Mayra Alsaeid

Prevalence of Type 2 Diabetes Mellitus among Kuwaiti Children and Adolescents

Objectives: To determine the prevalence of type 2 diabetes among 6- to 18-year-old Kuwaiti children. Subjects and Methods: Children with type 2 diabetes were identified at 182 schools (50 primary, 63 intermediate, and 69 secondary) randomly selected using the 2000/2001 educational districts’ registers as a sampling frame. Prevalence rates were adjusted to the 2002 Kuwaiti population. Diagnosis of type 2 diabetes was based on the World Health Organization and the American Diabetes Association criteria. Results: Type 2 diabetes was identified in 45 of the 128,918 children surveyed, thereby giving an overall prevalence of 34.9 per 100,000 [95% confidence interval (CI) 24.7–45.1]. There was a significant difference in prevalence between males (47.3, 95% CI 28.7–65.8) and females (26.3, 95% CI 14.8–37.8) at p = 0.05 and a significant trend for an increase in prevalence of type 2 diabetes with age (p = 0.026). The overall age-adjusted prevalence rate in the 2002 Kuwaiti population was 33.2 (95% CI 26.6–39.9), 41.6 (95% CI 31.2–52.0) in male and 24.6 (95% CI 16.4–32.7) in female children; the difference was significant at p = 0.013. There was no significant difference in prevalence between regions. Children with type 2 diabetes had a significantly higher frequency (51.1%) of a positive family history of diabetes than children of a similar age without type 2 diabetes (22.2%) (p = 0.004). Conclusion: The prevalence of type 2 diabetes in adult Kuwaitis is spreading to children and adolescents, making it an emergency public health problem. Efforts need to be initiated to address prevention strategies of type 2 diabetes in youth.

Prevalence of type 1 diabetes among 6- to 18-year-old Kuwaiti children.

Objectives: To determine the prevalence of type 1 diabetes among 6- to 18-year-old Kuwaiti children according to gender, age, and region. Subjects and Methods: Children with type 1 diabetes aged 6–18 years were identified at 182 schools (50 primary, 63 intermediate, and 69 secondary) in Kuwait during the study period October 2000 to September 2002. Schools were randomly selected using the 2000/01 educational districts’ registers as sampling frame proportional to the number of schools in each district. Prevalence rates were adjusted to the 2002 Kuwaiti population. Diagnosis of type 1 diabetes was based on the World Health Organization, and the American Diabetes Association criteria. Results: Prevalence of type 1 diabetes was 269.9 per 100,000 (95% confidence interval, CI 241.6–298.3). There was no significant difference in prevalence between male (247.6, 95% CI 205.2–290.0) and female (285.5, 95% CI 247.5–323.5). Type 1 diabetes was more prevalent in the age group 10–13 years (347.3), and lowest in the age group 6–9 years (182.6) per 100,000; the difference was significant at p < 0.001. The overall age-adjusted prevalence rate was 252.9 (95% CI 234.6–271.2), 229.1 (95% CI 204.6–253.6) in male and 277.4 (95% CI 250.0–304.7) in female children in the 2002 Kuwaiti population. The mean age at onset was 9.2, and 8.1 years in male and female children, respectively (p = 0.018). There was no significant difference in prevalence between regions. Conclusion: Type 1 diabetes is a common chronic disease in Kuwaiti children.

Impact of glycemic control on serum lipoprotein (a) in Arab children with type 1 diabetes

Abstract 
 Background : Lipoprotein (a) (Lp (a)) is an independent risk factor for coronary artery disease (CAD), a major cause of death in patients with type 1 diabetes mellitus. Both type 1 diabetes and CAD represent major problems in Kuwait. Data on the effect of metabolic control on Lp (a) in diabetic children are limited and this is particularly true for Arab children. The objectives of the present study were to analyze serum Lp (a) levels in patients with type 1 diabetes compared with non‐diabetic children, taking into account the effect of glycemic control.

Factors associated with type 1 diabetes in Kuwaiti children.

Type 1 diabetes is a common chronic disease in childhood, and the outcome of environmental, genetic and immunologic interactions. The aim was to study the social and metabolic characteristics (lipids, lipoproteins, apolipoproteins, lipoprotein(a) (Lp(a)) and total sialic acid) and predisposing factors in 6–18-year-old Kuwaiti children with type 1 diabetes. This pair-matched case-control study included 348 type 1 diabetic children (131 males, 217 females) matched by age and gender to 348 non-diabetic controls. Diabetic children were identified, according to the WHO and the American Diabetes Association criteria, at 182 randomly selected schools. Social and metabolic characteristics were adversely affected in diabetic children compared to their controls. The logistic regression analysis showed that the predisposing factors: family history of type 1 and type 2 diabetes and thyroid disease, were significant associated factors with type 1 diabetes after adjusting for demographic and social variables. The significant correlations of Lp(a) and total sialic acid with glycated haemoglobin, lipoproteins and apolipoproteins partially explain reporting them as possible markers for coronary heart disease. There are adverse metabolic changes in children with type 1 diabetes. As these changes are associated with early onset atherogenesis, metabolic markers need to be measured and possibly corrected at an early stage in children with diabetes.

Serum lipoprotein (a) concentrations among Arab children: a hospital-based study in Kuwait

Elevated lipoprotein (a) [Lp(a)] is an independent risk factor for premature atherosclerosis and coronary heart disease, both of which are prevalent among Kuwaitis. Our objective was to measure serum lipids, including Lp(a), in Arab children and compare them with values reported for other ethnic groups. To that end, serum concentrations of Lp(a), total cholesterol [T-CHOL], high density lipoprotein [HDL], low density lipoprotein [LDL], and triglyceride [TG] were assessed in 103 Arab children. The mean and median Lp(a) were 140.4 mg/l and 95 mg/l, respectively. The Lp(a) frequency distribution was skewed to the right with the highest frequencies appearing at low levels. Serum Lp(a) correlated positively with T-CHOL and LDL but did not correlate with age, HDL and TG. Only nine children (8.7%) had serum Lp(a) levels associated with increased cardiovascular risk, namely > or = 300 mg/l.

Lipoprotein A profiles in Arab newborns

Abstract Background: Lipoprotein A (LpA) is an intriguing lipoprotein with unquestionable genetic determination which is expressed early in life. The increasing interest in LpA is due to its established recognition as an important independent risk factor for premature atherosclerosis in cardiovascular diseases. Coronary heart disease is a major cause of morbidity and premature mortality in Kuwait. The present study was designed to measure serum LpA concentrations in Arab newborns to establish reference values for LpA in newborns and its relationship to factors present in the mother and baby.

Seroprevalence of human parvovirus B19 in children of a desert region

A seroepidemiological study was conducted in Kuwait to evaluate the pattern of acquisition of human parvovirus B19 by children in Kuwait and to compare it with patterns described in other regions in different climatic zones. A total of 218 serum samples from children less than 16 years of age were tested for the presence of anti-B19 IgG by enzyme immunoassay. The overall seroprevalence was 17.4%. Infants in Kuwait had low levels of maternally-acquired anti-B19 IgG (8.6%). The age of peak exposure to parvovirus B19 was 10-15 years compared with less than 10 years in England and Wales and more than 20 years in Singapore. The results of this study indicate an influence of geographic differences on transmission of parvovirus B19.

Case of the month: A 20-month-old boy with fever, respiratory distress and necrotizing skin lesions

tercostal recessions were present but air entry was not diminished. Results of initial laboratory investigations are summarized in Table 1. CSF examination was normal except for 18 mononuclear cells/mm3. Intravenous cefotaxime was started soon after blood cultures were taken. The patient’s condition deteriorated over the next few hours with a rise in respiratory rate, heart rate and episodes of bradycardia. Small 1.5 × 1.5 cm erythematous skin lesions developed over the trunk and the extremities. Some of the lesions had necrotic centres (Fig. 1). The patient was noticed to have difficulty swallowing his own secretions; and a lateral roentgenogram of the neck showed mild swelling of the epiglottis suggestive of epiglottitis. A diagnostic procedure was performed and result of blood culture was obtained. YOUR DIAGNOSIS? Eur J Pediatr (1996) 155 :341–342

Evaluation of undergraduate students in paediatrics at Kuwait University

Medical schools use a variety of methods to assess the clinical competence of students. The aim of this study was to evaluate the system in use at the Department of Paediatrics at Kuwait University. The analysis of the performance of 142 second clinical year students in three consecutive batches revealed that their performances in the final examination correlated well with the paediatric clerkship scores (r = 0.85, p < 0.0001). There was high correlation (p < 0.01) between the MCQs, short cases and long-case components of the final examination and the total final score (r = 0.79, 0.73 and 0.73 respectively) while the essay-type tests had a lower but significant correlation (r = 0.63, p < 0.01)). It may be concluded that, since end-of-block and final examinations assessed similar competences, one or the other can be discontinued. An alternative is to use the two stages of the examination to assess the candidates in different competences, thus increasing the content validity of the system.

Phytanic acid attenuates Insulin-like Growth Factor-1 activity via Nitric oxide-mediated γ-Secretase activation in Rat Aortic Smooth Muscle Cells: Possible Implications for Pathogenesis of Infantile Refsum Disease.

Background:Infantile Refsum disease (IRD), a peroxisomal disease with defective phytanic acid oxidation, causes neurological impairment and development delay. Insulin-like growth factor-1 (IGF-1) regulates child development and to understand molecular mechanism(s) of IRD, we examined the effect of phytanic acid (PA) on IGF-1 activity.Methods:Bromodeoxyuridine (BrdU) incorporation was measured in rat aortic smooth muscle cell (SMC) cultures following treatment with fetal bovine serum (FBS), basic fibroblast growth factor (bFGF), platelet-derived growth factor (PDGF) or IGF-1 in the absence or presence of PA. Gene expression and protein contents of IGF-1 receptor (IGF-1R) and PDGF receptor (PDGFR) were examined using quantitative PCR and western blotting. Results:PA inhibited mitogenic activities of FBS, PDGF and IGF-1 with more pronounced effect on IGF-1-induced bromodeoxyuridine (BrdU) incorporation. Palmitic acid or lignoceric acids did not inhibit IGF-1 activity. PA had no effect on PDGFR mRNA/protein levels but markedly increased IGF-1R mRNA levels. PA and nitric oxide (NO) markedly decreased IGF-1R protein. L-NAME, a NO synthase inhibitor and DAPT, a γ-secretase inhibitor, alleviated PA-induced decrease in IGF-1R protein. Both PA and NO donor increased γ-secretase activity which was alleviated by L-NAME. Conclusion:This study demonstrates that PA attenuates IGF-1 activity possibly through IGF-1R impairment and NO-mediated modulation of γ-secretase activity.