Kinda Khalaf

Inflammation, coagulation, endothelial dysfunction and oxidative stress in prediabetes — Biomarkers as a possible tool for early disease detection for rural screening

OBJECTIVES This study aims to increase understanding of the connection between oxidative stress and inflammation in diabetes disease progression to provide a basis for investigating improved diagnostic possibilities, treatment and prevention of prediabetes. DESIGN AND METHODS Differences in the level of biochemical markers of oxidative stress (erythrocyte GSH/GSSG and urinary 8-isoprostane), inflammation (CRP, IL-6), endothelial dysfunction (plasma homocysteine, urinary 8-hydroxy-2-deoxy-guanosine) and coagulation/fibrinolysis (C5a, D-Dimer) were determined in prediabetes and control subjects. RESULTS While no difference was found in the 8-isoprostane levels between the two groups, the erythrocyte GSH/GSSG ratio was significantly reduced in the prediabetes group compared to control, indicating increased oxidative stress in the prediabetic state. Both urinary 8-OHdG and surprisingly also plasma homocysteine were significantly elevated in the prediabetes group, indicating endothelial dysfunction. The inflammation markers were slightly elevated in the prediabetic subjects and the same trend was found for the coagulation/fibrinolysis markers C5a and D-Dimer. These results were however not significant. CONCLUSIONS The small elevation of blood glucose levels in the prediabetic state may have a detectable influence on endothelial function as indicated by changes to 8-OHdG, indicating an increased DNA-damage and homocysteine release from endothelial cells. Increased oxidative stress as indicated by the reduced GSH/GSSG ratio is likely to be the link between the moderate hyperglycaemia in prediabetes and pathological changes in endothelial function, which in the long-term may promote atherogenesis and result in the development of cardiovascular disease. Early detection of prediabetes is essential to avoid diabetes development and the associated complications like cardiovascular disease. The GSH/GSSG ratio and biomarkers like urinary 8-OHdG and plasma homocysteine offer a possible tool for the assessment of prediabetes in prevention screenings.

Identifying Common Genetic Risk Factors of Diabetic Neuropathies

Type 2 diabetes mellitus (T2DM) is a global public health problem of epidemic proportions, with 60–70% of affected individuals suffering from associated neurovascular complications that act on multiple organ systems. The most common and clinically significant neuropathies of T2DM include uremic neuropathy, peripheral neuropathy, and cardiac autonomic neuropathy. These conditions seriously impact an individual’s quality of life and significantly increase the risk of morbidity and mortality. Although advances in gene sequencing technologies have identified several genetic variants that may regulate the development and progression of T2DM, little is known about whether or not the variants are involved in disease progression and how these genetic variants are associated with diabetic neuropathy specifically. Significant missing heritability data and complex disease etiologies remain to be explained. This article is the first to provide a review of the genetic risk variants implicated in the diabetic neuropathies and to highlight potential commonalities. We thereby aim to contribute to the creation of a genetic-metabolic model that will help to elucidate the cause of diabetic neuropathies, evaluate a patient’s risk profile, and ultimately facilitate preventative and targeted treatment for the individual.

The effects of movement speed on kinematic variability and dynamic stability of the trunk in healthy individuals and low back pain patients

BACKGROUND Comparison of the kinematic variability and dynamic stability of the trunk between healthy and low back pain patient groups can contribute to gaining valuable information about the movement patterns and neuromotor strategies involved in various movement tasks. METHODS Fourteen chronic low back pain patients with mild symptoms and twelve healthy male volunteers performed repeated trunk flexion-extension movements in the sagittal plane at three different speeds: 20 cycles/min, self-selected, and 40 cycles/min. Mean standard deviations, coefficient of variation and variance ratio as variability measures; maximum finite-time Lyapunov exponents and maximum Floquet multipliers as stability measures were computed from trunk kinematics. FINDINGS Higher speed significantly reduced the kinematic variability, while it increased short-term Lyapunov exponents. Long-term Lyapunov exponents were higher at self-selected speed and lower in low back pain patients as compared to control volunteers. Floquet multipliers were larger at self-selected speed and during higher pace trunk movements. INTERPRETATION Our findings suggest that slower pace flexion-extension trunk movements are associated with more motor variation as well as local and orbital stability, implying less potential risk of injury for the trunk. Individuals with and without low back pain consistently recruited a closed-loop control strategy towards achieving trunk stability. Chronic low back pain patients exhibited more stable trunk movements over long-term periods, indicating probable temporary pain relief functional adaption strategies. These results may be used towards the development of more effective personalized rehabilitation strategies and quantitative spinal analysis tools for low back pain detection, diagnosis and treatment, as well as improvement of workspace and occupational settings.

Collaborative learning in action

In this paper we introduce the Collaborative Learning Environment (CLE), a novel document creation tool, designed at the Etisalat-British Telecomm Innovation Center (EBTIC) and created to enable and enhance team-based negotiation of online, interactive writing tasks. We provide the context in which the tool has been trialed, and discuss a case study where the tool is used to gain a deep understanding into the way students thought about and implemented given tasks.

Association of Diabetes Related Complications with Heart Rate Variability among a Diabetic Population in the UAE.

Microvascular, macrovascular and neurological complications are the key causes of morbidity and mortality among type II diabetes mellitus (T2DM) patients. The aim of this study was to investigate the alterations of cardiac autonomic function of diabetic patients in relation to three types of diabetes-related complications. ECG recordings were collected and analyzed from 169 T2DM patients in supine position who were diagnosed with nephropathy (n = 55), peripheral neuropathy (n = 64) and retinopathy (n = 106) at two hospitals in the UAE. Comparison between combinations of patients with complications and a control diabetic group (CONT) with no complication (n = 34) was performed using time, frequency and multi-lag entropy measures of heart rate variability (HRV). The results show that these measures decreased significantly (p<0.05) depending on the presence and type of diabetic complications. Entropy, (median, 1st- 3rd interquartile range) for the group combining all complications (1.74,1.37–2.09) was significantly lower than the corresponding values for the CONT group (1.77, 1.39–2.24) with lag-1 for sequential beat-to-beat changes. Odds ratios (OR) from the entropy analysis further demonstrated a significantly higher association with the combination of retinopathy and peripheral neuropathy versus CONT (OR: 1.42 at lag 8) and an even OR for the combination of retinopathy and nephropathy (OR: 2.46 at lag 8) compared to the other groups with complications. Also, the OR of low frequency power to high frequency power ratio (LF/HF) showed a higher association with these diabetic-related complications compared to CONT, especially for the patient group combining all complications (OR: 4.92). This study confirms that the type of microvascular or peripheral neuropathy complication present in T2DM patients have different effects on heart rate entropy, implying disorders of multi-organ connectivity are directly associated with autonomic nervous system dysfunction. Clinical practice may benefit from including multi-lag entropy for cardiac rhythm analysis in conjunction with traditional screening methods in patients with diabetic complications to ensure better preventive and treatment outcomes in the Emirati Arab population.

Energy efficient system-on-chip architecture for non-invasive mobile monitoring of diabetics

This paper presents an integrated biomedical processor system consists of a biomedical processor chip, MEMS-based ECG and oximetry-based Glucose alert sensors to achieve a non-invasive home diagnostic health monitoring system for diabetics. The biomedical processor integrates various computational engines such as FFT core, CAN severity algorithm classification and wireless interface. The chip targets extremely low power consumption to enable battery-powered operation for extended period of time. The sensors will provide non-invasive monitoring of ECG signals, and blood glucose levels alert at the same physical location on the human body. The unique sensor platform inevitably drives the SoC architecture to be wearable and less intrusive; thereby, providing patients with constant feedback on their critical health parameters.

THE PAST AND PRESENT OF HUMAN MOVEMENT RESEARCH: TOWARDS THE DESIGN OF HUMAN-LIKE ROBOTS

The Journal of Mechanics in Medicine and Biology(JMMB) has retracted the above paper from its April 2012 issue. The Publisher of JMMB was alerted to the fact that the conference paper was previously published in IEEE in 2011. The authors indicated that this manuscript was suggested by the conference organizers for journal publication. As stated clearly in the journal’s guidelines, only original manuscripts will be considered. Once a manuscript is accepted, the author is assumed to cede full copyright of their manuscript over to the publisher - World Scientific Publishing Co.

Clinical profiles, comorbidities and complications of type 2 diabetes mellitus in patients from United Arab Emirates

Objective To assess clinical profiles of patients with type 2 diabetes in the United Arab Emirates (UAE), including patterns, frequencies, and risk factors of microvascular and macrovascular complications. Research design and methods Four hundred and ninety patients with type 2 diabetes were enrolled from two major hospitals in Abu Dhabi. The presence of microvascular and macrovascular complications was assessed using logistic regression, and demographic, clinical and laboratory data were collected. Significance was set at p<0.05. Results Hypertension (83.40%), obesity (90.49%) and dyslipidemia (93.43%) were common type 2 diabetes comorbidities. Most of the patients had relatively poor glycemic control and presented with multiple complications (83.47% of patients had one or more complication), with frequent renal involvement. The most frequent complication was retinopathy (13.26%). However, the pattern of complications varied based on age, where in patients <65 years, a single pattern presented, usually retinopathy, while multiple complications was typically seen in patients >65 years old. Low estimated glomerular filtration rate in combination with disease duration was the most significant risk factor in the development of a diabetic-associated complication especially for coronary artery disease, whereas age, lipid values and waist circumference were significantly associated with the development of diabetic retinopathy. Conclusions Patients with type 2 diabetes mellitus in the UAE frequently present with comorbidities and complications. Renal disease was found to be the most common comorbidity, while retinopathy was noted as the most common diabetic complication. This emphasizes the need for screening and prevention program toward early, asymptomatic identification of comorbidities and commence treatment, especially for longer disease duration.

Novel miniature wearable microstrip antennas for ISM-band biomedical telemetry

This paper presents two innovative designs of miniature wearable microstrip antennas for biotelemetry in the Industrial, Scientific, and Medical (ISM) band (2.4-2.48GHz). The two proposed designs employ stacked triangular guiding patches as well as slotting of the patches. This results in a considerable size reduction of 60% with respect to the original antenna volume. Both designs have dimensions of of 39 × 39 × 2.1 mm3. Simulations of the two proposed designs have been carried out using HFSS for S-parameters, Specific Absorption Rate (SAR), and E-field distribution, on an equivalent human body phantom. Results demonstrate a return loss of -16.69 dB, and -15.53 dB for the stacked and stacked-slotted triangular patches, respectively. Furthermore, the maximum SAR value obtained from both designs satisfy the IEEE standard safety guidelines, which is necessary for ensuring patient safety. This makes the two proposed antenna designs great candidates for WBAN applications.

Poincaré plot analysis of heart rate variability in the diabetic patients in the UAE

Major complications such as cardiac death and cardiac autonomic neuropathy are caused by diabetic autonomic neuropathy. Heart Rate Variability (HRV) analysis has shown to detect variations in the autonomic balance of heart rate and is useful for early detection of autonomic dysfunction. This study presents the outcome of HRV analysis of short ECG recordings taken from nondiabetic and type 2 diabetes patients, applying Poincaré plot indices represented by short term variation (SD1), long term variation (SD2) and complex correlation (CCM) measure which measures the temporal dynamics, for early detection of cardiac autonomic neuropathy. SD1 and the ratio SD1/SD2 were found to be significantly lower in type 2 diabetes patients than the control group. The highest discriminatory power was observed with CCM, indicating the advantage of using a dynamic measure for HRV rather than the static Poincaré plot indices. SD1 and CCM could be markers for CVD risk in type 2 diabetic patients.