Hasil untuk "Specialties of internal medicine"

Jason A Gencher, Samaneh Salimian, Ricky D Turgeon et al.

V. Innao, A.P.M. Barbagallo, O. Bianco et al.

Introduction: Chronic Lymphocytic Leukemia (CLL) is the most common leukemia in Western countries, with age-related incidence and clinical heterogeneity. Evans Syndrome (ES), defined by the concurrent occurrence of immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA), is a rare immune disorder often associated with lymphoproliferative diseases and potentially fatal outcomes. Management relies on expert consensus due to the lack of randomized trials. Standard CLL therapies include BTK inhibitors (BTKi) and the BCL2 inhibitor Venetoclax, often with anti-CD20 antibodies. When CLL progression is associated with immune cytopenias, immunosuppressive therapy is used, with CLL-directed treatment in refractory cases. To date, no reports have described ITP onset following Venetoclax in a patient with prior AIHA successfully treated with Zanubrutinib. Patients and Methods: We report the case of a 75-year-old man diagnosed in 2019 with asymptomatic CLL who, in 2021, developed steroid- and IVIG-refractory warm AIHA, treated with Bendamustine-Rituximab, achieving partial response. In July 2024, he showed rapid lymphocytosis progression (DT <2 months), splenomegaly (23 cm), thrombocytopenia (PLT 86×10⁹/L), and constitutional symptoms (Rai IV/Binet C). FISH was negative; IGHV unmutated, TP53 wild-type, CLL-IPI 6. Venetoclax-Rituximab (Murano protocol) was started. In week 2 of ramp-up, the patient developed spontaneous ecchymoses and gingival bleeding. Labs showed PLT 0×10⁹/L, Coombs-positive tests, Hb 10.7 g/dL, and a positive SARS-CoV-2 swab. Steroids and IVIG were ineffective. After swab negativization, Rituximab 375 mg/m² was administered weekly ×4 without response. He was referred to our ITP hub. Results: Romiplostim (Rom) was initiated at 3 μg/kg/week and increased by 2 μg/kg/week; Zanubrutinib (Zanu) 160 mg BID was added in week 2. Platelet and hemoglobin normalization occurred within 4 weeks. After 6 months, BTKi was continued at full dose and Rom reduced to 5 μg/kg/week. A 10-day BTKi interruption led to PLT drop (11×10⁹/L), reversed after Zanu reintroduction. The patient has since maintained a complete hematologic response with no adverse events (fig.1). Conclusion: TPO-RAs are effective in ITP. However, when ITP is secondary to CLL, targeting the underlying disease is crucial. BTKi have shown efficacy in ITP, as highlighted in the LUNA3 trial. This case supports the safety and efficacy of combining BTKi and TPO-RAs in refractory secondary ITP.  

Joana Marques‐Antunes, Egon Rodrigues, Marta Guimarães et al.

PurposeRepairing complex abdominal wall hernias is challenging, often requiring component separation techniques (CST) for tension-free closure. Adjuvant therapies, such as botulinum toxin type A (BTA), preoperative progressive pneumoperitoneum (PPP), and intraoperative fascial traction (IFT), may reduce the need for CST by improving abdominal wall compliance and reduce the complexity of the hernia. There is limited knowledge about the effects of their combined use. Our aim is to evaluate the rate of CST in abdominal wall reconstruction for complex midline hernias after adjuvant therapies.MethodsA cross-sectional study was conducted on patients who underwent surgery for correction of midline complex abdominal hernias between June 2020 and June 2024. Patients submitted to BTA, PPP, or/and IFT were included. Exclusion criteria were non-midline hernias, non eletive surgeries and less than 3 months of follow-up.ResultsAmong the 44 patients studied, 61.4% underwent abdominal wall reconstruction without requiring CST. Traditional predictors like component separation index and rectus/defect ratio were not associated with a higher rate of CST after adjuvant therapies. 45.5% of patients underwent a combination of adjuvant techniques (BTA + PPP or BTA + IFT). The early and late complication rates were 20.5% and 9.1%. A recurrence rate of 4.5% was reported after a median follow-up of 13 months.ConclusionThis study suggests that adjuvant therapies may influence the surgical approach to abdominal wall reconstruction. The synchronous application of adjuvant therapies, both preoperatively and intraoperatively, could enhance their effect and contribute to the use of less disruptive techniques.

Choon Chiat Oh, Boon Yee Lim, Elizabeth Chun Yong Lee et al.

ABSTRACT Background Cutaneous squamous cell carcinoma (cSCC) remains poorly understood at the molecular level, both in the immunocompetent and immunosuppressed population with skin of colour. Data on the diversity of viruses found in cSCC is also lacking. Objectives We aimed to characterise the immunological and molecular profiles of cSCC in organ transplant recipients (OTR) and non‐transplant recipients in an Asian cohort (n = 53) and explore the diversity of viruses detected. Methods Gene expression analysis was performed on snap‐frozen cSCC tissues using the NanoString PanCancer IO360 panel. Viral detection was performed using the Twist Comprehensive Viral Research Panel. Results cSCC presented dysregulation of immune response pathways and tumour microenvironment remodelling compared to adjacent normal skin tissue. Cell‐type profiling based on gene expression profiles showed higher levels of exhausted CD8 cells, neutrophils, and cytotoxic cells in tumour cells. Furthermore, three distinct clusters of cSCC gene signatures could be observed, where Cluster 3 with the highest Tumour inflammation signature (TIS) scores displayed distinct upregulation of most pathways suggesting a more inflamed or “hot” tumour phenotype. cSCC of OTR exhibited greater expression of tumour markers (AQP9, SERPINA1) and reduced expression of T‐cell cytokines (CXCL10, CXCL11). Viruses were particularly enriched in tumour tissue, as compared with normal skin. In addition, there was an enrichment of detectable viruses in transplant‐associated cSCC, with several tumours harbouring multiple viruses (HPV, EBV, MCV, and TTV). Conclusions cSCC is marked by a pro‐tumorigenic immune environment with altered immune cell populations. These findings support the potential for stratified, immune‐tailored treatment approaches for cSCC, especially in OTR who have a higher disease burden. Future studies on the possible oncogenic role of the detected viruses can be undertaken.

Felix E Y Aggor, Martinna Bertolini, Bianca M Coleman et al.

Oropharyngeal candidiasis (OPC) is the most common human fungal infection, arising typically from T cell immune impairments. IL-17 and IL-22 contribute individually to OPC responses, but here we demonstrate that the combined actions of both cytokines are essential for resistance to OPC. Mice lacking IL-17RA and IL-22RA1 exhibited high fungal loads in esophagus- and intestinal tract, severe weight loss, and symptoms of colitis. Ultimately, mice succumbed to infection. Dual loss of IL-17RA and IL-22RA impaired expression of small proline rich proteins (SPRRs), a class of antimicrobial effectors not previously linked to fungal immunity. Sprr2a1 exhibited direct candidacidal activity in vitro, and Sprr1-3a-/- mice were susceptible to OPC. Thus, cooperative actions of Type 17 cytokines mediate oral mucosal anti-Candida defenses and reveal a role for SPRRs.

Lauren D. Branditz, Andrew P. Kendle, Cynthia G. Leung et al.

Background The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students’ procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school.Methods Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores.Results Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively.Conclusions Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training.

P. Phutrakool, K. Pongpirul

Background Complementary and Alternative Medicine (CAM) has gained popularity among the general population, but its acceptance and use among medical specialists have been inconclusive. This systematic review aimed to identify relevant studies and synthesize survey data on the acceptance and use of CAM among medical specialists. Methods We conducted a systematic literature search in PubMed and Scopus databases for the acceptance and use of CAM among medical specialists. Each article was assessed by two screeners. Only survey studies relevant to the acceptance and use of CAM among medical specialists were reviewed. The pooled prevalence estimates were calculated using random-effects meta-analyses. This review followed both PRISMA and SWiM guidelines. Results Of 5628 articles published between 2002 and 2017, 25 fulfilled the selection criteria. Ten medical specialties were included: Internal Medicine (11 studies), Pediatrics (6 studies), Obstetrics and Gynecology (6 studies), Anesthesiology (4 studies), Surgery (3 studies), Family Medicine (3 studies), Physical Medicine and Rehabilitation (3 studies), Psychiatry and Neurology (2 studies), Otolaryngology (1 study), and Neurological Surgery (1 study). The overall acceptance of CAM was 52% (95%CI, 42–62%). Family Medicine reported the highest acceptance, followed by Psychiatry and Neurology, Neurological Surgery, Obstetrics and Gynecology, Pediatrics, Anesthesiology, Physical Medicine and Rehabilitation, Internal Medicine, and Surgery. The overall use of CAM was 45% (95% CI, 37–54%). The highest use of CAM was by the Obstetrics and Gynecology, followed by Family Medicine, Psychiatry and Neurology, Pediatrics, Otolaryngology, Anesthesiology, Internal Medicine, Physical Medicine and Rehabilitation, and Surgery. Based on the studies, meta-regression showed no statistically significant difference across geographic regions, economic levels of the country, or sampling methods. Conclusion Acceptance and use of CAM varied across medical specialists. CAM was accepted and used the most by Family Medicine but the least by Surgery. Findings from this systematic review could be useful for strategic harmonization of CAM and conventional medicine practice. Systematic review registration PROSPERO CRD42019125628 Graphical abstract

Jin Hyun Joh, Sun Hyung Joo

Cyanoacrylate glue is a non-thermal, non-tumescent agent used to treat saphenous reflux. It was introduced to overcome heat-related discomfort and complications. Multiple randomized controlled trials using this therapy have demonstrated excellent clinical outcomes at long-term follow-up. However, diffuse injection-site inflammation and systemic urticaria are worrisome complications. In preclinical studies, serial histopathological findings demonstrated acute inflammatory reaction, subacute vasculitis, chronic granulomatous foreign body reaction, fibrotic changes with partial vascular recanalization, and chronic foreign body-type inflammatory response. While the exact nature of this unique complication remains undefined, complex hypersensitivity and irritation reaction phenomena have been suggested based on reported clinical presentations. The incidence of this complication has been reported as ranging from 0.3%-25.4%. Typically, erythematous reactions can occur near treatment sites, with symptoms ranging from mild pruritus and/or erythema that resolves without treatment to recurrent severe inflammation and pruritus requiring nonsteroidal anti-inflammatory drugs, antihistamines, and/or corticosteroids. Surgical excision has been rarely reported in patients with severe intractable inflammation or treatment-site infections. Although several anecdotal studies reported on using antihistaminics or corticosteroids, no effective strategies have been established to prevent this complication.

Mark W. D. Sweep, Mark W. D. Sweep, Martijn J. H. Tjan et al.

Immune checkpoint inhibitor therapy for cancer treatment can give rise to a variety of adverse events. Here we report a male patient with metastatic melanoma who experienced life-threatening colitis and duodenitis following treatment with ipilimumab and nivolumab. The patient did not respond to the first three lines of immunosuppressive therapy (corticosteroids, infliximab, and vedolizumab), but recovered well after administration of tofacitinib, a JAK inhibitor. Cellular and transcriptional data on colon and duodenum biopsies shows significant inflammation in the tissue, characterized by a large number of CD8 T cells and high expression of PD-L1. While cellular numbers do decrease during three lines of immunosuppressive therapy, CD8 T cells remain relatively high in the epithelium, along with PD-L1 expression in the involved tissue and expression of colitis-associated genes, indicating an ongoing colitis at that moment. Despite all immunosuppressive treatments, the patient has an ongoing tumor response with no evidence of disease. Tofacitinib might be a good candidate to consider more often for ipilimumab/nivolumab-induced colitis.

Kewei Wang, Kewei Wang, Rong Zhang et al.

Background and aimsWnt/β-catenin signaling plays an important role in regulating hepatic metabolism. This study is to explore the molecular mechanisms underlying the potential crosstalk between Wnt/β-catenin and mTOR signaling in hepatic steatosis.MethodsTransgenic mice (overexpress Wnt1 in hepatocytes, Wnt+) mice and wild-type littermates were given high fat diet (HFD) for 12 weeks to induce hepatic steatosis. Mouse hepatocytes cells (AML12) and those transfected to cause constitutive β-catenin stabilization (S33Y) were treated with oleic acid for lipid accumulation.ResultsWnt+ mice developed more hepatic steatosis in response to HFD. Immunoblot shows a significant increase in the expression of fatty acid synthesis-related genes (SREBP-1 and its downstream targets ACC, AceCS1, and FASN) and a decrease in fatty acid oxidation gene (MCAD) in Wnt+ mice livers under HFD. Wnt+ mice also revealed increased Akt signaling and its downstream target gene mTOR in response to HFD. In vitro, increased lipid accumulation was detected in S33Y cells in response to oleic acid compared to AML12 cells reinforcing the in vivo findings. mTOR inhibition by rapamycin led to a down-regulation of fatty acid synthesis in S33Y cells. In addition, β-catenin has a physical interaction with mTOR as verified by co-immunoprecipitation in hepatocytes.ConclusionsTaken together, our results demonstrate that β-catenin stabilization through Wnt signaling serves a central role in lipid metabolism in the steatotic liver through up-regulation of fatty acid synthesis via Akt/mTOR signaling. These findings suggest hepatic Wnt signaling may represent a therapeutic strategy in hepatic steatosis.

Alkhateeb A, Mahmoud HEM, AK M et al.

Areej Alkhateeb,1 Hossam Eldin M Mahmoud,1 Mohammed AK,1 Mohammed H Hassan,2 Abdel Rahim Mahmoud Muddathir,3 Ahmed G Bakry1 1Cardiology Division of Internal Medicine Department, South Valley University Hospital, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 2Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 3Department of Hematology and Blood Transfusion, Faculty of Medical Laboratory Science, Alzaeim Alazhari University, Khartoum, SudanCorrespondence: Abdel Rahim Mahmoud Muddathir, Department of Hematology and Blood Transfusion, Faculty of Medical Laboratory Science, Alzaeim Alazhari University, Khartoum, Sudan, Email abdelrahimm@gmail.comBackground: The prognostic role of the soluble circulating suppression of tumorigenicity 2 marker (sST2) in different cardiovascular diseases (CVD) is still under investigation. This research aimed to assess the serum levels of sST2 in the blood of individuals with ischemic heart disease and its relation to disease severity, also to examine any changes in sST2 levels following a successful percutaneous coronary intervention (PCI) in those patients.Methods: A total of 33 ischemic patients and 30 non-ischemic controls were included. The plasma level of sST2 was measured using commercially available ELISA assay kit, at baseline and 24– 48 h after the intervention in the ischemic group.Results: On admission, there was a significant difference between the group of acute/chronic coronary syndrome cases and controls regarding the sST2 plasma level (p < 0.001). There was an insignificant difference between the three ischemic subgroups at the baseline sST2 level (p = 0.38). The plasma sST2 level decreased significantly after PCI (from 20.70 ± 1.71 to 16.51 ± 2.43, p = 0.006). There was a modestly just significant positive correlation between the acute change in post-PCI sST2 level and the severity of ischemia as measured by the Modified Gensini Score (MGS) (r = 0.45, p = 0.05). In spite of the highly significant improvement in the coronary TIMI flow of ischemic group after PCI, there was insignificant negative correlation between the post- PCI delta change in the sST2 level and the post-PCI TIMI coronary flow grade.Conclusion: A significantly high plasma level of sST2 in patients with myocardial ischemia and controlled cardiovascular risk factors showed an immediate reduction after successful revascularization. The high baseline level of the sST2 marker and the acute post-PCI reduction was mainly related to the severity of ischemia rather than left ventricular function.Keywords: soluble circulating suppression of tumorigenicity 2 marker, percutaneous coronary intervention, acute/chronic coronary syndrome, severity of ischemia, modified gensini score, revascularization

Andrew Schlafly, Ronnie A. Sebro

Objectives Differences in National Institutes of Health (NIH) funding between specialties may affect research and patient outcomes in specialties that are less well funded.The aim of this study is to evaluate how NIH funding has been awarded by medical specialty. This study assesses differences and trends in the amount of funding, by medical specialty, for the years 2011–2020, via a retrospective analysis of data from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results). Study design Longitudinal cross-sectional study Setting NIH RePORTER data from 2011 to 2020 for awarded NIH grants (F32, T32, K01, K08, K23, R01, R03, R21, U01, P30) in the following medical specialties: anaesthesiology, dermatology, emergency medicine, family medicine, internal medicine, neurology, neurosurgery, obstetrics and gynaecology, ophthalmology, orthopaedic surgery, otolaryngology, pathology, paediatrics, physical medicine and rehabilitation, plastic surgery, psychiatry, radiation-diagnostic/oncology, surgery, and urology. Participants NIH grant awardees for the years 2011-2020 Intervention None Primary and secondary outcome measures The following measures were studied: (1) number of grants by specialty, (2) number of grants per active physician in each specialty, (3) total dollar amount of grants by specialty, (4) total dollar amount of grants per active physician in each specialty and (5) mean dollar amount awarded by specialty for each grant type. We investigated whether any of these measures varied between medical specialties. Results In general, internal medicine/medicine, psychiatry, paediatrics, pathology and neurology received the most grants per year, had the highest number of grants per active physician, had the highest total amount of funding and had the highest amount of funding per active physician, whereas fields like emergency medicine, plastic surgery, orthopaedics, and obstetrics and gynaecology had the lowest. The mean dollar amount awarded by grant type differed significantly between specialties (p value less than the Bonferroni-corrected alpha=0.00029). Conclusions NIH funding varies significantly between medical specialties. This may affect research progress and the careers of scientists and may affect patient outcomes in less well funded specialties.

Shelun Tsai, T. Truong, J. Eaton

Rachel X. Y. Wong, Michael Farrell, Louisa Degenhardt et al.

AbstractBackgroundThere have been few large‐scale nationally representative studies on the prevalence of substance use among doctors. In addition, the association of different medical specialties with the use of different substances requires further research.AimsTo investigate how the use of alcohol, tobacco and illicit drugs varied between junior doctors enrolled in different specialty training programmes.MethodsA secondary analysis was conducted on a national survey of 12 252 Australian doctors. The population of interest was junior doctors currently enrolled in a specialty training programme, termed vocational trainees (VT; n = 1890; 15.4% of the overall sample). Self‐report prevalence of current alcohol, tobacco and illicit drug use were assessed and hazardous alcohol use was assessed using the Alcohol Use Disorders Identification Test. Logistic regression was used to examine the association between specialty and substance use, adjusting for demographic characteristics when required.ResultsOne in six VT reported hazardous levels of alcohol use (n = 268; 17.3%). After adjusting for confounders, the association between the prevalence of alcohol use and the specialties of emergency medicine/intensive care unit (odds ratio (OR) 2.15; 95% confidence interval (CI) 1.40–3.32; P < 0.001), anaesthetics (OR 2.53; 95% CI 1.35–4.76; P = 0.004) and obstetrics/gynaecology (OR 1.89; 95% CI 1.19–3.02; P = 0.007) remained significant. No significant associations were found between tobacco use/illicit drug use/hazardous alcohol use and medical specialty.ConclusionsWhile rates of substance use and hazardous alcohol use in VT are similar, if not lower, than the general population, it poses a concern that there are higher rates of alcohol use in certain medical specialties.

Johannes Leiner, Vincent Pellissier, Sebastian König et al.

Abstract Background Severe acute respiratory infections (SARI) are the most common infectious causes of death. Previous work regarding mortality prediction models for SARI using machine learning (ML) algorithms that can be useful for both individual risk stratification and quality of care assessment is scarce. We aimed to develop reliable models for mortality prediction in SARI patients utilizing ML algorithms and compare its performances with a classic regression analysis approach. Methods Administrative data (dataset randomly split 75%/25% for model training/testing) from years 2016–2019 of 86 German Helios hospitals was retrospectively analyzed. Inpatient SARI cases were defined by ICD-codes J09-J22. Three ML algorithms were evaluated and its performance compared to generalized linear models (GLM) by computing receiver operating characteristic area under the curve (AUC) and area under the precision-recall curve (AUPRC). Results The dataset contained 241,988 inpatient SARI cases (75 years or older: 49%; male 56.2%). In-hospital mortality was 11.6%. AUC and AUPRC in the testing dataset were 0.83 and 0.372 for GLM, 0.831 and 0.384 for random forest (RF), 0.834 and 0.382 for single layer neural network (NNET) and 0.834 and 0.389 for extreme gradient boosting (XGBoost). Statistical comparison of ROC AUCs revealed a better performance of NNET and XGBoost as compared to GLM. Conclusion ML algorithms for predicting in-hospital mortality were trained and tested on a large real-world administrative dataset of SARI patients and showed good discriminatory performances. Broad application of our models in clinical routine practice can contribute to patients’ risk assessment and quality management.

K. Xenou, C. Sotiropoulou, P. Karousi et al.

Kristina Rodionova, Martin Hindermann, Karl Hilgers et al.

Background: Angiotensin II (Ang II) and the renal sympathetic nervous system exert a strong influence on renal sodium and water excretion. We tested the hypothesis that already low doses of an Ang II inhibitor (candesartan) will result in similar effects on tubular sodium and water reabsorption in congestive heart failure (CHF) as seen after renal denervation (DNX). Methods: Measurement of arterial blood pressure, heart rate (HR), renal sympathetic nerve activity (RSNA), glomerular filtration rate (GFR), renal plasma flow (RPF), urine volume, and urinary sodium. To assess neural control of volume homeostasis, 21 days after the induction of CHF via myocardial infarction rats underwent volume expansion (0.9% NaCL; 10% body weight) to decrease RSNA. CHF rat and controls with or without DNX or pretreated with the Ang II type-1 receptor antagonist candesartan (0.5 ug i.v.) were studied. Results: CHF rats excreted only 68 + 10.2% of the volume load (10% body weight) in 90 min. CHF rats pretreated with candesartan or after DNX excreted from 92 to 103% like controls. Decreases of RSNA induced by volume expansion were impaired in CHF rats but unaffected by candesartan pointing to an intrarenal drug effect. GFR and RPF were not significantly different in controls or CHF. Conclusion: The prominent function of increased RSNA – retaining salt and water – could no longer be observed after renal Ang II receptor blockade in CHF rats.

Joris H. J. van Sadelhoff, Selma P. Wiertsema, Johan Garssen et al.

Breastfeeding is indicated to support neonatal immune development and to protect against neonatal infections and allergies. Human milk composition is widely studied in relation to these unique abilities, which has led to the identification of various immunomodulating components in human milk, including various bioactive proteins. In addition to proteins, human milk contains free amino acids (FAAs), which have not been well-studied. Of those, the FAAs glutamate and glutamine are by far the most abundant. Levels of these FAAs in human milk sharply increase during the first months of lactation, in contrast to most other FAAs. These unique dynamics are globally consistent, suggesting that their levels in human milk are tightly regulated throughout lactation and, consequently, that they might have specific roles in the developing neonate. Interestingly, free glutamine and glutamate are reported to exhibit immunomodulating capacities, indicating that these FAAs could contribute to neonatal immune development and to the unique protective effects of breastfeeding. This review describes the current understanding of the FAA composition in human milk. Moreover, it provides an overview of the effects of free glutamine and glutamate on immune parameters relevant for allergic sensitization and infections in early life. The data reviewed provide rationale to study the role of free glutamine and glutamate in human milk in the protection against neonatal allergies and infections.

Sahile AT, Bekele GE

Addisu Tadesse Sahile,1 Getabalew Endazenew Bekele2 1Department of Public Health, Unity University, Addis Ababa, Ethiopia; 2Department of Social and Population Health, Yekatit12 Hospital Medical College, Addis Ababa, EthiopiaCorrespondence: Addisu Tadesse Sahile Tel +251 9 12096667Email sahdis91@gmail.comIntroduction: Diabetes mellitus is one of the most public health challenges of the twenty-first century. Globally, 382 million people had diabetes by the year 2013.Purpose: The purpose of this study was to determine the prevalence of diabetes mellitus and identify its associated factors at public health institutions in Addis Ababa.Patients and Methods: An institution-based cross-sectional study was carried out from June&nbsp;to&nbsp;July 2016. A total of 758 participants were selected using a multistage sampling technique. Data were collected with a structured interviewer-administered questionnaire; a WHO STEPwise approach of NCDs risk factors identification, and the collected data were checked for completeness immediately following data collection and the filled questionnaires were entered into Epi&ndash;Info 3.5.1, and then exported to SPSS 23 for further analysis. Descriptive statistics such as mean, percentages, standard deviation, and ranges were determined. To identify factors associated with diabetes mellitus, binary logistics regression was used.Results: The overall prevalence of diabetes mellitus was 14.8%, with a sex-specific prevalence of 18.35% and 16.62% for males and females, respectively. Older age participants had higher risks of developing diabetes mellitus than younger age individuals. Alcohol drinkers had more risks of developing diabetes mellitus than non-alcohol drinkers. Participants with plasma HDL-C &ge; 40mg/dl were more likely to develop diabetes mellitus than those with &lt; 40mg/dl. Participants with a higher level of plasma triglyceride &ge; 130mg/dl were found to be more exposed to the risks of developing diabetes mellitus than study participants with a low level of triglycerides.Conclusion: A higher prevalence of diabetes mellitus was observed in Addis Ababa public health institutions.&nbsp;Factors such as age, alcohol drinking, HDL, triglycerides, and vagarious physical activity were associated with diabetes mellitus. Concerned bodies need to work over the ever-increasing diabetes mellitus in Addis Ababa.Keywords: diabetes mellitus, prevalence, associated factors, health facilities

J. Walston, Thomas N. Robinson, Susan J. Zieman et al.