Objectives: Comparison of continuous subcutaneous insulin infusion (CSII) with multiple daily injections (MDI) in achieving glycemic control in youths with type 1 diabetes mellitus (T1DM). Methods: Retrospective cohort study including 2 matched groups of youths with T1DM treated by CSII or MDI in a tertiary specialized children’s hospital in Saudi Arabia. Children and adolescents aged up to 18 years, diagnosed with T1DM and using CSII or MDI, from the period 2016 to 2018. Patients on MDI were newly-diagnosed patients with T1DM who had the disease for only 1 year duration; all CSII patients had at least 1 to 2 years of T1DM but who had just started on pumps in the past 3 months. We excluded patients with other autoimmune diseases, non-ambulatory patients and those admitted to hospital for non-diabetes reasons. Primary outcome was HbA1c at 1, 2, and 3 years, with weight gain as a secondary outcome. Ambulatory glycemic profile was analyzed from a subset of patients using intermittently scanned continuous glucose monitoring (isCGM). Results: A total of 168 youths with T1DM (n = 129 in the MDI group, n = 39 in the CSII group) were included. The CSII group consistently had lower HbA1c levels compared to the MDI group throughout a 3-year follow up period: 8.1% versus 10.1, P-value < .001 at 1 year, 7.5% versus 10.1% at 2 years, P-value  < .001, 8.9% versus 10.3% at 3 years, P-value = .033. Body mass index significantly increased in both groups at 1 year, although greater in CSII group. In a subgroup using isCGM (n = 37 on MDI and n = 29 on CSII), the CSII group had a lower average blood glucose (194 mg/dL vs 228 mg/dL, P-value = .028) and a lower estimated HbA1c level (8.4% vs 9.6%, P-value = .022). Conclusion: Treatment with CSII resulted in lower HbA1c compared to MDI in our cohort, which was sustained over a 3-year period.

Background: Interactions between environmental factors, such as diet and lifestyle, and metabolic pathways are pivotal in understanding aging mechanisms. hNAA40, Nicotinamide phosphoribosyltransferase (NAMPT), and NAD-dependent protein deacetylase sirtuin-1 (SIRT-1) have been shown to exert important biological processes, including stress response and aging. Methods: hNAA40, NAMPT, and SIRT-1 mRNA expression in peripheral blood mononuclear cells (PBMC) were quantitated in 30 lean adult volunteers of normal weight, 30 obese, 20 drugnaïve obese Type 2 diabetes mellitus (T2DM), and 30 obese T2DM on Metformin. Similarly, hNAA40, NAMPT, and SIRT-1 expression in PBMC were quantitated in 36 normal healthy adults randomly assigned to three different groups (Glucose or Whey proteins or lipids; 300 kcal). Blood samples were obtained at 1, 2, and 3 hrs after the macronutrient intake. Results: There was an increase in hNAA40 and a decrease in NAMPT and SIRT-1 expression in PBMC from T2DM. Metformin treatment reverted hNAA40, NAMPT, and SIRT-1 expression levels to normal levels. Glucose intake resulted in a significant increase in expression of hNAA40 at 1 hr and decreased significantly at 3 hrs post intake. Lipid intake resulted in an increase in expression of hNAA40 at 2 hr post intake and returned to normal levels at 3 hrs. Neither glucose nor lipid intake resulted in a significant change in NAMPT or SIRT-1 expression. Whey proteins resulted in significantly lower expression of NAMPT at 3 hrs and did not alter the expression levels of SIRT-1 significantly. Conclusion: hNAA40, NAMPT, and SIRT-1 pathway could play a role in the determination of the healthy lifespan. Metformin modulates this pathway.

Unusual clinical course Background:Deep vein thrombosis (DVT) is a potentially fatal condition that occurs in 100 persons per 100 000 population, and accounts for 60 000 deaths per year in the United States, making its evaluation and diagnosis essential. Diagnosing DVT can be challenging due to symptom variations between patients. There are no previous reports of DVT patients presenting with foot drop in the literature. Therefore, the purpose of this case report is to present an unusual presentation of DVT in a middle-aged man with no clearly identifiable risk factors for DVT. Case Report:A 54-year-old otherwise symptom-free male smoker (for 30 years) presented to the Emergency Department complaining of pain in the left leg, which then escalated to weakness and decreased sensation in the left foot. However, he was able to walk with limping. Upon his presentation to the Emergency Department, he stated that his left leg felt quite weak. The neurological examination did not show any remarkable results, except for unilateral limb weakness. After that, a point-of-care ultrasound was carried out, which showed the possibility of non-compressible veins; then, a D-dimer test was conducted. When it tested positive, an official ultrasound was done, which showed thrombi in the left external iliac and common and superficial femoral veins. Conclusions:This study reported a unique presentation of foot drop due to DVT in a middle-aged man, with the absence of known risk factors. Utilizing point-of-care ultrasound is a valuable tool in the evaluation of acute unilateral lower limb weakness.

Background: Traumatic head injury represents a substantial cause of trauma in pediatric emergency rooms (ER). This study aimed to calculate the prevalence of abnormal CT scan reports (CT) in the pediatric ER at King Abdullah Specialized Children&apos;s Hospital (KASCH) in Riyadh. In addition, it examined different variables that are more likely associated with a normal CT scan. Methods: This single-center retrospective chart review study was conducted using non-probability convenience sampling; data were collected from the electronic health records of ER pediatric patients. Patients aged 0 to 14 years, who had a trauma and a brain CT scan ordered in KASCH ER, from May 2017 to May 2019 were included. Results: In total, 502 CT scans were done due to a traumatic head-related event. About a third (34.5%, n=173) had an abnormal CT scan, with the majority of the group (69.4%, n=120) being male. The highest rate of abnormal CT scans (28.9%) was in the 2 to 5 years age group. The most common mechanism of injury was falling (55%), followed by motor vehicle accidents (MVA) (33.5%). Falling, as a mechanism of injury, were accounted for more than half of the injuries in both the normal (57.1%) and abnormal (50.9%) CT scans. Conclusion: Two thirds of the head CT included in this study resulted in normal CT findings and a considerable number of the abnormal findings were linear non-displaced fractures that can be detected by X-ray.