Diabetic Ketoacidosis in Northern Jordan: Seasonal Morbidity and Characteristics of Patients.

Purpose: This study aimed to characterize adult patients admitted with diabetic ketoacidosis (DKA) in northern Jordan. Methods: The study examined medical records of patients diagnosed with DKA from January 2015 to April 2018. Variables analyzed included diabetes type, precipitating illness, admission month, hospital length of stay, and biochemical markers. Results: Out of 232 admissions with DKA, 70% were diagnosed with type 2 diabetes, and 56% were females. 12% of admissions had a new diagnosis of diabetes, of which 51% had type 2 diabetes. Sepsis (48%), Non-adherence (26%), and diabetic foot infections (18%) were the most encountered precipitating factors for DKA in T1DM. As for T2DM, sepsis (52%), acute coronary syndrome (12%), and pancreatitis (8%) were the most precipitating factors for DKA. High urea levels, high creatinine levels, low phosphorous levels, low hemoglobin levels, and high platelet counts were associated with a longer hospital stay for type 1 diabetes. For type 2 diabetes, low pH on admission, old age, and high Hb A1c within 6 months of admission were factors associated with a prolonged hospital stay. The study found a significant peak of admissions for DKA in both type 1 and type 2 patients in the winter and spring months (Pearson P-value= 0.0013). Conclusion: The results of the present study highlight the seasonal variation in the frequency of DKA hospitalizations. It also highlights sepsis as the most frequent precipitating factor of DKA in both type 1 and type 2 DM patients.

Leprosy: a 'common' and curable cause of peripheral neuropathy with skin lesions.

Leprosy (or Hansen's disease) is a curable chronic infectious disease caused by the acid-fast bacillus Mycobacterium leprae. While leprosy remains one of the most common causes of neuropathy worldwide, its rarity in the UK means that many doctors are unfamiliar with the typical clinical features. This is problematic because early recognition and treatment is vital in order to minimise disease-related complications such as nerve injury. We describe a 75-year-old man who presented with multiple mononeuropathy (mononeuritis multiplex, particularly affecting the ulnar nerves) and typical granulomatous skin lesions, in whom the diagnosis was made on the basis of skin biopsy. We highlight the clinical features, investigations and treatment of the patient, and provide information about the epidemiology and pathogenesis of leprosy.

Infant botulism following honey ingestion.

An apparently well baby girl born at term was presented with signs and symptoms suggestive of acute onset of generalised floppiness at the age of 3 months. Clinically, the baby had lower motor neuron type of muscle weakness; detailed investigation lead to the diagnosis of neuromuscular junction disorder secondary to botulism toxicity. Further tests confirmed the botulism toxicity secondary to honey ingestion. The baby was treated with specific anticlostridium antibodies; she recovered remarkably, now growing and developing normally.

A basic smell test is as sensitive as a dopamine transporter scan: comparison of olfaction, taste and DaTSCAN in the diagnosis of Parkinson's disease.

AIM: To evaluate relationship between odour identification, taste threshold, dopamine transporter scan (DaTSCAN) and motor function in early Parkinson's disease (PD) and their diagnostic accuracy. METHODS: Seventy-three patients with early parkinsonism were evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS), DaTSCAN, electrogustometry (EGM) threshold and University of Pennsylvania Smell Identification Test (UPSIT). Olfactory Event-Related potentials (OERP) were performed on 49 patients. At follow-up (mean 15.3 months), patients were diagnosed as 'PD' or 'non-PD'. DaTSCAN images were assessed visually and semi-quantitatively by QuantiSPECT. RESULTS: The sensitivity of UPSIT (86%) was not significantly different from that of the DaTSCAN (92%). UPSIT correlated moderately with DaTSCAN uptake (r = 0.44; P < 0.005) and UPDRS score (r = 0.43; P < 0.05) and weakly with symptom duration (r = 0.25; P < 0.05). In the PD group, OERP showed increased latency but no change in amplitude and no correlation with DaTSCAN. EGM thresholds were impaired in 22% of the PD group but they did not correlate with any other test parameters. DaTSCAN-UPSIT discordance was found in nine patients with PD, but neither was diagnostically superior. CONCLUSION: Our patients with early PD have a frequent and severe olfactory deficit that correlates with disease severity, symptom duration and DaTSCAN but not EGM. The sensitivities of UPSIT and DaTSCAN are high at 86% and 92%, respectively. Although DaTSCAN is superior for 'localization', UPSIT is considerably 'cheaper', and neither is disease specific. EGM threshold impairment in PD is independent of the smell deficit, and probably signifies advanced disease.

An exponential model of isometric muscular fatigue as a function of age and muscle groups.

Despite the recommendations that an important design criterion is not to exceed 15% of an operator's maximum voluntary contraction (MVC) with any muscle that must be used for a long period of time, many tasks involve the exertion of much higher forces coupled with long-term contractions. Many studies have investigated the force-time relationship of isometric muscle contractions to determine the endurance time of a given relative force. To date, however, direct studies of muscle performance throughout fatiguing tasks have not been conducted to the same degree. This research was concerned with studying the effects of different muscle groups (biceps vs quadriceps) of subjects with different age groups (20-29 vs 50-59 years of age) on long-term muscular isometric contractions at different levels of %MVC (20%, 40%, 60%, 80%, and 100% MVC), and modelling the functional data to describe the time course of strength decrement. The data revealed that the time course of strength decrement was best modelled by the function: [formula: see text] An experiment, using 20 subjects with each subject performing 10 conditions (two muscle groups x five levels of %MVC), showed that this function accounted for over 95% of the variance of strength decrement. All parameter estimates were statistically significant.

Symmetric and asymmetric manual materials handling, Part 2: Biomechanics.

Earlier studies of the biomechanics of handle placement and angles on boxes in Manual Materials Handling have been limited to sagittally symmetric tasks. This study extends the results to a palletization/depalletization task with considerable asymmetric movement. Part 2 shows how body posture, hand/handle interface, and disc compressive force change in this asymmetric task. The results were not too different from the earlier studies of symmetric tasks, except that a 'traditional' handle position in the upper part of each lateral face (the 2/2 position) proved more effective than had been anticipated.

Symmetric and asymmetric manual materials handling. Part 1: Physiology and psychophysics.

To study the physiological and psychophysical costs of symmetric and asymmetric manual materials handling, two tasks were performed by 30 industrial subjects. In both tasks, box weight and handle position were varied. The symmetric task, lifting and lowering between floor and conveyor, showed handles to be beneficial. The asymmetric task was palletizing and depalletizing 36 boxes between a pallet and a conveyor. Both palletizing and depalletizing proved strenuous for females with heart rates exceeding 140b/min. All handle positions were better than No Handles, but the best handle position changed from asymmetric for 9 kg boxes to symmetric for 13 kg boxes. The effect of handles was equivalent to a weight change of 1-2 kg for Heart Rate and Rated Perceived Exertion, but much higher (2-14 kg) for Body Part Discomfort measures.