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Vitamin D deficiency (VDD) and anemia are both public health nutrition concerns. An association between VDD and anemia has been suggested in various healthy and diseased populations. The current study aimed to elucidate the effect of VDD on iron status in children with type I diabetes mellitus (T1DM). The study recruited two groups of children with T1DM: control group comprised of 38 T1DM children with sufficient vitamin D (> 30 ng/ml) and a case group, consisted of 52 T1DM children with VDD (< 20 ng/ml). Both groups had comparable gender, age, BMI, and disease duration. The laboratory measurements included analysis of blood indices, markers of iron metabolism, hepcidin and inflammatory markers included interleukin 6 (IL-6) and C-reactive protein (CRP). Compared to control group, T1DM children with VDD differs specifically in terms of some markers of blood indices, such as decreased hemoglobin and increased red blood cell distribution width. Moreover, decreased serum iron, ferritin, total iron-binding capacity and transferrin along with elevated inflammatory markers were observed in case group. Results of the study indicated that VDD had increased the risk of iron deficiency anemia in children with T1DM as well as inflammatory related anemia. Furthermore, in T1DM children, VDD had raised the incidence of both absolute and functional iron deficiency, with greater incidence of the former. This study may indicate that VDD may be a risk factor that may worsen iron deficiency anemia in T1DM.

Late-onset rheumatoid arthritis (LORA) poses a great challenge for physicians regarding diagnosis and treatment. The prognosis for LORA was better in some early research but worse in more recent trials. The study aim was to compare the clinical, laboratory, and radiological characteristics assessed by musculoskeletal ultrasound (MSUS) of patients with LORA and early-onset rheumatoid arthritis (EORA) and to examine their associations with inflammation and treatment outcomes. The study included 64 RA with EORA and 64 RA patients with LORA, fulfilling the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA. Medical history, Health Assessment Questionnaire Disability Index (HAQ-DI), DAS 28 score, laboratory investigations, and MSUS of both hands and wrist joints were done. Female patients with EORA were more compared with those with LORA (89% vs 78.1%). Comorbidities were significantly more prevalent in the LORA group (28.12%) compared with the EORA group (10.9%) (  = .0143). A significant difference was also observed between the 2 groups regarding higher ESR values in LORA, with no significant difference detected in C-reactive protein (CRP) levels. Regarding joint involvement, shoulder, metatarsophalangeal (MTP), and knee joints were more frequently affected in LORA, with statistically significant differences (  < .0001, .0119, and .0285, respectively). The MSUS findings revealed higher gray-scale grades in patients with LORA, with significantly increased Doppler signal activity (  < .052), and a greater frequency of erosions compared with those with EORA. The mean HAQ-DI score was significantly higher in LORA than in EORA (  = .0004). Regarding treatment patterns, methotrexate (MTX) was more commonly prescribed in the EORA group (67.1%) compared with the LORA group (37.5%), whereas leflunomide was used more in LORA (68.75%) compared with EORA (46.8%), with statistically significant difference. Patients with LORA demonstrated more active synovitis and a higher frequency of erosions compared with those with EORA, despite the non-significant difference in DAS 28 scores. Moreover, patients with LORA exhibited a greater burden of comorbidities than those with EORA. Therefore, regular evaluation of inflammatory activity using MSUS, along with assessment of associated comorbid conditions, is recommended in patients with LORA.

Background This study aimed to assess the anthropometric measures and pubertal growth of children and adolescents with Type 1 diabetes mellitus (T1DM) and to detect risk determinants affecting these measures and their link to glycemic control. Patients and methods Two hundred children and adolescents were assessed using anthropometric measurements. Those with short stature were further evaluated using insulin-like growth factor 1 (IGF-1), bone age, and thyroid profile, while those with delayed puberty were evaluated using sex hormones and pituitary gonadotropins assay. Results We found that 12.5% of our patients were short (height SDS < -2) and IGF-1 was less than -2 SD in 72% of them. Patients with short stature had earlier age of onset of diabetes, longer duration of diabetes, higher HbA1C and urinary albumin/creatinine ratio compared to those with normal stature (p  <  0.05). Additionally, patients with delayed puberty had higher HbA1c and dyslipidemia compared to those with normal puberty (p  <  0.05). The regression analysis revealed that factors associated with short stature were; age at diagnosis, HbA1C > 8.2, and albumin/creatinine ratio > 8 (p  <  0.05). Conclusion Children with uncontrolled T1DM are at risk of short stature and delayed puberty. Diabetes duration and control seem to be independent risk factors for short stature.

Diabetic nephropathy is a major cause of morbidity and mortality in type 1 diabetes mellitus (T1DM). Fatty acid binding proteins (FABP1 and FABP2) play a role in the development and progression of chronic kidney disease including type 2 diabetes mellitus. We assessed serum FABP1 and FABP2 levels in children and adolescents with T1DM as potential markers for diabetic nephropathy and their relation to carotid intima media thickness (CIMT). Sixty patients with T1DM were divided into 2 groups according to the presence of nephropathy and compared with 30 healthy controls. CIMT, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), urinary albumin creatinine ratio (UACR), fasting lipid profile and serum FABP1 and FABP2 levels were assessed. FABP1 and FABP2 levels were significantly higher among type 1 diabetic patient with and without nephropathy compared with healthy controls with the highest levels among patients with nephropathy (p < 0.001). There were significant positive correlations between FABP1 and FABP2 and each of systolic blood pressure, CIMT, FBG, HbA1c and total cholesterol among T1DM patients. FABP1 was negatively correlated to glomerular filtration rate. Multivariable linear regression analysis showed that systolic blood pressure, CIMT, FBG and HbA1c were the significant independent variables related to FABP1 levels in type 1 diabetic patients with nephropathy. ROC curve analysis was performed to determine the cutoff value of FABP1 and FABP2 that could detect nephropathy. FABP1 and FABP2 levels are elevated in children and adolescents with T1DM and could represent a link between diabetic nephropathy and subclinical atherosclerosis. •We assessed serum FABP1 and FABP2 levels in children and adolescents with T1DM.•Elevated FABP1 and FABP2 levels were associated with microalbuminuria in pediatric patients with T1DM.•FABP1 and FABP2 were positively correlated to CIMT.•FABP1 and FABP2 represent a link between diabetic nephropathy and subclinical atherosclerosis.

Background Self-monitoring blood glucose (SMBG) includes an assessment of the capillary glucose concentration as well as the interpretation of and responding to the readings. The purpose of this study was to assess patients’ compliance to self-monitoring blood glucose (SMBG), identify factors and barriers that affect it, and to correlate performance of SMBG to blood glucose monitoring and patients’ quality of life. Three hundred and thirty children and adolescents with type 1 diabetes were subjected to the following: (1) an interview pre-structured questionnaire which included personal, medical history, and details about SMBG; (2) Questionnaire about Quality of Life Index (Diabetes Version-III) by Ferrans and Powers for patients aging 10–16 years; and (3) glycated hemoglobin (HA1C) measurement. Results About 67% of the patients assessed their blood glucose 3 times per day, while 0.57% assessed blood glucose 7 times. The most influential factors affecting compliance of SMBG were the cost of strips and glucometers, the fear of pain and injection, psychological frustration, lack of availability of information to deal with high reading, and the absence of motivation for doing regular SMBG. The more the frequency of SMBG daily, the better the HA1C of the patients ( p < 0.01). Adolescent patients aged 10–16 years who have more frequent SMBG and those with less HA1C have significant better quality of life ( p < 0.05). Conclusions More frequent SMBG practice was associated with better glycemic control and better quality of life. Patients’ compliance is influenced by several factors which affect their frequency of SMBG.

-Ankylosing spondylitis (AS) is a systemic infl ammatory disorder with extra-articular features including cardiovascular diseases. Objective The objective of this study was to assess the presence of atherosclerosis in Egyptian patients with AS and its relation to disease activity. Patients and methods Thirty patients with AS of at least 18 years of age and 30 age-matched and sex-matched controls were included. Assessment of medical history, clinical examinations, and assessment of AS disease activity using BASDAI, BASMI, and BASFI as well as dobutamine echocardiography were performed only for patients. Complete blood count, ESR, C-reactive protein, lipid profi le, serum von Willebrand factor ( vWF) Ag level by ELISA, ECG, and carotid duplex were performed for all participants. Results In patients, 11 had active disease and 19 were in remission. A hypertensive response ( HTNR) appeared in eight patients; six of them had active disease. There was a signifi cant increase in the level of vWF in actively diseased patients than inactive patients and controls. Carotid intima-media thickness (IMT) was signifi cantly increased in AS patients than controls. Levels of low-density lipoprotein were signifi cantly higher in AS patients than the controls and in AS patients receiving biologics than those not receiving biologics. In the inactive group, vWF and IMT were signifi cantly increased in patients receiving biologics. vWF correlated positively with BASDI, BASMI, BASFI scores, ESR, and carotid IMT and negatively with high-density lipoprotein. Conclusion Patients with AS are more susceptible to atherosclerosis, which is related to disease activity, and receiving biologics may place them at a higher risk. vWF, as a useful marker of atheroscl

Evaluate the oxidant-antioxidant balance and the efficacy of Alpha-lipoic acid (ALA) as an adjuvant therapy for diabetic nephropathy (DN) among individuals with type 1 diabetes (T1D). A 3 months prospective randomized controlled trial including 50 participants with DN randomly allocated (1:1) to one of two arms; an interventional arm receiving 300 mg/day of ALA (n = 25) and a non-interventional arm (n = 25). Initial assessments included HbA1c, urinary albumin excretion rate (UAER), malondialdehyde (MDA), and total antioxidant capacity (TAC). Baseline data was compared with 50 participants with T1D without DN and 50 healthy controls. T1D participants had significantly higher MDA and lower TAC levels compared to controls (P < 0.01). Within the T1D cohort, participants with DN showed significantly higher MDA and lower TAC levels (P < 0.01). MDA positively correlated with triglycerides (r = 0.53), UAER (r = 0.70), and HbA1c (r = 0.5) (p < 0.01), while TAC negatively correlated triglycerides (r = −0.41), UAER (r = −0.88), and HbA1c (r = −0.64) (p < 0.01). After 3 months of ALA supplementation, significant reductions in HbA1c, UAER, and MDA were observed, along with an increase in TAC (P < 0.01). The study demonstrates that 3 months of ALA supplementation effectively reduced oxidative stress and UAER, demonstrating a potential role in protecting renal tissue from diabetes-induced oxidative damage. •Oxidative stress plays a significant role in the development and progression of DN.•The addition of oral alpha lipoic acid (ALA) as a supplementary therapy for a period of 3 months was well tolerated.•Oral alpha lipoic acid (ALA) has shown to mitigate the oxidative stress in type 1 diabetes.

Background Type 1 diabetes mellitus (T1DM) is associated with serious micro‐vascular and macro‐vascular complications. Osteopontin (OPN) has emerged as a strong predictor of incipient diabetic nephropathy and a first‐ever cardiovascular event in adults with T1DM. OPN is linked to coronary atherosclerosis in type 2 diabetes. The aim of the study was to test the hypothesis that OPN could be a potential marker for micro‐vascular complications in children and adolescents with T1DM and we assessed its relation to carotid and aortic intima media thickness (CIMT and AIMT) as non‐invasive index for subclinical atherosclerosis. Methods Eighty patients with T1DM ≤18 years were divided into 2 groups according to the presence of micro‐vascular complications and compared with 40 age‐ and sex‐matched healthy controls. Fasting blood glucose, high sensitivity C‐reactive protein (hs‐CRP), HbA1c, urinary albumin creatinine ratio (UACR), OPN, CIMT, and AIMT were assessed. Results Both CIMT and AIMT were significantly higher in patients with and without micro‐vascular complications compared with healthy controls (P < .001). OPN concentrations were significantly elevated in all diabetic patients compared with controls (P = .002). OPN was also significantly higher in patients with micro‐vascular complications than patients without (P < .001) but levels were comparable among those without complications and controls (P = .322). Receiver operating characteristic curve analysis revealed that OPN cut‐off value 90 ng/mL could differentiate patients with and without micro‐vascular complications with 81.7% sensitivity and 95.8% specificity. Significant positive correlations were found between OPN and HbA1c, UACR, CIMT, and AIMT. Conclusions OPN could be considered a marker of vasculopathy and subclinical atherosclerosis in pediatric T1DM.

This paper investigates the development of Multimodal Social Semiotic Theory, starting from its foundations in general semiotics and then in social semiotics. It explains the objectives of social semiotics, which seeks to analyze how meaning is produced in society through communicative practices, drawing on Halliday's Functional Linguistics where language is conceptualized as a social semiotic system. The study highlights the concept of \"meaning potential,\" which emphasizes that linguistic and semiotic signs can only be understood within their sociocultural context. The paper outlines the shift from traditional semiotics to social semiotics by contrasting Saussure's notion of the arbitrary relation between signifier and signified with the social semiotic perspective that stresses the agency of the sign-maker and the motivated nature of the sign. The contribution of Kress and Van Leeuwen's \"visual grammar\" is recapped as a key framework for incorporating visual resources into semiotic analysis. Central issues are discussed, such as the tension between fixed meanings and socially negotiated meanings, and the role of social power in maintaining or reshaping conventions. Unlike traditional semiotics, which treats signs as fixed codes, social semiotics underscores the dynamic and purposeful use of signs in social interaction. The study also explains how social semiotics expanded to multimodality, incorporating diverse resources such as language, image, and visual modes, in response to the transformations of modern media environments. It concludes that multimodal social semiotic theory provides a comprehensive framework for examining the interplay of social, cultural, and individual factors in meaning-making across multimodal discourses. Abstract Written by Dar AlMandumh, 2025, Using AI