascular disease in higher risk populations are now required. Nil.

The interaction of tonal alignment with vowel length and syllable structure in Lebanese Arabic

Research on a variety of languages has shown that tonal alignment in pitch accents can be influenced by segmental factors such as syllable structure, onset type, and phonological vowel length (e.g., Ladd et al., 2000; Maddieson, 1997). However, the majority of work on these topics has been on European languages. The current study examines the interaction of these factors in the Beirut dialect of Lebanese Arabic. Disyllabic words with initial, stressed syllables that were either open or closed and contained either a long or a short vowel and had a simple or complex onset were examined when non-focused and in contrastive focus. Contrastive focus was associated with a wider f0 range. The focus pitch accent was H* or L+H*. In terms of segmental effects, neither vowel length nor syllable structure had a significant effect on tonal alignment. Timing of the f0 peak was found to be consistently about 45 msec from vowel onset. This study contributes to the literature on tonal alignment by examining a variety of Arabic that is understudied in terms of intonation.

Risk factors of early onset type 2 diabetes mellitus in young adults ≤ 40 years old

Risk factors of early onset type 2 diabetes mellitus in young adults ≤ 40 years old

Adjustment for sparse data bias in odds ratios: Significance to appraisal of risk of diabetes due to occupational trichlorfon insecticide exposure

BackgroundBias away from the null in odds ratios (OR), aggravated by low power, is a well-known phenomenon in statistics (sparse data bias). Such bias increases in presence of selection of “significant” results on the basis of null hypothesis testing (effect size magnification, ESM). ObjectivesWe seek to illustrate these issues and adjust for suspected sparse data bias in the context of a reported more than doubling of the odds of new onset type 2 diabetes in presence of occupational trichlorfon insecticide exposure reported in the Agricultural Health Study. MethodsWe performed ESM analysis on the crude ORs extracted from the contingency table in the published report, which is done by simulating selected OR given a posited true OR. Next, we applied easily accessible methods that adjust for sparse data bias to the extracted contingency tables, including data augmentation, bootstrap, Firth's regression, and Bayesian methods with weakly informative priors. ResultsDuring the ESM analysis, we observed that there was a reasonable chance that a “statistically significant” OR of around 2.5–2.6 would be observed for true OR of 1.2. Adjustment for sparse data bias revealed that Bayesian methods outperformed alternative approaches in terms of yielding more precise inference, while not making unjustified distributional assumptions about estimates of OR. The OR in the original paper of about 2.5–2.6 was reduced on average to OR of 1.9 to 2.2, with 95% (Bayesian) credible intervals that included the null. DiscussionIt is reasonable to adjust ORs for sparse data bias when the reported association has societal importance, because policy must be informed by the least biased estimates of the effect. We think that such adjustment would lead to a more appropriate evaluation of the extent of evidence on the contribution of occupational exposure to trichlorfon pesticide to risk of new onset diabetes.

Combined General Anaesthesia with Retrolaminar Block for Breast Cancer Surgery in Pompe&amp;rsquo;s Disease

Pompe’s disease is a rare metabolic disease that results in progressive muscle weakness which culminates in respiratory failure in the late onset type. Patients with Pompe’s disease are at high risk of cardiac and respiratory complications under general anaesthesia owing to their premorbid cardiac and respiratory impairments, as well as the respiratory depressant effects of anaesthetic and analgesic agents. We present a high-risk case of a patient with late onset Pompe’s disease complicated by severe restrictive lung disease scheduled for breast cancer surgery under general anaesthesia with a single shot retrolaminar nerve block for analgesia.

Predictive factors of diabetic ketoacidosis in patients with newly onset type 1 diabetes: A single center study

BackgroundDiabetic ketoacidosis is a severe metabolic emergency often associated with the onset of Type 1 Diabetes Mellitus, with significant morbidity and mortality. Its incidence as the initial presentation of Type 1 Diabetes Mellitus varies widely by country. In Morocco, there is a lack of comprehensive research on the prevalence and risk factors of diabetic ketoacidosis in children with newly diagnosed Type 1 Diabetes Mellitus, highlighting the need for this study. ObjectivesThe aim of our study was to analyze the predictive factors of diabetic ketoacidosis at the onset of Type 1 Diabetes Mellitus in children and adolescents at a single medical center in Morocco to develop prevention and management strategies. MethodsA retrospective, single-center study including 200 patients aged between 1 and 18 years at Type 1 Diabetes Mellitus onset, between September 2019 and September 2023. The population was divided into two groups according to the presence or absence of diabetic ketoacidosis. Medical records provided data for analysis with SPSS v21, employing Chi-square and Student's t-tests, followed by logistic regression to identify predictors of diabetic ketoacidosis. ResultsMultivariate regression identified several factors that were significantly associated with diabetic ketoacidosis at presentation, including age below 5 years (OR: 3.98; p = 0.021 compared to 6–10 years and OR: 5.07; P = 0.003 compared to 11–18 years), rural living (OR: 2.95; p = 0.032), low family income (OR: 9.22; p < 0.001), delayed diagnosis (OR: 21.27; p < 0.001), longer symptom duration before diagnosis (OR: 1.02; p = 0.010), preceding infections (OR: 2.72; p = 0.019), and lower vitamin D levels (OR: 0.90; p = 0.011). ConclusionOur findings underscore the critical need for increased awareness, education, use of point-of-care glucose testing, and targeted interventions in rural areas, in order to reduce the incidence of diabetic ketoacidosis. We also highlight the potential role of vitamin D in increasing the risk of diabetic ketoacidosis at the onset of Type 1 Diabetes Mellitus. This study provides important information on the present state of pediatric diabetes care in our country, and suggests target points for future interventions and research.