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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Viral infection has been suggested to play a triggering role in the pancreatic beta cell destruction which occurs in insulin-dependent diabetes (IDDM). However, the underlying mechanism of this phenomenon is unknown. In this study a human insulinoma cell line has been infected with measles, mumps and rubella viruses since a temporal association is reported between the clinical onset of IDDM and diseases caused by these viruses. The infection with measles and mumps viruses induced the release of interleukin-1 (IL-1) and interleukin-6 (IL-6) by the cell line as assessed by a bioassay and up-regulated the expression of human leucocyte antigen (HLA) class I and class II antigens as evaluated by cytofluorimetric analysis. Stimulation with rubella virus induced the release of IL-6 only and had no effect on HLA antigen expression. These data show for the first time that IL-1 and IL-6 secretion by an insulinoma cell line may occur after viral infection and suggest that cytokine release and increased expression of HLA molecules by beta cells may act to induce the immune response towards beta cells in IDDM.
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PMID:Viral infection induces cytokine release by beta islet cells. 159 39

In a nationwide incident case referent study we have evaluated vaccinations, early and recent infections and the use of medicines as possible risk determinants for Type 1 (insulin-dependent) diabetes mellitus in childhood. A total of 339 recently onset diabetic and 528 referent children, age 0-14 years, were included. Information about infections was collected from a mailed questionnaire and about vaccinations from childhood health care centres and schools. When vaccinations were considered as possible risk factors for diabetes, a significant decrease in relative risk estimated as odds ratio (OR) was noted for measles vaccination (OR = 0.69; 95% confidence limits 0.48-0.98). For vaccination against tuberculosis, smallpox, tetanus, whooping cough, rubella and mumps no significant effect on OR for diabetes was found. The odds ratios for Type 1 diabetes for children exposed to 0.1-2 or over 2 infections during the last year before diagnosis of diabetes revealed a linear increase (OR = 1.0, 1.96 and 2.55 for 0, 1-2 and over 2 infections, respectively). The trend was still significant when standardized for possible confounders such as age and sex of the children, maternal age and education and intake of antibiotics and analgetics. In conclusion, a protective effect of measles vaccination for Type 1 diabetes in childhood is indicated as well as a possible causal relationship between the onset of the disease and the total load of recent infections.
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PMID:The Swedish childhood diabetes study. Vaccinations and infections as risk determinants for diabetes in childhood. 188 89

In a nationwide incident case-referent study stepwise univariate analysis has revealed several risk determinants for childhood diabetes mellitus. In a multivariate analysis we have determined the set of risk determinants that would independently predict childhood Type 1 (insulin-dependent) diabetes. Possible interactions between the risk determinants and differences in risk profiles with different ages at onset were also examined. Reported familial insulin-treated and non-insulin-treated diabetes were significant risk factors in all age groups, as was also a low frequency of milk intake. The frequency of infections and a high intake of foods rich in nitrosamine tended to interact (OR 11.8, p = 0.053) indicating a synergistic effect. A Cox regression analysis revealed that stressful life events during the last year was the only variable that tended to affect the age at onset (p = 0.055). This indicated that psychological stress may rather precipitate than induce Type 1 diabetes. A short breast-feeding duration (OR = 3.81), and an increased body height (OR = 3.82) contributed significantly to the predictive model in only the youngest age group (0-4 years). An increased frequency of infections in the year preceding onset (OR = 2.15) and no vaccination against measles (OR = 3.33) contributed significantly to the model only in the age group 5-9 years. Various nutrients had different impacts on the risk of developing Type 1 diabetes in different age groups. It is concluded that in the genetically susceptible child, risk factors which are associated with eating habits, frequency of infections, vaccination status, growth pattern and severe psychological stress affect the risk of developing diabetes independently of each other.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The Swedish Childhood Diabetes Study--a multivariate analysis of risk determinants for diabetes in different age groups. 195 8

Type 1 diabetes mellitus is thought to derive from organ-specific autoimmune reactions, probably triggered by environmental factors. In view of the possible involvement of mumps virus and reoviruses in the pathogenesis of autoimmune endocrine disease, serum antibody levels to these viruses were measured in newly-diagnosed diabetic patients aged 5 to 25 years and in matched control subjects. Diabetic patients showed a significantly lower prevalence and reduced titers of antibodies to mumps and reoviruses. By contrast, the antibody response to measles virus (a non-diabetogenic agent) was remarkably similar in the two groups. It is suggested that individuals with an impaired humoral response to some viral agents are at increased risk of developing diabetes when exposed to pancreotropic viruses.
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PMID:Role of antecedent mumps and reovirus infections on the development of type 1 (insulin-dependent) diabetes. 302 16

Ethiopia is a country of 45 million people in northeast Africa. With a stagnant, agriculture-based economy and a per capita gross national product of $110 in 1984, it is one of the world's poorest nations. 70% of the children are mildly to severely malnourished, and 25.7% of children born alive die before the age of 5. Life expectancy is 41 years. The population is growing at the rate of 2.9%/year, but only 2% of the people use birth control. After the 1974 revolution, the socialist government nationalized land and created 20,000 peasant associations and kebeles (urban dwellers' associations), which are the units of local government. The government has set ambitious goals for development in all sectors, including health, but famine, near famine, forced resettlement programs, and civil war have prevented any real progress from being made. The government's approach to health care is based on an emphasis on primary health care and expansion of rural health services, but the Ministry of Health is allocated only 3.5% of the national budget. Ethiopia has 3 medical schools -- at Addis Ababa, Gondar, and the Jimma Institute of Health Sciences. Physicians are government employees but also engage in private practice. A major problem is that a large proportion of medical graduates emigrate. Ethiopia has 87 hospitals with 11,296 beds, which comes to 1 bed per 3734 people. There are 1949 health stations and 141 health centers, but many have no physician, and attrition among health workers is high due to lack of ministerial support. Health care is often dispensed legally or illegally by pharmacists. Overall, there is 1 physician for 57,876 people, but in the southwest and west central Ethiopia 1 physician serves between 200,000 and 300,000 people. In rural areas, where 90% of the population lives, 85% live at least 3 days by foot from a rural health unit. Immunization of 1-year olds against tuberculosis, diphtheria-pertussis-tetanus, poliomyelitis, and measles is 11, 6, 6, and 12% respectively. Infectious diseases dominate the medical scene in Ethiopia. In 1984, tuberculosis accounted for 11.2% of hospital admissions and 12.2% of deaths. The leading cause of childhood mortality in 1984 was diarrhea (45%). Malaria, trypanosomiasis, schistosomiasis, leishmaniasis, and meningococcal meningitis are endemic. Intestinal parasitism is rampant, and the nationwide prevalence of leprosy is 3/1000. Venereal diseases were the 9th most common cause of hospital outpatient visits in 1984, but AIDS is rare. The leading noninfectious diseases are rheumatic and syphilitic heart disease, hypertension, diabetes mellitus, hepatoma, and elephantiasis. Ethiopia has the highest number of cases of nonfilarial elephantiasis -- an estimated 350,000 cases -- in the world. Aside from a large influx of money, the most necessary changes to improve the health system are lowering the salaries of doctors and nurses, reorienting physician training toward primary health care, increasing the quality of existing health services, more efficient management, and better coordination between the Ministry of Health and the voluntary organizations.
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PMID:Health and medical care in Ethiopia. 271 Jan 85

Cytoplasmic islet-cell antibodies, insulin antibodies, islet-cell surface antibodies and islet-cell specific cytotoxicity were determined in serum of the following groups: 131 patients with type I diabetes, 19 with type II diabetes, 29 with mumps, 29 with enterovirus infections, 18 with measles and 28 healthy controls. Cytoplasmic islet-cell antibodies were found predominantly in type I diabetics. Islet-cell surface antibodies, on the other hand, were relatively frequently (60-80%) present in sera of both diabetics and patients with various virus infections. Islet-cell specific cytotoxicity in vitro was found not only in sera of diabetics, but also of patients with mumps or enterovirus infections. Sera of five patients with measles, however, had cytotoxic reactions comparable to those of the controls. These results suggest that cytotoxic antibody reactions against islet cells in vitro occur also in sera of non-diabetic patients. Under certain circumstances, infections which induce such immune reactions may be of significance in the pathogenesis of diabetes.
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PMID:[Autoimmunity and viral infections in type-I diabetes mellitus]. 351 25

An analysis is presented of data on all 30 129 inpatient admissions to a mission hospital in the West Nile District of Uganda in the 27 year period from July 1951 to August 1978. For most of this period the hospital was staffed by the same two doctors. For each patient admitted, a record was made of their age (adult or child), sex, place of residence, duration of stay in hospital, diagnosis and vital status at discharge. The annual number of admissions increased steadily from around 300 in 1952 to over 1600 in 1966 and subsequently declined to about 900 in 1977. Sixty-five per cent of admissions were medical, 12% surgical, 11% obstetric and 9% gynaecological. Thirty per cent of admissions were children (aged 0-9 years). Forty-five per cent of admissions were from those resident in the same county as the hospital and another 20% were from an immediately adjacent county. Infective and parasitic conditions (including respiratory diseases) accounted for over 60% of admissions among children and over 38% of admissions among adults (excluding obstetric patients). The six most common causes of admission were: uncomplicated delivery (2308 admissions), pneumonia (2020), hookworm (1999), malaria (1806), schistosomiasis (1742) and diarrhoea (1041). In total 1960 deaths were recorded (6.5% of all admissions). High case fatality rates were observed for tetanus (61%), immaturity (54%), meningitis (38%), kwashiorkor (21%), other malnutrition (19%) and anaemia (19%). A striking increase in the number of admissions for measles was observed in the period 1976 to 1978. Admission rates for schistosomiasis (S. mansoni) appeared to be highest from counties adjacent to the Nile and 104 deaths were recorded among the 1742 patients with this as the primary diagnosis. Admissions for diabetes, as a percentage of all admissions increased from 0.2% in 1951-54 to 1.5% at the end of the study period. Marked seasonal variations in admission patterns were found for diarrhoea, measles, meningitis and respiratory infections, the last two, but not diarrhoea, being most common in the wettest months. Admissions for malaria showed no strong seasonal associations. Despite the limitations of hospital-based data, it is argued that the data analysed provide a reasonable indication of the important causes of severe morbidity and mortality in the district. Furthermore, some of the changes in admission patterns over time are likely to represent true changes in disease rates rather than artefacts of diagnosis or referral. The analyses presented indicate the value of simple record systems, carefully maintained.
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PMID:Admissions to a rural hospital in the West Nile District of Uganda over a 27 year period. 378 13

A total of 1142 Massachusetts resident, insulin-dependent diabetics were identified from medical records of the Joslin Clinic. All patients were less than 21 years of age at onset and developed diabetes between 1 January, 1964 and 31 December, 1973. This group consisted of 598 males (52.4%) and 544 females (47.6%) with mean ages at onset (+/- SD) of 11.1 +/- 4.9 and 10.9 +/- 4.6 years respectively. The period between onset and diagnosis was less than two months in 634 cases (81.8%). A first degree family history was noted in 209 cases (18.3%), while an additional 689 cases (60.3%) had more distant relatives with diabetes. The seasonal distribution of onsets was examined in the total group, and in subgroups categorized by sex, type of onset, age of onset, and family history. Significant peaks were noted during the first six months (January-June) in the total group and in all subgroups except those less than five or greater than 14 years of age at onset. Maximum incidence occurred in either January or February. During the second six month period (July-December) strong peaks were noted only in females and in those with no family history. Maximum incidence occurred in late July and in August, respectively. Exceptionally pronounced seasonal variation was demonstrated in a subgroup of 129 diabetics less than 15 years of age with onsets less than two months prior to diagnosis, and with no family history. The distribution of year of onset, in this group, showed considerable variation which did not correlate with year to year fluctuations in the reported incidence of aseptic meningitis, rubeola or mumps.
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PMID:Seasonal incidence of insulin-dependent diabetes (IDDM) in Massachusetts, 1964-1973. 708 76

Recent observations have shown that insulin-dependent diabetes (JOD) may be the result of autoimmunity causing more or less rapid pancreatic isle cell destruction. This autoimmune process may be initiated in individuals who are genetically vulnerable to specific virus action. Several viruses have been implicated as causing JOD. Rubella and mumps viruses were the first viruses to be proved diabetogenic. A few years ago Coxsackie B viruses were added to the list. A prospective study of all new diabetics was undertaken in order to clarify the association of viral illness with JOD. 45 new insulin-dependent diabetics were studied (complement fixation, neutralizing antibodies or hemagglutination inhibition) within 3 days following admission. Screening for viral illnesses included the study for antibodies to the following: psittacosis, mycoplasma, Q fever, mumps, measles, herpes, CMV, rubella and chickenpox. Control bloods matched for sex, age, season and year with patients were obtained from individuals screened for viral illnesses during the same period. 18 JOD patients had antibodies against various Coxsackie B viruses. 4 patients had elevated rubella antibody titers.
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PMID:Are viral studies indicated in juvenile-onset diabetes? 711 Jul 40

In order to be effective those wishing to improve emergency care of children in an urban environment must be aware of barriers as well as resources. Urban children are at high risk for requiring emergency care as a result of both illness and injury. These children face a dangerous environment resulting from the problems of poverty, homelessness, overcrowded living conditions, drug abuse, and a shrinking tax base. They face this nation's highest rates of violent injury (intentional and unintentional), immunization delays, and preventable infectious diseases such as TB and measles. In addition, they have poor access to quality primary health care and suffer the greatest morbidity rates from chronic diseases such as asthma and diabetes. On the other hand, there is great opportunity to ensure that urban children receive quality emergency health care. The urban environment is rich in "centers of pediatric excellence," which often have paid full-time EMS systems in operation, and is the locale in which the majority of pediatric emergency medicine specialists and prehospital advanced life support providers practice. The child advocate must work to ensure that the urban child can benefit from these resources.
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PMID:Critical issues in urban emergency medical services for children. 759 33


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