RESUMEN
AIMS: To explore parental perspectives after flash glucose monitoring commencement in adolescents and young adults with type 1 diabetes who were not meeting glycaemic targets. METHODS: Twelve semi-structured interviews were conducted among parents of adolescents and young adults between the ages of 14 and 20 years (inclusive) with type 1 diabetes and not meeting glycaemic targets [HbA1c 81-130 mmol/mol (9.6-14.0%)] participating in a randomized controlled trial. Interviews were transcribed, then thematic analysis was performed to identify themes regarding parental experiences. RESULTS: Four key themes were found: flash glucose monitoring improved parental emotional well-being; flash glucose monitoring reduced diabetes-specific conflict within families; flash glucose monitoring facilitated the parental role in diabetes management; and sensor-related challenges, particularly sensors falling off, interfered with using flash glucose monitoring for diabetes management. The cost of self-funded sensors was the only barrier to continuing flash glucose monitoring that parents reported. CONCLUSIONS: This study provides new insights into the potential benefits and challenges of flash glucose monitoring use, drawn from the perspective of parents of adolescents and young adults not meeting glycaemic targets. As parents are often key partners in obtaining or purchasing this technology, these findings can be used to further inform parental expectations of this technology.
Asunto(s)
Diabetes Mellitus Tipo 1/sangre , Control Glucémico , Padres/psicología , Percepción , Adolescente , Adulto , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea/instrumentación , Automonitorización de la Glucosa Sanguínea/métodos , Estudios Cruzados , Diabetes Mellitus Tipo 1/psicología , Diabetes Mellitus Tipo 1/terapia , Equipos y Suministros , Femenino , Hemoglobina Glucada/metabolismo , Control Glucémico/instrumentación , Control Glucémico/métodos , Control Glucémico/normas , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Relaciones Padres-Hijo , Planificación de Atención al Paciente/normas , Percepción/fisiología , Investigación Cualitativa , Encuestas y Cuestionarios , Adulto JovenRESUMEN
We studied 23 children with steroid-sensitive nephrotic syndrome (SSNS), 21 children with steroid-resistant types of nephrotic syndrome and 32 children with other types of nephritis. Our controls were 43 apparently healthy children. We measured the urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) and the low molecular weight (LMW) protein beta 2-microglobulin (B2M), retinol-binding protein (RBP), alpha 1-microglobulin (A1M) and urine protein 1 (UP1). Results for B2M were considered only for a urine pH greater than 6.0. Comparisons were made with urine albumin excretion, glomerular filtration rate (GFR) and tubular abnormalities in selected renal biopsy samples. We found that abnormalities of LMW protein excretion occurred in between 50% (B2M) and 88% (UP1) of all subjects. In children with SSNS, A1M (r = 0.73), UP1 (r = 0.65) and NAG (r = 0.54) excretion were significantly correlated with albumin excretion, but not RBP or B2M excretion. Increased fractional excretion of A1M, B2M and UP1 and increased plasma A1M were demonstrated in 9 children with SSNS, suggesting competition for tubular reabsorption with albumin, most marked for UP1. In the steroid-resistant nephrotic and nephritic syndromes, correlation with albumin was found for all proteins. In these subjects, RBP (r = 0.37), B2M (r = 0.42) and A1M (r = 0.28) were inversely correlated with GFR, but not UP1, NAG or albumin. We found that RBP excretion was significantly greater in the presence of severe tubular abnormalities in 11 children with recent renal biopsies, but not A1M, UP1 or NAG. We conclude that LMW proteinuria is common in children with glomerular disease, and does not necessarily imply a poor prognosis. Factors other than histologically proven tubular abnormality may account for elevated LMW protein excretion. RBP is the LMW protein most closely associated with structural abnormality and least affected by increasing albuminuria.
Asunto(s)
Glomerulonefritis/orina , Proteinuria/metabolismo , Albuminuria/metabolismo , Biomarcadores , Niño , Creatinina/sangre , Glomerulonefritis/sangre , Glomerulonefritis/patología , Humanos , Riñón/patología , Peso Molecular , Síndrome Nefrótico/tratamiento farmacológico , Síndrome Nefrótico/patología , Síndrome Nefrótico/orina , Proteinuria/sangre , Esteroides/uso terapéuticoRESUMEN
We studied 40 children with a history of vesicoureteric reflux (VUR) without evidence of renal scarring, 93 children with a history of VUR and renal scarring and 10 children with previous urinary tract infections in whom the urinary tract was radiologically normal. Urine retinol-binding protein (RBP), albumin and N-acetyl-beta-D-glucosaminidase (NAG) were measured in each child. All were free from infection at the time of the analysis. Urinary RBP and NAG levels were significantly elevated (P < 0.001) in the group of children with renal scarring. Elevated RBP levels were detected in 51% of children with bilateral renal scarring compared with 7% of children with unilateral scarring. Urine RBP excretion increased progressively according to the type of scarring, best determined by the type of scarring of the less affected kidney. In children with renal scarring, elevated NAG levels were seen mostly in the 65 children with bilateral scarring and severe reflux. Urine albumin excretion was elevated in 10 children, 9 with bilateral scarring, all of whom had elevated RBP excretion. Urine protein excretion was unaffected by the presence or absence of persisting VUR. There was a strong negative correlation between glomerular filtration rate and RBP excretion (r = -0.69). We conclude that evidence of tubular dysfunction is common in children with bilateral renal scarring and usually precedes any glomerular protein leak. Tubular dysfunction may be the consequence of relative nephron hyperperfusion in the presence of bilateral scarring.
Asunto(s)
Acetilglucosaminidasa/orina , Albuminuria/orina , Enfermedades Renales/orina , Proteínas de Unión al Retinol/orina , Reflujo Vesicoureteral/orina , Adolescente , Niño , Preescolar , Femenino , Tasa de Filtración Glomerular , Humanos , Lactante , Enfermedades Renales/fisiopatología , Túbulos Renales/patología , Masculino , Infecciones Urinarias/fisiopatología , Reflujo Vesicoureteral/fisiopatologíaRESUMEN
Low molecular weight proteins are of interest in children because their increased urinary excretion is a sign of renal tubular disease and their increased plasma concentration is inversely related to glomerular filtration rate. These proteins include beta 2-microglobulin (B2M), retinol-binding protein (RBP), alpha 1-microglobulin (A1M) and lysozyme. B2M is unstable in acid urine, in contrast to RBP and A1M which are more stable. Any increase in the urinary excretion of B2M or RBP is highly specific for tubular disease, whereas increased excretion of A1M may be seen with glomerular proteinuria. Areas of clinical application include tubular and glomerular diseases, detection of drug toxicity, reflux nephropathy, birth asphyxia and insulin-dependent diabetes mellitus. Methods of sample collection and analysis of these proteins are discussed.
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Enfermedades Renales/orina , Seroglobulinas/orina , alfa-Globulinas/orina , Preescolar , Tasa de Filtración Glomerular , Humanos , Técnicas para Inmunoenzimas , Riñón/fisiología , Muramidasa/orina , Proteinuria/orina , Valores de Referencia , Proteínas de Unión al Retinol/orina , Proteínas Plasmáticas de Unión al Retinol , Manejo de Especímenes , Microglobulina beta-2/orinaRESUMEN
Enzyme-linked immunosorbent assays (ELISA) have been developed for the measurement of beta 2-microglobulin (B2M), retinol-binding protein (RBP), alpha 1-microglobulin (A1M) and urine protein 1 (UP1) in children. Results from random urine samples in 43 children (31 for B2M) are, when corrected for urine creatinine (geometric mean (range)): B2M 9.8 (6.0-40.7) micrograms/mmol, RBP 8.1 (less than 1-24.5) micrograms/mmol, A1M 0.4 (0.1-2.2) mg/mmol and UP1 17.8 (less than 2-309.4) micrograms/mmol. Fractional excretions (FE) in 23 children (14 for B2M) are (geometric mean (range)): FEB2M 0.04% (0.02-0.10%) and FEUP1 0.10% (0.01-1.21%). Results in overnight urine collections are also presented. Our results extend existing data for normal ranges in adults to include children and provide data on UP1 concentrations.
Asunto(s)
alfa-Globulinas/orina , Proteínas/análisis , Proteínas de Unión al Retinol/orina , Uteroglobina , Microglobulina beta-2/orina , Adolescente , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Lactante , Masculino , Valores de Referencia , Caracteres Sexuales , Microglobulina beta-2/análisisRESUMEN
The urinary extraction of albumin, retinol binding protein, and N-acetyl-beta-D-glucosaminidase were studied in 60 children with insulin dependent diabetes mellitus and in 45 normal children to find out whether the renal tubules played a part in causing the early increase in urinary excretion of albumin that occurs in diabetes mellitus. Two overnight urine samples were collected and the protein excretion measured and expressed as the geometric mean of the protein to creatinine ratio (urinary albumin:creatinine ratio, urinary retinol binding protein:creatinine ratio, and urinary N-acetyl-beta-D-glucosaminidase:creatinine ratio, respectively). The excretion of all three proteins was significantly higher in the diabetic children with 15 (25%) of urinary albumin:creatinine ratio, 16 (27%) of urinary retinol binding protein:creatinine ratio, and 43 (72%) of urinary N-acetyl-beta-D-glucosaminidase:creatinine ratio values being above the normal range. Significant correlations were observed between urinary albumin:creatinine ratio and urinary retinol binding protein:creatinine ratio, urinary albumin:creatinine ratio and urinary N-acetyl-beta-D-glucosaminidase:creatinine ratio, and urinary retinol binding protein:creatinine ratio and urinary N-acetyl-beta-D-glucosaminidase:creatinine ratio. There were also significant correlations between glycated haemoglobin 1c (HbA1c) and these proteins, especially N-acetyl-beta-D-glucosaminidase. No correlations were observed with the fractional excretion of sodium, flow rate of urine, glomerular filtration rate, or blood pressure. These data show that tubular abnormalities are present early in the course of insulin dependent diabetes mellitus and suggest that the early increase in urinary excretion of albumin may be at least partly tubular in origin, and that glycaemic control may influence this aspect of proximal tubular function.
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Albuminuria/etiología , Diabetes Mellitus Tipo 1/complicaciones , Nefropatías Diabéticas/etiología , Túbulos Renales/fisiopatología , Proteinuria/etiología , Acetilglucosaminidasa/orina , Adolescente , Adulto , Presión Sanguínea , Niño , Preescolar , Creatinina/orina , Nefropatías Diabéticas/fisiopatología , Nefropatías Diabéticas/orina , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Proteínas de Unión al Retinol/orinaRESUMEN
Changes in anal pressure have been monitored during the induction of anaesthesia. Falls in pressure accompany loss of consciousness following bolus doses of commonly used intravenous and inhalational anaesthetic agents. Subsequent rises in pressure towards pre-anaesthetic levels are usually associated with the time taken to correct responses and initial recovery. Premedication, including anticholinergic drugs in conventional dosage, does not affect anal pressure.
Asunto(s)
Canal Anal/fisiología , Anestesia General , Tono Muscular/efectos de los fármacos , Mezcla de Alfaxalona Alfadolona , Sistema Nervioso Autónomo/efectos de los fármacos , Etomidato , Halotano , Humanos , Metohexital , Óxido Nitroso , Medicación Preanestésica , Presión , Distribución AleatoriaRESUMEN
An investigation was carried out into the readiness with which magnesium trisilicate mixture BPC, Andursil suspension (Geigy) and 0.33 M aqueous sodium citrate mixed with gastric contents, to evaluate their suitability for use as an antacid before the induction of anaesthesia in obstetric patients. Laboratory investigations demonstrated that magnesium trisilicate and Andursil did not mix adequately with gastric contents, whereas sodium citrate mixed readily. A clinical investigation of sodium citrate revealed significant improvement in the mixing of gastric juice with the antacid if the patient was turned into the right lateral position following its administration (p < 0.05), but highly significant improvement followed a rotation through 360 degrees (p < 0.005). It was thought that these findings were caused by the division of the stomach into two sacs, a phenomenon confirmed by radiological studies and the use of a pig's stomach as a model of the human stomach.