RESUMEN
Hypoglycemia is due to defects in the metabolic systems involved in the transition from the fed to the fasting state or in the hormone control of these systems. In children, hypoglycemia is considered a metabolic-endocrine emergency, because it may lead to brain injury, permanent neurological sequelae and, in rare cases, death. Symptoms are nonspecific, particularly in infants and young children. Diagnosis is based on laboratory investigations during a hypoglycemic event, but it may also require biochemical tests between episodes, dynamic endocrine tests and molecular genetics. This narrative review presents the age-related definitions of hypoglycemia, its pathophysiology and main causes, and discusses the current diagnostic and modern therapeutic approaches.
Asunto(s)
Lesiones Encefálicas , Hipoglucemia , Lactante , Humanos , Niño , Preescolar , Hipoglucemia/diagnóstico , Hipoglucemia/etiología , Hipoglucemia/terapia , Hipoglucemiantes , Causalidad , Progresión de la EnfermedadRESUMEN
Nutrition during the prenatal period is crucial for the development of insulin resistance (IR) and its consequences in children. The relationship between intrauterine environment, fetal nutrition and the onset of IR, type 2 diabetes (T2D), obesity and metabolic syndrome later in life has been confirmed in many studies. The intake of carbohydrates, protein, fat and micronutrients during pregnancy seems to damage fetal metabolism programming; indeed, epigenetic mechanisms change glucose-insulin metabolism. Intrauterine growth restriction (IUGR) induced by unbalanced nutrient intake during prenatal life cause fetal adipose tissue and pancreatic beta-cell dysfunction. In this review we have summarized and discussed the role of maternal nutrition in preventing insulin resistance in youth.
Asunto(s)
Diabetes Mellitus Tipo 2 , Resistencia a la Insulina , Efectos Tardíos de la Exposición Prenatal , Embarazo , Femenino , Humanos , Niño , Adolescente , Resistencia a la Insulina/fisiología , Diabetes Mellitus Tipo 2/complicaciones , Fenómenos Fisiologicos de la Nutrición Prenatal , Insulina/metabolismo , Obesidad/metabolismo , Retardo del Crecimiento Fetal/metabolismo , Efectos Tardíos de la Exposición Prenatal/metabolismoRESUMEN
Diabetes is considered as a disease with a wide and continuous clinical spectrum, ranging from Type 1 (T1D) and Type 2 Diabetes (T2D) with complex multifactorial causes. In the last years, particular attention has been focused on the predictive value and therapeutic potential of single nucleotide polymorphisms (SNPs). SNPs can alter the seed-sequence in miRNA's loci and miRNA target sites causing changes in the structure and influencing the binding function. Only few studies have investigated the clinical influence of SNPs, in particular potassium inwardly rectifying channel, subfamily J, member 11 (KCNJ) gene variants in T1D population. The aim of the study is to investigate the occurrence and the possible metabolic significance of KCNJ polymorphism in a group of pediatric patients with T1D. The study was performed in a cohort of 90 Caucasian children and adolescents with T1D and 93 healthy subjects. Rs5210 polymorphism has been analyzed with a prevalence of the GG genotype in the patient group suggesting its association with T1D. Therefore, a relationship was found between GG genotype and body mass index (BMI) at diagnosis and insulin requirement (IR) after 6 months. The study suggested an action for rs5210 in determining the metabolic features of T1D pediatric patients, by showing some clues of insulin resistance in patients carrying that polymorphism.
Asunto(s)
Biomarcadores/sangre , Diabetes Mellitus Tipo 1/patología , Predisposición Genética a la Enfermedad , Resistencia a la Insulina , Polimorfismo de Nucleótido Simple , Canales de Potasio de Rectificación Interna/genética , Adolescente , Adulto , Glucemia/análisis , Índice de Masa Corporal , Estudios de Casos y Controles , Niño , Estudios de Cohortes , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/genética , Femenino , Estudios de Seguimiento , Estudios de Asociación Genética , Genotipo , Hemoglobina Glucada/análisis , Humanos , Masculino , PronósticoRESUMEN
AIM: This study want to examine (a) whether neutrophils, the neutrophil-elastase, C-reactive protein and the Interleukin- 6 are modified and how, in patients after laparoscopic cholecystectomy open cholecystectomy; (b) whether these findings are indicative of an increased risk to develop infectious complications. MATERIALS OF STUDY: Circulating Interleukin-6 level, C-reactive protein and neutrophil-elastase were measured in 71 patients (35 underwent open cholecystectomy and 36 laparoscopic cholecystectomy). The diagnosis was confirmed by ultrasound examination. During hospitalization the patients were not given antispastic drugs, steroids, or nonsteroidal antiinflammatory drugs (NSAID). RESULTS: The increase in the serum Interleukin-6 and neurtophil-elastase, during laparoscopic cholecystectomy, was found to be significantly smaller than that during open cholecystectomy and resulted in a smaller extent of postoperative elevations for C-reactive protein. We recorded three cases (8.5%) of postoperative infections in the "open'" group and neutrophil- elastase values normalized later in patient with complications. CONCLUSION: There were significant associations between the response areas of Interleukin-6, C-reactive protein and neutrophil- elastase levels. Neutrophils-elastase level is a more sensible inflammatory marker in comparison to the IL-6 and C-reactive protein. Excessive and prolonged post injury elevations of these mediators are associated with increased morbidity.