[RESEARCH] Side effects of phenobarbital and carbamazepine in childhood epilepsy: randomised controlled trial
Objective To compare the behavioural side effects associated with two commonly used antiepilepsy drugs--phenobarbital and carbamazepine--in children in Bangladesh.
Design Prospective randomised controlled single centre trial.
Setting Specialist children's hospital in Dhaka, Bangladesh.
Participants 108 children aged 2-15 with generalised tonic-clonic (n=51) or partial and secondary generalised seizures (n=57).
Main outcome measures Seizure control and behavioural side effects.
Results 91 children were followed up for 12 months. Six required a change of antiepilepsy drug. Side effects were compared in 85 children. In the last quarter of the 12 month follow-up, 71 children were seizure free after one year's treatment. Thirty two in the phenobarbital group and 39 in the carbamazepine group had no seizures in 74 and 102 days after randomisation, respectively. Ten children had increased behavioural problems, which were unacceptable in four (one in the phenobarbital group and three in the carbamazepine group). Independent t tests, however, showed no difference between the two trial drugs.
Conclusion There was no excess in behavioural side effects with phenobarbital in children with epilepsy in a country with limited resources.
Trial registration NCT00381537.
[RESEARCH] Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial
Objective To assess whether exclusive and prolonged breast feeding reduces the risk of childhood asthma and allergy by age 6.5 years.
Design Cluster randomised trial.
Setting 31 Belarussian maternity hospitals and their affiliated polyclinics.
Participants A total of 17 046 mother-infant pairs were enrolled, of whom 13 889 (81.5%) were followed up at age 6.5 years.
Intervention Breastfeeding promotion intervention modelled on the WHO/UNICEF baby friendly hospital initiative.
Main outcome measures International study of asthma and allergies in childhood (ISAAC) questionnaire and skin prick tests of five inhalant antigens.
Results The experimental intervention led to a large increase in exclusive breast feeding at 3 months (44.3% v 6.4%; P<0.001) and a significantly higher prevalence of any breast feeding at all ages up to and including 12 months. The experimental group had no reduction in risks of allergic symptoms and diagnoses or positive skin prick tests. In fact, after exclusion of six sites (three experimental and three control) with suspiciously high rates of positive skin prick tests, risks were significantly increased in the experimental group for four of the five antigens.
Conclusions These results do not support a protective effect of prolonged and exclusive breast feeding on asthma or allergy.
Trial registration Current Controlled Trials ISRCTN37687716.
Rats it's a Virus
Filed under: Type 1, Childhood, Lifestyle, Drugs, Research
No kidding! The rats are leading researchers to triggering events causing diabetes. The new findings suggest that there is, indeed, a genetic susceptibility to diabetes, but that the precipitating event is a viral infection.
The virus in question is the Ljungan virus. Previous reports indicate that infections with the Ljungan virus can induce diabetes in laboratory rats, and that the diabetes can be reversed if the animals are treated with antiviral drugs before the destruction of insulin-secreting islet cells becomes widespread.
I'm not sure how everybody else out there got their D-card. My diagnosing event happened shortly after I had the chicken pox, back in '85. The childhood christening event apparently left me out in the cold and caused the love-hate relationship between my islets and my insulin autoantibodies. Lucky me. Thanks to all the readers out there who have already shared their sequence of diagnosis with me. What's your story? Please, share with us.
Trouble in Paradise
Filed under: Type 2, Childhood, Research
Resisting the urge to throw in a 'Jamaican me crazy' anywhere in this post, I'm instead going to move forward with the 
hard facts.
1) Studies show that nearly 19 percent of adolescents living in Jamaica are considered obese, and;
2) Those same studies show that one in five of these youths was diagnosed with type 2 diabetes.
Research shows that type 2 diabetes is on the rise in the adolescent population in Jamaica, a disease once seen almost exclusively in middle-aged and elderly adults living on the Caribbean island. This points further to the growing obesity problem that exists worldwide.
The findings from this study will be presented at the American Association of Clinical Endocrinologists' 16th Annual Meeting and Clinical Congress, scheduled to be held in Seattle on April 11-15. Dr. Rulloch-Reid, along with colleagues from The University of the West Indies and the Kingston Public Hospital, will be presenting on this matter.
82 years with diabetes described in "Longevity" book
Filed under: Type 1, Childhood, Lifestyle, Drugs, Books, Care
Around a year ago I posted the story of two elderly brothers, both of whom have had type 1 diabetes since childhood. It's amazing to read about these guys for two reasons: first, they've lived with diabetes for a reeeaally long time. Secondly, for most of that time, they did not have the medical knowledge or technology on which today's diabetics depend. (Okay, so when it comes to stuff like Avandia, you could argue that's a good thing!)Anyway, one of the brothers - Robert "Bob" Cleveland (87) - will be featured in a new book titled 50 Secrets of the Longest Living People with Diabetes by Sheri R. Colberg and Steven V. Edelman. The book is part of the Marlowe Diabetes Library series. It will be published in November and is available for pre-ordering on Amazon.
Linda von Wartburg, writing for Diabetes Health, has posted an excerpt about Cleveland taken from the book, for those who want an advance taste. According to that post, Bob Cleveland has lived with the disease for an amazing eighty-two years. This makes Cleveland second in line for the title of person in the US who's lived with diabetes the longest. He was five years old when diagnosed in 1925. Bob's brother, Gerald, has not had diabetes for quite so long, but he is the oldest living person with diabetes in the US. The brothers are pictured at right, with Bob on the left and Gerald on the right.
Reading Cleveland's account of his early years with diabetes, before insulin became available, is quite harrowing. He describes being on a "starvation diet," hospital stays, and memories of his mother desperately trying to pull him out of hypoglycemic episodes. Incredible reading.
JDRF's kids online: Community of kids with diabetes
Filed under: Type 1, Childhood, Support
The Juvenile Diabetes Research Foundation International (JDRF) was started in 1970 by a group of parents advocating for their children. JDRF has grown into a powerful research and educational force for juvenile diabetes -- nothing short of amazing!
Check out JDRF's Kids Online, a community of kids handling their disease with grace, humor and courage. Kids Online offers a variety of interactive zones to engage youth and teens with juvenile diabetes. Just a sampling, the Your Life link provides tips to manage the disease from a kid's point of view. Don't miss the Your Stuff link boasting an Idea Zone to share artwork and ideas; Kids Say for a give-and-take of opinions; and Pen Pals where kids can forge friendships with other juvenile diabetics across the globe.
Sneak a peek at Kids Online and be inspired by this on-line playground. If you know a child with juvenile diabetes, make sure to send them a hyperlink!
Stem cells treat foot wounds
Filed under: Type 1, Type 2, Childhood, Adult Onset, Research, Care, Complications
Diabetic foot complications are responsible for many lower extremity amputations. But this last drastic step can be prevented up to 85 percent of the time with early diagnosis and proper care.
Now Thai researchers and physicians have shown using a patient's own stem cells can effectively heal chronic foot wounds. Diabetes patients with chronic foot wounds, aged 50-72, were injected with stem cells obtained from their own blood. Most excitedly, the wounds healed nicely within three to four months. The stem cell treatment also makes fiscal sense. According to this article, stem cell treatment for wounds in a patient with diabetes costs about $6,000, one-fifth the cost of conventional treatment for a leg wound.
Studies have shown primary care physicians often fail to examine the feet of patients with diabetes. It's a shame, as this step is the least costly and most effective way to prevent foot wounds and potential amputations. But at the same time, it is nice to know there is a promising, cheaper treatment utilizing patient-donated stem cells.
Reversing Autoimmunity Q & A
Filed under: Type 1, Childhood, Research, Events
Like a dog chasing its own tail (but nowhere near as funny), type 1 diabetes is caused by a self-imposed attack on insulin producing cells. Here's your chance to chat live and learn about the latest discoveries to interfere with the automimmune confusion. Chat live with the head of the Immunogenetics Program at the Diabetes Research Institute, Alberto Pugliese, M.D.
The DRI program is specifically focused on understanding how genetic and immunological factors play a role in the development of type 1 diabetes and how certain genetic and immunological factors may actually afford protection from diabetes. The program is uncovering ways to interfere with the immune cells that attack the insulin producing cells in the pancreas resulting in diabetes.
In plain English, join Dr. Pugliese to enlighten yourself and ask any questions you may have regarding this impressive research. The chat begins at 9pm EST and those who miss it can catch the excitement in the transcript, to be posted shortly thereafter. I hope to see fellow IDDMs on the chat roster.
Mary Tyler Moore champions research for kids with type 1 diabetes
Filed under: Type 1, Childhood, Research
I have always loved Mary Tyler Moore. I remember snuggling on the couch with my mom one night a week to watch the Mary Tyler Moore show. I don't know what was more comical -- the humor of the storyline or hearing my mom's roaring laugh each Saturday.
I found out years ago Moore has type 1 diabetes. Right away, it comforted me. Maybe it was because I admired her acting skills and love her warm smile. My young brain logic went something like this, "If Mary Tyler Moore has type 1, then maybe it's not so bad my older brother has juvenile diabetes." Whatever the reason, I did some research to catch up on Moore's activities these days.
Born in 1936, Moore turns 71 this year. Her activism in support of the Juvenile Diabetes Research Foundation International (JDRF) is remarkable. As JDRF's International Chairman, Moore has regularly testified before Congress for juvenile diabetes research. She is heading to Washington D.C. later this month to testify once again at Children's Congress 2007. Moore and over 100 kids with type 1 diabetes will meet with top U.S. Government officials to advocate for the cause. These pioneering delegates represent all 50 states and the District of Columbia.
I applaud Mary Tyler Moore for her efforts on behalf of type 1 diabetics worldwide. Watch for future posts on Children's Congress 2007 -- this influential event only comes around every two years.
Gene flaws may increase kids' risk for type 1 diabetes
Filed under: Type 1, Childhood, Research, Daily News
A new study, a report of which has been published in Nature, has identified gene flaws that increase the risk for type 1 diabetes in children. By examining the genetic codes of thousands of children, some with and some without diabetes, as well as those of parents of diabetics, the researchers identified three changes on one specific gene present in those with diabetes. They then looked at 1600 additional diabetes patients' genetic codes and again found the very same marks, sometimes called "flavors" or "flaws." Two of these variations increase a person's odds of developing diabetes by fifty percent, say the researchers. However, the third seems to decrease risk for the disease.Type 1, says lead author Hakon Hakonarson, is a complex genetic disorder "involving mutations in several genes acting in concert to predispose someone to the condition." Important? Very. Best case scenario: understanding how these genes operate is the kind of knowledge that could lead to a cure. At the very least, such knowledge could help medical caregivers identify at-risk children - a step that could eventually precede the standard diagnosis procedure as we know it today.
Click here for more details about this study.