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Introduction: Increasing evidence from human and animal model studies indicates the significant role of microRNAs (miRNAs) in pancreatic beta cell function, insulin signaling, immune responses, and pathogenesis of type 1 diabetes (T1D)., Methods: We aimed, using next-generation sequencing, to screen miRNAs from peripheral blood mononuclear cells of eight independent Kuwaiti-Arab families with T1D affected siblings, consisting of 18 T1D patients and 18 unaffected members, characterized by no parent-to-child inheritance pattern., Results: Our analysis revealed 20 miRNAs that are differentially expressed in T1D patients compared with healthy controls. Module-based weighted gene co-expression network analysis prioritized key consensus miRNAs in T1D pathogenesis. These included hsa-miR-320a-3p, hsa-miR-139-3p, hsa-miR-200-3p, hsa-miR-99b-5p and hsa-miR-6808-3p. Functional enrichment analysis of differentially expressed miRNAs indicated that PI3K-AKT is one of the key pathways perturbed in T1D. Gene ontology analysis of hub miRNAs also implicated PI3K-AKT, along with mTOR, MAPK, and interleukin signaling pathways, in T1D. Using quantitative RT-PCR, we validated one of the key predicted miRNA-target gene-transcription factor networks in an extended cohort of children with new-onset T1D positive for islet autoantibodies. Our analysis revealed that hsa-miR-320a-3p and its key targets, including PTEN, AKT1, BCL2, FOXO1 and MYC , are dysregulated in T1D, along with their interacting partners namely BLIMP3, GSK3B , CAV1, CXCL3, TGFB , and IL10 . Receiver Operating Characteristic analysis highlighted the diagnostic potential of hsa-miR-320a-3p, CAV1, GSK3B and MYC for T1D., Discussion: Our study presents a novel link between hsa-miR-320a-3p and T1D, and highlights its key regulatory role in the network of mRNA markers and transcription factors involved in T1D pathogenesis., Competing Interests: JT is a stock owner in Orion Pharma. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest., (Copyright © 2024 Nizam, Malik, Jacob, Alsmadi, Koistinen, Tuomilehto, Alkandari, Al-Mulla and Thanaraj.)

Mucopolysaccharidosis type I (MPS I) is an autosomal recessive lysosomal storage disorder characterized by deficient or absent α -L-iduronidase (IDUA) enzyme activity due to pathogenic variants in the IDUA gene. Early treatment with hematopoietic stem cell transplantation and/or enzyme replacement therapy is associated with improved outcomes in this progressive multisystem disease. The diagnosis is usually delayed due to late presentation and non-specific symptoms, which result in high morbidity and mortality. The incidence of MPS I is unknown in Kuwait. This pilot study was undertaken to screen MPS I in all Kuwaiti neonates born at Farwaniya Hospital (FH), a major center in Kuwait, over 12 months. This study examined the incidence of MPS I for inclusion in the national newborn screening (NBS) to enable its early detection and adequate treatment. All Kuwaiti neonates born at FH between December 2021 and December 2022 were screened for MPS I. The screening consisted of determining IDUA enzyme activity in dried blood spot-derived samples using tandem mass spectrometry. A follow-up genetic analysis of the IDUA gene has been planned to screen the cases with diminished IDUA enzyme activity as second-tier testing. A total of 618 newborns, including 331 (54%) boys and 287 (46%) girls, were screened. Of them, 20 had deficient IDUA enzyme activity but showed negative genetic testing. However, we have diagnosed one additional female infant with MPS I who belonged to FH, but the parents chose to deliver in a private hospital. The molecular genetic study revealed the presence of a previously reported pathogenic nonsense variant in the IDUA c.1882C>T, which is associated with severe phenotype. That being included, MPS I is estimated to be approximately 0.2% of all screened cases in Kuwait. Our study is the first to evaluate the incidence of MPS I in Kuwait. Given the single center, small number of screened infants, and the short study duration thus far, it is premature to calculate the incidence. It is anticipated that as the study continues, we would be able to estimate the incidence in our population correctly. Screening newborns in all maternity hospitals in Kuwait is necessary to calculate the actual incidence of this severe disorder. Still, our preliminary data support the inclusion of MPS I in national NBS program to allow early initiation of treatment and thus improve disease outcome., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Alsharhan, Haider, Qadoura, Ayed, Dhaunsi and Alkandari.)

Type 1 diabetes (T1D) incidence has increased globally over the last decades, alongside other autoimmune diseases. Early screening of individuals at risk of developing T1D is vital to facilitate appropriate interventions and improve patient outcomes. This is particularly important to avoid life-threatening diabetic ketoacidosis and hospitalization associated with T1D diagnosis. Additionally, considering that new therapies have been developed for T1D, screening the population and individuals at high risk would be of great benefit. However, adopting such screening approaches may not be feasible due to limitations, such as cost, adaptation of such programs, and sample processing. In this perspective, we explore and highlight the use of multiplexing chemiluminescent assays for T1D screening and emphasize on their advantages in detecting multiple autoantibodies simultaneously, maximizing efficiency, and minimizing sample volume requirements. These assays could be extremely valuable for pediatric populations and large-scale screening initiatives, providing a cost-efficient solution with increased diagnostic accuracy and deeper insights into T1D pathogenesis. Eventually, the adoption of such screening methods can help transform T1D diagnosis, especially in countries with high T1D prevalence, such as Kuwait, which will contribute to the development of novel therapeutic interventions, positively impacting the lives of those affected by T1D and other autoimmune diseases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Al-Mulla, Alhomaidah, Abu-Farha, Hasan, Al-Khairi, Nizam, Alqabandi, Alkandari and Abubaker.)

ONECUT1 gene, encoding hepatocyte nuclear factor 6, is involved in pancreas and liver development. ONECUT1 mutations impair the function of pancreatic β-cells and control a transcriptional/epigenetic machinery regulating endocrine development. Homozygous nonsense and missense mutations at ONECUT1 _p.E231 and a homozygous frameshift mutation at ONECUT1 _p.M289 were reported in neonatal diabetes individuals of French, Turkish, and Indian ethnicity, respectively. Additionally, heterozygous variants were observed in Northern European T2D patients, and Italian patients with neonatal diabetes and early-/late-onset T2D. Examining diverse populations, such as Arabs known for consanguinity, can generalize the ONECUT1 involvement in diabetes. Upon screening the cohorts of Kuwaiti T1D and MODY families, and of Kuwaiti and Qatari T2D individuals, we observed two homozygous variants-the deleterious missense rs202151356_p.H33Q in one MODY, one T1D, and two T2D individuals, and the synonymous rs61735385_p.P94P in two T2D individuals. Heterozygous variants were also observed. Examination of GTEx, NephQTL, mQTLdb and HaploReg highlighted the rs61735385_p.P94P variant as eQTL influencing the tissue-specific expression of ONECUT1 , as mQTL influencing methylation at CpG sites in and around ONECUT1 with the nearest site at 677-bases 3' to rs61735385_p.P94P; as overlapping predicted binding sites for NF-kappaB and EBF on ONECUT1 . DNA methylation profiles of peripheral blood from 19 MODY-X patients versus eight healthy individuals revealed significant hypomethylation at two CpG sites-one located 617-bases 3' to the p.P94P variant and 8,102 bases away from transcription start; and the other located 14,999 bases away from transcription start. Our study generalizes the association of ONECUT1 with clinical diversity in diabetes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Dashti, Nizam, John, Melhem, Channanath, Alkandari, Thanaraj and Al-Mulla.)

Aims: This study aimed to provide a global insight into initiatives in type 1 diabetes care driven by the COVID-19 pandemic and associations with glycemic outcomes., Methods: An online questionnaire regarding diabetes care before and during the pandemic was sent to all centers (n = 97, 66,985 youth with type 1 diabetes) active in the SWEET registry. Eighty-two responded, and 70 (42,798 youth with type 1 diabetes) had available data (from individuals with type 1 diabetes duration >3 months, aged ≤21 years) for all 4 years from 2018 to 2021. Statistical models were adjusted, among others, for technology use., Results: Sixty-five centers provided telemedicine during COVID-19. Among those centers naive to telemedicine before the pandemic (n = 22), four continued only face-to-face visits. Centers that transitioned partially to telemedicine (n = 32) showed a steady increase in HbA1c between 2018 and 2021 (p < 0.001). Those that transitioned mainly to telemedicine (n = 33 %) improved HbA1c in 2021 compared to 2018 (p < 0.001)., Conclusions: Changes to models of care delivery driven by the pandemic showed significant associations with HbA1c shortly after the pandemic outbreak and 2 years of follow-up. The association appeared independent of the concomitant increase in technology use among youth with type 1 diabetes., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: none reported. SWEET is a registered non-profit charity research collaboration in Hannover, Germany (NCT04427189). Declaration of Generative AI and AI-assisted technologies in the writing process: During the preparation of this work, the authors did not use Generative AI and AI-assisted technologies in the writing process., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Aim: To investigate the epidemiology and clinical management of patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (eASCVD) or high/very high ASCVD risk, defined by the 2021 European Society of Cardiology Guidelines, in seven countries in the Middle East and Africa (PACT-MEA; NCT05317845), and to assess physicians' attitudes and the basis for their decision-making in the management of these patients., Materials and Methods: PACT-MEA is a cross-sectional, observational study undertaken in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa and the United Arab Emirates based on a medical chart review of approximately 3700 patients with T2D in primary and secondary care settings, and a survey of approximately 400 physicians treating patients with T2D., Results: The primary and secondary objectives are to determine the prevalence of eASCVD and high/very high ASCVD risk in patients with T2D. Current treatment with cardioprotective antidiabetic medication, the proportion of patients meeting the treatment criteria for reimbursement in the study countries where there is an applicable reimbursement guideline, and physician-reported factors in clinical decision-making in T2D management, will also be assessed., Conclusions: This large cross-sectional study will establish the estimated prevalence and management of eASCVD and high/very high ASCVD risk in patients with type 2 diabetes across the Middle East and Africa., (© 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Background: Although most neonates with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection experience only mild disease, its impact on neurodevelopmental outcomes is unknown. This study aimed to assess the 18-month neurodevelopmental outcomes of infants who had SARS-CoV-2 infection as neonates., Methods: The authors conducted a prospective cohort study of neonates diagnosed with SARS-CoV-2 infection from June 2020 to December 2020 through nasopharyngeal coronavirus disease 2019 (COVID-19). A total of 58 neonates were identified from the Kuwait National COVID-19 Registry and enrolled. Historical controls were selected from the neonatal follow-up registry and matched in a 2 : 1 ratio based on sex and gestational age. When the subjects were 18 months of age, their neurodevelopmental outcomes were assessed by two trained assessors using the Bayley Scales of Infant and Toddler Development-3rd Edition (BSID-III)., Results: Forty children diagnosed with SARS-CoV-2 infection were included in the final analysis. The median age at infection was 18 days (range: 10-26 days). Eighteen (45%) patients were asymptomatic, 15 (37.5%) had a sepsis-like presentation, 5 (12.5%) exhibited respiratory distress, and 2 (5%) had a multisystem inflammatory syndrome in children (MIS-C)-like presentation. At the 18 months follow-up, only one child showed a severe developmental delay and one child had a language delay. BSID-III outcomes did not differ significantly between the SARS-CoV-2-infected and control groups., Conclusions: There was no difference in neurodevelopmental outcomes at 18 months in children infected with SARS-CoV-2 compared with controls, although longer neurodevelopmental follow-up studies are required., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Mariam Ayed et al.)

Several mitochondrial DNA (mtDNA) mutations of Leber's hereditary optic neuropathy (LHON) have been reported in patients with multiple sclerosis (MS) from different ethnicities. To further study the involvement of LHON mtDNA mutations in MS in the Arab population, we analyzed sequencing data of the entire mitochondrial genome from 47 unrelated Saudi individuals, 23 patients with relapse-remitting MS (RRMS) and 24 healthy controls. Ten LHON mutations/variants were detected in the patients but were absent in the controls. Of them, the common primary pathogenic mutation m.14484T>C and the rare mutation m.10237T>C were found in one patient, whereas the rare mutation m.9101T>C was found in another patient. The remaining were secondary single nucleotide variants (SNVs) found either in synergy with the primary/rare mutations or individually in other patients. Patients carrying LHON variants also exhibited distinct mtDNA variants throughout the mitochondrial genome, eight were previously reported in patients with LHON. Moreover, five other LHON-related SNVs differed significantly in their prevalence among patients and controls (P < 0.05). This study, the first to investigate LHON mtDNA mutations/variants in a Saudi cohort may suggest a role of these mutations/variants in the pathogenesis or genetic predisposition to MS, a possibility which needs to be explored further in a large-scale., (© 2022. The Author(s).)

Background: An increasing proportion of women are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. Intrauterine viral infections induce an increase in the levels of proinflammatory cytokines, which inhibit the proliferation of neuronal precursor cells and stimulate oligodendrocyte cell death, leading to abnormal neurodevelopment. Whether a maternal cytokine storm can affect neonatal brain development is unclear. The objective of the present study was to assess neurodevelopmental outcomes in neonates born to mothers with SARS-CoV-2 infections during pregnancy., Methods: In this prospective cohort study, the neurodevelopmental status of infants (N = 298) born to women with SARS-CoV-2 infections during pregnancy was assessed at 10-12 months post-discharge using the Ages and Stages Questionnaire, 3rd edition (ASQ-3). The ASQ-3 scores were classified into developmental delays (cutoff scores ≤ 2 standard deviations (SDs) below the population mean) and no delays (scores > 2 SDs above the population mean)., Results: The majority (90%) of the infants born to mothers with SARS-CoV-2 infections during pregnancy had favorable outcomes and only 10% showed developmental delays. Two of the 298 infants tested positive for SARS-CoV-2, and both had normal ASQ-3 scores. The majority of the pregnant women had SARS-CoV-2 infections during their third trimester. The risk of developmental delays among infants was higher in those whose mothers had SARS-CoV-2 infections during the first (P = 0.039) and second trimesters (P = 0.001) than in those whose mothers had SARS-CoV-2 infections during the third trimester., Conclusion: The neurodevelopmental outcomes of infants born to mothers with SARS-CoV-2 infections seem favorable. However, more studies with larger sample sizes and longer follow-up periods are required., (© 2022. The Author(s).)

Objective: The corticotropin-releasing factor neuropeptides (corticotropin-releasing hormone [CRH] and urocortin [UCN]-1,2,3) and spexin contribute to the regulation of energy balance and inhibit food intake in mammals. However, the status of these neuropeptides in children with overweight has yet to be elucidated. This study investigated the effect of increased body weight on the circulating levels of these neuropeptides., Methods: A total of 120 children with a mean age of 12 years were enrolled in the study. Blood samples were collected to assess the circulating levels of neuropeptides and were correlated with various anthropometric, clinical, and metabolic markers., Results: Plasma levels of UCNs were altered in children with overweight but less so in those with obesity. Furthermore, the expression pattern of UCN1 was opposite to that of UCN2 and UCN3, which suggests a compensatory effect. However, no significant effect of overweight and obesity was observed on CRH and spexin levels. Finally, UCN3 independently associated with circulating zinc-alpha-2-glycoprotein and UCN2 levels, whereas UCN1 was strongly predicted by TNFα levels., Conclusions: Significant changes in neuropeptide levels were primarily observed in children with overweight and were attenuated with increased obesity. This suggests the presence of a compensatory mechanism for neuropeptides to curb the progression of obesity., (© 2022 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society (TOS).)

The ZZ genotype of alpha-1 antitrypsin deficiency (AATD) is strongly associated with COPD, even in never-smokers. Moderate AATD genotypes (MZ and SZ) have been shown to increase the severity of COPD in smokers. In this comparative study, we examine the association between AATD, genotypes, and smoking cessation. Two hundred and ninety-three Irish people with AATD [MZ ( n  = 91), SZ ( n  = 72), and ZZ/rare ( n  = 130)] completed a custom questionnaire assessing their social and smoking histories. The primary outcomes analyzed were the predictors of ever-smoking and effect of genotype on awareness of AATD and maintained smoking cessation, using logistic regression analyses. Parental smoking exposure was associated with ever-smoking status (OR 1.84 vs. no parental smoking, p  = 0.018), higher cumulative tobacco consumption (23.47 vs. 14.87 pack-years, p  = 0.005) and more quit attempts required to achieve cessation among former-smokers (2.97 vs. 5.60, p  = 0.007). Awareness of genotype was 67.7% versus 56.3% versus 33% for ZZ, SZ, and MZ, respectively ( p  < 0.001). Among ever-smokers, current-smoking was uncommon (2.5% vs. 17% vs. 16% for ZZ, SZ, and MZ, respectively, p  = 0.009) with ZZs significantly less likely to be current-smokers (OR 0.15 relative to MZ, p  = 0.025). These results suggest that the genetic risk of COPD in AATD families is compounded by transmission of social risk factors ( via parental smoking). Increasing severity of genotype is associated with lower current-smoking rates among ever-smokers. Whether this is attributable to greater awareness of risk is an area of interest. Achieving a change in smoking habits may also result in positive health behavior in subsequent generations.

Objective: To screen 97 obese Arab adolescents for metabolic risk factors., Results: Insulin resistance, metabolic syndrome and intermediate hyperglycaemia was found in 56.7 %, 14.4 % and 27.8 % (HbA1c) while fasting plasma glucose was impaired in 0-16.5 %, using different cut-offs. Interventions to prevent obesity and diabetes are needed., (Copyright © 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

The study objective was to assess tobacco smoking prevalence in Kuwaiti adults in relation to sociodemographic characteristics. A cross-sectional study survey was conducted in 2014 on 3917 Kuwaiti citizens (18-69 years) following the World Health Organization (WHO) STEPwise Approach to Surveillance (STEPS) methodology. The study assessed prevalence of self-reported ever-smoking or currently smoking tobacco products and exposure to secondhand smoke in relation to demographic and smoking-related characteristics. The prevalence of "ever smoker" in men and women was 49.9% and 4.4%, respectively, whereas the prevalence of "current smoker" was 39.2% and 3.3%, respectively. Sex (adjusted OR [AOR], 19.2 [95% confidence interval (CI) 13.0-28.3], male versus female) was significantly associated with current smoking. Among daily smokers, 87.1% used manufactured cigarettes. The average daily number of manufactured cigarettes for men and women was 21.8 and 13.0, respectively. Mean age at smoking initiation was 17.5 years (95% CI 17.2-17.9). The prevalence of secondhand smoke at home and work was 38.6% and 29.9%, respectively. Half of Kuwaiti men have smoked at some point in their life with most of these being current smokers. Secondhand smoke is a common exposure at home and work, posing serious health risks to the population.

Objective: In recent decades, the Arab population has experienced an increase in the prevalence of type 2 diabetes (T2DM), particularly within the Gulf Cooperation Council. In this context, early intervention programmes rely on an ability to identify individuals at risk of T2DM. We aimed to build prognostic models for the risk of T2DM in the Arab population using machine-learning algorithms vs. conventional logistic regression (LR) and simple non-invasive clinical markers over three different time scales (3, 5, and 7 years from the baseline). Design: This retrospective cohort study used three models based on LR, k -nearest neighbours (k-NN), and support vector machines (SVM) with five-fold cross-validation. The models included the following baseline non-invasive parameters: age, sex, body mass index (BMI), pre-existing hypertension, family history of hypertension, and T2DM. Setting: This study was based on data from the Kuwait Health Network (KHN), which integrated primary health and hospital laboratory data into a single system. Participants: The study included 1,837 native Kuwaiti Arab individuals (equal proportion of men and women) with mean age as 59.5 ± 11.4 years. Among them, 647 developed T2DM within 7 years of the baseline non-invasive measurements. Analytical methods: The discriminatory power of each model for classifying people at risk of T2DM within 3, 5, or 7 years and the area under the receiver operating characteristic curve (AUC) were determined. Outcome measures: Onset of T2DM at 3, 5, and 7 years. Results: The k-NN machine-learning technique, which yielded AUC values of 0.83, 0.82, and 0.79 for 3-, 5-, and 7-year prediction horizons, respectively, outperformed the most commonly used LR method and other previously reported methods. Comparable results were achieved using the SVM and LR models with corresponding AUC values of (SVM: 0.73, LR: 0.74), (SVM: 0.68, LR: 0.72), and (SVM: 0.71, LR: 0.70) for 3-, 5-, and 7-year prediction horizons, respectively. For all models, the discriminatory power decreased as the prediction horizon increased from 3 to 7 years. Conclusions: Machine-learning techniques represent a useful addition to the commonly reported LR technique. Our prognostic models for the future risk of T2DM could be used to plan and implement early prevention programmes for at risk groups in the Arab population., (Copyright © 2019 Farran, AlWotayan, Alkandari, Al-Abdulrazzaq, Channanath and Thanaraj.)

Aims: To evaluate the influence of age at diabetes diagnosis, diabetes duration, BMI, comorbidity with hypertension and medication regimen on glycaemic control in native Kuwaiti Arab patients with T2D., Methods: This cross-sectional study considered 7657 patients from Kuwait Diabetes Registry and analysed data from their laboratory and hospital records., Results: HbA1c and prevalence of hypertension increased significantly with diabetes duration. Duration of diabetes (β=0.034; P<0.001) and age at diagnosis (β=-0.03; P<0.001) were independently associated with HbA1c. Inadequate glycaemic control was more likely in patients diagnosed at <60 than in those ≥60 years of age (OR:1.80, 95%-CI:1.39-2.31). Increasing duration of diabetes witnessed decrease in metformin prescription and increase in sulfonylureas prescription; proportion of patients treated with insulin increased from 5.6% to 44.4% in 9 years of diagnosis. Patients with 9-years duration of diabetes or with combination therapy of insulin-metformin-sulfonylureas differed in mean BMI for adequate or inadequate glycaemic control (29.5 versus 31.2kg/m 2 ; P<0.001 and 29.8 versus 33.2; P<0.01, respectively)., Conclusions: Only 25.6% of the T2D patients in this ethnic cohort exhibited adequate glycaemic control. The delineated relationship of inadequate glycaemic control with diabetes duration, onset age, obesity and hypertension prevalence has a bearing on diabetes management programs for Arabs., (Copyright © 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Aims: This study had 2 aims: to report data on the incidence of childhood-onset type 1 diabetes in Kuwaiti children aged 0-14 years during 2011 to 2013 and to compare the recent data with those collected during 1992 to 1997., Methods: All newly diagnosed patients were registered through the Childhood-Onset Diabetes eRegistry (CODeR) in 2011-2013, based on the DiaMond protocol used in 1992-1997., Results: A total of 515 Kuwaiti children (247 boys and 268 girls) aged 0-14 years newly diagnosed with type 1 diabetes were registered from 1 January 2011 to 31 December 2013. Data ascertainment were 96.7%. The mean age ± SD at diagnosis was 8.7 ± 3.4 years in boys and 7.9 ± 3.1 years in girls. The crude incidence rate (95% CI) was 40.9 (37.4-44.6) and the age standardized rate 41.7 (95% 38.1-45.4) per 100,000 per year, 39.3 (34.6-44.4) among boys and 44.1 (39.0-49.7) among girls. A statistically significant increasing trend in incidence was observed as the overall crude incidence rose from 17.7 in 1992-1994 to 40.9 per 100,000 per year in 2011-2013. The Poisson regression model depicting the trend in incidence revealed that, the incidence rates adjusted for age and sex in 2011 to 2013 was 2.3 (95% CI 1.9-2.7) times higher than 1992-1997., Conclusions: The incidence of type 1 diabetes in Kuwaiti children 0-14 years has doubled in the last 2 decades. The reasons for this increase requires further investigation., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Although many options are proposed for the treatment of cracked posterior teeth, most treatment decisions are not evidence based. Thus, considerable individual variation can occur regarding treatment recommendations for the same scenario. To our knowledge, there are no studies in the literature assessing practitioners' attitudes toward the treatment of cracked teeth. This research recorded variations between general practitioners and specialist groups regarding the treatment approaches of cracked teeth. In a cross-sectional structured questionnaire survey, 32 prosthodontists, 34 endodontists, and 29 general practitioners working in public and private dental health services in Kuwait were assessed regarding their treatment approach to 5 different clinical cracked tooth scenarios. Chosen treatment options varied greatly. Within each scenario, there was a wide range in treatment preferences across all groups and within each group, especially with respect to asymptomatic cracked teeth. Overall, treatment approaches did not relate to specialty training. Statistically significant differences were noticed between endodontists and general practitioners, in case of crowning teeth, in scenario 3 (P = .032), and in extracting teeth for scenario 5 (P = .048). This study highlights that, despite suggested guidelines, there are large differences in the approach to treatment planning for cracked teeth by practitioners and specialists, both as a whole and within each group. Further multicountry studies involving larger dental populations are needed to determine factors that influence practitioners' treatment choices and/or whether better or more widely accepted guidelines need to be established. More prospective well-controlled clinical case-based research with long-term follow-ups is required., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

We examined the frequency and severity of diabetic ketoacidosis (DKA) in 679 children and adolescents (0-14 years) at diagnosis of Type 1 Diabetes Mellitus (T1DM) in Kuwait. Between 1(st) January 2011 and 31(st) December 2013, all newly diagnosed children with diabetes were registered prospectively in a population-based electronic register. DKA was diagnosed using standard criteria based on the levels of venous pH and serum bicarbonate. At the time of diagnosis, mild/moderate DKA was present in 24.8% of the children, while severe DKA was present in 8.8%. Incidence of ketoacidosis was significantly higher in young children less than 2 (60.7% vs 32.4% p = <0.005) compared to children 2-14 years old, and a higher proportion presented with severe DKA (21.4% vs 8.3% p = <0.05). No association was seen with gender. Significant differences were found in the incidence of DKA between Kuwaiti and non-Kuwaiti children (31.1% vs 39.8%; p < 0.05). Family history of diabetes had a protective effect on the occurrence of DKA (OR = 0.44; 95% CI = 0.27-0.71). Incidence of DKA in children at presentation of T1DM remains high at 33.6%. Prevention campaigns are needed to increase public awareness among health care providers, parents and school teachers in Kuwait.